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HomeMy WebLinkAbout2472 MEETINGHOUSE WAY/RTE 149 - Health (2) 2472 Meetinghouse Way W. Barnstable P A 155 027 ' z. I ri No. 4210 1/3 ETU 10% COMMONWEALTH OF MASSACHUSETTS = s EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS W DEPARTMENT OF ENVIRONMENTAL PROTECTION ii IMP I sJ J �•�� PARCEL O LOT TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION P q RECEIVED Property Address: 2472 Meeting House Way r ko,rLv West Barnstable Ma.02668 0 1 2��3 Owner's Name: John Hall AUG Owner's Address: 121 West Long Pond Road Plymouth Ma.02360 T�WHEALTH DEPT BLE Date of Inspection: July 10,2003 Name of Inspector: PATRICK M.O'CONNELL Company Name: SEPTIC INSPECTION SERVICES CO. Mailing Address: 189 CAMMETT ROAD MARSTONS MILLS MA 02648 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 Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature Date: 7A? 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: Cesspool dry at time of inspection. Abutting well 88' from Cesspool tested clean. ****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. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 1 i OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 2472 Meeting House Way,West Barnstable Owner: John Hall Date of Inspection: July 10,2003 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: _XX_ 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: 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,wil I 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: 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 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 i 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: 2472 Meeting House Way,West Barnstable Owner: John Hall Date of Inspection:July 10,2003 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 t 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 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: ' I Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 2472 Meeting House Way,West Barnstable Owner: John Hall Date of Inspection: July 10,2003 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 1/2day flow 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 form.] _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 r —I PA or a mapped system is located in a nitrogen sensitive area Interim Wellhead Protection Area W a —. — Y g ( ) PP 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. A Page 5 of i I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS $UBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:2472 Meeting House Way,West Barnstable Owner: John Hall Date of Inspection:July 10,2003 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 ? N/A 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 condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? _X _ Was the facility owner(and occupants if different from owner)provided with information on the proper mai ntenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: i, 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)) I Page 6 of 1 I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 2472 Meeting House Way,West Barnstable Owner: John Hall Date of Inspection: July 10,2003 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 2 Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):220 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):Yes Water meter readings,if available(last 2 years usage(gpd)): N/A well water Sump pump(yes or no): No Last date of occupancy: N/A COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgfl;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: None available 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 Septic tank,distribution box,soil absorption system _Single cesspool _X_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 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 2472 Meeting House Way,West Barnstable Owner:John Hall Date of Inspection:July 