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HomeMy WebLinkAbout0046 MEADOW LANE - Health 46 Meadow Lane W. Barnstable . P A = 133 020 9 A I YI R i t , � . . r .. � - "R' . � �:. � .. ��e,�� �.< a � g*'"r e-r k r �`', v o• '*. � , '� r r e7 '9, � __� ax �.' � k`• _" d •: I.. C'_ c � 4 � `,_a � � ,� � � ..� _,�.. �aa} ,;.� �. is - � � ,. - Q�I .. > x - � � `' Y 3 � � a � '= eRs �` 4 �. "' Y'�`:.e� '$� h. � r.4 "i•.�•.✓ �" }u ,x 4. i o - °. s ,fig #.. 9 •.r`�tl` y3 Tom`• ' i p, .^-e Erb '. ,r. .r Y at„^ '.. Yet. dt ,, • ° - .s:r -•, b Y-•' : *�' `:+w: ..rwj tiv{ '.a- .'°r'•. "Q-t "r: ,, 5 _ ' y i}@a 'a n •^;, a+. 14 ' pp w . '. -. .".t, "�;�.,1�� ,'ei 6v ,�''� 9� `4''Y,#s ti� ;u a• .. P fl ��, � �. - ..� 'ay'.� ' _y, .. G n 4e rao "s - . eN'� Y3 v ° � a s , c _ a_ - . �J p ��,�,, �` a7n..,� a ^�-` '�r*'•'�c m � a � �� �'..•�� "fir.,� "cam. �. a ,., ct " ex ,,, a ^ e° ° e a s 4' fir: r' 'y y `ar. ,-' x P gt� IN .� �; rs „. Sv'Ary ...yf.#¢• ..,+ - t,a +x�.:�,e ft.F -� "' s -' :�a.z y x fw 9 ., .. � t ... � � --�h. - 3 3_ � '# - .. � es t � •,z.-='xa "d '+� aZ+3`� ''"`4 ,'$ �' . fol'�a d. r Sv a ' Iv flL x " s' s '.k- 'J s. ,�,r+ ,� � .`r;,-fie ' �+ :, o� g�' p ?'" «s- i..-!� 4• ,., x �.,=:�+ a,..- z dL n.o - s � % �'�• � � � .� .,y � s � �' ��-a `� � — t�` � cis� �3 'e�' ,� � P •s ' a a .p � � ,. r r g -,� � � 3 e $, .; � �� '�` s��di � � �q, �l �� i z 74 .�, t 3 Aq. A" r� � 3 !•sr rp > F $ R4j'jx 3 s Al r , r Page: CERTIFICATE OF ANALYSIS � o Barnstable County Health Laboratory Report Dated: 12/1/2005 Report Prepared For: Ann Quinlan Order No.: G0533856. Remax Cape Cod Route 28 Cotuit, MA 02635 Laboratory ID#: 0533856-01 Description: Water-Drinking Water Sample#: 33856 Sampling Location 46 Meadow Ln.W.Barnstable,MX__P Collected: 11/30/2005 Collected by: L.K.Stewart Received: 11/30/2005 Routine+Ammonia ITEM RESULT UNITS RL MCL Method# Tested LAB: IC Lab Ammonia BRL mg/L 0.20 EPA 350.3 11/30/2005 LAB: Inorganics Nitrate as Nitrogen BRL mg/L 0.10 10 EPA 300.0 11/30/2005 LAB: Metals Copper BRL mg/L 0.10 1.3 SM 31 11 B '12/112005 Iron tBRI, mg/L 0.10 0.3 SM 3111E /2005 w C= Sodium 22. mg/L 1.0 20 SM 33111B iItEl/zoo a M LAB: Microbiology 1 C t6 1 co Total Coliform Absent P/A 0 0 309 U) 113/0/200 -' LAB: 'Physical Chemistry Conductance 130 umohs/cm 1.0 � EPA 120.1 11730/200_'�M N 1`— pH 8.1 pH-units 0 EPA 150.1 1151k2005" EPA 524.2 - Volatile Organics by GUMS ITEM RESULT UNITS RL MCL Method# Tested LAB: GCIMS 1;1,1,2-Tetrachloroethane BRL ug/L 0.5 EPA 524.2 11/30/2005 1,1,1-Trichloroethane BRL ug/L 0.5 200 EPA 524.2 11/30/2005 .1,1,2,2-Tetrachloroethane BRL ug/L 0.5 EPA 524.2 11/30/2005 1,1,2-Trichloroethane BRL ug/L 0.5 5.0 EPA 524.2 11/30/2o05 1,1-Dichloroethane BRL ug/L 0.5 EPA 524.2 l l/30/2005' 1,1-Dichloroethene BRL ug/L 0.5.. 7.0 EPA 524.2 11/30/2605 RL'= Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605 t r rnti{ `W Page: 2 CERTIFICATE OF ANALYSIS �sr�C�SV�f ]Barnstable County Health Laboratory Report Dated: 12/1/2005 Report Prepared For: Ann Quinlan Order No.: G0533856 Remax Cape Cod Route 28 Cotuit, MA 02635 1,1-Dichloropropene BRL ug/L 0.5 EPA 524.2 11/30/2005 1,2,3-Trichlorobenzene BRL ug/L 0.5 EPA 524.2 11/30/2005 1,2,3-Trichloropropane BRL ug/L 0.5 EPA 524.2 11/30/2005 1,2,4-Trichlorobenzene BRL ug/L 0.5 70 EPA 524.2 11/30/2005 1,2,4-Trimethylbenzene BRL ug/L 0.5 EPA 524.2 11/30/2005 1,2-Dibromo-3-chloropropa BRL ug/L 0.5 EPA 524.2 11/30/2005 1,2-Dibromoethane (EDB) BRL ug/L 0.5 EPA 524.2 11/30/2005 1,2=Dichlorobenzene BRL ug/L 0.5 600 EPA 524.2 11/30/2005 1,2-Dichloroethane BRL ug/L 0.5 5.0 EPA 524.2 11/30/2005 1,2-Dichloropropane BRL ug/L 0.5 EPA 524.2 11/30/2005 1,3,5-Trimethylbenzene BRL ug/L 0.5 EPA 524.2 11/30/2005 1,3-Dichlorobenzene BRL ug/L 0.5 EPA 524.2 11/30/2005 1,3-Dichloropropane BRL ug/L 0.5 EPA 524.2 11/30/2005 1,4-Dichlorobenzene BRL ug/L 0.5 5.0 EPA 524.2 11/30/2005 2,2-Dichloropropane BRL ug/L 0.5 EPA 524.2 11/30/2005 2-Chlorotoluene BRL ug/L 0.5 EPA 524.2 11/30/2005 4-Chlorotoluene BRL ug/L 0.5 EPA 524.2 11/30/2005 Benzene BRL ug/L 0.5 5.0 EPA 524.2 11/30/2005 Bromobenzene BRL