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HomeMy WebLinkAbout0325 WILLOW STREET - Health 325 Willow'Awame W. Barnstable A = 131 019 ' e f hoe 325W`It TON OFBARNSTABLE LOCATION U)Q,5'f BACASI a3le_ SEWAGE# 2.cm8 -3z$ VILLAGE - ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. �; SEPTIC TANK CAPACITY 1500 G A L { -Z a LEACHING FACILITY:(type) `TC edict es S (size) t 8'L A Z'W X Z.,D NO.OF BEDROOMS ' 3 OWNER PERMITDATE: A-!-0q COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility i2 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 6Apew J e- LLL � Z a4 1 13. 1 i9 B Z7 t8 a YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must.do by M.G.L.-it does not give you permission to operate.] You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. DATE: , ._ Fill in please; :.. APPLICANT'S YOUR NAME/6- -F- . '��_4'f �. i� l c_�„ BUSINESS YOUR HOME ADDRESS: VaLv, z S0 -L- 3 4rA i t TELEPHONE # Home Telephone Number 5 o -L r ME OF CORPORATION: ME OF NEW.BUSINE55 a a C ' k-.cTYPE OF BUSINE58_C „ c c> ,� LHIS A HOME OCCUPATION? X YES N❑ - ADDRESS OF BUSINESS 4 Z G, L� a, ��L. U`a _ , \� MAP/PARCEL NUMBER (Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street) .t❑ make sure you have the appropriate permits and licenses required to legally operate your business In this town. I. BUILDING COMMISSIONER'S O E This individual has been r d of any er it requirements that pertain to this type of business. A th rued Signature** ' MUST COMPLY WITH HOME OCCUPATION COMMENTS: L v ULES AND REGULATIONS. FAILURE TO IF 2. BOARD OF HEALTH This Individual has ben iryfgg me l^of the permit requirements that pertain to this type of business, MUST COMPLY WITH ALL Authorized'Signature** HAZARDOUS MATERIALS REGULATIOI COMMENTS: S. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has bean informed of.the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: co YJ � Date:6/ /S/ �N TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS - NAME OF BUSINESS: 01 0`o, ,, BUSINESS LOCATION: 3Z S w. \\o.,_, S W �� ���� t�K-�1�JNVENTORY MAILING ADDRESS: Z S �,.� .\�� S ��v,,, ��c.1t,�e MaTOTAL AMOUNT: TELEPHONE NUMBER: 5c)(B CONTACT PERSON: o—� c--\c..- 7) EMERGENCY CONTACT TELEPHONE NUMBER: 5 o 1 S 1 \ MSDS ON SITE? TYPE OF BUSINESS: INFORMATION/RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The board of health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal Printing ink Degreasers for driveways &garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) Z c,a� Any other products with "poison" labels ❑ NEW ❑ USED (including chloroform, formaldehyde, c� Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes Laundry soil &stain removers (including bleach) Spot removers &cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash I WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS A licant's Signature Staff's Initial's v i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments G M , 325 Willow St Property Address MULLIN, WILLIAM D, JR & LINDA L Owner Owner's Name information is required for every West Barnstable Ma 02668 2/22/2014 page. Citylrown State Zip Code Date of Inspection 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. Important:When filling out forms A. General Information on the computer, use only the tab 1. Inspector: n key to move your \1 I 1 O cursor-do not Sean M. Jones use the return Name of Inspector key. S.M.Jones Title V Septic Inspection Company Name 74 Beldan Ln. Centerville Ma 02632 Clty7rown State Zip Code 774-248-4850 smjonestitle5@gmail.com S14522 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. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fao; ❑ Needs Further Evaluation by the Local Approving Authority 2/22/;014 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. t5ins•3/13 Title 5 OfficV,. ormbsurface Sewage Disposal System-Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 325 Willow St Property Address MULLIN,WILLIAM D, JR& LINDA L Owner Owner's Name information is required for every West Barnstable Ma 02668 2/22/2014 page. Cityrrown 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: The dwelling located at 325 Willow St West Barnstable is served by a Title V septic system consisting of a 1500 gallon septic tank, distribution box and a 18'x20'x2' leach field. The system was found to be in proper working condition at the time of inspection. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. 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): .r a I • i 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 a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 325 Willow St Property Address MULLIN, WILLIAM D, JR & LINDA L Owner Owner's Name information is required for every West Barnstable Ma 02668 2/22/2014 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ 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): ❑ 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 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 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 325 Willow St Property Address MULLIN, WILLIAM D, JR & LINDA L Owner Owner's Name information is required for every West Barnstable Ma 02668 2/22/2014 page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) 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 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: i Yes No ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded s or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 325 Willow St Property Address MULLIN, WILLIAM D, JR & LINDA L Owner Owner's Name information is required for every West Barnstable Ma 02668 2/22/2014 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® 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- 1.0,000gpd. ❑ ® 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. 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments , 325 Willow St Property Address MULLIN, WILLIAM D, JR & LINDA L Owner Owners Name information is required for every West Barnstable Ma 02668 2/22/2014 page. Cityrrown 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 ❑ ® 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? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ 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? ® ❑ 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? ® ❑ 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: ® ❑ 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): 343 gpd provided t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 325 Willow St Property Address MULLIN, WILLIAM D, JR & LINDA L Owner Owner's Name information is required for every West Barnstable Ma 02668 2/22/2014 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ 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 (gpd))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: current 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M , 325 Willow St Property Address MULLIN, WILLIAM D, JR& LINDA L Owner Owner's Name information is required for every West Barnstable Ma 02668 2/22/2014 page. Cityrrown 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: Was system pumped as part of the inspection? ❑ Yes ® No 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)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 G M , 325 Willow St Property Address MULLIN, WILLIAM D, JR & LINDA L Owner Owner's Name information is required for every West Barnstable Ma 02668 2/22/2014 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: system installed 8/21/2008 per town records Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1 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.): Joint were ok, no leaks, vented through the roof Septic Tank(locate on site plan): Depth below grade: .5 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: 1500 gallons Sludge depth: 61. t5ins•3113 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 9 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 325 Willow St Property Address MULLIN, WILLIAM D, JR & LINDA L Owner Owner's Name information is required for every West Barnstable Ma 02668 2/22/2014 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 3" Scum thickness 3" 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 10" How were dimensions determined? opened covers, took measurements 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 does not need to be cleaned now but should be done soon and again every 2 years for proper maintenance. water level was even with outlet, tank was not leaking and was structurally sound. Tank is located in driveway and is H-20 with steel covers to grade. 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 325 Willow St Property Address MULLIN, WILLIAM D, JR& LINDA L Owner Owner's Name information is required for every West Barnstable Ma 02668 2/22/2014 page. Cityrrown 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 ,.' 325 Willow St Property Address MULLIN,WILLIAM D, JR & LINDA L Owner Owner's Name information is required for every West Barnstable Ma 02668 2/22/2014 page. Citylrown 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.): Distribution box was video inspected and was found to be in good condition, no rot, water level was even with outlet invert. 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 �e Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 325 Willow St Property Address MULLIN, WILLIAM D, JR & LINDA L Owner Owner's Name information is required for every West Barnstable Ma 02668 2/22/2014 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ® leaching fields number, dimensions: 1 18'x20'x2' ` ❑ 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.): No sign of hydraulic overloading, vegetation normal. I 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 Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 325 Willow St i Property Address MULLIN,WILLIAM D, JR& LINDA L Owner Owner's Name information is West Barnstable Ma 02668 2/22/2014 required fcr every page. Cityrrown State Zip Code Date of Inspection D. System Information (cost.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 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.): t t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 325 Willow St Property Address MULLIN, WILLIAM D, JR & LINDA L Owner Owner's Name information is required for every West Barnstable Ma 02668 2/22/2014 page. Cityrrown 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 4 D j! �3 �S•S . � W 1 19 � a . 33 ,3q t5ins-3/13 £ Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 , Commonwealth of Massachusetts Title 5 Offlicial Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 325 Willow St Property Address MULLIN,WILLIAM D, JR & LINDA L Owner Owner's Name information is required for every West Barnstable Ma 02668 2/22/2014 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: 12'+ 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: 6/3/2008 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: design plan dated 6/3/2008 indicates that no groundwater was encountered at 12'and system is designed to have 5' seperation between bottom of s.a.s. and adjusted groundwater elevation. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments c�M 325 Willow St Property Address MULLIN,WILLIAM D, JR & LINDA L Owner Owner's Name information is required for every West Barnstable Ma 02668 2/22/2014 page. Cityrrown 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 01/13/2011 THU 15: 29 FAX 5083627103 Barnstable CTY HealthLab Barnstable Health 0001/001 l 8 t as CERTIFICATE OF ANALYSIS Page: 1 Barnstable County Health Laboratory Report Prepared For: Report Dated: 1/13/2011 William Mullin Mullin,Jr.William D.,Custom Builder Order No.: G1160797 325 Willow St. West Barnstable, MA 02668 Laboratory ID#: 1160797-01 Description: Water-Drinking Water Sample* Sampling Location: 325 Willow St.West Barnstable,MA Collected: 1/10/2011 Collected by: W.Mullin Received: 1110/2011 Routine i ITEM RESULT UNITS RL MCI, Method h Tested Nitrate as Nitrogen ND mgq. 0.10 10 EPA 300.0 Ii 10/2011 Copper ND md0, 0.10 13 SM 311111 Ul l/2011 f Iron ND mg/L 0.10 0.3 Sfvl3lliB lilt/20[l i pH 6.4 PH AT 25C NA 6.5-8.5 SM 4500-H-9 U10/2011 Sodium 64 mg,'L 1.0 20 SM 311111 1 i 11I2011 f Total Coliform Present P/A 0 0 SM9223 U10/2011 Conductance 390 umohs/an 2.0 EPA 120.1 lill/2011 The recommended maximum contamination level for drinking water exceeded due to Coliform Bacteria and Sodium. Those on a low sodium diet may wish to consult a physician.Retesting is recommended. Attached please find the laboratory certified parameter list. Approved B -- irector) j i i { j - i i {sFI E F F ND=None Detected RL= Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph:508-375-6605 F CERTIFICATE OF ANALYSISPage: 1 Barnstable County Health Laboratory assECFi� �I Report Prepared For: Report Dated: 5/14/2008 William Mullin Order No.: G0846138 199 Back Shore Road Round Pond, ME 04564 Laboratory ID 4: 0846138-01 Description: Water-Drinking Water Sample 4: Sampling Location 32-Willow SVW.