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Home My WebLink About4323 MAIN ST./RTE 6A(BARN.) - Health 4323 MAIN STREET, CUMMAQUID 17 A=350-003.002 3 � o Page: 1 of CERTIFICATE: OF ANALYSIS ?' Barnstable County Health Laboratory (M-MA009) U 4 .+EMI Report Prepared For: Report Dated: _9/20/2017j --- Paul M.Thompson Order No.: G17103268 NJ PO Box 91 " Cummaquid, MA 02637 . Q a. Laboratory ID#: 17103268-01 Description: Water- Drinking Water Sample#: Sample Location: ~,4323.Main St.Cummaquid, MA f Collected-ND 002/2017 Collected by: P.Thompson Received: 00/12/2017. Routine ITEM RESULT UNITS RL MCL METHOD# ANALYST TESTED NOTE Nitrate as'Nitrogen 6.2 mg/L 0.10 10 EPA 300.0 LAP 9/12/2017 Copper 0.21 mg/L 0A0 1.3 EPA 200.8 LAP 9/13/2017 Iron 0.13 mg/L 0.10 0.3 EPA 200.8 LAP 9/13/2017 pH 7.0 PH'AT 25C NA 6.5-8.5 SM 4500-H-B DCB 0/1 212 0 1 7 Sodium 19 mg/L 2.5 20 EPA 200.8 LAP 9/13/2017 Total Collform. Absent P/A 0 0 SM 9223B RG 9/12/2017 Conductance 390 umohs/cm - 2.0 EPA 120.1 DCB 9/12/2017 Water sample meets the recommended limits for drinking water of all the above tested parameters. Attached please find the laboratory certified parameter list. Approved By: (Lab Director) � -: — ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level 3195 Main Street, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 i5's��flk;✓ti; CERTIFICATE OF ANALYSIS Page: 1 Barnstable County Health Laboratory Report Prepared For: Report Dated: 7/26/2010 Paul M.Thompson Order No.: G1058512 P0 Box 91. Cummaquid, MA 02637 Laboratory ID#: 1058512-01 Description: Water-Drinking Water Sample#: Sampling Location: 4323 Main St,Cummaquid,Barnstable? Collected: 7/19/2010 Collected by: Customer 350-003-002 Received: 7/19/2010 Routine ITEM RESULT UNITS RL MCL Method# Tested Nitrate as Nitrogen 0.20 mg/L 0.10 !0 EPA 300.0 7/19/2Q!0 Copper 0.38 mg/L 0.10 1.3 SM 31 11B, 7/22/2010. Iron ND mg/L 0.10 0.3 SM 311 I B 7./22/2010 h Sodium 9.7 mg/L 1.0 20 SM 311113 7/22/2010 Total Coliform Present P/A 0 0 SM9223 7/19/2010 Conductance 230 umohs/cm 2.0 EPA 120.1 7/19/2010 pH 6.5 pH-units 0 SM 4500 H-B 7/19/2010 The recommended maximum contamination level for drinking water exceeded due to Coliform Bacteria.Retesting is recommended. Attached please find the laboratory certified parameter list. Approved By. _ _ _ (L irector) F � ,O d li M ND=None Detected RL = Reporting Limit MCL—Maximum Contaminant Level Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605 07/29/2010 THU 9: 20 FAX 5083627103 Barnstable CTY HealthLab --a-� Barnstable Health 0002/002 .......... ............. i COMMONWEALTH OF MASSACHUSETTS DEPARTMENT OF ENVIRONMENTAL PROTECTION Certified Parameter List as of:01 Dec 2009 M-MA009 BARNSTABLE COUNTY HEALTH&ENV DEPT,BARNSTABLE,MA Anal es Methods for NON-Potable Water Methods for Potable Water ALUMINUM EPA 200.8 ANTIMONY EPA 200.8 EPA 200.8 ARSENIC EPA 200.8 EPA 200.8 BARIUM EPA 206.8 BERYLLIUM EPA 200.8 EPA 200.8 CADMIUM EPA 200.8 EPA 200.8 CHROMIUM EPA 200.8 EPA 200,8 COBALT EPA.200.8 COPPER EPA 200.8;SM 3111 B EPA 200.8;SM 3111 B IRON SM 3111E LEAD EPA 200.8;SM 3111 B EPA 200.6;SM 3111 B MANGANESE EPA 200.8;SM 3111B MERCURY I EPA 200.8 NICKEL EPA 200.8;SM 3111 B EPA 200.8;SM 3111 B SELENIUM EPA 200.8 EPA 200.8 SILVER EPA 200.8 EPA 200.8 THALLIUM EPA 200.8 EPA 200.8 VANADIUM EPA 200.8 ZINC EPA 200.8;SM 3111 B PH SM 4500-H-B SM 4500-H-B SPECIFIC CONDUCTIVITY EPA 120.1;.SM 2510B HARDNESS(CAC03),TOTAL SM 2340B CALCIUM SM 3111B SM 3111E s MAGNESIUM SM 3111 B € SODIUM SM 3111.B SM 3111 B POTASSIUM SM 3111E ALKANILITY,TOAL SM 2320B SM.2320B CHLORIDE EPA 300.0 FLUORIDE EPA 300.0 EPA 300.0 SULFATE EPA 300.0 EPA 300.0 NITRATE-N EPA 300.0 EPA 300.0 NITRITE-N EPA 300.0 -TURBIDITY EPA 180:1 TOTAL DISSOLVED SOLIDS SM 2540C SM 2540C NON-FILTERABLE RESIDUE(TSS) SM 2540D TOTAL ORGANIC CARBON SM 5310B CHEMICAL OXYGEN DEMAND HACH METHOD 8000 BIOCHEMICAL OXYGEN DEMAND SM 5210B TRIHALOMETHANES EPA 524.2 VOLATILE HALOCARBONS EPA 624 VOLATILE AROMATICS EPA 624 VOLATILE ORGANIC COMPOUNDS EPA 524.2 1,2-DISROMOETHANE EPA 504.1 1,2-DIBROMO-3-CHLOROPROPANE EPA 504.1 PERCHLORATE EPA 314.0 HETEROTROPHIC PLATE COUNT SM 9215B l TOTAL COLIFORM MF-SM 9222E i TOTAL COLIFORM EPA 1604 TOTAL COLIFORM ENZ.SUB.SM 9223 FECAL COLIFORM MF-SM 9222D MF-SM 9222D E.COLI EPA 1603 EPA 1604 E.COLI EPA 1103.1 NA-MUG-SM9222G E.COLI MF-SM 9213D ENZ.SUB.SM 9223 ENTEROCOCCI EPA 1600 EPA 1600,SM 9230C Effective Date:01 Dec 2009_Expiration Date:30 Jun 2010 £ i CERTIFICATE OF ANALYSIS J, Page: 1 Barnstable County Health Laboratory yrrt('1-IVSb^�� Report Prepared For: Report Dated: 7/17/2008 Paul M.Thompson Order No.: G0847753 POBox91 Cummaquid, MA 02637 Laboratory ID#: 084/753-01 Description: Water-Drinking Water Sample#: Sampling Location: 4323 Main St.Cummaquid,MA Collected: 7/14/2008 Collected by: P.Thompson Map 350 Parcel 003-002 Received: 7/14/2008 Routine ITEM RESULT UNITS RL MCL Method# Tested i Nitrate as Nitrogen 4.7 mg/L 0.10 10 EPA 300.0 7/14/2008 Copper �-ND mg/L 0.10 1.3 SM 3111B 7/15/2008 Iron ND mg/L 0.10 0.3 SM 31 11 B 7/15/2008 Sodium 13 mg/L 1.0 20 SM 3111B 7/15/2008 Total Coliform Absent P/A 0 0 SM9223 7/14/2008 Conductance 390 umohs/cm 2.0 EPA 120.1 7/14/2008 pH 7.4 pH-units 0 SM 4500 H-B 7/14/2008 I Recommended maximum contamination level exceeded due to Coliform Bacteria. Retesting is recommended. Approved By (Lab irector) -7/�8�� N p Ct m - C= ! N � fl? W � N M ND=None.Detected RL Reporting Limit MCL—!Maximum Contaminant Lever Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 CERTIFICATE OF ANALYSIS Page: 1 'm Barnstable County Health Laboratory Report Prepared For: Report Dated: 7/22/2008 Paul M. Thompson Order No.: G0847968 P0 Box 91 Cummaquid, MA 02637 Laboratory ID#: 0847968-01 Description. Water-Drinking Water Sample#: Sampling Location: 4323 Main St.