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0081 CAPTAIN BELLAMY LANE - Health (2)
Centerville A = 230 — 182 UPC 12114 1110.2-15SLO it HA8TIN98.YN d t � No. ,: ` Fee i THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01ppYication for �Di5po5ar bpgtem Cott.5truction Ver it Application for a Permit to Construct( ) Repair((Upgrade( ) Abandon( ) ❑Complete System Individual Components Location Address or Lot No. BI i y.t,� Owner's Name,Address,and T�gL`No ���1-no— �CJV 6 i „ `t3G1 l ✓� �J �,rj Assessor's Map/Parcel 15 3 YYl Q `1 J �� �. a4 Cvrc n ��l u.T C'J-► ` 0 Installer's Name,Address,and Tel.No. ' ` ��� ""' esigner's Name,Address and Tel.No. � 3 Type of Building. Dwelling No.ofBedroorh�sy �� ^ Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures 19 !r Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets, Revision Date Title Size of Septic Tank r( ( Type of S.A.S. `/ Description of Soil 1�I:P L t� L S 0K_ Nature of Repairs or Alterations(Answer when applicable) v% 1()00 ST 4� r 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 pla the system in operation until a Certificate of Compliance has been issued by this Board of Health. 1pf Signed, Date 'y Application Approved by Date „i! Application Disapproved by: Date for the following rearrsons Permit No. .? ��' Date Issued o �.-• ry....�� �,.—t.rv-./r :,.,r. ...t .....-.. _. ... "W'_•:. ... r...a,-..._Yt.w"..✓..r ..r - +.... . v,�'*ES'••'. r -.l. �:i y. .. .. J r�' o Fee 1 e THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS a Yes 01pplication for �Digooar *pgtem Con5tructtoi n Permit Application for a Permit to Construct( ) Repair'(,/ Upgrade( ) Abandon( ) ❑Complete System ®Individual Components Location Address or Lot No. U) tt`�- ��e 1 �L Owner's Name,Address,and Tel AT .Not. f Ct'J�(j C'kXl YC�1'V t (�/ rn wd' 1/ 41 �_ ite_ os Ro 360 Assessor's Map/Parcel3 0 ! 6� 1 S—�! Qu,.t t C t �Q GrCC Wc �t"(1 rc/ 7 \\\ i i�c.J Installer's Name,Address,and Tel.No. -� ! �i Designer's Name,Address and Tel.No. Type of Building: er C Dwelling No.of Bedrooms ^ Lot Size sq. ft. Garbage Grinder ( ) Other Type of Building No.of.Persons Showers( ) Cafeteria( ) Other,F Pxtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Vp K, o 1 Nature of Repairs or Alterations(Answer when applicable) ,. o�r,vv� iDOO ST .'' p r�S f��� 1 ra-C D Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed _ Date 3 Application Approved by `f N1, Date Application Disapproved by: Date for the following reasons _ ; O ,l lq Date Issued `f o P r Permit No. � � ' ——————--————(——————————— — (�,, THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Or (Certificate of compliance A -THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ) Upgraded ( ) Abandoned( )by 0 0r mat ,r ,p dR 1�� has been constructed in accordance J with the provisions of Title 5 iand the for Disposal System Construction Permit No. a)OG�f'//�� dated Installer Designer #bedrooms /il ',A-- Approved design flow gpd t The issuance of this permit sh ndh con t grued_as a uarantee that the s stem unction as desi neY,A Date p Inspector ;',�: ,, l---j ------------ No. O(.ley' f f t,/ Fee 10d r THE COMMONWEALTH ORMASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS lwigoal *p6tem Cow5tructiou Permit Permission is hereby granted to Construct ( ) Repair I(C ) Upgrade ( ) Abandon ( ) System located at ��a „ r 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 pe�'�rrrlft. Date � �� Approved by= ✓Vv' — f�p� TOWN OF BARNSTABLE � c t �( � 45;l� SEWAGE # 0 LOCATION -��.-,-=— / \�l �,'1fLLAGE G1 I'v( a P ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) _ Lt ze) _ NO.OF BEDROOMS <1 U r BUILDER OR OWNER ��ii �� COMPLIANCE DATE: PERMIT DATE T�_� Separation Distance Between the: Feet Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Private Water Supply Well and Leaching Facility (If any wells exist Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility (If any wetlands exist Feet within 300 feet of leaching facility) Furnished by t J KO A z o , c� { i i .w Town of Barnstable °FtHE Tay, Regulatory Services ti Thomas F. Geiler, rector B" MASS. E ` Public Healt Division 1639• ♦0 ArFo�.�a Thomas McKean, Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Date: S o1.CU Sewage Permit# 6F -�1' Assessor's Map/Parcel 2So IS�L Installer & Designer Certification Form Designer: KC 7 C rib t o ee r i tj Installer: 'a Lek* 13W- G h p 4p Address: �(, G Leed v. IIe Address: on D 3! a tP Ro 6P. Dar OUW was issued a permit to install a (d te) (installer) septic system at 8( C11 p�Al tJ Qe l( A w, Ce_,Ao_r_v t CL_based on a design drawn by tua LRr� t� (address) o4, -TrwK 44A xok5 (4X:�V a A wev) p t I:zfCC�c! CY�tJ7tN( 1, Is-4a CNLUW ZACJk. 