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'' .i , t�1 t �x t ,}. at TOWN OF BARNSTABLE 3 ' LOCATION S-6 a' L& i SEWAGE V?LLAGE lJ ASSESSOR'S MAP&PARCEL :g INSTALLER'S NAME&PHONE NO. 3-, C SEPTIC TANK CAPACITY 4s 4 v LEACHING FACILITY: (type) f�� (size}-_3,��c 14.fg r Y-3-3t' NO.OF BEDROOMS 1z&-6j d Q' T '� OWNER ���GU1L t t-f _ Cgec1G.- 4 �'i OF, PERMIT DATE: 40- t'7, 14 COMPLIANCE DATE: I Separation Distance Between the: _ Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility J_S 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) I Feet FURNISHED BY � o � - y-I �- 43 3 -� 41 TOWN 0 BA.RNSTABLE 1/ LOCATION S SEWAGE # VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) lf 42 (size) NO. OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE D Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by ECO-'TECH ENVIRONMENTAL. THIS FORM IS A FACSIMILE OF THE STANDARD SEPTIC INSPECTION FORM ISSUED BY THE MASSACHUSETTS DEPARTMENT OF ENVIRONMENTAL PROTECTION (revised 6/15/2000) TITLE 5 OFFICIAL INSPECTION FORM _NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A RECEIVED CERTIFICATION Property Address: 50 Apollo Drive MAY 1 5 2002 West Barnstable Owner's Name: Mary Sulls Owner's Address: 50 Apollo Drive TOWN OF BARNSTABLE West Barnstable, MA HEALTH DEPT. Date of Inspection: May 14, 2002 Name of Inspector:(Please Print) David D. Coughanowr, R.S. wAP 3I Company Name: Eco-Tech Environmental Mailing Address: 43 Triangle Circle PARCEL. Sandwich, MA 02563 LOT Telephone Number: (508) 364-0894 CERTIFICATION STATEMENT: I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. I am a DEP approved system inspector pursuant to section 15.340 of Title 5 (310 CMR 15.000). The system: X Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails (TIN Inspector's Signature Date: k6lt 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 NOTES AND COMMENTS Inspector's Note==> A septic system is deemed to pass this Real Estate Transfer Inspection if it does not trigger any of the failure criteria listed below. The septic system has been evaluated according to the conditions observed on the day it was inspected. No estimate or guarantee of system longevity is made or implied by a passing determination. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 r OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 50 Anollo Drive West Barnstable Owner: Mary Sulls Date of Inspection: May 14, 2002 INSPECTION SUNIMARY: Check A, B;C,D or E/ALWAYS complete all of section D: A] System Passes: _X I have not found any information which indicates that any of the failure criteria described in 310 CMR 5.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. COMMENTS: B] System Conditionally Passes: One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no, or not determined (Y, N, or ND). in the_for the following statements. If"not determined" please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not), is structurally unsound, exhibits substantial infiltration or exfiltration, or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or breakout or high static water level 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 Board of Health). broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced. ND explain The system required pumping more than 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 ND explain 2 Page 3 of 11 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 50 Apollo Drive West Barnstable Owner: Mary Sulls Date of Inspection: May 14, 2002 C) Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system s failing to protect public health, safety and environment. 1 System will pass unless Board of Health determines in accordance with 310 CMR 15.303 (1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2) System will fail unless the Board of Health (and public water supplier, if any) determines that the system is functioning in a manner that protects the public health, safety, and environment The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis, performed by a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form 3) OTHER 3 Page 4 of 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 50 Apollo Drive West Barnstable . Owner: Mary,Sulls Date of Inspection: May 14, 2002 D) System Failure Criteria applicable to all systems: You mint indicate either "yes" or "no" to each of the following for all inspections: I 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 no _X_ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool. X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. __X_ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. _X_ Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. _X_ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _2L_ Any portion of the SAS, cesspool or privy is below high groundwater elevation. _X_ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone 1 of a public well _X_ 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 by a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form) No (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore, the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large 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 You must indicate either "yes" or "no" to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone 11 of a public water supply well. If you have answered "yes" to any question in Section E the system is considered a significant-threat, or answered "yes" in section D above the large system has failed. The owner or operator of any large system considered a significant threat under section E or failed under section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 r , Page 5 of 11 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 50 Apollo Drive West Barnstable Owner: Mary Sulls Date of Inspection: May 14, 2002 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. —X— Were any of the system components pumped out in the last two weeks? X Has the system received normal flows in the previous two week person? —X— Have large volumes of water been introduced to the system recently or as part of this inspection? jila- Were as built plans of the system obtained and examined? (If they were not available as N/A) X Was the facility or dwelling inspected for signs of sewage back-up? X Was the site inspected for signs of breakout? X Were all system components, excluding the SAS. located on site? Were the septic tank manholes uncovered, opened, and the interior of the septic 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 he facility owner(and occupants, if different from owner) provided with information on the proper maintenance of subsurface disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: Existing information. For example, Plan at the Board of Health. X Determined in the field(if any of the failure criteria related to part C is at issue, approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] 5 Page 6 of 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 50 Apollo Drive West Barnstable Owner: Mary Sulls Date of Inspection: May 14, 2002 FLOW CONDITIONS RESIDENTIAL Number of bedrooms (design): n/a_ Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): n/a-no plan on file at BOH Number of current residents Does the residence have a garbage grinder(yes or no): no Is laundry on a separate sewage system(yes or no): no If yes, separate inspection required). Laundry system inspected (yes or no): n/a Seasonal use (yes or no): na Water meter readings, if available (last two year's usage(gpd):n/a-well in use Sump Pump(yes or no): no Last date of occupancy: current O R A ,/IND IA Type of establishment: Design flow(based on 310 CMR 15.203):: gpd Basis of design flow(seats/persons/sgft/etc.): Grease trap present: (yes or no) Industrial waste holding tank present: (yes or no): Non-sanitary waste discharged to the Title 5 system: (yes or no) Water meter readings, if available: Last date of occupancy/use:_ OTHER: (Describe): GENERAL INFORMATION PUMPING RECORDS source of information: System last puped February., 2000(Owner) Was system pumped as part of the inspection: (yes or no) No If yes, volume pumped: gallons --How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM: X 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/Alternate technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight Tank attach a copy of the DEP approval " Other(describe) APPROIIIMATE AGE of all components, date installed(if known)and source of information: Age: assumed to be 30 years -Home built in 1972. New D-Box installed February 2000 (BOH permit#2000-53) Were sewage odors detected when arriving at the site: (yes or no)-m 6 i Page 7 of 11 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 50 Apollo Drive West Barnstable Owner: Maa Sulls Date of Inspection: May 14, 2002 BUILDING SEWER_(Locate on site plan) Depth below grade:_1 5 ft. Material of construction: cast iron X 40 PVC_other(explain) Distance from private water supply well or suction linedt_ Comments: (on condition of joints, venting, evidence of leakage, etc.) Sewer is vented through roof and appears structurally sound with no evidence of leakage or backup into dwelling SEPTIC TANK:X(locate on site plan) Depth below grader Material of construction: X_concrete metal fiberglass polyethylene _other(explain) If tank is metal, list age_ Is age confirmed by Certificate of Compliance_(yes or no): (attach a copy of certificate) Dimensions: 8.5 ft x 5 ft x 5 ft(1000 gallonl Sludge depth: 12 in Distance from top of sludge to bottom of outlet tee or baffle: 22 in Scum thickness: trace Distance from top of scum to top of outlet tee or baffle: 10 in Distance from bottom of scum to bottom of outlet tee or baffle: 14in How dimensions were determined: Probe to top of tank Comments: (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Puming recommended within 1 year, Liquid level at outlet invert_ Tank and tees appear structurally sound and functioning as intended. No evidence of leakage in or out. GREASE TRAP: none (locate on site plan) Depth below grade: Material of construction: concrete_metal fiberglass_polyethylene other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments: (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 50 Apollo Drive West Barnstable Owner: Mary,Sulls Date of Inspection: May 14, 2002 TIGHT OR HOLDING TANK: none (Tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrew metal fiberglass polyethylene other(explain) Dimensions: Capacity: gallons Design flow: _gallons/day Alarm present(yes or no):_ Alarm level: _ Alarm in working order(yes or no): Date of last pumping: Comments:(condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX: X (if present must be opened) (locate on site plan) Depth of liquid level above outlet invert: at outlet invert Comments:(note if box is level and distribution to outlets is equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.) D-box appears structurally sound with no evidence of leakage in or out Effluent level at nutlet invert No solids in tank. PUMP CHAMBER: none (locate on site plan) Pumps in working order: (yes or no) Alarms in working order: (yes or no) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): 8 Page 9 of 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 50 A�pollo Drive West Barnstable Owner: Mary Sulls Date of Inspection: May 14, 2002 SOIL ABSORPTION SYSTEM(SAS):X(locate on site plan; excavation not required) If SAS not located, explain why: Type: beaching pits, number leaching chambers, number beaching galleries, number beaching trenches, number, length beaching fields, number, dimensions one- 15 ft x 25 