ug/L 0.5 EPA 524.2 11/30/2005 Bromochloromethane BRL ug/L 0.5 EPA 524.2 11/30/2005 Bromodichloromethane BRL ug/L 0.5 EPA 524.2 11/30/2005 Bromoform BRL ug/L 0.5 EPA 524.2 11/30/2005 Bromomethane BRL ug/L 0.5 EPA 524.2 11/30/2005 Carbon tetrachloride BRL ug/L 0.5 5.0 EPA 524.2 11/30/2005 Chlorobenzene BRL ug/L 0.5 100 EPA 524.2 11/30/2005 Chloroethane BRL ug/L 0.5 EPA 524.2 11/30/2005 Chloroform BRL ug/L 0.5 EPA 524.2 11/30/2005 Chloromethane BRL ug/L 0.5 EPA 524.2 11/30/2005 cis-1,2-Dichloroethene BRL ug/L 0.5 70 EPA 524.2 11/30/2005 RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605 r •*' �`�� c ��L Page: 3 L CERTIFICATE OF ANALYSIS Barnstable County Health Laboratory Report Dated: 12/1/2005 Report Prepared For: Order N®.: G0533856 Ann Quinlan Remax Cape Cod Route 28 Cotuit, MA 02635 cis-1,3-Dichloropropene BRL ug/L 0.5 EPA 524.2 11/30/2005 Dibromochloromethane BRL ug/L 0.5 EPA 524.2 11/30/2005 Dibromomethane BRL ug/L 0.5 EPA 524.2 11/30/2005 Dichlorodifluoromethane BRL ug/L 0.5 EPA 524.2 11/30/2005 Et hylbenzene I?RL ug.0_ 0.5 700 EPA 524.2 11/30/2005 Hexachlorobutadiene BRL ug/L 0.5 EPA 524.2 11/30/2005 Isopropylbenzene BRL ug/L 0.5 EPA 524.2 11/30/2005 Methyl-tert-butyl ether BRL ug/L 0.5 EPA 524.2 11/30/2005 Methylene chloride BRL ug/L 0.5 5.0 EPA 524.2 11/30/2005 n-Butylbenzene BRL ug/L 0.5 EPA 524.2 11/30/2005 n-Propylbenzene BRL ug/L 0.5 EPA 524.2 11/30/2005 Naphthalene BRL ug/L 0.5 EPA 524.2 11/30/2005 p-Isopropyltoluene BRL ug/L 0.5 EPA 524.2 11/30/2005 sec-Butylbenzene BRL ug/L 0.5 EPA 524.2 11/30/2005 Styrene BRL ug/L 0.5 100 EPA 524.2 11/30/2005 tert-Butylbenzene BRL ug/L 0.5 EPA 524.2 11/30/2005 Tetrachloroethene BRL ug/L 0.5 5.0 EPA 524.2 11/30/2005 Toluene BRL ug/L 0.5 1000 EPA 524.2 11/30/2005 Total xylenes BRL ug/L 0.5 10000 EPA 524.2 11/30/2005 trans-1,2-Dichloroethene BRL ug/L 0.5 100 EPA 524.2 11/30/2005 trans-1,3-Dichloropropene BRL ug/L 0.5 EPA 524.2 11/30/2005 Trichloroethene BRL ug/L 0.5 5.0 EPA 524.2 11/30/2005 Trichlorofluoromethane BRL ug/L 0.5 EPA 524.2 11/30/2005 Vinyl chloride BRL ug/L 0.5 2.0 EPA 524.2 11/30/2005 Sodium level is above the maximum contaminant level. Those on a low sodium diet may wish to consult a ph v ician. Approved By• (/Lab ector) RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605 I MAP t _ PARCEL. ; fl 2® SOT 12 i r DATE 7119.104 PROPERTY ADDRESS: 46 /7eadow Lane 5 kF Baarzzi-a&.ee, Oa. 0266s On the above date, the septic. system at the 'above address was Inspected. This system consists of the following: 1- 1000 gaiion 3gpt is .tank. I-D-izi2.if,ui-ion Sox. 3-500 gae.eon eeach-ing chamle2,3. Based on inspection, I certify the following conditions: 4. 7h.iz. .ins a ii.Ue live zepztjc 6y,3.tem (95)code 5. The 6e/2.t is .syziem i s in RaoRea woak.ing olden ai the pee,3eni lime. 6. Leach.ing a2ea waz upgaaded 7129102 SIGNATURE: 1/� ` Bauee lrlaca-iiieiea Name:-----------=------------- k.0 Tli Com an a' P. Nacomgea and .son Inc. r. 'u Py:-------------=-------- ; Box 66 `- n Address: N; Cenieay.i.e-ee, tea. 02632 Phone:----L5a11J-33-3-8--------- THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY JOSEPH P. MACOMBER & SON, INC. Tan ks=Cesspoois-Leachfields Pumped .& Installed Town Sewer Connections P.O. Box 66 Centerville, MA 02632-0066 775-3338 775.6412 i f COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRpNM' NTAL AFFAIRS DEPARTMENT OF +NVIItON�ViEN' AI, PROTI` CTION i K� TITLE 5 OFFICIAL INSPECTION FORM—NOT--FOR.VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PARTA CERTIFICA'TI.ON Property Address: .: 46 Meadow Lane W. Barnstable MA •02668. Owner's Name: Brian Stewart Owner's Address: qamQ Date of inspection: 7.119 1 n a Name of Inspector: (please print) Br r Company aaom.8..e2,&.�SAn Z.nc. Mailing.Address: Can e,/st e, a.d.�,. 