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HomeMy WebLinkAbout0026 BUCKINGHAM WAY - Health 26 Buckingham Way Cotuit A = 021 - 057 s COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS I - - DEPARTMENT OF ENVIRONMENTAL-PROTECTION TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 26 BuckinQham Way Cotuit. MA 02635 Owner's Name: Frank Favne Owner's Address: Date of Inspection: April 5, 2006 E l Name of Inspector:.(Please Print).James M.Ford Company Name:. James M. Ford Mailing Address: P.O.Box 49 Osterville,MA 02655-0049 Telephone Number: (508)862-9400 cam,j �5 •-`J CERTIFICATION STATEMENT I certify that I have personally inspected the sewage'disposal system at this address and that the in ormation-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 Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: April12:2006 The system inspector shall stb copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional.office of the DEP. The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2.of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 26 Buckingham Way Cotuit, MA Owner: Frank Fayne Date of Inspection: April 5. 2006 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: ✓ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. 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 distribution box is leveled or replaced 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): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 26 Buckinzhani Wav Cotuit, MA Owner: Frank Fame Date of Inspection: Anri15. 2006• ; 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,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 and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than.5 ppm,provided that no other. failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 26 Buckingham Wav Cotuit, MA Owner: Frank Favne Date of Inspection: April S. 2006 D. System Failure Criteria applicable to all systems: You must indicate either"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. ✓ 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] No (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either."yes"or"no'.'to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a,mapped Zone 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. 4 f Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 26 Buckingham Wav Cotuit, MA Owner: Frank Fa vne Date of Inspection: April S. 2006' 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: Yes No ✓ — 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 15302(3)(b)]. i 5 Page 6.of 1.1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 26 Buckin¢ham Way Cotuit, MA Owner: Frank Favne Date of Inspection: April S. 2006 FLOW CONDITIONS RESIDENTIAL 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 Number of current residents: 0 Does residence have a garbage grinder(yes;or no): n/a Is laundry on a separate sewage system(yes or no): n/a [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Currently unoccupied COMMERCIALANDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): epd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Pumped in 2004 per owner Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: _gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM 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) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: 6119192-per as-built Were sewage odors detected when arriving at the site(yes or no): No 6 I Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 26 Buckingham Wav Cotuit,MA Owner: Frank Favne Date of Inspection: April S. 2006 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron _40 PVC _other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,'evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 20" Material of construction: ✓ concrete _metal _fiberglass _polyethylene _other(explain) If tank is metal list age: Is age confirmed by a Certificate of.Compliance(yes or no): (attach a copy of certificate) Dimensions:. 1006 gal. Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle:. . 30" Scum thickness: S" 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: 101, How were dimensions determined: Measuring stick Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Tees were present. The liquid level was even with the outlet invert There did'not appear to be any signs of leakage GREASE TRAP: None (locate on site plan) Depth below grade: Material of construction:. _concrete _metal _fiberglass _polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffler Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping:' Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert, evidence of leakage,etc.): 7 y Page 8 of l l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 26 Buckingham Wav Cotuit, MA Owner: Frank Favne Date of Inspection: April S. 2006 TIGHT or HOLDING TANK: None (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/day Alarm present(yes or no): Alann level: - Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert Even Comments(note if box is level and distribution to outlets equal,any evidence of solids canyover,any evidence of leakage into or out of box,etc.): There were no sign ofsolids PUMP CHAMBER: None (locate on site plan). Pumps in working order(yes or no): Alanns in working order(yes or no) Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 Page 9 of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 26 Buckingham Wav Cotuit, MA Owner: Frank Favne Date of Inspection: April S. 2006 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits,number: 2-6'x 6`(1000.gal) Per as-built 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.): The leach pit#3 was dry. There did not appear to be an,v signs of allure from either pit The bottom to grade was approximately 8.S' CESSPOOLS: None (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 or no): Comments (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: None (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 9 Page-'I 0 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: _ 26 Buckingham Way Cotuit MA Owner: Frank Favne' Date of Inspection: —April 1 2006 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. A 6 ao aq o a- a 33 30 . 3 Yo yc- 3 y to Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 26 Buckingham Wav Cotuit, MA Owner: Frank Fayne Date of Inspection: April 5. 2006 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to groundwater 35+/- feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: topogrqphic and water contours maps Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Using Barnstable topographic and water contours maps, the maps were showing ggproxiinately 35'+1-to ground water at this site. . This report has been prepared only for the septic system and components described herein. This septic system has been inspected and passed as of the date bf inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed,written or implied, relating to the septic system, the inspection, this report and/or any components of the septic system which have not been located and inspected. 