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HomeMy WebLinkAbout0295 LONG POND ROAD - Health 295 Long Pond Road, Marstons LA = 013-056-002 Mills I 2-0 I ooq �LS Z� Zo�%� �oav , • y { si i i { i Jq : f i : : • r � y t � t a 1 I , _ t y l 1 , F i { ` , ; « 1 t `s y { , 1 E i ! : y ; ` I a � tow, P t t j , } -- LL Gcd CS=C t^t'i { C k'a si - 1 • i � { i I � v �— y_. , ' i i t } f t s •� i � ,_ 3 1 t 1 ! 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Septic Inspection Services Co. 3 `° Company Name rab 189 Cammett Road Company Address i C Marstons Mills MA ---Q2648 M'e rerun City/Town State URg-ip Code 508-428-1779 Sl 12855 License Number Telephone Number -1 -I~- B. Certification 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 experier ce 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 15.000). The system: ® Pusses ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the L cal A proving Authority July 24, 2008 Inspector's Signature Date The system inspector shall submit a copy oft lis inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, an the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. 08-200 Breski.doc•08106 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 1 of 15 of Massachusetts h v OffiCiallns Subsurface Sewage Disposal System F� Ction Form Form Not for Voluntary Assessments 295 Long Pond Road Property Address Owner David Breski i information is Owner's Name required for Marstons Mills every page. City/Town MA 02648 Sta Zip Code JuIY 24, 2008 Date of Inspection B• Certification (cont.) Inspection Summary: Check A,B,C,D or E/a ways complete P all of Section D A) System Passes: ® I have not found any information.which ind Cates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 xist. Any indicated below. failure criteria not evaluated are Comments: Tank is not in need of pumping at this time, Lea hing pit was half full stain line indicating pit has 8"of effective leaching. at time of inspection with a high B) System Conditionally Passes: ❑ One or more system components as describ d in the "Conditional Pass" section need to be replaced or repaired. The system, upon com letion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y, N, ND) in t e❑ 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 infilt ation 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: ❑ Observation of sewage backup or break out oi high static water level in the distribution box due to broken or obstructed pipe(s) or due to a bro en, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed 08-200 Breski.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 Commonwealth of Massachusetts Title 5 Official Inspec ion Form Subsurface Sewage Disposal System Form - No for Voluntary Assessments w 295 Long Pond Road Property Address David Breski Owner Owner's Name information is Marstons Mills M 02648 Jul 24, 2008 required for Y every page. Cityrrown St to Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replac d ND Explain: ❑ The system required pumping more than 4 limes 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: C) Further Evaluation is Required by the Bo 3rd of Health: ❑ Conditions exist which require further evalu tion 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 Hea th determines in accordance with 310 CMR 15.303(1)(b)that the system is not functic ning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet oi a surface water ❑ Cesspool or privy is within 50 feet o 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 functioninc in a manner that protects the public health, safety and environment: ❑ The system has a septic tank ands it 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. 08-200 8reski.doc•08/06 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts s Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 295 Long Pond Road Property Address David Breski Owner Owner's Name information is required for Marstons Mills every page. Cityffown MA 02648 Jul y 24 2008 State Zip Code Date of Inspection i B. Certification (Cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS e nd the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analy is, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence o 7 ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No" to each of the following for all inspections: Yes No ❑ ® Backup of sewage into fE cility or system component due to overloaded or clogged SAS or cesspoo ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters .due to an overloaded or alogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than_day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: - ❑ ® Any portion of the SAS, c sspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool o privy is within 100 feet of a surface water supply or tributary to a surface water supply. 