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HomeMy WebLinkAbout0054 CEDARWOOD ROAD - Health ,r--'4 Cedarwood Road Cotuit A = 020 079 1 i COMMONWEALTH OF MASSACHUSETTS 414 EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS � d DEPARTMENT OF ENVIRONMENTAL PROTECTION W �O In_ SVey TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 54 Cedarwood Road L { Cotuit MA 02635 � \ I r Owner's Name: Estate of Allan Saunders `-"l "w Owner's Address: C/O Elizabeth Lynch ` - 702 Putnam Ave,Cotuit MA 02635 Date of Inspection: October 3,2007 Job#07-232 Z ' V c`D r; Name of Inspector: PATRICK M.O'CONNELL Company Name: SEPTIC INSPECTION SERVICES CO. Mailing Address: 189 CAMMETT ROAD MARSTONS MILLS MA 02648 Telephone Number: 508-428-1779 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section.15.340 of Title 5(310 CMR 15.000). The system: _X_ Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: 10/3/07 The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments: Leaching pit had 1' of standing water at time of inspection with a high stain line indicating pit has 14-16"of effective leaching.Tank is not in need of pumping at this time. ****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. Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 54 Cedarwood Road,Cotuit Owner: Estate of Allan Saunders Date of Inspection: October 3,2007 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: _XX_ 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: Page 3 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 54 Cedarwood Road,Cotuit Owner: Estate of Allan Saunders Date of Inspection: October 3,2007 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: r Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 54 Cedarwood Road,Cotuit Owner: Estate of Allan Saunders Date of Inspection: October 3,2007 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No _X_ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _X_ -Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool _X_ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _X Liquid depth in cesspool is less than 6"below invert or available volume is less than_day flow _X_ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _ _X_ Any portion of the SAS,cesspool or privy is below high ground water elevation. _X_ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _X_ Any portion of a cesspool or privy is within a Zone 1 of a public well. _X_ Any portion of a cesspool or privy is within 50 feet of a private water supply well. _X_ 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 Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply _ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone 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. Page 5 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 54 Cedarwood Road,Cotuit Owner: Estate of Allan Saunders Date of Inspection: October 3,2007 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No _X_ _ Pumping information was provided by the owner,occupant,or Board of Health _X_ Were any of the system components pumped out in the previous two weeks? _X_ Has the system received normal flows in the previous two week period ? _ _X_ Have large volumes of water been introduced to the system recently or as part of this inspection? _X _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) _X_ _ Was the facility or dwelling inspected for signs of sewage back up _X_ _ Was the site inspected for signs of break out ? _X_ _ Were all system components,excluding the SAS, located on site _X_ _ 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? _X _ 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 _X_ _ Existing information. For example,a plan at the Board of Health. X _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)J Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 54 Cedarwood Road,Cotuit Owner: Estate of Allan Saunders Date of Inspection: October 3,2007 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: l 10 gpd x#of bedrooms): 330 Number of current residents: 1 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): No [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use:(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): Two years total: 17,000 gal.