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. Stripout (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 c •fied as-built by designer to follow. Stripout (if required) was inspected and the soils e fo satisfacto -�N OF Mgss9� p� ROBERT A. yG Ins aller's Signature) DRAKE N rn o CIVIL y No.41642 GO (Designer's Signature) (Affi p 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:\office forms\designercertification form.doc Town of Barnstable Barnstable PofTHE Tdt a8 AmMCa C'sty Regulatory Services Department BARNSTABLE.) Public Health Division l�� -�� u c ea200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,,Director FAX: 508-790-6304 Thomas A.McKean,CHO March 14, 2008 Today Real Estate 1533 Falmouth Road Centerville, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 81 Captain Bellamy Labe, Centerville MA was last inspected on February 23, 2008, by Robert A. Drake, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Conditionally Passes" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • Water level in tank is showing signs of exfiltration. You are ordered to seal or replace the septic tank within One (1) year from the date of this notification. Failure to repair/replace the septic system within the deadline period will result in fixture enforcement action. PER ORDER OF THE BOARD OF HEALTH (S�i�asecKe , R.S., CHO Agent of the Board of Health CERTIFIED MAIL# 7006 2150 0002 1038 6957 Q:\SEPTIC\Letters Septic Inspection Failures\81 Captain Bellamy.doc r � i .�,� .� �� _ . � �� . � . ; Commonwealth of Massachusetts Title 5 Official Inspection Form _ Not for Voluntary Assessments Subsurface Sewage Disposal System Form Inspection results must be submitted on this form or on the official Title 5 Inspection Form dated 6/15/2000. Inspection forms may not be altered in any way. A. Certification Important: When filling out 1. Property Information: forms on the _ 1 LW computer,use 81 Captain Bellamy Lane 0U only the tab key Property Address to move your Today Real Estate 3 0 ' cursor-do not use the return Owner's Name key. 1533 Falmouth Road € Owner's Address -7= r-- Centerville MA :f-02632 Citylrown State Zip Code G i Date of Inspection: - — 2/23/08 z: Date b f; 2. Inspector: MR. ROBERT A. DRAKE r T Name of Inspector KCJ ENGINEERING Company Name 66 GREENVILLE DRIVE Company Address FORESTDALE MA 02644 Cityrrown State Zip Code 508-287-1253 Telephone Number 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 the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ❑ Passes ® Conditionally Passes ❑ Fails Further Evaluation by the Local Approving Authority Kd A J -1 1.,-h 8 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. 81 Captain Bellamy Lane-T51NSP1.DOC.doc-11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 1 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form A. Certification (cont.) 81 Captain Bellamy Lane Property Address Centerville MA 02632 Cityrrown State Zip Code Today Real Estate 2/23/08 Owner's Name Date of Inspection 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. Answer yes, no or not determined (Y, N, ND)in the❑for the following statements. If"not determined," please explain. ❑ The septic tank is metal and over 20 years old"or the septic tank(whether metal or not)is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. "A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: Water level in tank is at 2.1 feet, shows signs of exfiltration and needs to be sealed. 81 Captain Bellamy Lane-T51NSP1.DOC.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 2of16 i Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments ` Subsurface Sewage Disposal System Form A. Certification (cunt.) 81 Captain Bellamy Lane Property Address Centerville MA 02632 Cityfrown State Zip Code Today Real Estate 2/23/08 Owner's Name Date of Inspection 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 ❑ obstruction is removed ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed ND Explain: 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 81 Captain Bellamy Lane-T51NSP1.DOC.