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HomeMy WebLinkAbout0190 LITTLE RIVER ROAD - Health 190 Tittle River-Road Cotuit A 054-006-001 I� I YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you. must do by M.G.L.- it does not give you permission to operate.) You must first obtain the necessary signatures on this.form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. . DATE: i Fill in please: ' APPLICANT'S YOUR NAME �--- BUSINESS YOUR HOME ADDRESS:_ w TELEPHONE # Home Telephone Number c add ;q 4 _ NAME OF CORPORATION: NAME OF NEW BUSINESS i TYPE OF BUSINESS IS THIS A HOME OCCUPATION?. ._YES NO ADDRESS OF BUSINESS:: P MAP ARCEL NUMBER / Assessing) When starting a new business there are several things you must do in ordento be in compliance with the rules and Jtions of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200St. — (corner of Yarmouth' Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your usiness m t is town. 1. BUILDING COMI�VN NER'S OFFICE This individual h .s e n Info f ny p rmit requirem nts that pertain to this type of bus MUST MAP WITH HOME ACC� �ON Authogze Si nattire** AULF.S AND REGULATIONS. AI coMMENTs: �- F. LY MAY RESULT IN FINES. 2. BOARD OF HEALTH Thin individual s b informed gfre r�i requirements that pertain to this type of business. �""' "t' Y�TM ,ALL ..,. Authorized Signature** HAZARDOUS MATE REGULATIONS COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that,pertain to this type of business. Authorized Signature* COMMENTS: Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 190 Little River Road Property Address Paul Stewart Owner Owner's Name information is Cotuit MA 02635 May required for y 20 , 2010 every page. Cityrrown 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. ImpoWhen filling A. General Information When filling out forms on the 1 computer,use 1. Inspector: I only the tab key to move your David B. Mason cursor-do not Name of Inspector use the return key. David B. Mason Company Name tQ 4 Glacier path Company Address East Sandwich MA 02537 City/Town State Zip Code 508-833-2177 S 1287 Telephone Number License Number B. Certification 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 15340°f Title 5(310 CMR 15.000). The system: , w kFAI ® Passes ❑ Conditionally Passes ❑ Falls+ �f. ❑ Needs Further Evaluation by the Local Approving Authority May 20, 2010s-c, nspector's Si,614are 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. LvY � U t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disp al System-Page 1 of 17 . Commonwealth of Massachusetts w Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 190 Little River Road Property Address Paul Stewart Owner Owner's Name information is Cotuit MA 02635 May 20 2010 required for Y 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 I l_ I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M s 190 Little River Road Property Address Paul Stewart Owner Owner's Name information is Cotuit MA 02635 May required for y 20 , 2010 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 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•09/08 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 190 Little River Road Property Address Paul Stewart Owner Owner's Name information is Cotuit MA 02635 May 20 , 2010 required for Y every 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 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 Yz day flow t5ins•09/08 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 °M 190 Little River Road Property Address Paul Stewart Owner Owner's Name information is Cotuit MA 02635 May 20 , 2010 required for Y every page. Cityrrown 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- 1 0,000g pd. ❑ ❑ 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 El ❑ 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 190 Little River Road Property Address Paul Stewart Owner Owner's Name information is Cotuit MA 02635 May required for Y 20 , 2010 every page. CityrFown 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 CM 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins-09/08 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 �M 190 Little River Road Property Address Paul Stewart Owner Owner's Name information is Cotuit MA 02635 May 20 , 2010 required for Y every page. City/Town State Zip Code Date of Inspection D. System Information Description: System passes based on the information observed on May 20, 2010 at 2 PM.This does not guarentee the continued operation of the system. Increase in occupancy may result in hydraulic failure. Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage yes 9 ( Y 9 (gpd))� Detail 2008- 75,000 gallons and 2009 111,000 gallons Sump pump? ❑ Yes ® No Last date of occupancy: current 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 190 Little River Road Property Address Paul Stewart Owner Owner's Name information is required for Cotuit MA 02635 May 20 , 2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: 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•09/08 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 �^M 190 Little River Road Property Address Paul Stewart Owner Owner's Name information is Y required for Cotuit MA 02635 May 20 2010 every 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: Compliance issued April 14, 2010 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 24 feet Material of construction: ❑ cast iron Z 40 PVC ❑ other(explain): Distance from private water supply well or suction line: Not Applicable feet Comments (on condition of joints, venting, evidence of leakage, etc.): Appears in working order Septic Tank(locate on site plan): Depth below grade: 24 feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) 1000 gallon tank If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 - Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M s 190 Little River Road Property Address Paul Stewart Owner Owner's Name information is Cotuit MA 02635 May 20 , 2010 required for Y every 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 32 Scum thickness 2 Distance from top of scum to top of outlet tee or baffle 3 Distance from bottom of scum to bottom of outlet tee or baffle 12 How were dimensions determined? Scour Stick Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank appears structurally sound. Effluent level with outlet tee. 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-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 190 Little River Road Property Address Paul Stewart Owner Owner's Name information is Cotuit MA 02635 May 20 , 2010 required for Y 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 190 Little River Road Property Address Paul Stewart Owner Owner's Name information is Cotuit MA 02635 May 20 2010 required for Y every 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 Level with outlet inverts 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.): No evidence of solids carryover. 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.): Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 I` f Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 190 Little River Road Property Address Paul Stewart Owner Owner's Name information is Cotuit MA 02635 May 20 2010- required for Y every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: G ❑ leaching pits number: ® leaching chambers number: 2 ❑ leaching galleries number: ❑ leaching trenches number, length: -r ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system A Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): 2-500 gallons chambers with 4 feet of stone around. t , Cesspools (cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration j 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 I r Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments c�M 190 Little River Road Property Address Paul Stewart Owner Owner's Name information is Y required for Cotuit MA 02635 May 20 , 2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): i t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 190 Little River Road Property Address Paul Stewart Owner Owner's Name information is Y required for Cotuit MA 02635 May 20 2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 i - Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 190 Little River Road Property Address Paul Stewart Owner Owner's Name information is Cotuit MA 02635 May 20 2010 required for Y every page. City/Town State Zippode Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: 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: March 2005Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: Engineered plan on file ❑ Checked with local excavators, installers -(attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: Used engineered plan on file based on test hole data. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts W. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 190 Little River Road Property Address Paul Stewart Owner Owner's Name information is Cotuit MA 02635 May 20 , 2010 required for Y 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 a t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 l LOCATION TOWN OF BARNSTABLE �9c �j�• CC:gyp/li�,,e� �Pe VILLAGE C c?'vj,�-- SEWAGE# �STALL.IrR'S N ASSESSOR'S MAp&LOT NAME&PHONE NO._i ! ! UUS o SEPTIC TANK CAPAC 7 75 0> IT'Y ,,y CC�Y�,FTi�c is o o I LEACHING FACILITY: (type) No.OF BEDROOMS —S (size)' / X-Z!X BUILDER OR OWNER PERMnDATE: -/3�'' COMPLIANCE DATE:Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facifit Aivate Water Supply Well and Leach Facili y _Feet on site or within 200 feet of leaching facility) (If any wells exist Edge of Weiland and Leaching Facility(If any wetlands exist � � Feet Within 300 feet of leaching facility) Furnished by �M Feet t' UUU O A .�s i F � No. ` - Fee V D THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS application for Migogaf *pgtem ctCongtruction Vermtt Application for a Permit to Construct( )Repair( Upgrade Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. /p Owner's Name,Address and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,yAddress and Tel.No. p� 7 1L � 70,7 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other 'Ilype of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank t, q&9110ol Type of S.A.S. "' a. 