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HomeMy WebLinkAbout0264 INDIAN TRAIL - Health 264 INDIAN TRAIL, BARNSTABLE Y. Al i n � a a • n ^' , L f ,. ., • . t ., ^ � � ��+ � ^. v i.., sy � • 1. ' : a , Y , n I w v. pr „ i f a e� x'e c v , a Y ` r , M + .. �.. .0 a -. • � .� y. a i Department of Environmental Management/Division of Water Resources ' WELL COMPLETION REPORT WELL LOCATION GEOGRAPHIC DESCRIPTION Address 7-GA- r+0�taxi Ttc ta��. N S E W of (feet) (circle) City/Town Pol e Well owner. ,S.Hr—t iDc rA Sao cs t f (road) Address Sk?,P,r4 q CPA.-" L Q N S E W of K`A�Z�30 (mi.in tenths) (circle) P,�_n_ RQx �1�� ACZN'ViTAPv�: Board of Health permit obtained: yes E9 -no ❑ intersect. w/ (road) WELL USE WELL DATA Domestic[B fsublic❑ Industrial ❑ Total well depth 'J7 ft. Monitoring El Other - Depth to bedrock ft. Water-bearing rock/unconsolidated material: Method drilled Descriptionl'M-C-SAav11_-RAC. &ZANEL Date drilled' �`In Water-bearing zones: f CASING 1)From '7 To 31 Type .Sc_440 2) From To { Length 1' ft. Dia(I.D.) 4- in. 3) From To ,. Length into bedrock ft. Gravel pack well: dia. Protective well sea[: dia. Screen: , t Grout ❑ Other Slot# «- length from 33 tosi STATIC WATER LEVEL(all wells) Static water level below land.surface ft. Date 2'201 ZS-�oa WELL TEST(production wells) c^ Drawdown `LJ ft. after pumping hr. a min. at �J gpm %Vq'M'M%qZ"e H w measured - :TOPE Recovery ft. after — hr. — min. LOG of FORMATIONS COMMENTS 0 Materials From To a C Driller "C,AmrnPaS t1�.�rnasycl 3. r , Firm 1 c-,"y,ra"N \..lE_LA_ 3�rZ%L1_s N6 \NL. Address ri rLL1Y8E fe ° City/Town OR-L,E.A N S S pervising Driller Reg.# 2 g4 Signature of supervising registered well driller Please print firmly 6.1 EOARI3 OF HEALTH COPY - vi ,. Town of Barnstable snJWsrnsr.& * Department of Health, Safety, and Environmental Services mma 119- 04 Public Health Division 367,Main Street, Hyannis MA 02601 Office: 508-862-4644 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health TO: ELISABETH A. WOOLF DATE: JAN. 20, 2000 770 BOYLESTON ST.APT 24B BOSTON,MA. 02199 ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL CODE, TITLE 5. The septic'system owned by you located at 264 INDIAN TRAIL was inspected on 05/15/95 by RALPH OJALA a Massachusetts licensed septic inspector. The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: ° LEACHING PIT IS IN HYDRAULIC FAILURE. The above system, according to our records has been in a failed state for more than two years. Therefore, you are directed to hire a licensed Town of Barnstable septic system installer to sketch a proposed system..that will bring the septic system into compliance with 310 CMR 15.00, The State Environmental Code, Title 5 within(14)fourteen days of receipt of this notice. The septic system must be brought into compliance within (30) thirty days of your'receipt of this directive. You are also directed to maintain the system by hiring a licensed septage hauler to pump the septic system to prevent discharge of sewage or effluent into buildings, onto the surface of the ground, or into surface waters. Any person aggrieved by any order issued by the local approval authority may appeal to any court of competent jurisdiction as provided for by the laws of the Commonwealth. ` z PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, R.S., C.H.O. Agent of the Board of Health Town of Barnstable Q:�nn\&a1eMue52y.a« t tJ. t - 4 t ..... .......... glu .K.:0 M ................ ............ 11"M�� 0000000 ........... ............. AWWWW""w-, ...... ........ 76WB OT 4A ............ 15 47 101 OOLF,ELISABETH A 0 BOYLESTOrMPT OSTON 501 J9673 151 .............-W.. ..........- OOLF,ELISABETH A ......... 0 10700 ............ ........... .......... INDIAN TRAIL 002 ........... ME d Road Name ................................... spill IN. ................. .1W .l." ...... ..........I. ........... ,F S HM ] 61 H E A L T H M A S T E R ] HELP [ ] R E C O R D ] ACTION I] For Parcel Number 3371 0221 ] ] Rental Property(Y/N) [ ] Owner Name WOOLF, ELISABETH A ] Zone of Contrib (Y/N) [N] Location 264 INDIAN TRAIL CUMMA ] Contaminant Rel (Y/N) [ ] Business Name [ ] Area Number Contact Person [ ] Phone [000] [36267451 Fuel Storage Tank Permit [ ] Card on File [Y] Perc Test Well Septic File/Permit No. [ ] [ ] [95 742 ] Issuance Date [ ] [0328951 Completion Date [ J [ ] Last Communications [0325881 (MMDDYY) Comments [REPAIR ] Cancel [ ] NEXT SCREEN [HM ] ACTION [ ] PARCEL NBR [ ] [ ] [ ] TANK NBR [ ] ] t Z 348 651 '007 ' Receipt for Certified Mail e No Insurance Coverage Provided UMTED STATES Do not use for International Mail OOSTAL SEm E (See Reverse) in Seni to L Str 2to i P. ate and ZIP Code. . 10 40 Postage co Certified Fee Special Delivery Fee � if#'estnsteJ`D8iIU'r?'rV e'e° IR�iiimnReceipliSlioU7ing`f 1 /O to Whom&Date Delly Return Receipt S ing to Who Date,and Addr s8e' ress TOTAL Posta Q'y &Fees N �� Postmark or STICK POSTAGE STAMPS TO ARTICLE TO COVER FIRST CLASS POSTAGE, CERTIFIED MAIL FEE,AND CHARGES FOR ANY SELECTED OPTIONAL SERVICES(see front). 1. If you want this receipt postmarked,stick the gummed stub to the right of the return address leaving the receipt attached and present the article at a post office service window or hand it to your rural carrier Intl extra charge). IC 2. If you do not want Phis*receipt postmarked,stick the gummed stub to the right of the return M 11 address of the article,date,detach and retain the receipt,and mail the article. rn 3. If you want a return receipt,write the certified mail number and your name and address on a 02 return reccipY card,Form 3811,and attach it to the front of the article by means of the gummed a ends if space.permits.Oyherwise,affix to back of article.Endorse front of article RETURN RECEIPT REQUESTED adjacent"to the number. O 4. If you want delivery restricted to the addressee,or to an authorized agent of the addressee, endorse RESTRICTED DELIVERY on the front of the article. E a 5. Enter fees for the services requested in the appropriate spaces on the front of this receipt.If LL ti return receipt is requested,check the applicable blocks in item 1 of Form 3811. d 8. Save this receipt and yr'sgw it if you make inquiry. 105603-93-B-0218 Town of Barnstable II i Department of Health, Safety, and Environmental Services MAW l ABIB, 1639. � Health Division 367 Main Street, Hyannis MA 02601 Office: 309-790-6263 Thomas A.McKean FAX: 508-773-3344 Director of Public Health October 5, 1995 Sheldon Wolf P.O. Box 1135 ""'" Barnstable, MA 02630 SECOND ORDER TO COMPLY WITH 310 CMR 15.009 THE STATE ENVIRONMENTAL CODE, TITLE 5. The septic system owned by you located at 264 Indian Trail,Cummaquid was inspected on May 15, 1995 by Ralph Ojala a Massachusetts licensed septic inspector The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE 5 (310 CMR 15.00)due to the following: • Leaching pit in hydraulic failure. On July 17, 1995 you were directed to hire a licensed Town of Barnstable septic system installer to submit a sketch diagram of a proposed system to the Town of Barnstable Health Division Office (Town Hall, 367 Main Street, Hyannis) that will bring the septic system into compliance with 310 CMR 15.00, The State Environmental Code, Title 5 within (14) fourteen days of receipt of this notice. You were also directed to bring the septic system into compliance within thirty (30) days of receipt of this order letter. However, the system was not upgraded as ordered. You are again directed to upgrade the septic system within thirty(30) days of receipt of this letter. You are further directed to maintain the system by hiring a licensed septage hauler to pump the septic system to prevent discharge of sewage or effluent into the buildings, onto the surface of the ground, or in to surface waters. Any person aggrieved by any order issued by the local approval authority may appeal to any court of competent jurisdiction as provided for by the laws of the Commonwealth. PER ORDER OF THE BOARD OF HEALTH T omas A. McKean, R.S., C.H.O. CO N�\ Agent of the Board of Health opX Z 348 648 634 Receipt for f Certified Mail No Insurance Coverage Provided �0STy�i s Ego not use for International Mail POST�I SEfivICE 1 e everse) M Sent to t Stree 2 co M P. and ZIP Code CID Postage p( Co) E Certified Fee O LL Special Delivery Fee 0 a .q es i��e LDee:�ve�tryy I,9 y,e urq ecelpt Date `\ to Whom& Deliv rve r Oe Return'Receipt Show' Date,and Addresse dre s TOTAL Postage &Fees Postmark or Date q64 V ,1osao a STICK POSTAGE STAMPS TO ARTICLE TO COVER FIRST CLASS POSTAGE, CERTIFIED MAIL FEE,AND CHARGES FOR ANY SELECTED OPTIONAL SERVICES(see front). 1. If you want this receipt postmarked,stick the gummed stub to,the right of the return address leaving the receipt attached and present the article at a post office service window or hand it to yourgural carrier ino extra charge). m 2. f you do not want this receipt postmarked,stick the gummed stub to the right of the return addresslf the article,date,detach and retain the receipt,and mail the article. 3. If you want a return receipt,'write the certified mail number and your name and address on a t2 return,receipt card,Form 3811,and attach it to the front of the article by means of the gummed ends if space permits,Otherwise,affix to back of article.Endorse front of article RETURN RECEIPT, REQUESTED adjacent to the number, C 4. If you want delivery restricted to the addressee,or to an authorized agent of the addressee, M endorse RESTRICTED DELIVERY on the front of the article. 5. Enter fees for the services requested in the appropriate spaces on the front of this receipt.If " IL return receipt is requested,check the applicable blocks in item 1 of Form 3811. d 6. Save this receipt and presont it if you make inquiry. 105e03-93-B-021e i ( ^ SENDER: I also wish to receive the I y • Complete items 1 and/or 2 for additional services. I d • Complete items 3,and 4a&b. following services (for an extra d rn • Print your name and address on the reverse of this form so that we can fee): > return this card to you. d • Attach this form to the front of the mailpiece,or on the back if space 1. El Addressee's Address rn does not permit. + N • Write"Return Receipt Requested"on the mailpiece below the article number' 2. ❑ Restricted Delivery G r • The Return Receipt will show to whom the article was delivered and the date c delivered. Consult postmaster for fee. 0 3. Article ddressed to: 4a. Article Number ti 4'b. Service Type p� E _ [I Registered El Insured CertifiedIm ❑ COD 5 w ❑ Express Mail ❑ Return Receipt for t� Merchandise o pQ 7. Date of Delivery ddressee's Address(Only if requested Y n in� n v nd fee is paid) 0 ,u t w atu NJm H ® o� H PS , Dec r-,"91 *U.s.GPo: DOMESTIC RETURN RECEIPT . UNITED STATES POSTAL SERVICE Official Business PENALTY FOR PRIVATE USE TO AVOID PAYMENT ' OF POSTAGE, $300 Print your name, address and ZIP Code here Board of HeaRfl Town of Bamstable P.Q.Box 534 !h' r; ,Massachusetts 02601 I Town of Barnstable Department of Health, Safety, and Environmental Services &4XNffrA8U = Health Division M�°r f63� �� 367 Main Street,Hyannis MA 02601 Thomas A.McKean Director of Public Health Office: 508-790-6265 FAX: 508-775-3344 July 12, 1995 Sheldon Wolf P.O. Box 1138 Barnstable,MA 02630 ORDE R TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL CODE,TITLE 5. 64 Indian Trail, The septic system owned by you located at 2 Cummagud was inspected on May 15, 1995 by Ralph Ojala a Massachusetts license septic inspector. r system has failed under the The inspe ction of your septic system showed that you guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • Leaching pit in hydraulic failure. system submit a You are directed to hire a licensed Town of Barnstable septic Health installer to Office sketch diagram of a proposed system Hyannis)s to othat will bring Barnstable the Town of e septic system into compliance (Town Hall, 367 Main Street, fourteen days of with 310 CMR 15.00, The State Environmental Code, Title 5 within (14) receipt of this notice. You are also directed to bring the septic system into compliance within thirty (30) days of receipt of this order letter. sed er to You ar e further directed to maintain the system by hiringfaUeint into the bu dings, onto pump the septic system d or into suischarface ge of sewage or e the surface of the ground,. by any order issued by the local approval authority may appeal to Any person aggrieved Jurisdiction for by theelaws of the Commonwealth. any court of competenturisdiction as provid PER ORDER OF THE BOARD OF HEALTH. v Thomas A. McKean,.R.S., C.H.O. Agent of the Board of Health �J ASSESSORS MAP N0: PARCEL NO: II oZ Z 548. 641 155 ri: Receipt for Certified Mail No Insurance Coverage Provided UNttEDOSTATES Do not use for International Mail WSTLL SE—cE (See Revers N3 Seni to b W t Street an No. 2 Cal P.O.,State and ZIP Code Postage y CID M ,1� E Certified Fee O LL Special Delivery Fee C , I a Restncted Oeliver,�Y to Whom&Date Delivered Return Receipt Showing to Whom, Date,and Addressee's Address TOTAL Postage A &Fees y1 Postmark or Date STICK POSTAGE STAMPS TO ARTICLE TO COVER FIRST CLASS POSTAGE, CERTIFIED MAIL FEE,AND CHARGES FOR ANY SELECTED OPTIONAL SERVICES(see front). m 1. If you want this receipt postmarked,stick the gummed stub to the right of the return address Sri leaving the receipt attached and present the article at a post office service window or hand it to your rural carrier(no extra charge). 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the return Cl) address of the article,date,detach and retain the receipt,and mail the article. "� rn 3. If you want a return receipt,write the certified mail number and your name and address on a return receipt card,Form 3811,and attach it to the front of the articie by means of the gummed (a ends if space permits.Otherwise,affix to back of article.Endorse front of article RETURN RECEIPT REQUESTED adjacent to the number. C 4. If you want delivery restricted to the addressee,or to an authorized agent of the addressee, 0) endorse RESTRICTED DELIVERY on the front of the article. E `o 5. Enter fees for the services requested in the appropriate spaces on the front of this receipt.If UL return receipt is requested,check the applicable blocks in item 1 of Form 3811. (1) a S. Saxe this receipt and prAsepw#-if you make inquiry. 