The URL can be used to link to this page

Home My WebLink About0080 LOTHROP'S LANE - Health 80 LOTHRUPS LANE, W. BARNSTABLE A = " I i Commonwealth of Massachusetts l W Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ° M 80 Lothrop's Lane Property Address Chris Rezendes Owner Owner's Name information is required for W Barnstable Ma. 02668 11/23/2010 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: A. General Information When filling out forms on the v4, Do computer,use 1. Inspector: only the tab key to move your Robert Paolini cursor-do not Name of Inspector use the return key. Capewide Enterprises,LLC. Company Name 416:1 P.O.Box 763 Company Address Centerville Ma. 02632 le1°D City/Town State Zip Code (508)428-4028 S14454 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 11/23/2010 Inspect s ign re 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. /W t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sew a Disposal System-Page 1 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 80 Lothrop's Lane Property Address Chris Rezendes Owner Owner's Name information is required for W Barnstable Ma. 02668 11/23/2010 every page. City/Town 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: The septic system is in proper working order at the present time. 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): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 80 Lothrop's Lane Property Address Chris Rezendes Owner Owner's Name information is required for W Barnstable Ma. 02668 11/23/2010 every 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 ❑ 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): 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-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 80 Lothrop's Lane Property Address Chris Rezendes Owner Owner's Name information is required for W Barnstable Ma. 02668 11/23/2010 every page. City/Town 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 aseptic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria 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: 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 Y2 day flow t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 80 Lothrop's Lane Property Address Chris Rezendes Owner Owner's Name information is required for W Barnstable Ma. 02668 11/23/2010 every page. City/Town 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 m 9 9 q pp 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-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17. Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ° M 80 Lothrop's Lane Property Address Chris Rezendes Owner Owner's Name information is required for W Barnstable Ma. 02668 11/23/2010 every 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? ® ❑ 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. ❑ ® 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): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments o° 80 Lothrop's Lane Property Address Chris Rezendes Owner Owner's Name information is required for W Barnstable Ma. 02668 11/23/2010 every page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: unknown 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 Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage d Well Water 9 ( Y 9 (gP ))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 11/23/2010 Date 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 Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 80 Lothrop's Lane Property Address Chris Rezendes Owner Owner's Name information is required for W Barnstable Ma. 02668 11/23/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: 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 ❑ 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): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ° 80 Lothrop's Lane Property Address Chris Rezendes Owner Owner's Name information is required for W Barnstable Ma. 02668 11/23/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: Were sewage odors detected when arriving at the site? ❑ Yes ❑ No Building Sewer(locate on site plan): Depth below grade: 2.5 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.): Joints appear tight.No evidence of Ieakage.System vented through the house vents. Septic Tank(locate on site plan): 2' 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: 1500 Sludge depth: 5" t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of.Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° M 80 Lothrop's Lane Property Address Chris Rezendes Owner Owner's Name information is required for W Barnstable Ma. 02668 11/23/2010 every page. City/Town 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 27" Scum thickness 3 11 Distance from top of scum to top of outlet tee or baffle 5" Distance from bottom of scum to bottom of outlet tee or baffle 11" 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.): pump tank every two years.lnlet and outlet tees are in place.No evidence of Ieakage.Tank appears structurally sound. 