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0030 JOSIAH'S PATH - Health
t a 30 Joslah's yPath 6w� 40-109 093 M+r`a West Barristalile 4 f TOWN OF BARNSTABLE LOCATION 3 Q -Z0S 1414 S N-7t-( SEWAGE# (q r VILLAGE WG S-r N UST, ASSESSOR'S MAP^^&PARCEL 1®9 C)I" INSTALLER'S NAME&PHONE NO.( tAM NWE G1�T /�S�S��� iF17 �T7 SEPTIC TANK CAPACITY 1,000 LEACHING FACILITY:(type�3jS-oa!iAt.14'2c'Cww0d�(size) NO.OF BEDROOMS 4 OWNER 4-,4MC5 VC. Lf1T t PERMIT DATE: (®p 9 s l$ COMPLIANCE DATE: A® t 2 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility N Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) 1 J!, Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY d4 A4E w c 06 t---P T€ (3 5 E5 tRdo 2.31IN bar-K - i�- -b ; ILiy o 2 3�S' P k4 s 6B�.lr -5'° IBgp°S q TOWN OF BARNSTABLE LOCATION SEWAGE# ' C)// e -VILLAGE � ESSOR'S MAP&PARCEL/0 ~INSTALLER'S NAME&PHONE NO. �j � �^ � ✓( SEP.TIC TANK CAPACITY ann nq LCaij� LEACHING FACILITY (type)AI-?C G -.14 (size) `f0.5` .9 $7 NO.OF BEDROOMS OWNER f'C a' " GR i r-g,A) PERMIT DATE: COMPLIANCE DATE: 'Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on t site or within 200 feet of leaching facility) �� Q�' Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY � �6 No. { Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in comp ter: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 2ipfitatiou for Misposaf *pstetn Coustruttion permit Application for a Permit to Construct( ) Repair r) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 3 O -765 lAt(!S p,--Tt4 Owner's Name„Address,and Tel.No. Assessor'sMap/Parcel . 09 d, j ©1 WS gt c H*4 E�— 5 Installer's Name,Address,and Tel.No. �q �{ZZ—�� 'j Designer's Name A ess Tel. o. A-4 0 CjL&� E' tl/�"4.k l Y i Rks,q �ra�.c Cf 4P6Lv- 91 LeDA Anse LA N4xSZONSHILL51 Type of Building: // Dwelling No.of Bedrooms Lot Size �`t " sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) Lt4c) gpd Design flow provided 497 gpd Plan Date A POt L ($, AO M Number of sheets D, Revision Date Title 400 -4 05 l H IS 1 t-f WE� Cam' Size of Septic Tank_ 11060 CEA!C.LOO Type of S.A.S. CZ; C144"'O; Description of Soil FljiC 1�J'Q c*:- s _�f�r��� PCA4 Nature of Repairs or Alterations(Answer when applicable) &V S G l XX-' [1 D®0 -®j S5(C_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 Heal ed Date y "" ✓ Application Approved by Date Application Disapproved b Date for the following reasons Permit No. MIR Date Issued � � &o. f !/ Fee w- F THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN..OF,BARNSTABLE, MASSACHUSETTS I�JlILattOU for MI8�JD8alrbptPIU �OTYStrUctI01IPrlrilt l. � Application for a Permit to Construct Repair )) Upgade aaidon ❑Complete System ❑Individual Components V. Location Address or Lot No. 3 O TQ,5 Imi s 11� Owner's Name`*,A-ddre s and Tel No1l+E�C17`! Assessor's Map/Parcel (09 O( ae" 01. 30 0519'S Fr� Wa'V a.� Installer's Name,Address and Tel.No. - ,77—221 T Designer's N e Add e el. o. 53 Sx 641>eE" 9 L4EVi4 POse- 4-ANC N4XS" WS Type of Building: Dwelling No.of Bedrooms Lot Size T3(5 19 4 t sq.ft.. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) i Other Fixtures Design Flow(min.required) q40 gpd Design flow provided 44 7 gpd Plan Date A POU L !5t �I S Number of sheets �+ Revision Date Title 400 0 ,Z1551.4H/5 IW T 14 W 7- SO4W3*ri Size of Septic Tank r OOd (a—/4L..(.4XJ Type of S.A.S. 5760 Ca444A .) 01 � Description of Soil F1#VG 84M-0 �Cl�F7p � S �� L-oy( � '��rr / ( _56tF PCA4 Nature of Repairs or Alterations(Answer when applicable) V S l=S7,I kJF, (r 000 •O N :56PT(c, Th-�t�. 'Ziff t�'1,e1 �-a-o t'J-�©X. T� �3� moo© C��:.�J �•o'�c� C:E��1 1 trwb c"C-r- 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. Si ed Date ¢ � /�—C l ,, Application Approved by �,,., '�--1 ""'"` Date tr--r� Application Disapproved by, Date for the following reasons Permit No: i�i� ^� � � Date Issued h Al r THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS - Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(X) Upgraded( ) Abandoned( )by CAP640106 �1VTE�P r S at has been constructed-in accordance- with the provisions of Title 5 and the for Disposal System Construction Permit N4FE4 dated Installer LV r04E Designer G LcTl C. 4AP- 10dLT I R+5. #bedrooms Approved desigrrflow G 4 d gP The issuance of this permi shall not be construed as a guarantee that the system wilffunction s de igned Date Inspector _ „r,�..,._ --------------------------------------- ------- _--. ----------- - ---------- --------- p/ d' No. M ..-.I/1 Fee -A&V THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS Mispo8al 6pstem Construction i9Prmit Permission is hereby granted to Construct( ) Repair( Upgrade( ) Abandon( ) System located at �j Q 0,.,-1A,H .S 14TC » 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:/Construct n must be completed within three years of the date of this permit. Date 4 /01 ;?:01A Approved by °^�- Town of Barnstable P# Departinont of Regulatory Services 6 n�rwarenOo F Public Health Division Date /� y 200 Main Straet,Hyannis MA 02601 rFn tuts" �r=} Date Scheduled Tf , ma Fee Pd, ._ X: Sail Suitability Assessment for Se e Dzsposa/�l Performed-By: (YUt�tn f7 a r BrLPc4 (F: �r Witnessed By: Location Address LOCATION&.GENERAL INFORMATION � / r Owner.Name V,o�GS e 7 U-H Address 30 Aasossor'sMap/ParccL ` 0 15- 0 1 Engineer'sNamc NEW CONSTRUCT mN REPAIR V Tcla hbno# `•7- y -2 3$-1 ' Land Use. slop..m Surfhc.Stones J Distancoa flum: Opon Water Body ft Possible Wet Area ! A ft Drinking Water Well Z/ ft Drainage Way > 4 J-0 tt Property Llnc �` ZO ft Other {t SKETCHC(Strnat name,dimensions of lot,exact locations of test halal&Pero tests,Waste wetlands-in proximity to holes) 3 � Parent material(geologic) Depth t0 Bedrock #D Depth to Oroundwatcr. Standing Water In Hole: X-114 Weeping fYotn Pit Faoo Estimated Seasonal High Groundwater D NATION FOR SEASO AL'IlIGH WATER TABL ID Method Used: _3 r'% iv�_ t De th Observed standing In obs.hole. `'� _ lu. Depth to Soil mottles Dcoth to weeping from side of obs,hole: In. Groundwater Adju nrlent ft. Index Well Reading bate. index WeII lmYol Adj,fltotdr•,,_. ,r_Adj.dr'oundw4tar1avel., PERCOLATION TEST n�td , TIMN Observation Hole# Time at 4" Depth of Peru Time at 61' Start Pro-soak Time @. Tlmo(9"•6") End PT.-soak Pl J]q 75 Rate Mli►Anch , Site Sultabllity Aseassment: Sltd Passed t/ Sitp Palled: Additional Tceting Needed(YIN) Original: Public Health Division Observtitlon 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(1)week prior to beginning. Q:ISBPTICIPERCFORM.DOC DEEP•OBSERVATION HOLE LOG Hole# Depth from Sall Horizon Sall Texture Shcl Color Sall. Other Surfaca(in.) (USDA) ,(Munsell) Mottling (Stnucture,Stone;Boulders. ® Cori sistehc_V.96'arival) 0— laX�► d t0Y r,3 Z FI©eae40 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Sall Texture Sall Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. DEEP OBSERVATION HOLE LOG Hole# Depth from Sall Horizon Sall Texture Sall Color Sall Other Surface(in.) (USDA) (Munsell) '. Mottling (Structure,Stones,Boulders.. Consistanoy, DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Sall Color Boll Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Slopes;Boulders, Ca i Flood Insurance Rate Map: Above 500 year f load boundary No— Yes ; Within 500 yea boundary No_ Yes Within 100 year flood boundary No., Yes penth of Naturally Occurring Pervious Ma erlal Does at least four feet of naturally occurring pervious materlal exist in all areas observed thrpughout the area proposed for the soil absorptibn system? If not,what Is the depth of naturally occurring pervious material's�...