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0195 ROUTE 149 UNIT 7 - Health (10)
195 unit 9 Route 149 Marstons Mills A = 078 Lot 18 RAM (. 2UN (Z&BCDHE BAFP$TAsLE COUNTY DEPARTMENT OF HEALTH ANO ENVIFON.m_ 1 %N PROMOTE-PROTECT-SUPPORT .i 1926- 2016 June 19th, 2020 James Teegan 195A Cotuit Road Marstons Mills, MA 02648 RE: Missing reports for the Innovative/Alternative Septic System Installed at 195-A Route 149 in the town of Barnstable. - - Dear James Teegan,' My department oversees VA septic system management and compliance efforts for the Board of Health in your town. We are authorized by the Barnstable Board of Health to contact you to inform you of the following requirements and to request your compliance. Our records indicate that your wastewater operator,All Cape Environmental Inc, has not reported sample results and/or inspections as required. Please be aware that it is your responsibility as a homeowner to be sure that you are following state and local regulations which include periodic maintenance inspections and samples. Most towns on Cape Cod require that any reports be submitted through the septic database within 15 to 30 days of a site visit. Accordingly, please contact your current wastewater operator about why these reports have not been submitted.You may. also visit https://septic.barnstablecountyhealth.ora and sign-up as a homeowner to see information about your requirements and our records. Please be advised that if there continue to be missing reports after 30 (thirty) days of this letter, I may refer you to the Barnstable Board of Health for further enforcement action.You may be required to appear before the Barnstable Board of Health to show cause as to why your system has not been sampled or maintained as required. I can be reached at 508-375-3645; my fax number is(508)362-2603. 1 can also be reached via email at tacy.long@barnstablecounty.org. Thank you for your prompt attention to this matter. Sincerely, Tracy Long CC: Barnstable Board of Health Enclosures (1): Inspection and Testing Requirements . BARNSTABLE COUNTY COMPLEX 3195 MAIN STREET/PO BOX 427 BARNSTABLE,MASSACHUSETTS 02630 Phone:(508)375-6613 1 Fax:(508)362-2603 1 TDD:(508)362-5885 Web:barnstablecountyhealth.org I Twitter:@BCHDCapeCod (DOBCDHE BAK%TAm COUNTY DEPAAimu T OF HEALTH Am EnRoNM63r 4' PROMOTE-PROTECT-SUPPORT$ °° r i ♦ � • i October 26th, 2017 r James Teegan 195A Cotuit Road Marstons Mills, MA 02648 RE: Operation and Maintenance Contract for the Innovative/Alternative Septic System Installed at 195-A Route 149 in the town of Barnstable. Dear James Teegan, Our records indicate that the operation and maintenance contract with Bennett Environmental Associates, Inc, for your innovative/alternative wastewater treatment system.may have expired or was canceled as of October 13th, 2017.To date we have not received evidence that you have entered into a new operation and maintenance contract. I am writing to remind you that the Massachusetts Department of Environmental Protection (MA DEP)and the Town of Barnstable require you to keep an operation and maintenance (O&M)contract in effect at all times for your system. Information about these requirements may be found at https://septic.barnstablecountyhealth.org.You can access the list of wastewater operators of whom we are aware do business in Barnstable County. This septic database also provides further explanation about your I/A septic system, as well as any sample and inspection history for the performance of your system, as entered by previous service providers. My department oversees I/A septic system management and compliance efforts for the Board of Health in your town. We are authorized by your Board of Health to contact you to inform you of the above requirement and to request your compliance. Accordingly, please forward a copy of a signed contract via mail, fax, or e-mail within fifteen (15)days of receipt of this letter. For your convenience, I have enclosed a list of wastewater operators we are aware of that do business in Barnstable County. The firms listed operate multiple types of I/A technologies and are not associated with any particular technology or vendor. Please be advised that if you do not respond within fifteen (15)days of your receipt of this letter by forwarding a copy of a signed contract, you may be referred to the Barnstable Board of Health for further enforcement action. I can be reached Iat 508-375-6901; my fax number is (508)362-2603. 1 can also be reached via email at emilymichele.omsted@barnstablecounty.org. Thank you for your prompt attention to this matter. Sincerely, ` Emily Michele Olmsted CC:'Barnstable Board of Health Enclosures (2): Certified Wastewater Treatment System Operators List, Inspection and Testing Requirements BARNSTABLE COUNTY COMPLEX 3195 MAIN STREET/PO BOX 427 Ya BARNSTABLE, MASSACHUSETTS 02630 Phone:(508)375-66131 Fax:(508)362-26031TDD: (508)362-5885 Web:barnstablecountyhealth.org I Twitter:@BCHDCapeCod e F zKE r� Town of Barnstable Barnstable Inspectional Services Department j�ca� anxNsews,.E. ► I 9�A 6 9 �` Public Health Division I.F rD"" n 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO THIRD NOTICE CERTIFIED MAIL#7015 1730 0001 4987 9415 November 27, 2018 JAMES TEEGAN 195A COTUIT ROAD MARSTONS MILLS, MA 02648 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE,TITLE 5 The septic system located at 195-A Route 149, Marstons Mills was inspected on 12/01/2016 by Greg Brehm, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Conditionally Pass" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following:, • Will need to bring inspection port and lateral cleanouts to finished grade. Will need to conduct annual inspections of pressure closed system. You are ordered to repair or replace the septic system within six (6) months from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH as McKean; R.S., CHO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Conditionally Passes Letters\195 Route 149 Unit A Herring Run Place Third Notice.doc y �. Ln s. I� WIRITT-7,ME 0 Certified Mail Fee. Er $ Extra Services&Fees(check box,add fee as appropriate) ❑Return Receipt(hardcopy) -$ ��11ff r ❑Return Receipt(electronic) $ O ❑Certified Mail Restricted Delivery $ He e�V / � ❑Adult Signature Required $. V/iI_(� []Adult Signature Restdcted Delivery L--J Postage I � $ t 9 Total Postage and I JAM ES TEEGA N Ln Sent To 195A COTUIT ROAD 7 r 0 SfreefandApt:'No., MARSTONS MILLS, MA 02648 --- tti City State;ZIP+4�, " :r• r rr rrr•r. Certified Mail service provides the following benefits: ■A receipt(this portion of the Certified Mail label). for an electronic return receipt,see a retail u A unique identifier for your mailpiece. associate for assistance.To receive a duplicate ■Electronic verification of delivery or attempted return receipt for no additional fee,present this- delivery. USPS®-postmarked Certified Mail receipt to the ■A record of delivery(including the recipient's retail associate. L signature)that is retained by the Postal Service- Restricted delivery service,which provides for a specified period. delivery to the addressee specified by name,or Important Reminders: to the addressee's authorized agent -Adult signature service;which requires the ■You may purchase Certified Mail service with signee to be at least 21 years of age(not [ First-Class Mail®,First-Class Package Service®, available at retail). T or Priority Mail®service. Adult signature restricted delivery service,which ■Certified Mail service is notavailable for requires the signee to be at least 21 years of age international mail, and provides delivery to the addressee specified ■Insurance coverage Is notavailable for purchase by name,or to the addressee's authorized agent 3 wi%Certified.Mail service.However,the purchase (not available at retaiq. of Certified Mail service does not change the ■To ensure that your Certified Mail receipt is insurance coverage automatically included with accepted as legal proof of mailing,it should bear a 7 certain Priority Mail items. USPS postmark If you would like a postmark on+� ■For an additional fee,and with a proper this Certified Mail receipt,please present your `1 endsrsement on the mailpiece,you may request Certified Mail item at a Post Office'for ,-,the following services: postmarking.If you don't need a postmark on this -Return receipt service,which provides a record Certified Mail receipt,detach the barcoded portion . � of delivery(including the recipient's signature). of this label,affix it to the mailpiece,apply You can request a hardcopy return receipt or an appropriate postage,and deposit the mailpiece. electronic version.For a hardcopy return receipt, r complete PS Form 3811,Domestic Retum Receipt attach PS Form 3811 to your mailpiece; IMPORTAM:Save this receipt for your records. Ps Forth 3800,April 2015(Reverse)PSN 7530-02-000.9047 �,•yy • • • 61V • • Complete items 1,2,and 3. --lsignatu ■ Print your name and address on the reverse `X ❑Agent so that we can return the card to you. ❑ dressee ■ Attach this card to the back of the mailpiece, B. e ved by rinted c (P N C. Date of Delivery or on the front if space permits. ,)C! e 3 1• D. Is delivery address differen rom dem 1? `- Yes If YES,enter d ddress below: ❑No JAMES TEEGAN 1-95A COTUIT ROAD MARSTONS MILLS, MA 02648 �G IIII IIII III I II II I I III I III II I IIII I II I III 3. Service 0 Adult Signature 0 e El ❑Adult Signature Restricted Delivery ❑Registered Mail Restricted 9590 9402 3759 8032 3744 70 Certified WHO Delivery Certified Mail Restricted Delivery ?S[Vignature etum Receipt for ❑Collect on Delivery erchandise -i 1,y_- Lfrransfer_from_SeNiCeJabel ❑Collect on Delivery Restricted Delivery ConfirmationT"' ❑Signature Confirmation 7 015 1730 0001 4987 9 415 lil Restricted Delivery Restricted Delivery r, PS Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return Receipt � 1 I - FirSt-Class Mail � I Postage&Fees Paid t . USPS I Permit No.G-10 I 9590 9402 3759 8032 3744 70 United States •Sender:Please print your name,address,and ZIP+4®in this boxy I Postal Service � of Barnstable I � 8/ ;�;;�,µlth Division I � 20C Pviai-a Street I Hyannis,MA 026.01 (ij ill lillil sill Ip1-11ij'111Elfll ill,!hisfill hIII1N/Willi Town of Barnstable Barnstable Regulatory Services Department O"edcaC j 'p BARN5rABM " . ,,� Public Health Division m FAA 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#70f5 1730 0001 4987 7039 March 22, 2018 — SECOND NOTICE JAM.ES TEF_,GAN 195A COTUIT ROAD - MARSTONS MILLS, MA 02648 - ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 195-A Route 149, Marstons Mills was inspected on 12/01/2016 by Greg Brehm, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Conditionally Pass" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Will need to bring inspection port and lateral cleanouts to finished grade. Need to conduct annual inspections of pressure closed system. You are ordered to repair or replace the septic system within six(6) months from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. 5 PER ORDER OF THE BOARD OF HEALTH �= Thom s cRean, R.S.,DCHO ` Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Conditionally Passes Letters\195 Route 149 Unit A Herring Run Place SECOND NOTICE.doc i I Town of Barnstable Barnstable Regulatory Services Department i aicaC j RARNSTABM '39. ,m Public Health Division 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7012 1010 0000 2847 8360 January 3, 2017 James Teegan 195A Cotuit Road Marstons Mills, MA 02648 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 195-A Route 149, Marstons Mills was inspected on 12/01/2016 by Greg Brehm, certified Title V Septic Inspector for the State of �. Massachusetts. The inspection of the septic system showed that the system"Conditionally Pass" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Will need to bring inspection port and lateral cleanouts to finished grade. Need to conduct annual inspections of pressure closed system. You are ordered to repair or replace the septic system within one (1)year from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future -enforcement action. PER ORDER OF THE BOARD OF HEALTH fill Thomas McKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Evl\195 Route 149 Unit A Herring Run Place.doc D x CO �� € IL UE CO Postage $ ti t1NIs Certified Fee r r,9 C JJ420 M Retum Receipt FeeC3 (Endorsement Required)Restricted Delivery Fee i(Endorsement Required) \V_3Total Postage&Fees $ (�Sent To ti ------ t.No. ✓ - � Street,Apt.No.; //9 }A� � - - or PO Box;No. `--f�-5-�` ..... __ --------------- dhry State,ZIP+41,�r,,,,,s f�,lls n,1 d�(o Certified Mail Provides: e A mailing receipt a A unique identifier for your mailpiece e 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®. ■ Certified Mail is not available for any class of international mail. • NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. a 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 USPS®postmark on your Certified Mail receipt is required. o ror 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". m 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. IMPORTAW:Save this receipt and present it when making an inquiry. PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 p e • o • • o ■ Complete items 1,2,and 3. A. Signat e e Print your name and address on the reverse X ❑Agent so that we can return the card to you. ❑Addressee ■ Attach this card to the back of the mailpiece, , B! '�jeceived by(Printed Name) C. Date of Delivery or on the front if space permits. J -f 1. Article Addressed to: D. Is delivery address di erent from item 1? ❑Yes `r'f7'f�s —r n If YES,enter delivery address below: [3 No � q6 - AUU((�///li//// ,Ooa d wf I II I Illlll I'll lil I I I I I�'I Iil l II I II I I II II l it I III 3. Service Type ❑Priority Mail Express® ❑Adult Signature ❑Registered MaiIT"' ❑Adult Signature Restricted Delivery ❑Registered Mail Restricted 9590 9403 0521 5173 2826 16 Certified Mail( Delivery ❑Certified Mail Restricted Delivery $lieturr,Receipt for ❑Collect on Delivery / Merchandise 2. Article_Number(Cransfer_from_service_(a6e11 Collect on Delivery Restricted Delivery ❑Signature ConflrmationT ? • •`t'!I( i i i I 'I! 11 i I-t 9 t��'(lp 111`Mail 11-signature Confirmation 71112 1010 00,00 H 4 7 83 6 V IoMai:Restricted Delivery Restricted Delivery !; PS Form 3811,April 2015 PSN 7530-02-000-9053 v Domestic Return Receipt" UNITED STATES°}' AiWFtCCl�� ` First-Class Mail '^' Postage&Fees Paid usps Permit No.G-10 ^v • Sender: Please print your name, address, and ZIP+4®in this box* Town of Barnstable F I Health Division 200 Main Street Hyannis, MA 02601 I _ I I USPS TRACKING# l I I I 0 9403 0521 5173 2826 16 I I C ,i BENNETT ENVIRONMENTAL ASSOCIATES, INC. LICENSED SITE PROFESSIONALS,ENVIRONMENTAL SCIENTISTS,GEOLOGISTS,ENGINEERS 1573 Main Street,P.O.Box 1743 (508)896-1706 Brewster,MA 02631 fax(508)896-5109 LETTER OF TRANSMITTAL TO: DATE: JOB NUMBER: Massachusetts Department of Environmental Protection 9/25/13 BEA09-10156 Attention:Title 5 Program 1 Winter Street-6th Floor Boston,MA 02108 REGARDING: Fehnel Residence 195 Herring Run Place Unit A[Route 149] SHIPPING METHOD: Marstons Mills,MA Regular Mail ❑ Pick Up ❑ Priority Mail ❑ Hand Deliver ❑ Express Mail ❑ Other ❑ Certified Mail ❑X Green Card/RR ❑ COPIES DATE DESCRIPTION 1 DEP Approved Inspection and O&M Form for Title 5 I/A Treatment and Disposal Systems(December 2012;March,June and September 2013) 1 OMNI Environmental Systems,Inc.RSF Operation and Maintenance Checlist(December 2012;March, June and September 2013) 1 9/18/13 Alpha Analytical Laboratory Report For review and comment: ❑ For approval: ❑ As requested: ❑ For your use: ❑ REMARKS: Please find enclosed the DEP Inspection and O&M Forms and OMNI Environmental Systems,Inc.RSF Operation and Maintenance Checklists for operation and maintenance conducted during this reporting period for the above referenced property. Restoration of the residence due to water damage was completed as of the June 2013 maintenance event,but the home has been unoccupied and is listed for sale. It is noted that inspection ports or cleanouts for the pressure dosed leach field laterals are not accessible for inspection. If you have any questions or require additional information,please contact us at your earliest convenience. Thank you. cc:-Ba stable Board of Healthy Mr.Tom Fehnel,Owner David C.Bennett,Principal[Internal] Matthew Costa-OMNI Environmental Systems,Inc. [via email] FROM: David C.Bennett,WWTO#6243/Samantha Farrenkopf,WWTO#13265/Joseph Smith,WWTO#12529 If enclosures are not as noted,kindly notify us at once LlMassachusetts Department of Environmental Protection Bureau of Resource Protection - Title 5 DEP Approved Inspection and O&M Form for Title 5 I/A Treatment and Disposal Systems A. Installation Important:When Tom Fehnel filling out forms Owner on the computer, use only the tab Route 149 Unit 195-A key to move your Facility Street Address cursor-do not Marstons Mills 02648 use the return key. City Zip Mailing address of owner, if different: 722 Bear Creek Circle Street Address/PO Box: Winter Springs FL 32708 City State Zip (407) 971 -0477 ext. Telephone Number B. Authorized Service Provider BENNETT ENVIRONMENTAL ASSOCIATES, INC. O&M Firm 1573 Main Street/PO Box 1743 Street Address Brewster MA 02631 City State Zip (508) 896- 1706 ext. 129 Telephone Number Samantha Farrenkopf 13265 Certified Operator Name Certification Number C. Facility/System Information OMNI Environmental Systems OMNI RSF DEP ID Manufacturer ID Model Number 8/25/03 8/25/03 Installation Date Start of Operation Approval Type: ® General ❑ Provisional ❑ Piloting ❑ Remedial Seasonal Residence—used less than 6 mo./year: ® Yes ❑ No D. Operating Information 12/27/12 916/12 Inspection Date Previous Inspection Date Sludge Depth(to be checked yearly) Pumping Recommended ❑ Yes ® No t5aiom.doc•rev.11-07-05 Page 1 of 3 LlMassachusetts Department of Environmental Protection Bureau of Resource Protection - Title 5 DEP Approved Inspection and O&M Form for Title 5 I/A Treatment and Disposal Systems E. Field Testing Field Inspection: Color: ❑ gray ❑ brown ❑ clear ❑ turbid ❑ Other(specify): Odor: ❑ musty ❑ earthy ❑ moldy ❑ offensive ❑ turbid Effluent Solids: ❑ no ❑ some pH 6 to 9 SU DO 2 or greater TurbidityNTU 40 or less Should a Remedial or General Use system fail the Field Testing, effluent samples shall be collected per Standard Methods and analyzed for BOD and TSS. F. Sampling Information Samples Taken: ❑ Influent ❑ Effluent Commercial systems or systems with a design flow of 2000 gpd and greater, and General Use nitrogen reducing systems: gpd Parameters sampled: ❑ pH ❑ BOD ❑ CBOD ❑ TSS ❑ TN ❑ Other(list below) Other 1 Other 2 Other 3 G. Inspection and Maintenance Description of any maintenance performed since previous inspection &during this inspection: Notes and Comments: The residence is undergoing renovations and is currently unoccupied. The system has been shut down until an occupancy and use permit has been given and flow is restored to the system. Upon issuance of the occupancy and use permit, regular operation and maintenance will resume. . t5aiom.doc•rev.11-07-05 Page 2 of 3 LlMassachusetts Department of Environmental Protection Bureau of Resource Protection - Title 5 DEP Approved Inspection and O&M Form for Title 5 I/A Treatment and Disposal Systems H. Certification certify: I have inspected the sewage treatment and disposal system at the address above, have conducted the required Field Testing and/or sample collection in accordance with Standard Methods, have completed this report and the attached technology operation and maintenance checklist, and the information reported is true, accurate, and complete as of the time of the inspection. I am a Massachusetts certified operator in accordance with 257 CMR 2.00. Operator Signature Date System owner must submit this report, technology O&M checklist, and any required sampling results to the local board of health and DEP as follows for each inspection performed: Remedial Use—by January 31st of each year for the previous calendar year Piloting Use-within 45 days of inspection date Provisional Use—by March 31th of each year for the previous 12 months General Use—by September 30th of each year for the previous 12 months Send to: Department of Environmental Protection Attention: Title 5 Program One Winter Street, 6t Floor Boston, MA 02108 t5aiom.doc•rev. 11-07-05 Page 3 of 3 Massachusetts Department of Environmental Protection Bureau of Resource Protection -'Title 5 DEP Approved Inspection and O&M Form for Title 5 I/A Treatment and Disposal Systems A. Installation Important:When Tom Fehnel filling out forms Owner on the computer, use only the tab Route 149 Unit 195-A key to move your Facility Street Address cursor-do not Marstons Mills 02648 use the return key. City Zip VQ: Mailing address of owner, if different: 722 Bear Creek Circle Street Address/PO Box: rem WR Winter Springs FL 32708 City State Zip (407) 971 -0477 ext. Telephone Number B. Authorized Service Provider BENNETT ENVIRONMENTAL ASSOCIATES, INC. O&M Firm 1573 Main Street/PO Box 1743 Street Address Brewster MA 02631 City State Zip (508) 896- 1706 ext. 129 Telephone Number Samantha Farrenkopf 13265 Certified Operator Name Certification Number C. Facility/System Information OMNI Environmental Systems OMNI RSF DEP ID Manufacturer ID Model Number 8/25/03 8/25/03 Installation Date Start of Operation Approval Type: ® General ❑ Provisional ❑ Piloting ❑ Remedial Seasonal Residence—used less than 6 mo./year:. E Yes ❑ No D. Operating Information 3/8/13 12/27/12 Inspection Date Previous Inspection Date l Sludge; 0" Scum Sludge Depth(to be checked yearly) Pumping Recommended El Yes E No t5aiom.doc•rev. 11-07-05 Page 1 of 3 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Title 5 DEP Approved Inspection and OW Form for Title 5 I/A Treatment and Disposal Systems E. Field Testing Field Inspection: Color: ❑ gray ❑ brown ❑ clear ❑ turbid ❑ Other(specify): Odor: ❑ musty ❑ earthy ❑ moldy ❑ offensive ❑ turbid Effluent Solids: ❑ no ❑ some pH 6 to 9 SU DO 2 or greatermg/L Turbidity NTU 40 or less Should a Remedial or General Use system fail the Field Testing, effluent samples shall be collected per Standard Methods and analyzed for BOD and TSS. F. Sampling Information Samples Taken: ❑ Influent ❑ Effluent Commercial systems or systems with a design flow of 2000 gpd and greater, and General Use nitrogen reducing systems: gpd Parameters sampled: ❑ pH ❑ BOD ❑ CBOD ❑ TSS ❑TN ❑ Other(list below) Other 1 Other 2 Other 3 G. Inspection and Maintenance Description of any maintenance performed since previous inspection &during this inspection: Notes and Comments: The residence is undergoing renovations and is currently unoccupied. The system has been shut down until an occupancy and use permit has been given and flow is restored to the system. Upon issuance of the occupancy and use permit, regular operation and maintenance will resume. t5aiom.doc•rev.11-07-05 Page 2 of 3 LlMassachusetts Department of Environmental Protection Bureau of Resource Protection - Title 5 DEP Approved Inspection and O&M Form for Title 5 I/A Treatment and Disposal Systems H. Certification I certify: I have inspected the sewage treatment and disposal system at the address above, have conducted the required Field Testing and/or sample collection in accordance with Standard Methods, have completed this report and the attached technology operation and maintenance checklist, and the information reported is true, accurate, and complete as of the time of the inspection. I am a Massachusetts certified operator in accordance with 257 CMR 2.00. Operator Signature Date System owner must submit this report, technology O&M checklist, and any required sampling results to the local board of health and DEP as follows for each inspection performed: Remedial Use—by January 315t of each year for the previous calendar year Piloting Use-within 45 days of inspection date Provisional Use—by March 31th of each year for the previous 12 months General Use—by September 30th of each year for the previous 12 months Send to: Department