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 Certifi- cate of Compliance has been issued by4fis Board of Health. Signed Date �``�'��� Application Approved by Date Application Disapproved for the following reasons Permit No. caU 0 —l Ll 'P Date Issued ) U •�;-ram,., 'No: (J�J / r "a1 *4 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: _�L-" Yes PUBLIC HEALTH DIVISION -TOWN OF,BARNSTABLE, MASSACHUSETTS "f 2pprication for Ziooal *pgtem Construction Permit Application for a Permit to Construct( . )Repair( Upgrade(�)Abandon( ) . ❑Complete System ❑Individual Components Location Address or Lot No. /�� ��� GCjQ/!/�"� /{'� Owner's Name,Address and Tel.No. �y / Assessor's Map/Parcel 0 O O p O Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. ;7 7 �-' "n ice) Type of Building: Dwelling No.of Bedrooms Lot Size sq.-ft. Garbage Grinder( ) Other Type of Building � ' No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design.Flow y� gallons per day. Calculated daily flow `� gallons. Plan Date 9 �. c f Number of sheets Revision Date Title Size of Septic Tank k�A r U v o ' �rv� Type of S.A.S. Description of Soil / 1 Nature of Repairs or Alterations(Answer when applicable) Date last inspected:- , Agreement: / The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued is Board of Health. �jt.,J�—O s► Signed Date Application Approved by Date 44 1 Application Disapproved for the following reasons Permit No. r �CJ �> Z 1 (p Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance v THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( ) Repaired ( )Upgraded( ) Abandoned( )by 0_o'1--11 L dc��c�yf at li�j`Zc� �c�o2 d G has been constructed 'n accordance with the provisi ns of t 5 and a for Disposal System Construction Permit No.c0 ��5 D dated y13 )oP V Designer4� The issuance of this pe rutt-shall not be construed as a guarantee that the s fpe�m,411 functihn as designed a-f--f . Date "� Inspector ' •' ' V THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE} MASSACHUSETTS ligoaf *pg;tem Construction Permit Permission is hereby granted to Construct( )Repair( )Upgrade( )Abandon( ) System located at 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: Cons"ction m st be completed within three years of the da e of this ' Date: L r � Approved by r"`� TOWN OF BARNSTABLE SE LOCATION G/Tl`C"�'/�c�9t' �d WAGE # ®®� VILLAGE ��'��` ASSESSOR'S MAP & LOT —odS do INSTALLER'S NAME&PHONE NO. 07' .-V7 &� �oC`� SEPTIC TANK CAPACITY I. e LEACHING FACILITY: (type) • 'OG`'�fi (size) / X j � NO. OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distanpe Between the: i 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) 1 Feet Furnishe&,by ,l Town of Barnstable Regulatory Services P Thomas F.Geiler,Director 1 Public Heaft Division► •� Thomas McKean;Direeor '00 Main Street,Hyannis,Mai 02601 Fax: 508-790-6304 Office: 508-862-4644 installer&Desi ner Certification Form Date: ­P4 Designer: ` Installer: Address: Address: ► � o � was issued a permit to.install a On ( e) -- (installer} based on-a-design dr-awn-by septic system at v IA90W -ZS dated (designer) the septic system referenced above was installedlsubstantially accordin the to I certify that eP roved changes such as lateral relocation of the dessgn,which may include minor approved distribution box and/or septic tank. em referenced above was installed with major changes (i.e. I certifgreaWy that the septic. ep cyst ;ation of than 10, lateral relocation of the SAS or any vertical rel Iations. Plan revision or of the septic system)but in accordance with State&Local Reg.-_ :•_ certified as-buih by designer to follow. d � tl p J J' er Signawm) y ti � ) (Designer s Si e) (Affix esigner's Stamp Here) PLEASE RETURN TO BARNS BE ISSUED U1�PI'IL BOTH TffiS FORM OF COLiANCE W�L g�,T CARD ARE RECEIVED BY TM BARNSTABLE PIIBLIC HEALTH DIVISION. _ THANK YOU.. - Q:Healwseptic/Designer Certification Form THE COMMONWEALTH OF MASSACHUSETTS /F Rim Bic ....... BOAR® OF HEALTH Q-W.0..........oF.........E.A( .T.A:84c;........................................... Appliration for Disp oul Works Towitrnnrtion ratnit Application is hereby made for a Permit to Construct ( � or Repair ( ) an Individual Sewage Disposal System at .........� � �.....�.� .r. ..1` v Iffl-- - — '...._. .................................. Location-A�ddress or Lot No. - -------•--- wner Address 1 I ------- -------- Address•--------------------------------------- a ,J nstaller Q Type of Building Size Lot...�--3._=([/y .. ..Sgr€eet U Dwelling—No. of Bedrooms................... -- -____Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building ................ No. of persons............................ Showers — Cafeteria a' Other fixtures --------------------------------- W Design Flow....................5�__.yy'.._.___._gallons per person per day. Total daily flow........................... .....gallons. WSeptic Tank—Liquid capacity l_Q gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No. .................... Width.................... Total Length......._._____ Total leaching area___.__ ..._.......sq. ft. Seepage Pit No.___----_-0--____-- Diameter............ Depth below inlet........ Total leaching area... L>Esq. ft. Z Other Distribution box (Vs Dosing tank ( ) `~ �-- __.