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HomeMy WebLinkAbout1125 SERVICE ROAD - Health 1123 Service oad;y A = 153 - 038 t 3 n 1 t i a A i No. 4210 1/3 BLU C� ESSELTE 10% a 0 o c Er M rU Postage $ O • p Certified Fee C o O �q M Return Receipt Fee '/ , .7 U-l�re (Endorsement Required) •Y M Restricted Delivery Fee -0 (Endorsement Required) Total Postage&Fees u-I O o Sent To - G r - `�----- ------- ------------------- or PO Box No. ---------=----! s'-- 4 city,State ZlP ^-- ......... Certified Mail Provides:o A mailing receipt (awana a)zooz ounr use-od Sd o A unique identifier for your mailpiece • A record of delivery kept by the Postal Service for two years Important Reminders: e Certified Mail may ONLY be combined with First-Class Mail®or Priority Mail . o Certified Mail is not available for any class of international mail. o NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. o For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested'.To receive a fee waiver for a duplicate return receipt,a LISPS®postmark on your Certified Mail receipt is required. o For an additional.fee delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". o If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry. Internet access to delivery information is not available on mail addressed to APOs and FPOs. COMPLETE •N COMPLETE THIS SECTIONON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Sign e item 4 if Restricted'Delivery is desired. ❑Agent • Print your nam6and address on the reverse X .!G ❑Addressee so that we.can return the card to you. . Received gy(Printed Name) C. Dateof D livery ■ Attach this card to the back of the mailpiece, b or on the front if space permits. D. Is delivery address different from item 1? ❑As 1. Article Addressed to: If YES,enter delivery address below: ❑No Mr. Steven Cobb 1125 Service Road West Barnstable,MA 02668 3. Service Type ❑Certified Mail ❑Express Mail ❑Registered ❑Return Receipt for Merchandise ❑ Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2.. Article Number 7005 1160 0000 0191 2939 (rransfer from service label) PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid USPS Permit No.G-10 • Sender: Please print your name, address, and ZIP+4 in this box• PUBLIC HEALTH DEPARTMENT TOWN OF BARNATABLE 200 MAIN STREET HYANNIS, MA 02601 Ifh Mill I►1II Iflf,I„IIIIII I Iti<<JII II I III INI„III„III1,1 Town of Barnstable F tHE Tp� Regulatory Services Thomas F. Geiler,Director • BARNSPABLE, « MASS. 39. Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 March 16, 2007 Mr. Steven Cobb — 1125 Service Road West Barnstable,MA 02668 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system owned by you located at 1125 Service Road,West Barnstable,MA was last inspected February 5th, 2007 by James M. Ford, a certified septic inspector for the State of Massachusetts. The inspection of your septic system showed that your system"Failed" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: Backup of sewage into facility or system component due to overloaded or clogged SAS. The infiltrators were full,solids were present. The cover was 20" below grade. The liquid level was above the top and into the inlet pipe. Recommend risers be installed to bring covers to grade. 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 HEAL H DEPARTMENT Thomas A. McKean, R.S., C.H.O. Agent of the Board of Health Town of Barnstable 0 1Hf 1p� o Regulatory Services BARNMBLE Thomas F. Geiler, Director MASS.9� •�� Public Health Division �fD Mph A Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 March 16, 2007 Mr Steven Cobb 1125 Service Road West Barnstable, MA 02668 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system owned by you located at 1125 Service Road,West Barnstable,MA was last inspected February 51h,2007 by James M. Ford, a certified septic inspector for the State of Massachusetts. The inspection of your septic system after further evaluation"Fails"under the guidelines of 1995 TITLE 5 (310 CMR 1520)I�ue to the following: -J-0-j- I he infiltrators were full, solids were present. The cover was 20" below grade. The liquid level was above the top and into the inlet pipe. Recommend risers be installed to bring covers to grade. (jd You have ar 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 DEPARTMENT Thomas A. McKean, R.S., C.H.O. Agent of the Board of Health COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 1125 Service Road West Barnstable, MA 02668 Owner's Name: Steve Cobb Owner's Address: Date of.Inspection: February 5 2007 'Name of Inspector: (Please Print) James M. Ford Company Name: James M. Ford Mailing Address: P.O.Box 49 Osterville,MA 02655-0049 Telephone Number: (508)862-9400 . 