Loading...
HomeMy WebLinkAbout1895 MAIN ST./RTE 6A(W.BARN.) - Health 4� _'I)1895.,Main/Rte 6A B1'= Wek Barnstable - AI� A = 21.6 - 025 �1 1 f ti i No. a`a Og l V Fee 160 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Zipplication for 33ioozat 6potem Cow6trurtton VCrmtt Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑ Complete System E]Individual Components Location Address or Lot No. ��� Owner's Name,Address,and Tel.No. 11 /1� 1*14+j17 18 15 71t"C,( Assessor's Map/Parcel.14 Z/!9 04sC?4- 'O Z 5 �ry 11f Ins ller's Name,Address,and Tel.No.'3 Z /d�� G f Xla' Designer's Name,Address and Tel.No. i Type of Building: Dwelling No.of Bedrooms �� Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided f/C/O gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank .� Type of S.A.S. Q G S Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the onstructio and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 o he Envi n ental Code and not to place the system in operation until a Certificate of Compliance has been issued by this rd f Healt Signed a Date h/ D°Y r O Application Approved by — Date d 7 Application Disapproved by: Date for the following reasons Permit No. >®— I t b Date Issued '5 } --. ._ „_.y�,�„ ..w•l-�.. -,. n.-,-.-.. ,-.....-....-.,...,- ,-.,-.�....,+e..,.,,,�•�i„�—_. .- ...- T ..��-�� +�r-^-r's-"'�r3',+.�..-.....-•�.".,,,...,,!.-,"^,.r.pan.-..ate=:.,. .-v.{." ,.v. Ito No. BOO I 1 V Fee �yv THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Zipplication for Mi5po5al *pgtem Cow5tructiou permit Application for a Permit to Construct( )+ Repair( ) 'Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. L G!1 1 g 1,5 Al Owner's Name,Address,and Tel.No. ne- ' )� 3A,v►$����-- Assessor's Map/ParcelA4 Z f 6 /,+j//L -1 if �/{ 1�/fJs & Installer's Name,Address,and Tel.No.3 2 Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms V Lot Size sq.-ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) (Aw gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title ' Size of Septic Tank � � � Type of S.A.S. 7 Q G /I V,S Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: - a t The undersigned agrees to ensure the constructiiq and maintenance of the afore described on-site sewage disposal system,in accordance with the provisions of Title 5 o the Environ t ental Code and not to place the system in operation until a Certificate of Compliance has been issued by this ar of He r Signed a Date 2,1 //D .s- Application Approved by - Date - �/r O Application Disapproved by: Date for the.following reasons Permit No. 00X" Ito Date Issued ————= --———————— —=— ——=————---=—'= w 4 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO�CERTIFY,that tthh-e`On-site f,Sewage �Disposal System Constructed ( ) Repaired ( ) Upgraded ( ) Abandoned( )by'u/� (n() ) 1 rA ,i_,l&,,/ at 0 I S f `-�^- 1 has been constructed in accordance with the provisions of T-itlee 5rand the for Disposal System Construction Permit No. 02 0-0g r '10 dated 3 -ol l-o O Installer 9✓ , C76"t'( CA 1�, C6,'I1 Designer #bedrooms f Approved design flow / gpd The issuance of this permit shall not b(j'construed as a guarantee that the system will fu c`tion as designed. ��) !//�I1 ,U/ , 2 /C7 ✓"^J{ , Date f a) 1 r Inspector .Y,�iT ——————————— f-- { C-�j l'J-------------- ,�/ —'——v----�— No. a OO X` I t b Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS wigpogal *pgtem Cougtruction J)ermit Permission is hereby granted to Construct ( ) Repair ( ) Upgrade ( ) Abandon ( ) System located at and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this permit. Date 3" 1 f- d Approved by 1 • a llo- baZ� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1895 Main Street Property Address Paul&Debra Davidson Owner Owner's Name information is West Barnstable Ma 02668 8-11-2020 required for every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information jlf on the computer, Brett Hickey use only the tab y key to move your Name of Inspector cursor-do not B&B Excavation use the return key. Company Name 374 Route 130 Company Address Sandwich Ma 02563 City/Town State Zip Code mkea 1 (508)477-0653 S113747 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. ❑Q Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails Bre"Hickey Digitally signed by Brett Hickey ll H 1� y :'Date:2020.08.1307:as:32-0a'0o• 8-11-2020 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system 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. l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form ,ib Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 9 p Y rY 1895 Main-Street U� Property Address Paul&Debra Davidson Owner Owner's Name information is required for every West Barnstable Ma 02668 8-1`1-2020 page. City/Town 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: The system was in working order at the time of inspection. 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1895 Main Street Property Address Paul&Debra Davidson Owner Owner's Name information is West Barnstable Ma 02668 8-11-2020 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) i 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 15.303(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 cam, Commonwealth of Massachusetts Title 5 Official Inspection Form 1. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments .............. /% 1895 Main Street V Property Address Paul&Debra Davidson Owner Owner's Name information is West Barnstable Ma 02668 .8-11-2020 required for every page. City/Town 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 clogged of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ a 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 i Commonwealth of Massachu setts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1895 Main Street Property Address Paul&Debra Davidson Owner Owner's Name information is required for every West Barnstable Ma 02668 8-11-2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ El Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑. Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow ❑ El Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ 0 Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ n Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ 0 Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ R Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ El 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.] ❑ 0 The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ 0 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 l5insp.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 1895 Main Street �u Property Address Paul&Debra Davidson Owner Owner's Name information is West Barnstable Ma 02668 8-11-2020 required for every page: City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) youIf have answered"yes"t es o an question in i Section C 5 the system is considered a significant Y any Y 9 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 El ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ 0 Were any of the system components pumped out in the previous two weeks? El ❑ Has the system received normal flows in the previous two week period? ❑ 0 Have large volumes of water been introduced to the system recently or as part of this inspection? El ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ❑ El Was the facility or dwelling inspected for signs of sewage back up? ❑ El the site ins pected for signs of break out. El ❑ Were all system components, excluding the SAS, located on site? El ❑ 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: El ❑ 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)] t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 1 i f Commonwealth of Massachusetts �- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ' .. 1895 Main Street u— Property Address Paul&Debra Davidson Owner Owner's Name information is West Barnstable Ma 02668 8-11-2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: 4 Number of bedrooms (design): Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 440/GPD Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes No Does residence have a water treatment unit? ❑ Yes No if yes, discharges to: Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes No information in this report.) Laundry system inspected? ❑ Yes El No Seasonal use? ❑ Yes (E No Water meter readings, if available(last 2 years usage(gpd)): See below Detail: "WELL WATER" Sump pump? ❑ Yes ❑■ No Last date of occupancy: CurrentDate t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Farm:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form .1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1895 Main Street V Property Address Paul&Debra Davidson Owner Owner's Name information is required for every West Barnstable iMa 02668 8-11-2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: NA 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: Owner- last pumped 3 years ago 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 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ........... 1895 Main Street a v Property Address Paul&Debra Davidson Owner Owners Name information is West Barnstable Ma 02668 8-11-2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: El 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: 12-27-1974 per COC. D-box replaced 2008 Were sewage odors detected when arriving at the site? ❑ Yes ❑■ No 5. Building Sewer(locate on site plan): 12r`+rr Depth below grade: feet Material of construction: N cast iron ❑■ 40 PVC ❑other(explain): Distance from private water supply well or suction line: >100' from well to SASfeet Comments(on condition of joints, venting, evidence of leakage, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 I Commonwealth of Massachusetts A lF Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments .......... 