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HomeMy WebLinkAbout1821 SERVICE ROAD - Health 1821 SERVICE ROAD, ,T A=194-002.TOO r 0 M e • m f ENVIROTECHLABORATORIES,INC. V v v e MA CERT.NO.:M-MA 063 449 Rte.130 Sandwich, MA 02963' 908(888-6460) 1-800-339-6460 FAX(908)888-5446 CLIENT: Wil Swift LOCATION: 1821 Service Rd ADDRESS: 1821 Service Rd W Barnstable MA 02668 W Barnstable MA 02668 COLLECTED BY. Meehan Well Drilling . SAMPLE DATE 9/1/2000/9-8-2000* SAMPLE TIME: N/A WATER SAMPLE TYPE: New Well DATE RECEIVED: 9/1/2000/9-8-2000* LAB I.D. #. 0009005 10009141 WELL SPECS.: 115, RESULTS OF ANALYSIS: Parameters Units Recommended Results Method Date Analyzed Limits Coliform bacteria /100ml 0 0* 922213 9/8/2000* pH pH units 6.5-8.5 5.68 4500 H+ 9/1/2000 Conductance umhos/cm 500 80 120.1 9/1/2000 Nitrate-N mg/L 10.0 1.55 300.0 9/1/2000 Nitrite-N mg/L 1.00 < 0.003 300.0 9/1/2000 Sodium mg/L 28.0 11.1 200.7 9/1/2000 Iron mg/L 0.3 0.257 200.7 9/1/2000 Manganese mg/L 0.05 0.014 200.7 9/1/2000 *Retest Performed. COMMENTS: Low pH indicates high corrosive characteristics. WATER MEETS EPA STANDARDS AND IS SUITABLE FOR DRINKING PURPOSES FOR PARAMETERS TESTED. <=less than o 1�-�- Date I 0 >=greater than Ron ld J. Saa TNTC=too numerous to count Lab tory D or s 17 Ll No.--�.��to^ .� Fee-------� ---____ �-=�-= BOARD OF HEALTH I' OWN OF BARN T � T S ABLE Application-*rlett Congtructionpermit Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair (/)an individual Well at: -------------------------------- Location — Address Assessors Map and Parcel - --- --- - ---- - r Ow/n�er� f /, Address /�,�/ --'_ �� (/Z� !___G1��/©/S� ------------- ------------------ — - Installer Driller Address Type of B ' w ------------------------------------------------- Other - Type of Building------------------------ No. of Persons--------------------- ---------�___ Type of Well— Zlaee®u���--------------- 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. Signed- i� � — td Application Approved By t �,6.a.e z.��-----_______— �- I g ,7Jt4D-__ date Application Disapproved for the following reasons:--------------------------------__________—__—_—____—_ ----- -------- ------------------------------- ---------------- date Permit No.--- = — — Issued----- -- - - -- - —— — - date BOARD OF HEALTH TOWN OF BARNSTABLE ( ertifirate ®f Comptiance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered or Repaired V) �--------------------------------— Inst ler 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 W- -n--Y22----Dated-----THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE----- — - -- Inspector------ - -- ------------- .�-�r _. -,-.., .-.-r, ....-:-,.— --_..- -+ -, <. ... ._ r_.... .... .. :FAT•- _ .. .. ,r.--. yr ,... _..: oat 00-�h Fee------ -------- BOARD OF HEALTH TOWN OF BARNSTABLE 01pplicationiforWell Con0ruct ion Permit Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair (/)an individual Well at: Location Address Assessors Map and Parcel Owner n , Address 1 Installer — Driller Address Type of Building / --'Dwelling -------------------=------------------------------------- Other - Type of Building- ---------------------- No. of Persons------------------------------- Typeof-Well--------------------------------------- Capacity--`'---------------------------------------- Purpose of Well - -- -- -----_----- Agreement: The undersigned agrees to install, the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation until a Certificate .of Compliance has been issued by the Board of Health. Signed to Application Approved By—%n 6s^- c - ----------- I — 1 a---8 --- te Application Disapproved for the following reasons: -------------------------- -- - —-- -- -------------------------------------------------------- 1 date Permit No. Vj 20,2c> 1/ ---_ - Issued=----- ----------------------- --- ------- datey ? 9fM�!s!Gs.s.ly.o�eir:�l.:!I .iit.!a.:1sB.tAowe7+3"lt;+.:4'F.¢i!�'isw.!i..A.la!s_+taesa�d�as®sisMrra�iatil,6eaarsala�sas:Atrnea�+e9u++RLeS4Pi:�¢4G!Y� F*scm'9�k�eaE,�.`x`?Ss� .AFfC�Fe+a tRrasc'4 t6t3Le4-�"6�3?�#i" ` , m,-. '�,' ., ._... �"-• "as.'�.�ax��a'�:rat'i��i`.:sus,'.�a' ,.'