(Prev.on well). Sump pump(yes or no): No Last date of occupancy: Currently Occupied COMMERCIALANDUSTRIA L Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no):_ Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records: None Source of information: Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM _X_Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool Privy _Shared system(yes or no)(if yes,attach previous inspection records, if any) _Innovative/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: unknown Were sewage odors detected when arriving at the site(yes or no): No Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 54 Cedarwood Road,Cotuit Owner: Estate of Allan Saunders Date of Inspection: October 3,2007 BUILDING SEWER: XX (locate on site plan) Depth below grade: 3' Materials of construction:_X_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: XX (locate on site plan) Depth below grade: 3' Material of construction:_X_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:8.5'long x 5.2'wide—1000 gal. Sludge depth: 2" 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: 13" How were dimensions determined: STICK WITH HINGE FLAP. Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Baffles are intact liquid level was found at bottom of outlet invert.Tank is not in need of pumpine art this time. GREASE TRAP: No (locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Page 8ofII OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 54 Cedarwood Road,Cotuit Owner: Estate of Allan Saunders Date of Inspection: October 3,2007 TIGHT or HOLDING TANK: No (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): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: No (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: No (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 54 Cedarwood Road,Cotuit Owner: Estate of Allan Saunders Date of Inspection: October 3,2007 SOIL ABSORPTION SYSTEM(SAS): XX (locate on site plan,excavation not required) If SAS not located explain why: Type _X_leaching pits,number: One 6x6 pit. leaching chambers,number: leaching galleries,number: leaching trenches,number, length: leaching fields,number,dimensions: overflow cesspool,number: innovative/altemative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation, etc.): Observed one foot of standing water with a high stain line indicating pit has 14-16"of effective leaching. CESSPOOLS: No (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: No locate on site plan) ( p ) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): Page 10 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 54 Cedarwood Road,Cotuit Owner: Estate of Allan Saunders Date of Inspection: October 3,2007 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. ........... ..... ............. .................. ................... . . .....................j:::: .... ...................... . ............... ..................... ............ .... - -:: .......... ............ ............ ................. ..........-... . .. . . ........ ............................................................. ............ ........... .............. .... ................................................. ....................................... ............ .... ...... ...... ............................... . ........................ .......... ............ ............. .............. .. ........................... .................................. ............. ............................. S + B f e" ar.N M ,ry qlx L Water 16 '� Service 7 Tank cover + At " below grades '���a � I+ 4 sxtY , 611 S k s u yS Riser installed on1g4'�rn > pit as part of inspection. u t Cedarwood Road Page i l of 11 OFFICIAL INSPECTION FORM—'NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 54 Cedarwood Road,Cotuit Owner: Estate of Allan Saunders Date of Inspection: October 3,2007 SITE EXAM Slope None Surface water None Check cellar Dry Shallow wells None Estimated depth to ground water: More than 15 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: _X_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: Low area on opposite side of road with intermittent surface water is 6-8' lower than bottom of leaching pit. Town of Barnstable OF 1HE 1p� Regulatory Services BARNSfABLE ; Thomas F. Geiler,Director y MASS 16 9. •0� Public Health .Division ArED AAA A Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 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. No. C 3� I Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ZIppYication for Zigooar *pztem Construction Permit Application for a Permit to Construct( )Repair( grade( )Abandon( ) El Complete System C—dividual Components Location Address or Lot No. Owner's Name,Address and Tel.No. Assessor's Ma /Parcel ^ 7,l?. ^ Installer's Name,Address,and Tel.No. s G S. !