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HomeMy WebLinkAbout0010 JOSIAH'S PATH - Health 10 Josiah's Path West Barnstable A= 109-015-012 r � o i t i 9 1' 4 I 4 r TOWN OF BARNSTABLE LOCATION /Q ` 05)CAh'>yn � SEWAGE# �in5P VILLAGE ASSESSOR'S MAP&PARCEL INSTAtttWS NAME&PHONE NO-�c v'Z� SEPTIC TANK CAPACITY 1506 LEACHING FACILITY:(type) A S)l`YS (size) NO.OF BEDROOMS OWNER'—T'V10 PERMIT DATE: C ATE R Separation.Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility feet Private Water Supply Well and Leaching Facility(if any wells exist on site or within 200 feet of leaching facility) feet Edge of Wetland and Leaching Facility(if any wetlands exist within 300 feet of leaching facility). feet FURNISHED BY Front I t i ! G�ragQ I i 36 23 39 72 , 80 51 I 72 9 I -- ------- - -- -- - - ---4-----� TOWN OF BARNSTABLE LOCATION 1O -J'osja h'5 �L4k SEWAGE# 2013- 313 *ILLAGE W, Gartn54a►SI c- ASSESSOR'S MAP.&PARCEL log - J S'-)?- INSTALLER'S NAME&PHONE NO. B+?S3 Exe-AVoA ion YT)- 04,53 SEPTIC TANK CAPACITY f 000 jqt I LEACHING FACILITY:(type) Trc n c►.c S (size) Z x 3 x t13 NO.OF BEDROOMS y OWNER (3v►uc�' PERMIT DATE: 9.2S- 13 COMPLIANCE DATE: /O•`7 • 13 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 ori' " site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY A) - si - 3S' 8" Az- 2-6 ' i3*Z- 411 A3- L49*4 " 3 y 3. 7 •� u s 0 IAy. 51 , -T,� .oq I - CONSTRUCTION NOTES: 1. WILL BE BUILT IN ACCORDANCE WITH PRESCRIPTIVE RESIDENTIAL WOOD DECK CONSTRUCTION GUIDE. 2. ALL LUMBER SOUTHERN YELLOW PINE P.T.NO.2. 3. ALL 2X10 LUMBER JOISTS. • MAX SPAN:14'-0" • MAX JOIST SPACING:16" • MAX OVERHANG:3'-5" 3. FOOTING SONOTUBE SPACING:6'-6"MAX.WITH DOUBLE 2X10 BEAM. t 4. CONCRETE FOOTINGS. ROUND LARGE POST BASE WITH 12" ` SONOTUBE STEM. 4. 6X6 POSTS W/POST TO BEAM POST CAP ATTACHMENT 5. ALL GALVANIZED HARDWARE. ` v °s61 MAY 1$'16 Pn 3:01 °Q' c9l. , ..., °2i LOWER DECK 14.VX35't p 1669 7 FIRST FLOOR �ryp M� LEVEL DECK yy' W/RAILING 2 14.5'X76'3 �. m 47.5' ` y 9 s 3 rn 7 1 , 46.7' " 9' REMOVE EX. SHED DECK&STEPS ° 28 2' _ 'O JOSIAH'S PATH �l DEDK N O � CRAVEL "A'fM 1 h / GRAVEL r DRIVE Y � _ 9 ga I a \ 9''S�'y. rn� u g 96 9S � •� y�f fps A y m � 40• \ O' � � ' s�vr'� �- NIS \ L=34.661,R=200.000 L=25.996,R=150.000 0 30 SCALE IN FEET m Teh: P.J.. Pr"psnd For. Wsipn By in PROPOSED DECK JmonandMelmieCmsista mr.lerran�aoep,m". 10 Joslah'S Pape Smtalruble Emirvmmerdal 10 JOSIAH'S PATH WWI...roc West Barrstahle,MA 02666 E 10 CAySSISTA �"'ouzsyyns WEST BARNSTABLE,MA 02668 w Design BYJL Orarn I`& eneae JJL sp•apatddm 13 _ �3 . of� Town of Barnstable P# Department of Regulatory.Services -,M-Twa, Public Health Division Date f , * 200 Main Street,Hyannis MA 02601 Am Date Scheduled Fee Pd. ►Oil Suitability ,Assessment fog- Se Di ,po t p Performed By: Witnessed By: I.00AT ON& GENE RAC,][i�T�'ORMATION Location Address /0 /"���f pit Owner's Name (/J, B�Y✓L/J � J/\ Add.. Assessor's Map/Parcel: /Q? s Z Engineer's Name �1J 0 K)-- TR 1.61.,p Q NEW CONSUCTIONe � /// REPAIR Telephone# SQ J 39 Land Use:✓�i S/,C.PiV Slopes ,f1 Surface Stones ff&X4 W 4, Distances from: Open Water Body R possible Wet Area R ft Drinking Water Well / b ft Drainage Way ft Property Line � ft Other �— ft SIM'TCH'(Street name,dimensions of lot,c bt locations of test holes&pere tests,Joe to wetlands I1n proximity to holes) D��351 T D a U' 0101 pnf Parent material(geologic)A"r,(/A`'r G Depth to Batlroe)t �yP Depth to Groundwater. Standing Water in Hole:- N�� ` Weeping from Pit Fnee Q Estimated Seasonal High Groundwater ( L it DETERMIN-4,110N, FOR SEASONAL HICI1`►�ATLI�'I'A�3I,Iia - I Method Used: Depth Observed standingm obs.hole: —i la, Deptil In soil mottles: In,- Depth to weeping from side of obs.hole: In, ©roundwator Adjustment Index Well# Reading Date: Index Well Icval Adj,factor- Adj.Ora utldwtl�t'e vel � �"y Q PERCOLATION T �'ST bate xiva� Observation Hole# Time at 9" _ , Depth of Pere f,` Time at 6" - Start Pre-soak Time @ '1 --� Time(9"-6") � sr"�n End Pre-soak Rate Min./tuck Site Suitability Assessment: Site Passed ✓ Sitq Failed: Additional Testing Needed(Y/N) 7� �• Original: Public Health Division Observation Hole Data To Be Completed on Back---- ***If percolation test is to be conducted within 100' of wetland,you must first notify the. ]Barnstable Conservation Division at least one(I) week prior to beginning. Q:1S EPTICIPERCFORM.DO C DEEP.OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture .Sdil Color Soil- Other Surface(in.) (USDA) (Munsell) Mottling (Structure, Stones;Boulders, lijistengy.%'Gravel) 036—�o c LIS goy yr: ?Z - &6 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (structure,Stones,Boulders. " Consistency,%Grave ]SEEP OBSERVATION ROLE LOG Hole#. Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. o f to c p e ----------------- DEEP OBSERVATION HOLE LOG. Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders, ConslmoqmI Gruel) Flood insurance Date Map: e Above 500 year flood boundary No— Yes Within 500 year boundary No Yes Within 100 year flood boundary No._ Yes _ Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious tntiterial exist in all areas obstrved throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pervious material? Ceftiiication 1 certify that on � (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required training,exper'se and experience described in�10 CMR 15.017. Signature Datb QAS.FPT1al?FRCPORM.D0C ® Complete items 1,2,and 3.Also complete A. S' ure I item 4 if Restricted Delivery is desired. ❑Agent ■ Print your name and address on the reverse 1:1 Addressee so that we can return the card to you. B. Receiv y(Printed Name) C. Dat of livery ® Attach this card to the back of the.mailpiece, I or on the front if space permits. I D. Is delivery address different from item V) Ns 1. Article Addressed to: If YES,enter delivery address below: ❑No I Mr. & Mrs. Thomas M Bauer 10 Josiah's Path I I West Barnstable, MA 02668 3. Service Type ❑Certified Mail ❑Express Mail ❑Registered ❑Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number (Transfer from service labeo ;i?12 ;1010 '0 0 0 0�'2 8 5 0 �9 91,0�r PS Form 3811,February 2004. Domestic Return Receipt 102595-02-M-1540- U,NITED,STATES PbsTAt SERVICE First-Class Mail E Postage&Feet Paid USPs Permit No;G-10 I Sender: Please print your name, address, and ZIP+4 in this box • I I I I Town of Barnstable I Public Health Division 200 Main Street Hyannis, MA 02601 I _ i I I�iIN!' ll1i!!'1l dill,iJill""'f'!Il�1'!!P't1lli'1111411'!ll a .. Cr Ir F' •Ez:., COUI Postage $ fL Certified Fee MA Q,) C7 � Postma O 60 Return Fee Here I Q (Endorsement Required) M Restricted Delivery Fee QO (Endorsement Required) = SG C3 Total Postage&Fees ru C3 Mr. & Mrs. Thomas M Bauer 10 Josiah's Path West Barnstable, MA 02668 Certified Mail Provides a A mailing receipt a A unique identifier for your mailpiece o 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 Maile. o Certified Mail is notavailable for any class of international mail. a NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. o For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for, a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required. F�_ o For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". e 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.