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HomeMy WebLinkAbout0029 PINE ROAD - Health 9 Pine Road." Cotuit - -- - - 101.8-125-001 --- - ------- COMMONWEALTH OF MASSACHUSETTS EXECUTIVE'OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION W . ti Q ' v`y TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION N0: . ASSESSORS MAP � O Property Address: ;2`( P,yLt JZugc Owner's Name: e6 u I f?e1L'1Q-4v a. Owner's Address: �Y p,►t ,�a d �'r, �e�c� ✓VL� 13�6 j_S ' Date of Inspection: 16&/a-1 Name of Inspector: (please print) 1,4, 4.c,e'e ii Company Name: u yg-ii Mailing Address: P Telephone Number: 77 4- qS',,f- 9►L n CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in'the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: Passes _ t Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails - Inspector's Signature. Date: 0 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. _ Notes and Comments, ,5 y��,r, r=Ss�:� ****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. F • y Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A ;CERTIFICATION (continued) Property Address: d v /'la_ Ayl4 d Owner: I i.)��/ f f g S Date of Inspection• ,/y/��! Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: A 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: if/ One or more system components as described in the"Conditional Pass"section need to be replaced or r aired.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. ,l✓ 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 enfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not.leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: A///� 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: Page 3 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: -99 ?,n �•"fZ1Q I Owner: /Zdl /le wA kk.s— Date of Inspection: G&Z"!. 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 42. 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 l of a public water supply. j�r The system has aseptic tank and SAS and the.SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and-the-SAS is less than 100 feet but 50 feet or more from a private water supply well**.'Method used to determine distance **This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: S��c �lM dt Ili Liss ��A� �.4" ��i.✓�a,y `r.-.�s� ty� w�kr • ItAf�vsi3 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: J X R.�z. &;.sd do /4 Owner: & 1 Do.gym A-4 Iris Date of Inspection: 6/y1y 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 A Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool .k Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6"below invert or available volume is less than''/z day flow _ _c Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped _ _A_ Any portion of the SAS,cesspool or privy is below high ground water elevation. x Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. it Any portion of a cesspool or privy is within a Zone 1 of a public well. _ _y_ Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ g- Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] A10 (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: 14///� .. To be considered a large system the system must serve a facility with a design flow of 10,000 god 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 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. Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: iai %t:✓i.� Owner: PA-VI 1�.�►naa Date of Inspection: 6/9/ns% Check if the following have been done.You must indicate"yes'or"no"as to each of the following: Yes No `- 1 _ Pumping information was provided by the caner cupan or Board of Health (X' 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? j _ 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.? _ _.y Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no _ Existing information.For example,a plan at the Board of Health. Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] • r Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: .49 Ant jioAd Owner: n!1-U w;+I-U Date of Inspection: h/o%j FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):I Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): Number of current residents: Does residence have a garbage grinder(yes or no): ' - Is laundry on a separate sewage system(yes or no): yti [if yes separate inspection required] Laundry system inspected(yes or no):44 Seasonal use: (yes or no):-AV , Water meter readings,if available(last 2 years usage(gpd)): JLLk'l f Sump pump(yes or no): sic► Last date of occupancy: Cv✓ ►t� COMMERCIAL/INDUSTRIAL f Type of establishment: Design flow(based on 310 CMR 15203): gpd Basis of design flow(seats/persons/sgketc.): 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: Was system pumped as part of the inspection(yes or no): / If yes,volume pumped:_gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM a Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool —ivy _Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank _Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Were sewage odors detected when arriving at the site(yes or no): /�� Page 7 of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: /&'hwj Owner: Prt u I I9Q jja,4 jjt_g ' Date of Inspection: BUILDING SEWER(locate on site plan) Depth below grade: ° P 1�' Materials of construction:—cast iron _k, _40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints;venting,evidence of leakage,etc.): '46sn+9 Lae IC �u hx 4 f i ,"Un J MIA-e `c of 1&,-Akre SEPTIC TANK: (locate on site plan) ` Depth below grade: 6t` Material of construction: concrete— — ____polyethylene metal fiberglass —other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: low cat -77m k Sludge depth: 7" Distance from top of sludge to bottom of outlet tee or baffle: 3n " Scum thickness: /`r Distance from top of scum to top of outlet tee or baffle: le, Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensions determined:_>ytgAS,,," j,� I'I (cl Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,.liquid levels as related to outlet invert,evidence of leakage,etc.): i in hek c)vLIUl --A iARJAtV I :1IL d I-1w11 04 )N IACul 0 Nei rir�znez eti� I�¢.:���.w-vim . GREASE TRAP:�P(locate on site plan) Depth below grade: Material of construction:—concrete . metal fiberglass Uolyethylene—other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet 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.): Page 8 of 11 a f OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM_ INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 42' Pe. 1"d C'v+oil Owner: Date of Inspection: 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. m . . Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX:_ f�(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.): Lrc�cam:" IG e° Uete r 'V0 5nij (`Ari'X C'Ld'a .V /¢_ *qA Zr& cl Awe.L - a PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no):. Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): _ r, Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: P, d Owner: ks Date of Inspection: 6 R o SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: r�A[ �n� to•f Lo A3 &r,I A,Sbvi I t, 1,,*3 raj dq 6�-n t.1,A. d Type leaching pits,number: leaching chambers,number: leaching galleries,number: leaching trenches,number,length: , leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): 4�e v�fie fi6,,,A I 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 or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY.Aj (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 l ' Page 10 of 11 ` OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) .. Property Address: v21k Pr.0 kvi�d Owner: PAyl Vv►tia � s Date of Inspection: &/2/o y ° r SKETCH OF SEWAGE DISPOSAL SYSTEM -Provide a.sketch of the sewage disposal system including ties to at least two permanent reference landmarks-or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building. u o Q '7 r Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: &-?k QW-em 0i- ,r Date of Inspection: q SITE EXAM Slope — r,,A Surface water - NJAu Check cellar - Ye-5 Shallow wells - "-;-J1 WPr Estimated depth to ground water a5 feet Please indicate(check)all methods used to determine the high ground water elevation: _Y_Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain:. You must describe how you established the high ground water elevation: _ �MNY1 S t p�a-kA yl,7-)3�Jr ES de w-! , y L�,ioz+ p't r 11) eo 71,4 lnhin 91 11Y&)Aji s L0 c A'T ION I S E W AG E Pt RMI.T N0. VILLAGE. A� INSYA lER'S NAME ADDRESS oco N.UILOEIt Oft n�wN�• ' QATE PERMIT ISSUED DATA C0M0L.IAN-CE ISSUED 1 , 16-11 e � V f 20 FT. M/N. /YOTF /i E/TN&R /O /•7: M/N. _ -5-PT C 7-AV _ EACHlOVG ?/T ARE MORE " .7RAOE1i4 2Q O/AMETEK CpNC.PaFT's �5� fST/AqA-r [ONG4ETL -i•PVC o/Pz SJ,�ALL BE ,9APO&GNT TO GRADE. �i+N E pg "v'•�� /D p O COYEI�S M/,/. 00/7CN NERVY CA ST IRON CO L L QE S� �B•p �• /F/N OR/VEJkVA Y' Cd YE.4 CL EAN 4, 4•CA f. j I .+ ?a IRON P/PE Z`LAYER s•;@ MIN.PIl l0!,V M- GAL. o . o "• G1rr �/8 --f/Q -"•� AV A&R er. SEP'T/C TANK DIST, - I • • • • • • > • 2r ®OX • • • • • • • • • • • ♦ • WASHED 57t74 dP i • I $ • • • • • � .•• • ' � •• • I •EFFECT/VG I ' • , 3�4 - �2~ / 7Ir ?� • •a•• • I • • • • • • � ®moo " /' G D.� ♦ s. . • • • • • • • • • 0 r PRECAST See W lNfiCR? eLEii.�T/CNs pI•r Cam►yr+Cll r�/ S4� / y s •. • • • • • • . • a P/7 eL- /NYERT AT RULD/N6 7. � �q,FT Q fT. O/AM. { q INLET ".40rIC T.4,VK -Y 7,.3 FT, j�y -ONTLE r S&P77C TANK 9T•E, FT, - FT O/.4Jr1. C(3E'�' t /NGET D/STR/8l?/ON BOX 9 4%-S-FT. O(JTIETD/STR/Bt/7'jON BAX 6. 3 /r�► `SEC"ION OF GROUND P.CgTE*t 7A4E /NL6T LEACHING PIT S1 FT. SZ;V/AGE r0/Sf�OrSA L SYSTEM i t! Y 7ABU4ATI40/V DES/6!V CRITERIA sCALE O/MENS/ON A? Nl/MeER OF BEDROG/yS 3 0/'y'FN5I0Ai D/HENS/ON C _F r;A�n/• WReAGED/SPO.S.9L UN/r /►' SO/L. LOG T®T.eG dSr//�t�^ED R•LoAV }gyp V SOIL TEST / SOIL 77FS77#02 SDIL TEST NUMBER QF Ll�AGV/NG P/73 l •art t.K 97.9 S/DE 4eACH/NG PER PIT �sa fT f DA TE OF SO/L TEST OOTYOM 1.�rr9CN/NG PER P/T L",W, Ar 0 2" `' RES4/LTS h/ITNESSED. dY ` . Par JA-C-- TOTAC LEACHING ARAMA 2.6 6 sip. FT f'FR[OtAT/O!N MATE,#/ r-s3 MIN RESBRVE4P4CNIMS AREA 2 bb SQ• '-,F TPso ` FWROO[A77a*V R.A7•E AZ 72,0 to Qf `6 JF h:.' �. •. /� �D r. u M ' �� /'r 'j; •, : S�.N D U FF- �r NE 72v A r� -• . • : o RSE �,I 10951 O k 0 It A9 SFr. E ���`` REV SS,y ESL=;DREDGE ENCHAI"R/NG C. O �F . 7/Z MAIN Sr � .I%YfiNN/S• Miq:ho SUM� SSroN��E� � _ ($) N.OGROG/Nt7 y✓.4TE�-.ENCOUNTf,�'�O � L'L/FNT:/>2OTToS DAT S ,. --•-_,_......�1 CaRO C/N•D Lvsa'TE'rP �I T ELG•L! �__; ..'! 4 ENVIROTECHI ABORATORIES,INc. MA CERT.NO.:M-MA 063 8 J in Sehasdan Dr- Unit#12 Sandie ich, MA 02563 508(8884460) 1-800-3,39-6460 FAA (508)888-6446 CLIENT: Timothy Lovell LOCATION: 29 Pine Rd ADDRESS: PO Box 1061 Cotuit MA Plymouth MA 02362 COLLECTED BY: Timothy Lovell SAMPLE DATE: 6/11/2004 SAMPLE TIME: 2:30 WATER SAMPLE TYPE: Existing Well /Title 5 DATE RECEIVED: 6/11/2004 LAB I.D. #: 0406344 WELL SPECS.: N/A RESULTS OF ANALYSIS: Parameters Units Recommended Results Method Date Analyzed Limits Coliform bacteria /100ml 0 0 9222 B 6/11/2004 pH pH Units 6.5-8.5 6.23 4500 H+ 6/11/2004 Conductance umhos/cm 500 212 120.1 6/11/2004 Nitrate-N mg/L 10.0 2.14 300.0 6/11/2004 Nitrite-N mg/L 1.0 < 0.004 200.7 6/11/2004 Sodium mg/L 20.0 27.4 200.7 6/14/2004 Iron mg/L 0.3 0.2 200.7 6/14/2004 Manganese mg/L 0.05 0.032 200.7 