�7S_ T ov Designer's Name,Address and Tel.No. 3 �G r.,v S 7- w- Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other 'I�pe of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil., Nature of Repairs or Alterations(Answer when applicable) F Z C F I N Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been iss y this Board of Health. Signed Date y Application Approved by Date Application Disapproved for the flowing reasons Permit No. �2 6 Date Issued `0 i No. -` "�'3�• I Fee J THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 2pprication for Mig;poal bpotem Construction Permit Application for a Permit to Construct( )Repair( grade( )Abandon( ) 0 Complete System Z4f6vidual Components Location Address or'Lot No. Owner's Name,Address and Tel.No. .se/ C E-2),44 WOOD of ;;.5',qu�v> �.Ps Assessor's Map/Pazcel 00 0 CG'Tv/?' .S� C rA/�/P woof of h (ooTi,T Installer's Name,Address,and Tel.No. S G , !�9S_ o-� Designer's Name,Address and Tel.No. Type of Building: } i Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of BuildingIf No.of Persons Showers` ' Showers( ' ) Cafeteria( ) Other Fixtures i f Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil 5 Nature of Repairs or Alterations(Answer when applicable) 5' "ge/,� C f I/V Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been iss ed� y this Board of Health. � Signed n��" 1 Date oa o S� Application Approved'by � :^7 _ I. Date Application Disapproved for the f llowing reasons I Y Permit No. �2 0 0 y- P Date Issued Y`0 N r THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site.Sewage Disposal System Constructed( )Repaired( "-Upgraded( ) Abandoned( )by f� >E,� /(/C G 7 S'o gV 4 iiv 5 T LA..- e!sZ/C at -$'S� C" £ 7 A/r w oo l iP C1 a 1-4,11, has been constructed in accordance with the pr v'sions of Title 5 and the for Dis osal System Construction Permit No. 7 0 jt`I -3`a l dated Installer Designer (1 The iss nce of this permit shall not be construed as a guarantee that the sys e�m wif1 function as designed Date G D`I Inspector �K ' 1t/i� �v F -- Fee -© �'� � ------------------------- - - No. Li '._3 Y - THE COMMONWEALTH OF MASSACHUSETTS ' PUBLIC HEALTH DIVISION - BARNSTABLE} MASSACHUSETTS Migpozal *pztem Construction Permit Permission is hereby granted to Construct( )Repair(v)'Upgrade( )Abandon( ) s System located at -� C 20 /9 LcJ 0 (,/T and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. ^� Provided:Construction ust be completed within three years of the dat oe� f this per Date: y Approved by ✓ Q _ TOWN OF BARNSTABLE LOC-ATION �A� k/a SEWAGE # VILL�-S" C T Q ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. lT IA-6 (D/7,41 SEPTIC TANK CAPACITY LEACHING FACEL=: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE: 9 V®Sl COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 Yo Cx F}d��� ry Q)Ack �P he oA� 0V6'N OF BA TABLE LOCATION 1111, p C/L SEWAGE# VILLAGE D U r 7 ASS/ O 'S MAP&PAZCEL � S NAME&PHONE NO. G SEPTIC TANK CAPACITY LEACHING FACILITY:(type)'61 P 7 (size) NO.OF BEDROOMS OWNER &0 PERMIT DATE: C-09P�LIANCE DATE: �(��, b r Separation Distance Between the: ! T(� —1ns��c c) 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 k0 `3 ZOC3� Y ` } I _ 11 Nv x� r 16 ...... r - e 7 • Tank cover � �� 'below grade ' 4 44 5 Riser installed on .. pit as part of inspection. K P _ — Cedarw6Od_Road — = . O C CST ION S W A G E PERMIT NO. � V"l L CA G S INSTALLER'S NAME i ADDRESS 0 U I L D E R OR OWNER i 131 C(a-, �u ' DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED `LOCATION qSEWAGE PERMIT NO. VILLAGE INSTALLER'S NAME i ADDRESS S UILDE R OR COWNER s DATE PERMIT ISSUED DATE COMPLIANCE ISSUED r a r' Ofi d �Pa a No......... _°....U... Fes t.. THE COMMONWEALTH OF MASSACHUSETTS HEALTH ,........ OF' ........ -_------------------- Appliration for 43ispalittl Works Toustrurtiun Permit 5� Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Sys tw . .. ... : .�-.... :. - . .. . ..............Location- dre.s �i �� or Lot .. ......... .. ......... !.r.(�C� ............................................................ wner Address w ���................................................................ Installer Address UType of Building/ Size Lot....Z.��_. 0.Sq. feet Dwelling .?—/No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) A4 Other—Type of Building -------------------------- No. of persons...._....................... Showers ( ) — Cafeteria ( ) 04 Other fixtures ---------•---------------------.........----------------------------------....------------------...._._....