105603-93-13.0218 I , Town of Barnstable • Department of Health, Safety, and Environmental Services • .e►tttSreBU, I 6� � Health Division &, 367 Main Street, Hyannis MA 02601 Office: 508-790-6265 Thomas A McKean FAX: 508-775-3344 Director of Public Health May 30, 1995 TO: Richard Gysan 264 Indian Trail Cummaquid, MA ORDER TO COMPLY WITH 310 CMR 15.009 THE STATE ENVIRONMENTAL CODE,TITLE 5. The septic system owned by you located at 264 Indian Trail, Cummaquid was inspected on May 15, 1995 by Ralph Ojala a Massachusetts licensed septic inspector. The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • Leaching pit in hydraulic failure. You are directed to hire a licensed Town of Barnstable septic system installer to'submit a sketch diagram of a proposed system to the Town of Barnstable Health Division Office (Town Hall, 367 Main Street, Hyannis) that will bring the septic system into compliance with 310 CMR 15.00, The State Environmental Code, Title 5 within (14) fourteen days of receipt of this notice. You are also directed to bring the septic system into compliance within thirty (30) days of receipt of this order letter. You are further directed to maintain the system by hiring a licensed septage hauler to pump the septic system to.prevent discharge of sewage or effluent into the buildings, onto the surface of the ground, or in to surface waters. Any person aggrieved by any order issued by the local approval authority may appeal to any court of competent jurisdiction as provided for by the laws of the Commonwealth. PER ORDER OF T BOARD OF HEALTH Thomas A. McKean, R.S., C.H.O. Agent of the Board of Health Y [Installer letter] TO: f2L- ! v S an (Date) w. n� MA- ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL CODE, TITLE 5. I The septic system. owned by ,You located at �P 3r��Gn I ( was inspected on /Lf / /9'y5 by K� .�'1 4 a Massachusetts licensed septic inspector. The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due the following: r You are directed to hire a licensed Town of Barnstable septic system installer to submit a sketch diagram of a proposed system to the Town of Barnstable Health Division Office (Town Hall, 367 main Street, Hyannis) that will bring the septic system into compliance with 310 CMR 15.00, The State Environmental Code, Title 5 within (14) fourteen days of receipt of this notice. You are also directed to bring the septic system into compliance within thirty (30) days of receipt of this order letter. You are further directed to maintain the system by hiring a licensed septage hauler to pump the septic system to prevent discharge of sewage or effluent into the buildings, onto the surface of the ground, or in to surface waters. Any person aggrieved by any order issued by the local approval authority may appeal to any court of competent jurisdiction as provided for by the laws of the Commonwealth. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, R.S., C.H.O. Agent of the Board of Health Town of Barnstable L� 6AA-1 I! N t hW A97 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FO 00 �, �'. ' QCf �✓ Address of property ��o /VA �-�`� C�a N I Owner 's name ACOLct ro ytarJ �4y 2 iC�t 3 199 Date Of Inspection kN� 6 � N ��. PART A CHECKLIST to Check if the following have been done: S - � Y Pumping information was requested of the owner, occupant, and Board"'46f Health . /None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period . Large volumes .of. water ,have not been introduced into the system recently or-.as part of this inspection. V As built plans have been obtained and examined. Note if they :are.,.,not available with N/A. —lC The facility or dwelli,-,g was inspected for signs of sewage back-up. V The site was inspected for signs of breakout. All system components, excluding the. SAS,, have been located on the °ite . _ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, , ,aterial of construction, dimensions, depth of liquid, depth of sludge , depth of scup. VII1he size and location of the SAS on the site has been Bete rained based on existing information cr approximated by non-intrusive methods. s i The facility owner (and occupants, if different from owner) were prov: ::ed with information on the proper maintenance of SSDS. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM, ' P;.R T B SYSTEM INFORMATION ..: FLOW CONDITIONS. If 1 esr'dential _ number of bedrooms number of current esidents garbage grinder, a or no laundry connect e to system, yes or no YES seasonal use, yes or no If nonresidential , calculated flow: Water meter readings, if available: /493 a ayy�o Last date of occupancy GENERAL INFORMATION Puinpi,ng records and source of information: s�L LoV4 �G/t' d` r�S - /� ems, /�t 1/V=O 1='R,i-&4 jQWAJ /Z Systen pumped as part of inspection, yes or no if yes , volume pumped Reason for pumping: Type of system Septic tank/distribution box/soil absorption system Single cesspool v .._ Overflow_cesspool . .. -° �. .:,_ . . .� .. _ .. .. - -. . ... , i_ �. . • Privy Shared system (yes or no) (if yes, attach previous inspection records , if any) Other (explain) Approximate age of all components. Date installed, if known. Source of information: Nb Sewage odors detected when arriving. at the site, _yes or no r j � 9 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFOKKKTION continued SEPTIC TANK: �SOV. /rZll�/J (locate on site plan depth below grade: material of construction: _concrete metal FRP other(explain) dimensions: sludge depth LBO distance from top of sludge to bottom of outlet tee or baffle scum thickness r . . ,> . distance from top of scum to top of outlet. tee or baffle -� distance from bottom of scum to bottom of outlet tee or baffle Comments: (recommendation for pumping, condition of inlet and outlet tees . or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of lea age, recommendations for repairs, etc. ) or !l l.Nl DISTRIBUTIO?; BOX: Y //�//'�GGe-js (locate on site plan) depth of liquid level above outlet invert Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, recommendation for repairs, etc. ):' PUMP CHAMBER: Mr (locate on site plan) pumps .in working order, yes or no Comments:— (note condition of pump chamber, condition of pumps and appurtenances', , recommendations for maintenance or repairs,etc. )' e SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SOIL ABSORPTION SYSTEM (SAS) : G,r Ll f, (locate on site plan, if possible; ekcavation not required, but may be approximated by non-,intrusive methods) If not determined to be present, explain: Type leaching pits and number leaching chambers and number leaching galleries and number leaching trenches, number, length leaching fields, number, dimensions overflow cesspool , number Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of a etation, recommendations for; ma 'ntenance or repairs tc. ) IQGIC CESSPOOLS (locate on site plan) number and configuration depth-top of liquid to inlet invert depth of solids layer depth of scum layer dimensions of cesspool materials of construction indication of groundwater inflow (cesspool must be pumped as part of inspection) Comments:: ` condition note ( ition of soil, signs of hydraulic failure, level of ponding, condition 'of vegetation, recommendations` for maintenance or repairs,etc. ) PRIVY: (Locate on site plan) materials of construction dimensions depth of solids Con-tents : , note condition of soil , signs of hydraulic failure, level of pondino, of ve"Eta ti.on.; recoranendations for maintenance or repairs,etc. j f i 11 ` SUBSURFACE 'SEWAGE DISPOSAL SYSTEM. INSPECTION FORM +. PART B -;----SYSTEM-3-NFOR1iATION--coat-i-hued-------_— ; - - - - --- -- - t SKETCH -OF- SEWAGE DISPOSAL SYSTE$i: include tieso at :leiasV two 'permanent ;relierenbes landma`,rks or ben0hniarfcs I { 1pcae__all _wells- - 00 = - — -- ---- -- -- , f - _ re P {,l I - -DEPTH---TO-GR0UNDWATER---- depth' to groundwater- method ;of determination !or: approximation --I�Et�_�'Vv_ w e rV 11 Li :) , , Y SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C FAILURE CRITERIA Indicate yes, no, or not determined (Y, N, or ND) . Describe basis of determination in all instances. ' -.If !!not determined", explain why not) Backu of nto sews a i 9 1 facility? 