6/14/2004 Potassium mg/L 20.0 2.5 200.7 6/14/2004 Calcium mg/L N/A 3.3 200.7 6/14/2004 Magnesium mg/L N/A 2.8 200.7 6/14/2004 Hardness(as CaCO3) mg/L 500 19.7 200.7 6/14/2004 Alkalinity mg/L 200 7.8 2320 B 6/11/2004 Sulfate mg/L 250 10.4 300.0 6/11/2004 Chloride mg/L 250 47.1 300.0 6/11/2004 Color APC Units 15.0 < 5.0 2120 B 6/11/2004 Turbidity NTU 5.0 0.51 2130 B 6/11/2004 Ammonia mg/L 1.0 < 0.5 350.2 6/14/2004 Free CO2 mg/L 50 12.0 4500-CO2 D 6/11/2004 Volatile Organics ug/L See Report ND EPA 524.2 6/15/2004 ND = None Detected. COMMENTS: pH is below recommended limit and may have corrosive characteristics. Sodium level is not a health hazard. WATER MEETS EPA STANDARDS AND IS SUITABLE FOR DRINKING PURPOSES FOR PARAMETERS TESTED. <=less than >=greater than TNTC=too numerous to count r Date R ald J. Sa r Laboratory Director New England ChromaChem 6 Nichols Street Salem, MA 01970 978-744-6600 Sample Information EPA Method 524.2 Volatile Organic compounds in Water Client: Envirotech Laboratory,Inc. Lab ID: 406158 Client ID: 406344 Lovell 20 Pine Road State: Li uid Date Received: 06/15/04 Date Analyzed: 06/15/04 Date Sampled: 06/11/04 Analytical Results Parameter Results(ug/L) Parameter Results(ug/L) Acetone ND Trans-1,2-dichloroethene IND Benzene ND 1,2-Dichloropropane ND Bromobenzene ND 1,3-Dichloropropane ND Bromochloromethane ND 2,2-Dichloropro ane ND Bromodichloromethane ND 1,1-Dichioropropene ND Bromoform ND Eth (benzene ND Bromomethane ND Hexachiorobutadiene ND 2-Butanone ND Isoprop (benzene ND N-Butylbenzene ND P-isoprop (toluene ND Sec-Butylbenzene NO Methylene Chloride ND Tert-Butylbenzene ND Naphthalene ND Carbon Tetrachloride ND N-Propylbenzene ND Chlorobenzene ND Styrene ND. Chloroethane ND 1,1,1,2-Tetrachloroethane ND Chloroform ND 1,1;2,2-Tetrachloroethane ND Chloromethane ND Tetrachloroethene ND 2-Chlorotoluene ND Toluene ND 4-Chlorotoluene ND 1,2,3-Tdchlorobenzene ND Dibromochloromethane ND 1,2,4-Tnchlorobenzene ND 1,2-Dibromo-3-chloropropane ND. 1,11-Trichloroethane ND 1,2-Dibromoethane ND 1,1,2-Tdchloroethane ND Dibromomethane ND Trichloroethene ND 1,2-Dichlorobenzene ND Trichlorofluoromethane ND 1,3-Dichlorobenzene ND 1,2,3-Tdchloro ro ane ND 1,4-Dichlorobenzene ND 1,2,4-Trimeth lbenzene ND Dichlorodifluoromethane ND 1,3,5-Trirneth (benzene ND 1,1-Dichloroethane ND Vinyl Chloride ND 1,2-Dichloroethane ND O-X lens ND 1,1-Dichloroethene ND M-X lene ND Cis-1,2-dichloroethene ND P-Xylene ND Trans-1,2-dich loroethene ND Methyl-tert-butyl ether ND Recoveries of Internal Standards % Flurobenzene 95 romofluorobenzene 99 1,2-Dichlorobenzene-d4 1105 Method Detection Limit=0.5 uqIL Electronically signed and approved by Mr.Bruce A.BBornstein Date: 6/22/04 .rp No....V. ..........J FEs...... ......... 14NE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ..........""..-".".""-" . ....-.....OF....................................... ........................................ Appliration for Dhipos al Work,5 Taaaitrurtinaa amit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at � � � �� C��v�7- .......-- .. --- --- . ---------------- -----•-----....----•-------•------•-------- ---.•.....---.................------. 4.1 . `a or Lot No. ..................... ......................................•--•- Ogae Address W Installer Address U Type of Building Size Lot............................Sq. feet..... eet . �., Dwelling—No. of Bedrooms...........................................Expansion Attic ( } Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) pa Other fixtures ................................ . Q ��....................gallons per person --er day. Total daily flow_-_.�--Z.O-._____................