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0074 NYES NECK ROAD - Health
74- Nyes Neck Road Centerville P A = 233 611 r i I r i CERTIFICATE OF ANALYSIS Page: 1 of 1 N s°M Barnstable County Health Laboratory (M-MA009) Report Prepared For: Report Dated: 9/3/2016 Shaun F. Harrington All Cape Well Drilling Order No.: G1696380 oa P0 Box 126 M: Brewster, MA 02631 Laboratory ID#: 1696380-01 Description: Water-Drinking Water Sample#: Sample Location: 74 Nyes Neck, Barnstable Collected: 08/fC/2016 Collected by: well driller nn AA.nn Received: 08/30/2016 Routine_M ITEM RESULT UNITS RL MCL METHOD# ANALYST TESTED NOTE Nitrate as Nitrogen ND mg/L 0.10 10 EPA 300.0 LAP 8/30/2016 Iron 11 mg/L 0.10 0.3 SM 3111E LAP 8/31/2016 Manganese 0.49 mg/L 0.025 0.050 SM 3111B LAP 8/31/2016 pH 6.2 PH AT 25C NA 6.5-8.5 SM 4500-H-13 DCB 8/30/2016 Sodium 19 mg/L 2.5 20 SM 3111B LAP 8/31/2016 Total Coliform Absent P/A 0 0 SM 9223 RG 8/30/2016 Conductance 160 umohs/cm 2.0 / SM 2510B DCB 8/30/2016 Based on the results of the parameters tested, the water is suitable for drinking, but may present aesthetic problems . (taste, odor, staining)due to Iron. Attached please find the laboratory certified parameter list. Approved By: (Lab Director) ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level 3195 Main Street, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 '_A,' /t pF hq� 1 43a CERTIFICATE OF ANALYSIS O 4� tFM' *° Barnstable County Health Laboratory (M-MA009) Recipient: Shaun F. Harrington Matrix: Water-Drinking Water All Cape Well Drilling Sampled: 08/30/2016 10:00 P 0 Box 126 Received: 08/30/2016 12:33 Brewster, MA 02631 Collection Address: 74 Nyes Neck, Barnstable Order#: G1696380 Sample Location: Description: rtn_M+VOC-74 Nyes Neck Lab ID: 1696380-01 Date Analyzed: 8/30/2016 @ 14:13 Sample#: Analyst: yn Method: EPA 524.2 Dilution Factor: , 1 Comment: Based on the results of the parameters tested,the water is suitable for drinking, but may present aesthetic problems(taste, odor,staining)due to Iron. EPA"524,2 - Volatile Organics by GC/MS Result MCL MDL Result MCL FMQLParameter ug/L ug/L ug/L Parameter ug/L ug/L Dichlorodifluoromethane ND 0.50 Chloroform 0.61 80 0.50 Chloromethane ND 0.50 cis-1,2-Dichloroethene ND 70 0.50 Vinyl chloride ND 2.0 0.50 cis-1,3-Dichloropropene ND 0.50 Bromomethane ND 0.50 Dibromochloromethane ND 0.50 1,1,1,2-Tetrachloroethane ND 0.50 Dibromomethane ND 0.50 1,1,1-Tnchloroethane ND 200 0.50 Ethylbenzene ND 700 0.50 1,1,2,2-Tetrachloroethane ND 0.50 Hexachlorobutadiene ND 0.50 1,1,2-Tdchloroethane ND 5.0 0.50 Isopropyl benzene ND 0.50 1,1-Dichloroethane ND 0.50 Methylene chloride ND 5.0 0.50 1,1-Dichloroethene ND 7.0 0.50 Methyl-tert-butyl ether ND 0:50 1,1-Dichloropropene ND 0.50 Naphthalene ND 0.50 1,2,3-Tdchlorobenzene ND 0.50 n-Butylbenzene ND 0.50 1,2,3-Trichloropropane ND 0.50 n-Propylbenzene ND 0.50 1,2,4-Trichlorobenzene ND 70 0.50 p-Isopropyltoluene ND 0.50 1,2,4-Trimethylbenzene ND 0.50 sec-Butyl benzene ND 0.50 1,2-Dibromo-3-chloropropane ND 0.50 Styrene ND 100 0.50 1,2-Dibromoethane(EDB) ND 0.50 tert-Butyl benzene ND 0.50 1,2-Dichlorobenzene ND 600 0.50 Tetrachloroethene ND 5.0 0.50 1,2-Dichloroethane ND 5.0 0.50 Toluene ND 1000 1 0.50 1,2-Dichloropropane ND 0.50 Total xylenes ND 10000 0.50 1,3,5-Tri methyl benzene ND 0.50 trans-1,2-Dichloroethene ND 100 0.50 1,3-Dichlorobenzene ND 0.50 trans-1,3-Dichloropropene ND 0.50 1,3-Dichloropropane ND 0.50 Trichloroethene ND 5.0 0.50 1,4-Dichlorobenzene ND 5.0 0.50 Trichlorofluoromethane ND 0.50 2,2-Dichloropropane ND 0.50 Surrogates %Recovered QC Limits(%) 2-Chlorotoluene ND 0.50 p-Bromofluorobenzene 94% 70 130 4-Chlorotoluene ND 0.50 1,2-Dichlorobenzene-d4 92% 70 130 Benzene ND 5.0 0.50 Bromobenzene ND 0.50 Bromochloromethane ND 0.50 Bromodichloromethane ND 0.50 Bromoform ND 0.50 Carbon tetrachloride ND 5.0 0.50 Chlorobenzene ND 100 0.50 Chloroethane ND 0.50 Attached please find the laboratory certified parameter list. Approved By. (Lab Director) � ffLeel ND=None Detected RL = Reporting Limit MCL=Maxi"mum ontaminan 3195 Main Street, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 Page 1 of 1 Town of Barnstable Barn Regulatory Services Department """"°'�'�" • 1 1 • MASS. Public Health Division I I 639.��,� 2007 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7014 1200 0001 0358 3971 June 8, 2015 Mr. &Mrs. Richard Bettis 505 Ingleside Avenue Athens, Tennessee 37303 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE,TITLE.5 iThe septic system located at 74 Nyes Neck Road, Centerville,MA was last inspected on 5/13/2015 by Brett Hickey, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Conditionally Passes" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • The distribution-box is rotted and needs to be replaced. • Also; a well water analysis by.a DEP certified lab for fecal coliform bacteria and ammonia nitrogen and nitrate nitrogen. You are ordered to repair or replace the septic system within one (1)year from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH . Thomas McKean, R.S. CHO Agent of the Board of Health Q:\SEPTIC\Conditionally Passes Ltr\74 Nyes Neck Rd Cent Jun 2015.doc f n OF tKE r°w Town of Barnstable • snRtvsr,►st.�. 639� Regulatory Services Department i �� Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 4/28/15 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An"x"marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ONE (1) YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑ Any portion of the cesspool within a Zone 1 to a public well ❑ Any portion of a cesspool within 50 feet of a private water "supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2) YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑ Any"conditionally passed systems" (broken cover, relocation of a pipe, relocation of a driveway due to H-10 components, etc) ❑ Leaching pit or cesspool with high liquid level, <1.2"below pit(per Town Code §360-9.1) f OTHER —O D- box i S ro W e (I W w r �w f r j UI c, % I e J�i �jdc,\ r cc rrn ti� G;n�✓wu�ta 1,#4-n?p a�� n i�rti]e A i4-n'yR0, Repair deadline: yeo r �` Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc Commonwealth of Massachusetts �� 71 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 74 Nyes Neck Road Property Address Mary Jane & Richard Bettis Owner Owner's Name i information is required for every Centerville MA 02632 5/13/15-7 page. City/Town State Zip Code Date of f jspection 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: �1 key to move your cursor-do not Brett Hickey use the return Name of Inspector key. Excavation Company � Company Name 14 Teaberry Lane Company Address Itl Sandwich Ma. 02644 City/Town State Zip Code (508)477-0653 S113747 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 ® N eds Further E luation by the Local Approving Authority ;h- .30 5/13/15 Ins or's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. G V t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form e Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 74 Nyes Neck Road Property Address Mary Jane & Richard Bettis Owner Owner's Name information is Centerville MA 02632 5/13/15 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not , determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 74 Nyes Neck Road Property Address Mary Jane & Richard Bettis Owner Owner's Name information is required for every Centerville MA 02632 5/13/15 page. Cityrrown 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): d-box is in poor condition and must be replaced ❑ 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 o- v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 74 Nyes Neck Road Property Address Mary Jane & Richard Bettis Owner Owner's Name information is required for every Centerville MA 02632 5/13/15 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: S.A.S. approx. 