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HomeMy WebLinkAbout0080 PIONEER PATH - Health 80 Pioneer Path, A=128-004-003 r I 4� I 1 _ 1 F A k �1I l 1 9 � 1 A r No. 4210 1/3 BLU r Q e � ESSELTE r 10% o �. TOWN OF BARNSTABLE LOCATION �� r?(O AMC- ?Alta SEWAGE # VILLAGE ( f-.C-f 136141+46� ASSESSOR'S MAP & LOT�a� INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY r 1CM0 f LEACHING FACILITY: (type) 1 rl t'1 1�� 61 s (size) t 'I NO.OF BEDROOMS BUILDER OR OWNER AS 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 0 wcll r.. „ q3 113 - a3 TOWN OF BARNSTABLE Q L CATIO ® • SEWAGE# U L VILLAGE (,,I), ` et11-0, ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY (�C LEACHING FACILITY:(type) �02-�60&d C.a p,(size) 1 IT :k, w-r- lr' NO.OF BEDROOMS OWNER PERMIT DATE: , JJCOMPLIANCE DATE: 0- - (� Separation Distance Between the: i 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) ` 14-1�16 Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY "O �/ ct��9�' Ll } _ - s 4 No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ftpl.tation for.Bisposal ,6pstent Construction Permit Application for a Permit to Construct Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Q~® / Owner's Name,Address,and Tel.No. Assessor's Map/Parcel W - 't ^�1" �(� c Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size tsq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures �y Design Flow(min.required) gpd Design flow provided gpd Plan. Date Number of sheets 4-/ Revision Date Title Size of Septic Tank A10- Type of S.A.S. cde2 Description of Soil pZ O 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 Health. Signed Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. ®( Date Issued �C ,".-,J•.:.!'�.�:.3k.. .-c.:kr.,.r,rx..bw.ti„r+'„+F-.�'v'Yn•-.,-M-3-r•r,,,,�,a�„,. .. .. .. `n. s a .7y+71'..1:,...f*eti.'YJY++'�'an,,jl "4'L.,,^ -rR" '�.�,i,���-`�,."�..f'"M'-*h._•,+'r`,?�.R,f,..�...,.zd��•rr^'•"it'"`"„".,".,"e-�, P.l,.�,J r,,, �„ � �cl �, �.._.-...mow-�- •' 1 Fee No. THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION TOWN.OF BARNSTABLE, MASSACHUSETTS Yes 2pplication for Di8 osr&*pstrm Construrtion Permit Application for a Permit to Constructy Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or.Lot No V o �1 G Owner's Name,Address,and Tel.No. c v Assessor's Map/Parcel � K -,{�-��-I" •�GlG1� tO� Installer's Name,;Address,and Tel.No. Designer's Name,Address,and Tel.No. l 1440, u �!!�8 (_ f Type of Building: Dwelling No.of Bedrooms *. _ Lot Size Sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures , Design Flow(min.required) • 0 gpd _Design flow provided ~` gpd Plan Date ,i�./ (�Q Number of sheets Revision Date Title f Size of Septic Tank Type of S.A.S. Y,:75: JT—j 6,gKj Description of Soil ti Nature of Repairs or Alterations(Answer when applicable) t ' s i'9�p;•9+n Date last inspected: Agreement: The undersigned agrees to ensure the construe,t 6n 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 Health: -7 Signed �" rkA� / �. YV Date ! 1f "l >_ 1 ,�.I •;_ ApphcahonA -pprovedby - ,; a Application Disapproved by 7T—) Date for the following reasons ' f Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS ' BARNSTABLE,MASSACHUSETTS Certifirate of Compiia Ur THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed IN, Repaired( ) Upgraded( ) Abandoned( )by at .- . has been constructed in actor ance with the pro isionsofTitle5an the for Disposal System Construction Permit No.oZd/V -;9L/dated Installer 9/� Designer #bedrooms Approved design flow �j �j (/ gpd The issuance of this permit shall not be construed as a guarantee that the system will function, designed.. Date �� `3 �) Inspector - No. - - - - - - - - - - - Fee - � ��� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal Opstem Construction permit Permission is hereby granted to Construct Repair( ) Upgrade( ) Abandon( ) System located at a .4 yf-e-o is 4, 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. _ . Date � � Approved by-::..- • y, i Town of Barnstable Regulatory Services Richard V. Scali, Interim Director BAMSrAMM Aft �� Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form I , Date: `S 16 Sewage Permit# Assessor's Map\Parcel '140,3 Designer: st/�q S C, Installer: OAjj"w l Address: P 0 P3UX -t Address:CA �1,01>4 j LAIs JAAAA- On was issued a permit to install a (date) (installer) t septic system at � j � "� ' based on a design drawn by �_k- S � (address) dated `Q -- .(designer)—- •. _ 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. v I certify that the system referenced above was constructed in compliance with the terms of the IAA approval letters(if applicable) AOF' RREN (I r ler's 'gnatur 140 � � 1 (Designers Signature' \ (Affix ere) \O PLEASE RETURN TO B ' STABLE PUBLIC HEALTH DI ON. CERTIFICATE OF COMPLIANCE WIL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. QASeptic\Designer Certification Form Rev 8-14-13.doc Town of Barnstable P#_ 151i-(oi ' Department of RegWatory Services Z-1 Ly' Public Health Division Date 6- 14- z0 t e ° MAMA. r ab3p 200 Main Street,Hyannis MA 02601 r rEn taKt►, 110 _ > Date Scheduled- k�A Time Fee Pd._ joops "r? -t. C) Sail Suitahility Assessment for Se e Disposal ' Performed-By: �� G/YCs Witnessed By. / LOCATION&.GENERAL JINX ORMA.TIOIX Location Address E�Y_)P0'1WEK F61rii Owner's Name6�4e� �Lri�4u� W.t3 rR B l � ��.o 'it 1 ,w • Address i Fi�CC�- Assessor's Map/Parcel'` tZ 4i -00 4- du 3 Enginoer's Name C�A S cps NEW CONSTRUCTION REPAIR X Telephone fk StNe S21 _ r.vU Land Use '7�R-�F� St�E I aS . �tJ �- �Z oU Gv� Slopes(96) Surface Stones Distances firom: Open Water Body _$ Possible Wet•Area ' ft Drinking Water Well /0 ft Dmlhngc Wav�2 Ov ft Property Line _ GO ft Other ft SKETCH: name,dimensions of lot,exact locations of test holes&pore tests,locate wetlands-In proximity to holes) ' I_6T I' t A4,Z325v i �' ► �,oL , Parent material(geologic) +/ Eli Depth to 0edrook l�_ 1 Depth to Groundwater. Standing Water io Hole: ��' Woepltig to Pit Pnea �✓v^� Estimated Seasonal High Groundwater e 3 DETERIVIINATION FOR SEASONALHIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: in, Depth to soil mottles: Depth to weeping from side of obs.hole: hL aroundwntdr Adjuetmdnt�.._._. Index Weil-er�_ Reading Dato:�� Index Welt IgVol Adj4aetor ` Adj.Groundwater-Level, ,Z (3 ' PERCOLATION TEST //, Observation Hole fi 7— Time at 4" Depth of Pero L"� Time at 6" t Start Pro-soak Time @ Time(9"-6") L `� End Pro-soak �•j t t 3y Rate Mih./Inch . Site Suitabillty Assessment: Si to Passed Sit-Failed: Additional Testing Needed(Y/N) Original: Pubic Health Division Observation Hole Data To Be Completed on Back-------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Conse>}vation Division at least one (1)week prior to beginning. Q:\S EPTIGIPBRCFORM.DOC DEEP-OBSERVATION HOLE LOG Hole# Z_ Depth from Salt Horizon Soil Texture Shcl Color Soil• Other Surface(In.) (USDA) (Munsell) Mottling (Structure,Stonei;Boulders. Consistency,%'Oravei) — ZO sy s1/1 ?� 1 DEEP OBSERVATION HOLE LOG Hole# Z— Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(In.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistemy,%Orayell z s d TV/a A-V A e.0 //,,eC( DEEP OBSERVATION HOLE LOG Hole,# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.. Consistency, DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Solt Color Soil Other Surface(In.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. consistency. i I7ood Insurance Rate Man: Above 500 year Mood boundary No— Yes Within 500 year boundary No= Yes Within 100 year flood boundary No.-,— YEs Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious mtiterlal exist in all areas observed thrpughout the area proposed for the soil absorptibn system? Y# If not,what is the depth of naturally occurring pe lous material?"— Certificat'an er I certify that on g (date)I have passed the soil evaluator examination approved by the Department of Lnvironmental Protection and that the above analysis was performed by me consistent with . the required training, a Use an a rig Ca described in 10 CMR 15.017. Signature Datt: QASBPTICXRRCPORM.DOC r DEED RESTRICTION WHEREAS, (owners name) of (address) MA is the owner of�Q�61ne�2� ( �iSt- I�cc..vr►�f�,�, (address) located at , MA (hereinafter referred to as and in&s ow a Ala entitled � �; MA, Pro e o r-�lc�co.�-t v��...�►,�;,a;� �l� f� "0F� hoc /�ve. et al, dul' recorded i � of Y n Barnstable County Registry Deeds in Plan Book �' CLo 1 , Page Or on Land Court Plan Number WHEREAS, 'L i Y) as the owner of said lot has "T(ownela name) , agreed with the Town ofmstable Board o ealth to a restriction as to the number of bedrooms which can be included in any home built on said lot as a e . pre-condition to obtaining a disposal works construction permit in compliances# > with 310 CMR 15.000 State Environmental Code, Title V, Minimum ` Requirements for the Subsurface Disposal of Sanitary Sewage; WHEREAS, the Town of Barnstable Board of Health, as a pre-condition to granting a disposal works construction permit for a septic system in compliance with 310 CMR 15.200, State Environmental Code, Title V, Minimum _ Requirements for the Subsurface Disposal of Sanitary Sewage, and authorizing the issuance of a building permit for the construction of a single family home on this property, is requiring that the agreement for the restriction on the number of bedrooms in any house constructed on the lot be put on record with the Barnstable County Registry of Deeds by recording this document, dwdr a NOW, THEREFORE, ( 7n C. I�e( oes hereby place the (owner s name) following restriction on his above-referenced land in accordance with his agreement.w h the a. ^h '^ 1�r,shalt run with the land and be binding upon all.successors in title: .G�;.���. 61�r t'6 i (address) may have constructed upon the lot a h se ontaining no more than fi i. r .. � (3) bedrooms. L agrees that this shall be-permanent deed (owner's name) restriction affecting located on MA, and being shown on the plan recorded in Plan Book� , Paged Or on Land Court Plan For title of. see the following deed: Book i'?64_ , page 'Or Land Court Certificate of Title Number Executed as a sealed instrument O'H' day of J—AS Own r signat r l Owner's signature Owner's signature COMMONWEALTH OF MASSACHUSETTS ss v — -j0VU (O, . 20A �tpANI� �hh Then personally ap eared the above-named known to me to be the person who execute the foregoing i tr ,�# acknowled ed .