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HomeMy WebLinkAbout0106 CEDAR STREET - Health L.06 Cedar Street West Bamstable f A= 130 - 035 i I I i l Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments v �.. 106 Cedar Street,West Barnstable, MA 02668 n Property Address Daniel C& Patti M Kellog 00 Owner Owner s Name information is _ required for every West Barnstable MA 02668 11/22/2016 page. CityfTown State Zip Code Date of Inspection • fV 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 only the tab 1. Inspector: key to move your cursor-do not REID C. ELLIS use the return Name of Inspector key. ELLIS BROTHERS CONSTRUCTION VQ Company Name 23 ENTERPRISE ROAD Company Address YARMOUTH PORT MA 02675 City/Town State Zip Code 508-362-6237 S121891 Telephone Number License Number B. Certification I certify that I have personalty 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(3 CMR 15.000). The system: Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority z 14,OP 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 ryl�t address how the system will perform in the future under the same or different conditions of use. t5ins•3113 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-N 9 P Y of for Voluntary Assessments 106 Cedar Street, West Barnstable, MA 02668 Property Address Daniel C& Patti M Kellog Owner Owner's Name information is West Barnstable required for every MA 02668 11/22/2016 page. Cityrro fin 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: 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 dec,cribed 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. Check the box for"yes", "no"or"not determi ed"(Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years o d*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or elfiltration or tank failure is imminent_ System will pass inspection if the existing tank is replaced witl i 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 t n 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): i (Sins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 106 Cedar Street, West Barnstable, MA 02668 Property Address Daniel C& Patti M Kello Owner Owner's Name information isequired or every West Barnstable MA 02668. 11/22/2016 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑. Pump Chamber pumps/alarms not operati S stem will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out c r 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 I lealth): ❑ 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 tirr es a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval oi 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 a aluation by the Board of Health in order to determine if the system is failing to protect public he Ith, safety or the environment. 1. System will pass unless Board of lealth determines in accordance with 310 CMR 15.303(1)(b)that the system is not fui ictioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 fe t of a surface water ❑ Cesspool or privy is within 50 fe t of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System.Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 106 Cedar Street, West Barnstable, MA,02668 Property Address Daniel C& Patti M Kellog Owner Owner's Name information is required for every West Barnstable MA 02668 11/22/2016 page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of ealth(and Public water Supplier, if any) determines that the system is functions gin 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 tribut ary to a surface water supply. ❑ The system has a septic tank and SAE and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SA and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS ani i 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 analysi , performed at a D€P certified laboratory, for fecal coliform bacteria indicates absent and the pretence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other fE ilure 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 facility or system component due to overloaded or / clogged SAS or cesspool ❑ I,r11 Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ LJ-V/ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ,uJ Liquid depth in cesspool is less than 6"below invert or available volume is less than '/day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 l Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 106 Cedar Street, West Barnstable, MA 02668 Property Address Daniel C & Patti M Kello Owner Owner's Name information fo is every West Barnstable required for eve MA 02668 11/22/2016 page. 6Wrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No Required pumping more than 4 times in the last year NOT due to clogged or El No obstructed pipe(s). Number of times pumped: ❑ VVV 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 privy or cesspool p p y 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 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. /V E) Large Systems: To be considered a large syst m 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"c r"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 nit ogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped one II of a public water supply well If you have answered "yes"to any question in Sec ion 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 Sect;n E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The ystem owner should contact the appropriate regional office of the Department. t5ins-3/13 Tide 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 106 Cedar Street,West Barnstable, MA 02668 Property Address Daniel C& Patti M Kellog Owner Owner's Name information fo is every West Barnstable required for eve MA 02668 11/22/2016 page. 6Wr own 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 backup? ❑ ❑ Was the site inspected for signs of break out? ❑ ❑ Were all system components, excluding the SAS, located on site? ❑ ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ❑ 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. i ❑ ❑ 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): Number of bedrooms(actual):DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): `L t5ins•3/13 Title 5 Official Inspection Foam:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �.. 