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HomeMy WebLinkAbout0750 SANTUIT ROAD - Health 750 Santuit .Road i cotuit A = 006 048 i r_ I� a r k i { �a TOWN OF BARNSTABLE ' LOCATION -7$0 Smc-A ;-J SEWAGE# IQ IS - Z 93 VILLAGE ASSESSOR'S MAP&PARCEL G - q S INSTALLER'S NAME&PHONE NO. Q$fl 6xcg yo.A;off SEPTIC TANK CAPACITY 1 000 LEACHING FACILITY:(type) F,'r-1 6L (size) Z O X 3 8 NO.OF BEDROOMS $' OWNER c. PERMIT DATE: 9•Z 1 - 1 fi COMPLIANCE DATE: i b b Separation Distance Between the: . Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY Ai- a� Az. Bz- 35' 3'� .3- 1+1' a A4- aI ' Z s 1 � (. 1 1 Ab,. LOCATION SEWAGE -PERMIT NO. -7 5:D . � a(,6 ' YILLACE T f INST LLER'S NAME & ADDRESS Cca1AA e U 1 L D E R OR OWNER cow DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED Ili- -- - �y, � �' �\ � � t ,j� � � � �1 �� / ) ��fl1r / �1 / �i' of �,�d,� � � � � r� r�r/�' i � ^_�� ,�� '��: ; � III . 1 e � .� _'� ..r� -�' ' ` \�` 1 _ .• \ `� � �\ 1 4 _ � �����i No. �' Fee 'V THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Application for MispoSal 6pstem Construction Permit Application for a Permit to Construct( ) Repair(,Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.-O SA tjw= RoL Owner's Name,Address,and Tel.No. C`' Assessor'sMap/Parcel G t�$ �D�1/1'�' John Con �SOSan��►� � Installer's Name,Address,and Tel.No. i IB EgcoLVoj, 10 N Designer's Name,Address,and Tel.No.,DaV.-r0.1K-crA y 6y'Trc4\-',cf'*-1 w Fresidmic- y77-DGS o. C331 Nar.,wic1� ��4. 994- )1LG Type of Building: Dwelling No.of Bedrooms 5 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) SSO gpd Design flow provided GZ gpd Plan Date 9- 9- )$ Number of sheets Revision Date — v Title Size of Septic Tank 1 DOO qaa I Type of S.A.S. pc��,DG -t i r—IcL Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. , Signed Date 9.2 Application Approved by Date Application Disapproved by Date for the following reasons Permit No._a®I �� Date Issued 1 d •� �.:.. .t r /�) '�i , } `3�� a J ��,.ryryry t/ No. + e r Fee THE=MMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes 9ppIlcation for Disposal Opstem Construction Permit Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) ❑Complete System 0 Individual Components Location Address or Lot No.-150 SA 0JTU=-T R Owner's Name,Address,and Tel.No. Assessor's Map/Parcel t 0 hlrl' Installer's Name,Address,and Tel.No. I o 1 Designer's Name,Address,and Tel.No. —Da '��easet-'s-y �� Fors � atalt. t�..7?•DGS $a �33� Nar�..r��L. ��y - 99y• )iLG �r Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) �$S'Q gpd Design flow provided gpd "" n 4 Plan Date 9• Number of sheets OL Revision Date Of Title Size of Septic Tank �0 Type of S.A.S. ,OrG �PG �iG oti Description of Soil w, Nature of Repairs or Alterations(Answer when applicable) 1 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. Signed Date Application Approved by (� �' Date �t 1 Application Disapproved by / Date for the following reasons Permit No. .-,,)©)k .z� Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of:Compliance THIS I•S TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(Vl' Upgraded( ) Abandoned( )by B ge B 6 X C a j aL4 ►O at. 77,50- Sa n iu;l Rom- has been constructed in accordance'r with the provisions of Title 5 and the for Disposal System Construction Permit No. 024'a2c13 dated i Installer n �a,.•Q EXCcxuc.-11O n Designer _.DavC- ahc r A t-! #bedrooms `j Approved design flow A56- gpd 't The issuance of this perdiit shall not be construed as a guarantee that the system will fmj/cti3n,s,ksigned. Date �/f Inspector U IA./ q ______________�_______________.- __, _I_____. _ _____ _ _-__ _____________ _ __._________ ----------------- ______ No. Fee' �—v THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal �6pstpm Construction permit Permission is hereby granted to Construct( ) Repair( ..p' Upgrade( ) Abandon( ) I System located at 77S0 5-n4u;1 and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. , Provided:Construction must be completed within pee ee years of the date of this permit. C Date — Approved by f Town of Barnstable oFVE r Regulatory Services Thomas:F..Geiler, Director BARNSTAB►E. = Public Health Division 9�A 1639. ,��� Thomas McKean, Director. Tf0 MAC . 200 Main Street, Hyannis, MA 02601 Fax: 508-790-6304 office: 508-862-4644 Date: -9,27-118 Sewage Per Z0 8. Z23 Assessor's Map/.Parcel 1413 . : — ... ` Installer & Designer Certification_Form Designer, f�,uc F'1v�1-�ct-AQ.t In ExCaycj.. soh Address: O BOX 3'il Address: 4 '�ee�cc�-u L►J On - 21- 1-3 Q F)( 'X%J0A ion was issued a permit to install a (date) (installer) septic system at 7756 based on a design drawn by (address) t Svc ��a1�c�-�acu dated 9--Zl - 18. (designer) _ I certify that the septic system referenced above was�instalied substantially according to the design, which may include minor approved changes'.such as lateral relocation of the distri�-ution box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. X _ I certify that the :septic system referenced above was installed with major changes (i.e. greater than 10' lateraf relocation of the SAS or any vertical relocation of any.component of the septic system) but in accordance:with State& Local Regulations. Plan revision or certified as-built by designer'to follow. Stripout:(if required) was inspected and the soils were found:satisfactory. t!F D"D' D. tAHERTV,Jk (installer's Si e) No .1211 (Designer' Signatur�) r (Affix Des ig p Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED: UNTIL BOTH. THIS F6 M AND• AS- BUILT CARD ARE RECEIVED BY THE BAR STABLE PUBLIC HEALTH DIVISION. THANK YOU. q:\office forms\designercertification form.doc Town of Barnstable P# 1 7 25 Department of Regubtory Services . Public Health Division Date ca a 200 Main Street,Hyannis MA 02601 lrto tud` 6 1s Date Schedliled Time Fee,Pd./ H , CD Soil Suitability Assessment for Se Disposal' z - fP r'f'"1�D wit.� � r t�.'tf(�Q�I'� :.. : nessed$y:, Performed By: LOCATION&GENERAL INFORMATIONq�' Location Address 75- .S�j ftN�.�`. 1 .. Owner's Name �O`+• ..�•` " ✓9 Address Assessor's Map/Parcel: Engineer's Names l 0 NEW CONSTRUCTION, REPAIR .. Tele honey, •Tu Land Use 'v"✓r Slopes(`) Surface Stones /V .Distances from: Open WaterBody�ft Possible Wet Area, ft.'Drinking Water Well:,LOfr Drainage Way (i �_A Property Lino '- _ft' Other ft SKETCH:(Street name,dimensions of lot,exact locations oftest holes&pore tests,locate wetlands in proximity to holes) c Tl Parent material(geologi v t Ov ✓ Depth,to Bedrock_ _ Depth to Groundwater: Standing Water in Hole: _ Weeping;from Pit Face Estimated Seasonal High Groundwater .DETERMINATION FOTSEASONAL HIGH.WATER TABLE Method Used: Depth Observed sianding in obs.hole: in: Depth to soil mottles:� �/�.�—In- Depth to weeping from side of bs.hole: t,in. Groundwater Adjustment. ft. Index Weding Date'., index\Nellie Adj:factor," _Adj.Ground er Level t .- t PERCOLATION TEST Dat Time Observation Hole ft Time at 9" F F ..Depth of Perc I Time at 6' A j o 'S1ariPre-soakTime� Time(9^-6") -"' End Pre-soak 1 ` RateMin./Inch 42, Site Suitability Assessment:.Site Pawed' Site Failed: _ Additional.Testing Needed(Y/N) Original:Public Health Division Observation Hole Data To Be Completed on Back-— --- ***If percolation test is to be conducted within 100':of wetland;you must first notify the Barnstable Conservation Division at least one(1)week prior to beginning. Q:ISEM0PERCFORM,DOC DEEP OBSERVATION HOLE.LOG Hole# . Depth from Soil Horizon Soil Texture Soil.Color Soil Other, Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.-1 Gravel) -- �_�- DEEP OBSERVATION.HOLE:LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil er Surface(in.) (USDA) (Munsell) Mottling: (Structure,Stones,Boulders. Consistency, vel. DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture .Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. _ Consistenev%Gmvell q DEEP OBSERVATION'HOLE LOG Hole# :Depth from Soil Horizon - Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure;Stones,Boulders: Consistency,%gray I) Flood Insurance Rate Man: Above 500year.flood boundary No Yes.`_ , Within 500 year boundary No_ Yes Y Withinl00 year flood boundary No_ Yes . Depth of Naturally Occurrine Pervious Material :Does at least four feet of naturally occurring pe i aterial exist in all areas observed throughout the area proposed for the soil absorption system? Ifnot,what is,the depth of.naturalty occurring coos material? Certification �7 1 certify Ghat on V L(date)I have passed the soil evaluator examination approved by the Department of E tal Protection and that the:above analysis Was performed by me consistent with the required train" xpertis nd :Cscribedin3l0CMRl5.0l7./ Signature Date Q'ISEPTICIPERCFORM.DOC Jd� Y GSw .,, No......8.L/ ...1 ' Fmc.. �CR�.... THE COMMONWEALTH OF MASSACHUSETTS t BOARD OF HEALTH L ...........14W/?........OF............ Appliration for Disposal Workii Tonirnrtion Prrmit Application is hereby made for a Permit to Construct ( ) or Repair (A--f an Individual Sewage Disposal System at: , do......._4d......... .r s r---------- -------------------------------- • Loeat: -Address or Lot No. Ate ............................... ------------•------••---- ...._................--••-•----........_------ ;n r Address ...... o .._. � ------------------------------------------- Installer Address d Type of Building! Size Lot............................Sq. feet Dwell mg—Type of Building oB ms......................... No. of persons -' ----- showers — Cafet Expansion Attic ( ) —Cafeteria Grinder Othera ( ) W Other fixtures ..------•--•--•--•------•------- W Design Flow.............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area-----------.........sq. ft. 3 Seepage Pit No--------------------- Diameter..................... Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by........................................................................... Date------------........................... aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ (� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_._........................ P ODescription of Soil............til. -------------...............----------------•-••-----------------•--..................................... x W ------•--------------------•-----•--------------•-••-----------------•-----------•-----------•----•--------......................................... VNature of R a' s or Alt tons—Answer whe�pplicable�__.fs�D .__x. _____ _____ ............ ......_.4-��---- act :, Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT=% 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee issued b the board of health. Signe c Date Application Approved By..................... ...... ......ZA.._U_� -- Date Application Disapproved for the following reasons----------------------•----.._..------••---•-•••--••---•------------------•--•----•----•-----•-•--•----------- ..-----••-•---•------•...............•--....-•--••-----------......------------.......---------•-•--•-•-. ................... Date PermitNo......................................................... Issued_....................................................... Date G THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF ;. f Appl rathi t for Disposal Works Tottstru' lion rrutit 4 Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at.: w . f ._ .•- j•--•i jcs � 'l. ........... .......... ................................................................................. � Jf�� Locatrpn-Address or Lot No. _. ........................................•........ --•-------•-••..._..___....._........._.... f Owner Address ......I/'8__.._....d`i ���.t lhale.... ......a��. ... �''��c . ..........•••..............................................................•...................... Installer Address UType of Building Size Lot............................Sq. feet g -------- p ( ) Garbage`Grinder ( ) Dwelliri o. of Bedrooms______________________________ Expansion Attic 04 Other—T e of Building ........................... No. of ersons....................__...._ Showers — yP g p - ( ) Cafeteria04 ( ) dOther fixtures -------------------------------•-----------•----------.......---•--•--•--•-•------•--.........•••. W Design Flow............................................gallons per person per day. Total daily flow-___:--::...................................gallons. WSeptic Tank—Liquid capacity............gallons, Length................ Width................ Diameter-_______-____ - Depth................ Disposal Trench—No. .................•.. Width.................... Total Length..........:......... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter...................._Depth below.inlet.................. Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results ` Performed by•--•----•-•-•-•••-•••-•--••.............•••............--•-•-•----•-•--•• Date........................................ Test Pit No. I..............A_minutes per inch Depth of Test Pit.................... Depth to ground water........................ (X Test Pit No. 2..............'minutes per inch,' Depth.of Test Pit.....................Depth to ground water........................ �+ ---•---•-•-•---------••---------•••.._.._._..•... ............................•---------•--•---•-- Descriptionof Soil............. .t'",.0 it .... •...: ........:............•------••-••......----••---••---•• •-----•-•--•--•-•--••--•-•-•••--•-------••......--_----- x V .......................-................................................................................................................................•---------•-------------------------------•--••- VW -•-•••----------------------- ---•••••••.----- •----------I-•---------•-•---••-••--•--•-••--•-••----- Nature of Re airs or Alterations—Answer when,applicable/ / f Gl d 7 •� _5 ..------ l a�------.�!5 ��_ *f t�1 e a,.. ...... ._. Agreement: x' The undersigned agrees to in the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLL 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 b)y the bpard of health. Date Application Approved By...................... . ............... `.. --•-•-/ft Application Disapproved for the following reasons:--................... ..4..