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I.OWNER:mADDEli3 P.41 IN1RA E.NADOLNY
�4NK 9.31 95 ABBEY GATE RD.
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\� MOOD 5URVEY GROUP.LLC
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S.DEED TO LOCU515 RECORDED IN THE BAR1,15TAME COUNTY
o REGISTRY Or DEEDS AT BOOK 7094•PAGE 272.
4.ABUTTER INFORMATION 15 DERIVED FROM CURRENT TOWN OF
SARN.gTABIE ASSESSORS.ONLINE DATABA49E.
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5.PLAN REFERENCES:
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PREPARED FOR
ABBEY GATE ROAD TIIADDEUS NADOLNY
hood survey group, Ilc JOB Nc.:0720'V
DATE 17OCTO7
Rrd surveyors-eng!ne— SCALE:I•-2a
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fix:(50 )838Ph:(508�N C0
J
� f Commonwealth of Massachusetts _T0
flit a Icia1 nspection for
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
95 Abbey Gate lam' Cotuit
Property Address
Thaddeus Nadolny a Q
Owner Owner's Name
information is required for Cotuit MA 02635 12-12-07
every page. City/Town State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms nay not be altered in any
way.
A. General Information
1. Inspector_
Shawn Mcelroy _
Name of Inspector
c, 4S^.44�,�1J.?}i Fnfcr nSac
Company Name
29 Atwater Dr
Company Address '
E. Falmouth MA n �536
w
City/Town State Ap Code r-ry
1-568-495-0905 S1397 i a
f"3
Telephone Number License Number G` r-
_0
<r
B. Certification ru
I certify that 1 have personally inspected the sewage disposal system at this addres 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 funcfion 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 16.00O).The system:
0 Passes ❑ Conditionally Passes ❑ Fails
❑ Needs Further EvaluaVon by the Local Approving Authority y
• �i �" 12-12-07
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,I)IDD gpd orgreater,the inspect.: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.
t5insp•0=6 Tine 5 McW Im pedm Fomr Sudisurface Sewage Disposal System-Page i of 15
Commonwealth of Massachusetts ,
Title 5 Official cidi I i�SNcc.iion Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
95 Abbey Gate Rd Cotuit
Property Address
Thaddeus Nadolny
Owner Owner's Name
information is required for Cotuit MA 02635 12-12-07
every 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:
® 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:
All system components are in good condition with no signs of failure.
B) System Conditionally Passes:
❑ One or more system components as described in the"Conditional Pass"section need to be
replaced or repaired.The system, upon completion of the replacement or repair, as approved by
the Board of Health,will pass.
Answer yes, no or not determined (Y, N, ND)in the❑for the following statements. If"not
determined,"please explain.
❑ The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is
structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent.
System will pass inspection if the existing tank is replaced with a complying septic tank as
approved by the Board of Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate
of Compliance indicating that the tank is less than 20 years old is available.
ND Explain:
❑ Observation of sewage backup or 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
❑ obstruction is removed
t5insp•MM rrtlr S QfhrizL�nsry�c)iry.Fnma:.9 uJarr va@p r3K�n�l.S�Jem. ?arm 2oaf.1.5.
Commonwealth of Massachusetts
Title 5 Official ,Inspection Form
I o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
95 Abbey Gate Rd Cotuit ,
Property Address
Thaddeus Nadolny _
Owner Owner's Name
information is(enwed far Cotuit MA 02635 12-12-07
every page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
B) System Conditionally Passes (cont.):
Li distr7btifion box'is'ieveled or replaced 9
ND Explain:
❑ 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):
I
❑ broken pipe(s) are replaced
❑ obstruction is removed '
ND Explain:
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
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,
w 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.
t5insp•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15
I
Commonwealth of Massachusetts
Tine 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
�M 95 Abbey Gate Rd Cotuit
Property Address
Thaddeus Nadolny
Owner Owner's Name
information is required for Cotuit MA 02635 12-12-07
every page. City/Town t State Zip Code Date of Inspection
B. Certification (cunt.)
C) Further Evaluation is Required by the Board of Health (cunt.):
❑ 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 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'/2 day flow
❑ ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ ® Any portion of the 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.
