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HomeMy WebLinkAbout0084 MINTON LANE - Health 84 Minton Lane West Barnstable A = 174 - 027 l I Massachusetts Department of Environmental Protection Bureau of Resource Protection ' Well Completion Reports biL-1 Well Driller Please specify work performed: Address at well location: .......................................................................................................... New Well Street Number: Street Name: 84 MINTON LANE Please specify well type: Building Lot#: Assessor's Map#: Irrigation 174 Assessor's Lot#: ZIP Code: Number Of Wells: 027 02668 City/rown: Well Location y BARNSTABLE In public right-of-way: GPS . ................................................... j;� Yes jn No North: West: 41.68444 70.36749 Subdivision/Property/Description: Mailing Address: - ...._.._............_............--............................ ............................................................ b click here if same as well location addres Property Owner: Street Number: Street Name: ANTHONY NESE 84 MINTON LANE City/Town: State: Engineering Firm: 04 BARNSTABLE MASSACHUSETTS ZIP Code: 02668 Board of health permit obtained: n Yes Not R wired Permit Number: Date Issued: W2016 002 102/29/2016 r , Massachusetts Department of Environmental Protection Bureau of Resource Protection—Well Driller Program L Well Completion Reports(General) ill Well Driller - General Well Form DRILLING METHOD Overburden Bedrock (Auger ( Choose Bedrock-- I............................................._..................................... 1........................._.............._..........._...-............... WELL LOG OVERBURDEN LITHOLOGY From(ft) To(ft) Code Color Comment Drop in drill Extra fast or Loss or addition stem slow drill rate fluid j 20 Fine To Coarse S 4 Brown 6 , AF YES j,l NO ,i,j Fast jn Slow I Loss jn Addi 20 40 Fine To Coarse S { � Brown 61 YES n NO n Fast n Slow , Loss ,, Addi _s ,. _ ! I J J J� .I J .........._... 40 60 Fine To Coarse S �'Brown - mmmm� � I�__ .,....,.6.: 1_ _. ._._ b.; �YES j Fast j,i Slowj,i Loss j,� Addi gs . 60 80 Fine To Coarse S Brown ';I 7 6 6 n YES n NO j Fast jn.Slow j Loss jn Addi _.._ . .. .... G E l..... J---- I ' .1 .. 80 100 Fine To Coarse S Brown b In YES I,l NO jn Fast jo Slow l,i Loss ,, Addi 100 120 Fine To Coarse S Brown � � 6 b�; Ajn YES i,� NO J Fast jn Slow I„ Loss jn Addi mmmmmm .� __ � �___ 120 131 Fine To Coarse S 6}: [Prown �: jn YES jn NO in Fast jn Slow Eoss jn Addi _ _ � �— WELL LOG BEDROCK LITHOLOGY Visible Extra From(ft) To(ft) Code Comment Drop in drill Extra fast or Loss or addition of Rust Large stem slow drill rate fluid Staining Chips Choose Code YES n NO n Fast ,� Slow n Loss ,� Addition t Ye Ye ADDITIONAL WELL INFORMATION Developed I'i Yes jn No 'Disinfected I i Yes j,� No ...... ............................1 I...... .............. _......... Total Well Depth 131 Depth to Bedrock ........................................................................................... Fracture Surface Seal Type None Enhancement �n Yes jn No CASING e. Is Casing above ground. From To Type Thickness Diameter Driveshoe (0 ( 27 Polyvinyl Chloride � - Schedule 40 6 r Ye r Massachusetts Department of Environmental Protection d_ Bureau of Resource Protection—Well Driller Program Well Completion Reports(General) SCREEN a No Scree From To Type Slot Size Diameter 127 131 Stainless Steel Well Point ! 0.012 F WATER-BEARING ZONES e DRYWEL From To Yield(gpm) 99.......................... F131......._...._. PERMANENT PUMP(IF AVAILABLE) 2 Wire Constant Speed Pump Description Horsepower Submersible Pump Intake Depth(ft) 126 Nominal Pump Capacity(gpm) 15 ANNULAR SEAL/FILTER PACK From To Material l Weight Material 2 Weight Water Batches Method Of (gal) (count) Placement rChoose Material 6:s Choose Material G' � � � --Choose One WELL TEST DATA Time Pumped Pumping Level(ft Time To Recover Recovery(ft Date Method Yield(gpm) (HH:MM) BGS) (HH:MM) BGS) 4' 04/22/2016 Constant Rate 5777,6 E 1:30 ! 