HomeMy WebLinkAbout0041 DEBBIES LANE - Health 41 Debbies Lane, Marstons Mills
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ComnXMeOtth of MOSSQCWSettS John Grad
Executive Office Of ErMrorni al Altdrs D.E.P. Title V Septic Inspector
department of P.O. Box
�.,Teatckrt,MA 02536
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SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTIONRC�r+ /F�CERTFIICATIONPART AJ_U N 2 4 1997 N
Property Address: 41 Debbies Lane Marstons Mills Address of Owner: � TOWN ( ANSfAOLE
Date of Inspection:6119197 (If different) G it 1DEPfi.
Name of Inspector:John Graci Janice Black
Company Name,Address and Telephone Number: y
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:
X Passes This inspection is based on criteria defined in Title V
_ Conditional) Pa es code 310 CMR 15.303.My findings are of how the system is
_ Needs Fu er aluation B the Local A rovin Authori performing at the time of the Inspection.My Inspection does
Y PP 9 tY not Imply any warranty or guarantee of the longevitv of the
Fails septic system and any of its components useful life.
Inspector's Signature: Date: 6121197
The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this
inspections.. 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.
INSPECTION SUMMARY:
Check A, B,C,or D:
A] SYSTEM PASSES:
X I have not found any information which indicates that the system violates any of the failure criteria
defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below.
B] SYSTEM CONDITIONALLY PASSES:
One or more system components need to be replaced or repaired. The system, upon completion
of the replacement or repair, passes inspection.
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,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 conforming septic tank as approved
by the Board of Health.
(revised 11115195)
One Winter Street • Boston,Massachusetts 02108 • FAX(617)556-1049 • Telephone(617)292-5500
1
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 41 Debbie$Lane Marstons Mills
Owner: Janice Black
Date of Inspection:6119197
_ Sewage backup or breakout or high static water level observed in the distribution box is 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 leveled 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
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 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.
2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER, IF APPROPRIATE)DETERMINES
THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE
ENVIRONMENT:
_ The system has a septic tank and soil absorption system and is within 100 feet to a
surface of water supply or tributary to a surface water supply.
The system has a septic tank and soil absorption system and is within a Zone 1 of a public water
supply well.
The system has a septic tank and soil absorption system and is within 50 feet of a private water
supply well.
_ The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private
water supply well, unless a well water analysis for coliform bacteria volatile organic compounds indicates that the well is
free from pollution for that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal or less than 5 ppm.
3) OTHER
D] SYSTEM FAILS:
_ I have determined that the system violates one or more of the following failure criteria as defined 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.
_ Backup of sewage in 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
cesspool.
SAS is in hydraulic failure.
(revised 11115195)
2
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 41 Debbles Lane Marstons Mills
Owner: Janice Black
Date of Inspection:6119197
D] SYSTEM FAILS(continued)
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).
Numbers 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:
The following criteria apply to large systems in addition to the criteria:
_ 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:
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)
The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program
requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information.
(revised 11115195)
3
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECLIST
Property Address: 41 Debbies Lane Marstons Mills
Owner: Janice Black
Date of inspection:6119197
Check if the following have been done:
X Pumping information was requested of the owner,occupant, and Board of Health.
X None of the system components have been pumped for at least two weeks and the 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.
n1aAs built plans have been obtained and examined. Note if they are not available with N/A.
X The facility or dwelling was inspected for signs of sewage back-up.
X The system does not receive non-sanitary or industrial waste flow.
X The site was inspected for signs of breakout.
X All system components,excluding the Soil Absorption System,have been located on the site.
X The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected
for condition of baffles or tees,material of construction,dimensions,depth of liquid, depth of sludge, depth of scum.
X The size and location of the Soil Absorption System on the site has been determined based on existing information or
approximated by non-intrusive methods.
X The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Sub-
Surface Disposal System.
