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0122 PINQUICKSET COVE CIR - Health
122 'Pinquiokset.Cove Cir cotuit r A = 005 068 4 ' N . t Tl1,fQu OF T� Ks TOWN BARNSTABLE cr of - Z3S LOCATION I 2-- ��/II Calf( SEWAGE# VILLAGEr,-1-ce ° t ASSESSOR'S MAP&PARCEL oU5 —O66`Oa8 INSTALLER'S NAME&PHONE NO. (��h 4 '9ty&N(.C Z SO -f753 SEPTIC TANK CAPACITY Z50 0 r(500 r(n Od %rm lL —7 LEACHING FACILITY.(type)' T:X I S-L(/V G- (size) NO.OF BEDROOMS �\ �,��/ -p OWNER PERMIT DATE: —7 COMPLIANCE DATE: - �V3dZ Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY „�_ i Q.v X A V7- 4o � 3 _ CO2) o A 30,co � lq Town of Barnstable Barnstable Board of Health mmmi,eel" MUMS ABM 200 Main Street, Hyannis MA 02601 1 XAsa j01 s639. 2007 FD MAC Paul J.Canniff,D.M.D. Office:508-862-4644 Donald A.Guadagnoli,M.D FAX: 508-790-6304 John T.Norman F.P.(Tom)Lee,P.E.,Alternate Certified Mail# 7008 3230 0002 5177 7950 November 26, 2018 Steve and Dana Herweck RE: Underground Steel Fuel Tank 122 Pinquickset Cove Cir Heating Oil Tank: 500 gallons Cotuit, MA 02635 Tank Number: 1 Tag Number: 00357 Board of Health records indicate that an underground fuel(or chemical) storage tank at the above location exceeds thirty(30)years in age and has not yet been removed as required by the Town of Barnstable Code Chapter 326, Section 3, Fuel and Chemical Storage Tanks. You are directed to remove this tank within sixty(60)days from the date of this Notice. ' Upon completion of the tank removal and within ninety(90)days of receipt of this Notice, please submit to this office a copy of the permit for storage tank removal issued by your local Fire Department. This permit is required to be obtained prior to the tank removal. This copy of the removal permit serves as documentation that the underground storage tank was properly removed and disposed of. Should you be unaware of the existence of the above mentioned tank or its possible previous removal, an independent third party(i.e. oil company,tank removal company, or environmental services company) may be able to assist you in physically locating and/or verifying the current existence of the tank. Should this be the case, a written document from the independent third party is required within ninety(90)days of receipt of this notice as verification that the tank had been previously removed and/or does not exist. You may request a hearing before the Board provided that a written petition requesting same is received by the Board of Health within ten (10)days after this order is served. Failure to comply with an order of the Board of Health will result in automatic scheduling of a hearing before the Board at a future public meeting. If you have any questions or would like to discuss this problem, please call Tim Lavelle,Hazardous Materials Specialist, at 508-862-4645. Thank you. Per Order of the Board of Health Thomas A. McKean,RS, CHO Public Health Division, Director Q:\Hazmat\Underground Tanks\2018\30 yr old UST 122 Pinquickset Cove Cir COT.doc �I A No. Fee_ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01pphLation for MispoBal *pstrm Construction Permit Application for a Permit to Construct(,) Repair( ) Upgrade( ) Abandon( ) []Complete System ❑Individual Components Location Address or Lot No. /cv v� /9 Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 6 0'r— 6(�Fj CO'rl�I ` ` C,"-_ Installer's Name,Address and Tel.No. 4_ IF' Designer's Name Address,and Tel.No. I`�f°�(rt` Bois —7- Type of Building: _ i-9�Y/h Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) ._wtn A(xi a . Q ob Q1oKXxe,L, Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Hera" S' Date Application Approved by Date Q l Application Disapproved by Date for the following reasons Permit No _'A Date Issued ZZ - No: 't' ,/ ; Fee '' TH'gF MASSACHUSETTS Entered r ;0 THE COMMONWEAL, Yes . 1 PUBLIC HEALTH DIVISION ;TOWN,OF BARNSTABLE, MASSACHUSETTS . 0(pplication for MlspoBal%pstrm Construction Permit Application for a'Permit to Construct(Repair( ) Upgrade( ) Abandon( ) El Complete System ❑Individual Components Location Address or Lot No. / ` :Lx.;f CoUk Owner's Name,Address,and Tel.No. ti �a !! " Assessor's Map/Parcel (j 0,j - Q t il,!oFj Co 1 �, Installer's Name,Address and Tel.No. Designer's Name Address and Tel.No. NG g-aS -Z74 "53 • G.UC:.'k i �,J -4�'F' �.� o �� ���G�,f11c!S �`�,C�tJ.A4.'1•'�1 Type of Building: i ft/r1 k Dwelling No.of Bedrooms Irot}S'ize ;, sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons^ Showers( ) Cafeteria.( ) Other Fixtures ,t 4 t M Design Flow(min.required) gpd Design flog provided gpd Plan Date Number of sheets Revision Date s Title - Size of Septic Tank Type of S.A.S. Description of Soil a Nature of Repairs or Alterations(Answer when applicable) as t f , c)Z, (Jt ,_ P # \.� 'w^ Date last inspected: w i Agreement: , 4 i The undersigned agrees to ensure the construction and"maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Heaith. j= r .•�,• ".` r Signed, Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No 2WI '' Date Issued - ------ - -- -- ---- - - - - --- - -- - -,- - -•--• ------- ----- -- - -- -- ------ ------ - - -- ', THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS':IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( � Repaired( ) Upgraded( ) Abandoned( )by �_ " " "tirici (�-sA/1��" � i�fQAK_f k l at 1 QA f0i %.)!�oiCy-S e-1 C n ve, has been constructed in accordance j with the provisions of Title 5 and the for Disposal System Construction Permit Nq�7� -5 dated ,r J Installer ;4 Designer #bedrooms Approved design flow gpd The issuance of this permit sha I not�co trued as a guarantee that the system,11' ction esigned. Date3 / Inspector \. n -2 l 6 No. �� Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS BispoSal,*pBtrm Construction Permit Permission is hereby granted t�o^Construct( Repair( ) Upgrade( ) Abandon( ) System located at a a 1`�t*t•1 9Ui CI`Se--t CGU @, v and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this poimit. Date .,� ' �/1 -/ l / Approved l y ^ ► rJ L t Town of Barnstable Regulatory Services Richard V. Scali,Interim Director * antuvsrnat.�. • MAS& Public Health Division i639' ♦� AIEnMas°' - Thomas McKean, Director 200 Main Sireet,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: Z14 hcld Sewage Permit#�lll �3� Assessor's Map\Parcel Designer:( ,!'F) -} i,J�: %( �:,. .�!'it Installer• Address: ,7,r Address: On 7 was issued a permit to install a (date (installer) septic system at �;;�.,� 'i based on a design drawn by (address) / ; ,f , •/II,�Z Ci%.;1 %i �)1 z: dated (designer) I e€4 that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found.satisfactory. e I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required)was inspected and the soils were found satisfactory. I certify that the system referenced above was constnicted in compliance with.the terms of the IAA approval letters (if applicable) nstaller's Signature) _22A S_4� 1 -_ .:::,- .:�;.__ (Designer's Signature) (Affix Designer's`Siamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:\Septic\Designer Certification Fonn Rev 8-14-13.doc 'v Apr 02 1504:55p s -r Commonwealth of Massachusetts ' a 6, Title 5 Official Inspection Form 6 Subsurface Sewage Disposal System form-Not for Voluntary Assessments _ 122 Pinquickset Cove Circle Property Address Jim Feldt Owner Owner's Name information is Cotuit MA 02635 4-1-15 required for 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_ Important:When A. General Information filling out forms �3�p�1H OF FM iq�i1,�, on the computer, v^ '�' ���� qSO 111, use only the tab 1 Inspector9�y keyto move our cursor-do not James D.Sears = JA M ES =n,_- use the return — SEKK key. Name of Inspector CapewideEnterprises,LLC . l .o 0 Company Name ��i// `�5 1 N SP�e`:N ` 153 Commercial Street _ Company Address Mashpee MA 02649 Cityfrown State Zip Code 505-477-8877 S1623 Telephone Number License Number S. Certification I certify that I have personally inspected the sewage disposal system at this address and that the Information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 4-1-15 pector s Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the 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. t5irm.3113 Tx1a 5 Official kmpechon Form:Submsface Sewage Disposal System-Pape 1 of 17 Apr 02 15 04:55p p.2 Commonwealth of Massachusetts Title 5 Official Inspection Form -- Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 122 Pinquickset Cove Circle Property Address Jim Feldt Owner Owner's Name information is required for every Cotuit MA 02635 4-1-15 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: The system is a 2000 Gal Tank D Box and five chambers. All units are H-20. 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", ano or"not determined'(Y, N, ND)for the following statements. If"not determined; please explain. septic tank is metal and over 20 years old'or the septic tank(whether metal or not)is structurally unsound, exhibits substantial infiltration or exfiltrabon 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. I_j Y U r, jJ iIYLJ(txpidin oeiowj: !Sire•3M3 TNe 5 official Inspection Form:Subwfface Sewage Disposal System•Page 2 or 17 I� Apr 0215,04:56p p.3 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 122 Pinquickset Cove Circle Property Address Jim Feidt Owner Owner's Name information is required for every Cotuit MA 02635 4-1-15 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ill f Health approval if ❑ Pump Chamber pumps/alarms not operational. Systemw pass with Board o Heat app pumpslalarms are repaired. B) System Conditionally Passes(cunt.): ❑ 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 fleet of a bordering vegetated wetland or a salt marsh 15ins•W3 Title 5 Wide;Inspection Forum Subsia/ace Sewage Disposal System.Page 3 cf 17 Apr 02 15,04:56p pA Commonwealth of Massachusetts Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 122 Pinquickset Cove Circle Property Address Jim Feldt Owner Owner's Name Information is Cotuit MA 02635 4=1-15 required for every page. cityFrown 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: aysta,-n passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must 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 El 0 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 is less than 6e below invert or.available volume is less than 'h day flow A Ucl-�ioL,9 15ins-3M3 Tilte 5 Olfidai Inspection Forn SubwAaoe Sewage Disposal System•Page 4 of 17 Apr 02 151J4:56p p.5 Commonwealth of Massachusetts Title 5. Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 122 Pinquickset Cove Circle Property Address Jim Feldt Owner Owners Name information is required for every Cotuit MA 02635 4-1-15 page. cityfrown 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. EJ ® 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 labnrato ,for fecal coliform bacteria indicates absent and the presence vi oriiriiutiia iiiiivy2n and nitrate ftltrOg@rt is CAL•... ,_ . . th= ,, r..+,...., provided that no other failure.criteria are triggered.A copy of the analysis and chain of custody must be attached to this forma ❑ ® 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 Area 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 in. r-r_,rri=r.n jnjith '110 CMR 15.304.The system owner should contact the appropriate regional office of the Department. 15ins-W 3 - Title 5 Offidal Inspection Farm:6ubsuriacs Sewage Disposal System-Page 5 or 17 Apr 02 15,04:57p p.6 Commonwealth of Massachusetts Title 5 Official Inspection Form 11. Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 122 Pinquickset Cove Circle Property Address Jim Feldt Owner Owner's Name information is Cotuit MA 02635 4-1-15 required for every page_ Cityrrown 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? El ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® El 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)1310 CMR 15.302(5)) D. System Information Residential Flow Conditions: Number of bedrooms (design): Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550 t5ins.3ry 3 Title 5 Official tnspeaion Fcrm:SLt=rtwee Sewage 0 isposal System-Page 6 of 17 f - Apr 02 15,04:57p p.7 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 122 Pinquickset Cove Circle Property Address Jim Feldt Owner Owner's[Name information is Cotuit MA 02635 4-1-15 required for every page. CityrTown State Zip Code Dale of Inspection D. System Information Description: The system is a 2000 Gal Tank D Box and five chambers.All units H-20. Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): 2013-70,00OGaIs2014-70,000Gal's Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Present � y: Date Commercialllndustrial Flow Conditions: Type of Establishment: Design flaw(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/personsfsq.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•3113 Title 5 Offidad fnspec ion Form:Subsulaw Sewage Oisuoeal System-Page 7 0 IT r Apr 02 15.04:57p p.8 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ° 122 Pinquickset Cove Circle Property Address Jim Feldt Owner Owner's Name information is Cotuit MA 02635 4-1-15 required for every page. Cityfrown State Zip Cade Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: 4-14 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-3113 Title 5 Ofldel Inspection Form:Subsurraae Sewage Disposal System-Page 8 of 17 Apr 02 15'04:58p p.9 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 122 Pinquickset Cove Circle Property.Address Jim Feldt Owner Ovmees Name information is required for every Cotuit MA 02635 4-1-15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components,date installed (if known) and source of information: 2004 Permit # 2004-639. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 32" Depth below grade: feet Material of construction: ❑cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Pipeing is 4"PVC SCH 40. Septic Tank(locate on site plan): Depth below grader feet Material of construction: ®concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 2000 Gal.Precast H-20 1„ Sludge depth: t5ins-3113 Title 5 Official Inspection Farts:Subsurreoa Sewage visposel System-Page 9 or 17 Apr02 15,04:58p p.10 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 122 Pinquickset Cove Circle Property Address Jim Feldt Owner Owner's Name information is required for every Cotuit MA 02635 4-1-15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cunt.) Distance from top of sludge to bottom of outlet tee or baffle 29" Scum thickness 0 1. Distance from top of scum to top of outlet tee or baffle $ Distance from bottom of scum to bottom of outlet tee or baffle 18" Asbuilt-Tape-Plan How were dimensions determined? Sludge Judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank at working level.Tank at 22" below grade w/steel cover's at 4"below grade tank in stone drive way.Two inlet tees, out let tee. No sign of leakage or over loading. Tank is H-20. 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 15im-3113 - Title 5 Official Impaction Forth:Subsume Sewage Dispose!System•Page 10 of 17 it Apr 02 1504:58p p.11 Commonwealth of Massachusetts Title 5. Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 122 Pinquickset Cove Circle Property Address Jim Feldt Owner Owner's Name information is Cotuit MA 02635 4-1-15 required for every page. Cityrrown 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-3113 Tide 6 Vidal Inspection form:Subsurface Sewage Disposal System-Page 11 or 17 f Apr 02 15 04:59p p.12 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments P Y 122 Pinquickset Cove Circle Property Address Jim Feldt Owner Owner's Name information is required for every Cotuit MA 02635 4-1-15 page. Citylrown 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 0 Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D Box is 3' below grade. Box is clean and solid.No sign of over loading or solid carry over. Box is H-20. Box not opened inspected w/camera. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: tSkU•3/13 Title 5 OKcial Inspection Form Subsurface Sewage Disposal System-Page 12 or 17 r Apr 021 9 04:59p p.13 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 122 Pinguickset Cove Circle Property Address Jim Feldt Owner Owner's Name requiredinformation' fo is Cotuit MA 02635 4-1-15 required for every page. City/Town state Zip Code Date of Inspection D. System Information cunt. Y (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 5 ❑ leaching galleries number ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovativetaltemative system Typetname of technology: Comments (note condition of soil,signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leachingis five flows"'I 2'x4Wx2'"H-20. Flouts at 3'below grade. Ck D Box and area. No sign 9 9 of over loading. 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 constriction Indication of groundwater inflow ❑ Yes ❑ No t5in3•3113 Tile 5 Of oiai Inspection Form:Subsurrace Sewage Disposal System-Page 13 of 17 Apr 0215 04:59p p.14 Commonwealth of Massachusetts Title .5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 122 Pinquickset Cove Circle Property Address Jim Feldt Owner Ownees Name Information is required for every Cotuit MA 02635 4-1-15 page. cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy I i I Pr ovate on to an :s Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.): t5ins-3/13 Title 5 Orfidd Inspection Form:Subsurface Sewage Disposal System•Page 14 of V Apr 02 15 05:00P p.15 Commonwealth of Massachusetts Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 122 Pinquickset Cove Circle Property Address -- ^-- Jim Feldt Owner pWner's Name information is Cotuit MA 02635 4-1-15 required for every ._ page. Cityfrown State Zip Code Date of Inspection D. System Information (coat.) 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 i i 00 1354 ly 1 V i Apr 02 1 05:00p p.16 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 122 Pinquickset Cove Circle Property Address Jim Feldt Owner Owners Name reformation required for every Cotuit MA 02635 4-1-15 page. Ckylrown state Zip Code Date of Inspection D. System Information (cunt.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells �o Estimated depth t high ground water: 12'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: 2-23-83 Date ❑ Observed site(abutting propertylobservation hole within 160 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: T.H. on Design Plan 2-23-83 no G.W.at 12'. Bottom of flows at 4' below grade. Bottom of flows at 8' above T.H. Depth. Before filing this Inspection Report,please see Report Completeness Checklist an next page. tFins-3h3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Adr 02 15 05:00p p.17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 122 Pinquickset Cove Circle Property Address Jim Feldt Owner Owner's Name ---._ information is COtUIt required for eve MA 02635 4-1-15 page. . Cityfrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3113 Title 5 Offidel Inspection Form.Subsurfma Sewage Disposal System•Page 17 of 17 t No.—�-----7----- Fee-----=------------ BOARD OF HEALTH TOWN OF BARNSTABLE r/ VA 10 03 0pplicationArVell CootructiodPermit Ap licatio is hereby made or a permit to Construct (- , Alter ( ), or epair ( te rvidual Well at: �. Location — Address Assessors 'lap a d Parcel / , caner Add s Installer.— Driller Addres9� Type of Building Dwelling -------------------------------- 1 Other - T e of Building No. of Persons-------------------- Type of Well- "mod --- - Capacity-- Purpose of Well---=t-�n� �-�''�'------- 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 uo*ff__a)qert,4Fica lance has been issued by the Board of Health. Signed — - ------- _/a-45 07_ —-- date Application Approved By `. - s--------— date Application Disapproved for the following reasons:--=-------- - - ---— - ----- — date Permit No. tns1 0(i - 3 V - Issued—1b_-1 S—G --- -- -- -- date BOARD OF HEALTH TOWN OF BARNSTABLE (Certificate ®f (Compliante THIS I TO E31j � That the)ndividual Well Constructed (Altered ( ), or Repaired ( ) by—-- Installer / / 2 has been installed i accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No.I L?u0 7=VDated 4d---/5,_ ' 7 THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. I DATE- ---- --- --— - --- Inspector---- -- - ---------- si ,?Gb -U3 y ; ; ,. • k w +* �No. Fee ------ 5------ ------------------ BOARD OF HEALTHf TOWN' OF BARNSTABLE riri " Applicat ion ArWell Co0tructionPermit Ap licatio}. is hereby made'for a permit to Construct (�), Alter ( ), or Repair ( )an ' dividual Well at: t 005 —_ Location — Address Assessors ap a d Parcel '— Owner Address ' Installer — Driller Address/ Type of Building Dwelling --- -- —----- Other - Type of Building--------------------- No. of Persons---- ------------------- Type of Well �� yD f yp ���--___��---t-.----- - Capacity--�- �-{-�--------- - � - Purpose of Well--- 1 ------------ 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 I place the well in operation until a)Certifica e�.of Coo ¢fiance has been issued by the Board of Health. �. Signed � ----- --- date 0-7 Application Approved By �•V� `�`�- - -- date Application Disapproved for the following reasons: ---------- — r Ili -------- - - ----- . --------- --- = - i date I Permit No. G� �- -L� ---- Issued—) -- date — BOARD OF HEALTH TOWN OF BARNSTABLE C ertif irate Of COMPU nce THIS I _TO CE I That the ndividual Well Constructed (jam- Altered ( ), or Repaired,(• ) s — �/ _------- Installer 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. LJ 'U 7_2 3yDated!6- 7 THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE----- —- - Inspector—__--_-- ----- —- i f BOARD OF HEALTH i TOWN OF BARNSTABLE Well CongtructionPermit waw-7 a17 No. - Fee ------- -- Permission is hereby granted to Construct (t�Al,ter ( )t or Repair ( ) an Individual Wel.at:No. , sirc�t>.c�.to � �lr/ c�2 street as shown on the application for a Well Construction Permit rJ - No. -- Dated-`w(,1 /y'� —_-------------------- J ( Board of Health DATE 1� No. °? _-033 Fee BOARD OF HEALTH TOWN OF BARNSTABLE F C ro e e" P�,aUa7-o31-1 Zipplicat ion for Veil Congtruction3permit Applicatioa is hereby made for a permit to Construct (W, Alter ( ), or Repair ( )an individual Well at: ptr Ck'k-1 ----` -r-P�- -- _ I Location — Address Assessors Map n Parcel <� t Owner Add Installer — Driller Address Type of Building Dwelling _—--- -- -- ----------- Other - Type of Building------------ - - No. of Persons.----------------------- Type of Well ��� L- -.- --- - Capacity--_1s� --- --- Purpose of Well -�111_ -t ------ Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Bamstable Board of Health Private Well Protect* n Regulation - The undersigned further agrees not to place the well in operation untilna Cert' 'cate nce has been issued by the Board of Health. Signed — O- /s-o _ date Application Approved By date Application Disapproved for the following reasons:-------— - —- - - ---- -- •---------- — ------------------------ date Permit No.--12-00-7-U?Z -- Issued - date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliance THIS 1�0 CERTIFY. That the I dividual Well Constructed (Altered ( ), or Repaired ( ) by- -� (::: _ !L d -- --_ --- -- -- - - -- - ---- --- ---- -- Installerp of at C'0�1e- 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. It O"�-'B ---Dated 4-OL7------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE----- -- —- -- Inspector------ - - - - —----- - � Y No. a 7- D 33 �K Fee------------------- BOARD OF HEALTH TOWN OF BARNSTABLE F C �ro e� i 7-03 ZippCicat ion_*rVe[C Congtruct ion Permit ApplicatioA is hereby made for a permit to Construct ('4,) Alter ( ), or Repair ( )an individual Well at: _ T Location — Address Asses Map and Parcel Add Owner re al j — Installer — Driller — Address Type of Building j Dwelling -- ----------- -- - ---------- Other - Type of Building--- -------- No. of Persons----------------- g Type of Well - L'- --=-s- Capacity--- /—S,���--f--- i Purpose of Well ---- i 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 Protectt n Regulation - The undersigned further agrees not to place the well in operation until-a Certificate of% rnp' nce has been issued by the Board:of Health. Signed ----------- — /�^ date -- Application Approved By -----— � date r Application Disapproved for the following reasons:--------- --- --- - --- -date Permit No. 2 GO -�3 - -- Issued'—_J.0 5—d�--------- date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate ®f Compliance THIS IS 140 CERTI That the I dividual Well Constructed (41, Altered ( ), or RepairedN, ) —�-----=——-- ------— —-- r— --- — -- — —--— ` ----y__ Installers ! 