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HomeMy WebLinkAbout0035 COVENTRY LANE - Health 35 Coventry Lane W. Barnstable P A = 110 004002 i D r� L-1 boa CERTIFICATE OF ANALYSIS Page I` 7Y,�I. I _ I Barnstable County Health Laboratory Report Dated: 1/18/2005 Report Prepared For: Order No.: G0529046 Philip W.Ransom Jr. 35 Coventry Lane West Barnstable, MA 02668 Laboratory ID#: 0529046-01 Description: Water-Drinking Water Sample#: 29046 Sampling Location 35 Coventry Lane West Barnstable, MA Collected: 1/11/2005 Collected by: S.Ransom Received: 1/12/2005 Routine ITEM RESULT UNITS RL MCL Method# Tested LAB: Inorganics Nitrate as Nitrogen 0.65 mg/L 0.1 10 EPA 300.0 1/12/2005 LAB: Metals Copper 0.15 mg/L 0.1 1.3 SM 3111B 1/13/2005 Iron BRL mg/L 0.1 0.3 SM 311113 1/13/2005 Sodium 13 mg/L 1.0 20 SM 311113 1/13/2005 LAB._ .Microbiology ,'Total Co'16 m Absent P/A 0 Absent 307 1/12/2005 LAB: Physical Chemistry Conductance 160 umohs/cm 1 EPA 120.1 1/12/2005 pH 6.2 pH-units 0 EPA 150.1 1/12/2005 Water sample meets the recommended limits for drinking water for all above tested parameters. Approved By: Director) RC Reporting Limit " MCL=Maximum Contaminant Level Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 pp p r e 2 l U t0 Lx COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENT A N RECEIVED JUN 2 9 2004 TOWN OF BARNSTABLE HEALTH DEPT. TITLE 5 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A PAP CERTIFICATION PARCEL Property Address: 35 Coventry Lane L® West Barnstable, MA 02668 sf , Owner's Name: Phil Ransom I Owner's Address: C Date of Inspection: June 10, 2004 v7 cn C) ;:0 -0 M Name of Inspector: (Please Print) James M. Ford ' ' Company Name: James M. Ford Mailing Address: P.O. Box 49 CDrr-- Osterville,MA 02655-0049 `4 r7 Telephone Number: (508) 862-9400 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ✓ Passes Conditionally Passes Needs urther Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: June 13, 2004 The system inspector shall sub t 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 r Page 2 of 1 1 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 35 Coventry Lane West Barnstable, MA Owner: Phil Ransom Date of Inspection: June 10, 2004 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: ✓ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes, no or not determined(Y,N,ND) in the for the following statements. If"not determined", please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 ' Page 3 of 1 1 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE.SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 35 Coventry Lane West Barnstable, MA Owner: Phil Ransom Date of Inspection: June 10, 2004 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of 1 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 35 Coventry Lane West Barnstable, MA Owner: Phil Ransom Date of Inspection: June 10, 2004 D. System Failure Criteria applicable to all systems: You must indicate either"yes"or"no"to each of the following for all inspections: Yes No ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than '/2 day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation. ✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ✓ Any portion of a cesspool or privy is within a Zone 1 of a public well. ✓ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ✓ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. ]This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] Ago (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No the system is within 400 feet of a surface drinking water supply _ the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area- IWPA)or a mapped Zone I1 of a public water supply well l 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 I 1 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 35 Coventry Lane West Barnstable, MA Owner: Phil Ransom Date of Inspection: June 10, 2004 Check if the following have been done: You must indicate"yes"or"no"as to each of the following: Yes No ✓ Pumping information was provided by the owner,occupant,or Board of Health ✓ Were any of the system components pumped out in the previous two weeks ? ✓ _ Has the system received normal flows in the previous two week period? ✓ Have large volumes of water been introduced to the system recently or as part of this inspection? ✓ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ✓ _ Was the facility or dwelling inspected for signs of sewage back up? ✓ Was the site inspected for signs of break out? ✓ _ Were all system components,excluding the SAS, located on site? ✓ _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum ? ✓ _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes No ✓ _ Existing information. For example,a plan at the Board of Health. ✓ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)]. 