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HomeMy WebLinkAbout0209 PERCIVAL DRIVE - Health 209 P ercivai ®rive W. Barnstable P A = 110 001006 i i s ,ti TOWN OF BARNSTABLE LOCATION \0J Ls12.G i VAy 6g, SEWAGE# VILLAGE ,ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. =:t - C. ! SEPTIC TANK CAPACITY CK L lam" icoo LEACHING FACILITY:(type) (size) ,�A NO.OF BEDROOMS c�-- r -�c OWNER PERMIT DATE: COMPLIANCE DATE: (� Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility =tn ' Feet Private Water Supply Well and Leaching Facility(If any wells exist on l /� site or within 200 feet of leaching facility) ,r/°/ - Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY 6)OXA) j�,p®r G'ht .�,�� P ,���v ��,�- �, �° �j 7 ''`� �s G �� G% �s , , No. )-A (� Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes RpPlitation for bisposal 6pstem Construction Permit Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑Complete System Zliondividual Components Location Address or Lot No.jV9 Owner's Name,Ad ress,and Tel.No.S08v-36 a -d9 Assessor's Map/Parcel�f� /•,� ivJ•�`3YYI'1ls"Ie al, CryaeA -74a Installer's Name, ddress,and el.No - est ner's Name,Addr ss,and Tel.No. ".X ) (3U� � i vnSfrvC � .`su','�'�Jl )n��✓iex r39� z�i,�5f• Type of Building: Dwelling No.of Bedrooms 3 Lot Size 33 (o q,�,-> sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 33U gpd Design flow provided gpd Plan Date j1j)e_PL4T oao Number of sheets � Revision Date Title � J S;,k p� �'/ re L f t-F�2� 9 tm L : PUA o $ Size of Septic Tank Type of S.A.S.i2 -4410�50w ��,�9 5 M LX la-b3G,0 Description of Soi11, - �} Ap low) c t' 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 Environment4 Eode not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Si Date Application Approved by Date o Application Disapproved b Date for the following reasons Permit No. c ,ZO 2 Date Issued _-------------------------------------------------- a. No. .l d - r 3 � Fee j U THE MASSACHUSETTS O COMMONWEALTH F M Entered in computer: O Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 21ppYication for Misposal *pstrm Construction i9ermit Application for a Permit to Construct( ) Repair J06 Upgrade( ) Abandon( ) ❑Complete System Individual Components Location Address or Lot No,Zi'7 f&&Z& Owner's Name,Address,and Tel.No..$GJ -36 p (/ ,tifctrK 6-reenberj �xi Assessor's Map/Parcel 116//-C,, ia�'�aYi1S vJ�e (4), AM/1 MM AAA 0._a4,(,$ Installer's Name,Address,and Tel.No."Qs—vwa_arox, Designer's Name,Address,and Tel.No. !613�a 5/31y/ �+�ti/kc��� A IS A, o/f(A, 0 CY4a / Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Q � Design Flow(min.required) gpd Design flow provided �T gpd Plan Date „r�� Co, n2lJ a r Number of sheets r ] Revision Date Title 14, _ �.5_ ;4e M", n,A OZ9 1�re:Lkd or, -51 t�'�'1/2�T4z,/^ ib'A n )&"t .W' , it Size of Septic Tank,a?�,�'�.�-►`wY; /p/� � a 9 Type of S.A.S. -�pC?.`.�^..,Ci�,^� .�✓9,�r.:r��s,� a6 LX 1'2,'S3 4,) .� Description of Soil--)pf, , i�W)1r 11"XC.b)i d 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 andnot to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. fJ, Sig neda Date Application Approved by �.� Gt c' 'f" v� , Date Application Disapproved b Date for the following reasons Permit No. o .2 Date Issued '7// 7 he THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( Upgraded( ) Abandoned( )by Ay 14&, ( iar�S r at, (C, r,e ,11'. 401 1 -�f; 1� has been constructed in accordance with the provisions of Title�5 and the for Disposal System Construction Permit No a?a ' gated - / l 71,1 o Installer)��,P.Aca'[A1. :Inc• Designer #bedrooms Y Approved design_flow r _ �t.J 1 and The issuance of this permit shallnot be construed as a guarantee that the system will function as�desj 'gned. Date 1,5 /a,4p inspector No. C� 0 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Misposal *pstem Construction permit Permission is hereby granted to �Construct( ) � Repair(/,�O Upgrade( ), Abandon( ) System located at c(t 't'U �.)(j A j1)w Vt o`,4, Ale and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. 7rr'`r Date ? Approved by �,l�, AUG-11-2020 23:54 From: To:15087906304 Paee:1-11 I I I Town of Barnstable ` Inspectional Services • a°nr>erae�, • Public Health Division Thomas McKean,Director i o ° 200 Main Street,Hyannis,MA 02601 i Office: 509-8624644 Fax: 508-790-6304 Installer&Designer Certification Form Date: 0/Y/ao a.0 sewage Permit#i?AA0—Ai8 Assessor's MapWa/rlcel I I 0 1 Designer: DOWN f e Enfin '04.1C. Installer: LaO Address: q39 g00k &A Address: 45T yarmo Port Ntu.rSg .I 5 oa��tg On '1�l�Iaeao 'o [. was issued a permit to install a (date) (installer) septic system at 20 q Pe re l va l b r. W•aarfiSta.b i based on a design drawn by (address) h&njJJ A. 0'al0. S dated (o Zfv 2020 / esigner) V I 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. Strip out (if required) was inspected and the soils were found satisfactory. 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. Strip out(if required)was inspected and the soils were found satisfactory. I cer�RAva referenced above was constructed in with the to rms of the hers(if applicable) AZi�` o DANIELA. ,�� OJALA '' CIVIL '^ No.46502� �Ihstaller's Signature) a ^r �Fe� �1-7/ ni ASS s /0NAL ECG D gner's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. TIDWYOU. WodIdepLAHEAURSEWER connuASEPrILWesigncr Ccnifeadon Form Rev 8-1413.00C I i .. G's'vgM4H+n<c/ � '/L'SHEnr Hiu<q,�1.�o I . PS2n rzrna I f � I / C� 7 ,.I 3�fi.c-'4�.n:'._-. (jE rnvY) n�•c� d I 5uN�RooM I ,.. � - -. -_ � �� �.. �_ Rdf.\�tlVls..S�''�s - r� 3/i`.+. iwuH 'W\:~+�f_Euuv_��� 5(�I�IY.G�eu.. ___ _ .• I � �,v�> , ' e 4'aw"�o'.YILLTs' dwwtSHiu+a' - UA_�uaP•_ �n —^I� I _- \.e.ww\Hcc .a Fv.cxe rsinan e ye�vwC ce..rw�ea.. III, �. � I'I c NdI IpI IFI 1. - - c�ilas�'c`E"'S/�wowu u.0 � � " O)r W-`rG•.a'\.:tzn.___ 9umtVa.V ITS-- . I km= Pe4A^aS�FInaY L•�t,�D') j � ,.r sr' I"LWA.:GF nM�.S.'C•.-nb-) � - a I J _ 1 I' _L� rerun Jai 1 Y I —....-- i av2 cw•uw....a r.,vaa�rv...c . 'Bruce Devlin Designo ��- ----- _ 77423"773 �1 oPL �, I :4 - • COMMO MVEALTH.OF MASSACHU$E,S EXECUTZ</E OFFICE OF ENVIRONMENTAL,AFF DEPARTMENT Og E AIRS NVIRONMENTAL PROTECTION 0 20052005 TOWN Or B�ARNSTABLE TOWN OF bAr(NSTABLE TITLL'+�;5PT. HEALTH DEPT, OFFICIAL INSPECTION FORM— NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL,SYSTEM FORM PART A CERTIFICATION Property Address: 0 9vG es op)VG ;AP f® Owner's Name: are f . Owner's Address. D ate of InsPectlon: A-4 o o Odb(►8' ` - =� Name of Inspector.