5r1DT1 C. t&Aj 1^e h CXLGU.tiJGta F PIT Ve-2- 1APrS AUAE - -N— Discharge or ponding of effluent to the surface of the ground or surface waters? WiD.Static liquid level in the distribution box above outlet invert? " Liquid depth in cesspool <6" below invert or available volume< 1/2 day flow? Required pumping 4 times or more in the last year? number of times pumped / ' Septic tank is metal? cracked? structurally unsound? substantial , infiltration? substantial exfiltration? tank failure imminent? eV 0 F $044<UIP - H-MiWOM s pA v�1-e -ktti n, GG ot Is any portion of the SAS, cesspool r privy: below the high groundwater elevation? Nwithin 50 feet of a surface water? within . 100 feet of a surface water supply or tributary to a surface water supply? II within a 'Zone I of a public well? . . . _ _ Within 50 feet of a bordering vegetated wetland or salt marsh (cesspools and privies only, not the SAS) ? within 50 feet of a private water supply 1 well? less than 10 0 feet but greater, than 50 feet from a private water, supply well with no acceptable water .quality analysis? If the well has been analyz.ed;, to -be acceptable, attach copy of well water analysis for colif,orm bacteria, volatile organic compounds, an""tionia nitrogen and nitrate nitrogen. � rr 13 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PKRT D CERTIFICATION Name of Inspector Ralpb Ojala Company Name Down Cape Consulting Company Address 939 Route 6A, Yarmoutbport, MA 02675 Certification Statement I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true, accurate and complete as of the time of inspection. The inspection was performed and R ' any recommendations regarding upgrade, maintenance and repair are consistent with my training and experience in the proper function and rza �tenance of on-site sewage disposal systems. Check one : I have not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15. 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. I have determined that the system fails to protect public health and P the environment as defined in 310 CMR 15. 303 . The basis for this determin on is provided in the FAILURE CRITERIA section of this form. Inspector ' s Signature Date � �s ys Original to s}.s • "U,44(01 te;� owner Copies to: Abn,#vou �. a Buyer ( if applicable)_} �_�-�� Approving authority �_-L / �� / / /j`�G�I�C•l/u D uJ d SENDER: ■Complete items 1 and/or 2 for additional services. I also wish to receive the N Z ■Complete items 3,4a,and 4b. following services(for an 4) ■Print your name and address on the reverse of this form so that we can return this extra fee): card to you. r ai ■Attach this form to the front of thy^mailpiece,or on the back if space does not 1. ❑ Addressee's Address II permit. d ,I d ■Write'Retum Receipt Requested'on the mailpiece below the article number. 2. ❑ Restricted Delivery N r ■The Return Receipt will show to whom the article was delivered and the date E. delivered. Consult postmaster for fee. v 3.Article Addressed to: 4a.Article Number d 4b.Service Type c°� / ) ❑ Registered Certified a 770 ❑ Express Mail ❑ Insured f zq H C ❑ Return Receipt for Merchandise ❑ COD `a 0 Z 7.Date of Deli ry {¢ � / Received By: (P' t Na 8.Addres e's A ress(Only if requested C and f96 is paica 6. re: (Addressee orAgen) 0 Sri atu ( � i I I I I 1 E i 1 i. 4-i r.'. '.!. I 1 - i t I I .lI . t ; lilt i it f -; PS eorm 3811, Decernbw 1994 i I; i 4 1 102595-97-a-0179 Domestic Return Receipt l Now rst G13ss M_„ ail UNITED STATES POSTAL SERVIC r1 MA ............... os�ge�&Fetid ^F• J A c Print your am 4par s, and ZIP-Mde*4his '— .— Board of Health Town of Barnstable P.O.Box 534 Hyannis,Massachusetts 02601 Z 203 499 185 US Postal Service Receipt for Certified Mail No Insurance Coverage Provided. Do not us for International Mail See reverse Sent to � , Street&N ber. `77C� ',� P t Offi State,& P Code Postage $ Certified Fee Special Delivery Fee Restricted Delivery Fee Return Receipt Showing to . Whom&Date Delivered a Return Receipt Showing to Whom, Q Date,&Addressee's Address 0 TOTAL Postage&Fees $ Z. C•y Go M Postmark or Date li CL Stick postage stamps to article to cover First-Class postage,certified mail fee and charges for any selected optional services(See front). 1. If you want this receipt postmarked,stick the gummed stub to the right of the return I address leaving the receipt attached, and present the article at a post office service i window or hand it to your rural carrier(no extra charge). I 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the Q) r return address of the article,date,detach,and retain the receipt,and mail the article. LO 3. If you want a return receipt,write the certified mail number and your name and address °' on a return receipt card,Form 3811,and attach it to the front of the article by means of the rn gummed ends if space permits. Otherwise,affix to back of article. Endorse front of article a RETURN RECEIPT REQUESTED adjacent to the number. Q 4. If you want delivery restricted to the addressee, or to an authorized agent of the O O l addressee,endorse RESTRICTED DELIVERY on the front of the article. co 5. Enter fees for the services requested in the appropriate spaces on the front of this E receipt. If return receipt is requested,check the applicable blocks in item 1 of Form 3811. ti 6. Save this receipt and present it if you make an inquiry. 102595-97-B-0145 a r, Town of Barnstable • Department of Health, Safety,f , and Environmental Services • � • BAPMAREA 659. Public Health Division 367 Main Street, Hyannis MA 02601 Office: 508-862-4644 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health TO: ELISABETH A.WOOLF DATE: JAN.' 20, 2000 770 BOYLESTON ST.APT 24B BOSTON, MA. 02199 ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL CODE; TITLE 5. The septic system owned by you located at 264 INDIAN TRAIL was inspected on 05/15/95 by RALPH OJALA a Massachusetts licensed septic inspector. The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: LLEACHING PIT IS IN HYDRAULIC FAILURE" The above system, according to our records has been in a failed state for more than two years. Therefore, you are directed to hire a licensed Town of Barnstable septic system installer to sketch a proposed system that will bring the septic system into compliance with 310 CMR 15.00, The State Environmental Code, Title 5 within(14) fourteen days of receipt of this notice. The septic system must be brought into compliance within (30) thirty days of your receipt of this directive. You are also directed to maintain the system by hiring a licensed septage hauler to pump the septic system to prevent discharge of sewage or effluent into buildings, onto the surface of the ground, or into surface waters. Any person aggrieved by any order issued by the local approval authority may appeal to any court of competent jurisdiction as provided for by the laws of the Commonwealth. PER ORDER F T BOARD OF HEALTH Thomas A. McKean, R.S., C.H.O. Agent of the Board of Health Town of Barnstable y�nanmev;udxy.ax / 2 71hW0 C� 14PI,c �a Cape- Cie call, � No.. Xs._-:7]V'), THE COMMONWEALTH OF MASSACHUSETTS /Fim ......................... BOARD OF HEALTH TOWN OF BARNSTABLE , pphrtt#iun for Di-nVotial Wurk,i Touti#rnr#"tun 11ami# Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at• Z(v til�t��� � tL �x��s�5 } 22 ............ ----- -- . -- . -...._------------------- --- ->--------------•------------- ��-- LI'-AL1ZT� Lot�'1`1 At—L T• �. �Y�[U ........_.!..----•..... ...................•-.........-•-•--------....--------- -----------•-------•--- -------------------- r�h2q...--..... Owner Address W Installer Address U Type of Building Size Lot. } .._Sq. feet .., Dwelling— No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) d Other fixtures . -1---------------------- --------11---------- , l) W Design Flow.............1-Ib_-__..._ ,._._._......,_gallons per p r day. Total daily flow...-.--_--_ �----------_-----.___gallons fy Septic Tar&�I i t capacity_t gallons Lelrtgth_.lb...�--_ Width.S____�_. Diam er________________ Disposal �i—No. ...... ......... Width......_� _.----- Total Length--_---f!Z ... Total le�aac,hin area.___ .....sq. ft. 3 Seepage Pit No.-__---Z.--------- Diameter.....1,2..1----.-- Depth below inlet..__. : ..._. Total Ieachin area... 'b 'q. ft. Z Other Distribution box (� Dosing tank ( Vdi '-' Percolation Test Results Performed b .....................................................' Date.....__ .�_ .-__ ' W 2 Y4G1 It a�Tl• ,4 Test Pit No. 1. __.._..--minutes per inch Depth of Test Pit.................... Depth to ground water...L--.-__.............. f4 Test Pit No. 2.4t.?minutes er inch Depth of Test Pit.-.--«Z'I�.. epth to ground water....k b!' -AT I �6T t T 2 r�iZ LeT e -' 0�?`t"[ --T' Descrr t'�n Gof Soil... ' ••---- II . �( -2------- -..._ � -= � --� tt-4G------- ...v � ----- --- Y . U f a/V-•---7.. `19 v 1..... .A-0)--•---•---•--------.-•-•---•-••---•---- _ W UNature of Repairs or Alterations—Answer when applicable............................................................................................... ••-------------------------------•-••--•------------._..------•---•-------•-------------------------•-•--------••--•-------------------------------•---------•-•-•-•-----------•--------...........--•-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed ................................... ------------------------------------------ ---------------------------------------- Date ApplicationApproved BY -------- � .- ................................................--------------------------- ..Z. - ---'�:c--;S Da' Application Disapproved for the ollowing reasons- -------------------------------- ---................----------------------------------------- ------------------------------------------------------------------------------------------------------------------------- ------- ---- --------------------------------------------------------------- ---------------------------------------- Da'e Permit No. ........ t�.: .�� � '�,- Issued -- - ............................................ Daze ——————————————————— ——————————————————————————————————-—————————————————— THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE C�ertifirate of (111ontplianxe THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by ...:.................................................................................................................... 'Q,,'� /�++ losu�ue at - �� """ -------�Z.:..._. - Erc..fGa e .Er<1 c —r9.�� -....._..... has been installed in accordance wit�ovisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. 5-.-- .. .. dated ...... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT E CONSTR EA AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE... ---------------------------------------....._...--........-------------------------------- Inspector ._-------------------------------..............------------------------------------------ ------------------------------ ------------------------------------------ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No...� .'7�- 'CL' FEE.- ......... �i��ustt1 urk� C�rrnu#r�.c#iun �rrnti# Permissionis hereby granted..............................................-------------------------------------------------•-----.....------•-•••-••--------...........-- to Construct ( ) or Rep 'r,4>< an Individual Sewage Disposal S S at No................<. -fQ#---•- - ��`� '-------_.... . a --------------------•--_.. Street ((�� as shown on the application for Disposal Works Construction Permit Not. :7P- Dated_-_-_�.-0�15_.�T�r�-........... ..d� -------•------------------------•---------------......----------------------------------------------•---- Board of Health DATE----------------------------------------------- ---------------------------•--•. FORM 36508 HOBBS&WARREN.INC.,PUBLISHERS Z No....J..5. - - y e�"--- Fim............................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE -AVV iration for Diinpwml Works Tomitrurtion liPrmit Application is hereby made for a Permit to Construct ( ) or Repair (�� an Individual Sewage Disposal System at: / ----'-L�--z-AO-----....................... --•-----------•- v�a----.. --------------------------------------------- .................................- ----- __ Lo"ion- ess or Lot No zr� G . _.2..�.O.2.--- -- 2v z1G� o� Go ,- c ----------------------•-------•--------. ......................................................... Z3 Owner Address W --- lS feet Installer Address 4 g Size Lot_ ` }S�?�__ q. U Type of Building � .� _ .. Dwelling— No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures ------------------------------- Q • --------------------------------- -----•------..-- ---.................................. W Design Flow__._.__.____l...%�........................gallons per-pef-s@n per day. Total daily flow............................................gallons jl 1:4 Septic Talk—Liqui�capacity.). gallons Leingth_.lb.:��__. Width_S.... -- DiamgeTr-- _____ _________ Dept `...._`!1 Disposal Trench—No, ......4......... Width........z_._._ . Total Length...... ...... Total leaching area------ -----sq. ft. 3 Seepage Pit No------- Diameter-----1o..._..... Depth below inlet..... :.......... Total leaching area...?.`- sq. ft. z Other Distribution box (� Dosing tank �-� -= '-' Percolation Test Results Performed b -a-.___.---� a!!�� L L �.. q` Y----------- - --- Date----------------••-•--------- aj Test 'Pit No. I.L_.2-:_-minutes per inch Depth of Test Pit---�.� :«.... Depth to ground water.. 44-_-----__---- f= Test Pit No. 2.�--Z minutes er inch#Depth of Test Pit----- '�-�'D Depth to ground water....1J1-4� '17 1-5 Z -------------- kST IT 2 r;z ieT i 9 Ri ---•-•--•------------ -----------•----------•------------ ----•----•-•----------•-------- •------------------------------------ ------------� 3 D Descri Description of Soil_...G�. .............. EST L E � o L� -------o l� p �L, - U ............. ................................... ....... z• /•�r�!7......---- !� .... W 9---------------------------------------- Z Nature of Repairs or Alterations—Answer when applicable.-.-_._________________________________________________________________________•--------.