Loading...
HomeMy WebLinkAbout0025 CROSS WAY - Health a Cross Way A = 245--043 ivswrs 7 a a i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 25 CROSS Property Address 11 KLAMAN Owner Owner's Name information is required for HYANNIS PORT MA every page. City/Town Date of 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:When filling out A, General Information forms on the i 1 computer,use 1. Inspector: only the tab key to move your D cursor-do not OUGLAS A BROWN use the return Name of Inspector key. DOUGLAS A BROWN INC Company Name P.O BOX 145 Company Address CENTERVILLE MA 02632 '8Q1f City/Town State Zip Code 508-420-4534 S1 4297 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 7/7/10 Inspector's awre 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. l t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 25 CROSS ST Properly Address KLAMAN Owner Owner's Name information is HYANNIS PORT MA required for 5/6/10 every page. Cityrrown State Zip Code Date of Inspection B. Certification (font.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: SYSTEM APPEARS TO MEET MINIMUM PASSING REQUIREMENTS AT THIS TIME 13) 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•09M8 Title 5 Official Insp ection rronn: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 25 CROSS ST Property Address KLAMAN Owner Owner's Name information is required for HYANNIS PORT MA 5/6/10 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•09iD8 Title 5 Official Insp ection 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 ° 25 CROSS ST Property Address KLAMAN Owner Owner's Name information is HYANNIS PORT MA required for 5/6/10 every page. Cityfrown 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 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 dogged 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'/z day flow t5ins•09/08 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 25 CROSS ST Property Address KLAMAN Owner Owner's Name information is required for HYANNIS PORT MA 5/6/10 every page. City/Town Date of State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® - Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. , Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered`yes"to any question in Section E the system is considered a significant threat, or answered`yes"in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. t5ins•09/08 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 25 CROSS ST Properly Address KLAMAN Owner Owner's Name information is HYANNIS PORT required for MA every page. Cfty/Town 5/6/10 State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ❑ ® Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 t5ins-09M Title 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 6 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 25 CROSS ST Property Address KLAMAN Owner Owner's Name information is HYANNIS PORT required for MA 5/6/10 every page. City/Town State Zip Code Date of Inspection D. System Information Description: ACCORDING TO AS-BUILT AND PERMIT SYSTEM CONSISTS OF A 1000 GALLON TANK D-BOX AND 3 FLOW DIFFUSERS Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ® Yes ❑ No Water meter readings, if available(last 2 years usage(gpd)): 09-217/08-185 Detail: SEASONAL.HOUSE Sump pump? ❑ Yes ❑ No Last date of occupancy: 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-09A8 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 25 CROSS ST Property Address KLAMAN Owner Owner's Name information is required for HYANNIS PORT MA every page. Cityfrown 5/6/10 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•09/08 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 25 CROSS ST Property Address KLAMAN Owner Owner's Name ieg required is HYANNIS PORT re wired for MA 5/6/10 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: S.A.S INSTALLED INAUG OF 1988 ACCORDING TO SEPTIC PERMIT 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: feet Comments(on condition of joints,venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 1 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: Sludge depth: TRACE t5ins•09/0B Tide 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 25 CROSS ST Property Address KLAMAN Owner Owner's Name information is HYANNIS PORT required for MA 5/6/10 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 Scum thickness TRACE Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? WOODEN POLE 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 LOOKS CLEAN AT THIS TIME 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•09/08 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 25 CROSS ST Properly Address KLAMAN Owner Owner's Name information is HYANNIS PORT required for MA 5/6/10 every page. City/Town Date of 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 El 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•09M Title 5 Official Inspection Form:Subsurface Sewage Disp osal posal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 25 CROSS ST Properly Address KLAMAN Owner Owner's Name information is HYANNIS PORT required for MA 5/6/10 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cunt.) 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.): BOX LEVEL NO SIGNS OF LEAKAGE LOOKS TYPICAL FOR ITS AGE WITH SOME SIGNS OF CORROSION Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System(SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•09i08 Title 5 Official Ins pection Form:Subsurface Sewage Disposal System•Page 12 of 17 a Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 25 CROSS ST Property Address KLAMAN Owner Owner's Name information is HYANNIS PORT required for MA 5/6/10 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ® leaching galleries number: 3 ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/altemative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation,etc.): FLOW DIFFUSERS 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-O9iD8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 !N Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments '< 25 CROSS ST Property Address KLAMAN Owner Owner's Name information is HYANNIS PORT required for MA 5/6/10 every page. Cl mown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.): t5ins•09/08 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 25 CROSS ST Property Address KLAMAN Owner Owner's Name information is HYANNIS PORT required for MA 5/6/10 every page. Cdy/Town Date of 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 t5ins•09M Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 25 CROSS ST Property Address KLAMAN Owner Owner's Name information is HYANNIS PORT required for MA 5/6/10 every page. Cftyrrown 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: 14 INCHES feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: a ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database explain: You must describe how you established the high ground water elevation: ON 5/6/10 AT 6:48 AM AT HIGH TIDE I HAND AUGERED IN THE BOTTOM OF ONE OF THE FLOW DIFFUSERS AND HIT WATER AT 14 INCHES Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•09I08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 25 CROSS ST Property Address KLAMAN Owner Owner's Name information is HYANNIS PORT required for MA 5/6/10 every page. Cltyrrown 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•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 tUV!tN OF BARNSTABLE' &L,,q/ LUCATION r` �} W SEWAGE - VILLAGE_ i N ASSESSOR'S MAP & LOT _ INSTALLER'S IJAM & PHDNE NO_ , • ArPAVirf _ALs:2 SEPTIC TANK CAPACITY 1 LEACHING FACT LITY:(,tgpe)�� NO. OF BEDROOMS _PRIVATE WELL OR PUBLIC WATER_ BUILDER OR OWNER --- DATE PERMIT ISSUED: __�— --- DATE. COtiPLIANCE ISSUED: --- Nam_ VARIANCE GRA14TED: Yes __—_- --- 1 r< FEE.......$.._2 0.:.0 0 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town Barnstable .....................OF.......................... .-....... , pphration for Disposal Works Tonitrurtion 'P.rrutit Application is hereby made for a Permit to Construct ( ) or Repair C-X) an Individual Sewage Disposal System at: Klaman ................_........