10,2003 BUILDING SEWER: X (locate on site plan) Depth below grade: 6" Materials of construction; X cast iron _40 PVC_other(explain): Distance from private water supply well or suction line: 20' Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: No (locate on site plan) Depth below grade: Material of construction: 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: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: 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: 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.): 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 8ofII OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 2472 Meeting House Way,West Barnstable Owner: John Hall Date of Inspection: July 10,2003 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: No (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,etc.): 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.): Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 2472 Meeting House Way,West Barnstable Owner: John Hall Date of Inspection: July 10,2003 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: leaching chambers,number: leaching galleries,number: leaching trenches,number, length: leaching fields,number,dimensions: _X_overflow cesspool,number: One overflow trench 30' long 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.): CESSPOOLS: X (cesspool must be pumped as part of inspection) (locate on site plan) Number and configuration: One with overflow Depth—top of liquid to inlet invert: n/a Depth of solids layer: 0" Depth of scum layer: 0" Dimensions of cesspool: 6'dia.x 6'deep Materials of construction: Block Indication of groundwater inflow(yes or no): No Comments(note condition of Eoil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): Cesspool was dry at time of inspection.Observed a scum stain at bottom of outlet wipe blocks are in rood condition. PRIVY: No (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 2472 Meeting House Way,West Barnstable Owner: John Hall Date of Inspection: July 10,2003 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. w�.�l Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 2472 Meeting House Way,West Barnstable Owner: John Hall Date of Inspection: July 10,2003 SITE EXAM Slope None Surface water None Check cellar Dry Shallow wells None Estimated depth to ground water: More tban 25 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: _X_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) _X_Accessed USGS database-explain: USGS and town GIS. You must describe how you established the high ground water elevation: Town groundwater contour map shows groundwater at el. 15 and USGS topo map shows land elevation at or above el.40 also no groundwater inflow into cesspool. JUL-23-2003 09:02 15083627103 15083627103 HAM CERTIFICATE OF ANALYSIS Par: � Barnstable County Health Laboratory Report Dated: 07/181200) Report RXIM13d For: order ]Ia>pnbers G0320919 David Flagg P 0 Box 74 West Bertlstable, MA 02668 ILabor&a #: 0320919-01 Maw= water-Drinkin0wator 9atnQle#: t091401 OtmWine Lacatlon_ 2464 Meetlaphouar Way.W.0arnatabla Colleatade 0710212003 155424 wealvcde 0710 2003 Collected byi D M4119 ,Roatine+Ammonia LP6,M RE Orrs MDL 2ja— Mathod Tested LAB. fG 146 Ammonia .0.1 m0/L 0.1 EPA 350.1 07/02/2003 Nitrates 0.9 MgI 9.1 10 SPA 300.0 07/07/2003 LAB.Metals Copper <0.1 mgA: 0.1 1.3 WHIR 07110/2003 Iron CQ.1 M11 0.1 0.3 9M 3111B 07/10/2003 Sodium 12 sn01L 1.0 20 9M 3111B 07/10/2003 LABr MkrobloloV Total Cpliform Absent PIA 0 Absene 309 07/02/2003 LAB.PAVvical Chemistry Conductance 14$ atltahalcnl 1 EPA 120.1 07/02/2003 PH 6.6 p1.1•lmits 0.1 EPA 130.1 07/01003 Note: . Water sample meets the recommended limits(br drioldn0 water of all above tested parameters. Superior Court House, F0.Box 427, Barnstable, MA 02630 Ph:$00-375.6605 i 3UL-23-2003 09:02 15083627103 15083627103 P.02 a CERTIFICATE OF ANALYSIS Page: 2 Barnstable County Health Laboratory Report Dated, 07/18/2003 Report