t5insp-08/06 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 4 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form '
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
r
,M 95 Abbey Gate Rd Cotuit
Property Address -
Thaddeus Nadolny
Owner Owner's Name
information is Cotuit MA 02635 12-12-07
required for
every page. City/Town State Zip Code Date of Inspection
B. Certification (cost.)
D) System Failure Criteria Applicable to All Systems (cont.):
Yes No
N
El
N.- 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
j
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
Yf jou bane answMed°yW 11D aTry gjuBzbvn Tn SELllt n F-111E system is vuirb dieyeid a StgrlWicant lhresil,
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_
t5insp-08/06.` Title 5 Official Inspecrion Form:Subsurface Sewage Disposal System-Page 5 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
95 Abbey Gate Rd Cotuit
Property Address
Thaddeus Nadolny
Owner Owner's Name
information is required for Cotuit MA 02635 12-12-07
every page. City/Town State Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate"yes" or"no" as to each of the following:
Yes No
® ❑ Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
® ❑ Has the system received normal flows in the previous two week period?
❑ Have large volumes of water been introduced to the system recently or as part of
this inspection?
❑ ®_ Were as built plans of the system obtained and examined?(if they were not
available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
® ❑ Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered,opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
® ❑ Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS)on the site has
been determined based on:
❑ ® Existing information. For example, a plan at the Board of Health.
® ❑ Determined in the field(if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
t5insp•08/06 Tdte 5 official Inspection Form:Subsurface Sewage Disposal System•Page of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
95 Abbey Gate Rd Cotuit
Property Address
Thaddeus Nadolny
Owner Owner's Flame
information is r.P.r1+Ll.P.ri fN. Cotuit MA 02635 12-12-07
every page. City/Town State Zip Code Date of Inspection
D. System Information i
Residential Flow Conditions:
Number of bedrooms (design): 2 Number of bedrooms(actual):' 2
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 220
Number of current residents: - 2
Does residence have a garbage grinder? El Yes ® No
Is laundry on a separate Sewage system? rit)Jes separate inspealon required} ❑ Yes ® No
Laundry system inspected?
❑ Yes 2 No
Seasonal use? ❑ Yes ® No
Water meter readings, if available(last 2 years usage (gpd)): ;. r
Sump pump? ❑ Yes 0 No
Last date of occupancy: 12-12-07
Date
Commercial/industrial Flow Conditions:
Type of Establishment:
Design flow(based on 310,CMR 15.203):
Gallons per day(gpd)
Basis of design flow(seatslpersons)sq.ft., etc):.
Grease trap present? ❑ Yes ❑ No
ImhT-tryati veaste ttis,4da-Q ❑ Yes ❑ 40
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings,if availlabte.
Last date of occupancy/use: Date
Other(describe):
t5insp-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M 95 Abbey Gate Rd Cotuit
Property Address
Thaddeus Nadolny
Owner Owner's Name
inform on is Cotuit MA 02635 12-12-07
requ.red for
evert page. Cityfrown State Zip Code Date of Inspection
D. System Information (cunt.)
General Information
Pumping Records:
Source of information:
Owner—pumped last year
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped: gallons
How was quantity pumped determined?
Reason for pumping: Maintenance
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/Altemative technology.Attach a copy of the current operation and
maintenance contract(to be obtained from system owner)
❑ Tight tank.Attach a copy of the DEP approval.
❑ Other(describe):
Approximate age of all components, date installed(rf known)and source of information:
1970's
Were sewage odors detected when arriving at the site? ❑ Yes ® No
t5insp•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15
Commonwealth of Massachusetts ;
Title 5 Official Inspection Forni
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M s 95 Abbey Gate Rd Cotuit
Property Address
Thaddeus Nadolny
Owner Owner's Flame
information is required for Cotuit MA 02635 12-12-07
every page. City/Town State Zip Code Date of Inspection
D. System Information (cunt.)
Building Sewer(locate on site plan): ,
Depth below grade: 30' _
feet
Material of construction:
❑ cast iron 0 41D PVC ❑ other (explain):
Distance from private water supply well or suction line: feet
Comments(on WV4%tiari at jams,veattiog,evidence at tieakage,etc.}:
Septic Tank(locate on site plan):.
