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HomeMy WebLinkAbout0015 BOG ROAD - Health 15 BOGJRUP- MARSTONS MILLS A = 045 012 001 J \ . ENVIROTECHLABORATORIES,INC. MA CERT.NO.:M-MA 063 449 Rte.130 Sandwich, MA 02563 508(888-6460) 1-800 339-6460 FAX(508)888-6446 CLIENT. Donna Rigolizzo LOCATION: 15 Bog Rd ADDRESS: 15 Bog Rd Marston Mills MA 02648 Marston Mills MA 02648 COLLECTED BY. DA Scannell SAMPLE DATE: 12/13/2000/12-15-2000* SAMPLE TIME: 11:30 WATER SAMPLE TYPE: New Well DATE RECEIVED: 12/13/2000'/12-15-2000* LAB I.D. #: 0012163/0012203* WELL SPECS.: 43' RESULTS OF ANALYSIS: Parameters Units Recommended Results Method Date Analyzed Limits Coliform bacteria /100ml 0 0* 9222 B 12/15/00* PH pH units 6.5-8.5 6.18 4500 H+ 12/13/2000 Conductance umhos/cm 500 120 120.1 12/13/2000 Nitrate-N mg/L 10.0 1.15 300.0 12/13/2000 Nitrite-N mg/L 1.00 < 0.003 300.0 12/13/2000 Sodium mg/L 28.0 17.1 200.7 12/15/2000 Iron mg/L 0.3 0.31 200.7 12/15/2000 Manganese mg/L 0.05 0.069 200.7 12/15/2000 Volatile Organics See Report. Chloroform ug/L 100 0.9 EPA 524.2 12/14/00 *Retest Performed COMMENTS: pH is below recommended limit and may have corrosive characteristics., Iron and Manganese are not a health hazard, but can cause taste, staining and odor problems. WATER MEETS EPA STANDARDS AND IS SUITABLE FOR DRINKING PURPOSES FOR PARAMETERS TESTED. <=less than V � _ /ZCi L0 Date l �1 >=greater than �R nald J. Saa ' �T— TNTC=too numerous to count Laborato;,D ector r GROUNDWATER ANALYTICAL EPA Method 524.2 Volatile Organics by GC/MS Field ID: 0012163 #15 Laboratory ID: 37934-01 Project: Rigolizzo/15 Bog Rd QC Batch ID: VM5-1368-W Client: Envirotech Sampled: 12-13-00 Container: 40 mL VOA Vial Received: 12-13-00 Preservation: HCI/Cool Analyzed: 12-14-00 Matrix: Aqueous Dilution Factor: 1 Page: 1 of 2 _SAS Num4er Anal � --------- = - = :- - -C411Cen�l�cut tltiit'l lCeportin?3'-ti_r_ri_il 75 71 8 Dick lorodifluoromethane BRL ug/L - 0.5 74-87-3 Chloromethane _ BRL ug/L 0.5 75-01-4 Vinyl Chloride _ BRL _ - - ug/�- -0.5 74-83-9 Bromomethane . _ BRL ug/L 0.5 75-00-3 Chloroethane - BRL ug/L 0.5 75-69-4 Trichlorofluoromethane - _ BRL ug/L 0.5 75-35 4 i,l-Dichloroethene BRL ug1L 0.5 75-09-2 Methylene Chloride BRL ug/L 0.5 156-60-5 tran5-1,2-Dichloroethene BRL - ug/L - 0.5 1634-044 Methyl tert-butyl Ether(MTBE) - BRL -- ug/L 0.5 75-34-3 1,1-Dichloroethane - BRL ug/L 0.5 590-20-7 2,2-Dichloropropane - - - __ _ BRL ug/L 0.5 156 59-2 cis-1,2-Dichloroethene - _ _ BRL ug/L 0.5..._ 74-97-5 Bromochloromethane BRL ug/l 0.5 67-66-3 Chloroform 0.9 __ ug/L 0.5 - _ 71-55-6 1,1,1-Trichloroethane BRL ug/L 0.5 56-23-5 Carbon Tetrachloride - BRL ug/L .. _ 0.5 _563-58-6 1,1-Dichlor_o_propene BRL ug/L 0.5 _.. 71-43-2 Benzene - -- - BRL ug/L 0.5 1 7-06-2 1,2-Dichloroethane BRL ug/L 0.5 796-6 Trichloroethene - - - - - - - BRL ug/L 0.5 78-87-5 1,2-Dichloropropane BRL ug/L 0.5 74-95-3 Dibromomethane BRL ug/L 0.5 75-27-4 Brornodichloromethane _ BRL ug/L 0.5 10061-01-5 cis-1,3-Dichloroprop_ene BRL 108 88-3 Toluene -- ug/L 0.5 BRL ug/L 0.5 1006142-6 trans-1,3-Dichloropropene BRL ug/L 0.5 79-00-5 1,1,2-Trichloroethane - - _ BRL ug/L 0.5 127-18-4 Tetrachloroethene _. BRL u L 0.5 142-28-9 1'3-Dichloropropane _ BRL ug/L 0.5 124-48-1 Dibromochloromethane - BRL ug/L 0.5 106-93-4 1,2-D i bromoethane BRL ug/L 108-90-7 Chlorobenzene _ - BRL ug/L 0.5 630-20-6 1,1,1,2-Tetrachloroethane BRL ug/L 0.5 100-41-4 Ethylbenzene - - ug/L 0.5 -- - BRL 108-38 3/t06 42 3 meta-_ Xylene and Para-Xylene BRL ug/L 0.5 95-47-6 ortho-Xylene_ BRL _ _ 100-42-5 Styrene - ug/L 0.5 BRL ug/L 0.5 75-25-2 Bromoform - -- BRL ug/L 0.5 'oa a�t B ropylbenzene - - _ _ r) BRL ug/ L _ 0.5_ -. rnobenzene BRL ug/L 0.5 79-34-5 1,1,2,2-Tetrachloroethane - - - - BRL ug/L 0.5 Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 I _ GRDUNDWATER ANALYTICAL EPA Method 524.2 (Continued) Volatile Organics by GC/MS Field ID: 0072163 #15 Laboratory ID: 37934-01 Project: Rigolizzo/15 Bog Rd QC Batch ID: VMS-1368-W Client: Envirotech Sampled: 12-13-00 Container: •40 mL VOA Via[ Received: 12-13-00 Preservation: HCI/Cool Analyzed: 12-14-00 Matrix: Aqueous Dilution Factor: 1 �- -.