(revised 11115195)
4
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 41 Debbles Lane Marstons Mills
Owner: Janice Black
Date of Inspection:6119197
FLOW CONDITIONS
RESIDENTIAL:
Design flow: 339 gallons
Number of bedrooms: 3
Number of current residents: 1
Garbage grinder(yes or no): No
Laundry connected to system(yes or no): Yes
Seasonal use(yes or no): No
Water meter readings, if available: nla
Last date of occupancy: n1a
COMMERCIAL/INDUSTRIAL:
Type of establishment: ►da
Design flew:9 gallons/day
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: n1a
Last date of occupancy: n1a
OTHER:(Describe) nla
Last date of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and source of information:
System has not been pumped
System pumped as part of inspection: (yes or no)No
If yes,volume pumped: 6 gallons
Reason for pumping: n1a
TYPE OF SYSTEM
X Septic tank/distribution box/soil absorptions system
Single cesspool
Overflow cesspool
Privy
Shared system(yes or no) ( if yes, attach previous inspection records,if any)
Other(explain)
APPROXIMATE AGE of all components,date installed(if known)and source information:
1986
Sewage odors detected when arriving at the site: (yes or no) No
(revised 11115195)
5
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 41 Debbles Lane Marstons Mills
Owner: Janice Black
Date of Inspection:6119197
SEPTIC TANK: X
(locate on site plan)
Depth below grade: s'
Material of construction:X concreate_metal_FRP_other(explain)
Dimensions: L 9'6'H 5'7"W 4'10"
Sludge depth:4"
Distance from top of sludge to bottom of outlet tee or baffle: 23'
Scum thickness:3'
Distance from top of scum to top of outlet tee or baffle:6'
Distance form bottom of scum to bottom of outlet tee or baffle: 15•
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.)
Septic tank and all components are structurally sound.Recommend pumping septic system every two years for maintenance.
GREASE TRAP:_
(locate on site plan)
Depth below grade: Na
Material of construction: _concrete_metal_FRP_other(explain)
Dimensions: Na
Scum thickness:n►a
Distance from top of scum to top of outlet tee or baffle:Na
Distance from bottom of scum to bottom of outlet tee or baffle: n1a
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.)
Na
(revised 11115195)
6
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 41 Debbies Lane Marstons Mills
Owner: Janice Black
Date of Inspection:6119197
TIGHT OR HOLDING TANK:
(locate on site plan)
Depth below grade: n1a
Material of con struction:_concrete_metal_FRP_other(explain)
Dimensions: n1a
Capacity: n1a gallons
Design flow: n1a gallons/day
Alarm level: n1a
Comments:
(condition of inlet tee, condition of alarm and float switches, etc.)
n1a
DISTRIBUTION BOX: X
(locate on site plan)
Depth of liquid level above outlet invert: Liquid levelwith bottom ofpipe.
Comments:
(note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box etc.)
D-box is structurally sound
PUMP CHAMBER:
(locate on site plan)
Pumps in working order:(yes or no)
Comments:
(note condition of pump chamber,condition of pumps and appurtenances, etc.)
Na
(revised 11115195)
7
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 41 DebbleS Lane Marstons Mills
Owner: Janice Black
Date of Inspection:6119197
SOIL ABSORPTION SYSTEM (SAS):X
(locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive methods)
If not determined to be present,explain:
n1a
Type:
leaching pits, number: 1,oao gallon leach pit
leaching chambers,number:n1a
leaching galleries,number: n1a
leaching trenches,number, length: nla
leaching fields, number, dimensions:n1a
overflow cesspool, number:n1a
Comments:(note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.)
Sas is functioning properly and is structurally sound
CESSPOOLS:
(locate on site plan)
Number and configuration: nfa
Depth-top of liquid to inlet invert: n1a
Depth of solids layer: n1a
Depth of scum layer: n1a
Dimensions of cesspool: n1a
Materials of construction: n1a
Indication of groundwater: n1a
inflow(cesspool must be pumped as part of inspection)
n1a
Comments:(note condition of soil,signs of hydraulic failure,level of ponding, condition of vegetation, etc.)