�; `:sw4��L;.'-.bay�.:;:=v:su��i..��.� BOARD OF HEALTH TOWN OF BARNSTABLE Certificate ®f Compliance THIS IS TO CERTIFY, at the Individual Well Constructed ( ), Altered (• ), or Repaired (/) -------- Instiller at- -_ o�/ ..�� ,fU/L' .l° , ! _, �ii�..S /, /---------- 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 Dated----- -------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. I DATE----- - - Inspector--------- ____ - —-------- act�li?i!3litiTiti TrKlflitiilli!i!f!ili96PiDi4i?i9f9ili9i4iTG4f 9i!i9iligf9bNNale�Al3lY:!64ilSBi4if�4i.laTi9iSililililf!f!6ms4wRf!f!'i4aef!it%TO!bTiTv'�iTi4iSW T6@dTi!�tP4ir�i.ti' BOARD OF HEALTH TOWN OF BARNSTABLE Well Contruct ion Permit No. - __ Fee Permission is hereby granted--_L! - i to Construct ( ), Alter ( ), or Repair( '°) an Individual Well at: �- Street ------------------------ as shown on the application for a Well Construction Permit No.- Dated-- ��= ee - -- - --- ------------------- DATE--�-'- - oard of Health I — TROY WILLIAMS L - i SEPTIC INSPECTIONS Certified by MA Department of Environmental Protection (508) 385-1300 19 Hummel Drive South Dennis, MA 02660 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE, OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATIONi I'r.opertN Address: 1821 Service Road West Barnstable,MA Owner's Name: William Swift Owner's AddresN: 1821 Service Road West Barnstable,MA 02668 _ r ,� c��Q� Date of Inspection: November 16, 2000 O , Name of Inspector: Troy M. Williams Company Name: Troy Williams Septic Inspections Mailing Address: 19 Hummel Drive Telephone Number: South Dennis,MA 02660 (508) 385-1300 CERTIFICATION STATEMENT 1 c-nify 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 15.340 of Title 5(310 CMR 15.000). The system, Passes Conditionallk ['asses Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: zs� Date: li/I6/oo The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of I lealth or DE.P)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 DE.P. The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments Although system meets the minimum requirements set forth by the Massachusetts Department of Environmental Protection,certification is not to be construed as a guarantee of future working condition of system,piping or components. This inspection represents the conditions of the system on the Date of Inspection noted above. ""This report only describes conditions at the time of inspection and under the conditions of use at that time. Ihis inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 pace 1 I f Page 2 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) 1821 Service Road Property Address: West Barnstable,MA William Swift Owner: November 16, 2000 Date of Inspection: Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: VI have not found any information which indicates that any of the failure criteria described in 310 CN4R 15A03 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes:NIA 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. Answer yes, no or not determined(Y,N,ND)in the 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. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: 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 obstruction is removed ND explain: 2 f page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 1821 Service Road West Barnstable,MA. Owner: William Swift Date of Inspection: November 16,2000 C. Further Evaluation is Required by the Board of Health: N109 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 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: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank and SAS and the SAS is%sithin 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 froth 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 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,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 f Paoe 4 of I 1 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) 1821 Service Road Property Address: West Barnstable,NM William Swift Owner: November 16, 2000 Date of Inspection: 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 