- Page: 2 of 2 CA5Nu1»ber Analyt �: ConsnlrariFbn t 96-18-4 1,2,3-Trichloroprop_ane BRL ug/L 0.5 103-65-1 n-Propylbenzene BRL ug/L - 0.5 95-49-8 2-Ch6rotoluene BRL 108-67-8 ug/L .. 0.5 . _ i,3,5 Trimethylbenzene BRL ug/L 0.5 106.43 4 4-Chlorotoluene _ BRL ug/L 0.5 98-06-6 tert-Butylbenzene — __ BRL ug/L 0.5 95-63-6 1,2,4 Trimethylbenzene BRL 135 98 8 sec-Butylbenzene u ! _ 0.5 541-73-1 1,3-Dichlorobenzene BRL - 99-87-6 4-Is ro (toluene _ US/� 0.5 oP. R BRL ug/L 0.5 106-46-7 1,4-Dichlorobenzene ug/L 0.5 --- BRL _ 95-50-1 1,2-Dichlorobenzene BRL 104-51-8 n-But lbenzene ug/L 0.5 y —--_-_— _ ___B R L u L 0.596-12-8 /1,2-Dibromo-3-chloropropane ugBRL L120-82-1 0.5 I., , enzene BRL ug/L 0.5 — 87-68-3 Hexachlorobutadiene BRL ug/L 0.5 91-20-3 Naphthalene—. .._ - BRL ug/L 0.5 - - 1,2,3-Tric 8 7-61-6 hlorobenzene _BRL - - �d �- tZC_Surrogad .ands , _ - - --•---��� _ _ _ i 05 _ _ Recovery -_ 1,2-Dichlorobenzene dC, 93 % 70- 130 % 4 Bromofluorobenzene °100 /o 70-130% - -_ Method Reference: Methods for the Determination of Organic Compounds in Drinking Water, Supplement EPA-600/R-95/131 (1995). Method Revision 4.0. Analyte list as derived from40 C.F.R. 141.40 and 40 C.F.R. 141.61,and additional analyte MTBE. Report Notations: BRL Indicates concentration,if any,is below reporting limit for analyte. Reporting limit is the lowest concentration that can be reliably quantified under routine laboratory operating conditions. Reporting limits are adjusted for sample dilution and sample size. Groundwater Analytical, Inc., P.O. Box 1200, 228 Main Street, Buzzards Bay, MA 02532 No. -�--®- - �'"' Fee---X- -V;� OnZ) BOARD OF HEALTH TOWN OF BARNSTABLE 0(pplicat ion Ar V ell Conotruct ion permit Application is hereby made for a permit to Construct ( lo), Alter ( ), or Repair ( )an individual Well at: --�S----t3 o 6------RA -Ivek�S/aw C /�t l I s -- — -IS - — l a-l =- ----- Location — Address /�i n J� �� lsessors and Parcel paN�vA /��60 — — ---——_-- --— f �7— —— --� — -�/a�1, ---- —---— Owner Address t Installer — Driller ------�-----------------------Ad�---------------—------�-- ------------- Type of Building__ o..s--e------------------------------------------------- Other - Type of Building No. of Persons--- I e of Well��p�'j C----- - ----- - Ca acit --—---- ---YP P Y------------ Purpose of Well --"�-�i 4 -------- ------ Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation until a Certificate.of Compliance has been issued by the Board of Health. Signed ae'. dc4A----- — /-) ``oo—_-- date Application Approved B date Application Disapproved for the following reasons: --------------------------------------------______ date Permit No. Issued ---�� ��-- date _ BOARD OF HEALTH TOWN OF BARNSTABLE Certificate ®f Compliance THIS IS TO CERTIFY, That the Individual Well Constructed (9-T, Altered ( ), or Repaired ( ) by--- — Nr, /( ------------------------------------ --------- --- e� Installer at__1S lt3 eG ✓�� f ___ _ has been installed in accordance with the provisions of the Town of Barnstable Board Board of Health Private Well Protection Regulation as described in the application for Well Construction t'1;9' /Dated y �-c THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE-------- - . Inspector-------------____— _—_ — No. alp`- t - � ;,� r Fee-- - -- `'7-'--- Z, - --- BOARD OF HEALTH TOWN OF. BARNSTABLE Applicat ion AtWell Con0ruct ion Permit Application is Hereby made'Eor a permit to Construct ( v);' Alter ( ), or Repair ( )an individual Well at: Ys Location-- Address f ACVa ssessors Ma and Parcel t pd N"a !r 16 o 1, 2-2-0 _ - Ic7�'� Owner Address ticl�___wt�l-t—on1L� -= n0. 