100 0:01 � 99 WATER LEVEL Date Static Depth BGS(ft) Flowing Rate(gpm) Measured 04/22/2016 99 COMMENTS Massachusetts Department of Environmental Protection Bureau of Resource Protection—Well Driller Program Well Completion Reports(General) L7� WELL DRILLERS STATEMENT This well was drilled or altered under my direct supervision, according to the applicable rules and regulations, and this report is complete and accurate to the best of my knowledge. DESMON THOMAS E Monitoring[M] Supervising Driller III, Driller DESMOND III Registration# 764 Signature THOMAS, _. DESMOND WELL Firm DRILLING INC. Rig Permit# 023 Date Job Complete 05 i /LoI NOTE:Well Completion Reports must be filed by the registered well driller within 30 days of well completion. Page: 1 of 1 CERTIFICATE OF ANALYSIS Barnstable County Health Laboratory (M-MA009) r/y Report Prepared For: Report Dated: 4/2712016 Sally Desmond Desmond Well Drilling Order No.: G1692629 P O Box 2783 Orleans, MA 02653 Laboratory ID#: 1692629-01 Description: Water-Irrigation Well Sample#: Sample Location: 84 Minton Ln.W. Bannstable,MA Collected: 04/25/2016 Collected by: DWD 131'/99' Received: 04/25/2016 Routine M ITEM RESULT UNITS RL MCL METHOD# ANALYST TESTED NOTE Nitrate as Nitrogen 5.6 mg/L 0.10 10 EPA 300.0 LAP 4/26/2016 Iron - 0.15 mg/L 0.10 0.3 SM 3111E LAP 4/27/2016 Manganese 0.031 mg/L 0.025 0.050 SM 3111B LAP 4/27/2016 pH 6.4 PH AT 25C NA 6.5-8.5 SM 4500-1-1-13 DCB 4/25/2016 Sodium 15 mg/L 2.5 20 SM 3111B LAP 4/27/2016 Total Coliform Absent P/A 0 0 SM 9223 RG 4/25/2016 Conductance 180 umohs/cm 2.0 SM 2510E DCB 4/26/2016 Water sample meets the recommended limits for drinking water of all the above tested parameters. Approved Attached please find the laboratory certified parameter list. A pp By: (Lab Director) 4/2-7 12--v ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level 3195 Main Street, PO. Box 427, Barnstable, MA 02630 Ph: 508-375.6605 No. J ac) —� `_ Fee ✓ BOARD OF HEALTH TOWN OF BARNSTABLE 01ppYication jor Yell Con5tructiott permit Application is hereby made for a permit to Construct(�), Alter( ), or Repair( ) an individual well at: L.v\ ,W• -Iy I (0-41 Location-Address Assessors Map and Parcel �Y��'lr�arw Q— Wi,' Oy% �• 13Ams l9. KkA 6266r Own r Address ma Val , km az�53 Installer-Driller Address Type of Building Dwelling Other- Type of Building No. of Persons Type of Well , L�`ZLGOIZAY � _ Capacity Z (:2;PyP11 Purpose of Well L) C� Agreement: The undersigned agrees to install the afore described individual well in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation-The undersigned further agrees not to place the well in operation until a Certificate of Compliance has been issued by the Board of Health. Signed w Z 6 • J Application Approved B 1t Date Application Disapproved for the following reasons: �^ I Date Q Permit No.'� e�'�' l �.. O Issued Date BOARD OF HEALTH 17N� TOWN OF BARNSTABLE Y` Pv �14\ Certificate of Compliance THIS IS TO CERTIFY,that the individual well Constructed( ), Altered( ), or Repaired( ) by 1J iFRY),to/40 LU "—L� ;�) Installer at has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. Dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. Date joi/aeg, Inspector \\ ' y � No. V,.1 �(� � �p ---Q���"�:� Fee _ BOARD OF HEALTH TOWN OF BARNSTABLE ZlppYico.tion jfor Vern Construction Permit Application is hereby made for a permit to Construct a), Alter( ), or Repair( ) an individual well at: %y K:rsA-o + L,, .�q - go,rn�sb L�. 1 I off- Location-Address Assessors Map and Parcel Owner Address sincsMA W1 tw\\ o q �vv_ IAA nz(653 Installer-Driller .l Address Type of Building Dwelling Other-Type of Building No. of Persons Type of Well :T jq aLG4 W6P LA.)EQ(° Capacity 5 f C;,okkt Purpose of Well �` V C, Agreement: The undersigned agrees to install the afore described individual well in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation-The undersigned further agrees not to place the well in operation until a Certificate of Compliance has been issued by the Board of Health. Signed ,Q Z 11 Date rr Application Approved B p Date Application Disapproved for the following reasons: f /� Date Permit No.,\,-o -�-� l9 0 Issued 4`'L Date b BOARD OF HEALTH C� I TOWN OF BARNSTABLE Certificate of Compliance THIS IS TO CERTIFY,that the individual well Constructed( ), Altered( ), or Repaired( ) by vu 6�P�J l.0 !