(Please Company Name: �e,�� 11�Iatiling Address: o T F Telephone Numher� CERTIFICATION STATEMENT that I below is true have ft Inspected the sewage disposal system at this address and that the info '�'�and complete as of the time of Ills' rnnation ft g and experience in proper function and kwion.The inspection was performed based on reported approved system Inspector pursuant to Section ���of on��sewage disposal syste,ns, I am a DEp 40 of Tltle 3 j310 CMR 13.00p). The syst' Passes rw Conditionally Passes az�Further Evaluation by the Local AMOVing Authority Inspector's Signature: 0 Date: A), 'The system inspector shall submit a copy of this in 9EP)within 30 days of completing this' won report to the Approvin Authority Inspection,if the system is a shared system or has Board of Health or gPd or a Or t l for and the system owner shall submit the design flow of l()'0W authority gnat should be sent to the system owner and copies se to tithe ap if applicable,PPropriate regional office of the pP tile,and the approving Notes and Comments *""This report only time,Thit inspectio doedescribes nbeaddre..5A how the�yytem Wi time of ll pectirm and under the conditions of use at that conditions of use, ]l perform in the future under the yams or different pale 2 of l l c . OFFICIAL INSPECTION FORM— SUBSURFACE SEWAGE NOT FOR VOLUNTARY ASSESSMENTS SAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property AdI,,eS,,; oZ.0 9 Owner: S �nJ `` •¢ Date of Iespectlovi o2 0 0 Inspection Summary; Check AAC1 or E D !A3 A- SYs< Passes: YI complete ail of Section D 1 have not found any information which indicates ft i5.303 Orin 310 CMD 15.304 exist Any failure any of the failure criteria described criteria not evaluated one indicate below. in 310 CMR Comments; & System Couditlosalty Passes: �Qme or more system cmmuents as de repaired..Tu system, upon completion of the rye aceribed lathe"Conditional pass"section need to be re -- - - - Placement ar repair,as approved by the Boats of Health. pass. Answer yes,no or not determined(Y,N,Np)�the explain for the following statements,if"not determined"pl'm ---lu septic tam*is metal and over 20 years old"or the septic tank(whether existingtank��substantial u>filtration or exfiltraaion or tank failure is i metal o[not)is structurally, *A metal placed with a complying septic tank as a .System will pass�spection if the septic tank will pass inspection if it,, )proved by the Board of Health. indicating that the tank is less than 20 years old is a��le sound,�kik'n$and if a Certificate of Compere ND explain: Observation of sewage backup qr break qut or hi °acted ppe(s)or due to a broken,settled k uneven i h Stati water l vel in tivildi�buo0n box approval of Board of Health): 1 due to broken or Pass inspection if{with broken Pipe(s)are iced gNtruction is remove distribution box is leveled or replaced ND explain; —_._ The system required pumping more than 4 times a Pass inspection if(with approval of the Board of Health): Year to broken or obstructed lxPe(s). The system will broken pipe(s)are replaced obstruction is removed ND explain: ��. OJ Pav 3 of 11 ' OFFICIAL INSPECTION FORM.NOT FOR VOLUNTARY ASSESSMENTS ' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CE117IFICATION(Co Ptoperty Addresa: 9 ✓�C/✓.,t2 d wrnt E>wner: Date of laspectioa: p C. Further Ewalaation Is]Re Av� 9�d by the Bayard of Health: Conditions exist which require is failing fo p public-health, Anther� the Board of Health in order to determine if the system I. System will pass unless Board Of Health determines in accordance with 319 CMR 13�3 system is not f tio�ing In a-manner which wilt PrOted publiclbeWth,-aat*sad the-e ivi'ena"L. e —.. Cesspool or privy is within 50 feet of a surface water — Cesspool or Privy is within SO feet of a b'o�vegetated wetland or a salt nuush - - - 2.- System wilt fail unlem the Board of Health(and Public Water Sappiier,it an - - system is functioning in a manner that protects the public h y)determines that the ealth,safety and environment; surface water— The system has a septic tankard soil absorption system(SAS)and the SAS UPPlY or tributary to a surface water supply. is within i00 feet of a —= The system has a septic tank and SAS and the SAS is within aZone 1 of a public water supply The system has a septic tank and SAS and the . c tank an SAS is within 50 feet of a private water su 1 — The system has a pp Y well. �Y well mod used to deterrni�di Private water d SAS and the SAS less than 100 feet but 50 feet or more from a stance "Tws system paw if the well water analysis,perform bacteria and volatile organic compounds a DEP certifies>aboratery,for rgliform the presence of ammonia nitrogen and nitratet oen the wed -free�Pollution from dw failure criteria ant triggeredgen is equal to or less than S facility and A copy of the analysis must be attached to this f that no other 3, other, 7 PLe4of11 • OFFICIAL INSPECTION FORM_ • SUBSURFACE SEWAGE DISPOSAL NOT FOR VOLUNTARY ASSESSMENT POSAL S S SYSTEM INSPECTION FORM PART A CERTIFICATION(continued Parr Adds:. oZ 0 9 ao 1�le s „�„IVA pwner: ah s— -----/ 1*4- Ot6 Date of bspectiom 36 D. System Failure Criteria appueable to all systems; You mug indicate`des"or"no„to each of the following for alI inspections; Yes No/ =�vG of sewage into facility or system component due to over `//��Or ding of e�iuent to the surface of thAS or cesspoole loaded or cogged SAS or cesspool D'ound or surface waters due to an overloaded or S c liquid level In the dstribution box alcove outlet invert die to z1ftspoolan overloaded or clo d dqo in wool is less than 6"below invert gged SAS or times in the last Y ert or available volume is less than�K 4W flow =UMpumped18 more than 4 -11 W _due to clogged as eructed ldpe(s)�Number tin of the AS'cesspoolor privy is below hi Portion,of cesspool of Bb grarnd water elevation ptitry is witlutt 1(M feet of a surface water supply - - - - - - _- - - mPNy - - - - - or ttiliutary toAW a surface 4 AM Portion.of a cesspool or privy is within a Zone 1 of a of a cesspool.or Privy is within SO feet of a Public welL A portion of a Private water su supply well Of a l or privy is less than 100 feet but greater than 5feet from a acceptable water quality analysis, [This system private water performed at a DEP cecdtled lahoratory,for coliform bacteria and vola�ehe well water analysis, performed the well is free from Pollutlon from that facill Manic compounds amtriggered. n and nitrate nitro$en is equal to or less,than S �`and the presence of ammonia are triggered.A copy of the analysis must be pp°1'provided that no ether failure criteria dttac6ed to this form,] — (Yes/No)The system f ram,I have determined described in 310 CUR 15.303, ystem f therefore the t one Or more of the above failure criteria exist as Health to determine what will b e necessary to cQ�the f�us stem owner should contact the Board of E• Large Systems: To be considered a must indicate either $large system the stem must serge a facili with a design gpd. system ty Yost n flow of lO,iMlO gpd to t5,OQ11 (The following criteria a `yes„or"no"to each of