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HomeMy WebLinkAbout0004 GREAT MARSH ROAD - Health 01 4 GreatMarsh Road W. Barnstable A =.089 003 1 � ° 4 I i IJ _J Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ' 4 Great Marsh Road,West Barnstable M-89 P-03 Property Address Elizabeth Quinn Owner Owner's Name required fo is 4 Great Marsh Road,West Barnstable MA 02668 July 19, 2012 required for every page. City/Town State Zip Code. Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information • �L/'`(� on the computer, use only the tab 1. Inspector: key to move your cursor-do,not Troy Williams use the retim Name of Inspector key. Troy Williams Septic Inspections Company Name 19 Hummel Drive Company Address R,m A 51' South Dennis MA' 02660 City/Town State Zip Code (508) 385- 1300 S1682 Telephone Number License Number B. Certification 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'dection 1[5340 Title 5(310 CMR 15.000).The system: ; -== ® Passes ❑ Conditionally Passes ❑ Falls£ f ❑ Needs Further Evaluation by the Local Approving Authority July 19, 2012 ` Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. **.**This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. DIV —I/ t5ins 11/to Tile 5 Official Inspection F.:Subsurface Sewage Disposal System•Page 1 of 17 ' a Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments "• 4 Great Marsh Road, West Barnstable M-89 P-03 Property Address Elizabeth Quinn Owner Owner's Name information is required for every 4 Great Marsh Road, West Barnstable MA 02668 July 19, 2012 page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: System meets minimum standards set by Massachusetts DEP at the time of inspection only.This inspection is not a guarantee or warranty on the future working conditions of leaching, pipes, components or the future structural integrity of said components and only represents conditions found at the time of inspection only. 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. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old"or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or 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. ❑ Y ❑ N ❑ ND(Explain below): N/A t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 4 Great Marsh Road, West Barnstable M-89 P-03 Property Address Elizabeth Quinn Owner Owner's Name information is required for every 4 Great Marsh Road,West Barnstable MA 02668 July 19, 2012 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ElY ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): N/A ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): r ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): N/A C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 L Commonwealth of Massachusetts a Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments "t 4 Great Marsh Road, West Barnstable M-89 P-03 Property Address Elizabeth Quinn Owner Owner's Name information is every 4 Great Marsh Road, West Barnstable MA 02668 Jul 19, 2012 required for eve Y page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: N/A D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/:day flow t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments .•''� 4 Great Marsh Road, West Barnstable M-89 P-03 Property Address Elizabeth Quinn Owner Owner's Name information is y 19 4 Great Marsh Road, West Barnstable MA 02668 Jul required for every , 2012 page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 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. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 4 Great Marsh Road, West Barnstable M-89 P-03 Property Address Elizabeth Quinn Owner Owner's Name information is required for every 4 Great Marsh Road, West Barnstable MA 02668 July 19, 2012 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ . ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (if they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® El information the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 4 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 440 gpd e t5ins•11/10 s Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 4 Great Marsh Road, West Barnstable M -89 P-03 Property Address Elizabeth Quinn Owner Owner's Name information is 4 Great Marsh Road, West Barnstable MA 02668 Jul 19, 2012 required far every y page. CitylTown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d private well 9 ( Y 9 (gP ))� Detail: well is over 200'from leaching. Sump pump? ❑ Yes ® No Last date of occupancy: occupied Date Commercial/Industrial Flow Conditions: Type of Establishment: N/A Design flow(based on 310 CMR 15.203): N/A Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): N/A Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: N/A t5ins•11/10 Title 5 Official Insp ection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal g sposa System Form Not for Voluntary Assessments 4 Great Marsh Road, West Barnstable M-89 P-03 Property Address Elizabeth Quinn Owner Owner's Name information is 4 Great Marsh Road West Barnstable MA ' 02668 July 19, 2012 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: N/A Date Other(describe below): General Information Pumping Records: . . Source of information: Last pumped on 4/19/10 per info from owner. Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume,pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system El Single cesspool, ❑ Overflow cesspool ❑ 'Privy r ❑ 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)and a copy of latest inspection of the I/A system by system operator under contract - Tight tank.Attach a copy,of the DEP approval. ❑ Other(describe): t5ins-11/10. - Title 5 Official Inspection Fond:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 4 Great Marsh Road, West Barnstable M -89 P-03 Property Address Elizabeth Quinn Owner Owner's Name information is 4 Great Marsh Road West Barnstable MA 02668 Jul 19 2012 required for every � Y page. Cityfrown• State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: Tank, d-box and leaching were installed on 11/27/02 per as-built. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 18"+ Depth below grade: feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line. • feet Comments(on condition of joints, venting, evidence of leakage, etc.): Flushed lines and found clear at the time of inspection. Septic Tank(locate on site plan): fi 911 Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 6'X10.5'X6' 1500 gallon Sludge depth: 411 t5ins•11/10 Title 5 Official inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4 Great Marsh Road, West Barnstable M-89 P-03 Property Address Elizabeth Quinn Owner Owner's Name information is required for every 4 Great Marsh Road West Barnstable ' MA 02668 July 19, 2012 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) ' Distance from top of sludge to bottom of outlet tee or baffle 2' 8" Scum thickness thin layer Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? probe/measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pvc inlet and outlet tees were found present and in working order. No evidence of leakage or damage was found. Tank was not in need of pumping at this time. Grease Trap(locate on site plan): ' N/A Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): N/A Dimensions: N/A Scum thickness N/A Distance from top of scum to top of outlet tee or baffle • N/A Distance from bottom of scum to bottom of outlet tee or baffle N/A k Date of last pumping: +} N/A Date t5ins•11/10 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments y< 4 Great Marsh Road, West Barnstable M -89 P-03 Property Address Elizabeth Quinn Owner Owner's Name information is required for every 4 Great Marsh Road West Barnstable MA 02668 July 19, 2012 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): N/A Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: N/A Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene El other(explain): N/A Dimensions: N/A Capacity: N/A gallons Design Flow: N/A gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): N/A Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•11/10 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �r 4 Great Marsh Road,West Barnstable M -89 P-03 Property Address Elizabeth Quinn Owner Owner's Name information is required for every 4 Great Marsh Road West Barnstable MA 02668 July 19, 2012 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert level Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box was found level and in working order with equal distribution to outlet lines. No evidence of backup in the past were found at the time of inspection. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): N/A Soil Absorption,System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4 Great Marsh Road, West Barnstable M -89 P-03 Property Address Elizabeth Quinn Owner Owner's Name information is 4 Great Marsh Road,required for every West Barnstable MA 02668 July 19, 2012 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 3-500 gallon with stone ❑ leaching galleries number: 32'X1TX 2' ❑ 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.): Chambers were found with 1'of water present at the time of inspection. Checked stone and found dry and clean. No evidence of hydraulic failure or problems in the past were found at the time of inspection. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration N/A Depth—top of liquid to inlet invert N/A Depth of solids layer N/A Depth of scum layer N/A Dimensions of cesspool N/A Materials of construction N/A Indication of groundwater inflow ❑ Yes ❑ No t5ins-11/10 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r` 4 Great Marsh Road, West Barnstable M-89 P-03 Property Address Elizabeth Quinn Owner Owner's Name information is required for every 4 Great Marsh Road, West Barnstable MA 02668 July 19, 2012 page. City1rown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): N/A r. Privy(locate on site plan): Materials of construction: N/A Dimensions N/A Depth of solids N/A Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): N/A t5ins•11/10 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 14 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r 4 Great Marsh Road, West Barnstable M-89 P-03 Property Address Elizabeth Quinn Owner Owner's Name information is required for every 4 Great Marsh Road West Barnstable MA 02668 July 19, 2012 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately a35' � - 6 � 0 � y O ® 13 � y 51 , t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4 Great Marsh Road, West Barnstable M -89 P-03 Property Address Elizabeth Quinn Owner Owner's Name information is 4 Great Marsh Road West Barnstable MA 02668 Jul 19 2012 required for every Y page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 13.0'+ feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 3/1/01 Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health'-explain: ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: SDW 252 Zone B 47.1' 1.8'adjustment You must describe how you established the high ground water elevation: Test hole recorded on plan showed no water found at 12.0'. Groundwater adjustment at the time of inspection was 1.8'. Bottom of leaching at 6.0'was found not to be located in the high groundwater elevation at the time of inspection. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11/10 Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments lug 4 Great Marsh Road, West Barnstable M-89 P-03 Property Address Elizabeth Quinn Owner Owner's Name informatics is 4 Great Marsh Road,required for every West Barnstable MA 02668 July 19, 2012 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-11/1 J Title 5 Official Inspection Forth.Subsurface Sewage Disposal System-Page 17 of 17 f ,mot Town of Barnstable s Regulatory Services URMASM ,► MA Thomas F. Geiler,Director 1639. Public Health Division Thomas McKean,Director 367 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 November 8, 2002 Mr. J. Kevin O' Haire Wing Farm Realty Trust P.O. Box 444 E. Sandwich,MA 02537 Re: 4 Great Marsh Road Dear Mr. O' Haire, I am in receipt of your letter regarding the property at 4 Great Marsh Road West Barnstable. Please be advised, the Town of Barnstable Public Health Division obtains all property information from the town assessor's computerized database. As of 11-08-02 you are still listed as the current owner in this database. Once a property transaction is completed,it can be several months before the database available to the other town departments is updated. Please disregard the order letter issued from this department. The current owner of the parcel has been identified and has received notification to correct the violations. We regret any inconvenience this issue may have caused. Sincerely, David E. McKeame v Y Public Health Inspector 1 t O - TOWN OF HARNSTART.F' b $AA-w _ 3961 n- Ordinance or Regulation WARNING NOTICE Name of Offender/Manager I'EVIIV sT 0"A1,09/RE Address of Offender J O. f6Orl' 4¢4- MV/MB Reg.