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HomeMy WebLinkAbout0115 PIONEER PATH - Health d 115 Pioneer Path, A= 128-004-0 05 �r i i f +I �I R f No, 4210 1/3 BLU r Mm ESSELTE 10% p o e o rrt Commonwealth of Massachusetts . Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 115 Pioneer Path Property Address f Dan Carpenter `J1 Owner Owner's Name information is rX required for every W. Barnstable (� MA 02668 9-15-15 page. City/Town State Zip Code Date of Inspection gym;, Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. A. General Information , 1169 1. Inspector: Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name P.O. Box 73 Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S13971 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. 1 am a DEP approved system inspector pursuant to Section 16.340 of Title 5 (310 CMR 16.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Furth r Eval - the Local Approving Authority 9-15-15 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Water levels and stain lines indicate system was operating at about 80-85% of its capacity at one time. Recommend pumping every 2yrs for maintenance and to prolong life of the system. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 115 Pioneer Path Property Address Dan Carpenter Owner Owner's Name information is required for every W. Barnstable MA 02668 9-15-15, page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: System is in good working order with no sign of failure. B) System Conditionally Passes: t _❑ 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. i Check the box for"yes", "no"or"not determined" (Y, N, ND)for'the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 i Commonwealth of Massachusetts Title 5 official. Inspection Form 61 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments IA 115 Pioneer Path Property Address Dan Carpenter Owner Owner's Name information is required for every W. Barnstable MA 02668 9-15-15 page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) f ❑=Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): El broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced Y -N ND (Explain p ❑ ❑ ❑ ( p below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is'Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Tdle 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form ' o Subsurface Sewage Disposal System Form =Not for Voluntary Assessments .° 115 Pioneer Path Property Address Dan Carpenter Owner Owner's Name information is required for every W. Barnstable MA 02668 9-15-15 page. City/Town`- State Zip Code Date of Inspection B. Certification (cost.) 2. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: r . ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water suppl.y,or tributary to a surface water supply. ❑* The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. • ❑ The system has a septic tank and SAS and the.SAS is less than-100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure Criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes"or"No to each of the following for all inspections: Yes No Backup of sewage into,facility or system component due to overloaded or ❑ ® clogged,SAS or cesspool ' f 0 ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ' ❑, ® Liquid depth in cesspool,is less than 6" below invert or available volume is less than Y2 day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 I _� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary•Assessments 115 Pioneer Path Property Address Dan Carpenter Owner Owner's Name information is required for every W. Barnstable MA 02668 9-15-15 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No 3 ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or,privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ®, Any portion of a cesspool or privy is,less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of.custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. i E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to,each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection 'Area— IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form it o Subsurface-Sewage Disposal System Form -Not for Voluntary Assessments - 115 Pioneer Path Property Address Dan Carpenter Owner Owner's Name information is required for every W. Barnstable MA 02668 9-15-15 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No ' >.• ® E• Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the.previous two weeks? Has the system received normal flows in the previous two week period? ❑ ®� Y P Have large volumes of water been introduced to the system recent) or as art of ' ❑ ® g Y Y P this inspection? ® El available as built plans of the system obtained and examined? (If they were not available note as N/A) + -® • ❑ Was the facility or dwelling inspected for signs of sewage back up? . ® -❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth'of liquid, depth of sludge and depth of scum? C,El the facility owner(and occupants if different from owner) provided with ® El information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ' ® ❑ Existing information.'For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): ' 3, Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 I Commonwealth of Massachusetts f Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 115 Pioneer Path Property Address Dan Carpenter Owner Owner's Name information is required for every W. Barnstable MA 02668 9-15-15 page. Cftyfrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection El Yes ® No information in this report.) " Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage Well 9 ( Y 9 (9Pd))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 9-2015 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No . Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts a Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M s•''� 115 Pioneer.Path Property Address Dan Carpenter Owner Owner's Name information is required for every W. Barnstable MA 02668 9-15-15 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) ` Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Owner--pumped 3yrs ago Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Maintenance Type of System: ® Septic tank,distribution box, soil absorption system r ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): ; t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 I Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form =Not for Voluntary Assessments 115 Pioneer Path Property Address Dan Carpenter Owner Owner's Name information is required for every W. Barnstable MA 02668 9-15-15 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Leach pit added in 1996 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): . Depth below grade: 24"feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Good condition. Septic Tank(locate on site plan): 18" Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gal Sludge depth: 12" t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ' M Sve,� 115 Pioneer Path Property Address Dan Carpenter Owner Owner's Name information is required for every W. Barnstable ti. MA 02668 9-15-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) . Septic Tank(cont.) F Distance from top of sludge to bottom of outlet tee or baffle 20" - Scum thickness �. . . 