08-200 Breski.doc•08/06 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 4 of 15 -commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 295 Long Pond Road Property Address David Breski Owner Owner's Name information is required for Y Marstons Mills A 02648 Jul 24, 2008 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® 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 cesspo I 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 ell water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as describe J in 310 CMR 15.303, therefore the system fails. The system owner should co itact 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. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 'eet of a surface drinking water supply ❑ ❑ the system is within 200 eet 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 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. Tie system owner should contact the appropriate regional office of the Department. 08-200 Breski.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 r 'Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - N t for Voluntary Assessments •''f 295 Long Pond Road Property Address David Breski Owner Owner's Name information is Marstons Mills A 02648 Jul 24, 2008 required for Y every page. Cityrrown 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 c mponents pumped out in the previous two weeks? ® ❑ Has the system received iormal flows in the previous two week period? ❑ ® Have large volumes of we ter been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank man ioles uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liqui , depth of sludge and depth of scum? ® ❑ Was the facility owner(an J occupants if different from owner) provided with information on the proper aintenance of subsurface sewage disposal systems? The size and location of he Soil Absorption System (SAS) on the site has been determined based o : ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) (310 CMR 15.302(5)] 08-200 Breski.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 295 Long Pond Road Property Address David Breski Owner Owner's Name information is required for y Marstons Mills A 02648 Jul 24, 2008 every page. Cityrrown !;tate Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (forexample: 110 gpd x#of bedrooms): 330 Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (if y Ds separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ear, usage d N/A Well Water 9 ( Y 9 (gpd)): Sump pump? ❑ Yes ® No Last date of occupancy: Currently Occupied Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Gallons per day(gpd) . Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 s stem? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): 08-200 Breski.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 295 Long Pond Road Property Address David Breski Owner Owner's Name information is Marstons Mills A 02648 Jul required for Y 24, 2008 every page. Cityrrown E tate Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: None Was system pumped as part of the inspection., ❑ Yes ® No If yes, volume pumped: I gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, s it 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 th DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: Compliance date: 5/14/91 Were sewage odors detected when arriving at he site? ❑ Yes ® No 08.200 Breski.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 15 I Commonwealth of Massachusetts Title 5 Official Inspec ion Form Subsurface Sewage Disposal System Form - No for Voluntary Assessments M 295 Long Pond Road Property Address David Breski Owner Owner's Name information is Marstons Mills MA 02648 July 24, 2008 required for S to Zip Code Date of Inspection every page. City/town D. System Information (cont.) Building Sewer(locate on site plan): 1' Depth below grade: feet Material of construction: ❑ cast iron ® 40 PVC ❑ ther(explain): Distance from private water supply well or suct on line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): 1' Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ liberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Complianc ? (attach a copy of certificate) ❑ Yes ❑ No -------------------------------------------------------------------------------------- 8.5' long x 5.2'wide- 1000 gal. Dimensions: 2" Sludge depth: - 28" Distance from top of sludge to bottom of outlet tee or baffle 1 , Scum thickness 6. Distance from top of scum to top of outlet tee r baffle — 13" Distance from bottom of scum to bottom of ou let tee or baffle Measured How were dimensions determined? 08-200 Breski.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 -Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 295 Long Pond Road Property Address David Breski Owner Owner's Name information is required for Marstons Mills MA 02648 July 24, 2008 every page. City/Town E tate Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Liquid level was found at bottom of outlet invert, tees are intact and clear. Tank is not in need of pumping at this time. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ iberglass ❑ 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 Comments (on pumping recommendations, inlE t and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidencE of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): 08-200 Breski.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 •Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 295 Long Pond Road Property Address David Breski Owner Owner's Name information is required for y Marstons Mills A 02648 Jul 24, 2008 every page. Cityrrown !;tate Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank (cont.) Dimensions: Capacity: gallons , Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract (req fired). Is copy attached? ❑ Yes ❑ No Distribution Box (if present must be opened) locate on site plan): Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any _ evidence of leakage into or out of box, etc.): Liquid level at bottom of single outlet pipe, no solids or high stains. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 08-200 Breski.doc•08106 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form qot for Voluntary Assessments 295 Long Pond Road Property Address David Breski Owner Owner's Name information is Marstons Mills MA 02648 Jul 24, 2008 required for y every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.).- Soil Absorption System (SAS) (locate on sile plan, excavation not required): If SAS not located, explain why.- Type: ® leaching pits number: One 6x6 pit. ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: — — Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): -Leaching pit was found half full with a high staip line indicating pit has 8" of effective leaching. 08.200 Breski.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - of for Voluntary Assessments 295 Long Pond Road Property Address David Breski Owner Owner's Name information is required Mills re equir wired for MA__ 02648 July 24, 2008 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Cesspools (cesspool must be pumped as pat of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert . Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hyd aulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids ----- Comments (note condition'of soil, signs of hydr ulic failure, level of ponding, condition of vegetation, etc.): 08-200 Breski.doc.08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 15 -Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 295 Long Pond Road Property Address David Breski OwnerOwner's Name — _..-----___._..._-_------_ _---------------...------------------------------------- information is Marstons Mills A 02648 _ July 24, 2008 required for ----------------.----_.__.._.-_ ... .__....--.-- every page. Cityrrown Slate Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide e 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 bL ilding. \ \• \ \ \ \ \ \ \ \ \` \ F\F 12, ,* / i`f / f I r J`/ 1. 14 20 6 wl; 29 z�a 37 126 a i, :: Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,w 295 Long Pond Road Property Address David Breski Owner Owner's Name information is Marstons Mills IV A 02648 July 24, 2008 required for every page. Citylrown S ate Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells 30 Estimated depth to 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 re iewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Healt - explain: ❑ Checked with local excavators, installers - (attach documentation) ® Accessed USGS database -explain: USGS topo map and town GIS. You must describe how you established the h gh ground water elevation: Town groundwater contour map shows water elow el. 55 and topo map shows property at el. 90. 08-200 Breski.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 tHE Town-of Barnstable OF Tp� Regulatory Services BARNSTABM Thomas F. Geiler, Director 9^ i $ AjFp3,�A Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 REGARDING SEPTIC INSPECTIONS BY PRIVATE CONTRACTORS 6 DISCLAIMER This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original or copy of the report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observations and interpretations contained within this report. In addition, by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would be listed. on the "Disposal Works Construction Permit". If you should have any questions regarding this report, please contact the certified Septic System Inspector who conducted the inspection. QASLPTIC\Disclaimer Private Septic Inspect ions.DOC Commonwealth of Massachusetts John Grad Executive Office of Environmental Affairs D.E.P. Title V Septic Inspector 2119 Department of P.O. Box A 02 Environmental Protection Teaticket, MA 02536 ' (508) 564-6813 `� I_ .19 4 S d0 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM f �d CERTIFICATION ' J ;?tL��V�D (-U N(r �a N � UL 3 Property Address: 296 Longpond Rd. Marstons Mills Ma.02648%ddress of Owner: ToWNor 1 1ggT Date Nameof