49ox- G°- -/��sG�. - Installer — Driller — Address Type of Building Dwelling--/¢o c E----------------------------------------- Other - Type of Building-------------=-------- No. of Persons-- ----- ______--^--______ Type of Well -------- - ------- Capacity-- - - --—-— Purpose of Well--_Db Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection' Regulation - The undersigned further agrees not to place the well in operation until a Certificate .of Compliance has been issued by the Board of Health. / —— G G�J Signed �.r.k.✓J c�.- -- ---- 7-- date ��/-------- .� date Application Approved date Application Disapproved for the following reasons:-— -------------------- -------- -- --------- - -- ------------=----------------------- date — >t r Permit No. -�- � — Issued--.��-'--------�----�G =- -____-- date aOelliPiPi!ita}bl84iiiPiwiyi4i!IilYM4i'1i46.TATiRi4&4i.7ili4i'Pi!iti�J6$+64tilSPtifitiliwilitili'1iT07ix.4:l.�tioi4i4i441G'4p 36viF�►4iRi1!'i'1H19i.4.iQP'QtYmG0.YPi'454i9,'ili4ei68eblG:i!f!d!A!iPiiA!r!', BOARD OF HEALTH TOWN OF BARNSTABLE , Certificate Of Compliance THIS IS TO CERTIFY, That the Individual Well Constructed (iT, Altered ( ), or Repaired ( ) by D AS,-(A -----------r--------_- QQInstaller ° .� 15/t.:t�l Res been u at onsas described m the appled in ication t provisions he Town of Barnstable Board of.Health Private Well Protection'' g ppl cation for Well Construction I�e'�rr& i�b.�� ------ �Dated Y_ �=-7w r 'C alb THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE----- - - = -- Inspector-- —--- ---- —-- of�liPili!b!itNbEblili4i0ii4.iltaRS9iP6Pifilili VSP.TSO%LBilbB2&<!iti0i0oli!?4OBiT848R611iR1Eil6T.i9i$BliOblbli54+14i44i4b4i5H9i4q?L$Qi!IiC�iaw Kai+.fiO4iiTi@w�'i4i3i�.i44!ioi!i4iPi'!i!i?i4i W1+^. BOARD OF HEALTH TOWN OF BARNSTABLE Well Con5tructionvermit No. �. Fee-- � Permission is hereby granted D A "'``{ ff -- ----- to Construct (4"), Alter ( ), or Repair i an Individual Well at: No. IS . �06 �R�1 - — ------------------------ � as shown on the ap lication for a Well Construction Permit No.-� �'� ------- - Dated --------------- / r - Board of Health r DATE / ,. r - R f COMMONWEALTH OF MASSACHUSETTS ta�ft EXECUTIVE OFFICE OF ENVIRONMENTAL AFFA t5,� DEPARTMENT OF ENVIRONMENTAL.PROTE1�ION ONE WINTER STREET, BOSTON MA 02108 (617)29� "500 RR E6 JUL 5 20 ro"OF TRUDY COXE �MSfA Secretary � OEpr �':r ARGEO PAUL CELLUCCI DAVID,,B�STRUHS Governor `._� ( nu issioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM _ PART A CERTIFICATION Property Address: 15 Bog Road, Marston Mills, MA Name of Owner: Helen Petrovits Address of Owner: Scone Date of Inspection: July 13, 2000 Name of Inspector: (Please Print) James M. Ford I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) Company Name: James M. Ford Mailing Address: P.O. Box 49 Osterville, MA 02655-0049 Map: 045 Telephone Number: (508)862-9400 Lot. 012 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 inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: ✓ Passes Conditionally Passes _ Needs Further Eva luaf By the Local Approving Authority _� ails Ins Inspector's Signature: Date: July 18, 2000 p The System Inspector shall submA copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(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 Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. NOTES AND COMMENTS revised 9/2/98 Page 1of11 Printed on Recycled Paper r_ e SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 15 Bog Road, Marstons Mills, MA Owner: Helen Petrovits Date of Inspection: July 13, 2000 INSPECTION SUMMARY: Check A, B, C, or D: A. SYSTEM PASSES: ✓ I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 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,will pass. Indicate yes,no,or not determined(Y,N,or ND). Describe basis of determination in all instances. If"not determined",explain why not. The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank,whether or not metal, is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of.Health. Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health) broken pipe(s)are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four 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 revised 9/2/98 Page 2of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 15 Bog Road, Marston Mills, MA Owner: Helen Petrovits Date of Inspection: July 13, 2000 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 the public health, safety and 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 THE PUBLIC HEALTH AND 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. f 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 AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet to a surface water supply or tributary to a surface water supply. ' I , `, l The system has a septic tank and soil absorption system and the SAS is within a Zone 1 of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis 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. Method used to determine distance (approximation not valid). 3) OTHER revised 9/2/98 Page 3of11 I� SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 15 Bog Road, Marstons Mills, MA Owner: Helen retrovus Date of Inspection: July 13, 2000 D. SYSTEM FAILS: You must indicate either"Yes" or "No"as to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above'outlet invert due to an overloaded or clogged SAS or cesspool. _ Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone 1 of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E. LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"as to each of the following: The following criteria apply to large systems to addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well I The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further information. revised 9/2/98 Page 4of11 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 15 Bog Road, Marston Mills, AM Owner: Helen Petrovits Date of Inspection: July 13, 2000 Check if the following have been done: You must indicate either"Yes" or"No" as to each of the following: Yes No ✓ _ Pumping information was provided by the owner,occupant,or Board of Health. ✓ _ None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. ✓ _ As built plans have been obtained and examined. Note if they are not available with N/A. ✓ _ The facility or dwelling was inspected for signs of sewage back-up. ✓ _ The system does not receive non-sanitary or industrial waste flow. ✓ _ The site was inspected for signs of breakout. ✓ _ All system components,excluding the Soil Absorption System,have been located on the site. ✓ _ The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for conditions of baffles or tees, material of construction,dimensions,depth of liquid,depth of sludge,depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: r _ ✓ _ Existing information. For example, Plan at B.O.H. ✓ _ Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) [15.302(3)(b)]. ✓ _ The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of SubSurface Disposal Systems. revised 9/2/98 Page 5of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 15 Bog Road, Marstons Mills, MA Owner: Helen Petrovits Date of Inspection: July 13, 2000 FLOW CONDITIONS RESIDENTIAL: Design flow: 110 g.p.d./bedroom. Number of bedrooms(design): n/a Number of bedrooms(actual): 2 Total DESIGN