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Home My WebLink About0030 WILLIAMS PATH - Health 30 Williams Path W. Barnstable P A= 111 003 TOWN 0 BAR NSTABLE (iv1 LOCATION 30 Ii /4��Jh SEWAGE # VILLAGE W. 13Arr s 4 ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) ( rr (X4' (size) NO. OF BEDROOMS BUILDER OR OWNER G e t' I ovf.[� PERMITDATE: 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 P _ � 4 ojft�- > �c �a 3� CERTIFICATE OF ANALYSIS Page: 1 Barnstable County Health Laboratory "---- -�sw ` Report Prepared For: Report Dated: 5/22/2009 Kathryn M. Baird Order No.: G0951620 30 Williams Path West Barnstable, MA 02668 Laboratory ID#: 0951620-01 Description: Water-Drinking Water Sample#: Sampling Location: '30 Williams Path West Barnstable,MA Collected: 5/14/2009 Collected by: J.Clark Treated Received: 5/14/2009 Test Parameters ITEM RESULT UNITS RL MCL Method# Tested pH 7.0 pH-units 0 SM 4500 H-B 5/14/2009 EPA 200.8 Metals by ICP-MS 01 ITEM RESULT UNITS RL MCL Method# Tested Aluminum ND mg/L 0.001 0.05 EPA 200.8 5/20/2009 Antimony l ND mg/L 0.001 0.006 EPA 200.8 5/20/2009 Arsenic ND mg/L 0.001 0.01 EPA 200.8 5/20/2009 Barium ND mg/L 0.001 2.0 EPA 200.8 5/20/2009 I Beryllium ND mg/L 0.001 0.004 EPA 200.8 5/20/2009 Cadmium ND mg/L 0.001 0.005 EPA 200.8 5/20/2009 Calcium ND mg/L 0.13 EPA 200.8 5/20/2009 Chromium ND mg/L 0.001 0.1 EPA 200.8 5/20/2009 Cobalt;, ,.. t., . ND.; :mg/L a .:,;0.00.1 . ,,,, r EPA'2'00.8'� 5/20/2009 Copper 0.023 mg/L 0.001 1.3 EPA 200.8 5/20/2009 Iron ND mg/L 0.13 0.3 EPA 200.8 5/20/2009 i Lead 0.0012 mg/L 0.001 0.015 EPA 200.8 5/20/2009 Magnesium ND mg/L 0.13 EPA 200.8 5/20/2009 Manganese ND mg/L 0..001 0.0,5 EPA 200.8 5/20/2009 Molybdenum ND mg/L 0.001 EPA 200.8. 5/20/2009 Nickel ND mg/L 0.001 EPA 200.8 5/20/2009 Potassttl n Y':i mo/! 0.13 Fne,200).S 5i2012009 i Selenium ND mg/L 0.005 0.05 EPA 200.8 5/20/2009 Silver ND mg/L 0.001 0.10 EPA 200.8 5/20/2009 Sodium 125 mg/L 0113 20 EPA 200:8 5/20/2009 Strontium ND mg/L 0.001 EPA 200.8 5/20/2009 Thallium ND mg/L 0.001 0.002 EPA 200.8 5/20/2009 Vanadium ND mg/L 0:001 EPA 200.8 5/20/2009 Zinc'- 0.013 mg/L 0.001 5.0 EPA 200.8 5/20/2009 ,ol Sodium level is above the maxium contaminant level. Those on a low sodium diet may wish to consult°a:physician. ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605 n J' '` °F g'" CERTIFICATE OF ANALYSIS Page: 2 fir^ 0 MI V Barnstable County Health Laboratory ssnc;3`}5�.: Report Prepared For: Report Dated: 5/22/2009 Kathryn M.Baird Order No.: G0951620 30 Williams Path West Barnstable, MA 02668 Laboratory ID#: 0951620-02 Description: Water-Drinking Water Sample#: Sampling Location: 30 Williams Path West Barnstable,MA Collected: 5/14/2009 Collected by: J.Clark Raw Received: 5/14/2009 Test Parameters ITEM RESULT UNITS RL MCL Method# Tested pH 6.8 pH-units 0 SM 4500 H-B 5/14/2009 EPA 200.8 Metals by ICP-MS 01 ITEM RESULT UNITS RL MCL Method# Tested Aluminum ND mg/L 0.001 0.05 EPA 200.8 5/20/2009 Antimony ND mg/L 0.001 0.006 EPA 200.8 5/20/2009 Arsenic ND mg/L 0.001 0.01 EPA 200.8 5/20/2009 Barium 0.0036 mg/L 0.001 2.0 EPA 200.8 5/20/2009 Beryllium ND mg/L 0.001 0.004 EPA 200.8 5/20/2009 Cadmium ND mg/L 0.001 0.005 EPA 200.8 5/20/2009 Calcium 7.2 mg/L 0.13 EPA 200.8 5/20/2009 Chromium ND mg/L 0.001 0.1 EPA 200.8 5/20/2009 Cobalt ND mg/L 0.001 EPA 200.8 5/20/2009 Copper 0.031 mg/L 0.001 1.3 EPA 200.8 5/20/2009 Iron ND mg/L 0.13 0.3 EPA 200.8 5/20/2009 Lead 0.0041 mg/L 0.001 0.015 EPA 200.8 5/20/2009 Magnesium 3.4 mg/L 0.13 EPA 200.8 5/20/2009 Manganese ND mg/L 0.001 0.05 EPA 200.8 5/20/2009 Molybdenum ND mg/L 0.001 EPA 200.8 5/20/2009 Nickel ND mg/L 0.001 EPA 200.8 5/20/2009 Potassium 1.0 n g/L 0.13 EPA 200.8 5/20/2009 Selenium ND mg/L 0.005 0.05 EPA 200.8 5/20/2009 Silver ND mg/L 0.001 0.10 EPA 200.8 5/20/2009 Sodium 10 mg/L 0.13 20 EPA 200.8 5/20/2009 Strontium 0.055 mg/L 0.001 EPA 200.8 5/20/2009 Thallium ND mg/L 0.001 0.002 EPA 200.8 5/20/2009 Vanadium ND mg/L 0.001 EPA 200.8 5/20/2009 Zinc 0.044 mg/L 0.001 5.0 EPA 200.8 5/20/2009 Water sample meets the recommended limits for drinking water of all the above tested parameters. Attached please find the laboratory certified parameter list. Approved By: Director) ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level / Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 11 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENT -, E.^-Y RECEIVED MAR 0 7 2002 TOWN OF BARNSTABLE HEALTH DEPT. TITLE 5 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 30 Williams Path West Barnstable, MA 02668 Owner's Name: Christopher Lovely Owner's Address: Same Date of Inspection: February 22, 2002 Name of Inspector:(Please Print) James M. Ford Company Name: James M. Ford Map: III Mailing Address: P.O. Box 49 Parcel: 003 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 15.000). The system: ✓ Passes Conditionally Passes Nee Further Evaluation by the Local Approving Authority Fail Inspector's Signature: Date: February 26, 2002 The system inspector shall sub t 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 ****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 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 30 Williams Path West Barnstable, AM Owner: Christopher Lovely Date of Inspection: February 22, 2002 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 r Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 30 Williams Path West Barnstable, MA Owner: Christopher Lovely Date of Inspection: February 22, 2002 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: 30 Williams Path West Barnstable, M4 Owner: Christopher Lovely Date of Inspection: February 22, 2002 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 %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.] No )The system stem 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: 30 Williams Path West Barnstable, M4 Owner: Christopher Lovely Date of Inspection: February 22, 2002 Check if the following have been done: You must indicate`yes"or"no"as to each of the following: Yes No ✓ Pumping information was provided by the owner,occupant,or Board of Health ✓ Were any of the system components pumped out in the previous two weeks? ✓ Has the system received normal flows in the previous two week period? ✓ Have large volumes of water been introduced to the system recently or as part of this inspection ? ✓ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ✓ Was the facility or dwelling inspected for signs of sewage back up? ✓ _ Was the site inspected for signs of break out? ✓ Were all system components,excluding the SAS, located on site? ✓ _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions, depth of liquid,depth of sludge and depth of scum ? ✓ _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes 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 Page 6 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 30 Williams Path West Barnstable, MA Owner: Christopher Lovely Date of Inspection: February 22, 2002 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): S Number of bedrooms(actual): S DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): SSO Number of current residents: 0 Does residence have a garbage grinder(yes or no): Yes Is laundry on a separate sewage system(yes or no): No [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)): Private well Sump Pump(yes or no): No Last date of occupancy: Never fully occupied-per owner COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system (yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Never pumped-per owner 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: Auz 13193-per as built card 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: 30 Williams Path West Barnstable, MA Owner: Christopher Lovely Date of Inspection: February 22, 2002 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: Comments(on condition of joints,venting,evidence of leakage, etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 12" 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: 1 S00 gal. Sludge depth: -- Distance from top of sludge to bottom of outlet tee or baffle: 32" Scum thickness: -- Distance from top of scum to top of outlet tee or baffle: 10" Distance from bottom of scum to bottom of outlet tee or baffle: -- 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.): Tees were present. The liquid level was even with the outlet invert. There were no signs of leakage. ScuWsludge were minimal. 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 recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page 8 of 1 I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 30 Williams Path P West Barnstable, MA Owner: Christopher Lovely Date of Inspection: February 22, 2002 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: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Even Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): The D-box was level. There were no signs of leakage or solids. There were no water stains on the outlet pipes. The D-box was in new condition. 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 1 I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 30 Williams Path West Barnstable, AM Owner: Christopher Lovely Date of Inspection: February 22, 2002 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits,number: 2-6'x 6'with Y of stone-per design plans leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: Innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation, etc.): The pits were not dug up. There were no signs offailure in the D-box. The house has never been fully occupied. 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 scan 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: Comments(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: 30 Williams Path West Barnstable, AM Owner: Christopher Lovely Date of Inspection: February 22, 2002 Map: III Parcel: 003 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. nT (3 OUQ- PT 1 Fa (, I PTA 9-7 39 a 10 Page 11 of i l OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 30 Williams Path West Barnstable, AM Owner: Christopher Lovely Date of Inspection: February 22, 2002 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 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: Checked with local excavators, installers-(attach documentation) ✓ Accessed USGS database-explain: topographic and water contours maps You must describe how you established the high ground water elevation: Using the USGS topographic maps and the Cape Cod Commission water contours map the maps were showing approximately 90'+/-to ground water at this site. This report has been prepared and the system inspected and passed 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 system, the inspection and/or this report. 11 1 9- `, C% JUL 2 8 1997 �N TOWN OF BARNSTABLE BORTOLOTTI CONSTRtICTION, INC. HEALTH DEPT. 765 WAKEBY ROAD,MARSTONS MILLS, MA 412648 S 508-771-9399 508-428-8926 FAX: 508-428 9399 A y E SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A ICERTIFICATION Property Address: 30 Date of Inspection: 1 -7 Inspector's Name: ? Or— ner's Name and Address: CERTIFICATION STATEMENT: I certify that I have personally inspected the sewage disposal system at this address and that the informa- tion reported below is true,accurate and complete as of the time of inspection. The inspection was per- formed based on my training and experience in the proper function and maintenance of on-site sewage disposal stems. The System: Passes Conditionally Passe Needs Further Ev uation By,the Local Aproving Authority Fails Inspector's Signature: Date: I-/f The System Inspector shall submit a copy of this inspection report to the Approving authority within thir- ty(30)days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: A)SYS PASSES: I have not found any information wilier indicates fliat the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B)SYSTEM CONDITIONALLY PASSES; One or more system components need to be replaced or repaired. The system, upon comple- tion of the replacement or repair, passes inspection. Indicate yes, nor,or not determined(Y,Ni OR ND). Describe basis of determination in all instances. If "not determined",explain why not. The septic tank is metal,cracked, structurally unsound, shows substantial infiltration or exfiltration,or tank failure