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 15.006). The system: ; ._ Passes , Conditionally Passes "- Needs Further Evaluation by the Local Approving Authority ✓ a s c3� r w; Inspector's Signature: Date: February 8, 2007! The system inspector shall subm' 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 ****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 l Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS j SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 1125 Service Road West Barnstable, MA Owner: Steve Cobb Date of Inspection: Februaa 5. 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: 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: 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 ND explain: 2 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) C Property Address: 1125 Service Road West Barnstable, MA Owner: Steve Cobb Date of Inspection: February 5, 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 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: . 3 Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 1125 Service Road West Barnstable, MA Owner: Steve Cobb Date of Inspection: Februarys, 2007 D. System Failure Criteria applicable to all systems: You must indicate either"yes"or"no"to each of the following for all inspections: Yes No ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓ Discharge or ponding of effluent to the surface of the ground.or surface waters due to an overloaded or clogged SAS or cesspool. ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than '/2 day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped— ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation. ✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ✓ Any portion of a cesspool or privy is within.a Zone 1 of a public 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 must be attached to this form.] Yes (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 System: 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. 4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS ' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 1125 Service Road West Barnstable, MA' Owner: Steve Cobb Date of Inspection: February S, 2007 Check if the following have been done: You must indicate"yes"or"no"as to each of the following: Yes No ✓ _ Pumping information was provided by the owner,occupant,or Board of Health ✓ Were any of the system components pumped out in the previous two weeks? ✓ _ Has the system received normal flows in the previous two week period? ✓ Have large volumes of water been introduced to the system recently or as part of this inspection? ✓ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ✓ Was the facility or dwelling inspected for signs of sewage back up? ✓ _ Was the site inspected for signs of break out? ✓ _ Were all system components,excluding the S.AS,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: Yes No ✓ _ Existing information. For example,a plan at the Board of Health. ✓ _ Detennined 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 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 1125 Service Road West Barnstable, MA Owner: Steve Cobb Date of Inspection: February 5, 2007 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 3 Does residence have a garbage grinder(yes or no): n/a Is laundry on a separate sewage system(yes or no): n/a [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): Well water Sump Pump(yes or no): No Last date of occupancy: Currently COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): epd 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 Source of information: Unavailable 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 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: Installed on40/14/98-per as-built Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS ` SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1125 Service Road West Barnstable, MA Owner: Steve Cobb . Date of Inspection: February 5, 2007 BUILDING SEWER(locate on site plan). Depth below grade: Materials of construction: _cast iron _40 PVC other(explain): Distance from private water supply well or suction line: Continents(on condition of joints,venting,evidence of leakage,etc.): ( SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 