11 Q7 - COMPLETE • ■ Complete items 1,2,and 3.Also complete A. Signature item 4 if Restricted Delivery Is desired. ❑Agent ■ Print your name and address on the.reverse ❑Addressee so that we can return the card to you. B. Re ed by(Printed Nam) C. t of el ■ Attach this cans to the back of the mailpiece, or on the front If space permits. 1. Article Addressed to: D. Is delivery address different from Rem 1? JU Y If YES,enter delivery address below: ❑No a- ! 3. Service Type 13 Certified ail 13 Mall ❑Registered ❑Return Receipt for Merohandlse � M ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Y� 2. Article Number i t i i r i ` i i F (Transfer fmm service label) 0 0 6 2'15 0 0 0 0 2 10 4'1 9 7 61 PS Form 3811,February 2004 Domestic Return Receipt u,10*§-0??4o'4q UNITED STATESRQS LSf-F Z- ` u[' I • Sender: Please print your name, address, and ZIP+4 In'tnls box • I I I I m Town of Barnstable ° Public Health Division 1 200 Main Street Hyannis,MA 02601 I I r,1�.,.,#,Fri U.S. Postal ServiceTM CERTIFIED MAILTM REGEIPT Domestic Maii,C nly;No lnsurance,Coverage,P,rovided IFo�,deiivery,iiiformation,visit our website at www.usps.comm ----------------------- I, PS Form uoo, 71mt:2006 See_Reverse.tor,lnstructions Certified Mail Provides: n'A mailing receipt ® A unique identifier for your mailpiece o A record of delivery kept by the Postal Service for two years Important Reminders: o Certified Mail may ONLY be combined with First-Class Mails or Priority Mails. ra Certified Mail is not available for any class of international mail. a NO INSURANCE.-COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. 0 For arradditional fee,a Return Recelpt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the, fee:Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a LISPS®postmark on your Certified Mail receipt is required. fr 1 o For an additional-fee, delivery may be restricted to the addressee or addressee's authorized'agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". ® If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry. PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 �pF SHE Tp� Town ®f Barnstable Barnstable ' P Regulatory Services Department j e'caC hy IIARNSTABm MAC Public Health Division i639• �� m ArEb"�0�s 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO June 5, 2008 Frank Fayne 26 Buckingham Way Cotuit, MA 02635 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 26 Buckingham Way, Cotuit, MA was last inspected on May 27, 2008,by Patrick M. O'Connell, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Failed" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: Back up of sewage into facility or system component due to overloaded or clogged SAS or cesspool. You are ordered to repair or replace the septic system within sixty(60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. MPERORDER OF THE B ARD OF HEALTH Kean, S., CHO Agent of the Board of Health CERTIFIED MAIL #7006 2150 0002 1041 9761 Q:\SEPTIC\Letters Septic Inspection Failures\26 Buckingham Way.doc Commonwealth of Massachusetts 4 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form =Not for Voluntary Assessments t wM 26 Buckingham Way C > Property Address Frank Fayine Owner Owner's Name information's Cotuit MA 02635 May 27, 2008 required fo every pa g CitylTown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Iwnenrfi nt:ing out A. Gederal Information forms on the computer,use 1. -Inspector: only the tab key to move your Patrick M. O'Connell cursor-do not Name of Inspector use the return key. Septic Inspection Services Co. - Company Name 189 C;ammett Road Company Address Marstons Mills MA- 02648 inn Cityfrown State Zip Code 508-428-1779 SI 12855 Telephone Number License Number B:Certification ,. I certify that] 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 perfo',rmed based on my training and experience in the proper function and maintenance of on-site C= sewage disposal systems. I am a DEP approved system inspector pursuant to Section W, 40 of : Title 5(310 CMR 15.000). The system: ❑ Passes ❑� Conditionally Passes ® F ❑ Needs Further Evaluation by the Local Approving Authority 7 In , May 27, 2008 Inspector's Signatu Date de 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 ai design flow of 10;000 gpd or,greater, the inspecto,(and the system-owner shall submit the. P' 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 ° s I ****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. 08-133 Fayne.doc•08106 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 1 of 15 , Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 26 Buckingham Way Property Address Frank Fayne Owner Owner's Name information is required for -Cotuit i MA 02635 • May 27, 2008 every page. Cityfrown State Zip Code Date of Inspection i j i 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: i 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. i - *A metal septic tank will pass inspection if it is structuraliy'soulid,`not leaking.andf a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: i ❑ 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 08-133 Fayne.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 i _ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 26 Buckingham Way Property Address Frank Fayne Owner Owner's Name information is Cotuit MA 02635 May 27, 2008 required for y every page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) 9 B) System Conditionally Passes (cont.): - ❑ distribution box is leveled or replaced 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): 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, safety and environment: . El 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. 08-133 Fayne.doc-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments, 26 Buckingham Way Property Ad'.dress Frank Fayne Owner Owner's Name information is required for Cotuit MA 02635 May 27, 2008 every page. Cityrrown State Zip Code Date of Inspection. B. Certification (cont.) C) Further Evaluation is Required by the.Board of Health (cont.): -- 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 O ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool a ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool El ® Liquid depth in cesspool is less than 6" below invert or available volume is less than_day flow a ElRequired 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 El tributary to a surface water supply. 08-133 Fayne.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 f Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M , 26 Buckingham Way Property Address Frank Fayne Owner Owner's Name information is required for y Cotuit MA 02635 May 27, 2008 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No, LL Any portion of a cesspool or privy is within a Zone 1 of a public well.