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HomeMy WebLinkAbout0045 BRIDGET'S PATH - Health 45-Bridgets Path Centerville P A = 169 100 I A y Omr ford, NO. 152 1/3 ORA ���� 10% Commonwealth of Massachusetts Title 5 Officia-I Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4 u 45 Bridget's Path Property Address ' David B & Linda Still Owner Owner's Name information is required for every Centerville ✓ MA 02632 03-13-2019 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. Inspector Information SIB 131PS'+ on the computer, use only the tab Michael T Bisienere key to move your Name of Inspector cursor-do not Cape Septic Inspections use the return Company Name key. 52 Rivers End Road � Company Address Teaticket Ma. 02536 City/Town State Zip Code 508-280-3356 S13938 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 2z!� 1 03-16-2019 ' Inspector'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 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 form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: 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. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments . 45 Bridget's Path Property Address David B & Linda Still Owner Owners Name information is required for every Centerville MA 02632 03-13-2019 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) 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: This 3 bedroom home has a H-10 1000 gallon septic tank and a H-10 D-Box fedding two leacing pits.At the time of the inspection both leaching pits were empty. This system meets all the requirements to pass Title 5 in the Town of Barnstable. 2) 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): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 45 Bridget's Path Property Address David B & Linda Still Owner Owner's Name information is required for every Centerville MA 02632 03-13-2019 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ 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): 3) 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. a. 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: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form 11 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments .......... !% 45 Bridget's Path u- Property Address David B & Linda Still Owner Owner's Name information is Centerville MA 02632 03-13-2019 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 b. 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. c. Other: 4) 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 l5insp:doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments � /% 45 Bridget's Path u Property Address David B & Linda Still Owner Owner's Name information is required for every Centerville MA 02632 03-13-2019 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® 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 'h day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply 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 2000 gpd- 10,000 gpd. ❑ ® 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. 5) 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 CA. 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 El El Area system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments c !% 45Bridget's Path Property Address David B & Linda Still Owner Owner's Name information is required for every Centerville MA 02632 03-13-2019 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes" to any question in Section C.5 the system is considered a significant threat, or answered "yes" to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate "yes" or"no"for each of the following for all inspections: 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)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 Commonwealth of Massachusetts I� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ............. 45 Bridget's Path u— Property Address David B & Linda Still Owner Owner's Name information is required for every Centerville MA' 02632 03-13-2019 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 plus GPD Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: 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)): Detail: . In 2018 58,000 gallons were used and in 2017 70,000 were used. Sump pump? ❑ Yes ® No Last date of occupancy: two weeks agoDate t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth o wealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 45 Bridget's Path V� Property Address David B & Linda Still Owner Owner's Name information is required for every Centerville MA 02632 03-13-2019 page. CityTTown State Zip Code Date of Inspection D. System Information (cont.) 2. 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 Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 i Commonwealth of Massachusetts �n = Title 5 Official Inspection Form i� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments `........... 45 Bridget's Path Property Address David B & Linda Still Owner Owner's Name information is required for every Centerville MA 02632 03-13-2019 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 4. 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): Approximate age of all components, date installed (if known)and source of information: Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): " Depth below grade: 21feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 45 Bridget's Path Property Address David B & Linda Still Owner Owner's Name information is Centerville MA 02632 03-13-2019 required for every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 12"feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: standard H-10 1000 gallon Sludge depth: 6" Distance from top of sludge to bottom of outlet tee or baffle 30" Scum thickness 4" Distance from top of scum to top of outlet tee or baffle 3" Distance from bottom of scum to bottom of outlet tee or baffle 11" How were dimensions determined? sludge judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): recommend the new owner have the septic tank pumped and cleaned. After that I recommend the new owner put the tank on a maint. plan based on the future use of the home. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 45 Bridget's Path Property Address David B & Linda Still Owner Owner's Name information is required for every Centerville MA 02632 03-13-2019 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 7. 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 Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. 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 l5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 i Commonwealth of Massachusetts p Title 5 Official Inspection Form III Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 45 Bridget's Path V Property Address David B & Linda Still Owner Owner's Name information is required for every Centerville MA 02632 03-13-2019 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) 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 9. Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 011 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.): At the time of the inspection there were no visible signs of leakage. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form b Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 45 Bridget's Path Property Address David B & Linda Still Owner Owner's Name information is required for every Centerville MA 02632 03-13-2019 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 10. 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.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: 2 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 Commonwealth of Massachusetts �- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u 45 Bridget's Path Property Address David B & Linda Still Owner Owner's Name information is required for every Centerville MA 02632 03-13-2019 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Both of the leaching pit were empty at the time of the inspection. 12. 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 Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 45 Bridget's Path Property Address David B & Linda Still Owner Owner's Name information is required for every Centerville MA 02632 03-13-2019 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments w 45 Bridget's Path Property Address David B &Linda Still wner Owner's Name ion is quired for every Centerville MA 02632 03-13-2019 uired ige, Citylrown State Zip Code Date of Inspection D. System Information (cont.) 14. 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 d 6ALk A I �� I B Via• a� I I P"a• a� a 83 a..9 Aq, 33 3 6q, 59 Af 35 � as• 3� . s t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form ` Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 45 Bridget's Path u- Property Address David B & Linda Still Owner Owner's Name information is required for every Centerville MA 02632 03-13-2019 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 15 plus feetfeet 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: 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: I augered a hole at a lower elevation and I shot it with a transit to show 4 feet of seperation. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 • Commonwealth of Massachusetts Title 5 Official Inspection Form i� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u— 45 Bridget's Path Property Address David B & Linda Still Owner Owner's Name information is required for every Centerville MA 02632 03-13-2019 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 r � FORM30 C&W HOBBS&WARRENTM THE COMMONWEALTH.OFMASSACHUSETTS s 4 BOARD OF H , `t � CITY/TOWN W �� el DEPARTMENT ADDRESS r4 4^M SVBy`0W TELEPHONE Address ` — Occupant Floor Apartmen o. No. of Occupan T' No. of Habitable Rooms 2 No.Sleeping Rooms No.dwelling or rooming units--No.Stories Name and address of owner 1411 V Remarks Reg. Vio. YARD Out Bld s.: Fences: Garbage and Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT. —Steps,Stairs, Porches: Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: Roof Gutters, Drains: V I Walls: Foundation: on Chimney: BASEMENT Gen.Sanitation: Dampness: .� s Stairs: Lighting: STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: Central ❑ Y ❑ N Equip. Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) -- ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusing,Grnd.: AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den Living Room Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 �,. Hot Water Facil. Sup.Ten.,Gas, Oil, Elect.: Sjapks, Flues,Vents,Safeties: , Kitchen Facilities in' ove Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin,Shower or Tub: Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: General Building Posted Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR. (See Over) "THIS INSPECTION REPORT I SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES OF PERJU INSPECTOR TITLE �xL ` / A.M. DATE '3 r 27 TIME �C? ' � P.M. A.M. THE NEXT SCHEDULED REINSPECTION P.M. 9 z 7 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions, when found to exist in residential premises,shall be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises.This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter 11, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold,to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B)and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. H Failure to comply with the security requirements of 105 CMR 410.480(D). ( ) P Y tY q (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish,filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof,foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2) and 410.150(A)(3)or any defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the Board of Health. @.,10suS_ SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete Sig item 4 if Restricted Delivery is desired. ent ■ Print your name and address on the reverse ssee so that we can return the card to you. 9. k4ceived by(Printed Name) C. Date of Delivery ■ Attach this card to the back of the mailpiece, or on the front if space permits. D. Is delivery-add.restis nt m item 17 ❑Yes 1. Article Addressed to: t+" 1 If Y ,titter,deli—'very-addre low: ❑No MAR 08 2007 i (. 