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Home My WebLink About0453 CHURCH STREET - Health 7453 Church Street West Barnstable flipA = 176 — 003 i :�,, ;. �� a 7 t �: i I �, e �I �� i' r; �{ �, ;I �I �. � TOWN OF BARNSTABLE �- LOCATION Ys i (G u rel v SEWAGE # I f y VILLAG ASSESSOR'S MAP & LO r� T 7 a INSTALLER'S NAME&PHONE NO. l'/ �e +-✓mac SEPTIC TANK CAPACITY LEACHING FACILITY: (type) 'Z 01 S LTya-vr (size) _I/ )r �- NO. OF BEDROOMS S BUILDER OR OWNER 2j PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility f Feet Private Water Supply Well and Leaching Facility (If any wells exist i 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 IA C RE B E "A P3 �IA- FS 3a,s" Rv3� - No:.. oD of 0 t Fee Q THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes apphration for 3igponf *pgtem cougtructton vermtt Application for a Permit to Construct( ) Repair( ) Upgrade Abandon( ) t Complete System ❑Individual Components Location Address or Lot No. tf r S;T r,- 1 Owner's Name,Address,and Tel.No. oc,^14bt,- 2:61,motclid Assessor'sMap/Parcel 1 —761pp'3 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size � gut sq.ft. Garbage Grinder ( ) Other Type of Building nb`a_ w.�7 No. of Persons �— Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) !�7Sc) gpd Design flow provided _!57��X.g gpd Plan Date r L-L-L. ZOps Number of sheets Revision Date Title N5- S T- Size of Septic Tank 1,-U0 Type of S.A.S. r7. Description of Soil ^ .e=T(". Nature of Repairs or Alterations(Answer when applicable) &vo ,p �S�dM 7 6 IA'A-t o4 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 Compliance has been issued by this Board of Health. Signed Date /— 2 O ^ top(. Application Approved by Wa- f Date Application Disapproved by: Date for the following reasons Permit No. go 06— 6 I (o Date Issued — 2d— 90bb �( No. BU�O®G^ � -" Fee 1 � _ ��•"-'"""'"'' � Entered in computer:T"AtOMMONWEALTH OF MASSACiHUSETTS p Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Application for Tigpogal *pgtem Congtruetion permit Application for a Permit to Construct( ) Repair( ) Upgrade( Abandon( jF Complete System ❑Individual Components Location Address or Lot No. Y S 3 Gin v c kA, S-r reeT Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 1 —1 ca/D p3 Installer's Name,Address,and Tel.No.' Designer's Name,Address and Tel.No. 0-4�ew-ke e.1-r—,Zpl:ses LLC �-�SA Lyo„s " r3 o,c�b3 Ge��lt� ✓tw4 0�.103 t- Type of Building: Dwelling No.of Bedrooms Lot Size �� cr t sq.ft. Garbage Grinder Other Type of Building S�nsks_ No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided SSQ•rK gpd Plan Date IZ--L-L. 2.60S Number of sheets Revision Date Title L/5`3 l ti....r c�.. s T• / Size of Septic Tank 1500 Type of S.A.S. 1n I rd ado 2 f /0, 1 Y f Description of Soil Nature of Repairs or Alterations(Answer when applicable) eovw. to f 5..��f h, t SDo S�R� _1)amt 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 Compliance has been issued by this Board of Health. Signed Date /" Z o — top 6 Application Approved b Date 11— :?U — .?GO 6 CPA— Application Disapproved by: Date for the following reasons Permit No. U 0/o— 1 (D Date Issued - ,2 d— v?006 ------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance M THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded Abandoned( )by C r4na„o�d e IL,,C-C at has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated )`_2 0—29. Installer Cgk.j•,U QA d�e e S Designer G i s A Ly o hr #bedrooms Approved design flow gpd The issuance of this 1peqmit shall tjot be construed as a guarantee that the syste , will fu\ncb on esigned. Date ) tP Inspector -------------------------------------------- No. '2 y(/S/1 J(o Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS Bigpogal ,ps tem Construction Permit Permission is hereby granted to Construct ( ) Repair ( ) Upgrade (b<) Abandon ( ) System located at u 53 e,5 i3 ArA,t- and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. I Provided: Construction must be completed within three years of the date of this-permit. Date I / Approved I r t — �� — w...vwvv �uww OIY'1 u vvWr VLW1.1�1'Y V Lender Cape Cod Co-operative Bank 47.9 q4=• � jEntry <—Up 18A' Utility Area �� Living Room CO 5_'r Dining Room Walk- Thru C Closet Library a. —> (Built-ins) Up 240 Den First Floor B i2 V N o Bedroom Screen Porch U o Bath 47.0' 24.0' 23.9 52 Bedroom Bath Bedroom Cf...Down >1 <'70R*Z Bedroom :r cC Y xA„•. o Attic» <—Down 4r ;.` 24.0' CO Bedroom Ss: Second Floor o Bath ' ' "� ° " 'd �1s�� rl,g Of �tiled Notice: Sept1c Systems Only ��i _ PERCUATION TEST k: SOEL FV.,A IJATI()N E,.Y� lvii''TIO fopcm hereby..cetti. that t'he en °.,neexedplwi si ned by me dated `2�2'Z ®?