-Barnstable;MA• Collected: 5/13/2008 Collected by: W.Mullin Map 131 Parcel 19 Received: 5/13/2008 Routine ITEM RESULT UNITS RL MCL Method# Tested Nitrate as Nitrogen ND mg/L 0.10 10 EPA 300.0 5/13/2008 .:rr,,:. -•,?6 m_!1, 10 _ M 31.1 1 B 51140008 i Iron 0.12 mg/L 0.10 0.3 SM 3111B 5/14/2008 Sodium 61 mg/L 1.0 20 SM 311113 5/14/2008 Total Coliform Absent P/A 0 0 SM9223 5/13/2008 Conductance 490 umohs/cm 2.0 EPA 120.1 5/13/2008 pH 6.8 pH-units 0 SM 4500 H-B 5/13/2008 Sodium level is above the maximum contaminant level. Those on a low sodium diet may wish to consult a physic it. Approved By: (Lab D cfor) •- tiz: ND=None Detected . RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 Y lime Town of Barn ,w stable P# Department of Regulatory Services RAMMABMi Public Health Division Date bees 163 200 Main Street,Hyannis MA 02601 Date Scheduled Vd?Tlime Fee Pd. , ,{• Soil Suitability Assessment for Sewage Disposd Performed By Witnessed By: >. LOCATION& GENERAL INFORMATION Location Address R5 W tllory '6'I'w+ Owner's Name M or� Cacti h0 ,�tri4labLC_ Address ;2s b`1116w �+ W, f boar n 410 b 14— Assessor's Map/Parcel: I�10 1 q Engineer's Name)*(-,t W�fi kr1 GTowp NEW CONSTRUCrIOIN REPAIR Telephone#;OS $1S &&-O p Land Use �C�ot Slopes(%) Surface Stones Distances from:from: Open Water Body 7V-0 0 ft Possible Wet Area j1'—&0ft Drinking Water Well 71$d ft Drainage way -71 0 ft Property Line Z<). ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) Parent material(geologic) Depth to Bedrock N 1 A Depth to Oroundwater. Standing Water in Hole 00 P-4--0 b64" Weeping from Pit Face NIM.o Estimated Seasonal High Groundwater 29' la �U n� V.W-�f DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: __ ___In. Depth to soil mottles: In. Depth to weeping from side of obs.hole: —in. Groundwater Adjustment ft: Index Well# Reading Date: Index Well level -, AdJ,faetoor Adj.aroundwater Level PERCOLATION TEST Dates xl, FL `gym Observation Hole# 1 Q- 1 11ne at 9" .,,_. Li Depth of Perc 7 5 HE Time at 6' �? c Start Pre-soak Time @ b', a� ".ime(9"-6") �IOtrV End Pre-soak Rate MinJInch \ Site Suitability Assessment: Site Passed _ Site-Failed: Additional Testing Needed(Y/N)�� a Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100'of wetland,you must first notify the, Barnstable Conseirvation Division at least one(1)week prior to beginning. Q:1.SEPTICIPERCFORM.DOC DEEP•OBSERVATION HOLE LOG Hole# 0 Depth from Soil Horizon Soil Texture Soil Color Soil other Surface(in:) (USDA) , (Munsell) Mottling (Structure,Stones,Boulders. Consistengy.,%Gtivell ©�to w.,I2Li r& �. IQ-IS �.� lrL�l�. 5 j S Z la �2 7(8 Flo G Z'lo.L y8 *'I C a, 5 �� �3 1crn 1r, .4,L_ /Vt 5 1 o K 5�`I mo,�s�v va�os� co�c DEEP OBSERVATION HOLE LOG Hole# 2- .Depth from Soil Horizon Soil Texture' Soil Color Soil other _ Surface(in.) (USDA) (Munsell) -"'-Moulidg (Structure,Stones,Boulders. nsi a-1P, S1, Io H(L W I i to �(0 IS-- Sir:) c-1 2, o .. f StZ, to 17(L tlI3 1tm»1 4u- bl' �r��'i rc to�et5 S a13'1- ( 3 S Ito 4rL 6 ) F row e DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color. Soil offer Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consi tency.%Gravel) DEEP OBSERVATION HOLKLOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones:Boulders. Consistency, _ Flood Insurance Rate Map: Above 500 year flood boundary No— 'Yes .. Within 500 year boundary No I X Yes Within 100 year flood boundary No "� Yes Depth of Naturally'Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pervious material? Certification �.- I certify,that on'V ti� 1 (date)I have passed the soil evaluator examination appioved'by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training,ex ertise and experience described in 310 CMR 15.017. Signature Da 29 Q:4S.EP ICVERCFORM.DOC Town of Barnstable r# Department of Regulatory Services [� SAIVINTAI"i Public Health Division Date v —�k 9 0. 200 Main Street.Hyannis MA 02601 • z I Date Scheduled Time JU Fee Pd. Spa kildhility Assessment for Sewage Disposal Performed'By: V Wimessed:B : Y LOCATION&GENERAL INFORMATION Location Address 325 W,1}ovv S}C U'- Owner'sName i`Aor Cqr� W .�r»41ab1.t__ Address 32S W,I�w S Assessor's Mapmarcet. R I O 19 Engineer's Name -1 fa�y.l 11 yn (!fo lly ,/ NEW CONSTRUCTION REPABt v Telephone#ro0$ $3'3 Land Use W�o 8,-S slopes(%) .O--I Surface stones (�OTX/— Distances from: Open Water Body-7 VO D a Passible Wet Area rC ft Ihinkin8 wale wen 7152 ft F: Drainage way -7)ID O ft Property Line Z, . ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&pert tests,locite wetlands in proximity to holes) F - . Parent material(geologic) Depth to Bedrock Depth to Groundwater. Standing Water in Hole:tA°r1J 1D b&4\K� Weeping from Pit Face Estimated Seasonal High Groundwater Qa Ln DETERMINATION FOR SEASONAL HIGH WATER TA ,LE Method Used:- Depth Observed standing in obs.hole: In. Depth to soil mottles: Depth to weeping from side of obs.hole: in, Groundwater Adjustment.._. % V, lndex Well# Reading Date: Index Well level Adj.flletcr Adj.Groundwater Level PERCOLATION TEST D9105 mr -taFL �; Observation Hole# P-1 71me at 9" Depth of Pat Time at 6" r? = , Staff Prosoak Time @ b'• Al+� Time(9"-6") iJ mrti End Pre-soak Rate MinAach Site Suitability Assessment Site Passed Site-Failed:— Additional Testing Needed(Y/N) V Original:Public Health Division Observation Hole Data To Be Completed on Back-- ***If percolation test is to be conducted within 1001 of wetland,you must first notify the. Barnstable Conservation Division at least one(1)week prior to beginning. Q:ISEPTIGIPERUORM.DOC f DEEP.OBSERVATION HOLE LOG Hole# Soil. other Depth from Soil Horizon Soil Texture Soil Color Mottling (Structure.Stones Booklets. Surface(in.) (USDA). (Mansell) l0'12qI,1 rc& 101i (o i L S L j 0(12 7 18 5�10 G Z I..�— bu��y 5 ,6 LiR'7 13 —`z t a sk��y � � rn.s yo ��s�� ma�suv-L Sa : �.codc► i.. DEEP OBSERVATION HOLE LOG Hole# Z- soil omen lepth from 'Soil Horizon Soil Texture Soil Color Mottling (Strucuae,Stones,Boulders. Surface(in) i z (t7SDA) (Mansell) ns' Z-y 5 fZ�s sue . iotil l(0 ° 33 .So 5 2 o k2�7�8 5`/6Cs 2�1n C. { �z St2 10-4 q�3 itm,ra�ta b�' �y •�. ,•...