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1199 CRAIGVILLE BEACH ROAD - Health
1199 Craigville Beach Rd Centerville F A = 206 053 I -- IN UPC 12543 �' No�53L R 11i" � RIO-- 7�C 4e Commonwealth of Massachusetts a la- 053 ,F Title 5 Official Inspection Form I; Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a 1199 Craigville Beach Road Property Address h�t Mary Chiles ' Owner Owner's Name / information is required for every Centerville V Ma. 02632 09-14-2018 0 page. City/Town State Zip Code Date of Inspection ' Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information 6_4 33&8 on the computer, use only the tab Michael T Bisienere key to move your Name of Inspector cursor-do not Cape Septic Inspections use the return Company Name key. 624 Old Barnstable Road VQ Company Address Mashpee Ma. 02649 City/Town State Zip Code 508-280-3356 S13938 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails Ins rector'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 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 form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: 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. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1199 Craigville Beach Road Property Address Mary Chiles Owner Owner's Name information is required for every Centerville Ma. 02632 09-14-2018 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) 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: This four bedroom home has a Omni septic system and must be under contract with a waste water operator at times I hold the contract at this time. At the time of the inspection the system was operating as designed and there were no visible evedence of past hydraulic failure. 2) 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): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts �- Title 5 Official Inspection Form �I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1199 Craigville Beach Road Property Address Mary Chiles Owner Owner's Name information is required for every Centerville Ma. 02632 09-14-2018 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): - ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) 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. a. 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: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1199 Craigville Beach Road Property Address Mary Chiles Owner Owner's Name information is required for every Centerville Ma. 02632 09-14-2018 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 b. 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: r **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. c. Other: 4) 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1199 Crai ville Beach Road Property Address Mary Chiles Owner Owner's Name information is required for every Centerville Ma. 02632 09-14-2018 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/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 water supply 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 2000 gpd- 10,000 gpd. ❑ ® 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. 5) 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 CA. 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1199 Craigville Beach Road V� Property Address Mary Chiles Owner Owner's Name information is required for every Centerville Ma. 02632 09-14-2018 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes"to any question in Section C.5 the system is considered a significant threat, or answered "yes" to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate "yes" or"no" for each of the following for all inspections: 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)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form 11 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ........... !% 1199 Craigville Beach Road u Property Address Mary Chiles Owner Owner's Name information is required for every Centerville Ma. 02632 09-14-2018 page. Cityrrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 44 plus GP Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonal use? ® Yes ❑ No Water meter readings, if available (last 2 years usage (gpd)): Detail Sump pump? ❑ Yes ® No Last date of occupancy: occupied Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form 11 �b Subsurface Sewage Disposal System Form -Not for Voluntary Assessments .v 1199 Craigville Beach Road Property Address Mary Chiles Owner Owner's Name information is required for every Centerville Ma. 02632 09-14-2018 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 2. 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 Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: 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 below): 3. Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 Commonwealth of Massachusetts p Title 5 Official Inspection Form Il �I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u!% 1199 Craigville Beach Road Property Address Mary Chiles Owner Owner's Name information is Centerville Ma. 02632 09-14-2018 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. 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): Approximate age of all components, date installed (if known) and source of information: 06-2007 Were sewage odors detected when arriving at the site? ❑ Yes ❑ No 5. Building Sewer(locate on site plan): Depth below grade: 24"feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form iIo Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1199 Craigville Beach Road Property Address Mary Chiles Owner Owner's Name information is required for every Centerville Ma. 02632 09-14-2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank (locate on site plan): Depth below grade: 12"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Standard 1500 gallon Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle 34" Scum thickness 2° Distance from top of scum to top of outlet tee or baffle 4" Distance from bottom of scum to bottom of outlet tee or baffle 12" How were dimensions determined? Sludge Judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): The outlet tee was in place and the tank appeared structuraly sound. I would recommend the new owner put the septic tank on a maintenance plan with a local septic pumping co. based on the future use of the home. The local Health Dept. has a list of septic pumping co. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 r Commonwealth of Massachusetts Title 5 Official Inspection Form 11 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments V 1199 Craigville Beach Road Property Address Mary Chiles Owner Owner's Name information is Centerville Ma. 02632 09-14-2018 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 7. 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 Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 c� Commonwealth of Massachusetts r� Title 5 Official Inspection Form �. <iI Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1199 Craigville Beach Road Property Address Mary Chiles Owner Owner's Name information is required for every Centerville Ma. 02632 09-14-2018 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank (cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert N/A pressure dose system 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts -. Title 5 Official Inspection Form �I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1199 Craigville Beach Road Property Address Mary Chiles Owner Owner's Name information is required for every Centerville Ma. 02632 09-14-2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. 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. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ® leaching fields number, dimensions: one 14'x 44' ❑ overflow cesspool number: i ® innovative/alternative system Type/name of technology: Omni t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts �n p Title 5 Official Inspection Form `I, Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1199 Craigville Beach Road Property Address Mary Chiles Owner Owner's Name information is required for every Centerville Ma. 02632 09-14-2018 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): At the time of the inspection there were no visible signs of past hydraulic failure. 12. 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 Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1199 Craigville Beach Road Property Address Mary Chiles Owner Owner's Name information is required for every Centerville Ma. 02632 09-14-2018 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 13. 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.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 • Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1199 Craigville Beach Road Property Address Mary Chiles Owner Owner's Name rformation is quired for every Centerville Ma. 02632 09-14-2018 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately ` Al l�-(o" dZ Zy'G` C,kAlGUJ11E EAU/ .. ' 43 ZS'6" 83 Za=a" 06y 29;3r, By Z3-G A 196 BG I,!"" � b � �3 Z#U44. IN CLFA,vOd75 C 76 WX t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1199 Craigville Beach Road Property Address Mary Chiles Owner Owner's Name information is required for every Centerville Ma. 02632 09-14-2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 4 plus feet 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: 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: , I augered a hole at a lower elevation and I shot it with a transit. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form '• Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ; 1199 Craigville Beach Road Property Address Mary Chiles Owner Owner's Name information is required for every Centerville Ma. 02632 09-14-2018 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ' ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or checked t ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria)and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included v t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 Cape Septic Inspections 624 Old Barnstable Rd Mashpee MA 02649 508-280-3356 Waste Water Lic. 12979 Inspector Lic. SI3938 This contract is made this 11.day of March,2018 By and between Mary Chiles and Cape Septic Inspections having a principal place of business in Mashpee, Massachusetts. Cape Septic Inspections agrees to perform the following services regarding operation and maintenance of the subsurface sewage disposal treatment system At 1199 Craigsville Beach Road Centerville Ma.02632. (Address) The treatment system shall be supervised and/or operated by a Certified Wastewater Treatment Plant Operator in accordance with the requirements of 257 CMR 2.00 and the Board of Certification of Operators of Wastewater Treatment Plants. Services shall be provided as follows from 03-11-2018 until cancelled by either party. Perform field inspections and provide a service report and grab sample. Once a year the system will be checked for the following 1) Testing for Total Nitrogen 2) Testing for Dissolved Oxygen 3) Testing for the PH 4) Testing for Turbidity 5) Testing for the Temperature A. Testing of the electrical system 7) Inspection of the overall condition of the systems components 8) Notify the Owner of any problems 11 Services other than routine inspections will be invoiced at an hourly rate plus materials The Owner agrees that CSI may enter the property and have access to all areas necesSary to perform the above mentioned tasks. Cancelation of this contract by either party will result in notification to the Barnstable, Board of Health and The Department of Environmental Protection in writing. Permit#Barn-Cra119-05F Cape Septic Inspections Home Owner Signature Email Phone } I/A System Inspection 1199 Craigville Beach Road, Barnstable Barnstable County Department of Health and Environment $� P.O. box 427, Barnstable, MA 02630 i Site Address 1199 Craigville Beach Road,Barnstable I/A Component OMNI Recirculating Sand Filter Contractor Cape Septic Inspections Operator Name Michael T Bisienere Sample Date&Time 09/27/2017 @ 12:14 pm Field Testing Color' ❑ Gray ❑ Brown K Clear ❑ Turbid ❑ Other Odor K Musty ❑ Earthy ❑ Moldy ❑ Offensive ❑ Turbid Effluent Solids ® No ❑ Some pH 16.8 SU D.O. 4.800 mg/L Turbidity 12.00 NTU Settleable Solids 0. 00 ml/L Site Conditions Seasonal Residence ❑ No K Yes Air Temperature 74.0 degress F Weather Conditions Sunny; Operating Information , Sludge Depth 2.00 inches Scum!Layer Thickness 1.00 inches Pumping Recommended K No ❑ Yes Soil Absorption System Observations Signslof Breakout X No ❑ Yes ❑ Unknown i SAS P onding Above Invert K No ❑ Yes ❑ Unknown Depth of Ponding inches I f Maintenance Issues Inspection Completed?p K Yes ❑ No. Approval Violations None Cleaning/Lubrication Performed None Control Adjustments None Test Pumps/Switches/Alarms I ran the pump and tested the alarm Equipment Failures None Parts,Replaced None Corrective Actions Recommended None Other Comments Comments Samples were collected and take to The Barnstable County Lab Septic Tank Sludge Pumping Required ❑ Yes ❑ No Effluent Tee Filter ❑ Yes ❑ No Sludge Depth Scum!Depth If es inspect Y p ct ❑ Clean at least yearly Re-circulation Tank Check if sludge accumulating ❑ Odor Problems ❑ Yes IN No Effluent Tee Filter ❑ Yes ❑ No Pumping Required ❑ Yes $] No If yes, inspect i Clean at least yearly ❑ Equalization Tank (if installed) Sludge Pumping Required ❑ Yes ❑ No I Effluent Tee Filter ❑ Yes ❑ No Sludge Depth Scum Depth If yes, inspect ❑ Clean at least yearly Pump ChamberNault(if installed) Pump Inspections (all units) If problems, describe: Float,Switches ❑ Check all switches for operation: Pumps, Switches, Floats, Alarm Systems Pump Inspections (all units) L If problems, describe: Test pump alternator, or record hours ❑ Hours of operation Float switches Check all switches for operation Test alarm ❑ If not,functioning, corrective action(s) Filter Modules ("Sand Filters") k Inspect for pondin 9 Ponding Present ❑ Yes $ No Clean Bed: K Yes ❑ No Distribution pipes Flush; Yes ❑ No Brush ❑ Yes ❑ No Any,obstruction of airflow to filter modules ❑ Yes K No I If,yes„explain below (i.e. snow,dirt) £ r Sample Collection Yes ❑ No D If yes: K BOD rX'1 TSS K PH XJ TN WSJ Other 1 t , Yp4 Nis, Page: 1 of 1 CERTIFICATE OF ANALYSIS . , �... m .. Barnstable County Health Laboratory (M-MA009) J � � �sshcstu ^' Report Prepared For: Report Dated: 5/5/2016Clit - Michael T. Bisienere Cape Septic Inspections Order NO.: G1692792 624 Old Barnstable Road Mashpee, MA 02649 Laboratory ID#: 1692792-01 Description: Water�Waste-Wate Sample#: Sample Locatio 1199 Craigville Beach Rd. Centerville, MA Collected: 05/04/2016 Collected by: _ MTB _ _ _J�ceived: 05/04/2016 Test Parameters ITEM RESULT UNITS RL MCL METHOD# ANALYST TESTED NOTE Nitrate as Nitrogen 2.5 mg/L 0.10 10 EPA 300.0 LAP 5/4/2016 Nitrite as Nitrogen ND mg/L 0.050 1.0 EPA 300.0 LAP 5/4/2016 - Attached please find the laboratory certified parameter list. Approved By: L-ep _ _ _ _ _ _ (Lab Director) ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level 3195 Main Street, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 BENNETT ENVIRONMENTAL ASSOCIATES, INC. L ,cY��' LICENSED SITE PROFESSIONALS,ENVIRONMENTAL SCIENTISTS,GEOLOGISTS,ENGINEERS q-t/ 1573 Main Street,P.O.Box 1743 (508)896-1706 Brewster,MA 02631 fax(508)896-5109 LETTER OF TRANSMITTAL TO: DATE: JOB NUMBER: Massachusetts Department of Environmental Protection 9/23/14 BEA10-10213 Attention:Title 5 Program I Winter Street-6th Floor Boston,MA 02108 REGARDING: Hash Residence 1199 Craigville Beach Road SHIPPING METHOD: Centerville,MA 02632 .�,�Z-T..3 Regular Mail ❑ Pick Up ❑ y'a Priority Mail ❑ Hand Deliver ❑ y ;mot, Express Mail ❑� Other + e- Certified Mail Green Card/RR ❑ COPIES DATE DESCRIPTION I DEP Approv!5'/Inspection and O&M Form for Title 5 I/A Treatment and Disposal Systems(September 2014) 1 OMNI Environmental Systems,Inc.RSF Operation and Maintenance Inspection Checklist(September 2014) 1 9/17/14 Alpha Analytical laboratory report For review and comment: ❑ For approval: ❑ As requested: ❑ For your use: REMARKS: Please�nd enclosed the DEP Inspection and O&M Form,OMNI RSF Operation and Maintenance Inspection Checklist and laboratory analytical report for operation and maintenance conducted at the above referenced property during the reporting period. It is noted that the annual inspection was rescheduled from July to September at the request of the homeowner. The pressure dosed leaching field lateral jjZes were inspected on 9/10/14. If you have any questions or require additional information,please contact us at your earliest convenience. Thank you. "'"-- cc:Barnstable Board of Health Ms.Mary Hash,Owner David C.Bennett,Principal[Internal] FROM: David C.Bennett,WWTO#6243/Samantha Farrenkopf,WWTO#13265/Joseph Smith,WWTO#12529 If enclosures are not as noted,kindly notify us at once r , t, Massachusetts Department of Environmental Protection Bureau of Resource Protection - Title 5 DEP Approved Inspection and O&M Form for Title 5 I/A Treatment and Disposal Systems A. Installation Important:When Mary Hash filling out forms Owner on the computer, use only the tab 1199 Craigville Beach Road key to move your Facility Street Address cursor-do not Centerville 02632 use the return City Zip key. y�1 Mailing address of owner, if different: 3944 Baltimore Street Street Address/PO Box: Kensington MD 20895 City State Zip (301) 942-2110 ext. Telephone Number B. Authorized Service Provider BENNETT ENVIRONMENTAL ASSOCIATES, INC. O&M Firm 1573 Main Street/ PO Box 1743 Street Address Brewster MA 02631 City State Zip (508) 896 - 1706 ext. 129 Telephone Number Samantha Farrenkopf 13265 Certified Operator Name Certification Number C. Facility/System Information OMNI RSF-PF DEP ID Manufacturer ID Model Number Unknown Unknown Installation Date Start of Operation Approval Type: E General ❑ Provisional ❑ Piloting ❑ Remedial Seasonal Residence—used less than 6 mo./year: E Yes ❑ No D. Operating Information 9/10/14 7/2/13 Inspection Date Previous Inspection Date 6"of Sludge , 1" scum Sludge Depth(to be checked yearly) Pumping Recommended E Yes El No t5aiom.doc rev. 11-07-05 Page 1 of 3 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Title 5 DEP Approved Inspection and O&M Form for Title 5 I/A Treatment and Disposal Systems E. Field Testing Field Inspection: Color: ❑ gray ❑ brown ® clear ❑ turbid ❑ Other(specify): Odor: ® musty ❑ earthy ❑ moldy ❑ offensive ❑ turbid Effluent Solids: ® no ❑ some pH 7.0 SU DO 6.0 mg/L Turbidity 1.95 NTU 6 to 9 2 or greater 40 or less Should a Remedial or General Use system fail the Field Testing, effluent samples shall be collected per Standard Methods and analyzed for BOD and TSS. F. Sampling Information Samples Taken: ❑ Influent ® Effluent Commercial systems or systems with a design flow of 2000 gpd and greater, and General Use nitrogen reducing systems: gpd Parameters sampled: ❑ pH ® BOD ❑ CBOD ® TSS ❑ TN ® Other(list below) Nitrate Nitrite TKN Other 1 Other 2 Other 3 G. Inspection and Maintenance Description of any maintenance performed since previous inspection & during this inspection: Conduct an operation and maintenance event. Collect effluents ples for field testing and laboratory analysis. Recommend pumping of the recirculation tk. Notes and Comments: The system is operating correctly. Effluent quality passed field testing parameters. t5aiom.doc•rev. 11-07-05 Page 2 of 3 r ' Massachusetts Department of Environmental Protection Bureau of Resource Protection - Title 5 DEP Approved Inspection and O&M Form for Title 5 I/A Treatment and Disposal Systems H. Certification I certify: I have inspected the sewage treatment and disposal system at the address above, have conducted the required Field Testing and/or sample collection in accordance with Standard Methods, have completed this report and the attached technology operation and maintenance checklist, and the information reported is true, accurate, and complete as of the time of the inspection. I am a Massachusetts certified operator in accordance with 257 CMR 2.00. Operator Signature Date r� System owner must submit this report, technology O&M checklist, and any required sampling results to the local board of health and DEP as follows for each inspection performed: Remedial Use—by January 31st of each year for the previous calendar year Piloting Use-within 45 days of inspection date Provisional Use—by March 31th of each year for the previous 12 months General Use—by September 30th of each year for the previous 12 months Send to: Department of Environmental Protection Attention: Title 5 Program One Winter Street, 6t Floor Boston, MA 02108 t5aiom.doc•rev. 11-07-05 Page 3 of 3 OMNQ&� .Uvvironmewd—S yst-ems,-Inc. OMNI RSF Operation and Maintenance Inspection Checklist A. Installation &Service Information ki e�9� 0 - --;,; \kg\kA (& Facility Street Address Date of Service city (5p—eratorIO&M Firm 5 System Startup Date Weather Conditions B. Septic Tank Sludge Pumping Required: Yes El No Sludge Depth: Scum Depth: Effluent tee filter: Ye� No El If yes, inspe*clean at least yearly If the sludge layer is within 12"of the outlet invert,recommend that the homeowner have the septic tank pumped,note the approximate scum layer thickness as well.Also,inquire if the homeowner has a pumping schedule established with a licensed septage hauler,if not recommend a two to four year pumping schedule depending on how heavily the system is used. C. Recirculation Tank (:�\ VN Z check if sludge accumulating Pumping required: YeA 61 No El Odor problems: Yes Ll N If yes,description Effluent tee filter: Yes El No If yes, inspect El&clean at least yearly❑ If the sludge layer is greater than 4"request that the homeowner pump out the recirculation tank in order to prevent clogging of the filter modules. Note the characteristics of the effluent coming out of the manifold this may indicate that the filter bed may need servicing. D. Equalization Tank(if installed) Sludge Pumping Required: Yes El No El R Sludge Depth: F1 Scum Depth: Effluent tee filter: Yes F1 No El If yes,inspect 0&clean at least yearly 0 Same inspection criteria as septic tank: E. Pump Chamber I Vault(if Installed) '. -1 t 4 k 4- c,�� 3 APump Inspections(all units) Ifprob V ms;describe LFloat switches 11 30kk2F5?, CN, VhecnI[swifches for operation Make Sure the pump is operational by pulling up the float switch;if the pump is not operational immediate corrective actions need to be taken. F. Pumps, Switches, Floats, Alarm System Pump Inspections(ail units) If problems,dQscrIbe Test pump alternator, or record hours CC• ) _32,A Hours of operation Float switches Check all switches for operation Test alarm If non-functioning,corrective action(s) Make sure pump(s),Float(s)and audible alarm(s)are functional,if not make a note so that corrective actions can be made. \ G. Filter Modules ("Sand Filters") �v � �\"� 0%,o Inspect for ponding Ponding Present:Yes❑ No Clean bed: Yes❑ Nix V1 Distribution pipes Flush:Yes❑ Nox Brush: Yes❑ Nod Any obstruction of airflow to filter modules: Yes❑ No 0 if Yes,explain below(i.e. snow,dirt) To inspect the condition of the filter modules remove the mulch layer at one comer of the filter module area, then lift the filter fabric so that the media can be inspected through the end of the contactor. The media should have a thin biomass layer growing on it and should have a brownish shaggy coloration.If the surface of the filter module area appears to be clogged,or the biomass layer is too think it is suggested to completely expose the filter modules,and rake the filter beds thoroughly,then wash the filter beds down with a garden hose(with a pressure nozzle on it).Then Recover the filter beds as they were found. H. Sample Collection YekX No❑ If yes�BOD�TSS ❑pH KTN Other �)O All samples are to be taken from the manifold located in the recirculation tank,and are to be stored in sterile, laboratory supplied containers.In order to prevent any cross-contamination from a previous sample rinse the dip cup into the effluent stream at the manifold three times so that a representative sample can be obtained_ Make sure to wear proper safety equipment while pulling samples(i.e.rubber gloves), System Notes: f Serial_No:09171414:42 A . ,AANWOY.Y. T I C A L ANALYTICAL REPORT Lab Number: L1420884 Client: Bennett Environmental Associates 1573 Main Street Brewster, MA 02631 ATTN: Samantha Farrenkopf Phone: (508)896-1706 Project Name: HASH RESIDENCE Project Number: BEA10-10213 Report Date: 09/17/14 The original project report/data package is held by Alpha Analytical.This report/data package is paginated and should be reproduced only in its entirety.Alpha Analytical holds no responsibility for results and/or data that are not consistent with the original. Certifications&Approvals: MA(M-MA086),NY (11148),CT(PH-0574),NH(2003),NJ NELAP(MA935),RI(LA000065),ME(MA00086), PA(68-03671),USDA(Permit #P-330-11-00240),NC(666),TX(T104704476),DOD(1-2217),US Army Corps of Engineers. Eight Walkup Drive,Westborough, MA 01581-1019 508-898-9220 (Fax)508-898-9193 800-624-9220-www.alphalab.com Page 1 of 16 Serial No:09171414:42 Project Name: HASH RESIDENCE Lab Number: L1420884 Project Number: BEA10-10213 Report Date: 09/17/14 Alpha Sample Collection Sample ID Client ID Matrix Location Date/Time Receive Date L1420884-01 EFFLUENT WATER OSTERVILLE, MA 09/10/14 14:30 09/11/14 Page 2 of 16 f Serial No:09171414:42 Project Name: HASH RESIDENCE Lab Number: L142O884 Project Number: BEA1O-10213 Report Date: 09/17/14 Case Narrative The samples were received in accordance with the Chain of Custody and no significant deviations were encountered during the preparation or analysis unless otherwise noted.Sample Receipt,Container Information,and the Chain of Custody are located at the back of the report. Results contained within this report relate only to the samples submitted under this Alpha Lab Number and meet all of the requirements of NELAC,for all NELAC accredited parameters.The data presented in this report is organized by parameter(i.e.VOC,SVOC,etc.).Sample specific Quality Control data(i.e.Surrogate Spike Recovery)is reported at the end of the target analyte list for each individual sample, followed by the Laboratory Batch Quality Control at the end of each parameter.If a sample was re-analyzed or re-extracted due to a required quality control corrective action and if both sets of data are reported,the Laboratory ID of the re-analysis or re-extraction is designated with an"R"or"RE",respectively.When multiple Batch Quality Control elements are reported(e.g.more than one LCS),the associated samples for each element are noted in the grey shaded header line of each data table.Any Laboratory Batch,Sample Specific% recovery or RPD value that is outside the listed Acceptance Criteria is bolded in the report.All specific QC information is also incorporated in the Data Usability format of our Data Merger tool where it can be reviewed along with any associated usability implications.Soil/sediments, solids and tissues are reported on a dry weight basis unless otherwise noted.Definitions of all data qualifiers and acronyms used in this report are provided in the Glossary located at the back of the report. In reference to questions H(CAM)or 4(RCP)when"NO"is checked,the performance criteria for CAM and RCP methods allow for some quality control failures to occur and still be within method compliance. In these instances the specific failure is not narrated but noted in the associated QC table.The information is also incorporated in the Data Usability format of our Data Merger tool where it can be reviewed along with any associated usability implications. Please see the associated ADEx data file for a comparison of laboratory reporting limits that were achieved with the regulatory Numerical Standards requested on the Chain of Custody. HOLD POLICY For samples submitted on hold,Alpha's policy is to hold samples(with the exception of Air canisters)free of charge for 21 calendar days from the date the project is completed.After 21 calendar days,we will dispose of all samples submitted including those put on hold unless you have contacted your Client Service Representative and made arrangements for Alpha to continue to hold the samples.Air canisters will be disposed after 3 business days from the date the project is completed. Please contact Client Services at 800-624-9220 with any questions. I T\ tia Page 3 of 16 :: �.. Serial No:09171414:42 Project Name: HASH RESIDENCE Lab Number: L1420884 Project Number: BEA10-10213 Report Date: 09/17/14 Case Narrative (continued) Nitrogen, Nitrite L1420884-01 has an elevated detection limit due to the dilution required by the sample matrix. BOD, 5 day The WG721285-2 LCS recovery(79%), associated with 1-1420884-01, is outside the acceptance criteria. Due to the expiration of the method required holding time, no further action was taken. I,the undersigned, attest under the pains and penalties of perjury that, to the best of my knowledge and belief and based upon my personal inquiry of those responsible for providing the information contained in this analytical report, such information is accurate and complete. This certificate of analysis is not complete unless this page accompanies any and all pages of this report. ;mod Lura L. Troy Authorized Signature: Title: Technical Director/Representative Date: 09/17/14 Page 4 of 16 I _ i I Serial No:09171414:42 INORGANICS MISCELLANEOUS Page 5 of 16 Serial No:09171414:42 Project Name: HASH RESIDENCE Lab Number: L1420884 Project Number: BEA10-10213 Report Date: 09/17/14 SAMPLE RESULTS Lab ID: L1420884-01 Date Collected: 09/10/14 14:30 Client ID: EFFLUENT Date Received: 09/11/14 Sample Location: OSTERVILLE,MA Field Prep: Not Specified Matrix: Water Dilution Date Date Analytical Parameter Result Qualifier Units RL MDL Factor Prepared Analyzed Method Analyst General m Chemi stry Westborough Lab . _. . . .. m ,,. Solids,Total Suspended ND mg/I 5.0 NA 1 - 09/15/14 14:20 30,2540D DW -- ——— -- ----. .. Nitrogen,Nitrite ND mg/I 0.10 — 2 - 09/12/14 00:56 44,353.2 DB ................. .. ------- --... ...._ ....... . . ........ ........... ... ........ ---..._ ....-- Nitrogen,Nitrate 11. mg/I 0.20 2 - 09/12/14 00:56 44,353.2 DB Nitrogen,Total Kjeldahl 1.95 mg/I 0.300 — 1 09/11/14 23:15 09/15/14 21:33 30,4500N-C AT ---------- ---- -------------.._... -- — --..__._....._...................._......................-- - BOD,5 day 2.5 mg/I 2.0 NA 1 09/11/14 22:20 09/16/14 17:00 30,5210E SE Page 6 of 16 Serial No:09171414:42 Project Name: HASH RESIDENCE Lab Number: L1420884 Project Number: BEA10-10213 Report Date: 09/17/14 Method Blank Analysis Batch Quality Control Dilution Date Date Analytical Parameter Result Qualifier Units RL MDL Factor Prepared Analyzed Method Analyst General Chemistry We stb orough Lab for sa'mple(s) ,01 Batch WG721285 1' BOD,5 day ND mg/I 2.0 NA 1 09/11/14 22:20 09/16/14 17:00 30,5210B SE General or __ ..... __ . 01 'Batc Chemisry esboroug s (s :WG721296 1 Nitrogen,Nitrate ND mg/I 0.10 -- 1 09/12/14 00:19 44,353.2 DB General Chemistry. Westborough Lab for sampleO 01 Batch.`WG72:1298 1 Nitrogen,Nitrite ND mg/I 0.050 — 1 09/12/14 00:29 44,353.2 DB General Chemistry Westborough Lab for sample(s)� 01 $atch: 1NG721315 1 Nitrogen,Total Kjeldahl ND mg/l 0.300 1 09/11/14 23:15 09/15/14 21:15 30,4500N-C AT General Chemistry Westborough Lab for samples) 01 s'Bt h a :WG721926 1 T xy ry^t na F Solids,Total Suspended ND mg/I 5.0 NA 1 09/15/14 14:20 30,25401) DW ................ ........ ............ ................................................................. .._.... ._........ ._..__ ........... ..... -._. HA Page 7 of 16 Serial No:09171414:42 Lab Control Sample Analysis Project Name: HASH RESIDENCE Batch Quality Control Lab Number: L1420884 Project Number: BEA10-10213 Report Date: 09/17/14 LCS LCSD %Recovery Parameter %Recovery Qual %Recovery Qual Limits RPD Qual RPD Limits General Chemistry WestboroughiLab 'Associated samples) 01 Batch:.W.G721285-2 BOD,5 day `79 ,} Q - 85-115 - 20 General Chemistry'-Westborough Lab}Associated.`sample(-s) E01 Batch:W6721296 2 Nitrogen,Nitrate . 1Q0` - 90-110 General Chemistry Westborought'Lab Associated�sample(s) 01 'Batcfi: V1/G721298-2 Nitrogen,Nitrite 90-110 20 ....._...._ .. ----------- --------- .._....__., d -_, - -1---------------- ----..__.. —._..--- ------.._._.. ._-----.... _._._.._... .. ..._..._ .............._..... _.__.... ._ . -_-..___ ... .-------_ -.----____..........-- _ .. �, .., General Chemistry WestboroughSLab Associated':sample(s) 401. Batch.WG721315-2 ; Nitrogen,Total Kjeldahl ? -104" '" 78_122 - Page 8 of 16 \ L�Lr�HA Serial No:09171414:42 Matrix Spike Analysis Project Name: HASH RESIDENCE Batch Quality Control Lab Number: L1420884 Project Number: BEA10-10213 Report Date: 09/17/14 Native MS MS MS MSD MSD Recovery RPD Parameter Sample Added Found %Recovery Qual Found %Recovery Qual Limits RPD Qual Limits General Chemistry-.;Westboroiagh4LabvAsso.ciated",sample(,,, 01 QCtBatch ID:,WG721285-4 `QG Sample: L1420885 01 Client ID ;MS"Sample BOD,5 day 2.6 100 110 111 - 50-145 - 35 General-Chemistry ,W.estborough Lab.Associated`sample(s,' 0'1. =QC Batch ID`WG721296-4. jQC Sample; L1420.859=02 Client ID <MS Sample., Nitrogen,Nitrate ND 4 3.9 Y98' - - 83-113 6 General=Chemistry >Westborowgh Lab Assgciated.sample(s) 01 :QG,Batch ID WG72:1298 4? QC"Sample: L142Q.859=,02 Client ID - MS Sample, Nitrogen,Nitrite 0.12 4 4.1 100 - - 80-120 20 GenerahChemistry' :.Westborou.gWLab.Associate'daample(s:) r01 QC BatchalD',WG72.1315 4` QC-Sample; L1420914'05 Client MS?Sample Nitrogen,Total Kjeldahl 0.582 8 9.13 107 - 77_111 24 Page 9 of 16 l PHA Serial_No:09171414:42 Lab Duplicate Analysis Project Name: HASH RESIDENCE Batch Quality Control Lab Number: L1420884 Project Number: BEA10-10213 Report Date: 09/17/14 Parameter Native Sample Duplicate Sample Units RPD Qual RPD Limits General Chemistry. Westborough`,-Lab, Associated'sample(s): 01 QC Batch ID VVG721285-3. QGSample: L1420859 01- Client ID. ;DUP:Sampl"e,. BOD,5 day 71 73 mg/I 3 35 General Chemistry Westborough=Lab Associated sample(s) 01 QC'Batch°ID: 1NG721296 3 QC'Sample: L1420859=02 Client-lD. -DU}P..Sample Nitrogen,Nitrate ND 0.10 mg/I NC 6 General Chemistry ;Westborough Lab Associated sample(s). 01 QC Batch ID:. WG721298 3- -,QC Sample: "L1'420859--02 Client lD: DUO-Sample Nitrogen, Nitrite 0.12 0.11 mg/I 9 20 General Chemistry-_Westborough=Lab Associated sample(s): 01 ` QC BafchalD";'WG721315-3 QC°Sample: L1420914=05. Client ID: DUP°Sample. µ Nitrogen,Total Kjeldahl 0.582 0.648 Mg/1 r: 11` 24 _. ---- ------- —- --- --- - -- - --- -- —-- -- ------— --- ---- ----. .._ - - - - General Chemistry :,V1/estborooglitab Associatedtsample(s): 01 :QC Batch ID: VVG721"926 2 ` QC Sample -0L1420859`01 Client ID -DUP Sample _ a Solids,Total Suspended 64 69 Mg/1 "`'8` 29 Page 10 of 16 � � Serial No:09171414:42 Project Name: HASH RESIDENCE Lab Number: L1420884 Project Number: BEA10-10213 Report Date: 09/17/14 Sample Receipt and Container Information Were project specific reporting limits specified? YES Reagent H2O Preserved Vials Frozen on: NA Cooler Information Custody Seal Cooler A Absent Container Information Temp Container ID Container Type Cooler pH deg C Pres Seal Analysis(*) L1420884-01A Plastic 250ml H2SO4 preserved A <2 4.0 Y Absent TKN-4500(28) L1420884-01 B Plastic 1000ml unpreserved A 8 4.0 Y Absent NO2-353(2),BOD-5210(2),NO3- 353(2) L1420884-01C Plastic 1000ml unpreserved A 8 4.0 Y Absent TSS-2540(7) *Values in parentheses indicate holding time in days Page 11 of 16 Serial No:09171414:42 Project Name: HASH RESIDENCE Lab Number: L1420884 Project Number: BEA10-10213 Report Date: 09/17/14 GLOSSARY Acronyms EDL Estimated Detection Limit:This value represents the level to which target analyte concentrations are reported as estimated values,when those target analyte concentrations are quantified below the reporting limit(RL).The EDL includes any adjustments from dilutions,concentrations or moisture content,where applicable.The use of EDLs is specific to the analysis of PAHs using Solid-Phase Microextraction(SPME). EPA Environmental Protection Agency. LCS Laboratory Control Sample:A sample matrix,free from the analytes of interest,spiked with verified known amounts of analytes or a material containing known and verified amounts of analytes. LCSD Laboratory Control Sample Duplicate:Refer to LCS. LFB Laboratory Fortified Blank:A sample matrix,free from the analytes of interest,spiked with verified known amounts of analytes or a material containing known and verified amounts of analytes. MDL Method Detection Limit:This value represents the level to which target analyte concentrations are reported as estimated values, when those target analyte concentrations are quantified below the reporting limit(RL).The MDL includes any adjustments from dilutions,concentrations or moisture content,where applicable. MS Matrix Spike Sample:A sample prepared by adding a known mass of target analyte to a specified amount of matrix sample for which an independent estimate of target analyte concentration is available. MSD Matrix Spike Sample Duplicate:Refer to MS. NA Not Applicable. NC Not Calculated: Term is utilized when one or more of the results utilized in the calculation are non-detect at the parameter's reporting unit. NI Not Ignitable. RL Reporting Limit: The value at which an instrument can accurately measure an analyte at a specific concentration.The RL includes any adjustments from dilutions,concentrations or moisture content,where applicable. RPD Relative Percent Difference: The results from matrix and/or matrix spike duplicates are primarily designed to assess the precision of analytical results in a given matrix and are expressed as relative percent difference(RPD). Values which are less than five times the reporting limit for any individual parameter are evaluated by utilizing the absolute difference between the values; although the RPD value will be provided in the report. SRM Standard Reference Material:A reference sample of a known or certified value that is of the same or similar matrix as the associated field samples. Footnotes 1 The reference for this analyte should be considered modified since this analyte is absent from the target analyte list of the original method. Terms Total:With respect to Organic analyses,a'Total'result is defined as the summation of results for individual isomers or Aroclors.If a'Total' result is requested,the results of its individual components will also be reported.This is applicable to'Total'results for methods 8260,8081 and 8082. Analytical Method:Both the document from which the method originates and the analytical reference method.(Example:EPA 8260B is shown as 1,8260B.)The codes for the reference method documents are provided in the References section of the Addendum. Data QuaiiFers A Spectra identified as"Aldol Condensation Product". B The analyte was detected above the reporting limit in the associated method blank.Flag only applies to associated field samples that have detectable concentrations of the analyte at less than ten times(I Ox)the concentration found in the blank.For MCP-related projects,flag only applies to associated field samples that have detectable concentrations of the analyte at less than ten times(1 Ox) the concentration found in the blank.For DOD-related projects,flag only applies to associated field samples that have detectable concentrations of the analyte at less than ten times(1 Ox)the concentration found in the blank AND the analyte was detected above one-half the reporting limit(or above the reporting limit for common lab contaminants)in the associated method blank.For NJ- Air-related projects,flag only applies to associated field samples that have detectable concentrations of the analyte above the reporting limit.For NJ-related projects(excluding Air),flag only applies to associated field samples that have detectable concentrations of the analyte,which was detected above the reporting limit in the associated method blank or above five times the reporting limit for common lab contaminants(Phthalates,Acetone,Methylene Chloride,2-Butanone). C Co-elution:The target analyte co-elutes with a known lab standard(i.e.srurogate,internal standards,etc.)for co-extracted analyses. D Concentration of analyte was quantified from diluted analysis.Flag only applies to field samples that have detectable concentrations of the analyte. E Concentration of analyte exceeds the range of the calibration curve and/or linear range of the instrument. Report Format: Data Usability Report Page 12 of 16 f Serial No:09171414:42 Project Name: HASH RESIDENCE Lab Number: L1420884 Project Number: BEA10-10213 Report Date: 09/17/14 Data Qualifiers G The concentration may be biased high due to matrix interferences(i.e,co-elution)with non-target compound(s).The result should be considered estimated. H The analysis of pH was performed beyond the regulatory-required holding time of 15 minutes from the time of sample collection. I The lower value for the two columns has been reported due to obvious interference. M Reporting Limit(RL)exceeds the MCP CAM Reporting Limit for this analyte. NJ Presumptive evidence of compound.This represents an estimated concentration for Tentatively Identified Compounds(TICs),where the identification is based on a mass spectral library search. P The RPD between the results for the two columns exceeds the method-specified criteria. Q The quality control sample exceeds the associated acceptance criteria.For DOD-related projects,LCS and/or Continuing Calibration Standard exceedences are also qualified on all associated sample results. Note:This flag is not applicable for matrix spike recoveries when the sample concentration is greater than 4x the spike added or for batch duplicate RPD when the sample concentrations are less than 5x the RL.(Metals only.) R Analytical results are from sample re-analysis. RE -Analytical results are from sample re-extraction. S Analytical results are from modified screening analysis. J Estimated value.This represents an estimated concentration for Tentatively Identified Compounds(TICS). ND Not detected at the reporting limit(RL)for the sample. Report Format: Data Usability Report Page 13 of 16 Serial No:09171414:42 Project Name: HASH RESIDENCE Lab Number: L1420884 Project Number: BEA10-10213 Report Date: 09/17/14 REFERENCES 30 Standard Methods for the Examination of Water and Wastewater. APHA-AWWA- WPCF. 18th Edition. 1992. 44 Methods for the Determination of Inorganic Substances in Environmental Samples, EPA/600/R-93/100, August 1993. LIMITATION OF LIABILITIES Alpha Analytical performs services with reasonable care and diligence normal to the analytical testing laboratory industry. In the event of an error, the sole and exclusive responsibility of Alpha Analytical shall be to re-perform the work at it's own expense. In no event shall Alpha Analytical be held liable for any incidental, consequential or special damages, including but not limited to, damages in any way connected with the use of, interpretation of, information or analysis provided by Alpha Analytical. We strongly urge our clients to comply with EPA protocol regarding sample volume, preservation, cooling, containers, sampling procedures, holding time and splitting of samples in the field. 1 Page 14 of 16 Serial No:09171414:42 Certification Information Last revised April 15,2014 The following analytes are not included in our NELAP Scope of Accreditation: Westborough Facility EPA 524.2:Acetone, 2-Butanone (Methyl ethyl ketone (MEK)),Tert-butyl alcohol, 2-Hexanone, Tetrahydrofuran, 1,3,5-Trichlorobenzene, 4-Methyl-2-pentanone(MIBK), Carbon disulfide, Diethyl ether. EPA 8260C: 1,2,4,5-Tetramethylbenzene,4-Ethyltoluene, lodomethane(methyl iodide), Methyl methacrylate, Azobenzene. EPA 8330A/B: PETN, Picric Acid, Nitroglycerine, 2,6-DANT, 2,4-DANT. EPA 8270D: 1-Methyinaphthalene, Dimethylnaphthalene,1,4-Diphenylhydrazine. EPA 625: 4-Chloroaniline,4-Methylphenol. SM4500: Soil: Total Phosphorus, TKN, NO2, NO3. EPA 9071: Total Petroleum Hydrocarbons, Oil&Grease. Mansfield Facility EPA 8270D: Biphenyl. EPA 2540D: TSS EPA TO-15: Halothane, 2,4,4-Trimethyl-2-pentene, 2,4,4-Trimethyl-1-pentene,Thiophene, 2-Methylthiophene, 3-Methylthiophene, 2-Ethylthiophene, 1,2,3-Tri methyl benzene, Indan, Indene, 1,2,4,5-Tetramethylbenzene, Benzothiophene, 1-Methyinaphthalene. The following analytes are included in our Massachusetts DEP Scope of Accreditation,Westborough Facility: Drinking Water EPA 200.8: Sb,As,Ba,Be,Cd,Cr,Cu,Pb,Ni,Se,TI; EPA 200.7: Ba,Be,Ca,Cd,Cr,Cu,Na; EPA 245.1: Mercury; EPA 300.0: Nitrate-N, Fluoride, Sulfate; EPA 353.2: Nitrate-N, Nitrite-N; SM4500NO3-F: Nitrate-N, Nitrite-N; SM4500E-C, SM4500CN-CE, EPA 180.1, SM2130B,SM4500CI-D, SM232013, SM2540C, SM450OH-B EPA 332: Perchlorate. Microbiology: SM921513; SM9223-P/A,SM9223B-Colilert-QT, Enterolert-QT. Non-Potable Water EPA 200.8:AI,Sb,As,Be,Cd,Cr,Cu,Pb,Mn,Ni,Se,Ag,TI,Zn; EPA 200.7:AI,Sb,As,Be,Cd,Ca,Cr,Co,Cu,Fe,Pb,Mg,Mn,Mo,Ni,K,Se,Ag,Na,Sr,Ti,TI,V,Zn; EPA 245.1, SM4500H,B, EPA 120.1,SM2510B,SM2540C,SM2340B, SM232013, SM4500CL-E, SM4500E-BC, SM426C, SM4500NH3-BH, EPA 350.1:Ammonia-N, LACHAT 10-107-06-1-B:Ammonia-N, SM4500NO3-F, EPA 353.2: Nitrate-N, SM4500NH3-BC-NES, EPA 351.1, SM4500P-E,SM4500P-B, E,SM5220D,,EPA 410.4, SM521013,SM5310C,SM4500CL-D, EPA 1664, SM14 510AC, EPA 420.1, SM4500-CN-CE, SM2540D. EPA 624: Volatile Halocarbons&Aromatics, EPA 608: Chlordane,Toxaphene, Aldrin, alpha-BHC, beta-BHC, gamma-BHC, delta-BHC, Dieldrin, DDD, DDE, DDT, Endosulfan I, Endosulfan II, Endosulfan sulfate, Endrin, Endrin Aldehyde, Heptachlor, Heptachlor Epoxide, PCBs EPA 625: SVOC(Acid/Base/Neutral Extractables), EPA 600/4-81-045: PCB-Oil. Microbiology: SM9223B-Colilert-QT; Enterolert-QT,SM9222D-MF. For a complete listing of analytes and methods, please contact your Alpha Project Manager. Page 15 of 16 Serial No:09171414:42 F C 1US �T DY CHAIN 0 Date:ReadinLab: { ' � PAGE 1 OF 1 � :`,, b.: Proliect lnformation Report Information Data Deliverables Billing Information ❑ FAX ® EMAIL ® Same as Client info PO#:10213 Westborough,MA Mansfield,MA Project Name:Hash Residence TEL:508.89B-9220 TEL'508-822-9300 ❑ ADEX ❑ Add'I Deliverables FAX 508-898-9193 FAX 508-.822-3288 RegulatoryRequirements/Report Client Information Project Location:Ostervllle,MA Stafe/FedProgram 7 Criteria . Client:Bennett Environmental Associates EL SEA10-10213 Address:1573 Main Street/P:O.Box 1743 Project Manager:David C.Bennett Brewster,MA 02631 ALPHA Quote#: Phone:508-896-1706 ANALYSIS Fax;508-896-6109 ®Standard ❑Rush(ONLY IF PRE-APPROVED) SAMPLE HANDLING Filtration - Email:sfarrenkopMbennett-ea.com J ❑ Done ❑These samples have been Previously analyzed by Alpha Due Date: e: ® Not Needed — ❑ Lab to do Other Project Specific Requirements/Comments/Detection Limits: Preservation • ❑ Lab to do p {Please specify O below} to ALpFfALabID€=;;':: Sample ID Collection Sample Sampler's z ti:[Jse;Orily); .; Date Time Matrix Initials _ ''•`"' '"" "- Y 62mple Speelrie Z H Comments 14;4'1l >I Effluent V-30 wVV ® ® El ❑ ❑ ❑ ❑ El El 1-1 a _..._.. El 0 ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ El El El El ❑ ❑ ❑ El .,-ti ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ El ❑ ❑ El El ❑ ❑ ❑ El ❑ 11 El El El 11 9 Container Type P P P - 0 0 D Please:print clearly,regibly: ; Preservative arid'doinpletely. Samplesc�n.: -'—' RMOqulsheW. Datefrlme Received By: Datefnme turriarodnd;lime clock=wili:nt t start iintii;any @ml5iguities:a`te�".; , 1\ _ t�6 :'resolved,:'`1l�seihples • �y subitlitted ere sflbjebt to raRano o)•suFRJ) t„/ I' Alpha's Psyt.sh Terms. L! ;J Page 16of16 o-7o4q ruo r O Ia J� O li � BENNETT ENVIRONMENTAL ASSOCIATES, INC. LICENSED SITE PROFESSIONALS,ENVIRONMENTAL SCIENTISTS,GEOLOGISTS,ENGINEERS 1573 Main Street,P.O.Box 1743 (508)896-1706 Brewster,MA 02631 fax(508)896-5109 LETTER OF TRANSMITTAL TO: DATE: JOB NUMBER: Massachusetts Department of Environmental Protection 8/7/12 BEA10-10213 Attention:Title 5 Program 1 Winter Street-6th Floor Boston,MA 02108 REGARDING: Hash Residence 1199 Craigville Beach Road SHIPPING METHOD: Centerville,MA 02632 Regular Mail ❑ Pick Up ❑ Priority Mail ❑ Hand Deliver ❑ Express Mail ❑ Other ❑ Certified Mail Green Card/RR ❑ COPIES DATE DESCRIPTION 1 DEP Approved Inspection and O&M Form for Title 5 I/A Treatment and Disposal Systems(July 2012) 1 OMNI Environmental Systems,Inc.RSF Operation and Maintenance Inspection Checklist 1 7/19/12 Alpha Analytical laboratory report 7 -3 For review and comment: ❑ For approval: ❑ As requested: ❑ For your use:t REMARKS: Please find enclosed the DEP Inspection and O&M Form,OMNI Environmental Systems,Inc.RSF Operation and Maintenance Inspection Checklist and laboratory analytical report for operation and maintenance conducted at the above referenced property during the reporting period. The pressure dosed leaching field lateral lines were inspected and flushed on July 12,2012. If you have any questions or require additional information,please contact us at your earliest convenience. Thank you. cc:Barnstable Board of Health Ms.Mary Hash,Owner David C.Bennett,Principal[Internal] Matthew Costa,OMNI Environmental Systems,Inc. FROM: David C.Bennett,WWTO#6243/SamanthaFarrenkopf,WWTO#13265/Joseph Smith,WWTO#12529 If enclosures are not as noted,kindly notify us at once i LlMassachusetts Department of Environmental Protection Bureau of Resource Protection - Title 5 DEP Approved Inspection and O&M Form for Title 5 I/A Treatment and Disposal Systems A. Installation Important:When Mary Hash filling out forms Owner on the computer, use only the tab 1199 Craigville Beach Road key to move your Facility Street Address cursor-do not Centerville 02632 use the return City Zip key. Mailing address of owner, if different: rab . 3944 Baltimore Street Street Address/PO Box: Kensington MD 20895 City State Zip (301) 942 -2110 ext. Telephone Number B. Authorized Service Provider BENNETT ENVIRONMENTAL ASSOCIATES, INC. O&M Firm 1573 Main Street/ PO Box 1743 Street Address Brewster MA 02631 City State Zip (508) 896- 1706 ext. 129 Telephone Number Samantha Farrenkopf 13265 Certified Operator Name Certification Number C. Fac.ility/System Information OMNI RSF-PF DEP ID Manufacturer ID Model Number Unknown Unknown Installation Date Start of Operation Approval Type: ® General ❑ Provisional ❑ Piloting ❑ Remedial Seasonal Residence—used less than 6 mo./year: ® Yes ❑ No D. Operating Information 07/12/12 07/11/10 Inspection Date Previous Inspection Date 6"of Sludge. 