02632 a� Telephone Number: 5 0 8—7 7 3338 CERTIFICATION STATEMENT that I have ersonally inspected the sewage disposal system.at this address and that the.infor aced o reported I certify P 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 groper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to-Section.15:340.of')hitle 5(310 CMR I5:000). The system: L Passes -Conditionally Passes Needs Further Evaluation.by the Local Approving.Authority Fails i afire: Dater inspector's S gn. The system inspector shall submit a copy of this inspection repor -to the-Approving Authority(Board of Health or DEP)within 30 days of completing this:inspection.If the systemji .a,shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owiter.sliellsubmit the report to the appropriate regional,office of the DEP.The original should be sent tolhe system owner and copies sent to the buyer,if applicable,and the approving. authority. Notes and Comments -~ ****This report only describes conditions at the time of inspection-and under the conditions of use at that time.This inspection does not address.how the system will perform in the future under the same or different conditions of use. T:.,e C TTmPlit;A" Pnrm 6/15/2000 page I . Page 2 of I I OFFICIAL INSPECTIONYORM NOT:FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM � PART A CERTIFICATION (continued) Property Address: 46 Meadow Lane W. Barnstable MA Owner: Brain Stewart Date of Inspection: 7119104 Inspection Summary: Check+A;B;CD or+E/ALWAYS<comp:lete=all of Section;D" A. System Passes: n o I have not found any information.which indiC-ates'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, �C. 15 U-) Przoe&r W O A O' �•,r �r T. B. System Conditionally Passes: One or more system components as described in.the"Conditional Pass"_section.need to be replaced.or repaired.The system,upon completion of the replacement or repair,as approved by the Boa'rrd of Health,will pass. Answer yes,no or not.determined(Y,N,ND)in the for the following statements.If"not determined"please explain. `f _The septic tank is metal and over 20 years old*or the septic-tank(whether metal.or:not)is.structurally unsound,exhibits substantialt 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: RObservation 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 broker,settled or uneven distribution box. System will pass inspectionif(with approval of Board of Health): broken pipe(s)are replaced. . obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION NORM PART A CERTIFICATION(continued) Property Address: 46 Meadow. Lane W_ ..Barnstablt- MA Owner:. Brian Stewart Date of Inspection: 7.11Q.104 r , C. Further Evaluation is Required by the Board of Health: \l Conditions.exist whichrequirefiuther�.evaluation.by.the-Board:.ofHeaith;inorder.:to:.determineif.thesystem. is failing to protect public,health,safety or the environment. 1. System will pass unless Board of Health determines1h accordance with 314.CMR 15.303(1)(b)that the system is not functioning in.a manner which:will.protect public health,safety'and the•.environment: to Cesspool or privy is within 50 feet of a.surface water tVJ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh l 2. System will fail unless the Board-of Health(and Public Water Supplier,if any)determinesahat 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. �k) . The system has a septic tank and.SAS and the SAS is within.50 feet of a private water supply well. l� The system has a septic tank and SAS and the-SAS is less than 100 feet..�}itt 50 feet or;more from a private water supply well". Method used to determine distance Y11e,)AU t`?A ` E)J "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5.ppm,provided that no other failure criteria are triggered.A copy of the analysis must be:-attached to this form. 3. Other: Page 4 of I 1 OFFICIAL INSPECTION FORM—NOT`FOR:VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 46 Meadow Lane W. Barnstabie MA Owner: Brian Stewart Date of Inspection: 7 1 9 '0 4 " D. System Failure Criteria applicable to all systems:. You must indicate"yes"or"no"to each of the.following:for all inspections: Yes No _ Backup of sewage:into facility..or.systern component due°.to overloaded or clogged SAS.or cesspool Discharge:or-ponding of effluent to the surface ofthe::ground or surface waters due to an overloaded or clogged SAS or cesspool f Static liquid level in the distribution box above outlet invert due to an'overloaded or clogged SAS or cesspool _ l Liquid depth in-cesspool is less than 6"below invert or available,volume is less than'h•day flow Z Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped Any portion of.the SAS,cesspool or privy is below high ground water elevation. Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface / water supply. J Any portion of a cesspool or privy is within ar Zone l of a:public well Any portion of a cesspool or privy is within.50 feet of a private water supply well. <. Any portion of a-cesspool or-privy is less than 100 feet but greater.than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water:analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution;.from:that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis niust be attached to this€orgt.] (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 1%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 _ _� e system.is within 200 feet of a tributary.to a surface drinking water supply a _ the system is located'in a nitrogen sensrttve:area(Intenm Wellhead Protection Area—IWPA)or a inpped Zone 11 of a public water supply well If you have answered"yes"to any question in Section E the system is considered a sign.ificant threat,or answered "yes"in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. 4 Page 5 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL>SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 46 Meadow. Lane . W. Barnstable MA Owner: Brian Stewart Date of Inspection: 7/19 4q 4 , Check if the following have been done.You must indicate•"yes"or"no"as to each,of the following: Yes No Pumping information was provided by the owner,occupant,or Board of Health Were any of the system components pumped out in the previous two weeks - Has the system received normal flows in the previous two week period? _ ./ Have large volumes of water been introduced to the system recently or as part of this inspection? _ 7Were as built plans ofthe systern,obtained and examined?(If they were not available note as N/A) _ Was the facility or dwelling inspected for signs of sewage backup _ Was the site inspected for signs of break out Were all system components,excluding the SAS,located on site? _ Were the septic tank manholes uncovered,opened,and the interior.of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and.depth of scum? Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site-has been determined based on: Yeg no ✓ Existing information.For example,a plan at the Board of Health. ' Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance .. is unacceptable)[310 CMR 15.302(3)(b)] 5 r Page 6 of 11 OFFICIAL INSPECTIGN FORM'—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAE iSYSTUM,INSPECTION;FORM PART.0 SYSTEM INFORMATION Property Address: 4 6 Meadow Lane W. Barnstable MA Owner: Brian S wart Date of Inspection: 7/1 9/;Q 4 FLOW CONDITIONS RESIDENTIAL c� . Number of bedrooms(design): ; ::dumber of.bedrooms.(actual): _ fr DESIGN flow based on'S10 C1GIl 15.203(for example-110 gpd x#ofbedroonis): X i�� % �i ADD Number of current residents: .:3 - Doesresidence have a garbage grinder(yes or no): Is laundry on a separate sewage.sy,stem,(yes or.no):. [if.yes separate inspection required] Laundry system inspected(yes or no):(1 `� Seasonal use:(yes or no): i9-- ' Watermeter readings, if available(last 2 years usage(gpd)): S �� TF Sump pum5(yes or no).f3L� c Last date o occupancy: flT COMMERCIAX bUSTRIAL Type of estab bunt: Design flow( i on 310 CIvIR 15.203):. g;� Ud Basis.of d4iivflow(seats/persons/sgft,etc.): jN Grease trappresent(yes or no):tlr,_ Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title S system-(yes or no): Water.,meter readings,if available: Last date of occupancy/use: . OTHER(describe):. GENERAL INFORMATION Pumping Records Source of information: Was system pumped as part of the inspection(yes or no): If yes,volume pumped:_gallons--How was quantity pumped determined? Reason for pumping: TY E aF SYSTEM Septic tank,distribution box,soil absorption system - . Smgle