� �` ,7 ra,Tl K. 10 L5 10 'la sly DEEP OBSERVATION HOLE LOG Hole# j soil other I Depth from Soil Horizon Soil Texture Soil Color Mottling (Structure,Stoners,Boulders. i Surface(in-) (USDA) (MU➢sell) 13 i E DEEP OBSERVATION HOLE LOG Hole# 5011 Other Depth from Soil Horizon Soil Texture Soil Color Mottling (Structure,Stones.Boulders. Surface(in.) (USDA) (Munsel)) t Flood Insurance Rate Man: j Above 500 year flood boundary No_ 9 within Soo year boundary No QSL Yes Within 100 year flood boundary No X Yes _.._ Depth of Naturally Occurring Pervious Material out the Does at least four feet of naturally Occurring Pervious material exist in all areas observed through area proposed for the soil absorption system? If not.what is the depth of naturally occurring pervious material? Certification urination approved by the passed the soil evaluator examination I certify that on��� (date)I have pas performed by me consistent with Department of Environmental Protection and that the above anal'y sis was the required tri ning,ex rtise and experience described in 3 10 CMR 15.017. Date 29 Signature - ^.,.. •rrNvrRr`RORM.DOC No. . / ��Tt� Fee V THE COMMONWEALTH OF MASSACHUISETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZIppYication for 3fgpozar *pgtem Conotructfon permit Application for a Permit to Construct( ) Repair( ) Upgrade(iol Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No. 3Z5 W� �W Owner's Name,Address,and Tel.No. M ox y e \\o v� cJ�'t— Assessor's Map/Parcel 31 0 1, R Installer's Name,Address,and Tel.No. CCgdl-%)l&A� C LL XNV Designer's Name,Address and Tel.No. 1"CO���� GCR. 41$•4OLS C•� c o; ft0co z UiAa Type of Building: Dwelling No.of Bedrooms _ Lot Size 121y15 • Z sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures 2 Design Flow(min.required) gpd Design flow provided J gpd Plan Date d Number of sheets Revision Date Title �Z.�j \\11 UJ 2A - Size of Septic Tank l�j( ��p�s Type of S.A.S. Description of Soil Se O\ t,. C� L,5 's y1% Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board ,th. Signe Date b- z tip. Application Approved by Date Application Disapproved by: Date for the following reasons Permit No. 3 Wt Date Issued THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I M ^C&L DATA ^` _ . - - , ,.•s. �..i. . ...' .rv.�. ["�';a+H`"..r•.as^-" """."... _ �..::.a� �5�.,;.— ..—v''.r^v#.cr.._ _ r o. e e ..t. ,`"i"^'1 Fee THE,COMMONWEALTH OF MASSACKMETTS, Entered in computer. Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 7 . application for btgpogal 64p.5tem Congtructton Permit Application for aTermit to Construct( Repair( ,Upgrade(a bandon( ) ❑ Complete System ❑Individual Components Location Address r Lot No. (.�? G� \� "� ��` Owner's Name,Address,and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. �; CL '.� Designer's Name,Address and Tel.No.�, Type of Building: Dwelling No.of Bedrooms Lot Size ""1 ;} sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Desi n Flow'(min.required)g (,* .,.>C_ gpd Design flow provided ,_� ,� gpd -K Plan Date : � } ! .`, \\ Number of sheets Revision Date Title Size of Septic Tank tti(� -.,, \�,_,; Type of S.A.S. Descriptio'n`of Soil Nature of Repairs or Alterations(Answer when applicable) Pel,` ,_,(\ C .• "0 r Date last inspected: f Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board oMiva th. Signed / Date Application Approved by Date f 5 O Application Disapproved by: Date for the following reasons GG r Permit No. -�� 3 Date Issued 1 J ----------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded (�) Abandoned( )by r at ?�i > l , } ;. i �. e '� \ E has been.constructed in accordance f c� with the provisions of Title 5 and the for Disposal System Construction Permit No. _ >�^ 3 dated 5 Ja 0 Installer (� r, 3. C _� t e Designer #bedrooms ` 1) Approved design flow i gpd The issuance o£th's ermit hall not be construed as a guarantee that the system�VW.110?4 esd A o Date `!/( Inspector ----------------- ------- ---- —(--- �+� No. i-},�v� � � (7 —————— Fee 0 lJ THE COMMONWEALTH OF MASSACHUSETTS - PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS Migpogat *pgtem Congtruction Permit Permission is hereby granted to Construct ( ) Repair ( ) _Upgrade ( ) Abandon ( ) System located at j L� �,� J __�� 1,1 t i r •��.�1 c- and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the d�to o�f his peyr'mit. Date ' )0 o Approvel�.l y f - 09/03/2008 15:30 5088333150 HORSLEY WITTEN GROUP PAGE 01iC1 Ff?G1M":CP;PEtJIAE PAS N0. :5054283923 Aug. 26 2009 02'19PM P3 I y Town of Bar �le Regulatory Services Thorrtav F.Goiller,Director I BARMMA Public Health DIVlsion '"!�' Thomas McKean,:Director � ! 100 Niacin Street, I•Ly>annis,NIA 02601 Office; 509- G 464A FAic; 508-790.6304 I)atc: "'� ,Sewage'Perrmid Assomor's Maplllareel 131 ' 019 InA 1l r&_D�s an�r Cert' ratio >borm Resigner: Ir�stAlle>r: -, ��t� .�Q•;s�3 A(L(�rC9R; Add M. s' On i D0� ► �t a rtis�'was Issuer!a permit to instal{a I d e (installer septic syute O� W1 Ua t,.y2n,t&�Abaw' on a design drawn by (:address -� dated� • doslgner) 1 ,1,erlif Y that die sop& system refarcued above was.Installed substantial acc6rding to the daE ign, which may IttclUdO minor approved changes;Such as lateral reocatiOn ofth e di Wibi ition box and/or septic;tank. Str►pqut (if rcquind) was inspected and the soils wire f and satisfactory. I =fifv t)+atable septic ssy�sstem referenced above.:was i:I-talled with major changes (i.e. grcato than 10' lateral relcoaatien of the.SAS car aay ver6z-al relocation of any component of th eptic system) but In accordance with State:& Local Replations. Plait revision or eerti c as-built by dcslgrrer to fallow. Stripcut(if require ated and the soils ware and satisfactory. t� oF FIST PW t� m ( I r s Signature) - g eai e s SiL aurc). � (A Mix Hs ere) PL 5E JR O L LY,C. FuAL V S 4 CR'>t71�LtMATF. 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N"FOR SEASONAL FUGH WATER TABLE t� kdiM�d l,Jdn� i ' �'�' �llfh I nfdledlnpp In oR,, ^•^'..°� hr, iAolat m6all rn9lfla@I ._—. Iri. t qs lade ldudlmnelAnnPaM.fmle, gromt®aRtcr/1d�nARr1®nl 1� MgDm: InAealVelll�rel M,f.fhaedl,m�®_�Vl.ty�ndww!orLtiva � °'. Qhlf}Rmf&m PERCOIATIONTEST tMlra7onA1 .ant � Tuna of®„ } ftro MnA h {p: E91Q8:9nit�e'lly��esci�nt: Slro"I�Laea � � s5tr:'l�rllcd: hRrllAmnal4definRlVez�(YmU___L� s orl�lnnr:Fable Fig V%Blulsieso �'i' O�sm Tll�f)Pl male>9nrn TO t:nnpilot�d�n l�nCk----- pa q®fat Is to k condnew;MUD fy)r of wa land,you wme first�oflty the € �dg349t61��®4an�s¢v�floll Division al kaT i one(1)w0sk Prior to beenning• ' .`': " Q:\9&!R'FILSEQAL�t1R(b9,F3t3C fu � 3 I • h I FROI'h ::CAFEW I DI= FAX NO. :5084283928 Sep. 04 2008 11:06AM P2 I�EE(:3� 2�Ff 12 5 5®8833315® WORSL€V 4�ITTEN GROUP PAGE 02/..