clo2eed SAS or cesspool Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or cloQ2ed SAS or cesspool _V/ 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 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 SAS,cesspool or privy is below high ground water elevation. I 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. „ram Any portion of a cesspool or privy is within 50 feet of a private water supply well. ALZj 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 %%ater quality analysis. (This system passes if the well water analysis, performed at a DEP certified laboratory, 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, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this forma Ala (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as descrihed in 310 CMR 15.303. therefore the s"vstem fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: N119 To Ibe considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) 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—1WPA)or a mapped Zone 11 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. 4 Page 5 of I I OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 1821 Service Road West Barnstable, MA Owner: William Swift Date of Inspection: November 16, 2000 Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No information was provided by the owner. occupant. or Board of I1eakh Were any of the system components pumped out in the previous two weeks? Has the system received normal flows in the previous two week period? Have large volumes of water been introduced to the system recently or as part of this inspection? v/ _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) Was the facility or dwelling inspected for signs of sewage back up? v� _ Was the site inspected for signs of break out? v1 _ Were all system components,excluding the SAS, located on site? f _ 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? v/ _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on.the site has been determined based on: Yes no Existing information. For example,a plan at the Board of Health. vl 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(3)(b)) 5 . •Page 6 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION 1821 Service Road Property Address: West Barnstable,MA Owner: William Swift Date of inspection: November 16, 2000 FLOW CONDITIONS RESIDENTIAL 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): 3 3o Number of current residents: -3 Dces residence have a garbage grinder(yes or no): Ala Is laundn on a separate sewage system (yes or no):Ao_ (if yes separate inspection required] Laundry system inspected(yes or no):N/A Seasonal use: (yes or no): No Water meter readings, if available(last 2 years usage(gpd)): Pej v.r (,•�.-It Sump pump(yes or no):j) Last date of occupancy: p«,,a,e-a . COMMERCIAL/INDUSTRIAL A114 Tyne of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): 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/use: OTHER(describe): GENERAL INFORMATION Pumping Records Sourcc of information: A/o s/µ2�t i n _¢i/a:�_w��1 _f?arnsl.,l��i �c �.+.< } pl��r• Was system pumped as part of the inspection(yes or no): Ala If yes, volume pumped: gallons -- How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM Septic tank,distribution box,soil absorption system Single cesspool _ Overflow cesspool Privy _ Shared system(yes or no)(if yes,attach previous inspection records, if any) _ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank _Attach a copy of the DEP approval _Other(describe):. Approximate age of all components. date installed(if known)and source of information: rhs4-&.ham k /Z /Iy /s8 s-6,,:t4 r—t BoH- Were sewage odors detected when arriving at the site(yes or no): 4/0 6 •Paae 7 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1821 Service Road West Barnstable,MA Owner: William Swift Date of Inspection: November 16,2000 BUILDING SEWER(locate on site plan) Depth belo%% grade: 18`'t Materials of construction:_cast iron _Z40 PVC Zother(explain): i 1, _il„T P✓4- Di tance fron-; pri%ate water supply well or suction line: /oat-' Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: ,/ (locate on site plan) Depth below grade: 1 Material of construction:i/concrete_metal_fiberglass_polyethylene —other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no): _(attach a copy of certificate) Di_i-nensions: S' x g')r 6 ' /00o Sludge depth: /.21, Distance from top of sludge to bottom of outlet tee or baffle: �2 Scam thickness: I/ 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: /w, How were dimensions determined: Pro 6.