3. Serv�lce Type la Ce�tr ifier�At @18 E`�xp�Mall j I ❑Reglste P!L4 Return Receipt for Merchandise I ❑Insured Mail ❑C.O.D. 4. Restricted Delivery gxtra Fee) ❑Ye 2. (thole Numbrfrom sery 7006 0810 0000 3524 8684 (Transfer from ke IabelJ PS Form 3811,February 2004 Domestic Return Receipt 102595-02-*1540 UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid LISPS Permit No.G-10 I • Sender: Please print your name, address, and ZIP+4 in this box• I I I I I 9 Town of Barnstable � ( l° Health Division 200 Main Street 8 r Hyannis,MA 02601 Q Certified Mail#7006 0810 0000 3524 8684 tKE rahy Town of Barnstable v� O Regulatory Services •- d 13ARNSrABLE, •. .---' 90 KASS. g Thomas F. Geiler,Director O 059. Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 fU/ r Office: 508-862-4644 Fax: 508-790-6304 March 2, 2007 David& Linda Still P.O. Box 323 - West Hyannisport, MA 02672 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE II — MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE CODE CHAPTER 170. The property owned by you located at 45 Bridget's Path, Centerville, was inspected on February 27, 2007 by Timothy O'Connell, Health Inspector for the Town of Barnstable. This inspection was conducted on the basis of the rental registration in accordance with Chapter 170 of the Town of Barnstable Code. The following violations of the State Sanitary Code were observed: 105 CMR 410.190—Hot Water. Hot water temperature too low at 105°F. 105 CMR 410.351 —Owner's Installation and Maintenance Responsibilities. Inoperable outlet in bathroom; inoperable GFCI outlet in bathroom; open ground in first �Z bedroom outlet on left side of wall. /105 CMR 410.481 —Postingof Name of Owner. Owner's name address and telephone p number not posted.* 105 CMR 410.500—Owner's Responsibility to Maintain Structural Elements. Loose floor board observed at deck located adjacent to kitchen. QAOrder letters\Housing violations\Rental ordinance\45 Bridget's Path.doc You are ordered to correct the violations listed above within thirty (30) days of your receipt of this letter by repairing deck so that it is in sound condition; by repairing outlets in bathroom and bedroom so that they are grounded or by replacing with two prong outlets; providing hot running water at a temperature not less then 110°F and not exceeding 130°F. You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the order is served. Non-compliance will result in a fine of$100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. Should you have any questions regarding the above violations, please contact the Town Health Division and ask to speak with the inspector who performed the inspection. PER ORDER OF THE BOARD OF HEALTH 2 Thomas�AMcKean, R.S., CHO Director of Public Health Town of Barnstable Cc: Timothy O'Connell, Health Inspector QAOrder letters\Housing violations\Rental ordinance\45 Bridget's Path.doc Certified Mail#0000 0000 0000 0000 0000 4�t r Town of Barnstable - Regulatory Services ' Thomas F. Geiler, Director Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Jay j IViA i I date �state, 1 I �1 11r J"�j'� NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000 STATE SANITARY CODE II — MINIMUM STANDARDS OF FITN ES S FOR HUMAN HABITATION AND TITS TOWN OF BARNSTABLE CODE CHAPTER 170. The property owned by you located at was inspected (Ad ss) onc=� /c?- 0,07by�� , Health Inspector for the Town (date) (Inspector's name) of Barnstable, (Reason for inspection) The following violation(s) of the State Sanitary Code were observed: State code violation number-violation descr. tion 105 CMR 410. . 105 CMR 410.35-/ 105 CMR 410.351I s r5-j� d r orrr►-► o�. I� �s i cd� off' 105 CMR 410.-qo 1_ —O�dll�Gr's �N i�t4 Am l ye4 ppst��' QAOrder letters\Housing violations\Rental ordinance\template.doc 105 CMR 410. _ The following violation(s) of the Town of Barnstable Code were observed: (Town code violation number-violation description) §170-_ - §170-_- You are directed to correct the violations listed above within 11� ?�) days. (writt # (#) Ydl]'�(�I )(1 (,� �� of your receipt of this notice by W1 ; Igir Ai yi Luc kip �A ti�fy;roam �� HA■ / Y 5O C r Y�r iN r 6 A)() Qj You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the order is served. Non-compliance will result in a fine of $100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. Should you have any questions regarding the above violations, please contact the Town Health Division and ask to speak with the inspector who performed the inspection. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, R.S., CHO Director of Public Health Town of Barnstable Cc: (N4ten/� ner,Fire Dept.,Building Dept....) Cc: 0 (Health inspector's name) (Generic codes located at QAOrder letters\Housing violations\Rental Ordinance\GENERIC CODES.DOC) QAOrder letters\Housing violationsTental ordinance\template.doc A FORM 30 HOBBSB WARREN M THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH CIT�/TOW — a � DEPAR MENT c ADDRESSF � ���` ��•'� ���;C J Sye� ' + TELEPHONE Address `� � _ _Occupant_. Floor Apartment No. ___ No.of Occupants r No. of Ha itable Rooms- No.Sleeping Rooms __— No. dwelling or rooming units I✓ No.Stori s Name and address of owner Remarks Reg. Vio. YARD Out Bld s.: Ferices: Garbage and Rubbish 2_ Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: S 0 Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: Roof Gutters, Drains.- Walls: Foundation: Chimney: BASEMENT Gen.Sanitation: Dampness: Stairs: Lighting: STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: Central ❑ Y ❑ N Equip. Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusing, Grnd.: AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den Livin Room Bedroom 1 ] 1 Wex Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten.,Gas, Oil, Elect.: S tlaQks, FIy es,V t&§kties.- Kitchen Facilities in e Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin, Shower or Tub: Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: General Building Posted Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR.(See Over) "THIS INSPECTION REPORT SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES OF PERJURY." INSPECTOR - TITLE DATE a-- TIME—�LL._ F•M• A.M. THE NEXT SCHEDULED REINSPECTION P.M. 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions, when found to exist in residential premises, shall be deemed conditions which may endanger or impair the heaith, or safety and well-being of a person or persons occupying the premises. This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter 11, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B)and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1) and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof, foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2)and 410.150(A)(3)or any defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the Board of Health. /�CA �' TOWN OF BARNS STABLE LOCATION % 5�' 6rl ��S ��'+'1 SEWAGE # -,-VI.LAGE Cee CND &- ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY n LEACHING FACILITY: (type) a- Y S (size) NO. OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leachin facility) Feet Furnished by j1S�C,UT-10 i 6Lk t� Aq- 33 � r3q- s9 AS- 35 memo COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PRO ON— RE CEIVED P 3 0 202 TOWN OF BARNSTABLE HEALTH DEPT. TITLE 5 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION <� (9 3 Property Address: 45 Bridget's Path Centerville, MA 02632 Owner's Name: Joan Cash Owner's Address: Same Date of Inspection: August 21, 2002 Name of Inspector: (Please Print) James M. Ford Company Name: James M. Ford Mailing Address: P.O. Box 49 Map: 169 Osterville,MA 02655-0049 Parcel: 100 Telephone Number: (508) 862-9400 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ✓ Passes Conditionally Passes NeedS Further Evaluation by the Local Approving Authority Fai Inspector's Signature: Date: August 23, 2002 The system inspector shall sub t a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. r Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 1 I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 45 Bridget's Path Centerville, AM Owner: Joan Cash Date of Inspection: August 21, 2002 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: ✓ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304'exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined",please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 45 Bridget's Path Centerville, MA Owner: Joan Cash Date of Inspection: August 21, 2002 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water . Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 45 Bridget's Path Centerville, AM Owner: Joan Cash Date of Inspection: August 21, 2002 D. System Failure Criteria applicable to all systems: You must indicate either"yes"or`no"to each of the following for all inspections: Yes No i ✓ 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 '/z day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation. ✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ✓ Any portion of a cesspool or privy is within a Zone 1 of a public well. ✓ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ✓ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] No (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gPd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area- IWPA)or a mapped ' Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 1 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 45 Bridget's Path Centerville, AM Owner: Joan Cash Date of Inspection: August 21, 2002 Check if the following have been done: You must indicate"yes"or"no"as to each of the following: Yes No ✓ Pumping information was provided by the owner,occupant,or Board of Health ✓ Were any of the system components pumped out in the previous two weeks ? ✓ _ Has the system received normal flows in the previous two week period? ✓ Have large volumes of water been introduced to the system recently or as part of this inspection ? ✓ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ✓ Was the facility or dwelling inspected for signs of sewage back up? ✓ Was the site inspected for signs of break out? ✓ Were all system components,excluding the SAS, located on site? ✓ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid, depth of sludge and depth of scum ? ✓ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes No ✓ _ Existing information. For example,a plan at the Board of Health. ✓ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)]. 5 Page 6 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM . PART C SYSTEM INFORMATION Property Address: 45 Bridget's Path Centerville, MA Owner: Joan Cash Date of Inspection: August 21, 2002 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 1 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): No [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): 2001 - 75,000 gals.; 2000-83,000 gals. Sump Pump(yes or no): No Last date of occupancy: Currently occupied CO MMERC IAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): Vd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Pumped in 2000-per owner Was system pumped as part of the inspection (yes or no): No If yes, volume pumped: gallons-- How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM ✓ Septic tank, distribution box, soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records, if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: A new pit was added on May 12193-per as built card Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of 1 I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 45 Bridget's Path Centerville, AM Owner: Joan Cash Date of Inspection: August 21, 2002 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron _40 PVC _other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting, evidence of leakage, etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: Approx. 