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HomeMy WebLinkAbout0109 CHERRY TREE ROAD - Health 109-sherry Tree Road C;otuit -- _ _---— - - -- A= 018 - 007 — - - -�---- --�. I i I 1i1+ r I I� i I J �J i I� a� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 109 Cherry Tree Lane „ Property Address f Robert Dorfman Owner Owner's Name information is required for every Cotuit MA 02635 11-13-17 IR page, City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information �'j /off SOS onng out forms the computer, ��``���\`�,S�1OFrMASS lit��'�. use only the tab ��' 1. Inspector: key to move your o`' y� cursor-do not =� JAMES K, James D.Sears use the return Name of inspector = FS F 6 R Ig _ key. Capewide Enterprises ��;•,�F �o '� Company Name 153 Commercial Street ;, Sn "°\�` Company Address Mashpee MA 02649 Cityrrown State Zip Code 508-477-8877 S 1623 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system Inspector pursuant to Section 15.340 of Title S(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority c3� 11-14-17 spector's Signature Date I hO 9YR6 ri 111 Wtbf 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 has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and Copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5lns.dm•rev.6/16 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 I• a5ed xe� dH 9£U L 60Z 5 I• AoN Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 109 Cherry Tree Lane Property Address Robert Dorfman Owner Owner's Name information is required for every Cotuit MA 02635 11-13-17 page. Cityrrown state Zip Code Date of Inspection B. Certification (cont.) Inspection Surninary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The system is a 1500 Gal. Tank D Box and four chamber's. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined"(Y,.N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): 15ins.doc•rev.6116 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System.•Page 2 of 17 Z a6ed xe j dH KU L l0Z S i• ^oN f Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 109 Cherry Tree Lane Property Address Robert Dorfman Owner Owner's Name information is required for every Cotuit MA 02635 11-13-17 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumpslalarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): U I he system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins.doc rev.6116 Title 5 Official Inspedion Form:subsurface Sewage Disposes System-Page 3 of 17 £ a5ed xe� dH K£Z L 60Z S i, AoN I Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 109 Cherry Tree Lane Property Address Robert Dorfman Owner Owner's Name information is required for every Cotuit MA 02635 11-13-17 page. Cityfrown State Zip Code Date of Inspection B. Certification (cant.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well*". Method used to determine distance: This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must Indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in iOSM is less than 6"below invert or available volume is less than Y2 day flow t FAe//%wi; t5in3.doc-rev.6116 This 5 Official Iraspec:ion Form:Subsurface Sewage Disposal System-Page 4 of 17 b a5ed xezI dH 96:EZ L i3OZ S l• ^ON Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments z 109 Cherry Tree Lane Property Address Robert Dorfman Owner Owner's Name information is required for every Cotuit MA- 02635 11-13-17 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system falls. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, In addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. Mra.Coc•rev.6116 Title 5 Official Inspection Form;Subsurface Sewage Disposal System•Page 5 of 17 g a6ed xezI dH L£U L 1,02 S I• ^oN Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 109 Cherry Tree Lane Property Address Robert Dorfman Owner Owner's Name information Is required for every Cotuit MA 02635 11-13-17 page. Cityrrown Stale Zip Code Date of Inspection C. Checklist Chcck 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 NIA) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ , ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health, ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design); 5 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203(for example; 110 gpd x#of bedrooms): 550 t5ins.doc-rev.6118 Title 5 Official Inspection Form:Subsurface Sewage Disposal system-Page 6 of 17 9 a6ed xed dH L£:£Z L 60Z g l, AcN Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 109 Cherry Tree Lane Property Address Robert Dorfman Owner Owner's Name Information is required for every Cotuit MA 02635 11-13-17 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: 1500 Gal. Tank D Box and four chambers. Number of current residents: 3 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 2015-251,000Gal g ( y g (gp ))' 2016-285,OOOGal's Detail: Sump pump? ❑ Yes ® No Last date of occupancy: PresentDate Commercial/industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/personslscI t., 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: L5ins doc-rev.6116 Title 5 Oftal Inspedion Form:Subswface Sewage