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HomeMy WebLinkAbout0089 SANTUIT-NEWTOWN ROAD - Health .--�- __ (89 Santuit-Newtown Road 'M Marston Mills A = 031 003005 1 i ', i ` Commonwealth of Massachusetts Title 5 Official Inspection Form = Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 89 Santuit-Newtown Road Property Address Robert W. Blanchard Owner Owner's Name information is Marstons Mills MA 02648 August 9 2011 required for every _ 9 , page. Citylrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, use the tab 1. Inspector: key too m move your cursor-do not David D. Coughanowr use the return Name of Inspector key. Eco-Tech Environmental Company Name 43 Triangle Circle Company Address Sandwich MA 02563 Cityrrown State Zip Code 508 364 0894 1328 Telephone Number License Number 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 I was performed based on my training and experience in the proper function and maintenance-&on site I sewage disposal systems. I am a DEP approved system inspector pursuant to'S,ection 15:340 off Title 5(310 CMR 15.000).The system: = "j a -n ® Passes ❑ Conditionally Passes El Fails `� w ❑ Needs Further Evaluation by the Local Approving Authority ZJ A i S August 9, 2011 Inspector's Signature Date The system inspector shall submit a copy of this 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, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. G t5ins-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 Commonwealth of Massachusetts _ Title 5 Official Inspection Form = Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �.. 89 Santuit-Newtown Road Property Address Robert W. Blanchard Owner Owner's Name information is required for every _Marstons Mills MA 02648 August 9, 2011 � page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E!always complete all of Section D A) System Passes: ❑X I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: Inspector's Note==> A septic system is deemed to pass this Real Estate Transfer Inspection if it does not trigger any of the failure criteria listed below. The septic system has been evaluated according to the conditions observed on the day it was inspected. No estimate or guarantee of system longevity is made or implied by a passing determination. 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. t Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old" or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfltration 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 itJs structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•09108 Title 5 official Inspection Form:Subsurface,Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts j == Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 89 Santuit-Newtown Road Property Address Robert W. Blanchard Owner Owner's Name information is Marstons Mills MA 02648 August 9, 2011 required for every —g page. CitylTown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•09108 Tille 5 Official Inspeclion Form:Subsurface Sewage Disposal Syslem•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form - Not for Voluntary Assessments g p Y Y 89 Santuit-Newtown Road Property Address Robert W. Blanchard Owner Owner's Name information is required for every Marstons Mills MA 02648 _ August 9, 2011 page. City/Town State Zip Code Date of Inspection B. Certification'(cont,) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: '*This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No" to each of the following for all inspections: Yes No ❑ El Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ D 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 ❑ a Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow t5ins•09100 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 89 Santuit-Newtown Road Property Address Robert W. Blanchard Owner Owner's Name information is Marstons Mills MA 02648 August 9 2011 required for every 9 page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT dui to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of 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. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ® 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 described in 310 CM 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. 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 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 If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•09= Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 89 Santuit-Newtown Road Property Address Robert W. Blanchard Owner Owner's Name information is Marstons Mills MA 02648 August 9, 2011 required for every page. City/rown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ 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 manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ 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)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms (actual): 2 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 gpd t5ins-09M Title 5 Official tnspeetion Forth:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form P Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;;'1 Gr• 89 Santuit-Newtown Road Property Address Robert W. Blanchard Owner Owner's Name information is Marstons Mills MA 02648 Au ust 9, 2011 required for every _g page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Design plan calls for 3 bedroom system Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes QX No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ❑X No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes © No Water meter readings, if available last 2 ears usage d n/a 9 ( Y 9 (gP ))� Detail: well in use Sump pump? ❑ Yes © No Last date of occupancy: current Date 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 I Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 89 Santuit-Newtown Road Property Address Robert W. Blanchard Owner Owner's Name information is Marstons Mills MA 02648 August 9, 2011 required for every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? 