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2350 MEETINGHOUSE WAY/RTE 149 - Health
2350 MEETINGHOUSE WAY, W. BARNSTABLE y r FROM :down cape engineering inc FAX NO. :150836213880 Sep. 26 2013 10:41AM P2 /' •� Tho),naki Ti, ca`an�"�:%� '1'tna��n�g 189Id.g�:rt:.a1u1,JiPiiu'a:cda'i 9,1?�11�iLaAm 1tz•eep,V U.grauIDID�nF:,NIA IV26 1 Fax.' off cc: 508462-4644 �08=i40-51Q�1 Iimsrt�IIl:-_r& Ik.e8¢ .R7� i hiTum��nv�n B+'rnz'�n Date' � � I`� �sr�l5ad�•n?a+�mcuiit'" �l� ��+�J ,����rauu•'s 1l�a�Iu1�a»�'��I_ ��� �� `o� ' ��n� •em: lV D vv vt-_- � l.i'4�.°a h7�gt�Ill�u'a �, ._ ����'"`�" �a>I4Itn e�;a�: '� v' _ .^ddm'em � Hai v p: ,.unit to install a Ou ' iTStAf.eT sel7ti`: ;ystem at 1"L�e.! 1 U l�dl_ t i>�sE;�i.om.a cic;siFi�drawli )y (a.dClr�:SS Pi-Fated _ I aeAi y fbLat-ihc. sepTur: Gystem irdaz:r7c€d abvlre yes mBtallec}.IrUbstaauL,411.7 accorcii11.g W 1:ie design, which.mEt}i iatclude TT71Tlox ajProw—d c s:o.-:5 suca as lateral rcf.rzcatiou rf. i ic: dj3t.fj.buLoii box andlc r a-,pfic tank. T. ai:rbfy 'ihat the; septic Teferuu(-. 3. above: was, instal_I.ed wlth fn..2jur r.h .n.gey preate:�' thdti 10" lef'1,91 r.E'•lo^ati.on of tha: SAS' or au y verti�:al::el�c►iio:n.of��liy c o77�.punent of tb.e septic,system) U�7t 7n.a�.`.i:ordaTlce �>vith`::tsatN 7, L,octl Rr:,Rlll�;tious. Pfau revision or r..crtfie�l as-{i�tilt:by deaigue.c rn 'fullu�+�. t1A OF 4q DANIELA� OJALA -+ (ITn;lucr S Li[riaia e) 4 No.46602 {j) 51�71rt;'S Sllatur�) � x'�3C31ssnl'f''3 , I" 1�L`1F 1 ,'ll't�Filh�TeV Kt YET .I:, ]G t 1JBLAGJ' t���'1'l� [D4®'9�iU,RDP�. R�'Q Aiwa A:,i aaPT�i V�v-i �T u'A_rf 01 N.x t1!"�g3►... ED'�' li 6'tiTa� -a!CpTyt, r�2Q .1V%_jVTTLT.,B:J1.D j,I: RE,rF1�dT�IB"Z 7RB 9At�1�'A_p�1 fl°gTif���EC WiAJ,'aR DIVISION.. 'IHAA I1k4 i�u�IJ. r�-LT. 1rl�/C�.17Sr%11r.ciu,P.i f'rrTificati0U.1'o':Clj=:f-�7�_udr, . t t Town of Barnstable P# Department of Regulatory.Services a Public Health Division Date l'�-- 4 200 Main Street,Hyannis MA 02601I Date Scheduled Time / Fee Pd. v Soil Suitability .Assessment for Se is s Performed-By: 1 Witnessed By: G L O C t I` QN`& GENERAL INI+ORNIATION , LaeadonAddregs 1��� -h'0//k)gvvsName keV)n4 l4 �ad UAddress 0 Assessor's Map/Parcel: /SS/J-2 Engineer's Namee NEW CONSTRUCTION REPAIR Telephone# VVV�r�� Land Use: Slopes M ® � Surface Stones v Vd /sCJ4V0 1 /C Distances from: Open Water Body Possible Wet Area ft Drinking Water Well � f[ • ` I Drainage Way f Property Line 1 4 ft Other ft SIM'TCH:(Street name,dim ions of lot,exac ations of test holes&pert tests,locate wetlands•in proximity to holes) �9 - 0 ,X N ll Parent material(geologic)J0t,� Depth t0 Bedrock 7 yo c> Depth to Groundwater. S[andingWaterinHole: /V N4— Weeping from Pit Roe /VO��' Estimated Seasonal High Groundwater N/� DETERAHNATION FOR SEASONAL kRG [WATER TABLE DepthUsed: - Depth Observed standing,in obs.hole: iu. Depol to sell.mottles: In, Depth to weeping from side of obs,hold., In, Groundwater Adjustment 1G. Index Well# Reading Date: Index Well Ipvol____T.__. AdJ,faeter- Adj,Groundwater Leval , PERCOLATION TEST Dais / xhun /� , Observation Hole# tThma at 9" / Depth of Marc Tlmeat6"J. Start Pre-soak Time �r�j � _VAA Time(9,1-rV) End Yre-soak Rate Min./Inch L Z Site Suitability Assessment: Site Passed Sitp Failed: Additional Testing Needed(YIN) 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(1) week prior to beginning. Q:IS HPTIC\PL_RCFORM.D O C a DEEP-OBSERVATION HOLE LOG Hole#_i Depth from Soil Horizon Soil Texture .Shcl Color Soil• Other Surface(in.) (USDA) (Munsell) Mottling (Structure, Stones;Boulders. ��� i ten w.96'(iravell 0-6 5 L 7 yy DEEP OBSERVATION HOLE LOG bole#_o Depth from Soil Horizon Soil Texture Soll Color Soil Other 5urfacc(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. -Collsisttnov.%Cave 4— lei Y/_616 4 y 7y-101 ]SEEP OBSERVATION]STOLE LOG Role�. Depth from Soil Horizon Soil Texture. Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Co 1 to c Gomel) —orb DEEP OBSERVATION BOLE LOG Bole# Depth from Soil Horizon Soil Texture Soil Color Soil Other n. USDA)( Surface i . - (USDA) (Munsell) Mottling (Structure,Slopes;Boulders, • G_/ � Consistency,wsek I+lood Insurance Rate Map: Above 500 year flood boundary No_ Yea Within 500 year boundary No 'Yes Within 100 year flood boundary No.,__._ Vas,,_ Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas obstrved throughout the area proposed for the soil absorption systeml If not,what is the depth of naturally occurring pervious matorlal Certification I certify that on QZeG (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,expertise and experience described in�10 CMR 15.017. /> Signature Datb QAS.flPTI.C1l'W-ORM.DO C TOWN OF BARNSTABLE LOCATION bift SEWAGE# A-O/,?--,36r VILLAGE W 7�scLvy,.ST;-`b ASSESSOR'S MAP&PARCEVISS Z -Z INSTALLER'S NAME&PHONE NO. A Gkey --2 1 -41 Z-& SEPTIC TANK CAPACITY l k-O O b LEACHING FACILITY:(type) f2- (size) 13 .2 NO.OF BEDROOMS OWNER 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 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) Q Feet FURNISHED BY �r a7.9 i 7 `7 q �s cp' fffr--er--r 13 (vim .�,Ioo? Fee /W / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: es PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS fipritation for Misposal *pstem Construction permit Application for a Permit to Construct( ) Repair(.1elupgrade( ) Abandon( ) ❑Complete System Individual Components Location Address or Lot No."3b ��Ti� �iao5c W a7' Owner's Name,Address,and Tel.No. Assessor's Map/Parcel n I Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Ht e 6c e a,s 3f tnft .508-6 f3_ 30 & e— \76A-- 3'4 7 Type of Building: Dwelling No.of Bedrooms Lot Size e(C4 e.Y sq.ft. Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided �/ gpd Plan Date S410TJE /7 Number of sheets , Revision Date 9V d. Title Size of Septic Tank Oo Type of S.A.S. 6 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 Bo d of H alth. ig d „�__�,�.._�, Date _ Application Approved by Date Application Disapproved b Date for the following reasons Permit No. O lv �.� Date Issued /A No. 0 i i .. w'.n. Fee xv THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS es 01pplication for deposit 6pstem Construction permit Application for a Permit to Construct( ) Repair CIII pgrade( ) Abandon( ) ❑Complete System Individual Components Location Address or Lot No.X%5z> /`9e e n,, ko a GJa1 Owner's Name,Address,and Tel.No. Assessor's Map/Parcel Ir 7 6e"e Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Type of Building: �- Dwelling No.of Bedrooms Lot Size sae t-eS sq.ft. Garbage Grinder( � Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 2 30 gpd Design flow provided "?y 9 gpd M- Plan Date � i r7 Number of sheets > Revision Date J I f Title Y Size of Septic Tank . ( an IA Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 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 Bo d of Health. S fg► d ._ Date Application Approved by Date i Application Disapproved byV Date for the following reasons Permit No. 2 o I Z Date Issued TIC E COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS V1 Certificate of Compli afire { THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( �) ° Repaired(✓r Upgraded( ) Abandoned( )by at v o i has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. r?0 J dated / Installer e 'a Sc'-'- Designer ` / r #bedrooms Approved design 3 y / i and The issuance of this permit shall nolbe cons ed a guarantee that the system will nct on as designed. / /YN/m t'Ins ector �t�; n/� ��f Date V1 / ^/ pr(5 No. n - Fee 1 _ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION BARNSTABLE,MASSACHUSETTS Misposal *pstem Construction 3permit Permission is hereby granted to Construct( ) Repair( �Upgrade( ) Abandon( ) System located at o2 3 to 7-7 kr,j d,i 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 on m st be completed within three years of the date of this permit. rn Date / Approved by �, ��11� tj__J� i 9 • • .; , o . tra 4 3 ) n Complete items 1,2,and 3.Also complete A. Signature i item 4 if Restricted Delivery is desired. X Agent o Print your name and address on the reverse ❑Addressee so that we can,return the card to you. B. Received by(Pnnte Nam C. Date of Delivery o Attach this card to the back of the mailpiece, d or on the front if space permits. D. Is delivery address different from item 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑ No Mr. & Mrs .1-ifford L. Hagberg 2350:Meetirigbouse Way 3. Service Type .West-Barnstable, MA 02668 ❑Certified Mail ❑Express Mail ❑Registered ❑ Return Receipt for Merchandise # ❑ Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes !