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0039 SHEPERDS WAY - Health
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' ay ty�";f l `` �-;sf S •`,t.,. sty ;F''4.'`{ s sf n ^"°; .svar,�. a $Aa�' `sK y ''.•.bw'�,,R}.'+,. t, 't s�;,: o yki`";ifr b; '• # .4Sr,�,2; y x`�a ♦*i.,A 7,i; ?r, y-�R3 '+:yF} r f.,:ta' r� :}• �...:C'". =_:f_.x, �j. ,,1�d�' ..�'..1'.f..':ir�>�i..:.:a.�_.....aKF:Jd..•''r,L.`s A "y�{a �'*"�`_"...�. .. �t Massachusetts Department of Environmental Protection Bureau of Resource Protection ! X1 Well Completion Reports Well Driller Please specify work performed: Address at well location: . New Well �� Street Number: Street Name: Q9-=— _ r .-;{SHEPHERDS WAYS Please specify well type: Building Lot#: Assessor's Map#: Domestic 258 Assessor's Lot#: ZIP Code: Number Of Wells: 078 02668 ................. ......._ City/Town- Well Location BARNSTABLE In public right-of-way: GPS Efir, Yes p No North: West: 41.70685 70.32525 Subd ivision/Property/Descri ption: Mailing Address: b click here if same as well iocation addres Property Owner. Street Number: Street Name: STEVEN BERGLUND 39 SHEPHERDS WAY City/Town: State: Engineering Firm: BARNSTABLE MASSACHUSETTS ZIP Code: 02668 Board of health permit obtained: [p, Yes jn Not Required Permit Number: Date Issued: W2015 023 50/08/2015 i • Massachusetts Department of Environmental Protection ` Bureau of Resource Protection—Well Driller Program yy Well Completion Reports(General) Well Driller - General Well Form DRILLING METHOD Overburden Bedrock . Auger Choose Bedrock-- i l [ .... WELL LOG OVERBURDEN LITHOLOGY From(ft) To(ft) Code Color Comment Drop In drill Extra fast or Loss or addition stem slow drill rate fluid (0 15 Ciay Li ht Gra 5 .._.._...__ _........ � 9_ _.-.Y...._.. ..._. ; i,i YES j,� NOjn Fast j,1 Slow jr� Loss j,1 Addi ,.t 15 35 Medium Sand ( Brown ::5 j YES jn NO jri Fast jn Slow jn Loss jn Addi,� 6 (35 40 Medium Sand ( � Brown G } L.w F�_.. l I M I,� YES NO Fast j„ Slow in Loss jn Addi 40 60 Medium Sand Brown SOME CLAY 6 6 j In YE jrj Fast jn Slow LOSS jn Addi 60 74 Fine To Coarse S ( Brown y' i YES NO jr) I Fast ,l Slow Loss ,� Addi .._. .._ ............ _w .. .. l ' — J .i WELL LOG BEDROCK LITHOLOGY Visible Extra Drop in drill Extra fast or Loss or addition of From(ft) To(ft) Code Comment Rust Large stem slow drill rate fluid Staining Chips Choose Code YES NO In:FaTsSlow j,t Loss i'i Addition t Ye L Ye ADDITIONAL WELL INFORMATION Developed In Yes jn No Disinfected I„ Yes jn No C..�._..__.__..._...__. _ Total Well Depth 74 Depth to Bedrock Fracture ....................................... Enhancement IL Yes « No Surface Seal Type None I CASING ti Is Casing above ground. From: 1 To: 0 From To Type Thickness Diameter Drlveshoe I 71 Polywnyl Chloride Schedule 40 ( Ye ............................................. SCREEN E No Scree From To Type Slot Size Diameter :, = 5 Massachusetts Department of Environmental Protection Bureau of Resource Protection—Well Driller Program } Well Completion Reports(General) Y 71 µ 174 Stainless Steel Well Point— ( � 0.012 14 _1 WATER-BEARING ZONES e DRYWELd From To Yield(gpm) ....................... 12 PERMANENT PUMP(IF AVAILABLE) 2 Wire Constant Speed Pump Description i .'Horsepower Submersible `' 3/ Pump Intake Depth(ft) 70 Nominal Pump Capacity(gpm) 10 ANNULAR SEAL/FILTER PACK From To Material Weight Material Weight Water Batches Method Of (gal) (count) Placement ( �-Choose"M�a'terial g Choose Material 6 Choose One J WELL TEST DATA Date Method Yield(gpm) Time Pumped Pumping Level(ft Time To Recover Recovery(ft (HH:MM) BGS) (HH:MM) BGS) 11/6/2015 Constant Rate Pump _...._._6.._:. 1.2 [ 30 37 0:01 33 WATER LEVEL Date Static Depth BGS(ft) Flowing Rate(gpfin) Measured ~v ' COMMENTS Massachusetts Department of Environmental Protection Bureau of Resource Protection—Well Driller Program t Well Co/npletion Reports(General) x{J, WELL DRILLERS STATEMENT This well was drilled or altered under my direct supervision,according to the applicable rules and regulations, and this report is complete and accurate to the best of my knowledge. DESMON THOMAS E Monitoring[M] Supervising Driller III, Driller DESMOND III Registration# 764 Signature THOMAS, DESMOND WELL Firm DRILLING INC. Rig Permit# 023 Date Job Complete 11/12/2015 NOTE:Well Completion Reports must be filed by the registered well driller within 30 days of well completion. Fl nn, Judith From: Stanton, David Sent: Tuesday, October 06,2015 1:08 PMy • ' To: Heath DeptMailbox t'3 Subject: RE: Update 39 Sheperds Way, Barnstable:.Well I spoke with the design engineer this morning, he was confident he can install the new septic and comply with the well location setbacks. I called Desmond well drilling to let him know they are all set; they may'drop them off plans or mail them, I will take them and approve when they come in.. Thanks, , Dave "�' -----Original Message---- From: Stanton, David y s' Sent: Tuesday, October 06, 2015 8:09 AM, To: Heath DeptMa il box Subject: 39 Sheperds Way,,Barnstable: Well Late yesterday afternoon Tom Desmond came in for a well permit for said property'He said someone rejected it in the morning. I started to look at it and realized they had a.failed'septic°system,,in which I just did a.perca_est:out there, closer to the well location. I explained to Tom Desmond that he should consult with the design engineer (Dave Mason)to make sure everyone is on board with the locations of both:the well and the septic.* I am going't ' e-mail Dave Mason to let him know as well. Y Thanks, � ,,, •` � . ' .. Dave fr }• d , C, i N w_• , %� v a D C ra Ln OFFICIALrt► - SE Ln M Postage' $ ; 0 Certified Fee C,�� M A �.� ' eostmark O Return Receipt Fee ,r � 3 (Endorsement Required) �tZ Jere C3 Restricted Delivery Fee l3 (Endorsement Required) tiTotal Postage&Fees rs o, Steven E. & Kathleen N. Berglund 9 Shepareds'Way F Barnstable, MA 02630 Certified Mail Provides: e A mailing receipt o A unique identifier for your mailplaCd- • A record of delivery kept by the Postal Service for two years -' Important Reminders: I a Certified Mail may ONLY be combined with First-Class Mail®or Priority Malle. to Certified Mail is not available for any class of international mail. ,n to NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. a For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required. 1 n For an additional fee, delivery may be restricted to the addressee"or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". o If a postmark on the Certified Mail receipt is desired,please present the art!- , cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail.,•- f ' IMPORTANT.Save this receipt and present it when making an nquiry: PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 y . +x Town of Barnstable Barnstable Regulatory' Services De , artment " A1� Public Health Division �i639 ,� Fp"'"�� 200 Main Street, Hyannis A 02601 2007: M Office: 508-862-4644. t Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL # 7014 1200 0001 03587511 August 18;-2015 Steven E. & Kathleen N.` Berglund •r 39 Sheperds Way Barnstable, MA 02630. y ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE; TITLE 5 The septic system located at 39 Sheperds Way, Barnstable, MA was.last inspected on 7/20/2015 by Mike DeCosta, Jr; a certified septic inspector for the- State of Massachusetts. The inspection of the'septic system showed'that.the system "Fails" under the guidelines of the 1995 TITLE 5 310•CMR 1500 due to the following: '2 9 ( ) g� . Leaching pit or.cesspool with high liquid level <12" below inlet (per Town Code 360-9.1). You are ordered to repair or replace the septic system within Two (2) years from the date you receive this notification;. Failure to repair/replace the,septic system within the deadline period will result in . future enforcement action. PER ORDER OF THE BOARD'OF HEALTH o as c an., R.S. CHO -, Agent of the Board of Health Q:\SEPTIC�Letters Septic Inspection Failures or Future Evll39 Shepherds Wy Bam Aug 2015.doc 018/2015 _ Parcel Detail Eir BARNS ,l Logged In As: " Tuesday, August 13 2015 Parcel Detail Parcel Lookup .; Parcel Info Parcel ID �58-078 I Developer Lot ILOT 25 Location'39 SHEPERDS WAY I Pri-Frontage Sec Road j Sec Frontage Village BARNSTABLE I Fire District..BARNSTABLE Town sewer exists at this address No q ;I Road Index j1480 Asbuilt Septic Scan: , "� t 258078_1 tnteractive Map T� 258078 2t� Owner Info Owner'BERGLUND, STEVEN E Co- owner Streetl 39 SHEPERDS WAY • I StreetzI city BARNSTABLE state"MA. I zip Y02630 � I country Land Info Acres 2.04 l use",Sig Fam MDL-01 I zoning,R-2C I Nghbd 50114 Topography Level - -.I Road a payed .a a. Utilities Gas,Well,Septic I: Location I.Ma ginal View Construction Info Building 1 of 1 ► i Year1983 — Roof Gablp--�-r- Ext d Shingle Built Struct' Wall Living Roof AC 2982 Asph/F GIs/Cmp Type 4Central I .: I Area ��J Cover �J J ; Int Bed style de Mom/Contemp wan xDrywall T � Rooms`,4°B ours fi.» _,�>>..,._.a...v:. Int�`.."._'� Bath 1..�.�.'."-----.+.F.�+� - Model Residential Carpet 2 Full-1 Half ° Floor= Rooms Heata -, _ Total t""'.� '.�.ha-:.: . Grade A� ge�ra � Type Hot Air J Rooms t9� f.—r_. _ .ra.a.. Heat t� {2 .a".�. Found- Stories Stories_ Fuel Gas ation Poured Conc. J r e, Gross f558o � - A re a s_ Permit History Issue Date Purpose Permit# Amount Insp Date Comments. 'N 10/2/2013, Insulation M 201306706 $2,500 6/30/2014 12:00:00 AM INSULATE 6/1/1986 ' Addition B29492 $25,000 1/15/1987 12:00:00 AM BA ADD'N http:/f ssq l2 i ntraneVpropdata/Parce]D etai l.aspx?]D=19022 1/3 r Town of Barnstable • MASS Regulatory Services Department Public Health Division , 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 L Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 7/6/15 DEADLINES TO REPAIR FAILED SYSTEMS r (Town Code §360-44 and Title V:.310 CMR 15.000) An"x"marked in the ❑ is the failure criteria and.associated repair.deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑ Backup of sewage into the'house due to an overloaded or clogged SAS or cesspool ONE (1)YEAR DEADLINE CRITERIA`' i ❑ Static liquid level in the distribution box above outlet invert due to an overloaded'or clogged SAS.or cesspool ❑ Any portion of the SAS, cesspool, or privy below high groundwater.elevation ❑ Any portion of the cesspool within a Zone l to a public`well ❑Any portion ofa cesspool within 50 feet of a private water supply well with no acceptable water quality analysis.,(This system passes if the water analysis indicates the well is free from pollution).TWO (2) YEAR'DEADLINE CRITERIA' ❑� Single Cesspool _ ❑ Any "conditionally passed systems" (broken'cover,relocation.ofa pipe,'Telocation of a driveway due to H-10 components, etc) yLeaching pit or cesspool with high liquid level, <12"below inlet(per Town Code 360-9.1) OTHER Repair deadline: P Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc Commonwealth of Massachusetts Title 5 Offici'l I spec on Form Subsurface Sewage Dlsposa!System Form, Not;#or Voluntary Assessments _ r P 39 Shepherds Pro e P rty,Address;;. ,Kate&Steven:Ber�lund Owner Owner's.Ome information is required for every B rnsCak le , MA 02630' 67/20/2015 _ page. Ct /Town, r. 5 State: Zip Code; Date of Inspection `"" 'Vj Inspection resnits must be.submitted an this form. Inspection forms rriaynot be altered in any Way.-Please see-completerjess ch,ecklist.at the.end oft e:form.. Important:When filing out iotrt;s A General Information on the computer; use only the tab 1. Inspector: key to move,your cursor do not. Nuke:Decosta jr. use tire.return .__,. ___. _ _...._.„,M key; N-Ime.ofInspector; �._.x --..._. __....... __.._ Wind.River Environmental` ... .......... Company Marne ..— ...........— 577 Maih Street, Suite 110 a _ _. __......... _— _ _:.._...__;.. . Company AdtlresS ._.__..__._....... Mi& n _ MA .. 01749 Cftyrrown _... _..._. State Zip Code- (800},499- 1682' 1.323.0' Telephone Number. ._ t ieense Number B, Certification I certify.tttat I Have personaNy inspected the,sewage-disposal system atthis adiress and that the information reported below is true accurate aril complete as of the.:titrte of the inspection:The inspettion was performed based:on my training and experience in the proper function and maintenance of:on site sewage.dIsposaCsystems. )am a DEp approved system inspector pursuant.to Section'15.340,of Title 5,(310:GMR"15 000).The systern . [] Passes ❑" Conditionally .Passes: Fails. ❑ 'Needs Further Evalu ` n " theL' I Approving ority 07/20/2015 spector "Signature- :Date The system inspecto shalP;:submit a:eopyet nspection report to the Approving Authority(Board, of Health or DEP) ithin 3©�ays.of co is,inspection. If the system is a sharedsystem or has a design,flow of 10,000:gpd or greater, the inspector.and,the system owner shall submit the report to the;apropriateregnal"oficeo t e DEP.The original should be sent to the systern owner ancl.captes sentjo.the buyer;if applicable; and the,approving authority: report only describesconditions:at the time of Inspection and;under the conditions of use !at,that:time.This inspection does not�ad dross:how the system.witl.perform in the future under the,same or different conditions of.ustz:> t5ins 3t.73: Title 56f6c*inspection Form.Su6surface:Sewage Disposal$ystem-Page 1 of 17 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 39 Shepherd's Way Property Address Kate Berglund Owner Owner's Name information is required for every Barnstable MA 02630 07/20/2015 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. . The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 39 Shepherd's Way Property Address Kate Berglund Owner Owner's Name information is required for every Barnstable MA 02630 07/20/2015 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed El Y N 0 ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: . ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Tittle 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 39 Shepherd's Way Property Address Kate Berglund Owner Owner's Name information is required for every Barnstable MA 02630 07/20/2015 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well'water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ® ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ® ❑ Liquid depth in cesspool is less than 6" below invert or available volume is less than day flow t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 39 Shepherd's Way Property Address Kate Berglund Owner Owner's Name information is required for every Barnstable MA 02630 07/20/2015 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: Any y portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. The system fails. I have determined that one or more of the above failure ® criteria exist r'as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑. the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA)or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 39 Shepherd's Way Property Address Kate Berglund Owner Owner's Name information is required for every Barnstable MA 02630 07/20/2015 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 gpd t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 r Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 39 Shepherd's Way Property Address Kate Berglund Owner Owner's Name information is required for every Barnstable MA 02630 07/20/2015 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection El Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage Well Water 9 ( Y 9 (gpa))� Detail: On Well Water Sump pump? ❑ Yes ® No Last date of occupancy: Current Date ol Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 P Commonwealth of Massachusetts w Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 39 Shepherd's Way Property Address Kate Berglund Owner Owner's Name information is required for every Barnstable MA 02630 07/20/2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Wind River Environmental Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: .1,500 gallons gallons How was quantity pumped determined? Previous pump records. Reason for pumping: To check the structural integrity of the septic tank. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no)(if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 39 Shepherd's Way Property Address Kate Berglund Owner Owner's Name information is required for every Barnstable MA 02630 07/20/2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 1983 per plans Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 16" feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: 156' feet Comments (on condition of joints, venting, evidence of leakage, etc.): All joints sealed. No leaks, the vent is on the roof. Septic Tank (locate on site plan): Depth below grade: 1 feet Material of construction: ® concrete El metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 10ftx5ftx5ft. Sludge depth: 8„ t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 39 Shepherd's Way Property Address Kate Berglund Owner Owner's Name information is required for every Barnstable MA 02630 07/20/2015 page. CityrFown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 36" 4" Scum thickness Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Tape Measure Comments (on pumping recommendations; inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Outlet on riser 2" BG.Tees in good condition, no filter instaled. Liquid level normal, moderate solids/sludge. Structurally sound and not leaking. Grease Trap (locate on site plan):. Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-3/13. Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts p v Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 39 Shepherd's Way Property Address Kate Berglund Owner Owner's Name information is required for every Barnstable MA 02630 07/20/2015 page. City/Town. State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No I I Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No l5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Fora _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 39 Shepherd's Way Property Address Kate Berglund Owner Owner's Name information is required for every Barnstable MA 02630 07/20/2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 1" Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Box is 16" x 30". Box is 16" BG. One outlet to leach pit. Heavy deterioration in box. Liquid is 1" into outlet. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 39 Shepherd's Way Property Address Kate Berglund Owner Owner's Name information is required for every Barnstable MA 02630 07/20/2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 @ Tx 6' ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Liquid level is high within 4"of invert. No ponding, damp sandy soil. Showing signs of hydraulic failure. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 F Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 39 Shepherd's Way Property Address Kate Berglund Owner Owner's Name information is required for every Barnstable MA 02630 07/20/2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 p Commonwealth of Massachusetts Title 5 Official Inspection Form ( Subsurface Sewage Disposal S stem Form -P y Not for Voluntary Assessments Property Address - ---- ---------..----- Owner Owner's Name -- ----- --.._—._.-.-. information is required for every page. City/Town State Zip Code Date of Inspection D. System Information'(cont.) Sketch Of Sewage Disposal System: Provide_ a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: . .