Disposal System-Page 7 of 17 L abed xe:1 dH 8£:£2 Li,0Z 56 ^oN Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 109 Cherry Tree Lane Property Address Robert Dorfman Owner Owner's Name information is required for every Cotuit MA 02635 11-13-17 page. city/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below), General Information Pumping Records: Source of information: NA Was system pumped as part of the inspection? ❑ Yes ® No If yes,volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank,distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system(yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Mns.doe•rev.WO Tille 5 Of idal Inspection Form:Subsurface Sewage Disposal Systerr,-Page a of 17 9 a5ed xEJ dH K£Z Li,0Z 56 ^oN Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 109 Cherry Tree Lane Property Address Robert Dorfman Owner 0wner's Name information is required for every Cotuit MA 02635 11-13-17 page, City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 2002 Permit # 2002 -366, Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 55 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.): Pipeing is 4" PVC SCH -40. Septic Tank (locate on site plan): Depth below grade: 45" 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: 1500 Gal. Precast H-20 Sludge depth: 2" t5frre.doc-rev.6r16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 or 17 6 abed xe� dH KEE L I,0Z 5 6 AoN Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Forth-Not for Voluntary Assessments 109 Cherry Tree Lane Property Address Robert Dorfman Owner Owner's Name information is required for every Cotuit MA 02635 11-13-17 page. Citylfown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 28" Scum thickness 1' II Distance from top of scum to top of outlet tee or baffle 8 Distance from bottom of scum to bottom of outlet tee or baffle 17" I How were dimensions determined? Asbuilt- Plan-Tape Sludge Judge Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank at working level. Tank at 45"below grade, Inlet cover at 4" below grade w/outlet cover at 11". In and outlet tee's. No sign of leakage or over loading. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date tSins.doc-rev.6116 Title 5 Of i:W ks Wtion Form:Subsurlaoe Sewage Disposal System•Page to of 17 0l, a5ed xe:1 dH K£Z L 1,02 S 6 AoN Commonwealth of Massachusetts :. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 109 Cherry Tree Lane Property Address Robert Dorfman Owner Owner's Name information is required for every Cotuit MA 02635 11.13-17 page. Cfty/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Capacity: gallons Desion Flow: gollorro par doh Alarm present: ❑ Yes ❑ No Alarm level' Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and That switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No e5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewaoe Disposal System•Page 11 of 17 l,6 abed xed dN ObU L WE g 6 AON Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form •Not for Voluntary Assessments 109 Cherry Tree Lane Property Address Robert Dorfman Owner Owner's Name information required for every Cotuit MA 02635 11-13-17 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont) Distribution Box (if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover,any evidence of leakage into or out of box, etc.): D Box is 20"x 20" H-20 at 58" below grade w/H-20 cover at 26". Box is clean and solid w/four lines out. No sign of over loading or solid carry over. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No' Alarms In working order ❑ Yes ❑ No' Cumrnertts(rule uundit0i ur pufnp charrilimi, cundltlon of pumps and appurtenances, etc.): "If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: t5lns.doc•rev.WS Title 5 Official Inspection Forn Subsurface Sewage Disposal System•Pape 12 of 17 z i, abed xed dH Ot U L 02 S i• AoN Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 109 Cherry Tree Lane Property Address Robert Dorfman Owner Owner's Name information is required for every Cotuit MA 02635 11-13-17 page. City/Town Stabe Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 4 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Typetname of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding,damp soil, condition of vegetation, etc.): Leaching is four 500 Gal. dry well chamber's w14'stone. Ck D Box and camera out lines. No sign of over loading or holding water. c000poolo (oconpool munt be pumped 03 part of inapcction)(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 t5lns.4oc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 £l, abed xeJ dH 6t U L 60Z S i• AoN Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 109 Cherry Tree Lane Property Address Robert Dorfman Owner Owners Name information is required for every Cotuit MA 02636 11-13-17 page. City(rown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids CunmiwiiN(nutu conditiun of soil,signu or Iiydiaua;raive, level of pundiny, wriditlon of veyetatlun, etc.): t5ins.0oc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 t,t abed xed dH !,—£U L OZ S l• AcN Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form •Not for Voluntary Assessments 109 Cherry Tree Lane Property Address Robert Dorfman Owner Owner's Name information is MA 02635 11-13-17 required for every COtuit page ChyRown state Zip Code Date of Inspection D. System Information (cunt.