��( r 2. Article rfmo -q, g i t; �. 7012 1010 0000 2851 0947 (Transfe[fromservice.label); ,,,_ „:. -:; k PS Fomn 3811.February 2004'. Domestic Return Receipt:., 102595-02-.M-1540; • pfyy�171 o- 0 CO Postage $ �� •,, rU ��o C- Certified Fee ` C3Po fifark Return Receipt Fee i Here C3 (Endorsement Required) ( 1 C3 `1 ;. Restricted Delivery Fee s ^ (Endorsement Required)rA O Total Postage&Fees IU . C3 Mr. &Mrs Clifford L. Hagberg :-.2350'Meetinghouse Way :West Barnsta MA' N -ble; 02668 Town of Barnstable Barnstable Op THE Tp� Regulatory Services Department 1 er"a�I 9BARN r Public Health Division I �m � i639 a�0 200 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 2851 0947 October 17, 2013 Mr. &Mrs Clifford L Hagberg 2350 Meetinghouse Way West Barnstable, MA 02668 II The septic system located at 2350 Meetinghouse Way,West Barnstable, MA was last inspected on 9/16/2013 by Mark Polselli, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Failed" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: Y 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 may result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH Thomas McKean, R.S. ,CHO Agent of the Board of Health i Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\2350 Meetinghouse Way W.Barn Oct.2013.doc Parcel Detail http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=10393 j/.t{fpj ` k " �- a- ,�TF. Logged In As: Parcel Detail Wednesday, October 16 2013 Parcel Lookup Parcel Info Parcel 155-032-002 � � � � DeveloperID LOT 4 P r i _ . Location 2350 MEETINGHOUSE WAY/RTE 149 ( 150____ Frontage Sec ' Sec F -- - f Road Frontage' Village.WEST BARNSTABLE FirDistrict e(RNSTABLE Town sewer exists at this Road 1013 address'No Index Asbuilt Septic Scan: Interactive i , - I 155032002_1 Maps „. Owner Info Owner JHAGBERG, CLIFFORD L&MARGARET W Co- %RANDLEMAN, BRANDON S& EGGLEST� Owner Streetl 12350 MEETINGHOUSE WAY/RTE 149 1 Street2 I City!WES`— T BARNSTABLE State MA Zip 02668� Country Land Info Acres 2.44 Use Single Fam MDL-01 Zoning IRF �� Nghbd 0106 Topography Level Road 1Paved Utilities I Gas,Well,Septic Location[Rear Location Construction Info Building 1 of 1 Ye BuExt ilt ri 992 ~�S RUot Gable/Hip Wall Mood Shingle Living Roof AC I------- Area 2528 Cover Asph/F GIs/Cmp Type INone ° .' z' Style lColonial Wall Drywall Bed Rooms 13 Bedrooms Intr- Bath Model lResidentiall ( Floor IPine/Soft Wood Rooms 12 Full+ 1 H TJUs, ,0 _ A Grade Average Plus ( Type Hot Water _ Rooms 18 RoTotal oms Heat Found-— Stories 12 Stories Fuel JGas ation jPoured Conc. Gross http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=10393 10/16/2013 F7 Commonwealth of Massachusetts Title 5 official Inspection Form lug subsurface sewage Disposal System FormNot for Voluntary Assessments Ae Property Address ���✓ eve-7L U Ow ner Cw ner's Name I / / /� y �� information is we5l � �ilNsT-(ale- / ' 14 O� 61 required f or every State Zip Code Date of Inspection page. UyfTown Inspection results must submitted on checklist at s form,he end In p the form. forms may not be altered in any way. Please see completeness inn portant:When A. General Information filling out forms on the computer, I �I use only the tab 1, inspect / e / ` I key to move your /� � s / 17 cursor-do not (11✓, or: use the return Name of Inspector — - G key. Company Name Company Address -7 State Zip Code City/Tow n ,Sod Telephone ember 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 CM R 15.000). The system: ._- ❑ Passes ❑ Conditionally Passes E Fails ❑ Needs Further Evaluation by the Local Approving Authority Insp tor'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. Tide 501fidd Ins pec bon Form sumeace sewage Disposal System•Page 1 or 17 t51re•3+13 " 1 i f Commonwealth of Massachusetts rAi M Title 5 official Inspection Form i Subsurface Sewage Disposal System Form - Not for Voluntary Assessments N%19 Property Address r G ��r ON ner Ow ner's Name ,( inform /`J ation is /PS �G�vt S � 0o; 6/ ? required f or every State Zip Code Date of spec ion page. Gty(Town 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: 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): Title 50ffl681 lrepeeGenFam subsLeace Sewage Disposal System-Page 2of 17 t5ns-3113 com monwealth of Massachusetts Title 5 official Inspection Form s Subsurface Sewage Disposal System Form Not for Voluntary Assessments Ale Roperty Address � /�✓ Oa ner ow ner's Name 6� / / n information is eS-t G/✓�1 required for every State Zip Code Date f Ins actio page CityRown B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced C3 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 unlessystem Bo not functioning inard of Health rmines in accordance with a manna which will protectlpubliiR sy 15.303(1)(b)that the sy 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 T10500681lnspecuonForm Subsuface Sewage 01sposel system,Page30H7 INns 3113 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form • Not for Voluntary Assessments Property Address Owner O N � �G Information isrequired for everyState Zip Code Date Ins otion page. City/Town 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 bacteriacoliform o the presence of ammonia to or less than5 ppm provided that no other facture criteria are triggered A opyen and rofe nitrogen theana equal analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You Mg.8 indicate "Yes" or"No" to each of the following for AR inspections: Yes ❑ 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 clogged SAS or cesspool Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/z day flow Title 5 olficlei Ira pectlon F orm Subsulaoe Sewege Disposal System-Page A of 17 15lns•3H 3 Commonwealth of Massachusetts ugTitle 5 official Inspection Formments subsurface sewage Disposal System Form Not for Voluntary Assess 7Cwner's Address GI ✓ ON ner Name �J/ /�� (�01 G/�� d Information is �� G/ns?4 required for every Stale Zip Code Date of spec' n page. City(TOwn B. Certification (cont.) Yes No C3 [;3/ 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. ❑ m,-' 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 at aality DEP certified system passes if the well water analysis, performed laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 6 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- The s g e ❑ The system �l I have determid. ned that one or more of the above failure criteria exist as described in 310 CM R 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 16,000 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 Cl ❑ 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 syste cn acc significant grade ordance with 310CMRt under 15 304.SThelon E or failed system owner should contactt the appropriate regionalthe ropriate system regional office of the Department. Title 5 olflciai inspection F am Subsurface Sewage Disposal System•Page 5 of 17 Mn4.3113 Commonwealth of Massachusetts Title 5 Official Inspection Form b Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 0' Property Address c� Ow ner pnr ner's Name information Is ��4 required for every State Zip Code Date of I spect'on page, CilyRown C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes ,%fao ❑ j-Pumping information was provided by the owner, occupant, or Board of Health ❑ El" 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.sl�-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: of bedrooms (design): Number of bedrooms (actual): Number ( 9 '7/-'74(2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x #of bedrooms): --- Title50190e1 inspecBmFam Subsurlace Sewageolsposel System-Page 6of 17 t5ins•W3 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments .�sv 12e�l l�o�l� LZ Property Address ~" ON ner — information is pate of ns lion requiredforevery City(Town Stale Zip Code p page. D. System Information Description: / O �� ���� So �,c �a .�✓ I i Number of current residents: ; ❑ Yes p'�No Does residence have a garbage grinder? ,., Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes 2 No information in this report.) ❑ Yes p�No Laundry system inspected? ❑ Yes ©''No Seasonal use? Water meter readings, if available (last 2 years usage (gpd)): Detail: ❑ Yes No Sump pump? Cjf/eeN Last date of occupancy: Date Commercial/industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CM R 15,203): Gallons per day(gpd) Basis of design flow(seatslpersonslsq.ft., etc.): ❑ Yes ❑ No Grease trap present? Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Title 5 official Inspection Form Subsurface sewage Disposal system•Page 7 of 17 t5m•W3 commonwealth of Massachusetts . Form F Title 5 official Inspection Assessments s Subsurface Sewage Disposal system Form Not for/Vo N c'? C,/ Property Address ow ner ON ner's /q �6 information is ( , /Q{ , �z��1 J f !� ---- Date of in pectiofi required for every -�• -=— State Zip Code page CitylTown 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 L�J No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of Sy 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 IIA system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other (describe): Title 5 Ol flcl ai Ire pec Uon F am Subsurf ace Sewage Disposal System•page 8 of 17 t5im V3 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments r'II i' "fee�l✓1 �/o�is �i✓G Property Address ON ner Ory ner's Name Vv�S/ information is required for every GtylTow n State Zip Code Date o Insp ction page. D. System Information (cont.) Approximate age of all components, date installed (if known and source of Information: a odors detected when amving at the site? ❑ Yes CJ No Were sewage Building Sewer (locate on site plan): Depth below grade: feet Material of construction: ❑ cast iron 40 PVC ❑ other (explain): /o 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): c Depth below grade: feet Materi 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 x/0 Dimensions: Sludge depth: This 5 0lnciel Ins pecUcn F orm Subsuflace Sewage Disposal System•Page 9 of 17 l5 ra 3113 Commonwealth of Massachusetts Title 5 Official Inspection Form A�ug Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address v "� Lo Ory ner Cw ner's Name /- 7a:��-6 information is 7e- �requiredforevery State Zpoe Date of I spe tion Cty Row n page. D. System Information (cont.) Septic Tank (cont,) Distance from top of sludge to bottom of outlet tee or baffle 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 /��n c7j How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc,): a✓� lv Gvt� 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 7iUe501ficIal ins pec bon Form SubsuAaw SewageDisposel System.Page toot 17 t51re•3N 3 L Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address ON ner ON ner's Name/ P mat ion is infor c /' f �✓�S requiredforevery State G Zip Code Date of Inspec on t City[Tow n page. 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 worldng 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 TM850fAciel IrepecoonForm SubsLeam SewageOisposel System-Pegs 11 or 17 lyre-W13 Commonwealth of Massachusetts s Title 5 Official Inspection Form 6 Subsurface Sewage Disposal System Form •Not for Voluntary Assessments i Property Address � f Ow ner Cw ner's Name e f� �n jJ / information Is 7� Zip Code Date of nspe tion required for every c4 Tow n Stale p page. D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert V 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): ❑ Yes ❑ No" pumps in working order: ❑ Yes ❑ No" Alarms in working order: Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: TWO501ficial ins peciJonForm SubsXWO Sewa980406e1 System Page 12 of 17 t9ne 3113 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments � �35(✓ /2e�i''/ C Property Address Cw ner Cw ner's Name — information is State Zip Code Date of nspe tion required f or every ay/Town page. D. System Information (cont.) Type: / leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovativelaltemative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): / /�� 7<� �Uv� 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 TMO50fliciel ire pec bon Form Subsrlace Sewage Disposal System•Pape 13d 17 t5ins•3/13 Commonwealth of Massachusetts Title 5 Official Inspection Form ss Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address Cw ner Cw ner's information is required for every page. 5Town State Zip Code Date of Inspe lion 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.): tSns 3113 TIUe5Offldal ImpwOonForm Sub rface SewageOlSposal System Page 14 of 17 Commonwealth of Massachusetts ugTitle 5 official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments Property Address �� -Pt/ Ow ner Ow ner's NameQs information is � G//.S� ___LL required for every State Zip Code Date of spe Ion page Crtyrrown 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 ;h-an eputer supply enters the building. Check one of the boxes below: d-sketch in the area below ❑ drawing attached separately 14 a Tit a501rwis1lnspec bon Form Subsurface sewage Disposal System-page 15d 17 Ons-3113 I - - Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address Orr ner Owner's Name 7�- / C� fZpe information isrequtredforevery State Zip Code Date of Icti n page. i5t ow n D. System Information (cont) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar 1 ❑ Shallow wells O Estimated depth to high 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 1 Board of Health - explain: l� _ 9 /- /a✓t 1 7L /cif ❑ 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. TiO50fflcial inspectonForm Subsurface Sewage Disposel System-Page 16 of 17 `� �13 i I Commonwealth of Massachusetts Title 5 Official Inspection Form i a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address v � f Ow ner Cw ner's Name/ �� / cr/�j w ` { � 9 information Is (�� (�/C required uiredforevery C�yRown State Zip Code Date of ins ecCio E. Report Completeness Checklist Inspection Summary: A, B, C, D, or E checked Inspection Summary D (System Failure Criteria Applicable to All Systems) completed �tem Information— Estimated depth to high groundwater Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file TItle$Officiei Ins pw bon Form SubgLeaCe SewageDiaposel System-Page 17 of 17 t5ins-Yi3 i.