_...................................................................... -••---••------••---••••-------......-•--•......._... •--•••-••••----•••--------••---••-••......•. Location-Address o. .............25...Cxajs_...5 eet„West ,Hyannisport °r L°` _ ••----••........................ .•--......--•-----•-••-----•---•-•--•-•:............-•------•••- w Owner Address a .............J...P._Macomb-ex................................................... ..........-----...-------•--•--------•---••---•----••-----------------.... Installer Address U .Type of Building Size Lot............................Sq. feet DwellingX-X-No. of Bedrooms.............3---•-_---------_...__-__-__-Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q Other fixtures ------------------------- ---------------------------------•...._...•-•--...--•-----•--•-•----......-•--•••......----•- w Design Flow............................................gallons per person per day. Total daily flow--------_...................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter._._____.__...-- Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area____._.._.__...___..sq. ft. Seepage Pit No---------_---------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Other Distribution box ( ) Dosing tank ( ) a Percolation Test Results Performed by.. ---------•••......-•-• --•••--• Date........................................ Test Pit No. 1----------------minutes per inch Depth of Test Pid.................. Depth to ground water_._____.._.._._________. f� Test Pit No. 2................minutes per inch Depth of Test Pit.:;................. Depth to ground water____-_----_-___.-_-____. OP' ------------------------------------------------••-------•-----•-••---...`;------------...------------•--------------........-----•------...........--•--•.-- Description of Soil...........................------------------------------------------------------•----------•---•--•----•--------•- x ------------------------------------------------------------------•-•••---•----••- w x = •----- U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ------------------•-•-----------------------•-------------------------------------••-•...•-•---.....•--•-••---•-3�F 1 ow -D i f f u s s o r s Agreement: 4 The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'TILL� ; 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be issue*theard o-healthSigned .............••.••... . 8 25-Application Approved BY--- � D }� Da e Applicatior>,Disapproved for the following reason ............. -••-•---------•••-----••--•-••-----••-•-••---•-•---•--•--•-••----•......... �k x -{ ........................................................ �y jj ----••-•--••------•---------•-----•-------------------••-- � � r r Date Permit No. „,,yy,, # - - _- - Issued_................................ gj THE COMMONWEALTH OF MASSACHUSETTS y.3 BOARD OF HEALTH T oi.j z. Barnstable: ..........................................OF wntif irtttr of (luutpliattrr THISS, IS RTO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (x) J: : .,taconi.)er Cross S by.... ------------------------.......... .-...:__-------......_..... at 2 treet West Hyannis323ti+"'>s -------- ------•--•-•-••-••••-••--•••----•---•----...-••-•---•---. has been installed in accordance with the provisions of TI""''�— 5 of tate Sanitary r��od as �s lib ' the application for Disposal Works Construction Permit �'o.._ j =_...'`�._•'r" ----• dated.,..lS- -� 1 . THE ISSUANCE F THI CERTIFICATE SHALL NOT BE CO RUED AS A G RANT E THAT- THE SYSTEM WILL FU IONT FACTORY. DATE..'. --------------•-•--------- Inspector....... °1 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town Barnstable .......................................J . O F $ 20.00 FEE........................ iuros�tl urk (9onutrtion Prrutit Permission is hereby gran ...........................................................J•P•Macomber to Const t ll or Re air ( n Ind' idual Sera a Disposal System �rbss S1�'rect Tn>a`estyanniaprt ................... �r:_ Street as shown on the application or Disposal Works Construction e it No.-_ "" Dat ;--Z......................