is imminent. The system will pass inspection if the existing sep- tic tank is replaced with a conforming septic tank_as approved by The Board of Health. Sewage backkup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of The Board of Health): -1 - _ r _b +1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Broken pipe(s)replaced- Obstruction is removed Distribution Box is levelled or replaced The System required pumping more than.four times a year due to broken or obstructed pipe(s). p g The system will pass inspection if(with approval of The Board of Health): Broken pipe(s)are replaced,, Obstruction is removed C)FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by The Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1)SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 Feet of 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 APPROPRIATE)DETERMINES THAT THE SYSTEM IS FUNCTION- ING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 Feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is with a Zone I of a public water supply well. The system has a septic tank and soil absorption system and is within 50 Feet of a private water supply well absorption system and is less than 100 Feet but 50 The system has a septic tank and soil Feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is.free from pollution from the facility and the presence of ammonia nitrogen and nitrate nit xegen is equal to or less than 5 ppm. D)SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of efluent 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 clog- ged SAS or cesspool. Liquid depth in cesspool is less than G"below invert.or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NO 1 due to clogged or obstructed pipe(s). Number of times pumped -2- SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a 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 J of a-publicwell. 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. If the well has been analyzed to be acceptable,attach copy of well water analysis for colifonn bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E)LARGE SYSTEM FAILS: The following criteria apply to a large system in addition to the criteria above: The design flow of a system is 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: 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 f The system is located in a nitrogen sensitive area Interim Wellhead Protection Area (IWPA)or a mapped Zone II of a public water supply well. The owner or operator of any such system shall bring(lie system and facility into full compliance with the groundwater treatment program requirements of 314 CM.R 5.00 and 6.00. Please consult the local regional office of the Department for further information. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Check if the following have been done: dumping information was requested of the owner,occupant,and Board of Health. None of the system components have been pumped for atleast two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. ✓ As-built plans have been obtained and examined. Note if they are not available with N/A. _ The facility or dwelling was inspected for signs of sewage back-up. (l.The system does not receive non-sanitary or industrial waste flow. t/,The site was inspected for signs of breakout. t,/All system components,excluding.the Soil Absorption System, have been located on site. /The septic tank manholes were uncovered,opened,and the interior of the septic tank was in- spected for condition of baffles or tees,,material of construction,dimensions,depth of liquid, depth of sludge,depth of scum. The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B. CHECKLIST(continued) �he facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Subsurface Disposal System SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION FLOW CONDITIONS RESIDENTIAL Design Flow: allons Number of Bedroomsc�/ Number of Current Residents: Garbage Grinder. : Laundry Connected To Systciii:_�C� Seasonal Use: Water Meter Readings,if ayy;�ilable: 1711 OF, Last Date of Occupancy: X)J10-t-M Z /3Z4`21 , COMMERCIATANDUSTRIAL:�� Type of Establishment: Design Flow: galions/day Grease Trap Present: (yes or no) Industrial Waste Holding Tank Present: Non-Sanitary Waste Discharged To The Title V System: Water Meter Readings, If Available: _ Last Dale of Occupancy: OTHER: Describe) Last Date of Occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System Pumped as part of inspection: If yes,volume pum d: V gallons Reason for pumping: TYPE OF SYSTEM: Septic Tank/Distribution Box/Soil Absorption,System Single Cesspool Overflow Cesspool Privy Shared System(If yes,attach previous inspection records, if any) Other(explain): PROXIMATE AGE of all components,date installed(if known)and source of information: Sewage odors detected when arriving at the site:�/(�___ -4- SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C GENERAL INFORMATION (continued) SEPTIC TANK: Depth below grade: �� ,, Material of Construction:—1-concrete metal FRP—Other (explain) Dimisions:f0',r 6',r 51 Sludge Depth: Scum Thickness:»e Distance from top of sludge to bottom of outlet tee or.baffle:_ _ Distance from bottom of scum to bottom of outlet tee or baffle: Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation o outl invert,stpctural integrity,evidence of leakage,etc.) t0- ' �. GREASE TRAP: A)O Depth Below Grade: Material of Construction: concrete metal FRP Other (explain) — — — — Dimensions: Scum Thickness: Distance from top of scum to top of outlet tee or baffle: Comments: (recommendation for pumping,condition of inlet,and outlet tees or baffles,depth of liquid level in relation to outlet invert, structural integrity,.evidence of leakage,etc.) TIGHT OR HOLDING TANK: NO Depth Below Grade: Material of Construction:—concrete—metal FRP—Other(explain) Dimensions: Capacity: gallons Design Flow: gallons/day Alarm Level: Comments: (condition of inlet tee,condition of alarm and float.swi(ches, etc..) DISTRIBUTION BOX: v Depth of liquid level above outlet invert: Comments: (note if el and distribution is equal, evidence of solids carryover,.evidence of leakage into or out of box,etc.) �la:� /, �� /� PUMP CHAMBER:,-A.20 Pump is in'working order: Comments: (note condition of pump-chamber,condition of pumps and appurtenances,etc.) f -5- J SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (con(inued) SOIL ABSORPTION SYSTEM(SAS): !