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HomeMy WebLinkAbout0160 PINQUICKSET COVE CIR - Health 160 PINQUICKSFT COVE RD:, COTUIT A= - �i r f Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 160 Pinquickset Cove Road Property Address Enid Zimbler Owner Owner's Name information is y required for Cotuit MA 02635 May 3, 2013 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: A. General Information When filling out forms on the computer,use 1. Inspector: I only the tab key to move your Patrick M. O'Connell cursor-do not Name of Inspector use the return key. Septic Inspection Services Co. Company Name r� 189 Cammett Road Company Address Marstons Mills MA 02648 Cityrrown State Zip Code 508.428.1779 S1 12855 Telephone Number License Number B. Certification , c� I certify that I have personally inspected the sewage disposal system at this address' nd that the: 0 information reported below is true, accurate and complete as of the time of the inspection. The ihspecion was performed based on my training and experience in the proper function and maintenance of an site sewage disposal systems. I am a DEP approved system inspector pursuant to Se tion 15.340 off Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fail ❑ Needs Further Evaluation by the Local Approving,Authority May 3, 2013 Job#13-32 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent 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. t5ins•3/13 - Title 5 Official Inspection Form-Subsuri_:i Sewage Disposal System•Page 1 of 17 sI 15 1 is Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w 160 Pinquickset Cove Road Property Address Enid Zimbler Owner Owner's Name information is required for Cotuit MA 02635 May 3, 2013 , every page. Citylrown 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: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated'below. Comments: - Tank was not in need of pumping at time of inspection, leaching pit#2 was empty with no sidewall stains and pit#1 was not opened B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. - Check the box for"yes", "no"or"not determined.' (Y, N, ND) for the following statements. if"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or"not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic t4nk 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. a ❑ Y ❑ N ❑ ND (Explain below): ^ 5 .. ..« - Ai - _ w 4 I Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System form Not for Volunfary'Assessmerits' 160 Pinquickset Cove Road Property Address Enid Zimbler Owner Owner's Name information is Y required for Cotuit MA 02635 May 3, 2013 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (coot.): ❑ 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 broker., 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 accordavice with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments w 160 Pinquickset Cove Road Property Address Enid Zimbler Owner Owner's Name information is Cotuit MA 02635 May 3, 2013 required for every page. Cityrrown State Zip Code Date-,f Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen-and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No" to each of the following for all inspections: Yes No El ® Backup of sewage into facility or system component(.,-i.e to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than_day flow 15ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° 160 Pinquickset Cove Road Property Address Enid Zimbler Owner Owner's Name information is required for Cotuit MA ' 02635 May 3, 2013 - every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 fee'but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CM 15.303, therefore the system fails. The system owner should contact the Board of Health to c*;termine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply El ❑ the system is located in a nitrogen sensitive area (Inte:im Wellhead Protection Area—IWPA) or a mapped Zone II of a public water Rupply well, If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate , regional office of the Department. 151ns-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 160 Pinquickset Cove Road Property Address Enid Zimbler Owner Owner's Name information is required for Cotuit MA 02635 May 3, 2013 every page. CitylTown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface r'swage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms ;actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 l5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form R Subsurface Sewage Disposal System Form •Not for Voluntary Assessments ,M 160 Pinquickset Cove Road Property Address Enid Zimbler Owner Owner's Name information.is required for Cotuit MA 02635 W y 3, 2013 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Tank pumped two years ago. 