-•-llons. W Design Flow....... _________ g P P P Y• Y � WSeptic Tank—Liquid capacityf�. . ..gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area---s__. -----------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........................ 114 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ C4 •---•------------------------------------•---------•---••---------------•---.......----......------.....--------------------------------........---•--..•---- 0 Description of Soil-------------------------------------------------------•-•---•----------------•--------------------------------------------------------------•-•-------......---------- x • V ---------------------------•-------------------•........---------------------------...---•-•-•----------•---------------------------------------•--•......................._............................ W ----------------------------------------------------------------------------------------------------------------------------------------------------•-------•------.------ U Nature of Rep •rs or Alterations—Answer when a li a e___/4 .. e... ....�_.v.� ._._........ ----- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal Systemrin accordance with the provisions of iITLL 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by thheard of h "Signed- -- - ---- ............,... .. .. .... ................................ -•. .--f---��---• ate Application Approved BY - ---------- -••-------------------------------- . Date Application Disapproved for the following reasons:-------------------------------------------------------------------------------••----•------•------------....._ ---------------------------•-•----.........--•---------------...-----------------------------------••-----•-------------•--------------..........-..................................................... Date PermitNo........................................................ Issued....................................................... Date IVO /P ENTH— THE StPT/C TA V l< OR h 20 FT. M//V. 1E,4CH/ivG P/T ARE ADORE TNA."/ /2 BEtO.4v :WAOE, ,4 24 01AM ETER CONCRETE C'O!/ER _- _ SJ�ALL BF B0CUGHT TO 4RA O=.6f+N .EXT�E'A f✓TI�+AiTE CONCRCTE '0 PYC P/Pt JYEAVY CAST /BONY COINER SHALL OE [/SEO . • �; ��'� .� GOYE14S P/TGN !F/N DR/✓EH/A Y • . . P2W FT 2%q M/,V. C'D/V C.e '��TE COVER CL EA/V. .SA/V O ®A C.-le F/L L ,'* r /BON PIPE l©C!.d • o e ��B• 3�®r GAL. '. a .. • . • e• �e�:. b MlN.oTGt TAlYff }yA$HED 5727NE s ° %v'Pic r'r• 77 C , , . • • + . . • ,. • + . BOX a • $ •. •:. • ,• • i;' _ , •, • • DEPTH • • • 0 WASNED STONE Ap o r ♦ s •- • • •► I Leo • lip0. 0 400 Am PRECAST SEEPAGE z 7 8'x: a '� • a• • • '• • .e • •r • o .�v t. t lNfi�RT 4WLEtP.47"/oars . n ..1 /NYERT=AT:;Bl/!L'D/N6 . 9 'S` FT 1 y FT O/�1!►'f C SEETABULATI0VV 1/S/"LET `:aEpTlC`TANK 9�Ft' M _ . ,i: _ ,� ., ` . • �;Ti EPTl � 4NK g�/_FT D!/TLET S - a , lIVGET DISTR/4f/T/ M,BOX 9 ,FT '_-; Sd�'CT/O/V OF, GROV ND: jt�iTER TABL E ouTt.Er arsrRieuT oiv B ` 96. 3 r"T SPwAGE -OlSPG�S'A 4 SYSTEM /AfLET 1�ACKrrvG. f'!T: 9s.9 FT. 7 I-ATIONl �. LEACH,i p/T' a se�cE c MENsi0v A vvwSCq OF BEDROOMS' RQAGE'D/.SPO.SAL UNIT /Y°'�/,� SOIL LOG TOT.�L ESrft, .fr4eD FLOI'V t3 6.4L./DAY S01L TEST All SO/L TEST 2 +Sa/L TEST NUMBERF Q ,L,-ACJVlJVG P/,TS_I f^E[E✓ 979 �ELArK DATE OF SOIL TEST S/OEGA N6 LCH/ _PER P!T .S'�t AT a 2- RESULTS PV1rV&SSED d, Y J R d/q c�8/ aorrom LFYICNivcr PER P/T 7 S4. FT PERCC4AT/ON RATF At/ 55 MJAl1lNCM 2.-6 b Lv�_,. AE.tCOL. lON RA7,E I*2 /t'¢/✓!y/N.�INGN TOTi1L lEACH/NG AREA SQ, iT. T pso��. RESERVE LEACNIMSAREA �6 5Q: FT. Z^U Q tb OF P�S� cr r.,�sc .o c �J rav ,,,J O F� j?e/✓E 7zo A v F7 A -+ o RSE. w "r No.10951 C—L 0 FLOREDGE ENG/NF_PR/JVG CO,ING_�O .o9�FGr57EP�? EY SS.`j 712 MA//Y S T. , AeY.4N S N/ . MAS?, p�FSS/ONAIz \ NQ GROcIN(� Yi!.4TER ENCOU/VTEREO CL/�IVT:/>2vTTaS DRTE S �3 SUtN� GRO U/VD I-VA 7 A7'E-,ffV J06 NO.