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-siratrh in the arpa below ❑ drawing attached separately i 8 4 E= 13 -Vr 38-9 M t5ins.doc rev.6116 T''&5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 g l, a5ed xeJ dH 2�,U L l,0Z S l• AoN Commonwealtll of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ° 109 Cherry Tree Lane Property Address Robert Dorfman Owner Owner's Name information is required for every Cotuit MA 02635 11-13-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells >V9 12'+ Estimated depth t high ground water: feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 12-24-01 Date ❑ Observed situ(abutting property/observation hole within 150 fw�t 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: T,H. on Design plan 12-24-01 12'+ no G,W.. Bottom of chamber's at 7' below grade. Bottom of chamber's at 5'+above T.H. Depth. I Before filing this Inspection Report,please see Report Completeness Checklist on next page. t5ins.doc•rev.6MIS Title 6 official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 g i, abed xe:1 dH Zb:£Z L I,0Z S I. ^oN Commonwealth of Massachusetts Title 5 Official Inspection Form Ili Subsurface Sewage Disposal System Form - Not for Voluntary Assessments F a 109 Cherry Tree Lane Property Address Robert Dorfman Owner Owner's Name information is required for every Cotuit MA 02635 11-13-17 page. Citylrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inopoction Summary; A, 9, C, D, or E chaokotl ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file (A - 15ins.cloc•rev.06 T ila 5 Official Inspection Form;Subsurface Sewage Disposal System-Page 17 of 17 L 6 abed xezl dH ZIVEZ L 60Z 5 6 AoN I No.Cy t '" FEE I�V rc COMMONWEALTH Of M SACI4USETTS,',V*- Board of Health, VJ u./n. APPLIC�JION tOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit1to Construct(('Repair( ) Upgrade( Abandon( ) - W Complete System ❑Individual Components _I Location Owner's Name'4r i 4N1'kd L,, 7'le&PAA) Map/Parcel# Address Lot# Telephone# Lag -t'�a3 ! Installer's Name �00 �� Designer's Name Vwk-r.p Sul v CGv1 v(Z4 Address �� v Address !f� �P'bU'.�, HAAS70"kS J'►�► �S �Q- Telephone# %- �(� ",D I Telephone# S-ca- ya(9- S$ Type of Building S Lot Sizes U-sq.ft. Dwelling-No.of Bedrooms Garbage grinder f � Other-Type of Building No.of persons Showers ( ),Cafeteria ( ) Other Fixtures Design Flow (min.required) �`S O gpd Calculated design flow 0 Design flow provided SS gpd Plan: Date 8- I a—O Number of sheets Revision Date Title 1-1,e+ -�e w c"- G64 Description of Soil(s) S'-PC0 14 Soil Evaluator Form No. -N Name of Soil Evaluat rvc u/ ate of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees to not to place the system in operation until a Certificate of Compliance has been issued by the Board of Health. Signed Date r b �\ A No r r tif Y FEE_ no M* Board of Health, et, -P' MA. , ( , APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT 'Application for a Permit to Construct(•4epairO Upgrade(') Abandon( q1,Gdmple{System ❑Individual Components y1 Location Olt A Owner's'Name �. le Map/Parcel# i -,Address I `t L'ot# ,, TelephoneAA' zl;� I a3 Installer's Name '//�� /� Designer's Name A [ 1 �J � C (/ rl� P U C Address , Address �� � f Telephone# ( i., �— 3 (�� r` Telephone# u` - 7� Type of Building S Lot Size SQ.Lt. -Dwelling-No.of Bedrooms - Garbage grinder, Other-;Type of Building l No.of persons Showers ( ),Cafeteria/(") Other Fixtures . 4 Design Flow (min.required) O gpd Calculated design flow KKO Design flow provided _gpd Plan`. Date �'� Number of sheets Recision Date Title 5 a Q'� 8,e a Ci G ' Description of Soil'(s) i' ✓ -fit Soil Evaluator Form No. 0 x. Name of Soil Evaluat , �f` 's`.6te of Evaluation 1 DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and w further agrees to not to place the system in operation until a Certificate of Compliance has been issued by the Board of Health. Signed Date In...e. 1 ns~ t 6 Q No: CO[MONWEALT14 OF MASSACHUS ETTS Board of Health,�i eQ-v V2 f� a- ? MA. '. r r • CERTIFICATE OF COMPLIANCE Description of Work: ❑Individual Component(s) complete System The undersigned hereby certify that the Sewage Disposal System; Constructed J,).,-Repaired ( ),Upgraded ( ),Abandoned ( ) r by: f, 4 - i..A l_a at has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and the• pproved design plans/as-built plans relating to application No - dated •1 . Approved Design Flow C (gpd) Installer S-., t. I P� Designer: ..t./,-t-,t !�uJU!!, Cte"NSUC.