•4 i�, j IKE Town of Barnstable Barnstable Regulatory Services Department aicaC 1 9°" i639• LL MA� r Public Health Division B p 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 2851 0947 October 17, 2013 -- Mr. &Mrs Clifford L Hagberg 2350 Meetinghouse Way West Barnstable, MA 02668 The septic system located at 2350 Meetinghouse Way, West Barnstable, MA was last inspected on 9/16/2013 by Mark Polselli, a certified septic inspector for the State of Massachusetts. The inspection:ofthe septic system showed that the system "Failed"under the guidelines of.1995•TITLEPS (310 CMR 15.00) due to the following: • 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 t ul in future enforcement action. 6� PER ORDER OF THE BOARD OF HEALTH G Thomas McKean; R.S. CHO Agent ofthe Board°ofyHealth zs ,. r Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\2350 Meetinghouse Way W.Barn Oct 2013.doc . _ �� i ! ' .. . _ - t< I� y � .. t�_ I r , a �a 1 r. x 73 SOUTH SHORE DRIVE BASS RIVER,MASSACHUSETTS 02664 P� CJC� it r�,;=:� w •, _ IJ.�!'li''11lli,jli,�1�°i'if#�11'�'�lli'.1„�#i�l�l�'''i1�l��1�1111�:111 11 It 1 111 lilt lilt 111 11 it lilt 1 lilt llltllll i f 7 c AsBuilt Page 1 of 1 TOWN OF BARNSTABLE LOCATION Aft , .55,0 SEWAGE # ,.032- 002 VILLAGE �!, '�- p -n��" ASSESSOR'S MAP 6i LOT INSTALLER'S NAME PHONE NO. SEPTIC TANK CAPACITY 1 l 000 LEACHING FACILITY:(type) LT� (size) �,T 6 NO. OF BEDROOMS--_"3 PRIVATE WELL O PUBLIC WATER BUILDER OR WNER -�Oh�1 k N u4=Fy�c DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: I'll 0,2� VARIANCE GRANTED: Yes No lj l http://issgl2/intranet/propdata/prebuilt.aspx?mappar=l 55032002&seq=1 9/17/2013 FES...... .. .. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Dispnuttl Workii Tnntitrnrtiun Prrmit Application is hereby made for a Permit to Construct ) or Repair ( ) an Individual Sewage Disposal System at: 2 3 3 o n.-. 1 V 7 ...... '?mot----y........... -.....t ` .. .................................................................................................. Location Address or Lot No. ...........Wit..---=`...`-'C.................. ............. ............................................. .---------................................... Owner 1 Address ' --A -----•-•-k'r5± .`': `------. ..r...._.. F�'l. IAA!\�-•-------•---• a ... k L- ..._lonf3 e _w ...... C .--------------------- Installer Address QType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms......................................Expansion Attic ( ) Garbage Grinder ( ) p., Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures ----_---_---••-•---_--•-.-. W Design Flow........U d............................gallons per person per day. Total daily flow........ ...................gallons. WSeptic Tank—Liquid capacity _gallons Length_8-e� _._ Width._.Y�.:S._.. Diameter................ Depth................ x Disposal Trench—No..................... Width ....... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No........I............ Diameter-----6------------ Depth below inlet....1............. Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of.Test Pit...:................ Depth to ground water........................ *_ / •..... ..... ..........••-••-..........-•-•--....•------••••--•-•••••--••••-••-••••----------------------- O Description of Soil--- - IZO.............. .................. oll -- �6 I�- a-LE'"J 12!� S.-«r � -------------•_....--•-•.-•-•- .•••- W -----------------------------------------------------------------------------------------•--------------------------------------------------------.................................................... UNature of Repairs or Alterations—Answer when applicable............................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed ............................. Date ApplicationApproved By .... ` . . .............. ............................. ------------------- ------------ Date Application Disapproved for the following reasons- ..........--- --- - ------------------- -- --- -------------------------------- --------------------------------------- -------------------- -------------------------------- . .. --- ------------ ------------------.....-------------------------------...... .............. - ................... Permit No. Issued ----------------------------------- ----- -------Date----- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE C�ex#ifira e of C�IImp1ia1: re THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( C,�orpaired ( ) b I•+.�.t(C-A't-----------( 61� --------------- Installer at . -D C'....... .........e ��1- 1 l�Ebv S -........�.Ji- ....................CA,.........---.....� 2�............----------------------------- has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ................................................ dated ......................................--...---.. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE------------------------------------------------------------ -------------------- -------------------- Inspector ....--------..........--------......----------.......--.......................................... ' f \ THE COMMONWEALTH OF MASSACHUSETTS 1 BOARD OF HEALTH TOWN OF BARNSTABLE V Appliratiaan for Di ivadai z agrkii C owitrnrttlin ramit Application is hereby made for a Permit to Construct (U'-) or Repair ( ) an Individual Sewage Disposal System at: 2 3 3 6 r 1 L/ Location-Address or Lot No. ......................►l ............................. -_...Y I rJ......... f►k:E.2 c' ..........-----------------------•----------.......................-------•-----•---....•--.....-- Owner Address a \1............c `� was ._-�o. '� 'ate--•-••--•---...... --- 3a...._...- S. N4 N` Installer Address dType of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............ ...........................Expansion Attic ( ) Garbage Grinder ( ) `PL4L4 Other—T e of Building ............................ No. of persons--------------------•___-_-_ Showers — Cafeteria Q' Other fixtures .................................. W Design Flow........!!_a............................gallons per person per day. Total daily flow........ V-_------__..............gallons. WSeptic Tank—Liquid capacity_ .gallons Length___.__ .... Width___�._.__�... Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length..........._........ Total leaching area....................sq. ft. Seepage Pit No........I............ Diameter...... ------------ Depth below inlet----b............ Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) `-� Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water--_-_--______-__-_.--_-. �r4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 � r --------•••-----------------•-------------------•...-• ...-- ---------------------- �------......................................................... Description of Soil.... --_---- ZQ----.......... -........+. rt 0 ".. 21 (, C LE�-j F ` w UNature of Repairs or Alterations—Answer when applicable................................................................................................ ----------------------------•------------------------------------------------------......-------------------------------------------•-------------------------------------------------------------•----- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed < ......,_,.. (� 1...... ------ '"` :`=- -----------------"---------- `\ _ -:-7---- � b ate Application Approved By ..... ...