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0042 JENKINS LANE - Health
42 JENKINS LANE WEST BARNSTABLE A= 128 - 004 - 007 f a �I i I I Commonwealth of Massachusetts /028-004-00:�_ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments •.� 42 Jenkins Ln Property Address r Dumais ' Owner Owner's Name information is required for every West Barnstable MA 02668 9/9/20 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. A. Inspector Information /# 114040 Frank Nunes III Name of Inspector saa Company Name Box 841 Company Address East Falmouth MA 02536 Cityrrown State Zip Code 508.272.6433 13010 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑' Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 9/9/20 Inspect igna 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 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 form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: 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. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Y� c Commonwealth of Massachusetts �. 1p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 42 Jenkins Ln Property Address Dumais Owner Owners Name information is required for every West Barnstable MA 02668 9/9/20 page. CityrFown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) 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: 2) 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): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 I Commonwealth of Massachusetts ,ip Title 5 Official Inspection Form �~ Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 42 Jenkins Ln Property Address Dumais Owner Owner's Name information is required for every West Barnstable MA 02668 9/9/20 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ 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 ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): 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): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) 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. a. System will pass unless Board of Health determines in accordance with 310 CMR 16.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 42 Jenkins Ln Property Address Dumais Owner Owner's Name information is required for every West Barnstable MA 02668 9/9/20 page. Citylrown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 b. 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. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No El ® 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 c Commonwealth of Massachusetts ,i? Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments t, 42 Jenkins Ln Property Address Dumais Owner Owner's Name information is required for every West Barnstable MA 02668 9/9/20 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® 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 '/Z 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 water supply 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 2000 gpd- 10,000 gpd. ❑ ® 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. 5) 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 CA. 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 42 Jenkins Ln Property Address Dumais Owner Owner's Name information is required for every West Barnstable MA 02668 9/9/20 page. Citylrown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered"yes" to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes"or"no"for each of the following for all inspections: 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: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ E 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)] t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 42 Jenkins Ln Property Address Dumais Owner Owner's Name information is required for every West Barnstable MA 02668 9/9/20 page. Cityrrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Description: 3'bedroom permit on file at BOH Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ® Yes ❑ No If yes, discharges to: Septic Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d Well 9 ( Y 9 (9P ))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: occupied Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 42 Jenkins Ln Property Address Dumais Owner Owner's Name information is required for every West Barnstable MA 02668 9/9/20 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Pumped 5 months ago per owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 IL __ Commonwealth of Massachusetts ,�p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �a 42 Jenkins Ln Property Address Dumais Owner Owner's Name information is required for every West Barnstable MA 02668 9/9/20 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 4. 