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Home My WebLink About0035 CAPES TRAIL - Health r ' 35 Cape Trail West Barnstable , A= 108-002-002 W �� R i r Health Department Drop-Off hours: 8:00 AN o 4:30 P.M { 'Town of Barnstable ----- Rec.eived by Health g��pt"erow�� Regulatory Services Department on 7 Richard V,Scali,Director BARNMULE, ' MAS Public Healtb Division �7 i639, pTEDMP+s Thomas McKean,Director 200 Main Street,Hyaiinis,MA 02601 � --_._— Office: 508-862-4644 Fax: 508-790-6304 ACCESSORY AFFORDABLE APARTMENT SEPTIC QUESTIONNAIRE Property Address: � �V �c� L t)(e_" P rty Assessor's Map/Parcel Number: /(1 100 Applicant(s) Name: M c'!G, L--) Phone: E-Mail: Size of Lot: 35 ? 2a. How many bedrooms'exist at your property now? 2b. How many bedroom are you planning to add as of the Accessory Affordable Apartment Program application? 2c. How many bedrooms total are proposed at this property (including the Accessory unit)? 2e. Is the:7prposed Accessory Apartment contained within: the main house; OR a detached structure 2f. Submit floor plans for all buildings on the entire property. Show all existing rooms in the dwelling and the proposed accessory apartment. Label each room clearly. Label measured Width of all open doorways. Use straight edge for hand drawn plans and be sure all labeling is legible. Si ned`/� Date: 9 ' i. e ACCESSORY AFFORDABLE APARTMENT SEPTIC QUESTIONNAIRE FOR STAFF USE ONLY Ftheonnected to Town sewer? ❑ Yes G No Z. Dwelling located ❑ INSIDE U OUTSIDE the Saltwater Estuary Protection Zone 3. Dwelling located ❑ INSIDE 9-16-UTSIDE public supply well Zone of Contribution 4. Dwelling is connected to DON-SITE WELL ❑ PUBLIC WATER 5. Disposal works construction permit on file? ❑ Yes ❑ No 6. If yes, how many bedrooms were allowed by this permit: bedrooms 7. Were:. ildinglpermits obtained{.for additional bedrooms? El Yes El No S. Engineered septic system plan: � a. On file at the Health Division? [0/es ❑ No b. If proposed accessory unit is detached from principal dwelling, is that plan on file? [:]Yes ❑ No 9. Existing septic system capacity is bedrooms For the accessory unit to receive approval from the Health Department the following action must occur: ❑ Existing system accommodates proposed additional bedroom(s) ❑ Upgrade existing system to accommodate additional bedroom(s) ❑ Mu st remove a bedroom from the main house >❑ Must connect detached structure to the existing septic system ❑ Must install septic system for the detached structure Other Si Date A � r* • 33 1 i ` C e_f i '+ 1 �1 clt otr� 1 k ` A -,i �� -�� i 30 I ItEC ��.�•� �,4NA, ii � f v F l I� •�� I' T tpk` i TF ill 11 11 ( 1-3sroow-, \ _ 1 I i i � � h Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 35 Capes Trail Property Address t-+ Nelson Jenkins Owner Owner's Namei information is required for every West Barnstable Ma 02668 7-28-16 page. City/Town State Zip Code Date of Inspection r%2 W Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information # on the computer, use only the tab 1. Inspector: key to move your cursor-do not Matthew Gllfoy use the return Name of Inspector key. B&B Excavation r� Company Name 374 Route 130 Company Address Sandwich Ma 02563 City/Town 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 FurtherEvaluation by the Local Approving Authority 7-28-16 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 o� Vs t� Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments GSM 35 Capes Trail Property Address Nelson Jenkins Owner Owner's Name information is required for every West Barnstable Ma 02668 7-28-16 page. Cityfrown 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: System was found to be in working order at time of inspection. Missing outlet tee was replaced and 2 broken septic covers were replaced. Tank is not in need of pumping at this time but should pumped every 2 years for maintenance. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 35 Capes Trail Property Address Nelson Jenkins Owner Owner's Name information is required for every West Barnstable Ma 02668 7-28-16 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 W Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 35 Capes Trail Property Address Nelson Jenkins Owner Owner's Name information is required for every West Barnstable Ma 02668 7-28-16 page. City/Town State -Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS,is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 'h day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 35 Capes Trail Property Address Nelson Jenkins Owner Owner's Name information is required for every West Barnstable Ma 02668 7-28-16 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well i 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 W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 35 Capes Trail Property Address Nelson Jenkins Owner Owner's Name information is required for every West Barnstable Ma 02668 7-28-16 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 5 Number of bedrooms (Actual) 5 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550 l5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 35 Capes Trail Property Address Nelson Jenkins Owner Owner's Name information is required for every West Barnstable Ma 02668 7-28-16 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 3 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (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 ears usage d See below 9 ( Y 9 (gp ))� Detail: **WELL WATER" Sump pump? ® Yes ❑ No Last date of occupancy: Current Date Commercial/Industrial Flow Conditions: Type of Establishment: NA 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 W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 35 Capes Trail Property Address Nelson Jenkins Owner Owner's Name information is required for every West Barnstable Ma 02668 7-28-16 page. Cityrrown 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: Owner- last pumped 1 'h years ago 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•3/13 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 M 35 Capes Trail Property Address Nelson Jenkins Owner Owner's Name information is required for every West Barnstable Ma 02668 7-28-16 page. City/Town State Zip Code Date of Inspection D. System Information (cost.) Approximate age of all components, date installed (if known) and source of information: 1991 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: >150' from wellfeet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): Depth below grade: 11" 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: 1500gallons Sludge depth: 3 