HomeMy WebLinkAbout0444 POPONESSETT ROAD - Health `444 Popon eit Road
Cotui`#,
A = 019 005
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TOWN OF BARNSTABLE
LOCATIONf I .�®���C�S�i' SEWAGE#
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VILLAGE CoTu iT ASSESSOR'S MAP&PARCEL . 19
INSTALLER'S NAME&PHONE NO(2APF-Ca. 4'bQ &9rf9 M 45 ESIZ
SEPTIC TANK CAPACITY (15C4, Gv9rLLZ tj
LEACHING FACILITY. (type(q)500!5A,- e6J4mjAa3 (size) 40 yC l' •`Y,
NO.OF BEDROOMS C.�.
OWNER CIAAcc/ : 5�aZoQJ4,1C d
PERMIT DATE: 5 I c,' DLO d l COMPLIANCE DATE: 7
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility /v A Feet
Private Water Supply Well and Leaching Facility(If any wells exist on
site or within 200 feet of leaching facility) 4 Feet
Edge of Wetland and Leaching Facility(If any wetlands exist within
300 feet of leachiinngg facility) Feet
FURNISHED BY l �A06&J e Oi<
2 = WA a�a
a
5 �l .
9-1 - 2 t
QP'Z Z�p•1 '
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No. Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in co uteri
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
Application for Disposal 6pBtem Construction Permit
Application for a Permit to Construct( ) Repair o ( Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No.W4 RD Owner's Name,Address,and Tel.No.
CaZuc-r CAW--_`{ s 5_0Z ►A1yvL- C-Z�v'Ef._
Assessor's Map/Parcel I eciTtJ i f
Inst ller's Name,Address,and Tel.No. SC@-477-9'911 Designer's Name,Address,and Tel.No. 5 CQ—ck7"3-6 3'17
CAP6ZCA1D6 ,4-stfP�G 4rG w -
Type of Building: +
Dwelling No.of Bedrooms L Lot Size �t'g 9 'sq.ft. Garbage Grinder( )
Other Type of Building Q4!�S tD&V7(A4- No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd Design flow provided 5 3(9. gpd
Plan Date 5—4 0—;L o t l Number of sheets l Revision Date
Title Wq P.0P0 okb Cb-'U t
Size of Septic Tank i ,500 Cz*L4_0&I Type of S.A.S. t{) 470
Description of Soil Bbd_ L& ,4 SAW76 Q_ '7�� �$CL= Pam
Nature of Repairs or Alterations(Answer when applicable)_05.. tr EX46TrPG lJI�CX)
ids h-SL® A -6aX -tZ:) (q) Boo 14 -Aa L c6,,'Gr, cry r�
wOH Al PQT OR+Er � dr�, s bE5 /&� 3 frzr oy S
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health. s�
i r Date
Application Approved by Date
Application Disapproved y Date
for the following reasons 61
Permit No. kIZZ Date Issued
-- -------------------------------------
No. Fee
—/x
THE COMMONWEALTH OF MASSACHUSETTS Entered inwrnputer:
PUBLIC HEALTH DIVISION - TOWN OF xBARNSTABLE, MASSACHUSETTS Yes
21pplication for DistloBal 6pstem Construction Permit
Application for a Permit to Construct( ) Repair(,No Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components"
Location Address or Lot No.W4 PoPom,66SET- RD Owner's Name,Address,and Tel.No.
Assessor's Ma /Parcel �vIT, CA�4 s 50Za0"L` 45gJZQ/�„
p 19 S' dom0l'l
Installer's Name,Address,and Tel.No. S7C@-j77--2$-7`j Designer's Name,Address,and Tel.No. j cQ-,;k-t3-63`17
- G4Pe XDG &W7e;xPA45&T 7 IIIASWPeZ� 1--&s4C V &-,CLj Ai4A
Type of Building:
Dwelling No.of Bedrooms Lot Size "fg 65 -sq.ft. Garbage Grinder( )
Other Type of Building AC-_ `D4W7 r A44 * No.of Persons Showers( ) Cafeteria( )
Other Fixtures ��//
Design Flow(min.required) gpd Design flow provided 5;3�p Y' gpd
Plan; Date 5-16-a n 1`p Number of sheets I Revision Date
Title ��P� �, k dka C o?U t
Size of Septic Tank_ 5oo &4L4.0,4J Type of_S.A.S. M J O CWf-C.00 ff--U G6 �lUpC �
Description of Soil A460-I Crfs4 S r4b_Q- 5ce Pam
Nature of Repairs or Alterations(Answer when applicable) ��Tt G 1,4M 69 ( A) 5 `t prlrl.
lb &)6� ti-A0—0-6PX _M (q) Sao G-j4Gteog,,i 14-ace L04elQocm Ct4.4wf cAg
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 4x
Compliance has been issued by this Board of Health.
gne : Dates ' v
Application Approved by �144 - Date
Application Disapproved by v / / Date /
for the following reasons .
t
Permit No. 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 <2AFat rb E ExmJ _<�
at- _b d0TU i-r has been constructed in accord 1
with the provisions of Title 5 and the for Disposal System Construction Permit No.
Installer dAP wtjm Designer -1 61&J Z
#bedrooms Approved desi ow � gpd
The issuance of this permit shall of be co strued as a guarantee that the system will function de ' ed
Date 2 Inspector
---- ----- ,---- -------------------- -----
v C / / Fee�
No.
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS
Disposal *pstem Construction permit
Permission is hereby granted to Construct( ) Repair( Upgrade( ) Abandon
qt ( )
System located at q p jj)
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 n�)sq c m�?d within three years of the date of this permit.
Date L Approved by
05/25/2017 14:52 5082730367 #5493 P.001/001
Town of Barnstable
Regulatory Services
Richard V. Scali,Interim Director
a�tereH�s, i
Public Health Division
soraop' Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office: 508-862.4644 Fax: 508-790-6304
Installer& Designer Certification Form
Date: 5-Z5-�7 Sewage Permit# �XOt'Z-(55 Assessor's MapWarcel
Designer: �C'- C�►gtr�cuc�n ,IC. Installer: CaeZWicle. 61.4ceris
Address: 2 S a Y Cranb errT i�h wa rV Address 1 3 CN,6M erc i u 1 S�4��&f
Cask Waf�amt HA 6253$ rtas�►Q, e., }�f� 0.2loyq
On 5`{'01-,L0 i7 Caeewu& C-MUQrtse.S was issued a permit to install a
(date) (installer)
septic system at yy 10 P010 e55 of R ood based on a design drawn by
(address) MM
'TG lrcl�lne�cin �C.. dated
(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. Strip out (if required) was inspected and the soils
were found satisfactory.
I certify that ;he 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-bgilt by designer to follow. Strip out(if required)was inspected and the soils
were found satisfactory.
I certify that the system referenced above was construc ce with the terms
of the l\A approval letters(if applicable)
JOHN L
W CHUR ILL,IR.
VIL
(I tall 's Sign re) N 41
s
( signer's Sign e) (Affix igne s S mp Here)
PI.. SE RET TO BARN ABLE PUBLIC HEA . H D IS N. CERTIFICATE
OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOT11 EIIS FORM AND AS-
BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUMCIC HEALTH DIVISION.
THANK YOU.
Q%cptic0esigner Ccrtificgtion Form Rev 8-14.13.doc
i
Town of Barnstable r#
Departinent of Regulatory Services
F Public HeDivision'a + �x al� Date i �7
i'd39 MAM
200 Main Street,Hyannis MA 02601 r_5
• r�'f! f�
E"•n2
0.
Date Scheduled r-ws
Tuna �_ peep 1
Soil Suitability Assessment for Sewage Disposal
Performed-By: M i�Cl t• ��MQ e 'I T/� 6 S E Witnessed By:
LOCATION&.GENERAL INFORMATION ,
Location Address
Owner's Namo C.AiZEY ;$j A XfF ( RL VEQ
Address pa R,Q�C 10 •Cv-t v ltT'
Assessor's Map/Parcel. `(' G6-Tu r �R�Cczlit>E OF &M Al _r SC) ��73-03317
Q® Bngincer's Name
NEW CONSTRUCPION REPAIR _ Tcle hbne# 5 4 -6'11`7.