----_-. -•------------------------------------------•----------------------------------••---•-•-•--•--------•-•-•••--•------------------•-•-------------••-••-•-•-------------------------------...........•-•-- Agreement: The undersigned agrees to install the aforedescribedIndividual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed ........... ....................................................... .._..........--........:...... Dace ApplicationApproved BY ...........t �•-::.._t ----------------- ----------------------------------------------------------- Application Disapproved for the�fol/owing reasons: ......_...~........................ ... . ...................................................................... .... ................................ . .............. ... . .._................ Permit No. ........ :...:.�' ..L�. ti. Issued Dare THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE ILErtifi.rate of Tontlatiance THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by ------------------------------------------------------------------------------------------------- ------- ---- ---------------------------..........................................------------------------.._...----------- 1-01 at ........ `T... ....... -^rf_., yt------ � ----------- -- � t� • ..P c? � 1 cs_ .c: : � 9 ------------- has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. . h .. . dared .,�...-:.'J_ BE �'_--1'...... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE-------------------------------------------------- ---- ------------ .........--- Inspector --- --------------------------------------:................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No.... ..............�iY c,,t. FEE... -. �topo�a1 ork� Toa��trurtion �rrmit Permissionis hereby granted--_---_---------- ------------•---------------------------------------------------------------------------•-------------••------.--••----- to Construct ( ) or Repair�(x) an Individual Sewage Disposal System _ /,� P ____ , emu----- a . Street qq. as shown on the application for Disposal Works Construction Permit No/'__1, Dated_-__-z-J _ 0�. ........ •-•------------------•--•----•----•--•------------------._ .............................................. Board of Health DATE................................................................................ FORM 36508 HOBBS&WARREN,INC.,PUBLISHERS AO CA ; ION a S E W A G E PE MIT .:NO. VILLAGE INSTALLER'S - NA III E A DRESS �fl 3UIL0EIII OR OWN Em 4z DATE PERMIT ISSUED DATE COMPLIANCE ISSUED l� f� a� � � �? � �. +3jo`cv i , � �G��/ �"' r � �TgA fl �� �� � _� • �0� _ � �� . �--,. >.. s ro THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH Appliratilan for Utspvii al larks nnitrnrtiun amit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at: L2E:i i AAdd or Lot`Nlo •......................... S2�c�_ ../5..:!l e.------........................... Address ------------------- ---------------•----•----------. Installer Address U Type of Building Size LV-,....el.....4 !"et Dwelling No. of Bedrooms.......2 .............................Expansion Attic Garbage Grinder- Other—Type of Building ............................ No. of persons............................ Showers — Cafeteria Q' Other fixtures .. o.... .........-........................................ w Design Flow........fl%.........................gallons pew per day. Total daily flow.............-��->................gallons. x � qcapacity/ --- g ----------g-- Total Length leaching Depths�.;!�...`.� w Dis osal Trench—No. .................... Width...... area........ sq. ft. R� Septic T�:nk—Li—Liquid . �_-gallons Len th_lA-(o.__. Width�_�..__. Diameter_-_ Seepage Pit No......2 ._..._.. D'ameter./t)r_i�..... Depth belo inle�j...X.......... Total leaching area.,�,t..i6� sq. ft. Z Other Distribution box 1: Dosing tank o'er , '-' Percolation Test Results Performed ....&..Ka.... Date! a � ��1 71 ............. Test Pit No. 1,..............minutes per inch Depth of Test Pit................._.. Depth to ground water---------------....... f=, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water......................... a' •---.....-•--•------ ------------------•---•-----------•-••••.....•---- •---....................................------............. .... O Description of S it--- .... ......... ............... ----------------()..... w x -•••----•--------------••---•---------••--------------••-•-•-••••••••--•--•-•...---•••••---.....-••-----••-•. U, Nature of Repairs or Alterations—Answer when applicable................................................................................................ -•---•--.....-•-----------•------•--••--•-••------•-------------------------•------•...............-----•--....-----------------•-----------------------------------------------._..................---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITLB 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the boar f health. A!; Date Application Approved BY ----------------------------- �� ••---- Date Application Disapproved for the following reasons: --------------------------------•--•...... ---------------------•-----.........------••-•--......------•-------------•-----•------'------------...----------------••--•----•---------•----•----------.............. ............................ Date ............•............... Issued-.��..�.'.����d....Permit No......................................................... --------•-----...-----•-----... Date 5 i-• F F'w�rs�t_-J No.--••••• + v�.... `! Fss...'1.�.._..�............... THE COMMONWEALTH OF MASSACHUSETTS BOARD DF H A H �. ...-....--.0 F.:..........:..... � ,���lirtt�ilan .f�r �t.��u�tt1 �ark,�.�C�nn��rnr�uan p�uti� r � Application is hereby made4or a Permit to Construct '( ) or Repair ( ) an Individual Sewage Disposal System at: -•-- ......... ...... ..................................•--- -••--• -.................. . ................................. f �! ,• Lo(a onyAddress fr�or Lot:)No ... - .. • ...... ..... .... ............................. _...._.. ......._. ....... ....... .... ......................................... Ad Address W � Installer Address ivy d Type of Building .� F Size L� '.a _._ .:__Sq. feet e Dwelling—No. of Bedrooms............................................Ex panion Attic ( ) Garba g Grinder ( ) aOther—Type of Building ____________________________ No. 'of persons___......................... Showers ( ) — Cafeteria ( ) QI Other fixtures _. � 2 Design Flow______ ______ ___________ .......gallons per person per dqy. TotalAaily,,Oow----_......_- _'..........................gallowi, 04 Septic Tank—Liquid capacity_.... ....gallons Length .,Z.___."__. Width................ Diameter________________ Depth_____."_-- W x t, Disposal Trench ,No __ __. Wid�th,.,._. ______ Total Length ______ �___._._ Total leaching area "sq. ft. > ,iy• ,, Seepage Pit No ______ -_----Diameter .............. Depth be o inlet ___.___. Total leaching area............_.....sq. ft. Z Other Distribution box ( ) Dosing tank ( r) � ' - 1-1 - C C7 W.Fwd.m-4q tpp, /'�.:Cd "'<.-+..� d r 4 0 J J Percolation Test Results Performed by..........................:_._ .. ._.._.._. ..._.�._._____ Date._: �r_____ � "T, r ,.......•--------------- ,� Test Pit No. I................minutes per inch Depth of=;Test Pit.................... Depth to ground water..______.