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts _ W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 35 Capes Trail Property Address Nelson Jenkins Owner Owner's Name information is required for every West Barnstable Ma 02668 7-28-16 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 33" Scum thickness 0 11 Distance from top of scum to top of outlet tee or baffle NS Distance from bottom of scum to bottom of outlet tee or baffle NS _ 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.): Tank was in working order at time of inspection with liquid level equal to outlet invert. Tank is not in need of pumping at this time but should be pumped every two years for maintenance. Missing outlet tee was working. Grease Trap (locate on site plan): Depth below grade: NA 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 _ W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 35 Capes Trail Property Address Nelson Jenkins Owner Owner's Name information is required for every West Barnstable Ma 02668 7-28-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: NA Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 35 Capes Trail Property Address Nelson Jenkins Owner Owner's Name information is required for every West Barnstable Ma 02668 7-28-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 11 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 has some sign of deterioration but is still in working order with liquid level equal to outlet invert. Some carry over present. 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.): NA * 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 W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M _ 35 Capes Trail Property Address Nelson Jenkins Owner Owner's Name information is West Barnstable Ma 02668 7-28-16 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: (2) Pits ❑ leaching chambers number: ❑ leaching galleries number: — ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching was in working order at time of inspection. System has 2 leach pits one has 5' of standing water and one has 1' of standing water. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration NA 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 �.� 35 Capes Trail Property Address Nelson Jenkins Owner Owner's Name information is required for every west Barnstable Ma 02668 7-28-16 page. Cityfrown 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.): 1 Privy (locate on site plan): Materials of construction: NA Dimensions Depth of solids — Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 35 Capes Trail Property Address Nelson Jenkins Owner Owner's Name information is required for every West Barnstable Ma 02668 7-28-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal! System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately *WELL I Ma 42`4" B4.4' 2 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 35 Capes Trail Property Address Nelson Jenkins Owner Owner's Name information is required for every West Barnstable Ma 02668 7-28-16 page. CityFrown State Zip Code. Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: No GW 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. Oct-3-91 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: Plan on file with BOH. 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 c Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° 35 Capes Trail M Property Address Nelson Jenkins Owner Owner's Name information is required for every West Barnstable Ma 02668 7-28-16 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 . 639 Town of Barnstable Accessory Affordable Apartment Program Site Approval Application Site Approval for an Accessory Affordable Apartment confirms that the proposed apartment unit(s) meets all of the requirements of the Accessory Affordable Apartment Program (AAAP) and that you as an applicant understand to and agree all the requirements of program participation. An initial consultation with Growth Management Department staff should be completed prior to submitting a Site Approval Application.. If you have not yet had an initial consultation, please contact the Growth Management Department, Special Projects Coordinator - Affordable Housing at 508-862-4678. Submitting an Application All required information and materials must be submitted with your application. It is strongly recommended that all applications be reviewed by Growth. Management Department staff to ensure a complete application prior to submittal. The following are required for a complete Site Approval tion: 7S1te Approval Application Please submit a a completed copy of the attached application. Deed to Property, Applications must be accompanied by a copy of your Certified quit Claim Deed (or a valid Purchase & Sales Agreement) Property Survey/Existing Conditions Plan Applications must be accompanied by a survey or plan showing the dimensions of the lot and the existing buildings on the property and the locations of buildings relative to property lines. A plot plan typically accompanies your mortagage or a copy may be found in the Town's Building Division or Health Division files. Site Approval Inspection with Building Division A site visit to confirm the proposed unit meets or will meet all Building Code requirements must be scheduled and completed with the Building Division prior to site approval. If you have not yet scheduled a site visit, contact the Building Division at 508-862-4038. F, Septic Questionairre from Health Division Submit a completed septic questionnaire, signed by staff with the.Health Division, confirming that your septic system complies with the total number of bedrooms requested for program participation at your property. Note. Floor plans for development on the properly, including --room measurements; must accompany the questionnaire. Accessory Affordable Apartment Program Participation Affadavit Submit a signed, notarized affidavit agreeing to the conditions of participation in the .Accessory,Affordable Apartment Program. [V/ Demonstration of Primary Residency ❑ $100/unit Application Fee Growth Management Department o 200 Main,Street - Hyannis; MA • 02601 y An application fee of $100/unit is required. Checks should be made payable to the Town of Barnstable. We do not accept credit/debit cards. Process &Timeframe Growth Management Department staff will process the-application for Site Approval once all materials have been completed and submitted. Site Approval is issued by the Town Manager under the authority of Chapter 9, Article II of the Barnstable Town Code and Massachusetts General Law Chapter 40B. The Town Manager may issue a Site