106 Cedar Street, West Barnstable, MA 02668 Property Address Daniel C & Patti M Kello Owner Owner's Name information is West Barnstable required for every MA 02668 11/22/2016 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: 4� Number of current residents: Does residence have a,garbage grinder? ❑ Yes ±/No Is laundry on a separate sewage system?(Include laundry system inspection information in this report.) ❑ Yes Y"No Laundry system inspected? ❑ Yes /N, Seasonal use? El Yes No Water meter readings, if available(last 2 years usage(gpd)): Detail: ` Sump pump? t❑ Yes No Last date of occupancy: Date CommerciaUlndustrial Flow Conditions: AIA„-- 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 syst m? ❑ Yes ❑ No Water meter readings, if available: t5ins-3/13 .Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 106 Cedar Street West Barnstable, MA 02668 Property Address Daniel C& Patti M Kello Owner Owner's Name information is required for every West Barnstable MA 02668 11/22/2016 page. citylrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): �V General Information Pumping Records: / Source of information: Was system pumped as part of the inspection? Yes ❑ No If yes, volume:pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: LtiJ Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) I ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Dis posal sposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 106 Cedar Street,West Barnstable, MA 02668 Property Address Daniel C& Patti M Kellog Owner Owner's Name information is West Barnstable MA 02668 11/22/2016 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if knownJ and source of information: ��.r.. " Were sewage odors detected when arriving at the site? ❑ Yes [ /No Building Sewer(locate on site plan): ��y Depth below grade: feeJ ) Material of constructio n: ��I► El cast iron 40 PVC ❑other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): 7AVe- 6el-v�,04, Septic Tank(.locate on site plan): Depth below grade: feet Material of construction: M/Concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) /OOv � //f�� a If tank ism al,Zertificate v �Is age n firme of Compli nce? (attach a copy of certificate) )❑ Yes ❑ No Dimensions: ` '" / _7;o� Y , Sludge depth: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 106 Cedar Street, West Barnstable, MA 02668 Property Address Daniel C &Patti M Kello Owner Owners Name information is required for every West Barnstable MA 02668 11/22/2016 page. Cityrrown 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 e_A'Y Scum thickness Distance from'top of scum to top of outlet tee or baffle a Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as r lated to let i vert, evidence of leakage, alp.): Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal fiberglass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness Distance from ZOP of scum to top of outlet I ee or baffle Distance from Bottom of scum to bottom ol outlet tee or baffle Date of last pumping: Date t5ins•3113 Title 5 Official Inspection Forth: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 106 Cedar Street, West Barnstable, MA 02668 Property Address Daniel C& Patti M Kellog Owner Owner's Name information is every West Barnstable required for eve MA 02668 11/22/2016 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 f leakage, etc.): Tight or Holding Tank(tank must be pum d 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 swi ches, etc.): *Attach copy of current pumping contract( quired). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �., 106 Cedar Street, West Barnstable, MA 02668 Property Address Daniel C&Patti M Kellog Owner Owner's Name information is required for every West Barnstable MA 02668 11/22/2016 page. CityrFown 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 /✓ Comments(note if box is level and distribution to outlets equal, any evidence of ids carryover, any evidence of leakage into or out of box, etc.): ®we- 6v / ; � s ® ® ";P4— .1 ® �/ T Pump Chamber(locate on site plan): 1 Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, cot idition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, sys em is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: �f t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 r v Commonwealth of Massachusetts_ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 106 Cedar Street, West Barnstable, MA 02668 Property Address Daniel C& Patti M Kellog Owner Owner's Name information is required for every West Barnstable MA 02668 11/22/2016 page. CityrFown State Zip Code Date of Inspection D. System Information (cos Type: ` p,✓., ❑ leaching pits number: leaching chambers number: ❑ leaching galleries number. leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/altemative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): WKI � AIVI M&4 —'-, ,"Z�Ws s 1� Cesspools (cesspool must be pumped asp rote spection) (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 t5ins-3/13 Tile 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 106 Cedar Street, West Barnstable, MA 02668 Property Address Daniel C& Patti M Kellog Owner Owner's Name information is required for every West Barnstable MA 02668 11/22/2016 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) ,� Comments(note condition of soil, signs of hydr Ic failure, level of ponding, condition of vegetation, etc.): Privy (locate o,i site plan): 11114 �f Materials of construction: �s Dimensions Depth of solids Comments(note condition of soil, signs of hydraul c failure, level of ponding, condition of vegetation, etc.): t5ins•3113 Title 5 Official Inspedion Forth: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 �M 106 Cedar Street,West Barnstable, MA 02668 Property Address Daniel C & Patti M Kellog Owner Owner's Name information is required for every West Barnstable MA 02668 11/22/2016 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 6 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 f whe public water supply enters the building. Check one of the boxes below: 0- 7and-sketch in the area below -/ ❑ drawing attached separately / V /J +tV 1 W � . 