# Village/State/Zip 114A 0y.5 3 r— - Co . CO _Co Business Name am/pm, on - 20 CO Business Address / C • ram'/E.�+�nA� co Signature of Enforcing 9&f Icer Village/State/Zip Location of Offense 'j��jC T/h�ie r// /OKO, �/E_$T���P LF 116*G7W . 0,,1V 7-,ow E4rr Enforcing Dept/Division Offense /4.5- C.-WA 4/O, DOO . &OaL14 Facts QU/LD/N�r /YIi�T7��9LS f�//� CO�Di77lryE�if' .Ols1'o;S� of flit/ PW4fO J7- Ld 4Lo/y L✓p0� 11Q ,Q` a action has been taken. serve only as a warning. At this time no legal This will g _ Y g , v volunt ary compliance of Town to achieve o T agencies he oal f own It is trY mP g Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFEN DER CANARY-ORDJREG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. N CV O N - O NOV-07-2002 THU 12: 15 PM 5087782887 P. 01 Wing Farm Realty Trust P.O. Box 444 East Sandwich, MA 02537 November 7, 2002 VIA FAX and MAIL Mr. Thomas A. McKean Town of Barnstable Public Health Division P.O.Box 534 Hyannis,MA 02601 Re: 4 Great Marsh Road Warning Notice-David E. McKeamey Dear Mr. McKean, I received the attached notice along with your letter of. October 25th, 2002 regarding violations of 105 CMR 410.00 on 4 Great Marsh Road, West Barnstable. It appears some debris, shingles and wood brush were observed by David McKearney on October 241h, 2002 in the vicinity of this lot or on Great Marsh Road. Please be advised that checking with the Town Assessor would have shown that I am not the current owner of this property. I purchased it on November 16th, 2000 as sold it on July 19th., 2002 as recorded at the Barnstable Registry of Deeds in Book 15384 -Page 186. 1 enclose a copy of the Tax Assessor. Field Card showing this transaction and the current owner information. I believe the current owner is starring the Building Process on this parcel in November and any debris would be removed and disposed of during excavation and preparation of the site. i would also ask if the person who filed the"complaint"is also the individual who has blocked Great Marsh Road with the fence shown in the photos that accompany you letter. Please send me written correspondence to the above address acknowledging your mistake and removing me as the "Offender". If you have any questions,please do not hesitate to call me directly at my office number(508) 778-4700. Very Truly Yours, J.tevm O'FIairc, Trustee for Wing Farm Realty Trust a Wing Farm Realty Trust P.O. Box 444 East Sandwich, MA 02537 November 7, 2002 VIA FAX and MAIL Mr. Thomas A. McKean Town of Barnstable Public Health Division P.O. Box 534 Hyannis, MA 02601 Re: 4 Great Marsh Road Warning Notice - David E. McKearney Dear Mr. McKean, I received the attached notice along with your letter of October 25th, 2002 regarding violations of 105 CMR 410.00 on 4 Great Marsh Road, West Barnstable. It appears some debris, shingles and wood brush were observed by David McKearney on October 24th, 2002 in the vicinity of this lot or on Great Marsh Road. Please be advised that checking with the Town Assessor would have shown that I am not the current owner of this property. I purchased it on November 16th, 2000 as sold it on July l9th, 2002 as recorded at the Barnstable Registry of Deeds in Book 15384 -Page 186. I enclose a copy of the Tax Assessor Field Card sh6w ng this transaction and the current owner information. I believe the current owner is starting the Building Process on this parcel in November and any debris would be removed and disposed of during excavation and preparation of the site. I would also ask if the person who filed the"complaint"is also the individual who has blocked Great Marsh Road with the fence shown in the photos that accompany you letter. Please send me written correspondence to the above address acknowledging your mistake and removing me as the"Offender". If you have any questions,please do not hesitate to call me directly at my office number(508) 778-4700. Very Truly Yours, J. Kevin O'Haire, Trustee f6r Wirig Parini Realty Trust, . . . .. r • r 1 r r a x t I • f > TOWN OF BARNSTABLE BAR-W N_ 3961 Ordinance or Regulation WARNING NOTICE Name of Offender/Manager �E�'//V �/`7��/i2E Address of Offender /'O. 490X MV/MB Reg.