flow n/a Number of current residents: 1 Garbage grinder(yes or no): No Laundry(separate system)(yes or no): n/a; If yes, separate inspection required Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings, if available(last two year's usage(gpd): Private well Sump Pump(yes or no): No Last date of occupancy: Currently occupied COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow: Qpd(Based on 15.203) Basis of design flow Grease trap present: (yes or no) Industrial Waste Holding Tank present: (yes or no) _ Non-sanitary waste discharged to the Title 5 system: (yes or no) _ Water meter readings, if available: Last date of occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION. PUMPING RECORDS and source of information: None on file-per treatment plant. System pumped as part of inspection(yes or no): No If yes,volume pumped: gallons Reason for pumping: TYPE OF SYSTEM ✓ Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy .Shared system(yes or no) (if yes,attach previous inspection records, if any) I/A Technology etc. Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components,date installed(if known)and source of information: Sep 28193-per as built card. Sewage odors detected when arriving at the site: (yes or no) No revised 9/2/98 Page 6of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 15 Bog Road, Marstons Mills, MA Owner: Helen Petrovits Date of Inspection: July 13, 2000 BUILDING SEWER: _ (Locate on site plan) Depth below grade: Material of construction: _cast iron _40 PVC _other(explain) Distance from private water supply well or suction line Diameter Comments: (condition of joints,venting,evidence of leakage,etc.) SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 24" Material of construction: ✓concrete _metal _Fiberglass _Polyethylene _other(explain) If tank is metal, list age_ Is age confirmed by Certificate of Compliance_(Yes/No) Dimensions: 1000 gal. Sludge depth: I" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: I" Distance from top of scum to top of outlet tee or baffle: 9" Distance from bottom of scum to bottom of outlet tee or baffle: 12" How dimensions were determined: Measuring stick Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage,etc.) The tees were present. The liquid level was even with the outlet invert. There were no signs of leakage. Scum and sludge were minimal. GREASE TRAP: None (locate on site plan) Depth below grade: 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: Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage,etc.) revised 9/2/98 Page 7of11 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 15 Bog Road, Marston Mills, AM Owner: Helen Petrovits Date of Inspection: July 13, 2000 " TIGHT OR HOLDING TANK: None (Tank must be pumped prior to, or at time,of inspection) (locate on site plan) Depth below grade: Material of construction: _concrete _metal _Fiberglass _Polyethylene _other(explain) Dimensions: Capacity: gallons Design flow: gallons/day Alarm present: Alarm level: Alarm in working order: Yes_ No Date of previous pumping: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) DISTRIBUTION BOX: ✓ (locate on site plan) Depth of liquid level above outlet invert: -- Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) The box was not dug up. There were no sign of failure in the leach pit. I PUMP CHAMBER: None (locate on site plan) Pumps in working order: (Yes or No) Alarms in working order: (Yes or No) Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) revised 9/2/98 Page 8of11 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 15 Bog Road, Marstons Mills, MA Owner: Helen Petrovits Date of Inspection: July 13, 2000 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan, if possible;excavation not required, location