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 3 of 16 'Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments ` Subsurface Sewage Disposal System Form A. Certification (cunt.) 81 Captain Bellamy Property Address Centerville MA 02632 Cityfrown State Zip Code Today Real Estate 2/23/08 Owner's Name Date of Inspection C) Further Evaluation is Required by the Board of Health (cunt.): 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 81 Captain Bellamy Lane-T51NSP1.DOC.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 4 of 16 r Commonwealth of Massachusetts . Title 5 Official Inspection Form Not for Voluntary Assessments y` Subsurface Sewage Disposal System Form M A. Certification (cunt.) 81 Captain Bellamy Lane Property Address Centerville MA 02632 Cityfrown State ZipCode Today Real Estate 2/23/08 Owner's Name Date of Inspection D)System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No" to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or 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'/2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] Yes No ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 81 Captain Bellamy Lane-T51NSP1.DOC.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 5of16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form A. Certification (cont.) 81 Captain Bellamy Lane Property Address Centerville MA 02632 City/Town State Zip Code Today Real Estate 2/23/08 Owner's Name Date of Inspection 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. 81 Captain Bellamy Lane-T51NSP1.DOC.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 6 of 16 I Commonwealth of Massachusetts - -- Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form B. Checklist 81 Captain Bellamy Lane Property Address Centerville MA 02632 Citylrown State Zip Code Today Real Estate 2/23/08 Owner's Name Date of Inspection 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(3)(b)] 81 Captain Bellamy Lane-T51NSP1.DOC.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 7 of 16 'Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments _. ,q` Subsurface Sewage Disposal System Form C. System Information 81 Captain Bellamy Lane Property Address Centerville MA 02632 Citylrown State Zip Code Today Real Estate 2/23/08 Owner's Name Date of Inspection 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 Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage 140 gpd 9 ( Y 9 (gpd)): Sump pump? ❑ Yes ® No Last date of occupancy: a couple of months ago Commercial/Industrial Flow Conditions: Type of Establishment: N/A 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: Last date of occupancy/use: Date Other(describe): 81 Captain Bellamy Lane-T51NSP1.DOC.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 8 of 16 i 'Commonwealth of Massachusetts lugTitle 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) 81 Captain Bellamy lane Property Address Centerville MA 02632 City/Town State Zip Code Today Real Estate 2/23/08 Owner's Name Date of Inspection General Information Pumping Records: Source of information: N/A Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: N/A gallons How was quantity pumped determined? N/A Reason for pumping: N/A Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no)(if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: House built in 1985. Leaching field was upgraded in 2000 according to Town of Barnstable Board of Health records. Were sewage odors detected when arriving at the site? ❑ Yes ® No 81 Captain Bellamy Lane-T51NSP1.DOC.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 9of16 'Commonwealth of Massachusetts . Title 5 Official Inspection Form Not for Voluntary Assessments SV � Subsurface Sewage Disposal System Form C. System Information (cunt.) 81 Catain Bellamy Lane Property Address Centerville MA 02632 Cityrrown State Zip Code Today Real Estate 12/15/07 Owner's Name Date of Inspection Building Sewer(locate on site plan): Depth below grade: approx. 2.25' feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: N/A feet Comments(on condition of joints,venting, evidence of leakage, etc.): Joints appear to be structurally sound, no signs of leakage. Septic Tank(locate on site plan): Depth below grade: 1.2 feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) Tank appears to be leaking and needs to be sealed.Water level in tank is at 2.1'. Tees are in place. If tank is metal, list age: N/A years Is age confirmed by a Certificate of Compliance?(attach a copy of ❑ Yes ❑ No certificate) Dimensions: 1,000 Gallon Sludge depth: approx. 