• the same to be '�•'� ~p�j �Gf' t free act and deed, before me, �L-61 �. Public Notary My commi sion expire: (date) dear ENVIROTECHLABORATORMS,INC MA CERT.NO.:M-MA 063 8Jan Sebastian Dr-Unit#12 RECEIVE® Sandwich, MA 02563 908(888-6460) 1-800 339-6460 FAX(508)888-6446 BAR 2 2 ?pp4 TOwEACTH pEpTASLE CLIENT: Eric Bright LOCATION: 80 Pioneer Path ADDRESS: 80 Pioneer Path W Barnstable MA 02668 W Barnstable MA 02668 COLLECTED BY: Meehan Well Drilling SAMPLE DATE: 3/15/2004 SAMPLE TIME: WA WATER SAMPLE TYPE: New Replacement Well DATE RECEIVED: 3/15/2004 LAB I.D. M 0403198 WELL SPECS.: 92'71 w RESULTS OF ANALYSIS: Parameters Units Recommended Results Method Date Analyzed Limits Coliform bacteria /100ml 0 0 9222 B 3/15/2004 pH pH units 6.5-8.5 ,6.25 4500 H+ 3/15/2004 Conductance umhos/cm 500 169 120.1 3/15/2004 Nitrate-N mg/L 10.0 3.49 300.0 3/15/2004 Nitrite-N mg/L 1.00 < 0.004 300.0 3/15/2004 Sodium mg/L 20.0 14.1 200.7 3/16/2004 S Iron mg/L 0.3 < 0.1 200.7 3/16/2004 Manganese mg/L 0.05 < 0.008 200.7 3/16/2004 COMMENTS: pH is below recommended limit and may have corrosive characteristics.- WATER MEETS EPA STANDARDS AND IS SUITABLE FOR DRINKING PURPOSES FOR PARAMETERS TESTED. ND= None Detected. <=less than >=greater than TNTC=too numerous to count Date 1 1-1 Y PdbJ. Sa Laboratory ctor No.='�-d=--e1 ' --dC�G?� Fee--- `f-^r---------- BOARD OF HEALTH TOWN OF BARNSTABLE i Zippiicat ion for Well Com5truct ion Permit Application is hereby made for a permij to Construct ( ), Alter ( ), or Repair ( )an individual Well at: - - - -- -------- -- --------- Location — Address Assessors Map and Parcel c Owner Address -------------_l- = - -��° sf�d/F . Installer — Driller Address Type o�welling --- - -— - ---------ter - ypeof Building---------------- - No. of Persons----------------------------- Type of Well—•t � ---— Ca acit 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. Si ed - — --—------ - — - /d --- . Application Approved B — ---- ----—— /� --- date Application Disapproved for the following reasons:---------- - - —--— - ---—---- date Permit No. 01 date------- Issued-- — {1att - —--------------- BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( ) by------- -- `-- - - f`-- '!� --- lle - -- - - -- --- - ---------- 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 SATISFACTORY. DATE- ---- -- --- -- Inspector----—-- -- __ ----- ---- No.�.�-- � Fee---�_---------- ` BOARD OF HEALTH TOWN OF BARNSTABLE ZppCitation fur Well Confitruction3permit Application is hereby made`for a peimit to Construct ( ), Alter ( ), or Repair ( )an individual Well at: 4111 ------------------------- - - — -------- ----- — ---- Location — Address Assessors Map and Parcel Owner Address Installer — Driller Address Type of Building /Dwellings --- — -- — —- -— ( 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. da e -_ Application Approved By-- --— --—— date Application Disapproved for the following reasons: ----------------- -------- --- ------------ - -- -------------------------------------- --- date Permit No. Issued / /� --- ---- �t date BOARD OF HEALTH TOWN OF BARNSTABLE �ertifitate ®f �Com�[iance ' THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( ) by------ ---------------------------------------------------------- ---- Installer at ... INit�S �__/"�I -------- 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 SATISFACTORY. DATE-------- — —- — Inspector-- ---- - =- --------- BOARD OF HEALTH TOWN OF BARNSTABLE Well Con5tructionVermit No. �=� 7C) Fee Permission is hereby granted ���'`�� - /� ���i/�f — -- ------— to Construct ( ), Alter ( ), or Repair ( ) an Individual Well at: Street as shown on the application for a Well Construction Permit oc No.--��C�A`� -r — — Dated-- —��__- -------------------- —-- -------------------------- Board of Health DATE— — _r ____ ENVIROTECHI.ABORATORIES,INC. MA CERT.NO.:M-MA 063 449 Rte.130 Sandwich, MA 0250 5�7 908(888-6460) 1-800 339-6460 FAX(908)888-6446 i CLIENT. Steve Binder LOCATION: 55 Pioneer Path ADDRESS: 55 Pioneer Path W Barnstable MA 02668 W Barnstable MA 02668 COLLECTED BY. Meehan Wells SAMPLE DATE: 10/5/2000 SAMPLE TIME. N/A WATER SAMPLE TYPE. New Well Replacement DATE RECEIVED: 10/5/2000 LAB I.D. #. 0010069 WELL SPECS.: 95, RESULTS OF ANALYSIS: Parameters Units Recommended Results Method Date Analyzed Limits Coliform bacteria /100ml 0 0 9222 B 10/5/2000 pH pH units 6.5-8.5 6.02 4500 H+ 10/5/2000 Conductance umhos/cm 500 117 120.1 10/5/2000 Nitrate-N mg/L 10.0 1.04 300.0 10/5/2000 Nitrite-N mg/L 1.00 < 0.003 300.0 10/5/2000 Sodium mg/L 28.0 13.2 200.7 10/6/2000 Iron mg/L 0.3 < 6.005 200.7 10/6/2000 Manganese mg/L 0.05 < 0.001 200.7 10/6/2000 COMMENTS: pH is below recommended limit and may have corrosive characteristics. WATER MEETS EPA STANDARDS AND IS SUITABLE FOR DRINKING PURPOSES FOR PARAMETERS TESTED. <=less than t Date y/11 k d >=greater than Ronald J. S ri TNTC=too numerous to count Laboratory ctor ^ 1 p - `\�R�}71�11� .:. �+, 1 »,. 4 ,,8 -.< !fit" 'Sra:•. �`1R f i�` �3 r' ENVIROTECH LABORATox 449 Route 130 Sandwich, MA 02563 • (508) 888-6460 _ CLIENT: '' ' G LOCATION: ADDRESS: 15 Pioneer Path W. Barnstable,MA 8/28/90 TIME: 6 PM COLLECTED BY: Meehan SAMPLE DATE: ET 420 c: DATE RECEIVED: 8 29 90 SAMPLE ID: Mpg #: New Well WELL DEPTH: 115 ft RESULTS OF ANALYSIS: 3 c z`= Parameter Units Recommended limit Result 0 0 Coliform bacteria/100 ml (MF Method) _ p H pH units 6.0-8.5 5.72 Conductance umhos/cm 500 106 Sodium mg/L 20.0 14.8 10.0 Nitrate-N mg/L 0.03 Iron mg/L 0.3 <0.05 Manganese mg/L 0.05 _ 500 c: Hardness mg/L as CaCO 3 Sulfate mg/L 250 mL g/ 20.0 Potassium w 200 Alkalinity mg/L ; : Chloride mg/L 250 Turbidity NTU 5.0 APC units 15.0 Color =x c Background bacteria ; COMMENT: c. c DRINKING PURPOSES FOR PARAMETERS TESTED. YES No WATER IS SUITABLE FOR c XUX O � DATE r �P - ll111lllli iillitilltilUli!!1!lilliUliiit flt!lltii!!l11UtillUll!!llitUl!llulilllEutt!llliti!!!lluti!!:i!!t!!tt!lllfltil:!!t!l1t41!!I!!i!!I!!!!l11i1'! lawliltl ,lt!!!!!uu!liill;!!!luluu+ftlUitittltllillllilil!!!l1►1 r1l-�"� �® MA Cert. No.: M-MA 063 �� U� Q 449 Rte.130 Sandwich, MA 02563 (508) 888-6460 1800-339-6460 FAX(508) 888-6446 CLIENT: John Britton LOCATION: Lot 8 ADDRESS: Jenkins Lane W. Barnstable, MA COLLECTED BY: L. Wile SAMPLE DATE: 8-26-97 SAMPLE TIME: 12:OOPM WATER SAMPLE TYPE: New Well DATE RECEIVED: 8-26-97 LAB I.D.#: 978467 WELL SPECS.: 4" PVC, 125750', 20GPM RESULTS OF ANALYSIS: Parameters Units Recommended Results Method Limits Coliform bacteria /100ml 0 0 9222 B pH pH units 6.5-8.5 7.28 4500 H+ Conductance umhos/cm 500 151 120.1 Sodium mg/L 28.0 16.2 200.7 Nitrate-N/Nitrite-N mg/L 10.0 0.05 4500-NO3 E Iron mg/L 0.3 0.08 200.7 Manganese mg/L 0.05 0.007 200.7 Hardness(as CaCO3) mg/L 500 11.9 200.7 Sulfate mg/L 250 1.4 . 375.4 Potassium mg/L 20.0 0.9 200.7 Alkalinity mg/L 200 12.4 2320 B Chloride mg/L 250 15.2 4500-CI L Turbidity NTU 5.0 7.0 2130 B Color APC units 15.0 10.0 2120 B Magnesium mg/L N/A 1.3 200.7 Calcium mg/L N/A 2.6 200.7 Volatile Organics ug/L See attached report. None Detected. 502.2 YES WATER IS SUITABLE FOR DRINKING PURPOSES FOR PARAMETERS TESTED. I Date �/ S--n— Ron d J. Saari Laboratory Dire or <=less than >=greater than TNTC=too numerous to count COMMONWEALTH OF MASSACHUSETTS A EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS tRE �VE0 DEPARTMENT OF ENVIRONMENTAL PROTECTIO ' ONE WINTER STREET, BOSTON MA 02108 (617)292-5500 A UG 2 6 1999 , %0 &q QggHsrAA, TMo� TRUDY CORE, � Secretary' ARGEO PAUL CELLUCO ADD B�STi Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 80 Pioneer Path, West Barnstable,MA Name of Owner: Kathy Askew Address of Owner:Same Date of Inspection: August 20, 1999 Name of Inspector: (Please Print) James M.Ford I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) Company Name: James M. Ford Mailing Address: P.O. Box 49, Osterville, MA 02655-0049 Telephone Number: (508)862-9400 Map.128 Parcel:004 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system- ✓ Passes Conditionally Pass Needs Further Ev at n By the Local Approving Authority _ Fails Inspector's Signature: Date: August 22. 1999 The System Inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thiry(30)days of completingthis ins inspection. If the system is a shared system or has a design flow of 10,000 Pce� Y Y gn gpd or greater,the inspector and the system owner shall submit the.report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. NOTES AND COMMENTS revised 9/2/98 Page Iof11 Printed on Recycled Paper + ) t+! SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A ER C TIFICATION (continued) Property Address:: "80 Pioneer Path, West Barnstable, MA Owner: K ithy Askew Date of Insp;ecttiiom, August 20, 1999 INSPECTION SUMMARY: Check A, B, C, or D. A. SYSTEM .PASSES: ✓ I have n t 0 found an information which indicates that an of the failure conditions described in 310 CMR 15.303 exist. An Y Y failure Y criteria not evaluated are indicated below. COMMENTS: B. SYSTEM CONDITIONALLY PASSES: One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair,as approved by the Board of Health,will pass. Indi cate to yes,no,or not determined(Y,N,or ND). Describe basis of determination in all instances. If not determined",explain.why not. The septic tank i metal unless the wn i s o e or operator has provided the system inspector with a co of a Certificate of P Pe P Y Pce PY Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank,whether or not metal, is cracked, structurally unsound,shows substantial infiltration or exfiltration,or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken,settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health) broken pipes)are replaced obstruction is removed distribution box is levelled or replaced The system required pumping'more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed f F revised 9/2/98 Page2of11, SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 80 Pioneer Path, West Barnstable, AM Owner: Kathy Askew Date of Inspection: August 20, 1999 C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303(1)(b) THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone 1 of a public water supply well. _ The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER revised 9/2/98 Page 3of11 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 80 Pioneer Path, West Barnstable, MA Owner: Kathy Askew Date of Inspection: August 20, 1999 D. SYSTEM FAILS: You must indicate either"Yes"or"No"as to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than 