3 ` 72-. A-Q1 T 15 • P. • • 1 1 , 1 Q t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System.Page 15 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments °a 106 Cedar Street, West Barnstable, MA 02668 Property Address Daniel C& Patti M Kellog Owner Owner's Name information is required for every West Barnstable MA 02668 11/22/2016 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope s ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: 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: You must describe how you established the high ground water elevation: ��29& � / N .tt�'tA/'`,O-kp,v d , 28� ��pv Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts IMS Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ... - 106 Cedar Street, West Barnstable, MA 02668 Property Address Daniel C& Patti M Kellog Owner Owner's Name information is required for every West Barnstable MA 02668 11/22/2016 page. Cityrrown State Zip Code Date of Inspection E. Re ort Completeness Checklist spection 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 t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 AypF uaRtir CERTIFICATE OF ANALYSIS Page: 1 of 1 wAlj 4 Barnstable County Health Laboratory (M-MA009) rr�f„�s r Report Prepared For: Report Dated: 11/2.812016 Patti Kellogg Order No.: G1697513 106 Cedar St W. Barnstable, MA 02668 I Laboratory ID#: 1697513-01 Description:. Water-Drinking Water _-- Sample#: Sample Location: 106 CedarSt W.Barnstable Collected 11/28/2016 -_ - Collected by: PKM Received: 11/28/2016 Test Parameters ITEM RESULT UNITS RL MCL METHOD# ANALYST TESTED NOTE pH 7.1 PH AT 25C 6.5-8.5 SM 4500=11-13 DCB 1`1/28/2016 Water sample meets the recommended limits for drinking water of all the above tested parameters. f; Attached.please-find the laboratory certified.parameter list. Approved By: (Lab Director) ///Z 9/2� ND=None Detected RL Reporting Limit MCL=Maximum Contaminant Level 3195 Main Street,. PO. Box 427, Barnstable, MA 02630 Ph:508-375-6605 COMMONWEALTH OF MASSACHUSETTS DEPARTMENT OF ENVIRONMENTAL PROTECTION Certified Parameter List as of.01 Jul 2016` M=MA009 BARNSTABLE COUNTY HEALTH&ENV DEPT,.BARNSTABLE,MA Anal es Methods for NON-Potable Water Methods for Potable Water ALUMINUM EPA 200.8 ANTIMONY EPA 200.8 EPA 200.8 ARSENIC EPA 200.8 EPA 200.8 BARIUM EPA 200:8 BERYLLIUM EPA 200.8 EPA 200.8 CADMIUM EPA 200.8 EPA 200.8 CHROMIUM EPA 2008 EPA 200.8 COBALT EPA 200.8 - COPPER EPA 200.8;SM 3111B EPA.200:8;SM 3111 B j IRON SM 31118 LEAD EPA 200:8 EPA 200.8 MANGANESE EPA 200.8;SM 3111 B MERCURY EPA 200.8 NICKEL EPA 200 8;SM,31.11B EPA 200.8;SM 31118 SELENIUM EPA-200.8 EPA 200.8 THALLIUM EPA 200.8 EPA 200:8 VANADIUM EPA 200:8 ZINC EPA 200:8;SM 311.1B PH SM 4500-H-B SM 4500-H-8 SPECIFIC CONDUCTIVITY EPA 120.1;SM 2510B HARDNESS(CAC04 TOTAL SM 2340B CALCIUM SM 3111B SM 3111 B MAGNESIUM SM 3111B SODIUM SM 3111B SM 3111B POTASSIUM SM 3111B ALKANILITY,TOAL SM 2320B SM 2320B AMMONIA-N EPA 350.1 CHLORIDE EPA-300.0 CYANIDE,TOTAL EPA 335:4: EPA 335.4 - FLUORIDE EPA 300.0 KJELDAHL-N EPA 351.2 SULFATE EPA 300.0 EPA 300.0 NITRATE-N EPA.300:0 EPA 300.0 NITRITE-N EPA 300.0 TURBIDITY EPA 180:1 TOTAL DISSOLVED,SOLIDS SM 2540C SM.2540C NON-FILTERABLE RESIDUE(fSS) SM 2540.D. TOTAL ORGANIC<CARBON SM 5310B CHEMICAL OXYGEN DEMAND HACH METHOD 8000 BIOCHEMICAL OXYGEN DEMAND SM 5.21013 TRIHALOMETHANES EPA 524.2 VOLATILE HALOCARBONS EPA 624 VOLATILE AROMATICS EPA 624 VOLATILE ORGANIC COMPOUNDS EPA 524.2 PERCHLORATE - EPA 314.0 HETEROTROPHIC PLATE COUNT SM 9215B TOTAL COLIFORM MF-SM 9222E TOTAL COLIFORM EPA 1604 TOTAL COLIFORM ENZ:SUB.SM 9223 FECAL COLIFORM MFSM 022D MF-SM 9222D E.COLI EPA 1603 EPA 1604 E.COLI EPA 1103.1 NA-MUG-SM9222G E.COLI MFSM.9213D ENZ.SUB.SM 9223 ENTEROCOCCI EPA 1600. EPA 1600 Effective Date:01 JUly 2016,Expiration Date:30.Jun 2011 �I TOWN OF BARNSTABLE LOCATION ` U C f C,�4r ,��`, SEWAGE# a 00 VILLAGE ASSESSOR'S MAP&PARCEL 13 3. 3 S INSTALLERS NAME&PHONE NO. R',h-3 (366O -It'r-f Cc.,nV- - 3(a a Cab 3 SEPTIC TANK CAPACITY _ rrx i TT f P& l O oo LEACHING FACILITY:(type) i'44FLz7 (size) �3 O �® X S NO. OF BEDROOMS X /V1X k 2'4�`6ti� OWNER fq �+� PERMIT DATE: �W-j is I A COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY d>i4a� 5�T Pr i A-4 ' 7Co 6- 1 3Cv �1`S { N'/� E L L I S BROTHERS C 0 N S T CO . 508-362-A237 TOWN- OWNER , o ° NAME 0-►J+ i Ll-eklosq Z BUILDLRS NAME u.j_ LOCATION JOG Cecici1r SEWAGE PERMIT NOjoo3,-338DATE a10a uj Ln COMPLIANCE ISSUED DATE '" FINAL INSPECTION BY : uj ' I � DATE J NEW [] OR REPAIR U 4 S WATER PUBLIC[ ] OR WELL[ u- " SEPTIC TANK CAPACITY 1000 1500 2000 NEW OR EXISTING' � � LE,A-CHING FACILITY TYPE SIZE//af `'AoZ Ft&oN s c ` E L L I S BROTHERS C0NST - 00 . a 508-362 -A237 TOWN- (A/CS)- &9jlSd `► A � ~! (o } (Y'WNER NAME P-)t,- r `W s: BUILDERS NAME LOCATION �C�C�. C�cl�r s� \ 4 ' SEWAGE PERMIT NO.00,� -?DATE b-1 oa rw r COMPLIANCE - IS SUED DATELu - FINAL INSPECTION BY : •w DATE NEW [ I OR REPAIR �< WATER PUBLICS OR WELL[ ] , SEPTIC TANK CAPACITY 100 1500 2000 cD —_ ` NEW OR EXISTIN ! •LEACHING FACILITY'Y-PESO 3oSc' : �. ,SIZE/ �aXar �€'� ` cn�- - Pn '" 1. ¢ Lon t .u......_..+3-•...v.• ,......,.x . r , _. ..a...3:..r..<+,,.,....:.. : .,.