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0112 NYES NECK ROAD EAST - Health
�1 112 Nyes Neck Road East_ Centerville A= 232-011-002 ,1 f S M E A D No.2-153LOR UPC 12534 sm"d.com • UuW In USA �o i�t 1�Nllii OiOLMICTt�i SFI OF TI*SRPROGRAM " CERTIFIED SOURQMG WWWSRPROGRAMLORG I 1- A„y - t'e: ad 1p✓v�, t+�y-e,IC, m rn C4--� 2 .5-- 1 ca _e c-,r— u Y \ cJY-C-\ L' . �opt►+e rok� Barnstable Town of Barnstable ��a� BAFMA S.LE, ` Board of Health 1.6g9. �0 Arfb 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 30, 2015 Mr. Michael Lavington 112 Nyes Neck Road East Centerville, MA RE: Sampling of Wastewater Effluent from your Innovative/Alternative (MicroFAST) System at 112 Nyes Neck Road East, Centerville Dear Mr. Lavington, You are granted permission to reduce the frequency of sampling and monitoring of the wastewater effluent from your onsite sewage disposal system consisting of innovative/alternative technology (MicroFAST system) at 112 Nyes Neck Road East, Centerville. A public hearing was held before the Board of Health on May 12, 2015. The Board has. received the nine test results which were satisfactory. This permission is granted with the following conditions: ❖ The wastewater effluent shall continue to be tested twice per year for TSS, BOD, pH, TN TKN,Nitrate, and Nitrite. Operation and Maintenance Inspections shall be conducted on a regular basis in accordance with MA DEP Regulations. Since 1 , W ne llei :D., Chairman B ARD OF HEALTH CC: Barnstable County Health Department Q:\WPFILES\IA Monitoring 112 Nyes Neck Road East 2015.doc 44 ComrneQ Street Raynham, MA 02767 a Tel: (508) 880-0233 . (Fax: 8 80-7232 F ram " March 31,,2015 � f Barnstable Board of Health -Y 200 Main Street Hyannis, MA 02601 Subject: Request for Testing Reduction FAST Treatment System Reference: Serial Number: 201985 112 Nye's Neck Road East, Centerville, MA Attached please find the results for testing performed at the property of Michael Lavington, 112 Nye's Neck Road East, Centerville,MA. We are asking the Barnstable Board of Health to review the test data for that property to see if that testing may be reduced. Please forward a copy of your decision to our office. Your help in this matter would be greatly appreciated. Sincerely, e w� d-e e- 5 . Wastewater Treatment Services, Inc. Service Department Cc: Michael Lavington f emisiry Environmental Services fLn l Anal ,CCIf �' Balmce Site Sampling i Assurance Services Data Auditing C O R P O R A T I O N e Moreau'�tic �M CERTIFICATE OF ANALYSIS `V` Wastewater Treatment Services,Inc. 44 Commercial Street REPORTED: 11/30/2012 Raynham, MA 02767 ORDER#: G1252908 COLLECTED BY: M.Dillen SAMPLE DATE: 11/19/2012 TIME: 13:45 DATE RECEIVED: 11/20/2012 LOCATION: 112 Nye's Neck Rd. East Centerville,MA SAMPLE ID: Hooker Grab (201985) DESCRIPTION: WATER �.�c RESULTS OF ANALYSIS a`'U' `. 090112ip Pa ter P � alyhcal nits a Detesultl '. etfio �Ana�led mu*.- .d7��a.''`ak� .kc Test Parameters LAB-ID#: 1252908-01 Alkalinity 310.2 EPA 310.2 11/21/2012 mg/L 4.00 103 BOD SM 5210B 11/21/2012 mg/L 4 <4.0 Kjeldahl,Nitrogen EPA 351.2 11/29/2012 mg/L 0.50 0.66 Nitrate,Nitrogen 4110B SM 4110 B 11/20/2012 mg/L 0.50 0.55 Nitrite,Nitrogen 4110B SM 4110 B 11/20/2012 mg/L 0.25 ND PH SM 4500 H+B 11/20/2012 S.U. 0-14 8.1 Solids,Suspended SM 2540 D 11/21/2012 mg/L 4 <4.0 NA=Not Applicable ND Not Detected Approved By: <' = Less Than L Manager / Date *' = Detection Limit RECE DEC 0 51011 Page 1 of 1 Analytical Balance Corp., 422 West Grove Street, Middleboro, MA 02346 Ph: 508-946-2225 I' hemistry Environmental Services s Ana,, ca Balance ment l ., Site Sampling ity Assurance Services Data Auditing C 0 R Y U R A T 1 O N Mike Moreau CERTIFICATE OF ANALYSIS Wastewater Treatment Services, Inc. 4 REPORTED: 03/05/2013 4 Commercial Street Raynham, MA 02767 ORDER#: G1354998 COLLECTED BY: M.Dillen SAMPLE DATE: 2/25/2013 TIME: 8:00 DATE RECEIVED: 2/27/2013 LOCATION: 112 Nye's Neck Rd.Centerville,MA SAMPLE ID: Hooker Grab(201985) DESCRIPTION: WATER RESULTS OF ANALYSIS r #�,�-��� "i� ��; { ��� ,�, .�,��-;�- �rya �.�� ;;Parameter �H�Date�� 4�' -ilnrts� •Det � :� '�Result=��,fp '��� 'ea•',y ���i3x"�,. '��,, m`�'.�'4 'Ta�� 3f -s`'" � � her° yMethod � Anal ze Limit* . y Test Parameters LAB-ID#: 1354998-01 Alkalinity 310.2 EPA 310.2 03/01/2013 mg/L 4.0 123 BOD SM 5210B 02/27/2013 mg/L 4 <4.0 Kjeldahl,Nitrogen EPA 351.2 03/04/2013 mg/L 0.50 0.74 Nitrate,Nitrogen 4110B SM 4110 B 02/27/2013 mg/L 0.50 1.49. Nitrite,Nitrogen 4110B SM 4110 B 02/27/2013 mg/L 0.25 ND pH SM 4500 H+B 02/27/2013 S.U. 0-14 8.0 Solids,Suspended SM 2540 D 02/28/2013 mg/L 4 <4.0 NA=Not Applicable ND=Not Detected Approved y 3 J/� '<' = Less Than b Manag / Date *' = Detection Limit RECEIVED MAR 0 7 2013 Page 1 of 1 Analytical Balance Corp., 422 West Grove Street, Middleboro, MA 02346 Ph: 508-946-2225 ; vnmental Chemistry Environmental Services Re-Assessment r�1 E Site Sampling j Quality 1 1 Assurance Services 11a y C O RfPI.ic Balance Data Auditing 0 R A T 1 0 N Mike Moreau CERTIFICATE OF ANALYSIS Wastewater Treatment Services,Inc. REPORTED: 05/17/2013 44 Commercial Street Raynham, MA 02767 ORDER#: G1356836 COLLECTED BY: M.Dillen SAMPLE DATE: 5/8/2013 TIME: 11:30 DATE RECEIVED: 5/10/2013 LOCATION: 112 Nye's Neck Rd. Centerville,MA SAMPLE ID: Hooker Grab (201985) DESCRIPTION: WATER RESULTS OF ANALYSIS °a• "Ua .�s'�'*�i3 �,7"'yx?•'c i ry ��-.T'-�'`� # d v "' r� �-'C"a. i4f` �� � �p 1 a . 'fir ��t^-$ ° Parameter �, s � £" Analytical - �'���-Date. `��ilrnfs '°-� �Det-� - ,.� F "� • esult ..o.,,, n-. yy. 'yy ?v war`'" - . �f��' ����'�' .� � etliod ;�p'",=a �An`�yzed �' �� ::ti, RIM Test Parameters LAB-M: 1356836-01 Alkalinity 310.2 EPA 310.2 05/14/2013 mg/L 4.0 139 BOD SM 521013 05/10/2013 mg/L 4 <4.0 Kjeldahl,Nitrogen EPA 351.2 05/17/2013 mg/L 0.50 0.91 Nitrate,Nitrogen 4110B SM 4110 B 05/10/2013 mg/L 0.50 1.40 Nitrite,Nitrogen 411013 SM 4110 B 05/10/2013 mg/L 0.25 ND pH SM 4500 H+B 05/10/2013 S.U. 0-14 8.2 Solids, Suspended SM 2540 D j 05/14/2013 j mg/L 1 4 <4.0 NA=Not Applicable ND=Not Detected Approved By. z,s eA34 < = Less Than Detection Limit La Manager / Date *' = RECEIVED MAY 2.11013 Analytical Balance Corp., 422 West Grove Street, Middleboro, MA 02346 Ph: 508-946-2225 Page 1 of 1 b jEnvironmental Chemistry Environmental Services -� Site Assessment • ,,�y.���++p Site Sampling Quality Assurance Services � �ll. Data Auditing C 0 It P O R A T 1 0 9 Mike Moreau CERTIFICATE OF ANALYSIS Wastewater Treatment Services,Inc. 44 Commercial Street REPORTED: 09/26/2013 Raynham, MA 02767 ORDER#: G1361235 COLLECTED BY: M.Dillen SAMPLE DATE: 9/19/2013 TIME: 8:30 DATE RECEIVED: 9/19/2013 LOCATION: 112 Nye's Neck Rd. Centerville,MA SAMPLE ID: . Grab(201985) DESCRIPTION: WATER RESULTS OF ANALYrSIS i,1' � +, ��� - 1. F �..nj ., �• �t�.. - - a� Test Parameters LAB-m#: 1361235-01 Alkalinity 310.2 EPA 310.2 09/25/2013 mg/L 4.0 60.0 BOD SM 5210B 09/19/2013 mg/L 4.0 7.8 Kjeldahl,Nitrogen EPA 351.2 09/23/2013 mg/L 0.50 6.71 Nitrate,Nitrogen 411013 SM 4110 B 09/19/2013 mg/L 0.50 10.9 Nitrite,Nitrogen 4110B SM 4110 B 09/19/2013 mg/L 0.25 ND H SM 4500 H+B 09/19/2013 S.U. 0-14 6.9 Solids,Suspended SM 2540 D 09/24/2013 mg/L 4 <4.0 NA=Not Applicable ND=Not Detected Approved By. <' = Less Than Manage / Date '*' = Detection Limit AA RECEI V ED Page 1 of 1 Analytical Balance Corp., 422 West Grove Street, Middleboro, MA 02346 Ph:508-946-2225 Environmental Chemistry Environmental Services Site Assessment Ana Balance Site Sampling Quality Assurance Services YY���1 L Data Auditing G O 11 P O R A T 1 0 N- PV Mike Moreau CERTIFICATE OF ANALYSIS Wastewater Treatment Services,Inc. 44 Commercial Street REPORTED: 01/22/2014 Raynham, MA'02767 ORDER#: G1464251 COLLECTED BY: M.Oliveria SAMPLE DATE: 1/15/2014 TIME: 10:30 DATE RECEIVED: 1/15/2014 LOCATION: 112 Nye's Neck East Centerville,MA SAMPLE ID: Michael Lavington Grab(201985) DESCRIPTION: WATER RESULTS.OF ANALYSIS W. Pazamete�r� m � Anyhcal � � ate s4 Umts a Det esult: - Test Parameters LAB-M#: 1464251-01 Alkalinity 310.2 EPA 310.2 01/21/2014 mg/L 4.0 43.8 BOD 01/16/2014 SM 5210B mg/L 4.0 <4.0 Kjeldahl,Nitrogen EPA 351.2 01/17/2014 mg/L 0.50 1.42 Nitrate,Nitrogen 4110B SM 4110 B 01/15/2014 mg/L 0.50 14.8 Nitrite,Nitrogen 4110B SM 411013 0 111 5/2 0 14 mg/L 0.25 ND pH SM 4500 H+B 01/15/2014 S.U. 0-14 7.7 Solids,Suspended ISM 2540 D 01/17/2014 mg/L 4 1 5 NA=Not Applicable Timothy A. (:A dgndbyrnm* ND=Not Detected Begley jk m PP xs = Less Than Approved y:B oaaxmu12xrsarox *' =Detection Limit Lab Manager i Date Page 1 of I Analytical Balance Corp., 422 West Grove Street, Middleboro, MA 02346 Ph:508-946-2225 ,-v 1 Environmental Chemistry Environmental Services Site Assessment �� j�cp Site Sampling Quality Assurance Services Analvfic l• Data Auditing C O R Y O R A T I O N Mike Moreau CERTIFICATE OF ANALYSIS Wastewater Treatment Services,Inc. 44 Commercial Street REPORTED: 03/11/2014 Raynham, MA 02767 ORDER#: G1465299 COLLECTED BY: M.Oliveira SAMPLE DATE: 3/3/2014 TIME: 9:00 DATE RECEIVED: 3/3/2014 LOCATION: 112 Nyes Neck Rd.,Centerville,MA SAMPLE ID: Michael Lovington Grab(201985) DESCRIPTION: WATER RESUI TS yOF ANALYSIS * '!•+.#7"^'•y'a.�`+`Paztto r1s R eisl'tzL ; "h �a�y�� c � Y:� "vw...�.s...k,%'�KSd aa.- ,...•__�f,,�, .��-G :.�1e.x �'ix'1.f .IF?�a«?i.��irXiati:: :..�m. :-+.,� .h. `�i...'.'' .�C„ r,�.�u< a.}g{ Test Parameters LAB-ID#: 1465299-01 Alkalinity 310.2 EPA 310.2 03/05/2014 mg/L 4.0 51.2 BOD SM 5210B 03/05/2014 mg/L 4.0. <4.0 Kjeldahl,Nitrogen EPA 351.2 03/10/2014 mg/L 0.50 1.86 Nitrate,Nitrogen 4110B SM 4110 B 03/03/2014 mg/L 0.50 12.7 Nitrite,Nitrogen 4110B SM 4110 B 03/03/2014 mg/L 0.25 ND pH SM 4500 H+B 03/03/2014 S.U. 0-14 7.9 Solids,Suspended SM 2540 D. 03/05/2014 mg/L 4 8.0 NA=Not Applicable Timothy A == .fMiMeOryA BepY, ND=Not Detected Begley Approved By: = Less Than Detection Limit Lab Manager / Dare Page 1 of 1 Analytical Balance Corp., 422 West Grove Street, Middleboro, MA 02346 Ph:508-946-2225 f Serial No:09121410:47 Project Name: 112 NYES LANE NECK RD. E. CENT Lab Number: L1420095 Project Number: 201985 Report Date: 09/12/14 SAMPLE RESULTS Lab ID: L1420095-01 Date Collected: 09/03/14 09:00�. Client ID: EFFLUENT Date Received: 09/03/14 7 Sample Location: MICHAEL LAVINGTON Field Prep: Not Specified Matrix: Water Dilution Date Date Analytical Parameter Result Qualifier Units RL MDL Factor Prepared Analyzed Method Analyst Gereral Chemistry Westborough Lab Alkalinity,Total 56.3 mg CaCO3/L 2.00 NA 1 - 09/04/14 10:22 30,2320E SD Solids,Total Suspended ND mg/I 5.0 NA 1 - 09/09/14 13:20 30,2540D DW pH (H) 7.3 SU - NA 1 - 09/03/14 20:21 30,4500H+-B MR Nitrogen,Nitrate/Nitrite 12. mg/I 0.50 — 5 - 09/05/14 04:34 44,353.2 DB Total Nitrogen 14. mg/l 0.60 — 2 - 09/09/14.14:43 41,- JO Nitrogen,Total Kjeldahl 1.64 mg/I 0.600 - 2 09/04/14 11:01 09/08/14 22:01 30,4500N-C AT BOD,5 day 5.9 mg/I 2;0 NA 1 09/03/14 23:10 09/08/14 16:30 30,5210B SE /1LrHA i LPage 12 f rEnvir7onmentaWlhemistry Environmental Services eAssessmen �� ��� Balance Site Sampling Quality Assurance Services a Data Auditing C C} R I' O R A T 1 0 N Mike Moreau CERTIFICATE OF ANALYSIS Wastewater Treatment Services,Inc. 44 Commercial Street REPORTED: 12/10/2014 Raynham, MA 02767 ORDER#: G1473143 COLLECTED BY: M. Oliveira SAMPLE DATE: 12/1/2014 TIME: 11:00 DATE RECEIVED: 12/2/2014 LOCATION: 112 Nyes Ln.Neck Rd,E. Centerville,MA SAMPLE ID: Michael Lavington Grab(201985) DESCRIPTION: WATER RESULTS OF ANALYSIS E. - r Test Parameters LAB-ID#: 1473143-01 Alkalinity 310.2 EPA 310.2 12/04/2014 M91L 4.0 87.6 BOD SM 5210B 12/03/2014 mg/L 4.0 <4.0 Kjeldahl,Nitrogen EPA 351.2 12/05/2014 mg/L 0.50 2.21 Nitrate,Nitrogen 4110B SM 4110 B 12/02/2014 mg/L 0.50 3.00 Nitrite,Nitrogen 4110B SM 4110 B 12/02/2014 mg/L 0.25 ND pH SM 4500 H+B 12/02/2014 S.U. 0-14 6.5 Solids,Suspended SM 2540 D 12/08/2014 mg/L 4 70.5 NA=Not Applicable Timothy A. 1}G�.lmAryABWH UNIT-.vE9 ND=Not Detected , Begley " '<' = Less Than Approved By. �';'� * = Detection Limit Lab Manager / Date '.I I Analytical Balance Corp., 422 West Grove Street, Middleboro, MA 02346 Ph:508-946-2225 Page 1 of 1 �l �ppINETO Town of Barnstable Barnstable ` Board of Health "F""'e'caC iR DAnM , • ' g 9 MASS. $ I �A 039. rfaMA+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 Michael Lavington, 112 Nye's Neck Road East, Centerville, MA 02632 Michael Lavington, 10510 Copper Lake Drive, Bonita Springs, FL 34135-8435 Wastewater Treatment Services, 44 Commercial Street, Ra nham, MA 02767 ACKNOWLEDGEMENT. April 20, 2015 Tou are on the agenda for our Board of Mealth meeting Re: 112 Ave's k.IW Qad East, Centerviffe , requesting review for reduction of monitoring for your I/A septic system. Thankyou. Your item will be on Board of Health Meeting on the: Date of: Tuesday, May 12, 2015 You, or a representative for you, is expected to be present to answer questions the Board may have. Meeting Location: Town Hall, 367 Main St, Hyannis Hearing Room, Second Floor Time: 3:00—6:00 P.M. Approximately three days prior to meeting, an agenda will be sent out to you- once it is available. It will also be available on line at the town website: www.town.b arnstab 1 e.ma.us Go to ..."Boards & Committees > Board of Health - or- Go to Official Agendas Any questions, please call Sharon Crocker at 508-862-4739. Thank you. QAAGENDAS BOHUet Receipt of 130H Submission 112 Nye's Neck Rd East Cent May 12 2015.doc CLjn��I 3- '� Jffr ece&, Yip 44 ComaQ Street Raynham, MA . 0 - 2767 ` ..� Tel: (508) 880-0233 " F,:. ax: (508) 880-7232 March 31,.2015 Barnstable Board of Health 200 Main Street . Hyannis, MA 02601 Subject: Request for Testing Reduction FAST Treatment System Reference: Serial Number: 201985 112 Nye's Neck Road East, Centerville, MA Attached please find the results for testing performed at the property of Michael Lavington, 112 Nye's Neck Road East, Centerville, MA. We are asking the Barnstable Board of Health to review the test data for that property to see if that testing may be reduced. Please forward a copy of your decision to our office. Your help in this matter would be greatly appreciated. Sincerely, Wastewater Treatment Services, Inc. Service Department Cc: Michael Lavington i z emistry Environmental Services ont ' Site Sampling AnaltlCal Balance ;/Assurance Services Data Auditing C O R P 0 R A T I 0 N tice Moreau CERTIFICATE OF ANALYSIS Wastewater Treatment Services,Inc. 44 Commercial Street REPORTED: 11/30/2012 Raynham, MA 02767 ORDER#: G1252908 COLLECTED BY: M.Dillen SAMPLE DATE: 11/19/2012 TIME: 13:45 DATE RECEIVED: 11/20/2012 LOCATION: 112 Nye's Neck Rd.East Centerville,MA SAMPLE ID: Hooker Grab(201985) DESCRIPTION: WATER RESULTS OF ANALYSIS �`°'-�l?arameter�-�-��z , aly�ical�" Date nits Det'. esulty �F�{� ;�'c�"*a�r��i�r�`�,y end �`€�wed �_ -s. _ �• -t:1n11*. c�� � a Test Parameters LAB-ID#: 1252908-01 Alkalinity 310.2 EPA 310.2 11/21/2012 mg/L 4.00 103 BOD SM 5210B 11/21/2012 mg/L 4 <4.0 Kjeldahl,Nitrogen EPA 351.2 11/29/2012 mg/L 0.50 0.66 Nitrate,Nitrogen 4110B SM 4110 B 11/20/2012 mg/L 0.50 0.55 Nitrite,Nitrogen 4110B SM 4110 B 11/20/2012 mg/L 0.25 ND pH SM 4500 H+B 11/20/2012 S.U. 0-14 8.1 Solids, Suspended SM 2540 D 11/21/2012 mg/L 4 <4.0 NA=Not Applicable ND=Not Detected Approved By: '<' = Less Than L Manager / Date *' = Detection Limit 1V Ep DEC 5 2012 RECE Page 1 of 1 Analytical Balance Corp., 422 West Grove Street, Middleboro, MA 02346 Ph: 508-946-2225 hemist, Environmental Services sment Ana �}*• � Site Sampling Pity Assurance Services A11C.Li}�liC 'i Lc�w`�1C� Data Auditing G O R Y 0 R A T 1 O N Mike Moreau CERTIFICATE OF ANALYSIS Wastewater Treatment Services, Inc. 4 REPORTED: 03/OS/2013 4 Commercial Street Raynham, MA 02767 ORDER#: G1354998 COLLECTED BY: M.Dillen SAMPLE DATE: 2/25/2013 TIME: 8:00 DATE RECEIVED: 2/27/2013 LOCATION: 112 Nye's Neck Rd. Centerville,MA SAMPLE ID: Hooker Grab(201985) DESCRIPTION: WATER RESULTS OF ANALYSIS S � �,i ...Sb�°. e � s1 ` Aarameter � 3" x 3 t Anal cal � .Date ti�L7iitt"s � at I. - Test Parameters LAB-ID#: 1354998-01 Alkalinity 310.2 EPA 310.2 03/01/2013 mg/L 4.0 123 BOD SM 5210B 02/27/2013 mg/L 4 <4.0 Kjeldahl,Nitrogen EPA 351.2 03/04/2013 mg/L 0.50 0.74 Nitrate,Nitrogen 4110B SM 4110 B 02/27/2013 mg/L 0.50 1.49 Nitrite,Nitrogen 4110B SM 4110 B 02/27/2013 mg/L 0.25 ND pH SM 4500 H+B 02/27/2013 S.U. 0-14 8.0 Solids,Suspended SM 2540 D 02/28/2013 mg/L 4 <4:0 NA=Not Applicable ND=Not Detected Approved '<' = Less Than *' = Detection Limit b Manag Date/ RECEIVED OR 012013 Page 1 of 1 Analytical Balance Corp., 422 West Grove Street, Middleboro, MA 02346 Ph: 508-946-2225 vnmental Chemistry Environmental Services re Assessment E Site Sampling / Quality Assurance Services Ana ical Balance Data Auditing G O R P O R A T 1 0 N Mike Moreau CERTIFICATE OF ANALYSIS Wastewater Treatment Services,Inc. REPORTED: 05/17/2013 44 Commercial Street Raynham, MA 02767 ORDER#: G1356836 COLLECTED BY: M.Dillen SAMPLE