1h day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s)- Number of times pumped Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion.of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone 1 of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If:the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria, volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E. LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"as to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply _ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further information. revised 9/2/98 Page 4ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 80 Pioneer Path, West Barnstable, MA Owner: Kathy Askew Date of Inspection: August 20, 1999 Check if the following have been done: You must indicate either"Yes"or"No"as to each of the following: Yes No ✓ _ Pumping information was provided by the owner,occupant,or Board of Health. ✓ _ None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. ✓ _ As built plans have been obtained and examined. Note if they are not available with N/A. ✓ The facility or dwelling was inspected for signs of sewage back-up. ✓ _ The system does not receive non-sanitary or industrial waste flow. ✓ _ The site was inspected for signs of breakout. ✓ _ All system components,excluding the Soil Absorption System,have been located on the site. ✓ _ The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for conditions of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: ✓ Existing information. For example,Plan at B.O.H. ✓ _ Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) [15.302(3)(b)]. ✓ _ The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of SubSurface Disposal Systems. revised 9/2/98 Page 5of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: W Pioneer Path, West Barnstable,MA Owner: Kathy Askew ' Date of Inspection: August 20, 1999 FLOW CONDITIONS RESIDENTIAL: Design flow: 110 g.p.d./bedroom. Number of bedrooms(design): n/a Number of bedrooms(actual): 2 Total DESIGN flow n/a Number of current residents: 2 Garbage grinder(yes or no): No Laundry(separate system)(yes or no): No ; If yes, separate inspection required Laundry system inspected(yes or no): NO Seasonal use(yes or no): No Water meter readings,if available(last two yearg;usage(gpd): Private well Sump Pump(yes or no): No Last date of occupancy: Currently occupied COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow: god(Based on 15.203) Basis of design flow Grease trap present: (yes or no) Industrial Waste Holding Tank present: (yes or no). Non-sanitary waste discharged to the Title 5 system: (yes or no) Water meter readings,if available: Last date of occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: Never Dump - per er owner System pumped as part of inspection(yes or no): No If yes, volume pumped: gallons Reason for pumping: TYPE OF SYSTEM ✓ Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool — Privy Shared system(yes or no) (if yes,attach previous inspection records, if any) I/A Technology etc. Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components,date installed(if known)and source of information: Added infiltrators on 6124197-per as built card Sewage odors detected when arriving at the site: (yes or no) No revised 9/2/98 Page 6of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 80 Pioneer Path, West Barnstable, MA Owner: Kathy Askew Date of Inspection: August 20, 1999 BUILDING SEWER: _ (Locate on site plan) Depth below grade: Material of construction: _cast iron _40 PVC _other(explain) Distance from private water supply well or suction line Diameter Comments: (condition of joints, venting,evidence of leakage,etc.) SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 12" Material of construction: ✓concrete _metal _Fiberglass _Polyethylene _other(explain) If tank is metal,list age_ Is age confirmed by Certificate of Compliance_(Yes/No) Dimensions: 8'6" x 4'10" x S'11000Qal.) Sludge depth: I" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: I" Distance from top of scum to top of outlet tee or baffle: 8" Distance from bottom of scum to bottom of outlet tee or baffle: 12" How dimensions were determined: Measuring stick Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage,etc.) The tees were Present. The liquid level was even with the outlet invert GREASE TRAP: None (locate on site plan) Depth below grade: Material:of construction: _concrete _metal _Fiberglass _Polyethylene _other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage,etc.) revised 9/2/98 Page 7of11 - 1 r S SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 80 Pioneer Path, West Barnstable,AM Owner: Kathy Askew Date of Inspection: August 20, 1999 TIGHT OR HOLDING TANK: None (Tank must be pumped prior to,or at time,of inspection) (locate on site plan) Depth below grade: Material of construction: _concrete _metal _Fiberglass _Polyethylene _other(explain) Dimensions: Capacity: gallons Design flow: gallons/day Alarm present: Alarm level: Alarm in working order: Yes_ No_ Date of previous pumping: Comments: (condition of inlet tee,condition of alarm and float switches, etc.) DISTRIBUTION BOX: ✓ (locate on site plan) liquid Depth of level above outlet invert: Even P Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) The D-box was level and there were no signs of failure PUMP CHAMBER: None (locate on site plan) r Pumps in working order: (Yes or No) Alarms in working order: (Yes or No) Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) revised 9/2/98 Page 8of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 80 Pioneer Path, West Barnstable, MA Owner: Kathy Askew Date of Inspection: August 20, 1999 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan, if possible;excavation not required, location may be approximated by non-intrusive methods) If not located,explain: Type: leaching pits,number: leaching chambers,number: leaching galleries,number: leaching trenches,number, length:4-infiltrators(per as built card) leaching fields,number,dimensions: overflow cesspool, number: Alternative.system: Name of Technology: Comments: (note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.) The Infiltrators were not dux up.No sign of failure in D-box CESSPOOLS: None (locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: inflow(cesspool must be pumped as part of inspection) Comments: (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.) PRIVY: None (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.) revised 9/2/98 Page 9of11 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 80 Pioneer Path, West Barnstable, MA Owner: Kathy Askew Date of Inspection: August 20, 1999 Map:""12_8�� Parcea�.w SKETCH OF SEWAGE DISPOSAL SYSTEM: O ill ELL include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) 3 1 ' V� ' �3 1 q i- a3, 3 i31 p (, Aa - AC)' A� - 3a ` . r33 - a3 revised -9/2/98 Page 10ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ' SYSTEM INFORMATION (continued) Property Address: 80 Pioneer Path, West Barnstable,AM Owner: Kathy Askew Date of Inspection: August 20, 1999 NRCS Report name Soil Type Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth:Shallow Moderate Deep SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to Groundwater Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observed Site(Abutting property,observation hole,basement sump etc.) Determined from local conditions Checked with local Board of Health Checked FEMA Maps Checked pumping records Check local excavators,installers ✓ Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) Using the Barnstable Topographic Map and the Cape Cod Commission Water Contours Map, the maps were showing approximately 90' +/- to groundwater at this site. This report has been prepared and the system inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied, relating to the system, the inspection and/or this report. revised 9/2/98 Page 11of11 no 00 6 L-_ COMMONWEALTH OF MASSACHUSETTS A� ;�7 EXECUTIVE OFFICE OF ENVIRONMEN AF Fffi.RS DEPARTMENT OF ENWIRONMENT ]b RQ�ECTION � ' ONE WINTER STREET. BOSTO'�. 1\tA 0_1108 61 : -9 •S�V►ON c jgg7 lOWlu `N VdILL1.4�t F.V1'ELD \� TRUDY CO e Secretaq Govemo- � I ARGEO PAUL CELLUCCI DAVID B.STRUHS Lt.Govcmor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissioner PART A �1 l CERTIFICATION Property Addressi�� V '�w � J `u� ��`(J — Address of Owner:::�2.-�- � Date of Inspection: Ajwv+.V- l6 3/q (If different) Name of Inspector: n I am a DEP approved system inspector pursuant to Section 15 40 of Title 5 (310 CMR 15.000) Company Name: �;�; 7� 7#1 LX4 �E Mailing Address: n/3 or '� IY P S"d 7 Telephone Number: CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: 7 _ Passes Cor,drt ona!Iv Passes / L _ ',eed� Further Eva:uat, ^ B� the Local Approving Au;hont} 1 IY l Inspector's Signature• Date: The S\,stem Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: A] SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: B] SYSTEM CONDITIONALLY PASSES: One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not. _ The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tank was installed within twenty (20) years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked,.structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 04/25/97) Page 1 of 10 DEP on the Worid Wide Wet) http:lnvww.magnet.state.ma.us/dep 0 Printed on Recyded Paper P - , SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Proparty Address: © ,`� ,� ,ems` ceL&�� ►'��V - Owner. Date of Inspection: t . BJ SYSTEM CONDITIONALLY PASSES (continued! ✓nor breakout Sewage backup,or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due'to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). Describe observations: broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed Cl FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privv is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone 1 of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER (revised 04/25/97) Page 2 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: Owner: ���� Date of nspection: 04�'/0 3 f y �-- Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes No _ Pumping information was provided by the owner, occupant, or Board of Health. None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. _ As built plans have been obtained and examined. Note if they are not available with N/A. _ The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow. The site was inspected for signs of breakout. _ All system components, excluding the Soil Absorption System, have been located on the site. •. _ The septic tank manholes were uncovered, opened. and the interior of the septic tank was inspected for condition of baffles or tees, material o: construction, dimensions, depth of liquid, depth of sludge, depth of scum. —The size and location of the Soil Absorption System on the site has been determined based on: The facility owner (and occupants. if different from ciwnen were provided with information on the proper maintenance of Sub-Surface Disposal System. _ Existing information. Ex. Plan at B.O.H. _ Determined in the field {if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) [15.302(3)fb)) (revised 04/25/97) Page 4 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued)�� Property Address: ( �; , p�� ��� �� - w` 'Owner: -:I—. /\Jc>V-I -t,,� Date of Inspection: D] SYSTEM FAILS: You must indicate either "Yes" or "No" as to each of the following: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. _ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipets). Number of times pumped _. Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. An,.., portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. And portion of a cesspoo! or pricy is within a Zone I of a public well. Any portion•, of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: You must indicate either "Yes" or "No" as to each of the following. The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to public heaith and safety and the environment because one or more of the following conditions exist: Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water,supply the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area- IWPA) or a mapped Zone 11 of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 04/25/97) Page 3 of 10 J' n SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION �,, �• Property Address: �r w a�n �cc �`�- i J��• �" Owner: &D 0 Date of Inspection: FLOW CONDITIONS RESIDENTIAL: Design flow: 3JQ R.p.dJbedroom for S.A.S. Number of bedrooms:A2?- Number of current residents:!3 Garbage g,::der (yes or no):_ Laundry co-rected to system (yes or no):�i {� Seasonal use tyes or no):A Water meter readings, if available (last two (21 year usage (gpd): Sump Pump (yes or no):�O Last date of occupancy ( COMMERCI.AUINDUSTRIAL: Type of establishment: Design flow: gallons/day Grease trap present: Ives or no'_ Industrial Waste Holding Tank present: (yes or no)_ Non-sanitary waste discharged to the Title S system: (yes or no:'_ beater meter readings, if available Last pate or o cupanc% OTHER: (Describe Last date of occuoancv GENERAL INFORMATION PUMPING RECORDS and source of information.: Shnairi, pbm&cl, ICM System pumped as part of inspection: (yes or no) fop If yes, volume pumped: eallons Reason for pumping TYPE OF SYSTEM _� Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) VA Technology etc. Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed (if known) and source of information: Iyy►P1. Sewage odors detected when arriving at the site: (yes or no) (revised 04/25/97) Page 5 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: - ��- Owner: J—, Date of Inspection: a�/p 3 /� BUILDING SEWER: � (Locate on site plan) Depth below grade: Material of construction: _cast iron _40 PVC _other (explain) Distance from private water supply well or suction lire Diameter Comments: (condition of joints, venting, evidence of leakage, etc.) SEPTIC TANK: ' Lb (locate on site plan, Depth below grade:�M Material of construction: 1%concrete _metal _Fiberglass _Polyethylene _other(explain) If tank is metal, list age _ Is age confirmed by Certificate of Compliance _(Yes/No: Dimensions 1006!!�Al Sludge depth: 0" rj Distance from top of sludge to bottom of outlet tee or baffle: 37 m thickness: w Scum O 1( Distance from top of scum to top of outlet tee or baffler_ Distance from bottom of scum to bottom of outlet tee or barfie:�� How dimensions were determined: K'^UdPA Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, eva ce of leakage, etc.) b r"de vZ W t- GREASE TRAP:�{� (locate on site plan) Depth below grade: Material of construction: _concrete _metal _Fiberglass _Polyethylene _other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) (revised 04/25/97) Page 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner:�� Date of Inspection: SOIL ABSORPTION SYSTEM (SA ): (locate on site plan, if possible; excav tior. not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number:_t1Lk leaching chambers, number: leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions. overflow cesspool, number: Alternative system: Name of Technologv: Comments: inote condition of soil, signs of hydraulic failure, level of ponding, c ndition i etation, etc.) �.\ s✓ \ Tb T CESSPOOLS: NO (locate on site plan; Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth'of scum laver: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow (cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY:�u (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (revised 04/25/97) Page 8 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C (� SYSTEM INFORMATION (continued) Property Address-6-00 o u<G� �c�V(,� - LAD Owner: -;�- . 10a V- y4-k< Date of Inspection:01C TIGHT OR HOLDING TANK: /JJ (7ank must be pumped prior to, or at time, of inspection) (locate on site plan) Depth below grade: Material of construction: _concrete _metal _Fiberglass _Polyethylene —other(explain) Dimensions: Capacm gallons Design flow: gallonvda� Alarm level. Alarm in v.-orking order _ Yes; _ No Date of previous pumping Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:-�{S (locate on site plan: !! Depth of liquid level above outiet invert: tJli►W��'K.� Comments: (note if level and di tributior, is equal, evidence of s lids carryover, evidence of leakage into or out of box, etc.) t v uw 1: up PUMP CHAMBER: N� (locate on site plan) Pumps in working order: (Yes or No) Alarms in working order (Yes or No) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 04/25/97) Page 7 of 10 r •I , SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: LO lea r� Owner: V, 14, Date of Inspection: . dV6-10 -3 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) O a ► L 3 ' + t . VOL N- 3Z' isS- 3Z f�4 37 6" (revised 04/2S/97) Page 9 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:-O ���;.._20�•—�c� _ �� i.�� Owner: Date of Inspection: Depth to Groundwater aMFeet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observation of Site (Abutting property, observation hole, basement sump etc.) Determine it from local conditions " Check with local Board of health Check FEMA Maps Check pumping records Check local excavators, installers Use USGS Data r .. Describe in your own words how you established the High Groundwater Elevation. Must be completed) USC?S Su2v,.� b dw�o�o��c, $�vear�5�R�vJ , t�, f�. L,�i?) (raviiad 04;25/97) Page 10 of 10 7 TOWN OF BARNSTABLE LOCH ION �3O � °r ID ��- SEWAGE # 2 — ,� 1� VILLAGE W ` � ASSESSOR'S MAP & LOT/a'1 do 4.GO'131 INSTALLER'S NAME&PHONE NO. —L K- Ct r t SEPTIC.TANK CAPACITY LEACHING FACILITY: (type) �y��1`:Ttr U25 (size) Ak NO.OF..BEDROOMS BUILDER OR OWNER I�— T;77 PERMIT DATE: /� a.y — COMPLIANCE DATE: a — Separation Distance Between the: Feet Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Private.Water Supply Well Leaching Facility (If any wells exist Feet on site or within 200 feet of leaching facility) Edge of.Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility) Furnished'by 13 S A 1123 .20 TOWN OF BARNSTABLE LOCATION 0 We e' 2 4T i SEWAGE # — �!,LLAGE ASSESSOR'S MAP &LOTJ -6eti.d INSTALLER'S NAME&PHONE NO. .4. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) Wit+- (size) ?z NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE:� COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 .J 1 1 a q 3 l ,12- �3 3� �, 03 No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE,, MASSACHUSETTS 01ppYication for Mi5poga1 *p5tem Construction Permit Application for a Permit to Construct( )Repair grade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 90 P i Q lve'W 'P lqFFT Owner's Name,Address and Tel.No. Assessor's Map/Parcel n r coq 00 L�� �`►�. „ Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms �J Lot Size sq. ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 73-3D gallons per day. Calculated daily flow �� gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank 1060 Type of S.A.S. 12) "NCc.125- t s Description of Soil tN` sla,_n Nature of Repairs or Alterations(Answer when applicable) N ih criL►� '1 �L �1TU 12S ei.1 o i S Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Boar Signed Date D y Application Approved by Date Application Disapproved for the following reasons _ Permit No. -��2- Date Issued `t r r .. ' No.q-7 ��2_ Fee ��� 1 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: i Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 2pprication for Migpoof *patent Construction Permit Application for a Permit to Construct( )Repair grade( )Abandon( ) ❑Complete System ❑Individual Components a Location Address or Lot No. O Q 9 i U �'CE'tr P W'T Owner's Name,Address and Tel.No. 2 Assessor'sMap/Parcel - 003 � i Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. iG» /` S Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.A` Garbage Grinder( ) Other Type of Building No.of Persons Showers yp g ( Cafeteria( ) Other Fixtures i Design Flow 3 gallons per day. Calculated daily flow 3 �1 gallons. r Plan Date Number of sheets Revision Date s Title { Size of Septic Tank �l�`r S1 Y`• UOO Type of S.A.S. t4 ,2) �N C1'-12G t `I E Description of`Soilso .SIA� t ^ Nature of Repairs or Alterations(Answer when applicable) t" _5Tf'9 ` G =�-- Jam` aX >R-(t h e e i i .ter. OYLS �y f. t Date°last inspected: I )` ' \, Agreement: The undersigned agrees to ensure the consti ut;tfon and to nten mce of)thee afore described on-site sewage disposal system } in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- `. Cate of Compliance has been issued b this ar of lfih Signed .- Date t I Application Approved by Date Application isapproved for the following reasons r Permit No. �2 Date Issued y `�► } i THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,�jat the O Sewage Disposal System Constructed( )Repaired ( )Upgraded Abandoned( )by oc �.