� �. l�- L-// ,/Leo Installer att/Ll has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. Dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. Date ���1 a' Inspector BOARD OF HEALTH TOWN OF BARNSTABLE l VeYY Congtruction permitNo. W��-.O� � � � Fee Permission is hereby granted to E O Ly ,G-L_ ILQ 1 G-.4.-1,V Installer to Construct Alter( ), or Repair O an individual well at: D No. g - �- Street as shown on the application for a Well Construction Permit No. L � �� Dated Q Date Approved By�, 9 13 -r- 129.1 THE HODS + \jgo ? 0 co �TH2 + 136. 13 .1 13 t3 +� 8.5 TH1 l34 34 +-:134�h3 �p - 13 + ti� . + 1. 135.7 I PROVIDE APPROX. 62' 13 139p ,tiry OF 40 MIL LINER AT i13 14o4i1 5' OFF SAS IN. AREA p, SHOWN. TOP AT ELEV. ��3 + 14 137.0'. BOTTOM AT -17'�� .L 1h`L 1 tiNN ELEV. 133.0'. 14 .3 + _ + 44. �14 2.8 1 5 - �141 OVER HANG 146 , �14 TH3 ON POSTS _ 145.3 14 EC 144. (DIRT UNDER) 147 , CK WALKOUT BASEMENT SLAB AT 148 �1 4.9 145.9 EXIST: DWELL ELEVATION 143.5' (ALTERNATE 1 _ BENCHMARK) 148 'v 1 147.0 TO FNDN -cz--40148. LP EXISTIN LEACH PIT (SEE SHED \` NOTE o) ,.'Ir O 147.4 149.1 V rf ES 146.5 jy149.5 - 49.4 149.8 \ c 146 149.5 49.2 99 ag'\R=52.50 ' 2 48 40.00 S 444.Z_ 147 i44: -F-1.4 4 * - 5. - GARAGE 45.0 --- GRAVEL 1' 8. �,�-� 5. DRIVE '145 3 MINTON LANE 105 4 .6 i .59. 8 + 145.3 .5 14t.3 . BENCH MARK - TOP OF WATER SHUT OFF EL.=147.0 + 145.2 f FROM :down cape engineering inc FAX NO. :15083629880 Jan. 19 2006 12:40PM P1 Town of Barnstable Regulatory Services Copy Thomas F. Geiler,Director Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: .508-790-6304 Installer& DesigMer.Certification Form Date: Ad—lei Sewage Permit# a® 1015�9 Assessor's MaplPareel Designer: �VLJK. n�e� Installer: 0✓' 6 O - •t,o�/1.LC l Address: ?i39 / �a4 K U "li ` Address: �• , �Ox �� My u M e-e /y , /`-1, yjr A)x 0 krIP1011j, , was issued a ermit to install a On 1fLP1 C�F%�1�� p (date) (insialler) septic system at ✓)�U#.- LA t:�: w- Qa✓" • rased on a design drawn by (address) r AOL dated /0 desi h6r ( g ) T certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as Lateral relocation of the distribution box and/or septic tank. i certify that the septic system referenced above was installed with major changes (i.e. greater than. 1.0' lateral .relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. �.._.. \JN�0 'sq ARNE H csc• OJALA + —GjstayZs Signature) CIVIL No. 30792 NAL (Designer's Signature) (Affix Designer's Stamp Here) �— PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION CERTIFICATE OF COMPLIANCE W1I L NOT ft ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RE FTVED BY THE BARNSTABLE PUBLIC IIEAT,TH DIVISION. THANK YOU. Q:Hcallh/Septic/Designer CcriificA ion Dorm 3-26-04.doc ' f . li 3 � F '�///} ... V � �� � F Z ��`�+ �!� � 2 'a�� �. � d I^\ �� J U • , � y .,. _. a -� a � � V ., .. � r .� a t. TOWN Date:7/31 ` O N OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORMy NAME OFBUSINESS: 92ah., +v BUSINESS LOCATION: G /' - vINVVEE' NTORY w MAILING ADDRESS: .S w••t�" TOTAL AMOUNT:00 -rt TELEPHONE NUMBER: yZr> yU -ZO Boa M Pti,7 CONTACT PERSON: EMERGENCY CONTACT TELEPH E NUMBER: 7_24 15-16-S MSDS ON SITE? b TYPE OF BUSINESS: INFORMATION / RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month re uires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED - Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives (creosote) o„I Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible i C� Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform, formaldehyde, q, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous(please list): Metal polishes Laundry soil &stain removers (including bleach) �jo►�-� ` (�v� Spot removers &cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers ey1 Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initials TOWN OF BARNSVABLE ��- LOCATION T 9 SEWAGE VILLAGE G✓• azlonyY,4 je ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO.Z112a Zo" 0,u SEPTIC TANK CAPACITY LEACHING FACILITY: (type) 41" e%haoAtj (1 (size) NO. OF BEDROOMS BUILDER 0 WNER � PERMITDATE: IA.09 or COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by ✓e"V Ghsiss•r�si�s _ '°e► t ,D jr, y/G .v � `. �. ,���� y Si�� �� � 36� \ II � i9 � 3/ .