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. W2 =6? ---f Dated-j ?1°-2------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. s it �,✓"- I' DATE----= — . --- - Inspector-------- -- - __--- --- BOARD OF HEALTH TOWN OF BARNSTABLE Mell Con5truct ion Permit ' No. w� ����3l --- G Fee- Permission is hereby grantedto Construct (Z'); Alter ( ), or Repair ( ) an Individual Well t: -- -— -- � street as shown on the application for a Well Construction Permit f No. -- ------- Dated--�� S!�? ' U lnl. _ Board of Health DATE -- _..t4 s TOWN OF BARNSTABLE 4. 1. � /, LOCATION /�� Joki yyrtkazlY C" !3/7 SEWAGE # 1"VtLAGE C01,v,/- ASSESSOR'S MAP & LOT 0G'�'06 INSTALLER'S NAME&PHONE NO.- r�y��i �o».: r im.f 5s�Y4�vz SEPTIC TANK CAPACITY &ayp LEACHING FACU Y: (type) (size) i NO.JU BEDROOMS J r- Bi.TIL.DER R OWNER PERMIT DATE: /?- 3-® 5/ COMPLIANCE DATE: y 13 6 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility r� Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by O'C',J,-_ f &/ �3`___3i-__ 00 9L 1' j s7 '( " 0 .f i i1y 3y`6` \r Y 7 � t No. li 09_�(1 J r ' , Fee—ITZ — THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 0(pprication for Miopozar bp5tem Conotruction 3permit Application for a Permit to Construct(/)Repair( )Upgrade( )Abandon( ) L Complete System El Individual Components Location Address or Lot No.f Owner's Name,Address and Tel No. Assessor's Map/Parcel C67`u Installer's Name,Address,and Tel.No, Designer's Name,Address and Tel.No. / Type of Building: Dwelling No.of Bedrooms Lot Size��sq.ft. Garbage Grinder(f/Cs Other Type of Building o. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Z-� ® Number of sheets 1 Revision Date / Title A 4!�04'- C e Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued this Bo of alth. l Signed Date <� Application Approved by .1. Date �•� v Application Disapproved for the following reasons Permit No. 2 of -6 .?G Date Issued 12 j �,� _ .• �",� .a.,. t"t tY '.. o � �No _- rf � •--ems Fee _ .. '-� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:. Yes ,PUBLIC HEALTH-DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS ' Zlpprication for-30i�ponl *pztem Contrurtion-Permit �,. Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) .U Complete System ❑Individual Components Location Address or Lot No. e Owner's Name.Address and Tel No. ' �a��s Assessor's Map/Parcel n6,Iv Installer's Name,Address,and el.N . U(f p Desig er's Name,Address and Tel.No. Type of Building: C Dwelling No.of Bedrooms J Lot Size 1 7f q 71 sq.ft. Garbage Grinder( � S Other Type of Building Gt'1/O�e ke 7�No. of Persons —Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Z Plan Date 777 Number of sheets /I Revision Date Title /Z �fl�l/I/C�SIj� �4G� GIAC— e Size of Septic Tank Type of S.A.S. Description of Soil �O •d/?� 7`—C/S�/S No ) ' 1 gNature of Repairs or Alterations(Answerkwhen 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 yjfj this BoaxdW Health Signed Date Application Approved by \ Date �� :02 v Application Disapproved for the following reasons Permit No. 2 UV y ` �cJ Date Issued 1 2 P11 L , THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CER IFY,�ttha�tt t e O -site wage Disposal System Constructed( ) Repaired ( )Upgraded( ) Abandoned ) y /U� m 1 Z-Z- Pi&Q41r s- C© + 457 W17_� has been constructe in "cc�of ance with the provisions of Title 5 and the for Disposal System Construction Permit No. a G o`�/ o-6 3 5 dated a�� T Installer Designer The issuance l!o�� this p1e t shall not be construed as a guarantee that the system will,fu fction as designed. Date `I f 3t Inspector � No. d�UO b� / ----------------------.----Fee /5 � THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS �Bigogal *pgtem Construction Permit Permission is hereby granted to Co §truct( Repair( )U grade( )Abando ( ) System located at Z / /�Q tll ee5i! , G J' and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of thirpe it Date: Approved by i �T Town of Barnstable Regulatory Services Thomas F.Geiler,Director yam;. Public Health Division ... Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-8624.644 Fax: 508-790-6304 Installer&Designer Certification Form Date: Sewage Permit# 200Y-G39 Assessor's Map\Parcel ►'h 5 P�-1 G8' Designer: 15k ohco A . Wi Isom PI L . Installer: 13ar4-o I to fit; Cc ns+-, Address: Be Kke—N4.4. Address: ('. o , >3 dx 2p 4 C� �ItlYJ'L S7. HNLNHI S �2�i�) •I oysh-, wits n2�.,i On 12 f 7- 200q B s r o l e W Crxs}ryQ}Lhn was issued a permit to install a (date) (installer.) septic system at 122 �n�u�eks�F r�� Gtrcl�.Cn�u,f based on a design drawn by (address) �— Skc r kc„ A lily ly at , -P.C- . dated S 12o,-,�! (designer) [_ I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with.State &Local.Regulations. Plar.revision or certified as-built by designer to follow. STEPHEN. �G ALLYN (Installer's Signature) W -Say+ No.S 16 9�GISTC ��sS/CdAL (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form 3-26-04.doc 6,98) 1 t' rf B LE i 79 OS APR 19x PH ! : 39 i r r S T only; q . Ili "'� Q COMMONWEALTH OF MASSACHUSETTS EXECUTIVE'OFFICE OF ENVIRONMENTAL AFFAIRS M DEPARTMENT OF ENVIRONMENTAL PROTECTION RECEIVED SEP232002 TOWN OF BA'K.iv' ,IILE h TITLE HEALTH DEPT. OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A , ti CERTIFICATION -7 K� Property Address: 122 PINQUICKSET COVE COTUIT,MA 02635 Owner's Name: MCCUBBIN Owner's Address: PO BOX 1923 COTUIT MA 02635 Date of Inspection: 9/4/02COP? Name of Inspector: (please print),',,;, '.; JOHN GRACI h Company Name: z,SEPTIC INSPECTIONS Mailing Address: P•.O BOX 2119 TEATICKET, MA. 02536 Telephone Number: 508-564-6813 FAX 508-564-7270 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 r 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�0 Title 5(310 CMR 15.000). The system: X Passes _ Conditionally P^ ses _ Needs:Furth valuation by the Local Approving Authority. Fails Inspector's Signature:q, ! Date: 9/4/02 The system inspector shall submit alcopy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspecti n. 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 of ice 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 SYSTEM PASSED TITLE V INSPECTION. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. n ' ,, 0 Y ****This report only describes edn`ditiuns at the time of inspection and undo► the conditions of use at that time.']'his inspection does not address how the-system will perform in the future under the same or different conditions of use. Titlr C Imnif-rtion Form Ali snnrio Page 2 of I 1 i �i OFFICIAL INSPECTIONYORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 122 PINQIJICKSET COVE COTUIT,MA 02635 Owner: MCCUBBIN Date of Inspection: 9/4/02 Inspection Summary: Check%A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: X 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: SYSTEM PASSED TITLE V,INSPECTION. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. • ' B. System Conditionally Passes:, _ One or more system components`a`s�,described in the"Conditional Pass"section need to be replaced or repaired.The system, upon completion of the replacementAor,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. n/a The septic tank is metal an&6ver 20 years old* or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is'available. ND explain: n/a n/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 _`&structivin is'Iremoved _ distribution box is leveled or replaced ND explain: n/a n/a The system required pumping more t:i2n'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 pine)are replaced _obstruction'is removed ND explain: n/a is t :s Page 3 of I 1 t OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM .. PART A ,CERTIFICATION(continued) Property Address: 122 PINQUICKSET COVE COTUIT,MA 02635 Owner: MCCUBBIN Date of Inspection: 9/4/02 C. Further Evaluation is Requir`ediby'the Board of Health: _ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment.. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner'which will protect public health,safety and the environment: Cesspool or privy is within,50 feet of a surface water _ Cesspool or privy is within 50'feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: - _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a,surface`water`supply. _ The system has a septic tank and•SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic ta6kaan8 SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank tand SAS'and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used io dieferrnine distance n/a "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. ' 4 f ,ri 3. Other: �►`� Y.� n/aa 4'1 f it;1 Ea: Page 4 of 11 w, OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A jtt CERTIFICATION(continued) Property Address: 122 PINQUICKSET COVE COTUIT,MA 02635 Owner: MCCUBBIN Date of Inspection: 9/4/02 , D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each ofthe•.following for alLinspections: Yes No X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _ X Discharge or ponding of effluent to,the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ,. s X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in cesspool is less than 6"below invert or available volume is less than ''/2 day flow X Required pumping more than,,4.times in the last year NOT to clogged or obstructed pipe(s).Number of times pumped NO PUMINd INFORMATION. X Any portion of the SAS,cesspool or privy is below high ground water elevation. _ X Any portion of cesspool orlprivy is within 100 feet of a surface water supply or tributary to a surface water supply. _ X Any portion of a cesspool or-privy is,within a Zone 1 of a public well. _ X Any portion of a cesspool or'privy is within 50 feet of a private water supply well. X 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 facilityand the of ammonia presence a nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form..] (Yes/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.'' F� 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. 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 X the system is within 400 feet-of a'surface drinking water supply _ X the system is within 200 feet of a tributary to a surface drinking water supply _ X the system is located in a nitrogen'sensi'tive area(Interim Wellhead Protection Area—1 WPA)or a mapped Zone 11 of a public water supply well If you have answered"yes"to anyquestion 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 lailcd under Secti01101)shall*upgrade the system in accordance with 310 CMR 15.304. The system owner' should contact the appropriate regional office of the Department. t s, Page 5 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE''SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B @ 1 CHECKLIST Property Address: 122 PINQUICKSET"COVE COTUIT,MA 02635 Owner: MCCUBBIN ' Date of Inspection: 9/4/02 ' Check if the following have beerijdone`:You must indicate "yes"or"no" as to each of the following: Yes No X _ Pumping information was provided by the owner, occupant, or Board of Health X Were any of the system components pumped out in the previous two weeks? X _ Has the system received normal flows in the previous two week period? _ X Have large volumes of water been introduced to the system recently or as part of this inspection'? X _ Were as built plans of the system obtained and examined?