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 t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 80 Lothrop's Lane Property Address Chris Rezendes Owner Owner's Name information is required for W Barnstable Ma. 02668 11/23/2010 every page. City/Town 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.): 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 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 t5ins-09/08 Title 5 Official Inspection Form: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 80 Lothrop's Lane Property Address Chris Rezendes Owner Owner's Name information is required for W Barnstable Ma. 02668 11/23/2010 every page. City/Town 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 No 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.): Box is Ievel.Box has two outlet Iaterals.No evidence of solids cagyover.No evidence of leakage. 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.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts W Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ° M 80 Lothro 's Lane Property Address Chris Rezendes Owner Owner's Name information is required for W Barnstable Ma. 02668 11/23/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 2 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Sandy dry soil.No signs of hydraulic failure.Pit#1 was dry at time of inspection.Pit#2 water level was 3' below invert. 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 t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 80 Lothrop's Lane Property Address Chris Rezendes Owner Owner's Name information is required for W Barnstable Ma. 02668 11/23/2010 every page. City/Town 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.): 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.): i t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Map Page 1 of 2 Town of Barnstable Geographic Information System Parcel Viewer Custom Map Abutters Map Size ® ❑ E] Zoom Out J J�In y11 K. R • -i '� boa. 5�0 • tr f u" M ,t i 0 20 Feet Set Scale 1" = 20 I Aerial Photos I MAP DISCLAIMER r �„ ti+7nnr._,)nln Tn... n+ ri.hf. Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 80 Lothrop's Lane Property Address Chris Rezendes Owner Owner's Name information is required for W Barnstable Ma. 02668 11/23/2010 every page. City/Town 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: Bottom of LP 100'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: Date ❑ Observed site (abutting property/observat'ion hole within 150 feet of SAS) ® Checked with local Board of Health -explain: As-Built ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: USED:USGS Observation Well Data.USED:Technical Bulletin 92-0001 annual ranges of groundwater elevations. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17. Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 80 Lothrop's Lane Property Address Chris Rezendes Owner Owner's Name information is required for W Barnstable Ma. 02668 11/23/2010 every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist E Inspection Summary: A, B, C, D, or E checked E Inspection Summary D (System Failure Criteria Applicable to All Systems) completed E System Information—Estimated depth to high groundwater E Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 ro�Y: Page: CERTIFICATE OF ANALYSIS Barnst UTj Ealth Laboratory KePF"U d. :D2003 Report Prepared For: Christopher Rezendes $EP 0 5 2003 Order Number: G0322435 107 Capes Trail TOWN OF BARNS?P West Barnstable, MA 02668 HEALTH DEPT Laboratory ID#: 0322435-01 Description: Water-Drinking Water y Sample#: 22435 Sampling Location: 80 Lothrops Lane,West Barnstable Collected 8/22/2003 Collected by: C.R. Received 8/22/2003 Routine ITEM RESULT UNITS MCL Method# Tested LAB:IC Lab Nitrates <0.1 mg/L 10 EPA 300.0 8/25/2003 LAB: Metals Copper <0.1 mg/L 1.3 SM 3111B 8/27/2003 Iron <0,1 mg/L 0.3 SM 311113 8/27/2003 Sodium 13 mg/L 20 SM 311113 8/27/2003 LAB: Microbiology Total Coliform Absent P/A Absent 309 8/22/2003 LAB: Physical Chemistry Conductance 147 umohs/cm EPA 120.1 8/25/2003 pH 7.4 pH-units EPA 150.1 8/25/2003 Note: Water sample meets the recommended limits for drinking water of all above tested parameters. AV Approved By: (Lab Director) Superior Court House, PO.Bog 427, Barnstable, MA 02630 Ph: 508-375-6605 CERTIFICATE OF ANALYSIS �� Page: 1` _P Barnstable County Health Laboratory / Report Prepared For: Report Dated: 11/15/2002 TO�� Thomas,Robert&Karen Order Number: y �027<7q, Robert Thomas 4FAST PMB#122 3821 Route 28 T9elF Marstons Mills, MA 02648 Laboratory ID#: 0218027-01 Description: Water-Drinldng Water Sample#: 18027 Sampling Location: 80 Lothrops Lane,West Barnstable Collected: 11/04/2002 Collected by: Karen Thoma 110-039 Received: 11/04/2002 Routine ITEM RESULT UNITS MCL Method# Tested LAB: IC Lab Nitrates <0.1 mg/L 10 EPA 300.0 11/06/2002 LAB: Metals Copper 0.1 mg/L 1.3 SM 311113 11/12/2002 Iron <0.1 mg/L 0.3 SM 3111B 11/12/2002 Sodium 16 mg/L 20 SM 3111B 11/12/2002 LAB:Microbiology Total Coliform Absent P/A Absent 307 11/04/2002 LAB: Physical Chemistry Conductance 102 umohs/cm EPA 120.1 11/04/2002 pH 6.1 pH-units EPA 150.1 11/04/2002 Note: Water sample meets the recommended limits for drinking Water of all above tested parameters. Approved By: (Lab Director) Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 e I h I COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS John Grad DEPARTMENT