24"
Depth below grade: 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:
1000 Gal
Sludge depth:
4"
Distance from top of sludge to bottom of outlet tee or baffle 28"
Scum thickness 0
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 AT
How were dimensions determined? Tape
t5insp-08106 Tdte 5 Off eW Inspection Form:Subsufiace Sewage Disposai System•Page 9 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
o subsurface Sewage Disposal System Form -Not for Voluntary Assessments
wM 95 Abbey Gate Rd Cotuit
Property Address
"Ilfhaddeus Nadolny
Owner Owner's Name
information is required for Cotuit MA 02635 12-12-07
'
every page. City/Town State Zip Code Date of Inspection
®. 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.):
Tank in good shape with concrete baffle intact.
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: V
Date
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan):
Depth below grade:
Material of construction:
El concrete ❑metal ❑fiberglass ❑polyethylene ❑other(exp?aia).
t5insp-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
95 Abbey Gate Rd Cotuit
Property Address
Thaddeus Nadolny
Owner Owner's Name
information is required for Cotuit MA 02635 12-12-07
every page. City/Town State Zip Code Date of Inspection
D. System Information (cunt.)
Tight or Holding Tank(cont.) .
Dimensions:
Capacity:
gallons
Des1lgn riT1VV':
gallons per day
Alarm present: ❑ -Yes ` ❑ No `
T".W.w.rl(2.'QR.Ii. 04RR�?.iRm(/`.1.krg, U U
Date of last pumping: Date
Comments-(wndi6.on of alarm and float s%fitrhes,etr_j:
* ftwzb.^.r�r�g^.f,.^.:.�r�Qst.^,�.�ran��ry^,srir w f(&_ Jr&_z4%j.Is rzw?)f Wt w."&d'! L, Ves L, Wi
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.):
Goon condition.
Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No
Alarms in working order: ❑ Yes ❑ No
t5insp•081W) Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 11 of 15
IlCommonwealth of Massachusetts
"Title 5 Official Inspection Form
:subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M Abbey Gate Rd Cotuit
Wroperty Address
'Thaddeus Nadolny
Owner Mwner's Name
information is required for �f, otuit MA 02635 12-12-07
every page. City/Town State Zip Code Date of Inspection
IID. System Information (cunt.) '
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:
Type:
z leaching pits number: 1
❑ leaching chambers number:
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number,dimensions:
❑ overflow cesspool number.
❑ innovative/aftemative system
Type/name of technology:
Comments (note condition of soil, signs of hydraulic failure, level of ponding,damp soil, condition of
vegetation, etc.):
Leach pit in good condition with water level 22" below inlet invert and no stain line.
t5insp•08/06 Title 501ficial Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M , 95 Abbey Gate Rd Cotuit
Property Address
Thaddeus Nadolny
Owner Owner's Name
information is required for Cotuit - MA 02635 12-12-07
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Cesspools (cesspool.must be pumped as part of inspection) (locate on site plan):
Number and configuration
Depth—top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑- Yes ❑ No
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
Privy (locate on site plan):
Nfateriats of construction:
Dimensions
Depth of solids
Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,
etc.):
t5insp 08/06 TRIe 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
95 Abbey Gate Rd Cotuit
Property Address
Thaddeus Aladolny
Owner Owned's Nam
required for MA 02635 12-12-07
every page. Cityrown state Zip Code Crate of fnspectfon
D. System Information (cunt.)
Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties
to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet.