ft(approximate) _overflow cesspool, number innovative/alternate system Type/name of Technology Comments: (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.) Soils above leach field appeared unsaturated. No evidence of surface ponding breakout, lush vegetation, or other evidence of hydraulic failure was observed. Observation hole dug into field showed no level of standing water or sulfide staining. CESSPOOLS: _none (cesspool must be pumped at time of inspection) (locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): PRIVY: none (locate on site plan) Materials of construction: Dimensions:— Depth of solids: Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 9 Page 10 of 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 50 Apollo Drive West Barnstable Owner: May Sulls Date of Inspection: May 14, 2002 SKETCH OF SEWAGE DISPOSAL SYSTEM: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100' (Locate where public water supply enters the building) LEACH LOCATIONS Field A B 1 57 ft 24.5 ft 30 D-BOX 2 59 f t 28 f t 3 62 f t 36.5 f t 2 SEPTIC TANK o i 8 A 4 BEDROOM DWELLING # 50 W z J W F- i WELL APOLLO DRIVE NOT TO SCALE 10 .f• Page 11 of 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 50 Apollo Drive West Barnstable Owner: Mary Sulls Date of Inspection: May 14, 2002 SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to ground water: 12+ feet Please indicate(check)all methods used to determine high ground water elevation: Obtained from system design plans on record-If checked. date of design plan reviewed Observed Site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of health-explain: Checked local excavators, installers-attach documentation) X Accessed USGS database You must describe how you established the high ground water elevation. GIS office information shows area of leach field to be approximately 12 feet above the groundwater table Applying a groundwater adjustment of 2.9 feet(SDW-252 Zone B, level = 47.8 for April 2002) and estimating the bottom of the field to he 2 feet below the surface, leads to the conclusion that the field is entirely out of the seasonal high groundwater table. 11 Page 10 of 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 50 Apollo Drive Wes Barnstable Owner: Mary Sells Date of Inspection: May 14, 2002 SKETCH.OF SEWAGE DISPOSAL SYSTEM: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100' (Locate where public water supply enters the building) LOCATIONS LEACH Field A B 57 f t 24.5 f t 2 59 ft 28 ft 30 D-BOX 3 62 f t 36.5 f t 2 SEPTIC TANK no B A 4 BEDROOM DWELLING # 50 W Z_ " J K W I- Q WELL APOLLO DRIVE NOT TO SCALE 10 No. 'C�'� " r Feel f THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01pprication for Migonl *pgtem Construction Permit Application for a Permit to Construct( )Repair Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. S(gy p` 0(( Owner's Name,Address and Tel.No. Assessor's Map/Parcel s i iao& 'J 10 L0 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. i oitS S�. ���� S. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil: Nature of Repairs or Alterations(Answer when applicabl J IV r S`r�•a s�w� P u� �a � �c r�� s �J_ 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 Certifi- cate of Compliance has been issued oar ` Signed 1 Date /'1:V`4E51_1 Application Approved by G Date 7,dr-0 Application Disapproved for the following reasons Permit No. Date Issued 4No. Z,�Ziq ' or2 Fee S�Z71 THE COMMONWEALTH OF MASSACHUSETTS Entered in-computer: Yes PUBLIC HEALTH DIVISION-TOWN OF BARNSTABLE, MASSACHUSETTS 01pprication for Zigpogar *pgtem Congtruction Vermit Application for a Permit to Construct( )Repair Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. `s A061 Qf tom_ Owner's Name,Address and Tel.No. Assessor's Map/Parcel , ( Po ( Installer's Name,Address,and Tel.No: Designer's Name,Address and Tel.No. Sept C 1 Type of Building: ` Dwelling No.of Bedrooms-_w 14- Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures esign Flow gallons per day. Calculated daily flow gallons. Zan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable 5roa-i A)-C AG}e S 6 V Date last inspected: Agreement: The undersigned agrees to en"sure 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 Certifi- cate of Compliance has been issued Board o _ Signed zi A, -` Date Application Approved by._ - K Y. Date /-?_ 4ZO Application Disapproved for a following reasons Permit No. Date Issued --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certif irate of Compliance - THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired(V )Upgraded( ) Abandoned( )by S at l S,-t has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. '7erm - 5-3 dated l- Z P-CFO. Installer Designer f The issuance of this? ,pe t a not be construed as a guarantee that th s 'stem ill function as d i ned. f v c Date Inspector ——————————————————————————————————————— No. Z U� 'S Fee THE COMMONWEALTH OF MASSACHUSETTS J -0 PUBLIC HEALTH DIVISION - BARNSTABLE} MASSACHUSETTS 1wigo0ar *pgtem Congtruction permit Permission is hereby granted to Construct( )Rep ' ( Upgrade( )Abandon( ) System located at r% t " —0, and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of t:00"4, R. �t /� Q Date: Z �' / Ti�'�s7 Approved by . r GL 'I ' - / ra 1/6/99 NOTICE: This Farm Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) hereby certify that the application for disposal works construction permit signed by me dated —;)(51 e , concerning the property located at 5-o A-©P KD 0#4ea-5 meets all of the following criteria: VThis failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. �• The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. T� There are no wetlands within 100 feet of the proposed septic system �• There are no private wells within 150 feet of the proposed septic system There is no increase in flow and/or change in use proposed • There are no variances requested or needed. "• The bottom of the proposed leaching facility will not be located less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when pplicable] • If the S.A.S.will be located with 250 feet of any vegetated wetlands,the bottom of the proposed leaching facility will not be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation(using GIS information) B) G.W.Elevation +the MAX.High G.W.Adjustment. _ DIFFERENCE BETWEEN A and B SIGNED : DATE: � U [Please Sketch propos plan of system on back]. NOTICE Based upon the above information,a repair permit will be issued for bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. q:health folder:cert i FRiSOU & FRISOU _ AT MNEY'S AT LAW 797 Cambridge Street Cambridge, Massachusetts 02141 (617) 354.2220 (617) 3,15"939.Facsimile Frank J. Frisoli, Jr. Lawrence W. Frisoli, P.C. Wendy Stander, Esq. FAX TRANSMB98ION FFROM oPIENM Fax M FCOPENM TEL #: FROMa„•, DACE: /o d RE= o o r Special kvWucdanw Page l of,� findi6ng this page) This communication and all accompanying documents are intended solely for the individual or entity _ designated above and constitute confidential privileged information fivm the Law Firm of Frisoli& Frisoli, Attorneys at Lew. Any disclosure.copying.distribution or other use of this communication end/or the socompenying tents by anyone other than the addressee is strictly prohibited. If you have received Oft communication in error. please notify this office by telephone at (617) 35"220 to arrange retrieval of the entire communication at the cost of Frisoli S Frisoli. TOOO 9,S11V TTosTJ3 V TTosTJ3 � 6C69 tSC LT9 %V3 MCT 311.E 00/10/i0 FROM WALSH REALTY 775—r3M 'PHONE NO. ; 508 771 12S2 Nov. 15 1999 03:49PM P2 / `16.. CO I\IQ.\tt'E LTH OF 1`*LAS SAC HL;SFTTS OFFICE OF E\vIRO1�NlENT�- AFF,�JF=; r' OF ENVoNMENTAL PR.oTECTION DEPARTMENT ON NiA 0210iE tet;l 291•�',tlu r. ON RZy7ER SIRS ?•BOST TRUPY CO!, Svtre:a DAVID B.STP.-3 tornntiss:_. ARG£O PAUL CELLL'CC( Governor SUBSURFACE SEWAGE DIS PART p TST>?FA 1HSP6CT10N FORM CrRT1F1CAT11OK r� Pot�e� �� t�tame of 0vrne� property Address: O ddress of Co^mr: 1 �,•�v+�•�tlS'tlrb� //// Date of b-peeeo•r:.It3`tt,�5 Jr �c U Marne of Wp�t(Ptoase Pt+ l �. � 15.W of Trde 5(310 CIAR 15.901 secdon I arlt a Depa�p,.//Oroved arstom Inspector purwartt t� o company Kartx: £'LZLss._�, — !7 y- c"s 4-r7 pt Mng Address: 1 I a . Tdeyl+ona Mwltbet: /�o CEATIPtGAT10H STA"CEMB)i7 $ ora�s stern st thin address and that the Information rcpo fed below is true. accurate I oenih that I haue personally Inspected the sewage e" Y ertormed based on my trelning and.axperience-;n the proper runetlan and and carnplete as of the,time of inspection. The'navt�Uo^vss p maln:enonee of en•sit@ sewage diapobal systerns. The system; Pastes Cand;tionaUy Posses Needs Further vDlUb n 6 local Approving Authority Faits � C—L sate: V y�prector•s Siyraiwre: 11te Syseertr Inspector shall subrrtit s espy of this tnspeetion report to the Approving Author;ty(Board or Heahh or GEplwithln thirty(30) days completl^g ttt s Inspection- 11 the system is a shared system or%as a design flow co 10,000 gro or greeter.the original Should and the srststat ow shall submit the report to the appropriate regional offiee of the Oepartn7ent of ERvito^mental Proteetlon. The or(Sinel should be acne to ttte tystern owner and copies sent to the buyer,if appGeable.and the approving authority. NOTES AND COMMENTS revised 9/2/98te�:ert1 • �,'• •• ��vrwrtd as aayetd irp:r 11/15/99 MON 14:21 [TX/RX NO 6535) Z00 s•a11y TtOsTJ3 'S T109T.13 6£69 bSC LT9 %`r3 £S CT 311E 00/TO/ZO FROM : WALSH REALTY 775-7330 ^ PHONE NO. : 508 771 1202 ^ Nov. i5 1999 03:50PM P3 SUBSURFACE SEWAGt DISpo5A1.S+STEtA INSPECTION FCftM PART A 1 CERTIFICATION Icwydrtuedl -,covey Addrea:: JvrrnY: Date of irtspocyon: INSPECTION SUMMARY: Check A. 0. C. Of D: A. ISrSTFM PASSES: t Of the failure conditions described in 310 CMR t 5.303 exist. Any fsiture I hove not found any infaffation which ind4atts that any ofiteris not evaluated are indicated'below. commeNTS: g. Sy9TEM comPITIONALLY PASSES. One or mere systaM eompononts as dase:ibed in pipe'Conthtr tHoa►d ofsHealth,will Das needs- to be replaced or repaired. The syatnm.open completion of the replacement or rao01r,as approved by ►,tdeata yes.no,er not determined IV. N, of NO). Oeeeribe basis of determination in all Instance:. 1t not determined-.explain why not. The septic tank is metal,unlegs the owner or oparatar has provided the systen+inspeet°r with a copy of a Cerlfreate of _ Cornp6ence(attached)indicating that the tank was instaltod within twenty 1201 Years prior tC the date a!the ihapeetion:or the septie tank,whetftet or not metal,is ereeked,structurally unso septic eep`clank 1 urepiaeed wjil ith at Compiling ion at iseptic tank a= failure is Imminent. The system will pass lnapeertion if the esistin�. P approved by the Board of Health. sulb obstructed Sewage backup or breakout o level baz.