Approval letter confirming your application has been approved. Within three months of receiveing Site Approval, you must file a Comprehensive Permit application with the Zoning Board of Appeals to complete the requirements for participation in the.Accessory Affordable Apartment Program. Please review all application requirements and the review process prior to applying. Prior to submitting an application, you are encouraged to contact the Growth Management Department, Elizabeth Jenkins, Principal Planner at (508) 862-4665 or elizabeth.jenkins town.barnstable.ma.us. Growth Management Department - 200 Main Street • Hyannis, MA - 02601 MKS� Town of Barnstable Accessory Affordable Apartment Program Site Approval Application The undersigned hereby applies in accordance with the General Ordinance of the Town of Barnstable Chapter III,Article LXV, Pre-existing&Unpermitted Dwellings,for the issuance of a site approval letter. Applicant Name Applicant Mailing Address ,�OiS "%G lam,@ Town/State/Zip ! �� Applicant Phone Number 7741 �5 2�—IO&I _fW> 77& 79�d / Applicant E-Mail1,��y�� Property Information: Assessor's Map/Paroel Number: Zoning District: Number of Years Owned: �7 Groundwater Overlay District: Program Eligibility—Threshold Criteria: Please check the following, as applicable. The proposed unit(s) is/are: ❑ A dwelling unit or dwelling units for which there does not exist a validly issued variance, special permit or building permit, does not qualify as a lawful, non-conforming use or structure,for any or all the units, and which was in existence on a lot of record within the Town as of January 1, 2000, ❑ A dwelling unit or dwelling units that was in existence as of January 1, 2000 and which has been cited by the Building Department as being in violation of the zoning ordinance. ❑ A new accessory unit in a single-family owner-occupied dwelling ❑ This is a multi-family dwelling where there exists a total of dwellings, but are currently unpermitted. - Brief Explaination of Request: Ile Proposed Number of Bedrooms in Unit(s): Proposed Unit Square Footage(s): ?sq.ft Existing Level of Development on the Property: Number of Buildings: _ Gross Living Area: sq.ft z.. . Growth Management Department • 200 Main Street • Hyannis, MA • 02601 f . I understand that, as property owner, I must within three months of receiveing a site approval letter,file an application for a comprehensive permit under the local Chapter 40B program with the Barnstable Zoning Board of Appeals to participate in the ssory Affor ble Apartment Pro Signature: Date: An -V/ l Print Name: ,/6%,E O� � �1 ✓ � Signature: C0-4i'� Date: 14;;2111� Print Name: For Department Use Only: A conditional inspection of the premises was conducted by the Building Division on 17-1 See attached requirements for conformance with the State.Building Code. A Health Agent reviewed the on-site septic on ❑.The unit was found to be in conformance with the State Sanitary Code. ❑ See attached requirements for conformance with the State Sanitary-Code. Growth Management Department 200 Main Street • Hyannis, MA • 02601 Town of Barnstable - yP o4,He r Health Inspector Regulatory Services Office Hours A ; LE' . 8:30-9:30 Richard V.Scali,Director 1659. Public Health Division 3:30-4:30 Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 5.08-790-6304 ACCESSORY AFFORDABLE APARTMENT PROGRAM APPLICANT SEPTIC QUESTIONNAIRE Dater 1. General,Information: Property Address: _� Assessor's Map/Parcel Number: I — Size of Property: Applicant(s)Name: Applicant Address: �� - � �� Home Phone: -��'Y/ Email: 2a. How many bedrooms exist at your property now? 2b. How many bedrooms are proposed in the Accessory Unit? (Studios=1 bedroom) ' 2c. How many bedrooms total are proposed at this property(including the Accessory unit)? 'JJ` 2d.Please include a copy of the floor plans for the entire property. Neatly use a straight-edge. Show all existing rooms in the home and the proposed amnesty apartment. Provide width measurements of any open doorways. Label each room clearly. 3. Is the dwelling connected to public sewer? No Yes If the dwelling is connected to public sewer,skip questions#4 through#9 below. 4. Location of dwelling is INSIDE or UTS a Saltwater Estuary Protection Zone? 5 Location of dwelling is INSIDE or UTSID a Zone of Contribution to public supply wells? .6. Is the dwelling connected to an ON--SITE WELL or to PUBLIC WATER? t 7. Is a:disposal works construction permit on file? YES or NO 8. If yes,how many bedrooms were approved according to this permit? Bedrooms 9. Were any building permits obtained for construction of additional bedrooms? YES or NO 10. Is there an engineered septic system plan on file at the Health Division? KIYES or NO 11. Has the septic system been inspected by a DEP certified inspector within the last two years?C or NO FOR OFFICE USE ONLY; The Pub11c Health Division has no'objection to bedrooms at this property. Special Conditions.: Date: opTxe auwsreeue, y Mess bs� ED(My� Town of Barnstable Accessary Affordable Apartment Program Single-Family ®welling Affidavit , first being duly sworn, on oath, depose. and state as follows: I am the owner of the property located at: ��AA7 � �, � � �� Map and Parcel Number: f22--00__�2 —00 z a I am the owner of the property and the dwelling thereon is my primary occupied residence. o I understand that upon receipt of a comprehensive permit, the unit will be rented in perpetuity to a person or family whose income is 80% or less of the Area Median Income (AMI) of Barnstable Metropolitan Statistical Area (MSA) and the rent (including utilities) shall not exceed the 30% of the monthly income of a household earning 80% or less of the AMI, adjusted by household size. In the event that utilities are separately metered, the utility allowance established by the Barnstable Housing Authority shall be deducted from the rent. e I am prepared to sign a Regulatory Agreement and Declaration of Restrictive Covenants and to have it recorded at the Barnstable Registry of Deeds upon the issuance of a Comprehensive Permit from the Zoning Board of Appeals. Sworn to under the pains and penalties of perjury this /J/may of 20 117 Signed: COMMONWEALTH OF MASSACHUSETTS County of Barnstable; ss:. r, On this O(V day of Uh{r , 201+before me,the undersigned notary public,personally appeared . ,the Owner,proved to me through satisfactory evidence of identification,which was to be the person who signed the preceding or attached document,and who swore or affirmed to me that the contents of the document are truthful and accurate to the best of his/her knowledge and belief. �A+.a+un++gHa�ah Notary Public ....... PNl EXp� pG a. Printed: �% i b�' - r-f h� My Commission Expires: W • - r 4 ray. C1,'k �' Y � :•o�'•�, 'N pBACHVp�;`� McKean, Thomas From: McKean, Thomas Sent: Wednesday, October 29, 2014 9:52 AM To: Cadrin, Arden Subject: 35 Capes Trail West Barnstable I received an amnesty application/septic questionnaire dated 10/21/14 for five bedrooms (was five adding two, then going back to five). The septic system does have capacity for five bedrooms. I didn't receive a floor plan on this one. Did you receive a floor plan for this proposal? Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 35 Cape's Trail Property Address SILVERMAN, MICHAEL& ELIZABETH Owner Owner's Name information is required for every W Barnstable MA 02668 9/19/13 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in an p P Y Y way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, _use only the tab 1. Inspector: key to move your l/ (� cursor-do not Robert Paolini U y use the return key. Name of Inspector Robert Paolini Septic Service "�11 Company Name 17 Playground Lane Company Address > Yarmouthport MA 02675 City/Town State Zip Code 508 362-3555 S 14454 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. 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: S C:) Passes ❑ Conditionally Passes ❑ Fails r NeWirtherEtluation by the Local Approving Authority 9119/13 rU I ctor's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall,submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the.conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3113 Tille 5 OVlnsni: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 35 Cape's Trail Property Address SILVERMAN, MICHAEL& ELIZABETH Owner Owner's Name information is required for every W Barnstable MA 02668 9/19/13 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑x 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 35 Cape's Trail 1W - Property Address SILVERMAN, MICHAEL& ELIZABETH Owner Owner's Name information is required for every W Barnstable MA 02668 9/19/13 page. City/Town state Zip Code Date of Inspection B. Certification (cunt.) ❑ 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 35 Cape's Trail Property Address SILVERMAN, MICHAEL& ELIZABETH Owner Owner's Name information is required for every W Barnstable MA 02668 9/19/13 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No 0 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 ❑ Liquid depth in cesspool is less than 6" below invert or available volume is less than'/day flow t5ins•3113 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 35 Cape's Trail Property Address SILVERMAN MICHAEL& ELIZABETH Owner Owner's Name information is required for every W Barnstable MA 02668 9/19/13 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ 0 Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ 0 Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ 0 Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ 0 Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ 0 Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ 0 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.] ❑ 0 The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ 0 The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes" to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•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 35 Cape's Trail Property Address SILVERMAN MICHAEL& ELIZABETH Owner Owner's Name information is required for every W Barnstable MA 02668 9/19/13 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no" as to each of the following: Yes No ❑x ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ❑x Were any of the system components pumped out in the previous two weeks? ❑ ❑x Has the system received normal flows in the previous two week period? ❑ ❑x 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) 0 ❑ Was the facility or dwelling inspected for signs of sewage back up? R ❑ Was the site inspected for signs of break out? 0 ❑ Were all system components, excluding the SAS, located on site? 0 ❑ 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? Eq ❑ 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: ❑ ❑x Existing information. For example, a plan at the Board of Health. ❑ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 440 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 35 Cape's Trail Property Address SILVERMAN, MICHAEL& ELIZABETH Owner Owner's Name information is required for every W Barnstable MA 02668 9/19/13 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes 0 No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes 0 No information in this report.) Laundry system inspected? 0 Yes ❑ No Seasonal use? 0 Yes ❑ No Water meter readings, if available(last 2 years usage(gpd)): na Detail: Sump pump? ❑ Yes 0 No Last date of occupancy: NA 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•3113 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 ' Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 35 Cape's Trail Property Address 'SILVERMAN, MICHAEL& ELIZABETH Owner Owner's Name information is required for every W Barnstable MA 02668 9/19/13 page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) 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: ❑x Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑x 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-3/13 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 35 Cape's Trail Property Address SILVERMAN MICHAEL& ELIZABETH Owner Owner's Name information is required for every W Barnstable MA 02668 9/19/13 page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) Approximate age of all components, date installed(if known)and source of information: Were sewage odors detected when arriving at the site? ❑ Yes Z No Building Sewer(locate on site plan): Depth below grade: 1.5' feet Material of construction: ❑ cast iron 0 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.): Joints appear tight.No evidence of leakage.System vented through the building vents. Septic Tank(locate on site plan): ' Depth below grade: 1 feet Material of construction: 0 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: 1500 gl. Sludge depth: 4-1 t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 35 Cape's Trail Property Address SILVERMAN MICHAEL& ELIZABETH Owner Owner's Name information is required for every W Barnstable MA 02668 9/19/13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 32" Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 14" 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.): Pump tank every 2 years.Inlet and outlet tees are in place.No evidence of leakage.Tank appears structurally sound. 