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): l5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 160 Pinquickset Cove Road Property Address Enid Zimbler Owner Owner's Name d information is required for _M Cotuit MA 02635 May 3 2013 every page. City/rown State Zip Code Da*.of Inspection D. System Information Description: ' 1 Number of current residents: Does residence have a garbage grinder? ® Yes ❑ No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No N/A Irrigation Water meter readings, if available (last 2 years usage (gpd)): system. Detail: Sump pump? ❑ Yes ® No Currently Last date of occupancy: Occupied. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? El Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No I I Water meter readings, if available: 15ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17, Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form Not for Voluntary Assessments 160 Pin uickset Cove Road Property Address Enid Zimbler Owner Owner's Name information is Cotuit MA 02635 May 3 2013 required for State Zip Code Date of Inspection every page. City/Town D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Installed 5/2/86 • Were sewage odors detected when arriving at the site? ❑ Yes. ® No Building Sewer(locate on site plan): 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.): Septic Tank(locate on site plan): 3' Depth below grade: feet -Material of construction: ® concrete ❑ metal ' ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No 10.5' long x 5.8'wide- 1500 gal. Dimensions: 0„ Sludge depth: Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 t5ins•3113 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments M 160 Pin uickset Cove Road Property Address Enid Zimbler Owner Owner's Name information is Cotuit MA 02635 May 3 2013 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 0„ Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of ou tlet tee or baffle Measured How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank had liquid only, no solids. Liquid level was at bottom of outlet invert and tees were intact. r Grease Trap (locate on site plan): Depthrbelow 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, t5lns•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts = Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 160 Pinquickset Cove Road Property Address Enid Zimbler Owner Owner's Name information is Cotuit MA 02635 May 3 2013 required for every page. CitylTown 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: f 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.): s *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3113 Title 5 Official Inspection Form:Subsurfe Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 160 Pinquickset Cove Road Property Address Enid Zimbler _ Owner Owner's Name information is required for Cotuit MA ' 02635 May 3, 2013 every page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): 0 Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): 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: s, 15ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Forma Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 160 Pinquickset Cove Road Property Address Enid Zimbler Owner Owner's Name information is Cotuit MA , 02635 May 3 2013 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: Two 6x6 pits. ® leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number.- leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching pit#2 had no standing water and no sidewall stains. Pit#1 was not opened. Cesspools(cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction` Indication of groundwater inflow [; Yes ❑ No 15ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 e Commonwealth of Massachusetts Title '5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 160 Pinquickset Cove Road Property Address Enid Zimbler Owner Owner's Name information is required for Cotuit MA 02635 May 3, 2013 every page. Cityfrown State Zip Code Date of Inspection D. System Information(cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 2 t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments µ., 160 Pinquickset Cove Road Property Address Enid Zimbler Owner Owner's Name information is Cotuit MA 02635 May 3, 2013 required for -- ------------------------ -- Y every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all well:,within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawincl attached seoaratPly 25 / / / r / / / / / / / / I / / / / / r / / / I / 54 54 - • / , , , r / / , / / , , , , , }1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -,Not for Voluntary Assessments 160 Pinquickset Cove Road Property Address Enid Zimbler Owner Owner's Name information is Cotuit MA 02635 May 3 2013 required for every page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar Shallow wells More than 12 feet Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevai°on: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: Hand auger hole 12 feet deep (3 feet lower than SAS) found no water. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurfec.F Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 160 Pinquickset Cove Road Property Address Enid Zimbler Owner Owner's Name information is Cotuit MA 02635 May 3, 2013 required for every page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file !bins 3/13 Title 5 Official Inspection Form:Subsurfa—:Sewage Disposal System-Pap 17 of 17 Permit Number: Date: . Completed by: HIGH GROUND-WATER LEVEL COMPUTATION Site Location:lcrr(o ORjoutcfter Ql Cl p— lot No. M41L Owner. r1 Tocwn� Addr ess: 50 COmlf t Contractor: Address: Notes: 'STEP 1 Measure depth to water table to nearest 1/10 ft. ............... ; ............ .Date '.�O tl $ 13.0 i ..... .._. mon h/d /year STEP 2 Using Water-Level Range Zone } and Index Well Map locate site and determine: OAppropriate index well............................ © Water level.range zone....................................................... . l , I STEP 3 Using monthly report".Current Water Resources Conditions" determine current depth to i2 ¢ . Ia5 . water level for index well (. ................ ........ month/year x STEP 4 Using Table of Water-level Adjustments for index well (STEP 2A),current depth to water level for index well (STEP 3), and water-level zone (STEP 2B) determinewater-level adjustment .......... ........................................ ...: .. STEP 5 Estimate depth to high water by subtracting the water- level adjustment (STEP 4) 5 from measured depth to water level at site (STEP 1) ....................... .................... ........ .................... .....................-... k Figure 14. Suggested computation,form. .13 . GZA Engineers and Principals: GeoEnvironmental,Inc. Scientists John P.Hartley, District Office Manager Michael A.Powers,P.E.,L.S.P. David R.Carchedi,Ph.D.,P.E. John J.Spirito,P.E.,L.S.P. Philip P.Virgadamo,P.E.,L.S.P. Russell J.Morgan,P.E. April 29, 1998 File No. 31751.13-C � REC�E0 Mrs. Enid B. Zimbler P.O. Box 2007 MAY 1 1998 Cotuit, Massachusetts 02635 TOWN OFBAW17AKE ; ® il'r,i TV Re: Residential Well Sampling Program ' Cocuit, Massachusetts �' ' � c.; l , 140 Broadway Providence Rhode Island 02903 Dear Mrs. Zimbler: 401-421-4140 FAX 401-751-8613 Per your recent conversation with Tom McShane of Thomas & Betts Corporation, attached II is a revised copy of the letter report presenting the laboratory analytical results for your well water, dated April 24, 1998, which we understand you had not received as of yesterday. The cover letter discussing the results is correct, however, the attached laboratory data sheets for your well sample (designated, RW-4) had been inadvertently switched during reproduction with those of another well sample (RW-13) being copied at the same time. We are sorry if this caused any confusion. Thank you again for your assistance and understanding. If you have any questions, please do not hesitate to call Tom McShane at(508)699-9820. Sincerely, GZA GEOENVIRONMENTAL, INC. A-Subsidiary of Gz GeoEnvironmental Technologies,Inc. Hilary D nes Fortune, P.G. . Senior roject Manager Attachment: April 24, 1998 Letter (revised) cc: Town of Barnstable Board of Health Mark Wood, DEP William Fri-on, T&B l i.YOBS\EN413175?