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) 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): Approximate age of all components, date installed (if known)and source of information: 1990 per BOH record Were sewage odors detected when arriving at the site? ❑ Yes ❑ No 5. Building Sewer(locate on site plan): 2'6" Depth below grade: feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: >10' feet Comments(on condition of joints, venting, evidence of leakage, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �o 42 Jenkins Ln Property Address Dumais Owner Owner's Name information is required for every West Barnstable MA 02668 9/9/20 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): 2' Depth below grade: feet Material-of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) H-10 tank appears to be structurally sound, inlet and outlet covers raised to 6"of grade If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes _❑ No Dimensions: 1000g Sludge depth: trace Distance from top of sludge to bottom of outlet tee or baffle >12" Scum thickness trace Distance from top of scum to top of outlet tee or baffle >2" Distance from bottom of scum to bottom of outlet tee or baffle >2" How were dimensions determined? 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.): Pumping suggested every 3yrs to prolong the life of the system t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts - Ip Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 42 Jenkins Lin Property Address Dumais Owner Owner's Name information is required for every West Barnstable MA 02668 9/9/20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): Depth below grade: feet 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: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(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 per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts r: Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 42 Jenkins Ln Property Address Dumais Owner Owner's Name information is required for every West Barnstable MA 02668 9/9/20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) 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.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" 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 video inspected, no adverse conditions observed t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 I f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments !J 42 Jenkins Ln Property Address Dumais Owner Owner's Name information is required for every West Barnstable MA 02668 9/9/20 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 10. 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.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 i Commonwealth of Massachusetts ,ig Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 42 Jenkins Ln Property Address Dumais Owner Owner's Name information is required for every West Barnstable MA 02668 9/9/20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leach pit is 8' below grade, cover raised to grade, effluent level is 18" below the invert, no indication of past hydraulic failure 12. Cesspools (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 ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts Imp Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments v 42 Jenkins Ln Property Address Dumais Owner Owner's Name information is required for every West Barnstable MA 02668 9/9/20 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): II t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments •� 42 Jenkins Ln Property Address Dumais Owner Owner's Name information is required for every West Barnstable MA 02668 9/9/20 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 14. 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 t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 9/9/2020 Assessing As-Built Cards 0 D t U 0 1 TOWN OF BARNSTABLE LOCATION L.0 1 -5 Te n K 6 n S lc,ne SEWAGE# AA VILLAGE a), &4C-N 5•T«N It, ASSESSOR'S MAP& LOT INSTALLER'S NAME&PHONE NO._T.T JYC SL0I1 �F C N. SEPTIC TANK CAPACITY ! LEACHING FACILITY:(type) (size) l'rG •v NO.OF BEDROOMS RiVATE WELL R PUBLIC WATER BUILDER OR OWNER Cr(e_e._n Ff l0'& 1:)e y c c•!Z P. DATE PERMIT ISSUED--I ,;Z 4/76 DATE COMPLIANCE ISSUED- /k4' VARIANCE GRANTED: Yes No t t ,{{ r I https://www.townofbarnstable.us/Departments/Assessing/Property_Values/HMdisplay.asp?mappar-128004007&seq=1 1/2 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ./ 42 Jenkins Ln Property Address Dumais Owner Owner's Name information is required for every West Barnstable MA 02668 9/9/20 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope iZ Surface water ❑ Check cellar ® Shallow wells Estimated depth to high ground water: >13' 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: NGW 13 1990 permit Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health-explain: 4' seperation per 1990 compliance ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: Site is at 100'msl and adjacent terrain is at 78'msl You must describe how you established the high ground water elevation: In addition to the above a well log in the file shows static water at 68' Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 It Commonwealth of Massachusetts ,F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments t; 42 Jenkins Ln Property Address Dumais Owner Owner's Name information is required for every West Barnstable MA 02668 9/9/20 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6(Checklist)completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 I ' TOWN OF ""ARNSTABLE LOCATION/.