60'from private well and must be tested 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 1/day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments . 74 Nyes Neck Road Property Address Mary Jane & Richard Bettis Owner Owner's Name information is Centerville MA 02632 5/13/15 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 74 Nyes Neck Road Property Address Mary Jane& Richard Bettis Owner Owner's Name information is required for every Centerville MA 02632 5/13/15 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (if they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 2 Number of bedrooms (actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 220 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments .�' 74 Nyes Neck Road Property Address Mary Jane & Richard Bettis Owner Owner's Name information is required for every Centerville MA 02632 5/13/15 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 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: unknown Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts a . Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 74 Nyes Neck Road Property Address Mary Jane & Richard Bettis Owner Owner's Name information is required for every Centerville MA 02632 5/13/15 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: 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 - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 74 Nyes Neck Road Property Address Mary Jane& Richard Bettis Owner Owner's Name information is Centerville MA 02632 5/13/15 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 21811 Depth below grade: feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: approx. 60' feet Comments(on condition of joints, venting, evidence of leakage, etc.): At time of inspection building sewer appeared to be in good working order with no sign of leakage. Septic Tank(locate on site plan): 2'2" Depth below grade: 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: 1000 gallon Sludge depth: 7" 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 74 Nyes Neck Road Property Address Mary Jane & Richard Bettis Owner Owner's Name information is required for every Centerville MA 02632 5/13/15 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 29" Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 16" How were dimensions determined? measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): At time of inspection septic tank appeared to be in working order. Baffles present with no sign of back-up. Liquid level equal with outlet invert. Tank is not in need of pumping at this time but should be pumped every 2 years for maintenance. 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 N Commonwealth of Massachusetts _ . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 74 Nyes Neck Road Property Address Mary Jane& Richard Bettis Owner Owner's Name information is Centerville MA 02632 5/13/15 required for every 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 r Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 74 Nyes Neck Road Property Address Mary Jane & Richard Bettis Owner Owner's Name information is required for every Centerville MA 02632 5/13/15 page. CitylTown 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 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.): At time of inspection d-box is deteriorated and must be replaced Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 74 Nyes Neck Road Property Address Mary Jane& Richard Bettis Owner Owner's Name information is required for every Centerville MA 02632 5/13/15 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: (3) 7x21infiltrators ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): At time of inspection leaching was dry and appears to be in working order with no sign of hydraulic failure. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 I Commonwealth of Massachusetts G - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments .'t 74 Nyes Neck Road Property Address Mary Jane & Richard Bettis Owner Owner's Name information is Centerville MA 02632 5/13/15 required for every page. CitylTown 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.)-. l5ins•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 °( 74 Nyes Neck Road Property Address Mary Jane& Richard Bettis Owner Owner's Name information is Centerville MA 02632 5/13/15 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks orvbenchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: Z hand-sketch in the area below drawing attached separately o 13 ,24� L]L _ AZ,3It f3i- a4' I ' t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 r - Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 74 Nyes Neck Road Property Address Mary Jane & Richard Bettis Owner Owner's Name information is required for every Centerville MA 02632 5/13/15 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: no GW 4' below system feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: test hole dug at time of previous inspection Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 ' Commonwealth of Massachusetts Title 5 Official Inspection Form _ a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 74 Nyes Neck Road Property Address Mary Jane & Richard Bettis Owner Owner's Name information is Centerville MA 02632 5/13/15 required for every page. Cityrrown 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 i I ' • r Town of Barnstable Office: 508-862-4644 Fax: 508-790-6304 Regulatory Services Department Public Health Division MAS. Thomas A.McKean, CHO 200 Main Street, Hyannis, MA 02601 Payment Receipt Septic Inspection Payment received: 2$ 5.00 (Check) on 5/22/2015 Permit number: 10886 (Check number: 2096 Check amount: $25.00 Name on check: b &b excavation Owner: RICHARD LYNN & MARY 7ANE BETTIS ' (Address: 74 NYES NECK ROAD, Centerville i - - i f LA r fir, ...