may be approximated by non-intrusive methods) If not located,explain: Type: leaching pits, number: I-6'x 6' leaching chambers,number: leaching galleries, number: leaching trenches,number, length: leaching fields,number,dimensions: overflow cesspool,number: Alternative system: Name of Technology: Comments: (note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.) The pit had 2'6"of water on the bottom. The scum line was at the same level. There were no signs of failure. The bottom to grade was approximately 10'. CESSPOOLS: None (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(cesspool must be pumped as part of inspection). Comments: (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.) PRIVY: None (locate on site plan) Materials of construction: Dimensions: Depth of solids: j Comments: (note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,etc.) I revised 9/2/98 Page 9of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 15 Bog Road, Marstons Mills, AM Owner: Helen Petrovits Date of Inspection: July 13, 2000 Map: 045 Lot: 012 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) 13.At. `B i A A l- a3 gi_ 3 S AP- ac) a .. f3a- y 1 A3- 3 3 3 f33- u 5' Ay fay- S� II t w y /03 revised 9/2/98 Page 10of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 15 Bog Road, Marstons Mills, AM Owner: Helen Petrovits Date of Inspection: July 13, 2000 NRCS Report name Soil.Type Typical depth to groundwater USGS Date website visited Observation Wells checked Grojmdwater depth: Shallow Moderate Deep SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to Groundwater 33 +1- Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observed Site(Abutting property,observation hole,basement sump etc.) ✓ Determined from local conditions Checked with local Board of Health Checked FEMA Maps Checked pumping records Check local excavators, installers ✓ Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) The bottom of the pit to grade was approximately 10'. Using the USGS topographic map and the Cape Cod Commission water contours map, the maps were showing approximately 33' +/-to groundwater. Using the Cape Cod Commission Technical Bulletin, the high groundwater adjustment for this site(SOW 253, Zone B, 6100)was 4.7'. This report has been prepared and the system inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied, relating to the system, the inspection and/or this report. revised 9/2/98 Page 11of11 r TCWN OF BARNSTABLE !r� LOCATION �OS R� SEWAGE # VII.LAGE MA��M,S .W1 �IS ASSESSOR'S MAP & LOT OY� 01 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY I�� LEACHING FACILITY: (type) t? t 1 (size) X(O NO.OF BEDROOMS oZ BUILDER OR OWNER Hclp-n PCTrOy►I,S PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Ma�:imum Adjusted Groundwater Table and 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) 103 Feet Edge of Wetland and Leaching Facility(If any wetlands -xist within 300 feet of leaching facility) Feet Furnished by r y. E t = TOWN OF BARNSTABLE LOCATION Mr SEWAGE # yfi'- Ola,. VILLAGE lYl � �a mrjls ASSESSOR'S MAP & LOT /3" INSTALLER'S NAME & PHONE.NO. al , laa e, /A/ZT SEPTIC TANK CAPACITY 2 n1, LEACHING FACILITY:(type)- (size)_ NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: V A T?T A Nr V r.R A NTRD- Yes NO .