5 Page 6 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 35 Coventry Lane West Barnstable, MA Owner: Phil Ransom Date of Inspection: June 10, 2004 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 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): n/a [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): Private well Stamp Pump(yes or no): No Last date of occupancy: Currently occupied COMMERCIAL/INDUSTRIAL 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 Source of information: Never pumped-per 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 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: Mstalled 7111194-per as built card Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of 1 1 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 35 Coventry Lane West Barnstable, MA Owner: Phil Ransom Date of Inspection: June 10, 2004 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron 40 PVC other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 12" 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: 1500 gal. Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 5" Distance from top of scum to top of outlet tee or baffle: 4" Distance from bottom of scum to bottom of outlet tee or baffle: 10" How were dimensions determined: Measuring stick Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Tees were present. The liquid level was even with the outlet invert. There did not appear to be any signs of leakage Recommend pumping. GREASE TRAP: None (locate on site plan) Depth below grade: Material of construction: _concrete metal fiberglass _polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page 8 of 1 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 35 Coventry Lane West Barnstable, MA Owner: Phil Ransom Date of Inspection: June 10, 2004 TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Even Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): The D-box was level. No solids were present. PUMP CHAMBER: None (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no) Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 ?age 9 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 35 Coventry Lane West Barnstable, MA Owner: Phil Ransom Date of Inspection: June 10, 2004 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) I SAS not located explain why: Type ✓ leaching pits,number: 2-6'x 6'(1000 gal.) leaching chambers,number: leaching galleries,number: leaching trenches,number, length: leaching fields,number,dimensions: overflow cesspool,number: Innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.): One leach pit(44)had 2'of liquid on the bottom. The scum line was at the same level. There did not appear to be any si nos o/ failure. The bottom to grade was 11'and the cover was 14"belowgrade. The other leach pit 05)did not appear to have any signs of failure. CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): PRIVY: None (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): 9 f r Page 10 of 1 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 35 Coventry Lane West Barnstable, MA Owner: Phil Ransom Date of Inspection: June 10, 2004 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. y F�wcr A Q 1 aa� tia3 3 a 18 3S i a 3 3 O y 339 �a y �` 336 10 M A Page_l l of 1 1 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 35 Coventry Lane West Barnstable, MA Owner: Phil Ransom Date of Inspection: June 10, 2004 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 50+/- feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record- If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: topographic and water contours maps Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Using Barnstable topographic maps and water contours maps, the maps were showing approximately 50'+/-to ground water at this site. This report has been prepared and the system inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied, relating to the system, the inspection and/or this report. 