1" scum Sludge Depth(to be checked yearly) Pumping Recommended El Yes ® No t5aiom.doc•rev. 11-07-05 Page 1 of 3 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Title 5 DEP Approved Inspection and O&M Form for Title 5 I/A Treatment and Disposal Systems E. Field Testing Field Inspection: Color: ❑ gray ❑ brown ® clear ❑ turbid ❑ Other(specify): Odor: ® musty ❑ earthy ❑ moldy ❑ offensive ❑ turbid Effluent Solids: ® no ❑ some pH 7.0 SU DO 8.11 mg/L Turbidity 6.58 NTU 6 to 9 2 or greater 40 or less Should a Remedial or General Use system fail the Field Testing, effluent samples shall be collected per Standard Methods and analyzed for BOD and TSS. F. Sampling Information Samples Taken: ❑ Influent ® Effluent Commercial systems or systems with a design flow of 2000 gpd and greater, and General Use nitrogen reducing systems: gpd Parameters sampled: ❑ pH ® BOD ❑ CBOD ® TSS ❑ TN ® Other(list below) Nitrate Nitrite TKN Other 1 Other 2 Other 3 G. Inspection and Maintenance Description of any maintenance performed since previous inspection &during this inspection: Performed regularly scheduled preventitive O&M. Collect effluent samples for field testing and laboratory analysis. Notes and Comments: The system is functioning properly and effluent quality passed field testing parameters. The pressure dosing leaching field lateral lines were flushed. t5aiom.doc•rev.11-07-05 Page 2 of 3 1 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Title 5 DEP Approved Inspection and ®&Ili Form for Title 5 I/A Treatment and Disposal Systems H. Certification I certify: I have inspected the sewage treatment and disposal system at the address above, have conducted the required Field Testing and/or sample collection in accordance with Standard Methods, have completed this report and the attached technology operation and maintenance checklist, and the information reported is true, accurate, and complete as of the time of the inspection. I am a Massachusetts certified operator in accordance with 257 CMR 2.00. NN Operator Signature Date— System owner must submit this report, technology O&M checklist, and any required sampling results to the local board of health and DEP as follows for each inspection performed: Remedial Use—by January 315t of each year for the previous calendar year Piloting Use-within 45 days of inspection date Provisional Use—by March 31th of each year for the previous 12 months General Use—by September 30th of each year for the previous 12 months Send to: Department of Environmental Protection Attention: Title 5 Program One Winter Street, 6th Floor Boston, MA 02108 t5aionn.doc•rev. 11-07-05 Page 3 of 3 OIWN , Envkonmen&I Systems,Inc. OMNI RSF Operation and Maintenance Inspection Checklist A. Ins(t�allation &Service Information Facility StreetAddres CDat&of Se ice City Operator/O&M Firm System Startup Date Weather Conditions B. Septic Tank Sludge Pumping Required: Yes❑ Na ] Sludge Depth: Scum Depth: Effluent tee filter: Ye ��TT � s No❑ If yes, inspec�&clean at least yearl9k If the sludge layer is within 12"of the outlet invert,recommend that the homeowner have the septic tank pumped,note the approximate scum layer thickness as well.Also,inquire if the homeowner has a pumping schedule established with a licensed septage hauler,if not recommend a two to four year pumping schedule depending on how heavily the system is used. C. Recirculation Tank ry ��� a 0 V �� VCheck if sludge accumulating Pumping required: Yes❑ No Odor problems: Yes❑ No If yes,description Effluent tee filter: Yes❑ N If yes,inspect❑&clean at least yearly❑ If the sludge layer is greater than 4°request that the homeowner pump out the recirculation tank in order to prevent clogging of the filter modules.Note the characteristics of the effluent coming out of the manifold this may indicate that.the filter bed may need servicing. D. Equalization Tank (if installed) Sludge Pumping Required: Yes❑ No❑ ❑Sludge Depth: ❑Scum Depth: Effluent tee filter: Yes❑ No❑ If yes, inspect❑ &clean at least yearly❑ Same inspection criteria as septic tank: E. Pump Chamber/Vault(if Installed) Pump Inspections(all units) If problems,describe Float switches Check all switches for operation Make Sure the pump is operational by pulling up the float switch;if the pump is not operational immediate corrective actions need to be taken. F. Pumps, Switches, Floats, Alarm System I Pump Inspections(all units) If problems,describe Test pump alternator, or record hours . I qZ5S-3 (C_�) cjo Hours of operation I Float switches Check all switches for operation Test alarm If non-functioning,corrective action(s) Make sure pump(s),Float(s)and audible alarm(s)are functional,if not make a note so that corrective actions can be made. G. Filter Modules ("Sand Filters") nspect for ponding (� Ponding Present:Yes❑ Nd A] Clean bed: Yes❑ Nod�}` V Distribution pipes 1/ ` Flush:Yes❑ NoNNo Brush: Yes❑ NY4 Any obstruction of airflow to filter modules: Yes❑ If Yes,explain below(i.e. snow, dirt) C ) To inspect the condition of the filter modules remove the mulch layer at one corner of the filter module area, then lift the filter fabric so that the media can be inspected through the end of the contactor. The media should have a thin biomass layer growing on it and should have a brownish shaggy coloration. If the surface of the filter module area appears to be clogged, or the biomass layer is too think it is suggested to completely expose the filter modules,and rake the filter beds thoroughly,then wash the filter beds down with a garden hose(with a pressure nozzle on it).Then Recover the filter beds as they were found. H. Sa pile Collection Yes No❑ If yes:��,BOD �TSS ❑pH XTN AOther�All samples are to be taken from the manifold located in the recirculation tank,and are to be stored in sterile, laboratory supplied containers.In order to prevent any cross-contamination from a previous sample rinse the dip cup into the effluent stream at the manifold three times so that a representative sample can be obtained. Make sure to wear proper safety equipment while pulling samples(i.e.rubber gloves). System Notes: da ..MIS C, \ ly;cam c\\ VON l 1 Serial No:07191213:28 /A\�PHA A N A L Y,T I C A L ANALYTICAL REPORT Lab Number: L1212399 Client: Bennett Environmental Associates 1573 Main Street Brewster, MA 02631 ATTN: David Bennett Phone: (508)896-1706 Project Name: HASH RESIDENCE Project Number: BEA10-10213 Report Date: 07/19/12 The original project report/data package is held by Alpha Analytical.This report/data package is paginated and should be reproduced only in its entirety.Alpha Analytical holds no responsibility for results and/or data that are not consistent with the original. Certifications&Approvals: MA(M-MA086),NY (11148),CT(PH-0574),NH(2003),NJ NELAP(MA935),RI(LA000065),ME(MA00086), PA(68-03671),USDA(Permit #P-330-11-00240),NC(666),TX(T104704476),DOD(1-2217),US Army Corps of Engineers. Eight Walkup Drive,Westborough, MA 01581-1019 508-898-9220 (Fax)508-898-9193 800-624-9220-www.alphalab.com ',,ALPHA Page 1 of 17 Serial No:07191213:28 Project Name: HASH RESIDENCE Lab Number: L1212399 Project Number: BEA10-10213 Report Date: 07/19/12 Alpha Sample Collection Sample ID Client ID Location Date/Time L1212399-01 EFFLUENT OSTERVILLE, MA 07/12/12 09:20 f� LPL?HA Page 2 of 17 Serial No:07191213:28 Project Name: HASH RESIDENCE Lab Number: L1212399 Project Number: BEA10-10213 Report Date: 07/19/12 Case Narrative The samples were received in accordance with the Chain of Custody and no significant deviations were encountered during the preparation or analysis unless otherwise noted.Sample Receipt,Container Information,and the Chain of Custody are located at the back of the report. Results contained within this report relate only to the samples submitted under this Alpha Lab Number and meet all of the requirements of NELAC,for all NELAC accredited parameters.The data presented in this report is organized by parameter(i.e.VOC,SVOC,etc.).Sample specific Quality Control data(i.e.Surrogate Spike Recovery)is reported at the end of the target analyte list for each individual sample, followed by the Laboratory Batch Quality Control at the end of each parameter.If a sample was re-analyzed or re-extracted due to a required quality control corrective action and if both sets of data are reported,the Laboratory ID of the re-analysis or re-extraction is designated with an"R"or"RE",respectively.When multiple Batch Quality Control elements are reported(e.g.more than one LCS),the associated samples for each element are noted in the grey shaded header line of each data table.Any Laboratory Batch,Sample Specific% recovery or RPD value that is outside the listed Acceptance Criteria is bolded in the report.Performance criteria for CAM and RCP methods allow for some LCS compound failures to occur and still be within method compliance.In these instances,the specific failures are not narrated but are noted in the associated QC table.This information is also incorporated in the Data Usability format for our Data Merger tool where it can be reviewed along with any associated usability implications.Soil/sediments,solids and tissues are reported on a dry weight basis unless otherwise noted.Definitions of all data qualifiers and acronyms used in this report are provided in the Glossary located at the back of the report. In reference to questions H(CAM)or 4(RCP)when"NO"is checked,the performance criteria for CAM and RCP methods allow for some quality control failures to occur and still be within method compliance. In these instances the specific failure is not narrated but noted in the associated QC table.The information is also incorporated in the Data Usability format of our Data Merger tool where it can be reviewed along with any associated usability implications. Please see the associated ADEx data file for a comparison of laboratory reporting limits that were achieved with the regulatory Numerical Standards requested on the Chain of Custody. HOLD POLICY For samples submitted on hold,Alpha's policy is to hold samples free of charge for 30 days from the date the project is completed.After 30 days,we will dispose of all samples submitted including those put on hold unless you have contacted your Client Service Representative and made arrangements for Alpha to continue to hold the samples. Please contact Client Services at 800-624-9220 with any questions. I, the undersigned, attest under the pains and penalties of perjury that, to the best of my knowledge and belief and based upon my personal inquiry of those responsible for providing the information contained in this analytical report, such information is accurate and complete. This certificate of analysis is not complete unless this page accompanies any and all pages of this report. Elizabeth Simmons Authorized Signature: "v' Title: Technical Director/Representative Date: 07/19/12 Page 3 of 17 ��'� Serial No:07191213:28 0N 0'R%G.7 A NO I C.%#S S(.%�E L LA N E 0 U S Page 4 of 17 Serial No:07191213:28 Project Name: HASH RESIDENCE Lab Number: L1212399 Project Number: BEA10-10213 Report Date: 07/19/12 SAMPLE RESULTS Lab ID: L1212399-01 Date Collected: 07/12/12 09:20 Client ID: EFFLUENT Date Received: 07/12/12 Sample Location: OSTERVILLE,MA Field Prep: Not Specified Matrix: Water Dilution Date Date Analytical Parameter Result Qualifier Units RL MDL Factor Prepared Analyzed Method Analyst General Chemistry-Westborough Lab Solids,Total Suspended 7.4 mg/I 5.0 NA 1 07/17/12 12:15 30,2540D DW Nitrogen,Nitrite 0.42 mg/I 0.20 2 07/13/12 17:32 44,353.2 JO .. ........... ......_....... ._._.._..._... ......-.- - -- - __._..._ . ......-.._ _......... . --------- — ----- Nitrogen,Nitrate 10 mg/I 0.20 2 - 07/13/12 17:32 44,353.2 JO ---- — ----- - .........................__..._. ----- - -- — .........._ .............. .. ......_.. _.. -- — ---- _ .. ......._... ........... .. .... Nitrogen,Total Kjeldahl 3.2 mg/I 0.60 - 2 07/16/12 09:30 07/18/12 00:37 30,4500N-C AT BOD,5 day 8.2 mg/I 2.0 NA 1 07/12/12 23:25 07/17/12 18:35 30,5210B SC to� ------- HA Page Page 5 of 17 I Serial No:07191213:28 Project Name: HASH RESIDENCE Lab Number: L1212399 Project Number: BEA10-10213 Report Date: 07/19/12 Method Blank Analysis Batch Quality Control Dilution Date Date Analytical Parameter Result Qualifier Units RL MDL Factor Prepared Analyzed Method Analyst General Chemistry-Westborough Lab for sample(s): 01 Batch: WG548162-1 9 BOD,5 day ND mg/I 2.0 NA 1 07/12/12 23:25 07/17/12 18:35 30,521013 SC General Chemistry-Westborough Lab for sample(s): 01 Batch: WG548302-2 Nitrogen,Nitrite ND mg/1 0.10 -- 1 07/13/12 16:46 44,353.2 JO General Chemistry-Westborough Lab for sample(s): 01 Batch: WG548305-2 Nitrogen,Nitrate ND mg/I 0.10 -- 1 07/13/12 16:44 44,353.2 JO General Chemistry-Westborough Lab for sample(s): 01 Batch: WG548489-1 Nitrogen,Total Kjeldahl ND mg/1 0.30 1 07/16/12 09:30 07/18/12 00:14 30,4500N-C AT General Chemistry-Westborough Lab for sample(s): 01 Batch: WG548842-1 Solids,Total Suspended ND mg/1 5.0 NA 1 07/17/12 12:15 30,2540D DW ALPHA Page 6 of 17 Serial No:O7191213:28 Lab Control Sample Analyses Project Name: HASH RESIDENCE Batch Quality Control Lab Number: L1212399 Project Number: BEA10-10213 Report Date: 07/19/12 LCS LCSD %Recovery Parameter %Recovery Qual %Recovery Qual Limits RPD Qual RPD Limits General Chemistry-Westborough Lab Associated sample(s): 01 Batch: WG548162-2 BOD,5 day 93 - 85-115 20 ..... ----- ...._... --—- — _. _..._._.� . .._..._...... .._....._. ........... General Chemistry-Westborough Lab Associated sample(s): 01 Batch: WG548302-1 Nitrogen,Nitrite 104 - 90-110 20 General Chemistry-Westborough Lab Associated sample(s): 01 Batch: WG548305-1 Nitrogen,Nitrate 106 90-110 General Chemistry-Westborough Lab Associated sample(s): 01 Batch: W6548489-2 Nitrogen,Total Kjeldahl 95 85-110 - Page 7 of 17 j Serial No:07191213:28 Matrix Spike Analysis Batch Quality Control Project Name: HASH RESIDENCE Lab Number: L1212399 Project Number: BEA10-10213 Report Date: 07/19/12 Native MS IVIS MS MSD MSD Recovery RPD Parameter Sample Added Found %Recovery Qual Found %Recovery Qual Limits RPD Qual Limits General Chemistry-Westborough Lab Associated sample(s): 01 QC Batch ID: WG548162-3 QC Sample: L1212387-07 Client ID: MS Sample BOD,5 day ND 100 120 115 - 50-145 35 General Chemistry-Westborough Lab Associated sample(s): 01 QC Batch ID: WG548302-3 QC Sample: L1212387-07 Client ID: MS Sample Nitrogen,Nitrite 0.24 4 4.6 109 - 80-120 20 General Chemistry-Westborough Lab Associated sample(s): 01 QC Batch ID: WG548305-3 QC Sample: L1212376-01 Client ID: MS Sample Nitrogen, Nitrate 0.14 4 4.6 112 - 83-113 6 General Chemistry-Westborough Lab Associated sample(s): 01 QC Batch ID: WG548489-4 QC Sample: L1212382-01 Client ID: MS Sample Nitrogen,Total Kjeldahl 23 8 32 105 - 77-111 24 Page 8 of 17 Serial No:07191213:28 Lab Duplicate Analysis Project Name: HASH RESIDENCE Batch Quality Control Lab Number: L1212399 Project Number: BEA10-10213 Report Date: 07/19/12 Parameter Native Sample Duplicate Sample Units RPD Qual RPD Limits General Chemistry-Westborough Lab Associated sample(s): 01 QC Batch ID: WG548162-4 QC Sample: L1212398-02 Client ID: DUP Sample BOD,5 day 250 260 mg/I 4 35 General Chemistry-Westborough Lab Associated sample(s): 01 QC Batch ID: WG548302-4 QC Sample: L1212399-01 Client ID: EFFLUENT Nitrogen, Nitrite 0.42 0.36 mg/I 15 20 General Chemistry-Westborough Lab Associated sample(s): 01 QC Batch ID: WG548305-4 QC Sample: L1212387-07 Client ID: DUP Sample Nitrogen,Nitrate 3.1 3.1 mg/I 0 6 General Chemistry-Westborough Lab Associated sample(s): 01 QC Batch ID: WG548489-3 QC Sample: L1212382-01 Client ID: DUP Sample Nitrogen,Total Kjeldahl 23 23 mg/I 0 24 General Chemistry-Westborough Lab Associated sample(s): 01 QC Batch ID: WG548842-2 QC Sample: L1212361-03 Client ID: DUP Sample Solids,Total Suspended 470 560 mg/I 17 20 t� Page 9 of 17 'A -HA Serial No:07191213:28 Project Name: HASH RESIDENCE Lab Number: L1212399 Project Number: BEA10-10213 Report Date: 07/19/12 Sample Receipt and Container Information Were project specific reporting limits specified? YES Reagent H2O Preserved Vials Frozen on: NA Cooler Information Custody Seal Cooler A Absent Container Information Temp Container ID Container Type Cooler pH deg C Pres Seal Analysis(*) L1212399-01A Plastic 1000ml unpreserved A 7 4 Y Absent TSS-2540(7) L1212399-01 B Plastic 1000ml unpreserved A 7 4 Y Absent NO2-353(2),BOD-5210(2),NO3- 353(2) L1212399-01C Plastic250ml H2SO4 preserved A <2 4 Y Absent TKN-4500(28) *Values in parentheses indicate holding time in daysiFHA Page 10 of 17 Serial No:07191213:28 Project Name: HASH RESIDENCE Lab Number: L1212399 Project Number: BEA10-10213 Report Date: 07/19/12 GLOSSARY Acronyms EPA Environmental Protection Agency. LCS Laboratory Control Sample:A sample matrix,free from the analytes of interest,spiked with verified known amounts of analytes or a material containing known and verified amounts of analytes. LCSD Laboratory Control Sample Duplicate:Refer to LCS. LFB Laboratory Fortified Blank:A sample matrix,free from the analytes of interest,spiked with verified known amounts of analytes or a material containing known and verified amounts of analytes. MDL Method Detection Limit:This value represents the level to which target analyte concentrations are reported as estimated values, when those target analyte concentrations are quantified below the reporting limit(RL).The MDL includes any adjustments from dilutions,concentrations or moisture content,where applicable. MS Matrix Spike Sample:A sample prepared by adding a known mass of target analyte to a specified amount of matrix sample for which an independent estimate of target analyte concentration is available. MSD Matrix Spike Sample Duplicate:Refer to MS. NA -Not Applicable. NC -Not Calculated: Term is utilized when one or more of the results utilized in the calculation are non-detect at the parameter's reporting unit. NI -Not Ignitable. RL Reporting Limit: The value at which an instrument can accurately measure an analyte at a specific concentration.The RL includes any adjustments from dilutions,concentrations or moisture content,where applicable. RPD Relative Percent Difference: The results from matrix and/or matrix spike duplicates are primarily designed to assess the precision of analytical results in a given matrix and are expressed as relative percent difference(RPD). Values which are less than five times the reporting limit for any individual parameter are evaluated by utilizing the absolute difference between the values; although the RPD value will be provided in the report. SRM Standard Reference Material:A reference sample of a known or certified value that is of the same or similar matrix as the associated field samples. Footnotes 1 -The reference for this analyte should be considered modified since this analyte is absent from the target analyte list of the original method. Terms Analytical Method:Both the document from which the method originates and the analytical reference method.(Example:EPA 8260B is shown as 1,8260B.)The codes for the reference method documents are provided in the References section of the Addendum. Data Qualifiers A Spectra identified as"Aldol Condensation Product". B The analyte was detected above the reporting limit in the associated method blank.Flag only applies to associated field samples that have detectable concentrations of the analyte at less than five times(5x)the concentration found in the blank.For MCP-related projects,flag only applies to associated field samples that have detectable concentrations of the analyte at less than ten times(10x) the concentration found in the blank.For DOD-related projects,flag only applies to associated field samples that have detectable concentrations of the analyte at less than ten times(1 Ox)the concentration found in the blank AND the analyte was detected above one-half the reporting limit(or above the reporting limit for common lab contaminants)in the associated method blank.For NJ- Air-related projects,flag only applies to associated field samples that have detectable concentrations of the analyte above the reporting limit. C Co-elution:The target analyte co-elutes with a known lab standard(i.e.surrogate,internal standards,etc.)for co-extracted analyses. D Concentration of analyte was quantified from diluted analysis.Flag only applies to field samples that have detectable concentrations of the analyte. E Concentration of analyte exceeds the range of the calibration curve and/or linear range of the instrument. G The concentration may be biased high due to matrix interferences(i.e,co-elution)with non-target compound(s).The result should be considered estimated. H The analysis of pH was performed beyond the regulatory-required holding time of 15 minutes from the time of sample collection. I The RPD between the results for the two columns exceeds the method-specified criteria;however,the lower value has been reported due to obvious interference. M Reporting Limit(RL)exceeds the MCP CAM Reporting Limit for this analyte. NJ -Presumptive evidence of compound.This represents an estimated concentration for Tentatively Identified Compounds(TICS),where the identification is based on a mass spectral library search. Report Format: Data Usability Report ILPHA Page 11 of 17 1 Serial No:07191213:28 Project Name: HASH RESIDENCE Lab Number: L1212399 Project Number: BEA10-10213 Report Date: 07/19/12 Data Qualifiers P The RPD between the results for the two columns exceeds the method-specified criteria. Q The quality control sample exceeds the associated acceptance criteria.For DOD-related projects,LCS and/or Continuing Calibration Standard exceedences are also qualified on all associated sample results. Note:This flag is not applicable for matrix spike recoveries when the sample concentration is greater than 4x the spike added or for batch duplicate RPD when the sample concentrations are less than 5x the RL.(Metals only.) R Analytical results are from sample re-analysis. RE Analytical results are from sample re-extraction. J -Estimated value.This represents an estimated concentration for Tentatively Identified Compounds(TICS). ND -Not detected at the reporting limit(RL)for the sample. Report Format: Data Usability Report `X Page 12 of 17 Serial No:07191213:28 Project Name: HASH RESIDENCE Lab Number: L1212399 Project Number: BEA10-10213 Report Date: 07/19/12 REFERENCES 30 Standard Methods for the Examination of Water and Wastewater.APHA-AWWA- WPCF. 18th Edition. 1992. 44 Methods for the Determination of Inorganic Substances in Environmental Samples, EPA/600/R-93/100,August 1993. 1 LIMITATION OF LIABILITIES Alpha Analytical performs services with reasonable care and diligence normal to the analytical testing laboratory industry. In the event of an error,the sole and exclusive responsibility of Alpha Analytical shall be to re-perform the work at it's own expense. In no event shall Alpha Analytical be held liable for any incidental, consequential or special damages, including but not limited to,damages in any way connected with the use of, interpretation of, information or analysis provided by Alpha Analytical. We strongly urge our clients to comply with EPA protocol regarding sample volume, preservation, cooling, containers, sampling procedures, holding time and splitting of samples in the field. 4ALPHA Page 13 of 17 Serial No:07191213:28 Certificate/Approval Program Summary Last revised May 11,2012 -Westboro Facility The following list includes only those analytes/methods for which certification/approval is currently held. For a complete listing of analytes for the referenced methods, please contact your Alpha Customer Service Representative. Connecticut Department of Public Health Certificate/Lab ID: PH-0574. NELAP Accredited Solid Waste/Soil. Drinking Water(Inorganic Parameters: Color, pH, Turbidity, Conductivity, Alkalinity, Chloride, Free Residual Chlorine, Fluoride, Calcium Hardness, Sulfate, Nitrate, Nitrite, Aluminum, Antimony, Arsenic, Barium, Beryllium, Cadmium, Calcium, Chromium, Copper, Iron, Lead, Magnesium, Manganese, Mercury, Molybdenum, Nickel, Potassium, Selenium, Silver, Sodium, Thallium, Vanadium, Zinc, Total Dissolved Solids, Total Organic Carbon, Total Cyanide, Perchlorate. Organic Parameters: Volatile Organics 524.2, Total Trihalomethanes 524.2, 1,2-Dibromo-3-chloropropane (DBCP) 504.1, Ethylene Dibromide (EDB) 504.1, 1,4-Dioxane (Mod 8270). Microbiology Parameters: Total Coliform-MF mEndo (SM9222B), Total Coliform - Colilert (SM9223 P/A), E. Coli. - Colilert (SM9223 P/A), HPC - Pour Plate (SM9215B), Fecal Coliform-MF m-FC(SM9222D, Fecal Coliform-EC Medium 9221 E). Wastewater/Non-Potable Water (Inorganic Parameters: Color, pH, Conductivity, Acidity, Alkalinity, Chloride, Total Residual Chlorine, Fluoride, Total Hardness, Silica, Sulfate, Sulfide, Ammonia, Kjeldahl Nitrogen, Nitrate, Nitrite, 0- Phosphate, Total Phosphorus, Aluminum, Antimony, Arsenic, Barium, Beryllium, Boron, Cadmium, Calcium, Chromium, Hexavalent Chromium, Cobalt, Copper, Iron, Lead, Magnesium, Manganese, Mercury, Molybdenum, Nickel, Potassium, Selenium, Silver, Sodium, Strontium, Thallium, Tin, Titanium, Vanadium, Zinc, Total Residue (Solids), Total Dissolved Solids, Total Suspended Solids (non-filterable), BOD, CBOD, COD, TOC, Total Cyanide, Phenolics, Foaming Agents (MBAS), Bromide, Oil and Grease. Organic Parameters: PCBs, Organochlorine Pesticides, Technical Chlordane, Toxaphene, 2,4-D, 2,4,5-T, 2,4,5-TP(Silvex), Acid Extractables (Phenols), Benzidines, Phthalate Esters, Nitrosamines, Nitroaromatics & Isophorone, Polynuclear Aromatic Hydrocarbons, Haloethers, Chlorinated Hydrocarbons, Volatile Organics, TPH (HEM/SGT), Extractable Petroleum Hydrocarbons (ETPH), MA-EPH, MA-VPH. Microbiology Parameters: Total Coliform - MF mEndo (SM9222B), Total Coliform - MTF (SM9221 B), HPC - Pour Plate (SM9215B), Fecal Coliform-MF m-FC(SM9222D), Fecal Coliform-A-1 Broth (SM9221 E), Enterolert, E.Coli 9223. Solid Waste/Soil(Inorganic Parameters: pH, Sulfide,Aluminum,Antimony, Arsenic, Barium, Beryllium, Boron, Cadmium, Calcium, Chromium, Hexavalent Chromium, Cobalt, Copper, Iron, Lead, Magnesium, Manganese, Mercury, Molybdenum, Nickel, Potassium, Selenium, Silver, Sodium, Thallium, Tin, Vanadium, Zinc, Total Cyanide, Ignitability, Phenolics, Corrosivity, TCLP Leach (1311), SPLP Leach (1312 metals only), Reactivity. Organic Parameters: PCBs, PCBs in Oil, Organochlorine Pesticides, Technical Chlordane, Toxaphene, Extractable Petroleum Hydrocarbons (ETPH), MA-EPH, MA-VPH, Dicamba, 2,4-D, 2,4,5-T, 2,4,5-TP(Silvex), Dalapon, Volatile Organics, Acid Extractables (Phenols), Benzidines, Phthalates, Nitrosamines, Nitroaromatics & Cyclic Ketones, PAHs, Haloethers, Chlorinated Hydrocarbons. ) Maine Department of Human Services Certificate/Lab ID:2009024. Drinking Water(Inorganic Parameters: SM9215B, 9222D, 9223B, EPA 180.1, 353.2, SM2130B, 2320B, 2540C, 4500CI- D, 4500CN-C, 4500CN-E, 4500E-C, 4500H+B, 4500NO3-F, EPA 200.7, EPA 200.8, 245.1, EPA 300.0. Organic Parameters: 504.1, 524.2.) Wastewater/Non-Potable Water (Inorganic Parameters: EPA 120.1, 1664A, 350.1, 351.1, 353.2, 410.4, 420.1, SM2320B, 2510B, 2540C, 2540D, 426C, 4500CI-D, 4500CI-E, 4500CN-C, 4500CN-E, 4500E-B, 4500E-C, 4500H+B, 4500Norg-B, 4500Norg-C, 4500NH3-B, 4500NH3-G, 4500NO3-F, 4500P-B, 4500P-E, 5210B, 5220D, 5310C, 9010B, 9040B, 903013, 7470A, 7196A, 2340B, EPA 200.7, 6010B, 200.8, 6020, 245.1, 1311, 1312, 3005A, Enterolert, 9223D, 9222D. Organic Parameters: 608, 624, 625, 8081A, 8082, 8330, 8151A, 8260B, 8270C, 3510C, 3630C, 5030B, ME- DRO, ME-GRO, MA-EPH, MA-VPH.) Solid Waste/Soil(Inorganic Parameters: 9010B, 9012A, 9014A, 9030B, 9040B, 9045C, 6010B, 7471A, 7196A, 9050A, 1010, 1030, 9065, 1311, 1312, 3005A, 3050B. Organic Parameters: ME-DRO, ME-GRO, MA-EPH, MA-VPH, 8260B, 8270C, 8330,8151A, 8081A, 8082, 3540C, 3546, 3580A, 3630C, 5030B, 5035.) Massachusetts Department of Environmental Protection Certificate/Lab ID: M-MA086. Drinking Water (Inorganic Parameters: (EPA 200.8 for: Sb,As,Ba,Be,Cd,Cr,Cu,Pb,Ni,Se,TI) (EPA 200.7 for: t -N Fluoride Sulfate EPA 353.2 for: Nitrate-N Nitrite-N Ba,Be,Ca,Cd,Cr,Cu,Na,Ni) 245.1, (300.0 for: Nitra a ), ( ), (SM4500NO3-F for: Nitrate-N and Nitrite-N); 4500E-C, 4500CN-CE, EPA 180.1, SM2130B, SM4500CI-D, 2320B, SM2540C, SM4500H-B. Organic Parameters: (EPA 524.2 for: Trihalomethanes, Volatile Organics); (504.1 for: 1,2- Dibromoethane, 1,2-Dibromo-3-chloropropane), EPA 332. Microbiology Parameters: SM921513; ENZ. SUB. SM9223; ColilertQT SM9223B; MF-SM9222D.) N n fP able Water(Inorganic Parameters:, (EPA 200.8 for: AI,Sb,As,Be,Cd,Cr,Cu,Pb,Mn,Ni,Se,Ag,TI,Zn); (EPA 200.7 Page f1o) . 