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 r 35 Cape's Trail Property Address SILVERMAN MICHAEL& ELIZABETH Owner Owner's Name information is required for every W Barnstable MA 02668 9/19/13 page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 35 Cape's Trail Property Address SILVERMAN, MICHAEL& ELIZABETH Owner Owner's Name information is required for every W Barnstable MA 02668 9/19/13 page. Cityfrown 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 No 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.): Box is level.Box has two outlet laterals.No evidence of leakage. 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 35 Cape's Trail Property Address SILVERMAN, MICHAEL& ELIZABETH Owner Owner's Name information is required for every W Barnstable MA 02668 9/19/13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑x leaching pits number: 2 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Sandy dry soil.No signs of hydraulic failure.Leaching pits were dry at time of inspection. 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 35 Cape's Trail Property Address SILVERMAN, MICHAEL& ELIZABETH Owner Owner's Name information is required for every W Barnstable MA 02668 9/19/13 page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r 35 Cape's Trail Property Address SILVERMAN, MICHAEL& ELIZABETH Owner Owner's Name information is required for every W Barnstable MA 02668 9/19/13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ❑ drawing attached separately r (y ya' t5ins•3/13 Title 5 Official Insp ection 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 35 Cape's Trail Property Address SILVERMAN, MICHAEL& ELIZABETH Owner Owner's Name information is required for every W Barnstable MA 02668 9/19/13 page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) Site Exam: ❑x Check Slope ❑x Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 60+ feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) R Checked with local Board of Health-explain: As-Built ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: USED:USGS observation well data.USED:Technical bulletin 92-0001 annual ranges of groundwater elevations.. 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 Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 35 Cape's Trail Property Address SILVERMAN, MICHAEL& ELIZABETH Owner Owner's Name information is required for every W Barnstable MA 02668 9/19/13 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist 0 Inspection Summary: A, B, C, D, or E checked 0 Inspection Summary D (System Failure Criteria Applicable to All Systems) completed 0 System Information—Estimated depth to high groundwater 0 Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 jti�!(?!stt??tlll?'t?T'Tt?l??tl?Tlt??tlllt?Tit???it???TT?Tl??TttlilTTlITI?Tl???tTM?m,t??? tttlnttttttptlttttnt�,tt�ntTtTTtm�tftlretttttTntt:tpntT�ttl iT TTT?T????TlT?Tn:ftlryitTlTTilttrm111nJ1 f _ ENVIROTECH LABORATORIES _ .Mass. Cent.#:MA063 l 449 Route 130 Sandwich,MA 02563 (508) 888-6460 Built Well Homes Cape Trails z= CLIENT: LOCATION: .Rue 134 ADDRESS: W. Barnstable, MA - Dennis, MA 02638 COLLECTED BY: M.L. Harrington SAMPLE DATE: 11-22-91 TIME: 8:00 11-22-91 ET647 DATE RECEIVED: SAMPLE ID: _ ' New Well 150/350 JOB #: WELL DEPTH: :; - RESULTS OF ANALYSIS: Parameter Units Recommended limit Result = Coliform bacteria/100 ml (MF Method) 0 0 pH pH units --- 6.0-8.5 6.66 A Conductance umhos/cm 300 142 z Sodium mg/L 20.0 10.8 ff Nitrate-N mg/L 10.0 <0.03 Iron mg/L 0.3 0.37 - _ _ Manganese mg/L 0.05 ; Hardness mg/L as CaCO 500 _ 3 Sulfate mg/L 250 - Potassium mg/L 20.0 Alkalinity mg/L 200 Chloride mg/ ?50 E Turbidity .. NTU 5.0 t Color t ' APC. units. 15.0 Background'bacteria COMMENT: Iron.level:is not a. health hazard. EPA 601/6027 ulg%L - Chloroform = lx See-attached report _4 E YES No WATER IS SUITABLE FOR DRINKING PURPOSES FOR PARAMETERS TED. 4a ..L t DATE '3 �Jlil!l1111!!!!1!llUll111t1I111UlllUllllUillllhlllllllllhll11L1111111111UI11111i11111111I111Illititfih!(!liiiiillilUliillliliihliUliiiilillilllllliiiiiili litlUllll11U1i11I1111l111111111iillllil!!!Ulllll�llhilllliltlilliil� � F .4 } r =JC7riDv=.__R yV^.ter C: 3V :oTEC- .— j 602 -59 447s:4 z/ GROUNDWATER ANALYTICAL ' EPA METHODS 601 and 602 Volatile Organics (GC/PID/ELCD) Field ID: ET647 Lab ID: "-2295-01 Project: Cape Trails/ET647 QC Batch: VGA-889 Client: Envirotech Sampled: 11-22-91 Cont/Prsv: 40ml VOA Vial/NaHSO4 Cool Received:- 11-25-91 Matrix: Aqueous Analyzed: 11-30-91 PARAMETER CONCENTRATION REPORTING LIMIT Dichlorodifluo.romethane BRL 5 Chloromethane BRL 1 Vinyl Chloride BRL 1 Bromomethane BRL 5 Chloroethane BRL 1 Trichlorofluoromethane BRL I 1,1-Dichloroethene BRL 1 Methylene Chloride BRL i trans-1,2-Dichloroethene BRL 1 1,1-Dichloroethane BRL 1 cis-1,2-Dichloroethene * BRL 1 Chloroform 1 1 x` 1,1,1-Trichloroethane BRL 1 Carbon Tetrachloride BRL 1 ` Benzene . BRL 1 1,2-Dichloroethane BRL 1 ' Trichloroethene BRL 1 k 1,2-Dichloropropane BRL 1 Bromodichloromethane BRL 1 2-Chloroethylvinyl Ether BRL 1 trans-1.,3-Dichloropropene BRL 1 Toluene BRL 1 cis-1,3-Dichloropropene BRL 1 x 1;1,'2-Trichloroethane BRL 1 Tetrachl oroethene BRL 1 zy Dibromochloromethane BRL 1 ' Chl.orobenzene BRL 1 ' fT. `Ethyl benzene BRL 1 r ' m+p.-Xylene * BRL 1 o-Xy1 ene Bromoform* BRL 1 4 #°a BRL ; 1 } u 1,I',2;2-Tetrachl oroethane BRL 1 . 1,3 Dichlorobenzene BRL Y 1,4- 7°Dichlorobenzene BRL 1 1,2Dichlorobenzene BRL 1 . . - a, QC SURROGATE COMPOUND SPIKED MEASURED RECOVERY QC LIMITS , Bromochloromethane 30 28 93 % 83 117 %. Fluorobenzene 30 30 100 % 87 - 113 % F BRL Below Reporting Limit.. * Non-target compound. "Trace" indicates probable presence below listed Reporting Limit. Method References: Method 601 - Purgeable Halocarbons and Method 602 - Purgeable Aromatics, 40 C.F.R. 136, Appendix A (1986). t I v t- a - k i AsBuilt Page 1 of 1 3s TOWN OF BARNSTABLE LOCATION G",a� �ru.�� J J SEWAGE # 91 5 J-3 VILLAGE GfU ASSESSOR'S MAP & LOT O -My� INSTALLER'S NAME & PHONE NO. v, N, /-2c,If SEPTIC TANK CAPACITY /S'U© LEACHING FACILITY:(tgpe) 2 s /y P o (size) /G X 6 NO. OF BEDROOMS 3" PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: /2 -j/�•- �}/ DATE COMPLIANCE ISSUED• VARIANCE GRANTED: Yes No 1, .ry 5s �-?>� http://issgl2/intranet/propdata/prebuilt.aspx?mappar=108002002&seq=1 8/15/2012 �S TOWN OF BARNSTAB E pool -x6J LOCATION SEWAGE # 5 S-3 VILLAGE k�vl 4' lop` ASSESSOR'S MAP & LOT —Xc`-A INSTALLER'S NAME & PHONE NO. J4H 19, Aa /to, SEPTIC TANK CAPACITY /5-00 LEACHING FACILITYAtype) 1= Iyao L1,9 (size) /d ,-6 NO. OF BEDROOMS S PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER 11ctyarp1 0h of Colo? s't DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No, 99 a i �� r \ •�" � '� /1 �,, ' S � ! - ��,- ' �. � � �� _ _L_ � � r 7.