# Village/State/Zip �oC MA O2S� Business Name am/pm; ojn/ 20_ C O. Business Address w! Signature of Enforcing q9ticer Village/State/Zip Location of Offense y(rRE7JT 1��•�/�/ ���� �✓E-��� 5 � y�L rN. . OC��4V?7 i�l FA,7 Enforcing Dept/Division Offense e)00 Facts %7 41'4VEif QA1 k-qG.f� Ld r .4 o/v � L✓OoI /zoo-O, This will serve only as a warning. At this time no legal action has been taken. voluntary compliance of Town It is the goal of Town agencies to achieve Ordinances, Rules and Regulations . Education efforts and warning notices are n voluntary compliance. Subsequent violations will result in attempts to gai appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. ,f _ Property Location: 4 GREAT MARSH ROAD MAP ID: 089/003/ Vision ID:'5053 Other ID: Bldg#: 1 Card 1 of 1 Print Date:10/28/2002 CURREIVT-OWNER +;, i ;t( ;" ¢ ;aTOPO .�.; "::UTILITIES.; STRT.-/ROAD:410CATIOIV .:;>c.,,.,,.k i»: `_.,i�._#::,C,URRENT..ASSESSMENT HAIRE,J KEVIN TR Description Code Appraised Value Assessed Value "YoGOLDRICK,JANET M''&QUINN,E A RESLAND 1310 33,300 33,300 801 2 NATHANIELS DR OCHESTER,MA 02770 , SUPPLEMENTAL'DATA}; `C. IVE DATA-I C ( * v Additional Owners: Account# 43349 Plan Ref. 278/012 ax Dist. 500 Land Ct# er.Prop. #SR CEDAR ST Life Estate �" isil DL I PART OF PARCNotes: DI-2 GIS ID: 5053 Totall 33,3001 33,300 x RECORD OFQWNERSHIP... >< BK=VOL/PAGE'• SALEDATE. /u ;vA SALEPRIGE V.C. PREVIOUS ASSESSMENTS HISTORY OLDRICK,JANET M& 15384/186 07/19/2002 Q V 175,000 00 Yr. Code I Assessed Value Yr. Code Assessed Value Yr. Code Assesse. HAIRE,J KEVIN TR 13370/195 11/16/2000 U V 110,000 IN 2003 1310 43,600 2002 1310 43,600 2001 1310 iOXIE,EDWARD W&EDWARD W JR 1595/124 Q 0 Total: 43,6001 Total: 43,6001 Total: • 4 " :EXEMPTIONS ? $,s fr . ._._ _:s OTHER ASSESSMENTS €' , .. ..;5:": This signature acknowledges a visit by a Data Collector or A Year Ty e/Descri tion Amount Code Description Number Amount I Comm.Int. APPRAISED VALUE SUMMARY Appraised Bldg. Value(Card) Appraised XF(B)Value(Bldg) Total: Appraised OB(L)Value(Bldg) :NOTES L Value Appraise Lan Value 0 ,-, Special and Total Appraised Card Value Total Appraised Parcel Value Valuation Method: Cost/Market et Total Appraised Parcel Value BUILDING:PERMITRECORD ;, VISIT/CHANGE;HISTORY.. Permit ID Issue Date TvDe Description Amount his .Date %Comp. Date Comp. Comments Dale ID Cd. Pur ose/R, .;.. .._ _..,, -1 t'jj` ,q:;r „1.... .*};'?.J.=t «,;. .in., :' v"..-4 ,. r�r,Y,.f1M; �Fy6t �lFt,[' : ,'rsy 7,. ,...x ..-^h a .f , ,,:��,r.=������rs„`?��it'`�'�r�Y,�..,.�t����..:�z :-�3�:.�.. �..+°�,.,,` ,�'i '°r�� �'�:�:; ��:��rLANDrLINE.VALII:4TION.SEGTlON<a .�.,-:v �... •_:.r. k..:.'t' _. n.`t�.::•�-. : Y ,..�:� B# Use Code Description Zone D Frontage Depth Units Unit Price L Factor S.I, C.Factor Nbad. Ad'. Notes-Ad lS ecial Pricing Ad. Unit Price Land 1 1310 Pot Dev Ld RF 5 1 1.00 AC 40,000.00 1.00 P 1.00 0103 0.60 1 1310 Pot Dev Ld RF 5 0.15 AC 25,000.00 4.13 R 1.00 0103 0.60 r! Total Card Land Units 1.151 ACI Parcel Total Land Area: 1.15 AC Total Land Valu i--- �Y TOWN OF BARNSTABLE .lr LOCATION PAHr j�d SEWAGE # QUa/_5�23 VILLAGE ASSESSOR'S MAP & LOT 00 .00 3 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY I `o� LEACHING FACILITY: (type) Vd tA.A0,4 C size) 131 X 32 rXa NO.OF BEDROOMS 1-1 I (1/Lel�) BUILDER OR OWNER 37. 0� PERMITDATE: -74101 COMPLIANCE DATE: II a7/U,2 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet Furnished by ro Ll C - 17' A D y31 o ql y ' a � � 3 A� No. 064 e { THE CQMMON-WEALTH OF MASSACHUSETTS Entered in cCmnuter: Yes �OJ3� PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ( 01ppYication for ligpogal *pgtem Comaruction i3ermit Application for a Permit to Construct( , )Repair( )Upgrade( )Abandon( ) Complete System ❑Individual Components Location Address or Lot No. 4 Great Marsh Road Owner's Name,Address and Tel.No. 508-833-6154 West Barnstable, MA J. Kevin O'Haire, Trustee Assessor's Map/Parcel 89 — 3 P.O. Box 444 East Sandwich, MA 0253,7 Installer's Name,Address,and Tel.No. -;----; __ Designer's Name,Address and Tel.No. Earl Lant e ry Advanced Technical Solutions , Box 99 'Jny P5,UX, Sandwich, MA 02537 508-888-4029 Type of Building: J3 N N 5 j JVO 0� 1 Dwelling No.of Bedrooms 4 Lot Size 50,094 sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 110 gallons per day. Calculated daily flow 440 gallons. Plan Date April 19, 2001 Number of sheets 1 Revision Date Title Sewage System Design for Heritage Custom