__/ ____________________ Date....... .: ." ....... Percolation Test Results Performed by-_ aTest Pit No.'l....�.....minutes per inch Depth of Test it--------LQ..... Depth to ground water-----____!`___.__...._. Test Pit No. 2..... .:__._minutes per inch Depth of Test Pit ........//...... __... Depth to ground water------ ............ x .....--•---•----•---------------------------l Descriptionof Soil------............................. j---.:) 0 ',.W.-• -----•-- -- ------------------•--••--------------•-----•---•......•..........--- N --------••---------- --------------------------------•••---...----•-••---•--•----•-•-•--- W �',AAI� ---------------------------------------- -=�� / --------------------------------...---- UNature of Repairs or Alterations—Answer when applicable-----------------------------•-.-------.--_-__-----•--_------_-------_-_--•.-_------_----_----. -----------------------------------------------------------------------------•--------•--••-•----------......------------------------------------...------....---------------••-••----•............---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Complia ce has be�e��n issued by the board of health. Signed _� -----i,.,---, A" a Application Approved By ----------- ....--�1... .. -------------------------------------------------- Application Disapproved for the following reasons: .......... ........... .................................. . ... -----......_....---............ -- ------------------ ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------- Permit No. -------7-A._no._. .7� ... ............................ Issued ......................................................... ......... Date f No......................... Fxs............................_ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Tiowt.,).------...oF....... tWiT_ ."................................••----- Appliratiun for Disposal Works Toustrurtiun prrmff Application is hereby made for a Permit to Construct ( � or Repair ( ) an Individual Sewage Disposal System at: ................---......-..... ................................................. 6Location Address or Lot No. ......................».......................................................................... .......••••-•••.......----------------•---------•-•-..........---•------.......................... Owner Address W Installer Address QType of Building Size Lot.._ __ -=(-__ ..Sct—fit v Dwelling—No. of Bedrooms................. .....................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria a Other fixtures ................................... d --------•---------..----••--•-•---••---•--••••••••-••---------•...................•--•-•-•••. W Design Flow..•....•....._._...__T5...._.......gallons per person per day. Total daily flow........................... Q......gallons. WSeptic Tank—Liquid capacity,CPW.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.__-�C _.sq. ft. .Z Other Distribution box (L_� Dosing tank ( ) Percolation Test Results Performed by._�2'l I�r __ "�Yi �-___- !�G.................... Date_._....�....�.�r�.Z^......... Test Pit No.'L... ��'....mmutes per inch Depth of Test...__...1 v_,__.. Depth to ground water...._--''........... fs, Test Pit No. 2........Zr......minutes per inch Depth of Test Pit......../....... Depth to ground water....... .:............ •----------------- --- --—-------- ----------- ----------------- --------- ----------------------------------------------------------- Description of Soil............................ .`"/..... �' (, `5+/! ' r A/+iQ._......,...•....-•---..,...--•----•-•---•-------------•-•--...-•-------•-----••-------•--- x --••-•-•-•-••------------------••-••-------•----•-----••---•�--=-11-••---AA� ----.-AAID---- U Nature of Repairs or Alterations—Answer when applicable................................................................................................ --------•--------------------------------------------------•---•-----------•--•••---•-•-••-•-.------•-•--•--••-•-••--------••-•-----••-••-----•••-•-----••-•-•----••-•-•••.......----••••--............. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed ----------------------------------------------------------------------------------------------------------- ------------------------------------ Date ApplicationApproved By ---------------------------------------------------------------------------------------------------------------------- -------------- ----.....------- -Date------------------- Application Disapproved for the following reasons: ...................................... ... ..... ........................................................ --...-- --- ......-----.............................................I..................................................................................................----............................-----........-. ---------------- ----------------- Dace PermitNo. ................................................................... Issued .-------....----'------..-....----------.....------..------- Dace THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH --------------------I!)GtJ/v------- OF ........ --- --.................................. Cex#tft-ra e of (111oxttplianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( or Repaired ( ) by -------------------------- ------- ----- ------------------------------- Installer at . C &........�17.6 .....-1�A:+.-+s----- ..�.......���----...... 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. ....7.1 --- s;�77.......... dated ------------------------------------------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE............. .. . .......................................... .... .. .................. Inspector ----........----------........--................................................................. THE COMMONWEALTH OF MASSACHUSETTS T_.., BOARD OF HEALTH .......1.�11�� ...OF....._....AST"F1.�3' i No... .... __[ FEE....Lo.z......... Disposal Works Tunutr ion rrmi# Permission ishereby granted............L`�'=t..., ...... . ..................---•--..._..--•................................................... to Construct ( ) or Repair ( ) an Individual S,,a a Disposal System at No................. _¢ ....(�. l -sr.-i_.... .. 19 Street qq--- as shown on the application for Disposal Works Construction Permit No._r�-.,��_�_ Dated.......................................... t �.::)...................................................... _ DATE.---...-•.................•-------••-•------•--.........................._..... Board of Health FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS Pr 1JESIG�1. y.AT _-- =' ,Sl�161 FMMIL`( .3ECi?rx�ltit� �llc_ _ I o�'L ; 1 'P?A � SEPI'l C" TAB V- 33b p 4 01•e t'AG!! EL AL FIT r 51.DcWt�CL. _.AW,6A = [56 _5F LOT'- G Lrmt& Tt T . L 6fZ FEV-40C.AT1ot�t..__QA(E Psi', 3 i 33' - TES r.12.`18 40LE- 12e m l i /'6-. 3�• T _Four- Pv.c. I s` D�sj �r GQL ric 7ceo , _ LIFALW _ '.. .MAD.... . WA496p I .SAIJ�. sTo�lE 44 .CEo-i IT7-I ID R-or Fa N PL.A N RF�.IcJE,.r,I• , C eV-T I FY ,T�kr T-, - i 10W N NE2Eah.l a �A�tR" 15: �acQT wltlti�l � LDOD �t0AIQ , � xT � �• NyE {� Suev �/r> S .FLAQ IS NOT ?/1/� Svt?vcY .. Ai�v 7NE OFFSET 440uLD u yr o E�JG!N CE�GS _b ESTQIN—IS(-� Ptza�Elz.T y La+�L S 5(Erzv t tit A,4 -- ; . dPPL I CA N 7, . PuL FA U r { oT = , VAGQ►Jr t 3 q �,I rAl*Z'W i • �` � � �uTUl2� 433.3 BAT2il , i ?s.z ..�'co L i 30 t � DWEI,C•, 1•6 1 TANtI �� w �Y 132•�' ,I ��/ 3222:3"- r ..,, 31 cmr � P�r�� � SULLIVAN ' t 1 Q. o. ♦' C R Cr u'., -a O.�XlSnrsG t ,b(l Cel(,nh TO r i c t a 1 i k 1 1 f ` +ASSESSORS MAP N0: . No.-- ----�-(� PARCEL NO: Fee—�� --- BOARD OF HEALTH- TOWN OF BARNSTABLE ���ricatiort,�or�eYr �Cor��tructiot��ermit Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair ( , n individual Well at: Location — Address Assessors Map and Parcel Owner Address / Installer — Driller Address Type of Building ® Dwelling---4 '-�1--- - Other - Type of Building--_____—__________ No..of Persons-----------___�________—_____ Type of Well--_ Capacity Purpose of Well --- -- -- - ----------------- Agreement: The undersigned agrees to insiall 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 a Certificate ofCompliance has been issued by the Board of Health. " Signed -- date Application Approved By-- -- date Application Disapproved for the following reasons: ------ — --.------ --- -----_--_ _----__--------- date - --- Permit No. ---"'"--Ld-=' ----- Issued - - ----- — date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate ®f Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( ) ns I— "-Il- — er --------- --------------—— —--—-- __ —--_-- — n has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. Dated------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. I ` DATE---- -_ —--—----- -=--- ---- Inspector �_ i • _wa!_ f.. w hyr�ro} No.--�_�,_/_�__�---- �� •-. � Fee- BOARD OF HEALTH TOWN OF BARNSTABLE ZippYitat ion for lVell Cootructionpermit Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair ( )an in idual Well at: 1 ------------- Location — Address Assessors Map and Parcel 1. ------------! �_s 1A �/ - - -� D �, �_�� ��.i ��' �,c" v �----------------------- ------ Owner Address Installer — Driller Addressr — ! �• Type of Building_____ Dwelling Other - Type of Building ---------- No. of Persons---------------------------------•-- '� ------ Capacity Type of Well-----r------>---� -�--�� -A--------------- ---------------------------------------------------------------- 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 a Certificate of Compliance has been issued by the Board of Health. Signed;Eyj c "— � /—� r�v,: date A lication Approved B -- - - �J �--------------------- date Application Disapproved for the following reasons:---------------------------------------------------------------------------- - ----- ----------------------------- ---- date -_ � Permit No.-----------------.- -;--Zg---------------------------- Issued------�------------------------------------------ ----------------- date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliance x THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or�Repaired ( ) 1 b - ' ----------------------------------Y-—---- - - ------ --- In4311er at^ - --------- ----- has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. -- �?