OF ENVIRONMENTAL PROTECTION DEP Title V Septic Inspector ONE WINTER STREET BOSTON MA 02108(617)292-3500 P.O.Box 2119 TeaTicket,Ma. (508)564-6813 TRUDY CORE Secretary ARGEO PAUL CELLUCCI DAVID B.STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 80 LOTHRUPS LANE W. BARNSTABLE MAP 110 PAR 030 LOT 16 g Name of Owner ROBERT CINCOTTA Il f 1 Address of Owner: SAME c.0 Date of Inspection: 10/27/99 � NO I/ Name of Inspector:(Please Print)JOHN GRACI 7��oF 19 df. I am a DEP approved system inspector pursuant to Section 15.340 of Tdle 5(310 CMR 15.000) 99 Company Name: n/a Mailing Address: n/a ♦� Telephone Number: n/a 9 L CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of Inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.The system: X Passes The inpectlon Is based on criteria defined In Title V Conditionally Passes code 310 CMR 15.303.My findings are of how the system is _ Needs Further Ev ation By the Local Approving Authority performing at the time of the Inspection.My Inspection does _ Fails not imply any warrarty or guarantee of the longgevity of the septic system and any of Its components useful life. Inspector's Signature: /submit Date:10/27/99 The System Inspector sh a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(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 Department of Environmental Protection.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. NOTES AND COMMENTS THE SYSTEM PASSES TITLE V INSPECTION.RECOMMEND PUMPING THE SYSTEM EVERY TWO YEARS. revised 9/2/98 Page 1 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 80 LOTHRUPS LANE W.BARNSTABLE MAP 110 PAR 039 LOT 16 Owner: ROBERT CINCOTTA Date of Inspection:10/27199 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 the public health,safety and the environment. 1) 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 ThE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ Cesspool or privy Is within 50 feet of surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a saR marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER.IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE 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 soil absorption system and the SAS is within a Zone I of a public water supply well. _ The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well, The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well Is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,Method used to determine distance W&(approximation not valid). 3) OTHER n1a revised 9/2198 Page 3 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 80 LOTHRUPS LANE W.BARNSTABLE MAP 110 PAR 039 LOT 16 Owner: ROBERT CINCOTTA Date of Inspection:10/27/99 INSPECTION SUMMARY: Check A, B, C, or D: A. SYSTEM PASSES: I have not found any Information which indicates that any of the failure conditions described in 310 CMR 15.303 exist.Any failure criteria not evaluated are indicated below. COMMENTS: System passes Title V Inspection B. SYSTEM CONDITIONALLY PASSES: nla 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. Indicate yes,no,or not determined(Y,N,or ND).Describe basis of determination in all Instances.If"not determined",explain why not. n/a The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the Inspection;or the septic tank,whether or not metal,is cracked,structurally unsound,shows substantial Infiltration or exriltration,or tank failure is imminent.The system will pass inspection If the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. n/a Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken,settled or uneven distribution box.The system will pass inspection If(with approval of the Board of Health). broken pipe(s)are replaced obstruction Is removed distribution box is levelled or replaced n& The system required pumping more than four times a year due to broken or obstructed pipe(s).The system will pass inspection If(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed revised 9/2/98 Page 2 of 11 • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 80 LOTHRUPS LANE W.BARNSTABLE MAP 110 PAR 039 LOT 18 Owner: ROBERT CINCOTTA Date of Inspection:10/27/99 D. SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: 9 I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303.The basis for this determination is identified below.The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No X Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. X Liquid depth in cesspool is less than 6"below Invert or available volume is less than 1/2 day flow, X Required pumping more than 4 times In the last year NOT due to clogged or obstructed pipe(s). Number of times pumped Wa. X Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. X Any portion of a cesspool or privy Is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy Is within a Zone I of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well, X Any portion of a cesspool or privy is less-than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis.If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic omP ounds, ammonia nitrogen and nitrate:rntrogen. X The liquid level in the SAS is over the Invert pipe,is in Hydraulic Failure. E. LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: The