10 I,Sb,As,Be,Cd,Ca,Cr,Co,Cu,Fe,Pb,Mg,Mn,Mo,Ni,K,Se,Ag,Na,Sr,Ti,TI,V,Zn); 245.1, SM4500H,B, EPA 120.1, Serial No:07191213:28 SM2510B, 2540C, 2340B, 2320B, 4500CL-E, 4500E-BC, 426C, SM4500NH3-BH, (EPA 350.1 for: Ammonia-N), LACHAT 10-107-06-1-B for Ammonia-N, SM4500NO3-F, 353.2 for Nitrate-N, SM4500NH3-BC-NES, EPA 351.1, SM4500P-E, 4500P-B,E, 5220D, EPA 410.4, SM 5210B, 5310C, 4500CL-D, EPA 1664, SM14 510AC, EPA 420.1, SM4500-CN-CE, SM2540D. Organic Parameters: (EPA 624 for Volatile Halocarbons, Volatile Aromatics),(608 for: Chlordane,Toxaphene,Aldrin, alpha-BHC, beta-BHC, gamma-BHC, delta-BHC, Dieldrin, DDD, DDE, DDT,Endosulfan I, Endosulfan II, Endosulfan sulfate, Endrin, Endrin Aldehyde, Heptachlor, Heptachlor Epoxide, PCBs-Water), (EPA 625 for SVOC Acid Extractables and SVOC Base/Neutral Extractables), 600/4-81-045-PCB-Oil. Microbiology Parameters: (ColilertQT SM92236; Enterolert-QT: SM9222D-MF.) New Hampshire Department of Environmental Services Certificate/Lab ID: 200307. NELAP Accredited. Drinking Water (Inorganic Parameters: SM 9222B, 9223B, 9215B, EPA 200.7, 200.8, 245.2, 300.0, SM4500CN-E, 4500H+B, 4500NO3-F, 2320B, 2510B, 2540C, 4500E-C, 5310C, 2120B, EPA 332.0. Organic Parameters: 504.1, 524.2.) Non-Potable Water (Inorganic Parameters: SM9222D, 9221 B, 9222B, 9221E-EC, EPA 3005A, 200.7, 200.8, 245.1, 245.2, SW-846 6010B, 6010C, 6020, 6020A, 7196A, 7470A, SM3500-CR-D, EPA 120.1, 300.0, 350.1, 350.2, 351.1, 353.2, 410.4, 420.1, 426C, 1664A, SW-846 9010B, 9030B, 9040B, SM426C, SM21206, 2310B,2320B, 2540B, 2540D, 4500H+B, 4500CL-E, 4500CN-E, 4500NH3-H, 4500NO3-F, 4500NO2-B, 4500P-E, 4500-S2-D, 5210B, 5220D, 2510B, 2540C, 4500E-C, 5310C, 5540C, LACHAT 10-204-00-1-A, LACHAT 10-107-06-2-D. Organic Parameters: SW-846 3510C, 3630C, 5030B, 8260B, 8270C, 8270D, 8330, EPA 624, 625, 608, SW-846 8082, 8081A, 8081B, 8151A.) Solid & Chemical Materials (Inorganic Parameters: SW-846 6010B, 6010C, 7196A, 7471A, 1010, 1030, 9010, 9012A, 9014, 9030B, 9040B, 9045C, 9050, 9065,1311, 1312, 3005A, 3050B, 3060A. Organic Parameters: SW-846 3540C, 3546, 3550B, 3580A, 3630C, 5030B, 5035, 8260B, 8270C, 8270D, 8270C-SIM, 8270D-SIM, 8330, 8151A, 8015B, 8082, 8082A, 8081 A, 8081 B.) New Jersey Department of Environmental Protection Certificate/Lab ID: MA935. NELAP Accredited. Drinking Water (Inorganic Parameters: SM9222B, 9221 E, 9223B, 9215B, 4500CN-CE, 4500NO3-F, 4500E-C, EPA 300.0, 200.7, 200.8, 245.2, 2540C, SM2120B, 2320B, 2510B, 5310C, SM4500H-B. Organic Parameters: EPA 332, 504.1, 524.2.) Non-Potable Water(Inorganic Parameters: SM521013, EPA 410.4, SM5220D, 4500CI-E, EPA 300.0, SM21206, 2340B, SM4500E-BC, EPA 200.7,200.8, 351.1, LACHAT 10-107-06-2-D, EPA 353.2, SM4500NO3-F, 4500NO2-B, EPA 1664A, SM5310B, C or D, 4500-PE, EPA 420.1, SM510ABC, SM4500P-B5+E, 2540B, 2540C, 2540D, 2540G, EPA 120.1, SM25106, SM15 426C, 9222D, 9221B, 9221C, 9221E, 9222B, 9215B, 2310B, 2320B, 4500NH3-H, 4500-S D, EPA 350.1, 350.2, SW-846 1312, 7470A, 5540C, SM4500H-B, 4500SO3-B, SM3500Cr-D, 4500CN-CE, EPA 245.1, 245.2, SW-846 9040B, 3005A, 3015, EPA 6010B, 6010C, 6020, 6020A, 7196A, 3060A, SW-846 9010B, 9030B. Organic Parameters: SW-846 8260B, 8260C, 8270C, 8270D, 8270C-SIM, 8270D-SIM, 3510C, EPA 608, 624, 625, SW-846 3630C, 5030B, 8081 A, 8081 B, 8082, 8082A, 8151 A, 8330, 1,4-Dioxane by NJ Modified 8270, 8015B, NJ OQA-QAM- 025 Rev.7, NJ EPH.) Solid& Chemical Materials(Inorganic Parameters: SW-846, 6010B, 6010C,6020, 6020A, 7196A, 3060A, 9010B, 9030B, 1010, 1030, 1311, 1312, 3005A, 3050B, 7471A, 7471B, 9014, 9012A, 9040B, 9045C, 9050A, 9065. Organic Parameters: SW-846 8015B, 8015C, 8081A, 8081B, 8082, 8082A, 8151A, 8330, 8260B, 8260C, 8270C, 8270D, 8270C- SIM, 8270D-SIM, 3540C, 3546, 3580A, 3630C, 5030B, 5035L, 5035H, NJ OQA-QAM-025 Rev.7, NJ EPH.) New York Department of Health Certificate/Lab ID: 11148. NELAP Accredited. Drinking Water (Inorganic Parameters: SM92236, 9222B, 9215B, EPA 200.8, 200.7, 245.2, SM5310C, EPA 332.0, SM23206, EPA 300.0, SM2120B, 4500CN-E, 4500E-C, 4500NO3-F, 2540C, SM 2510B. Organic Parameters: EPA 524.2, 504.1.) Non-Potable Water (Inorganic Parameters: SM9221 E, 9222D, 9221 B, 9222B, 9215B, 5210B, 5310C, EPA 410.4, SM5220D, 2310B-4a, 2320B, EPA 200.7, 300.0, SM4500CL-E, 4500E-C, SM15 426C, EPA 350.1, SM4500NH3-BH, EPA 351.1, LACHAT 10-107-06-2, EPA 353.2, SM4500-NO3-F, 4500-NO2-B, 4500P-E, 2540C, 2540B, 2540D, EPA 200.8, EPA 6010B, 6010C, 6020, 6020A, EPA 7196A, SM3500Cr-D, EPA 245.1, 245.2, 7470A, SM2120B, LACHAT 10- 204-00-1-A, 4500CN-CE, EPA 1664A, EPA 420.1, SM14 510C, EPA 120.1, SM251013, SM4500S-D, SM5540C, EPA 3005A, 3015, 9010B, 9030B. Organic Parameters: EPA 624, 8260B, 8270C, 8270D, 625, 608, 8081A, 8081B, 8151A, 8330, 8082, 8082A, EPA 3510C, 5030B.) Solid&Hazardous Waste (Inorganic Parameters: EPA 1010, 1030, EPA 6010B, 6010C, 7196A, 7471A, 7471B, 9012A, 9014, 9065, 9050A, EPA 1311, 1312, 3005A, 3050B, 9010B, 9030B. Organic Parameters: EPA 8260B, 8270C, 8270D, 8270C-SIM, 8270D-SIM, 8015B, 8015C, 8081A, 8081B, 8151A, 8330, 8082 8082A, 3540C, 3546, 3580, 3580A, 5030B, 5035.) Page 15 of 17 Serial No:07191213:28 North Carolina Department of the Environment and Natural Resources Certificate/Lab ID : 666. Organic Parameters: MA-EPH, MA-VPH. Drinking Water Program Certificate/Lab ID: 25700. (Inorganic Parameters: Chloride EPA 300.0. Organic Parameters: 524.2) Pennsylvania Department of Environmental Protection Certificate/Lab ID : 68-03671. NELAP Accredited. Drinking Water(Organic Parameters: EPA 524.2, 504.1) Non-Potable Water(Inorganic Parameters: EPA 1312, 3005A,200.7, 410.4, 1664A, SM2540D, 5210B, 5220D, 4500- P,BE. Organic Parameters: EPA 3510C, 3630C, 5030B, 625, 624, 608, 8081A, 8081B, 8082, 8082A, 8151A, 8260B, 8270C, 8270D, 8330) Solid & Hazardous Waste (Inorganic Parameters: EPA 350.1, 1010, 1030, 1311, 1312, 3050B, 3060A, 60106, 6010C, 7196A 7471A 9010B 9012A 9014, 90406, 9045C, 9050, 9065, SM 4500NH3-H. Organic Parameters: 3540C, 3546, , g 3580A, 3630C, 5035, 8015B, 8015C, 8081A, 8081B, 8082, 8082A, 8151A, 826013, 8270C, 8270D, 8330) Rhode Island Department of Health Certificate/Lab ID: LAO00065. NELAP Accredited via IVY-DOH. I� Refer to MA-DEP Certificate for Potable and Non-Potable Water. Refer to NJ-DEP Certificate for Potable and Non-Potable Water. Texas Commisson on Environmental Quality Certificate/Lab ID: T104704476-09-1. NELAP Accredited. Non-Potable Water(Inorganic Parameters: EPA 120.1, 1664, 200.7,200.8, 245.1, 245.2, 300.0, 350.1, 351.1, 353.2, 410.4,420.1,6010, 6020, 7196, 7470, 9040, SM 21206,2310B, 2320B, 251013, 2540B, 2540C,2540D,426C, 4500CL- E,4500CN-E,4500E-C, 4500H+B,4500NH3-H, 4500NO2B,4500P-E,4500 S2 D, 510C, 5210B, 5220D, 5310C, 5540C. Organic Parameters: EPA 608, 624, 625, 8081, 8082, 8151, 8260, 8270, 8330.) Solid&Hazardous Waste(Inorganic Parameters: EPA 1311, 1312, 9012, 9014, 9040, 9045, 9050, 9065.) Virginia Division of Consolidated Laboratory Services Certificate/Lab ID:460195. NELAP Accredited. Non-Potable Water(Inorganic Parameters: EPA 3005A,3015,1312,6010B,6010C,SM4500S-D, SM4500-CN-CE, Lachat 10-204-00-1-X. Organic Parameters: EPA 8260B) Solid&Hazardous Waste(Inorganic Parameters: EPA 3050B, 1311, 1312, 6010B, 6010C, 903013, 901013, 9012A, 9014. Organic Parameters: EPA 5035, 5030B, 8260B, 8015B, 8015C.) Department of Defense, L-A-B Certificate/Lab ID: L2217. Drinking Water(Inorganic Parameters: SM 4500H-B. Organic Parameters: EPA 524.2, 504.1.) Non-Potable Water (Inorganic Parameters: EPA 200.7, 200.8, 6010B, 6010C, 6020, 6020A, 245.1, 245.2, 7470A, 9040B, 9010B, 180.1. 300.0, 332.0, 6860, 353.2, 410.4, 9060, 1664A, SM 4500CN-E, 4500H-B,4500NO3-F, 4500CL-D, 5220D, 5310C, 2130B, 2320B, 2540C, 3005A, 3015, 9010B, 9056. Organic Parameters: EPA 8260B, 8260C, 8270C, 8270D, 8270C-SIM, 8270D-SIM, 8330A, 8082, 8082A, 8081A, 80816, 3510C, 5030B, MassDEP EPH, MassDEP VPH.) Solid&Hazardous Waste(Inorganic Parameters: EPA 200.7, 6010B, 6010C, 7471A, 6860, 1311, 1312, 3050B, 7196A, 901013, 9012A, 90406, 9045C, 3500-CR-D,4500CN-CE,2540G, Organic Parameters: EPA 8260B, 8260C, 8270C, 8270D, 8270C-SIM, 8270D-SIM, 8330A/B-prep, 8082, 8082A, 8081A, 8081B, 3540C, 3546, 3580A, 5035A, MassDEP EPH, MassDEP VPH.) The following analytes are not included in our current NELAP/TNI Scope of Accreditation: EPA 8260B: Freon-113, 1,2,4,5-Tetramethylbenzene, 4-Ethyltoluene. EPA 8330A: PETN, Picric Acid, Nitroglycerine, 2,6-DANT, 2,4-DANT. EPA 8270C: Methyl naphthalene, Dimethyl naphthalene, Total M ethyl na pth alenes, Total Dimethylnaphthalenes, 1,4-Diphenylhydrazine (Azobenzene). EPA 625: 4-Chloroaniline, 4-Methylphenol. Total Phosphorus in a soil matrix, Chloride in a soil matrix,TKN in a soil matrix, NO2 in a soil matrix, NO3 in a soil matrix, SO4 in a soil matrix. EPA 9071: Total Petroleum Hydrocarbons, Oil&Grease Page 16 of 17 LPH CHAINF CUSTODY PAGE 1 OF Date Rec'd In,Lab 4'rw' AA Job'#F19 �f 1 i • ecte • -•• n • • y, _ - 6- vAtN ❑ FAX ® ENTAIL ® Same as Client info PO#:10213.. N Westborough,MA Mansfield,MA TEL:508-898-9220 TEL:508-822-9300 Project Name:Hash Residence ❑ ADEX :❑ Add1 Deliverables ' N FAX:.508.898.9193 FAX:508-822,3288 Client Inf6rinniatiOn Project Location:Ostetville,MA State/Fed Program Criteria Client:Bennett Environmental Associates Project.#:BEA10-10213 Z Address:1573 Main Street/P.O.Box 1743 Project Manager.David C.Bennett to L Brewster,MA 02631 ALPHA Quote.#: c.—Phone:508-896-1706 ANALYSIS. Fax:508-896-5109 ®Standard' ©Rush(ONLY IF PRE-APPROVED) SAMPLE HANDLING Email:sfarrerikopf@bennett-ea:com Filtration t'r a, .'Q.t Done ❑These samples have been Previously analyzed by Alpha Due Date: ` I Ime:t IR Not Needed 0 Lab to do Other Project Specific Requirements/Comments/Detection Limits: Preservation 0 Lab to do ' ❑ (Please specify 00 below) cc aALPHA:La'tS ID' Sample lD Collection Sample Z sampler's... .. '?��(LaIt. L nlyj i .';: Date Time Matrix Initials __. . . ._.� m to Z to .Y .... F— ... mmten�ecfflc Z Comments Effluent '- i WVV ® ® ® ❑. ❑ ❑., ❑ :❑ ❑ ❑ .❑ ❑ 3 w ;; ❑: ❑ ❑ ❑ ❑ .❑ ❑ ❑ ❑ ❑ ❑ El ti. iF;.;; ❑ ❑ ❑ ❑El ❑' El El ❑ ❑ ❑ is :, ,*` ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ a (.r;. ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 3 Container Type P P P Preservative 0 0 D _ _ Please prin(.clearly,legibly and'bompletely:.Samples can not be logged ih and, Relinquishe Date/Time R ceiv By: aterTime rnarouhd time clock` ill.'not .. - .start until, a g ny ambi. uitie's.are..Arf;a*4 JAZI 11L, `t� resctyed..AII samples..' ' � FORM NO:er•01(I-N.p re sutijecNto_ p (rev.tANPR•09) _ � ` �Klt�l'K. trienf`Terr'ns:. _ � 0) LL 1 7- -� _ BENNETT ENVIRONMENTAL ASSOCIATES, INC. LICENSED SITE PROFESSIONALS,ENVIRONMENTAL SCIENTISTS,GEOLOGISTS,ENGINEERS 1573 Main Street,P.O.Box 1743 (508)896-1706 Brewster,MA 02631 fax(508)896-5109 LETTER OF TRANSMITTAL TO: DATE: JOB NUMBER: Massachusetts Department of Environmental Protection 9/13/11 BEA10-10213 Attention:Title 5 Program 1 Winter Street-6th Floor Boston,MA 02108 REGARDING: Hash Residence 4 199 Craigville Beach Road SHIPPING METHOD: Centerville,MA 02632 Regular Mail ❑ Pick Up ❑ Priority Mail ❑ Hand Deliver ❑ Express Mail ❑ Other ❑ Certified Mail Green Card/RR ❑ COPIES DATE DESCRIPTION 1 DEP Approved Inspection and O&M Form for Title 5 UA Treatment and Disposal Systems(July 2011) 1 7/20/11 Groundwater Analytical laboratory report For review and comment: ❑ For approval: ❑ As requested: ❑ For your use: x❑ REMARKS: Please find enclosed the DEP Inspection and O&M Form for operation and maintenance conducted at the above referenced property during the reporting period. If you have any questions or require additional information,please contact us at your earliest convenience. Thank you. cc:Barnstable Board of Health Ms.Mary Hash,Owner David C.Bennett,Principal[Internal] Matthew Costa,OMNI Environmental Systems,Inc. FROM: David C.Bennett,WWTO#6243/Samantha Farrenkopf,WWTO#13265/Joseph Smith,WWTO#12529 If enclosures are not as noted,kindly notify us at once f LlMassachusetts Department of Environmental Protection Bureau of Resource Protection -Title 5 DEP Approved Inspection and O&M Form for Title 5 I/A Treatment and Disposal Systems A. Installation Important:When Mary Hash filling out forms Owner on the computer, use only the tab 1199 Craigville Beach Road key to move your Facility Street Address cursor-do not Centerville 02632 use the return key. City Zip Mailing address of owner, if different: 3944 Baltimore Street Street Address/PO Box: Kensington MD 20895 City State Zip (301)942-2110 ext. Telephone Number B. Authorized Service Provider BENNETT ENVIRONMENTAL ASSOCIATES, INC. 0&M Firm 1573 Main Street/ PO Box 1743 Street Address Brewster MA 02631 city State Zip (508)896- 1706 ext. 129 Telephone Number Samantha Farrenkopf 13265 Certified Operator Name Certification Number C. Facility/System Information OMNI RSF-PF DEP ID Manufacturer ID Model Number Unknown Unknown Installation Date Start of Operation Approval Type: ® General ❑ Provisional ❑ Piloting ❑ Remedial Seasonal Residence—used less than 6 mo./year: ® Yes ❑ No D. Operating Information 7/11/11 7/6/10 Inspection Date Previous Inspection Date 4"of Sludge , 1"scum Layer Pumping Recommended ❑ Yes ® No Sludge Depth(to be checked yearly) t5aiom.doc•rev.11-07-05 Page 1 of 3 LlMassachusetts Department of Environmental Protection Bureau of Resource Protection - Title 5 DEP Approved Inspection and O&M Form for Title 5 I/A Treatment and Disposal Systems E. Field Testing Field Inspection: Color: ❑ gray ❑ brown ® clear ❑ turbid ❑ Other(specify): Odor: ® musty ❑ earthy ❑ moldy ❑ offensive ❑ turbid Effluent Solids: ® no ❑ some pH 7.0 SU DO 14.30 mg/L Turbidity 1.18 NTU 6 to 9 2 or greater 40 or less Should a Remedial or General Use system fail the Field Testing, effluent samples shall be collected per Standard Methods and analyzed for BOD and TSS. F. Sampling Information Samples Taken: ❑ Influent ® Effluent Commercial systems or systems with a design flow of 2000 gpd and greater, and General Use nitrogen reducing systems: gpd Parameters sampled: ❑ pH ® BOD ❑ CBOD ® TSS ❑TN ® Other(list below) Nitrate Nitrite TKN Other 1 Other 2 Other 3 G. Inspection and Maintenance Description of any maintenance performed since previous inspection &during this inspection: Performed regularly scheduled preventitive 0&M for system, pulled effluent samples for lab analysis and conducted effluent quality field testing. Notes and Comments: System functioning properly and effluent quality passed field testing. t5aiom.doc•rev.11-07-05 Page 2 of 3 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Title 5 DEP Approved Inspection and O&M Form for Title 5 I/A Treatment and Disposal Systems H. Certification certify: I have inspected the sewage treatment and disposal system at the address above, have conducted the required Field Testing and/or sample collection in accordance with Standard Methods, have completed this report and the attached technology operation and maintenance checklist, and the information reported is true, accurate, and complete as of the time of the inspection. I am a Massachusetts certified operator in accordance with 257 CMR 2.00. �1?�I1t per or Signa ure Date System owner must submit this report, technology O&M checklist, and any required sampling results to the local board of health and DEP as follows for each inspection performed: Remedial Use—by January 31 st of each year for the previous calendar year Piloting Use-within 45 days of inspection date Provisional Use—by March 31th of each year for the previous 12 months General Use—by September 30th of each year for the previous 12 months Send to: Department of Environmental Protection Attention: Title 5 Program One Winter Street, 6th Floor Boston, MA 02108 t5aiom.doc•rev.11-07-05 Page 3 of 3 GROUNDWATER Groundwater Analytical,Inc. P.O.Box 1200 ANALYTICAL 228 Main Street Buzzards Bay,MA 02532 Telephone(508)759-4441 FAX(508)759-4475 www.groundwateranalytical.com July 20, 2011 Mr. David Bennett Bennett Environmental Associates, Inc. P.O. Box 1743 Brewster, MA 02631 . LABORATORY REPORT Project: Hash Residence/BEA10-10213 Lab ID: 143314 Received: 07-12-11 Dear Dave: Enclosed are the analytical results for the above referenced project. The project was processed for Priority turnaround. This letter authorizes the release of the analytical results, and should be considered a part of this report. This report contains a sample receipt report detailing the samples received, a project narrative indicating project changes and non-conformances, a quality control report, and a statement of our state certifications. The analytical results contained in this report meet all applicable NELAC standards, except as may be specifically noted, or described in the project narrative. The analytical results relate only to the samples received. This report may only be used or reproduced in its entirety. attest under the pains and penalties of perjury that, based upon my inquiry of those individuals immediately responsible for obtaining the information, the material contained in this report is, to the best of my knowledge and belief, accurate and complete. Should you have any questions concerning this report, please do not hesitate to contact me. Sincerely, 2tir�c� Karyn E. Raymond Project Manager KER/ker Page 1 of 11 GROUNDWATER ANALYTICAL Sample Receipt Report Project: Hash Residence/BEA10-10213 Delivery: GWA Courier Temperature: 3.0°C Client: Bennett Environmental Associates,Inc. Airbill: n/a Chain of Custody: Present Lab ID: 143314 Lab Receipt: 07-12-11 Custody Seal(s): n/a iv`"�ali IDS` ,Feld ID:;s' ''b ..: Mafnx" Sam led a '+R Method '= - 'x a ' " Notes t:fi Kj�44; ....r_ ! b.#`,-Y.:SL4..,s.„eR.A 3c�'x. r .,;n.:a"',.,r..a.«•_ _ ) 3 t.,..k^k P 143314-1 Effluent Aqueous 7111111 9:15 Lachat 10-107-04-1-C(SM 4500-NC3 F)Nitrate Lachat 10-107-04-1-C(SM 4500-NO3 F)Nitrite Con ID Container Vendor QC Lot Presery QC Lot Prep Ship C2039255 250 mL Plastic n/a n/a None n/a n/a n/a LaIID°� Feld lO # s 'Matnx r'Sam led Py lNethod a " . P>... „r .,:ai�c Notes. ut .. f.a -r 143314-2 Effluent Aqueous 7111111 9:15 Lachat 10-107-06-2-D(EPA 351.2)TKN Lon ID Container Vendor QC Lot Presery QC Lot Prep Ship C2024257 250 mL Plastic Industrial BX39112 H2504 R-6407C 05-06-11 n/a 1`- LaklD ,x; .Fieldll) ��nb twa ,aMatnxr ; Sampled, aMe{hod� a ;A r1' s ;_ ,.�7 « ;yam? Nofesl "Fc� A nf, 2 143314-3 Effluent Aqueous 7/11/11 9:15 SM 5210 B Biochemical Oxygen Demand SM 2540 D Total Suspended Solids Con ID Container Vendor QC Lot Presery QC Lot Prep Ship C2034316 1LPlastic Proline BX39291 None n/a n/a n/a C2034258 1LPlastic Proline BX39291 None n/a n/a n/a Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 Page 2 of 11 GROUNDWATER - ANALYTICAL Inorganic Chemistry Field ID: Effluent Matrix: Aqueous Project: Hash Residence/BEA10-10213 Received: 07-12-11 18:10 Client: Bennett Environmental Associates,Inc. Lab ID: 143314-01 Sampled: 07-11-11 09:15 Container:250 mL Plastic Preservation: Cool Analyte _ ?'kResult.`'� Units RL._ DF Vol r QCatch Method '_Inst N�Nitrate(as Nitrogen) 9.4 mg/L 0.1 5 1 mL11 21:25 NI-4922-W "0h"10.107—" (W 1 LD 15COW03 F) Nitrite(as Nitrogen) 0.20 mg/L 0.02 1 5 mL 07-12-11 21:01 NI4922-W �h.t 6107-4 (SM 1 L) 45001J03 n Lab ID: 143314-02 Sampled: 07-11-11 09:15 container:250 mL Plastic Preservation: H2SO4/Cool =�,,-;��?: Arialyte.��,_` „'��� Result:' _Units RL�` D_F Voluriie �Analyied,."aQC Batch ,,Method _Irist �Irn Nitrogen,Total Kjeldahl(TKN) 2.0£ mg/L 0.5 r 1 t 20 ML9 07-16-11 72:28 TKN-2959-W 1chi10.1351101-0)y (Ep A u Lab ID: 143314-03 Sampled: 07-11-11 09:15 container: 1L Plastic Preservation: Cool ti, ? uAnalyteo-`a � ResultmK ,UnttsRL 3DF VolumeTIT,AnalyzedQCBatch Method Instr Biochemical Oxygen Demand BRL mg/L. 2 1 3001nL 07-13-11 00:02 BOD-3891-W 5M 5210 B 2 UD Solids,Total Suspended BRL mg/L 2 7 500 mL 07-14-11 17:14 TSS-1949-W SM 2540 D 3 BH Method Reference: Methods for Chemical Analysis of Water and Wastes,US EPA,EPA-600/4-790-020(Revised 1983),and Methods for the Determination of Inorganic Substances in Environmental Samples,US EPA,EPA/600/R-93/100(1993),and Standard Methods for the Examination of Water and Wastewater,APHA,Twentieth Edition(1998),and Test Methods for Evaluating Solid Waste,US EPA,SW-846,Third Edition,Update III(1996). Report Notations: BRL Indicates concentration,if any,is below reporting limit for analyte. Reporting limit is the lowest concentration that can be reliably quantified under routine laboratory operating conditions. Reporting limits are adjusted for sample size and dilution. RL Reporting Limit. DF Dilution Factor. 1 Instrument ID: Lachat 8000 Autoanalyzer 2 Instrument ID: YSI 5100 3 Instrument ID: Mettler AT 200 Balance Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 Page 3 of 11 GROUNDWATER ANALYTICAL Project Narrative Project: Hash Residence/BEA10-10213 Lab ID: 143314 Client: Bennett Environmental Associates,Inc. Received: 07-12-11 18:10 vi A Documen-AiGWtation and'CUent C m omumcafion y q„ ioate'... a`^'z•. 5" i The following documentation discrepancies,and client changes or amendments were noted for this project: 1 . No documentation discrepancies,changes,or amendments were noted. �az BT'Method Modifications,Non-Conformances,and Observations ,Fatt� E'. . : .�. of s� :��tr ���,gs�.�'#+t��"ys+��+t ;. a��u:�.r«psi= x;i�'s ;f ���`��"`• . The sample(s) in this project were analyzed by the references analytical method(s),and no method modifications, non-conformances or analytical issues were noted,except as indicated below: 1 . No method modifications, non-conformances or analytical issues were noted. Groundwater Analytical, Inc., P.O. Box 1200,228 Main Street, Buzzards Bay, MA 02532Page 4 of 11 r a a •� iM'kt aXW"AaVri O .DaxCwn@'rJp�iC'mimo-JF.na rsa; :i»W: : n^:..: - � ;;n§':W�+vctammz aaaUvkm6P.aaWdII�imnt ,F7t ".�' �. 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Ir'. &eai K ❑i W.C tE'J w p w ID y a s E m S a1Ai 0. cc •. 9W lnaaa if 3 Sil:. * tZ Ark ,rok'. �. 6, p O mum AIT -1:Yi � � $ Z di. .3 `!:L�uN � t'z"^% y3c;: Lt1 ¢m�c z'=, ❑ m !i Op 4 9 S as1+ . `: a t i1 E :�`Q an ¢E. a a.. a p _.;.?§ws ¢. ? uM`:• x3. ¢•'; € �: roLF a m-m a U R.u to9YlayNS ': ' F o m H.anez . 3 a .. ,• G �'y e sac�me�wwaVIIp N m n p�+�- 9aly„auN.mirya>:a ,�*F m a 'Ls -" � ��3 m a:m maronI as � a � $' 3 3 F.e m ro m d: CL , '.._�'NNm ��a s'. � �� vk.Y. ¢ m' '7 CI ❑.-..❑ ❑ CI b L']: ati J .m amonimquanm q. 4, a S 1 a a �z Ewaf tn. ❑ O O ❑ ❑ ❑'O y an•m N S®z 5 `i aYn: ea.F t `I.g g n� m 49 0 +� eu9naasarsrmm -it sus At v Z .g N . q.'.FRS' 'p Alk gg. lzy; a v 1 a ; a` cc we C3 W. w ap aP, PNe of 1 W > GROUNDWATER ANALYTICAL Quality Assurance/Quality Control �'" � .� r,�"^'� R{r ^ tx'•".. ,F,' w,� r -w-.-,»x`v's'J` .. arm � � ,Y � �•�'"`� � c ��' �' + .+�c.,,f �`�' ° Groundwater Analytical conducts an active Quality Assurance program to ensure the production of high quality, valid data. This program closely follows the guidance provided by Interim Guidelines and Specifications for Preparing Quality Assurance Project Plans, US EPA QAMS-005/80 (1980), and.Test Methods for Evaluating Solid Waste, US EPA,SW-846, Update III (1996). Quality Control protocols include written Standard Operating Procedures (SOPs) developed for each analytical method. SOPS are derived from US EPA methodologies and other established references. Standards are prepared from commercially obtained reference materials of certified purity, and documented for traceability. Quality Assessment protocols for most organic analyses include a minimum of one laboratory control sample, one method blank, one matrix spike sample, and one sample duplicate for each sample preparation batch. All samples, standards, blanks, laboratory control samples, matrix spikes and sample duplicates are spiked with internal standards and surrogate compounds. All instrument sequences begin with an initial calibration verification standard and a blank; and excepting GC/MS sequences, all sequences close with a continuing calibration standard. GC/MS systems are tuned to appropriate ion abundance criteria daily, or for each 12 hour operating period,whichever is more frequent. Quality Assessment protocols for most inorganic analyses include a minimum of one laboratory control sample, one method blank, one matrix spike sample, and one sample duplicate for each sample preparation batch. Standard curves are derived from one reagent blank and four concentration levels. Curve validity is verified by standard recoveries within plus or minus ten percent of the curve. Wx4 3r' 'a.%^ Definitions Ail Batches are used as the basic unit for Quality Assessment. A Batch is defined as twenty or fewer samples of the same matrix which are prepared together for the same analysis, using the same lots of reagents and the same techniques or manipulations,all within the same continuum of time, up to but not exceeding 24 hours. Laboratory Control Samples are used to assess the accuracy of the analytical method. A Laboratory Control Sample consists of reagent water or sodium sulfate spiked with a group of target analytes representative of the method analytes. Accuracy is defined as the degree of agreement of the measured value with the true or expected value. Percent Recoveries for the Laboratory Control Samples are calculated to assess accuracy. Method Blanks are used to assess the level of contamination present in the analytical system. Method Blanks consist of reagent water or an aliquot of sodium sulfate. Method Blanks are taken through all the appropriate steps of an analytical method. Sample data reported is not corrected for blank contamination. Surrogate Compounds are used to assess the effectiveness of an analytical method in dealing with each sample matrix. Surrogate Compounds are organic compounds which are similar to the target analytes of interest in chemical behavior, but which are not normally found in environmental samples. Percent Recoveries are calculated for each Surrogate Compound. Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 Page 6 of 11 GROUNDWATER ANALYTICAL Quality Control Report Laboratory Control Sample Category: Inorganic Chemistry Matrix: Aqueous r -AnalyYe e.„ , pqovery Units Splked Atea;ured Rec QC L1m1ts,;,, Ana(yX ,QC Ba#ch „Method lost a+alyst Solids,Total Suspended mg/L 100 88 86 % 80-120% 07-14-11 14:43 TSS-1949-W SM 2540 D 3 BH Total Kjeldahl Nitrogen(rKN) mg/L 40 39 98 % 80-120% 07-16-11 12:14 TKN-2959-W L h.-m-0 1 )R (EPA 351.2) Nitrite(as Nitrogen) mg/L 1.0 1.1 107% 80-120% 07-12-11 20:35 NI-4922•W 06,t1 0-1-C 1 LD (SM 4500NO3 F) Nitrate(as Nitrogen) mg/L 2.0 2.1 104 % 80-120% 07-12-11 20:35 NI4922-W 1c1i1010'--C 1 LD (SM 4500NO3 F) Biochemical Oxygen Demand mg/L 1 200 1 220 1 112 % 1 85-115%1 07-12-11 17:32 1 BOD-3891-W SM 5210 B 2 BH Method Reference: Methods for Chemical Analysis of Water and Wastes,US EPA,EPA-600/4-790-020(Revised 1983),and Methods for the Determination of Inorganic Substances in Environmental Samples,US EPA,EPA/600/R-93/100(1993),and Standard Methods for the Examination of Water and Wastewater,APHA,Twentieth Edition(1998),and Test Methods for Evaluating Solid Waste,US EPA,SW-846,Third Edition,Update III(1996). Report Notations: All calculations performed prior to rounding. Quality Control Limits are defined by the methodology; or alternatively based upon the historical average recovery plus or minus three standard deviation units. 