=-��----Dated------------------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. - —W) rN ------------------------------—----— DATE -'- = -- --';i = '' -` Inspector - BOARD OF HEALTH TOWN OF BARNSTABLE Yell Construction jermit No. -A1_17 --=-1 ='- Fee-- Permission is hereby grantedu_A----------- r.=,_ J,_=, ---------- --- - ---- J to Construct ( L,,),Al er ( ), or Repair ( ) an Individual Well at: No. `r t7-P,. t1 b-Q /'',P, Street as shown on the application for a Well Construction Permit r^ No.------------------------------------------------------------------------------------ Dated-- - r (Board of Health DATE - —` =-5,- e ° ' - I a ; Z, L_ 3 $E JVt i Sty L ;. 4 l,AZBAt;G .6WOI 'Ev- RA SEMC: - ANV . -?3o x1 P 56 41G6I /�^ U7G It�00 GAA I 7 �j GG I `r�Si, lai RAGl4 I�UG C�t�i- DIS�oSQL PtT I��GA� �I 57vV . :51DcW41 APeAl Lv7 • =; ; :-BOTTOM AazA . - 5.5F 6ry IT' i T.�� T?E2ca4 ATtot-4:_._BATE. \t PETER SULLIVANr .a 1 r � F T 3 7J I [C�17 — . 7i177r777�. TJ I` Fapr=sr Joao . i i -sa,uD DIST N/ 6AL.1 ,7 TA N �Z 3 I , t 'NO L: W,d4 PS-?77 I C> I�FIP PST' �/�N tom--- • I,(p 'i°'EL=2/•5+ ! �G�,!{ �'-«mac DATC; 2-- r ___ _- ? _� •Pi20��C1 . ::1�. PLAN 2El=E.IZF CC" _ NE2ED MMPL 6 y ITA. .` lAE 5lvF=LjQ E I2Eh I -.:`fbW OF`-3AOtJ5T-AR Le, / iAitD i 15 :... !~o :`N►t:'itJ 1�1� oD �'l Alt,! , PcA �o¢ C�c02ZIA PAS. k7t' Y I —a--d--- �d 'r -� � N�{ NC 1 IS={ FYAQ.:.� IS NOT" .-{3AED DI.( /aN .l�S'TI?DktEC z�.✓It_ E�JGINl=EtG$ - 6urZVey- . AND THE PFF5e1"S �I�tiul� uvr 23� 05�rzvtu G MA� . c-�TQ�:isl� .`Po�E�TyU�ic5 APPLIcAW7 PAuC.. n l OT Lor u Q C-a Nr 1 3 q AcrzEs d z07, JV1-3 r4 Z oW BAU 13•e 21 } ?3 7, PRo� j /5 30 t DWG, ``f o. .�� r 31. 7 Af TER L AN 733 J , Sri r Yr:vr�11� �f f • 1 / - ;,,�\'V ° ' rr ! :i Y .. SEP1"tC aFi_t t +• r r i i -- �onesQA t �ia o 02 rA e_s �� weR cxitbu- � n "'6ARNSTABLE COUNTY HEALTH AND ENVIRONMENTAL DEPARTMENT LABORKTORY` REPORT VOLATILE ORGANIC CHEMICAL ANALYTICAL RESULTS Client. : f?AUL STEWART , Collection Date: 05/27/92 Mailing Address : 140 LITTLE RIVER ROAD - Date of Analysis : 05/29/92 COTUIT MA 02635. Type o,f Supply: WELL Well Depth (FT) : Not Given Telephone : 888-5458 Sample Location : LITTLE RIVER ROAD LSAT. (DDMMSS) : Not Given BARNSTABLE LONG. (DDMMSS) : Not Given Col-l-ector C STTEFEL - Map/Parcel : Affiliation : BCHD Analytical Method : 502 . 1=1 , 502 . 2=2 , 503 . 1=3 , 504=4 , 524 . 1=5 , 524 . 2=6 , f� 502 . 1/503=7 Contaminants Anal . Result MCL Detection Detected Meth . ug/l ug/1 Limits (ug/1) ---------- �'Lloroform 2 73 . 0 C . 5 10 Only those. c:oml:,c:>unds listed above, were detected . Attached is a list of compounds for wli.i c li , i hi.s sample was analyzed . NOTE: Contaminant levels equal to or exceeding the Detection Limits reported . MCI, means . Maximum Contaminant Level for EPA-regulated compounds . (ug/l = micrograms per liter = Parts Per Billion) The Environmental. Protection Agency has 'set Maximum Contaminant Levels (MCL) for the following compounds . This sample compares as follows : COMPOUND MCL (in PPB) Benzene 5 . 0 * level not exceeded * Carbon Tetrachloride 5 . 0 * level not exceeded * 1 , 2-Dichloroethant, 5 . 0 * level .not exceeded * 1 , 1-Di.chl.oroethen 7 . 0 * level not exceeded * 1 , 4-Dichlorobenzene 75 * level not exceeded * 1 , 1 , 1-Trichloroethane 200 * level not .exceeded * Trichloroethene 5 . 0 * level not exceeded Vinyl Chloride 2 . 0 * level not exceeded Comments or additional compounds found: LOT, 6 + Bernar E. Bar els , Ph .D . Laboratory Director Log Number: Bottle # V99 Date: June 1, 1992 sa BARNSTABLE COUNTY HEALTH AND ENVIRONMENTAL DEPARTMENT SUPERIOR COURT HOUSE p BARNSTABLE,MASSACHUSETTS 02630 J Y p ArA55 DRINKING WATER LABORATORY ANALYSIS PHONE:362-2511 '-Ext. 337 Client: Paul Stewart Collector: C .Stiefel Mailing Address: 140 Little River Road Affiliation: BCHD Cotuit MA 02635 Time & Date of Collection: 5/27/92 1:45 p.m. Telephone: 888-5458 Type of Supply: well Sample Location: o _ 6 Little Riv rRd Well Depth: Cotuit, MA Date of Analysis: 5/27/92 3:40 p.m. PARAMETER SAMPLE RESULT RECOMMENDED LIMITS Total Coliform Bacteria/100 ml 0 0 H 5.8 Conductivity (micromhos/cm) 73 500.0 Iron ( m) 8.0 0.3 Nitrate-Nitro en ( m) <.1 10.0 Sodium` (ppmj 10 , 20.0 Copper (ppm) <.1 1.3 I . Water sample meets the recommended limits for drinking of all above tested parameters. II . XX Based only on results of the parameters tested for this sample, the water is suitable for drinking but may present the problems checked below: ' A. Water sample has higher than average'levels of Nitrate. Future monitoring is recommended (2-3 times per year) to establish any upward trends. B. The low pH of the water may shorten the useful life of the house's 'plumbing" . C. X Water may present aesthetic problems (taste, odor, staining) due 'to ' iron D. Water sample has high levels of sodium: Persons on low sodium diets should consult their doctor. III. Due to one or more of the reasons checked below, this water _sample exceeds the recommended maximum contamination level for drinking water: ` A. High Bacteria B. High Nitrates REMARKS: The Barnstable County Health and Environmental Depar'.ment shall not endorse