® ' 57 n S "/cAng- SEWAGE VILLAGE � c'N 5 1ta,-�l o ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. - j"-' 15760/1 :5 0 lei, 1 SEPTIC TANK CAPACITY f "0 LEACHING FACILITYAtype) %'iti% �� Jar/^,/ % (size) !,D --. NO. OF BEDROOMS RIVATE WELL OR PUBLIC WATER BUILDER OR OWNER ('fie I0 e.y c ; DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No ,� , 6 �p�i VJ� �` � � � b_ � - '� � . , .. . tv ►�' � y , � _ 1 � � r � 1, . �j � y 1 5 �r L& < A 4 ov. No.. ... i FES_. jl--, . THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ...........J_6.Wq...............OF.......✓0.ar44*k/ .... Appliru#ion for Disposal Works Tonstrurtioit Frrutit Application is hereby made for a Permit to Construct (X ) or Repair ( ) an Individual Sewage Disposal System at: ... lis..k , 4 ._..moo.}. 9 . s.: .. .... /� Location-Addres*s �T or Lot No. ......................................................... ......_.. .`?Vtc�n�?S`�SJt'.. Owner Address W � Installer Address Type of Building Size Lot....._____'____73------Sq. feet Dwelling—No. of Bedrooms---_ f _________________________Expansion Attic ((�/o) Garbage Grinder (Nle,) �1 '1 Other—T e of Building No. of persons............................ Showers a Other—Type g ---------------------------- P ( ) — Cafeteria ( ) dOther fixtures ------------------------------------•--•--------•----.......-----•---------------------- ............................................................. W Design Flow...................................55___gallons per person per day. Total daily flow...............................�✓___a_.®..gallons. WSeptic Tank—Liquid capacity.k .gallons Length- !74.1.. WidthA.`:Ld'_. Diameter....-._.-------- Depth e 6_ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No------UYSR�-...... Diameter.....l.d......... Depth below inlet-----6........... Total leaching area...0.62....sq. ft. Z Other Distribution box (K ) Dosing tank ( ) aPercolation Test Results Performed by..1�Gy�_ ls�r. __l sa 3a,crc................... Date...../Z_+jr?-----_-_-_-__. ,.� Test Pit No. I.....P?t......minutes per inch Depth of Test Pit------L3......... Depth to ground water...... ................. f% Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground w -____ •--•-------•---.. ....-•-•a•-•------•------•--• -----•--•-••-•----------------•----------.......-•....-................. xDescription of Soil....T-?&I...... ._'l..o_TQp_ .5c b ,(�............................... -------------------------- V --•----- ---41 lia L..F1.W....-------••-•-.-----•-------•-- ......At.LYX.......jlkt SON -----------------------•--••--•---•--:----•-•-•--•----•----•-------•-•---••------•-•----••------•-•----------------•-•-----...........------------... ••----•-.......------ . Ux Nature of Repairs or Alterations—Answer when applicable_________________________________________________ _____ .p Ro�302 6 ® _ca --••---•-------------P---- •••-•-•-•--------------•-•--------•----------•--•--•---__-- -•----------.........--- Agreement: 0 The undersigned agrees to install the aforedescribed Individual Sewage Disposal System acc ce with 1212/gf the provisions of iIT?: . 5 of the State Sanitary Code—The undersigned further agrees not to place the system in 0 operation until a Certificate of Compliance has e issued th rd of healt Signed..... ... ......... . ........................... .... -----_--•- Date Application Approved By..... . ---•...-- . . • ------ --------------------------------------•- Date Application Disapproved for the following reason -------------......................................----------•-----------------•---•-•---••---•---------------- Date Permit No.------- �s ...l---------------------- IssuecL..../ _ -•-- � • ------ Date No..' THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............../G.wr1................0 F........ rrrn.�.... .................. . ppliration for 14sp>asaf 10orks Tomitrnrtion Famit Application is hereby made for a Permit to Construct (x) or Repair ( ) an Individual Sewage Disposal System at: L?o r,S".--- ................. .------------.......------.....-•--------- Location•Addres or Lot No W Owner Address Installer Address Type of Building Size Lot...... ......Sq. feet Dwelling—No. of Bedrooms......!.! rc4 a .. .._.....•...............Expansion Attic (416) Garbage Grinder (4/14 Other—Type Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) P4 Other fixtures ........... W Design Flow..................................... _gallons per person er day. Total daily flow................ q.ga lons Ra Septic Tank—Liquid capacity.L gallons Length..�.-�.... Width.4.:'.(�2... Diameter................ Depth_S_:�o._.. Disposal Trench—No..................... Width....._.............. Total Length........... Total leaching area....................sq. ft. Seepage Pit No......9a-_..... Diameter......10......... Depth below inlet.....4........... Total leaching area.... 4'7...sq. ft. z Other Distribution box ( K) Dosing tank ( ) Percolation Test Results Performed by._- c w..........•........ Date...... #?Ikk 1.•............. Test Pit No. 1------A......minutes per inch Depth of Test Pit.......13.......... Depth to ground water......... _..... PLI Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.. ------ 04 •--•••••----------------------•---..........-•------•----•••••----•-......--•---•---...._.__................................... ODescription of Soil.....-tom----1.34-....-O--1- myt Su Anitat.I..--•--------------------------•---------•--------------------- x --••-------••-•-•-•.............. .. STEPHEN 'j V --••--•---•--•----••-•-•--•---•----•------••---------------•I�---I-'a�--.1.YYIIc+:_Q•.., �.!'t�.0....�s ._FIt:�Q --- -� -----•- •-- • - .. ........ X ALLYN W ••-•-•-•---•-------------------------------••---------•------------•--••.........----•------•----••--•••---...------•---••--•--...-••-•------••---------•-•-•------- x 8a -----WIL909'------� U Nature of Repairs or Alterations—Answer when applicable........................................................... . ..� ;F ivo:302M IST Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in > i yfef the provisions of TLIT111 5 of the State Sanitar Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has a issued tVard of heal . Signed.........._ l` (� �! r•-•----------•-•-- ---•-----•--Date•••••--------- Application Approved By......-• ---•-•... ._.... /. ..-----•----•••••.----....--••--......•- Date Application Disapproved for the following reason -------------------•--.•............---------------------------------------------------......................... .................. Date Permit No.......... . ........ ..................... Issued....1.. Da -• - THE COMMONWEALTH OF MASSACHUSETTS Tf ...... FR..466`1..w t',1 L...................... Trrtifiratr of TnmliliFanrr THI IS TO CER F , That the Individual Sewage Disposal System constructed',( ) or Repaired ( ) by.. .. -.---•------------ --------------- •. ------- has been installed in accordance with the provisions of TI 5 of he ate Sanitary o e a /d ,-.,r bed in the application for Disposal Works Construction Permit No......... ""_ . ...... dated---.1- _ - . . .................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL F NCTION SATISFACTORY. DATE........... ......9�4�... 19- 40>.•............................... Inspect _. .... ...._.. ............... THE COMMONWEALTH OF MASSACHUSETTS OARD OF HE LT' /� ........... ro ..l!.1�:...O F.... 2. .. ./....J._►. ` No.... .4,/•.... . FEE.... Rapno al rkp Tnnotrnrtilan "permit Permission is hereby granted. ��---c '""------•-------•----•-••------ ......................................................... to Construct or Repair ( a} dinvjidual Sewa nDi po al Syst J ..... J...... .. s ................. as shown on the application for Disposal Works Construction Permit tNo_ �. ODated..___. �,�1. ..� ......-- .................................... .----------------------------------•-•••---•••-•-•-. 1 DATE...................... ..._°�r�. ••-----------------------•--•--- Board of Health FORM 1255 HOBBS & WARREN, INC., PUBLISHERS o:---N -- Y Fee--g -1- t . BOARD OF HEALTH TOWN OF BARNSTABLE Applitation-*rVell Con5truct ion Permit Application is hereby made for a permit to Construct (-*"), Alter ( ), or Repair ( )an individual Well at: -M ------------------ f_e-l-------------- Location — Address Assessors Map and Parcel ------------------------------ �- �X_�La er_" %�'!l�p -0�6 3a ---------- - // nOwner Address n�y "Ct�n7ae��as e c l_IF✓lr/',�,�nC----- - - -- -- --`--� ----------- Installer — D'ller Address Type of Building Dwelling-_Au C - Other - Type of Building-------------— -- - No. of Persons----—--------------------------------------------- Typeof Well- Y-d----8J t;-------- --------------------------------- Capacity----------------------------------------------------------------------------------- Purpose of Well- Q!ue3r« a e�------------------------------ 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 off �ompliance has been issued by the Board of Health. GG ° . of 1 J /`l� Signed - S - - - 11 1-— ---------- date Application Approved By------�/' date Application Disapproved for the following reasons:---------------------------------------------------------------------------_-_______—_______________-_ ------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------- - date Q-------- ------------------ Issued------------------------- --------- Permit No.