DATE: 5/8/2013 TIME: 11:30 DATE RECEIVED: 5/10/2013 LOCATION: 112 Nye's Neck Rd. Centerville,MA SAMPLE ID: Hooker Grab (201985) DESCRIPTION: WATER RESULTS OF ANALYSIS 4tr� iv ., f Awr-t � sf3 d �i � d.y" i ✓u ,7��xro s a n :F ,� srY 2aS FN Parameter ��� Analytical= Date m_fs � eta• es11: INN Afflw—lm Pt110 rAnalyZed L'llI11t�. h a a 4 "ti u Test Parameters LAB-ID#: 1356836-01 Alkalinity 310.2 EPA 310.2 05/14/2013 mg%L 4.0 139 BOD SM 521OB 05/10/2013 mg/L 4 <4.0 Kjeldahl,Nitrogen EPA 351.2 05/17/2013 mg/L 0.50 0.91 Nitrate,Nitrogen 411OB SM 4110 B 05/10/2013 mg/L 0.50 1.40 Nitrite,Nitrogen 41 1OB SM 4110 B 05/10/2013 mg/L 0.25 ND pH SM 4500 H+B 05/10/2013 S.U. 0-14 8.2 Solids,Suspended SM 2540 D 05/14/2013 mg/L 4 <4.0 NA=Not Applicable ND=Not Detected Approved By. < = Less Than er / Date '*' = Detection Limit LaMana g RECEIVED MAY 212013 Page 1 of 1 Analytical Balance Corp., 422 West Grove Street, Middleboro, MA 02346 Ph: 508-946-2225 i Environmental Chemistry Environmental Services Site Assessment W- P Site Sampling Quality Assurance ServicesAnal, Balance Data Auditing C0 R .. A T T O ITT Mike Moreau CERTIFICATE OF ANALYSIS Wastewater Treatment Services,Inc. 44 Commercial Street REPORTED: 09/26/2013 Raynham, MA 02767 ORDER#: G1361235 COLLECTED BY: M.Dillen SAMPLE DATE: 9/19/2013 TIME: 8:30 DATE RECEIVED: 9/19/2013 LOCATION: 112 Nye's Neck Rd. Centerville,MA SAMPLE ID: _ Grab (201985) DESCRIPTION: WATER RESULTS OF ANALYSIS Test Parameters p LAB-ID#: 1361235-01 Alkalinity 310.2 EPA 310.2 09/25/2013 mg/L 4.0 60.0 BOD SM 5210B 09/19/2013 mg/L 4.0 7.8 Kjeldahl,Nitrogen EPA 351.2 09/23/2013 mg/L 0.50 6.71 Nitrate,Nitrogen 4110B SM 4110 B 09/19/2013 mg/L 0.50 10.9 Nitrite,Nitrogen 4110B SM 4110 B 09/19/2013 mg/L 0.25 ND H SM 4500 H+B 09/19/2013 S.U. 0-14 6.9 Solids,Suspended SM 2540 D 09/24/2013 mg/L 4 <4.0 NA=Not Applicable ND=Not Detected Less Than Approved = Manage• / Date '*' = Detection Limit RECEIVE Analytical Balance Corp., 422 West Grove Street, Middleboro, MA 02346 Ph:508-946-2225 Page 1 of 1 5 Environmental Chemistry Environmental Services. Site Assessment Site Site Sampling _Quality Assurance Services �1 Data Auditing c O R Y O R A T 1 O N Mike Moreau CERTIFICATE OF ANALYSIS Wastewater Treatment Services,Inc. 44 Commercial Street REPORTED: 01/22/2014 Raynham, MA 02767 ORDER#: G1464251 COLLECTED BY: M.Oliveria SAMPLE DATE: 1/15/2014 TIME: 10:30 DATE RECEIVED: 1/15/2014 LOCATION: 112 Nye's Neck East Centerville,MA SAMPLE ID: Michael Lavington Grab(201985) DESCRIPTION: WATER RESULTS.OF ANALYSIS Para�mete ?Anal $balms ate UnitsO'etN Analyzed: j ; #�-��_',' .sa.. - - Test Paranwters LAB-D1#: 1464251-01 Alkalinity 310.2 EPA 310.2 01/21/2014 mg/L 4.0 43.8 BOD SM 5210B 01/16/2014 mg/L 4.0 <4.0 Kjeldahl,Nitrogen EPA 351.2 01/17/2014 mg/L 0.50 1.42 Nitrate,Nitrogen 4110B SM 4110 B 01/15/2014 mg/L 0.50 14.8 Nitrite,Nitrogen 4110B SM 4110 B 01/15/2014 mg/L 0.25 ND pH SM 4500 H+B 01/15/2014 S.U. 0-14 7.7 Solids,Suspended ISM 2540 D 01/17/2014 mg/L T 4 23.5 �•°°' NA=N Timothy Applicable y A. ND=Not Detected Approved By:Begley EiN�IRnIm~L� < = Less Than oae xm4ntn x,acoz *' =Detection Limit Lab Manager I Date Page 1 of 1 Analytical Balance Corp., 422 West Grove Street, Middleboro, MA 02346 Ph:508-946-2225 Environmental Chemistry Environmental Services Site Assessment �ical Site Sampling Anal Ba1mce Quality Assurance Services Data Auditing C O R P O R A T 1 0 N Mike Moreau CERTIFICATE OF ANALYSIS Wastewater Treatment Services,Inc. 44 Commercial Street REPORTED: 03/11/2014 Raynham, MA 02767 ORDER#: G1465299 COLLECTED BY: M.Oliveira SAMPLE DATE: 3/3/2014 TIME: 9:00 DATE RECEIVED: 3/3/2014 LOCATION: 112 Nyes Neck Rd.,Centerville,MA SAMPLE ID: Michael Lovington Grab(201985) DESCRIPTION: WATER RESULTS OF ANALYSIS - 0����� s> Method �An yzed' •unit* - o Test Parameters ~LAB-ID#: 1465299-01 Alkalinity 310.2 EPA 310.2 03/05/2014 mg/L 4.0 51.2 BOD SM 5210B 03/05/2014 mg/L 4.0. <4.0 Kjeldahl,Nitrogen EPA 351.2 03/1=014 mg/L 0.50 1.86 Nitrate,Nitrogen 4110B SM 4110 B 03/0Y2014 mg/L 0.50 12.7 Nitrite,Nitrogen 4110B SM 4110 B 03/03/2014 mg/L, 0.25 ND pH SM 4500 H+B 03/03/2014 S.U. 0-14 7.9 Solids,Suspended SM 2540 D. 03/05/2014 mg/L 4 8.0 NA=Not Applicable Timothy A =* l:N.l4ro0ryA Beek, ND=Not Detected Begley -� < = Approved By: Less Than m.az+++ Detection Limit Lab Manager i Date Analytical Balance Corp., 422 West Grove Street, Middleboro, MA 02346 Ph:508-946-2225 Page 1 of 1 Serial—No:09121410:47 Project Name: 112 NYES LANE NECK RD. E. CENT Lab Number: L1420095 Project Number: 201985 Report Date: 09/12/14 SAMPLE RESULTS Lab ID: L1420095-01 Date Collected: 09/03/14 09:00 Client ID: EFFLUENT Date Received: 09/03/14 Sample Location: MICHAEL LAVINGTON Field Prep: Not Specified Matrix: Water Dilution Date Date Analytical Parameter Result Qualifier Units RL MDL Factor Prepared Analyzed Method Analyst Gerieral Cfiemistry Westborough Lab i s Alkalinity,Total 56.3 mg CaCO3/1- 2.00 NA 1 - 09/04/14 10:22 30,2320B SD Solids,Total Suspended ND mg/I 5.0 NA 1 - 09/09/14 13:20 30,2540D DW pH (H) 7.3 SU - NA 1 - 09/03/14 20:21 30,4500H+-B MR Nitrogen,Nitrate/Nitrite 12. mg/I 0.50 — 5 - 09/05/14 04:34 44,353.2 DB Total Nitrogen 14. mgll 0.60 — 2 - 09/09/14.14:43 41,- JO Nitrogen,Total Kjeldahl 1.64 mg/I 0.600 -- 2 09/04/14 11:01 09/08/14 22:01 30,4500N-C AT BOD,5 day 5.9 mg/I 2.0 NA 1 09/03/14 23:10 09/08/14 16:30 30,521013 SE Page 6 of 12 f FEnvironmental Chemistry Environmental Services e Assessment MO ���� Bice Site Sampling Quality Assurance Services c l e Data Auditing R P O R A T 1 O N Mike Moreau CERTIFICATE OF ANALYSIS Wastewater Treatment Services,Inc. 44 Commercial Street REPORTED: 12/10/2014 Raynham, MA 02767 ORDER#: G1473143 COLLECTED BY: M. Oliveira SAMPLE DATE: 12/1/2014 TIME: 11:00 DATE RECEIVED: 12/2/2014 LOCATION: 112 Nyes Ln.Neck Rd,E. Centerville,MA SAMPLE ID: Michael Lavington Grab.(201985) DESCRIPTION: WATER RESULTS OF ANALYSIS i� Yi"""r sit k Test Parameters LAB-ID#: 1473143-01 Alkalinity 310.2 EPA 310.2 12/04/2014 mg/L 4.0 87.6 BOD SM 5210B 12/03/2014 mg/L 4.0 <4,0 Kjeldahl,Nitrogen EPA 351.2 12/05/2014 mg/L 0.50 2.21 Nitrate,Nitrogen 4110B SM 4110 B 12/02/2014 mg/L 0.50 3.00 Nitrite,Nitrogen 4110B SM 4110 B 12/02/2014 mg/L 0.25 ND - pH SM 4500 H+B 12/02/2014 S.U. 0-14 6.5 Solids,Suspended SM 2540 D 12/08/2014 mg/L 4 70.5 t/:,,�N'.w.aWmmoupA . NA=Not Applicable Timothy A. IW�BTTEE ND=Not Detected = Less Than Approved By: Begley * — DetectionLimit Lab Manager /^ Date I Page I of 1 Analytical Balance Corp.,' 422 West Grove Street, Middleboro, MA 02346 Ph:508-946-2225 1� i f �Op1HE Tp Town of Barnstable Barnstable ` 41FtNSTABLE, ` Board of Health ;eficaCftv MASS. Qjo a639. TfD MAt" 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 Michael Lavington, 112 Nye's Neck Road East, Centerville, MA 02632 Michael Lavington, 10510 Copper Lake Drive, Bonita Springs, FL 3413 5-843 5 Wastewater Treatment Services, 44 Commercial Street, Raynham, MA 02767 ACKNOWLEDGEMENT: April 20, 2015 Tou are on the agenda for our Board of Yfealth meeting Re: 112 5Vye s 5Veck.q?Qad East, Centerrville , requesting review for reduction of monitoring for your 1/A septic system. 2hankyou. Your item will be on Board of Health Meeting on the: Date of: Tuesday, May 12, 2015 You, or a representative for you, is expected to be present to answer questions the Board may have. Meeting Location: Town Hall, 367 Main St, Hyannis Hearing Room; Second Floor Time: 3:00—6:00 P.M. Approximately three days prior to meeting, an agenda will be sent out to you— once it is available. It will also be available on line at the town website: www.town.barnstable.ma.us Go to ..."Boards & Committees > Board of Health - or- Go to Official Agendas Any questions, please call Sharon Crocker at 508-862-4739. Thank you. I QAAGENDAS BOH\let Receipt of BOH Submission 112 Nye's Neck Rd East Cent May 12 2015.doc I � I/A System Sample Report °f- 112 Nye's Neck Road East, Barnstable ` k : Barnstable County Department of Health and Environment �sss P.O. Box 427, Barnstable, MA 02630 Physical Address 112 Nye's Neck Road East, Barnstable Technology - Model FAST - MicroFAST 0.5 Sample Date and Time 12/01/2014 @ 11:00 am Effluent Results Sampling_Parameter � � ° �� �� ��� � � � Result''°` ��" ,Unit' Range Alkalinity (Alkalinity) 87.60000 mg/L Nitrate Nitrate . ' < _ __ )__._ 3.00000 m /L 19.00 Nitrite (Nitrite) BRL mg/L <19.00 Total Kjehldahl Nitrogen (TKN) ` _ 2.21000, mg/L <19.00 Total Nitrogen (TN) 5.21000 mg/L <19.00 Biochemical Oxygen Demand, 5Day (BOD5)� BRL mg/L <3000 _... - -- �-A Total Suspended Solids (TSS) 70.50000 mg/L <30.00 SU 6.00 9.00 BRL- Below Recordable Limit, DNS - Did Not Sample, NR- Not Reported CA �-{ �z- AIL a n � T.y� 1' � ` f, tl' _ ` 4 t e. , ' - •� � t.y .. i � € ` ' . m{ .u4. , � � ` ' � + ' ♦ + .' � � • r. % i .. _. I. � 1 � � - ` F 3 - • : F . l Commonwealth of Massachusetts Tithe 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 112 Nyes Neck rd East Property Address Hooker Owner Owner's Name information is required for every Centerville Barnstable Ma 9/17/13 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. General Information on the computer, use only the tab 1. Inspector: key to move your I cursor-do not Chad Hathaway I use the return key. Name of Inspector H.P.S. Q Company Name P.O.Box 151 Company Address Forestdale Ma 02644 Cityrrown State Zip Code 774-274-2581 12866 Telephone Number License Number B. Certification 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: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 9/17/13 spector's Signature Date The system inspector shall bmit a copy of this inspection report to the Approving Authority (Board of Health or DEP)withi 0 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. VI D/N t5ins•3/13 Title 5 Official Inspection IS.bce Sewage Disposal System•Page 1 of 17 l Commonwealth of Massachusetts . U W Off@ 5 Off cW �nzpecflan Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 112 Nyes Neck rd East Property Address Hooker Owner Owner's Name information is required for every Centerville Barnstable Ma 9/17/13 page. City/Town State Zip Code Date of Inspection B. CertufucaVon (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 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: tank, pump chamber,Dbox and leach field in good working condition B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements.'If"not determined," please explain. The septic tank is metal and over 20 years old*,or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts H u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 112 Nyes Neck rd East Property Address Hooker Owner Owner's Name information is required for every. Centerville Barnstable Ma 9/17/13 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ 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): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form / Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 112 Nyes Neck rd East Property Address Hooker Owner Owner's Name information is required for every Centerville Barnstable Ma 9/17/13 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 112 Nyes Neck rd East Property Address Hooker Owner Owner's Name information is required for every Centerville Barnstable Ma 9/17/13 page. CityfTown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ❑ The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 f } � Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 112 Nyes Neck rd East Property Address Hooker Owner Owner's Name information is required for every Centerville Barnstable Ma 9/17/13 page. Citylrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 112 Nyes Neck rd East Property Address Hooker Owner Owner's Name information is required fcr every Centerville Barnstable Ma 9/17/13 page. Cityrrown State Zip Code Date of Inspection D. System. Information Description: Number of current residents: seasonal Does residence have a garbage grinder? ❑ Yes ® No 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: seasonalDate Commerciallindustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-3/13 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 I 0 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 112 Nyes Neck rd East Property Address Ho oker Owner Owner's Name information is required for every Centerville Barnstable Ma 9/17/13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: none Was system pumped as part of the inspection? ❑ Yes ® 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) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 112 Nyes Neck rd East Property Address Hooker Owner Owner's Name information is required for every Centerville Barnstable Ma 9/17/13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 2008 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2'feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: 15+feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): Depth below grade: 2' 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: 2 compartment microfast tank Sludge depth: 0 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 112 Nyes Neck rd East Property Address Hooker Owner Owner's Name information is required for every Centerville Barnstable Ma 9/17/13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness 0 Distance from top of scum to top of outlet tee or baffle 0 Distance from bottom of scum to bottom of outlet tee or baffle 0 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.): no sludge or scum on inlet end of tank Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface •Sewage Disposal System Page 10 of 17 P Y 9 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 112 Nyes Neck rd East Property Address Hooker Owner Owner's Name information is required for every Centerville Barnstable Ma 9/17/13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No 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 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments � 112 Nyes Neck rd East Property Address Hooker Owner Owner's Name information is required for every Centerville Barnstable Ma 9/17/13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert g 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.): dbox clear no leaks or cracks cover at grade 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.): good condition. ran pump and set of high water alarm both work as should system has proper weep hole in pump line * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: c4 panals dry clean sand observed through 4" inspection port t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 112 Nyes Neck rd East Property Address Hooker Owner Owner's Name information is required for every Centerville Barnstable Ma 9/17/13 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ® leaching fields number, dimensions: 12x32 ❑ overflow cesspool number: ® innovative/alternative system Type/name of technology: microfast 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 Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M . 112 Nyes Neck rd East Property Address Hooker Owner Owner's Name information is required for every Centerville Barnstable Ma 9/17/13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 112 Nyes Neck rd East Property Address Hooker Owner Owner's Name information is required for every Centerville Barnstable Ma 9/17/13 page. City/Town State Zip Code Date of Inspection D. System Information (cone.) 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 w� , 3-2, C11)) 41 b a2 �� t c.2 3 `7 c7) D?) -6) 1 ) LC'1 F`6) E G � F t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 112 Nyes Neck rd East Property Address Hooker Owner Owner's Name information is required for every Centerville Barnstable Ma 9/17/13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 9'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: 2008 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: plan shows 6'6"of GW seperation between bottom of leaching and seasonal high G/W Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 112 N es Neck rd East Property Address Hooker Owner Owner's Name information is required for every Centerville Barnstable Ma 9/17/13 page. Citylrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 CarmodyTM Service History Page 1 of 7 CarmodyTM Environmental Management Services BARNSTABLE County, Massachusetts - Karen Malkus -5/21/2014 Main Menu Service History Home ---._...._. Lo Out How To:All Tutorials I rint Service History Apply for Passwords P Support Phone/Fax Report Tech Problem Property Information Range/Request Form Chan a Password Property ID BANye112FAS(Tracking Number) Carmody Training Links Map Register Event File a Service Event Name Hooker,Joanne How To:File Event Site Address 112 Nye's Neck Road East Data Resources Centerville, MA Search/Add Property Service Activi Create a Report Service Statistics Create an Excel File Reconcile Addresses Total Service Events (To Date) 36 Statistics Report ,Split Parcels �< s View Onsite Service History: 1� a2 �3 All Years r Include Inactive Show All I�� Reports Service History -All Date Report Type Entered Gallons Recorded By or Comments Date Pumped Disposal Site Serviced 3/10/2014 0 Wastewater "Inspection" 1:14 PM Treatment ;1/16/2014P Services, Inc. / 1 10:13 PM ------ Using:The Web Site , J3/10/2014 0 Wastewater Sampling 1:01 PM Treatment Report 512014 Services,Inc. Using:The Web Site 1/2/2014 System No Service No service event reported within 12:00 AM Generated Recorded service schedule: 09/19/2013 to 112/2014 01/01/2014. 