�... Certi.--�°° I certify that on l� (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 trai ng,a erdse and ex rlence d scribed in�10 CMR 15.017. Signature Date Q;\gaPT(C\PRACPORM.DOC Town of Barnstable oF� rO . Regulatory Services ti c� Richard V. Scali,Interim Director » snitxsrasie, 9� MASS. Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: � Sewage Permit# -2—cW3-14 i Assessor's Map\Parcel !!g Designer: Installer: Address: Leo{A ��+ Address: !3 '0 On l�1 20 �6 �,�(1,e,�.� �-�f was issued a permit to install a date (installer) septic system at 3 G iDs lk r �'a +, Al.&.,rwly*based on a design drawn by (address `�4�>ff, dated (designer I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed in compliance with the terms of the I\A approval letters(if applicable) ( ller's Signatu H O GTOi11 lV1o.1070 74� (Design is S gnature) (Affix D ere) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:\Septic\Designer Certification Form Rev 8-14-13.doc i YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you. , must do by M.G.L.-it does not give you permissiori'to operate.) You must-first obtain the necessary signatures on this form'at 200 Main St., Hyannis, Take the completed form to the Town Clerk's Office,.1'st FL, 367 Main St., Hyannis, MA 02601 (Town Hall) and get'the Business Certificate that is required by law. nN DATE: �� S Fill in'please• iti^.•4✓r% �]LS;!s':1 �":Ms , cYh`S ChU lfi ,4 APPLICANT'S YOUR NAME%S: J JVI +'I r"b�tR.,i1��,'�r , `' '.l BUSINESS YOUR HOME ADDRESS: 30 l y ��✓�S <— 'M fi i914i a?;?Ez 3,1�4gF Z 706Q °"" l► `!� `' TELEPHONE # Home Telephone Number S :... ;: E O . CORPORATIO • '�� ` ' NAM F , .:.... ,,G,•sr+�c.:.�:.. ., ,,' z.v1 . •. � .. : : N . ti_....:-� ......... :.. . .. .. .. .: ...... ...:. _.,.. .� --' PE OF�BUSINESS;... ...t��r^ ?•:a:.�::.:,: NAME.OF NEVV BUSINESS,..��-•,.,... ._....,... ... . :. . TY 'Y r,% t Elat (;1' • =� CEL.IVUIViB'�`i... �i",= X11?4•PAIR _ •A..�. a', ADDRESS:.OF Bt�511VES5:: fib,.:::- ,'� `�3 ....... .. .......: ... .:. .. When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you.may need. You MUST GO TO 200 Main St. — (corner of Yarmouth Rd. &Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this crown. 1. BUILDING CO IS510 R'S OFF E This individ of halls e infor, ed any rm' re uirements that pertain to this type of business: . MUST COMPLY WITH HOME OCCUPATION eo./'�� RULES AND REGULATIONS. FAII_U.RE-TO ut oriz ig aWre* COMPLY MAY RESULT IN FINES. M ENT CJ l mcc v-I j2 r U� r f !�>°���s o nb� 2. BOARAF H LTH1 ��tld� This individual has been i o mac#df`the per requirements that pertain to this type of business. Authoq.ze i MUST COMPLY WITH'ALL . COMMENTS: HAZARDOUS MATERIALS REGULATIONS. 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** ' COMMENTS: I� -Commonwealth of Massachusetts Ia°I ^OIS .DI-7 . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 30 Josiah's Path Property Address Scott Griffin Owner Owner's Name information is required for West Barnstable MA 02668 October 18, 2011 every 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: 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 Of 189 Cammett Road Company Address Marstons Mills MA 02648 rcr,en Cityrrown State Zip Code 508-428-1779 SI 12855 _ Telephone Number License Number tta K� B. Certification E- I.certify that I have personally inspected the sewage disposal system at this address and that the CD 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 o �i sewage;_disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of b Title 5(310 CMR 15.000). The system: C) `'`" ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local A proving Authority October 18, 2011 Job# 11-183 Inspector's Signa ure Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins-11/10 Title 5 Official Inspection Form Subsurface Sewage Disposal System-Page 1 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form = Not for Voluntary Assessments 30 Josiah's Path Property Address Scott Griffin Owner Owner's Name information is required for West Barnstable MA 02668 October 18, 2011 every page. CitylTown 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): 15ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 30 Josiah's Path Property Address Scott Griffin Owner Owner's Name information is required for West Barnstable MA 02668 October 18, 2011 every page. City/Town 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): r 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 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 30 Josiah's Path Property Address Scott Griffin Owner Owner's Name information is required for West Barnstable MA 02668 October 18, 2011 every page. CitylTown 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_day flow 15ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 L Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 30 Josiah's Path Property Address Scott Griffin Owner Owner's Name information is required for West Barnstable MA 02668 October 18, 2011 every page. Citylrown 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 30 Josiah's Path Property Address Scott Griffin Owner Owner's Name information is West Barnstable MA 02668 October 18, 2011 required for every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °w 30 Josiah's Path Property Address Scott Griffin Owner Owner's Name information is West Barnstable MA 02668 October 18, 2011 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: 2 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 Water meter readings, if available (last 2 years usage (gpd)): N/A Well Water Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Currently 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: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 L i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 30 Josiah's Path Property Address Scott Griffin Owner Owner's Name information is required for West Barnstable MA 02668 October 18, 2011 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Tank pumped March 2010 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts = Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 30 Josiah's Path Property Address Scott Griffin Owner Owner's Name information is required for West Barnstable MA 02668 October 18, 2011 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Compliance date: 9/18/91 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: 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 Dimensions: 8.5 long x 5.2'wide - 1000 gal. Sludge depth: 6 t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 30 Josiah's Path Property Address Scott Griffin Owner Owner's Name information is required for West Barnstable MA 02668 October 18, 2011 every 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 24" Scum thickness 4 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 101, _ How were dimensions determined? Measured 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 over outlet invert. Observed solids on top of tees indicating surcharge from leaching system. 