Inspection:of Inspector:J1ohn9Grac1 (Ed Fif lanningnt) HE(Np vs N Company Name,Address and Telephone Number: A 1 E ti 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 y _ Conditionally Pa es code 310 CMR 15.303.My findings are of how the system is _ Needs Fu er aluation B the Local Approving Authority performing at the time of the Inspection.My Inspection does y PP 9 ty not Imply any warranty or guarantee of the longevity of the Falls septic system and any of Its components useful life. r Inspector's Signature: G Date: 7129197 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 1 lit 5195) 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: 295 Longpond Rd.Marstons Mills Ma.02648 Owner: Ed Fanning Date of Inspection:7123197 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: 295 Longpond Rd.Marstons Mills Ma.02648 Owner. Ed Fanning Date of Inspection:7123197 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: 295 Longpond Rd.Marstons Mills Ma.02648 Owner: Ed Fanning Date of Inspection:W23197 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. x As 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: 295 Longpond Rd.Marstons Mills Ma.02648 Owner: Ed Fanning Date of Inspection:7123197 FLOW CONDITIONS RESIDENTIAL: Design flow: 330 gallons Number.of bedrooms: 3 Number of current residents: 4 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: nfa COMMERCIAL/INDUSTRIAL: Type of establishment: n1a Design flow:9 gallons/day Grease trap present:(yes or no) No Industrial Waste Holding Tank present: (yes or no)_!0 Non-sanitary waste discharged to the Title 5 system: (yes or no) No Water meter readings,if available: nia 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 in the last year. System pumped as part of inspection: (yes or no)Yes If yes,volume pumped: 1500 gallons Reason for pumping: Maintenance. 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: 5.14.01 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: 295 Longpond Rd.Marstons Mills Me.02648 Owner: Ed Fanning Date of Inspection:7123197 SEPTIC TANK: X (locate on site plan) Depth below grade: 1' Material of construction:X concreate_metal_FRP_other(explain) Dimensions: L 8'6'H 5'7"W 4'10' Sludge depth:3' Distance from top of sludge to bottom of outlet tee or baffle: 24" Scum thickness:V 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: 17" 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 system every one to two years for maintenance. GREASE TRAP: (locate on site plan) Depth below grade: nla Material of construction: _concrete_metal_FRP_other(explain) Dimensions: Na Scum thickness:n1a Distance from top of scum to top of outlet tee or baffle:n1a 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: 295 Longpond Rd.Marstons Mills Ma.02648 Owner: Ed Fanning Date of Inspection:7123197 TIGHT OR HOLDING TANK: (locate on site plan) Depth below grade: n1a Material of con struction:_concrete_metal_FRP_other(explain) Dimensions: nia Capacity: n1a gallons Design flow: nia gallons/day Alarm level: n1a Comments: (condition of inlet tee,condition of alarm and float switches, etc.) n1a. DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: n1a Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box etc.) nla 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.) n1a (revised 11115195) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 295 Longpond Rd.Marstons Mills Ma.02648 Owner: Ed Fanning Date of Inspection:7123197 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: 1,000 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.) The leach pit is structurally sound and functioning property.It had 2'of water in it Shows signs of being 314 full CESSPOOLS: (locate on site plan) Number and configuration: nia Depth-top of liquid to inlet invert: n1a Depth of.solids layer: n1a Depth of scum layer: n1a Dimensions of cesspool: nia 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.) nla PRIVY:_ (locate on site plan) Materials of construction: n1a Dimensions: n1a Depth of solids: nla Comments:(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) nla (revised 11115195) I 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 295 Longpond Rd.Marston Mills Ma.02648 Owner: Ed Fanning Date of Inspection:7123197 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' no Ag �y Ac 37 11 DEPTH TO GROUNDWATER Depth to groundwater: 12 feet method of determination or approximation: USGS Maps and Charts-12+feet (revised 11115/95) 9 TOWN OF BARNSTABLE LOCA c SEWAGE # VILLAGE �'I M , �� ASSESSOR'S MAP & LOT INSTALLER'S NAME PHONE NO. T 0 v;v '� o SEPTIC TANK CAPACITY 16%3 0 t LEACHING FACILITY:(type) /000 (size) ( 72 NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OWNER `FA/V NI 41� DATE PERMIT ISSUED: � � � l DATE COMPLIANCE ISSUED:'` VARIANCE GRANTED: Yes No �� L�, �.�.. �� ct Z� 3`� �� No... . ..... � Fus..., ............_. THE COMMONWEALTH OF MASSACHUSETTS BOARD F H D/}✓I✓--------------------OF.