12:00 AM Notes: No service event was recorded by the system for this component: FAST 1/2/2014 System No Service No service event reported within 12:00 AM Generated Recorded service schedule: 09/19/2013 to 1/2/2014 01/01/2014. 12:00 AM Notes: No service event was recorded by http://www.carmody.biz/pump/Service_History.aspx?permit_id=977578 5/21/2014 CarmodyTM Service History Page 2 of 7 the system for this component: Sample Report(Effluent) 10/2/2013 System No Service No service event reported within 12:00 AM Generated Recorded service schedule: 05/08/2013 to 10/2/2013 10101/2013. 12:00 AM Notes: No service event was recorded by the system for this component: FAST 10/2/2013 System No Service No service event reported within 12:00 AM Generated Recorded service schedule: 05/08/2013 to 10/2/2013 10/01/2013. 12:00 AM Notes: No service event was recorded by the system for this component: Sample Report(Effluent) 12/18/2013 0 Wastewater "*Inspection" M Treatment 9/19/20 Services, Inc. 8:30 AM ------ Using: The Web Site 12/18/2013 0 Wastewater Sampling 1:40 PM Treatment Report Services, Inc. :30 A ------ Using:The Web Site 6/10/2013 0 Wastewater "Inspection" 9:50 A Treatment 3 Services, Inc. 11.30 AM ------ Using: The _ Web Site 3 6/10/2013 0 Wastewater Sampling ,9:43 AM ,. Treatment Report /8/201 Services, Inc. 11:30 AM ------ Using: The Web Site 3/22/2013 0 Wastewater "Inspection"* 1:06 PM Treatment 2/25/2013 Services, Inc. 8:00 AM ------ Using: The Web Site 2 l 3/22/2013 0 Wastewater Sampling 1:02 PM Treatment Report 25/2013' Services, Inc. Using: The Web Site 2/2/2013 System No Service No service event reported within 12:00 AM Generated Recorded service schedule: 02/01/2012 to 2/2/2013 02/01/2013. 12:00 AM Notes: No service event was recorded by the system for this flag: Maintenance Contract http://www.carmody.biz/pump/Service_History.aspx?permit_id=977578 5/21/2014 CarmodyTM Service History Page 3 of 7 S 1/2/2013 System No Service No service event reported within 12:00 AM Generated Recorded service schedule: 08/28/2012 to 1/2/2013 01/01/2013. 12:00 AM Notes: No service event was recorded by the system for this component: Sample Report(Effluent) 1/2/2013 System No Service No service event reported within 12:00 AM Generated Recorded service schedule: 08/28/2012 to 1/2/2013 01/01/2013. 12:00 AM Notes: No service event was recorded by the system for this component: FAST 1/21/2013 0 Wastewater '"Inspection" 1:06 PM Treatment 11/19/2012 Services, Inc. 1:45 PM ------ Using:The 'n Web Site 1/21/2013 0 Wastewater Sampling 1:04 PM Treatment Report 11/19/2012, Services,Inc. 1:45 PM ------ Using:The Web Site 10/2/2012 System No Service No service event reported within 12:00 AM Generated Recorded service schedule: 05/29/2012 to 10/2/2012 10/01/2012. 12:00 AM Notes: No service event was recorded by the system for this component: Sample Report(Effluent) 10/2/2012 System No Service No service event reported within 12:00 AM Generated Recorded service schedule: 05/29/2012 to 10/2/2012 10/01/2012. 12:00 AM Notes: No service event was recorded by the system for this component: FAST 10/10/2012 0 Wastewater *"Inspection"* 11:57 AM Treatment 8/28/2012 Services, Inc. (` 3:00 PM --- Usin ngg: The �'1( L Web Site 10/10/2012 0 Wastewater Sampling 11:55 AM Treatment Report ,18/28/20121 Services, Inc. 3:00 PM ------ Using: The Web Site 7/2/2012 0 Wastewater "*Inspection" 1:16 PM Treatment 5/29/2012 Services, Inc. ------ Using:The Web Site http://www.carmody.biz/pump/Service_History.aspx?permit_id=977578 5/21/2014 CarmodyTM Service History Page 4 of 7 7/2/2012 0 Wastewater Sampling 1:15 PM Treatment Report 5/29/2012, Services, Inc. '11:30 AM- ------ Using: The Web Site 4/23/2012 0 Wastewater *"Inspection" Unable to service or test-system 2:57 PM Treatment is off. 2/14/2012 Services, Inc. 9:00 AM ------ Using:The Web Site 2/2/2012 System No Service No service event reported within 12:00 AM Generated Recorded service schedule: 02/01/2010 to 2/2/2012 02/0112012. 12:00 AM Notes: No service event was recorded by the system for this flag: Maintenance Contract 1/2/2012 System No Service No service event reported within 12:00 AM Generated Recorded service schedule: 08/15/2011 to 1/2/2012 01/01/2012. 12:00 AM Notes: No service event was recorded by the system for this component: Sample Report(Effluent) 1/2/2012 System No Service No service event reported within 12:00 AM Generated Recorded service schedule: 08/15/2011 to 1/2/2012 01/01/2012. 12:00 AM Notes: No service event was recorded by the system for this component: FAST 4/23/2012 0 Wastewater "*Inspection" Unable to service-blower is off at 2:54 PM Treatment the breaker. Please note that the 12/14/2011 Services, Inc. blower needs to be running to 9:00 AM ------ insure the proper operation of the Using: The FAST system. Web Site 10/2/2011 System No Service No service event reported within 12:00 AM Generated Recorded service schedule: 05/18/2011 to 10/2/2011 10/01/2011. 12:00 AM Notes: No service event was recorded by the system for this component: FAST 10/2/2011 System No Service No service event reported within 12:00 AM Generated Recorded service schedule: 05/18/2011 to 10/2/2011 10/01/2011. 12:00 AM Notes: No service event was recorded by the system for this component: Sample Report(Effluent) 10/18/2011 0 Wastewater *"Inspection** 3:07 PM Treatment f�f 8/15/2011 Services,Inc. 10:00 AM ------ http://www.carmody.biz/pump/Service_History.aspx?permit_id=977578 5/21/2014 CarmodyTM Service History Page 5 of 7 Using: The Web Site 10/18/2011 0 Wastewater Sampling 3:04 PM Treatment Report 8/15/201.1- Services, Inc. `10:00 AM ------ Using: The Web Site 73/2011 0 Wastewater **Inspection** 9:16 AM Treatment 5/18/2011 Services, Inc. 12:30 PM ------ Using: The Web Site 6/3/2011 0 Wastewater Sampling 9:02 AM Treatment Report ,.5/18/2011:- Services, Inc. 12:30 PM ------ Using:The Web Site 4/2/2011 System No Service No service event reported within 12:00 AM Generated Recorded service schedule: 11/23/2010 to 4/2/2011 04/01/2011. 12:00 AM Notes: No service event was recorded by the system for this component: FAST 4/2/2011 System No Service No service event reported within 12:00 AM Generated Recorded service schedule: 11/23/2010 to 4/2/2011 04/01/2011. 12:00 AM Notes: No service event was recorded by the system for this component: Sample Report(Effluent) 4/4/2011 0 Wastewater **Inspection** 1:34 PM Treatment 3/9/2011 Services, Inc. 8:30 AM ------ Using:The Web Site 4/4/2011 0 Wastewater Sampling 1:29 PM Treatment Report 3/9/2011 Services, Inc. 8:30 AM ------ Using:The Web Site 12/22/2010 0 Wastewater **Inspection** 12:27 PM Treatment 11/23/2010 Services, Inc. d 9:30 AM Using:The Web Site 12/22/2010 0 Wastewater Sampling 12:25 PM Treatment Report i11/23/2010 Services,Inc. 9:30 AM ------ Using:The Web Site 10/2/2010 System No Service No service event reported within 12:00 AM Generated Recorded service schedule: 05/18/2010 to 10101/2010. http://www.carmody.biz/pump/Service_History.aspx?permit_id=977578 5/21/2014 I CarmodyTM Service History Page 6 of 7 10/2/2010 12:00 AM Notes: No service event was recorded by the system for this component: Sample Report(Effluent) 10/2/2010 System No Service No service event reported within 12:00 AM Generated Recorded service schedule: 05/18/2010 to 10/2/2010 10/01/2010. 12:00 AM Notes: No service event was recorded by the system for this component: FAST 10/18/2010 0 Wastewater "Inspection" 3:43 PM Treatment \ 9/16/2010 Services, Inc. �Q \ 1:00 PM Using: The Web Site 10/18/2010 0 Wastewater Sampling 3:40 PM Treatment Report --9/16/2010 Services, Inc. 1.00 PM ------ Using:The Web Site 6/22/2010 0 Wastewater "*Inspection" 3:53 PM Treatment 5/18/2010 Services, Inc. 2:45 PM ------ �\•(`�' Using:The Web Site 6/22/2010 0 Wastewater Sampling 3:49 PM Treatment Report �5/18/2010� Services, Inc. l 2:45 PM ------ Using:The Web Site 3/1/2010 0 Wastewater "Inspection" 2:03 PM Treatment 2/9/2010 Services, Inc. 12:00 PM �D Using:The Web Site 3/1/2010 0 Wastewater Sampling Ammonia 0.12 2:00 PM Treatment Report r2/9/2010 Services, Inc. 12:00 PM ------ Using:The Web Site 2/25/2011 Wastewater .,Saved Sample <0.25 is not a valid number and 9:41 AM Treatment Message' could not be processed Services, Inc. q. 2:41 4/2009 0 Wastewater "*Inspection"" / PM Treatment 6/2009 Services, Inc. 30 AMUsing:The Web Site 4/2009 0 Wastewater Sampling 36 PM Treatment Report 16/2009- ` Services, Inc. 30 AM ...... 5/21/2014 CarmodyTM Service History Page 7 of 7 Using: The Web Site 10/26/2009 0 Wastewater "*Inspection" 2:34 PM Treatment 8/28/2009 Services, Inc. 2:45 PM ------ Using:The Web Site 10/26/2009 0 Wastewater Sampling 2:31 PM Treatment Report 8/28/2009` Services, Inc. 2:45 PM ------ Using: The Web Site 6/30/2009 Wastewater Message Serial number for this unit 201985. 8:38 AM Treatment Board History Startup date 2/17/09.Testing 6/29/2009 Services, Inc. Item results Alkalinity 122; BOD 0.0; 1:25 PM TKN 16.5; Nitrate 1.33; Nitrite 4.32; pH 7.4; TSS <4.0. ::: 06/30/09- Updated permit and submitted sample report. -BB 6/30/2009 0 Wastewater Sampling 06/30/09-Operator put sample 8:37 AM Treatment Report report on message board.-BB 5/12/2009 Services, Inc. 10:15 AM ------ Using:The Web Site 6/29/2009 0 Wastewater "*Inspection"* 1:32 PM Treatment 5/12/2009 Services, Inc. 10:15 AM ------ Using:The Web Site Total Gallons Pumped=0 This is a privately operated web site. Sponsorship does not constitute an endorsement from any participating regulatory agency. Copyright©2014 Carmody@.All rights reserved. Legal I Privacy http://www.carmody.biz/pump/Service_History.aspx?permit_id=977578 5/21/2014 g 44 Commercial Street Raynham, MA 02767 Tel: (508) 880-0233 • Fax: (508)880-7232 February 19, 2009 Barnstable Board of Health 200 Main Street Hyannis, �iA 02501 Attention: Board of Health Agent Reference: Home FAST Treatment Serial Number: 201985 Attached please find a copy of the Product Registration Report for the FAST Treatment System for the startup performed on 02/17/2009 at the home of Joanne Hooker located at 112 Nye's Neck Road East, Centerville, MA. Also, attached is a copy of the fully executed Inspection & Testing Agreement. If you have any questions or require additional information please do not hesitate to call. Sincerely, ; Donna L. Callahan -o F w � Enclosures .. t :f .^ . d; t ...s.t .. F E.:•, a . . ,. . .. ..., a .,k .t... ; =t r � itdC08P0R "Ai E 0 8450 Cole Parkway zu Shawnee, KS 66227 m Phone 913-422-0707 w Fax: 912-422-0808 e-mail: onsite(@biomicrobics.com w www.biomicrobics.com M 800-753-FAST(3278) PRODUCT REGISTRATION REPORT Product Registration Report must be completed and returned to Bio-Microbics, Inc. in order to effect warranty. Date of Start-Up > Date Shipped to End User 2/2/09 Serial # 201985 OWNER NAME Joanne Hooker ADDRESS It 2 Nye's Neck Road East . CITY/STATE/ZIP Centerville,MA 02632 PHONE/FAX BIO-MICROBICS DISTRIBUTOR NAME Wastewater Treatment Services,Inc. ADDRESS 44 Commercial Street CITY/STATE/ZIP Raynharn, MA 02767 PHONE/FAX 508-880-0233 FAX: 508-880-7232 INSTALLER NAME Pastore Excavating ADDRESS P.O. Box 1289 CITY/STATE/ZIP Forestdale,MA 02644 PHONE/FAX 508-428-9300 CONSULTING ENGINEER if applicable) NAME EAS Land Services ADDRESS P.O. Box 1729 CITY/STATE/ZIP Sandwich,MA '02563 PHONE/FAX 508-888-3619 Good Bad NA , . Good_ Bad NA ELECTRICAL PANEL(S) TREATMENT UNITS) Visual Alarm Operating r 0, Air vent clear Audio Alarm Operating ° - Q Septic tank level BLOWER(S) Septic tank meets min. size Wired for correct voltage �. Septic tank filled to operating level Inlet/outlet piped correctly d Air Lift Operation d Filter element installed 7� Recirculation tube in place Blower hood secure' b Fasteners tight Blower works correctly Lj WATER-TIGHT JOINTS Blower located within 100' of ❑ Treatment unit to septic tank [� treatment unit Air line clear Entrance tube to insert cover Air inlet screen clear LjInsert to insert cover Blower hood vents clear Discharge line connection Factory Authorized Personn G� Title. Firm: Wastewater Treatment Services, Inc. Date: 10-SEP-08 14:57 FROM-AMPROD +15088807232 T-974 P.02/03 F-902 f'Y 91_w&2PW 44 Commercial Street p>e all items marked• Raynham, MA in sips .including dua Mad 02767 sivwd original Contract to: Tel: (508) 880.0233 4t Commercia�rSt W Fax: (Wit)880-7232 Rmmhum MA W67 INSPECnoN AND EFFLUENT TESTING AGREEMENT Agreement entered into by and between Wastewater Treatment Services,Inc.(herein called WTS)and the FAST•System OWNER(herein called OWNER)for the inspection by WTS of certain equipment of OWNER which is described below. Upon acceptance of this agreement at WTS's office,WTS will render the following services only: Equipment will be inspected at least 4 times per year that this Agreement remains in effect,with the first inspections beginning • These inspections will include: 1) Testing of the sludge depth in the septic tank. 2) Inspection,power testing and clean/replace intake filter of the air blower. 3) Inspection of the alarm System: 4) Inspect overall condition of FASTS System. 5) Notification to OWNM of any problems encountered. 6) Service other than routine maintenance will be billed at an hourly rate,plus travel and parts. WTS shall notify the local.Board of Health and Department of Environmental Protection in writing within 24 hours of a system failure or alarm event including corrective measures that have been taken. OWNER will be billed standard WTS charges for any parts used in repairs or maintenance. Any additional labor time will be billed to the OWNER at current labor rates of$78.00 per hour. Emergency service between regular inspections will be provided at standard labor rates during normal business hours;at time and one-half after 5:00 PM and on Saturdays;and at double time on Sundays and holidays. Emergency service charges will include a minimum four(4)hours of labor, plus standard WTS charges for parts,plus mileage and travel charges. The annual.raw includes routine maintenance,but does not include repairs required for damages caused by abuse,accident,theft,acts of third persons,forces of nature, or alterations made to the equipment. WTS shall not be responsible for failure to render the agreed services if caused by strikes,labor disputes,noncooperation by OWNER,or other factors beyond the control of WTS. OWNER understands and agrees that WTS is not responsible for special, incidental or consequential damages,including but not limited to loss of time, injury to person or property,or equipment failure. OWNER agrees that WTS may enter OWNEWs property and have acceptable access to all areas deemed by WTS to be necessary or appropriate for WTS to perform its duties hereunder. IO-SEP-08 14:5T FROM-AENGPROD +150888OT232' T-974 P 03/03 F-902 p Current WTS practice is to send OWNER approximately 10 days before expiration of the term of the current contract(1)either a new contract or an offer to extend the current contract's term,and(2)an invoice for one year of service. It is OWNER's responsibility to timely return the payment and either the new contract or the accepted extension,completed and signed. WTS must receive the payment and document before expiration of the then current contract year to assure continuous contract coverage. Failure to return such documents on time or to otherwise comply with this contract,may result in suspension of service,cancellation of the contract and/or nullification of warranties, at the election of WTS. OWNER may not assign this contract without the prior writtewconsent of WTS. It will remain in force until a party cancels by written notice to the other at the address given herein, or until the contract term expires,whichever is sooner. MANUFACTURER MODEL NO. SERIAL.NO. LOCATION ANNUAL PATE Bio-Microbics MicroFAST 6% Centerville,MA $440.00 E W-WNT O te Waswater Treatment Servicm Inc. *Signed by OWNER: f Joanne Hooker Signed- * i Address: 112 Nye's Neck Road East 44 Com rcial Street Raynham,MA 02767 Tele:(508) 880-0233 *City: State: Zip: Fax:(508)880-7232 Centerville MA 02632 J� , Telephone 617-795-2 222 Effective Date of Agreement Daytime Telephone: This is a two-year contract which will be billed annually. OWNER understands that(1)ANNUAL RATE payment is for one year only commencing on the effective date set forth above and is non-refundable;and(2) Current DEP Regulationt require O VIrNE to maintain a service agreement for the life of the FAST®System. I HAVE READ ERST FOREGOING. *Signed by OWNER: Effluent T.,estim Effluent sample taken 4 ti es per year for the first two years and delivered to a qualified testing lab for evaluation. Results sent to State and local Agencies as well as the OWNER.OWNER is responsible for providing acceptable access to effluent to enable a grab sample to be taken for laboratory testing performed. PERMIT: '(PLEASE CHECK ONE) ( X)GENERAL ( )REMEDIAL ( )PROVISIONAL (X)pH,BOD5,TSS,Alkalinity;Total Nitrogen *Cost for testing: $270.0dNVisit Operator assigned: Wffiiam Everett Telephone: (§n 400- /*Enggineer: EAS Land Services *Approval for Effluent Testing 1 ome Wner's Signature 3 � I'e z Q Oft on {- 10-SEP-08 14:67 FROM-JREMPRO^ +15088807232 __ T-974 P.02/03 F-902 _ ` L `�QdCP.uJ�ter` �redti!?,eI2G tlCrrx,�, ��LG 44 Commercial Street New Comprem all ita m marked Aaynham,MA ineludingd=3iPaDM.Mail 02767 I`, 1 yipw 0609 oMUM W. k w Tel:(508)880�0933 c, inl se 4A Fax:(608)8072! 