- at go \ e✓c" ��� CSC -e.l has been consiruc ed in accordan e with the provis'. s of Title 5 an for Di os 1 System Construction Permit No. ✓ dated Installer Designer i The issuance of thi permit shall not be construed as a guarantee that the system will function as designed. Date - �i Inspector { No.�� f -----------------------------Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS ` Mi.5pont *pztem Cott'Otruction Permit f Permission is hereby granted to Construct( )Repair Upgrade( )Abandon( ) System located at c7 O V��ev WT l� Lkj f , and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. i Provided:CCons cti/oJn must be completed within three years of the date of this Date: [� Z.7 Approved by i i E. i t NOTICE: This Form is to be used for the Repair of Failed Septic Systems Only p Y t CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL , WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS) 1 � _hereby certify that the application for disposal works construction permit signed by me dated concerning the property located at Fto Zx0,e,-, V t-Ty l4- meets all of the following criteria: • There are no wetlands within 300 feet of the proposed septic system JThere are no private wells within 150 feet of the proposed septic system ✓• The observed groundwater table is 14 feet or greater below the bottom of the leaching facility / There is no increase in flow and/or change in use proposed • There are no variances requested or needed. SIGNED : DATE: LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER" [Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. 51 �--e v r i 1 7 i TOWN OF BARNSTABLE G � _(D�Pee�r� SEWAGE # C� ���6 �VILLAGH__La&5TASSESSOR'S MAP Cz I.0T _ c5o (`SEPTIC TANK_ CAPACITY 07rV fGf U ,,qq LEACIIING FACILITY:(tgpe) �,'� �h P% T (size:) l 0 0 �� vNO. OF BEDROOMS IVATE EL OR PUBLIC WATER BUILDER OR OWNER reenjgf'iek DATE PERMIT ISSUED: lollihm DATE COLIYLIANC:E ISSUED VARIANCE GRANTED: Yes No __ _ � "° `� ' � - t is 1 � n L®'� � �- � r THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH Y° 'J... ..... ......OF........5..4, ...... ......----------------------...._.........-------------- Appliration for Uhipvii al Works Tnnitrartiun .umit Application is hereby made for a Permit to Construct (x ) or Repair ( ) an Individual Sewage Disposal System at: IjAe.as:ogl.f Locati Addres or Lot No. -567C $—/0 C E AJ tf.0 ---•--—�—!�--------------•--------------•----•----- ..........----------- ........ J- jr. �rZ l SCp;L Owr}gr Sow Address •xz -------...---- ........ Instal ler Address y� ��� Type of Building Size Lot._:_._. ________..........Sq. felt U Dwelling—No. of Bedrooms.___________J___________________________Expansion Attic (NV Garbage Grinder ( ) '4 Other—T e of Building No. of persons---------_------------------ Showers — Cafeteria a' Other fixtu s •-----•-•-----•-•-•-•-•-•--•-•--•--•-•••••••-•-........ W Design Flow______________SS______________________gallons per person per day. Total daily flow.............. .3 6...................... Gd Septic Tank—Liquid'capacity_._.________gallons Length................ Width................ Diameter................ Depth................ 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., ) c -a 89 W Percolation Test Results Performed by.__C_____ __________________________________ Date_.____/.___.�/_.?V_ ............ 4 Test 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........................ W •-•-•-••-•------------------•--••----••------•------•--- Description of Soil------ ........................................................ W ------------------------------------------•--.--.-..----------------------------------•-•---------------------------------------------------.......................................................... U Nature of Repairs or Alterations—Answer when applicable_______________________________________________________________________________________________ ---------------------------------------------------•--------------------•--•-•------------------------------...-------------------------------------------------.............. ...................... Agreement: The undersigned agrees to install the aforedescribed IndividuLgd Disposal System in accordance with �'t T/•1T^ the provisions of i T t LE of the State Sanitary de— The un erer agrees not to place the system in operation until a Certificate of Compliance has been sued by the oa . Signed--••--- ----------'---- ----- •-....-----•---- �� ��Date Application Approved By.-••-•-=•-•-`-�.-'..� ate Application Disapproved for the f ollozOing reasons:--------•••• -------•---------•--------•------------- .......................................... •-•--•-•----••-•--------------------•--_____-•-•--------_____-•-------•-•--------------------------- -------------------------------------------------------•- Permit No.. --^ � Issued--------------••--- Date.... I�Ste iYi_li 'Y No.d.11'.•• = �= , ._. Fps.� ` ...... ` THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH � ............... ........OF.................. .................................................................... Appfiration for Ui"aa al Works Cnoaa uurtion "rraaait Application is hereby made for a Permit to Construct (s: ) or Repair ( } an Individual Sewage Disposal System at _61`+ _..._ 1 - ... .A;_...... __ .._.. .._..... _ ...._ _...._._. .�._•-_..._-••_____...k t" ... Location'-Address it or t '�o. t Ct k ✓ ( � 0 _6cx } tI f r[r V[C ( ......................_.... .. �....:. -- .... Owner Address W j. J 6, 8 ,i{fy{ hItf Installer Address d Type of Building Size Lot-_ 4....�'. .................Sq. feet Dwelling—No. of Bedrooms............. ...........................Expansion Attic (Ai Garbage Grinder ( ) Other—T e of Building ............................ No. of persons............................ Showers — Cafeteria Q' Other fixtures es -----------------------------=.......................................................................................................................... W Design Flow...............5'�?.___.._...............gallons per person per day. Total daily flow............................................gallons. C4 Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Percolation Test Resr"t �Other Distribution box ( ) Dosing tank �, �-' Results Performed by-•. � �, Date-- ,.� Test Pit No. 1__ ..___.....minutes per inch Depth of Test Pit--- .............. Depth to ground water.--_.'4/............... Gi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water..__--__--_-____..-__--. R'+ --------•- •---•---••---- ...----.•--- .......................................................... O Description of Soil.......I!�4 .��:��' `".`.``� !ni-._-__.---��'"-� ' �'�� - -- x - V ---••----------------•-------•-----------..._.......................................................................................................................................................... W Z. -------------------------------------------------------------------------------------------------•----•------•••--------••-•--....------------------------•------------•-----•----------............... U Nature of Repairs or Alterations—Answer when applicable----------------------------•--................................................................ ................................•....--------------------•----•--------------------................-•--...------------------------•--------•--•------•--•------------------•-----•-----................ Agreement: The undersigned agrees to install the,aforedescribed Individual wage Disposal System in accordance with the provisions of .L:Lb 5 of the State Sanitary C de—The undersig!fd further agrees not to place the system in operation until a Certificate of Compliance has been issued by the oar 01 healtli. Signed ^ +; r ...... m.... .. w Dates. . .. ...... .............................. `r .....APPlication Approved BY � / Date. Application Disapproved for the following reasons:._.._ -. . .............•-----•-----.....-----------....------•-•-------------------...-•••-------........----•----•.._....._...........•---••••---------•-----------•--•---•---••-----------------•------....... _ Date Permit No. _'- ----------- -- --•-- Issued ti:.t.. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....................' .................OF.........:........................................................................... M.F. rr#ifiratr ,af f�� t li�aatre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( Y) or-Repaired ( } by.......... ........ ---•- ---•••-- --•--... .....----••--------------•-----------•-.........-•-•------------------------•-------•-•---•------•---•---•-----..._•---._ Installer at........ 'eI -_ ---_-4-- ..._ ......e C �.4..w..s... fi..r_......_{..............................._.._.....____...........__...._ has been installed in accordance with the provisions of T I T E 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated-............................................... THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. � DATE........ .r'''4.. '*` -........................ Inspecto aid' �° ° -� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 3G .......................................OF..... ......... ......... ............................................... o NO.. ... .......k'✓._. - Dispuml Varkii V6111nstrudivit rr�ttt# Permission is hereby granted............41.4n' 4�se.x S C n c 0- It .S 4' � ......•. ------------•-----•...... ...................................... to Construct ( .;) or Repair ( ) an Indivld al Sewage Disposal System # at No •1-�- 4 � € � ----- --------------------- ----.. ..... ------------. •---_.-•--•-•-•---- Street % , I as shown on the application for Disposal Works Construction Permit .�ated.._.ZOO' ,.`../fd,�- �, t Board of Health DATE..------�_.l , !