1895 Main Street Property Address Paul&Debra Davidson Owner Owner's Name information is required for every West Barnstable Ma 02668 8-11-2020 . page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): 1'6" Depth below grade: feet Material of construction: ■❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain) If tank is metal, list age: years Is age confirmed b a Certificate of Compliance? attach a co of certificate Y g y p ( copy ) ❑ es ❑ No 1 � Dimensions: 500gallons 8" Sludge depth: 2811 Distance from top of sludge to bottom of outlet tee or baffle 211 Scum thickness 6" Distance from top of scum to top of outlet tee or baffle 1419 Distance from bottom of scum to bottom of outlet tee or baffle measured How were dimensions determined? Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): The tank was in working order at the time of inspection. The tank is in need of pumping at this time and should be pumped every two years for maintenance. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts +d Title 5 Official Inspection Form } Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1895 Main Street Property Address Paul&Debra Davidson Owner Owner's Name information is West Barnstable Ma 02668 8-11-2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): Depth below grade: NAfeet 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: NA Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day l5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 i c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1895 Main Street V� Property Address Paul&Debra Davidson Owner Owner's Name information is west Barnstable Ma 02668 8-11-2020 required for every 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): 0" Depth of liquid level above outlet invert Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): The d-box was in working order at the time of inspection. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 I Commonwealth of Massachusetts �M Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u 1895 Main Street Property Address Paul&Debra Davidson Owner Owner's Name information is West Barnstable Ma 02668 8-11-2020 required for every page. City/Town 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.): NA * 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: 6' ' pit El leaching pits number: (2) x6 ❑ 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 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form " Subsurface Sewage Disposal System Form -Not for Voluntary Assessments l; 1895 Main Street u� Property Address Paul&Debra Davidson Owner Owner's Name information is west Barnstable Ma 02668 8-11-2020 required for every 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.): The SAS was in working order at the time of inspection. First pit was full and the second pit was empty when viewed. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): NA 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 ,p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1895 Main Street Property Address Paul&Debra Davidson Owner Owner's Name information is West Barnstable Ma 02668 8-11-2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: NA Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): a t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments I ,, 1895 Main Street Property Address Paul&Debra Davidson Owner Owner's Name information is West Barnstable Ma 02668 8-11-2020 required for every page. City/Town 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 Main Street/Rt A Y 36 V '- 49 44 63 41„ 50 t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts +e Title 5 Official Inspection Form to Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1895 Main Street V� Property Address Paul&Debra Davidson Owner Owner's Name information is West Barnstable Ma 02668 8-11-2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: Check Slope ■❑ Surface water ❑■ Check cellar ❑■ Shallow wells r Estimated depth to high ground water: No GW @ >20'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/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers -(attach documentation) Q Accessed USGS database-explain: USGS topo maps and town GIS You must describe how you established the high ground water elevation: Town groundwater maps show GW to be greater than 20' below grade. Bottom of SAS is greater than 10' above high groundwater. 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 1 Commonwealth of Massachusetts �v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1895 Main Street u= Property Address Paul&Debra Davidson Owner Owner's Name information is West Barnstable Ma 02668 8-11-2020 required for every page. City/Town 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 I� t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 CERTIFICATE OF ANALYSIS Page: 1 Barnstable County Health Laboratory �y.sc�y Report Prepared For: Report Dated: 1/14/2009 Shaun F. Harrington All Cape Well Drilling Order No.: G0950472 P O Box 126 Brewster, MA 02631 Laboratory ID#: 0950472-01 Description: Water-Drinking Water Sample#: Sampling Location PS 55-Route6A Ba-r-nstablle -A CollCollected: 1/12/2009 Collected by: Customer � � � Received: 1/12/2009 Routine +Ammonia ITEM RESULT UNITS RL MCL Method# Tested i Ammonia ND mg/L 0.20 EPA 350.1 M 1/12/2009 Nlitrate as Nitrogen 4.9 mg/L 0.10 10 EPA 300.0 1/12/2009 Copper ND mg/L 0.10 1.3 SM 311 IB 1/13/2009 Iron ND mg/L 0.10 0.3 SM 3111B 1/13/2009 Sodium 24 mg/L 1.0 20 SM3111B 1/13/2009 Total Coliform Absent P/A 0 0 SM9223 1/12/2009 Conductance 210 umohs/cm 2.0 EPA 120.1 1/12/2009 pH 6.4 pH-units 0 SM 4500 H-B 1/12/2009 Sodium level is above the maxium contaminant level. Those on a low sodium diet may wish to consult a physici n. Approved B (La irector) ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 CERTIFICATE OF ANALYSIS Page: 1 i Barnstable County Health Laboratory 5.r Report Prepared For: Report Dated: 1/14/2009 Shaun F.Harrington All Cape Well Drilling Order No.: G0950472 P O Box 126 Brewster, MA 02631 Laboratory ID#: 0950472-01 Description: Water-Drinking Water Sample#: Sampling Location 1865 Route 6A Barnstable,MA Collected: 1/12/2009 Collected by: Customer Received: 1/12/2009 - EPA 524.2- Volatile Organics by GCMS ITEM RESULT UNITS RL MCL Method# Analyst Tested Note. Dichlorodifluoromethane ND ug/L 0.50 EPA 524.2 yn 1/12/2009 Chloromethane ND ug/L 0.50 EPA 524.2 yn 1/12/2009 Vinyl chloride ND ug/L 0.50 2.0 EPA 524.2 yn 1/12/2009 Bromomethane ND ug/L 0.50 EPA 524.2 yn 1/12/2009 1,1,1,2-Tetrachloroethane ND ug/L 0.50 EPA 524.2 yn 1/12/2009 1,1,1-Trichloroethane ND ug/L 0.50 200 EPA 524.2 yn 1/12/2009 1,1,2,2-Tetrachloroethane ND ug/L 0.50 EPA 524.2 yn 1/12/2009 1,1,2-Trichloroethane ND ug/L 0.50 5.0 EPA 524.2 yn 1/12/2009 1,1-Dichloroethane ND ug/L 0.50 EPA 524.2 yn 1/12/2009 1,1-Dichloroethene ND ug/L 0.50 7.0 EPA 524.2 yn 1/12/2009 1,1-Dichloropropene ND ug/L 0.50 EPA 524.2 yn 1/12/2009 1,2,3-Trichlorobenzene ND ug/L 0.50 EPA 524.2 yn 1/12/2009 1,2,3-Trichloropropane ND ug/L 0.50 EPA 524.2 yn 1/12/2009 1,2,4-Trichlorobenzene ND ug/L 0.50 70 EPA 524.2 yn 1/12/2009 1,2,4-Trimethylbenzene ND ug/L 0.50 EPA 524.2 yn 1/12/2009 1,2-Dibromo-3-chloropropane ND ug/L, 0.50 EPA 524.2 yn 1/12/2009 1,2-Dibromoethane(EDB) ND ug/L 0.50 EPA 524.2 yn 1/12/2009 1,2-Dichlorobenzene ND ug/L 0.50 600 EPA 524.2 yn 1/12/2009 1,2-Dichloroethane ND ug/L 0.50 5.0 EPA 524.2 yn 1/12/2009 1,2 LichIOlopaGp4ne i:D vg/l- 0.50 !:PA 5?4.2 ;m 1/12_/2009 1,3,5-Trimethylbenzene ND ug/L 0.50 EPA 524.2 yn 1/12/2009 1,3-Dichlorobenzene ND ug/L 0.50 EPA 524.2 yn 1/12/2009 1,3-Dichloropropane ND ug/L 0.50 EPA 524.2 yn 1/12/2009 1,4-Dichlorobenzene ND ug/L 0.50 5.0 EPA 524.2 yn 1/12/2009 2,2-Dichloropropane ND ug/L. 0.50 EPA 524.2 yn 1/12/2009 2-Chlorotoluene ND ug/L 0.50 EPA 524.2 yn 1/12/2009 4-Chlorotoluene ND ug/L 0.50 EPA 524.2 yn 1/12/2009 Benzene ND ug/L 0.50 5.0 EPA 524.2 yn 1/12/2009 Bromobenzene ND ug/L 0.50 EPA 524.2 yn 1/12/2009 Bromochloromethane ND ug/L 0.50 EPA 524.2 yn 1/12/2009 Bromodichloromethane ND ug/L 0.50 EPA 524.2 yn 1/12/2009 Bromoform ND ug/L 0.50 EPA 524.2 yn 1/12/2009 ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 r - CERTIFICATE OF ANALYSIS Page: 2 - Barnstable County Health Laboratory Report Prepared For: Report Dated: 1/14/2009 Shaun F. Harrington All Cape Well Drilling Order No.: G0950472 P O Box 126 Brewster, MA 02631 Laboratory ID#: 0950472-01 Description: Water-Drinking Water Sample#: Sampling Location 1865 Route 6A Barnstable,MA Collected: 1/12/2009 Collected by: Customer Received: 1/12/2009 EPA 524.2- Volatile Organics by GUMS ITEM RESULT UNITS RL MCL Method# Analyst Tested Note Carbon tetrachloride ND ug/L 0.50 5.0 EPA 524.2 yn 1/12/2009 Chlorobenzene ND ug/L 0.50 100 EPA 524.2 yn 1/12/2009 Chloroethane ND ug/L 0.50 EPA 524.2 yn 1/12/2009 Chloroform ND ug/L 0.50 80 EPA 524.2 yn 1/12/2009 cis-1,2-Dichloroethene ND ug/L 0.50 70 EPA 524.2 yn 1/12/2009 cis-1,3-Dichloropropene ND ug/L 0.50 EPA 524.2 yn 1/12/2009 Dibromochloromethane ND ug/L 0.50 EPA 524.2 yn 1/12/2009 Dibromomethane ND ug/L 0.50 EPA 524.2 yn 1/12/2009 Ethylbenzene ND ug/L 0.50 700 EPA 524.2 yn 1/12/2009 Hexachlorobutadiene ND ug/L 0.50 EPA 524.2 yn 1/12/2009 Isopropylbenzene ND ug/L 0.50 EPA 524.2 yn 1/12/2009 Methylene chloride ND ug/L 0.50 5.0 EPA 524.2 yn 1/12/2009 Methyl-tert-butyl ether ND ug/L 0.50 EPA 524.2 yn 1/12/2009 Naphthalene ND ug/L 0.50 EPA 524.2 yn 1/12/2009 n-Butylbenzene ND ug/L 0.50 EPA 524.2 yn 1/12/2009 n-Propylbenzene ND ug/L 0.50 EPA 524.2 yn 1/12/2009 p-Isopropyltoluene ND ug/L 0.50 EPA 524.2 yn 1/12/2009 sec-Butylbenzene ND ug/L 0.50 EPA 524.2 yn 1/12/2009 Styrene ND ug/L 0.50 100 EPA 524.2 yn 1/12/2009 test-P_.0 j'lhet�.ze.e STD ug/t 0.50 EPA S24.2 n 1,12n 2.0 in„o Tetrachloroethene ND ug/L, 0.50 5.0 EPA 524.2 yn 1/12/2009 Toluene ND ug/L 0.50 1000 EPA 524.2 yn 1/12/2009 Total xylenes ND ug/L 0.50 10000 EPA 524.2 yn 1/12/2009 trans-1,2-Dichloroethene ND ug/L 0.50 100 EPA 524.2 yn 1/12/2009 trans-1,3-Dichloropropene ND ug/L 0.50 EPA 524.2 yn 1/12/2009 Trichloroethene ND ug/L 0.50 5.0 EPA 524.2 yn 1/12/2009 Trichlorofluoromethan-.