1 �hmn_MA Mb7 a RMpECTION AM F,,FF'f.,rJENT TESTING AGREEMENT Agreement entered into by and between Wastewater Treatment Services,Inc.(herein called WTS)and the FAS, System OWNER(herein called OWNER)for the inspection by WTS of certain equipment of �. OW;ER which is described below. Upon acceptance of this agreement at WTS's office,WTS will render the following services only: I Equipment will be inspected at least 4 times per year that this Agreement remains in effect,with the fust inspections beginning= �•l� • These inspections will include: I: I 1) Testing of the sludge depth in the septic tank. 2) Inspection,power testing and clean/replace intake filter of the air blower. 3) Inspection of the alarm system. 4) Inspect overall condition of FAST°System. $) Notification to OWNER of any problems encountered. 6) Service other than routine maintenance will be billed at na hourly rate,plus travel and parts. WTS shall notify the local Board of Health and Department of Environmental Protection in writing within 24 hours of a system failure or alarm event including corrective measures that have been taken. OWNER will be billed.standard WTS charges for any parts used in repairs or maintenance. Any additional labor time wilrbe billed to the OWNER at current labor rates of$78.00 per hour, Emergency service between regular inspections will be provided at standard labor rates during normal business hours;at time and one-half after 5:00 PM and on Saturdays;and at double time on Sundays and holidays. Emergency service charges will include a minimum four(4)hours of labor, plus standard WTS charges for parts,plus mileage and travel charges. The annual rate includes routine maintenance,but does not include repairs required for damages caused by abuse,accident,then,acts of third persons,forces of nature, or alterations made to the equipment. WTS shall not be responsible for failure to render the agreed services if caused by strikes,labor disputes,non-cooperation by OWNER,or other factors beyond the control of WTS. OWNER understands and agrees that WTS is not responsible for special,incidental or consequential damages,including but not limited to loss of time,injury to person or property,or equipment failure. OWNER agrees that WTS may enter OWNER's property and have acceptable access to all areas deemed by WTS to be necessary or appropriate for WTS to perform its duties hereunder. 10-SEP-08 14:6T FROM-JRENGPRO__.. +1608880T232_ `_ T-874 P.03/03 F-002 - Current WTS practice is to send OWNER approximately 10 days before expiration of the term of the current contract(1)either a new contract or an offer to extend the current contract's term,and(2)an invoice for one year of service. It is OWNER's responsibility to timely return the payment and either the new contract or the accepted extension,completed and signed. WTS must receive the payment and document before expiration of the then current contract year to assure continuous contract coverage. Failure to return such documents on time or to otherwise comply with this contract,may result in suspension ofservice,cancellation of the contract and/or nulIificatioa of warranties,at the election of WTS. OWNER may not assign this contract j without the prior written consent of WTS. It will remain in force until a party cancels by written notice to the k other at the address given herein,or until the contract teffn expires,whichever is sooner. MANUFACTURER MO DU NO, S LOCATTO�j ANNUAL RATE Bio-Microbics NUcroFAST 01 Centerville,MA $a40.00 I; TQ>lIIPMEN1 O Waste„water Treatment. Inc *Signed by 01 R: A Joanna Hooker Signed- *Address: 112 Nye's Neck Road East 44 Co roial Street Raynham,MA 02767 Tale:(508)880-0233 Is *City: State: Zip: Fax:(509)880-7232 Centerville MA 02632 Telephone 617-795, 722 Effective Date of Agreement Daytime Telephone: This is a two-year contract which will be billed annually. OWNER understands that(1)ANNUAL RATE payment is for cue year only commencing on the affective date set forth above and is non-refundable;and(2) Current DEP RegulatiqsNs require to maintain a service agreement for the life of the FAST®System. T HAVE READ ER;3T FOREGOING. e *Signed by OWNER: ✓' Eft T ig Effluent sample taken 4 ti es per year for the first two years and delivered to a qualified testing lab for evaluation. Results sent to State and local Agencies as well as the OWNER.,OWNER is responsible for providing acceptable access to effluent to enable a grab sample to be taken for laboratory testing performed. *(PLEASE CHECK ONE) ( X)GENERAL ( )REMEDIAL ( )PROVISIONAL (X)pH,BOD5,TSS,Alkalinity,Total Nitrogen *Cost for testing: S270d10/V;sit Operator assigned: William Evv.EW . Telephone: tsml 400-3 *Engineer. EAS Land Services *Approval for Effluent Testing- Home wner's Signature i3i11i �4ress 6�? e -A v-c 1JeWJ70n, ,MA o a 4 G ( Of 8 New I/A System Permit Summary Sheet Site Information �,ssA` 55 Town: 4 t . j S`r% r6 �" Town Permit# LOOT Assessor Map/Parcel: _� 32 " ! I ► Unique Town ID# Site Address: I I N s e C (oc Qpe a5,cL A\S 71 r� Owner Name: '1.- k) r"�rl t•---y -e Alternate Name: Home-Phone: Mailing Address: ' Work Phone: r Title 5 Information Building Type/Use: (.e— VV'%P Design Flow: y H Q (gpd) Seasonal Use? Yes ❑ No ❑ Unknown ❑ Bedrooms: Title V N.S.A.? Yes J4 No ❑ Unknown ❑ Lot Size: Cc 6- P Non-standard components: Please list all components e.g. 1/A treatment unit, pump chamber,pre-and post equalization tanks, pressure distribution SAS, effluent filter, UV unit, etc., and maintenance schedule for/each component e..g.. ,quarterly, 2x/yr, annual, etc. I �V `^� �sr my °'G✓w�f� �`�.o C �� f �� 1s N� ^B. I/A Treatment Unit Make and Model# (mil i' C f°"D fZ DEP Permit Type: ,General Board Approval Date: 0 COC Date: 2- 1 5 U ❑ Provisional O & M Contract Entity: 7' ❑ Remedial Contract Start Date: 2 I' jo u{ Contract Duratiom ❑ Pilot Unit Installation Date: Unit Startup Date: DEP Permit ID #:' 2.0 1 Influent/Effluent Monitoring Requirements and Water Quality Limits Please indicate water quality parameters that must be monitored and any town mandated water quality limits;if no limits are shown, we will assume parameters.and effluent limits specified in the system's DEP approval will apply. Effluent PH BOD5 x CBOD ❑ TSS"_9 TN ❑ Nitrate'— Nitrite 9 _ Organic.N.❑ Ammonia ❑ TKN 9 Fecal Coliform ❑ Total P ❑ Organic P ❑ TDS ❑ ONG rease ❑ Conductance ❑ Alkalinity ❑ Water Usage ❑ Temp. ❑ Monitoring Schedule: Other Applicable Limits: Influent PH ❑ BODS ❑ CBOD ❑ TSS ❑ TN ❑ Nitrate ❑ Nitrite ❑ Organic N ❑ Ammonia ❑ TKN ❑ Fecal Coliform ❑ Total P ❑ Organic P ❑ TDS ❑ Oil/Grease ❑ Conductance ❑ Alkalinity ❑ Water Usage ❑ Temp. ❑ Monitoring Schedule: Other Applicable Limits: BCDHE Tracking# Please return this sheet to: FAX: 508-862-2603 Email: bciatech@cape.com Page 1 of 1 Malkus, Karen From: Sharon Foster[sfoster@wwtsinc.com] Sent: Wednesday, May 21, 2014 12:58 PM To: Malkus, Karen Subject: 112 Nye's Neck Road East, Centerville, MA Hello Karen Attached please find a copy of the Operations &Maintenance agreement for the above referenced site. As discussed, this contract expired in 2/14 and has not been renewed to date. Kind regards, Sharon Al. Foster Wastewater Treatment Serv-ices, Inc. 44 Commercial Street Raynham, Ml1 02767 Tel: 508-880-0233 Fax: 508-880-7232 12/31/2014 r CERTIFICATE OF ANALYSIS Page: 1 Barnstable County Health Laboratory 9SS�eFn3�'r Report Prepared For: Report Dated: 9/26/2008 Sally Desmond Desmond Well Drilling Order No.: G0849439 P O Box 2783 Orleans, MA 02653 Laboratory ID#: 0849439-01 Description: Water-Drinking Water Sample#: Sampling Location, 112 Nye Neck Rd.East:Centerville,MA Collected: 9/24/2008 Collected by: Desmond Wel Map 12.1 Parcel 26.1 Received: 9/24/2008 'Routine ITEM RESULT UNITS RL MCL Method# Tested Nitrate as Nitrogen 0.35 mg/L 0.10 10 EPA 300.0 9/24/2008 Copper ND mg/L 0.10 1.3 SM 3111B 9/24/2008 Iron ND mg/L 0.10 0.3 SM 311 i B 9i24i2008 Sodium 6.8 mg/L 1.0 20 SM 3111B 9/24/2008 I Total Coliform Present P/A 0 0 SM9223 9/24/2008 Conductance 67 umohs/cm 2.0 EPA 120.1 9/24/2008 pH 5.9 pH-units 0 SM 4500 H-B 9/24/2008 Recommended maximum contamination level exceeded due to Coliform Bacteria. Retesting is recommended Approved B (Lab uector) rn o x N ., co cn co ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605 ° CERTIFICATE OF ANALYSIS Page: 1 y i Barnstable County Health Laboratory �9s�fctn}� Report Prepared For: Report Dated: 9/26/2008 Sally Desmond Desmond Well Drilling Order No.: G0849439 P O Box 2783 Orleans, MA 02653 Laboratory ID#: 0849439-01 Description: Water-Drinking Water Sample#: Sampling Location 112 Nye Neck Rd.East.Centerville,MA Collected: 9/24/2008 Collected by: Desmond Wel Map 12.1 Parcel 26.1 Received: 9/24/2008 EPA 524.2- Volatile Organics by GUMS ITEM RESULT UNITS RL MCL Method# Analyst Tested Note Dichlorodifluoromethane ND ug/L 0.50 EPA 524.2 yn 9/24/2008 Chloromethane ND ug/L 0.50 EPA 524.2 yn 9/24/2008 Vinyl chloride ND ug/L 0.50 2.0 EPA 524.2 yn 9/24/2008 Bromomethane ND ug/L 0.50 EPA 524.2 yn 9/24/2008 1,1,1,2-Tetrachloroethane ND ug/L 0.50 EPA 524.2 yn 9/24/2008 1,1,1-Trichloroethane ND ug/L 0.50 200 EPA 524.2 yn 9/24/2008 1,1,2,2-Tetrachloroethane ND ug/L 0.50 EPA 524.2 yn 9/24/2008 1,1,2-Trichloroethane ND ug/L 0.50 5.0 EPA 524.2 yn 9/24/2008 l,l-Dichloroethane ND ug/L 0.50 EPA 524.2 yn 9/24/2008 1,1-Dichloroethee ND ug/L 0.50 7.0 EPA 524.2 yn 9/24/2008 1,1-Dichloropropene ND ug/L 0.50 EPA 524.2 yn 9/24/2008 1,2,3-Trichlorobenzene ND ug/L 0.50 EPA 524.2 yn 9/24/2008 1,2,3-Trichloropropane ND ug/L 0.50 EPA 524.2 yn 9/24/2008 1,2,4-Trichlorobenzene ND ug/L 0.50 70 EPA 524.2 yn 9/24/2008 1,2,4-Trimethylbenzene ND ug/L 0.50 EPA 524.2 yn 9/24/2008 1,2-Dibromo-3-chloropropane ND ug/L 0.50 EPA 524.2 yn 9/24/2008 1;2=Dibromoethane-(EDB) ND ug/L 0.50 -EPA 524:2 yn 9/24/2008 1,2-Dichlorobenzene ND ug/L 0.50 600 EPA 524.2 yn 9/24/2008 1,2-Dichloroethane ND ug/L 0.50 5.0 EPA 524.2 yn 9/24/2008 1,2-Dichloropronane ND ug/L 0.50 EPA 524.2 yn 9/24/2008 1,3,5-Trimethylbenzene ND ug/L 0.50 EPA 524.2 yn 9/24/2008 1,3-Dichlorobenzene ND ug/L 0.50 EPA 524.2 yn 9/24/2008 1,3-Dichloropropane ND ug/L 0.50 EPA 524.2 yn 9/24/2008 1,4-Dichlorobenzene ND ug/L 0.50 5.0 EPA 524.2 yn 9/24/2008 2,2-Dichloropropane ND ug/L 0.50 EPA 524.2 yn 9/24/2008 2-Chlorotoluene ND ug/L 0.50 EPA 524.2 yn 9/24/2008 4-Chlorotoluene ND ug/L 0.50 EPA 524.2 yn 9/24/2008 Benzene ND ug/L 0.50 5.0 EPA 524.2 yn 9/24/2008 Bromobenzene ND ug/L 0.50 EPA 524.2 yn 9/24/2008 Bromochloromethane ND ug/L 0.50 EPA 524.2 yn 9/24/2008 Bromodichloromethane ND ug/L 0.50 EPA 524.2 yn 9/24/2008 Bromoform ND ug/L 0.50 EPA 524.2 yn 9/24/2008 ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605 r � , CERTIFICATE OF ANALYSIS Page: 2 7� Barnstable County Health Laboratory �9rf�_1ct3S� � Report Prepared For: Report Dated: 9/26/2008 Sally Desmond Desmond Well Drilling Order No.: G0849439 P O Box 2783 Orleans, MA 02653 Laboratory ID#: 0849439-01 Description: Water-Drinking Water Sample#: Sampling Location 112 Nye Neck Rd.East.Centerville,M.A Collected: 9/24/2008 Collected by: Desmond Wel Map 12.1 Parcel 26.1 Received: 9/241.2008 EPA 524.2- Volatile Organics by GUMS ITEM �. RESULT UNITS RL MCL Method# Analyst is'I`ested Note._ a, Carbon tetrachloride ND ug/L 0.50 5.0 EPA 524.2 yn '9/24/2008 Chlorobenzene ND ug/L 0.50 100 EPA 524.2 yn 9/24/2009 Chloroethane ND ug/L 0.50 EPA 524.2 yr 9/24/2008 Chloroform 2.3 ug/L 0.50 80 EPA 524.2 yn 9/24/2008 cis-1,2-Dichloroethene ND ug/L 0.50 70 EPA 524.2 yn 9/24/2008 cis-1,3-Dichloropropene ND ug/L 0.50 EPA 524.2 yn 9/24/2008 Dibromochloromethane ND ug/L 0.50 EPA 524.2 yn 9/24/2008 Dibromomethane ND ug/L 0.50 EPA 524.2 yn 9/24/2008 Ethylbenzene ND ug/L 0.50 700 EPA 524.2 yn 9/24/2008 Hexachlorobutadiene ND ug/L 0.50 EPA 524.2 yn 9/24/2008 Isopropylbenzene ND ug/L 0.50 EPA 524.2 yn 9!24/2008 Methylene chloride ND ug/L 0.50 5.0 EPA 524.2 yn 9/24/2008 Methyl-tert-butyl ether ND ug/L 0.50 EPA 524.2 yn 9/24/2008 Naphthalene ND ug/L 0.50 EPA 524.2 yn 9/24/2008 n-Butylbenzene ND ug/L 0.50 EPA 524.2 yn 9/24/2008 n-Propylbenzene ND ug/L .0.50 EPA 524.2 yn 9/24/2008 p-Isopropyltoluene ND ug/L 0.50 - EPA 524:2 yn 9/24/2008 sec-Butylbenzene ND ug/L 0.50 EPA 524.2 yn 9/24/2008 Styrene ND ug/L 0.50 100 EPA 524.2 yn 9/24/2008 tert-Bntylbepzene ND ug/L 0.50 EPA 524.2 yn 9/24/2008 Tetrachloroethene ND ug/L 0.50 5.0 EPA 524.2 yn 9/24/2008 Toluene ND ug/L 0.50 1000 EPA 524.2 yn 9/24/2008 Total xylenes ND ug/L 0.50 10000 EPA 524.2 yn 9/24/2008 trans-1,2-Dichloroethene ND ug/L 0.50 100 EPA 524.2 yn 9/24/2008 trans-1,3-Dichloropropene ND ug/L 0.50 EPA 524.2 yn 90..4/2008 Trichloroethene ND ug/L 0.50 5.0 EPA 524.2 yn 9/24/2008 Trichlorofluoromethane ND ug/L 0.50 EPA 524.2 yn 9/24/2008 Recommended maximum contamination level exceeded due to Coliform Bacteria. Retesting is recommended ----- - -----Approved B (Lab rector)) ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605 I N c 44 Commercial Street RaY nham, MA 02767 Tel: (508) 880-0233 Fax: (508) 880-7232 May 5, 2011 Barnstable Board of Health 200 Main Street Hyannis, MA 02.601 Subject: Request for Testing Reduction FAST Treatment System Reference: Serial Number: 201985 112 Nye's Neck Road East, Centerville, MA Attached please find the results for testing performed at the property of Joanne Hooker, 112 Nye's Neck Road East, Centerville, MA. We are asking the Barnstable Board of Health to review the test data for that property to see if that testing may be reduced. Please forward a copy of your decision to our office. Your help in this matter would be greatly appreciated. Sincerely, y � Wastewater Treatment Services, Inc. Service Department =l' vn Cc: Joanne Hooker i erital Chemistry Environmental Services assessment ���� 1Ca� E � Ce Site Sampling h CL L 1 ality Assurance Services Data Auditing F: C; O R P O R f A T 1 O N 4 r CERTIFICATE OF ANALYSIS Wastewater Treatment Services,Inc. 44 Commercial Street REPORTED: OS/28/2009 Raynham, MA 02767 ORDER#: G0915375 COLLECTED BY: M. Dillen SAMPLE DATE: 5/12/2009 TIME: 10:30 DATE RECEIVED: 5/13/2009 LOCATION: 112 Nye's Neck Rd.East Centerville,MA SAMPLE ID: Hooker Grab (201985) DESCRIPTION: WATER RESULTS OF ANALYSIS Test Parameters LAB-ID#: 0915375-01 Alkalinity 310.2 EPA 310.2 05/27/2009 mg/L 4.0 122 BOD SM 5210B 05/13/2009 mg/L 4 <4.0 Kjeldahl,Nitrogen EPA 351.2 05/15/2009 mg/L 0.50 16.5 Nitrate,Nitrogen 4110B SM 4110 B 05/13/2009 mg/L 0.50 1.33 Nitrite,Nitrogen 4110B SM 4110 B 05/13/2009 mg/L 0.25 4.32 pH SM 4500 H+B 05/13/2009 S.U. 0-14 7.4 Solids, Suspended ISM 2540 D 05/14/2009 mg/L 4 <4.0 NA=Not Applicable ND=Not Detected Approved By: k ° <' = Less Than Lab Director / Date *' = Detection Limit kc iii MAY 2 9 2009 fi BY:-----------------.. Page 1 of 1 Analytical Balance Corp., 422 West Grove Street, Middleboro, MA 02346 Ph: 508-946-2225 al Chemistry Environmental Services s'sment An 'c Balance Site Sampling ity Assurance Services t 1 Data Auditing Y tJ R A '.I; T O N r.. CERTIFICATE OF ANALYSIS ` Wastewater Treatment Services, Inc. 4 REPORTED: 09/09/2009 4 Commercial Street Raynham, MA 02767 ORDER#: G0919078 COLLECTED BY: M. Dillen SAMPLE DATE: 8/28/2009 TIME: 14:30 DATE RECEIVED: 8/28/2009 LOCATION: 112 Nye Neck Rd. East Centerville MA SAMPLE ID: Hooker Grab (201985) DESCRIPTION: WATER RESULTS OF ANALYSIS Exsx ' C Sd vn a� Test Parameters LAB-ID#: 0919078-01 Alkalinity 310.2 EPA 310.2 09/02/2009 mg/L 4.0 29.1 BOD SM 5210B 08/28/2009 mg/L 4 9.5 Kjeldahl,Nitrogen EPA 351.2 09/03/2009 mg/L 0.50 9.84 Nitrate,Nitrogen 411013 SM 4110 B 08/28/2009 mg/L 0.50 11.6 Nitrite,Nitrogen 4110B SM 4110 B 08/28/2009 mg/L 0.25 0.56 pH SM 4500 H+B 08/28/2009 S.U. 0-14 7.1 Solids, Suspended SM 