-13.HDF\L=ERS\T&B-II L.DOC An Equal Opportunity Employer NVFN/H t Thomas& Betts Corporation 452 John Dietsch Blvd. P.O. Box 2510 Attleboro Falls, MA 02763 (508) 699-9800 Facsimile(508) 695=8111 n®mas °W, S _.L,71 D � � Ric VE0 � April 1998 MAY 1 1998 Enid B. Zimbler TOWN OF BARNSTABLE P.O. BOX 2007 ® HE.a!T4;-FT Cotuit, Massachusetts 02635 Dear Mrs. Zimbler. Enclosed please find the laboratory results of the analysis of your well water, which we recently sampled at your property located at 160 Pinquickset Cove Road in Cotuit, Massachusetts. The water sample, designated as RW-4, 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 first 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 Tom McShane at Thomas & Betts (505-699-9820). Sincerely, William O. Friaon Attachment: Laboratory Analysis Report cc: Town of Barnstable Board of Health Mark Wood, DEP c1 Cl MITKENI I 966L 9I 8dd CORPORATION April 14, 199 GZA GeoEnvironmental, Inc. _ �_ 140 Broadway Providence, RI 02903 1� Attn: Ms. Hilary Fortune �� MAY 1 1998 TOWN OF SAN, ®� HEALTH (IRA) RE: Client Project#: 31751.13, Cotuit Well Sampling ( ) Lab Project#: E0519 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. Sincer y, Edward A. Lawler Laboratory Operations Manager 175 Metro Center Boulevard • Warwick, Rhode Island 02886-1755 • (401) 732-3400 • Fax (401) 732-3499 email: mitkem@worldnet.att.net CoRpoRATWN Client: GZA GeoEnvironmental, Inc. Client Project: 31751.13, Cotuit Well Sam b 'J Lab Project: E0519 c� Date samples received: 4/10/98 MAY 1 1998 TOWN OF EARN_PRI_F Project Narrative , .y This data report includes the analysis results for three (3) aqueous samples that were received from GZA GeoEnvironmental, Inc. on April 10, 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. I Edward A. Lawler Laboratory Operations Manager 0 0 _. Analysis Report: Purgeable Volatile Organics Client: GZA GeoEnvironmental, Inc. Analysis Date: 4/11/98 Client ID: RW-4 Concentration in: ug/ 2 _ `13 Lab ID: E0519-02 Dilution: 1 �� Analysis: Method 524.2 y Reporting P�1 AY 1 1998 Analvte Results L1ID>f Dichlorodifluoromethane ND 0.5 0 Chloromethane ND 0.5 Vinyl chloride ND 0.5 Bromomethane NO 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 Br ornochloromethane ND 0.5 Chloroform 1 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 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 Dibromochloromethane ND 0.5 1,2-Dibromoethane ND 0.5 Chlorobenzene ND 0.5 1,1,1,2-Tetrachloroethane ND 0.5 0 Page 1 of 2 E0519-02 Client ID: RW-4 Lab ID: E0519-02 t2► Reporting f`� Analyte Result U112A Ethylbenzene NO 0.5 RECEaVF Xylenes (total) ND 0.5 MAY 1 1998 Styrene ND 0.5 TOWN OF BP,R}'"rqg:c Bromoform NO 0.5 `+F°!T" Isopropylbenzen.e NO 0.5 a Bromobenzene ND 0.5 6 a E 1,1,2,2-Tetrachloroethane ND 0.5 1,2,3-Trichloropropane ND 0.5 n-Propylbenzene ND 0.5 2-Chlorotoluene NO 0.5 4-Chlorotoluene NO 0.5 1,3,5-Trimethylbenzene ND 0.5 tert-Butylbenzene NO 0.5 1,2,4-Trimethylbenzene ND 0.5 sec-Butylbenzene ND 0.5 1,3-Dichlorobenzene NO 0.5 4-Isopropyltoluene NO 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 NO 0.5 Hexachlorobutadiene ND 0.5 1,2,3-Trichlorobenzene ND 0.5 . Naphthalene NO 0.5 1,1,2-Trichloro-1,2,2-trifluoroethane NO 0.5 QC Batch: V5B0411A Surrogate Recovery:. Bromofluorobenzene 87% 1,2-Dichlorobenzene-d4 100% ND= Not Detected 005 Page 2 of 2 E0519-02 MITKEM CORPORA]ION Analysis Report: Purgeable Volatile Organics Client: GZA GeoEnvironmental, Inc. Analysis Date: 4/11/98 Client ID: Trip Blank Concentration in: ug/L 2 !1 3 Lab ID: E0519-03 Dilution: 1 1 Analysis: Method 524.2 R�c�lv�n Reporting 998 "1 p g .� MAY 1 1 Analyte Results Limit 1UNMOF Dichlorodifluoromethane ND 0.5 Chloromethane ND 0.5 Vinyl chloride ND 0.5 a 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-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 0.5 0.5 cis-1,3-Dichloropropene ND 0.5 Toluene 1 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 0.5 006 Pagel of 2 E0519-03 MITKEM CORPORATION Client ID: Trip Blank Lab ID: E0519-03 ReportingCYI 3�Analyte Result Limit 'Ethylbenzene ND 0.5Xylenes (total) ND 0.5998Styrene ND 0.5f Bromoform ND 0.5Isopropylbenzene ND 0.5 Bromobenzene ND 0.5 + �� 1,1,2,2-Tetrach Ioroethane N D 0.5 1,2,3-TrichIoropropane 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 1,1,2-Trichloro-1,2,2-trifluoroethane ND 0.5 QC Batch: V5B0411A Surrogate Recovery: Bromofluorobenzene 95% 1,2-Dichlorobenzene-d4 104% ND= Not Detected 001 Page 2 of 2 E0519-03 Analysis Report: Purgeable Volatile Organics Client: GZA GeoEnvironmental, Inc. Analysis Date: 4/11/98 Client ID: Concentration in: ug/L '�` �-2 A�,(y" . Lab ID: Method Blank, V5B0411A Dilution: 1 �� n Analysis: Method 524.2 �rI - Reporting MAY 1 1998��, Analyte Results L�1I111Y n' 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 