0" Distance from top of sludge to bottom of outlet tee or baffle N/A Scum thickness approx. 0" Distance from top of scum to top of outlet tee or baffle N/A Distance from bottom of scum to bottom of outlet tee or baffle N/A How were dimensions determined? MEASURED IN FIELD 81 Captain Bellamy Lane-T51NSP1.DOC.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 10 of 16 'Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments ` Subsurface Sewage Disposal System Form C. System Information (cunt.) 81 Captain Bellamy Lane Property Address Centerville MA 02632 Citylrown State Zip Code Today Real Estate 2/23/08 Owner's Name Date of Inspection Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): All components appear to be structurally sound and working properly. The existing pvc inlet tee and outlet concrete baffle are in place and appear to be in good working condition. Grease Trap(locate on site plan): Depth below grade: N/A 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 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: N/A Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): 81 Captain Bellamy Lane-T51NSP1.DOC.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 11 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments ` Subsurface Sewage Disposal System Form M C. System Information (cunt.) 81 Captain Bellamy Lane Property Address Centerville MA 02632 Cityfrown State Zip Code Today Real Estate 2/23/08 Owner's Name Date of Inspection Tight or Holding Tank(cunt.) Dimensions: N/A Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert No 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.): Appears to be sound and working propoerly. No evidence of carryover.Water level slightly below invert of outlet pipes. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 81 Captain Bellamy Lane-T51NSP1.DOC.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 12 of 16 r Commonwealth of Massachusetts w Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form wM C. System Information (cont.) 81 Captain Bellamy Lane Property Address Centerville MA 02632 Citylrown State Zip Code Today Real Estate 2/23/08 Owner's Name Date of Inspection Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): N/A Soil Absorption System(SAS)(locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 4 ❑ Teaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: 4-infiltrator chambers installed,field size 11'x33'. Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching field everything appears to be working properly. No signs of hydraulic failure or ponding. Lawn area appears to be fine. 81 Captain Bellamy Lane-T51NSP1.DOC.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 13 of 16 Commonwealth of Massachusetts . Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form �M C. System Information (cont.) 81 Captain Bellamy Lane Property Address Centerville MA 02632 City/Town State Zip Code Today Real Estate 2/23/08 Owner's Name Date of Inspection Cesspools(cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration N/A 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 Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: N/A Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 81 Captain Bellamy Lane-T51NSP1.DOC.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 14 of 16 1 'Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments ` Subsurface Sewage Disposal System Form M C. System Information (cont.) 81 Captain Bellamy Lane Property Address Centerville MA 02632 Cityrrown State Zip Code Today Real Estate 2/23/08 Owner's Name Date of Inspection Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. 81 Captain Bellamy Lane-T51NSP1.DOC.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 15of16 i Commonwealth of Massachusetts Title 5 Official Inspection Form ° Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) 81 Catain Bellamy Lane Property Address Centerville MA 02632 Cityfrown State Zip Code Today Real Estate 2/23/08 Owner's Name Date of Inspection Site Exam: Slope Surface water Check cellar Shallow wells Estimated depth to ground water: 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: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: You must describe how you established the high ground water elevation: Barnstable GIS Groundwater Maps indicate high groundwater elevation is at approx. = 52', GIS Contour Maps indicate ground elevation is at approx. 30', approximately 22+/-feet to groundwater. 