Lund Use slopes(96) �— Gib Surfhco Stones /v
1
Distancoa ftom: Open Water Body ft Possible Wet,Area ��G ft Drinking Water Well 130 ft
Dmlhage Way L 1 C ft Property Llne L 1O ft Other
i
ft
SI +'TCHC(Stract name,dimensions of lot,exact locations of test holes&pore tests,locate wetlands-in
I I I proximity to holes)
• Sep �-+���.�� �` �.r1 a l
Parontmaterlal(gcolo IcInlof� ��a� �) r
Depth to Bedrock,,
Depth to Groundwater. Standing Water in Holo: > J -'J 19) Weeping froir Pit Face > 13 13K S
Estimated Seasonal High Groundwater
D 'gATION FOR SEASONALHIGD WATER TA LR
Method Used: t rC C} 0 WVC n >' 3
De th Observed standing in obs.hole: In. Depth tv'svll mottles,
Do th to weeping from side of obs.hole: > f in, atnundwator Adjuattaont .A/J
Index Well•# _ Reading Dato: — Index Well Imval Adj•thetor Adj.gtautidw ter
PERCOLATION TEST bate -lo-+ ''lime 1G!pC`�c
Observation
Hole# I _ Tine at 9"
Depth of Pow3 D Time at 6"
Start Pro-soak Time Tinto(911•6")
End Pre-soak `V• C.Ml
Rate Mln./lnoh '
Site Suitability Assessment: Slid Passed � Site Failed: Additional Testing Needed(Y/N) _
I
Original: Public Health Division Observation Hole Data To Be Completed on Back
I
***If percolation test is to be conducted within 100' of wetland,you must fir notify the
Barnstable Conservation Division at least one(i)week prior to beginning.
QASBPPIWJ3RCF0RM.D0C
DEEP.OBSERVATION HOLE LOG Hole# }
Depth from Sall Horizon Soil Texture Sdil Color Sall, Other
Surface(In.) (USDA) (Munsell) Mottling (Stnuctum,Stonat;Boulders.
a nststency.%'Graval)
C) c S
`tr - -
aC)-4 Loa �'nd, 10 r . 1' 6
�S- 132 C mejIun1 son0 .•SY 6l — —
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Sall Color Sall Other
Surface(in.) , (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
1. r
, tk
DEEP OBSERVATION HOLE LOG 11010#
Depth from Soil Horizon Sall Texture Sall Color Sall Other
Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulder..
DEEP OBSERVATION HOLE LOG Hole#
Depth from Sall Horizon Soil Texture Sall Color Noll Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,SSonat;Boulder,
Flood Insurance Rate Map:
Above 500 year Mood boundary No— Yes
Within 500 year boundary No. Yes
Within 100 year flood boundary No. Yes
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring porvious mtitorial oxist in all areas observed thrpughout the
area proposed for the soil absorption system? Z S
If not,what is the depth of naturally occurring pervious material?
Certification
I certify that on 2'7: 2q (date)I have passed the soil evaluator examination.approved by the
Department of Environmental Protection nd that the above analysis was performed by me consistent with
the required training,expertise and a erl nce described In 10 CMR 15.017.
Signature Datb s/6!7
Q;ISBPT Mfl1t.CPORM.DOC
YOU WISH TO OPEN A BUSINESS?
For Your Information: Business certificates (cost$140.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which
you.must do by M.G.L.-it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, 1"FL., 367
Main Street, Hyannis, MA 02601 (Town Hall)
DATE: Fill in please:
11in; .
,r lLwl!iu��� i� , �' .� N ; APPLICANT'S YOUR NAME/S:
Vim ' .�'� BUSINESS YOUR HOME ADDRESS:
�.4
eA 'P `li l TELEPHONE y s�5� Home Telephone Number
T9 §fa4�il m9�Riktd ��
NAME OF CORPORATION:
NAME OF NEW BUSINESS 1/4" s' TYPE OF BUSINESS
IS THIS A HOME OCCUPATION? YE NO
ADDRESS OF BUSINESS G MAP/PARCEL NUMBER 0Z� (Assessing)
When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of
Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. — (corner of Yarmouth
Rd. &Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in.this town.
1: BUILDING COM(Ih ?e
SER'S OFFICE
This individu in#ortof!ay p rmit requirements that pertain to thiRToPQNFe6XWITH HOME OCCUPATION
RULES AND REGULATIONS. FAILURE TO
Auth riz=Si tur ® COMPLY MAY RESULT IN FINES.
�CPMMENT
f ,
2. BOARD OF HEALTH
This individual h 17n infV d f the emit requirements that pertain to this type of business.
MUST,XMPLY WITH ALL
COMMENTS:
Authorize ignature** KAWDOUS MATERIALS REGULATIONS
•
3. CONSUMER AFFAIRS (LICENSING AUTHORITY)
This individual has been informed of the licensing requirements that pertain to this type of business.
Authorized Signature** .
COMMENTS:
r ,
CERTIFICATE OF ANALYSIS Page: 1
�.
�M
~t. !� Barnstable County Health Laboratory
Report Dated: 9/25/2006
Report Prepared For:
Order No.: G0638259
Carey C. Grover
P O Box 1080
Cotuit, MA 02635
Laboratory ID#:
, 0638259-01 Description: Water-Drinking Water
Sample#: Sampling Location 444 Popponesset Rd.Cotuit,MA _ Collected: 9/20/2006
Collected by: C.Grover _ Received: 9/20/2006
Routine +Ainnionia
ITEM RESULT UNITS RL MCL Method# Tested
i
LAB: IC Lab
Ammonia BRL mg/L 0.20 EPA 350.3 9/20/2006 j
i
LAB: Inorganics
i
Nitrate as Nitrogen 0.16 mg/L 0.10 10 EPA 300.0 9/20/2006
LAB: -Metals � ,;_
Copper 0.10. mg/L 0.10 1.3 SM3111B 9/21/2�06 i
Iron x C :'` :-7 BRL, mg/L 0.10 0.3 SM 311113 9/2172466
mg/L 1'0 20 SM 3111B 9/21i2006'
LAB: Microbiology
Total Coliform Absent P/A 0 o SM9223 mot. �9 2o/2o06•
s ro
LAB: Physical Chemistry `
Conductance 81 umohs/cm 2.0 EPA 120.1 C' 9/20/2006 v
PH 6,4 pH-units 0 EPA 150.1 1 9/20%2006; !