- El ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. El ® 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. r ❑ 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: I For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the euestions'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. 08-133 Fayne.doc•08106 Title 5 Official Inspection 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 �M 26 Buckingham Way Property Address Frank Fayne Owner Owner's Name information is Cotuit MA 02635 Ma 27, 2008 required for Y 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)] 08-133 Fayne.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments N 26 Buckingham Way Property Address Frank Fayne Owner Owner's Name information is Y Cotuit MA 02635 May 27 2008 required for , every page. Cityfrown State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based.or, 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 2 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 Z No Laundry system inspected? ❑ Yes ❑ No Seasonal use? Y. ❑ Yes ® No . Water meter readings, if available(last 2 years usage (gpd)): Sump pump? ❑ Yes ® No Last date of occupancy: Currently Occupied Commercial/Industrial Flow Conditions: Type of Establishment: i 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: Last date of occupancy/use: Date Other(describe): 08-133 Fayne.doc-08106 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 r 26 Buckingham Way Property Address Frank Fayne Owner Owner's Name information is Cotuit MA 02635 May 27, 2008 required for Y every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: .Source of information: Tank pumped two 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: Typeof 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) ❑ Tight tank. Attach a copy of the DEP approval. ❑: Other(describe): Approximate age of all components, date installed (if known) and source of information: i - 1977, Overflow pit installed in 1987 i Werefsewage odors detected when arriving at the site? ❑ Yes ® No 08-133 Fayne.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 • Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 26 Buckingham Way Property Address Frank Fayne Owner Owner's Name information is required for Cotuit MA 02635 May 27, 2008 every page. Cityrrown State Zip Code Date of Inspection - D. System Information (cont.) 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: 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: ' 8.5' long x 5.2'wide- 1000.gal. Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 28" Scum thickness trace 6„ • _ Distance from top of scum to top.of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 13 How were dimensions determined? Measured 08-133 Fayne.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 15 Commonwealth of Massachusetts 4 Title 5 Official Inspection Form . Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 26 Buckingham Way Property Address - Frank Fayne Owner Owner's Name information is. Cotuit - MA 02635% May 27, 2008 required for Y every page. Cityrrown 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.): Liquid level was found at bottom of outlet invert, structural integrity of outlet baffle is marginal recommend replacing with a PVC tee at time of repair. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: A ❑concrete ❑ metal ❑ fiberglass ❑ polyethylene . ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee-or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle.condition, structural integrity,' liquid levels as related to outlet invert, evidence of leakage, etc.): Tightaor 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):, 08-133 Fayne.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form p - Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 26 Buckingham Way ' Property Address Frank Fayne Owner Owner's Name information is Cotuit MA 02635 May 27, 2008 required for Y every page. Cityrrown . State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cont.) 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 ' Distribution Box (if present must be opened) (locate on site plan); Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.):, Pump Chamber(locate on site plan): Pump's in working order: ❑ Yes ❑ No Alarms in working order: _ ❑ Yes ❑ No 08-133 Fayne.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 26 Buckingham Way Property Address Frank Fayne Owner Owner's Name information is Cotuit MA 02635 May 27, 2008 required for y every page. Cityfrown State Zip Code .. Date of Inspection i D. System Information (cont.) 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: - -® leaching pits number: Two 6x6 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,1evel of ponding, damp soil, condition of vegetation, etc.): Original pit was found empty with high stains to top of structure. Overflow pit was found half full with high stains over top set of holes. Both pits are in hydraulic failure: 08-133 Fayne.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 15 r Commonwealth of Massachusetts. Title 5 Official Inspection. Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 26 Buckingham Way Property Address Frank Fa:yne Owner Owner's Name " information is required for Cotuit MA 02635 May 27, 2008 every page. Citylrown 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.): R 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.); 08-133 Fayne.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 15 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 26 Buckingham Way Property Address Frank Fayne Owner Owner's Name information is required for Cotuit MA 02635 May 27 2008 every page. City1rown State Zip Code Date of Inspection D. System Information (cont.) 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. Buckingham Wa Watre Service, ` / . . . . . . . . . . . . . . . 20 36 3 4 4 58 64 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M • 26 Buckingham Way Property Address Frank Fayne Owner Owners Name information is required for Cotuit MA 02635 May 27, 2008 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope :Surface water ® Check cellar ® Shallow wells Estimated depth to ground water: N/A feet Please indicate all methods used,to determine the high groundwater elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: pate ❑ Observed site(abutting property/observation hole within 150 feet of SAS) S ❑ 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: i 08-133 Fayne.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 or 15 Town of Barnstable �p�HE Tp� regulatory Services lARNSrABLE, ; Thomas F. Geiler, Director 1 ��� Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-004 REGARDING SEPTIC INSPECTIONS BY PRIVATE CONTRACTORS DISCLAIMER 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 or copy of the report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observations 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 Works Construction.Permit". If you should have any questions regarding this report, please contact the certified Septic System Inspector who conducted the inspection. Q:ISEPTIC\Disclaimer Private Septic Inspections.DOC TOWN OF BARNSTABLE LOCATION Jwp / *, y��Gvs V4 I SEWAGE#,AZ T---"7® VILLAGE 16614/- ASSESSOR'S MAP&PARCEL al r 7 INSTALLERS NAME&PHONE NO. /).a,�4/), , &a/ SEPTIC TANK CAPACITY GQic<��iyJ LEACHING FACILITY:(type),/a> 300 (size) 3;0.)