��• No. i '� G Fee t 0 e,. THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes �< PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 0(pplitation for 33isposal *pstrm Construction 3pPrmit d-b Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System Aindividual Components Location Address or Lot No. ry4 Nyes Owner's Name,Address,and Tell..No. Assessor's Map/Parcel a 3 3 Oil `l " - r y Jame me '`'e 4t s 2-9 S_ Y S 7 Installer's Na e,Address,and Tel.No. Designer's Name,Address,and Tel.No. ate XCQ�GZ.�ron 50N • Y77- 0653 A) 1,+ Type of Build ng: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(mina required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Boar f a . Signed Date 6 •-I Application Approved by �'�- .. Date f ✓( Application Disapproved by Date for the following reasons Permit No. Date Issued No. ( ! 8 Fee fTHE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Ye PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ftplitatlon for Vsposai 6pstem Construction Vermit u - bq Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System Ykindividual Components ` Location Address or Lot No. /7 4 N y eS 1,- e&_ Owner's Name,Address,and Tel.No. -I-1Cj J4 t7e eke 14/ 5 �Z3-- z9 S' 7 S Assessor's Map/Parcel �"j� �' � � t , y '�� Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. C3 r a xCa✓Q f��n Soil �7� o�s� A) JA � Type of Buildmg: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title - Size of Septic Tank Type of S.A.S. Description of Soil -- Nature of Repairs or Alterations(Answer when applicable) U 2 011 - ha\/ Date last inspected: r Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board�of H a Signe 29j Date 6 -1(, - Application Approved by 11'L ; Date Application Disapproved by Date for the following reasons Permit No. Date Issued --------.------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS CCertifitate of Compliaute THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(y Upgraded {. ( ) Abandoned( )by 1 I at r14 K /t.ts has been constructed in accordance with the_p ovisions of Title 5 and the for Disposal System Construction Permit No. dated Installer U Designer Lk #bedrooms Approved design flow gpd The issuance of this permit shall no)be con trued as a guarantee that the system ill functt � as desi ned. Date ( 5 Inspector —� -- --------- - -- -- - - --- - - - - - _ _ _ _. Fee • *�, -•. -. THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Misposal 6pstem CCoustruttion permit Permission is hereby granted to Construct( ) Repair(�) Upgrade( ) Abandon( ) System located at \/P �J' �/�, (/P P( kill I k and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date �/ [(O � Approved by Ki 94 (1K0 i > ,v AsBuilt Page 1 of 1 t7,7/ //� TOWN OF BARNSTABLE LOCATION / A L S N£Ck R SEWAGE# VILLAGE C £�` ASSESSOR'S MAP&LOT'233"C �asPj«R: �B IIV�,LER'S NAME&PHONE N0. 14 rlAr fC O SEPTIC TANK CAPACITY c-777—.c. LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER G�a��£Lfvslj PERMIT DATE: C-"N PLatdCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by t� 02/ r 3 7 r'R 0 V http://issgl2/intranet/propdata/prebuilt.aspx?mappar=233011&seq=1 6/16/2015 TOWN OF BARNSTABLE :LOCATION ` C4 tJucS rJcCt4 RA SEWAGE# 5 2015 - )88 VILLAGE Ccnic-Tu"11C ASSESSOR'S MAP&PARCEL 0 INSTALLER'S NAME&PHONE NO. Q (i EXCAV q7,7. O GS SEPTIC TANK CAPACITY LEACHING FACILITY: (type),JD BOX � 11 (size) NO.OF BEDROOMS k)l OWNER va PERMIT DATE: G- JG• /S• COMPLIANCE DATE: �( Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY AI- ZI �3l ' 24 > o 82 A3- 3 'i 63- 34` M " 3) ' A a 39 O U •C V CERTIFICATE OF ANALYSIS Page: 1 .1off 1 M Barnstable County Health Laboratory (M-MA009) '� _ eti Report Prepared For. Report Dated. 9/17/2015 , (0 Shaun F. Harrington act a,C All Cape Well Drilling Order No.: G1590334 P O Box 126 Brewster, MA 02631 Laboratory ID#: 1590334-01 Description: Water-Drinking Water �/� . Sample#: Sample Location: 74 Nyes Neck Rd. Barnstable, MA Collected: 09/15/2 5 Collected by: Received: 09/15/2015 Routine ITEM RESULT UNITS RL MCL METHOD# ANALYST TESTED NOTE Nitrate as Nitrogen ND mg/L 0.10 10 EPA 300.0 LAP 9/15/2015 Copper 0.15 rn9/L 0.10 1.3 SM 3111 B LAP 9/16/2015 Iron 2.4 mg/L 0.10 6.3 SM 3111E LAP 9/16/2015 pH 5.8 PH AT 25C NA 6.5-8.5 SM 4500-H-13 DCB 9/15/2015 Sodium 19 mg/L 2.5 20 SM 3111B LAP 9/16/2015 Total Coliform Absent P/A 0 0 SM 9223 RG 9/15/2015 Conductance 160 umohs/cm 2.0 EPA 120.1 DCB 9/15/2015 May present aesthetic problems(taste, odor, staining)due to Iron. Attached please find the laboratory certified parameter list. Approved By: AjLn �'� (Lab Director) ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 i CERTIFICATE OF ANALYSIS Barnstable County Health Laboratory (M-MA009) Recipient: Shaun F. Harrington Matrix: Water-Drinking Water All Cape Well Drilling Sampled: 09/15/2015 10:00 P 0 Box 126 Received: 09/15/2015 13:20 Brewster, MA 02631 Collection Address: 74 Nyes Neck Rd. Barnstable, MA Order#: G1590334 Sample Location: Description: rekit74 Nyes Neck Rd Lab ID: 1590334-01 Date Analyzed: 9/15/2015 @ 9:32 Sample#: Analyst: yn Method: EPA 524.2 Dilution Factor: 1 Comment: May present aesthetic problems(taste, odor,staining)due to Iron. EPA 524.2 - Volatile Organics by GC/MS Result MCL MDL Result MCL MDL Parameter ug/L ug/L ug/L Parameter ug/L ug/L ug/L Dichlorodifluoromethane ND 0.50 Chloroform ND 80 0.50 Chloromethane ND 0.50 cis-1,2-Dichloroethene ND 70 0.50 Vinyl chloride ND 2.0 0.50 cis-1,3-Dichloropropene ND 0.50 Bromomethane ND 0.50 Dibromochloromethane ND 0.50 1,1,1,2-Tetrachloroethane ND 0.50 Dibromomethane ND 0.50 1,1,1-Trichloroethane ND 200 0.50 Ethlbenzene ND 700 0.50 1,1,2,2-Tetrachloroethane ND 0.50 Hexachlorobutadiene ND 0.50 11,1,2-Trichloroethane ND 5.0 0.50 Isopropyl benzene ND 0.50 1,1-Dichloroethane ND 0.50 Methylene chloride ND 5.0 0.50 1 1-Dichloroethene ND 7.0 0.50 Methyl-tert-butyl ether ND 0.50 1,1-Dichloropropene ND phthalene ND 0.50 1,2,3-Trichlorobenzene ND 0.50 n-Butylbenzene ND 0.50 1,2,3-Trichloropropane ND 0.5o n-Propylbenzene ND 0.50 1,2,4-Trichlorobenzene ND 70 0.50 p-Isopropyltoluene ND 0.50 1,2,4-Tri methyl benzene ND 0.50 sec-Butyl benzene ND 0.50 1,2-Dibromo-3-chloropropane ND 0.50 Styrene ND 100 0.50 1,2-Dibromoethane(EDB) ND 0.50. tert-Butyl benzene ND 0.50 .1,2-Dichlorobenzene ND 600 0.50 Tetrachloroethene ND 5.0 0.50 1,2-Dichloroethane ND 5.0 0.50 Toluene ND 1000 0.50 11,2-Dichloropropane ND 0.50 Total xylenes ND 10000 0.50 1,3,5-Trimethylbenzene ND 0.50 trans-1,2-Dichloroethene ND .100 0.50 1,37Dichlorobenzene ND 0.50 trans-1,3-Dichloropropene •ND 0.50 _------- 1,3-Dichloropropane ND 0.50 Trichloroethene ND .5.0 0.50 1,4-Dichlorobenzene ND 5.0 0.50 Trichlorofluoromethane ND 0.50 i2,2-Dichloropropane ND 0.50 Surrogates %Recovered QC Limits(%) 2-Chlorotoluene ND 0.50 p-Bromofluorobenzene 74% 70 130 4-Chlorotoluene ND 0.50 1,2-Dichlorobenzene-d4 810/n 70 130 Benzene ND 5.0 0.50 Bromobenzene ND 0.50 18romochloromethane ND 0.50 - Bromodichloromethane ND 0.50-1 Bromoform --t-- ND - 0.50 Carbon tetrachloride ND 5.0 0.50 'Chlorobenzene ND 100 0.50 I&roethane ND 0.50 --- Attached please find the laboratory certified parameter list. Approved By:(Lab Director) ND=None Detected RL = Reporting Limit ° MCL=Maximum Contaminant Level Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 Page 1 of 1 " Sep. 17. 