=� _ � , a v� No. 16 a .. , Fee V U i I > THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: • PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes application for Mtgozo.Y 6pgtemc Cow5truction Permit Application for a Permit to Construct( ) Repair(W Upgrade( ) Abandon( ) ❑Complete System U Individual Components Location Address or Lot No. �`C j �!��°�� �s�. Owner's Name,Address and Tel o. ssessor'sMap/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No._ e . de 90 Type of Building: x Dwelling No.of Bedrooms Lot Size t/ivS_sq.ft. Garbage Grinder (leycl Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min,required) gpd Design flow provided _ gpd Plan Date 1� 7-k eT Number of sheets Revision Dat 2 -2Z o s Title O' Size of Septic Tank 10Z�O'Q/ Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of, ealt Signed Date _ I// fi-�©.5 a Application Approved b 1AZ Date Application Disapproved by: Date for the following reasons Permit No. )—oo — 600 Date Issued q OJ'A No. Dod A6 waP � a a, ,'A.: Fee l oo — THE COMMONWEAL-TH'OF MASSACHUSETTS Entered in computer: Y.f es PUBLIC HEALTH DIVISION - TWN OF BARNrSTABLE, MASSACHUSETTS ZIpplication for Mig0gal �&pgtetn Con.5truction Permit Application for a Permit to Construct Repair(V)�Upgrade O Abandon O ❑ Eomplete`System [?Individual Components Location Address or Lot No. C/ W4 1,f. Owner's Nam O Addle, and Tel.No. Assessor's ap/parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. _ Type of Building:', Dwelling No.of Bedrooms Lot Size Vl �S sq. ft. Garbage Grinder ( Q Other Type of Building .5/ P e7e No._of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided > �� —'"—� gpd Plan Date /D/Z OS Number of sheets / Revision Date �,�, u S } Title �J 'fP. /a4 D .Gf/ — Size of Septic TankiU,•I'%Sj'A;Y Type of S.A.S. �, s�� �Q� C' �A Z-X_5 i Description of Soil ,�,�,,1" J'j X f,j O i, Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: . The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of ealt . Signed 1 \' Date XX a- ©✓ Application Approved by Date Application Disapproved by: Date .. for the following reasons Permit No. ')d0S- 600 Date Issued I I 0 S^ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,,that the On-site Sewage Disposal System Constructed ( ) Repaired ( V�' Upgraded ( ) /'Abandoned( )by 0 QY at % Y/A//®/1 /01 4 affl A4?,6 e has been constructed in accordance with the provisions of itle 5 anjJ thg for)))*sposal System Construction Permit No. �2oo s ""6 a(/ dated // o?f! 0,1.E Installer b ! / Designer #bedrooms Approved design flow Z3 y gpd The issuance of this perm't a I not construed as a guarantee that the s tem will funcfo si e Date ji Inspec or No. 9b05__ 400 Fee w THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS i$po$a[ �&pgtem Cowaruction Permit 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 S and the following local provisions or special conditions. Provided: Constru ion must be completed within three years of the date oft N s p i. Date / a 9 d Approved by tel.(508)362-4541 ` 939 main street rt 6a fax(508)362-9880 yarmouth port mass 02675 dawn cope engineering civil engineers& land surveyors structural design Arne H.Ojala P.E., P.L.S. Daniel A.Ojala,P.L.S. land court Timothy H.Covell, P.L.S. surveys January 19, 2006 site planning Thomas McKean, RS sewage system Director, Barnstable Health Department designs 200 Main Street Hyannis, MA 02601 inspections Re: 84 Minton Lane, West Barnstable permits Dear Tom: Down Cape Engineering, Inc. performed a soils removal inspection as required on the approved plan at the above- referenced location. This is to certify that the soils removal was completed satisfactorily. Yours truly, Arne H. Ojala, PE , PLS Down Cape Engineering, Inc. cc: Bortolotti Construction FROM :down cape engineering inc FAX NO. :15083629880 Jan. 19 2006 12:40PM P1 Town of Barnstable Regulatory Services Thomas