81 Captain Bellamy Lane-T51NSP1.DOC.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System. Page 16of16 JHE Town of Barnstable Regulatory Services BARMSTABM ; Thomas F. Geiler,Director $ 1Mnss. . g Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-8624644 l Fax: 508-790-6304 This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental.Protection. Although the Town of Barnstable Health Division received the original/copy of this report; this Division does not warranty the functionality of the septic system in the future not does this Division agree with any technical observation s and interpretations contained within this report. In addition, by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would-be listed on the"Disposal Work Construction Permit". If you should have any questions regarding this report, please contact the certified Septic System Inspector who conducted the inspection. TOWN OF BARNSTABLE LOCATION SEWAGE # �a D S I VIL AGE e e f v[ ASSESSOR'S MAP . t 4 & LOT INSTALLER'S NAME&PHONE.NO. � �'. (_._�Q SEPTIC 1AANx �.APAcrrY cv C - .�' LEACHING FACILITY: (type) �( �!f L/ t,,,�✓ ` y NO. OF BEDROOMS i i BUILDER OR OWNER U r' PERMITDATE: —G COMPLIANCE DATE:�=�-� UU Separation Distance Between the: j Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any.wells exist on site or witfun 200 feet of.leaching facility) ty Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Fur. shed by Feet Ci i i No. si?7 _ Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 2ppficatiou for nigogal *pgtem Cougtruction Permit Application for a Permit to Construct( )Repair( grade( )Abandon( ) O Complete System ❑Individual Components Location Address or Lot No. ,��G. /��,� jAO Owner's Name,Address and Tel.No. Assessor's Map/Parcel q _ G(/7 lr��G 19 ne/ .16al,7 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. ,(14e Lear Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow .f® gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil 177 Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issu d by s Board-of Health. Signed P Date Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued x2 S - Fee THE COMMONWEAL" OF MASSACHUSETTS Ent ed inrcor-puter Y s PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE,, MASSACHU � TS 01ppYication forlDigpont *paem Congtruction Permil Application for a Permit to Construct( )Repair(✓)Upgrade( )Abandon( ) O Complete Sy tee m f Individfi al Components Location Address or Lot No. /Ca"-,I 4 f Owner's Name,Address and Tel.No: Assessor's Map/Parcel T C ' Installer's Name,Address,and Tel.No. Desi ner Name,Address and Tel.No. gI`'r Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building r?�� ®S' No.of Person Showers( ) Cafeteria( ) Other Fixtures " Design Flow �� gallons per day. Calculated daily`flow gallons. Plan Date Number of sheets 1 Revision Date Title t Size of Septic Tank Type of S.A.S. Description of Soil M1' Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the'afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been iss ed by is BoPof Health. Signed Date y —� Application Approved by U Date y Application Disapproved for the following reasons Permit No. 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 at oc-4qif lrW'+ r �V U it; h s en constructed in.accordance with the provisions of Title 5 and the for D sposal System Construction Permit N . '' dated Installer Designer The issuance of this permit shall n e ?ons ed as a guarantee that tl� .s em will functi n as desig11 L 0 Q f i Date 1 ��� /�.. Inspector U r/ll. .0 —————————————————————————— --------- No. yu ,J-3 7 Fee THE COMMONWEALTH OF MASSACHUSETTS 30,/� Z PUBLIC HEALTH DIVISION - BARNSTABLE,, MASSACHUSETTS 30igponl *pgtem Congtr '-on Permit Permission is hereby granted to Construct( Repair( )Upgrade )Abandon( ) System located at 7 to 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 thi erjXt. Date: //�� � Approved by w_ 1/6/99 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT.(WITHOUT DESIGNED PI ANS) I, , hereby certify that the application for disposal works construction permit signed by me dated 00 , concerning the property located at CO /� meets all of the following criteria: This failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. {/The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. C✓ There are no wetlands within 100 feet of the proposed septic system 41XThere are no private wells within 150 feet of the proposed septic system r✓ T ere is no increase in flow and/or change in use proposed T ere are no variances requested or needed. • The bottom of the proposed leaching facility will not be located less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when a licable] • If the S.A.S.will be located with 250 feet of any vegetated wetlands,the bottom of the proposed leaching facility will not be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation(using GIS information) B) G.W.Elevation +the MAX. High G.W.Adjustment. _ DIFFERENCE BETWEEN A and B SIGNED : DATE: [Please Sketch proposed plan of system on back]. NOTICE Based upon the above information, a repair permit will be issued for bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. q:health folder:cert � ,�,� � � 1Y �s�Q� � � � � � ��� �: l � U . .. r j0 Ov4/ _ O0 , r No.. -- Fim... In...... Pgo�7 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratiolt for Diliipoottl Warkii Towitriirtioit rrritiit Applicatio s zfV di f rt o a oristruct ( ) or Repair ( ) an Individual Sewage Disposal System at: Lw-=t•1TZ ®—�a.�2Y �A�V .....f st ..__ sss0slWK/�J/ lb ............................................. R��•�N, - IO,VI/1�-= ..... .4 Loca s N ,S • . Owner a -••�'�. ...................................................--------------------------------------------------- 3/_�_ /�01� 4 o -- i f- s -----� 1�1... Installer Address ®� Type of Building Size LA0L....................Sq. feet Dwelling—No. of Bedrooms..........0--------------------------_----Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) aOther fixtures --------------------------------------------------------------------------------------- ------------------------------------------------------------- W Design Flow..........5S________________--.---.-gallons per person j2,, day. Total daily flow------- �.�._�..__.___._..___-__._-___gallons. WSeptic Tank—Liquid capacity f®a�_gallons ength___ -___Z_.. Width�i'-----_ Diameter................ Depth.. ..__ W Disposal Trench—No. ..0V ...._.. Width... _____________ Total Length.-.46......... Total leaching area__-I- _Q........sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank Percolation Test Results Performed by.._._.��.............dVCGa=iLLA� .. pf- Date----3•�/l'............... aTest Pit No. 1__'4.Z..-__.minutes per inch Depth of Test Pit----f 44___-__. Depth to ground water.....10NC__._. (i Test Pit No. 2----------------minutes per inch Depth of Test Pit.................... Depth to ground water........................ <i-----•----------------••--••••----------•--• •-----••-•----------------•--•......_-_..................•-• ................................... 0 Description of Soil.O_- ..._.W 5149-<%¢ � I�' 1`7�f...GIN6.-•A ... U ..............�z-I rk....-� '�1�--- I..... -----------------•---------------------------------------------------------------- W - -------------------------------------•-------------------------------------------------------------------------------------------------------------------------------------------------------------- UNature of Repairs or Alterations—Answer when applicable..... .......................................................................................... ------------------------•----------------------------------•--------------------•---------------------------•---....--------------------------------------------------•-------------------•----•--..•--- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Co T e undersigned further agrees not to place the system in operation until a Certificate of mpl' nce h iss by the board of health. ( ------------------------- Signed . �L � Date Application Approved By .............. ...... . ^ - g " Application Disapproved for the following reason.r.- -------------------------------------------------........................------------------------------------------- -------- ------------------------------------------------------------------------------------ -------------- ---- Date Permit No. -------7.��1...«----- -r Issued ------------------------------------------------------- ..... Date 00 Jf d No..7V.X,3 ;L— Q �0l -7 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratintt for Ditripatial Works Taftbtfudion 1rrmit Application is her>eby made�,for• Per I o (oristruct ( ) or Repair ( ) an Individual Sewage Disposal System at: 41 6g 4V"4, t 3,1' -GtIT Z 0 77?y_LAoU.�....G'I��7`F3 t 157 ( SS SSA, S f i#' alb .... ----�---�--- J S°`dc" . cares � G• (.... � lv r� r.,Lot N Owner A dress -•---------•-----•............................... -....... 