11 TOWN OF BARNSTABLE 10/ LOCATION 3S Co%Tr•y I4A SEWAGE # — VILLAGE w• 9Arn s�416 ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY �W LEACHING FACILITY: (type) A nS a" 6<4 (size) NO.OF BEDROOMS 4 Q BUILDER OR OWNER �"n. +AAA SOM PERMITDATE: 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) ��o Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leachi facility) ) Feet Furnished by ion FO/C r 1 p W to F�t)nT A Q 1 aa6 ya3 3 a / F 3S a 3 �a3 O y 3 � y Sg6 336 f TOWN OF BARNSTABLE LOCATION I CoJr-,t r2.y "g-:: SEWAGE # VILLAGE W , ASSESSOR'S M A FF 6z LOT INSTALLER'S NAME 6a PHONE NO. S-TE-V E.i4 SEPTIC TANK CAPACITY i LEACHING FACILITY:(type) H-z-c> NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER `'BUILDER OR OWNER DATE PERMIT ISSUED: `1-2-S cj - DATE COMPLIANCE ISSUED: VARIANCE GRANTED: ,Yes No V �z4-� 02/�� �� � i No.� ...... F�a...... . ...... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE App iratiou for Di►ipoon1 Worlt,, Towitrurtion Errant Application is hereby made for a Permit to Const uct ( ) or Repair ( ) an Individual Sewage Disposal System at: S A55e5 A -0 110 j - � 1 '� ..IGID fJdJ►S P14'A' �S Q�-zA0, --3 .6TA9t ---Lo ' i-----C4vaIT .--- fi M '. — ....................................... LocationnAddress W No.6 lv_ ?...01 ..CY CQ�------- ...... _ T s� ,a ------• --•-•••-••••••.............•-••-••------••--•-••--•-•---------------••------•-----•••. , -------- c7 Installer Address Type of Building Size Lot____.._..i30 __..___t._....Sq. feet ,., Dwelling— No. of Bedrooms__________________________________________Expansion Attic ( ) Garbage Grinder ( ) pa•, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) 04 Other fixtures ._._--__\_____________________ _ _ W Design Flow..........5.�--------------d -- ..._gallons per person per day. Total daily flow.---_-.4t.�_0._._..............._....galloo s. WSeptic Tank—Liquid capacity- : gallons Length___$_yZ-__._ Width_..__ ..Y.3,--- Diameter................ Depth...'P- _.... x Disposal Trench--No. ............. ..... Width._.................. Total Length.._____............. Total leaching area....................sq. ft. - . .VZ.---.- Diameter------ Depth below inlet..._f'o.............. Total leaching area.- 1. �o i 3 Seepage Pit No....�N .. p g sq-h. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by..."1RQ✓�'I _M_!- LL�S N....P5................ Date... ................... a Test Pit No. I...... !....minutes per inch Depth of Test Pit.-- ...... Depth to ground water---/oYfQ -------- (i Test Pit No. 2....`Z..._minutes per inch Depth of Test Pit---IR.q-------- Depth to ground water..fd ....... 9 it -------------------------- ----- ------------------•••....---•----•--...................--•-•--•..._...---•----•---..........-----..............---•....-- O Description of Soil.....I•-••Q-'1�`�" TDp SU13r5011.....Z. .' ILTK GiN .................EA►tit� ��-1qy x W VNature of Repairs or Alterations—Answer when applicable............................__..._.............................................................. Agreement: The undersigned agrees to install the aforede cri ed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environm n 1 ode—T undersigned further agrees not to place the system in operation until a Certificate of Comp ' nc been iss ed_ y the boa o health. ...... Z 16 Signed ........... - .............. - - .. ... . .. ......................................... �-e-. ....... .... ApplicationApproved By ....... ------.a�r J...................................................................................... ..... ,..—.Dare Application Disapproved for the following reasons- ------------------------------------------------------------------ - ------ ........ . .............................. ................................ .............................................. . ....... .............................................. . .................................... ............ ............------------ Dare PermitNo. ....... ...-7/................................ Issued .................................................................... Dare . ti:.w•a+::j::t,.r�r-^�_�t_;_..•fw.`�.•S.t...-�....•--_-:.`.�.._�..-..'.....�.•a...s•-----..._�: .�..5.•�'r--.tag...-�-...i'a. r NZq .