- ND ug/L 0.50 EPA 524.2 yn 1/12/2009 Sodium level is above the maxium contaminant level. Those on a low sodium diet may wish to consult a physician. Approved B ` (La irector)1 /C7 ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605 t y t a• Town of Barnstable CF tME 1p� ti Regulatory Services yP 0� ,AxxscnsLe Thomas F. Geiler,Director "�. •0`a Public Health Division �FG MA'S a Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 i May 28, 2007 Ms Sonya Phillips 1895 Main Street West Barnstable, MA.02668 The septic system located at 1895 Main Street, West Barnstable, MA was last inspected on - - ---April11th 200- b�-P- trLiek-M.-O'Conne l-a certified septic-inspeEtor�or the-Sate-of-- --- Massachusetts. The inspection of the septic system showed that the system"Failed" under the guidelines of 1995 TITLE 5 ( 310 CMR 15.00) due to the following: Distribution box is deteriorated and leaking. One leaching pit was empty at time o inspection and the other had 4' of standing water You have 60 days from the date of the system failure to bring the system into compliance. If there are any questions about this reminder,please feel free to contact the Barnstable. Health Department. BARNSTABLE HEALTH DE TMENT Thomas A. McKean,R.S., C.H.O. Agent of the Board of Health t r COMMONWEALTH OF MASSACHUSETTS W EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION 4 ti� W� � O TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION E r Property Address: 1895 Main Street West Barnstable MA 02668 Owner's Name: Sonya Phillips Owner's Address: Same �3 Q7 Date of Inspection: April 11,2007 Job#07-66 cr% Name of Inspector: PATRICK M.O'CONNELL Company Name: SEPTIC INSPECTION SERVICES CO. Mailing Address: 189 CAMMETT ROAD MARSTONS MILLS MA 02648 0) t Telephone Number: 508-428-1779 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: Passes _X_ Conditionally Passes Needs Further Evaluation by the Local A roving Authority Fail Inspector's Signature: Date: 4/11/07 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. Notes and Comments: Tank is not in need of pumping at this time.Distribution box is deteriorated and leaking.One leaching pit was empty at time of inspection and other had 4' of standing water. ****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. Page 2 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 1895 Main Street,West Barnstable Owner: Sonya Phillips Date of Inspection: April 11,2007 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: XX Distribution box is collapsing and leaking. One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND) in the for the following statements. If"not determined"please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: XX_ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed _XX_ distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 1895 Main Street,West Barnstable Owner: Sonya Phillips Date of Inspection: April 11,2007 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This asses system if the well water analysis,performed at a DEP certified laboratory,for coliform Y P Y bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 1895 Main Street,West Barnstable Owner: Sonya Phillips Date of Inspection: April 11,2007 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No _X_ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool —X— Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool _X— Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _X_ Liquid depth in cesspool is less than 6"below invert or available volume is less than_day flow _X_ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _X Any portion of the SAS,cesspool or privy is below high ground water elevation. _X_ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone 1 of a public well. X_ Any portion of a cesspool or privy is within 50 feet of a private water supply well. _X_ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this forma _No_(Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 1895 Main Street,West Barnstable Owner: Sonya Phillips Date of Inspection: April 11,2007 Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No _X_ Pumping information was provided by the owner,occupant,or Board of Health _X_ Were any of the system components pumped out in the previous two weeks? _X— Has the system received normal flows in the previous two week period ? _X_ Have large volumes of water been introduced to the system recently or as part of this inspection _X_ Were as built plans of the system obtained and examined?(If they were not available note as N/A) _X_ _ Was the facility or dwelling inspected for signs of sewage back up? _X_ _ Was the site inspected for signs of break out? _X_ _ Were all system components,excluding the SAS, located on site? X _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the — P condition of the baffles or tees material of construction dimensions depth of liquid,depth > p q ,d pt of sludge and depth of scum? _X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: Yes no _X_ _ Existing information. For example,a plan at the Board of Health. _X _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] Page 6 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 1895 Main Street,West Barnstable Owner: Sonya Phillips Date of Inspection: April 11,2007 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 1 10 gpd x #of bedrooms): 440 Number of current residents:0 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): No [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use: (yes or no): No Water meter readings, if available(last 2 years usage(gpd)): N/A Well Water Sump pump(yes or no): No Last date of occupancy: unknown COMMERCIALANDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no):_ Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records: Tank had been pumped regularly,last service is unknown. Source of information: Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: gallons-- How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM _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) _Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank _Attach a copy of the DEP approval _Other(describe): Approximate age of all components,date installed(if known)and source of information: unknown Were sewage odors detected when arriving at the site(yes or no): No Page 7 of I 1 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1895 Main Street,West Barnstable Owner: Sonya Phillips Date of Inspection: April 11,2007 BUILDING SEWER: XX (locate on site plan) Depth below grade: I Materials of construction:_X_cast iron _40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints, venting,evidence of leakage,etc.): SEPTIC TANK: XX (locate on site plan) Depth below grade: 16" Material of construction:_X_concrete_metal_fiberglass_polyethylene —other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: 10.5'long x 5.8'wide—1500 gal. Sludge depth: 0" Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: 0" Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensions determined: STICK WITH HINGE FLAP. Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Tank has liquid only,no solids. Liquid level is at bottom of outlet invert.Condition of concrete baffle is mareinal,recommend realacine with a PVC tee. GREASE TRAP: No (locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Page 8 of 11 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1895 Main Street,West Barnstable Owner: Sonya Phillips Date of Inspection: April 11,2007 TIGHT or HOLDING TANK: No (tank must be pumped at time of inspection) (locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass__polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: XX (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.): Box is deteriorated and leaking.Box was originally set out of level diverting flow to only one pit PUMP CHAMBER: No (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): I Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property p ty Address: 1895 Main Street, West Barnstable Owner: Sonya Phillips Date of Inspection: April 11,2007 SOIL ABSORPTION SYSTEM(SAS): XX (locate on site plan,excavation not required) If SAS not located explain why: Type _X_leaching pits,number: Two 6x6 pits. _leaching chambers,number: _leaching galleries,number: _leaching trenches.number, length: leaching fields,number,dimensions: _overflow cesspool,number: _innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation, etc.): One leaching nit was empty at time of inspection with a high stain line 6"from bottom of structure Other pit had 4'of standing water and had high stains indicating pit had been full to ton CESSPOOLS: No (cesspool must be pumped as part of inspection) (locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): PRIVY: No (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note conditior of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): Page 10 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1895 Main Street,West Barnstable Owner: Sonya Phillips Date of Inspection: April 11,2007 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Main Street/Rt 6A Y e, a. ;; ............. ... . . . ..... ........... ........... 