45" 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: 1500. ,of aL Sludge depth: 4" Distance from top of sludge to bottom of outlet tee or baffle: 28" Scum thickness: 10" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 10" How were dimensions determined: Measuring stick 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 tees were present. The liquid level was even with the outlet invert. There did not appear to be any signs of leakage Recommend risers be installed to bring covers to grade. GREASE TRAP: None (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 recommmendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): 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: 1125 Service Road West Barnstable, MA Owner: Steve Cobb Date of Inspection: February 5, 2007 TIGHT or HOLDING TANK: None (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: Conunents(condition of alarm and float switches,etc.): DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) I 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.): Solids were present and the cover was 20"below grade PUMP CHAMBER: None (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.): 8 Page 9 of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1125 Service Road West Barnstable, MA Owner: Steve Cobb Date of Inspection: February 5, 2007 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not.required) If SAS not located explain why: Type leaching pits,number: ✓ leaching chambers,number: 6 infiltrators 10'x40'per as-built card leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: Innovative/alternative system Type/name of technology: Conunents,(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.): The infiltrators were full. The liquid level was above the top and into the inlet wipe. CESSPOOLS: None (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: None (locate on site plan) Materials of construction: Dimensions: Depth of solids: Commments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): 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: 1125 Service Road West Barnstable, MA Owner: Steve Cobb Date of Inspection: February 5, 2007 SKETCH OF SEWAGE.DISPOSAL SYSTEM Provide a sketch of the sewago 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. GALA BAD A/ O � (3 l aY 31 a -7o q3 3 5° 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: 1125 Service Road West Barnstable, MA Owner: Steve Cobb Date of Inspection: February 5 2007 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 70+/- 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 hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: topographic and water contours snaps Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: UsiniBarnstable topographic and water contours snaps the snaps were showing approximately 70'+/-to groundwater at this site. This report has been prepared only for the septic system and components described herein. This septic system has been inspected and failed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied, relating to the septic system, the inspection, this report and/or any components of the septic systent which have not . been located and inspected 11 Department of Regulatory Services r Public Health Division Date tli1y 200 Main Street,Hyannis MA 02601 Date Scheduled ) Time Fee Pd.—ZB Soil Suitability Assessment for S%qgeLs&0sa1 Performed By: 'Tah/1/ /0,�Q`VL i Witnessed By / Location Address LOCATION& GENERAL INFORMATION 7Tc1 �/G�� p zoo. —r. Owner's Name Address Assessor's Map/Parcel: J� �.� Engineer's Name NEW CONTR SUCTION REPAIR 1 Telephone Land Use Slopes �/ Surface Stones Of dBS,-2✓E-e Distances from: Open Water Body 3 DO ft Possible Wet Area g O0) ft Drinking Water Well /=7 a ft Drainage Way AJJ , ft Property tine /� ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands�n proximity to holes) k �o 3�,� � >s 0 t � 7�4, /Z S- s� .309 Parent material(geologic)/p-,4`*`9 5, Depth to Bedrock Depth to Groundwater: Standing Water in Hole: /f0 AT Weeping from Pit Pace Estimated Seasonal High Groundwater 4�—:� t V' 7l Al,,- ra CD J�pp (� DETERMINATION FOR SEASONAL HIGH WATER TABU - S Method Used: Depth Observed standing in obs.hole: in. Depth to sell mottles: Depth to weeping from side of obs.hole: .. in. Groundwater Adjustment Index Well# Reading Date: Index Well level,�____ Adl,faetor- Adj,Gmunl6cwt1ter 1--vel PERCOLATION TEST bate/23 0 Thn1e Observation Gj Hole# -re_ I .