the following; Pply to large systems in addition to the criteria above Yes no ) the system is within 400 feet of a surface ddnlang water supply the system is within 200 feet of a tributary to a surface driakivg water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWP Zone if of a public water supply well A)or a mapped If you have answered"yes" to any question in Section E the system is considered a si "Yes" in Section I7 above the I.ar significant threat ge systcm has failed,The owner or operator of a_ large apt,or answered under Section E or failed under Section D shall '� a ge system considercd a I5,3A4, Th_e system owner should contact the a PBmde the system in accordance with 310 CMR 1>propriate regional ollicc or the r)cpartrnent, r Page 5 of I I • OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CRECKLIST Property Address; S Owner. CAMh Date of Inspection: p O Check if the followinghave been you most indi cake es"or-non as to each of the followin Y No 8 information was Provided by the owner,occupaak or Board of Health Wen any of the system components pumped out in the previous two weeks syskm received.normal nows"m tW Pwim two wean period la voinmes of watrr.been iced to the system recently or as Part Of is spoction Wen as built plans of.the system obtained and emured?(If they were not available MOM N/A) as the facility or dwelling inspected for.si8ns Of sewage bade up Was the-site in spected for signs of break out ��W, �of aUystemcomponents,."idudin8 theSAS.located on site the es the septic tank manholes w des,material of co '° and the interior of the tank inspects for the condi{ian nstroction,dia►ensions,depth of liquid,depth of sludge andof scum Was the facility mW= mnoe of mace owner(and ifqaax different from owner)provided with information on the proper The size and location of the Soil Absorption System(SAS)on the site has been Yes no 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 top C is at issue approximation of di is unacceptable)P 10 CMR 15.302 3 sta= Page 6 of I I OFFCIAL INSPECTION FORM NOT FO SURFACE SEWAGE DISPOSAL R VOLUNTARY ASSESSMENTS SUBSURFACE SYSTE PART C M INSPECTION FORM SYSTEM FORMATION Property Addre= 0 vn I oar; GGI" ' �i�1 4 o� Date of Inspecdm. g��, OW CONDITIONS Number of bedrooms(deli _ /> h Number of DPISIGN w based on 310 Ch 3.203(umber for exa bedrooms(ate): N13VI �residents. I— 0 t3pd x#of bedrooms): Is Jatm on a lwve$ �Winder(yes or no):-AV system (yam system(yes of n°):Laulkhy �.C [if yes separate it on requ Mdl or �7 me Water ter �or no): Sump pump b no e(last 2 years usage Qpmy .v Last due of °a„psv4; C ��DUSTWAT, Design flow oned on 3I0 t I5.203 );_ Basisdesign flow(seatype�ns/sgR,etc.): Grease tmp present.(y,es or no);_ NNI a'este hold<ag tank psent(yes or no): rneca waste discharged to the.�l,ft g system es or no): readings,if available: � East darts of oyAL9e: OTHER(describe): PusnPWB Records. GENERAI,INFORMATION Source of information: H If� v tem e pumpea as part of the inspection(yes or no soa _- 011_ - llons-How was ) k � q�tY Pumped determined? T�YPIt Wk distribution box, x, sort absorption system _Overflow�l Privy —.Sly system(yes or no)(if yes,attach =WMftatm1vdyASjtW,,.n atiyetechnology. Attach ao��Pection records;if any) Tg� owner) copy of the cwr�ent operation and maintenaz�contract to be —Attach a copy of the DEp approval ( —Other(describe): Appr°jcimate age of all components, � cxl if!mown �p )and sourc�Ofiftformafiofl: Were sewa ge odors dctwW when�ving at the site(yes or noy" • paBe 7 of�I • OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMUffS • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM FORMATION(contimred) il'roperh►Address: 0 9 ldv4��ivo,el D� Date of Inspmdoa v BU LDING SKWli.R(locate on site plan) Depth below grade: 9 Materials of construction: iron 129'iron Distance from privge water supply well or section : (expo): Commeuts(on condition of jointly venting evidence of leaks gR etc.): SEPTIC TAWx._(locate on site plan) Depth below grade: Material of co . _odmr(vTWn) —metal-- asa:_polyethylene Tf tank is Mew list Is age confirmed - - - - certiacate) Dimension a Certificate of Compliance(yes or no):_(attach a copy of d .,Sludge dep X 1 . DisbNe.� P /sludge to bottom of outlet tee or bale: Distance g'om top of scum to top of outlet tee or baffle: Distance from f outlet tee How were di Ar ba81e: ned: Ion) Cow(°D Pumping neoommendti asJa� ted la to outlet ury evidence of g0,etc.).inlet and ou et tee or baffle condition,structural integrity,limed levels H 101 GREASE TRAP, pocate on site plan) Depth below grade: Material of construction:—concrete (explain): ___.metal_ erglass Polyethylene_other Dimensions: Scum thidme .._ Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee Date of last pumping or ba81�-- Comments(on pumping recommendations,inlet and outlet tee or baffle as conditio related to outlet invert,evidence of leakage,etc.): "'"ual in sty, liquid levels i pagie 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Prop"Addrew o2 0 g- Pea►rw I 0, Owner: h f �4 Oa 9 6--r —CIL Date of vadon: ?e 0 TIGHT or HOLDING TANK: tank must be pumped at time:of' mspecdonxlocate on site plan) Depth below grade: Material of construction concrete metal fiberglass_polye lens �Y other(explain): Dimensions: Capactr Design Flow: salloadday Alarm present(yea or no): Almm level:_ Ah m in working order(yes or no), Date of last punting: Comments(coridtim of alarm and float switches,etc.): DISTRIBUTION BOX: Z (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert:0D.-wt•e I Commras(note if box is level and distribution to outlets leaks ' to or out of x,etc.): ems,any evidence of solids carryover,any evidence of v7i PUMP CHAMBER: (locate on site per) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,ctc.): Post 9 of I I oF>FrczAi,INSPECTIONFO'M_NOT FOR VOLUNTARY SUBSURFACg SEWAGE DISPOSAL pOSAL ASSES MENTS PART C FORM v SYSTEM INFORMATION(con P11operb'Addresa dt o 9 P r �� tam Owner. � Cr:� t �nf /Date ofkve pd 3o Q e/ t ! SOIL,AMRP170lq SYSTEMS (SAS); pocate on site Plan,eicavatiou not required) If SAS not loci c y: plain wh f l �g�►number:L' i0 x �/� — �G f number: lead salIaick number —.lambing traochq,nunber,l g . eacting$elds,number, overfl / C�"dtivelaikru •ve��— S /,r Co zents(note condition of soil,sfgoshydraulic of teChnoloV. � Oh /'h � fail,,r,�Level ofpon c� o� f P soil,condition of vegeoq CESSP001 S:/V" Number and cesspool must be Pumped as part of on on site 1 gamtion: pan) Depth-top of liquid to inlet invert: Depth of solids layer. Depth of scan layer. Dimensions ofMaterials cesspool: •cation o�&o n: z Commentsnmow n( ote condition _ of soli,signs of hydraulic fail ure,level of Pon�B,condition of vegetation,etc.): PB>ryys L�(locate on sim fan) Materials of cronstnu,.tion; I�rnenswns: DqM of solids: Comments(rote Condition of soil,signs of hydraulic fail,,,.,level of pondinl,condition of vegctatioq etc.): page 10 of 11 OFFICIAL,INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued Property Address: Owner: C�s► a o,r,�s Date of bspedion: o SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a Sketch of the sewage disposal SYstem inchxling ties to at least two benchmarks,Locate all wells within 100 feet,Locate where public water su or pply enters the building, +0 S�f 1 3 - (o 0 pgze11ofll . a OFFICIAL INSPECTION FORM'NOT FOR VOLUNTARY ASSESSMENTS • SUBSURFACE SEWAGE-DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: -2n 9 Ae 4,t4,.,1 Ot-i.r, Date of Impewon: SIZE EXAM. �] o N„ �o Slaps x / C surface water �.o Check cellar Sbanow wells .