` D' ® OVA, C AlC:9 Lt)G. Rode�w� D }Rfi1t; lSItlib m Sa i1Ho,km edITUA a soy color sm 0" t,�r��.. , Stnt6xrFfltM Al9DA). (Asurt®alll mnag (Btnmulmso m.,DuRklem, i . r Si. i. S'I— �; �, iq•�`7 3 a ; — 5 � �4 o`l�—��l _ /11$� al1�.SI`•il ft��79'ev rt tct�� ._�. r s DM q$MAVATTION,BOLL LOG '( :I upph flown Im ttuhm 8o l to awo : soil calar Soil Olhar g• = f burla,wdn,) (MAC (AttrnealA lEewtang (svomlam stonoff,umthh". i I'I, �- 11 0 Esr+tl,n o�+�e bIP 4.0 DP I $RVA TI N7gIOL C. 1JOZC# �k IAsp[h tmM' owl koAm 96.11'mt6m Bolt ccamt ' 3td OArer �.t. F�uPleea in umn tnaunoar) I=(ow g l lPuOd[n;SYoao•. oritilux. E — I I , :t MEP OBSERV'AE9P N IIOZZ LOG Role# ra+` loll Olh PltpAl thaat 0dl Plerimia eo'{1�ttis® S1dlCgltv crM6uaag Nmevtats,(9 ' a Boadil . s t SIdA9®a N't.) (1180A) (tdunadll � . t f's• � 4+: ` '$ y���$[,• � AMvcS�y�rfl[mdheuadnry' N�� 'ram iN1UIdro86pS'ur6[pmdary ME 'W,- • W)Al1i[[1009mPflao01[dtltl6lry 19u� r Y #�.. ; total at cal fbtlr loot nFenatl wly oacw ft pal M,mtalerlAl allot in all Ilfwa t rved ehraoghout fhe tjm b fcw lite stall AbsWptlbe),yFtan[Z v*at l8 thl depth of tttl urslly a OMMInA ioerVICIM Wtadnl? ... + Y t:ePdfy t6nr. have pan%kl the mil evnlu®tor nx m9tmtlOA a rovctl tty the ;DcpnMM1t Of BHVItotmtMVAI Pnamot Ion epd lliat the above nfe>481A aee PcfDMwmd by TM comdetent wlda w l etRetto®nd c> (7b913]3.0)7. anewe damartbad fn: �t,. epte'f�uirod �, P DAM q=t T E_ { x i I : TOWN OF BARNSTABLE 325td1illy� sTtee,i LOCATION !Q.S i Barns t A3 ie_ SEWAGE# 2008 - Z$ VILLAGE ASSESSOR'S MAP&PARCEL t 8 \— O�9 i INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 1600 9-AL 14 -?,o LEACHING FACILITY:(type) 'Tfefic,�%es PO 5 (size) 4 C 8 P L X Z'W X 2�D NO. OF BEDROOMS 3 OWNER 13;11 Pal: 112 v� PERMIT DATE: COMPLIANCE DATE: 9- Z.i 'L00q Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility "`� �'� 1�- feet Private Water Supply Well and Leaching Facility(if any wells-exist on site or within 200-eet of leaching facility) feet Edge of Wetland and Leaching Facility(if any wetlands exist within 300 feet of leaching facility). feet FURNISHEDBY CAgew'Je- riYti�(�C `7p.5 C•t-L ' J 1 . 'I I I I n1 i4 0 F� 2 3 I ►3 i i g I I I ! Massachusetts Department of Environmental Management 118448 Office of Water Resources TYPE OR PRINT ONLY Well Completion Report 1'.WELL LOCATION GPS (OPTIONAL) LATITUDE LONGITUDE Address at.Well Location: 3 S t halo .. -�_ Property Owner: m ram- - �-�'— `� Sub division.Name Mailing Address: a�[ S City/Town: `ram ►`� �cr� � Cityrrown: C:;�r , . Assessors Map 1.3 Assessors Lot#: 61 NOTE: Assessors Map and Lot # mandatory if no street address available Board-of Health.permit obtained:- Yes. - Not Required ❑ Permit Number W 2 662.0 Datedssued'. 2.WORK PERFORMED 3.PROPOSED USE 4. DRILLING METHOD y New Well ❑ Abandon Domestic ❑ Irrigation ❑ Cable ,` ;Auger" ❑ Deepen ❑ Recondition ❑ Monitoring ❑ Municipal ❑ Air Hammer-NEI Direct Push Other otF.] Re lacee a "- ❑ Other 5. WELL LOG `" OC Unconsolidated Consolidated 6. SITE SKETCH (use permanent landmarks with distances) W 5ftrmeabilily — , N ca From (ft) To (ft) Low U) (D g m Other Rock Type O — S'7 IYX X x r-M-C Co_6blg5 t > S A w 11_-b W IS-rrz T 7. WELL CONSTRUCTION 8. CASING Total Depth Drilled 67 From (ft) To (ft) Casing Type and Material Size O.D. (in) Well Seal Type Date Drilling Complete -1- S'i — -49 , 9.SCREEN , . From (ft) To (ft) Slot Size ;. m Screen-Type and Material Screen Diameter 10. FILTER PACK/GROUT/ABANDONMENT MATERIAL 11. ADDITIONAL WELL INFORMATION Developed? [' Yes ❑ No From (ft) To (ft) Material Description"-_ Purpose Fracture Enhancement? ❑ Yes No Method Disinfected? Yes ❑ No 12. WELL TEST-DATA(PRODUCTION WELLS) 13.STATIC WATER LEVEL(ALL WELLS) Yield-\,Time Pumped Drawdown to Time Recovery to Depth Below Date Method (GPM)e'," (hrs &min) (Ft. BGS) (hrs&min) (Ft. BGS) Date Measured Ground Surface (FT) 10_1 14. PERMANENT PUMP(IF AVAILABLE) 15.NAMEIADDRESS OF PUMP INSTALLATION COMPANY Pump Description 10 C,-�4>5 Horsepower Ida DES m!t>W D U�)GL-L 1712c LL(t,( Pump Intake Depth W (ft) Nominal Pump Capacity ) 0 (gpm) l�k at7e_'3 a2LGAWS MA 16. COMMENTS �s�` �! �aG 5.3 6 - 17.WELL DRILLER'S STATEMENT This Well-.was drilled and/or aband ned under\my supervision, according to applicable rules . , and regulations, and this report ' complete and correct to the best of my knowledge. Dnller:Yu3Nt/1s� `�F kt T) (� Supervising Driller Signature: Registration #:I I 7 16141 ! - Firm: D r AMZ21_1 12 U)C--/_(_ 172l LL► Date: f Rig Permit#: I I V 10 I U NOTE: Well Completion Reports must be filed by the registered well driller within 30 days of well Completion. BOARD OF HEALTH COPY ENVIROTECHLABORATORIES,INC. MA CERT.NO.:M-MA 063 449 Rte. 130 Sandivich, MA 02563 508(888-6460) 1-800-339-6460 FAX(508)888-6446 CLIENT: Mrs. L.F. Cary LOCATION: 325 Willow St. ADDRESS: Box.283 W. Barnstable, MA 02668 W. Barnstable, MA 02668 COLLECTED BY. Desmond Wells SAMPLE DATE: 11/5/2002 SAMPLE TIME: 3:30PM WATER SAMPLE TYPE: New Well DATE RECEIVED: 11/5/2002 LAB I.D. #: 0211069 WELL SPECS.: 4'7 297 53' RESULTS OF ANALYSIS: Parameters Units Recommended Results Method Date Analyzed Limits Coliform bacteria /100ml 0 0 9222 B 11/5/2002 pH pH units 6.5-8.5 76.06 4500 H+ 11/5/2002 Conductance umhos/cm 500 240 120.1 11/5/2002 Nitrate-N mg/L 10.0 0.12 300.0 11/5/2002 Nitrite-N mg/L 1.00 < 0.004 300.0 11/5/2002 Sodium mg/, 20.0 38.1 200.7 11/5/2002 Iron mg/L 0.3 < 0.1 200.7 11/5/2002 Manganese mg/L 0.05 < 0.008 200.7 11/5/2002 Volatile Organics See Report Chloroform ug/L 80 2.4 EPA 524.2 11/14/2002 COMMENTS: pH is below recommended limit and may have corrosive characteristics. Sodium level is not a health hazard, but if on a low sodium diet, consult a physician before drinking. WATER MEETS EPA STANDARDS AND IS SUITABLE FOR DRINKING PURPOSES FOR PARAMETERS TESTED. ND= None Detected. j <=less than >=greater than TNTC=too numerous to count Date l l 2 Ro Id J. Saari Lab ratory Dire for R.I. Analytical Specialists in Environmental Services CERTIFICATE OF ANALYSIS Envirotech Laboratories, Inc. Date Received: 11/06/02 Attn: Mr. Ron Saari Date Reported: 11/15/02 449 Route 130 P.O. #: Sandwich, MA 02563 Work Order #: 0211-14738 DESCRIPTION: L.F. CARY (ONE DRINKING WATER SAMPLE) Subject sample(s) has/have been analyzed by our laboratory with the attached results. Reference: All parameters were analyzed by U.S. EPA approved methodologies. The specific methodologies are listed in the methods column of the Certificate Of Analysis. Data qualifiers (if present) are explained in full at the end of a given sample's analytical results. Certification#: RI-033, MA-RI015, CT-PH-0508, ME-RIO15 NH-253700 A & B, USDA S-41844, NY-11726 If you have any est ons regarding this work, or if we may be of further assistance, please contact us. Approved y Paul t11 Data ortin an ger enc C ain f usto y 4 Illinois Avenue,Warwick, RI 02888 131 Coolidge Street, Bldg 2, Hudson, MA 01749 el:(401) 737-8500 Fax: (401) 738-1970 Tel:(978)'568.0041 Fax: (978) 568-0078 Page 2 of 3 R.I. Analytical Laboratories, Inc. CERTIFICATE OF ANALYSIS Envirotech Laboratories, Inc. Date Received: 11/06/02 Approved by: Work Order# 0211-14738 R.I. Analyti Sample#: 001 UX SAMPLE DESCRIPTION: 0211069 325 WILLOW STREET, BARNSTABLE GRA 04/02 @1530 SAMPLE DET. ANALYZED PARAMETER RESULTS LIMIT UNITS METHOD DATE/TIME ANALYST Volatile Organic Compounds Bromodichloromethane <0.5 0.5 ug/I EPA 524.2 11/14/02 18:47 NPV Bromoform <0.5 0.5 ug/I EPA 