--X /0 'XJ ° NO.OF BEDROOMS 3 OWNER PERMIT DATE: 'dG"®' COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility �.j 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 P� within 300 feet of leaching facility) Feet FURNISHED BY •o! y C�,�t��w-,vv1 rE U w NZ AN No. ZAD6S" Z70 THE COMMONWEALTH OF MASSACHUSETTS FEE leo — / y� BOARD OF HEALTH OF Jt?10 etJ/IV� le t�✓ G..n1/ . APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct ( ) Repair ( Upgrade ( ) Abandon ( ) - ❑Complete System ndividual Components Location O ner's Name Map/Parcel# fed Ste ' S�1 ' ?773 Lot#/ Telephone# /lT',� �lInstaller's Name signer's Name f/1Sl"'KiYi <op� �J ` q Ad ess ff'- Address Telephone# Telephone# Type of Building: . Lot Sizoy4n Zef fe Sq.feet Dwelling—No.of Bedrooms .3 Garbage Grinder' Other—Type of Building No.of persons Showers ( ), Cafeteria ( ) Other fixtures Design Flowimin.required) j 36 gpd Calculated design flow 30y gpd Design flow provided 3VX gpd Plan: Date,lvW.e Number of sheets J Revision Date Title %�/t S' te' a too 1-1ic/4!Ylslsa•�+ 6+'�+/ �o v Description of Soil(s) lyl-e Iola 7 Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONSYP9/d� The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE S and further agrges not top e/thy system in operation until a Certificate of Compliance has been issued b the Board of Health. Signed Date Inspections & Q 4olza,,r b FORM I - APPLICATION FOR DSCP DEP APPROVED FORM S/96 No. ZOo _ 270 THE COMMONWEALTH OF MASSACHUSETTS FEE /00 r BOARD OF HEALTH -cnC,o APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to'Construct ( ) Repair ( Upgrade ( ) Abandon ( ) - ❑Complete System M"Individual Components Location r Owner's Name a2/ 7 .. to �uC/7141lrGn Map/Parcel# Address ° 149tv 7773 Telephone# Ins/�ems'���- ��y.S�7i1r•-fia-✓ ,��/.�✓ C. ��! C%irr......ti,.,,,j tvr�S Name // ��pesigner's Name S -/. Address Address /Telephone# Telephone# Type of Building: Lot Sizev* Sq.feet " Dwelling—No.of Bedrooms Garbage Grinder We Other—Type of Building No.of persons Showers ( ), Cafeteria ( ) Other fixtures 'Design Flowjmin.required) 336 gpd Calculated design flow 3yy gpd Design flow provided yy gpd Plan: DateJ&,--e Number of sheets Revision Date Title 7,14, s-- S,L< /�Xv-1 v 0C^ ,16 /.1,4.>gals�.�. e�c•t L'��.., ' Description of Soil(s) �►-� e��7 / Soil Evaluator Form No. Name of Soil Evaluator f.w0l��'t-z, Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS J�OA'144/#4 The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further a�arees not to pla a th system in operation until a Certificate of Compliance has been issued b the Board of Health. Signed wry%/ Date Inspections FORM 1 - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 No. Z065 70 THE COMMONWEALTH OF MASSACHUSETTS FEE BOARD 07 HEALTH CERTIFICATE OF COMPLIANCE tion of Work: individual Component(s) �'Descri pEl System � The undersigned hereby certify that the Sewage Disposal System;Constructed( ),Repaired/upgraded( ),Abandoned( ) by: �JOr �iJ/o/ 4rt.S/'•vC has been installed in accordance with th pr visions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No . ',// dated Approved Design Flow 3 V'l (gpd) Installer � oY /,0 OrO vJ7, r, N Designer:Uowr/ 6o)fe G7y/v-�.Q•nhr Inspector /7yI .� �Jl {ll� ,Dpfic( 1. �V v >f The issuance of this certificate shall not be construed as a guarantee thar/ti system will function as designed. _ I FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96 No.20✓S` Z-70 THE COMMONWEALTH OF MASSACHUSETTS FEE BOARD OF HEALTH DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby ranted to Construct ( ) Repair (,, �Upgrade ( ) Abandon ( ) an individual sewage disposal system at �� 3 �,�G y� u_ c l'a ��• // as/described in the application for Disposal System Construction Permit No. CEO 6- 2 7b ,dated er,S2 t/ 05 . Provided: Construction shall be completed within three years of the date of this per it,All locallccanditio must be met. Date /1 �26120 a v Board of Health .....- _ � FORM 2 - DSCP ° DEP APPROVED FORM 5/96 r� FORM 1255 (REV 5/96) H&W HOBBS&WARREN rM PUBLISHERS- BOSTON � O FROM :down cape engineering inc FAX NO. :150836213880 Jul. 01 2008 07:41AM P1 Town of Barnstable Regulatory $erv.zces t Thomas F. Geiler,Director atsxar�Bt�, � . Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Of Tee, 508-862-4644 Fax: 508-790-6304. Installer& Designer Certification Corm Date: Sewage Permit-4 a206 d 70 Assessor's MapTarcel ?/ Designer: Ua,Jrl �� Gh Instaallcr: �(/� Address: rr�. Address:��..��' -. Po V-�f "4 Ile, On t '�Gi'�j' `( l i /d�� Co S�. was issued a permit to install a (date) (instal ler) septic sy~Item At- 2_� d tAC 'if) .�.� �.. based on a design drawn by (add ss) dated .uwz (des] er} i certify that the septic system referenced above was installed substantially according to the design, wlri.cb may include minor approved.change~ such as lateral relocation of the distribution box acid/or septic tank.. � d.`���� � e,>� b f 5 A5 1 certify that the septic system referenced above was installed with major changes (i.e. g•eate.r than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State& Local Regulations. Plan revision Or certified as-built by design.er to follow. SHOFAf,4 9 tea`' AR NE N Cy. -(lnslaller's Signature) OJALA , CNfL N4. 30792 n L 9. Dc igner s Signii re) (A.ffix Desig tnp ilcrc) PLEASE--..RETURN TO BARNSTABLE P'IJRj jf7 HEALTH DIVIST0N CERTIFICATE OF IC RECEIVED BY TF�F,RA1S C HF I,jLANCE WILL NOT VED BE ISSUEDISSUEDUNTILNTiL VI ON, THANK YO FORM AND U. CA1ZU ARE TABLE PUBLIAI.T)7 D1 Q: i iealth/Septic/Desigy.jer Certification Farm 3-26-04.doe ,9 TOWN OF BA.RNSTABLE 'L(0CATION L/ I A L.J& SEWAGE# C)a c�' VILLAGE GO'r�,}- ASSESSOR'S MAP&PARCEL O,�1' 01-7 INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY on LEACHING FACILITY:(type) a— Pil S (size) . /GUb NO.OF BEDROOMS 3 OWNER PQy/It PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Welland 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 j7�s tcm, �D/� r P r. . Q a I ao aq ° a. 33 34 3 qO �y s� TOWN OF BARNSTABLE �. LOCATION ,�c�r,, U+�,G.t/,�t 4-U 4'y SEWAGE # VILLAGE , .j ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO.�, Z,,C' SEPTIC TANK CAPACITY 4de5eq LEACHING FACILITY Atype) (size) G X NO. OF BEDROOMS 3 PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: 1, l9 qiZ DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No f P' QD n t` �ti I t'- r�. 4� a' pp�� w• No...1...�dZ_ .......... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Appfiratiuu for 11iipuial Workii Tuuitrurt' ---t Application is hereby made for a Permit to Construct ( ) or Repair (q an Individual Sewage Disposal. System at: LZ — - o a,on-A ress �r Lot No I y v Y f a�r �6 C�y Installer Address Type of Building Size Lot----------------------------Sq. feet U Dwelling—No. of Bedrooms.............. .......................Expansion Attic ( ) Garbage Grinder ( ) a`4 Other—T e of Building No. of persons.......................... Showers YP g ---------------------------- P -- ( ) — Cafeteria ( ) Otherfixtures ----------------•-------------------------•------------------•----------•--•-•-•----•------•-•-••-••--•-------••------•••-•--....--•-•-------•-----. 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. Z Other Distribution box ( ) Dosing tank ( ) . Percolation Test Results Performed by...................................................•-•----••---.......... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ �Xq Test Pit No. 2................minutes per inch Depth of.Test Pit---................. Depth to ground water........................ a -•----•-•--•--------------•-•-••---•--•-••--••--......---•--••••-•..............---•-•------•----•-•......................................................... 0 Description of Soil........................................................................................................................................................................ W V ......_..-••-•---•-••......---•••----•-•---•-••....-----•--•-------•---------••••••................•----•-••-•••--••----•--•-------•---•--•-------•------•-••---•---•••--u...------------......--.•---- ----------------- -------------------------------------------------------•---- --- •• -------------•-•- --- - - ----- --- U Nature o Repairs or Alterations—Answer.,when plica le � � � .. r /. �� ,gyp Agreement: The undersigned agrees to install the afore-described 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 Complian ha . en issued by the bgard of health. Signed $�''.! .-3 _°� /`%'/ - ... ...Nate Application Approved By { 1 �� e t ...................... Dat Application Disapproved for the following reasons- --- ----------------------- ------------------------------------------------------------------- ----------- ------------------- ----------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------ -- -- PermitNo. ----------- . ........ ...Y....7---------- Issued .........------------------------- Dnt THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH / ,�J TOWN OF BARNSTABLE,/ 7/ r Allp iratinn for Bi,ipuiia1 Works Tonstrn.rtwu Vamit Application is hereby made for a Permit to Construct ( ) or Repair (Van Individual Sewage Disposal stem at: 05 Lo ation-Ad ress / 'or Lot No t {� Owne -....................................................�.-� ..... ._.�---- `-- _7`...... .. ................... . 4 Installer Address Q Type of Building Size Lot............................Sq. feet U f � Dwelling—No. of Bedrooms...............:-eT__________________ ___Expansion Attic ( ) Garbage Grinder ( ) a Other—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. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 0 Description of Soil.................................................................... ............................------ -------------------•----------------------------••••--------._...--- x V ....................................................•--•--------••-•------------•---------------------•••----•----------•------------•---------------•-•-------------.............................. ---------------------------------------------------------------------------------------------------•--------------------------------- = = ........................................... U Nature of Repairs or Alterations—Answer when applicable..__. _fe--'._.� ��!��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.Veen issued by the board of health. Signed .......... '....... .. Application Approved By - - --`1. . / - �p— J..............------------------------------------' --------------I'll Dale-------------'-- Application Disapproved for the following reasons- ---------------- ------- -------------------------------------................................................-------------- ----- ---------------------- - ---------- ------- - --- ------------------------------------------------------------------------------------------------------- .................... - -------- �p _ ; Y Dare PermitNo. ----...../............ .... ........... ---------- Issued ....----............. ---. --------.......... ----------- Da[e THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Crrtifi afro Df Contyliana THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( V) byZ_Vl % S----.... ......................................... InstAler at .-- .-.. �'" ��........ -.,�4,; '+�-- (A/44. ...................-----......V...................................----.-........--..................-------------------------- has been installed in accordance wjth the provisions of/TITLE 5 ct&7The S ate,En�ironmental Code as described in the application for Disposal Works Construction Permit No. -......................................// ......... dated ...-...--..-.-.---.---.---------..-------------. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSI`�M WILL CT ON SATISFACTORY. DATE\............................................ / Inspector v. •r t' THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 9a y7 TOWN OF BARNSTABLE No....................... 3o .............. Permission is hereby granted �' �M f -�-'-� .w ' = to Construct ( ) or Repair ( '4n Individual Sewage Disposal System at No.............. /�. �. 1.!2 ...... rt --------------------•-••--------------------•-------•--------------•----------•_........ Street q. as shown on the application for Disposa Works Construction Permit No.__/a: _ 7 Dated.......................................... ------------------------•----= ------------------•---•---- Board of Health DATE................................................................................ IL FORM 36508 HOBBS h WARREN,INC.,PUBLISHERS • R. A. Bousfield Backhoe Service ' 17 Burbank Street Sandwich, Massachusetts b 02563 Name ., 4:5 b 21 D r`2 .-R S 1 y Sewer_Permit No. g 4-2 7 Location: C') l3 cs cEL tw G—K `P V--,' DRVV-*E Builder's Name and Address r^ C-S Date Permit Issued:_ Date Compliance Issued , FY i N t • a THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH r�'` 1-------.OF........... Appliratiun -fax Bi_gpoml Worbi Tonstrnrtinn Prrntit Application i hereby'made for a P mit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System -F. I6�r�19 ( C9A ;7— •------•--- --•---------------------------------•---.4�.............................................. catio d ress Lot No. / O r Add, s nstallcr Address d Type of Building Size Lot----------------------------Sq. feet U ' - Dwelling—No. of Bedrooms------------------A--------------------Expansion Attic (s/f Garbage Grinder (Ab aOther—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) a' Other fixtures -------------------------------- d ------------- W Design Flow-___._-_--__--_ jo....../1._.,..��.._.gallons per person per day. Total daily flow.......`....