Locate where public water supply enters the building. -
fre t
Q A
0 C A-C- .20 Z
0 _
y '
lJ�
ALL y G,,te R
t5insn•f1 M Title 5 Official Irmaection Form_Subsurface Sewaae Dismsal Stistem•Pace 14 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
95 Abbey Gate Rd Cotuit
Property Address
Thaddeus Nadolny
Owner Owner's Name
information is required for Cotuit MA 02635 12-12-07
every page. City/Town State Zip Code Date of Inspection
D. System Information (cunt.)
Site Exam:
F1 Check Slope t
0 Surface water
R Check cellar
[l Shallow wells
Estimated depth to ground water: feet feee
t
Please indicate all methods used to determine the high ground water elevation:
❑ Obtained from system design plans on record
If checked, date of design plan reviewed: Date
® Observed site(abutting property/observation hole within 150 feet of SAS)
® Checked with local Board of Health-explain:
Checked with local excavators,installers-(attach documentation)
® Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
USGS maps show.groundwater at about 20'.
t5ins 08/06
P• We 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 15 of 15
To
wn of Barnstable
Regulatory Services
s�xrvsrns Thomas F. Geiler,Director
`b .��
>Fo3�A Public Health .Division
Thomas McKean,Director
200 Main Street, Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
t
This septic system inspection report was completed by a private inspector who is certified
by the State of Massachusetts, Department of Environmental Protection.
Although the Town of Barnstable Health Division received the original/copy of this
report; this Division does not warranty the functionality of the septic system in the future
nor does this Division agree with any technical observation s and interpretations
contained within this report.
In addition, by receiving this report the Town of Barnstable Health Division does not
automatically approve the number of bedrooms listed within this report. The actual
number of bedrooms approved at a. particular property would-be listed on the "Disposal
Work Construction Permit".
If you should have any questions regarding this report,please contact the certified Septic
System Inspector who conducted the inspection.
1
- TOWN OF BARNST E. ,
L'Jr�'AT10N !� 1�ct SEWAGE#
VII.LAGE �u -ASSESSOR'S.MAP,&LOT0 31 O /
IN9TALL.ER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY
LEACHlNG:FACII,TTY:cl type)�"€p=' I (size) /"o_G Q "
NO.OF BEDROOMS'
A � /
BVILDEk oR 6wlvER adeGS a (-t
- ~-~ - 4
PERMIT DATE; s �. ;-COMPLIANCE DATE:
ILI
Separation Distance Between the:_
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
1 Private Water Supply,Well and Leaching Facility (If any wells exist;}
on site or within 200 feet of leaching facility) Feet
qEdge of Wedand and-Leaching Facility(If any wetlands exist - -
within 300 fee of leaching facility)_. Feet
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VILLAGE 6rV r1 ASSESSOR'S MAP&PARCEL OZ/ Z
INSTALLERS NAME&PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) (size)
NO.OF BEDROOMS
OWNER-7—/V4*0
PERMIT DATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility(If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
Within 300 feet of leaching facility) Feet
FURNISHED BY
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LOCATION SEWAGE PERMIT N0.
VILLAGE
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I N S T A LLER'S NAME & ADDRESS
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BUILDER wt
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DATE PERMIT ISSUED S---27 _ 77
DATE COMPLIANCE ISSUED 9 7j
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THE COMMONWEALTH OF MASSACHUSETTS i
BOARD OF HEALTH
. _..........OF...... ct�/�a •9 -.�-- ......-.................
Appliratiuu -fur 3i.6Vuiiai Works Tuustrurtion Vrruift
Application is hereby made for a Permit to Construct (l/ror Repair ( ) an Individual Sewage Disposal
System at: f
q Location-Address ,[� n/ or Lot No.
.._.. .vlC_ !.1----__�li�a-��------.1.126 _/:r&&-`-�--`--- -------------------••-•-------•----•--•
Owner -•••--_-•-'-.••----------•------•Address
Installer Address
U Type of Building ize Lot...3_!?.ePq .Sq. feet
Dwelling—No. of Bedrooms---------- -----------------------------Expansion Attic V, Garbage Grinder
aOther—Type of Building . ___6No. of persons____________________________ Showers ( ) — Cafeteria ( )
Q' Other fixtures
d -------------------------------------------------------------------
W Design Flow__-__�%_®U.........................gallons per person per day. Total daily flow.... 0_0.._____-_____-.-.---.---gallons.