- /tA-- A/;rli fY :�/ /� --------------------------------- ----------------�-------------------- Application Disapproved for the following reasons- ----------------------- -------------------------- --------------------.......................... ................................................ ------------------ ------------------ ----------------------------- n ;";.-...... Date Permit No. --------(.�!--- --........ Issued ... lJ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE 0! er r#tttca#P of Compliance THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( or Repaired ( ) --------------------------------------------------- ------------------------------------------ Installer at9 ........ - .. . . --.-- ---------------------------------------------------------------- has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. --"............................................. dated ...........---.-----.---........................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE-- -------------------------------------------------------------------------------------- ---- Inspector -----.------------------------.........-----.----------------------------------------- ----- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No.--�±.................... FEE.......«0......... Disposal Works 0131nitrnrtiaan amit Permission is hereby granted_...� _��. �E 4._....('a N 1�._..______________ __ _ ---. ••--------------------•----•-•-•--------------..................-•---- to Construct ( b or Repair ( ) an Individual Sewage Disposal System ' at No.......... -6�........`-k ----t"`t z�r�4----V\Q-)I�--------•---.. ��----- _... �._�' ��h C� �11 � s �' " - " � ti et �,��i I(,� t as shown on the application for Disposal Works Construction Permit�No.__._�____ _�___ Dated'_-�_�_h"I.!-_�.........��1� I ................,ram^ ..V..---•-� B/o}ard�.�o f Health y{f`y DATE---------•-•... ]... INA] ................................. FORM 36508 HOBBS&WARREN,INC.,PUBLISHERS I Fee' --- A P P R 0 V E D BOARD OF HEALTH Barnstable: Cons©rvatiotT Wt4 OF B A R N S T A B L E � 10, �,�or�efr �or��tructior��ermit Signed Application is hereby� made for a, permit to Construct ), Alter ( ), or Repair ( )an individual Well at: T � --/yee7in _4_o_vse CGS_ /,r/�f -ns �/� _ Pa _ Losdion — Addres ' Asses rs Map and Parcel _-- R /'/'- ------------------- y Owner Address 0236 Installer — Driller —~_ Address Type of Building Dwelling-- ate h c c. - ---------------- Other - Type of Building--______—__________ No. of Persons------------- Type of Well—_��r l_11�- ___/ Capacity------------------------ --- Purpose of Well--- -�o --- 5��2� 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 Certificate of Complian has been issued by the Board of Health. ? - e= ----— u ---Signed---- ---- - ! —— � _ 1 d to Application Approved By-- date Application Disapproved for the following reasons:------------------------------- ------ -- date Permit No. qq _Issued-----------__— __—_---------- date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of (compliance THIS IS TO CERTIFY That the Individual Well onstructed (Altered ( ), or Repaired ( ) — ?-_- - - - by- - ---L�- - -- - �_1� -------------------------- - I staller IV1 Q�v S Q_ 4 w@sL—�- AWNS 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 --Dated------------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE--= --- - —--- ------- --- Inspector—---------------— - - - ------ ---- -�--- N0.-� 1_ � BOARD OF HEALTH TOWN OF BARNSTABLE 3p riiat ton-1brVeil Confstruction Permit Application is hereby made for a permit to Construct Alter ( ), or Repair ( )an individual Well at: l.c? —A/cc---ng�ouse__�—_ �s � '-' `�!�- - --- - - 5 -- - -f -------------------------- Location — Address- Assessors Map and Parcel ———'�----------—-----—— — 1 9 ��1��Tt�/—j=-----��-�------ Owner Address -------------------------------- oZ 3�� - Installer — Driller Address Type of Building Dwelling S `r 4 - - ------------------- Other - Type of Building-------------------------------- No. of Persons---------------------------- Type of Well--—1 r s�lc ----��- ------------/ Capacity------------------------------------------------------ -- --------------- Purpose of Well Agreement: v , 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 Compliant has been issued by the Board of Health. Signed ------------ --'71 Z� ------ date 4 Application Approved By--=— e-' =._ — 9"/__ date Application Disapproved for the following reasons:----------------------------------------------------------------________—__________ ---------------------------------------------------------------------------------------------------------------------------- q date Permit No. ------ ---�cy — -------------------------------- Issued-------------------------------------------------------- -------- __ date i BOARD OF HEALTH TOWN OF BARNSTABLE Certificate ®f Compliance THIS IS TO CERTIFY, That the Individual Well Constructed (✓Altered ( ), or Repaired ( ) y dstaller at----�(0: --------4-------/ -�_-�i r,�-�,ow S�� -�J G y-------- n —T_ A N S — f 2 - -------------------------- 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 AP?1'—L;r/-_--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 Vert CongtructionVermit d NO. ----i-�,/'----L4-g Fee--?—�-a--- Permission is hereby granted-------------� - A�=I '- �,_S n1 - = l I: J -------------------------------- to Construct (-`)Alter ( ), oar Repair ( /) an Individual Well Aat: �(�p /t No. -- C�- ------c-J---------------/_"ee T,,%,ni /._�_U,=(-- _---------liv ,1_=1-----G✓-ell-1-------201 PA/ 4p_ as shown on the application for a Well Construction Permit No. �d/ 71 � Dated - --Y - r --------- --� -r - — -- -- �� ------------------ Qoard of Health DATE-------------------------------------------------------------------------------------- ..... +ttt+mm�tn++tn+nt++tt+tt+++nnntnnt+mnt+++t+tt+nn+++++nm+s+n++++ttn .....+ ....t ttmn+tt+tt ttnntttt ++ nt+n+nntrl� ENVIROTECH LABORATORIES Mass. Cert.#:MA063 =- EE 449 Route 130 Sandwich,MA 02563 (508) 888-6460 -= _= John J. Kennefick CLIENT: _ LOCATION: 204 Meetinghouse Way ADDRESS: _ _ W. Barnstable, .PIA _ r j = COLLECTED BY: L. Wile SAMPLE DATE: 8-22-91 TIME: 12N -_ DATE RECEIVED:8-22-91 SAMPLE ID: Z364 JOB x: New Well — WELL DEPTH: 70/28 RESULTS OF ANALYSIS: Parameter Units Recommended limit Result - Coliform bacteria/100 ml (MF Method). 0 0 _ pH pH units 6.0-8 5 _ 6.97 Coriductance umhos/cm 500 _ 104 --"; Sodium mg;L 20.0 8.9 Nitrate N mgi'L 10.0 0.12 Iron mgj L 0.3 _ 0.31 Manganese mg/L 0.05 0.06 _ r _ Hardness mg/L as CaCO 500 24.0 c 3 M Sulfate mgi L 250 15.7 Potassium mg/L 20.0 0.8 B:E — -- = Alkalinity mg/L 200 20.0 -- Chloride mg L 250 14.2 c Turbidity N•TU 5.0 5.8 c =x Color APC units 15.0 <1.0 Background'bacteria COMMENT: Iron level is not a health hazard. EPA 601/602- ug/L Below Reporting Limit* see attached report A YES NO WATER IS SUITABLE FOR DRINKING PURPOSES FOR PARAMETERS ESTED. BE X�X DATE 3c� Cl J{uiJiiUuiUiiJ!lliilUliUliliUlUtllllt;iiiiuilllillJillliiUitillli,il{liiUililti{Ulttliutil{JJ1Jitili{313tlltil3311tttil{t{1{+t1t11UIlti{i!