�1•--- Fas.... . .. ....... Pb �� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH UJ 9 1y TOWN OF BARNSTABLE Apphratiun for Dijpn ial Wi nrbi Tomitrnrtiun Prrmit Application is hereby made for a Permit to Construct ( ) or Rcpai, ( ) an Individual Sewage Disposal System at: f �, A55tEs min 110 pA�z� - ---""------------------------"-----------...----- ... -----� L=on�._....... - --------z- Location = tt No. 0 -t,er t r `� n ,------------"------------------ --{��o= X. ............... t Installer t Address UType of Building Size Lot_. Q,5 3` ......Sq. feet a Dwelling— No. of Bedrooms.............1......................... ....Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons......................... Showers ( ) — Cafeteria ( ) a' Other fixtures --------------------------------- - w Design Flow.........5_ ______________It!V1,__gallons per person per day. Total daily flow.......�_-q.0........................gallons. WSeptic Tank—Liquid capacity,-gallons Length---- y�<__-_ Width... yZ.... Diameter................ Depth...�4'. F:F x Disposal Trench—No. ............./---. Width.................... Total Length.................... Total leaching area....................sq. ft. 3` Seepage Pit No....t?N.G------ Diameter------1-44 Depth below inlet----(............... Total leaching area..8J.,4.UJ9sq—. ft. Z Other Distribution box ( ) Dosing tank ( ) ~' Percolation Test Results Performed by.__' l.!�t�1 S.. - 1 t( N-••-E................ Date...�.:.<<.- 3_.__._____.____... Test Pit No. 1.....L T--_-_minutes per inch Depth of Test Pit.... ...... Depth to ground water...N6_AJK........ 04 'Pest Pit No. 2..... z_-___minutes per inch Depth of Test Pit---Pq.4!'_.__. Depth to ground water.-DaRt- _.._-.. 9 � .....-- ........... ' ---•----••-•---------------•-----"------•-•----......--•----•-------...._..----.............---............---.......-•-•-•-- 0 Description of Soil--- !) 7 ...._.Tao.......SU3Shct --`�-"1-'�-"--Sl_t_fq... Lrl __NfE!�-SAwh 8`1.. y M:Ft�...54n9 xov w U Nature of Repairs or Alterations—Answer when applicable.............................................................................................. Agreement: The undersigned agrees to install the aforede cribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State EnvirommntalfCode—T�.e undersigned further agrees not to place the system in operation until a Certificate of Comp§ancd\'1hhA,,...'been issded by the boardof health. ISSigned .. ......... ................ ........ . ...... . ....................... ................................. ---- Dace Application Approved By .......... ,P .<_<f.............:........................_... - ................ ID are Y Application Disapproved fort e following reasons: ....................................... - ............---.......... -....... . . ........................... '+°-'" c� Dace PermitNo. / v-----7/............. ._.. ...... Issued .. .------................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Certifirate of Contylianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( � ) or Repaired ( ) by ----------------------�-�_ .�., y---.�An.�---...----------_-- -------- ..------...-----------------.-----------...........--­-----------------............... at ......... 1,..C.T`...../.........i�� . e ta ........./.-Al-------------------------------...... ........ ..... -- . ............. ...... ...... . ............. has been installed in accordance with`the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ......... ........ dated .......-... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE ......................_.�. �............. ..... _............__... ...... Inspector ---------- ;--. .-,............. .........._............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH aa TOWN OF BARNSTABLE Raposal Workii To % htrtion ramit Permission is hereby granted............ •o-&" ............ o,.OA------- --------------------------------------•"--------------••-•-- to Construct (,/) or Repair ( ) an Individual Sewage Disposal System atNo................. ......... - . / 0J........... ' �� w 7r, ......................................................... =>i - Street as shown on the application for Disposal VVorls Construction Permit No.. t�^.171.... Dated___.._ ..- '....r ..................... ---------------------- �fard of Health DATE..................)-,...-. ..--- vv FORM 36508 HOBBS A WARREN.INC..PUBLISHERS ENVIROTECH LABORATORIES Mass. Cert.