� ffand-sketch in the area below ❑ drawing attached separately U(�S + D ® t i 2. C TO ( _ ( C> , 13T62. = ill '43M t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 c° Commonwealth of Massachusetts - W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 39 Shepherd's Way Property Address Kate Berglund Owner Owner's Name information is required for every Barnstable MA 02630 07/20/2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 12' feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: April 1980Date ❑ Observed site(abutting property/observation hole wiithin 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Obtained from copy of design plans on file at BOH. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3/13 Title 5 Official Inspection(Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 39 Shepherd's Way Property Address Kate Berglund Owner Owner's Name information is required for every Barnstable MA 02630 07/20/2015 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 Comtnonwealtli of Massachusetts .. °w nb ° 2 A gr 1100E - ® T ��r (RES. � Wayne'F. MacCallum, Director April_26, 2007 Kathleen.Berglund 39 Shepards Way Barnstable,MA'026K... Dear Ms.Berglund .\� I am writing to notify you of the official certification by the Massachusetts Natural Heritage and:. Endangered Species Program of a vernal pool in the town of Barnstable: The"official certification. number of this pool is 4409. Thank you .very much for contributing:to the conservation of a threatened resource. The certified status of this vernal pool potentially affords it protection under the following regulations: 1... Massachusetts Wetlands Protection Act Regulations(310 CMR 10.00); within wetland resource areas,.protectable vernal,pool habitat includes. the pool itself and up to 100 feet beyond the pools margin... 2. Massachusetts Surface Water Quality Standards (314 CMR 4.00); discharges of redge� fill material are strictly prohibited within the boundaries of certified vernal pools. " - 3. Title 5 of the Massachusetts Environmental Code ` s ., . N 71. 4. The Massachusetts Forest Cutting Practices Act Regulations. � -r� to Please note that even after a Notice of Intent has been filed, the presumption that vernal pool abitat.w does not occur on a site is overcome upon a.clear showing to he contrary, either.through fficial uo certification or the presentation of credible evidence at'a.public hearing (310 CMR 10.57( (a)5). Altering vemal:pool habitat may be permitted. only if it will. have.no adverse effects on wildlife habitat, as determined.by procedures contained in310 CMR 10.60. Please contact Dan Gilmore at the.DEP`Southeast. Regional Office with all regulatory questions pertaining to.this pool. Once again, thank you for your concern for the conservation of vernal pools. I hope that you will continue to search for and document vernal pools in your town. Sincerely;:. �r Thomas rench,Ph.D.. ------------------------ Assistant Director, cc: file Natural Heritage & Endangered Species.Program Route 135, Westborough, MA 01581 .Tel: 508)389-6360 Fax: (508)389-7891: ..An Agency of the Department of Fisheries,Wildlife&.Environmental Law Enforcement httP://www.state:ma.us/clfweleidfw/nhesp Commonwealth of Massachusetts Wayne F. MaeCallum,Director.; , NHESP VERNAL POOL CERTIFICATION FORM Certified...Vernal Pool: 4409 Town: BARNSTABLE Date Certified: 2007-04-25 Directions:. 2007-04-14: Off Route 6A'in Barnstable onto Scudder Lane: Left at next.turn,:Calves Pasture Lane. Proceed down Calves Pasture Lane and turn left onto Shepards.Way: Proceed on Shepards Way to next right turn. Turn right and go 50,feet stop.Vernal pool.is to the im. mediate left on the.other.side of the rock wall at 39 Shepards Way. Land Ownership Information (If supplied): Kathleen Berglund 39 She Way, Barnstable,MA.02630 . Maas submitted with certification and attached to this form . x USGS topographic map showing location of the vernal pool x Assessor's map(or other property map)showing location of pool Compass bearings and distances to l to pool from permanent landmarks x . Aerial photograph/80 or 100 scale topographic map.:showing location of pool Professional survey showing location of pool Sketch map or description of the immediate vicinity of the pool Documented bioloeical indicators accepted by NHESP. . x Wood Frog(Obligate Amphibian) Mole Salamander(Obligate Amphibian) Fairy Shrimp(.Obligate Invertebrate) . Facultative Amphibian Facultative Invertebrate Facultative Reptile The NHESP HAS NOT been.notified of the presence of rare state-listed wildlife species in.this vernal.pool habitat. Vernal pools.may be protected under,the following regulations: Massachusetts Wetlands Protection Act Regulations Q 10 CMR 10.00) Massachusetts Surface Water Quality Standards Regulations(314 CMR 4.00) -Title V.(Subsurface Sewage Disposal).Regulations(30 CMR 15.00) -Forest Cutting Practices Act Regulations(304 CMR 11.00)' www.nhesp.org Natural Heritage & Endangered Species Program Route 135, Westborough, MA.01581 Tel:(508)389-6360 Fax: (508)389-7891 . Help Save Endangered Wildlife! Contribute to the Natural Herita;e & Endangered Species Fund TopoZone IISGS Hyannis(MA)Topo:Map Page 1 of l •`T DP® ;nyyfi2U°3iA7F9 tar7d9!Jr ` �,�d ti r j_rx�y4,f .. ,}�y�y.�j , .1 t , - y, {am} �y fir• ' �w'[ -e^f'aY t {JJ J. 1 5 .{• JrJ 1 ,t. L+.yY wIG{ f1.�d ' ,. �I�a•�4 M{I _�"L; 1�i St -� 7 •, ,-15 t...r�5Y1RT J ��- .1 h :'� '"T' '. J J J SS t -1 4-1-44 '.�l''a`"'J•>,'�s J _17. !'L:.,,{ 1 .� ° i i J J � 'r.�=j 1 a..am.�`+ ,'� S + l _t-� _ ' 1 J .,t. � •i I S I.8 CLd I. r N , t t �--E .b? 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Report Dated:: 11Y1.tN2015 Sally Desmond Desmond.Well Drilling Order No..: G1591026 P'O Box.2783 rti.a Qdeans; :MA 02653 _. __ _. Laboratory ID#: 1591025-01 Desarlptton;: Water Drinking 1Nater Sample.:#t Sample Location: 39 Shepard Way W. Barnstable,MA j C'oliecte.d: 1 6/2Q15 Collected by' DWD c Recefved; 1:1106/201.5 Poutine_M ITEM RESULT.. UNITS...... RL, MCL METHOD# ANALYST TESTED NOTE Nitrate as;Nitrogen ND rriglL 0,1.0 10 . EPA 300.0 LAP 11[0612015 Iron. 0.35. mg/L 0.10- Q:? SM 3111B LAP 111.1;w2015 mg/L 0;025: ^0.050 SM 311113 LAP` 11.11012015 Manganese; ND - PH g 6. PH AT 25C` NA 6 5 8 5; SM 4500 M B DCB 11106/2015 Soditarri• �'Q mgll . . 2:5 20: SM 3111E LAP 11110/2015 Total Coliform p 1100m1 0. 0 SM 9222 131 RG, 11106/2015 Conouctance; 100 umohsicm 24 SM"251ot3 D°cB 11106/2015 t3ased on°the;results of the parameters festetl, Elie wafer is sortable for drinking, 5uf may present aesthefic problems l (taste;odor;:staining):due to.lron. Attached please find the laboratory certified parameter list;: ApprOVed By yw � 'Pb Manager) nw, ND;=None;:Qetecfed-: RL Repor3rng;Lmt; MCL.