F. Geiler,'Director, Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-962-4644 Fax: 508-790-6304 Installer&Desiggerfertification Form Date: I Sewage Permit# 0415 � V Assessor's Map�Pareel 77 °� / �b / Designer: wf LJK. �p^ i"1 eeo'0 �Installer: 0� `O - �/ kC - Address: �L39. A U`t ` Address: 0 On 111z%1L,21 6*r1')'6P/ol , was issued a permit to install a (date) (installer) septic system at i✓)�D k.. LA,.q- w 4&-" , based on a design drawn by /J (address) dated (desi r) T certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as Lateral relocation of the distribution box and/or septic tank. rj&vkswo s-�m f-A-0- OAI-W-) 11.1 z.Y(, I certify that the septic system referenced above was installed with major changes (i.e. greater than. 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision.or certified as-built by designer to follow. ARNE H OJAL4 � (Instal s Signature) C CIVIL in No. 30792 4 o�F F0/STE.�� SSIUNAL LNG (Designer's Signature) (Affix De Stamp Here) PLEASE, RETURN TO BAItNSTABLE PUBLIC HEALTH DIVISION, CERTIFICATE OF COMPLIANCE WII L NOT RIB' ISSUED UNTIL BOTH 'PHIS FCIRM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC 11EAT.,TH DIVISION. THANK YOU. Q:Hcallb/Septic/Designer Certification Dorm 3-26-04.doc I LO :fsATION M EWACE PERMIT NO. VILVACE' o 174- 02--1 I l 6 C INST-A L"LER'S NAME i ADDRESS d \ 0 U I L D E R OR OWNER 4, . DATE PERMIT ISSUED Nzgz 0 • k DATE COMPLIANCE ISSUED �n2 �12-��1 r 1, lit No..... :1.a2- .� ....... TH9 COMMONWEALTH OF MASSACHUSETTS BOARD OF --!-MEAL ...........................................OF.........................13AIi Appliratiou for Dhipus al Works Tonti rurtiou rnmit Application is hereby made for P t to Construct ( L4*"or Repair ( ) an Individual S4ageis osal System at: - ... ............ .. . ........... . c. ��- : — �; .............._ ..._.....I..__• --- .._. = Location-Addre or Lot No. Owner ...................................Address a lit '. 7�"/ ...................................... Installer Address UType of Building ^^-.� Size Lot.__ _�e_�.�1. .....Sq. feet Dwelling—No. of Bedrooms............... ........................ Attic ( ) Garbage Grinder ( ) `4 Other—Type T e of Building ....... No. of persons............................ Showers � yP g ----------•---------- P ( ) — Cafeteria ( ) P4Other fixtures ----------------•------------------------•-------------•••••-•-•----•-----••-••-••••......-•---•......•... W Design Flow....................... .. ............gallons per person per day. Total daily flow................. �..............gallons. Septic Tank—Liquid capacity..(.OaOgallons Length................ Width................ Diameter................ Depth................ W Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No...................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box Dosing tank ( ) a Percolation Test Results Performed by. ... ,A..------ Date.-----5----�v- ----�-----•---- a Test Pit No. 1__C! ._minutes per inch Depth of Test Pit..............L�pth to ground water.... _. _. . f1 Test Pit No. 2..-""-....minutes per inch Depth of Test Pit.................... Depth to ground water..._..__...®....._... Pa' .................................................../---------------------------------------------------.-------•--•----•--•--------------------•---------- O Description of Soil................................................ y� Vc-••-----�- •-•------------•-------:-- ........ �'.�`. `'`� .. ------ C 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'L I Ti TIE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by t board of hea igned....... ----•-•. --•..eti,F✓. ?L z t Application Approved By. • ................. ... . •-------------------•------- ••_.........4 �t �-----•--- Date Application Disapproved r the following reasons---------------•----------------•--------------------•--•-------------------------------•--....--•----•....•..... ----------------------------------•--------.......---------•-----•-••----------•-•--••--•---•--•--••----••---•••-•••--••-•------••••--•-•-•----••--•••••--••-••••---••••_•-•-- Date tNo......................................................... Issued........................................................ Date No......................... F�a.... :..................._ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH , OF.........................t.:._I7... v= , �t •.................................... Appliration for Disposal Works Tnnstrnrtion Upumit Application is hereby made for a Permit to Construct ( 1 ) or Repair ( ) an Individual Sewage Disposal System at: f Location-Address /� or Lot No. f ..................... '.......................... .......t'.....,....... ......................................a �' ��!... -------------- Owner l / tAddress a ................................` _ - .-.. _.t............ := '' <:.Y-- -•••••--•------------•-••-----•-•••---•--....... '=fix =�--....................... Installer Address Y d Type of Building tt Size Lot...._ f _j. _=~:-_-._Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures ...................................................... W Design Flow.............................Y, .......gallons per person per day. Total daily flow..................:3'T_b..........gallons. WSeptic Tank—Liquid*capacity.t.-). '2gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box (��" Dosing tank ( ) ,�1 _. _ ~' Percolation Test Results Performed by......................... :.. .; T* /._,,_-__ L-.!...... Date...._4-....�'?.....�...... a c Test Pit No. 1..�.�:'_`r_..minutes per inch Depth of Test Pit.......... . .. Depth to ground water.... .......... f=, Test Pit No. 2...:.``........_minutes per inch Depth of Test Pit.__......�......_.. Depth to ground water...��'�. ...._... --------------------------------------------•••• ...............................................:......................................................... DDescription of Soil................................................ ........ '.... .......-•--. ............................................................................ 4 .------------------------- .----------------- -•---------- --------------•--•-----------_---------_---. -.•---•------ _._..._•_____'_._•__._..;----�-------.___._.____ •• ~A`� / ....i. ........ _. 1..^ �_L.............. �_ _'_.______._.._...._._-_-_ ._}____...____._..............__.. .................. 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 TITIZ- 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Z Signed.......................... -...._..._.. _._..--==-- --- •• ---•--_.._ ..... .... ate Application Approved BY----•-- ; :.'= • -- -•-------�/ Date Application Disapproved for the following reasons---------------•-----•-----------------------•----------•----•-----------------------......•-•---••--•-----_..._ ...........................-----.._.......--•--•-----••--------••--•----•.....••........---------......_-----•---•---•-••••.............................--------------•------------------------------ Date PermitNo..................................................-...... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........................I.................OF. l °;Q41 C ...�'S�`ti T-pPrtifirFatle of (inrnt�li�anr�e THIS IS TO CERTIFY That the Individual Sewvagq/Disposal System constructed (, ') or Repaired ( ) bY-•------•------••--•---•-••.....---•-----...--- Vi:���) ram' ./ .. /.t '7 .._ / ,r ` Installer — ....-- at............................................................................- 1 has been installed in accordance with the provisions of TITrr 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No..___ ...1....... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................. .........................................` �' Inspector...._. .rr`. ......-••--•--...............................-•-----•--......... i THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF..................................................................................... Nog.. FEE......................... Dis pos al Works Tonstrudion r mit Permission is hereby granted................................. ......'C_ ..-''' to Construct r( ' ) or Repair ( ) an Individual Sewage Disposal System at No I =-.