&-. Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): p6LT� + �nrx Cthcr,cic_ t< uJ�tc+ w<✓� v 4( .r w�. ov.Acr. 7 ,G c�)C to G.i �J✓ ok­W 4.4, u o 0.S N if r -A-c�, /4 1 i rc t- ` .cn-l-cA . 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: Dale of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): 7 • Page 8 of 1 1 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1821 Service Road West Barnstable,MA Owner: William Swift Date of Inspection: November 16, 2000 TIGHT or HOLDING TANK: IVIA(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 Flo%%: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): )Nate of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: le,,,-( 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.): �0`13 ox W K f 7�v.,.� GV G C".,dA r. W o (rt,i `.c G.e f . ✓1 v G✓ �.c c.� U SD �. c1 C•�r�.. Duel Or �q,� o->t PUMP CHAMBER: A114(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.): L 8 Page 9 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM .PART C SYSTEM INFORMATION(continued) Property Address: 1821 Service Road West Barnstable,MA Owner: William Swift Date of Inspection: November 16, 2000 SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain wh). Type leaching pits, number: i ' (7 /X6 L-i t, h; V- w �� ;2 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.): 3._S /o w f c r W i /2+ cc v /+, c S-►a 2 en'), / �+ �.t✓ /�+oh b..tw,•F• ✓ �L�y� WO GUi t/f<v+G{ OY G'�rGA.0 �1 �- �. fJrt G✓ Pi`O�J�i Y.. 1 h �< �lh3�wt✓<- YL J`...( K•�' �t �4hC O� / 'IfPtG,,I•U 4�, CESSPOOLS:IJIA (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 or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: Al/I (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.): 9 -Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 1821 Service Road Property Address: West Barnstable,MA William Swift Owner.: November 16,2000 Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch 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. C.u.. �0% ; s �6, �1 35' bo' 17 /�OUy41l�h n�i3°X K-• Ss' a 10 Page 11 of 1 1 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 1821 Service Road West Barnstable,MA Owner: William Swift Date of Inspection: November 16, 2000 SITE EXAM Slope ✓ Surface water Check cellar Shallow wells Estimated depth to groundwater feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record If checked,date of design plan reviewed: V 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) —7 Accessed USGS database-explain: SDw S X Z 13 y7.y 3 a a A� You must describe how you established the high ground water elevation: . G✓--. -A w.+.Y'w I e_. l Pc c. ✓.A� ✓� O M hJ t It IO ti S by W c k 704 J- C�4 GWA now; 11 TOWN OF BARNSTABLE � I$2A LOCA'CIOW—a71,4GC_E3'5-ff l�A/l.Ycj� IfA EWAGE # �_`7�0 _ VILLAGE fdl d,19'e 5_7`9/3/If ASSESSOR"S MAP & LOTI ICI" 602- T O6 ij INSTALLER'S NAME & PHONE NO. Ase-"I SEPTIC TANK CAPACITY LEACHING FACILITY:(tyEe) o"XS.9.r i-e,:" r 6,d�(sire)/UayG�1�.�rT�� NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER //1��� BUILDER OR OWNER DATE PERMIT ISSUED: SS DATE COMPLIANCE ISSUED: _� Lq- VARIANCE GRANTED: Yes No ✓ f �7W V 115 ASSESSORS MAP NO:_ ?L i PARCEL NO: THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH .. ..............OF...---`4 sS Appliratiou for Uhip gal Workii Tonstrurtiun ami# A?plication is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: Location_Address r or Lot No. we fw�/. ----------------- Owner Address . a1l y--- .9 -.---C4.C................................. ......... 'e9.r1!�?�,Sr-�'il S• .......................................... Installer - � Address �ecif�'c/d�� d Type of Building Size Lot____________________ ____Sq--feet Dwelling—No. of Bedrooms........ ................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons____________________________ Showers ( ) — Cafeteria ( ) a' Other fixtures W Design Flow............13.0.....................gallons per person per day. Total daily flow___________-}.....................gallons. W Septic Tank—Liquid ca.pacit}%&O__gallons Length................ Width................ Diameter................ Depth................ Disposal Trench—No_ ____________________ Width__/?..__._._._ Total Length____ ....... Total leaching area_Y p---sq. ft. 3 Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by------ -____! ___________________ Date... 1Z2 Test Pit No. 1_<__�_-_minutes per inch Depth of Test Pit....A�_z__. Depth to ground water________________________ f14 Teat Pit No. 2................m_nutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 .-•---•••-------- - -------------------••-•------.......----.....----------•••-•••---•-....----•---- O Description of Soil_._-----1-----G i''±________.l��?�_____- .�!%eQ______ -__/f°L1 �fC_ �'So`�� x W x -------------------------------------------------------------------•----------------------•------------•-------------------------------------------------------------------•--------------------_---•-- V Nature of Repairs or Alterations—Answer when applicable............................................................................................... ---------•----------------------•---••---------------------------------------------------------------------••••-••--•-•-....-••-- Agreement: The undersigned agrees to install the sforedescribed Individual Sewage Disposal System in accordance with the provisions of iT i T.t,:. p 5 of the State Sa tar _Code—The undersigned further agrees not to place the system in operation until a Certificat of o 1• n s been issued by the boar of health. rgned.......... Date Application Approved By---------- t� CJ :r..-------•- — ----------- Date �6�` $ • Application Disapproved for the following reasons: ------------•----•----------•---•--•--------------------------------•-----•----...... ........................................................-----•---------••-•-----•-•-•-••-....---•-•--•-•- Date PermitNo $ _. ..' �....................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .r� .....................OF........ yzge��szd ...__.-------------.....---..-....._- Appliratinn for Disposal Works Tow3trttrtion Prrutit Application is hereby made for a Permit to Construct PC ) or Repair ( ) an Individual Sewage Disposal System at: A, ------------------------------- ................ -�!Z..... ............................................. Location_Address or Lot No. Owner y Address rf�....r_.._._...... ................................ .......,�` l ...... .5... = Installer Address Type of Building Size Lot_________•_________________ rfeeC .f U _Ex Expansion Attic Garbage Grinder Dwelling—No. of Bedrooms._.__ ______________________________ p ( ) g ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) } Q' Other fixtures -------------------------------- - W Design Flow............l0_.....................gallons per person per day. Total daily flow..____._•_�30.....................gallons. G; Septic Tank—Liquid capacitV ...gallons Length................ Width................ Diameter________________ Depth................ Disposal Trench—Nlo_ __________ _____•• Width__/Z.......... Total Length....�,I Z,.......... Total leaching area_y2Z-t...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.....60. -Z?.....&��................... Date... .7.............. ,.-I Test Pit No. 1 e__.�.__-_minutes per inch Depth of Test Pit.... !`_'•' ....... Depth to ground water________________________ Gi, Test Pit No. 2................minutes per inch Depth of Test Pit____________________ Depth to ground water........................ D Description of Soil..4 -k6-•----....��Cc Gc /Li--------� •6.