#:MA063 449 Route 130 Sandwich,MA 02563 • (508) 888-6460 CLIENT: Reef Realty - LOCATION: Lot #1 Coventry Lane ADDRESS: P.O. Box 186' W. Barnstable. MA W. Dennis. MA COLLECTED BY: Fr-pd m i fford SAMPLE DATE: 2-2-94 TIME: 3:OOP.M. DATE RECEIVED: 2-2-94 SAMPLE ID: 1C JOB#: NPw wP1> WELL DEPTH: 70' RESULTS OF ANALYSIS: Parameter Units Recommended limit Result Coliform bacteria/100 ml (MF Method) 0 0 pH pH units 6.0-8.5 6.73 Conductance umhos/cm 500 95 Sodium mg/L 28.0 8.7 Nitrate-N mk:/L 10.0 0.18 Iron mg/L 0.3 0.06 Manganese mg/L 0.05 Hardness mg/L as CaCO3 500 Sulfate mg/L 250 Potassium mg/L 20.0 Alkalinity mg/L 200 Chloride mg/L 250 Turbidity NTU 5.0 Color APC units 15.0 Background bacteria/100 ml , (MF method) 200 EPA ug L COMMENT: * See report attached. N.D. YES NO UX ❑ WATER IS SUITABLE FOR DRINKING PURPOS R P RS TESTED. DATE Z.t 4 :,. ;(1pOL'NDaFIATEP. ANALYTICAL ENGIROTECH SU8 759 4475;# ! 4 GROUNDWATER EPA METHODS 601 and 602 ANALYTICAL Volatile organics (GC/PID/ELCD) Lab ID: 6942-01 Field ID: 1C Batch ID: VG2-0316-W Project: Reef Realty Lot 1 Sampled: 02-02-94 Envirotech Received: 02-03-94 Client: Cont/Prsv: 40mL VOA Yia1/NaHSO4 Cool Analyzed: 02-09'94 Matrix: Aqueous LIMIT CONCENTRATION REPORTING(ug/) PARAMETER (ug/L) 5 BRL 5 Dichlorodifluoromethane BRL 5 Chloromethane BRL 5 Vinyl Chloride . BRL 5 Bromomethane BRL 1 Chloroethane BRL 1 Trichlorofluoromethane BRL 1 1,1-Dichloroethene BRL 1 Methylene Chloride BRL I trans-1 ,2-Dichloroethene BRL 1 1 1-Dichloroethane BRL I cis-1,2-Dichloroethene * BRL 1 Chloroform BRL 1 1,1,1-Trichloroethane BRL 1 Carbon Tetrachloride BRL I Benzene BRL I 1,2-Dichloroethane BRL I Trichloroethene BRL I 1,2-Dichloropropane BRL 5 Bromodichloromethane BRL I 2-Chloroethyyl Vinyl Ether BRLBRL 1 cis-1,3-Dichloropropene 1 Toluene BRL 1 trans-1,3-Dichloropropene BRL 1 1,1,2-Trichloroethane BRL I Tetrachloroethene BRL I Dibromochloromethane BRL 1 Chlorobenzene BRL 1 Ethylbenzene �R� 1 meta-and para-Xylene * 1 ortho-Xylene * BRL 1 Bromoform BRL 1 11,2,2-Tetrachloroethane BRL 1 1,3-Dichlorobenzene BRL I 1,4-Dichlorobenzene BRL 1,2-Dichlorobenzene RECOVERY QC LIMITS QC SURROGATE COMPOUND SPIKED MEASURED 0 31 104 /0 87 - 113 30 100 % 83 - 117 % a,a,a-Trif1uorotoluene 30 30 1,2-Dichloroethane-d4 .. «_� oeforartCOS: Method 601 - Purgeable No.--- --- - --- � Fee--- --------- BOARD OF HEALTH TOWN OF BARNSTABLE 0pprication-*rVell Con5truction3pffmit App)icat' n is hereby made fo ape it to Construct (X), lter ( ), or Repair ( )an individual Well at: ---G- ----D�------�Ov � -- - - -- -------------------- - Location — Address Assessors Map and Parcel r Q • --------------------------------- -< ��-------�� �S ---- -— Ow r Addreesssn Installer — Driller ddress Type of Building Dwelling-- - - - — _--------------------- Other - Type of Buildin ---------------------_----------- No. of Persons— Type . Type of Well- — — --— - --------- 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 u 1 a C i 'ca C pli�an�ceas been issued by the Board of Health. Signed — --- -© ® �Tt�� Application Approved BY-- date ---- . Application Disapproved for the following reasons: date Permit No. — -------- ---- - -- -- ------------- Issued-------------_- ------ —---------- date BOARD OF HEALTH r TOWN OF BARNSTABLE (Certificate Of (Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( ) bY------------ ---- —--------- ---------------------- -- Installer at— -- -- -- - — - _——__--_— -_----- ---—_—__ -- — —- ---- - has been installed in accordance with the provisions of the Town of Barnstable Boar alth rivate Well Protection Regulation as described in the application for Well Construction Permit No.//Le _ ted ----------- d THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE Inspector---------—_-- ___—__—_____ 0 O �^ --� No.