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) ❑ Innovative/Altemative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract 13 Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•0908 Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 89 Santuit-Newtown Road Property Address Robert W. Blanchard Owner Owner's Name information is Marstons Mills MA 02648 August 9, 2011 required for every —g page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Age 25 years. Certificate of Compliance dated 1/4/1985 (permit 84-1040). Were sewage odors detected when arriving at the site? ❑ Yes © No Building Sewer(locate on site plan): Depth below grade: 2 feet Material of construction: ❑ cast iron ❑X 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Sewer line appears structurally sound with no evidence of backup or leakage into dwelling. Septic Tank (locate on site plan): Depth below grade: 1feet Material of construction: X concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: --- years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 8.5ftx6ftx5ft(1000gaI) Sludge depth: 4 in 15ins•09108 Title 5 official lnspeclion Form;Subsurface Sewage Disposal System•Page 9 of 17 IN Commonwealth of Massachusetts � . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 89 Santuit-Newtown Road Property Address Robert W. Blanchard Owner Owner's Name information is Marstons Mills MA 02648 August 9, 2011 required for every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 30 in Scum thickness 1 in Distance from top of scum to top of outlet tee or baffle 9 in Distance from bottom of scum to bottom of outlet tee or baffle 14 in How were dimensions determined? Design Plan Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumping is not required at this time but maintenance pumping is recommended within and every two years. Tank appears structurally sound and functioning as intended. No evidence of leakage in or out was observed. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-09= Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 89 Santuit-Newtown Road Property Address Robert W. Blanchard Owner Owner's Name information is Marstons Mills MA 02648 August 9, 2011 required for every 9 page. Cityrrown State 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.): 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): 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(required). Is copy attached? ❑ Yes ❑ No t5tln osfo8 Title 5 official Inspection Fonn:Subsurface Sewage Disposal System-Page 11 of 17 r Commonwealth of Massachusetts .= Title 5 Official Inspection Form 1= � Subsurface Sewage Disposal System Form Not for Voluntary Assessments 89 Santuit-Newtown Road Property Address Robert W. Blanchard Owner Owner's Name information is required for every Marstons Mills MA 02648 Au g ust 9, 2011 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert at 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.): D-box appears in sound structural condition. Some solids in sump. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: 15ins•09108 Tille 5 Official Inspection Form:Subsurface Sewage Disposal System•Pane 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 89 Santuit-Newtown Road Property Address Robert W. Blanchard Owner Owners Name information is Marstons Mills MA 02648 August 9 2011 required for every 9 , page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ❑ 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.): No evidence of surface ponding, breakout, lush vegetation, or other evidence of hydraulic failure was observed. Leaching pit was uncovered and found to contain 5 ft of effluent in a 6 ft effective depth pit Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No l5ins-09= Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official.Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 89 Santuit-Newtown Road Property Address Robert W. Blanchard Owner Owner's Name information is Marstons Mills MA 02648 August 9, 2011 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic 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 hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•09108 Me 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 89 Santuit-Newtown Road Property Address Robert W. Blanchard Owner Owner's Name information is Marstons Mills MA 02648 August 9 2011 required for every __.. _g , page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑X hand-sketch in the area below ❑ drawing attached separately 2_ U SEPTIC Z lC 3 �- 13 . 