1 Distance from top of scum to top of outlet tee or baffle 6" - Distance from bottom of scum to bottom of outlet tee or baffle 15" How were dimensions determined? Tape Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is in good condition with baffles installed and no sign of leakage. Recommend pumping every 2yrs for maintenance and to prolong life. 4 Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top"of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 I Commonwealth of Massachusetts W Title 5 official Inspection Fora "^ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a 115 Pioneer Path Property Address Dan Carpenter Owner Owner's Name information is required for every W. Barnstable MA 02668 9-15-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection_ Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments s °L 115 Pioneer Path Property Address Dan Carpenter Owner Owner's Name information is required for every W. Barnstable MA 02668 9-15-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Good condition with water at working level and no sign of back-up from pits. Pump Chamber(locate on site plan): - Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments G M , 115 Pioneer Path Property Address Dan Carpenter Owner Owner's Name information is required for every W. Barnstable MA 02668 9-15-15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 2-1000 gal ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number,dimensions: - ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Stain line in new pit was at 24" below top of tank. Inlet invert enters into riser. Recommend pumping every 2 yrs for maintenance and to prolong life. Cesspools(cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form y Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 115 Pioneer Path Property Address Dan Carpenter Owner Owner's Name information is required for every W. Barnstable MA 02668 9-15-15 page, City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding,,condition of vegetation, etc.): f Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3M 3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 115 Pioneer Path Property Address Dan Carpenter Owner Owner's Name information is required for every W. Barnstable MA 02668 9-15-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately a C OF r J - l- CPS ' 7 / 66 i0 �' -37L IS y , r ACC _ t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage.Disposal System Form -Not for Voluntary Assessments M 115 Pioneer Path Property Address Dan Carpenter Owner Owner's Name information is required for every W. Barnstable MA 02668 9-15-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site-Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 20'+ feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health explain: ® Checked with local excavators, installers- (attach documentation) ® Accessed USGS database- explain:- You must describe how you established the high ground water elevation: USGS and town maps show groundwater at greater than 20'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 r Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 115 Pioneer Path Property Address Dan Carpenter Owner Owner's Name information is required for every W. Barnstable MA 02668 9-15-15 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 TOWN C7JF EARN' L.E, r rw► e:, S WAG8# LOCATION;�IL.tAGIE 77 SSESa^C1R°S MAC'&Lo, LNSTALL 'S NAB&Klol+tE Y+& O a AC ] b LV,ACILtNG,1F,A►CMLrrY: (fie) AtO. •3�)wP?R0OM. 1, D UI !DER Oft mwi�t�t... rat.�a�n ,ta<aae 3c�tv� �a sae MAxljttum Acljusterl GR aui�iJwHte�'t'�bie to t{�e 13nitam ol'i.raehtn�l?ncilily w. � �'�� pdiio$o wmck ld Wld Leadhlao adty Cmuy wp19s 6i6t. cn sgtc,ap�v�thir►:�4q feet a�;14aeEuai��ucallly) w�...,.�....�. r�aat. Ed Gm c)fi Wed'aard and Leac6llfg Facility If any Wtei)a)tcis ems iiCg13 fill Q) V.L / C;. M . . �?2 4✓^" �': " r. OD F- 3r D.'7r- -7 7 `5l y TOWN OF BARNSTABLE LOCH I01 1/5 _;9P&eC Qa47 SEWAGE # VIL•LAGiE LkY_/ /-19s1a6le_ ASSES R'S MAP & LOT/9v�1, p05 1 VO P $K41VE&PHONE NO. iocl SEPTIC TANK CAPACITY LEACHING FACILITY: (type) / (size) NO.OF BEDROOMS 3 BUII DER R�R 4Z/'G��c PERMITDATE: 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) k_ Feet. Furnished by i 0 µt� 04 e Ulf c 3�'' TOWN OF BARNSTABLE LOCAfRA W5 ✓alllel l �'2' 441� SEWAGE # V LLAGE ���/"�157 <c� ASSESSOR'S MAP & LOT/�S'•���/�S INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) �"�� �/ NeW (size) ,X/0 NO.OF BEDROOMS 3 BUILDER OR� PERMITDATE: g/z®/1U/ COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility S Feet Private Water Supply Well and Leaching Facility (If any wells exist "" on site or within 200 feet of leaching facility) �'�® � Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet.. Furnished by i a'� �k = � aj�7�q` - - 4 No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS application for Mi!6paal bpotem Construction Permit Application is hereby made for a Permit to Construct( )or Repair( )an On-site Sewage Disposal System at: Location Address or Lot No. I/ �����y �L'/ Owner's Name Address and Tel.No. Assessor's Map/Parcel 1341/rIS��YG�i" �� rG�� q Zo Inst er's Name,Address,and Tel.No. Designer's Name,Add s and jel.No. Getiy, 77 /-9399 Type of Building: Dwelling No.of Bedrooms Garbage Grinder(_160 Other Type of Building G:Sr eee-e No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date IF/2 y/rd Q Number of sheets Z_ Revision Date Title Description of Soil Nature of Re airs or ter ons..SSAnswer when applicable) rI9 / f Odle Qr �egGh �r A// 7— �O v`TOl1� vlGf/'/'©Gl/' ��t A Date last inspected: Agreement: The undersigned agrees to ensure the construction f 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 9thi f H th. Signed Date Application Approved by Date Application Disapproved for the following reasons rj Permit No. Date Issued _ r / CIA 07. No. / Fee • THE COMMON�ALTH OF MASSACHUSETTS �• PUBLIC HEALTH DIVISION DOWN OF BARNSTABLE, MASSACHUSETTS Otporiration for ;Mi0ooar bpgfem Cottgtruction Permit j Application is hereby made for a Permit to Construct( )or Repair( )an On-site Sewage Disposal System at: Location Address or Lot No. f f�` f f���� �Cj � Owner's Name Address and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address andjel.No.� 7 /- 45 ' x: Type of Building: .y .e / `' j Dwelling No.of Bedrooms Garbage G3'nder(w© { Other Type of Building /ZCy No.of Persons Showers( ) Cafeteria( ) Other.Fixtures Design Flow /t gallons per day. Calculated daily flow, gallons. Plan Date f Z f 3 0 Number.'of sheets Revision Date { Title r — � Description of Soil I z_ Nature of Re Z airs or Alterations Answer when applicable) A >7 O S DI/�' Su/'/ocr�i i.�g //i F Date last,• pected: "ins Agreement: The undersigned agrees to ensure the construction=44gainbanumwof the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of thetEnvironmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued y this Boar• f'H lth: Signed Date )K/10/& Application Approved by ,1. Date Application Disapproved for the following reasons z i Permit No. ..� Date Issued ————— — ———— ——— THE COMMONWEALTH OF MASSACHUSETTS Z "" BARNSTABLE, MASSACHUSETTS Certif irate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System installed )or repaired/replaced( ")on by Ins er Ao r f"?2Ila at / /4,Ieel , a w. e1e a / has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No, dated "' Date Inspector THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARAN E THAT THE SYS- TEM WILL FUNCTION SATISFACTORY. .THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS 30igooal bpztemc (Construction Permit � Permission is hereby grant to Dr e�421,1CO1L51 to construct( )repair( an On Sewage System located at No: 11# street and as described in-the above Application for Disposal System Construction Permit. No. I I Date The applicant recognizes his/her duty to comply with Title 5 and the following 10 1 provisions or spec i con ' 'ons. All construction mu be co pleted within three years of the date below. i Date: Approved by �! ! Board of a t6 •ws 3 L6. j 4.. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WURKS C ONS'FRUC TIUN I'EI(NII'I' (NVI-I'IIOU'I' DESIGNED PLANS) ereby certify that the application for disposal works �. construction permit signed by me dated ������ , concerning the property located at !/� �o�r°�� 4 ,r�or�s�� � meets all of the following criteria: /Thcreed sc is system arc no n•cilands within _00 feet of the proposed � , Y/liThcre arc no rivate wells within 15o tec! of the proposed septic system P e 2 r below the bottom of the leaching facility i he obscn_d gronndti�•atcr table .s 1 fc_,or.,reate q Xhcre is no increase in 11ow and/or chance in use proposed There are no variances requested or needed. SIGNED : — DATE:. —49� '0� LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER IAttach a sketch plan of the proposed system. Also if the licensed installer posesses a cer[ified plot plan, this plan should be submittcdl. 