•..rx { r of HCalth DATE.. = ' ------------------•--------•--•---• 1 FORM 1255 HOBBS & WARREN. INC..'PUBLISHERS 20 -00 No. .... / FRs............................. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH Town Barnstable ...................... OF......................................................................................... Applirutivat for KliupuuFal Works Towitru.rtiou Prrutit Application is hereby made for a Permit to Construct ( ) or Repair X) an Individual Sewage Disposal System at: Klaman ................-................................................................................ ----...--------------------------....-------------•••--------------------------------------------. Location-Address or Lot No. 25 �,�QS-...feet--.Wes ---t Hyannisport ....................................---------------------------------------------------------- Owner Address a .............J...P. ................................................... ..................................•--•---.._..----..... Installer Address dType of Building Size Lot............................Sq. feet U Dwellings No. of Bedrooms..........................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Ga Other fixtures -----•-------------------------- - - W Design Flow............................................gallons per person per day. Total daily flow....................................:.......gallons. WSeptic Tank—Liquid*capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length-................... Total leaching area...........___--_.._sq. ft. 3 Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.-,...................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit-.................. Depth to ground water------------------------ riq Test Pit No. 2................minutes per inch Depth of Test Pit_ ................. Depth to ground water------------------------ -------------------------........................................................ 0 Description of Soil.....................................................................................---------------•------•--------------------------------=---------------•-•.....--- W -----------------•-----•--•-----------....---•--------------------------------------•._........---- W 1 ------ ---------- ------------------ --- ------------- - ---------------------------------------•------•----•-----------=-----------------------------•---------------•----------•-----------------.------ V Nature of Repairs or Alterations—Answer when applicable.............................................................................................. 34Flow Diffussors -------------------------------- ----------------------------------------------------•--•---------------------------------------------------------------------......................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TiTIE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be n issue b the board o'health Signed /_ a .. 25 ....... ---- 8 D Application,Approved By--- -- - ............ . ...----- Q . 1 i ae Application Disapproved for the following reason •................................ Date PermitNo 0. .................... '� Issued....................................................... 'mot No..f�.o.. '...... / Fizs...........................- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town Barnstable ... ....... - -- OF------------------------------------------------------------------------------------------ AllphrFatiou for UhipwiFal Vorkg Towitrur#iou Prruld Application is her made for a Permit to Construct ( ) or Repair M an Individual Sewage Disposal System%t: �laman ....... ._........_......_... ................................................... ------•--••••---------•-----------••-------- -----••----------------------------------- Location-Address or Lot :�o. i Z5_.Cross___Street-.West -Hyannisport Owner Address W, -•••••.... ,7A p��Ix Sao �? z ------!.. _.•-- Installer Address d Type of Building Size Lot............................Sq. feet D elling'(`�-No. of Bedrooms.............3..._.._....._.._._.._______.Expansion Attic ( ) Garbage Grinder ( ) Or—Type of Building No. of persons............................ Showers — Cafeteria QI YP g ------•-•-•----------•--•--- P ( ) ( ) -- a' Other fixtures ------------'......................................................................................................................................... W Design ` ow............................................gallons per person per day. Total daily flow............................................gallons. 9 Septic Ta lk—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................ Disposal�Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage 'tt No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other D stribution box ( ) Dosing tank ( ) J. aPercotation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water......................_. vo Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------------------- a •-•----•--•-•--•........-•------•-•••-•-••••--••-•••-•-•••-..........•-••---•-----------------------......................................................... 0 Desc:ption of Soil..........................................................................................................................................................x U - ---------------------••-•------------•--••----•-•--•---------•------...-----••------•----•-----.-.....--------------•--••-------•---•........................................ 0 Nature of Repairs or Alterations—Answer when applicable______•_ _______ ______________________---------------------------------------- 3-F'1ot� Diifu;»ors ------.=-•-••-----•-•-----•---•-•••••-••••--•-••-•----•--•-----------••--••••-•-•••••-•••----•••--•-•-••••••••-----------•-----•••••••••••••••-------------•----•-•--•-•••••••••-•--•-........._••--•- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T t Ej 5 of the State Sanitary Code— The undersigned further agrees not to place the system in ; opera ion until a Certificate of Compliance has be n issued by the board of health. ,{' �Q.....� .i �, . t -•---•-------------- ••... ­4A lication Approved BY it � ---�--t- /r..*!'4T�y�1Z a-•--- ---------�1 D �......... .•.. �Dafe , Api, lication Disapproved for the following reason---•----•-••• .-••-•••••-••••-•-•••••••-•••---•••••-------•-••••-•-•-•-••----•----•---•••-••-••--•••••---- ...............................••••-•---•...._._..._......-- .--•------._.......----•--•-•••--•....--•-••-•--••--•-•--•-•-•---•••-•-•••--............................................. Date r '� PermitNo. -- --------=----- -• -------------------- Issued----------•---•---------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Torn Barnstable ..........................................OF..................................................................................... C.5rrfif iratr of Ta mpliatta TFI1S IS TO CERTIFY That the Individual Sewage Disposal System constructed ( ) or Repaired (X) J P.Macomber by.............:-••-•••----•-••-•--•••-••-••..................•......___...--•-•--•-----••-------••--•--•---••-••-----......_..---------•-----•-••••.......-•••-----•---••-•....-----•-------•----•-- 2 Cross Street West Hyannis3b?U at. ..._...----•------------------•-•------------•-•--•-----------------•••---•-••--•-••-•---•-------•••----•-•••••-••-••---•••••-••••••-•-••-...•-•••-•--•••......••---••-••••......•--- has been i stalled in accordance with the provisions of T I 5'Of tate Sanitary Cod ass b(edj the application for Disposal Works Construction Permit NoMY dated 1 . ,��............. TA ISSUANCE F THI CERTIFICATE SHALL NOT BE CO RUE® AS A G RANT E THAT THE S'YSTEMj WILL FU ON FACTORY. � 4 DATE..- . ?t�.__ Inspector----- --- -- ----- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town Barnstable 9 .......................I...................OF..................... $ 20.00 ..........._._........_......._.._.._........................... NO... . .. FEE....... PeLssion is hereby gran J P.Macomber to Const t or epair 4 n Indivyariri apgr�isposal System �� '' r ss tre t Waes as shown on the application - - Street -- � � Street pp `or Disposal Works Construction e it No..