4-? L WI_,-LL �5 t JTU iT ZO R D 15ins-09108 7itfo 5 Official Inspection Form:Subsurface Sewage Disposal Systom•Pago 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 89 Santuit-Newtown Road Property Address Robert W. Blanchard Owner Owners Name information is required for every Marstons Mills MA 02648 August 9, 2011 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 40+ft feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 6/2/04 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: Barnstable GIS Department records You must describe how you established the high ground water elevation: Septic design plan shows bottom of leaching pit to be 4 feet above the bottom of a witnessed test pit in which no groundwater was observed. Town of Barnstable GIS Department records indicate that the property is over 40 feet above groundwater table. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 89 Santuit-Newtown Road Property Address Robert W. Blanchard Owner Owner's Name information is Marstons Mills MA 02648 August 9, 2011 required for every 9 page. Cityfrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file I Mm'09= Tale 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 o117 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS � � tA6LE DEPARTMENT OF ENVIRONMENTAL PROViEffibie AM 9: Q f .,.�......_.._.�.:..d..,_.,_ it it�fSfOF! TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 89 Santuit-Newtown Road Marstons Mills MA 02648 Owner's Name: Hazel Packer 1 J Owner's Address: Date of Inspection: April 15, 2005 Name of Inspector:(Please Print) Janes M. Ford Company Name: James M. Ford Mailing Address: P.O.Box 49 Osterville MA 02655-0049 Telephone Number: (508)862-9400 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ✓ Passes Conditionally Passes Needs urther Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: _ Adrill9. 2005 The system inspector shall subm copy of this 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,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 E Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 89 Santuit-Newtown Road Marstons Mills MA Owner: Hazel Packer Date of Inspection: April 15, 2005 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: ✓ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined",please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. 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 or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 89 Santuit-Newtown Road Marston Mills MA Owner: Hazel Packer Date of Inspection: April 15, 2005 Check if the followin2 have been done: You must indicate"Yes"or"no"as to each of the followin Yes No _ Pumping information was provided by the owner,occupant,or Board of Health ✓ Were any of the system components pumped out in the previous two weeks? Has the system received normal flows in the previous two week period? ✓ Have large volumes of water been introduced to the system recently or as part of this inspection? _ 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 manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems ? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes No ✓ _ 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(3)(b)). 5 r Page 6 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 89 Santuit-Newtown Road Marstons Mills, MA Owner: Hazel Packer Date of Inspection: April 15, 2005 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: I Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage 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 2 years usage(gpd)): Well water Sump Pump(yes or no): No Last date of occupancy: Currently occupied COMMERCIALANDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): i 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/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Pumped after the inspection for maintenance Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: ,_gallons--How was quantity pumped determined? 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) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Installed on 114185-per as built card Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOR M PART C SYSTEM INFORMATION(continued) Property Address: 89 Santuit-Newtown Road Marston Mills MA Owner: Hazel Packer Date of Inspection: April 15. 2005 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron _40 PVC —other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 16" Material of construction: ✓ concrete _metal _fiberglass _polyethylene _,other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): certificate) (attach a copy of Dimensions: 1000 gal. Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 6" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 10" How were dimensions determined: Measurin stick Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Cement tees were resent. The liquid level was even with the outlet invert. There did not a ear to be any sijzns of leaka e. The tank was pumped after the inspection for maintenance 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(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 89 Santuit-Newtown Road Marston Mills MA Owner: Hazel Packer Date of Inspection: April 15. 2005 TIGHT or HOLDING TANK: Non e (tank must be pumped at time of inspection) p )(locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other(explain): Dimensions: Capacity: gallons Design Flow: allons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Even 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.): The D-box was level. No solids were resent. 