-- I; IMPORTANT: Save this receipt and present it when making an inquiry. ;� PS Form 3800,August 2006(Reverse)PSN 7530.02-000-9047 Town of Barnstable Barnstable ��s�Teti Regulatory Services Department edea�i KAM aawvsrnst.s, 11 A,�� Public Health Division 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL #7012 1010 0000 2850 9910 September 3, 2013 Mr. & Mrs. Thomas M Bauer 10 Josiah's Path West Barnstable, MA 02668 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 10 Josiah's Path, West Barnstable, MA was last inspected on 8/01/2013, by Matthew Gilfoy, a certified septic inspector for the state of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the following: • Septic system is in hydraulic failure. You are ordered to repair or replace the septic system within sixty (60) days 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 E BOARD OF HEALTH l Thomas McKean, R.S. CHO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\10 Josiah's.Path W.Barn Aug 2013.doc I Parcel Detail http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=6176 7 77- ' F44 w 1 taut'STMILE .I «V Logged In As: T _ Parcel Detail Monday, August 26 2013 Parcel Lookup Parcel Info _. ......... ..............- Par Iel 1109-015-012 ) Developer LOT 10 ) D Lot Location(1 JO OSIAH'S PATH Pri Frontage Sec• __� ___.. ____� _--- - ---__ - _ Sec Road Frontage Fire ___� .._....__ Village iWEST BARNSTABLE District W BARNSTABLE Town sewer exists at this Road address!No Index 2191 Asbuilt Septic Scan: Interactive '�� ' 109015012 1 Owner Info �__ _ _.m ___ _ ) Co- Own e r[BAUER,THOMAS M&MARY K Owner Streets i10 JOSIAH'S PATH — — I Street2 __ v City,WEST BARNSTABLE State IMA Zip 0266 Country Land Info Acres#1.0 Use SingleFam MDL-01 Zoning RF Nghbd 010�� Topography Level Road Paved __ Utilities Location _ Construction Info ..... Building 1 of 1 Year Roofer __� ! Ext mm I Built 1991 Struct I"ablelHip 1 Wall Wood Shingle Living Roof _, _ AC i,._.___ �2245 __ fAsph/F Gls./Cmp ( None Area Cover Type �.�_— a�F . s ii Style Colonial _ 1 Wall Drywall RoomInt s[4 Bedrooms Model Residential Floor I`=arpet T Rooms 13 Full mm2.5 Y ¢ In t 1Bath Grade Average + Type Hot Water Rooms Rooms P s, Stories 2 Stories Heat Gas Found-IPoured Conc._ _ as Fuel ation Gross http://issg12/intranet/propdata[ParcelDetaii.aspx?ID=6176 8/26/2013 1 i ,� 4 � � `' _ - __ J Commonwealth .&Massachusetts Title 5 Official Inspec ion Form - Subsurface Sewage Disposal System Form Not for Voluntary Assessments �M 10 Josiahs Path Property Address Thomas Bauer Owner Owner's Name information i e required for every. W. Barnstable Ma 02668 8-1.-13 Rage - City/Town- - - - State Zip Code - Date ofinspection -- 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 A. General Information .filling out forms on the computer, use only the tab n key to move your 1. Inspector. cursor-do not... Matthew Gilfoy use the return Name of Inspector key. B & B Excavation,ine. reb Company Name 14 Teaberry Lane Company Address.. Forestdale MA 02644 City/Town State Zip Code 508-477-0653 $113640 Telephone Number License.Number B. Certification 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 15000). Thesystem: ❑ Passes. ❑ Conditionally Passes ® Fails Needs Further Evaluation by the Local Approving:Authority 8-1-13 - 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 is a shared system or has a design rfloW 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. : : .. � L ell ,3 t5ins•11/10: Title 5 Official Inspection Form:Suti ulrface Sewage Disposal System _Page 1 of 17 I i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 10 Josiahs Path Property Address Thomas Bauer Owner Owner's Name information is required for every W. Barnstable Ma 02668 8-1-13 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): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 10 Josiahs Path Property Address Thomas Bauer Owner Owner's Name information is required for every W. Barnstable Ma 02668 8-1-13 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °w 10 Josiahs Path M Property Address Thomas Bauer Owner Owner's Name information is required for every W. Barnstable Ma 02668 8-1-13 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: 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 Y day flow t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 f Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4M 10 Josiahs Path Property Address Thomas Bauer Owner Owner's Name information is required for every W. Barnstable Ma 02668 8-1-13 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 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•11/10 Title 5 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 10 Josiahs Path Property Address Thomas Bauer ..Owner Owner's Name information is W. Barnstable Ma 02668 8-1-13 required for every_ page: City/Town State Zip Code Date ofInspectiorr C. Checklist Check if:the following have been done. You must indicate":yes" or"no"as to each of the following Yes No El ® 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? El 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 E El 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.); 3 -_ DESIGN flow based.on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 440 t5ins•11/10.._ Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 10 Josiahs Path Property Address Thomas Bauer Owner Owner's Name information is required for every W. Barnstable Ma 02668 8-1-13 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 3 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ® Yes ❑ No Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage see below 9 ( Y 9 (gPd))� Detail: well Sump pump? ❑ Yes ® No Last date of occupancy: currentDate 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 10 Josiahs Path Property Address Thomas Bauer Owner Owner's Name information is required for every W. Barnstable Ma 02668 8-1-13 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: Was system pumped as part of the inspection? ❑ Yes ❑ No If es, volume I ume pumped:y p p 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-11/10 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 °M 10 Josiahs Path Property Address Thomas Bauer Owner Owner's Name information is required for every W. Barnstable Ma 02668 8-1-13 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: 1991 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 2' Depth below grade: feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: 165 from well feet Comments(on condition of joints, venting, evidence of leakage, etc.): At time of inspection building sewer appeared to be in working order no sign of leakage or blockage. Septic Tank(locate on site plan): Depth below grade: 2 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: 1250 Sludge depth: 411 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 10 Josiahs Path Property Address Thomas Bauer Owner Owner's Name information is required for every W. Barnstable Ma 02668 8-1-13 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 32" Scum thickness 2 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 15" How were dimensions determined? scour stick i Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): At time of inspection septic tank appears to be structurally sound. 1250 gallon per plan at BOH 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-11/10 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 10 Josiahs Path Property Address Thomas Bauer Owner Owner's Name information is required for every W. Barnstable Ma 02668 8-1-13 page. CitylTown 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 10 Josiahs Path Property Address Thomas Bauer Owner Owner's Name information is required for every W. Barnstable Ma 02668 8-1-13 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 above invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box in poor condition with staining due to clogged 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.): Soil Absorption System (SAS)(locate on site plan, excavation not required): i If SAS not located, explain why: I t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 10 Josiahs Path Property Address Thomas Bauer Owner Owner's Name information is required for every W. Barnstable Ma 02668 8-1-13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 2 ❑ leaching chambers number: ❑ Teaching 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.): At time of inspection leaching backed up due system being in hydraulic failure. 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 10 Josiahs Path Property Address Thomas Bauer Owner Owner's Name information is required for every W. Barnstable Ma 02668 8-1-13 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-11/10 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of.Massachusetts p Title 5 Official Inspection Form Subsurface Sewage:Disposal System Form Not for Voluntary Assessments 10 Josiahs Path Property Address Thomas Bauer Owner Owner's Name information i e required for every W Barnstable Ma 02668 8-1-13 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 n o nt rr u i t - ' • r't L'zti, tiff t•k f•; t .1' r ti rr,• 1,X,o 4 s t:X. : 23. 72 , t5ins•11/10 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 15 of 17 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 10 Josiahs Path Property Address Thomas Bauer Owner Owner's Name information is required for every W. Barnstable Ma 02668 8-1-13 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: no gw @ 15' 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: 5-28-91Date ❑ 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: plan on file @ BOH Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 10 Josiahs Path Property Address Thomas Bauer Owner Owner's Name information is required for every W. Barnstable Ma 02668 8-1-13 page. City/Town 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 �fQI� No. C.� .s fi Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Application for Mispo8AY 6pstem Construttiun Vrrmit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑ lete System ❑Individual Components Locatio Address LLot No. jV T06 FL5�4-�Fe_. Owner's Name,Address,and Tel.No. As�br'�sMap7P�arcel -/ 4 101 pbrce! /S-!2_ ��m G41�P� SD8 317- D(08v Installer' N e,Address,and Tel.No. Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.Uli(e red) 140 gpd Design flow provided gpd Plan Date 13 Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date 9— Z4_13 Application Approved by Date Application Disapproved bK Date for the following reasons Permit No. Zo(7j " 3-13 Date Issued I ZS 17013 9 ' No. � Fee (w ' THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: d Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS r Rpplitation for Disposal 6pstem Construction 3permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Lo�� ,dress r Lot No. 0 �U5 10 h5—Pell h Owner's Name,Address,and Tel.No. T �f -� Tv rrt / �vet _5o g -3 17- U h8 0 Assessor's Map/Parcel /�G� 11.1 9 l n r! ( !S-12► Inser�tt J�ler'�.,N e,Address,and Tel.No. Designer's Name,Address,and Tel.No.% 7" rr � C �vre tci Lz �i 5o�'3tm2• ysy�� Type of Building: Dwelling No.of Bedrooms / Lot Size : sq.ft. Garbage Grinder( ") Other Type of Building No.of Personsh Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) Ll 4 6; gpd Design flow provided �i 2 gpd Plan Date ///0 11 Number of sheets , Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil i Nature of Repairs or Alterations(Answer when applicable) i Date last inspected: Agreement: j The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board ofiffealth. Signed a Date 2-H Application Approved by t< Date 2� /Z1_0 13 Application Disapproved + Date for the following reasons i i Permit No. Zp i-5 Date Issued 7 1Z.5 Zip 13 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired Upgraded( ) Abandoned( )by 1;1 B �%( n U01 I U n at 10 -It) i n h 5 —Pn I h has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit NoZ��7 dated Zh ZO►3 Installer ��(���(�, j t 1 L t(J �( Designer �(�(�(� ;1 _�Q, •t'i(� 1 d 1 f'U A l C1 #bedrooms Approved ign fl �{ t l U J gpd The issuance of thi perm t shall not be construed as a guarantee that the system ill f ion as des' ned. Date 77111Inspector No. ..0 f5 373 Fee , THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS ]Disposal 6pstem Construction J)ermit Permission is hereby granted t nstruct Repair( ) (Upgrade( ) Abandon( ) System located at v-)h c) t'c and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Co struction must be completed within three years of