01 Septic Tank—Liquid capacitvli9ll_Qallons ' Length---------------- Width.--_-..-._.._. Diameter__---_------_: Depth.--_---_--._-
W Disposal Trench—No. ..................... Width-------------------- Total Length.................... Total leaching area-------------- __sq. ft.
x
IL, Seepage Pit No.?® ° iameter____________________ Depth below inl __._____ G__ _ Total l�aching�area_� _sq. ft.
z Other Distribution box ( ) Dosing tank ) �_ 71yl_, 77
Percolation Test Results Performed by. V -- - Date .._.��� }1.'� . ---- US
a. Test Pit No. 1----------------minutes per,iftich Depth of Test Pit../ -:. ...... Depth to ground water---------------._ .
f� ,�--, Test Pit No. 2................minutes per' inch Depth of Test Pit-------------------- Depth to ground water-_.......... -..--.-.
ty
Description of Soil ® ._"_Z, __ .t _ /,e�X-.._-`:�-4 ��--4'-� & ��� ------ -
x ,
� ---��-------- '------�` '"v ................ -----r'` �'�L-----------------------------------------
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 Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has be ssued b the o d of health.
Sig�ne -----------'--- --------------
2 -77Application Approved By--------- --- LL�P/!- / ..-._.. ��._--... -------------------
Date
a;
Application Disapproved for the following reasons:........................... F.
--•-•--..._..---•-••----:.•.•.-.----•-•--•---•------•----•----•-•----------------------•-•-•------------------------------------•--•-------------------------------------------------------------------
Date
Permit .............................................................................. Issued
Date
-------- —--------------------------------------------------- --- -------- ----- _,-----------------_-----
No.......................... t F$s......Pn..................
THE COMMONWEALTH OF MASSACHUSETTS t,
£;:.. BOARD OF HEALTH
. 3
ApphrFatinn;for 13hip. iat orkii Tomitrnrtinn rrmit
.Application is her eby=made' for a Permit to Construct ( r Repair ( ) an Individual Sewage Disposal
System at: ,r
Location Address or Lot No
................................................______________ _________________________________ 4;
ow Address r
Installer Address
U Type of Building ize Lot... 40004—Sq. feet
Dwelling—No. of Bedrooms.... ►.-•------------- ---------Expansion Attic (Q Garbage Grinder
4
per-, Other—Type of Building ...... _______. o. of persons............................ Showers ( ) — Cafeteria ( )
0.i Other fixtures _____________
-- 11i -- -.- -
W Design Flow.____° �_________ ________ g. ons peryperson per day: Total daily}.flow_._.. ._ .-0--_--_____-__--------..gallons..
WSeptic Tank—Liquid capacifv,/4" allons Length Wldtl . Diameter......... ..... Depth _.........
x Disposal Trench No �,.� V1>dth Total Length - Total leaching area..__ ..-_ -_sq. ft.
i
Seepage Pit No}r'I� �,�lliameter..................... Depth:,'below inl _______ otal leaching area. sq. ft.
z Other Distribution box ( ) Dosing tank ) � + ` ' �'��` 7
Percolation Test Results Performed b .___ Date__y _
-�' ' ' '
Test Pit No. 1----------------minutes per inch Depth of Test-:Pit`/#*—c... Depth to ground water ----------
(14 Test Pit No. 2________________minutes per inch. Depth:of 'lest Pit.................... Depth to ground water_ ___.___.-_._---_. .
Gy
O Description of Soil-----Q. '".+ _QE'�`r._/ s",r.t + 't1!� ' » ''! " -----.�- (0 .�'" ►_ '{j rf
v -------------- f G +..? " ' ....... �?------+ .:.. At.+'� �"�'�'�"�_ ----- - ----- ---------
W
VNature of Repairs or Alterations—Answer wheri applicable_............ .. .. :__.,.................. __..__:...