°bstrvtd in The sr Samhwill pass inspecSon It 1w th approval ref the Boa a ojatsl or Cue to a broken, settled at uneven distribution Health). broken pipets) are replaced obstruction it feenoved distribistion box Is levelled ar replaced e, qulred wR+DinA m°re than four times a year due to btaken or obstructed plpetsl, The system will pass The yYstaR. inspection if(with approval of the Board of Health(: broken pipa(si are replaced obstruction is fernoved c 2 e!ll t r' revised 11/15/99 RON 14:21 CT%/RX NO 65351 `� C000 9,d12F TTO9T-13 'S TT09TJ3 6C69 6SC LT9 %V3 CS-7-CT 3t1Z 00/TO/ZO i FROM WRLSH RZ—ALTY 775-7330 ''` PHONE NO. SGa 771 1282 ^ Nov. 15 1999 93:50PM P4 su65UIVACE SFWA09 OIS PA A OSALSYSTEM INSPECTION FVRM AT CERYIFICATiONt Icortinuodi PropcttY Address: Oate of Ittapa t;MR: C. r-uRTHER EVALUATION IS REQUIEtED 8y THE BOARD OF HEALT"; Cortd(tio..e exist.which require fYRhet evaluation by the Board of h{eafth in order to determine if the system is sailing to protect the Public health. Safety and the envifcn`*nt. 11 INSS STSYM WILL PASS OIKi�t;Ct IN UNLESS 1JlBOARIPANNPJt QF C�WILL PLTH RO pCT THE Pyi3tlf:NFAITH IN ACCORDANCE AND SAFETY AND•THE 303(ENVIRO M IXT:SySTE tS NOT FUNCTIONING Cesspool or privy is Within 5o I[* ' of su►fate waterated wetland or a salt marsh. Cesspool at privy is Within 50 feet'gf a bordering gSt 21 S7STt,lrl WILL PAIL WNLFSS THE BOARD OF SALT 8ti M��TM AND SAvFER,(AKO mET�V(RONMEN7 THAT THE SYSTEM FVNCMON(NG IN A pitANNER TKAT PROT6 The system has a seotie tottk and ao0 obsorvven SYS rn(SASI and the SAS is within 100 feet of a surface water supply r tributary to a surfaoa water supply. p wcli. The system has a septic tank and soil absorption systarrl and the SAS is within o 2one{et p ub(ie water supply well. The system has S septic tank and Solt absorption system oQ the SAS is less the SAS is ithan 100 leer but y50 act or ntopeyfrvm a The SYsteri+has a Septta tank end toll ebsorpdan STstam oft private water tsup0lY rre1t•unless s well water one for titform bacteria and volatile orpanie con+pounda indicates tnat well t free from pollution from that fell water and the present of ammonia nitrogen and nitrate nitrogen is equal to or less Iappro:fmadom not•alidl. than 5 ppm. Method used to determine distance 3I OTHER Page 3 or 11 revised 9/2/96 11/15/99 MON 1.4:21 [TI/RX NO 65351 too in 9,9118 T103TJ3 29 TTOsTJ3 6C69 6SC LT9 1N3 bS:CT 31U 00/TO/ZO FRl7M WALSH FEALTY 775-7330 PHONE NO. = 5� 771 1282 �.. Nov. 15 1999 03:50PM P5 SUBSURSACE SEWAGE DIS P SAL a T's7Eµ INSPECTION FORM RT CERTIFICATION(cendrwedl � y Address: Owfwt Date of lnspesaon: p_ SYSTEM PANS: you must 7ndieate eleher 7es" or 'Nd" to each of the tw ng foil I have detarrnine that one or merit o!the fallowing t8lure conditions exist as described in 310 -MR 15,303. The basis for this I have is i ntt on below• The}hoard of Maslth ah0uid be eontaeted to determine what will be necessary to COrract the Iailvrr, Yes No ed SAS or Cesspool. Backup of at age into facility at system come°rent duo to an overloaded or eta8g Discharge at pan ing of aHlu°nt to the surface of the ground or surface watara doe to an overloaded at eioggod SAS at cesspool• _ Static liquid love)1rt t diatributien boa above cutlet invert due to an overloaded or clogged SAS Or Cesspool. Liquid depth in cesspool less than fi"below invert Or available v°lume Is less than 172 day now. r Required pumping meta the a times in the last year NOT due to clogged or Obs1rue1s4 pipalsr. Number of times gumpad_ Any portion of the Soil Abserpu \Yatrm.Gas spool or privy is below the high grov^dr.eto, c!evetien. Any portion of n cesspool or Privy r witnin 100 feet of a svrfaee water suopiy or tributary to a aurtaCe water supply portion of a cesspool of privy is we him a Zone I of a public Well_ Any p \\ Cesspool of rive is with So feet Of a private water svpolr wall-_ Any pertton of a eesap D 'C privy is less eh 10e teat but greater than SO feet from a private water Any pO►den of a Cesspool Or supply well with no water quality analysis. It the we" es been anaiy¢ed to be acceptable, attach eocy at wail watt?analysis tar aet:epaMOiable coliform bacteria, volatile organic compounds. enimanis nitrogen and nitrate nitrogen. F L&NGE SYSTEM FAILS! You must Indicate tither'Yss-at'No" to each eI the followings The following criteria apply to large systems In addition to the iteris above: The system serves a teeitity wlth a design Row of 10.000%Pd or renter(Large System)and the system is a sisnifieant threat to pi health and safety and the environment because one or mare of the allowing conditions exists Ya: Na the systertt is within 400 foes of s surface drinking water supP the system is within 200 fact of a tributary to a surface drinking ater supply the system is located In a nitrogen tenslt)ve area(Interim Wellhead P teetlon Area•TWPA)or a mapped Zone ll 01 a pot water supply woltl all upgrade the system in accordance with 310 mR 1 S.30412). Please eOnsU11 the local re91t The owner Of operator Water any such system sh otrice of the Department for further InfOfmOtion. Mg♦of 11 revised 9/2/98 11/15/99 MON 14:21 iTX/RX NO 65351 I� 30018 9,S11V TTOSTJ3 s8 TTOSTJ3 6C69 bS'C LT9 %1'3 bS CT 311E 00/TO/ZO FROM 6qLSH ReALTY 775-7330 r-. PHONE NO. 508 771 12e2 Nov. 15 1999 03:51PM P6 SUBSURFACE SEWAOF DIS CART g YS.TEM iNSPECTIOK FORM CMECKIIST p,opeety Address: pit Oar net, Dote of Inspection. Check if the fotlowing have boon done:vow roust indicate either'yes" or-No' as to each of the foliowimp: yes No Pumping Information was provided by the owner.occupant. or Bowd of Health. None of the sYstam components have been pumped for aT 1e861 Two weeks ands the system has boen•raeelving IMMEi flow rates during that period. large volumes of water have not been introduced into The system re<entty or a5 part'of this inspoction. �( As built plans have been obtained and examined, Note if They ere not eVBllpble with N:A, The facility or dwelling was inspected for Signs of sewage back-P. The system does riot receive non-sfinitery or industrial waste Row. The site was inspected for signa or breakout. All system components.excluding the Soil Absorption SYrte"%- have been located on the site. The septic tank enenholas were uncovered,opened.end the interior of the septle tank was inspected for condition at bafrles or tees.material of eonstruetion. dlm,cnsions,depth of liquid.depth of sludge,depth of saum. The size and legation of the Soil Absorption System on the site has been determined based on: r p EYistinq interestottan. Fo►example.Plan ar®.O.N• 9. tWermined in the flcto (if any of the failure criteria related to Pan C is at issue.approximation of distanoo is unecceptabiel �-\ jT5.3(l2t3ltDil The facility owner land eceupanes-11 d;Iteran!Item owned were provided with inferrnatlan an the pro pat maintenaaoa-cl r Subsurface,Disposal systems. revised 9/2/98 Pa¢r9ofII 11/15/99 MON 14:21 [TIC/RX NO 65351 900 Qj a,d11T' T1091J3 V Ti09TJ3 6C69 M. LT9 YVA W CT MU 00/10/ZO FROM WAL.SH REALTY 775-7330 PHOW NO. . WEI 771 1282 Nov. 15 1999 03:51PM P7 SUBSURFACE SEWAGE DISPOSALR SYSTEM INSPECYtON FORM SYSTEM INFORMATION ,,apart/Address: O Cornet! Date of Insp,entian: FLOW CONDITIONS RFS1^ DENTIAL: Derlgn flow: g,P.d,lbedroom. -Number of bedrooms idesigni:_ Number of badrearns taetvall:_ Tatst DESIGN flow_ Number of current rasidents:_ Garbage grinder Ives or no]!_ Laundry(sepafato system) Eyes or hol:�-: If yes,soDaratt inspection required Laundry system inspeated (yes or not Seasonal use(yes Of MCI:_,_ di. Water meter readings,If avaltabie Mast two-foot's usage (gp Sump Pump(yes or no)'.— Last date of occuponcy: COMtMERC /INDUSTRIAt,: Type of estabiishmant; Design flow: a I Basco on ts.20) Basis of design flow Grtose trap present: (yoe at not— lndustrief Waste Molding Tank present:(yea Or not_ Non sanitary waste discharged to the Title 5 system:Ives or no1— ,Water meter feedings,if avaitabte: Last date of occupancy: OT14ER:(De:cribe) Last date of occupaney:� O>,1f(cRAt INFORMATION PUIMpING RECORDS and source of informs ion: System pumped as part of inspec,on:Iyes or no) If yes,volume pvmpad: Saflons Reason for pumping: p or SYSTEM Septic tank ldistribution boxlsoil absorption system Single cesspool Overflow Cesspool Privy Shared system Ives of no) (if yes. attach previous inspection record:,if onyl I/A Technology etc.Attach copy of up to date operasion and maintenance contract Tight Tsnk Capy of DEP Approval Other APPROXIMATE AGE of ell componcnto.dace instaued 10 knowfl)and source of information: " Savage odgrs detooted when erfiving at the size:(yes or no) T� G+f 11 revised 9/2/96 Pale .11/15/99 NON 14:21 ITX/RX NO 65353 L00@j 9,1118 Ti09TJ3 V Ti09TJ3 659 FS£ L TO/ZO I FROM WALSH REALTY 775-7330 PHONE NO. 508 771 1282 Nov. 15 1999 03:52PM PS SUgSUAFACE SEWAGE D1S PART RT C VS�M INSPECTION FPRM SYSTEM INFORMATION(cortln+utd] ?apettY Adareas: �6 ��a `\� prner: pane of Inspection: BUILDING 56WER: ,� ILecate on site plate�{� Q--) Depth below grade:!^ other(explain) Material of constructwn: enst item 40 PVC_ Distenee from prirete water supply Well or suction fine�� Diameter Cornmente:loandition of ioirrts, venting. evidence of leakage,ate• SEPTIC TANK: (locate en site p nl r Material of Construction: eone+sue rn+ststFiberglass polyethylene Depth below grade �ether(acDlainl If tank Is metate tistt.ag�e_ Is aga confirmed by Cerdntote of CoMpntrnec (YeslNol Dimensions: t _ sludge depth: (1 Distance from top o;ONdge to ba"em of outlet tee or baffle: Scum thinknese:�__ �1 Distanes Item top of scum to top of outlet tee of baffle: ` I� Distance from bottom of maul"to bottom at outlet tee t beHfe: NOW d;l"eniions orate atterrnined: :emtnents: (recon+trtendation tar pumpi eond'it%off Inlet and outlet or baffles,d;pth of liquid level in relation to pull t irr art.atructyral integntr- enct a Ienkoge,etc.) GREASE TRAP: (locate on site plan) Depth bolow prede:_ Material of construction:_,Concrete—metal_Fiberglass _,polyethylene_ethsrte:plainl Dimensions Scum thiekness:�_ City .&no*ftom.top of scum to top of outlet tee or baffler_ Distance from ballot" at scum to bottom Of outlet tee or baffle:�.� Date of Iavt pumping: comments: (receeti7rwendetion ou boMas.depth of liquid tees)In relation to outlet invert,struetutsl integrity- lot pumping•eonS+tion of Intel andtlet tses or evidcnee of leakage,ate,) tree 7 of tt revised 9./2/98 11/15/99 RON 14:21. [TX/RX NO 63353 8000 9,919V TI09TI3 28 TT09TJ3 6f 69 bSC LT9 Tt'3 SS:CT 311E 00/TO/ZO FROM WALSH REALTY 775-7330 PHONE NO. : 508 771 1282 Nov. 15 1999 03:52PM P9 SUDSVPFAC6 gEWAGE OISP SA SYSTEM INSPECtIOI�FORM ART SY5YFjA tljFORjAAYlON lcortt-0df •reperty Address: O W nor: Dirge of IrWoeclion. TIGHT OR HOWING TANK:—CA!L'NTank must be PutwPed Fehr to. or at time of.Inspection) ,locate on site plan! 0e91h bolo-grader Pot�ethylmnm _other(e><plain} I1tlatorlal of construction:__concrete_metal,^,Fiberglass Oimenxions: CaDacity:_� gallon6 Design flow' �gellens/day Alarm Pres•nr Alarm le-el•_ Alarm in wetting order:Yes No_ ('date of previous pumping: Comments: (condition el inlet tea,eonditlert o1 alarm and!toss switches.etc.) OSSYat[tuT10N 9OX: LS (locate on site plan) ��11 Depth ei liquid level above oultmt invert: comments: (note i, vel end diatrtbegie is equal. evidanea of solids arryov Ima videnee of kage into of out of box,cie. v PUMP CHAMBER:•y 3 ()agate on site planl Pumps in working order:(Yes or No) Alarfns in working order IYes or Neil_ Comments: urtenences_etc" Inotf:condition of Pump eharnbet,•eonditfan of pumps end apP Pspc 8 of 11 revised 9/2/98 11/15/99 MON 1.4:21 [TX/RX NO 65351 600 in 9,911V TIOSTJ3 t8 TTOSTJ3 6C69 bSC LT9 IVd SS=CT 311.E 00/TO/90 FROM WALSH RERLTY 775-7330 PHONE NO. : 508 771 1282 r-, Nov. 15 1999 03:53PM P10 ti SUBSURface SEWAGE OIS ppA"SYSTEM INSPECTION FORMA RIC SYSTEM INFORMmATION loofr6"w �pp4ytY Address: pate of lnspeCtion: 30t1 ABSORPTION SYSTEM(SAS): rea(niated by nvn•intrvsive methods) tloeate on site plan.if Possible:eaeav ton not feduired,leeetlon mar be aoP if not located..