•ten..t+ 4 ..:r,_: ALu ^ '. lx. ef ,F."":M9^. �.._: .f No. . - Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZIpplication for �hgponl *p!5tem Cowaructiou permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No.6//� Owner's Name,Address,and Tel.No. co-dc W� 1O,6�, e7aX&r` s- Assessor's Map/Parcel/y���p ��O �'�► e0 -/- 84/A"`7A44w �W_ Installer's Address and Tel.No. ���� r� 3 Designer's Name,Address and Tel.No. -5rzp 9—j;6 Z// A 17 6-A Type of Building: A Dwelling No.of Bedrooms Lot Size /��Sq.ft. Garbage Grinder Other Type of Building /W2_157 No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) �� gpd Design flow provided -5w6 gpd Plan Date 46 '�v Cl�_g _Number of sheets Revision Date Title �!/ =Cr4 C�� e� A .�/6 A Size of Septic Tank � y / Type of S.A.S. �!/ �PsC�ri �t7s /jZCA C, - Description of Soil Of Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environm tal Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. 'L Signed Date Fro - 'T Application Approved by Date Application.Disapproved by: Date for-the following reasons Permit No. ® 3 Date Issued g s THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC,HEALTH DIVISION-- TOWN OF-BARNSTABLE, MASSACHUSETTS Yes 2pplication for TN!5 o$al *_ p5tem Con5trui ction permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No.�< lC` �+ �' Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 0Ap f 3C> OA'R— saw ..v � Installer's � 361, dd �an t A Designer's Name,Address and Tel..°V Type of Building: Dwelling No.of Bedrooms �` Lot Size �' � sq. ft. Garbage Grinder ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min,required) �� gpd Design flow provided _j'e_Z51 gpd Plan Date 46; ._. °, (? Number of sheets Revision Date z Title Gr/ 9XC.1-1/.v.� � 1•✓sT//.-c/ 4 /oli -A/L Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) /� �' U *10V Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of 00, Compliance has been issued by this Board of Health. -- Signed cL, Date a C� Application Approved by �(i--�� Date Application Disapproved by: . U Date for the following reasons Permit No. a-v `536 Date Issued ^ / 5 - ' THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded ( ) Abandoned( )by / at 16X_ 4 � a has been constructed'n accordance � o with the provisio is of Title 5 and the for Disposal System Construction Permit No. d oo& —3 3 dated 8" S a Installer �/ Designer /✓ e-,i,,5,-t z7ti/­� I #bedrooms Approved design flow CA gpd The issuance of this permit ishall not be construed as a guarantee that the system will-function as,designed. Date O 0 Inspector _(i. /J —————— No. a.OUg - 338 Fee /6ZL/ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION=BARNSTABLE, MASSACHUSETTS { 3 -pi!5po!5a[ J§Wem Construction permit Permission is hereby granted to Construct (-/ ) Repair � Upgrade ) Abandon ( ) System located at and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions-or special conditions. Provided: Construction must be co, pleted within three years of the date of this,p Iel nit. Date n S�� Approved by / FROM :down cape engineering inc FAX NO. :15083629880 Aug. 26 2008 03:08PM P1 Town of Barnstable Regulatory Services 1 Thomas••�,u F. Geller,Director s>" Public Health e Division Thomas McKean,Director 20D Mala Street,Hyannis,K'k 02601' Officc:,508-862-4644 Fax: 5W790-6304 s lle ! `cation Fo m Date: Sewage Permit# rook--33cY Assessor's M \P ap arcel Designer: � � installer: d3o-1?w f-S Address: Address: oa ( � was issued a permit to install a �1 I nstaller septic system at jj—. (address) based on a design drawn by deli er dated 1 certify that the septic system referenced above was installed the deadgn, which xd/o an ptir. minor approved chang suc as�late arelocation accordi of t tO he distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory, 1 certify that the septic system referenced above was installed with major clan greater than 10' lateral relocation of the SAS or any vertical relocation of stay component Of the septic 3 � $� (ent cP system) but in accordance with State&Local Regulations. Plan revision or certified built by designer to follow. were foundd satisfactory, Stripout(if required) was inspected and the soils , (H OPs (Insta ler's Signature) A NE H. JALA CIVIL y No. 30T82 e es) C re (A x es� p Herc) F RN TO BARNST D I N. T B I UE I HE E C TE I B B FO Pou.. B T LE P C ALT ION. Q:%8ePUe\t�Wi8ner COrdficBtion Foes Rev 03-09.06,doc o L-OC- iTlON SEWAGE PERMIT NO. 1-4; 7- 5e VILLAGE: I N S T A LLER'S NAME i ADDRESS l/F7-01elft,,O �3rLu5 V a/g1t/c-6 BUILDER OR OWNER DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED - --8-�� s ��� bit L 0o"vo&/" Vo3� ( THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH 7' ..... ...... Appliratiun -fur 43hipmal urku Tonutrurtiun PPrnnit ,Application is hereby made for a Permit to Construct ()() or Repair ) an Individual Sewage Disposal Sysjtn at` ,/'-14�1 40�Lo /.?a Ae.3 'e;A_ 51, 4), 4 A-$-^ 9 41// __ (/ �� L on Ad s o Lot _ �� be L Owner Address the � Installer Address UType of Building Size Lot../ 5/--_--_.-_.._........ �-, Dwelling—No. of Bedrooms...............3------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons---------6.-.--._.---_... Showers ( ) — Cafeteria ( ) Otherfixtures ` ----•-•---•---•----------------•---------•------------------------•------------------- Q �+v; W Design Flow---------------- - �--- Mons per day. Total daily flow--__-_--_-__-_-___�-----®_ . ----.---gallons. g g P Y Y 9 Septic Tank—Liquid capacity/VC?-gallons Length......j-----_ Width-.--y....... Diameter................ Depth.... xDisposal Trench—No- --------- - ----- ��Iidtli_-_---_.-----------_ Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit No........../-------- Diameter....... ®-/... Depth below inlet---------C........ Total leaching area..;.Z6'45-----sq. ft. Z Other Distribution box (#i— Dosin�j to ( ) c ~" Percolation Test Results Performed by.