2540 D 09/01/2009 mg/L 4 13.0 NA=Not Applicable ND=Not Detected Approved By;., <' = Less ThanLa Manager / Date *' = Detection Limit SEP 1 1 2009 BY----------- ---- Analytical Balance Corp., 422 West Grove Street, Middleboro, MA 02346 Ph: 508-946-2225 Page 1 of 1 FSitee ental Chemistry Environmental Services sment �n�1[��r�� E � rp Site Sampling Quality Assurance Services n lY 1 1. `f - Balance Data Auditing C n R 'P O T,A T 1 O N CERTIFICATE OF ANALYSIS Wastewater Treatment Services,Inc. 44 Commercial Street REPORTED: 11/30/2009 Raynham, MA 02767 ORDER#: G0921569 COLLECTED BY: M. Dillen SAMPLE DATE: 11/16/2009 TIME: 10:30 DATE RECEIVED: 11/17/2009 LOCATION: 112 Nye's Neck Rd.East, Centerville, MA SAMPLE ID: Hooker Grab (201985) DESCRIPTION: WATER RESULTS OF ANALYSIS a` m %^•� � aan�etex, �..,5 alytlC ]�aPi3 x f' n d V ysuit, °a x r Deb sult ki Test Parameters LAB-ID#: 0921569-01 Alkalinity 310.2 EPA 310.2 11/19/2009 mg/L 4.0 105 BOD SM 5210B 11/18/2009 mg/L 4 <4.0 Kjeldahl,Nitrogen EPA 351.2 11/25/2009 mg/L 0.50 1.52 Nitrate,Nitrogen 4110B SM 4110 B 11/17/2009 mg/L 0.50 1.59 Nitrite,Nitrogen 4110B SM 4110 B 11/17/2009 mg/L 0.25 <0.25 pH SM 4500 H+B 11/17/2009 S.U. 0-14 8.0 Solids, Suspended SM 2540 D 11/19/2009 mg/L 4 <4.0 NA=Not Applicable ND= Than Approved By: Less *' = Detection Limit Wmanagafv / Date' DEC" 0 L� BY---------------------- Analytical Balance Corp., 422 West Grove Street, Middleboro, MA 02346 Ph: 508-946-2225 Page 1 of 1 hemistry Environmental Services ty_ ssnent Anal iA Fi B 1C� Site Sampling i Assurance Services 1 L Data Auditing C: 0 R P A T 1 0 N Mike Moreau CERTIFICATE OF ANALYSIS Wastewater Treatment Services, Inc. 44 Commercial Street REPORTED: 02/23/2010 Raynham, MA 02767 ORDER#: G 1023 599 COLLECTED BY: M. Dillen SAMPLE DATE: 2/9/2010 TIME: 12:00 DATE RECEIVED: 2/11/2010 LOCATION: 112 Nye's Neck Rd. Centerville,MA SAMPLE ID: Hooker Grab (201985) DESCRIPTION: WATER RESULTS OF ANALYSIS _ ReSUlt =� k q Test Parameters LAB-1D#: 1023599-01 Ammonia,Nitrogen 350.1 EPA 350.1 02/16/2010 mg/L 0.10 0.12 BOD SM 5210B 02/17/2010 mg/L 4 5.2 Kjeldahl,Nitrogen EPA 351.2 02/18/2010 mg/L 0.50 2.15 Nitrate,Nitrogen 4110B SM 4110 B 02/11/2010 mg/L 0.50 2.93 Nitrite,Nitrogen 4110B SM 4110 B 02/11/2010 mg/L 0.25 <0.25 pH SM 4500 H+B 02/1 l/2010 S.U. 0-14 8.0 Solids, Suspended SM 2540 D 02/16/2010 mg/L 4 4.0 NA=Not Applicable ND=Not Detected <' = Less Than Approved By:_ ys,✓ = U *' = Detection Limit Lab Manager /a Date p �G�3C�7� FEB 2 4 2010 BY----------------------Page 1 of i Analytical Balance Corp., 422 West Grove Street, Middleboro, MA 02346 Ph: 508-946-2225 i al Chemistry Environmental Services sA Ana sment Cal Balance Site Sampling i utility Assurance Services � Data Auditing , C 0 R P O R A T I O N Mike Moreau CERTIFICATE OF ANALYSIS Wastewater Treatment Services,Inc. 44 Commercial Street REPORTED: 05/25/2010 Raynham, MA 02767 ORDER#: G1026265 COLLECTED BY: M. Dillen SAMPLE DATE: 5/18/2010 TIME: 14:45 DATE RECEIVED: 5/20/2010 LOCATION: 112 Nye's Neck Rd. Centerville,MA SAMPLE ID: Grab(201985) Hooker DESCRIPTION: WATER RESULTS OF ANALYSIS ss3� P"s�.u�"6 t -- '� r "N x- � � .��' `,. 9�rc.�en�y� a.'+� ,y� ,�+� v ,.a, x :.�{� .-, #•�' �'. 4` .�� �aratn '� �� Cal'ltz � a e• � � &�.: r - ` ���`C"��aRy,`.'��"ri � w eS111t t f �x_:.,r. ' 'a"• ,y�Hyq ,Y :i� ,' F' F�' P.tl�� Y E''a�y�P' "�' �3i. g 'f.� .mltllt4'I k Ft • §fir,.� -�.��_. .'� Test Parameters LAB-ID#: 1026265-01 Alkalinity 310.2 EPA 310.2 05/20/2010 mg/L 4.0 95.6 I BOD SM 5210B 05/20/2010 mg/L 4 7.4 Kjeldahl,Nitrogen EPA 351.2 05/21/2010 mg/L 0.50 1.73 Nitrate,Nitrogen 4110B SM 4110 B. 05/20/2010 mg/L 0.50 7.09 Nitrite,Nitrogen 4110B SM 4110 B 05/20/2010 mg/L 0.25 0.74 pH SM 4500 H+B 05/20/2010 S.U. 0-14 7.7 Solids, Suspended SM 2540 D 05/24/2010 mg/L 4 <4.0 1 NA=Not Applicable I ND=Not Detected Approved By: < = Less Than ab Mana er / '*' Detection Limit g f i 1 AY27 �10 dY:-------------------- Page 1 of 1 � Analytical Balance Corp., 422 West Grove Street, Middleboro, MA 02346 Ph: 508-946-2225 I hemistry Environmental Services ent � �� ��� �r. Balance Site Sampling Assurance Services ` }L{ L1. Data Auditing C O RIP O R A T 1 O N ike Moreau CERTIFICATE OF ANALYSIS Wastewater Treatment Services, Inc. 44 Commercial Street REPORTED: 09/29/2010 Raynham, MA 02767 ORDER#: G1030532 COLLECTED BY: M.Dillen SAMPLE DATE: 9/16/2010 TIME: 12:30 DATE RECENED: 9/16/2010 LOCATION: 112 Nye's Neck Rd. Centerville,MA SAMPLE ID: Grab (201985) Hooker DESCRIPTION: WATER 1 .A RESULTS OF ANALYSIS '�.`+..i ktw :�ti� y *,�, f' 'r�, td;' F "",R�`'� ',*''"` . k .1{,i'�,w. ° � -s:•.. S , - y s �"�,,° _ arameler, y. . �,.,`,L f,. y.�',- ��''_z+t �h� '. '"'fi"�§'q ! ��rka_,_.:.: E `S°'d i:. i °sk•s'"' '£i }-�C+r,a y, ,+�8'2.i� +.� r+: i*'� 'r-4,`,`�*.ti•s. :r'' " a, xr ,:, �..F.:..; ,.•� 4Ca1 � rateN 'L4"tuts ' '` Y �j +D.:p.Y xy`r(.tas ,g;,ti., G,:..N-t, ..�,y� ��," A�� .st"`-'�'�` �^z ,?7,. x Y ;6 .L. �', -.. t � "&kq. ti,.y';'* a NL� � >� § � 1 .�c� ��'�."�ir '� a:.' e 4'�'"k "' t �:�' Anal d ?k„ a s'�w' � < °-i�E -ij1EL�rfi''a` -"� xk tt� y ��:..r: `�s��e4 � ` �.: � �;� jj j*� x".��i �� ?� �"" � M ' y w.z �; ���'a„'�.'� a s ': z�Y: •°" a `'ir y'S il�'a'k='. ss 4 #�,r=..- ' ��`, ..�'v� m�I11� �a7' �� 'r�'��'�Y� r i� 3.aul.:. k�� ����� Y. } �'.� a. � .y �[�...z�•�. r q4 �� " ��a a�. �tsz� ��Yl-� ' �,� #�i���, a"��s• �.rr -� a k. �',x� �� `�'� k�' � „ 't"x r"F r�". .ki ,i` ,�iT.d�e � h Test Parameters LAB-ID#: 1030532-01 Alkalinity 310.2 EPA 319.2 09/21/2010 mg/L - 4.0 12.3 BOD SM 5210B 09/16/2010 mg/L, 4 17.0 Kjeldahl,Nitrogen EPA 351.2 09/28/2010 mg/L 0.50 4.30 Nitrate,Nitrogen 4110B SM 4110 B 69/16/2010 mg/L 0.50 18.8 Nitrite,Nitrogen 4110B SM 4110 B 09/16/2010 mg/L 0.25 <0.25 PH SM 4500 H+B 09/16/2010 S.U. 0-14 6.5 Solids, Suspended SM 2540 D 09/20/2010 mg/L 4 21.0 NA=Not Applicable ND=Not Detected <' = Less Than Approved By: � *' = Detection Limit LYb Manage ate SEP 3 0 2010 ' i BY:------------------ Analytical Balance Balance Corp., 422 West Grove Street, Middleboro, MA 02346 Ph: 508-946-2225 Page 1 of 1 ,i f hemistry ��++rr77 lEnvironmental Services �nent �l,Cl E palmce Site Sampling ,`}+Assu rance Services Anal` L `, Data Auditing G 0 R P O R �. T I O N Mike Moreau CERTIFICATE OF ANALYSIS Wastewater Treatment Services, Inc. 44 Commercial Street REPORTED: 12/02/2010 Raynham, MA 02767 ORDER#: G1032513 COLLECTED BY: M. Dillen SAMPLE DATE: 11/23/2010 TIME: 9:45 DATE RECEIVED: 11/23/2010 LOCATION: 112 Nye's Neck Rd. East Dennis,MA SAMPLE ID: Grab (201985) Hooker DESCRIPTION: WATER RESULTS OF ANALYSIS ' •:13' �•.��"...* �. "±4 irsi* 9 ti 9;' *rr P r -J•w ,�+ sex.', A .ai.�••.. :.. �H. u.; =j�.•+,{�;� ��y3%�. y��r + y.�;"' �'S:;6:;7'��, � k+���hr.t�•.w�i y4"W �a3'}5 ".�,"- `% „� .t�':-.rEF u,...., �''sy"�3�".�•�n�i,.E�";:�`s. ...�. ��'r� .� ty.: s� .�+�;i ffi•�iPa>?amete�. .-�•"i,�s„'-�`'"��.� "'�4'^�i6,,c. W � , ��' ny�k; �` t e�. •k �s a aa, a�. �'tr'``" '@��iatr i.�. r�,�.,rc+ �.a+s*n'���n � �s'�.¢�. � NI't:.�t�: ��_:.. .�r�' -� ���. ��;�=��t r. ��k�� .. ' �'v � ,:�• '�?��, �' ,���n� �:. � � ,s� ,� � yn, ��� �y��� ,'�. ..,� �, t3 r � mow. � 'h, .F:�,`.' ,�a°-,.••e '� r => � _ :�. �,z����.r'3'j�6 r;�, tr. * i�`�'-��, n`7u '$ t} x,����e ps �-���,�.,_.���:.� �- .. ;�,. ���,R���:•_e ho:.a� ?,,Analysed , r� �� ��.� .r�. >✓tmi��k ��� ��^�a�: � ,�.� '� 5���-z��=>i ,;;.a,�`i' ���:ir,. ,��i p ,;z.7�ss�,+�•.'..r l .K � i��� _'x,'�C 9 i+' � h.y4.�y �'i,� f�.�'_- i.� u';.,Yd�a.;��—" 210 • 'w��,. §a� 1`� `fif rFs.. .)F z "�h �. •ram �yµ�.:§fyrj- '.r?�i '•"�` p+`� -*'fir {,�. :�'?...�''�,aS.: �4g�+'�'''� 9 ?�.�,,�'�.y�,�,. Y. ,,�s�'��:.,.����x- -7 ..�,aE,•� xp�`L��r� ra` 7`/5 ''�i'r'�„;,.�' �X..'y..M�-1.� �Test Parameters LAB-ID#: 1032513-01 Alkalinity 310.2 EPA 310.2 11/29/2010 mg/L 4.0 107 BOD SM 5210B 11/24/2010 mg/L, 4 8_0 Kjeldahl,Nitrogen EPA 351.2 12/01/2010 mg/L 0.50 1.38 Nitrate,Nitrogen 4110B SM 4110 B 11/24/2010 mg/L 0.50 4.08 Nitrite,Nitrogen 4110B SM 4110 B 11/24/2010 mg/L 0.25 <0.25 pH SM 4500 H+B 11/23/2010 S.U. 0-14 7.8 Solids, Suspended SM 2540 D 11/29/2010 mg/L 4 <4.0 NA=Not Applicable ND=Not Detected Approved By: '<' = Less Than = Detection Limit L61 Man 7 Date p C�MX ? DEC 0 3 2010 Page 1 of 1 Analytical Balance Corp., 422 West Grove Street, Middleboro, MA 02346 Ph: 508-94 2-2-&---------------- I� emistry Environmental Services ent r� ��}' E Site Sampling Assurance Services An( L�C Ba +� ce Data Auditing G 0 R P O R A T 1 O N ike Moreau CERTIFICATE OF ANALYSIS Wastewater Treatment Services,Inc. 4 REPORTED: 03/17/2011 4 Commercial Street Raynham, MA 02767 ORDER#: GI 134782 COLLECTED BY: M.Dillen SAMPLE DATE: 3/9/2011 TIME: 8:30 DATE RECEIVED: 3/10/2011 LOCATION: 112 Nye's Neck Rd. Centerville,MA SAMPLE ID: Grab(201985) Hooker DESCRIPTION: WATER RESULTS OF ANALYSIS aras- ��r:..Y J � .• ��_ � "�t ';^�',�;a�$�a �v w ��$°' r'Q,m r °'*A4���,.r'x �� �„:. qr f;t �, -`'�' s�r°e i� ' tiG ate t1s y s etesul r '� w � q _ a" tl� �` �'.' "'l�C'",�'�'Sa3 � it '�"°�� �� * d ��5 �' �' "�.� ' •# v. 1< .a, �P �A� _.h e.��. "`-. +�•,, ft W��i s�'{.,^',. -:.-: �.'�c.-:� _ .._-., .�:E� ;5� �'f -`�i.f 2 i»tl. 4x �"1!+�'t�-Fad.ete�@3 4fi.. ?» �'�a. `0 Vest Parameters LAB-ID#: 1134782-61 Alkalinity 310.2 EPA 310.2 03/10/2011 mg/L 4.0 114 BOD SM 5210B 03/11/2011 mg/L 4 <4.0 Kjeldahl,Nitrogen EPA 351.2 03/11/2011 mg/L 0.50 0.79 Nitrate,Nitrogen 4110B SM 4110 B 03/10/2011 mg/L 0.50 1.61 Nitrite,Nitrogen 4110B SM 4110 B 03/10/2011 mg/L 0.25 ND pH SM 4500 H+B 03/10/2011 S.U. 0-14 8.1 Solids, Suspended ISM 2540 D 03✓14/2011 mg/L 4 <4.0 NA=Not Applicable ND=Not Detected Approved By: '<' = Less Than Lab/&Ianager / Date *' = Detection Limit MAR 18 2011 BY--------------------- Page 1 of 1 Analytical Balance Corp., 422 West Grove Street, Middleboro, MA 02346 Ph: 508-946-2225 <. - w r i , a t,. No. ��® y J Fee `"� / 6 / a THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABL'E, MASSACHUSETTS O0 3vvfication for �Biopozal *p.5tem Con!5truction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) %complete System ❑Individual Components Location Address or Lot No. 117 N�V5 Nr.-L Q0 GpZt, Owner's Name,Address and Tel.No. ��� ��1� 1 906B(, Assessor's Map/Parcel CBn--Tts_V t 5 6 P141 I.t Qs RD H6017tru-0 • -m ozoSZ Installer's Name,Address,and Tel.No. PMSTC reg r_— c,A V A'—)1 iS%v Designer's Name,Address and Tel.No. A o,m t-A.--o .,Is s 1 P.o SjkL 12_811 ¢cxn ,-s��a� ►w''a G I$ M ra,1-1 s`r �,, %?AaM cs-ur!-ta, tAvb" . e) 771 - SLG 3 Type of Building: A e,&'6S Dwelling No.of Bedrooms Lot Size •bz' swf' Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow tlqb gallons per day. Calculated daily flow 7�' gallons. � Plan Date 7'27- 'a 00 Number of sheets Revision Date Title Size of Septic Tank C-4►'5rdVvG !cr&O 91 Type of S.A.S. C','61 aR�►�ru�'I S>tiA VA'J'r Description of Soil 'T'65 ?i-AN 561t- 10b Nature of Repairs or Alterations(Answer when applicable) 0 IPblLAVE O T F' IL6V 5 Y5TO� Date last inspected: I Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Envir nmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issu this and ealth. Signed Date E 0 o£� Application Approved by 4L 6wwt Date Application Disapproved f the following reasons Permit No. "' Date Issued r t J, f•a''"J"'l�c i• l ', („,. .a `�, .>q,...;. t,+.3 ` :� No. tt THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION>,- OF BARNSTABLE, MASSACHUSETTS Q ZIPPOcation for Migoal *pztemZon5truction Verutit' Application for a Permit to Construct( )Repair(�)Upgrade( )Abandon( ) Complete System O Individual Components Location Address or Lot.No. 120 G45r. Owner's Name,Address and Tel.No. [ r CZNT% v 1 50 P1,1 i t.1 Ps RD Assessor's Map/Parcel / M E D 1=IT,� O to W_ O,Z O S Z Installer's Name,Address,and Tel.No. P A'STGQb 16hGA V A 1 t6'3"v Designer's Name,Address and Tel.No. A a" wk,� O ' P.6.$� IL�i� F�SZ�O+.�i.{� �M�+a G!$ srt q 4 u gT •w, �1�1n.M oti+ila Jtirs, z S oe� lee -S3�v (S.P) 77 l - S z Type of Building: A C2 7S5 Dwelling No.of Bedrooms �l Lot Size b� s Garbage Grinder( ) + Other Type of Building No.of Persons Showers( ) Cafeteria( ) a ' Other Fixtures s Y.. Design Flow �d" gallons per day. Calculated daily flow � gallons. Plan Date y'7� 'a f�' Number of sheets Revision Date / Title Size of Septic Tank GX4 Sy'��►G ✓� 9 Type of S.A.S. C -1Y DAA,r'U 1 I FA0 UA-) .r•f Description of Soil S•'S'6 ?,,LAW S cs►C G Nature of Repairs or Alterations(Answer when applicable) 0 0U R.A DS Or- rq t 1-60 Date last inspected: Agreement: 1 y: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal systems _ in accordance with the provisions of Title 5 of the Envi� nmental Code and not to place the system in operation until a Certifi- -� cate of Compliance has been issu this and 9 'ealth. r.. Signed Date Application Approved by / GE. /r Date `I 0 2OC Application Disapproved following reasons Permit No. 2,0o37 Date Issued —— — ——— ———-— --— —————— —— —— —— THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed ( ) Repaired ( )Upgraded( ) Abandoned( )by PA/ ;TsnT;, Qc_Ay-A_r1 61r' at 11 Z MZAS k.J ec-K q 0 NR%!r' C FaJ.msgU t(-1LZ has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit NoZWO-20"I dated q- `G- Installer PWSTa2-n n-)e<nvA-7)611� Designer Q- M LAB : 41,4- r n The issuance f t.is ermit, hall n" e/��onstrued as a uarantee that the / Este, �j11 ffunc ion as dCe/s gne�. Date 11 .%�-/1 v V'� 4 Inspector ! All p 4 ,... . No. �t�G � + �� ---"----------------- - . " ----Fee `60 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Mi�po5al *pgtem Conelructiou Permit , Permission is hereby granted to Construct( )Repair(X )Upgrade( )Abandon( ) System located at I1 Z Y6t & ce,W... IUD E;g'r and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this pe/ t. Date:_ A- f ;Z d 0 3 Approved by 1 TOWN OF BARNSTABLE LOCATION 1 1 A VAX • � ' leraG se' SEWAGE # 6C�is VILLAGE 0 f V' i WC ASSESSOR'S MAP& LO INSTALLER'S NAME&PHONE NO. � � SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE: 9L O ° COMPLIANCE DATE: — W/-3/ Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility G' G Feet Private Water Supply Well and Leaching Facility (If any wells exist / on site or within 200 feet of leaching facility) 196 Feet Edge of Wetland and Leaching Facility (If any wetlands exist �� within 300 feet of leaching facility) Feet Furnished by PA5T6rE lXc;AVKTI A-�gzz ae A-5= OY 03 iC. G- �� TOWN OF BARNSTABLE LOCATION I s�,1'► �� SEWAGE # 4 C�ib �� VILLAGE ZVA� v+ y�L \ ASSESSOR'S MAP & LOTI INSTALLER'S NAME&PHONE NO.Vd,- �'c� •� o`er ' SEPTIC TANK CAPACITY 15 0 LEACHING FACILITY: (type) C12 �('a (size) 1 x NO..OF BEDROOMS n _ BUILDER OR OWNER PERMITDATE: 'at�o COMPLIANCE DATE: Q 1► Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (lf.any wells exist / on site or within 200 feet of leaching facility) f�L� Feet Edge of Wetland and Leaching Facility (If any wetlands exist J�41 within 300 feet of leaching facility) Feet Furnished by }�A�'f iexcr�,y ACT 1 o C -az ��" L o/ q-5= 16 OY 03 cAa ' i i dC r Massachusetts Department of Conservation and Recreation Massach—tts Office of Water Resources Well Completion Report 15-OCT-08 15:09:44 - WELL LOCATION 254343 GPS North: 410 40.368' GPS West: -700 20.097' Address: 112, Nyes Neck Road East Property Owner/Client: Joanne Hooker Subdivision Name: Mailing Address: 112 Nyes Neck Road East City/Town: Barnstable City/Town, State:Centerville MA Assessors Map: Assessors Lot #: Permit Number:W2008-040 Board of Health permit obtained: Y Date Issued: 09/11/2008 Work Performed Proposed use Drilling Method Overburden Drilling Method Bedrock New Well Domestic Auger CASING From (ft) To (ft) Type Thickness Diameter 1.00 -22.00 PVC Schedule 40 4.00 SCREEN From (ft) To (ft) Type Slot Size Diameter -22.00 -25.00 Stainless Steel Well .012 4.00 Point 6 N = WELL SEAL / FILTER PACK / ABANDONMENT MATERIAL From (ft) To (ft) Material Description Pur ose C') r` WELL TEST DATA (ALL SECTIONS MANDATORY FOR PRODUCTION WELLS Date Method Yield Time Pumped Pumping Level Time to Ascover Recovery (GPM) (hrs & min) (Ft. BGS) (Hrs & 6n) (Ft. BGS) 09/22/2008 Constant Rate Pump 20.0000 1:30 8.0000 0:01 5.5 STATIC WATER LEVEL (ALL WELLS) PERMANENT PUMP (IF AVAILABLE) Date Depth Below Ground Pump Description: Measured Sa::cfaca (ft) Type: Intake Depth: 09/22/2008 5.5 Nominal Pump Capacity: Horsepower: WELL DRILLER'S STATEMENT ADDITIONAL WELL INFORMATION Driller: Patrick Desmond Developed: Yes Fracture Enhancement:No Supervisor: Patrick Desmond Rig #: 138 Disinfected: Yes Well Seal Type:None Firm: Desmond Well Drilling Inc. Total Well Depth: 25.000 Depth to Bedrock: Registration #: 877 Date Complete:09/28/2008 Comments: OVERBURDEN From To Description Color Comment Water Loss/Add Drill Drill (ft) (ft) Zone of Fluid Stem Drop Rate .00 25.00 Fine to Coarse Sand Brown Yes N/A BEDROCK From To Code Comment Water Drill Extra Drill Rust Loss/ # of (ft) (ft) Zone Stem Large Rate Stain Add of Frac Droll per ft 1�1 Fee BOARD OF HEALTH TOWN OF BARNSTABLE ZippCicatiott,forVeil Congtructionpermit Application is hereby made for a permit to Construct ( �, Alter ( ), or Repair ( )an individual Well at: Location — Address I Assessors Map and Par i ,��'wner _ Address E�f77OfJ�_ L �,�/GG/h _�G �o. _ �� ��/i/s_l'7l do2los s-------y, ------- ---------------- --- --�-- � — Installer — Driller / Address Type of Building Dwelling---- -- - -- --------- Other - Type of Building--//-//_--________________ No. of Type of Well - �� __7fI_�YC_- �_� Capacity -- --__.