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 l5ins•11/10 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 10 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 30 Josiah's Path Property Address Scott Griffin Owner Owner's Name information is required for West Barnstable MA 02668 October 18, 2011 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-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 30 Josiah's Path Property Address Scott Griffin Owner Owner's Name information is required for West Barnstable MA 02668 October 18, 2011 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 6 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 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: 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 30 Josiah's Path Property Address Scott Griffin Owner Owner's Name information is West Barnstable MA 02668 October 18, 2011 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: One 6x6 pit. ❑ 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.): Probing to locate leaching pit found saturated soils over top of structure. Pit is 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 L Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 30 Josiah's Path Property Address Scott Griffin Owner Owner's Name information is required for West Barnstable MA 02668 October 18, 2011 every 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.): 15ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 � | g�� �°o����«»nweaomm o»/ m Massachusetts --'` �����N�� �� ���������°��N N������������°���� ����U�0�� ^ Title �� ��y@ � @��N�mN Nwo�����p���w��nn Form Subsurface Sewage Disposal SystemForm ' Not for Voluntary Assessments 30Jouioh'oPoth ___.______________-_-_______ -_______________________________________ Scott Griffin _.. _________ Owner Owner's Name U2GS8 October 2O11 |mbnnaVoni, K4A required for `'--' --�--- =--------------------'—'--- ��� , Zip Code Date mm»neum" every page. ~`''—' D. System Information (cont.) Sketch Cf Sewage Disposal System Provide e view o[1he sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100fmeL Locate vvhonu public water supply enters the building. Check one of the boxes below: hand-sketch in the area below E] drawing attached separately Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 30 Josiah's Path Property Address Scott Griffin Owner Owner's Name information is West Barnstable MA 02668 October 18, 2011 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: N/A 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: You must describe how you established the high ground water elevation: 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 30 Josiah's Path Property Address Scott Griffin Owner Owner's Name information is West Barnstable MA 02668 October 18, 2011 required for every page. City(fown 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 r Town of Mmstable. P# / Department oL Regulatory Services Public Heal I Division Date ss�q. 200 Main Street:Hyaanis MA 02601 A. i Date Scheduled I �'� _ Time _ Fee Pd. roil Suitability Assesskent'for Se ' e Disposal Performed By: _IL /7Y19' Ap.�. witnesaea By. r LOCATION&GENFRIL INFORMATION Location Address Ownds Name 56 a { Address �� T�Si4 � 6 ��s>!/e, ,Uri 11��6� Assessor's Mapmoce.L /o 9//� ' Engineer's Name i,R A a M C�5 NEW CONSM!!tM, RBPAIlt _ Telephone# �„2 74 !/ GSSoe- , S0CoyLIL�� ���, Surface Stones a Land Use�S,''/�/° d�_-- -�-- Slopes(96) Distances front: Open Water Body R- Passible We 1 Area_4A R Drinking Water Well ft Drainage Way oy ft Property line Other R SKETCH:(sbw name,d'umensiods of lot,exact locations of test holes&pert tests,locate wetlands in proxitnity to boles) s � Parent material(geologic) /�. cckli�t ds/Anwh to Bedrock �dj� 1L Depth to Groundwater: Standing Water in Hole:' A i Weeping from Pit F#08 Estimated Seasonal il$gh Groundwater ud3 D ' =Stawndinglin TION O/R SEASONAL HIGH WATER TALE Method Usedrr ' 'G //`g,� ,' �s " '� in. D th o 'erved obs.hole �� ie.--Depth t0 agll Afottlea: Depth toiweeping from side of abs.ho �7 ' 0mundwnter Aus i �$ty ejbtt ent Index Well# Reading Data� f index Well gew:l .�CtOr.,, �.�AtU.Clt+OundWnter Le1rol.,,.s, PERGOLA ON TEST note ObservationJ _..— Hole# ti Time at Ir f IS!q.-�---- Depth of Perc -�, stag Pre�ak'[itne.@ Rime m-0) �, !.�.._..._. End Presoak AV ^/w Rate Wm./Inch Site Suitability Assebstnent: Site Passed__. Site Failed; - Additional Testing Needed(Y/N):.LZ� ' leW(M Back----- OriginaL•:Public He�ltlt Division Observation Hole Data To Be Comp ***If percola lon test is to be conducted within 100'of wetland,you must first notify the Barnstable C4i#servation Division at least one(1)wedk prior to beginning. DEEP OBSERVATION HOLE LOG ' Hole# Depth from Soil Horizon Soil Texture Soil Color Soil other Surface cm.) (USDA) (Mumdo Mottling (Sttuow;stones,B04WA. E /00, ii 1 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistencm. 0 • �, ` �' 2Cq 7 S DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil • Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. i ' J DEEP OBSERVATION HOLE LOG Hole# r Depth from Soil Horizon Soil Texture Soil Color Soli other Surface(in.) (USDA) (Munsell) : Mottling (Structure.Stones.Boulders. Flood Insurance Rate Mai): Above 500 year flood boundary No_ Yes Within 500 year boundary No✓ Yes Within 100 year flood boundary No Z Yes Death of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist.in all areas observed throughout the area proposed for the soil absorption system? -- I 5— If not,what is the depth of naturally occurring pervibus material? _..:, Certification I certify that on k/A///�(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, and experience described in 3:10 CMR 15.017. Signature Date — / i NotA�J Fee ® U THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE,,`MASSACHUSETTS Yes Zippfitatinu for Nsposal *pstrm Coustruftiou Vermit Application for a Permit to Construct( ) Repair( ) Upgrade(Abandon( ) ❑Complete System Individual Components Location Address or Lot No.3o --c;51*f,1s ?47� Owner's Name,Address,and Tel. L E , 57co 6 Assessor's Map/ParcelRAJZ Installer's Name,Address,and Tel.No. V6 33•o2 4168 Designer's Name,Address,and Tel. o. cb 3 3 _C9C�4t/ UTt11 5 C' djSGGi u 1! Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder Other Type of Building No.of Persons "3 Showers(- 'Cafeterias---Y Other Fixtures Design Flow(min.required) © gpd Design flow provided,/� gpd Plan Date�'2 1 Number of sheets Revision Date Title Size of Septic Tank O O Type of S.A.S. Description of Soil r— Nature of Repairs or Alterations(Answer when applicable) d GIN. a - 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 Boar of H h Sign Date Application Approved by Date / 1 Application Disapproved by Date for the following reasons Permit No. Cl'�� Date Issued Bp No. 0 1 Fee �® THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Ye PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ltlYicat1011 fDr im18t1o$at *Pstrm Construction permit Application for a Permit to Construct( ) Repair( ) Upgrade(Abandon( ) ¢ ❑Complete System G?fnndividual Components Location Address or Lot No. Owner's Name,Address,and Tel.N . ssessor s Map/Parcel M _ -TT� 1 � � 7 Installer's Name,Address,and Tel.No. c6.3-3 Designer's Name,Address,and Tel. o/ 3 3 _00J4 17?)U1ZNF-, Is i r )tr Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder.(, Other Type of Building No.of Persons Showers(--)-Cafeteria,-). Other Fixtures U Design Flow(min.required) /Z10 gpd Design flow provided 1, 17 gpd Plan Date 1 /� Number of sheets_ Revision Date Title Size of Septic Tank �T���;� p Type of S.A.S. i Description of Soil PIZ— Nature of Repairs or Alterations(Answer when applicable) `4 i 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 Hea h Sign d Date 1171-0, Application Approved by Date F Ile I Application Disapproved by Date for the following reasons s Permit No. Date Issued 3 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 7�w K � at 3 n _ (nS 1 � has been constructed in accordance 1 with the provisions of Title 5 and the Dis osal S stem Construction Permit No,. 0)/ dated 1 1 I Installer (&E h i�^S oz�5ce iz,,rk}T W 6= Designer — #bedrooms Approved"design flow f �') gpd The issuance of this permit shall not/�"a construed as a guarantee that the system will_fu ction�a d sig ed. Date I / l Inspector y � t No. ��� k ^L`1 c'X Fee ) 0 0 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS Misposal �6Pstrm ConstrUctiott Permit Permission is hereby granted to Construct( ) Repair( ) Upgrade(e/) Abandon( ) System located at 3 0 `�� / �� P / �Z 2_/`� 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:Construction must b+e-�completed within three years of the date of this permit. t'�` Date / ` Approved Bye 1 I Town of Barnstable � E Regulatory Services Thomas F. Geiler,Director 'MAM Public Health Division °1 Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer&Designer Certification Form Date: / -2e'lll Sewage Permit# ,2611 " LOAssessor's Map\Parcel Designer: feS Installer: &r1k,' Address: 5 67i/f ��� Address: // 1;;4!// ���f�4� On was issued a permit to install a (date) (installer) septic system at 3() Jarly4l/ S ,� 7* based on a design drawn by (address) 10,5: dated //-4,6—/1 / (designer) V I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State &Local Regulations. Plan revision or certified as-built by designer to follow. OF kA q o� AW (Installer's Signature) o VON HONE � 9 #1068�a sgNITAR�P (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form 3-26-04.doc �D/ ' �� ► ® )TOWN OF BARNSTABLE . LOCATIONk 7OS I �S ,ly �4 J SEWAGE # �! 3 VILLAGE Y+1/I ASSESSOR'S MAP Cz LOT/0746-01 INSTALLER'S NAME & PHONE NO. p,®� ��? 26�jZ + SEPTIC TANK CAPACITY /OCo Q/f %LEACHING FACILITY:(type) (size) lC�OQ �f �NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER M 1 C S l iW ew.S DATE PERMIT ISSUED: /�)A, DATE COMPLIANCE ISSUED: e, lrj2 VARIANCE GRANTED: Yes No CHAR 0 �z yZ S6 SZ i to i { 3� f� No....- -•- -•-- - A P IFIM.0... THE COMMONWEALTH OF MASSACHUSETTS$arnstablu Cci.-rervation Cormiss.ion -�^ BOARD OF HEALTH ��w 7—�� -% .........../.o1�it1�...............OF............ '1i'/ �%� -------------------------Signed Datb Appliratiou for ; ispasal Works Toustrurtuan Farad Application is hereby made for a Permit to Construct (x) or Repair ( ) an Individual Sewage Disposal Systemat: .LO r ..1�. -•-.•-•�Gi ..... ---.---_. . �.......................................................... ocation.Add or Lot No ......, ll... _.. .J.........- d....C•/...........ih' .................................. ...............-............... - ,-Owner.,,- Address a Z Pomil G�� // _ •••. ................ f -•----•..........------............ ................ Installer Address Type of Building ? Size Lot., ........Sq. feet .-� Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aa Other—T e of rBuildiii No. of persons............................ Showers —Type g -------••---....--•-•------- P ( ) — Cafeteria ( ) d Other fixtures ----------------•--------------.----- d WW Design Flow..............Lt.Q....................gallons per pewit prr day. Total doily flow......... F� .......... ......._....gallons. WSeptic Tank—Liquid capacityf�...gallons Length.-g..6a ... Width:.�'.lD�.. Diameter................ Depth..5'.(.r x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No............L....... Diameter.....Lp......... Depth below inlet................ Total leaching area-ZAt- ...... ft. Z Other Distribution box,6() Dosing lApk ( ) Percolation Test Results 2 Performed by...... �.tr. _ I.................... Date.....f 16 .jz............ 1.4 Test Pit No. 1................minutes per inch Depth of eT s P ---------- Depth to ground water.,e(�(� ..__. Gz. Test Pit No. 2..<?n._..minutes per inch Depth of Test Pit......112..... Depth to ground water................... 04 ...................•------...............--••------•---•-....._.....----.....•--••---•-.:_--•-...........--•-••--•...........------.................----_.... O Description of Soil.... _...... U .........................................1 ...-•---..---------------------•--.------.._.........................•. -------•••--------•..._................................ ----- ----- w - .................... --------..........------------.......----------.........-----------•---------------......_..-------------=-----------------------------........_.....................-•-........... U 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 LI'PLZ 5 of the State Sanitary Code-,= he undersigned further agrees n t t place the system in operation until a Certificate of Compliance has been issyed y t oard of h -lth. * Z Signed------.. ---- ....... ... ... Application Approved By... . ._... j Application Disapproved for the following reason ......•--------•--•--------------------------•-------•---------••------------•------......_......._........--- ........ `. - --•-----------------..--._.-.._.---•---------------•--•---------•-••-•---•---------._.._............ ...._..._� Date Permit No....•--qj-----------� .0... ...... Issued--------------------Date i Ali No,J..... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF ' HEALTH ,� U � �1 ...... ..............OF............8A.r!A)S% 1 ( - y Applirtttinu for Diiip.a,ittl Warks Tonstrnrtion' permit kpplication is hereby made for a Permit'to Construct ( x) or Repair ( )-an Individual Sewage Disposal y.......---.....__.._....LO r......!l._....._..- �.-....t y!�.•...... �_.._ r `S stem at• /s / t ......... - Location-Address / / or Lot No. ..... ..Al _....� ..� .a _eG.�._..._...../f?r ,.. ... w� •..... --•-•• •......................•......._..... •. . ne Address ---:------- ✓'.. .....'........................