2C15,, 3: 1Sf'M k 2691 P. 1 CERTIFICATE OF ANALYSIS use: of 1 Barnstable County Health Laboratory (M-MA009) Report Prepared For: Report Dated: 9117/2015 Shaun F. Harrington All Cape Well Drilling Order No.: G159433d Fri n P 0 Sox 126 Brewster, MA 02631 Laboratory ID M 1590334-01 Description: water-Drinking Water -r Sample 0: Sample Location: A Nyes Neak Rd.Barnstable,MA Collected: 09115/2013 R' Collected by: Recelved: 09115/2015 " Routine ITEM RF-SULT UNITS ILL MCL METHOD# ANALYST TESTED NOTE Nitrate as Nitrogen ND mgiL 0.10 10 EPA 300.0 LAP 9/1512016 Copper 0.16 mglL 0.10 1.3 SM 3111B LAP 9/16/21)15 j 1 ron 2.4 mg1L 0.10 0.3 SM 3111 B LAP 9/1612015 pH 5.8 PH AT 25C NA 6.5.8.5 SM 4500-H-B DCB 9/1 W2015 Sodium 19 mg/L 2.5 20 SM3111B LAP 9/16/2016 Total Coliform Absent PIA 0 0 SM 9223 RG 9/15/2015 Conductance 160 umohs/cm 2.0 EPA 120.1 DCB 9/1512015 May present aesthetic problerr►s(taste,odor,staining)due to Iron.' Attached please find the laboratory certllled parameter list. Approved By: _.. (Lab Dkectar) ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph:506-375-6605 Sep. 17. 2C15 3: 16PM VD 2691 P. 2 }�yoF Pp CERTIFICATE OF ANALYSIS : f Barnstable County Health Laboratory (M-MA009) Recipient: Shaun P.Harrington Matrix'. Water Drinking Water All We Well Drilling Sampled; 09/15/2015 10:00 P 0 Box 126 Received: 09/15/2015 13:20 Collection Address; 74 Nyes Neck Rd.Barnstable,MA Brewster, MA 02631 Sample Location: Order#: G1590334 Description: reklt74 Nyes Neck Rd Lab ID: 1S90334-01 Date Analyzed; 9/15/2015 @ 9:32 Sample#: Analyst: yn Method: EPA 524.2 Dilution Factor. 1 Comment: May present aesthetic problems(taste,odor,staining)due to Iron. EPA 524.2- Vela & drganks by GC/MS MCL MCL MPS Parameter ug/L ug/L uA/L l Parameter ug/L uglL utalt Dichlorodifluaromethane ND 0.50 Chloroform ND go 0.50 Chloramethane ND 0.50 cis-1,2-Dichloroethene ND 70 0.so Vinyl chloride ND 2.0 0.50 cis-1,3-Dichloropropene . ND 0.50 BrotnOmethane ND 0,50 Dibromochloromethane_ - ND - 0.50 1,1,1,2-Tenadtloroethane NO 0.50 Ditxomomethane NO 0.50 1,1,1-Trichloroethane ND 20D osD Ethylbenzene ND 700 D.50 1,1,2,2-Tetrachlaroethane ND 0.50 -1!9 robutadlen- -_ ND O.SD 1,1,2-Trichloroethane ND 5.0 0.50 ylbenzene ND o.50 i1,1-Dlchloroethane ND 0,50 ne chloride ND 5.0 0.50 7.0 0.so tent-butyl ether ND o.SD ,1-Dichloraeene ND - ,-DichloropropeneNp 0.5D alene NDD'�1,2,3-Tichlorobenzene ND 0.50 benzene ND1,2,3-Trichloropropane ND _ D.5D lbenzene ND --- ...o,"W- 0.59 1,2,4-TrichtorobenzeneND 70 D.o opyltoluene NOD' 0 0.50 (benzene NO 0. 1,2,4-Trimethylberrzene' ND ry 1,2-DForomc-3-chloropropane ND Styrene ND 100 D,s 1,2-Dibromoethane(E09) NO 0,50 tart Butylbenzene ND D.50 1,2-Dichlarobenzene ND 600 0.5D Tetrachloroethene ND 00 0.50 ND 5.p 0.50 Toluene ND 1000 0.5D 1,2-pichloroeffitane _ - - - - 1,2-Dichloropropane ND 0.50 Total xylenes ND 10DOD 0.50 1,3,5-Tomethylbenzene ND 0.50 trans-1,2-Dichbroethene ND Ica 0.50 NO 0.50 trans-1,3_Dichloropropene NO 0.5D �1,3.Dichlorobenzene NO _ - ND s,o b.5D 11,3-Dichloropropane 0.50 Trk�loroethene 11,4-Oichlorobenzene NO s.D 0.50 Trlchiorolluaromethane ND o.50 2,2-Dichloropropane NO 0.50 Surrogates %Recovered QC Limits(%) 2-Chlorotoluene NO 0.50 p.Bro1110fluorobenzene 74111-71b 70 130 C]i i-aluem NO 0.50 1,2-Dlchlorobenzene-d4 81 °/o 7U 130 Benzene ND 5.0 0.50 Bromobe ene ND 0.50 Bramochloromethane ND 0_50 Bromodlchloromethane ND �BrOmOform- NO 0.50 - ,Carbon tetrachloride ND s.o 0.50 Chlorobereene NO 100 0.50 lChlaroet9hane ND 0.50 Approved By: -• Attached pleaes find the laboratory cortified parameter 11et. (Lab Dimotcr) ND=None Detected RL = Reporting 1-Imll MCL=Maximum Contaminant Laval Superior Court House, PO.Box 427', Barnstable, MA 02630 Ph:508-375-5505 Page i of 1 � T 5 COMMONWEALTH OF MASSACHUSETTS z w EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS m d DEPARTMENT OF ENVIRONMENTAL PROTECTION i0,9M SVe 350 MAIN STREET WEST YARMOUTH,MA 508-775-2800 CEN TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION MAP 233 PAR 611 Property Address: 74 NYES NECK ROAD CENTERVILLE,MA 02632 Owner's Name: GOSSELIN,PAUL Owner's Address: 48 PALMER ROAD WABAN,MA 02468 Date of Inspection JULY 2,2003 RECEIVED Name of Inspector: (please print) JAMES D. SEARS Company Name: A& B Canco AUG 0 6 2003 Mailing Address: 350 Main Street West Yannouth,MA 02673 Telephone Number: 508-775-2800 TOuv;v OF BARNSTABLE HEALTH DEPT. CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was perfonned 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 Needs Further Evaluation by the Local Approving Authority Fails �7 Inspector's Signature: Date: / The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent tot he buyer,if applicable,and the approving authority. Notes and Comments ****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. Title 5 Inspection Form 6/15/2000 1 � t Page 2 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 74 NYES NECK ROAD CENTERVILLE,MA 02632 Owner: GOSSELIN,PAUL Date of Inspection: JULY 2,2003 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: ✓ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: N/A One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined" please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health)" broken pipe(s)are replaced obstruction is removed ND explain: Title 5 Inspection Form 6/15/2000 2 Page 3 of 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 74 NYES NECK ROAD CENTERVILLE,MA 02632 Owner: GOSSELIN,PAUL Date of Inspection: JULY 2,2003 C. Further Evaluation is Required by the Board of Health: N/A Conditions exist which require further evaluation by the Board of Health in order to detennine 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 salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of 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 detennine distance **This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: Title 5 Inspection Form 6/15/2000 3 Page 4 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 74 NYES NECK ROAD CENTERVILLE,MA 02632 Owner: GOSSELIN,PAUL Date of Inspection: JULY 2,2003 D. System Failure Criteria applicable to all systems: N/A 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 leaching is less than 6"below invert or available volume is less than '/z day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation N/A Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply N/A Any portion of a cesspool or privy is within a Zone 1 of a public well N/A Any portion of a cesspool or privy is within 50 feet of a private water supply well N/A Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. (This system passes if the well water analysis performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this