-___--_—__-- Purpose of Well-.-&-in-gaze __—_— Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation until Certificate of pliance has been issued by the Board of Health. Signed - — - - — -- _ date Application Approved By --------- ^//- 06 _.._ date .Application Disapproved forte following reasons:-----------------.-----__________—_—_—_-._..__ — - --- ---- __-_----------•---------- - ------ -- ---- date Permit No. 2 Off` 6 YD 2 - //- ?-Coe,Issued—_-_-___------------------_�_:�____.-. ----__.-_-_--- date BOARD OF HEALTH TOWN OF BARNSTABLE Certifirate ®f Compliance THIS IS TO CERTIFY, That the Individual Well Constructed (✓f Altered ( ), or Repaired ( ) by ,�/ E/ , / Ph nstaller a'Y /y at //a /I/�% - C ' i erv.Lc zE' - - --- ---- --- - -- - -- —-- has been installed i 'own of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. ----.---.--__________Dated----------------- THE ISSUANCE`OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL - SYSTEM WILL FUNCTION SATISFACTORY. DATE—___-__- _____-- --_ Inspector—_------------.---- ' Now .--------- Fee ------------ BOARD OF HEALTH TOWN OF BARNSTABLE� --",; 2pplicabon- or'Vell Con5truct ion V'e�%t Application is hereby made for aspermit,to'Constru'ct ( ,may, Alter. ( ), or Repair ( )an''individual`Wel at: Location — Address / Assessors"Map and Parc ✓ Owner "'¢' Address . ------ �-J%J---- --�----�-------� Installer — Driller j Address Type of Building Dwelling " Other - Type of Building--=---------------------- No. of Persons------------------------------___-._ Type of Well—- - `r�� !� � -_-?r Ca acit /0-i6�---------------- P y---- CJ f Purpose of Well---- Agreement: _ The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation until Certificate.of C/6mpliance has been issued by the Board of Health. Signed _ ' ' cr -- - - _ 11 -- / date- .t Application Approved By - //— Q ------ r,. —---------___—_—_— ' date Application Disapproved for ifollowing reasons: -------- ------_---------.__ -- _ ------ ------------------- date Permit No. W20-0-6--.-- d Issued _ --CJ� - -------------------- date �wsrr+isYarf�w�l.+rs+i�►r+rr�ww.�.:�rwr��►w�.+'wa4+�s.irw.!yy.�� rtr+!�+r�Mrs.�r�w+i►+ra�rw.wwa+t�+R+��sMnt�ll�►wAM�r�rrr+r�lrw�w+wa►wµ�tirrrw+�lMirw.�e+ls�w�..ri.r�►w+ww.la.�rrwrrs.+�< BOARD OF HEALTH TOWN OF BARNSTABLE ¢^Certifitate ®f Compliance - - THIS IS TO CERTIFY, That the Individual Well Constructed (, Y, Altered ( ), or Repaired I�taller -------------------------------=------------- ` LZ -<->� p f7 i r v=c c< ------------------- -------------------------- has been installed ii'i accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. ------------- Dated------------------- THE ISSUANCE OF,THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE-------- --— - --- -Inspector-- -------- ----------------------- `��..=��o�.®�rrc•®rre.c�rrarr.-is®®so- rasavr.rrrr..rrrrrrrra . .rrrr..rrrr�rrrrar�rrrmrr�r�rrrr•rr�rr�rrrorrrrr�rFo�c BOARD OF HEALTH TOWN OF BARNSTABLE Vell Con0ruct ion Permit No. LA-U---aaQ5—:a/q0 Fee- -------- Permission is hereby granted—� � ✓/O f� i L s.. ��r1>�-,�-_--- -- -- - to Construct ( ,�., Alter ( ), or Repair ( ) an Individual Well at:_ ' No. -- �-'!� �� --�� — �� �? _!!1_���=----------------------------------- -— j street as shown on the application for a Well Construction Permit No.- /,,^_�_C�r�_ Dated ��'-- dU�J - - ---� -- -- -------------------- Board of Health DATE -- -4 up— - \ .. ..- L °�g `- V CERT WATE OF ANALYSIS Page: 1 } Barnstable County Health Laboratory sssq�MyS Report Prepared For: Report Dated: 9/26/2008 Sally Desmond Desmond Well Drilling Order No.: G0849439 P O Box 2783 Orleans, MA 02653 Laboratory ID#: 0849439-01 D king Water Sample#: Sampling Location 112 Nye Neck Rd.East.Center Collected: 9/24/2008 Collected b - m0Qfi Wel� -N1ap12. Parce126.1 Received: 9/24/2008 Routine RESULT UNITS RL MCL Method# Te d itrate as Nitrogen 0.35 ing/L 0.10 10 EPA 300.0- --� - 9/24/2008 Copper ND mg/L 0.10 1.3 SM 3111B 9/24/2008 Iron \\\ ND mg/L 0.10 0.3 SM 3111B 9T/2008 Sodium 6.8 mg/L 1.0 20 SM 3111B 9/24/2008 Total Coliform Present P/A 0 0 SM9223 9/24/2008 Conductance 67 umohs/cm 2.0 EPA 120.1 9/24/2008 H 5.9 pH-units 0 SM 4500 H-B 9/24/2008 ecommended maximum contamination level exceeded due to Coliform Bacteria.Retesting is.recommended Approved B 7 1 � (Larirector t l �H� / 3� ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph:508-375-6605 is v i CERTIF ATE OF ,ANALYSIS Page: 1 Barnstable County Health Laboratory Report Prepared For: Report Dated: 9/26/2008 Sally Desmond Desmond Well Drilling Order No.: G0849439 P O Box 2783 Orleans, MA 02653 Laboratory ID#: 0849439-01 Description: Water-Drinking Water Sample#: Sampling Location 112 Nye Neck Rd.East.Centerville,MA Collected: 9/24/2008 Collected by: Desmond Wel Map 12.1 Parcel 26.1 Received: 9/24/2008 EPA 524.2- Volatile Organics by GUMS ITEM RESULT UNITS RL MCL Method# Analyst Tested Note Dichlorodifluoromethane ND ug/L - 0.50` -- - EPA 524.2, yn 9/2412008 Chloromethane ND ug/L 0.50 EPA 524.2 yn 9/24/2008 Vinyl chloride ND ug/L 0.50 2.0 EPA 524.2 yn 9/24/2008 Bromomethane ND ug/L 0.50 EPA 524.2 yn 9/24/2008 1,1,1,2-Tetrachloroethane ND ug/L 0.50 EPA 524.2 yn 9/24/2008 1,1,1-Trichloroethane ND ug/L 0.50 200 EPA 524.2 yn 9242008 1,1,2,2-Tetrachloroethane ND ug/L 0.50 EPA 524.2 yn 9242008 1,1,2-Trichloroethane ND ug/L 0.50 5.0 EPA 524.2 yn 924/2008 I,1-Dichloroethane ND ug/L 0.50 EPA 524.2 yn 9242008 1,1-Dichloroethee ND ug/L 0.50 7.0 EPA 524.2 yn 9/24/2008 I,1-Dichloropropene ND ug/L 0.50 EPA 524.2 yn 924/2008 1,2,3-Trichlorobenzene ND ug/L 0.50 EPA 524.2 yn 9/24/2008 1,2,3-Trichloropropane ND ug/L 0.50 EPA 524.2 yn 9242008 1,2,4-Trichlorobenzene ND ug/L 0.50 70 EPA 524.2 yn 9242008 1,2,4-Trimethylbenzene ND ug/L 0.50 EPA 524.2 yn 9242008 1,2-Dibromo-3-chloropropane ND ug/L 0.50 EPA 524.2 yn 9/24/2008 1,2-Dibromoethane(EDB) ND ug/L 0.50 EPA 524.2 yn 9242008 1,2-Dichlorobenzene ND ug/L 0.50 600 EPA 524.2 yn 924/2008 1,2-Dichloroethane ND ug/L 0.50 5.0 EPA 524.2 yn 924/2008 1,2-Dichloropropane ND ug/L 0.50 EPA 524.2 yn 9242008 1,3,5-Trimethylbenzene ND ug/L 0.50 EPA 524.2 yn 924/2008 1,3-Dichlorobenzene ND ug/L 0.50 EPA 524.2 yn 924/2008 1,3-Dichloropropane ND ug/L 0.50 EPA 524.2 yn 9/242008 1,4-Dichlorobenzene ND ug/L 0.50 5.0 EPA 524.2 yn 9/242008 2,2-Dichloropropane ND ug/L 0.50 EPA 524.2 yn 9242008 2-Chlorotoluene ND ug/L 0.50 EPA 524.2 yn 9/24/2008 4-Chlorotoluene ND ug/L 0.50 EPA 524.2 yn 9/24/2008 Benzene ND ug/L 0.50 5.0 EPA 524.2 yn 9242008 Bromobenzene ND ug/L 0.50 EPA 524.2 yn 9242008 Bromochloromethane ND ug/L 0.50 EPA 524.2 yn 9/242008 Bromodichloromethane ND ug/L 0.50 EPA 524.2 yn 924/2008 Bromoform ND ug/L 0.50 EPA 524.2 yn 9/242008 ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph:508-375-6605 CERTiP&ATE OF •ANALYSIS Page: 2 + � Barnstable County Health Laboratory 'sstC�,yY Report Prepared For: Report Dated: 9/26/2008 Sally Desmond Desmond Well Drilling Order No.: G0849439 P O Box 2783 Orleans, MA 02653 Laboratory ID#: 0849439-01 Description: Water-Drinking Water Sample#: Sampling Location 112 Nye Neck Rd.East.Centerville,MA Collected: 9/24/2008 Collected by: Desmond Wel Map 12.1 Parcel 26.1 Received: 9/24/2008 EPA 524.2- Volatile Organics by GUMS ITEM RESULT UNITS RL MCL Method# Analyst Tested Note Carbon tetrachloride ND ug/L 0.50 5.0 EPA 524.2 yn 9/24/2008 -- Chlorobenzene ND ug/L 0.50 100 EPA 524.2 yn 9/24/2008 Chloroethane ND ug/L 0.50 EPA 524.2 yn 9/24/2008 Chloroform 2.3 ug/L 0.50 80 EPA 524.2 yn 9/24/2008 cis-1,2-Dichloroethene ND ug/L 0.50 70 EPA 524.2 yn 9/24/2008 cis-1,3-Dichloropropene ND ug/L 0.50 EPA 524.2 yn 9/24/2008 Dibromochloromethane ND ug/L 0.50 EPA 524.2 yn 9/24/2008 Dibromomethane ND ug/L 0.50 EPA 524.2 yn 9/24/2008 Ethylbenzene ND ug/L 0.50 700 EPA 524.2 yn 9/24/2008 Hexachlorobutadiene ND ug/L 0.50 EPA 524.2 yn 9/24/2008 Isopiopylbenzene ND ug/L 0.50 EPA 524.2 yn 9/24/2008 Methylene chloride ND ug/L 0.50 5.0 EPA 524.2 yn 9/24/2008 Methyl-tert-butyl ether ND ug/L 0.50 EPA 524.2 yn 9/24/2008 Naphthalene ND ug/L. 0.50 EPA 524.2 yn 9/24/2008 n-Butylbenzene ND ug/L 0.50 EPA 524.2 yn 9/24/2008 n-Propylbenzene ND ug/L 0.50 EPA 524.2 yn 9/24/2008 p-Isopropyltoluene ND ug/L 0.50 EPA 524.2 yn 9/24/2008 sec-Butylbenzene ND ug/L 0.50 EPA 524.2 yn 9/24/2008 Styrene ND ug/L 0.50 100 EPA 524.2 yn 9/24/2008 tert-Butylbenzene ND ug/L 0.50 EPA 524.2 yn 9/24/2008 Tetrachloroethene ND ug/L 0.50 5.0 EPA 524.2 yn 9/24/2008 Toluene ND pg/L 0.50 1000 EPA 524.2 yn 9/24/2008 Total xylenes ND ug/L 0.50 10000 EPA 524.2 yn 9/24/2008 trans-1,2-Dichloroethene ND ug/L 0.50 100 EPA 524.2 yn 924/2008 trans-1,3-Dichloropropene ND ug/L 0.50 EPA 524.2 yn 9242008 Trichloroethene ND ug/L 0.50 5.0 EPA 524.2 yn 9242008 Trichlorofluoromethane ND ug/L 0.50 EPA 524.2 yn 9/242008 Recommended maximum contamination level exceeded due to Coliform Bacteria. Retesting is recommended 1 Approved B (Lab rector)I ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605 .4 U9/3U/ZUUU TUE 1.�: US FAX SOU3621103 Barnstable CTY HealthLabv, Im002/002 06 CERTIFICATE OF ANALYSIS Page: 1 Barnstable County Health Laboratory Report Prepared For: Report Dated: 9/30/2008 Sally Desmond Desmond Well Drilling Order No.: G0849490 P 0 Box 2783 Orleans, MA 02653 ---- -- - --_ _---------- 1, Laboratory ID#: 0849490-01 Description: Water-Drinking Water Sample k: Sampling Location: 112 Nyes Neck Rd.East;Centerville,MA Collected: 9/29/2008 Collected by: Desmond Well Received: 9/29/2008 i Test Parameters ITEM RESULT UNITS RL MCL Method# Tested Total Coliform Absent p/A .01 0 SM9223 9/29/2008 Approved By. �tor) (Lab ec g4 a / l t I t i I . 1 I I I f I ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph:508-375-6605 EXCERPT FROM BOARD OF HEALTH MEETING—DEC 9, 2009 A. Mike Aucoin, A & M Land Services, representing Roger & Richard Bergenheim, owners — 112 Nyes Neck Road East, Centerville, Map/ Parcel 232-011-002, 1 acre lot, one variance requested regarding setback of existing well to proposed septic tank (57 feet). Mike Aucion presented the plan, dated 11/6/2008, and explained how the installation error of the well being placed too close to the septic occurred (as the state regulations are 50 feet and the local are 100 feet). Discussion covered the procedure of how the septic tank will be water-tight and will, in addition, protect the pond. Upon a motion duly made by Dr. Canniff, seconded by Mr. Sawayanagi, the Board voted to approve the septic plan dated 11/6/2008 with the variance for the setback of the existing well to the proposed septic system of 57 feet (in lieu of 100 feet) with the following conditions: 1) the septic tank will be inspected for its integrity for water tightness on an annual basis by the Fast System inspector at the time of the annual Fast inspection, 2) the well water will be tested annually for the standard contaminants including PH bacteria, Nitrate, and Nitrogen, 3) the well test will continue until such time that the property is connect to town sewer, and 4) the Fast System will be monitored. (Unanimously voted in favor.) CAcache\Temporary Internet Files\OLK176\Excerpt BOH Dec 2008 112 Nyes Neck doc.doc .. . OF THE r Town of Barnstable BA MASS. 1639. A M p Board of Health 9 A35. 0 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul J.Canniff,D.M.D. Junichi Sawayanagi June 13, 2008 Mr. Michael Aucoin A & M Land Services 618 Main Street, Unit# 3 West Yarmouth, MA 02673 RE: 112 Nyes Neck Road East, Centerville A= 232-011-002 Dear Mr. Aucoin, You are granted variances on behalf of your client, Roger Bergenheim, Trustee, Bergenheim Trust, to construct an onsite sewage disposal system at 112 Nyes Neck Road East, Centerville, Massachusetts. The variances granted are as follows: Section 360-1, Town of Barnstable Code: To construct a soil absorption system 71 feet away from a bordering vegetated wetland, in lieu of the minimum 100 feet separation distance required. Section 360-1, Town of Barnstable Code: To construct a soil absorption system 54 feet away from a bordering vegetated wetland, in lieu of the minimum 100 feet separation distance required. Section 360-1, Town of Barnstable Code: To install a septic tank 42 feet away from an existing pond, in lieu of the minimum 100 feet separation distance required. I. Section 360-1, Town of Barnstable Code: To install a pump chamber 52 feet away from an existing pond, in lieu of the minimum 100 feet separation distance required. 310 CMR 15.227 (5): To install a pump chamber inlet invert at a 2 1/2" separation above maximum high ground water, in lieu.of the 12" required. Q:\WPFILES\112 Nyes Neck Rd East Cent Jun2008 var.doc r 310 CMR 15.227 (5): To install the septic tank inlet invert is at 7" and outlet invert is at 3" above historic Lake Level Elevation 34.80). You are also granted permission on behalf of your client, Roger Bergenheim, Trustee, Bergenheim Trust, to construct and utilize an innovative/alternative (I/A) nitrogen reduction system at 112 Nyes Neck Road East, Centerville, Massachusetts. This permission is granted with the following conditions: (1) A quitclaim deed shall be recorded at the Barnstable County Registry of Deeds for each lot individually identifying the fact that innovative/alternative technology was incorporated into the septic system construction, requiring proper operation and additional maintenance and testing. (2) No more than four (4) bedrooms maximum are authorized at this property. Dens, study rooms, offices, finished attics, sleeping lofts, and similar-type rooms are considered "bedrooms" according to the MA Q� Department of Environmental Protection. record a properly worded deed restriction signed b (3) The applicant shall rec p p y 9 Y n the owner of the property, at the Barnstable County Registry of Deeds restricting the property to four (4) bedrooms maximum. A copy of the recorded deed restriction shall be submitted to the Health Agent prior to Q obtaining a disposal works construction permit. (4) The system shall be installed in strict accordance with the engineered plans signed on June 8, 2008. (5) The designing engineer shall supervise the construction of the onsite sewage disposal system and shall certify in writing to the Board of Health that the system was installed in substantial compliance with the submitted plans signed June 8, 2008. (6) The wastewater effluent shall be tested quarterly for the first two years of operation for nitrates, TKN, pH, CBOD, TSS, TN, and alkalinity. (7) The applicant shall submit a copy of the signed two-year Operation and Maintenance Agreement (O&M) between the contractor and the homeowner to the Board of Health. The engineer or O& M contractor shall conduct inspections to the I/A system quarterly for two years and may come before the Board of Health after two years to request a review. Q:\WPFILES\112 Nyes Neck Rd East Cent Jun2008 var.doc These variances are granted because physical constraints at the site severely restrict the location of a soil absorption system due to its close proximity to wetlands and to the groundwater. The proposed septic system is designed to meet the maximum feasible compliance standards contained within the State Environmental Code, Title V. Sincer y yours, Way e Iler, M.D. Chairman Q:\WPFILES\112 Nyes Neck Rd East Cent Jun2008 vandoc /OFIKE hN DATE: 2it il IAIISIAOLF-) FEE: 0"13 69- REC. BY Sn Town of Barnstable StD. DATE: Board of Health 200 Main Street,Hyannis MA 02601 Office: 509-86246" Wayne A.Miller,M.D. FAX: 508-790-6304 Paul J.Canniff,D.M.D. VARIANCE REQUEST FORM LOCATION Property Address: 1J.2. Nyes 'Necks Road', :East,;;Centerv-ille Assessor's,Map and Parcel Number. 12.1 - 26 .1 Size ofLot 1 .02 Acres Wetlands Within 300Ft. Yes X Business Name: oZ 3 2 011 0 0 2-.7;7' No Subdivision Name: 1 ci; ra APPLICANT'S NAME: A & M Land Services Phone 508 771 -5263 1:71 Did the owner of the property authorize you to represent him or her?. Yes X No rQ Co CO PROPERTY OWNER'S NAME CONTACT PERSON Name:Bergenheim Trust Name: Mike Aucoin Address:50 Phillip St. Medford, MA Address: 618 Main St Unit 3 W. Yarmuth-T" Phone: 02052 phone: 508 771 -5263 026 3 VARIANCE FROM REGULATION(L1st Reg) REASON FOR VARIANCE(may attach if more space needed) Local 360-1 S-Tank within 1001��-of Pond Local 360-1 P-rhamhpr wit-hin 1 .Q0'of Pnnd Local 360-1 SAS within 100 ' of Wetland Local 160-1 .9 A S wi t h.i n 1 0-0 , Q-f- Pend NATURE OF WORK House Addition 130=1 D House Renovation 0 Repair of Failed Septic System 5a Checklist (to be completed by offlce 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(eg.