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 Dibromochloromethane ND 0.5 1,2-Dibromoethane ND 0.5 Chlorobenzene ND 0.5 1,1,1,2-Tetrachloroethane ND 0.5 0 0 Page 1 of 2 E0519-MB CORPORATION Client ID: Lab ID: Method Blank, V5B0411A Reporting nalyte Result Ltm1t ,� 2 Ethylbenzene ND 0.5 Xylenes (total) ND 0.5 �� 4' Styrene ND 0.5 RECEIVE Bromoform ND 0.5 MAY 1 1998 Isopropylbenzene ND 0.5 TOW-orPpp,"�T%Rj 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 1,1,2-Trichloro-1,2,2-trifluoroethane ND 0.5 QC Batch: V5B0411A Surrogate Recovery: Bromofluorobenzene 91% 1,2-Dichlorobenzene-d4 105% ND= Not Detected 009 Page 2 of 2 E0519-MB MITKEM CORPORATION Lab Project#: E0519 Client Name: GZA GeoEnvironmental, Inc. Client Proj #: 31751.13 Logged In By: Client PO #: 3-01096 •�y, � Project Name: Cotuit Well Sampling (IRA) 'V 2 Reviewed By: 3 Date Due: 4/14/98 r Total Price: REC ED D llate: � U Time: Project Mgr: PASSalesman: PAS 1 1998 st~ � . nF� h,,.T.. m, DeYRegd: NA PLF Completed?: YES ' Lab ID Client 11) Matrix Analysis Price Sampled Received TNH IR BNA Herb PNP Wet Met V-GC V-NIS Sub -01 RW-13 AQ 524.2 4/9/98 4/10/98 1 -02 RW-4 AQ 524.2 4/9/98 4/10/98 I -03 Trip Blank AQ 524.2 4/9/98 4/10/98 1 I'I'I I L L;NA Ltrli) L'L!_ W&t Md -V-GC Y--M SAW 0 0 0 0 0 0 0 0 3 0 NOTES: Add Freon 113 to list--one point calibration. 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 ProvidenceJU 02903 Fax: 401 751-8613 n F--1 CD 4/13/98 8:41 AM Page 1 of 1 Lab Project #: E0519 WHITE COPY-Original YELLOW COPY-Lab Files PINK COPY-Project Manager W.O. CHAIN-OF-CUSTODY RECORD (for lab use only) ANALYSES REQUIRED Sample Date/Time Matrix I.D. a m s a s_s Total (Very Important) GW=G,—d W. m e a a N of Note —sw=sad W. d n D u w VAV wW .W. N o o m w �? 4 a -", Cont. ti DW=D'iking W. n Z O Omni(Vecly) -� 2U '1 1 l l l a 1- a r w- yy 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 ECEIVED BY:(Affiliation) NOTES:Preservatives,special reporting limits,known contamination,etc.`. (Unless otherwise noted,all VOA vials have been preserved w/1:1 HCL.) RE I QUISHED BY: (Affiliation DATE/TIMEjREC��EDBY:(Affili lion)��v — L ` - �Lbt�L ��4 T o-r /1 f� �f'�c �v �'1 i fro w ers �'6 E INQUI HED BY:(Affiliate n) DATE IME RECEIVE BY:(Affiliation) 0 n 1 /� 7 //---- '� '0071) til�ax l��Gc�7E�G� PROJECT MANAGER: / EXT: TURNAROUND TIME Standard Gush —Z Days,Approved by: GZA FILE NO. �J 7,5//, P.O. N.O. p' " 010741 GZA GEOENVIRONMENTAL, INC. ENGINEERS AND SCIENTISTS PROJECT ( /T Lt�f%LL Sr1il�h'LIti1/� f�/'nG2AM� �+� 140 Broadway C� PROVIDENCE,RI 02903 LOCATION r.a (401)421-4140 6 FAX(401)751-8613 COLLECTOR(S) C;;-7- SHEET / OF / MITKEM CORPORATION Sample Condition Form Page of Received By: Reviewed By: Date: // FMITKEM Project: E76,a Client Project: C Client: Sample ID Preservation (pH) Comments/Remarks/ Condition: Lab Client - HNO3 H2SO4 HC1 NaOH Corrective Action* -�� La -13 1) Custody Seal(s) Presen bsen ,ottles � Coolers/ � r1� Intact/Broken 2) Custody Seal Number(s) 3) Chain-of-Custody resent/ bsent 4) Cooler Temperature !/{ _ Coolant Condition 5)Airbill(s) Present/ sen Airbill Number(s) r' - 6) Sample Bottles nta Broken Leaking 7) Date Received 7 8)Time Received 9) Project Due Date * See Sample Condition Notification/Corrective Action Form yes/ o i1 f MAY 1 1998 TOWN OF F'�'' Last Page of Data Report 01 :� I CERTIFICATE OF ANALYSIS Page: 1 KU Barnstable County Health Laboratory -do." ; Report Dated: 8/24/2005 Report Prepared For: Order No.: G0532443 Enid Zimbler P 0 Box 2007 Cotuit, MA 02635 Laboratory ID#: 0532443-01 Description: Water-DrLddn Water Sample ti: 32443 samplhig L�ocaQi Pinquickset Cove,Cotuit,M Collected: 8/11/2005 Collected by: E.Zunbler Received: 8/11/2005 ,r Test Parameters s i , ITEM RESULT UNITS RL MCL Method# Tested''' LAB: Microbiology Total Coliform Present CFU/IOOmL 0 0 309 9/11/2005 LAB: Organics RDX BRL Ug/L 0.500 _1..r ,.Y 833{h4..,� 8/16/2005 Recommended maximum contamination level exceeded due to life teria. Retesting is recommende Approve PP Y� (Lab rector) RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 Page: 1 CERTIFICATE OF ANALYSIS Barnstable County Health Laboratory s Report Dated: 8/11/2005 ! erg Report Prepared For: ' :a Order No.: G0512- Enid Zimbler Ct) z P O Box 2007 c3 -� Cotuit, MA 02635 rrs Laboratory ID#: 0532161-01 Description: Water-DrinldngWater Sample#: 32161 Sampling Location: '160 Pinquickset Cove,Cotuit,MA Collected: 8/3/2005 Collected by: E.Zimbler Received: 8/3/2005 Test Parameters ITEM RESULT UNITS RL MCL Method# Tested LAB: IC Lab Perchlorate BRL ug/L 1.0 0 EPA314.0 8/9/2005 Routine ITEM RESULT UNITS RL MCL Method# Tested LAB: Inorganics -+•-. Nitrate'as Nitrogen 0.26 ing/L 0.10 10 EPA 300.0% �- ."bs'.