(6A),Cummaquid,MA Collected: 7/21/2008 i Collected by: P.Thompson Received: 7/21/2008 I Test Parameters ITEM RESULT UNITS RL MCL Method# Tested Total Coliform Absent P/A 0 0 SM9223 7/21/2008 A N N c ii vc L,j✓ .3 (Lab64ctor) � X15 { C3 CD c C. 0 tV P, O ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court'1House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 r Qy Page: CERTIFICATE OF ANALYSIS Barnstable County Health Laboratory Report Prepared For: ' Report Dated: 3/9/2004 Order Number: G0424303 Paul M.Thompson POBox 91 Cummaquid, MA 02637 Laboratory ID#: 0424303-01 Description: Water-Drinking Water Sample#: 24303 Samnline Location: 4323 Main St Cummaquid MA Collected 2/24/2004 Collected by: P Thompson Received: 2/24/2004 Routine 3jq�� ITEM RESULT UNITS MCL Method# Tested LAB: IC Lab Nitrates C7 2.8 mg/L 0.1 10 EPA 300.0 2/24/2004 LAB: Metals Copper 0.1 mg/L 0.1 1.3 SM 3111B 2/26/2004 Iron 0.1 mg/L 0.1 0.3 SM 311 IB 2/26/2004 Sodium 12 mW 1.0 20 SM 3111B 2/26/2004 LAB: Microbiology Total Coliform Absent P/A 0 Absent 307 2/24/2004 LAB: Pllysical Chemistry Conductance P 350 umohs/cm I EPA 120.1 2/24/2004 pH 7.5 pH-units 0 EPA 150.1 2/24/2004 Note: Water sample meets the recommended limits for drinking water of all above tested parameters.. Approved By: (IV Director) Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605 tL' Mi CERTIFICATE OF ANALYSIS Page: Barnstable County Health Laboratory Report Prepared For: Report Dated: 2/7/2003 Order Number: G0318767 Paul M.Thompson POBox 91 Cummaquid, MA 02637 Laboratory ID#: 0318767-01 Description: Water-Drinldng Water Sample#• 18767 Samolina Location: 4323 Main St.,Cummaquid Collected 1/28/2003 Collected by: Paul Thumps ID 350-003-002 Received 1/28/2003 Routine ITEM .RESULT UNITS MCL Method# Tested LAB: IC Lab Nitrates r 7:0t mg/L 10 EPA 300.0 1/28/2003 LAB: Metals Copper 0.2 mg/L 1.3 SM 311113 2/6/2003 Iron _ _____._. <0.1 �__ _ mg/L-- 0:3,.,. . ..,SM3114B 2/6/2003-- Sodium 12 mg/L 20 SM 3111B 2/6/2003 LAB: Microbiology Total Coliform Absent P/A Absent 307 1/28/2003 LAB: Physical Chemistry Conductance 227 umohs/cm EPA 120.1 1/28/2003 pH 5.9 pH-units EPA 150.1 1/28/2003 Note: Sample has higher than average levels of Nitrates.Monitoring is recommended(2-3 times per year)to establish any upward I trends. Approved By: . (Lab Director) z/7k-".3 Rh OVhD t i TOWN OF BARNSTABLE HEALTH DEPT. i Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605 /y gjd,S,TOWN OF BARNSTABLE LOCATION 3Z3 �T�� G��/!�f�l�!/,t� SEWAGE # 98' VILLAGE I`W IVX VW /ASSESSOR'S MAP&:LOT.3.j4' 3 INSTALLER'S NAME&PHONE NO. d��`f�i�s7� �'�/—�✓a1� SEPTIC TANK CAPACITY laro 9gr/ 0 �� LEACHING FACILITY: (type):1V1� � e-� (size) 1[ xXa: NO.OF BEDROOMS 3, BUILDER OR �✓�� ll PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by 6S _ ,r s �� ` 1 �.w �� •� ts' � w �` v� c i C:• � 'y No. `�� `r - Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 2pplicatfon for Migogar *pgtem ConMrurtion 3permit Application fora Permit to Construct( )Repair( 14pgMde( )Abandon( ) ❑Complete System ElIndividual Components Location Address or Lot No. q 32-3 if�—vl A Owner's Name,Address and Tel.No. Assessor's Map/Parcel G 611111VIQ 4110 Installer's NamJ�,Address,and Tel.No. Designer's Name,Address and Tel.No. f7�9'7`t®,40111 lOilse�SG �o"e _ � _ 73?�) Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder Other Type of Building -449, No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow 3 3® gallons. Plan Date f Z 17,Z Q7 Number of she ts' 7 Revision Date Title l 6� / �4' 3i 7`7 4, Size of Septic Tank i Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) ��7`<z� A�4"Z Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued V d of ealth. Signed Date Application Approved by Date /— Application Disapproved for the following reasons Permit No. TOWN OF BARNSTABLE .,..' . I; 3Z3 �T6/� GG�/tl/yJrl"c2ll/�O SEWAGE# T- OCATION VII, AGE �,U�� ASSESSOR'S MAP &LOT.3�'�3a'L INSTALLER'S NAME&PHONE NO. ,00/r�`�1 SEPTIC TANK CAPACITY O �°X%s cif LEACHING FACILITY: (type) (size)1! NO OF BEDROOMS 3 / BUILDER OR� ' PERIviITDATE: /- Z I- COMPLIANCE DATE: Separation Distance Between the: Mal"'urn Adjusted Groundwater Table and Bottom of Leaching Facility Feet Priva4e,Water Supply Well and Leaching Facility (If any wells exist ait;site or within 200 feet of leaching facility) � Feet Edge of'Wedand and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility) i Furnished by S b, loth No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH'DIVISION TOWN OF BARNSTABLE.,MASSACHUSETTS ZIoprication for Miopozar Opotem Construction J)ermit Application for a Permit to Construct(, )Repair( k4upgrade(: .)Abandon( ) El Complete System. L"l l dividual Components Location Address or Lot No. /J 3Z Owner's Name,Address and Tel.No. Assessor's Map/Parcel t✓ Ltivy w/9//fJ'�� Installers Nam ,Address,and Tel.No. Designer's Name,Address and Tel.No.1 1. Type of Building. Dwelling No.of Bedrooms ?J , Lot Size sq.ft. Garbage Grinder(/50 r. Other Type of Building 2K �9G� No.of Persons Showers{ ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flo% 0 gallons. F' Plan Date / ZZ' Q7 Number of sheets' Z Revision Date Title % P1_ 5� �`%G. /Q��?