� Estimated depth to ground water Sif../feet Please HUIC a(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If chocked,date of design plan reviewed: site(abutting property/observation hole within 150 feet of SAS) Chocked with local Board of Health-explain:—_ ✓`�t,,No f Checked with local excavators,installers-(attach docnmeraation) I 0 F Accessed USGS database-explain: You must describe h -you shed- gk ater elev lion: - - /OOy' �It �pC 20.-7 le, Zz Ojo o 0 ~ >12, / SEPrI c t;rN - rl }_L,a�v..r_ 1, l: Zpoor�. AG -7- T I a� `fi(.�4� bra BAck !'•,- � _'i•i':j�"v f•� - + �L��..r�..r•j••j 1, /,-�i..w . V.�,IVC �j_.Z.�ti �- L ��' . __L_..11VEST AS2.1�5M`BL.E 7-1 t l •T r is ..q I Al V -- I -� dnxTER !!' r + , i i � a ! ,5t1L't - __�.._•...I .I. , j Age , !, •�;� �..; " 81 .�.{�.; giST_ ENV, F�o ;4L S rrc 80.g r 7r T 7G. , i� i TNT - ! 1 i- t ; I ;. •{_ f?To1N ALL ' l..r.r. 149, a MAP c.� Pam' `' raga BAIZIJ STQ LE z 4L IAM T�kT'i PLAN Q� ' �.., ':ydz�aN- �M��: s:;yv�-r.,��:• �nt�..-�Sc�EtJ+���• 1- L-�' 25 �71;rl o, I -=•�1�tl'' !tl.: ' ora - � ' • 413 _ 4 Ir � 'j —r mil_ CZ•_•t'—`-7 Y ``�,r �'l!S � � , � t ' --=--.._.:..�_._�-�-;- --•--•��j-�-�-,- P�`hlorJa�. '�Au � Sue _;...,. r N ! IS, 'N a: �35E� oN `.�N V>~�o�� :�U(�/G`�;�::aIJD -1'�{ i:�oFFSE�s::'�I�vU4D'•iJ�;�3E 1-..,_ . .. c�.�;L _. E�1G1►J LEz; r Ut"; 1•; fz u L ."S�n,_.iro , Tg ls( :_ opE� y - -..c i .,_,._;. 5PE V I MA•;l, , P� e •�.W.,.� 1v ......j .. ;-. , ................. Avr VW i-t � { h F'.. �.J ' t ..J � � (/�y✓� � '��,�� / ri � , � 1 r i i r t _ I J : } E3{2 - r l Z r. V J ! o I cu- rj W , rA44 AL rco \ . ... -1 1 ( l ,f��P S,9c� .jti ^{_t '. . � i 1. �::p� • . �o a .PETER.._ "SULLIVAN No.29733 : y ZG ft low r r. : �tHE ' �, Town of Barnstable - SrABIX • Board of Health 200 Main Street RFD MA'1 A Hyannis, MA 02601 Office: 508-8624644 Susan G.Rask,R.S. FAX: 508-790-6304 Wane Miller,M.D. Sumner Kaufman M.S.P.H. July 17, 2003 Revised August 26,2003 Ms. Anne Reveliotis 209 Percival Drive West Barnstable, MA 02668 RE: Weekes Crossing, Lifeguard Modification for the Outdoor Swimming Pool Dear Ms. Reveliotis, We will allow you to employ "qualified swimmers," in lieu of the requirement to employ fully certified lifeguards, at your swimming pool located at the Weekes Crossing Pool, located off of Percival Drive, West Barnstable, MA. This includes persons in your pools and includes all other persons within the pool enclosure. The following conditions must be complied with: (1) The pool must be supervised by a "qualified swimmer" all times the pool is open. We wish to make it clear that this swimmer must be at the pool and cannot be observing from the desk unless another swimmer is provided and physically present at the pool. This swimmer must be certified in adult, child, and pediatric CPR by the American Red Cross, American Heart Association or equivalent, be familiar with lifesaving equipment and knowledgeable in first aid procedures. (2) All qualified swimmers shall wear orange colored hats or orange colored visors with the words "POOL STAFF" in 15 millimeter (5/8 inch) black colored lettering on the front of the hats. (3) The maximum capacity of the swimming pool is reduced to nineteen (19) persons. (4) You shall maintain a permanent record on a form prescribed by the Board of Health listing each swimmer supervising the pool when it is in use. (5) You shall submit a copy of the applicant's insurance policy naming the Town as coinsured in the amount of$1,000,000. PoolWeekesCrossing (6) All other regulations contained in Chapter V, Minimum Standards for Swimming Pools, must be strictly complied with. (7) The qualified swimmers must hold a current American Heart Association, American Red Cross, or equivalent CPR certificates with training in adult, child, and pediatric CPR. (8) The swimming pool water must be tested for coliform bacteria at least monthly by a certified laboratory. Please be advised that if you exceed this capacity of 19 persons, your modification will be invalid and you will be required to cease operation of the pool. This modification expires December 31, 2003. It is your responsibility to ensure that you request renewal of the variance from the lifeguard requirements each year prior to opening the pool. Sincer I yours, ayne iller IVYD. Chairrton BOARD OF HEALTH TOWN OF BARNSTABLE PoolWeekesCrossing r Revised August 26, 2003 CRITERIA FOR GRANTING MODIFICATION OR VARIANCE FROM THE RECOMMENDATION OF THE STATE ENVIRONMENTAL CODE REGARDING SWIMMING POOLS AND LIFEGUARD REQUIREMENTS QUALIFIED SWIMMER: In constant attendance when pool is open. Only CPR certified personnel who have passed a swimming test shall be used at pool. General Requirements Swimming Test: The swimming test, administered by the Operator of the pool, consists of: - Swimming 2 lengths of pool. - Treading water 5 minutes. - Retrieving an object from bottom of pool. CPR Certification: The qualified swimmer(s) shall be 18 years of age or older holding a current American Heart Association or American Red Cross CPR certificate with training in child, adult, and pediatric CPR. Familiarity With The qualified swimmer(s) must demonstrate First Aid: familiarity with life saving equipment, including rescue procedures and administering first aid. Swimwear: All qualified swimmers while on duty shall wear an orange hat or visor with the words "POOL STAFF" in 15 millimeter (5/8 inch) black colored lettering on the front of the hat. Pool Capacity: The maximum capacity at the swimming pool site is restricted not to exceed 19 persons. Insurance: The insurance policy of the pool must name the Town as co-insured in the amount of$1,000,000. PER ORDER OF THE BOARD OF HEALTH Wayne Miller,M.D. Susan Rask,R.S. Sumner Kaufman,M.S.P.H. Q:Health/WP/lifeguazdmodificationReq IL 2-1 op y PET, TArzrAN / 63{2 �lz cp- j PIZ Dw . 1 L �o f�zopio.c� TA4 l �o 94 m e _ F cP`� ss PO ! r7 ° Il PETER ��, _. :1.. ` a o :SULLIVAN ,plo. 29733 �..