Na
PRIVY:_
(locate on site plan)
Materials of construction: n1a Dimensions: n1a
Depth of solids: Na
Comments:(note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation, etc.)
n1a
(revised 111115195)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 41 Debbies Lane Marsions Mills
Owner: Janice Black
Date of Inspection:6119107
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100'
Al30
J�
s9
DEPTH TO GROUNDWATER
Depth to groundwater:12 feet
method of determination or approximation:
USGS Maps and Charts
(revised 11115195)
9
I TOWN OF BAR NSTABLE v
� r +
LOCATION SEWAGE
VILLAGE ASSESSOR'S MAP & LOTOII
INSTALLER'S NAME & PHONE NO. \ _� (���
SEPTIC TANK CAPACITY 'lo00 AL-
LEACHING FACILITY:(type) ��� (size)
M
;�-NO. OF BEDROOMS__a- PRIVATE ELL OR UBLIC WATE
UILDE R OWNER �A
DATE PERMIT ISSUED: 1
DATE COLIPLIANCE ISSUED: 1 �/
VARIANCE GRANTED: `Yes No '<
Qu
� J
-k�I
E
T S
No.........6........� Z Fss.... ..............
_
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
............:7QWJU...............O F...........:
0\\
Appliration for Uiu uuttl Works Tonstrnr#tun ramit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
................_. .....Lft. .................................... ............................... ......./- ---......------..........................
-.--- L.cation-Address or Lot No.
................SSrL?�C 1 N a�! ?....-----........-----------------. ......-----------------------------......... . ......------..............----...........-----
w Address
1.4 � ��--� ----------- ----------------------_----...
Y. ler Address
Type of Building Size Lot...ZjQ/_- _00......Sq. feet
Dwelling—No. of Bedrooms.......�................................Expansion Attic ( ) Garbage Grinder ( )
WOther—Type of Building ............................ No. of persons..........................-- Showers ( ) — Cafeteria ( )
dOther fixtures ------------------------------------------------------••----•-••-•............•--••-••• -•-•-••••••••••••••••••••--..........--••••............•.•••-
w Design Flow............ .......................gallons per person per day. Total daily flow.--.......3.56.......................gallons.
WSeptic Tank—Liquid capacity) ....gallons Length... .......... Width... ._.-........ Diameter------------:--- Depth.. ......--.
x Disposal Trench—No..................... Width.................... Total Length..______......._... Total leaching area....................sq. ft.
Seepage Pit No-------/------------ Diameter.... ........ Depth below inlet................ Total leaching area_7"!Qb__`._sEr-ft.�. p�
z Other Distribution box ( ) Dosing tank ( )
a Percolation Test Results Performed by-�Owfv..CAPE.. G!-.�&..................... Date........ : �..._............
a Test Pit No. 1...4_:,.--minutes per inch Depth of Test Pit.../.4C....... Depth to ground water...NO ......
rZ Test Pit No. 2..1-2......minutes per inch Depth of Test Pit... .... Depth to ground water...JW/29�----
ODescription of Soil------------—<4119--........pOIJ............................................................................................................................
x
U -------------------------------------------------------------•..-----..........................-----------------------....----------------------....--------------....................................--
w
VNature of Repairs or Alterations—Answer when applicable...............................................................................................
Agreement:
The undersigned agrees to install the aforedescr'be I iv'dt Sewage Disposal System in accordance with
the provisions of TITLE; 5 of the State Sanitary od T e i I,igned further agrees not to place the system in
un • rtificate of Compliance has a ss d the and of health.
Signed.. . ------•.... ---� D�(e
tion Approved By.. -•••••-•-•-••-••.......- .... ..._.. �� 7 _....
D
Application Disapproved for the following re ons:---••••••......••••••...•......•-•--•••••-•-••---••••-•-•-•••-•••-...•••-•....:................•............----
...............................•-----•••••••••-•--•-•••-•-••-••--••••-•••-•••-••-•--•................•••.-•...••-•-•--•--•••--••••-•--••-••••---•-••--•••••--•-••-••••-••-••••••-•--••-•••••••••--•-----
Date
PermitNo........,... ............................. Issued_........................................................
Date
No.. .......��...L+ 4Jw Fick......._....-_-•--.._r
THE COMMONWEALTH OF MASSACHUSETTS �� !