--- ........................•......................................................................... Installer Address / — f Type of Building 3 Size Lot.. 3.. ...... feet .-, Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) a04 Other—' Type,of Building .....0.._...... No. of persons............................ Showers .. g ------------- P ( ) — Cafeteria ( ) Other fixtures .-----------•-•-•-----------•-----....2.r-? ' .Q -- ��. W Design Flow................ ............_._._._.._.._gallons per person,per day. Total daily flow.......... 0......................... WSeptic Tank—Liquid capacity� ...gallons Length..8..Ir+..... Width;+.Jr_... Diameter................ Depth..,;_.4..._.. x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit,.No.. ......!-------- Diameter.....1.0......... Depth below inlet..... .......... Total leaching area.z�!.;Z......sq. ft. Z Other Distribution box Dosing tank ( ) / aPercolation Test Results Performed bY....__................................................................... Date..... y �& f��.__......... ,a Test Pit No. 1..L.Z.....minutes pet inch Depth of Test Pit.._._►G.!...... Depth to ground water.,!1•.,,t�?::._t__...... 44 Test Pit No.'2..'S..�.....minutesper inch Depth of Test Pit....... ?._... Depth to ground water_..................... ODescription of Soil:...v.......................................................................................-......................................................................... W •.........•..................F*w-1:7� ....------•.............•--....---•-•-----•----•.....----------•----•--........------.....--•-•.--.------------•. --.........0............. w ------------------------- ----------------------------------------------------------------------•----------------------------=------..._...----------------.....-....-------------.....---.....---_.... V _ Nature of Repairs or Alterations—Answer when applicable...............................................................................0............... ---.........................-.....................................-............................................................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITL: 5 of the State Sanitary Code— The undersigned further agrees not tce the system in operation until a Certificate of Compliance has been issu,ed by the*board of health. } 4_ _ - Signed.....~ .. A lication Approved B �.... ............ /-�`/ �� I'�••/ 'Sf/1` / f. PP PP Y f. / . .........I y k j o Date ' I Application Disapproved for the following reasons. ..............................................................................................0.............. ................ --------------------- --------------------------------------------------------- .......---••--- Date .......'� .�.r..--M.vr..,er-----.c n - rrLQ^2.Q0N.a.s...............i...............Y. M..R. .- _.. __._249.........................c THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALT/H��, ' �l_U).1.. .......OF.....:It�"1. ��!7� 11_..................I.-'G,-t✓.................... Trrtif irtttr of Tomplittnr � THIS IS TO CERTIFY That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by ......... :. ••----_... ...............l -•- ----------------I....------- ----.a..........^__._.......----•--•'-•-•----.................... _ _ InstalleF �,._.�.... ,_.I has been installed in accordance with the provisions of T'ITL4 j of rThe-State Sanitary Code as described in the application for Disposal Works Construction Permit No............. ... ,.' dated-......._� L _1 ............. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE C SYSTEM WILL FUNCTION SATISFACTORY. L J DATE............................................... .. . � "......-•- Inspector--•-_.... '!...... ................. .................................. .«.�...M...........w.ww.....M..i...................M ......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .....................i...1..±! .........OF......v............._.:_...., ..................... NO......._r................ FEE...... Dt ern tti Vrkg Tuntrurtinn Permit IOU Permissiois hereby granted.......... l--------------�:�...................................................................................................... to Construct ( ),,or RRepah. ) an Inds 'dual Sewage Deposal Sys em as shown on the a �\-application for Disposal orks Construction Permit No.r ..,_...:::.... D21ted....... r_,���-%L%!...±.�,�. .... _ ----••......-••....................... .......................................................... Board of Health DATE ..._..I............ .. .. •a i qc�', ,I No. -K-=- - Fee-- ---------- BOARD OF HEALTH TOWN OF BARNSTABLE �.��ritatior�,�or�erY �Cor��truction�erntit � Application is hereby made fo�ermit to Constr ( ), Alter ( ), or Repair ( )an indivi well at: ----------------------------------- _Location — Address Assessors Map and Parcel f Owner A ss r Driller` Address Type of Building e� Dwelling-------- l----------�---------- C Other - Type of Building ------ No. of Persons------------------------------------------------------- Type of Well— - --- ___ - - ---------------------------------------------------------- ---� - -----�-- - -- Capacity 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 Certifi of Comp - ce as b n issued by the Board of Health. -- -- -- - - Signed- �� --- date ----- AppliApplication -� cation Approved By—__--------------------------------------------------------------------------- ------------------------------------- date Application Disapproved for the following reasons:-----------------------------—--------------------------------------------------------------------------- ----------------------------------------------------------- - ----------- date PermitNo. - ��-' - -- - -- - Issued------------------------------------------------------------------------------- date m BOARD OF HEALTH TOWN OF -BARNSTABLE Certificate Of Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ); or Wepaireb --IJ - -- --- - - -- - - - -------------------------------- sta has been installed in accordance ith the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. L4/-?/:! Dated--------------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE------------------—-----------------------— - —--------------------- Inspector---------------------------------------------------------------------------------- No. /_ /-=--L Fee--r--=----------- BOARD OF HEALTH TOWN OF BARNSTABLE Applitatton-*rVell Con5trurttonPermtt Application is hereby made four as permit to Construct ( ), Alter ( or Repair ( )an individual e11 at: --------- or Repair r ---------------------- — Location — Address �,ow # Assessors Map and Parcel `_-,� - -�� ------------- .r - ------ -�,c> --•�'C,�_ - �-�- Owner Add ss i - •Instabl Driller' — Address Type of Building Dwelling Other - Type of Building------------------------------------ No. of Persons-------------- - ------------------------ Typeof Well-- -- --v - — -- Capacity--------------------------------------- -- -- ------------- Purpose of Well------------------ �1�'-'-'1'--------- 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 Certifi ate of Compl'arrce•as been issued by the Board of Health. Signed— -- —- t� ----- date ApplicationApproved By--------------------------------------------------------------------------------------- — ------------------------- date Application Disapproved for the following reasons:------------------------------------------------------------------------------- ------------------------------------------------------------------------- --------------------------- - -------------------------------------------------------------------------------- date PermitNo.'