�'�' � '- -- - a FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS - Log Number: Bottle # BC592 g Date: Sept 25, 1989 } $AR'e's� BARNSTABLE COUNTY HEALTH AND ENVIRONMENTAL DEPARTMENT 2 SUPERIOR COURT HOUSE VBARNSTABLE, MASSACHUSETTS 02630 o • Asa DRINKING WATER LABORATORY ANALYSIS PHONE: 362-2811 Ext. 337 Client: Green Briar Dev. Corp. Collector: Sean O'Brien Mailing Address.: P. 0. Box 510 Affiliation. other Centerville, MA 02632 Time & Date of Collection: 9120189 2$301) m _ Telephone: Type of Supply: well _^ Sample Location: Lot 1 Pioneer Path Well Depth: A9, W. Barnstable, MA Date of Analysis: 9/21/89 11.10_a m PARAMETER SAMPLE RESULT RECOMMENDED LIMITS Total Coliform Bacteria/100 ml 0 f 0 H 6.2 Conductivity (micromhos/cm) 129 500.0 _ Iron ( m) 0.4 ' 0.3 Nitrate-Nitro en ( m) 1,8 10.0 Sodium ( m) 17 20.0 I . Water sample meets the recommended limits for drinking of all above tested parameters . II . XX Based only on results of the parameters tested for this sample, the 'water is. suitable. for drinking but may present the problems checked below: A. Water .sample has higher, than average levels of Nitrate. Future monitoring is' ' recommended (2-3 times per year) to establish any upward trends. ' B. The low pH of the water may shorten the useful life of the house's plumbing._ C. X Water may present aesthetic problems (taste., odor, staining) due to iron 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 is unfit for human consumption: -A„ High Bacteria B• ,, High Nitrates i REMARKS: The Barnstable County Health and Environmental Department shall not endorse any statements, interpretations or co nclusions made by anyone else concerning these results without written consent, CC: Barnstable Board of Health CC: DEQE Laboratory Director 117185 Explanation of Test Results Total Coliform Bacteria Coliform bacteria are an indicator of the sanitary quality of a water supply. Water supplies may become contaminated from malfunctioning septic systems, cesspools and surface runoff. A total coliform count of zero indicates that your water supply is safe and approved for human consumption. A total coliform count of greater than zero is most often the result of accidental contamination of the sample bottle through improper sampling methods. For this reason, it would be advisable to retest any well water that is not approved. 'pH. - pH is the measure of acidity or alkalinityof the water. On the pH scale,the number 7 is neutral,less than 7 is acidic and more than 7 is alkaline. The pH of water on 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 solution. Amounts in excess of 500 micromhos/cm are generally considered unacceptable and may have a•laxative effect upon'users. Iron The presence of iron in water in concentration of:3 ppm or greater may: give the water a bittersweet astringent taste, cause ati unpleasant odor, often gives the water a brownish 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 considered deleterious to health. Iron may be removed by use of an iron removal system. Nitrate-nitrogen - { The Massachusetts Drinking Water Regulations have set a maximum contaminant level,for`nitrates at 10 ppm. Excessive concentrations may cause methemoglobinemia (an 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 A concentration of sodium over 20 ppm is only of concern to people who are on a low sodium diet. If the water supply has more than 20 ppm sodium, it is up to the people who are on 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 indicate that there maybe ocean v✓ater'or 'road salt runoff water getting into the well. 13ARNSUBLE COUNTY HEALTH AND ENVIRONMENTAL DEPARTMENT SUPERIOR COURT HOUSE ' p �/ BARtIS1AEILE, hIASSACIiUSETTS 02630 v )t1A 55 PHONE: 362-2511 EXT. 330 VOLATILE ORGANIC COI(POUNDS REPORT LAB 337 ------ - ------ --- -- CLINIC 340 Client: Greenbrier Development Collector: S. O'Brien Mailing Address: P. 0. Box 510 Type of Supply: private well Centerville, MA 02632 Date Collected: 9/20/89 Telephone: - Date Received: 9 20 89 Sample Location: Lot I Pioneer Path Analyst: S. Williams W. Barnstable, MA Date Analyzed: 9/21/89 LOCAT I OII E298 COMPOUND Lot 1 Pioneer Path W. Barnstable,MA Chloroform 10 'Methylene Chloride 0.5 Dichlorobromomethane .0.2 cc Barnstable Board of 'ea►th All values are in micrograms per liter (equivalent to parts per billion, or ppb) . EPA Method 502.1 was used and only those compounds listed above were detected. Attached is a list of chemicals which the method is capable of detecting. Detection limits for these compounds are stated on the attachment. Chloroform is commonly found in Cape Cod groundwater at levels ranging from 0.2 to several ppb. The drinking water limit for Total Trihalomethanes , of which chloroform is an example; is 100 ppb. THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I M ^C&L DATA No. BOARD OF HEALTH - TOWWOF BARNSTABLE } galI1b�lrHttQttrflrr �.UCtlOt� <'. Department of tnviroh. ental Management/Drvision of Wafer Aesou�ces ert�ttt t r. WATER WELL COMPLETION REPORT W � ) or Repair P ( )an in Well at: WELL LOCATION �/� GEOGRAPHIC DESCRIPTION` �� `� �^ i'r y< `f _(__ Addressor �'• wniCe/ !Z Assessors Map and Parcel 07 N S E W of i� r i Ckty/TOvunQS�p. T /r:,CTG "�0 1K fte`rl �/cylrclel Address U r l/o', eft �4l R. �'.X � G r'✓ ;` �; wrn Welt owner N zY .r©EJe� r�P.�7~_; (road). -,��__ rr �r !_o�P Address ~ Address�s(( Po S E W of Board of Health permit yes no rnterSct w/ lO� /rn8d/r o. of Persons-_�_�__ --- WELL USE " WELL DATA - --_-__---_- Domestic r [�PufjltcD Industrial ❑ Tota[•�uv�U depth �✓� ' ft ^� _____-�� Monitorihq© OtFier�� Depth to bedrock Water bearing rock/unconsolidated material: Met�todidrilka?d Dateditttid", 5 Descfrption (1-tf� .l���e� s4tic� t S —77-7— — ell in accordance with the provisions'of The Ci4SING water bearing zones �5 ion = The undersigned further agrees not to T e Sc [ ► From To yP Eo u C issued by the Board of Health. r 2 From.7-77 : To tength �� ft D a l k D) _in 76 Length into'bedrock, ft Graver,pack well dia date Protective welt seal.; Screen dia ; 1 Grout 1r OtheF. S1;ot length_`Lfrom�o r h4 It + SfUc water level below land surface, 1 ft Date _— Drawdownftt after Pe �9 flu ,*rr�ir� atT ,gib date Hove m2a uled RecQu� #tf e Chr� tr�� 5„ n+, ,�/ :i� s 5,55 ` ,.,��, Xs`•� kK ihs date { �`�a+-54t1` 1 7 t 'Yjr M i i�'s b i. th LOf o Fyt:8l1 DOlafSt � iCON"T.,-S��� r TABLE� + Jv t s i��9Y ° " iry� Djs SAY # r � ibi86i� k ,Drtt�eis �e�,l ,6 r w tiTt��r�t*w�'Saf%xf'��•' h � i r �' '. tared ( )r or Repaired( ) �...�lx t J• .t•5r c r a �4 � r _ .'" `�a``a a"j r'�x. s ,� �y ��r 4�Y4b �"�,,,,� _'__----- - table Board of Health Private Well P otection � f•�-73'�3'"v L¢'��-4' a8�.y : iR"�,} y Y� '�-"c�'ia '��.F '� ,§`�" `' ..+ fl� , � { it NoAM Ey q�f��'y e9 DAte - 47 /PDs,RaArinC Ilm„Y''t+ �' ^ �, sr i, s t � � 1, • n;,w xo- ,� xt. .' t a7:%�' P `` ?k� -, "''tt•', ' �"' � 'y�� TPT A C A I—T T w n—.1......,. s COUNTY HEALTH AND ENVIRONMENTAL DEPARTMEN STABLE QC" Pa�� RIO plop 0 03 SUPEF210R COUR-fr"HOUSE /2 S^0 0 BARNST'ABLE. MASSACHUSETTS 02630 VPHONE: 362-2St 1 DRINKING WATER LABORATORY ANALYSIS AS_ Ext. 337 Client: Green Briar Dev. Corp. Collector: Sean O'Brien Affiliation; other Mailing Address;: P,. O. Box 510 Time & Date of Centerville, MA 0262 Collection: A��n/89 2• �n n m Type of Supply: well Telephone: Well Depth: �9' ---- Sample Location: Lot I pioneer Path__ Date of Analysis: W. Barnstable MQ SAMPLE RESULT RECOMMENDED LIMITS PARAMETER 0 Total Coliform Bacteria/l00 m1 0 6.2 H 500.0 129 Conductivit (micromhos/cm 0.3 0.4 Iron ( m) 10.0 1.8 Nitrate-Nitro en ( m 20.0 7 Sodium ng of all above tested parame' Water sample meets the recommended limits for drinki I_ p Based only on results of the parameters tested for this sample, the water is II . XX B but may present the pr suitable.,.fpr drinking m 1e has higher. than average levels of Nitrate trends,iu monitoring �s A. Water ,sa p recommended (2-3 times per year) to establis any up Hof the water may shorten the useful life of the house's plumbi►�y. i B. The low p Water,may present aesthetic problems (taste, odor, .staining) due to iron .. high levels of sodium. Persons on low- sodium diets should D. _Water sample has g consult their doctor. III. Due to one or more of the reasons checked below, this wateratesple is unfit for .human cons urnption: A,. High Bacteria B. High The Barnstable County Hea t an Environments REMARKS: Department shall not endorse any statements, interpretations or conclusions made by anyone Its without written conse else concerning these_resu �at. CC: Barnstable Board of Health CC: DEQE Laboratory Director 4 V7/Or, ►',ram �'"9 - � ---- Fee---- -------- BOARD OF HEALTH TOWN OF BARNSTABLE 2[pplitation-*rVeri Con5truttionpermit Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair ( - an individual Well at: Location — Address Assessors Map and Parcel Owner � Address I / t t e - Installer — Driller Address Type of Building Dwelling Other - Type of`Building-------------------------------------- No. of Persons-------------------------------------------------------- Type of Well Capacity- - - - Purpose of Well— }S�. i � - - — 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. a---------- --- - -- ----------- date Application Approved By---------------- -- -±--,- -= ----------------------- ------ - date Application Disapproved for the following reasons:----—---------------------------------------------------------------—-------------------------------- -------------------------------------------------------------------------------------------------------------------------------------- date Permit No.- ,- --------------—------------------ Issued----------------------------------------------- -------------------------------------- date i BOARD OF HEALTH TOWN OF BARNSTABLE C ertif itatr ®f Comphante THIS IS TO CERTIFY, That the Individual Well Constructed k),.Altered ( ), or Repaired ( ) Ins er at----------- ---------- --------------------------------------------------- has been installed in accord nice 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. — `'--1 --Dated----------------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE---------------------------------------------------------------------------------------- Inspector---------------------------------------------------------------------------------- ry - No.-----:------- ,o--- _ _ Fee------- -- ------- BOARD OF HEALTH " TOWN OF BARNSTABLE Zipplication forlVerr Con5tructionPermit Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair ( u)an individual Well at: v — — — — ----------------------------- — Location — Address--t— Assessors Map and Parcel J/ i�T�c_c'.nbr< e_ r cL,v. o r (1 U Qa v /t✓ t --I r✓ Ue� �� c�.�G 32 - —— --- -- ---6 — — — —— —r — - — ,-- -- — - t�r Owner i j t A^�ddress 1 )j � y /_!/.sM. -r t - -'�-M------;-r--"i=±�-L'--------- -----d_`a__✓fl_/�.__&.)Oi-�---- - l"e5 , '`J t'� .{'L. i'1;^C.� '{ "u.�•.�/'4/' -- - -- — — — ` Installer Driller ) Address Type of Building ' Dwelling Other - Type of Building ---------- No. of Persons---------------------------------------------------- Type of Well-- -!