(If they were riot available note as N/A) of 4 X _ Was the facility o0dwelling inspected for signs of sewage back up? X _ Was the site inspected for signs of break out'? X _ Were all system components,excluding the SAS, located on site '? X _ Were the septic tank mail io*les 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 ? X _ Was the facility owner`(and,occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems--? k: The size and location of the Soil'Absarpation System (SAS)on the site has been determined based on: Yes no }_ X _ Existing information. For example;a plan at the Board of Health. X _ Determined in the field(if any of then failure criteria related to Part C is at issue approximation of distance is unacceptable) [3 10 CMR 15.302(3)(b)] of S Page 6 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 122 PINQUICKSET COVE COTUIT, MA 02635 Owner: MCCUBBIN , t, Date of Inspection: 9/4/02 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 5-4 Number.of bedrooms(actual): 5 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550 Number of current residents::2 Does residence have a garbage grinder(yes or no): NO - Is laundry on a separate sewage.system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes ortno): NO ' Seasonal use: (yes or no): NO 1` Water meter readings, if available p(last42 years usage(gpd)): n/a Sump pump(yes or no): NO Last date of occupancy: n/a It ,1 . . COMMERCIAL/INDUSTRIAL Type of establishment: n/a z� ;•'." Design flow(based on 310 CMR 151.203;):"n/agpd Basis of design flow(seats/persons/sgft,elc): n/a Grease trap present(yes or no) NO.;" k. Industrial waste holding tank present,(yes cr no): NO Non-sanitary waste discharged to the Title 5 system(yes or no): NO Water meter readings, if available: Last date of occupancy/use: n/a A OTHER(describe): n/a 'GENERAL INFORMATION Pumping Records Source of information: NO PUMING INFORMATION Was system pumped as part of the inspection(yes or no): NO If yes,volume pumped: n/agallons--How was quantity pumped determined?n/a . Reason for pumping: n/a TYPE OF SYSTEM X Septic tank,distribution box,soil'ab'sorption system _Single cesspool Overflow cesspool _Privy i _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): n/a Approximate age of all components,,date installed(if known)and source of infonnation: 18 YEARS BY OWNER Were sewage odors detected when arriving at the site(yes or no): NO tt e Page 7 of l 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ",..SYSTEM INFORMATION(continued) Property Address: 122 PINQUICKSET COVE COTUIT, MA 02635 Owner: MCCUBBIN " Date of Inspection: 9/4/02 BUILDING SEWER(locate on site'plan) Depth below grade: 22" Materials of construction:_cast iroii'_40 PVC Xother(explain): 20 PVC Distance from private water supply'welI or suction line: n/a Comments(on condition of joints,venting,evidence of leakage,etc.): WELL WATER SEPTIC TANK: X(locate on site plan) Depth below grade: 16" Y Material of construction: Xconcrete metal_fiberglass_polyethylene other(explain)n/a If tank is metal list age: n/a Is age`'o'nfirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) Dimensions: 150OG L 10' 6". H 5�6" W 5'"83'" Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 32" Scum thickness: 2" ' Distance from top of scum to toR of outlet.-tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 16" How were dimensions determined: MEASURED Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): SEPTIC TANK AND ALL CQMPONENTS ARE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY. RECOMMEND PUMPING EYERY,TWO,YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. GREASE TRAP: _(locate on site plan) Depth below grade: n/a r Material of construction:_concrete,. metal. fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or.baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle: n/a J. Date of last pumping: n/a, Comments(on pumping recommendations;inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of.leakage,etc:): n/a t;p Page 8 of I I T 4, •k OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 122 PINQUICKSET COVE COTUIT,MA 02635 Owner: MCCUBBIN t Date of Inspection: 9/4/02 ^t TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: n/a Material of construction: concrete, metal._fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Capacity: n/a gallons Design Flow: n/a gallons/day .i Alarm present(yes or no): N/A Alarm level: N/A Alarm in working order,(yes or no):NO Date of last pumping: n/a " t, Comments(condition of alarm an'd float`switches,etc.): n/a ' DISTRIBUTION BOX: X(if`prese6t,mustb6,opened)(locate on site plan) Depth of liquid level above outlet invert:.LEVEL WITH BOTTOM OF PIPE 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.): D-BOX WAS VIDEO INSPECTED"AND APPEARS TO BE STRUCTURALLY SOUND. PUMP CHAMBER: _(locate on site plan);'"-, Pumps in working order(yes or no): NO Alarms in working order(yes or no):NO Comments(note condition of pump chamber;i;condition of pumps and appurtenances,etc.): n/a .k ' 3 { s. � Page 9 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued). Property Address: 122 PINQUICKSET COVE COTUIT, MA 02635 Owner: MCCUBBIN Date of Inspection: 9/4/02 + SOIL ABSORPTION SYSTEM(SAS): X:,(locate on site plan,excavation not required) If SAS not located explain why: n/a Type 1000 GAL 6' X 6' leaching pits, number: 2 n/a leaching chambers, number: n/a n/a leaching galleries, number: n/a n/a Teaching trenches, number, length: n/a n/a leaching fields, number: n/a n/a ra overflow cesspool, number: n/a n/a system .'Type/name of technology: n/a Comments(note condition oflsoil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.): DID NOT EXPOSE LEACH PITS,APPEAR TO BE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY. SYSTEM SHOWS NO SIGNS OF FAILURE. CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: n/a Depth—top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer: n/a , Dimensions of cesspool: n/a Materials of construction:n/a Indication of groundwater inflow(yes or no):NO Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a PRIVY: (locate on site plan) ,`; Materials of construction: n/a 4 Dimensions: n/a Depth of solids: n/a Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a Page 10 of 1 l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 122 PINQUICKSET COVE COTUIT, MA 02635 Owner: MCCUBBIN Date of Inspection: 9/4/02 t,. a a 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. 0 0 ZD,N. p Q 2�O gyp=° 1�`� ° 3. 4 " in Page I l of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE_SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) tik Property Address: 122 PINQUICKSET COVE COTUIT,MA 02635 Owner: MCCUBBIN , Date of Inspection: 9/4/02 SITE EXAM _Slope a . _Surface water _Check cellar Shallow wells Estimated depth to ground water 10a+feet' , Please indicate(check)all methods used to determine the high ground water elevation: NO Obtained from system design plans on record-If checked,date of design plan reviewed: n/a YES Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain: n/a NO Checked with local excavators, installers-(attach documentation) NO Accessed USGS database-ex`pfa:5n.`n/a .r You must describe how you established the high ground water elevation: HAND AUGER- 10+FT. ty,, T►. f 10 Yf i 8 Thomas&Betts Qorporatlon A f0' 452 John Dietsch Blvd. P.O. Box f � Attleboro Falls, MA 02763 4 (508) 699-9800 S EP 4 1998 Facsimile(508) 695-8111 ~ Thomas° efts August 10, 1998 Mr. and Mrs.John T. McCubbin 122 Pinquickset Cove Road Cotuit, Massachusetts 02635 Dear Mr. and Mrs. McCubbin: Enclosed please find the laboratory results of the analysis of your well water, which we recently sampled at your property located at 122 Pinquickset Cove Road in Cotuit, Massachusetts. The water sample, designated as RW- 2, was collected by GZA GeoEnvironmental, Inc. and analyzed by the Mitkem Corporation laboratory. Chloroform was found in your well water at a concentration of 1 part per billion. This contaminant is not related to the 106 Falmouth Road Site. These results were sent to the Massachusetts Department of Environmental Protection(DEP). We understand that the DEP generally advises that"there is currently no drinking water standard for chloroform in non-chlorinated water supplies. The Department's Office of Research and Standards has established a drinking water guideline for chloroform of 5.0 ppb in non-chlorinated water supplies. Chloroform is considered to be naturally occurring and ubiquitous throughout Cape Cod. Chloroform has also been associated with on-site septic systems." If you have any questions regarding chloroform, please call the Barnstable Board of Health or DEP. As you may recall, the contaminants of concern at the 106 Falmouth Road Site were industrial solvents and cleaners potentially related to historic operations at that facility. To test for such materials, the laboratory analyzes for the range of VOCs specified by the EPA's testing method. That is why the Laboratory Analysis Report covers such a long list of organic compounds. Beside the list of compounds are two columns of data. The fast column shows the concentration of the compound,in parts per billion(ppb),that was found in your well water. The letters "ND" mean the compound was not detected. The second column shows the lowest level at which the laboratory could accurately quantify the compound. We appreciate your allowing us to come and test your water. If you have any questions,please do not hesitate to call Mike Powers at GZA(401-421-4140, ext. 3404). Sincerely, William O. Frigon Attachment: Laboratory Analysis Report cc: Town of Barnstable Board of Health Mark Wood,DEP MIT KENI CORPORATION June 29, 1998 GZA GeoEnvironmental, Inc. JUL 01 1y98 140 Broadway Providence, RI 02903 Attn: Ms. Hilary Fortune RE: Client Project#: 31751.13, Residential Well Sampling Lab Project#: E0963 Dear Ms. Fortune: Enclosed please find the data report of the required analyses for the samples associated with the above referenced project. If you have any questions regarding this report,please call me. We appreciate your business. Sin ely, Edward A. Lawle Laboratory Operations Manager 175 Metro Center Boulevard• Warwick,-Rhode Island 02886-1755 • (401) 732-3400 • Fax (401) 732-3499 email: mitkem@worldnet.att.net f O POR Client: GZA GeoEnvironmental,Inc. Client Project: 31751.13, Residential Well Sampling Lab Project: E0963 Date samples received: 6/22/98 Project Narrative This data report includes the analysis results for five (5) aqueous samples that were received from GZA GeoEnvironmental, Inc.'on June 22, 1998. Analyses were performed per specification in the Chain of Custody form. For reference, a copy of the Mitkem Sample Log- In form is included for cross-referencing the client sample ID and laboratory sample ID. All of the analyses were performed according to method specifications. No unusual occurrences were noted during sample analysis. This data report has been reviewed and is authorized for release as evidenced by the signature below. Edward A. Lawler Laboratory.Operations Manager 00i MITKENi CORPORATION Analysis Report: Purgeable Volatile Organics Client: GZA GeoEnvironmental, Inc. Analysis Date: 6/25/98 Client ID: RW-2 Concentration in: ug/L Lab ID: E0963-04 Dilution: 1 Analysis: Method 524.2 Reporting Analyte Results Lida t Dichlorodifluoromethane ND 0.5 Chloromethane ND 0.5 Vinyl chloride ND 0.5 Bromomethane ND 0.5 Chloroethane ND 0.5 Trichlorofluoromethane ND 0.5 1,1-Dichloroethene ND 0.5 Methylene chloride ND 0.5 trans-1,2-Dichloroethene ND 0.5 1,1-Dichloroethane ND, 0.5 2,2-Dichloropropane ND 0.5 cis-1,2-Dichloroethene ND 0.5 Bromochloromethane ND 0.5 Chloroform 1 0.5 1,1,1-Trichloroethane ND 0.5 Carbon tetrachloride , ND 0.5 1 1 1-Dichloropropene ND 0.5 Benzene ND 0.5 1,2-Dichloroethane ND 0.5 Trichloroethene ND 0.5 1,2-Dichloropropane ND 0.5 Dibromomethane ND 0.5 Bromodichloromethane ND 0.5 cis-1,3-Dichloropropene ND 0.5 Toluene ND Y 0.5 trans-1,3-Dichloropropene ND 0.5 . 