cesspool IW Overflow cesspool Privy RA Shared system(yes or no)(if yes,attach previous inspection records,if any) pA Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be &�Tighttank ined from system owner) . _Attach a.copy of the DEP.approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Were sewage odors detected when arriving at.the site(yes or no): 6 - BARNSTABLE COUNTY DEPARTMENT OF HEALTH & THE ENVIRONMENT P,O, BOX 427 e°` ��R SUPERIOR COURT HOUSE O v BARNSTABLE, MASSACHUSETTS 02630 J • 4ASs PHONE: 362 -251 ' EXT. 337 SAMPLING INSTRUCTIONS FOR PRIVATE WELLS : An improperly taken sample wastes your money and has. neither scientific accuracy nor IegaJ acceptance. 1. Obtain sterile sampling bottle from the County Lab or Town Health Department. Bottles sterilized at home are not acceptable. 2. It is recommended to use a straight faucet, preferably NOT sveingtype. 3 Turn on the cold water and let it run for five (5) minutes. 4. Fill the bottle leaving one inch air space. Do not fill bottle to the top. Be careful not to touch the inside of the bottle or cap with the faucet, your hands, or anything else. 5. Fill out the reverse side of this form. The laboratory requires accurate and complete information. The person filling the bottle must sign the form 6. The charge for a routine well analysis (coliform bacteria, pH, conductivity, iron, nitrate, sodium and copper) is 525.00. Checks should be made payable to BnrnstAble Counrv.- Exact change is required if paying in cash. Additional tests require additional fees. Consult lab or a price list for exact information. 7. Samples are accepted Monday - Thursday from 8:00 AM to 4:00 PM and Friday 8:00 AM to 1:00 PM. They must be delivered to the lab within 6 hours of collection or 24 hours if refrigerated. 8. Completion of tests and results takes 7-10 business days. Results will be sent in the mail. 9. Special requests such as results in 2 -3 days and sample acceptance on Friday from 1:00 PM to 4:00 PM are available for an additional charge. Contact the laboratory for availability. NOTICE: WATER FROM THE SAME SOURCE CAN PRODUCE CONTRARY RESULTS FF TESTED AT DIFFERENT TIMES AND/OR DIFFERENT LOCATIONS. THE COUNTY OF BARNSTABLE SHALL NOT BE LIABLE FOR DAMAGES RESULTIQ FROM THE RELIANCE_ ON RESULTS OF WATER TESTS ACCURATELY PERFORMED. PLEASE COMPLETE REVERSE SJDE :O_F FORM i PRIVATE WELL WATER SAMPLE DATA COLLECTION SHEET. IIAL NUHBERS FIELD DLA14K -E ID NUMDER DINE REC ' D r COLLECTION DINE :NG ADDRESS COLLECTION TIME WELL DEPTH :T ADDRESS YEAR WELL INSTALLED MAP/PARCEL 'HONE COLLECTED BY : APPOINTMENT NEEDED• ? F N FOR TESTING : ( ) SUSPECT A PROBLEM (EXPLAIN) ( ) REQUIRED ( ) FOR INFORMATION ONLY ( ) NEW WELL ( ) REAL ESTATE TRANSACTION ( ) OTHER ( EXPLAIN) C NCE OF WELL FROM POSSIBLE CONTAMINATION SOURCES ( IN FEET) . SEPTIC TANK\CESSPOOL FARM SALTED ROAD UST LANDFILL INDUSTRY SAS STATION OTHER T AENT USED: ( ) NONE ( ) WATER SOFTENER ( ) FILTER; SAMPLE TAKEN BEFORE/AFTER TREATMENT (CIRCLE) x . x x * * * * * ** * * * ** * * * * * *****.* ****** **** * * ****** * ** *** * ** * x x * t • • RESULTS VOC ROUTINE C' )FORM TOTAL COLIFORM\100 ML . 11 TRICHLOROETHANE ( PPB) pli _ CONDUCTIVITY IRON ( PPM) NITUTE-11ITROGEN ( PPM) SODIUM ( PPM) COPPER ( PP14) Al IS DATE : AIIALYSIS DATE: f Page 7•of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTIO NON FORM PART C SYSTEM INFORMATION(continued) Property Address: 46 Meadow Lane W_ Rarnstable MA Owner:_ Ar i an s t ewart Date of Inspection: '7 11 A 10 4 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: cast iron 440 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of j oints,venting,evidence of leakage,etc.): SEPTIC TANK: (locate on site plan) �r Depth below grade:_ Material.of construction: concrete metal fiberglass_polyethylene _other(explain) — If tank is:metal list age: 17 Is age confirmed by a Certificate of Compliance certificate) TnP (yes;or no):—(attach a copy of Dimensions?r to1� 11 �� t, - Sludge depth:�?