____________._- (i, Test Pit No. 2................minutes per inch Depth of`Test Pit.................... Depth to ground water........................ ................................................................... Description of ,foil,.___. __ - W . -- ••-------------- ---------------------------------------•----------------•----------------------------------------._...---------•- U Nature of Repairs or Alterations—Answer when applicable...................................................._..........................__............... Agreement: s The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T I T 1 L 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until.a Certificate of Compliance has been issued'.by the board of Health. gnd ---=------------------------------------=---------•-•----------••••--•-_•••-- ................................ D Application Approved By... ...... • ._._ -------------------------------= ......... _-------- D1 Application Disapproved for the following reasons-......... ---............................................................-....................................... Date Permit No......................................................... Issued_,P:�/�?_ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD HEALTH .. ..�:...OF......... ... ........................ .._ n if'rtt# oaf Tomplittnre THIS IS TO CERTIF ', ewage Disposal System constructed ) or Repaired ( ) byr ._..... ................ a -------------- at__.., � ._... 40 'y ' Ins =_ ...... has been installed in accor lice with the provisions of o T e State Sanitary C de.,,.,,as descyi d in the application for Disposal Works Construction Permit N --------•_• I*_�------.-•-- dated_.-.�.....� ............................. THE ISSUANCE O;e7HIS CERTIFICATE SHALL N'O:T BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY:='"' DATE................................................................................ Inspector...:_:...-------•---•---••••••=•------- ......................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD RF HEALTH // ...+ .2 4 ........... d-14..'>�..........OF..--.. ... ............................................... No.......... ........... FEE........................ �i��r.ttsttl r, ��� .ernti# - Permission is herebyranted-�"-...................................... ------- -- .,__. g to Constr ( or Repair ( ) a ' In ' Idual evc� e pispo st at No._. _Y' _. '�` ........................... ......................... f �9t - Y" Street as shown on the application for Disposal'Works Construction it.N _a ._____ y__'__`_ �D,aated___......... ..........................r Board of H DATE.................... �._... ----._..:-•-...... vvv FORM 1255 HOBBS & WARREN, INC., PUBLISHERS i No.- -- _=_ Fee BOARD OF HEALTH TOWN OF BARNSTABLE ApplicationArVell Con!5tructioni3ermit Application is hereby made for a permi to. Construct ( ✓J, Alter ( ), or Repair ( )an individual Well at: =Q�`L____ - 7 ----- Location — Address Assessors Map and Parcel Owner Address = =------------------- ------ ----------- Installer — Driller Address Type of Building Dwelling------ ------------------------------------------------ Other - Type of Building-------------------------------- No. of Persons---- �`�----------- --- o.Sc-h -�o Type of Well- —---- ---- --- -- - Capacity--- -- - - - --— Purpose of Well----' /e� G1770 --------------------- 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 qpmpliance has been issued by the Board of Health. Signed - —----------- -- -�Q'0 �e ------- / date Application Approved By -.1'V'& -- date Application Disapproved for the following reasons:--------=-----------------------------------------------_ q•�. date PermitNo. —�`= - — --------- Issued------------------------------------------------=--------- - date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( ) by- ------ � =-------------------------------------------------------- - ----------- ---- Installer at :t (J _ A 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.VJ_97-_B-6-7-Dated------ -------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE--------- __— ---- --- Inspector --- No.-A-17 --�= -` Fee-9--J--------- ---- BOARD OF HEALTH T•OWW OF. BARNSTABLE 0pp[icationAr Me!i construct ion 30ermif .. �- r 1 !Win• - Application is hereby made for a permi&to Construct(:v); Alter (` '), or Rep it ( )an.individual Well at: 2N,61,V A1 7,P4i4- � ✓�f 7 ti, t -- - 'l�— -�Z= p and Parcel Ma " Assessors'• �,,/Lotanon Address h P IQrO Al_ lNOO/� - - ---- - ----- // Owner Address Installer — Driller Address Type of Building Dwelling — ---------- --------------- = -f Other - Type of Building No. of Persons----2 f`--' Type of Well ----=---- --- --= -`'Ca /4 - Purpose o f - -------.:--- - - �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 mpliance has been issued by the Board of Health. Signed - r /— ----- ------ - =/d'W� ---- ! 'date/ Application Approved By ------- —— date — Application Disapproved for,the following.reasons: -----=------------------________—_—_—�—_ -------- --- - -------------------------- date Permit No. Issued- --- -- - --- - -— ----- date 1i4s4L4i4FL•J9o'.to9'�!Tls±a°� ,.v..o4e,..`smo4��40�ibit`yim'!'o4.�_.ii,..64oDmbc.4"v4e4 $GTa4'61i9S'?sE9 9 1e oD�9cS'a�,4ceOmPa9a}a0.'!�e,�c'C'r}R�AmCsaV.wliA"e'+m9e:Yn:4F:4�lminS:a�:�TmlaO�i4iiRu:.i'in!Fs�s4v!ab.i' BOARD OF HEALTH� � TOWN OF BARNSTABLE Certificate Of Compliance THIS IS TO CERTIFY, That the Individual.Well Constructed ( ), Altered ( ), or Repaired ( ) b __------ w�- ---- --- -- --------------- -------- = -- _-_----- y Installer at— - � � Y J0.'�"� --Ls _-------- --has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection . :Regulation as described in the application for Well Construction Permit No. Dated----- =------- a THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE Inspector -- - - - - ---------—-=----- Pi4i9ii!i0iSi4ii e4:LK9G►i4D4ilibi4i4i64i 4i469f.fFli?i9iCiTiOi�iTi4iPiaFei•Cil4ibiTi9i9i9i9ipi Vi@iK(n'iSiLTy0i4iilir!i90 Ti!1i9F4i4b!'ibiRYSiIi�X�i4iSYO9JTMi4li!i�i?i4i!sla9J.�•Y'.1�'+om8 BOARD OF HEALTH TOWN OF BARNSTABLE Well Con0ruct ion Permit No.W 9q - gJ� Fee_ _ Permission is hereby,granted —__— to Construct (y), Alter ( ), or R� ) an Individual Well at: Street — — —as shown on the application for a Well Construction Permit No. ------ Dated-- ��-= = --Ct-�- ------------------- --- — ---Zard' -----------------------------of Health DATE — i • PRICE AMOUNT I = pG�MOO�L ]O 'j8 8 7 I JOB PHONE DATE OF ORDER ' DESMONC IVELL 'DRILLING,. INC:-. ' CAPE,COD TEST BORING-: JOB NAME/LOCA1luN F 5 Rayber Road ` ' ORLEANS, MASSACHUSETTS-02653, (508) 240-1000 Co�F o F nQ /,� PHONE �y r �I. t 3�a _ o ORDER ER TAKEN BY .� t F �-TERMS I Apt, ..� , ,. •- s� 1 , }a I I LABOR HOURS RATE AMOUNT { I TOTAL MATERIAL I TOTALLABOR j .> '. WORK ORDERED BY DATE COMPLETED t SIGNATURE(I hereby acknowledge the satisfactory camptetlon of TAX the above described work.) - t " 3 i `?"hank`You.► I PAY THIS AMOUNT r h� e� ',y ♦X' ...�: ✓` Y @F;9 �� ' ' ~ }r � :.,.a� w^ ;�� .w, ,:.�— :.,�, n - � � TOWN OF BARNSTABLE ��]� UNDERGROUND FUEL AND CHEMICAL STORAGE SYSTEMS �G�' ' IM ASSESSORS MAP N0. � j�3 �_ PARCEL N0. ADDRESS: .7N()j J N 1 / !L— VILLAGE,' �RA IMY� cs:t� NAME.', _ 1_S� A•.l._ --i/S f 6lJ .:a CONTACT PERSON )00 0 PHONE NUMBER f 2-6"7Lif— LOCATION OF TANKS: CAPACITY: TYPE OF FUEL. AGE: TYPE: LEAK OR CHEMICAL: DETECTION SYSTEM' C�o C1 )Q r Ira - sGc ors DATE OF PURCHASE OF. EACH: 1. ���_ 2. 