1 Instrument ID:.Lachat 8000 Autoanalyzer 2 Instrument ID: YSI 5100 3 Instrument ID: Mettler AT 200 Balance Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 Page 7 of 11 GROUNDWATER ANALYTICAL Quality Control Report Method Blank Category: Inorganic Chemistry Matrix: Aqueous Analyteat r, Result' Units4RL`x Analyed; QCyBatch S wMethod�s� Irst Analyst Solids,Total Suspended BRL mg/L .2 07-14-11 14:43 TSS-1949-W SM 2540 D 3 BH Total Kjeldahl Nitrogen(TKN) BRL mg/L 0.5 07-16-11 12:14 TKN-2959-W """'"101-06SD 1 )R (EPA 351.2) Nitrite(as Nitrogen) BRL mg/L 0.02 07-12-11 20:35 NI4922-W `"""'°'07-0 1` 1 LID (SM 45MN03 n Nitrate(as Nitrogen) BRL mg/L 0.02 07-12-11 20:35 NI4922-W Lthi 1-7-1L 1 LID 114101131 Biochemical Oxygen Demand BRL. I mg/L 2 1 07-12-11 17:32 BOD-3891-W SM 5210 B 2 BH Method Reference: Methods for Chemical Analysis of Water and Wastes,US EPA,EPA-600/4790-020(Revised 1983),and Methods for the Determination of Inorganic Substances in Environmental Samples,US EPA,EPA/600/R-93/100(1993),and Standard Methods for the Examination of Water and Wastewater,APHA,Twentieth Edition(1998),and Test Methods for Evaluating Solid Waste,US EPA,SW-846,Third Edition,Update III(1996). Report Notations: BRL Indicates concentration,if any,is below reporting limit for analyte. Reporting limit is the lowest concentration that can be reliably quantified under routine laboratory operating conditions. Reporting limits are adjusted for sample size and dilution. RL Reporting Limit. 1 Instrument ID: Lachat 8000 Autoanalyzer 2 Instrument ID: YSI 5100 3 Instrument ID: Mettler AT 200 Balance Groundwater Analytical, Inc., P.O. Box 1200,228 Main Street, Buzzards Bay,MA 02532 Page 8 of 11 _ I GROUNDWATER ANALYTICAL Certifications and Approvals Groundwater Analytical maintains environmental laboratory certification in a variety of states. Copies of our current certificates may be obtained from our website: httl2://www.groundwateranalZical.com/qualifications.htm s CONNECTICUT �u f ? � ** a <.�t�3{z? s � it '-n' Department of Health Services,PH-0586 Potable Water,Wastewater,Solid Waste and Soil http://www.ct.gov/dph/I ib/dph/envi ron mental_health/environmental_laboratories/pdf/Out_State.pdf ?MASSACHUSETTSr Department of Environmental Protection, M-MA-103 Potable Water and Non-Potable Water .http://publ ic.dep.state.ma.us/labcert/labcert.aspx Department of Labor, Asbestos Analytical Services,Class A Division of Occupational Safety, AA000195 http://www.mass.gov/dos/forms/la-rpt_list—aa.pdf NEW HAMPMIREkW_'�Z Department of Environmental Services, 202708 Potable Water,Non-Potable Water,Solid and Chemical Materials http://www4.egov.nh.gov/DES/NH E LAP rNEW__l!ORK ' Department of Health, 11754 Potable Water,Non-Potable Water,Solid and Hazardous Waste http://www.wadsworth.orgAabcertlelap/comm.html .RHODEISLAIV_D �;a.r�t _,:<�`� r�. ��x��� �:3a�xr ...,��', �'��" �!^�s�*��>• ?��s+'�r,;�r �. .�++r,r "' Department of Health, Potable and Non-Potable Water Microbiology,Organic and Inorganic Chemistry Division of Laboratories, LA000054 http://www.health.ri.govAabs/outofstatelabs.pdf :U S'DEPARNT EA,TMEGRICULTURE " 5 .. 'A USDA,Soil Permit, S-53921 Foreign soil import permit ;. �,VERMOIVT,��_ 1���;�_..��._;�'t. # =��� �°t-�.-�3 •, � :?�'' �,��'"� aim' t� 'a�. :+ a+ � I Department of Health, VT-87643 Potable Water http://healthvermont.gov/enviro/ph_lab/Water—test.aspx#cert Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 Page 9 of 11 GROUNDWATER ANALYTICAL Certifications and Approvals 'INASSACHUSETTS;a � ;� 1 Departmentof;EnviroIn talProtectlon?14=MA=103 Groundwater Analytical maintains MassDEP environmental laboratory certification for only the methods and analytes listed below. Analyses for certified analytes are conducted in accordance with MassDEP certification standards,except as may be specifically noted in the project narrative. Potable Water(Drinking Water) Non-Potable Water(Wastewater) Analyte Method Analyte Method 1,2-Dibromo-3-Chloropropane EPA 504.1 Aluminum EPA 200.8 1,2-Dibromoethane EPA 504.1 Ammonia-N Lachat 10-107-06-1-B Alkalinity,Total SM 2320-B Antimony EPA 200.7 Antimony EPA 200.8 Antimony EPA 200.8 Arsenic EPA 200.8 Arsenic EPA 200.7 Barium EPA 200.7 Arsenic EPA 200.8 Barium EPA 200.8 Beryllium EPA 200.7 Beryllium EPA 200.7 Beryllium EPA 200.8 Beryllium EPA 200.8 Beta-BHC EPA 608 Cadmium EPA 200.7 Biochemical Oxygen Demand SM 5210-13 Cadmium EPA 200.8 Cadmium EPA 200.7 Calcium EPA 200.7 Cadmium EPA 200.8 Chlorine,Residual Free SM 4500-CL-G Calcium EPA 200.7 Chromium EPA 200.7 Chemical Oxygen Demand SM 5220-D Copper EPA 200.7 Chlordane EPA 608 Copper EPA 200.8 Chloride EPA 300.0 Cyanide,Total Lachat 10-204-00-1-A Chlorine,Total Residual SM 4500-CL-G E.Coli(Treatment and Distribution) Enz.Sub.SM 9223 Chromium EPA 200.7 E.Coli(Treatment and Distribution) NA-MLIG SM 9222-G Chromium EPA 200.8 Fecal Coliform(Source Water) MF SM 9222-D Cobalt EPA 200.7 Fluoride EPA 300.0 Cobalt EPA 200.8 Fluoride SM 4500•F-C Copper EPA 200.7 Haloacetic Acids EPA 552.2 Copper EPA 200.8 Heterotrophic Plate Count SM 9215-B Cyanide,Total Lachat 10-204-00-1-A Lead EPA 200.8 DDD EPA 608 Mercury EPA 245.1 DOE EPA 608 Nickel EPA 200.7 DDT EPA 608 Nickel EPA 200.8 Delta-BHC EPA 608 Nitrate-N EPA 300.0 Dieldrin EPA 608 Nitrate-N Lachat 1 04 0 7-04-1-C Endosulfan I EPA 608 Nitrite-N EPA 300.0 Endosulfan 11 EPA 608 Nitrite-N Lachat 10-107-04-1-C Endosulfan Sulfate EPA 608 pH SM 4500-H-B, Endrin EPA 608 Selenium EPA 200.8 Endrin Aldehyde EPA 608 Silver EPA 200.7 Gamma-BHC EPA 608 Silver EPA 200.8 Hardness(CaCO3),Total EPA 200.7 Sodium EPA 200.7 Hardness(CaCO3),Total SM 2340-B Sulfate EPA 300.0 Heptachlor EPA 608 Thallium EPA 200.8 Heptachlor Epoxide EPA 608 Total Coliform(Treatment and Distribution) Enz.Sub.SM 9223 Iron EPA 200.7 Total Coliform(Treatment and Distribution) MF SM 9222-B Kjeldahl-N Lachat 10-107-06-02-D Total Dissolved Solids SM 2540-C Lead EPA 200.7 Trihalomethanes EPA 524.2 Magnesium EPA 200.7 Turbidity SM 2130-B Manganese EPA 200.7 Volatile Organic Compounds EPA 524.2 Manganese EPA 200.8 Mercury EPA 245.1 Non-Potable Water(Wastewater) Molybdenum EPA 200.7 Analyte Method Molybdenum EPA 200.8 Nickel EPA 200.7 Aldrin EPA 608 Nickel EPA 200.8 Alkalinity,Total SM 2320-B Nitrate-N EPA 300.0 Alpha-BHC EPA 608 Nitrate-N Lachat 10-107-04-1-C Aluminum EPA 200.7 Non-Filterable Residue SM 2540-D Oil and Grease EPA 1664 Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 Page 10 of 11 f GROUNDWATER ANALYTICAL Certifications and Approvals MASSACHUSETTS , '- .` r `f,W-0 Department of,Environ_'mental Piote`ction .M MA=103 Groundwater Analytical maintains MassDEP environmental laboratory certification for only the methods and analytes listed below. Analyses for certified analytes are conducted in accordance with MassDEP certification standards,except as may be specifically noted in the project narrative. Non-Potable Water(Wastewater) Analyte Method Orthophosphate Lachat 10-115-01-1-A pH SM 4500-H-B Phenolics,Total EPA 420.4 Phenolics,Total Lachat 10-210-00-1-B Phosphorus,Total Lachat 10-115-01-1-C Phosphorus,Total SM 4500-P-B,E Polychlorinated Biphenyls(Oil) EPA 600/4-81-045 Polychlorinated Biphenyls(Water) EPA 608 Potassium EPA 200.7 Selenium EPA 200.7 Selenium EPA 200.8 Silver EPA 200.7 Sodium EPA 200.7 Specific Conductivity SM 2510-13 Strontium EPA 200.7 Sulfate EPA 300.0 SVOC-Acid Extractables EPA 625 SVOC-Base/Neutral Extractables EPA 625 Thallium EPA 200.7 Thallium EPA 200.8 Titanium EPA 200.7 Total Dissolved Solids SM 2540-C Total Organic Carbon SM 5310-B Toxaphene EPA 608 Vanadium EPA 200.7 Vanadium EPA 200.8 Volatile Aromatics EPA 602 Volatile Aromatics EPA 624 Volatile Halocarbons EPA 624 Zinc EPA 200.7 Zinc EPA 200.8 Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 Page 11 of 11 BENNETT ENVIRONMENTAL ASSOCIATES, INC. LICENSED SITE PROFESSIONALS,ENVIRONMENTAL SCIENTISTS,GEOLOGISTS,SANITARIANS 1573 Main Street,P.O.Box 1743 (508) 896-1706 Brewster,MA 02631 fax(508)896-5109 LETTER OF TRANSMITTAL TO: DATE: JOB NUMBER: Massachusetts Department of Environmental Protection 9/24/10 BEA10-10213 Attention:Title 5 Program 1 Winter Street-6th Floor Boston,MA 02108 REGARDING: Hasse Residence .JWCraigville Beach Road -- 'Centei-01e,MA 02632 SHIPPING METHOD: Regular Mail ❑ Federal Express ❑ Certified Mail ❑X UPS ❑ . Priority Mail ❑ Pick Up ❑ Express Mail ❑ Hand Deliver ❑ COPIES DATE DESCRIPTION 1 DEP Approved Inspection and O&M Form for Title 5 I/A Treatment and Disposal Systems(July 2010) For review and comment: ❑ For approval: ❑ As requested: ❑ For your use: '❑X REMARKS: Please find enclosed the DEP Inspection and O&M Form for operation and maintenance conducted at the above referenced property. If you have any questions or require additional information,please contact us at your earliest convenience. Thank you. cc:Barnstable Board of Health Ms.Mary Hash,Owner David C.Bennett,Principal[Internal] c ..I c O CO � r-n FROM: David C.Bennett,WWTO#6243/Samantha Farrenkopf,WWTO#13265/Joseph Smith,WWTO#1W5 9 -rt cO a) If enclosures are not as noted,kindly notify us at once Massachusetts Department of Environmental Protection { ; Bureau of Resource Protection -Title 5 Ll DEP Approved Inspection and O&M Form for Title 51/A Treatment and Disposal Systems A. Installation Important: Mary Hash When filling out Owner forms on the computer,use 1199 Craigville Beach Road only the tab key Facility Street Address to move your Centerville 02632 cursor-do not City Zip use the return key. Mailing address of owner, if different: -�I 3944 Baltimore Street Street Address/PO Box: Kensington MD 20895 B"0! City State Zip (301) 942-2110 ext. Telephone Number B. Authorized Service Provider BENNETT ENVIRONMENTAL ASSOCIATES, INC. O&M Firm 1573 Main Street/PO Box 1743 Street Address Brewster MA 02631 City State Zip (508) 896- 1706 ext. 102 Telephone Number Joseph Smith 12529 Certified Operator Name Certification Number C. Facility/System Information Unknown OMNI RSF-PF DEP ID Manufacturer ID Model Number Installation Date Start of Operation Approval Type: ® General ❑ Provisional ❑ Piloting ❑ Remedial Seasonal Residence—used less than 6 mo./year. ® Yes ❑ No D. Operating Information 7/6/10 Inspection Date ", Previous Inspection Date 5"of Sludge , and No scum Layer Pumping Recommended ❑ Yes ® No Sludge Depth(to be checked yearly) t5aiom.doc•rev. 11-07-05 Page 1 of 1 r Massachusetts Department of Environmental Protection Bureau of Resource Protection - Title 5 DEP Approved Inspection and OW Form for Title 5 I/A Treatment and Disposal Systems E. Field Testing Field Inspection: Color: ❑ gray ❑ brown ® clear ❑ turbid ❑ Other(specify): Odor: ® musty ❑ earthy ❑ moldy ❑ offensive ❑ turbid Effluent Solids: ® no ❑ some pH 6.53 SU DO 3.90 mg/L Turbidity 3.62 NTU 6 to 9 2 or greater 40 or less Should a Remedial or General Use system fail the Field Testing, effluent samples shall be collected per Standard Methods and analyzed for BOD and TSS. F. Sampling Information Samples Taken: ❑ Influent ❑ Effluent Commercial systems or systems with a design flow of 2000 gpd and greater, and General Use nitrogen reducing systems: gpd Parameters sampled: ❑ pH ❑ BOD ❑ CBOD ❑ TSS ❑ TN ❑ Other(list below) Other 1 Other 2 Other 3 G. Inspection and Maintenance Description of any maintenance performed since previous inspection &during this inspection: Performed regularly scheduled preventitive O&M for system along with field sampling. Notes and Comments: System functioning, and passed field sampling. i t5aiom.doc•rev. 11-07-05 Page 2 of 2 i LlMassachusetts Department of Environmental Protection Bureau of Resource Protection - Title 5 DEP Approved Inspection and O&M Form for Title 5 I/A Treatment and Disposal Systems H. Certification I certify: I have inspected the sewage treatment and disposal system at the address above, have conducted the required Field Testing and/or sample collection in accordance with Standard Methods, have completed this report and the attached technology operation and maintenance checklist, and the information reported is true, accurate, and complete as of the time of the inspection. I am a Massachusetts certified operator in accordance with 257 fCMR 2.00. �9 6-L 110 Operator Signature Date System owner must submit this report, technology O&M checklist, and any required sampling results to the local board of health and DEP as follows for each inspection performed: Remedial Use—by January 31st of each year for the previous calendar year Piloting Use-within 45 days of inspection date j i Provisional Use—by March 31th of each year for the previous 12 months General Use—by September 30th of each year for the previous 12 months Send to: Department of Environmental Protection Attention: Title 5 Program One Winter Street,6 Floor Boston, MA 02108 I I . I t5aiom.doc•rev. 11-07-05 Page 3 of 3 BENNETT ENVIRONMENTAL ASSOCIATES, INC. LICENSED SITE PROFESSIONALS,ENVIRONMENTAL SCIENTISTS,GEOLOGISTS,SANITARIANS 1573 Main Street,P.O.Box 1743 (508)896-1706 Brewster,MA 02631 fax(508)896-5109 LETTER OF TRANSMITTAL TO: DATE: JOB NUMBER: Massachusetts Department of Environmental Protection �/15/10 BEA10-10213 Attention:Title 5 Program 1 Winter Street-6th Floor Boston,MA 02108 REGARDING: �199 Craigville Beach Roa Centerville,MA 02632.1 SHIPPING METHOD: Regular Mail Federal Express ❑ Certified Mail 0 UPS ❑ Priority.Mail ❑ Pick Up ❑ Express Mail ❑ Hand Deliver COPIES DATE DESCRIPTION 1 DEP Approved Inspection and O&M Form for Title 5 I/A Treatment and Disposal Systems(July 2010) r E� F -74 For review and comment: ❑ For approval: ❑ As requested: ❑ For your use: ❑x REMARKS: Please find enclosed the DEP Inspection and O&M Form for operation and maintenance conducted at the above referenced property. If you have any questions or require additional information,please contact us at your earliest convenience. Thank you. cc:Barnstable Board of Health Ms.Mary Hash,Owner David C.Bennett,Principal[Internal] FROM: David C.Bennett,WWTO#6243/Samantha Farrenkopf,WWTO#13265/Joseph Smith,WWTO#12529 If enclosures are not as noted,kindly notify us at once LlMassachusetts Department of Environmental Protection Bureau of Resource Protection - Title 5 DEP Approved Inspection and O&M Form for Title 5 I/A Treatment and Disposal Systems A. Installation Important: Mary Hash When filling out Owner forms on the computer,use 1199 Craigville Beach Road only the tab key Facility Street Address to move your Centerville 02632 cursor-do not use the return City Zip key. Mailing address of owner, if different: _I� 3944 Baltimore Street Street Address/PO Box: Kensington MD 20895 City State Zip (301) 942-2110 ext. Telephone Number B. Authorized Service Provider BENNETT ENVIRONMENTAL ASSOCIATES, INC. O&M Firm 1573 Main Street/PO Box 1743 Street Address Brewster MA 02631 City State Zip (508) 896- 1706 ext. 102 Telephone Number Joseph Smith 12529 Certified Operator Name Certification Number C. Facility/System Information Unknown OMNI RSF-PF DEP ID Manufacturer ID Model Number Installation Date Start of Operation Approval Type: ® General ❑ Provisional ❑ Piloting ❑ Remedial Seasonal Residence—used less than 6 mo./year: ® Yes ❑ No D. Operating Information 7-6-2010 Inspection Date Previous Inspection Date 5"of Sludge , and No scum Layer Pumping Recommended ❑ Yes ® No Sludge Depth(to be checked yearly) t5aiom.doc•rev.11-07-05 Page 1 of 1 f Massachusetts Department of Environmental Protection Bureau of Resource Protection - Title 5 DEP Approved Inspection and O&M Form for Title 5 UA Treatment and Disposal Systems E. Field Testing Field Inspection: Color: ❑ gray ❑ brown ® clear ❑ turbid ❑ Other(specify): Odor: ® musty ❑ earthy ❑ moldy ❑ offensive ❑ turbid Effluent Solids: ® no ❑ some pH 6.53 SU DO 3.90 mg/L Turbidity 3.62 NTU 6 to 9 2 or greater 40 or less Should a Remedial or General Use system fail the Field Testing, effluent samples shall be collected per Standard Methods and analyzed for BOD and TSS. F. Sampling Information Samples Taken: ❑ Influent ❑ Effluent Commercial systems or systems with a design flow of 2000 gpd and greater, and General Use nitrogen reducing systems: gpd Parameters sampled: ❑ pH ❑ BOD ❑ CBOD ❑ TSS ❑ TN ❑ Other(list below) Other 1 Other 2 Other 3 G. Inspection and Maintenance Description of any maintenance performed since previous inspection &during this inspection: Performed regularly scheduled preventitive O&M fors stem, along with field sampling. Notes and Comments: System functioning, and passed field sampling. t5aiom.doc•rev. 11-07-05 Page 2 of 2 r Massachusetts Department of Environmental Protection Bureau of Resource Protection - Title 5 DEP Approved Inspection and O&M Form for Title 5 I/A Treatment and Disposal Systems H. Certification I certify: I have inspected the sewage treatment and disposal system at the address above, have conducted the required Field Testing and/or sample collection in accordance with Standard Methods, have completed this report and the attached technology operation and maintenance checklist, and the information reported is true, accurate, and complete as of the time of the inspection. I am a Massachusetts certified operator in accordance with 257 CMR 2.00. Operator Signature Date System owner must submit this report, technology O&M checklist, and any required sampling results to the local board of health and DEP as follows for each inspection performed: Remedial Use—by January 31 st of each year for the previous calendar year Piloting Use-within 45 days of inspection date Provisional Use—by March 31'h of each year for the previous 12 months General Use—by September 30'h of each year for the previous 12 months Send to: Department of Environmental Protection Attention: Title 5 Program One Winter Street, 6 Floor Boston, MA 02108 t5aiom.doc•rev. 11-07-05 Page 3 of 3 -_� 04/15/2010 16:55 FAX —Se C— .BEN'NETT E+ NVMONMENTAE.AssociATES, INC' * LICENSED SITE PROFESSIONALS ® ENv1ItoNMENTALSCI.ENTISTS O.GEOLOGISTS Q ENGINEERS 157.3 Main Street-P.Q.Box 1743,Brewster,MA 02631 $08-898-1708 @ Fax 508-898-5109 D i+ww.bennett-ea,com 13 PROPOSAL, April 13,2010 Ms.Mary Hash 3944 Baltimore Street Kensington,MD 20895 RE: OPERATION AND MAINTENANCE CONTRACT Innovative/Alternative Wastewater Treatment System 1199 Craigville Beach Road;Barnstable,MA C . . SPY Dear Ms.Has% 8M-VNETT ENVIRONMENTAL ASSOCIATES,INC.(BEA)is pleased to provide you with a budget estimate for professional services relative to the operation and maintenance of the innovative/alternative septic system located at the above referenced property. The aomual system inspection and laboratory analysis of samples collected from the effluent of'the septic treatment system is a required condition of the approved Innovative Wastewater Treatment System,as set forth by tl,e Massachusetts Department of Environmental Protection W DEP)and the Barnstable Board of Health to qualify treatment capacity: As such,work proposed by BEA includes.the collecction bf waste~water samples for laboratory analysis and the preparation ofthe•required forms'for distributian•to the appropriate town and state offices as well as you..'Additicnally,at the time of such sampling,blowers,filters and associated piping will be irnspected.to assure working condition and regularly scheduled maintenance performed on a fixed cost basis will be invoiced on a semi-an-uual basis. Should anyrepair or treatment system component replacement be required, or additional sampling beyond the annual requirements necessary,you will be notified:to,autiorite the additional work and expenses. The following budget represents estimated annual'costs through one year of service to include sampling and inspection events. These annual costs are valid for two years subsequent to the date of the first inspection, SEMI-ANNUAL INSPECTION/MAINTENANCE/SAMPLING Inspect 1/A system and take field measurements of dissolved oxygen,pH and turbidity, Collect annual treated effluent wastewater samples under a proper chain-of-custody for analysis by a MA certified laboratoryfor analysis of SOD,TSS, and nitrlte/nitratwTICN for total nitrogen. At the time of sampling events the conditions of rho system will be inspected and documented with regards to the blower units,sludge level and associated piping. t EMERGENCY SPILL RESPONsrz WASTE SITE CLEANUP Q $ITEAS$ESSMENT Q PERMITTINa b SEPTIC.DESIGN&INSPECTION WATER 5UPPLY DEVELOPMENT,OPERATION&MAINTENANCE Q WASTEWATER TREATMENT,OPERATION&MAINTENANCE 04/ a/2010 16:55 FAX 2002 APRIL 13,2010 HASH/PR OPOSAL PAGE 2 OF 2 4410BY S LANE.OSTIMMLE,MA REPORT 1NWELING Review laboratory results rolative to conditional requimmients of the system under the MA DEP and local Board of Health approvals, Prepare DEP transmittal forms on an annual basis. Submit laboratory repott and I'DEP transmittal forms to MA DEP,local Board of Health,and associated vendoWconttactors,as appropriate,on an annual basis. Professional Fees Operation&Maintenance and Monitoring - $ 180.00 Laboratory Analysis DX TSS,BOD,TN(nitrito,nitrate,TKIV —-- $ 118.26 TOTAL ANNUAL� SE; S VS.26* // %te:]/A systetrts locatod in Barnstuble County are requircti to rcport' speetlon and same- Its on tho MA Septic onllno datebw for use by the Barnstable County Department of Health and Etiviro and the local boards ofHealth.At this time.BCDHII has found it necossery to institute annual user fees for filing on this required database. 'Phis the is$50 per year.This fee will be Inciudcd on your invoice on an annual bsgig, Therefore,if you aro in agreeinent and wish to proceed with the wort,as outlined,please sign the authorization below to indicating acknowledgement and acceptance of our Terms&Conditions and return one copy ofthis proposal to our office. Should you have any questions or need additional inforination,please contact me directly at our office. Very truly yours, MN_ETT EMq. - TAL ASSOCIATES,INC. Samantha.Farrenkopf Wastewater Program Coordit Ertor co; Kara Risk,Business Manager enol. Terms&Conditions(2009)1Fee Schedule(2010) AVT1-I0RIZAT10X; ,,PATE: / !, /j 17 I �OpVE ip Barnstable Town of Barnstable AHmedcaC0 naEMAS'S'' ' Board of Health 1 l Ass. 0 Dm 9�0 1639 �� pTfb MAt A' 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi June 14, 2009 Mary Bailey Hash 1199 Craigville Beach Road Centerville, MA 02632 RE: Monitoring of your Innovative/Alternative (OMNI) System at 1199 Craigville Beach Road, Centerville A= 206-053 Dear Ms. Mary Bailey Hash: You are granted permission to reduce sampling and monitoring of the wastewater effluent from your onsite sewage disposal system consisting of innovative/alternative technology, OMNI, at 1199 Craigville Beach Road, Centerville, to once per year. A public hearing was held before the Board of Health on May 12, 2009. The Board received the information that the property is currently being rented seasonally. Permission is granted to reduce the frequency of testing the wastewater effluent from your I/A system at your property provided it is used as a seasonal property will the following conditions: ❖ The wastewater effluent shall be tested for Total Nitrogen once per ❖ Operation and Maintenance Inspections shall be conducted on a regular basis in accordance with MA DEP Regulations. The Board voted unanimously to allow you to reduce the testing to once yearly for total nitrogen while seasonal use exists. Sincerely, Wayne Miller, M.D., Chairman BOARD OF HEALTH Qi\WPFILES\IA Monitor Adj Hash 1199 Craigville13eaehMay2009.doc EXCERPT FROM BOARD OF HEALTH MINUTES -MAY 12, 2009: I/A - Monitoring Plan Review : Mary Hash (unable to attend), owner— 1199 Craigville Beach Rd, Centerville, requesting reduction of quarterly monitoring on Omni I/A System of seasonal property. Mrs. Hash lives out of town and wrote a letter with the request. Dr. Miller acknowledged that the I/A system does not work well when they are only used seasonally and suggests the monitoring be changed to once yearly. Upon a motion duly made by Mr. Sawayanagi, seconded by Dr. Miller, the Board voted to approve the I/A system to an annual monitoring while it is a seasonal rental. (Unanimously, voted in favor.) i U.S. •S. POSTAGE i � ; -+ ID OSTERVILLE.MA �9 y i 02655 SAPR 03.'10 a C C3 UNITEDSTATES ( f. AMOUNT cC3, C3 POSTAL SERVICE SLj 1000 $3*21 {E-' L-' 02601 00044599 18 E-' IC O C3 C3 �IC3 C3 t0 O ip C3 t _ �� Ln = ' C 66 ,� w `'' L- CIO ry 6 m l 1, -Towns of Barnstable, Barnstable Board of Health AUUnWcaCft * MUNSTAei E *, r 9 MASS. $ 200 Main Street,Hyannis MA 02601 039 10 2007 OFFICE: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. JunichiSawayanagi BOARD OF HEALTH MEETING AGENDA Tuesday, May 12, 2009 at 3:00 PM Town Hall, Hearing Room -� 367 Main Street, Hyannis, MA L Show-Cause Hearing Marilyn Higgins and Cindy Gould at 92 County.Seat, Hyannis - Refuse, Violations: II. Hearing: Septic: A. Michael Picard owner-288 South Main St; Centerville, requesting extension of septic repair deadline to-March 14, 2010. III. Hearing Underground Storage Tank: A. Bill Larmee,-owner- 3625 Main Street; Barnstable. IV. . Septic Variance (Cont.): Michael Ford representingMichael and Gisa Belanger, owner- 100 . Cross.Street,,Cotuit,.Map/Parcel 033-032, .0.9 acre lot, four (4)variances for repair (continued from Oct and Dec 2008) V: Septic Variance (New): A. Stephen Wilson;.Baxter'Nve Engineering, representing John Spargo 178 and 188 Merchant Mill Way, repair of failed system Map/Parcels.266- 024 and 266-037, 1.1 acres (upland), variance to reg. 360-1 setback requirement of pump chamber to BVW to 82 feet in lieu of 100 feet. B. Brian Yergatian, BSC Group,, representing Timothy and EilaiDesrocher, owners - 307.2 Falmouth-Road, Marstons Mills,Map/Parcel 099-029; 2.2 acre parcel, requesting variance from 310 CMR 15.203 (4) to vary the design flow rate for the daycare facility. vim--y...�.---••,.�.�.,....,_-�..b,....�,:_ VL I/A Monitoring Plan Review Mary Hash (unable to attend), owner- 1199 Craigville Beach Rd; Centerville, requesting reduction of quarterly monitoring on Omni I/A System of seasonal property. • BO:�L,..,...Ma. 2Q09..._.�a -1�- �'�`"' 04/27/2009 15:40 3019498173 KEN BUSINESS CNT PAGE 01/01 ot V\A- sty ca c+C-•� t�� (��/� c� � �1.'l , ` �` �m�r GG I'�i'l.u_� /n�� `� ! (.