of Environmental Protection Attention: Title 5 Pro ram One Winter Street, 6t Floor Boston, MA 02108 t5aiom.doc•rev.11-07-05 Page 3 of 3 Massachusetts Department of Environmental Protection LlBureau of Resource Protection - Title 5 DEP Approved Inspection and O&M Form for Title 5 I/A Treatment and Disposal Systems A. Installation Important:When Tom Fehnel filling out forms Owner on the computer, use only the tab Route 149 Unit 195-A key to move your Facility Street Address cursor-do not Marstons Mills 02648 use the return key. City Zip VkA Mailing address of owner, if different: 722 Bear Creek Circle �I Street Address/PO Box: Winter Springs FL 32708 City State Zip (407) 971 -0477 ext. Telephone Number B. Authorized Service Provider BENNETT ENVIRONMENTAL ASSOCIATES, INC. O&M Firm 1573 Main Street/PO Box 1743 Street Address Brewster MA 02631 City State Zip (508) 896- 1706 ext. 129 Telephone Number Samantha Farrenkopf 13265 Certified Operator Name Certification Number C. Facility/System Information OMNI Environmental Systems OMNI RSF DEP ID Manufacturer ID Model Number 8/25/03 8/25/03 Installation Date Start of Operation Approval Type: ® General ❑ Provisional ❑ Piloting ❑ Remedial Seasonal Residence—used less than 6 mo./year: ® Yes ❑ No D. Operating Information 6/6/13 3/8/13 Inspection Date Previous Inspection Date 4" Sludge , 0" Scum Pumping Recommended ❑ Yes ® No Sludge Depth(to be checked yearly) t5aiom.doc•rev. 11-07-05 Page 1 of 3 Massachusetts Department of Environmental Protection Bureau of Resource Protection -Title 5 DEP Approved Inspection and O&M Form for Title 5 I/A Treatment and Disposal Systems E. Field Testing Field Inspection: Color: ❑ gray ❑ brown M clear ❑ turbid ❑ Other(specify): Odor: M musty ❑ earthy ❑ moldy ❑ offensive ❑ turbid Effluent Solids: ® no ❑ some pH 7.0 SU DO 7.0 mg/L Turbidity 0.85 NTU 6 to 9 2 or greater 40 or less Should a Remedial or General Use system fail the Field Testing, effluent samples shall be collected per Standard Methods and analyzed for BOD and TSS. F. Sampling Information Samples Taken: ❑ Influent ❑ Effluent Commercial systems or systems with a design flow of 2000 gpd and greater, and General Use nitrogen reducing systems: gpd Parameters sampled: ❑ pH ❑ BOD ❑ CBOD ❑ TSS ❑ TN ❑ Other(list below) Other 1 Other 2 Other 3 G. Inspection and Maintenance Description of any maintenance performed since previous inspection &during this inspection: Conduct an operation and maintenance event. Collect effluent samples for field testing. Notes and Comments: The residence listed as for sale and is currently unoccupied. The system is operating correctly, and the effluent quality passed field testing parameters. t5aiom.doc•rev. 11-07-05 Page 2 of 3 Massachusetts Department of Environmental Protection Bureau of Resource Protection -Title 5 DEP Approved Inspection and O&M Form for Title 5 I/A Treatment and Disposal Systems H. Certification I certify: I have inspected the sewage treatment and disposal system at the address above, have conducted the required Field Testing and/or sample collection in accordance with Standard Methods, have completed this report and the attached technology operation and maintenance checklist, and the information reported is true, accurate, and complete as of the time of the inspection. I am a Massachusetts certified operator in accordance with 257 CMR 2.00. gl�d Operator Signature Date System owner must submit this report, technology O&M checklist, and any required sampling results to the local board of health and DEP as follows for each inspection performed: Remedial Use—by January 31st of each year for the previous calendar year Piloting Use-within 45 days of inspection date Provisional Use—by March 31th of each year for the previous 12 months General Use—by September 30th of each year for the previous 12 months Send to: Department of Environmental Protection Attention: Title 5 Program One Winter Street, 6th Floor Boston, MA 02108 t5aiom.doc•rev. 11-07-05 Page 3 of 3 LlMassachusetts Department of Environmental Protection Bureau of Resource Protection -Title 5 DEP Approved Inspection and O&M Form for Title 5 I/A Treatment and Disposal Systems A. Installation Important:When Tom Fehnel filling out forms Owner on the computer, use only the tab Route 149 Unit 195-A key to move your Facility Street Address cursor-do not Marstons Mills 02648 use the return key. City Zip Mailing address of owner, if different: � 722 Bear Creek Circle Street Address/PO Box: Winter Springs FL 32708 City State Zip (407) 971 -0477 ext. Telephone Number B. Authorized Service Provider BENNETT ENVIRONMENTAL ASSOCIATES, INC. O&M Firm 1573 Main Street/PO Box 1743 Street Address Brewster MA 02631 City State Zip (508) 896- 1706 ext. 129 Telephone Number Samantha Farrenkopf 13265 Certified Operator Name Certification Number C. Facility/System Information OMNI Environmental Systems OMNI RSF DEP ID Manufacturer ID Model Number 8/25/03 8/25/03 Installation Date Start of Operation Approval Type: ® General ❑ Provisional ❑ Piloting ❑ Remedial Seasonal Residence—used less than 6 mo./year: ® Yes ❑ No D. Operating Information 9/12/13 6/6/13 Inspection Date Previous Inspection Date Sludge Depth(to be checked yearly) Pumping Recommended ❑ Yes ® No t5aiom.doc•rev.11-07-05 Page 1 of 3 Massachusetts Department of Environmental Protection Bureau of Resource Protection -Title 5 DEP Approved Inspection and O&M Form for Title 5 I/A Treatment and Disposal Systems E. Field Testing Field Inspection: Color: ❑ gray ❑ brown ® clear ❑ turbid . ❑ Other(specify): Odor: ® musty ❑ earthy ❑ moldy ❑ offensive ❑ turbid Effluent Solids: ® no ❑ some pH 7.0 SU DO 5.0 mg/L Turbidity 0.66 NTU 6 to 9 2 or greater 40 or less Should a Remedial or General Use system fail the Field Testing, effluent samples shall be collected per Standard Methods and analyzed for BOD and TSS. F. Sampling Information Samples Taken: ❑ Influent M Effluent Commercial systems or systems with a design flow of 2000 gpd and greater, and General Use nitrogen reducing systems: gpd Parameters sampled: ❑ pH ❑ BOD ❑ CBOD ❑ TSS ❑TN ® Other(list below) NO2 NO3 TKN Other 1 Other 2 Other 3 G. Inspection and Maintenance Description of any maintenance performed since previous inspection &during this inspection: Conduct an operation and maintenance event. Collect effluent samples for field testing and laboratory analysis. Notes and Comments: The residence is listed as for sale and is currently unoccupied. The system is operating correctly, and the effluent quality passed field testing parameters. t5aiom.doc•rev.11-07-05 Page 2 of 3 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Title 5 DEP Approved Inspection and O&M Form for Title 5 I/A Treatment and Disposal Systems H. Certification certify: I have inspected the sewage treatment and disposal system at the address above, have conducted the required Field Testing and/or sample collection in accordance with Standard Methods, have completed this report and the attached technology operation and maintenance checklist, and the information reported is true, accurate, and complete.as of the time of the inspection. I am a Massachusetts certified operator in accordance with 257 CMR ii2.00. &ZMLZ!� — �`2s l i� Operator Signature Date System owner must submit this report, technology O&M checklist, and any required sampling results to the local board of health and DEP as follows for each inspection performed: Remedial Use—by January 31st of each year for the previous calendar year Piloting Use-within 45 days of inspection date Provisional Use—by March 31th of each year for the previous 12 months General Use— by September 30th of each year for the previous 12 months Send to: Department of Environmental Protection Attention: Title 5 Program One Winter Street, 6t Floor Boston, MA 02108 t5aiom.doc•rev.11-07-05 Page 3 of 3 -�,7-7� OMNW- &� Inc. OMNI RSF Operation and Maintenance Inspection Checklist A. Installation & Service Information I& Ok L'i\ \' 0c, o 0 racility Street Address Date f Servicet k VN- � � City Operator/O&M Firm System Startup Date Weather Conditions V, B. Septic Tan-k Sludge Pumping Required: Yes 0 Nox El Sludge Depth: El Scum Depth: Effluent tee filter: Yes E] N If yes, inspect El&clean at least yearly E] If the sludge layer is within 12"of the outlet invert,recommend that the homeowner have the septic tank pumped,note the approximate scum layer thickness as well.Also,inquire if the homeowner has a pumping schedule established with a licensed septage hauler, if not recommend a two to four year pumping schedule depending on how heavily the system is used. C. Recirculation Tank R Check if sludge accumulating Pumping required: Yes El Nox Odor problems: Yes 0 NOW If yes,description N Z Effluent tee filter: Yes El NO If yes, inspect El&clean at least yearly 0 W If the sludge layer is greater than 4"request that the homeowner pump out the recirculation tank in order to prevent clogging of the filter modules. Note the characteristics of the effluent coming out of the manifold this may indicate that the filter bed may need servicing. l ° D. Equalization Tank (if installed) Sludge Pumping Required: Yes 0 No El 0 Sludge Depth: ❑ Scum Depth: Effluent tee filter: Yes EJ No El If yes, inspect❑&clean at least yearly El Same inspection criteria as septic tank:. E. Pump Chamber/Vault(if Installed) Pump Inspections(all units) If problems,describe Float switches Check all switches for operation Make Sure the pump is operational by pulling up the float switch;if tre pump is of operational immedi corrective actions need to be taken. r F. Pumps, Switches, Floats, Alarm System ❑Pump Inspections(all units) If problems,describe ❑Test pump alternator, or record hours Hours of operation El Float switches Check all switches for operation ❑Test alarm If non-functioning,corrective action(s) Make sure pump(s), Float(s)and audible alarm(s)are functional, if not make a note so that corrective actions can be made. G. Filter Modules ("Sand Filters") �� 5 4��'��� , �\�-� '�''�`'5 Inspect for ponding Ponding Present:Yes❑ NOA Clean bed: Yes❑ No h ],Distribution pipes Flush:Yes❑ NoW] Brush: Yes❑ No 'O,Any obstruction of airflow to filter modules: Yes❑ No 0If Yes, explain below(i.e. snow,dirt) To inspect the condition of the filter modules remove the mulch layer at one corner of the filter module area, then lift the filter fabric so that the media can be inspected through the end of the contactor. The media should have a thin biomass layer growing on it and should have a brownish shaggy coloration. If the surface of the filter module area appears to be clogged,or the biomass layer is too think it is suggested to completely expose the filter modules,and rake the filter beds thoroughly,then wash the filter beds down with a garden hose(with a pressure nozzle on it).Then Recover the filter beds as they were found. H. Sample Collection Yes❑ No u If yes: ❑BOD ❑TSS ❑pH ❑TN ❑Other All samples are to be taken from the manifold located in the recirculation tank,and are to be stored in sterile, laboratory supplied containers. In order to prevent any cross-contamination from a previous sample rinse the dip cup into the effluent stream at the manifold three times so that a representative sample can be obtained. Make sure to wear proper safety equipment while pulling samples(i.e. rubber gloves). S\ys�tem\ Notes: \ � i'y�-- ! C�"���r�{,.2. r.J �'��(\�7\ ��F'�`r"fi�'11� 1.-7v✓"� ,�-'/�}^'(,4�JK.�,� C;V� '1� _ (Ak— ? �� — u1 \) �V l r 2/S O'A\ t{"`f ti1M �.� I\,J�.�V G�..� h.7 Wv'\ �\a" �`�J�fir— Y �L�: �U,��{ F \ `/t � �J 4 Envirvnu;gnt41Syste t s,Inc. OMNI RSF Operation and Maintenance Inspection Checklist A. Installation &Service Information b. Facility Street Address Date of S rvice City Operator/O&M Firm SRO" System Startup Date Weather Conditions B. Septic Tank Sludge Pumping Required: Yes ❑ No Sludge Depth: Scum Depth: Effluent tee filter: Yes❑ N If yes, inspect ❑&clean at least yearly❑ If the sludge layer is within 12"of the outlet invert, recommend that the homeowner have the septic tank pumped, note the approximate scum layer thickness as well.Also,inquire if the homeowner has a pumping schedule established with a licensed septage hauler, if not recommend a two to four year pumping schedule depending on how heavily the system is used. \\ _ C. Recirculation Tank `Check if sludge accumulating Pumping required: Yes❑ N6,Vq Odor problems: Yes ❑ Nom If yes,description Effluent tee filter: Yes❑ No If yes, inspect❑&clean at least yearly❑ If the sludge layer is greater than 4"request that the homeowner pump out the recirculation tank in order to prevent clogging of the filter modules. Note the characteristics of the effluent coming out of the manifold this may indicate that the filter bed may need servicing. D. Equalization Tank (if installed) Sludge Pumping Required: Yes❑ No❑ ❑ Sludge Depth: ❑Scum Depth: Effluent tee filter: Yes❑ No❑ If yes, inspect❑&clean at least yearly❑ Same inspection criteria as septic tank: \ E. Pump Chamber/Vault(if Installed) i Pump Inspections(all units) • If problems,describe t Float switches Check all switches for operation Make Sure the pump is operational by pulling up the float switch;if the pump is not operational immediate corrective actions need to be taken. Ln ru M Postage $ O Certified Fee C3 Return Receipt Fee t1 O (Endorsement Required) ! 7 Restricted Delivery FeeJ,� O (Endorsement Required) C3 0bN1 �' M Total Postage&Fees r-q Sent To es r3 Street,Apt.No. or PO Box No.Z City, -- a ZIP+4 ...... --------------------- hG-� 62-01-(3 w Certified Mail Provides: o A mailing receipt o A unique identifier for your mailpiece o A record of delivery kept by the Postal Service for two years Important Reminders: o Certified Mail may ONLY be combined with First-Class Mail®or Priority Maile. e Certified Mail is not available for any class of international mail. r n NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. o ForamAdditional fee,a Return Receipt may be requested to provide proof of delivery'"7o obti6 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 USPSe postmark on your Certified Mail receipt is required. e 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°. e If a postmark on the Certified Mail receipt is desired,please present the art!- 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.. PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 i>. • • P • • s■ Complete items 1;2,and 3.Also lete a 5rtnat e item 4 if Restricted Delivery is desired. X ❑Agent 0 Print your name and address on the reverse ❑Addressee so that we can return the card to you. B. Rec wed by(Print d Name) C. Dietaa i ■ Attach this card to the back of the mailpiece, or on the front if space permits. D. Is delivery address different from item 1? ❑ es 1. Article Addressed to: If YES,enter delivery address below: ❑ No T —Ta rn e S 1 012 QC"✓N 25 +--iz v--.)Ic,rvJ T ' 1 �� `� 3. Service Type Cj"20 Certified Maih 0 Priority Mail Express- 0 Registered ❑Return Receipt for Merchandise ❑Insured Mail ❑Collect on Delivery .x 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number "F i (transfer from service label) " I t 7 014 112 0 0 0 0 01 0 3 5 8 2�'� PS Form 3811,.July 2013 , Domestic Return Receipt UNITED STATES POSTAL SERVICE First-Class Mail Postage&Feed Paid USPS Permit No.G-10 • Sender: Please print your name,address,and ZIP+4®in this box* mw Town of Barnstable Health Division Y 200 Main Street I Hyannis,MA 02601 I " I I I il}l�'illlllii�llr�irl1l�Piij' F. Pumps, Switches, Floats, Alarm System ❑ Pump Inspections(all units) =4'`� vS '� � If problems,describe ❑Test pump alternator, or record hours Hours of operation J ❑ Float switches Check all switches for operation ❑Test alarm If non-functioning,corrective action(s) Make sure pump(s), Float(s)and audible alarm(s)are functional, if not make a note so that corrective actions can be made. G. Filter Modules ("Sand Filters") :��Sv��� `\ Inspect for ponding Ponding Present:Yes❑ NoA Clean bed: Yes❑ N ' Distribution pipes ` Flush:Yes❑ Nom Brush: Yes❑ NAA 0 Any obstruction of airflow to filter modules: Yes❑ No KIf Yes, explain below(i.e. snow, dirt) To inspect the condition of the filter modules remove the mulch layer at one corner of the filter module area, then lift the filter fabric so that the media can be inspected through the end of the contactor. The media should have a thin biomass layer growing on it and should have a brownish shaggy coloration.If the surface of the filter module area appears to be clogged,or the biomass layer is too think it is suggested to completely expose the filter modules,and rake the filter beds thoroughly,then wash the filter beds down with a garden hose(with a pressure nozzle on it).Then Recover the filter beds as they were found. H. Sample Collection Yes❑ No If yes: ❑BOD ❑TSS ❑pH ❑TN ❑Other All samples are to be taken from the manifold located in the recirculation tank,and are to be stored in sterile, laboratory supplied containers. In order to prevent any cross-contamination from a previous sample rinse the dip cup into the effluent stream at the manifold three times so that a representative sample can be obtained. Make sure to wear proper safety equipment while pulling samples(i.e.rubber gloves). System (Votes: J Q\__1 OJQ r.\,— \S r � "— n 0j MN!46� EnvironIneni�c!Systems, Inc.. OMNI RSF Operation and Maintenance Inspection Checklist A. Installation & Service Information Facility Street Address Date.of Se ice N,� City Operator/O&M Firm Sum System Startup Date Weather Conditions D. Septic Tank Sludge Pumping Required: Yes❑ No XSludge Depth:U� \, (Scum Depth: 0 Effluent tee filter: Yes❑ Nov If yes, inspect❑&clean at least yearly❑ If the sludge layer is within 12"of the outlet invert,recommend that the homeowner have the septic tank pumped, note the approximate scum layer thickness as well.Also,inquire if the homeowner has a pumping schedule established with a licensed septage hauler, if not recommend a two to four year pumping schedule depending on how heavily the system is used. C. Recirculation Tank Check if sludge accumulating Pumping required: Yes❑ N Odor problems: Yes ❑ N If yes,description Effluent tee filter: Yes❑ N If yes, inspect❑ &clean at least yearly❑ If the sludge layer is greater than 4"request that the homeowner pump out the recirculation tank in order to prevent clogging of the filter modules. Note the characteristics of the effluent coming out of the manifold this may indicate that the filter bed may need servicing. D. Equalization Tank (if installed) Sludge Pumping Required: Yes❑ No❑ ❑ Sludge Depth: ❑ Scum Depth: Effluent tee filter: Yes❑ No❑ If yes, inspect❑&clean at least yearly❑ Same inspection criteria as septic tank: E. Pump Chamber/Vault(if Installed) Pump Inspections(all units) If problems,describe Float switches Check all switches for operation Make Sure the pump is operational by pulling up the float switch;if the pump is not operational immediate corrective actions need to be taken. F. Pumps, Switches, Floats, Alarm System Pump Inspections(all units) If problems,describe Test pump alternator, or record hours Hours of operation Float switches Check all switches for operation Test alarm If non-functioning,corrective action(s) Make sure pump(s), Float(s)and audible alarm(s)are functional, if not make a note so that corrective actions can be made. G. Filter Modules ("Sand Filters") Inspect for ponding Ponding Present:Yes❑ No Clean bed: Yes❑ NoCK Distribution pipes Flush:Yes❑ No ] Brush: Yes❑ NS4 9Any obstruction of airflow to filter modules: Yes❑ No If Yes, explain below(i.e. snow, dirt) V To inspect the condition of the filter modules remove the mulch layer at one corner of the filter module area, then lift the filter fabric so that the media can be inspected through the end of the contactor. The media should have a thin biomass layer growing on it and should have a brownish shaggy coloration. If the surface of the filter module area appears to be clogged,or the biomass layer is too think it is suggested to completely expose the filter modules,and rake the filter beds thoroughly,then wash the filter beds down with a garden hose(with a pressure nozzle on it).Then Recover the filter beds as they were found. H. Sample Collection Yes❑ Nck 17L If yes: ❑BOD ❑TSS ❑pH ❑TN ❑Other All samples are to be taken from the manifold located in the recirculation tank,and are to be stored in sterile, laboratory supplied containers.In order to prevent any cross-contamination from a previous sample rinse the dip cup into the effluent stream at the manifold three times so that a representative sample can be obtained. Make sure to wear proper safety equipment while pulling samples(i.e.rubber gloves). System Notes: vs �.tr�✓ e.�� ��v G,��. �(:�J`.�.% ♦S C.�',(`f`T,w�� l:`�t3C.C,���oa t'.