36 tr W 5 49 44 63 41 50 r Page 1.1 of 1 I r OFFICIAL'INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1895 Main Street,West Barnstable Owner: Sonya Phillips Date of Inspection: April 11,2007 SITE EXAM Slope None Surface water None Check cellar Dry Shallow wells None Estimated depth to ground water: More than 20 feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from sys_em design plans on record- If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) _Checked with local Board of Health-explain: _Checked with loca'excavators, installers-(attach documentation) _X_Accessed USGS database-explain: USGS topo map and town GIS You must describe how you established the high ground water elevation: Town groundwater contour map shows water below el.30 and topo map shows property above el.70. Page 10 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1895 Main Street,West Barnstable Owner: Sonya Phillips Date of Inspection: April 11,2007 SKETCH F C O SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Main Street/Rt 6A Driveway 895 ... . ....... . ................................... ...... .... .............. ........... ...... .. .... ...... 7 36 5 49 ` 44 63 41 50 �r _ ;11 r� t`or. CERTIFICATE OF ANALYSIS Page: 1 lO MI Barnstable County Health Laboratory Report Prepared For: Report Dated: 4/8/2008 Stephen M.Flynn Coldwell Banker Atlantic Realty Order NO.: G0845652 125 Underpass Road Brewster, MA 02631 Laboratory ID#: 0845652-01 Description: Water-Drinking Water Sample#: Sampling ocation: 1895 Main St.W.Barnstable,MA i Collected: 4/3/2008 Collected by: S.Flynn P Received: 4/3/2008 EPA 524.2 - Volatile Organics by GUMS ITEM RESULT UNITS RL MCL Method# Analyst Tested Note Dichlorodifluoromethane ND ug/L 0.50 EPA 524.2 yn 4/4/2008 Chloromethane ND ug/L 0.50 EPA 524.2 yn 4/4/2008 Vinyl chloride ND ug/L 0.501 2.0 EPA 524.2 -yn :/4/2008 Bromomethane ND ug/L 0.50 EPA 524.2 yn 4/4/2008 1,1,1,2-Tetrachloroethane ND ug/L 0.50 EPA 524.2 yn 4/4/2008 1,1,1-Trichloroethane ND ug/L 0.50 200 EPA 524.2 yn 4/4/2008 1,1,2,2-Tetrachloroethane ND ug/L 0.50 EPA 524.2 yn 4/4/2008 1,1,2-Trichloroethane ND ug/L 0.50 5.0 EPA 524.2 yn 4/4/2008 1,1-Dichloroethane ND ug/L 0.50 EPA 524.2 yn 4/4/2008 1,1-Dichloroethene ND ug/L 0.50 7.0 EPA 524.2 yn 4/4/2008 IJ Dichloropropene ND ug/L 0.50 EPA 524.2 yn 4/4/2008 1,2,3-Trichlorobenzene ND ug/L 0.50 EPA 524.2 yn 4/4/2008 1,2,3-Trichloropropane ND ug/L 0.50 EPA 524.2 yn 4/4/2008 1,2,4-Trichlorobenzene ND ug/L 0.50 70 EPA 524.2 yn 4/4/2008 1,2,4-Trimethylbenzene ND ug/L 0.50 EPA 524.2 yn 4/4/2008 1,2-Dibromo-3-chloropropane ND ug[L 0.50 EPA 524.2 yn 4/4/2008 1,2-Dibromoethane(EDB) ND ug/L 0.50 EPA 524.2 yn 4/4/2008 1,2-Dichlorobenzene ND ug/L 0.50 600 EPA 524.2 yn 4/4/2008 1,2-Dichloroethane ND ug/L 0.50 5.0 EPA 524.2 yn 4/4/2008 1,2-Dichloropropane ND ug/L 0.50 EPA 524.2 yn 4/4/2008 1,3,5-Trimethylbenzene ND ug/L 0.50 EPA 524.2 yn 4/4/2008 1,3-Dichlorobenzene ND ug/L 0.50 EPA 524.2 yn 4/4/2008 1,3-Dichloropropane ND ug/L 0.50 EPA 524.2 yn 4/4/2008 1,4-Dichlorobenzene ND ug/L 0.50 5.0 EPA 524.2 yn 4/4/2008 2,2-Dichloropropane ND ug/L 0.50 EPA 524.2 yn 4/4/2008 2-Chlorotoluene ND ug/L 0.50 EPA 524.2 yn 4/4/2008 4-Chlorotoluene ND ug/L 0.50 EPA 524.2 yn 4/4/2008 Benzene ND ug/L. 0.50 5.0 EPA 524.2 yn 4/4/2008 Bromobenzene ND ug/L 0.50 EPA 524.2 yn 4/4/2008 Bromochloromethane ND ug/L 0.50 EPA 524.2 yn 4/4/2008 Bromodichloromethane ND ug/L 0.50 EPA 524.2 yn 4/4/2008 Bromoform ND ug/L 0.50 EPA 524.2 yn 4/4/2008 ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605 CERTIFICATE OF ANALYSIS Page: 2 �o s: Barnstable County Health Laboratory cH�ySw ' Report Prepared For: Report Dated: 4/8/2008 Stephen M.Flynn Coldwell Banker Atlantic Realty Order No.: G0845652 125 Underpass Road Brewster, MA 02631 Laboratory ID#: 0845652-01 Description: Water-Drinking Water Sample#: Sampling Location: 1895 Main St.W.Barnstable,MA Collected: 4/3/2008 Collected by: S.Flynn Map 216 Parcel 025 Received: 4/3/2008 EPA 524.2 - Volatile Organics by GUMS ITEM RESULT UNITS RL MCL Method# Analyst Tested Note Carbon tetrachloride ND u911- 0.50 5.0 EPA 524.2 yn 4/4/2008 Chlorobenzene ND ug/L 0.50 100 EPA 524.2 yn 4/4/2008 Chloroethane ND udi 0.50 EPA 524.2 yn 4/4/2008 Chloroform ND ug/L 0.50 80 EPA 524.2 yn 4/4/2008 cis-1,2-Dichloroethene ND ug/L 0.50 70 EPA 524.2 yn 4/4/2008 cis-1,3-Dichloropropene ND ug/L 0.50 EPA 524.2 yn 4/4/2008 Dibromochloromethane ND ug/L 0.50 EPA 524.2 yn 4/4/2008 Dibromomethane ND ug/L 0.50 EPA 524.2 yn 4/4/2008 Ethylbenzene ND ug/L 0.50 700 EPA 524.2 yn 4/4/2008 Hexachlorobutadiene ND ug/L 0.50 EPA 524.2- yn 4/4/2008 Isopropylbenzene ND ug/L 0.50 EPA 524.2 yn 4/4/2008 Methylene chloride ND ug/L 0.50 5.0 EPA 524.2 yn 4/4/2008 Methyl-tert-butyl ether 11 ug/L 0.50 EPA 524.2 yn 4/4/2008 Naphthalene ND ug/L 0.50 EPA 524.2 yn 4/4/2008 n-Butylbenzene ND ug/L 0.50 EPA 524.2 yn 4/4/2008 n-Propylbenzene ND ug/L 0.50 EPA 524.2 yn 4/4/2008 p-Isopropyltoluene ND ug/L 0.50 EPA 524.2 yn 4/4/200$ sec-Butylbenzene ND ug/L 0.50 EPA 524.2 yn 4/4/2008 Styrene ND ug/L 0.50 100 EPA 524.2 yn 4/4/2008 tert-Butvlbenzene ND ug/L. 0.50 EPA 524.2 yn 4/4/2008 Tetrachloroethene ND ug/L 0.50 5.0 EPA 524.2 yn 4/4/2008 Toluene ND ug/L 0.50 1000 EPA 524.2 yn 4/4/2008 Total xylenes ND ug/L 0.50 10000 EPA 524.2 yn 4/4/2008 trans-1,2-Dichloroethene ND ug/L 0.50 100 EPA 524.2 yn 4/4/2008 trans-1,3-Dichloropropene ND ug/L 0.50 EPA 524.2 yn 4/4/2008 Trichloroethene ND ug/L 0.50 5.0 EPA 524.2 yn 4/4/2008 Trichlorofluoromethane ND ug/L 0.50 EPA 524.2 yn 4/4/2008 Water sample meets the recommended limits for drinking water of all the above tested parameters. Approved By?'(Lab rctor) -4- ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605 CERTIFICATE OF ANALYSIS Page: 1 Barnstable County Health Laboratory rIs' ' Report Prepared For: Report Dated: 4/22/2008 Stephen M. Flynn Coldwell Banker Atlantic Realty Order No.: G0845681 125 Underpass Road Brewster, MA 02631 Laboratory 1D#: 0845681-01 Description: Water-Drinking Water Sample#: Sampling Location:rfrm—Main scw Barnstable,MA Collected: 4/7/2008 Collected by: S.Flynn Map 216 Parcel 25 Received: 4/7/2008 Test Parameters ITEM RESULT UNITS RL MC Method# Analyst Tested Note Radon 250(+-30) pCi/L 16 300 SM 7500-Rn B TFB 4/10/2008 Total Coliform Present P/A 0 0 SM 9223 AF 4/7/2008 I/P - rRerntrimet�rlp �raxi�e rtit rn.;tr�c�r inr,, live/yP�CQP._L/PII-Ave 1n���,fnYln R.�tQYln R../^�t.ltg'r.S Yornatilliv!tQrl Approved By ' (Lab ector) co y zM !'e (— t— �� rT1 I ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 CERTIFICATE OF ANALYSIS Page: 1 Barnstable County Health Laboratory yss�CtNs Report Prepared For: Report Dated: 4/14/2008 Stephen M. Flynn Coldwell Banker Atlantic Realty Order No.: G0845651 125 Underpass Road Brewster, MA 02631 Laboratory 1D 0: 0845651.-01 Description: Water-Drinking Water Sample 9: Sampling Location: 1895 Main St.West Barnstable,MA Collected: 4/3/2008 Collected by: S.Flynn Map 216 Parcel 025 Received: 4/3/2008 Routine +Ammonia ITEM RESULT UNITS RL MCL Method# Tested Ammonia ND mg/L 0.20 EPA 350.1 M 4/4/2008 Nitrate as Nitrogen 6.1 mg/L 0.10 10 EPA 300.0 4/3/2008 Copper 0.32 mg/L 0.10 1.3 SM 31 1 1 B 4/9/2008 Iron 8.0 mg/L 0.10 0.3 SM 31 1 1 B 4/9/2008 Sodium 16 mg/L 1.0 20 SM 311 IB 4/9/2008-- Total Coliform Present P/A 0 0 SM9223 4/3/2008 Conductance 180 umohs/cm 2.0 EPA 120.1 4/3/2008 pH-units 0 SM 4500 H-B 4/3/2008 pH 6.4 Recommended maximum contamination level exceeded due to Coliform Bacteria. Retesting is recommended. May present aesthetic problems(taste,odor- staining)due to Iron. ------------------- ------- ---- -- -------------- - ------- - ------ ----._....__.... - - ------------- ---- Approved B �usl (Lab rector) ND=None Detected RI, = Reporting Limit MCI,=Maximum Contaminant Level Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 ENVIROTECHLABORATORIES,IATC. MA CERT.IVO.:A4f JVL4 063 Sfiui Sebastian Drive-Unit#12 / Sandi ich NIA 02563 ✓✓✓ 508(888-6460) 1-800-3316460 FAX(508)888-6446 CLIENT. Mr. Phillips LOCAT19N. �4 1895 Route 6A ADDRESS: 1895 Route 6A /89� 4ik 9170& � '/ W Barnstable, MA 02668 W. Barnstable, MA 02668 COLLECTED BY: Meehan Wells SAMPLE DATE: 11/19/2004 SAMPLE TIME: NA WATER SAMPLE TYPE: Existing Well DATE RECEIVED: 11/19/2004 LAB LD. #: 0411296 WELL SPECS.: NA RESULTS OF ANALYSIS: Parameters Units Recommended Results Method Date Analyzed Limits pH pH units 6.5-8.5 6.00 4500 H+ 11/19/2004 Conductance umhos/cm 500 176 120.1 11/19/2004 Nitrate-N mg/L 10.0 3.5 300.0 11/19/2004 Nitrite-N mg/L 1.00 < 0.004 300.0 11/19/2004 Sodium mg/L 20.0 23.0 200.7 11/19/2004 Iron mg/L 0.3 1.5 200.7 11/19/2004 Manganese mg/L 0.05 0.009 200.7 11/19/2004 COMMENTS: pH is below recommended limit and may have corrosive characteristics. Sodium level is not a health hazard. Iron level is not,a health hazard, but may cause taste and staining problems. < = Less than > = Greater than TNTC = Too numerous to count / WPI,4, _Date L q,�0 o J. Saa Laboratory D re for °FAi`'.. CERTIFICATE OF ANALYSIS Page: 1 Id MI Barnstable County Health ]Laboratory 9Sk,�}ns ` Report Prepared For: Report Dated: 4/22/2008 Stephen M. Flynn Coldwell Banker Atlantic Realty Order No.. G0845681 125 Underpass Road Brewster, MA02631 Laboratory ID#: 0845681-01 Description: Water-Drinking Water Sample ti: Sampling Location:,.'?, 95 Main St.W Barnstable,°MA.'1 Collected: 4/7/2008 Collected by: S.Flynn Map 216 Parcel 25 Received: 4/7/2008 Test Paka►neters ITEM RESULT UNITS RL MCL Method# Analyst Tested Note Radon 250(+-30) pCi/L 16 300 SM 7500-Rn B TFB 4/10/2008 Total Coliform Present P/A 0 0 SM 9223 AF 4/7/2008 1?ecnnrm�lteti mlrz:ffa»n cr�ztam!n tqn IeveC Cc exceeitnd dust 0rrn,qe ckrI 'Fete�t ng q.rf7P!P.itan�+ed: r 0 w�- Approved By 1 // (Lab ector) s1� �t G� •' ta' (_n M ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 r 09130/2008 03:10 FAX 0001/0002 ENUR®TECII LAB®RAT®RIES, INC. gt ILIA CERT. NO.:M MA 063 1' 8 Jan Sebastian Drive Unit 12 Sandwich,MA 02563 (508)888-6460 1-800-339-6460 i FAX(508)888-6446 t Clt=at Name Scannell Well Drilling Location 1895 Rte.6A r:i t Adikess 2366 Me.28 West Barnstable,MA j Teaticket MA 02536 Sample Date 09/22/08 �Q1Tectetl�1�° DA Scannell Sample Time NA �'ara�Dle �r�ln ! Existing Well Date Received 09/22/08 y� rs: '40 Order Ala ether DW-83438 Well Specs NA - ocratav .4' taPceaate C®ltecterl 7'ttve Collected Coatattaents $1a2J2Q8... NA ll;irsis Requested Units Recommended Limits Analysis Result Method IDateAnalyzedl Analyzed By —= ------ F:F -i ntai Cofifomt /100ml 0 Confluent 9222B 9/22/2008 MC i pH H p units 6.5-8.5 6.09 4500-H-B 9/22/2008 LL .