EPA 524.2- Volatile Organics by GUMS
ITEM RESULT UNITS RL MCL Method # Tested
LAB: GUMS
1,1,1,2-Tetrachloroethane BRL ng/L 0.5 EPA 524.2 9/20/2006
ug/L o.5 20o EPA 524.2 9/20/2006
1,1,1-Trichloroethane BRL
1•,1'2 2'Tetrachloroethane BRL ug/L o.s EPA 524.2 9/20/2006
4,'12-Trichloroethane BRL ug/L 0.5 5.0 EPA 524.2 9/20/2006
x.l.'1''DichlOroethane BRL ug/L 0.5 EPA 524.2 9/20/2006
�- IJ-Dichloroethene BRL ug/L 0.5 7 0 EPA 524.2 9ilo/2o06
RL = Reporting Limit
MCL=Maximum Contaminant Level
Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605
M
CERTIFICATE OF ANALYSIS Page: 2
Barnstable County Health Laboratory
Report Dated: 9/25/2006
Report Prepared For:
Order No.: G0638259
Carey C. Grover
P O Box 1080
Cotuit, MA 02635
1,1-Dichloropropene BRL ug/L 0.5 EPA 524.2 9/20/2006
1,2,3-Trichlorobenzene BRL ug/L 0.5 EPA 524.2 9/20/2006
ug/L o.s EPA 524.2 9/20/2006
1,2,3-Trichloropropane BRL
1,2,4-T rich lorobenzene BRL ug/L 0.5 70 EPA 524.2 9/20/2006
i
1,2,4-Trimethylbenzene BRL ug/L 0.5 EPA 524.2 9/20/2006
1,2-Dibromo-3-chloropropa BRL ug/L 0.5 EPA 524.2 9/20/2006
1,2-Dibromoethane (EDB) BRL ug/L o.s EPA 524.2 9/20/2006
1,2-Dichlorobenzene BRL ug/L 0.5 600 EPA 524.2 9/20/2006
1,2-Dichloroethane BRL ug/L 0.5 5.0 EPA 524.2 9/20/2006
t1,2-Dichloropropane BRL ug/L 0.5 EPA 524.2 9/20/2006 j
1,3,5-T rim ethyl benzene BRL ug/L o.s EPA 524.2 9/20/2006
1,3-Dichlorobenzene BRL ug/L 0.5 EPA 524.2 9/20/2006
1,3-Dichloropropane BRL ug/L 0.5 EPA 524.2 9/20/2006
1,4-Dichlorobenzene BRL ug/L 0.5 5.0 EPA 524.2 9/20/2006
2,2-Dichloropropane BRL ug/L 0.5 EPA 524.2 9/20/2006
2-Chlorotoluene BRL ug/L o.s EPA 524.2 9/20/2006
4-Chlorotoluene BRL ug/L 0.5 EPA 524.2 9/20/2006
Benzene BRL ug/L 0.5 5.0 EPA 524.2 9/20/2006
Bromobenzene BRL ug/L 0.5 EPA 524.2 9/20/2006
Bromochloromethane BRL ug/L 0.5 EPA 524.2 9/20/2006
i
Bromodichloromethane BRL ug/L 0.5 EPA 524.2 9/20/2006
Bromoform BRL ug/L 0.5 EPA 524.2 9/20/2006
Bromomethane
BRL ug/L 0.5 EPA 524.2 9/20/2006
Carbon tetrachloride BRL ug/L 0.5 5.0 EPA 524.2 9/20/2006
Chlorobenzene BRL ug/L 0.5 100 EPA 524.2 9/20/2006 I
Chloroethane
BR1_. ug/L 0.5 EPA 524.2 9/20/2006
Chloroform BRL ug/L 0.5 80 EPA 524.2 9/20/2006
Chloromethane BRL ug/L 0.5 EPA 524.2 9/20/2006
i
cis-1,2-Dichioroethene BRL ug/L 0.5 70 EPA 524.2 9/20/2006
RL = Reporting Limit
MCL=Maximum Contaminant Level
Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605
CERTIFICATE OF ANALYSIS Page: 3
Barnstable County Health Laboratory
Report Dated: 9/25/2006
Report Prepared For:
Order No.: G0638259
Carey C. Grover
P O Box 1080
Cotuit, MA 02635
-------_---
cis-1,3-Dichloropropene BRL ng/L 0.5 EPA 524.2 9/20/2006
Dibromochloromethane BRL ug/L 0.5 EPA 524.2 9/20/2006
Dibromomethane BRL ugn- 0.5 EPA 524.2 9/20/2006
Dichlorodifluoromethane BRL ug/L, 0.5 EPA 524.2 9/20/2006
Ethylbenzene
BRL ug/L 0.5 700 EPA 524.2 9/20/2006 !'
Hexachlorobutadiene BRL ug/L 0.5 EPA 524.2 9/20/2006
Isopropylbenzene BRL ug/L 0.5 EPA 524.2 9/20/2006
I Methyl-tert-butyl ether BRL ug/L 0.5 EPA 524.2 9/20/2006
ug/L o.5 s.o EPA sz4.2 9/2o/zoo6
Methylene chloride BRL
n-Butylbenzene BRL ug/L 0.5 EPA 524.2 9/20/2006
ug/L o.s EPA sz4.z 9/zo/zoo6
n-Propylbenzene BRL
Naphthalene BRL ug/L 0.5 EPA 524.2 9/20/2006
p-Isopropyltoluene BRL ug/L 0.5 EPA 524.2 9/20/2006
sec-Butylbenzene BRL ug/L 0.5 EPA 524.2 9/20/2006
Styrene BRL ug/L 0.5 100 EPA 524.2 9/20/2006 !,
�i
tert-Butylbenzene BRL ug/L 0.5 EPA 524.2 9/20/2006
Tetrachloroethene BRL ug/L 0.5 5.0 EPA 524.2 9/20/2006
Toluene BRL ug/L 0.5 1000 EPA 524.2 9/20/2006
ug/L 0.5 10000 EPA 524.2 9/20/2006
Total xylenes BRL
trans-1,2-Dichloroethene BRL ug/L 0.5 I'oo EPA 524.2 9/20i2006
trans-1,3-Dichloropropene BRL ug/L o.5 EPA 524.2 9/20/2006
Trichloroethene BRL ug/L 0.5 5.0 EPA 524.2 9/20/2006
T rich lorofluoromethane BRL ug/L 0.5 EPA 524.2 9/20/2006
Vinyl chloride BRL ug/L 0.5 2.0 EPA 524.2 9/20/2006
i
['Water'sample meets the recommended limits for drinking water of all the above tested parameters.I
Approved By ........ .------
(L ector)
RL = Reporting Limit
MCL=Maximum Contaminant Level
Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph:.508-375-6605
•►
r,�y OF.aA/Z,�S
9 CERTIFICATE OF ANALYSIS Page:
Barnstable County Health Laboratory
9SShGt31�_
Report Dated: 12/8/2004
Report Prepared For:
Order No.: G0428768
Carey C. Grover
P 0 Box 1080
Cotuit, MA 02635
Laboratory ID#: 0428768-01 Description: Water-Drinking Water
Sample#: 2876801 Sampling Location 444 Poponesset Rd Cotuit MA Collected: 12/2/2004
Collected by: C.Grover Received: 12/2/2004
Routine
ITEM RESULT UNITS RL MCL Method# Tested
LAB: Inorganics
Nitrate as Nitrogen 0.29 mg/L 0.1 10 EPA 300.0 12/2/2004
LAB: Metals
Copper BRL mg/L 0.1 1.3 SM 3111 B 12/7/2004
Iron BRL mg/L 0.1 0.3 SM 311113 12/7/2004
Sodium 13 mg/L 1.0 20 SM 3111B 12/7/2004
LAB: Microbiology
Total Coliform Absent P/A 0 Absent 309 12/2/2004
LAB: Physical Chemistry
Conductance 150 umohs/cm 1 EPA 120.1 12/2/2004
pH 7.2 pH-units 0 EPA 150.1 12/2/2004
EPA 524.2- Volatile Organics by GUMS
ITEM (RESULT UNITS RL MCL Method# Tested
LAB: GUMS
1,1,1,2-Tetrachloroethane BRL ug/L 0.5 EPA 524.2 12/3/2004
1,1,1-Trichloroethane BRL ug/L 0.5 200 EPA 524.2 12/3/2004
1,1,2,2-Tetrachloroethane BRL ug/L 0.5 EPA 524.2 12/3/2004
1,1,2-Trichloroethane BRL ug/L 0.5 5.0 EPA 524.2 12/3/2004
1,1-Dichloroethane BRL ug/L 0.5 EPA 524.2 12/3/2004
1,1-Dichloroethene BRL ug/L 0.5 7.0 EPA 524.2 12/3/2004
1,1-Dichloropropene BRL ug/L 0.5 EPA 524.2 12/3/2004
1,2,3-Trichlorobenzene BRL ug/L 0.5 EPA 524.2 12/3/2004
1,2,3-Trichloropropane. BRL ug/L 0.5 EPA 524.2 12/3/2004
RL = Reporting Limit
MCL=Maximum Contaminant Level
Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605
4
o�y59 , CERTIFICATE OF ANALYSIS Page. 2✓
Barnstable County Health Laboratory
SACFNS��
Report Dated: 12/8/2004
Report Prepared For:
Order No.: G0428768
Carey C. Grover
P O Box 1080
Cotuit, MA 02635
1,2,4-Trichlorobenzene BRL ug/L 0.5 70 EPA 524.2 12/3/2004
1,2,4-Trimethylbenzene BRL ug/L 0.5 EPA 524.2 12/3/2004
1,2-Dibromo-3-chloropropa BRL ug/L 0.5 EPA 524.2 12/3/2004
1,2-Dibromoethane(EDB) BRL ug/L 0.5 EPA 524.2 12/3/2004
1,2-Dichlorobenzene BRL ug/L 0.5 600 EPA 524.2 12/3/2004
1,2-Dichloroethane BRL ug/L 0.5 5.0 EPA 524.2 12/3/2004
1,2-Dichloropropane BRL ug/L 0.5 EPA 524.2 12/3/2004
1,3,5-Trimethylbenzene BRL ug/L 0.5 EPA 524.2 12/3/2004
1,3-Dichlorobenzene BRL ug/L 0.5 EPA 524.2 12/3/2004
1,3-Dichloropropane BRL ug/L 0.5 EPA 524.2 12/3/2004
1,4-Dichlorobenzene BRL ug/L 0.5 5.0 EPA 524.2 12/3/2004
2,2-Dichloropropane BRL ug/L 0.5 EPA 524.2 12/3/2004
2-Chlorotoluene BRL ug/L 0.5 EPA 524.2 12/3/2004
4-Chlorotoluene BRL ug/L 0.5 EPA 524.2 12/3/2004
Benzene BRL ug/L 0.5 5.0 EPA 524.2 12/3/2004
Bromobenzene BRL ug/L 0.5 EPA 524.2 12/3/2004
Bromochloromethane BRL ug/L 0.5 EPA 524.2 12/3/2004
Bromodichloromethane BRL' ug/L 0.5 EPA 524.2 12/3/2004
Bromoform BRL ug/L 0.5 EPA 524.2 12/3/2004
Bromomethane BRL ug/L 0.5 EPA 524.2 12/3/2004
Carbon tetrachloride BRL ug/L 0.5 5.0 EPA 524.2 12/3/2004
Chlorobenzene BRL ug/L 0.5 100 EPA 524.2 12/3/2004
Chloroethane BRL ug/L 0.5 EPA 524.2 12/3/2004
Chloroform BRL ug/L 0.5 EPA 524.2 12/3/2004
Chloromethane BRL ug/L 0.5 EPA 524.2 12/3/2004
cis-1,2-Dichloroethene BRL ug/L 0.5 70 EPA 524.2 12/3/2004
cis-1,3-Dichloropropene BRL ug/L 0.5 EPA 524.2 12/3/2004
Dibromochloromethane BRL ug/L 0.5 EPA 524.2 12/3/2004
Dibromomethane BRL ug/L 0.5 EPA 524.2 12/3/2004
RL = Reporting Limit
MCL=Maximum Contaminant Level
Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605
I
• 'OF�A .