------------------------ �` Date ------ f .............................................................................................•-•-----___..--•------'-------------•---......--•-------•--•--•----•------.....••-•---•-•-•---•--•-------- )� � Date PermitNo......................................................... Issued-:........`........................................... "< Date THE COMMONWEALTH OF M'ASSACHUSETTS BOARD OF HEALTH t e!l r........O F....... ! .�d'.......'...;� ......�............ Trtifirgtr of (loutplialta THIS IS TO CERTIFY That ahe Individual ewage Disposal— ,System. constructed ( ) or Repaired (4-)-^�' -•-- ;;ap Installer � ,:fir«^ ;at....... .v......... has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction-Permit No........9.10_1.ej........ . dated........:....................................... THE ISSUANCE,OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION ATISFACTORY. DATE............................ .l Inspector .,/ . ..2._ ...................................................... THE COMMONWEALTH, OF MASSACMUSETTS BOARD O„F HEALTH ?A No._........7(1 ✓ R �- FEE.!'..�--��•�--•• Permission is hereby granted......ti /.: _____ ____ ___....-^6" °....•-•-••.............•-•..... to Construct ( ort Repair ✓/,a-Tn Individual SewAg✓ Disposal'S-stem at No............... .....` Street as shown on the application for Disposal Works Construction Permit No.................... Dated-_____...--__............................. ...................�f ------------------......----- DATE. ............................... Board of Health FORM 1255 A. M. SULKIN, INC., BOSTON 1 USPS TRACK NG# First-Class Mail Postage&Fees Paid USPS Permit No.G-10 9590 9402 1933 6123 1784 15 J� United States •Sender:Please print your name,address,and ZIP+4®in this box* I EPostal Service � (az "Town of Barnstab}e Heath'°Division I 200 Main Street Hyannis,MA 02601 I I (13 31 ;.i i1101,1 �N, ,tli € E l i r , ! _:1 . i Ii► j. fi!!r ( Iri':. i i SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3. A 78,gnure ■ Print your name and address on the reverse q Agent so that we can return the card to you. X La,— ❑Addressee ■ Attach this card to the back of the mailpiece, B. Re ived by(Printed Name) C. Date of Delivery or on the front if space permits. _ 1—----`�' `- — D. Is delivery address diffet�en�from item 1? If YES,entjoeliveryam" elow: N I �I BACON, JOHN C & RAMUTA H 750 SANTUIT RD COTUIT, MA 02635 ' -111111111 III III 1111111111 T IIII I II II II I I II I IIIService Type T❑Adult gntn ❑RegisteredMail Adult Restricted Delivery ❑Registered Maile Restricted 9590 9402 1933 6123 1784 15 Certified Mail® Aet1luvery Certified Mail Restricted Delivery ro Receipt for ❑Collect on Delivery 2.-Article Ni imhw Delivery Restricted Delivery ❑Signature ConfirmationTm ❑Signature Confirmation 7 015 1730 0001 4988 0121 over �)il Restricted Delivery Restricted Delivery PS Form 3811,July 2015 PSN 7530-02-000-9053 V-S Domestic Return Receipt U.S. Postal Service"" CERTIFIED MAILP RECEIPT Domestic.Mail 0 nly �, r-3 For delivery information,'visit our website at www.USPs.coM(1. C3 co 0 F F I C I A L -.U .S E) cO Certified Mail FeeEr E• $ y Extra Services&Fees(check box,add fee as appropnate) ❑Return Receipt(hardcopy) $ d _,•, y i ❑Retum Receipt(electronic) $ K S arks-r 1-3 ❑Certified Mail Restricted Delivery $ O�®� Here d;'<d r3 ❑Adult Signature Required $" -�' 1' []Adult Signature Restricted Delivery$ C-3 Postage ---- - — -- ��� -_ I`- $ Y r-3 Total Postage; $ BACON, JOHN C & RAMUTA H _ u7 Sent To I ,a 1 750 SANTUIT RD Siree�andApti+ COTUIT, MA 02635 Ciry-$[aie,ZIF �� Certified Mail service provides the following benefits: •A receipt(this portion of the Certified Mail IabeQ. for an electronic return receipt,see a retail •A unique identifier for your mailpiece. associate for assistance.To receive a duplicate ■Electronic verification of delivery or attempted return receipt for no additional fee,present this delivery. , USPS®-postmarked Certified Mail receipt to the ■A record of delivery(including the recipiem s retail associate. signature)that is retained by the Postal Service- Restricted delivery service,which provides for a specified period. delivery to the addressee specified by name,or to the addressee's authorized agent. Important Reminders: Adult signature service,which requires the •You may purchase Certified Mail service with signee to be at least 21 years of age(not First-Class Mails,First-Class Package Service®, available at retail). or Priority Mail®service. Adult signature restricted delivery service,which ■Certified Mail service is notavailable for requires the signee to be at least 21 years of age international mail.. and provides delivery to the addressee specified ■Insurance coverage is not available for purchase by name,or to the addressee's authorized agent e with Certified Mail service.However,the purchase (not available at retail). of Certified Mail service does not change the •To ensure that your Certified Mail receipt is insurance coverage automatically included with accepted as legal proof of mailing,it should bear a certain Priority Mail items. USPS postmark.If you would like a postmark on •For an additional fee,and with a proper this Certified Mail receipt,please present your endorsement on the mailpiece,you may request Certified Mail Item at a Post Office-for the following services: postmarking.If you don't need a postmark on this Return receipt service,which provides a record Certified Mail receipt;detach the barcoded portion., of delivery(including the recipient's signature). of this label,affix it to the mailpiece,apply You can request a hardcopy return receipt or an appropriate postage,and deposit the mailpiece. electronic version.For a hardcopy return receipt, complete PS Form 3811,domestic Return Receipt,attach PS Form 3811 to your mailpiece; IMPORTANT:Save this receipt for your records. PS Form 3800,April 2015(Reverse)PSN 7530-02-000-9047 1 TIMElQw Town of Barnstable Barnstable ANoWcaCRY Regulatory Services Department RARNSUBLL 9� 1639. ,� Public Health Division m �F0"AA�A 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7015 1730 0001 4988 0121 February 26, 2018 BACON, JOHN C & RAMUTA H 750 SANTUIT RD COTUIT, MA 02635 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 750 Santuit Road, Cotuit, MA was inspected on 02/15/2018 by Brett Hickey, certified Title V Septic Inspector for the State of Massachusetts. " The inspection of the septic system showed that the system."Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Leaching galleries are in hydraulic failure`and must be replaced. • The effluent was half way "over outlet pipes" according to the inspection report. You are ordered to repair or replace the septic system within two (2)years from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH fio as McKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further EvaluationLetters\750 Santuit Road Cotuit:doc i Town of Barnstable CON Regulatory Services Department Public Health Division 200 Main Street,Hyannis MA'02601 Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKcar,CHO Feb 6, 2007 Rev. 5111116 DEADLINES T O REPAIR FAILED SYSTEMS (Town Code§360-44 and Title V: 310 CMR 15.000) _ An`Y'marked in the ❑is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑Discharge or ponding of effluent to the surface of the ground 4 . ❑Pumping more than 4 times during the last year not due to clogged or obstructed pipe. :. ❑Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ONE(1)YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑Any portion of the cesspool within a Zone 1 to a public well ❑Any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution).' TWO (2)YEAR DEADLINE CRITERIA q Single'Cesspool ❑Any"conditionally passed systems" (broken cover,relocation of a pipe,relocation of a driveway due to H-10 components, etc) ' . Leaching pit or cesspool with high liquid level,<12"below inlet(per Town Code 360-9.1) p f S��/�'`t�J C �ei� ❑Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER Repair deadline: Q:\SEPTICIDEADLINES TO REPAIR FAILED SYSTEMS.doc i Commonwealth.of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments rri ry.4i M 750 Santuit Road :Property Address John Bacon Owner Owner's Name information is , required for every Cotuit: MA 02635 2/15/18 page. City/Town State Zip Code: :: Date:of Inspectiot N a„! Inspection results must be submitted on this forma Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. s. Important:out forms . A. General Information c (�filling out forms G��i4t /�7 on the computer, use only the tab 1. Inspector: key to move your cursor-do not Brett Hickey . use the return Name of Inspector key p B&B:Excavation Company Name 14 Teaberry Lane Company Address. Sandwich : Ma. 02644 City(Town " State Zip Code (508)477-0653 S113747. Telephone Number License Number 'B. Certification _. certify:that I have personally inspected the sewage disposal system:at this address and that the information reported below is true, accurate and Complete as of the time of the;inspection. The inspection was-performed based on my.training and experiehce in the proper function.and'maintenance.of on site sewage disposal systems. I am:a.DEP approved system inspector pursuant to Section 15:340 of Title 5(310 CMR 1:5.000). The system: :Passes Conditionally,Passes Fails " ❑ :Needs Further Evaluation by the Local Approving Authority 2/15/18 n to Signatu Date,:The system,inspector shall submit copy of.this inspection report.to the Approving Authority (Board of Health.:or DEP)w.ithin: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.DER,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:conditio.n 'of use: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewege'Disposal System'•Page 1 of 17 �9 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary'Assessments M 750 Santuit Road: ... .. . Property Address = John Bacon' Owner Owner's Name infomiation is required for every Cotuit: MA 02635 2/15/18 page. Cityfrown .. —. • State .' : : Zip Code::. Da4e:6f Inspection B.:Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D .' A) System Passes:. I have not found any information which indicates that any of the failure criteria:described:. in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below: :. Comments: B) System Conditionally.Passes: One or more system components as:'described in the"Conditional Pass" section need to be replaced or repaired. The system, upon•completion'of the replacement or repair, as approved by the,Board.of Health,millipass. so 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\S.ystem will:pass inspection if.the existing tank is replaced with a complying septic tank as approved,by the Board of Health. *A metal septic.tank will.pass inspection if it is structurally:sound, not leaking and;if a Certificate of Compliance indicating that the tank is less than 20 years,old is available. - ❑:Y ❑ N ❑. ND (Explain:below): q. 15ins+3113' Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 2 of.17: Commonwealth of Massachusetts •Mmw Title 5 :0ficial ns ec tion Form r Y Voluntary . Subsurface-Sewage Disposal,S stem Form - Not for Volunta Assessments 750 Santuit Road . :Property Address John Bacon Owner Owner's Name information is required for every Cotuit MA 02635 2115/18 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: 7i pumps/alarms are repaired. w. :. B) System Conditionally Passes (cont.): s. ❑. Observation of:sewage backup or break.:out or high static.water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled.or uneven distribution box. System will pass.inspection if:(with approval of Board of Health): El:. 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 ❑ Nb (Explain below): c. ❑. The system required PUMpihg.more.th an 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 re moved ❑ Y ❑ N ❑ .ND (Explain below):. C); Further Evaluation is Required by the. Board of:Health: . El 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 ac.cordance:with 310 CMR 15.303 1 b :that the system is not functioning in.:a manner-which will protect public health O1. ) Y 9 p 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:$uosurface Sewage Disposal System-Page 3 of,17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary,Assessments 750 Santuit Road :Property Address John Bacon Owner Owner's Name information is required for every Cotuit MA 02635 2/1.5/18 page. cityfrown "State Zip Code: :: Date:&Inspection. &aCertification (cont.) s. - - 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 within50 feet of a private water supply well. ❑ The systerri.has a septic tank and;SAS and:the SAS is,less than,100 feet but 50 feei: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, forfecal 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: ai s. D) System Failure Criteria Applicable to All Systems: You must indicate:"Yes" or"No"to each :of the following for all inspections: Yes No .. Backup of sewage into facility or system component due to overloaded or ® ❑ clogged SAS or cesspool:.. . E] 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 El Z than '/Z day flow f5ins 3113' Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of IT i Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 750 Santuit Road :Property Address John Bacon Owner Owner's Name. information Is .. otuit : MA 02635 ..: 2/15/18 requiredfor every •• •. page. City/Town . :. State :. : :: Zip Code: :: Dafe:of Inspection & :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: E] Z Any portion:of the SAS, cesspool-or privy.is:below.high groundwater elevation. y portion io P. P PP y• supply or ❑ ® An ortion of cesspool or privy Is within 100 feet of a surface.water tributaryto a surface water su I :: Z Any portion of a cesspool or:privy ismithin aZorie 1 of a public well:: 10 ®: :: . Any:portion of a:cesspool or.privy is within 50 feet of a private water:supply well. Any portion of a cesspool or privy is less than 100:feet but greater than:50.feet from a private water supply well with no acceptable