fonn.) NO (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: N/A To be considered a large system the system must service a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone 11 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 is 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. Title 5 Inspection Form 6/15/2000 4 Page 5 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 74 NYES NECK ROAD CENTERVILLE,MA 02632 Owner: GOSSELIN,PAUL Date of Inspection: JULY 2,2003 Check if the following have been done. You must indicate"yes"or"no"as to each of the following Yes No ✓ Pumping infonnation 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 scorn ✓ Was the facility owner(and occupants if different from owner)provided with infonnation on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)has been determined based on: Yes No ✓ Existing information. For example,a plan at the Board of Health. ✓ Detennined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CM 15.302(3)(b)] Title 5 Inspection Form 6/15/2000 5 Page 6 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 74 NY ES NECK ROAD CENTERVILLE,MA 02632 Owner: GOSSELIN,PAUL Date of Inspection: JULY 2,2003 FLOW CONDITIONS RESIDENTIAL Number of Bedrooms(design): 2 Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms: 220 Number of current residents: 2 Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no): YES Seasonal use(yes or no): NO Water meter readings,if available(last 2 years usage(gpd)): WELL WATER Sump pump(yes or no) NO Last date of occupancy: PRESENT COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CM 15.203): Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: N/A Was system pumped as part of the inspection(yes or no): NO If yes,volume pumped: gallons—How was quantity pumped detennined? Reason for pumping: TYPE OF SYSTEM J Septic tank,distribution box,soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no)(if yes,attach previous inspection records,if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank Attach copy of the DEP approval Other(describe): Approximate age of all pp g components,date installed(if known)and source of information: 1992 PERMIT#92-350 Were sewage odors detected when arriving at the site(yes or no): NO Title 5 Inspection Form 6/15/2000 6 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 74 NYES NECK ROAD CENTERVILLE,MA 02632 Owner: GOSSELIN,PAUL Date of Inspection: JULY 2,2003 BUILDING SEWER(locate on site plan): N/A Depth below grade: Materials of construction: Cast iron _ 40 PVC _ other(explain) Distance from private water supply well or suction line: . Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK(locate onsite plan): ✓ Depth below grade: 22" Material of construction: ./ concrete metal fiberglass polyethylene _ other(explain) f tank is metal list age: Is age continued by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1,000 GALLON PRE CAST Sludge depth: 2" Distance from top of sludge to the botton of outlet tee or baffle: 28" Scum thickness: I" Distance from top of scum to top of outlet tee or baffle: 12" Distance from bottom of scum to bottom of outlet tee or baffle: 17" How were dimensions detennined: ASBUILT AND TAPE Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): MAIN TANK AT WORKING LEVEL. INLET BAFFLE,OUTLET BAFFLE. INLET COVER 4"BELOW GRADE. NO SIGN OF OVERLOADING OR LEAKAGE. GREASE TRAP(located on site plan) N/A Depth below grade: Material of construction: concrete metal fiberglass _ polyethylene other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Title 5 Inspection Form 6/15/2000 7 Page 8 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 74 NYES NECK ROAD CENTERVILLE,MA 02632 Owner: GOSSELIN,PAUL Date of Inspection: JULY 2,2003 TIGHT or HOLDING TANK: N/A (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass polyethylene other(explain) Dimensions: Capacity: gallons Design Flow: gallons/day Alann present(yes or no) Alann level: Alann in working order(yes or no): Date of last pumping Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: 0 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.,): DISTRIBUTION BOX IS 12"x16",30"BELOW GRADE.ONE LINE IN,ONE LINE OUT. BOX IS CLEAN AND SOLID.NO SIGN OF OVERLOADING OR SOLID CARRYOVER. PUMP CHAMBER: N/A (locate on site plan) Pumps in working order(yes or no): Alanns in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Title 5 Inspection Form 6/15/2000 8 Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 74 NYES NECK ROAD CENTERVILLE,MA 02632 Owner: GOSSELIN,PAUL Date of Inspection: JULY 2,2003 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: ./ leaching chambers,number: 3 leaching galleries,number leaching trenches,number,length leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) LEACHING IS THREE INFILTRATORS WITH STONE.LEACHING IS 3' BELOW GRADE.PROBED AND DID TEST HOLE.NO SIGN OF OVERLOADING,SAND DRY. CESSPOOLS: N/A (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 or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation etc.): PRIVY: N/A (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.) Title 5 Inspection Form 6/15/2000 9 Page 9 of'I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 74 NYES NECK ROAD CENTERVILLE,MA 02632 e Owner: GOSSELIN. PAUL Date of Inspection: JULY 2,2003 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewa-c disposal system including ties to at least two pennanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. i G�OLI Title 5 Inspection Form 6/15/2000 10 Page I I of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 74 NYES NECK ROAD CENTERVILLE,MA 02632 Owner: GOSSELIN,PAUL Date of Inspection: JULY 2,2003 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to no groundwater 8'6" Please indicate(check)all methods used to detennine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observation site(abutting property/observation hole within 150 feet ot'SAS) Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation Accessed USGS database-explain: N'ou must describe how you established the high ground water elevation: LOT HIGH.TEST HOLE 8'6"NO WATER. TEST HOLE 4' BELOW BOTTOM OF LEACHING. 