�C-7-0----------------gallons. WSeptic Tank-/Liquid capacitvA ---±_ allons Length................ Widtli_:.............. Diameter_-.---..-.-.___ Depth..-..---__--- x Disposal Trench—No_ ____________________ Width-------------- otal Length--_______--_-..__-.- Total leaching area........------------sq. ft. Seepage Pit No---------/--------- Diameter_... Ruth below inlet____________________ Total leaching area.....___-------sq. ft. Z Other Distribution box ( ) Dosing tan ( ) . /04 1;7A- - 2 7 Percolation Test Results Performed b- --------------------- Date..?:.-./to/- 3 7--------- a Test Pit No. 1......2-------minutes per inch Depth o Test Pit.................... Depth to ground water..-.-.-.._-__-.-_.-----. �14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------------ ------------------ _______... ------•----•------ ----- --------••-.•. ----- Description of Soil . .o -.. a= / � ..$�.. � ..."_ _........� . ------ 4�-� - - f11 U Nature 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 Co — The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b ued e boar >he h. 1 ned... . — .1 ---- -- -- ---------- -------------------------------- Date Application Approved By............ •. . •--•• .......f.�-��' �'-"-7.-�------------- Date Application Disapproved for the following reasons:._......._ ................................................................................... Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEALTH 4� ....... .(. .0 --------OF.......... ... .....wl�Iil......-..-.. A.VVfiratiun -for Diipo_qttl Norks C otui#rurtion Vrruift Application is hereby'mrade for a Ptrmit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: /�,6f/ t?✓cJ6> C.C�Aj , -- / cation.—Ad ress/y j Cyr Lot No. p f lslt'�aaller er / Add, s l a .5.. Address Q Type of Building Size Lot............................Sq. fee U -Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic (t/S Garbage Grinder pa., Other—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) —.,Cafeteria ( ) P4 Other fixtures ------------------------------ Desi n W g Flow__-__-__-__._-. 7710---------------gallons per person per day. Total daily flow.........--. .................gallons. W Septic Tank-1 Liquid capacity)la 'gallons Length---------------- Width.--.-- ......... Diameter--------:------- Depth.--._...-..._. x Disposal Trench—No. .................... Width--------------- -Total Length.------------------- Total leaching area.._.........-_.---sq. ft. Seepage Pit No........./--------- Diameter---/( Dep h below inlet------------- _-.- Total leaching area------------------sq. ft. Z Other Distribution box ( ) Dosing to ;( ) /N- - .�" /�' 7 7 Percolation Test Results Performed by.-=_ ... �t� ._../_ C..................... Date_f�_-k_'.�..7�--.-._.. Test Pit No. 1._...�a minutes per inch Depth o Test Pit------ ---------- Depth to ground water........---_.._---- . -__--.. L� Test Pit No. 2. ---.....minutes per inch Depth of Test Pit-------------------- Depth to ground water................ ------ . ----------/---_------ ----) ---- � t ---- f.......-'7----------- -- -----j-------- Description of Soil-------- ------------- - ce. j- � z x y- -- c.> --------------------- •------------- ....----------------------------------------------------..--------------------------------- w x ••- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- U Nature 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 Co �j The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b rued y e board f�h�eh.igned-- f�j --------- -------•------------------------ j�1� G�i' E.. . Date Application Approved BY----------- -/== -=- - -------- ------ -- - ----�'-�-------- - ---�.-3.-.7..7------------- Date Application Disapproved for the following reasons---------------------------------------------------------------------------------------------------------- Date PermitNo......................................................... Issued........................................................ Date F THE COMMONWEALTH OF MASSACHUSETTS F BOARD OF HEALTH .........oF.. /. � �' t....................................... TH TO E Y h tr J $iratr of TomViiaurr S , T at t e���, i al Sewage Disposal System constructed ( ) orRepaired (... f -- ----------------- ............ , r 1 at.- �=-- --------A 4 = ®' •--- � �� �� has been installed in accordance with the provisions 461e XI of Z State Sanitary Code as described in the application for Disposal Works Construction Permit N ...10111 - -•------------------ dated---•!�---3....7-•�---............... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.................... -----.c:: /--------- Z-............. Inspector---------- . --- ......................... THE COMMONWEALTH OF MASSACHUSETTS / _ BOARD�F HEALTH 1�...L, . .......OF............... ........ - No........7 ......... FEE........................ Permissio is ereby granted ---- .�(,/_D"h�._ --- •--- ....................................................... to Constr ) or Repa' ( ) a Individu Sewage is oral s j /� at No.- �!� ------------- �'� �!l c�z-�r /.t...Lll ��� Street as shown on the application for Disposal Works Construction P it --✓- ..---- Dated........:3........................... DATE....................... ......................................................... Board of Hev ` FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS . ` a • , N " e F � .a o - k titY ' - 45.,. 1J f, } `^... c• r v a i', S' _ G Fit. -'A dl K•..5 �" " , • -� ' � `°�"Yf�1.�' ie. _ �:. A 1 .,u , 1 r . II + � ��� __ •v •fir F .. -. 6 - -�. w'�d'h `a,. 1 �- n. 1 �{- • Icy lT 1 ] P e°x .. 14, L -. •' u F./ � ''1`v iak.xT''i.' �' '�(� Jy, J ° x 181� 4 _ {�' , k ' 1' • .. �M t Slat S - - '•`` } a`ra S � •b^F�� ,�h -._ ,' P`-a 1 i1 v 1 F � -�• ¢.{y��, -.� �y�• om 1-. -u( '�Y�sry .�, ,'.1' aS'.:t.� _d. +"'�9' i (..I (" Nt"�`�,•. 1 °'I` - v`• T . i r 1 �P'9`1'T > ��� �.���� r � �_ n•+'-� --. ..x._.. w. �w"'s 'ae,�"`-,�' .k�'�• 5"h.+.` �' {,: w• '��{�' 1! w, e ► �t 4'..fit . a' :,.� j,,, ... {' �Y � !„ ^,d �&s�c�` �� �{�yii 8• •R 1 �r�� ,�i�� 4 ''r r1 P v w 0 O o 0 ?'� v ¢w� E_ 3Wcq INSTALL NEW VELUX SKYUGHTS W=O VS 101 IN S.F.BEDROOM,SLOPED CEILING CONT.RIDGE VENT m �X AUGN W/LIVING ROOM WINDOWS BELOW O C13 Q.L< U �T tn..Ls_ l® El r � NEW ASPHALT SHINGLES TO MATCH EXISTING _ M TOP OF PLATE ® ® � � NEW SHUTTERSIT p^ TO MATCH Z nno EXISTING w FM L E:1=11 E 0 0 Ei - S BR,FLOOR v i rA I f ' FRONT E L E VAT I O N NEW CEDAR CLAPBOARD SIDING AT Q�•i 05 FRONT OF ADDITION TO MATCH I EXISTING CONDITIONS. L . l ^� � O VERIFY NEW ROOF PITCH IN THE FIELD TO � AVOID ANY CONFLICT W/DUSTING WINDOWS 12 B U ��v7- D�� � EXIST. LINE OF EXISTING _ �p�/� �'/�,�. Y-7 O *~S • - HOUSE BEYOND Ud/rf. rl Z° oie12 4 Q' I — HE EXIST. - 1 NEW RAKE b TRIM BOARDS r r���""" L I TO MATCH EXIST. '(VC�y IS 0�AI�1 TD I•. MATCH 12 NEW FASCIA b FRIEZE �� F1 or. BOARDS TO MATCH EXIST. �1 EXIST. �L� - • ® ® TOP OF PLATE —- W M ® Cam. N Z NEW CORNER BOARDS N _ TO MATCH EXIST. X w SCALE: NEW W.C.SHINGLE SIDING /A^ _ �_O�� TO MATCH EXISTING `Y SUBFLOOR R DATE 2/7/2007 DRAWING NO.. RIGHT SIDE ELEVATION r �t LL] a 0 Q CV 11 CV CCO Vim' ' . 