__ ______ �,�Da [�..._._ !� e r�( �t B r of H alth DATE --•--••.... �- FORM 1255 HOBBS & WARREN, INC.,'IaUBLISHERS R § As IECC2009 RESIDENTIAL ENERGY EFFICIENCY DETAILS CLl ,ZN SALEIS I !; �-.(2ESCRIPTIVE VALUES OR RESCHECK CALCULATION 23'-G' TABLE 402.9.1 (MINIMUM PRESCRIPTIVE INSULATION&FENESTRATION REQUIREMENTS) REBUILT FENESTRATION SKYLIGHT CEIU�G WOOD fRAWEDWALL FLOOR BASEMENTWALL BASEMENTSIAB CRAWLSPACEWALL NEW PT 6x6POSTSWI �. U•FACTQR U-F/�2T0 ;d-V RiVALI�IE� R•VALUE R•VALUE R•VALUE R-VAWE DECK AZEKCASING p35 f_ ,`. t 38 20 - 30 10113 10(2 FT.DEEP) 10113 V-4 1r s 1r-s s-r NOTES: 1.R VALUES ARE MINIMUMS$U-FACTORS ARE MAXIMUMS. 2.10113 MEANS R=15'CONTIN000S INSULATED SHEATHING ON THE INTERIOR OR EXTERIOR _ OF THEHOME.OR-R T13_CAV.ITfY:INSULATION AT THE INTERIOR OF THE BASEMENT WALL L ———————————— ——— ——————— {�' ® 3.REFS��{TO IECC5L2009,CHAPTER 4 FOR ALL INSULATION$ENERGY REQUIREMENTS LINE OfSF C/ Ix a S4�S4 DECKABOVE (NEW AZEK OR TIMBERTECH ,- DECKING,VERIFY COLOR) I 36'4T :a i EXIST. EXIST. EXIST. EXIST ~ EXISTCLdS. EIST Afi e a NEW STUDY UNEOFS.F. OVE Z (FORMER B1:DR EXIST. OAS{ /- LIVING GAS !? S {� FIREPLACE T"fJ EXIST CL S. a A -dS sT n ------- -- I AB Q ---- �� .♦ I RE-BUILT . --- ----- -JI (VERIFY KITCHEN EXIST_ re•xgr GARAGE 4 NEW ---- ___ LAYOUT W!OWNER) 2 LI LE c p -----� 0 BATH/ CLINE OF I (PlSx6 TOOKDOOR L'DRY. 3'x5 __=J SF.ABOVE I I EXPANDS Wf6x6VLWF EMBEDDED B EEZE- II SHN ! R I- '� WAY 0 ——— HE LT EXIST. I A UNDE© ENTRY 1 REMOD. om ® r I I KITCHEN p ,• In SUP I - ----------- --- - E /_1 f UN tE OF S.F A9 T0.0VE ST x O.H DOOR EXIST EXIST_ EXIST. J EXIST. " NEW COVER OVER b CONC EXIST.PLATFORM B APRON C As Afi n 3T-O' FIRST FLOOR PLAN i LEGEND: i ©SMOKE DETECTOR [� EXISTING WALLS ©CARBON MONOXIDE DETECTOR HEAT DETECTOR CONSTRUCTION TO BE REMOVED ® REVISED:.5/8/2012 &M NEW CONSTRUCTION t COTUIT BAY DESIGN. Llc NEW ADDITION/REMODELi.N-G FOR. THEMES w"3S =;I TO FRT OF .SCALE: DRAWING NO.: I.�® ERA MS lB5Tm an h1c;MI N lyal B PESP N THE 6JRDhV CO1JIM-W 0.9 11 1- N THESE OOR 0-M-S PK.CR TO START OF 43 BREWSTER ROAD INTfEERESPO.-MOSI CM4T;=ON 114 1 0 MASHPEE ,MA. 02649 DEV.GWE CA WE FCOtORON= C"MEMES IwTHMTNOT, MIte MA HP 27 A. 0 KLAMAN RESIDENCE j 01"IRE RCFANTERRORSG'TH=RSEO DATE 71ESE MV.II V S ME SOLELY FOR TY=USE RE OF_SS DaAW N3S f EO ANY OTIL'.%"x? FaX (50$) 539-9402 25 CROSS WAY WEST HYANNISPORT, MA A ���9R�°RtOKf "EC"N' s/1/2o'2 Al CONSENT OF THE CE90l-R wz—ut TIC ACT OF I IIAAI CO?VRIGHi PROTECP.ON REVISED: 5/8/2012 •.� 6 4' 23'F - 6'-T' 6-fi' tG'sy q. RE-BUILT f DECK 364r 4•-4' 3'_a AZEK OR TIMBERTECH .I RAILINGS B DECKING (VERIFY ALL.DETAILS 8 COLORS W/OWNERS) -a EXIST. EXIST. EXIST. I NEW ,{i B NEW BALCONY K:=Z: 7"CEMOD. VERIFY LOCATIN A6 OF OAS F.P.VENT ANDERSEN ANDERSEN ANDERSEN v BATH - FROMFIRSTFLOORD TRHOUGH SECOND FWG2668S � ST G606BL CH STORMYVATCH FLOOR FWGZb68S FVJG6062L FWG2658S 0 E zc a zs EXPANDED LOFT REMODELED NEW © II 3 3 BEDROOM#1 BEDROOM#2 G x68 I CA9Nc to i b NEW © CLOS. MASTER © �] BEDROOMNON A SHELVES© EXIST. SHELVES .`I Z£x6B' A 1 1© L ;Al As 4,�, I VAULTED CEILING) m b r NEW © HALL x ° ON. O- N b V'x 68' aY CLOS. R. FOLDING —— ® LIN. 4'-a ---- - - EXIST- ---------- ENTRY NEW - O NEW MASTEzfi I NEW BELOW BATH HVAC. BATH .6 x 0 CLOS. CLOS_ N C C C TO C B 8 8 M ` C e A6 A6 NEPIROOF i.. OVER EXIST- ' - 'PLATFORM 3=6' 3'6' 3'-a 7-10 2'-7a Z-ta 3 t T a 15,-ta 7t4r 3•_t• 4•-O• 4•-a 8'-[7• 8-a 36 B-a t6-0 SECOND FLOOR PLAN. I TH=n=_mm::R sTui cE.wnFlEo�F AHr COTUIT BAY DESIGN, LL.0 NEW ADDITIONIREMOI FLING FOR: E �°��ONSAREFWUW PLAN- SCALE . DRAWING NO.: TIC-SEORATMM VRIoRTOSTARTOF COh9tRUCRON THE BURON]OONIRACIOR 1/bTt= 1�-0�t 1�.�. W-LL BE RFSFf NOSt fOR THE XTlW: 43 BREWSTER ROAD R,THESE nRA•NHOS�f OOISTRJCTIO^7 COYATFNCES VATTgUf AVP.FfuA TIE MASHPEE ,MA. 02649 KLAMAN RESIDENCE OcS�-R°fA�YERR�S°R°�:s ro� DATE THEE nRAtY1NJS ARE 501E1V fOR llrc USE OF THE CNNER Nol1D A.W OTNER USE OF PH. (508)274-1166 TFSEnRxiw+cspoRaESTIeV,TT,ET 4/19/2012 A2 FAX (508)539-9402 25 CROSS WAY WEST HYANNISPORT, MA CGTOF°F' °- °�" "� AROwiECiUrtAl CGPYpGH(FROTECR0.V ACT OF 1540 {