�Z e S �Si�� \co°/" ���2.. U - V to _r3 go t IVINQ Divri,ontrzerz i Systersss,Inc. OMNI RSF Operation and Maintenance Inspection Checklist A. Installation & Service Information VL 3—k<1 ML\ t ck<� — A - A)i � t-') 0 Facility Street Address Date of Se ice { City Operator/O&M Firm System Startup Date Weather Conditions D. Septic Tank Sludge Pumping Required: Yes❑ Nod ❑ Sludge Depth: ❑ Scum Depth: If yes, inspect❑ &clean at least yearly❑Effluent tee filter: Yes El Nd If the sludge layer is within 12"of the outlet invert, recommend that the homeowner have the septic tank pumped, note the approximate scum layer thickness as well.Also,inquire if the homeowner has a pumping schedule established with a licensed septage hauler, if not recommend a two to four year pumping schedule depending on how heavily the system is used. C. Recirculation Tank `���!, ��S �►' °`'' c"� ' �' i ❑ Check if sludge accumulating Pumping required: Yes❑ N4 Odor problems: Yes El Ne� If yes,description Effluent tee filter: Yes El No0 If yes, inspect El &clean at least yearly❑ If the sludge layer is greater than 4"request that the homeowner pump out the recirculation tank in order to prevent clogging of the filter modules. Note the characteristics of the effluent coming out of the manifold this may indicate that the filter bed may need servicing. D. Equalization Tank (if installed) Sludge Pumping Required: Yes❑ No ❑ ❑ Sludge Depth: ❑Scum Depth: Effluent tee filter: Yes❑ No❑ If yes, inspect❑&clean at least yearly❑ Same inspection criteria as septic tank: E. Pump Chamber/Vault (if Installed) Pump Inspections(all units) If problems,describe Float switches Check all switches for operation Make Sure the pump is operational by pulling up the float switch; if the pump is not operational immediate corrective actions need to be taken. F. Pumps, Switches, Floats, Alarm System Pump Inspections(all units) If problems,describe Test pump alternator, or record hours Hours of operation Float switches Check all switches for operation Test alarm k If non-functioning,corrective action(s) Make sure pump(s), Float(s)and audible alarm(s)are functional, if not make a note so that corrective actions can be made. G. Filter Modules ("Sand Filters") tAny spect for poncling Ponding Present:Yes ElNo(�lean bed: Yes ElNo istribution pipes Flush:Yes ❑ No� Brush: Yes ElNo obstruction of airflow to filter modules: Yes❑ No L4 If Yes, explain below(i.e. snow, dirt) To inspect the condition of the filter modules remove the mulch layer at one corner of the filter module area, then lift the filter fabric so that the media can be inspected through the end of the contactor. The media should have a thin biomass layer growing on it and should have a brownish shaggy coloration. If the surface of the filter module area appears to be clogged,or the biomass layer is too think it is suggested to completely expose the filter modules, and rake the filter beds thoroughly,then wash the filter beds down with a garden hose(with a pressure nozzle on it).Then Recover the filter beds as they were found. H. Sample Collection Yes:t No❑ If yes: ❑BOD ❑TSS ❑pH VTN POther N All samples are to be taken from the manifold located in the recirculation tank,and are to be stored in sterile, laboratory supplied containers. In order to prevent any cross-contamination from a previous sample rinse the dip cup into the effluent stream at the manifold three times so that a representative sample can be obtained. Make sure to wear proper safety equipment while pulling samples(i.e.rubber gloves). System Notes: 70, r, q%a � `l�► �V t� �� l��v� V t t 1 f Serial_No:09181315:54 NA A,N A L Y.T O CAL ANALYTICAL REPORT Lab Number: L1317960 Client: Bennett Environmental Associates 1573 Main Street Brewster, MA 02631 ATTN: David Bennett Phone: (508)896-1706 Project Name: FENNEL RESIDENCE Project Number: BEA09-10156 Report Date: 09/18/13 The original project report/data package is held by Alpha Analytical.This report/data package is paginated and should be reproduced only in its entirety.Alpha Analytical holds no responsibility for results and/or data that are not consistent with the original. Certifications&Approvals: MA(M-MA086),NY (11148),CT(PH-0574),NH(2003),NJ NELAP(MA935),RI(LA000065),ME(MA00086), PA(68-03671),USDA(Permit #P-330-11-00240),NC(666),TX(T104704476),DOD(1-2217),US Army Corps of Engineers. Eight Walkup Drive,Westborough, MA 01581-1019 508-898-9220 (Fax)508-898-9193 800-624-9220-www.alphalab.com Page 1 of 18 Serial No:09181315:54 Project Name: FENNEL RESIDENCE Lab Number: L1317960 Project Number: BEA09-10156 Report Date: 09/18/13 Alpha Sample Collection .Sample ID Client ID Location Date/Time L1317960-01 EFFLUENT MARSTONS MILLS, MA 09/12/13 11:50 Page 2 of 18 Serial No:09181315:54 Project Name: FEHNEL RESIDENCE Lab Number: L1317960 Project Number: BEA09-10156 Report Date: 09/18/13 Case Narrative The samples were received in accordance with the Chain of Custody and no significant deviations were encountered during the preparation or analysis unless otherwise noted.Sample Receipt,Container Information,and the Chain of Custody are located at the back of the report. Results contained within this report relate only to the samples submitted under this Alpha Lab Number and meet all of the requirements of NELAC,for all NELAC accredited parameters.The data presented in this report is organized by parameter(i.e.VOC,SVOC,etc.).Sample specific Quality Control data(i.e.Surrogate Spike Recovery)is reported at the end of the target analyte list for each individual sample, followed by the Laboratory Batch Quality Control at the end of each parameter.If a sample was re-analyzed or re-extracted due to a required quality control corrective action and if both sets of data are reported,the Laboratory ID of the re-analysis or re-extraction is designated with an"R"or"RE",respectively.When multiple Batch Quality Control elements are reported(e.g.more than one LCS),the associated samples for each element are noted in the grey shaded header line of each data table.Any Laboratory Batch,Sample Specific% recovery or RPD value that is outside the listed Acceptance Criteria is bolded in the report.Performance criteria for CAM and RCP methods allow for some LCS compound failures to occur and still be within method compliance.In these instances,the specific failures are not narrated but are noted in the associated QC table.This information is also incorporated in the Data Usability format for our Data Merger tool where it can be reviewed along with any associated usability implications.Soil/sediments,solids and tissues are reported on a dry weight basis unless otherwise noted.Definitions of all data qualifiers and acronyms used in this report are provided in the Glossary located at the back of the report. In reference to questions H(CAM)or 4(RCP)when"NO"is checked,the performance criteria for CAM and RCP methods allow for some quality control failures to occur and still be within method compliance. In these instances the specific failure is not narrated but noted in the associated QC table.The information is also incorporated in the Data Usability format of our Data Merger tool where it can be reviewed along with any associated usability implications. Please see the associated ADEx data file for a comparison of laboratory reporting limits that were achieved with the regulatory Numerical Standards requested on the Chain of Custody. HOLD POLICY For samples submitted on hold,Alpha's policy is to hold samples free of charge for 21 calendar days from the date the project is completed. After 21 calendar days,we will dispose of all samples submitted including those put on hold unless you have contacted your Client Service Representative and made arrangements for Alpha to continue to hold the samples. Please contact Client Services at 800-624-9220 with any questions. I,the undersigned, attest under the pains and penalties of perjury that,to the best of my knowledge and belief and based upon my personal inquiry of those responsible for providing the information contained in this analytical report,such information is accurate and complete. This certificate of analysis is not complete unless this page accompanies any and all pages of this report. Cy `�rl� Cynthia McQueen Authorized Signature: Title: Technical Director/Representative Date: 09/18/13 HAPage 3 of 18 - Serial No:09181315:54 INORGANICS MISCELLANEOUS Page 4 of 18 Serial No:09181315:54 Project Name: FENNEL RESIDENCE Lab Number: L131796O Project Number: BEA09-10156 Report Date: 09/18/13 SAMPLE RESULTS Lab ID: L1317960-01 Date Collected: 09/12/13 11:50 Client ID: EFFLUENT Date Received: 09/12/13 Sample Location: MARSTONS MILLS,MA Field Prep: Not Specified Matrix: Water Dilution Date Date Analytical Parameter Result Qualifier Units RL MDL Factor Prepared Analyzed Method Analyst General Chemistry-Westborough Lab Nitrogen,Nitrite ND mg/I 0.050 1 - 09/14/13 00:34 44,353.2 DB Nitrogen,Nitrate 4.3 mg/I ... _........_... .. _...._... ......_. . .....- ..._.._ ........_ Nitrogen,Total Kjeldahl 1.48 mg/I 0.300 - 1 09/13/13 12:20 09/17/13 19:14 30,4500N-C AT 6 Page 5 of 18 Serial No:09181315:54 Project Name: FEHNEL RESIDENCE Lab Number: L1317960 Project Number: BEA09-10156 Report Date: 09/18/13 Method Blank Analysis Batch Quality Control Dilution Date Date Analytical Parameter Result Qualifier Units RL MDL Factor Prepared Analyzed Method Analyst General Chemistry WestboroughLab for,sampl'6 s): 01 Batch- WG635897 1 Nitrogen,Total Kjeldahl ND mg/I 0.300 1 09/13/13 12:20 09/17/13 18:58 30,4500N-C AT General Chemistry-Westborough.Lali for sample(s): 01. Batch: WG636045-1 Nitrogen,Nitrate ND mg/I 0.10 1 09/14/13 00:17 44,353.2 DB General Chemistry`-'Westborough Lab for'sample(s): 01 Batch ;WG636046=1 Nitrogen,Nitrite ND mg/I 0.050 1 09/14/13 00:18 44,353.2 DB IL1L'HA Page 6 of 18 Serial No:09181315:54 Lab Control Sample Analysis Project Name: FENNEL RESIDENCE Batch Quality Control Lab Number: L1317960 Project Number: BEA09-10156 Report Date: 09/18/13 LCS LCSD %Recovery Parameter %Recovery Qual %Recovery Qual Limits RPD Qual RPD Limits General Chemist ry ,:VVestborough�Lab Associated sample(s): 01 Batch WG635897 Nitrogen,Total Kjeldahl ` W97— - 78-122 - General Che mistry-Westborougl%Lab Associatedsample(s)r01_ Batch WG636045 2 Nitrogen,Nitrate 101 ' 90-110 - General Chemist - Westborough;Lab Associated samples) '0:1 Batch WG636046 2 ry � - . Nitrogen,Nitrite 1 104 _ - 90-110 - 20 Page 7 of 18@6 ,a.. Serial No:09181315:54 Matrix Spike Analysis Project Name: FEHNEL RESIDENCE Batch Quality Control Lab Number: L1317960 Project Number: BEA09-10156 Report Date: 09/18/13 Native MS MS MS MSD MSD Recovery RPD Parameter Sample Added Found %Recovery Qual Found %Recovery Qual Limits RPD Qual Limits General�Chemistry-Westborough.Lab,Associatedsample(s):a01 QC.Batch:ID: WG635897 4` QC�Sample�L1317914 01� -Client --MS'Sample a R Nitrogen,Total Kjeldahl 1.37 8 8.61 M�90ry - ` - 77-111 - 24 General Chemistry WestboroughxLab Associated"sample(s):.01 QGBatch,lD <WG'636045 4 QC Sample Lf1.317998 01 'Client ID MS Sample_ Nitrogen,Nitrate ND 4 4.2 105 "; - 83-113 - 6 General Chemistry=Westborough,Lab Associated-sample(s): 01 QC Batch.ID iWG:636046 4 QC Sample. L1.317995,01 Client iD -MS Sample Nitrogen,Nitrite ND 4 4.099" 80-120 - 20 Page 8 of 18 ?�;� Serial No:09181315:54 Lab Duplicate Analysis Project Name: FEHNEL RESIDENCE Batch Quality Control Lab Number: L1317960 Project Number: BEA09-10156 Report Date: 09/18/13 Parameter Native Sample Duplicate Sample Units RPD Qual RPD Limits General„Chemistry Westborough Lab Associate"daample(s): 01* QC'Batch`ID °WG635897=3,::QC Sample. :L1:317914=01 :Client ID: .DUP, Sample, Nitrogen,Total Kjeldahl 1.37 1.36 mg/I 24 GeneralGhemistry Westborough Lab:Associatedsample,(s): .0.1.; QCsBatchID W6636045-3 QC.Sample ,%L1317.998-01 Client ID:: DUF:Sample Nitrogen,Nitrate ND ND mg/I `NC,7'_ 6 ..,€. ...,T. {;..«.�.,r3F3' �m,.,�„- r.M1_...� ..,.�..,�n„e..,,«„�..e+_ ,j..,.".'; r.. ;.w �... ..,..:.y.. T.-.,,,,n ........... ..--..:.....w..,...,, .r.- ;.,.�...... y,.,€. w.+:..,;..„. ..«_.......:... y......<,y:, ...„,.,..— ...-,........, ,-...,.,. ..,,..,,„5 Generaly.Chemistry WestboroughlLab%•Ass.ociated sample(s). 01` ,QC'Batch°ID MG636046-3:�'QC Sample L_1:397995-01 ClienVID:: DUP Sa riple.' .. �. Nitrogen,Nitrite ND ND mg/I NC".7 20 Page 9 of 18 Serial No:09181315:54 Project Name: FEHNEL RESIDENCE Lab Number: L1317960 Project Number: BEA09-10156 Report Date: 09/18/13 Sample Receipt and Container Information Were project specific reporting limits specified? YES Reagent H2O Preserved Vials Frozen on: NA Cooler Information Custody Seal Cooler A Absent Container Information Temp Container ID Container Type Cooler pH deg C Pres Seal Analysis(*) L1317960-01A Plastic 250ml unpreserved A 7 4 Y Absent NO2-353(2),NO3-353(2) se <2 4 Y Absent TKN-4500 28 L1317960 01 B Plastic 250m1 H2SO4 preserved A ( ) Container Comments L1317960-01A Values in parentheses indicate holding time in days ik.o.. Page 10 of 18 Serial No:09181315:54 Project Name: FENNEL RESIDENCE Lab Number: L1317960 Project Number: BEAO9-10156 Report Date: 09/18/13 GLOSSARY Acronyms EDL Estimated Detection Limit:This value represents the level to which target analyte concentrations are reported as estimated values,when those target analyte concentrations are quantified below the reporting limit(RL).The EDL includes any adjustments from dilutions,concentrations or moisture content,where applicable.The use of EDLs is specific to the analysis of PAHs using Solid-Phase Microextraction(SPME). EPA Environmental Protection Agency. LCS Laboratory Control Sample:A sample matrix,free from the analytes of interest,spiked with verified known amounts of analytes or a material containing known and verified amounts of analytes. LCSD Laboratory Control Sample Duplicate:Refer to LCS. LFB Laboratory Fortified Blank:A sample matrix,free from the analytes of interest,spiked with verified known amounts of analytes or a material containing known and verified amounts of analytes. MDL Method Detection Limit:This value represents the level to which target analyte concentrations are reported as estimated values, when those target analyte concentrations are quantified below the reporting limit(RL).The MDL includes any adjustments from dilutions,concentrations or moisture content,where applicable. MS Matrix Spike Sample:A sample prepared by adding a known mass of target analyte to a specified amount of matrix sample for which an independent estimate of target analyte concentration is available. MSD Matrix Spike Sample Duplicate:Refer to MS. NA Not Applicable. NC Not Calculated: Term is utilized when one or more of the results utilized in the calculation are non-detect at the parameter's reporting unit. NI Not Ignitable. RL Reporting Limit: The value at which an instrument can accurately measure an analyte at a specific concentration.The RL includes any adjustments from dilutions,concentrations or moisture content,where applicable. RPD Relative Percent Difference: The results from matrix and/or matrix spike duplicates are primarily designed to assess the precision of analytical results in a given matrix and are expressed as relative percent difference(RPD). Values which are less than five times the reporting limit for any individual parameter are evaluated by utilizing the absolute difference between the values; although the RPD value will be provided in the report. SRM Standard Reference Material:A reference sample of a known or certified value that is of the same or similar matrix as the associated field samples. Footnotes I The reference for this analyte should be considered modified since this analyte is absent from the target analyte list of the original method. Terms Analytical Method:Both the document from which the method originates and the analytical reference method.(Example:EPA 8260B is shown as 1,8260B.)The codes for the reference method documents are provided in the References section of the Addendum. Data Qualifiers A Spectra identified as"Aldol Condensation Product". B The analyte was detected above the reporting limit in the associated method blank.Flag only applies to associated field samples that have detectable concentrations of the analyte at less than ten times(I Ox)the concentration found in the blank.For MCP-related projects,flag only applies to associated field samples that have detectable concentrations of the analyte at less than ten times(IOx) the concentration found in the blank.For DOD-related projects,flag only applies to associated field samples that have detectable concentrations of the analyte at less than ten times(10x)the concentration found in the blank AND the analyte was detected above one-half the reporting limit(or above the reporting limit for common lab contaminants)in the associated method blank.For NJ- Air-related projects,flag only applies to associated field samples that have detectable concentrations of the analyte above the reporting limit. C Co-elution:The target analyte co-elutes with a known lab standard(i.e.surrogate,internal standards,etc.)for co-extracted analyses. D Concentration of analyte was quantified from diluted analysis.Flag only applies to field samples that have detectable concentrations of the analyte. E Concentration of analyte exceeds the range of the calibration curve and/or linear range of the instrument. G The concentration may be biased high due to matrix interferences(i.e,co-elution)with non-target compound(s).The result should be considered estimated. H The analysis of pH was performed beyond the regulatory-required holding time of 15 minutes from the time of sample collection. I The lower value for the two columns has been reported due to obvious interference. Report Format: Data Usability Report Page 11 of 18 Serial No:09181315:54 Project Name: FEHNEL RESIDENCE Lab Number: L1317960 Project Number: BEA09-10156 Report Date: 09/18/13 Data Qualifiers M Reporting Limit(RL)exceeds the MCP CAM Reporting Limit for this analyte. NJ Presumptive evidence of compound.This represents an estimated concentration for Tentatively Identified Compounds(TICs),where the identification is based on a mass spectral library search. P azY P The RPD between the results for the two columns exceeds the method-specified criteria. Q The quality control sample exceeds the associated acceptance criteria.For DOD-related projects,LCS and/or Continuing Calibration Standard exceedences are also qualified on all associated sample results. Note:This flag is not applicable for matrix spike recoveries when the sample concentration is greater than 4x the spike added or for batch duplicate RPD when the sample concentrations are less than 5x the RL.(Metals only.) R Analytical results are from sample re-analysis. RE Analytical results are from sample re-extraction. S Analytical results are from modified screening analysis. J Estimated value.This represents an estimated concentration for Tentatively Identified Compounds(TICS). ND Not detected at the reporting limit(RL)for the sample. I Report Format: Data Usability Report Page 12 of 18 Serial No:09181315:54 Project Name: FEHNEL RESIDENCE Lab Number: L1317960 Project Number: BEA09-10156 Report Date: 09/18/13 REFERENCES 30 Standard Methods for the Examination of Water and Wastewater.APHA-AWWA- WPCF. 18th Edition. 1992. 44 Methods for the Determination of Inorganic Substances in Environmental Samples, EPA/600/R-93/100,August 1993. LIMITATION OF LIABILITIES Alpha Analytical performs services with reasonable care and diligence normal to the analytical testing laboratory industry. In the event of an error, the sole and exclusive responsibility of Alpha Analytical shall be to re-perform the work at it's own expense. In no event shall Alpha Analytical be held liable for any incidental, consequential or special damages, including but not limited to,damages in any way connected with the use of, interpretation of, information or analysis provided by Alpha Analytical. We strongly urge our clients to comply with EPA protocol regarding sample volume, preservation,cooling, containers,sampling procedures, holding time and splitting of samples in the field. Page 13 of 18 Serial No:09181315:54 Certificate/Approval Program Summary Last revised August 29,2013 -Westboro Facility The following list includes only those analytes/methods for which certification/approval is currently held. For a complete listing of analytes for the referenced methods;please contact your Alpha Customer Service Representative. Connecticut Department of Public Health Certificate/Lab ID: PH-0574. NELAP Accredited Solid Waste/Soil. Drinking Water(Inorganic Parameters: Color, pH, Turbidity, Conductivity, Alkalinity, Chloride, Free Residual Chlorine, Fluoride, Calcium Hardness, Sulfate, Nitrate, Nitrite, Aluminum, Antimony, Arsenic, Barium, Beryllium, Cadmium, Calcium, Chromium, Copper, Iron, Lead, Magnesium, Manganese, Mercury, Nickel, Selenium, Silver, Sodium, Thallium, Zinc, Total Dissolved Solids, Total Organic Carbon, Total Cyanide, Perchlorate. Orqanic Parameters: Volatile Organics 524.2,Total Trihalomethanes 524.2, 1,2-Dibromo-3-chloropropane(DBCP)504.1, Ethylene Dibromide(EDB)504.1, 1,4- Dioxane (Mod 8270). Microbiology Parameters: Total Coliform-MF mEndo (SM9222B), Total Coliform - Colilert (SM9223, Enumeration and P/A), E. Coli. - Colilert (SM9223, Enumeration and P/A), HPC - Pour Plate (SM9215B), Fecal Coliform-MF m-FC (SM9222D), Fecal Coliform-EC Medium (SM 9221 E). Wastewater/Non-Potable Water (Inorganic Parameters: Color, pH, Conductivity, Acidity, Alkalinity, Chloride, Total Residual Chlorine, Fluoride, Total Hardness, Silica, Sulfate, Sulfide, Ammonia, Kjeldahl Nitrogen, Nitrate, Nitrite, 0- Phosphate, Total Phosphorus, Aluminum, Antimony, Arsenic, Barium, Beryllium, Boron, Cadmium, Calcium, Chromium, Hexavalent Chromium, Cobalt, Copper, Iron, Lead, Magnesium, Manganese, Mercury, Molybdenum; Nickel, Potassium, Selenium, Silver, Sodium, Strontium, Thallium, Tin, Titanium, Vanadium, Zinc, Total Residue (Solids), Total Dissolved Solids, Total Suspended Solids (non-filterable), BOD, CBOD, COD, TOC, Total Cyanide, Phenolics, Foaming Agents (MBAS), Bromide, Oil and Grease. Organic Parameters: PCBs, Organochlorine Pesticides, Technical Chlordane, Toxaphene, Acid Extractables (Phenols), Benzidines, Phthalate Esters, Nitrosamines, Nitroaromatics & Isophorone, Polynuclear Aromatic Hydrocarbons, Haloethers, Chlorinated Hydrocarbons, Volatile Organics, TPH (HEM/SGT), CT- Extractable Petroleum Hydrocarbons (ETPH), MA-EPH, MA-VPH. Microbiology Parameters: Total Coliform-MF mEndo (SM9222B), Total Coliform-MTF (SM9221B), E. Coli-Colilert(SM9223 Enumeration), HPC- Pour Plate (SM9215B), Fecal Coliform-MF m-FC(SM9222D), Fecal Coliform-A-1 Broth(SM9221 E), Enterococcus-Enterolert. Solid Waste/Soil(Inorganic Parameters: pH, Sulfide,Aluminum,Antimony, Arsenic, Barium, Beryllium, Boron, Cadmium, Calcium, Chromium, Hexavalent Chromium, Cobalt, Copper, Iron, Lead, Magnesium, Manganese, Mercury, Molybdenum, Nickel, Potassium, Selenium, Silver, Sodium, Thallium, Tin, Vanadium, Zinc, Total Cyanide, Ignitability, Phenolics, Corrosivity, TCLP Leach (1311), SPLP Leach (1312 metals only), Reactivity..Organic Parameters: PCBs, PCBs in Oil, Organochlorine Pesticides, Technical Chlordane, Toxaphene, CT-Extractable Petroleum Hydrocarbons (ETPH), MA-EPH, MA-VPH, Dicamba, 2,4-D, 2,4,5-T, 2,4,5-TP(Silvex), Dalapon, Volatile Organics (SW 8260), Acid Extractables (Phenols) (SW 8270), Benzidines (SW 8270), Phthalates (SW 8270), Nitrosamines (SW 8270), Nitroaromatics & Cyclic Ketones (SW 8270), PAHs (SW 8270), Haloethers (SW 8270), Chlorinated Hydrocarbons (SW 8270). ) State of Illinois Certificate/Lab ID: 003155. NELAP Accredited. Drinking Water (Inorganic Parameters: SM212013, 2320B, 2510B, 2540C, SM4500CN-CE, 4500E-C, 4500H-B, 4500NO3-F, 5310C, EPA 200.7, 200.8,245.1, 300.0. Organic Parameters: EPA 504.1, 524.2.) Wastewater/Non-Potable Water (Inorganic Parameters: SM2120B, 2310B, 2320B, 2340B, 2510B, 2540B, 2540C, 2540D, SM4500CL-E, 4500CN-E, 4500E-C, 4500H-B, 4500NH3-H, 4500NO2-B, 4500NO3-F, 4500P-E, 4500S-D, 4500S03-B, 5210B, 5220D, 5310C, 5540C, EPA 120.1, 1664A, 200.7, 200.8, 245.1, 300.0, 350.1, 351.1, 353.2, 410.4, 420.1. Organic Parameters: EPA 608,624, 625.) Hazardous and Solid Waste (Inorganic Parameters: EPA 1010A, 1030, 1311, 1312, 6010C, 6020A, 7196A, 7470A, 7471 B, 9012B, 9014, 9038, 9040C, 9045D, 9050A, 9065, 9251. Organic Parameters: 8011 (NPW only), 8015C, 8081 B, 8082A,8151A, 8260C, 8270D, 8315A, 8330.) Maine Department of Human Services Certificate/Lab ID:2009024. Drinking Water(Inorganic Parameters: SM9215B, 9222D, 9223B, EPA 180.1, 353.2, SM2120B, 2130B, 2320B, 2510C, 2540C,4500CI-D, 4500CN-C, 4500CN-E, 4500E-C,4500H+B, 4500NO3-F, 5310C, EPA 200.7, EPA 200.8, 245.1, EPA 300.0. Organic Parameters:504.1, 524.2.) Wastewater/Non-Potable Water (Inorganic Parameters: EPA 120.1, 1664A, 300.0, 350.1, 351.1, 353.2, 410.4, 420.1, 8315A, 9010C, SM2120B, 2310B, 2320B, 2510B, 2540B, 2540C, 2540D, 426C, 4500CI-E, 4500CN-C, 4500CN-E, 4500E-B, 4500E-C, 4500H+B, 4500Norg-C, 4500NH3-B, 4500NH3-H, 4500NO2-B, 4500NO3-F, 4500P-B, 4500P-E, 4500S2-D, 4500S03-B, 5540C, 5210B, 5220D, 5310C, 9010B, 9030B, 9040C, 7470A, 7196A, 2340B, EPA 200.7, f6010C, 200.8, 6020A, 245.1, 1311, 1312, 3005A, Enterolert, 9223B, 9222D. Organic Parameters: 608, 624, 625, 8011, Page t�ofi 18 8 , 8082A, 8330, 8151A, 8260C, 8270D,3510C, 3630C, 5030B, ME-DRO, ME-GRO, MA-EPH, MA-VPH.) Serial No:09181315:54 Solid Waste/Soil(Inorganic Parameters: 9010B, 9012A, 9014, 9040B, 9045C, 6010C, 6020A, 7471 B, 7196A, 9050A, 1010, 1030, 9065, 1311, 1312, 3005A, 3050B, 9038, 9251. Orqanic Parameters: ME-DRO, ME-GRO, MA-EPH, MA- VPH, 8260C, 8270D, 8330,8151A, 8081B,8082A, 3540C, 3546, 3580A,3620C, 3630C, 5030B, 5035.) Massachusetts Department of Environmental Protection Certificate/Lab ID: M-MA086. Drinking Water (Inorganic Parameters: (EPA 200.8 for: Sb,As,Ba,Be,Cd,Cr,Cu,Pb,Ni,Se,TI) (EPA 200.7 for: Ba,Be,Ca,Cd,Cr,Cu,Na,Ni) 245.1, (300.0 for: Nitrate-N, Fluoride, Sulfate); (EPA 353.2 for: Nitrate-N, Nitrite-N); (SM4500NO3-F for: Nitrate-N and Nitrite-N); 4500E-C, 4500CN-CE, EPA 180.1, SM2130B, SM4500CI-D, 2320B, SM2540C, SM4500H-B. Organic Parameters: (EPA 524.2 for: Trihalomethanes, Volatile Organics); (504.1 for: 1,2- Dibromoethane, 1,2-Dibromo-3-Chloropropane), EPA 332. Microbiology Parameters: SM9215B; ENZ. SUB. SM9223; ColilertQT SM9223B; MF-SM9222D.) Non-Potable Water(Inorganic Parameters:, (EPA 200.8 for: AI,Sb,As,Be,Cd,Cr,Cu,Pb,Mn,Ni,Se,Ag,TI,Zn); (EPA 200.7 for: AI,Sb,As,Be,Cd,Ca,Cr,Co,Cu,Fe,Pb,Mg,Mn,Mo,Ni,K,Se,Ag,Na,Sr,Ti,TI,V,Zn); 245.1, SM4500H,B, EPA 120.1, SM2510B, 2540C, 2340B, 2320B, 4500CL-E, 4500E-BC; 426C, SM4500NH3-BH, (EPA 350.1 for: Ammonia-N), LACHAT 10-107-06-1-B for Ammonia-N, SM4500NO3-F, 353.2 for Nitrate-N, SM4500NH3-BC-NES, EPA 351.1, SM4500P-E, 4500P-B,E, 5220D, EPA 410.4, SM 5210B, 5310C, 4500CL-D, EPA 1664, SM14 510AC, EPA 420.1, SM4500-CN-CE, SM2540D. Organic Parameters: (EPA 624 for Volatile Halocarbons,Volatile Aromatics),(608 for: Chlordane,Toxaphene,Aldrin, alpha-BHC, beta-BHC, gamma-BHC, delta-BHC, Dieldrin, DDD, DDE, DDT,Endosulfan I, Endosulfan II, Endosulfan sulfate, Endrin, Endrin Aldehyde, Heptachlor, Heptachlor Epoxide, PCBs-Water), (EPA 625 for SVOC Acid Extractables and SVOC Base/Neutral Extractables), 600/4-81-045-PCB-Oil. Microbiology Parameters: (ColilertQT SM9223B; Enterolert-QT:SM9222D-MF.) New Hampshire Department of Environmental Services