't� 1 r.. . 5.....---•h'��T1.!�. ►-� Installer Address ao h5 9 QType of Building Size Lot_-_-..!....................Sq. feet Dwelling— No. of Bedrooms_________ __________________________.._Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) aOther fixtures -------------- ----------------------------------------------------------------------- ---------------------------•------•------------•------------- d Desrgn Flow.............5;�.......... ...............gallons per person per day. Total daily flow......... .........................gallons. fy Septic Tank—Liquid capacity e gallons Length._V!,Z_-_ Width. 2.._.. Diameter....---...__.-- W x Disposal Trench—No. -.BN.4%�.......... Width... 'Z............. Total Length...- Total leaching area.- �........sq. ft. Seepage Pit No..................... Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft. Other Distribution box ( ) Dosing tank Z Percolation Test Results Performed b �------------944 --1" ---Pf--------------- Date._.._✓--.1l L1.5.............. a Test Pit No. I.-�7-....minutes per inch' Depth of Test Pit..-.S` -'.--.__ Depth to ground water_..._ ----- Test Test Pit No. 2................minutes per inch Depth of Test Pit-..--.-..-.._-_--__. Depth to ground water....................--.. p4 •----------------•------------•-- -• ....................................................----••....---•---•-•--................................ D Description of Soil_---"-7VP.4 S1455"D-91- 'J�..--77- 5,-IL7�f GIN6=-:-.& ... ---------------------•--------. x -7,Z_-_/ �=ice_-G!rl Q 7 1"` _..a ..slLT--------------------------------------------------------------••------------------- U ----* --- W ----- --------------------------------------------------------------------------- .................. -----------------------------•-•••--------------••----•----•-----•-•-------•---•---•--•---------•-- VNature of Repairs or Alterations —Answer when applicable...-............................................................................................ ••-------------------------------------------------------------------------------------------------------------------------------•------------------------- ............................................ Agreement:- The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. "A-' Dacr Application Approved B - �s� ------------------------------------------------------------ D------ pP PP Y - V � -°,`.�-� Dare Application Disapproved for the following reasons- -------- ---------------------------------------------....------------------------------------------------------------------ ----------------- Dace....._..._..__-- PermitNo. qq .............. Issued -----------------------D ace-...-------------------------------------- . —— -- — — 1—— ———————i—— ——r ..ems —————————i——— THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Ce>r#ifirate of Graylianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (,-{) or Repaired by -------------------------------------------- at ( ) t ------------ - ---------- - --------------------------_.-------------------------in n/ .-`--� 5 pF -------- - - - - lam- �� has been installed in accordance with the rovisions of TITLE 5 o. The State Environmental Code as described in the application for Disposal Works Construction Permit No. ...... .- _e-- ------- dated -------_--------------.-..---.._.._..... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE------/. ✓..'� ...-- .x' y --------------- ------ Inspector'-... ... -- -�------1----- ---- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �y )� TOWN OF BARNSTABLE � FEE......1(2-C: �t��ns�tl nrk� �nn��rinn ��ernti# Permission is hereby granted............Aq._ c -....... A-- ------------•----------------------------------------------•-••-----•--- to Construct (�) or Repair ( ) an Individual Sewage Disposal System -2- .........--^ ------------—Z. C? �,, �Q�r at NO. �^ L' rStreet � as shown on the application for Disposal Works Construction Pe � , v-_F Permit' t-�,)-Datpd_ � ..-..---------------.- ... a r'- . "---- ---... •-----••'-'-_•-----•. `'� '�• `�,. �"°"Board•of Health DATE......"'�Z�•. FORM 36508 MOBBS&WARREN.INC..PUBLISHERS I ENVIROTECH LABORATORIES, INC. MA Cert. No.: M-MA 063 449 Rte. 130 . Sandwich, MA 02563 (508)888-6460 . 