water quality.analysis. [This system-passes if the well water analysis,performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate:nitrogen:is equal to or less than 5 ppm, provided that:no other failure criteria are triggered. A copy of the analysis and chain of custody must•be attached to this form j The system1s a cesspool serving:a facility with a design flow of 2000gpd El z 10,000gpd. ® ❑ The system fails. l:have determined that one or more.of the:above failure criteria exist as described in 310 CMR 15.303; thereforeahe system fails. The system.owner.should contact the Board of Health to determine what will be necessary to correct the,failure. E) Large Systems: To:be considered a large system:the system must serve a facility with a:. design flow of 10,000.gpd to:16 000 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 .:.. j..:.. .. ..:.. .... ow ❑ the s stem,is within 400 feet of a:y surface drinking water supply.. the system is within.200 feet of a tributary to a surface drinking water supply El ❑ the system is located in a nitrogen,sensitive area (Interim Wellhead Protection Area=:IWPA) ora mapped:Zone II of a public:water supply well If you have answered "yes".to any question in Section E the system:is considered a significant threat, or answered "yes" in Section D above the large system.has failed..The owner or operator of any large system considered a significant threat under Section E or failed:under Section D shall.upgrade the system in!accordance with 310 CMR 15.304. The system owner.should:contact the appropriate regional office of the:Department: t5ins 3/13' Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 i i Commonwealth-of Massachusetts Title 5 fficial In pection Form O m Subsurface Sewage Disposal System Form - Not for Voluntary.Assessments ,M 750 Santuit Road Property Address John Bacon Owner Owner's Name. information is ... .. . required for every CotUit: MA 02635 2/15/18 page. City/Town :,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? ® Q 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 backup? ® ❑: 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? Ei ® . Was the facility.owner(and occupants if different from owner) prov idedr with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing`information,'For example., a plan at the Board.of Health. Determined ih 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:. ... Nurnber of bedr'odms (design): Number of bedrooms (actual): 5 DESIGN flow based on 31,0 CMR 15.20,3 (for no info at example 110 gpd x#of bedrooms): BOH t5ins•3/13: Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of:17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form = Not fob Voluntary'Assessments 5 750 Santuit Road Property Address John Bacon Owner Owner's Name _. information is required for every Cotuit MA 02635 .: 2/1,5/18 page. Cityrrown ' State :. :':;Zip Code, .: -date—of Inspection. M System Information Description: i Number of current residents: Does'residence have a garbage grinder? ❑ Yes ® No :Is:laundry on a separate sewage system?.(Lnclude laundry system inspection information in:this report.) El Yes :� No ...::Laundry system inspected? ❑ Yes E No Seasonal use?: ❑ 'Yes ® :No . Water meter readings, if aVailable,(last 2 yea N/A.usage (gpd)): Detail: Sum um ?. _ Y . P P P ❑: es ® No current Last date of occupancy: Date Commercial/industrial Flow Conditions: Type of. Establishment: — Design flow.(based on 310 CMR 1,5.203): . : dauons per day(gpd) Basis of design flow. seats/ ersons/s ft., etc. Grease trapresent? P ❑ Yes ❑ No: Industrial waste holding tank,present? ❑ Yes ❑ No har ed to.the Title 5 system?:, . on-sanitary,waste disc g ❑ Yes ❑; No "Water meter readings,.if available: - l5ins•3/13' Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17' Commonwealth of Massachusetts Title 5 Offic al Inspection. u � � � F®rm R Subsurface Sewage Disposal System Form Not for Voluntary;Assessm.ents, M 750 Santuit Road Property Address j :. j. John Bacon Owner Owner's Name information is required for every COtUit MA 02635 2/15/18 page. City/Town State : Zip Code: Date of Inspection D. System.Information (cont.) Last date of occupancy/use:; Date Other(describe:below): i General:Information Pumping.Records: :Source of:information: Was:system pumped as part of the:inspection? ❑. Yes No If yes, volume pumped: gallons,. How was:quantity q y pumped determined? Reason forpumping:. _ Type of System: .::. Sep tic tank; distribution box, soil absorption sY stem ❑ Single cesspool 'El. Overflow:cesspool : . ❑ Privy Shared system(yes or no) (if�yes, attach previous inspection recordsjf any) ❑ Innovative/Alternative technology. Attach a copy.of the current operation and maintenance.contract(to be:obtained:from system owner)and a copy of latest inspection of:the I/A system by system operator under:contract ❑. Tight tank.:Attach a copy of the:DEP approval. Other. (describe)::: t5ins-3I13 Title 5 Official,Inspection Form:,Subsurface Sewage Disposal System•Page 8 of 17 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for;Voluntary:Assessments 750 Santuit Road Property Address John Bacon' Owner Owner's NameW. information is . required for every Cotuit; .:MA 02635, 2/15/18 W. page. City/Town State .. .' Zip Code: `: Date:of Inspection D. System.Information (cont.) Approximate age of all components, date installed(if known)and source of information: 1984. Were sewage a odors detected when arriv:in at the site?:g . El:.Yes ® :No .... Building,Sewer(locate,on site:plan): 2, Depth:below grade: feet Material.of construction: :: : El: 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.): At time of inspection building sewer appeared to be in workin order with no sig n of leakage. Septic Tank (locate on site plan): 1,..: 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: j. Dimensiohs:' 1500 gallon 8„ Sludge depth: t5ins•3l13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System'•Page 9 of 1 T Commonwealth of Massachusetts N Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary'Assessme'nts ' 750 Santuit Road :Property Address John Bacon, Owner Owner's Name information is required for every Cotuit MA 02635 2/15/18 page. Cityfrown 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; 28" 4„ :Scum thickness - Distance,from top of.scum to top;of outlet tee or baffle: 6" 12 Distance from:bottom of scum to bottom of outlet tee or baffle How:were dimensions determined?: measured Comments(on pumping recommendations, inlet and,outlet tee or baff le.condition,.5tructural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): At time of inspectionseptic tank appeared:to be in working order. Baffles:present with no sign of back-up, Septic tank is in need of pumping 8, should be pumped every 2 years for maintenance Grease Trap (locate.onsiteplan): Depth below grade::: feet Material:of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness .: Distance from top of scum to.top of outlet tee or baffle Distance'from bottom of scum to:bottom of:outlet tee or baffle Date of last pumping: Date t5ins•3/13' Title 5 Official Inspection Form:,Subsurface Sewage Disposal System-Page 10 of 17. Commonwealth of Massachusetts v W Title 5 Official Inspection Form 'Subsurface Sewage Disposal System Form = Not for Volunta Assessments ry. M 750 Santuit Road Property Address John Bacon Owner Owner's Name _. .. . information is . required for everyCOtuit MA 02635 ... 2/15/18 page. City/Town State Zip Code' Dateiof Inspection D. .System Information (cont.) Comments (on pumping recommendations, inlet:and outlet:tee or baffle condition, structural integrity:, li uid levels as related to;outlet invert;.evidence of leakage,.etc.): etc.): � _. q. Tight or Holding Tank(tank.must.be pumped:at time of:inspection) (locate on site plan): i Depth below:grade; . ::Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity:: gallons. Design.Flow gallons per day .. arm present: Yes No Alarm level:: Alarm in working order: : ❑:Yes ❑ No Date.of last pumping: Date' Comments (cond ition ition of alarm and float-switches, etc.): `Attach copy of current pumpih.g:contract:(required): Is copy attached? ❑ Yes ❑ :No t5ins•3/13 Title 5 Official,Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments t . . M 756 Santuit Road Property Address John Bacon Owner Owner's Name* information is .. . .. .. . required for every Cotuit. MA 02635 2/15718 page. City/Town State Zip Code Date:of Inspection. i D.-:System Information (cont.) Distribution Box.(if present must be opened)(locate on site plan): 0.. Depth:of liquid level above:outlet invert C.omments:(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:); .:At time of:inspection:d=box appears to bean working order with no sign of.c arryover.. Pump Chamber(locate on site plan): Pumps irrworking order: ❑ Yes ❑ No* Alarms in workin 9.order: ❑ Yes ❑ No Comments (note condition of:pump chamber, condition of pumps and appurtenances, etc.): * I,fpumps 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: 15ins•3/13' Title 5 Official,Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary,:Assessments 750 Santuit Road Property Address John Bacon Owner Owner's Name information is required for every Cotuit MA 02635 2/15/18 page. Cityrrown State Zip Code: : Dafe:of Inspection D: :System Information (coot.) Type: q. ❑ leaching pits. number:.::: ' :E] leaching chambers. number: ]z leaching galleries:, number: .(3)flow diffusers El leaching trenches number jength: El:':: . leaching fields. number; dimensions: overflowcesspool number: E1 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.): At time of inspection leaching is in hydraulic failure:and:must be.'replace.d. Effluent:is 1/2 way:.over outlet pipes. s. 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 0 Yes No t5ins!3113' Title 5 Official Inspection Form:.Subsurface Sewage,Disposal System•Page 13 of 17; Commonwealth,& Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary;Assessments 750 Santuit Road :Property Address ' John Bacon Owner' Owner's Name information is required for every Cotuit: MA 02635 2/15I18 page. City/Town State Zip Code, Date:of Inspection. D. System Information (cont.) i Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): I Privy (locate on site plan:):: aterials.of construction: .::Dimensions: Depth of solids Comments(note condition.of soil, signs.of hydraulic failure, level of ponding,condition of vegetation,: etc..): q. t5ins•3/13 Title 5 Official,Inspection Form:,Subsurface Sewage Disposal System Page 14 of.1 Z :.Commonwealth of Massachusetts _ Tithe 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 750 Santuit Road .. Property Address John Bacon .Owner .:Owner's Name information is .required for every Cotuit: MA : .02635 2/15/18 page. Cityrrown State Zip Code ' Date of Inspection D. System:Information :(Pont.) Sketch Of Sewage:DisposaL:System::Provide a.view of the sewage disposal system, including ties•to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: hand-sketch in the:area below: ° ❑ drawing attached separately i �( r II n-r u;it t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System+Page 15 of 17 I Commonwealth.of Massachusetts W Title 5 Official Inspection Form e Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 750 Santuit Road Property Address John Bacon Owner Owner's Name information is ,. MA required for every Cotuit .. 02635 2/15/18 page, Cityrrown State Zip Code: Date:&Inspection: D. :System Information (cont.) Site Exam: Check Slope 0: Surface water Check;cellar ® Shallow wells: ; Estimated depth to.high ground water: feet Please indicate all methods used to determine the high ground water elevation: Obtained from system design plans on record If checked, date of design plan reviewed: pate ® Observed site(abutting property/observation hole within 150 feet of SAS) El 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 augered hole Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•'311.3' Title 5 Official Inspection Form:.Subsurface Sewage:Disposal System:•Page 16 of 17: Commonwealth of Massachusetts Title 5 Official Inspection Form L a 9 P Voluntary :.. Subsurface Sewage Disposal System stem Form Not for Volunta Assessments 750 Santuit Road. Property Address John Bacon Owner Owner's Name _.. _. information is .required for every Cotuit MA 02635 . 2/15/18 •page. City7own State :. ': :: Zip Code. :. Date:of Inspection. E. Report Completeness Checklist ® Inspection Summary.: &;B, C, D .orE checked ® Inspection Summary D (Syste ':Failure Criteria Applicable to A11 Systems) completed System Information— Estimated depth to high groundwater' Z: Sketch of Sewage:DisposaF System.either drawn:on page.15 or attached in separate file. t5ins•3113' Title 5 Official Inspection Form:Subsurface Sewage Disposal System'-Page 17 of.17 Thomas&Betts Corporation 452 John Dietsch Blvd. P.O. Box 2510 Attleboro Falls, MA 02763 (508) 699-9800 Facsimile(508) 695-8111 Thomas o efts April 2, 1998 John C. & Ramuta H. Bacon s 750 Santuit Road Cotuit, Massachusetts 02635 Dear Mr. and Mrs. Bacon: Attached please find the laboratory results of the analysis of your well water, which we recently sampled. The water samples were collected by GZA GeoEnvironmental, Inc. and analyzed by the Mitkem Corporation laboratory. No Volatile Organic Compounds (VOCs) were detected in your well water. The Department of Environmental Protection has been provided a copy of these results. 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) found in the' water sample. 