Certificate/Lab ID:200307. NELAP Accredited. Drinking Water(Inorganic Parameters: SM 9222B, 9223B, 9215B, EPA 200.7, 200.8, 300.0, SM4500CN-E, 4500H+B, 4500NO3-F,2320B,2510B, 2540C,4500E-C, 5310C,2120B, EPA 332.0. Organic Parameters:504.1, 524.2.) Non-Potable Water(Inorganic Parameters: SM92221), 9221 B, 9222B, 9221 E-EC, EPA 3005A, 200.7, 200.8, 245.1, SW- 846 6010C, 6020A, 7196A, 7470A, SM3500-CR-D, EPA 120.1, 300.0, 350.1, 350.2, 351.1, 353.2, 410.4, 420.1, 426C, 1664A, SW-846 9010B, 9010C, 9030, 9040B, 9040C, SM2120B, 2310B, 2320B, 2340B, 2540B, 2540D, 4500H+B, 4500CL-E, 4500CN-E, 4500NH3-H, 4500NO3-F, 4500NO2-B, 4500P-E, 4500-S2-D, 4500S03-B, 5210B, 5220D, 2510B, 2540C, 4500E-C, 5310C, 5540C, LACHAT 10-204-00-1-A, LACHAT 10-107-06-2-D, 3060A. Organic Parameters: SW-846 3510C, 3630C, 5030B, 8260C, 8270D, 8330, EPA 624, 625, 608, SW-846 8082A, 8081 B, 8015C, 8151A, 8330, 8270D-SIM.) Solid& Chemical Materials (Inorganic Parameters: SW-846 6010C, 6020A, 7196A, 7471 B, 1010, 1010A, 1030, 9010C, 9012B, 9014, 9030B, 9040C, 9045C, 9045D, 9050, 9065, 9251, 1311, 1312, 3005A, 3050B, 3060A. Organic Parameters: SW-846 3540C, 3546, 3050B, 3580A, 36201), 3630C, 5030B, 5035, 8260C, 8270D, 827013-SIM, 8330, 8151A, 8015B, 8015C, 8082A, 8081B.) New Hampshire Department of Environmental Services Certificate/Lab ID: 2064. NELAP Accredited. Drinking Water(Organic Parameters: EPA 524.2: Di-isopropyl ether(DIPE), Ethyl-t-butyl ether(ETBE),Tert-amyl methyl ether(TAME)). Non-Potable Water(Organic Parameters: EPA 8260C: 1,3,5-Trichlorobenzene. EPA 8015C(M):TPH.) Solid& Chemical Materials(Organic Parameters: EPA 8260C: 1,3,5-Trichlorobenzene.) New Jersey Department of Environmental Protection Certificate/Lab ID: MA935. NELAP Accredited. Drinking Water (Inorganic Parameters: SM9222B, 9221 E, 9223B, 9215B, 4500CN-CE, 4500NO3-F, 4500E-C, EPA 300.0, 200.7, 200.8, 245.1, 2540C, SM2120B, 2320B, 2510B, 5310C, SM4500H-B. Organic Parameters: EPA 332, 504.1, 524.2.) Non-Potable Water(Inorganic Parameters: SM5210B, EPA 410.4, SM5220D, 4500CI-E, EPA 300.0, SM2120B, 2340B, SM4500E-BC, EPA 200.7,200.8, 351.1, LACHAT 10-107-06-2-D, EPA 353.2, SM4500NO3-F,4500NO2-B, EPA 1664A, SM5310B, C or D, 4500-PE, EPA 420.1, SM510ABC, SM4500P-B5+E, 2540B, 2540C, 2540D, EPA 120.1, SM2510B, SM15 426C, 92221), 9221B, 9221C, 9221E, 9222B, 9215B, 2310B, 2320B, 4500NH3-H, 4500-S D, EPA 350.1, 350.2, SW-846 1312, 7470A, 5540C, SM4500H-B, 4500S03-B, SM3500Cr-D, 4500CN-CE, EPA 245.1, SW-846 9040B, 9040C, 3005A, 3015, EPA 6010B, 6010C, 6020, 6020A, 7196A, 3060A, SW-846 9010C, 9030B. Organic Parameters: SW-846 8260B, 8260C, 8270C, 8270D, 8270C-SIM, 8270D-SIM, 3510C, EPA 608, 624, 625, SW-846 3630C, 5030B, 8011, 8015C; 8081A, 8081B,8082, 8082A, 8151A, 8330, 1,4-Dioxane by NJ Modified 8270,8015B, NJ EPH.) Page dal c , 8Chemical Materials(Inorganic Parameters: SW-846, 6010B, 6010C, 6020, 6020A, 7196A, 3060A, 90306, 1010, i� A, 1030, 1311, 1312, 3005A, 3050B, 7471A, 7471B, 9010C, 9012B, 9014, 9038, 9040B, 9040C, 9045C, 9045D, Serial No:09181315:54 9050A, 9065, 9251. Organic Parameters: SW-846 801513, 8015C, 8081A, 808113, 8082, 8082A, 8151A, 8330, 8260B, 8260C, 8270C,8270D,8270C-SIM, 8270D-SIM, 3540C,3546, 3580A, 3620C,3630C, 503013, 5035L, 5035H, NJ EPH.) New York Department of Health Certificate/Lab ID: 11148. NELAP Accredited. Drinking Water (Inorganic Parameters: SM922313, 922213, 9215B, EPA 200.8, 200.7, 245.1, SM5310C, EPA 332.0, SM23206, EPA 300.0, SM212013, 4500CN-E, 4500E-C, 4500NO3-F, 2540C, SM 2510B. Organic Parameters: EPA 524.2,504.1.) Non-Potable Water (Inorganic Parameters: SM9221 E, 9222D, 922113, 922213, 921513, 521013, 5310C, EPA 410.4, SM5220D, 2310B, 2320B, EPA 200.7, 300.0, SM4500CL-E, 4500E-C, SM15 426C, EPA 350.1, SM4500NH3-BH, EPA 351.1, LACHAT 10-107-06-2, EPA 353.2, SM4500-NO3-F, 4500-NO2-B, 4500P-E, 2340B, 2540C, 25406, 2540D, EPA 200.8, EPA 6010C, 6020A, EPA 7196A, SM3500Cr-D, EPA 245.1, 7470A, SM212013, 4500CN-CE, EPA 1664A, EPA 420.1, SM14 510C, EPA 120.1, SM251013, SM4500S-D, SM5540C, EPA 8315A, 3005A, 3015, 9010C, 9030B. Organic Parameters: EPA 624, 8260C, 827013, 8270D-SIM, 625, 608, 80816, 8151A, 8330, 8082A, EPA 3510C, 503013, 8015C, 8011.) Solid&Hazardous Waste(Inorganic Parameters: EPA 1010A, 1030, EPA 6010C,6020A, 7196A, 7471 B, 8315A, 9012B, 9014, 9065, 9050A, 9038, 9251, EPA 1311, 1312, 3005A, 305013, 9010C, 903013, 9040C, 9045D. Organic Parameters: EPA 8260C, 8270D, 8270D-SIM, 8015C, 8081B, 8151A,8330, 8082A, 3540C, 3546,3580A, 5035A-H,5035A-L.) North Carolina Department of the Environment and Natural Resources Certificate/Lab ID :666. (Inorganic Parameters: SM231013, 2320B,4500CI-E,4500Cn-E, 901213, 9014, Lachat 10-204-00-1-X, 1010A, 1030,4500NO3-F, 353.2,4500P-E,4500SO4-E, 300.0,4500S-D, 5310B,5310C,6010C, 6020A, 200.7,200.8, 3500Cr-B, 7196A,245.1, 7470A, 7471 B, 1311,1312. Organic Parameters: 608, 8081 B, 8082A, 624, 8260B, 625, 8270D, 8151 A, 8015C, 504.1, MA-EPH, MA-VPH.) Drinking Water Program Certificate/Lab ID: 25700. (Inorganic Parameters: Chloride EPA 300.0. Organic Parameters: 524.2) Pennsylvania Department of Environmental Protection Certificate/Lab ID : 68-03671. NELAP Accredited. Drinking Water(Inorganic Parameters:200.7,200.8, 300.0,332.0,2120B, 23206,2510B, 2540C,4500-CN-CE,4500E- C,4500H+-B,4500NO3-F, 5310C. Organic Parameters: EPA 524.2, 504.1) Non-Potable Water(Inorganic Parameters: EPA 120.1, 1312,3005A,3015, 3060A, 200.7, 200.8,410.4, 1664A, SM2540D, 5210B, 5220D,4500-P,BE, 245.1, 300.0,350.1, 350.2, 351.1, 353.2,420.1, 6010C, 6020A, 7196A, 7470A, 9030B, 2120B, 2310B, 2320B, 2510B,2540B, 2540C, 3500Cr-D,426C,4500CN-CE,4500CI-E,4500E-B,4500E-C, 4500H+-B,4500NH3-H,4500NO2-B,4500NO3-F,4500S-D,4500S03-B,5310BCD, 5540C, 9010C, 9040C. Organic Parameters: EPA 3510C, 3630C,5030B, 625, 624, 608, 8081B, 8082A, 8151A, 8260C, 8270D, 8270D-SIM,8330, 8015C, NJ-EPH.) Solid & Hazardous Waste (Inorganic Parameters: EPA 350.1, 1010, 1030, 1311, 1312, 3005A, 3050B, 3060A, 6010C, 6020A, 7196A, 747113, 9010C, 9012B, 9014, 9040B, 90451), 9050A, 9065, SM 4500NH3-BH, 9030B, 9038, 9251. Organic Parameters: 3540C, 3546, 3580A, 3620C, 3630C, 5035, 8015C, 8081B, 8082A, 8151A, 8260C, 82701), 8270D- SIM,8330, NJ-EPH.) Rhode Island Department of Health Certificate/Lab ID: LA000065. NELAP Accredited via NJ-DEP. Refer to MA-DEP Certificate for Potable and Non-Potable Water. Refer to NJ-DEP Certificate for Potable and Non-Potable Water. Texas Commisson on Environmental Quality Certificate/Lab ID:T104704476. NELAP Accredited. Non-Potable Water(Inorganic Parameters: EPA 120.1, 1664,200.7, 200.8, 245.1, 245.2, 300.0, 350.1,351.1, 353.2, 410.4,420.1, 6010, 6020, 7196, 7470,9040, SM 212013,2310B, 2320B, 2510B,2540B, 2540C, 25401),426C,4500CL- E,4500CN-E,4500E-C,4500H+B,4500NH3-H,4500NO2B,4500P-E,4500 S2 D, 510C, 5210B, 522013, 5310C, 5540C. Organic Parameters: EPA 608, 624,625, 8081, 8082, 8151, 8260,8270,833.0.) Solid&Hazardous Waste(Inorganic Parameters: EPA 1311, 1312,9012, 9014, 9040, 9045, 9050, 9065.) Virginia Division of Consolidated Laboratory Services Certificate/Lab ID:460195. NELAP Accredited. Drinking Water(Inorganic Parameters: EPA 200.7, 200.8,300.0, 2510B,2120B,2540C,4500CN-CE, 245.1, 2320B, 4500E-C,4500NO3-F,4500H+B,5310C. Organic Parameters: EPA 504.1, 524.2.) Non-Potable Water(Inorganic Parameters: EPA 120.1, 1664A, 200.7,200.8,245.1,300.0, 350.1, 351.1,351.2, 3005A, 3015, 1312,6010B, 6010C, 3060A, 35.3.2,420.1, 23406,6020, 6020A, SM4500S-D, SM4500-CN-CE, Lachat 10-204- 1- 7196A, 7470A, 2310B,2320B,2510B, 2540B, 2540C, 2540D,3500Cr-D,426C,4500CI-E,4500E-B,4500E-C, Page��& h3-H,4500NO2-B,4500NO3-F,4500 S03-B,4500H-B,4500PE, 510AC, 5210B, 5310B 5310C,5540C,9010Cm Serial No:09181315:54 9030B, 9040C. Organic Parameters: EPA 3510C, 3630C,5030B, 826013, 608,624,625, 8011,8015C, 8081A, 8081B, 8082, 8082A, 8151A, 8260C,8270C, 8270D, 8270C-SIM,827013-SIM, 8330, ) Solid&Hazardous Waste(Inorganic Parameters: EPA 1010A, 1030, 3060A, 3050B, 1311, 1312, 601013, 6010C, 6020, , 7196A, 7471A, 7471B, 6020A, 9010C, 9012B, 90306, 9014, 9038, 9040C, 90451), 9251, 9050A, 9065. Organic Parameters: EPA 50306, 5035, 3540C, 3546,355013,3580A,3620C, 3630C, 6020A, 826013, 8260C,801513,8015C, 8081A, 8081B, 8082, 8082A, 8151A, 8270C, 8270D, 8270C-SIM, 8270D-SIM, 8330.) Department of Defense, L-A-B Certificate/Lab ID: L2217. Drinking Water(Inorganic Parameters: SM 4500H-B. Organic Parameters: EPA 524.2, 504.1.) Non-Potable Water (Inorganic Parameters: EPA 200.7, 200.8, 6010C, 6020A, 245.1, 7470A, 9040B, 9010B, 180.1, 300.0, 332.0, 6860, 351.1, 353.2, 9060, 1664A, SM 4500CN-E, 450011-13, 4500Norg-C, 4500NO3-F, 5310C, 21306, 2320B, 2340B, 2540C, 5540C, 3005A, 3015, 9056, 7196A, 3500-Cr-D. Organic Parameters: EPA 8015C, 8151A, 8260C, 8270D, 8270D-SIM, 8330A, 8082A, 8081B, 3510C,503013, MassDEP EPH, MassDEP VPH.) Solid&Hazardous Waste(Inorganic Parameters: EPA 200.7,6010C, 6020A, 7471A, 6860, 1311, 1312, 305013, 7196A, 9040B,9045C,9010C, 9012B, 9251, SM3500-CR-D, 4500CN-CE, 2540G, Organic Parameters: EPA 8015C, 8151A, 8260C, 8270D, 8270D-SIM, 8330A/B-prep, 8082A, 8081 B, 3540C,3546, 3580A,5035A, MassDEP EPH, MassDEP VPH.) The following analytes are not included in our current NELAP/TNI Scope of Accreditation: EPA 524.2: Acetone, 2-Butanone (Methyl ethyl ketone (MEK)), Tert-butyl alcohol, 2-Hexanone, Tetrahydrofuran, 1,3,5- Trichlorobenzene, 4-Methyl-2-pentanone (MIBK), Carbon disulfide, Diethyl ether. EPA 8260B: 1,2,4,5- Tetramethylbenzene, 4-Ethyltoluene. EPA 8260 Non-potable water matrix: lodomethane (methyl iodide), Methyl methacrylate. EPA 8260 Soil matrix: Tert-amyl methyl ether (TAME), Diisopropyl ether (DIPE), Azobenzene. EPA 8330A: PETN, Picric Acid, Nitroglycerine, 2,6-DANT, 2,4-DANT. EPA 8270C: Methyl naphthalene, Dimethyl naphthalene, Total Methylnapthalenes, Total Dimethylnaphthalenes, 1,4-Diphenylhydrazine. EPA 625: 4-Chloroaniline, 4-Methylphenol. Total Phosphorus in a soil matrix, TKN in a soil matrix, NO2 in a soil matrix, NO3 in a soil matrix. EPA 9071: Total Petroleum Hydrocarbons, Oil&Grease. Page 17 of 18 Serial No:09181315:54 CHAIN Al raDateRed'd:Irr Lab: `s ='^t :Y,• N OF CUSTODY PAGE -.a,..ALPHAJo r<' fi - HA Project Information Report Information Data Delliverables Billing Information Westborough,MA Mansfield,MA ❑ FAX ® EMAIL.. ® Same as Client in PO#:101b6 Project Name:Fehnel Residence a TEL:509.89e-9220 TEL:508-622-9300 ❑ ADEx ❑ Add'I Deliverables FAX:508-898-9193 FAX,508,8223288 Regulatory Requirements/Report Client Information Project Location:Marstons Mills,MA State/FedPro gram Criteria Client:Bennett Environmental Associates Project#:BEA09-10156 Address:1573 Main Street/P.O.Box 1743 Project Manager:David C.Bennett Brewster MA 02631 ALPHA Quote#: Phone:508-896-1706 - ANALYSIS Fax:508-896-5109 ®Standard ❑Rush(ONLY IF PRE-APPROVED) SAMPLE HANDLING Filtration _Email:sfarrenkopf@bennett-ea.com El Done _ ❑These samples have been Previously analyzed by Alpha Due Date: Time: ® Not Needed Other Project Specific Requirements/Comments/Detection Limits: ❑ Lab to an Preservation C] Lab to do (Please specify below) N .0 l AL•PH&-.E6j lb Sample ID Collection Sample Sampler's z. (Lab;UsetOnly) Date Tlme Matrix Initials °3 ii Q common Specific EfFluent 7, 3 I i��v wvv 1—� ® ® ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 2 t ,i..,X..:y. .. : ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ t....*.:, ❑ ❑ ❑ ❑ El ❑ ❑ ❑ ❑ El El ., Container Type P P - Preservative 0 D pjeaseprintcls'ay,.Iegibly .' and:Compl@lely;:\SBmples;can i notbe-Iogged.in'.and > j Reif uished Date�me Received By at ime ;:.t�parouridrane.elocxwifl°not StaAuntil.any.amhiguiUesafe:,. . .1Xosolved.:AII ssinples tted ate subject'to...y:,' FORM NO:•1.01p.N.1) 0 - ayment Terms;='-.r.: (ray.9a.APR-M) .. - . Page 18 of 18 r , i BENNETT ENVIRONMENTAL ASSOCIATES, INC. LICENSED SITE PROFESSIONALS,ENVIRONMENTAL SCIENTISTS,GEOLOGISTS,ENGINEERS 1573 Main Street,P.O.Box 1743 (508)896-1706 Brewster,MA 02631 fax(508)896-5109 LETTER OF TRANSMITTAL TO: DATE: JOB NUMBER: Barnstable Health Department 6/12/2013 BEA09-10156 200 Main Street Hyannis,MA 02601 REGARDING: TITLE 5 INSPECTION SHIPPING METHOD: Regular Mail ❑X Pick Up ❑ - Priority Mail ❑ Hand Deliver ❑ Express Mail ❑ Other ❑ Certified Mail ❑ Green Card/RR ❑ COPIES DATE DESCRIPTION 1 6/6/13 Title 5 Official Inspection Form Herring Run Place Route 149 Unit 195-A 1 6/12/13 Filing fee check($25.00) For review and comment: ❑. For approval: ❑ As requested: ❑ For your use: ❑ REMARKS: Please find enclosed the Title 5 inspection for 195A Herring Run Place.This inspection has found the system to pass.If you have any questions or need additional information,please feel free to contact us.Thank you. cc: Tom Fehnel,Owner . FROM::: JRS If enclosures are not:as noted,kindly notify us at once I� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M Herring Run Place Route 149 Unit 195-A Property Address Tom Fehnel Owner Owner's Name information is required for every Marstons Mills MA 02648 6-6-13 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information n on the computer, � �q use only the tab 1. Inspector: key to move your cursor-do not Joseph R. Smith (also 4M WVVTO for I/A system) use the return Name of Inspector key. Bennett Environmental Associates, Inc. % Company Name 1573 Main Street/P. O. Box 1743 Company Address Brewster MA 02631 City/Town State Zip Code (508) 896-1706 S14994 Telephone Number License Number B. Certification 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 ❑ Fails ❑ Needs Fu�FIer Evaluation by the Local Approving Authority 6-11-13 e s Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system 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. ****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. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Herring Run Place Route 149 Unit 195-A Property Address Tom Fehnel Owner Owner's Name information is required for Marstons Mills MA 02648 6-6-13 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 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: System is in working condition and is functioning as intended. None of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 existed at the time of inspection. 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. Check the box for"yes", "no"or"not determined" (Y, N,.ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally,sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form- Not for Voluntary Assessments M Herring Run Place Route 149 Unit 195-A Property Address Tom Fehnel Owner Owner's Name information is required for Marstons Mills MA 02648 6-6-13 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 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 t5ins•3/13 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Herring Run Place Route 149 Unit 195-A Property Address Tom Fehnel Owner Owners Name information is required for Marstons Mills MA 02648 6-6-13 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 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 fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or 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 1/day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Herring Run Place Route 149 Unit 195-A Property Address Tom Fehnel Owner Owner's Name information is required for Marstons Mills MA 02648 6-6-13 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® 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 fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. El ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. 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. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments °M Herring Run Place Route 149 Unit 195-A Property Address Tom Fehnel Owner Owner's Name information is Marstons Mills MA 02648 6-6-13 required for every page. City/Town State Zip Code Date of Inspection C. Checklist 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: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions`. Number of bedrooms(design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form- Not for Voluntary Assessments ° M Herring Run Place Route 149 Unit 195-A Property Address Tom Fehnel Owner Owner's Name information is required for Marstons Mills MA 02648 6-6-13 every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Septic System that serves a single family residence is comprised of a 1,500 gallon Septic Tank, Innovative/Alternative septic technology(OMNI Environmental Systems, Inc. OMNI Recirculating Sand Filter System), Pump Chamber, and a pressure dosed trench that is 75' long, 4'wide, and 2' effective depth. Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ❑ No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonal use? ® Yes ❑ No Water meter readings, if available(last 2 years usage (gpd)): See Details Detail: 2011 -52,000 gallons = 142 gpd : 2012-79,000 gallons 216 gpd Sump pump? ❑ Yes ® No Last date of occupancy: October 2012 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M Herring Run Place Route 149 Unit 195-A Property Address Tom Fehnel Owner Owner's Name information is required for Marstons Mills MA 02648 6-6-13 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Town of Barnstable B.O.H - None on file Was system pumped as part of the inspection? ❑ Yes ® 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) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments Herring Run Place Route 149 Unit 195-A Property Address Tom Fehnel Owner Owner's Name information is required for Marstons Mills MA 02648 6-6-13 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Installed: 8-25-2003 Barnstable Counties Carmody Database for I/A Treatment Technologies. Installed 2003-Town of Barnstable Disposal System Construction permit#2001-399 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 3.5'feet Material of construction: ❑ cast iron ®40 PVC ❑other(explain): Distance from private water supply well or suction line: 75+ feet Comments (on condition of joints, venting, evidence of leakage, etc.): Vented properly to roof. No evidence of leakage in piping or joints for building sewer line. Septic Tank(locate on site plan): Depth below grade: 3.0' feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain) 1,500 concrete septic tank,with polylok outlet riser and cover to grade. Furnished with 4" Schedule 40 PVC inlet and outlet Tees. If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1,500 gallon Sludge depth: 4" t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts ti W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not.for Voluntary Assessments Herring Run Place Route 149 Unit 195-A Property Address Tom Fehnel Owner Owner's Name information is required for every Marstons Mills MA 02648 6-6-13 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 37" Scum thickness 0" 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 14" How were dimensions determined? Tape Measure, sludge Judge, Mirror, Probe Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumping not recommended at time of inspection. Schedule 40 pvc inlet and outlet tees functioning properly. Liquid level as related to the outlet invert is at a normal operating height. No evidence of leakage encountered while conducting the inspection on the septic tank. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M01Herring Run Place Route 149 Unit 195-A Property Address Tom Fehnel Owner Owner's Name information is Marstons Mills MA 02648 6-6-13 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(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 per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Herring Run Place Route 149 Unit 195-A Property Address Tom Fehnel Owner Owner's Name information is required for Marstons Mills MA 02648 6-6-13 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert No D-Box Present, Pressure Distribution SAS 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.): No D-Box Present, Pressure Distribution SAS Pump Chamber(locate on site plan): Pumps in working order: ® Yes ❑ No* Alarms in working order: ® Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): 250 gallon concrete Pump Chamber with polylock risers and cover to grade. Pump, on/off float switch, and alarm float switch functioning properly. *If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-3/13 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,M Herring Run Place Route 149 Unit 195-A Property Address Tom Fehnel Owner Owner's Name information is required for Marstons Mills MA 02648 6-6-13 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: 1- 75' long ❑ 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.): Trench is 75' long, 4'wide, with a 2' effective depth. No inspection ports or cleanouts to final grade for pressure dosing trench. Vegetation is normal in the area of the leaching trench, no signs of hydraulic failure present at the time of inspection. Cesspools (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 ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 f Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M Herring Run Place Route 149 Unit 195-A Property Address Tom Fehnel Owner Owner's Name information is required for Marstons Mills MA 02648 6-6-13 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(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.): t5ins•3/13 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M Herring Run Place Route 149 Unit 195-A Property Address Tom Fehnel Owner Owner's Name information is required for Marstons Mills MA 02648 6-6-13 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ® drawing attached separately / A� ` 13 vac, P t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Herring Run Place Route 149 Unit 195-A Property Address Tom Fehnel Owner Owner's Name information is required for every Marstons Mills MA 02648 6-6-13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 7.0' + feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: Plan Date: 9/30/02 Revised: 10/22/02 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Established estimated depth to high groundwater by referencing the septic system design plan by Christopher Costa&Associates, of East Falmouth, MA with a plan date of September 30, 2002, with a revised plan date of October 22, 2002 wherein it is noted that the bottom of the leaching trench is at elevation 52.2. Also the soil test data taken by Bruce Murphy and witnessed by Jerry Dunning notes within the same plan that no groundwater was encountered at elevation 44.5, which puts groundwater at an elevation greater that 7.0'+ from the bottom elevation of the leaching trench. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 f Commonwealth of Massachusetts a v r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Herring Run Place Route 149 Unit 195-A Property Address Tom Fehnel Owner Owner's Name information is required for Marstons Mills MA 02648 6-6-13 every page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 TOWN OF BARNSTABLE LOCATION 7- SEWAGE # ,�,,-�©� VILLAGF �'U � T"Dl/V /Vj ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. /.f//A,h- 121ZU4; 7 JO SEPTIC TANK:E?.PACITY iz i R /,OWT&" ) l`r LEACHINGCILITY: (type) ,� ����G (size) y NO. OF BEDROOMS BUILDER OR OWNER PERMITDATE: '�� b� COMPLIANCE DATE:.' Separation Distance Between the: Feet Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Private Water.Supply Well and Leaching Facility (If any wells exist. Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility) Furnished by s� J `/ > ' 7v U ti - �.� no � O % a i BENNETT ENVIRONMENTAL ASSOCIATES, INC. LICENSED SITE PROFESSIONALS & ENVIRONMENTAL SCIENTISTS 17 GEOLOGISTS & ENGINEERS 1573 Main Street-P.O. Box 1743, Brewster, MA 02631 0 508-896-1706 Fax 508-896-5109 0 www.bennett-ea.com BEA09-10156 November 30,2011 Py Mr. &Mrs. Tom Fennel 772 Bear Creek Circle Winter Springs,FL 32708 RE: OPERATION AND MAINTENANCE CONTRACT 2012 AND 2013 Innovative/Alternative Wastewater Treatment System:OMNI RSF Unit 195-A Herring Run Place—Marstons Mills, MA Dear Mr. &Mrs. Fennel, BENNETT ENVIRONMENTAL ASSOCIATES,INC.