Preuured__Fnr: Order Number: G0320919 David Flagg P0 Box 74 West Barnstable, MA 02668 Laboratory M* 0320919-02 Descriptl Water-Drinking Water Sample#: P338 339 340 Sampling Location, 2464 Meetinghouse Rd,^11nrngtable Collected: 07/0=003 Collected by. 0 Flagg IS"28 Reeelved: 07/02/2003 EPA 524.2- Volatile Organics by GC/MS ITEM RE9UI,T_ UNITS MDL MCL Method jested L4$. GC/MS 1,1,1,2-Tetraebloroethane BRL up)L 0.5 EPA 524.2 07/07n003 1,1,1-Trichlaroethane BRL dVL 0.5 200 EPA 524.2 07/07/2003 1,1,2,2-Tetrachloroethane BRL uSIL. 0.5 EPA 524.2 07/07n003 1,1,2-Trichloroethane BRL ug/L 0.5 5.0 EPA 5242 07/07/2003 M-Dichloroethane BRL ug/L 0.5 EPA 524.2 07/07n003 1,1-Dichloroethene BRL upIL 0.5 7.0 EPA 524.2 07/07/2003 1,1-Dichloropropene RRL, ug/L 0.5 EPA 524.2 07/07/2003 1,2,3-Trichlorobenzene BRL ug/L 0.3 EPA 524.2 07/07/2003 1,2,3-Trichloroprepane BRL uga 0.5 EPA 524.2 07/07/2003 1,24-Trichlorobenzene BRL ug& 0.3 70 EPA 524.2 07/07/2003 1,2,4-Trimethylbenzene BRL ug/L 0.5 EPA 5241 07/0712003 1,2-Dibromo-3-chloropropan BRL ug/L 0.5 EPA 524.2 07/07/2003 1,2-Dibromoethane(EDB) BRL ug/L 0.5 EPA 524.2 07/07n003 1,2-Diehlorobenzene BRL as& 0.5 600 EPA 524.2 07/07/2003 1,2-Dichloroethane BRL ug/L 0.5 5.0 GPA 524.2 07/07/2003 1,2-Dichloropropane BRL ug/L 0.3 EPA 524.2 01107/2003 1,3,5-Trimethylbenzene BRL ug/L 0-5 FPA 524,2 07/07/2003 1,3-Dichlorobenzene BRL ug/L 0.5 EPA 524.2 07/07/2003 1,3-Aichloropropane BRL ug/L 0.5 EPA 524.2 07/07/2003 1,4-Dichlorobenzene BRL ug/I. 0.5 5.0 EPA 524.2 07/07/2003 2,2-Dichloropropane BRL ug/G 0.5 CPA 124.2 07/07/2003 2-Chloroteluene BRL ug/L 0.5 EPA 524.2 07/07/2003 4-Chlorotoluene BRL ug/L 0.5 EPA 524.2 07/07/2003 Superior Court House, PO.Box 427, Barnstable, MA 02630 Pb,508-375-6605 JUL-23-2003 09:02 15083627103 15083627103 P.03 CERTIFICATE OF ANALYSIS Page.- 3 Barnstable County Health Laboratory Renort_Prepgred For*- Report Dated: 07/154003 Order Nuimben G0320919 David Flagg P b 13ox 74 West Barnstable, MA 02668 Laborato. _ID- :_ 0320919-02 Descrinli Wake-Beinhing Water Sample M. P338 339 340 Sampling Location: 2464 Meetinghease Rd.M.Barnstable Collcetedt 07/02/2003 Collected by- D Flagg 10-028 Rceelved: 07/02/2003 Benzene BRL ag/L 0.5 S.0 EPA 524.2 O7/0712003 Bromobenzene BRL ug/L 0.5 EPA 524.2 07/07/2003 Bromochlorolmetbane BRL ug/L 0.5 EPA 524.2 07/07/2003 Bromodichloromethane BRL ug/L 0.5 EPA 524.2 07/07/2003 Bromoform BRL ug/L 0.5 EPA 1241 07/07/2003 Bremomethane BRL ug/l. . 0.5 EPA 524.2 07/07/2003 Carbon tetrachloride DRL ug/L 0.5 5.0 EPA 524.2 07/07/2003 Chlorobenzene BRL ug/L 0.5 t00 EPA 5241 07/07/2003 Chloroethane BRL ug/L 0.5 EPA 524.2 07/0M003 Chloroform BRL og/L. Os EPA 524.2 07107/2D03 Chloromethane BRL ug/L 0.5 F.PA 524.2 07/07/2003 cis-1,2-Dichloroethene BRL a91L 0.5 70 EPA 524.2 07/0712003 cis-1,3-Dichloropropene BRL eg/L 0.5 l.PA$241 07/07/2003 Dibromochlorometbane BRIE ug/L 0.5 EPA 524.2 07/07/2003 Dibromomethane BRL ug/L 0.5 EPA 524.2 07/07/2003 Dichlorodifluoromethane BRL ugft. 0.5 EPA 524.2 07107/2003 Bthylbenzene BRL ug/L 0.5 700 FPA 524.2 07/07/2003 I Heaachlorebutadiene BRL U9tL 0.3 EPA 524.2 07/07/2003 Isopropylbenzene BRL UB/L. 0.5 EPA 524.2 07/09/200 Methyl-tert-butyl ether BRL ug/L, 0.5 EPA 524.2 07/07/2003 Methylene chloride BRL ug/L. 0.5 5.0 EPA 524.2 071 2003 n-Butylbenzene BRL u$1L 0.5 EPA 524.2 07/07/2003 a-Propylbenzeoe BRL ug1L 0.5 CPA 5241 07/07/2003 Naphthalene BRL ug/L 0.5 EPA 524.2 07/07/2003 p-Isopropyltoluene BRL ug/L. 0.5 CPA 524.2 07/07/2003 see-Butylbenzene BRL ug/L 0.5 EPA 5M.2 07/07/2003 Styrene BRL ug/L. 0.5 100 EPA 524.2 07/07/2003 Superior Court House, PO.Bore 42.7, Barnstable, MA 02630 Ph:508-375-6605 I ' JUL-23-2003 09:03 15083627103 15083627103 P.04 CERTIFICATE OF ANALYSIS rags: 4 Barnstable County Health Laboratory �p�} reaJlred Far-, 114pe l MOM 07119/2003 Order._Number: G0320919 David Flagg P 0 Box 74 West Barnstable, MA 02660 2 19 LJ1borJ�tArx_.iD#•_ 03 �� -02 Aes¢riot;on; Wider-Drinking Wstdr SAMP1e9s P338 339340 taamoling Landant 