-�5.�. `4 _f----------------------------------------- Date--/ "--------_------------------- Test Pit No. 1_(f*.�_.--minutes per inch Depth of Pest Pit.................... Depth to ground water..-----._-_--------_- f14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water--.--z---------------.._. ---- -----e'_4 �-,---- ' Vf7p � � � / � Description of Soil------- ----...--- (( `V .---------------------------wt­ W ---' -- - :..-(-1-U h- •--........./-�-=--� � ��,------------------------------------------------------- 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 Article XI 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. ' Sied-•-•� _.._-.-•• ----------------------------------------- Date Application Approved BY ...-_r •-••-•--•--------- ....... Date Application Disapproved for the following reasons:--•--------------••_:_...-•------------•-------•-----•••-•------.. .-•-•-------._....----------•-••-•-••-----•-- ---•-------------•---.....----------------•--•----------•-------•-•---------•-------------•-•--------••-----------------•-----------•-------------•--•--------•-----------------------•_---------------- Date PermitNo........................................................... Issued........................................................ Date --------------- --------------------- T THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ' � / A , ... .............----OF.....Y) ......................................................................... .. .. Appliration -for 15iopoottl Workii Tontrurtion- Puniit Application is hereby made for a Permit to Construct ( ) or Repair ) an Individual Sewage Disposal Sys aid .................../ t ..._.. -• -•••••--•-_.._. _..•-•- •..........•••••••••••••-•---• .........._ L c tion-Ad s Lot `� gr J `� _ .......... � /_-------------------•----•-----•-•-•-• ---• - - _ : ......... Owner l Address .................................................'hI INCy ..'f.. �e Installer Address `j S Type of Building Size Lot. ...�'!.. . "._ afe®t Dwelling—No. of Bedrooms_______________ ________________________Expansion Attic ( ) Garbage Grinder ( ) p-I Other—Type of Building ___--_-._-._`______________ No. of persons..-_____C_`__....._.._. Showers ( ) — Cafeteria ( ) 0.i Other fixtures -------------------------- - W Design Flow....................1Z_'_.__..____..gallons per-per9en per day. Total daily flow................... _-----_-.-.---.---gallons. WSeptic Tank—Liquid capacit/K;� _gallons Length-----f------- Width..:x✓........ Diameter................ Depth---5.''......... x Disposal Trench—No_ ____________________ Width---------------..... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No_________ _________ Diameter------{�+`'------- Depth below inlet....... Total leaching area.:C''C._._.sq. it. z Other Distribution box (Pol- Dosing to� ( ) o ~' Percolation Test Results Performed by. .i fr" _!. _:.t__________________________________________ Date_ ' :- Test'Pit No. l_�b__{/____mmutes per inch Depth of Pest Pit____________________ Depth to ground water.----------..-..-_.-_..- (J, Test,Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water.......-._-._--.---_.--- G Description of Soil ---- "� �«r. �-- .. .. ' '` ram ".......... -- y -- -f_ _ /------ x }} . �►u r PO a (IU Nature of.Repairs or Alterations—%nswer when applicable................................................................................................ _ . Agreement: ,*^, The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI 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. Sied------- -----...............................=...................................... / Date Application Approved By----- - - -............. Date Application Disapproved for the following reasons:.........................................................................::: 4` :r---------------•---•- Date PermitNo........................ ................................. Issued...............................-......................... Date l"+'°. THE COMMONWEALTH OF MASSACHUSETTS ' BOARD OF HEALTH +l 0j'1.............OF............ '-- •----.........---- %Lkrrtifirntr of 60,omplinnrr TH TO CERT Y, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by....... `Jr d ..................................... r .Q-�^�_------••- -;rZ -•-- f--�r-+i- -.--f�='t---- `- -• --•-��"T�"'---"�,"�.0441.►- ••--•--_____-•--- at I has been installed in acce with the provisions of � __-__XI of The State Sanitary Code as described in the application,for.Disposal Works Construction Permit No � _� _;____:0 __________ date .______._. THE ISSUANCE .OF THIS CERTIRCATE SHALL. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM''WILL FUNCTION SATISFACTORY.� _ ector DATE-L---------------------------- / -------- In -----/ . � -- - ----- - THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEALTH .. p k�...........OF.......... ................F� No -_�S FEE...Ze)_S�......... Dispolial tzlj k,i Qlontrurtion jorrmit Permission is hereby granted--"----�t- ---:--- ll. -.`.----------------------------------------•------------------------•--•----- at to Cons t �or e it ( �n Indivi 1 ern age D o5 Syste ...- ..................No. ........ Sa�- ,, Street as shown on the application for Disposal Works-Construction .Per. it No..._.__ _r?..J_. Da ed__- '_-- - -•--- -------------_ DATE.............. �� ��--------- of a q [/ ------•______________•__•__ Board lth --� .- - FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS : s® RT. PO/M. /1r"OTEr Ipw �YTAIeR TiiIE3EPT/C TANA< OR LBAcAel YG P/T •4Rc MORP TNA.IV 1Z'J&L0rV &dQAPAr f A "'D/AM EVER CONC eir7.F CO dd'R FL• /U ZO M/N. P/TICK NERVY CAST//VON CD S/yi44L &A: CO US�O �• Cl'�NCRLrT.E ' I� r� Moz CO VE'R CLEAN SANG SLAYER �Q ; O M/N.P?CN -- GAL. ° s • • • • • • •• 1 i o G1F :. V4 AMt'T" SEPTIC TA/VEC OLS7;..