Building Size of Septic Tank 1,500 gallons Type of S.A.S. Description of Soil, Hole #1 1at 106.0 — Loam, 105.2 — Loam Sand, 103.2 Fine med Sand, 100.5 Fine Sand Hole #2 109.0 — Loam, 108.2 — Loamy Sand, 106.3 — Fine Med Sand, 102.9 — Fine Sand Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisio f Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been ' s' y o e lth. Sign Date Application Approved by _ Date Application Disapproved for the following reason Permit No. _.r Date Issued �r n.,� •Enteredi.. omputer: l-� � THE C �VlM,0.0FALTH OF MASSAtbHUSETTS{ 'Yes PUBLIC HEALTH DIVISION'- TOWN OF BARNS_TABI S MASSACHUSETTS Appileation for M:tgpool *pgtem Congtruction Vermit �•_ Application for a Permit,to Construct( . )Repair( )Upgrade( )Abandon( ) ®Complete System ❑Individual Components Location Acdress or Lot No. 4 Great Marsh Road Owner's Name,Address and Tel.No. 508-833-6154 ""• `" West Barnstable, MA J. Kevin O'Haire, Trustee Assessor'sMap/Parcel 89 — 3 P.O. Box 444 East Sandwich, MA 025V •a Installer's Name,Address,and Tel.No. >�azicc�-v�ris8�. Designer's Name,Address and Tel.No. Earl Lantery Advanced Tee-hnical Solutions , Box 99 .���.esrr•�x�et�a�t�a;�-Mtn---8�4rOfi -.._..._-�- ti7,S"andwich, MA 02537 508-888-4029 .. —' Type of Building: ��' j � N N 5t t/!-�v4l -~ <- Dwelling., No.of Bedrooms 4 Lot Size 50.094 sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 110 gallon•s per day. Calculated daily flow 440 gallons. Plan Date April 19, 2001 Number of""sheets 1 Revision Date Title Sewage System Design for Heritage Custom Building Size of Septic Tank 1,500 gallons Type of S.A.S. Description of Soil Hole #1 at 106.0,/ Loam, 105.2 — Loam Sand, 103.2 Fine med Sand, ! 100.5 Fine Sand Hole #2 L09.0 — Loam, 108.2 — Loamy Sand, 106.3 — Fine Med Sand, 102.9 — Fine Sand Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on=site sewage disposal"'system in accordance with the provisions-of Title 5 of the Environmental3C-ode#and-not•to-place the system in operation until a Certify- w., cate of Compliance has been e 6y g oNealth.Sig � ! ki Date / ? Application Approved by / !/ t1� .P Date �11_ Application Disapproved for the following reason �... Permit No. Date Issued ' --.------------- —————— � — -------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded( ) -- Abandoned( )by JJ at H t�,4N4 m w N rd. INe C F�r�c-�bIt has been nstructed in accordance _ with the provisions of Title 5 and the for Disposal System Construction Permit N0 . a d A Installer- Designer > t The issuance of thi pem t i shall not be construed as a guarantee that the syst�Gm twill function as�dbsrgned. %/ n Date I 1 Inspector A�,d%�7 t`_ , -pol THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS lwigpotar 6 Repgtem Congtruction Permit Permission is hereby granted to Construct(✓ air( )Up)f de( )Abandon( ) System located at -e wV' 6�P/G G� f f I G-.-h t4,43 At and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply wide Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this p` rtrt. D Date: I I?7/0 z ' Approved by I /, `,A ``n -f I I TOWN OF BARNSTABLE LOCATION �) �re�7 ������ r� SEWAGE # !auk I'57.23 VILLAGE WCA trl-rla ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIg TANNIC CAPACITY 0 d � � LEACHING FACILITY: (type) d � o6'� CL size) 13 Y72 y TJ ' 1 NO.OF BEDROOMS m,� ( f(�' IBUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: 'I�a7I1 Separation Distance Between the: iFeet Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Private Water Supply Well and Leaching Facility (If any wells exist Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility (If any wetlands exist Feet within 300 feet of leaching facility) iFurnished by A- D _ � F o a L NEW DK�.JePAITN �d �� �� �- dam" Extended-release o(oxybu nin chloride) tablets C s " sa n � C, i Manufactured/ 1-888-395-1232 Distributed/Marketed by Marketed by w .DitropanXL.com pp_�lll2 �Phar a PKAR-CEUT¢ALS 0008789 Palo Alto,CA 94304 Smyrna,CA 30080 0 1999 ALZA Corporation ENVIROTECHLABORATORIES,INC. MA CERT.NO.:M-MA 063 449 Rte. 130 Sandwich, MA 02.563 508(888-6460) 1-800 339-6460 FAX(908)888-6446 CLIENT: Heritage Custom Builders LOCATION: Lot 3 ADDRESS: 72 Pine St. Cedar St. Hyannis, MA 02601 W. Barnstable, MA COLLECTED BY. DA Scannell SAMPLE DATE: 6/5/2001 SAMPLE TIME: 1:OOPM WATER SAMPLE TYPE: New Well DATE