2' .; r' CEIVED - k AUG 8 19�3�b �. BORTOLOTTI CONSTRUCTION,INC. ;�" 765 WAKEBY ROAD,MARSTONS MILLS,MA 02648 508-771-9399 508-428-8926 .FAX: 508-428-9399 SUBSURFACE SEWAGE DISPOSAL SYSTEM.INSPECTION FORM PART A CERTIFICATION / V z Fr Pli, Property Address: /j/ '0 �C - c 1QS� �(,rr/� �P E�✓ Date of Inspection:' - Inspector' Name: Owner's Nam and Address: CERTIFICATION TAT MENT• I certify that I have personally inspected the sewage disposal system at this address and that the informa- tion reported below is true,accurate and complete as of the time of inspection. The inspection was per- formed based on my training and experience in the proper funclion and maintenance of on-site sewage disposal systems. The System: Passes Conditionally Passes Needs Further Evaluation By,the Local Aproving Authority Fail_S'^" In` speetor's-Signature: '� Date: -✓7Y� The System Inspector shall submit a copy of this inspection report to the Approving authority within thir- ty(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 1M ARY• 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. B)SYSTEM CONDITIONALLY PASSES; One or more system components need to be replaced or repaired. The system,upon comple- tion of the replacement or repair, passes inspection. Indicate yes,nor,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,cracked,structurally unsound, shows substantial infiltration or exfiltration,or tank failure is imminent. The system will pass inspection if the existing sep- tic tank is replaced with a conforming septic tank as approved by The Board of Health. Sewage backkup 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): ' - i _ i `1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Broken pipe(s)replaced' Obstruction is removed Distribution Box is levelled or replaced The System required pumping more than four times a year due to broken or obstructed pipe(s).. The system will pass.inspection if(with approval of The Board of Health): Broken pipe(s)are replaced Obstruction is removed C)FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by The Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1)SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM 1S NOT FUNCTIONING IN,A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT- Cesspool or privy is within 50 Feet of a surface water Cesspool or privy is within 50,Feet.of a bordering vegetated wetland or a salt marsh. 2)SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER,IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTION- ING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 Feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is.with a Zone I of a public water supply well:. The system has a septic tank and soil absorption system and is within 50 Feet of a private water supply well. The system has a septic tank and soil absorption system and is less than 100 Feet but 50 Feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from the facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 porn. -_ D)S}tiTEM FAILS: V 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. ackup of sewage into facility or system component,due to an overloaded or,clogged SAS - or cesspool. Discharge or ponding of efluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid.level in the distribulion_box above outlet invert due to an overloaded or clog- ged SAS,or cesspool. Liquid depth in cesspool is less than G"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 pipe(s). Number of times pumped. 2- SUBSURFACE SEWAGE DISPOSAL SYSTEM.INSPECTION FORM PART A CERTIFICATION (continued) Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 Feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 Feet of a private water supply well. Any portion of a cesspool or privy is less than 100 Feet but greater than 50 Feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E)LARGE SYSTEM FAILS: The following criteria apply to a large system in addition to the criteria above: The design flow of a system is 10,000 gpd or greater(Large System)and the.system is a significant threat to public health and safety and the environment because one or more of the following .conditions exist: The system is within 400 Feet of a surface drinking water supply The system is within 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 Il of a public water supply well: The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314_CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Check if the following have been done: _yPumping information was requested of the owner, occupant, and Board of Health. ✓ None of the system components have been pumped for atleast two weeks and the system has been receiving normal flow rates during that.period. Large volumes of water have not been 1 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 NIA. _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. a/All system components,excluding the Soil Absorption System, have been located on site. The septic tank manholes were uncovered,opened,and the interior of the septic tank was in- spected for condition of baffles or tees, material of construction,dimensions,depth of liquid, depth of sludge,depth of scum. //he size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. -3- SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST(continued) s The facility., owner(and occupants,if different from owner)were provided with information on the proper maintenance of Subsurface Disposal System SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION FLOW CONDITIONS $ 'SH)ENTIAL: .Design Flow: allons Number of Bedrooms:_ Number of Current Residents:_ . Garbage Grinder:_ Laundry Connected To System:�C S Seasonal Use: A G' Water Meter Readings, ifa v;iilable: ��. ✓ Last Date of Occupancy: psi/'6i) =---- - --=— - --- COMMERCIAL./INDUSTRIAL /A� Type of Establishment: , Design Flow: gallons/day Grease Trap Present: (yes or,no) Industrial Waste Holding Tank Present: Non-Sanitary Waste Discharged To The Title V System: Water Meter Readings, If Available: Last Date of Occupancy: OTHER: Describe) Last Date of Occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System Pumped as part of inspection: if yes,volunie,pumped: - gallons Reason for pumping: TYPE OF SYSTEM: ___tL"'Septic Tank/Distribution Box/Soil Absorption System Single Cesspool Overflow Cesspool ' Privy Shared.System(If yes,attach previous inspection records, if any) Other(explain): AP RO TE AGE of all mponents,date installed(if known)and source of information: Sewage odors detected when arriving at the site: SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART GENERAL. INFORMATION (continued) SEPTIC TANK: !✓`'" Depth below grade: /57" Material of Construction: c ncrete metal FRP Other (explain) — Dimisions ' Sludge Depth: �S- Scum Thickness: /V Distance from top of sludge to bottom of outlet tee or baffle: 33 Distance from bottom of scum to bottom of outlet tee or baffle` Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation t outlet invert, structural integrity, evidence of leakage,etc.)-Z:j � tZ 00 GREASE TRAP: Depth Below Grade: Material of Construction: concrete metal FRP -Other _(explain) — — — — Dimensions: Scum Thickness: Distance from top of scum to top of outlet tee or baffle: 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.) TIGHT OR HOLDING TANK:=ACl1 Depth Below Grade: Material of Construction:_concrete metal—FRP Other(explain) Dimensions: Capacity: gallons Design Flow:_ - gallons/day Alarm Level: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) DISTRIBUTION BOX: _ j Depth of liquid level above outlet invert:_W01_41%2 Comments: (note evel and distribution qual,evi nee of solids carryover,evidence of leakage int �or o of box,etc. ` .�Ci.,�j �I r) Ye 1 G/tID6 �. )j__ < <. >or e PUMP CHAMBER: Pump is in working order: Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) .. 5. '� i.tom. �• µ, -5- SUBSURFACE SEWAGE DISPOSAL-SYSTEM INSPECTION FORM PART.0 SYSTEM INFORMATION(continued) SOIL ABSORPTION SYSTEM(SAS): t/ (Locate on site plan, if possible;excavation not.required,but maybe approximated by non-intrusive methods)' If not determined to be present,explain: Type: Leaching pits, number:_Leaching chambers, number: Leaching galleries,number: Leaching trenches,number,length: Leaching fields, number,dimensions: Overflow cesspool, number: . Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition ve tation, etc.'7` GL -��' �� fir° cv/v Fr / 12 CESSPOOLS: nn V 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 soilk,signs of hydraulic failure, level of ponding,condition of vegetation, etc.) II PRIVY:1 Materials of construction: Dimensions: Depth of Solids: Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc.) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) SKETCH OF SEWAGE DISPOSAL SYSTEM: Include ties to atleast two permanent references, landmarks or benchmarks. Locate all wells within 100 Feet. i jj-7 031 53 0 3� DEPTH TO GROUNDWATER: i Depth to groundwater: 35 Feet % /� Method of Deter ation or Approximation: �X% Q' `' ��0/0'f /5 - 7- U l -', No............... 0 y Fss �� j THE COMMONWEALTH OF MASSACHUSETTS BOAR® Off' HEALTH ....--.oF . ...- ..................... Appliration for Bigias al Workii Towi rurtivat Prrutit Application is_bmeby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: /4 .1 ....P� �: .... �..h ---------••.................... .......... ------•----•---- •----- Location-Address r Lot No, her Address a .� ...... /I'... .�� ---------------------------- -----•---••-•---•..------------------------------------------------------ - Installer Address r Type of Building Size Lot_.__, 5n. ..Sq. fe t U Dwelling—No. of Bedrooms--- Expansion Attic ,( v) Garbage Grinder '4 Other—Type of Building No. of persons____________________________ Showers — Cafeteria p" Other fixtures ...... W Design Flow............................ _`?.._..____gallons per person per day. Total daily flow............... ..................gallons. WSeptic Tank—Liquid capacity_I&A_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. it. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.... r__6"��- �f ________________ Date_____ ��•.••-•--.- ,aa Test Pit No. 1_Z_2_____minutes per inch Dept-1 of Test Pit.....15..�_ Depth to ground ater........................ ri Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ P4 / ::-----•---------------•---•-----•---------•---•--______---------------------------•---- O Description of Soil---------------- /• QIO- x .__________________________________________________C_,_,,r_____� ,_ ___ .a._ __._.c ___..:r�^�e_c jj_�'__.______________.._.____.____.__..___ w --------------------------'-------------------...----'-------•--------------._...------._...----------•----------------'----------------------------•--------------...-------------••••••••-••-•--•-••-- V Nature of Repairs or Alterations—Answer when applicable............................................................................................... ----------------------------•----------------------------•-•-------------------•------•------------------------------------•-••----••••............................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with T�'1�^ the provisions of .f!1 s i LE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed..........- '� ...-•------•---..._...-••••...•_-- ld D._e..... Application Approved ) ,.w. ��1s' . "--------------•----____----- ----------•-------- -��- I---- ate Application Disapproved for the following reasons:------••-------•--------------------------------------•-------•-------------•------------------------.....--••-- ...•-••••-•••---•-••-----•----•••-=•-••••-•-••••••--•--•_._...••-•••••-••-••----•••-•--••--•---••••••_._..--••----•--•--••-•----•-••-----•-----•---•-------•-•-••••••••••••---••-•---••--•••••••••---•--- � Date Permit No.. ----��..`�.._..._.. Issued---•......�.�_�_ - �------------•---. No FiRs� _..:__+�. THE COMMONWEALTH OF MASSACHUSETTS BOARD -OF HEALTH ........... RNIQ ...OF..... ...+�'...i -'- .% • .._... , ppliration for Bitipuia1 kirks Tonstrnrtion Frrntit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: 4 ... .f f � 'r". `..` ............................................................. -- ------ Location-Add ss r Lot W Address = y _ -- . ......................................... .......••....._ a Installer Address Type of Building Size Lot.............................Sq. feet U .Dwelling—No. of Bedrooms......... .............................Expansion Attic Ala) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures .................................. W Design Flow...........................6.6..........gallons per person per day. Total daily flow............... ..................gallons. WSeptic Tank—Liquid capacity j .O&gallons Length................ Width---------------- Diameter.................. Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area.......__........sq. ft. Z Other Distribution box ( ) Dosing=t nk ( ) )12 �,r 'Percolation Test Results Performed b �l?'. __. `...a p' Date.- ._,--4 Test Pit :Vo. 1_�_ __-_-minutesperinch Deptki of Test Pit.....�'�_ _`�.... Depth-to ground ter-__--..._._'.,._._..-_. Gi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ �'° 3 �'! � '° $�.. O Description of Soil................. .. ..I --------------------------------------•-•-------- ---Vim-.--15 ..... .................................................. UW ...........................-------•-•••--••---•--•••--•-----••-•-••--•-•-•-•---------•-----•-••••-------•-•---•••••••---••---•....---•---•--•----------•--•---•-••---•••-••---••---•••-----•--------... Nature of Repairs or Alterations—Answer when applicable............................................................................................... --------••--------------------------------------------------------------•---------------------•--•--------•---------------------•-----------------------------------------------•-•--------..._...---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with x.� the provisions of('1T f1:: t; 5 of the State Sanitary Code- The unrsigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. --------------------•-------....... r ... � tee`1 Application Approved By.................................................................................................. ---------- ---------------------------- Date Application Disapproved for the following reasons---------------------------------------------------•---------••-------------------------••-...--•--•------•--•--. ----------•--------------� •- -----Date ------------ .............................. 1 PermitNo......................................................... Issued....................................................... D.St_ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .. $ ...........OF..... ....�� ! .���` .;. .. .............. Trrtif irtttp of Toutplinna TH{.S I. T CERTIFY, That the Individual Sewage Disposal System constructed X) or Repaired ( ) bfir y.. . . " . 11 1 Ins ller ...Y.2* - ---------- has been installed in accordance with the provisions of TIiiE 5 of The State Sanitary Code a described in the application for Disposal Works Construction Permit No......................................... dated............................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FU CTI N SATISFACTORY. DATE........... 1 "`""">`'""`' .................................... Inspecto ----= ------•---------•- •. .................. ------•-- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH, No......................... FEE........................ anti# Permissionis hereby granted............................................................................................................................................... to Construct O or Repair ( ) a In vidual Sewagl Disposal Sys - ==�-�-S•-_-------- ----------------•-----•-•-----•---•-.�at No. _':.._._ .:._. Street / as shown on the application for Disposal Works Construction.Permit No..................... Dated..l4l__.-::)_1. at................ -------------- � - -------- Board of Health p DA, E- == ....... ---- FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS �- �l || |!|iFllml, i9fli!!!| tl9ml,ltel, #i|l ,1,l� m !1, ti!lei,!|llnm |1, fn!| !!|! t!lnm !! n!! ,!|! tlnm |!||!tom!!|! 1 m ||!||l9iiillnm |lit|!|| i|9m mRA k g ENVIROTECH LABORATORIES k 49 Route l3 Sandwich, MA.053 (50) 8y66 % 9 � CLIENT: Green Brier Development LOCATION: Lot � do eer path q k ADDRESS: x 510 W. Barnstable, MA Centerville, COLLECTED BY: MA 0263Z— D. eeeee7 SamPEE DATE- I*/J/89 TIME: IO:JO AM E D.A. Scannell Well RATE RECEIVED. 1173789 SAMPLE I: ET 526 k . a JOB ± New Well WELL DEPTH: 101 £t q � — % RESULTS OF ANALYSIS: k a = Parameter Units Recommended limit Result m Color b c! r/10 m (MF Method) O 0 . � pH PH units 6.