-:8/3/2005 " LAB: Metals r Copper 0.2� 0.10 s�.3, SM'311.1B .'''� tiR/4F2005 Iron--..__.. _ _ — - BRL _.-.. .. . . mg/L .. -0.10 " - 0.3. _ ..._ SM3111B-r_.. Sodium 21 mg/L 1.0 20 SM3111B 8/4/2005 LAB: Microbiology Total Coliform Present P/A 0 0 309 8/3/2005 LAB: Physical Chemistry Conductance 130 umohs/cm 1.0 EPA 120.1 8/3/2005 pH 6.4 pH-units 0 EPA 150.1 8/3/2005 EPA 504.1 - EDB ITEM RESULT UNITS RL MCL Method# Tested LAB: GC LAB 1,2-Dibromoethane BRL ug/L 0.02 0.05 EPA504.1 8/9/21005 Recom mended maximum contaminatio n- ,.- n,level exceeded due-to Collhirm.Bacteria.-Retestipg is,recommended. Sodium level is above the maximum contaminant level' Aose on a low sodlium diet may wish to consult a physician. `Z") Approved By &(La E' Ct =rector)", . = Reporting Limit M MCL=r Maximum Contaminant Level / Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 s ; Page: 1 CERTIFICATE OF ANALYSIS 's3nyu5- Barnstable County Health Laborato y RECEIVED Report Prepared For: Report Dated: 7/17/2003 Enid Zimbler Order N mb�-uL3b697 P O Box 2007 LTOWNH LF BARNSTA TH DEPT.BLE Cotuit, MA 02635 Laboratory ID#: 0320697-01 Description: Water-Drinking Water Sample#: 20697 Sampling Location: 160 Pinquickset Cove Cotuit MA Collected 6/25/2003 Collected by: Enid Zimbler Received 6/25/2003 Routine ITEM RESULT UNITS MCL Method# Tested LAB: IC Lab Nitrates 0.2 mg/L 10 EPA 300.0 6/26/2003 LAB: Metals Copper 0.2 mg/L .1.3 SM 311113 7/3/2003 Iron <0.1 mg/L 0.3 SM 311113 7/3/2003 Sodium 14 mg/L 20 SM 3111B 7/3/2003 LAB: Microbiology Total Coliform Absent P/A Absent 307 6/25/2003 LAB: Physical Chemistry Conductance 92 umohs/cm EPA 120.1 6/25/2003 pH 6.0 pH-units EPA 150.1 6/25/2003 Note: Water sample meets the recommended limits for drinking water of all above tested parameters. r Approved By: (Lab Director) "7 - s t Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph; 508-375-6605 TOWN OF BARNSTABLE P;LOCATION # VILLAGE 17 ASS SOR'S MAP&PARCEL - 'S NAME&PHONE NO. / 75 SEPTIC TANK CAPACITY U / LEACHING FACILITY:(type) C;L 91 (size) G NO.OF BED OOMS 4 OWNER /� I m PERMIT DATE: DATE: 0-U13 Separation Distance Between the: ' C, 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 f f f f f f J f f J i f _ \ • \ t \ \ • • t \ • • \ % �. \I♦ftI\f if♦J\f\f♦I\ \ ♦ tf f f /tf•I1J♦f\�\ ♦ \ \ f JI f f f f F f J J J J I ! f f J f d f ! f F ! f f f 1 J 25 r r f f f f F f J f f / \ \ 4 \ \ 4 4 \ t o t ♦ \ 4 \ \ 4 \ \ \ 4 4 4 4 • t \ t \ ♦ 4 ♦ ♦ \ 4 4 4 t 4 \ ♦ 4 \ 4 4 \ \ 4 \ \ 4 • 4 ♦ \ t 4 ♦ 4 4 ♦ \ ♦ 4 4 t 54 5 4 ♦ \ 4' ♦ t 4 \ 4 ♦ 4 4 4 \ \ r f F F f J f F r f F f I f 6 51 \ ♦ \ 4 ♦ \ \ 4 \ \ t ♦ r LOCATION � ! SEWAGE PERMIT NO. a � C VILLAGE (A INSTALLER'S NAME L ADDRESS -� Cotl5T, B U I L D E R OR OWN ER D T PERMIT-' D A E ISSU E DAT E -Cl M P L I A N C E ISSUED �y T- ov /5®D C/t. Tgiv�c r { C ft THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Allp iration for Disposal ioarkii Tnnutrurtion 1hrmit Application is hereby made for a Permit to Construct (,,�or Repair ( ) an Individual Sewage Disposal System at Location-Add ss r Lot o. caner Add es W 77 n tal er Address Type of Building Size Lot................ 0 Dwelling—No. of Bedrooms............... __.....................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of BuildingNo. of ersons____________________________ Showers — Cafeteria Q' Other fixtures ____________________________ _ _ W Design Flow................__��____________..gallons per person per day. Total4ily flow------------ _.._ gallons.______.____. WSeptic Tank—Liquid"capacity,���0gallons Length/'_P__'�a__ Width_ __. ______ Diameter________________ Depth t x Disposal Trench—No ____________________ Width------7............ Total Length........... Total leaching area....................sq. ft. 7------ Seepage Pit No.___ __$ _:,� D.... Depth below inlet___6__.._....._. Total leaching area..... z Other Distribution box (j,� Dosing tank ( ) '—' Percolation Test Results Performed ____ Date.....Qa oj `. .____... �a Test Pit No. 1_._.2,_-..___minutes per inch Depth of Test Pit... `. ''. Depth to ground water_ tAd:_______. Test Pit No. 2......._ _______minutes per inch Depth of Test __.. Depth to ground water...r3_ a ••-•--•••------•--••-•-••••••---•-•• Description of Soil '' `'— �' � .t✓��� s2C - `f�. s ---- ------- , ,rt��------- � ' V Nature of Repairs or Alterations—Answer when applicable............................................................................................... ---------------------•---._.......