RECEIVED: 6/5/2001 LAB I.D. #: 0106081 WELL SPECS.: NA RESULTS OF ANALYSIS: Parameters Units Recommended Results Method Date Analyzed Limits Coliform bacteria /100ml 0 0 9222 B 6/5/2001 pH pH units 6.5-8.5 6.12 4500 H+ 6/5/2001 Conductance umhos/cm 500 69 120.1 6/5/2001 Nitrate-N mg/L 10.0 < 0.005 300.0 6/5/2001 Nitrite-N mg/L 1.00 < 0.003 300.0 6/5/2001 Sodium mg/L 28.0 7.6 200.7 6/6/2001 Iron mg/L 0.3 < 0.1 200.7 6/6/2001 Manganese mg/L 0.05 < 0.008 200.7 6/6/2001 Volatile Organics See Report Chloroform ug/L 100 0.53 EPA 524.2 6/12/01 MTBE ug/L 70 1.4 EPA 524.2 6/12/01 COMMENTS: pH is below recommended limit and may have corrosive characteristics. WATER MEETS EPA STANDARDS AND IS SUITABLE FOR DRINKING PURPOSES FOR PARAMETERS TESTED. <=less than Date ( G >=greater than Ro Id J. S ri TNTC=too numerous to count Laboratory re for CERTIFICATE OF ANALYSIS /Page: 4 LAPUCK LABORATORIES INC. Report Prepared For: Report Dated: 06/14/2001 Envirotech Laboratories,Inc. Order Number: L0169430 Ron Saari 449 Me. 130 Sandwich, Ma 02563 Laboratory ID#: 0169430-02 Description: 0106081 Lot 3 Cedar Street Sample#: Samnline Location: Collected: Collected by: Customer Received: 06/07/2001 Test Parameters ITEM RESULT UNITS MDL Method# Tested LAB: Organics MTBE 1.4 ppb 1.0 EPA 524.2 06/12/2001 EPA 524.2- Volatile Organics by GC/MS ITEM RESULT UNITS MDL Method# Tested LAB: Organics 1,1,1,2-Tetrachloroethane ND ppb 0.5 EPA 524.2 06/12/2001 1,1,1-Trichloroethane ND ppb 0.5 EPA 524.2 06/12/2001 1,1,2,2-Tetrachloroethane ND ppb 0.5 EPA 524.2 06/12/2001 1,1,2-Trichloroethane ND ppb 0.5 EPA 524.2 06/12/2001 1,1-Dichlorethane ND ppb 0.5 EPA 524.2 06/12/2001 1,1-Dichloroethene ND ppb 0.5 EPA 524.2 06/12/2001 1,1-Dichloropropene ND ppb 0.5 EPA 524.2 06/12/2001 .1,2,3-Trichlorobenzene ND ppb 0.5 EPA 524.2 06/12/2001 1,2,3-Trichloropropane ND ppb 0.5 EPA 524.2 06/12/2001 1,2,4-Trichlorobenzene ND ppb 0.5 EPA 524.2 06/12/2001 1,2,4-Trimethylbenzene ND ppb 0.5 EPA 524.2 06/12/2001 1,2-Dibromo-3-Chloropropa ND ppb 0.5 EPA 524.2 06/12/2001 1,2-Dibromoethane(EDB) ND ppb 0.5 EPA 524.2 06/12/2001 1,2-Dichlorobenzene ND ppb 0.5 EPA 524.2 06/12/2001 1,2-Dichloroethane ND ppb 0.5 EPA 524.2 06/12/2001 1,2-Dichloropropane ND ppb 0.5 EPA 524.2 06/12/2001 1,3,5-Trimethylbenzene ND ppb 0.5 EPA 524.2 06/12/2001 1,3-Dichlorobenzene ND ppb 0.5 EPA 524.2 06/12/2001 1,3-Dichloropropane ND ppb 0.5 EPA 524.2 06/12/2001 1,4-Dichlorobenzene ND ppb 0.5 EPA 524.2 06/12/2001 f CERTIFICATE OF ANALYSIS Page: 5 LAPUCK LABORATORIES, INC. Report Prepared For: Report Dated: 06/14/2001 Envirotech Laboratories,Inc. Order Number: L0169430 Ron Saari 449 Rte. 130 Sandwich, Ma 02563 Laboratory ID#: 0169430-02 Description: 0106081 Lot 3 Cedar Street Sample#: SamWine Location: Collected: Collected by: Customer Received: 06/07/2001 2,2-Dichloropropane ND ppb 0.5 EPA 524.2 06/12/2001 2-Chlorotoluene ND ppb 0.5 EPA 524.2 06/12/2001 4-Chlorotoluene ND ppb 0.5 EPA 524.2 06/12/2001 4-Isopropyltoluene ND ppb 0.5 EPA 524.2 06/12/2001 Benzene ND ppb 0.5 EPA 524.2 06/12/2001 Bromobenzene ND ppb 0.5 EPA 524.2 06/12/2001 Bromochloromethane ND ppb 0.5 EPA 5.24.2 06/12/2001 Bromodichloroethane ND ppb 0.5 EPA 524.2 06/12/2001 Bromoform ND ppb 0.5 EPA 524.2 06/12/2001 Bromomethane ND ppb 0.5 EPA 524.2 06/12/2001 CarbonTetrachloride ND ppb 0.5 EPA 524.2 06/12/2001 Chlorobenzene ND ppb 0.5 EPA 524.2 06/12/2001 Chloroethane ND ppb 0.5 EPA 524.2 06/12/2001 Chloroform 0.53 ppb 0.5 EPA 524.2 06/12/2001 Chloromethane ND ppb 0.5 EPA 524.2 06/12/2001 cis-1,2-Dichlorethene ND ppb 0.5 EPA 524.2 06/12/2001 cis-1,3-Dichloropropene ND ppb 0.5 EPA 524.2 06/12/2001 Dibromochloromethane ND ppb 0.5 EPA 524.2 06/12/2001 Dibromomethane ND ppb 0.5 EPA 524.2 06/12/2001 Dichlorodifluoromethane ND ppb 0.5 EPA 524.2 06/12/2001 Ethylbenzene ND ppb 0.5 EPA 524.2 06/12/2001 Hexachlorobetadiene ND ppb 0.5 EPA 524.2 06/12/2001 Isopropylbenzene ND ppb 0.5 EPA 524.2 06/12/2001 MethyleneChloride ND ppb 1.0 EPA 524.2 06/12/2001 n-Butylbenzene ND ppb 0.5 EPA 524.2 06/12/2001 n-Propylbenzene ND ppb 0.5 EPA 524.2 06/12/2001 Naphthalene ND ppb 0.5 EPA 524.2 06/12/2001 sec-Butylbenzene ND ppb 0.5 EPA 524.2 06/12/2001 CERTIFICATE OF ANALYSIS ' Page: 6 LAPUCK LABORATORIES, INC. Report Prepared For: Report Dated: 06/14/2001 Envirotech Laboratories,Inc. Order Number: L0169430 Ron Saari 449 