(BEA),is pleased to provide a proposal for the continuation of professional services for the operation,maintenance and environmental monitoring of the innovative/alternative wastewater treatment system for you and your neighbors as described in accordance with the governing regulations under 310 CMR 15.00 as regulated under the Barnstable Health Department. These services include quarterly inspections for standard operation and maintenance of the treatment system, as well as annual effluent sampling for total nitrogen. The costs for such services are presented below as annual costs for the first and second year of this contract reflecting standard laboratory fees and reporting requirements. This contract and the quoted annual costs are good for a period of two years subsequent to the date of the next operation and.mainteriance event scheduled for December 2011. This proposal replaces the previous renewal contract proposal dated November 18, 2011. QUARTERLY INSPECTION/MAINTENANCE/SAMPLING:Inspect I/A system and take field measurements of dissolved oxygen,pH and turbidity on a quarterly basis. Collect treated effluent wastewater samples on an annual basis under a proper chain-of-custody for analysis by a MA certified laboratory for nitrite/nitrate/TKN for total nitrogen. At the time of sampling events the conditions of the system will be inspected and documented with regards to the blower units,sludge level and associated piping. REPORTING/FILING: Review laboratory results relative to conditional requirements of the system under the MA DEP and local Board of Health approvals. Prepare DEP transmittal.forms on a quarterly basis. File inspection reports on the Barnstable County online database quarterly. File sampling reports on the Barnstable County online database annually for effluent sampling. Submit laboratory report, DEP transmittal forms to MA DEP, Barnstable County Department of Health and Environment,local Board of Health,and associated vendors/contractors,as appropriate,on an annual basis. Professional Fees Operation/Maintenance and Reporting[Dec 2011-Sept 2012] $ 475.00 Professional Fees Operation/Maintenance and Reporting[Dec 2012-Sept 2013] $ 600.00 Laboratory Analysis[Total Nitrogen(NO2,NO3,TKN)] $ 47.73 Barnstable County Data Base Fee $ 50.00* 1 EMERGENCY SPILL RESPONSE 0 WASTE SITE CLEANUP 6 SITE ASSESSMENT 0 PERMITTING 6 SEPTIC DESIGN&INSPECTION WATER SUPPLY DEVELOPMENT,OPERATION&MAINTENANCE t' WASTEWATER TREATMENT,OPERATION&MAINTENANCE NOVEMBER 30,2011 FEHNELBEA09-10156 PAGE 2 OF 2 UNIT 195A HERRING RUN PLACE,MARSTONS MILLS,MA * Noted: I/A systems located in Barnstable County are required to report inspection and sampling results on the Mass Septic online database for use by the Barnstable County Department of Health and Environment(BCDHE)and the local Boards of Health. At this time,BCDHE has found it necessary to institute annual user fees for filings on this required database of$50 per year. At the time of inspections the wastewater treatment equipment will be inspected to ensure that the system is working as designed. Should repair or replacement of equipment or sludge pumping be necessary beyond standard maintenance, such material and additional time beyond that.of a normal inspection will be billed at time and expense. We are proceeding with the work as outlined. Immediate notification in writing is required if you do not wish to proceed. Otherwise, please sign the authorization below and return one copy of this proposal to our office. Should you have any questions or need additional information,please contact me directly at our office Very truly yours, BENNETT ENVIRONMENTAL ASSOCIATES,INC. Samantha Farrenkopf,ES WWTO,PWSO Wastewater Program Coordinator cc: Kara Risk,Business Manager encl. Terms&Conditions (2009)/Fee Schedule(2010) AUTHORIZATION: ATE: ' 7 "2 C/L &VIropmews�Inc, OMNI RSF Operation and Maintenance Inspection Checklist A. Installation&Service Information I"Lkcl lLkfk — 1 � < - � 6 I � .3 Q E 30 Facility Street Address Qate..of Se ice , N . city Operator/O&M Firm SVh System Startup Date Weather Conditions B. Septic Tank p t\ ��-1l,1� Sludge Pumping Required: Yes❑ No� `, Sludge Depth: Scum Depth: V Effluent tee filter: Yes❑ Nod If yes, inspect❑&clean at least yearly❑ If the sludge layer is within 12"of the outlet invert,recommend that the homeowner have the septic tank pumped,note the approximate scum layer thickness as well.Also,inquire if the homeowner has a pumping schedule established with a licensed septage hauler,if not recommend a two to four year pumping schedule depending on how heavily the system is used. C. Recirculation Tank C� Check if sludge accumulating Pumping required: Yes❑ NdUq Odor problems: Yes❑ N If yes,description Effluent tee filter: Yes❑ N If yes, inspect n&clean at least yearlyEl If the sludge layer is greater than 4"request that the homeowner pump out the recirculation tank in order to prevent clogging of the filter modules.Note the characteristics of the effluent coming out of the manifold this may indicate that the filter bed may need servicing. D. Equalization Tank(if installed) Sludge Pumping Required: Yes❑ No❑ ❑Sludge Depth: ❑Scum Depth: Effluent tee filter: Yes❑ No❑ If yes, inspect E&clean at least yearly❑ Same inspection criteria as septic tank: E. Pump Chamber/Vault(if Installed) Pump Inspections(all units) If problems,describe Float switches Check all switches for operation Make Sure the pump is operational by pulling up the float switch;if the pump is not operational immediate corrective actions need to be taken. i J F. Pumps,Switches, Floats,Alarm System Pump Inspections(all units) If problems,describe Test pump alternator,or record hours Hours of operation b(Float switches Check all switches for operation Test alarm If non-functioning,corrective action(s) Make sure pump(s),Float(s)and audible alarm(s)are functional,if not make a note so that corrective actions can be made. G. Filter Modules ("Sand Filters") Inspect for ponding Ponding Present:Yes❑ Now Clean bed: Yes❑ NoO 14 Distribution pipes Flush:Yes ElNo ] Brush: Yes❑ No Any obstruction of airflow to filter modules: Yes❑ Noolf Yes,explain below(i.e.snow,dirt) To inspect the condition of the filter modules remove the mulch layer at one corner of the filter module area, then lift the filter fabric so that the media can be inspected through the end of the contactor. The media should have a thin biomass layer growing on it and should have a brownish shaggy coloration.If the surface of the filter module area appears to be clogged,or the biomass layer is too think it is suggested to completely expose the filter modules,and rake the filter beds thoroughly,then wash the filter beds down with a garden hose(with a pressure nozzle on it).Then Recover the filter beds as they were found. H. Sample Collection Yes❑ Nd If yes: ❑BOD OTSS ❑pH [:]TN ❑Other All samples are to be taken from the manifold located in the recirculation tank,and are to be stored in sterile, laboratory supplied containers.In order to prevent any cross-contamination from a previous sample rinse the dip cup into the effluent stream at the manifold three times so that a representative sample can be obtained. Make sure to wear proper safety equipment while pulling samples(i.e.rubber gloves). System Notes: s-lg tw. Pot�z/ 's go 76 r 4 j5ENNETTEwmoNWNTAL Ass®cuns INc® 1573 Fain St.,F.O.Box 1743, Brewster,MA 02631 +( 508-896-1706 a www.bennett-ea.com Date&time of visit: c" b �3 @ 3� A site visit was conducted today for: (ZiR5 Testing Repair Alarm Call Your system is operating correctly M YES ❑ NO Tank(s) in need of pumping ❑YES W NO Further maintenance required ❑YES la`J NO Repairs needed ❑YES NO Please contact our office ❑YES nEd NO Contract renewal required ❑YES u NO Field testing: S/ Fail Sample pulled: YES / Q Laboratory sampling conducted ❑YES 04 NO .:>..::.:9�f:3E#l`:ETi3VIRO.li1JV16D1T�Al:i�>::�» No. D -3 9 0THE commbNWEALTH OF MASSACHUSETTS Entered in computer:_ Yes PUBLIC HEALTH DIVISION-TOWN OF BARNSTABLE,MASSACHUSETTS . ZIppfication for Migoal &pgtem Com5truction Permit Application for a Permit to Construct(v�epair( )Upgrade( )Abandon( ) 9 Complete System 0Individual Components Loc ❑Address or Lot No.,QQ U�e fC�!/ Owner's Name,Address and'1'el.No. - /1 1gam k1c M Rea/fy Trust'SGt�-'717/-3y/y Assessor's ap/Parcel 7 g1l �' ,n t f 7 D 0,8og /��y /yl py D ,�/ ann is Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Car/ Cci Vajss , Tr VP-35133 g,:i5-bes,q„, 7f1c 5Dd'-5V0-8805 57 Palmer Ale, c-ahnoafX MA artne /.neBakl�;Rd. >raIntouf-A /mt� Type of Building: Dwelli No.of Bedrooms J� Lot Size !/qi 56�sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3,30 gallons per day. Calculated daily flow -3-3®, 2 6 gallons. Plan Date /h1 l a.000- Number of sheets r7. Revision Date .100/ Title Plo�- P/iln _Prnoo f•Pd u f Sa c/ar rp Seep hrcnar�0 Stir1�,� Size of Septic Tank / <J 00 6a lion S TypeofS.A.S. rt'SSure_ b tt dh CIS+rt t Description of Soil 0- 7 ^� A San,-N Loam L Oa,'✓ty S a nc� d Merltu.mn Sllr�C/ Nature of Repairs or Alterations(Answer when applicable) Ne!,) < Dn Sf-r r c t ft o rl 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 plac system in operation until a Certifi- cate of Compliance has been issGl d by this oazd of Hplth. / J `7 y� Signed c / Date / ,/ / Application Approved by Date -1 tP� Application Disapproved for the following reasons Permit No. �� Date Issued --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed(x)Repaired( )Upgraded( ) Abandoned( )by at Ld iy,T <-? I has been constructed/in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No Qn,ll- Sri C1 dated Co(Q01 r) 1 Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector --------------------------------------- No. __;)n(-) I 3:�/ Fee60 1 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS -Mi.5tlo$al.6p$tem Construction Permit Permission is hereby granted to Construct(:•.)•Repair( )Upgrade System located at 41L</ci V-7 .' and as described in t&e above�A�,��p.�lcation for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title:5,and the following local provisions or special conditions. Provided:Construction just be completed within three years of the date of thiset. �^ 1 C Date: i(--�1 I i (`,1 Approved by 1�_� � 4- \cC,t, ,.ate 1 ' k I Town of Barnstable Board of Health KA S& 200 Main Street, Hyannis MA 02601 1639• Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi October 15, 2014 James M. Teagan 195 Route 149 #Unit A Marstons Mills, MA 02648- RE: Correction to Sampling of Wastewater Effluent from your Innovative/Alternative(OMNI) System at: 195 Route 149 #A, Marstons Mills A=078-018-40A Herring Run Place Condo Dear James Teegan: The Board of Health has updated the approval letters for the Herring Run condos. As of October 2014, the monitoring of your innovative/alternative technology (OMNI 2000 Recirculating Sand Filter system) at 195 Route 149, unit#A has not changed. The previous owners Thomas and Sandra Fehnel had a quarterly Operation and Maintenance (O+M) plan. The O+M visits should continue four times per year, each with a Total Nitrogen effluent test. The system originally had a seasonal DEP approval letter; if the property is occupied seasonally less than six months the system can be monitored twice per season, each visit with H, ( ) Y p p CBOD5, TSS, TN and alkalinity effluent test. Based on your usage of the condo, and a with a letter verifying occupancy to the Board of Health the system can be monitored 45 days after occupancy and again before shut down at the end of the season (per DEP certification letter 9/9/2008 p.7) Q:\IA systems\195 Rtl49\Final correction unit#A 2014.doc In the future, a reduction can be requested in writing from the Board of Health. Before a reduction can be granted at a hearing, the.Board of Health will need to look at eight consecutive Total Nitrogen results, if the unit is used year round, or review the results after two seasons for seasonal usage. If you have any questions, please contact the Health Division at 508-862-4644. Sincerely, Wayne Miller, M.D., Chairman BOARD OF HEALTH QAIA systems\195 Rt149\Final correction unit#A 2014.doc i BENNETT ENVIRONMENTAL ASSOCIATES, INC. LICENSED SITE PROFESSIONALS,ENVIRONMENTAL SCIENTISTS,GEOLOGISTS,ENGINEERS 1573 Main Street,P.O.Box 1743 (508)896-1706 Brewster,MA 02631 fax(508)896-5109 LETTER OF TRANSMITTAL TO: DATE: JOB NUMBER: Massachusetts Department of Environmental Protection 9/23/14 BEA09-10156 Attention:Title 5 Program 1 Winter Street-6th Floor Boston,MA 02108 REGARDING: Fehnel Residence 195 Herring Run Place Unit A[Route 149] SHIPPING METHOD: Marstons Mills,MA Regular Mail ❑ Pick Up ❑ Priority Mail ❑ Hand Deliver ❑ Express Mail ❑ Other ❑ Certified Mail Green Card/RR ❑ COPIES DATE DESCRIPTION 1 DEP Approved Inspection and O&M Form for Title 5 I/A Treatment and Disposal Systems(December 2013;March,June and September 2014) 1 OMNI Environmental Systems,Inc.RSF Operation and Maintenance Checklist(December 201 ; March,June and September 2014) ❑] �?_ C 1 9/22/14 Alpha Analytical Laboratory Report :. 1 's E For review and comment: ❑ For approval: ❑ As requested: ❑ For your us% ❑ REMARKS: Please find enclosed the DEP Inspection and O&M Forms,OMNI RSF Operation and Maintenance Checklists,and laboratory analytical report for operation and maintenance conducted during this reporting period for the above referenced property. It is noted that inspection ports or cleanouts for the pressure dosed leach field laterals are not accessible for inspection. If you have any questions or require additional information,please contact us at your earliest convenience. Thank you. cc:Barnstable Board of Health Mr.Tom Fehnel,Owner David C.Bennett,Principal[Internal] FROM: David C.Bennett,WWTO#6243/Samantha Farrenkopf,WWTO#13265/Joseph Smith,WWTO#12529 If enclosures are not as noted,kindly notify us at once t. Qrs N TT E VIRONMENT L Asso-CIATE g I ® L[GENSEb SITE PROFS-° SWNA#it N.+ `( T.NVIkONl1 ON`IM,,SC1[ENTOOS _6 G'EaLOGIST, ENGINEEItS- 1573 Mani Street-P.Q.B6.x 174.3,Br-6Wster,MAD263:1 5W896-1706. 6 Fax.508 8W510.9 Q WWWbenhett ea:cem PROPOSAL Felivary 12:,.2p.t.S W,James Teegazi P.-03oX 569 �arstons N1i11s,.IV.C.A.:02$48: RR: OPERATION ANT)MAINTENANCE CON7'13A,CT Z.015 Innovative/Alternative:�Vm ewatei'Vtea ent.S..stern:OMMI R8P 'U ii 1-957A.,Hear ng;R tul.i'lace r 1Vlarstoiis,>lvliils,.MA. Dear 1v1i`:Teegari; B NNETT l✓NV ZONIVIENTAT..ASSaCIAT1✓S,.II C.(BEA):is.pjeasetitoprov de.youvcritl a proposal; for profess�.onxl ;seryloes relat V t:i�: the ttpeXdtio>t. aiid maintenance of f e Innovative/Alternative Wastewater Treatment System located.at.the.above refereneed.property. The quarterly inspection and collection.of sampaes:: rorn:tlie:effluent:of the septic treatmont:system i:s a Yequiied condition.:of tbe: systgn.; as: set forth, by the. 13arastabl.e:ffeal.tl�.T)epa��inent.and.MA Departn%ent of:Environnaental Protection.(N A.DEP)to qualify treatmejit:capaciiy; As sudi, Wo*proposed.:by.BEA includes the quarterly operation and.rriAintel'>axtce of tho- treatmeritsystem;as well as gquarterly effliient sairipliiig fof:total:nitrogen;and the preparation:of the reguirect'fortris for distribution to the ap#6� iatd towxi.and state Ofliees: .A.dflit kually,:at the time of sucla;:saiiiplin ,l?lowears,fltefs awl asso"Red piping'?yill.he:iiy'sp'ected to assume vvoikizig condition and regWLrly'scheduled maintenance performed on18.,1xed cost:l m1S:-will bt invoiced.quarterly hlrrul az y'repau'ortreatrnent:systerii OorripoAonts roplaorriet t:l,e:required,iif.addit"ional.s.ampjx g: beyond.thcquarterjyrequirernentsbe.mcessa.r qou:w'Ilbe:notitied.to-au6.oiizetboa dxtionalwork. ana ex T < wil a bal.rwbeb p Tlie fi�Iiowing.b>.tdget represents:esfinYated ettsts four the tr:�r7E'zoa�o;f'tl�e existirzg�H.eraiagRun. de,,lelopment eoritracts:.to-ine.hrde three:'inspectiorl and sampling events. The eostas_are.valid'tlu'augh. November.: 201.5.. 'lease. note:tlzat,:tliis contract runs with :tl?c property. As such, it is.your respons bility to notiiy.our o:flce:in-writing.of any.sale of the subject property:so that.there is no d sruptioa of so&--ices:„ rthern&6, y.bu afe kdc Uiied to notify. any-buyer for the transk-r pf this eonuact:. EMERGENCY SPI.LLftESPQN$E;. WAvTE.SITE:CLEANUP:A SITE ASSESSMENT rv:Fa RMMING. SEPTIC DESIGN&:INSPECTION WATER SUPPLY DEV6LQPMENT,:Op 'ATION&:MAINTENANCE O WASTEWATER TREAtmtNt.oPi~RAT,IQN&:M61NT NANCE rEMOARY t2;'2415 TEEGdN1QROPOSAL VAOW10111 C1tJ1i'I95A.IiPTtRTNG:RUNYI.AGF,.MAitsEONSN La'MA O:U ARTER Y [IVSI('p;t"'1'.lUly'�k..i�1<11 C NANCR/�3Albi'Lr1VG inspect_1/A:systern and take:field immurements of llssdived oxygen,:p13;, and turbidity. .Collect treatedd-effliimt wastewater samples on a.:quarterly basis under.°a proper chain-of castody for MA:certified laboratory analysis.:of nitriteJtiitrate/T1CN folfocal nitrogen. M the tiitre.orsampling:even :the.cortditioal.s oFtho system will be inspeeted and. documented:with'regards to.the bioweriibitssludge li vel*-rTi�i:as5o4iated'pipir g;. RPOIt`I`ll�/F:Ilr�iyC Review inspection; i`eportrela.'rive to coiiditional.rogVirtments ofthe system*Bader tlieNIADEI?and:lrrcal`k3Uaid.ox:kiealtti: pt7riivaxs. Frepaie'I?EFtiarisrnittal.fiirin ::anti:submitfri;pectionaad-sainp.Mg roports on the BarxlStabk County peparunetif of Health€uid.Edvironmentonline.daidbase:op:a.gaarterly basis, 814bmit: laboratory repbil aild.DEP.tiansirdttal:fonns to lv1ADEP.;locatBoard of Health;and associatedvendors/contractors,:as: pro.'06.,can An annual basis. Professional Services[MarchiJune and September 2015]' $ 4495,00 Laboratory fl7xalysis[3x'nitrate/nitrite/II�N lvlarchr:ltine Arid.Septezi Nt:2Q1-S] 14119 F3arnsfable.County.11ata:L3aso,7ycc:[2(?l ]. SUO* Notede llA systems located ixt l3airiista'ile;Coro ty are required to:rzport inspection and.samp.lIng results or}:the 1V1ass Septic online'database for'use-by the lianxstable Cupimly Department o M'Ith and Shviromnent.:(BCDIl.8)and.tlie.locall3oards.offlealth::A this tirne,,B.C17HEhas[ound:ifnecessary to iustitdte an-nual user'ites for filings:on thisxNuired database of3-56` er year. We a re'ptoceedhig.with.the work as outlined. Iininediate notification in writing:isrecluirW ifyou do not.wish.10 .Otitel'VVlso. please:sign t1w aut 6rizatlon bolbw and return one•copy ofihis Proposal to our off"tce: Should.yo.0 have any.'quesfiions or need:iidditonal i� ormatiiort,please contact the dlectly at our office. Yveyttu.ly yours, BENNET.ENVIRO : TAL ASSOCIATE%-IN.G. , Sartiarifin:Parri;rikgpf,.ES°,'WWT.O PW WasteWatCr.Progr.Oill 600rdinotor• CO.; Mara_Risk;Bust mess Manager encI_ Abbbreviated Terra :Bc Conditions<(2O:l.i)%F4c.S krcclule.(2Q14} AUJ IIORIZATIOM. : : :-,.-DATE: of B BARNSTABLE COUNTY , � `�� DEPARTMENT OF HEALTH AND ENVIRONMENT BARNSTABLE COUNTY COMPLEX y� f �" 3195 MAIN STREET/ PO BOX 427 ill Phone: (508) 375-6613 e, ~='ie=y BARNSTABLE, MASSACHUSETTS 02630 rr= �S '1- FAX (508) 362-2603 CHVgQ`S c TDD (508) 362-5885 December 23rd, 2014 5 Tom Fehnel 772 Bear Creek Circle Winter Springs, FL 32708 RE: Operation and Maintenance Contract for the Innovative/Alternative Septic System Installed at 195-A Route 149 in the town of Barnstable. Dear Tom Fehnel, Our records indicate that the operation and maintenance contract with A&B Canco for your innovative/alternative wastewater treatment system may have expired or was cancelled as of December 23rd, 2014. To date we have not received evidence that you have entered into a new operation and maintenance contract. I am writing to remind you that the Massachusetts Department of Environmental Protection (MA DEP)and the Town of Barnstable require you to keep an operation and maintenance (O&M)contract in effect at all times for your system. Information about these requirements may be found at https://septic.barnstablecountyhealth.org. My department oversees I/A septic system management and compliance efforts for the Board of Health in your town.We are authorized by your Board of Health to contact you to inform you of the above requirement and to request your compliance. Accordingly, please forward'a copy of a signed contract via mail,fax or e-mail within fifteen (15)days of receipt of this letter. For your convenience, I have enclosed a list of wastewater operators we are aware of that do business in Barnstable County. The firms listed operate multiple types of I/A technologies and are not associated with any particular technology or vendor. Please be advised that if you do not respond within fifteen (15)days of your receipt of this letter by,forwarding a copy of a signed contract, you may be referred you to the Barnstable Board of Health for further enforcement action. I can be reached at 508-375-6901; my Fax number is (508)362-2603. 