�...... ......'i9..................................... x x --------------------------------------- -•-•••--•--•--•----•--------------------•----••••-••••••••------•••-•-••----------------•--•--•-----•----•-••-••••••--•--•••••-••••-••••••••---•---••-------•••- U Nature of Repairs or Alterations—Answer when applicable--------------------------------------------------------------•................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'41 ; of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certifica of, z01pi s been issued by the board of health. Signed------- .................................. ....------- Application Approved BY �` Y' .�: .. �_T__._= ' _...._.. ` S Date Application Disapproved for the following reasons:----••--------------•-------------------------------•---------•------------------------------------------._...-- ..............•-------•------••••----•---•-•-----•-•••-•••--•--•-----••-----•--••-•-•--------•-••----•----------•--••-•-•••••••••••-••••••-•----••-••••---•••--•••--•-••-----•-------•--•---••-•--•-•--- Date Permit No----- ...... .__:ZZO....................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...................OF...... ...�.-.2rv - 3 ......._..----....._......._... (Entif irtt#r of Tninplianrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ) or Repaired ( } by 4� - ----------------------------------------------------------------------------------------------------------- // Installer at..... 67 � •--•-•-----.•��� /'��G��S5 r{rQ'..>*1 ........................ has been installed in accordance with the provisions of Ti 'L�•,-j`of The State Sanitary Code as described in the application for Disposal Works Construction Perm�HALL ._____.7.?%........ dated_--_____________________--- ................. THE ISSUANCE OF THIS CERTIFICATE BE CONSTRUED'AS A GUARANTEE THAT IYHE SYSTEM WILL FUNCTION SATISFACTORY. \� DATE......................1..1....... y -----' Inspector.................. �..J -------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH o.•. ..7..' Q :TGLc�'ro O F.._-..-. ! ......................................................�- N + �1.�. FEE. ---�.....::...... Disposal Works Tonstration rantit Permission is hereby granted........� I:- L r"� 3f J i�C. to Construct (�( )�or Repair ( ) an Individual Sewage Disposal System at No.-----.G` /.._..._... Street �� —7 as shown on the application for Disposal Works Construction Permit No._;__•='._..___l-___. Dated���._'_�_:_cam_�_._........ ----••------------------------------- P:-------------- `--•------ f Health DATE............. ........................ FORM 3255 HOBBS & WARREN, INC., PUBLISHERS y LOCATION SCALE . ./N:. . . . DATE PLAN REFERENCE Tpf 4'F �7\ 14 411 /3lv_ v s We ��' �r p7Gro f "1 1 � � Lo7" / OF E*A. yes CELLEY N ° No. 26100 �Fs 9fC1 ST ER�� age" L Lp�D S� � 1 ' \ i TOP OF FOUNDATION CONCRETE COVER CONCRETE COVERS 9Qo' 4"CAST IRON ff2"MAX. rrmr 12"MAX. a OR SCHEDULE 40 4"SCHEDULE 40 P.VC.(ONLY) P.V.C. PIPE PIPE - MIN. � Ler}cH PITCH 1/4"PER.FT PITCH I *P R/4 E .FT. c - - Tau'' PRECAST \—INVERT e �Lx32' ° EL.1.3G,.8o V INVERT INVERT ' � °•, SEPTIC TANK i3So3 DIST. /3FC6 �i' e INVERT EL... .. . . . . BOX EL......... ',. ���� •• •• GAL, INVERT INVERT p'F�i$0 3A"TO I I/2 a; E ......-. WASHED STONE e.'+• , /� Imo--- 3 zcov.�7�7Lt� PROF! LE OF GROUND WATER TABLE SEWAGE DISPOSAL SYSTEM NO SCALE SOIL LOG WITNESSED BY DATE TIME. . . .. . . . . . . .T�Tc2� �uy�/�{./G BOARD OF HEALTH TEST HOLE I TEST HOLE 2 e- ENGINEER ELEV. ./4/./o . . . ELEV. �37 7d W�•ooLoFta� WooDGcRr/ Su DESIGN DATA sag-so,c. 4B" e-so,� 3 EZ, /33,7o NUMBER OF BEDROOMS HAD' SRO TOTAL ESTIMATED FLOW . . '�3� . . . GALLONS/DAY 7z° A�,�p_ L Ice E�Z/3Z.7o BOTTOM LEACHING AREA 38 o . SQ.FT. /PIT/c,/,p /-E 6 4°Z_ /3.S,i,> SIDE LEACHING AREA . . . 9. . . SO.FT./ PIT/noCp,,D, ME7� GARBAGE DISPOSAL AREA INCREASE) CesA'RS� SAD � A TOTAL LEACHING AREA 47z- v SQ.FT PERCOLATION RATE .LL S �?`! 