16-T (ADDITION) (ADDITION) _ L(n L 00 101F' 4%l(r E33 ZIn p Lfl POST UP TO RIDGE - BASEMENT O Q Z S DOWN TO FOUND. ————— WINDOW —— V V' n.Li.. If - ------ A A A A5 A5 Z BASEMENT o - I IWNNDOW - Z .. NEW 30'x 30'x 12' §oa ( < p I CONCRETE FOOTING F �) NEW4xSWOODPOSTUP - ;,�o ( I m rn NEW 72'DUL o TO RIDGEBEAM 8 DOWN "g I 3 m STEEL LALLY CO MN - �1 I3 TO FOUNDATION I T-4 iI I MULTI LVL GIRT 44 Elm- BEAM BEAM + POCKET POCKET I I I 4 NEW 2 x 8 RAFTERS @ 16'o -TO BE BUILT OVER MAIN i INSTALL NEW DOOR NEW I I - ROOF SRUCTURE.FLASH 8 �!F` ( ,Py POST UP TO RIDGE NSULATE WALLSEAL ALL GAPS S b EXIST. FULL I I MATCH ROOF SHINGLES TO PREVENT LEAKS I 8 DOWN TO FOUND. OIL TANK BASEMENT I 'BASEMENT ULTI LVL RIDGEBEAM b o (WINDOW 5y o - (4'CONC.SLAB) I v F F INSTALL NEW 6'BATT. I - o INSULATION R=19)IN ^O THE FIRST FLOOR JOISTS NEW 9 7?E IGINE i REDIOISTS@161*..,.c I I < ( I _ SAWCUT 3'0'OPENING IN EXIST.FOUNDATION FOR ACCESS INTO NEW BAS NEW 8'CONC.BLOCKTO FILL EXIST.WINDOW O EXIST 8.2x12 GIRT - ---- — ------ --- _ —e--_—_ NEWB'CONC. B FOUND.WALLS B W . A5 NEW 8'x IT _ 7 A5 - _ CONC.FOOTINGS N _ - O - DRILL 8 PIN NEW FOUNDATION 7 F� TO EXIST.FOUNDATIONWALL EXIST• X J O TOP 8 BOTTOM - !? FULL o® NOTE:DROP TOP OF NEW FOUNDATION BASEMENT H TO MATCH NEW SUBFLOOR W/THE Q� EXISTING SUBFLOOR,(VERIFY IN FIELD Q ►�.1 IF REQUIRED). ^ r� EXIST.FOUND.WALLS O 8 FOOTINGS TO REMAIN }Q..�.1( 06 F� �h N 16-(P 16.P SCALE: (ADDITION) (ADDITION) 1/4 ^= 7•_O^ ROOF FRAMING PLAN FOUNDATION PLAN DATE: 2/7/2007 NOTES: 1.) ALL ROOF RAFTERS TO BE 2 x 19s DRAWING NO.: UNLESS OTHERWISE NOTED 2.) USE SIMPSON H 2.5 HURRICANE CLIPS AT ALL RAFTERS ENDS 3.)VERIFY GUTTER TYPE&AYOUTA41 - W/OWNERS (EXISTING) (EXISTING) - (ADDITION) .. - 4'•R T-S 414r 0 'V ANDERSEN ANDERSEN O t7 Q' TW24310 TW24310 L w l B• (VAULTED) 'r 0' �Lo LINEN NEW =c Lp e °° A5 ASTER SHELVES I AS ccn o z Q :O BATH NEW I 0 p ¢ r LUX � _ W.I.C. I o EXIST. EXIST. EXIST. F I S3°4 I ROWER ; a PORCH .� I I N g AB L J EXIST. :�— B DECK �xyou AsANDERSEN U EXIST- - EXIST. - TTW 2446,3 NEW ` I 1 . ILI MASTER _f L CENTER ON EXIST. BEDROOM ANDERSEN x rn r � WINDOW OPENING TW 244G W/ w x I1 O O !j NEW — —— (VAULTED CEILING) ———— ANDERSEN :I SHELVES __ __ _ PNT 2415 ABOVE >; I EXIST. ANDERSEN b gEXIST. Co. DEE'KITCHENGARAGE EXIST - NEW EXIST. i BATH STUDY LR —————— _ TWT24,5ABDVE Q HALL . I CLOS. TvElux-1 I ��' ]IN (FORMER BEDROOM) ISKYL GH4 EXIST.. i� ® (ABOVE 1I W_ NEW 10'DIA COLUMN L—JEXIST. �.636'HIGH HALF WALL W/CAP HALL EXI N W X L.'s w NE't�MI1LTl LVL OR STEEL BEAM - ANDERSEN ANDERSEN - r N —_—_-----_— DN. __ _ v_ _ TVtf 2446 TW 2446 B W I a6 Xs8 zQ A5 ✓ EXIST, NEW 10'DIA COLUMN - I BIFOLD �7 8 36'HIGH HALF WALL W/CAP q•0' 8'•0' 4'-O' DINING CLOS• NEW COLUMN TO BE - EXIST. I DIRECTLY ABOVE LALLY - O COLUMN IN BASEMENT _ O b EXPANDED LIVING Z � � Q EXIST. � N EXIST. EXIST. 06 V NOTES: (EXISTING) (EXISTING) - (EXISTING) O G) (ADDITION) W � FIRST FLOOR PLAN z N 1.) CONTRACTOR IS TO VERIFY ALL EXISTING CONDITIONS &DIMENSIONS IN THE FIELD EXIST.FIRST FLOOR =1410 S.F. 2-) CONTRACTOR TO VERIFY ALL INTERIOR&EXTERIOR MATERIALS, NEW ADDITION =412 S.F. SCALE: DETAILS,&FINISHES IN THE FIELD WITH OWNER 1/4"= F-V 3.) ROUGH OPENING HEAD HEIGHT OF WINDOWS AT 0 SMOKE DETECTOR DATE FIRST FLOOR TO BE 6'-10"ABOVE SUBFLOOR ©CARBON MONOXIDE DETECTOR THE DESIGNER SHALL BE NOTIFIED IF ANY 4.) ALL CONSTRUCTION TO CONFORM TO 780 CMR MASSACHUSETTS ERRORS OR OMISSIONSARE FOUND ON 2I7I2007 THESE DRAWINGS PRIOR TO START OF STATE BUILDING CODE LEGEND: L C C A EN I D. CONSTRUCTION.THE BUILDING CONTRACTOR 5•) CONTRACTOR TO REMOVE EXISTING DOORS,WINDOWS, C WILL BE RESPONSIBLE FOR THE CONTENT DRAWING NO.:WALLS,&ROOFING AS REQUIRED FOR NEW CONSTRUCTION. IN THESE DRAWINGS IF CONSTRUCTION �+ COMMENCES VOTHOUT NOTIFYINGTHE Q EXISTING WALLS - DESIGNER OF ANY ERRORS OR OMISSIONS. 6.) ALL CONCRETE USED FOR FOUNDATION WALLS,FOOTINGS&SLABS I----, THESE DRAWINGS ARE SOLELY FOR THE USE TO BE 3000 PSI&FIBER MESH EMBEDDED IN SLAB L__J CONSTRUCTION TO BE REMOVED ON THE PROPERTY NOTED.ANY OTHER USE OF 7.) VERIFY ALL PLUMBING&ELECTRICAL DETAILS IN THE FIELD W/ ''''M NEW CONSTRUCTION THESE DRAWINGSOF THE DESIGNER.REQUIRES THE WRITTEN CONSENT OF THE DESIGNER.THESE DRAWINGS CONTRACTOR,SUBCONTRACTORS,&OWNERS ARE PROTECTED UNDER THE ARCHITECTURAL Al COPYRIGHT PROTECTION ACT OF MO. r 00-7 S g q2"2y7 COTUIT a � 1� A.M. 21-48P A.M. 21-49 t OLD OYSTER ROAD S88 3940"E 132.00' - i LOC S � THE SEPTIC SYSTEM �� �¢ WAS DRAWN FROM THE v% SEPWN OF BARNSTABLE TIC INSTALLERS CARD SHED ABBEY GATE Isiah b LOT 60 o%0 0 Q) � Ln A.M. 21-57 1 aa AREA=20,819fS.F. ® � LOCUS' MAP o PLAN REF oo` 19 1, ASSESSORS MAP.- 21/57 Q DECK ZONING.- DEED REF 2730-105 SETBACKS- 30115115 LOT 59 FLOOD ZONE.- C 11 A. 21-58 PANEL NUMBER.- 250001 0021 D DATED.- 7/2/92 LOT 61 35. 7 ,,,,,,,,,,,,, PROPOSED A.M. 21=56 ADDITION T PLA LAND LOCATED AT w 1126 BUCKINGHAM W y CO TUIT, MA. PREPARED FOR.- .20 FRANCIS & JOAN FA YNE Isv 115.98 L_10.00 ���®A®®m,� 5»E r:�<.s., 79.pp'p �' 40 v FEBRUARY 07, 2007 WAY cl ��G� �S�EP"- � � REV QpoY�E J REV.• REV UCH a YANKEE LAND SURVEYORS GRAPHIC SCALE & CONSULTANTS 30 0 15 30 60 P. 0. BOX 265 UNIT 1, 40 INDUSTRY ROAD MARSTONS MILLS, MA 02648 1 inch = 30 f t. TEL- 508-428-0055 FAX 508-420-5553 SHEET 1 OF 1 JOB 0!• 54185 JS (EXISTING) (EXISTING) -(EXISTING) (� O CV LJ V' .9 E..+CAI Ls]N toy C3z7 4" c) C-' co(n x u O M ¢L Q Ewsr. EXIST. EXIST. PORCH 11 W EXIST. I DECK U EXIST. EXIST. EXIST. N 1wils OEXIST. I EXIST. CC.GARAGE I KITCHEN EXIST. EXIST. W EXIST BATH BEDROOM HALL I +- x I CLOS. � `'? LIN. EXIST. EXIST. EXIST. s HALL Os w EXIST. c7 w --------------------_ ON. �y U. EXIST. I NEW 4 U2-CROWN MOULDING EXIST. DINING ICLOS. @PERIMETER OF THIS ROOM ONLY EXIST. - - NEW FIREPLACE b z MANTLE SURROUND O W EXIST. LIVING Z REPAIR&TIGHTEN UP d EXIST. EXISTING STAIR TO SECOND FLOOR bx oX O W » z W d EXIST. EXIST. _ O RESTORE EXIST. - (((���iiilll MASONRY STOOP, REPLACE 8 REPOINT ^ >� AS REQUIRED ' d � (EXISTING) (EXISTING) (EXISTING) , 24 IN ~f' (EXISTING) FIRST FLOOR PLAN w N NOTES: EXIST.FIRST FLOOR =1410 S.F. l SCALE: > v EXIST.SECOND FLOOR =578 S.F. 1.) CONTRACTOR IS TO VERIFY ALL EXISTING CONDITIONS SECOND FLOOR ADDITION =100 S.F. 1/4" = 1'-0*' &DIMENSIONS IN THE FIELD QQ SMOKE DETECTOR . 2.) CONTRACTOR TO VERIFY ALL INTERIOR&EXTERIOR MATERIALS, TE: ©CARBON MONOXIDE DETECTOR THE DESIGNER SHALL BE NOTIFIED IF ANY DETAILS,&FINISHES IN THE FIELD WITH OWNER ) ERRORS OR OMISSIONS ARE FOUND ON 3.) ALL CONSTRUCTION TO CONFORM TO 780 CMR MASSACHUSETTS LEGEND. THESE DRAWINGS PRIOR TO START OF STATE BUILDING CODE(SIXTH EDITION) CONSTRUCT ON .THE BUILDING CONTRACTOR , WILL BE RESPONSIBLE FOR THE CONTENT DRAWING NO.: IN THESE DRAWINGS IF CONSTRUCTION 4•) CONTRACTOR TO REMOVE EXISTING DOORS,WINDOWS, EXISTING WALLS COMMENCES WITHOUT NOTIFYING THE DESIGNER OF ANY ERRORS OR OMISSIONS. WALLS,&ROOFING AS REQUIRED FOR NEW CONSTRUCTION. CONSTRUCTION TO BE REMOVED THESE DRAWINGS ARE SOLELY FOR THE USE -J ON THE PROPERTY NOTED.ANY OTHER USE OF NEW CONSTRUCTION THESE DRAWINGS REQUIRES THE WRITTEN CONSENT OF THE DESIGNER.THESE DRAWINGS ARE PROTECTED UNDER THE ARCHITECTURAL COPYRIGHT PROTECTION ACT OF 1990. i� 2z•a't B'-6'3 (EXISTING) (EXISTING) rn y b) i C^ aISTI V J (EXISTING) mq o ' I 03 m Z i mV r V - 14'-6"t O I O �n (EXISTING) ti O (EXISTING) I I ~n Sitl = r D q ID- Z C� r� z 3.