=Maximum Eontaminant,Level 3195 Main Street, P:O;:Box 427, Barnstable,.• MA 02630. Ph`;508=375-660,5 iI lidl���l CERTIFICATE OF ANALYSIS Barnstable. County Health: La:b..o.ratory (M-MA009:); ' 4q' y...... .........,.:..:: .............. ..... ......._ .... ..:........_,. Recipient: Sally Desmond Matrix: Water:-Drinking'Water Desmond Well Drilling . Sampled: 11L06/20.15 14 30 - 130''13oz 2783: _ Received: W06/2615 14 55 Orleans, MA. 02653. Collection Address. 39 Shepard:INay W Barnstable,MA. Order#: G1591028: Sample Locations; Description 2day=39 Shepard Way Lab ID 1591025 01, Date Analyzed:, 11/10/26.5 Sample Analyst.; yn Method:. EPA,5242 btlutlon,Factor� 1 Comment:. Based on the results of the parameters`tested,'tle water is.suitabie for drinking,,bwt;may presentaesthetc problems(taste;.. odor,•staln(ng)due talron. EPA 524,2 Volatile Organics by GC/INS __ � fi MC)L L - Rook. MCL MDL Parameter ug/C ug/� ug/t Parameter u9/� ug(L ug/u. DlchlorodiMuoromethane NO 0150, Chloroform 1.4 80 0.50 . _. ..... Chloromethane NO 0;5o cis 1,,2-DI'1p .' oethene. NO zo o so. .. -- _.. Vinyl chloride ND' 2.0 o,5o cis-1,3-Dichloropropene.: NO 0.50 Bromomethane NO, 0.50 Dibrarnochloromethane NO .0.50. 1,1;1,2-Tetrachloroethane ND U:So Dltargmomethane ND 0.50- _. __. 1,1,1-Trlciiloroethane:, NO 0 o:50 Ethyll enzene ND 700 0.50. 1,1,2;2 Tetrachioroethane N. o.so Hexachlorobufad':ene ND 0:50' _ .....__ _ _ ... ........ . ..._.... _. 1,i,2-TrlM6roethane ND 5.0 9.50 Isopropylbenzene N;D 1,14chloroethane ND o.5o Methylene chloride: ND ~.5.0 0;56 11-DichlbWethene NO: 2,0: 0 50 Methyl-tert butyl ether NO 0.50: 1 1 D(chloropropene; ND o.so Naphthalene NO 0.50 1,2,3=Trichlorobenzener ND a•5o n-Butylbenzene:: NO a 50 1,2,3-THchioropropane ND A:50 n Propylbenzene ........ .::... 1,2,4-Triciilorobenzene NO 70 Aso p Tsopropyltoluene NO oc5o �.._ _ _.. 1,2;4-Trirnethylbenzene NR Mo sec-8utylbenzene. NO: 0.50 1,2-Dibromo-3 chloropropane; NO .0.5.0 Styrene . „ ND im ....... 1.2-b1brornoet6ne(EDO) NO 0:50 tart tylbenzene Bu Np. 0 50 1,2-Dichlorobenzene NO 600 0.50 Tetiabhloroethene; ND 5.o 0.50 1,2-Dichioroethane NO 5:0 0.5o Toluene - ND: 1000: . 0.50 _... _.. ._. _.... -- . - __ 1,2 Dichloropropane ND o 50_ Totalxylenes ND ioo0o 050 �..._ 1,3;5 TrirnethylbenzPn.P< RD 0:50 t"tans-1;1 Dichloroetf!ene ND: ioo, •to _ .._ 1,3=Dichlorobenzene NO U.SU trans-1,3 Dichloropropene NO 0.50' .._-.._.. __ 1;3-D(chloropropane ND 0 50 Trichloroethene ND' 5i0: 0.50 __. 1;4 pichlototerizene ND .5.0 0.5o TdchloroFluoromethane ND: 0.5o 2,2 Dichlororo ane, ND. a 50 _.:-. ... p p _....... _. .._: Surrogates %Recovered QC Limits(%) .... 2 Chlorotoluene NO 0 50 Oromofluorobenzene 116%i: 70 130 4 Chlorotoluene ND 0.50 - 12 Dichlorobenzene d4 a 131/0 70 136 Qenzena. c.. . _. Brprnobenzene: ND Bromochloromethane NO M Bromodichloromethane: _ ND 0:50 _.. _ ....., Brotngform ND 0 50 Carbon tetrachlonde: NO 5.0 6.50 Chlorobenzene. ND 100. 0.50' _.------------ Chioroethane. ND o.50 Attached please find th laboratory certified parameter list., Approved. By Lab Director NO None`Detected; RI = Reporting;limit MCL=Maximum Contaminant Level 3195 Main,Streety P.0: Box:427, Barnstable, MA 026.30 Phi 508 3764605 Page 1 of TOWN OF BARNSTABLE LOCATION S &,4tl SEWAGE#,Zar, 9 VILLAGE ASJIESSOR'S MAP&PARCEI,z INSTALLER'S NAME&PHONE NO,�koe ell" ' SEPTIC TANK CAPACITY LEACHING FACILITY:(type)5, .420 4146, 64"_ ,&(size) 555- �' l272 NO. OF BEDROOMS S PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the 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 1 �� 1� � ��1 � � � O \� 1�'� 0 0 TOWN OF BARNSTABLE 2 LOCATION 6 swe p e4y s (/( of y SEWAGE# ZO/S-V'? VILLAGE-3��& ASSESSOR'S MAP&PARCEL02 f$—y78 INSTALLER'S NAME&PHONE NO(! ,Q iAMt 6a.<. : IYW- /Z4!r- SEPTIC TANK CAPACITY j-CX is Ti n d00 S'4//0.ti LEACHING FACILITY:(type)?j j 614A?!k0-S (size) �?j�X l 3 NO.OF BEDROOMS OWNER 57-cveA) PERMIT DATE: Lo-N / COMPLIANCE DATE: Separation Distance Between the- Maximum Adjusted Groundwater Table to the 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) �•y l� Feet FURNISHED BY 1 e Vial 0 0 Apt No. Fee Or) THE COMMONWEALTH OF MASSACHUSETTS Entered incoinputer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Iication for b his aY stetu Construction 30ermit Application for a Permit to Construct( ) Repair( Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's,,N�am ,Address, d T No. Assessor's Map/Parcel 71 E5� �� � �` �r� � Installer's Na dr� a�� Desigctg�s r\ Address,a dk eql�� 1 Type of Building: Dwelling No.of Bedrooms Lot Size 2 ' 1`— sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.requir t) f-Z—X0 gpd Design flow provided - 5 gpd Plan Date L� Number of sheets Revision Date Title fdyj Size of Septic Tank 1 dCO 42,4�0\1 Type of S.A.S. \A�) � Description of Soil oD' Nature of Repairs or Alterations(Answer when applicable) 12 Date last inspected: Agreement: l ^ The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Boar f Health. ne Date 1 0 Application Approved by Date Application Disapproved by Date for the following reasons Permit No. Date Issued , t 6 1 ° Fee No ai T E COMMON E/4L F MASSACHUSETTS Entered in com$uter: IlkPUBLIC HEALTti DIVISIOWr TOWN OF,BARNSTABLE, MASSACHUSETTS Yes I Rpplicatioh for Bis� o. at-6p' Btrm Construction permit Application for a Permit to Construct( ) Repair( Upgrade( )' Abandon'( ) ❑Complete System ❑Individual Components Location Address or Lot No. Z9 t5 1 Owner's Name,Address,and Tel.No. Assessor's Map/Parcel �j� a FN2�wW Installer's Na dress,and T o Designer's Name,Address,and Tel.No. a�v) C> M 4t�OLIIJ Type of Building: Dwelling 41No.of Bedrooms �' Lot Size G 1 C I sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) { Other Fixtures 4 Design Flow(min.requir ) gpd Design flow provided __-- rr'J 9 gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. j Description of Soil tO 1A.0 Nature of Repairs or Alterations Answer when applicable) 2 p ( Date last inspected:. Agreement: The undersigned agrreees'to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Boar of Health. gne Date Q 7 Application Approved by // XA1 Date '- Application Disapproved by Date for the following reasons i Permit No. WA Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed ) Repaired ) Upgraded( ) Abandoned( )by l w C_DLQ 5Q1y l at } D> ( has been cons ructed'n ac o e with the provisions ��o//f��Title 5 and the for Disposal Symms' ,rn Construction Permit No. ted f ( 3 Installer 0jK aaw� LJ ��'G�-1 IllJ�1 Designer I ~~~ #bedrooms Approved design flow gpd