any statements, 4} interpretatio s or conclu 'ons made by anyone else.conc emg f . se r �s w,;. o ' ritten consent. CC: Barnstable Board of Health CC: 1 /7/8! � a-borator Director Explanation of Test Results Total Coliform Bacteria Coliform bacteria are an indicator of the sanitary'quality of a water supply. Water supplies may become' contaminated from malfunctioning septic systems. cesspools and surface runoff. A total coliform count of, zero indicates that your water supply is safe and approved for human consumption.A total coliform count of greater thar zero is most often the result of accidental contamination of the sample bottle through improper sampling methods. For this reason. it would be advisable t:: retest are% wcli water than is not approved: pH pH is the measure of acidity oralkalinit.of the.water. On the:pH scale. the number 7 is neutral• less than 7 is acidic and more than 7 is alkaline. The pH of water on Cape Coil tends to be acidic in the range of 5.0 to 6.5. Conductivitv Conductivity is a measure of the dissolved salts in salution. Amounts in excess of 500 micromhos/cm are generally considered unacceptable and may have a laxative effect upon users. Iron The presence of iron in water in concentration of .3 ppsn or greater may: give the water a bittersweet astringent taste, cause an unpleasant odor. often gives the water a brownish color and cause staining of laundry and porcelain. The average concentration of iron in Cape Cod's water is .2 - .6 pnm. Although the presence of iron in water may cause the problems listed above, it is not considered, deleterious to health. Iron may be removed by use of an iron removal system. Nitrate-nitrogen , The Massachusetts Drinking Water Regulations hnvc sct a nnaximurn contaminant level for nitrates at 10 pprn. Excessive concentrations may cause methemoglobinemia fan infant disease) and have been suggested to form potentially carcinogenic nitrosamines. Contamination soirees include fertilizers—cesspools and industrial wastes. t Copper Due to the acidic nature of the water on Cape=Cod. copper tends to leach from pipes. This normally does not present a health hazard; however.`concentrations in excess of 1.0-ppm' may cause a metallic taste and/or a bluish-green stain on porcelain fixtures. Sodium A concentration of sodium over 20 pnm is oni%r of c,mcern ro people who are on a.loxv sodium diet. If the water supply has more than 20 ppm sodium, it is up to the people who are on such a diet to find another source of drinking water or contact their doctor to determine if consuming the water is advisable. Concentrations exceeding 50 ppm ind`..:ate that there may be ocean water or road salt runoff water getting into the well. f.pf 6qR RECEIPT N° 21099 E vironme tal Heal h Services From: For:(specify service) Amount: Signed: Date: 61� c5: BARNSTABLE COUNTY HEALTH AND ENVIRONMENTAL DEPARTMENT Telephone Superior Court House 362.2511 Barnstable,Mass.02630 Ext.337 BARN� TABLE COUNTY� HEALTH AND ENVIRONMENTAL DEPARTMENT LABORATORY REPORT VOLATILE ORGANIC CHEMICAL ANALYTICAL RESULTS Client: PAUL STEWART Collection Date: 05/27/92 Mailing Address:140 LITTLE RIVER ROAD Date of Analysis : 05/29/92 COTUIT MA 02635 Type of Supply: WELL Well Depth (FT) : Not Given Telephone: 888-5458 Sample Location: LITTLE RIVER ROAD LAT. (DDMMSS) : Not Given BARNSTABLE LONG. (DDMMSS) : Not Given Collector: C STIEFEL Map/Parcel : Affiliation: BCHD Analytical Method: 502 . 1=1 , 502 .2=2 , 503 . 1=3 , 504=4 , 524 . 1=5 , 524 . 2=6 , 502 . 1/503=7 --------------------------------------------------------------------- --------------------------------------------------------------------- Contaminants Anal . Result MCL Detection Detected Meth. ug/l ug/1 Limits (ug/1) --------------------------------------------------------------------- Chloroform 2 73. 0 0 . 5 Only those compounds listed above were detected. Attached is a list of compounds for which this sample was analyzed. NOTE: Contaminant levels equal to or exceeding the Detection Limits are reported. MCL means Maximum Contaminant Level for EPA-regulated compounds . (ug/1 = micrograms per liter = Parts Per Billion) The Environmental Protection Agency has set Maximum Contaminant Levels (MCL) for the following compounds . This sample compares as follows : COMPOUND MCL (in PPB) Benzene 5. 0 * level not exceeded * Carbon Tetrachloride 5 .0 * level not exceeded * 1 , 2-Dichloroethane 5. 0 * level not exceeded * 1 , 1-Dichloroethene 7 .0 * level not exceeded * 1 , 4-Dichlorobenzene 75 * level not exceeded * 1 , 1 , 1-Trichloroethane 200 * level not exceeded * Trichloroethene 5.0 * level not exceeded * Vinyl Chloride 2 .0 * level not exceeded * Comments or additional compounds found: LOT 6 + ` ti Bernar E. Bar els , Ph.D. Laboratory Director F, :�.c TOWN OF BARNSTABLE LOCATION SEWAGE # �01 _y) l� VILLAGE ('I(7� ASSESSOR'S MAP & LOT 05 Y DO�.Wl INSTALLER'S NAME & PHONE NO. �b,U )CC/`f-U YixLl ice? / SEPTIC TANK CAPACITY LEACHING FACILITY:(type) P7 e r NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER LuP� BUILDER OR OWNERS DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: 16 VARIANCE GRANTED: Yes No / JY 6 Dlq � 13 pc } L TOWN OF BARNSTABLE LOCATION �I `C" /l�c�.l�' 'fib SEWAGE VILLAGE T��� ASSESSOR'S MAP & LOT —�tlS dca INSTALLER'S NAME&PHONE NO. G "��G��� ; 5-o.),e0, SEPTIC TANK CAPACITY LEACHING FACILITY: (type) � (size) NO. OF BEDROOMS BUILDER OR OWNER PERMITDATE: 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 j within 300 feet of leaching facility) Feet Furnished by "Z - — � � .. � � �� . � �.