__._.._.. _...._.__ Sreclrm Conductance umhos/cm 500 155 120:1 9/2212008 LL t. . .... .. IJ trite N- mglL i O0 -.. <0 004 . 300 0 9/2212008 LL -. .. _. .__.. . .. __ ._._._._... ..._. . s= Nitr'. 9 -N m /L 10.0 3.91 300.0 9/22/2008 LL F. 5cs13um mg/L 20 0 12.1 200 7 9/22/2008 MC san-----...----.... __... ,.._....................._._.-._.__.. ..._..-._ _._ - - --.............._ ._...._ ... :. 'Total Iron mg/L - 0.3 0.88 200.7 9/22/2008 ....... ............ ....... .............. ....... ................ be mg/L 0.05 <0.008 200.7 9/22/2008 MC f: ........... ..............._--------....-.._,..- -_.._.._..-.-_.._..._--_----._-,...__.,._...._............... .-.--.-_---__,._,.__- __........ -- '��afra�r�ea�ts': IronAevel is not of health hazard,but may cause taste and staining problems. pH h,beiovu re:conimended limit and may have corrosive characteristics. CArm enm ds maximum contaminant level. suggest retest. 61%.1ltet'Is aiat Ruitable for drinking purposes for parameters tested. YfAd! ' S TMil i a' Date Ronald J.Saari K,s Laboratory Director �.t 4.j; . *fU Sx2- j , Page1of1 BRA=EEiaw.F's,�ortlble Ltmrts '"Seefittached Yrt :E 3 fM3012008 03:10 FAX CJ0002/000.2 5 E V7ROTECII LABORATORIES,INC. "{ MA CERT NO.:M-AIA 063 Ur r 8 Jan Sebastian Drive Unit 12 x � Sandwich,AIA 02563 (508)888-6460 1-800-339-6460 ` P FAX(S08)888-6446 � fs V Vent Maine Scannell Well Drilling Location #1895 Route 6A 'dress, 2366 Rte.28 West Barnstable MA Teatickat MA 02536 €, i Sample Date 09/25/08 p s-�F ,. 6,Weceed Efy Bryant B Sample Time NA S�' ,c"P a Type Existing Well Date Received os/25/o6 e'T• ' ab OMer.l`Jeatiaber DW-83511 Well Specs NA f. Hr:i o�vaemazn� oa�t��va�mum .1 <� f mg gt8ituri 'Qtarc Dt�to�leclrlttiieColected v` Corraes k' z • �l.�y. ,{ � 1 /i sr v � , rpp Gipp- ii�� t, rY ��11yy r .r, 1 � Z 3� �: 3'_ '1{5 a. � ��l t ear FYI ���. .,..�'.' .J�.� � .. 'r �R��,.7IHS... .:;i � p`A...c # v, � ; :Ze jr .� E•s-a I .Jo .w.�...b ,,. .i.-t..:_1., .i.., ...,...';• f ...;i,, 1.�,_„. ,.- .. ..r�.. 7. ). J ..:.:::-.. ,1k,.u.... J ., x..:,,.. r i; AnrrYpis Requested Units Recommended Limits Analysis Result Method Date Analyzed Analyzed By Total Coliform /loom[ 0 0 9222B 9/25/2008 RS 1 i Wg'i*r molts EPA standards and is suitable for drinking for parameters tested. Date IEt. Ranaid J.Saarl Laboratory Director 4 jf>C' ty Rv J irY}, is pppppp T !� ;=Below 1PRjanrs7ble Limits Page 1 of 1 [ tp� #f. A`�t. 09/19/2008 FRI 14: 41 FAX 5083627103 Barnstable CTY HealthLab 2001/001 r CERTIFICATE OF ANALYSIS Page: 1 Barnstable County Health Laboratory t �sPaca�os` Report Prepared For: Report Dated: 9/19/2008 Paul Davidson Order No.: G0849364 44 Ocean Ave. South Yarmouth, MA 02664 I Laboratory ID#: 0849364-01 Description: Water-Drinking Water Sample N: Sampling Location: 1895 Main St,Barnstable,MA Collected: 9/18/2008 I Collected by: P.Davidson u Received: 9/18/2008 ; I Test Parameters ITEM RESULT UNITS RL MCL Method N Tested Total Coliform Present P/A 0 0 SM9223 9/18/2008 Absent for Eeofi Approved By: (Lab Director) F I E a i i r? f{ t ( j I i i I I I - j i I. ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO. Box 427, Barnstable, MA 02630 -Ph: 508-375-6605 Town of Barnstable 1HE Tp�� yP o� Regulatory Services * BARNsrABLE, * Thomas F. Geiler, Director 9�A b;: ,0�a Public Health Division TFD A4P'�A Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 May 28, 2007 Ms Sonya Phillips 1895 Main Street West Barnstable, MA 02668 The.septic system located at 1895 Main Street,West Barnstable, MA was last inspected on - -April IV",20079--by PatrickM. O'Connell,a certified septic inspector--for the State of Massachusetts. The inspection of the septic system showed that the system"Failed" under the guidelines of 1995 TITLE 5 ( 310 CMR 15.00) due to the following: Distribution box is deteriorated and leaking. One leaching pit was empty at time o inspection and the other had 4' of standing water You have 60 days from the date of the system failure to bring the system into compliance. If there are any questions about this reminder, please feel free to contact the Barnstable. Health Department. BARNSTABLE HEALTH DE TMENT Thomas A. McKean; R.S., C.H.O. Agent of the Board of Health i'i j: /2005 TEE i1: 50 FAX 5083627103 Barnstable CTY HcalthLab Barnstable Health 20:11/003 1 fT� _ CJE TEFICATE OF ANALYSIS Page: _: — sl;r�td E''rr - � Barnstable County Health Laboratory Report Prenared For: Report Dated: 1/1 4/2009 jlIt E �'•' Shaur,F.Harrington I` l All Cape Well Drillir_g Order No.: G0950472 P O Box 126 :� of i lt' �� �t t .a s --- Brewster, MA 02631 (J,�p mu - - --_ lliat�arat��ry_IID#: 0950472-01 Description: Water t ,.e E f _; (c ample#: Sampling Location r18J5 Route Arnstable,NIA 31'�l�7 Collected: 1/1=069 Calic:cted by: Customer I Received: 1113/0(19, RESULT UNITS _ RL MCL Method# Tested 4 1 f h �*no .i.a ND mg/L 0.20 EPA 350.1 M 1/12/2009 I Nstrate=as N iirogen 4.9 mg/L 0.10 10 EPA 300.0 1/12/2009 it ki Co--der ND mg/L 0.10 1.3 SM 3111B 1/13/2009 1rc�R ND 0.10 0.3 SM3II1B 1/13/2009 i�hn'. ,4 ; t Sodium 1 tl I t Z4 mg/L 1,0 20 SIv13111B 1/13/2009 r �I p l t l'ts:af Co.li#arn1 Absent PIA 0 0 SM9223 1/12/2009 k j 4 '+I` ;• i!t:C+'s1C�UL'1:iEtiCw 210 uniohs/cm 2.0 EPA 120.1 1/12/2009 .p�� 6.4 pH-units 0 SM 4500 H-B 1/12/2009 sbd iim level is above the maxium contaminant level, Those on a low sodium diet may wish to consult a physics n. f1 ;I y i i ✓' Approved B ° (Ls Director) EI I / I. x G j. K' f IIt�� t3• I: r v'.' f it it tj , I i ,9 R E i s; IT I v:6 oa, ND=Nine Detected 4 FtL = Reporiing i:,imit MCL=Maximum Contaminant Level I, Superior Court House, PO.Box 421, Barnstable, MA 02630 Ph: 508-375.6605 ° .........._- --— .............._... _.__... ....--- 1 ' I.. . ; j'!,200u THU 11: 50 FAX 508.1627103 Barnstable CTY HealthLab - Barnstable Healti1 140i12i G 0 3 I ' 'Sit- CERTIFICATE ®F ANALYSIS Page: 9 Barnstable County Health Laboratory Report Prepared For: Report Dated; 1/14/2009 "3 r +:: Shaun F.Harrington + AlI Cape Well Drilling Order No., G0950472 P 0 Box 126 , IA Brewster, MA 02631 Ir' +li + tLaiicr�f.,l _ID#. 0950472-01 Description: Water-Drinking Water :ample#: Sampling Location 186S Route 6A Barnstable,lt4A Collected: 1/12C260 Collated by: Customer Received: i/1'1C30(9 11RA 5-2-42- Volatile Organics by GC131S t ! a '{ ; N�I'PEi11 RESULT _UNITS _ RL MCL Method# Ana .st Tested Not, I is i fDichlorodifluoromethane ND ug/L 0.50 EPA 524.2 yn 1/12/2009 IE ` 6 t a + C1I6ron.et2ane ND ug/L 0.50 EPA 524.2 vn 1/12/2009 i !, uryl chlo;-ide yn ND u�L 0.50 2.0 EPA 524. 1/12/2009 2 �'; grornonieti3:ze ND u_/L 0.50 EPA 524,2 yn 1/1212009 Il i,•1�1,1,21'etrachloroethane ND ug/L 0.50 EPA 524.2 yn 1/12/2009 1 TJ,l•-T'richl.oroethane ND ug/L 0.50 200 EPA 524.2 yn 1/12/2009! i I i I11 1,'1 2 ,-'1•'etrachloroethane ND ug/L 0.50 EPA 524.2 yn 1/12/2009 I �iL1,2-Tri+ch.lo:roethane ND ug/L 0.50 5.0 EPA 524.2 yn 1/12/2009 1;1 ifli,I.-Dichl.o-1-0ethane ND ug/L 0.50 EPA 524.2 yn 1/12/2009 t ' `•! 11-Dichloroethene ND ug/L 0.50 7.0 EPA 524.2 yn 1/I2/2009 li,4-13ichloropropene ND ug/L 0.50 EPA 524.2 vn 1/12/2009 is 1;2;3-Trichlorobenzene ND ug/L 0.50 EPA 524.2 yn 1/12/2009 '_.3-1"rirhIoro ro ane NI) ug/L 0.50 EPA aL P p" yn 1/12/2069 r it ? � 1; ,4-Trichlorobenzene ND ug/L 0.50 70 EPA 524.2 yn 1/12/2009 ;;1ii;4-Trunethylbenzene ND ug/L 0.50 EPA524.2 yn 1/12/2009 i I 1;,< € k` ! 1,2-Dibron.o-3-chloropropane ND ug/L 0.50 EPA 524.2 yn 1/12/2009 i 1i a ,U2-Lribron-.oethane(EDB) ND ug/L 0.50 EPA 524.2 yn 1/12/2009 ; ! i. Dichiorcibenzene. ND ug/L 0.50 600 EPA 524.2 yn 1/12/2009 filllzi .I:..; 1]';,b2- �ichloroethane ND ug/L 0.50 5.0 EPA 524.2�-1 a.1 yn 1/12/2009. ,,2 Dichloropropane ND ug/L 0.50 EPA 524.2 yn 1/12/2009 i: . .i + ;3,5••Trsrncthylbenzene ND ug/L 0.50 EPA 524.2 yn 1/12/2009 3-Dichlororenzene ND ug/L 0.50 EPA 524.2 yn 1/12/2009if ' {.` ill ,3-Elichloropropane ND ug/L 0.50 EPA 524.2 yn 1/12/2009 •i�, 4-Dichlorobenzene ND ug/L 0.50 5.0 EPA 524.2 YA 1/12/2009 ( ! t 'L'rz-bichloropropane ND ug/L 0.50 EPA 524.2 yn 1/12/2009 i,1bilorotolaene ND ugJL 0.50 EPA 524.2 yn 1/12/2009 rt !; Citiclrotolaene ND ug/L 0.50 EPA 524.2 yn 1/12/2009 ND ug/L 0.50 5.0 EPA 524.2 vn 1/12/2009 k ti {I ( !l Iictliobzme ND ug/L 0.50 EPA If' E-i,:l yn 1/12/2009 ,rpmochl:oromethane ND ug/L 0.50 EPA 524.2�lil � yn 1/12/2009 :hloromethane ND ug/L 0.50 EPA 524.2 yn 1/12/2009 '13roITiofb:nn o { ND ug/L 0.50 EPA 524.2 yn 1/12/2009 ND=None Detected 1Zh = Reporting Limit MCL=Maximum Contaminant Level Superior Court Douse, PCB.Box 427, Barnstable, MA 02630 Ph: 508•-375-6605 1 ii J is1l Ia'f:=UU9 THU 11: 50 FAX 5083627103 Barnstable CTY HealthLab ��� Barnstable Health 000VC63 1J Y CER T IFICAT'E d ANALYSIS l xi � + t rI }' ` � , Barnstable County Health Laboratory i1 f { cll a `'te a} y Report_Prepared For: Report Dated: 1/14/2009 Shaun P.Harrington All Cape Well Drilling 01 delr°No.: G0950472 P O Box 126 Brewster, MA 02631 O950472-01 Description: Water-Drinking Water J � yyJ ' ±; ±J {t 1 ``1I ,ample#: Sampling Location 186_,Route 6A Barnstable,MA Collected: 1/11/1009 Cbll+xted by: Customer Received: 1112/20619 I aI.rEp f 5274.2 d Volatile Organics by GC/MS RESULT UNITS RL MCL Method 9 Ina�l .st Tested Note i'Carbon tetrachloride ND ug/L 0.50 5.0 EPA 524.2 yn 1/12/2009 } , ' :1.11o1'ob:;nzene ND ug/L 0.50 100 EPA 524.2 yn 1/12/2009 1 ,1'� 111)1oI'OEai1e 1)e ND ug/L 0.50 EPA 524.2 yn 1/12/2009 Uorotilrtn. ND ug/L 0.50 80 EPA524.2 yn 1/12/2009 pis-1,2•-Clichloroethene ND ug/L 0.50 70 EPA 524.2 yn 1/12/2009 Cliclgloropropene ND ug/L 0.50 EPA 524.2 yn 1/12/2009 1� € } ;!) olrtnc41loromethane ND ug/L 0.50 EPA 524.2 yn 1/12/2009 s j.0 € >»romomethane ND ug/L 0.50 EPA 524.2 yn 1/12/2009 yibe: &-ne ND ug/L 0.50 700 EPA 524.2 yn 1/12/2009 1 (` Tc.u<Ic hlortibutadiene ND ug/L 0.50 EPA 524.2 yn 1/12/2009 fi j { `1 '1} iT5o <ro* lb°nzene ND uel, 0.50 EPA 524.2 5 yn 1/12/2009 > M(Abytene chloride ND ug/L 0.50 5.0 EPA 524.2 yn 1/12/2009 ' 1 fTNIi thy]-tterl-!butyl ether ND ug/L 0.50 EPA 524.2 yn 1/12/2009 t , I�l�TaplltllaiCr.f; ND ug/L 0.50 EPA 524.2 yn 1/12/2009 1 i 4-4 utylb4mzene ND ug/L 0.50 EPA 524.2 yn 1/I2/2009 'rrF'ro1)y.'