The issuance oj this permit shall not be construed as a guarantee that the system will n� as designed. Date 2 Inspector ' 0 I 1 s No. Fee THE COMMONWEALTH OF MASSACHUSETTS P L HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS D �� �Bls�losaY *pste Construction VerITCIt Permi ion is hereby granted to Construct( ) Repair Upgrad W an n( System located at ✓�"�� �/ t - and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction in st a mplete wit�i1 three years of the date of this permit. Date Approved by � 1 ` a Town of Barnstable �FIKE rOwti Regulatory Services Richard V. Scali,Interim Director swxtvsrnet.e. 9� MAW. �0g Public Health Division 039. ATEo �° Thomas McKean;birector 200 Main Street,Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer &Designer Certification Form Date: JU Sewage Permit# �05= y Assessor's Map\Parcelrj Designer: � � ��71�^-i Installer: 1W � Address: CN�t%— Address: �T On a 7) 13 1 g- �Tu✓� 1�045) was issued a permit to install a (date) (installer) septic system at SNC. based on a design drawn by' (address) vl Wu1'�a4 V2-'-_2dated tD 51f3 (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. �/ AW1T'DW � R I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required)was inspected and the soils were found satisfactory. I ce 'fy that the system referenced above was constructed in co niiance with the terms of t l\A approval letters (if applicable) . �%" � •+�Qr�t1 O F rl9gss��4 T f � UAVIDC - �', � ( staller s Si N1Asorl ature) -� J 9 No-1066 v (D er s Signature) (Affix Desi �s,:; ~, mp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. t THANK YOU. Q:\Septic\Designer Certification Form Rev 8-14-13.doc �o I �� Fee J /No. I — Q 3 BOARD OF HEALTH TOWN OF BARNSTABLE application _for Yell Con!5trurtton Permit Application is hereby made for a permit to Construct(�, Alter( ), or Repair( ) an individual well at: 3c\ S" e(-d 2-5B16-1,8 ocation-Address Assessors Map and Parcel Z er41 uYNk 3g r&UL `dA 02Y,3 v Owner Address cvronk,\N0 'pc `c� ,�fi�: �a o ax Z��3, 0V ,S MA Q 2- S 3 Installer-Driller Address Type of Building Dwelling V Other-Type of Building No. of Persons Type of Well Lk S QM n eV(— Capacity I b�9 ph1 Purpose of Well e Agreement: The undersigned agrees to install the afore described 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 Certifi ate of Compliance has been issued by the Board of Health. ~� Signed 1 Date Application Approved By 4 1 t. at i Application Disapproved for the following reasons: Date Permit No. Issued Date BOARD OF HEALTH TOWN OF BARNSTABLE (Certificate of Compliance THIS ISS TO CERTIFY,that the individual well Constructed(- Altered( ), or Repaired by I ( ) c LL Installer at % T7 -�'� C�� 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 THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. Date Inspector No. 0 3 Fee / I BOARD OF HEALTH TOWN OF BARNSTABLE ZIpprication jFor Vern Con.5truction Permit Application is hereby made for a permit to Construct Alter( ), or Repair( ) an individual well at: Location-Address Assessors Mar and Parcel l Ur 3 She (-M KM OU30 wner Address A <vrc�n �Q`l 66l 4 2653 Installer-Driller Address , Type of Building Dwelling Other-Type of Building No. of Persons Type of Well L1�� •S M,n eve . Capacity I b q P' , Purpose of Well 666 1 Agreement: The undersigned agrees to install the afore described individual well in accordance with the provisions of the f Town of Barnstable Board of Health Private Well Protection Regulation-The undersigned further agrees not to place the well in operation until a Certificate of Compliance has been issued by the Board of Health. Signed ' Z Date Application Approved By �f /d /i - Date Application Disapproved for the following reasons: Date Permit No. Issued 'Date_ BOARD OF HEALTH TOWN OF BARNSTABLE • Certificate of Compliance THIS IS TO CERTIFY,that the individual well Constructed( /Altered( ), or Repaired( ) by IFC ) �z.C..L Y2 I L C—IN � Installer at e. ��►f��1 LAD D 64`� Z R 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 THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. Date ` Inspector BOARD OF HEALTH TOXIN OF BARNSTABLE Yell Cow5truction Permit No. G,/ 1J( Fee Permission is hereby granted to 1 ) F—sw oojc. L"JF(.,.L Z c/uL/N<5 Installer to Construct��, Alter( ), or Repair( ) an individual well at: No. ?� I. -9L1 `��J� Street as shown on the application for a Well Construction Permit No. W)U(5- „ Dated /0 - Date Approved By ;A P Town of Barnstable P# I a� Department of Regulatory Services a,,axsrnat.e.: -Public Health Division Date $ 2 059. �� 200 Main Street,Hyannis MA 02601 A Date Scheduled Z Time Fee Pd. U 4 • J Soil Suitability Assessment for Sew Di_s/p/)os+a,1. Performed By: Witnessed By: v. t/�. ,J 7/�-/�'�•// C 10, LOCATION&GENERAL INFORMATION Location Address ��'� Owner's Name�!q}•r�(C Ci ( 9µ V Q Address Map/Parcel: t�� / �J Assessor's Map/Parcel: / Engineer's Name�/� NEW CONSTRUCTION REPAIR I// Telephone# F)* /J 10 Land Use Slopes(%) - Surface Stones Distances from: Open Water Body ft Possible Wet Area " ft Drinking Water Well - ft Drainage Way ft Property Line II ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) Parent material(geologic). Depth to Bedrock Depth to Groundwater:Standing Water in Hole: # Weeping from Pit Face _ Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: w Depth Observed standing in obs.hole: in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level PERCOLATION TEST Date Time Observation - Hole# Time at 9" Depth of Perc " M_ M Time at 6" Start Pre-soak Time @ L1. Time(9"-6") •End Pre-soak ',�-^ `/,•�/� - ,. - Rate MinAnch G. ✓,r_"' / Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) ` Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100'of wetland,you must first notify the Barnstable Conservation Division at least one(1)week prior to beginning. Q:\SEPTIC\PERCFORM.DOC - DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel t r 1p 44 L, 7 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency%Gravel) DEEP OBSERVATION HOLE LOG Hole# } Depth from Soil Horizon Soil Texture Soil Color Soil Other " Surface(in.) - (USDA) (Munsell) Mottling (Structure,Stones,Boulders. - Consistency,%Gravel) - DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) Flood Insurance Rate Mao: Above 500 year flood boundary.No" es Within 500 year boundary No Yes Y LL Within 100 year flood boundary No_ Yes - Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pery o rial exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of n tumlly occurring pery ous material? _ Certification ^. �q I certify that on 1 V L (date)I have passed the soil evaluator examination approved by the Department of Environmental tection and that the above analysis was performed by me consistent with the requir ::!t�mg, exp ' nc d cribed in 310 CMR i 5.017 Signature Date I Q:\SEPTIC\PERCFORM.DOC Town of Barnstable oFt KME rokti Regulatory Services ti �� Richard V. Scali, Interim Director f MASS. 1 Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer &Designer Certification Form Date: �' Sewage Permit# Assessor's Map�Pa cel .