� �� �� ` � �' �� �� � F � C ���� � � �� � � � r, � � �' � �� � � � �� �. IS Air its BARNSIA©LE COUNTY HEALTH AND ENVIRONMENTAL DEPARTMENT SUPERIOR COURTHOUSE ] r BARNSTABLE MASSACHUSETTS 026 0 O M � 3 J = TABLE 1 . Compounds Detectable b EPA Method 502.1* p y PHONE: 362-2511 EXT. 330 LAB 337 COMPOUND D.L . COMPOUND D.L. CLINIC 340 Benzene 0.5 1 ,1-Dichloroethane 0.5 Carbontetrachloride 0.5 1 ,1-Dichloropropene 0.5 IE 1 ,1-Dichloroethylene 0.5 1 ,3-Dichloropropene 0.5 1 ,2-Dichloroethane 0.5 1 ,2-Dichloropropane. 0.5 para Dichlorobenzene 0.5 1 ,3-Dich1oropropane 0.5 Trichloroe.thylene 0.5 2,2-Dichloropropane 0.5 1 ,1 ,1-Trichloroethane 0.5 Ethylbenzene 0.5 Vinyl Chloride 0.5 Styrene 0.5 Bromobenzene 0.5 112-T 1 rich oroethane 0.5 Bromodichloromethane 0.5 1 ,1 ,1 ,2-Tetrachloroethane 0.5 Bromoform 0.5 .1 ,1 ;2,2-Tetrachloroethane. 0.5 Bromomethane 0.5 Tetrachloroethylene 0.5 Chlorobenzene 0.5 1 ,2,3-Trichloropropane 0.5 Chlorodibromomethane 0.5 Toluene 0.5 Chloroethane 0.5 para Xylene 0.5 Chloroform 0.5 ortho Xylene 0.5 Chloromethane 0.5 meta Xylene 0.5 ortho Chlorotoluene 0.5 Bromochloromethane 0.5 para Chlorotoluene 0.5 . Dichlorodifluoromethane 0.5 Dibromomethane 0.5 Fluorotrichloromethane 0.5 meta Dichlorobenzene 0.5 Hexachlorobutadiene 0.5 ortho Dichlorobenzene 0.5 Isopropylbenzene 0.5 trans-1 ,� Dichloroethylene . 0.5 n-Propylbenzene 0.5 cis-1 ,2 Dichloroethylene 0.5 Sec-butylbenzene 0.5 Dichloromethane 0.5 Tert-butylbenzene 0.5 D.L. is Detection Limit in micrograms per liter .or parts per billion (ppb) . This table lists our. normal limits of detection. If we report, a smaller amount, then our detection limit .was lower for that analysis. *A photoionization detector is used in series with the .electroconductivity detector, thus allowing for the analysis of most of the compounds listed in EPA Method 503.1 as well . TABLE 2. Compounds which have, Maximum Contaminant Levels (MCLs) . set by the Environmental . Protection Agency. COMPOUND MCL (in ppb) Benzene 5.0 Carbontetrachloride 5.0 1 ,2-Dichloroethane 5.0 1 ,1-Dichloroethylene 7.0 para Dichlorobenzene. 75 .1 ,1 ,1-Trichloroethane. 200 Trichloroethylene 5.0 V.i.nyl Chl. ride 2.0 Total Trihaolomethanes 100 Chloroform, 9romodichloromethane, Chlorodibromomethane, and . Bromoform comprise I the. total trihalomethanes. G,La ASSESSORS MAP: '�cS �6 oy/ ------ TEST HOLE LOGS PARCEL: _ NOTES: � i a FLOOD ZONE: 1a �??7-�..aL/C-xl�� SO I L EVALUATOR -✓ wip AY-4 , ► _ — ac WITNESS : N.07 A? . ✓ REFERENCE: �2)Eicc> anc-p>t=f 20/ R cs�� DATE: �-V�4 _ � 1 1) The installation shall comply with Title V and Town of Barnstable Board of f'�i4•../ Q� ,"� '� ', �- �f PERCOLAT ON RA`"E • - �Ji 1 t Health Regulations. i /y ff 2) The installer shall verify the location of utilities, sewer inverts and septic n �F �1�-✓G _ O,c �, VV , P ' � components prior to installation. �C:��� TH- I TH- I , -- 3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8"per foot. I 4) This plan is not to be utilized for property line determination nor any other /Z q �i to I � purpose other than the proposed system installation. _ 5) All septic components must meet Title V specifications. b,� -.. b) 'Parking shall not be constructed over H10 septic components. L O C A T ION MAP 1�'-�j /� �� � 7) The toe is bounded b property comers and property lines as de acted. / property rt3' � Y P Pert3' P PAY P� C '�' ) y W 8) The property owner shall review design considerations to approve of total design flow to be considered for design. Receipt of payment for the plan and installation based on the plan shall be deemed approval of the design flow. 9) The existing leaching system shall be pumped and backfilled per Title V D 1 Abandonment Procedures. �j 10)System components to be 10 feet from water line. The property owner is responsible for relocating all water services that are discovered or damaged during construction. E 11)Units with garbage grinders-are to have the garbage grinders removed. 12)Unsuitable material encountered during the installation are to be removed for ` \ `o SEPT SYSTEM DES I ON 5 feet around and down to 80 inches and re laced with clean washed sand per 1 �-- Title V specs. FLOW ESTIMATE 7 i � i 5 P v �5 tv04r4e-vl 3 BE)ROOMS AT IU GAL/DAY/BEDROOM - L/DAY 1 b SEPTIC TANK `7 GAL/DAY x 2 DAYS GAL y 4. USE G�LLON SEPTIC TAx�s " OIL ABSORPTION, SYSTEM t:::, 0 a .-.... >I DE AREA: �C. �'t' t3� y( 2,x + b? ., �t{ I. OTTOM AREA: 1 v•`? -` t I SEPT I C SYSTEM SECT I ON I jut AMA O . GALS D-BOX 3.1 .� TANK , �- IC AN b 4; 1N rt7 /-�Y 7% �' /rtQO tom./ c� 0J5) - r. x pm p ` �/6 \ V - SITE AND SEWAGE PLAN J L ATION ' �d / fi OCR 77c PREPARED FOR : � c17� o �, ----- A.1 1vj cc SCALE: DAV I D B . MASON DATE:i 2i oS s - DBC ENVIRONMENTAL DESIGNS DATE HEALTH AGENT EAST SANDWICH . MA ( 508 ) 833- 2177