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 in and test your water. If you have any questions, please do not hesitate to call Tom McShane at Thomas & Betts (508-699-9820). Sincerely, William 0. Frigon Attachment: Laboratory Analysis Report cc: Town of Barnstable Board of Health Mark Wood, DEP . CORPORATION APR 02 1998 f March 31, 1998 GZA GeoEnvironmental, Inc. u U� 140 Broadway •�'-'"" -'r��� Providence, RI 02903 Attn: Ms. Hilary Fortune RE: Client Project#: 31751.13, Cotuit Well Sampling (IRA) Lab Project#: E0410 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. Sincerel Edward A. Lawler Laboratory Operations Manager 175 Metro Center Boulevard • Warwick, Rhode Island 02886-1755 • (401) 732-3400 • Fax (401) 732-3499 1232 East Broadway, Suite 210 • T6mpe, Arizona 85282 • (602) 303-9535 • Fax (602) 921-2883 email: mitkem@worldnet.att.net MITKENI CORPORATION Client: GZA GeoEnvironmental,Inc. Client Project: 31751.13, Cotuit Well Sampling (IRA) Lab Project: E0410 Date samples received: 3/27, 3/30/98 Project Narrative This data report includes the analysis results for ten(10) aqueous samples that were received from GZA GeoEnvironmental, Inc. on March 27,30 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. The method blank associated with these volatile organic sample analyses contained low levels of common laboratory contaminants methylene chloride and 1,12-trichloro-1,2,2-trifluoroehtane. -These compounds were also detected in several samples. Where they are detected in samples, their concentrations are flagged with a`B No other unusual occurrences were noted during sample analysis. This data report has been reviewed and is authorized for release as evidenced by the signature below. Edward A. Lawler Laboratory Operations Manager 001, t I Data Qualifiers: J This flag indicate&an estimated value due to either • the compound was detected at below the Reporting Limit, or estimated concentration for Tentatively Identified Compound B This flag indicates the analyte was also detected in the associated Method Blank D This flag indicates the analyte concentration was obtained from a diluted analysis E This flag indicates the analyte concentration exceeded the Calibration Range P This flag is used for Pesticides/PCB/Herbicide analyte when there is a greater than 50% difference for detected concentration between the two GC columns used for Primary and Confirmation analyses. The lower of the two values is reported in the Analysis Report V � r) CORPORATION Analysis Report: Purgeable Volatile Organics Client: GZA GeoEnvironmental, Inc. Analysis Date: 3/30/98 Client ID: RW-1 Concentration in: ug/L Lab ID: E0410-01 Dilution: 1 Analysis: Method 524.2 Reporting An alvte Results L1 DA 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 0.5 111-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 0 r 1 ND ' V Pagel of 2 E0410-01 MITKENI CORPORATION Client ID: RW-1 Lab ID: E0410-01 Reporting Analvte Result L�nA Ethylbenzene ND 0.5 Xylenes (total) ND 0.5 Styrene ND 0.5 Bromoform ND 0.5 . Isopropylbenzene ND 0.5 Bromobenzene ND 0.5 1,1,2,2-Tetrachloroethane ND 0.5 1,2,3-Trichloropropane ND 0.5 n-Propylbenzene ND 0.5 2-Chlorotoluene ND 0.5 4-Chlorotoluene ND 0.5 1,3,5-Trimethylbenzene ND 0.5 tert-Butylbenzene ND 0.5 1,2,4-Trimethylbenzene ND 0.5 sec-Butylbenzene ND 0.5 1,3-Dichlorobenzene ND 0.5 4-Isopropyltoluene ND 0.5 1,4-Dichlorobenzene ND 0.5 1,2-Dichlorobenzene ND 0.5 .n-Butylbenzene ND 0.5 1,2-Dibromo-3-chloropropane ND 0.5 1,2,4-Trichlorobenzene ND 0.5 Hexachlorobutadiene ND 0.5 1,2,3-Trichlorobenzene ND 0.5 Naphthalene ND 0.5 1,1,2-Trichloro-1,2,2-trifluoroethane ND 0.5 QC Batch: V5B0330A Surrogate Recovery: Bromofluorobenzene 92% 1,2-Dichlorobenzene-d4 100% ND= Not Detected Single point calibration V � Page 2 of 2 E0410-01 Analysis Report: Purgeable Volatile Organics Client: GZA GeoEnvironmental, Inc. Analysis Date: 3/31/98 Client ID: TB (3/27) Concentration in: ug/L Lab ID: E0410-08 Dilution: 1 Analysis: Method 524.2 Reporting Analyte Results Lifat 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 0.6 B 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-Tetrachloroethene N D 0.5 Pagel of 2 E0410-08 MITKENII CORPORATION Client ID: TB (3/27) Lab ID: E0410-08 Reporting Analyte Result Ll. 2 Ethylbenzene ND 0.5 Xylenes (total) ND 0.5 Styrene ND 0.5 Bromoform ND 0.5 Isopropylbenzene ND 0.5 Bromobenzene ND 0.5 1,1,2,2-Tetrachloroethane ND 0.5 1,2,3-Trichloropropane ND 0.5 n-Propylbenzene ND 0.5 2-Chlorotoluene ND 0.5 4-Chlorotoluene ND 0.5 1,3,5-Trimethylbenzene ND 0.5 tent-Butylbenzene ND 0.5 1,2,4-Trimethylbenzene ND 0.5 sec-Butyl benzene N D 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 0.7 B 0.5 QC Batch: V5B0330A Surrogate Recovery: Bromofluorobenzene 94% 1,2-Dichlorobenzene-d4 102% ND= Not Detected " Single point calibration 013 Page 2 of 2 E0410-08 CORPORATION Analysis Report: Purgeable Volatile Organics Client: GZA GeoEnvironmental, Inc. Analysis Date: 3/30/98 Client ID: Concentration in: ug/L Lab ID: Method Blank, V5130330A Dilution: 1 Analysis: Method 524.2 Reporting Analyte Results L nA 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 0.4.J 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 t 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-Tetrachloroethene ND 0.5 0 213 Pagel of 2 E0410-MB CORPORATION Client ID: Lab ID: Method Blank, V5B0330A Reporting Analyte Result L MA Ethylbenzene ND 0.5 Xylenes (total) ND 0.5 Styrene ND 0.5 Bromoform ND 0.5 Isopropylbenzerie ND 0.5 Bromobenzene ND 0.5 1,1,2,2-Tetrachloroethane ND 0.5 1,2,3-Trichloropropane ND 0.5 n-Propylbenzene ND 0.5 2-Chlorotoluene ND 0.5 4-Chlorotoluene ND 0.5 1,3,5-Trimethylbenzene ND 0.5 tert-Butylbenzene ND 0.5 1,2,4-Trimethylbenzene ND 0.5 sec-Butylbenzene ND 0.5 1,3-Dichlorobenzene ND 0.5 4-Isopropyltoluene ND 0.5 1,4-Dichlorobenzene ND 0.5 1,2-Dichlorobenzene ND 0.5 -n-Butylbenzene ND 0.5 1,2-Dibromo-3-chloropropane ND 0.5 1,2,4-Trichlorobenzene ND 0.5 Hexachlorobutadiene ND 0.5 1,2,3-Trichlorobenzene ND 0.5 Naphthalene ND 0.5 1,1,2-Trichloro-1,2,2-trifluoroethane 0.6 0.5 QC Batch: V5B0330A Surrogate Recovery: Bromofluo robe nzene 93% 1,2-Dichlorobenzene-d4 99% ND= Not Detected " Single point calibration 024 Page 2 of 2 E0410-MB MITKEM CORPORATION Lab Project#: EO41 O "1 �1 Client Name: GZA GeoEnvironmental, Inc. Client �'Pro #: 31751.13 Logged In By: Client PO#: 3-01096 Project Name: Cotuit Well Sampling (IRA) Reviewed By: Date Due: 3/31/98 Total Price: $ - Date: Time: JO Project Mgr: PAS Salesman: PAS Del-Re4'd: NA Completed?: YES Lab ID Client ID Matrix n I i Price Sampled Received TPH IR B A Herb P/P_ )y&l Md V-GC y-MS �u4 -01 RW-1 AQ 524.2 3/27/98 3/27/98 1 -02 RW-7 AQ 524.2 3/27/98 3/27/98 1 -03 RW-24 AQ 524.2 3/27/98 3/27/98 1 -04 RW-17 AQ 524.2 3/27/98 3/27/98 1 -05 RW-23 AQ 524.2 3/27/98 3/27/98 1 -06 RW-18 AQ 524.2 3/27/98 3/27/98 1 -07 RW-8 AQ 524.2 3/27/98 3/27/98 1 -08 TB(3/27) AQ 524.2 3/27/98 3/27/98 1 -09 RW-15 AQ 524.2 3/28/98 3/30/98 1 -10 TB (3/28) AQ 524.2 3/28/98 MOM 1 nH IR MA Hfflz PLP 3yd Mgt V- 'C Y--M Smh 0 0 0 0 0 0 0 0 10 0 �'l 3/31/98 9:52 AM Page 1 of 2 Lab Project#: E0410 MITKEM CORPORATION Lab ID Client ID Matrix Analysis PriceSAmplgd ReceivedTPA- IR BNA Herb PIP Xd NMgt `t' -MS auh NOTES: Addreprll l01;$t o � oi cltliratic�n ' .. ._� �.,,..,�.�.. �: M> R1 nape adds d' �� ` � 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 Providence,RI 02903 Fax: 401 751-8613 C:` r` /31/98 9:52 AM Page 2 of 2 Lab Project#: E0410 G' WHITE COPY-Original YELLOW COPY-Lab Files PINK COPY-Project Manager W.O. ## CHAIN-OF-CUSTODY RECORD (for lab use only) ANALYSES REQUIRED Sample Daterrime Matrix a — z d a � S e ; I.D. _ s s_soa _ , E m Total F S o o n - (Very Important) cw=c o..e W. m m d i ? a �. p of Note SW=SuAace W. -� 7 -� 1 U rn WW=Wa51a W. , 6 ^ �, o o N C! U a c —° m Cont. # DW=D�snking W. n 2 U N m m m U n = U 0he'l pecdy) _l x 0 p ❑ n ❑ ►Lf yY �� ✓ 2-4 / 16.00 C,W ✓ II : 3Q, Dd PRtll— 23 / Iz .o2 DW ff VJ_ g io.,4X DV 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 RECEIVED BY:(Affiliation) NOTES: Preservatives,special reporting limits,known contamination,etc.: Q =� ����y� �- ,�� (Unless otherwise noted,all VOA vials have been preserved w/1:1 HCL.) 3 .'; 9 RELINQUISHED BY:(Affiliation) DATE/TIME E EI BY:(Affiliation) 10 bn 71t cy�c�a y� �.e,du, 6 �,t4tx �dA,� P?��� RELINQUISHED BY.(Affiliation) DATE/TIME RECEIVED BY: (Affiliation) , / - ►,�f L411 PROJECT MANAGER: �F ��rU�� EXT: 31 a Io A TURNAROUND TIME:❑Standard 02 Rush -Z--Days,Approved by: Se-#L e-c GZA FILE NO. I S I•1 3 P.O. N.O. GZA GEOENVIRONMENTAL, INC. ENGINEERS AND SCIENTISTS PROJECT COTV1 i" tAII�LL ShMpL l l.1 (� (L�4� 140 Broadway PROVIDENCE,RI 02903 LOCATION COTt>I•ram f&A (401)421-4140 FAX(401)751-8613 COLLECTOR(S) 5_/[A b /wT-_ SHEET OF�_ WHITE COPY-Original YELLOW COPY-Lab Files PINK COPY-Project Manager W.O. # CHAIN-OF-CUSTODY RECORD (for lab use only) ANALYSES RE UIRED Sample Date/Time Matrix m S I.D. a m m s n A` H c s=sea F s m 8 m d Total (Very Important) GW=aeend W. m e a d ? a v p of Note sW=Sudace W. % u WW=Wasie W- "! o o H 7 ul (f a "' m (J Cont. M DW=D,mk,ng W. C 2 0 .n m m .00 U a = U a 1^ Olhe'(apecay) 1 mir Z f V -RVJ-15 3n e, IloiZo GVi 3 PRESERVATIVE (CI-HCI,N HNO3,S-H,SO4,Na-NaOH,O-Other), CONTAINER TYPE (P-Plastic,G-Glass,V-Vial,T-Teflon,O-Other)* Vp, UISHED BY:(Affiliation) DATE/TIME RECEIVED BY:(Affiliation) NOTES:Preservatives,special reporting limits,known contamination,etc.: � cR, 3 U`f �(S C� (Unless otherwise noted,all VOA vials have been preserved w/r1:1 HCrL.) RE IN HED BY: (Affiliation DATE/TIME , RECEIV DrBY:(Affiliation) t t v� w,rvl s le C-V(1-e-d A C� Ae-r rV-v—�e-C(4-D I �3 lfc RELINQUISHED BY:(Affiliation) DATE/TIME IVED BY: (Affiliation) PROJECT MANAGER: t'n lzzrooL EXT: 3 I 242 TURNAROUND TIME:❑Standard ❑ Rush —Days,Approved by: GZA FILE NO. 9J l�Sl 13 P.O. N.O. 3 — O I Oq (o GZA GEOENVIRONMENTAL, INC. PROJECT CoT ENGINEERS AND SCIENTISTS L7 1"r l� -S�M�tf.� 140 Broadway PROVIDENCE,RI02903 LOCATION CoTUrr, AAA (401)421-4140 J FAX(401)751-8613 COLLECTOR(S) W CfIeTOOF:'�[ 44 F02TUh. e, SHEET u MITKEM CORPORATION Sample Condition Form Page ( 14 Received By: Reviewed By: Date: J?, IMITKEM Project: ��-(�0 / Client Project: `v t(t. w C�t,� Client: Sample ID Preservation (pH) Comments/Remarks/ Condition: ELa Client HNO3 H2SO4 HC1 NaOH Corrective Action* 1) Custody Seal(s) Presen Absent —� Cooler(/Bottles — ,)3 Intact/Broken c3/ 2) Custody Seal Number(s) 3) Chain-of-Custody Presen bsent 4) Cooler Temperature Coolant Condition 5)Airbili(s) Presen bsen Airbill Number(s) 6) Sample Bottles I tta Broken Leaking 7) Date Received 8) Time Received 9) Project Due Date • r1 i * See Sample Condition Notification/Corrective AFtion Form yes no n r i MITKEM CORPORATION Sample Condition Form Page fQ Received By: Reviewed By: Date: 3 3 a C IMITKEM Project: E- b Client Project: Client: Sample ID Preservation (pH) Comments/Remarks/ Condition: Lab Client HNO3 H2SO4 HC1 NaOH Corrective Action' 1) Custody Seal(s) Presen Absent -`la ooler'/Bottles Broken c n 2) Custody Seal Number(s) 3) Chain-of-Custody oPreseAbsent 4) Cooler Temperature Coolant Condition 1 LE c << 5)Airbill(s) Prese Absent Airbill Number(s) 6) Sample Bottles Intact Broken Leaking 7) Date Received 3 8)Time Received 00 9) Project Due Date See Sample Condition Notification/Corrective Action Form yes/ no ' VJ I i Last Page of Data Report MAILING LIST FOR 106 FALMOUTH ROAD SITE-MASHPEE,MASSACHUSETTS DATE: FILE NO. 7S DOCUMENT• ADDRESSEE "reg.cc:" "blind cc:" VIA SENT Massachusetts Dept.of Environmental Protection Southeast Regional Office 20 Riverside Drive , Lakeville.Massachusetts 02347 _Adn: Mr.Gerard Martin,Acting Chief Attn: Mr.Mark Wood,Project Manager Massachusetts Department of Public Health Environmental Health Assessment 250 Washington Street,7'Floor Boston,Massachusetts 02108 Attn: Ms.Elaine Kroueger,Chief,Environmental Toxicology Mashpee Board of Health 16 Great Neck Road Mashpee,Massachusetts 02649 Attn: Mr.Elias McQuaid,Chairperson Mashpee Board of Selectmen P.O.Box 1108 16 Great Neck Road Mashpee,Massachusetts 02649 Attn: Ms.Judith Mills,Chairperson Mashpee Water District P.O.Box 1543 Mashpee,Massachusetts 02649 Attn: Mr.Dave Rich Mashpee Public Library P.O.Box 657 Mashpee,Massachusetts 02649 Barnstable County Dept.of Health and the Environment Superior Court House P.O.Box 427 Barnstable,Massachusetts 02630 Attn: Mr.Stetson Hall Barnstable Board of Health - Attn: Thomas&Betts Corporation 452 John Dietsch Blvd. Attleboro Falls,Massachusetts 02763 /yG Attn:Mr.William Frigon Thomas&Betts Corporation / 1555 L}}��nnfield RoadOK Men�¢h,s,Tennessee 38119 ✓ K�li�- ✓Y Attn:Mr.Om Chopra LA Hale&Dorr 1455 Pennsylvania Avenue Washington,DC 20004 Attn: Mr.Jeffrey J.Davidson,Esq. Willowbend Development Corporation 130 Willowbend Drive Mashpee,Massachusetts 02649 Attn: Mr.Bruce A.Besse,Jr.,V.P. IN-HOUSE COPIES Michael A.Powers,P.E.,LSP Hilary Downes Fortune,P.G. File Copy # , I-o"q HC " j:jobslenvl31751-1.mapladres-3.doc 3 f r COTUIT WELL SAMPLING PROGRAM This well sampling work plan was prepared by GZA GeoEnvironmental, Inc. for the Thomas & Betts Corporation (T&B). The plan was prepared to describe how certain residential wells in Cotuit, Massachusetts will be tested for Volatile Organic Compounds G� (VOCs). The program is part of an ongoing study being conducted pursuant to the Massachusetts Contingency Plan ("MCP") and in coordination with the Massachusetts Department of Environmental Protection ("DEP"), and is designed to meet all applicable state standards. 