1 F,4 c,aiti� 4Z Title 5 Inspection Form 6/15/2000 1 I 07/14/03 MON 23:07 FAX 978 232 8975 INOTEK CORP Z 002 JUL-14-2003 15:27 150e3627103 15093627103 P.e1 •� CERTIFICATE OF ANALYSIS Page: 7 Barmtable County Health Laboratory Report Prel)ared For: Report Dated: 07/14/2003 Order Number: G032101-15 Jean-Paul G-oa®elin 48 Palmer 11 L Waban, MA 02468 Laboratory 1D#;_ 0321015-01 Description: Water-Drinking Waver Sample it: P656 657 6S8 659 Samvliam Lacs don: 74 Nyes Neck Rd Centerville MA Collecled: 07/07/2003 Collected by. J Gossello Received: 07107/2003 EPA S24.2- M2 fatile Organics by GC1MS rrEM RESULT UNITS MDL MCL Math 1!! Tested r e R�GClMS 1,1,1,2-Tetracliloroethaue BRL ug/l, 0,9 EPA 524.2 07108/2003 1,1,1-Trichlortiethane BRL uWL 0s 200 EPA524,2 07(08/2003 1,1,2,2-Tetrarl iloroethane BRL urjL 0.5 EPA 524.2 07108/2003 1,1,2-Trichlort iethane BRL ag/L 0S 5.0 EPA 524.2 07108/ = 1,1-Dichloroct;raae BRL ug/L 0.5 EPAS24.2 07/08n003 1,1-Dichloroethene BRL u6/L 0.5 7,0 EPA 5242 07108/2003 M-Dichloropropene BRL ug/L 0.5 EPA 524.2 07108/2003 1.2,3-Trichlolrcibenzene BRL ug/L OS F,PA$24.2 07109/2003 1,2,21-Trichlolrr propane BRL ur/L 0.5 EPA 524.2 07/010003 1,24-Trichlorubenzene BRL ug/L a's 70 EPA 5242 0V08/2003 1,2,4-Trimeth)(benzene BRL ug/L 0-5 EPA 524,2 07/OM003 1,2-Dibromo-3•chloropropsn BRL ug/L os EPA 524.2 071(08/2003 1,2-Dibromod'sane(ME) BRL Lig/L 0.3 EPA 524-Z 07108/2003 1,2-Dichlorobenzenc BRL op/L 0,s 600 EPA 524.2 07.'06/2003 1,2-Dichloroetl lane BRL ug/L 0-5 5.0 EPA$24.2 07,'082063 1,2-Dichloropr pane MM u8(L 0,S EPA 5242 07MB/2003 1,3.5-Trimethy lbenzene BRL ug/L 0.5 EPA 5242 0N08/2003 1,3-Dichlorobe szene BRL vgtL 05 EPA 524.2 07108/2003 1,3-Dichlorop,r)pane BRL ag/L 0-5 EPA 24.2 07109rz003 1,4-Dichlorob.e=ene BRL ug/L 0.5 5.0 EPA 5242 07l08/1003 2,2 Dichloropr 0pane BRL ug/L 0,s EPA 5242 07)D82003 2-Chlorotolimem a BRL ug/L o,s EPA 524.2 07)ODr2003 4-Chlorotolueme BRL „p!L 0.5 L•PA5a4,2 07198P2003 Superior Court House, PO.Bow 427, Barnstable, MA 02630 Ph:508-375-6605 07/14/03 MON 23:07 FAX 978 232 8975 INOTEK CORP Q 003 JUL-14-2003 1.5:28 15083627103 1SOS3627103 P.02 CERTIFICATE OF ANALYSIS Page: 2 �+ Barnstable County Health Laboratory Report Pre pared For: . Report dated: 07/14/2003 Order Number: G0321015 Jean-Paul Gosselin 48 Palmer]Rd. Wabaa, W, 02468 Laborakory_ID 4: 0321015-01 mn-,riwion: Water-Drinking Wader Sample k; P656 657 658 6S9 +ImpliB Lpeation: 74 Nyes Neck Rd Cenravllle MA Collected: 07/07/2003 Collected by; ]Coamelin RedelVed. 071072003 Benzene BRL ug/L 0.5 5.0 F-PA 524.2 M708/2003 Bromobenzene BRL ug/L 0.5 EPA 524.2 01.1/09/2003 Bromochloroniethane BRL ug(L o.s EPA124.2 07106/2003 Bromodichlon)methane BRL ug/L 015 FPA3241 07/082003 Bromoform BRL ug/L O.S EPA 524.2 07/082003 Bromomethane BRL ug/L 0,5 EPA$242 01/09/2003 Carbon tetrarJdoride BRL Uwt O.5 5.0 EPA324.2 07/09/2003 Chlorobenzeuu BRL ug4, 0.5 100 EPA$24.2 07/082003 Chloroethane BRL ug/L 0.5 EPA 524.2 07/082003 Chloroform BRL Ug& 0.5 EPA$242 07(08)2003 Chlorcmethan: BRL ug/L a.s EPA 524.2 01/0e/2003 cis-1,2-Diehlor:Pethene BRL ug/L 0.5 70 EPA 524.2 07,108h003 cis-1,3-Dichlor)propene BRL ug/L 0.5 EPA 524.2 0M312003 Dibromochloinimethane BRL uglL O.5 EPA 5242 071'082003 Dibromomettiane BRL ug/L 0.5 EPA 5242 07/08/2003 Dichlorodifluoromethane BRL ug/L 0.5 EPA 5242 07/08/2003 Ethylbenzene BRL ug/L 0.5 700 F,PA 324,z 07/082003 Hexachlorobiut idlene BRL 0g& 0.5 UFA 524.2 07/082003 Isopropylbedzt ne BRL us/L 0.5 EPA 524.2 07/382003 Methyl-tert-butyl ether BRL ag/L O.s EPA524-2 07/082003 Methylene chloride BRL ug/L 0.5 5.0 EPA 5242 07/118/2003 n-Butylbentene BRL up/L 0.5 EPA$24.2 07/08/2003 n-Propylbenzene BRL npfL 015 EPA 524.2 07/09/2003 Naphthalene BRL og/1- 0.5 LPA 524.2 07/08/2003 p-hopropyltol'u ene BRL va(L 0-5 EPA$24.2 07AIN12003 sec-Butylbenzelto BRL Ut/L 0.5 EPA 524.2 07/11812003 Styrene BRL ug/L 0.5 l u0 EPA 624.2 07/092003 Superior Court House, PO.Box 42:7, Barnstable, 1tiiA 02630 Ph:503-375-6605 I 07/14/03 MON 23:07 FAX 978 232 8975 INOTEK CORP Z 004 JUL-14-2003 15:28 15083627103 15063627103 P.03 H) CERTIFICATE OF ANALYSIS Page. 3 Barnstable County Health Laboratory Report Prepared For: Rcpore Dated: 07/14/2003 Order Number: G0321015 Jean-Paul Cosselin 48 Palmer Rd. Waban, MA. 02469 Laboratory lU#: 0321015-01 DeseripTiQnt Water-Drinldne Water Sample N: e656 657 658 659 Samwlim,Location, 74 Nyee Neck Rd Centerville MA Culfleeled- 07/07/2003 Collected by: J Cowelin Received: 01/07/2003 tert Butylbew ene BRL u&fL 0.1 BPA$24.2 01/09/2003 Tetrachlaroetllene BRL ug/L 0.5 5.0 EPA 524.2 07/02/2003 Toluene BRL 0.5 1000 EPA 524.2 07/082003 Total iyleues BRL ug/L 0.5 10000 EPA 5241 01/09/2003 trans-1,2-Dich lornethene BRL ug/L 01 100 EPA 5241 01108W03 trans-1,3-Dich loropropene BRL ug/L 0.5 EPA 5241 07108/2003 Trichloroethet,e BRL ne/L 0.5 5.0 EPA 5242 0710M003 Trichlorafluor 0methane BRL ug/l. 0.5 EPA 524.2 OVOV20113 Vinyl chloride 13ItL yam- 0.5 2.0 SPA 5242 071022003 Approved By: [Lab irector) Superior Court Rouse. PO.Box 427, Barnstable, MA 02630 Ph:S08-375-6605 TOTAL P.03 JUL-09-2003 13:33 15003627103 15003627103 P.02 r ' CERTIFICATE OF ANALYSIS page: 1 Barnstable County Health Laboratory Resort Prepared For: Report Dated: 7/9/2003 Order Number: G0320987 Jean-Paul Gosselin 48 Palmer Rd. Waban, MA 02468 Laboratory ID#: 0320987-01 PAWIRIL— Water-Drinldng'Water Sample 0: 20987 Sampline_Locafloou 74 Nyes Neck Rd.,Centerville Collected 7/2/2003 Collected by: JPG Received 7/2/2003 Routine ITEM RESULT . UNITS MCL Method# Tested LAB: IC Lab Nitrates 0.3 mg/L 10 CPA 300.0 7/7/2003 LAB: Metals Copper <0.1 mg/L 1.3 SM 3111B 7/9/2003 Iron <0.1 mg/L 0.3 SM 311113 7/9/2003 Sodium 82 mg/L 20 SM 311113 7/9/2003 L4B: Microbiology Total Coliform Absent P/A Absent 309 7/3/2003 LAB: Physical Chemistry Conductance 383 umolls/cm EPA 120.1 7/3/2003 pH 8.1 pH-units EPA 150.1 7/3/2003 Note: Sodium level is above the average. Those on low sodium diet may wlsh to contact physician. Approved By: (Lab Director) Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph:508-375-6605 TOTAL P.02 R m CERTIFICATE OF ANALYSIS Page: 1 Barnstable County Health Laboratory �rsncHu�% Report Prepared For: Report Dated: 7/9/2003 Order Numb r: Jean-Paul Gosselin 48 Palmer Rd. J U L 15 2003 Waban, MA 02468 TOWN OF BARNSTABLE Laboratory 1D#: 0320987-01 Description: Water-Drinking Water Sample#: 20987 Sampling Location: 74 Nyes Neck Rd.,Centerville Collected 7/2/2003 Collected by: JPG Received 7/2/2003 Routine ITEM RESULT UNITS MCL Method# Tested LAB: IC Lab Nitrates 0.3 mg/L 10 EPA 300.0 7/7/2003 LAB: Metals Copper <0.1 mg/L 1.3 SM 311113 7/9/2003 Iron <0.1 mg/L 0.3 SM 3111B 7/9/2003 Sodium 82 mg/L 20 SM 3111B 7/9/2003 LAB: Microbiology Total Coliform Absent P/A Absent 309 7/3/2003 LAB: Physical Chemistry Conductance 383 umohs/cm EPA 120.1 7/3/2003 pH 8.1 pH-units EPA 150.1 7/3/2003 Note: Sodium level is above the average. Those on low sodium diet may wish to contact physician. bT, Approved By: (Lab Director) 77 Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605 Page: 1 CERTIFICATE OF ANALYSIS `y Barnstable County Health Laboratory i Report Prepared For: Report Dated: 07/14/2003 "` `',• `% nI Order Number: G0321015 Jean-Paul Gosselin j ij i' 3 �� 48 Palmer Rd. ABLE Waban, MA 02468 TUv'HEALTH DEPT. Laboratory ID#: 0321015-01 Description: Water-Drinking Water Sample#: P656 657 658 659 Sampling Location: 74 Nyes Neck Rd Centerville MA Collected: 07/07/2003 Collected by: J Gosselin Received: 07/07/2003 EPA 524.2- Volatile Organics by GC/MS ITEM RESULT UNITS MDL MCL Method# Tested LAB: GUMS 1,1,1,2-Tetrachloroethane BRL ug/L 0.5 EPA 524.2 07/08/2003 1,1,1-Trichloroethane BRL ug/L 0.5 200 EPA 524.2 07/08/2003 