following criteria apply to large systems in addition to the criteria above: _ The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply X 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) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.30412).Please consult the local regional office of the Department for further information. C revised 9/2/98 Page 4 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 80 LOTHRUPS LANE W.BARNSTABLE MAP 116 PAR 039 LOT 16 Owner: ROBERT CINCOTTA Date of Inspection:10/27/99 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: Yes No X Pumping information was provided by the owner,occupant,or Board of Health. X None of the system components have been pumped for at least two weeks and-the system has been receiving normal flow rates during that period.Large volumes of water have not been introduced into the system recently or as part of this inspection. X As built plans have been obtained and examined.Note if they are not available with N/A, X The facility or dwelling was Inspected for signs of sewage back-up. X 'The system does not receive non-sanitary or industrial waste flow. X The site was Inspected for signs of breakout, X All system components,excluding the Soil Absorption System,have been located on the site. X The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum.The size and location of the Soil Absorption System on the site has been determined based on: X Existing information,For example,Plan at B4O,H, X Determined In the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) [1 5.302(3)(b)] X The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Subsurface Disposal Systems. revised 9/2/98 Page 5 of 11 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 80 LOTHRUPS LANE W.BARNSTABLE MAP 110 PAR 039 LOT 16 Owner: ROBERT CINCOTTA Date of Inspection:10/27/99 FLOW CONDITIONS RESIDENTIAL: Design flow:AM g.p.d./bedroom Number of bedrooms(design): 4 Number of bedrooms(actual):4 Total DESIGN flow: 40 Number of current residents:2 Garbage grinder(yes or no):YEA Laundry(separate system)(yes or no): NO If yes,separate inspection required Laundry system inspected(yes or no):M Seasonal use(yes or no):M Water meter readings,if available(last two year's usage(gpd): n[a Sump Pump(yes or no): NO Last date of occupancy: Wa COMMERCIAL/INDUSTRIAL Type of establishment: n& Design flow: nfa gpd(Based on 15.203) Basis of design flow: n1a Grease trap present:(yes or no):_p(Q Industrial Waste Holding Tank present:(yes or no): NQ Non-sanitary waste discharged to the Title 5 system:(yes or no):MQ Water meter readings.if available:n& Last date of occupancy: n/a OTHER: (Describe) n& Last date of occupancy: n& GENERAL INFORMATION PUMPING RECORDS and source of information: 1997 System pumped as part of inspection:(yes or no):1MO If yes,volume pumped nhL gallons Reason for pumping: n& TYPE OF SYSTEM X 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) I/A Technology etc.Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other: n& APPROXIMATE AGE of all components,date installed(if known)and source of information: 1996 PERMIT 95-968 Sewage odors detected when arriving at the site:(yes or no): NQ revised 9/2198 Page 6 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 80 LOTHRUPS LANE W.BARNSTABLE MAP 110 PAR 039 LOT 16 Owner: ROBERT CINCOTTA Date of Inspection:10/27/99 BUILDING SEWER: (Locate on site plan) Depth below grade: Z' Material of construction:_ cast iron X 40 PVC _ other(explain) Distance from private water supply well or suction line: TOWN Diameter: n/a Comments: (condition of joints,venting,evidence of leakage,etc.) n/a SEPTIC TANK: X (locate on site plan) ' Depth below grade: J& Material of construction:X concrete_ metal_ Fiberglass _ Polyethylene _ other(explain) n/a If tank is metal,list age Is age confirmed by Certificate of Compliance(Yes/No): No n/a Dimensions:'L'10'6"H 6'7"W 6'8" Sludge depth: r Distance from top of sludge to bottom of outlet tee or baffle: M 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: H How dimensions were determined: AdEASIURM Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage, etc.) SEPTIC TANK AND ALL CQMP0NF TS ARE TR TL A Y SOUND,RECOMMEND PUMPIN SY 1M TWO YEARS- GREASE TRAP: (locate on site plan) Depth below grade: Material of construction:_concrete_ metal_ Fiberglass _ Polyethylene_other(explain) WA Dimensions: n/a Scum thickness: n/a Distance from top of scum to top of outlet tee o-baffle:ji& Distance from bottom of scum to bottom of outlet tee or baffle n(a Date of last pumping: n/a Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage, etc.) n/a revised 9/2/98 Page 7 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 80 LOTHRUPS LANE W.BARNSTABLE MAP 110 PAR 039 LOT 16 Owner: ROBERT CINCOTTA Date of Inspection:10/27199 TIGHT OR HOLDING TANK: NO (Tank must be pumped prior to,or at time of,inspection) (locate on site plan) Depth below grade: nla Material of construction:_ concrete_ metal_ Fiberglass _Polyethylene_ other(explain) nLa Dimensions: nLa Capacity: n[a gallons Design(low: nfa gallons/day Alarm present: NQ Alarm-level`_n(a_ Alarm in working order:Yes_No : MQ Date of'previous pumping: Wa Comments: (condition of inlet tee,condition