---•-•----••----•-•------------•------•---•--.....--•----•-----------------------------------------•----------------------•--------•--••-•--•--•------••-_---•. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITL U 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed--- ua,...------- Dto Application Approved By..... ..... °- - ----•--..................... ..... Zf +-=--••--•••- ate Application Disapproved for the following reasons:................................................................................................................. ...........................•----•-----••--•-•----•----••---•-•-•••••-•-•-----•---••----•-•--•--------•---I•••--------•---•--------•:- Date Permit No......................................................... Issued....................................................... ------------ Date No------ ........... 3 / FEs �. .....`:.. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH. : ..---.....OF....:'..... __ - . Appliration' for Disp tliFal r .s ontrurtiun pamit Application is hereby made for a Permit to Construct (toj"or'�Repair ( ) an Individual Sewage Disposal System at: Location-Addr ss Lot ....:... _ " :� 3 . ..--•--------------•---•--........... '`` ? { r:� - ..... al o. ner .._..... d es.. d a ---� -.ate ..---.. . ._.. - - ---•----------=-----=� ------:---------- �................................... In tal r Address ii Type of Building Size Lot........... _..... '1...:.: Dwelling—No. of Bedrooms................ _..._-.__--___-__-Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures ------------------------------------------------------------••-•-• •----------•••••-•------•-----•-•••-•------•••----•-••-•-••----••-.............--- W Design Flow.................. -------------gallons per person perr, day. Total daily. flow.............. .................gallons WSeptic Tank—Liquid'capacity/,%(kallons Length.,/92.'4pa...'Width.: : ..._ Diameter-_-____--__-_- Depth. .... ..�� x Disposal Trench—No. .................... Width........ Total Length............;el Total leaching area..._. s . ft. I . Seepage Prt No...._.--- __ „ Diameter........ ?....... Depth below inlet....&........... Total leaching area...:...` F. Z Other Distribution box ( t, '' Dosing tank ( ) Percolation Test Results Performed Q.C... Date..... '_ Test Pit No. 1.....2.xs----minutes per inch Depth of Test Pit /.Vn " Depth to ground water 44 Test Pit No. 2....... minutes per inch Depth of Test Pit _._. Depth to ground water.... .............. a -•-•••----• ............. O Description of Soil �2° ' . V. . xPt" ' ,t! ...�------..�.e�� �------. g- ----------- ------------------- ------. --------------------------------------------.........------. U Nature of Repairs or Alterations—Answer when applicable...................................•........._._._..............__._...__......._..._.......... ------------------------------------•------•-------------------------------......_................---------------------------------------------------...--------------------------------.......-------•- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT1..E 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed••. ----------------•---- •---••--•--- .............. r Da e Application Approved By---••••--•- =" .V ......l�-2l� 7 Date Application Disapproved for the following reasons:................................................................................................................ ------•----•--•-------•-•------------••---•-•----•••--•-----.....•-••--•------•--••----•......-•----•....----------•-•----•-•---•••-----••---•---•----=--••--•••--•••--•--•-----------------•••----..... Date PermitNo......................................................... Issued....................................................... Date { THE COMMONWEALTH OF MASSACHUSETTS Lr C BOARD CLF HEALTH f 1 � ::........OF...... t ................. (Intifiratr of Tuntplittnrr T I I TO CERTIFY, That t In age Disposal System c structe ) epaired ( ) by -• -------------•-----•......-- ••.• ... --•-------------•---- . - s ller at c�. ----.., -- --- - ' has been installed in accordance with tl provisions of TIT _5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit.No....... . r`..�?��.�...... da.ted_-_.