` 7GD Z JT we" Sire of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable). 7-�r/i Date last inspected:. Agreement: � t The undersigned agrees to ensure the construction and maintenance of the'afore described on-site sewage dispos, system in accordance-With the provisions of Title 5'of the Environmental Code and not.to P lace the system in o eration until a Ceti fi- R Y Cate of Compliance-has been issued by�tlus oard of ealth. r Signed Date f' Application Approved by • ' Date Application Disapproved for the following reasons Permit No: Date Issued ----------- - -------------------------- THE COMMONWEALTH OF MASSACHUSETTS' � I BARNSTABLE, MASSACHUSETTS C Certificate of Compliance ` .. THIS IS TO CERXIFY,that the On-site.Sewage Disposal System Constructed.,(: )Repaired( W1.Upgraded( ) Abandoned( )by at Y,3 Z-1 o7` re 4//)9/y!"kl 10 has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permif No. S� dated Installer Designer The issuance of this permit shall not be construed.as a guarantee that the system will function as designed. Date Inspector 'S i .w.,,.�-w!wW^ti+,ow.•r a...&.-.�a,^� ,:.r'S•:'^�� '2•r✓Y-+'b.�e,i•-n., fn.r,�i•ae'�.r^^.�{xw.y�,:,` :,a d.`+'.!.4�,=m Nw •r,..rak� a++i�n�.br.W.,n,.,..a..c..,w,..x.w+,r�'.• �,r.,Y _ - THE COMMONWEALTH OF MASSACHUSETTS IIE PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS 9)p5tem Con.5truction permit Permission is herery granted to Construct Repair aue Abandon t System located,at >y,3 Z J /�1`�/� 6 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 date of this P Apmt. Date: Z/- 9� Approved by y3Z3 R�-6/f c 203 498 760 US Postal Service Receipt for Certified Mail No Insurance Coverage Provided. Do notuse for International Mail See reverse Sent to Street&,Mumber/ J/1�y121 Post ce,State,&ZIP e e �m Post 02 Postage $ Certified Fee Special Delivery Fee Restricted Delivery Fee Lo Return Receipt Showing to Whom&Date Delivered a Retum Receipt Showing to Whom, Q Date,&Addressee's Address 0 TOTAL Postage&Fees $ Postmark or Date 0 LL 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 m 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 M return address of 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 °) rn on a 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 n 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 addressee,endorse RESTRICTED DELIVERY on the front of the article. M 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. Y 8 LL i` 6. Save this receipt and present it it you make an inquiry. 102e9e-97-e-0145 a d SENDER: v ■Complae items 1 and/or 2 for additional services. I also wish to receive the Z ■Complete items 3,4a,and 4b. following services(for an W ■Print your name and address on the reverse of this form so that we can return this extra fee): card to you. ai m ■Attach this form to the front of the mailplece,or on the back if space does not 1. ❑ Addressee's Address permit. ■Write'Retum Receipt R uested'on the mail lace below the article number. 41 $ p eq a' 2. ❑.Restricted Delivery N ■The Return Receipt will show to whom the article was delivered and the date C delivered. Consult postmaster for fee. ° 3.Article Addressed to: 4a.Article Number cc r� /V ��- z oZO3 y9e 7" E 4b.Service Type � � c°� X ❑ Registered iCertified °C rn ❑ Express Mail "°4 ❑ Insured W ❑ Return Receipt for Merchandise ❑ COD �UiW/n 7.Date of Delivery 0 5.Received By: (Print Name) 8.Addressee's Address(Only if requested W and fee is paid) r t— g 6.Signatur :(Addressee orA ant) N PS ForMA81f, December 1994 102595-97-13-0179 Domestic Return Receipt Fir - ass Lail �4 UNITED STATES POSTAL SERVICE M4 O O -��.,,, O s`Paid . „.- - ermit�le,G10 • Print your name,� de in this box• Public Healt Di WRI 8 1997 (own of Barnsta le P 0.Box 534 Hyannis,Massachu � � �t Town of Barnstable Department of Health, Safety, and Environmental Services txarAaz Public Health Division MAW 367 Main Street, Hyannis MA 02601 QED Mld� Office: 508-790-6265 Thomas A. McKean, RS, CHO FAX: 508-790-6304 Director of Public Health Mr./Mrs. White December 2, 1997 Box 416 Cummaquid, MA. ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL CODE, TITLE 5. The septic system owned by you located at 4323 Route 6A, Cummaquid was inspected on November 14, 1997, by John Graci, 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: • The soil absorption system was in hydraulic failure. The"pit was full". 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 ;oomVasA. McKean, R.S., C.H.O. Agent of the Board of Health q\hea1th\dbfi1es\tit1e3 i.doc Town of Barnstable • � Department of Health, Safety, and Environmental Services _'M'MB Public Health Division FDA 367 Main Street, Hyannis MA 02601 Office: 508-790-6265 Thomas A McKean,RS,CHO FAX: 508-790-6304 Director of Public Health TO: 9 ^� X I DATE: ,Q!