Agreement
The unders•' tied agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in
operation u 1 a Certificate of Compliance has bee ssued y the- o Ad
of he th
Signe
Applica on Approved BY------- -- t .............. -= '--D-
Date
Appli tion Disapproved for the follow' ing reasons:----------------------------:_._...--•--•-------•----------------_.__-_---•--------------------•-----------------
........ .......•-...-----------•----•-----------------------•---...-------------------•-•-•------------•.._--.......................................................-----------------------------------
Date
PermitNo........................ "............................ Issued. ---• --
i Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
✓.�.................0 F.... A4 .% .4►..14 ........ ............
(111rrtifiratr of Tomplinurr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( or Repaired ( )
by!............................... / _ ;I! 'p---------------•---------
t Installer
at 1, --- < --1 - " ;''
has.been installed in accordance with the provisions of � i XI of The State Sanitary Code as described in the
application for Disposal Works Construction Permit Nlo_: • "' . 'dated � 't __________________
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS'A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE. Inspector
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THE COMMONWEALTKOF MASSACHUSETTS l
BOARD OF HEALTH
S' '' ..................of...-.±C " - ..................
No.-•-•-•-- ------ FEE--- ---------••-•_-•-
4. RnVoiittl ork.i QTomitrurtion amit
Permission is ereb ranted•_. / /�+�-
Y g -i -- -
to Construct or Re air ( ) an Indivi ual Sewage Disposal System ;
atNo..••, O--- ------ ---- _ _ _.. .. + ' ,+�'----------------=--------------------- -----
------------
Street
•on P t No.. __ 1 _--
ass own on the appelca Ion or Disposalors Construction •- - - # / y
Boar of Health
DATE..... --•--` 7- .. -
FORM 1255 HOBBS &-WARREN. INC.. PUBLISHERS
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1 HEREBY CERTIFY THAT THE 6 U I L DIN R G. LAND SUR ` YOR
SHOWN ON THIS PLAN 15 LOCATE D O
THE G ROUN D AS SHOWN' HEREON AND
THAT IT 470E-5 CONFORM TO THE
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WHEN CONSTRUCTE D . -V JOSEPHM. G�
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C M S ASSOCIATES , INC . � 13660 �0
REGISTERED ENGINEERS d LAND S U R V EYORS hpSUR�'yo�
MID - CAPE OFFICE BUILDING - 1 265 ROUTE 28
77-38 SOUTH YARMO UTH., MASS . 02664-
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C43O RS BAY DESIGN; LLeL
NEW ADDITION FOR BEWTER
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tiS ROAD
' LAURA & TED NADOLNY PH.(5 8)2 4-11 02649
PH.(508)274-1166
k , 95 ABBEY GATE ROAD COTUIT, MA FAx(508)539-9402
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CONT.RIDGE VENT 'd
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NEW-ASPHALT SHINGLES W N
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EXIST. F_ EXIST. / w L
NEW.FASCIA'&FRIEZE W Q
/ BOARDS TO MATCH EXIST. -
.. TOP OF PLATE .
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TO MATCH EXIST.a a NEW W.C.SHINGLE SIDING _
TO MATCH EXISTING O
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FIRST FLOOR
SUBFLOOR
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BOARD W/6'x 16'VENTS -
RIGHT SIDE ELEVATION
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EXI
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TOP OF PLATE � - Q
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FIRST FLOOR r T 1
SUB
FLOOR
J/ SCALE:
1/4" = 1,_0„
DATE:
LEFT SIDE ELEVATION 11/20/2007
DRAWING NO.:
-
U
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EXIST. P.T.2 x 10 LEDGER BOARD LAG.BOLTED TO EXIST.
SOLID BLOCKING W/(2)LEDGERLOK BOLTS - " W Q QD
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EXIST.FOUND.WALLS& � LQ p L
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NEW 17'CONC.SONOTUBE NEW 3 P.T.2 x 17s \ \ON 24"DIA.CONC.BIGFOOT NEW 1T DIA CONC.