� �� ne f �'J /_ r / No. .217b 5 G./-c i,1 fJ� G ra,q eo{ G jf Fee J joy= �/ t THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ZfppYication for Migpooar 6potem Construction Permit Application for a Permit to Construct( . )Repair( )Upgrade QY)Abandon( ) ®Complete System 0 Individual Components Location Addressor Lot No.1 1 9 9 C RA t G v I L L S 9EAC M RO Owner's Name,Address and Tel.No. (--LA,rrSRvtLLEr MASS STEvt d MARV HASH Assessor's Map/Parcel 3 9 L(L-1 13A LT I M oR L ST- M '2-0 ZP053 kGA1_5jrv6_T0N11 MD Z0995- Ins er's Name,Addre�.s,and Tel.No. Designer's Name,Address and Tel.No.Sa S- Hz S-3 3 4 y c4c StJ L_L 1 vAN (75TLRVILLE ^4,4S,' Type of Building: Dwelling No.of Bedrooms �-r✓ Lot Size 1 2 A sq-€t- Garbage Grinder(No) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 440 gallons per day. Calculated daily flow 4 5 to -gallons. Plan Date MARCH 27 2005- Number of sheets I Revision DateS- Title SITC f>LA,N -PfZoPOSE1> IMPfLoYMEA/TS Size of Septic Tank 1 5 o O GA LLo rUY Type of S.A.S. I LI'X L1`1#LL AcU 1 Pr_ t=•11=L D Description of Soil 0-1 o O RG.AN1 c/L-oAM -O- } I o'-25"YES`i S I-t QRK SANDY LoA M 10%/R. SG - 13-0 2- q9" OLlvi BRN. ► e-_D_ SAND 2 •SY G G - C— CrRDuNDWA-T1 fL Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ens the constejir�q�ntal Vi and maintenance of the afore described on-site sewage disposal system in accordance with the provisio of Tie 5 of t Code an of to place the system in operation until a Certifi- cate of Compliance has been- sued by thi d of ealt . Signed _ Date �� Application Approved by Date Application Disapproved for the following reasons Permit No. od% 3D-t Date Issued -7- 1 -oS� �' to �rJJ (� Fee �). � s..: Entered in,computer: ' THE COMMONWEALTH OF MASSACHUSETTS - Yes " PUB LIC_HEALTH,.DIVISION -TOWN OF BARNSTABLE'_MASSACHUSETTS e5 n " "ZIPPYtcat on for Miopooaf Opotem Conotruction Permit-, Application for a Permit to Construct( . )Repair( )Upgrade )Abandon p (J( ( ) 'L1 Complete System ❑Individual Components Location Address or Lot No.1 1 9 9 C R A 1 G V I L L r= 13 L AC 1-4 R D Owner's Name,Address and Tel.No.' M,rGfLvIt.LL , MASS STM-4a d- MARY WASH y Assessor's Map/Parcel 3 9 LI L4 13 A L'r 1 M 0 R L S T• M 2U(D P053 kErVSfrV(,TON, MD 2 S9s" No.-`Installer's Name,Adds and Telel.^No.�i� Designer's Name,Address and Tel.No.-` 05- H 4 8 V/ SLILLIVAN LNG I(VGLz R1lvC- 10-I C i Z�-E /,�.i -7 t�At21<�R 1Z 17 Alm USTL.RV)LLLE Type of Building: Dwelling No.of Bedrooms Lot Size o- "A- sq- .ft4'' Garbage Grinder(No) C� Other Type of Building a No.of Persons Showers( ) Cafeteria( ) \Other Fixtures I v-. Design Flow 440 gallons per day. Calculated daily flow H 6!o -gallons. 'Plan Date MARCH Z.� z 0 0 S Number of sheets I Revision Date /0 5- Title Slrtm PLAN - PR0P0S6D IMPR.OVMf=NT-S Size of Septic Tank 1 5 0 O GA t-Lry rU s Type of S.A.S. i H'X H `1 'LE AC N 1 IVG (•1 L L D Description of Soil 0—1 0" 0 RG.AI/1 clL.OA' M -0- , 10'=23"Ye L'I S H F3RK SANDY LOAM 10VR. 5/6 - Cis- . 2-_i. — 48" oLIVE RRN. "eD. SANID Z.SY C— (rRrju Nature of Repairs or Alterations(Answer when applicable) Date last inspected: q _e' - Agreement: , - ,,. The undersigned agrees to ensure the consi t�n and maintenance of the afore described on-site sewage disposal system. in accordance with.the provisions of Title 5 of the Envir ental Code an not to place the system in operation until a Certifi- cate of Compliance has been issued by th O-B.and of ealtli. - Signe7 _ Dates v Application Approved by Kf ! Date_ - /1-0 S_ Application Disapproved for the follo iw ng,reasons Permit No. ?QD�� �a Date Issued 7- 1 ? -03' 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 1 I Q cl r U A14 VI L t_r= Bte AC 1-1 R,D j0jfgN7 ftV 1 i tj , M/4 has been constructed in accordance with the pravmisions of Title g)and the for Disp System Construction Permit No. a 110 S- Rd f' dated '7 1?-OS' Installer�/ 177 zg!. Designers u I-L I iA LNG: 1 rV15E 21 A/ 1 IV C. The issuance of this permit all tot be construed as a uara tee that the sys e 'wi 1 function as des ed. ,� C Date 7,- i' ft ���Inspector ��/,t�� n � � l�� No. a V O C 312 U Fee OU- THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS ]igponf �&p!5tem Con,5truction Permit Permission is hereby granted to Construct( )Repair( )Upgrade X)Abandon( ) System located at 1t 9 9 2AIGVIL_L_L= f3C-AC 1-i Ida ADT C_ef/vT 2l/iL Lt= 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 th 0-p-ermit. Date: - "U S Approved by v1''' E0 JIJL.-1'_;-2C0D 16: 13 CAUOSSA EXAUATING. `� 5t�85635�28 P:Ei,'�a Town of Barnstable . Regulat6ry Services . Thomas F. filter,Director Public Health Division Thomas McKean,Director 'Far. 5US-790-6304 Installer ai€ ggg er CcKggia a F'or w Q U M�F— Z5, °7 13 S U LU V 4 NI Address- on �taua) was imed a p it to in a Gi .s !rae 1, q5 C. 1&-\( LLLF- z � ig based on a de a dravm by sap�.� ) 7E dates :C certify that,the scptac systmn referenced above was imtalled substantially according to fte dcaip, wbich may include nor appmveA chamses such as .lateral relocation of the dirt*uti n box and/or scot tas=. y ced. above was installed with major ch=gcs (i.e. � � y that the septic fit® gcfcren 1 go-cater tbAu 10' la wal-relocaAon®f the SAS or any veftical reloc;itior- of my co nent O:r the sic tcm)but in accardmce with State dz Local Regulatiow. Plau revision or ce,bbhcd asbwht by du igmer to foHlowa s•� eoi r .✓ w , "Les WL TO ST C Oft if -- TOTAL YID.011 Ili - r , Doi_: 1 9 006 Y BU3 07-11-2005 3: 1 BARNSTABLE LAND COURT REGIST Y DEED RESTRICTION i WHEREAS, Mary Bailey Hash, of 3944 Baltimore Street, Kensington, Maryland is the owner of a certain parcel of land together with the buildings thereon at 1199 Craigville Beach Road, Barnstable (Centerville), Barnstable County, Massachusetts by deed from Mary L. Mayer recorded in Barnstable County Land Court in Document No. (lam WHEREAS, Mary Bailey Hash as the owner of said lot have agreed with the Town of Barnstable Board of Health to a restriction as to the number of bedrooms which can be included in any home built on said lot as a pre-condition to obtaining a variance from the State Environmental Code, 310 CMR 15.211; WHEREAS, the Town of Barnstable Board of Health, requires that said —r restrictions be put on record in the Barnstable County Registry of Land Court; r4 \ NOW, THEREFORE, Mary Bailey Hash does hereby place the following restriction on their above-referenced land in accordance with their agreement with the Town of Barnstable Board of Health, which restriction shall run with the land and be binding upon all successors in title: Until such time as technology changes and the Barnstable Board of Health changes its regulations or otherwise grants permission, said premises at 1199 Craigville Beach Road, Centerville may have constructed upon the lot a house containing no more than four (4) bedrooms maximum and agree that this shall be a permanent deed restriction affecting said premises. For title of Mary Bailey Hash see Document No./ �� a Executed as a sealed instrument thisday of , 2005. MAR$BAILHASH .W OFFICES OF I R.ALGER.P.C. >ARKER ROAD O.BOX 449 IERVILLE.MA )Z655-0449 O f COMMONWEALTH OF MASSACHUSETTS Barnstable, ss. DATE. /, : cz day of , On this � y �� �' 2005, before me, the undersigned notary public, personally appeared ary ailey Hash, roved to me through satisfactory p which was �'% � +, '. ,, to be the person whose identification, whi ' entifica evidence of id , name is signed on the preceding or a ached doc ent,"and acknowledged to me that she signed i oluntarily for its stated purpose. Notary Public f�� My commission expires s� JOHN R. ALGER NOTARY PUBLIC COMMONWEALTH OF MASSACHUSETTS �..'M+•MY COMMISSION EXPIRES 1%��7/P005 1 Search for MaplParcel� 206053 ' Tow% n of Barnstable 4or�ParceYP umber 206053 y v �' Rental Pro a ON � Business Name Zone of Cont bution(ym T l Numbe t , '' ContaminantRel(1(/N) Phone Fuel Storage TankPermit Y� p ' ` Card On�Fil 1 x �� v s osa11A/orks ' �� � PercTes�t b11e l permitC n Ai 7,1 i Fife/PertNo 2005328 y ' y . r� ✓ X.�r" "/ 3 .: vTs3 sc Issuance Date 07/13/2005 11-1 �Gompletion�Date � Size of Septic ' Type/Size SAS 14 x 44 leaching field t 3 Tank 1500 i� y ,5 y a Comments a ., f ' r mw failed septic 11/19/04 variance granted by BOH 4 bed deed restriction A f a� 206053Owner M A H E R,THOMAS F& ROBERT C 1199 CRAIGVILLE BEACH ROAD X,F r '» w , In 3 �" P s %// 'y � innovative/Alternative TechnologySeptic S stems Smgleor x y i /i y s �, `,. Clusteri"� r� IlA Type i�I/A ServiceType add delete records? t E r 5 i TOWN OF BARNSTABLE LOCATION /J /Gy«L�,��A�f�40 SEWAGE " VILLAGE ASSESSOR'S MAP& PARCEL 206 - OS.� INSTALLERS NAME& PHONE NO. � � D�SSfI, SD�•SL.�'SS.30 SEPTIC TANK CAPACITY �SOOG'AG LEACHING FACILITY: (type) /y'6 �' y� —O NO. OF BEDROOMS 7 OWNER /7�11�e y tfAJiy 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) 1Z Feet FURNISHED BY 14e h2- C,PAIG U/CLE �c,N A3 zS=G" J33 20 =2." �y Z9'3 241 Z3as _G R 1 — 3 r� b� V 7D 6/04A6 P�SsueF Z22S'ir�� TOWN OF BARNSTABLE �C LOCATION ��/7 ��iLL�� L'� SEWAGE# VILLAGE 45W7EX1/ 4E ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. ,� Sad-SG�'SS30 SEPTIC TANK CAPACITY SDOG'i9G' LEACHING FACILITY:(type)/1% aaz Dyr (size) NO.OF BEDROOMS 7 OWNER /ff},fiy PERMIT DATE: T I3-OS COMPLIANCE DATE: a h a 77 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) /Y 114 Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY ,�,����bSSA�✓Q�C�l/fj?7tiG' " i /41 AL /8?-o C,Pi9/G LLE A3 ZS'6 2 5 G 195 28!cl as S_f 0 1 3 ra L�7L�IZr�L �" G'LEfI,tJOv7� 7D a9446 i°�SSu,� 1�25'ir✓G LE�aH JC/� 1-888-450-OPINI (503) 548-0343 o OFFICE MANUFACTURING P.O. Box 128 Falmouth Te-lchnokc-qy Park 46'5 Eas- FaInlouth, Higfn�jay OMNJ��� 52(.') Thornas, B. Lnfid''et's Road East ':"almouC , MA 02536 Environmental Systems,Inc. E,-,s Fair o L it h, VA 2 5 6 April 27, 2005 Mr. Steve Hash 3944 Baltimore Street Kensington, MD. 20895 RE: 1199 Craigville Beach Road, Centerville— Operation and Maintenance Services Dear Mr. Hash: OMNI Environmental Systems, Inc. (OMNI) is pleased to submit the following Maintenance Contract for your review and approval. This.contract is an agreement by OMNI to provide the services necessary for the operation and maintenance of an OMNI Recirculating Sand Filter (RSF) located at the above referenced property. The OMNI Operation and Maintenance Contract has been designed to fulfill the Department of Environmental Protection (DEP) requirements for maintenance of an RSF by a licensed wastewater technician. DEP requires that a valid maintenance contract be kept on file with the local and state authorities. OMNI will supply all materials and equipment outlined in the proposed contract. OMNI will also supply certified wastewater technicians specially trained with regard to operation and maintenance standards and practices for Innovative and Alternative Technologies. The outlined contract does not include any testing or repairs not covered under warranty. The homeowner is responsible for the following: supplying OMNI with all local and state septic system approvals, payments as outlined for operation and maintenance services, and any testing requirements required by state and/or local authorities. For your convenience OMNI accepts all major credit cards and is now offering payment options for customers with accounts in good standing. Please note, for monthly payments options a credit card is required. Please carefully read all Terms and Conditions listed below. Should you have any questions with regard to the contract, scope of work or any additional services, please feel free to contact our office. You may authorize the contract by signing and returning a copy with the first payment installment. Sincerely, Matthew C. Costa, President OMNI Environmental Systems, Inc. �,,=�" t 1�ystenls, Inc. Contract for Operation and Maintenance Services � • o as Owners Name Steve Hash System Location 1199 Craigville Beach Road Home Address 3944 Baltimore Street Town Centerville City,State Zip Kensington,MD.20895 DEP File No. Phone System Type OMNI RSF Billing Address SAME Contract Terms Life of Ownership City,State Zip Contract Start Upon Use and Occupancy Issuance NOTE:OMNI Environmental Systems shall not be responsible for any misuse or improper operation by non-omni personnel or the system owner,and any operation NOT in accordance with the OMNI RSF System Owner's and Operator's Manual. Terms and Agreement for Standard and Preventative Maintenance Innovative/Alternative Technology OMNI is hereby authorized to render Standard and Preventative Maintenance for the OMNI Recirculating Sand Filter listed at the above address for the contract period specified above under"Contract Terms". This agreement may be terminated or extended by the system owner by providing OMNI Environmental Systems,Inc(OMNI).with 30 days written notice of intent. OMNI will provide the system owner with thirty (30) days written notice of its changes to the current pricing schedule. The system owner will not be obligated to renew contract in the event of any pricing changes. OMNI will be obligated to provide all prepaid services in the event of any pricing changes. This agreement consists of all Standard and Preventative Maintenance listed in the Owners and Operators Manual. This agreement will include quarterly inspections as required by the Department of Environmental Protection(DEP). It is the responsibility of the system owner to supply any local or state septic system approvals and/or conditions to OMNI. This agreement includes routine maintenance inspections and does not include costs occasioned by neglect,misuse and accident or consumables. This agreement does not include travel costs for the Islands and any locations outside a 20 mile radius of East Falmouth. This agreement DOES NOT COVER ANY TESTING/SAMPLING REQUIREMENTS. In consideration of the services contained in this agreement the system owner agrees to pay OMNI Environmental Systems,Inc.the sum specified in the payment options section for the above maintenance agreement on a prepayment basis. Payment is due fifteen (15) days from Invoice Date prior to execution of services and will be subject to any applicable late charges. Monthly payees are excluded from prepayment requirements. This agreement is not assignable by either party and is non-refundable for any prepaid services.This agreement will not become effective until the first payment as outlined below has been received by OMNI Environmental Systems, Inc. If the terms and conditions contained herein,including the terms and conditions set forth on the enclosed documentation titled TERMS AND CONDITIONS,are acceptable,kindly sign and return one(1)copy of this contract along with the first prepaid payment. It is understood and agreed that the foregoing,including the TERMS AND CONDITIONS set forth will constitute the full and complete agreement between the parties to this agreement. The contract offer expires thirty(30)days from the date hereof,but may be accepted at any later date at the sole option of OMNI. The undersigned agrees to the following payment schedule: Select payment option below by marking appropriate box. See Terms and Conditions for details on eayments options. Payment Options: 1 $29 Monthly❑ 1 $100 Quarterly[] F $185 Semi-Annual❑ 1 $350 Yearly❑ The above costs, Project Scope of Work, terms and conditions are satisfactory and are hereby accepted. OMNI is hereby authorized to provide the services as specified. Authorized OMNI Personnel Date Print Name(Owner) System Owner Signature Date g TERMS AND CONDITIONS 1. DEFINITIONS OMNI Environmental Systems, Inc.will be referred to as"Provider"and the person or company purchasing as indicated on the"Contract for Operation and Maintenance Services"will be referred to as"Consumer" 2.ACCEPTANCE Unless otherwise stated on the contract, it is subject to.acceptance within thirty(30)days of the date on the proposal. Acceptance of the Consumer's request for services is expressly made conditional on the Consumer's assent to the terms and conditions in the proposal and the attachments hereto which shall constitute the complete agreement between the parties. This contract shall remain valid and in effect until the Consumer is otherwise notified from Provider for reasons including but not limited to, pricing schedule change, and termination due to payment default and/or improper use. Contract will also expire upon any change of system ownership. See CHANGE OF OWNERSHIP for details. 3. CHANGE OF OWNERSHIP Any new or proposed Consumer(s)shall take title to the equipment and should be notified of operation and maintenance requirements by the Seller and/or Seller's agent and the Terms and Conditions of this contract. Existing Consumer(s)are fully responsible for supplying the Provider information of such ownership transaction including but not limited to,date of purchase, name,address, and telephone number of any new Consumer. It will be the sole responsibility of the existing Consumer(s)to notify prospective Consumer(s)of any and all system requirements including but not limited to Maintenance and Testing/Sampling requirements. In the event that the Provider is not notified of a change of ownership a$25 setup fee shall be applied to the first scheduled payment of the new Consumer. 4. PAYMENT OPTIONS Payment options are available for customers and are to be made on a prepayment basis for Quarterly, Semi-annual, and Annual payees. Quarterly payments shall consist of four(4) payments per year. Semi-annual payments shall consist of two(2) payments per year.Yearly payments shall consist of one(1) payment per year. The prices show above for quarterly and semi-annual payment options will be higher than the monthly and annual payment options due to administrative fees that have been added. Monthly options are only available for payment by credit card. Consumers who select the Monthly payment option do not need to include fist payment. Monthly payees will be contacted by OMNI for account setup. Monthly payments will be charged on the first week of every month and shall remain in effect throughout the terms of the contract. Upon cancellation or termination of said contract monthly payees shall be responsible for all services rendered to the date of the cancellation request and all balances shall be paid in full on the final scheduled payment. In the event of a"credit"to the newly terminated account a refund shall be issued to the payee and applied to the credit card from which the payments were made within thirty(30)days of the termination or cancellation date. In the event that payments are not made within the allowable time frame the subject contract shall be automatically terminated and all applicable late and/or reinstatement fees shall apply. At the option of the Consumer the contract shall be reinstated upon receipt of all owed payments and applicable fees. The Provider reserves the right to deny any payment options to any Consumer(s)whose contracts have been terminated due to payment defaults. 5. PRICING Maintenance service prices are set by the Provider and are subject to change. Upon any change in the current pricing any existing Maintenance Contracts will be terminated thirty days after notifying current Consumer and Provider will issue a new Maintenance Contract outlining the current pricing schedule. It is the sole option of the Consumer to continue services with Provider and under no circumstances is the Consumer obligated to any Maintenance Contract changes. 6. CREDIT If the Provider shall at any time doubt the Consumer's financial responsibility, Provider may decline to continue services hereunder except upon receipt of cash payment in advance or security, satisfactory to Providers. If Consumer fails in any way to fulfill the terms and conditions on the"Contract for Operation and Maintenance Services"the Provider may defer further services until such default is corrected and may at the option of the Provider treat such default as refusal by Consumer to accept.further services hereunder. ' 7. LATE CHARGES AND FEES A finance charge of 1 '/s% (18% per annum)will be charged on all past due invoices. A$25 reinstatement fee will be assigned to all Maintenance Agreements that have been terminated by the Provider for misuse and/or payment default and all past balances shall be paid in full. All applicable payments, finances charges and fees shall:be paid in full prior to contract reinstatement. 8. OPERATION Consumer shall take title to the equipment only upon Provider's receipt of all payments due for said services, including payments for all applicable options, late charges and fees. In the event of damage or loss due to improper operation and/or maintenance by unauthorized personnel and/or the Consumer;the Consumer shall be responsible for all damages. Consumer shall NOT hold the Provider liable for damages or associated costs for � N any services or advice rendered as corrective action in the event of system failure due to improper operation and/or maintenance by unauthorized personnel and/or the Consumer. It is the Consumer(s) responsibility to insure that all personnel,agents,tenants,or other, operating and/or using the system read the Operation and Maintenance Manual provided by the system Manufacturer. 9.WARRANTY OMNI warrants its products will perform the process function for which they were recommended by the OMNI for a period of three(3)years from the date of installation, provided pertinent and accurate items of data were submitted buy the Consumer to the OMNI and the Provider and further provided that the products are used under normal and proper use in accordance with instructions of OMNI. If this warranty is breached,the warranty is terminated and Consumer shall be liable for any and all corrective actions and/or repairs. 10.TECHNICAL ADVICE AND ASSISTANCE Provider's warranty shall not be enlarged,and no obligation or liability shall arise, as a result of Provider's rendering of technical advice,facilitates or services in connections with Consumer's order for the services furnished.Although any technical advice furnished,or recommendation made, by Provider or any representative of Provider concerning any use of application of any product furnished under this contract is believed to be reliable, Provider makes no warranty, expressed or implied, of results to be obtained. 11. DELIVERY OF SERVICES The time for services rendered is approximate and is estimated from the date of Maintenance Contract inception of order with complete information and local and/or state approvals and drawings as may be necessary. The obligation of Provider to deliver or perform services and the obligation of Consumer to furnish specifications for purchase and take the products or services stated on the front hereof shall be suspended by fire,floods, accidents,act of God,war or acts of war, strikes, lock-outs, slow-downs, picketing or other labor controversies, sabotage, riots, civil commotions,default or failure of carriers, shortage of labor, inability to obtain materials from regular sources,whether or not a kind hereinbefore specified,to the extent that such happening or contingency limits or prevents the services, sale or delivery of any products or the performance of any services by the Provider or the purchase or taking thereof by the Consumer,except, however,that not withstanding the foregoing,the Consumer shall not be excused from accepting and paying for services which are completed or in the process of being completed at the time. Upon the elimination of cessation of any such happening or contingency the obligation of Provider to deliver or perform services and the obligation of Consumer to purchase and take the products or services shall be reinstated. If by request of the Consumer with acquiescence by the Provider, service is delayed beyond the original service date for a reason other than as set forth above in this Section 4,the Consumer will pay a reasonable charge for expenses caused by the delay, and after the delay is ended,the agreement will be completed at the prices and on the terms and conditions agreed to in this document. The products contracted for under this Contract cannot be canceled except with the written consent of the Consumer and then only with reimbursement for services rendered as agreed upon by the Consumer. 12.ASSIGNMENT The Consumer may not assign any of the Consumer's rights hereunder. 13. DISPUTES The parties'agreement in.respect of the services shall be deemed to be entered into in Massachusetts and to be a Massachusetts contract and shall be governed and construed in accordance with the laws of the Commonwealth of Massachusetts. Provider and Consumer specifically agree that any legal action brought relating to services purchased or relating to this contract will be commenced in Massachusetts within one(1) year after the relevant claim arises,failing which such claim shall be barred notwithstanding any longer statutory period of limitations. All objections to venue are hereby waived by both parties, and Consumer consents to service of process by certified mail addressed to the same address at that address designated for delivery of the services purchased hereunder. In the event of any such litigation under or arising out of the agreement,the prevailing party shall be entitled to its costs, including reasonable attorney's fees. 14. SEVERABILITY In the event that any work, phrase, clause sentence, or other provision hereof shall violate any applicable statue, ordinance, or rule of law in any jurisdiction in which it is used, such provision shall be ineffective to the extent of such violation without invalidating any other provision hereof. 15. ENTIRE AGREEMENT This document contains the entire agreement between Provider an Consumer and constitutes the final, complete and exclusive expression of the terms of the agreement, all prior or contemporaneous written or oral agreements or negotiations with respect to such terms as are included herein or are the subject matter hereof being merged herein. By way of illustration and not limitation, Consumer's order shall be deemed to incorporate,without exception, all the terms and conditions hereof notwithstanding any order form of Consumer containing additional or contrary terms or conditions, unless Consumer shall have expressly advised Provider to the contrary in a writing apart from the printed provisions of such order form, and no acknowledgment by Provider of, or reference by Consumer to, or performance by Provider under an order of Consumer shall be deemed to be. acceptance by Provider of any such additional or contrary printed terms or conditions by a written instrument signed by one of Provider's office. 