• a •'r ° • • • • • • • • s i 1YASHE-�D 57t7NE :.. t. Emma== .s e • •:.0 � ` o� WASHED STVAF -I*VVZR'T &ARS4AWONS t i. • • • •� • • •:• s o P/7 OR G9pl!/V. /NY.ERIT AT 4u/.t•D/N6 C(spa�u1.ArION), 0iV7% .ArY S&PT/C TAmK `�1: 3 fT. r j. MAR-r A-07 OT/O)v @OX 'J 5 /°T. t . GJQD61ND A447ZAW VIAL,- OVTI �'D/177�/®l/T/ON BOX y f°T . 3�CT/C/ rOI�' +,> Li'r Z.&ACN/NG I'/T Y3? 0Bj'VA6 .: �a'� i4 L .�'Y ``i ► <>. - , _ LEi4CHING p/7' r : .7lOSlI"TIDN CRI�''�R/.� � ,M , .. � �' jf�!/�EN.�`/'fl/V'A S ITT. :' • i yPINAW, �-T jr Z.,AMINaMWAIMOOM A. r { .'I I�+Af.-dal�i�R'�,�� ���• • 33 Q�� �Js _ 11��� - � i t v/ a 's .•. s yu.[ �X''v:., 7�r` t - `a< ' - `): 's$ v',� /� CN/I�.i�fl�P/T': '- ., �^ � •:•&_` '�•"•-�" � ��`�( �G'�`.�'. j.T_.i�i�'$�.�b.'�9'1'�'�Y� 13uN/Kl�". + T 1C9iA :AA4CY///N'�_A.�R 7•y�f` '� .a �' � z• � �„� COtii17►ye�'�/�ir,ll;�4�Tr�-IQE�- • ' '.lWt�t r►�+r!cz !^��/, wr } (rartil ,:. 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''.►.^ri` �' ''y�"zyj�� .ib;``'`l: y.' i'. �. �•.� "�v ,I ''��: ° � �+'-. `� '¢` �'`* $:+�: -ew 3'. �.�'.' �.t �� :`.�.1.,, 'h:..-(°a,.. fi5�'•-'�.�� �$-'p'+ � ,� •e,f •@,s,�ys�x�.�`��` No.- -- -- --- ----- Fee-- - -- ----------- BOARD OF HEALTH TOWN ' OF BARNSTABLE 0(ppritat ion-for Melt Con5truttionpermit Application is hereby made for a permit to Construct (✓), Alter ( ), or Repair ( )an individual Well at: 1,6 7--�= --�e 0 `-/- `7-' - - - --- ---1?I - /5--/'--- --------------------------------------- Location — Address Assessors Map and Parcel 0g------------- ----^-'-`e Owner Address Installer — Driller Address Type of Building Dwelling-- ous e--- -------------------------------------- Other - Type of Building ----------- No. of Persons------------------------------------------------------- Type of Well Capacity---------------------------------------------------- -- Purpose of Well--Qo.vt es7`1� _ +ate ire/ - ----------------- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned-further agrees not to place the well in operation until a Certificate CoinjoLance has been issued by the Board of Health. � Sined-- --_ S ,_____----------- - ------a----------------- o date - - -Application Approved By--1- -- -- ------ --- ----- - -- - date Application Disapproved for the following reasons: ___----—- — -------------------------------------- date ' r ' Permit No.- - ---- --- ------- --------------- Issued—— - --- -- ---------------------- ------------------- ------ ---- ---- date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate ®f Compriaute THIS IS TO CERTIFY, That the II�dividual Well Constructed ( , Altered ( ), or Repaired ( ) (�j� - - at-------�----�— �f—�j�—j ?�J nstal — has been installed in accordance with the provisio1s of the Town of Barnstable By of ealt Private Well Protection Regulation as described in the application for Well Construction Permit No� J -- --Dated---------------_-_-_____ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE-------------------- -- - Inspector---- -- - ----------------------------------------------- FeeF--�--. -------- ----- z;- ------- BOARD OF HEALTH TOWN OF BARNSTABLE Applicatiou,forlDeYr Congtrurtionpermit Application is hereby made for a permit to Construct (✓), Alter ( ), or Repair ( )an individual Well at: L_6 != - e-°-`-=------------------------------------------------------- ----�1 - - -!S- !' - -------------------------------------------- Location — Address Assessors Map and Parcel 5! �I� ne o USG `fit Owner Address-- 1 >1--------------------------------------------------------- c�./ u M"—'�1--- -� Installer — Driller Address Type of Building Dwelling-- �vus t - - -------------------------------------- Other - Type of Building No. of Persons--------------------=------------------------- r Typeof Well--y ---------------------------------------------- Capacity------------------------------------------------------------------------------ Purpose of Well_'0 o/�r s ri c_ �u tc-/-- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until a Certificate f Co ance has been issued by the Board of Health. Snd ------- --- ------ 1--__ _ . � - Application Approved B � date date Application Disapproved for the following reasons:--------------------------------------------------------------------------------------- --------------------- ----------------------------------------—------------------------------------------------------------------------------ / date � PermitNo.-((-nt/-`Y •-- Issued---------------------------------------------------------------------- ------------------- --------------------------- date BOARD OF HEALTH TOWN OF BARNSTABLE Certlflrate (Of Compliance THIS IS T,(O CERTIFY, That the Individural Well Constructed ( �), Altered ( ), 'or Repaired ( ) Installer at- r� "_-f- - . s rr�-_ /11_0_ m------------------------------------------------------------- has been installed in accordance with the provisio>s of the Town of Barnstable Board of . ealth Private Well Protection 4k r. ) Regulation as described in the application for Well Construction Permit No. Dated--Dated---------------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE---------------------------------------------------------------------- ----------- Inspector---------------------------------------------------------------------------------- BOARD OF HEALTH TOWN[ OF BARNSTABLE � er erC �on�truction� mit �---~ C/ No.hn��j ----------- Fee------------------- Permission is hereby granted D'A -a-(`=�' ---1 1'/ to Construct (Plter (/� ),:or Repair ( ) an Individual Well at: 7 No. P/ / - ---------------------------------------------------- Street / as showna,°T the application for a Well Construction Permit �lq No. /V r �. -- Dated----- ' „ „ ----- ------------------------------- ---------------- ----- Board of Health DATE---------'-- "' - --------------- f � i -- ---Ah- ` ENVIROTECH LABORATORIES i-~ r Mass. Cert.