� � `�.` Nd. .� F>$.....1...:... ....... 5� THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH T ODz -V0V TOWN ... --- ...OF.............BARNSTABLE ..... - Aliv iratiun for Dispati al Works Tuntrurtiun throb# Apphcc�ati,Q n is hereby made for a Permit to Construct (X ) or Repair ( ) an Individual Sewage Disposal System at.11 CAPES TRAIL 36 ................_................................................................................ ----------------•-------..............-----------------......---------------------------------.--- BU EtieSiOMESJ- 90 Route 1-3-4, Town P1aza, S.Dennis 02660 ......................-.......................................................................... --._...-----...................................................................................... O er ress Installer Address Type of Building Size Lot.....48-!813..-_-.Sq. feet U DwellingF i v e—No. of Bedrooms__________________________ Expansion Attic ( ) GarbageGrinder ( ) p`I., Other—Type of Building ............................ No. of persons.................._.._______ Showers ( ) — Cafeteria ( ) aOther fixtures ..-•----•-------------•--•-•-••----•--••---•---•------•-••--•••----••----•---.............._..----•---•---•-•---••----•••-•-.......-•--.....-•-------- d W Design Flow.....................5.`.................___gallons per person per day. Total daily flow..............550_______-_-___________gallons. WSeptic Tank—Liquid'capacity_1500gallons Length...10. 6 VVidth`��.8..�_..._ Diameter__._____--._. Depth_-5_'.Z"_. x Disposal Trench—;aTo..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter......... _..._. Depth below inlet....._6.'____... Total leaching area40,1_=:6:9.6q. ft. Z Other Distribution box (X) Dosing tank ( ) Percolation Test Results Performed by.-__----OX 1.. .E __ Date----10. 10 91 as Test Pit No. 1----<.�....minutes per inch Depth of Test Pit...... ...... Depth to ground water.....nonp_....... 44 Test Pit No. 2_...<........minutes per inch Depth of Test Pit....... Depth to ground water.....none....... 1:+ --------•- ........-•--•--•..............................•--••--•-•-----------•-----•------.---_---------------------------- O Description of Soil,!) 0 - subsoil, 24" - 72" Ti ht sand, 72" 144" c� k� �......................................................... - ---- x e -ium sand j----0---- 24 Top- subsoil, 24• 72�� A ht nd. 72 156" U ..Medium sand ----- ------ -------------------------------------------------------------•-----•••--..........-•-- VNature of Repairs or Alterations—Answer when applicable................................................................................................ ---•---•---•-•----••-------------------•------•-----•---•--•--------•-------•--•------------------------•---•-•-----•--.••-•----•-------•-------•--•----•--•--------•-•----------------•---------------• Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has ee issued by the board of health. Signed ................. ...--.-.... vccc�-- ---------------- - --- n- Application Approved By .... .- � ' - �y -... / _.... �-PPlication Disapproved for the following reasons: ...................... .................. .... . .......................... ..... ------------------------ ------------------- !r� Permit No. ---------.�---------- --- Issued � . ... .. ..........�e No:..q A, ' THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ........TOWN.........................0 F.............BARN.STABLE------......-----------•---••-......---•--•. •Z ppliration for Dhipasal Works Towitru.rtion ramit Application is hereby made for a Permit to Construct (X ) or Repair ( ) an Individual Sewage Disposal System at: CAPES TRAIL" ' 36 ................_................................................................................ ............................................. ............ ........................................ Bv, tfW Rfa�resUOMES Route r Town Plaza,S.Dennis 02660 ......................------- - _... --; Address Installer Address QType of Building Size Lot....48 813......Sq. feet U Dwelling—No. of Bedrooms...........i...e Expansion Attic ( ) Garbage Grinder ( ) 04 Other—Type of Building ___________________________•�No. of persons........................_--- Showers ( ) — Cafeteria ( ) a � Other fixtures ---------------------------.....................................................................................................•------------•-'..... ' Design Flow........:..................................gallons per person per day, Total daily flow_.__.__......_ 50........._...........gallons. 1:4 Septic Tank—Liquid capacity.l-500gallons Length..10'.6"Widths.8_ ..... Diameter....... Depth..5.11".., W x Disposal Trench—I o. .......... ........ Width-:.---".-.- .Total.Length......__.._........_ Total leaching area._, _...___-_Sq. ft. Seepage Pit No..__................. Diameter......... Depth below inlet....___.6.......... Total leaching area Q _s�6q. ft....,, z Other Distribution box (X) Dosing tank (( ) Doy Te En ineerin 10rrZ0 9l Percolation Test Results Performed by...___.___.. .............. ..•---------------- -----.---------___-. Date--------__1_-- - ------- 0.� Test Pit No. 1....�2_._.minutes per inch Depth of Test Pit_._.._z2!...._. Depth to ground water-----nOn@ . ---- ` f? Test Pit No. 2_...� ___.minutes per inch Depth of Test Pit__..__13_�__._._ Depth to ground water___..non@ . .. O l) 0 ,- j Topa.subsoil_,_24" •-•--72-"---Tight sand,72" - 14411 .. z D cr Ion of Soil_ _______________ x ed iu® sand 2) p 24" Top subs©il-r 24"_---- 72 W ... and: -- •-••-•--------------------- V Nature of Repairs or Alterations—Answer when applicable_____________________________•-................................................................... r'. -•-•---•----------••--•-•---•-••------•----------------•--•-•-----•-•-•-----•--•----.........-•----•----•------....---••--------•-•-----•-•---•-•-••---••-------------•-----•••••-•-•••-•--••-•--. -- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the'-- system in operation until a Certificate of Compliance has been.issued by the board of health. . . 1 Signed ---�\Y C---Gc - .. / - ..� .....v. Application Approved BY --- � .�. '�. -.:1Q- r....--�j� /.:�--1:? f ......... ... - ------------------ /. ---- --1�-----�/ Application Disapproved for the following reasons: t ....................................... ...---.......------...---...