{Jttit:ithilt {iittutJltilittltlJiUlli{tJlJliitlullltlllilUltlI3III{tlJli111UJt1 GROUNDWATER ANALYTICAL EPA METHODS 601 and 602 Volatile Organics (GC/PID/ELCD) Lab ID: 1866-01 Field ID: Z-364 i Project: Kennefick 204 Meeting House Sa Batch: VGA-833 mpled: 08-22-91 Client: Envirotech Sa Received: 08- Cont/Prsv: 40ml VOA Vial/NaHSO4 Cool 2 Matrix: Aqueous Analyzed: 08-27-91 -91 PARAMETER CONCENTRATION REPORTING LIMIT j (ug/L) (ug/L) 5 Dichlorodif1uoromethane BRL 1 Chloromethane BRL 1 Vinyl Chloride BRL 5 Bromomethane BRL BRL Chloroethane BRL 1 TrichlorofIuoromethane BRL 1 l, l-Dichloroethene BRL 1 Methylene Chloride BRL 1 trans-1,2-Dichloroethene BRL 1 , 1-Dichloroethane BRL 1 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-Dich1 oroethane Trichloroethene BRL 1 1 - 2-Dichloropropane BRL 1 Bromodichloromethane BRL 1 2-Chloroethylvinyl Ether BRL 1 trans-1,3-Dichloropropene BRL 1 l Toluene BRL 1 cis-1,3-Dichloropropene BRL 1 1,1 ,2-Trichloroethane BRL 1 Tetrachloroethene BRL 1 Di bromochl oromethane BRL 1 Chlorobenzene BRL 1 Ethylbenzene BRLBRL 1 mtpp-Xylene * BRL 1 o-Xylene * BRL 1 _ Bromoform 1;1,2;2-TetrachloroethaneBRL 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 32 107. % 83 - 117 % Fllorobenzene 30 30 100 % 87 - 113 % BRL - Below Reporting Limit. * Non-target compound. "Trace" indicates probable presence below listed Reporting Limit. Method References: Method 601 - Purgeable 4alocarbons and Method"602 Purgeable Aromatics, 40 C.F.R. 136, Appendix A (1986). COMI\IOINIVEALTH OF MASSACHUSETTS �o EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON MA 0210E (617) 292-5500 TRUDY CONE Secretary ARGEO PAUL CELLUCCI DAVID B. STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 2350 Meetinghouse Way Name of Owner J. Kennef iek W. Bar s t ab l MA Address of Owner:c a Me Date of Inspection: Name of Inspector:(Please Prirn)Wm,. _F . Robinson Sr . I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CNIR 15.000) Company Name: Wm.. E . Robinson Septic Service Mailing Address: _20 Box 1089, Centerville , MA Telephone Number: 7r TT� h CERTIFICATION STATEMENT I certify that I have personally inspected the"sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: _Passes Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority Fails P Inspector's Signature: Date: J d . The System Inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within thirty (30) days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner `shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. NOTES AND COMMENTS 9 10 Q A Towrl�TMNSTAU �. revised 9/2/98 Pagel of11 f I Pnrted on Reucird Paper - r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM r PART A CERTIFICATION (continued) 'roperty re : 2350 Meetinghouse inlay, W. Barnstable , MA Jwner: 2 ennefick q Date of Inspection:, ¢ G`- 9 `/� INSPECTION SUMMARY: Check/A.I A C, or D: A. SY PASSES: !-J I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist. Any failure criteria not evaluated are indicated below. COMMENTS: r B. S STEM 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. Indicate es, no, or not determined (Y, N, or NO). Describe basis of determination in all instances. If 'not determined": explain why not. _ The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached)indicating that the tank was installed within twenty (20)years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked,structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. Sewage backup or breakout or high static water level observed in the distribution'box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced _ The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed j, revised 9/2/98 Page 2of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Prop"Address:2350 Meetinghouse Way, W. Barnstable , KA Owner: J. Kennef ick Date of Inspection: S j(ja 4 07 C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the I ublic health, safety and 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 THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) YSTEM 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 AND SAFETY AND THE 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 soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER I revised 9/2/98 Page 3of11 • r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 2350 Meetinghouse` Way, W. Barnstable , MA Owner: J. Kennefick - Date of Inspection: ,-/a--Q D. SYSTEM FAILS: You m t indicate either."Yes" or "No to each of the following: have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes o Backup of sewage into facility-or system component due to an overloaded or-clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 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 Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ Any portion of a cesspool or privy is less-than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E. LA GE SYSTEM FAILS: You mus indicate either "Yes" or "No" to each of the following: The following criteria apply to large systems in addition to the criteria above: he system serves a facility with a design flow of 10,000 gpd or greater(Large System) and the system is a significant threat to public ealth and safety and the environment because one or more of the following conditions exist: Yes o 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) The ow er or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of he Department for further information. revised 9/2/98' Page 4ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Prop"Address2350 Meetinghouse Way, W. Barnstable , MA Owner: J. Ke.nnef ick Date of Inspection: 5 16- Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes No / Pumping information was provided by the owner, occupant, or Board of Health. _ None of the system components have been pumped for at least two weeks and-the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. _ As built plans have been obtained and examined. Note if they are not available with N/A. Y _ The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow. The site was inspected for signs of breakout. 1J _ All system components, excluding the Soil Absorption System, have been located on the site. v _ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: _ Existing information. For example, Plan at B.O.H. Determined in the field(if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) [15.302(3)(b)] _ The facility owner(and occupants,if different from owner) were provided with information on the propermaintenaaca-0f SubSurface Disposal Systems. revised 9/2/98 Page 5ofII 1 } SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION )ropertyAddress: 2350 Meetinghouse ;Way, W: Barnstable., MA Owner: J. Kennefick Date of Inspection: ' FLOW CONDITIONS RESIDENTIAL: Design flow:?GO g.p.d./bedroom. Number of bedrooms (design): J Number of bedrooms (actual):_ Total DESIGN flow 34 0 Number of current residents:3 Garbage grinder lyes or no):4-O. Laundry(separate system) (yes or no):/✓ If yes, separate inspection required: Laundry system inspected (yes or no) Seasonal use (yes or no):_,�- O Well Water Water meter readings, if available (last two year's usage(gpd): Sump Pump(yes or no)A, Last date of occupancy: <-10 g COMMER IAL/INDUSTRIAL: Type of establishment: Design floe : gpd ( Based on 15.203) Basis of de ign flow Grease tra present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)— Non-sanitai y waste discharged to the Title 5 system: (yes or no)_ Water met r readings, if available: Last date f occupancy: OTHER:I gibe) Last date f occupancy: i GENERAL INFORMATION PUMPING RECORDS and ource of information: p System pungped as part of inspection: (yes or no)A<) If yes, volume pumped: gallons Reason for pumping: TYPE OF STEM 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) I/A Technology etc. Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components, date installed lif known)and source of information: ty Sewage odors detected when arriving at the site: (yes or no).0 revised 9/2/98 Page 6of11 f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 'TopertyA ess: 2350 Meetinghouse Way, W. Barnstable , MA Owner: Kenne f icck Date of Inspection: 6 q BUIL NG SEWER: (Locate on site plan) Depth be ow grade:_ Material f construction:_cast iron_40 PVC_ other(explain) Distanc from private water supply well or suction line Diamet Comm nts: (condition of joints, venting, evidence of leakage,-etc.) SEPTIC TANK:_ (locate on site plan) Depth below grade: Material of construction:_L"concrete_metal_Fiberglass _Polyethylene_other(explain) If tank is metal,list age_ .Is.age confirmed by Certificate of Compliance_ (Yes/No) Dimensions: Sludge depth: /U " Distance from top of sludge to bottom of outlet tee or-baffle: „ Scum thickness:5_ o Distance from top of scum to top of outlet tee or baffle:_ , Distance from bottom of scum to bottom of outlet tee or baffler How dimensions were determined: I L%"- )a C 'omments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid Ievel in relation to outlet invert, structural integrity, evidence of leakage,etc.) / 0. 0 e '^� T S' v— GRDJE TRAP: (locate n site plan) Depth be w grade:_ Material o construction:_concrete_metal_Fiberglass _Polyethylene_other(explain) Dimension Scum thic ess: Distance fr m top of scum to top of outlet tee or baffle: Distance f m bottom of scum to bottom of outlet tee or baffle: Date of la pumping: Commen (recomm ndation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evident of leakage,etc.) revised 9/2/98 Page 7of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Icorttirwed) 2350 Meetinghouse Way, W., Barnstable , MA 3toperty AdOW.M. � . Kennefick Date of Inspection: 5 ye-.q I TIGH OR HOLDING TANK: (Tank must be pumped prior to, or at time of, inspection) (locate o site plan) Depth belo grade:_ Material of onstruction:_concrete_metal_Fiberglass_Polyethylene_other(explain) Dimension Capacity: gallons Design flo gallons/day Alarm pre ent Alarm le el: Alarm in working order: Yes_ No Date of revious pumping: Comm ts: (condi on of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:_V . (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) - � � z PUMP C MBER:_ (locate on site plan) Pumps in orking order: (Yes or No) Alarms in working order(Yes or No) Commen (note co ition of pump chamber, condition of pumps and appurtenances,etc.) revised 9/2/98 Page 8of11 n SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 'roperty Address:23 50 Meetinghouse May, -W. Barnstable , . MA 0`"ner: J. Kemnefick Date of Inspection: / SOIL ABSORPTION SYSTEM(SASO (locate on site plan, if possible; excavation not required, location may be approximated by non-intrusive methods) If not located, explain: Type: leaching pits, number: leaching chambers, number:_ leaching galleries,number:_ leaching trenches, number, length: leaching fields, number, dimensions: overflow cesspool, number:_ Alternative system: Name of Technology: Comments: (note condition of spill, si ns of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.) le.0C' e oft, A � a CES POOLSsite pla:_ (loca on n) Number and configuration: Depth-to• of liquid to inlet invert: Depth of olids layer: )epth of s um layer: Dimensions of cesspool Materials of construction: Indication of groundwater: infl w (cesspool must be pumped as part of inspection) Comments: (note conditi n of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY:_ (locate on ite plan) Material of construction: Dimensions: Depth of olids: Comment (note con ition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) revised 9/2/98 Page 9ofII " i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C wv SYSTEM INFORMATION(continued) 'roper Address: 2350 Meetinghouse ,Way, W. Barnstable , MA Jwner: J. Kennefick . ,)ate of Inspection: (� SKETCH OF SEWAGE DISPOSAL SYSTEM: I S include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) v ti G w revised 9/2'/98 Page 10ofII i r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) ropertyAddress: 2350 Meetinghouse Way, W. Barnstable , MA Owner J. Kennefick Date of Inspection: -)b-4 a/ NRCS Report name Soil Type_ Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep SITE EXAM Slope Surface water Check Cellar Shallow wells X Estimated Depth to Groundwater Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record V/Observed Site(Abutting property, observation hole, basement sump etc.) Determined from local conditions Checked with local Board of health Checked FEMA Maps Checked pumping records Checked local excavators, installers Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) I- i 4 //Ic revised 9/2/98 Page 11of11 ` L ROFFICE LABORATORY ✓ 1498 HIGH STREET 176,PLYMOUTH STREET BRIDGEWATER, MA 02324 BRIDGEWATER, MA 02324 OLIVEIRA ENVIRONMENTAL LABORATORIES, INC. FOOD- DAIRY PRODUCTS-WATER-WASTEWATER CHEMICAL&BACTERIOLOGICAL ANALYSES (508)697-2650 January 6, 1989 L. Wile & Son Drilling Co. 11 Annasnappitt Drive Plympton, Mass. 02367 Source: Well Water - Drilled Well '(6 inch PVC) - 70 feet deep - producing 25 gals/min. Located on the property of Jane Burke - 2340 Meeting House Road - W. Barnstable, Mass. Coliform Count /100 ml @ 35 C 0 Membrane Filter S.P.C./ml @ 35 C 740 Color (APC units) 25.0 Sediment none Turbidity (NTU) 2.40 Odor none Taste metallic pH 6.50 Specific Conductance 80..0 micromhos/cm mg /liter Total Alkalinity (CaCO,) 17.0 Free CO, 10.4 Total Hardness (CACO,) 14.0 Calcium (Cal 4.80 Magnesium (Mg) 0.49 Sodium (Na) 6.70 Potassium (K) 0.88 Total Iron (Fe) 0-92 Manganese (Mn) L 0.01 Silica (SiOZ) 15.0 Sulfate (SO,) 12.0 Chloride (C1) 10.0 Nitrogen - Ammonia 0.08 Nitrogen - Nitrite 0.008 Nitrogen - Nitrate 0.29 Copper (Cu) _ L = less than On site collection made by L. Wile - 1/4/89 at 9:30 A.M. Sample delivered to laboratory by L. Wile - 1/4/89 at 10:15 A.M. Bacteriologically, this well water is of a satisfactory sanitary standard and is suitable for drinking and domestic purposes. Chemically, this well water is high in iron content. The color and taste are affected by the high iron content. All other chemicals tested meet the standards. Director • The Standard Plate Count indicated the general bacterial population of the well at the time of collection. Coliform Group Bacteria: Significance The coliform group bacteria includes organisms found in the intestinal tracts of warm blooded animals, birds,decaying organic matter(hay, leaves, wood, etc.), the top 2 to 3 feet of the soil, lakes, ponds, brooks, rivers, drainage and types of vegetation. Because.the organisms can cause some illness; because the presence of coliform organisms in the water suggests that other more harmful organisms may be present, water containing one or more coliform group bacteria per 100 ml of sample should not be used for drinking or cooking purposes unless boiled 5 minutes or disinfected by other means. This bacteria is of animal origin (intestinal tract)and may be considered as closely associated with disease causing organisms.On this factor, none should be present. Color — APC Units- Ground water ought to be practically free from color. For attractive water- color should not exceed 15 units. Turbidity — NT Units- Recommended limit not to exceed 5 units. Odor Et Taste — For water to be of high quality, the water should be odor free and taste good. pH — The pH value defines the concentration of free hydrogen ions in solution. Expressed on a scale extending from 0 or very acid to 14 or very alkaline with 7.0 being neutral. Specific Conductance — Conductivity is a good criterion for measuring the degree of mineralization and assessing the affect of diverse ions on chemical equilibria. Total Alkalinity — The alkalinity of this water represents its content