CERTIFICATE OF ANALYSIS Page: 3
Barnstable County Health Laboratory
Report Dated: 12/8/2004
Report Prepared For:
Order No.: G0428768
Carey C. Grover
P O Box 1080
Cotuit, MA 02635
Dichlorodifluoro methane BRL ug/L 0.5 EPA 524.2 12/3/2004
Ethylbenzene BRL ug/L 0.5 700 EPA 524.2 12/3/2004
Hexachlorobutadiene BRL ug/L 0.5 EPA 524.2 12/3/2004
Isopropylbenzene BRL ug/L 0.5 EPA 524.2 12/3/2004
Methyl-tert-butyl ether BRL ug/L 0.5 EPA 524.2 12/3/2004
Methylene chloride BRL ug/L 0.5 5.0 EPA 524.2 12/3/2004
n-Butylbenzene BRL ug/L 0.5 EPA 524.2 12/3/2004
n-Propylbenzene BRL ug/L 0.5 EPA 524.2 12/3/2004
Naphthalene BRL ug/L 0.5 EPA 524.2 12/3/2004
p-Isopropyltoluene BRL ug/L 0.5 EPA 524.2 12/3/2004
sec-Butylbenzene BRL ug/L 0.5 EPA 524.2 12/3/2004
Styrene BRL ug/L, 0.5 100 EPA 524.2 12/3/2004
tert-Butylbenzene BRL ug/L 0.5 EPA 524.2 12/3/2004
Tetrachloroethene BRL ug/L 0.5 5.0 EPA 524.2 12/3/2004
Toluene BRL ug/L 0.5 1000 EPA 524.2 12/3/2004
Total xylenes BRL ug/L 0.5 10000 EPA 524.2 12/3/2004
trans-1,2-Dichloroethene BRL ug/L 0.5 100 EPA 524.2 12/3/2004
trans-1,3-Dichloropropene BRL ug/L 0.5 EPA 524.2 12/3/2004
Trichloroethene BRL ug/L 0.5 5.0 EPA 524.2 12/3/2004
Trichlorofluoromethane BRL ug/L 0.5 EPA 524.2 12/3/2004
Vinyl chloride BRL ug/L 0.5 2.0 EPA 524.2 12/3/2004
Water sample meets the recommended limits for drinking water for all above tested parameters.
Approved By: �
(La Director)
2 /9
U DUPLICATE
RL = Reporting Limit
MCL=Maximum Contaminant Level
Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605
Page:
CERTIFICATE OF ANALYSIS 1
r RECEIVED
Barnstable County Health Laboratory
Report Prepared For: Report Dated: s/1s/zoo3 .MAY 19 2003
Order Number: G0319533
Care C.Grover TOWN OF BARNSTABLE
y . HEALTH DEPT.
P O Box 1080
Cotuit, MA 02635
Laboratory ED#: 0319533-01 Description: Water-Drinking Water
Sample#: 1953301 Sampling Location: 444 Poponessett Rd Cotuit MA Collected 4/28/2003
collected by: C Grover Received 4/28/2003
Routine
ITEM RESULT , UNITS MDL MCL Method# Tested
LAB: IC Lab
Nitrates <0.1 mg/L 0.1 10 EPA 300.0 4/29/2003
LAB: Metals
Copper <0.1 mg/L 0.1 1.3 SM 3111B 5/2/2003
Sodium 8 mg/L 1.0 20 SM 3111B 5/2/2003
LAB: Microbiology
Total Coliform Absent P/A 0 Absent 309 4/28/2003
LAB: Physical Chemistry
Conductance 128 umohs/cm 1 EPA 120.1 4/28/2003
pH 7.0 pH-units 0 EPA 150.1 4/28/2003
Note: Water sample meets the recommended limits for drinking water of all above tested parameters.
s
,
Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605
}
�.. RECEIVE.
r 4 Mi. CERTIFICATE OF ANALYSI ° Page. 2
Barnstable County.Health Laboratory MAY 1 9 2003 f
Report Preuared For: Report Dated: 5/15/2003 TOWN OF BAR- TABLE I
HEALTH DEFT.
Order Number: 6319.533 __
Carey C.Grover
P O Box 1080
Cotuit, MA 02635
Laboratory ID#: 0319533-02 Description: Water-Drinking Water
Sample#: N427 428 Sampline Location: 444 Poponessett Rd Cotuit MA Collected 4/28/2003
Collected by: C Grover Received 4/28/2003
EPA 524.2- Volatile Organics by GUMS
ITEM RESULT UNITS MDL MCL Method# Tested
LAB: GC/MS
1,1,1,2-Tetrachloroethane BRL ug/L 0.5 EPA 524.2 5/3/2003
1,1,1-Trichloroethane BRL ug/L 0.5 200 EPA 524.2 5/3/2003
1,1,2,2-Tetrachloroethane BRL ug/L 0.5 EPA 524.2 5/3/2003
1,1,2-Trichloroethane BRL ug/L 0.5 5.0 EPA 524.2 5/3/2003
1,1-Dichloroethane BRL ug/L 0.5 EPA 524.2 5/3/2003
1,1-Dichloroethene BRL ug/L 0.5 7.0 EPA 524.2 5/3/2003
1,1-Dichloropropene BRL ug/L 0.5 EPA 524.2 5/3/2003
1,2,3-Trichlorobenzene BRL ug/L 0.5 EPA 524.2 5/3/2003
1,2,3-Trichloropropane BRL ug/L 0.5 EPA 524.2 5/3/2003
1,2,4-Trichlorobenzene BRL ug/L 0.5 70 EPA 524.2 5/3/2003
1,2,4-Trimethylbenzene BRL ug/L 0.5 EPA 524.2 5/3/2003
1,2-Dibromo-3-chloropropa BRL ug/L 0.5 EPA 524.2 5/3/2003
1,2-Dibromoethane(EDB) BRL ug/L 0.5 EPA 524.2 5/3/2003
1,2-Dichlorobenzene BRL ug/L 0.5 600 EPA 524.2 5/3/2003
1,2-Dichloroethane BRL ug/L 0.5 5.0 EPA 524.2 5/3/2003
1,2-Dichloropropane BRL ug/L 0•5 EPA 524.2 5/3/2003
1,3,5-Trimethylbenzene BRL ug/L 0.5 EPA 524.2 5/3/2003
1,3-Dichlorobenzene BRL ug/L 0.5 EPA 524.2 5/3/2003
1,3-Dichloropropane BRL ug/L 0.5 EPA 524.2 5/3/2003
1,4-Dichlorobenzene BRL ug/L 0.5 5.0 EPA 524.2 5/3/2003
2,2-Dichloropropane BRL ug/L 0.5 EPA 524.2 5/3/2003
2-Chlorotoluene BRL ug/L 0.5 EPA 524.2 5/3/2003
4-Chlorotoluene BRL ug/L 0.5 EPA 524.2 5/3/2003
Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605
RECEIV�_T)
CERTIFICATE OF ANALYSI page. 3
'O M
Barnstable County Health Laboratory MAY 19 2003
Report Prepared. For: Report Dated: 5/15/2003 TOWN OF BAk, STABLE
HEALTH Di--PT.