5 I PURPOSE The purpose of this sampling program is to provide additional information related to groundwater contamination associated with the former Augat manufacturing facility in Mashpee. The-specific purpose of this work plan is to describe: (1) how wells were selected for sampling; (2) how samples will be collected and transported; (3) how samples will be analyzed; and (4) how the results of the testing will be documented and reported. The testing program is intended to provide information which will identify an unanticipated condition. Beyond this sampling program, ongoing and additional studies will be aimed at better defining the discharge location of the contaminated groundwater which is found beneath portions of the 106 Falmouth Road Site in Mashpee, and will help establish the long-term monitoring program required to confirm the identified discharge location(s). BACKGROUND Groundwater contaminated with volatile organic compounds (VOCs), primarily i trichloroethene (TCE), tetrachloroethene (PCE), 1,1,1-trichloroethane (TCA), and associated degradation products, was found at the 106 Falmouth Road Site in Mashpee, Massachusetts in 1997. T&B has assumed responsibility for compliance with MCP procedures with respect to that contamination. The vertical and horizontal extent of that groundwater contamination has been well delineated from just south of Falmouth Road (Route 28) to the edge of Shoestring Bay. Based on the geometry of the aquifer and the Bay, and well-established geohydrological principles, it was initially estimated that the contaminated groundwater discharged to Shoestring Bay in the immediate vicinity of Bryant's Point. Subsequent detailed piezometric studies found that the groundwater discharge mechanism is more complex. Based on measured hydraulic heads and inferred hydraulic parameters, we now believe that the VOCs are discharging, or will discharge, to Shoestring Bay at locations more distant from shore than originally estimated. Although very unlikely,there is a possibility that at least a portion of the groundwater flow beneath Shoestring Bay also flows beneath Cotuit. Page 1 of 3 Because the discharge location has not yet been fully defined, and based on technical discussions with the DEP, T&B has elected to undertake a one-time testing of certain residential water supply wells in Cotuit for VOCs. This work plan describes that sampling and analysis program. It is noted that, because of the observed geohydrological conditions, the distances of the subject wells from the Site, and the earliest possible date of a release of VOCs, it is highly unlikely that Site-related VOCs will be found in groundwater beneath Cotuit. We also G� emphasize that the sampling and analysis program detailed in this work plan is only a part of T&B's ongoing effort to be sure historical releases of VOCs pose no unacceptable risk to human health or the environment. Additional tasks to better delineate.the discharge location of Site-related VOCs continue to be performed as part of an evaluation of the Site's Class C Response Action Outcome(RAO). SELECTION OF RESIDENTIAL WELLS Based on published geologic informations, the identified groundwater flow path at the 106 Falmouth Road Site, and topographic features in Cotuit, it is evident that if groundwater from the Site passes beneath Shoestring Bay to beneath Cotuit, it does so in the vicinity of Fullers Marsh. We selected 20 residences which utilize private drinking water wells in the area of Fullers Marsh from a map depicting properties serviced by the Cotuit Water Company2. It is,our intent to sample and test all 20 of these wells. SAMPLE COLLECTION We will make good faith efforts to contact owners at each of the identified 20 properties. With the permission of the owner, we will draw a sample of water from a cold water tap within the home. To the extent practical, we will observe the plumbing system so that samples are collected before any water treatment systems, and we will obtain whatever information the owner has on the construction of the well. The water will be run vigorously for a minimum of 15 minutes or until .two volumes of any holding tank are withdrawn. This is to help ensure that the sampled water has not been in residence in the house's plumbing system for an extended duration. The sample will be collected by running the water gently (without an aerator) into new 40 ml glass vials, preserved with hydrochloric acid to a pH <2, and sealed with caps equipped with a teflon septum. The vials will be uniquely labeled, in the field, using a project code, placed on ice, and transported to the selected laboratory under chain-of-custody within 48 hours of collection. A trip blank will be transported in each cooler, and provided to-the ' Use of Particle tracking to Improve Numerical Model Calibration and to Analyze Groundwater Flow and Contaminant Migration..Massachusetts.Military Reservation,Western Cape Cod,Massachusetts. USGS Open-File Report 96-214, 1996. 2 Map of Parcels with Connections to the Cotuit Water Company in the Poponessett Bay Area. Barnstable G.I.S. Unit G.M.C. 1/21/98. Page 2 of 3 laboratory for testing. Additional QA/QC procedures will include the collection of two or more samples for analysis as blind duplicates. SAMPLE ANALYSES Samples will be analyzed by EPA Method 524.2 by an independent laboratory certified in Massachusetts using contract laboratory procedures. G� REPORTING GZA will compile the analytical results in a table, identifying each constituent found above its laboratory method detection limit. We will also compare these data to those compounds which have been found at the 106 Falmouth Road Site. The table will be supplemented with a brief report which will describe the sampling procedures and provide complete copies of the actual laboratory Certificates of Analysis. Each homeowner will be provided a copy of the Certificate of Analysis and a letter providing an appropriate description of the laboratory's analysis of the sample collected from their well. SCHEDULE Contingent upon homeowners' availability, the sampling will be"conducted over a period of three days, from March 27 to March 30, 1998. The distribution of results to homeowners will occur within a week of sampling. The final report will be provided to the DEP, local officials and homeowners on or before April 10, 1998. gAjobs\env\31751-1..map\cotuit\workplan.doc F Page 3 of 3 Ca LIB Thomas&Betts Corporation 1—-121 --4146 452 John Dietsch Blvd. P.O.Box 2510 Attleboro Falls,MA 02763 ` (508) 699-9800 Facsimile(508)695-8111 Thomas etas WPI March 20, 1998 MAR 23 1998 � 1 TOWN OF urH DEPTH LE p� HEAITHDEPT. � Dear(Homeowner): 8 Just over a year ago,Thomas & Betts acquired Augat Inc. which operated a manufacturing facility in your neighboring town of Mashpee. Augat conducted manufacturing operations at its facility, located at 106 Falmouth Road, from the late 1960's until the plant was retired in December 1996. Upon closing the plant, Augat began a standard assessment of their property to determine if there was any historical industrial contamination at the site. Groundwater at the facility was found to be contaminated with volatile organic compounds associated with the use of industrial cleaning solvents. Since then, Augat, and subsequently Thomas &Betts, have been conducting a full technical investigation to resolve any potential environmental issues. As an extension of this investigation, Thomas & Betts is now requesting your permission to take a sample of water from your well at (address). That sample will be analyzed for volatile organic compounds. If you agree to participate, you will be provided with a copy of the laboratory results within roughly a week of the sampling. Obviously, this testing will be done at no charge to you. The purpose of this testing is to provide additional information for the on-going study related to the groundwater contamination that was found at the former Augat facility in Mashpee. Based upon the current facts and the professional opinion of our Licensed Site Professional and our engineering consultants, Thomas &Betts believes that the contamination originating at the former Augat facility has or will discharge into Shoestring Bay. The quantities of contaminants released to the Bay are expected to be so small that they will present no significant risk to the Bay or the environment. However, although very unlikely, there is also a possibility that at least a portion of the groundwater flowing beneath Shoestring Bay may also flow beneath Cotuit. Therefore, as a precautionary measure and as part of our complete hydrogeological assessment, Thomas & Betts, in coordination with the state Department of Environmental Protection,would like to sample certain residential wells including your own. Of course, if this data suggests any need for concern or follow-up action, we will irrunediatel.y contact you directly. A more detailed description of the sampling program which we have outlined to the state DEP is attached. _ ;r, i Page Two q A representative of Thomas &Betts.will be calling you in the next few days to further answer any questions and hopefully to schedule a convenient time to take the water sample. In the meantime, should you wish to contact us,please call Tom McShane at(508) 699-9820. s Thank you in advance for your cooperation. Sincerely, :. f William O. Frigon f Manager Corporate Environmental, Health& Safety Attachments: Well Sampling Work Plan -Area Map cc: Massachusetts Department of Environmental Protection j. F t t i { i 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. March 20, 1998 Russell J.Morgan,P.E. File No. 31751.1 Mr. Mark Wood 2 Department of Environmental Protection 1 3 20 Riverside Drive 1`�► ,� G� Lakeville, Massachusetts 02347 RICEIV EO i Re: Immediate Response Action Work Plan MAR 2 6 1998 N 106 Falmouth Road Site o TOWN OF HApNSTO Mashpee, Massachusetts (RTN 4-11904) 140 Broadway Providence Deaf Mr.Wood: Rhode Island 02903 401-4214140 FAX 401-751-8613 GZA GeoEnvironmental, Inc. prepared the attached Immediate Response Action (IRA) work plan for the 106 Falmouth Road Site in Mashpee, Massachusetts. We are submitting this document on behalf of our client, the Thomas & Betts Corporation (T&B), in accor dance with 310 CMR 40.0420. We believe this document provides the information you require. If you have any questions, please do not hesitate to call us at(401)421-4140. Very truly yours, GZA GEOENVIRONMENTAL,INC. Hilary Do nes Fortune, P.G.- Mi ael A. Powers,P.E.,LSP Seni oject Manager Se for Principal A Subsidiary of GZA GeoEnvironmental Technologies,Inc. Attachments: BWSC-105: IRA Transmittal Form IRA Work Plan cc: Town of Mashpee Board of Health Town of Mashpee Board of Selectmen Mashpee Public Library Barnstable County Department of Health ,/'Town of Barnstable Board of Health Cotuit Water Company William Frigon,T&B i J:\JOBS\ENV\31751-I.MARCOTUrMA-LE7.DOC An Equal Opportunity Employer NVFN/H IMMEDIATE RESPONSE ACTION (IRA)WORK PLAN I This document is an Immediate Response Action (IRA) Work Plan. It was prepared by GZA GeoEnvironmental, Inc. for the Thomas &Betts Corporation (T&B). PURPOSE The purpose of this IRA is to provide additional information related to groundwater contamination associated with the 106 Falmouth Road Site (the Site) in Mashpee, Massachusetts. The specific purpose of this work plan is to describe: (1) how wells were selected for sampling; (2) how samples will be collected and transported; (3) how samples will be analyzed; and (4) how the results of the testing will be documented and reported. The testing program is intended to provide information which will identify an unanticipated condition. Additional studies will be aimed at better defining the discharge location of the contaminated groundwater which is found beneath portions of the 106 Falmouth Road Site, and will help establish the long-term monitoring program required to confirm the identified discharge location(s). BACKGROUND Groundwater contaminated with volatile organic compounds (VOCs), primarily trichloroethene „ (TCE), tetrachloroethene (PCE), 1,1,1-trichloroethane (TCA), and associated degradation products, was found at the 106 Falmouth Road Site in Mashpee, Massachusetts. T&B has assumed responsibility for compliance with MCP procedures with respect to that contamination. The vertical and horizontal extent of that groundwater contamination has been well delineated from just south of Falmouth Road (Route 28) to the edge of Shoestring Bay. Based on the geometry of the aquifer and the Bay, and well-established geohydrological principles, it was initially estimated that the contaminated groundwater discharged to Shoestring Bay in the immediate vicinity of Bryant's Point. Subsequent detailed piezometric studies found that the groundwater discharge mechanism is more complex. Based on measured hydraulic heads and inferred hydraulic parameters, we now believe that the Site VOCs are discharging, or will discharge, to Shoestring Bay at locations more distant from shore than originally estimated. Although very unlikely, there is a possibility that at least a portion of the groundwater flow beneath Shoestring Bay also flows beneath Cotuit. Because the discharge location has not yet been fully defined., and based on technical discussions with the DEP, T&B has elected to undertake a one-time testing of certain residential water supply wells in Cotuit for VOCs. This IRA work plan describes that sampling and analysis program. Page 1 of 3 t. It is noted that, because of the observed geohydrological conditions, the distances of the subject wells from the Site, and the earliest possible date of a release of VOCs, it is highly unlikely that Site-related VOCs will be found in groundwater beneath Cotuit. We also emphasize that the sampling and analysis program detailed in this work plan is only a part of T&B's ongoing effort to be sure historical releases of VOCs pose no unacceptable risk to human health or the environment. Additional tasks to better delineate the discharge location of Site-related VOCs will be performed as part of an evaluation of the Site's Class C RAO. SELECTION OF RESIDENTIAL WELLS Based on published geologic information[ the identified groundwater flow path at the 106 Falmouth Road Site, and topographic features in Cotuit, it is evident that if groundwater from the Site passes beneath Shoestring Bay to beneath Cotuit, it does so in the vicinity of Fullers Marsh. We selected 20 residences which utilize private drinking water wells in the area of Fullers Marsh from a map depicting properties serviced by the Cotuit Water Company2. It is our intent to sample and test these 20 wells. SAMPLE COLLECTION We will make good faith efforts to contact owners at each of the identified 20 properties. With the permission of the owner, we will draw a sample of water from a cold water tap within the home. To the extent practical, we will observe the plumbing system so that samples are collected before any water treatment systems, and we will obtain whatever information the owner has on the construction of the well. The water will be run vigorously for a minimum of 15 minutes or until two volumes of any holding tank are withdrawn. This is to help ensure that the sampled water has not been in residence in the house's plumbing system for an extended duration. The sample will be collected by running the water gently (without an aerator) into new 40 ml glass vials, preserved with hydrochloric acid to a pH <2, and sealed with caps equipped with a teflon septum. The vials will be uniquely labeled, in the field, using a project code, placed on ice, and transported to the selected laboratory under chain-of-custody within-48 hours of collection. A trip blank will be transported in each cooler, and provided to the laboratory for testing. Additional QA/QC procedures will include the collection of two or more samples for analysis as blind duplicates. SAMPLE ANALYSES Samples will be analyzed by EPA Method 524.2 by a laboratory certified in Massachusetts using contract laboratory procedures. F Use of Particle tracking to Improve Numerical Model Calibration and to Analyze Groundwater Flow and Contaminant Migration Massachusetts Military Reservation Western Cape Cod,Massachusetts. USGS Open-File Report 96-214, 1996. 