-• f/ ,, A A r = , �,- , . t ,Y I Street as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... /C Board of Health DATE................................................................................ FORM 1255 HOBBS & WARREN. INC., PUBLISHERS 93,�g T .2 � 4 i 6,193 S, D w l SO i t = N 0 \ f 1 o ems, 013 —140 --�� 6a. � I J. r • o ti _ v t o3 0 , �o p �8 ay ��S �,3 a . 4�9•es 2,0Al eF 2. 1 t �PpNOFM�ss CERTIFIED PLOT PLAN :� 1. yP'ry?`}/ �'r!• LU7 ZD M/IVTO L NE s q•, CC-/V TE._K,V/L.L_�-- ORSE. ti Is, No 10951 O '�a' I t � ����� br. �:�r'ST' ��yi��� �. • '' � s•► ` • w � � .mil . �.'.I J• ; ;A� SCALEIU DATE I IZ DREDGE`E-NG/NEER/NG CO. WL CLIENT I CERTIFY THAT THE PROPOSED EGISTERE REGISTERED JOB NO. BUILDING SHOWN ON THIS PLAN CIVIL LAND �: , CONFORMS TO THE ZONING LAWS ENGINEER R EY DR. �'� OF BARNSTABLE , MASS. 12 MAIN STREET CH. BY, (�.'57:._. H YA N N I S, MASS. SHEET...I OF z ATE bO — D SURVEYOR e. • -• �' � ,� 5., "^L L , .�.,�1�d74I4�T •�'wc� 1+eP� , .h►�:4V y CA S,?'/RCN.,co���t ,�'�,qL L 1QiE US��'7 ._°• MIA& W71CAl lN 1>RlVEwl4 Y �` C� a,l• CO Y.ER Ct EAN eSANO r BACX F/L L- :4` _ z LAYER lOA/ P/Plr . /UOD i . o ' •''� MIN.PlTEN �si4t. D/ST. • • ' • e • • • s �,•' )VA.5-YEV 5T01YE : BOX o e o �� $ • .• ova • •,��. t .M •- e TX.° a • ° •: WA5/XED ST®Nff � • e , a O°♦ 1 fie'• • 221-;2- z S� SAS ° • • ��3./• ° •° _ �/3 i s. • � • e e • �• • a : . PRE!,ASTS �9G �I7 (��� -� L f r��tY t e • e s • e • • a s• o P17 OR LVV/V. ll�lVWAPT AEARVAT/�S . . r 2- .(3 lAly,M7 _.dlT mil!/10/N6 /4�.d x < 3 Q!I<4,M. lNLET .SffPTAC 7,4,v.V. S Z- FT, T LeATtQ/Y) tWIFLAFT SEPTIC,T.4NAK !_ _FT. _- /JVLET DISTIL/ /TION BOX 13yZ FT. ,G,gOuNo )9TE/�Ti1�C€ •S°�CT'!OA/ ®I= 00724 TD/5TRIMIrYON -FT. _ lNLA-T k.-ACNIA49 IP/T 133.6 .d ffWAG,ff P!S A L .9V.S7 Wo del 1.EACH11VCr olMEJN.S/®R/ A XT JrL,AaR 0I= DM sa� aDeMENSi�no r T07'AL EaTI~7'ED /_LOAV. %3 o G.4 4.1,oAY SOIL 7E57 A/ SOIL TM'ST 1l UM& � 40ACRtoVt P/73 / �-�z&✓. /30 �L�a! O'4 7"E ®X'.S®lt. ?'SST � /f 3 S/OE A,-ACM/NG P&iq Pn 7-26.Z .1 AT. �� Z r RE SLIL.7'S It//TNE�S�t� jr R C Z5 9A�7'OM C+64�i�/AIG PE1� /yam �r�Q. .ter 1 v.G-�, c AWRCOLAWOM JIAT NVeAtCht } TOTAL. LZ4CH1WCr AREA 33 CY —Sf,? FT. �_ 5ur3.5�� l L A-COd�'r/CN RA7-.E 2 ZlLft J�°IIIV I ilVC-q . �ES�R�/EL�L'N/�YYG.4R�A 335 50 FT. Z C; Of )AW4` 0Ft SrtO�/O_ P�.�' �O N/r1E/7oAl L/+.!/6 ���_ �t� i'• +1q J ul RUCE t` ELDRED . yf A. ORSELJ —+ 7Trrti cn -1VI -7t� Ms9tN ST. NYAAIA11$. AIA %0NA " �LJ Yq � 2ccn/3 [3 GeeC uwzvD t v,47'ER AY SL Y - Z LOCA7�ION7' 20 /ArjZlj VTJ;LADE_ ' DATE Q3-IC-fa . APPLICANT �' � /'�tL i� 1/ 2� i� s �' FEE S A DRESS'. (sdx SlG C 7 -� (Non-rofundabhc: Zltci �3' TELEPHONE NO. �' ENCaINEER . TELE HONE N.O. '7�S~-'22Y� E DJI►TE SCHEDULED - 1 (Applicant' ignature • • • �.•'•-• •• o • ••• • • • • o o. • • • • w • • w • ♦• • • • •'••• • • o • • • w • • • • • • • • o • • • • • • w w • • o • w • • • • o ww 0 ♦ w-•- - - SOIL LOG: SUB-DT.VTSTON NAMEA71= .DATE `/ TIME Aih EXPANSION AREA: YES 1/NO /Z ENGINEER 1 TOWN WATER .t"�PRIVATE WELL R•w�,cFoAPBOARD OF HEALTH EXCAVATOR. SKNTCII: . ;(Street name,etc. ,dimensions• of lot, exact location of test holes and 4 percolation tests, locate wetlands in proximity to test holes ) NOTES: 14,4 30 !off 130 + ` 1 r Lor-,LO N �PERGOLATTON RATE: 2- TEST HOLE .NO: ELEVATION: TEST HOLE NO: ELEVATION: z 3 3 4 'o , 4 5 5 7 5�NsO 7 8 8 9 9 10 10 _ lz _ 12 '4J7�sr4N SM�AI 13 13 14 2,+ g„aAM 14 15 15 16 16 SUITABLE FOR SUB-SURFACE SEWAGE: LEACHING FIELD LEACHING PITS LEACHING. TRENCHES UNSUITABLE FOR SUB-SURFACE SEWAGE. REASONS: *xNO TE: ENGINEERING PLANS MUST SHOW NUMBER ASaS T NED ON PERC TE QR (aINAL: COMPLETgD IN EI2jjjg� M ly. P 0 B01e C'( 1'Y� RETAINED BY APPLICAN,,k TOP FNDN. AT EL: 150.65' SYSTEM PROFILE TEST HOLE LOGS LOCUS ACCESS COVER TO WITHIN 6" OF FIN. GRADE (NOT TO SCALE) PROVIDE INSPECTION PORT WITHIN ACCESS COVER (WATERTIGHT) TO 6" OF FINISH GRADE ENGINEER: LISA LYONS, RS I_ MwTON LANE ' MINIMUM .75' OF COVER OVER PRECAST /� WITHIN 6" OF FIN. GRADE 2T SLOPE REQUIRED OVER SYSTEM 139.0' 14 : DON DESMARAIS, RS o .. - 0.0' WITNESS � 2" DOUBLE WASHED PEASTONE 10/26/05 ELEV. 141.5' RUN PIPE LEVEL \ HOLDER = / FOR FIRST 2' DATE: -. EXISTING 1000 - / 3 MAX. PERC. RATE _ < 5 MIN/INCH (TH3 IN c2) W GALLON sEPric 140.1't* TEE 137.0' CLASS I SOILS P# TANK (H- 10 ) GAS 136:28' w Aid .;.: . (RE-USE - SEE NOTE) BAFFLE 136.45' �� o 0 0 0 0 CI C7 0 136.17 l� 0 O 0 0 0 O o 4' AROUND 6" CRUSHED STONE OR MECHANICAL Q 0 0 0 0 0 C� LOCATION MAP NTS COMPACTION: (15.221 [2]) �ZSo 2' 0 CI o00 134.17' ASSESSORS MAP 174 PARCEL 27 DEPTH of Flow 4 TEE SIZES: 9 % SLOPE) ( 1 % SLOPE), 3/4" TO 1 1/2" DOUBLE WASHED STONE n ELEV. Q Q IN DEPTH = 10" 0" 134.0' 0" 134.5' p" 142.0' A OUTLET DEPTH =' 14" r FI LL LS 10' A 1OYR 3/2 LS EXIST. 