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.): 8 Page 9 of 1 I r OFFICIAL INSPECTI ON FORM_NOT SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM TS PART C SYSTEM INFORMATION(continued) Property Address: 89 Santuit-Newtown Road Marston Mills MA Owner: Hazel Packer Date of Inspection: April 15, 2005 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits,number: 1 -6'x 6'(1000 gal.) 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.): The pit had 2'o liquid on the bottom. The scum line was annroximately 2 S'up from the bottom There did not appear to be an signs o ailure The bottom to Qrade was 10 5' The cover was 12'below grade. CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction, Indication of groundwater inflow(yes or no): 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: Comments(note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 9 i Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 89 Santuit-Newtown Road Marston Mills MA Owner: Hazel Packer Date of Inspection: April 15, 2005 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. ,e PAck P► Sun f00r\ O a l3 Y 3 ai 3� y 33 10 Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 89 Santuit-Newtown Road Marstons Mills MA Owner: Hazel Packer Date of Inspection: April 15. 2005 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 50+/- feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain:__ topographic and water contours maps Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Using Barnstable to o ra hic and water contours ma s the maps were show in a roximatel site. 50'+/-to round water at this This report has been prepared and the s stem inspected and passed Y p p ssed 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. 11 —.. CERTIFICATE OF ANALYSIS NO ;:.,�.r. Page: 1 � .. Barnstable County Health Laboratory Report Dated: 4/28/2005 Report Prepared For: Order No.: G0529831 Amy L. Wallace 598 Boxborry Hill Rd. E. Falmouth, MA 02536 Laboratory ID#: 0529831-01 Description: Water-Druildng Water Sample#: 29831 Sampling Location: 89 Santuit-Newtown Rd.Marstons Mills,MA Collected: 4/21/2005 Collected by: A.Wallace Received: 4/21/2005 Rouf tine +Ammonia ITEM RESULT UNITS RL MCL Method# Tested LAB: IC Lab Ammonia BRL mg/L 0.10 EPA 350.3 4/21/2005 LAB: Inorganics Nitrate as Nitrogen 1.2 mg/L 0.10 10 EPA 300.0 4/21/2005 LAB: Metals i Copper 438 mg/L 0.10 1:3 SM 311113 4/26/2005 11'011 9" 'F" BRL mg/L OJO 0.3 SM 3-171B 4126/2005 p` 20 'SIv1'31I1B 4l26/2005 Sodium 1'=7 ' m€� +_1:0 LAB:'- Microbiology Total Coliform Absent P/A 0 Absent 309 4/21/2005 LAB: Physical Chemistry Conductance 160 umohs/cm 1.0 EPA 120.1 4/21/2005 pH 6.4 pH-units 0 EPA 150.1 4/21/2005 EPA 524.2 - Volatile Organics by GUMS ITEM RESULT UNITS RL MCL Method# Tested LAB: GUMS 1;1,1,2-Tetrachloroethane BRL ug/L 0•5 EPA524.2 4/22/2005 1,1,1-Trichloroethane BRL ug/L 0.5 200 EPA524.2 4/22/2005 1,1,2,2=Tetrachloroethane BRL ug/L 0.5 EPA524.2 4/22/2005 1,1,2=Trichloroethane BRL ugfl: 03, 5:0 EPA524.2 4/22/2005' i l j1 Dichloroethane BRL' ug/L 0.5' "' EPA s24.2 4iiizo05 1,1-Dichloroethene BRL ug/l' 0.5., 76' EPA524.2 4/22/2005 RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court House, P0. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 s CERTIFICATE OF ANALYSIS Page: 2 , ?..` Barnstable County Health Laboratory Report Dated: 4/28/2005 Report Prepared For: Order No.: G0529831 Amy L. Wallace 598 Boxberry Hill Rd. E. Falmouth, MA 02536 1,1-Dichloropropene BRL ug/L 0.5 EPA 524.2 4/22/2005 1,2,3-Trichlorobenzene BRL ug/L 0.5 EPA 524.2 4/22/2005 1,2,3-Trichloropropane BRL ug/L 0•5 EPA 524.2 4/22/2005 1,2,4-Trichlorobenzene BRL ug/L 0.5 70 EPA 524.2 4/22/2005 1,2,4-Tri methyl benzene BRL ug/L 0.5 EPA 524.2 4/22/2005 1,2-Dibromo-3-chloropropan BRL ug/L 0.5 EPA 524.2 4/22/2005 1,2-Dibromoethane (EDB) BRL ug/L 0.5 EPA 524.2 4/22/2005 1,2-Dichlorobenzene BRL ug/L 0.5 600 EPA 524.2 4/22/2005 1,2-Dichloroethane BRL ug/L 0.5 5.0 EPA 524.2 4/22/2005 1,2-Dichloropropane BRL ug/L 0.5 EPA 524.2 4/22/2005 1,3,5-Trimethylbenzene BRL ug/L 0•5 EPA 524.2 4/22/2005 1,3-Dichlorobenzene BRL ug/L 0.5 EPA 524.2 4/22/2005 1,3-Dichloropropane BRL ug/L 0.5 EPA 524.2 4/22/2005 1,4-Dichlorobenzene BRL ug/L 0.5 5.0 EPA 524.2 4/22/2005 2,2-Dichloropropane BRL ug/L 0.5 EPA 524.2 4/22/2005 2-Chlorotoluene BRL ug/L 0.5 EPA 524.2 4/22/2005 4-Chlorotoluene BRL ug/L 0.5 EPA 524.2 4/22/2005 Benzene BRL ug/L 0.5 5.0 EPA 524.2 4/22/2005 Bromobenzene BRL ug/L 0.5 EPA 524.2 4/22/2005 Bromochloromethane BRL ug/L 0.5 EPA 524.2 4/22/2005 Bromodichloromethane BRL ug/L 0.5 EPA 524.2 4/22/2005 Bromoform BRL ug/L 0.5 EPA 524.2 4/22/2005 Bromomethane BRL ug/L 0.5 EPA 524.2 4/22/2005 Carbon tetrachloride BRL ug/L 0.5 5.0 EPA 524.2 4/22/2005 I Chlorobenzene BRL ug/L 0.5 100 EPA 524.2 4/22/2005 Chloroethane BRL ug/L 0.5 EPA 524.2 4/22/2005 Chloroform 10 ug/L 0.5 EPA 524.2 4/22/2005 Chloromethane BRL ug/L 0•5 EPA 524.2 4/22/2005 cis-1,2-Dichloroethene BRL ug/L 0.5 70 EPA 524.2 4/22/2005 RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 Pa CERTIFICATE OF ANALYSIS Page: 3 Barnstable County Health Laboratory ,yT` Report Dated: 4/28/2005 Report Prepared For: Order No.: G0529831 Amy L. Wallace 598 Boxberry Hill Rd. E.Falmouth, MA 02536 cis-1,3-Dichloropropene BRL ug/L 0.5 EPA 524.2 4/22/2005 Dibromochloromethane BRL ug/L 0.5 EPA 524.2 4/22/2005 Dibromomethane BRL ug/L 0.5 EPA 524.2 4/22/2005 Dichlorodifluoromethane BRL ug/L 0.5 EPA 524.2 4/22/2005 Ethylbenzene BRL ug/L 0.5 700 EPA 524.2 4/22/2005 Hexachlorobutadiene BRL ug/L 0.5 EPA 524.2 4/22/2005 Isopropylbenzene BRL ug/L 0.5 EPA 524.2 