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HomeMy WebLinkAbout0035 CEDARCREST LANE - Health 35 Cedarcrest Lane --CI9 7 R Omford. NO. 152 1/3 BLU 10% 0 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION r RECEIVED / Va JUL 2 3 2001 TOWN OF BARNSTABLE TITLE 5 HEALTH DEPT. OFFICIAL INSPECTION.FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION ` Property Address:. 3s w ,A ` .Xe Owner's Name:ep ,,?,7 Owner's Address �,[ �SA/ Date of Inspection: r7 e�l p Z a Name of Inspector:° please print)Iak,(-47 sj y-io10� 1 ` Company Name" �"(/ Zoa^(;e .� . Mailing Address: C�-,� Telephone Number: ,''-ems �� • ��=�� 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 pursuantf to Section 15.340 of Title 5(310 CMR 15.000). The system: R� Passes Conditionally Passes Needs Further Evaluation by the.Local Approving Authority. s 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. 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 i Page 2 of 11 f ,, OFFICIAL INSPIECTION FORM—.NOT FOR VOLUNTARY ASSESSMENTS —SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: `�' �� rr,flr°+/r?� /�/517, t Owner: C /rr�,? • irj�wF. I ..�> Date of I spection: �Fi� i Inspection Summary: Check A,B,C,D or E/ALWASIS complete all of Section D A System Passes: j.i 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 nbt evaluated are indicated below. i Comments: i 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�ank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of.H.ealth. *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 le l eled 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):.J: broken pipe(s)are replaced obstruction is removed ND explain: t Page 3 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued). Property Address: 3S CP Jrr A 1s Owner Date of In pection:. 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 11 OFFICIAL.INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A . CERTIFICATION(continued) 6)),"Property Address: 1n,2- Owner: 41,71 r Date of 16w6tion: D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections Yes No ABackup 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 liwater supply. t 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:] �u p (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 Systems: To be considered a large'systemahe 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.system's 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 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. 4 Page 5 of 1.1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST � s Property Address: Owner: Date of In ection: 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.ofHealth 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? V 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: Yes no Existing infonnation.For example,a plan.at the Board of Health. aJ _ 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 Page 6 of 1 1 OFFICIAL INSPECTION-FORM—NOT FO.R VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION.FORM PART C SYSTEM INFORMATION Property Address: y I 7 .,�.fqwn Owner: Date of Inspection: fr-A) FibW CONDITIONS RESIDENTIAL g Number of bedrooms(design): .. Number of bedrooms(actual): - DESIGN flow basedon 390 C-A _5:203 (for example: l 1:0 - d x#of bedrooms): f 1 Number of current residents: ( Chu' Does residence.have a garbage grinder(yes or no):-.410— - Is laundry on a separate sewage`system(yes or no)./ .[if yes separate inspection required] Laundry system inspected(yes or no), ?' Seasonal.use: (yes or no) �. Water meter readings, if available(last 2 years usage (gpd)): Sump pump(yes or no `. Last date of occupancy: COMMERCIAL/INDUSTRIAL Type of establishment: Design flow.