��e— 2, f q9 / u v�� AAA ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL CODE, TITLE 5. (off V ti 7 The septic system owned by you located at 4 3a3 Q� was inspected Nay. only Jb 1 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: fm- 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 r 1 } tly 1 -� Commonwealth of Massachusetts Executive Office of Environmental Affairs Dept. of Environmental Protection •titl One winter Street Boston Ma. 02108 � ' D.E.P. Titlee V Septic Inspector P.O. Box 2119 Teaticket, MA 02536 WILLIAM RWELD „ _ (508)564-6813 r �n3. po 2 Governo 3S ARGEO PAUL CELLUCCI Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM •'�� PART A CERTIFICATION NO Property Address: 4323 Rt.6A Cummaquid Address of Owner: V ,1 8 Date of Inspection: 11M4/97 (if different) TOWN 199? Name of Inspector: John Graci tNhite:Box 416 Cummaquid r H OFBg9rlST 1 am a DEP approved system inspector pursuant to Section 15.340 of Title%(310 CMR 15.000) Fg(TyOFpT,gBIF Company Name,Address and Telephone Number: 5 � CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: Passes This Inspection Is based on criteria defined In Title V code 310 CMR 16303.My findings are of how the system Is — Conditionally Pas es performing atthe time of the inspection.My inspection does, _ Needs Fur er aluation By the Local Approving Authority not imply anywarranty or guarantee orthe longevity ofthe septic system and any of Its components useful life. x Fails Inspector's Signature: Date: 11114197 The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspections. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer,if applicable and the approving authority. INSPECTION SUMMARY: Check A, B,C,or D: A] SYSTEM PASSES: _I have not found any information which indicates that the system violates any of the failure criteria defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: B] SYSTEM CONDITIONALLY PASSES: _One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes inspection. Indicate yes,no, or not determined(Y,"N,or ND). Describe basis of determination in all instances. If "not determined",explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Colhpliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank,whether or not metal, is cracked,structurally unsound, shows substantial infiltration or exfiltration,or tank failure is imminent.The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised(IM97) One Winter Street • Boston,Massachusetts 02108 • FAX(617)556-1049 • Telephone(617)292-5500 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 4323W 6ACummaquld Owner: White:Box 416 Cummaquid Date of Inspection:11114/97 _ Sewage backup or.hreakout or hicih.static water level observed.in.the distribution box is due to a broken. or obstructed pipe(s)or due to broken,settled or uneven distribution box.The system will pass inspection if (with approval of the Board of Health). Describe observations: broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced —The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:. Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER,IF APPROPRIATE)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 feet to a surface of water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone 1 of a public watersupply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presense of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method usedto determine distance (approximation not valid) 3)Other D] SYSTEM FAILS: You must indicate either"Yes"or"No"as to each of the following: x I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No _ _x_ Backup of sewage in facility or system component due to an overloaded or clogged SAS or cesspool. x_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged cesspool. x_ SAS is in hydraulic failure. (revised 0427197) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 4323 RL BA cummaquld Owner: White:Box 416 Cummaquid Date of Inspection:11114197 D]SYSTEM FAILS(continued) Yes No Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Numbers of times pumped Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone 1 of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"as to each of the following: The following criteria apply to large systems in addition to the criteria: _ The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area(IWPA)or a mapped Zone II of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 0412797) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECLIST Property Address: 4323 RL BACummaquid Owner: White:Box 419 Cummaquid Date of Inspection:11114197 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: _x_ — Pumping information was requested of the owner,occupant,and Board of Health. x None of the system components have been pumped for at least two weeks and the 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. x As built plans have been obtained and examined. Note if they are not available with N/A. x — The facility or dwelling was inspected for signs of sewage back-up. x _ The system does not receive non-sanitary or industrial waste flow. _c_ — The site was inspected for signs of breakout. x All system components,excluding the Soil Absorption System,have been located on the site. x The septic tank manholes were uncovered,opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction,dimensions, depth of liquid,depth of sludge,depth of scum. x The size and location of the Soil Absorption System on the site has been determined based on — — The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub-Surface Disposal Systens. x Existing information. Ex. Plan at B.O.H. x Determined in the field(if any failure criteria related to Part C is at issue, approximation