-rP -3_ c� r Timeat4���'SZ 'vo 2;26 t Depth of Pere Time at64// '3� Start Pre-soak Time @ d/o.�`G O //;'s _'v O Time(9"-60') /G in ` f 7,"V O End Pre-soak Rate MinJlnch 5 Z b 5 5 3 Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back---------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Conset'vation Division at least one(1)week prior to beginning. Q:\SEPTICWERCFORM.DOC DEEP-OBSERVATION HOLE LOG , Hole# Depth from Soil Horizon Soil Texture m Soil Color Soil' Other Surface(im) (USDA) , (Munsell) Mottling (Structure,Stones;Boulders. i to ravel 39 Loamy Sao Wo c, LoAin /oye Y3 90ve-9tz-3 60',-137- cz Z�0/7"My s � ��y,� /� 7�2ou� DEEP OBSERVATION HOLE LOG Bole# 2- Depth from Soil Horizon Soil Texture Soil Color .i Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consi enc % y 5YQ S Z -3 7 B . L o�m S�,v� G � yQ / 4 b/ 37 - (6 myxz %3 Dvv�a�hs w0''- 130" G 7 Ze*m Y,4 -711 T}26u6 611 DEEP OBSERVATION HOLE LOG Hole# Tom-3 Depth from Soil Horizon Soil Texture Soil Color. Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Cons istency,%Gravel) 59�b zarrj 7,5yR / GoDrLS 41 4 f — G o 5? T L 5,hL40 DEEP OBSERVATION HOLE LOG Hole# TP Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones.Boulders. Cons' t y,Vo y L,9,0n 7; 1/0`'— 58 '' C .5rc.T 52"- /3 Z".. Gz L°Amy 5AA1,6 oy,Q .�arJ6yo�T Flood Insurance Rate Mau: Above 500 year flood boundary No— 'yes Within 500 year boundary No_ Yes Within 100 year flood boundary No yes . Depth of Naturally Occurrine Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? YE-S If not,what is the depth of naturally occurring pervious material? Certification I certify that on G 5— (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required training,expertise and experience described in 310 CMR 15.017. Signature Date Ao4 TOWN OF BARNSTABLE CATION Seyvi o, 2�- SEWAGE# V LLAGE �n1. �Ar/1s7�i�� ASSESSOR'S MAP&PARCEL /S?'03� INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY S00 r ,� LEACHING FACILITY:(type) (,' I^I'f /At��1 (size) NO.OF BEDROOMS 3 OWNER CUSS PERMIT DATE: COMPLIANCE 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 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 Fore r3� GArAr— poor L) BAD a �. A' O A L3�� a o `t3 3 E0 S° TOWN OF BARNSTABLE L CATION Z$ SCPV,ez r-a SEWAGE# �7•®�( VILLAGE W��. ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. &r"G''i ConS�,r4e�� r� SCiSs 771 �t3�l�i SEPTIC TANK CAPACITY i gem Q,1Lon LEACHING FACILITY:(type) L+• 666�;\ &,m6zP S (size)13 X 3P*2 NO.OF BEDROOMS OWNER .!S� e-r, _ �p PERMIT DATE: A ZO-0-1 COMPLIANCE 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 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 T 'Q611& Al - Iq rtma, ea r A2, g7 I . Az-��� i9 l B3 v C � Z 11 C _ iio W 9-7-20 No.-------------------- Fee------------------------- BOARD OF HEALTH TOWN OF BARNSTABLE Applicat ion-for lVell Congtruct ion Permit Application is hereby made for a e t to ConstruXter ( ), or Repair ( )an individual Well at: 1�----------- = - = - -- �` :— � - Location — Address Assessors Map bag Parcel �' Owner Address ------------------- ---- L ".`f-------------------------------------------------- ----- --------------------------- - Installer — Driller Address Type of Building /�L f%-1 Dwelling------------— ( - -- --------------- 7 Other - Type of Building---------------------------------- No. of Persons------------------------------------------------------ // Type of Well------------�-- -------------— ----- YP ---------------------------- 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 C plia has b issued by the Board of Health. ow oe Signed r �� ------ -- -- Application Approved By— --------------- ------------- AKIT�; =--- -- Application Disapproved for the following reasons:------—------------------------------------------------------------------------—---- ---------------------------------------------------- ------------------------------------------------ date tA) j`� Permit No. -------`=-!— - -?- —----------------- Issued----- -- -= - — ------------------ da BOARD OF HEALTH .TOWN OF BARNSTABLE Certificate ®f Compliance � THIS IS TO RTIFY, That he Individual Well Constructed (Altered ( ); or Repaired ( ) -- - - - - ------------- z------------------------------------------- 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-----------------------------------------—--- ------------ v' �,` � _, _ y -" �3 "�"��i e.. ri`_Ff.•.-��,..ii 'b'"t .,i'w�, w � .�., No------=-------------- - t \ Fee-----------------.-...