.1)e.azcna ND ug/L 0.50 EPA 524.2 yn 1/12/2009 Isopropy!.toluene ND ug/L 0.50 EPA 524.2 n 1/12/2009 1 1. k y � ,'sec.-Buty'lbonzene ND ug/L 0.50 EPA 524.2 yn 1/12/2009 1 1' '•11 r r i,ti0 ND ug/1'.. 0.50 100 EPA 524.2 yn 1/12/2009 1 } iiieri 11ut5']bf:nzene ND ug/L 0.50 EPA 524.2 yn 1/12/2009 , / ';;•j I '4n 7'et:.•a.ehlorcethene ND ug/L 0.50 5.0 EPA 524.2 yn 1/12/2009 ii 11 { 1. ]aene ND ug/L 0.50 1000 EPA 524.2 yn 1/12/2009 � 9s!,ibi� xyl n ug/L i 0.50 10000 EPA 524.2 yn 1/12/2009 , 3 2 i1i, i trans 1 2-•Dichloroethene ND ug/L 0.50 10( EPA 524.2 yn 1/12/2009 6`d11S ].,'3•.:Dictaloropropene ND ug/L 0.50 EPA524.2 yn 1/12/2009 1 i, �d' 4'richlorcethene i; ND ug/L 0.50 5.0 EPA 524.2 yn 1/12/2009 s{ ,jlj"richlorolluoromethane ND ug/L 0.50 EPA 524.2 yn 1/12/2009 ' 1�1 i( j5+ya'ia rrc!eyed Is above then:axiom contaminant level. Those on a law sodium diet may wish to consult a physiei�n J. + .' FJ n Approved B 1, t h1D=I`'=Detected RL Reporting Limit MCL=Maximum Contaminant Level Superior Court Douse, PAD.Box 427, Barnstable, MA 02630 Ph: 505-375-6605 ,11 ! I` E j�l II i �.lyar. !C, 1009 i . 5IPI� IViP,S� D�P No. 9248 P. 1 COMMONWEALTH OF MASSACHUSETTS ! ►' ! ;' l;°� ' __ EXECUTIVE OFFICE OF ENERGY& ENV'IRONMENTAL AFFAIRS _ _= DEPARTMENT OF ENVIRONMENTAL PROTECTION SOUTHEAST REGIONAL OFFICE 20 Riverside Drive, Lakeville MA 02347 508 946-2700 l� lil�A.x L.F'ATRICK�'`1:� l i e� a' p IAN A.B®tiYIaT;.i II S2CI'E:tIr�e is [&0`r'I'rf P.9(lTi.Ii.AY ,� L�AURTF tat.Ae Emi,Governos Commis�iol}e FAX COVER SHEEN, I A � F&K # (508) 946-2565 TELEPHONE # (505) 946-2851 i !ll DATE 1/14/09 FROM: Roberta Edwards 1?L7'AJ5 H DELIVER TO. Barnstable Berard of Health 508 790 6304 Town Manager 506 790 6226 j; Fire Dept. 508 776 6440 ! re I (O AL NUMBER OF PAGES: 4 (INCLUDING COVER PAGE) PL IMSE CALL, IF YOU 130 NOT RECEIVE COMPLETE FAX. r� k Notice Of Responsibility, 293 Sea St. , Hyannis PEjPEj 1 11 �; f hJs information Is available in mlteruate format.Call Donald M.GOrnes,ADA COOrdin®tor at 6I7-9_%b1057.TDD Semice•14M.29&2209. DEP on the World Wide Web: http:/Avww.rnass.gov/dep Printed on Recycled Paper No.- Fee---9-1-�1-=-------- BOARD OF HEALTH TOWN OF BARNSTABLE Application-for Melt Con0ructionPermit Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair ( )an Individual Well at: Location — Address Assessors Map and Parcel Owner Address Installer — Driller Address Type of Building Dwelling Other - Type of Building - No. of Persons__--_ ------------ - _ 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 Certificate .of Compliance has been issued by the Board of Health. Signed` �!� � <! —__— __Zz:z�?— date Application Approved By— - ------ �1 --- date Application Disapproved for the following reasons: ----------------------- -------- date _ Permit No. ob ._�_— Issued���-`-L���-[--'�_____-_-------- date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliance THIS IS TO CE TIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( ) by-Ait---/-_ - .------- -- ----------- Installer has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. -- ----------Dated-------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE-----— —- _ Inspector-- ----- - -- •• ma�c�.,.jj • No. �--_L_� Fee--C/J-=-�----- _ BOARD OF HEALTH Y TOWN OF BARNSTABLE Zpplication-for Well Conaruction3permit Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair ( )an in dual Well at: Location — Address Assessors Map and Parcel 14 Owner Address t L�✓ �'U -L�'- - �� b ar _S 14c.� �!� 11-7 A Installer — Driller -- _ Address Type of Building Dwelling Other - Type of Building-=---------- No. of Persons------ Type of Well-- - ,< // �vr YPCapacity--------------------------------- Purpose of Well----13 -- ---L _---_-. Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions„of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation until a Certificate.of Compliance has been issued by the Board of Health. Signed °� -� - - —-._- _1�_�D�D date Applic#tion Approved By ! ' ' -- ©.fa'7 - — ------- date Application Disapproved for the following reasons: ------------------- ----— ------ -- — ----------- ------------ date Permit No. � --� IssuedL � -5_ date -. _ -------- ------- ----------------------- ------------------------------ -- BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Comphance i- �G �tC t vN r✓I-f- THIS IS TO CE TIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( ) by lAA-_- l _� /_L Installer at____- _, - 5 '• / -/ /�� -------------------------------------------------------------- has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. -------------------Dated------------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE -- Inspector--_-------- --- --------- BOARD OF HEALTH TOWN OF BARNSTABLE Well CongtructionPermit No. - / D Fee- �---- Permission is hereby granted -- --- - ---------------------------------- to Construct ( ), Alter ( ), or Repair ( an Individual Well at: o No. - -- — -- -------- -- ---- - ----- - - Street as shown on the application for a Well Construction Permit No._b��� - Dated-/ p lv-0 __- t n Boar of Health DATE TOWN OF BARNSTABLE LOCATION ��l �U� VILLAGE (,L),r .-f 1'1. ASSESSOR'S MAP&PARCEL 02��G daS� rNSWA4,-ERSNAME&PHONE NO. ��t'I� CCC�c;�+ �I SEPTIC TANK CAPACITY I SDU l 0 LEACHING FACILITY:(type) 1tiS size) NO.OF BEDROOMS OWNER �! 7�'PERMIT DATE: °�� CG►€�DATE: � - Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist j on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Faculty(If any wetlands exist within 300 feet of leaching facility) Feet i FURNISHED BY _ I Main Street/Rt m b� ' rk �i T sr • �'n ',7�i�� ,E� '' x"� fffN,r Ca h'i:i•i:•iii rat.. ,gip t I" ::•:is:.::::::.. i:�.;;:}�::�: 69 } 4 .., y0�x a 7 36 Y � n 49 44 - 63 41 So i i s; TUE 13: 56 FAX 5083627103 Barnstable CTY HealthLab ---� Barnstable Health t" 2001, u01 CER TIF La ATE 0H AI A YSIS Page: I Barnstable County Health Laboratory "� LE \'tcrru Report For: Report Dated: 11/18/2008 i£ Paul Davidson Orden-No. G0850039 44 Ocean Ave. South Yarmouth, MA 02664 }Y'i).aboratary I 50039-01 De cription: Water-Drinking Water ` *' Sample 4: Sampling Location: 1895 Main St.Barnstable,MAl Collected: 11/17/200£ 1 l.. _ fir,' Collected by: P.Davidson Received: 11/17/2043€ ;r4J OGd1iwe J. ITEM RESULT UNITS RL AICL Method# Tested q',Nitrate as Nitrog en 3.4 mg/L 0.10 10 EPA 300.0 11/17/2008 >1=` Cotner 0.35 mg/L 0.10 1.3 SM 3111B 11/18/2008 ( Copper 11s. )IQIt 1,9 mg/L 0.10 0.3 SM 3111B 11/18J2008 t 'Sodurn 13 mg/L 1.0 20 SM3IIIB 11/18(2008 i' Tota:f Co iform Present PIA 0 0 SM9223 11/17/2008 . 1 ' Conductance 180 umohs/cm 2.0 EPA 120.1 11/17/2008 4 u 1w PH $,9 pH-units 0 SM 4500 H-B 11/17/2008 4.J , ,Recoynmended maximum contamination level exceeded due to Coliforrn Bacteria Retesting is recommended. May present { f ttt aesthetic problems(taste,odor,staining)due to Iron ; .. . -- - - ......,....- .......... --..... ------------------- Approved B • (Lab ' ector) i yL ' . T. p.1t t S , 3R'�.�(: qh�.: I :A ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level 't Superior Court Douse, PO.Box 427, Barnstable, MA 02630 Ph:508-375-6605 l.' it I i. -Rj CERTIFICATE OF ANALYSIS Page: 1 ;`off_ . g Barnstable County Health Laboratory Report Prepared For:• Report Dated: 11/18/2008 Paul Davidson Order No.: G0850039 44 Ocean Ave. South Yarmouth, MA 02664 i Laboratory ID#: 0850039-01 Description: Water-Drinking Water Sample#: Sampling Location: 1895 Main St.Barnstable,MA Collected: 11/17/2008 Collected by: P.Davidson Received: 11/17/2008 Routine ITEM RESULT UNITS RL MCL Method# Tested Nitrate as Nitrogen 3.4 mg/L 0.10 10 EPA 300.0 11/17/2008 C;inner 0_35 mg/L 0.10 1.3 SM 31 1 1 B 1 1/18/2008 Iron 1.9 mg/L 0.10 0.3 SM 31 1 1 B 1 1/18/2008 Sodium 13 mg/L 1.0 20 SM 31 1 113 1 1/18/2008 Total Coliform Present P/A 0 0 ,SM9223 11/17/2008 Conductance 180 umohs/cm 2.0 EPA 120.1 11/17/2008 pH 5.9 pH-units 0 SM 4500 H-B 11/17/2008 Recommended utaxintiun contmninat:on level exceeded due to Coliform Bacteria. Retesting is recommended. May present aesthetic problems(taste,odor,staining) due to Iron. Approved B_y �_ _ (Lab ector) G� v? z 1v W � Cn rt► s. ND=None Detected RL = Reporting Limit MCL=Maxinwm Contaminant Level Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605 09/18/2008 THU 15: 40 FAX 5083627103 Barnstable CTY HealthLab 2002/002 1J a. . CERTIFICATE OF ANALYSIS page: 1 1Q r. Barnstable County Health Laboratory Report Prepared For: Report Dated: 9/28/2008 Paul Davidson Order No.: G0849317 44 Ocean Ave. South Yarmouth, MA 02664 Laboratory ID#: 0849317-01 Description: Water-Drinks Water Sample tl: Sampling Location 1895 Main St.Barnstable,MA Collected: 9/16/2008 Collected by: P.D. Received: 9/16t2008 Routine ITEM RESULT UNITS RL MCL Method k Tested Nitrate as Nitrogen 3.2 mg/L 0.10 10 EPA 300.0 9/16/2008 Copper 0.32 mg/L 0.10 1.3 SM 311113 9/17/2008 Iron 0.86 , mg/L 0.10 0-3 SM 3111B 9/17/2008 Sodium 32 mg/L 1.0 20 SM 3111B 9/17I2008 Total CoIiform Present P/A 0 0 SM9223 9/16/2008 Conductance 190 umchs/cm 2.0 EPA 120.1 9/16/2008 pH 6.3 pH-units 0 SM 4500 H-B 9/I6/2008 I The recommended maximum contamination level for drinking water exceeded due to Coliform Bacteria and Sodium May present aesthetic problems(taste,odor,staining)due to Iron.Those on a low sodium diet may wish to consult a physician. Retesting is recommended lei ` � s Approved By: (Lab uector) i i f d.: ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level S. Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph:508-375-6605 ::. CERTIFICATE F ANALYSIS O SS Page: 1 Barnstable County Health Laboratory yt Iri`% Report Prepared For: Report Dated: 9/19/2008 Paul Davidson Order No.: G0849364 44 Ocean Ave. South Yarmouth, MA 02664 Laboratory ID#: 08493641-01 Description: Water-Drinking Water Sample#: Sampling Location: 1895 Main Sttarnstab!e,MA Collected: 9/18/2008 Collected by: P.Davidson Received: 9/18/2008 i Test Parameters i ITEM RESULT UNITS RL MCL Method# Tested Total Coliform Present I'/A 0 0 SM9223 9/18/2008 I Absent for F_.coli .7 i s . Approved By: r (Lab Director) A \I I Uj N --.1 O r N Uj N ND=None Detected RL = Reporting Limit MCL—Maximum Contaminant Level Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 TO V rmlt�- aO08- N OF)f# RNSTABLE G LOCATION ���� —0— S n$� VILLAGE (,U, (`y�. ASSESSOR'S MAP&PARCEL CV(P �aS� fN&TA+4,ERS NAME&PHONE NO. r IC-1C(3d0 cJ C4,96— l"n SEPTIC TANK CAPACITY /SOU d LEACHING FACILITY:(type) 62 14S -OVi size) NO.OF BEDROOMS O� OWNERS PERMIT DATE: ATE: /j 67 Separation Distance Betwee e: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY 0 Main Street/Rt 6A m�a tip. 5 49 ` t e 63 q� 1 50 Garage I:000T10Ki 7 SEWO,(:�E PERMIT 1.1O. IMSTQLLER•5 IJ&MF- ADDRESS bUILDER5) Q I MF- ADDRESS DATE PERNAIT ISSUED DATE COMPLI WACE ISSUED \ - s 9 ~� i � . ..� '°� 1 �. . , ,, --��� ;� �; ��� � _ C;Z 0....` T FEE ....../............. S THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH gq 5 J Appliration -for iiivviial orkii Towitrurtion Vrrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: cation-Address or I of .V. Jo_ __=�►x_. . ............. ............. �_.. {L�Ain,_1�1+4 Owner Address / a 40_1+ AA 1. �o------------------------------------- ------14-5-18....44JAt,.AVU-1... -- ------- Installer Address d Type of Building Size Lot--._____—t.A,-----------Sq. feet U Dwelling—No. of Bedrooms-------------�------•--____-_-.___-_.Expansion Attic (Y) Garbage Grinder (Al) 44 Other—Type of Building ____________________________ No. of persons---------------------------- Showers (Z) = Cafeteria (N ) Q' Other fixtures ----- --------- ------------- - - W Design Flow-------------_ 4..........._.........gallons per person per day. Total daily flow.....6;.ZA U_._..................._....gallons. WSeptic Tank—Liquid•capacitv�OA�gallons Length-------------_. Width.............. Diameter---------------- Depth.-.------------- x Disposal Trench—No-____________________ Width.................... Total Length......_.--..---_---. Total leaching area-------------.------sq. ft.Seepage Pit No......../---------- Diameter.................... Depth below inlet.................... Total leaching area------------------s(l. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by------- -----------------•-----._......._...•--. ......................... Date---------------------------------------_ . Test Pit No. 1................minutes per inch Depth of "Pest Pit.................... Depth to ground water..___-__--_.-__.--._.... �14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-_.-.---------_---_---.. Ix ------...--•----------------•--------...•---------•--------•----•-•----•-•-•-••--•-•--••--•-------••......................................................... Description of x Soil - � -------_---------------- _ rU- ----------- - /6- Fr . ----- � - ---- .. -------------------------------------------------------------------------------------------------------------------------------------------------------------1k,11TEA......------------•--- U Nature of Repairs or Alterations— nswer when applicable.-..---------------------------- �����-._-_-�_�__..��.____--__---- 1)lows= I • d r � q -------------------------------------------------------- --�r`--------------------------------------------------------- k,l/�-w &X�y c�enl _ COCOPP///fiou✓yG _K"Ole- 3.- ;de 1 e o�lS------------------------------ Agreement: - i The undersigned agrees to install the-Ucfesri�ee Individual Sewage Disposal System in accordance with the provisions of Article \I of the State Sanitary Code— The undersi ned further agrees not to place the system in operation until a Certificate of Compliance has be ' su y the d f alth. / Signed------ ----------------• ----- -------- Application Approved By —----A.:.._..__.. _ pace�y Date Application Disapproved for the following reasons-----------------•----•--------------------------.....---------------------...............---••------------------ i i Date PermitNo.-_ L�Z,-----------•-----•---------------------- Issued........................................................ Date e t r � , t 1 THE COMMONWEALTH OF MASSACHUSETTS ' BOARD OF HEALTH . ......... .. _ _...-.... -- .OF....................................... --.................. Appliration for Di,ipoiitt1 Worko Tonitrnrtion Vrrmit pl&ation is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: -, JG s " �_.TEA........................ - T ----------------------------------------------------I------------------------�-_j_-._---------- ddress or Lot NoceALD --------- .........t- --------------T —ttQ................... -•------- Address ,a y� Installer Address d Type of Building Size Lot.......1..1'Q............Sq. feet U Dwelling—No. of Bedrooms---- .........................Expansion Attic (Y ) Garbage Grinder 01) pa., Other—Type of Building ............................ No. of persons._-._-----.--.----..---.-- Showers (2 ) — Cafeteria (N ) Q' Other fi_ ures ...................................................... w Design Flow............ ..0........._...........gallons per person per day. Total daily flow.._.¢�.Q.Q--.--..-_-.----..........gallons. WSeptic Tank—Liquid capacity���----.gallons Length---------------- Width.............-.. Diameter------.--------- Depth................ x Disposal Trench—N ---------------_--_ Width--_--------------- Total Length-------------------- Total leaching area--------------------sq. ft. Seepage Pit No................. Diameter---.-----------.---- Depth below inlet........-........... Total leaching area......-.-_----.-sq. ft. z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date----•---------------------------------- ,� Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water.....--.--.............. f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water --..-.------------------ ------------ --- --- ------------------------------------------------------------------ D Description of •-•-•-.....f � � - -------------------------------- ------------------------------ --------------------•-•---------•--••----------•----------•-------U - ------- - ----- -----------........ 1 ,t14o*r.A-----.------------------ V Na�ttire:of Repa�i,r�' e�atons—Answer when ap li�able,.........._ 9...... -------------- _.J.�B,E, ---....'_.� �.....•---... .' zogr........ T�-3rd ----"-----�tp ------------------------- Agreement: kJ/4�P_ Cam'X j#,0x 01ee, ' /�f l/ `o - E �a��� � .Fc . The undersigned agrees to install the a e escrlbed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersi nevi further agrees not to place the system in operation until a CertificagekofrCompliarice his b ssu y.th �r of �alth" t Signed..... . ----•-...... ,,.. . s O '�/�?`.�.y A ltcatton A raved I3 ..- }- .... y........ �,. „,�pP ,, .f Y- ((JJ 4 M1 f.'. fY£ �q��� ._ . .`t �.�I...................... 'L.`v g .'tt "r K. :ir'S.a t. .) ' r Date Application Di§approved f or:,tlte following"reasons'"`.---. -.t "_ ' r �x' 4" 41 :,: Date. PermitNo.3y 7......•----•--•-•-------------------------- Issued....................................................... Date % 'a%''+_HE COMMONWEALTH OF MASSACHUSETTS BOARD � OF HEALTH �� w.................O F..1 .0# l Sr `C�..................:............................ ................... T.rxtifirtttr of Tompfialtrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by.............J-P 1-1,........... L D------------•----•------------------------------------------------------------------------------------------------•......... Installer at------......`-y•r- -----------------=-------------------------------------------------------------------------------------- has been installed in accordance with the provisions of Article XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit�Not.o_s 4.. ... --. . --- dated.. 1C.. ..-..a4/............. � = THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARA4EE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE THE COMMONWEALTH OF MASSACHUSETTS BOARD OF` 1=1EALTH31/7 ......... .................OF... 1� .Ll............................................. 11 Di Vatial lVork,i 01onitrnrti-A rrrmit Permission is hereby granted 0 1v�, A#i-ra - -----.................------------•--•------------------------------------------------------------••-•-----••--•---_-•... to Construct or Repair ( ) a . Individual ew�age Disposal System {......f./ Street + - 4. .L as shown on the applicattoti f.•"or,,Disposal Works Constructiolitermit No..-. -7-.---- Dated.... of Health DATE-------------------------------------------------------------------------------- FORM 1255 kOBBS & WARREN, INC.,`*P IJBtISH ERS 4- a SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVER,Y. ■ Complete items 1,2,and 3.Also complete A. Signature$0 e,17t j,,, f�/ item 4 if Restricted Delivery is desired. A D Agent ■ Print your name and address on the reverse /rf PL ❑Addressee so that we can return the card to you. B. Rec ived by(Printed Name) C. Dat of livery ■ Attach this card to the back of the mailpiece, Sf/� or on the front if space permits. D. Is delivery address different from hem 1 es 1. Article Addressed to: If YES,enter delivery address below: ❑No MsISonyal'nillips 1895 Main Street 3 Service Type West}3arnstable,MA' 02668 .V Certified Mall ❑Express Mail L ❑Registered ❑Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article N.u{nber (iransfer`firni service tabs►) 7,0 0 5 1160 0000 0191 3240 eipt 102595-02-M-1540 UNITED STATE`S S�i. & I -1 e .Y• %.