(r FQ DD I A N y0m I I 1 �Dzqa m 1!1 4D i1 5� 11 �Ii A o 9 ;{ cogm !' TTDB DZ I I N I I Np o i' 0�0 II 4 �y I I o II v I NO I II j1 N n 1 S N I II LIZ I 4 EXIST. EXIST, 26'-a'! (EXISTING) NEW ADDITION FOR: COTUIT BAY DESIGN � y � m �" FRANK & JOAN FAYNE MASHPEE MA. 02649 o p C) PH.(508)274-1166 26 BUCKINGHAM WAY COTUIT, MA FAX(508)539-9402 O N W d Qc� _�' NEW ASPHALT SHINGLES 8� TO MATCH EXISTING NEW FASCIA&FRIEZE .?�Liz N 00 BOARDS TO MATCH EXIST. O L Z 005 TOP OF PLATE o m x �V cn�nz.� , . . . . . 'NEW SIDING TO Z MATCH EXISTING y . X W mf SECOND FLOOR SUBFLOOR TOP OF PLATE . LID Ll N ooaa W El E117 0 0 LlrtE:iE::i � FIRST FLOOR SUBFLOOR _ FRONT ELEVATION NEW RAKE&TRIM BOARDS O TO MATCH EXIST. 12 o 12 0 cy�, MATCH EXIST. 1� 70P OF PLATE 7 NEW CORNER BOARDS O z ® TO MATCH EXIST. - z m /�—� NEW W.C.SHINGLE SIDING W c=i TO MATCH EXISTING � O f 12 ^ EXIST. SECOND FLOOR 1 12 F��i QQ�� z SUBFLOOR EXIST. "' TOP OF PLATE rz xFM N W V 1- Q f SCALE: 2.RaS FLOOR RNMI 1/4"= i r_On DATE: 4/9/2007 RIGHT SIDE ELEVATION DRAWING NO.: F _(MATCH EXISnNO) c II TN 19 ti O pT prO IC A Y� m i I I —y -1 N I I I I I I I I O rtZj I I y�y SmmZ 3 2 050 (nD I I p3D rn~ I I DP Mtn n o I I ® p Z Z 2 o II rn l N rn N �N r rm— C n A o z z MEE JN N OZI� Q�Z�99 -i r29 3 2 ;2 O 3 n<1 c�iC pD . m 2 �mSnp Z A X 4� yy 1 O y O Z Y.D � O N y NEW ADDITION FOR: _ m COTU[T BAY DESIGN r NIA A � . 0 EERo2�FRANK & JOANFAYNE MAH MA 9 o o PEI.(508)274-1166 26 BUCK INGHAM WAY COTUIT, MA FAX(508)539-9402 (MATCH EXISTING) m to a p N" z c r0 m �� Ao AZCp0` g s 0 rtoo °p, D 0 Am A y a O)v>>D y r CZp�=�no r p O p Z p _ m cP o A r- so O 0 z z � Yl 74 m x 0 Q 0 z myX vu,�ID :U— > Omz 9 x �" Ohm �o q 10 0) °Z N / co M M T X 0 0 O r/ N 00 ~S T Z r 3 2 C 3 (EXISTING) zqe-Di3(�m�=�N�K z , p > ny(n-mno m v�p�rFAFA� smm p O A mD=CC N a Dy A B 00 mT S.LN Y zi In�bT O y 2C N p Z y N I I 1 O y y C0 O I s TI (EXISTING) I �y Z 0 I GI m --Icn zID- m O I O� Dm N� � 1 RMo I me 0 0- TO in I ,,(O =m --I—_— m MZ mT T (n= �m D z6 M)U O -n cl m� EnNc zo ° o N yo z xV. M - � z§ cnD o I N fn v A D m o zv 3 I I I 9 iF 26'•C't (EXISTING) NEW ADDITION FOR: COTUIT BAY DESIGN EEE�043 BREWSTER ROAD FRANK & JOAN FAYNE MASFIPEE,MA. 02649 PH.(508)274-1166 Cji ° C> 26 BUCKINGHAM WAY COTUIT, MA. PAX(508)539-9402 SYSTEM PROFILE ALL MTEM COMPONENTS SHALL BE NOTES MARKED WITH MAGNETIC TAPE OR COMF4RABLE MEANS FOR FUTURE LOCATION. PROVIDE IF NEC. (NOT TO SCALE) 1. DATUM IS ASSUMED ACCESS COVERS TO WHIN 6" OF FIN. GRADE 2" PEASTONE OR GEOTEXTILE OBSERVA''ION PORTS TO WITHIN 3" GRADE FILTER FABRIC -OVER STONE ( 2. MUNICIPAL WATER IS EXISTING 44'f 2% SLOPE RQUIRED OVER SYSTEM 45' -46' W I 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. MINIMUM .75 OF COVER OVER PRECAST 4. DESIGN LOADING FOR ALL PROPOSED PRECAST �r L Jr r-"c_0Q %4i4(L)A1­1C-` Lk},z, UNITS TO BE AASHO H-Q ' 4"OSCH40 PVC Sampsans 43.0 PIPES LEVEL 1ST 2' OUOOOL 5. PIPE JOINTS TO BE MADE WATERTIGHT. Md�R O 00 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE RE-USE EXIST. 2' NTH a 10" 1000 GAL H-10 14" ' ** 40.83 00000 00000� ; SEPTIC TANK TEE 1.6 f 0 0 0 0 0 00000 310 CMR 15.000 (TITLE V.) o k TEE (SEE NOTE) 0o0g0g0o0g0o 38.83 o GAS BAFFLE0C'_O- ^0 (4) H-20 3050 IN ILTRATOR CHAMBERS �-2� 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND Locus 4' LI0. LEVEL (ACME OR EQUAL) 41.0' 40.83' f OVERALL DIMENSIONS TG� OUTSIDE OF STONE: 30.4' X 10' NOT TO BE USED FOR LOT LINE STAKING OR ANY OTHER PURPOSE. * " ' 3/4"-1-1/2" DOUBLE WASHED STONE o�G'ss 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. 6" CRUSHED STONE OR MECHANICAL Ln 9. COMPONENTS NOT TO BE BA'CKFILLED OR 4 COMPACTION. (15.221 [2]) CONCEALED WITHOUT INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED FROM BOARD *THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL of HEALTH. NOTE: THE INSTALLER SHALL CONFIRM SEPTIC TANK SIZE AS MIN UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS 33.8' BOTTOM TH-1 10. •CONTRACTOR SHALL BE RESPONSIBLE FOR LOCUS MAP MIN. 1000 GALLONS AND ITS SUITABILITY FOR RE-USE ( 1 qo SLOPE) PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM No GROUNDWATER-FOUND CALLING DIGSAFE (1-888-344-7233) AND VERIFYING THE LOCATION OF ALL UNDERGROUND & OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF NOT TO SCALE SCALE 1"=2000'f LEACHING WORK. FOUNDATION- EXIST. SEPTIC TANK 60' D' BOX 2' FACILITY 11. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL BE REMOVED 5' BENEATH AND AROUND THE ASSESSORS MAP 21 PARCEL 57 PROPOSED LEACHING FACILITY. 12. EXISTING LEACHING FACILITY SHALL BE PUMPED LEGEND AND REMOVED OR PUMPED AND FILLED WITH CLEAN SAND. 5.07 99 _ EXISTING CONTOUR 132.00' + X 99.1 EXIST. SPOT ELEV. 99 PROPOSED CONTOUR TH1 PIT 78 /198.41 PROPOSED SPOT EL. 4�� �F.25 43.91 TH 1 k(6 TEST HOLE X { 44.13 2� SLOPE OF GROUND TH2 4 A5 LPIT 43.99 SYSTEM DESIGN. UTILITY POLE +-4 .60 SHED GARBAGE DISPOSER IS NOT ALLOWED FIRE HYDRANT j43:84I �- 43.86 TE: NOT ALL SYMBOLS MAY APPEAR IN DRAWING -NO � 44.03 3FLOW: X BEDROOMS ® 110 GPD = 330 GPD +44.M 3.95 1 1 USE A 330 GPD DESIGN FLOW ISTI TEST HOLE LOGS 24" TREE 4 . 44.84 44.64 '-±4i2r97 SEPTIC TANK: 330 GPD (2) = 660 GLEN HARRINGTON, IRS21• 1 0' ,� PATIO BENCHMARK RE-USE 1000 GAL. SEPTIC TANK ENGINEER: 3• 4 .03 PORCH DECK COR. BULKHEAD WITNESS: DONNA MIORANDI, RS ELEV. 44.6' LEACHING: = 44.42 DATE: JUNE 9, 2008 GARAGE SIDES: 2 (30.4 + 10) 2 (.74) 119 GPD -� BOTTOM 30.4 x 10 (.74) = 225 GPD PERC. RATE _ < 2 MIN/INCH Q0 co EXISTING TOTAL: 465 S.F. 344 GPD CLASS i SOILS p# 12264 `''- DWELLING (313rz) USE (4) INFILTRATOR 3050 CHAMBERS (H-20) ELEV. ELEV. WITH 1' STONE AT ENDS AND 2.9' AT SIDES 4 4 PROVIDE VENT WITH CH COAL FILTER off45.8 0" 45.8 AND BUGSCREEN (FINAL PLACEMENT WITH HOMEOWNER CONSULTATI N) PAVED DRIVE. Ap Ap LOT 60 LS LS 20,820 SFt M A 10YR 3/1 10YR 3/1 APPROVED DATE BOARD OF HEALTH 12" 11" 10 „� Bw Bw 42142.00 oX TITLE 5 SITE PLAN i N � LMS LMS 41.74 OF 28" 10YR 5/6 43.4' 25" 10YR 5/6 43.7' +41. 4 21 a 7- 26 BUCKINGHAM WAY 00 So COTUIT PER C C 40.85 R_1 g8 22 PREPARED FOR 115•99 Gg113E�PLK 45.68 MS MS TEL. BORTOLOTTI CONST./FAYNE THEC.PAD J�54RISER 73 G�-G-- JUNE 23, 2008 2.5Y 6/4 2.5Y 6/4 G�-G 3 -`G HOFMAs off 508-362-4541 G 41 v ���j sq�y �A OF Mgss fax 508-362-9880 --G o MA 1 DANIELA. G�� oaf gcyG I downcape.com G 1 BU�KrrN�H A U O IV o.46502 OJALA � pLA DA v� A IEL down ca a en ineerin81 Inc. " " 144 33.8 120 35.8 �� ,moo �� No.4098 civil engineers n r 0 GIST E �� 'Q P NO GROUNDWATER ENCOUNTERED Scale: 1 = 20 SsroNAll-� ! PFss\ t I-- land Surveyors u URA 939 Main Street ( Rte 6A) �' I 0 p_ 1 5� 0 10 20 30 40 50 FEET DATE DANIEL A. OJALA, ., P.L.S. YARMOUTHPORT MA 02675 ` O