30 4. 5. -DATE ':0F FIRE DEPARTMENT PERMIT: &A S N-L&VI. L't 011 TESTING CERTIFICATION SUBMITTED: PASSED DID NOT PASS PLEASE PROVIDE A SKETCH SHOWING TIIE LOCATION OF TANKS ON THE BACK OF THIS CARD. t9n ( c, i 5 t TEST HOLE LOGS � ' -� ENGINEER: W TNESS: -, ,' C . 1 _�__--- �' i DATE: ---- PERC. RATE _ < "= ' PEP,C. TEST # Q43 0' [Top AND T--�� r � f--- ------------. --. SUBSOIL suesal ` LOCATION MAP (NOT TO SCALE) ' .IrT`1�»fJG ASSESSORS MAP lfl�a PARCEL. FLOOD ZONE L_21 1 . DATUM IS ------- n `____L \G 2. MUNICIPAL. WATER IS 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. E{I h- - 2.-y -- - - - 4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO-H-!�-_. - _ ,. ,`.' ��b Q 1,2 W 5. PIPE JOINTS TO BE MADE WATERTIGHT. RF _� ' �N�-�+ � -tiG 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH r,IASS. 00 I45.60pC 'b?mil. �-� ENVIRONMENTAL CODE TITLE V. _- A 'A� ` T - 7. 4, �' T41•►t> h ATE. �?r..s.-t F'•m�c- t K.o�ogr© Worz-�-- D►1�,i=c �- 1'�- Ic._T i'a 1� r "1�L—'� `�' } -�-0 4s,c PC'. e c?�QTzr L-AP-ACi '1TA� i ►-L j`y '1_ ;f 8. PIPE FOR SEPTIC SYSTEM FO SCH. 40-4" PVC. "` SEPTIC PROFILE 94 ; (HOT To 5c�t� EV-I�ir. A .-erema:svcooe. amr- ..` •- I T I' 1..�'�-ICY. � .. _ ' ,S.ZU T. � I .0.F A! LL. 1`1. A ten. 040 4 k Y MINtMUM 1' OF COVER OVER PRECAST t�fT r c'E RUN PIPE LEVEL T h r r ,2' _�, 1► " '?? L N ' —`� E L --_il_J - FOR FIRST Z' (DB-:) �YI� _..� .�'� , �a :•� (G.4� I ���1. Cm,Y T°—\ c„c ,,, �,_.., --`s Y,rrF;,y ' V K:T r tit%`tL N L!1!,T M c. GALLO TANK SEPTIC -- t1 F L-�f2 C7 i I - - (F1J�� �5•q� L --- "mayf�i tcE �.L' I ,in — I -G `z- G r' 1wJ _T,►�_N DEPTH OF Flow �S 1 ., TEE SIZES: Qti L2Tv41 �-� � � 1 L✓ INLET DEPTH SLOPE) OUTLET DEPTH ,� (�X SLOPE) 7-1 I �- ..k'-� � `=�G PLf ►.} LEACHING p FOUNDATION— SEPTIC TANK - - D BOX - FACILITY,�� t r, G _ - =r'�Zo(j► !'�/l�t�i .ram" �, - _ �-�^"�i LET i-I t �. b F F l�Tv�-r 4 i�-a" 1 DE - TIL T �LALV TzI, �,� , rp -rN� n.r vE SITE AND SEWAGE PLAN r�, IypTTO SEPTIC IC DESIGN: (c,ARBAGE DISPOSER IS -- '1 p f-- N 55I1, X l 1 , �= C'.?5!a. r = ` `? ._ � DESIGN FLOW: t? BEDROOMS,,(iio G?D) _ GPO i.,?� ►� ID . T',C,j'P ir�Th �: F-'�A US A GPD DESIGN FLOW ' 56 � r , t' ,, = a(a� GALLONS PREPARED : -IGI-Hp�Ti�'����.E Mf�1. .�e, SE- TIC TANK__ 4R�_ GPD, (_-�) FOR �p' {� ''�L -` -Mom. USE A i��- GALLON SEP"IC TANK -i 711�� !►�:, 2- � � LEACil'Ng, BREAKOUT: _ --- �--�--=- --- — - - , -- - --(1SOX) _ FROM EL. 80-IT 0M: ! -_�_" G P D - -- - -_ - �- --- -- -�-_TOTAL: u c DATE: -=�-_ <--� -TOTAL: �.ca S. . "-+>R (��-sy �-� - ---- SYSTEM IS F-ROM EL. /� / 41 P L���U !.ow ram! F u�iz� # ��"'Y� ►.� �- �F�r�-�t down cape engineering, Inc. 1'o Thl, _ == >✓, r rL �F p u,, ray •,,4 CIVIL ENGINEERS N ,r LAND SURVEYORS ���A �� c� .--?��/i i1�_�: `� __ �,�`' ��,P�-•._.-'�T.�+ � Ho�uzn of xaai rH - �- 4 y, �-7 .�1 ,F � ARC', aRN>t N'� PHONE 50e-3e2-+541 FAx 50e-3e2-9ee0 � :o��i d'`3 h F > o. G��. �� ` BZ►.�� �aF Mlhl H '` _styl>`__�`I s39 main st. armouth, ma APPROVED-- -DAB- — ---._ �, �F u a �s -�_.`� - 4 >� , Pt:� ., ^gyp . N DATE°tS Y R���• a►Stta .�'•" '�fC►S; ONAI .v MSG.t Too o,c fc►cr,.r,oyric„�/ / 20 /L t. �.2� 77y,��/C /S�O o. •s- �cl9J NG 0 STe.v i �n B /S. 9� /�Zo so• 7ce Z a 9 7 P f H_O Ae E . / _ /O �/ / �J 1 1 E_/ 'o--o—o—o-- proposed c�rour-7cl P/ of, e- 4 S G r!�-;:.� .q J ,�".C' ( rr,i n/rr>u� % G•F r f^c,r` � i / — -- - -� Si-7-7- r —. I � '`` ii71VVTT / Z u . ,�-seed � �-o.���; •• �'G�4 L E � •',¢ � C' cp �.,► .e s�r.�..,cE ,�,s - / ;s. .� Tb - - �� S / v ;, --- _ T �- T H O L E- / Z Pc: O�OGM f/OC/SE' lO,g7-� . //1" J TEST BY ✓ G?�Lv6GL A•1udT �/� LOC•IT�"O ' �1 �-/ ,.!/J/Tiy '`'S��S,^� r" I/ wI•w/,,,�u.•-! ♦ /0' 1 ram,l 'f l S _ �! T - +C 'c.. /L? /t'�/n/G/-/ , ... '� / Z Z o PfrTc�M M S L C D�+-'.r.IeA-:..c'� €ly i='sLf✓rl,�y �a•s�e� ,�.sc�c�T7! � �'"-..y c� . �= __ CL•'l,' T& 5 T t' �w0 47 M1. T S/J /9' 7iCST .5/CaG E fa �' T �o�9--.0 r �6 So.L - � � •� �Q� mac. =/B. Z � �fr= � L_ -- �y — E'c. -/6,z-� � 'P r ,3 � E Fes. ��,�7.ti• -�-Y---- �` /3/ 9 4 &L. 2o. (.S \ OT TG N7 - BG, Ce SF /,o) 6rG• (® �G. ���ivi�G 611T, �.v rOis/F /-�si�} 7--,,, , —a �/ - ! �•-- '►`'�1,,, �' t of Fir- 4 oloo ,, vFi / ter 1 _, / 6 e _ coo w n G �: / ,-7 e- e r/n T�- j !�/.� 07 �" f L /� h � rzAv y ry �-- GOT ^- /A/•O/�'9�,/ 7�1C. �4/G.__ `�l/�-.�'�L�,�C�✓i.rj` c:,ems G AJ N ✓ - �,E�,r_c2 .v-,� 800.E g/7 1 51 z E ef:a .c C e ��cc,/�9z•G� S��'-4.�/ z"k of • ���PIJ-- • 5 G .q C_ � L?S .� t-! � ��./�� :3A T� /q,�2i� /9,8 we o +A At Y6 SG � LE / = GQ . i9PP�© LSE G> E3uf' = Cf HEALTH ' < -' -- - -' - -- — eX � St�r, 9 Co✓�for�r,5 ," MASS - o---o�---o—o — proPo.Seo/ GontourS -- no 'jWMvfMM-LMr } FJ11rL11-�iT�2>l.� ti�f�pQ- - I TEST HOLE LOGS ENGINEER:_ W TNESS: DATE:_— 7' fl PERC. RATE = < PERC. TEST # (v a F �j I -r•i.JT�- - - - � ' SUBSOIL ��.Z SUBSOIL �_z �'1�'''�' LOCATION MAP (NOT TO SCALE) � 411 1 _moo ---- -- ! H VTI`zo C> , ASSESSORS MAP PARCEL � FLOOD ZONE ���;� Ir _t I I *�71�,11•� ��D 4.y} \l aF -N_- TES=- I , / 1 . DATUM IS '�+ 62 y � � I 2. MUNICIPAL WATER IS �e 3. MINIMUM PIPE PITCH TO BE 1/8 PER FOOT. i44" L• '�� �!' 4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO-H-�. � _ . ------- ----. .--- --- - _ . _ 7� �� +� O 5. PIPE JOINTS N T �• rr � �.trc �[ . "„ • _ND � � S TO BE MADE WATERTIGHT O ►� ' i � ,� A-ry jL� 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS. ENVIRONMENTAL CODE TITLE V. �1.,vPO`ic.0 WorLi, 15 a• To E '�iGp Foy!. � jX�GTk {,1►�G �'"per.{► 1C� PT PROFILEB. PIPE FOR SEPTIC SYSTEM �0 SCH. 40-4" PVC. --t--- J!ZL S E I C• J It.Z- -z i 4 0 MINIMUM 1' OF 7--- I ------COVER OVER PRECAST 4' ( \ v 4,To0 -; > tai bh!jFT` RUN PIPE iRST 2 LEVELm- . ' �IT`i41 1�'f� 7 jy l t �7 i r !_ b�l� U1Z�"t^ /p I .» L SEPTIC - ' ^ I u<< TI � �'f iE �b I TAW (Rio IS 1v, Ea S f`a�1� c"xl�r�r7 3z� T� �� L �N��: � _ _ _ - �4•q�t � � I h1Gr (T^� % .v . .. -T Iw I6 N DEPTH OF ctOWI' `�.(r( \ 3/�y To {Jrz ^} R _!4t '_`' ✓ TEE SIZES: O �" { y [> C-, ram, rjf-C / INLET DEPTH (� II {—Q$� l �z * S r.�, I� "? (: % SLOPE:) OUTLET DEPTH �4 (iX SLOPE) ! { y T rr � ! ��J�. S 'x'II '; _ � yt� J� ED T:4FFU�f- ks r 4---7 S 1 _ LEACHING FACILITY F s r ------- D Box rOUNDATION-- SEPTIC TANK -AL �-�" Izhi.� -1-� `(-F IE 4�f-r'rIC- �,ALti 1�44a`L L FEE I ►-JGft6'rf P I TZF, Ccfr - -a -T'N� ,� �� SITE AND SEWAGE PLAi�1 -- -Pill SEr11C DESIGN. (C-ARRAGE DISPOSER IS _� BE F ` �� X �. %.s _ - D, DESIGN FLCW: N BEDROOMS i(� c�o) _ GPo ,' ;r.•tl�a��u ID . L�zFk;Tv( � F-�f Q 5$Ir -cc- USE .A 4- 9 GPD DESIGN FLOW ', '5 '2F > o �,�,F MIa !a ) SE,DTIC TANK: 4`�_ GPD x('2) _ ��^� GALLONS PREPAP.ED FOR: _2EIl b- USE A l`2�' GALLON SEI✓_'IC TANK - �41��1",� �b. 1�� 2-�d�'d LEACHING' BREAKOUT: w-- --._zlit ^ �- . r„ %,; 0 I I Z1, ;51r Feet - (1 SOX) _ ___ FROM EL. 607OM: 1 L �__ � `��f. .� Z �i 1 A R I GPD �, u_ — � ------ TOTAL: = L�•°� S.F. r-R r')y4 S„AI.E: :,�� DATE: sYsrEr� Is _ ROM EL. _ /' v . r-r� ipW t�l FU�tz� '4;.�_; .�.{P� oF�ro11E down cape engineering, inc. 6-7 j CIVIL ENGINEERS LAND SURVEYORS HOARD OF HIALTli 4- L�.�S <.� o�� � �,� ARNb ARNE M. � '1 PHONE 50e-3E2-4541 FAX soe-362-9850 7, ¢�,?�©•-NyG.L..F p..tlrl�vR) �$�.�� L�. M•�; " _ < , 4 �,nLA ` /�S MA - L APPROVED DATE ;,l2,czb 67F. X o, S'G - ? ''P DATE 939 main st. yarmouth, ma � -, `� ` `��- �� �- PU a I ' v,9� � •. • ,e