/ (Locate on site plan, if possible;excavation not required, but may be approximated by non-intrusive methods) If not determined to be present,explain: Type: Leaching pits, number: _Leaching chambers, number: Leaching galleries,number: Leaching trenches,number, length: Leaching fields,number,dimensions: Overflow cesspool, number: Comments: (note condition of soil,signs of hydraulic failure level of ponding, ondition of vegetation, etc. o? OD rJ v CESSPOOLS:: Number and configuration: r Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of Cesspool: Indication of groundwater: Materials of construction: g Inflow(cesspool must be pumped as part of inspection) Comments: (note condition of soilk, signs of hydraulic failure, level of ponding,condition of vegetation, etc.) PRIVY: Materials of construction: Dimensions: Depth of Solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.) -6 - SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) SKETCH OF SEWAGE DISPOSAL SYSTEM: Include ties to atleast two permanent references, landmarks or benchmarks. Locate all wells within 100 Feet. DEPTH TO GROUNDWATER: Depth to groundwater: ZC // Feet Method of Determination or AP roxi ation: elvj/v lew, o -7- . r v ,.07/25/97 09:11 U508 428 9399 BORTOLOTTI COST -L3 ' 1 10001 BORTOLOTTI CONSTRUCTION,INC. 765 WAKEBY ROAD,MA RSTONS MILLS,MA 02648 $08-&771-9399 509-428-8926 FAX: 508-428-9399 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERITFICATION Property Address; 2 Date of Inspectioi 7 Inspector's Name pees Name IdAddress: _ I certify that I have Personallyinspected the sewage di;.g posal system at this address and that the informa- tion reported below is true,accurate and complete as of the time,of inspection. The inspection was per- formed based on my training and experience in the proper function and maintenance of on-site sewage disposal y�stems. The System, V Passes Conditiomally Passe Needs Further Ev uation B the Local Aproving Authority Fails Inspector's Signature: Date: q The System Inspector shall submit a copy of this inspection report to the Approving authority within thir- ty(30)flays of completing this inspection. If the System is a shared system or has a design flow of 1g000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection, nce original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. INSZE A)SYSV11 PASSES: have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15,303. A oy failure criteria not evaluated are indicated below. R)SYSTEM CONDITIONALLY PASSES; One or more system components need to b;replaced or repaired. The system,upon comple- tion of the replacement or repair,passes inspection. Indicate yes, nor,or not determined(Y,N;OR ND).Describe basis of determination in all instances. If not determined",explain why not. The septic tank is metal,cracked,structurall-unsound,shows substantial infiltration or exflltration, or tank failure is imminent. The system will pass inspection if the existing sep- do tank is replaced with a conforming septi;,tank as approved by The Board of Health. Sewage backkup or breakout or high static water level observed in the distnibution box is due to broken or obstructed pipe(s)or due to a troken, settled or uneven distribution box. The System will pass inspection if(with approw�.1 of The Board of Health): -1- j07/25/97 09:11 U508 428 9399 BORTOLOTTI CONST 10002 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Broken pipe(s)replaced Obstruction is removed _Distribution Box is levelled or replaced _The System required pumping more four times a year due to broken or obstructed pipe(s). than The system will pass inspection if(with approval of The Board of Health): Broken pipe(s)are replaced Obstruction is removed C)FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by The Board of Health in order to determine if the system is failing to protect the public hearth,safety and the environment. 1)SYSTEM WILL PASS UNLESS BOARD Orr HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A AkNNER WHICH WILL PROTECT'TIM PUBLIC HEALTH AND SAFETY AND TH-E 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,H'APPROPRIATE)DETERY]NES THAT THE SYSTEM IS FUNCTION- ' ING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil at sorption system and is within 100 Feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil at-sorption system and is with a Zone I of a public water supply well. The system has a septic tank and soil absorption system and is within 50 Feet of a private water supply well. The system has a septic tank and soil at sorption system and is less than 100 Feet but 50 Feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from the facility and the presence of ammo:ua nitrogen and nitrate nitrogen is equal to or less than 5 ppm. D)SYSTEM FAILS; I have determined that the system violates one;or more of the following failure criteria as defined in 310 CMR 15,303, The basis for this determination is identified below. The Board of Health should be contacted to determine what will lie necessary to correct the failure. Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of efiuent to thc-surface of the ground or surface waters due to an overloaded or clogged SAS or cessp)ol. Static liquid level in the distribution tpx above outlet invert due to an overloaded or clog- ged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year&U due to clogged or obstructed pipe(s). Number of times pumped_ -Z- ,07/25/97 , 09:12 U508 428 9399 BORTOLOTTI COnST 10 003 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is with;n 100 Feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is with n a Zone I 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 Ihan 100 Feet but greater than 50 Feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrite nitrogen. E)LARGE SYSTEM FAILS: The following criteria apply to a large system in addition to the criteria above: The design flow of a system is 10,000 gpd or g eater(Large System)and the system is a significant thereat to public health and safety and the environment because one or more of the following conditions exist: ____The system is within 400 Feet of a surf ice 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 sen;;itive area Interim Wellhead Protection Area (IWPA)or a mapped Zone II of a public water supply well, The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 C NR 5.00 and 6,00. Please consult the local regional office of the Department for further informat on. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Check if the following have been done- mping information was requested of the owner,occupant,and Board of Health. None of the system components have been pumped for atleast two weeks and the system has been receiving normal flow rates during that period, Large volumes of water have not been introduced into the system recently or as p,;rt of this inspection. !r As-built plans have been obtained and exam:ned, Note it they are not available with N/A. _jZThe facility or dwelling was inspected for signs of sewage back-up, G/ The system does not receive non-sanitary or industrial waste flow_ The site was inspected for signs of breakout All system components,excluding the Soil absorption System,have been located on site, y The septic tank manholes were uncovered,o.?ened,and the interior of the septic tank was in- spected for condition of baffles or tees,material of construction,dimensions,depth of liquid, depth of sludge,depth of scum. The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods, -3. 07%25%97 09:12 =508 428 9399 BORTOLOTTI CONST 10004 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ?ART B CHECKLIST(continued) —zThe facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Subsurface Dispo wl System SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION FLOVI CONDITIONS 1 Design Flow. llons Number of Bedrooms:_ Number of Current Residents: Crarbage Grinder: Laundry Connected T�System: &2e Seasonal Use: A !1 Water Meter Readings, if ayailabie:_ Last Date of Occupancy: ( ` .AA Type of Establishment: Design Flow: _gallons/day Grease Trap Present: (yes or no) Industrial Waste Holding Tank Present:_, Nan-Sanitary Waste Discharged To The Title V System: Water Meter Readings, If Available: _ Last pate of Occupancy:_ OTHER. Describe) Last Date of Occupancy: GENEpA1)'L INFORMATION PUMPING RECORDS and source of information:.&�CJ 5 stem Pun as part of in5pection:�U_ If yes.volume pum Y I� ons Pe Reason for pumping: TYPE OF SYSTEM: Septic Tank/Distribution Box/Soil Absorption �ystem Single Cesspool Overflow Cesspool Privy Shared System(If yes,attach previous inspectic n records, if any) Other(explain): ROX1MATE AGE of all components, date insta[led(if known)and source of information:, Sewage odors detected whet,arriving at the site:��' . -4- 07/25/97 09.13 U508 428 9399 BORTOLOTTI COnST 10005 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION)FORM PART C GENERAL INFORMATION (continued) SE1rnC'TANK: Depth below grader '' Material of Construction: ✓concrete metal FRP_Other (explain) Dimisions./D'X 61x S-7 Sludge Depth: jjZa 2 Scuin Thickness: .c,Y�r� Distance From top of sludge to bottom of outlet tee or baffle.- Distance from bottom of scum to bottom of outlet tee or baffle: Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relationip outigs invert,s ctural integrity, t vidence of leaks e, etc.)'a' Q. f V - la `f � GREASE TRAP: A)O Depth Below Grader Material of Cons truction:—concrete_metal_FRP Other (explain) Dimensions: Scum Thickness: Distance from top of scum to top of outlet tee or baffle; Comments, (recommendation for pumping, condition,of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert, structural integrity,evidence of leakage,etc.) TIGHT OR JROLDING TANK /)O Depth Below Grade: Material of Construction:_concrete meta]_FRP other(explain) Dimensions: Capacity: .. lions Design Flow: Rallons/day Alarm Level: Comments: (condition of inlet tee, condition of alarm and float switches,etc.) D ISTRIBUTION BOX. Depth of liquid level above outlet invert:_ Comments: (note if)lveland distribution is equal, evidence of olids carryover,.evidence of leakage into or out of box,etc.) PUMP CRAMBER:-J Pump is in working order: Comments: (note condition of pump chamber,conditi on of pumps and appurtenances,etc.) -5- 07%25/97 09:13 U508 428 9399 BORTOLOTTI CONST 10006 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) SOEL ABSORPTION SYSTEM(SAS): 1/ (Locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive methods) U not determined to be present,explain:_ Type: Leaching pits,nu nber:__�q_Leaching chamber:i, number: Leaching galleries,number: Leaching trenches,number, length: Leaching fields,number,dimensions: Overflow cesspool;number; Comments. (note condition of soil,signs of hydraulic::ailure level of ponding, ondition of vegetation, CESSPOOLS: 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(cesspool must be purnped as part of inspection) Comments: (note condition of soilk,signs of hydraulics failure, level of ponding,condition of vegetation, etc.) PRIVY:- Materials of construction: Dimensions: Depth of Solids: _ Comments:(note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation, etc.) -6- %07/25%97 09:14 U508 428 9399 BORTOLOTTI COST 41 007 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) SKETCH OF SEWAGE DISPOSAL SYSTEM: Include ties to atleast two permanent reference;,, landmarks or benchmarks. Locate all wells within 100 Feet. ;?0 7' ?3� 0 DEPTH TO GROUNDWATER: Depth to groundwater: Z //_ : Feet , j Method of Determination or Ap to 'Malion: -7- -.4 THE COMMONWEALTH OF MASSACHUSETTS 7766 BOARD OF HEALTH TOWN OF BARNSTABLE Appliratiun for Uhipusal Works Tonutrnrtiun Prrutit Application is hereby made for a Permit to Construct (vj or Repair ( ) an Individual Sewage Disposal System at: b4sT ................__..__._............-- .............................................. ................................................. Location-Address or Lot No. E Z�7Z/ S ...................... ... •-......• .......................................... ..