of alarm and float switches,etc.) Iva DISTRIBUTION BOX: X (locate on site plan) Depth of liquid level above outlet invert:LEVEL WITH BOTTOM OF PIP Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) DISTRIBUTION BOX IS SIRUCTURALLY SO iNn PUMP CHAMBER: NQ (locate on site plan) Pumps in working order:(Yes or No): NQ Alarms in working order(Yes or No): NQ Comments: (note condition of pump chamber,condition of pumps and appurtenances.etc.) nLa revised 9/2198 Page 8 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 80 LOTHRUPS LANE W.BARNSTABLE MAP 110 PAR 039 LOT 16 Owner: ROBERT CINCOTTA Date of Inspection:10/27199 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain: nla Type: E leaching pits,number: 2-1000 GALLON LEACH PIT leaching chambers,number: -n/a leaching galleries,number: -n& leaching trenches,number,length: nLa leaching fields,number,dimensions: n[a overflow cesspool,number: n(a Alternative system: nta Name of Technology: - & Comments: (note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) THE LEACH PIT ALL SOUND AND F INTIONING PROPERLY- CESSPOOLS: _ (locate on site plan) Number and configuration: n& Depth-top of liquid to inlet invert: n& Depth of solids layer: n& Depth of scum layer. n& Dimensions of cesspool: n& Materials of construction: n& Indication of groundwater: n& inflow(cesspool must be pumped as part of inspection)n& Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) PRIVY: _ (locate on site plan) Materials of construction:n& Dimensions:WA, Depth of solids: n/a Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) nfa revised 9/2198 Page 9 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 80 LOTHRUPS LANE W.BARNSTABLE MAP 110 PAR 039 LOT 16 Owner: ROBERT CINCOTTA Date of Inspection:10127/99 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanert reference landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) n/a �ScIG a !� AA 3� AP 1,4 ac S1 IIr s gc 6a O� revised 9/2/98 Page 10 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) ess: 80 LOTHRUPS LANE W.BARNSTABLE MAP 110 PAR 039 LOT 16 ROBERT CINCOTTA spection:10/27/99 .iRCS Report name: n/a Soil Type: nla Typical depth to groundwater: n/a USGS Date website visited: n[a Observation Wells checked: NQ Groundwater depth:Shallow _ Moderate _ Deep _ SITE EXAM _ Slope _ Surface water - _ Check Cellar Shallow wells Estimated Depth to Groundwater 15 Feet Please indicate all the methods used to determine High Groundwater Elevation: _ Obtained from Design Plans on record _ Observed Site(Abutting property,observation hole,basement sump etc.) _ Determined from local conditions _ Checked with local Board of health _ Checked FEMA Maps _ Checked records pumping _ Checked local excavators,installers X Used USGS Data Describe how you established the High Groundwater Elevation.(Must be completed) USGS MAPS AND CHARTS-15++FEET revised 9/2198 Page 11 of 11 TDWN OF BARNSTABLE LOCATION ''�/(p SEWAGE # — � VILLAGE f,-,kplGr�l ,d/ ASSESSOR'S MAP & LOT �- INSTALLER'S NAME & PHONE NO /` T(1/C�V i SEPTIC TANK CAPACITY LEACHING FACILITY:(type) �S ��J (size) NO. OF BEDROOMS PRIVATE WELL R PUBLIC WATER QB:UIA � OR OWNERS'S'�{l'C�'/aC�'''�/ r DATE PERMIT ISSUED: / — DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No A Al ��LU 614 No.q,91 _qS9 QR�Qe��n � FEic THE COMi WEAL7RIMOUSSAC' TTS BO _.�D40� +i9gQ►L TOWN OF r TAB'L 1 Appliratinn for Di- jiytl 109ork �T1 iitrnr#inn jhrmit Application is hereby made for a Permit to ( onst;u Rcpair ( ) an Individual Sewage Di osal System at: a . r ,' ......- ........... (�O s . ri�n�...........••..----- --•---------------------l....•-----. C'� ------ Locatid.-i\ddress or t No. /�!1.r.L..FI..�i�- A-C.e_-tb---------------------------------- ------ ...G �1 ------ �P wnerU Address -1 - -+- a ... avoL,&m.....�T.# ,O,1w." riqK.............................. ---------------------•-------------------------------- -•-••••--_.. Installer Address „q i.! q 0 l S feet Type of Building Size Lot_.h....1-- q. Dwelling— No. of Bedrooms______________y.___.._. _------.--Expansion Attic (1Vd Garbage Grinder W. p`a, Other—Type of Building _._____._.N__l4 No. of persons____________________________ Showers ( ) — Cafeteria ( ) a Q Other fixtures ---._.---.--•-----•--• V/11 W Design Flow............. .>._._...._.___t ._.___._gallons per perso>iaper�ay. Total daily flow..........4d -_---------_---._..dons. WSeptic Tank—Liquid capacity_ .QQ_gallons Length. -___-____._ Widths__ __9__.. Diameter_!Uj'9_-_-_- Depth__. _`�----- x Disposal Trench—No_ __________________ Width_ __.__t1�_ __ Total Length.--_-_�_-__-.�;___ Total leaching area,�_sq. ft. Seepage Pit No..__.. ..... Diameter---Ga..._.de th below inlet__(o..`_�.._.__ Total leaching area_ 4a.7 s ft. P g a- . q Z Other Distribution box ( ) Dosing tank ( ) � Percolation Test Results Performed by------------------ti.0J.1.e_..!4 5.5�?4�-----____•_--.____-__ Date----/.b.- Q-..2 __- C.-g ........ Test Pit No. 1-------X----_-minutes per inch Depth of Test Pit-A). .S...... Depth to ground water--� ---.... Gz, Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........e_/IC:.0_Qj)4'ej) O .....................I--------... l- ------- -------------------------------` ......... f .... j Description of Soil_...Dt_Q.