• $3 0 a SHEET?OF Z Q 'F'HE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .................................OF..........................---..._...........---------------------------------------------- Appliratiou for llhipaa al luorks Tonstrurtiuta Permit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Syste>e Sat N t« 0 jC ................ ........•• ....._.�........................................................ --...-----...------•------•----•............ ..----------------------------.•--•-••••-- 1^� F' y1 „ Lo�td � �d- or Lot No. .._.. J ®�.......................... ...........•... ... . -•-__- ------------------------ ------------------------.................. -•----................................._..... Address e ................................ Installer Address .r Type of Building Size Lot............................Sq. feet �., Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) p,, Other—Type of`•Building ...........:................ No. of persons..........._---------------- Showers ( ) — Cafeteria ( ) PL4 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. Seepage Pit No-_----------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ a Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------_................. 9 -----------------------------------•--•-••---------•----------------.............---•--•••....--•---......................................................... ODescription of Soil-....................................................................................................................................................................... x 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 TITIZj 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board 11 o health r Qj I e� ate Application Approved By------ �.. <%� -----•-•••------------------------- ... -,fa Date Application Disapproved for the following reasons---------------------------------------------------------------•-----------------•-------------------------.--•-- ------••--•---••----•--------•---•-------------------------------•-------•-------............•--••---------- ---------------- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... Tetifiratr laf TautpliFana THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by••--•--•••-------------•--........------...........-•---•........---------•-----•-•.......------------•-------------•....•--••--•----•-----------...._..••--- Installer at...................................................................................................................................................................................................... has been installed in accordance with the provisions of TITIE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated_-...-.--_._._-_---___---__---_-__---_-_-__-•-_. THE ISSUANC OF THIS CERTIFICATE SHALL NOT BYCONSTR S A GUARANTEE THAT THE SYSTEM WIL CTION SATISFACTORY. DATE.-••--� �l -•--•-----------------•-------------------- Inspecto --------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Q ...........................................OF..................................................................................... Nd................-...... FEE........$_ l........ �i��.ar�aal �rk� �.a��a��railaaT ermi� Permission is hereby granted............ _-_--•---------------------------------------------------------------------------------•-•--- to Construct ( air 'IndividualSewage DisposalY System at No . Repair ( ) an .......... ... •-•-•-. Street as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... .........................................................................