524.2 11/14/02 18:47 NPV Dibromochloromethane <0.5 0.5 ug/I EPA 524.2 11/14/02 18:47 NPV Chloroform 2.4 0.5 ug/I EPA 524.2 11/14/02 18:47 NPV 1,2-Dibromoethane(EDB) <0.5 0.5 ug/I EPA 524.2 .11/14/02 18:47 NPV Benzene <0.5 0.5 ug/I EPA 524.2 1'1/14/02 18:47 NPV Carbon'Tetrachloride <0.5 0.5 ug/l EPA 524.2 11/14/02 18:47 NPV 1,2-Dichloroethane <0.5 0.5 ug/I EPA 524.2 11/14/02 18:47 NPV Trichloroethene <0.5 0.5 ug/I EPA 524.2 11/14/02 18:47 NPV 1,4-Dichlorobenzene <0.5 0.5 ug/I EPA 524.2 11/14/02 18:47 NPV 1,1-Dichloroethane <0.5 0.5 ug/l EPA 524.2 11/14/02 18:47 NPV 1,1,1-Trichloroethane <0.5 0.5 ug/l EPA 524.2 11/14/02 18:47 NPV Vinyl Chloride <0.5 0.5 ug/I EPA 524.2 11/14/02 18:47 NPV Bromobenzene <0.5 0.5 ug/l EPA 524.2 11/14/02 18:47 NPV Bromomethane <0.5 0.5 ug/I EPA 524.2 11/14/02 18:47 NPV Chlorobenzene <0.5 0.5 ug/I EPA 524.2 11/14/02 18:47 NPV Chloroethane <0.5 0.5 ug/I EPA 524.2 11/14/02 18:47 NPV Chloromethane <0.5 0.5 ug/I EPA 524.2 11/14/02 18:47 NPV 2-Chlorotoluene <0.5 0.5 ug/l EPA 524.2 11/14/02 18:47 NPV 4-Chlorotoluene <0.5 0.5 ug/I EPA 524.2 11/14/02 18:47 NPV Dibromomethane <0.5 0.5 ug/I EPA 524.2 11/14/02 18:47 NPV i 1,3-Dichlorobenzene <0.5 0.5 ug/I EPA 524.2 11/14/02 18:47 NPV 1,2-Dichlorobenzene <0.5 0.5 ug/I EPA 524.2 11/14/02 18:47 NPV trans-1,2-D ichloroethene <0.5 0.5 ug/l EPA 524.2 11/14/02 18:47 NPV cis-1,2-Dichloroethene <0.5 0.5 ug/1 EPA 524.2 11/14/02 18:47 NPV Methylene Chloride <0.5 0.5 ug/l EPA 524.2 11/14/02 18:47 NPV 1,1-Dichloroethene <0.5 '0.5 ug/I EPA 524.2 11/14/02 18:47 NPV 1,1-Dichloropropene <0.5 0.5 ug/1 EPA 524.2 11/14/02 18:47 NPV 1,2-Dichloropropane <0.5 0.5 ug/I EPA 524.2 11/14/02 18:47 NPV 1,3-Dichloropropane <0.5 0.5 ug/I EPA 524.2 11/14/02 18:47 NPV cis-1,3-Dichloropropene <0.5 0.5 ug/l EPA 524.2 11/14/02 18:47 NPV 2,2-Dichloropropane <0.5 0.5 ug/I EPA 524.2 11/14/02 18:47 NPV Ethylbenzene <0.5 0.5 ug/I EPA 524.2 11/14/02 18:47 NPV Styrene <0.5 0.5 ug/I EPA 524.2 11/14/02 18:47 NPV 1,1,2-Trichloroethane <0.5 0.5 ugh EPA 524.2 11/14/02 18:47 NPV 1,1,1,2-Tetrachloroethane <0.5 0.5 ug/I EPA 524.2 11/14/02 18:47 NPV 1,1,2,2-Tetracliloroethane <0.5 0.5 ug/I EPA 524.2 11/14/02 18:47 NPV Tetrachloroethene <0.5 0.5 ug/1 EPA 524.2 11/14/02 18:47 NPV Page 3 of 3 RJ. Analytical Laboratories, Inc. CERTIFICATE OF ANALYSIS Envirotech Laboratories,Inc. Date Received: 11/06/02 Approved Work Order.# 0211-14738 R.I. alyti Sample#: .001 0211069 325 WILLOW STREET, BAR STAB GRAB 04/02 @1530 SAMPLE DET. ANALYZED PARAMETER RESULTS LIMIT UNITS METHOD DATE/TIME ANALYST 1,2,3-Trichloropropane <0.5 0.5 ug/I EPA 524.2 11/14/02 18:47 NPV Toluene <0.5 0.5 ug/I EPA 524.2 11/14/02 18:47 NPV Xylenes <0.5 0.5 ug/I EPA 524.2 11/14/02 18:47 NPV 1,2-Dibromo-3-Chloropropane <0.5 0.5 ug/l EPA 524.2 11/14/02 18:47 NPV Bromochloromethane <0.5 0.5 ug/l EPA 524.2 11/14/02 18:47 NPV n-Butylbenzene <0.5 0.5 ug/l EPA 524.2 11/14/02 18:47 NPV Dichlorodifluoromebane <0.5 0.5 ug/l EPA 524.2 11/14/02 18:47 NPV Trichlorofluoromethane <0.5 0.5 ug/1 EPA 524.2 11/14/02 18:47 NPV Hexachlorobutadiene <0.5 0.5 ug/l EPA 524.2 11/14/02 18:47 NPV Isopropylbenzene <0.5 0.5 ug/I EPA 524.2 11/14/02 18:47 NPV p-Isopropyltoluene <0.5 0.5 ug/I EPA 524.2 11/14/02 18:47 NPV Naphthalene <0.5 0.5 ug/I EPA 524.2 11/14/02 18:47 NPV n-Propylbenzene <0.5 0.5 ug/l EPA 524.2 11/14/02 18:47 NPV sec-Butylbenzene <0.5 0.5 ug/I EPA 524.2 11/14/02 18:47 NPV tert-Butylbenzene <0.5 0.5 ug/I EPA 524.2 11/14/02 18:47 NPV 1,2,3-Trichlorobenzene <0.5 0.5 ug/I EPA 524.2 11/14/02 18:47 NPV 1,2,4-Trichlorobenzene <0.5 0.5 ug/l EPA 524.2 11/14/02 18:47 NPV 1,2,4-Trimethylbenzene <0.5 0.5 ug/I EPA 524.2 11/14/02 18:47 NPV 1,3,5-Trimethylbenzene <0.5 0.5 ug/I EPA 524.2 11/14/02 18:47 NPV Methyl Tertiary BuVil Ether <I I ug/I EPA 524.2 11/14/02 18:47 NPV n-Hexane <10 10 ug/I EPA 524.2 11/14/02 18:47 NPV SURROGATES RANGE EPA 524.2 11/14/02 18:47 NPV 4-Bromofluorobenzene 119 80-120% EPA 524.2 tl/14/02 18:47 NPV j 1,2-13ichlorobenzene-J4 116 80-120% EPA 524.2 11/14/02 18:47 NPV No.W aud2__6� ��-5 ���� 7OtJ) a. olcgy/it,� c+ �vculr"� Fee - ------- BOARD OF HEALTH TOWN OF BARNSTABLE Applicat ion,iorVeil Conkruct ion Permit Application is hereby made for a permit to Construct ( te, Alter ( ), or Repair ( )an individual Well at: Location — Address Assessors Map and Parcel ffa Owner - -4— -- _ — Address — �r—.5�o,+✓,o lf/�cc ���c.L�.L, _.?__ems. �o /�3�y a��3 ��'Cc s��vs /�i� Installer — Driller Address JC� Type of Building Dwelling --- Other - Type of Building ------ No. of Persons------------__---______ lj Type of Well Capacity---- Purpose of Well Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until Certificate of ompliance has been issued by the Board of Health. Signed —_— __— _— /0 e/ 'dui L date _ D Application Approved By "" ^ —-— �v_ It U? date Application Disapproved for the following reasons: ------------------- ------------- - - - ---- --------------- — ---- date Il.i�002 7 I 1 U d - Permit No. - ---- Issued---- -- --------- --------- ------------ date BOARD OF HEALTH TOWN OF BARNSTABLE (Certificate ®f Compliance THIS TO CERTIFY, That the Individual Well Constructed (-'),'Altered ( ), or Repaired ( ) Inst er at has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well/Protection W o vodd�-Dated-_/-�T Regulation as described in the application for Well Construction Permit No. ------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE �� �- O a-- Inspector-------------- — -- No.- c��r1yAM Qr � Fee�5-- BOARD OF HEALTH TOWN OF BARNSTABLE Application Ar Verr Con5truct ion Permit Application is hereby made for a permit to Construct ( 1,1, Alter ( ), or Repair ( )an individual Well at: __ /c C a w LST. LU n s r,oemu. _ --�3/ J�---- --- Location — Address Assessors Map and Parcel �. Owner j 1-4 — --- Address �7 7J&.3 Off'&_/-7 //s /'27,a Installer — Driller — Address Type of Building Dwelling �-# R �''c-� -- Other - Type of Building-- ------ No. of Persons------------=- ------ �i Type of Well Capacity--.710 � ! -�- ----- Purpose of Well--- --- ?.g r3 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 9,Certificate .of ompliance has been issued by the Board of Health. Signed — _ date Application Approved By ------- Id- d_ 1 0' date Application Disapproved for the following reasons: --------- -- ---------- -=---- iA� - --- ----------- -------------_----date------- �,� oo? —�7 Issued Permit No. - ----- ----�� /�-------- --- -------------- date, BOARD OF HEALTH TOWN OF BARNSTABLE Certificate ®f Compliance THIS IS TO CERTIFY, That the Individual Well Constructed (✓f Altered ( ), or Repaired ( ) Inst—er _ has been instated 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. 