1,1,2-Trichloroethane ND 0.5 Tetrachloroethene ND 0.5 1,3-Dichloropropane ND 0.5 Dibromochloromethane ND 0.5 1,2-Dibromoethane ND 0.5 Chlorobenzene ND 0.5 1,1,1,2-Tetrachloroethane ND 0.5 008 Page 1 of 2 E0963-04 MITKE CORPORATION Client ID: RW-2 Lab ID: , E0963-04 Reporting Analyte Result Licat Ethylbenzene NO 0.5 Xylenes (total) ND 0.5 Styrene ND 0.5 Bromoform ND 0.5 I sopropy I benzene ND 0.5 Bromobenzene ND 0.5 1,1,2,2-Tetrachloroethane ND 0.5 1,2,3-Trichloropropane ND 0.5 n-Propylbenzene ND 0.5 2-Chlorotoluene ND 0.5 4-Chlorotoluene ND 0.5 1,3,5-Trimethylbenzene ND 0.5 tert-Butylbenzene ND 0.5 1,2,4-Trimethylbenzene ND 0.5 sec-Butylbenzene ND 0.5 1,3-Dichlorobenzene ND 0.5 4-Isopropyltoluene ND 0.5 1,4-Dichlorobenzene ND 0.5 1,2-Dichlorobenzene ND 0.5 n-Butylbenzene ND 0:5 " 1,2-Dibromo-3-chloropropane ND 0.5 1,2,4-Trichlorobenzene ND 0.5 Hexachlorobutadiene ND 0.5 1,2,3-Trichlorobenzene ND 0.5 Naphthalene ND 0.5 QC Batch: V1 B0625A Surrogate Recovery: Bromofluorobenzene 114% 1,2-Dichlorobenzene-d4 102% ND= Not.Detected Page 2 of 2 E0963-04 9 I Analysis Report: Purgeable Volatile Organics Client: GZA GeoEnvironmental, Inc. Analysis Date: 6/25/98 Client ID: Trip Blank Concentration in: ug/L Lab ID: E0963-05 Dilution: 1 Analysis: Method 524.2 Reporting Analyte Results Dichlorodifluoromethane ND 0.5 Chloromethane ND 0.5 Vinyl chloride ND 0.5 Bromomethane ND 0.5 Chloroethane ND 0.5 Trichlorofluoromethane ND 0.5 1,1-Dichloroethene ND 0.5 Methylene chloride ND 0.5 trans-1,2-Dichloroethene ND 0.5 1,1-Dichloroethane ND 0.5 2,2-Dichloropropane ND 0.5 cis-1,2-Dichloroethene ND 0.5 Bromochloromethane ND 0.5 Chloroform ND 0.5 1,1,1-Trichloroethane ND ` 0.5 Carbon tetrachloride ND 0.5 1,1-Dichloropropene ND 0.5 Benzene ND 0.5 1,2-Dichloroethane -ND 0.5 Trichloroethene ND 0:5 1,2-Dichloropropane ND 0.5 v Dibromomethane ND 0.5 Bromodichloromethane ND 0.5 cis-1,3-Dichloropropene ND 0.5 Toluene ND 0.5 trans-1,3-Dichloropropene ND 0.5 1,1,2-Trichloroethane ND 0.5. Tetrachloroethene ND 0.5 1,3-Dichloropropane ND 0.5 r Dibromochloromethane ND 0.5 1,2-Dibromoethane ND 0.5 Chlorobenzene ND 0.5 1,1,1,2-Tetrachloroethane ND 0.5 ��-- qq oto Pagel of 2 E0963-05 v Client ID: Trip Blank Lab ID: E0963-05 Reporting Analyte Result Limit Ethylbenzene ND 0.5 Xylenes (total) ND 0.5 Styrene ND 0.5 Bromoform ND 0.5 Isopropylbenzene ND 0.5 Bromobenzene ND 0.5 1,1,2,2-Tetrachloroethane ND 0.5 1,2,3-Trichloropropane ND 0.5 n-Propylbenzene ND 0.5 2-Chlorotoluene ND 0.5 4-Chlorotoluene ND 0.5 1,3,5-Trimethylbenzene ND 0.5 tert-Butylbenzene ND 0.5 1,2,4-Trimethylbenzene ND 0.5 sec-Butylbenzene ND 0.5 1,3-Dichlorobenzene ND . 0.5 4-Isopropyltoluene ND 0.5 1,4-Dichlorobenzene ND 0.5 1,2-Dichlorobenzene ND 0.5 n-Butylbenzene ND 0.5 1,2-Dibromo-3-chloropropane ND 0.5 1,2,4-Trichlorobenzene ND . 0.5 Hexachlorobutadiene ND 0.5 1,2,3-Trichlorobenzene ND 0.5 Naphthalene ND 0.5 QC Batch: V1 B0625A Surrogate Recovery: Bromofluorobenzene 114% 1,2-Dichlorobenzene-d4 102%- ND= Not Detected Oil Page 2 of 2 E0963-05 CORPORATION Analysis Report: Purgeable Volatile Organics Client: GZA GeoEnviron mental, Inc. Analysis Date: 6/25/98 Client ID: Concentration in: ug/L Lab ID: Method Blank, V160625A Dilution: 1 Analysis: Method 524.2 Reporting Analyte Results Limit Dichlorodifluoromethane ND 0.5 Chloromethane NO 0.5 Vinyl chloride ND 0.5 Bromomethane ND 0.5 Chloroethane ND 0.5 Trichlorofluoromethane ND 0.5 1,1-Dichloroethene ND 0.5 Methylene chloride ND 0.5 trans-1,2-Dichloroethene ND 0•5 1,1-Dichloroethane ND, 0.5 2,2-Dichloropropane ND 0.5 cis-1,2-Dichloroethene ND 0.5 Bromochloromethane ND 0.5 Chloroform ND 0.5 1,1,1-Trichloroethane N D 0.5 Carbon tetrachloride ND 0.5 1,1-Dichloropropene ND 0.5 Benzene ND 0.5 1,2-Dichloroethane ND 0.5 Trichloroethene ND 0.5 1,2-Dichloropropane ND 0.5 Dibromomethane ND 0.5 Bromodichloromethane ND 0.5 cis-1,3-Dichloropropene. ND 0.5 Toluene ND 0.5 trans-1,3-Dichloropropene ND 0.5 1,12-Trichloroethane ND 0.5 Tetrachloroethene ND 0.5 1,3-Dichloropropane ND 0.5 Dibromochloromethane ND 0.5 1,2-Dibromoethane ND 0.5 Chlorobenzene ND 0.5 1,1,1,2-Tetrachloroethane ND 0.5 12 Page 1 of 2 E0963-MB MITKEIM CORPORATION Client ID: Lab ID: Method Blank,.V1B0625A Reporting . Analyte Result L1mt Ethylbenzene 1 ND 0.5 Xylenes (total) ND 0.5 Styrene s ND 0.5 Bromoform ND 0.5 Isopropylbenzene ND 0.5 Bromobenzene ND 0.5 1,1,2,2-Tetrachloroethane ND 0.5 1,2,3-Trichloropropane ND 0.5 n-Propylbenzene ND 0.5 2-Chlorotoluene ND ' 0.5 4-Chlorotoluene ND 0.5 1,3,5-Trimethylbenzene ND 0.5 tert-Butylbenzene. ND 0.5 1,2,4-Trimethylbenzene ND 0.5 sec-Butylbenzene ND 0.5 1,3-Dichlorobenzene ND 0.5 4-Isopropyltoluene ND 0.5 1,4-Dichlorobenzene ND 0.5 1,2-Dichlorobenzene ND 0.5 n-Butylbenzene ND 0.5 1,2-Dibromo-3-chloropropane ND 0.5 1,2,4-Trichlorobenzene ND 0.5 Hexachlorobutadiene ND 0.5 1,2,3-Trichlorobenzene ND 0.5 Naphthalene ND 0.5 QC Batch: V1 B0625A Surrogate Recovery: Bromofluorobenzene 108% 1,2-Dichlorobenzene-d4 102% ND= Not Detected. 013 Page 2 of 2 E0963-MB MITKEM RPO Analysis Report: Purgeable Volatile Organics Client: GZA GeoEnviron mental, Inc. Analysis Date: 6/26/98 4 Client ID: Concentration in: ug/L Lab ID: Method Blank,VlB0626A Dilution: 1 Analysis: Method 524.2 Reporting Analyte Results L1II]!t Dichlorodifluoromethane ND 0.5 Chloromethane ND 0.5 Vinyl chloride ND 0.5 Bromomethane ND 0.5 Chloroethane ND 0.5 Trichlorofluoromethane ND 0.5 1,1-Dichloroethene ND 0.5 Methylene chloride ND 0.5 trans-1,2-Dichloroethene ND 0.5 1,1-Dichloroethane ND 0.5 2,2-Dichloropropane ND 0.5 cis-1,2-Dichloroethene ND 0.5 Bromochloromethane ND 0.5 Chloroform ND 0.5 1,1,1-Trichloroethane. ND 0.5 Carbon tetrachloride 1 ND 0.5 1,1-Dichloropropene ND 0.5 Benzene ND 0.5 1,2-Dichloroethane ND _ 0.5 Trichloroethene ND 0.5 1,2-Dichloropropane ND 0.5 Dibromomethane ND 0.5 Bromodichloromethane ND 0.5 cis-1,3-Dichloropropene ND 0.5 Toluene ND 0.5 trans-1,3-Dichloropropene ND 0.5 1,1,2-Trichloroethane N D 0.5 Tetrachloroethene ND 0.5 1,3-Dichloropropane ND 0.5 Dibromochloromethane ND 0.5 1,2-Dibromoethane ND 0.5 Chlorobenzene ND 0.5 1,1,1,2-Tetrachloroethane ND 0.5 014 Page 1 of 2 E0963-MB MITKEM CORPORATION Client ID: Lab ID: Method Blank,V1B0626A Reporting Analyte Result Limit Ethylbenzene ND 0.5 Xylenes (total) ND 0.5 Styrene ND 0.5 Bromoform ND 0.5 lsopropylbenzene ND 0.5 Bromobenzene ND 0.5 1,1,2,2-Tetrachloroethane N D 0.5 1,2,3-Trichloropropane ND 0.5 n-Propylbenzene ND 0.5 2-Chlorotoluene - ND� 0.5 4-Chlorotoluene ND 0.5 1,3,5-Trimethylbenzene ND 0.'5 tert-Butylbenzene ND 0.5 1,2,4-Trimethylbenzene ND 0.5 sec-Butyl benzene ND , 0.5 1,3-Dichlorobenzene ND 0.5 4-Isopropyltoluene ND 0.5 1,4-Dichlorobenzene ND . 0.5 1,2-Dichlorobenzene ND 0.5 n-Butylbenzene ND 0.5 1,2-Dibromo-3-chloropropane ND 0.5 1,2,4-Trichlorobenzene _ND 0.5 Hexachlorobutadiene ND 0.5 1,2,3-Tdchlorobenzene ND 0.5 Naphthalene ND 0.5 QC Batch: V1 B0626A Surrogate Recovery: Bromofluorobenzene 112% 1,2-Dichlorobenzene-d4 106% ND= Not Detected Page 2 of 2 E0963-MB MITKEM CORPORATION Lab Project MI E0963 aR1 Client Name: GZA GeoEnvironmental, Inc. Client Proj#: 31751.13 Logged In By: Client PO M 3-02043 Project Name: Residential Well Sampling Reviewed By: Date Due: 6/26/98 Total Price: $ - Date: d—2y Time: V 0 u Project Mgr: PAS Salesman: PAS Del R&4d: Std�&Raw Data Completed?: YES Lab ID Client ID' Matrix Analysis Price Sampled Received TPH 1R BNA Herb lL Wet IvL�e_ V-GC V-MS Silt -01 RW-22 AQ 524.2 6/19/98 6/22/98 1 -02 RW-21 AQ 524.2 6/19/98 6/22/98 1 -03 RW-16 AQ 524.2 6/19/98 6/22/98 1 -04 RW-2 AQ 524.2 6/19/98 6/22/918 1 -05 Trip Blank AQ 524.2 6/19/98 6/22/98 1 TPH IR BNA Herb P/P Wet ' Met V-GC V-MS Si4 O E Rlehvialile added 0 0 0 0 0 0 0 0 5 0 ORIGINAL REPORT GOES TO: INVOICE GOES TO: ADDITIONAL REPORT GOES TO: GZA GeoEnvironmental,Inc Attn: Hilary Fortune Same None 140 Broadway Phone: 401 421-4140 Provid ce,RI 02903. Fax: 401 751-8613 6/24/98 1:28 PM Page 1 of 1 Lab Project M E0963 /' c 1 WHITE COPY-Original . YELLOW COPY-Lab Files PINK COPY-Project Manager W.O. # —Z O T(0 3 CHAIN-OF-CUSTODY RECORD (for lab use only) ANALYSES REQUIRED Sample Date/rime Matrix m m Q I.D. sas a F s s g a 8 . Total (Very Important) GW=Greund W. a C I % 3 3 a .0 #of Note Sw=Sude,a W. o WW.Waere W. _ $ c �i VU' L� n _ N DW=Drinking W. to � i C7 Cont. # /^' Olh1ar(aI/Pe/c/A�) _7 2 lU7 7 l .7 1 g .7 6 Y FV- It R GJ- Z. 4 I V2 /?IN- h� 1.3110 Z PRESERVATIVE (CI-HCI,N-HNO3,S-H,SO,,Na-NaOH,O-Other)' CONTAINER TYPE (P-Plastic,G-Glass,V-Vial,T-Teflon,O-Other)* RELINQUISHED BY: Affiliation) DATE/TIME BY:(Affiliate NOTES: Preservatives,special reporting limits,known contamination,etc.: 6.22-/ Unless otherwise noted,all VOA vials have been preserved w/1:1 HCL.) RELINQUISHED BY:(Affiliation) DATEfTIME R IVEDA,011 ion) / 017 G) RELINQUISHED BY:(Affiliation) DATE/TIME RECEIVED BY:(Affiliation) PROJECT MANAGER:—' EXT: TURNAROUND TIME:❑Standard ❑ Rush Days,Approved by: GZA FILE NO. `� / /- P.O. N.O. k9-62 D�� GZA GEOENVIRONMENTAL, INC. �C J���N�l�/ ti�� /�` .—� ENGINEERS AND SCIENTISTS PROJECT 140 Broadway PROVIDENCE,RI 02903 LOCATION •V `���� r' FAX(401)751-8613 COLLECTOR(S) ll/ iC-� SHEET OF MITKEM CORPORATION Sample Condition' Form Page_of Date: I-MITKEM Project: Received By: keviewe4�2� Client Project: Client: Sample ID Preservation (pH) Comments/Remarks/ Condition: Lab Client HNos H2SO4 Ha NaOH Corrective Action* 1 Custody Seal(s) Present/Absent ` Coolers/Bottles Intact/Broken 2)Custody Seal Number(s)- 3)Chain-of-Custody Present/Absent 4)Cooler Temperature Coolant Condition 5)Airbill(s) Present/Absent Airbill Number(s) 6)Sample Bottles Intact Broken s Leaking 7) Date Received 8)Time Received 9)Project Due Date See Sample Condition Notification/Corrective Action Form yes/no lJ 8 LO CAT I(ON -�� SEWAGE PERMIT NO. ;1-® 7-8 VILLAGE INSTALLER'S NAME i ADDRESS I t U 1 L D E R OR OWNER �e ti5 s �3,-2�4A DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED QF !�/�� 1 1' h VI Oil .S"q IS9 ri�YJ�P�9v r e- ` THE COMMONWEALTH Oir MASSACHUSETTS BOARD OF HEALTH ...--- �. ...................OF....... �- .1... L 4 E i�................................... Appliration for Uiovo,itti Workii Tonotrnrtion .ermi# Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal. System at: / L,o.t' Location.Addr zs or Lot No. C. �AS6 gin.. --"- ' .... - - .... Ow er Address a ---••• . �-eV-c�z.��--_C�x------------------------------------------• ••--••••.......................... ......_-------- - ....... t� Installer Address 1 C6 AC k- d Type of Building 5 ��\ems Awe���( —w crts��rc.�.�Q Size Lot_��;--D--•4-d.....Sq. feet V Dwelling—No. of Bedrooms.............f.�.......,....................Expansion A�tic ( ) Garbage Grinder ( ) Other—Type of Building L'Cd�a _C!�" o. of persons_..........-«........... Showers ( ) — Cafeteria ( ) Q, Other fixtures .---•----•-••-•-•-••----•----• . W Design Flow...................... ............�2.._..gallons per person per day. Total daily flow........... ......................gallons. 1:: Septic Tank—Liquid capacitylZC.P._gallons Length................ Width..........----.. Diameter-----------. Depth.:'...... W Disposal p Trench—No. _.!!��....... Width....... Total Length...... ........ Total leaching area...... ...sq. ft. xb..,....._ Seepage Pit No._...._2-.._._.... Diameter......LZ..... Depth below inlet.......Y.......... Total leaching area... ....sq. ft. Z Other Distribution box (r/� Dosing tank 14Percolation Test Results Performed by...J.?....4Ck�....�AGe?43f .. Date...... ..Z3��'a3.............. a Test Pit No. 1..L..Z._minutes per inch Depth of Test Pit.....t3......... Depth to ground water_._��._h�S�o,pgo�s Gti Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ OG ...................... : -••-------------•-....--- O Description of Soil-----••-••--.....-b _ C2.6 ... � .. ... .[��Sov� x .................................................................................. ---------------------------•- ,':z. t-� �` ---5 ----------------------------------••--• ............................................. W ---•.........................•-•••••-••••--••••-•••----•---------••-----•--•---•-••---------•••...---•••------•------------------•---•----•---••--•---•-•---•••-••••-•--•-•-----••----•-•-••---....... VNature of Repairs or Alterations—Answer when applicable............................................................................................... Agreement: The undersigned agrees to install the aforedes ibed Indi ' ual Sewage Disposal System in accordance with the provisions of IT1Z 5 of the State Sanitary d signed further agrees not to place the system in operation until a Certificate of Compliance has u by b and of health. e . ......... . . ...... '......... .......................................... .._..... .._.................. ApplicationApproved By------. ---•--- •----••.............