_,concerning the propert•�located at VV Ip��A6L__meets au of the following cxi°ter%a: 0 TWO nail makado is wxcavated for d tailed examination.(tlo hand augeTr.ing') amd two . Percolation tests shall be conducted, • This failed system is connected to a residential dwelling only. There are,no conime,vial or b .sir cas mes associated with the dwelling. $ The soil'is classU e;d as CLASS I and the percolation rate is Less than.or eelwd. to 5 minutes per in.,h.. • There is no increase inflow and/or change hi use proposed 'I here are no variances requested or needed. The bottom of the proposed leaching;facility M' 1l be located ro less than five :feet above the maximum adiusted =-undwater table elevation. [Adjust th?t groundivater table using the :Min-ator method wl en applicable) Please compUte:the following: A) Top of aouad Surface Elevation{:using;018 informer-tio::z) _ 9 ) 2 E) G.Y'V.Elevats:on �+4ustment fear high G.W DIFFERENCE EE'T"'WEEK A and i3 SIO:TED _ DATE: NOTICE Eased upon,the above information, a repair perm t N4U' be issued fm- bedrooing maximum. No additional.bedrooms are authorized in the fittute without engineered sepgic systam Town of Barnstable fRE 'O`'y Regulatory Services Thomas F.Geiler,Director +.HARNS..AM Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office:.508-862-4644 Fax: 508-790-6304 Installer &Designer Certification Form Date: g,7 a(o Designer: u SA LYbr15 Installer: 04f6 Address: . lob I,t). {'fLlu viyu,5�6T Ct✓GLe- Address: So'I iZ F,a lrvw„d , 7 On '2� _ � ��e,,,o�� 6'4�w ILV was issued a permit to install a (date) (installer) septic system at 453 6 HVAe.GN .51 0 (304 1 -RgCEbased on a design drawn by (address) ASA LY" dated (designer) I certify that,the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. X E�j N 0�� ezi • • =C' ± (SSA �, • ' -Z�ek' ign e) 9 �Ai S�0 SAMISi��►�� A ..Ilk � Sign e) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form nn � 5 f .0 L �1 �Massachusetts Department of Environmental Management � "dam' V" Office of Water.Resources 144115 TYPE OR PRINT ONLY Well Completion Report 1. WELL LOCATION GPS (OPTIONAL) LATITUDE LONGITUDE_°! .DATUM .Address at Well Location: �� 1,;yIrcL Property;Owner/Client: Subdivision,Name: Mailing Address: �i Sin } . I 1 h . City/Town A,% R r� i'CC�'�l I�� -� City/Tow - ��r�s _ � C_G. r � �'2� - Assessors Map Assessors.Lot#: NOTE:.Assessors Map and Lot# mandatory rf no treet•address available Board of.Health permit obtained: Yes C Not Required ❑ Permit Number lnf + %� Date Issued !I -Idt 2. WORK PERFORMED 3. PROPOSED USEi`*-� _.:' 4. DRILLING'-METHOD FA New Well ❑ Abandon [5jj Domestic ❑ Irrigation ❑ Cable `C :Auger ❑ Deepen ❑ Recondition ❑ Monitoring ❑ Municipal ❑ Air Hammer `M, Direct Push ElReplace ❑ Other El Industrial ❑ Other ❑ Mud`Rota i_ _,E] Other 5.WELL LOG Water Unconsolidated Consolidated 6. SITE SKETCH (use permanent landmarks with distances) Bearing ID Other Roca Typed From (ft) To (ft) Zones C) m Material Description '-- -,U F A.-C. L _ 7. WELL CONSTRUCTION - 8. CASING Total Depth Drilled From (ft) To (ft) Casing Type�and Material Size I.D. (in) Well Seal Type CDate Co to- - 2 4 t ` f VC. f(t'LM A0017J 9. SCREEN From (ft) To (ft) Slot Size _ Screen.Type and Material Screen Diameter 40 6 k t� qt y 1• 10. FILTER PACK/GROUT/ABANDONMENT MATERIAL 11.ADDITIONAL WELL INFORMATION Developed? 5d Yes ❑ No From (ft) To (ft) Material Description'-.",_ Purpose Fracture 7Enhancement? ❑ Yes [,;Q No Method Disinfected? E�l Yes ❑ No 12. WELL TEST DATA(ALL SECTIONS MANDATORY FOR PRODUCTION WELLS) 13. STATIC WATER LEVEL(ALL WELLS) Yield Time Pumped Drawdown to Time to Recover Recovery to Depth Below Date Method (GPM)_ (hrs& min) (Ft. BGS) (hrs & min) (Ft. BGS) Date Measured Ground Surface (FT) !?� NmekAFE 45 "J ``'G • "ice ►2 �2Gcti '� 14. PERMANENT PUMP (IF AVAILABLE) 15.NAMEJADDRESS OF PUMP INSTALLATION COMPANY Pump Description Glx'� is f[`��S€J-rq Z.Z Horsepower � _ w 1 �! (�iyvl 16 Pump Intake Depth `=(ft) Nominal Pump Capacity fb (gpm) rl t t rC AAOZ. 16. COMMENTS 17. WELL DRILLER'S STATEMENT This well was drilled, altered, and/or abandoned under my supervision, according to applicable rules and regulations, and this report is cernp ete and corre= to the best of my knowledge. Driller: Yak' F Supervising Driller Signature: egistration #:1 1 �.J Firm: e'i' Date: '' �Y' Rig Permit#: 1Fj NOTE. Well Completion Reports must be filed by the registered well driller within 30 days of well completion. -BOARD OF COPY. " _ _ SENDER: COMPLETE THIS SECTION ■'Complete items 1,2,and 3.Also complete 7Received. item 4 if Restricted Delivery is desired. 