(based on 310 CMR.15.203): - . gp�i Basis of design flow('seats/persons/sgft,etc.); 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): GENEP.AL INFORMATION Pumping Records Source of information:. I:. ,��'1%1, 4196< - Y�,/✓;�;����� %� � Was system.pumped as part of the inspectiob'(yes or no): — If yes, volume pumped: gallons--How was quantity pumped determined? Reason'forpumping: . TYKOF 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 fa/g//e of all components,date installed (if known)and source of information- Were sewage odors detected when arriving at the site(yes or no): Z 6 Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: �j W ' �;A Owner ,' Date of Inspection: /0 % BUILDING SEWER(locate on site plan)—�2 " 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: Zoocate on site plan) 162 is / 5-=48- Depth below grade/ 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):_(attach a.copy of certificate) Dimensions: • Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: 9'/d °I Distance from top of scum to top of outlet tee or baffle: Z r° Distance from bottom of scum to bottom of outlet tee or baffle: 3 How were dimensions determined:xlah F Comments(on pumping recommend'ations, i'nlet and outlet tee or baffle condition,structural integrity, liquid levels i/- s related to outlet invert, evidence of leakage etc.): ,4 GREASE TRAP-# -(`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 I l <: , OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) i` % � Property Address: �� ��.�y�.�1�?/%fi��� Owner:" ✓, fJ/�' ��. °� . � "e� �a Date of.Inspection: -?��,���?� TIGHT or HOLDING TANK-Z&_(tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete' metal fiberglass_polyethylene other(explain):" .� • _ Y.. . ..-. .. . .... .• .. .�.�� � .. .. a �. ..-.. .. . + • •. Dimensions'. Capacity: gallons ' Design Flow: gallons/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: aZ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into orj out of boxz etc.)- PUMP CHAMBER.,A (1 co ate 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.): r 8 Page 9 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owners 7 c : Date of nspection: -71j —16) SOIL ABSORPTION SYSTEM (SAS):.Zoocate on site plan,excavation not required) If SAS not located explain why: Typed ✓leaching,pits,number: 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.): C:U--t,u�`�t.���i�=v1 f�C�.�' �b d,✓�'.,o`�n � .{-j��.a`,�'sr..C,.,�� CESSPOO�!�(cesspool must be pumped as part of inspection)(]ocate 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 noT x 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.): 9 i Page 10 of 11 r , OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM P�RT C SYSTEM INFORMATION(continued) Property,Address: Owner: Date of.Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system includi Ig ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate were public water supply enters the buildingoo jr� � o Xb e to Page 11 of'].1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: S � � /1� 1 Owner: � r.�//-P , t� Date of Inspection: SITE EXAM Slope Surface water Check cellar. Shallow wells Estimated depth to ground water 3 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: _,Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: 11 , LOCkTION r��L SEWAGE PERMIT '-NO. VILLAGE INST_A LLER'S NAME i ADDRESS 3UILDER OR OWNER ' DATE PERMIT I S S U E D Y v DAT E COMPLIANCE ISSUED " /J9 Y dry•'} .�• v V a rl q2 a` ,,, � s� >a ;;fit ' ar ;7,� `'�. ��•,�'�` �_t5�-o,�i i +. ,,; • � ..sky-� � - • • �•� x���;1 L �: t7;t ra, �, „� S ( W R C !� 6: � :�1 P. • 9 L I'°I Si (""' s'y'S�i'i' cif }h` 'Y:, Si° ' dHT ,tt �.• qfu ta` ,� � t, r `_ �+•� i:. a `� 3` ,"�'*t�`s))( +/^. •� F h P 1 fi +Y'�t W jai �'• ���+ .� a - 3. _� ,:Y .w ���� ,..e+... .ram+- � s � t p�X t E sY.1 f �_ _�• rt r� r,k'�r. f '� THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I M ^C&L DATA k VRg.r-"_............... THE COMMON`�NEALT;N OF MASSACHfiSETT-i BOARD OF HEALTH `T w^,.. .............. OF. .`...tA ...P� ............................. AVV iratinn for Diiipviial Markfi Tnnritrnrtinn Urrmit Application is hereby made for a Permit to Construct (X4 or Repair ( ) an Individual Sewage Disposal System at: LOT ................----....-..................................................................... -••-•-•-••----••••---•-•••-•• -------------.................................................. / Location- ddr or Lot No. (. jC�co/"��R�' ....................( l�l • +/Ownez - — ------- `^' ........._51 ..... Address ' Installer Address `-�, � Type of Building Size Lot-(-�___x.---_S...