4/22/2005 Methyl-tert-butyl ether BRL ug/L 0.5 EPA 524.2 4/22/2005 Methylene chloride BRL ug/L 0.5 5.0 EPA 524.2 4/22/2005 n-Butylbenzene BRL ug/L 0.5 EPA 524.2 4/22/2005 n-Propylbenzene BRL ug/L 0.5 EPA 524.2 4/22/2005 Naphthalene BRL ug/L 0•5 EPA 524.2 4/22/2005 p-Isopropyltoluene BRL ug/L 0.5 EPA 524.2 4/22/2005 sec-Butylbenzene BRL ug/L 0.5 EPA 524.2 4/22/2005 Styrene BRL ug/L 0.5 100 EPA 524.2 4/22/2005 tert-Butylbenzene BRL ug/L 0•5 EPA 524.2 4/22/2005 Tetrachloroethene BRL ug/L 0.5 5.0 EPA 524.2 4/22/2005 Toluene BRL ug/L 0.5 1000 EPA 524.2 4/22/2005 Total xylenes BRL ug/L 0.5 10000 EPA 524.2 4/22/2005 trans-l,2-IDichloroethene BRL ug/L 0.5 100 EPA 524.2 4/22/2005 trans-1,3-Dichloropropene BRL ug/L 0.5 EPA 524.2 4/22/2005 Trichloroethene BRL ug/L 0.5 5.0 EPA 524.2 4/22/2005 Trichlorofluoromethane BRL ug/L 0.5 EPA 524.2 4/22/2005 Vinyl chloride BRL ug/L 0.5 2.0 EPA 524.2 4/22/2005 Water sample meets the recommended limits for drinking water for all above tested parameters. Approved By. (La irector) �J RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 T OF BARNSTABLE LOCATION .5 A �1 e,WTOW^ R 8 SEWAGE # 'gy- 10Y0 Vt,LAGE_M• 011s ASSESSOR'S MAP & LOT O31 d 0 INSTALLER'S NAME&PHONE NO. . SEPTIC TANK CAPACITY 100o LEACHING FACILr Y: (type) Pr 1 (size) ,";�NO. OF BEDROOMS 3 BUILDER OR OWNER PAU4t� } 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 leac 'ng facility) Feet Furnished by .TnS�cu1 on FOI� �✓�s�Df L 6 Sun rOOM 0 a Q o3 l �/ al r i a i acP y 3 3c,a Y 33 q� n� vU 31—X �� 1. 0 CAT ION3Anplf SEWAGE PERMIT NO. L6 5 Uee-, ovxj (Tz VILLAGE INST LLER'S NAME i ADD III ES-S rCR UILDER OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED �` y._ �(o �.y No...�._�O tl b .......•J`^..... THE COMMONWEALTH OF MASSACHUF_ETTS ------- _ BOARD,,OF HE LT �� ► d0� 0®� ...................OF... .. . .�1.�^.T/..._l_ ApplirFatiun for DiipuuFal Works Tonstrurtiun rprmit "L plication is hereby made for a Permit to Construct (�/) or Repair ( ) an Individual Sewage Disposal S at• -. . ...... ..... _ -------------------------•----...---...--------•--.---------........._..........-•-....-___ ocation ress �� or No. ... ti'.!"!. � C ..� �. .......Co-�_....... .......... `.... _..L. ...... .� -�d�.t.11..l. .: . Owner / Address c�.11 .............................. ............. C�.✓i'1�,,,- -.-•--------........................... Installer Address Q Type of Building Size Lot_' ._ _ 4 F.Sq. feet V Dwelling—No. of Bedrooms___________ ---•-.---____-__-_Expansion Attic ( Garbage Grinder ( rV a Pk Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfi;�ures -••----------------------------------------------------------------------------• .........•... W Design Flow............6.... ..................gallons per person per day. Total daily flow____-_1.11:................_._....gallons. WSeptic Tank—Liquid capacity�O3®.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..................sq. ft. Z Other Distribution box ( ) Dosing nk Percolation Test Results Performed by...........Ur,.-Vot.e._ _n1 fjE�t-L-1°%'-1.1�1.�}_. Date..... Test Pit No. ..._.. inutes per inch Depth of Test Pit__ __ _ 4..... Dep�f to ground water___�onc fz, Test Pit N mutes per inch Depth of Test Pit.. _ ........ Depth to ground water....._`................ Ra' ----- 0 Description of Soil........ 'A il Cep .s�91 n W t.zi--------_me w..c m- �' CS n ................................................... 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 hashbbeen ' ed by the board of health.Signed. _. l �------------_------ ...� Dat Application Approved BY ... ... �G 1_5.---------- -•--- Date Application Disapproved for the following reasons----------------------------------•-----------------------------------------------.............................. ..............•----------..........------....._...-•---------•---•••.....-•-•--------.......•-------...--•-----------•-----------------------••-•-••----------•------------------------------------...._ - .�(�--------------------- ....... Issued_--•---------. ------------- Date Log Number: 4166 Bottle # D017 Date: 1.0/11/84 OF BA �w s� BARNSTABLE COUNTY HEALTH DEPARTMENT SUPERIOR COURT HOUSE vBARNSTABLE, MASSACHUSETTS 02630 o • wss DRINKING WATER LABORATORY ANALYSIS PHONE: 362-2511 EXT. 391 j Client: Greenbriar Development Collector: . ' Fred Clifford Mailing Address: Box 510 Affiliation: well driller Centerville; MA- 02632 Time & Date of Collection: 10/9/M 1:00 P.M. Telephone: Type of Supply:, well water Sample Location: Lot 5, Newtown Road, Well -Depth: 73 ft. Mars tons Mills. MA Date of Analysis:, 10/10/84 PARAMETER SAMPLE RESULT RECOMMENDED LIMITS Total Coliform Bacteria/100 ml 0 0 H Conductivity (micromhos/cm) 500.0 Iron m) 0.3 Nitrate-Nitrogen ( m) 10.0 Sodium m) 20.0 I . X ater sample meets the recommended limits for drinking of all above tested parameters. II . 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. Water may present aesthetic problems (taste, odor, staining) due to D. Water sample has high levels''of sodium.