} Distance from top of sludge to bottom of outlet tee or baffle: _ Scum thickness: --Ac L Distance from top of scum to top of outlet tee or baffle: _ Distance from bottom of scum to bottom of outletttee or baffle: _ How were dimensions determined: K�ar_s Vi� Comments(on pumping recommendations,mlet and outlet tee or baffle conditio structural irate as related to outlet invert,evidence of leakage,etc.): n' gnh',liquid levels c GREASE TRAP:e(locate on site plan) Depth below grade:N� , Material of onstruction:—&concrete N metal«;fiberglass (explain): 1 , polyethylene other Dimensions: 1A Scum thickness: Yy— Distancefrom top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or Fie: _ Date of last pumping: _ ,i Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage. etc.): q -P -C TMA G TTQnP/tllln 17nrm(�/1 Ghl1l1l1 7 Page 8 of 11. OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM %— PART C SYSTEM INFORMATION(continued) Property Address: 4 6 Meadow Lane W. Barnstable MA Owner: Brian Stewart- Date of Inspection:-// 9110 4 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade:1 Material of construction: A.concrete metal fiberglass N.olyethylene other(explain): Dimensions: M, Capacity: V gallons Design Flow:V\A\ gallons/day Alarm present(yes or no):(W\_ Alarm level:t% Alarm in working order(yes.or no): Date of last pumping: J1 Q,_ Comments(condition of alarm and float switches,etc.%-I DISTRIBUTION BOX: (if present must be opened)(locate on site plan) �. 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 et .): PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or no):0� , Alarms in working order(yes or no): Comments(note conditionn,of pump chamber, ondition of pum san _ d appurtenances,etc.): `7 YvrnY7 C Y U� IIo 4r 8 Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C: SYSTEM INFORMATION(continued) Property Address: 46 Meadow Lane Barnstable MA Owner:. Brian ewar Date of Inspection: 77 TD7 0 4 SOIL ABSORPTION SYSTEM(SAS): /�Iocateonplan,excavation not required) e If SAS not located ex lain why: I��o,�Ce d eQ, , ,� 110 Type V z leaching pits,number: leaching chambers,number Oo leaching galleries,number: JSQ_leaching trenches,number,length: r�b leaching fields,number,dimensions: 143 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.): ,� +� �o S F a. ®fir• � t • ��0�� 5 o szkr4 VW Korl 15 rur7ral CESSPOOLS:M (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: 0 Depth—top of liquid to inlet invert: Y1x, Depth of solids layer: PA, Depth of scum layer: Dimensions of cesspool: UL Materials of construction: Indication of groundwater inflow(yes.or no . �_ Comments(note condition of soi�signs of hydr�ulic failure,level of ponding,condition of vegetation,etc.): 0(� VU 7 'f . erg PRIVY: flj�(locate on site plan) Materials of co struction: I� Dimensions: Depth of solids: +� Comments(note condition of soil,si s of hydraulic failure,level of ponding,condition of vegetation,etc.): iV 9 Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address, 4 6 Meadow Lane W. Barnstable MA Owner: Brian Stewart Date of Inspection: 7/1 9/0 4" 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. t — - - Cr ql 3 0 WeGc 10 _ Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 46 Meadow Lane W. Barnstable MA Owner: Brian Stewart Date of Inspection: 7/1 9/0 4 n I SITE EXAM Slope Surface water Check cellar Shallow wells 1 Estimated depth to ground water 90 feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hple within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators,insta er - a ach documentatio Accessed USGS database-explain: a � r'`" You mli4t describe 4ow you establish the hieh g o nd water elevation: f - _ AA bys, Li e, J1 Q&I tvJ o�P � ����• ronl r„u ��rr �� u�m�' t,g•�� �'4�+i. 5 el "'W C T__..--a:_..T7....... L/I Ch'1 Ai)A t :,•>Rnr+.+-tft•,T.,•r•.,l�-mrI+,-T.S—esR ZTi•:TT,:'t,T„'i'iTT:Tai-tT,T:�,•.f,-Ci,.=-S..RT.' _ TOWN OF WARD OF HEALTH SUIISIJUFACE SEWAGE; DISPOSAL SYSTEM INSPECTION FORM - PART D •- CERTIFICATION •J•t•T71T,'^.:'iT'ftT.fi�L::tT1Rr`T''7::��1 � RRf.R'RRS'TfT[SO•TT1T'fTlfR.•.TtPl'T"•TT•^t••••••� -TYPE OR PRINT CI.EARLY- PROPERTY INSPECTED STREET ADDRESS 46 Meadow Lane � ASSESSORS MAP , DLO„CK AND PARCEL # OWNER' s NAME 13/t ian S.t ewa2t PART D - CERTIFICATION NAME OF INSPECTOR Bztuce Macaiii.z.toa COMPANY NAME a.,P.