7'�fnd ❑Agent ■ Print your name and address on the reverse ❑Addressee so that we can return the card to you. . C. Date of Delivery * Attach this card to the back of the mailpiece, or on the front if space permits. D. Is delivery address different from item 1? ❑Yes 1. Article Addressed to: S,enter delivery address below: ❑ No s 8 9zo Mssrs Peter, John & Edwin Jen 453 Church Street c� 71n peWest Barnstable, MA 02668 `j d Mail ❑ Express Mail red ❑ Return Receipt for Merchandise Mail ❑ C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes [2. Article,�!jmber (transfer from service label) J �- PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 UNITES 7.1 POSTAL SERVICE First-Class Mail Postage&Fees Paid USPS Permit No.G-10 ur • Sender: Please print�your name, �W6 ,, t�c�ZIP+4 in this box • O A PUBLIC HEALT.0 IVISION TOWN OF BARNSTA�� 200 MAIN STREET HYANNIS, MASSACHUSETTS 02601 I � I cva IInj I - G - a •. • IT C3 Postage $ ��\ �S O Certifted Fee Postmark��.� O t3 Return Receipt Fee C3 (Endorsement Required) if DEC p Restricted Delivery Fee \ _D (Endorsement Required) \`,•_,// rq r-I Total Postage&Fees US PSG 0 SenjTo T �o MOSrS Street,iipt'N;v or PO Box No.o.7dl C h u N e A 5 t r e e 't' --- CV"liple,ZI 2clrj toh.La itif,1 oa 61. Certified Mail Provides: o A mailing receipt (esieney)zooz eunf'oo8g wood Sd o A unique identifier for your mailpiece o A record of delivery kept by the Postal Service for two years Important Reminders: o Certified Mail may ONLY be combined with First-Class Mail®or Priority Mail®. o Certified Mail is not available for any class of international mail. . o NO INSURANCE-COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. o For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a LISPS®postmark on your Certified Mail receipt is required. o For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted-Delivery". o If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach,and affix label with postage and mail. IMPORTANT:Save this receipt and present'it when making an inquiry. Internet access to delivery information is not available on mail addressed to APOs and FPOs. r • • • • •� ■'Complete items 1,2,and 3.Also complete gna u item 4 if Restricted Delivery is desired. X ,Agent ■ Print your name and address on the reverse ❑Addressee so that we can return the card to,you. B. Received by(P'n d Name) C. Date of Delivery ® Attach this card to the back of the mailplece, or on the front if space permits. D. Is delivery address different from item 11 0 Yes rAMrticlesed to: 8 S,enter delivery address below: ❑No 2® Q � Mssrs Peter, John&Edwin Jerio: 453 Church Street Servi West Barnstable, MA 02668 oL - ,lY�Ce ad Mail ❑Express Mail ❑ gistered ❑Return Receipt for Merchandise t -- Insured Mail ❑C.O.D. 4. Restricted Dellvery?(Extra Fee) ' ❑Yes_ 2. ArticieZ-Aber t ` � � t 11 { 1 4 i t l t ill 1 t1 ,(Transfer from servrce { PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 MA Pew QMWO tit q; U jALUD U AGtiIL_�u'} {{ n i, t. F A ' ai f ..:ra.. E::."i E�«-sad 0 Postage $ �S h+,4 n E3 Certified Fee �f 61 M Return Receipt Fee / DECostmark 1 [::I (Endorsement Required) '. C-Htft 0 Restricted Delivery Fee _a (Endorsement Required) rl ✓+' ;. `1 Total Postage&Fees $ ._,sps Ln Se) To o .- SSrg{�ettr n e,E-2� wtq ... -- .......... [� Street Apt.No.;v I or PO Box No.7S3 Ch u H e h 5 t--e a t- ------------------------------- ------------------- ---------------------- Q Late,ZIP* - e arm to �.e l'yl�l oa G 6 � bf, s. CERTIFICATE OF ANALYSIS Page: Barnstable County Health Laboratory Report Dated: 12/8/2005 Report Prepared For: Sally Desmond Order No.: G0533941 Desmond Well Drilling P O Box 2783 Orleans, MA 02653 Laboratory ID#: 0533941-01 Description: Water-Drinking Water Simple#: 33941 p Sampling Location r453'Churcli St:W.Barnstable,MA� Collected: 12/6/2005 -- - Collected by: Desmond Wei Mpap 176 Parcel 3 Received: 12/6/2005 Routine ITEM RESULT UNITS RL MCL Method# Analyst Tested Note LAB: Inorganics - Nitrate as Nitrogen BRL mg/L 0.10 10 EPA 300.0 LAP 12/6/2005 LAB: Metals Copper . BRL mg/L 0.10 1.3 SM 3111B LAP 12/8/2005 Iron BRL mg/L 0.10 0.3 SM 3111B LAP 12/8/2005 Sodipirn 10 mg/L 1.0 20 SIvI31lIB LAP 12/8/2005 LAB: Microb ology- Total;Coliform.._ Absent P/A 0 0 309 AF 12/6/2005 LAB Physical Chemistry Conductance 100 umohs/cm 1.0 EPA 120.1 DCB 12/6/2005 pH 6,6 pH-units 0 EPA 150.1 DCB 12/6/200005 EPA 524.2- Volatile Organics by GUMS M ITEM RESULT UNITS RL MCL Method# AAr a�st Tested dote LAB: GC/MS N > o -z� 1,1,1,2-Tetrachioroethane BRL ug/L 0.5 EPA 524.2 Fyn 12/6/ZU05 u) 1,1,1-Trichloroethane BRL ug/L 0.5 200 EPA 524.2 yn 12/6/2005 CU 1,1,2;2-Tetrachloroethane BRL ug/L 0.5 EPA 5N.2 yn 12/6/iA5 r*t .1.,1,2-Trichloroethane. BRL ug/L 0.5 5.0 EPA 524.2 yn 12/6/2005 1,1;Dichloroethane BRL ug/L 0.5 EPA 524.2 yn 12/6/2005 ,1J. D.ichloroethene BRL ug/L 0.5 7.0 EPA 524.2 yn 12/6/2005 1,1-D.ichloropropene BRL ug/L 0.5 EPA 524.2 yn 12/6/2005 0 