•-•-• .•-•----•-•----.....-•---•-•-•-•--••--•----•-----• l��. .................. Date Application Disapproved r th ollowing reasons:__....-•--------------•-------.....---------•--...........----•-----------------•--------- .......------ ....••-•-•-•--••••-•--•-••...........•••••••••-•------•-••.................•--•---•--.... ...--•-------------•------•------•----•••-••-------••-•-••-•----•-•-• •---•••----- -••-......_.. Date PermitNo.....................-•-•--------------------•---•----... Issued......................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH --------------- OF.......................................................................................... Avv irtttion for UhipsFal Works Tonutrnrtion rrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ---.....--•-•--•--------•.........................•---------•-•-•---.........---.........------... ...._..--•--...._..•--......••-----------•------------.......--•--•-------••-----••-------------•• Location-Address or Lot No. ......................_.......................................................................... _............---•-----••-----.................---•........._._.__...............................-- Owner Address W Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms................................. _Expansion Attic ( ) Garbage Grinder ( )U 04 Other—Type of Building �Uc�a r2��"�0. of persons........___.v..____._.__ Showers ( ) — Cafeteria ( ) Otherfixtures ---------------------•------------------•--------------•--------•-•--------------•----------...........------..._ ........... W Design Flow.................... ............._..gallons per person per day. Total daily flow...........ZIy.v......................gallons. Septic9 p s� gallons - --------=:.. Width.-----•.::7= Diameter----------_. Depth__--!:.••--- W D sposal T ench Jl No C.N.�i ...._.. Width LengthTotal Length...--•---____....... Total leaching area......- ......sq. ft. x - Seepage Pit No........ Diameter....../.___.__..... Depth below inlet.......q.......... Total leaching area... _' ....sq. ft. Z Other Distribution box Dosing tank ( ) Percolation Test Results Performed by....1.-C:;------ 1`�l�^..... ts!}T i 2..E_5 W ,K Date ._l..................... Test Pit No. 1._L_.L-..minutes per inch Depth of Test Pit.....�_�......... Depth to ground water-.!—e.'.." 4.4 Test Pit No. 2----------------minutes per inch Depth of Test Pit.................... Depth to ground water........................ PG •--•------•--••-••--•-;•-------------•-••---•••-------•..........----•................_---•--------------•---•.....---------..........---.............--..•--- 0 Description of Soil................... I-....... x W U Nature of Repairs or Alterations—Answer when applicable............................................................................................... Agreement: The undersigned agrees to install the aforedescrib I " id a Sewage Disposal System in accordance with the provisions of IT IL- 5 of the State Sanitary Co e u rsi ned further agrees not to place the system in operation until a Certificate of Compliance ha lss e of Health. / j c } erd.__... .. 1i 1 r ApplicationApproved BY--------- -------- -----•--•--.-•---. ---•---•••-••-•-••......-------------_..._ •Date Application Disapproved f o he�® lowing reasons:...........................••--....-•----•--•-----------------••-•-••---••----••.......... •----•------------ --•--•-•----------------------•--•---••-•-----•---........•-••--•-•--•----.....-•-•-•---..............................-•-•-•••-••---•••-•--•-••-----------•...-•••---•--- -•---••-•---••-------•--.-•--- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... Trrtifirdr, of Tomphatta THIS CTO� ER FY That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by -. ` .t: 'I..;,.._•= =.... -•--------..-•-•--•---------- ---------------- ...------.-..... . . ---- �� d I alley�� at.. ,v i2r= -•---•- �-•---•-�-------------•-!---..__ ........---------------- --------------------------------------------------- ------------------•- /06/c -•--•-•-------- has been installed in accordanch with the provisions of TIT F of�Mp S' e Sanitary C��e bed in the application for Disposal Works Construction Permit No......................................... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. J DATE.............................................L"--1--_..r� j ....... Inspector..............-----.-•-•- • ----: ................................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH / d No.......Z/............ FEE........................ Biovoottl,-Fvlra, � otration rrmit � Permission is hereby granted...---==---- •----------•--.... ....__ ----- ------ ------••.............................................•---•--....... to Construct ( ) a}F-( )�a. ndividual Sevin os S "ste I atNo......... ..------.�..._...--••----•---.... -- -------•--------•-•---------------------•--•--------•-----•--------•--•----••-•---.. Street as shown on the pli ion for Disposal Works Construction Permit No.,.._ — ....._ Dated.......................................... p ...............................V......---•---•---•----•---•-••......--•-----•-...................... Board of Health DATEr... ...••. •... -••------•-...••.....•...... ................ FORM 1255 A. M. SULKIN• INC.. BOSTON .../ 1 �bd,n,t7 e lj r` v O i Qo ( LIP Jt NO 1 � 9i •, �1 r t. 'Qotl�1 . I rr�rs 3't `,��.�. _.. uu� ��flFiL -•- l t � AlAPee- Dr'if1,4 S r r F 40. a 3� a T ( ` - G A rn ! / MORSE No.10951 rJ 2 �FSSJC;NAL cl, f. CERTIFIED' PLOT PLAN I A _ ,.r-- `� 1�= �f t�. f�,r�C7 `•� ROBERT G,n C.CJ �rr�y�Ul rX 52_F7� C-G�(iE , b ,88UCE r,.. fit/ 511�1� 1 �FviSv.J� 3 SCALE, f gO DATE LDREDGE ENGINEERING C0! IN CLIENTS I CERTIFY THAT THE PROPOSED ~ EGISTERE ^ZR ISTLREO JOB No 6 � BUILDING SHOWN ON THIS PLAN � CIVIL LAND CONFORMS TO THE -ZONING LAWS ENGINEER EYORS DR by, OF" ARNSTA9LE , MASS 712 MAIN STREET CN. BY, `J, R �, 7 83 y'.✓/ � .�--'� H YA N N I S, .M A.3'S '. _ ------ --- - $HEETL, OF AT E REG. L ND SURVEYOR YYYstr, rl B S.PT/GTAN �a': LEACs,►iivG PiT ,4.rE MORE Th►q:/ /d"BELOtv'`� z �4r4 0��/¢ ?4'O/A�f E TER COiyC.t TE CO v CO/yGelTL. "PVC PIPESw000eia RA OF. `.:,y .,.. ?a'�w µ "IW. P/TC/l /&Oe-4VY CAST /.PO/Y G YE.� Si�+.4LL, 3F :�'SE� t /F/.V oR/vE;vA)e i ,+INN. C�;M'C.?�T� i O MIX A/T+GE - _ �i d v YY t/FO S s ��t� �„cz .y yM ,a...Y >�k eei-✓.a-. w s y-��, A : '.. ,. .� I • . ,a off r • • EPTJ4I • • • • / 3•?7 t • • t • • ♦ • WA.SY" STdNE / C� X P/:T �►R�cr7� 4`�4 +��wety/ptT • �• t • r • • a• . o , PREC45TSEEPI4GE //-4., ` /piitCtTl y Z •' • �• P/7 OR EQUI V. � G o r �� A9y • -s lXYEJI�T AT Ot!!LD/NQt': �, IYr! : .�If- TIT53 '` a s.• .Y` �2 , ds= :� r L FT. O.IAM_. (:�SFC TAd1JLAT10N lJrfii f7iFt♦W�..:` Sit, :.�'lc!'.t �.. -._ "" 'hx-'rcv '' >S.a: omE�lwsT�teurron dare 3 111t�T' J1�' I py .� l�G4TE1t TiteL ` K y tAG `` f��f5 1. - �,.'� r :. a h. rt ++c_ .. .s� .,�, r �a. •t, T ,i e a;D.Esia�r :catTl l�r.�t :er,L,E yrs _ =o� D/MENJ/0/1f Z x° y N t 4 rlaA!?GI[GgD/.SJvO DI�/EK?/QN - .Sia/� „ DtMEJV S/aN C, uv TaT.�tc Esrl�%crw Flow YSo G.4t/QAY i -SOIL XU�►/BEe QF MIACIII 'a P/T.S /, _ T�S�`A►! So1C`r�sT,ltp SD/L TF.?T Art,,, �s �• EtEK ": S/DF Ll'ACHIIr/6'PER PITATE OF' SO/L TEST %.S 1. � '.•►T � ` �.. � 9 o TTOM.LFr4CM/Nli OAR P1T l/3 D / z •;L�S[1LTS iV/TNf SSED dr'J Rc-JN ct�g SO IcT` LD. M PFRGOL�tT/Oiv TE, / LESS TOTAL L�oCN/wG .<.4E�: _.SQ fT. 7vPS�%t AF.rCocr�rioN R.�TE,�2 _ ^S� ?ESER'E LE11G'IVJN6 AREA SF SG� FT. 13 `�'N•'fl X.f/NCN: s [?� ROBERT, G 02 AIBE `f BRUCE.` .10951 O `�� No MJrST;; 7/2 MA1,Y ST-- HYAN.vi6, ,ti/gSl. I •b0'..SUR`aE� FFSSiO'NA�� ® NQ G�O[!NJ ksl,4 fNCOCJNTE2r0 � CL/ENT:COYsdtZv4,& DRTE Q G�lO L/NO Hr.4 TiE.Q .4T �L.EN': Z.O 85nmst p o1241e: M. t•w, JOD ,VO.' �3 n I S' SHEET z.:pF 2 [ TOWN OF BARNSTABLE - UNDERGROUND FUEL AND CHEMICAL STORAGE REGISTRATION OWNER AND INSTALLER INFORMATION+� ADDRESS: MAP NO. PARCEL NO. OWNER NAME: J ' V I LLAGE: INSTALLATION DATE: BY: :ADDRESS: CERT. NO- TANK INFORMATION LOCATION OF TANK: CAPACITY TYPE AGE FUEL/CHEMICAL TESTING CERTIFICATION E I PASS E I FAIL DATE e)nt LijTi <d LEAK DETECTION E I CHECK IF N/A TYPE/BRAND ZONE OF CONTRIBUTION E I YES E I NO DATE TO BE REMOVED FIRE DEPT. PERMIT ISSUED E I YES E I NO DATE CONSERVATION k3 CHEC /A DATE BOARD OF HEALTH TAG NO. 4:A ]E 1E ] DATE r, 177 PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD i � i t j _��� `';��� '! 1 � 1 . ��� cy�sQaT0cic-Ac. TOWN OF BARNSTABLE UNDERGROUND FUEL AND CHEMICAL STORAGE SYSTEMS NAME ADDRESS Pt N�V VILLAGE LOCATION OF TANKS: CAPACITY: TYPE OF FUEL AGE: TYPE: OR CHEMICAL q, (Give same information for any additional tanks on reverse side of card) DATE OF PURCHASE OF EACH: 1. A.%194 2. 3. 4. DATE OF FIRE DEPARTMENT PERMIT: TESTING CERTIFICATION SUBMITTED: PASSED DID NOT PASS t /-IZ,All Z, TOWN OF BARNSTABLE UNDERGROUND FUEL AND CHEMICAL STORAGE SYSTEMS NAME SO rz - ADDRESS l� 3 Slfw/. / ti/ �Y� VILLAGE ��-e�- LOCATION OF TANKS: CAPACITY: TYPE OF FUE PE: OR CHEMICAL 11 a1/c,�f g a �✓o./ v i t o o " (Give same information for any additional tanks on reverse side of card) DATE OF PURCHASE OF EACH: /-a 5-8 Z 1. 2. 3. 4. DATE OF FIRE DEPARTMENT PERMIT: TESTING CERTIFICATION SUBMITTED: PASSED DID NOT PASS A P P R O V E D BazsUbleConservation Commission 0 Signed D to MRNSTABLE P.O. BOX 534 HYANNIS, MASS- 02601. r - s Lf .'ate,'1 { _ i g h 8�, 1,3'1 , � " sniPPe�s No A4853 it Carrier's No - It2arne of Carrier) ------- '_ ' ;is ling,-, rcCDri),s� ubject to ;file ci_•ssifice:ions and tariffs in of= t cn t; is"a c`::e issue � ' ` RMSACHUSE�TS BNGINEFRING CO., INC• a t"ON, MASS. 02322 s�7/ 1953 r r^:n _ OcL order,except as rr��erl 4�,nSe:as a\t,t cor.rl ltlon of co nter.ts n:\!'`:'.:r.:,tn'inn\.r:J. ur}:,�d.t1nmiii tenet)ayrecsand !o c,rry t tested tusu belned as Ind ow. ce ot.dellvery aC t!x property described Aglow,in apparent So 1)ar.r rrr tthe word car rier bcinR unlers[ood throughout this contract as mrnn:n any >n or cnrporttl^n•is!t..�e)nntu.i!ly t:)':'�+=^t' Jo cat!\ten:c:of ail or any of said property over all or ariY DOrtlonoC co s::id destinatlCn,If on Its nti ndit own route,otl:envi of the se to tlelriCr Lp another carrier on the route m said de.>t1.).. Ir fall' to deaf lnatio n,:unl as in each party at ally tim lnterister!ut::!nr any D:s:ad,trnperty i tt L,_.r0!:ica':Ja-I ti c.tu.,on�tbe date tl)r erCOt,1[i this sit 8 rail or [Is]1-Wii[eT'&!tile terms]1P>ue9t: ss.., olte s i rifonn Domestle Straight IIJII of Lading set tart{[(1)to OtT!c)il.::,utbrrn.�ti"e;tC:n a::a Illinois I n ,, applica Ill e-moter carrier classification or tariff it this is a motor earner shliml 11 . Shipper hereby certifies that,he {s familiar with all the terms and c nditions of the sa?d bill o/ ladin5, including those on the back thereof sot forth In the ClasaiHeatlou 0} tariff which governs the transportation of this shipment,and tho said terms and conditions are h iroby agreed to by Lio shipper and accepted for himself and hl,assigns,y ._•, Consigned to South Shore Heating & Cooling, Inc, cL Roger & Marne a� _ t?.i,:il or sheet oedress of consignee—For purposes of notification Orlyl Delivery %. Ostervi l l a State—MA yip ^un;v___.- _Address Destination - - { )il or..y who-:[ship,:er desires end�,overr.incd tariffs providc•tor delivery cheroot. 639 Seav i ew Avenue ——_-- _---_-__---_____-- - ---- _._—.—_.,._._____ No.— Section 7 1 Cnnditlorx at 11 OC IadIng.lt fill:Riipf(le!lt It i 1 ' t�: II\ f 1 to VieLD 11 t \ - on colislgnor, coll. -= 1,000 gallon UG tank _ --- -- - h u ; t Ih! n in fnit)wlnl, to shin • �1 - I tio,!!o car (-r St a n she h.l 'l.r .C- ith s;hl{ nt vltou t payment of fru.KaG -- al:Q all other lawful charges. ANODE CON I NU I1iY ! -- —at!,re (r)rsignnr> I } I I, I =-_—�- --- ___ .Pri �l_if � � ,�ahar,es are to be prepaid,tyrito or Stamp here;"To be Prepaid:' MECO UST. _ Set i nstoll atig.n — /�y j ---J�� /ro^ Received S -- 1 --� G�a u S t 1 c{C _-_ -- _.