-.a� -----��b c��.l. f--- j .. .r .{...d-,: :. Ctr►c` x .'t to�Q i =tln P v r-±. c' `d..GV L01 �--------------------------•--------------------•-....------------..._... W -•---•--------- ----------------'----�- �� "; ►1 in�---------------------------------------------------------------------------------------------------------------------- UNature of Repairs or Alterations—Answer when applicable----------------------------------------------------------------------------------------------- ----•----------------------------------------•-----....-------------------------•----........._....:....--•---••-------------•---------------------------------•------------------------•--------.------ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Corn ii nce has ee issued he board of health. gne -, -.. - ---------------- ------ Application.Approved BY ------------ -d ....... - --- ----- . - ............... ............. .. --�---- ce Application Disapproved for h following reasonr: .--------------------------------=--------------------- -------- -------------------- ---.._--------- --------- ------------ ----------- -...-------- -----------...----------- ------- .......------------------ ... r� Date h Permit No. ---------- Issued �.�v �� ------------- Dace i K �� Sob � 5os� ...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF - HEALTH TOWN OF BARNSTABLE Appliratiott for Uiti-poottl IV nrl; Tomitrnrtion amit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at, 1 13 o ........- _ ------—------t ro-- _S L n -------------------- ------••----•.......----�. -- s Q .... Locatid" Address r� or t No. J. n,q Owner ............................... ............................................Address.....-•---_............................... Installer Address 3 U 2-_ U Type of Building Size Lot`_ a_�.` ___.r..Sq. feet Dwelling— No. of Bedrooms._............ ......... -----------------Expansion Attic (/)d Garbage Grinder W.) aOther—Type of Building ----------A—/,....... No. of persons._-----`: ................ Showers ( ) — Cafeteria ( ) d Other fixtures .................. ��A------------------------------------------------------------------------ ............................................. W Design Flow-------------5-5.____........�...__....gallons per person per day. Total daily�flow.______.__4.9d__......................gallons. 1:4 Septic Tank—Liquid capacity- _QQ_gallons Length- a._-__.____ Width.�r.__-_— _ Diameter-N0A.____- Depth.`�_'�.._.. Disposal TrenclL`7 -No."_`: -_-_-�...._.. Width--------- �_#__ Total Length-------------------- Total leaching area_„*.?.. sq. ft. � �`Seepage Pit No.--__. l ...'Diameter e th below inlet.-( +-------- ,�, ----- P ••`-0--•--- Total leaching area_,Z.�.7._..sq. ft. Z Other Distribution box( `"')f ^Dosing tank ( ) "-- __. '-' Percolation Test Results Perforine8'by_----------------Q_s�j___........s_SdC,-_-•____-_-_---_ -__ Date----LLB-..Q�,/1._.-.gC�........ Test Pit \o. 1.__.__ minutes per inch Depth of Test Pit._�.a�_ .:.... Depth to ground water__1.!161n�?...... . (s,- Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to,ground water........C..ACU-l.t/Aej) �O Description of Soil.•. Q'Q- �.r. .. To� x c� — ► .... ) rs -- Fi - - --- - --------- ------•- UW ............. ------------- ----------1-0-- ,-, h---S-��------.............--------- ------------------------------.........--------------•------..._......-•-`---...•.....-•-- Nature of Repairs or Alterations—Answer when applicable................................:..........a__-._'..__-_-----_--.._r__....._._.............__. ....................•------...................•-•-•-....._..----•-------•---•-----------.............---...........----------- Agreement- The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Corn h nce hasrbtee issued-by the board of health. igne ._< --------------------- Application, f A roved B .,,.:...:Z�� .------!//j/p+, .._........:r- �. �.. <....... - - //A PP Y ...... . r-- ---- Y Application Disapproved for th following reasons- --------------------------------------------------------------------- .....................:?. ......_................. ...... .............. --- ---- .. ------------------- ----------------------------------- ------ i l Dace Permit No. ..-- -- ....� Issued ------- �v .':1... Dare THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Compliance THIS S� T�Q CE51:, Tht t �;dividual Sewage Disposal System constructed ( ) or Repaired�� . L ,_ ---- -- ------- - - - .. by --- ...... ... In t / at . -..__..... . .. ! -- (i Lh... has been installed in accordance with the provisions of TITLE of The tat vironmental ode as described in the application for Disposal Works Construction Permit No. _.. �'.. ..._................ dated .......-...._.........._...._.............. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT E CON, A AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTOR _. - - Ins ec - .......DATE ..........�. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE ��'')) — No. ......:...... FEE.. Dv.... �t��roo�tl >ur��uno�r . ion �rrntt� Permissio s hereby granted _/FQ0 . ---...1 ------- to Construct ) r Rep )r ( an Indiv >al Sewage Di o al System at No. v VX 61j - as shown on the application for Disposal Works Construction Pe!rmt No: -- ted----------- . ................... Board of Health DATE. ----------------------------------- FORM 36508 HOBBS h WARREN.INC..PUBLISHERS 00 " OS ° Fee"—, BOARD OF HEALTH TOWN[ OF BARNISTABLE Application-for Melt Con.5truction3permit Ap lication is hereby made for a permit to Construct K), Alter ( ), orR�epair ( )an individual Well at: �2w{ 11 --- ---�3, 6_ ��x___1__°& - &_ Location — Address Assessors Ma and Parcel_ Owner Address F�CvI�EZICc�_&//l 6' °' - Installer — Driller Address -- Type of Building Dwelling'Other - Type of Building ---------- ------- No. of Persons---------------------------------------- --- ®liG ----- TYPe of Well------- ---------------- ___—__—_—_ Capacity--------_—____ Purpose of Well-- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until a ertificatq of Compliance has.been issued by the Board of Health. - 9 Signed - date Application Approved By — -i _ --LAG_= = _ � ) ---- date Application Disapproved for the following reasons: —------ --------------------------------- - ---- -- - -- - - - date Permit No. -Jf ----1-- Issued------------ --------date BOARD OF HEALTH TOWN OF BARNlSTABLE Certificate Of Coniphante THIS IS TO CERTIFY, That the Individual Well Constructed (X), Altered ( ), or Repaired by 6,2_1A • Installer at-----, o __ -�-� "/��l� s - E------ ---------------------- 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. �7/—Dated-�- ------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE-------------------------------------- ---------- Inspector-------------==-------------------------- ---- __ No. f -_j.-y Fee------ 1ZVI------- BOARD OF HEALTH r " TOWN - OF BARNSTABLE Appricat ion-*rWell Con0ruct ion Permit Application is hereby made for a permit to Construct , Alter ( ),�r Re air ( )an individual Well at: �1- h -'S_fA �--------------- - ry----� 15 --i-I------------------- Location Address Assessors Ma and Parcel 70 fj 4 Owner Address ----------------------------- Installer — Driller Address Type of Building Dwelling------ ----------------- — Other - Type of Building-------------------------------- No. of Persons------------------------------------------------------ Typeof Well—- - ------------------------------------------- YP — �r--G-- --- - --- Capacity- --- - - Purpose of Well Agreement: The undersigned agrees to install the afored'escribed 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 unl "ertificat of Compliance has been issued by the Board of Health. Signed-Y., ----------------------------------------- --- date Application Approved By-- -- — ` — ------------------- -- ...��e- v datt — d Application Disapproved for the following reasons:-----------------------_-__-----__________________-___—____-____________________________________--- Permit No.---------�---�-�--T---�� ------- Issued------------------------------------------------ -------------ate------------- ----------------- date r d BOARD O��EA,LTH B YTOWN OF / BARNSTABLE Certificate Of Compliance THIS IS TO CERTIFY, That the Individual Well Constructed (X), Altered ( ), or Repaired ( ) = 40/� '-a_"_-------/---- °23 Installer at-- -- Ae--------�`"� �^(eQ p-S — r- /V�� — — -_ /tlS�' 1�1. ----------------------------------------- I - ! 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. 110-1—cf Py--Dated---------------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. i DATE--------------------------------------------- ------- -------------- Inspector-------------------------------------------------------------------------------- BOARD OF HEALTH TOWN OF BARNSTABLE Well Con5truct ion Permit No. __----- ---- --Fee------->-- Permission is hereby granted------— '' �`-`^- -lit/j-�------------------------------------------------------------------------------------ to Construct (W), Alter ( ), or Repair ( ) an Individual Well at: No. --�'� r `�-�---------------40-------��1�� ----------- as shown on the application for a Well Construction Permit No----------—2 - `=! = ------------------------------------ Dated-- --------------------------------- ---------------- ---=--- ------------------------------------ Board of Health DATE---------Ld------- - ly----------------------------------------- ENVIROTECH LABORN 'ORIES, Ii TC. J MA Cert. No.: M-MA 063 449 Rte. 130 . Sandwich, MA 02563 (508) 888-6460 • 1-800-339-6460 FAX(508) 888-6446 CLIENT: Robert Carleton LOCATION: Lot 15 ADDRESS: Lothrops Lane W. Barnstable SAMPLE DATE: 4-27-94 COLLECTED BY: L. Wile DATE RECEIVED: 4-27-94 TIME: SAMPLE ID: 15L JOB #: New well WELL DEPTH: 145' 4" PVC 95 static 15 gal/min. RESULTS OF ANALYSIS: Parameters Units Recommended Result Limit Coliform bacteria/100ml (MF Method) 0 0 pH pH units 6.0-8.5 7.15 Conductance umhos/cm 500 115 Sodium mg/L 28.0 8.5 j Nitrate-N mg/L 10.0 0.05 Iron mg/L 0.3 0.10 Manganese mg/L 0.05 0.007 Hardness mg/L as CaCO3 500 17.9 Sulfate mg/L 250 1.3 Potassium mg/L 20.0 0.7 Alkalinity mg/L 200 14.2 Chloride mg/L 250 15.8 Turbidity NTU 5.0 4.0 Color APC units 15.0 LT 1.0 Volatile Organics EPA 601/602 ug/L see attached None Detected COMMENTS: Yes No WATER IS SUITABLE FOR DRINKING SES F PAIZADffiTERS TE TED xxx Date 2 �' Ron ld J. S ri IT Less Than Laboratory Ohrector