1,2,3-Trichlorobenzene BRL ug/L 0.5 EPA 524.2 yn 12/6/2005 1,2,3-Trichloropropane BRL ug/L 0.5 EPA 524.2 yn 12/6/2005 RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 i,pF AA� Page. 2 CERTIFICATE OF ANALYSIS Barnstable County Health Laboratory 'SACk3u_5, Report Dated: 12/8/2005 Report Prepared For: Sally Desmond Order No.: G0533941 Desmcnd Well Drilling P O Box 2783 Orleans, MA 02653 1,2,4-T rich lorobenzene BRL ug/L 0.5 70 EPA 524.2 yn 12/6/2005 1,2,4-Trimethylbenzene BRL ug/L 0.5 EPA 524.2 yn 12/6/2005 1,2-Dibromo-3-chloropropa BRL ug/L 0.5 EPA 524.2 yn 12/6/2005 1,2-Dibromoethane (EDB) BRL ug/L 0.5 EPA 524.2 yn 12/6/2005 1,2-Dichlorobenzene BRL ug/L 0.5 600 EPA 524.2 yn 12/6/2005 1,2-Dichloroethane BRL ug/L 0.5 5.0 EPA 524.2 yn 12/6/2005 1,2-Dichloropropane BRL ug/L 0.5 EPA 524.2 yn 12/6/2005 1,3,5-Trimethylbenzene BRL ug/L 0.5 EPA 524.2 yn 12/6/2005 1,3-Dichlorobenzene BRL ug/L 0.5 EPA 524.2 yn 12/6/2005 1,3-Dichloropropane BRL ug/L 0.5 EPA 524.2 yn 12/6/2005 1,4-Dichlorobenzene BRL ug/L 0.5 5.0 EPA 524.2 yn 12/6/2005 2,2-Dichloropropane BRL ug/L 0.5 EPA 524.2 yn 12/6/2005 2-Chlorotoluene BRL ug/L 0.5 EPA 524.2 yn 12/6/2005 4-Chlorotoluene BRL ug/L 0.5 EPA 524.2 yn 12/6/2005 Benzene BRL ug/L 0.5 5.0 EPA 524.2 yn 12/6/2005 Bromobenzene BRL ug/L 0.5 EPA 524.2 yn 12/6/2005 Bromochloromethane BRL ug/L 0.5 EPA 524.2 yn_ 12/6/2005 Bromodichloromethane BRL ug/L 0.5 EPA 524.2 yn 12/6/2005 Bromoform BRL ug/L 0.5 EPA 524.2 yn 12/6/2005 Bromomethane BRL ug/L 0.5 EPA 524.2 yn 12/6/2005 Carbon tetrachloride BRL ug/L 0.5 5.0 EPA 524.2 yn 12/6/2005 Chlorobenzene BRL ug/L 0.5 100 EPA 524.2 yn 12/6/2005 Chloroethane BRL ug/L 0.5 EPA 524.2 yn 12/6/2005 Chloroform 0.76 ug/L 0.5 EPA 524.2 yn 12/6/2005 Chloromethane BRL ug/L 0.5 EPA 524.2 yn 12/6/2005 cis-1,2-Dichloroethene BRL ug/L 0.5 70 EPA 524.2 yn 12/6/2005 cis-1,3-Dichloropropene BRL ug/L 0.5 EPA 524.2 yn 12/6/2005 Dibromochlorornethane BRL ug/L 0.5 EPA 524.2 yn 12/6/2005 Dibromomethane BRL ug/L 0.5 EPA 524.2 yn 12/6/2005 RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 Page: 3 CERTIFICATE OF ANALYSIS �39r fig' Barnstable County Health Laboratory sgCtN�- Report Dated: 12/8/2005 Report Prepared For: Sally Desmond Order No.: G0533941 Desmond Well Drilling P O Box 2783 Orleans, MA 02653 Dichlorodifluoromethane BRL ug/L 0.5 EPA 524.2 yn 12/6/2005 Ethylbenzene BRL ug/L 0.5 700 EPA 524.2 yn 12/6/2005 Hexachlorobutadiene BRL ug/L 0.5 EPA 524.2 yn 12/6/2005 Isopropylbenzene BRL ug/L 0.5 EPA 524.2 yn 12/6/2005 Methyl-tert-butyl ether BRL ug/L 0.5 EPA 524.2 yn 12/6/2005 Methylene chloride BRL ug/L 0.5 5.0 EPA 524.2 yn 12/6/2005 n-Butylbenzene BRL ug/L 0.5 EPA 524.2 yn 12/6/2005 n-Propylbenzene BRL ug/L 0.5 EPA 524.2 yn 12/6/2005 Naphthalene BRL ug/L 0.5 EPA 524.2 yn 12/6/2005 p-Isopropyltoluene . BRL ug/L 0.5 EPA 524.2 yn 12/6/2005 sec-Butylbenzene BRL ug/L 0.5 EPA 524.2 yn 12/6/2005 Styrene BRL ug/L 0.5 100 EPA 524.2 yn 12/6/2005 tert-Butylbenzene BRL ug/L 0.5 EPA 524.2 yn 12/6/2005 Tetrachloroethene BRL ug/L 0.5 5.0 EPA 524.2 yn 12/6/2005 Toluene BRL ug/L 0.5 1000 EPA 524.2 yn 12/6/2005 Total xylenes BRL ug/L 0.5 10000 EPA 524.2 yn 12/6/2005 trans-1,2-Dichloroethene BRL ug/L 0.5 100 EPA 524.2 yn 12/6/2005 trans-1,3-Dichloropropene BRL ug/L 0.5 EPA 524.2 yn 12/6/2005 Trichloroethene BRL ug/L 0.5 5.0 EPA 524.2 yn 12/6/2005 Trichlorofluoromethane BRL ug/L 0.5 EPA 524.2 yn 12/6/2005 Vinyl chloride BRL ug/L 0.5 2.0 EPA 524.2 yn 12/6/2005 Water sample meets the recommended limits for drinking water of all the above tested parameters. - 0 Approved By: ,�•1J-e-1 (Lab ector) RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605 41 j571 N Fee BOARD OF HEALTH TOWN OF BARNSTABLE Application is hereby made for a permit to Construct Alter or Repair, ( )an individual Well at: CAnWrj—(, 5A:, -�) - G -.&.— --- P(07q -- Location Address Assessors Map and Parcel ?WAVY,oy,& Gmnw'�c Owner Address 7- 0 c.�t4m c)2,165 ...... Installer Address Type of Building / Dwelling —------------------- Other - Type of Building No. of Type of Well--LL&Aqz) PV-C, Capacity Purpose of Well 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 .of Compliance has been issued by the Board of Health. Sig C date -W Application Approved By date Application Disapproved for the following reasons: ------ date Permit No. 79 t4fc Issued date BOARD OF HEALTH TOWN OF BARNSTABLE (Urtifiratt Of COMPhaTICE THIS ISO CERTIFY, the Individual Well Constructed Altered or Repaired by Installer at 14 C,k has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private WeV Protection Regulation as described in the application for Well Construction Permit NoY `—�::Q�9-Dated_L11-30 15--- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE Inspector 1 Fee--��- No.