__ M 4, BOARD OF HEALTH j TOWN OF BARNSTABLE - A lication-*rVell Construction'V ermit Application is hereby made fora �e *t to Construct ), Alter.( ), or Repair ( )an individual Well at: Location — Address r Assessors Map 5p8 Parcel Owner Address w.--------------- ! Installer — Driller Address Type of Building /�J ✓ �/t Dwelling-------- - JJ --------------- 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 C mplia has bee issued by the Board of Health. Signed—=— - - - -- - -------- ----- - - --_ -- - _ ale pvc Application Approved By � - — --= =---— —_- - --- date Application Disapproved for the following reasons:----------------------------------------—---------------------------------------- -------------------------------- ----------------------------------------- ------- ------- -------- --------- ------------------- date Permit No. --- __ ---- Issued-- - — - -------------------- da — ansm am.�ma imas BOARD OF HEALTH TOWN OF BARNSTABLE Certifitate Of Compliance THIS IS TO RTIFY, That he Individual Well Constructed (Altered ( ), or Repaired ( ) by------ ---------------------------------- - - - - - -- -- . C Installer __��// / � at- � — ---------:------�-'_��"��C''t — Cf`'-"' - `-/____�------�--------- 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 Melt Construct ion-permit -----c(7- 26 �--,- No. ----------- Fee--- -- ---------- Permission is hereby granted------=-!/Ci--------`s--ter----------� x"'-`-- to Construct )6, Alter ( ), or Repair ( ) an Individual 1 at: No. �=--------- 0------------ -------------------------------- Street as shown on the application for a Well Construction Permit - --------------------- Dated-------- --- _=_ - - --�----------------------- No.- - — -___- ---- --- - - ------------ ------ ------------ ------ /,, Board of Health DATE----- �! _ __ h y No.c:�:, 7—© ` 47 FEE Board of Health, 9L Lr-- , MA. APPLICATION FOP DISPOSAL SYSHM CONSTRUCTION PERMIT Application for a Permit to Construct Repair( ) UpgradeA) Abandon( ) - ❑Complete System Individual Components Location 112_5� S& VI C& 4ffef.V aS Owner's Name 5��� V6 (A� Map/Parcel# j f�O ,3 1'04 J2-G, 39 Address Jf ZT s iF'✓� Lot# Y- Telephone# Installer's Name �T 0 ' Designer's Name �, D Y G .4,5_S D G/ v%;!s Address Q v j i ,� Address Zd �Lp 1/�2Cf�l.d� Ivy, ,FV1.1'nj rW Telephone# --a 9T- �� s .�e 771 Telephone# 5 O Type of Building Lot Size 7 Q l Z,S sq.ft. Dwelling-No.of Bedrooms Garbage grinder ( ) Other-Type of Building No.of persons Showers ( ),Cafeteria ( ) Other Fixtures Design Flow (min. required) R/h. gpd Calculated design flow �}'�� Design flow provided 93 gpd Plan: Date Z- � Number of sheets Revision Date Title /::7-� S7-mWPfW tOL CU Description of Soil(s) 0 "SL �- 3$" L ,54W l 32°4d"L0*1)7 er0°- ,32 L0*, 5,1A1,,0 Soil Evaluator Form No. R Name of Soil EvaluatorJ,0&,1 ,66YL-16' Date of Evaluation 3'O 7 DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees to no` o place tem in ation i too fiance h be issued by the Board of Health. Signe to Inspections � 411r No.� 09 '•'; a _. FEE .,COMMONWEALTH OF MASSACHUSETTS " . Board of Health, 2-4ICWS-7-49L 15- , MA. APPLICATION FOP, DISPOSAL SYSTEM CONSTRUCTION PERMIT " Application for a Permit to Construct Repair( )`Upgrade (Abandon - ❑Complete System Individual Com/nent�§ } ,, Location 112-5" SS/?0CE- 4afd Owner's Name S7Z' V& Gp,6 4Map/Parcel# MA/D 153 /`4/2G, 3 8 Address J/z�' S��✓/C F /�U � i ti Lot# �' Telephone# Installer's Name �/� �� Designer's Name J, (� 0 Y 4 Address Address 170 eLOV&IZAI C.6) 1#/ C . 1C'-511-1ndV W Telephone# �"4 - j a 77`, 90,2 Telephone# 50 S-- s6 3 - Type of Building Lot Size_ 7 14✓� sq.ft. Dwelling-No.of Bedrooms Garbage grinder ( ) Other-Type of Building No.of persons Showers ( ),Cafeteria O Other Fixtures Design Flow (min.required) g n1, gpd Calculated design flow "t}y Design flow provided !�93 —gpd Plan: Date Z'�tv - 407 Number of sheets Revision Date Title 5 i -f SE"W 9 bit64 S7c0 lV t 67"1- Description ofSoil(s) 0`/'f'' Soil Evaluator Form No. 1P-JX GO sl� Name of Soil Evaluator,.///0,Y/V/ XYL 6;- Date of Evaluation /3 'A a I DESCRIPTION OF REPAIRS ORALTERATIONS The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees to notleo place the ystem' o oration a!C'er•" irate_of_Compliance h been issued by the Board of Health. Signedoo Inspections l f ( (� � No. 'L_.