of distance is — — unacceptable)]15.302(3)(b)] Qevlaed 04l17)97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 432311L BA Cummaquid Owner: White:Box 416 Cummaquid Date of Inspection:11H4197 FLOW CONDITIONS RESIDENTIAL: Design flow: 3" g•p•d./bedroom for S.A.S. Number of bedrooms: Number of current residents: 4 Garbage grinder(yes or no): No Laundry connected to system(yes or no): Yes Seasonal use(yes or no): No Water meter readings,if available:(last two(2)year usage(gpd): � rda Sump Pump(yes or no): No Last date of occupancy: nib COMMERCIAL/INDUSTRIAL: Type of establishment: nib Design flow:o gallons/day Grease trap present: (yes or no) No Industrial Waste Holding Tank present:(yes or no) No Non-sanitary waste discharged to the Title 5 system:(yes or no) No Water meter readings,if available: rda Last date of occupancy: nra OTHER:(Describe) rds Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System was last pumped 2 months ago by Ace System pumped as part of inspection: (yes or no)No If yes,volume pumped:o gallons Reason for pumping: nla TYPE OF SYSTEM x Septic tank/distribution box/soil absorptions system Single cesspool Overflow cesspool Privy Shared system(yes or no) ( if yes,attach previous inspection records, if any) I/A Technology etc.Copy of up to date contract? Other: APPROXIMATE AGE of all components,date Installed(If known)and source Information: 1989 Sewage odors detected when arriving at the site:(yes or no) No (revised 04127A7) I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 4323 RL BACummaquld Owner: White:Box 416 Cummaquid Date of Inspection:11114197 SEPTIC TANK: X (locate on site plan) Depth below grade:e" Material of construction:x concreate metal FRP Polyethylene_other(explain) If tank is metal, list age o . Is age confirmed by Certificate of Compliance No (Yes/No) Dimensions: t.e•e••He 7^w4'10 Sludge depth:2" Distance from top of sludge to bottom of outlet tee or baffle: 25^ Scum thickness:"' Distance from top of scum to top of outlet tee or baffle:6" Distance form bottom of scum to bottom of outlet tee or baffle: 17" How dimensions were determined: Mesusured Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage,etc.) Septic tank and all components ere structurally sound.Recommend pumping system every one to two years for maintenance. GREASE TRAP:_ (locate on site plan) Depth below grade: nra Material of construction: _concrete_metal_FRP Polyethylene_other(explain) Dimensions: rda Scum thickness:rda Distance from top of scum to top of outlet tee or baffle:nra Distance from bottom of scum to bottom of outlet tee or baffle: nra Date of last pumping;, Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage,etc.) rda BUILDING SEWER: (Locate on site plan) Depth below grade: 14" Material of construction:_cast iron x 40 PVC_other(explain) Distance from private water supply well or suction linetovm Diameter: 4' Qmments: (conditions of joints,venting,evidence of leakage, etc.) (revised 04717)97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PARTC SYSTEM INFORMATION (continued) Property Address: 4323 RL BA Cummaquid Owner: White:Box 410 Cummaquid Date of Inspection:MUM TIGHT OR HOLDING TANK: (locate on site plan) Depth below grade: rda Material of construction:_concrete_metal_FRP_Polyethylene_other(explain) Dimensions: rda Capacity: rda gallons Design flow: rda gallons/day Alarm level:_nra Alarm in working order?_Yes .No Date of previous pumping:. Comments: (condition of inlet tee,condition of alarm and float switches,etc.) rBa DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: rda Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box etc.) rda PUMP CHAMBER: (locate on site plan) Pumps in working order:(yes or no)No Alarms in working order(yes or no)Ye: Comments: (note condition of pump chamber,condition of pumps and appurtenances, etc.) rda (revised 04l2107) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 432311t.6ACummaquid Owner: White:Box 416 Cummaquld Date of Inspection:11114197 SOIL ABSORPTION SYSTEM (SAS):x (locate on site plan,if possible;excavation not required, but may be approximated by non-intrusive methods) If not determined to be present,explain: Ma Type: leaching pits,number: 1,000 gallon leach pit leaching chambers,number:nla leaching galleries,number: nla leaching trenches,number,length: nia leaching fields,number, dimensions:nla overflow cesspool,number:nla Alternate system: nia Name of Technology:_rda Comments:(note condition of soil,signs of hydraulic failure,level of ponding, condition of vegetation, etc.) The teach pit Is past the effective depth of leaching.The tea Is In hydraulic rallursYlt was full. CESSPOOLS:_ (locate on site plan) Number and configuration: rda Depth-top of liquid to inlet invert: nla Depth of solids layer: rda Depth of scum layer: n1a Dimensions of cesspool: rda Materials of construction: Ne Indication of groundwater: nia inflow(cesspool must be pumped as part of inspection) rda Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc.) nia I PRIVY: (locate on site plan) Materials of construction: nla Dimensions: Na Depth of solids: rda Comments: (note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation, etc.). nro (revised 04R7)971 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 4323 Rt.6A Cummaquid White:Box 410 Cummaquid - 11114197 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references, landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) G AA �6 if (revived 04)27197) Pepe ! of so SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 4323 Rt GA Cummaquld White.Box 416 Cummaquld 11114197 Depth of groundwater 12 Please indicate all the methods used to determine High Groundwater Elevation: Obtained from design plans on record. Observation of Site(Abutting property, observation hole, basement sump etc.). Determine it from local conditions Check with local Board of Health Check FEMA Maps Check pumping records Check local excavators,installers x Use USGS Data Describe in your own words how you established the High Groundwater Elevation.