2Vd'Qd 7 Dated- J 10 -- y THEdSSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE--!�? - /�' O Inspector _ ---------------__._ �..------- ------- ___- - -��-_ BOARD OF HEALTH { TOWN OF BARNSTABLE Iverf Con!5truct ion Permit Uv�G�2_ 67 No. ---- Fee_�.�--------- Permission is hereby granted to Construct (,.)!Alter ( ), or Repair ( ) an Individual Well at: No. !S T /�/ /�AR/t05 - Street as shown on the application for a Well Construction Permit No._ t,--1 o _� -�— Dated--/ -� DATE Board of Health _—_ PROVIDE COVER AND PROVIDE COVER CONNECT DISTRIBUTION 4" SCH. 40 PVC SYSTEM 4" SCH. 40 PVC SYSTEM MIRAFI 140N FILTER FABRIC FINISH GRADE OVER MIRAFI 140N FILTER FABRIC LATERAL TO VENT VENT MANIFOLD VENT MANIFOLD OR APPROVED EQUAL RISER TO WITHIN 6" AND RISER TO FINISH GRADE DISTRIBUTION BOX= 104.5t OR APPROVED EQUAL MANIFOLD (TYP.) OF FINISHED GRADE GRADE OVER TANK _ 9 MIN FIRST 2' LEVEL - EL.-1 o3.5t r I I If .I:I �LII I II�1I1,1111111111111,�11 IIIIIII1111111111111111111111 zi s II 1(-llII LEI 1111111IIIII 11111. III EL. 105 1 o4f �(IIILiII fJLI I I1111_II4I_il I 111 I IIIII11li I �11111111111111111111 I ll_IIllII Illl L[1L� �f11 I �.II I !_LL ILI I_ I IIIIIIIilllilllllililllllllllllll Ililllllllllilil y 3 MAX _I. �_�_l,J 1)�_�t t) _t �� t l 1 f-i a!i �- i f i�$-6 i -t f f��d LOAM & SEED .d li�1_ . i s In`�i i l d i t t _ll d±_._f I N!I-•-i i 1-.l f 1__l 11-- )1�.__�1�-`W 11�I� -�!� -I�f_ ��._�i f._ t I I I I I( I I 4�.._.__i8E i 3 �ii i lfE--94�-iIm -i�9 111- 9ld-fil- 1I[-tII ;i1i (mf-I Y- ;:, .. it idi _�fd ..f'fff�dissfdfd--d•r -tsd-LOAM & SEED --f,,-d,i-.-i, - ,f �t --;tt---t.t �y sdf�imiffd�iff, aiifi-eta:-fsa- f,t-tis s,.: ... d, ,s .:._ttf- Eft-tdi= -- td- ftd--d f i ._.iii.__iiiii_ ~' 9" MIN _ _ _ ' =-i:LOAM AND SEED -m":- BACKFILL .. : o •• ,--I 6I i! _ 4.7' MAX. BACKFILL , • CLEAN BACKFILL Q _ a _. GRAVEL DRIVE4t 7 :. _ BACKFILL . 7. , S.BACKF`ILL' _.._.,r , _ BREAKOUT LATERAL 9 ,. DISTAL EL. 10" , RESIDENCE '' 1 2.0' , 20 n o � : ..�: 10 MIN. 1 -1/2" DOUBLE WASHED STONE 2 .`� o <.•., _ MINIMUM 4 _ , : a:. •, _ • GAS � ' � , , 3 DROP BAFFLE _ BOTTOM OF l 6" OF 3 4" COMPACTED CRUSHED STONE _ SYSTEM 6" OF 3/4" r, '' m COMPACTED TYPICAL DISTRIBUTION BOX DETAIL PERFORATIONS SET AT 5 & 4 SCH. 40 ,u �U_ UNDISTURBED EARTH CRUSHED STONE NOT TO SCALE 7 O'CLOCK EVERY 3-FEETDISTRI Y PVC 1500 GALLON SEPTIC TANK PROFILE 5' MIN. LATERALS (TYP )UTION 2' 4' 2' PROVIDE 5-OUTLET DISTRIBUTION BOX r 18 -"► NOT TO SCALE INSTALLED ON LEVEL STABLE BASE. 4-OUTLETS USED, 1 CAPPED TYPICAL TRENCH PROFILE PROPOSED 1500 GALLON CONCRETE SEPTIC TANK , r " r " r » r t+': '� m - INSTALL FIRST TWO FEET LENGTH: 1 1 -0 WIDTH: 6'-2' DEPTH: 6 -p OF OUTLET PIPES LEVEL. GROUNDWATER EL. 81.76 r k h p, MODEL 1500 H-20 BY ACME PRECAST OR EQUAL I g : : r g• o p # MODEL NO. DB5 H10 BY ACME PRECAST OR EQUAL BASED ON DEPTH TO WATER IN WATER SUPPLY WELL � � - ( ) UNDISTURBED ( ) � CO) PROVIDE MUSHROOM VENT CL EARTH LEACHING TRENCH DETAILS ti OR APPROVED EQUAL 4-INCH PVC NOT TO SCALE ,. - - PROVIDE CURB BOX MOUNTED ��� s •�, � � � ` , .. , ��`,i;, � , ` ; � � �� cu o e so as _�, + - FLUSH WITH GROUND „ THREADED CAP SCHEDULE OF ELEVATIONS rr 4 ,__ ...w,,._................. ..........��......_..........._._..,... .,..._...._..._.,_....»..._._....,_...,...,.,,__....,.,..,.......,..,-.___. _.._ ._,.,..,. ";.r3x a;t� „ !. .'` f"' e ..,, o C p w-_.,_. ,_...__ 4 r a v+ i X y lNV EL. � W _ .....,. ,.....>.. .......... . .... _» .__.,._. } .... ,..,. ....,.,._.._..._..........,:_.,....,,...............,,...-.....-».....w_..,..-.....,...v.,.:..,..--..,,. .......,....-.-«..._....,.....,..ti..,..-_,,.......-._ ,.... .,..,,.,..,._,.,_.. 1 w..n .,. ,.,'r a$r._e"..`ti.��:� "l,V.' ?s' a.l.. '`.w: PROVIDE END CAPMIN. _ yt m as Q o w co o � co -' ;: r` - 1 [R' I r'-d 't 01 i,. _ __,._,_... ._ _r_..,_d....._ w_.r....,.__,.:_1 ! ',r s, ' :F -�; �*< �;c� :,s ..rrF `e ,`a" '� � •S.. tp M O t d W S A r•O O � ' �rei�,�r'� 1 °• ",-� r�� ; ��''a?� ", �.+ O v+ M M N TOP OF FOUNDATION 104.00 x� _ `" i cc 'c 0166 00 0 SYSTEM VENT- 4 STOCK - �� • WASTEWATER BUILDING SEWER 102 00 i 4" SCH. 40 PVC VENT HEADER PERFORATED SCH. 40 PVC � GREYWATERBUILDING SEWER`': 102,00# » .. _ PROVIDE ADAPTER TO _,_ _ _.M __._.. _ _. ___.._._..w._,,.w __ .._ _._ .. _.__ .., w...__ .._ F. __. _,m__._.. ... ,u_.__M.. NOTE. NO VARIANCES ARE REQUIRED ,, 1/4 PERFORATIONS 5' 45 DEGREE PVC BEND > SEWER OR LATERAL . JOIN E R a._._.._..._. ._ _... „_._ BETWEEN PERFORATIONS, MIN. AT END OF LINE _ SEPTIC TANK-INLET(WASTEWATER) 101.5T .:' TO 4 INCH ELBOW -- 77 a�•7- -1 2 ROWS OF PERFORATIONS WYE CONNECTION FOR °= r t SEPTIC TANK-INLET(GREYWATER) 101.573 , . > Q 6 f ---� I N LINE . � - 32, u SEPTIC TANK OUTLET 10132r LOCUS PLAN D-BOX INLETx 100 64 C DESIGN CRITERIA D-BOX-OUTLET 100.47 r� ~ __.»._.NUMBER OF BEDROOMS SCALE- 1 =1000 TYPICAL CLEAN-OUT DETAIL i FLOW PER ROOM; 110iGP'D vI__, _. „ _.... ..__. .._. r.. ...._....__,.__.._,_ __..»...__ ._...... _,_.___.____...._____;_W.. .______.._,_,_____....,_ � ._. .,.._ _ __ .._,. ZONING & RESOURCE PROTECTION NOTES TYPICAL SYSTEM VENT DETAIL NOT TO SCALE TRENCH INVERT IN ` 100 09 DESIGN FLOW 330!GP'D _..m• _.. .. _..,.. _ n__._ __, __ ._.._mw_. __.._w . ..__- ._ W... ..w.._.. a_. m ___.. .._v. .._. BREAKOU? 100 42; � NOTTO SCALE i:_�2....__,_..�.._..�.�_.�_____..___.aw_.,_.,.._�..,_._..._ . .._.;_»,�._ ._._._.�,.,..».-.� / �. _ _ .._... _ _..._.,_._ ..,_ , d LATERAL DISTAL INVERT 100 00= __ _.__.. ..._,_ _.__ ___._ __ ..__ ,. i. ASSESSORS MAP#: 131 PARCEL: 0196-7 l t _. ., , ._.....; SEPTIC TANK I / l BOTTOM OF SYSTEM; 98.09 �- .-W-.:.,_w .,.--._-_-_ ._, _.i I J - - OWNER OF RECORD: MARY B. CARY TRUST I ,_._._�,. .__.. _. ., ._.w _._, __. -._,,__v_._...__» __.. .'• ADDRESS: 325 WILLOW STREET, W. BARNSTABLE, MA 02668 �^ / f ESHG W 81.76 X i SEPTIC TANK(DESIGN FLOW) 3301GAIL. - �, _a. THE LOCUS IS LOCATED IN FLOOD ZONE C (AREA OF MINIMAL FLOODING) AS . ___. SHOWN ON F.I.R.M. MAP 250001 0015C. USE 1,500 GALLON SEPTIC TANK �+ 2. THERE ARE NO SURFACE WATER SUPPLY OR GRAVEL PACKED WELLS WITHIN / 4 s I 400 , NO TUBULAR PUBLIC WELLS WITHIN 250 . �f ,,�f ,,'' � f � ✓ 1 � � � t� !� I � ' LEACHING SYSTEM DESIGN CRITERIA ' { 3 1 t 1 f RE aVE AND PLAC UNS ITAB E MATERIAL 5-FEET I 3. SITE IS NOT IN A GROUNDWATER PROTECTION OVERLAY DISTRICT OR A ZONE U ( SYSTEM MATERIAL T B RWOVItD HAL BE I SOIL ABSORPTION SYSTEM ARO D I 11 RECHARGE AREA. I THF�C2, 'SILT LOX LAYER SH(NN IN THE TEST, PIT OGS r.,w . . „�w...._ .., �_., _ r- f ( LEACHING SYSTEM USED !STONE TRENCHES TO /TKE DEPTH SHC N IN THE/ TEST PIT LObS fR A _,._. .... , _._. . .mw_r__, .,...__.. ... .___ ___„_.___.•_,-__,.._ ___ ._ .___ ., . ___ ..w_,;» _ _ .v.