-... ........................... ......................................... Appliration for Disposal Marks onstrnr#ion Prrmit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal Sys at .......... . .�s �.'...a/6....t�. ?'. ---4................. .���. - ........ •--- .... ------------------------------------ -.� Locati ry�Address or Lot No. -Owner Address W a .. ...................• .... ....... ..... ........................... Iastaller Address a Type of Building Size Lot..��r�7.. .Sq--€eet Dwelling—No. of Bedrooms.._ ...�..............................Expansion Attic. (, Garbage Grinder (-M Other—Type e of Building �....._._. No. of persons............................ Showers — Cafeteria a yP g ... P ( ) ( ) 124 Other��lres ..........-----•---•--•................................I------------------------------------------....... ............Design Flow........ .. .............gallons per person per day. Total daily flow...................... •.---.............. Ions. W b WSeptic Tank—Liquid'capacity/ .ga.11ons Length.A...... Width %........ Diameter................ Depth..._� '_..... x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....--.............sq. ft. Seepage Pit No...®? Diameter.../ ......... Depth below inlet..(o. l 4;4...yq. ft. Z Other Distribution box ( ) Dosing tank ( ) - 41S RT. 8A �7 Percolation Test Results Performed by..... 7.n. -a-A�t................EAS P•O. 818 /` ,.� Test Pit No. 1................mmutes er inch Depth of Test Pit.................... o ou9i wa er_....................... f=, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ -------------------- ------------ -... •... •.......... ------------------ -------------------- --- •------------- --•----•----•-----•-••-•••---------- ---- 0 Description of Soil........................................................................................................................................................................ W U -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- W x ---------------••----•-••---------•---•------------•-----••--------..........--•--..........----------------------------------------.......---------•-------..........---------•----•----------•----.... U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ----•---------------------------•------.....----••--•-•---•--........................----.....----•----•----.........--------•-----...........-•----......-------•--•--••--------------...--•-------..-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of L I'L LE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has as been i s by he board of health. �-�lJ to Application Approved By....... . . .._.... Date Application Disapproved for the following reasons---------------------•-•--------•------------- .......................................................... - ...................................................................................................................................................................................................... - Date Permit No....---, - `°'_� ............... Issued - k-X- .. to .. .. - --- -- -- -Date No.... f FEs............._............_. -� THE COMMONWEALTH OF MASSACHUSETTS BOARD. :.:..��r F H _ /w--------------------OF..... :..:..::: C`e Appliraa#ion for Bisposaal Works 0austrurtion Famit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal Syst at: ........ ---.___., ..... �- --- ...._........... .. . ... ............. . r Locatio -,Address -�. � Owner Address W Installer Address Type of Building Size �-, Dwelling—No. of Bedrooms..__ _._,�___-----------------Type Building No. of persons............................ Showers — Cafeteria a YP g P ( ) ( ) P' Other fix res ---------------------------------- ------ -- W Design Flow.........t5. '............. ...gallons per person per day. Total dailyflow......Rn....._.........._...---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.._ZP..._...... Depth below inlet._ �. .___. Total leaching area.1_4.%+.,.. q. ft. Z Other Distribution box ( Dosing tank ( ) '-' Percolation Test Results Performed by..... -_ � ..._......: ' W ••----•--••--------------- Date-------------"-.........------�------ Test Pit No. l................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fi Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ... ----------------------------------------------------------------- -------------------------------- ----..--------•-•-•----------•---•----------- -•------- .-- 0 Description of Soil......................................,................................................................................................................................. x U ---••------------------------------------••----•-•••-----...._.........•-••-.......----------._..........-------------------------------•--•----------------------------------------•----•-•-----•....._ W -----------------------------------------------------------------------------------------------------------•-----------------------------------•--...