the date of this permi. Date 0 1�2 Approved by 1 FROM :down cape engineering',inc FAX NO. :15083629860 Oct. 08 2013 09:09AM Pl 13 -1�3 ic,keuuiator S, ry es t ffil Tlhomm F. Gell.err, Directur ka gli, Ue-alih Divisioll Tharrus McKnla, Director 200 rVL,&n Street,HyalmlMis,M.A.02601 Officz: 308-362 4611 Fax: 5OR-790-6304 C art Mile at klu,1,41 qrTl Date: penn.10 12- t f AM ly ga, was issiled a permit to lnulaE a �J0110-44 ba3i-ci Q-P.a duSiga dfS-WDl0Y ....... ..... (address) 10, I certify th'all thu so-otir P'Y" 1.l(f Otm t9bove -yvas instalted sublLant:Aqlly according to IlL Y ciclude minor�ippioved ;,-s lateral r(Aocati.nr.of the Ast.fibubou box )IlcU(jT sc,-,pj'.jr,t.Fj.'n.k,. I cel'zily 1-n-1 the suptl:-, system. -ruFtxuxud 'above -,var, with major r.holage.4 greatu than iG' [,,lteml rcdonsfao.of the SAS'uy a-ay ve,.itical relomior.of any compou.tut JOLI OT cx!,&fierl Eis,U Jt by-dc.slpej.,to follow-. K OF MA DANIELA. OJALA u CIVIL 40 No,46502 �SslONAL 1 Otto (A.ex -T pgAgy, j.3AT .E OF IL35-1 TUP TBJS FoPdq AN') AS-11RUILL ,-AE.TJ �:EU r17L M ENTIL 1!11011'ff -K coil �WiU—INOTJKZ 1, TKU, OU. L. , ULLH F04STABL.R,PUBLItC�M QW1,3101S. 'RR(M'VE A.)�W —A ? 3.26 04.cicr. Date:./ l 15 I zV I TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: BUSINESS LOCATION: INVENTORY MAILING ADDRESS: AQ Drap TOTAL AMOUNT- MAILING ��� t� �,,� T� j��, TELEPHONE NUMBER: !!Fag- gg -7�-�, CONTACT PERSON: „�,,`k EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: INFORMATION/RECOMMENDATIONS: Fire District: I Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The board of health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene,#2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal Printing ink Degreasers for driveways &garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's Paints, varnishes, stains, dyes c�/ acZl Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform, formaldehyde, Paint&varnish removers, deglossers k ctzl hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes Laundry soil &stain removers (including bleach) Spot removers &cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initials ' Commonwealth of Massachusetts a Title 5 Official Inspection Form "s Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ' 10 Josiah's Path Property Address I Tom Bauer l Owner Owner's Name information is West Barnstable MA 02668 April 24, 2008 required for State Zip Code Date of Inspection every page. City/Town Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important: A. General Information When filling out forms on the computer,use 1. Inspector: only the tab key to move your Patrick M. O'Connell cursor-do not Name of Inspector use the return key. Septic Inspection Services Co. Company Name 189 Cammett Road Company Address Marstons Mills MA 02648 nrtn Citylrown State Zip Code 508-428-1779 S1 12855 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 f � I \ P April 24, 2008 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 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. 08-102 Bauer.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page I of 15 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 10 Josiah's Path Property Address Tom Bauer Owner Owner's Name information is West Barnstable MA 02668 April 24, 2008 required for 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: ® 1 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: Recommend pumping tank. One leaching pit was found half full with no definite high stain lines, other leaching pit was under brush pile. 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: µ ❑ 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 08-102 aauer.doc-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 f Commonwealth of Massachusetts 'VTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ol` 10 Josiah's Path Property Address Tom Bauer Owner Owner's Name information is West Barnstable MA 02668 April 24, 2008 required for every page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ 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: 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. 08-102 Bauer.doc•08/06 Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 10 Josiah's Path Property Address Tom Bauer Owner Owner's Name information is required for West Barnstable MA 02668 April 24, 2008 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ 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 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 El ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than_day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. 08-102 Bauer.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 10 Josiah's Path Property Address Tom Bauer Owner Owner's Name information is West Barnstable MA 02668 April 24 2008 required for State Zip Code Date of Inspection every page. Cityrrown B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. El ® 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 El ❑ 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. 08-102 Sauer.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 5 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 10 Josiah's Path Property Address Tom Bauer Owner Owner's Name information is West Barnstable MA 02668 April 24, 2008 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 El ® this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as NIA) ® ❑ 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)] 08-102 Bauer.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 15 Commonwealth of Massachusetts Aim. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments "f 10 Josiah's Path Property Address Tom Bauer Owner Owner's Name information is West Barnstable MA 02668 April 24, 2008 required for every page. Cityrrown State Zip Code Date of Inspection 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 Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No N/A well water Water meter readings, if available (last 2 years usage (gpd)): Sump pump? ❑ Yes ® No Currently Last date of occupancy: Occupied 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: Last date of occupancy/use: Date Other(describe): 08-102 Bauer.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 10 Josiah's Path Property Address Tom Bauer Owner Owner's Name information is West Barnstable MA 02668 April 24, 2008 required for every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Tank pumped 4 years ago. 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: 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: Com liance date: 12/18/91 Were sewage odors detected when arriving at the site? 0- Yes ® No 08-102 Bauer.