- Persons on low sodium diets should 1 consult their doctor. I 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: t. CC: Barnstable Board of Health /y�0 CC: Clifford We11 Drilling 1 Labora ory Director 7/17/84 - Explanatton'of Test Results,. Total Coliform Bacteria 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 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 any well water that is not approved. pH pH is the measure of acidity or alkalinity of 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 Cod.tends to be'acidic in the i singe of 5.0 to 6.5 Conductivity Conductivity is a measure of,the dissolved salts in solution. Amounts in excess of 500 micromhos'cm are generally considered unacceptable and may have a laxative effect upon users. Iron The presence of iron.in11 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 cause.the problems listed above, it;is,not considered deleterious to health. Iron may be removed by use of,an iron.removal eystem } Nitrate-nitrogen The Massachusetts Drinking Water:.Reguta iwis have set a maximum contaminant level for nitrates at 10 ppm. Excessive concentrations may cause, ri6themoglohinemia (an infant disease) and have been suggested to form potentially carcinogenic nitrosamines. Contamination sources include fertilizers, cesspools and industrial wastes. Coppe f 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. Sodium A concentration of sodium over 20 ppm is only: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 indicate.that.there may be ocean"water or road salt runoff water Qetting into the well. Massachusetts Water Resources Commission/Division of Water Resources WATER WELL COMPLETION REPORT 1 WELL LOCATION n Address In City/Town_MA-vz_-:�Vr,,% S Yl11ft S G.S.Quadrangle Map Grid Location ;� Owner t,T A 16 2 L, a! 2..f A- o bvn o- �,rA 1 r Address_f)0,( . -I[) WELL USE CONSOLIDATED WELL Domestic Public ❑ Industrial ❑ Type of Water-bearing Rock Other Water-bearing Zones METHOD DRILLED 1) From To Rotary(type) Cable❑ 2) From To Other 3) From To 4) From To CASING Depth to Bedrock Length Diameter Type —I UNCONSOLIDATED WELL STATIC WATER LEVEL Water-bearing Materials Feet below land surface Sand: fine❑ medium❑ coarse Date measured Gravel: fine❑ medium❑ coarse❑ Screen: GRAVEL PACK WELL Slot# 1�16- ength 3) from 70 to_]:3 Yes ❑ No Split Screen(or 2nd screen) WATER QUALITY TESTS MADE Slot length from to Chemical Bioloqical ❑ Depth To Bedrock PUMP TEST Drawdown feet after pumping days hours at GPM. How measured Recovery feet after hours. LOG of FORMATIONS COMMENTS: (On well or water) Materials From To Zlz e s 3 DRILLER z m 4 3 i Firm CLIFFORD WELL DRILLING g d s ` 73 Address 65 Blue Rock Road SCA I� v City South Ynrrnntjth., nss_ R 'stration No. 01 pe ator s SignaturF Please print irm y 1OM-8181.164843 L)40 No................... Fps..... ........ THE COMMONWEALTH OF MASSACHUSETTS, BOARD OF HF7ALTH -------------_-- . ................................ Appliration for Disposal Works Tonstrurtion ramit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal �f fS t at. . ........ ..... ........................................................................................... *Location dress or J.Qt No. j jj... .........(0. .......... ...... La...... Owner Address id............................... ............. C. .............................................................. Installer Address Type of Building Size Lot_'.04!�.97.3...Sq. feet Dwelling—No. of Bedrooms-------------------------------------------Expansion Attic V\(J Garl5age Grinder 9 a Other—Type of Building ............................ No. of persons__..___..............._.____ Showers )'—'Cafeteria Otherbtu 0s ..................................................................................................................................................... Design Flow-.... 6 ...................gallons per person per day. Total daily flow...._3.330.---_--------...........gallons. 1:4 Septic Tank—Liquid capacitA W 'j.000.gallons Length................ Width.__............_ Diameter................ Depth................ Disposal Trench—No..................... Width_.............._.... Total Length_......_-...__...... Total.leaching area....................sq. ft. Seepage Pit No____________________ Diameter.............__..... Depth below inlet...........-........ Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing taM ) -- Performed by..Iz ,r Percolation Test Results Date....C1.h�./`­`­" ....... Test Pit No I . .......winutesper inch Depth of Pit' - ...1...... Devp to ground water_. Test Pit Nd. _A Allitites per inch Depth of Test PitTGL......... Depth to ground water........................ ...........................................---------------- ..................... -----------------------­---------*-------------*.......... 0 Description of Soil....... 45d ---------------------------------------------------- .h �C ................................................. ----------------- .......................................... .........me 641--n. ..................................................... Z .... 01 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 Joard of health. Signed ......M--0&4- e�.. . ...................... f'Z Application Approved By.................................................................................................. ...........I ............................. Date Application Disapproved for the following reasons:............................................................................................................... ......................................................................................................................................................................................................... 10 J43 Date PermitNo................................... ..................