•;2'k ;en� .ro..Fi•r1s•'l�.�MH.i,�Y,..,.c\,'� 'dHv �Mty�rD�Olp7��+Wi�j��4atU�V��,sM0IXt}i�cr��ih.Arj�-�aaprj,i�yiseA�f,bprh My�P�\I\�•n riv:l , Sender. Please print your name, address, aRZIP+4 in this box • PUBLIC HEALTH DEPARTMENT w TOWN OF BARNSTABLE 200 MAIN STREET HYANNIS, MA 02601 I I I .�r�.�L'.rr«i�•'�'.• S'„}�i`,jrJ,•,� .. 1�7:trttt2 1 31.1 {rtr:rtt) : .;111.,l�At�.lit't.t•��!eti 5- Al il�,l,E PERT✓ltT 1.!'O:I /ate--1�p-G►� J�-�-�� � �� =.-- —l�l-��-L�.l..l.E�-S-IJ�►ME-�_AD DRE S,S /A- ' 8-U-1-L-U-E-R-S—iJ-L��l_l AA Do►TEP-E-R- M%T 155UED—d_-- --- r - — - st _ �.o � " ti: � � R` . i/ s r•. �4� No.. - _. 67 .. ...........J..... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH _ 5 :e ..DEN f� � . ....................`.. , ppliratiott for Bigpoii ti Worka Towi#rurtion Vrruift Application is hereby made for a Permit to Construct ('� ) or Repair ( ) an Individual Sewage Disposal System at F�'-..'••-13 a-....�/�......�..� r �a t-•-•-•-----•----------••••••-•-•••-•-•-•--•--�..--•••--•................................ Location-Address Owner Address W. ..... ................................................ ................. � nstat ller Address Q Type of Building Size Lot...j®b_q O_�._..Sq. feet U Dwelling—No. of Bedrooms---------- ______________________________Expansion Attic Garbage Grinder ()q) aOther—Type of Building ____________________________ No. of persons.--------------------------- Showers ( ) — Cafeteria ( ) dOther fixtur -- --•- - ----------------- --------------- ------------------------------- ...... Design Flow. allons per person per day. Total daily flow.............. g�allons. WSeptic Tank Liquid capac�v --- alions Lent `.'�_°y. VVidth..���d�✓_ DiameterL _N._. Deptll. L '✓ x Disposal Trench—No_ __________________ Width _ . _�1 ,otal Length-------------------. Total leaching area „ ,_. .sq. ft. Seepage Pit No..J4- . . Diameter.._ Depth'below i�et(... .. � otal leach:ig a�t.n__ sq. ft. Z Other Distribution box ( ) Dosing tank ( ) �t6� —' aPercolation Test Results Performed by........ .e.tP_A4�j✓...................... Date___ " 3_ .7. _..__--.. Test Pit No. 1_..e�� minutes per inch Depth of Test Pit.-.-____•_________-- Depth to ground water------------------------ ,(Lq Test Pit No. 2----- __minutes per inch Depth of Test Pit____________________ Depth to ground water--_.-.-.-_-.---.----.._. W _________ ______ ___ _--_______-_--_--________-_---•-. ---- ..--..... .... _..... Description of Soil__....__. '.___ �h/ r—. " Z - ------------ -------- •--- � -- --- -• -- _ W ------------------------------- ----•-----`�::-•------•-------•--•-----------•--------•------------------------- -- 1 :- - -- U P` PP ........ ..Nature of Repairs or Alterations—Answer when applicable.. ....._.._...___... .. A Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article NI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issue bvy tl}e board At health. `j9 igned_ . . - .---• ---- - {D ate Application Approved By--------- ` Date Application Disapproved for the following reasons------------------------------------- ----------------p-----------------------------------.--------e--------------- ------------------------ --------------------------------------------••------------------------•----------•-•-•••-•••--••------•----•---••-•---••-•••............---------------------..... ------------ at Permit No. Issued.... - Date No..... _ Flziic.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ���r�•r� OF . ...5. c .� Iirtttiuu -fur Bi,ipniitt1 Vorks Towitrurtiou Vrrmit Application is-hereby made4or,a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: -• . ....... . !_3a_ .�3���r7i� Lo ion-Address q or Lot No 1 f? / , r � e rya, e, ------------=---------------- --=- --- Address ------------ - ._................! .!..__._.._.; W q Installer Address Q Type of Building Size Lot...........................Sq. feet U DwelVng—Yo. of Bedrooms---------------_-.......................Expansion Attic (/X,) Garbage Grinder (X) aOther—,Type of Building ............................. No. of persons---------------------------- Showers ) — Cafeteria ( ) ther fixtur W Design Flowt......... ................. allons per person per day. Total daily flow______._. :.._..__._,._ _ -.--_.--__.._ allons. Septic TankLiquid capacity. _ . allons Le t kA� . Width-/��?!' _ Diameter_/�G� . t x Disposal Trench—No. Width- _ Total Length Total leaching area .�s ft. Seepage Pit No----� :Diameter ..... Depth..below inlet..;..� "`✓.. Total leaching,area._-_---.-__-------sq. ft. ,., Z Other Distribution box ( )` }Dosing tank ( ) Percolation Test Results Performed b},-�" ........... Date.............'t___ . _ Test Pit No. 1------------ minufes per inch' }Depith of Test Pit____________________ Depth,to ground water--. ---------------- (� Test Pit No. 2........ .minutes per inch;`,Depth, '� of Test Pit.................:.. Depth to ground. water...::.__:_--__.___ ------------------------------ ..........................................------------------••--------••-------••-•-•-----.....--•--••-------------------.. . O Description of Soil------.S'! !l. .... �! - . •------- V ---------------------------------------- .......... ...•- --------------- --- ---------•--. .. .... ........................................................ ............. _ UNature of Repairs or Alterations Answer when applicable.................................................................................. • Agreement The undersigned agrees to install the aforedWribed Individual Sewage Disposal ,System in accordance with:, the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place,the._system in operation until a#Certificate of Compliance has been is bylthe bo r f ealth. rnate �. At Application Approved By ---..----• ---•----- . --•--- •--•-- ( f T �� Date r Application Disapproved for the following reasons----------------------------------------...................................................... = ------------------......................................................................................... = Date Permit No........................................................... Issued-•--l`` 2 `7 / -- �.�,.. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALT, ..OF...... (11rrttfirate of Tompliaurr T S TO CE IYq Tha theidual Sewage Disposal System constructed ( ) or Repaired by...... i--------------•- =---------•-- -•----. ----- . . --- ------- - ----------•--- .rr nsta er [ 21 at.............................. . ................ --........... ___ �4- a... .. _ �s .�' ... ..�----------- .. has been installed in accordance with the p ovisions of Article o +The State Sanitary Co /as.described in the �.Pp p _application for'Dis osal Works Consruction Pdr- 't No..____..._ ....... dated________716 __ .f•?tTHE PSSUANCE OF .THIS CERTIFICATES ALl. IdOT BE CONSYRUED AS UNYEE THAT SYSTEM -WILL FUNCTION SATISFACTORY. DATE _:�_:�..7 f G t s Inspector_:: -------•-----=---•- / THE %_%j1VjMONWEALAA OF MASS41CHLJSEITS ;. . r`+ BOARD 3 / ...........................................OF.....................--• 0....= �,. FEE........................ u ruWpjn Permtssto ereby granted__. . . .. !f!�.._....... ------ ------ - ------- - ------------- - Const t or I 1 1 a atNo.-------••-- ---- ---•---------------------•••••--•---.._... ............. y as shown on the application for Disposal W�`iks Const P ---------------- i " ___.... Dat __�_ * ................ Board f eat DATE ............. .............................................................. FORM 1255 HOBBS & WARREN. INC..r PUBLISHERS !' - +_ice _. � �.•; . DES/604% DATA 4 SEO)eoo/ RESIDENCE x /00 GAC.`DAy/BEG�oOM 400 6AL./DAY Flow 400 GAL.. x I.5 - 600 GAL SEPTIC TANK kEQwRCf, ; USE /250 SEPTC TAtik (MRTTgPOISET OR E(?U,09C) \ To7t1L CEACN/I)G AREA REQWREC: 40o 661- ORY x 2 5. PEF \ 6AL./0,41Y : goo 5•5• USE Z- 8,E"re CTIVC DEPTH x /2' CIA. LEACP PIT- Fok. 7aTl4L LEACHiNC ACEA o f 8 2 9. 2 •�. \ Y �o So \ M HH Mom• \ /G• \ � L \ f1uG 2 l 97¢ a1 oGSF � t / � -� GHQ-• C / } Z i / 7 C:.5 LE Rc N �C, 25 ` PEieCOL •� \ .�T / HOLE b C l Fk qr e,, Go✓E!k AT f/N/5/(GRHDE At i 114 WASHED STnN'E � to p � � o O Il LEA/CN�P�T d TOTAL CEACN/NG v 19kEA _ 4/4. 6 s.f cMA-77APOISE a { W B'O @ LERCH P/T x e''_ D OR EQU.g4) �, o , tN aF JAME5 G Po AN / L O T / L /-7/ V o,-- C 1 ova 41 ~ SIGNAL En1GInIEE�E' �Q/� �H�L L C 71, `�� /gyp. dac��7 Ca/oe e�9%r7ee�i�9 ��/ ' scALE : / 40 ' JUGY eS, /974 C/I//G E/vG/NEE.eS G ANO SUwEYo�S ToPoGRflPNY f�PPROX/MATED F/2oM 'Ile U S 6 S 0,Q7-Uf-7 . H YA N N I S Cr U 19 li R'f�NG L E ,eT6 6A 6WEPV57"ER /"1.9S5e9CHUSE77-S AeNE H. oJf'Lfq i 1 I l t I 1 i 1 Z6) 7- L I i Ci f( / T { 1 t ! ; 1 lb 2,90 I � � / (__ _ I for a — --� I S�� j e 7 4k lot i tt) TEST f I r / Y A / I 2z' w cS'/o6 C'�n,r�/ Fd// $osems�i�� mivf� trot'e za/ /sr AZW'r r,,4 2---le vofiaw 41,c, fyuvf E'levaillor. 46c ve Level c�uo/s 9B'!'"E/worior� fn 7h/s 1 // In 1 2, T�'•f P Dug By /11r. Ta4r; A, Qa/faj C Zo, /?743 al& I Pd by Ll-Aou/ �Ni�rrz✓/, f�eo�`fh 7nspPr-A-0 75can or/ 1oh/e. lae Ia. f o�' Pay u:co awe os ©iv,4oxed AV Locorior� of T��� i s o� /o 4?1i0.r: DATE MADE I A4, p :7/ ry)n - ?� aAV{U \`"t y DRAWN Y/CC' ;/. L>i("/L$ X� F. , CHECKED CARPEtffjF - i lC'7 IN CHARGE _ No. 73ba , &AAM, rA 51 F, ���7 S �o APPROVED SCALE / F7- 4yp/i c'riAi� ,Si9nar�urt . - --- - ----- --- -- - ----- CLIENT JOB DWG NO REV DATE APPROVED DATE ISSUED FOR NO. REVISIONS DATE The Draftboard,Inc.