•:Plaln: Type: lesehing pits. nurnbel:— teaching chambers.number:_. Ipeching galleries,number'_ leeching trenches. number,Ien9th:� -UPC PQ� Ieaelting fields.number,dlfnensions:" everfloW cesapeat,number:_ Alternative system: Name of Teehnolog't" Gonimente: iA (note eenditlon of 6e11. signs of hydrautie failure,level Do„ding, (temp soil,conon o}ye9etetlon e1C.) 6 C. �. -A 814 I; P OL'. Iloeate on site plan) Number and eonfi9uretion: Depih•tco of fiquid to inlet invert: geoth of so)ids laver: iepth of scum layer: Dirnenslons of ceespoel: Materials of eons'rucldon: Indication of groundwater: Inflow Ieesspeol muss be pumped as Part of inspoctionl Comments: condition of•egetetion, eft.) (note eohdnieri of soil, si4na of hydraufle lailure,level e}ponding. PRIVY:✓'L.i (locate on site plan) Dimensions:�„�� Materials of evnstruetion:• Depth of setids•�� Comments: (note caniftlert of soil_ signs of hydraulic failure.level of pofiding,con�[ron of vegetation. ete.l pa.¢e 9 of t t revised 9/2/98 11/15/99 RON 14:21 1TX/RX NO 65351 OTO[j 9•S11V TT09TJ1 V TT09TJ3 i6C69 bSC LT9 3 MU CT 31U 00/TO/ZO Commonwealth of Massachusetts Title 5 Official Inspection Form I' Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 50 Apollo Drive Property Address 3 Crook Owner Owner's Name information is required for every West Barnstable 11 MA 02668 4/26/19 ` 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. A. Inspector Information Frank Nunes III Name of Inspector saa Company Name Box 841 Company Address East Falmouth MA 02536 City/Town State Zip Code 508.272.6433 13010 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 4/26/19 Inspect l Wignat-ure ADate The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should.be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts (P Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 50 Apollo Drive Property Address Crook Owner Owner's Name information is required for every West Barnstable MA 02668 4/26/19 page. City[Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® 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: 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired.The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 50 Apollo Drive Property Address Crook Owner Owner's Name information is required for every West Barnstable MA 02668 4/26/19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts rn - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 50 Apollo Drive Property Address Crook Owner Owner s Name information is required for every West Barnstable MA 02668 4/26119 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 l Commonwealth of Massachusetts Title 5 Official Inspection Form jr w Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 50 Apollo Drive Property Address Crook Owner Owner's Name information is required for every West Barnstable MA 02668 4/26/19 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 li Commonwealth of Massachusetts ,9 Title 5 Official Inspection Form w Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 50 Apollo Drive Property Address Crook Owner Owner's Name information is required for every West Barnstable MA 02668 4/26/19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered"yes" to any question in Section C.5 the system is considered a significant threat, or answered"yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes"or"no"for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts (o Title 5 Official Inspection Form �~ Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 50 Apollo Drive Property Address Crook Owner Owner's Name information is required for every West Barnstable MA 02668 4126/19 page. Citylrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms(design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage(gpd)): Detail: Well Sump pump? 0 Yes ❑ No Last date of occupancy: OccupiedDate t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 Commonwealth of Massachusetts ,ig Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 50 Apollo Drive Property Address Crook Owner Owner's Name information is required for every West Barnstable MA 02668 4/26/19 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Pumped 3 yrs ago per owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form I. i Subsurface Sewage Disposal System Form Not for Voluntary Assessments 50 Apollo Drive Property Address Crook Owner Owner's Name information is required for every West Barnstable MA 02668 4/26/19 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: Original septic tank , new d-box and infiltrators 2016 per BOH record Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 10"feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: >10'feet Comments (on condition of joints, venting, evidence of leakage, etc.): t5insp.doc•rev.1/26/2018 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts (o Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 50 Apollo Drive Property Address Crook Owner Owner's Name information is required for every West Barnstable MA 02668 4/26/19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): 3" Depth below grade: feet Material of construction: ®concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) H-10 compartment style tank appears to be structurally sound If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000g Sludge depth: 5" Distance from top of sludge to bottom of outlet tee or baffle >12 Scum thickness 1/2 11 Distance from top of scum to top of outlet tee or baffle >2" Distance from bottom of scum to bottom of outlet tee or baffle >2" 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.): Pumping suggested every 3yrs to prolong the life of the system t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts r� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 50 Apollo Drive Property Address Crook Owner Owner's Name information is required for every West Barnstable MA 02668 4/26/19 page. CityrFown State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts (o Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 50 Apollo Drive Property Address Crook Owner Owner's Name information is required for every West Barnstable MA 02668 4/26/19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0" Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): , D-box is 2" below grade, average condition for its age t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 Commonwealth of Massachusetts �- - Title 5 Official Inspection Form w Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 50 Apollo Drive Property Address Crook Owner Owner's Name information is required for every West Barnstable MA 02668 4/26/19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No' Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): ' If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 40 infiltrators ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 L r Commonwealth of Massachusetts (P Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 50 Apollo Drive Property Address Crook Owner Owner s Name information is required for every West Barnstable MA 02668 4/26/19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Chambers were video inspected and are damp at this time, bottom is approximately 2' below grade, no indication of past hydraulic failure 12. Cesspools(cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 i Commonwealth of Massachusetts 119 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 50 Apollo Drive Property Address Crook Owner Owner's Name information is required for every West Barnstable MA 02668 4/26/19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18 c� Commonwealth of Massachusetts �a - ,p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 50 Apollo Drive Property Address Crook Owner Owner's Name information is required for every West Barnstable MA 02668 4/26/19 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: k hand-sketch in the area below �. drawing attached separately t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 TO"OF BARNSTABLE 13 I-09 b LOCATION TO IL SEWAGE0 VILLAGE ASSESSOR'S MAP 11 PARCEL INSTALLER'S NAME&PHONE NO. 3 SEmc TAATK CAPACrrY l=KYI—j�r3 Mpy f+Q-[ LEACHING FACBdrY:(type) r i OLtI (siuY31 eK 4,S )LIS" NO.OF BEDROOMS OWNER t2�t'Jl� PERMrf DATE: la'i Z-16 COMPLIANCE DATE: Separation Distance Between the: Mmdmmn Adjusted(imimdwatcr Table toft Bottom ofLuChiogFacility Fat Private Water Su ply Well and Leaching Facility Of any=Us exist on she or wi`hin 200 fee of leaching facility) 100 a' Fat Edge of Wetlmd and I caching Facility(if say wetlands exist within 100♦— Fat 300 fee of leaching kcitity) FURNISHED BY tZSM�- B F Hvt-4rse I 35 l 1 k 3 g4 it 1 0 / \_ \ h-4 -t4S`r �- o/i A-S LVF„ / 4 ° / dH • 4ry 3 ti Commonwealth of Massachusetts (P Title 5 Official Inspection Form Ali; Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 50 Apollo Drive Property Address Crook Owner Owners Name information is required for every West Barnstable MA 02668 4/26/19 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: 90"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: GW obs. at 90" Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: 5.15' seperation provided per BOH record. Installer and Designer certification form signed ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: TOPO mapping You must describe how you established the high ground water elevation: See above Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 L cam, Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 50 Apollo Drive Property Address Crook Owner Owner s Name information is required for every West Barnstable MA 02668 4/26/19 page. CitylTown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria)and 6 (Checklist)completed ® D. System Information: For 8:Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 No. I 04 t Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS NpliLation for Mispo8al *pstrm Construrtiun Permit Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) ❑Complete System �Individual Components Location Address or Lot No., CF Owner's Name,Address,and Tel.No.50 5&0 93'� to Or Assessors Map/Parcel b-qt, w , _ 8a f s• e 0 6 Installer's Name,Address,and Tel.No. S08- 5�� es 8-SY;lG Designer's Name,Addrs,and Tel.No. &4" Gv rr k {-i`t vn; c P o• Goy )Oq M #- 61:af7 s,arc. P-v• 160 x q-8 I Type of Building: Dwelling No.of Bedrooms Lot Size Y9, goo sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) �{yl1 gpd Design flow provided() gpd Plan Date Jc3 31 ICo Number of sheets Revision Date Title �y SU 1U / S Size of Septic Tank Type of S.A.S. T_�,4 /1/4l e. c t IJ C ed Description of Soil 6A c 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 o e and no o place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Si Date Application Approved by Date u Application Disapproved by V Date for the following reasons 3 Permit No. L Ot�„— �� Date Issued 10 No. D 01 - J 8 n, y Fee -kl THE COMMONWEALTH OF. MASSACHUSETTS Entered in computer. I ' - Yes � PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS x 2pplication for Misposal,6pstrm Construction permit Application for a Permit to Construct( ) Repair K/Upgrade( ) Abandon( ) ❑Complete System Wridividual Components Location Address or Lot No. s-0 ,Apo 110 Or" `p- Owner's Name,Address,and Tel.No. 506-S-&D-9 3 a Assessor's Map/Parcel / Installer's Name,Address,and Tel.No. SO$• y;?r5-85a G Designer's Name,Address,and Tel.No. SUS 3�a-a 9 ( ir�o�a iConstrv�f-icti�;Lr,c• P.O. (fix Ivy Me f- Soo6,Tpc. P.v. fox qsI rs�vn r 1 vacoy$ Sa v-ch Type of Building: Dwelling No.of Bedrooms Lot Size 00 sq.ft. Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) yL�U gpd Design flow provided S&O gpd Plan Date /o� -3114 ++ Number of sheetsa. Revision Date s Title �n�.nGSn ��r.Z�GC�(r S Fer t �1!l J`U /`1:7G k!fir rr i r j I Size of Septic Tank Type of S.A.S. T-41Q c-.r*.rlr i/ T Description of Soil 64 �9r LvA lr 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 r" accordance with the provisions of Title 5 of the Environmental Code and no o place the system in operation until a Certificate of Compliance has been issued by this Board of Health. - Siane _- Date Application Approved by ` Date e / Application Disapproved by Date I for the following reasons Permit No.20(L2 - K s/ Date Issued /v r ..