(MUST be completed) USGS Maps and Charts (ravmed0A/27197) page 10 of 10 7' TOWN OF BARNSTABLE LOCATION SEWAGE # 31 VILL GE �c,�/r1/riQay ��• _ ASSESSOR'S MAP & LOT 15-0- 0;;-ov2 INSTALLER'S NAME di PHONE NO. pi1n A : A a l�n SEPTIC TANK CAPACITY (DQQ LEACHING FACILITY:(type). 900 L-P (size) 3. k `' NO. OF BEDROOMS 3 PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER ye ri �®t.-��J9 f� DATE PERMIT ISSUED: G(- /3 ®:69 DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No �/ i t ON b i 1 C_ __ x _. No.... /��t . -h 3 .THE COMMONWEALTH OF MASSACHUSETTS , BOAR® . OE HEALTH o �� OF. _, :....../-��... 'LL3. _- Appliration for Uiiprr ial Worka Tnnitrnrtinn Vamit Application is hereby made for a Permit to Construct ( "--Or Repair ( ) an Individual Sewage Disposal System at: � ................ .1... .............. ..........- -----•-••--•---- ._ .....s - r .. -............. Location.Address or Lot No. S c� 4 S/'� vt/c�e_ t7C," -c L` - .......... .........•--.. ._°1....... 9.. ....-----•-----...7 ......... ---...---...-----•--•-•----....•..-Y 2-- .---...... O er Address Installer Address d Type of Building Size Lot_._ . �....Sq. feet Dwelling—No. of Bedrooms.............3_.............•.___.__..Expansion Attie Garbage Grinder-{---jam' Pq Other—Type of Building .1___e..f'2.. No. of persons......._' .............. Showers_(- --- afeteria!-(---` a' Other fixtures ..._ ............................................................................................................................................ W Design Flow..................... .........__gallons per person per day. Total daily flow.......:�...�...-d......... gallons. WSeptic Tank—Liquid capacity[4 o?gallons Length o. .&.._. Width._`.[ _ Diameter________________ Depth... . x Disposal Trench—No. .................... Width........................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No........../--------- Diameter......I.A._.... Depth below inlet... 5---- Total leaching area.3.R:!�__sq. ft. Z Other Distribution box ( Ilf- Dosing ank_(_ ' '-' Percolation Test Results Performed by--- r` ..��est --�--•.�hd�_�---•--- Date_._. -�. _� � j Test Pit No. 1..._:..Z'minutes per inch Depth of Pit../ Depth to ground water..__` ....` ) fs, Test Pit No. 2....�- minutes per inch Depth of Test Pit:__ --- Depth to ground water-_-_- R+' .................••--------•-• •••...:..... --------.--•---- O Description of Soil--------C` ! C ' I9 S �z ............................. .-------------------------------------------�.... '-----•---- -•f -18-r/---'•--•-----•--••-•---'--'----------- W 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 TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system n operation until a Certificate of Compliance has been issued by the rd of li - �� /3— -in operation �2 Z Application Approved By--••-••1 ---- .,C.ty j Date Application Disapproved for the following reasons: -------------•-------•--------------------------------------•-•---------------------------------------•-••---- ................••--••--•------------••-•••----•-•-•--•-------••-•••.........••----------..._...•--•---••---••••--..._...----•--------•-••-•-----•----•--••••-•••-••••--•-----------••••••••-••----•.--- Date PermitNo...... -Z - �� ---1-..............-.... Issued........................................................ . Date ........................................................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH � �rr�i�irtt#r laf �unt�li�anr�e _ THLF IS TO CERTIFY, Thg the Individual Sewage Disposal Sy tem constructed or Repaired ( ) --.-•----....................•--•---••••-•---......-------•............. ..-- Installer o has been installed in accordance with the provisions of TITLE j of TI State Sanitary Code as described in the application for Disposal Works Construction Permit No.--9-1....3JI............... dated_------------------........................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... 1 r No..--P-71x Fis...... ............. ' T.HE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....... . .................... Allp iration for Mopos al Works Tomitrnriinn trnti# Application is hereby made for a.Permit to Construct (1,,Kor Repair ( ) an Individual Sewage Disposal System at: / ,/ /� eF°""` �'1 T ,/�.•��... t "L. SCj'.f`� C..._ �../.>•v, r.— c:c +;Y �j7 r-C/l la '�N. -'a ' '.� //✓Q i ^' ................... .... ..............• ------------ r..-.- -- -• --'-----••... - ....... ,f or Lot o. F _ Location-Address + s Owner y Address a ....... C...:...........:... .. .......�.�..�....----.......................... .................�......