Order Number: G0319533
Carey C.Grover
P O Box 1080
Cotuit, MA 02635
Laboratory ID#: 0319533-02 Description: Water-Drinking Water
Sample#: N427 428 Sampline Location: 444 Poponessett Rd Cotuit MA Collected 4/28/2003
collected by: C Grover Received 4/28/2003
I
Benzene BRL ug/L 0.5 5.0 EPA 524.2 5/3/2003
Bromobenzene BRL ug/L 0.5 EPA 524.2 5/3/2003
Bromochloromethane BRL ug/L 0.5 EPA 524.2 5/3/2003
Bromodichloromethane BRL ug/L 0.5 EPA 524.2 5/3/2003
Bromoform BRL ug/L 0.5 EPA 524.2 5/3/2003
Bromomethane BRL ug/L 0.5 EPA 524.2 5/3/2003
Carbon tetrachloride BRL ug/L 0.5 5.0 EPA 524.2 5/3/2003
Chlorobenzene BRL ug/L 0.5 100 EPA 524.2 5/3/2003
Chloroethane BRL ug/L 0.5 EPA 524.2 5/3/2003 .
Chloroform BRL ug/L 0.5 EPA 524.2 5/3/2003
Chloromethane BRL ug/L 0.5 EPA 524.2 5/3/2003
cis-1,2-Dichloroethene BRL ug/L 0.5 70 EPA 524.2 5/3/2003
cis-1,3-Dichloropropene BRL ug/L 0.5 EPA 524.2 5/3/2003
Dibromochloromethane BRL ug/L 0.5 EPA 524.2 5/3/2003
Dibromomethane BRL ug/L 0.5 EPA 524.2 5/3/2003
Dichlorodifluoromethane BRL ug/L 0.5 EPA 524.2 5/3/2003
Ethylbenzene BRL ug/L 0.5 700 EPA 524.2 5/3/2003
Hexachlorobutadiene BRL ug/L 0.5 EPA 524.2 5/3/2003
Isopropylbenzene BRL ug/L 0.5 EPA 524.2 5/3/2003
Methyl-tert-butyl ether BRL ug/L 0.5 EPA 524.2 5/3/2003
Methylene chloride BRL ug/L 0.5 5.0 EPA 524.2 5/3/2003
n-Butylbenzene BRL ug/L 0.5 EPA 524.2 5/3/2003
n-Propylbenzene BRL ug/L 0.5 EPA 524.2 5/3/2003
Naphthalene BRL ug/L 0.5 EPA 524.2 5/3/2003
p-Isopropyltoluene BRL ug/L 0.5 EPA 524.2 5/3/2003
sec-Butylbenzene BRL ug/L 0.5 EPA 524.2 5/3/2003
Styrene BRL ug/L 0.5 100 EPA 524.2 5/3/2003
Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605
oF kA�� RECEIVED.
. ��•, � Page: 4
1 M CERTIFICATE OF ANALYSIS
Barnstable County Health Laboratory MAY 19 2003
�°TS'1[:H1ist�i
Report Dated: 5/15/2003 TOWN OF BARNSTABLE
Report Prepared For: HEALTH DEPT.
Order Number: G0319533
Carey C.Grover
P 0 Box 1080
Cotuit, MA 02635
Laboratory ID#: 0319533-02 Description: Water-Drinking Water
Sample#: N427 428 Sampling Location: 444 Poponessett Rd Cotuit MA Collected 4/28/2003
Collected by: C Grover Received 4/28/2003
tert-Butylbenzene BRL ug/L 0.5 EPA 524.2 5/3/2003
Tetrachloroethene BRL ug/L 0.5 5.0 EPA 524.2 5/3/2003
Toluene BRL ug/L 0.5 1000 EPA 524.2 5/3/2003
Total xylenes BRL ug/L 0.5 10000 EPA 524.2 5/3/2003
trans-1,2-Dichloroethene BRL ug/L 0.5 100 EPA 524.2 5/3/2003
trans-1,3-Dichloropropene BRL ug/L 0.5 EPA 524.2 5/3/2003
Trichloroethene BRL ug/L 0.5 5.0 EPA 524.2 5/3/2003
Trichlorofluoromethane BRL ug/L 0.5 EPA 524.2 5/3/2003
Vinyl chloride BRL ug/L 0.5 2.0 EPA 524.2 5/3/2003
Note:
Approved By: Y1GY J s v
(Lab Director)
Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605
pp r'
No.---Ff!k.g-
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
-------
.........................OF...............................................................
Appiiratiun for Dhipati ai Works Tomuurtiun pamit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at
.... ?z--....__...._.. I�2.-- e & �-------------------------------------•----
Location_Address ,,L
Ownerer Ad ess
y nsta er . AddressPQ //ll�
UType of Bu ding �.S,GW, Size Lot_._7-Q�._-Ol_--_Sq. feet
Dwelling—No. of edrooms............... �.._.__-.__--_---Expansion Attic (LO) Garbage Grinder (A�
`4 Other—Type T e of Building No. of persons Pa YP g ---------------------------- P a?................ Showers Cafeteria W
Q' Other fixtures ---------------------------------
vv/`I/.�.. ---------•.......................
w Design Flow.............. �. ...__�L�-_-gallons per person per day. Total daily flow.._........T.7Y ....................gallons.
9 Septic Tank—Liquid capacity.J,�.W.___gallons Length................ Width................. Diameter-------------... Depth................
Disposal Trench—No... ................. Width___..__._._........ Total Length........... Total leaching area....................sq. ft.
Seepage Pit No-----------c ------ Diameter.......0......... Depth below inlet..... ........... Total leaching area...�,�V....sq. ft.
Z Other Distribution box (�Y Dosing tank ( ),aPercolation Test Results Performed by...._R,._..�+� ......I-----------------_- Date__....-�A-371 ......-__..
04 Test Pit No. 1.... ___minutes per inch .Depth of Test Pit...../ra?......... Depth to ground water...0-4
14
fTq Test Pit No. 2.... ..9..hunutes per inch - Depth of Test Pit-la./......... Depth to ground water..i1,1Q__ ._.
- ------ - - --------------- �.._..
O Description of Soil.....Lx � ..... ---. .--•-----•-----•---•-•--•-.--•-------------
x
w
U Nature of Repairs or Alterations—Answer when applicable.-.......................................................................................;...............................................................
-- -----•---------------------------•-----------------------------------------------...-----------------------------••---••-•-•--•------••--------•••--•-•--------••-------------------............-----
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
f`1T�'1F--�
the provisions of 1 y 1 LE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
eratio u a *fica of en 'ssued by the board.o-health.
Signed-- ..----- ---- • =
• ate
Application Approved B .... ........................... .
Date
Application Disapproved for the following reasons:...........................
••----•---•------------•-•---•................................ ---.........._
•-•---•--••---•-----.....-••-----••-•-------•-....••p-----...-•---••-•--------•---•-•----------••-----•••----------------------•------------------•---••----•------------•-----------------•••------
PermitNo. ................................ Issued-...........................................Date
��'7-No...