-------------------------------------------------------------------- h THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(3<) Upgraded( ) :r I Abandoned( )by t�,(�y�oi �y.S f�X �'c�Yt L at�_6 /-n � A I-),;L,-e W.arnS+& has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. -),I(.-%& dated 10 Installer� v "v` ��,,��-/�1-lor► I— Designer A41 5 < r s #bedrooms Approved desi flow//� ���d D¢- 1°Ir 7//� - gpd The issuance of th' permit shall not be construed as a guarantee that the system wi'�fun 'ofi as desi fed. a. Date 1116 Inspector. !�o --------------------- ------------------------------------------------------------------------------------------------------------------ No. -_----------------------------------------------------------------------------------------------------------------- No. D d Fee l THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS bisposal *pstem �onstrnction 'permit Permission is hereby granted to Construct( ) Repair Upgrade( ) Abandon( ) System located at 67 14,Dr re-u i t ) I-,A(n S f-eLt I e ° 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' must'be completed within three years of the date of this permit. Date % 0 1 �� Approved by r / 508-477-4829 MASHPEE HIGH GUIDANCE 08:06:54 a.m. 10-14-2016 1 /1 - Town of Barnstable �Of VIE T, Regulatory Services Richard V. Scaii, Interim Director OA MASS.SABIE. : Public Health Division .p hlA 1639• �� Thomas McKean.Director prEO►AAA A 200 Blain Street,Hyannis,NLA.02601 Office: 508-962-4644 Fax: 508-790-6304 Homeowner Certification Form for Alternative Systems Property address: Sb ty6 LLo (-oye W. 'g ys j &e Assessor's Map\Parcel: Property Owners Name: ��OD In accordance with Massachusetts DEP alternative system approval letters, the following certification information is required by the Owner of record. The Owner of record must place an "x" in the applicable box next to each line certifying the information. Yes NI\A r ❑ I have been provided a copy of the Title 5 I/A technology Approval letters. (15 page Standard Conditions letter and the specific technology letter) � /1 have been provided with the Owner's Manual Y I have been provided with the Operation and Maintenance Manual ❑ YFor Systems installed under a Remedial Use Approval, I agree to fulfill my responsibilities to provide a Deed Notice as required by 310 Ct,iR 15.287(10) and the Approval (- '/For Systems installed under a Remedial Use Approval, I agree to fulfill my responsibilities to provide written notification of the Approval to any new•Owner, as required by 310 CMR 15.287(5) I '❑ If the design does not provide for the use of garbage grinders,the restriction is understood and accepted Whether or not covered by a warranty, I understand the requirement to repair, replace, modify or take any other action as required by the Department or the LAB,, if the Department or the LAA determines the System to be failing to protect public health and safety and the environment, as defined in 310 C1vIR 15.303 c v agree to comply with all terms and conditions above. Property O rinted name f y Ow-ners Signature ll to Note: This form must be submitted along with the septic system disposal works permit I application for all I\A systems including new construction, repairs\upgrades, with and without aggregate (stone) and with conventional design criteria or credited design i I criteria. Q:\Septic\IA homeowner certification.doc f - _ � - rz. _- �! Supplement Table-6. Potential water-level rise, in-feet;for use with index well Sandwich-252 WATER ZONE A ZONE B ZONE C ZONE D LEVEL 45.9 0.0 0.0 0.0 0.0 46.0 0.1 0.2 0.2 0.3 46.1 0.2 0.3 0.4 . -0:5 46.2 0.3 0.5 0.6 0.8 46.3 0.4 0.6 0.8 •1,0 46.4 0.5 0.8 1 .0 1 .3 4.6.5 0.6 0.9 1 .2 1..5 46.6 0.7 ` -1 .1. 1 .4 1.8 46.7 0.8 1 .2 1 .6 2.0 46.8 0.9 . 1 ..4 1 .8 .2.3 46.9 1 .0 1 .5 2.0 ' 2.5 47.0 ' 1 .1 1 .7 2.2 2.8 47.1 1.2 1 .8 2.4 3.0 I 1 r l 47.2' 1 .3 2.0 2.6 3.3 47.3 1 .4 2.1 2.8 3•.5 2U� 47.4 1 . 2.3D 3.0 3.8 47.5 .6 2. 3.2 4.0 COA 47.6 1 .7 2.6 .3.4 4.3 47.7 1 .8 2.7 3.6 4.5 r� 47.8 . 1 .9 2.9. 3.8 4.8 47.9 -2.0 3.0 4:0 5.0 . 48.0 . 2.1 3.2 4.2 5.3 48.1 2.2 . 3.3 4.4 5.5 �j"'' 48..2 2.3 3.5 4.6 5.8 48..3 .2.4 3...6. 4.8 6.0 8.4 2.5 • '3:8 5.0 6.2 48.5 2.6 _ -?9 :- 5.2 6.5 QA S 0.6 6 2.7 4.1 5.4 6.8 O jRd4v 48.7 2.8 4.2 .5.6 • 7.0 p 48.8 2.9 4.4 5.8 7.3 "`Kl 48.9 3.0 4.5 6.0 -7.5 49.0 3.1 4.7 6.2 7.8 • ��(' v.,e���M�s. 4.9.1. 3.2 4.8 6.4 8.0 f USGS Groundwater for USA: Water Levels -- ] sites Page 13 of 14 Date i Time ? 7 Wat�IW Referenced ,�= R,�,. .- _�.. € 7 Water i le a eve !level, vertical !� I WaterlllJ level, fee ever �alf datums Water- ? Status ? Method of ? Me Water- €tfeet II erenced ;� I level feet bel a � level measurement ag Date Time level`s] ❑ ove ( Cal Water- j 1 date-b low lae� Page It ,� � racy Meth�efl of Mr�asuring � Sourct of date r pecific ,�y level t i f accurac{end su � verbcal measi rement aruency me as, time; 19 tical ( accuracy I surfacedatum , I I { I accuracy � datum 2011-06-22 10:20 EDT m 46.80 2 T U5G5 2011-07-25 10:05 EDT m 47.12 2 T USGS 2011-08-22 14:15 EDT m 47.21 2 T USGS 2011-09-26 14:20 EDT m 47.35 2 T USGS 2011-10-26 13:30 EDT m 47.37 2 T USGS 2011-11-28 11:40 EST m 47.14 2 T USGS 2011-12-22 10:40 EST m 47.34 2 T USGS 2012-01-27 10:05 EST m 47.06 2 T USGS 2012-02-27 10:30 EST m 46.98 2 T USGS 2012-03-28 10:10 EDT m 47,07 2 T USGS 2012-04-2S 14:10 EDT m 47.09 2 T USGS 2012-05-31 10:50 EDT m 47.31 2 T USGS 2012-06-21 10:30 EDT m 47,15 2 T USGS 2012-07-25 14:40 EDT m 47.47 2 T USGS ' 2012-08-29 14:00 EDT m 47.53 2 T USGS 2012-09-26 14:30 EDT m 47.El 2 T USGS 2012-10-31 10:25 EDT m 47.53 2 T USGS 2012-11-28 11:20 EST m 47.43 2 T USGS 2012-12-20 14:25 EST m 47.35 2, T USGS 2013-01-24 14:55 EST m 47.32 2 T USGS 2013-02-25 12:C0 EST m 47.23 2 T USGS 2013-03-26 14:45 EDT m 46.45 2 T USGS 2013-04-24 14:35 EDT m 46.58 2 S USGS 12013-05-31 10:10 EDT m 46.75 2 T USGS 2013-06-20 13:10 EDT m 46.39 2 V USGS 12013-07-29 12:30 EDT m 46.38 2 T USGS 2013-08-28 13:35 EDT m 46.81 2 T USGS 2013-09-25 11:10 EDT m 46.94 2 T USGS 2013-10-25 15:40 EDT m 47.19 2 T USGS 2013-11-26 11:20 EST m 47.39 2 T USGS 2014-01-02 09:30 EST m 47.56 2 T USGS ] 2014-01-31 14:50 EST m 47.34 2 T USGS ({ 2014-02-28 14:15 EST m 47,22 2 T USGS 2014-03-24 13:50 EDT m 47,07 2 T USGS i 2014-04-24 13:50 EDT m 46.84 2 T USGS 2014-05-30 13:00 EDT m 46.65 2 T USGS 2014-06-27 13:30 EDT m 46,92 2 T USGS 2014-07-31 10:10 EDT m 47.26 2 T USGS i 2014-08-29 12:45 EDT m 47,40 2 T USGS 2014-09-30 14:20 EDT m 47.63 2 T USGS 2014-10-24 15:10 EDT m 47,44 2 V 2014-11-25 11:05 EST m 47.50 2 V MA031 2014-12-19 14:00 EST m 47.06 2 V MA031 2015-01-29 14:00 EST m 47.09 2 V MA031 2015-02-24 10:45 EST m 47,02 2 T MA031 2015-03-27 09:15[EDT m 46.82 2 V MA031 2015-05-01 12:00 EST m 46.43 2 V MA031 l 2015-05-26 14:00 EDT m 46.79 2 V MA031 2015-06-29 14:25 EDT m 47.04 2 V MA031 12015-07-28 13�EDT 2 V MA031 ( 203� -24 11 m 47.43 2 V MA031 2t0'^fi9-'3''ri-i w 2 V MA031 http://nwis.waterdata.usgs.gov/nwis/gwlevels?site_no=414418070241601&agency_cd=U... 10/14/2016 Town ®f Barnstable SNE TO�y Regulatory Services Richard V. Scali, Interim Director saxxsrne[.g. 9 MASS. Public Health Division 163q. �0 AIEo►na+'' Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: dl E��� Sewage Permit# Assessor's MapTarcel JI o , Designer: ��r �'�'�� Installer-: Address: � � Address: yS'indo S ✓ , 0 0,LD�r7 On i.0/�� l�� Ur��/at i- ` as issued a permit to install a (date) (installer) septic system at houo-- or - eor l 5 based on a design drawn by (address) 9 Axe , , j^� dated /L (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 e system referenced above was constructe { ai e with the terms of the I ap oval letters (if applicable) RRSM (Installer's Signature) (Designer's Signatur (Affix Designer amp Here) PLEASE RETURN T ARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE `VILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE B RNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. QASeptic',Designer Certification Form Rev 8-14-13.doc rt " � I h m rTt r"- Certified Mail Fee ru ru Extra Services&Fees(check box,add lee as appropriate) rq ❑Return Receipt(hardcopy) $ j C ❑Return Receipt(electronic) $ "�T Postmark 1- ❑Certified Mall Restricted Delivery $ :) Hero C3 ❑Adult Signature Required $ `•tj,, []Adult Signature Restricted Delivery$ cd O Postage rU ul $ � Total Postage and Fees '3 t11 $ --- Douglas E. &Tina M Crookr�f r 50 Apollo Drive West Barnstable, MA 02668 SENDER: COMPLETE THIS SECTidN COMPLETE THIS SEC�16N ON DELIVERY 11 Complete items 1,2,and 3.Also complete A.,,Sl9h*;j re" ) item 4 if Restricted Delivery is desired. X _ 6 O Agent ■ Print your name and address on the reverse " ❑Addressee so that we can return the card to you. B-focelved by($rioted N e) C. Dale of Efyrry ■ Attach this card to the back of the mailpiece, or on the front if space permits. 17 D. Is delivery address different from item 11 Y s 1. Article Addressed to: If YES,enter delivery address below: O No Douglas E. &Tina M Crook 50 Apollo Drive West Barnstable, MA 02668 3. Service Type ❑Certified Mail® ❑Priority Mall Express' ❑Registered ❑Return Receipt for Merchandise O Insured Mall O Collect on Delivery 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number (transfer from service labeq 7 015 1520 0001 2273 3 2 0 3�kk PS Form 3811,July 2013 Domestic Return Receipt M � � 5 7_ -air S 7 71-991fo Town of Barnstable Barnstable .� Regulatory Services Department ��� "M 1 9 Public Health Division m 200 Main Street, Hyannis MA 02601 2007 SECOND NOTICE Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7015 1520 0001 2273 3203 February 29, 2016 Douglas E & Tina M Crook 50 Apollo Drive West Barnstable, Ma 02668 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 50 Apollo Drive, West Barnstable,MA was last inspected on 7/22/2014, by Matthew F. Gilfoy, 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: • At time of inspection leaching is in hydraulic failure. Water level over outlets in distribution box. You are ordered to repair or replace the septic system within one (1)year from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. P THE B ARD OF HEALTH N Thomas McKean, R.S., CHO Agent of the Board of Health • Q:\SEPTIC\Letters Septic Inspection Failures or Future Evl\50 Apollo Dr W.Barn 2014.doc Town of Barnstable Barn .� Regulatory Services Department AtAnmftC' s,►iuvsrr►Bt.�. � I `""9 6� Public Health Division �.