-------- ---------- - ------------------------------------ date BOARD OF HEALTH TOWN OF BARNSTAB LE Certificate Of Compliance THIS IS TO CERTIFY, That the Individual Well Constructed), Altered ( ), or Repaired ( ) 0-1 .. --' ------------------------------- --- ------------------------------------ - Installer lei at— —- - - -- ,�"'_'-- ---------------— � ---------------------------- has been installed in accordance wit�ovisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit Now_"'�&: �,----Dated---------------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE-- -- -- ----------------------------------------------------- Inspector----------------------------------------------------------------------------- t� No. r-�- Fee-- ==- --------- BOARD OF HEALTH TOWN OF BARNSTABLE Application-*rVeri Con5tructioupermit Application is hereby made for a permit to Construct (^ �), Alter ( ), or Repair ( )an individual Well at: 1 o"1.S_ 5�.�lf i,vC—�.J ,Cic,n,s U{� M`1— — — 1'�h--�'&y `G_c 7�,/o!.,✓h5'Y�/ /�G a��1_—11 Location — Address Assessors Map and Parcel _ ��{_C c J,1�1�/ IJP J<'lO/�tPn� t;,r P �0•13o�rS/c CPiv�[rU�/�� tt o��3.� Owner Address Installer — DAller Address Type of Building Dwelling- OUS e------------------------------------------- Other - Type of Building---------------------------------- No. of Type of*Well— y- P�C_----------- ----------------— — - - --- YP � ------------------------------- Capacity of Well-t_2Qru------ � � --- --------------- 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.. Signed---------=-------- _�-------- date Application Approved By-- *-^—^^-=-=------------ t =) =�©- C) date , Application Disapproved for the following reasons:------------------------ — - -- ----=---- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- date PermitNo. -- - -= "------- --------------------- Issued---------------------------------------------- — -- --------------- date BOARD OF HEALTH TOWN OF BARNSTABLE (Certificate ®f Compliance THIS IS TO CERTIFY, That the Individual Well Constructed,(S*—,), Altered ( ), or Repaired ( ) Installer at-----------` — — —— "" ��= —'_1!/ ------------------- fir�.r�J? YRA l��C/C_ =—----------------------- 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 w--1-6-- -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 Yell Con!5truct ion Permit No.E / Y3 ~ Fee— ---- - Permission is hereby granted --------C ------—----------------------------------------------------- f to Construct (5-6, Alter ( ),\or Repair ( ) an Individual Well at: - - Street as shown on the application for a Well Construction Permit No.---------------------------------------------------------------------------------------- Dated------------------—------------------------------—----------—---------------- ------------------------------------ oard of Health DATE -------- Department of Environmental Management/Division of Water Resources WATER WELL COMPLETION REPORT WELL LOCATION GEOGRAPHIC DESCRIPTION Address 21��TS• fC^�l��nS LN w ®S E W of /J (feet) (circle) City/Town �?' l S<Ge r1/� //Ka •7- 3" K 4'V Well owner�r ,J/B/r�r +r�pue(oPna��/ Gor� (road) Addresss, sw N S 0 W. Of GGN/e�t�r`�P IWO- D 0 +). (mi.in tenths! (circle) Board of Health permit: yes [r]' no ❑ intersect. w/ 14—oad/'G�� WELL USE 14 'WELL DATA Domestic ®Public❑ Industrial ❑ Total well depth Id O ft. Monitoring❑ Other Depth to bedrock ft. + Water-bearing rock/unconsolidated material: Method drilled lfo*u/Y //� Date drilled ZS/90 p Uescri tlon A4 e j LoolSe .54 CASING Water-bearing zones: Type. Si j yo 1) From To Length//6 ft. Dia(.I.D.)_ r 2) From To in.. 3) From To Length into bedrock ft. Gravel pack well: ilia. Protective well seal: r1 Screen: ilia. Grout_ Other Slot#�length�from /6 to�J� PUMP TEST � Static water level below land surface ft. Date ye hD Drawdown 0Z ft. after pumping"hr. min.at /s gpin How measured Recovery J� ft. after_/'hr. min: y f r LOG of FORMATIONS COMMENTS Materials From To /tc Driller Z'AJr e Mass. Re istraUon 4t 60 G�o�� / D 68 g Firm 40A cam 614,V GP' oo ' Address ' Med Coorvt sur.�l /Q7; /JO' City/Town./�1G1�jlGa /+�A e)C) Signature of'sDpervismg registered well driller Please print firmly BOARD OF,KAIr, H C.OPY... .. -.ate--^-�!r _�— _ .,w ^vw, ...,r:,r.,x. ., ... ..o ,�'r ' ,..h�-,..y:.,._" .ia��,�'r.4u^.,7r_: t*'a'�''.. ��,.1.1,rrr;t,�,„,,,;,�..Z,✓•.... M Log Number: Bottle # BC586 ' Date: Jan. 19, 1990 �OF B�l1pM sa BARNSTABLE COUNTY HEALTH .AND ENVIRONMENTAL DEPARTMENT SUPERIOR COURT HOUSE p BARNSTABLE, MASSACHUSETTS 02630 J � e AlASe' DRINKING WATER LABORATORY ANALYSIS PHONE:362-2511 ' xt.337 Client: Greenbrier Development Collector: Sean O'Brien Mailing Address: Route 28 Affiliation: other Centerville. IA 02632 Time & Date of Collection: 1/17/90 3:50 p.m. Telephone: Type of Supply: well Sample Location: Lot 5 Pioneer Path Well Depth: 120' Hest Barnstable, MA Date of Analysis: 1/17/90 4:25 p.m. PARAMETER SAMPLE RESULT RECOMMENDED LIMITS Total Coliform Bacteria/100 ml 0 0 pH 5.8 Conductivity (micromhos/cm) 90 500.0 Iron ( m) 0.1 0.3 Nitrate-Nitro en ( m) <.1 10.0 Sodium ( m) 10 20.0 I , r. Water sample meets the recommended limits for drinking of all above tested parameters. II . Based only on results of the parameters tested for this sample, the water is suitable for drinking but*may present the problems checked below: A. Water sample has higher than average levels of Nitrate. Future monitoring is recommended (2-3 times per year) to establish any upward trends. B. The low pH