-____..Sq. feet �l _________ .Ex Expansion AtticDwelling— No. of Bedrooms__ .4 Garbage Grinder �— pa Other—Type of Building ____________________________ No. of p ----------- Showers ( ) — Cafeteria (�}— Other fixtures ------- ------ ---------- -- - - W Design Flow--____-•-.__-_5...........:...........gallons per person per day. Total daily flow---------ZZT-c7 3,3 O ---gallons. WSeptic Tank—Liquid capacity_`P.Pq.gallons Length__-.-:-7------- �;Vidth_..._�----- Diameter---------------- Depth............. x Disposal Trench—No. -_.-__--____-_--_-- Width.................... Total Length-------------------- Total leaching area.....................sq. ft. 3 Seepage Pit No-------/._....------ Diameter....JAt_5 __ Depth below inlet--------4........ Total leaching area_A27 .....sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by._�_._ _ _ _ ____ v______________________________________ Date-_1 ..'�1.�_�6._____......__... Test Pit No. 1_,,3__...__---minutes per inch Depth of Test Pit.-._-A!-_--...--.'Depth to ground water---. ���? fi Test Pit No. 2_�---------minutes per inch Depth of Test Pit_..43...._.._._. Depth to ground water..NoN� R: O Description of Soil . ' 1y1 .SY TF ------.,ZA271--------1�---------------- v4c oc,v------------------------------------ w ---- ---- - --------- - - ------ UNature of Repairs or Alterations—Answer when applicable----_---------------- ------------------------------------------------ --------------------------------------------------------------------------------------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in acco' the provisions of L ITLL 5 of the State Sanitary C e— The undersigned further agrees not to place operation until a Certificate eCompliancee issu by(]the board of health. Application Approved By___ _______Application Disapproved rons:-_-.•________________________________________________________________ -------•••--•---•--••---••---•---------•••--•--••-••--•-......-•••-...--•-•.....................................------•-------------------------- PermitNo..................................................... Issued_---- o Fss THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH d.�^� ......_.........OF.... 2.. J� PAL ---------------------------- AVVfiration fear Diiipn,iai Warkri TInnBtrnrtinn Urrntit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ••--�vT 7 Location-Address or Lot No. A1�4 Owner Address w -5 A��N� `- �t?��-- ----------............ Installer Address Q Type of Building Size Lot(05..._____.,___Sq. feet U Dwelling—No. of Bedrooms___•----------------------r____-_____--._..Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) ` f11 Other fixtures Q W Design Flow............ _________________________gallons per person per day. Total daily flow---------4_2•jCV.?3.4-.....gallons. n: Septic. Tank—Liquid capacityl.©.QV__gallons Length____-:�___--_-- Width..... Diameter---------------- Depth___-__--__-- �' Disposal Trench—No. .................... Width-------------------- Total Length.................... Total leaching area....................sq. ft. Seepage Pit No......j------------- Diameter..__ _--__ Depth below inlet---....�......... Total leaching areal 9-:4......sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.k. G\Orf G:Z_Q-----------------__...................... Date.I- IA:`.�.-13.............__.. a Test Pit No. I _.M____-__._minutes per inch Depth of Test Pit-----i:............ Depth to ground Ci. Test Pit No. 2-,-..____._._minutes per inch Depth of Test Pit... ........_._.. Depth to ground water.NSO _ ---------------------------------••--------------------------------- -------------•------•-•-......................................................... 0 Description of Soil---- -•--------- ........... ----- (xj A '.0 GyC.G W UNature of Repairs or Alterations—Answer when applicable..........................._________________________________________________________________-. --------•-••-••------•-----••-•-----•••••---•---•--------•..............