12" Material of construction: ✓ concrete _metal _fiberglass _polyethylene _other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1000 gal. Sludge depth: 1" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 2" Distance from top of scum to top of outlet tee or baffle: 10" Distance from bottom of scum to bottom of outlet tee or baffle: 12" How were dimensions determined: Measuring stick Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): Tees were present. The liquid level was even with the outlet invert. There were no signs of leakage. GREASE TRAP: None (locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 45 Bridget's Path Centerville, MA Owner: Joan Cash Date of Inspection: August 21, 2002 TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches, etc.): DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Even Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): The D-box was level. There were no signs of solids. PUMP CHAMBER: None (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no) Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 Page 9 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 45 Bridget's Path Centerville, MA Owner: Joan Cash Date of Inspection: August 21, 2002 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits,number: 2-6'x 6'(1000 gal.) leaching chambers,number: leaching galleries,number: leaching trenches,number, length: leaching fields,number,dimensions: overflow cesspool,number: Innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.): The newer pit 04)had approximately 2'ofwater on the bottom. The scum line was approximately Y up from the bottom. There were no signs of failure. The bottom to grade was approximately 9. The cover was approximately Y below grade. The old pit was not dug up. CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth -top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.): PRIVY: None (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,etc.): 9 Page 10 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 45 Bridget's Path Centerville, MA Owner: Joan Cash Date of Inspection: August 21, 2002 Map: 169 Parcel: 100 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. A � - a3 " A3� aF a 63- a-9 Aq- 33 3 (3y- SDI �s- 3 5-' y as- 3-7 10 Page 11 of 1 I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 45 Bridget's Path Centerville, AM Owner: Joan Cash Date of Inspection: August 21, 2002 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 25' +/- feet Please indicate (check) all methods used to determine the high ground water elevation: Obtained from system design plans on record- If checked, date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: topographic and water contours maps Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: The bottom of the leach pit to grade was approximately 9. Using the Barnstable topographic map and the Cape Cod Commission water contours maps, the maps were showing approximately 25'+/-to ground water at this site. This report has been prepared and the system inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied, relating to the system, the inspection and/or this report. ]1 i 30.00 No..-- THE COMMONWEALTH OF MASSACHUSETTS APPROVE® BOARD OF HEALTH Barnstable Conservation Department TOWN OF BARNSTABLE Appliration for Dbrip 1 ial Work ®ate Application is hereby made for a Permit to Construct ( ) or RcpairWX)K an Individual Sewage Disposal System at: 45 B r i d e t s j a t h...C e n t e r v i l l e ------- ---------- --------•--------_-------------- ---. ..--•--.._.............. ..... --------•---•----------------•--•-----•------- ........ Location-Address or Lot No. JoanCash -------------------------------............ ....................................•------•-- Owner Address WJ.P Macomber Jr. - ------=-----------------------••-----------. -•--•-••-----••-•------.._.._•---•----...---=------- .............................................. ..... ►•� Installer Address Type of Building Size Lot----________________________Sq. feet U Dwelling X- No. of Bedrooms..........Z------------- _-•------------Expansion Attic ( ) Garbage Grinder ( ) a --_- Showers — Cafeteria a Other—Type of Building ---------------------------- No. of persons---------------------------- ( ) ( ) a+ Other. fixtures ----------_-- --- --------- -------------------------•----------------•-•------ •-- --•--------------------- ----•--------•-•-------------------- d W Destgn Flow............................................gallons per person per day. Total daily flow.............................................gallons. WSeptic Tank—Liquid capacity--------_---gallons Length-_-__--___._.._ Width________________ Diameter---------------- Depth................ x Disposal Trench--No. -------------------- Width----.-..-----..__-._ Total Length.................... Total leaching area....................Sq. ft. 3 Seepage Pit No------------ ------- Diameter.___-.-_--.__:.-__ Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by-------------------------------------------------------------------------- Date........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit----._._...._ Depth to ground water........................ (% Test Pit No. 2_-------------minutes per inch Depth of Test Pit.................... Depth.to ground water......................... Gd --•---------------- ----- - --•------------•----------------•:•-•--•--------•----....,........................................... .......................... O Description of Soil &Sand----------- G ...Te....1. V .......----••••-•--•----•-----------•-•••-----•-••---•---------•--•---••------••------------------------•••.....---------------.• --•-------•--••----••-•-•--------••------......------........-----•---- W •----....•-•---------------•----......--•---••-•--•. •••---------•-----............•---•--•--- ........................................... Nature of Repairs or Alterations—Answer when applicable...-1JJQ---.;alton---leach n �...p- t--. ae_lz.e_d in stone .- Add- n€' to. exlstinr- tangy._ & Pj_t. _-Off distribution._bQ�......................... Agreement-. The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code —The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee issued by the boa d.:of health. 110 Signed . .. ... ` .. .....::°: ...................... .