of the water may shorten the useful life of the house's plumbing. C. Water may present aesthetic problems (taste, odor, staining) due to D. Water sample has high levels of sodium. Persons on low sodium diets should consult their doctor. III. Due to one or more of the reasons checked below, this water ,sample is unfit for human consumption: A. High Bacteria B. High Nitrates REMARKS: CC: ;arn:.tabi e Goard of Health 117185 Laboratory Director L_ L Explanation of Test Results Total Coliform Bacteria Coliform bacteria are an indicator of the sanitary quality of a water supply. Water'supplies may become contaminated from malfunctioning septic systems, cesspools and surface runoff. A total Coliform count of zero indicates that your water supply is safe and approved for human consumption. A total Coliform count of greater than zero is most often the result of accidental contamination of the sample bottle through improper sampling methods. For this reason, it would be advisable to retest any well,water that is not approved. pH pH is the measure of acidity oralkalinityof the water. On the pH scale,the number 7 is neutral.less than 7 is acidic and more than 7 is alkaline. The pH of water on Cape Cod tends to be acidic in the range of 5.0 to 6.5. Conductivity Conductivity is a measure of the dissolved salts in solution. Amounts in excess of 500 micromhos/cm are generally considered unacceptable and may have a laxative effect upon users. Iron The presence of iron in water in concentration of .3 ppm or greater may: give the water a bittersweet astringent taste. cause an unpleasant odor. often gives the water a brownish color and cause staining of laundry and porcelain. The average concentration of iron in Cape Cod's water is .2 - .6 ppm. Although the presence of iron in water may cause the problems listed above, it is not considered deleterious to health. Iron may be removed by use of an iron removal system. Nitrate-nitrogen The Massachusetts Drinking Water Regulations have set a maximum contaminant level for nitrates at 10 ppm. Excessive concentrations may cause methemoglohinemia (an infant disease) and have been suggested to form potentially carcinogenic nitrosamines. Contamination sources include fertilizers. cesspools and industrial wastes. Copper Due to the acidic nature of the water on Cape Cod, copper tends to leach from pipes. This normally does not present a health hazard; however. concentrations in excess of 1.0 ppm may cause a metallic taste and/or a bluish-green stain on porcelain fixtures. Sodium A concentration of sodium over 20 ppm is only of concern to people who are on a low sodium diet. If the water supply has more than 20 ppm sodium, it is up to the people who are on such a diet to find another source of drinking water or contact their doctor to determine if consuming the water is advisable. Concentrations exceeding 50 ppm ind'cate that there may be ocean water or road salt runoff water getting into the well. BARNSTABLE COUNTY HEALTH AND ENV7_RONMENTAL DEPARTMENT LABORATORY REPORT i � VOLATILE ORGANIC CHEMICAL ANALYTICAL RESULTS Client : GREENBRIER DEVELOPMENT Collection Date : 01/17/90 Mailing Address : P . 0 BOX 510 Date of Analysis : 01/24/90 ROUTE 28 Type of Supply: WELL CENTERVILLE, MA 02632 Well Depth (FT) : 120 Telephone : 771-'3616 Sample Location :LOT 5 PIONEER PATH, WEST LAT. (DDMMSS) : Not Given BARNSTABLE LONG . (DDMMSS) : Not Given Collector: SEAN O' BRIEN Map/Parcel : Affiliation: BCHED Analytical Method.: 502 . 1=1 , 502 . 2=2 , 503 . 1=3 , 504= 4 , 601/602=5 r -------------------------------- ------------------------------------ Contaminants Anal . Result MCL Detection Meth . ug/l ug/1 Limits (ug/1) Chloroform 1 13 . 0 0 . 5 Only those compounds listed above were detected . Attached is a list of chemicals which the method is capable of detecting. NOTE: Contaminant levels equal to or exceeding the Detection Limits are reported. Contaminant levels below the indicated Detection Limits are reported as -ND- MCL means Maximum Contaminant Level for EPA-regulated rompounds . (ug/1 = micrograms per liter = Parts Per Billion) The Environmental Protection Agency has set Maximum Contaminant Levels (MCL) for the following compounds . This sample compares as follows : COMPOUND MCL (in PPB) Benzene 5 . 0 * level not exceeded * Carbon Tetrachloride 5 . 0 * level not exceeded * 1 , 2-Dichloroethane 5. 0 * level not exceeded * 1 , 1-Di_chloroethene 7 . 0 * level not exceeded * 1 , 4-Di_chlorebenzene 75 * level not exceeded * 1 , 1 , 1-Trichloroethane 200 * level not exceeded * Trichloroethene 5 . 0 * level not exceeded * Vinyl Chloride 2 . 0 * level not exceeded Comments or sdditiontil co ipoliildh found ; "IAO .g '0 + Bernard E. Bartels , Ph. Labo �itohy Director. BA RNSTABLE COUNTY HEALTH AND ENVIRONMENTAL DEPARTMENT LABORATORY REPORT VOLATILE ORGANIC CHEMICAL ANALYTICAL RESULTS Client: GREENBRIER DEVELOPMENT Collection Date: 01/17/90 Mailing Address:P. 0 BOX 510 Date of Analysis :01/24/90 ROUTE 28 Type of Supply: WELL CENTERVILLE, MA 02632 Well Depth (FT) : 120 Telephone: 77 - Sample Location• OT 5 PIONEER LAT. (DDMMSS) : Not Given NSTABLE LONG. (DDMMSS) : Not Given Collector: SEAN O' N Map/Parcel : Affiliation: BCHED Analytical Method: 502 . 