•••--------------•-------••••-•••-......••----......--•--•••••••---•..._••---.._..........--•--- W a OwnerL . .Address = — . Installer Address Type of Building Size Lot. 3 ..Z� .Sq. feet Dwelling—No. of Bedrooms..................:.........................Expansion Attic ( ) Garbage Grinder ( ) '4 Other—T e of Building ............................ No. of persons............................ Showers — Cafeteria a, Other fixtures .................................. W Design Flow..................__✓�.-......_.....--....---._gallons per person per day. Total daily flow........-g�-�__. -......................gallons. W Septic Tank—Liquid capacity.!. gallons Length__ a.��_'_�.. Width.. �r'�_°`_ Diameter................ Depth_S'"8... x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.___-_Z...._..... Diameter.._... .'..... Depth below inlet................. Total leaching area..AM._!..sq. ft. Z Other Distribution box ( ) Dosing tank ( ) '-' Percolation Test Results Performed b ..__ 1n� ? ___G_=__.� ____.. _ .. Date_`T�!'`!�_._4C /f9/ Y - ----------------- ,.1 Test Pit No. 1... _4_..minutes per inch Depth of Test Pit.... Depth to ground water.._'.............. Test Pit No. 2..G¢....minutes per inch Depth of Test Pit--- .... Depth to ground water...... ............... �+ ------------------------------------------------------------------------------------------•------------------------------------------------- O Description of Soil._....._D_��__g�u__ avoL ! r� 5 1-? So/G %}�� vL--�tsL-- S�rv�> 0-� x - - --------------------------------•--------...------------------------•---•-•• •----- VfIX.--------g ��_� ..... �+9 z��Co�zse-r_._-SAD --------------------•----------------------------•---------...-----........••....---------------- W -------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------•------- UNature of Repairs or Alterations—Answer when applicable............................................................................................... -•---------------------------------------------------------------------------------------••---•-........-----•-----------------------------•----------------------------------------------------•------ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliant as b i ued y the board of health. Signed ....---. - - - -- -- --- ............................. Dare ApplicationApproved BY ------------- ----.........--------...------....-- ------........--------------- Y......)..2..:.......... Dace Application Disapproved for the following reasons- ----------------------------------------------_ ------...----------------...--------------------------:-----------..-.-..-------- - - - -------------------------- -- ---- --- --- ----------------------------- -----------------------------------... - a Permit No. /-3-- 1..3--�--------------------- -- Issued ---------------------------Dace------ Daze � .} • •t r - � r _ Yam.—.. No ., / Fss..... /............. THE COMMONWEALTH OF MASSACHUSETTS 77�� BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Disposal Works 11onstrur#ion_ .r'rmi# Application is hereby made for a Permit to Construct (f,-) or Repair ( ) an Individual Sewage Disposal System at: .Wn e_4/4 Ms F'A-rh1 h/c-3T BR��vs7�3/3G�' /Issue sso�z s M //i /�'/�i 2....•..' _-- ...-•----•-•-- .............................................. ..•-•----•--------....•-•.....-•••-•---•••---•-_. ..... Location-Address or Lot No. 1/iG.c/�S 4- e Z44-7, s ` �0 Address 1 -•---�3� G� �i t�:. :.4 --•---------•................................................................•---- Installer Address d Type of Building `Size Lot.f33 Z 90_-Sq. feet V Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) 'q Other—T e of Building No. of persons............................ Showers — Cafeteria a � Other fixtures ------------------------------------•------•------------------------------------------------•---•----------------------•-------------•---------•----• Design Flow........................-.r..............._--.gallons per person per day. Total daily flow........-5-3--.'t:F......................gallons. WSeptic Tank—Liquid ca.pacity_ZS gallons Length-_4?-e".- Width... Diameter................ Depth..-:5_7. 19.... x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. 01 Seepage Pit No.....-y---------. Diameter......ZZ...`..... Depth below inlet................ Total leaching area...G Z4�_!.sq. ft. Z Other Distribution box ( ) Dosing tank ( ) '"' Percolation Test Results Performed by....4T'^!� ......G.:...'�-� ............. Date.`TZ"!� .._G../. � as Test Pit No. I...4.`'r...minutes per inch Depth of Test Pit....44 4. Depth to ground water...---------------- LL, Test Pit No. 2_.G ...minutes per inch Depth of Test Pit...j ...... Depth to ground water..--- ............. a ....................................,........................................................................................................................ "= 9,C A, � •5�No- 0G��O Description of Soil......... !_ . ••-•••--•••--------- SL J-�------------------------------•------••---------------- U .....................................••••......-----•----•- W ------------------•-•---•------------•-------------------------------•-----------------•----•------•---------------------------------•-•----•-••--...------••-•--•-•---------------------------------... UNature of Repairs or Alterations—Answer when applicable............................................................................................... •----------•------•-----------------------------•---------•--•-•-...-•--••---•••--•-•--•--••-------•----••-•••---------------•--------•-----•-••---.............-•-------------......................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be'n�issued by the board of health. Signed ..... ....--�--..tiG.0 Application Approved B r ;F - 14 ---�......_-- .. . - pp pp Y ..... --.. _. 'R µ -i ' J � Date Application Disapproved for the following reasons- ..........................................------------------------------------------------------------------------------.............. ........................ ------------------------------------------------..........-----.......