� 4. .. "`��� a + e I � qh � � ��s w�` 6. TOWN OF BARNSTABLE I OCATION/—,5 SEWAGE # 9e'02V0 VILLAGE �� ASSESSOR'S MAP & LOT — 7— INSTALLER'S NAME&PHONE NO. J ' �P � `� S J%0- 00S SEPTIC TANK CAPACITY A tRt 2n 6M L ° / LEACHING FACILITY: (type) 2— NO.OF BEDROOMS aJ `' BUILDER OR OWNER 1 f ClJ't S' PERMIT DATE: COMPLIANCE DATE: 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 J d 4.. S R ZZ I ,a r 1 No. ` FEE Ca C®MMONWEA T14 OF MASSAC14 SETTS Board of Health, 80EV 15-TR$1Lt, , MA. APPLICATION FOP, DISPOSAL SYSHM CONSTRUCTION PERMIT Application for a Permit to Gonstruct(� Repair( ) Upgrade( ) Abandon( ) - I/Complete System ❑Individual Components Location L 0"f 6 B OG 3"RY L R'M Owner's Name Map/Parcel# _ p Address Lot# Telephone# Installer's Name 3E 1n 'S ' Designer's NameCPr�-'Wl— LPY$` 'V S U R V�Y)a; i r Address 3 Address-3Q6 OLV PL ul d "rAA Rp dUR Telephone# t? ZZ 7 Telephone# Type of Building Lot Size ( �6 8 sq.ft. Dwelling-No.of Bedrooms 3 Garbage grinder (4 0 Other-Type of Building No.of persons Showers ( ),Cafeteria ( ) Other Fixtures Design Flow(min.required) 13 D gpd Calculated design flow Design flow provided gpd Plan: Date 4' Number of sheets Revision Date Title P 1 0 3WW)hJ9 `r}�,_1T---S N6 JQ UV- A Description of Soil(s) L 7^ Soil Evaluator Form No. Name of Soil Evaluator"5sAd'�,I Date of Evaluationa LAN 9W--GPfvuE1f DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with.the provisions of TITLE 5 and further agrees o of to p the system in operation until a Certificate of Compli iceJhas been issued by the Board of Health. Signed Date Z G� Inspections No. CI FEE COMMONWEALTH OF MASSACHUS ETTS � Board of Health, SP K U JtRf Lf, , MA. APPLICATION FOP, DISPOSAL SYSTEM CONSTRUCTION PERMIT --Application for a Permit to Construct(V Repair( Upgrade( Abandon( - Complete System ❑Individual Components Location l„0 6 BOG !S L Owner's Name Map/Parcel# _ p,oj7 - G Address Lot# Telephone# Installer's Name e Joy 'S ' Designer's Name CW�"VrL Address U r(y Gl d(7' Si�lWl� Address 3d1� O�.V Telephone# a Telephone# rJ Type of Building Lot Size (i lu 94 sq.ft. Dwelling-No.of Bedrooms 3 Garbage grinder (}AC) Other-Type of Building No.of persons Showers ( ),Cafeteria ( ) Other Fixtures Design Flow (min.required() 130 gpd Calculated design flow Design flow provided gpd Plan: Date, 2�• >f! Number of sheets Revision Date Title PLA� 13ww g `-ft x2i,-S\r N or- A pnorn y �'9 p yiSUQ.-'Air-k Description of Soil(s) M SAL S tAM)^ r Soil Evaluator Form No. s Name of Soil Evaluator" , Date of Evaluation Y. LProo+©� —GPrUl.�1� DESCRIPTION OF REPAIRS OR ALTERATIONS 1 4J M The undersigned agrees to install the'above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees o not to p e the system in operation until a Certificate of Compliance has been issued by the Board of Health. Signed + Date 7 t 1 1 Inspections No. COMMO FAIT14 Of MASSAC14USETTS FEE V'V' _ Board of Health, �T, MA. CERTIFICATE Of COMPLIANCE Description of Work: ❑Individual Component(s) Xomplete System ,r The undersigned hereby certify that the Sewage Disposal System; Constructed 1>e,Repaired ( ),Upgraded ( ),Abandoned ( ) by: eo�oX . at has been installed in accordance with the Ppvisions of 31k vIR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No. dated Approved Design Flow (gpd) Installer ���Jy Designer: / l:C�t?1"N/ Inspector: Date: The issuance of this permit shall not be construed as a guarantrItl t the system will function as designed. No.' FEE COMMONWEALTH 'OF MASSAC14USETTS Board of Health, MA. DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to; Construct( Rep�air( ) Upgrade( ) Abandon( ) an individual sewage disposal system at IL � !} 1^ "�f 11 s as described in the application for r � Disposal System Construction Permit No. dated ! Provided: Construction shall be completed within three years of the date of this permit. All local conditions must be met. Form 1255 Rev.5/96 A.M.Sulkin Co.Boston,MA Date Board of Health TOWN OF BARNSTA.BLE LOCATION eaC'/� SEWAGE # VELLAGE_L'�L ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. e,.Z ��7-P SEPTIC TANK CAPACITY LEACHING FACILITY: (type) NO. OF BEDROOMS .,� ��LL BLUDER OR OWNER �,�� f co", S' PERMUDATE: COMPLIANCE DATE: 