2 Map of Parcels with Connections to the Cotuit Water Company in the Poponessett Bay Area. Barnstable G.I.S. Unit G.M.C. 1/21/98. Page 2 of 3 r REPORTING GZA will compile the analytical results in a table, identifying each constituent found above laboratory method detection. Samples will be identified so that, with the aid of a separate key, the DEP will be able to identify which sample came from each residential well. We will also identify, on that table, which compounds, if any, have also been found_at the 106 Falmouth Road Site. The table will be supplemented with a brief report which will describe the sampling procedures and provide copies of the laboratory Certificates of Analysis. Each homeowner will be provided a copy of the Certificate.of Analysis and a letter providing an appropriate description of the laboratory's analysis of the sample collected from their well. SCHEDULE Contingent upon homeowners' availability, the sampling will be conducted over a period of three days, from March 27 to March 30, 1998. The distribution of results to homeowners will occur within a week of sampling. The final report will be provided to the DEP, local officials and homeowners on or before April 10, 1998. gAjobs\env\3175 I-L.map\cotuit\ira-3.doc i Page 3 of 3 TABLE I COTUIT PROPERTIES SELECTED FOR RESIDENTIAL WELL SAMPLING IMMEDIATE RESPONSE ACTION PLAN 106 Falmouth Road Site -Mashpee, Massachusetts .... WELL.LD.-: PLAT MAP: LOT 1 6 48 750 Santuit Road 2 5 A72 122 Pin uickset Cove Road 3 5 144 Pin uickset Cove Road 4 5 160 Pin uickset Cove Road 5 5 180 Pin uickset Cove Road 6 S 190 Pin uickset Cove Road 7 5 189 Pin uickset Cove Road 8 4167 Pin uickset Cove Road 9 41617 Main Street Pin uickset Cove Road 10 4 8 1619 Main Street (Peppercorn Lane 11 4 9-1 114 Peppercorn Lane 4 9-2 120 Peppercorn Lane 4 10 144 Peppercorn Lane 4 11 160 Peppercorn Lane 4 12 N/A 12 6 10 12 Clatshell Cove Road 13 6 26 605 Popponesset Road 14 5 18 off Santuit Road conservation land 15 16 32 85 Peppercorn Lane 16 15 7 315 Vineyard Road 17 3 4 42 Bailey Road 18 6 63 312 Pine Ridge Road 19 5 35 72 Cotuit Cove Road 20 5 3 262 Clamshell Cove Road t G:UOBS\ENV\3175I-I.MARCOTUMCotuit-i.xls Page I of 1 3/20/98 Bureau of Waste Site Cleanup Release Traddng Number. IMMEDIATE RESPONSE ACTION (IRA) ❑ TRANSMITTAL FORM Pursuant to 310 CMR 40.0424-40.0427(Subpart o) 9 11904 A. RELEASE OR THREAT OF RELEASE LOCATION: Release Name:(optional) Street 106 Falmouth Road Location Aid: west of Bormdoin_Road cityrrown: Mastipee ZIP Code: 02649 ❑ Check here if a Tier Cl Nitasa lcation Submittal has been provided to DEP for this Release Tracking Number. Check here ff tide loeatlon is Adequately Regulated,pursuant to 310 CMR 40.01104114. Specify Program:❑ CERCLA ❑ HSWA Corrective Action ❑ Solid Wade Management ❑ RCRA State Program(21 C Fad6ties) Related Release Tracdng Numbers That This IRA Addresses: B.THIS FORM IS BEING USED TO: (check all that apply) Submit as IRA Plan(complete Sections A.8,C,0,E,H.I.J and Iq. } ❑ Check here if this IRA Plan Is an update or modification of a previously approved written IRA Plan. Date Submitted: ❑ submit an hrrr'rw. Hazard Evaluation(complete Sekdions A.B,C,F,H,I.J and lq. ❑ SubrNt an IRA Status Report(complete Section A,B,C,E,H,1,J and Iq. . ; ❑ Submit a Request to TOW and@ an Active RarredW System and/or Temrinate a Continuing Response Action(s)Taken to Address an t Immino t Hazard(complete Sections A,S.C.D,E,H,I,J and Iq. ❑ Submit an IRA CompWton Statement(complete Sections A,B,C,D,E.G,H,I,J and Iq. You mast attach all supporting docurnentallon required for each use of torn indicated,including copies of any Legal Notices and Notices to PuWk OHkfals required by 310 CMR 40.1400. C. RELEASE OR THREAT OF RELEASE CONDITIONS THAT WARRANT IRA: Identify Media and Receptors Affected: (cheek ali that apply) ❑ Air J] Groundwater ❑ Surface Water ❑ Sediment ❑ Sod ❑ Wetland ❑ Storm Drain ❑ Paved Surface ❑ Private Well ❑ Pubic Water Supply - ❑ Zone 2 ❑ Residem, ❑ Scholl ❑ Unknown ❑ Other Speer. identity Conditions That Require IRA,Pursuant to 310 CMR 40.0412: (check all that apply) ❑ 2 Hsu Reporting Condition(s) ❑ 72 Hour Reporting Conditions) ❑ Subetafdd Release Migration ® Other Condition(s) Describe: while very nnI i 1rp1 y,`theirp is a Rotential for aronndnra _ r to mi aratca beneath a nnrt i nn if catui t Identify Offs and Hazardous Materials Released: (check all that apply) ❑ oils ® Chlorinated solvent ❑ Heavy Metals ❑ others spew. s D. DESCRIPTION OF RESPONSE ACTIONS: (check all that apply) Assessment and/or Mordtoring Only , ❑ .Deployment of Absorbent or Cafthlfrlefnt Ma Kitt, ❑ ❑ , Exkcavatlon of Contaminated Soib `Teriiporary Cavern or Caps ❑ Re-use,Reeykdirrg or Treatment k ❑ Bioremed don 0 On Site (D Off Site Est.Vol.: cubic yards Q Sail Vapor Extraction r. Describe: , r, ❑ Structure Venting system ❑ Store O On Site O Off Site Est.Vol.: cubic yards ❑ Product or NAPL Recovery ❑ landfill O Cover O Disposal Est.Vol.: cubic yards ❑ Groundwater Treatment Systems Removal of Drums,Tanks or Containers Air Sparging Describe: ❑ Temporary Water Supplies o r SECTION D IS CONTINUED ON THE NEXT PAGE. Revised 2r24195 Supersedes Forms SWSCr0051 006, 010(►n part)and 011 Page 1 of 3 Do Not Alter This Form i Massachusetts Department of Environmental Protection BWSC-105 Bureau of Waste Site Cleanup Release Tracking Number IMMEDIATE RESPONSE ACTION (IRA) _ TRANSMITTAL FORM Pursuant to 310 CMR 40.0424-40.0427(Subpart D) 11904 H. LSP Opinion(continued): I am aware that significant penalties may result,Including,but not limited to,possible fines and Imprisonment,If I submit Information which I(know to be false, Inaccurate or materially incomplete. Check here If the Response Action(s)on which this opinion Is based,if any,are(were)subject to any order(s),permlt(s)and/or approvals)Issued by DEP or EPA. If the box is checked,you MUST attach a statement identifying the applicable provisions th V4� LSP Name: Michael A. Paiders LSP#: 3436 Stamp: ��N OF Telephone: (401) 421-4140 Ext.: 3404 9AIC FAX:(optlonal (401) 751-8613 P S rn 36 v Signature: F /g Date: 20, 1998 SiIE PRO SS I. PERSON UNDERTAKING IRA: Name of Organization: ThdUas & mitts Coraoration Name of Contact: William 0. Frigon Tide: Oorp. Hanaaer. EW41 ra®mental Street: 452 John Dietsch Boulevard Health & Safety CltylTown: Attl ebo_m Fa71 g state: HA zip.code: 02763 Telephone: (508) 699-7646 Ext.: FAX(optional) (508) 695-7010 Check here If there has been a change in the person undertaking the IRA. J. RELATIONSHIP TO RELEASE OR THREAT OF RELEASE OF PERSON UNDERTAKING IRA: (check one) ® RP or PRP Specify. J) Owner Q Operator Q Generator Q Transporter Other RP or PRP: Fiduciary,Secured Lender or Municipality with Exempt Status(as defined by M.G.L.c.21 E.s.2) Agency or Public Utility on a Right of Way(as defined by M.G.L.c.21 E,s.50)) Any Other Person Undertaking IRA Specify Relationship: K. CERTIFICATION OF PERSON UNDERTAKING IRA: I, William 0. FriQan ,attest under the pains and penalties of perjury(l that I have personally examined and am familiar with the information contained In this submittal,Including any and all documents accompanying this transmittal form,(ti)that,based on my inquiry of those individuals Immediately responsible for obtaining the information,the material Information contained in this submittal Is,to the best of my knowledge and belief,true,accurate and complete,and(lit that I am fully authorized to make this attestation on behalf of the entity legally responsible for this submittal. 1/the persoS7 entity on whose behalf this submittal is made arn/is aware that there are significant penalties,including,but not limited to, possible fines and i nment, Ilfully submitting false,inaccurate,or Incomplete information. air Title: QWP. Manager. E[iyiraln ental Ogre) Health & Safety For Thomas & Betts CorPoration Date: Harch•20; 1998 (print name of person or entity recorded in Section l Enter address of the person providing certification,N different from address recorded in Section I: Street: Clty/Town: State: ZIP Code: Telephone: Ext.: FAX(optional YOU MUST COMPLETE ALL RELEVANT SECTIONS OF THIS FORM OR DEP MAY RETURN THE DOCUMENT AS INCOMPLETE. IF YOU SUBMIT AN INCOMPLETE FORM,YOU MAY BE PENALIZED FOR MISSING A REQUIRED DEADLINE. Revised 2/24195 Supersedes Forms BWSC-005, 006, 010(in part)and 011 Page 3 of 3 Do Not Alter This Form COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION SOUTHEAST REGIONAL OFFICE n ARGEO PAUL CELLUCCI TRUDY CORE Governor \ i 1 Il { i 'f Secretary DAVID B. STRUHS 10 Commissioner C(D March 26, 1998 Mr. William Frigon RE: MASHPEE=-W.SC/SMP 4-11904 Thomas and Betts Corporation 106 Falmouth Road = 452 John Dietsch Boulevard IMMEDIATE RESPONSE ACTION Post Office Box 2510 PLAN APPROVAL Attleboro Falls, Massachusetts 02763 MGL c . 21E & 310 CMR 40 . 0000 Dear Mr. Frigon The Department of Environmental Protection, Bureau of Waste Site Cleanup (the Department) , received and verbally approved an Immediate Response Action (IRA) Plan on March 23 , 1998, for the above-referenced disposal site. The IRA Plan was submitted by GZA GeoEnvironmental, Inc . .(GZA) •on behalf of Thomas and Betts Corporation (T&B) Recent information presented to .the Department indicates that fresh groundwater exists below the portion of Shoestring Bay near where the contaminated groundwater is located. This fresh groundwater may provide a pathway for the contaminated groundwater in the plume migrating from south of the Augat Facility to beneath Cotuit . As a result, an IRA Plan was discussed and proposed during meetings at the Department' s Southeast Regional Office in Lakeville on February 6, 1998 and February 27, 1998 . A written submittal was requested by the Department at the February 27, 1998 meeting. The IRA Plan proposes the sampling^of 20 residential wells in Cotuit . The potential exists for these wells to be impacted with contaminated groundwater from the Site if it passes beneath Shoestring Bay. Sample locations are based on identified groundwater flow paths and topographic features in Cotuit . Sampling is contingent upon homeowners' availability and approval . Each homeowner will be provided a copy of the Certificate of Analysis and a letter providing a description of the laboratory' s analysis of the sample collected from their well . As stated in the Thomas and Betts Corporation letter to individual homeowners, dated March 20, 1998 , if data suggests any need for concern orfollowup, the homeowner will be -immediately contacted. A final report will be provided to the DEP, local officials and homeowners on or before April 10, 1998 . 20 Riverside Drive • Lakeville, Massachusetts 02347 9 FAX(508) 947-6557 0 Telephone (508) 946-2700 " ' -2- In addition, Thomas and Betts has proposed to conduct additional tasks to better delineate the discharge location of site-related volatile organic compounds as part of the work conducted to support the review of the Class C (temporary) Response Action Outcome. The Department hereby approves the .IRA.plan ,with thefollowing conditions/modifications : 1 . A detailed plan for any proposed additional studies to better delineate the discharge location of site-related volatile organic compounds must be submitted to the Department within 30 days of the final report due date (April 10, 1998) If you have any questions, please contact, Mark Wood at the letterhead address or at (508) 946-2874 . All future communications regarding this site must reference the site number: 4-11904 . Sigcely, erard M.R. Martin, Chief Site Management & Permits Section M/MW/cb CERTIFIED MAIL NO. Z 333 584 123 RETURN RECEIPT REQUESTED CC : Barnstable Board of Health Post Office Box 534 Hyannis, MA '02601 ATTN: Thomas A. McKean, Chairman Barnstable Board of Selectmen 367 Main Street Barnstable, MA 02601 ATTN: William Rutherford, Chairman Mashpee Board of Health 16 Great Neck Road North Mashpee, MA 02649 ATTN: Mr. Elias McQuaid, Chairperson Mashpee, Board of Selectmen _ Post Office Box 1108 16 Great Neck Road Mashpee, MA 02649 ATTN: Ms . Judith Mills, Chairperson 1_ -3- cc : Mashpee Water District 108 Cape Drive Mashpee, MA 02649-3077 ATTN: Mr. Dave Rich GZA GeoEnvironmental, Inc. f 140 Broadway i Providence, RI 02903 ATTN: Mr. Michael Powers, John C. and Ramuta H. Bacon 750 Santuit Road Cotuit, MA 02635 John T. and Gladys E. McCubbin 206 Thornton Court Palm Beach Garden, FL 33418 John Sedlack, Tr. 243 Westbourne Street La Jolla, CA 92037 Enid B . Zimbler Post Office Box 2007 Cotuit, MA 02635 Robert E. and Regina G. Flynn 30 Lincoln Road Wellesley, MA 02181 Beth F. McParland 220 Boylston Street, #9018 Boston, MA 02116 Kathleen C. France 20 Bogart Court Princeton, NJ 08540 Gregg and Roberta M. Ribatt 84 Eldredge Street Newton, MA 02158 Margaret H. Lloyd 524 E. 72nd Street, Apt . 28B New York, NY 10021 David G. Mugar f 222 Berkley Street Boston, MA 02116 l s r, r • �fil _ -4- cc : Benjamin H. Heckscher, Trs . Maurice Heckscher, II, Trs . John H. Heckscher, Trs . 