� � G/STC`t - 1 ®q TOWN OF BARNSTABLE LOCATION ,•Car�_S' ;��,p C //s^A e, Z&SEWAGE # VILLAGE / jrrSESSOR'S MAP & LOT 8 - INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY Z 6 D b L, LEACHING FACILITYAtype) //7� (size) AQ 6 a 15�Ad-. NO. OF BEDROOMS- PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER 1 4 L? r—A" h/ DATE PERMIT ISSUED: z� DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No L� 1 A ., �� P 13 3 . �� f 1 .. y r t 4 THE COMMONWEALTH OF MASSACHUSETTS !llrrr+++ BOAR® OF HEALTH l ......1.�.�.n..............oF........... . ' Apptiratiou for Disposal Works ( onstrurtiott Pumit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at ......'7 .L',.i u.L '�r�.c -...... :. .:. .............................. f....a ...................................... Locat7- ess -----------------------••.-_-_----.--_----or•Lot No. Address ,11'1��------------------------ ----------- Installer Address ```��� UType of Building Size Lot f.(V.41_____..Sq. feet ,., Dwelling—No. of Bedrooms._._____.............................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons____________________________ Showers — Cafeteria a' Other fixtures ------------------------------ . W Design Flow.................-0...................gallons per person per day. Total daily flow---____-•-.______ ..............gallons. WSeptic Tank—Liquid capacity.)_CM..gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No......... .._.. Width.................... Total Length.................... Total leaching area___-__-_____•-`--_�___sq. ft. Seepage Pit No......-1-------/Diameter......Lo........ Depth below inlet.......4......... Total leaching area...dkl�..sq. ft. Z Other Distribution box ( v) Dosing tank ( ) Percolation Test Results Performed by----------------- Q �_�..... !'?�1n 6nG Date........q"_..._.._..............._.. aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water_--_--_--____--_-----.-. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 04 •-•••--•-•••-----•---•-•--------------- C-._ ---............................................................................................. ODescription of Soil................... 0.2� __..........__1 P..+.Scab........................................................................................... ---••••-------------------•-•--•------......_._..... .:a = ...f`�. .. - ra�:eL w ..................................................... x --------••••-------------•--------••----••--•-••---••-••-•-•--------------------••••-••------------•---•-------•----•-•-•---------•------------•-•••---------••-•-------•---••-•••••......----•----•---- U Nature of Repairs or Alterations—Answer when applicable...____......................................................................................... --------------------------------- ------------- •------- •------------------------_-_----------------------------------------------------------------•---------------------•--•_---•__--------•------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b ' sued by the board of health. Signed .--- - --- - -0.� ............... ........... t...... ... Application Approved By Pthe Application Disapproved ffollowing reaso - ..........................-'---'............. --------------- ------- . .....r, " Dace Permit No. - -.....--.. Issued ... .r /� ......a..-f.--- ........... -------------------- Permit � Y A No........ -_ -- `J V ( /J (/t , s............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..............oF.......... r ec..b.�----..........------.............. ApplirFa#ilan for llhipoii ai Vorkg Tomitritr#inn firrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ----------------- . '.r :�' v w:C. r� 'r 13 .............................................................................................. Location-Address or Lot No. ......................_.......................................................................... _ ..............................• Owner Address W Installer Address Type of Building Size Lot-l� `+-kq-l .....Sq. feet Dwelling—No. of Bedrooms___._... _____________________________Expansion Attic ( ) Garbage Grinder ( ) pa-I Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures -------------------------------- - W Design Flow.................`.......___.._.___..gallons per person per day. Total daily flow............._-_•.-3-�-----.--. ......gallons. WSeptic Tank—Liquid capacity.(_ .gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.............._..... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No....._.f�+,_________ Diameter.._....' ....... Depth below inlet.......6,7/....... Total leaching area...__.....sq. ft. Z Other Distribution box ( 4� Dosing tank ( �) `" y ..-A 6, Date........................................ a Percolation Test Results Performed b ................. � _.. ..C.........._.�:±�%f 6 2 Test Pit No. I________________minutes per inch Depth of Test Pit.................... Depth to ground water-._-----__--_---_____--- (� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a .......................................-........................-•.......................................................................................... 11 Description of Soil.................... ° - ......---•-- '�� •-•--•-••-••-•--••---•••--•------•................. .. ........� -•-•--.e •-• �� +- (6 U P L. --------•-•-................................................... 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 Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed ................................. ...... ..r:.... f _ Application Approved BY P <............................-........------ --------------- �-.. Application Disapproved for the following reasons./.......................................................................................----------.---.. ..I�te .�./--- . ................/..............r.J.....•:^ .........--Date--.-.-.-.-.-.....- Permit No. �'7 % % -.......... Issued ........................................../ //� `� / ; 1.Date . .............. .�+ ...... r — - — THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........ --------------------------------------- J.. .t::c .t �------------- OF ........F f............ Gertifirate of Clatuptiance THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by---. ---- . .......................................... ----- ------------------------ f p / Instnllfr / ! / , at -........i............. V-----{.- F"�.....; -- -- --r—`C rr�._.UCI I.,'----. .. C¢ `,• ---------__...(:4-.-...N.�--.-........ has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. .....Q...Y,..-4. � dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE 'C�NSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE...............................