�-_ .............................................................. Installer Address Type of Building Size Lot. _.1 _4'.....Sq. feet a Dwelling—No. of Bedrooms.............��.._.................__.__..Expansion Atti Garbage Grindea-(-- -)-- aOther—Type of Building ... No. of persons.........!;F............... Showers_(-----=-Cafeteria"( Otherfixtures ---- -------------------------------------------•-•. -------•••---•-----•----••----. -----------....------------------...-•---•---•-••----•------. w Design Flow.................... � =-..........gallons per person per day. Total daily flow--_---.: __ ._. .._..........gallons. WSeptic Tank—Liquid capacityf_?.!S?gallons Lengthe�._..�_-•_. Width_ ._> . Diameter................ Depth.._��._y.J x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit No........- ......... Diameter......1. .1.... Depth below inlet._ _-- ..... Total leaching area..Y=-Q-.-B'--.-sq. ft. z Other Distribution box ( ') Dosingrtank�.(_ -^)1 _ V Cl f S :> Percolation Test Results Performed by..................---.....................•......................... Date......`r ------- --•-•-=---. 10 Test Pit No. 1....�._ .minutes per inch Depth of est Pit_;��.._�k..._ Depth to ground water....f.- GL, Test Pit No. 2__.�-K__minutes per inch Depth of Test Pit..,)__�: _`�. Depth to ground water----- lfj.. .�. ...............................................=---••--•--.........---...............---•--•....-----•----•-•--------•---•----•-•-••----••......•-----•-•-•- DDescription of Soil.........jL -•�.-C4...------ ��`��......."=� �� ------------------------------------------------------------------------------ x ... -�- ............................................................................................................... w UNature of Repairs or Alterations—Answer when applicable............................................................................................... ---........................................................4------------------------------------------------------------------....................................................................... Agreement: The undersigned agrees-,".to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT1Z 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 hf$-al . y � � �`!'. - a Signed-�,r -I- -•.� ------.p. -•-----•--------- ------------------------•--- -'.�� --�� i Application Approved B Dat Date Application Disapproved for the following reasons:.:...................�.__.__._....___.....__._...._...___._......•...............•••-•--- .._-.___.____ --------------------------------------------------------------------•--•--•----------...........----.....--•--•--------•--•--••---•--...-•-•-•---•-•----•-••••---••--•-----•--------•-•••----••---.•.--- Date Permit No.....' -_7 _ � {,, ---------------- Issued------...-•---.• •---••---•--•--•••------.......... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH o�,� ..................O F... J/. .................................................... (9rdifiratr of Tuntplittnrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed jt-j or Repaired_( ) by......... :._.%_ . . y:' >m. +�� .� cd ....a n�/ _...`...�..�...V. ... ...==...------------ Installer_at has been installed in accordance with the provisions of TITLE 5 of Td State Sanitary Code as described in the application for Disposal Works Construction Permit ................ dated-.---------------------------------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector----------.- ---- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....................... .. . ............................... No. ..7.:..3.1--?.. ................................ FEE.--s�;:57,'..... Disposal ork,5 Towitrurtivit Frrutit - g �- rC `' <_ Permission > herebyranted..........:........................... �- --.__-�- � ._!:, ` to Construct ( �or=.Repair, an Individual Sewage Disposal System at No.....4------ ... t Street,o' ' as shown on the application for Disposal Works Construction Permit No------ -•-_-.-____-- Dated.......................................... = --------------------•--------- oard o ealth DATE .......................................... FORM 1255 A. M. SULKIN, INC., BOSTON j CUMMAQ UID - 00 1, 0 SITE & SEP_-TIC 0 PLAN -OF LAND AT / / ,o ASSESSORS MAP 350 PAR.. 3-2 / ��01 a, CUMMAQ UID, 'MA. PREPARED FOR. Locus +F S LL0 YD & MELINDA WHITE �-- ti� / / rol M.H.B. g� \ A.M. 350/49 cam\ AREA=-49, 794 f S.F. / PAUt_ yN ol A. c c5' i -�� MERITHEIN y LOCUS MAP 6� '�'T Q� �4 — c-' O o ° AAA _ g? Qr�ys C/STE�� ► AN 90 LAN PLAN REF- 433/64 RES. ZONE „RF—2" FLOOD ZONE` C � I _ _ BENCHMAR TOP OF FND k EL.=103.25' (ASSU' ED) LO TILAND /,wCD OF s r2) Q o A.M. 350/3-1 g E PESCE 5�p 2 EXIST. 1p2 ` EXISTING No 32001 �4 H SEPTIC WELL _/ / 90 �013-T i TANK 8, ° __-_------ 50 i 98 EXIST. a �� CEDAR =___ 4 323=_ EXIST. 1`,. TP , 42.2 _=-_-_=-_-=_--_- �Cj.� /// p 26 LEACHPIT 2L� oO , � --------___ ----__--- -------1----------- -..1 5 y o /1 - — ——— j � RESERVE _ _ GRA vEL PESCE ENGINEERING & A SSOCIA TES � / — — CD DRIVE -� - ---- 2 P. O. BOX 32 �--- - 104 ------------ -�1 i �� / / — — _ OSTERVILLE MA. 02655 1106 .,� PH. (508)428-3730 Zol- SCALE. 1"=30' DA. TE. 12/02/97 \ \: JOB NO. 51490 SHEET 1 OF 2 3 - 103,25' < TOP OF FOUNDATION 20' MIN. 10' MIN. CONCRETE COVERS 4" SCHEDULE 40 P. VC MIN. PITCH 1/8 PER FT. 2"LA YER OF CONCRETE COVER WASHED STONE /12"/MAX EL.