13' LEACHING 10YR 3/2 FOUNDATION SEPTIC TANK 39 D' BOX q FACILITI' „ „ *THE INSTALLER SHALL VERIFY THE 5 LS 3 3 LOCATIONS OF ALL UTILITIES AND ALL THE INSTALLER SHALL CONFIRM MIN. SEPTIC TANK 1OYR 3/2 B B BUILDING SEWER OUTLETS AND ELEVATIONS SIZE AT 1000 GALLONS AND ITS SUITABILITY FOR 13 AP PRIOR TO INSTALLING ANY PORTION OF RE-USE B LS LS SEPTIC SYSTEM LS 1OYR 4/4 15" 10YR 4/4 15„ 41.17' 10YR 4/4 Cl LOT 20 48" 130.0' SL/LS + 1��.5 - C 13 - _ 46,635t S.F. i- 2.5Y 6/4 13 Ig 13 + 1 5� 0. - C FIRM IN SL/LS 140" PLACE 135 Ig 1 �. SL/LS 2.5Y 6/4 C2 134 4 43.1 2.5Y 6/4 LS SIEVE SAMPLE TAKEN IN TH3 IN 133 Ig3 C2 LAYER: FINE SAND (< 5 13 1g2 MIN/INCH PERC RATE DESIGN) + 31. 141 143.1 2.5Y 6/3 131 l3 140 43 5' REMOVAL OF UNSUITABLE SOIL „ CA 13 & REQUIRED AROUND PERIMETER OF 163 120.4' 192» 118.5, 192" 126.0' T LEACHING FACILITY, DOWN TO NGWE NGWE yl + 129.0 �z SUITABLE SOI:_ LAYER. REPLACENTH CLEAN �,AED. SAND. NGWE � 13 0 INSPECT ,ND CERTIFYENGINEER 1 9 jgl REMOVAL NOTES 1 13 ScPTIC NOT _ALLOWED e APPROX. NGV + 129.1 o THE HODS + 7 1� G�S��rv. (GARBAGE DisFosER 1s ) 1. D. ,TUr.. IS Q- 13 ~ "' 13 1 �CID TH2 + 136. DESIGN FLOW: _3 BEDROOMS ( 110 GPD) = 330 GPD 2. MUNICIPAL WATER IS EXISTING SE A 330 GPD DESIGN FLOW ., 13 TH1 +� 8.5 4 3. MINIMUM PIPE PITCH TO BE 1/8 PER FOOT. ~ SEPTIC TANK: 330 GPD ( 2 ) = 660 4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO H- 10 134 - 3g + 13�41sh3 0 5. PIPE JOINTS TO BE MADE WATERTIGHT. 13 + ti� + ti ey USE A 1000 GALLON SEPTIC TANK (RE-USE EXISTING) 6. CONSTRUCTION ---- 0 STRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS. 13 135.7 13e 4 ti o OVIDIPPROX. 62' LEACHING: ENVIRONMENTAL CODE TITLE V. ti �o ti LINER ER AT 25 + 12.83 i01 401 5' OFF SAS IN AREA SIDES: 2( ) 2 ('74) = 112 7. THIS PLAN IS FOR PROPOSED SEPTIC SYSTEM ONLY AND IS NOT 14� o SHOWN. TOP AT ELEV. 74) TO BE USED FOR ANY OTHER PURPOSE. ,ls + 14 137.0', eorroM AT 25 x 12.83 1�'J�3 1�� ELEV. 13OT BOTTOM: 237 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. _'4 5 `"- + 44. TOTAL: 472 S.F. 349 GPD 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT + 2.8 t OF HEALTH AND PERMISSION OBTAINED 142.3 O 5 1�5 USE (2) 500 GAL LEACHING CHAMBERS (ACME -0R INSPECTION BY BOARD I �3 OVER HANG FROM BOARD OF HEALTH. 4 145.3 146 EQUAL 10. PUMP & REMOVE (OR FILL W/CLEAN SAND) FAILED LEACH PIT ON Posrs ) WITH 4' STONE ALL AROUND 14 ECK 144. (DIRT UNDER) 147 I DECK - �144 WALKOUT BASEMENT SLAB AT 148 ! 1 4.9 145.9 EXIST. DWELL. ELEVATION 143.5' (ALTERNATE + 1d8 BENCHMARK) CS TITLE 5 SITE PiJI/^t 148 ✓ i 00.0 PROPOSED SPOT ELEVATION 1 147.0 TOP FNDN = LP �� OF SHED 150:65' G' �,148. EXISTIN LEACH PIT (SEE �� \ NOTE o) 100x0 EXISTING SPOT ELEVATION 84 M I N TO N LANE 1c 1 Op IN THE TOWN OF: F� c ER N 147.4 PROPOSED CONTOUR \ J qo WEST BARN STABLE 149.1 , Vl/ 100 EXISTING CONTOUR \ q. 146.5 PREPARED FOR: RICK PRESBRY 149.5 IFS L_7.69' R 449.85' MELANIE POWERS 49.4 149.8 \ 0146 149.S 49.2 99 ag'\R=52.50' 20 0 20 40 60 2 484 145 _�0.00' \ 444,�_ `44.3 GARAGE 147 �44 +-14.4 4--t 5 BOARD OF HEALTH „ , GRAVEL 1 8. +'�' 5. 45.0 14 -143 SCALE: 1 = 20 DATE: OCTOBER 28, 2005 DRIVE APPROVED DATE MA REV 12/22/05 TON "N c '145 3 Ml / off 508-362-4541 4 05 59 .6 / fox 508 362-9880 1 , 8 ; I -t 145.3 .5 r C110W12 cape E11g1I1 eeI"II2g; 112C. ����N of r� ssgc �tN of�As ARNE H - CIVIL ENGINEERS �� o1aLA ARNE ti r 14 .3 BENCH MARK TOP OF _ 3 CIVIL � •� WATER SHUT OFF EL.=147.0 LAND SURVEYORS �o ,N 07¢� Cn 26348 + 145.2 ma 02675 F . y ,05-255 0JALAN, ­q4L;;a_, / Z DA TE