----------------------------------------------- ----------------------- Inspector ................................................................................................ THE COMMONWEALTH OF MASSACHUSETTS r ~I BOARD OF HEALTH ...... .....................................o F............... ...C........:......:..t...................-................. ... f / No.........Z............. FEE.+... ..... ....... n Miipowd Workii 0.1ncni#r uan rrntif Permission i1 hereby granted................................................. ............................... ............................................................ to Construct (1/) o Repair ( an Individual Sewage ispos System , at No...........................A f --------- 0_ - - - ------...__.........------------•---•-•-••----•-•-•...........-- Street as shown on the application for Disposal Works Construction Permit No.i.......a:. u� Dated.......................................... •----------------------•-•---•-----------------------------------------•---------•-••-----•----••--...... Board of Health DATE................................................................................ FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS 1_ -, , No. Fee— BOARD OF HEALTH TOWN OF BARNiSTABLE Zipplicat ion,f"orVerr Con5tructionPermit Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair ( n individual Well at: Location — Address /,Z� l�G Assessors Map and Parcel Owner Address 1 N� Installer — Driller —� Address Type of Building Dwelling------------------------------------------------------------- Other - Type of Building---------------------------- No. of Persons-------- ---------- Type of Well------------ --------------_--------------------------------------- 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 until a Certificate of Compliance has been issued by the Board of Health. Signed - __ date Application Approved B}%=�-= date Application Disapproved for the following reasons:—------------_----- —--------------- --- date � +!�' � _ Issued--_____v___�_w�-_—� -- Permit No.----=------------------------=- ------------------- date BOARD OF HEALTH TOWN - OF BARNISTABLE Certificate Of Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( . ) by------ � � ------------------------ -- - --- -- --- - - ----- - - ,o Installer / 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 k- j_?_?�" O Ated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE-- - -- --------------------- -- -------------— Inspector— --- ----- =_---- — -_— - p No.- ---/-_ ___� �� Fee---''�--- ------^-"-----� BOARD OF HEALTH TOWN OF BARNSTABLE Rpplication-*rVell Con0ructionpermit Application is 'hereby�F made for a permit to Construct ( ), Alter ( ), or Repair (.-)an dividual Well at: —Q__- _1'_ •-�__� _ -_AT _-______-______________________ __ ____-________-__________ __ _ ___________________________ _______ 144- Location — Address / ©�! G Assessors Map and Parcel 269 - - - ----------------------------------- - 1�_D � _ Owner Address I_rr* A:::-�- --..��� �� ��J z Installer — Driller Address e Type of Building Dwelling------------------------------------------------------------------- Other - Type of Building ----- No. of Persons-----------------------------------------_-- Typeof Well-------------�--- - - --------------------- 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 until a Certificate of Compliance has been issued by the Board of Health. p Signed /` --_ _ /✓'�_ date Application Approved By� � - - °-- --- -- '� ==- •� date Application Disapproved for the following reasons:-----------------------------`,----------------------------------------------------- ------------------------------------------------------------------------------------- date Permit No.- - -J --------------------- Issued----------�L__�- �57 = -- ---------- date BOARD OF HEALTH TOWN OF BARNSTABLE (Certificate ®f Compliance 41y� THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( ) by- � - /1 r am{_ �R- ------------------------------------------------ - ----------------------- --------------------- - - --------- Installer p dat------ -- - - - ---- 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./ff'-> s'- -�,D"ated --`` - _ 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 Very con5truct ion Permit No. '�✓- ^=�� ' Fee Permission is hereby granted ---------------------------------------------------------- to Construct (P�, Alter ( ), or Repair ( ) an Individual.Well at: No Street as shown on the application for a Well Construction Permit No.- .� ------------T-------------� ------------------------- Dated —---------"-'dam-�---------�-l14--///-------------------- -- ----------------- 7" r^ Board of Health DATE---------- -- ------------------------ r I 7.J.. 4 r �_ 7l C N'-:1 ".V'H 1 !•'�' '.:�4.: ,.7. 1 ' _I I �.�.. 1 `•"' -,�.........._....,».......-,...,. ......«.....,...-_.-...........�.._.._._._,�-_,.._._—_..__ I t FAN`( '3pEn�c� 1 OF .L • �pA I L. � t Dl�poSd l� t , ,laoa, �L 12..'�s � f��_` ; , .�,� I i`�1,.�-� orgy BAck �IErZEr�-• - 40 i UOTTOM is r /� Q A L._ . r `TOTAL. tDAIL -0Y/ � 12G�LA�t-r oNZXA'r1-o�2 Lam{ �- E `l' .. AZZt�S '"Qr`St.. r PETEtt a o `SULLIVIy ✓ . . . uo i I , , ' I r 6 r T g lcG �8 _ i t INV V� 1 , T t Ali ,,�Io.. locrj P 8/ Bic Gr2 j + GALE 7¢ , TAN .: t a 1sTo r: : M.F. L.t F�: Pew F -or 'Pa� r.., '�.-.,...i. .I � r SGA��'�''• ( ' , , r i' I..I ... 1��`�l •..- W�f (, ArG.fV S�L.J�( r 2� i -G23 �; �'z �£j 'DATA r l�' G ....... iff.O'.�� e . ._ i GLIL A 1-4 REI:'�,:RFJJC,�- ' SNOW 'NE7ZEpN: CoMPr_ S. yvl- TIT µ . �. SI�E�u� LcTr Z �'Y V'•�I� �7F�✓�"Y`i� �"ail 11J' L� vY' , Al�'r; � ��`-'.J � ��./-.L�I� � �'I3 �� P F �lOrJdt: Au Sues/~ycve l oN tiN IiJS'TI�17�itE�1'r' l . ; , � SETS•:. z,l-�tiUly.. t��-�,`QE i - 0 5 - uSet> T'o.�GSTA'�IS 'r v l t_.LL it�tA ,._ t j t7li I1 r i ,1 r I 1�w } I f roc } { I �._•{ ,� ' 1 4 a I. , H t LLLrrr r , V —f^ 7 ' I t 1 PETCR No 29733TS y . 0 , ^ Iz JL j I f i 1 — I I r ¢ Y Department of Environmental Management/Division of Water Resources WATER WELL COMPLETION REPORT - I ELL LOCATI0,�11 GEOGRAPHIC DESCRIPTION ddress�ti(�2r_� �l�.a / N s ci w or (leer) (eircle) ity/Town ' !J, 42A►"fti S�i4 � Well owner �_T/f/t� / ^ 4— (road) r�_ Address /�ak i/ `� N S E W of /� � ' ��`v (mi in tenths) (circle) ,. Board of Health permit: yes ❑ no ❑ intersect. w/ (road) WELL USE WELL DATA Domestic ublic❑ Industrial ❑ Total well depth 7 2 ft. Monitoring❑ Other Depth to bedrock ft. Water-bearing rock/unconsolidated material: Method drilled���� Date drilled .�=// S Description CASING Water-bearing zones: Typef s��.v� 1) From /�?� To 7 3 2) From To Length ? "ft. Dia(.I.D.) _in.. 3) From To Length into bedrock ft. Gravel pack well: dia. Protective well seal: Screen: dia. Grout.❑ Other Slot$'AZ length _from?1Ztorte_ WELLTEST _ Static water level below land surface ft. Date 5- Drawdown—? ft._ after pumping hr. min.at gpm How measured C +2131 Recovery - ft. after—hr.