� m ,FD 200 Main Street, Hyannis MA 02601 2007 Office: 508-8624644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7015 1520 0000 1971 7132 November 30, 2015 Douglas E &Tina M Crook 50 Apollo Drive West Barnstable,Ma 02668 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE,TITLE 5 • The septic system located at 50 Apollo Drive,West Barnstable, MA was last inspected on 7/22/2014,by Matthew F. Gilfoy, 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: • At time of inspection leaching is in hydraulic failure. Water level over outlets in distribution box. You are ordered to repair or replace the septic system within one (1)year from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH - asG �zWas McKean, R.S.; CHO Agent of the Board of Health Ole.G Q:\SEPTIC\Letters Septic Inspection Failures or Future Evl\50 Apollo Dr W.Barn 2014.doc Town of Barnstable Barnstable Regulatory Services Department 1 �STABM ' , 659. Public Health'Division m 2.00 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7015 1520 0000 1971 7132 November 30, 2015 Douglas E &Tina M Crook 50 Apollo Drive West Barnstable, Ma 02668 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 50 Apollo Drive,West Barnstable, MA was last inspected on 7/22/2014,by Matthew F. Gilfoy, 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: • At time of inspection leaching is in hydraulic failure. Water level over outlets in distribution box. You are ordered to repair or replace the septic system within one (1)year from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH c, as McKean, R.S., CH0 Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Evl\50 Apollo Dr W.Barn 2014.doc Parcel Detail Page 1 of 4 -TVII�, M1 eYe Logged In As: w Parcel Detail Wednesday, November 25 2015 Parcel Lookup Parcel Info _ Parcel ID 1131-046 ! DevelopeerLot LOT 12 Location J50 APOLLO DRIVE Pri Frontage�160 Sec Sec Road F- � �I Frontage Village;EST BARNSTABLE Fire District JW BAR STABLE Town sewer exists at this address No � � Road Index 0033 f Asbuilt Septic Scan: Interactive 1310461 Map l Owner Info Owner:CROOK, DOUGLAS E&TINA M ) Co Owner 9 streets '50 APOLLO DRIVE Street2 City kWEST BARNSTABLE State MA zip 02668 Country J Land Info Acres 11.15 Use Single Fam MDL-01 ( zoning .RF � Nghbd 1-0106 Topography 'Level � � Road Paved. _ Utilities 'Gas,Well,Septic Location, Construction Info Building 1 of 1 Year 974 -" - Roof(Gable/Hip ..�. Ext Wood Shingle _ Built' Struct Wall 6 ,5:>� 0 Living`2806 - "` Roof;Asph/F GIs/Cmp AC one 2 w-I- m. Area' Cover Type ;4� Style .Cape Cod Wall ,Dnt rywall �� Rooms€4 Bedrooms BasMT s Bas BM` o Visas —_ �� _ _. - EMT, Int '- Bath Model 1Resldentlal Floor ICar et Rooms e2 Full-1 Half _ _ __ _ Sit Grade Average Plus � ( Heat,Hot Water '�I Total 10 Type Rooms �c'A ' Stories i 1/2 Stories Heat tail �I Found 'POUred COnC1 Fuel ®®J ation . Gross Area 5484 Area e Permit Histo I http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=8332 11/25/2015 I �jq / a 0,2 r� g� ter: �t J� U'L11U Y I Postal CERTIFIED o RECEIPT ru •, Only m a ra .- 1, I A r" Certified Mail Fee Ir rq Extra Services&Fees(check box,add fee as"Pon Plate) O ❑Return Receipt(hardcopy) $ - O ❑Return Receipt(electronic) $ Postmark C ❑Certified Mail Restricted Delivery $ I- Here C3 []Adult Signature Required $ ❑Adult Signature Restricted Delivery$ O Postage ruLn $ Total Postage and Fees $Douglas E &Tina M Crook 50 Apollo Drive West Barnstable, Ma 02668 D © - ste' m .. r� tt 7Exe l Fee _ ra �11 a s Fe (check box,add tee as appropriate) Oceipt(hardcoPy) � Postmarkr ceipt(electronic) $ail Restricted Delivery $ /�Here C7% a ature Required $ + NOVtIV �(/2�tt Adult Signature Restricted Delivery$ It /J t 0 Postage f l !,Ln Total Postage and Feea V J 5 -f Y Douglas E &Tina M Crook 50 Apollo Drive ' West Barnstable,Ma 02668 I l Town of B• instable. P# oF� Department of Regulatory Services Public Health Division Date Mesa ,bsy, tee$ 200 Main Street;Hyannis MA 02601 cw, f( Fee Prl. Date Scheduled `' Time—�F -� c ,,oil ,SuitahXty Assessment fog- Sew e D sposal Performed 1 wt ` Witnessed By: RA V' 1 LOCATION & GENE_ RAL INFORMATION Location Address'. 90 "Q LLO D A Owner's Name Address S . 8a�0S_t�Li d �-^^ Assessor's Map/P4reel: I�i 4"� I Engineer's Name May �Ut'L-T. ®g 3Go "3'S t NEW CONSIRU4'T10N REPAIR '` - � Telephone# Land Use e)lrf)ki J .gl'opes•,(%). I — � 5 Surface Stones N Distances from: Open Water Body �� ft Possible Wee Area (� ft Drinking Water Well i 7l op l ft Other ft Drainage Way ft Property Line SKETCH:($treet name,dimensions 4104 exact locations of test holes&perc tests,locate wetlands in proximity to holes) S'.ec- ash S� S S s t P1a,,, j4l�_4 io 13{, I • i . Parent material(geglogic) Depth to Bedrock • tl 9 S i Depth to Groundaakdr. S ding Water in Hole Weeping from Pit Face Estimated Seasonal;F igh Groundwater D TION OR SEASONAL HIGH WATER TADLE (� (ro1 t� 1b t• I �' A in. Method Used: G � io. Depth td Sall mottir s; Depth db�served standing in obs.hole: in Groundwater Adjustment $' Depth toiweeping from side of obs.hole i A�;factors Adj.fJtaundwaterl Level n2" index Well# Reading D it index Well level — - , PERCOLATION TEST ' D�tp '� e Observation I I Time at 9" ------- Hole# `� n Time at 6"bo a--^--- Depth of Pere ► J e i Time(9"•6") -- Start Pre-soak Time.@ End Pre-soak � r � �►-+14 1`1G Rate MinJInch � ssed Site Suitability Assessment: Site Pa4. Site Failed; Additional Testing Needed(YIN) r Observation Hole Data To Be Compl steel on Back -- Original:,Public He*lth Division ***If Percolati ibn test is to be conducted within 100' of wetland,you must first notify the71 Barnstable C4 servation Division at least one(1) weik prior to beginning. DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. onsistenc Gravel oN_ It r V 13 la & 4.1.,1_ err 2' DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consist nc %Gra el Loa Ai n-Po 2 DEEP OBSERVATION HOLE LOG Hole# W IA- Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. nsiste c o Gravel)- DEEP OBSERVATION HOLE LOG Hole# N A Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Qra I i Flood Insurance Rate May: Above'500 year flood boundary No— Yes Within 500 year boundary No k Yes Within 100 year flood boundary No 2X Yes. Depth 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 . If not,what is the depth of naturally occurring pervious material? Certification I certify that on (date)I have passed the soil evaluator,examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the requi r ' g,jexptlise and.experience described in 3.10 CMR,15.017. Signature ` Date i Q;\SEPTICIPERCFORM.DOC 1 c Cr Ln ru r I co Postage $ ru Certified Fee 0 Postmark 0 Return Receipt Fee Here 0 (Endorsement Required) 0 Restricted Delivery Fee O (Endorsement Required) �` •„ ra 0 Total Postage&Fees ri ru Y�l o Douglas E & Tina M Crook 50 Apollo Drive West Barnstable, Ma 02668 'SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Si item 4 if Restricted Delivery is desired. ❑Agent ■ Print your name and address on the reverse X %f Addressee so that we can return the card to you. B.Aecelved by(Printed Name) C..Date of Deliv ry io Attach this card to the back of the mailpiece, or on the front if space permits. Z D. Is delivery address different from item 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑No Douglas_E & Tina M Crook 50 Apollo Drive 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 2. Article Number (transfer from service label) 7 012 1010 0000 2851 4 2 5 9 PS Form 3811,February 2004 Domestic Return Receipt 102595.02-M-1540 i ti Town of Barnstable Barn Regulatory Services Department j 0,59. � ' Public Health Division �ONiA 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7012 1010 0000 2851 4259 August 7, 2014 Douglas E &Tina M Crook 50 Apollo Drive West Barnstable, Ma 02668 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 50 Apollo Drive, West Barnstable, MA was last inspected • on 7/22/2014,by Matthew F. Gilfoy, 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: 0 At time of inspection leaching is in hydraulic failure. Water level over outlets in distribution box. You are ordered to repair or replace the septic system within one (1)year from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF T BO OF HEALTH Thomas McKean, R.S., CHO Agent of the Board of Health • Q:\SEPTIC\Letters Septic Inspection Failures.or Future Evl\50 Apollo Dr W.Barn 2014.doc i -..emu :L. v -y http I/yssgl2rm[arF/prripde etP=reek t 6 aepx Live F•jrct p I Application Center(2) A]http--www,town.barnstable,.. Application Center Suggested Stew A'eb 5fice Gallery- 7,r Favorites Parcel Detail ypF Tiff —''.' , "''• tip' i 11h15 r xr r �# -gf� •. i 3 kV' Parcel Info �;. Parcel" 3 Developer D11 Lot FLOT 12 �} P ri , Location 160 APOLLO DRIVE Frontage`160 - Sec ......._.. - -- - Sec; Road Frontage Fire Village WEST BARNSTABLE I District 'W BARNSTAB 11 LE y; Town sewer exists at this - -- I Road Index,0033 address'No Asbullt Septic Scan: Interactive 131046 1 Map Owner Info Co-owner;CROOK,DOUGLAS E&TINA h9 IOwner; c Streetl 150 APOLLO DRIVE Street2 - - - — - - ....... City,WESTBARNSTABLE S-`ate N1A Zip'02665 Country , h: Land Info �}— Done _ _ l 1! a t_ t Local Intranet iSta-t � 0 la �.,�` --- - V 11.37AM .. F Parcel Data -Windows I I p � � �, Tuesday �t,� + ^_ --a' - 90 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 50 Apollo Dr. Property Address ' I" Tina & Douglas Crook Owner Owner's Name c information is required for W. Barnstable Ma. '02668 7-22-14 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 Matthew F. Gilfoy cursor-do not Name of Inspector use the return key. B&B Excavation Company Name VQ 14 Teaberry Lane Company Address Sandwich Ma. 02644 ' Cityrrown State Zip Code (508)477-0653 S113640 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority 7-22-14 Inspe is 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. Z� t5ins•3/13 Title 5 Official I e on Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 50 Apollo Dr. Property Address Tina & Douglas Crook Owner Owner's Dame information is required for W. Barnstable Ma. 02668 7-22-14 every page. City(rown 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 ass inspection if it is structurally sound, not leaking and if a Certificate of + P P P Y 9 } Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts fi Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments , 50 Apollo Dr. Property Address Tina & Douglas Crook Owner Owner's Name information is W. Barnstable Ma. 02668 7-22-14 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ! 50 Apollo Dr. Property Address Tina & Douglas Crook Owner Owner's Name information is required for W. Barnstable Ma. 02668 7-22-14 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. F' The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ® ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/z day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 50 Apollo Dr. Property Address Tina & Douglas Crook Owner Owner's Name information is required for W. Barnstable Ma. 02668 7-22-14 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No El ® 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. i ❑ ® 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 f 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 i questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed,under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 50 Apollo Dr. Property Address Tina & Douglas Crook Owner Owner's Name information is required for W. Barnstable Ma. 02668 7-22-14 every page. Cityrrown 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. ® El approximation 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): nnoans design Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): no plans t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts 3 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 50 Apollo Dr. Property Address Tina & Douglas Crook Owner Owner's Name information is W. Barnstable Ma. 02668 7-22-14 required for every page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 4 Does residence have a garbage grinder? ❑ Yes ® No Is Laundry on a separate sewage system?.(Include laundry system inspection ❑ Yes ❑ No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage (gpd)): Detail: Unable to determine if washer machine is tied to septic due to piping. Sump pump? ❑ Yes ® No Last date of occupancy: current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,.' 50 Apollo Dr. Property Address Tina & Douglas Crook Owner Owner's Name information is required for W. Barnstable Ma. 02668 7-22-14 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: 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-3113 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 50 Apollo Dr. Property Address Tina& Douglas Crook Owner Owner's Name information is required for W. Barnstable Ma. 02668 7-22-14 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Approx. 