-t"� - --- BOARD OF HEALTH TOWN OF BA'-RNSTABLE s App[icat ion,f or Yell Construct ion])ermit Application is hereby made for ac permit to Construct ( ), Alter ( ), or Repair ( )an individual Well at: Location — Address Assessors Map and Parcel Owner Address -----_au`t Z-1� 3 -�t}2(rr��s1��-�-_02�0�.3-- - - 1 _. - -r - --------- Installer — Driller Address Type of Building Dwelling ------ - —- - Other - Type of Building-- —_____ No. of Persons--------------------- -------- SC � � C-pm Type of Well kA( 1a PVC� - Capacity---Q-_`------------------ -- Purpose of Well---c'-L 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 .of Compliance has been issued by the Board of Health. Sig e � -2AYvruw�------------ - -------- date Application Approved By --—--------— , `w 1 15 - date Application Disapproved for the following reasons:------------ —- --- - - ---- ' ------------- — ! date tt,� Permit No. 16� a 79 14 e07 — Issued ---- date j_ BOAR"D OF HEALTH TOWN OF BARNSTABLE (Certificate ®f (Compliance THIS IS TO CERTIFY, ThYa the Individual Well Constructed , Altered ( ), or Repaired by- - s_mxa�n dj-------— ---- ---- - ----- - -- - — --- --=-- - Installer has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit NobLMO �t`!4!;NDated-W-QJ-g- 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 Vell (Con5tructionpermit No. W v�.� `7 Fee- Permission is hereby granted � � — ---------------____— to Construe ( ), Alter ( ), or Repair ( ) an Individual Well at: No. -- _3 C I't t St N'G� - y - --------——=-- ------------------------------ reet as shown on the application for a Well Construction Permit '� J t_�- -G� �_ Date -- '` t -� ! -- -------------------------- -- .. No. -— — ------------------------- Board of Health DATE— 1 -- r , 00 N 00 �0 0� J � 1 ! o 0 m rl 4 a� Cl 1 a� in O P r r r Qe `' mui o x > 1 ¢ \ I I O ao Ln rI li ` J o ur, I \ N z i r rr °® e 5�0 n® 0 a �� CL PO W \ \ \6d. \ \ PR d X OO V \\\ \\\ \\ ala OD J \ \ X a \ ® a go �9e ►y �` I �5>b� �u�M�`� \ ONLY 1 pPPR�xiMptE �\\ I � 31 dwIxodddd PeopcglY a ' COMMONWEALTH OF MASSACHUSETTS A' F EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS a DEPARTMENT OF ENVIRONMENTAL PROTECTION A F . 174 0 0-S TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 453 Church Street West Barnstable MA 02668 Owner's Name: Peter,John& Edwin Jenkins Owner's Address: Same Date of Inspection:October 19,2005 Job#05-320 Name of Inspector: PATRICK M.O'CONNELL Company Name: SEPTIC INSPECTION SERVICES CO. Mailing Address: 189 CAMMETT ROAD MARSTONS MILLS MA 02648 Telephone Number: 508-428-1779 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 approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: %1,1 N OF f� S •:;�� Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority * ; X Fails N 'LL `.) / / • �� Inspector's Signature: � - Date: /0I 1`t f ��i�� F �coez,o`�� The system inspector shall submit a copy of this inspection report to the Approving Authority(Bo of Healthcor DEP)within 30 days of completing this inspection. If the system is a shared system or has a design w of 16:,U00 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office offce DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable,an the apprWing :r- authority. Notes and Comments: Cesspool with overflow,overflow pit has been full to top. System fails due to hydraulic failure,however it is not an immediate health hazard and can temporarily continue to service house until a new system is installed. ****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 I Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 453 Church Street,West Barnstable Owner: Peter,John& Edwin Jenkins Date of Inspection: October 19,2005 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: TWA C TncnPrtinn Rnrm Ail snnnn 2 i . Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 453 Church Street,West Barnstable Owner: Peter,John& Edwin Jenkins Date of Inspection: October 19,2005 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 CNIR 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 sur=ace 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: Titla f inenantinn Anrm 4/1 r%fonnn 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: 453 Church Street,West Barnstable Owner: Peter,John & Edwin Jenkins Date of Inspection: October 19,2005 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No —X— _ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool — —X— Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool —X— Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool —X— Liquid depth in cesspool is less than 6"below invert or available volume is less than ''/z day flow —X— Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _X_ Any portion of the SAS, cesspool or privy