`Nacomeea and .6oiT'Znc. COMPANY ADDRESS /3No. 02632 ox 66 Csra��^bt�� Street 1Fown or ity State LIP COMPANY TELEPHONE (508 775 - 3338 FAX CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that t)ie information reported is true , accurate, and omplete as of the ti.rme of .,inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . n i Ilitt, Check one: System PASSED The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public Itealtl► or, the environment as defined in 310 CMR. 16 . 303 . Any failure cr.i.teria not evaluated are as stated in the FAILURE CRITERIA section of this form. System FAILED* The inspection which I have con ircted has found - that the system fails to protect the public health and the environment in accordance with Title 6 , 3.10 CMR 15 . 303 , and as specifically noted on PART Cam- FAILURE CRITERIA of this inspection form . Inspector Signature Date L copy of this certification must be provided to the OWNER, the BUYER One where applicable ) and the BOARD OF HEALTH. * If the inspection FAILED, the owner ortoperator shall upgrade ' the system. within o'ne year of the date of the inspection., unless allowed or requi..red otherwise as provided in 3.,10 ChJ.R 16 . 305 . partd.doc r v 3 :r I o o N, 77am 0 S'6 4er4 ,x/oW A No..GiJl .Z�� Fee-C. ('C THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS 39iq;pooat :&p!9tem Conoruction Vermit Permission is hereby granted to Construct()()Repair( )Upgrade( )Abandon( ) SY stemlocatedat 46 MFa(5wc Lane wa-st sarn••t•ah1P and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this t. Date: �� Approved -------- ------ --------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed(X )Repaired( . )Upgraded( ) Abandoned( )by Jc)senli P. Macomber & Son Tn a,46 Meadow Lane West Barnstable has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permi / dated d", 9"�a Installer J,.P. macomber. & Son Inc Designer J.P. Macomb r & Soj r-nc The issuanc of thi rmit shall not be construed as a guarantee that the syste ill fu ti n�s de ' ed. Date2 Inspector �lr' I TOWN OF BARNSTABLE �L LOC-kTION �Vt11P_sda uJ •L A SEWAGE # a�U1- I 17 VILLAGE e 5l 9AR ol.5 IA j94 e ASSESSOR'S MAP & LOT—LILL©a 0 INSTALLER'S NAME&PHONE NO. -�-',/Ll , e e'41 r e o A SEPTIC TANK CAPACITY ©6 d— el ZQ LEACHING FACILITY: (type)3-1,.Qiv'w e L S (size) 3 3 '` X /3 NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: 1,2° © COMPLIANCE DATE: e Z D Z Separation Distance Between the: Maximum Adjusted,Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by - 0 weL� 1"' Ll If 0 0 TOWN OF BARNSTABLE LOCATION IJ4 eAcl .0 u) I— - SEWAGE # DUI' yfll VILLAGE W e S'? gAk AIS I A RZ e ASSESSOR'S MAP & LOT L3 .3 ' 020 INSTALLER'S NAME&PHONE NO. -,�', 0.4 C 0,41 p e P, i N O y SEPTIC TANK CAPACITY l G 6 d— 01,0 LEACHING FACILrrY: (type)-37-4VV 2 _1 S (size) NO.OF BEDROOMS BUILDER OR OWNER S wu r PERMTTDATE: o COMPLIANCE DATE: D 2 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by I '• ��am p No. • � Fee 50_00 s ` THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: v Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Application for ;Migpooal 6potem Con!aruction Permit Application for a Permit to Construct pC )Repair('.)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 46 Meadow Lane West Barnstable Brian L. Stewart Assessor's Map/Parcel 1,3 3 0 ,9, O 46 Meadow Lane West Barnstable Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Joseph P. Macomber & Son Inc Joseph P. Macomber & Son Inc Box 66 Centervill 775-3338 Box 66 Centerville 775-3338 Type of Building: Dwelling No.of Bedrooms t _ Lot Size sq.ft. Garbage Grinder( ) Other TI pe of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Loamy sand to clay to fine sand. Nature of pairs or Al ratio (Answer when applicable) Installing 3-500 gallon chambers e Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by thi AB d o Health. Signed ��' Date Application Approved by _ Dates Application Disapprove or the following reasons Permit No. Date Issued V ' Fee 5 0-00 Entered in computer: V' _ 3+1E-COMMONWEALTH OF MASSACHUSETTS _:v- ` Yes � ,p PUBLIC HEALTH„DIVISION -TOWN OF BARNSTABLE.