•-•---------•---------------•--•---•--••---•----•••-•--- •••---•••-•-•-•--•----•----••-----••-••-------.. ...................... Agreement: The undersigned agrees to install tfie aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the.State Sanita Code — The undersigned further agrees not to place the system in operation until a Certificate of Compliance een Asued by the board of health. te --- ........... -- --------•-------------- ----- ----•--------------- .. ate Application Approved B ...... .................. ... /i-- -----. ---•----•---• ate Application Disapprov, for e following reasons:_____________________ !_ ____•--__----____-_____-_-•-----•--_ ----•.............•...................................................------------------------------................................ -•-•-----•..... ---------------------------------------- Dan — — PermitNo--------------------------------•---------------------- Issued----------------------------------------------------- Date THE COMMONWEALTH OF MASSACHUSETTS I BOARD OF HEALTH ..........................................OF........................................................--------.------••---------•- Qlratifiratr of Tantplinnrr A T S IS T CERTI at Individual Sewage Disposal System constructed ( or Repaired ( ) ' ------------------------------------------ - ------------------ ---- - Instauer u . t- --------------------- ha en T� `> of The State Sanitary ode '-s described in the app Icatlon for Disposal cWorks eConstru Construction Pe m t of dI ' fig daVA'PG _with the P �,`� - -----------------•-•-- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT'BE CONSTRUED � flTKRANTEE THAT THE SYSTEM W1 F NCTION SATISFACTORY. DATE L/j - _ Inspector :t ------------------------------------------------------ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ' o`. .__...:. ............................... . ...... OF_--- .........................-_....-----...._.........----.........----... . SEE -•----••-------•.... • �i��nr , >��'k� �lan��rztr�inn rrnti� Permission�•s hereby b <-: = ------------------- ---------------------------------------------------------------------------------- - ,�.. lam. to Construe(, , epair ( a dual S,e age Disposal System at No... �. e -• --- a ----------- ---- ..__-- el • street as shown on the applicatio for Disposal «`orks Construction Permit No,.---.............._ Dated-________..._._.-___.__.._............. / �� Board of Health DATE-----/^--'-- 3 FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS Log Number: ' 3006 Date: 9/16/83 OF BA td BARNSTABLE COUNTY HEALTH DEPXRTMENT 5 SUPERIOR COURT HOUSE BARNSTABLE, MASSACHUSETTS 02630 �$B PHONE: 362-2311 DRINKING WATER LABORATORY ANALYSIS Exr. 331 Client: Harry Davidson. Jr. Collector: R. R. Clough Mailing Address: Maple St. Affiliation. Clough & Cahoon West Barnstable. MA 02668 Time & Date of Collection: _ 9/13/83, 4:30 p.m. Telephone: Type of Supply: well water Sample Location: Lot #7 Cedar Crest Lane Date of Analysis: 9/14/83 W Barnstable Parameter Sample Result Recommended Limits Colifonm bacteria (organisms/100 ml) 0 0 pH 6.1 Conductivity micromhos/cm 68. 500.0 Iron (ppm) V.05 0.3 Nitrate-Nitrogen (ppm) V'.04 10.0 x Water sample meets the recommended limits of all above-tested parameters. Water sample is drinkable but has higher than average levels of This does not represent a health hazard but future monitoring is recommended (2-3 times per year). We will test for Sodium. Water sample is drinkable but may present aesthetic problems to users (staining, odor or taste). Water sample is of poor quality and is not recommended for human.consumption. Resampling and retesting is suggested. Results only. REMARKS: cc: Barnst ble Board of Health cc C gh & Cahoon Analyst: 11/18/81 ( _ . ,: ,:......x . 1 . 11 I . . II.T _­ � . -, � , ,� . . � 1, .. _ . . . . . . � ­ I ,.., I­ I � 1. I-'- , ­ I 11- :''. I '. I I . � I - I -;l . � I . I I . . I I I" 1, I I - I I . I I I . I I I 1'k-, . .. ., . . , ­ . . - I . " * I I . '.- I I I ; . �_ ,. I i A . . I ,r ' I . 1 t " . "I I .. I I I .11 ,. I I . '. 'r ' a2 .. ,' , I f- fl. = , .I✓* 4 E' SEPTIC TANK - 'D' `'BOX - - LEACH, �'_r WRw�tlA . e. i. Ir , I i, "! r 1 OP OF RbN ., , i. a., - (MSL_).� .t - «,2 ,©k= teTo.7h„ , $ , , , - E a-. ;b t WA WED.STON r , I - .' 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