is below high ground water elevation. —X— Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _X_ Any portion of a cesspool or privy is within a Zone 1 of a public well. —X— Any portion of a cesspool or privy is within 50 feet of a private water supply well. —X— 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 forma _Yes_(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 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 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. Titles i Tncnartinn Rnrm 411;/Innn 4 Page 5 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 453 Church Street,West Barnstable Owner: Peter,John& Edwin Jenkins Date of Inspection: October 19,2005 Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No _X_ _ Pumping information was provided by the owner,occupant,or Board of Health _X_ Were any of the system components pumped out in the previous two weeks _X_ _ Has the system received normal flows in the previous two week period? _ _X_ Have large volumes of water been introduced to the system recently or as part of this inspection? _X_ Were as built plans of the system obtained and examined?(If they were not available note as N/A) _X_ Was the facility or dwelling inspected for signs of sewage back up? _X_ _ Was the site inspected for signs of break out? _X_ _ Were all system components,excluding the SAS, located on site? _X_ _ 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? _X_ _ 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 _ _X_ Existing information.For example,a plan at the Board of Health. _X _ 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)] Titla G Incnantinn Rnrm 4/119Onnn 5 Page 6 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 453 Church Street,West Barnstable Owner: Peter,John& Edwin Jenkins Date of Inspection: October 19,2005 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): unknown Number of bedrooms(actual): 6 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): Number of current residents:2 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): No [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use:(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): N/A 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.): 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: None Source of information: Owner 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 _X_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: 1960's Were sewage odors detected when arriving at the site(yes or no): No Titles i Tnenartinn T7nrm A/1 vInnn 6 f Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 453 Church Street,West Barnstable Owner: Peter,John & Edwin Jenkins Date of Inspection: October 19,2005 BUILDING SEWER: XX (locate on site plan) Depth below grade: 1' Materials of construction:_X_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: No (locate on site plan) 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: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensions determined: STICK WITH HINGE FLAP. Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): GREASE TRAP: No (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.): Title'; tnenantinrn Form tiii VInnn 7 Page 8 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 453 Church Street,West Barnstable Owner: Peter,John&Edwin Jenkins Date of Inspection: October 19,2005 TIGHT or HOLDING TANK: No (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: gal Ions 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: No (if present must be opened) (locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): PUMP CHAMBER: No (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.): Titla 5 rnenantinn Rnrm 411�qijnnn 8 Page 9 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 453 Church Street,West Barnstable Owner: Peter,John& Edwin Jenkins Date of Inspection: October 19,2005 SOIL ABSORPTION SYSTEM(SAS): XX (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: leaching chambers,number: leaching galleries,number: leaching trenches,number, length: leaching fields,number,dimensions: _X overflow cesspool,number: One block pit. 