___.._ GENERAL IVOTE�S, ,,� F ND INf THE FfLLDJDU ING (CO'NtTRUION. 1 �{d DESIGNPERCOLATIONRATE f SMIM/lN (� ! ! f ! ER I SOIL CLASS.. - : l d _ _ 1 ., -._-_ _ _,. •'UNLESS-OTHERWISE: NOTED,-ALL~-SYSTEM COMPONENTS-AND CONSTRUCTION Fy FF _, . _ ...._w._ _... __ _ _._.__._._._. - .__v_ �� � W / S , L V LONG TERMACCEPTANCE RATE(LIAR): 0 74 LLGPD/S F„^ METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE o I wE� w �__.._ `F / ,- / , I • I Opp _ TOTAL AREA REQUIRED-LOCAL CODE s 446�S F ENVIRONMENTAL CODE AND THE RULES AND REGULATIONS OF THE • i � .._ -•-•' ,,,- - � PROPOSED FOUR 2-FOOT WIDE r'81(' �-, } { S��F _• »_�.. TOTAL AREA RE h � =�_--- _ I I f � � TOTAL REQUIRED 5 1 446 S_F: __.,.�_. BARNSTABLE BOARD OF HEALTH. C� F � \2-FOOT DEEP LEACHING TRENCHES I, �F - •Q ,� / 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD C O �"� F � { / � ,__ � � I • ( �TOTAL AREA PROPOSED 1 F / i OF HEALTH AND THE DESIGN ENGINEER. __ _ E ��--�••-a`�� . , -' �� / �� / \I \ \ �, A(sidewalq (18'+ 2'+ 18'+ 18)x 2'x 4 f.. 320 d S f� w __. -._..--- _ --- -_ t - J. USE 4 IN. SCH. 40 PVC PIPING WITH WATERTIGHT JOINTS UNLESS OTHERWISE � 1 d A(bottom)._18 x 2 x 4:I 144;S t= j WALL PROPERTY 1 _ _.__» TOTAL AREA ? 464 S.F. NOTED ON PLAN. ALL PIPE SHALL BE PLACED ON A COMPACTED FIRM BASE. N o CD STONE L !�.. a:20:D': TOTAL ALLOWABLE FLOW € 343 GPD LINE (TYP.) - / / . .. .. ) 1 _a,.._. ... . _._ . ._ . :.._.._. . 4. THIS ON-SITE WASTEWATER TREATMENT SYSTEM IS NOT DESIGNED FOR USE O .�' '��, L 'f ;1 ., :: :::: . USE 4 18'L X 2'W x 2'D LEACHING TRENCHES__�. 1___.... . ... .... . . __.._ n,,..._.... _... _._. __.,.__...f WITH A GARBAGE GRINDER. ° a 100-FOOT WELL BUFFER : 1 : 5• ELEVATIONS, PROPERTY LINE AND EXISTING CONDITIONS ON THIS PLAN ARE -a / ✓ f. I \� .•-� �.. �--- -- TEST PIT LOGS BASED ON FIELD SURVEY AND PLAN BY HORSLEY WITTEN GROUP, INC. 1 PERFORMED MAY 1, 2008. ~ ---_ ... SYSTEM VENT (LOCATION �- - ' TO BE FIELD DETERMINED) JFF� INSPECTOR =J HENDERSON I _ 0 ; '� '` t SOIL EVALUATOR D. DESMARAIS _ 6 CALL "DIGSAFE" AT LEAST 72 HOURS PRIOR TO COMMENCING CONSTRUCTION rn .' o / ` ���� DATE -� AT 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES NECESSARY TO 5/29/2008 1 _ _..._ . _ , _,_M_. w.._.. ,.._v_, _ _..___.__ FIELD VERIFY LOCATION OF EXISTING UTILITIES. SHED TO BE RELOCATED Fp0 PERC # 12214 j , CU APPROXIMATE LOCATION OF :-'`l NED `�° ch IF NECESSARY ��p� _,,.., _.., ._._.p.-.,,._..__. u_...._ _m-._ -_. ..-.. 7• PROVIDE WATERTIGHT SEALS BY USE OF NON-SHRINK GROUT AT ALL POINTS , o L I '� I WHERE PIPES ENTER OR LEAVE ANY CONCRETE STRUCTURES. � EXISTING ORNAMENTAL GARDENS � f f I MARK EDWIN NELSON ------------ __.:., ___. _._..., _v___.,. ..___,_ .___...____.___ _._ & REFER TO SITE PLAN FOR LOADING CAPACITIES OF INDIVIDUAL SEPTIC o & KRISTIE KAPP �_- _p jHEDGEµ„_ .m... TP 2 I 1 SYSTEM COMPONENTS. �, TP 1 ` l � -' ..•- ,� '�!'�' .., � �,�-•,�. 307 WILLOW STREET � # � .. -- --�� , , MAP 131 PARCEL 020 m __.. ..__w_,__.._,_L _ _. EXISTING 3 BEDROOM DWELLING x , 0.0 105.0 9 ALL STONE TO BE DOUBLE-WASHED AND FREE OF DIRT, DUST AND FINES. Q .,.. PROPOSED 5-OUTLET / \ GARDEN - MARY B. CARY TRUST DISTRIBUTION BOX / \ ''---�_ 1 EXISTING CESSPOOL TO BE ABANDONED ;.__ .._ !q _.;.... .__ .. W.. . A_ # _•_._,,_,,_ _._.__ _,, „_r__w,_.w 10. THE CONTRACTOR IS RESPONSIBLE TO REPORT ANY DISCREPANCIES FOUND IN STREET `� / �'` ~ ~~~ i IN PLACE IN ACCORDANCE WITH TITLE 5 i SANDYLOAM i 325 WILLOWS �- - SANDY LOAM SITE CONDITIONS FROM THOSE SHOWN ON THE PLAN TO THE DESIGN / SEE NOTE 14 08 � 10YR4/1 1032 MAP 131 PARCEL 019 ° ( ) 10 YR 411 104.2 ENGINEER. �j 1.67 ACRES 4-INCH SCH, 40 PVC. o� L-67.2, S-1.0% T_ 4-INCH SCH. 40 PVC � m _ ' / - - STONE WALL PROPERTY LINE (TYP.) --.-- ---•-- 8...- " ' ._ i 8 1 I CHANGES TO EFFLUENT FLOW GRADING OR LANDSCAPING EITHER ON-SITE _._._. m r_._.,,. �_a_,... _. t , �+ L=10.9, S-4.0% SANDYLOAM OR ADJACENT TO THE SITE, OR FAILING TO PROPERLY INSPECT OR PUMP 0.7 ,� SANDY LOAM 1 - ' THE SEPTIC TANK MAY EFFECT THE PROPER FUNCTIONING OF THE LEACHING I 10 YR 6/6 $ i 10 YR 6/6 2 1 102.9 , € 2.8 '' 101 3 : SYSTEM. N WATER SUPPLY WELL I �/ d GROUND ELEVATION 110.96 I O ��r f a� �d .. _......._ _ .t 4. _ _ ,.. .__ _._,.__. _ 12 THE OWNER SHALL INSPECT AND PUMP THE SEPTIC TANK ONCE EVERY 2 00 WATER ELEVATION=81.76 YEARS: MEASURED ON 11/4/2002 \ ii4� I WATER SUPPLY WELL I SANDY LOAM 1 SANDY LOAM o 10 YR 7/8 t 10 YR 7/8 .3 13. THIS PLAN IS INTENDED TO ADEQUATELY PROVIDE THE INFORMATION " o n I d k 4.101' 101.0E 42 '.' 99.8 f OIL CAP FOUND, POSSIBLE UNDERGROUND �� WL I ---� - r SP C f NECESSARY TO LAYOUT AND CONSTRUCT THE PROPOSED SEWAGE DISPOSAL OIL TANK, THE CONTRACTOR SHALL VERIFY t SYSTEM REPRESENTED ON IT AND SHOULD NOT BE USED FOR ANY OTHER b r o �:) THE LOCATION OF THE TANK, IF PRESENT, I f PROPOSED 1,500 I._,_.___u. 00 PRIOR TO CONSTRUCTION I ( ` .,� I I GALLON SEPTIC TANK ,£ E ± SILT LOAM SILT LOAM PURPOSES. 2 o o r ' , j 10 YR 7/3 6 G SEPTIC COMPONENTS SHALL BE ABANDONED IN PLACE IN ;, o o d, 10 YR 7/3 14 ALL EXISTING .�; STONE WALL PROPERTY 6 3 98 8 5 4 d 98.6 1.. .- ACCORDANCE WITH TITLE 5, 310 CMR 15.354(3). o o O LINE (TYP.) .,. 3 n 3 cn � a, wwQ 4-INCH SCH. 80 PVC t� FULL . O Y- CAP ;=43.4, S=1.0% s 15. AREAS UNDER THE LEACHING FIELD FOUND TO HAVE UNSUITABLE SOIL MUST Registration: BASEMENT ,r BE REPLACED WITH TITLE 5 SAND AS SPECIFIED IN 310 CMR 15.255(3). NOF M SAND 16. PRIOR TO CONSTRUCTION THE CONTRACTOR SHALL COORDINATE WITH THE M SAND _ 10 YR 5/4 HOMEOWNER AND ENGINEER ON THE CONSTRUCTION SITE ACCESS AND MPNJ t� �.4 • J / 10 YR 5/4 PERC TEST 1 MATERIAL STOCK PILE AREAS. EXISTING CESSPOOL TO BE ABANDONED i ' 00 IN PLACE IN ACCORDANCE WITH TITLE 5 I— _' _.I " i PERC TEST �� -��' _ 5 M/N/INCH INSPECTION NOTES '�eiel O / � � � � l CLEANOUT (TYP,) SEE NOTE 14 � 93 I co ( ) I 5 MIN/INCH _ LLo� �� v 92.0 1. FINAL CONSTRUCTION INSPECTION OF ALL SYSTEM COMPONENTS INCLUDING �8 CV IYj I 12 0 d NO GROUNIDWATER/MOTTLES INVERT ELEVATIONS ARE TO BE CONDUCTED BY THE DESIGN ENGINEER AND THE Cfl 'ST.tQF, / � ` � I Project Number: O �T L� ` F __._,u_,.._..,__.,_ _.._.w__v_,. .. .__.,.. _.. ,., BOARD OF HEALTH OR THEIR REPRESENTATIVE PRIOR TO BACKFILLING SYSTEM. GRAPHIC SCALE `' y f 804� 4 12.0 g 93.0 2. IT IS THE RESPONSIBILITY OF THE CONTRACTOR(S) TO MAINTAIN UP TO DATE - 20 0 �0 20 ao $o NO GROUNDWATEWMOTTLES AS-BUILT MARK UP DRAWINGS AND NOTES (PREFERABLY IN A SURVEY FIELD / s,_.»_._ __.._ _.., ._,. _._.LL.._._._ _..__ Sheet Number: NOTEBOOK) INDICATING THE HORIZONTAL AND VERTICAL LOCATION OF ALL SYSTEM COMPONENTS INSTALLED. THESE MARK UP DRAWINGS AND NOTES WILL 1 Of 1 n ( IN FEET ) / ' `� �� BE UTILIZED BY THE ENGINEER FOR THE PREPARATION OF AS-BUILT PLANS. cu ,/ 4