®�'l MON V'��j��rl-1 LTH OF MASSACHUSETTS FEE Board of Health, "{ +�'" CERTIFICATE Of COMPLIANCE Description of Work: ❑Individual Component(s) ❑Complete System t The undersigned hereby certify that the Sewage Disposal System; Constructed ( ),Repaired ( ),Upgraded ( ) Abandoned ( ) at. ` // 7 / l: C 4C ,/ e-,C has'been installed in aacc rdanc with thero 'sri�o of 310 CMR 15.00 (Title 5) and the`a�proved design plans/as-built plans relating to application No. � "� ,!dated �" Approved Design Flow / ��✓ (gpd) Installer Designer: %• r}""/' /!" Inspectdx: Date: p4/Z3� The issuance of this permit shall not be construed as a guarantee that the system will function as designed. No. � FEE COMMONWEALTH OF MASSACHUS ETTS Board of Health, �Pl rA '4Z MA. DISPOSAL SYSTEM-CONSTRUCTION PERMIT Permission is hereby granted to; Construct( )= R pair( ') 1 ygrade( ) Abandon( ) an individual sewage disposal system at a scr-V+�� as described in the application for Disposal System Construction Permit No., 7`C-�9, dated 3 ✓)"l( Provided: Construction shall be completed within three years of the dat'of-this "! -it All local conditions must be met. Form 1255 Rev.5/96 A.M.Sulkin Co,Boston,MA Date /� ' Board of Heah-h y Town of Barnstable '"E' ►.� Regulatory Services Thomas F. Geiler, Director �exrsr�atE. pTMAS& Public Health Division .1639. Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form e � Date: �o� Sewage Permit# 2007- OOA Assessor's iVlap\Parcel �S3a Designer: � .�� SS®G Installer: R1111tJ\o_"Cd0AUAc11 Address: l'�D CLOV6r�6 17 `� Address: t��� � t'rni- On 3 3 ne.Rt was issued a permit to install a (date) c (installer) septic system at 25 S Qyd RD. based on a design drawn by (address) Assoc. dated Zl 10 104 (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved chances such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. {� greater than 10' lateral relocation of the SAS or any vert' _ ocation of a onent. of the septic system) but in accordance with State & ea 4 s. PI n revision or certified as-built by designer to follow. 'o. 1140 P� . 4- (Installers Signature) d of s7� q T. (Designer's Signature) (Affix Designer's Stamp Here) f .. PLEASE RETURNtO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF I COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q: Health/Septic/Designer Certification'Form 3-164..doe TOWN OF BARNSTABLE LC AnON Atlly 1ykV SGN�//ZS� « SEWAGE - VIL AGE w ASSESSOR'S MAP & LOT 4 INSTALLER'S NAME&PHONE NO. •'G�t SEPTIC TANK CAPACITY &;d 153-030 LEACHING FACILrrY: (type) .�ii�� / (size) /C X CA NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE: COMPLIANCE DATE: IMP Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility /Ia 7t Feet Private Water Supply Well and Leaching Facility (If any wells exist -on site or within 200 feet of leaching facility) J J6 Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching faV ity) S Feet Furnished by r � Io r. ' Town of B rnstable P# Irtmf Health,Safety,and Envir nmental Services ublic Health Div' ion Date 367 Main Street,}4 annis A 02601 BARNMBU& MASI 03� �� tEe tit+'' Date Scheduled Time y� Lo Fee Pd. ll'6 Soil Suitability Assessment for Sewage Disposal Performed By: /6 `!a'/ �� Li'p�/ Witnessed By: LOCATION & GENERALr1NFORMATION Location Address 1/6 � [�� Owner's Name /✓f�e`C /zGlt a �"C /rG41404* Address 40 9VX— ��@ � C,P46,r.0 17 Assessor's Map/Parcel: 1—f 7 '170"'/ Engineer's Name l. P ' NEW CONSTRUCTION REPAIR �JTelephone# Cr Land Use ��dd 5 /L � 'r Slopes(%) F,0 Surface Stones Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well �ft Drainage Way_ft Property Line ft Other It SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) 44 7'i `^ 2¢3 /A6' �S ... i bo - 3 y Parent material(geologic) Depth to Bedrock Depth to Groundwater: Standing Water in Hole: /9/lJA12' _ Weeping from Pit Face 10AUT Estimated Seasonal High Groundwater bETERMINATtON F OR SEASONAL HIGH WATER TABLE Method Used Depth Observed standing in obs.hole: in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level PERCOLATION TEST date Z 27 Ime /!`3�J Observation r J Hole# Time at 9" S7' 7—d �j Depth of Perc Time at 6" 0 Start Pre-soak Time @ 3,6 Time(9"-6") 12 e`13°'0 End Pre-soak ��'r ', ,d Rate Min./Inch 3 'All!Al ��e L�� d c�l6 ✓ AP4 `- Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back Copy: Applicant �L e DEEP.OBSERVATION HOLE LOG Hole# T" Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. C nsistenc ° ravel 6 - 14 Smear 34 -34-148`� � L6� 2,5VIA . .... DEEP OBSERVATION HOLE LOG Hole#; T Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency.% ravel U -9N 4 -I&WyLam yH ly Lo'gf f S*V6 /DY- 4 4 31``lam" G Lm o7 2,s� N 4 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. n istenc %Gravel DEEP.OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency,°°Gravel) Flood Insurance Rate Map: Above 500 year flood boundary No_ Yes Within 500 year boundary No— Yes Within 100 year flood boundary No_ Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pervious material? Certification I certify that on (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training,expertise and experience described in 310 CMR 15.017. Signature rj Date 1 /sa , _= - Y No. �., �O THE COMMONWEALTH OF MASS` USETTS Entered in computer: L/ Ye_s PUBLIC HEALTH DIVISION -TOWN OF BARNS ABLE, MASSACHUSETTS V Zipprication for Migozaf *p6tem Construction Permit Application for a P nstruct Repair( )Upgrade( )Abandon( ) Complete System ❑Individual Components Lo �tion AddreM of No. G/'d, t C W,3 Owner's Name,Address and Tel.No. / 3 � Assessor's Map/Pazcel Installer's Name,Address,and Tel.No. 76 Z G Z Designer's Name,Address and Tel.No. 7 r CIS Type of Building: i Dwelling No.of Bedrooms Lot Size Jsq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow &0 gallons per day. Calculated daily flow 3 3 G gallons. Plan Date y/2vp Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. ✓' li� Description of Soil ��'••--�.�9 Zir!r--7 Nature of Repairs or Alterations(Answer when applicable) 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 this Board ealth. Signed Date / Application Approved b Date ,�•'. "�� � Application Disapproved for the following reasons 1 Permit No. — Date Issued d` c� No. �,F l \ �.57 1 ` "f aft-- "' LJ� rn !� Fee 1!/z�, 6z> THE COMMONWEALTH 1OF MASSA USETTS Entered in computer: Ye PUBLIC HEALTH DIVISION -TOWN O� BARNS BLE, MASSACHUSETTS �., Zfpp��tcatton for �Digogal *pgtem CoWariuction Permit m_ Application for a. struct-XRepair( )Upgrade( )Abandon( ) El Complete System El Individual Components .-.. Lo i��d oL, Tel.of No. �/'V �, Owner's Name,Address and o. r ' 1*�J 4/YID'/ /�� f ✓! ? Assessor's Map/Parcel Installer's Name,Address,and Tel.No. /// C.✓< <JllGG��C/ � i � �(� 'Z, fj Z '' Designer's Name,Address-and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size ,/f sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow / 0 gallons per day. Calculated daily flow G gallons. Plan Date P Number of sheets / Revision Date Title Size of Septic Tank C Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 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 it,.Aeration until a Certif- cate of Compliance has been issued by this Board ealth. �J Signed Date Application Approved b Date Ay ,;5�^� J' Application Disapproved for the following reasons Permit-No. -- ,« Date Issued ar-- --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance Y THIS IS TO CERTIFY, that the On-site Sewage ispo al System Constructed ('� )Repaired ( )Upgraded( ) Abandoned )by �r/• � �c- i at 4 V SE'1�>t'If v vI,lo!,//Z r has been construct d in accordance r� with the provisigns of Title 5 and the for Disp sal System Construction Permit No ated Installer ,�-^-��� `"`% /'5�C' � r� Designer -► The issuance of this permit shall not be construed as a guarantee that the system ill function as designed. Date — r��� - q Inspectors —�s----------------------------- No. Fee%v_drw THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS _ 30igogal ApAem Construction Permit 00, Permission is hereby grantedto onstruct( )Repair( )Upgrade( )Abandon( ) System located at y A/U / o.H 1 a 14 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:Constru tion must be completed within three years of the date of this it. Date: 47�' Approved br ENVIROTECH LABORATORIES, INC.: MA Cer. No.: M-MA 063 - 449 Rte.130 Sandwich, MA 02563 - (508) 888-6460 1800-339-6460 FAX(508) 888-6446 CLIENT: Nickulas Building Co. LOCATION: Lot 4, Service Rd. ADDRESS: PO Box 507 W. Barnstable, MA 02668 W. Barnstable, MA 02668 COLLECTED BY: Desmond Wells SAMPLE DATE: 6-13-97 SAMPLE TIME: 11:OOAM WATER SAMPLE TYPE: New Well DATE RECEIVED: 6/13/97 LAB I.D.