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.): Pit shows evidence of prior backup,observed solids buildup on top of inlet pipe CESSPOOLS: XX (cesspool must be pumped as part of inspection) (locate on site plan) Number:and configuration: One with overflow Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: 6x6 Materials of construction: Block Indication of groundwater inflow(yes or no): Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,etc.): Previously full to top,in hydraulic failure. PRIVY: No (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.): Ti41a C Tne—tinn 17—All 9 Page 10 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 453 Church Street,West Barnstable Owner: Peter,John& Edwin Jenkins Date of Inspection: October 19,2005 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. Church Street #453 79 80 Titles C Tncnartinn T:nn„ 4i1 ci')nnn 10 I i Page 11 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 453 Church Street,West Barnstable Owner: Peter,John& Edwin Jenkins Date of Inspection: October 19,2005 SITE EXAM Slope None Surface water None Check cellar Dry Shallow wells None Estimated depth to ground water 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: A perc test will be performed prior to repair to determine groundwater elevation. Title C Inonrartinn Anrm 4/1 CJ7nnn 1 I OF.HA �'cJ, o� �. CERTIFICATE 'OF--ANALYSIS Page: 1 Barnstable(:o'untl�aMboratory J I9 T �5/900�05 Report Prepared For: '(l 3- 5 Order No.: G0530051 Edwir_B. Jenkins 453 Churc Street D1VISI0 West 3arnstable, MA 02668 Laboratory ID#: 0530051-01 Description: Water-Drinking Water Sample#: 30051 Sampling Location 453 Church St.W.Barnstable,MA Collected: 5/5/2005 Collected by: E.Jenkins Received: 5/5/2005 Test Parameters ITEM RESULT UNITS RL MCL Method# Tested LAB: Microbiology Total Codiform Absent P/A 0 0 309 5/5/2005 Water sample meets the recommended limits for drinking water of all the above tested parameters. �\ Approved By: (La irector) RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 is : ' CERTIFICATE OF ANALYSIS Page: 1 . , ` Barnstable County Health Laboratory Report Dated: 5/3/2005 Report Pretlaretl For: Order No.: G0529938. Edwin B. Jenkins 453 Church Street West Barnstable, MA 02668 Laboratory ID 4: 0529938-01 Description: Water-Drinking Water Sample 4: 29938 Sampluig Location: 4-93 Church St.W.Barnstable,MA Collected: 4/28/2005 Collected by: E. lenldns Received: 4/28/2005 Test Parameters ITEM RESULT UNITS RL MCL Method# Tested LAB: Microbiology Total Coliform Present CFu/100mL 0 0 309 4/28/2005 Recommended maximum contamination level exceeded due to Coliform Bacteria. Retesting is recommended. Approved By ' Dire :— — ctor) CD CD M RL = Reporting Limit MCL=Maximum Ccntaminant Level Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 CERTIFICATE OF ANAL SIS Page: 1 39s3` Barnstable County Health Laboratory dr BARNSTABLE Report Dated: 4/28/2005 2005 MAY -2 pM Report Prepared For: Order No.: G0529870 Edwin B. Jenkins 453 Church Street B►YIS10 West Barnstable, MA 02668 Laboratory ID#: 0529870-01 Description: Water-Drinking Water Sample#: 29870 Sampling Location 453 Church St.W.Barnstable,MA Collected: 4/26/2005 Collected by: E.Jenkins Received: 4/26/2005 Vest Parameters ITEM RESULT UNITS RL MCL Method# Analyst Tested Note LAB: Microbiology Total Coliform Present P/A 0 0 309 AF 4/26/2005 Recommended maximum contamination level exceeded due to Coliform Bacteria. Retesting is recommended. Approved By:_ . \ ( Director) s RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 CERTIFICATE OF ANALYSISPage: Barnstable County Health Laboratory Report Dated: 4/19/2005 Report Prepared For: Order No.: G0529750 Edwin B. Jenkins 453 Church Street West Barnstable, MA 02668 Laboratory ID#: 6529750-01 Description: Water-Diinilcing Water Sample#: 29750-01 Sampling Location:,453 Chruch St.West Barnstable,MA Collected: 4/14/2005 Collected by: E.Jenkins ns 1st Retest Received: 4/14/2005 Test Parameters ITEM RESULT UNITS RL MCL Method# Tested LAB: Microbiology Total Coliform Present CFU/100mL 0 Absent 309 4/14/2005 Recommended maximum contamination level exceeded due to Coliform Bacteria.— Retesting is recommend Approved By: ab Director) RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 Page: 1 CERTIFICATE OF ANALYSIS s :: . : :��. Barnstable County Health Laboratory Report Dated: 4/19/2005 Repon Prepared For: Order No.: G0529688 Edwin B. Jenkins 453 Church Street West Barll<table, MA 02668 Laboratory ID#: 0529688-01 Description: Water-Dr n1dug Water Sample#: 29688 Sampling Location: 453 Church Street West.Baenstable,MA Collected: 4/12/2005 Collected by: E Jejdcuis — Received: 4/12/2005 Routine ITEM RESULT UNITS RL MCL Method# Tested LAB: Inorganics Nitrate as Nitrogen 0.25 mg/L 0.1 10 EPA 300.0 4/12/2005 LAB: Meads Copper 0.12 mg/L 0.1 1.3 SM3111B 4/14/2005 Iron 0.22 mg/L 0.1 0.3 SM 311113 4/14/2005 Sodium 9.4 mg/L 1.0 20 SM 311113 4/14/2005 LAB: Microbiology Total Co.liform Present P/A 0 Absent 307 4/12/2005 LAB: Phy:sicai Chemistry Conductance: 98 uniohs/cm 1 EPA 120.1 4/12/2005 pH 6.1 pH-units 0 EPA 150.1 4/12/2005 Recommended maximum contamination level exceeded due to Coliform Bacteria. Retesting is recommende Approved By: ( Director) 1 RL = Reportilg Limit MCL=Maximum C ontaminant Level Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 