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments '( 10 Josiah's Path Property Address Tom Bauer Owner Owner's Name information is West Barnstable MA 02668 April 24, 2008 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): 2' Depth below grade: feet 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.): Septic Tank(locate on site plan): 2' Depth below grade: 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 ---------------------------------------------------------------------------------------------------- 10.5' long x 5.8'wide- 1500 gal. Dimensions: 5" Sludge depth: 28" Distance from top of sludge to bottom of outlet tee or baffle 4° Scum thickness 611 Distance from top of scum to top of outlet tee or baffle 9„ Distance from bottom of scum to bottom of outlet tee or baffle Measured How were dimensions determined? 08-102 Bauer.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts 4 Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 10 Josiah's Path Property Address Tom Bauer Owner Owner's Name information is West Barnstable MA 02668 April 24, 2008 required for State Zip Code Date of Inspection every page. Citylrown 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.): Liquid level was found at bottom of outlet invert, tees are intact Tank shows no evidence of backup. i 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.): 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): 08-102 Bauer.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 10 Josiah's Path Property Address Tom Bauer Owner Owner's Name information is west Barnstable MA 02668 April 24., 2008 required for every page. City/town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cont.) 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 I cate on site plan): Distribution Box(if present must be opened) (o p ) Depth of liquid level above outlet invert 0" Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 08-102 Bauer.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 10 Josiah's Path Property Address Tom Bauer Owner Owner's Name information is required for West Barnstable MA 02668 April 24, 2008 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: Two 6x6 pits. ❑ 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.): Leaching pit#1 was half full at time of inspection with no definite high stains, pit has sufficient effective leaching to pass inspection. Pit#2 was located under brush pile.and was not opened. 08-102 Bauer.doa-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts 4 Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 10 Josiah's Path Property Address Tom Bauer Owner Owner's Name information is west Barnstable MA 02668 April 24, 2008 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 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.): ` Q 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.): 08-102 Bauer.doc•08l06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 Commonwealth of Massachusetts : Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 10 Josiah's Path Property Address Tom Bauer Owner Owner's Name information is required for West Barnstable MA 02668 April 24, 2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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. Front Rot 36 23 3 72 80 51 72 9 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 10 Josiah's Path Property Address Tom Bauer Owner Owner's Name information is west Barnstable MA 02668 April 24, 2008 required for State Zip Code Date of Inspection every page. City/Town D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells 30 Estimated depth to ground water: 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: 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: USGS topo map and town GIS. You must describe how you established the high ground water elevation: Town groundwater contour map shows water at el 35 and topo map shows property above el. 100. 08-102 Bauer.doc-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 15 Town of Barnstable OF tHE l� Regulatory Services HARNSPAHLE. : Thomas F. Geiler,Director MASS. E 639n. � Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 REGARDING SEPTIC INSPECTIONS BY PRIVATE CONTRACTORS DISCLAIMER This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original or copy of the report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observations and interpretations contained within this report. In addition, by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a . particular property would be listed on the "Disposal Works Construction Permit". If you should have any questions regarding this report, please contact the certified .Septic System Inspector who conducted the inspection. QASEPTIC\Disclaimer Private Septic Inspections.DOC N Q �TOrWN OF BARNSTABLE f" LOXATION I' SEWAGE # l09'015-a5, VILLAGE SSOR'S MAP & LOT ' CARE LAMPI INSTALLER'S NAME & PHONE NO. 319 Cedar Stra:4 —05T garnif577,,,:,r, 74,--'7w SEPTIC TANK-CAPACITY /<V I> LEACHING FACILITY:(type) (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER� BUILDER OR OWNER DATE PERMIT ISSUED: yw DATE COMPLIANCE ISSUE : VARIANCE GRANTED: Yes No TAIV gd D-T3ox a 3 'Oo err tv ♦! AF4'f .� ..� { • i 1w.4 mot AL ' �'- •t . +•�.{.f.- `y�.t �'. �.r �.u.?%;'tR3,ty +� +r-�v'a' may• d�l/r/ 1S •Tj'�' .Ii�� :.tF y_ '� � �y^ w.1 j0q,oS No...I.i.......3J1 THE COMMONWEALTH ormAesAc*ussrrs U���� ��K� ���� HEALTH ���~��" ~�~ ��" TOWN OF BARNSTABLE Application is hereby made for u Permit to Construct (Vor Repair ( \ an Individual Sewage Z)is000u System at: --------------------------------------------------------------------------------- Address No. '-'------------- -----'--- ----------------------'---'--'-'-----'--'--'-'---- ~� / �J�- ��«�� --------�_�����.c-- '��1.'-------------- ---------------__--________________^______________ s"^, Address Type cf Building Size Lot...........................Sq. feet Dwell'ng—No. of Bedroomo-----'. -------'-----ExnunsiuoAttic (xo Garbage Grinder ( \ (}ther--Tvnmof No. ofycsoua----iC-__-- 56owero (Z) -- Cufcteria ( ) � Other c fixtures ^� ..................................................................................................................................................... Flow........ ..........................gallons per person per day. Total daily flow--------................................... . 5codc Tank—Liquid -cubma Length................ Width................ Diameter................ Depth................ Trench--No. .................... ....... Total Length.................... Total leaching area-----'--'--sq. 8. Seepage Pit No..