Rte. 130 Sandwich, Ma 02563 Laboratory ID#: 0169430-02 Description: 0106081 Lot 3 Cedar Street Sample#: Sampling Location: Collected: Collected by: Customer Received: 06/07/2001 Styrene ND ppb 0.5 EPA 524.2 06/12/2001 tert-Butylbenzene ND ppb 0.5 EPA 524.2 06/12/2001 Tetrachloroethene ND ppb 0.5 EPA 524.2 06/12/2001 Toluene ND ppb 0.5 EPA 524.2 06/12/2001 trans-1,2-Dichloroethene ND ppb 0.5 EPA 524.2 06/12/2001 trans-1,3-Dichloropropene ND ppb 0.5 EPA 524.2 06/12/2001 Trichloroethene ND ppb 0.5 EPA 524.2 06/12/2001 Trichlorofluoromethane ND ppb 0.5 EPA 524.2 06/12/2001 VinylChloride ND ppb 0.5 EPA 524.2 06/12/2001 Xylene ND ppb 0.5 EPA 524.2 06/12/2001 f� 4 No. F-� - ----- -- -ee— - .---- -- ---- - BOARD OF HEALTH TOWN OF BARNSTABLE Application-ArlVell Con5truct ion Permit AVA-4 r4 Application is hereby made for a permit to Construct (*1, Alter ( ), or Repair ( )an individual Well at: ^�^ Location — Address Assessors Map and Parcel O ner Address 1�_l4�s w c.?c APB � ___ �o✓'D�r �jloe� /1-c4q ko " tics. �2G y -- - ------------ ----------------------------- ------ -------------- Installer — Driller -- Address Type of Building Dwelling `'" Other - Type of Building---- ------ No. of« �,L9c Persons-_-----_______—__—_T------- _ .Type of Well 41 ------------- 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 or Compliance has been issued by the Board of Health. Signed - --- to • - Application. Approved By I da e Application Disapproved for the following ,— — —— — _ � --- date— Permit No. -- Issued-- — -- — -------------- date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate ®f Compliance THIS IS TO CERTIFY, That the Individual Well Constructed (&I, Altered ( ), or Repaired ( ) -/,)A —Isle a.,—ff Installer at-— L 3 --_—--__ _ -- -- -- ----------- 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 No. ----- -—Dated----THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE---- — Inspector—___--_-------_____ -------___-- __— I - - No.- aO.- .Fee---�-=------- ---- t 'ABARD OF HEALTH - TOWN -OF BARNSTABLE 01pithAt ion AM ell Conoructionpermit AtA Ick r) Application is hereby made for a permit to Construct (�_ Alter-( ), or Repair ( )an individual Well at: 3. ,ee;0o/ f-r- w y?or ��-- 663 -- -- Location — Address —-- Assessors Map and Parcel Owner Address _ - - --- -------------- ----- ---- ------------ Installer — Driller Address Type of Building Dwelling '"1` --- --------- Other - Type of Building-_-- ----------- - No. of Person—s------------------------ - TYPe of Well 41 C Capacity-_-___ Purpose of Well • /�v. ,r —__— ---- ----- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation until a Certificate f Compliance has been issued by the Board of Health. ✓// �5`/O Signed _— —_ to Application Approved By / � —® - - -O•- l4 date Application Disapproved for the following reasons: ------- wc-yoor date Permit No. - Issued-- - — -�f-/J -- --- — date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliance THIS IS TO CERTIFY, That the Indiidual Well Constructed (`I, Altered ( ), or Repaired ( ) _- by---- ;,---- �-�-----�R ____-------- -------------- Installer at--- z.r- ona si•• 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 No. ---------Dated---=- ------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE------ - Inspector-------- - —_-- —_ ----- BOARD OF HEALTH TOWN OF BARNSTABLE Vell Con5truct ion Vermin W --- No. ----- � Fee- ------ - ( w✓ L/ �Lu /p Permission is hereby granted ---- - - --------- -- - Alter ( ), or Repair ( ) an Individual Well St t: T k to Construct ( "f � eet - —_.--_—— as shown on the pplication for a W 1 Construction Permit No.- �D — Dated-- - — --------------------------- X?_5------------------- 1 _ oard ofYHealth DATE 0000 0 0 0 0 0 00000 000 0 00 - / U'Am P u u H wiv CTC � P P P P P P P P �-� c- ALI o � F° 0 4a-0' NZ �- 1rv+` s6• rvz 9%314' 4'6tW Tb' W 1/2" fT�� D x Cl V� MI Q Q x y 4 m � # 7CS �aF m 24610 24510 < 2446 ----------------- ------------------ 1668 493n z 4499V4'f O N 'AI � /B°%41V4• III Age ar $ t y III !'A" Gs y � VIII � 1nr Y III �iw N 4 O S III 9 fy^ # # A. 73 Ili � W 9068CA. z�a' � I I 4• �� � � � III � �� �^�� £ N � ca u I III a vs 6M 4 0 2446 PC-61H' 7K tAVB°M 41V4e y+b.� R I qu p s 6b V4 Tb lib Z a 111 \ 8 4 I I 2668 F1419' 16-29N' 7F1Q17M A' . 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