5 Guernsey Road Swarthmore, PA 19081 Richard A. Kraus and Patricia G. Fiero 12 Clamshell Cove Road Cotuit, MA 02635 Carl and Bettina S. Sonderegger 605 Popponesset Road Cotuit, MA 02635 Town of Barnstable Conservation Commission Town Offices 367 Main Street' Hyannis, MA 02601 ATTN: Rob Gatewood Paul A. and Maureen K. Tempests Post Office Box 452 Cotuit, MA 02635 Amnon and Prudence Rosenthal 2105 Devonshire Road Ann Arbor, MI 48104 Wingate and Janet W. Lloyd 4.500 Cathedral Avenue, NW Washington, DC 20016 Jennifer J. .Lempke and Robert C. Livingston Post Office Box 424 Cotuit, MA 02635 E.T. and R.A. Martin et . al . , Trs . 2750 Gulf Shore Boulevard, N. , Ste. 602 Naples, FL 33940 Frances M. Tallman 262 Clamshell Cove Road Cotuit, MA 02635 Cotuit=Santuit Civic Association Post Office Box 121 Cotuit, MA 02635 ATTN: Richard G. Barry, President SCC Coalition C/o Mr. Christopher Tufts , 76 Sampson' s Mill Road Mashpee, MA 02649 -5- cc : Mashpee Environmental Coalition Post Office Box 274 Mashpee, MA 02649 ATTN: Mr. Charles Costello Maslipee Public Library Post Office Box 657 Mashpee, MA 02649 ATTN: Augat. Information Repository DEP-SERO-Operations ATTN: Kevin Kiernan, Assistant Regional Counsel DEP-SERO ATTN: Liz Kouloheras, Chief, Cape Cod Watershed DEP-SERO-Data Entry,; i l w �y, -- -- _ — ,fly — COTUIT WEL L SAMPLING AREA 9 ° ruwan�FtYtr ` 4moaPiind/ t' `coo ij l: M .} t Former Angat Pl10 ant I 28. ° ;x. tRi Ro 1d,m \ 1P1411 3 I v : ;.a.CpOSt FN ME_ T R D0 'y' {•1 �c 1 }. °� �1 Dwell Pack= ;y�^jd ,� Nit core �'_._ tT�...__. m 7 -"•--'..c / r m r Y WI Uq-`•9G ` a�} .t'a!`�•i j OVEN l ( Area of Contaminated Groundwater �o s vor�}>so cy �N m y fiy Ptar` �r4t�' P int Tree Comer ,y Stms W►fi LowtsPond \� o 9=. 5 voRT+OLE �.. I Sl�PSXCAOR ° e o t o �... \ ,3J4� }it y OP,� ✓� �T.- ig} 28 eDB ECRES Z `A'p0 t - .- , t'-.ix.�a ytt L�y�� pa 4 �'�.•��'! 1 -1 ` �- 7�t� CFIEQ1r+0 1. iFd Resrdenhal Well Targeted for Sampling by TBcB(typ.) s\..' y �ueERlt�! 'Ro R''TP€E_rta ' Oww F;D \� ' �X \° � r ; otwt �hlands t%.r S Istetid oath suvRvN�\ 9l iF ns Island v+ �o w sN rK}� ., f / o d Northeast Boundary of VoluataryTesttng]?rogramv , iR0A.P0MCLOSE. ''Q t ` .•�-.._.' t?,\4 s7 4, fi t a5tii1• 1 ,�"�"^\ S m aT ker Neck" r i�r Yrr �k*`� > Y� 4§" r 'y 1 ' it 7 ' 1 r. ash Neck I Ptyopilokret Ru Alm�rP k, a ( R fh � 4 �� .3*tputEs ear wa a: Pee v\ i k ti i r I r ,� ti 0. i 7 �y tU'U •> { �. �s Y ,E4� •` ' o, � � Al' 4 .. 'r .a�-.: � r�?*r � N b\�f�'�ie,,C jH�°1,���af c��.�'�, t "'TG��`T,j,ti y�4 Rp,,,�OW�d Pinto I 1 e/'�-"" t f r 5 d l s CIO r�' @' Goo9ellenYls�ndV. r �}[ J k l2. ''•�1 t.�3 d '.�r Mk °r ,� PLAaD!gRN POIM ' x2fV'�C y -i°.. ' -x ywR`w"'G`w"1•�'1''}t r'�. 1 7( ,'' u1 r-. t i. r� _J C�Atit•Y VIa J•d t�' 7'�r y 5-yz +=� ,� .tr �h Y5.1 Wro �Sr, c �ca:'•c_ Y�r�: J wins a Hill rya g i _. �. \o_r �.- � �' �y� � •x � 7i �.rlr , �. t �x�k Ctir`i�\C-syr,.�'�iz }' \ ._.. GPrT�_. \.gY C~ .•,;3 r �',� -_ �. J (� - r S Ji '¢ l �,..,iy.,r-2e• �t ,.��. 5 1r ____t>�l sw�f'` ', , I m zf f dvleado4l!'Orta�� ^ s� i c ��•�k r��tt�4',� t �, 3 01 �Poc /knett NecJc c r t AnnsCo,e` T}12tChfstand {° .'( , �E a ac Y= > aPoppeaesset dad Smdnary a y ; w 1 � 1 wnTF_Rwar .'" ........'_._-. 'South Mas +? �• /+°'• � -f T?196Ch Islald d , ;tt i- t -r i 1 r r n l > c ` ,........ ti , r - 7 i5 !,+•u N'S ^* gar r iK \ �._i J F' tti, r t 7 ?n"L •i"r, _ \ O/ (y \q�1 s Y SF,�''i i .t ,�� J.x�,�S 7 f t[rt l�, f-��, k- �Y' •c'^�t,=_2 .r- i ,� �•:� '��t/ / yr. S Y� x x ra r 7"'�?c, iy t � ttc ct r ®1996 Delorme Street Atlas USA b_ � G end Bill Frigon (508)699-9946' Manager,Corporate Fax:(508)643-3761 Environmental Health&Safety billfrigon/chq/augat®augat Thomas&Betts Corporation 8155 TO Boulevard _ Memphis,TN 38125 (901)252-5000 WWW.TNB.com Thomes O.Reffs r . 777 . . r Z1 05 COMMONWEALTH OF MASSACHUSETTS ,, EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS ,'U ,yJ 31 DEPARTMENT OF ENVIRONMENTAL PROTECTION d SAP 00 (0---� , -C: �°"w7) -ARcCEt �M s�. ���- • -�- JAN 1 8 2005 TOWN 01-Br^ TITLE 5 HEM:`7H F)FQ- OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 750 SANTUIT ROAD COTUIT,MA 02635 Owner's Name: MR JOHN C.BACON Owner's Address: 750 SANTUIT ROAD COTUIT,MA 02635 Date of Inspection: 12/17/04 Name of Inspector: (please print) JOHN GRACI,INC. Company Name: SEPTIC INSPECTIONS Mailing Address: P.O. BOX 2119 TEATICKET,MA.02536 Telephone Number: 508-564-6813 FAX 508-564-7270 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of ' le 5(310 CMR 15.000). The system: X Passes _ Condition asses Needs Fu r valuation by the Local Approving Authority Fails Inspector's Signature: Date: 12/17/04 The system inspector shall submit copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspect n. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable,-and the approving authority. Notes and Comments SYSTEM PASSED TITLE V INSPECTION. RECOMMEND PUMPING EVERY ONE TO TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. RECOMMEND RAISING COVER TO D-BOX AND LEACH FIELD-RECOMMEND KEEPING BUSHES OFF D-BOX. ****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. Title 5 IncnPrtinn Fnrm A/1 V?000 1 Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 750 SANTUIT ROAD COTUIT,MA 02635 Owner: MR JOHN C.BACON Date of Inspection: 12/17/04 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: X I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: SYSTEM PASSED TITLE V INSPECTION.RECOMMEND PUMPING EVERY ONE TO TWO YEARS TO PROLONG THE SYSTEMS USEFUL LIFE.RECOMMEND RAISING COVER TO D-BOX AND LEACH FIELD- RECOMMEND KEEPING BUSHES OFF D-BOX. 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. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined"please explain. n/a The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: n/a n/a Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): _ broken pipe(s)are replaced _ obstruction is removed _ distribution box is leveled or replaced ND explain: n/a n/a The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): _broken pipe(s)are replaced _obstruction is removed ND explain: n/a Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM, PART A CERTIFICATION(continued) Property Address: 750 SANTUIT ROAD COTUIT,MA 02635 Owner: MR JOHN C.BACON Date of Inspection: 12/17/04 C. Further Evaluation is Required by the Board of Health: _ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 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 n/a "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: n/a Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 750 SANTUIT ROAD COTUIT,MA 02635 Owner: MR JOHN C. BACON Date of Inspection: 12/17/04 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all-inspections: Yes No X _ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in cesspool is less than 6"below invert or available volume is less than'/Z day flow X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped NOT IN THE LAST YEAR PER OWNER. X Any portion of the SAS,cesspool or privy is below high ground water elevation. X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone 1 of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well. X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that.no other failure criteria are triggered.A copy of the analysis must be attached to this form.] NO (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. d Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 750 SANTUIT ROAD COTUIT,MA 02635 Owner: MR JOHN C.BACON Date of Inspection: 12/17/04 Check if the following have been done.You must indicate"yes" or"no"as to each of the following: Yes No X _ Pumping information was provided by the owner,occupant,or Board of Health X Were any of the system components pumped out in the previous two weeks? X _ Has the system received normal flows in the previous two week period? X Have large volumes of water been introduced to the system recently or as part of this inspection? X _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up? X _ Was the site inspected for signs of break out X _ Were all system components,excluding the SAS, located on site? X _ Were the septic tank 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? X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no X _ Existing information.For example,a plan at the Board of Health. X _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] 5 . Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 750 SANTUIT ROAD COTUIT,MA 02635 Owner: MR JOHN C.BACON Date of Inspection: 12/17/04 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 5 Number of bedrooms(actual): 5 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550 Number of current residents:2 Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no): NO Seasonal use:(yes or no): NO Water meter readings, if available(last 2 years usage(gpd)):is Sump pump(yes or no): NO Last date of occupancy: n/a U( ] -1 010d) COMMERCIALANDUSTRIAL Type of establishment: n/a Design flow(based on 310 CMR 15.203): n/agpd Basis of design flow(seats/persons/sgft,etc.): n/a Grease trap present(yes or no): NO Industrial waste holding tank present(yes or no): NO Non-sanitary waste discharged to the Title 5 system(yes or no): NO Water meter readings,if available: n/a Last date of occupancy/use: n/a OTHER(describe): n/a GENERAL INFORMATION Pumping Records Source of information: NOT IN THE LAST YEAR PER OWNER Was system pumped as part of the inspection(yes or no): NO If yes,volume pumped: n/agallons--How was quantity pumped determined? n/a Reason for pumping: n/a TYPE OF SYSTEM X Septic tank,distribution box,soil 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) _Tight tank Attach a copy of the DEP approval Other(describe): n/a Approximate age of all components,date installed(if known)and source of information: 1974,FIELDS 1984 PER ASBUILT Were sewage odors detected when arriving at the site(yes or no): NO Page.?of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 750 SANTUIT ROAD COTUIT,MA 02635 Owner: MR JOHN C.BACON Date of Inspection: 12/17/04 BUILDING SEWER(locate on site plan) Depth below grade: 14" Materials of construction:_cast iron X40 PVC_other(explain): n/a Distance from private water supply well or suction line: n/a Comments(on condition of joints,venting,evidence of leakage,etc.): WELL WATER-150+FT.AWAY SEPTIC TANK: X(locate on site plan) Depth below grade: 8" Material of construction: Xconcrete_metal_fiberglass—polyethylene other(explain)n/a If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) Dimensions: L 10' 6" H 5' 7" W 4' 10"" Sludge depth:2" Distance from top of sludge to bottom of outlet tee or baffle:32" Scum thickness: 1" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 17" How were dimensions determined: MEASURED Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY. RECOMMEND PUMPING EVERY ONE TO TWO YEARS TO PROLONG THE SYSTEMS USEFUL LIFE. GREASE TRAP: _(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle: n/a Date of last pumping: n/a Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): n/a i 7 Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 750 SANTUIT ROAD COTUIT,MA 02635 Owner: MR JOHN C.BACON Date of Inspection: 12/17/04 . TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Capacity: n/a gallons Design Flow: n/a gallons/day Alarm present(yes or no): N/A Alarm level:N/A Alarm in working order(yes or no): NO Date of last pumping: n/a Comments(condition of alarm and float switches,etc.): n/a DISTRIBUTION BOX:X(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: LEVEL WITH BOTTOM OF PIPE Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): D-BOX IS STRUCTURALLY SOUND.RECOMMEND RAISING COVER AND KEEPING BUSHES OFF D-BOX TO PREVENT ROOT DAMAGE. PUMP CHAMBER:-(locate on site plan) Pumps in working order(yes or no): NO Alarms in working order(yes or no):NO Comments(note condition of pump chamber,condition of pumps and appurtenances,etc,): n/a R Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 750 SANTUIT ROAD COTUIT,MA 02635 Owner: MR JOHN C.BACON Date of Inspection: 12/17/04 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: n/a Type n/a leaching pits, number: n/a FLOW DIFFUSERS leaching chambers, number: 3 n/a leaching galleries, number: n/a n/a leaching trenches, number, length: n/a 1 leaching fields, number: LEACH FIELD n/a overflow cesspool, number: n/a n/a innovative/alternative system Type/name of technology: n/a Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.): THE LEACH FIELDS SHOWED NO SIGNS OF FAIULRE AT THE TIME OF THE INSPECTION-FIELD PROBED DRY-RECOMMEND RAISING COVER TO FLOW DIFFUSERS.BOTTOM APPROXIMATELY AT 5' 8" CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: n/a Depth—top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer: n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater inflow(yes or no):NO Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): n/a PRIVY: (locate on site plan) Materials of construction: n/a Dimensions: n/a Depth of solids: n/a Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a 9 Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 750 SANTUIT ROAD COTUIT,MA 02635 Owner: MR JOHN C.BACON Date of Inspection: 12/17/04 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. m w,ell t5� g RT rDe�l� 6 A B P Ac y� aA 3 C� 30 Qp S6 . pE �$ in Page 11 of 11 .a OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 750 SANTUIT ROAD COTUIT,MA 02635 Owner: MR JOHN C.BACON Date of Inspection: 12/17/04 SITE EXAM _Slope _Surface water _Check cellar Shallow wells Estimated depth to ground water 8+feet Please indicate(check)all methods used to determine the high ground water elevation: NO Obtained from system design plans on record-If checked,date of design plan reviewed: n/a YES Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain: n/a NO Checked with local excavators,installers-(attach documentation) NO Accessed USGS database-explain: n/a You must describe how you established the high ground water elevation: GROUNDWATER DETERMINED BY HAND AUGER NO WATER AT-8 FT. 11 BROUGHT TO WITHIN 6" OF FINAL GRADE SEPTIC SYSTEM PROFILE COVERS TO BE WATERTIGHT AND EL. 0. FOUNDATION Flaherty Environmental Services ;IT11 EL. 50.0' EL. 48.0' (not to scale) y • INSP. PORT W I 3" OF GRADE P. O. Box 339 r 11 GEOTEXTILE �.