=100I i / i i i i i i / / 4" CAST IRON PIPE 12' / • i i (OR EQUAL MINIMUM INVERT PITCH 1/4' PER FT. RISER EL.= 97.2 ;00 CLEAN SAND 9 Ir FLOW LINE Jc' INVERT 1 10 14„ 7» — EXISTING MIN. —z 0, ° °0. ,.,..._.,,,... EL.------- cAs INVERT 6 SUM LEVEL ° °° o °o 0°, 0 BAFFLE _EXISTING IN °°°o° o°o° 11 INVERT EL.— INVERT o .— 99 5 — 4' EXISTING ----- EL.------ ° ° o °° °o ° °% 00 ° ° °o ° °o ° °°o ° °o ° r EL. �r -- (TO BE PLACED ON FIRM BASE) EXISTING °° o o ° o o° ° o o° ° o o° ° o o° ° o o°° o o ° ° ° ° o ° 34" 6 ' 60 MECHANICALLY COMPACTED OR 6" OF 57Y7NE DISTRIBUTION EL• 95.8' o 0 0 0 0 0 ° o o ° o 0 o EL•=95.2' o°o ° 0 0 0 0 0 o 0 _1000_—GALLONS 4 HIGH CAPACITY INFILTRATORS } BOX 3f4" TO 1-1/2" 4' 2.B' 4" EXISTING TO BE WATER TESTED WASHED STONE 10.B' X 32.9'TRENCH FORMA td SEPTIC TANK IF MORE THAN ONE OUTLET SOIL ABSORPTION END VIEW PLACE ON/G"' STONE SYSTEM (SAS BOTTOM OF TEST HOLE OR VSGS PROBABLE WATER TABLE ELEV=_9O_�'_ (INDEX WELL—AIW 11,?47 ZONE B) PROFILE OF, OBSERVED WATER TABLE (4130187) ELE V.=_ 89.5' SEWAGE" DISPOSAL SYSTEM OBSERVATION HOLE 1 . NOT TO SCALE 0" EL=102.5' 0„ OBSERVATION HOLE 2 EL=101.5' OF M419 LOAMY, SANDY LOAMY, SANDY — SUBSOIL SUBSOIL o 30 EL=100' -24„ EL-99.5' E PESCE L. o . CIVIL CLEAN. CLEAN 0 No.32o01 0 MEDIUM SAND GENERAL NOTES �o� 9`G/STEP�o\�4� 96" EL=94.5' LOOSE �SS/ONAL 0N� MEDIUM SAND W/FINES 1) ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. (<2MIN./IN.) MEDIUM SAND TITLE 5 AND THE TOWN OF _BARNSTABLE_ RULES AND 138" EL=91.0' TIGHT SAND REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE. & CLAY 120" EL=91.5' 156" EL=89.5 NO WATER ENCOUNTERED 2) ONE COVER ON SEPTIC TANK SHALL BE BROUGHT TO WET A T 156" WITHIN 6" OF FINISHED GRADE, OTHERS WITHIN 12" SOIL . TEST 3) ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF DATE OF SOIL TEST 41,,30187 SOIL TEST DONE BY CRAIG SHORT, P.E. WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS. H-20 LOADING SHALL BE WITNESSED BY: JERRY DUNNING, BOH USED UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS. 4) ANY MASONARY UNITS USED. TO BRING COVERS TO GRADE SHALL DESIGN CAL C ULA TIONS.' BE MORTERED IN PLACE. 3 5) NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH NUMBER OF BEDROOMS . . . . . DEEDED OR ZONING REGULATIONS. OWNER/APPLICANT IS TO GARBAGE DISPOSAL . . . . . . No OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. TOTAL ESTIMATED FLOW INSTALL: ( 110__GAL./BR./DA Y x 3___ BR.) 330 GAL/DA Y 6) UTILITIES SHOWN ARE APPROXIMATE ONLY, EXCAVATION CONTRACTOR 4 HIGH CAPACITY INFILTRATORS IS TO CALL "DIG- SAFE" AT 1-800-322-4844 AT LEAST 72 HOURS EXISTING SEPTIC TANK CAPACITY 1000 GAL re 17". DEPTH PRIOR TO COMMENCING WORK ON SITE. F SOIL CLASSIFICA TION . 1 7) CONTRACTOR IS TO VERIFY GRADES AND ELEVATIONS AS WELL AS 4' STONE SIDES AND ENDS DESIGN PERCOLATION RATE . . . . . < 5 MIN./IN. SITE CONDITIONS PRIOR TO COMMENCING WORK ON SITE. 10.��' X 32.9' EFFLUENT LOADING RATE . . . . . . • 74 GALIDA Y/S.F. 8) PARCEL IS IN FLOOD ZONE C . TOTAL LEACHING CAPACITY 354.5 GAL/DAY 9) LOT IS SHOWN ON ASSESSORS MAP _350 AS PARCEL _3-2__. SIDEWALL: 2(32 9'f10.8)(17/12)( 74) BOTTOM (32.9)(10.8)( 74) 262.9 SHEET 2 OF 2 JOB # 51490 BENCH MARK . 9 0 TEST HOLE RESULTS P (4 4 3 1� DATE : Z7�Fre te- L),^V^ll A/ C77 31412AY, a WITNESSED BY x Q�V 1 / I j /� v . _ re- p i Ar, C3 ell) ^11 >e 9, J 0 -A 4. C7 A.1 z —'nv'.7!j 0 'E-4 91"T 7- 7-* 43 IT J 7-fir J=0 7- 'tea E_7 Q�) A-as J. ZEL E MA NHOLES AND COVER TO BE BUILT TO 7 is V. TOP OF WITHIN 12 OF FINISHED GRADE OU F NDATION )L F I N I S H E D OR A Dg —,e j9- MIN. 2% SLOPE AID A�l 1 4 DIA 4 DIA. PIPE FIRS 2M MIN- 2 LAYER OF 4 'PI P E • MIN. PITCH I FT. LEVE PEASTONE MIN. PITCH 14f &* 9 Q Ell" F T. I V E%� INVERT CD INVERT GALLON I N'VE 46 1 N V-R D I A. DIST. 4 WASHEDSEP TANJK VINVERT Box 7 _Nll.-i j STONE INVERT INVERT as AROUND PL A C E ON cr . ALL a. J7 FIRM BASE / 7— BOTTOM AT ELEV.L-a4 FI ;.1 lIO' Ml N.) - 40 61 t4O GARBAGE O GRINDER 77 ELEV. 9 PROF [ LE OF GROUND WATER TABLE SANITARY DISPOSAL SYST-E M 0"X\ ( NOT TO SCALE 0 DESIGN DATA 'S I—P 7 0 CONSTRUCTION OF SANITARY DISPOSAL BEDROOMS 7,7 SYSTEM SHALL CONFORM TO THE MASS. 130 GAL. DAY �7_ ENVIRONMENTAL CO-DE TITLE 3r DESIGN FLOW AK LEACH RATE 2- MIN. INCH (REVISED , 7- 1-77) AND T-HE TOWN OF -A� REQUIRED LEACHING CAPACITY : 3 A 0 HEALTH REGULATIONS. SEPTIC TANK, DISTRIBUTION BOX AND LEACH— PROPPSED GAL DAY 1- vwd ING UNIT TO BE OF REINFORCED CONCRETE . 2, -S- ')4 7) MIN. CONCRETE STRENGTH = 3000PS.I. REQUIRED SEPTIC TANK : MIN. STEEL STRENGTH • 209000 PS. I. MIN. DESIGN LOADING : PROPOSED SEPTIC TANK : JOS' 0 DRIVEWAYS NOT TO BE LOCATED OVER SYSTEM UNLESS H2O DESIGN LOADING IS USED V_ 0 ALL PIPES AND FITTINGS TO BE WATERTIGHT cz"'_j AND TO BE OF CAST IRON OR APPROVED P.V.C. HEALTH AGENT APPROVAL DATE . ` � ��- SITE PLAN SHOWING PROPOSED CONSTRUCTION ZONING DATA L E G EN D LOCATION : e 7- -7— — DATE --f Z FOR : ZONE : TEST HOLE LOCATION REFERENCE REVISIONS : REQUIRED AREA EXISTING SPOT ELEVATION 17.6 7-R 7— L4 Y OF EXISTING CONTOUR - 16 REQUIRED FRONTAGE CRAIG yG REQUIRED FRONT SETBACK : PROPOSED CONTOUR 16 SHORT SCALE 3%SO *. REQUIRED SIDE SETBACK PROPOSED WATER SERVICE —W No.CIVIL 2748a CA -'p,ry STREQUIRED REAR SETBACK : PROPOSED GAS SERVICE —G AL_ PROPOSED ELEC. & TELE —EBIT— CRAIG R . S H O R T , P. E . PROFESSIONAL CIVIL ENGINEER BUILDING INSPECTOR APPROVAL DATE 131 OLD ROUTE 132 HYANNISl MA. 02601 FILENO. G 2Cj I SHEET OF A