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) Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility) Furnished by Feet + 4 3�^ 00 /.ram I I GENERAL NOTES.' ,-or o� ��► 0 �"10,� ��, �, fL�-r -rE SOS TEST PIT DATA 1. THIS PL AN IS FOR THE DESIGN AND �l"NVER T EL f VA TIONS.' �`' ' I I��n� GR D-1 EL FV. I 0&6O GRND. EL EV. 10$. I CONSTRUCTION OF THE SEYAGE DISPOSAL i FACILITY ONL Y. INVERT AT PUILOING 10' b G. IV. ELEV. G. Y. ELEV. — 2. ALL CONSTRUCTION RETHODS, MATERIALS AND ` INVERT IN AT SEPTIC TANK _109- 5 `0��0� I MAINTENANCE FOR THE SEPTIC SYSTEM SHALL_ I _ ACCESS COVERS MUST BF WITHIN 6 ` OF FINISH GRADE. CONFOP ' -7 MASS. D.E. 0.E. TI TL E 5 AND L OCAL INVERT OUT A T SEPTIC TANK l 0 4,QQ u 15 N a KA D INDICA TES BOARD Ur HEAL TH REGULA TIONS. INVERT IN A T DIST. BOX 1 17 U ��1 •5 . a INVERT OUT A T GIST. BOX ►O I��b 10 = 1 I• 1. 10 ► n PERC. TEST 3 3. ALL SEPTIC SYSTEM COMPONENTS SUBJECT TO ={'I,�^ �� N VEHICLE LOADING (I.E. UNDER DRI VENA YS, ETC.) INVERT IN A T S. A. S. 101, 00 — MIN. 2 OF 9 ` Q ou.�5 101.00 1/8'-1/2' DIA. SHALL BE DESIGNED TO WITHSTAND H-20 LOADING. ©OTTO,�I OF S. A, S. __!� Ob ` 4 'SIN' WASHED STOP✓F INDICA TES 4. ALL SEWER PIPE SHALL BE SCHEDULE 40 OR j OBSERVED GPOUA'DNA TERM L IOUIO 10 y.�b OBSERVED " �'! '{ APPROVED EQUAL. i L� DEPTfI ` GROUNDi✓A TER i AD✓USTED GF ,.OhA TER 10 ' DIST. N 3/4 -1 1/2 CIA. p CALL DIG SAFE min, i500 GAL BOX Wv Y,,4SHED STONE 5. BEFORE STARTING CONSTRUCTION ! SEPTIC TANK' 44-1 O p INDICATES 0-3' -4844 F R L OCA TION OF _9 __ { 1 BO 22 0 � ,� !•o TEST PIT UNDERGROUND UTILITIES. I 4` 1 O I SEPTIC T,4)W 6 D-BOX TO BE SET ON A 6' BFD OF COYP,4 CTFD CRUSHED STONE. I 5. DATUM IS A�55UN1tI7 I � I � CONTRACTOR TO NA TER TEST D-BOX TO f F70P. S. A. S, ,�F�, •SHOX L E✓EL NESS. 7. A'0 DE TERMINA TION HAS BEEN MADE AS TO COMPL IANCE •H—2 O ! WITH DEED RESTRICTIONS OR ZONING REGU[_ATIONS. ' � i i I T St/ALL REMAIN THE Oh'N.�P'S RESPONSIBILITY TO OBTAIN ALL REQUIRED PEPYI TS, SPECIAL PERMITS, DA TER.' VARIANCES, ETC. FOR THIS PROJECT. CAs-` s`' lz-v r )f TEST BY.' 0 _t_4t-sRS Ca t}LAY L11�'L B. IT SHALL REMAIN THE OYNER 'S RESPONSIBILITY TO HA VE THE PROPOSED OWEL L ING FOUDA TION DESIGNED TO ACCOUNT FOR THE EXISTING GRADE j h'ITNESSED BY.' T. �u Nut uG� �`� AND SOIL CONDITIONS A T THE LOCATION OF THE PERC. R4 TE '� S MIN./ IN. 11--L C PROPOSED OYELZING. 1 DE S-ION CRITERIA.' I �'S ( OESIG,v FL 01✓ Q, 3 SEOPOO,N OJ'ELL IiUG P 110 GAL/OA Y PER BEDROOM �� co EQUALS _33a GALS. PAR DAY. rn NO GA KGA6C-- G V-1 a-JDV,2. 4 1;1 Doti SEPTIC TANG PFOUIPEED.- 66 0 � ,q, i 33 0 GPD X 200,r SAL. is ox SEPTIC TANS' PROVIDED: = 1 O SAL, SIZE OF LEACHING FACILITY REOUIPED . O �'¢ I LEGEND Pd � DESIEN PERC. RATE - 5 ,i;'INUTES/INCH Ea6 330 GALLONS PER DAY -- 50-- = EXISTINS CONTOUfl SIZE OF LEACHING FACILITY PROVIDED, L,o Gu S 50 = PROPOSED CONTOUR I-YVC)- 5 0 a G A L G4P'P1C.t Y LeAc—w p-�G 6 T01.4E M ! 50 = PROPOSED SPOT GRADE SIDEW I L L i in. S.F. X 0,14 - 11 . GPD I �,►= DIRECTION OF 5TORCIF%A TER BOTTOM 32 5 S. F. X jP-1 - 240 GPD ip FZ-0 P RUNOFF To rAL s -477 S.F. GPO f / ' 35'09 1� • NE — -p1;�o�'. L A �'SO D GAL o� s ,� BERRY � h'EVISION.S:' ROGER < �s BOG PpuL pp 25 _ ✓ �6' j MicHr3CA z NO. OATS r'r: YISIO,v ti civii . O ~ bt,,l tsl ,���o' � 3 � 0 10 `\♦ \ \ FESSIONA EN INFER ,_ (CI VILE JAN S, 1 . \ \ P t"0 pro CZ �3� ! , `s';� ` GP�p,F,�s �i �,v.00 DATE AA� �OFMAgs s N PAUL a��G CIO I 1 �? R. u) \0 RYLL a r, G THE DESIGN OF A PROPOSED 2�S No.32448 11 PLAN SHOla/IN v mo o °NPv SUBSURFACE SEPTIC D16POSAL SYSTEM `�11o�'�E� ERR Y LANE, BARNS TABL E, MA �- ��R BOG B TOP OF CONCRETE BOUND `�0 LOT T 6 LOT 6 „ _ , APRIL 20, 1998 . EL . = 100. 00 ASSUMED 18684f S. F. SCALE 1 30 PROF SSIONAL L A Ng S&WEYOR CANAL LAND SURVEYING ry x 306 OLD PL YMOUTH ROAD, BUZZARDS BA y MA DA TE PROJECT NUMBER 98-045