- -------- -- Issued-------------------------— - -—=-----------------—- ------------------------ - dal r' BOARD OF HEALTH II TOWN OF BARNSTABLE 4 Certtfttate Of Compliance THIS IS TO CERTIFY, That/the Ind(Jij�vidual Well Constructed ( ), Altered ( ), or Repaired ( ) by. - - - -t---------------- Insta er !/ at------------------------------------------ - -------------------- - (rJ{ has been installed in accordance ith 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 lVell QCon5trurttonPermit No.1t-/_-a/-----Y - Fee-_2 C--=---- Permission is hereby granted-------/--------WLZ -----� - to Construct, Alter ( ), or Repair ( ) anhndividual Well at: No. --------- ------ -----------------1� l/ Street as shown on the application for a Well Construction Permit No.------------------------------------------------------------------------------------------ Dated--------------------------------------------------------------------------------------- ----------------- — �r �---------------------------------------------- d Board of Health DATE------------ - \T(1(, t!}t7?Tt!!ii!TitnTTntTttnin(nititttnnrrnnnTtifglTnTTttiiTttitTifif}tTitTT!tlifnt}ttltt}77tSfi7TTiliTiiT1!ittiS7lSSnnTiTiTitTl(�tTiiititt}tTitTiliiTn.... .t T!1[nTiitT nTittTtitttTit nitinTn ili nn ENVIROTECH LABORATORIES =_ Mass. Cert. #:MA063 449 Route 130 Sandwich,MA 02563 (508) 888-6460 CLIENT: Larry Nickulas t_OCATIO\: Lot 11 Berkshire Trails. ADDRESS: r [d. Barnstable COLLECTED BY: L. [file & Son SAMPLE DATE: 7/12/91 TIME: _ DATE RECEIVED 7��91 SAMPLE ID: Z 333 ", JOB �: New Well WELL DEPTH: RESULTS OF ANALYSIS:, Parameter Units Recommended limit Result - z=; Coliform bacteria;100 mi iMF Method) 0 0, _- PH pH units -- - — 6.0- 5 Conductance umhos. cm — ---- 700- - 204 Sodium mg, L 20.0 19.0 Nitrate-N mg/L 10.0 - 0.09 . = Iron -. mgi L ---- --`l 3 0.05 - m L 0.05 Manganese g; 0.04 Hardness mg/L as CaCO 500 46.4 Sulfate mg;'L 250 = 5.4 Potassium mg:`L 20.0 - 0.9 Alkalinity mg,.'L - --- 200 ---- 8.0 Ei Chloride mg'L 250 _ 50.0 — Turbidity NTU ------ ---'-- 5.0 2.8 -� i= a ~ Color APC units 15.0 <1.0 Background bacteria EPA Method ug/L See Attached Sheet None Detecte COMMENT: � 3 YES NO WATER IS SUITABLE FOP, DRINKING PURPOSES FOR PARAMETER TESTED. KXX ❑ DATE / t' i`{�{i{i" "i`�'i{{"i`{'iiii""i`i" ++111iilit)ill)illilllfill�lilUllllllii11i11iliiltiiiiiiiWhilllllillliUtiiiliictiiill i+ uiiiiiliiliiu ui u i 7 uu a uiiiiiiiliiiiiiiiiiiiiiiiuiiiiiiiiiiiiiliiiiiiiiuiiiilliiltiiliiiliiii{iiliiiiii+l i GROUNDWATER ANALYTICAL EPA METHODS 601 and 602 Volatile Organics (GC/PID/ELCD) Field ID: Z-333 Lab ID: 1662-01 Project: Lot it Berkshire/Z-333 QC Batch: VGA-808 Sampled: OT-12-91 Client: Envirotech Cont/Prsv: 4Dml VOA Vial/NaHSO4 Cool Received: 07-12-91 Matrix: Aqueous Analyzed:. 07-16-91 PARAMETER CONCENTRATION REPORTING LIMIT (u9/L) (u5/L) Dichlorodifluoromethane BRL 5 Chloromethane BRL 1 Vinyl Chloride BRL I Bromomethane BRL 5 Chloroethane BRL 1 Trichlorofluoromethane BRL I 1,1-Dichloroethene BRL 1 Methylene Chloride BRL 1 trans-1,2-Dichloroethene BRL 1 1,1-Dichloroethene _ BRL 1 cis-1,2-Dichloroethene * BRL 1 Chloroform BRL 1 1,1, 1-Trichloroethane BRL 1 Carbon Tetrachloride BRL 1 Benzene BRL 1 1,2-Qichloroethane BRL 1 Trichloroethene BRL 1,2-Dichloropropane BRL 1 Bromodichloromethane BRL 1 2-Chloroethylvinyl Ether BRL 1 trans-1,3-Dichloropropene BRL 1 Toluene BRL 1 cis-1,3-Dichloropropene BRL 1 1,1,2-Trichloroethane BRL 1 Tetrachloroethene BRL 1 Dibromochloromethane BRL 1 Chlorobenzene BRL Ethylbenzene BRL m+p-Xylene * BRL 1 o-Xylene * BRL 1 Bromoform BRL1 1,1,2,2-Tetrachloroethane BRL 1 1,3-Dichlorobenzene BRL 1 1,4-Dichlorobenzene BRL 1 1,2-Dichlorobenzene BRL 1 QC SURROGATE COMPOUND SPIKED MEASURED RECOVERY QC LIMITS Bromochloromethane. 30 33 110 % 83 - 117 % Fluorobenzene 30 29 97 % 87 - 113 % BRL - Below Reporting Limit. * Non-target compound. "Trace" indicates probable presence below listed Reporting Limit. Method References: Method 601 Purgeable Halocarbons and Method 602 - Purgeable i Aromatics, 40 C.F.R. 136. Appendix A (1986). ` ( If� Map 109 Ss Map 109 \ I Map 109 / l' Parcel94 #40 Josiah's Path Parcel93 I Parcel92 #45 Josiah's Path \ #747 Cedar Street 01 \ t \ saw Map 109 _. Parcel 15-14 #733Cedar Street \ \ Lot 11 '. 50 m 6 { 43,584t S.F. m E 1.00t AC. \ Map 109 13 \ +Map 109 Parcel 11 #25 Josiah's Path / a Parcel1515 (Well notfound) `P� ` \ s 102 85 Map 109 \ \ #30 �oP Parcell5-13 #717 Cedar Street \ O N — �, =-150 30 JOSIAH'S PATH W. BARNSTABLE MA 0V H • �N (fGJ.1.06 \ PREPARED FOR: Map 109 associates Scott Griffin Parcel 15-12 50�\ I SEPTIC SYSTEM DESIGNS #10Josiah'sPath Well 30 Josiah's Path NOTE: No known wells within 150' 3dwich,20 it,Road Sandwich, .0041 Setbacks West Barnstable, MA 02668 of proposed leach facility. Well (c)508.274.0074 (c)508.274.0074 locations derived from field survey and Health Department records. Surveying by: Terry A. Warner.P.L.S. oad Harwich. MA 02645 DATE REVISED SCALE SHEET NO. (Sos) 432-8309 11/26/11 1" = 50' 3 of 3 olf" \ ASS SSOR'S MAP: 109 well 1 Ole GENERAL NOTES: se ce` PARCEL: 15-15 / ap 109 W.Meetin ✓o d \Stree a • � I /,,Pmacelr 92 1. VERTICAL DATUM: Assumed Rd � v- �� t o� REVERENCE: PL. BK. 462 PG. 32 ,4 \ 7 Cedars eet 2. MUNICIPAL WATER.IS —AVAILABLE. / F OD ZONE: C Town of Barnstable / NOTE: ed known wells within Ica of 3. SCHEDULE-4O-PVC PIPE TO BE USED THROUGHOUT YSTEM 3cCa e� �o� #250001 0011 C (8/19/85) proposed leach facility. Well locations �_U.N-LESS OTHERWISE NOTED. .� Pes � derived from field survey and Health Tr / y ALL PRECAST& PLASTIC UNITS TO COI FORM TO o Route s / Department records. AAS4TO: H-10 & 20 �o en'ice Road / �, 5. PIPE PITCH-1/4" PER FOOT UNLESS OTHERWISE NOTED. �m LOCUS as 50' Qc� ALL CONSTRUCTION DETAILS TO BE IN CONFORMANCE WITH MA m Well S back � ENVIR. CODE (TITLE 5)AND LOCAL REGULATIONS. �• CONTRACTOR TO VERIFY LOCATIONS OF ALL UTILITIES PRIOR TO LOCUS MAP N.T.Q. CONSTRUCTION. M LEGEND: Map 109 Well S tback Map 109 Parcel 93 / 1622 E 1 0' Parcel 9/$ / #40 Josiah's Path #45 Josia Path N 29311 G2 N PROPOSED CONTOUR 99�-''s / cr / 0 99 PROPOSED SPOT GRADE 48' 5 0\° Shy ro o o Map 109 — 40 EXISTING CONTOUR ss a N o g ? parcel 15 14 — 30.23— EXISTIN E loo/ , 9� �� 96 956 . pr' 96 s�9� 1r p `r #731 Cedar Street pp/ / / ( r�r �i TEST PIT /prtve,. Vent with Charcoal'Filter. 