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
------- --------------------...........OF...........
♦ pplirFation for Disposal Works Tonotrurtiun rrrutit
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
Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
`4 Other—T e of Building No. of persons............................ Showers — Cafeteria
Otherfixtures --------------------------------------------------•---------------------•---•------•--------------------••-------...--•-•------------...............
w Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................
x Disposal Trench—NTo. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water.........................
fT4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
p+' -••----------------------------•----•----------•--•.........••••-•------.........-••---•-----_----•-.............................
•-------•---•-----•---------
ODescription of Soil........................................................................................................................................................................
x
U
w
VNature of Repairs or Alterations—Answer when applicable...............................................................................................
..................................................-.....................................................................................................................................................
Agreement:
The undersigned agrees to install the afor edescribed Individual Sewage Disposal System in accordance with
the provisions of T±TL:
p 5 of the State Sanitary Code— The undersigned furtl er agrees not to place the system in
operatio ui l a e ificaAe of Cal h�inc�'�en issued by the board of health.
-/ Signed ----------------•-------•----•---...-•------.......•-•-----......-•-------------•- ------•-- ---•-.......-••-----
� Date
Application Approved B .___
Date
Application Disapproved for the following reasons:............................................................................•.............. _.___.._._____
..............•--------------•----.........--•---------------.......--------------•-----•---------...-•--•--•-•-----------••-----...--------•---...-----••--••------••--...----•-•---•••---••••••---•---
Date
Permit No........... n Issued_.......................................................
D: a
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
�'
..................OF.....6.6.4 ............................
Trrtif irFate of ToutpliFaurr
THIS I&TO CERTIFY, That the Individual Sewage Disposal System constructed (e) or Repaired ( }
by.............. ........ ----------------------------------------------------------------------------------------------------------------------
_ Installer
at..... ---- ------•- i .�-�_6�.IY ' �'! 7._._.., .....! ...................
has been installed in accordance with the provisions of TITIE of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No.........J..7__'°"__,V-2--- dated........
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE............................. �^ Inspector............... ..............................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
o.... .µ..L.. - ..t1.Illy'.........OF..... ..................
N ✓
FEE.....I........
Disposal,Works Tonotriulion Urrmit
Permission is hereby granted.........
to Constru t ( or Repair an Individual Sewage Disposal System
at No._---�-0----_ 72.----• -- �_�l f_/J;f'.!_.' `.-/�___... sf eet q r /' !.............
* .__._....... ^_....
as shown on the application or Disposal Works Construction �t No., /f�.�.A ed.......
' .�.-.
46
Board of Heath
DATE..........................
FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS
I
f
ttmmst n rsrtstrmmnsrsrssss nszntrtfttntrrattnrstmmnttrtsn!tmmttrsnn rs nrnsrmnsurns}.estsnsrtns:Atntttnrt:ninnnns�rnrnninrstmnpinririnnmttiRfittiinritimsnfi^iirriitnrt
::.:.,:::,,,:,:::::,,,:,:::,::,,::.,::,,;::,;;,,;;iil,Ti,,,:,;:,::::::,,:,.:::.:;::,.:::.::,:::,::,:,:,:,:,,;,,,..:,,,;,::.,,,;,;,,;,,,,,,,.,,;,,,;;,..... ,.. ,......::.:.........:..,..:,/
. . i�
_ ENVIROTECH LABORATORIES
449 Route 130 Sandwich, MA 02563 • (508) 888-6460
CLIENT: Carey Grover LOCATION: Lot 72 Poponessett Rd. —_
ADDRESS: Box 159 Cotuit _
Cotuit, MA 02635
COLLECTED BY: D. Muckey SAMPLE DATE: 1/10/89 TIME: 12 PM
DATE RECEIVED-1/10 89 SAMPLE ID: ET 457
JOB #: New Well WELL DEPTH: 61 ft
RESULTS OF ANALYSIS:
Parameter Units Recommended limit Result
Coliform bacteria/100 ml (MF Method) 0 0
pH pH units 6.0-8.5 5.76
Conductance umhos/cm 500 87
Sodium mg/L 20.0 9.1 -
Nitrate-N mg/L 10.0 .07 _
Iron mg/L 0.3 <.05
Manganese mg/L 0.05
Hardness mg/L as CaCO 3 500 -
=z
Sulfate mg/L 250
Potassium mg/L 20.0
Alkalinity mg/L 200
Chloride mg/L 250
Turbidity NTU 5.0
Color APC units 15.0
Background bacteria
COMMENT:
,.= YES NO WATER IS SUITABLE FOR DRINKING PURPOSES FOR PARAMETERS TESTED.
DATE
���iiulitttuuttuulsstttuuttttu t:tsluttss:tusts:sttitttu ` i i i i ii i iisiiisi:l l ,:v, ,:,,:
ut111 l "Hiiiii i ii , „I ii ittus::ticstisistu tttsusstt iiiuilu`liiiiiutstli uuiuilts iliiv
.,. 0. a
Department of Environmental Management/Division of Water Resources
WATER WELL COMPLETION REPORT
WELL LOCATION
Address ~
City/Town
G.S.Quadrangle Map
Grid Location
Owner
Address
WELL USE CONSOLIDATED WELL
Domestic❑ Public ❑ industrial ❑
Type of Water-bearing Rock
Other
Water-bearing Zones
Method Drilled 1) From To
i
2) From To
Date Drilled 3) From To
4) From To
CASING Depth to Bedrock
Length Diameter
Type - UNCONSOLIDATED WELL ,
STATIC WATER LEVEL Water-bearing Materials
Feet below land surface Sand: fine❑ medium Q` coarse❑'
Gravel: fine medium coarse
Date measured ❑ ❑ ❑ .
GRAVEL PACK WELL Screen:
Slot# length from to
Yes No /
❑ ❑
Split Screen (or 2nd screen) „
WATER QUALITY TESTS MADE Slot# length from to
Chemical ❑ Biological ❑' Depth To Bedrock
PUMP TEST
Drawdown feet after pumping days hours at / GPM.
How measured Recovery feet after hours.
LOG of FORMATIONS COMMENTS: (On well or water)
Materials From To
o
n
DRILLER
Firm ! ' 0
Address \
City
Registration No.
I /
Operator'sSignatu—
re
ease pnnr rirm y BOARD OF HEALTH COPY 25M toss-amlol
• I
!� Li TOWN OF BARNSTABLE
LOCATION �p �i�1fin' r,4P SEWAGE #_
VILLAGE r
�QT ASSESSOR'S MAP & LOT
INSTALLER'S NAME PHONE NO. LL►`R'u-�� IZ,Z���
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) : Z,&r,14 (size)_ D Z' &�LJ_�p
NO. OF BEDROOMS PRIVATE.WELL OR PUBLIC WATER
BUILDER OR OWNER
DATE PERMIT ISSUED:_
DATE COMPLIANCE ISSUED;
VARIANCE GRANTED: Yes No ll
F �-
J
1
_ _ - s��
�t.
���► � ��
!/�
�',�� �<
�9' � 3q,
�� � ��
_" � /
/ 1
TOWV OF"'BARNSTABLE
)CATION LK�2, , ?,SEWAGE # "` 7
.LAGE —Al* ASSESSOR'S MAP LOT 017^ 005�
STALLER'S NAME Sz PHONE NO. e5; /j x L,4 j5tk r, - Y17 Idv!