1=1 , 502 . 2=2 , 503 . 1=3 , 504= 4, 601/602=5 -------------------------------- ------------------------------------ Contaminants Anal . Result MCL Detection Meth. ug/l ug/l Limits (ug/1) ------------------------------- ------------------------------------ Chloroform 1 13 . 0 0 . 5 I Only those compounds listed above were detected. Attached is a list of chemicals which the method is capable of detecting. NOTE: Contaminant levels equal to or exceeding the Detection Limits are reported. Contaminant levels below the indicated Detection Limits are reported as -ND- MCL means Maximum Contaminant Level for EPA-regulated compounds . (ug/1 = micrograms per liter = Parts Per Billion) The Environmental Protection Agency has set Maximum Contaminant Levels (MCL) for the following compounds . This sample compares as follows : COMPOUND MCL (in PPB) Benzene 5 .0 * level not exceeded * Carbon Tetrachloride 5. 0 * level not exceeded * 1 , 2-Dichloroethane 5. 0 * level not exceeded * 1 , 1-Dichloroethene 7 . 0 * level not exceeded * 1 , 4-Dichlorobenzene 75 * level not exceeded * 1 , 1 , 1-Trichloroethane 200 * level not exceeded * Trichloroethene 5. 0 * level not exceeded * Vinyl Chloride 2 . 0 * level not exceeded * Comments or additiondl Q®IfiP®Hfid§ f®iAfld: + Bernard E. Bartels , Ph. Labo tory Director I Log Number: Bottle # BC586 Date., , Jan. 19, 1990 BAP. sa BARNSTABLE COUNTY HEALTH AND ENVIRONMENTAL DEPARTMENT SUPERIOR COURT HOUSE p BARNSTABLE, MASSACHUSETTS 02630 J 0 0 A1As5 DRINKING WATER LABORATORY ANALYSIS PHONE:362-2511 '_Ext.337 Client: Greenbrier Development Collector: Sean O'Brien Mailing Address Route 28 Affiliation: _ other Centerville, MA 02632 Time& Date of Collection.: 1/17/90 3:50 p.m. Telephone: Type of Supply: well Sample Location: Lot 5 Pioneer Path Well Depth: 120' West Barnstable. MA Date of Analysis: 1/17/90 4:25 p.m. PARAMETER SAMPLE RESULT RECOMMENDED LIMITS Total Coliform Bacteria/100 ml 0 0 pH 5.8 Conductivity (micromhos/cm) . 90 500.0 Iron ( m) 0.1 0.3 Nitrate-Nitrogen ( m) <.1 10.0 Sodium m) 10 20.0 I . X Water sample meets the recommended limits for drinking of all above tested parameters. II . Based only on results of the parameters tested for this sample, the water is suitable for drinking but may present the problems checked below: A. Water sample has higher than average levels of Nitrate. Future monitoring is recommended (2-3 times per year) to establish any upward trends. B. The low pH of the water may shorten the useful life of the house's plumbing. C. Water may present aesthetic problems (taste, odor, staining) due to D. Water sample has high levels of sodium. Persons on low sodium diets should consult their doctor. III. Due to one or more of the reasons checked below, this water sample is unfit for human consumption: A•. High Bacteria B. High Nitrates REMARKS: Barnstable County Health and Enviponmental Department shall not endorse any statements, interpretations or conclusions made 6 else concerning these results wit y anyone t written consent. CC: Barnstable Board of Health CC: 1/7/85 L ratory Vfector .. ,� Explanation of Test Results Total Coliform Bacteria 'W Coliform bacteria are an indicator of the sanitary quality of a water supply. Water'supplies may become contaminated from malfunctioning septic systems, cesspools and surface runoff. A total coliform count of zero indicates that your water.supply is safe and approved for human consumption. A total coliform count of greater than zero is most often the result of accidental contamination of the sample bottle through improper sampling methods. For this reason. it would be advisable to retest anv•wcll water that is not approved. pH pH is the measure of acidity,or alkalineyof the water:On the pH scale, the number 7 is neutral.less than 7 is acidic and more than 7 is alkaline. The pH of water on`Cape Cod tends to be acidic in the range of 5.0 to 6.5. Conductivity Conductivity is a measure of the dissolved salts in solution. Amounts in excess of 500 micromhos/cm are generally considered unacceptable and may have'a laxative effect upon users. Iron , The presence of iron in water in concentration of .3 ppm or greater may: give the water a bittersweet astringent taste, cause an unpleasant odor, often gives the water a brownish color and cause staining of laundry and porcelain. The average concentration of iron in Cape Cod's water is .2 - .6 ppm. Although the presence of iron in water may cause the problems listed above, it is not considered deleterious to health. Iron may be' removed by use of an iron removal system. Nitrate-nitrogen The Massachusetts Drinking Water•Regulations.have set a maximum contaminant level for nitrates at 10 ppm. Excessive concentrations may cause methemoglobinemia (an infant disease) and have.been suggested to form potentially carcinogenic nitrosamines. Contamination sources include fertilizers.