BOARD OF HEALTH
i
+ lirtttion for Disposal Works Tnnitrnrtinn Prrmit
Application is hereby made for a Permit to Construct O or Repair ( ) an Individual Sewage Disposal
System at
................_- _��.� .:'5........� ................ •-•-••---•-••-•...•-•--•••-••--�..:�1..:..---�D.....--------------.............--•---.....
.-...
_ Location-Address or Lot No.
W ��� we r/ Address
................ ........ y. ......................
............
-•----•----•------------•...............••. •---------•-••--•......••--......----••••
Insta ler Address
Type of Building , Size Lot..__ 6� t.0 l).....Sq. feet
U Dwelling-No. of Bedrooms.......: .....:............ .. p ( )Showers Cafeteria ( )
Other—Type e of Building No. of persons
Attic Garbage Grinder 'I
ayP g. ...............•--•--•----. P ( ) ( )
GaOther fixtures -------------------------------•----..........._.....-'--••-------•-------••------------..---------------------- •--•----•...--•-...........--•
WDesign Flow............. 5..5...........`.........gallons per person per day. Total daily flow..........:�:3 ......................gAlons.
WSeptic Tank—Liquid capacity.. ...gallons Length............ Width.... ._._.__ Diameter---------------- Depth_`9:_.._..._..
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
3 Seepage Pit No-------- Diameter..... Depth below inlet...�'............. Total leaching area..&..�.:sgc--ft.� ' -
Z Other Distribution box (}O Dosing tank (� )
'-' Percolation Test Results Performed by._kMAJ-__t NF--- ........................
r... Date
,aa Test Pit No. 1....<.,....minutes per inch Depth of Test Pit.... 4...... Depth to ground water...NQU ......
(3, Test Pit No. 2._�,Z.....minutes per inch Depth of Test Pit____. j.... Depth to ground water_-__luQ!� ..
.........................................................................................................----- ------ ----•---------
Description of Soil............ ' ------�l 1lJ.......-•.....................•-"•----------------...
V -------------------------------------------•---•-•-••------.-_--....................--------------------.------•---•----.---
W --•---------•••-----------------------------------•---•----------- ------•...._....--•-•------•---•------.......---------------•-••-------------------...---------................-•-.......
U "Nature of Repairs or Alterations—Answer when applicable........................................:......................................................
.....---•-----•-----------------------------------------------------------------------------------------------------------------------------•------._....------------------------------...--•--•••-----•
Agreement:
- The undersigned agrees to install the aforedescribed Indivdt al Sewage Disposal System in accordance with
the provisions of TIT1s 5 of the State Sanitary Code/The undersigned further agrees not to place the system in
tificate of Compliance has abbeenn iss/u/ed/bby the oard of health.
g
Da
)9tion!Approved By --•---•.• - �.�_. . 1............................ 111 D to
Application Disapproved for the following re ons----------------•---•....-•-•-----------------------•--•-----------------------------.......---•--..............
..............•-..............------........---....._....._...------. ..................................................................................................................................
Date
PermitNo......................................................... Issued................................................t.....
Date
THE COMMONWEALTH OF MASSACHUSETTS
OF HEALTH
�rrtifirtttr laf f�larnt�littnrr
THIS IS TO CERTIFY, That the Individual Sewage Di posal System constructed;( ) or Repaired ( )
by------------------------------------------------------------------------�----- 11: .�t?s�_vti�Q.M. ................................-•-------•--.............
Installer
at ��. ..........
- �01 P ----------._. Q------------........1....r....1....---•-----..................----•---
has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Coda as described in the
application for Disposal Works Construction Permit No.... . ?...-_0 _ .Z...__ dated_....��_//._L.7..//_. _e................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL .FUNC ION S TISFACTORY. ��-----
DATE................ ...Z Z-"�(`1 ..?......... 11
Inspector...... f,
i r
s.
fl — 011 — 01 4 THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
G?.I ( .:...OF........=........... ..... ................................
No.......... . Z FEE---••---................
Disjumttl nrkii 00 nptrnrtilan rrmii
Permissionis hereby granted----•----. 1 �:................J.. ------------...-•---...--------------------------------.........._•-•.•••---
to Construct (k) or Repair ( ) an Individual Sewage Dispo4 System `p n
atNo......................---------•- q...........__D... ...........................................- ---------------........