—min. 0 LOG of FORMATIONS COMMENTS Materials From To Driller ✓�� l Mass. Registration# Firm Addres / City/Town D l2l)kA Si nature oI su ervisln B is era we"drlNer Momms lasso print firmly BOARD OF HEALTH COPY BARNSTABLE COUNTY HEALTH AND ENVIRONMENTAL DEPARTMENT LABORATORY REPORT VOLATILE ORGANIC CHEMICAL ANALYTICAL RESULTS Client: TARTAN INC Collection Date: 05/13/93 Mailing Address :P 0 BOX 1198 Date of Analysis :05/13/93 WEST CHATHAM MA 02669 Type of Supply: WELL Well Depth (FT) : Not Given Telephone: Sample Location: 25 PERCIVAL LANE LAT. (DDMMSS) : Not Given BARNSTABLE LONG. (DDMMSS) : Not Given Collector: C STIEFEL Map/Parcel : Affiliation: BCHD Analytical Method: 502 . 1=1 , 502 . 2=2 , 503 . 1=3 , 504=4 , 524 . 1=5 , 524 . 2=6 , 502 .1/503=7 --------------------------------------------------------------------- --------------------------------------------------------------------- Contaminants Anal . Result MCL Detection Detected Meth. ug/1 ug/l Limits (ug/1) --------------------------------------------------------------------- Chloroform 2 2 . 5 0 . 5 Only those compounds listed above were detected. Attached is a list of compounds for which this sample was analyzed. NOTE: Contaminant levels equal to or exceeding the Detection Limits are reported. MCL means Maximum Contaminant Level for EPA-regulated compounds . (ug/l = micrograms per liter = Parts Per Billion)' The Environmental Protection Agency has set Maximum Contaminant Levels (MCL) for the following compounds . This sample compares as follows : COMPOUND MCL (in PPB) Benzene 5 . 0 * level not exceeded * Carbon Tetrachloride 5.0 * level not exceeded *. 1 , 2-Dichloroethane 5. 0 * level not exceeded * 1 , 1-Dichloroethene 7 . 0 * level not exceeded * 1 , 4-Dichlorobenzene 75 * level not exceeded * 1 , 1 , 1-Trichloroethane 200 * level not exceeded * Trichloroethene 5 . 0 * level not exceeded * Vinyl Chloride 2 . 0 * level not exceeded * Comments or additional compounds found: Thomas F. Bourne , Laboratory Director Log Number: - Bottle # 9.3-9 Date:—A' BARNSTABLE COUNTY HEALTH AND ENVIRONMENTAL DEPARTMENT SUPERIOR COURT HOUSE vj BARNSTABLE, MASSACHUSETTS 02630 0 6 AiASe' DRINKING WATER LABORATORY ANALYSIS PHONE:362-2511 _Ext. 337 Client: Tartan Inc Collector: C -Stiefel Mailing Address: F 0 Box 1198 Affiliation: BCHD West Chatham MA 02669-1138me & Date of " Collection: 5/13/93 9:25 a.m. Telephone: Type of Supply: well Sample Location: Lot 25 Percival Lane Well Depth: W Barnstable MA Date of Analysis: 5/13/93 10.30 a.m. PARAMETER SAMPLE RESULT RECOMMENDED LIMITS Total Coliform Bacteria/100 ml 0 0 H 6.0 Conductivity (micromhos/cm) 85r 500.0 Iron ( m) 0.1 0.3 Nitrate-Nitrogen ( m) 1.0 10.0 Sodium ( m) 14 20.0 Copper (ppm) 0.1 1.3 I . XXXX Water sample meets the recommended limits for drinking of all above tested parameters. II . Based only on results of the parameters tested for this sample, the water is suitable for drinking but may present the pr,,obl'ems checked below: A. Water sample has- higher than average levels of Nitrate. Future monitoring is recommended (2-3 times per year) to establish any upward trends. B. The low pH of the water may shorten the useful life of the house's plumbing. C. Water may present aesthetic problems (taste, odor, staining) 'due to D. Water sample has high levels of sodium: Persons on low sodium diets should consult their doctor. III. Due to one or more of the reasons checked below, this water sample exceeds the recommended maximum contamination level for drinking water: ' A. High Bacteria B. High Nitrates REMARKS: CC: BOH 1 /7/85j Laboratory Director . r - .�-�. -:.'vw•!�a'yh+���...e•'-4-w.+.t..�•ML.'+..��^-.ti '^u a. ..ti,..... -.. ., .—v-..... .... - �' �YAr�•.,• , a-�' Expl'ana,ic;t?of Test Results &` a Total Coliform Bacteria •Coliform bacteria are an indicator of the sanitary quality of a water supply. Water supplies may hearth contaminated from malfunctioning septic systems, cesspools and surface runoff. A total coliform count of zer�' indicates that your water supply is safe and approved for human consumption. A total coliform count of,greater ,ha-n zero is most often the result of accidental cnr,tnm;nntion of"he sample bottle throueh imnroner samrline me-hoeis. For this reason. it would be advisable < rcte-i ant- well water t"a: is ;zn; approved: pH pH is the measure of.acidity or alkali nitcof the u ater.'On the ph'scale.the number 7 is neutral:less than _ is acidic and'more than i is alkaline. The pH of water'or Cape Cod tends to be acidic in the range of 5.0 to 6.5. Conductivity Conductivity is a measure of the dissolved salts in s;;lntinn. Amounts in excess of 500 micromhos%cm are generally considered unacceptable and may have a laxative affect upon users. r Iron M The presence of iron in water in concentration of .3 ppm or greater may: give the water a bittersweet astrineent taste, cause an unpleasant odor. often gives the wafer a irlrownish color and cause staining of laundry and porcelain. The average concentration of iron in Cape Cod's water is .2 - .6 ppm. Although the presence of iron in water may cause the problems listed above, it is not considere; de leterions to health. Iron may be removed by use of an iron removal system. Nitrate-nitrogen The Massachusetts Drinking Water Reattlations hsyc set a maximum contaminant level for nitrates at 10 ppm. Excessive concentrations may cause methemoolobinemia fan infant disease) and have been suggested to form potentially carcinogenic nitrosamines. Contamination sources include fertilizers. cesspools and industrial wastes. Copper Due to the acidic nature of the water on Cape Cod. copper tends to leach from pipes. This normally'does not . present a-health hazard: however, concentrations in excess of 1.0 ppm may cause a metallic taste and/or a bluish-green stain on porcelain fixtures. Sodium X concentration of sodium over 20 ppm is >n!Y of ,.nnce"7- people who are on a low sodium diet: If the water supply has more than 20 ppm sodium. it is up to the pc�)ple who are nn such a diet.to find another source of drinking water or contact their doctor to determine if consuming the water is advisable. Concentrations exceeding 50 ppm ind:,_-ate that there may be ocean water or road sal* runl)ft water ec°trine into the well. " BARN'STABLE COUNTY AALA AND ENVIRONMENTAL DEPARTMENT LABORATORY REPORT VOLATILE ORGANIC CHEMICAL ANALYTICAL RESULTS Client: TARTAN INC Collection Date: 05/13/93 Mailing Address:P 0 BOX 1198 Date of Analysis:05/13/93 WEST CHATHAM MA 02669 Type of Supply: WELL Well Depth (FT) : Not Given Telephone: Sample Location: 25 PERCIVAL LANE LAT. (DDMMSS) : Not Given BARNSTABLE LONG. (DDMMSS) : Not Given Collector: C STIEFEL Map/Parcel: Affiliation: BCHD Analytical Method: 502. 