------------...................--•---------••------ U Nature of Repairs or Alterations—Answer when applicable................................................................................................ ------------------------------------------------•-•--------•-------------------••---.......•----------------------------------------------- ............................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed...................................................................................... .................... Date Application Approved By..-- =-••- ---:•-. m fir.' Application Disapproved for the following reasons:.............................................'`.............................................................. ............................................•------------•--............_..-•--------•-•---••------_........ ...........•----...•------•----....---.----------------------------- -•------•••--- Date Permit No.......4F. ' ! ... Issued......... _ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................oF....,/ sb ""............................... Tertifiraatr of Tompliaanrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (405�0e) or Repaired ( ) by... .... ................ ----------- .....'-•--•.....----•..............•--•'-•"'-_.._.._..-•---•......••.._...-•-•-....__ Instal has been installed in accordance with the provisions of TITLE 5 o h �ani Coe as escribe in the application for Disposal Works Construction Permit No.... � ,,._. dated__.-___ _ _. ..• __�,,,, ? THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.........- 1��. ............. Inspect ._..:- ------ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........... ..... OF..... y,.. �.... ....�/.................... Disposal Workii Tondrnrt#inn rranit Permission is hereby granted.........-............................................................................................................................ to Construct ( />) or Repair ( ) an Individual Sewage Disposal System � ,�� at No / '�.. - eet as shown on the application for Dispo Works Construction Permit N p__ _� ated..... ------------ •........... ............... --------- ---------------------------- oard of Health DATE.............g--- I.C2...- ------------------------------------ FORM 1255 A. M. SULKIN, INC., BOSTON r Log Number: ' Bottle # BC 974 Date:_4 April 1.9, 1991 BA BARNSTABLE COUNTY.HEALTH AND ENVIRONMENTAL DEPARTMENT .1_ SUPERIOR COURT HOUSE p BARNSTABLE, MASSACHUSETTS 02630 J . �sAS5 � DRINKING WATER LABORATORY ANALYSIS PHONE:362-2st1 �ixt.337 Client: Ed Fannin2l Collector:— - Sean 9 O'Brien Mailing Address: ong on ""' Affiliation:+ ` '' ' ` BCHED Mars tons Mills , MA 02648 '' Time'& Date of " " Collection: ' ' " 4/16/91 , 1:40pm Telephone: 428-7411 Type of Supply: Well Sample Location: 291-B Long Pond Rd. Well Depth: - 74' Marstons Mills, MA Date of Analysis: 4/16/91 , 3:25pm PARAMETER SAMPLE RESULT RECOMMENDED LIMITS • to . . , . t Total Coliform Bacteria/100 ml 0 0 pH 5.1 Conductivity micromhos%cm "• "t 104 ' ' ` ' 500.0 Iron m) 0.8 0.3 Nitrate-Nitro en m 3.1 10.0 Sodium m :,,, 8' 20.0 Copper m ,` 0.1... 1.0 I. Water sample meets the recommended limits for drinking of all above tested parameters. II . XX Based only on results of the parameters tested for this sample, the water is suitable for drinking but may present the problems checked below: A. Water sample has higher than average levels'of Nitrate. , Future monitoring is recommended (2-3 times per year) to establish any upward trends. B. The low pH of the water may shorten the useful life of the house's plumbing. C. XX Water may present aesthetic problems' (taste,' odor',* staining) 'due to � Iron D. Water sample has high levels of sodium. Persons on low sodium diets should consult their doctor. III. Due to one or more of the reasons checked below, this water sample is unfit for human 'consumption: A. High' Bacteria' B'. High' Nitrates REMARKS: CC: Barnstable Board of Health CC: Laboratory Director 1 /7/85 i iCt,1 t. 5 Al Explanation of Test Results 3 Y.t • '1?J�'t•1 ir.r t��,� ctr;'n<,;;w s� �t ;,.a Rt.wC(1 a � ,dtS,JS'�.i94M1 ,:�•tS/iif�'.�teac,^• � ;'.'� '' �aa Total Coliform Bacteria F' TCa•t() �i_i 5� 11�.s' Coliform bacteria are an indicator of the sanitary quality-of a water supply. Water'supplies may become contaminated from,malfunctioning septic systems,,.cesspools and surface runoff:,:A total coliform count of zero indicates that your water supply is safe and approved for.human consumption. A total coliform count of greater than I i zero is most often the result of accidental.contamination;of the sample bottle through improper sampling methods. For this reason. it would be advisable to retest, anyf:well,Watee that is not approved. pH I «J)'�� - '..__.'.' fr1.. . 