1,1,2,2-Tetrachloroethane BRL ug/L 0.5 EPA 524.2 07/08/2003 1,1,2-Trichloroethane BRL Ug L 03 5.0 EPA 524.2 67/08/2003 1,1-Dichloroethane BRL Ug/L 0.5 EPA 524.2 07/08/i003 1,1-Dichloroethene BRL ug/L, 0.5 7.0 EPA 524.2 07/08i2003 1,1-Dichloropropene BRL ug/L 0.5 EPA 524.2 07/08/2003 1,2,3-Trichlorobenzene BRL ug/L 0.5 EPA 524.2 07/08/2003 1,293-Trichloropropane BRL ug/L 0.5 EPA 524.2 07/08/2003 1,2,4-Trichlorobenzene BRL ug/L 0.5 70 EPA 524.2 07/08/2003 1,2,4-Trimethylbenzene BRL ug/L 0.5 EPA 524.2 07/08/2003 1,2-Dibromo-3-chloropropan BRL ug/L 0.5 EPA 524.2 07/08/2003 1,2-Dibromoethane(EDB) BRL ug/L 0.5 EPA 524.2 07/08/2003 1,2-Dichlorobenzene BRL ug/L 0.5 600 EPA 524.2 07/08/2003 1,2-Dichloroethane BRL ug/L 0.5 5.0 EPA 524.2 07/08/2003 1,2-Dichloropropane BRL ug/L 0.5 EPA 524.2 07/08/2003 1,3,5-Trimethylbenzene BRL ug/L 0.5 EPA 524.2 07/08/2003 1,3-Dichlorobenzene BRL ug/L 0.5 EPA 524.2 07/08/2003 1,3-Dich1or0propane BRL ug/L, 0.5 EPA 524.2 07/08/2003 1,4-Dichl6robenzene BRL ug[L 0.5 5.0 EPA 524.2 07/08/ioo3 2,2-Dichloropropane` BRL U4;x 0.5 EPA 524.2 07/08/2003 2-Chiorotoluene BRL Ug/i 0.5 EPA 524.2 07/08/2003 4-Chlorotoluene BRL ug/L 0.5 EPA 524.2 07/08/2003 Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 p _ _ ' v pF HARK. sa. Page. 2 CERTIFICATE OF ANALYSIS 9SSA�H„5�% Barnstable County Health Laboratory Report Prepared For: Report Dated: 07/14/2003 Order Number: G0321015 Jean-Paul Gosselin 48 Palmer Rd. Waban, MA 02468 Laboratory ID#: 0321015-01 Description: Water-Drinking Water Sample#: P656 657 658 659 Sampling Location: 74 Nyes Neck Rd Centerville MA Collected: 07/07/2003 Collected by: J Gosselin Received: 07/07/2003 Benzene BRL ug/L 0.5 5.0 EPA 524.2 07/08/2003 Bromobenzene BRL ug/L 0.5 EPA 524.2 07/08/2003 Bromochloromethane BRL ug/L 0.5 EPA 524.2 07/08/2003 Bromodichloromethane BRL ug/L 0.5 EPA 524.2 07/08/2003 Bromoform BRL ug/L 0.5 EPA 524.2 07/08/2003 Bromomethane BRL ug/L 0.5 EPA 524.2 07/08/2003 Carbon tetrachloride BRL ug/L 0.5 5.0 EPA 524.2 07/08/2003 Chlorobenzene BRL ug/L 0.5 100 EPA 524.2 07/08/2003 Chloroethane BRL ug/L 0.5 EPA 524.2 07/08/2003 Chloroform BRL ug/L 0.5 EPA 524.2 07/08/2003 Chloromethane BRL ug/L 0.5 EPA 524.2 07/08/2003 cis-1,2-Dichloroethene BRL ug/L 0.5 70 EPA 524.2 07/08/2003 cis-1,3-Dichloropropene BRL ug/L 0.5 EPA 524.2 07/08/2003 Dibromochloromethane BRL ug/L 0.5 EPA 524.2 07/08/2003 Dibromomethane BRL ug/L 0.5 EPA 524.2 07/08/2003 Dichlorodifluoromethane BRL ug/L 0.5 EPA 524.2 07/08/2003 Ethylbenzene BRL ug/L 0.5 700 EPA 524.2 07/08/2003 Hexachlorobutadiene BRL ug/L 0.5 EPA 524.2 07/08/2003 Isopropylbenzene BRL ug/L 0.5 EPA 524.2 07/08/2003 Methyl-tert-butyl ether BRL ug/L 0.5 EPA 524.2 07/08/2003 Methylene chloride BRL ug/L 0.5 5.0 EPA 524.2 07/08/2003 n-Butylbenzene BRL ug/L 0.5 EPA 524.2 07/08/2003 n-Propylbenzene BRL ug/L 0.5 EPA 524.2 07/08/2003 Naphthalene BRL ug/L 0.5 EPA 524.2 07/08/2003 p-Isopropyltoluene BRL ug/L 0.5 EPA 524.2 07/08/2003 sec-Butylbenzene BRL ug/L 0.5 EPA 524.2 07/08/2003 Styrene BRL ug/L 0.5 100 EPA 524.2 07/08/2003 Superior Court House, PO. Box 427, Barnstable, MA 0200 Ph: 508-375-6605 „a o�vs ar Page: 3 CERTIFICATE OF ANALYSIS 'ss�cHusw�%'. Barnstable County Health Laboratory Report Prepared For: Report Dated: 07/14/2003 Order Number: G0321015 Jean-Paul Gosselin 48 Palmer Rd. Waban, MA 02468 Laboratory ID#: 0321015-01 Description: Water-Drinking Water Sample#: P656 657 658 659 Sampling Location: 74 Nyes Neck Rd Centerville MA Collected: 07/07/2003 Collected by: J Gosselin Received: 07/07/2003 tert-Butylbenzene BRL ug/L 0.5 EPA 524.2 07/08/2003 Tetrachloroethene BRL ug/L 0.5 5.0 EPA 524.2 07/08/2003 Toluene BRL ug/L 0.5 1000 EPA 524.2 07/08/2003 Total xylenes BRL ug/L 0.5 10000 EPA 524.2 07/08/2003 trans-1,2-Dichloroethene BRL ug/L 0.5 100 EPA 524.2 07/08/2003 trans-1,3-Dichloropropene BRL ug/L 0.5 EPA 524.2 07/08/2003 Trichloroethene BRL ug/L 0.5 5.0 EPA 524.2 07/08/2003 Trichlorofluoromethane BRL ug/L 0.5 EPA 524.2 07/08/2003 Vinyl chloride BRL ug/L 0.5 2.0 EPA 524.2 07/08/2003 Approved By: (Lab 4 irector) Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 3310 Fxs. 3................... � THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH APPROVED TOWN OF BARNSTABLE Appliratiun for Disposal Works Cnuuu Application is hereby made for a Permit to Construct ( ) or Repair (,oe4"`an Individual Sewage Disposa System at: ................_ y.. es �c/� . = ... ..._..---•--•----• .... .. -------------------•------....---......_. ocation-A Tress or Lot No. . ..... A? ._1� 1._.. '01-F. ......................................... ner //1 � Address a QC _��C.%14?'./ . r_/_f 1..._ ...........•••••••......................... •• . ...� ._c'1 Installer Address Type of BuildingfL/ Size Lot............................Sq. feet Dwelling No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ------------------------------------------------------•-------•--•----....-------------------•---•-•-•-•---••-•-•---•--•••-•--••---••--••••-•-.-•-•-- W Design Flow............................................gallons per person per day. Total daily flow--------------------------------------------gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by --- ------------------- Date. Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water----_-_-_____------_-_-- f4 Test Pit No. 2................minutes per inch Depth of.Test Pit---................. Depth to ground water........................ a •-•-•••••----•••------------•--•••-•--......-••-••-••-•-....---•.....-•••••......-•••-•••-•.._.....•......................................................... 0 Description of Soil........................................................................................................................................................................ x UW ------------------------------------------------------------------------------------------------------------------ --•------------- Nature of Repairs or Alterations—Answer when applicable_..._.___ lJ.l1 ../__ _r? /r�JO.! ................ ©,0V b � ----------------•------------------------------------------.....---------•-----------------------------•--•....•••. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of nhas been ' sued by t and of health. Signed . ............. --........X/ -.._------------------ ---_--------------------------------------- ... .......... .� Dace Application Approved By .. - - .t7Y2------- ......................................................................... n Date Application Disapproved for the following reasons- -------------....................... ...--.................. -- ------------------------------ ----------------- -------------------- - -------------------------------------------------------------------------- --------------------- ................... --------- ........... Date PermitNo. ...... ------- --------------------- Issued ......................................... -...... Date l Jam" C2 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 'r ftcb 1 TOWN OF BARNSTABLE Appliratilin for Disposal Works Tonstr6f16n,Vrrunt -ga Application is hereby made for a Permit to Construct ( ) or Repair (A-)"an Individual Sewage Disposal System at: ................Z_!Z--•�!