--------------------------------------------------- -- Date Permit No. i -------------------- Issued ----- .. at ,.. < THE COMMONWEALTH OF MASSACHUSETTS ... BOARD OF HEALTH TOWN OF ..............BARNSTABLE... - C�ez#tftett#e of (foutylianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by -1 .... � �1 / ................ �-- at ......r— ----- ................-------I has been installed in accordance with the provisions of TITLIE 5 o�f, he State.Environmental Code as d scr�d in the application for Disposal Works Construction Permit No. ......... �'.t".� ----... dated ......... _ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE COST D AS A GUAR�TE T A�THE SYSTEM WILL FUNCTION ATISF TORY. DATE--------------------------------------- ......- Inspector .. , - C../o. -------- ---- ---- °----- -- ------ THE COMMONWEALTH OF MASSACHUSETTS -, BOARD OF HEALTH t ��/ ................TOWN.............OF..........---•---BARNSTABLE FEE...h� Disposal Works Cnons#riott lermi# ` Permissionis hereby granted.............................................................................................................................................. to Construct ( ) or Repair ( ) an Individual Sewage Disposal System,,, atNo........................................................................................................--•--------------------_ --------------------- --- _ Street . ^ � as shown on the application for Disposal Works Construction Permit No��,,J,� Dated_./ ___f_l.�_.�^___.�_-----•-- -- Board of Health DATE.................................. ®•---•- .;- ......... FORM 1255 HOBBS & WARREN, INC., PUBLISHERS to /v�i2 J C�°Pk �� o m 100007 tl ®0 ®,e- ' r No----------------- --- Fee--------------------- BOARD OF HEALTH TOWN OF BARNISTABLE . � ��fitation,�ior�PYr �or��truction�Ermit Application is here y made four-a pe t to Construct ( ), Alter ( ), or Repair )an individual Well at: -L- <��-�` �= - f -- - - - --------------- LoEation — ddress Assessors Map and Parc 1 r -------------- 3 -------- ---!�------ - - - - Owner �Address — -- �—"-'.---------------------------- —------------------—----------------------------------------------------------------- ---- �er — Driller Address Type of Building DwellingJ '-r Other - Type of Building----------------------------------- No. of Persons---------------------------------------------------------- Typeof Well- 1 ----------------------------—----------- Capacity------------------------------------------------------------------------------ Purpose of Well -- - Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until a Certificate of Comp ' nce has been issued by the Board of Health. �, -- 191 Signed- ri�; --------------- ----- ------ d e Application Approved By---4-�' - date Application Disapproved for the following reasons:---------- --------------—----------------- - -- -- ------------------------------------------------------------------------------------ date ----- --- ---- ------------ 1 Permit No.- - ----------------- `- -------------- Issued-------------------------------------------------------------- --------------------- --------- ------ --- date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliance THIS IS TO CERTIF h Individual Well Constructed ( ), Altered ( ), or Repaired ( ) WEE by — - - - - -- m -- - ------------------------ � - - at-------�-�- -------OA -------- ---�©- - --- -----------------------------=- has been installed in accordance with the provisions of the Town of Barnstable Bogard Vq 'e47 rivate Well Pro ectiRegulation as described in the application for Well Construction Permit No. 1V Dated-LR -3--- J THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE-------------------------- -------------- Inspector-------------------------------------------------------------------------------- '7r;dk No.--w — ----- Fee BOARD OF HEALTH TOWN OF BARNSTABLE ZIpplication forVerf CougtructiouperMit Application is herk made for a pe it to Construct ( ), Alter ( ), or Repair ( )an individual Well at: --------------------------------- L ation —,Address Assessors Map and Parcel ------------------------ Owner T Address -�- w ----------------------------- -------------------------------------------- - ------------------------------------------------- Fnsta r — Driller Address Type of Building l S heoR t�sor. Dwelling-- - - --- ----- Other - Type of Building---------------------------------- No. of Persons---------------------------------------------------------- Typeof Well- ----------------------------------------- Capacity----------------------------------------------------------------------------------- Purpose of Well ra-o----------------------------------- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until a Certificate of Comp Ance has been issued by the Board of Health. Signed -!�/ - - - ------ --------- 0/ Application Approved By---�H-l-t! ----- '®---- - -- ' - -�- ------ ----�y/ date ' Application Disapproved for the following reasons:----------------------------------------------------------------------------------------------------------------- ------------------------— - ---- -1--------------------------------------------- ------------------------------------------------------------------------------------------- / date Permit No. -?-- ---- ------------------------------------- Issued-------------------------------------------- -- - ---------------- --------------- date BOARD OF HEALTH TOWN[ OF BARNSTABLE Certificate Of Compliance THIS IS TO CERTIF That the Individual Well Constructed ( ), Altered ( ), or Repaired ( ) �( l�' n to e at-------/W _ � OAP6S---------/ — \11 e a)0 -------------------- has been installed in accordance with the provisions of the Town of Barnstable Board o He�Vbated rivate Well Prgtectio r l� , ' Regulation as described in the application for Well Construction Permit No. - ------- - `-- J THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL J SYSTEM WILL FUNCTION SATISFACTORY. DATE------------------------------------------------ Inspector----------------------------------------------------------------------------------- BOARD OF HEALTH TOWN OF BARNSTABLE lVerr Con5truction3permit NO. _-I_--------l_-, Fee---�,L------------- V� _� Permissionis hereby granted------------------------------- ------------------------------------------------------------------------------------------------------------ to Construct ( , Alter,( ), ore a'r (, an Individual�Well at: ; 1 No. -------�� tj-------------`xf' 1 ,- � 1- Streei - ------------------------------------- as ------------------------------------- r- 1 - Street " T as shown on the applicati•n for a Well Construction Permit - No.