�MASSACHUSETTS r Application for �Btoo!gar 6potem Conotruction Vermit Application for a Permit to Construct(A)Repair(X )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components f ' Location Address or Lot No. Owner's Name,Address and Tel.No. 46 Meadow Lane West Barnstable -`Brian L. Stewart Assessor'sMap/Parcel " 46 Meadow Lane West Barnstable Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Jiiseph P. Macomber & Son Inc Joseph P. Macpmber & Son Inc Box 66 Centervill 775-3338 Box 66 Centerville 775-3338 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 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date `^ Title Size of Septic Tank ILI Type of S.A.S. Description of Soil= Loamy ssad to clay to finbesand. Nature of epairs orAlteratio s(Answer when a plicable) Installing 3-500 gallon chambers Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by thisFlBp*d o Health. Signed7 Date Application Approved by _, Application Disapprove or the following reasons Permit No. Date Issued 995�_ � '^ =� —————— THE COMMONWEALTH OF MASSACHUSETTS •BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed Repaired( X )Upgraded( ) Abandoned( )by Joseph P. Macomber & Son' Inc .t at46 Meadow Lane West Barnstable w -°."I, 1� t has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permits dated Installer J.P, macomber & Son Inc Designer J.P. Macomber & Son Inc The issuanc of this permit shall not be construed as a guarantee that the syste ill fu tip as dey�'g ed. Date � � I 0 Z Inspector ✓ A 7�e � `•- i NO. Fee5Q000 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS =i�po!6A*pgtem Conotructton Permit Permission is hereby granted to Construct(*-, )Repair(X )Upgrade( )Abandon(X ) System located at 46 Meadwo Lane Vest Barnstable and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this e'' 't. Date: 6 i' ���1-s � Approved .r� i,FGr'�.�.a�/t/Z-mil .. . , TOWN OF BARNSTABLE ! t— LOCATION 19&/ -44 e—&2 0 1 L A - SEWAGE # �aOO/ yk� VILLAGE U1 e 5l )!?AX AIS T A e ASSESSOR'S MAP& LOT / 3 .3 - 020 • j INSTALLER'S NAME&PHONE NO. - /L ,4 C o/m9 e o,✓ SEPTIC TANK CAPACITY e7 Zo LEACHING FACILITY: (type) -lJ,ev fib eLL-T (size) 3 3 61 9 /3 NO.OF BEDROOMS / BUILDER OR OWNER S wp r PERMTTDATE: 2 ' 0 2COMPLIANCE DATE: 712 D 2- Separation Distance Between the: . Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by IV 0 AV be p W Y.+ 0 we6c 01 i i S a �--p E 116199 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) L Joseph P.Macomber Jr- hereby certify that the application for disposal works construction petznit signed by me dated 6/28/01 concerning the property located at 46 Meadow Lane West Barnstable_ meets all of the following criteria: • The failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. • The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. • There are no wetlands within 100 feet of the proposed septic system • There are no private wells within 150 feet of the proposed septic system • There is no increase in flow and/or change in use proposed • There are no variances.requested or needed. • The bottom of the proposed !caching facility will n_2Lbe located less than five feet above the maximum adjusted groundwater table elevation. (Adjust the groundwater table using the Frimptor method when applicable) • 1f the S.A.S. will be located with 250 feet of any vegetated wetlands, the bottom of the proposed leaching facility will no( be located less than fourteen (14) feet above the maximum adjusted groundwater table elevation, , Please complete the following: A) Top of Ground Surface Elevation(cuing GIS information) 7 B) G.W. Elevation +the MAX, Mgh G.W. Adjustment DIFFERENCE BETWEEN A and B /7 f SIGNED : DATE: 6/28/01 (Ske6 7.070V tc pr sed plan of system on back). Q:hulth roll .cen Existing 1000 tank Existing 1000 Pit. P New pump cham er 3-500 gallon leachin chambers packed in 4 ' of 1z'-" stone. 5 ' dig out. All around and under the SAS. 34 'X1'3 'X2 ' ' I