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 hirather 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 (forTitle V and/or local sewage regulation variances only) Full menu submitted(for grease trap variance requests only) Variance request application fee collected(no fee for lifeguard modification renewals,grease trap variance renewals[same owner/leasee only), outside dining variance renewals[same ownerneasee only],and variances to repair failed sewage disposal systems[only if no expansion to the building proposed]) — variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED .. ........ Wayne Miller,Chairman NOT APPROVED Paul J.Canniff.D.M.D. REASON FOR DISAPPROVAL c:\Documents and settingsWecollik\Local gettings\Temporary Internet FiIes\0LK1\VARIRE0 .D0C EA:> M7 r -17--Ic Cu C'A& Town of Barnstable of THE Tp� Board of Health E`' MASS.� 200 Main Street - Hyannis MA 02601 039. ATED MAC a Agreement to Extend Time Limit for Acting Upon a Variance Request In the Matter of a variance request form received on L 2 0 the Petitioner(s), (ILL regarding the property at i the petitioner(s) and the Board of Health a ree that the Board of Health has until � /U (insert date)to act upon the Petitioners'completed application for a variance. In executing this Agreement, the Petitioner(s) hereto specifically waive any claim for a constructive grant of relief based upon time limits applicable prior to the execution of this Agreement. Petitioner(s), ( ) Board of Health: Signature: Signature: Petitioner(s)or Petitioner's Representative Chairman Print: Print: Wayne Miller, M.D. Date: Z Date: Address of Petitioner(s)or Petitioner's Representative Town of Barnstable Board of Health Public Health Division 200 Main Street Hyannis, MA 02601 Phone: (508) 862-4644 Fax: (508) 790-6304 file q:extend.doc Town of Barnstable Regulatory Services y ;yy Thomas F. Geiler,Director =nxxsrABLM MAS& ®g Public Health Division r ` Thomas McKean;-Director 200 Main Street,Hyannis,MA 02601 Office:. 508-862-4644 -Fax: .508-790-6304 Installer &Designer Certification Form Date: Z `/ o 9 Sewage Permit# ZWb'-3?7 Assessor's Map\Parcel Designer: T WA MCAI Installer: ss Address: 3�C Address: Po bLoc� g � ©Z,6 On ,O 5 s was issued a permit to install a {"date) .installer) S tl`C S .Stem at_ ZF ` - ' 4?l3, y � � c,cc n stgII draWn17y (address} e o d _._ _'-�' . '.. .�r._.__.•_ dated qlA/08 (designer) .I certify that the septic system referenced above was installed substantially according to the design, which may include-minor approved changes-such as lateral relocation of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. I"certify that,the,septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS-or any vertical relocation of any component of the septic system).but in accordance with.State & Local Regulations.,Plan revision or certified, as=built by de igner to follow- Stripout(if r inspected and the soils o d satisfactory. �N OF VAs ( s s Signature) - No. 1140 /STEP . _. _. .___ __._.__..._ SgNlTAR� �:_. esigner's Signa (Affix Designer's Stamp Here) PLEASE.RETURN TOJ-BARNSTABLE PUBLIC--HEALTH DIVISION.- CERTIFICATE OF, CONNIPLIANCE WILL NOT BE ISSUED UNTIL BOTH'THUS FORWAND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.. THANK YO ,.. .. . QASeptic\Desiener Certification Form Rev 03-09-06.aac: EXCERPT FROM BOARD OF HEALTH MEETING—DEC 9 009 A. Mike Aucoin, A & M Land Services, representing Roger & Richard Bergenheim, owners — 112 Nyes Neck Road East, Centerville, Map/ Parcel 232-011-002, 1 acre lot, one variance requested regarding setback of existing well to proposed septic tank (57 feet). Mike Aucion presented the plan, dated 11/6/2008, and explained how the installation error of the well being placed too close to the septic occurred (as the state regulations are 50 feet and the local are 100 feet). Discussion covered the procedure of how the septic tank will be water-tight and will, in addition, protect the pond. Upon a motion duly made by Dr. Canniff, seconded by Mr. Sawayanagi, the Board voted to approve the septic plan dated 11/6/2008 with the variance for the setback of the existing well to the proposed septic system of 57 feet (in lieu of 100 feet) with the following conditions: 1) the septic tank will be inspected for its integrity for water tightness on an annual basis by the Fast System inspector at the time of the annual Fast inspection, 2) the well water will be tested annually for the standard contaminants including PH bacteria, Nitrate, and Nitrogen, 3) the well test will continue until such time that the property is connect to town sewer, and 4) the Fast System will be monitored. (Unanimously voted in favor.) CAcache\Temporary Internet Files\OLK176\Excerpt BOH Dec 2008 112 Nyes Neck doc.doc Bk 2298.2 Pg 237 #32491 EXHIBIT A TO DEED RE: Sale of 112 Nye's Neck Road East,Centerville,(Barnstable),Massachusetts 02632 Said premises are sold subject to the following notifications and restrictions: 1. The premises are serviced by an alternative innovative Title V in-ground septic system(a Fast System). 2. . The premises are sold with the Barnstable Board of Health Restriction for four(4) bedrooms unless the premises are served by Town sewer or said Board of Health approves a Title V system that would allow for more bedrooms. BARNSTABLE REGISTRY OF DEEDS Bk 22982 Pg 236 #32491 v ' IN WITNESS WHEREOF,the undersigned have executed this as a sealed instrument as of this day 9f June, 2008. C. Roger C. Befgenheim, TRUSTEE and not individually r Richard C. Bergenheim, R STEE and not individually STATE OF RHODE ISLAND WOV11449wca a"TY ,ss.. On this day of Nam,_ , 2008, before me,the undersigned notary public, personally appeared Roger C.Bergenheim,TRUSTEE proved to me thro gh satisfactory evidence of identification, which is a//r /61ow,r) , to be the person whose name is signed on ing r attached documents, and acknowledged to me that he signed it voluntarily purpose. Not9y Public My Commission Expires: /a/iU`O9 COMMONWEALTH OF MASSACHUSETTS 1 1114-e ss.. » /b , 2008 On this 19 day of Jail e , 2008, before me,the undersigned notary public,personally appeared Richard C.Bergenheim,TRUSTEE proved to me through satisfactory evidence of i dentification,which is A SQL vSe_ r�lri vee5 I eemg t , to be the person whose name is signed on the preceding or attached documents, and acknowledged to me that he signed it voluntarily for its stated purpose. C � MERRit.YT.ROWSE Notary ublic �J H,r„y Public My Commission Expires: mod" i'�/;t8la oil. My coNSMssim Expires DOOMIbWn.2012 Bk 22982 Pg 234 #32491 WITNESS our hands and seals this // day of 2008. Roger C.ABergenheim,Trustee Richard C. Bergenheim, Trustee STATE OF RHODE ISLAND 4D V/1SE�CEY 02'Y- // ,2008 On this // day of 2008,before me,the undersigned notary public,personally appeared R ER C. BRGENHEIM proved to me through satisfactory evidence f'dentification,which is tk.5otWIV &qo w h ,to be the p e is signed on the preceding or attached documents, and acknowledged to me 4 �tarily for its stated purpose. Notary ublic My Commission Expires: COMMONWEALTH OF MASSACHUSETTS SU 0l- `OtJ.afu SS. s L�h� /D ,2008 On this /0 cJ day of a h-C , 2008,before me,the undersigned notary public,personally appeared RICHARD C. BERGENHEIM proved to me through satisfactory evidence of identification,which is u6etts dz/ * A begs�5e >to be the person whose name is signed on the preceding or attached documents,and acknowledged to me that he signed it voluntarily for its stated purpose. r N tary kblic MERRiLYT.ROWSE My Commission Expires: I ZI A�l oZ0lo'L NOWY PW& 1�a�w�llkdi� My CORKM O ExPkft 10 D Re h--2&2012 Bk 22982 Pg 235 #32491 2 PAGES TRUSTEES' CERTIFICATE We, ROGER C. BERGENHERA and RICHARD C. BERGENHEIM, TRUSTEES of THE 112 NYE'S NECK ROAD TRUST under Declaration of Trust dated C January 3, 2000 and recorded with the Barnstable County Registry of Deeds in Book 12821, o Page 141, hereby state under oath that: U 1. We are presently the sole Trustees of said Trust. 2 Said Trust has not been terminated and is in full force and effect. 3. We further certify said Trust has not been altered, amended or revoked. U x0 4 We have been directed by the beneficiaries to execute and deliver a deed to Mark Hooker and Joanne Hooker in consideration of One Million One Hundred Sixty-Five Thousand Dollars and No ty Cents($1,165,000.00)relating to 112 Nye's Neck Road, Centerville, Barnstable County, Massachusetts. z 5. Under the Declaration of Trust, we are authorized to sell the Trust property. v� a6 No beneficiary is a minor, a corporation selling all or substantially all of its Massachusetts assets, or a personal representative of an estate subject to estate tax liens. Y v ` Bk 22982 Rsr232 ;32441 06-16--2008 Q 01 a 4?v NASSACHUSETTS STATE EXCISE TAX BARNSTABLE COUNTY REGISTRY OF DEEDS Date: 06-16-2008 8 01:47pe Ctlo: toot Docf: 32491 Fee: S3gr934.30 Cons: Sir165rOo0.00 BARNSiT OL.E COUNTY REGISTRY OF DEEDS QUITCLAIM DEED Date: Qo�6-2003 A 01:47�p 32491 Fee: $2r656.20 Cons: 31r165r000.00 We,Roger C.Bergenhe*of Medfield,Massachusetts, and Richard C.Bergenheim,of Boston,Massachusetts, as Trustees of"The 112 Nye's Neck Road Trust"under indenture dated January 3,2000,recorded with the Barnstable County Registry of Deeds in Book 12821,Page 141,hereby grant to Mark A.Hooker and Joanne K. Hooker,husband and wife as tenants by the entirety,of 73 Erie Avenue,Newton,Massachusetts,02461 for One Million One Hundred Sixty-Five Thousand Dollars($1,165,000.00)consideration paid,with QUITCLAIM COVENANTS,the land with the improvements thereon known as and numbered 112 Nye's Neck Road(East),Barnstable(Centerville),Barnstable County,Massachusetts,bounded and described as follows: NORTHEASTERLY by land of Elizabeth M. Bergenheim, as shown on a plan hereinafter referred to, in two courses,ninety-two and 26/100 (92.26)feet and one hundred seventy-six(176) feet,more or less; EASTERLY and SOUTHEASTERLY by Bearse's Pond,as shown on said plan, three hundred seventy- five(375) feet,more or less; SOUTHWESTERLY by Wequaquet Lake, as shown on said plan,three hundred fifteen (315) feet; WESTERLY by land now or formerly of G.Richard,Michael R. and Kenneth D. Kramer, as shown on said plan, in three courses, eighteen(18) feet, more or less,ninety-seven and 42/100 (97.42) feet, and two hundred fifty and 11/100(250.11) feet; SOUTHWESTERLY by said land now or formerly of G. Richard Kramer et al, as shown on said plan,ninety-four(94)feet; and Bk 22982 Pg 233 #32491 NORTHWESTERLY by Nyds Neck Road,as shown on said plan, twenty and 02/100 (20.02) feet. Said Parcel is designated as "1.02 ACRE"on plan hereinafter referred to. Said parcel is shown on a plan of land entitled"Plan of Land in Barnstable(Centerville), MA for Donald P. &Donna McKeag",which plan is duly recorded in the Barnstable County Registry of Deeds in Plan Book 405,Page 66, and said parcel is shown as "1.02 ACRE." Said premises are conveyed together with a right of way over Parcel"l Acre"(Paved driveway) shown on said plan with shared maintenance. See grant of easement recorded herewith from Elizabeth M.Bergenheim. Subject to restrictions of record,if any,as set forth in deed from Ila Louisa Alcott King to Curtis recorded.with the Barnstable County Registry of Deeds in Book 518, Page 469. Subject to restrictions set forth in deed from Old Colony Trust Co. Tr. to Curtis recorded in the Barnstable County Registry of Deeds in Book 523,Page 305. For Grantors'title,see a portion of the land described in a deed of Elizabeth M. Bergenheim dated January 24,2000 and recorded with the Barnstable County Registry of Deeds in Book 12821,Page 153. SEE EXHIBIT A ATTACHED HERETO 4 CERTIFICATE OF ANALYSIS Page: 1 Barnstable County Health Laboratory ',Y:S`•:•i(:fir.:�,:. Report Prepared For: Repot Dated: 9/30/2008 r Sally Desmond Desmond Well Drilling Order No.: G0849490 P 0 Box 2783 Orleans, MA 02653 Laboratory ID#: 0849490-01 Description: Water-Drinking Water Sample H: Sampling Location: 112 Nyes Neck Rd.Cast,Centerville,MA Collected: 9/29/2008 Collected by: Desmond Well Received: 9/29/2008 Test Pai-aineters ITEM RESULT UNITS RL MCL Method t`I Tested Total Coliform Absent P'/A 0 0 SM9223 9/29/2008 Approved By:—•�/ 'tts �`—� (Lab � e;tor) o 7- C-) w d . CD lD ry"t ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 Sample Total j Mail Date Organizatio System Nitrate Nitrite TKN Nitrogen BODS CBOD TSS pH Alkalinity Tracking p First Name Last Name Address Mail City Mail Zip Site Address Site City Sampled n Type Lab (effluent) (effluent) (effluent) (effluent) (effluent) (effluent) (effluent) (effluent) (effluent) Wastewat Analytical Trade 780 er Balance Winds 94 St. Craigville 3/3/2014 Treatmen Corp.Mic BACra780 Residence Botolph Beach Centervill 9:30:00 t Services, hael FAS-A LLC Street I Boston 02116 lRoad a 02632 AM I Inc. FAST Oliveira 125.5 0 10.81 26.31 12.0 2.0 7.1 Wastewat er 112 Nye's 3/3/2014 Treatmen Analytical BANyell 73 Erie Y Neck .Centervill 9:00:00 t Services, Balance 2FAS Joanne lHooker Avenue Newton 02461 Road East a AM Inc. FAST Corp. 1.7 0 1.86 3.56 2.0 J8.0 7.9 51.2 ti 44 Commercial Street Raynham, MA 02767 Tel: (506)880-0233 Fax: (508) 880-7232 February 19, 2009 Barnstable Board of Health 200 Main Street Hyannis, MA 02601 Attention: Board of Health Agent Reference: Home FAST Treatment Serial Number: 201985 Attached please find a copy of the Product Registration Report for the FAST Treatment System for the startup performed on 02/17/2009 at the home of Joanne Hooker located at 112 Nye's Neck Road East, Centerville,MA, Also, attached is a copy of the fully executed Inspection&Testing Agreement. If you have any questions or require additional information please do not hesitate to call. Sincerely, Donna L. Callahan Enclosures 99Z-d VO/10'd 802-1 Z8Z20888091+ a0ONW-MOH 19:91 00-93d-61 I � t . Z r N C 0 R PO H A r C r) 8450 Cole Parkway uY Shawnee, KS 66227 m Phone 913-422-0707 w Fax: 912-422-0808 e-mail: Qniite hiomicrobles.com to 4aML iomicrobics.com m 800-753-FAST(3278) PRODUCT REGISTR.A,TION REPORT Product Registration Report must be completed and returned to Sio-Microbics, Inc. in order to effect warranty. Date of Start-U • 0 9 Date Shipped to End User 2/2/09 Serial #201985 OWNER NAME Joanne Hooker ADDRESS 112 Nye's Neck Road Bast CITY/STATEIZIP Centerville,MA 02632 PHONE/FAX BIO-MICROBICS DISTRIBUTOR NAME Wastewater Treatment Services.Inc. ADDRESS 44 Commercial Street CITY/STATE/ZIP Rayrtham MA 02767 PHONE/FAX 508-880-0233 FAX; 508-880-7232 INSTALLER NAME Pastore Excavatin ADDRESS P.O.Box 1289 CITY/STATE/ZIP Porestdale MA 02644 PHONE/FAX 508-428-9300 CONSULTING ENGINEER if applicable NAME 1:A5 Land Services ADDRESS P.O.Box I729 CITY/STATE&& Sandwich,MA 02563 PHONE/FAX 508-888-3619 Good Bad NA Good Bad NA ELECTRICAL PANEL(S) TREATMENT UNIT(S) Visual Alarm Operating © Air vent clear Lj Audio Alarm Operating Septic tank level BLOWER($) Septic tank meets min.size Lj Wired for correct voltage Septic tank filled to operating level Inletloutlet piped correctly Air Lift Operation Filter element installed Recirculation tube In place ❑ Blower hood secure ❑ Fasteners tight Ll Slower works correctly D WATER-TIGHT JOINTS Blower located within 100'of © U Treatment unit to Septic tank [� 13 treatment unit Air line clear C3 Entrance tube to insert cover Ll 0 Air inlet screen clear L] Insert to insert cover El Blower hood vents clear Discharge line connection Lj Factory Authorized Personnels Title: i �/ 06-r • MCI-. _ 99Z-d VO/ZO*d E02-1 ZEZ10888091+ (IN14 3ar- ud Z9:91 60-93d-61 z 10-SEP-08 14:57 FROM- MOPRO� +150888OT232 T-974 P.03/03 F-902 Current WTS practice is to send OWNER approximately 10 flays before cxpirativa of the term of the cunt contract(1)either a new contract or an offer to extend the current contract's term,and(2)an invoice for one year of service. It is OWNER's responsibility to timely return the payment and either the new contract or the accepted extension,completed and signed. WTS must receive the payment and document before expiration of the then rawent cot et year to gssum continuous contract covergge. Failures to return such documents on time or to otherwise comply with this contract,may result in suspension of service,cancellation of the contract and/or nullification of warranties,at the election of WTS. OWNER may not assign this contract without'the prior written consent of WTS. It will remain in force until a party cancels by written notice to the other at the address given herein,or until the contract term expires,whichever is sooner. MANi1 ACTURER MODEL NO. SE .Vr^. 