TOWN OF BARNSTABLE LOCATION C14444 c,), &,C�A SEWAGE # VILLAGE ASSESSOR'SMAP & LOT�°J� 003 R49T,AA� 1 NAME&PHONE NO. Ar' 0 2(/-•02(-AIA& SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS " 1O B�1&�OWNER�e�� PERMITDATE: COMPLIANCE DATE: Separation Distance Between they Maximum Adjusted Groundwate"'Jhle 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 I 1500 GALLON SEPTIC TANK DISTRIBUTION BOX HIGH CAPACITY INFILTRATORS CROSS SECTION LOCUS PLAN NOT TO SCALE NOT TO SCALE NOT TO SCALE NOT TO SCALE NOT TO SCALE BM old well cover MIN 2° L PEA 99.7 COVER TO BE WITHIN 6"OF GRADE \ T INSPECTION PORT TO BE WITHIN 6" OF GRADE 4'SCH_40 P.V.C. 3"MINIMUM MIN. 12"COVER a^ x.ao P. a•scx.as P.V.c 3" 1/8"-1/2" WASHED STONE0.01 MIN. s8.9 13" 3 11 t 97.95 / � �T7 wf . 5 98.1 97.65 4.0' 97.5 97.2 / / '2.0 .92 / .. / 3/4-.1 1/2 DOUBI E.WASIIEA STONE-.'.'.;•..•.•.. .. .,:.. .. 1.08 MIN / / ....,. .. ..'..'.. .. ..... 10.5' 2.1'I 43.8' 1 2.14 �4' 2.8 4' 48.0' BOTTOM OBS 86.5' 10.83' ' SITE SPECIFIC NOTES SOIL TO BE REMOVED TO C2 LAYER FOR 5' MI-76 � DESIGN CALCULATIONS GENERALNOTES AR❑UND SAS. CALL IF S❑IL IS N❑T AS 3 NOTED EXISTING BEDROOMS 5 BEDROOMS ALL PIPING TO BE SCHEDULE 40 P.V.C. ALL LOCATIONS OF UTILITIES SHOWN ARE AS EXISTING CESSPOOL TO BE REMOVED (1ST E �� 550 G.P.D. MARKED BY DIG-SAFE AND ARE TO BE 7 VERIFIED BY INSTALLER PRIOR TO ONE MAY BE UNDER SHED) NO. OF UNITS 7 CONSTRUCTION DEPTH BELOW INV. 2' THERE ARE NO KNOWN WETLANDS WITHIN INSTALLER TO NOTIFY DESIGNER 24 HOURS 92,SJc LENGTH 10. UNLESS SHOWN. PRIOR TO BEGINNING OF JOB TO C❑❑RDINATE WIDTH 48' 150E OF THE PROPOSED LEACHING FACILITY INSPECTIONS _ 9 �(�G SIDEWALL AREA 235.3SF THERE ARE NO KNOWN POTABLE WELLS WY. T BOTTOM AREA 519.8 SF 150E OF THE PROPOSED LEACHING FACILITY. TOTAL SQUARE FEET 755.1 SF THERE 50'EOFOTHE PROPOSWN IEDTION LEEACH,INGLS FACILITY f CAPACITY SIDEWALL 00.74 174.1 G.P.D. THIS PROPERTY DOES NOT FALL WITHIN A CAPACITY BOTTOM 0 0.74 384.7 G.P.D. CAPACITY TOTAL 558.8 G.P.D. FLOOD ZONE AS SHOWN ON FIRM MAP THIS DESIGN DOES NOT REQUIRE VARIANCES TO TITLE 5 (310 C.M.R. 15.00) OR BARNSTABLE THIS SYSTEM NOT DESIGNED TO SUPPLEMENTAL REGULATIONS. ^i ACCOMODATE A GARBAGE ALL CONSTRUCTION SHALL BE IN ACCORDANCE WITH TITLE 5 AND BARNSTABLE SUPPLEMENTA / y DISPOSAL REGULATIONS. PROPOSED SAS / � �� 94,313 IN-LINE ELEVATIONS PROPOSED AS-BUII.T SURVEY INFORMATION 10.83E X 48' 7 HIGH CAP INFILTRAT❑RS /� if NV 0 HOUSE 98-9 PROPERTY LINE DATA FROM INV INTO TANK 98.2 TERRY WARNER SURVEYING NOV/05 _13t� A,B & C1 LAYERS TO BE REMHVED // INV OUT OF TANK s7.ss I FOR 5' AROUND SAS '1 / ��'n�~''\ �\ 'fJO PLAN TO BE USED FOR INSTALLATION INV INTO D-BOX 97.65 APP❑XIMATE ELEVATION' 92 �� \, '�� INV OUT OF D-BOX 97.5 OF SEPTIC SYSTEM ONLY INV INTO INFILTRATOR 96.2 BOTTOM OF INFILTRATOR 96.28 NOT FOR DETERMINING PROPERTY LINES BOTTOM OF STONE 95.2 BENCH MARK /% \ �` , / �� 901 TOM OF OBS HOLE 86.5 \J /. WATER TABLE NONE ENCOUNTERED OLD WELL COVER 101.29 �/ c� �, ��. DATE: OBSERVED BY: WITNESSED BY: SOIL LOGS NOV 4, 2005 LISA C. LYONS UNWITNESSED f ~ / SOIL EVALUATOR BOARD OF HEALTH o OBS. HOLE #1 OBS. HOLE #3 ELEV. DEPTH ELEV. DEPTH 98.37 A LOAMYND 0YR 3/2 ND 10" 98.7 A LO 0YR 3/2 12„ B LOAMY SAND B LOAMY SAND 1 OYR 514 10YR 5/6 96.8 28" 97.4 28" jj' PC/7 DiG \ C 1 SANDY LOAM/ C 1 SANDY LOAM `�.. MEDIUM SAND 2.5Y 6/4 2.5Y 5/4 92.8 83" 7M � g(� /' - - �\'\ 3 3 C2 MEDIUM SAND Q 931 C2 MEDIUM SAND n 85" Ip / J Sl`P POCKETS OF S.LOAM 105 POCKETS OF/S.3 LOAM 97- / / 2.SY 6/3 86.5 2.SY 6/3 52„ 88.1 39�� : 0 GROUNDWATER ENCOUNTERE 0 GROUNDWATER ENCOUNTERE o PERC RATE 3 MINS./INCH PERC RATE 3 MINS./INCH E OBS. HOLE #2 T H 3 Q NC T� C ® ' T C�'\ N 98.9 ELEV.A LOAMY SAND DEPTH 99.7 4 V =-- e�✓ h�E�� 9 6.4 5 97.9` 12" �O�e r. _ --• 1" B LOAMY SAND S z ' AVOID THI5 AREA 96.4 I SILT LOAM 30 f �� r / O O AV I /T H 2 '' 001, TH 1 S2`or�E, '� 96,71 9O.6 C2 MEDIUM SAND „ f $ f 98.2 - 99,2 DVP � PERCHED GROUNDWATER C3 SILT LOAM 29 ENCOUNTERED AT 129" 86.4 FINE/MEDIUM SAND 50" Ifij,RPp ,- i 96.g 85.9 57" LQ ShP � 8 SCALE 1 20 0 a CID �%A'F pAAgsq��ie PVTMOFMASS o�i�0 �...■■■ y!/,�j pa,eMent Quo TERRY GJ�� St.G^ •� �� PLAN SHOWING: Cyf U WARNER �-� OAS a- D PROPOSED SEPTIC SYSTEM REPAIR IN WEST BARNSTABLE Edge No.38721 �i11A : �� FOR: DEBBIE&RICHARD RICHMOND DESIGNEDY& CHECKEDLBONS -O o *"�"t+" LISA C. LYONS g8'86 9g 05 n 9c� iv �i#�.�C Q�`y. LOCATION: REVISIONS:DESCRIPTION: DATE: } a A L ss '� 4# R ��` ��A 453 CHURCH ST W.BARNSTABLE / h�A s®� s LOT#: nATE:DEC 22 2005 � �ttt�I� M176 Pg , 98.13 p R K E R 0'5� LISA C. YON , R.S. I / � 1 CERTIFY THAT THIS PLAN CONFORMS TO LISA C. L Y 0 N S , R . S. (508) 790-92�0 TITLE 5 AND BARNSTABLE B.O.H. REGULATIONS (774) 487-1638 (EXCLUDING WAIVERS SPECIFIED) HYANNIS, MASSACHUSETTS