a a`f GROUNDWATER ANALYTICAL EPA METHODS 601 and 602 Volatile Organics (GC/PID/ELCO) Field ID: 15L Lab ID: 7545-01 Project: Carleton/Lot 15 Lothrop Batch ID: VG2-0370-W Client: Envirotech Sampled: 04-27-94 Cont/Prsv: 4OmL VOA Vial/NaHSO4 Cool Received: 04-27-94 Matrix: Aqueous Analyzed: 04-29-94 PARAMETER CONCENTRATION REPORTING LIMIT (ug/L) (ug/L) Dichlorodifluoromethane BRL 5 Chloromethane BRL 5 Vinyl Chloride BRL 5 Bromomethane BRL 5 Chloroethane BRL 5 Trichlorofluoromethane BRL 1 1,1-Dichloroethene BRL 1 Methylene Chloride BRL 1 trans-1,2-Dichloroethene BRL 1 1, 1-Dichloroethane BRL 1 cis-1,2-Dichloroethene * BRL 1 i Chloroform BRL 1 1,1,1-Trichloroethane BRL 1 Carbon Tetrachloride BRL 1 Benzene BRL 1 1,2-Dichloroethane BRL 1 Trichloroethene BRL 1 1,2-Dichloropropane BRL 1 Bromodichloromethane BRL 1 2-Chloroethyl Vinyl Ether BRL 5 cis-1,3-Dichloropropene BRL 1 Toluene BRL 1 trans-1,3-DichloroproF,ene BRL 1 1, 1,2-Trichloroethane BRL 1 Tetrachloroethene BRL 1 Dibromochloromethane BRL 1 Chlorobenzene BRL 1 Ethylbenzene BRL 1 meta-and para-Xylene * BRL 1 ortho-Xylene * BRL 1 Bromoform BRL 1 1,1,2,2-Tetrachloroethane BRL 1 1,3-Dichlorobenzene BRL 1 1,4-Dichlorobenzene BRL 1 1,2-Dichlorobenzene BRL 1 QC SURROGATE COMPOUND SPIKED MEASURED RECOVERY QC LIMITS a,a,a-Trifluorotoluene 30 32 106 % 87 - 113 1,2-Dichloroethane-d4 30 27 91 % 83 - 117 BRL = Below Reporting Limit. * Non-target compound. Method References: Method 601 - Purgeable Halocarbons and Method 602 - Purgeable Aromatics, 40 C.F.R. 136, Appendix A (1986). ALL COMPDXENTS` SHALL; BE (H-20 'LOADING). n r..� TOP OF FOUNDATION 20' MIN. { � 10 min CONCRETE COVERS �Ew� (H-20 LOADING) (H-20 LDADIf&e.No- �� 105.0E 104.5E CONCRETE COVERS #1-106f / 4" CAST IRON 6.5E � � � • • � � � / / / i � >#I #2-107�OR SCHEDULE 40P. V.C. PIPE 4" .SCHEDULE 40 P. V.C. DIST 118"-112 R OF FLOW LINE S=0 O� 0=8 BOX s=0.055,d=61.4fV WASHED STONE #2 s=0.11,d=3z CAST INVERT S=O.02, D=19.4' i 10;; __.� 19" �..�__'_�..- / CHING MIN. 1 OR HI EL.= 98.10 _ INVERT 2' w - 97.45 IVALENT INVERT EL.—_-- LEVEL 4 EL.= 97. 70 INVERT o 6' 1-1/2" INVERINVER STONE 1500 GALLONS EL.=_9 29 EL.=_97.12 EL = 93_6 _ o° :SEPTIC TANK o WEL EL. 87.5 (H-20 LOADING) z,I LEAcs P y z, PROFILE OF IO'DIAM.-- 20 LOADING SEWAGE DISPOSAL SYSTEM NOT TO SCALE BOTTOM OF TEST HOLE OR VSGS PROBABLE WATER TABLE EL=_ 83.0 ALL ELEVATIONS ARE ASSIGNED BOTTOM OF TEST HOLE # 2 IS 12.5 FEET BELO W SURFACE. SOIL LOG doyle engineering, inc. WITNESSED BY: T. Mclean �;N Gi HN P# 6-191 LANDERS-CAULEYy`n•^ GENERAL NOTES PERCOLATION RATE _z_ MINI INCH cwIL *roa i � A I THIS PLAN IS FOR REPAIR OF SEWERAGE DISPOSAL SYSTEM. FG/S 2. PLAN REFERENCE BOOK 418 PAGE 55, LOT 16, BARN. REC DEEDS. DATE 110-21-86 DATE 3. THIS PLAN IS FOR INSTALLATION/ REPAIR OF SEPTIC SYSTEM TEST. HOLE I TEST HOLE 2 AND NOT TO BE USED FOR SURVEYING OR ZONING PURPOSES. DESIGN DATA. o EL. = 95.5 EL= 4. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.R - TITLE 5 AND THE TOWN OF BARNSTABLEI RULES AND REGULATIONS FOUR 4 FOR THE SUBSURFACE DISPOSAL OF SEWAGE. TOP SUB NUMBER OF BEDROOMS 5. ALL COVER TO SANITARY UNITS SHALL BE BROUGHT TO WITHIN 2 SOK, 12" OF FINISHED GRADE. GARBAGE DISPOSAL NONE 6. EXLSTINO AND FINAL GRADES SHALL REMAIN ESSENTLMLLY THE -fine sar..d TOTAL ESTIMATED FLOW 440 GPD SAME, UNLESS NOTED BY FINAL CONTOURS. w/bo sor., s 7 ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE 6 ( —110_GAL./BR./DAY x _4_ BR.) OF WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN 10' OF DRIVES OR PARKING AREAS. H-20 LOADING SEPTIC TANK CAPACITY 1500 SHALL BE USED UNDER OR WITHIN 10' OF DRIVES OR PARKING. medium sand UNLESS NOTED. and gv� vel LEACHING AREA REQUIREMENTS 8. ANY MASONRY UNITS USED TO BRING COVERS TO GRADE SHALL SIDEWALL AREA _188.5*GAL./S.F. 2.5 BE MORTARED IN PLACE. 1 78.5 9. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH BOTTOM AREA CAL/S/F DEEDED OR ZONING REGULATIONS. OWNER/APPLICANT IS TO LEACHING CAPACITY BOTTOM & SIDEWALL 549*GAL OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITYno water encountered *CAPACITY PER PIT 10. THE EXCA VATOR\CONTRACTOR SHALL VERIFY THE LOCATION OF ALL UNDERGROUND UTILITIES` PRIOR TO ANY EXCAVATION. RESERVE LEACHING CAPACITY 549* _ GAL SHEET 2 OF 2. JOB NUMBER__ 50656______ STK.& TACK fnd. / LOT 17 90 104, `So- 2 DRAINAGE EASEMENT 3 2 ve area reset \o_ � 96 � N-G�__ /'��'� \ �_� � — — —� � PLAN REF.: 418/55 / /` `� RES. ZONE. RF CATCH®— o ,P _ _ _ / / FLOOD ZONE. C BASIN 0� ED D \ _______ PROPOSED LOT 16 / , ASSESSORS MAP 110-39 2 ROpo i —_____- HOUSE 31,027 fsf� 1ti6 / / �_ STK.&" /wa• _ _ _ _ _ _ � fnd. O , � EXISTING WELL / / „ 124 / OPEN SPACE i "xO I STK&— ASSUMED TA ' 9-e r /� /fnd � PROJECT LOCATION EL. =100. 00 ►-- / LOT 16 ON NAIL PA O gP�OLOTHROP'S LANE IN ROAD. iv - ' BENCHMARK WEST BARNSTABLE c.a. Ep I / 1� EL. =122.8 4 . fnd ELEC. I I ON STK. Na W�'10' APPLICANT. MICHAEL ACETO M.H. I I rs & TACK 6 CORPERWMD ROAD 9 �" / ,►A� MEDFIELD, MA 02052 YANKEE SURVEY CONSULTANTS UNIT 5, 40B INDUSTRY ROAD tN Of P. 0. BOX 265 MARSTONS MILLS, y� MA. 02648 o c. PAUL 1K. '` � � . TEL. 428—0055, FAX 420—5553 / o MEiilT*W N SCALE l" = 30' DATE. 02127195 I / SURVE I / REV 3 23 9 [REV. GAS c "' I TEL FJOB NO.: 50656 SHEET 1 OF 2