1 can also be reached via email at Iwright@barnstablecounty.org.Thank you for your prompt attention to this matter. Sincerely, Lindsey Wright CC: Barnstable Board of Health Enclosures (1): Certified Wastewater Treatment System Operators List BENNETT ENVIRONMENTAL ASSOCIATES, INC. LICENSED SITE PROFESSIONALS,ENVIRONMENTAL SCIENTISTS,GEOLOGISTS,ENGINEERS 1573 Main Street,P.O.Box 1743 (508)896-1706 Brewster,MA 02631 fax(508)896-5109 LETTER OF TRANSMITTAL TO:, DATE: JOB NUMBER: Massachusetts Department of Environmental Protection 9/23/11 BEA09-10156 Attention:Title 5 Program 1 Winter Street-6th Floor Boston,MA 02108 REGARDING: Fehnel Residence 195 Herring Run Place Unit A[Route 149] SHIPPING METHOD: Marston Mills,MA Regular Mail ❑ Pick Up ❑ Priority Mail ❑ Hand Deliver ❑ Express Mail ❑ Other ❑ j Certified Mail Green Card/RR ❑ COPIES DATE DESCRIPTION 1 DEP Approved Inspection and O&M Form for Title 5 UA Treatment and Disposal Systems(Jan-Sept 2011) 1 9/22/11 Alpha Analytical Laboratory Report For review and comment: ❑ For approval: ❑ As requested: ❑ For your use: ❑ REMARKS: Please find enclosed the DEP Inspection and O&M Form,and laboratory test results of wastewater samples collected during this reporting period for the above referenced property. If you have any questions or require additional information,please contact us at your earliest convenience. Thank you. cc:Barnstable Board of Health Mr.Tom Fehnel,Owner David C.Bennett,Principal[Internal] Matthew Costa-OMNI Environmental Systems,Inc. FROM: David C.Bennett,WWTO#6243/Samantha Farrenkopf,WWTO#13265/Joseph Smith,WWTO#12529 If enclosures are not as noted,kindly notify us at once Massachusetts Department of Environmental Protection Bureau of Resource Protection -Title 5 L=- DEP Approved Inspection and O&M Form for Title 5 I/A Treatment and Disposal Systems A.. Installation Important:When Tom Fehnel filling out forms Owner on the computer, use only the tab Route 149 Unit 195-A key to move your Facility Street Address cursor-do not Marstons Mills 02648 use the return key. City Zip Mailing address of owner, if different: 722 Bear Creek Circle Street Address/PO Box: Winter Springs FL 32708 City State Zip (407)971 -0477 ext. Telephone Number B. Authorized Service Provider BENNETT ENVIRONMENTAL ASSOCIATES, INC. O&M Firm 1573 Main Street/PO Box 1743 Street Address Brewster MA 02631 City State Zip (508)896- 1706 ext. 129 Telephone Number Samantha Farrenkopf 13265 Certified Operator Name Certification Number C. Facility/System Information OMNI Environmental Systems OMNI RSF DEP ID Manufacturer ID Model Number 8/25/03 8/25/03 Installation Date Start of Operation Approval Type: ® General ❑ Provisional ❑ Piloting ❑ Remedial Seasonal Residence—used less than 6 mo./year: ® Yes ❑ No D. Operating Information 1/5/11 9/8/10 Inspection Date Previous Inspection Date 6"of Sludge, and No Scum Layer Pumping Recommended ❑ Yes ® No Sludge Depth(to be checked yearly) t5aiom.doc•rev.11-07-05 Page 1 of 3 { Massachusetts Department of Environmental Protection Bureau of Resource Protection - Title 5 DEP Approved Inspection and O&M Form for Title 5 I/A Treatment and Disposal Systems E. Field Testing Field Inspection: Color: ❑ gray ❑ brown ® clear ❑ turbid ❑ Other(specify): Odor: ® musty ❑ earthy ❑ moldy. ❑ offensive ❑ turbid Effluent Solids: ® no ❑ some pH 6.75 SU DO 17.74 mg/L Turbidity 0.07 NTU 6 to 9 2 or greater 40 or less Should a Remedial or General Use system fail the Field Testing, effluent samples shall be collected per Standard Methods and analyzed for BOD and TSS. F. Sampling Information Samples Taken: ❑ Influent ❑ Effluent Commercial systems or systems with a design flow of 2000 gpd and greater, and General Use nitrogen reducing systems: gpd Parameters sampled: ❑ pH ❑ BOD ❑ CBOD ❑ TSS ❑TN ❑ Other(list below) Other 1 Other 2 Other 3 G. Inspection and Maintenance Description of any maintenance performed since previous inspection &during this inspection: General O&M visit for system functionality and conducted field testing. Notes and Comments: System is functional and passed field testing. t5aiom.doc•rev.11-07-05 Page 2 of 3 LlMassachusetts Department of Environmental Protection Bureau of Resource Protection - Title 5 DEP Approved Inspection and O&M Form for Title 5 I/A Treatment and Disposal Systems H. Certification I certify: I have inspected the sewage treatment and disposal system at the address above, have conducted the required Field Testing and/or sample collection in accordance with Standard Methods, have completed this report and the attached technology operation and maintenance checklist, and the information reported is true, accurate, and complete as of the time of the inspection. I am a Massachusetts certified operator in accordance with 257 CMR 2.00. Operator Signature Date System owner must submit this report, technology O&M checklist, and any required sampling results to the local board of health and DEP as follows for each inspection performed: Remedial Use—by January 31 st of each year for the previous calendar year Piloting Use-within 45 days of inspection date Provisional Use—by March 31th of each year for the previous 12 months General Use—by September 30th of each year for the previous 12 months Send to: Department of Environmental Protection Attention: Title 5 Pro ram One Winter Street, 6t Floor Boston, MA 02108 t5aiom.doc•rev.11-07-05 Page 3 of 3 i� Massachusetts Department of Environmental Protection v Bureau of Resource Protection - Title 5 DEP Approved Inspection and O&M Form for Title 5 I/A Treatment and Disposal Systems A. Installation Important:When Tom Fehnel filling out forms Owner on the computer, use only the tab Route 149 Unit 195-A key to move your Facility Street Address cursor-do not Marstons Mills 02648 use the return key. City Zip Mailing address of owner, if different: 722 Bear Creek Circle Street Address/PO Box: �» Winter Springs FL 32708 City State Zip (407)971 -0477 ext. Telephone Number B. Authorized Service Provider BENNETT ENVIRONMENTAL ASSOCIATES, INC. O&M Firm 1573 Main Street/PO Box 1743 Street Address Brewster MA 02631 City State Zip (508)896- 1706 ext. 129 Telephone Number Samantha Farrenkopf 13265 Certified Operator Name Certification Number C. Facility/System Information OMNI Environmental Systems OMNI RSF DEP ID Manufacturer ID Model Number 8/25/2003 8/25/2003 Installation Date Start of Operation Approval Type: ® General ❑ Provisional ❑ Piloting ❑ Remedial Seasonal Residence—used less than 6 mo./year: ® Yes ❑ No D. Operating Information 3/8/11 1/5/11 Inspection Date Previous Inspection Date 5"of Sludge, and No Scum Layer Sludge Depth(to be checked yearly) Pumping Recommended ❑ Yes ® No t5aiom.doc-rev.11-07-05 Page 1 of 3 1 LlMassachusetts Department of Environmental Protection Bureau of Resource Protection - Title 5 DEP Approved Inspection and O&M Form for Title 5 I/A Treatment and Disposal Systems E. Field Testing Field Inspection: Color: ❑ gray ❑ brown ® clear ❑ turbid ❑ Other(specify): Odor: ® musty ❑ earthy ❑ moldy ❑ offensive ❑ turbid Effluent Solids: ® no ❑ some pH 6.44 SU DO 14.57 mg/L Turbidity 1.33 NTU 6 to 9 2 or greater 40 or less Should a Remedial or General Use system fail the Field Testing, effluent samples shall be collected per Standard Methods and analyzed for BOD and TSS. F. Sampling Information Samples Taken: ❑ Influent ❑ Effluent Commercial systems or systems with a design flow of 2000 gpd and greater, and General Use nitrogen reducing systems: gpd Parameters sampled: ❑ pH ❑ BOD ❑ CBOD ❑ TSS ❑TN ❑ Other(list below) Other 1 Other 2 Other 3 G. Inspection and Maintenance Description of any maintenance performed since previous inspection &during this inspection: General O&M visit for system functionality and conducted field testing. Notes and Comments: System is functional and passed field testing. t5aiom.doc•rev.11-07-05 Page 2 of 3 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Title 5 DEP Approved Inspection and O&M Form for Title 5 I/A Treatment and Disposal Systems H. Certification certify: I have inspected the sewage treatment and disposal system at the address above, have conducted the required Field Testing and/or sample collection in accordance with Standard Methods, have completed this report and the attached technology operation and maintenance checklist, and the information reported is true, accurate, and complete as of the time of the inspection. I am a Massachusetts certified operator in accordance with 257 CMR 2.00. - Operator Signature Date System owner must submit this report, technology O&M checklist, and any required sampling results to the local board of health and DEP as follows for each inspection performed: Remedial Use— by January 31 st of each year for the previous calendar year Piloting Use-within 45 days of inspection date Provisional Use—by March 31th of each year for the previous 12 months General Use—by September 30th of each year for the previous 12 months Send to: Department of Environmental Protection Attention: Title 5 Program One Winter Street, 6t Floor Boston, MA 02108 t5aiom.doc•rev. 11-07-05 Page 3 of 3 LlMassachusetts Department of Environmental Protection Bureau of Resource Protection - Title 5 DEP Approved Inspection and O&M Form for Title 5 I/A Treatment and Disposal Systems A. Installation Important:When Tom Fehnel filling out forms Owner on the computer, use only the tab Route 149 Unit 195-A key to move your Facility Street Address cursor-do not Marstons Mills 02648 use the return key. City Zip Mailing address of owner, if different: 722 Bear Creek Circle Street Address/PO Box: Winter Springs FL 32708 City State Zip (407)971 -0477 ext. Telephone Number B. Authorized Service Provider BENNETT ENVIRONMENTAL ASSOCIATES, INC. O&M Firm 1573 Main Street/PO Box 1743 Street Address Brewster MA 02631 City State Zip (508)896- 1706 ext. 129 Telephone Number Samantha Farrenkopf 13265 Certified Operator Name Certification Number C. Facility/System Information OMNI Environmental Systems OMNI RSF DEP ID Manufacturer ID Model Number 8/25/03 8/25/03 Installation Date Start of Operation Approval Type: ® General ❑ Provisional ❑ Piloting ❑ Remedial Seasonal Residence—used less than 6 mo./year: ® Yes ❑ No D. Operating Information 6/10/11 3/8/11 Inspection Date Previous Inspection Date Sludge Depth(to be checked yearly) Pumping Recommended ❑ Yes ® No t5aiom.doc•rev.11-07-05 Page 1 of 3 LlMassachusetts Department of Environmental Protection Bureau of Resource Protection-Title 5 DEP Approved Inspection and O&M Form for Title 5 I/A Treatment and Disposal Systems E. Field Testing Field Inspection: Color: ❑ gray ❑ brown ® clear ❑ turbid ❑ Other(specify): Odor: ® musty ❑ earthy ❑ moldy ❑ offensive ❑ turbid Effluent Solids: ® no ❑ some pH 7.5 SU DO 14.21 mg/L Turbidity 0.24 NTU 6 to 9 2 or greater 40 or less Should a Remedial or General Use system fail the Field Testing, effluent samples shall be collected per Standard Methods and analyzed for BOD and TSS. F. Sampling Information Samples Taken: ❑ Influent ❑ Effluent Commercial systems or systems with a design flow of 2000 gpd and greater, and General Use nitrogen reducing systems: 9pd Parameters sampled: ❑ pH ❑ BOD ❑ CBOD ❑ TSS ❑TN ❑ Other(list below) Other 1 Other 2 Other 3 G. Inspection and Maintenance Description of any maintenance performed since previous inspection &during this inspection: General O&M visit for system functionality and conducted field testing. Notes and Comments: System is functional and passed field testing. t5aiom.doc•rev.11-07-05 Page 2 of 3 LlMassachusetts Department of Environmental Protection Bureau of Resource Protection - Title 5 DEP Approved Inspection and O&M Form for Title 5 I/A Treatment and Disposal Systems H. Certification I certify: I have inspected the sewage treatment and disposal system at the address above, have conducted the required Field Testing and/or sample collection in accordance with Standard Methods, have completed this report and the attached technology operation and maintenance checklist, and the information reported is true, accurate, and complete as of the time of the inspection. I am a Massachusetts certified operator in accordance with 257 CMR 2.00. oc� � 9IZc��t� Operator Signature Date System owner must submit this report, technology O&M checklist, and any required sampling results to the local board of health and DEP as follows for each inspection performed: Remedial Use—by January 31 st of each year for the previous calendar year Piloting Use-within 45 days of inspection date Provisional Use—by March 31 th of each year for the previous 12 months General Use—by September 30th of each year for the previous 12 months Send to: Department of Environmental Protection Attention: Title 5 Program One Winter Street, 6th Floor Boston, MA 02108 t5aiom.doc•rev. 11-07-05 Page 3 of 3 LlMassachusetts Department of Environmental Protection Bureau of Resource Protection - Title 5 DEP Approved Inspection and O&M Form for Title 5 I/A Treatment and Disposal Systems A. Installation Important:When Tom Fehnel filling out forms Owner on the computer, use only the tab Route 149 Unit 195-A key to move your Facility Street Address cursor-do not Marstons Mills 02648 use the return key. City Zip Mailing address of owner, if different: rab 722 Bear Creek Circle Street Address/PO Box: Winter Springs FL 32708 City State Zip (407)971 -0477 ext. Telephone Number B. Authorized Service Provider BENNETT ENVIRONMENTAL ASSOCIATES, INC. O&M Firm 1573 Main Street/PO Box 1743 Street Address Brewster MA 02631 City State Zip (508)896- 1706 ext. 129 Telephone Number Samantha Farrenkopf 13265 Certified Operator Name Certification Number C. Facility/System Information OMNI Environmental Systems OMNI RSF DEP ID Manufacturer ID Model Number 8/25/03 8/25/03 Installation Date Start of Operation Approval Type: ® General ❑ Provisional ❑ Piloting ❑ Remedial Seasonal Residence—used less than 6 mo./year: ® Yes ❑ No D. Operating Information 9/14/11 6/10/11 Inspection Date Previous Inspection Date Sludge Depth(to be checked yearly) Pumping Recommended ❑ Yes ® No t5aiom.doc•rev.11-07-05 Page 1 of 3 LlMassachusetts Department of Environmental Protection Bureau of Resource Protection - Title 5 DEP Approved Inspection and O&M Form for Title 5 I/A Treatment and Disposal Systems E. Field Testing Field Inspection: Color: ❑ gray ❑ brown ® clear ❑ turbid ❑ Other(specify): Odor: ® musty ❑ earthy ❑ moldy ❑ offensive ❑ turbid Effluent Solids: ® no ❑ some 7.0 SU 12.21 mg/L 0.11 NTU pH 6 to 9 DO 2 or greater Turbidity 40 or less Should a Remedial or General Use system fail the Field Testing, effluent samples shall be collected per Standard Methods and analyzed for BOD and TSS. F. Sampling Information Samples Taken: ❑ Influent ® Effluent Commercial systems or systems with a design flow of 2000 gpd and greater, and General Use nitrogen reducing systems: gpd Parameters sampled: ❑ pH ❑ BOD ❑ CBOD ❑ TSS ®TN ® Other(list below) Nitrate Nitrite TKN Other 1 Other 2 Other 3 G. Inspection and Maintenance Description of any maintenance performed since previous inspection &during this inspection: General O&M visit for system functionality. Conducted field testing and collected effluent samples for laboratory analysis. Notes and Comments: System is functional and passed field testing. t5aiom.doc•rev.11-07-05 Page 2 of 3 LlMassachusetts Department of Environmental Protection Bureau of Resource Protection - Title 5 DEP Approved Inspection and O&M Form for Title 5 I/A Treatment and Disposal Systems H. Certification I certify: I have inspected the sewage treatment and disposal system at the address above, have conducted the required Field Testing and/or sample collection in accordance with Standard Methods, have completed this report and the attached technology operation and maintenance checklist, and the information reported is true, accurate, and complete as of the time of the inspection. I am a Massachusetts certified operator in accordance with 257 CMR 2.00. Sca��Q,9 0��c�L q w t\ Operator Signature DatTn System owner must submit this report, technology O&M checklist, and any required sampling results to the local board of health and DEP as follows for each inspection performed: Remedial Use— by January 31't of each year for the previous calendar year Piloting Use-within 45 days of inspection date Provisional Use—by March 31th of each year for the previous 12 months General Use—by September 30th of each year for the previous 12 months Send to: Department of Environmental Protection Attention: Title 5 Program One Winter Street, 6th Floor Boston, MA 02108 t5aiom.doc•rev.11-07-05 Page 3 of 3 Town of Barnstable Barnstable Regulatory Services Departmenta'�C " sexivsrnat.e. , I Public Health Division 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7012 1010 0000 2847 8360 January 3, 2016 James Teegan 195A Cotuit Road Marston Mills, MA 02648 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 195-A Route 149, Marstons Mills was inspected on 12/01/2016 by Greg Brehm, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Conditionally Pass" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Will need to bring inspection port and lateral cleanouts to finished grade. Need to conduct annual inspections of pressure closed system. You are ordered to repair or replace the septic system within one (1)year from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE\ OARD OF HEALTH Thomas McKean, R.S., CHO Agent of the Board of Health Q'.\SEPTIC\Letters Septic Inspection Failures or Future Evl\195 Route 149 Unit A Herring Run Place.doc Town of Barnstable + + + HARNSTAR*w 6 ,0� Regulatory Services Department �fD MKl# Public Health Division 200 Main Street,Hyannis MA'02601 Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 5/11/16 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) _ An"x"marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑Discharge or ponding of effluent to the surface of the ground ❑Pumping more.than 4 times during the last year not due to clogged or obstructed pipe. ❑Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ONE (1)YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑ Any portion of the cesspool within a Zone 1 to a public well ❑ Any portion-of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2)YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑Any"conditionally passed systems" (broken cover,relocation of a pipe, relocation of a driveway due to H-10 components, etc) ❑ Leaching pit or cesspool with high liquid level, <12" below inlet(per Town Code §3 60-9.1) ❑ Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER �` ✓l�r�anti / H J1 !V fir/ In �.�1 t. b.. y�T � r^�Pf'r.�( �' �Fv"�o�/�" I Repair deadline: ft' `l`' A`j P gradpa, N ad O:ISEPTIMDEADLINES TO REPAIR FAILED SYSTEMS.doc Cd,.�✓. c� o�nnV` ( i.�tpc'C ,o'J a� Q('ellvre dose d S y.J4e A, l r 07g,01$- 0A Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments m Herring Run Place Route 149 Unit 195-A Property Address James Teegan Owner Owner's Name information is � required for every MarstonsMills ✓ MA 02648 12-1-2016 CA page. City/Town State Zip Code Date of Inspection �... Inspection results must be submitted on this form. Inspection forms may not be altered m any way. Please see completeness checklist at the end of the form. Important:When A. General Information 'S / a L filling out forms on the computer, use only the tab 1. Inspector: key to move your cursor-do not Greg Brehm use the return Name of Inspector key. Bennett Environmental Associates, Inc. Company Name 1573 Main Street/ P. O. Box 1743 Company Address Brewster MA 02631 Cityrrown State Zip Code (508) 896-1706 S113633 Telephone Number License Number B. Certification 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 ❑ Fails ® Needs Further Evaluation by the Local Approving Authority 'lam 12-1-2016 Inspector's ature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system 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. ****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. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M Herring Run Place Route 149 Unit 195-A Property Address James Teegan Owner Owner's Name information is required for every Marstons Mills . MA 02648 12-1-2016 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 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. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts ' Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Herring Run Place Route 149 Unit 195-A Property Address James Teegan Owner Owner's Name information is required for every Marstons Mills MA 02648 12-1-2016 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts . v Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Herring Run Place Route 149 Unit 195-A Property Address James Teegan Owner Owner's Name information is required for every Marstons Mills MA 02648 12-1-2016 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 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 fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: System is in working condition and is functioning as intended. None of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 existed at the time of inspection. However, the inspection port and lateral cleanouts are not to final grade for the pressure dosing leaching field, it is recommended to bring them to final grade for operation and maintenance purposes. Vegetation is normal in the area of the leaching bed, no signs of hydraulic failure present at the time of inspection. In addition, no records are on file that indicate that the pressure dosed leaching field has had any of the annual inspections of the pressure dosed system performed as required by Title V(310 CMR 15.254: Section 2, attached as appendicies) D) System Failure Criteria Applicable to All Systems: You must indicate "Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or 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 Y2 day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts ' Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Herring Run Place Route 149 Unit 195-A Property Address James Teegan Owner Owner's Name information is required for every Marstons Mills MA 02648 12-1-2016 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ® ❑ 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 fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. 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 11 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. t5ins•3/13 Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts ' W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M s Herring Run Place Route 149 Unit 195-A Property Address James Teegan Owner Owner's Name information is required for every Marstons Mills MA 02648 12-1-2016 page. City/Town State Zip Code Date of Inspection C. Checklist 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: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection For Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Herring Run Place Route 149 Unit 195-A Propet#y Addr James Teegan Owner Owner's Name information is required for every Marstons Mills MA 02648 12-1-2016 page. City/Town State Zip Code Date of Inspection D. System Information Description: Septic System that serves a single family residence is comprised of a 1,500 gallon Septic Tank, Innovative/Alternative septic technology (OMNI Environmental Systems, Inc. OMNI Recirculating Sand Filter System), Pump Chamber, and a pressure dosed trench that is 75' long, 4'wide, and 2' effective depth. Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ❑ Na Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonal use? 0 Yes ❑ No Water meter readings, if available last 2 ears usage d See Details 9 ( y 9 (gpd)): Detail: 2014: 72,000 gallons = 197.26 gpd; 2015: 80,000 gallons=219.18 gpd; 2016(first half) 13,000 gallons=71.23 gpd Sump pump? ❑ Yes ® No Last date of ocoupaney: current Date Commercial/industrial Flow Conditions: Type of Establishment: Design flow-(based on 340 CMR 15.203). Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industriat waste holding tank present'l ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-3/13 'title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17- Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments GSM , Herring Run Place Route 149 Unit 195-A Property Address James Teegan Owner Owner's Name information is required for every Marstons Mills MA 02648 12-1-2016 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Homeowner, pumped in 2014 Was system pumped as part of the inspection? ❑ Yes ® 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)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachuietts w Title 5 Official Inspection Subsurface Sewage Disposal System Form Not for Voluntary Assessments Herring Run Place Route 149 Unit 195-A Woperty.Additess James Teegan Owner Owner's Name information is required for every Marstons Mills MA 02648 12-1-2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Installed: 8/25/2003 Barnstable County's Carmody Database for 1/A Treatment Technologies. Installed 2003:Town of Barnstable Disposal System Construction permit#2001-399 Were sawaga odors,detected:when arriving:at the site? ❑ Yes 0 No Building Sewer(locate on site plan): Depth below grade: 3.5'feet Material of c,.o_.nstruGt.Qn; ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: 75'+ feet CQm.met?ts(Qn cpr�dittQn of) 4Ktt , ye., t ng, +Kvidertce.Qf teekeQ a fit+ ). Vented properly to roof. No evidence of leakage in piping or joints for building sewer line. Septic Tank(locate on site plan): Depth below grade: 3.0' feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) 1,500 concrete septic tank, with polylok outlet riser and cover to grade. Furnished with 4"Schedule 40 PVC inlet and outlet Tees. If tank is metal, list age: years !s age confirmed by a Certificate of CQMPUance? (attach a copy Qf certiflcatel ❑ Yes ❑ Rio Dimensions: 1,500 gallon Sludge depth: 6" t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �M Herring Run Place Route 149 Unit 195-A Property Address James Teegan Owner Owner's Name information is required for every Marstons Mills MA 02648 12-1-2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 35" Scum thickness 0" 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 14" How were dimensions determined? Tape Measure, sludge Judge, Mirror, Probe Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumping not recommended at time of inspection. Schedule 40 pvc inlet and outlet tees functioning properly. Liquid level as related to the outlet invert is at a normal operating height. No evidence of leakage encountered while conducting the inspection on the septic tank. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M Herring Run Place Route 149 Unit 195-A Property Address James Teegan Owner Owner's Name information is required for every Marstons Mills MA 02648 12-1-2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(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 per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M Herring Run Place Route 149 Unit 195-A Property Address James Teegan Owner Owner's Name information is required for every Marstons Mills MA 02648 12-1-2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert No D-Box Present, Pressure Distribution SAS 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.): No D-Box Present, Pressure Distribution SAS Pump Chamber(locate on site plan): Pumps in working order: ® Yes ❑ No* Alarms in working order: ® Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): 250 gallon concrete Pump Chamber with polylock risers and cover to grade. Pump, on/off float switch, and alarm float switch functioning properly. * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Herring Run Place Route 149 Unit 195-A Property Address James Teegan Owner Owner's Name information is required for every Marstons Mills MA 02648 12-1-2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: 1-75' long ❑ 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.): Trench is 75' long, 4'wide, with a 2' effective depth. No inspection ports or cleanouts to final grade for pressure dosing trench. Vegetation is normal in the area of the leaching trench; no signs of hydraulic failure present at the time of inspection. System is in working condition and is functioning as intended. None of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 existed at the time of inspection. However, the inspection port and lateral cleanouts are not to final grade for the pressure dosing leaching field, it is recommended to bring them to final grade for operation and maintenance purposes. In addition, no records are on file that indicate that the pressure dosed leaching field has had any of the annual inspections of the pressure dosed system performed as required by Title V (310 CMR 15.254: Section 2, attached as appendicies) Cesspools (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 ❑ No t5ins•3/13 Title 5 Official.Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Herring Run Place Route 149 Unit 195-A Property Address James Teegan Owner Owner's Name information is required for every Marstons Mills MA 02648 12-1-2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(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.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts f Title 5 Official Inspection Form 01 _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments GM , Herring Run Place Route 149 Unit 195-A Property Address James Teegan Owner Owner's Name information is required for every Marstons Mills MA 02648 12-1-2016 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ® drawing attached separately -3 ` 0 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 24 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °. Herring Run Place Route 149 Unit 195-A Property Address James Teegan Owner Owner's Name information is Marstons Mills MA 02648 12-1-2016 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 7.0' + feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: Plan Date: 9/30/02 Revised: 10/22/02 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Established estimated depth to high groundwater by referencing the septic system design plan by Christopher Costa&Associates, of East Falmouth, MA with a plan date of September 30, 2002, with a revised plan date of October 22, 2002 wherein it is noted that the bottom of the leaching trench is at elevation 52.2. Also the soil test data taken by Bruce Murphy and witnessed by Jerry Dunning notes within the same plan that no groundwater was encountered at elevation 44.5, which puts groundwater at an elevation greater that 7.0'+from the bottom elevation of the leaching trench. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection r Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Herring Run Place Route 149 Unit 195-A Property Address James Teegan Owner Owner's Name information is required for every Marstons Mills MA 02648 12-1-2016 page. CityTTown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file l5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 No. —7 .LJ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:_ Yes PUBLIC HEALTH DIVISION-TOWN OF BARNSTABLE.,MASSACHUSETTS . Rpplication for �Di#pooal %pOtem Con$trUction Vermit Application for a Permit to Construct(Vj`Repair( )Upgrade( )Abandon( ) U? omplete System ❑Individual Components Locatign Address or Lot No.ROu fe /y9 mar -Oj�S /��/I Owner's Name,Address and tel.No. r ap4 _ �7 #a,t,florvt Red l'v 7 ru sf sw Assessor's ap/Parcel ry g I fi J,n,f / A&Ao>e /aa y m A l d u Ala Installer's Name,Address,and Tel.No. Designer's Name,Address and TeL No. Czar/ '(7 VOSs�, Tr. 60� 3yD-3933 e ljesrgn, ��� St��-Sya-SSoS 57 PaImer Ale. almaili /n/1 MA Type of Building: Dwelli No.of Bedrooms 3 Lot Size 11q,54 q.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) OtherFixtures Design Flow 330 gallons per day. Calculated daily flow -5-3Q 26 gallons. Plan Date / ,)'l/ a.DOO Number of sheets r?, Revision Date / /Vla-00/ Title i0lof- P/.n _Prnaorrd l-W Pus o Sti curyacP ,Seance _��t Grp�D 5y, awl 'J Size of Septic Tank / 0 6a lion S TypeofS.A.S. re SS e t- �iSfrrbci�ta(\ Description of Soil -7 " S-a r)d�/ Loam `7`3 0 11 B L od,rot y S Q nett Rio- I�ftl'l Ale�,uwt S4roc/ Nature of Repairs or Alterations(Answer when applicable) Met,) <?on Sfr cc c -i on 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 plac system in operation until a Certifi- cate of Compliance has been is d this oar •H Signed y, c / Date Lf e// Application Approved by Date �O dq' Application Disapproved for the following reasons Permit No. rg Date Issued l --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed(x)Repaired( )Upgraded( ) Abandoned( )by at U ti%,-v 1 C21 1`A!Ci has been constructed,in accordance with theprovisionsofTitle5andtheforDisposal System Construction Permit No_ill-3c7c1 dated Co QO f Installer Designer The issuance of this•pennit shall not be construed as a guarantee that the system will function as designed. Date Inspector ------------------------------------/—�-- No. .nl� _10R Hee/t X 2 O THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS �i tl4$al•�p$teln Con#trUction periCit Permission is hereby granted to Coilstrruct(; )--Repair( )Upgrade_4 ")''7ibandori t` , System located at - /�i �, r,t� C7 �.X C' 'Y Sri.,'i�(�YLT f� - "r yr :p and as described d','t iel'above A Rlication for Disposal Sj stem Construction Permit.The applicant recognizes his/her duty to comply with Title.5,*anA tifrrfoowing local provisions or special conditions. S Provided:Construction must be completed within three years of the date of thts�pe/rAit. Date: (U 17 t I Approved by lL-4 u1���t l(cC� '1, �\ 'r l TOWN OF BAR,N�STABLEp LOCATION, !/ SEWAGE# VILLAGF %V ST�DGl1 AAS'SESSOR'S MAP &LOT o INSTALLER'S NAME&PHONE NO. /'el lx lL mf.��l Z>/'/Ut;;M ��7/d� �� • sEPTrc rertiK:EAPACITX .�S" c9 0 i2��G/ Ttd�21 7 -lQ < 5 Q ,� _ TGQ ,NGI S (size) LEACHING..iF4CILITY: (type) NO.OF BEDROOMS • BUILDER OR OWNER • � _ , PERMITDATE: ZS o-2- COMPLIANCE DATE:.' 3 Separation Distance Between the: Feet MaximumAdjusted Groundwater Table to the Bottom of Leaching Facility Private.Watei.$upply Well and Leaching Facility (If any wells exist Feet on site of within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(if any wetlands exist Feet within 300 feet of leaching.facility) Furnished by �r 1 4 r R V Cf 57. BENNEYY EPWIRONMENI&L AssocffA,711ES-,- 9 119NICD LICENSED SITE PROFESSIONALS 8 ENVIRONMENTAL SCIENTISTS 6, GEOLOGISTS A ENGINEERS 1573 Main Street-P.O.Box 1743, Brewster, MA 02631 61 508-896-1706 Fax 508-896-5109 www.benneft-ea.com BEA15-10768 October 28,2015 Mr. James Teegan P.O. Box 569 Marston Mills,MA 02648 RE: OPERATION AND MAINTENANCE CONTRACT 2016 and 2017 Innovative/Alternative Wastewater Treatment System: OMNI RSF Unit 195-A Herring Run Place—Marston Mills,MA Dear Mr.Teegan, BENNETT ENVIRONMENTAL ASSOCIATES,INC.(BEA)is pleased to provide you with a budget estimate for the continuation of professional services relative to the operation and maintenance of the Innovative/Alternative Wastewater Treatment System 1'ocated at the above referenced property. The quarterly inspection and collection of samples from the effluent of the septic treatment system is a required condition of the system,as set forth by the Barnstable Health Department to qualify treatment capacity. As such,work proposed by BEA includes the standard quarterly operation and maintenance of the treatment system, as well as effluent sampling for total nitrogen, and the preparation of the required forms for distribution to the appropriate town and state offices. Additionally,at the time of such inspections,blowers,filters and associated piping will be inspected to assure working condition and regularly scheduled maintenance performed on a fixed cost basis will be invoiced quarterly. Should any repair or treatment system components replacement be required,or additional sampling beyond the quarterly requirements be necessary,you will be notified to authorize the additional work and expenses.- This work will be billed at time and expense,portal to portal. The following budget represents estimated annual costs through one year of service to include four inspection and sampling events. The annual costs are valid for two years (2016 and 2017) subsequent to the date of the first inspection scheduled for March 2016. Please note that this contract runs with the property. As such,it is your responsibility to notify our office in writing of any sale of the subject property so that there is no disruption of services. Furthermore, you are required to notify any buyer for the transfer of this contract. EMERGENCY SPILL RESPONSE WASTE SITE CLEANUP SITE ASSESSMENT PERMITTING SEPTIC DESIGN&INSPECTION WATER SUPPLY DEVELOPMENT,OPERATION&MAINTENANCE 6 WASTEWATER TREATMENT,OPERATION&MAINTENANCE OCTOBER 28,2015 TEEGAN/BEA15-10768 PAGE 2 OF 2 UNIT 195A HERRING RUN PLACE,MARSTONS MILLS,MA QUARTERLY INSPECTION/MAINTENANCE/SAMPLING Inspect I/A system and take field measurements of dissolved oxygen, pH, and turbidity. Collect treated effluent wastewater samples on a quarterly basis under a proper chain-of-custody for MA certified laboratory analysis of nitrite/nitrate/TKN for total nitrogen. At the time of sampling events the conditions of the system will be inspected and documented with regards to the blower units,sludge level and associated piping. REPORTING/F LING Review inspection,field-testing,and laboratory analytical report relative to conditional requirements ofthe system under the MA DEP and local Board of Health approvals. Prepare DEP transmittal forms and submit inspection and sampling reports on the Barnstable County Department of Health and Environment online database on a quarterly basis. Submit laboratory report and DEP transmittal forms to MA DEP,local Board of Health,and associated vendors/contractors,as appropriate,on an annual basis. Professional Services [March,June,September and December 2016] $ 844.00 Professional Services[March,June,September and December 2017] $844.00 Laboratory Analysis[lx nitrate/nitrite/TKN Mar,June, Sept&Dec 2016] $211.60 Laboratory Analysis [lx nitrate/nitrite/TKN Mar,June,Sept&Dec 2017] $211.60 Barnstable County Data Base Fee[2016] $ 50.00* Barnstable County Data Base Fee[2017] $ 50.00* * Noted: UA systems located in Barnstable County are required to report inspection and sampling results on the Mass Septic online database for use by the Barnstable County Department ofHealth and Environment(BCDHE)and the local Boards of Health. At this time,BCDHE has found it necessary to institute annual user fees for filings on this required database of$50 per year. We are proceeding with the work as outlined. Immediate notification in writing is required if you do not wish to proceed. Otherwise, please sign the authorization below and return one copy of this proposal to our office. Should you have any questions or need additional information,please contact me directly at our office Very truly yours, BENNETT ENVIRO NTAL ASSOCIATES,INC. Samantha Farrenkopf, WWTO Wastewater Program Manager cc: Kara Risk,Business Manager encl. Abbreviated Terms &Conditions (2011)/Fee Schedule(2014) AUTHORIZATION: ,DATE: I/A System Inspection of$ 4 195-A Route 149, Barnstable Barnstable County Department of Health and Environment IT P.O. Box 427, Barnstable, MA 02630 Site Address 195-A Route 149, Barnstable I/A Component OMNI Recirculating Sand Filter Contractor Bennett Environmental Associates, Inc. Operator Name Dan Meany Sample Date &Time 09/07/2016 @ 10:00 pm Field Testing . Color ❑ Gray ❑ Brown ® Clear ❑ Turbid ❑ Other Odor ® Musty ❑ Earthy ❑ Moldy ❑ Offensive ❑ Turbid Effluent Solids ® No ❑ Some pH 6.5 SU D.O. 6.000 mg/L Turbidity 0.74 NTU Settleable Solids ml/L Site Conditions Seasonal Residence ® No ❑ Yes Air Temperature 75.0 degress F Weather Conditions Sunny; Operating Information Sludge Depth 6.00 inches Scum Layer Thickness 0.00 inches Pumping Recommended ® No ❑ Yes Soil Absorption System Observations Signs of Breakout ® No ❑ Yes ❑ Unknown SAS Ponding Above Invert ® No ❑ Yes ❑ Unknown Depth of Ponding inches Maintenance Issues Inspection Completed? ® Yes ❑ No Approval Violations None Cleaning/Lubrication Performed None Control Adjustments . None Test Pumps/Switches/Alarms None Equipment Failures None Parts Replaced None Corrective Actions Recommended None Other Comments Comments None • 310 CMR: DEPARTMENT OF ENVIRONMENTAL PROTECTION 15.254: Pressure Dosing and Pressure Distribution (1) Gravity Distribution. (a) Dosing systems employing gravity distribution to the soil absorption system shall be restricted to systems designed to accept less than 2,000 gpd. (b) The dosing chamber and pumps shall be designed in accordance with 310 CMR 15.231. (c) Distribution lines to the soil absorption system shall have a minimum diameter of two inches and shall otherwise be in conformance with the provisions of 310 CMR 15.25 1(Trenches). (d) Septic tank effluent shall be dosed to the soil absorption system at a rate based on volume and number of doses that prevent the ponding of the effluent in the soil absorption system. (2) Pressure Distribution. (a) Pressure distribution of septic tank/recirculating sand filter effluent to the soil absorption system shall be required for a system to serve a facility with a design flow of 2,000 gpd or greater,a system that is not designed to discharge by gravity either from the septic tank or to the soil absorption system,a system designed for intermittent discharge of effluent to the soil absorption system,and a system with amultiple soil absorption system,unless otherwise determined in writing by the Department. (b) The pumping chamber and pumps shall be designed in accordance with 310 CMR 15.231. (c) The pressure distribution system shall be designed in accordance with Department guidance. (d) Pumps, alarms and other equipment requiring periodic or routine inspection and maintenance shall be operated, inspected and maintained in accordance with the manufacturer's and the designer's specifications and Department guidance.In no instance shall inspection be performed less frequently than once every three months for a system serving a facility with a design flow of 2,OOO.gallons per day or greater and annually for a system serving a facility with a design flow of less than 2,000 gallons per day. The system owner shall submit the results of such inspections to the local Approving Authority annually by January 3 V of each year for the previous calendar year. 15.255: Construction in Fill (1) Any system where fill is required to replace topsoil,peat or other unsuitable or impervious soil layer above the requisite four feet of naturally occurring pervious material is a system constructed in fill.Any system constructed in fill which extends either wholly or partially above natural grade for the purpose of complying with 310 CMR 15.212(depth to groundwater)is a mounded system. All soil absorption systems constructed in fill shall be sized using the soil class of the underlying naturally occurring pervious material. (2) The finished side slopes of a mounded system shall not be steeper than 3:1 (horizontal:vertical). A minimum 15 foot horizontal separation distance shall be provided between the soil absorption area and the adjacent side slope as measured from the edge of the top of the two inch layer of- to''/z inch washed stone aggregate.or geotextile fabric cover. The toe of the slope shall be a minimum of five feet from any property line,or a swale or other drainage system directing runoffaway from the adjacent property shall be installed.Adjustments to the above horizontal separation maybe allowed if a suitable impervious barrier is installed to prevent potential sewage breakout. The impervious barrier shall meet the following requirements: (a) the impervious barrier shall be designed by a Massachusetts Registered Sanitarian or a Massachusetts Registered Professional Engineer. (b) construction of the impervious barrier shall be supervised by the designer. (c) prior to issuance of a Certificate of Compliance, the applicant shall submit to the Approving Authority an as-built plan prepared and certified by the designer that the impervious barrier has been constructed in accordance with the approved design plan. (d) the elevation of the top of the impervious barrier shall be no lower than the"breakout" elevation,which is the elevation of the top ofthe two inch layer of. inch to''/2 inch washed stone aggregate cover. (e) the recommended distance from the impervious barrier to the edge of the soil absorption system closest to the barrier should be at least ten feet. Serial No:09221112:06 tiA A .A. Y T I C A L ANALYTICAL REPORT c c Lab Number: L1114552 Client: Bennett Environmental Associates 1573 Main St. PO Box 1743 Brewster, MA 02631 ATTN: David Bennett Phone: (508)896-1706 Project Name: FEHNEL Project Number: BEA09-10156 Report Date: 09/22/11 The original project report/data package is held by Alpha Analytical.This report/data package is paginated and should be reproduced only in its entirety.Alpha Analytical holds no responsibility for results and/or data that are not consistent with the original. Certifications&Approvals: MA(M-MA086),NY NELAC(11148),CT(PH-0574),NH(2003),NJ(MA935),RI(LA000065),ME(MA0086), PA(Registration#68-03671),USDA(Permit#S-72578),US Army Corps of Engineers,Naval FESC. Eight Walkup Drive,Westborough, MA 01581-1019 508-898-9220 (Fax)508-898-9193 800-624-9220-www.alphalab.com Page 1 of 17 Serial No:09221112:06 . Project Name: FENNEL Lab Number: L1114552 Project Number: BEA09-10156 Report Date: 09/22/11 Alpha Sample Collection Sample ID Client ID Location Date/Time L1114552-01 EFFLUENT MARSTONS MILLS 09/14/11 14:00 Page 2 of 17 Serial No:09221112:06 Project Name: FENNEL Lab Number: L1114552 Project Number: BEA09-10156 Report Date: 09/22/11 Case Narrative The samples were received in accordance with the Chain of Custody and no significant deviations were encountered during the preparation or analysis unless otherwise noted.Sample Receipt,Container Information,and the Chain of Custody are located at the back of the report. Results contained within this report relate only to the samples submitted under this Alpha Lab Number and meet all of the requirements of NELAC,for all NELAC accredited parameters.The data presented in this report is organized by parameter(i.e.VOC,SVOC,etc.).Sample specific Quality Control data(i.e.Surrogate Spike Recovery)is reported at the end of the target analyte list for each individual sample, followed by the Laboratory Batch Quality Control at the end of each parameter.If a sample was re-analyzed or re-extracted due to a required quality control corrective action and if both sets of data are reported,the Laboratory ID of the re-analysis or re-extraction is designated with an"R"or"RE",respectively.When multiple Batch Quality Control elements are reported(e.g.more than one LCS),the associated samples for each element are noted in the grey shaded header line of each data table.Any Laboratory Batch,Sample Specific% recovery or RPD value that is outside the listed Acceptance Criteria is bolded in the report.Definitions of all data qualifiers and acronyms used in this report are provided in the Glossary located at the back of the report. Please see the associated ADEx data file for a comparison of laboratory reporting limits that were achieved with the regulatory Numerical Standards requested on the Chain of Custody. For additional information,please contact Client Services at 800-624-9220. Nitrogen, Nitrate L1114552-01 has an elevated detection limit due to the dilution required to quantitate the result within the calibration range. I,the undersigned, attest under the pains and penalties of perjury that,to the best of my knowledge and belief and based upon my personal inquiry of those responsible for providing the information contained in this analytical report, such information is accurate and complete. This certificate of analysis is not complete unless this page accompanies any and all pages of this report. Authorized Signature: Elizabeth Simmons Title: Technical Director/Representative Date: 09/22/11 HAPage 3 of 17 Serial No:09221112:06 INORGANICS MISCELLANEOUS Page 4 of 17 Serial No:O9221112:O6 Project Name: FENNEL Lab Number: L1114552 Project Number: BEAO9-10156 Report Date: 09/22/11 SAMPLE RESULTS Lab ID: L1114552-01 Date Collected: 09/14/11 14:00 Client ID: EFFLUENT Date Received: 09/15/11 Sample Location: MARSTONS MILLS Field Prep: Not Specified Matrix: Water Dilution Date Date Analytical Parameter Result Qualifier Units RL MDL Factor Prepared Analyzed Method Analyst General Chemistry-n'-..—,..Westborotagh`Lab a i1 L _ .««..._r. «.-``Jw+....�-..—�... .-�-.........-..-.......+.�-.-- ..w-«. - ..M1 ....,_.•.u._.�,.—.-...-..�..........�..-...5-«.�..-... . .-..tea... -.4! Nitrogen,Nitrite ND mg/I 0.05 — 1 09/16/11 00:50 44,353.2 TH Nitrogen,Nitrate 11 mg/I 0.50 — 5 09/16/11 02:02 44,353.2 TH Nitrogen,Total Kjeldahl 0.78 mg/1 0.30 1 09/16/11 13:50 09/20/11 20:05 30,4500N-C AT Page 5 of 17 Serial No:09221112:06 Project Name: FENNEL Lab Number: L1114552 Project Number: BEA09-10156 Report Date: 09/22/11 Method Blank Analysis Batch Quality Control Dilution Date Date Analytical Parameter Result Qualifier Units RL MDL Factor Prepared Analyzed Method Analyst General Chemistry;�,Westboro"u h Lab for sam le s 01 Batch:.WG490293-2 Nitrogen,Nitrate ND mg/I 0.10 1 09/16/11 00:38 44,353.2 TH General Chemistrys Westborough Lab for sample(s). 01- Batch W9490295=2 Nitrogen,Nitrite No mg/I 0.05 — 1 09/16/11 00:46 44,353.2 TH *ral - ":-- =!.\R -. .-�'ai:uah"'Lab r-,;Cr,:C.x"�T—IO(.. General Chemistry=Westborough L'ali for sample(s): 01� Batcfi: WG490372-1 Nitrogen,Total Kjeldahl ND mg/I 0.30 — 1 09/16/11 13:50 09/20/11 20:02 30,4500N-C AT Page 6 of 17 Serial No:09221112:06 Lab Control Sample Analysis Project Name: FENNEL Batch Quality Control Lab Number: L1114552 Project Number: BEA09-10156 Report Date: 09/22/11 LCS LCSD %Recovery Parameter %Recovery Qual %Recovery Qual Limits RPD Qual RPD Limits .ro r , w q r f ._ ! - p.at .{".T X�, ( S-r w R: !,•••_ ,r++' fl ...r,yu„�.: v General Chemistry Westborough;Lab' Associated1sample(s) Nitrogen,Nitrate ',102r 90-110 - General"Chemistry--';Westborough�L''ali.-Associated samples) `01l- Batcf%WG'490295-1; Nitrogen,Nitrite Y 98 - 90-110 20 General Chemistry-West66rou6h;LabAss6ciatedsample(s) 014 Batch;WG490372-2� Nitrogen,Total Kjeldahl ;_' 95 - 85-116 Page 7 of 17 .�'�. Serial No:09221112:06 Matrix Spike Analysis Batch Quality Control Project Name: FENNEL Lab Number: 1-1114552 Project Number: BEA09-10156 Report Date: 09/22/11 Native MS MS MS MSD MSD Recovery RPD Parameter Sample Added Found %Recovery Qual Found %Recovery Qual Limits RPD Qual Limits General Chemistry--Westborough L°ab'Associated sample(s): 01, `QCIBatch ID:fWG490293-3 xQCfSample. L11�14553=01 ',Client-ID: ME�Sampie Nitrogen,Nitrate 5.9 4 9.8 98- - 83-113 - 6 General Chemistry-Westborough',Lab Associated:?sample(s):10,1' QC'13atbh;lD:r,WG490295-31 QC'Sample:11114553=01,--7Clier t<ID:'MS Sample,-` Nitrogen,Nitrite 0.06 4 4.1 •101: - 80-120 20 General'Chem istry-Westborough'`Lab Associated`sample(s):=01 QC°Bafch3lD ;,VVG490372=3`_ QCiSample fL1:114558=01 ::client ID MSSample Nitrogen,Total Kjeldahl 1.8 8 9.7 99 - 77-111 24 Page 8 of 17G11: HA S e ri a l_N o:09221112:06 Lab Duplicate Analysis Project Name: FENNEL Batch Quality Control Lab Number: L1114552 Project Number: BEA09-10156 Report Date: 09/22/11 Parameter Native Sample Duplicate Sample Units RPD Qual RPD Limits General;Chemistry'-Westboro''ugh Lab :Associatedssample(s) 01 ]QGBatch�ID:_1NG490293=4 .QC SampleL�11:1'4553=01iClient ID: ;DUPSampler'-r Nitrogen,Nitrate 5.9 6.0 mg/I -2 6 General;Chemistry';Westborough�Lab l'Associated?sample.