-cesspools and industrial wastes. Copper Due to the acidic nature of the water on,Cape_Cod, copper tends to leach from pipes: This normally does not present a health hazard; however. concentrations in excess of I.0 ppm may cause a metallic taste and/or a bluish-green stain on porcelain fixtures. Sodium A.concentration of sodium over 20 ppm is only of concern to,people who are on a low sodium diet. If the water supply has more than 20 ppm sodium, it is up to the people who are on such a diet to find another source of drinking water or contact their doctor to determine if consuming the water is advisable. Concentrations exceeding 50 ppm indicate that there may be ocean water or road salt runoff water getting into the well. t u A • S 0 F NOTES: .� INTERCHANGE - R D Jt 5 E L B 20 MINIMUM OR AS INDICATED ON PLAN 1. AL WORKMANSHIP AND MATERIALS SHALL-CONFORM TO D. .E. T A L LE.Q. BARNS E _W. N , R TA LE L TITLE 5 THE TOWN OF _-.�- ---� RULES AND L 0 S . .�. _.WAY i I WHITE .BIRCH o MIN. REGULATIONS FOR THE .SUBSURFACE .:DISPOSAL OF .SEWAGE ,.- , , AND THE REQUIREMENTS 0 THIS PLAN. f o MINIMUM � >PIONEER PATH <: 1 I� UM N UNITS L BE BROUGHT 0 ,;,: ^ ,.fo t1. ,lsa/dc� Grt�l 2. ALL COVERS TO SANITARY NI S SHALL T T , LOCUS ACKFl T.O. N A B LL WITH FOU 0 ?ION I i 8 MIN. ,A � 6i► ,� � WITHIN 12 OF FINISHED 'GRADE. _ G7 CLEAN W I 0 0 ON UNl S. E D ` 0 BRING COVERS-T0 GRAD D 3. ALL MASONRY T US I T C E MASONRY D ASO RY d SION :_.SHALL BE . MORTARED IN PLACE R/l'E - 3 TE 4 ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE PITCH 4 SCH. 40 PVC PI PE PE F WITHSTANDING H 0 IL G THEY ARE UNDER 0� 4 P� FT. 0 WITHSTA DIN 1 OADIN UNLESS T E R / MIN. PITCH.1 f8 .PER a , 3 MIN. 0LOADING WITHIN 10 FT. OF bRIVES OR PARKING. AREAS H 2 Y LAYER of 0 :.FLOW LINE P Q _ R , _ 1 8 1 2 _ SHALL BE USED UNDER OR WITHIN 10 FT. OF DRIVES OR to � / / H LL ER ~u� r WASHED STONE (t* PARKING. E 5 d F LD _ 0 2 0 b5o 1C.A f- 5. ' CAST IN...PLACE CONCRETE TEES ARE SI�o.CiF. . LLY DISAPPROVED. 2 MIN. :.. , _ LEVEL � , 4 0 0 + A.(e 6 1 -A UtR D. 65.3 LIQUID 4.8 SANITARY TY S WHERE INDICATED RE 'REQ E � 3 4' — 1 1 Y LEVEL \9 WASHED STONE 5 .O �8 6 N F HALL ENTER LEACH -PIT 11 DISTRIBUTION EFFLUENT PIPING FROM `DIiSTRIBUTION BOX S , LOCATION MAP y . BOX .. THROUGH SIDEWALL OR TOP ONLY. ENTRANCE THROUGH"MASONRY .. _ I0 NO E .AL 'OWED k , I EXTENS N WILL T � L / 7, 0 : TER IN TION BEEN MADE 0 :COMPLIANCE WIT ED �. cntLaN SEPTIC 'TANK 2 � z N DE M A HAS ASH DE RESTRICTIONS `0 NN . , OWNER/APPLICANT SH R ZO G REGULATIONS. , ALL'` 1 l.o T/ 7 OBTAIN SUCH DETERMINATION FROM THE APPROPRIATE AUTHORITY , - SEWAGE / _ DISPOSAL SYSTEM PROFILE i T?�s HOLE, SOTTO r_E,_ M OF TEST HOLE // t� NOT o c — �� 8. HORIZONTAL` AND VERTICAL CONTROL :SEE LEVY ELDREDGE N T SCALE f OR USGS PROBABLE HIGH WATER_LEVEL :WAGNER FIELD NOTEBOOK& L - r _ DESIGN CNCALCULATIONS . 147.23 CURRENT' ZONING INTERPRETATION. D S F., �o . \ MIN. FRONT SETBACK 3 . - FEET � rr NUMBER OF BEDROOMS - 70 r MIN. SIDE SETBACK / FEET . GARBAGE DISPOSAL UNIT .�Q_ TOTAL ESTIMATED FLOW J \ \ ♦ \ \ MIN. REAR SETBACK FEET ( 110 GAL./BR./DAY X_ -? BR.) 330 GAL DAY r , \ \ ♦ \ REQUIRED SEPTIC TANK CAPACITY 415 GAL , \ \ \ \ ACTUAL SIZE OF SEPTIC TANK 1,000GAL. 47 773 s .ft.±. - , . _ .. � LEACHING AREA REQUIREMENTS � _ � �. \ \ - Q \If 1. IN SIDEWALL AREA —.GAL. S.F. 0 / \ BOTTOM AREA GAL. S.F. _ PERCOLATION SOIL TEST _ ♦ \ � LEACHING CAPACITY BOTTOM + SIDEWALL 1 � , 1 _ 60 -r DATE OF SOIL ...TEST�`za ,. __. 27T( I j2) � )(2.5) +7T( �C� �2) (1 0) ....,..rl�GAL -NE`~ �! .ram RESERVE LEACHING . CAPACITY .. \ \ SAME PERCOLATION RATE MIN./INCH \ ., v _ OBSERVATION HOLE ,�_ _.��., OBSERVATION NOL . 1 B ERVATIQN H E 2 f � LaT � — EASE�i� T 70 ELEV. i N , r 1 ,— _ .. 0 00 0.00 �o _ V 50 _ � � . `BREAKOUT CALCULATION. � � _ a / c + t Z i / � \ l 1 r " t / LEGEND:__ r / r \ t/ -I - .. ,� . 1 r r 9 50 SPOT VA ✓ , / 86 EXISTINGTEL ION 00 0E T X l / , p EXISTING CONTOUR. . 00 , . .- o W a � y �� frr- r- , c / / 13 � FINAL 'SPOT ELEVATION : 00.0 r - l T- i / / r / N A r f � I L CONTOUR R v v � � _ .e WATER V.N A RAT 'ELEV. WATER AT 'ELEV. ��.,� : r l SOIL TEST PIT LOCATION , / 86 TOWN WATER V11 VII .. l y SEPTIC TANK 1 I.. r DISTRIBUTION BOX WA' TER LEVEL ADJUSTMENT. N r r � t PRIMARY LEACHING PIT O _ ..,! , t _.� � r / LEACHING PI R / , 1 ,. , , , , RESERVE LEA HI T , 1 cl _ / 1 / WATER LEVEL 911, 68. J TEST DATE 4 t un , INDEX WELL _ o: WATER LEVE L RANGE ZONE INITIAL ISSUE SAV4 80 DEPTH TO WATER LEVEL FOR INDEX WELL DATE DESCRIPTION BY FOR THIS MONTH .►. _-- __ SITE .PLAN & SEPTIC DESIGN t > -- _.. ` WATER LEVEL ADJUSTMENT 70 - -- - , DEPTH TO HIGH WATER LOT JENKINS LANE 1._ IN _ 4 , 3 _ 0 L 7 5+0 BARNSTABLE MASSACHUSETTS Oo 4+ FOR _ . OF E o � 5 s C sTEPHEN G GREENBRIER DEVELOPMENT CO. INC. 0 ALtYN S � JENKIN / LANE Cs ;WILSON t� --- _- ,APPROVED: 0____. .___.- BOARD OF HEALTH Nu.3ozis ._ SCALE. 1 40 JOB N0. - .� 1120 1120 5 ISM Fs �o SITE PLAN E A � —DATE AGENT LEVY, ELDREDGE 8c WAGNER ASSOCIATES INC. . Glb! i2 2� S' ERS I�ND SORVEI'ORS 889 WEST MAIN E STR ET CENTERVILLE MA 02632