*&5 6,&8 E » Conductance umh scm 500 62 § K Sodium mg/L 20.0 8.7 F = Nitrate- mg/L 10.0 .03 I n mg E 0.3 <.05 k Manganese mgE CO � k F Hardness mg LasCaCO) 50 2 . Sulfate mg/L 250 E Potassium mg E 2.0 q Alkalinity . mg E 200 BE, Chloride mg/L 250 2 q � Turbidity NTU &O a � q k Color APC units 1&O = & � E a Background bacteria COMMENT m - k � YES NO WATER G SUITABLE FOR DRINKING PURPOSES FOR PARAMETER ESTED. d XXI O 7 / DATE F M � �.sW ate a Department pf Environmental Management/Division of Water Resources %,A'TER WELL COMPLETION REPORT WELL LOCAT N GEOGRAPHIC DESCRIPTION Address //o^'e e Pcc T� /00 N S 9) W of (feet) (circle) City/Town 2.&ir.� /vta / A.T� Well owner(,1,cenlyQJC/Ww1tiT (road) Addresss,00. ' K /.syo O �j S © W of 026 v J (mi.in tenths) (cirglell- Board of Health permit: yes [R' no ❑ intersect. w/�u. io d WELL USE . WELL DATA Domestic KPublic❑ Industrial ❑ Total well depth ft. Monitoring❑. Other Depth.to bedrock ft. Water-bearing rock/unconsolidated material: Method drilled o u/ Date drilled $ Description CASING Water-bearing zones: Type 1/0 p UL 1) From To Length .9 7 ft. Dia(.F.D.) "Y rr in.. 2) From To 3) From To Length into bedrock ft. Gravel pack well: dia. Protective well seal: Screen: dia. Grout.2" Other Slot*1s length Se' fromQZ O/ PUMP TEST Static water level below land surface S' L ft. Date Drawdown ft. after pumping � lir. min:atgpm How measured: �4(lC ` Recovery 12 ft. alter h r. LOG of.FORMATIONS COMMENTS Materials From To tt �' (c+"CLbiSC � r. Driller r Mass:"Reglstra ion• , y, Flrm'Qh r, Cutij.ivQ L.J¢�/ s�/,�F Address Mas� s Ci r.18�f2 Clty/Town nature of supervisIng registered ivelt driller, Please Print 5rmty - r >, �. ,. BOARD OF HEALTH COPY n,.lwM.<< ,,,. P..:.�u . K. BARNSTABLE'COUNTY HEALTH AND ENVIRONMENTAL DEPARTMENT SUPERIOR COURT HOUSE O BARIISTABLE, MASSACHUSETTS 02630 o � o AIA 5`,- PHONE: 362-2511 EXT.'330 VOLATILE ORGAIIIC C011PO1111DS REPORT LAB337 -- -- CLINIC 340 Client: Greenbriar Developm. Collector: Sean O ' Brien Mailing Address: Route 28 Type of Supply: private well Centerville , MA Date Collected: 11/3/89 Telephone: 02635 Date Received: Sample Location: Lat #13 Pioneer Pa h Analyst: S . Williams West Barnstable , MA Date Analyzed: 11/6/89 LOCAT 1011 E630 COMPOUIID Lot #13 Pioneer Path W . Barnstable ,M Chloroform 5 . 3 cc Barnstable Board o 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. y s� BARNSTABLE COUNTY HEALTH AND ENV1 1RONMENTAL DEPARTMENT Z SUPERIOR COURT HOUSE r BARNSTABLE, MASSACHUSETTS 02630 o M =5 TABLE 1 . Compounds Detectable by EPA Method 502.1* PHONE: 362-2511 Mns 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 Trichloroe.thylene 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 MCLMCL (inppb) 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. No.------- -- ----- BOARD -- BOARD OF HEALTH TOWN[ OF BARNiSTABLE Appl(ration for Vell cfootruct ion 3permit Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair ( ran individual Well at: P1:2�-r----�-=---6ar nAilt- c- --------------------------:------------------------------------------------------------------- Location — Address Assessors Map and Parcel et`��ater-- -�e ----v' -Cor --�------------- - ---------- - Owner l Address rn - iL--- ' �'---2- --------------- - - t � � Installer — Driller Address Type of Building Dwelling--AP w---C n 4 ------------- Other - Type of Building ------- No. of Persons----------------_---------_---------------________ Type of Well----�a � --------------- - --- -- YP --- - --------- - - Capacity- - - Purpose of Well--,f --�.�x►� ��^� -------------------------------- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until a Certificate of Compliance has been issued by the Board of Health. Signed � G // - -- ----- - - - date Application Approved ---------------------- date Application Disapproved for the following reasons:—---------------___-------_-----__----------_-------__-__—-----------------__________________ -------------------------------------------------------------- ------------------------------------ -------------------------- date — PermitNo.- ------- Issued---------------------------------------------------------------------------------- date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( ) by-------------- =�e. �a----- ' - - ----------------------------------------------------------------------------------------------------- Ins Iler has been installedcc dan w the provisions ------�" - z - -------------------------------------------------- p of he Town of Barnstable Board of Health Private Well Protection b�.� Regulation as described in the application for Well Construction Permit Nk—yt?-7-J-y---------Dated---------------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE----------------------' -------------------------- Inspector--------------------------------------------------------------------------------- Fee-,--- c.....a- No.------------=�--� -- -- _ BOARD OF HEALTH TOWN OF BARNISTABLE Application-*rVell Con5tructionpermit Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair (G')anndividual Well at: --- ------------------------------- nPg Location — A. - -U-c ------------------------------------- -ddress Assessors Map and Parcel — Owner T Address D, T--------- -- -- f 'fI5/ Installer — Driller Address Type of Building Dwelling_,�//i.,� �n s-f�u� ����------------- Other - Type of Building--------------------------------- No. of � Persons----------------------------------------------------- Type of Well -------- Capacity -------------------------------------------- Purpose of Well -= --x^_- ----- ------------------- 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. ------- ---�'= = 9------------ Signed �'�,-,-`--.'- date p� � Application Approved By-----------� =^^?,— e° ,�," ----------------------- = -d�te�- c Application Disapproved for the following reasons:--------------------------------------------------------------------------------------------------------- ---------- ---------------------------------------------------------------------------- date PermitNo.-- — '=—t -- ----------------------- Issued----------------------------------- --------------------------------------- dare 1 BOARD OF HEALTH TOWN OF BARNISTABLE f (Certificate ®f compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ),!Altered ( ), or Repaired ( ) by------------------ ----- ------ 4 ------ --------------------------------------------------------------------------------------------------- Instjaller at- - _ 2 � -� -�- = r 1_ """" ----------------------------------------------- r —t, — z -- — has been installed in accordance with the provisions of the Town of Barnstable�Booard of Health Private Well Protection Regulation as described in the application for Well, Construction Permit NA4/ '- -- --------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 Ivell con5tructionpermit No.--- "------- Fee— -- --------- Permission is hereby granted------------ ---' '� *"�=` '� to Construct (X, Alter ( ), or Repair ( ) an Individual Well at: No. -------- - - y� r ••:�-__ Q_ago, -�1=---�Rs ---------------------------------------------------- V street as shown on the application for a Well Construction Permit No.--------—---------------- - Dated - - --- Sr - - --- ---- ------------------------_- __ ___L _---------------------_-____-_____-_-__-_--_ `Board of Health DATE---------------------------------------- ----------- ---- -------------------------- � 5 y FEB THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .............. .�11.......OF.-.-.....-..4,�. -- 1,1 .L.6------•--••----•--•- Applirafioo for Diopoon1 Vorkg T000trurtion Vamit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at: ---�L? 11- ------------------•----- ---- -----•------....................-•---.......-- " Location-Address or Lot No. Owner ! Address . ........................max... ....................................................... � 'Installer Address � � d Type of Building Size Lot_._._____ �_ ____Sq. feet Dwelling No. of Bedrooms_______ ________________________________Expansion Attic Garbage Grinder A Other—T e of Building No. of persons____________________________ Showers — Cafeteria aOther fixtures -------------------------------•-------•••••-• W Design Flow......................5_'>�____.______.gallons per person per day. Total daily flow................. . ...................gallons. WSeptic Tank—Liquid capacityjW...gallons Length_:.........