PTIC TANK CAPACITYL-
.ACHING hACILITY:(type) : �f4eP (size) k" ui44,
). OF BEDROOMS_. _PRIVATE WELL OR PUBLIC WATER-kfg'�
JILDER OR OWNER
ATE PERMIT ISSUED: 3/�
I
ATE COLiPLIANCE ISSUED:
RIANCE GRANTED: Yes 41No `` `�
Uy
a
/ _`
✓ ..
u
F�
I
PROP. VENT WITH CHARCOAL FILTER TO ABOVE GRADE C A I C p /� NOTES
OT C
FINISH GRADE OVER CHAMBERS -- 31 .1' - 33.3' \ E t V E f�A �V E
fT.O.F. EL.= 41 .2 t FINISH GRADE OVER Q-BOX= 33.0 t SLOPE @ 2% MIN. OVER SYSTEM 3/4" TO 1-1/2" DOUBLE WASHED
PROVIDE EXTENSION RISER STONE TO CROWN OF PIPE 1. UNLE SS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION
WITH COVER OVER INLET& REMOVABLE WATER-TIGHT COVER OVER 4" SCHEDULE 40 PVC INSPECTION PORT WITH ACCESS
RISER TO WITHIN 6" OF FINISHED GRADE METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL
FINISH GRADE OUTLET TO WITHIN 6" OF F.G. MIN SLOPE 1% BOX TO F.G. (SEE NOTE 21) N OF 1/8" TO 1/2" DOUBLE WASHED CODE AND ANY APPLICABLE LOCAL RULES.
@ FND. EL.- '40•0'f F.G. OVER TANK EL. = 37.5 t �5" DIA. OUTLET(S) \ STONE OR GEOTEXTILE FILTER FABRIC -
2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE
r I t PLACE RISERS ON ALL DESIGN ENGINEER.
9" MIN. TOP OF SAS = 30.33' CHAMBERS WITH
36" MAX. 9' MIN. 3. 4" SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL
4" PVC TEE 29.33' 36" MAX. BREAKOUT EL = 29.83' INLET PIPES TO 6" OF FINISHED GRADE f SYSTEM UNLESS OTHERWISE NOTED.
PROVIDE WATERTIGHT 4. TO PREVENT BREAKOUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN
2" DROP MIN
6" 3" 3" DROP MAX 3„ 9„ JOINTS (TYP.) o ELEVATION = 29.83' FOR A DISTANCE OF 15' AROUND THE PERIMETER OF THE SAS. UNLESS A
13" 4" PVC IN FROM o o \ 0 40 Mll_ GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S. AND THE TOP OF
14" SEPTIC TANK 4" PVC CD
OUT TO 0 0 = O 0 0 C� 0 C� THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION.
CONTRACTOR TO PROVIDE O LEACHING FACILITY To0 0 0
o O oo 0 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM.
SPECIFIED DROP BETWEEN 12" 6" o0 00 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL.
INLET AND OUTLET CONTRACTOR CONTRACTOR SHALLk\\ OUTLET TEE 29.77' MIN. 29.60' 2 0 0 �\ 0 (� 0 0 0 0 0 0 0 o0
SHALL VERIFY SIZE 48" VERIFY CONDITION OF \ o0 00 00 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK
AND CONDITION OF EXISTING TEES GAS BAFFLE 6" CRUSHED STONE o 0 0 0 oo FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS
EXISTING SEPTIC AND REPLACE AS OVER MECHANICALLY o _ NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH
TANK NECESSARY COMPACTED BASE I AND DESIGN ENGINEER.
3.0' 8.5' (TYP) 1 1U. 4.0' 4.83' 4.0'
3 OUTLET DISTRIBUTION BOX ( .83' 8. ELEVATIONS BASED ON APPROXIMATE M S.L. DATUM. BENCHMARK ELEVATION OF
TO BE INSTALLED ON A LEVEL STABLE 40.0' 31.49' ESTABLISHED ON A NAIL IN AN OAK TREE AS SHOWN ON PLAN,
BASE. FIRST TWO FEET OF OUTLET GROUND WATER ELEV.= < 20.00' 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION
EXISTING 1 ,500 GALLON CONCRETE SEPTIC TANK PIPES TO BE LAID LEVEL. 27.33 12.83'
THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT
4 - 500 GALLON H-20 CHAMBERS 5' MIN. CHAMBER END VIEW 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES
CROSS SECTION VIEW TYPICAL CHAMBER PROFILE TO THE DESIGN ENGINEER.
�f-' A K I I.,-
PROFILE � .-,X DETAIL HHMBEI IF: _rAILS
H-LO Di� , 4 -- -� 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONC. STRUCTURES SHALL BE MADE WATERTIGHT.
NOT TO SCALE 1 NOT TO SCALE
______.__ __._ __-.____ __^__.___._._- ��( `` + ,i P --• --',�--- ----- -- ---- - --- -- - 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING
Pend ..�
TEST PIT DATA REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM
`� !# • �' PERC NO. 15351 APPROPRIATE AUTHORITY.
•�_'! ••'- • � � Donald Desmarais, R.S. 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS LOCATED
; INSPECTOR:
J� ' • (' ' F' UNDER MORE THAN 3 FEET OF COVER OR LOCATED UNDER PAVEMENT, DRIVES, OR
��� ' ��� Vie; , • if ! EVALUATOR: Michael Pimentel, E.I.T. TRAVELED WAYS IN WHICH CASE THEY SHALL WITHSTAND H-20 LOADING.
`' - "- i •'
" C.S.E. APPROVAL DATE: Oct. 1999
May 10, 2017 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES.
+,ti {,... • . i . DATE: Y
TEST PIT#: 1 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE
MAP 19 . .�� `%. ,b• MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY,
LOT 11 f ` al lj . : . ELEV TOP = 33.00' _ REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY,
'" • .r ' '�'` �';'�� ELEV WATER = < 22.00' FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3).
Ir
ya nt./ %�\ '.� ',��' r("�+ 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN
. . •- . !% PERC RATE _ < 2 min./inch
MAP 7 07le /� •' , • ?O - SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK.
O' DEPTH OF PERC = 20" - 38" 16. PROPOSED PROJECT IS LOCATED WITHIN:
LOT 11 Jj • 'R __ .- " .�� -
�_ ,
/ ' r. '= ` ' • • TEXTURAL CLASS: 1 ASSESSOR'S MAP 19 PARCEL 5
cotuit
� �o � 6 / : .--: `.'• OWNER OF RECORD: CAREY C. & SUZANNE S. GROVER
Highland
5 g8� t 0" 33.00' ADDRESS: PO BOX 1080
2 . ;•',
LOCUS Organics COTUIT, MA 02635
CL • g° 32.50'Loamy Sand FEMA FLOOD ZONE X
• •li = " 10Yr 3/2 COMMUNITY PANEL# 25001CO752J
00
• = 20" 31.33'
17. DEED REFERENCE: BOOK 7015, PAGE: 152
ii. rr ?j Loamy Sand 18. PLAN REFERENCE: P.B. 19, PG. 143
• j • ' 38 10Y-5/6
' •
MAP 19 �� "�' ` 1 �� B 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION.
Al 48"
29.00'
LOT 6 'SM '4 It - 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY
i P FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY
j �� > > II �\ = c w ti /%: ; �'.. • FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE.
6'o d' II rfj ` .�. v �. Medium Sanc
�, Q? �s " '• (I C 2.5Y 6/6 21 A 4" PERFORATED SCH. 40 PVC PIPE SHALL BE PLACED IN A VERTICAL POSITION TO A
DEPTH OF THE BOTTOM OF THE SAS AND EXTEND TO WITHIN 3" OF FINISH GRADE. A
REMOVABLE THREADED CAP SHALL BE PLACED ON THE TOP TO ALLOW FOR INSPECTIONS.
/ 17,777771,11i
o 22. OWNER /APPLICANT/ CONTRACTOR SHALL BE RESPONSIBLE TO OBTAIN ANY AND ALL
#444 REQUIRED PERMITS AND APPROVALS FOR THIS PROJECT.
EXISTING _ MAP 19 LOCUS PLAN
4-BEDROOM
DWELLING LOT 5 SCALE: 1" = 1000'
TOF =41.2't HC_2 / 48,694 S.F. t 132" 22.00'
No Mottling, Weeping or Standing Observed
GRAVEL DRIVE
r-�€�40 #\
DESIGN DATA TEST PIT DATA EC�F '
I �1 h" TR[= 36 PERC NO. 15351 _ 50xO EXISTING SPOT GRADE
S _ \, 31 • INSPECTOR: Donald Desmarais, R.S.