7WO MIN/INCH LEACHING AREA PER PERCOLATION RATE .6"¢. . SQ.FT./C;/?D, !Vd_WATER ENCOUNTERED NUMBER OF LEACHING PITS APPROVED . . . . . . . . . . . BOARD OF HEALTH `�So2S Wi77 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . DATE . . . . . . . . . . AGENT OR INSPECTOR LLEY is cF OF hf4-S Zo7 # ED R .S&-JZVICe /Zp/�j 0 o. 26100 ih/G�T9Fc1STmR�° e ` t PETITIONER $ ss�®SAL L,��S`� Centerville-Osterville-Marstons Mills Fire District Water Department P.O. BOX 369 - 1138 MAIN STREET - OSTERVILLE, MASSACHUSETTS 02655 �E OFFICE OF u WATER i BOARD OF WATER COMMISSIONERS ?i DEPT. WATER SUPERINTENDENT 9 v �STONS lf` April 21 , 198.7 44 Heralith 'DeparfinentM 4 • ',� FTown 1of' Barnstable 1; Town Hall- Hyannis , MA 02601 h . Re: Availability of to ri water Dear Mr. Kelley: Please be advised that town water is not available at Lhis time f.or parcel, #2 , assessors map #194 on the service road-. Very tru s , Jon R. Erickson Adr�. Assistant JRE/ec enc. Department ofEnvirbnm"tal.Management/Division of Water Resources i WAfER WEI-L COMPLETION REPORT WELL LOCAAION Address tF'EaViLz City/Town N std.41/7_ M4 5S AV 64 G.S.Quadrangle Map Grid Location �+ y- Owner[& ✓4,h't:/ _ Address&--x///0$ R�✓,s�� , �_�q S�j ELL USE CONSOLIDATED WELL Domestic Public ❑ Industrial ❑ Type of Water-bearing ock Other Water-bearing Zong�i 1) From ��f To Method Drilled L 2) From To Date Drilled �_ _ q0 3) From _ To 4) From To CASING Depth to Bedrock Length Diameter__ Type.. UNCONSOLIDATED WELL STATIC WATER LEVEL Water-bearing Materials Feet below land surface_ Sand: fine❑ medium❑ coarse❑ Date measured row Gravel: fine❑ medium❑ coarse[!� GRAVEL PACK WELL Screen.: Yes No [� Slot#44length fromZ�to�Q ❑ Split Screen (or 2nd screen) WATER Ql}?rl ITY TESTS MAt)E Slot 9 lenqth from to Chemical � Biological I`yJf Depth To Bedrock PUMP TEST Drawdown tofeet after pumping days hours at GPM. How measured, Recovery��ket after_ hours. LOG of FORMATIONS COMMENTS: (On well or water) Materials From To o m DRILLER V U Firm `d.iG(l 2 d-s; f �1�f). (U Address A if City /N D x Registration o. � Q� s perato s ign" ature Please print orm y CUSTOMER COPY 2SM-10-85-807101 Department of 6nvl nmerta'i Management/Division of Water Resources r� r.• WATER' WELL COMPLETION REPORT WELL LOCATION s�� V /)- N�f) , ,y ywI t�A Address City/Town G,/d/J_l �I tt eU� /#fa�/ /"! �� /•/�` G.S.Quadrangle Map Grid Location Owner(yd/ 5&,/AC' Addressl3l7X /Q y 1?.44 /S/'A�,.( NI�S4 /WELL USE CONSOLIDATED WELL Domestic 0 Public ❑ Industrial ❑ Type of Water-bearing Rock Other Water-bearing ZoneOW 1) From To Method Drilled �s r ,,r�tt�� 2) From / To Date Drilled c' 4 0 1 MI,,/ 3) From To 4) From To CASING Depth to Bedrock Length /01 Diameter Type PVC_ UNCONSOLIDATED WELL r STATIC WATER LEVEL Water-bearing Materials Feet below land surface �� Sand: fine❑ medium❑ coarse❑ Date measured C04 ..� /�/ ^1 Gravel: fine❑ medium❑ coarse Q' Screen: GRAVEL PACK WELL / g �toLL1 ❑Yes ❑ No Slot#/ len th from Split Screen (or 2nd screen) WATER QUALITY TESTS MADE Slot/F length from to �Chemical QBiological ® Depth To Bedrock PUMP TEST Drawdown eet after pumping days S hours at //5 . GPM. How measured 4APJ- Recovery 5'4�41'/Beet after / hours. LOG of FORMATIONS COMMENTS: (On well or water) Mat Fro m om y To _Anc m naf4 ell f DRILLER /� ,,pp Al J n►A - oZfJ (� Firm •(�1/�!� 4 IA'd 1� Wl, f C) 6 A( Address 27 ///SAV A A I) City l/�� Registration No. a 'IT' Aerator's ignature print pnr firmly BOARD OF HEALTH COPY 25M-to•b5•So1111 OFFICE RY R �1498 HIGH STREET 176 PLYMO THOSTREET BRIDGEWATER, MA 02324 BRIDGEWATER, MA 02324 OLIVEIRA ENVIRONMENTAL LABORATORIES, INC. FOOD- DAIRY PRODUCTS-WATER-WASTEWATER CHEMICAL Et BACTERIOLOGICAL ANALYSES 697-2650 October 8, 1987 L. Wile & Son Drilling Co. 11 Annasnappitt Drive Plympton, Mass. 02367 Source: Well Water - 4" PVC Well - 120 feet deep - producing 10 gals/mina Located on the property of Mr. Will Swift - Service Rd. , W. Barnstable, Mass. Coliform Count /100 ml @ 35 C 0 Membrane Filter S.P.C./ml @ 35 C 2,200 Color (APC units) 0.00 Sediment slight Turbidity (NTU) 5.00 Odor none Taste satisfactory pH 6.80 Specific Conductance micromhos/cm 55.0 mg /liter Total Alkalinity (CaCO3) 12.0 Free CO, 3.72 Total Hardness (CACO,) 8.00 Calcium (Ca) 2.40 Magnesium (Mg) 0.49 Sodium (Na) 9.00 Potassium (K) 0.43 Total Iron (Fe) 0.09 Manganese (Mn) L 0.01 Silica (Si0,) 11.5 Sulfate (SOO L 1.00 Chloride (CI) 9.50 Nitrogen - Ammonia 0.05 Nitrogen - Nitrite 0.003 Nitrogen - Nitrate L 0.10 Copper (Cu) _ L = less than On site collection made by L. Wile & Son - 10/6/87.at 2:00 P.M. Sample delivered to laboratory by Mr, Paul Frenchko of L. Wile & Son Well Drilling Co. - 10/6/87 at 4:00 P.M. Bacteriologically, this well water is of a satisfactory sanitary standard and is suitable for drinking and domestic purposes. Chemically, this well water meets the standards for all of the chemicals tested. ` r -Director The Standard Plate Count indicated the general bacterial population of the well at the time of collection. Coliform Group Bacteria: Significance The coliform group bacteria includes organisms found in the intestinal tracts of warm blooded animals, birds,decaying organic matter(hay, leaves, wood, etc.), the top 2 to 3 feet of the soil, lakes, ponds, brooks, rivers, drainage and types of vegetation. Because the organisms can cause some illness; because the presence of coliform organisms in the water suggests that other more harmful organisms may be present, water containing one or more coliform group bacteria per 100 ml of sample should not be used for drinking or cooking purposes unless boiled 5'minutes or disinfected by other means. This bacteria is of animal origin(intestinal tract)and may be considered as closely associated with disease causing organisms.On this factor, none should be present. Color — APC Units- Ground water ought to be practically free from color. For attractive water- color should not exceed 15 units. Turbidity — NT Units - Recommended limit not to exceed 5 units. Odor Et Taste — For water to be of high quality, the water should be odor free and taste good. pH — The pH value defines the concentration of free hydrogen ions in solution. Expressed on a scale extending from 0 or very acid to 14 or very alkaline with 7.0 being neutral. Specific Conductance — Conductivity is a good criterion for measuring the degree of mineralization and assessing the affect of diverse ions on chemical equilibria. Total Alkalinity — The alkalinity of this water represents its content of carbonates and bicarbonates. Free Carbon Dioxide — Well water having a low pH and a Free CO, level in excess of 50. mg/I will be corrosive to iron, bronze, brass and copper tubing and fittings. Total Hardness — Standard not to exceed 50. mg/I. Waters having a hardness level of 50 to 100 are in the medium hardness range, over 100 very hard. Calcium -- Calcium contributes to the total hardness of water.Appreciable amounts of calcium salts break down on heating and form scale in boilers, pipes and cooking utensils. Magnesium — Magnesium is a common constituent of natural water. Magnesium and calcium ions are principal contributors to water hard- ness. Concentrations in excess of 125 mg/I can exert a cathartic and diuretic action. Sodium — Recommended limit not to exceed 20 mg/I. Potassium — Potassium concentrations in drinking water seldom exceed 20. mg/l. Total Iron — Standard not to exceed 0.3 mg/I. Manganese — Standard not to exceed 0.05 mg/I.The principal reason for limiting the concentration of manganese is to reduce esthetic and economic problems. Silica — Silica content of natural water is most commonly in the 1 to 30 mg/I. Silica in water is undesirable because it forms difficult to remove silica scales. Sulfates — Standard not to exceed 250 mg/I. Chloride — Standard not to exceed 250 mg/I. Nitrogen — Ammonia is present in variable concentrations in many surface and ground waters.Its occurrence in ground water is generally a result of natural reduction processes. Nitrogen - Nitrite — Nitrite in water poses a health hazard, but fortunately seldom occurs in high concentrations. Waters with a nitrogen - nitrite concentration over 1 mg/1 should not be used for infant feeding. Nitrogen - Nitrate — Standard not to exceed 10. mg/I. Nitrate, in high concentrations can and do cause methemoglobinemia or so-called nitrate poisoning in infants.Water with 10 or more mg/I of nitrate is unsatisfactory and is not considered safe for drinking or cook- ing. It is especially dangerous to children and should never be used in infant formulas. Copper — Standard not to exceed 1.0 mg/I.