#: 976-330 WELL SPECS.: 4" RESULTS OF ANALYSIS: Parameters Units Recommended Results Method Limits Coliform bacteria /100ml 0 0 9222 B pH pH units 6.5-8.5 6.25 4500 H+ Conductance umhos/cm 500 142 120.1 Sodium mg/L 28.0 12.1 200.7 Nitrate-N/Nitrite-N mg/L 10.0 0.14 4500-NO3 E Iron mg/L 0.3 0.42 200.7 Manganese mg/L 0.05 0.099 200.7 Volatile Organics See attached report. Chloroform ug/L 100 2 524.2 COMMENTS: Iron and Manganese are not a health hazard, but can cause taste, staining and odor problems. YES WATER IS SUITABLE FOR DRINKING PURPOSES FOR PARAMETERS TESTED. Date ./ / ' R ald J. Stctor Laboratory <=less than >=greater than TNTC=too numerous to count ------'------------------------------ _ ----------- "6-17-97 16: 17 ;GROUNDWATER ANALYTICAL ENVIROTECH 508 759 4475;# 2/ 5 GROUNDWATER ANALYTICAL EPA METHOD 524.2 Volatile Organics (GC/MS) Field ID: 976330 Lab ID: 16986-01 Project: Hickulas/Lot 4 Batch ID: VM2-1633-W Client: Envirotech Sampled: 06-13-97 Cont/Prsv: 40mL VOA Vial/HC1 Cool Received: 06-16-97Analyzed: 06-16-97 Matrix: Aqueous PARAMETER CONCENTRATION ( REPORTING ( T u Dichlorodifluoromethane BRL 0.5 BRL 0.5 Chloromethane BRL 0.5 Vinyl Chloride BRL 0.5 Brom6methane BRL 0.5 " ' . Chloroethane BRL 0.5 Trichlorofluoromethane BRL 0.5 1,1-Dichl.oroethene BRL 0.5 Methylene Chloride BRL 0.5 trans-1,2-Dichloroethene BRL 0.5 1,1-Dichloroethane BRL 0.5 2,2-Dichloropropane BRL 0.5 cis-1,2-Dichloroethene BRL 0.5 Bromochloromethane 2 0.5 Chloroform BRL 0.5 1,1,1-Trichloroethane BRL 0.5 Carbon Tetrachloride BRL 0.5 1,1-Dichloropropene BRL 0.5 Benzene BRL 0.5 1,2-Dichloroethane BRL 0.5 Trichloroethene BRL 0.5 1,2-Dichloro.propane BRL 0.5 Dibromomethane BRL 0.5 Bromodichloromethane BRL 0.5 cis-1,3-Dichloropropene 0.5 .Toluene BRL 0.5 trans-1,3-Dichloropropene BRL BRL 0.5 1,1,2-Trichloroethane BRL 0.5 1,2-Dibromoethane (EDB) BRL 0.5 Tetrachloroethene BRL 0.5 1,3.-Dichloropropene BRL 0.5 Dibromochloromethane BRL 0.5 Chlorobenzene BRL 0.5 b1111122-Tetrachloroethane Ethylenzene BRL 0.5 BRL 0.5 m+p-Xylene BRL 0.5 o-Xylene BRL 0.5 Styrene 0.5 Isopropylbenzene BRL 0.5 Bromobenzene BRL 0.5 Bromoform BRL 0.5 1,1,2,2-Tetrachloroethane BRL 0.5 1,2,3-Trichloropropane BRL 0.5 n-Propylbenzene BRL (Continued) Page 1 of 2 ------- ----------------------------------------------------------------- 6-17-97 16:17 ;GROUNDWATER ANALYTICAL ENVIROTECH 508 759 4475;# 3/ 5 y GROUNDWATER ANALYTICAL EPA METHOD 524.2 Volatile Organics (GC/MS) Field ID: 976330 Lab ID: 16986-01 Project: Nickulas/Lot 4 Batch ID: VM2-1633-W Client: Envirotech Analyzed: 06-16-97 PARAMETER CONCENTRATION REPORTING LIMIT (ug/L) (ug/L) 2-Chlorotoluene BRL 0.5 1,3,5-Trimethylbenzene BRL 0.5 4-Chlorotoluene BRL 0.5 . test-Butylbenzene BRL 0.5 1,2,4-Trimethylbenzene BRL 0.5 sec-Butyylbenzene BRL 0.5 1,3-Dichlorobenzene BRL 0.5 4-Isopro%ltoluene BRL 0.5 1,4-Dichlorobenzene BRL 0.5 1,2-Dichlorobenzene BRL 0.5 • • n-Butylbenzene BRL 0.5 1.,2-Dibromo-3-chloropropane (DBCP) BRL 0.5 1,2,4-Trichlorobenzene BRL 0.5 Hexachlorobutadiene BRL 0.5 Naphthalene BRL 0.5 1,2,3-Trichlorobenzene BRL 0.5 C SURROGATE COMPOUND RECOVERY C LIMITS Q P ND SPIKED MEASURED Q I Dibromofluoromethane 10 10 99 % 86 - 118 % Toluene-d8 10 10 102 % 88 - 110 % 4-Bromofluorobenzene 10 10 99 % 86 - 115 % BRL - Below Reporting Limit. Method Reference: Method 524.2 - Measurement of Purgeable Organic Compounds in Water by capillary Column Gas Chromatography/Mass Spectrometry, Methods for the Determination of Organic Compounds in Drinking Water, US EPA EPA/600/4-88/039 (1988). Page 2 of 2 TOWN OF BARNSTABLE � Gf 3 LOCATION -�•��' SGN SEWAGE # 7 VII;I.AGE ��ram' ASSESSOR'S MAP & LOT O? Pr� INSTALLER'S NAME&PHONE NO. WC SEPTIC TANK CAPACITY LEACHING FACILITY: (type) �� � (size) NO.OF..BEDROOMS BUILDER OR OWNER PERM1yI'DATE: _COMPLIANCE DATE: Separation Distance Between the: Maumi m Adjusted Groundwater Table and Bottom of Leaching Facility /Ja`rt Feet Private Water Supply Well and Leaching Facility (If any wells exist I on site or within 200 feet of leaching facility) 6. . Feet Edge>of Wetland and Leaching Facility(If any wetlands exist a Feet within 300 feet of leaching f ity) Furnished by 7 `� 1 IT Car or y of /a o CSC! FRO Ai Etgy rt7-1oM- FT-Tl ! IL r r=� 6CAU8: g/gaa.J..Oi /1PPpOVCD BY: DRAWN BY OW . . . . i DATE: /'/.r2.•C)i REVOM - LA-OLR uY N 1 C FC.L.�t.•;^/ ..L .�.-w. - waa orro."Mcompows 3 3' '' C--Or y �/LG `'ire r, —rr �I 3lS".>1130°X.105>'COW". R° I'1 /'M /!/. 7��' 1 /{ / l 1 aVsT CAP Cry a .... a � c I �XIST:R)Cs A?�rGy r~ E_ ���(' 4�LoaJ!_. eLfi�°...- rf--l.Qpa'?7 C! 5cAe rr oio r ;r 1 GUT joOkTS ---- _ k._. _�_ -- --- - r f� u. �� i, �ry/ _.,__/,_....-------._�_�--_______..._.��•i�-- /q`=�__�.;O J ® 7-WdYV&.2 742ayr.-2 Qc 7W a va a ZEN _ •"s7vv�� ar,av_, ow I ` I I I � .� Ll 3 - -_ t y` o« y to ! a ,°� x Li ula)� ��an � a-� ! - i STE£ OR M GRD. LAA4. [ n�YY hd_ 3' '� }o - ' `� ! _ I ► fir: LZA a i v rE I _ kn . 7 C00- ! :, V Oo%. VL fl 9LT �- C:'!' 7Zsid+lYra•- �! 7ul yYa lF 7w?�Y-� I I i ° I lac � •� -.�""` - - � �L. 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