-c;�----. Dianucor..6K3.--.. Depth bclmvioloc---------' Iota leaching area..................sq. ft. � Z Other Distribution box / ) Dosing tank ( ) � ~~ Percolation Test Results Performed by.......................................................................... Date........................................ 1.4 Test Pit No. l................minutes per inch Depth of Test Pit.................... Depth to ground water---_.---,- 44 Test Pit No. 3................minutes per inch Depth of.Test Pit.................... Depth to ground wuccr--_..'-----.. -_ .--'_-.-_'---'-_---- ......................................................... `' Description c6 Soil................................. ----------------_---_-_----..----...------------ __-.-'----'---...'__---'_------'__.__'---__----._--.----__-._-----_-''-_-_------------------.. � �4 .---------.-----'---.----_'-_---.-.----__-.__'_----.--'-_'-_'-_-'-'-.--'--__'--------- � U Nature of Repairs or Alterations--Answer when applicable........................................ ...................................................... ....................................................................................................................................................................................................... � Agccroeuz: The undersigned ' rcco no iuoruU the u6orcdeocrUbe6 Individual Sewage Disposal 8vsocoo in accordance with the provisions of TITLE 5 of the State Environmental Code The undersigned further agrees not to o6cc the .a_ "�i loq,oig lJ ~ Ficz THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH , TOWN OF BARNSTABLE Appliration for Uigpuiial Workii Tomitrnrtinn r-Writ Application is hereby made for a Permit to Construct (V or Repair ( ) an Individual Sewage Disposal System at: ...�,�•T -� - .�.O��A.�l ..?'ai:......., 'V ...---•---•------...--••--•...-••-•...---- Location-Address or Lot No. ......1 0 VYLI-ICAr�---zsu al........-••-•...................................... _.........-----------...-------------•-----•-------•--•--•--•-----.............••---............. Owner Address W } !.r�. ..- 1I ' Typeof Building .............................................................................................. � Installer, Address U // Size Lot............................Sq. feet Dwelling—No. of Bedrooms___..._._.__7.............................Expansion Attic (,tfo) Garbage Grinder ( ) Other—T e of Buildin �: rs.R.___. No. of ersons___.___._. ._ a —Type g ------- - -- p S.______________ Showers ( Z) — Cafeteria ( ) Otherfixtures d ----------------------------------------------------•----- -•---•---•--. W Design Flow......... ..........................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity/.SVO...gallons Length................ Width................ Diameter__-_-__--___-_- Depth.............. x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area............_.......sq. ft. Seepage Pit.No...�......_.__.. Diameter._.(oXk---_--- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) . . Percolation Test Results Performed by.......................................................................... Date........................................ W Test Pit No. I----------------minutes per inch Depth of Test Pit.................... Depth to ground water........................ fr4 Test Pit No. 2........:.......minutes per inch Depth of Test Pit.................... Depth to ground water........................ a -•-•------••-••--••---------------•-.----•...-•-----•-•------•------•••---------•----------•--••-................-•-------•-----..............-----••-------- rDescription of Soil ... ---------p--- ;Z_.f� x---------------------------------•------------------------------------------------•--------------- U ---•--•---•--•----•---------••----•--•-------••-•---•------------•--------•-••-•------•---....-----•-••---••••-••----••---••-------------•••-•------•--••-•----••-•-------......---•-----•---------•--•- W xi--------------------------------------------------------------------------------------------------------------•----------------•----.---- V Nature of Repairs or Alterations ' Answer when applicable.............................................................................t..........__..... •---------------------------•-----------•--•---------------•------------------------------......-----------...----------------------------------------------------------------------..............---•• 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„'l�een ' s y j, ' board of h6alth. Signed .. E -- '= Application Approved By .. . ---- - .... . J Dare !!! Application Disapproved for the following reasons: .............................................. ........ .... ... ........... - -------------------------------- i t Permit No. .............? Issued ...-------- ! ............... ..........Dare Dare THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE C�ex#tftra e of Q.10mylian.ce THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by-------------................................... ja� tg at v �E r 7,` . ,, V-V--O !` . ........ ----. /. ............... ...... has been installed in accordance with the provision3-ti, LE Whil Environmental Code as described in the application for Disposal Works Construction Permit No. .. ............. dated ................................................ THE ISSUANCE OF THIS C TIFICATE SHALL NOT BE CONSTRUED AS A GUARA TEE THAT THE SYSTEM WILL FUNCTION SATIS ACT PRY. DATE ---------�.- -� F}�.. Inspector ............. ... ....... -�----- ------------ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH / TOWN OF BARNSTABLE 9f FEE.... ........... t Raposal Workii 01.11.11nitr ion ermit .. . Permission 's hereby granted.............................................................................................................................................. to Construct ( or Repair �S Jv�T a Di a stemLe st et as shown on the application for D-sposal forks Construction _NoDat �d --, .--..� ► Boa Z.rd of He..ht DATE. .... =---- ------ ---- I FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS �1----No Fee---- -' -------- BOARD OF HEALTH TOWN OF BARNSTABLE Appritation-ftlVell Con5truttionVermit Appl'c�ation is ereby m de for a permit to Construct (x), Alter ( ), or Repair ( , )an individual Well at: Location — Address Assessors Map and P4rcel Owner f Address Installer — 1 r Address Type of Building �-�, Dwelling--- ----------------------------------------------- Other - Type of Building—--------------------------— No. of Persons---------___________ Type of Well-Z__ _v ____ ____ Capacity----______ Purpose of Well - — - �� - Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until a Certificate of Complianc as been issued by the Board of Health. Signed - — --( �— Application,Approved By--- -- ar--- --- -¢ -Q-^--11Z — --— date Application Disapproved for the following reasons:,--------- ------_______________________________.