(s) ,01w AQCJBatchf'ID-WG490295-4 ,QCSampie .LL,l1l14553-01�Client lD: �DUP;Sample,:'" Nitrogen,Nitrite 0.06 0.06 mg/I 5'' 20 General;Chemistry-';Westborough;Lab;,'Associateasample(s) 01�;:X�QC BatchlID WG490372'4-"QC`;Sample L111450T03*Client ID: DUP Sample {. Nitrogen,Total Kjeldahl 0.38 0.35 mg/I „'8,; `' 24 Page 9 of 17 "'~''- Serial No:09221112:06 Project Name: FEHNEL Lab Number: L1114552 Project Number: BEA09-10156 Report Date: 09/22/11 Sample Receipt and Container Information Were project specific reporting limits specified? YES Reagent H2O Preserved Vials Frozen on: NA Cooler Information Custody Seal Cooler A Absent Container Information Temp Container ID Container Type Cooler pH deg C Pres Seal Analysis(*) L1114552-01A Plastic 250ml unpreserved A 7 3.9 Y Absent NO3-353(2) L1114552-01 B Plastic 250ml unpreserved A 7 3.9 Y Absent NO2-353(2) L1114552-01C Plastic 250ml H2SO4 preserved A <2 3.9 Y Absent TKN-4500(28) *Values in parentheses indicate holding time in days Ak Page 10 of 17 Serial No:O9221112:O6 Project Name: FEHNEL Lab Number: L1114552 Project Number: BEAO9-10156 Report Date: 09/22/11 GLOSSARY Acronyms EPA Environmental Protection Agency. LCS Laboratory Control Sample:A sample matrix,free from the analytes of interest,spiked with verified known amounts of analytes or a material containing known and verified amounts of analytes. LCSD Laboratory Control Sample Duplicate:Refer to LCS. LFB Laboratory Fortified Blank:A sample matrix,free from the analytes of interest,spiked with verified known amounts of analytes or a material containing known and verified amounts of analytes. MDL Method Detection Limit:This value represents the level to which target analyte concentrations are reported as estimated values, when those target analyte concentrations are quantified below the reporting limit(RL).The MDL includes any adjustments from dilutions,concentrations or moisture content,where applicable. MS Matrix Spike Sample:A sample prepared by adding a known mass of target analyte to a specified amount of matrix sample for which an independent estimate of target analyte concentration is available. MSD Matrix Spike Sample Duplicate:Refer to MS. NA Not Applicable. NC Not Calculated: Term is utilized when one or more of the results utilized in the calculation are non-detect at the parameter's reporting unit. NI Not Ignitable. RL Reporting Limit: The value at which an instrument can accurately measure an analyte at a specific concentration.The RL includes any adjustments from dilutions,concentrations or moisture content,where applicable. RPD Relative Percent Difference: The results from matrix and/or matrix spike duplicates are primarily designed to assess the precision of analytical results in a given matrix and are expressed as relative percent difference(RPD). Values which are less than five times the reporting limit for any individual parameter are evaluated by utilizing the absolute difference between the values; although the RPD value will be provided in the report. SRM Standard Reference Material:A reference sample of a known or certified value that is of the same or similar matrix as the associated field samples. Footnotes 1 The reference for this analyte should be considered modified since this analyte is absent from the target analyte list of the original method. Terms Analytical Method:Both the document from which the method originates and the analytical reference method.(Example:EPA 8260B is shown as 1,8260B.)The codes for the reference method documents are provided in the References section of the Addendum. Data Qualifiers A Spectra identified as"Aldol Condensation Product". B The analyte was detected above the reporting limit in the associated method blank.Flag only applies to associated field samples that have detectable concentrations of the analyte at less than five times(5x)the concentration found in the blank.For MCP-related projects,flag only applies to associated.field samples that have detectable concentrations of the analyte at less than ten times(IOx) the concentration found in the blank.For DOD-related projects,flag only applies to associated field samples that have detectable concentrations of the analyte at less than ten times(1 Ox)the concentration found in the blank AND the analyte was detected above one-half the reporting limit(or above the reporting limit for common lab contaminants)in the associated method blank.For NJ- Air-related projects,flag only applies to associated field samples that have detectable concentrations of the analyte above the reporting limit. C Co-elution:The target analyte co-elutes with a known lab standard(i.e.surrogate,internal standards,etc.)for co-extracted analyses. D Concentration of analyte was quantified from diluted analysis.Flag only applies to field samples that have detectable concentrations of the analyte. E Concentration of analyte exceeds the range of the calibration curve and/or linear range of the instrument. G The concentration may be biased high due to matrix interferences(i.e,co-elution)with non-target compound(s).The result should be considered estimated. H The analysis of pH was performed beyond the regulatory-required holding time of 15 minutes from the time of sample collection. I The RPD between the results for the two columns exceeds the method-specified criteria;however,the lower value has been reported due to obvious interference. M Reporting Limit(RL)exceeds the MCP CAM Reporting Limit for this analyte. NJ -Presumptive evidence of compound.This represents an estimated concentration for Tentatively Identified Compounds(TICs),where the identification is based on a mass spectral library search. Report Format: Data Usability Report Page 11 of 17 Serial No:09221112:06 Project Name: FEHNEL Lab Number: L1114552 Project Number: BEA09-10156 Report Date: 09/22/11 Data Qualifiers P -The RPD between the results for the two columns exceeds the method-specified criteria. Q -The quality control sample exceeds the associated acceptance criteria.Note:This flag is not applicable for matrix spike recoveries when the sample concentration is greater than 4x the spike added or for batch duplicate RPD when the sample concentrations are less than 5x the RL.(Metals only.) R -Analytical results are from sample re-analysis. RE -Analytical results are from sample re-extraction. J -Estimated value.This represents an estimated concentration for Tentatively Identified Compounds(TICS). ND -Not detected at the reporting limit(RL)for the sample. Report Format: Data Usability Report h�A Page 12 of 17 Serial No:09221112:06 Project Name: FEHNEL Lab Number: L1114552 Project Number: BEA09-10156 Report Date: 09/22/11 REFERENCES 30 Standard Methods for the Examination of Water and Wastewater.APHA-AWWA- WPCF. 18th Edition. 1992. 44 Methods for the Determination of Inorganic Substances in Environmental Samples, EPA/600/R-93/100,August 1993. LIMITATION OF LIABILITIES Alpha Analytical performs services with reasonable care and diligence normal to the analytical testing laboratory industry. In the event of an error,the sole and exclusive responsibility of Alpha Analytical shall be to re-perform the work at it's own expense. In no event shall Alpha Analytical be held liable for any incidental, consequential or special damages, including but not limited to, damages in any way connected with the use of, interpretation of, information or analysis provided by Alpha Analytical. We strongly urge our clients to comply with EPA protocol regarding sample volume, preservation,cooling, containers, sampling procedures, holding time and splitting of samples in the field. ha Page 13 of 17 Serial No:09221112:06 Certificate/Approval Program Summary Last revised September 19,2011 -Westboro Facility The following list includes only those analytes/methods for which certification/approval is currently held. For a complete listing of analytes for the referenced methods, please contact your Alpha Customer Service Representative. Connecticut Department of Public Health Certificate/Lab ID: PH-0574. NELAP Accredited Solid Waste/Soil. Drinking Water(Inorganic Parameters: Color, pH, Turbidity, Conductivity, Alkalinity, Chloride, Free Residual Chlorine, Fluoride, Calcium Hardness, Sulfate, Nitrate, Nitrite, Aluminum, Antimony, Arsenic, Barium, Beryllium, Cadmium, Calcium, Chromium, Copper, Iron, Lead, Magnesium, Manganese, Mercury, Molybdenum, Nickel, Potassium, Selenium, .Silver, Sodium, Thallium, Vanadium, Zinc, Total Dissolved Solids, Total Organic Carbon,'Total Cyanide, Perchlorate. Organic Parameters: Volatile Organics 524.2, Total Trihalomethanes 524.2, 1,2-Dibromo-3-chloropropane (DBCP), Ethylene Dibromide (EDB), 1,4-Dioxane (Mod 8270). Microbiology Parameters: Total Coliform-MF mEndo (SM9222B), Total Coliform-Colilert(SM9223 P/A), E. Coli.-Colilert(SM9223 P/A), HPC-Pour Plate(SM9215B), Fecal Coliform- MF m-FC(SM9222D)) Wastewater/Non-Potable Water (Inorganic Parameters: Color, pH, Conductivity, Acidity, Alkalinity, Chloride, Total Residual Chlorine, Fluoride, Total Hardness, Silica, Sulfate, Sulfide, Ammonia, Kjeldahl Nitrogen, Nitrate, Nitrite, 0- Phosphate, Total Phosphorus, Aluminum, Antimony, Arsenic, Barium, Beryllium, Boron, Cadmium, Calcium, Chromium, Hexavalent Chromium, Cobalt, Copper, Iron, Lead, Magnesium, Manganese, Mercury, Molybdenum, Nickel, Potassium, Selenium, Silver, Sodium, Strontium, Thallium, Tin, Titanium, Vanadium, Zinc, Total Residue (Solids), Total Dissolved Solids, Total Suspended Solids (non-filterable), BOD, CBOD, COD, TOC, Total Cyanide, Phenolics, Foaming Agents (MBAS), Bromide, Oil and Grease. Organic Parameters: PCBs, Organochlorine Pesticides, Technical Chlordane, Toxaphene, 2,4-D, 2,4,5-T, 2,4,5-TP(Silvex), Acid Extractables (Phenols), Benzidines, Phthalate Esters, Nitrosamines, Nitroaromatics & Isophorone, Polynuclear Aromatic Hydrocarbons, Haloethers, Chlorinated Hydrocarbons, Volatile Organics,TPH (HEM/SGT), Extractable Petroleum Hydrocarbons (ETPH), MA-EPH, MA-VPH. Microbiology Parameters: Total Coliform - MF mEndo (SM9222B), Total Coliform - MTF (SM9221 B), HPC - Pour Plate (SM9215B), Fecal Coliform-MF m-FC(SM9222D), Fecal Coliform-A-1 Broth(SM9221 E).) Solid Waste/Soil(Inorganic Parameters: pH, Sulfide,Aluminum,Antimony,Arsenic, Barium, Beryllium, Boron, Cadmium, Calcium, Chromium, Hexavalent Chromium, Cobalt, Copper, Iron, Lead, Magnesium, Manganese, Mercury, Molybdenum, Nickel, Potassium, Selenium, Silver, Sodium, Thallium, Tin, Vanadium, Zinc, Total Cyanide, Ignitability, Phenolics, Corrosivity, TCLP Leach (1311), SPLP Leach (1312 metals only), Reactivity. Organic Parameters: PCBs, PCBs in Oil, Organochlorine Pesticides, Technical Chlordane, Toxaphene, Extractable Petroleum Hydrocarbons (ETPH), MA-EPH, MA-VPH., Dicamba, 2,4-D, 2,4,5-T, 2,4,5-TP(Silvex), Volatile Organics, Acid Extractables (Phenols), 3.3'-Dichlorobenzidine, Phthalates, Nitrosamines, Nitroaromatics & Cyclic Ketones, PAHs, Haloethers, Chlorinated Hydrocarbons. ) Maine Department of Human Services Certificate/Lab ID:2009024. Drinking Water(Inorganic Parameters: SM921513, 9222D, 9223B, EPA 180.1, 353.2, SM2130B, 2320B, 2540C, 4500CI- D, 4500CN-C, 4500CN-E, 4500E-C, 4500H+B, 4500NO3-F, EPA 200.7, EPA 200.8, 245.1, EPA 300.0. Organic Parameters:504.1, 524.2.) Wastewater/Non-Potable Water (Inorganic Parameters: EPA 120.1, 1664A, 350.1, 351.1, 353.2, 410.4, 420.1, SM2320B, 2510B, 2540C, 2540D, 426C, 4500CI-D, 4500CI-E, 4500CN-C, 4500CN-E, 450017-13, 4500E-C, 4500H+B, 4500Norg-B, 4500Norg-C, 4500NH3-B, 4500NH3-G, 4500NH3-H, 4500NO3-F, 4500P-B, 4500P-E, 5210B, 5220D, 5310C, 9010B, 9040B, 9030B, 7470A, 7196A, 2340B, EPA 200.7, 6010, 200.8, 6020, 245.1, 1311, 1312, 3005A, Enterolert, 9223D, 9222D. Organic Parameters: 608, 8081, 8082, 8330, 8151A, 624, 8260, 3510C, 3630C, 5030B, ME- DRO, ME-GRO, MA-EPH, MA-VPH.) Solid Waste/Soil (Inorganic Parameters: 9010B, 9012A, 9014A, 9040B, 9045C, 6010B, 7471A, 7196A, 9050A, 1010, 1030, 9065, 1311, 1312, 3005A, 3050B. Organic Parameters: ME-DRO, ME-GRO, MA-EPH, MA-VPH, 8260B, 8270C, 8330, 8151A, 8081A, 8082, 3540C, 3546, 3580A, 3630C,5030B, 5035.) Massachusetts Department of Environmental Protection Certificate/Lab ID: M-MA086. Drinking Water (Inorganic Parameters: (EPA 200.8 for: Sb,As,Ba,Be,Cd,Cr,Cu,Pb,Ni,Se,TI) (EPA 200.7 for: Ba,Be,Ca,Cd,Cr,Cu,Na,Ni) 245.1, (300.0 for: Nitrate-N, Fluoride, Sulfate); (EPA 353.2 for: Nitrate-N, Nitrite-N); (SM4500NO3-F for: Nitrate-N and Nitrite-N); 4500E-C, 4500CN-CE, EPA 180.1, SM213013, SM4500CI-D, 2320B, SM2540C, SM4500H-B. Organic Parameters: (EPA 524.2 for: Trihalomethanes, Volatile Organics); (504.1 for: 1,2- Dibromoethane, 1,2-Dibromo-3-Chloropropane), EPA 332. Microbiology Parameters: SM921513; ENZ. SUB. SM9223; ColilertQT SM922313; MF-SM9222D.) NQQntP.�able Water(Inorganic Parameters:, (EPA 200.8 for: AI,Sb,As,Be,Cd,Cr,Cu,Pb,Mn,Ni,Se,Ag,TI,Zn); (EPA 200.7 Pageo`F:° F(I,Sb,As,Be,Cd,Ca,Cr,Co,Cu,Fe,Pb,Mg,Mn,Mo,Ni,K,Se,Ag,Na,Sr,Ti,TI, V,Zn); 245.1, SM4500H,B, EPA 120.1, Serial No:09221112:06 SM2510B, 2540C, 2340B, 2320B, 4500CL-E, 4500E-BC, 426C, SM4500NH3-BH, (EPA 350.1 for: Ammonia-N), LACHAT 10-107-06-1-B for Ammonia-N, SM4500NO3-F, 353.2 for Nitrate-N, SM4500NH3-BC-NES, EPA 351.1, SM4500P-E, 4500P-B,E, 5220D, EPA 410.4, SM 5210B, 5310C, 4500CL-D, EPA 1664, SM14 510AC, EPA 420.1, SM4500-CN-CE,SM2540D. Organic Parameters: (EPA 624 for Volatile Halocarbons,Volatile Aromatics),(608 for: Chlordane,Aldrin, Dieldrin, DDD, DDE, DDT, Heptachlor, Heptachlor Epoxide, PCBs-Water),(EPA 625 for SVOC Acid Extractables and SVOC Base/Neutral Extractables),600/4-81-045-PCB-Oil. Microbiology Parameters: (ColilertQT SM9223B;Enterolert-QT: SM9222D-MF.) New Hampshire Department of Environmental Services Certificate/Lab ID:200307. NELAP Accredited. Drinking Water (Inorganic Parameters: SM 9222B, 9223B, 9215B, EPA 200.7, 200.8, 245.2, 300.0, SM4500CN-E, 4500H+B,4500NO3-F,2320B,2510B, 2540C,4500E-C, 5310C,2120B, EPA 332.0. Organic Parameters: 504.1, 524.2.) Non-Potable Water (Inorganic Parameters: SM9222D, 9221 B, 9222B, 9221E-EC, EPA 3005A, 200.7, 200.8, 245.1, 245.2, SW-846 6010B, 6020, 7196A, 7470A, SM3500-CR-D, EPA 120.1, 300.0, 350.1, 350.2, 351.1, 353.2, 410.4, 420.1, 1664A, SW-846 9010, 9030, 9040B, SM426C, SM2120B, 2310B, 2320B, 2540B, 2540D, 4500H+B, 4500CL-E, 4500CN-E, 4500NH3-H, 4500NO3-F, 4500NO2-B, 4500P-E, 4500-S2-D, 5210B, 5220D, 2510B, 2540C, 4500E-C, 5310C, 5540C, LACHAT 10-204-00-1-A, LACHAT 10-107-06-2-D. Organic Parameters: SW-846 3510C, 3630C, 5030B, 8260B, 8270C, 8330, EPA 624,625, 608, SW-846 8082,8081A,8151A.) Solid & Chemical Materials (Inorganic Parameters: SW-846 6010B, 7196A, 7471A, 1010, 1030, 9010, 9012A, 9014, 9030B, 9040B, 9045C, 9050C, 9065,1311, 1312, 3005A, 3050B. Organic Parameters: SW-846 3540C, 3546, 3550B, 3580A, 3630C, 5030B,5035, 8260B,8270C, 8330,8151A, 8015B,8082, 8081A.) New Jersey Department of Environmental Protection Certificate/Lab ID: MA935. NELAP Accredited. Drinking Water (Inorganic Parameters: SM9222B, 9221 E, 9223B, 9215B, 4500CN-CE, 4500NO3-F, 4500E-C, EPA 300.0, 200.7, 200.8, 245.2, 2540C, SM2120B, 2320B, 2510B, 5310C, SM4500H-B. Organic Parameters: EPA 332, 504.1, 524.2.) Non-Potable Water (Inorganic Parameters: SM5210B, EPA 410.4, SM5220D, 4500CI-E, EPA 300.0, SM2120B, SM4500E-BC, EPA 200.7, 351.1, LACHAT 10-107-06-2-D, EPA 353.2, SM4500NO3-F, 4500NO2-B, EPA 1664A, SM5310B, C or D, 4500-PE, EPA 420.1, SM510ABC, SM4500P-B5+E, 2540B, 2540C, 2540D, EPA 120.1, SM2510B, SM15 426C, 9222D, 9221 B, 9221 C, 9221 E, 9222B, 9215B, 2310B, 2320B, 4500NH3-H, 4500-S D, EPA 350.1, 350.2, SW-846 1312, 6020, 6020A, 7470A, 5540C, 4500H-B, EPA 200.8, SM3500Cr-D, 4500CN-CE, EPA 245.1, 245.2, SW- 846 9040B, 3005A, 3015, EPA 6010B, 6010C, 7196A, 3060A, SW-846 9010B, 9030B. Organic Parameters: SW-846 8260B, 8270C, 8270D, 8270C-SIM, 8270D-SIM, 3510C, EPA 608, 624, 625, SW-846 3630C, 5030B, 8081A, 8081B, 8082, 8082A, 8151A, 8330, NJ OQA-QAM-025 Rev.7, NJ EPH.) Solid& Chemical Materials(Inorganic Parameters: SW-846, 6010B, 6010C, 7196A, 3060A, 9010B, 9030B, 1010, 1030, 1311, 1312, 3005A, 3050B, 7471A, 7471B, 9014, 9012A, 9040B, 9045C, 9050A, 9065. Organic Parameters: SW-846 8015B, 8015C, 8081A, 8081 B, 8082, 8082A, 8151A, 8330, 8260B, 8270C, 8270D, 8270C-SIM, 8270D-SIM, 3540C, 3545, 3546, 3550B, 3580A, 3630C, 5030B, 5035L, 5035H, NJ OQA-QAM-025 Rev.7, NJ EPH.) New York Department of Health Certificate/Lab ID: 11148. NELAP Accredited. Drinking Water (Inorganic Parameters: SM9223B, 9222B, 9215B, EPA 200.8, 200.7, 245.2, SM5310C, EPA 332.0, SM2320B, EPA 300.0, SM2120B,4500CN-E, 4500E-C,4500H-B, 4500NO3-F, 2540C, SM 2510B. Organic Parameters: EPA 524.2, 504.1.) Non-Potable Water (Inorganic Parameters: SM9221 E, 9222D, 9221 B, 9222B, 9215B, 5210B, 5310C, EPA 410.4, SM5220D, 2310B-4a, 2320B, EPA 200.7, 300.0, SM4500CL-E, 4500E-C, SM15 426C, EPA 350.1, SM4500NH3-BH, EPA 351.1, LACHAT 10-107-06-2, EPA 353.2, LACHAT 10-107-04-1-C, SM4500-NO3-F, 4500-NO2-B, 4500P-E, 2540C, 2540B, 2540D, EPA 200.8, EPA 6010B, 6020, EPA 7196A, SM3500Cr-D, EPA 245.1, 245.2, 7470A, SM2120B, LACHAT 10-204-00-1-A, EPA 9040B, SM4500-HB, EPA 1664A, EPA 420.1, SM14 510C, EPA 120.1, SM2510B, SM4500S-D, SM5540C, EPA 3005A, 9010B, 9030B.. Organic Parameters: EPA 624, 8260B, 8270C, 625, 608, 8081A, 8151A,8330, 8082, EPA 3510C, 5030B.) Solid&Hazardous Waste(Inorganic Parameters: 1010, 1030, EPA 6010B, 7196A, 7471A, 9012A, 90149 9040B, 9045C9 9065, 9050, EPA 1311, 1312, 3005A, 3050B, 9010B, 9030B. Organic Parameters: EPA 8260B, 8270C, 8015B, 8081A, 8151A, 8330, 8082, 3540C,3545,3546,3580,5030B,5035.) North Carolina Department of the Environment and Natural Resources Certificate/Lab ID: 666.Organic Parameters: MA-EPH, MA-VPH. Drinking Water Program Certificate/Lab ID: 25700. (Inorganic Parameters:Chloride EPA 300.0. Organic Parameters: Page 7 Serial No:09221112:06 Pennsylvania Department of Environmental Protection Certificate/Lab ID : 68-03671. NELAPAccredited. Drinking Water(Organic Parameters: EPA 524.2,504.1) Non-Potable Water(Inorganic Parameters: EPA 1312, 200.7,410.4, 1664A, SM25401), 521013, 5220D,4500-P,BE. Organic Parameters: EPA 3510C, 3005A, 3630C, 503013,625, 624, 608, 8081A, 8082,8151A, 826013, 8270C, 8330) Solid & Hazardous Waste (Inorganic Parameters: EPA 350.1, 1010, 1030, 1311, 1312, 30506, 60106, 7196A, 7471A, 901013, 9012A, 9014, 904013, 9045C, 9050, 9065, SM 4500NH3-H. Organic Parameters: 3540C, 3545, 3546, 355013, 3580A, 3630C, 5035, 8015B, 8081A, 8082, 8151A, 826013, 8270C,8330) Rhode Island Department of Health Certificate/Lab ID: LAO00065. NELAP Accredited via NY-DOH. Refer to MA-DEP Certificate for Potable and Non-Potable Water. Refer to NJ-DEP Certificate for Potable and Non-Potable Water. Texas Commisson on Environmental Quality Certificate/Lab ID:T104704476-09-1. NELAPAccredited. Non-Potable Water(inorganic Parameters: EPA 120.1, 1664,200.7,200.8,245.1, 245.2, 300.0,350.1,351.1, 353.2, 376.2,410.4 420.1 6010 6020 7196 7470 9040 SM 21206 231013 232013 251013 2540B, 2540C, 2540D,426C, 4500CL-E,4500CN-E,4500E-C, 4500H+B,4500NH3-H,4500NO2B,4500P-E,4500 S2 D, 510C, 521013,5220D, 5310C, 5540C. Organic Parameters: EPA 608,624, 625,8081, 8082, 8151, 8260, 8270,8330.) Solid&Hazardous Waste(Inorganic Parameters: EPA 1311, 1312, 9012,9014, 9040,9045, 9050, 9065.) Department of Defense Certificate/Lab ID: L2217. Drinking Water(Inorganic Parameters: SM 45001-1-13. Organic Parameters: EPA 524.2, 504.1.) Non-Potable Water(Inorganic Parameters: EPA 200.7, 200.8, 601013, 6020, 245.1,245.2,7470A,904013, 300.0, 332.0, 6860, 353.2,410.4,9060, 1664A,SM 4500CN-E,4500H-B,4500NO3-F, 5220D,5310C,2320B, 2540C, 3005A, 3015, 90106, 9056. Organic Parameters: EPA 82606, 8270C, 8330A, 625, 8082, 8081A,3510C,503013, MassDEP EPH, MassDEP VPH.) Solid&Hazardous Waste(Inorganic Parameters: EPA 200.7, 6010B, 7471A,9010,9012A, 6860, 1311, 1312, 3050B, 7196A, 901013, 3500-CR-D,4500CN-CE,2540G, Organic Parameters: EPA 8260B, 8270C,8330A/B-prep,8082, 8081A,3540C, 3546, 3580A, 5035A, MassDEP EPH, MassDEP VPH.) The following analytes are not included in our current NELAP/TNI Scope of Accreditation: EPA 8260B: Freon-113, 1,2,4,5-Tetramethylbenzene, 4-Ethyltoluene. EPA 8330A: PETN, Picric Acid, Nitroglycerine, 2,6-DANT, 2,4-DANT. EPA 8270C: Methyl naphthalene, Dimethyl naphthalene, Total Methylnapthalenes, Total Dimethylnaphthalenes, 1,4-Diphenylhydrazine (Azobenzene). EPA 625: 4-Chloroaniline, 4-Methylphenol. Total Phosphorus in a soil matrix, Chloride in a soil matrix, TKN in a soil matrix, NO2 in a soil matrix, NO3 in a soil matrix, SO4 in a soil matrix. Page 16of17 . a o 0 9 .H0 USE /��/¢y�� 7 1 =60 ` a/ ' 55.86 I Sari AVERA i �i 50.E 55.85 R e S C i i ,91 Re—Cis 5&30 Sand I Sand. 56.7 56.39 ' 36.10 / 57.2 56.83 Re—Cir 56.31 ` 57.13 TANK �`� Sand I \CK TO 5s.9 `�A 9�9 0 CF CURB STOP 56.6 .ATION TA K` �, ��GS OoFp .s\5e.82 . 72 SACK TO56.8 4TING 57.5 ES REQ.) - -- _ ----------- O............. .. .. . S OH ................................... 75 0' 57.9 ...... ......... /,•. m W RESERVE AREA N __— 58 77?ANSFr?,4MER VAUL T / Ld .� o`�• I �:�w ��.8 P 57.2 •0 � 57.3 56 R c • 5ss C I . I, t t .1 kq!'.• . i . t ' 1 ,. .. 1 ; , ' .,1 , , .i',u. . Ni :1 n . , , 1( • .,i. . ., . . i .1 , 1 SEWAGE ® . I2000 j�I. � I SANDFILTERP. N� 1 1® SCALD NOTE: RISERS AND COVERS TO WITHIN 6"..OF FINISH GRADE 6� 6" PINE BARK MULCH OMNI 2000 RE—CIRCULATING SAND I 2 MODULES REQUIRED FILTER FABRIC COVER ENO SUBSTITUTION) FINISH GRADE=56.2 AIRATION HOODS �0 (3) COVERS TO GRADE F.FL.=58.0 1.5" PRESSURIZED LINE SEPTIC 3" PVC RETURN LINE . TANK= 55.7 56.0.. TOP OF EFFLUENT-r ILTER RECIRC, R.S.F. Acme Precast Model PL122 TANK= 55.5 011 SLOPE 29; ��-�•/ •:,....:, ;�. �,. :.� R.S.F. 52.3 ; •.i . t: ,�, '< MODULE .�;. 52.72 �' 10" 14AC FLOW } SPLITTER — — INV. 52.61 _" — —� 52.36 52.83 " 1-1/2 PVC C f �,� 52.05 3 LIQUID , AC LEVEL �� 24 •HR: RES. PUMP ON 54.2 HIG ; WATER ALARM I . F 52.0 ' I I `� t t j C 1500 GALLON SEPTIC TANS "LOW 'HATER "SHUT OFF" r I I�-i---I—PUMP OFF SET LEVEL 1000 GALLON ."OMNI .2000" ; :J I ' } I E'7LUtNT hLTER' RECIRCULATION TANK ' } 52.2 By. "Zoeller" (NO SUBSTITUTION.) OMNI' 2000 PUMP CHAMBER BOTTOM p®YOPASSIORIFACE" 256 GAL.PUMP CHAMBER NOTE:TIMER AND EVENT COUNTER "CHECK VALVE" SHOULD BE MONITORED FROM CONTROL PANEL Ar t D'ESIGN SP`E'CIEI'CATIGNS ' DESIGN CRITERIA Sand Filter Media . _ . . . . . . . . . 24" hoin. depth <1 sieve, 2mm to 4mm size i NUMBER OF BEDROOMS 4 AVFRAC�F I�AII"Y FI OW - _ _ 5.5 nnri/r•sr rrl�wenn /r�pr h®r9rr►nrr, •_ ' } OMNI 2000 RE—CIRCULATING SAND FILTER { 2 MODULES REQUIRED (NO SUBSTITUTION) ' 1 i 56.0.. TOP OF ' SLO7R.S.F. FINISH GRADE 56.0-57.3 Prze ,7 TYp '. . �... R.S.F. , MODULE — z 3" PEASTONE ` 52.83 1-1/2" PVC 17 — — AC 54.2 e 4 ? ALARM I PUMP ON q 'I d . I _ 3/4", TQ 1_1,/2" CRUSHEDr• �I 52.0 I d `° WA-SHE[#STOWS d SHUT OFF" 1 I -�---�--PUMP OFF d ° .• d I=� d ;a 4 ...... � 52.2 .i TWn . OMNI 2000 PUMP CHAMBER BOTTOM SOIL A. �I®�° SYSTEM �1V1{ 250. GAL.PUMP CHAMBER p//�-���rr TT11 JT COUNTER DNSSIGNED BY OTHERS IITORED FROM 4/1.5' LONG, 1 .00" DIA. PVC LATERALS EACH WITH FIVE 1 /4" DIA. HOLES SPACED r 3 O.C. ALONG PIPE INVERT. GN CRITERIA ONE TRENCH: 75.0' LONG, 4' WIDE WITH BEDROOMS 4 2' EFFECTIVE DEPTH. I R BEDROOM 2 PER PERSON 55 FLOW 440 SOIL EVALUATOR'S LOG 'EA REQUIRED 594.6 sq.ft.(440 gal. 0 0.74 gal./s.f.) 'EA PROVIDES 616: —sq. ft. Depth, from Soil Soli Soil Soil Other , Surface Hor. Texture Color Mott. Relative .PACITY PROVIDED '455.84 _9.p•d.. (616)(0.74) (inches) (USDA) (Munsel) Factors �ULATIONS S6.7 DEEP .OBSERVATION HOLE ;; C—i g ---.,:. - 0"-7'°` A Sandy i 74 222 a.D.d. 56.1 Loam 7"-30" B Loamy 0.74 3.3.84 g•p•d• 54.2 Sand 455.84 g.p.d./0.74 = 616 s.f. 30"-144" C Med. Sand 44.7 56,.5 DEEP OBSERVATION HOLE #C-2 0"-7" A Sandy 15.255(5) 55.9 Loam 7"-30" B Loamy 54.0 Sand 144 OF aq • 30"-144" C Med. N.DOUGLAS saHW,OER Sand Cwt ft 44.5 PERCOLATION RATE = 5 MIN./IN.CH 01,�,•,/ DEPTH TO GROUNDWATER = NONE ENCOUNTERED OBSERVATIONS BY: JERRY DUNNING TAKEN BY: BRUCE MURPHY DATE TESTED: 3/20/98 t� 9 q nj td ' A )PHER . �? �o���