1-800-339-6460 FAX(508)888-6446 CLIENT: Reef Realty LOCATION: Lot 2 ADDRESS: School St. Coventry Lane West Dennis, Ma 02670 West Barnstable, MA SAMPLE DATE: 7-20-94 COLLECTED BY: Fred Clifford DATE RECEIVED: 7-20-94 TIME: 11:OOAM SAMPLE I.D. : 2C JOB TYPE: New Well WELL DEPTH: 67' RESULTS OF ANALYSIS: Parameters Units Recommended Limit Result Coliform bacteria/100m1 (MF Method) 0 0 pH pH units 6.0-8.5 6.48 Conductance umhos/cm 500 94 Sodium mg/L 28.0 7.97 Nitrate-N mg/L 10.0 0.17 Iron mg/L 0.3 0.05 Volatile Organics EPA 601/602* ug/L N.D. COMMENTS: * See report attached. Yes No WATER IS SUITABLE FOR DRINKING PURPOSES R PARAMETERS TESTED. XXX Datel Z f, Ronald J. Aari Laboratory Director LT = Less Than GROUN13WATER j ANALYTICAL EPA METHODS 601 and 602 Volatile Organics (GC/PID/ELCD) Field ID: 2C Lab ID: 8251-01 Batch ID: VGZ-0422-W Project: Reef Realty/Lot 2 Coventry Lane Sampled: 07-20-94 Client: Envirotech Received: 07-20-94 Cont/Prsv: 40mL VOA Vial/NaHSO4 Cool Analyzed: 07-21-94 Matrix: Aqueous PARAMETER CONCENTRATION REPORTING LIMIT (ug/L) BRL 5 Dichlorodifluoromethane BRL 5 Chloromethane 5 Vinyl Chloride BRLBRL 5 Bromomethane BRL 5 Chloroethane BRL 1 Trichlorofluoromethane BRL 1 1,1-Dichloroethene BRL Methylene Chloride BRL 1 trans-1,2-Dichloroethene BRL 1 1,1-Dichloroethane 1 cis-1,2-Dichloroethene * BRLBRL 1 Chloroform BRL 1 1,1,1-Trichloroethane BRL I Carbon Tetrachloride BRL I Benzene BRL 1 1,2-Dichloroethane BRL I Trichloroethene BRL 1,2-Dichloropropane BRL 1 Bromodichloromethane BRL 5 2-Chloroethyl Vinyl Ether BRL 1 cis-1,3-Dichloropropene BRL 1 Toluene BRL I trans-1 ,3-Dichloropropene BRL 1 1,1,2-Trichloroethane BRL I Tetrachloroethene BRL 1 Dibromochloromethane BRL 1 Chlorobenzene BRL 1 Ethylbenzene RL I meta-and para-Xylene * BRL 1 ortho-Xylene * BRL I Bromoform BRL 1 1 1 .2,2-Teti; ac-hlcroethare BELL I 1,3-Dichlorobenzene- BRL 1 1,4-Dichlorobenzene BRL 1 1,2-Dichlorobenzene - QC SURROGATE COMPOUND SPIKED MEASURED RECOVERY QC LIMITS 30 29 96 % 87 - 113 % a,a,a-Trifluorotoluene 30 31 103 % 83 - 117 % 1,2-Dichloroethane-d4 BRL - Below Reporting Limit. * Non-target compound. Method References: Method 601 - Purgeable Halocarbcns and Method 602 - Purgeable Aromatics, 40 C.F.R. 136, Appendix A (1986). L v-7- Il TOWN OF BARNSTABLE L'l(A r1UN c (? RIC--Me?t-`M SEWAGE # ASSESSOR'S MAP INSTALLER'S NAME&PHONE NO. e- SEPTIC TANK CAPACITY U LEACHING FACILITY: (type) el NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: �' �� COMPLIANCE DATE: Separation Distance Between the: { Feet Maximum Adjusted Groundwater Table and Bottout of Leaching Facility 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 fi - D 4 ii tffC,ATION , 1 SEWAGE PERMIT NO. VILLAGE IN` STA LLER'S NAME i ADDRESS t� R UILDE R OR OWNER o N DATE PERMIT ISSUED DATE COMPLIANCE ISSUED �� a t �� ' SPA . I riQ t x, .............�..__...:._ - .._ s 7 i i t ,.. .. -�•�-�-.-�--sue- t t.`Lf (r F 15) 1 .��► x �� u+��f� t � 1. Cbtt 3 is i � { � - � S• a 2 0 . „ `-�i . ____.., _,....-•- _-_�..,..... .. 1 �}ram,,_ � f4' � z - k a a Lo Sv „ f} - T A . _K. . 81 C A PMMM A M.Y L LE Li If SCALE:A/ Z. 1 �" APPROVED BY: DRAWN BY 1�40CE4. DATE: 3 .30-I dc,81 R - Hyannis,MA 9 DRAWING NUMBER O F' _ - _ BARRY,JONES=HENRY DESIGNER r. . _ _ n m _ a N: f 55 E550tZ5 f' I g 1'? r E d y N S l � v ua o N v A 5 �1 E+� F2o M G � E � � ) � HT ZON I N co �ibt�{AS M trt�q ?'E . {. Y �.tICAt.� L�7uM ,. (Z2.E t.f r 5 I 1 T Tx1 h1 6 c.) G.- 4 tL AVAILABLE , � E� _M N � ;Prat. WATER. /�� 1 LE . uI 1 cT ,Y t..aD N Cam- Br, , R S y� 4 0. r 1 Jf � � 4 TO ' USED r -�r , 3 1 � '' 3. S CH EtxJt�E � PYc. 'PIPE SE r 1 5 _ 5 F 3D 15 Z 1� r1 V c. S TE f PEA. f�AT'E. . 2 M /I*� �l7 o GYN o�.�T SE:PTt YS M r � j t;,:.rx� �o t,!>E. ,4t_L_. 2E.cA C✓ t T o Go�.t�o `W i T , 1..�=•vs F � 4. P ST N S T jz.M H , e, {; .5 5. 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Y E.LE.V i t 0 4 5 El., 4 i } E � T�pJ�. t �-- �' v�1nEt'. 9a t � K Ear. • ,f S EPTI TAN D Ob � s I z.E.S, s �}- ,F t..D P i f' T� x ':. ,F 1 4.o F S Tb Ne �-A t2 p.96 � � � I N L�T� Co V V d tbi�d,►�I �_S�D WELL, ` / r f H 20 � sa .� pV t_ET � vp �{•.11J � } {5 To �+�+�lbtFi:-u iz-� � T , I`� r foZ CA( , y r 1 150 i (0 2.5 - (oD x LOT, J _ o -70 30 030 1 / oGATaoN t k T 2r G"1OY�►�J'7" F.1 9 BEST' $A¢.4asTA 3t.� , M> J l-Tt�l` T�E.P ; Pi�7✓Al_.. L�l'rE l Z HEM T' ,+cP E A;ze-D For?-: Yiz- P 1 EJC t 1 l.1 Cam- C.f N,ro 0 c.ALE �T r M QS� 'Pd 1 Y n , 1 { { 'a +vu...:.ter 1-♦;'T"t• v f�..3 f , ..y ra `o D D� �. N NEE IN S TM i✓EtLA'N E dt R _ T Pt DEMARES c . J. LE t1JltJ P.E. JOH PI Z:bEM/1WEs J iZ, S ,., 1�IoMtiS Mc , b