� PROP.EL.s1.0'f CLEAN MEDIUM SAND Harw%Ch, MA 02645 t �+ 4" CAST IRON or EQUIVALENT 4" SCHEDULE 40 PVC PIPE FILTER FABRIC ;j 5o.w MIN. PITCH 1 4" PER FOOT fOVER ENTIRE FIELD 774.994.1166 �•;� ,, PIPE a"SCHEDULE 40 PVC 2" SCHEDULE 40 PVC PIPE FLOW LINE E�r VENT IF REQUIRED „ Mr t210 be level) • '" THE PROPERTY'S LOCATION APPEARS DB-5 � —#` TO BE WITHIN 300'OF A TIDAL WATERBODY �.' L.EXISTING —► {{ EL. 50.0'f FULL AD7U5 MENT USED REGARDLESS. EL.EXISTING ► I r :}r`«iti ''vi'!%y:}:':r:a•"..... ;t• �;' +: ...: : ..._:a.; +:n c•;` ,. WELL- MIW-29 ,!.. .I.`...r �;�.• 'v •,a..It•r;el,. y.'r.;n:a'M,t"i..x,�¢"� 4s:• ";Y .9:: .":,..:1'r.'.rr.�i :i^o __5 EL.48.9' ZONE- A c EL.49.03' —�— 0.05%SLOPE —i► READING- 8.49' AS BAFFLE DATE- AUGUST 2018 ' EL.49.0' SOIL ABSORPTION SYSTEM ADJ.- 1.9' SEE PUMP CHAMBER w (5) LATERALS OF SCH 40 PERFORATED PVC PIPE REQUIRED:A REMOVAL OF UNSUITABLE j DETAIL PAGE 2 .. WITH 6"STONE BENEATH IN A 20.0 X 38,0 ^•S" e;,,,,:•� '. 6 CRUSHED STONE OR ` NSTALL INLET TEE I ► 5.0 MATERIAL BENEATH THE PROPOSED SAS MECHANICALLY COMPACTED'`Z"�+BOVE OUTLET INVERT DOWN TO EL.45.St(31^) 1000 GALLONS ANK FIELD FORMATION (SEE DETAIL PAGE 2) �EL.(DATUM: ASSUMED) EXISTING 43 9' BOTTOM OF TEST HOLE#1 EL. 38.0' USGS ADJUSTMENT: 1.9' OBSERVED GROUNDWATER ELEV: 42.0' LOCATIONMAP SANTUI� N TH School St. 91 �pd 48 BENCHMARK: \ SHOESTRING ® I TOP 0, ' // URI A� \ + BAY \ EL.50.0' C� \ � � popponesseK Rd-' . nA �_ LOT 53 d. ' 39.1' \ _ / 0.96 ACRES* �\ EXIST, SAS 1 LOCUS \ (APPROX.) 1 GARAGE \ 4 \\\ 0.3' EXISTING5 BR 1 NTS \ -2 DECK DWELLING \\` "OF DAVI \ 0 SWIMMING POOL • D \\ - (APPROX.) - F E I \ 5' REMO L EXIST. 1000 GST 0. 1 150' TO WETLAND \\\\ 00� G/STEREO \\ SHED 2 S'4NFTARI'PN- \ \\ DATE.'911 912 0 18 R VISED: / 48. SITE & SEPTIC PLAN FOR B & B EXCAVATION, INC./ 47 JOHN BACON 750 SANTUIT ROAD BARNSTABLE (COTUIT), MA SCALE : 1 " 40' REP PS22PG23 Pa e I of 2 ............................................................ .. ................... ........................ ... ........................ .............. ................ .................................................................. ...... .......... ............................................................. ...... .............................................................................................................................. ................................................................................................. ...................................................................... ........... ............................................................................... GENERAL NOTES CALCULATIONS DESIGN SAS DETAIL Flaherty ly En wronmen tal Services • P. 0- Box 81 20.0 1, ALL PRECAST COMPONENTS TO BE H-1 0 Yarmouth Port, MA 02675 RATED. ALL COMPONENTS WITH ANY NUMBER OFACTUAL BEDROOMS 5 ANTICIPATED VEHICULAR TRAFFIC TO BE 2.00 774.994.1166 H-20 RATED. GARBAGE DISPOSAL UNIT NO 4,00 4' SCH 40 PERFORATED PVC -- 2. THE DESIGN OF THIS SYSTEM DOES NOT T SET IN A BED CONFIGURATION �T ALLOW FOR THE USE OFA GARBAGE TOTAL ESTIMATED FLOW 4.00 --- 38.0' AND SPACED AS SHOWN GRINDER. (110 GALIBRIVA YX 5 BR) 550 GAL./DAY 3. MUNICIPAL WATER IS AVAILABLE, 4,00 -7-7 4. ALL CONSTRUCTION TO CONFORM WITH REQUIRED SEPTIC TANK CAPACITY 1100 GAL. 4.00 310 CMR 15.000 AND ALL OTHER 2 00 1.J 4' SCH 40 PERFORATED PVC (STANDARD) . APPLICABLE LOCAL, STATE AND FEDERAL SIZE OF SEPTIC TANK 1000 GAL. (EXISTING) CODES AND REGULATIONS. SET ON 6' OF 3/4' TO 1 1/2' DOUBLE WASHED STONE (ADDN. CAPACITY IN 5, INSTALLER/CONTRACTOR TO REVIEW& SOIL CLASSIFICATION VERIFY ALL ELEVATIONS AND DETAILS AND REPORT ANY DISCREPANCIES TO DESIGN PERCOLATION RATE <5 MINAINCH DESIGNER PRIOR TO CONSTRUCTION OR ASSUME ALL RESPONSIBILITY. EFFLUENT LOADINGRATE 0.74 GAL./DAY/FTC ALARM AND CONTROL PANEL 6. INSTALLER/CONTRACTOR 15 TO BE INSTALLED INSIDE RESPONSIBLE FOR MAINTAINING SAFE LEACHING AREA BUILDING. ALARM TO BE ON WORK AREA, VERIFYING ALL UTILITIES 20'X 38'LEACHING BED SEPARATE CIRCUIT FROM PUMP AND NOTIFYING "DIG SAFE" (20'x 38)x 0.74 562 GAL./DAY (1-888-344-7233) 72 HOURS PRIOR TO - CONSTRUCTION. USE(5)LATERALS COMPRISED Z ANY CHANGES TO OR DEVIATIONS FROM OF SCH 40 PERF PVC PIPE 98.0 THIS PLAN MUST BE APPROVED IN WITH 6"STONE BENEATH WRITING BY FLAHERTY ENVIRONMENTAL (SEE DETAIL TO RIGHT) SERVICES AND LOCAL BOARD OF INV. IN 4 2" PRESS HEALTH. RESERVE LEACHING CAPACITY NIA GA LADA Y 1000 GAL. H-10 P/ 8. FINISH COVER OVER COMPONENTS IS 550 GAL.+ SLOPE TO DRAIN BACK TO PC ALARM ON NOT TO EXCEED YPER 310 CMR 15.000 FLOAT SWITCH RESERVE WEEP HOLE UNLESS SHOWN PER PLAN SETTINGS: PUMP ON CHECK VALVE 5.3" WORKING RANGE 9. ALL ABANDONED SEPTIC SYSTEM '3. COMPONENTS TO BE PUMPED DRY AND 5 SUBMERSIBLE 4 10 HP PUMP PUMP OFF 12' SYSTEM (OR EQUAL) FILLED WITH CLEAN SAND OR REMOVED (NTS) AND REPLACED WITH CLEAN SAND. 0.5'CRUSHED STONE OR 10.ALL COMPONENTS TO BE PROVIDED MECHANICAL COMPACTION WITH WATERTIGHT ACCESS PORTS SOIL EVAL UA TION WITHIN 6"OF FINISH GRADE. PUMP CHAMBER 11.ALL SEPTIC TANKS, DISTRIBUTION TESTHOLE#1 P#15775 TESTHOLE#2 PW 15775 (NOT TO SCALE) BOXES AND PIPING TO BE INSTALLED Evaluator. David D.Flaherty Jr.,RS,REHS Evaluator. David D.Flaherty Jr.,RS,REHS WATERPROOF WATERTIGHT. SE 2755 SE 2755 12.NO KNOWN WETLANDS OR WELLS BOH Witness Don Desmarais,RS BOH Witness: Don Desmarais,RS WITHIN 150 FEET OF PROPOSED Date. September 17,2018 Date. September 17,2018 OF LEACHING. Test Hole#1 El.=48.0' Test Hole#2 El.=48.0' 13.THIS IS NOT A CERTIFIED PLOT PLAN 11 cerffily that on November 12,2002 have passed the examination approved by the Department of AND UNDER NO CIRCUMSTANCES IS THIS Environmental Protection and that the above analysis 0.-9. 0. PLAN TO BE USED FOR ZONING OR FILL -9. FILL has been performed by me consistent with the F BUILDING PURPOSES. 9. required training expertise and experience described 15" AIE LS IOYR212 9'-15' AvE LS IOYR212 in 310 CMR 15.018(2). 14.LOT IS SHOWN AS ASSESSOR'S MAP 6 PARCEL 48. - TE 15"-31" B LS IOYR516 15%31" B LS IOYR516 15. LOCUS PROPERTY IS NOT LOCATED IN N i AN AQUIFER PROTECTION DICTRICT (ZONE 11). PERC GW 72' 16. CONTRACTOR TO DETERMINE GW 72" SITE A SEPTIC PLAN FOR FEASIBILITY AND CAPACITY TO 31'-120" C FMS 2.5Y 616 31'-120- C FMS 2.5Y 616 13 & B EXCAVATION, INC./ ACCOMMODATE ADDITIONAL ELECTRICAL ADJ. GW1 ADJ. GW1 CAPACITY FOR PUMPS PRIOR TO --------------------EL. 43.9' --------------------- EL. 43.9' JOHN-BACON INSTALLATION. 750 SANTUZT ROAD GROUND WATER V GROUND WATER BARNSTABLE (COTUIT), MA OBSERVED ATElev.=42.01 OBSERVED ATElev.=42.0' BOTTOM Elev.- BOTTOM Elev.=38.0, Page 2 of 2 .......................... .............. .................... ................... .................................................... ...................................... ............ .. .................. ....... ................................................................................................................... ........................................................................................................................................................................... ............ �f BROUGHTCOVERS BE TOWITHINRTIGHT AND 6"OF FINAL GRADE SEPTIC SYSTEM PROFILE TOP OF FOUNDATION Flaherty Environments/ Services EL. 50.0' EL. 48.0' (not to scale) INSP. PORT W I 3" OF GRADE P. O, Box 331 GEOTE)MLE PROP.EL.51.0'f CLEAN MEDIUM SAND Harwich, MA 02645 4"CAST IRON or EQUIVALENT 4" SCHEDULE 40.PVC PIPE FILTER FABRIC ! 774.994. 1�66 MIN. PITCH 1 4" PER FOOT OVER ENTIRE FIELD . :; a^SCHEDULE 40 PVC PIPE 2" SCHEDULE 40 PVC PIPE" , ••..•• '••' •: '•. • '• VENT IF REQUIRED FLOW LINE (first Zito be level) EL. 50.0f L.EXISTING -► -">,! :3ibl.v.l.�:•.a.. •.�.'%.�f:!•�Ci',:�, ..�Y, it:w1.L�•'`:.�'L.n�..y...; �.�"•�IL�).�.•h.:i..w.•..'L... , y,.; EL.EXISTIN --�► _� �; ,fit. 5,. .".n:,•.^.:: <i•>::^: :.1' �..•;.= 0.5 EL.48.9' • EL. ------�•^�0.05%SLOPE '-a► '!r'• EL.49.03' ` GAS BAFFLE EL.49.0' SOIL ABSORPTION SYSTEM SEE PUMP CHAMBER (5) LATERALS OF SCH 40 PERFORATED PVC PIPE� 5.0' 'l�S..•...'•�):,•••.•:.� - DETAIL PAGE 2 6"CRUSHED STONE OR NSTALL INLET TEE WITH 6"STONE BENEATH IN A 20.0'.X 38.0' J 1000 GALLON SEPTIC TANK MECHANICALLY COMPACTED` 1"ABOVE OUTLET INVERT FIELD FORMATION (SEE DETAIL PAGE 2) ' (DATUM: ASSUMED) (EXISTING) ` EL. 43.9 e BOTTOM OF TEST HOLE#1 EL. 38.0' USGS ADJUSTMENT: 1.9' OBSERVED GROUNDWATER ELEV: 42. LOCATIONMAP 750 SANTUI T ROADschool 0' St N TH F R�N� BA RNS TA BL E (CO TUI T)., MA SHOESTRING TO B a4Y PoPtmnessett Rd. 1 2 3 4 5 6 EXISTING y9o� / / / / p / p 21 41 6 5 0 2 5 B R LOCUS A 27 22 5" 21'6" � DWELLING B 1 29' 35'3" 41'8" 45'8" 67' 52' DECK NTS 1 �o DAVI cy o D. A " F R 0. 1 4 3 NtTA N ` d DATE.912712018 REVISED: _ AS BUILT PLAN FOR B & B EXCAVATION, INC./ 55 JOHN BACON 750 SANTUIT ROAD BARNSTABLE (COTUIT), MA NOT TO SCALE REF.PB 22 PG 23 Pa e 1 of 2 ................................ ................... .. ......................................................................................................................................................................................................... ................................................ ......................................... ................................................................................................................................................................................................... ............................ ................................. ................. ......... ...... .................... GENERAL NOTES DESIGN CAL CULA TIONS SAS DETAIL Flaherty Environmental Services P. 0. Box8l 1, ALL PRECAST COMPONENTS TO BE H-10 20.0' Yarmouth Pod, MA 02675 RATED. ALL COMPONENTS WITH ANY I -d NUMBER OFACTUAL BEDROOMS 5 2.00 774.994.1166 ANTICIPATED VEHICULAR TRAFFIC TO BE H-20 RATED. GARBAGE DISPOSAL UNIT NO 4.00 4' SCH 40 PERFORATED PVC -- 2. THE DESIGN OF THIS SYSTEM DOES NOT T SET IN A BED CONFIGURATION ALLOW FOR THE USE OFA GARBAGE TOTAL ESTIMATED FLOW . 4,00 --- GRINDER. -- 38,0' AND SPACED AS SHOWN (110 GALIBRIDA YX 5 BR) 550 GAL./DAY 3. MUNICIPAL WATER IS AVAILABLE. 4.00 4. ALL CONSTRUCTION TO CONFORM WITH REQUIRED SEPTIC TANK CAPACITY 1100 GAL. 400 310 CMR 15.000 AND ALL OTHER APPLICABLE LOCAL, STATE AND FEDERAL SIZE OF SEPTIC TANK 1000 GAL. (EXISTING) 2�00 4' SCH 40 PERFORATED PVC (STANDARD) CODES AND REGULATIONS. SET ON 6- OF 3/4' TO 1 1/2' DOUBLE WASHED STONE (ADON. CAPACITY IN P C.) 5. INSTALLERICONTRACTOR TO REVIEW& SOIL CLASSIFICATION VERIFY ALL ELEVATIONS AND DETAILS ri AND REPORT ANY DISCREPANCIES TO DESIGN PERCOLATION RATE <5 MIN./INCH DESIGNER PRIOR TO CONSTRUCTION OR INEW ASSUME ALL RESPONSIBILITY, EFFLUENT LOADING RATE 0.74 GAL./DAY/FTC ALARM AND CONTROL PANEL 6. INSTALLER/CONTRACTOR IS TO BE INSTALLED INSIDE RESPONSIBLE FOR MAINTAINING SAFE LEACHING AREA BUILDING. ALARM TO BE ON WORK AREA, VERIFYING ALL UTILITIES 20'X38'LEACHINGBED SEPARATE CIRCUIT FROM PUMP AND NOTIFYING "DIG SAFE" (20'x 38)x 0.74 562 GAL./DAY (1-888-344-7233) 72 HOURS PRIOR TO CONSTRUCTION. USE(5)LATERALS COMPRISED 7. ANY CHANGES TO OR DEVIATIONS FROM OF SCH 40 PERF PVC PIPE THIS PLAN MUST BE APPROVED IN WITH 6"STONE BENEATH WRITING BY FLAHERTY ENVIRONMENTAL (SEE DETAIL TO RIGHT) SERVICES AND LOCAL BOARD OF INV. IN HEALTH. RESERVE LEACHING CAPACITY r I IMF NIA GAL.IDA Y 1000 GAL. H-10 P PRESS 8. FINISH COVER OVER COMPONENTS IS ALARM ON 550 GAL SLOPE TO DRAM BACK TO PC NOT TO EXCEED 3'PER 310 CMR 15.000 FLOAT SWITCH RESERVE WEEP HOLE UNLESS SHOWN PER PLAN SETTINGS: PUMP ON 9. ALL ABANDONED SEPTIC SYSTEM 5.3" WORKING RANGE CHECK VALVE COMPONENTS TO BE PUMPED DRYAND bd 5.3' SUBMERSIBLE 4 10 HP PUMP FILLED WITH CLEAN SAND OR REMOVED (N PUMP OFF 12' SYSTEML) AND REPLACED WITH CLEAN SAND. TS) 10.ALL COMPONENTS TO BE PROVIDED WITH WATERTIGHT ACCESS PORTS WITHIN 6"OF FINISH GRADE, SOIL EVAL UA TION PUMP CHAMBER 11.ALL SEPTIC TANKS, DISTRIBUTION TESTHOLE#1 P#15775 TEST HOL E#2 FW 15775 (NOT TO SCALE) BOXES AND PIPING TO BE INSTALLED Evaluator David D.Raheffy Jr.,RS,REHS Evaluator. David D,Flake*Jr.,RS,REHS WATERTIGHT SE2755 SE2755 WATERPROOF 12 NO KNOWN WETLANDS OR WELLS BOH Witness: Don Desmarais,Rs BOH W10ess: Don Desmarais,RS WITHIN 150 FEET OF PROPOSED Date. September 17,2018 Data: September 17,2018 LEACHING. Test Hole#1 El.=48.0' Test Hole#2 El. 48.01 j"OF 13.THIS IS NOT A CERTIFIED PLOT PLAN SSq 7 certify that on November 12,2002,l have passed AND UNDER NO CIRCUMSTANCES IS THIS the examination approved by the Department of 0.-9. Environmental Protection and that the above analysis PLAN TO BE USED FOR ZONING OR FILL 01-91 FILL BUILDING PURPOSES. has been performed by me consistent with the 9'-15' AIE LS 1 9--15- AIE LS IOYR212 0 YR 212 required training,expertise,and experience described 14.LOT IS SHOWN AS ASSESSOR'S MAP 6 0 1 In 3N CMR 15.018(2). PARCEL 48. 15. LOCUS PROPERTY IS NOT LOCATED IN 15"-31' B LS 10YR 516 15'-31- B LS IOYR516 AN AQUIFER PROTECTION DICTRICT 4NI Rk (ZONE 11). 1777 [!:L/Z PERC 16 CONTRACTOR TO DETERMINE GW.'72" GW.•72, FEASIBILITY AND CAPACITY TO AS BUILT PLAN FOR 31'-120, C FMS 2.5Y616 31'-120, C FMS B & 8 EXCAVATION, INC./ ACCOMMODATE ADDITIONAL ELECTRICAL ADJ. GW1 ADJ. GWi CAPACITY FOR PUMPS PRIOR TO --------------------- EL, 43.9' ------------------- EL. 43.9' JOHN BACON INSTALLATION. 750 SANTUZT ROAD GROUND WATER GROUNDIWATER OBSERVED A T Eley. 42.0T OBSER ATElev.=42.01 z- BARNSTABLE (COTUZT), MA BOTTOMElay.=38.0, BOTTOM Elev.=38.01 Page 2 of 2 ................................................................................ ................................. .................................... .. ............. .......... ......................................................................................................................... ......................................................... .............................................................................................................................................................................................................................. ............ ------------ ............... ........... ... ...... . .......................