#:MA063 I 449 Route 130 Sandwich,MA 02563 • (508) 888-6460 CLIENT: Resources Group Trust LOCATION: Lot 1 Cedar Street ADDRESS: P.O. Box 599 West Barnstable, MA Mashpee, MA COLLECTED BY: L. Wile & Son SAMPLE DATE: 2-16-94 TIME: DATE RECEIVED: 2-16-94 SAMPLE ID: §182 JOB#: WELL DEPTH: 140'/108 Static 411PVC Flow: 1 . RESULTS OF ANALYSIS: Parameter Units Recommended limit Result Coliform bacteria/100 ml (MF Method) 0 0 pH pH units 6.0-8.5 6.82 Conductance umhos/cm 500 86 Sodium mg/L 28.0 9.1 Nitrate-N mg/L 10.0 0.31 Iron mg/L 0.3 0.14 Manganese mg/L 0.05 0.004 Hardness mg/L as CaCO3 500 16.5 Sulfate mg/L 250 4.38 Potassium: mg/L 20.0 0.7 Alkalinity mg/L 200 11.2 Chloride mg/L 250 16.8 Turbidity NTU 5.0 8.1 Color APC units 15.0 <1.0 Background bacteria/100 ml (MF method) 200 EPA 601/602 * ug L N.D. COMMENT: * See report attached. YES NO nX Q WATER IS SUITABLE FOR DRINKING PURPOS. S FOR PARAMETERS TESTED. /t DATE I Ni GROUNDWATER ANALYTICAL EPA METHODS 601 and 602 Volatile Organics (GC/PID/ELCD) Field ID: Z182 Lab ID: 7023-01 Project: Resource Group/Lot 1 Cedar Batch ID: VG2-03224 Client: Envirotech Sampled: 02-16-94 Cont/Prsv: 40mL VOA Vial/NaHSO4 Cool Received: 02-17-94 Matrix: Aqueous Analyzed: 02-22-94 PARAMETER CONCENTRATION REPORTING LIMIT (ug/L) (ug/L) Dichlorodifluoromethane BRL 5 BRL 5 ChloromethaneBRL Vinyl Chloride 5 BRL 5 Bromomethane BRL 5 Chloroethane BRL 1 Tri chl orofl uorometh ane BRL 1 1,1-Dichloroethene BRL 1 Methylene Chloride BRL 1 trans-1,2-Dichloroethene 1,.1-Dichloroethane BRL 1 cis-1,2-Dichloroethene * BRL 1 BRL 1 Chloroform BRL I 1,1, 1-Trichloroethane BRL 1 Carbon Tetrachloride BRL 1 Benzene BRL 1 1,2-Dichloroethane BRL 1 Trichloroethene BRL I 1,2-Dichloropropane BRL 1 Bromodichloromethane Z-Chloroethyl Vinyl Ether BRL I cis-1,3-Dichloropropene BRL 1 Toluene BRL 1 trans-1 ,3-Dichloropropene BRL 1 1,1,2-Trichloroethane BRL 1 Tetrachloroethene BRL 1 Dibromochloromethane BRL I Chlorobenzene BRL 1 Ethylbenzene 1 meta-and para-Xylene * BRL SRL I ortho-Xylene * BRL 1 Bromoform BRL 1 1,1,2,2-Tetrachloroethane BRL 1 1,3-Dichlorobenzene BRL 1 1,4-Dichlorobenzene BRL I 1,2-Dichlorobenzene QC SURROGATE COMPOUND SPIKED . MEASURED RECOVERY QC LIMITS a,a,a-Trifluorotoluene 30 28 94 % 87 - 113 % 1,2-Dichloroethane-d4 30 31 104 % 83 - 117 % C BRL - Below Reporting Limit. * Non-target compound. Method References: Method 601 - Purgeable Halocarbons and Method 602 - Purgeable Aromatics, 40 C.F.R. 136, Appendix A (1986). i 4.NO LLJ tA ( � � � "mac � � •y V i f r 4Z s ISO 44 Irx kv i AO • + � �s"s .it �r� 1 j� p�.I'f.f•'-}a �! 17. * 72; . ZJCT; -3' 6) I!/4 L�/F'T/J r��It�A:4� L� V1C�It.t�rr�'II�J�,.✓ _ ALL E G E N D SYSTEM DESIGN. SYSTEM PROFILE MARK D WITH COMPONENTS TAPE SHALL BE NOTES LCOMPARABLE MEANS FOR FUTURE LOCATION. APPROXIMATE NGVD 99 _ EXISTING CONTOUR • " (NOT TO SCALE) 1. DATUM IS GARBAGE DISPOSER IS NOT ALLOWED AccEss covERs To WITHIN s OF FIN. GRADE 2. MUNICIPAL WATER IS NOT AVAILABLE o- X 99•1 EXIST. SPOT ELEV. PROVIDE INSPECTION PORT TO WITHIN 3" OF FINAL GRADE DESIGN FLOW: 4 BEDROOMS ® 110 GPD = 440 GPD \ 57.0' MINIMUM .75' OF COVER OVER PRECAST 2% SLOPE REQUIRED OVER SYSTEM 53.0 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. M• 99 PROPOSED CONTOUR USE A 440 GPD DESIGN FLOW 4. DESIGN LOADING FOR ALL PROPOSED PRECAST UNITS PRECAST H-10 198.4 T L. RISERS (TYP.) TO BE AASHO H-M PROPOSED SED SPOT E] P 0 0 2'0 " W �o e 'I 0 rH1 � SEPTIC TANK: 440 GPD (2) = 880 +. 4"SCH40 PVC n/ 56.2 4 0SCH40 PVC 5. PIPE JOINTS TO BE MADE WATERTIGHT. MoPI W� 1 PIPES LEVEL 1ST 2 2" DOUBLE WASHED PEASTONE et Stye o TEST HOLE **RE-USE EXISTING 1000 GAL. SEPTIC TANK OR GEOTEX�rI'E FABRIC 6. CONSTRUC110N DETAILS TO BE IN ACCORDANCE WITH Stre c� *EXISTING 1o" --Ems-nNG 1000 GAL 14• * - 50.25' 310 CMR 15.000 (TITLE V.) o, 2% SLOPE OF GROUND TEE , LEACHING: EXISTING TEE SEPTIC TANK 54.8 f cocas a o°o°o°o°o°o °Oo 00 00 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO ` .� UTILITY POLE SIDES: 2 (42 + 11) 2 (.68) = 144 GPD ° °°°°°°°°°° °° ' GAS ° o°o°O°o°o°o° °O o 49.75 W3.4' AT SIDES BE USED FOR LOT LINE STAKING OR ANY OTHER49.96' „o„o„o„o„o„0 49.79' o0 2 .5' AT ENDS FIRE HYDRANT BOTTOM 42 x 11 (.68) = 314 GPD PURPOSE. �cy 47.75' 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. NOTE: NOT ALL srM80Ls MAY APPEAR IN DRAWING TOTAL: 673 S.F. 458 GPD � ADD INLET TEE DEPTH OF FLOW = 4' 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALEDWITHOUT BY Chv�ch OF HEALTH USE (5) "3050" INFILTRATORS IN A TRENCH CONFIGURATION TEE SIZES: 6" CRUSHED STONE OR MECHANICAL 3/4" TO 1 1/2" DOUBLE WASHED STONE ERMISSIONSPECTION OBTANED FROMARD BOARD OF HEALTH. st WITH 3.4' STONE AT SIDES AND 3.5' AT ENDS INLET DEPTH = 10" COMPACTION. (15.221 [21) *THE INSTALLER SHALL VERIFY THE » ** r- 10. CONTRACTOR SHALL BE RESPONSIBLE FOR CALLING LOCATIONS OF ALL UTILITIES AND ALL OUTLET DEPTH = 14 INSTALLER SHALL CONFIRM MINIMUM SEPTIC TANK SIZE AT `' 1000 GALLONS AND ITS SUITABILITY FOR RE-USE. REPLACE 00 LOCATION (OF ALL3 UNDERGROUND AND VERIFYING THE BUILDING SEWER OUTLETS AND LOCATION OF ALL UNDERGROUND & OVERHEAD UTILITIES i WITH 1500 GALLON H-`; ;zPs�oP TANK IF NOT SUITABLE. ( 1 % SLOPE) 39.0' BOTTOM TH-1 PRIOR TO COMMENCEMENT OF WORK. LOCUS ��^ ELEVATIONS PRIOR TO INSTALLING ANY C P PORTION OF SEPTIC SYSTEM 11. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL BE , MA NO GROUNDWATER FOUND REMOVED 5' BENEATH AND AROUND THE PROPOSED SCALE 1"=2000'f APPROVED DATE BOARD OF HEALTH FOUNDATION EXISTING SEPTIC TANK 43' D' BOX 6' LEACHING FACILITY LEACHING FACILITY. 