of carbonates and bicarbonates. Free Carbon Dioxide — Well water having a low pH and a Free CO, level in excess of 50. mg/I will be corrosive to iron, bronze, brass and copper tubing and fittings. Total Hardness — Standard not to exceed 50. mg/I. Waters having a hardness level of 50 to 100 are in the medium hardness range, over 100 very hard. Calcium -- Calcium contributes to the total hardness of water.Appreciable amounts of calcium salts break down on heating and form scale in boilers, pipes and cooking utensils. Magnesium — Magnesium is a common constituent of natural water. Magnesium and calcium ions are principal contributors to water hard- ness. Concentrations in excess of 125 mg/I can exert a cathartic and diuretic action. Sodium — Recommended limit not to exceed 20 mg/I. Potassium — Potassium concentrations in drinking water seldom exceed 20. mg/I. Total Iron — Standard not to exceed 0.3 mg/I. Manganese — Standard not to exceed 0.05 mg/I.The principal reason for limiting the concentration of manganese is to reduce esthetic and economic problems. Silica — Silica content of natural water is most commonly in the 1 to 30 mg/I. Silica in water is undesirable because it forms difficult to remove silica scales. Sulfates — Standard not to exceed 250 mg/I. Chloride — Standard not to exceed 250 mg/l. Nitrogen — Ammonia is present in variable concentrations in many surface and ground waters. Its occurrence in ground water is generally a result of natural reduction processes. Nitrogen - Nitrite — Nitrite in water poses a health hazard, but fortunately seldom occurs in high concentrations. Waters with a nitrogen - nitrite concentration over 1 mg/I should not be used for infant feeding. Nitrogen - Nitrate — Standard not to exceed 10. mg/l. Nitrate, in high concentrations can and do cause methemoglobinemia or so-called nitrate poisoning in infants. Water with 10 or more mg/I of nitrate is unsatisfactory and is not considered safe for drinking or cook- ing. It is especially dangerous to children and should never be used in infant formulas. Copper — Standard not to exceed 1.0 mg/I. SYSTEM DESIGN. SYSTEM PROFILE ALL SYSTEM COMPONENTS SHALL BE NOTES FF TLEGEND i E N V MARKED WITH MAGNETIC TAPE OR PROVIDE MIN. 20" DIAM. WATERTIGHT (NOT TO SCALE) COMPARABLE MEANS FOR FUTURE LOCATION. 1. DATUM IS APPROX. FROM GIS MAP aSTING CONTOUR GARBAGE DISPOSER IS NOT ALLOWED ACCESS COVERS TO WITHIN 6" OF FIN. GRADE 2' PEASTONE OR GE❑TEXTILE CONCRETE COVERS TO WITHIN 3' GRADE 2, MUNICIPAL WATER IS NOT AVAILABLE X 99 EXIST, SPOT ELEV, FILTER FABRIC OVER STONE DESIGN FLOW: 3 BEDROOMS © 110 GPD = 330 GPD _0 DESIGN 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. MINIMUM .75' OF COVER OVER PRECAST 2% SLOPE REQUIRED OVER SYSTEM 41.0' 99 PROPOSED CONTOUR USE A 330 GPD DESIGN FLOW 4. DESIGN LOADING FOR ALL PROPOSED PRECAST UNITS PRECAST H-10 BLOCKS OR TO BE AASHO H-2.Q and E-9-971 PROPOSED SPOT EL, SEPTIC TANK: 330 GPD (2) = 660 RISERS cTYP,� PRECAST RISERS e �o TH1 .a. 2+a 4'OSCHAO 2' 4' COMPONENTS H-30 5. PIPE JOINTS TO BE MADE WATERTIGHT. Street �600 TEST HOLE **RE-USE EXISTING 1000 GAL. SEPTIC TANK �ENDS (TYP.) INV S EL. 4 SIDES 36.0' 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH ' 310 CMR 15.000 (TITLE 5.) 10' 14" P 00000000000000°o° EXISTING TEE 48.3' ®®®� 0��� 0��� -�0El0 '°°°°° 2% SLOPE ❑F GROUND ' " TEE * ° ° ° ° °°°°° LEACHING: SEPTIC TANK** °°°°°°°° o0000000000 00000000000 °°°°°°°° 0 0 0 0 ° ° ° ° ° 7. THIS PLAN IS'FOR PROPOSED WORK ONLY AND NOT TO 00000000 0° 'o°oo ° O O O O O O O O D O O O O O O O O O�) UTILITY P❑LE ( = 0 0 0 o c ° ° ° ° DDO��OOaO�� a00000�0000 ° ° ° ° BE USED FOR LOT LINE STAKING OR ANY OTHER Locus SIDES: 2 25 + 12.83) 2 (.74) 112 GPD GAS BAFFL .. 0000000o ni >ooa000mo o o 0 0 o 0 0 0 °o°o°°° �BOTTOM 25 x 12.83 .74 = 237 GPD ° ° ° ° ®�®��O�O�DO OO®®®®®( ) 35.:2rT 35.10 33.0' PURPOSE. FIRE HYDRANT 6""MIN. SUMP °°°°°°°° °°°°°°°° 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. NOTE: NOT ALL SYMBOLS MAY APPEAR IN DRAWING 12 MIN DIAM. TOTAL; 472 S.F. 349 GPD aia°-1-1/2' DOUBLE WASHED STONE 4' MIN, H-20 500 GAL. LEACHING CHAMBER BY ACME PRECASTOR EQIUAL ALL 1-1UND PRECAST STRUCTURES (2) UNITS REQUIRED 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED USE (2) 500 GAL. LEACHING CHAMBERS ACME OR EQUAL 6" CRUSHED STONE OR MECHANICAL OVERALL DIMENSI❑NS TO OUTSIDE OF ST❑NEs 25' X 12,83' WITHOUT INSPECTION F BOARD OF HEALTH AND WITH 4' STONE ALL AROUND ( ) COMPACTION. (15.221 [21) PERMISSION OBTAINED FROM BOARD OF HEALTH. *THE INSTALLER SHALL VERIFY THE **INSTALLER SHALL CONFIRM MINIMUM SEPTIC TANK SIZE AT ***2.0' LOCATIONS OF ALL UTILITIES AND ALL 1000 GALLONS AND ITS SUITABILITY FOR RE-USE. REPLACE 10.DIGSAFE (1 888R 344- 3 RESPONSIBLE FOR CALLING WITH 1500 GALLON SEPTIC TANK APPROPRIATE TO SITE LOCATION (1 F ALL UNDERGROUND AND VERIFYING THE LOCUS MAP LOCATION OF ALL UNDERGROUND & OVERHEAD UTILITIES BUILDING SEWER OUTLETS AND CONDITIONS IF NOT SUITABLE ELEVATIONS PRIOR TO INSTALLING ANY 31,0' BOTTOM TH-2 PRIOR TO COMMENCEMENT OF WORK. NOT TO SCALE ( 5.2% 'SLOPE) ( 1 % SLOPE) NO GROUNDWATER FOUIND PORTION OF SEPTIC SYSTEM 11. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL BE MA LEACHING ***INSTALLER SHALL CONFIRM NO GROUNDWATER REMOVED 5' BENEATH AND AROUND THE PROPOSED ASSESSORS MAP 155 PARCEL 32-2 APPROVED DATE BOARD OF HEALTH ' FOUNDATION EXIST. SEPTIC TANK 24�7' D' BOX 12' FACILITY FOR MIN. 5' BELOW BASE OF SAS & 4' OF LEACHING FACILITY. N A?. V�) 1116 POTABLE WELLS WITHIN 200' OF PROP. SAS CONTIGUOUS SUITABLE SOIL 12. EXISTING LEACHING FACILITY SHALL BE PUMPED AND REMOVED OR PUMPED AND FILLED WITH CLEAN SAND. �Ir9 o`er TEST HOLE LOGS �6 ENGINEER. ARNE H. OJALA, PE, SE WITNESS: DONNA MIORANDI, RS DATE: SEPTEMBER 16, 2013 ExtsTlNc WELL PERC. RATE _ < 2 MIN/INCH TH 3 BENCHMARK: STK. SET AT CLASS I SOILS P 14149 ELEV. 44.0' 1 00� TH 1 I ELEV. � ELEV. 4 0„ 4 . ' 0" 0,1 44.D' 430 `V 44.0' 0" 4 43.0' A A A A �SL �SL TYR L7 /SL TH 4 EXIST. 6'0 1OYR 4/3 6" 1OYR 4/3 6" 4/3 6'1 1 OYR 4/3 BARN \ (SLAB) 3 P B B B B 0 TH 2 /SL /SL SL 36" 10YR 6/6 ' 40" 1OYR 6/6 36" 10YR 6/6 36" 1OYR 6/6 \ '\ 40.7 O 5� jC1�j �C1� �C1�// �C1// SILT LOAM/ SILT LOAM SIFT LOAM SILT LOAM 10YR 6 4 10YR 6 4 10YR 6 4 11OYR 6 4 72" 38.0 740p 36.8' 66" 38.5' 72" 37 PERC C2 C2 C2 PERC C2 4 12" MAPLE \ MS MS MCS MCS 2.5Y 7/4 2.5Y 7/4 2.5Y 7/4 2.5Y 7/4 EXISTING DWELLING 144" 32.0' 144" 31 .0' 138" 32.5' 138" 31 .5' NO GROUNDWATER ENCOUNTERED NO GROUNDWATER ENCOUNTERED o ` \ 0 36" t MAPLE \ 50. �1 I 14" APLE � I 20" / TITLE 5 SITE PLAN MAPL / EXIST. SEPTIC TANK** OF I MAPL R• VARIANCES FOR SEPTIC SYSTEM, REPAIRS WHICH MAY BE 2350 RTE. 149 I LE IMMEDIATELY GRANTED BY THIE BOARD OF HEALTH AGENT OR SO BY HEALTH INSPECTOR 18„ WEST BARNSTABLE I PAPERWORK AND HE ARING REDUCTION .PROPOSALS APPROVE D 1 v BY THE BOARD OF HEALTH RZEVISED DURING A PUBLIC HEARING HELD ON AUG. 4, 21009 PREPARED FOR PROP. C.O. / FAILED SYSTEMS ONLY `.BOAC ABSORPTION SYSTEM IN HICKEY CONSTRUCTION INSTALLATIONS PROPOSED MORE THAN THREE FEET BELOW 1 GRADE WITH PROPER VENTING PIPED TO THE ATMOSPHERE AND WITH H-20 LOADING, BUT IN NO CASE SHALL THE SAS / BE LOCATED MORE THAN SIX FEET BELOW GRADE. SEPTEMBER 17, 2013 Scale: 1"= 20' 0 10 20 30 40 50 FEET - * , � �, off 508-362-4541 �jH OF�qs �F M fax 508-362-9880 Assq downcape.com DANI o SL A. DfiNIEL � I o OJALA A. �. CIVIL I down cope engineefing ift. I �; OJALA �� , �a �� 465a�� : �o n.4 civil engineers ��ST R land surveyors o FS Fs, y r. I 5 s uR 939 Main Street ( Rte 6A) IDATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02675 9 >-236 i