--'---,PS- �..._.C_(�!?/ ..........----------------------------------------------------------------_-....._...._.._. /ovation s or Lot No. ------------------------------------ --------------------------------------------------------------------------------'-----.�. W nt:r Address Installer Address Type of Buildings Size Lot............................Sq. feet V Dwelling X No. of Bedrooms-__--------_..............................Expansion Attic ( ) Garbage Grinder ( ) pal Other—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) Cafeteria ( ) a' Other fixtures W Design Flow--------------------------------------------gallons per person per day. Total daily flow--------------------------------------------gallons. WSeptic Tank—Liquid-capacity------------gallons Length________________ Width----............ Diameter---------------- Depth---------------- x Disposal Trench—No..................... Width................__.. Total Length.................... Total leaching area--------------------sq. ft. 3 Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area------------------sq. ft. Z Other Distribution box ( ) Dosing tank ( ) 1-4 Percolation Test Results Performed by......................-.........................................----------- Date....0----------------------------------- a M Test Pit No. 1________________minutes per inch Depth of Test Pit-------------------- Depth to ground water.-___-_________________. 44 Test Pit No. 2----------------minutes per inch Depth of Test Pit---___.-_-.-__-•---- Depth to ground water----------.............. a' --------- •------------------- ---------------------------------------------------------- ----- ---------------------------------------------------------------- 0 Description of Soil...................................................................................--------..................-------------------------------............................ x V --------------------------------------------------------------------- a ---•------------------------------------------------------------------------------------------------------------------------------ - V Nature of Repairs or Alterations—Answer when applicable_-_______A4,9,0_J-�__/_/2 -jAeA ___ __j ----------------------------•------------------------------------------------------------..............--------------------------------------------------------------------- -= - ------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Complian has been issued by thb and of health. Signed-------------------- .................................... ------------------- -`' --�`�---- Date Application Approved By -----------( ? *� •c.t�v,,, ��% ------------------------------------------------------------------------- -_7--e--- -- �l Date Application Disapproved for the following reasons- --------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------- ---------------------------------------- PermitNo. �a'1.,,------3 =�� -------------- Issued -------------------------------------------------------------------- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH - TOWN-OF BARNSTABLE__ ._ - - -- - -- ----==- - (fErtift.rak of (gam linurP THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired byt............................. -.............................-.......-------------------------------------------------------------------------------------------------------------------- Installer �//J- at --------7----'-/ r -�'° ----/V-----A----- - �i'.�'`��I.�CJ{�---------------------------------------------------------------------------------------------------------- has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. __----..� .... dated ------------------------------------------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE-------------------------------- '=� -------------------- ----------------------- Inspector -------------N ------------•--------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No..%. 9 '. 2 TOWN OF BARNSTABLE Fes_.. .. Disposal Works Tunstrnrtiun f rrmit Permissionis hereby granted_--------- ........ ---------•----=•-•- ------------------•----------------------•--------------------------- to Construct ( ,)` or.Repairan Individu al Sewage Disposa�System 'Yl _ /(4--t) .YV •_--------------------- --------------------------------------------------------------------------•--------------at No.. l - Street as shown on the application for Disposal Works Construction Permit No. -3:�_D. Dated------------------- ------------------------------ ---------------------------------------------------- Board of Health DATE_.............7 ���= �............ -..................... FORM 3630E HOBBS&WARREN.INC..PUBLISHERS THE F T Town of Barnstable Regulatory Services BMWSTABLE, + 9 MASS. g Thomas F.Geiler,Director •iGg9 �0 39 Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 July 16, 2003 To Whom It May Concern: This letter is to state that the septic system for 74 Nyes Neck Road, Centerville is a PASS status. Canco has inspected the system which passed but fell into the category of "needs further evaluation by local approving authority" due to the fact that the well had not been tested. The well has since been tested and passes drinking water standards for bacteria and volatile organic compounds (VOC's). Thank you for your time and attention to this matter. Sincerely, e o Donna Z. Miorandi, RS Health Inspector Town of Barnstable u TOWN OF BARNSTABLE ,LOCATION 7 ✓Uy£S ev t ck Ra SEWAGE # n�f VILLAGE C —CA,T ASSESSOR'S MAP & LOT`237 s /NSPt«.e: �IC� C'�.yC G II ER'S NAME&PHONE NO. SEPTIC TANK CAPACITY .S'�.�7 i /N X, £c �- LEACHING FACILITY: (type) (size) NO. OF BEDROOMS BUILDER OR OWNER "'v T PERMIT DATE: @61.4P619&CE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet �Pnvate Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by � � l . * 3�' `Y— . , �� �' o 1%/�ON� TOWN OF BARNSTABLE LOCATION 7-// . �y =� /����� � SEWAGE # �jZ) VILLAGE C��irT.��� //c/, ASSESSOR'S MAP & LOT 22 b ll INSTALLER'S NAME 6z PHONE NO. ('Cry-t 6r=,c_1,111 SEPTIC TANK CAPACITYQ LEACHING FACILITYAtype) ��-fr`//f�°�% / (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: ' VARIANCE GRANTED: Yes No 1.o ti s` 77 W ��. G� ' ------------ O is / CAS .LVo Zjk -'� A - ; = 31 ' 3 InFiffrAtois - 3 = 37 ' N FS NFc k Rd . eAn pu Go Syr.ii h 4�� rVvaa aay.. - VILLAGE C�,�i•�T��l` ASSESSOR'S MAP Q LOT 21) b LI I INSTALLER'S NAME & PHONE NO. C 651-1 ` SEPTIC,TANK CAPACITY:. Tax 1 (size) LEACHING FACILITY:(type) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER 172_ TSB/;7 DATE PERMIT ISSUED: �7/. /�� DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No ti O �