FOOTINGS TO 4'O'BELOW SONOTUBES TO
GRADE 9'•0" 9'-0" T-6' 4'0"BELOW GRADE
REMOVE EXISTING PATIOT/PLANTER AS r
REQUIRED FOR NEWCONSTRUCTION FOOTING PLAN
NEW ROOF CONST. O
CONT.RIDGE VENT -2 x 12 ROOF RAFTERS @ 16'ox. O 7
-1/7'CDX PLYWOOD ROOF SHEATHING
2-1.75"x 14"1.9 E LVL -ASPHALT ROOF SHINGLES
RIDGBEAM -15LB.FELT PAPER
(VERIFY SIZE W/SUPPLIER) 9"BATT INSULATION O
MATCH F @ FLAT CEILINGS(R�0)
EXIST.
BOTTOM OF -SIMPSON H 2.5 HURRICANE CLIPS. O
- CEILING JOISTS � NEW 1 'G .B .O 2 x 8's�16'o.e. AT ALL RAFTER ENDS -
1 x 3 STRAPPING @ 16'O.c. - -ICE/WATER SHIELD AT BOTTOM -
3'0"OF ROOF -
" PROP-A"VENT BETWEEN RAFTERS
NEW 2 x 8 BLOCKING FOR WIND WASHING
TOP OF PLATE
CONT.ALUMINUM -
I" SOFFIT VENTS -
§ NEW WALL CONST. F �X
■ ■ ❑ -2x6.STUDS @16'o.c. y. - W
P.T.2 x 10 LEDGER BOARD LAG BOLTED TO -1/T PLYWOOD SHEATHING
SOLID BLOCKING W/(2)LEDGERLOK BOLTS _ W
16'O.C.W/JOISTS HANGERS AT BOTH ENDS -V'BATT INSULATION(R=19)
- I -1fY'GYP.BD. ¢ w CORRECTDECK ON El Lj -W.C.SHINGLE SIDING
2 x 8 P.T.JOISTS @ 16'o.c. E NEW 3/4"T&G PLYWOOD -TYVEK HOUSE WRAP - "
FIRST FLOOR - SUBFLOOR-GLUED&NAILED. FIRST FLOOR -
SUBFLOOR .SUNROOM SUBFLOOR NEW P.T.2 x 17s @ 16'ox APPLY SEALANT UNDER PLATE
3-P.T.2 z 10's Y
Y NEW DUROROCKIN/6'x 16'VENTS -
R=14 RIGID INSUL. 3 P.T.2x.17s - -
2 LAYERS(R=28) SCALE
NEW 28"DIA."BIGFOOT'FOOTING
7CON
UNDER 17'DIA..SONOTUBESAT DATE:PORCH 4'O'DEEP1/2O/2OO f
NEW 1SONOT4'0"BE -
DRAWING NO.:
A BUILDING SECTION NEW SUNROOM
z _ :
10 10VN'
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NEW 2 X 8'RAFTERS TO
BE BUILT OVER EXIST
ROOFSTRU
,.. ./ STRUCTURE . ,. ✓ W'�OLIO
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/ � 6 POST UP
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• MULTI LVL HEADER ',.,. _ _ - •.
3 1/7'x 5 1/4' 3 1/7'x 5 1/4"
LVL POST POST UP TO LVL POST
RIDGESEAM
101-01 18'-(Y' Is - 29'_0"
ROOF FRAMING PLAN
NOTES: O Q
1.)"ALL ROOF RAFTERS TO BE 2 x 10's
UNLESS OTHERWISE NOTED
2.) USE SIMPSON H 2.5 HURRICANE CLIPS
AT ALL RAFTERS ENDS Posi UP To RIDCEBEAM
O .
3.)VERIFY GUTTER TYPE/LAYOUT 12
MATCH May W
W/OWNERS: � EXIST:
TTO
"80M OF
". MULTI LVL HEADER
3 1/7'x 5 1/4"LVL POSTS W
TOP OF PLATE. 1�1 C,.,,6
FIRST FLOOR �' - - FIRST FLOOR
ASI IRFI OCR I-] I SUBFLOOR SCALE:
1/4" = 1'-0".
DATE:
11/20/2007
DRAWING NO.:
A BUILDING SECTION 0 NEW SUNROOM