-----....--------...----...---------- ------------------...---.....----------------------------------- ........................................ Permit No. ....... --- - ...�.. .......... Issued ----------- ----------------- Dare Date � I THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Certifi rate of C antylianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( V-11) or Repaired ( ) by .0 ------ .-------- ----------------------------------------------------------------------•--- -------------------------------------------;--------------- �7- f ,(►n Installer ` �� ' at ��. a--. _ -._ c .�r 1�+-�! !................. hV.. ,% .- ,.r :� ..... has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ..... ............... dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE ... U ----------------------------------- Inspector . <..a�-- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No..... .'..�.. � FEs.//....r.a......... Disposal Works Tonu#rudion "pleruti# Permissionis hereby granted........ ...... :== 'a'------...---•--------------•---------•-----••----................................-•--•-•-•--- to Construct (r,-) or Repair ( ) an Individual Sewage Disposal System at No L_.17-•' ..a 10 ,'/., �79' . . .... Pa.�+ �.,a ly ................ .. -• .............. Street � as shown on the application for Disposal Works Construction Permit No.•..^ ,__.. � Dated.......................................... -••-• DATE Board ofHealth FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS <rrrt: R t ri i 4 1 , .. `� Mq LE SEw.1GE OISPOS L 6lFEy 0-7EG4 t..m ,IITNEi�D BT- .. � 'SOIL VERGM DATA: o ,OIN co � e.aimum.. rt.tkwi \\ .nn t PE bn 1 h• I fl�.r �jj mil•�(.i 7 Li-'. i r- ENVIROTECH LABORATORIES Mass. Cert. //:MA063 449 Route 130 Sandwich, MA 02563 • (508) 888-6460 k CLIENT: Vilnis Ezernis LOCATION: 30 William Path ADDRESS: Baj:nsr-dbtu-,MA- COLLECTED BY: L.Wile SAMPLE DATE: 8/7/92 TIME: DATE RECEIVED:-81719,)_SAMPLE ID:7�g_ JOB #: New Well WELL DEPTH: 150/87 Ft 6" PVC RESULTS OF ANALYSIS: I Parameter Units Recommended limit Result Coliform bacteria/100 ml (MF Method) 0 0 PH pH units 6.0-8.5 6.53 Conductance u /cm 500 87 Sodium 20.0 8.2 Nitrate-N mg/L 10.0 1.24 Iron mg/L 0.3 <0.05 Manganese mg/L 0.05 0.02 Hardness mg/L as CaCO3 500 15.8 Sulfate mg/L 250 0.6 Potassium mg/L 20.0 0.5 Alkalinity mg/L 200 3.4 Chloride mg/L 250 12.2 Turbidity NTU 5.0 2.60 Color APC units 15.0 6.0 Background bacteria COMMENT: VOC EPA 601/602 ug/L Below reporting limit # # See attached report YES NO WATER IS SUITABLE FOR DRINI§ING PURPOSES FOR PAR METERS TESTED. ®X ❑ rk DATE GROUNDWATER ANALYTICAL EPA METHODS 601 and 602 Volatile Organics (GC/PID/ELCO) Field ID: Z-679 Lab ID: 3596-01 Project: Ezernis William Path Batch ID: VHA-1043-W Client: Envirotech Sampled: 08-13-92 Cont/Prsv: 40ml VOA Vial/NaHSO4 Cool Received: 08-17-92 Matrix: Aqueous Analyzed: 08-22-92 PARAMETER CONCENTRATION REPORTING LIMIT (u9/L) (ug/L) Dichlorodifluoromethane BRL 5 Chloromethane BRL 1 Vinyl Chloride BRL 1 Bromomethane BRL 5 Chloroethane BRL 1 Trichlorofluoromethane BRL 1 1,1-Dichloroethene BRL 1 Methylene Chloride BRL 1 trans-1,2-Dichloroethene BRL 1 1,1-Dichloroethane BRL 1 cis-1,2-Dichloroethene * BRL 1 Chloroform BRL 1 1,1,1-Trichloroethane BRL 1 Carbon Tetrachloride BRL 1 Benzene BRL 1 1,2-Dichloroethane BRL 1 Trichloroethene BRL 1 1,2-Dichloropropane BRL 1 Bromodichloromethane BRL 1 2-Chloroethylvinyl Ether BRL 1 trans-1,3-Dichloropropene BRL 1 Toluene BRL 1 cis-1,3-Dichloropropene BRL 1 1,1,2-Trichloroethane BRL 1 Tetrachloroethene BRL 1 Dibromochloromethane BRL 1' .Chlorobenzene BRL 1 Ethylbenzene BRL 1 m+P-Xylene * BRL 1 o-Xylene * BRL 1 Bromoform BRL 1 1,1,2,2-Tetrachloroethane BRL 1 1,3-DichlGrobenz-ene BRL 1 1,4-Dichlorobenzene BRL 1 1,2-Dichlorobenzene BRL 1 QC SURROGATE COMPOUND SPIKED MEASURED RECOVERY QC LIMITS Bromochloromethane 30 30 100 % 83 - 117 % Fluorobenzene 30 30 101 % 87 - 113 % BRL = Below Reporting Limit. * Non-target compound. Method References: Method 601 - Purgeable Halocarbons and Method 602 - Purgeable Aromatics, 40 C.F.R. 136, Appendix A (1986). , r � � r. � 1 `\\ .\ .\\� .1 ? /us •�;l i 9:dr<r:.n�� < >q �•�7c1 a<:,, ?O&D wu.µ,�i.�j..ow AB 036S3NLIM �, 7,' om 1105 WL s "y r . m .S c , . �� No.-�b�-�.�=�� Fee--��------------ BOARD OF HEALTH TOWN OF BARNSTABLE Application fibrlVell Cootruction Permit Application is hereby made for a permit to Construct (V), Alter ( ), or Repair ( )an individual Well at: IWAWASAI Location — Address c Assessors Map and Parcel Owner Address t �— Installer — Driller Address Type of Building Dwelling----------------- _ Other - Typeof Building-------------------------- ---- No. of Persons----' --------------------------------------------- Type of Well-------- . �O � - - Capacity------------------------------------------------------------------------------ Purpose of 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 a0-11 -L--7 Certificate of Compliance has been issued by the Board of Health. Signed---- -t1 � _____=____ ------------------------ '7 --------------------X L{ 9 v------------------ date Application Approved By----- '''t-!--'- ----A- date Application Disapproved for the following reasons:-------------------------------------------------------------------------------------------_--------____ ------------------------_-_------------------------------------ ------------------------------------------------------------------------------------------------------------- // date Permit No. ------------------------ Issued---------------------------------------------------------------- -------------- date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate ®f Compliance THIS IS TO CERTIFY, That the Individual Well Constructed (X, Altered ( ), or Repaired ( ) b -- -- —W-�-----—------------------------------------------------------------------------------------------------------------------ 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—------------------- - =------------------------------- No. _--- BOARD OF HEALTH TOWN OF BARNSTAB LE ZippYication forlVell Congtruction'Permit Application is hereby made for a permit to Construct (y), Alter ( ), or Repair ( )an individual Well at: � j t,I=cam i/��,t,. i Q?