--- Design Flow..................... .... �.____J_gul,lons llons per person per day. Total daily flow........__..._....- - -gallons. WSeptic Tank—Liquid capacity Length................ Width................ Diameter................ Depth.............. x Disposal Trench— o..................... Wid ........ Total Length................... Total leaching area....................sq. ft. .Seepage Pit No..... .............. Diameter. ...`.... Depth below inlet....... /........ Total leaching area 4 -sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water-_.___.---___-__-___-__. (� Test Pit No. 2................min es per incl Depth of Test Pit.................... Depth to ground water-----_.................. W ........... --•---•---... -------------------------------------------•--------•-----------......................................................... 0 Description of Soil.......... ------------------------------------------------------------------------------------------------------------------------- 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 Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Sig Dat Application Approved B J/ �2 _._ __. .. _ Date Application Disapproved for the following reasons:............................. ............................................................... ....................•--------•-----------------------------------------------------.....-----------•--•--........................................... Date Permit No......................................................... Issued....--- •---7-3...° Date . No...... .. .. H• 2 F��. ................ THE COMMONWEALTH OF MASSACHUSETTS BOARD RF H EA LT .. .... °F.... ................ .. . .. .... ................. Appiiration for BiapoiialWorks: Tolifitrurtion Vrrmit t Application is hereby made for a Perinit to Construct ( ) or Repair .,( ) an Individual Sewage Disposal Syst at .0. . ...... ... ............... ' ,.., Location•Addres - or Lot ....,.. ............ ...............o........................................ er � �, Address nstaller Address.....'. � `hype of Building ,�. Size Lot............................Sq. feet Dwelling--VNo. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type e of Building persons............................ Showers Pa YP g ----...---•-•--•-•--•----.._ No. of P ( ) — Cafeteria ( ) QOther fixtures ....-c.�................. W Design Flow_________________ ...._•__:.E_..__] gallons per person per day. Total daily flow................�z!'_—._—Ld .....gallons. Septic Tank—Liquid capacity�Q l_-gallons Length................ Width................ Diameter................ Depth................ Disposal Trench—No..................... Wi ,tl......... . Total Length_........_ Total leaching area:,:_: .__.' _....... _sq. ft. Seepage Pit No._.._1-------------- Diameter epth below inlet------- ......... Total leaching area.. 4 !--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........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ .. _. _ O Description of Soil........... ••--•- -•-� ::. v ....•••................•-•--•-•--•--•--..._...•••-•-••-•...-•---......•-•-•••••--•-•--••--•-...-•----•-------•-...................... = ............................................................... UNature 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 YI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed .,,, - --------------------------- Date ............ .•--•-__.• --......_.._.:_.._..... f./"-•• /��"'a" S Application Approved By................... •' � �'' Date Application Disapproved for the following reasons---------------------------•-•.......------------•-----------••--•----•--•••••-:•--........_...__................ ...........-•_...•----•---•••--•-•••--••••----•--••------•-•---••......-••-----••....- 3. Date Permit No.......................................................... Issued...- ..... ---7.3.. ....... —ate THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .- . ..........OF...... � ...�✓.. r.....:...�.......................... TH S IS T , i he Individual Sewage Disposal Syst constructed ) r Rfepaired ( ) b CERTIF Th. G®• • ...... :- -!- .r lnsc.:ue• at �'Z G-,a.,- L.J� ' � - �iJ' has been installed in accordance with the.provisions of Article X 1 of T 1 State Sanitary Code a descri d in the application for Disposal Works Construction Permit No.-_---_-----------------��1�. dated.-_... �2_r�7�''.... THE ISSUANCE OF THIS CERTIFICATE $HALL NOT BE CONS 1JE® AS A GOARANTEE THAT THE SYSTEM WILL PNCTIOP SATISFACTORY. ' DATE . ....... Inspector...