40 years+/- Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 11" 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.): At time of inspection building sewer appeared to be in good working order no sign of leakage. Septic Tank(locate on site plan): 3„ 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: 1000 gal. Sludge depth: 12" t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts t Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 50 Apollo Dr. Property Address Tina & Douglas Crook Owner Owner's Name information is required for W. Barnstable Ma. 02668 7-22-14 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 22" 8" Scum thickness r 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 9" 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.): At time of inspection septic tank appeared to be in working order, baffels present. Water level over outlet pipe due to clogged leaching. Grease Trap(locate on site plan): Depth below grade: feet Material.of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 50 Apollo Dr. _ Property Address Tina& Douglas Crook Owner Owner's Name information is required for W. Barnstable Ma. 02668 7-22-14 every page. Citylrown 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 t . Design Flow: F gallons per day f Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm,and float switches, etc.): " Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 I - Commonwealth of Massachusetts Title 5. Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 50 Apollo Dr. Property Address Tina & Douglas Crook Owner Owner's Name information is W. Barnstable Ma. 02668 7-22-14 required for every page. Cityrrown 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 d-box full Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): At time of inspection level in d-box was over outlet pipes. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No" Alarms in working order: ❑ Yes ❑ No' Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): ' If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 50 Apollo Dr. Property Address Tina & Douglas Crook Owner Owner's Name information is required for W. Barnstable Ma. 02668 7-22-14 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ® leaching fields number, dimensions: 15'X25' ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): At time of inspection leaching is in hydraulic failure. Water level over outlets in d-dox. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 50 Apollo Dr. Property Address Tina & Douglas Crook Owner Owner's Name information is required for W. Barnstable Ma. 02668 7-22-14 every page. Cityrrown 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.): t t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 f Commonwealth.of Massachusetts Ti-tte 5 official Inspection Fora' Subsurface-Sewage-Disposal-System Form-Not for Voluntary Assessments yyo 5Q Apollo Dr. Property Address Tina& Douglas Crook Owner Owner's Name information is required for W Barnstable Ma. 02668 7-22-14 every page. City(rown State Zip Code Date of Inspection D. System Information (cont.) . Sketch Of Sewage:Disposal System: Provide a View of the sewage disposal system, including ties to at least two permanent reference landmarks or:benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: hand.-sketch in the area below E drawing.attached separately / I LEACH LU('ATI(�N�) NOW A B 1 57 ft 24.5 f t a n t)-sox 2 59 f t 28 IF l 3 62 ft 3(5.5 ft Y SEPTIC o TANK I 8 A i i 4 BEDROOM DWELLING Y # S0 w i � I t_ 1C. VIELL APOLLO DRIVE NOT TO SCALF t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 •� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 50 Apollo Dr. Property Address Tina & Douglas Crook Owner Owner's Name information is required for W. Barnstable Ma. 02668 7-22-14 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: 12 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: pate ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: previous inspection report ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: see above Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 •� Commonwealth of Massachusetts Title 5 official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 50 Apollo Dr. Property Address Tina & Douglas Crook Owner Owner's Name information is required for W. Barnstable Ma. 02668 7-22-14 every page. City/Town State Zip Code. Date of Inspection E. Report Completeness Checklist I® 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 �l FT�.o Town of Barnstable b w BARNSUBM Department of Health, Safety, and Environmental Services �a•� Public Health Division 367 Main Street, Hyannis MA 02601 FAX Date: l �� Number of pages to follow: c To: Fro � f� oN 0 Phone: 4 Phone: 508-862-4644 Fax phoneyFax phone: 508-790-6304 CC: REMARKS: ❑ Urgent ❑ For your review ❑ Reply ASAP ❑ Please comment r C3 Q � �l A second set of situations involve septic tank and soil absorption systems, where the soil absorption system (SAS) is too close to 3 drinking water supplies, drinking water supply tributaries, or public ` or private water supply wells . In these situations, the systems are deemed to be failed unless the Board of Health (in conjunction with .-the public water supplier in the case of public surface- water supplies and their tributaries) determines that the systems are functioning in a manner that protects the public health and safety and the environment . Again, the system inspector can NOT make this .evaluation. The information collected during the inspection and the guidance provided by the Department will- be -used-by the Board of Health to make the determination. The system inspector can assist the Board of Health in the case of soil absorption systems located less ._-than 100 feet from.a .private .drinking water ..well by arranging to -have the" well tested .Lor .-co-lif arm bacteria, volatile organic zompounds and ammonia and nitrate nitrogen. if SYSTEM FAILS The system fails if any of the criteria listed in 310 CMR 15 . 303 (1) (a) through (c) are violated. If the system fails, the owner or operator of the system should contact the Board of Health.before any attempt is made to upgrade or repair the system or otherwise attempt to bring the system into compliance . In virtually every situation, a permit will be needed from the Board of Health. It only makes sense, therefore, to contact the Board of Health to determine what the Board will require before arranging to have plans drawn, etc . LARGE SYSTEMS In addition to the criteria that apply to all Title 5 regulated systems, there are several criteria that apply to systems which -serve facilities with a design flow of 10, 000 gallons per day or greater. If the large system is located within 400 feet of a surface drinking water supply, 200 feet of a tributary to a .surface drinking water supply or within a nitrogen sensitive area (Interim Wellhead Protection Area (IWPA) or a mapped Zone II of a public water supply well) ; the system is failing to protect the public health and safety and the environment . In this instance, the owner/operator of the system will be required to obtain a groundwater discharge permit from the Department . The owner/operator should contact the local regional office of the Department to determine what must be done . The completed System Inspection Form must be- submitted. to the approving authority within 30 days by the approved System Inspector. The regulations (310 CMR 15 . 301 (10) ) provide the owner of a system the ability to have their system assessed without having a complete inspection. Such an assessment need not be done by an approved System Inspector. It can NOT be used to satisfy the requirements to have a system inspected as required in 310 CMR 15 . 301 . Finally, the results of a voluntary assessment not performed to comply with the requirements of section 310 CMR 15 . 301 need not be submitted to the Local Approving Authority. (revised 09/2/98) 3 :i 2s' GUIDANCE FOR THE INSPECTION '• y OF SUBSURFACE SEWAGE DISPOSAL SYSTEMS INTRODUCTION On-site sewage disposal systems are governed by Title 5 of the State Environmental Code (310 CMR 15 . 000) . Experience has shown that when properly designed and sited, these systems provide an acceptable level of wastewater treatment and are a legitimate treatment and disposal option in areas where centralized sewers are not available . However, given the traditional view that these systems are temporary solutions until sewers are provided, they are often neglected and this can result in harm to the environment and threats to the public health. In order to address this problem and correct the prevailing attitude toward on-site systems, Title 5 requires that systems be inspected under certain circumstances . In this manner, system owners can be educated about the importance of properly maintaining their systems, and those systems which are an environmental or public health threat can be identified and upgraded. This document is intended to provide guidance to both the system owner and the system inspector for evaluating the adequacy of existing subsurface sewage disposal systems . Approved System Inspectors are charged with the responsibility of inspecting systems in accordance with 310 CMR 15 . 302 , 15 . 303 , and this guidance and reporting their findings to the approving . authority. The goal of the inspection is to provide sufficient information to make a determination as to whether or not the system is adequate to protect public health and the environment . If conditions exist which show the system is failing to protect public health or the environment, the system must be repaired, replaced, or upgraded. The only grounds for failing a system or conditionally passing a system are if any of the criteria listed on the inspection form and specified in 310 CMR 15 . 303 are met . The inspection must avoid disruption of the functioning of the system and should be conducted to minimize disruption of the site in general . However, at a minimum, all manholes, covers, and cleanouts must be exposed in order to achieve the goal of this inspection. Pumping of system components, when required, shall be done after an initial inspection of the entire disposal system to observe normal operating conditions . Each component requiring pumping can then be reinspected after pumping has been completed. The Department has developed an approved System Inspection Form (attached to this guidance) which is to be completed by the Inspector when doing an evaluation. The Form consists of : Part A- Certification Part B- Checklist Part C- System Information (revised o9/2/98) 1 ./9 ���� � Fee No.- ------------ P BOARD OF HEALTH TOWN OF BARNSTABLE Applitation-*rIVeYC Congtructioll Permit t Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair (-*")an individual Well at: /W--t Location — Address Assessors Map and Parcel / ------------------------------------------- - � - �'�'{'fo (._ _, w-7 = Owner Address n / � D /'L^ o.ZG- Installer — Driller� Address Type of Building Dwelling ------------------------------------ Other - Type of Building-— -- - --------- No. of Persons------------------------------------------ - Type of Well--- )/�-- L -------------------------- Purpose of Well ------------------ Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned.further agrees not to place the well in operation until a Cer 'ficate f Compliance has been issued by the Board of Health. a s a - - lasl9i----------- Signed— --- - --------------��`---�-------------- - date 1-1/1p,f Application Approved By-4---- -- -- --- -- date Application Disapproved for the following reasons:------____--------_________________________________________________:______________ ---------------------- ---------------------------------------------------- ----------------- ------- -------- J- date / � Permit No.