-............................._ Board of Health DATE............................................................................... FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS Log Number: 2492 Date: 5/4/83 �"Of BAi? ,i► s� BARNSTABLE COUNTY HEALTH DEPARTMENT SUPERIOR COURT HOUSE w. v BARNSTABLE, MASSACHUSETTS 02630 362-2511 o �2q$6 • DRINKING WATER LABORATORY ANALYSIS PHONE: EXr. 331 Client: Alvaro Mattos . Collector: D. A. Scannell Mailing Address: Nickerson Rd. • Affiliation: ' . D. A. Scannell-Well Drilling i Cotuit; MA 02635 Time & Date of Collection: 5/2/83 9s00 a,m, Telephone: 428-2442 Type of Supply: wall water Sample Location: Albina Ave. & Pine Date of Analysis: 5/2.183 Cotuit Parameter Sample Result Recommended Limits Coliform bacteria (organisms/100 ml) 0 0 r pH 5.4 Conductivity' mieromhos/cm 66 500.0 . F Iron (ppm) .12 0.3 Nitrate-Nitrogen (ppm) a .04 10.0 X7- Water sample meets the recommended limits of all above tested parameters. Water sample is drinkable but:has higher than,average levels of .This does not represent a-health hazard but future monitoring is recommended (2-3 times per year). We will test for Sodium. r Water sample is drinkable but may present aesthetic problems to users (staining, odor or taste). Water sample is of poor quality and is not recommended for human consumption. Resampling and retesting.is suggested. „ Results only. REMARKS: cc: 'D. A. Scannell Well Drilling cc: Barnstable Board of r Health Analyst: Z�Z"4e 11/18/81 _ I 4 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 . in:dicates that,your water,supply is safe and approved for human consumption..A total coliform,count of greater than zero is most often the result of accidental contamination of the sample bottle through-improper sampling methods:.:For this.teason;it'would be advisable to retest any well water that is not approved. pH , pH is the measure of acidity or alkalinity 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 Cod tends to be acidic in the range of 5.O to 6.5 Corrduz iivity- Conductivity is a measure of the dissolved salts-in solution. Amounts in excess,of,$00-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 ppm 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 ppm. 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 t X The Massachusetts Drinking Water Regulations have seta maximum contaminant level for nitrates at 10 ppm. Excessive concentrations may cause methemoglobinemia•(an infant disease) and'have been suggested to form potentially carcinogenic nitrosamines. Contamination sources include fertilizers, cesspools and industrial wastes. 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 ppm is only of concern to people who are on a low 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. tConcentrations exceeding 50 ppm indicate that there may be ocean water or road salt runoff water,getting into-the,well..., T ION I _ SEWAGE PERMIT NO LACE , Co4o*c — s IMSTA lER'S NAME & ADDRESS` .o-- OCO C � c I.UIL0ER OR OULU- ,4k1w DATE PERMIT ISSUED DATE COMPLIANCE ISSUED ti �3 o o �--- 7 0 �to as �, pr f F4 . 17 ALVALD V. TTOS V A CA IT) v� G► / �G����T � r-L try(r�TJn�4 , N C i STY. N°�C411)00 -4 G 9 p o 4 �a oQ rJUL� N WCY-L'�e�(IsTtib _ \ \ r SEPnc SvsTEAn PU U p�o i z \ zo Qi rx 11vo , APe4L 2�. 1983 Gg FAD 4 a 1p 1 . JN F A Ul t o DTaNa OF all I: 0v Ewa let f m b (p � 1_ 45, LEGEND A >. EXISTING -SPOT ELEVATION OAO CERTIFIED PLOT PLAN EXISTING CONTOUR Raft `FINISHED SPOT ELEVATION 7- FINISHED' CONTOUR 0 1N APPROVED= BOARD OF HEALTH ��,�'$��� �v����� ����• "'.—DATE AGENT ��,�;roF:�� SCALES I"-7-so ' ATE, L:,( DR EDGE ENGI EE ! G .lfJ o� Al Cl1ENT -N� .; o I CERTIFY THAT THE a4IS1�1Jl� Ea1STERED REGISTER EID . SE BUILDING 'SHOWN ON THIS PLAN r7 J08 M0. 50q E No 10951 O ' CIVIL LAND .� �� P� w� CONFORMS TO THE ZONING LAWS rENGINEER SURVEYOR OR.BYs A,1A, �o� �I TE �� _ Fss/oN�c � OF BARNSTA LEI ASS. 712 M A I N 'S T R E ET ----�-- 56 3 _ A ! - Amvir*_L OFF MATS