-_ ---- O 50 EXISTING CONTOUR
\ %1 �� NUMBER OF BEDROOMS (DESIGN) 4 - - - -
'v .,6 � EVALUATOR: Michael Pimentel, E.I.T. _
,-- --
38" �' DESIGN FLOW 110 GAL/DAY/BEDROOM
38
C.S.E. APPROVAL DATE: Oct. 1999 50 PROPOSED SPOT GRADE
TOTAL DESIGN FLOW 440 GAL/DAY
�_ 1•-- - / � DATE: May 10, 2017
PROPOSED \ / DESIGN FLOW x 200 % = 880 GAL/DAY -,-=�-
PROH-20 D-BOX / i --- -. 2" PINE TEST PIT#: _ 2 _ PROPOSED CONTOUR
"�• USE EXISTING 1,500 GALLON SEPTIC TANK ELEV TOP = 31.00 EXISTING GAS LINE'
PROPOSED 4-500 GALLON H-20 �,,� -� '2C.00 -
EXISTING UNDERGROUD UTILITIES
LEACHING CHAMBERS WITH � (1� -'�--- �� o�� i ELEV WATER = < _
AGGREGATE
I 20 OAK � (2) \ A INSTALL 4 - 500 GALLON H-20 CHAMBERS PERC RATE _
? � -0 1 ` � � � DEPTH OF PERC -_ _ EXISTING WATER LINE
cOo I ' / ( w/ AGGREGATE �� TEST PIT LOCATION
0 x TEXTURAL CLASS: 1
0 0 � I O £ ?� o SIDEWALL CAPACITY
PROPOSED 4" PVC O (LENGTH + WIDTH) (2 SIDES) (2' HIGH) (0.74 GPD/S.F.) = GAL/DAY EXISTING 1,500 GALLON SEPTIC TANK
VENT; LOCATION I 0 m 6°OAK v fi (40.0' + 12.83') ( 2 ) ( 2' ) ( 0.74 GPD/S.F.) = 156.4 GAL/DAY
TO BE DETERMINED O ' 0 Organics 31.00' PROPOSED 4" SOLID SCHEDULE 40 PVC PIPE
PV n�MNFP- / ' Z 6„ 30.50'
m BOTTOM CAPACITY Loamy Sand PROPOSED H-20 DISTRIBUTION BOX
Benchmark t
(LENGTH x WIDTH) (0.74 GPD/S.F.) = GAL/DAY A 10Yr 3/2
Nail in Oak Tree (4)
Elev. - 31.49' r Tp 2 (40.0' x 12.83') (0.74 GPD/S.F.) = 380.0 GAL/DAY 20" 29.33'
PROPOSED 500 GALLON H-20 LEACHING CHAMBER
Approx. M.S.L. `� _ '4■ F: �-(3) SWING-TIES Loamy Sand
31x0 TOTALS: 10Yr5/6 _
PROPOSED I 9„ 0if r � DESCRIPTION HG-1 hC-2 4 B REV. DATE BY APP'D. DESCRIPTION
MAP 7 INSPECTION PORT TOTAL NUMBER OF CHAMBERS
� � i �w,
' LEACHING CORNER (1) 65.0' 63.1' TOTAL LEACHING AREA 724.9 SQ FT.
LOT 15 48 27.00' PROPOSED SEPTIC SYSTEM UPGRADE
TOTAL LEACHING CAPACITY 536.4 GAL./DAY PREPARED FOR.-
LEACHING
CORNER (2) 75.3' 55.6' Medium Sand
LEACHING CORNER (3) 102.9' S4.5' C 2.5Y 6/6 CAPEWIDE ENTERPRISES
-T-
LEACHING CORNER (4) 95.7' 93.1'
i -- LOCATED AT
Q
P
444 POPONESSET ROAD
o���
g6 �y - COTIUT, MA 02635
`�v \�� NOTES: 132" 20.00' SCALE: 1 INCH - 20 FT. DATE: MAY 16, 2017
Ez�1�. OQC• ��
\�` 1.) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE TOP EDGE OF EACH No Mottling, Weeping or Standing Observed o 10 zo ao ao FEET
Q SEPTIC SYSTEM COMPONENT. Otto OF
PREPARED BY.
2.) CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE LOCATION OF THE RESERVED FOR BOARD OF HEALTH USE ,qHNL JC ENGINEERING, INC.
_ PROPOSED LEACHING FACILITY TO ENSURE CONSISTENCY WITH TEST PIT DATA CHtWaJR. -4 2854 CRANBERRY HIGHWAY
SHOWN ON THIS PLAN. REPORT TO ENGINEER AND LOCAL BOARD OF HEALTH IF " �'
EAST WAREHAM, MA 02538
SOILS ARE NOT CONSISTENT WITH TEST PIT DATA. p
SITE PLAN E 508.273.0377
3.) ENTIRE PROPERTY IS LOCATED WITHIN THE ESTUARINE WATERSHED.
SCALE: 1" = 20' Drawn By: SJI Designed By SJ1 Checked By MCP JOB No. 3816
1
� Tow•-✓
•��?r.c s/Ct'rsM 77 Ra.
/. E��✓,9J'iC�JS <39SCa On/ i-jSSvry7G'O �?�i�'"aJM
C1
i
� f
CEO END
i
( toT 7.f
I VC
I ' -sue vT1, 74i<,'-� 1 r' �f6 6c�a C O T _7 \
r
I ;
( S `. r$ /•it! j!f✓,C \ L
i4r✓L
TOP OF FOUNDATION
APOx AR�a ', / CONCRETE COVER�I� .° CONCRETE COVERS
t •'. 4' CAST IRON 12"MAX.
_ / OR SCHEDULE 40 4,. 12"MAX
_ SCHEDULE 40 PVC (ONLY)
. PIPE
l7 r ----- �•' P TCH %4'PER.F . PIPE - MIN. LEACH I 2D
PITCH 1/4"PER.FT PIT<L�v� 6 %s i�� �• a r - o , PRECAST
f/
•
INVERT • �
LEACHING
yy,6G EL.4o. INVERT INVERT
PIT OR
tc49,.96' SEPTIC TANKEL EQUIV.
D O
80X _
INVERT o Asa DIST E. LSO u _
t /SQ4 GAL. !NVEfl T 6,~a � •�
4rx ',Z a EL 90, (n. L.4 INVERT, ' - :i. 3/4"TO it/2•
-� - - - w/ \ w<L: • , EL ,.S. U.�0 WASHED
STONE
T t
• 2 76 �,EL9/td «oJ, ,, .' 2� S'DIA —+-� ,✓L.✓E
I �_--r _.—_._ - / r r c�h f r ` ° o • l0• D I A.�:r✓CpU^/T�T c�
5u J PROFI LE OF GROUND WATER TABLE
O ce sr,-�� ' SEWAGE DISPOSAL SYSTEM
.✓ar"44
LD % 80 f NO SCALE
SOIL LOG WITNESSED BY
DATE 7/2.9icf6 TIME . , /!!. ,C �.�nos' ,[ y.:>�1, BOARD OF HEALTH
\ �•� / J 9R�,�� TEST HOLE I! TEST HOLE 2 ENGINEER
I
ELEV. 9�?.1. ELEV. �S!/.: G. .
DESIGN DATA
NUMBER OF BEDROOMS !y
TOTAL ESTIMATED FLOW 9V41 . GALLONS/DAY
! BOTTOM LEACHING AREA SQ.FT. /PIT/:.P,p
SIDE LEACHING AREA / B•.S. SO.FT./ PIT/4-1
4 ' %.rs)l✓a - . GARBAGE DISPOSAL -10 (50 % AREA INCREASE)
TOTAL LEACHING AREA
Y SQ.FT
T L� / _ � /�v I ��/ � � � � � � � PERCOLATION RATE L e MIN/INCH �
/ / LEACHING AREA PER PERCOLATION RATEI099,SSQ.FT��Z,D
} /�•O WATER ENCOUNTERED ,
NUMBER OF LEACHING PITS - G Gi :'�. X,
APPROVED BOARD OF HEALTH
DATE
1` AGENT OR INSPECTOR
1IOFp
WE-4 ( — F w• y
rh /�C.s.C,� ` F6'
f}r �{t�4� � �STE O
No. 23100
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e6 RA/1'IdLEAI" RAgO .'�, . . t$Tt_�/� p
STFc.LE, /''l,• pzG.s� PETITIONER r
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