1,QQAT ANNUAL A►.X..TtATE Eio-Nierobics MicroFAST Q/ Centerville,MA $440.00 EQE=NT O Was�ewnter.TreatmLat.Seryices,larg *Signed-byOW1T — - -- -- --= - - Joanne Hooker Signed: -� *Address: 412 Nye's Neck Road East 44 Com rciai Street Raynharn,MA 02767 Tele:(508)880-0233 *City: State: zip: Fax:(508)880-7232 Centerville MA 02632 , 69 Telephone 617-745-2 222..._______. _ Effective Date of Agreerneg Daytim Telephone., , 5 This is a two-year contract which will be billed annually. OWNER understands that(1)ANNUAL RATE payment is for one year only commencing on the effective date set forth above and is Ron-refundable;and(2) Current DEP Regulatiopf require OWNFJkto maintain a service agreement for the life of the FAST*System. r Il3AVll;REA10 il��-FO-R1ECOnv G. � *Signed by ONMR; Efilaeut Tcgtinn 'v ed to a ualified testing lab far Effluent sample taken 4 tres r year for the first two years and deh er q ffi evaluation. Resift sent to State and local Agencies as well as the OWNER. OWNER is responsible for providing ieeeptaEe access toe ueni to enabre a graFs`amp-Te—t6-15e�en for lab4ratary twang performed: PFRNW, *(PLEASE CHECK ONE) ( X)GENERAL ( )REMEDIAL ( )MO'VISIONAL (X)pK BOD5,TSS,AEkalinity,Total Nitrogen *Coat for to iDg; 70Z.00O/V t Operator assigned: 'William F..yyrvK Telepbone: 40&3868 �*Engineer. 1sAS Land SerViom 'Approval for Effluent Testis Horn wtter's signature �illi � ,�a��ess Ce Ee -A\)-e, Qum, ,MA 004G ( 59Z-d VO/£O'd £01-1 Z£Z20888091+ ON ON38r-WOad Z9:91 60-93d-B1 r . t to-SEP-08 14:57 FROM-JRENGPRO� +15088607232 T-074 P.02/02 P-902 44 Commercial$trW Please CMVI oe all tams rnm*zd• Raynham,MA including maxi d MAR 02767 s;V=d aftnd conUM so: '4PeSM"M 7hatm=SMisM Ing- Tel., (508)980.0233 RC'=�mCMWS Fax:(508)880r7232 ]IgSip%ETION A"EF>E'11 UBNT TES_JorZ AG Agreement entered into by and between Wastewater Treatment Serviees,Inc.(herein called WTS)and the I'AS"1c°0 System OWNER(herein called OWNER)for the inspection by WT9 of certain equipment of OWNER which is described below. Upon acceptance of this agreement at WTS's office,WTS will render the following services only: Equipment will be inspected at least 4 times per year that this Agreement remains in effect,with the first inspections bd&ning 77 -:' --These-IMP0 5ns 1) Testing of the sludge depth in the septic tmlr. 2) Inspection,lower tasting and clean/replace intake filter of the air blower. 3) Inspection of the alarm system. 4) Inspect overall condition of FAS1*System. S) Notification w OWNER of any problems encountered. b) Service other than mutine maintenance will be billed at an hourly rate,plug travel and parts. WTS shall notify the local Board of health and Department of Environmental protection in writing within 24 hours of a system failure or alarm event including corrective measures that have been taken. OWNER will be billed standard WTS charges for any parts used in r"irs or maintenance. Any additional labor time will be billed to the OWM at current labor rates of$78.00 per hour. -- --bntcy-t,�wi�pegulae 3asgections.�d11 bepzoacided� _ ' A normal��.. business hours;at time and one-half after 5:00 PM and on Saturdays;and at double time=Sundays and holidays. Emergency service charges will include a minimtun four(4)hours of labor, plus standard WTS charps for parts,plus mileage and travel charges. Ile annual rate includes routine maintenance,but does not include repairs required for damages caused by abuse,accident,theft,acts of third persons,fortes of Mature, or alterations made to the equipment. WTS shall not be responsible for failure to render the agreed services if caused by strikes,labor disputes,anon-cooperation by OWNER,or other factors beyond the control of WTS. OWNER understands and agrees that WTS is not responsible for special,incidental or consequential damages,including but not limited to loss of time, injury to person or property,or equipment failure. OWNER agrees that WTS may cow OWNER's property and have acceptable access to all areas deemed by WTS to be necessary or appropriate for WTS to perform its duties heneunder- 99Z-d V000'd £01-1 Z£Z20888091+ 00a6or-Woad £9:91 60-93d-81 t�xrswn l,uuo,c;at /� / t— lea chfleld .. g /rr ✓• / %• IfK c ,C.V r� / \ per 310CMR15,, Septic Tank o be abandoned 13. 5 :_. P ura ed sand filled &'crushed Prop ose d H0 per p3,10CMR15 ` �, 5' Dia Steel Tank Two i o, mpartmen t _ _ � Abandoned Per Title 5 # � Plan Reference 00 Gal — Tank . _c = strop ^ j PL Bk 405 Pg 66 Wi th 0. 5 �'as t Sys te. n I .  Fence Install weer—o w� weep c.o. crew cap a( l \ R►}1 ' 1 to grade. / t _ � .0 � Sao°s.•' !.�,�-' / � /' Ba do--�" ~ ' ppumb n outside / _ % Roger & Richard Bergenh eim, Planter-- 4_1 ` P g t Island < -50 Phillip Street Bldg 11 r Medfield, MA 02052 Electric 4 Bedrooms Connection \ s .!unction Box O � s s � per,, TOF EL = 38.5 / Inside Stonewall. ae,n, m�rdN /out of driveway. � %• Exist l'roP i well Blo wer / (toee Unit & -Existing Pa ved D/W .�ioeaeee) Vent / Location ASSESSORS MAP _ 12.1 LOT 26.1 Proposed H 0 1, 000 Gal Pump Chafer /09� '� 1 y� °Q. ` a� Se i1 c �a d e Re air Pia Ie1 � p �� .P / i III ��°� % r Centerville, MA L 0 T e o ;` I ' UA (J d T LAKE' Located At i Area 1. Acres N 112 es Neck Road East i-a k"e .E'le v = �34. 8 Y (Historic) Centerville, MA $ _ 50, off Applicant 250..1" -- _ ! Roger Bergenh elm 50 Philip.. Stree t r _ H of n.>gss�c� Medfield, MA 02052 F,DWARO SO`ALE.•1" _ 20' - DATE: April 22. 2008 A- j0 STONE Cn Rev. June B, 2008 No. 2ssso Prepared By. A & M Land Services T 618 Main Street Rte 28 Unit 3 I 7,09 West Yarmouth, MA 02673 6 Pb. 508—771-5263 Cell 508—737-1777 _ GRAPHIC SCALE �N OF A46 sq0 •20 0 10 20 40 A o� DA EN ti V Existing Well � 1 M YER IN FEET outside 150' of No. 1140 Proposed SAS I. inch = 20 ft. r �� �FG � DWg 1L IgTE Tl— L) CULTEC410 FILTER CLOTH MUST BE UTILIZED TO MAINTAIN CULTEC PERFbRMA 8 STANDARDS Plan View 2.J MINIMUM OF 24" OVERLAP BENEATH BEGINNING'CULTEC C4 PANELS TO HOLD 1410 FILTER CLOTH TO ACT AS SPLASH GUARD AT ENTR TO HE DEEP OBSERVATION DEEP OBSERVATION Blower With r, Hood& Vent 4' ie 3.J FILTER CLOTH TO BE INSTALLED SMOOTH TO RIBBED SURFACES T(B Rio-Microbics OVER CULTEC C4 PANELS, CONSULT MANUFACTURORS' REP/DEALER FOR /'� HOLE TOP OF Install 24" K Dut j' ) Install electric connection box PROPER WIDTH AND LE'NCTH SITING AND OVERLAP LOG IVLLj LOG fJ' y Install 24 Nty Duty - lnstail ONE 4"DIA PORT TO BE UTLILIZED 1fWH 4.• DIA PVC PIPE INSTALLED FOUNDATION Cast Iron M.H. to.grade inside of stonewall out 4 Ilorz g Cast Iron M.H. to grade of driveway Tee FROM BOTTOM OF SAS (FIRST 10 PERF) TO COUPLE.AT TOP OF PANEL AND _. �i'L 38.5 Double 14" Tees Erec Conduit (to biower EXTENDED WIM SOLID PIPE TO GROUND SURFACE CAPPED WITfI COUPLE AND Test Hate #1 Test Hote #2 Existing Patio El = 38.18 control system D-Box Riser Extension SCREW TOP LOCATED AT CENTER OF LAST PANEL " { to within 6" Install 4 cbs port at corner (EL = 44.Of). EL = 45.2f Ex FG 38.2 DB-9 of SAS Bottom section to,be -- FG 38.2 INSTALL ALARM& CONTROL of grade perforated wrapped w1filtercloth D !i leV Soil Sofl Soil D h Gov Soil soil. Soil 37.0 Replumb Outside Plumbing Top _ p - _ screw cap to grade MSDA) (Munsell) (USDA) (Mu'nsell), BOX INSIDE OF BLDG Proposed Top section to be sofld with ��n� F(tt) Horizon Teztura Color ��n� �ft) Horizon Texture Color Proposed 37;47 Install Wire Quick \ 4' Casting & Rim WIRING CONNECTION TO D Box NC - 430 . Boot _ - Proposed, DiscoIT ct PUMP TO BE OUTSIDE OF o - tx as.0 A LOAMY SAND f0YR4/3 0 s" 44.7 A LOAMY SAND 10YR4/3 Boot Proposed 2 - 8' Conc CHAMBER IN WATERTIGHT 4 Horz Tee Cultee #410 2' - 4"Expander Filter Cover N 12" - zx• 42.z B LOAMY SAND 7.5YR5/s 6" - 20" 43.5 B LOAMY SAND 7.5YR5/6 s-DIa Boot Mock BOX AND CONDUIT p 41.0 36.15 Fast fixated o 36.25 To p 22" - f2o" 34.0 C COARSE SAND 2.5Y7/4 20" - 120" 35.2 C COARSE SAND 2.5Y7/4 35.39 rmoare Pro osed INVERT EL INVERT EL ,� _ 35.06 Boat Z" PVC to a� 3D'Alin 3" eff a-f/2 ti Secure Chain 51OP' to P•c' r Nei ht Overall Existing ""-=-- t, Wou Batl V Discharge i ti -t INV•EL b,,x prior�to 4-ffor4-r Yee I - flojbht To Remain i v i 24' Min Le vel Level x4"grin n d d 35.00 EMERG M. a 85.17 O DC Overlap b Overlap soo cat loon Gat.. INVERT EL STAR W o 1/4" fl'eep Hole 6' STONE BASE Deep Obi Hole Date: 2/29/O8 Deep Obs Hole Date: 2129108 �0.77 Bot 30.47 _........................._..........................................._..... ALARM ON LEVEL 2-8' w r c. 40.60 5 • •: 32.33 o CHEcx VALVE OSED LEACHING FACILITY spit Evainaior ED STONE _.......................... ......... ........-... .....•...................... .................................................... ........ - �w f- m INVERT.EL PROP , , w Q'i a Soil Evaluator. ED STONE ............. David Stanton 32.08 3 W�o IIVV EL 12 Panels ® (4 X t? X 8-1�2,,,t 40 3 Witnessed By: Witnessed Hy:' David Stanton Replumb.Outside Plumbing Proposed (H,20) PUMP ON LEVEL .i 4a55 40.3 , iC a BOTTOM EL Pero Rate: < 2 MIN/1N 0 60., Pere Rate: < 2 MIN/1N 0 60 = TWO Compartment t 6" W 2 MERCURY FLOAT 96 Effective Length I y. p Soil Survey Description: CARVER p a ,� INVERT EL H Gavel Soil Surve Descri Lion CARVER one ® 38' s 0.02 BOTTOM EL PUMP OFF LEVEL 31.58 � LEVEL CONTROLS Level Cultee C4 Panels 34 8 Geologic Material: caAcrAt our�rAsx uoRRarNs Geologic Material: GLACIAL OurMASH dfORRarNS Olre C$f 15' s = 0.05 1,500 Gal Septic Tank - EL Depth to Standing Water. NA Depth to Standing Water. NA p 3t1 75 10 SEWAGE PUMP, GOULDS ESTIMATED HIGH GROUND WATER Depth to weeping Water. NA Depth to Weeping Water- NA With U 5 Fast Unit (MODEL 2 WD HISTORIC LAKE ELEVATION USGS/NGVD DATUM Depth to Mottling(Color): NA Depth to Mottlin Color): NA ., 30.25 - 0.25 (7-0 x t)-2 x 11 -O J o 0 0 0 0 0 0 0 o a000 oco 0 00 0 0 00 0 0 0 0 o BOt 'OR EQUIVALENT) DTH #2 EL 35.2 Est Seasonal High GX NA Est Seasonal High GW: NA B°t LOCATED UNDER 24 DIA MH DTH#1 EL 34.0 USGS Observation Well: NA USGS Observation Well: NA WT 23,780 lbS S = 0.015 81�6" Date of Last Measurement: NA Date of Last Measurement: NA BUOYANCY CALCULATION 6" STONE BASE Cornments: Comments: * Waterproof.and Watertight 4' � 4"xe'x16" Sotm DETAIL LEACHING FACILITY - 1,500 Gallon H-20 Septic Tank * Double Bute and Poly/Glue Proposed 1,000 Gal CONCRETE BLOCK 12 Panels ® (4' x e' x t3=1/2J - (7'-0n x 6'-2n x 11'-0'� Wrap Seams BUOYANCY CALCULATION H-20 2 REQ. 6 End Sections & 6 Mid Sections 96' Effective Length WT 23,780 lbs 4000 Gallon H-20 Pump Chamber Pump Chamber 2" Force Main Install Cultee "C4" Panels 6.I7 x 11.00 x �/ f LBS 5=8 x 4=70 x 8-6 Mono Tank 2"Forced Main DESIGN. DA TA �`.33 x 62.4 =18,338 f 32.0' Cu. Fr. 500 lbs N'T = 14, Waterproof 23,780 1 •f- 5,698 + 29,4781 Its > 18,338 f 1- LBS 0. K. S,?Jc 9.00 / 48 T7e :v x 4.55 x B2¢ =13,415 } t LBS Cultee 4106.17 x 11.00 x 0.73 xH5 !bs/cu ft- 5,698 �tbs -- cu Fr FfltercloEh' Number of Hedroorns: ¢ O 1450!� 1 + 10,595 25,095 tbs� >13,415 �' LBS OK Instal! Garba a Grinder:_ � f E" - 4",E'xpander grr/horz teeDesi n Flow5.ti 5 '9.00 x 1.95 x 115 lbs/cf = 10,595) 4 0 g 440 PUMP AND ALARM NOTES n �, Mln 2' of 4 4 4%°as per p B c / /Day x Number of BR�e �r w screw ce to rode 110 Gal BR ) �7tQrage l�alc 3 L''fl` rlap at end Kin 24 'Overlap at end Two Compartment per 2.67 x 250 al ft = 6,�?' a1 > 440 a 8-t/2 of pangs prior� backftll of panels prior to beckllll Septic Tank: 0 05 Fast Specs. 1,50U S 1) PUMP MUST BE INSTALLED ACCORDING TO MANUFACTUER's g 1 g g I a K. for Sp (Minimum - Design Flo.r x 2009) Gal sPECIFrcATloNs Pump Cale MAXIMUM FEASIBLE` COMPLIANCES APPeovr-D er, . ° og PUMP. OR EQUIVALENT' _ < � � � Per DEP Titles 310. CMRis O Mod. Cart. for Gen Use of Cultee-'C4"Panels 2) USE GOULD 1/3 HP Q ® 30 ppm 9.19 f 3.41 -- 12 60 E 15.50 Chart OK 1,) VARIANCE TO THE �_10n SETBACK BETWEEN THE EDGE OF THE LEACHING FIELD Leaching Area: Bath Bed #2 ;,,,,10,, 3 PUMP MUST BE CAPABLE OF PASSING 2" SOLIDS 0.5 x 250 = 125 al o cle, t 30 m = 4 txzin 10sec AND THE EXISTING BV) A 71 SETBACK IS PROVIDED. A 29' VARIANCE IS REQUESTED. 12 x 8 96 LF x 8.7 = 643.2 SF sh Bed#1 Famil Bed #4 g �Y gP4 ALARM MUST BE WIRED ON SEPARATE CURCUIT FROM PUMP. 110 f 15 125 gal x 4 cycles = 500 gpd.> 440 gpd OK LOCAL SETBACK BYLAW 360-1 - U111 yLong Terui Acceptance Rate (LIAR):X 0.74 Rm Living Bath 5) ELECTRICAL WORK TO BE-INSPECTED BY WIRING INSPECTOR. 2) VARIANCE TO THE _t 0_b SETBACK BETWEEN THE EDGE OF THE LEACHING FIELD Bth Rm ALARM MUST BE LOCATED IN THE HOUSE. AND THE EXISTING .BVW. A 54' SETBACK IS PROVIDED. A 46' VARIANCE IS REQUESTED. Leaching Area Design Capacity. 476 GPD 6) LOCAL SETBACK BYLAW 360-1 3.) VARIANCE TO THE ILL SETBACK BETWEEN THE EDGE OF THE SEPTIC TANK Kt Bed;#3 � ink t AND THE EXISTING POND. A 42 .SETBACK IS PROVIDED. A 58 SETBACK IS REQUESTED. Study LOCAL,SETBACK BYLAW 360-1 4--- GPD Provided - 440 GPD Required =36_GPDReserve 4.) VARIANCE TO THE, 100'SETBACK BETWEEN THE EDGE OF THE PUMP CHAMBER AND THE. EXISTING POND. A 52' SETBACK IS PROVIDED. A 48' VARIANCE IS REQUESTED. First Floor Second [%Ivor LOCAL SETBACK BYLAW 360-1 Q N.T.S. N.T.S. 5.) (310 CMR 15.227 (5)) Maximum Feasible Compliance A SEPERATION OF 2-112 REQUESTED AT PUMP CHAMBER INLET IIt1VERT 1.Variance to the 100' Setback between the edge of the leaching field ABOVE MAXIMUM HIGH GROUND WATER (ELEV. 34.80) and the existing well.A 57' setback is provided.A 33' setback is requested. REGULATIONS STATE 12" REQUIRED BUT NOT LESS THAN I" GRANTED, 12" > 2-1/2" < I" ALSO NOTE SEPTIC TANK INLET INVERT AT 7" Local Setback Bylaw: 360-1 �\ AND OUTLET INVERT AT 3 ABOVE HISTORIC LAKE LEVEL ELEV 34.80 USGSINGCD DATUM. B.E'ARSE POND � Pond Ele v 34. 8 (Historic) USGS/NG VD Da t um Aquifer Protection Zone L - _..-*---Edge of Water 40 Zone: R Exrst. Ex Co t to e _...._ 6 Well F Ele v 39.95I Side 15 Rear 15 - / oo \ . _. Pond EL 33.7 14L06 LOT I -� ti g• , `'��. Abandon E:�asting ----.....___-_ - Deed Reference s0, �� leachffeld Septic ExIsUnTank t 4000 Gal abandoned /y /� Bk 2VcJ6 Po 205 oar �\ \ per 310CMR15 um ed1sand filled & crushed a f -' E Proposed H �O �� . Per SIOCMRl5 �4 6' Dia Steel Tank / � Two �ompartmen t Abandoned Per Title 5 % -' _ Plan .Reference �xisting �.`� t °u n hd'o , 1,500 Gal S--- Tank �. _ .... 1,500 Gal I `; L. ` barrier to rot S .....- _r... . _ .. Prop. ; PL Bk 405 Pg' 66 _--- o , j ---- - �TYi th 0. 5 Fast Sys te. z silt ^ , ..-- S-Tank i i. /' ! \ e»CC .. o Fence >✓ / Existing Pa v �o ,/ - ed D i �� Instetl veep o. _ /W \ \ /I_ y / L• Orj� .\ f"'�; , ao. w�crew cap - i to grade. �.•- �.. _..-•_,__ -.•--- ----.- _,� �- ---- -- r% _ r� G X X ST l�G7"_• � t�}C•�,!-��I �7f"" � �J ,`. )!t-' _ M-j / _ = � - Approx --- "--,'. = �,,, �' SAS ,' [D-Eox •,, � , Sta+�_ �._� ., / Owner.SAS Area 1 i •.� Brick / r i Pa do -_'�' ^� Replumb outside % ;- - -- �r� �� --_ -,�°� ► H !A ,' Boa / plumbing Roger & Richard Ber enh eim Trs 45.2 I Planter i \ r .i / �`''\. ;'V\�•' , ON` E11 3�, DTH: "�3, Island +moo '``. .� ! / 50 Phillz Stre e t �.- N/F s 1 (44.OJ Medfield, MA 02052 ::::.: �- �--' Map e3,e Parcel 011l001 `�- Al ///� ; ��._ � . obi -. ! Electric E s 4 Bedrooms 1 r. - Port Connection -� \ ' Eliza be th M. Bergenheim !, _,� - _ �, ~\;\ •�1 o, / ' lnSld function Bo wall , A/erm Insld / ' 110 N es Neck Road ,� ,� ,. E s r TOF EL 38.5 i .y ,• f( - - C Yt -Pro off o _ out of driveway. y / Centerville, MA 0,2632 `� Wetland Flagged by" � - � Prop i i , � -✓ ,,,-. � F•xlsG Prop ;. �. Brad Hall ¢� _`_ _ Unit & / 4� Well Blotrer ` j j' y3 --�- Fence so� Ito ba ' N 42 Existing Pa relocatae) Vent Location y. 40 _....:.. loe All" stag f3 , - _ 1/"'Ja , - 'x t s�-t,,t l . ASSE'SS4RS MAP 12.1 LOT �26.1 --_ ` s Fie 4 T _ _ Pro osed H--20 `' ; ,, - -- Wooded - - o P l R _ 126.7z � _. - .. .. _. Area 1,040 Gal. NIF �. L = 83.04' �. \-Pumpchamber /�o° -�.. �� ,� _ Se tKramerp lc Upgrade I�'epalr Pl �z Bk 1580 Pg ,249 / / ``. Fnd 3� f .p i in Map B32 Parcel 78 �, S CB/Dx Flag #z '"�� � � /'-. LOT � � Centerville, .MA 2 Ca Garage\ 1 r� �r r�7 j j �'{IL Q UA Q UL'f l LA11 Located At r w ``' �� Area 1. 02-- Acre, j _ 112 N es Neck Road East Lake Ele v --- <34. 8 .Y Wetland Tagged by _ 1 Centerville, MA �� 6 9�. N 07`5455" (Hl5torlC> Bra d Hall _ o� \ Pia 7 Piag # gQ OQ r `ag #1 E - 5. t j Applicant _ ' � �NOf/Nq °f� \ , 5 - s Roger Ber enheim .250• Alag ; ,�„ ,��` ''`•' o2Q� . Fla 10_--- ag #11 11' "' -- �` cy. g g ��, •�, 32 s oARFlog � 50 .Philip Street ~ \ Flag r Medfield, MA 02052 LOCUS' MAP . MEYER � Na 1140 SCALE-1" = ,20' - DATE.• April ,2 . 8 N F _ �_ _ F / r- -1 �(� v j SGl$TtiFa Rev. Jun 8, 2008 �12LN' Il,lolo$, Krasner �' FL r gWARi�' � Shallow � \ O \ ��' o 3g --._., Prepared By tl is r- t4 s i/1S eearse Pond \ d \ '�w. Frid� �- Bk 1362 Pg 928 �-- -- -j � C r -° �. A & M Land Service c t� Pond CB 11P Map 232 Parcel 012 1 �_ y o 618 Main Street Rte 28 Un 3 "� \ 1-'Ieg. 40 .--' L ` �Q o West Yarmouth, MA 02673 :.- _ Ph. 508- Ce j1 508-737-1777 Neck a tir Flag ►• J� A2 RA HIC /AALE LOCUSK(l zo o to so ao eo Wequaquet Lake l Existing Well % i ( IN FEET ) Proposed SAS °i*- 3 •" '*a 1 inch = 20 ft. i } outside 150' of '