�.41. 3 .o/a�eJ........:...... Application Approved By ... .. ...........................:.............................:.. .•--.--'-'.pie.....:............ Application Disapproved for the following reasons: .................................. • a ...... ................................................... ........................................ Date.......................... ............................................................ . IssuedPermtt No: - • V ��1 Dace TOWN OF BARNSTABLE Teti ATION �S e77�,S /G%/, SEWAGE # VILY.AGE ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY i po LEACHING FACILITY:(type) y 'T (size) c f NO. OF BEDROOMS_ PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: / l v DATE COMPLIANCE ISSUED: 3 VARIANCE GRANTED: Yes No ;/ i i Q a No..-- FlUc A...3 o..00... THE COMMONWEALTH OF MASSACHUSETTS APPPO/ED BOARD OF HEALTH Barnstable Conservation Department TOWN OF BARNSTABLE ) -/_-,-5�j Appliratiou for Diripwial lVor1w Tontitrurtion l itt Date Application is hereby made for a Permit to Construct ( ) or ltcpairX0CX)X an Individual Sewage Disposal System at: 45 Bridgets-path Centerville .... .......... '•----------'--------'-------•----_----- ................................................................................................. Joan Cash Location-Address or.Lot No. ......................_.......................................................................... ----------------•---------'-'------'----•---••--- ......_. Owner Address W J.P.Macomber Jr. lustalIer Address Type of Building Size Lot............................Sq. feet .., Dwelling X-No. of Bedrooms----------2___________________-___--___Expansion Attic ( ) Garbage Grinder ( ) p� Other—Type of Building ............................ No. of persons_________._______.._:__._.._ Showers ( ) — Cafeteria ( ) Other fixtures ------------------------------- - - W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity------------gallons Length________________ Width...._........... Diameter................ Depth................ x Disposal Trench--No_ ____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No..................... Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit-.................... Depth to ground water......................... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth.to ground water........................ ----------------------------------------•----------------------------....----•...._..--------'-----'......................................................... O Description of Soil......Sand & Gravel --------------------------------------------------------------------------------------------------------------•-----............._._.._•-•"-_.. W U ------- ------------------- •------------- .....__..._..--------------------------------------------------- ------------------------ •--------------------------------------- _'------------------•-••-------- W -------- --------------------------------------------------------------------------------'------------------------------------..-....--------'-----------------------..._--..__.._......--"••'------•-- UNature of Repairs or Alterations—Answer when applicable._1-lO J J gal-lO n_--le ac hng---pit--- a,�-}z-e-d ln....stone-.__-Addln.g.. to---existing.- tank---&- Pit.----Off- distribution.-box- ....................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee issued by the oa,d.of health. Signed _.__x...... ......... 5/.11/93.....:...... ...................... Dare ApplicationApproved By ... . ... ...... ..... . .....-.......... .................. ............................................. ................. Application Disapproved for the following reasons: ...... ................... ........................ ....................................................................... ................................................. . ...... .. ... .............. ............-.....--......--- . - ............... .................oa.........-........- Permit No. ...... ... .. /-- --------------- Issued ... Dace $=�30.o0 ................No Fz�s....... ...._............... tr THE COMMONWEALTH OF MASSACHUSETTS 'BOARD OF HEALTH" TOWN OF BARNSTABLE lirttti�n �nr i�; n ul Works Towitrurftun Vvimit Application is hereby made for a Permit to Construct ( ) or RepairX(XX)Y an Individual Sewage Disposal System at: 45 Bridgetspath Centerville ...-•---•-•.................................---.....---••-••---•---•---•----------•---........... --------•-•---•----•---------------------.......--•-•------••-•---••-•••-•-•-••--------••---..... Location-Address or Lot No. Joan Cash WJ.P.Macomber Jr. Owner Address•------------------------------•--------- •-••------•---------•--•-•--------•---•---- Installer Address d Type of Building Size Lot............................Sq. feet a -Dwelling X-No. of Bedrooms..........Z_____________________________-Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons_-.--_--_...___--_________-_ Showers ( ) — Cafeteria ( ) dOther fixtures -----•------------------•-•----•-------•---•-•--•••--.....-----._.....-----...........-- ---.._......--•-----•-----.......----•---........---......... W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity------------gallons Length---------------- Width________________ Diameter---............. Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) 0-4 Percolation Test Results Performed by.......................................................................... Date........................................ 1.4 0.4 Test Pit No. I................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ -••----•......................•---------------•-------------••--•••--..........---••...........----......................................................... 0 Description of Soil.....Sand & Grave 1 W x •------------------------- ------------•---------•---------------...•-----------------•-•-•-•------•---------------.._._.........---•-----------...........-•-•--•-•-....................---•--•..