-__.__�. �2 '/�� .................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION,SATISFACTORY. DATE ...... .; -------------------- Inspector ---------------------------••••--------------•-••-••. THE COMMONWEALTH OF MASSACHUSETTS -•-� BOARD OF ;± SI HEALTH ............... ...OF.......Chq?- A(� 3. No... . :.......... FEE.......`................. \All Disposal Ivor � C��ntrnrtion antit ��,Permiss>on > he.eby granted �' to Construct ( ")j R pair ( )�,a,n��Individual Se�yage Disposal S sty( at No:......••--•- ......---•._. --••----........ .........•-- ---•-•-•-•••---•---•---•----•-----••--•--••---••-••-•--•----......._-_.... Street _ as shown on the application for Disposal Works Construction Permit N ._'_��'"�=� Dated.._.__.�'b �r1 mS ......... ----......-`-------------------------- ......................... Board of Health DATE -)---- J ................................... . FORM 1255,,'HOBBS & WARREN. INC.. PUBLISHERS "'•>5, E`EN: tU GEIV ERA 4., IYO TES rTpr' sv3 Lis E�LEY.9 TONS S I�Yi1/ ARE soy t.g 21'24 it Cc EAJ l MBE Un'1 ♦% �� /-`�� �J ` M�oIU�-�( ��Xi, S4M� .r' -:.„ � � � � ��'1 ,Z. PITCH A/.�.. ,C,1/VFS A .GI/,N/MUM ?F ?•- I 2 4 �, �I O �/ O O © � C� UNX,ESS O THERW!SE Sf E C/F/E P i ' 'Zr I Sov►)E Srr S4 Ct B ' II t� ��I � ! '' --�/ @ O O O ��`� 3. A�,�C, PIPES T O 4,VP IN THE S YSTEM SHAL,4, x _ �%06 ! - }- _ BE CAST IRON OR SCHEP414,E -4c PVC. - - O O 0003 (DO 4 ,41,4 S/=f'T/G' T,4Nk S, D/STR/BUT/O!t/ BOXES, _ - - ,: ; 1 O O O O O C� CD 41V P o t ACH/N6 P1 T�5 S1444,4 BE OE:516N-A`D 00 - � " FOR /Y ZO N'HEE.G 40..AOING S 1'Yf/Ef1i . t o O OO O (D UNVEh' P,4VING SA►� £R 1 O �_ --J -- _ I C� O L"J O S REMOVE 44,1- UNSU/TABS,t' 111,4 TER/A4, BE,A,/EA Th' Th'E /IV YE R 7- EtYA TIONS O (D (D O OO O (D (D 0 of THE P/FFUSORS FOR A J/S TgNC E OF r'' .1 /. 5ANI URY TEE C) O .0 N P OACKF/1,4, 4'V/TN Ck A Y-FRE-E- 4¢" TYPICAL DJ`J`�' f�jf.�UT/ G ; m - -- --- -- `v _ SANG' 4NP G�'AV6 .HAVI.IV 4 fERCOA,, 7!ON P 3 _ T C1N BOX RA TE OF z M/NUTS S PE!' /NCH Of �.ESS. rJO u/A t Ee? ASSU"S � A iS @ -- TYPICAL C�4�, ,G,E.4 CN/NG P� T 6. Tf1E e�k. � `: 'i 80AR0 OF .HEAD(,TN MUS r %VO T TO SCAB,E ,- -o'� IVOTE DISTRIBUTION LROX AMPI AGAR,. C1E�SERYAT/G�/V P/T-S r NOT TO SCq,LE l3E NOT/F/E!� W,,' A, Tl E SYSTEM/S NEAR REI/b FORC 6E� SEPTIC TANK BY TYp/C,4,C, C'.4 ASEPTIC TANK C,0M1 ki'- T/ON,4ND PRIOlf TO BACkF/l,,Li/VC. F'ERCOI,,.A%D,� 9,4 TE �'I rJ/t►,_IC;t Ait�1 f ft'!C.4,N' r'A'6 C,4ST OR E(7OA 4.. - 7 UNZ ES S C THER W!SE NOTED ,44,4 SYSTEM �f3 SErf'Y,4 TIONS B>' AM r +.�r 1 NOT TO SCA,C E ' 'O�LlPONENTS T OF H 5P,44,, 3E /NST,4k.,z ED IN BQ NC1 TE -4/VA-S 1-?EINFORCEG' TI/ROO(3HOU T 4C'CUROA!1/CE W/TH TI T4,E -Y OF THE STATE �+,'�'G' HEAL. H ,,� W/T y E�.E"CTFt'/C !•`VE�,GEP f1'/Ir'�" N�/7N �;�st %z"c-NGINEER ARROW E,NG/lVEER!/VG i%Vt ' S4N/TARY COVE AND ANY I,OCA.4 1,f414.ES P.4 S TE - SEio?� /�',�j EfNBE00El� TEE,C, I?O P,5 //V 7"D!',��' BD T 7-0M. IVH/Ciy iO4 Y APPk Y. ' Cc1NCRETE" /s �o©o Ps/ rE,sT NOTE ACC E55�MA,/Vf•/D,� SF TC S'E�TIC TAAIe (� A ND 4,EACH/Nv P/7,5 TO B,E BUILT LIP TO EC EY• I+ 1,2 " E3E�0 t t1 /iti�/S H G,CAD,E. V II FINISH GRADE FIN/Sf1 c,RAOE �OYER TANK F/N H GR,40E F/N/S H G,eA D E O✓Ee , E.C,EY 1�+ E,CE �-b Y { OYE „p., BOX _ l � PIT ` 8? ASTONC li+-ITS a � �' i� ---- " �• 9 N a o'o 0 0 0 G] N �I7 O I .._ {5+1 o ao 0 O O @ a8 � /� OF '3/4 -y - �iST. BOX !o �� ao$C t �rco,� ' ':. O (' O G°o°c -CreUSNEO STONE ae-j•t (D_ w t. Y ST4B,CE� o ° z O O@ v oo C'C�NC/PETE / r� j ,t fl r J f�h ,� �Q,,,, i♦ /� * \ 2o y ,�j PT/C TANK IoB� boa jm O O O � o" c3O / , -TOM ``• iIVV= t �0 8 OF F>IT 1 a+ ,-,EACH/NG n!T 7-0 BE /-FVEL 4 STAOB -E) TYPICAL SEWAGE 5 y5 TEM P,0oFIL E NOT- op To scA� r �' r�� •y/Ao SEG'T/ON o41TCEI, /,OT ADDRESS k3, Cl� - -- ! \ ,/ .ZONING O/STRICT r400p yA,ZARD ,ZONE LPG$ PE&GN CRiTEIVA PROPO G O - SED ZOC.4T/ON OF OkYZI,.4ING NUMBER OF BEDROOM S FX/ST CONTOUFr PERSONS PER BEDROOM ©R4PCSEO CONTOUR �4FRIQ6E 05PWA SYSTEM 6A4.,,0NS PER PERSON PER PAY �.��-� EXIST SPOT El,EVAT/ON 9*0 � LOT G 1 EACN/NG P,RE UIR6 i Q _ ROPC7SEv S<'OT EkEV.4T/O/v �O � ti EAC/NING /'RO Y/OED ;'� RERCOI.A TION T EST m �o v�sPoaA�. o�sERYATroN sir m ;! j, f' ARR41CANT : ENGINEER .' Iv,1WT-1 r-i -rc-)DM P1r ARROW:ENGINFERIM6 INC / 1 ,��! a�► 60 E. F,441MOUTH HW Y, SF�YE/g DES. C/1� Q� • _ .��-F , s.♦.9Z w.a�.�, Z t r' r. ti x E. FAI.1001J, III�l,4 X536 " dOTTO,ti1 = n �..o ..� ,� 21583�Jr,�', SC'AC E' P4T ' SHEET: TO TA,,. r- 2 - l�P ter . PI?4 H'N OY. CHEc"'it E'G' ,c3Y A,, PP B Y: Pk,,4N NO.