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH if.................................. ................OF.......a.r!�� .......... ..skb Trrfifiratr of Toutphatta Tji�LS IS TO CkRTIFY, .Thkt the Individual Sewage Disposal System constructed &0111or Repaired by.....tJ Cts-^_1 C 1.5 J)r;S<0.11. ................................ -----------------*----------*-------------*---------------------­-----"-------------- at7P ...r... ...... ..........W....7. ...42�ls .................................................... has been installed in accordance with the provisions of TISE-4 j cif Chq Bette Sanitary J� described in the op 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. b DATE........... ........................................... Inspector--.----- .........................6�_- ------------------------------ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HE........ ... No......................... OF .... ................................... FEE..S*�o .................... DO Disposal Works: %T ustrurtion 'pamit Permissionis reby granted.............................................................................................................................................. to Constru4.401 R an uaWIrage isposal;Sy t,, '0 d atNo........ ...... e.-A -0i ---------------- Street as shown on the application for Disposal Works ConstructiopAer4"it No...__ aed- : ................. ...................................................................................................... Board of Health DATE------------------------------ ....................... FORM 1255 A. M. SULKIN, INC_ BOSTON G { l✓ S � G z 4 p Sax •' cam•+^�*yc t t c • �� T t + �* / I Ff b /� h► e� *yam n ,y , sap Tr` w n -7A,ovj< tags,.,ykk} 67_ f� C)xs /� � c2L` 3l4.ci�S c.L pweP ��H OF/y4 wa,A, ss oa 14 ORSE r / SS' dr G7 N } 0. No.10951 0 'Q ervr 0 L O o ' ta//D ocFs IS7� T��l�/I�� r � S�ONAL� LEGEND x '€:XISTIN0 SPOT ELEVATION ' Ox0`� CERTIFIED PLOT PLAN ! ,EXISTINO. 'CONTOUR ——— 0 - - - Lp 7 $ T i!/EvYTDuJiI/ lZD_ USWED ;SPOT . ELEVATION (0 Y R06ERT D; CONT,OUR `0 � 1 BRUGE, r f AlA%-e,S'TUIVS NJ/LLS ` x r '• -ELORE' IN r R ABOARD OF HEALTHAli su 1 AGENT ' SCALEf / =.�o: DATES xDI�L'46EENG.INEER/NG CQ IN ,.. a CLIENT _ I :CERTIFY ' THAT THE PROPOSED7� , ,,r EGISTEIRE REGISTERED JOB NO. F407-7 BUILDING. SHOWN., ON``-THIS-,,PLA N # rCIVFL'_ LAND f c i N131N ER URVfYOR t CONFORMS TO WS THE. ZONING MA d a �N DR BY OF BARNSTABLE MASx: ?I.2, ML1I.N STREET CH. BY= } ` ' SHEET_.L_ OF A E REG , -LANO ,S:URVE=YOR ; fsv H"✓. s ,3 . i 4 :.� Ak. . . -x s. ., 2 ✓Fe<sxr IV07,6 /F E/TNER THE SEPT/C TANfC OR, Z_WACN//YG P/T .4ji /yORF 7NA.'V /2-"eBLOJ•V rRAOE',,A R4'O/AM ET.ER CONCRETE COYE.e SNALL BE BI?Ou6�lT TO 4RAAE. (AN EXr TA GONCRCTE 4+PyC PIPE oil - "iy CAST /RON CO//A=-R SHALL a3= USED s+ EL, p z o M/N• P/TGN /F/IV GRI VA-- WA y / CODERS oFiQ FT + 2•,L M/N. CONCRETE COVER CLEAN SANS . 6AC;e'0= LL L/4V/40 LEVEL 4'• SCNEOVL640 LAYER .PKf P/PE � ► o o .. s'b MtA/.PircN ;' (o 0 o GAL. DlST. t r • • • • • • t • •• LEASHil 570, %4 r Prm»:.i SEPTIC TANK , s • • . . . . . . , ~ •: BOX v • e • t � • t • • • � ••�� M t s / + / • i • • DEPTH • • f • •. WASHED STOkE 7-1 70 7 x /,o = 7=_ i m , • e • • • • t P ; PRECAST SEf.AQGE lN�/PRT CLE✓ATIONS PIT c .D�tcaTy Sg -��f.L/o y s : . . . . . . . . . �• '•C� JP/7 9 oR EOIJIV. s - t /NY,ERT AT Oa/LDING `�g FT, 6 D✓Al�l. INLET TIC T.FNK 517 8 FT, ,� /O FT. PIAM. y C�SEF�4BUL.4rION�, OU?LL�T SEPTIC 7A.-V K 97•�fT• r INLET OJSTR/8L7/ON BOX 9 7 3 FT. GROUND HATER -rAftE ' SECTION OF' Ot/TLETD15-M1,®[/T/ON 6QX 9-7>> F7: SEJ�VAGE O/SPi�SA L SYSTEM I/VLET LEACNINtr / v-,r FT. —rAJVLATIDN LEACHIIV6 P/T vJMF/V.TioN A4' IrT. TCALE �4 : /=Or 6 �T, DES/G/V CM17ER/A D/tliElvs/oN 8 NUM9ER OF BEDROOMS GoAR�,4GE D/SPO.S�I L UNIT A-o SD/. L LOG ro7A- L EST/I►'ArFo FLOW 33 D G.4L.1DAV SO/L TEST AP/ SO/L TEST#2 .?►'D/L TE$T NUMBER 01or 4rAcm/NG 0/7:S / f`-ill' AM0jo/ .DATE OF.SOIL TEST A S/OE L.O'ACHIN6 oER P/T / SFr 5Vt PT. r Pof2G+7` p _ 7, RESULTS I+tIlTNESSED dY Re E' aoTTOM LagCN/NG.PER P/T 7 o so. FT._ AWN COLAT/ON JeATE#/ L Es s I„/tAV/^jCH• TOTAL 4F54CH/NG .AREA Z 6 6 S41 'F'T. .,� �'�3 d "" RFRCOLI4TyON RATE 2 '`}—^�M/N f/NtW RESERIiELP,4G'HlN6AREA 2-6 6 SQ. FT. Zw MEo. r R N A 5 o i L 7 _ 1 s. �StS ���,�� LtJT S SoSNTv/T-nlErn/TU�r//`� T��- TS �y� ¢ _t Z x� 5� T S o MAR 5 ? w 9DIN /1/f ILLS /.t �� . �o1N .z CoAPZ,SC wLoO O oV Cal :C203 r -✓a/9-�i/� q �• �,y -QP „EL , G 9, 7fP MAtN .9�s NYA�I�/!3}I►��t` 5 Nv�1 w w E CDUiS�7.�REv 'L/.E awro• Ze f. ...�d.ld,i.�.. 4 h. .,4 =ri '.;i;pl.a' �'7Y -�� /.'r�T���1' i71'�►' ."�a t •,� ..�'�. :.` :t�., ., • r ,<an..;+,..� '�'4' '�.F.�x i>�,,-� rtPYt ,� a. '�`..��.'�.v'�"-'-.'.. +,.& ;i.,. ,< '°_ •.>X ,�,`.a i� _ I I i Z./Z/ Z- ZX/z h1��9��� CG9RRyiN� Z 6�Loo�� dM f C- l7 o �u 16 Ta Oct Z O cl�TES /A1 CENTER 3r�q.RIIIJ4 tV4LL Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 89 Santuit-Newtown Road Marston Mills MA Owner: Hazel Packer Date of Inspection: April 15. 2005 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water — Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of 1 I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 89 Santuit-Newtown Road Marston Mills MA Owner: Hazel Packer Date of Inspection: April 15, 2005 D. System Failure Criteria applicable to all systems: You must indicate either"yes"or"no"to each of the following for all inspections: Yes No ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓ 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 %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,cesspool or privy is below high ground water elevation. ✓ Any portion of 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. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] No (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No 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 11 of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 03 CERTIFICATE OF ANALYSIS Page. Barnstable County Health Laboratory �`�s�ct�L_�=✓ Report Dated: 4/10/2006 Report Prepared For: Order No.: G0634924 Amy L. Wallace 89 Santuit-Newtown Road Marstons Mills, MA 02648 Laboratory ID#: 0634924-01 Description Water-Drinking Water Sample#: Sampling Location 89 Santuit-Newtown Rd.A7arstons Mills,MA Collected: 4/3/2006 Collected by: A.Wallace Received: 4/3/2006 Routine +Antntonia ITEM RESULT UNITS RL MCL Method# Tested LAB: IC Lab Ammonia BRL mg/L 0.20 EPA 350.3 4/6/2006 LAB: Inorganics Nitrate as Nitrogen 3.3 mg/L 0.10 10 EPA 300.0 4/3/2006 LAB: Metals Copper BRL mg/L 0.10 1.3 SM 3111B 1 -4/.6/2006'— Iron. BRL ang/L 0:10 0.3 SM 3111 B =� C6/2006 Sodium ;11 rog/L J.0 20 SM 311113 -4��4,6/2006-- - v LAB: 'Microbiology W Total Coliform Absent P/A 0 0 309 L4/3/20Q6" LAB: Physical Chemistry Conductance 310 umohs/cm 2.0 EPA 120.1 4/3/2006 PH 7.5 pH-units 0 EPA 150.1 4/3/2006 EPA 524.2- volatile Organics by GC/MS ITEM RESULT UNITS RL MCL Method# Tested LAB: GC/MS 1,1,1,2-Tetrachloroethane BRL ug/L 0.5 EPA 524.2 4/4/2006 1,1,1-Trichloroethane BRL ug/L 0.5 200 EPA 524.2 4/4/2006 1,1;2,2-Tetrachloroethane BRL ug/L 0.5 EPA 524.2 4/4/2006 1;1;2-Trichloroethane BRL ug/L 0.5 5.0 EPA 524.2' 4/4/2006 1,17Dichloroethane BRL- ug/L 0.5 EPA 524.2, 4/4/2006 1;1-Dichloroethene BRL` ug/L 0.5 7.0 EPA 524.2 4/4/2006 R RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 e '.F J .Hq.R `. � S�9`. 4 CERTIFICATE OF ANALYSIS page. 2 t M; Barnstable County Health Laboratory Report Dated: 4/10/2006 Report Prepared For: Order No.: G0634924 Amy L. Wallace 89 Santuit-Newtown Road Marstons Mills, MA 02648 1,1-Dichloropropene BRL ug/L 0.5 EPA 524.2 4/4/2006 1,2,3-Trichlorobenzene BRL ug/L 0.5 EPA 524.2 4/4/2006 1,2,3-Trichloropropane BRL ug/L o.5 EPA 524.2 4/4/2006 1,2,4-T rich lorobenzene BRL ug/L 0.5 70 EPA 524.2 4/4/2006 1,2,4-Trim ethyl benzene BRL ug/L 0.5 EPA 524.2 4/4/2006 1,2-Dibromo-3-chloropropa BRL ug/L 0.5 EPA 524.2 4/4/2006 1,2-Dibromoethane(EDB) BRL ug/L 0.5 EPA 524.2 4/4/2006 1,2-Dichlorobenzene BRL ug/L 0.5 600 EPA 524.2 4/4/2006 1,2-Dichloroethane BRL ug/L 0.5 5.0 EPA 524.2 4/4/2006 1,2-Dichloropropane BRL ug/L 0.5 EPA 524.2 4/4/2006 1,3,5-T rim ethyl benzene BRL ug/L 0.5 EPA 524.2 4/4/2006 1,3-Dichlorobenzene BRL ug/L 0.5 EPA 524.2 4/4/2006 1,3-Dichloropropane BRL ug/L 0.5 EPA 524.2 4/4/2006 1,4-Dichlorobenzene BRL ug/L 0.5 5.0 EPA 524.2 4/4/2006 2,2-Dichloropropane BRL ug/L 0.5 EPA 524.2 4/4/2006 2-Chlorotoluene BRL ug/L 0.5 EPA 524.2 4/4/2006 4-Chlorotoluene BRL ug/L 0.5 EPA 524.2 4/4/2006 Benzene BRL ug/L 0.5 5.0 EPA 524.2 4/4/2006 Bromobenzene BRL ug/L 0.5 EPA 524.2 4/4/2006 Bromochloromethane BRL ug/L 0.5 EPA 524.2 4/4/2006 Bromodichloromethane BRL ug/L 0.5 EPA 524.2 4/4/2006 Bromoform BRL ug/L 0.5 EPA 524.2 4/4/2006 Bromomethane BRL ug/L 0.5 EPA 524.2 4/4/2006 Carbon tetrachloride BRL ug/L 0.5 5.0 EPA 524.2 4/4/2006 Chlorobenzene BRL ug/L 0.5 100 EPA 524.2 4/4/2006 Chloroethane BRL ug/L 0.5 EPA 524.2 4/4/2006 Chloroform BRL ug/L 0.5 80 EPA 524.2 4/4/2006 Chloromethane BRL ug/L 0.5 EPA 524.2 4/4/2006 cis-1,2-Dichloroethene BRL ug/L 0.5 70 EPA 524.2 4/4/2006 RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 r 4 QF.:.HA�S Page CERTIFICATE OF ANALYSIS 3 �o M Barnstable County Health Laboratory yrrhGHi;SY,�/ Report Dated: 4/10/2006 Report Prepared For: Order No.: G0634924 Amy L. Wallace 89 Santuit-Newtown Road Marstons Mills, MA 02648 cis-1,3-Dichloropropene BRL ug/L 0.5 EPA 524.2 4/4/2006 Dibromochloromethane BRL ug/L 0.5 EPA 524.2 4/4/2006 Dibromomethane BRL ug/L 0.5 EPA 524.2 4/4/2006 Dichlorodifluoromethane BRL ug/L 0.5 EPA 524.2 4/4/2006 Ethylbenzene BRL ug/L 0.5 700 EPA 524.2 4/4/2006 Hexachlorobutadiene BRL ug/L 0.5 EPA 524.2 4/4/2006 Isopropylbenzene BRL ug/L 0.5 EPA 524.2 4/4/2006 Methyl-tert-butyl ether BRL ug/L 0.5 EPA 524.2 4/4/2006 Methylene chloride BRL ug/L 0.5 5.0 EPA 524.2 4/4/2006 n-Butylbenzene BRL ug/L 0.5 EPA 524.2 4/4/2006 n-Propylbenzene BRL ug/L 0.5 EPA 524.2 4/4/2006 Naphthalene BRL ug/L 0.5 EPA 524.2 4/4/2006 p-Isopropyltoluene BRL ug/L 0.5 EPA 524.2 4/4/2006 sec-Butylbenzene BRL ug/L 0.5 EPA 524.2 4/4/2006 Styrene BRL ug/L 0.5 100 EPA 524.2 4/4/2006 tert-Butylbenzene BRL ug/L 0.5 EPA 524.2 4/4/2006 Tetrachloroethene BRL ug/L 0.5 5.0 EPA 524.2 4/4/2006 Toluene BRL ug/L 0.5 1000 EPA 524.2 4/4/2006 Total xylenes BRL ug/L 0.5 10000 EPA 524.2 4/4/2006 trans-1,2-Dichloroethene BRL ug/L 0.5 100 EPA 524.2 4/4/2006 trans-1,3-Dichloropropene BRL ug/L 0.5 EPA 524.2 4/4/2006 Trichloroethene BRL ug/L 0.5 5.0 EPA 524.2 4/4/2006 Trichlorofluoromethane BRL ug/L 0.5 EPA 524.2 4/4/2006 Vinyl chloride BRL ug/L 0.5 2.0 EPA 524.2 4/4/2006 Water sample meets the recommended limits for drinking water of all the above tested parameters. Approved By: ( ab irector) RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 ASSESSOR'S MAP NO. '3-5 PARCEL y0CATI0PC, h. WAGE PERMIT N0 177 IAJ VILLAGE Od �INSTA LLER'S NAME A ADDRESS �0 B U I L D E R OR OWNER s I� DATE PERMIT ISSUED D MPLIA 1 ED ATE CO NCE SSU / r� qr, U