-.... Width................ Diameter................ Depth................ x Disposal Trench—No_____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area____ _____._.sq. ft. Z Other Distribution box ( ) Dosing tank ( ) ~' Percolation Test Results Performed by.........(au. _.:f:_��,� Date----iu_14-----------•- aTest Pit No. 1./—.Z_-_.minutes per inch Depth�f Test Pit-------------------- Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ---•--------------------•---............................. f O Description of Soil--------------------Q--- ..-•�_?.�-------`0.�..... � ._.......- x -------------------------------------- �.�- -- 7 _: : Sit ------� �d ----------------- w UNature of Repairs or Alterations—Answer when applicable................................................................................................ --------------------------•-•---........_...._....-•----•--•-------------------------.............-•---.._........-..................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITL 1E 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been qis ; the board of healt . ined ------•-•--••-------------- ...... ate Application Approved By..... - ._._... C�� �- 1/Da�� -7 te Application Disapproved for the following reasons-.............--........................................................-............-----------------........... -•-------------------------------------------- --------------------------------------------••--------.....--------------••--------•-----.-.---------...-------------------•----------•-•-••------------- ....................................... Issued....................................................... Date No �f ..70 ,FE$....- ] THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Trt y.A,,!.......OF............ ApplirFation for Uisvniial Works Ton.stxn.rtiun Famit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: .---�,�....: �#- s r...t�-.t �t._ ..t tJ•: ...�(�t �............................................................................... • _- •- Location Address /or Lot No. _ Owner I - Address ................. --•-•--•--••-•••••••----•-•-•----•-•..................................•....-•••---------------•-- Installer Address .y UType of Buildin Size Lot...... .:�,�� ...S feet .4 Dwelling=gNo. of Bedrooms............................................Expansion Attic Garbage Grander( ) aOther—Type of Building ___________________•-__..... No. of persons....__.._.__.__..._.--_---_- Showers ( ) — Cafeteria ( ) QI Other fixtures --------..................................................... W Design Flow......................5 ..........:..gallons per person per day. Total daily flow..................'...... ..............gallons. WSeptic Tank—Liquid capacity./kO_...gallons Length-___-_---___-_- Width................ Diameter-___--__--_-_- Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No...................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) q W Percolation Test Results Performed b. ..._..._.��l..T_..:'--�:�-r-----------------�.•_-•--•---•-•---•-• Date___ /Z�r/j................ � I Test Pit No. 1. .._?_._____minutes per inch Depth of Test Pit.................... Depth to ground water-....................__. �Xq Test Pit No. 2................minutes per inch Depth of Test Pit..................... Depth to ground water........................ ---------------................................................. -•........................................................................ Descriptionof Soil .. ...........................................................•--••-•--•-•••--- W x ----•••----•----------------•--------------••--••------•-•----------•-----••--------.....--•••••-•••-•--•-•---•-----------------------••--•-••-------••••-•-••••••••••--••----••--•---•-•....._.._--••-- V Nature of Repairs or Alterations—Answer when applicable..-_............................................................................................ ----------------------------•-------•------•--------•--•---•---•--•-----------------.....-•--•-------------....--------------------------------------------------------------------------•••-.........-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLi� 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued:-by the board of health. /Date . PP PP Y•-•-------•-•--•--•---A lication A roved B == Application Disapproved for the following reasons--------------------------------------------------------........................................................ ..........................................................................................................--------------•--------•--------------------------...--------- Date Permit No....... •. ...........-1-F-1)2....... Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 17A ��............O F.......... ✓ .I��. �,�.............................. Trrtifiratr of TrrntpliFanrr THIS IS TO CERTIFY, That the Individual Sewage,Disposal System constructed (V or Repaired ( ) by........J. �........ .r S . ........................................................ . --- r� Installer at........�-��-�-------: 1'-1. ,tiP,f �Y. � ........... ! - '` has been installed in accordance with the provisions of 11"IT111, 5of The State Sanitary Code as e•cri ed ' the � � application for Disposal Works Construction Permit No. 5� ________----P. _ r ............ ' --_.. dated_.-..----�---- ---- ---- - ..,. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE............�� ................................... Inspector' - ...•• /-._... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH rjU ............ t1 tiJ.......OF.. .................................`� ..... ........................ ? No......................... FEE........................ Disposal Work Tonotrnr�ilan rrnt�tt Permission is hereby granted ---= --•---•- __!�er) // Construct (V) or Repair ( ) an Indivi ual Sewage Disposal System at No. !P f .� 1 I�t 1 , �... ......._______________ ...._.f._......:.._.._......_ .._treet___._r_..._Y............................................_ __......_...... Street as shown on the application for Disposal Works Construction Permit No k.. . Dated...../.��2_ _...�_.�_....__.. .............................. -'---- -,. --------------------- •------- DATE........... .................................... Bard of Health o FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS 1 No. � - Fee S, -- BOARD OF HEALTH TOWN OF BARNSTABLE ZppCitation orlVell Cort5truutioriperruit A/pplicationQis hereby mad�ey for a permit toy Cp/nstruct (V), Alter ( ), or Repair ( )an individual Well at: Location — Address Assessors Map and Parcel ✓e1 c�7-----Goy a_ 4X _S-/0-----G_evT-<,iu���r- --- -- -- n Owner/ — Address _ Installer — Driller Address Type of Building Dwelling /------------------------------------------------------------ Other - Type of Building ---------- No. of Persons------------------------------------------------------- n Type of Well-y-- UG_ _-- _—_ --- - Capacity------------------ - - ------ ----- - Purpose of Wel i"04Ate� -------------------- 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. �qJrxp Signed _-------�'-� ------aJa---------------------- - /�?�&p------------- date 1 Application Approved By G'-- — -- - - - - // a tz -- -r Application Disapproved for the following reasons: ------------------------------------------------------------------------------------------------------------------------------------------------------— - - ---- -- date Permit No: Issued - �� -1 --- - -- -- date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of CoMpliance THIS IS TO CERTIFY, That the Individual Well Constructed ( Altered ( ), or Repaired ( ) bY------------V------ ------------------------------------------------------------------------------------------------------------------ Installer at4 L �. -�4= =_ .� R -!.� 'v�h ----------------------- has been installed in accordance with the"provisions of the Town of Barnstable Board of Health Private Well Protec ion Regulation as described in the application for Well Construction Permit No �`n-��-�` -Dated-f � THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE ---- -- ------------ Inspector------------—-----'---------------------------------------------------- Department of Environmental Management/Division of Water Resourcesgo a; 3 WATER WELL COMPLETION REPORT WELL LOCATION GEOGRAPHIC DESCRIPTION Address Le? 3. Piowea♦ /�4 �� dY N S (t) W of (Ieet) (circle) City/Town r.