37' ® EXISTING WATER SERVICE I Well Setback Stone �� •�95----------- o M7 0 �5511--96-,,Locate at o�ner's�diseretio�.' � � �� i'a r a ° o p�p l I WELL SETBACK 150' ` m NOTE:Watckrfor Underground I' I 9s `b 6' �� NOTE: a rade,as nee ed,to maintain a Utilities in Front Yard! p� r ! 1? < o g / OF f rinaxim, m 0'of�cove over leaph facility. Lot 11 fq�, tt ® 9\ r Maximum 6'cover allowed per Title 5. 43,584t S.F. y t' / F ✓o s T� r r \ 8br p9�6 0\ rti . l ', r T ERRY Y 9 \T°6 9tis roo \ Ga�tden� \ v .o ° �� r fi ' ro �r 1.00t AC. 1/' rO?�, r9 + + n, +r F°� Map 109 cam, WARNE Parcel 151538721v o p > 0 ti H 2 o Well Setback\ � 7 L�LA�t�cv O ump and Backfill \ 33932 85 32,\Faile Leah Pit\ qp° ��� OF A19JJ+ Map 109 + \ \ 5�2\ Parcel15-13 �. Re-use Existin�� — u 9 _ co \ \ � S? p rrc,AMY L. n I p ` �r \ \ \ r VON HONE i #717 Cedar Street +r �— 1000 gal'Tank s 66 9p \ O biz Cro o #30\ '=96� / Sip + 69 1 \ \ m ... TOF=103.84:, - 9 Fss �Wn + \ v No. 1068 y (Assumed) �� s Edge. f E, I F 9OI �6 r9 FPS s S' \ ��ps t E�� NOTE: This plan is to be used for septic Fro ss h�Oa x CO o+ g4 system purposes onlyand is not to be \ +r ro \\. 9 0 considered a property line survey. I 6 r o IR 6 r / 9g Benchmark set: + /� °gip p p(''9 6r \ \' I Orange paint on rock 30 JOSIAH'S PATH W. BARNSTABLE MA I rOs� / / ^�'/ ��s 9c� EL.=97.72(Assumed) r s VH /ors �s8' 9oze� �/ Setback PREPARED FOR: , associates Scott G riff in �°+b +r°� `°c ��� 9r99 i' 30 Josiah's Path C SEPTIC SYSTEM DESIGNS 320 Cotuit Road d9 5 CO, Sandwich,MA 02563 Map 109 i I (o)508.833.0041 West Barnstable, MA 02668 Parcel 15-12 (c)508.274.0074 #10 Josiah's Path Maximum Feasible Compliance 9 Title 5,Section 15.405(1)(b): 150 \ Surveying by: NOTE:Contractor to Setback ' -1.7'variance request,proposed Terry A. Warner. P.L.S. provide minimum 24 hours ��! 4.7'fill over leach facility Harwich,nMAR02645 DATE REVISED SCALE SHEET NO. Sop s d notice for final inspections. (508) 432-8309 11/26/11 ill 30' 1of3 i - Provide Riser over D-box NOTE:All components to be marked with NOTE:To prevent breakout,final grade T.O.F.(Full) to within 6"of final grade magnetic tape or similar prior to final cover. of EL.91.29 to be carried out a EL. 103.74 (Cover to be watertight) minimum 15 beyond edge of leach F.G. EL:96.09103.3± EL:95 F.G. F.G. EL:96.24± .8± ° �. facility. Existing �- Maintain Min.2 slope over leach facility to prevent ponding F.G. EL:96.0± Install risers w/covers over inlet and # Clean Fill per Title 5 Specifications Inspection Ports within 3"to grade Slab Floor outlet to within 6"of final grade i EL.96.24± :: L=14' (Access Covers min.20"diam.per Code) • • 4"SCH 40 PVC L=97' Naturally Occurring Suitable Sand o"Per u It Re eat Le 6" a 4"SCH 40 PVC L=10' Top of Unit/Breakout EL 91.29 4 SCH 40 PVC Existing Main Line 1 @S=1%(1%MIN) s 0 Below Slab Floor ,,p @S=0.8O%(0.5/°MIN) 0.89 Eff.Depth EL.92.33± EL.92.1± EL.90.93 Install Gas Baffle EL.91.1 PROPOSED DB-3 t EL.90.85 Use 16(2 Rows of 8 units)Biodiffuser Arc 36HC H-20 DISTRIBUTION BOX H-20 with End Caps without Stone in a Trench 7 08' 104.98' (Install PVC Inlet&Outlet Tees) Watertest for levelness if SEPTIC SYSTEM PROFILE. Configuration set 6'apart more than one outlet (40.5'x 2.87'x 0.89' Each Trench) EXISTING 1000 GALLON EL. 2.88 EL.-15.02 H-10 SEPTIC TANK + PRECAST CONCRETE ADDITIONAL NOTES N.T.S. Bottom of TH-2 Calculated Adj.Groundwater (Per Health Dept.As-Built&Septic Report DESIGN CRITERIA dated 10/18 2011 SOIL LOG 1. Contractor to confim soil suitability prior to installation. Contact BOH and Design Sanitarian in the event of varying soils from original soil test. Number of Bedrooms: Existing 4 Bedrooms SOIL EVALUATOR: AMY VON HONE,R.S. S.E.#2517 INSPECTOR: DON DESMARAIS, R.S. , BOH 2. Failed leach pit to be pumped and backfilled. Proposed leach trench to be a minimum Soil Type: Class I DATE: NOVEMBER 21,201111:00 AM of 5'from failed leach pit and all contaminated soils. Design Percolation Rate: <2 min/Inch in C2 Horizon PERCOLATION RATE: <2 MIN/INCH IN C2 PERMIT#: 13475 3. Water line to be sleeved at any sewerline crossings and within 10'of any septic components, as needed, per Water Department requirements. Daily Flow: 110 G.P.D./ Bedroom x 4=440 G.P.D. TH - 1 TH - 2 Design Flow: 440 G.P.D. (Min. Required) 4. Septic Tank and Distribution box to be placed on 6"crushed stone or compacted, level EL.95.88 EL.96.55 Garbage Grinder: Not Allowed A/E base. Fill Sandy Loam LeachingArea Required: (440)/0.74 = 594.59 S.F. 6^ 95.38 4^ 10YR2/1 96.22 FLOOR PLAN Septic Tank Required: 440 G.P.D.x 200%= 880 G.P.D Sand Loam Sandy Loam N.T.S. Minimum 1000 Gallon (Existing) 10YR3/1 10YR5/8 Use 16 Biodiffuser Arc 36HC Units (H-20) in a Trench Configuration: 11" 94.96 30" 94.05 B ':c1 . .. ....:: 2 Rows of 8 Units Each with End Caps, Stoneless: 40.5'x 2.87'x 0.89' " " Kitchen Bath............................... Bedroom Bath Sandy Loam Sandy Loam::::-.... 1 Bedroom Effective Leaching Area: 10YR 5/8 ? :2.5Y5/6: :::::: ::.: Garage j 3 Bedroom 35" 92.96 42e :;: :: : 'U Suitable:;:::::;:: 93.05 4 .;�:-:�:C1 ;:;:;:;`: ;:;:;;: Perc C2 Bedroom � 7.79 SF/LF x 5.0/Unit= 38.95 SF/Unit (Per DEP General Approval Letter) ... Sandy Loam @ Fine Loamy Sand Living 2 Eves 594.59 SF/38.95 SF/Unit= 15.26 Units. Use 16 x 38.95 SF/Unit= 623.2 2.5Y5/6 46"To 2,5Y6/4 Room Storage SF `.. � s... Design Flow Provided: 623.2 SF(0.74) = 461.17 GPD 54.. :i .............u;tabt6 91.38 PERC RATE:<2 MIN/IN.(C Horizon) 1st Floor 2nd Floor 30 JOSIAH'S PATH, W. BARNSTABLE, MA Fine Loamy Sand I 2.5Y6/4 12"-9":4:13 minute 9"-6" :5:14 minuted Walkout V H PREPARED FOR: Laundry/ associates 156" Unfin.Storage Finished Scott Griffin $2.88 132" 85.55 Family SEPTIC SYSTEM DESIGNS ' No Groundwater Observed No Groundwater Observed Room 320 Cotuit Road 30 Josia h s Path No Groundwater Observed in TH-1 or 2:Use Groundwater Data from Barnstable Groundwater Contour Map . Sandwich,MA02563(o)508.833.0041 West Barnstable MA 02668 SDW-252,October 2011,Zone B(47.375'),Adj=2.1% Map Obs.Water @ EL.34±+2.1'=Adj.Water @ EL.36.1± 11 (c)508.274.0074 Barnstable GIS Site EL. 134-EL.36.1 Adj.Water=97.9'Adj.Water below grade " Unfinished TH-1 EL.82.88-97.9'= EL.-15.02 Adjusted Water Utility Area Surveying by: I,Amy L.von Hone,R.S., hereby certify that I am currently approved by the DEP pursuant to Terry A. Warner. P.L.S. 310 CMR 15.017 to conduct soil evaluations and that the above analysis has been Basement Level Ho22cLong Road DATE REVISED SCALE SHEET NO. performed by me consistent with the requirements of 310 CMR 15.017. 1 further certify that �' (508) 432-8309 I have successfully passed the Soil Evaluator's Exam on November, 1994. t 111/26/11 1" = 30' 2 of 3 1 N CONSTRUCTION NOTES GENERAL NOTES . 1. ADDRESS: 3 OS ABLE 1. Contractor is responsible for Digsofe notification 2. ASSESSOR'S NUMBER: MAP 109 PARCEL 15-15 and protection of oil underground utilities and pipes. 3. DEVELOPER'S LOT: LOT #11 ��4J 2. The septic tank on j distribjjtion box shall be set 4. TOPOGRAPHIC INFORMATION WAS COMPILED FROM ��� level on 6" of 3/4 —11/2 stone. AN ON THE GROUND INSTRUMENT SURVEY. R 3. Backfill should be clean sand or gravel with no 5. WELL WATER IS PROVIDED TO THE SITE & SURROUNDING PROPERTIES. 