--= - --`-`--- --- Issued------------------ — - --- — - — --- date I No.- -----`-�--- --� � Fee--------------------- BOARD OF HEALTH � TOWN OF BARNSTABLE . 0(pprication forlVerr Congtructionpermit Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair (-")an individual Well at: �D QY/QT.� l�r� L� +I.Iu/N /4 SJ_�f —M U ----—-------—----------------—--------------------------------—-------------------------------- yf?Location — Address Assessors Map and Parcel //� �l��/O__S_1_____Y___ O�w Sv''�- U______ j� (` / Owner �j� �, .�t ,Q Addre s !l �1 Cle. �r�t'l�_� �C ���/�_//-L-r.�C 7 I _,__�—'Jv— ____----_U___L/�-�G `__`_______��___�'�fly Installer — Driller Addre s, -, .Type of Building r ouSe • Dwelling-----�l------------------------------------------------------ Other:- Type of Building -------- No. of Persons-------- Type of Well Ca acit Purpose of Well �, P ST_,c -wu-L° ------------------- Agreement: The undersigned agrees to install the aforedescribed indivil ual well in accordance th the provisions of The Town of Barnstable Board of Health Private Well Protection egulation — The undersigned further agrees not to place the well in operation until a Certificate of Compliance has been issued by the Boa d of Health.- J / Signed--- C_J daate Application Approved By- � ��� %j`Y_____� TIsued date Application Disapproved for the following reasons:------------ -_0-------------------------------------------------------------------------------- --- ------------------------------------—- - --- -- f /+ ldate `7 /Perms No.--rl ----- ---/ -- date -- -- -- date BOARD OF H ALTH TOWN OF BAI NSTABLE Certificate Off Compliance THIS IS TO CERTIFY, That the ndividual Well Co s rt'ucted ( ), Altered ( ), or Repaired ( ) 11 — --�--= — - - — - - - - ---------------- - Installer' lee has been installed in accordance with the pro visions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. Dated Dated--:� `` '1' C•' r- o THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL, �v SYSTEM WILL FUNCTION SATISFACTORY. Q DATE - - ------ Inspector--=- • -- - � l BOARD OF HEALTH OWN Off'` 'BAR'NS"TABLE Vell Con5truct ion Permit , Fee= --------- �I Permission is hereby gra ted— c. «�,!1-- � `='-----�-------------------_ -- -- —------------------------------- to Construct ( ), Alter ( ), r Repair ( gran Individual Well at: No. -s---- - -> - - Street as shown 'AonJthe application to a Well Construction Permit No.- �'�--/`- r l-✓ ---— ------ --- Dated----- - ---------------'�'°� - - ------------ oa_ ealth �- - i u DATE---------- --------------- ----------- ----------------------------------------- � z Y O O d X� y� 0 I .\I 4� LEGEND WEST BARNSTABLE 3 PROPOSED CONTOUR �� LOCUS: E,q ® PROPOSED SPOT GRADE OF ' EXISTING CONTOUR !!� EDGE + 96.52 EXISTING SPOT GRADE �'FO O,A W— EXISTING WATER SERVICE 9 TEST PIT O-3 -- _ iDD.Do• ' 0 27 OGT� t �p LOCUS MAP .yw CONVENTIONAL BEDROOM 27------------------ C�2Q__- ,--- 26 �' _ __ LOCUS INFORMATION LEACHING FIELD (I 5X40) 100 ft FROM WETLAND � PLAN REF: LCP-37712-B TITLE REF: C114669 t PARCEL ID: MAP 064 PAR. 092 26- TH-1.- ----- 5 PT. 501L REMOVAL F� (see note 1 7) � per+ <-vti° '° ' - <F SEPTIC SYSTEM q` REPAIR PLAN Cop \ \ LOCATED AT: 50 APOLLO DRIVE `Qua WEST BARNSTABLE, MA 26 PREPARED FOR EXIST. 1 ,00 0 GALLON SEPTIC TANK(re-use) D O U G CROOK 27 o c T°� G `\ OCTOBER 3, 2016 ` pF- 1 \ t t OF ass 0 ` D R M. ✓ 2 i \` i t R y ' No. 1140 — — ' O • v 29 ' pF \\\ MEYER & SONS, INC. EDGE OF PAVEMENT �, rn \, P.O. BOX 981 a D I BENCH MARK APOLLO Z EAST SANDWICH,` — MA. 02537 > r' i i i' � � � 25 LOT � 2 TOP OF FOUNDATION ARE/ — 49900 sf+- 30. 66 (508)362 2922 PLAN 6 233 PAGE BARNSTABLE GIS DATUM ASSR'MAP 131 PCLDRI / E SCALE: 1 in = 30 ft SHEET 1 OF 2 J 1542 NOTE: MAGNETIC TAPE TO BE PLACED OVER ALL COVERS T.O.F. X SEPTIC TANK PROPOSED 0-BO EL. 30.66 INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & COVER OUTLET AND SET TO 6" OF FINISH GRADE SET TO 6" OF GRADE FINISH GRADE=26.0 It .=27.8t F.G. EL.=27.20 t F.G. EL:26.0t MIN. COVER OVER SA.S. = 9" MAINTAIN 2% MIN SLOPE OVER LEACHING AREA 9' MIN C ` 36' MAX COVER L 31' L 12'(MAX) INSTALL TWO INSPECTION PORTS(MIN.) MIN.) EL=26.45 0 S�1% (MIN.) 0 S=1% (MIN.) PVC 4'SCH40 PVC 4"SCH40 PVC 10' 3.3" TO u t1 IN VERT- INV.= 25.43 48' uauio �INV.=25-18 LEVELGAS BAFFLE 1 ' PROPOSED 5 ROWS OF 8 UNITS AT 4.0'/UNIT = 32.0'/ROW D-BOX INV.ELEV.=24.58 SOIL ABSORPTION SYSTEM (PROFILE) INV.=24.87 (DB 7) 24.70 RESTORE VEGETATIVE COVER ' EXISTING 1.000 GALLON SEPTIC TANK 20) BACKFILL NTH CLEAN PERC SAND EXISTING OUTLET TO TOP of CHAMBERS PLACE FILTER FABRIC OVER UNITS NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING 9REAKOUT=TOP ELEV.=24.97 r• PIPE INVERTS PRIOR TO CONSTRUCTION INV. ELEV.= 24.58 2) D-BOX SHALL BE SET LEVEL AND TRUE TO BOTTOM ELEV.= 24.30 GRADE ON A MECHANICALLY COMPACTED SIX EXISTING SUITABLE INCH CRUSHED STONE BASE, AS SPECIFIED IN 2.83' MATERIAL 310 CMR 15.221(2) 5' MIN. ABOVE .BOTTOM OF T.P. E WIDTH 14.15' 3) REPLACE EXISTING 1,000 GALLON SEPTIC TANK . EXCAVATION OR G.W. EFFECTI = 5 x 2.83' = (5.15' PROVIDED) USE 5 ROWS OF 8 INFILTRATOR QUICK 4 PLUS WITH 1,500 GALLON SEPTIC TANK IF FAILED, ADJ. GROUNDWATER EL.=19.30 STD LP (3.3" INVERT) UNITS-NO STONE DAMAGED, NOT H2O LOADING, OR UNDERSIZED. SEPTIC SYSTEM PROFILE 4) INSTALL INLET & OUTLET TEES W/ TYPICAL SECTION GAS BAFFLE AS REQUIRED N.T.S. nr3 GENERAL NOTES: DESIGN CRITERIA 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL BOARD OF HEALTH AND THE DESIGN ENGINEER. NUMBER OF BEDROOMS: 4 BEDROOM DESIGN 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS SOIL TEXTURAL CLASS: CLASS I DESIGN PERCOLATION RATE: <2 MIN IN OF THE STATE ENVIRONMENTAL CODE. TITLE V, AND ANY APPLICABLE / LOCAL RULES AND REGULATIONS, EXCEPT AS FOLLOWS: `� OF ,y9s, DAILY FLOW: 440 G.P.D. DESIGN FLOW: 440 G.P.D. - 310 CMR 15.405 (1) (B): J 1) A 2.1 FT. VARIANCE FROM 310CMR15MI M ALLOW LEACHING ��`V�' SOIL LOG P#:14795 GARBAGE GRINDER: NO (NOT DESIGNED FOR GARBAGE GRINDER) TO BE 17.9 Fr (MAX) FROM DWELLING VS. REQUIRED 20 Fr. DA N J' BARNSTABLE TITLE 5 REGULATIONS- M R DATE: AUGUST 25, 2015 SEPTIC TANK: 440gpd x 200% = 880 gpd (USE EXIST 1,000G TANK) ALLOW LEACHING TO BE MIN OF 100 Fr. FROM PRIVATE WELL VS. REQUIRED 150 FT. N 1140 "' SOIL EVALUATOR: DARREN M. MEYER, R.S., CSE #1614 LEACHING AREA REQUIRED: (440)/0.74 = 594.59 S.F. 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE WITNESS:\ DAVID STANTON, BARNSTABLE HEALTH DISTRIBUTION BOX: (4 OUTLETS (MINIMUM)) DESIGN ENGINEER. } 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING Elev. TP- 1 Depth Elev. TP-2 Depth PRIMARY S.A.S. FROM THOSE SHOWN.HEREON SHALL BE REPORTED TO THE DESIGN SA#ITAR\� 25.30 0" 25.70 0" USE 5 ROWS OF 8 - INFILTRATOR QUICK 4 STD LP 3.3" INVERT) ENGINEER BEFORE CONSTRUCTION CONTINUES. (�� I�u A LOAMY SAND 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. 10YR 3/2 i. A L 110YrR 53A/P2 UNITS WITH NO STONE 24.ti3 8" 23.03 8" 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF LOAMY SAND B LOAMY SAND BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.73 SF/LF OF CHAMBER) THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF 21 80 IOYR 6/6 42" 22 20 10YR 6/6 42" HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. PERC TEST C (CHAMBER UNITS) 40 UNITS x 4.00 LF x 4.73 SF/LF = 756.8 SF 7. WATER SUPPLY PROVIDED BY PRIVATE WELL, O 20.30 8. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED TOTAL AREA = 756.8 SF TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. MEDIUM MEDIUM SAND DESIGN FLOW PROVIDED: 0.74GPD/SF(756.8SF) = 560 GPD > 440 GPD req'd 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE SAND 2.5Y 6/4 LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING CONSTRUCTION. 2.5Y 6/4 **14.15 X 32 = 452 SO. FT., MEETS THE 400 SO. FT. REQUIREMENT** 10. EXISTING LEACHING TO ABANDONED IN PLACE. 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION PROPOSED SEPTIC SYSTEM/SITE PLAN 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY 160" 17.37 1Do" S0 APOLLO DRIVE, WEST BARNSTABLE, MA AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY 16.97 13. THE DESIGN OF THIS SYSTEM DOES NOT ALLOW FOR THE USE OF A GARBAGE GRINDER PERC RATE <2 MIN/IN. ('C" HORIZON) Prepared for: Crook 14. ALL PIPING TO BE 4" SCH 40 ® 1/8"/FT (UNLESS SPEC. OTHERWISE) GROUNDWATER OBSERVED AT 90' EL 17.8 GROUNDWATER OBSERVED AT 95' EL. 17.78 15. NO PRIVATE WELLS WITHIN 100 FT. OF PROPOSED LEACHING WELL- SDW-252, ZONE: A. LEVEL: 47.4, ADJUST. 1.5 FT., USE 19.3 AS ADJUSTED GROUDWATER E^g�^�^^g and Surveying by: SCALE DRAWN GATE: 18. NO WETLANDS WITHIN 100 FT. OF PROPOSED LEACHING • I, Darren M. Meyer, R.S., CSE, hereby certify that I am currentlyapproved by MADEP pursuant to 310 CMR 15.017 PO MEYER BOX981 DNS,INC. NTS D.M.M. 10/03/16 17. REMOVE UNSUITABLE SOILS 5 Fr. AROUND LEACHING TO EL. 21.80 OR to conduct soil evaluations and that the above analysis has been performed by me consistent with the EAST&gNDwICH,MA02537 REV. DATE: CHECKED SHEET NO. TOP OF "C" LAYER AND REPLACE W/CLEAN MEO. SAND PER TITLE 5. requirements of 310 CMR 15.017. 1 further certify that I have passed the Soil Evol. Exam in October, 1999. 508-362-2922 D.M.M. 2 OF 2 5 iwww�wwwwwwww��.wwr�rwluu��wwwww�._ - _ ■�!_wwii.._w_!!!!!w_�_w_�wwwww_w_!_!_w_ww___ - - - _ , wwwww swwiwwwwwwwwwTwwwwwwwww-==- ww-w-www--wiwww�-�--w--1�lwww■=' ■wwwi.rww�wwwrwiMwwwr�wwwwwr-wwww ■ • • • ww�wwwwwww�wwww�wwwwww�ww mow.. . 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I•i •: •.,. �": •�. � �• ..e . . .�.a: ! •�••� i'•',�. jd B REAR FRONT R-19 Insulati n 3/4' T&G (Glued) Joist Hangers At GARAGE CONVERSION Rim Joist THE CONVERSION OF THE GARAGE TO REC ROOM WILL CONSIST OF FOLLOWING+ 240 Floor Stringers -THE REMOVAL OF THE TWO GARAGE DOORS 1016' Span, 16' On Center 2x10 Upset Beam -THE ADDITION OF TWO ANDERSON WINDOWS ((TW31042) 4'4 7/8' x 3 1/8') TO THE FACADE Vapor Barrier on + • at Center -THE REPLACEMENT OF TWO ORIGINAL WINDOWS Concrete S(Qb WITH ANDERSON WINDOWS (TW31042) -THE INSTALLATION OF 2X10 FLOOR STRINGERS CROSS SECTION BB -INCREASE THE HEIGHT OF THE CEILING ff - ADDITION OF TWO SKYLIGHTS TO THE REAR OF (Not to S c Q l e THE HOUSE (24'x381) NFRC VALUES - FLOOR STRINGERS SUPPORTED BY 2X10 RIM WINDOWS TW31042 .35 JOIST SKYLIGHTS SKS 2438 .44 - INSTALL VAPOR BARRIER ON CEMENT FLOOR BELOW NEW PLYWOOD FLOOR - INSTALL VENTS BELOW FLOOR IN FRONT AND REAR OF HOUSE SCALE 0' 5' 10.4 0 APOLLO DRIVE WEST BARNSTABLE, MA IGURE 4 6/01/04 Closet Futt Bath Bedroom 4 New Floor Plan NTS Hattway 5 Bedroom 3 Bedroom 2 2nd Ftoor Master S Pantry Closet Laundry Dining Kitchen 1/2 Master Bath Bedroom 5 Rec Room 5 Living Room Master Bath Den 1st Ftoor WEST BARNSTABLE MA FIGURE 3 3/11/04 y 8/I2 $Wpt, 1? r 141. . Asphalt Shingle�s To Match Ho.us --vent a i $h ngte swing" 2'x9' whaow's Flo*er Box 1x41 Pihe Trim Painted White : lo notube Set 4' BOW* Grade 6' Double Doors Ta fine Zx8 Rldge Board �4 Rafters 16' CC' SIZE, 12x14' PITCHY e/12 ,8x4 Wall FrQming 16'' OG SIDING, T1-11, SIDING; FOUNDATIQN1 10' SdNOTUBES SIDING C01,.ORt TRIM= 1x4 %A�HI1`E PwA PT Stringor's 16' oc: 1 ROOF, ASPHAUL:T SHI.NGL;ES thIM Fro ming $cheduale 50 APQ LLO DRIV � o" WEST $ARNSTABL,E, MA s ae` MAP NO. �31' LOT NO. Q46 SHED} PLANS