—A-)�� ---- ----- ------�� Fee BOARD OF HEALTH TOWN OF BARNSTABLE ApplitationArIftl Congtructioniermit A lication is hereby made fora permit to Construct (/), Alter ( ), or Repair ( )an individual Well at: PP /Y� P r -- --------------------------------------------------------------------------------- Location — Address / Assessors Map and Parcel OwQer Address -------------- Installer — Driller Address Type of Building Dwelling -------------------------- Other - Type of Building--------------------- No. of !1.C _d i Type of Well--- �D� -------------------------- Capacity------�lJ-----��-/-�------=----------- 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 C rtifica 4%'I C•mpli ce as been issued by the Board of Health. Signed, / � date Application Approved By-- -- —------------- --- - date Application Disapproved for the following reasons:--------------------- ------- ----------------------------------- ------------------------------------------------------------------------------------------------------ �/ date Permit No. -------(�-/—/-- --------__-------—------------- Issued date BOARD OF -HEALTH TOWN OF BARNSTABLE Certifitate ®f Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( ) by-- -— -- -------------------------------—------------- - Installer at---- -------- - has been installed in accordance with the provisions of the Town of Barnstable Boar) Health rivate Well Protection Regulation as described in the application for Well Construction Permit No.tl'_ --_�------ Haed-------------__-------_ 7 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 )PeYY (4C0115tructi011 j)ermit ` No. ---------------------- o Fee ------------------- CL-o � 1�_ Permissio "s hereby granted-------.------------------------------------------------ ----------------------------------------------------------------------------------- to ConstruLct� Alter ( ), oor�Rep it ((/ ) y Individual ,Well at: l Street as shown omt a application for a Well Construction Permit No.------ !-- -- - - --- -- - Dated - VV - j ? Board of Health DATE-------F� -a- ;= ------------------------------------— j I .z ~4 ri 'A55e5501z5 MAP- 110 W • pAQc.r--L-• -7 t� Gv2Q EhIT ZpNl t4&' It F e gulLviNcv 5eT5ACAS 80 . 80 AF 7e =Lor 30,00o i 5 P 79 77 c�, l0' 2EhbvAC. -16 78 $ealc,r K4M Ar carer} a (_p / a 73 . 01vA 71 -7o GA[ridG� pKOP DRive i✓'�� D GS 1. 7z . PK'oFaSEv aN i 4 8ecrunM ' 67 71 DWELu►JG sT i ri; i4 • .66 t � �. 1 tP=�5.0 M'N ; � � b 32' 64, 62 g , f � 60 io b WeLL- bet (160' T'o E£SEaWE LAACLA P IT) 54� \ y y 5G _ I ' S4k _ y ka CDUTOuR-: -- — 5 Por EL>✓Y: 7 4.3 '* # Y SPOT ELEY �4 y. � � w '�T ENVIROTECH LABORATORIES Mass. Cert.#:MA063 449 Route 130 Sandwich, MA 02563 • (508) 888-6460 CLIENT: Reef Realty LOCATION: Lot #1 Coventry_ Lane ADDRESS: P.O. Box 186 W. Barnstable, MA W. Dennis. MA COLLECTED BY: Fred r1 ifford SAMPLE DATE: 2-2-94 TIME: 3:OOP.M. DATE RECEIVED: 2-2-94 SAMPLE ID: 1C JOB#: NPm WP1 1 WELL DEPTH: 70' RESULTS OF ANALYSIS: Parameter Units Recommended limit Result Coliform bacteria/100 ml (MF Method) 0 0 pH pH units 6.0-8.5 6.73 Conductance umhos/cm 500 95 Sodium mg/L 28.0 8.7 Nitrate-N mg/L 10.0 0.18 Iron mg/L 0.3 0.06 Manganese mg/L 0.05 Hardness mg/L as CaCO3 500 Sulfate mg/L 250 Potassium mg/L 20.0 Alkalinity mg/L 200 Chloride mg/L 250 Turbidity NTU 5.0 Color APC units 15.0 Background bacteria/100 ml (MF method) 200 EA ugL COMMENT: * See report attached.YES NO N.D. 22X Q, WATER IS SUITABLE FOR DRINKING PURPOS R P RS TESTED. DATE 2 1 �� z-11-94 6; 14 PM ;GRC, DiDFJATE AAiALYTICAL ENV IP:"?TECH f GROUNDWATER ANALYTICAL EPA METHODS 601 and 602 Volatile Organics (GC/PID/ELCO) Field ID: 1C Lab ID: 6942-01 Batch ID: VG2-0316-W Project: Reef Realty Lot 1 Sampled: 02-02-94 Client: Envirotech Received: 02-03-94 Lont/Prsv: 40mL VOA Vial/NaHSO4 Cool Analyzed: 02-09-94 Matrix: Aqueous PARAMETER CONCENTRATION REPORTING LIMIT (ug/L) BRL 5 Dichlorodifluoromethane BRL 5 Chloromethane BRL 5 Vinyl Chloride BRL 5 Bromomethane BRL 5 Chloroethane BRL 1 Trichlorofluoromethane BRL 1 1,1-Dichloroethene BRL 1 Methylene Chloride BRL 1 trans-1 ,2-Dichloroethene BRL I 1,1-Dichloroethane RL 1 cis-1,2-Dichloroethene * BRL 1 !Chloroform BRL 1 1,1,1-Trichloroethane BRL I Carbon Tetrachloride BRL 1 Benzene BRL 1 1,2-Dichloroethane BRL 1 Trichloroethene 1 .1,2-Dichioropropane BRL 1 Bromodichloromethane 5 2-Chloroethyl Vinyl Ether BRLBRL I cis-1,3-Dichloropropene BRL 1 Toluene BRL 1 trans-1,3-Dichloropropene BRL I 1,1,2-Trichloroethane BRL I Tetrachloroethene BRL 1 Dibromochloromethane BRL 1 Chlorobenzene BRL I Ethylbenzene - 1 meta-and para-Xylene * BRLBRL 1 ortho-Xylene * BRL 1 Bromoform BRL 1 1,1,2,2-Tetrachloroethane BRL 1 1,3-Dichlorobenzene BRL 1 1,4-Dichlorobenzene BRL 1 1,2-Dichlorobenzene QC SURROGATE COMPOUND SPIKED MEASURED RECOVERY QC LIMITS % 87 - 113 % a,a,a-Trifluorotoluene 30 31 1030 104 % 83 - 117 % 1,2-Dichloroethane-d4 30 Below Reporting Limit. * Non-target compound. 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