6. NO WETLANDS ARE LOCATED WITHIN 200 FEET OF THE PROPOSED SAS. atones over 3" In size. m 4. This system is subject to inspection during installation, 7. REFERENCE PLAN: PLAN BOOK 462 PAGE 32 ` REFERENCE PLAN: 30 JOSIAH'S PATH, W. BARNSTABLE, MA PREPARED FOR �n by Glen E. Harrington, R.S. SCOTT GRIFFIN, 30 JOSIAH'S PATH, WEST BARNSTABLE, MA 02668" BY pR 51R� 5 5. The contractor shall install this system in accordance VH ASSOCIATES & TERRY WARNER. PLS, DATED 11/26/11. SCALE:1"=30', SHEETS 1-3. #747 CEO pAR 92 Cedar Stree H with Title V of the Massachusetts Environmental Code B. UTILITIES LOCATED BY DIGSAFE. MAp 109 WAS I T E and local Board of Health Rules and Regulations. 9. THIS DESIGN PLAN IS TO BE UTILIZED FOR SEPTIC REPAIR PURPOSES ONLY. / 6. If, during installation the contractor encounters any 10. EXISTING SEPTIC COMPONENTS.LOCATED IN THE FIELD AND FROM AS—BUILT PLAN. a soil conditions or site conditions that are different 11. FLOOR PLANS OF DWELLING ON FILE AT BOH ON 2011 SEPTIC REPAIR PLAN. o R�dai m� from those shown on the soil log or in the design, the installer shall halt installation and immediately notify 12. Remove existing SAS and all leachate contaminated soil and replace Glen E. Harrington, R.S. soil meeting specifications of 310 CMR 15.255. "WEST BARNSTABLE" 7. No vehicle or heavy machinery shall drive over the 13. If the existing leach pit was not abandoned during the last repair, install LO C U S septic system unless noted as H-20 septic components. a pipe from the proposed distribution box for future use. 8. Install Zabel Model A1800 effluent tee filter or equal on septic tank outlet tee. NO SCALE Maintain outlet tee filter per monufaxturers specifications (at a minumum annually). AH'S pAN g. All piping shall be SCH 40 PVC., 109 pWAR g3 o LOCAL UPGRADE APPROVAL VARIANCE 10. No wells ore located within 150 of proposed SAS. WEU- 11. Provide 1 H-20 DB-5 distribution box and 3 H-20 500-gal. Q0 I• 310 CMR 15.405(1)(b) — A VARIANCE IS REQUESTED TO ALLOW THE PROPOSED SOIL ABSORPTION SYSTEM TO BE INSTALLED 4.3' BELOW GRADE IN LIEU chambers by Wiggin Precast or equal. �2' O OF THE REQUIRED 3 FEET. H-20 COMPONENTS & VENT PROVIDED. 19 �'. 4 vent with carbon filter �QcDRIVEWAY0. .i:i;i::;c :. IR ;' PROPOSED SAS I — — 3 H T.H. 2 20 500 gal chambers I • ° ":;: :with 4 stone all around in (201 36.5' x 13' x 2' leach trench. v\ t'a 'O� oak tree ° T.H.:• 1 �q�1®FA�gS o� --..LOT 11 ; # Remove existing SAS. * ARA=43,584±SF (2011 See Construction Note #12 G AR Q I a7® � ��asGAS SIM 0 �I \ �,, +. + �13 A� + } Q , w cry- H. +*++ ge�ock P D I e o /e (2018) cn rep I � o LEGEND PROPOSED SEPTIC SYSTEM REPAIR .... ................... PREPARED FOR I qr 333.3, Test Hole Location JAM ES VEN UTI ET UK —20' LP Lamp Post AT #30 JOSIAH'S PATH I DRA INAGE i '• � RP�N �2 �1 APP rox imt_ _ ea tfnlocation 150' war e EASEMENT BARNSTABLE (WEST BARNSTABLE), MA I PP,�pPwP�K ..........48........ Existing contour O O Ex.1,000 gal. H-10 loading PREPARED BY: SITE PLAN septic tank I I ,� Glen E. Harrington., R.S. 9 Leda Rose Lane / 1 MA 02648 I i SCALE: 1 " = 30 ,y r' 1 , Existing Leach Pit Marstons Mills, I CONTOUR INTERVAL—2' , See Constr. Note #13 Tel: 774-238-1813 I ` / Email: ghorr88®hotmoil.com B.M.= 100.31 ' (ASSUMED) ON I P.K. NAIL FN D. I . Potable well SCALE: 1"=30' DRAWN BY: GEH DATE: 15 APR 2018 °�� DATUM: ASSUMED I FILE: Venuti SHEET 1 OF 2 Dwelling Septic tank cover must be SYSTEM PROFILE 4" vent with Existing g secured at finished grade carbon filter First Floor Elev.= 103.8' Not to Scale Septic tank covers,must be 5 HPROPOSED POSE 20 within 6" of finished grade DIST. BOX Existin Grade Finished grade over system=2% slope away Existing Grade = 96't CELLAR D-Box cover shall be One chamber cover shall be 2 MIN. In. f/2" Double-Washed Stone WALL S = 0.02' f{, within 6" of.finished grade within 6" of finished grade 36•MAX or geo-textile Ilter cloth . To of SAS= 91.7 S=0.01 /FT Level for 2' 4;=0.01 ft/ft -. 10' EXISTING 1000 GAL. 103' 25' Invert Elev.= 0.6T SEPTIC TANK ® ® ® ® ® CM i H-10 = P=90.90 ® ® ® ®. CM ® ® 24'Bottom of Leach Facility Elev.=88.67' 1 stall Zabel A180 Ex. = 92.35' tee filter or is ua =91.07' 6. 3/4"-115" Double-Washed Stone 5' Min. (5.8't PROVIDED) 6" OF 3/4"-11/2" STONE H—2 O 6" OF 3/4"-11/2" STONE BottomTest Hole Elev.=82.88' LEACHING CHAMBERS Design Calculations one chamber cover shall be Min• z• of 1�e•-1/z• Doable-washed stone Number of Bedrooms: Existing 4 Equivalent to 440 Gal./Day 1.5 1.5 within 8• of finished grade or gootext a niter clotToo of h Garbage Disposal: Not allowed with this design a ne Septic Tank Capacity Required: 440 gpd x 200% 880 gpd. a O O to to o C= 24,. Septic Tank Capacity Provided: Existing 1,000—gal H-10 septic Tank C3 to to to Learh Facility Elev. Leaching Capacity Required: 440 gpd x LTAR= 595 SF Req'd Area a s a LTAR for Class I soil .at <2 min./inch = 0.74 gal/sq. ft. a/a•-16 Double—Washed Stone 5' Min. Proposed Leaching Structure: 1-36.5'x13'x2' Leaching Trench 36.5' 1-4 Bottom of H-20 t Hole Elev./GW Elev. Bottom Leaching Area Provided = 474.5 Sq.Ft. SAS LAYOUT LEACHING CHAMBERS Sidewall Leaching Area Provided = 198 sq. ft. CROSS SECTION Total Leaching Area Provided = 672.5 sq. ft. > 595 sq. ft req'd. PLAN VIEW — NOT TO SCALE Leaching Capacity Provided =672.5 sq. ft X 0.74 gal/sq.ft.=497 gpd P 15628 P 13475 Date of SOIL EVALUATION: APRIL 2, 2018 Date of SOIL EVALUATION: November 21, 2011 Evaluation Performed By: Glen E. Harrington, R.S. Evaluation Performed By. Amy Von Hone, R.S. Witness: DONALD DESMARAIS, R.S., Health.Inspector Witness: Donald Desmarais, R.S., Health Inspector Excavator: SCOTT FRANK, MASS CAPE CONSTRUCTION Percolation Rote:<2 mpi, in TH #2, C2 at 46 . 9 —6 =5 min 14 sec: Percolation Rate:< 2 mpi IN C2 PER P#13475 Test Hole Test Hole Test Hole No. 1 (2018) No. 1 (2011)' No. 2 (2011) DEPTHI SOILS ELEV. DEPTH SOILS ELEV. DEPTH SOILS ELEV. 0 96.21' 0. 95.88 0 96.55 1 ,OYR3/2 6"` FILL 95.38' A/E I PROPOSED SEPTIC SYSTEM REPAIR 8" 95.54' A andy foam i. Bw• andy oam 4" 10YR2 1 96.22' PREPARED FOR Dam son 11" 1OYR3/1 94.96 10YR5/8 B ; JAM ES VENUTI ET. U X 56" vnriAq 91.54 sandy loom sandy loarr OF AT 35" 10YR5 8 92.96 30" 10YR5/8 4.05' �p�. S 30 JOSIAH'S PATH s C1 sandy loa sandy loa " Unsuitable soil fine sand 1 BARNSTABLE (WEST BARNSTABLE), MA w/op fi 2.5Y56 kets 54" / 91.38' 42" 2.5Y5/6 93.05' andy�oa fine C2 N Q PREPARED BY: 2.5Y7 4 oomy son monlyToo ' g 144" / 84.21' 1561, 2.5Y6/4182.88'1 132" �2.5Y6/4 85.55' 4 3�„� f�S'� Glen E. Rosen Lane R.S. No Observed Ground Water No Observed Ground Water No Observed Ground Water T1'r Marstons Mills, MA 02648 + Tel: 774-238-1813 Soil Evaluation Evaluation Certification j Email: gharr880hotmail.com I, Glen E. Harrington, R.S, certify that on October, 1995, 1 have passed the soil evaluator i1 examination approved by the DEP and that the analysis was performed by me consistent with the required training, expertise and experience described In 310 CMR 15.017. i SCALE: 1"=20' DRAWN BY: GEH DATE: 15 APR 2018 DATUM: ASSUMED FILE: VENUTI SHEET 2' OF 2