-___ _ L/ -1-� _i- t"pro er Urepal'm Cnt oC the chargCS On the property described hereon. i i Agent;of Cashier" Luke Per t ,natu acknowl edges onlY COST. P. 0• # 6673 the arioutt prepaid.) -CharKes Advanced: - 'If t :;hipmeut m,r;oti betwera two ports by a carrier by w.:er,the!. c ragalres butt the bill of l:^_flins' stet:;1'r�t"`_hc;:[fie Barr,^_r's or.!:t!:UCr's >;i)TE—Where the rate is depr-ndent.un value,shipper..,arc roquired to state 1;Ivc!:Ocnlly In writ1w,'the ag rec:i or declared value DE tile property. -- The agreed or declared value of the property{s hereby specifically st:,,ted by Lie shipper to be not x:cced:^❑ TSh rt of s(reprint in Ilea of approved by not. apart of Bill of[,ailing aPDroved by the i ,-The:fibre boxes used for this:shlDnlr'It conform to the speelticatton set G r it iG t:!e 1),x rna cr':=certificlue thereon,and::!L other ret�ments o•:[he Interstate Commerce Commission. (;.t::sullifaCCd I relght C 1ft:;!flc:lt!U!:. --- �ASSACHUSETTS ENGINEERING CO., INC. % G _Agent, Per-- ------------ - —_Shipper, Per ---...----' / "ON, MASS. 0232 F�;rro;;erd F-st.cfik,acdr_,,;ct saip„e:;- ----- sao I ():115•1'r.NTED!VU.SA.9Y I. i WilsonJones GRAYl.YEF0111,144-30 :-PART 1 12 13 i ! 14' I 1^ l j ! j I i I I I : ! I Speed. Letter® 44-912.., • MASS. E:4CIs\lFnR�tG.CO. INC, To VLO �• From AE�[�� t i'- "ei ��.`OkQK �1l 1/•` ��y\7 A AVQN 17�tr 'X.r rj ✓ _1.L 1 a WkS 62322', Tel n F Subject -No.9&10 FOLD MESSAGE Date 2— ys aJ 4 . � i aP%.�[Ai. t ,� r±l .:br `l d i t '^' �4` wr �'., r - -4�}'�..,� \ �f sr 'tE' NVOL iv r n'�,,. .. fi Sig -No.SO FOLD Si [ 1 t.. _+>•.. .�... *k: -eta�. f r ''� ;Ara �. .,.1.,., • )n . '�'�1S _E`l'G ,i u:t i a � t - k7-R.�•"dx:J 'fin ✓�� r7�1\ r •-Y � �'�*.' `,�i�p n e u' �' >,:,yr"�f "•�k x � Mmil"Q V V L = +r. F r . s� x •" t :#�e` vrY�.,*J'�d�h d i +'•PiJ. 7. �: ✓ 1 f C• �v'.,,`t ! �4 ar. f '��� n1� v°..f `�r .0 , 4 a r r. �. 1.: ' ts Each steel storage tank designed foraunderground'storage purposes,fabricated by a duly auihonzed,�censeenf the Steel Tank Institute,an.I�linols';lot for-profit corporation,and`bearing,the;;."atiP3n".trademark;label.:and embossed nameplate.show;i gthe"atiF3".series:numbec 4�sw ggttefl`(a)by the Licensee whose name appearstibelowi st non-corrosion failure due to defective material4 "f t18�#dlii fora riod:;of lk+ er date of deliveryof the tank to urch � y� . the:p ,,asetd(;ba primarily by the Licensee.and secondanlybiy Ttis =1„11�E' � Illinois 60601 ("STI")againstfailure.due+to'ezterior corrosIon;caused by reaction°of the`telt`� tlE sdlE ert�ttonmt for a pcikidtf ) " years from date of delivery of the tank to$the purchaser,Each suoh limited warranty is subject to the follovvliig conditions: 1. The tank must be installed u► accordance with STI:installation in 6. The warrantors' aIlhngt I liable.for labor or other lgstaUation structions. r costs of any;i eiit tank furnished in accordaztce with the terms Of this li 7 k s st 2. Electrical conductivity of so l environmeri •at the installation site r' must not be less than 2000 ohms/cc resistivity x + s} } k e w or t bable for;failure of the piping e li 9y$tem 3. Non-conductive bushings fiimi ed with the"tank'must be used for: t > ', ` Hof for any coasequeritiatt dot agesto per all connections of the piping system with the tank r ;from,,or attributed to the failure oany piping system, regardless?of cause of failure. 4. In the event of tank..failure due to.exterioT,.,c oston,the rc r*y+ must promptly inform_STI so•as to .pern t a claun"` n ose states do knot°allow the limitation of imp Led warranfies or approved by STI to inspect the tank site prior to t a e,, xclusto>t of incC tal or Forisequtntial dac>tages, sb tote a>tbove and the tank after it is excavated, The pure S it ff such notice in writing' >ts'< ahon or ex�cdlibn,mays not apply to you,•i you ar+e> eort sumei f M 5. The obligation of the;;warrantors un&ri an slim Ozr T the delivery to the same..installation slte,of a,r ank of ap+ - 9:This wartanty �#des otirspaetfic legal rights and your►also have proximately the.same size, design, quality of" an worksman- other rights:which to Varyfroin state`to state, if yQu.bco' ship as the original tank, d the purchaser ::fpr the an *lace—, sumer ° zEC, st 2� , x ment tank on a prorated din basis accorgg tto the:;period of tune.that has M.,, ,F� t �u` ?;� elapsed since the delivery'of theoriginal.tank,as follows ' 10; ':' THE FOR$Gn ,. ^ �;IIVIt�WARRANTY- IS","Y'trM 13I ww , . ( ITED,WA E `y THERI MITUXW 4 OF First 10 years—no charge: { ANY; E�}�;plilD,AI:�, s ` From the first to the last day of the,eleventh;year l'0%of the then RANTIES'a �� F A, ,N current price of the replacemeiit'tank a + i3 TICULARJ GEp rx#i$ AFO Qa LIGATION;S,, BYs4I I:AIMED BY-'I'IIExVIt Twelfth year-20% and an additiona110%each succeeding'year until D,E�CC 'UD =FRO S'AGRE ENT OF7 l3 twentieth year when .the purChase�yv l be charged 90gb of the then '� �, ��� r � T � 1 current price of the replacement tank RAN yy LICENSEE " ti•/ _ --., ,.: .�- s 1rr.. J #t,•d.r Rr '�'f r, + y ti5c1 Company Mdssac.husetts;Eri� r]eez�:rig Co Ida. sti P3,Tank Series No `171+03 4 r b 't rt By Peter H. Murnhv" f.. " r Date of Delivery: 22/82 ti Its President' 4 a (Title)Authorized epresentative Attest: Chairman,sti-P3® Executive Committee Secretary,sU 3b Eva Committee `v f. .[9 �"+'v",N,n.4!"9{.:. 9 .5.... . ra•• .. !, +. `r,. f -fY}F� ,..v P 1-n#.. . '�4y�{J� ...Jl J,.' s e'FSan'.i'�1 M�y •.t ., a, TOWN OF BARNSTABLE UNDERGROUND FUEL AND CHEMICAL STORAGE SYSTEMS NAME ADDRESS � VILLAGE LOCATION OF TANKS: CAPACITY: TYPE OF FUEL AGE: TYPE: !=i= c h'i v P C-A OR CHEMICAL `'uel CAL (Give same information for any additional tanks on reverse side of card) DATE OF PURCHASE OF EACH: 1. J 2. 3. 4. DATE OF FIRE DEPARTMENT PERMIT: TESTING CERTIFICATION SUBMITTED: PASSED DID NOT PASS Barnsta�ls Conservation COM: ss"d �= ate Signed �s. NAME LOCATION LAMPI, Henry H, Cedar.St ` Cedar; St, West.Barnstable West Barnstble, Mass, s R . AMOUNT STORED � BOOK &. PAGE _ DATE GRANTED. ,._ Y 77/113 March 2$, 196 PATE PAID , 1973 - MzrGh z3 MAR a �9i6 G MAY MAR 201975 22 ,980 41976 APR TOWN OF BARNSTABLE UNDERGROUND FUEL AND CHEMICAL STORAGE SYSTEMS NAME ADDRESS `� /9JP�'� �� 1��� VILLAGE LOCATION OF TANKS: CAPACITY: TYPE OF FUEL AGE: TYPE: OR CHEMICAL /00 O v�/, ��e1 a/Z 3 (Give same information for any additional tanks on reverse side of card) DATE OF PURCHASE OF EACH: 1. i 9 77 2. 3. 4. DATE OF FIRE DEPARTMENT PERMIT: S 7 7 TESTING CERTIFICATION SUBMITTED: PASSED DID NOT PASS l� TOWN OF•BARNSTA gFo' UNDERGROUND FUEL AND'CHEMICAL) S�O MS ��Q�. UE_ n -. NAME J e-�-�v c� L I- Jam( x} ►C S'' ADDRESS g� `1 -�- VILLAGE �oL, Y'-)A SS• 6 LOCATION OF TANKS: CAPACITY: TYPE OF FUEL AGE: TYPE: OR CHEMICAL . 6 "9 (Give same information for any additional tanks on reverse side of card) DATE OF PURCHASE OF EACH: . 1. 2. 3. 4. DATE OF FIRE DEPARTMENT PERMIT: TESTING CERTIFICATION,SUBMITTED: �� 4,�y�- 1� /`7 'NK We"7L ove:D of 20// PASSED DID NOT PASS .. . Iv!AR29 � Mi�FTHE B -- TOWN OF BARNSTABLE UNDERGROUND FUEL AND CHEMICAL STORAGE SYSTEMS NAME U ADDRESSi/ Q LOCATION OF TANKS: CAPACITY: TYPE OF FUEL AGE: TYPE: OR CH IC L (Give same information for any additional tanks on reverse side of card) DATE OF PURCHASE OF EACH: 1. 2. 3. 4.• ' DATE OF FIRE DEPARTMENT PERMIT: TESTING CERTIFICATION SUBMITTED: PASSED DID NOT PASS a VIg".; pl'f)qaj,ckyev- 6�w- c(,r SMEADI KEEPING YOU ORGANIZED No. 10334 2.153L MADE IN USA GET ORGANIZED AT SMEAD.COM ARCHrrECrS WRASrRWCZWooDAvENue I`ARAMUS,NEW JeR5ev 07692 0•IMR�tO - _ NY �ppN�f[Jry61�1� I JFYI') PH:am-w5-%45 aA.►w .unbr'e,a I � i AI AW OIf"1tlN' GOROl1bQ�ObbtOY111L ra 8 ip.'.+�• Y �; J } - 00VMIOTiMAL fi N 6 ' IxY�loorwx�w� t r IX6VAM Y 0017btiRblr A10 _ �. _ - 4' �e `y .. 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MCKnWW, fto� k 10 oitAGENT Al4oulw;M, p P. . -Ij , r I:V . 4': I I I�l I . Q 4 ,"IN ION N UA#ft MU, PECEW AMONk F0 R IIN WMb ON WAIAMON ST9F. A py co py lot AP AU BE 4 PVC.,!$CH, 40 4'� tL 9 3t 24 30 P, To A52 UATERIAL VAE'A P A, RAE, INN IS FIDRjA OF 51,' PER of AN ivo J. .7/3. 4 POW. JWF tkk ;-4 nv a `14440 ,41 AL eD VE MD VIM BE VERIRED OY THE CONIMCM To,AW to1440 UNTM NO WAT UL EMATION E W 17.0, MAN 34836 6 (SH.'f., (W 2) IN/F WYANT L I"N f"Er 16.5 lk to15.7 PAW 1522 TANK sI15.0 DISMIlau" BOX . 14,6 12.6 m4c 13.5 NOW`ossaw, "AT ffill 1! o163P 'in, Areat;: Re' ents g quirem ry �5 qEDR T t:j0-,,qPD/BED" 550 cm A FOR CARME DISPOS� Isr PIT #I# L --NA--,GPD ow* 9 —<2. WIN. I'INCH CLASS �LTAR�IL-X"�6.,?*-,,VD/Sl#.`,� I 7:ifl 7 PIT 02' + ILoW 1, V*fA OF75.&S. AAWW WL 5'�'t 9 ��'P, , /S.F. 743 S.F. WN. P4 �v �48) 2 2' 240 SF f tCo a At N 2 5 A S'F' LC. 3406 B'i(SH-2 OF 816 SF PLWD AM A "U TOTAL 11 L I W 144 AJW) ji to IF 41.A FW AM A, T JS A� po -d% cirtle. t'Co" WAM SW JIM CID DH oItFND Ilk. 24"M rrA 4* 0i 71 4 lot' Wim, ds 'Pem Plan IL ME= LEAGM, CAST, CBA)m Nc. RO.W- UN, I 49 W^E 20 NO p ' STE TYP Y ICA .108ackeas 02655 .08)42$-3 fA4i FOOO WAR a OMITE'OF ITO mo 750 tNOV TO, SCU'UVHU COM AND FMk 4t Jill PLm 3 a a (sm. FUM L CIA 40 WAX OVER N 'F SCILACK Nk ..60 F1 7, 40 SCH. 40 PVC 47 SCH. 40 pvc A0 2.OX EF 17 ,H. 4q,r SUMP low c4vil; �r A WWAU. x It IGAS MR.E. ltAC� W& 07/28/44 DAfE TV: k"'NNL FW Sa EL 16.80'. NGVD MCR R" UMIT E WRK o1/1 AM DRIVEWAY Z W ID;/lot, SAW ?Aom Im &I U.G. UTILITIES WWW NWM vil ilDETAIL D-H TAW BER W�m 1 1, .. , �' NAT.S. N6 C. 2 RVWABLE Is FOR I H-20 ell, SOIL LOGS DATE:2-23-1983 ' In - P#=P 10,759 ?' I CERTIFY THAT TO THE BEST OF MY KNOWLEDGE THE FOUNDATION D.E.P. FILE No. SE 3■4320 • 'F SHz HEREON Der COMPLIANCE WITH THE APPLICABLE BARNSTABLE AND sErINISBk(X HOWL AND GENERAL NOTES • SOIL EVALUATOR: BOARD OF HEALTH AGENT: c6/DH LOCATED w RELATION in THE MONUMETJIS REQUIREMENTS,AND IS NOT STEP�vA. WII.SON,P.E. DAVE STANTON ,�, D / HELD LOCATED WITHIN A SPECIAL. FILM HAZARD AREA. CONSERVATION NOTES : • TEST PIT 1 TEST PIT 2 i , o THIS PLAN IS NOT TO BE RECORDED NOR IS IT TO BE USED TO ESTABLISH PROPERTY LINES. G.S.E. = 18.5t G.S.E. = 19.6f EDGE OF FLAGGED �' / 1.ALL ROOF RUNOFF TO DISCHARGE TO DRYWELLS OR DRIP TRENCHES. ALL SYSTEM COMPONENTS SHALL BE INSTALLED IN ACCORDANCE WITH 0 0 DELINEATED 02/02/04 OY ENSR % %• ;' �, t I - !5• 2.UMIT OF WORK SHALL CONSIST OF STAKED HAY BALES AND SILT FENCE TITLE V OF THE STATE SANITARY CODE DATED MARCH 31,1995 0 0 RE, LAND SURVEYOR DATE TO BE MAINTAINED FOR THE DURATION OF THE PROJECT. ANY LOCAL RULES APPLICABLE. ANY CHANGE TO THIS PLAN MUST BE APPROVED IN WRITING 3 3 ; r / , i / •: / �; 3.PRIOR TO STARTING ANY WORK PROOF OF RECORDING OF ORDER OF CONDITIONS BY DESIGNING ENGINEER WLF / a/ AND FORMS A & B SHALL BE SUBMITTED TO THE CONSERVATION COMMISSION AP AP ENSR-2 _ , / / �''•�; ' `�S ALONG WITH THE REQUIRED PHOTOGRAPHS. WHEN CONSTRUCTION IS COMPLETED, PRIOR TO BACKFILLING, 10 YR 5/1 10 YR 5/1 1 / r ( / •• , t, / �� / NOTIFY THE ENGINEER & BOARD OF HEALTH AGENT 11• SANDY LOAM 11- SANDY LOAM ' �% I' �/ ' 1 / �> ie.f 4.AREAS WITHIN BUFFER ZONE; BUT BEYOND WORK LIMIT WILL. RECEIVE ADDITIONAL FOR INSPECTION. B B / //' '�/ / ^, M Opp •? N PLANTINGS IN CONSULTATION WITH CONSERVATION COMMISSION STAFF. FOUNDATION ELEVATION MUST BE CHECKED WHEN COMPLETED. w 10 YR 5/4 w 10 YR 5/8 - ; •� / S N 24 SANDY LOAM 30 SANDY LOAM / , / , a THESE ELEVATIONS MUST NOT BE CHANGED WITHOUT WRITTEN �� r' lHWW / ti h TSM: CB/DH FND (HELD) W APPROVAL BY DESIGNING ENGINEER C 1 C 1 ' / ' , O EL 17.44' NGVD 10 YR 7/8 10 YR 5/8 0 • / x l / ALL SANITARY DISPOSAL SYSTEM PIPING TO BE 4' PVC., SCH 40 / r _ 60' MEDIUM SAND 52- MEDIUM SAND ' a �% / J' /' •• • / °`•:` ,{f z EXCAVATE AND REPLACE ALL UNSUITABLE MATERIAL SURROUNDING 2 10 YR C2 = j WL•F /f r' / j " g SURROUNDING THE LEACHING FIELD FOR A DISTANCE OF 5 , PER STRATIFIED 6 10 YR 7/3 � ENSR-4 I ( • . I I 310 CMR 15.255. SAND .MED. SAND do GRAVEL 72 do GRAVEL 144 WLF C3 4SR-5ALL UNDERGROUND UTILITIES ARE APPROXI' 'y •j/ I 1� AND SHOULD BE 10 YR 7/2 /r i� ! ��, /I „p 4's O ' IN THE FIELD PRIOR 0 ANY CONSTRUCTIONATE 13Y THE CONTRACTORVERIFlED 144' MEDIUM SAND 1 \ Q NO WATER ENCOUNTERED } ' , DESIGN SCHEDULE ELEVATION ' • v .I TOP OF FOUNDATION 20.0 PERC O 60' 1 ENSR 6, 1 RATE- <2 MIN/IN LOT.9 � FINISHED BASEMENT FLOOR 11.5 UNABLE TO SOAK •i ' •, `'� .'s I ' i LC. PUN 34636 B (SH. 2 OF 2) FINISHED GARAGE FLOOR 17.0 ' , � � , � �' I ; �•, ,' - F. N/F BRYANT SEWER INVERT AT FOUNDATION O GARAGE GUEST HSE 16.5 • I J \ SEWER INVERT AT FOUNDATION MAIN HOUSE 16.5 Ir P � ' r SEWER INVERT INTO SEPTIC TANK 15.7 I ENSR47_ i i i I I i E "` / I I SEWER INVERT OUT OF SEPTIC TANK 15.2 ;VENT SEWER INVERT INTO DISTRIBUTION BOX 15.0 I SEWER INVERT OUT OF DISTRIBUTION BOX 14.6 SEWER INVERT INTO LEACHING SYSTEM 12.6 BOTTOM OF LEACHING TRENCH 13.5 WATER TABLE: NONE OBSERVED AT ELEV. 6.5 PROPOSED I *TuRm RAWnNGS I k a DUSTING,/ IRRIGATION LL .,k .x - To BE R-� I � o Leaching Area Requirements J CIV / 5 BEDROOMS AT 110 GPD/BEDROOM = 550 GPD WHO 111175 W&F SR-9 I I 1 ,�• 1 ` 4' PEST PIT /1 �� / `�1► ADDITIONAL 50% FOR GARBAGE DISPOSAL _NA_GPD PERC RATE = <2 MIN. / INCH ('CLASS 1 ) � I 1 '� � � • t' � r � I l WOOD I I r LTAR = 0.74 GPD/S.F 1 1 ! i ' ' ,` I TEb'T PIT F2 } �_ ' I / rr �� ' , \ MIN. LEACHING AREA OF SAS. \ , 1 � 550 GPD/ 0.74 GPD/S.F.