�`Q^^--' —{ - -- - ----- ---- Capacity Purpose of Well ----------------------------------- t 4 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. Sign d - 9f -I �--- —---- date ` Application Approved By --------------------- ----— "—da te '- Application Disapproved for the following reasons:----------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------- date Permit No. -- '' --I's --------- Issued------------------------------------------------------------------------------------- ------------------------ date BOARD OF HEALTH r1 TAW TOWN OF BARNSTABLE � � -ic-nFre, Certificate ®f Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ), Altered ( ), or Repaired ( ) . by--------------- ------- - - - 4 - .--------------------------------------------------------------------------------------------------------- Installer at----------- 8 - - has been installed in accord ce 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 SATISFACTORY. DATE------------------------------------ -------------------------------------- Inspector---------------------------------------------------------------------------------- BOARD OF HEALTH TOWN' OF BARNSTABLE VrIl Con5truct ion Permit No. --- -- -�-=-� Fee---��--- ---- Permission is herebyranted----------- !!-" 4'--------� ---------����— —�=� ---------------------------- g i to Construct ( Alter ( ), or Repair ( ) an Individual Well at: 77 .� l t.. a— ------------------------------------------- - - Street as shown on the application for a Well Construction Permit �/ No.-- - - Dated - - 9 -- 9-~D `------------------------------------- -----------------------------------�� i =-------------------------------------- B`o�rd of Health DATE-------------------------------------------------------------------------------------- BARNSTABLE COUNTY HEALTH AND ENVIRONMENTAL DEPARTMENT SUPERIOR COURT HOUSE ©ARHSiABLE. ►,1ASSACHUSETTS 02630 �1q 5S% PHONE: 362-2� EXT. 330 VOL AT 11.E ORGANIC C01WOUNDS REPORT LAS 337 - --- - - --- ------ CLIUIC 340 Client: Greenbrier Development Collector: S. O'Brien Mailing Address: P. 0. Box 510 Type of Supply: private well Centerville, MA 02632 Date Collected: 9/20/89 Telephoner Date Received: 9 9 Sample Location: Lot I Pioneer a Analyst: S. Williams W. Barnstable , MA Date Analyzed: 9/21/89 LOCATIOII E298 COMPOUND Lot: 1 Pioneer Path W. Barnstable,MA Chloroform 10 'Methylene Chloride 0.5 Dichlorobromomethane 0.2 cc Barnstable Board of 'ealth All values are in micrograms per liter (equivalent to parts per billion, or ppb) . EPA Method 502.1 was used and only those compounds listed above were detected. Attached is a list of chemicals which the method is capable of detecting . Detection limits for these compounds are stated on the attachment. Chloroform is commonly found in Cape Cod groundwater at levels ranging from 0.2 to several ppb. The drinking water limit for Total Trihalomethanes , of which chloroform is an example , is .100 ppb. 1t r� BARNSTABLE COUNTY IIEALTI I AND ENVIRONMENTAL DEPARTMENT �p SUPERIOR COURT HOUSE BARNSTABLE. MASSACHUSETTS 02630 PHONE: 362-2 EXT.*330 VOLATILE ORGANIC COl1POUNDS REPORT LAB 337 - ------- - -------- - -- CLINIC 340 Client: Greenbriar Development Collector: S. O'Brien Flail ing Address: P. 0. Box 510 Type of Supply: private well en ervi e, MA 02632-- Date Collected: 9/20/89 Telephone : Date Received: 9/20/89 Sample Location: Lot 14 Pioneer Path Analyst: S. Williams W. Barnstable, MA Date Analyzed: 9/21/89 L OCAT I O11 E299 COMPOUND Lot 14 Pioneer Pat W. Banrstable,MA - Chloroform 240 Trichloroethene 0.3 Dichlorobromomethane 0.5 Barnstable Board of Health All values are in micrograms per liter (equivalent to parts per billion, or ppb) . EPA Method 502.1 was used and only those compounds listed above were detected. Attached is a list of chemicals which the method is capable of detecting . Detection limits for these compounds are stated on the attachment. Chloroform is commonly found in Cape Cod groundwater at levels ranging from 0.2 to several ppb. The drinking water limit for Total Trihalomethanes , of which chloroform is an example, is 100 ppb. BARNSTABLE COUNTY HEALTH AND ENVIRONMENTAL DEPARTMENT SUPERIOR COURT HOUSE p BARNSTABLE, MASSACHUSETTS 02630 MA55 C TABLE 1 . Compounds Detectable by EPA Method 502.1* P HONE: 362-2511 EXT. 330 LAB 337 COMPOUND D.L. COMPOUND D.L. CLINIC 340 Benzene 0.5 1 ,1-Dichloroethane 0.5 Carbontetrachloride 0.5 1 ,1-Dichloropropene 0.5 1 ,1-Dichloroethylene 0.5 1 ,3-Dichloropropene 0.5 1 ,2-Dichloroethane 0.5 1 ,2-Dichloropropane 0.5 para Dichlorobenzene 0.5 1 ,3-Dichloropropane 0.5 Trichloroetthylene 0.5 2,2-Dichloropropane 0.5 1 ,1 ,1-Trichloroethane 0.5 Ethylbenzene 0.5 Vinyl Chloride 0.5 Styrene 0.5 Bromobenzene 0.5 1 ,1 ,2-Trichloroethane 0.5 Bromodichloromethane 0.5 1 ,1 ,1 ,2-Tetrachloroethane 0.5 Bromoform 0.5 1 ,1 ,2,2-Tetrachloroethane 0.5 Bromomethane 0.5 Tetrachloroethylene 0.5 Chlorobenzene 0.5 1 ,2,3-Trichloropropane 0.5 Chlorodibromomethane 0.5 Toluene 0.5 Chloroethane 0.5 para Xylene 0.5 Chloroform 0.5 ortho Xylene 0.5 Chloromethane 0.5 meta Xylene 0.5 ortho Chlorotoluene 0.5 Bromochloromethane 0.5 para Chlorotoluene 0.5 - Dichlorodifluoromethane 0.5 Dibromomethane 0.5 Fluorotrichloromethane 0.5 meta Dichlorobenzene 0.5 Hexachlorobutadiene 0.5 ortho Dichlorobenzene 0.5 Isopropylbenzene 0.5 trans-1 ,2 Dichloroethylene 0.5 n-Propylbenzene 0.5 cis-1 ,2 Dichloroethylene 0.5 Sec-butylbenzene 0.5 Dichloromethane 0.5 Tert-butylbenzene 0.5 D.L. is Detection Limit in micrograms per liter or parts per billion (ppb) . This table lists our normal limits of detection. If we report a smaller amount, then our detection limit was lower for that analysis. *A photoionization detector is used in series with the electroconductivity -detector, thus allowing for the analysis of most of the compounds listed in EPA Method 503.1 as well . TABLE 2. Compounds which have Maximum Contaminant Levels (MCLs) set by the Environmental Protection Agency. ,. COMPOUND MCL (in ppb) Benzene 5.0 Carbontetrachloride 5.0 1 ,2-Dichloroethane 5.0 1 ,1-Dichloroethylene 7.0 para Dichlorobenzene 75 1 ,1 ,1-Trichloroethane 200 Trichloroethylene 5.0 Vinyl Chloride 2.0 Total Trihalomethanes 100 Chloroform, Bromodichloromethane, Chlorodibromomethane, and Bromoform comprise the total trihalomethanes. nn t - - _ w:c- - __ PC El 1 _ IM - DID Ll --1— - _F1Z-FJr•ITE.LE�(�CTTUr:a. ---- - - Yr ENGLNCs6tL tv0'i'ES iCD��2I0q . 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EDWARD `'� t 150' TO WELL 40 A , � � too0 CURRENT OWNER JENNIFER & STON�4,� o.�� � i ERIK BRIGHT N .2890 J ftft ftft WWI owl00 to*- PLAN REFERENCE 465-44 / 45 0 /lu1WR� f DEED REFERENCE - \ '/ , E 299.00 �\ p 10 81'5613 I o I DRAINAGE EASEME T ZONING DISTRICT RF / GP 1 I o FLOOD ZONE X I I ( �o / 56�3"jr'W o3.aT / I 65�� I � S 8' ASSESSORS MAP 128 l 44,2331t S F. OP �- — `'� / PARCEL 004-003 ss I I PROP. � �o / IPROPOSEDI VENT f OVERLAY DISTRICT N.BORHOOD WELLS l / o EXISTING —� \ — 58-- — I 13'x25' I S.A.S. TO BE rr-- _� SHED // I LOT AREA 44,231 f S.F. / ABANDONED s / ACCORDANCE WITH / TI TLE 5. �\`60 SI TE & SEWAGE 6b� J / ,' D.T.V� 2\ o REPAIR PLAN � OK SHED ,' /i ��O j//T- ~ D•': #1 \ /- PROPOSED #80 PIONEER Pal TH , � � _= � � , � , � w � ' D-BO� 6 �� / �� ( �65 EXISTING CEN TER VIL L E = 63 s4 C\ 6� I 6 66 GENERATOR IN BARNSTABLE' MASS yr _f ___--r\ EXISTING � I / SEPTIC N K REMAIN DATE: SEPTEMBER 6, 201800 00 I o OWNER/APPLICANT: 6b � // T.o F8071.0 ERIK & JENNIFER BRIGHT ,��� _ �, DECK FF 72.0f 80 PIONEER PATH 68 18-0116 69- 100' TO WELL WEST BARNSTABLE 7- --- 7 70 - _ .4 MA 02668 61 — 9 ♦i SHEET 1 OF 2 6 GARAGE o/ /A% \�3 EXISTING PREPARED BY: N LOCUS 2 4 DRIVEWAY EAS SURVEY INC. P X 1 ,7 2 9 po��< �oN��� 1 ' 41.7 . 0. �a��` Q 0 30 45 60 'Atib, SANDWICH , MA 02563 PH. (508) 888-3619 �� WELL Psi j/ // BENCHMARK CELL (508) 527-3600 GRAPHIC SCALE: 73 NAIL SET LOCUS MAP 1 INCH = 30 FEET `— / / // ELEVATION 67.08 EAS.SURVEY©YAHOO.COM NOT TO SCALE: / 1 SYSTEM DESIGN RAISE COVERS TO WITHIN 6" OF FINISH GRADE TOP OF FOUNDATION CENTER CHAMBER RISER DESIGN FLOW ELEV. 71.0 FINISH GRADE RAISE TO WITHIN 6" VENT 3 BEDROOMS AT 110 GPB D 3-M GPD 70.0 ELEV. 62.7 FINISH GRADE / ELEV. 61.2 OF FINISH GRADE / / ELEV. 61.0 60.0 GROUND ELEVATION •,;_ � //,C�� /� /,�� ///�� ��� \�///\� REQUIRED SEPTIC TANK v: = 5.5' COVER TOP ELEV 55.5 4.5' COVER 330 x_2 _ 660 GAL. 22'CAS= 0.25. EX. SEPTIC TANK PROVIDED = -1.000-GAL. SCH 40 - 4 PVC ��' 4" PVC SCH 40 5'OS= 0.03 O p O p 0 0 o 00000 0 INV.= 2 MIN-3 MAX „ p pp pp o o p pp pp SIZE OF LEACHING FACILITY REQUIRED INV.= EXISTING 60.56 10"TEE 14 TEE INV.= INSTALL 60.36 6„ p p 0 p 0 0 o 0 p 0 p o •+? GAS BAFFLE 3 OUTLET DESIGN PERC RATE _«____MIN./INCH 4'-1" LIQUID LEVEL H-20 D83 TWO 5'-0"x8'-6"x3'-O" H-20 CHAMBERS LONG TERM APPL. RATE-9•�4_GPD/S.F. INV.=54.85 S.A.S. (13.0' x 25.0') > d o SIZE OF LEACHING SYSTEM PROVIDED: TEE REQ' INV.=54.65 a 52.5 DATUM: o e e INV.=54.5 't o 330 _ 46 0.74 SF/GPD = 4 S.F. MIN. REQ. VERTICAL DATUM: EXISTING 1,000 GALLON ELEV. 47.6 USING H-20 CONCRETE LEACHING CHAMBERS PRIOR SITE PLAN PRECAST CONCRETE SEPTIC WITH 4' OF STONE ALL AROUND BENCH MARK USED: TANK TO REMAIN TOP OF FOUNDATION BOTTOM (13.0' x 25.0') = 325 S.F. ELEVATION 71.0 CONSTRUCTION NOTES: O 0O 0O o o 00000 SIDE WALL (13.0' + 25.0') 2x2 = 152 S.F 18-0116 00000 o c 00000 477 S.F. 1. CONTRACTORS / INSTALLERS SHALL VERIFY GRADES AND 000 p0 0 0 0 p0 p0 ELEVATIONS AND SITE CONDITIONS PRIOR TO COMMENCING O O O O 477 S.F.x 0.74 G/SF = 353 GPD SITE & SEWAGE WORK ON THE SITE. 353 GPD PROV > 330 GPD REQ. = 23 GPD RES. 2. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE �--- 4.0 5.0 �f--4.0----� REPAIR PLAN WITH DEEDED OR ZONING REGULATIONS. OWNER / APPLICANT NO (GARBAGE DISPOSAL / GRINDER ALLOWED) IS TO OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. 13.0' -I P #15764 , 80 PIONEER PA TH 3. VEHICULAR TRAFFIC, PARKING OF VEHICLES AND PLACING SIDE VIEW MATERIALS OVER THE SEPTIC TANK, DISTRIBUTION BOX AND D.T.H. #1 ib D.T.H. #2 ib CENTER i/ILLE S.A.S. AREA IS PROHIBITED DATE: 8/27/18 DATE: 8/27/18 I CERTIFY THAT I AM CURRENTLY APPROVED BY THE DEPARTMENT OF ENVIRONMENTAL PROTECTION TO CONDUCT GROUND ELEV. 61.0 GROUND ELEV. 60.6 GENERAL NOTES: NO GROUNDWATER NO GROUNDWATER (N 1. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. SOIL EVALUATION ARE AND THAT THE RESULTS A MY SOIL TITLE V AND THE TOWN OF BARNSTABLE RULES AND REGULATIONS EVALUATION ARE CCUR .10 N IN ACCORDANCE WITH 310 FILL FILL B A R N S TA B L E, MASS FOR SUBSURFACE DISPOSAL OF SEWERAGE. CMR 15. UG 5.10 A 20" A 28 2. AT LEAST ONE ACCESS POINT OVER TANK TEES SHALL BE _ LOAMY SAND LOAMY SAND DATE: SEPTEMBER 6, 2018 ACCESSIBLE WITHIN 3" OF FINISH GRADE, WITH ANY REMAINING EDW A STONE, CERTIF11 SOIL EVALUATOR 10YR 5/2 10YR 5/2 „ ACCESS PORTS BROUGHT TO WITHIN 12" OF FINISH GRADE. B 24 B 32 3. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF WITHSTANDING H-10 LOADING UNLESS LOAMY SAND LOAMY SAND OWNER/APPLICANT: OTHERWISE SPECIFIED. 7.5YR 6/6 7.5YR 6/6 E R I K 8C J E N N I FE R BRIGHT 4. THE EXCAVATION CONTRACTOR SHALL VERIFY THE LOCATION • DTH #1 ib INDICATES DEEP 36" 44" OF ALL UTILITIES PRIOR TO ANY EXCAVATION. 't1'� 5 TEST HOLE Cd-1 Cd-1 80 PIONEER PATH 5. ANY MASONRY UNITS USED TO BRING COVERS TO GRADE SILT LOAM SILT LOAM OR WITHIN 6" OF GRADE SHALL BE MORTARED IN PLACE. REN 2.5Y 7/6 2.5Y 7/6 WEST B A R N S TA B LE 6 FOOTFINISHOVERDTHEHALL S.A.SHAVE A AND DISTRIBUTION 0.02 BOX? FEET PER P-1 82" INDICATES TEST EL. = 56.0 60" EL. = 55.2 64" MA 02668 7. SEPTIC TANK SANITARY TEE'S SHALL BE CONSTRUCTED OF 1140 SCHEDULE 40 PVC AND SHALL EXTEND A MINIMUM OF 6" ABOVE 1 p NO MOTTLING THE FLOW LINE AND SHALL BE ON THE CENTERLINE AND �F SHEET 2 OF 2 82" LOCATED DIRECTLY UNDER THE CLEAN OUT MANHOLES. T �� Q NO WEEPING MEDIUM SAND MEDIUM SAND 8. THE INLET PIPE INVERT ELEVATION SHALL BE NO LESS THAN ��AUTAR�A - �( O 2.5Y 7/4 2.5Y 7/4 PREPARED BY: 2 INCHES NOR MORE THAN 3 INCHES ABOVE THE INVERT NO GWATER NO G.WATER ELEVATION OF THE OUTLET PIPE. 156 INDICATES ADJ. GROUNDWATER . 156' 156" E A S SURVEY, INC. 9• THE SEPTIC TANK SHALL HAVE A MINIMUM COVER OF 9 INCHES NO OBS. GROUNDWATER B.L. 48.0 EL. = 47.6 10. THE OUTLET SANITARY TEE SHALL BE EQUIPPED WITH A GAS P. O. B 0 X 1729 11.BAFFLE, 4 INCHES IN DIAMETER AND CONSTRUCTED OF 4 PVC DON DESMARAIS ALL PIPES SHALL BE SCHEDULE 40 PVC SEWER PIPE AND ) SOIL EVALUATOR SHALL BE SLOPED 1/4 INCH PER FOOT MIN. EXCEPT FOR THE ED. STONE SANDWICH , MA 02563 FIRST TWO FEET OUT OF THE DISTRIBUTION BOX WHICH SHALL NO OBSERVED GROUNDWATER BACKHOE OPERATOR. BE LEVEL 12. CHANGES OR REVISIONS TO SEPTIC DESIGN REQUIRE NOTIFICATION DEPTH TO BOTTOM OF HOLE 156" ELLIS BROTHERS PH. (SOB) 888-361 g TO EAS SURVEY INC. FOR B.O.H. AND DESIGN ENGINEERS REVIEW SOIL TYPE: L CELL (508) 527-3600 AND APPROVAL. VARIANCES REQUESTED PERC RATE: 3 MIN.-PER INCH EAS.SURVEY©YAHOO.COM 13. MAGNETIC TAPE ON ALL COMPONENTS. NONE LOADING RATE: 0.74 GALTSF/MIN - - - A A NOTES. 0 INITERCHANGE RD ON 5 B LE - -20' MINIMUM OR AS INDICATED ON PLAN. 1. ALL WORKMANSHIP AND MATERIALS' SHALL CONFORM TO D.E.Q.E. TA , OW F ARNST B E RULES AND LE-'W. BARNS TITLE 5 ; THE TOWN 0 S_ �� �.. R ER�� REGULATIONS >FOR THE SUBSURFACE DISPOSAL OF `SEWAGE; OST WHITE BIRCH WAY' 10' MIN. AND THE 'REQUIREMENTS OF THIS PLAN. icr MINIMUM - PIONEER PATH 2. ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO 64 ,� LOCUS sACICFIu. WITH WITHIN `12 OF FINISHED GRADE. T.O. FOUNDATION ��,d Gs 5•SS CLEAN SA r a MIN. 3. ALL MASONRY UNITS USED TO BRING COVERS TO GRADE c)ODS -� a MASONRY /®E D EX c I ; SHALL BE MORTARED IN 'PLACE. R/ -- 4. ALL COMPONENTS ,OF THE SANITARY SYSTEM SHALL BE CAPABLE \os ITCH 4 SCH. 40 PVC PIPE OF WITHSTANDING H-10. LOADING UNLESS THEY ARE UNDER OR t 4' PER FT. MIN. PITCH 1/8" PER a / { . P AS. H LOADING Q 3 MN - WITHIN 10.FT. 'OF DRIVES OR PARKING ARE 2Q L p 2 LAYER OF (}P FLOW uNE' 8' - 1 _SHALL BE USED UNDER OR WITHIN 10 FT. OF DRIVES OR R cs 0 WASHED STONE PARKING. S Q -1 TEES ARE SPECIFICALLY DISAPPROVED. �3.� 5. CAST IN PLACE CONCRETE E 2 MIN. _ LEVEL �i T TY S WHERE INDICATED ARE REQUIRED. 4 a (02. 3 SANITARY Q 3'!J UQU10 (oZ• 5 3/4 - 1 1/2 � WASHED STONE .' LEVEL F 6. EFFLUENT PIPING FROM DISTRIBUTION BOX SHALL ENTER LEACH PIT DISTRIBUTION GO 0 LOCATION MAP BOX THROUGH SIDEWALL OR TOP ONLY. ENTRANCE THROUGH MASONRY � s4,o J EXTENSION WILL NOT BE ALLOWED. • NO DETERMINATION HAS BEEN, MADE AS TO COMPLIANCE WITH DEED 2 t- E 7 /GOt?GALLON SEPTIC TANK Z1 �° -I- -I �- ,; RESTRICTIONS`OR ZONING REGULATIONS.,OWNER/APPLICANT SHALL L —I �r - OBTAIN SUCH DETERMINATION FROM THE `APPROPRIATE AUTHORITY. SEWAGE DISPOSAL SYSTEM PROFILE t-; ; --} BOTTOM OF TEST HOLE 47 0 $. HORIZONTAL AND .VERTICAL CONTROL, SEE LEVY, ELDREDGE NOT TO SCALE ---` OR USGS PROBABLE 'HIGH WATER LEVEL & WAGNER FIELD :NOTEBOOK #_�57�. / DESIGN CALCULATIONS CURRENT ZONING INTERPRETATION: 6 4 p MIN. FRONT SETBACK 3 FEET 3 � NUMBER OF BEDROOMS _ MIN. SIDE SETBACK 15' FEET GARBAGE DISPOSAL UNIT NONE" TOTAL ESTIMATED FLOW / _ MIN. REAR SETBACK ! S FEET ' � 33O . 62 ( 110 GAL./BR./DAY X 8R.) GAL. /DAY 1 REQUIRED SEPTIC TANK CAPACITY 49 S_tGAL. ACTUAL SIZE OF SEPTIC TANK 10 --GAL. _ LEACHING AREA. REQUIREMENTS 60 SIDEWALL AREA 2.5 GAL./S.F. 1.0 I BOTTOM AREA ___ GAL./S.F PERCOLATION SOIL TEST 552 LEACHING •CAPACITY (BOTTOM + SIDEWALL) _ (GAL. 54 7 Z4L T 3 3, 27� 10 2 2.5 +1T to 2 1.0 SS`4 - / DATE OF SOIL TEST ,� T � / )� ){ ) � , / ) � ) (GAL. LOT T Je Du rJIN RESERVE LEACHING CAPACITY lJ I r , / ' WITNESSED BY 1�R}� 1 G ..: ___ _ �. _ter ._ � / 4 r �.y.:: _ .-. - � Z SAME 66 f 9 / PERCOLATION RATE MIN./INCH 44,232 sq: `fit. O 54 l -- ti i o N OBSERVATION HOLE 2 OBSERVATION HOLE 1 N . 6.0 + i ELEV. 6' __ ELEV. , -- 00 —0.00 _ 4 _ BREAKOUT CALCULATION. St.ot'tr Ec.. Go. o;- cn .. -ro� Su S o i t- , / r _ 4 c)o N x t's _ 2© 5 q c G} 6 M HE 5A � - �.------- / - LEGEND �.4 , some FIrv . \ EXISTING SPOT ELEVATION 00 0 I, X o t r l E --- ;: Q EXISTING CONTOUR 00 �. . r O _ � , �ti 4, _ FINAL SPOT ELEVATION -00.0 • FIN `L CON70UR � / O A ' . fl ,P 47 ii �. NO WATER AT ELEV. _ WATER- AT ELEV.—. - SOIL TEST PIT LOCATION � S TOWN WATER � ' SEPTIC TANK U N � I , , � NLUAM E. DACEY , - WATER LEVEL ADJUSTMENT, � A DISTRIBUTION BOX ❑ 1 I ► , ` PRIMARY LEACHING`PIT O i i � � ► � �., � RESERVE LEACHING PIT R i + q , 't •1 t �' o i / WATER ;LEVEL TEST 'DATE ATE N I ,• 1� 1 i � , � ,, � ,• F• / , INDEX WELL T V RANGE ZONE WATER LEVEL 1 8/Z 3/89 INITIAL ISSUE ELK DEPTH TO WATER LEVEL FOR INDEX WELL NO._ DATE DESCRIPTION BY FOR THIS MONTH WELL WATER LEVEL ADJUSTMENT SITE PLAN 8c SEPTIC. DESIGN =8 .92 so E DEPTH TO HIGH WATER -- LOT 1 PIONEER PATH O IN �` o -F-} ,,- ,-- -�' � = - BARNSTABLE, MASSACUUSETTS r FOR �i ` �H OFM GREENBRIER DEVELOPMENT CO. INC. t6 o PAUL G 70 N j g A, rn' „ , F HEALTH APPROVED. BOARD 0 E � E�Y � SCALE, 1 — 40 J06 Ivor 1120 — 1120 1 cl No.10050 SITE PLAN F� FS LEVY ELDREDGE & WAGNER ASSOCIATES INC. sr nc - DATE AGENT ,�r NL �,= PI�O � SIJQ�. 889 WEST MAIN' STREET CENTERV= MA 02632 NOTES: ��'� INTERCHANGE 5 20• MINIMUM OR AS INDICATED ON PLAN 1. ALL `WORKMANSHIP AND MATERIALS SHALL CONFORM TO 'D.E.Q.E. NS1Ag>vE RD TITLE 5 ; THE TOWN OF BARNSTABLEY__ RULES AND BAR OS-�RVILLE,W. 10• MIN. REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE;. WHITE BIRCH WAY to• MINIMUM AND THE REQUIREMENTS OF THIS PLAN. PIONEER PATH �4.0 2. ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO LOCUS T.O. FOUNDATION CSACKFILL LEAN SAN WITH WITHIN 12" OF FINISHED GRADE. W 8' MIN. lorl•d is7�s 71,o MAsoNRY I 3. ALL `MASONRY UNITS USED TO BRING COVERS TO GRADE WOOL) /�— — SHALL BE MORTARED IN PLACE. DRiV� PITCH 4' SCH. 40 PVC PIPE 4. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL- BE CAPABLE � � 1/4' PER FT. MIN. PITCH 1/8' PER N OF WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR 3 MIN' 2' LAYER OF WITHIN 10 FT. OF DRIVES OR PARKING AREAS. H-20 LOADING FLOW LINE R � 1/8" 1/2" SHALL BE USED UNDER OR WITHIN 10 FT. OF DRIVES OR GE 10" WASHED STONE t c>�P &4.O ~ 63 5 PARKING. pL0 2- MIN, �vel 5. CAST IN PLACE CONCRETE TEES ARE SPECIFICALLY DISAPPROVED. lo3.f3 uQulo GZ.S (a2, 3 SANITARY TY'S WHERE INDICATED ARE REQUIRED. _ LEVEL 3/4' - 1 1/2" DISTRIBUTION 6014 F WASHED STONE ! 6. EFFLUENT PIPING FROM DISTRIBUTION BOX SHALL ENTER LEACH PIT BOX 54,0 f THROUGH SIDEWALL OR TOP ONLY. ENTRANCE THROUGH MASONRY LOCATION MAP W EXTENSION WILL NOT BE ALLOWED. i000GALLON SEPnC TANK I_z1 , : I z �- 7. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEED RESTRICTIONS OR ZONING REGULATIONS. OWNER/APPLICANT SHALL - SEWAGE DISPOSAL SYSTEM PROFILE 1. 10 i OBTAIN SUCH DETERMINATION FROM THE APPROPRIATE AUTHORITY. BOTTOM OF TEST HOLE ' 47,0 NOT TO SCALE — — i 8. HORIZONTAL AND VERTICAL CONTROL, SEE LEVY, ELDREDGE OR USGS PROBABLE HIGH .WATER LEVEL & WAGNER FIELD NOTEBOOK # 257 66 CURRENT ZONING INTERPRETATION: DESIGN CALCULATIONS 64 f MIN. FRONT SETBACK 3o FEET 3 NUMBER OF BEDROOMS MIN. SIDE SETBACK I' FEET GARBAGE DISPOSAL UNIT ivotiJC / I S TOTAL ESTIMATED FLOW 62 2 . MIN. REAR SETBACK FEET ( 110 GAL./BR./DAY X _ BR.) 330 /DAY f / 49 5_GAL. REQUIRED SEPTIC TANK CAPACITY ACTUAL SIZE OF SEPTIC TANK tom GAL. j LEACHING AREA REQUIREMENTS 60 SIDEWALL AREA _2.5 GAL./S.F. PERCOLATION SOIL TEST BOTTOM AREA 1_� GAL./S.F. SSO LEACHING CAPACITY (BOTTOM + SIDEWALL) GAL. , 54% ,�, �� DATE OF SOIL TEST 7 Z4 f 8(l P.-r:A 7313 2TT( to f 2)( � )(2.5) +TT( to /2)2 (1.0) SSO GAL. LOT I ' ,' JE2R DUNn?1 NG RESERVE LEACHING CAPACITY ' WITNESSED BY Y SAME 66 44,232 sq."tt/t � � 299 pp, � � , 54 PERCOLATION RATE � z MIN./INCH '5IZeA �- l ; � 4^ OBSERVATION HOLE 1 OBSERVATION HOLE 2 Gc�t- -- )o�R ,� „ ELEV. ELEV.= /bo /a o.00 o.00 BREAKOUT CALCULATION: SLOPE @ 61- C.O. a = 4/" 0.13 00 TOP wQS01L 2.0' 4 x5 • S N w OD SRD / pro T , LEGEND: � i, \ ��8), _► /� , r SOME p EXISTING SPOT ELEVATION OOXO EXISTING CONTOUR-------00----- 70 FINAL SPOT ELEVATION 00.0 ! FINAL CONTOUR IN� 5. O� _ NO WATER AT ELEV..-4!0 WATER AT ELEV.— LL , TP --- SOIL TEST PIT LOCATION Cc'` `�C..f ,• '� , TOWN WATER W W N/F I 6 SEPTIC TANK L� WILLIAM E. DACEY WATER LEVEL ADJUSTMENT: a DISTRIBUTION eox N i PRIMARY LEACHING PIT 0 Z I , RESERVE LEACHING PIT ' ,�` '� N TEST DATE — WATER LEVEL 40'O. - '` INDEX WELL ' �x WATER LEVEL RANGE ZONE INITIAL ISSUE EcK DEPTH TO WATER LEVEL FOR INDEX WELL N0. DATE DESCRIPTION BY Vb!ELL '0 1-- g '/.�,'�,' ' FOR THIS MONTH WATER LEVEL ADJUSTMENT SITE PLAN & SEPTIC DESIGN L-89.92' )13 DEPTH TO HIGH WATER —" LOT 1 1 PIONEER PATH ' `60 x E O a `/ IN o -44 � _ .� BARNSTABLE, MASSACUUSETTS FOR r GREENBRIER DEVELOPMENT CO. INC. O F M,gss90 70 6 �o� P A U L y� APPROVED: BOARD OF HEALTH `S L A. scALE: �» 40' Jos No. 1120 / 1120-1 SITE PLAN A\ A No.1 5 O Q ss, A a LEVY, ELDREDGE & WAGNER ASSOCIATES INC. DATE AGENT ENGIIIEERS LANDSCAPE ARCFII'fRCTS PLANNERS LAND SUmRS 889 WEST MAIN STREET CENTERV= MA 02632