--•••- U Nature of Repairs or Alterations—Answer when applicable._1-1000__.fra1lon---leaching... p t... n0x.k.e_.d in stone. Addim7 to existinv tank & Pit Off--dlstribution•_box..________ _____•__•__• Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. s Signed . .:: --- ------------------------------- ---5 11�93............ j' Dare Application Approved By A_J--- ------7 1�/�/ ........................................----. -..--._.-.....-Dace..................... L" v. a �,�,.......... c. Application Disapproved for the following reasons: . .........................................:............................................................... ------ ---------------- ----------------------- -----------......................................-'.....................I.................. �............r....�....... ..............-Dace.-................ PermitNo. ...�... '`� .....�..:.. .................. Issued ................_.....-pa.e....................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Compliance THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( XX ) by J.P.Macomber Jr. - ........... ................._.........................--......... ......... ------------------------- lnsmllcr at .---.45.- Bridgets Path Centerville ._._....................._.................. ........._. .. .. ... . -- .._................ . ...--........... ............._.................. -- .............. has been installed-in accordance with the provisions of TITLE f T e State Environmental Code as described in the application for Disposal Works Construction Permit No. -_..- .��f . _.1. .. dated __.............._..............._...... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT B CONSTRUEA AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE ................. .-"...�. ----------3....................................... Inspector -..---------................................................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH I TOWN OF BARNSTABLE FEE.... .... .00 Disposal Workii Tlani#rudioan Verntit Permission is hereby granted-----J.P.Macomber Jr. - ------------ ---- ...... Ito Construct ( ) or Repair �'X) an Individual Sewage Disposal System at No.45_.Bridw_ets Path_ CEnt_ erville Street �� 9 as shown on the ar1,icatA for Disposal �'l'orls Construction Pe rt N.......... ...;.............o.. ...,�...v...�'at�d........... . .............�..n._........ .... . ......j. Boad of Heal hDATE ... ..-••••••-•••---------------•-•---- t FORM 36508 HOBBS 6 WARREN,INC..PUBLISHERS LO• ( SEWAGF;dPERMIT N.O. t VILL vE INST,A L R'S NAME S ADDRESS 8 U 11 E R OR �R M—JkAn K z z. DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED { , i � �� ay - o N � � - No.. ....���U FEs...............' -.A- THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH .....!..,-LD.17.............0F... ! �-_.-5 ��l-e..----------------.. ApplirFation for Bhipoii ai Work.5 Tnnitrnrtion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: >j /l /' /� �S 1 7. �O (� 7-- "T�r�- ............/........... ........_�.----•----- e ........�_& cation-Address 1 // /�° G. .-----_--.-... � ... "t/! �' .. rc� d!, ¢teat �,=e!-/-K:•S t N�j ' - Asa.y/.:i.......... Owner — W ... ....... ...... _.... . .............................. a .. Installer Address ,,++ Type of Building Size Lot/Ar ......Sq. feet U Dwelling—No. of Bedrooms.__.. .............................Expansion Attic Ate Garbage Grinder (/0 p, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ............................ W Design Flow.................__.....••_..gallons per person per day. Total daily flow....... ..........................gallons. WSeptic Tank—Liquid capacl!ity/ ?gallons Lengtl��.._.. Width._,b.._..___ Diameter................ Depth..... x Disposal Trench—No. ....../............ Width... ............... Total Length...........v._..... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.. ------- Depth below inlet....-........... Total leaching area.jgqo._..._sq. ft. z Other Distribution box (/) Dosin toy '—' Percolation Test Results Performed by. �- -PeYEA.Y---•-&�:-o--------•----•------ Date__/j2//, ���.... ..... . aTest Pit No. 1.._�.......minutes per inch Depth of Test Pit......_6_........ Depth to ground water...... ................ f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ... - ------- Description of Soil----------- .................................................. ...•---••-•-•••... • ----••-• . •...� •• txj ---------- ---------------------------- ---•-•--------------- •------------- •---------------------------------------------------------- •------------- .... -------------- --------------------------------- W --•••••••-•••--------- ................................................................................................................................................................................. VNature of Repairs or Alterations—Answer when applicable............................................................................................... ................--...........................................---•-----------------•---••---........••••-••--•--••••••----•-•-•-•--•-----•-•....-•-------•••---•-•-•-•••••••-•••••........--•-•-•--••--- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iIT L' 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance hAbenissued brdof health. Date APplication Approved BY --- ......•-•........•••-•--••-•••••-•-------------•----- ... Date Application Disapproved for the following reasons:................................................................................•--. . ---- . ..-------- -----------------------------•---•----------------•------._.....-•--------•-------------------------------•••-•-••-•--••--••-•--•---------•-•--•--••••••. -- -•---- ........ Date PermitNo......- .-II ....................................... Issued_....'............................................... Date 7 Fint -....j ..... No....._.. :... .......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......... ........................................ ... ................... . ..... Appliration for Disposal Works Tonstrurtion runit lication is hereby made for a.Permit to Construct or Repair an Individual S.e'wage,._,.Disposal System at: ................................ ........ ................. t 4.72­� '7 oca ion-Address N AFT-- " -i!�L ........... 2��... , A111 .� /�� -------------- --------------------- .... ..j;ner----------I.......... ---------- ..........A.... IE! . ................................................. ...(Iti........... ....................................................... Installer Address r Type of'Building Size Lot�J_......Oo...............q_q. fW rooms.... e o. o Dwell ing—Nf Bd . / U .......................................Expansion Attic A Garbage Grinder 09 4 PLI Other—Type of Building ............................ No. of persons.________.__.____.__________ Showers Cafeteria Other fixtures ..................................................................I------­*------------------- ---------------- Design Flov�...........%..A_%_�.___________________gallons per person per day. Total 6il/ flow........6. ...............gallons. P4 Septic Tank—Liquid'capacity/421��gallons Lengtl4k. !.... Width___&......... Diameter________________ Depth..... Disposal Trench_No. ....../........... Width Total Length........... Total leaching area_._©.........sq. ft. ...r............... Seepage Pit No..................... Diameter.___..__._...__...._ Depth below inlet......6.............. Total leaching area. ......sq. ft. Z Other Distribution box DosinVa/ak Percolation Test Results Performed ......................... Date./o ....... 7.........*---------- ......ho/...;r. Test Pit No. I...0?.......minutes per inch Depth of Test Pit.......k......... Depth to ground water_._...r......... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_-___________________._. .......... ....... .. ..... ;EE!1_5-------------- .5---- ----I---Ar....... ... --------------------------------------------------------------- -0 Description of Soil............. .... ......:0 4:!!- .............................................. .............................................................. ............. Nature of Repairs or Alterations—Answer when applicable............... ............................................................................... ....................................................................................................................................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T I T ILE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b en issued bfthe-beard of health. Signe .......V ..... . ............................... ................................ Date 4�4 ... ........... ...... Application Approved By....... �A...................... .................................................... ....................................... Date Application Disapproved for he following reasons:......................................................................................................I.......... ........................................................................................................................................................................................................ Date PermitNo....... 19Q...................................... Issued........................................................ Date T�,-,`E--(�6`M MON WEALTH OF MASSACHUSETTS ,fir yam. BOARD OF HEALTH ............. OF.......!P/.................................................................. Tntifiratr tit Coutpliattrr THIS IS TO,CERTIFY, That the Individual Sewage Disposal System constructed (A) or Repaired by--------------1.4r. ............ZA*44 y .............r.......................................................................................................................................... I all 61 1-lu at.................X-P................. .....! ........................................................................... has been instilled in accordance with the provisions of,TITLns------- ----------------i.... *E 5 of The State Sanitary Code as described in the - application for Disposal Works C6 r'uc'tion Permit No'--, ....................... dated-----Zkl.......I................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE__........:' -... . ......................................................... Inspector..................................................................................... • THE COMMONWEALTH OF MASSACHUSETTS ti BOARD OF HEALTH 7,41"L ...................................................... ...........................................OF t No..............41........... FEE........................ Disposal Worko Tyalustrudiatt prrufit � Ix V Permission is hereby granted...........6....6...........I/A........��4L ............................................................................................... to Construct (k) or Repair an Individual Sewage Disspxal S atN&...............4 ........ ...............A ........ ............................................................................................. Street spqs:,.- 7�YIO Dated.._. //7. as shown on.the application for Di"' al�'�fork�IC-oris'iiui�ii6ifl;�-P Permit No..................... ......................... ----------------------------------------------7------------------------------------ ------------------Board of Health DATE........................................................ --------------- FORM 1255 HoBBS & WARREN, INC., PUBLISHERS � J r 4 7`3 t/C -7- 0 _ P y o v�/07 D �/. G'Y✓7.5/I �k 1�e /p r"h�c.� c clislho.1q. z t � .0� 3 r� ✓ �E._5 / chi Al C�vAI_S G-T/bJy/ 7`o �� �4 c• ° � � �A.S.s , r'��/ !//f?O.�,/M E/1/"T"A ,� C,YU .���, i ,r / �� - -�� _ \\- / ( w,. .__.. ',� ..��•-- / .... `�4�.`irk �`�S:-r �- �.;��/, !`./� /Tr,.� ll� � /O0 0 qf'Z Z Pa C17 1 /f ! 14� 'C3 1 0 i // or OF 14.4.y FRANK ' t i FRANK U CONERY a � •�` �. CONERY y o p�No. 6573 fvQ ~ Q� ,Q No. 6232�Q ,'� � � • '�p�, G/STEP \.��, FO/STEP �� S�ONAL E D su �--- © , -- -- -- �, PLAN OF* LAND -- 1N t//4.j, � MASS. E� /pO„n ` , p I OWNED 6r FRANK CONERY S TRENTON ST. HYANNIS. MASS. 02601 RSGISTINUM ancuaum Q LAND.URVw►aR SCALE 1 IN -?0FT. /D f/6/ 7,5