= 743 S.F. MIN. .\ NA_F ENSR-1 �� / ` I Op,.• 1 , I PROPOSED SYSTEMS�pp W P / OD ' ' `- ( • I ' / , I 1 I SIDEWALL (12' + 48) X 2 X 2 = 240 SF r 10 \ i / / I 1 ; BOTTOM 12 x 48' = 576 SF 1 �' LC. PLAN 34636 81(SH. 2 OF 2) I \ ' �\ �\ ( TOTAL UPLANQ AREA k .N oc 816 SF ' MANHOLE FRAME AND \ \ 149,971 t SQ. FT. � I �� c UCOVER TO GRAM NDER PAVEMENT IF1 a\ �� \ ` \\ � 3.44t AORES i \ '� � � JOHN 74 ` + I iCISTE � � �s � � ,' l II - Is•2ao4 2' PEASTONE r: 122 Pin uickset Cove Circle ' -. WASHED STa� 12 I r /-� Co DH 24'EFFECTIVE DEPTH y.. F .. , 1:'• � FND HELD / /` I CB/DH -•��'r i,, �• ��-�• � ,�'.f � is•t-� •: :.'.-. . •i: 12' O O . O O O FND Cotult, IYlassachusetts j12L - -, r / � ,• PREPARED FOR \ - James Feldt 12 48' � - PLAN OF �'\, _ - - - - - - - Wetlands Permit Plan CONCRETE LEACHING CHAMBER DETAIL PRECAST LEACHING CHAMBERS (H 20 LOADING) \\ \\` \ \ NO SCALE (H 2�LOADING) � ------ _____ FND HELD BAXTER, NYE & HOLMGREN, INC. � Registered Professional FINISHED GRADE - 19.0t TYPICAL SYSTEM PROFILE ti -'' ,�% � Engineers and Land SurveyorsOt NOT To SCALE �' �a �`� a 812 Main Street Osterville,Massachusetts 02655 !��'� EP s� \ MANHOLE COVER AND FRAME 2' _____ ,��pb �' '� Phone- (508)428-9131 Fax - (508)428-3750TOP OF " U FOUNDATION '+ _ \\ , 30213 � \ / r t Pc 20.0 _•-i FINISHED MANHOLE COVET? O GRATE TANK GRADE ovER 1 7 Dt LOT 7 / / SS/r FINISHED GRADE OVER D. BOX : 16.5t LC. PLAN 34636 B (SH. 2`OF 2) �. /P.rL FuIrsHED GRADE OVER LEACHING TRENCH : 16.51 N/F SEDLACK '``\ do �,���� 30 0 30 60 3 min. ��. 4' SCH 40 PVC -� 4' SCH. 40 PVC FIRST 2' (TO BEF LEVEL) �� -' ,` �/ _ ) r . O 2.Ox OL2• ( then O 2.OX _ SCALE IN FEET t "" 9' (min) Cover `� - A `� ,•. O 2.Ox 10. PYC or BAFFLE - 6 SUMP 4' SCH. 40 PVC 36' (max) Cover CO \` 1 SALE: In = 30' FINISHED _ p FEESCAS i -• �--� CONNECTION ► DATE: 07/28/04 BASEMENT :` -rrr CONCRETE LEACHING CHAAOERS 1T3M: MAG NAIL •CONC '. �;�•.••-'y.f'i.:-'a;::a:FLOOR wC / EL 16.80' NGVD6' /OVISHEDBASE FOOTING t� O O O O O v rY ,� 0a S••,-.�s ••-y.�.M%' :.-.!-;�._.. •' -e+• .._-Y'';';ice - '. ' � ' /' / T 2. SAW 1 15 MOVE GARAGE REVISE DRIVEWAY ■ t 21 ... .:- .. ..�,-. : : y .;;. • � � .., . .: •: . - .•: �Rs. ?� °or \�. � C 2 1. SAW 9 28 04 . �s ~ (SEE WAIL C-t � � / SOIL LOGS $ U.G. UTILITIES , ' _ 1F• EL 12.6 �y gyp' , / / N0. BY DATE REMARKS DRAWING NUMBER 5' MINV- STONE v DETAI 2000 GALLON SEPTIC TANK DISTRIBUTION BOX LEACHING CHAMBER Cu N.T.S. / ,6 0: 2004 2004-008-B SURV wrksht 2004-08-B-PB2.dw No Groundwater Observed O Elev. 6.5t' 7r H-20 H-20 H-20 2004-008-B LOT COVERAGE NOTES (FOR ZONING PURPOSES) EXISTING PROPOSED MAXIMUM ALLO`L11ABLE BY STRUCTURES 5.1% 5.4% 20% CB/DRILLHOLE CB/DRILLHOLE CB/DRILLHOLE BY STRUCTURES/ 7.9% 8.2% 40% FOUND 287.18' FOUND PAVING/PARKING io.o' FOUND h •- S80' 39' S5"E 822'f •` + BENCHMAI �,/75 SSO• ¢ CB/DRILLHOL.E `° PROPOSED WETLAND=4.2f ACRES �+ CB/DRILLHOLE FOUND 4.5' GUEST 9"� FOUND 6.80 NAVD88 HOUSE N sops LOT 8 PLAN VIEW 4• 7.6f TOTAL ACRES S80' 39' 551 822t I / ENTRY UPLAND=3.4t ACRES i c�;// r N79' 24' 10"W 843t N64- o 9. 16.3 14 3Q"W Ili II / EXISTING 302 47. -' CARRIAGE HOUSE �� ts.3 DETAIL ' /f INV.=16.5 SCALE: 1"=10' i (AS PROPOSED) 16.3 . 16.8 KEY MAP 16.6 SCALE: 1"=120' 16.8 16. 16.s COBBLESTONE LAWN 16.7 17.0 EXISTING 4" OUTLET PIPE y APRON • (APPROXIMATE ONLY) t 16.6 < FM �p0 4" SEPTIC PIPE TO BE VERIFIED ; �/.11` � 16.6 pO� PRIOR TO CONS7RUCTION. IF �, ` r'�p , ti ' F� , / \ py DIFFERENT, CONTAC T ENGINEER , �O\ F IMMEDIA TEL Y 7.2 / /� �� `.\16.5 tir �+ zEXISTING Nl < �00 FsF�, eo�F of SEPTIC TANK0 `�\ GF Fq 7.2 �� `\ R�NC 17.5 ELECTRIC METER b F• v `\ // 16.3 �� ELECTRIC x LAWN ��� o SERVICE tz F , f (AS PROPOSED) l PROPOSED 2,500 GALLON ELECTRIC CTV / Q0,� , 16.8 SEPTIC TANK/PUMP CHAMBER TRANSFORMER SERVICE � / II I _ � G� 25 CATCH 17.2 / 17.3 L.w-NO SEPTIC �`` -BASIN I 17 , ' 7.5 II 18. 16.6 R=16.27 ; , ' F sP~`� �� , / RHODODENDRONS 17.7X C COBBLESTONE 16 o � .1 it a APRON \ p, / 2a .---,, 1 s. PROPOSED 0 ...... FM ,y GUEST HOUSE O,o A PM '.�.�..� IRRIGATION 17.1 ( SEE DETAIL) p 9CF CONTROL � �.Oc•4 Sp06 92 1 2 N,p �/ 0 2801- L.F. PROPOSED p Z ti ' s 17.0 RHODODENDRONS !C Z� �n �-�',o FORCE MAIN 1 PVC ✓" ! �' 171 17.7 5 .� 9.8 17.p 17.3 �. r O 7.0 18.$ 20.3 `` , :► '+ LAWN 4 17.0 17.1 1 LAWN 20.4 LAWN " • 1 J�O 2 ` STONE w `� a RETAINING WALL \ O O (TYPICAL) 16.7 , 8 •. 6.5 w „` \ 1 o , .5 t 16.4 16.8 17. \ .6 ' '.. 0 LAWN ��F ` ,� W 8.8 APPROXIMATE LOCATION OF 6 , -,.. -1 EXISTING WATER SERVICE 17.0 (AS PROPOSED) r . pp �� \ LAWN \ i .• ep \F J ' ►F7 LAWN o• NOTE � OF WETLAND COMPILED �5--- ! E FROM A PLAN PREPARED BY �.' BAXTER, NYE & HOLMGREN, INC. , <•�� J 15.4 �--, 17.5 '8�� 18.tXP DATED: JULY 28, 2004. J \ c�EaRiNc i 1 17.4 $ LOT 8 10,0�1<<\00 00 1 UPLAND=3.4f ACRES 1 - w \ �F` oti 1s.2 1 NOTICE " Unless and until such time as the original red stain of the \ �!- 1 responsible Professional Engineer, or Profesional Land Surveyor r,l appears on this plan: Op 1 (A) no person or persons, including any municipal or other ,t, 1 public officials, may rely upon the information contained herein; and (B) this pion remains the property of Holmes & McGrath, Inc. N79. 24' 10"W 843't -• DATE DESCRIPTION Draw hecke'd 1 R E V I S I 0 N S PLAN .Ng4 OF PROPOSED GUEST HOUSE & SEPTIC CONNECTION �4~ � NOTES GRAPHIC SC, 30 W 3 PREPARED FORa 2'4j HARBOR HOMES 1. BUILDING NUMBER:122 20 10 0 20 60 FOR LOT 8, #122 PINQUICKSET COVE ROAD 2. ASSESSOR'S NUMBER: MAP 005, BLOCK 068 LOT 008 IN 3. ZONING DISTRICT: RF { zx FM ) COTUIT BARNSTABLE, MA 4. FLOOD HAZARD ZONES: VE (EL.14), AE (EL.11), X (500 YR.) & X I inch 20 tt fi a 6 4 SCALE: 1"=20' DATE: JULY 12, 2017 5. BENCHMARK: AS SHOWN 6. TOPOGRAPHIC INFORMATION BASED ON AN ' 3} aT, X jAICHAEL �. ON THE GROUND INSTRUMENT SURVEY ` Cn holmes and me rath Inc. `3 1 8 s t r°.' g � s 4 r.�cc aTµ 7. ELEVATIONS SHOWN ARE BASED ON THE NORTH ' tea; vo.3ua;� AMERICAN VERTICAL DATUM OF 1988. (NAVD88) civil engineers and land surveyors � 1E� 9 Y $. REFERENCE: LAND COURT PLAN 34636--B 205 Worcester court•suite a4•falmouth, may 0254010 9. WIND EXPOSURE CATEGORY: C 50$-548-3564 www.holmesandmcgrath.com 10. OVERLAY DISTRICT: RESOURCE PROTECTION F,= I �, I ,, I., DRAWN: PJR, LAC CHECKED: ,,. : °._..,`� i' ^ " � .;I< T�,;-r" 1 .;';R `. ' 0: 17194 DWG. NO.: 88-7-8A SHEET 1 OF 2 F """ JOB N 2 PUMP CONTROL PANEL LOCH 77ON TO BE DETERMINED IN FIELD 25.0 - . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 2-REMOVABLE COVERS W;rHIN 6" OF FINISHED GRADE. ACCESS HOLES IN TANK TOACCESS COVER SHALL BE A MINIMUM BE 24" IN DIAME7ER. OF JO" TO ALLOW REMOVAL OF PUMPS FOR SERVICE. COVER SHALL BE SET A r First Floor FINISH GRADE. El. 21.0 3; 10' min. distance- -111110- FORCE MAIN FROM PROPOSED —— ————— ——— . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 20.0 - . . . EXIS77NG 4" PVC SEP77C PIPE 2,500 SEP77C TANK/PUMP CON77NUES TO CARRIAGE HOUSE CHAMBER (GUEST HOUSE) EXISTING GROUND SURFACE -E E ff BEND 4 GRA WTY 1,fim ELEC7RIC CONDUIT SERVICE LINE O MAINTAIN FORCE MAIN 11 L.F. 4"PVC BEL 0 W FROS T DEPTH 15.0 - S=0.02 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Ex* isting 15 IL . Septic Tank N 17.1,11,41.�!.n 1� 421 Hold Existing Invert 1500 Gallon le CONNEC77ON *Foundation geptic Tank :7— y To be verified prior Design (ON TOP SIDE) to construction By Others INSTALL THRUST stock. SEE DETAIL 2801f WDISCHARGELINE 10.0 - W PVC FORCE MAIN PRESSURE 7ESTPROPOSE9 10 FORCE MAIN LINE TO 150'PSI SLOPE CON 77NUOUSL Y UPWARD 6" LAYER OF CRUSHED-/ CORFAC7FD STONE , z 5.0 . . 11► . . . . . . 1 I . I . . . . 1 . 5Pr000sed 2,500 Gallon 180' Existing . Foundatlon Septic Tank / Pump Chamber Septic Tank SEPTIC PROFILE QUEST HOUSE SCALE: 1/4* 1' PROPOSED 1%- PVC FORCE MAIN PROPOSED THRUST BLOCK AT FORCE MAIN/SEWER CONNECTION 1 C.F. MIN. CEMENT CONCRETE 310 CMR 15.221(6)(c) 4" SCH 40 SEWER PIPE TRENCH EXCAVATION WALL THRUST BLOCK SHALL ALSO BE INSTALLED AT ALL BEDS AND SWEEPS. THRUST BLOCK DETAIL 12'-0 -NOT TO SCALE 2 24" Diameter 4" BAFFLE Access Holes Zabel Filter (o OUTLET INLET---@=--- CCESS . 1 2 PUMPS REQUIRED, MUST ALTERNATE FLOATS SHALL BE HUNG COVER I PUMPS SHALL BE CAPABLE OF PUMPING FROM STAINLESS STEEL 110 15 GPM AGAINST 15' OF TD BARS MOUNTED WITHIN CONTRACTOR SHALL SUPPLY ENGINEER 18" OF THE HATCH. 30" DIAM. PUMP ACCESS COVER WITH PUMP CURVE AND SPECS. PRIOR SLIDE RAILS SHALL BE PROPOSED 1X" PVC FORCE MAIN 280.-k L.F. AVAILABLE FOR USE. CONnNUOUS FROM PROPOSED 2,500 SEP77C 7777 T*. -I 'Vr� ��#Yf-1.,e TO INSTALLATION FOR APPROVAL. STEEL REINFORCED PRECAST CONCRETE TANK/ PUMP CHAMBER <11<1 PLAN VIEW HATCH COVER TO FINISH GRADE PROPOSED 2,500 GALLON FORM ACCESS COVER OVER PUMPS. ACCESS COVER MAKE HATCH WATERTIGHT AND WATERPROOF SEP77C TANK /PUMP CHAMBER SHALL BE LARGE ENOUGH TO ALLOW REMOVAL OF THE PUMPS FOR SERVICING AND CAPABLE OF WITHSTANDING H-20 WHEEL LOADS. Cover Shall Be Set To Within 6" Of Finish Grade. 0 PRECAST CONCRETE 3 OPENING Removable 4 TANK RISER. 0 2" ELECTRICAL CONDUIT Covers (TYP) 1 SCH 40 PVC FORCE MAIN --A NOTICE 6" INV.= 16.00 4" PVC SCH-40 Mh clerm mpw - -1 Unless and until such time as the original (red) stomp of the an C NLET r; INLET—LeEz r min.wet to WN j6w- ALARM LIGHT responsible Professional Engineer, or Professional Land Surveyor GATE VALVE SEWER PIPE, appears on this plan: quiTx BLEEDER 11 L.F S=2,9 (A) no person or persons, including any municipal or other o E FeVel % Do] Liquid -E 4.1 le ,,-CONTROL PANEL public officials, may rely upon the information contained herein; and (:�t, y CHECK VALVE level 7'-Ovv INSTALL IN READILY (B) this plan remains the property of Holmes McGrath, Inc. is 5jnpq, ACCESSIBLE LOCATION START LAG AND ALARM Pf ,—PROPOSED PUMP ALARM AND 5'-0 min. LTq u Id VOL CONTROL PANEL TO BE INSTALLED Iwo 12.75 *HOUR METERS REQUIRED DATE DESCRIPTION jDrawn hecked Liquid depth 491 RAILS I —0 1 mg* FOR BOTH PUMPS IN A REA D&Y A CCESSISLE L OCA 77ON CONTRACTOR TO INSTAL\L START LEAD= 12.25 TO BE DETERMINED ON THE GROUND. R E V I S UF1n1NG ZABEL RLTER MODEL CHAINS ALARM SHALL BE WIRED • A1800 IN OUTLET TEE • ALL PUMPS OFF= 11.75 TO SEPERATE CIRCUIT. SEPTIC TANK CONSTRUCTION DETAILS . . I *EVENT COUNTER REQUIRED BOTTOM OF PUMP A 6" CHAMBER= 10.75 FOR BOTH PUMPS OF PROPOSED GUEST HOUSE & SEPTIC CONNECTION SLIDE AWAY COUPLING3 "T PREPARED FOR 7' " 14��— 4*----N-- 5'-10" PROPOSED H ARBOR HOMES low — 11'-4" ow- GUEST HOUSE FOR LOT 8, #122 PINQUICKSET COVE ROAD CROSS--SECTION END--SECTION IN COTUIT BARNSTABLE, MA SEPTIC , PLAN DETAIL " ' , SCALE: AS SHOWN I DATE: JULY 12, 2017 SCALE: 1 10 TYPICAL 2,500 GALLON SEPTIC TANK & PUMP CHAMBER NOT TO SCALE holmes and mcgrath, inc. (H-20 LOADING) '14,�'TH civil engineers and land surveyors 205 worcester court.suite a4.%1mouth, ma-02540 508-548-3564 www.holmesandmcgrath.com DRAWN: LAC CHECKED: 40- I CK S T\Vl CR',K.5, ........ DWG. NO.: 88-7-8A SHEET�2 OF 2 c-P Ar F\`,'I Q A 9 4 P'l fM NO. 217194