___ t date —-- Permit No.-—--- —----- —--- —_- _------- Issued-- - -- ----- — _ ___ -- date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of comphante THIS IS TO CERTIFY, That the Individual Well Constructed ()4), Altered ( ), or Repaired ( ) Installer -- at--- - - /-_ ------ !_ ___,C-c - ---- ---- ---------- -- — —- -- - has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. Mom /= - -Dated-------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT,BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE-------------------------—-------------- - - Inspector----- —___---- -__ -_—_--- - - No.- --- --- Fee—'!--a 'C7; BOARD OF HEALTH A TOWN OF BARNSTABLE r Application-*rVell Cootruct ion Permit Application is hereby m de for a permit-,to Construct ((y), Alter{ ), or Repair ( )an individual Well at: h ------ -407LId -- - --------- Location - Address Assessors Map and P rcel Owner Address - t /, Address Type of Building Dwelling ------------------------------------- Other - Type of Building-----------------_______ No. of Persons--____—______________---�_____ r _ _ _ +� Type'of Well---- t� �� Capacity-------------------- ------------__ _ �_—___ Purpose of -------- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until a Certificate of Complianc has been issued by the Board of Health. /o Signed=' 7 � J�-- — — — - _----_— 41 — Application Approved By-------- - -._.._,.... _ �_ ^-^ ------------- __ 1 -- date Application Disapproved for the following reasons:----------------------------------------- ------ --- -----------------_ --_ - -----___--_-- date r' — Permit No.- — —_ _ —- - - -------- Issued-------------------- --_____— - -------- - date BOARD OF HEALTH TOWN OF BARNSTABLE (Certificate (Of Compliance THIS IS TO CERTIFY, That the Individual Well Constructed (}<), Altered ( ), or Repaired ( ) ---= InstallerJ at has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. �'- --�-----Dated-------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE-- — ---------- - ----- ——- - Inspector--- - ------—-- =- — ____—--- BOARD OF HEALTH TOWN OF BARNSTABLE Vell �Con�tructionermit No. --- �-=-- Fee Permission is hereby granted- - - ----1 = - 'n -"^-^--------- - to Construct (�, Alter ( ), or Repair (� ) an Individualell at: me - NO. -----�-�'--f�-�------�--^c-------r'�------------- -—�---Street --------------------------------- as shown on the application for a Well Construction Permit No.------------------------------------------------------------------------------------- Dated------------------------------------------------------------------------------ DATE of Health --------��----!--f�---��___--________�_�__ r < a � t xn tt t t tt tt IN ��,,i*.?TT(1::T::?Ti::Si:T:T::Tt::?TT??SSt�SnttTTT xtStrrrtntrxmnrnmrrrnr+rnt+rrtrrtr+rnxrnnx1.t nnrm tr+nnnnrxrt+rr+nr+rrnrrrrrnrarnnrr+nrrr mnn n tru xrrnr xnrtnn nfi jx�r+nn�:r rrtrnmxtr r_ _ ENVIROTECH LABORATORIES =3 _ Mass. Cert.#:MA063 449 Route 130 Sandwich,MA 02563 • (508) 888-6460 E. CLIENT: Mary Bower _ LOCATION: Lot 10 Joshua's Path ADDRESS: _ — W. Barnstable, MA COLLECTED BY: All Cape Well SAMPLE DATE: 6/20/91 TIME: 3 PP1 _ DATE RECEIVED: 6/21/91 SAMPLE ID: ET 734 New Well 102/50 = JOB �: WELL DEPTH: _ RESULTS OF ANALYSIS:. Parameter Units Recommended limit Result - e� s Coliform bacteria/100 ml (MF Method) 0 0 PH pH units 6.72 Conductance- umhos;cm 500 226 Sodium mg-L 20.0 r 33.3 a Nitrate-N mg/L 10.0 0.06 - Iron - mg/L --- 0.3 - <0.05 - - Manganese mg/L 0.05 ~_ Hardness mg/L as CaCO 500 r: 3 — Es Sulfate mg/L 250 Potassium mg/L 20.0 Alkalinity mg/L 200 = Chloride ma/L 250 Turbidity NTU 5.0 c t= Y Color APC units 15.0 c Background bacteria 3 COMMENT: Sodium level is not a health hazard. E E YES NO WATER IS SUITABLE FOR DRINKING PURPOSES FOR PARAMETER,)TESTED. M(X El DATE` , �iiillillll!!l!ll1lU1l11llUUllllUllI111U1t1111U111,UUllullUltUllUliIli lililllis,lists,!!(lulls,{111111)silliltiiiiilitiiilillilll{illii{iii{1{{i{liiii{ii illliil{is,iiiiI{ii{{ilL++{llt+utl1t111+rU+UiiilliiillIiiiilliiliiilliill+ll� `�`l+lnr nprtttmlllttrrtnttlpttnrtrrrnt+tntn+t+n+++++tnnnnnttrn+r tnrntrrrnnnttr+trmtttnttnttr+srtrr+ttnn+nntnnntnmtntttn+nttnttnttnt+rt ntttv mttttra. .....rn+tt nnmrn r +t+m ' ENVIROTECH LABORATORIES _= Mass. Cert. #:MA063 rn 449 Route 130 Sandwich,MA 02563 (508) 888-6460 CLIENT: Mary Boger LOCATION: Lot 10 Joshua's Path ADDRESS: ----- - W. Barnstable, .111A _ COLLECTED BY: All Cape Well SAMPLE DATE: , 7/8/91 TIME: _ S. Harrington DATE RECEIVED: 778191 SAMPLE ID: ET .734 . JOB — WELL DEPTH: RESULTS OF ANALYSIS: _ Parameter Ur:it_ Recommended limit Result CoNorm bacteria;"100 ,ml ,MF Method) 0 - z PH pH units - -- -—...6.0-8 5 - _ Conductance umhos cm 500 - Sodium mg.'L 20.0 = c Nitrate-N mg;'L 10.0 Iron mg/L ---- 0.3 _— - _= Manganese mg/L 0.05 = Hardness mg%L as CaCO 500 3 Sulfate mg/L 250 '' ff Potassium mg/L 20.0 Alkalinity mg'L 200 --- - Chloride mg; L 250 Turbidity NTU 5.0 Color APC units 15.0 Background bacteria EPA Method 601/602 UG/L See Attached Sheet COMMENT: s '= YES No WATER IS SUITABLE FOR DRINKING PURPOSES FOR PARAMETERS T ED. _ x DATE 7 I - �riilli:itIiiiiiliii111iiallilliiull:al1111aluutlttrtuluul:{l:ltt{tltu:u::::fuu:::uauu::::ut:t:u:::uta:uuut:::+:c::u::a:iiiliiiiiiiu:::u+iu:+:. iiiiiiilliiliiiiiiiiiii�� 7-11-91 13: 23 iGRC N DWA'i EI-, A IvA L,Y 1 ! ..L � _ • GROUNDWATER ANALYTICAL EPA METHODS 601 and 602 Volatile Organics (GC/PID/ELCD) Field ID:. ET-734 Lab ID: 1636-01 Project: Bower Lot 10 Joshua's Path QC Batch: VGA-804 Client: Envirotech Sampled: 07-08-91 Analyzed: 07-08-91 Cont/Prsv: 40ml VOA Vial/NaHSO4 Cool Matrix: Aqueous Analyzed: 07-08-91 PARAMETER CONCENTR(ATTION REPORTING( MI LI Dichlorodifluoromethane BRL 5 Chloromethane BRL ', I Vinyl Chloride BRL I BRL 5 Bromomethane BRL I Chloroethane BRL I Trichlorofluoromethane BRL I 1,1-Dichloroethene BRL I Methylene Chloride BRL I trans-1 2-Dichloroethene BRL I 1,1-Dichloroethane BRL I cis-1,2-Dichloroethene * B 1 Chloroform 1 BRL 1 1,1,1-Trichloroethane BRL I . Carbon Tetrachloride 1 Benzene BRL 1 11 2-Dichloroethane BRL I Trichloroethene BRR� 1 1,2-Dichloropropane BRL I Bromodichloromethane 1 2-Chloroethylvinyl Ether BRR� I trans-193-Dichloropropene BRL. 1 Toluene BRL I cis-1,3-Dichloropropene BRL 1 1,1,2-Trichloroethane BRL 1 Tetrachloroethene BRL 1 Dibromochloromethane BRL 1 Chlorobenzene BRL I Ethylbenzene BRL 1 m*Xylene * BRL 1 o-Xylene * BRL 1 Bromoform BRL 1 1,1,22-Tetrachloroethane BRL 1 1,3-Dichlorobenzene BRL 1 1,4-Dichlorobenzene BRL 1 1,2-Dichlorobenzene QC SURROGATE COMPOUND SPIKED MEASURED RECOVERY QC LIMITS Bromochloromethane 30 26 87 % 83 - 117 % - Fluorobenzene 30 32 107 % 87 - 113 % w listed BRL = Below Reporting methodLimit. References:Non-target Method compound. Purgeable Hal rocarbons andlmethodpresence 602 belPurgeable Reporting Aromatics, 40 C.F.R. 136, Appendix A (1986). a I ALL TEM S SHALL SYSTEM PROFILE MARKED WITHCMAGNETICTTAPE OR BE NOTES PROVIDE WATERTIGHT: MIN. 20" DIAM. (NOT TO SCALE) COMPARABLE MEANS FOR FUTURE LOCATION. 