2464 Meetinakovie 11d.,W.Baenetable Callectedt 07/02/2003 Calleeted byx D FIaag 155.028 Received- 07/02/2009 Pert Butylbenzene BRL awt 0.3 EPA 524.2 07/07/2003 Tetraehloroethene BRL ROIL 0.5 5.0 EPA S24.2 07/07/2003 Toluene DRL UA 0.5 Joao EPA 524.2 07/074003 Total xylonm BRL aglL 0.5 10000 EPA 524.2 07/07/2003 tans-1,2-Dlchloroethene 1'9LL ug/L 0.5 100 EPA 524.2 07/07/2003 trans-1,3-Dlchlorepropene ORL ug/L 0.5 EPA 524.2 07/07/2003 TrIchloroethene HRL ug/L U 5.0 ePA 524,2 07/07/2003 Trlchlorolluoramethane BRL ug/L 0.3 EPA n4,2 g7�a7/aoas Vinyl chloilde DB,L, ag/L 05 2.0 EPA 524.2 07/0712003 N010; Amiroved Hy, —pr' 9tJpe1Vhlr Court 13out11, PO.fox 427, BAraateble, MA 02630 Ph:308-375.6605 TOTAL P.04 NoA20 ------� Fee--------- ---- ----- BOARD OF HEALTH TOWN OF BARNSTABLE Application-for Vell Con5truct ion Permit Application is hereby made for a permit to Construct (Alter ( ), or Repair ()an individual Well at: L2, 40/N S/Z 6lr -_ /S • o 02 - -- Location — Address Assessors Map and Parcel Owner /'— Address � .vv._,� -- -- --- _— 0� - —�__I__t v J' `, i 'o _ Installer — Driller Address Type of Building Dwelling --- --- --—- —- Other - Type of Building-- ------- No. of Persons--- ------------- Type of Well r &_c �___—— Capacity------------——--- —— Purpose of Well-QonA 0 01 L - J — 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 placi he well in operation until a Certificate of Compliance has been issued by the Board of Health. Y Signe — — J211 ° ------ date Application Approved B —_— pp pp y97 date Application Disapproved for the following reason : -------------- ---- ______—_ ___—_ - — -----___------ date --- Permit No. - - Issued-------------- ____----_---____-- date BOARD OF HEALTH TOWN OF BARNSTABLE (tertificate ®f (tompliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired by-----0 A ,.a.-& --— ___-- ------ — -- - — --- -------- Installer at— — —----------- 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--------------- ——_—_--___ N\OV—. ------- - .-» Fee=----------- ---------- BOARD OF HEALTH TOWN OF BARNSTABLE �J ZippYicat ion,for)Veit Con5structionpermit Application is hereby made for a permit to Construct (Alter ( ), or Repair (�)adividual Well at: a_�T- --((. L.), c S�� 4/� --- =_ LSD ��?__. _ -- Location — Address Assessors Map and Parcel Owner Address f Installer — Driller Address Type of Building Dwelling --- --—----—- Other - Type of Building - No. of Persons--- Type of Well C — Capacity------------------------1 Purpose of Well--��"��(F� L ''-- — Agreement: \\'' The undersigned agrees to install the aforedl&ibs dividual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protec'tlon Regulation — The undersigned further agrees not to pla&'the well in operation until a Certificate .of Compliance has been issued by the Board of Health. Sig _ A /0 date Application A roved'-B Y PP PP date CZ _Application Disapproved for the following reason �`= '� = --- ------ -- date------- Permit No. -- Issued - ------ -- ----------- _date BOARD OF HEALTH TOWN OF BARNSTABLE _ Certificate Of Compliance a THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired (4' by____ ---- ' per— n Installer at---- /t I yJ c/ w /G &__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 Veil Con5tructionPermit --'�� - No. � Fee— Permission is hereby granted 6-A to Construc ( ) Alter ( ), or Repair (c4 an Individual Well at: Street as shown on;--he application for Well Construction Permit ----- -- -------------------- No.- �� — Dated— - kllci Boa�of Health DATE _ . � R e� �`� � Lf s t , m liwnar,: HALL,JOHN C II >�r�tt€xM�p�Pa cei; o� 4A Deve �t.3 LOT PARC x © Sl` .81 *,,. H �nI'll,E�vtrn HALL,JOHN C II � � ��� ass 101 %EPSI 0 9s 1 00000540 Yeas A S 31 SMITH PLACE 00 CAMBRIDGE MA 02138 vy 00-0000 000 x{ 052080 �" fe€erg a 3099 261 . f 2p'a 's HALL,JOHN C II «M 0580 3099/261 000045400 i s' 000044000 x eater s 0000003100 ' Locatr� 2472 MEETINGHOUSE WAY/RTE 149 W, Roa nex . 1013 t 0038 3. re ► '� WB VVV 0000 1 0000 r r� a �