�.,�'c..� ST, //J� Well owner 4rce.ti,6-or Oeoelo02^,,JT L"J A (road) Y Address 6�. �ox S/o (7 ® S E W Of 4 rNte y t✓� �`/ r-t o 6 3 (mi.in tenths) (circle) Board of Health permit: yes 2' no � i ttersect. w/OS�`erur tJ�ST (road) d) ll. WELL USE WELL DATA I Domestic gr Pub lic❑ Industrial ❑ Total well.depth /00 ft. Monitoring❑ Other Depth to bedrock ft. Water-bearing rock/unconsolidated material: Method drilled To/ Date drilled /��/'3/$ Description/!ej GVGrs R CASING Water-bearing zones: Type S l ti0 youC t) From To 2) From To . !. Length'—ft. Dia(I.D.) LL—in! 3) From To Length into bedrock ft. Gravel pack well: dia. Protective well seal: Screen: dia: Grout.Kr Other Slot#.&e length IV ' fromAL,to��d PUMP TEST Static water level below land surface s�r ft. Date /314 Drawdown O ft. after pumping_L_�/__hr.'—' min.at gprn How measured 8c Recovery ��p` •ft. after'l hr.- Mmr. r o LOG of FORMATIONS COMMENTS 4 Materials- ,From' To !kt Driller �t Y '' t, �. r O S/' Mass.Registrations r;,.o Sul Firm'nA: r.�. Address.. .] $•� O...i f..lty/,i OW rY"'•GS�1i' � �JJtsn ]r'A l y^` ` r �, } f. .'`Slgnature.oLsu'ervisin;rie isteredwel/draper i% Please Pnnt firmly, BOARD 4QF HEAi.TH„C.pPY tysrK � ' wr 5..: I' tt✓r�.. .'+�:xSs,Pr.'d • s •� � rti i 0 * . --- No.-------------------- � Fee�--------- BOARD OF HEALTH a M TOWN OF BARNSTABLE ZIpplication-*rVell Construction ermit Application is hereby made for a permit to Construct (k), Alter or or /Repair (/� )an individual Well at: ` 7�' 4--s[r4 0" 6,17� � �7 `—�p —�i/.L IA(s S—`-J�--31 Location — Address Assessors Map and Parcel 61 ee .611 eel 1)l y-c%rcwT_fig,f - - /�. 3 - --- ----------------------------------------- Owner nn / S Address 0-IOX ��6v MQ II+ -� /W a -6:?e5 - Installer — Driller Address Type of Building ✓ Dwelling---- Other - Type of Building-'------------------------- No. of Persons------------------=-------------- I Type of Well �/ _ PUG:_--- - ----- - Capacity------------::_---:---------------__ - - - Purpose of Well-QOn�csTc__ l�uT�! ' Agreement: r The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation until a Certificate of Compliance has been issued by the Board of Health. Signed date Application Approved By -� - �� - date Application Disapproved for the following reasons:---------________________ _____________________________—_____________________ date Ae'50 Permit No. - - �'--- I_._ — -----=---- Issued --��� "1 ------------------------------ date a*• BOARD OF HEALTH TOWN OF BARNSTABLE i Certificate Of Compliance THIS IS TO CERTIFY, That the Individual Well Constructed (1/), Altered ( ), or Repaired ( ) by-------- ------ ----------------------------------------------------- -- - -- - ----------------- Installer has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private W-91-Protection.-; - Regulation as described in the application for Well Construction Permit No�' ef—~ J-Dated-� �---4/--J9 THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE------------------------__--- --------------------- -- Inspector----------------------------- ----------—------------------- BOARD OF HEALTH TOWN OF BARNSTABLE Very CongtructionVermit �✓ *�' � `�,�° Fee--A�F • No. - ------------------- Permission is hereby granted--- = -- !`�'� -(-/----------_--------__ ------- to Construct (�,Alter ( ), or Repair ( ) an Individ fua} Well at: No.'&T e/ A&T4 --------------------- Street as shown on the application'for a Well Construction Permit No.- - _A _~ - ---- ---- - Dated---------- _ -i "� N Board of Health DATE---- ----r ----�� ------------------------ - I 20' MINIMUM OR AS INDICATED ON PLAN 10' MIN. - _ 10' MINIMUM ' 71_O t T.O FOUNDA110N S- MIN. /1 U I'O ND/ - JG,O ITCH 4" SCH. 40 PVC PIPE T 1/4" PER FT. .1�4�— MIN. PITCH 1/!" PER MASONR - FLOW LINE — N CLEANOUT EXIENSI I ()— _ s�-�� rl —4,i _ 4-O' (p _8.2'MIN. LEVEL 2" LAVER OF --- - LIQUID' (a9•0 1/0- - 1/2" LEVEL WASHED STONE DISTRIBUTION -- ------- BOX \9 J 4• _ 1 1/2. - WASHED STONE - - I � GALLON SEPTIC TANK 6" C -- — _SEWAGE_.DISPOSgI�$Y�LE11_P.B9FLLE__ -� 11, NOT TO SCALE I S 10 BOTTOM OF TEST HOLE__ _ �• I.C) OR USGS PROBABLE HIGH WATER LEVEL • NOTE: CONTRACTOR SHALL EXCAVATE 4' BELOW BOTTOM of LEACH FACILITY ► AND SHALL REPLACE MATERIAL WITH GRANULAR FILL HAVING A PERC. RATE < 2 MIN./INCH i _ WHITE BIRCH WAY N/F 54 JOHN P. & PAUL X. MERLESENA70 I 70 287.36 --------------- WELL i43 8O$ sq.lft.f/76 , , I - O I., h 1. , ( I / ► C1 i DRAINAGE EpMENT \ I I 1 / to it PIONEER so 70 pis 76 70 so PATH 4 (50'' WIDE) e i j SITE PLAN j t TES: °sq 1. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.Q.E. INTERCHANGE TITLE 5 ; THE TOWN OF __UARN_5TAQLL_--- RULES AND RD 5 T ABLE -----� REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE; AND THE REQUIREMENTS OF THIS PLAN. _ OgTERVIL�E. WHITE BIRCH WAY TH - 2. ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO PIONEER PA !- WITHIN 12" OF FINISHED GRADE. 3. ALL MASONRY UNITS USED TO BRING COVERS TO GRADE �- �� - LOCUS ! SHALL BE MORTARED IN PLACE. K'Op 1L 4. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OS�OF OF WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR V� WITHIN 10 FT. OF DRIVES OR PARKING AREAS, H-20 LOADING i z SHALL BE USED UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING 5. CAST IN PLACE CONCRETE TEES ARE SPECIFICALLY DISAPPROVED. SANITARY TY'S WHERE INDICATED ARE REQUIRED. j! 6. EFFLUENT PIPING FROM DISTRIBUTION BOX SHALL ENTER (EACH PIT THROUGH SIDEWALL OR TOP ONLY. ENTRANCE THROUGH MASONRY -------- ---------- -- EXTENSION WILL NOT BE ALLOWED. LOCATION MAP 7 NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEED RESTRICTIONS OR ZONING REGULATIONS. OWNER/APPLICANT SHALL OBTAIN SUCH DETERMINATION FROM THE APPROPRIATE AUTHORITY. 8. HORIZONTAL AND VERTICAL CONTROL, SEE LEVY, ELDREDGE & WAGNER FIELD NOTEBOOK CURRFNT ZONING INTERPRETATION: DESIGN CALCULATIONS : MIN. FRONT SETBACK _—_ v.._ FEET NUMBER OF BEDROOMS -=- MIN. SIDE SETBACK FEET GARBAGE DISPOSAL UNIT 000c- TOTAL ESTIMATED FLOW MIN. REAR SETBACK _____�._'_____— FEET ( 110 GAL./BR./DAY X _3_ BR.) -33(2-GAL. /DAY i REQUIRED SEPTIC TANK CAPACITY 49�GAL. ACTUAL SIZE OF SEPTIC TANK -IL000 GAL. . LEACHING AREA REQUIREMENTS v' SIDEWALL AREA _2.5 GAL./S.F. PERCOLATION SOIL TEST BOTTOM AREA �_� GAL./S.F. 5 `� LEACHING CAPACITY (BOTTOM + SIDEWALL) _ s _GAL OATE .OF SOIL TEST__. /_!4A 89 ----.-.--- 27T( 10 /2)( G, )(2.5) +TT( 10 ./2; (1.0) .�GAL. WITNESSED BY c RESERVE LEACHING CAPACITY PFRCQI_ATION RArF ..� .._-- MIN./INCHSAME OBSERVATION HOLE 1 OBSERVATION HOLE 2 ELEV.=_G7.0__ ELEV.=----.-- __ _O.DO -- --0.00 BREAKOUT CALCULATION: v.f•ve e Fc . c 1 0 (°�.4 - 0-is- 4 r- oK LEGEND: EXISTING SPOT ELEVATION OOXO EXISTING CONTOUR-- ---- -00---=- I FINAL SPOT ELEVATION 00.0 4/0 _ - FINAL CONTOUR —.... C LTA NATER AT ELEV. WATER AT ELEV.----_---- SOIL TEST PIT LOCATION TOWN WATER--- - W-...---W—----- SEPTIC TANKDISTRIBU C�7 WATER ' LEVEL ADJUSTMENT: AYA. PRIMARY LE Box ❑ PRIMARY LEACHING PIT O RESERVE LEACHING PIT R` TEST .DATE --- -- ------------ __. ...........WATER LEVEL - --- ------: _-_.------ - - ---.__.._.-_ -- --- INDEX WELL -- - - ----------- -----.- --- WATER LEVEL RANGE ZONE -_'_..__._ 1 g z4. I INITIAL ISSUE _ _ £�►<_ DEPTH TO WATER.LEVEL FOR INDEX WELL -- - N0. DATE DESCRIPTION BY . FOR THIS MONTH -_ --- WATER LEVEL ADJUSTMENT SITE E PLAN & SEPTIC DESIGN DEPTH TO HIGH WATER ____- __- LOT 3 PIONEER PATH IN BARNSTABLE, MASSACUU.SETTS FOR PA ` � t GREENBRIER DEVELOPMENT CO. INC. }o LEVY c APPROVED: BOARD OF HEALTH No.1ooso A Fcl So. SCALE; 1" = 4-0' -JOB N0. 1120 / 1120-3 LEVY, ELDREDGE WAGNER ASSOCIATES INC. __..._^,T . ._ __. ..._. ...... ... ...'..^f . ,.,,. rnr.>Nhvttc L1t111�r:�P9 r,RCI11'�N'C1'S PI�INNRR4 IaND 9ltRYlttt►R¢ d � A NOTES: 1.'' ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.Q.E. � INTERCHANGE TITLE 5 ; THE TOWN OF _ BARNSTA LE _M RULES AND RD `�'� 5 20' MINIMUM OR AS INDICATED ON PLAN REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE; W g ARNSTAg�E AND THE REQUIREMENTS OF THIS PLAN. WHITE BIRCH WAY 10' MIN. 2. ALL COVERS TO SANITARY- UNITS SHALL BE BROUGHT TO to' MINIMUM WITHIN 12" OF FINISHED GRADE. PIONEER PATH. 71.0 3. ALL MASONRY UNITS. USED TO BRING COVERS TO GRADE LOCUS BACKFILL WITH SHALL BE MORTARED IN PLACE. 