- - -: ;- l ----------------------------------- Dated------------------------------ - - I ------------------------- ` Board of Health � DATE-------• -L__ �/ -/ ------------------------------------- . I i I SEWAGE SYSTEM.,.PROFILE NOT TO SCALE I I, 2"LAYER OF , 171.0' TOP OF FOUNDATION 1/8" TO 1/2" WASHED PEASTONE I • ALL AROUND FREE OF IRONS, FINES AND DUST IN PLACE. • MIN. 27 GRADE WITH MIN. 1' COVER OVER LEACHING PIT 167.2' V MAX. COVER OVER TANK 166.8' 166.4' • . e o O O 0 0 0 0 o o O O O O 0 e . • • e 0 0 0 O 0 o e 4' F •e o 0 0 0 O o e . . LIQUID LEVEL .: ' ' . . . e o 0 0 0 0 o e . . • 167.4'. • , ' . .e o 0 O O o o DIST. BOX • . e o 0 0 0 0 o e . • • • , • • o-000 000o . . 166.6 : INSTALLED . . eooO 000e • : • 166 2 , TO.BE ON A LEVEL BASE . :c o O o '0 O 0 e.. . • •..• " . . e o o O O o 0 0 . . • WITH A 6 SUMP. 160.2' SEPTIC TANK 0 0 0 . . 00 0 O 0 -0 oo . . • e 0 0 0 O o o e . . PROPOSED WELL USE 1500 GALLON TANK �+�.�t� - TO BE INSTALLED ON A LEVEL BASE 3/4" 1'0 1/2" LEACHING PITJ WITH P.V.C. OR C.I. TEES WASHED. STONE: FREE OFIRONS. FINES 6 DIA. x 6 a EFF. DEPTH 4' MIN: \ :.' (;► PERVIOUS �4� p AN'A DUST IN PLACE PRECAST STRUCTURE TO ALL AROUND PIT BE SET ON LEVEL BASE MATERIAL WITH FEET OF 3/4" TO 1/2" WASHED, hb \ Y. STONE FREE OF IRONS, FINES ` \ �� ij� ` 'dos AND DUST IN PLACE. in \ <. 0�$ \ 3 \ \'S 8 1 -PROFILE OF PROPOSED SEWAGE SYSTEM Fl56.2 BAtNSTABLE :: . ' �\ �', B.M. N/E CORNER SYSTEM DESIGNED BY THE TOWN -OF REGULATIONS ; ' — TRANS. PAD AND TITLE 5 OF THE MASSACHUSETTS STATE ENVIRONMENTAL CODE �°j gip': ' �� ` �� - ELEV: 181.24 I az _ GENERAL NOTES: • 1. ALL PIPES SHALL BE SCHEDULE 40 P:V.C. SEWER PIPE ,'::: 40. \ `� 2. ALL PIPES SHALL BE SLOPED 1/4" PER FOOT EXCEPT THE FIRST TWO FEET OUT OF THE DISTRIBUTION BOX, WHICH a, - SHALL BE LEVEL 3. DESIGN FLOW E BEDROOMS AT 110 GALLONS PER DAY PER BEDROOM = ssa GALLONS PER DAY. I�\ ory� T ,�2 ry� I-N SEPTIC TANK SIZE: 550 x i.s' = ers GALLONS �\ .o^ r ^� ��. .fe.$ USE 1560 GALLON TANK W/ auT GARBAGE DISPOSAL ° 17G' \ \ ``'J �/8 /d 1500 GAL/TANK LEACHING SYSTEM: 1 USE CZ) PRECAST LEACING PIT \ ^ ` w/l. STONEDAROUND �P. RES. ,\� �e, I NOTE;ss ttta Osp- aL m >`SU wE�L � stPtic Lo«,*td,�s 78 1 ps lSROPos>?t.'D ota gBLLY'jtMC.I t_cTS. i \ ` ^y;, � - ,� ` \ � � � NbT�: -t'N'�,, L>CRGNItic, 'F'IT•'S sH�KJN ox L_oT 3�G. EFFECTIVE AREA: ; f9tl\ \ ` \ \ I 'bo NdT LIE W1714IN ?_So' OF WETLRN1�,51. SIDE zr-l4)le-> x z.5' - S-17 4gc/vAy BOTTOM r z x L-0 = so L bR C4) � ! y TOTAL FLOW 427 x z.o = 8s4 44c./Day LOT 38 TOTAL REQUIRED FLOW E. n x i•o 5�o W OL GARBAGE DISPOSAL / ` 48,813 Slq.ft. RESERVE FLOW 094-ssa = Z64 GALLONS PER DAY IN RESERVE i .SOIL. LOGS 6. ELEV. _ 168.2' NO. 1 NO. 2 ELEV. = 166.9, T Is- SITE FLAN OF LAND TOP a SUBSOIL 1 SUBSOIL i 2 I a4 3 PREPARED FOR I TIGHT SAND 4 TIGHT SAND I SG I \ 6 I BUILTWELL HOMES 8 OF �» �M 9 PERC TEST RESULTS: �� Mqs . �' MED. SAND 10 MED. SAND PERC. RATE: `p MIioRAN H o�'``A LOTi 36 CAPES TRAIL, 8ARN5TABLE, MASS. 11 WITNESSED BY 12 BARNSTABLE BOARD OF HEALTH Q p. �, ,. „ _ , No WATER ENCOUNTERED oOYLt,Itr :.} SCALE: 1 40 DATE, OCTOBER 3, 1991 13 DATE: 10/10/91 No.39e9 �x, ��- NO WATER ENCOUNTERED b P# 7820 NE��SERO '� DOYLE ENGINEERING ASSOCIATES INCORPORATED i d `� iP.O. BOX 595 - 530 THOMAS B. LANDERS ROAD Olt WEST FALMOUTH, MASSACHUSETTS 02574 5/g/ �� TEL: 508/540-4411 FAX: 508/457-9680 i I I i I I SEWAGE A E SYSTEM PROFILE NOT TO SCALE p 2"L'A'YER 0; - 171.0 1/8", TO 1/2" TOP OF FOUNDATION WASHEb,PEAS ONE ALL AROUND FR!'.E OF IRONS, FINES I'-,'!D DUST IN PLAE +. MIN 2% GRADE WITH MIN. 1 COVER OVER LEACHING PIT 1i 167.2' 1' MAX. COVER •'; OVER TANK 166.8' 166.4' + o o O O O O o o . . • eo'O.O O O oe . • : o o 0 o 0 0 00 • 4, : oo O O O O oe • . LIQUII') LEVEL • - e o 0 0 0 0 o e 167.4' . • e 0.0 0 0 O o a • - DIST. BOX . . a e 0 0 0 o • . . - 166.2 . . eoo0 ,0oo.e . . 166.E TO BE.INSTALLED o 0 e o 0 0 0 0 • �``�. ON A.LEVEL-BASE' e o 0 0 O 0 o 0 . . . ': .- . .;. , .. . . • - S WITH A 6" SUMP. _ • S.EPTIC TANK . . o 0 .00 0 0 O o • • 160.2 ` • . . e o o O o 0 o e . . ' ..• e o O 'O O O o e • . PROPOSED WELL `- •, USE1500 . GALLON. TANK �_ t-rt3,4Z TO BE INSTAL LED ON A LEVEL BASE , " , LEACHING PIT WITH P.V.C. OR C.I. TEES 3/ TO ./� WASHED, _ 1'7e' .� S1'O 6' 6' , • 4 IIN. NNE Mrk OF IRONS FINES DIA. x EFF. DEPTH :: • a ANA DUST IN PLACE PRECAST STRUCTURE TO PRODS .- ALL AROUND PIT BE SET ON LEVEL BASE MATERIAL , \ \ ,,`t�•zs S WITH FEET OF 3/4" TO 1 2" WASHED, IK� ` Y. ..�• STONE FREE OF IRONS, FINES R \ •>- 8 AND: DUST IN PLACE. � � IC; \ \ Sd 0 9 PROFILE OFF PIO h � SE ,56.2 a_ \ D SEWAGE SYSTE1VI I SYSTEM DESIGNED BY TH T BARNSTABLE O.M. N�EcoRNER 1 E OWN -OF REGULATIONS `� �^ I •.. . •• � � � �, � � TRANS. -PAD AND TITLE 5 OF THE MASSACHUSETTS STATE E•NVIRONMENTALCODE ELEV. 181.24 ..GENERAL NOTES. . - _n 1. ALL PIPES ��.�rfALLbE SCHEDULE40 P.V.C. SEWERPIPE !. r,I eo• i 2. ALL: PIPES SHALL BE' SLOPED. 1/4 P.ERFOOT E.XCEPTTHE,. , . , • _ •. . . •. , y � „ , , .•FIRST TWO FEET OUT OF THE DISTRIBUTION BOX, WHICH If. ••• ' I SHALL BE LEVEL 3. DESIGN FLOW ' I�I�aP6s � BEDROOM r S AT 110 GALLONS :.PER DAY- PER BEDROOM - sso GALLONS PER DAY. 174' ..r.tlWtLLr"� 174 . /.5 S w /\ SEPTIC TANK SIZE. Sso x �� GALLONS .a USE 1660 GALLON TANK W our GARBAGE DISPOSAL ? \ 17 R S. #1 G € A 6 ..:LEACHING SYSTEM: � D/ 1500 GAL/TANK 2 5 x If DIA I� ) LP. RES. «- USE z7 P STME PI �� 5 Mf! .�R PLpu �eFt WE<.L 5Ef+T�L o '.•>✓ �_ RECAST LEACING PIT w/t sTchE ARouND �a l $ L cn toes � as }•ttoP 5t_'ts owi FI'flu•I"I'tT•lq Lots. I, ' 3o� \ \ .+ SHp oy LGsr se- EFFECTIVE AREA: -Do mo-r LtF W Ia1 t ZsovoF f w6TLgwtfs, z SIDE 1Y" 4 'C )� � x z•5 377 4/aL/nn��. z a L \ \ BOTTOM �c4� ,x i.0 50 �� Av 4Z7 x z•a = 85'4' #t \ \TOTAL FLOW /mr> ` LOT .3� S ,n /•a'_ 551� u \ \ ` �\ TOTAL REQUIRED FLOW .�_x _ W/��' GARBAGE .DISPOSAL � �!• •� � � RESERVE FLOW es4 55'6 3-0 GALLONS PER DAY IN RESERVE ; .o SOIL LOGS ss \ NO. 1 13, �, \ \ 174' 1s8.2 N0. 2 _ r I�� ELEV. ELEV. — 166.9 •_ � TOP SUBSOIL / I 1 TOP ee suBsotL 2 I e4 8 \ gd SITE PLAN OF LAND 3 ez 4 PREPARED FOR TIGHT SAND TIGHT SAND 18G 5 Iais BUILTWELL HOMES s OF 9 PERC TEST RESULTS. �: . 6F MED. SAND 10 MED: SAND PERC 'RATE. < 2 MIN/INCH ., LO I` 36 -CAFES TRAILr s,BARNSTABLE MASS. N , D. MIORA I 11 WITNESSED BY 12 BARNSTABLE +. BOARD OF HEALTH o . . " , OOYE Ill - .;,r ;,.... ' No WATER ENCOUNTERED , col ,, SCALE. 1 -40 DAZE. OCTOBER 3 1991 13 DATE: 10/10/91 NO.�19989, , i ..., NO WATER ENCOUNTERED P# 7820 t� o „ .� DOYLE ENGINEERING ASSOCIATES INCORPORATED I U SURN� P.O. BOX 595 530 THOMAS B. LANDERS ROAD � �1 WEST FALMOUTH, MASSACHUSETTS _02574 TEL: 508/'S4(�-4411 FAX: 508/457-9680 _ I I