- 1r_ . .... .... __.. THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEALTH ...:.............:' .... ^...O F........:.... ..! .......` .rF ice.,..::... FEE.. .............. lgtiipwia orks To JArr nil Permission s ereby granted... to Cons" or Repair ( ) Ii ividual Sewage Disp al st A . ... .... .. ..... Sheet �� n fi. as shown on the application for Disposal Works Construction e "lit N .:'7�a. . Dated__.... .. F' Board o '11calth DATE.. :. ...... ....� ....�,.,-....--- .-_------••-•-- FORM 1255 H BBS & WARREN, -INC., PU3LiSHFRB - e i r 4 O cp uN_.� L247�1m OfYm D� G M X V m 1 M N� � I O O � O U) F n - V) � � s m m== C) C mNOiWAmN,V M Z C 1'I t 1 1 1 I C O• MC xxIC �^I ooaq m O WNmmo�00m � S 2= 2 2 I 7'_0• 22_0. 10'-10' 41-6• I .. i 01 u I� b KING m Z 72•VAN N I- 13'-2' D O !sY ! w I� I N o 1 I VI D )21 S a 4 N V c • a in O � o 9 a O - � Q 3•-6. 3-s• 3-6� 8'-8� D � D 36'REF. O I m m O i C N TO 1 O 1 Ot i 1'-p• 1'-0' a i N O ClI W I O I N W o j NN O N N O N v� N O I • O N I- N N 3'_0. O rr i I 4'-0' 3'-6' . 20'-0' i P _ = Rockwood °RQIEGT: mtE: � WE utscwmow Desi n Inc. Hemingway Residence FIRST FLOOR PLAN : ems 5 ❑ 6s4 w .s Cedorwood Road 3 5/IeAI0 FRAMING .,� Manhneld.►1A Ozoso Cotuit, MA " (761)837—/BB8 00 (781)834—01D2 Far< �mu0:ioekweddnl nOwA[er�n�t � I r i I t t i I i E) 0 (S) 24'-W iS'-S' 6'-2' 1. g'- Ir / \ b 1 $ _ s sNE�F Npno Cl O q O o 0 o no r Z M n 12 \ -Ti o O Npn0 ht 4W VAN ryO r �• Ow II O r N h O ❑ ❑ SHELF u Z w i o O , t i i •yi I i : = Rockwood PROJECT: � MM WE DeFi n Inc. Hemingway Residence SECOND FLOOR PLAN 2 � SMM DWI------] Cedorwood Road 3 SAWN «, BnM Cotuit, MA 00 Cm+)es+-oAaz ro. j � I i I i i I 8 G 8 m m 6 8 i o m � I • o ' o 0 2.2'-0' i i m q ?00 I' I .o ! c°a fr D Ot Oore 1 cn O W D u r Z N$ r� D r Q OCrt II� Z g i 0 I 8'-0' 3'-0' o D j z o '-0. a N ° Q i N O r I I ° O 0 i N 1 O 4 O i i. C 4 i 20'-0' r I I I I r I _ a Rockwood PROJECT: �, Due OMCRF oN e Design, Inc. Hemingway Residence FOUNDATION PLAN : e"`� scauor Cedarwood Road M„IING �e�i6� Cotuit, MA (781)834-0132 Fax 1 �maD•rxk�ooddnl nOwAxon.nIt C 12 2x12 RIDGE 2-8d TOE NAILS 12 2x10 RAFTER 2X12 RI H2.5 SIMPSON 2x8 �' JOISTS 2x8 CEILINGjOIST U) 2x12 RIDGE BOARD i� FELT� � Z 1/2'COX PLYW00 / {€�: .,- 2x4 STUDS O 16't]C. 2-8d TOE NAILS 4 F 1x6 FASCIA J € I„ M.. _._ ________ H2.5 SIMPSON - U-- 4 2 W/ix6 SOFFIT e W U iV 1 X 3I ^ Y • d1 2 NAILING I 70 a LEDGER i 2-8d TOE NAILS 35r H2.5 SIMPSON LI 1x8 FASCIA 4�_6• (3) 2x10 P.T.� W 1x6 SOFFIT Y SIMPSON PC CONN. -O_ * - ir TYPICAL ALL I t2--Ol CANE. Ir m ] SECTION "C-C" 5 z _ 6x6 P.T. POST To 10 I Ei SCALE: 1/4"=1'-0" 1. 4P � U Z C 2X10 P. GRADE GRADE m p GRADE O O i GRADE W -`---- - - iQ - _ _— O �O 030 �u O aGjj 10'SONO TUBE ON o C C 3 18'x18'x12'CONC. FIG. a W 3 10'SONO BE a O O O 2 U U (2) /4 DOWELS Y SECTION "B-B" SECTION "A-A" ° = -01$g SCALE: 1/4"=1'-0" SCALE: 1/4"=1'-0" 3 CQ s a =m O DATE 6/16/08 DRAWN W. J6 CHECKED BY: SCALE. M Notsd 5 . OF 8 1 a I I I f I i f a ps y L i+ PROPOSED U FLOOR JOLT w �j �4' 1, �o v O -1 Ll VEE�:� 1 PROPOSED DOU I I FLOOR JOIST ------------ A (n 71 C7 f. 0 D °N m mj I — � o Z El t f 2 2 V a' o Ott i I 10 N i I ^ ' 0 I ^ I • o` ' r I FBI = Rockwood PROJECT. �: DESCRFWN Design, nC. Hemingway Residence FIRST FLOOR FRAMING PLAN ? $M �D `, sag s ..t Cedorwood Road $Avm FROMM �°"TMa w►ired Cotuit, MA Co peg)sn-�sse emd (701)654-- Fmt I , 4 F;I i (I I I I I 2'-0'CANTILEVER I I i A, PC O z-1a•LVLe. a•cANn r r+ N 1 L s + r - V M 9 0 Lf t + O of ! JL '^ 2-14•LVLs W/24• 1 D i o i z GIRT. 3-14'LW w/24'CANTI R r+r *+� I act Z I I I I It. I I 2-9�' LVLs r I r +* r Lc _ e Rockwood PROJECT: 7m,E: I WfM WE DESCRWnM es on, Inc. Hemingway Residence SECOND FLOOR FRAMING PLAN ? , ;,o� 5 P', a"SW.P.8 o s{rsat Cedarwood Road 3 511e/w ° Mal,.h ld,MA ntoso Cotuit, MA 00 pal)es�-aeee (781)834-0132 FOK , emo0:roekreeddn on.�t I I I f i I i f I } i DOUBLE RAFTER I NUELE W rCR- I I I I - I DOUBLE RAFTER DOU RAFTER 2%1 RI GE o C] DOUBLE RAFTER I 66UBLE RAFTER I ^'\'\ f \ OUB D'o DOUBLE RAFTER ` 2z1 RI E O a; DOUBLE R DOUBLE RAFTER WO n n n rDOUBLE RAFTER DOUBLE RAFIiER -71 m TT N N 2z1 RI E Do DOUBLE RAFTER I 66URE RAOTER II� Z G� L DOUBLE RAFTER DfUBLE RAFTER zI DOUBLE RAFTER N p \ A O 0 m O �O n O. 4 ! �Op I ! I : = Rockwood PROJECT: TTTL E: i WIMN WE DESCRP MN Desi n, Inc, Hemingway Residence ROOF FRAMING PLAN ' °j0 oe iIRSf DRKf �/v Q Y 06/08 SECOND DRAFT o �sDPce�Yo.� Cedarwood Road dha/ae rxwwc 'n N0 h" ld WA oz�o Cotuit, MA (�eq erg-- QO heT)es4-ois2 Fdx ama0:mOk�ooddn nONd=on.net