1=1 , 502.2=2, 503.1=3 , 504=4 , 524 . 1=5, 524 . 2=6 , 502.1/503=7 --------------------------------------------------------------------- --------------------------------------------------------------------- Contaminants Anal . Result MCL Detection Detected Meth. ug/1 ug/1 Limits (ug/1) --------------------------------------------------------------------- Chloroform 2 2 . 5 0 . 5 Only those compounds listed above were detected. Attached is a list of compounds for which this sample was analyzed. NOTE: Contaminant levels equal to or exceeding the Detection Limits are reported. MCL means Maximum Contaminant Level for EPA-regulated compounds . (ug/l = micrograms per liter = Parts Per Billion) The Environmental Protection Agency has set Maximum Contaminant Levels (MCL) for the following compounds . This sample compares as follows: COMPOUND MCL (in PPB) Benzene 5._0 * level not exceeded * Carbon Tetrachloride 5.0 * level not exceeded * 1 , 2-Dichloroethane 5. 0 * level not exceeded * 1 , 1-Dichloroethene 7 .0 * level not exceeded * 1 , 4-Dichlorobenzene 75 * level not exceeded * 1 , 1 , 1-Trichloroethane 200 * level not exceeded * Trichloroethene 5.0 * level not exceeded * Vinyl Chloride 2 .0 * level not exceeded * Comments or additional compounds found: � r Thomas F. Bourne, Laboratory Director AsBuilt Page 1 of 2 TOWN OF BARNSTABLE LOCATION ..0 a f��,E�,� /y,a f,?ASE WAG E # VILLAGE A-lew ' 4ad e&CC9j(6SESSOR'S MAP & LOT D)-bo INSTALLER'S NAME & PHONE NO.�IJ�,Q/1yn SEPTIC TANK CAPACITY Ad a o e�—ALr LEACHING FACILITY:(type) (size) jd p a r oz_- NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER R -A b Ay c 1' DATE PERMIT ISSUED: DATE COMPLIANCE ISSUEDL Cd f�r VARIANCE GRANTED: Yes No 1—_ 14 aZ 3 4Gh �c Or 1\p¢.S� IV AU 4'U �U I� a�Ccel7 JW � Jr�i�yi Main-,h�Ce r Cry( s oCt or- SIC4 to �e�b�•ck. � n� ,1,\Cv eoje ,h A,\e� pe d.�e http:Hissgl2/intranet/propdata/prebuilt.aspx?mappar=110001006&seq=1 10/28/2015 SYSTEM DESIGN: C LEGEND SYSTEM PROF ILE ALL SYSTEM COMPONENTS SHALL BE NOTES MARKED WITH MAGNETIC TAPE OR GARBAGE DISPOSER IS NOT ALLOWED COMPARABLE MEANS FOR FUTURE LOCATION. PROVIDE MIN. 20" DIAM. WATERTIGHT (NOT TO SCALE) 1. DATUM IS NAVD 88 99_ EXISTING CONTOUR ACCESS COVERS TO WITHIN 6" OF FIN. GRADE CONCRETE COVERS TO WITHIN 3" GRADE X 99 EXISTING 3 BEDROOM DWELLING 2" PEASTONE OR GEOTEXTILE 2. MUNICIPAL WATER IS NOT AVAILABLE e EXIST. SPOT ELEV. TOP FOUND. EL. 82.5' FILTER FABRIC OVER STONE DESIGN FLOW: 3 BEDROOMS ® 110 GPD = 330 GPD \ 1 3. MINIMUM WIPE PITCH TO BE 1/8" PER FOOT. —[99]— PROPOSED CONTOUR USE A 330 GPD DESIGN FLOW MINIMUM .75' OF COVER OVER PRECAST 2% SLOPE REQUIRED OVER SYSTEM 75-76' 198 4 NOTE: 2" MIN. WALL 4. DESIGN LOADING FOR ALL PROPOSED PRECAST UNITS ] PROPOSED SPOT EL PRECAST H-io BLOCKS OR RISERS (TYP.) THICKNESS REQUIRED TO BE AASHD H-LQ TH1 2'0 4"OSCH40 PVC MORTAR ALL PRECAST RISERS SEPTIC TANK: 330 GPD (2) = 660 PIPEs LEVEL 1ST 2' COMPONENTS H-10 5. PIPE JOINTS TO BE MADE WATERTIGHT. y TEST HOLE *` s" MIN. SUMP T,P Q 9h 12" MIN. INT. DIM. ENDS ( ) INV'S EL. 72.20 4' \ S YY **USE EXISTING 1000 GAL. TANK SIDES 73 0 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH 2% SLOPE OF GROUND ° ° ° ° �o" �a" EE'. ;°,o�oo�> f: 310 CMR 15.000 (TITLE 5.) Qe ' TEE "EXISTING TEE , � � � � � � � � � o 0 0 >°°>°°°°°° ' LEACHING: SEPTIC TANK *78.2 ���� ���� ®®® — ]ADO UTILITY POLE GAS BAFFLE :• ,_0 0 '00 0_• ` o a�®D���a�DO aDODO�00®®® '00'°o°O°o 0°0°0°0°0°o WATERT�ST, D'BOX O o 0 M. ° °°'o°O°O° SIDES: 2 (25 + 12.83) 2 (.74) = 112 GPD ° ° ° ° ° ° ° ° ° ° ®®���®®®0® o0000000000 °°'°°°°°° ° ° o ° o ° FOR LEVELNESS N o ° ° ° 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO >°°°° BE USED FOR LOT LINE STAKING OR ANY OTHER { L cus 6. FIRE HYDRANT - y 72.57' 72.40' °� BOTTOM 25 x 12.83 (.74) 237 GPD :' °> ° ° ° 70.20' PURPOSE. q NOTE: NOT ALL SYMBOLS MAY APPEAR IN DRAWING 00000°000000000°00°o°o°Oo°0000o00000000p0000� 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 TOTAL: 472 S.F. 349 GPD '000000000n0 _1.g0000000000oeonono�o oo°o°o° H-10 500 GAL. LEACHING CHAMBER BY ACME PRECAST OR EQUAL. _ ALL AROUND DOUBLE WASHED STONE 4' MIN. (2) UNITS REQUIRED 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED ALL AROUND PRECAST STRUCTURES USE 2 500 GAL. LEACHING CHAMBERS ACME OR EQUAL 6" CRUSHED STONE OR MECHANICAL OVERALL DIMENSIONS TO OUTSIDE OF STONE: 25.00' X 12.83' WITHOUT INSPECTION BY BOARD OF HEALTH AND o jj COMPACTION. (15.221 [2]) OBTAINED FROM BOARD OF HEALTH. �S�P l ) * WITH 4' STONE ALL AROUND PERMISSION THE INSTALLER SHALL VERIFY THE 10. CONTRACTOR SHALL BE RESPONSIBLE FOR CALLING s LOCATIONS OF ALL UTILITIES AND ALL DIGSAFE (1-888-344-7233) AND VERIFYING THE BUILDING SEWER OUTLETS AND LOCATION OF ALL UNDERGROUND & OVERHEAD UTILITIES ELEVATIONS PRIOR TO INSTALLING ANY LOCUS MAP 65.0' BOTTOM 1fH-1 PRIOR TO COMMENCEMENT OF WORK. PORTION OF SEPTIC SYSTEM ( 12 % SLOPE) ( 2 % SLOPE) NO GROUNDWATER FOUND 11. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL BE NOT TO SCALE • MA APPROVED DATE BOARD :OF HEALTH FOUNDATION REMOVED BENEATH AND 5' AROUND THE PROPOSED EXIST. SEPTIC TANK 45 D' BOX 12' LEACHING LEACHING FACILITY: ASSESSORS MAP 110 PARCEL 1-6 FACILITY **INSTALLER SHALL CONFIRM MINIMUM SEPTIC 12. EXISTING LEACHING FACILITY SHALL BE PUMPED AND TANK SIZE AT 1000 GALLONS AND ITS SUITABILITY REMOVED OR PUMPED AND FILLED WITH CLEAN SAND. FOR RE-USE. REPLACE WITH 1500 GALLON a SEPTIC TANK APPROPRIATE TO SITE CONDITIONS IF NOT SUITABLE a � _ 4U v � ^N O U g TEST HOLE LOGS 80 \ ENGINEER: CRAIG J. FERRARI, SE #13871 WITNESS: DONALD DESMIARAIS o 424 ,�o o b o DATE: 6/22/2020 o is %ftj 87 / \ o PERC. RATE _ < 2 MIN/INCH VL Q Q gs `„° 2 CLASS I SOILS P# 20-1 12 I � N PAVED 00 ELEV. ELEV. DRIVE- — o„ 4 76' O„ 76' Q I D A A a LS LS --------- 10YR 3/3 10YR 3/3 60 co �6 7S BENCHMARK: B B \ ALL UTILITIES •6 E` DECK CORNER - \ OUT FRONT . =83.6' NAVD88 LS 1 LS / / \ CP I / 28„ 10YR 5/6 73.7' „ 10YR 5/6 32 73.3, \ / \ EXISTING DWELILIN DECK C C \ PORCH Cb PERC MS MS 82 a 2.5Y 7/4 2.5Y 7/4 s 132" 65' 132„ 65' • � a \ � 2)0 �:- H2 TH1 \ \ _ NO GROUNDWATER ENCOUNTERED 3�0 9 ,6 TITLE 5 SITE PLAN �� � 1 �" OF 7 6 LOT 35 - _ �° ^�/\7 35,645 S.F. 209 PERCIVAL DRIVE WEST BARNSTABLE, MA I� PREPARED FOR 0 BORTOLOTTI CONSTRUCTION/ D GREENBERG DATE: JUNE 26, 2020 Scale: 1"= 20' � s�H OF Mq OF M ��,P Sqp� �o o DANIELA. GJ 0 10 20 30 40 50 FEET DANIEL ��� o OJAA. CIVIL LA , OJALA " No.46502 No.40980 w P lt, o �� off 508-362-4541 � 0- G/STERN��`� fax 508-362-9880 �q�pESs\.4 FSSIONAL ECG I downcope.com scum down c111100e engineefiag, inc. C civil engineers fland surveyors 2���0 l 939 Main Street Rte 6A DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02675 LICE #20- >28 20-128 BORTOLOTTI-GREENBERG.DWG I