1,`!,1� f'• pH is the measure of acidity or alkaliniyof the water.On-the pH scale,the number 7 is neutral,less than 7 is acidic and more than 7 is alkaline. The pH of water on Cape Cad tends to be!acidic in the range of 5.0 to 6.5. i _ Conductivity rr Conductivity is a measure of the dislolved salts in solution. Amounts in excess of 500,micromhos/cm,are generally,-,,- ' considered unacceptable and may have a laxative effect upon users. I Iron ,• ,,r. I .__.. .. _.. . ..... � �` . !t^t7;` a'i ! " - � f.. �. The presence of iron in water in concentration of .3 ppm or greater may: give the water a bittersweet astringent taste, cause an unpleasant odor, often gives the water a brownish color and cause staining of laundry and porcelain. The average concentration of iron in Cape Cod's water is .2 - .6 ppm. Although the presence of iron in water may. : I: cause the problems listed above, it is not considered deleterious to health. iron may be removed by use of an iron removal system. I fr. Itt, 2.i (;fli ` !—t :��at1; :al. ;r•:; Nitrate-nitrogen The Massachusetts Drinking Water, Regulations ha%,c-tiet a;maximum contaminant level for nitrates at 10 ppm. Excessive concentrations may cause methem�globinemia (an infant disease) and have been suggested to form potentially carcinogenic nitrosamines.•Conta,mination-sourcps include fertilizers, cesspools and industrial wastes. ' VfiF': i� i ( ! :Ir^ 3 U_Ic(f?; .; h ;. ,.l:, .,. � ( --,,t ?ii,i 1,` i'y(':Ii� yi:•ill '"f (.il`1 .��,'. +.1 ;'�� i.•. : '' ., Copper Due to the acidic nature of the water,on Cape Cod,:copper,,tends to leach from pipes.,This normally does not present a health hazard; however, concentrations'in excess of 1.0 ppm may cause a metallic taste and/or a bluish-green stain on porcelain fixtures. p ;,d i' t 11`f_�r� 'I ho $odium r n f• r, n�rc,^. r! i try ,r..,,a "Pf1 E^,'� "` ' !,4"' A concentration of sodium over 20 ppm is onlv of;concern,to)people,who are on,a low sodium-diet. If the water supply has more than 20 ppm sodium, it is up to the people who are on such a diet to find another source of drinking water or contact their doctor to determine if consuming the water is advisable. Concentrations exceeding 50 ppm ind;cate that there may be ocean water or road salt runoff water getting into the well. "" ' 1B1 = BARNSTABLE COUNTY HEALTH ,AND ENVIRONMENTAL DEPARTMENT SUPERIOR COURT HOUSE p BARNSTABLE, MASSACHUSETTS 02630 p r n/ TABLE 1. Compounds Detectable by EPA Method 502.1* PHONE: 362-2511 Mn5C - EXT. 330 . LAB 337 COMPOUND D.L. COMPOUND D.L CLINIC 340 Benzene 0.5 1 ,1-Dichloroethane 0.5 . Carbontetrachloride 0.5 1 ,1-Dichloropropene 0.5 , l ,l-Dichloroethylene 0.5 1 ,3-Dichloropropene 0.5 1 ,2-Dichloroethane 0.5 1 ,2-Dichloropropane 0.5 para Dichlorobenzene 0.5 1 ,3-Dichloropropane 0.5 Trichloroethylene 0.5 2,2-Dichloropropane 0.5 1 ,1 ,1-Trichloroethane 0.5 Ethylbenzene 0.5 Vinyl Chloride 0.5 Styrene 0.5 Bromobenzene 0.5 1 ,1 ,2-Trichloroethane 0.5 Bromodichloromethane 0.5 1 ,1 ,1 ,2-Tetrach,loroethane 0.5 Bromoform 0.5 1 ,1 ,2,2-Tetrachloroethane 0.5 .. Bromomethane 0.5 Tetrachloroethylene 0.5 Chlorobenzene 0.5 1 ,2,3-Trichloropropane 0.5 . Chlorodibromomethane 0.5 Toluene 0.5 Chloroethane 0.5 para Xylene 0.5 Chloroform 0.5 ortho Xylene 0.5 Chloromethane 0.5 meta Xylene 0.5 ortho Chlorotoluene 0.5 Bromochloromethane 0.5 para Chlorotoluene 0.5 . Dichlorodifluoromethane 0.5 Dibromomethane 0.5 Fluorotrichloromethane 0.5 meta Dichlorobenzene 0.5 Hexachlorobutadiene 0.5 ortho Dichlorobenzene 0.5 Isopropylbenzene 0.5 trans-1 ,2 Dichloroethylene 0.5 n-Propylbenzene 0.5 cis-1 ,2 Dichloroethylene 0.5 Sec-butylbenzene 0.5 Dichloromethane 0.5 Tert-butylbenzene 0.5 . � D.L. is Detection Limit in micrograms per liter or parts per billion (ppb) . This table lists our normal limits of detection. If we report a smaller amount, then our detection limit was lower for that analysis. *A photoionization detector is used in series with the electroconductivity detector, thus allowing for the analysis of most of the compounds listed in EPA Method 503.1 as well . TABLE 2. Compounds which have Maximum Contaminant Levels (MCLs) set by the Environmental Protection Agency. COMPOUND MCL (in ppb) Benzene 5.0 Carbontetrachloride 5.0 . 1 ,2-Dichloroethane 5.0 l ,l-Dichloroethylene 7.0 para Dichlorobenzene 75 1 ,1 ,1-Trichloroethane 200 Trichloroethylene 5.0 j. Vinyl Chloride 2.0 Total Tr'h 1 i a ometh anes 100 Chloroform, Bromodichloromethane, Chlorodibromomethane; ,and Bromoform comprise the total trihalomethanes. A BARNSTABLE COUNTY HEALTH AND ENVIRONMENTAL DEPARTMENT LABORATORY REPORT VOLATILE ORGANIC CHEMICAL ANALYTICAL RESULTS Client: ED FANNING Collection Date: 04/16/91 Mailing Address: 291 LONG POND ROAD Date of Analysis:04/17/91 MARSTONS MILLS , MA 02648 Type of Supply: WELL Well Depth (FT) : 74 Telephone: 428-7411 Sample Location:291 LONG POND ROAD LAT. (DDMMSS) : Not Given MARSTONS MILLS LONG. (DDMMSS) : Not Given Collector: SEAN O' BRIEN Map/Parcel: Affiliation: BCHED Analytical Method: 502 . 1=1 , 502 . 2=2 , 503 . 