1v T.O. FOUNDATION Tll MIN. 71.0 �I'� =AN ODD -� 72,D �---- 4. ALL COMPONENTS OF- THE SANITARY SYSTEM SHALL BE CAPABLE SIDE DRIVC OF WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR - WITHIN 10 FT. OF DRIVES OR PARKING AREAS, - H-20 LOADING ITCH 4' sCH. 40 PVC PIPE z ` SHALL BE USED UNDER OR WITHIN 10 FT. OF DRIVES OR /4- PER FT. MIN. PITCH 1/8' PER MASONR I FLOW LINE CLEANOUT EXTENSI N PARKING. ROPp vQ 5. CAST IN PLACE CONCRETE TEES ARE SPECIFICALLY DISAPPROVED. 1pGE 104 '^ - GS.O r SANITARY TY'S WHERE INDICATED ARE REQUIRED. pip S "(> 2- 2•-0�`E' �� 2' uYER of6. EFFLUENT PIPING FROM DISTRIBUTION BOX SHALL ENTER LEACH PIT 4.-0' ?LIQUID 1/8' - 1/2' THROUGH SIDEWALL OR TOP ONLY. ENTRANCE THROUGH MASONRY LEVEL DISTRIBUTION �03' a WASHED STONE EXTENSION WILL NOT BE ALLOWED. LOCATION MAP BOX o I , F 7. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEED 3/4• - 1 /2' RESTRICTIONS OR ZONING REGULATIONS. OWNER/APPLICANT SHALL lap( GALLON SEPTIC TANK WASHED STONE 6' OBTAIN SUCH DETERMINATION FROM THE APPROPRIATE AUTHORITY. o W 5S 0 I 8. HORIZONTAL AND VERTICAL CONTROL, SEE LEVY, ELDREDGE SEWAGE DISPOSAL SYSTEM PROFILE & WAGNER FIELD NOTEBOOK #� NOT TO SCALE F I (O J W BOTTOM OF TEST HOLE * g f.O ; OR USGS PROBABLE HIGH WATER LEVEL L _ CURRENT ZONING INTERPRETATION: DESIGN CALCULATIONS : * NOTE: CONTRACTOR SHALL EXCAVATE I ON. FRONT SETBACK ?a FEET 3 4' BELOW BOTTOM OF LEACH FACILITY NUMBER -0F BEDROOMS AND SHALL REPLACE MATERIAL WITH MIN. SIDE SETBACK I S FEET GARBAGE DISPOSAL UNIT NO�JC TOTAL ESTIMATED FLOW GRANULAR FILL HAVING A PERC. I MIN. REAR SETBACK I FEET 2 r ( 110 GAL./BR./DAY X _3_ BR.) 1��GAL. /DAY I REQUIRED SEPTIC TANK CAPACITY RATE < 2 MIN,/INCH 4-9 5 GAL. ACTUAL SIZE OF SEPTIC TANK 1000 GAL. LEACHING AREA REQUIREMENTS ► ? SIDEWALL AREA �2.5 GAL./S.F. PERCOLATION SOIL TEST BOTTOM AREA _L•o GAL./S.F. WHITE BIRCH WAY •� - `LEACHING CAPACITY (BOTTOM + SIDEWALL). `�� GAL.. N/F DATE OF SOIL TEST . �,fR089 27T( Id /2)( Go )(2-5) -+-TT( Icy /2) (1.0) SSU GAL.. " JOHN P. & PAUL X. MERLESENA 7-3 RESERVE ,LEACHING--CAPACITY WITNESSED BY SAME' - - - 54 . JerV-(- Gvn�nt,nq P_ P 5 r .-- ' i . -`- 70___ RC PE OLATION RATE MIN./INCH Q _ ----- - OBSERVATION HOLE 1 OBSERVATION HOLE 2 / - j ELEV- •O WELL � -- --- ��� �. /' ,i f� �J ' —0.00 0.00 ' = '� - . BREAKOUT CALCULATION: . sw� C mac.. �r.o= �i� = o.zS 1 ,�• �'_� I I r T •� rop 0•Z5 x I M 37. 5 < 4S" oK r r , j ' \ r ► '-� r43r,80,5 sq.tft.t � M to s4 A-3U ' ' , I ,, LEGEND: �oMc F a. ,��'. 1 ► r' ! 60 cD EXISTING SPOT ELEVATION OOXO i r t�/ �- , r ► r ! ��'�� \ EXISTING CONTOUR-------00----- `10; 00 FINAL SPOT ELEVATION 00.0 r•i ' ' i I i i ' F►' I j l l i i` ,, ��\ __ '����_ �� { ND WATER AT ELEV. SS's _ WATER AT ELEV._-_--__ FINAL CONTOUR I , , I ► T� ,o / / SOIL TEST PIT LOCATION ' - , - \ TOWN WATER W W �� r SEPTIC TANK O EAS>=MENT r / ,' / ;WAGE \ WATER LEVEL ADJUSTMENT: A DISTRIB ¶OAc BOX PIT O r' ,' ,j j �'� - �, � `, / PRIMARY _ I , ,$ , r' -p ( 50 - " to RESERVE LEACHING PIT 'R; TEST DATE WATER LEVEL 297.69' `� �� `�' ��` `.� �\ 1\ �l ri r� INDEX WELL EL I<- WATER LEVEL RANGE ZONE 1 $ �4 f�i INITIAL ISSUE , DEPTH TO WATER LEVEL FOR INDEX WELL N0. DATE DESCRIPTION BY FOR THIS MONTH SITE PLAN & SEPTIC DESIGN / I ( I I I ', t \ �� �, `�_ - V WATER LEVEL ADJUSTMENT 56 \ r T PIONEER 60 70 76 76 70 60 DEPTH TO HIGH WATER `- LOT PIONEER PATH H PATH �- N I (50' WIDE) BARNSTABLE, MASSACUUSETTS „�•.,a�a�ra�. a FOR • - '�NTH OF Mgss�.`� . o� PAU GREENBRIER DEVELOPMENT CO.. INC. $ u � A. o L'EVY o APPROVED: BOARD OF HEALTH No.l005 0 �� t, , ,�� c� �w SCALE: .1 = 40 JOB N0. 1120 / 11120-3 SITE PLAN FFss A LEVY, ELDREDGE & WAGNER ASSOCIATES INIC. DATE AGENT BNG11i 0 LANDSCAPE ARCHrfBCl'S PLANNF�i.S LAND SUM ES 889 WEST MAIN' STREET CENTERVII.T.F MA 02632 NOTES: .opo s,� 1. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.Q.E. ��'� INTERCHANGE TITLE 5 ; THE TOWN OF -_BARNSTABLE_�_ RULES AND 5 20' MINIMUM OR AS INDICATED ON PLAN REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE; RNSTA$�E RD AND THE REQUIREMENTS OF THIS PLAN. OSTERVILEE_W BA ,O' MIN. 2. ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO WHITE BIRCH WAY 10' MINIMUM WITHIN 12" OF FINISHED GRADE. PIONEER PAT 7i•4 3. ALL MASONRY UNITS USED TO BRING COVERS TO GRADE LOCUS T.O. Fo7Z.0� e' Mw. 71.0 71,Q BAD N AWITH SHALL BE MORTARED 'IN PLACE. tiyo �- NY 4. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OOSIOE 'D OF WITHSTANDING; H-10 LOADING UNLESS THEY ARE UNDER OR ITCH 4' SCH. 40 PVC PIPE WITHIN 10 FT. OF DRIVES OR PARKING AREAS, H-20 LOADING /4" PER FT. MIN. PITCH 1/8" PER z SHALL BE USED UNDER OR WITHIN 10 FT. OF DRIVES OR 3 MIN. � MASONR ; (v FLOW uNE CLEANOUT ExTENSI N /r l D PARKING. 0Pp 10 `~ C! 5. CAST IN PLACE CONCRETE TEES ARE SPECIFICALLY DISAPPROVED. p S�pGE R a GS,O 2._0. SANITARY TY'S WHERE INDICATED ARE REQUIRED. 4'-0, 2" MIN. LEv� I 6. EFFLUENT PIPING FROM DISTRIBUTION BOX SHALL ENTER LEACH PIT Co4.8 LIQUID to4,0 �03 8 2" LAYER OF LEVEL ? 1/8" - 1/2• ' THROUGH SIDEWALL OR TOP ONLY. ENTRANCE THROUGH MASONRY DISTRIBUTION Ca3• WASHED STONE I EXTENSION WILL NOT BE ALLOWED. BOX a LOCATION MAP 7. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEED 3/4- - 1 1/2• RESTRICTIONS OR ZONING REGULATIONS. OWNER/APPLICANT SHALL I GALLON SEPTIC TANK WASHED STONE 000 6" OBTAIN SUCH DETERMINATION FROM THE APPROPRIATE AUTHORITY. SS 0 8. HORIZONTAL AND VERTICAL CONTROL, SEE LEVY, ELDREDGE SEWAGE DISPOSAL SYSTEM PROFILE W & WAGNER FIELD NOTEBOOK #---�S7 - NOT TO SCALE I + I 2- BOTTOM OF TEST HOLE * SI.0 OR USGS PROBABLE HIGH WATER LEVEL CURRENT ZONING INTERPRETATION: DESIGN CALCULATIONS * NOTE: CONTRACTOR SHALL EXCAVATE MIN. FRONT SETBACK 30 FEET NUMBER OF BEDROOMS 4' BELOW BOTTOM OF LEACH FACILITY AND SHALL REPLACE MATERIAL WITH MIN. SIDE SETBACK 1 5 FEET GARBAGE DISPOSAL UNIT nlos'�C � GRANULAR FILL HAVING A PERC. I5- TOTAL ESTIMATED FLOW -.MIN. REAR `SETBACK FEET RATE < 2 MIN./INCH ( 110 GAL./BR./DAY X BR.) 3 3Q GAL. /DAY REQUIRED SEPTIC TANK CAPACITY 49 S GAL. ACTUAL SIZE OF SEPTIC TANK t000 GAL. LEACHING AREA REQUIREMENTS SIDEWALL AREA _2.5 GAL./S.F. BOTTOM AREA 1_� GAL./S.F. WHITE BIRCH WAY "" PERCOLATION SOIL- ,TEST "LEACHING CAPACITY (BOTTOM + SIDEWALL) 550 GAL. 2 N/F DATE OF SOIL TEST -7/R4-/89 27T( 10 ;/2)( (o )(2.5) +Tf( 10 /2) (1.0) SSo GAL.. 54 y JOHN P. & PAUL X. MERLESENA J Th�s�a PTA 73� 4 WITNESSED B _ S RESERVE LEACHING CAPACITY _, __ __ -. -- - TION PERCOLATION INCH 70 RATE MIN./ --- ------ 287.36' 70 _ OBSERVATION MOLE, 1 OBSERVATION HOLE 2 WELL / __ \ \ \ . ,., / � ,� �--�-,_ I ,--_ ----- 1 I ELEV.= ELEV.= �5>0 ----- . TOP 5Uss�01!_ BREAKOUT CALCULATION: �,, 1 5 O•z S x t 50 7• S 4 SF OK 43ti80p sq.%ft.tr - M i-t� s/��JD i r LEGEND: ', .' ' �� '��• /Z76� �1 ►I 11 -,� ; gp _ ..� co � p � L�/ SoMc F�raES p , , i ( ,I , , ! , 1 �� / , / EXISTING SPOT ELEVATION OOXO ` —_ EXISTING CONTOUR-------00--- .�. , , I i I ' � � , ,' ,' ,' �-�`` ,`>1 ,\ CO �,` .\ t 3. S FINAL SPOT ELEVATION 00.0 / 1 , , N I f r l I / r r i `\ FINAL CONTOUR l r ' ,/ i\ \ F, / / , ��,, NO WATER AT ELEV. 55. S WATER AT ELEV.-------= rn T° . ' - \ SOIL TEST PIT LOCATION , �P54.v f �� �`\ TOWN WATER W W ' • � � , SEPTIC TANK � �R'AINAGE EASEMENT `\ __ WATER LEVEL ADJUSTMENT: N/A DISTRIBUTION Box ❑ r � i � f 1 ' � � � � / ! � � / �- ``�` �` \' \\` PRIMARY LEACHING PIT` ; , , i �' I �$ ; l` rll l \ 50 t0 RESERVE LEACHING PIT TEST DATE WATER LEVEL r > , INDEX WELL ! O I r r r l 1 1 �� r l t l l WATER LEVEL RANGE ZONE 1 8 z4 $`� INITIAL ISSUE r , , \ \ \ / /! % ; ,r ; i ! r� / / / I 1 \\ \\ \ ,,`\ \\\ \\ \\\ ,� �' J DEPTH TO WATER LEVEL FOR INDEX WELL / / / / i ' \ �_.� / / ! FOR THIS MONTH N0. DATE DESCRIPTION BY 56 ' SITE PLAN & SEPTIC DESIGN �y WATER LEVEL ADJUSTMENT PIONEER 60 70 36 76 7o so �`------ . PATH 4" DEPTH To HIGH WATER - LOT 3 PIONEER PATH (50' WIDE) IN BARNSTABLE, MASSACUUSETTS FOR P AA GREENBRIER DEVELOPMENT CO. INC. o LEVY �. APPROVED: BOARD OF HEALTH No.10050�;� FBI 5 �`0 SCALE: 1" = 40' JOB NO. 1120 1120-3 SITE PLAN FFSS� LEVY, ELDREDGE & WAGNER ASSOCIATES INC. DATE AGENT t:v5; ENGINFO 11WEE PCHITBCTS PUNM LAND SURVBYORS 89 WEST MAIN STREET CENTERVILLE MA 02632 - - - ------- _ _