16. GOVERNING LAW This document and the sale of any products hereunder shall be governed by and construed in accordance with the laws of the Sate of Massachusetts. Whenever there is a conflict of laws,the laws of the State of Massachusetts shall prevail. J ��`-1 Postal. CERTIFIED MAILT. RECEIPT u1 (Domestic Mail Only; Er For delivery information visit ou,websile a, .usps,corno OFFICIAL JU-S.JE ` o Q Postage $ Q` r? r9 �® Certified Fee s ru JUL -FS-M p Return Receipt Fee Here O (Endorsement Required) C3 Restricted Delivery Fee tf, Q (Endorsement Required) VsPs � Total Postage&Fees ru Sent To e -*...._..••. ---- ---- •- r6- or PO Box No. City,State,Z/P+4 �_ � sA ... ...........-- PS Form . August 2006 �j� Certified Mail Provides: ■ A mailing receipt ■ A unique identifier for your mailpiece ■ A record of delivery kept by the Postal Service for two years Important Reminders: ■ Certified Mail may ONLY be combined with First-Class Mail®or Priority Maile. a Certified Mail is not available for any class ofinternationatmail.. o NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. s 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 maiipiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPSe postmark on your Certified Mail receipt is required. r 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". ■ If a postmark on the Certified Mail receipt is desired,please present the arti- 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. IMPORTANT,Save this receipt and present it when making an inquiry. PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 .> .` .. _ .... _ -_ -- - � .... ._.,..,.. :,.�+ ,..ems:=�,•s, _._..-_, _. ._ - I 1�ry JF�" 'O�ti� Town of Barns 1 0 Public Health Dig 2 _ � BMNB�ABIL. ` 0 _" PI7NEY a0WE5 r 059. �e� 200 Main Street RFD MP'�° � 02 1A Hyannis, MA 026 05 32° �.: � 0004606235 JUL03 2008 7006 2150 0002 1041 9945 1 MAILED FROM ZIP CODE 02601 r ,t 1 i Mary B. Hash 1199 Craigville Beach Road �. Centerville, MA 02632 . E' � tll,I�11l�11l1111111„I�Ii�1111111ItlI�„Irillll11,11„��I,l�! aNn - .. _ 'ER: COMPLETE THIS SECTION i ■ Complete items 1,2,and 3.Also complete A Signature `�• item 4 if Restncted.Delivery, X Is desired. ❑Agent ■ Print your name and address on the reverse ❑Addressee I so that we can return the card to you. B. Received by(Printed Name) C. Date of Delive I I ■ Attach this card to the back of the mailpiece, ry or on the front If space permits. 1 1. Article Addressed to: D. Is delivery address different from item 1? ❑Yes 1 If YES,enter delivery address below: ❑No i t I i. 3. Service Type �Certified Mall ❑Express-Mail ❑Registered ❑Return Recelpt for MemhwWbe ❑Insured Mail ❑C.O.D. I 4. Restricted Delivery?(Extra Fee) ' 0 Yes I 2. Article Number - - - - --— -- - - - I (rransfer from service.iabei) i 7 0 0 6 ' 215 0 0002 10 41 9945 I 1 PS Form 3811,February 2004 Domestic Return Receipt to259-2 M 1640 Certified mail: 7006 2150 0002 1041 9945 Town of Barnstable Regulatory Services ti BARNSMOLF, NAM Thomas F. Geiler, Director x6gq. 1� Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 July 1; 2008, Mary B. Hash 1199 Craigville Beach Road Centerville, MA 02632 NOTICE OF VIOLATIONS OF 310 CMR: 15.00 THE STATE ENVIRONMENTAL CODE TITLE V: MINIMUM REQUIREMENTS FOR THE SUBSURFACE DISPOSAL OF SANITARY SEWAGE AND TOWN OF BARNSTABLE CODE., On-June 30, 2008; Health Inspector David W. Stanton, R.S. observed a summer rental sign at.ihe,property owned by you located at 1199 Craigville Beach Road, Centerville '_ Thelfollowing,is a violation.of the State Environmental Code Title V: ` 310 CMR 15.021(1): A certificate of compliance has not been issued for said location. You cannot discharge sewage to said septic system until a certificate of compliance has been issued. Our office has not been provided with an asbuilt card for said septic system as required. Our office,has not been provided with the installers and engineer's certification for said septic system as required. The following is a violation of the Town of Barnstable Code: Town of Barnstable Code & 170-4 (A): Offering to rent dwelling without registering with the Board of Health. You are ordered to correct the violations listed about within twenty-four (24) hours of your receipt of this notice by filing the asbuilt card and installers\engineers certification form for the septic system so a certificate of compliance can be issued and by registering your rental propertywith the Board of Health. Failure to comply .with this.order will.result in the issuance of a non-criminal ticket citation of $100 for each violation. Each day's failure to comply with an order shall constitute a separate violation::. The Board of Health may condemn the dwelling`.'The Board.of Health may also.file a criminal complaint against you. You rnay-reque8t;a hearing before the Board of Health if written petition requesting same is"received withiA ten(10)"days after the date the order is served. Q:\Order letters\Septic\l 199 Craig4ille beach rd.doc Iv,' PER ORDER OF THE BOARD OF HEALTH h mas A. McKean Director of Public Health Q:\Order letters\Septic\l 199 Craigville beach rd.doc UIVITEDSWES.. / Home I Help I Sian In , „� ,., ,..�.. ....... Track&Confirm FAQs Track & Confirm Search Results Label/Receipt Number:7006 2150 0002 1041 9945 Status: Unclaimed "ac�C onf Fm Enter Label/Receipt Number. Your item was returned to the sender on July 22,2008 because it was not claimed by the addressee. t Nio,ificatioa Options. Track&Confirm by email Get current event information or updates for your item sent to you or others by email. fib> Site R4ay ContacL Us Fom:?s Gov't Services Jogs Privacy Policy Terms of Use National&Premier Accounts weg CopyrightO 1999-2007 LISPS.All Rights Reserved. No FEAR Act EEO Data FOIR � Stanton, David From: McKean, Thomas Sent: Wednesday, July 30, 2008 12:09 PM To: Stanton, David Subject: Diane at Southerby's Please call back Diane Ablet at Southerby's Realty(508)957-5561. She left a message on my phone indicating she received a"strong" message from you and is now trying to get a hold of you. 1 Certified mail: 7006 2150 0002 1041 9945 � tirq�,o Town of Barnstable Regulatory Services Y m 1* a�nss. $ Thomas F. Geiler, Director Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 July 1, 2008 Mary B. Hash 1199 Craigville Beach Road Centerville, MA 02632 NOTICE OF VIOLATIONS OF 310 CMR: 15.00 THE STATE ENVIRONMENTAL CODE TITLE V: MINIMUM REQUIREMENTS FOR THE SUBSURFACE DISPOSAL OF SANITARY SEWAGE AND TOWN OF BARNSTABLE CODE. On June 30, 2008, Health Inspector David W. Stanton, R.S. observed a summer rental sign at the property owned by you located at 1.199 Craigville Beach Road, Centerville. The following is a violation of the State Environmental Code Title V: 310 CMR 15.021(1): A certificate of compliance has not been issued for said location. You cannot discharge sewage to said septic system until a certificate of compliance has been issued. Our office has not been provided with an asbuilt card for said septic system as required. Our office has not been provided with the installers and engineer's certification for said septic system as required. The following is a violation of the Town of Barnstable Code: Town of Barnstable Code 170-4 (A):. Offering to rent dwelling without registering with the Board of Health. You are ordered to correct the violations listed about within twenty-four (24) hours of your receipt of this notice by filing the asbuilt card and installers\engineers certification form for the septic system so a certificate of compliance can be issued and by registering your rental property with the Board of Health. Failure to comply with this order will result in the issuance of a non-criminal ticket citation of $100 for each violation. Each day's failure to comply with an order shall constitute a separate violation. The Board of Health may condemn the dwelling. The Board of Health may also file a criminal complaint against you. You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the order is served. Q:\Order letters\Septic\1199 Craipille beach rd.doc L PER ORDER OF THE BOARD OF HEALTH h mas A. McKean Director of Public Health Q:\Order letters\Septic\1199 Craigville beach rd.doc �w� - C-� �v s�� Jf•,� . i -� 9� Town of Barnstable 0 1aARrMASM HAM ,0 Board of Health 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Susan G.Rask,R.S. FAX: 508-790-6304 Sumner Kaufman,MSPH Wayne Miller,M.D. June 1, 2005 Mr. Peter Sullivan, P.E. Sullivan Engineering, Inc. P.O. Box 659 Osterville, MA 02655 RE: 1199 Craigville Beach Road, Centerville A= 206-043 Dear Mr. Sullivan, You are granted conditional variances on behalf of your clients, Steve and Mary Hash, to construct a replacement onsite sewage disposal system at 1199 Craigville Beach Road, Centerville. The variances granted are as follows: 310 CMR 15.21111)1 The soil absorption system will be located ten feet away from the foundation wall, in lieu of the twenty (20) feet minimum separation distance required. 310 CMR 15.211 (1): The soil absorption system will be located twelve (12)feet away from a bordering vegetated wetland, in lieu of the fifty (50) feet minimum separation distance required. Section 360-18: Three and 2/10 (3.2) feet of naturally occurring pervious soil (measured vertically) located above the maximum adjusted groundwater table elevation in the area of the proposed soil absorption system location. A minimum of four (4) feet of naturally occurring pervious soil is required. Section 360-1: The soil absorption system will be located twelve (12) feet away from a bordering vegetated wetland, in lieu of the one-hundred (100) feet minimum separation distance required. CnllivanT-Tach - s SULLIVAN ENGINEERING INC. 7 PARKER ROAD/P O BOX 659 OSTERVILLE, MA 02655 Peter Sullivan P. E. Mass Registration No. 29733 psullpe@aol.com phone 508-428-3344 fax 508-428-3115 May 2, 2005 Thomas A. McKean, R. S. CHO Director, Public Health Division Town of Barnstable 200 Main Street .Hyannis, MA 02601 RE: Revised plan for 1199 Craigville Beach Road, Centerville Dear Mr. McKean, Attached please find a revised plan, latest revision date 4/28/05 for the .above referenced property. The .project was previously before the Board of Health at their April 19, 2005 Public Hearing. The revision was to satisfy the Board's recommendation to incorporate a recirculating sand filter with a pressure dowsing field. I trust this meets your present needs. If you have any questions or require any additional information, please feel free to call. Very truly yours, Peter Sullivan, P. E. Sullivan Engineering Inc. Cc: Mary Hash John Alger, Esq, Members of American Society of Civil Engineers, Boston Society of Civil Engineers �• �TNE y. DATE: FEE: �Jr'(�7J >,tnss. REC. BY Town of Barnstable SCHED. DATE: [`�� Board of Health 200 Main Street,Hyannis MA 02601 Office: 508-862-4644 Susan G.Rask,R.S. FAX: 508-790-6304 Sumner Kaufman,M.S.P.H. Wayne A.Miller,M.D. VARIANCE REQUEST FORM LOCATION n �l Property Address: X� ✓p 9 C�CR1(��l IZ-LE ZG7AC_[A 1`C>P V l..ENTC2Vk i.Le Assessor's Map and Parcel Number: �D[ C6 3 Size of Lot: 0 A%C-eQ Wetlands Within 300 Ft. Yes _X Business Name: 1II,A No Subdivision Name: APPLICANT'S NAME:SAVE k ' _M`AQ.� G�66 i-� Phone \-Z 410" JCS- EA 1 Did the owner of the property authorize you to represent him or her? Yes _ No PROPERTY OWNER'S NAME CONTACT PERSON Name: \+ oc A ks E' �ll F!"E e_ Name: C�2��t L�va�v FG C&D C—awe0z17�1 MPIi7k6t'? �n ikat &L.G(526sG� Y Address: t�5 -�1-.0 'Dt2 Address: '7 CFCvz -tr nn z lG ucr>-o Phone: Phone: VARIANCE FROM REGULATION(List Reg) REASON FOR VARUNCE(May attach if more space needed) 16 MEt ?opj act Q, An U G NATURE OF WORK House Addition D ????? House Renovation Repair of Failed Septic SystemX Checklist (to be completed by office staff-person receiving variance request application) Please submit copies in 4 separate completed sets. Four(4)copies of the completed variance request form ✓ Four(4)copies of engineered plan submitted(e.g.septic system plans) ✓ 'Four(4)copies of labeled dimensional floor plans-submitted(e.g.house plans or restaurant kitchen plans) _✓ Signed letter stating that the property owner authorized you to represent him/her for this request ✓ Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense (for Title V and/or local sewage regulation variances only) Full menu submitted(for grease trap variance requests only) „ C:\Documents and Settings\decollik\Local Settings\Temporary Internet Fi1es\0LK3\VARIREQ.D0C SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Sig atu item 4 if Restricted Delivery is desired. [3 Agent ■ Print your name and address on the reverse ❑A dre ee so that we can return the card to you. B. Received by(Printed Nam C. D f ve i Attach this card to the back of the mailpiece, or on the front if space permits. 16 D. Is delivery address different from item 1 ❑ es 1, Article Addressed/too: if YES,enter delivery address below: ❑No 0 3. Service Type ,jo Certified Mail ❑Express Mail ❑Registered ❑Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number • i ;7 0 0 3 ,3110 i 0001 i 1380 510 (transfer from service labe# #` ,31101 F, PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 11 UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid LISPS Permit No.G-10 M • Sender: Please print your name, address, and ZIP+4 in this box• I � I � I � SULLIVAN. ENGINEERING INC. P.O. BOX 659 OSTERVILLE, MA. 02655 I � � I I � I I E �'` 5��1!llii!ISIISil�11l1{31l�11Itf113lktlllll�ililllllt{fi�3tlkf SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Signature item 4 if Restricted Delivery is desired. X } ❑Agent ■ Print your name and address on the reverse. ❑Addressee so that we can return the card to you. B. R c 'ved by(Printed Name) C. Date of Delivery ■ Attach this card to the back of the mailpiece, or on the front if space permits. 61 �} D. Is delivery address different from item 1?kpyes 1..��Ayyrticle Addressed to: If YES,enter delivery address below: ❑110 7— ©&001 3. Service Type Certified Mail ❑Express Mail Registered ❑ Return Receipt for Merchandise ❑ Insured Mail ❑C.O.D. 4. Restricted D=livery?(Extra Fee) ❑Yes 2. Article Number 7003 3110 0 0 01 1380 51=13 (rransfer from service ,2S Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 (e Fi�dd t dttil!difrijf(3�i£i��dii l�f li i( i�iflf(dflif�l r -�,•,,, , UNITED STATES POS4iIL S�f�WOE ff 9 !! =i i { zd 1 9 t First-&A Mail Postage&Fees Paid USPS Permit No.G-10 I • Sender: Please print your name, address, and ZIP+4 in this box• I I I I SULLIVAN ENGINEERING INC. P.O. BOX 659 OSTERVILLE, MA. 02655 Attachment Project Narrative 1199 Craigville Beach Road r Centerville The project site consists of approximately a 1 acre parcel of land in Centerville. Wetland resources on site are salt marsh;BVW and land subject to coastal storm flowage. The site is presently developed with a four(4) bedroom dwelling and a detached garage. The buildings were built circa 1920. The intent of the project is to elevate the building first floor elevation above the 100 year flood plain in compliance with the State Building Code Flood Plain Provisions and FEMA requirements.It is the intent to upgrade the septic system to Maximum Feasible Compliance 310 CMR15.404 The variances required are as follows: Board of Health Variances Required State Title V 310 CMR14.211 Minimum Setbacks Cellar Wall 20 feet required 10 feet provided 50 feet BVW required 12 feet provided Town of Barnstable Chapter 360 On-Site Sewage Disposal Systems Article I: Location of Components 100 foot separation required 12 feet provided Article Vlll: Marginal Lots 4 feet of dry suitable material above corrected ground water approximately 3.2 feet provided Sullivan Engineering Inc Osterville Mass 4/5/2005 U.S. Postal Service CERTIFIED MA(L. .R'E?CEWT (Domestic Mail Only;No Insurance Coverage Provided) For delivery information visit our website at www.usps.come, OFFICIAL USE , PS Form 3800,June 2002 See Reverse for Instructions t Certified Mail PrAvides■ A mailing receipt (asianaa)ZOOZeunf'008E-odSd ■ A unique identifier for your mailpieee- ■ A record of delivery kept by the Postal Service for two years Important Reminders: ■ Certified Mail may ONLY be combined with First-Class Maile or Priority Maile. ■ Certified Mail is not available for any class of international mail. ■ NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please:ciinsider:lnsure'd,or. Registered Mail. ■ For an additional feet a Retur`h.,Receipt may be requested to provide proof of delivery.To obtain Rbtum ReceipFservice,please complete and attach a Return Receipt(PS Eorm(3811)to the article and add applicable postage to cover the fee.Endorse`mailpiece.YRetum Receipt Requested".To receive a fee waiver for a duplicate rgtum receipt,a USPS®postmark on your Certified Mail receipt is required. i r a F r ■ For an additionawee, delivegrlmay be restricted to the addressee or addressee's aathorized,agenteAdvise the clerk or mark the mailpiece with the endorsement"Restricted%ivery�' ■ If a postmark on the Certified'Mail receipt is desired,please present the arti- 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. IMPORTANT:Save this receipt and present it when making an inquiry_ Internet access to delivery information is not available on mail addressed to APOs and FPOs. i (.V N) _ 43 jOnN AL,ZA = .^:42 .. ._ =A::•n'. .ii L MARY L, MAHER, hereby give permission to M.AAY B. HASH,her agents and representatives to appear before the Board of Health of the Town of Barnstable and secure permits for the upgrade and improvement of the septic system. WITNESS my hand and seal this_ day of April, 2005. r MARY ,. . R . t i Z6 Q REC ,IVED COMMONWEALTH OF I ASSACHUSETTS NOV 2 9 2004 EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRSF BARNSTABLE �! HEALTH DEPT. DEPARTMENT OF ENVIRONMENTAL PROTECTION FABLED INSPECTION .i]AP Z i PARCEL, LOB` ° TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION i Property Address: 1199 CraiRville Beach Road Centerville, MA 02632 I Owner's Name: Mary Maher Owner's Address: 1 Ashley Drive Shrewsbury, MA 01545 Date of Inspection: November 17. 2004 i Name of Inspector:(Please Print) James M. Ford Company Name: James M. Ford Mailing Address: P.O.Box 49 Osterville,MA 02655-0049 Telephone Number: (508)862-9400 i 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. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: i Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority ✓ Fails i Inspector's Signature: Date: November 19. 2004 i The system inspector shall subm' 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 I.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. Notes and Comments I ****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. I i I Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 1199 CraiRville Beach Road Centerville, MA Owner: Mary Maher Date of Inspection: November 17, 2004 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: 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: 2 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 1199 Craivville Beach Road Centerville, MA Owner: Mary Maher Date of Inspection: November 17. 2004 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 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: 3 Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 1199 Crai-eville Beach Road Centerville, MA Owner: Mary Maher Date of Inspection: November 17, 2004 D. System Failure Criteria applicable to all systems: You must indicate either"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 ''/z 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 (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. NOTE.Single cesspools automatically fail in the Town of Barnstable. E. Large System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) 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. 4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 1199 CraiQville Beach Road Centerville, MA Owner: _ Mary Maher Date of Inspection: November 17, 2004 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? . n/a _ 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: Yes No ✓ 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)]. 5 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 1199 Crai2ville Beach Road Centerville, MA Owner: Mary Maher Date of Inspection: November 17, 2004 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): n/a Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Number of current residents: 0 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): n1a [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings,if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Unknown COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sqft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Unavailable Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM Septic tank,distribution box,soil absorption system ✓ Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records,if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Original cesspool-date of installation unknown Were sewage odors detected when arriving at the site(yes or no): No 6 n " Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 1199 Craigville Beach Road Centerville, MA Owner: Mary Maher Date of Inspection: November 17, 2004 BUILDING SEWER(locate on site plan) Depth below grade: None Materials of construction: _cast iron _40 PVC other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: None (locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: 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: How were dimensions determined: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): GREASE TRAP: None locate on siteplan) Depth below grade: 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: Comments(on putnping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page 8 of 11, OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1199 CraiQville Beach Road Centerville, MA Owner: Mary Maher Date of Inspection: November 17, 2004 TIGHT or HOLDING TANK: None (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/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: None (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: 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.): PUMP CHAMBER: None (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no) Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1199 CraiQville Beach Road Centerville, M,4 Owner: Mary Maher Date of Inspection: November 17. 2004 SOIL ABSORPTION SYSTEM(SAS): None (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: 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.): CESSPOOLS:' ✓ (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: 1 single cesspool Depth-top of liquid to inlet invert: 10" Depth of solids layer: 0 Depth of scum layer: 0 Dimensions of cesspool: 3'Wx3'Tx4.5'bottomtojzrade Materials of construction: Concrete Indication of groundwater inflow(yes or no): Yes Comments (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): The cesspool appeared to be a square box with holes on the bottom and sides The cover was ]'below grade PRIVY: None (locate on site plan) Materials of construction: Dimensions: Depth of solids: Carmnents(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): 9 Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS .SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1199 Craigville Beach Road Centerville. MA Owner: Mary Maher Date of Inspection: November 17. 2004 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. 3 (3c,�r�nn SAc k — 13 Po•c.L• r sti` TzA 10 Page I of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1199 Crai—aville Beach Road Centerville, MA Owner: Mary Maher Date of Inspection: November 17, 2004 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: ✓ 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: 1 hand auizered beside the cesspool down to ground water,which was 32"below Qrade. The liquid level in the cesspool was also 32"below grade. The cesspool was in the ground water. The cesspool was within 50'of a salt marsh and also in a flood zone. This report has been prepared and the system inspected and failed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed,written or implied,relating to the system, the inspection and/or this report. 11 1 • 12734A PLAN OF LAND 1N BARNSTABLE j Scale 20 feet to an Inch f i , OCTOBER 1927 , Nelson Bearse, Surveyor . Stit i 90AD W UNT Y ff �. 44, it •yo _�� a ��l •1 ti ........... - o J c� MAI r e 0 I� SEEK , Copy oft�M of plan UND REGIST1'TION OFFICE H'A /9?B Scale of tha plan S fed to an inch Ohis plan n led with Certificate No. 1849. 1 xz 1 %'�= 5x? QjEc7 x v9 x t3'/Z 7 Q G -- S�.,es� i 5 ' First Floor As Built Floor Plans 1199 Craigville Beach Road Centerville Mass. Sullivan Engineering Inc.Osterville Mass �4 IZcoo F 37 240 Q. � x,2.t Second Floor As Built Floor Plans 1199 Craigville Beach Road Centerville Mass. Sullivan Engineering Inc Osterville Mass TOW`N GF BARNSTABLE LOC.�4IiON CrA (�C SEWAGE # VII.LAGE Cat er�,I� ASSESSOR'S MAP &LOTZo6 O5 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITYS�GU LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER MA L ✓�✓,��.r PERMITDATE: COMPL 6 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 leac 'ng facility) cc Feet Furnished by S S %r� 3 (3e,�rdonn _ - 13 Po"L� rAArSy` a -7747 _rD— L� � M A-bCAA a g Olt r�u« aN a _ „ i It a wh5A 69 o a a 15 LT � A)/ N(o Vf af T i it It t, , / R/ Ir q � 3 ID �_ 3 (o- �� (Q�lt 3 ' p y -7 9 _a y _f p -� - j i I i I �i rb Y a I , , P ► r�C��-� a q at a J \ Y +_- (2- 9 rr IO'7 r/ rG' s CALL c? QZ' 3 - -- -Iq I N m I J�- V I- 43 NJ i P Finished Grade I- • d"' •f • :• � �4„`! ;y,::,' � (tQ , • /' 44+ LeBaron Cost IronLAo9Ia Female Ada M-20Va1veBoxtoGradeat Phra , Top E1=8.6 NGVD Threaded Plug �p Top Conc Nail Each End g 9 (�\ ,:w Poured Conc.Base \/u, 1/8'-1/2" Filter r.j P 1.5Cu.Ft.* •" 'Jo S Orifice(T ) o Poo Stona Fabric SleevetoAllow ` A i - _ YP. :-. , ..: ::.... ... ....:_....._.,. .. Movement � 1 T a, !" N� I ( yP•) 0) Office Shield I I/4 0 Lateral II/2°0 Sch.40 PVC 90° ` {>P ... r,.� %] i )rod A Elec.Conduit Sweep _ • +, a? v & Christine E 7homm A(TYP) B(T .) 0 244 (Record) co Ctf,� 150749 °9P Laterial �"`- �4 _ --'--'-- -- --. Ditch A - S 0 PVC Vent. 1- i�•B t �: of C 2"0Man Sch.40 PVC ' 3/4° II/2°Double 193f(Record) -"?_ g FEMA Zone Line o t Manifold SECTION VIEW washed Stone . \S8<43'05 E a , .