� `r�t-(_� (1!�5'i — = _'�___J_ __-;��--�_ �` —_— n 1 Location — Address , Assessors Map and Parcel Owner •Address t- L' —I-- -------------------------------- -- �.�r-i _ 1 c7 —Installer — Driller Address Type of Building Dwelling Other - Type of Building - No. of Persons---3---- —- c Type of Well------------co------------------------------------------------------- Capacity------------------------ -------------------- — Purpose of Well C- =-�=- 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 na� Certificate of Compliancehas been issued by the Board of Health. Signed date Application Approved By------` �--�� - - -- - --�_'Ltd date Application Disapproved for the following reasons:-------------------------------- - -------------------------------------------- date Permit No.----- � -- , — ---- Issued---- ---- —_—_ — date BOARD OF HEALTH TOWNa..--.O..F �_B-A-R-NSTABLE_ Certificate Of Compliance THIS IS TO CERTIFY, That the Individual Well Constructed (/Ntl Altered ( ), or Repaired ( ) -- - _ ----- - -- -------=------------- - Installer Aa— has been installed in accordance with the rovisions of the Town of Barnstable Board of Health Private Well Protection ° Regulation as described in the application for Well Construction Permit No. ---�3----Dated__-------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE------------- ___ - -- - - - -- Inspector--------------------------— --— ---- --- " -1 BOARD OF HEALTH 4 TOWN OF BARNSTABLE Yell Con5trurt ion Permit No.--7-„0 Fee-- — ------ Permission is hereby granted----------L- -sw---- ------------------------ to Construct (�, Alter ( ), or Repair ( ) an Individual Well at: No. - -- 1�,{ �-- SFr� 5f ---_ ___----- Street tv as shown on the application for a Well Construction Permit ^ q No.---— — —--- ---- —- --- - -Dated +� ,, Board of Health DATE---------7- ).-t� -_ --------------------- ASSESSORS MAP NO: Il No. - 1 PARCEL NO: Fee-- BOARD OF HEALTH TOWN OF BARNSTABLE App[ication-ftlVe[Y Con5truct ion Permit Application is hereby made for a permit to Construct ( -1, Alter ( ), or Repair ( )an individual Well at: a tag It,a' AG ----------------- --------- - -- — --- --- - --- - ----- --- --------- Location — Address Assessors Map and Parcel Owner Address SCJA - --------- -- ------ Installer — Driller Address Type of Building Dwelling---------------------------------------------------- Other - Type of Building---------------________ No. of Persons--------------------_____ Type of Well y (( �j G YP — ---------------- - Capacity---------------------------- Purpose of Well-- f----------- 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 untiil�a �Cer ificate .of Compliance has been issued by the Board of Health. Signed -d a 5 date Application Approved gagG?%_— — -n-— n ! 44; � date Application Disapproved for the following reasons:--------------------------------___—__— __—_ ------------- -- -- ---- --------------------------------- ------------- A— ----------- dat y� ` Permit No. rf _ `'�-��-----��--------- Issued--��--------------------�-----�',� ----- date BOARD OF HEALTH TOWN OF BARNSTA5LSSES MAP NO: �Certifsate (Of (Compriante PARCEL N0: THIS IS TO CERTIFY, That the Individual Well Constructed Altered ( ), or Repaired ( ) -----Q Ac " '-�-- _ by---- -------------------------------------- - ----------------- nn 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 1)4'�:- q99� ated � 'p 1'7,41? THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE—----- -- - Inspector------—------- —--- ... .._._-..... � ,..._. __.,.. -�-._-�.. ro•Y.r-ws'_ -.�.-_.. � _ _ ___ — __ ....yam .,._..o,-.,. ,. .,._ _ ' � .. � .- o -.r .. .•'Y.�'b...F.YL.Xr. - r - + '�`,..,-.,.... tip{ - _ � - NO. BOARD OF HEALTH Fee--- ---------------- li f - '��' r OWN OF }" BARNSTABLE �[ppfirat ion-*rMelt Conotruct ion Permit Application is 1b; e y made for al permit to Construct( '1, Alter ( ), or Repair ( )an individual Well-at: Location -,Address Assessors Map:and Parcel t Owner Address AA act, �� °�"�`- _?!6 6 n t u c`I`'- —�`-"------- Installer - Driller Address Type of Building j Dwellinrhedagre ------------------------------------------------- Other - Building Altii -6 ersf'I'ons�.------------------------------------ Type of Well � ----- ---=- --- Capacity-------------- Purpose of Well _"�--�Agreement: The undersi to install the afore described individual well in accordance with the provisions of The Town of Barnsta le Boarc of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation until a Cer ificate .of.Compliance has been issued by the Board of Health. lJ /�_ S • Signed —-- ----- --- � ---- . date t APPIic$tion Approved �C -- ----— i ^ / _- 4x / !� i� date t Application Disapproved for the,following reasons:—=--- t -------- —---- - -------- 4i } fG t YP,ermita No — __ Issued .I �--= t 'date .t..!i asaps'{3Fa#*a�{t5�:�§��^l { li�t�"11�s+rf.�+woes,essi+asasawe.bvras�e►'w'w�4s'aewsa�a�';ka��rasi*e#gueHs +osi+s,. eagasa�e�+ewyp'¢he'a w:sa pis rasz�a nl BOARD'.OF HEALTH : TOWN O�F ' BARNSTABLE f � , � c�erfi irate f omp iante E THIS.IS TO CERTIFY, That the Individual Well Constructed ( �,'Altered ( ) or Repaired ( ) 1 _ by -- � 4_��cG,.�_� ' Installer 'has been msialled in accordance with the provisions-Of the Town of Barnstable Board of Health:Private Well Protection ,Regulation as'descnbed in the application for`Well Construction Permit e✓ -` ated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT-BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL"FUNCTION.SATISFACTORY:', DATE----- _ Inspector.=---=-----== _ 'A+N+eas�?d1►�Wi�frli+MFiM30�??'. �C'l��ee+.9+ltiiawor+he+•'�F�++�tt�+'�d�•+ea:,riea�v�+.asrainawr*reams.�s�axa+isr's�tert{�'!r�'lyve�r�.m.e��a»ea+aroesra.�a�sa�s=ins-��a�. r r; BOARD-OF HEALTH ; t TOWN �OF �BARNS.T`ABLE eIC On tru(t101i ,erifif f SESSORS MAP.NO I�f /� /"' PARCELNO: - - No. Aklz! / .: . Fee- - Permission is hereby-granted — r. to Construct -Alter ( ), orI Repair ( ) an Individual Well at: r r Street ;,as shown o Ithe p1. lion fo Well Construction Permit f '1*7 ;_ sled- - --- - - - - -------- --------- a X 4 C Board of He s .`. °.� '. Health DATE T well j