1. DATUM IS APPROXIMATELY NGVD ACCESS COVERS TO WITHIN 6" OF FIN. GRADE 2" PEASTONE OR-GEOTEXTILE 2. MUNICIPAL WATER IS NOTE AVAILABLE { \ TOP FOUND. EL. 130.0' FILTER FABRIC OVER STONE MINIMUM .75' OF COVER OVER PRECAST 2% SLOPE REQUIRED OVER SYSTEM 128 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. PRECAST H-10 PROVIDE INSPECTION PORT TO WITHIN 3" OF FINAL BADE 4. DESIGN LOADING FOR ALL PROPOSED PRECAST Locus '' RISERS H-1 UNITS TO BE AASHO H-M � 20 2cJ cJ' 4"OSCH40 PVC PIPES LEVEL 1ST 2' 2" DOUBLE-WASHED PEASTON 5. PIPE JOINTS TO BE MADE WATERTIGHT. o�sl oyo a°� OR GEOTEXTILE FABRIC 10" EXISTING 14" 122.3' ,6�TMONSTRUCTION DETAILS TO BE IN ACCORDANCE TEE SEPTIC TANK** TEE 24.1**' 0 0 0 0 0 0 o 0 0 0 0 0 0 0 0 0 0 0 0 0°0°0 0 000 00000°0 310 CMR 15.DOD (TITLE V.) 1 2 1 .8' o°o000000°O°O°O°Oo°°°°°°°°°°°°°°°°°°°°°'°°°°o°°°° °°°° ° °°°°°° G o 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0000 0 0 0 �Oo°:°:°:°:° :°:°:0:°°00°0°0°0°0°0°0°0°:00°0°0°°0°0°0°0 0 000000° 00000000000000 GAS BAFFLE::: 0 0. 000000000°o0000000000000000000.0000°000 0 000000 000000000000000 1 19.6 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND � 122.02' 121 .85' 4" PVC SET AT .005'/' SLOPE NOT TO BE USED FOR LOT LINE STAKING OR ANY eet ON 6" DOUBLE WASHED 3/4"- 1 1/2" STONE OTHER PURPOSE. le Str .` 6" MIN. SUMP MaP 12" MIN. INT. DIM. 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. 6" CRUSHED STONE OR MECHANICAL 9. COMPONENTS NOT TO BE BACKFILLED OR COMPACTION. (15.221 [2]) CONCEALED WITHOUT INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED FROM BOARD OF HEALTH. (6.5 % SLOPE) ( 1 % SLOPE) BOTTOM- TEST HOLE 2 EL 117.8' 10. CONTRACTOR SHALL BE RESPONSIBLE FOR CALLING DIGSAFE (1-888-344-7233) AND FOUNDATION- EXIST. SEPTIC TANK 32' D' BOX 7' LEACHING VERIFYING THE LOCATION OF ALL UNDERGROUND & LOCUS MAP FACILITY ***INSTALLER TO CONFIRM SUITABLE SOIL OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF **INSTALLER SHALL CONFIRM MINIMUM SEPTIC TANK SIZE AT FOR 4' MIN. BENEATH BASE OF SAS PRIOR WORK. NOT TO SCALE *THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL TO INSTALLATION OF ANY PORTION OF 1000 GALLONS AND ITS SUITABILITY FOR RE-USE. REPLACE 11. ANY UNSUITABLE MATERIAL ENCOUNTERED UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS SYSTEM PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM WITH 1500 GALLON SEPTIC TANK APPROPRIATE TO SITE SHALL BE REMOVED 5' BENEATH AND AROUND THE ASSESSORS MAP 109 PARCEL 15-12 CONDITIONS IF NOT SUITABLE PROPOSED LEACHING FACILITY. 12. EXISTING LEACHING FACILITY SHALL BE PUMPED PROPOSED LEACHING FACILITY IS > 150' AND REMOVED OR PUMPED AND FILLED WITH CLEAN FROM ABUTTING POTABLE WELLS AND. PROP. VENT WITH CHARCOAL FILTER VARIANCES FOR SEPTIC SYSTEM REPAIRS WHICH MAY BE AND BUGSCREEN (FINAL PLACEMENT BY IMMEDIATELY GRANTED BY THE BOARD OF HEALTH AGENT OR CONTRACTOR WITH HOMEOWNER "130.29 BY HEALTH INSPECTOR CONSULTATION) - .1 0.86 PAPERWORK AND HEARING REDUCTION PROPOSALS APPROVED BY THE BOARD OF HEALTH REVISED DURING A PUBLIC J5 SYSTEM DESIGN. HEARING HELD ON AUG. 4, 2009 69 � ,33.26 3 FAILED SYSTEMS ONLY : SOIL ABSORPTION SYSTEM \1 //, 4cO � , xt28.68 18" P.PINE �o ' o GARBAGE DISPOSER IS NOT ALLOWED INSTALLATIONS PROPOSED MORE THAN THREE FEET BELOW GRADE WITH PROPER VENTING (PIPED TO THE ATMOSPHERE) M�' �V�� S \ 12 .45 DESIGN FLOW: 4 BEDROOMS 110 GPD = 440 GPD BEDL LOCATED MORE THAN LOADING,NTH H-20 C6 7.0>\ 6 SIIX FEET BELOW GRADE BUT IN NO CASE . THE SAS 27�2 \ \\ 0 USE A 440 GPD DESIGN FLOW x 1 73 x \\ 8.05 BENCHMARK: USE TOP , x' 6 3 OF SEPTIC TANK AT \ 811 ELEV. 125.5' 26.59 18""o�uc rTM"OABKS \t" \\ TM 12 38 m_. ._ r SEPTIC TANK: 440 GPD (2) = 880 _ 2764 E1aST. ST**x12 .4 \ \ .36 RE-USE EXISTING. SEPTIC TANK** 126.85 1 30 Ix \ " / , TEST HOLE LOGS 126.66 29. 12755GK ` / 28.04 " LEACHING: i 29.22 SHED SIDES: 2[2 (43 + 3) 2 (.74)] 272 GPD 9 BOTTOM 2[43 x 3 (.74)] = 190 GPD ENGINEER: ARNE H. OJALA, PE, SE 129.98 28.43 � �\ 128.30 ^�, EXISTING 24D 28/3 / WITNESS: DONNA MIORANDI, IRS ME DWELLING oEDK�1 ze 1 ��' TOTAL: 625 S.F. 462 GPD MET R 28.s3 TOP fNDN. 1`12�48 SEPT. 13, 2013 .28.32 a.-130•0' GARAGE / USE (2.) 43' LONG x 3' WIDE x 2' DEEP DATE: 28 �o LEACH TRENCHES OF PERF. SCH. 40 PVC PIPE AND STONE PERC. RATE _ < 2 MIN INCH C3) / c / METER 129. 9 // \ 12703 UGWIRES / \ CLASS I (C3) SOILS p# 14123 . /127.64 \ \ 129ELEV. ELEV. j.1(�8. EXISTLNG 72 >�28.55 WELL _ 1, - / \ 0�, 4 128.0' 0" . 127.8 ._ MA 129.02 APPROVED DATE BOARD OF HEALTH 12" FILL 8" FILL /e28.81 �,' 128.84 E E STONE �68 DRIVE �.�8.79 /LS /LS 8.98 k}g8.99 129.07 30. 14" 10YR 4/1 10" 1OYR 4/1 ® / 131.01 / TITLE 5 SITE PLAN 2.75 �`9„32.87 11 131.87 / X 31.15 OF B \\X132.98 CY.W.84 / Lr•, C � /L•7 10 JOSIAH'S PATH 36" 10YR 5/4 36" lOYR 5/4 \\\`\\ / � /' WEST BARNSTABLE \\ \\\�33.55 / e.e7 1.0 ACRES C 1 �I\`3\\i / 32. EXILL ING �LS AS \ 333.556 PREPARED FOR \ / ., \ 60" 10YR 6/4 60" 10YR 6/4 vO B&B EXCAVATION/BAUER\`\\\\ 113 S� \ 34. /C2 34 SEPTEMBER 16, 2013 SILT LOAM SILT LOAM A� \\\ ,� \ " 2.5Y 5 3 � off 508-362-4541 72 2.5Y 5/3 122.0' 72 / 121 .8 y \\\\\ 4.85 ,jy► )F 1*. �NA OF S dowfox na e6com88© H 0 Mq / 9c ( P SIEVE C3 C3 °\ � ssa� r�So� DANIEL �u� MS MS �506 ��� Rs DANIELA. ti� A. down cape engineering Inc. 120" 2.5Y 6/6 1 18.0' 120" 2.5Y 6/6 1 17.8' \\\\\ s 49 Y 1 CIVIL ;o N 4A P n civil engineers Scale: 1"= 30' \\\ T N�46502 �'0� o P land Surveyors NO GROUNDWATER ENCOUNTERED \`\\ ^�'ti�`\17 �o��F ti �� t „�q�r Fss� a� \ s 939 Main Street ( Rte 6A) 0 15 30 45 60 75 FEET �135.76 1 2.33 DATE C `�' OJALA, " `S. YARMOUTHPORT MA 02675 > 3- 193 'II, -- ----- - --- -1--l- - -----------.-.- -------------------.--.---- - � ! I � i I I I I I I . I I . I � . � I - � � I .I I I . � : I I �, � ; :-'l . .� . � . - I I I � I � - I . �. - -- . .... ��� . I I � - 1. � I I I'� , , , I . 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