Street
-6 {
as shown.on the application for Disposal Works Construction Permit No.__...-_-----_'__'� Dated __.....�... .._....._. ...... ?......
............................................,U --------------MT.............................
_, , ` Board of Health---E--
DATE. ..--Q.C-. �... . p �-�------ l/
i wr• �
t of Environmental Management/Division of Water Resources II
vm WATER WELL COMPLETION REPORT
Addres WELL LOCATION
s
CitY/Town ejiSrr
G.S.Quadrangle Map
Grid Location ;S
Owner TPV S
Address .�. f mar e.(
WELL USE
Domestic Or- Public❑ Industrial[j CONSOLIDATED WELL
Other TVPe of Water-bearing Rock
Water-bearing Zones
Method Drilled of L1 6=— 1) From
'� /J 2) From—To---
To
Date Drilled -� $L
3► From �—
r CASING 4) From—To=--
Length Diameter Depth to Bedrock ---
• Type /1L
-------- "-- UNCONSOLIDATED WELL
STATIC WATER LEVEL
� r Water bearing Materials
Feet below land surface 0
Date measured 4 (, r Sand: fige❑ m ilium�
' Gravel: fine❑ m coarse®'
GRAVEL P edium❑ coarse❑
ACK WELL Screen:
Yes 0No ❑ Slot _length c�
_from d,7 to f Q t
WATER QUALITY TESTS MADE S oltt#Green for 2nd screen)
Chemical l
❑ Biological ength from_to
�.
❑ Depth To Bedrock
PUMP TEST
Drawdown •
_feet after
How measud Recovery Pumping_ day S
re _ hours at��`GPM•
feet after
•---__ J
LOG of FORMATIONS ---�hours.
Materials From To COMMENTS: (On we//or water)
e
U - �"—
DRILLFR
C°4y�C Firm
yp" Address
�`g�Q
City /LjG•S r a
oa6 y9
Registration No. opSo7
ease pant irm y
i CUSTOMER COPY Aerator s ignature
15M•10.•8S•807101
r
TOWN.OF BARNSTABLE
LOCATION . . SEWAGE n Q\Q
VILLAGE • \ V l ll`
• ,—�_. ASSESSOR'S MAP & LOT DII'"4*
INSTALLER'S NAME PHONE NO-a\ - --^fit 16W J
SEPTIC TANK CAPACITY' t oo6 c,
LEACIlING FACTLY:(tYPe)_ (size)
'o NO. OF BEDROOMS; PRIVATB ELL OAR UBLIC WATE
�; UILTE R OWNER
DATE PERMIT ISSUED:-
DATE .COMPLIANCE ISSUED; I Z 2.�)
VARIANCE GRANTED: -Yes NO '�
CERTIFICATE OF ANALYSIS Page. 1
Barnstable County Health Laboratory
Report Dated: 5/13/2004
Report Prepared For:
Order No.: G0424927
Lavia Scroggins
41 Debbie's Lane
Marstons Mills, MA 02648
Laboratory ID#: 0424927-01 Description: Water-Drinking Water
Sample#: 24927 Sampling Location 41 Debbie's Lane Marstons Mills MA Collected: 4/28/2004
Collected bv: L Scroggins Received: 4/28/2004
I I
Routine
ITEM RESULT UNITS RL MCL Method# Tested
LAB: IC Lab
Nitrates 2.4 mg/L 0.1 10 EPA 300.0 4/28/2004
LAB: ffetals
Copper 0.1 mg/L 0.1 1.3 SM 3111 B 4/29/2004
Iron <0.1 mg/L 0.1 0.3 SM 3111B 4/29/2004
i
Sodium 10 mg/L 1.0 20 SM 3111B 4/29/2004
LAB: Microbiology
i
Total Coliform Absent P/A 0 Absent 307 4/28/2004
i
LAB: Physical Chemistry
I
Conductance 110 umohs/cm I EPA 120.1 4/28/2004
i
pH 5.5 pH-units 0 EPA 150.1 4/28/2004
Water sample meets the recommended limits for drinking water of all the above tested parameters.
Approved By: Ca_ _ ` cw
bb Director)
Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605
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