--.--�-- --"- As Shown on FIRM i 4•• 4,e� --- \ / IF Panel #250001 0008D /� , II -«` - "!'�• rr ` i Lce \ ._.. -] Rev July 2.1992 I 3-6\ ' O \ Fnd F a I t 0•• - l a+9 w jIII -\ -`-1 4"0 Sch.40 Peforations .. .� ? �ul„`wy-• �- Kj ' . if O 111, \/ I Down Vent as Shawn. ••. a• • ., .• O t>�t \ I I/4°0 Sch.40 O f - I NOTE"fit \ _� ` A7 -- -- _ ______--_- I PVC Lateral(Typ.) ' �. •u ' tlre�• y o. � rex+ P. e' ' " I I ` Cast Iron Cover t"•O f• ••� ! 0 %! W 1TF1 C0NsF_MVATION COIUIM\SSION ~ 1 I _T1 2 V Manifold r p Connection, a ��• ".Y ! O FLA\N-rINGS -ro 12..5E IW COt-4SUL-TATiO -I -9 (Typ.) Vent Vim, / \\ a Over Flushing �,,, +• .' _ 1 ! O / wTA1=F 33.13 \ �( ( I_ 4'-o"o.C. I ..p.: .. Il I I 1 Pijbll O 1 ' I I s I andin� a s �! O /// / D \ e ao Leaching ', ? o V 1 o PRESSURE DOSED FIELD ,r � Field O / �3 i Scale 118 - I -0 elf rr f 3 ; I Aas'O li \ ' 1 CD '�m o I Cone.Base e / v Z _.. . .----._.. .-- ..-----'---- • office n, rFo A-BO / / / / O : �X._� _.. .____-,. - - 1 ORIFICES ON ADJACENT LATERALS SHALL N� I Shield I n• s I �o ( , BE STAGGERED TO BE EQUIDISTANT AS (31 AREA SHALL BE SCAR IFIED TOO ARC (T p.) D I O / �� / O 11 / A2 ( cD 3• SHOWN ABOVE MINIMUM OF 3 INCHES JUST PRIOR TO )d ';'.,a'+"\ �� Locus Yqp i �" o o TABLE OF DIMENSIONS PLACING STONE � I O % // 4 ' o DESCRIPTION VARIABLE QUANITY UNIT (21 ALL ORIFICES SHALL BE DRILLED IN CROWN 4 ALL STONE SHALL BE DOUBLE WASHED. " ' /� \ I I L- - - Scale: w�.� 2,OOOt' I O - 1\ � � � a FORCE MAIN DIA. Dr 2 IN. OF PIPE q ---- \ �i .Pitch Force-Main Bl ., \ ° ' % Edge of BVW L►h/tIT �1Ne p� Doe:ngChamber ForOcaMcI14,OPVc y FLOOD ZONE: ASSESSORS REF.: O ��p MANIFOLD DIA. DM 2 IN. - Manifold Back'a LATERAL DIA. DL 11/4 IN. Inspection Schedule ' l \ O as Flogged b / WORRp,IgING �� '� -- P Pour I Cubic Ft.Min. Zone A10 (el 11) Map 206 t \ O Z 99 y roR s #OF LATERALS N 4 EA. 24 hour mmtmumnotice required phone 50&428-3344 300OPSrConc. PLAN VIEW Parcel 053 USE Thrust Block. Community Panel No. \�n p / 'ENSR 51JAN105 V4 o / \ tam m ORIFICES PER LATERAL n I I EA. 1. Soil removal to be inspected when excavation completed for each field - y250001 0008 D \ O / o / / A4 oea ORIFICE TYP.SPACING S 4 B. IN. 2. Replacement clean sand to be verified at time of bed installation. July 2, 1992 ZONE: \c �/ Ag -D� y*�� j w �I�� PIPING DETAILS (1 O o Oo ORIFICE DIA. Do 1/4 IN. 3. Engineer to inspect shop drilled orifices to ensure sue and burr removal, \. ee O / a� ��j- " - o \ ::t•� 8 P P Not to Scale f a (m ---� BEGIN OFFSET' A 12 IN. 4. Engineer to inspect pump installation,float levels&alarm. I D U7 Area (min.) 87,120 SF (RPOD) \ O / / / a3 \ END OFFSET B 36 IN. i O / 1 L o _ + Fron to a (min) 20' \\ o/ % a� SF OVERLAYi - -_ OVERLAY DISTRICT: Width min 12s ! FFTa 2 ---- : - Setbacks: I \ O AO - -- - Finished Grade E AP - Aquifer Protection District Front 30' i O / D / g I / �� ,, SHIELD As Shown o Plan Entitled Side 10' i \ CQ / -6 Q' 50' / w 11 ELBOW LA7£RAL 11/4"0 �- -s"'ao "Revised Groundwater Protection Rear 10' \ Salt Marsh ( % W ! O .\ / O, R:-"•...::::..;....; �__- _: _ ��_. -- --- - Overlay Districts" - April. 1993 •\\ I � ,` / / � QQ'p= � ohw onw ;- � o ORIFICE SHIELD oszoo y {7 : .... � Compacted OR EQUALl Filter II 4"0Sch40 0f2EHCO Legend: I onw Fill VC Laterla .._.._._...-- anW lI/4'"x 2" o Fabric I P I I 1 dw TEE M 1 G Light Post \ 11 1 i� �� / srEPs l ' . .' t - - -��--- � � Wetland Flog \I I I a7 �\ \ ohw \ ' I/4"0Holesna Water Manhole I 1� \ v \ V ` w I,-' dL ,1 n 'NOTOr'CCLOCCX POSITION '1 MAIN 2 0 n E� O Iron Pipe a, \� on \J` $ - I/8 -I/2 xAcr DNMETTiR HbLEs - - O CB/DH - Concrete Bound w/Drill Hole \ I w ! '` c� F \ Orifice G SHOULD BE SHOP D,:ILLED WITH NOTE ORIFlCE SHIELDS PREVENT PEASrONE t Eq o (O floe o * 2 0 O Q� Pea Stone A DRILL PRESS TO ENSURE I O LCEI Land Court Bound parC/asE+y \ co Te/ j \,_. Pole \gZ� \ MAN/FOLD -1 Shield - �`- C)� UNIFORMITY. REMOVE BURRS WASFL.O STORE FROM PLUOOLNO OBLIGE -p Guy o PRIOR TO PLACING PIPE. A h onw Q\ (,\\p h Lateral (ENGINEER TO INSPECT) ORIFICE SHIELD DETAIL 4 Utility Pole N�i r - Not to Scale \\ 1 1 1 T,i,N I G _ o MANIFOLD DETAIL ^ „ „ s�' Deciduous Tree \ i I k \ N 1� ` S 020 \ Not to Scale 3/4 -I I/2 Double _._ z.rt•: O T \\ Y I L - 4 ��,� __ _ as n - rr lu J -rr� d a - - w- - Overhead Wire 1 , 1 \ as p o "� t� y l�0 y Washed Stone cb" ' Ground ` r Observations s W .aO ry Q rTl \ ---- �\ 4` o S t 1\G a r .,,ice,to r- r a I + \ Lawn ,q Gr n 11 � �,,Z \ _--_ _ ._. . _ .__ _ ..:._ - � Date .Time Elea G.W. Tide �s� #1199g MIN' o 9-9�� DESIGN DATA ` . SECTION A-A 4�y/2005 11:54am 2.83 3.2.84 9 H 110:46am 1 Sty �,, �� s Single Family-4 Bedrooms 2 $ W/f of \ No Garbage Not to Scale 4l22/ 5:17 m 2.88 0.2 L 5:19 m i�< F Oq\ o d 4LL7S Dwelling / `'' - �' g Grinder W -_.... P P j I , AB� 9 ti S, o '' uI_ Dail Flow- 4 x I10 al.=440 Lv F� ti 1ReG\RGOL-ATION wn o. Y 9 gpd 4/23/ 5:41am 2.92 0.1 L 5:44am _ - . DOSING CHAMBER VOLUME • � , � Septic Tank,440 gpd x 200%= 880 gpd 4/23/ 12:30pm 2.92 3.1 H 12:28pm TrE,�k c o \° Use a 1500 Gallon Septic Tank. 1.DOSES PER DAY: 4 >uvssmrwvstlar►�szu.slazT �� r 2.AVERAGE DAILY FLOW: 440 d 4/23/ u:05pm 2.96 0.1 L 5:59pm C/o 1 m LEACHING AREA _ ° 1 -0.1 L 6:26am FuI1MOOn s81. y O 1 1 F 3.MIN.VOLUME PER DOSE: I10 Gal. 41241 6:28am 440 4.DESIGN VOLUME PER DOSE: 110 Gal 4/24/ 1:10 m 3.13 3.2 H 1:09 m 6:09am gpd/0.74 = 595 s.f.Required P P 5.EMERGENCYSTORAGE: 440 Gal. + \ \ 41/ \ � • ' \`� _ � Use Bottom Area Only 4/24/ 6:35pm 3.17 0.1 L 6:39pm �rrLfcaxl•sTaAIL�: StEVEa-M M RY 1-,A S H ` o 6.USE CAPACITY: 1000 Gai. 14 x 44 = 616 sf. Provided 4/25/ 7:02am 3.3 -0.2 L 7:09am Controls i 1 q Q C RA I(:� I t-L-G;-pc►-4 RD. 12 I IovL1��s \ O 41251 1:54pm 3.27 3.2 H 1:52 m MASS t3 -- LEACHING BED DESIGN P inorscrLoc.►T1ox: CE�"RV1L.:...�/ f�- \ \•\ \ << `• \ \ �j •... _. - -,pq_ 013SEfZ`rA � ^' I All Pipes tobe Schedule 40 PVC � ----- - _-- - 4/25/ 7:17pm 3.29 0.1 L 7:20pm A9 T.:''�_ 1`°" I Hp1-'= ��. 2 �_. ~ Use 4-I I/4 �0 Laterials in a 14�x 44� 4/26/ 7:57am 3.29 -0.3 L 7:53am \ \ �=�" :7- �_ A13 Washed Stone Leaching Field as Shown. 4/26/ 7:31pm 3.17 0.1 L 8:03pm TbisProjecehas Tr,lYheeni n�danOrierofConditiom Ssf Record 'I�` \ _ -B ( �W,c a w��6 \ _. _ o T,t-,, /d,8 4/27/2005 8:50am 3.25 -0.3 L 8:39am ai 305 f�'Qecor �.�,.,� `\ \ \. L-�ACH p NOTES O ORGANIC/LOAM OR Cbe,•k one d� \\\ RooF RU NOFOR ax l sT I-A \\ 1• Water Supply For This Lot is Municipal Water. 1O YEL ISH E3RW. Sc,t.luY F R R � \N N,,� '� � g Order of Conditions iL^t�1..,,rA Board of Health Variances Required ] \\ 47.8' CTYR) �`�?�Azov o St=R QTO �c 2.Location of Utilities Shown on This Pion Are Approx. 23' L ox t�i to YR 5'/w LA Sbte Title V \\ \ \\ At Least 72 Hours Prior to Any Excavation For This oLI11/E f3FdN, MEo, 310CMR14.211 Minimum Setbacks Project The Contractor Shall Make The Required C SANI> Z,I5Y L/G TLLpLnwtllbeoonatdaedon Cellar Wall 20 feet required O \\ ` 48' `Nottficoticn to DIG SAFE-i-888-344-7233. I�.r. 10 feet \ -- -� \\\ 3.1he Contractor is Required to Secure Appropriate hROUNOIA/A'T13_RO jprovided O �` Permits From Town Agencies For Construction PEr�K No. t0,95s 50feet / -----. -- Definedb ThisPlan. pAtEc H/x.o/os Z BVW required t) -3- =- -- -- \ \ y „ LESSTHAN zl\nlr,/INCH �r 12 feet Q,3 - \ �\s\ 4.Install Risers as Required to Within 12 of Finished ) M provided O S7g.� - - \ at 0 \! \ \ \ Grade. q q-Y 1-r H; I-1 j �Y ::.''ul-LlVsati i�t�ICrIN�ECr2\!vG\NC Town of Barnstable Chapter360 8�, ,�E -.�.r _' \` \ 5.All Structures Buried Four Feet(4') or More or WI tts.Ss: D. DtASMARAI s,T O,f'S, 0 NI I r7h•SNe cA,v r, _.,..Qat Svster"•, nyan,as'Ny11 o \ \ Subject to Vehicular to be H-20 loading. y� PROP. .,1t6.ie,.�ocaiLu„ur""Components No V Bk 721¢ m%iron \\ZL,, 6.Septic System to be installed in Accordance With 'T':H,2 ' ELEv. G.S C) F@NGti 100 foot separation required /1s4 O Did Po,r Ran \ 310 CMR 15.00 Latest Revision And The Town of •o W �"PROP r-ou"D I,•o fbnce TOP oc WAIL.Io.O 12 feet provided •., �' \ Barnstable Board of Health Regulations. 1a ArticleVlal: Marginal Lots PLAN ViE'r� L --� �- a\ �. S 1p 10 P opoLam.Fw,aL+co 4 feet of d suitable material above cotTected round water \ g O O 1iGAn•\C L ora\.if - 7. All Piping t0 be Sch.40 PVC. A RZIST F F �.4 ty g 'ram �� � •YEL\SN 13T2N ---_-- approximately 3.2 feet provided "Scale 1 _ O `�- -- �.r.�1 \ S.Depth of Inlet Tee Below Flow Line t I0"Min. L-O^" 10 Ytz S/G a - - -- -- t' O 2 4- NOTE _ ._._.�...-_. ._.. ....... � � OLIVE 13(-2 N. MCT�. 4 _.-. __ __ C�w•x _._,_ C SANI' Z,5-Y G/4, 2 f;RAOE CONCRETE COVER 1. GREEN POLYLOK RISERS AND III, Lit 4, ---- COVERS TO FINISH GRADE, UNLESS OTHERWISE NOTED, GrzoLl r->VVA-�R(a �L, 2 e) o 6" BELOW AND BACK FILLED BY HAND FINISH GRADE 2. H-10 COMPONENTS AND SCHEDULE 40 PVC PIPE THROUGHOUT 6"-8" HAND HOLES REAR Y RD SECTION A-A TO WITHIN 4" OF FINISH GRADE ' - NOT TO SCALE ELECTRICAL HAND HOLE THRU-OUT SYSTEM - - 11.0 POLYLOK RISER & COVER - IL 1 1/2" PRESSURIZED IO.I ' " Pr<ov,FrINISHep -_ _� r-.oP• 0 TO FINISH GRADE MULCH COVERING I-o P. 10.0 - - BOP• LEACH pE.NGtc. W PVC LINE a rkz of I I/4 0 SCH 40 PVC LATERALS FIeiLO 10.0 1D.2 S-I%MIN. 1D.D ^ FINISH S.D 12 P R O P,FOUND.11.O 6.54 6.39 _._.. ..-.__- -._- EZgv.VARIES �•)CHAMFL•R G,R At>C� F TOP OF WALL 10.5 8.O 8.8 _._.. -.- --- la mPo .i•`. 6.39 INLET FROM SEPTIC TANK -s 3" PVC OUTLET ' - - _ _ - 1 1 1/2"E IRCED MAIN a'cwtxR E,F 1 ;_• AC ,1' 1: - AC FROM RECIRCULATION TANK TO F MODULE Ts I --- - -- --- -- -_- - AC` 1 t/2" PVC FORCE TYP � e OMNI RSF Y ' - RS I5 BPJJ 2:' r-x s•r 1 , FILTER CLOTH E,F riR`Acr --� r7L•1sliRy+a.b GROucdowA-rcR E`_?.3 v/z�s/ns ,PITCH LATERALS TOWARD MANIFOLD 11= BUBBLER SYSTEM OVER 2 6.99 _ -• = 1. - OMNI ' BUBBLER SYSTEM SUPPLY LOCATE 4 PeAerolvLr�wG®P rT COVERING RS• S AC POWER• - HR RESERVE CAPACITY -• O SCHD. 40 PVC TEES �'- - - IN ELECTRICAL 1.LT'INb J tiOLE 1 CF. Ij h -1 Z Li-1 11Cy�yL��-- J ll-nl rt II ._ILittill�r U= -INLET TEE WITH u, u „ ` tE EE71 NL E FLOAT NOTES , wEaP HOLes- I"ef FRot�tT YARD SEGT40N -t3 •' ZABEL MODEL 2 0 PVC MANIFOLD . "„ fix,: Yu _ _ Llu.Ido,c. r1n r co scat ..� .. - ,, ;.; :e:J,Mt�I a ayJx'. ir � I• - n ..1 .• A100-12x28vCF 7.03 j �6i' �cn�+� a� �',y u coRo ALL PUMP FLOATS ARE TO BE LOCATED 6.7 i A M �"?"' DRAIN HOLE_- N AWAY FROM INLET FLOW EFFLUENT FILTER ljf- - s M4 .. CO �.r \, , .r•�� .. . p C , h ,per, .�, t 1 (2) MYERS - PRESSURE DOSING MANIFOLD SYSTE � R. ��u. � I :; £�t � \,•�,L �• n FLOAT POLE a ALL FLOATS TO HAVE 4" TETHER - '. 1. PUMP ON/OFF - ME40PC-1 _i FASIEERE 5Q1S-r, RETURN LINE FROM 6.29 '•:r n' ' .�,'r ; xGENERAL NOTES 1500 GALLON SEPTIC TANK - RECIRCULATION TANG PUMPS R M OMNI RECIRCULATION TANK � - ,-�-{ �"� + s' ":z� 1 , 2. TIMER OVERRIDE _ -. l� 2" PRESSURIZED TRANSPORT LINE f' � 'r,"`; � CHECK VALVE s N � +z"COCONT H-10 P ODUCT"• AC E RETURN LINE TO � � � tY D TO RSF PVC FORCE - 3. HIGH WATER ALARM E,F, •'3-,�. PRECAST MODEL OR EQUAL 1000 GALLON H-t0 LOADING - - 1. SLOPED TOWARD DOSING CHAMBER �. To RSF MODULE ,t, pl OTas� _ - RECIRCULATION TAN<, 1000 GALLON DOSING TANK 1 „ 5r0 12 -AI_I_u�INFoaclNv ere�4 To 1. ALL CONSTRUCTION AND MATERIALS SHALL CONFORM TO MASS ENVIRONMENTAL _ OMNI FLOW MYERS ME40PC-1 H-10 PRODUCT- ACME - FRONT VIEW SIDE VIEW' SPUTTER 1xTH EFFLUENT PUMP �tN Z x 4 6•,F, DE EXPOxY COAT•ED,40,000Psl CODE (310 CMR 15.00,TITLE 5), AND THE LOCAL BOARD OF HEALTH. RETURN LINE TO PRECAST MODEL OR EQUAL _ Observed Groundwater l'al Elev. 3.3 1 FLOAT VALVE N K�VwA,/ -CONCP ErC To BE 4IR ENTRAIN60, SEPTIC TANK INLET -�i 111=117= 111 2'eLoex :: a o0o i SI WITH 1 PANrA ppoeb 2. THERE SHALL BE NO CHANGES MADE IN THIS PLAN WITHOUT THE WRITTEN 2.29 6" MIN. CRUSHED STONE BASE - -lF 11-1�L[_ 4/25/05 I 8'-6� i . :.-.... _>.-•:.....•_ .. •.. :•. .,.: .. .,.....,, . , PERMISSION OF THE LOCAL BOARD OF HEALTH //''''►► + p j� SIDE VIEW WALL SECTION 3. ALL ERRORS, OMISSIONS, AND CHANGE OF CONDITIONS AT THE SITE SHALL SEWAGE SYSTEM PROFILE 8c DETAILS For Additional Information • •- - • NO110SC01@ THE ATTEN OF THE ENGINEER PRIOR TO PERFORMING AN 2.29 _ 8,_6„ I BE BROUGHT TO TION See Dosing Chamber Detail Below Y Y "- f RELATED WORK 4. THIS PLAN HAS BEEN PREPARED SPECIFICALLY AS A SEPTIC SYSTEM DESIGN NOt t0 Scale WOt@rpr00f/S@ol Concrete Septic Tank,R@CirCUtatlo!I : IS NOT TO BE USED TO ESTABLISH PROPERTY LINES OR BUILDING SETBACKS. Tank 8L Dosing Tank W/2 Coats of Approved Sealant o I PIPING NOTES i ''< PROPERTY LINES AND BUILDING LOCATIONS ARE GRAPHIC ONLY, PROPERTY LINES 3" RETURN LINE FROM FILTER MODULES NOT HAVING BEEN VERIFIED. NO REPRESENTATION OR CERTIFICATION AS TO THE or Concrete Addative. L7 ' I 1 AND 4" INLET FROM SEPTIC TANK „ ACCURACY OF THOSE SHOWN IS IMPLIED OR INTENDED. RSF DESIGN CALCULATIONS FOR 4 BEDROOMS : 1 ALL ENTER ON SAME SIDE OF TANK 24 OOpening Above For M.H. 1 i I / / 3" RETURN LINE FROM FILTER MODULES I/2 Gala.Pipe.FOr Frame a Cover.(Typ.) 5 TO PREVENT ALL DISTURBED SONS ARE TO BE LOANED, SEEDED AND MAINTAINED Not Valid Without An Original / _/ ENTERS ONE SIDE OF FLOW SPUTTER AND Float Support- Plans i g Sand Filter Media 24" minimum depth <I% #200 sieve, 2mm to 4mm size i -� EXITS ON OPPOSITE SIDE TO LEACHING FIELD 6. FOR PROPER PERFORMANCE, SEPTIC TANK SHOULD BE INSPECTED AT LEAST Signature 81 Stamp. - _ EXCEEDS, l ��,!.'.'• ONCE A YEAR AND WHEN THE TOTAL DEPTH OF SCUM AND SOLIDS EXC 1 t� r Average Daily Flow Flow = 110 gpd per bedroom -!- s `*`' �: _ 1/3 THE LIQUID DEPTH OF THE TANK, THE TANK SHOULD DE PUMPED. ,. i r -;v\• Wastewater Strength-BOD5 Residential = 230 mg/I TOP VIEW TOP VIEW Pump Power Si Float Contro; • /� � 3000 PSI Thrust 7. THIS SYSTEM HAS BEEN DESIGNED FROM DATA REVIEWED AND ACKNOWLEDGED i PETER FLOW SPUTTER Cables Installed in Accordance _ Block 8Y THE MASS. D.E.P. AND THE LOCAL BOARD OF HEALTH; AND Ge �Ifl /°�Q cgs: t n n n rr g, i -. CONFORMS WITH THE REQUIREMENTS OF TITLE 5 OF THE MASS. SANITARY CODE. 6' Recirculation Ratio 3:1 _ With.Local Bid B EIeC.Ccldes. 04", �,° , �� OMNI RSE SAND FILTER DETAIL 1,000 GAL. OMNI RSF RECIRCULATION TANK DETAIL �r \1�/ NO GUARANTEE OF PERFORMANCE IS EXPRESSED OR IMPLIED. C NOT TO SCALE NOT TO SCALE I -' w' Recirculation Tank Size 150% of Design Flow (Use o 1000 gallon tank) - n 8. TEST HOLE INFORMATION SHOWN HEREON IS LIMITED TO SOIL CONDITIONS FOUND i I' aL NOTES xt, a 4 0 PVC From AT THAT PARTICULAR TEST HOLE LOCATIONS AND IS NOT CONSIDERED AN ' Recirculation Tank Sand Filter Loading Rate (Residential) Loading Rate = 1219 / BOD5 = 5.3 gpd/ft2 NOTES : 1. 1 l - IMPLIED OR EXPRESSED WARRANTY OF SOIL CONDITIONS BEYOND LIMITS OF " OMNI RSF RECIRCULATION TANK (NO SUBSTITUTES) \ / -- F 8�-O SUCH TEST HOLES. r° ^a `' ---- --.---- Sand Filter Surface Area SA = (Flow gpd) / (Loading Rate gpd/ft2) 1) OMNI RSF MODULES NO SUBSTITUTIONS). 2.) PUMP CHAMBER SHALL BE STEEL REINFORCED CONCRETE. , 9. ALL ORGANIC AND UNSUITABLE MATERIAL MUST BE REMOVED FROM THE AREA 2 0 Sch.40 PVC Force DIreetiOns t0 the Site: From Hyen,",Is' 440 gpd / 5.3 gpd/sq. ft = 83 sq. ft. Required (103 sq. ft. Provided) 2 p DIRECTLY UNDER AND 5 FEET BEYOND THE PROPOSED LEACHING FACILITY. THIS FILTER MODULES SHALL BE COVERED WITH MULCH TYPE MATERIAL PUMP CHAMBER TO WITHSTAND H-10 LOADING UNLESS UNDER PAVEMENT• DRIVES OR a x,;,, e'er;•,so zt';.;o, Main to Dosing Field. AREA MUST BE BACK FILLED TO THE ELEVATIONS INDICATED ON THESE PLANS Town Halt, take Maln Street to the 3 OMNI RSF Filter Modules Required ONLY. 3.) TRAVELED WAYS, WHEREIN H-20 LOADING SHALL APPLY. WITH SELECT ON-SITE OR IMPORTED SOIL MATERIAL, CONSISTING OF CLEAN West End Rotary and then take a rlht 9 y GRANULAR SAND OR OTHER GRANULAR MATERIAL, FREE FROM ORGANIC Recirculation PumpSize Average Dail Flow + Recirculated Flow + Back Flow 3.) ALL PIPE CONNECTIONS AND CONCRETE CONSTRUCTION SHALL BE WATERTIGHT. 4•) ALL PIPE CONNECTIONS AND CONCRETE CONSTRUCTION SHALL BE WATERTIGHT, MATTER AND OTHER DELETERIOUS SUBSTANCES. MIXTURES AND LAYERS onto take der Avenue; At the Stop 440 + (4x440) + 5 = 2,205 gpd PLAN SHALL NOT BE USED. THE FILL MATERIAL SHALL CONFORM TO MA STATE g a right onto Smith Street 2,205 24hrs = 92 a) per Cycle 5•) 27" MANHOLE COVER TO BE BROUGHT TO FINAL GRADE. HEALTH CODE TITLE 5 - 310 CMR SECTION 15.225(3) AND SHALL HAVE Per 5/24/05 Conservation Comm. Hearing / g p 60 Minute C le 4.) OUTLETS TO BE SCHEDULE 40 PVC. which will turn Into Crai ville Beach use Myers Model f/ME40 or Equal 65 - - - --- --- - - - - PERCOLATION RATE OF BETWEEN TWO AND FIVE MIN. PER INCH, BEFORE AND i 5/26I05 Added Planting Note 81 Deleted Deck 9 ye q ( gallons/min ® 12 ft. Total Head) - .._ Road and continue past the beach and 5.) 1-1/2" PRESSURIZED LINE TO BE BACK FILLED BY HAND. 6) INLET AND OUTLETS TO BE SCHEDULE 40 PVC. Finished M•H.From@ a Cover AFTER PLACEMENT. Added DeWaterinq Area $i Work Limit Line over the small bridge and then the sand Filter Module Setbacks Some os Title V Septic Tank 4 ci Sch 40 PVC From Grade to Grade ORGANIC MATERIAL AND MUST HAVE LESS THAN 0.2 PERCENT MATERIAL ^' 5/16/05 LPrer r Raisin of House house is on the left#1199 Recirculation Tank-, 10. ALL STONE MUST BE DOUBLEUS WASHED AND FREE FROM FINES AND ANY I ,,, ;; • .� t VA FINER THAN A NUMBER 200 SIEVE. B.O.H. 4/19/04 MeetingModified IS.A.S. ,.,� •�a�d ' - 11. THE DESIGNER HAS NOT BEEN RETAINED BY THE CLIENT TO CONSTRUCT OR REVISION 4/Z8/05Recirculating Sand Filter 8 (Pressure Dosing � _ _:. _ _ ;o SUPERVISE THE CONSTRUCTION OF THE SYSTEM. THE CONTRACTORAS , - •. - Candurt Thru Chamber For Power&Float Galr' ,, To Dosing Field 2� Title: P.REPARED BY. PREPARED FOR: Notes/Revision: Emergent Storage << RESPONSIBLE FOR MAKING ARRANGEMENTS FOR INSPECTION OF INSTALLATION y Chain o: OF THE SYSTEM WITH THE LOCAL BOARD OF HEALTH." Vol.440 Gala Cables. oe Min.Cover. Alarm on 4.59 Inv. 12. THE GENERAL CONTRACTOR IS RESPONSIBLE FOR ALL HORIZONTAL AND Lag Pump On 4.09 '� VERTICAL CONTROL OF ALL SYSTEM COMPONENTS. Sullivan En ieerin Inc. CapeSury 2 � Sth.4°PVCMercury Float ' Threaded Pipe 13. TIGHT JOINT PIPING TO CONSIST OF POLYVINYL CHLORIDE (P.V.C.) Lead Pumoon3.59 SCHEDULE 40, UNLESS OTHERWISE NOTED.SITE PLAN g _ g, Steve & Mary Hash 1.) The property line information shown wcs Switchs-4Req'd- 1/8"Wee Hole �D p 14. THE CONTRACTOR SHALL NOTIFY THE DESIGN ENGINEER FOR CONSTRUCTION - PO BOX 659 7 Porker Road compiled from ovoiloble record information. Pumps off 3.17 Check Valve INSPECTION AFTER EXCAVATION FOR THE LEACHING BED (PRIOR TO THE PROPOSED IMPROVEMENTS ostervale, MA 02655 Osterville MA 02655 3944 Baltimore Street ~� Secure Pi eat Top Gate Valve PLACEMENT OF STONE) AND ALSO AFTER PLACEMENT OF PIPE k STONE p PRIOR TO BACKFILLING 2. The topographic information was obtained Bottom of Chamber J L• p ?' 15, DESIGN ENGINEER SHALL CERTIFY CONSTRUCTION OF SYSTEM AND MATERIALS 1199 CRAIGVILLE BEACH ROAD (508)428-3344 (508)428-3115 fax (508)420-3994 (508)420-3995 fax Kensington MD 20895 .. 8etttm El. 2.29 �; �o- 6"Washed INSTALLED. THE CONTRACTOR SHALL PROVIDE A SIEVE ANALYSIS OF THE FILL from On On the ground survey performed .:"e A •o. D . R. Stone Min. MATERIAL REQUIRED, AN AS-BUILT PLAN SHALL BE SUBMITTED TO''THE LOCAL CENTERVILLE , MASS. on or between 02IFEB105 & 10/FEB/05. o 8°- rda oa e BOARD OF HEALTH UPON COMPLETION SECTION �- 16. NO RUBBER TiRE CONSTRUCTION MACHINERY SHALL DRIVE OVER THE,PROPOSED SEPTIC BED EXCAVATION DURING CONSTRUCTION, Draft: MJD Field; RRLIWHK 20 0 10 20 40 80 J. The datum used is NGVO '29, a fixed mean (1000 GALLON) 17. DIG-SAFE AND ALL OTHER NECESSARY AUTHORITIES SHALL BE NOTIFIED FOR DOSING CHAMBER DETAIL UTILITIES PRIOR TO ANY EXCAVA71oN. S8a level datum. THE PROPER LOCATION of EXISTING Dote: Scale: Review: PS Comp/Draft: RRL/WHK Not to scale March 22, 2005 As Shown ' Proj. # 25005 Drawing # C442_1131 TBM EI=8.6 NGVD Top'Conc Noilvwt a o Y ^, o Bay _ , �.� r b NhF r ' Conrad A & Christine E Thomm ` 244±(Record) Ctfy 150749 __.—---—-- —_ — Record) ��K•n` a� FEMA Zone Line o •.,,,, .,, ----- \S8B��•43'05 E f a` , As Shown on FIRM / ------- ♦ LCB _ IP Panel #250001 0008D % _. Fnd Rev Jul 2.1992 / • ': . w l �-.. ..7- LCB Y ` 6 4 .. / - \ / ° -\ Fnd �. a — 1 Fnd Q- 1r61• N'• �, ••• ... :i• •. Al FLOOD ZONE: ° i <, : \ _., Zone A10 (el 11) o .. 6 / AL Community Panel No, a banding / J O O j 33.13' �� 0 6 s tc s % I i 1 D 250001 0008 D x F p July 2, 1992 O / ! Y \ N 7 1 O % 0 Locus MO_ p %N)- O A= a � ° ° 'w %� .` A2 �� a OVERLAY DISTRICT.• Sco/e: 1 "=2,000±' `\ o ; �+� ;. _ AP - Aquifer Protection District 1` o° / '/ � \ �, As Shown on Plan Entitled ` ° "Revised Groundwater Protection ASSESSORS REF.: \ % Edge of BVW , \\ O O / i as Flagged by 4� -- < Overlay Districts" - April, 1993 Map 206 / ENSR 51JAN105/ i , / UD iu Parcel 053 \ O eA/ i� oc `1 ILI O �Da --5 As ° ZONE. `\\ of 0 A 02 RD-1 \ O /i / / g 1 Area (min.) 87,120 SF (RPOD) \\ salt Marsh ( ; Q, / / ;-� o cv .1i 50 -f' °w Frontage (min) 20' \\ Quo- I l °hW °nw Width (min) 125' 4" - v , Setbacks: ohw Fron t 30 AIrZ Side 10' s ' A7 1 \ / ohw ohw, :.` , Rear 10' \ \ A I / E�Cl °w w o \ Flog osey 34.9• Pole i Legnpoh � d:°n \ 1 _ ` ai Light 'Post o m \ ` , a D Wetland Flag Lawn #119t � y o P / O Ircn Pipe 2 Sty v,s " w� \ 13 CB/DH - Concrete Bound w/Drill Hole < o s Dwellir w i ti o AYAeq o Low ElLCB - Land Court Bound J 1 ��''��F o 1E � -O Guy i ! y �� % �• Utility Pole 1 EOC/ _ o zo o� Deciduous Tree 11 4, \\ \ \\ �Oc�` HgMBFR \ o - ohw Overhead Wires A�• 2 -- Town Directions TownI, take Mainto the •St From to annis f R — - �-'-"' �` �N-r AIa West End Rotary and then take aright e--, Ail,55' a _ \ ROA�ti P '� - - P���EM- onto Scudder Avenue; At the stop ord \ oF— ITs AID / \ 30sf \\ RuN0r�R �..... _ TR�� \ \ °£ sign take a right onto Smith Stree ` ��P� j which will turn Into Craigville Beach Record) _ k Re�� LAwN A �\ Road and continue past the beach and ° O co � ©E" over the small bridge and then the RNA NSErZ, \ \� house Is on the left#1199 O \� ��DAT`pNs 250. - Q r rnOFco ° 9.1820E ` d�` P_ R .: \ I � coon,°S"/f ° 5 PSULIIL§§1I�9`l�A, U Bk H HOmi/ton \ /e V 714/194 O Old Post \ �. L CIVIL R°!l Fence dIl, \ ��\ \ ohw RX. PLAN VIEW ° ss ° , Scale : I1 =201 IL CD Title: PREPARED BY. DREPARED FOR: Notes/Revision: Sullivan Engineering, Inc. CapeSurv-1-1SITE PLANSteve & Mary Hash 1.) The property line information shown was PO Box 659 7 Parker Road ,' compiled from available record information. cb PROPOSED IMPROVEMENTS Osterville, MA 02655 Osterville MA 02655 a 3944 Baltimore r�Strreet 1199 CRAI GV I L L E BEA CH ROAD (508)428-3344 (508)428-3115 fax (508)420-3994 (508)420-3995 faa Kensington MD 20895 2.) The topographic information was obtained from an on the ground survey performed CENTERVILLE MASS. / o on or between 02 FEB/05 & .10/FEB/05. Draft: MJD Field: RRL/WHK 20 0 10 20 4o s0 3.) The datum used is N N)' � GVD '29, a fixed mean N Date: March 221, 2005 Scale: As Shown Review: PS Comp/Draft: RRL/WHK ,� sea level datum. Prol• # 25005 Drawing # C442_1G1 . : : ... , .-. a _.- ,. .. -, •r.: ter. + r -:. . - _ - Z F.G.10.0 F.G.10.0 Vent 3 , nnn nTop Elev.9.0 0 8.2 1500 Gallon 8.7 r t Bot.Elev.8.0 . >:. i PIgoP.-c-IMt3ER pEcl< 8.0 Install Flow PROP. Septic Tank 8.5 5.2 S FE1.IG6 Ems. lo.s Levelers Observed Groundwater Elev.2.8 12 TOP PROP FOUND 1100 t TOP OFVVA0-10.0 -,.�. 3/16/05 PROS. F•INIs14Mp c>Rna -t_awN ex1sT.F.F �.a Bedding Per Title 1000Gollon V Pump Chamber y rwrA 57. DEVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM o - - Not to Scale REAR YA\RD SECTION A-,A 5CALEt I"= 10' NOTES - I. Water Supply For This Lot is Municipal Water. 24'0 Opening Above For M.H. 1/2 0 Goly Pipe For Frame&Cover. 2.Location of Utilities Shown oh This Plan Are Approx. Float Suppert At Least 72 Hours Prior to Any Excavation For This t> Project The Contractor Shall Make The Required a>� PROPI FIN15NED PRdP• a Notification to DIG SAFE-1-888-344-79233. GRADE PROP, 1-EAG41 1:=1EL0 �"'�«' W 3.The Contractor is Required ;to Secure Appropriate Pump Power Float Control To D-Box 12 TOPOF PROP. FOUND. 11.0 TOP O F WAt_l 10-S LAWN Permits From Town Agencils For Construction Cables Installed in Accordance 0 - \�/�y-'T- 10 n ) Defined by This Plan. With.Local Bldg.&Elec.Codes. I 4:Install Risers as Required toWithin 12 of Finished 8 Exlsr. F'.F: a.a b Grade. a a- 4 0 From. Septic e 5.Al Structures Buried Four Fiet (4) or More or Precast Pump Tank. Sch.40 PVC y �xts�"• �- Subject to Vehicular to be H-20 Loading. I Chamber (3 RAOCs OD9t3RV1LD GRoUN01"ATEI4 E�-.2.0, 3�Il.�OS e 2 - 6.Septic System to be Installed in Accordance With a: 8-0 e 310 CMR 15.00 Latest Revision And The Town of ,�; ,:�.e,,,� s,o.•oo Barnstable Board of Health Regulations. 7. All Piping tobe Sch.40 PVC. FRONT YARD SECTION g-B 8.Depth of Inlet Tee Below FIoW Line I O��Min. PLAN SCALE 1' = l o' Depth of Outlet Tee Below Flow Line'.14"Min. With Gas Baffle. 4. 0 Sch.40 PVC Finished From Septic Tank Grade DESIGN DATA y, . .a.=.a�yT; �/�iIi7 Jar iv. TL Single Family -4 Bedrooms d$ �_� �S° �aA fl6 0. No Garbage Grinder Al Conduit Thru Chamber ro Daily Flow, 4 x I10 gal. =440 gpd For Power 81 Float LG n To D-Box Septic Tank:440 pd x 2f�0 /o = 880 pd Emergency Storage • ,: g ° 9 Volume: 440gal. o Cables. on Min.2 Cover Use a 1500 Gallon SepticTank. Alarm on Inv. 7.6 II.CNAMFI R t=1N1sNED Fv.vs+cites CTRA-iL LEACHING AREA ° 2"0 Sch.40 PVC 440 d/0.74 = 595 s.f. Re uired Pump on 5.4 Mercury Float ' Threaded Pipe 'osCa 12 coN�. 9P q Switchs-3 Req'd 3'crweR E•F _ Use Bottom Area Only P 16 x 38' 608 s.f. Provided _,Pumpoff 4.9 . - CA"'. Check Valve -ry�-' Secure Pipeat Top B Gate Valve _ �S BeNTSI�I Z' E F LEACHING BED DESIGN Bottom of ChamberAll Pipes to be Schedule 40 PVCBottom El. 3.6 �� 6"Washed Perforated With EndstobeVented, Use " t• •o. Stone Min. Hot-ES, I c.F. 4 - 4 0 Distribution Linesina 16 x38aED ,:::. •. . Leaching Bed as Shown. SECTION - 1000 GALLON ' � �.•:�•. ,' WEEP NOl_E3- 1"GS PUMP CHAMBER DETAIL Not to Scale 5 an IZ'CONT 1. G2AOF ELCV.3.8 E•F, Boa rd of Health Variances Required E!X u,1 $cni 1'LII - Al.t_ rzPIN�RCING STEEL To KcyWAy E.F, I3ti=EXPDXY COATEO� 40,000JPsI State Title V -coNcR�Tv_ -ro Br-AIR Erv-rRAlrvtU, 310 CMR14.211 Minimum Setbacks a,0oo PSI WITH I PAWrmA AbaeD Cellar Wall 20 feet required WALL SECTION 10 feet provided Not to Scale BVW 50 feet required 12 feet provided Town of Barnstable Chapter 360 On-Site Sewage Disposal Systems Article I: Location of Compon6rits 100 foot separation required 12 feet provided Article VIII: 'Marginal Lots 4 feet of dry suitable material above corrected ground water approximately 3.2 feet provided I /per rj��( 4 a • k• ? CI tZ.2973 CIVIL SHEET 2 of 2 SECTIONS 8 DETAILS PROPOSED IMPROVEMENTS 1199 CRAIGVILLE BEACH ROAD CENTERVILLE , MASS.