1=3 , 504=4 , 524 . 1=5, 524 . 2=6 , 502.1/503=7 --------------------------------------------------------------------- --------------------------------------------------------------------- Contaminants Anal . Result MCL Detection Detected Meth. ug/l ug/l Limits (ug/1) --------------------------------------------------------------------- Chloroform 7 3 .1 0 .2 Only those compounds listed above were detected. Attached is a list of compounds for which this sample was analyzed. NOTE: Contaminant levels equal to or exceeding the Detection Limits are reported. MCL means Maximum Contaminant Level for EPA-regulated compounds . (ug/1 = micrograms per liter = Parts Per Billion) The Environmental Protection Agency has set Maximum Contaminant Levels (MCL) for the following compounds . This sample compares as follows : COMPOUND MCL (in PPB) Benzene 5.0 * level not exceeded * Carbon Tetrachloride 5. 0 * level not exceeded * 1 , 2-Dichloroethane 5.0 * level not exceeded * 1 ,1-Dichloroethene 7 .0 * level not exceeded * 1 , 4-Dichlorobenzene 75 * level not exceeded * 1 , 1 , 1-Trichloroethane 200 * level not exceeded * Trichloroethene 5.0 * level not exceeded * Vinyl Chloride 2.0 * level not exceeded * Comments or additional compounds found: /_' - Z i1o"I'a + Bernard E. Bartels , Ph.D. L orato Director TO NF BA STABLE O LOCATION C'� .. SEWAGE# VILLAGE �Y1 �Vli I�5 -ASSESSOR'S MAP&PARCEL 1 *h+ 'S NAME&PHONE NO. r►`G O a n�wll L `�'�9 SEPTIC TANK CAPACITY 16.00 LEACHING FACILITY:(type)'�?i (size) 1000 NO. OF BEDROOMS 3 .OWNER, PERMIT DATE: XE DATE.-)P. -7 b4166 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 W b w" 1 IF` j 1 i i 14 20 6 29 Arai � i T 37 36 a, . I . . . . _ ^ . . ,, : _ II I._I 1I.�I.I I I..��1II I I i..-1�...I�.I. ,II-.-\..__._,1_I�:II �- • ;�% .�/.I I�.�_��I._I-�I.I I I�.I I,I rI 1.I.1I�I...-I.I/-I,It..I1 I�II.I-I I,'I..,I�.-,I.I 4I I1 1.�r.'.1,III.� SEPTIC TANK LEACJr-IING PIT ; �. , j. , : TOP OF FO NDATIOh t 2. -FINISH GRADE OVER LEACHING PIT 7 S EL • T ,.� --�- - ', .. , r RADE VAR E . . I2 A . .. G I S _ M I , ,,. • FINISH GRADE �... �-i- ' d. ,r Q. y�? o �* as , EL. 4 PVC OR EOU/Y •.:Q' :C.: =4.• 'biy-: -V�I•:.V.�%q.•,tV"aad•: :`�4: l''RISER �: g IN Pi'f+C3Y //4ER. FT K ,r 4; - . 3"faF' G'B !!2 .: - - tl a _ . iYe4SJf PEA N a Sr4 E`, � 6• 'y ,1 ,:: .y.' _ . - .: s 4 • - ., a . b : .� �` O Oat 3 Q' a , p S . .d:v •.; a ,0 ; - • _ $- I i, �a . ; .. •;qua �• p b U a s p D d �..: :C g g, ,, ri �} v a ,, 0. w _ �� �, 4 , p 0 ,� W . �i �, b - , 0 0 � � •Q 4, , C� y . .. p• 4 0 0o CAT ° Q 0 ,� / GALLON PRE S 0U � e BASEMENT Q:4 . a .a a ` ` . : . . v..4:: CONCRETE H-/a REINFORE'D "C1 Q C.. ,� O O D PRECAST CONCRETE '% J .4:. _V 1112 V d - .. O 0 0 O N-/D, REINFORCED , P.. . i4'�SHEa 0 � ���- :.:v: 4 0 e':�0•r4'•1�:•o:t4 ?A•.A.%. :1Q;�O 4':r4..A' 4 ,19E , 01^ '2 fF'f CRUSE 0 i � 0 •Q•4•;c-:V'•:q: O : 7) Sr, / srONE d 0 Q p ` To /9£ sET' oN A !r`vEL AA!sz' D , o �� w x so a . a p t qos'' ,D/AEiNS/ NS 8_6"L X . . . 1, ;, /r. �00 , . . . , . FFFEcrivE aIMErER /q.1oZ .9 qfl _ X 'J fJ` /(v3 Td lgC SET©N A L - - ,�AS,�- w • - I. iI t.,. D o r?"oCl bF, 7`hj f�r°G �} �, . . . ... i - - - . „ ' ,. TP" TP-� EL. DESIGN CRI TERIA L �g f - 3 , o NUMBER OF BEDRt?OMS= GARBAGE DISPOSAL-` , YES NO TOTAL ESTIMATED FLOW=_ZZ 1D GP.IJ ; ,� PERCOLAr10N,RATE A m1N/1NCH. k NUMBER OF LEACHING RTS_L `` z SIDEWALL AREA= 21l RH= 3 1 8 8 S.Fx�G.P.0./SF= q7/ G PD. 5, o - ::.� j, k 80TT0M AREA=, TIRY, " , 78 s.Fx Z G.PD./S.F. : G.p • . l ' TOTAL LEACHING PROVIDED= G.P•D, x. r . ( . . . ,.. _ _ !: �I.� I. I I��.. .Ii!;/I..I.I/,4�..�. 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Z -_.. d' O i 4 r I/ • - 1 ' . . - . . FLOOD PLAIIV• C ERVA77ON PI TS . l�BS ZONE . DATE' 3/X/ - /_� cr R�F�CGf' , �92 PERFORMED BY: •T. AG o,,r' ',-z. �i ir9C.K5o/ ` . cps /� i9 NCO ' .� c- BOARD OF HEALTH �_ .tea /yo,�i� I E EXCAVATOR - L E E,va ? t . 1i j xls:ivy ,5/'07- ,1'4: .2 3 x Sc3 NOTES• ,�ZIS171 -a.,4// --,� -- . , Wovo sEa,sAoT .cl j Q s� FVATION ARE BASED OYV..�gSd/lE7.� DATI//y J U I RfDIhIG TO OlfovoDsE.D cowrlDUrI - _ , - . � ~ i 2. THE SEPTIC SYSTEM SHALL BEINSTALLED ACCO ._ \ -d <�T T7TLE V B ANYLOC4L RULES THAT APPLY . TZ`s T Hot"-. 4- T ': .3 PRIOR TO BACKFILLING THE .l" r XARD O/F 3 3> f FIED. :r HEALTH SHALL 8E NO @� 1 tp0 4 WATER SUPPLY ISPROVIDEG 8Y L - v �? , . ... ;. " .� `Z9g 5. REMOVE ALL UN5wTAB._E MATER.fAL FOR TEN FE ETIN ALL •6y ,�, r DIRL TIONS AND TO A1+J E>_EV OF S. o BACKr IL L W/TH 1 r I e CLEAN SAND 1N COlYPL1ANCE WITH 3I0 CMR.r'S 02 f171 ,� �; G • � � Cenf'a�c�E�v?"g of T�Y�` S v_s T.r/r Sf•'B.0 C ,t�E" _ -- 1-�* • ni :a�±a. n,r. . -a 4 ., SS 7)x s, �.. _-, 7• � o Jr�s vo��sr� .y-lo .Cv�s'.Oi�l/� '� ti.��^ -,,«;r:•`ly � �,A u,444 . r k 4-,f"l�,6,Cr f W/TN 4 "t \.� r •, s oT.Y�%t t% F f✓a T�I> ''�5vr" e. ,5w ;,' yti 6 Qf M s� °; ,. � ti � \ / • I \, G >.. pr lF�s��"'J..f ��* a �D K' " k =. tt �{ , i ,� O IJ 0 A' i L Qk 6 ? 0 -1, aura ,1. . 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