12. EXISTING LEACHING FACILITY SHALL BE PUMPED AND ASSESSORS MAP 130 PARCEL 35 REMOVED OR PUMPED AND FILLED WITH CLEAN SAND. LOCUS IS WITHIN WP OVERLAY DISTRICT i a r 19 �3.66, I SEASONAL WET AREA . I - TEST HOLE LOGS I i 45 \ ENGINEER: DAVID FLAHERTY, R.S., SE2755 I WITNESS: DONNA MIORANDI, R.S. �1 LOT 1 DATE: JULY 3, 2008 SHED \ 1.51 ACRESt PERC. RATE _ < 7 MIN/INCH GARD CLASS I SOILS P# 12274 � ELEV. ELEV. � ELEV. � ELEV. �b 0 53.0 0 53.0' 0 3 53.0 p 4 53.0 A/E A/E A/E A/E s LS LS LS LS o 1OYR 5 4_ 10YR 5 4 1OYR � 5/4 1OYR 5/4 4„ 491 y B B B B LS LS LS LS �s \ " 34 36 1OYR 5/6 50.0' ,9 50.2 36 50.0 1OYR 5/6 1OYR 5/6 34" 1OYR 5/6 50.2' NJ C1 C1 C1 C1 PERC FMS FMS PERC FMS FMS 2.5Y 6/4 2.5Y 6/4 2.5Y 6/4 2.5Y 6/4 TH- TH- , (POCKETS OF LS) (POCKETS OF LS) (POCKETS OF LS) (POCKETS OF LS) 5" ti� 126" 42.5' 125" 42.6' 126" 42.5' 125" 42.6' 14 HOLLY " 'I-I- � C 2 C C 2 C i 8" HOLLY MS MS MS MS 2.5Y 7/4 2.5Y 7/4 2.5Y 7/4 2.5Y 7/4 I 168 39.0 168 39.0 168" 39.0' 168" 39.0' - A• 58 S s� ss _59 \ _ NO GROUNDWATER ENCOUNTERED NO GROUNDWATER ENCOUNTERED v DECK /O EXISTING\\ 09 WEL I �s 0 ER \ EXISTING \ DWEU.!NG 9 TITLE 5 SINE PLAN of 10 CEDAR ST. (WEST) BARNSTABLE MA WIRES UG \\ PREPARED FOR PATTI KELLOGG \ DATE: JULY 14, 2008 Scale: 1"= 20' 0 10 20 30 40 50 FEET \\\ • �H of MAS of Mq off 508-362-4541 . ti o� DANIEL ti� s9c s ESN ssq� fax down08-362-988 D © R I \\ o ANIELA. G \\ o OJALA ; o A• .� CIVIL OJALA down cope engineering inc. a/SAT 5E0E2N,ww, No.4 09 0 1 {S�o civil en ineerso P' Ds land surveyors i ( n J �Is 939 Main Street e t ( R to 6A) i YARMOUTHPORT MA 02675 F WELL DATE DANIEL A. OJALA, P.E., P.L.S. APPROX. W 08 142 a 08-142 KELLOGG.DWG (DDF) I i TEST PIT #1 TEST PIT #2 GENERAL NOTES 9 9xl 0 103x1 — 10 -6_.' �I TOPSOIL l --� _ _ 1. ALL ELEVATIONS SHOWN ARE BASED UPON AN a ASSUMED BASE. 2' SUBSOIL. _i97x1 I _� —� TOPSOIL 2 PITCH ALL LINES A MINIMUM OF 1/8� /FT. UNLESS I — OTHERWISE SPECIFIED. GO 0 0 0 o O 0 C. 0 0 0 00 g I I 1' _ -� 000 0 0 0 (3) 5 6) 0 0 0 000 3. ALL PIPES TO AND IN THE SYSTEM SHALL BE CAST CLEAN - - - - - - - - l' I 0 00 p O O @ 0 0 0 0 0 00 IRON OR SCHEDULE 40 PVC. 00 0 0 0 0 0 0 000 _M 4 ALL SEPTIC TANKS, DISTRIBUTION BOXES, AND SUBSOIL � 1 000003� 0 0 0 000 _ LEACHING PITS SHALL BE DESIGNED FOR H-20 WHEEL MEDIUM 7' I 96x1 000003 O @ 0 00 0000 LOADINGS 'WHEN UNDER PAVING. `C � -- -- L___ I �' 000003 Q (D 0 0 0 000 CLEAN --{- 000000 O 1J 0 0 0 0 000 5. REMOVE ALL UNSUITABLE MATERIAL BENEATH THE SAND �o„ 3 14" 00 0 0 0 C� �O 0 0 0 000 INVERT ELEVATIONS OF THE LEACHING PIT FOR cn MEDIUM co - -- —p, - TYPICAL DISTRIBUTION BOX 000 U 0 O 0 f� OOCO A DISTANCE OF 10FT AND BACKFILL WITH CLAY- 4 -0" FREE SAND 8 GRAVEL HAVING A PERCOLATION RATE SAND LIQUID LEVEL I = -NOT TO SCALE _ 6 0„ OF 2 MINUTES PER INCH OR LESS. _14' ! _ 14' 89x1 �_- - �- NOTE DISTRIBUTION BOX AND 1500 6. THETOWN OF BARNSTABt-E BOARD OF HEALTH MUST NO WATER ENCOUNTERED GAL REINFORCED SEPTIC TANK BY BE NOTIFIED WHEN THE SYSTEM IS NEAR COMPLETION OBSERVATION PIT TYPICAL 1500 GAL. SEPTIC TANK ACME PRECAST OR EQUAL. TYPICAL LEACHING PIT AND PRIOR TO BACKFILLING . 7 UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS PERCOLATION RATE=<2 MIN/ INCH NOT TO SCALE NOT TO SCALE SHALL BE INSTALLED IN ACCORDANCE WITH TITLE 7 OBSERVATIONS BY JERRY DUNNING NOTE TANKS REINFORCED THROUGHOUT WITH OF THE STATE SANITARY CODE AND ANY LOCAL TOWN OF BARNSTABLE BOARD OF HEALTH ELECTRIC WELDED WIRE WITH 24-1/2 RULES WHICH MAY APPLY ENGINEER- ARO ENGINEERING INC. EMBEDDED STEEL RODS iN TOP 8t BOT- il. OBSERVATION PIT TO BE EXCAVATED TO 4'BELOW THE PROPOSED BOTTOM OF FIT 8 CONTRACTOR IS TO NOTIFY_ ENGINEER, PRIOR TO THE INSTALLATION OF SEPTIC SYSTEM OF ANY DISCREP- DATE JANUARY 6,1994 TOM :;ONCRETE IS 4,000 PSI TEST. ELEVATION TO VERIFY SOIL CONDITIONS ANCIES BETWEEN TEST PIT RESULTS AND FIELD P 8168, AND WATER TABLE. ENIG!NEER TO BE CONDITIONS. LZAE BEAi9ZMS OZSrA4Vf' NOTIFIED OF ANY VARIATIONS PRIOR TO t S as*If loo oo THE START OF CONSTRUCT! .)!,. 9. ACCESS MANHOLES TO SEPTIC TANKS AND LEACHING PITS TO BE BUILT UP TO 12 INCHES BELOW FINISH GRADE. 10. NORTH ARROW IS NOT TO BE USED FOR SOLAR PURPOSES TOP OF FOUNDATION ' -� ELEV.= III+oo FINISH GRADE FINISH GRADE FINISH GRADE OVER LEACHING .6a FINISH GRADE OVER TANK OVER IUD" BOX AREA ELEV. = 104+0 f ELEV= 107+5 ELEV. = 105+0 ELEV.= 104«8 EXIST GROUND ll\vl%'\_4pxl_\l�1%1\14�XllN rs ..-.�.--._._"-•-r �13.O ! risers 'x X �4 • �11.si ..;--i �c�iy-=_-_--- -•---..-- _ �..,,, ...<-.._._.�. ;:=�"' �lo� � _ WASHED STONE TT ,c:. L ,_-- INV.= IO2+00 INV.= 99�*67 �. INV.= 100+50 _ 100+25I-NV ..,.. . . . . ...... ► 500 GAD_ INV.- i .. _ T„�.. ..: 1/ D I ST. 30 X a or.� . ....... o "X 3�4 X 1'�2 , _ _...._. o REINFORCED24 9.? o C(.,NCRE7 t (TO BE LEVEL ►° . WASHED STONE lev. 06 & STABLE) „: . . ..... 1`�f V ___. i - "� Pto low --�. _ 1 �N. '3 SEPTIC TANK ..»:. : . . . ...... BOTTOM OF PIT .foe. c �,. 1- .� 1/11-�fk-, T Dk ix (TO BE LEVEL 8� STABLE' INV.= 96.00 FLEV.= 90t00 21 :�� • '� � ��°.�' s..,, �"� "`��_. .�-� lob � I 'Z -, TYPI CAL � SEWAGE SYSTEM PROFILE PRECAST LEACHING PIT TO BE LEVEL B STABLE) NO T TO SCAL E SS LEGEND ' tom, 1 f i �. �fQ MAP CTI N PARCEL LOT ADDRESS EXIST CONTOUR — -- — -- 8 — .., (}a g 1 ►o 9 --- - 1.5=1. I is 6 9 0 roa PROPO CONTOUR J 2 . 0 � � � - .• ' �. , �'��..:, � Ex•4-5T SPOT ELEVATION 8 x 0 PROPOSED SPOT ELEVATION 8 + 0 - '"'` - ZONING DISTRICT FLOOD HAZARD ZONE PERCOLATION TEST x I oo ` - - ,�.. ' ..� JIM OBSERVATION PIT H RF C IAL STREET .� -�� DESIGN CRITERIA I PROPOSED LOCATION OF DWELLING CEDAR ,. DES G C E B SEWAGE DISPOSAL SYSTEM NUMBER OF BEDROOMS 4 - - �____� L9 •���� _.-�.--�'-� -�r{_..� PERSON PER BEDROOM _ 2 _ _7 I LOT I (#69o) CEDAR STREET J. .00 G4LLONS PER PERSON PER DAY 55 +Q LEACHING REQUIRED 44� gpd BARNSTABLE MA. Lli LEACHING PROVIDED 549.7 Qpd I I = J DISPOSAL NO _-- - f APPLICANT ENGINEER cn < RESOURCES GROUP TRUST ARO ENGINEERING INC. SEWER DESIGN 13 STEEPLE STREET,SUITE 202 39 STRIPER LANE i ASHPEE, MA. 02649 ' SIDEWALL- 2n x 5 x 6 x 2.5 � 471.2 gpd � � � E. FALM,'�,„'TH, MA. 0253E i L1.i i BOTTOM = n x 5' - 1.0 = 78.5 gpd SCALE : DATE SHEET c'YI JO O 21� IO 60 TOTAL= 3.7 gpd AS SHOWN JANUARY 10, 1994 1 _ 1 DRAWN BY: CHECKED BY APPD BY PLAN NO- PLAN SCALE : 1'1= t CF " RF_F REa A-895