�, ` e Designer: xuloM*" Installer: C � Address: iW � ` Address: On ID r� 1 CWA was issued a permit to install a at (installer) septic system at based on a design drawn by (address) dated (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. - I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required) was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed in-co njiance with the terms of the AA approval letters (if applicable) . .` t\t]F rl9gssq�TM DAVID (Installer's Signa e) m sbPi No.1Dss FalSTE M (Designer's lgnature) (Affix Desi t _..__,`L mp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:\Septic\Designer Certification Form Rev 8-14-13.doc Town of Barnstable Barnstable Regulatory Services Department Public Health Division %639. ♦� 200 Main Street, Hyannis MA 02601 2007 3 Office: 508-862-4644. ' Richard V.'Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL # 7014 1200 0001 0358 751 August 18, 2015 Steven E. & Kathleen N. Berglund 39 Sheperds Way - Barnstable, MA 02630, ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE,TITLE 5 The septic system located at 39 Sheperds Way, Barnstable, MA was last inspected on 7/20/2015 by Mike DeCosta, Jr, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that:the system "Fails" under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the following: 0 Leaching pit or cesspool with high liquid level, <12" below.inlet (per Town Code 360-9.1). You are ordered to repair or replace the septic system within Two (2) years from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THEBOARD'OF HEALTH, r ` j ;6�Aas rc ean, R.S. CHO. Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Evl\39 Shepherds Wy Bam Aug 2015.doc PERMIT RI T N . LOCATIOW WAGE E 1 Q VILLA AVE y � o f7 � INSTALLER'S A b ADDRESS �d Z 0 UILDE R--�OR OWNER V l 'Yj'I ��l C A ��RyCsc,vd DATE PERMIT - ISSUED 46DAT E C 0 M P L I A N C E ISSUED fir. l �� � ', x �� -� � --a � s � . � �� as __ �, �� a ��i ,o `' �-- THE COMMONWEALTH OF MASSACHUSE17S BOARD OF HEALTH ............. ! .........OF...... �� Vby' fur Uiivn rks Tontitrnrttnn amit pplication ;<s here m e�ftm it to (✓j or Repair ( ) an Individual Sewage Disposal System at: �C � �................�.. -... .r. ...... ............................................ .._.......-.............................. Location- or Lot No....Q���:4a ............................•-------•-- -- ✓ �C<.. ,C--/-- 5 ........................... Owner Address .ems. /LlS --.........................�4t �_.... Installer � Addres ... ............... Type of Building Size Lot./!.Z 3---e 4 q. f t ------_ Dwelling—No. of Bedrooms...._._................................Expansion Attic ( ) Garbage Gri er �) Other—Type e of Building _.._._.... No. of persons............................ Showers � YP g ---•--•--•-•------ P ( ) — Caf rIa dOther fixtures ------------------------------------------------------•••••-•----•-------•••••••-••••----•-•-------•-----...-----....-•••-•--._......------------_... Design Flow...............«r....................gallons per person per day. Total daily flow------------33®.__..._.___...___.__.gallons . WSeptic Tank—Liquid capacity./90-9_gallons Length.�a'C"... Width..C`4 /... Diameter................ Depth_S'�"_ x Disposal Trench—No..................... Width.................... Total-Length.................... Total leaching area....................sq. ft. Seepage Pit No......./........... Diameter......./4..... Depth below inlet.... ........... Total leaching area....Z�_A...sq. ft. Z Other Distribution box ( ) Dosing tank ( ). aPercolation Test Results Performed by........................... Date........................................ Test Pit No. 1_L---z....minutes per inch Depth of Test Pit-_/ ........ Depth to ground water----- ----.-•-_-- 44 Test Pit No. 2_.G. "__..minutes per inch Depth of Test Pit--- ------- Depth to ground water........................ 0 Description of Soil........ L4 p Z&A:?!�1.... -CC' ( 6¢"-/¢9�"...ti •_ ... x - . 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'TT IL-p 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. Sig •:r••----------------•-----•---•••-----..........--•---......--••--....••--• ----------------- Application ........ n Approved B Date ApplicationDisapprov fo he following -- --• -------------•-----------------------------------------......•------•-••--------------------------------•-•------•-------------•----•-----••-=--•-----------------------•-•------------•••-•--•--•---•----••--••-------••-----••-••--------••••-••----•-------•--------••-•---......_ Date PermitNo......................................................... Issued......................................... Date k c �- E , Now - ` Fx$....�..�.....::............ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .7. ......_OF.......................VS.�i..._/?G:....... App iratiun for Eliupug al Works Tonutrurtion rrutit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: of/- , "ram L r + LO%` ................_...._.._..---•-----...--•-----........_.................................._..... ..._............---•----•......____•••--•-•--•.._...------.....-•••------•---•---................. Location-Address i. or Lot No. 7714 ......... - -... ...... ................................. ---- /� j ,r Owner /�" [ Address a _/����if j........_ ..�.f.��.................•---.............--•--•-----•-•- ......................................................... . ....�?� .�. I._/ 'ASS Ceria . Installer /0 Z 34 AddressType of Building Size Lot....UDwelling—No. of Bedrooms.............:-..............._....__..__..Expansion AtticGarbage GrOther—T e of Buildin ............... No. of ersons............._.............. Showers — Caf a Other—Type g ------------- P ( ) p-I Other fixtures ................................... ...„ W Design Flow............... - ........_.._........._gallons per person per day. Total daily flow.._.........�':��•.•..............•_._gallons. G: Septic Tank—Liquid capacity.f PP` .gallons Length.!°_.I.____. Width..:%_........ Diameter................ Depth__`�.......... W Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. x Seepage Pit No......... Diameter....... ..:_._. Depth below inlet.....:;�........... Total leaching area......2........._.sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by..................•----....................------------------........••_.. Date........................................ aTest Pit No. 1.4....7....minutes per inch Depth of Test Pit...I r.•...... Depth to ground water.__................ (i, Test Pit No. 2..�...Z._..minutes per inch Depth of Test Pit.../ +%' Depth to ground water........................ •---•-----------------------------•-......-•-----...---.....---••--•---••----...........----..............................--................................. � �....... �Z � '14�-I �.�.: ->� aT�D Description of Soil........ G0l)/`--• ...CC ----------•-...... -- • ..... . _ V ....••-••-••---•--•--•••---•••••-•••-••••-•-•-••--••-•-•••-•-•••-••••---•-•-•-•--••••••-----•••..........•-•-••••••-=••---••••••-•-•-•-----•-----•••••••-••-•-•----••••----•--•-----•••-•---••--•--•-•-- 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`TT' L, p 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. All F _ Siged -•--•-•--••........................•--••--•--.-_-.....-------••-.....•--•--•-- -•••-•-----_._( fi Application Approved Bye ` •. •••.......•-- ----• ` a' Date Application Disapprov f o he following reasons---------------••---------------•-------------------------------•--••--•-•-•-•--••-•-•-•••-• -•-•••••---•-••••-- ----------------------•-••---••----••--•--_•-•--••-••---•-•--•-----••-•••--••--••-------••....---•---••------•-••..................................................................................... Date PermitNo......................................................... Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................ .............{.C>Ih✓ f.........OF....... !! A./.S 7-1.............................................. - C�pdifirtt#r of Toutpltttnrr THIS ,0 CERTIFY, That the Individual Sewage Disposal System constructed (!i') or Repaired ( ) by--•• ` . ...................L ZZ :x- = ..................................... .—staller .t� has been installed in accordance with the provisions of T r j of The State Sanitary Co�d a abed in the application for Disposal Works Construction Permit No._ - _ _____________ dated_ f' . -- -__ _____--•---_____-•. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED S A GUARANTEE THAT THE SYSTEM WIL F CTION SATISFACTORY. DATE....11 1j 1__.A_,l-_-..................................................... Inspector..... .::... ...----------• a , THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH r '�+ ................. ......... ............................ 7 No. FEE........................ Permission is hereby granted . •-••-_...,.-- to Constru Re air!(�*. n Ind- Semi a Disposal Sat No.. -..: '�", ,+" " -----•--------..... ............. Street as shown on the ap li on for Disposal Works Construction Permit No....:.............. ed. ._� : ............. ........... :_ ..................................................... ................_ rd of Health DATE--- •--------------------- , FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS 4 7- LO CAT 10-N `3 %YrEWAGE PERIS9tT H.O. 3/9 VILLA, c �• .; - _ © f7g. . IHS-TALLER'S . AIDE •g ADDRESS g; � D- UILDER----;OR OWNER, . w DATE PERIAIT'- ISSUED' pD'AT,E COMPLIANCE ' . ISSUED lop `!� 77 ASSESSORS MAP : lvv _ TEST HOLE LOGS :! �V PARCEL: -- .7�3 1) 'I lie ins(allation dull coinjAy with "I'ille V and 1'mwu ol*Aobl)o ud of FLOOD ZONE: SOIL EVALUATOR: ��1t��3 Ilealth Itegula(ions. _kloT _ ____ .._-_ ..___._...__.. WITNESS : Z0401L I 2) The installer'shall verily the location of utilities, sewer inverts and septic I ' REFERENCE: ,/ DATE: �5E ZZ 2U! components �irior to installation and selling base elevatic its PERCOLATION RATE: .G Z /01V, I 3) All gravity septic piping to be 4 inch Sell 40 PVC at 1/8 per toot.]he first �U &A � I7j I'�/ ���Y. ��7 two feet out of the d-box to the ieuchin shall be level. -- - -------- y't� � �13�.7 4) l-his plan is not to be utilized for property line determination nor any other TH- I 1H-2 purpose other than the proposed system installation. 5 All septic components must meet'I'itle V specifications. D ��� /C 7/ O��/G 6) Parking small not be constructed over I110 septic components. 6`hl� �� 7) 'fhe property is bounded by property corners and property lines. rb/8 8) 'Hie property owner sliall review design considerations to approve of total LOCATION MAP '�j 30 design flow and number of bedrooms to be considered for design. Receipt of payment for the plan and installation based on (lie plan shall be deemed approval of the design [low by the owner. G9) •1'l►e existing leaching or cesspools shall be pumped and filled with material �l 1/0 7/ per"Title V abandonment procedures. 7'hose within (lie proposed SAS shall be removed along with contaminated soil and replaced with clean sand per i0�,/6 " 20,E Citle V .r- -_ __ specs. 10)System components to be 10 feet Gom water line. Sewer !hies crossing the L, I /Ca �O water line shall be sleeved with 4 inch SCI140 PVC with ends grouted if applicable: 7 lie proposed SAS is being ins(alled below the water service line. 7'he line is to be sleeved as aforementioned and maintained in place. / \ ` SEPTIC SYSTEM DESIGN 11) If a garbage grunter exists it is to be removed and is the responsibility oI'the ��1 \ �►� `, 1 `0 owner to ensure such. FLOW ESTIMATE 12)"I he installer is to take caution in excavation around the gas line if such 1 f� ,Y \ p'� 1 \ �, &GAL/DAY exists. 13)Tneinstallershall verify the location, quantity and elevation of the sewer BEDROOMS AT 1�t'J GAL/DAY/BEDROOM � ' ina the dwelling"r.lines exiting p wr to llte installation. 3� � 14)'I'his plan is representative only that a system can fit on a property meeting �pO s 1 A ( SEPTIC Tl1fJK ` �----�- \ � "I'itle V requirements. 1 1 GAL/DAY x 2 DAYS -l/-D GAL I USE I GALLON SEPTIC TANK e SO L ABSORP ION SY91E*51 ar±,l�,�s :, I DE: AREA: �'K �J 12� I � 1V e o UAVIO W IVIAsorl BOTTOM AREA:. �Z � ��L = ����V�:J VN )YSTEM SECTION WOx�/ l•� DF Wo y.� F ,L U -- qyl 55- _ :L I --- ` 0 I -- U—EU. ^ —' .c LQQ�,"GAL ,�1 l l f�yt r v ►01.7 � SEPTIC TANK U 2� _ � wt ► fAV. 2-7-7 SITE AND SEWAGE PLAN L0CAT1 ON : vP jW&U1 PREPARED FOR : G�D���1.� Gy 610JXTOd J CV-TOT 1 ± � 0 ` SCALE: DAV I D B . MASON R5 DATE: 10 02015 DBC ENVIRONMENtiAL DESIGNS iu DATE HEALTH AGENT EAS e SANDWICH . MA Z ,/` ( 50� ) 8 3- 2177