�4i%t%spector: ty /► M�\ Date: V •' The issuance of this permit shall not be construed as a guarantee that the system will function as designed. N � "'tom FEE COMMONWEALTH OF MASSACHUSETTS a# Board of Health,, Q v ��c. l-2 ' MA. DISPOSAL SYSTEM ON PERMIT ` 1 IPermission is hereby granted to; Construct({- Repair( ) Upgrade( ) Abandon( ) an indi«dual sewage disposal system at C— � ��7`rl��"i-�7 ---� A •Z 9 (�y 'rl ry�asf&&(bed/in the application for Disposal System Construction Permit No)-��- , dated, f`ZI ' Provided: Construction shall be completed within three years of the date of this permit. All local cony.;tions must be , Form 1255 Rev.5/96 A.M.Sulkin Co.Boston,MA Date l 7/01 Board of Health ► F nJ �J t` i• ) 1 � v 1 ! r Of- 43'•21/2" o ; — 366 -------- ------ ---------------- ----------- I � I . OFFICE ( : I M iv-r Basement I� 92"celling height J 4 Ilinen ! t* ( ( r I •-� I ' 4' i L / ~ I4TI I I R exlsling Lchlmney both l closet ' r 52'to bottom of duct _ I I7i•8" -� - - - - - - - - - L — — —_ + I i udlitd I I v _______ --� T T 8' a I ~ N I I I R Date: 0.23-10 Revisions: I ;;• I ': I B•B•ti L——— e•s•11 —� I ,. ------------ 1 27" Builder to confirm all conditions Basement Plan scale: 1><411= 1 r-Qrr Fend dimensions prior to construction r` a o p C j? 7 f' �� 9J �� - � � , �. �� � �� 1 c r � ��� �P s � � � � � j � � � , � .� I � � `1 1' c� ss C� , , u Commonwealth of Massachusetts A. Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 10 109 Cherry Tree Road Property Address Brian and Robyn Tiernan Owner Owner's Name information is required for Cotuit MA 02635 June 28, 2009 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out A. General Information (�J forms on the computer, use 1. Inspector: only the tab key to move your David D. Coughanowr cursor-do not Name of Inspector use the return key. Eco-Tech Environmental Company Name 43 Triangle Circle Company Address Sandwich MA 02563 ' City/Town State Zip Code 508 364 0894 1328 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority Zvg M. �� i�S June 28, 2009 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. r t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 4 ., Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 10 109 Cherry Tree Road M Property Address Brian and Robyn Tiernan Owner Owner's Name information is required for Cotuit MA 02635 June 28, 2009 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: Inspector's Note==> A septic system is deemed to pass this Real Estate Transfer Inspection if the inspector cannot answer Yes to any of the failure criteria listed in Section D on pages 4-5 of this report. The septic system has been evaluated according to the conditions observed on the day it was inspected. No estimate or guarantee of system longevity is made or implied by a passing determination. B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): l5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 109 Cherry Tree Road Property Address Brian and Robyn Tiernan Owner Owner's Name information is required for Cotuit MA 02635 June 28 2009 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ .Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 109 Cherry Tree Road Property Address Brian and Robyn Tiernan Owner Owner's Name information is required for Cotuit MA 02635 June 28 2009 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ 0 Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 109 Cherry Tree Road Property Address Brian and Robyn Tiernan Owner Owner's Name information is required for Cotuit MA 02635 June 28 2009 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15,303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 109 Cherry Tree Road Property Address Brian and Robyn Tiernan Owner Owner's Name information is required for Cotuit MA 02635 June 28, 2009 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? p W h® ❑ as the facility owner(and occupants if different from owner) provided with information on the maintenance f proper e o subsurface sewage disposal systems. The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 5 Number of bedrooms (actual): ' 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550 gpd t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 109 Cherry Tree Road Property Address Brian and Robyn Tiernan Owner Owner's Name information is required for Cotuit MA 02635 June 28, 2009 every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 6 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 244 gpd 9 ( Y 9 (gpd)): Detail: 2007-2008 Sump pump? ❑ Yes ® No Last date of occupancy: currentDate Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts r Title 5 Official Inspection Form i Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 109 Cherry Tree Road Property Address Brian and Robyn Tiernan Owner Owner's Name information is required for Cotuit MA 02635 June 28 2009 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 109 Cherry Tree Road Property Address Brian and Robyn Tiernan Owner Owner's Name information is required for Cotuit MA 02635 June 28, 2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Age: 5+ years. Disposal Works Permit issued 8/21/2002 (Permit#2002-366) Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 4 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.): No evidence of leakage or backup into dwelling was observed. Septic Tank (locate on site plan): Depth below grade: 2 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: 11 ft x 6 ft x 6 ft(1500 gallon) Sludge depth: 2 in t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 109 Cherry Tree Road Property Address Brian and Robyn Tiernan Owner Owner's Name information is required for Cotuit MA 02635 June 28 2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 32.in Scum thickness trace Distance from top of scum to top of outlet tee or baffle 10 in Distance from bottom of scum to bottom of outlet tee or baffle 14 in How were dimensions determined? Design Plan Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumping not required at this time but maintenance pumping is recommended within and every two years. Tank and tees appear structurally sound and functioning as intended. No evidence of leakage in or out was observed. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM e''t 109 Cherry Tree Road Property Address Brian and Robyn Tiernan Owner Owner's Name information is required for Cotuit MA 02635 June 28, 2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments GSM ,a�'r 109 Cherry Tree Road Property Address Brian and Robyn Tiernan Owner Owner's Name information is Cotuit MA 02635 June 28 2009 required for , every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert at 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.): D-box appears structurally sound with no evidence of leakage in or out. Few solids in sump. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: l5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 109 Cherry Tree Road Property Address Brian and Robyn Tiernan Owner Owner's Name information is required for Cotuit MA 02635 June 28 2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ® leaching galleries number: 1 ❑ 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.): Soils above leaching gallery appeared unsaturated. No evidence of surface ponding, breakout, lush vegetation, or other evidence of hydraulic failure was observed. A bucket of water was poured into the distribution box and was observed to pass through in a rapid and unobstructed manner, and could be heard splashing down into the leaching gallery. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 109 Cherry Tree Road Property Address Brian and Robyn Tiernan Owner Owner's Name information is required for Cotuit MA 02635 June 28, 2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM ,e 109 Cherry Tree Road Property Address Brian and Robyn Tiernan Owner Owner's Name information is required for Cotuit MA 02635 June 28 2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately TANK C, c K z N 2_1h t A g I TANK 4 4- OV7 TRNK . D-Box =C= LiACNI\G &P, ,E2 CHLR�`� TRec RoA +� t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 109 Cherry Tree Road Property Address Brian and Robyn Tiernan Owner Owner's Name information is Cotuit MA 02635 June 28 2009 required for , every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 20+ feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 8/21/02 Date I ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: i ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: j Approved design plan on file with the Board of Health shows bottom of system to be 5.7 feet above the bottom of a witnessed test pit in which no water or groundwater mottling was encountered. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 109 Cherry Tree Road Property Address Brian and Robyn Tiernan Owner Owner's Name information is required for Cotuit MA 02635 June 28, 2009 every page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 ji No. ��� � Fee BOARD OF HEALTH TOWN OF BARNSTABLE 01pplico.tiou _for Yell Cow5tructiou Permit ,Application is-hereby made.for a.permit.,too Construct(v< Alter(_), or Repair( ) an individual well at: LoY C.�e-rfy Tcc �T- ocation-Address Assessors Map and Parcel Sc.oy /�'1 1 U 4/ /�j+ C�e/�V 7 /Z a Cam t� Owner Address peNtilS 3C,wN.e1j d��ll�raS��c�^ sT,,,,c oFs c1��,�4ss Rj //4S4&,- /�Ico aa� Yy Installer-Driller Address Type of Building Dwelling Other-Type of Building No. of Persons Type of Well Y .�- Capacity Purpose of Well �/��u//o;0 Q P Agreement: The undersigned agrees to install the afore described individual well in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation-The undersigned further agrees not to place the well in operation until a Certifi to of Comp ' nce been issued by the Board of Health. Signed ! 'd 2 Date Application Approved By Date --A�.n�lication,T'%,approved for the following reasons: .�._.r.►— ----„r—�u .....,..--...,--�.--,�..-.�:_...._..----F-ter._.,.... Date Permit No. /A) Ob 2iZ; OD 2-- Issued �� t Date -------------------------------------------------------------------------------------------------------- BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of (Compliance THIS IS TO CERTIFY,that the individual well Constructed(+< Altered( ), or Repaired( ) by 6 c-uwll Sc krupuel/ Installer at /out �cc �c Co�u IT has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. Dated 70 THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. Date Inspector No.�� ZV Z 1 Fee �J , -^— -BOARD OF HEALTH TOWN OF BARNSTABLE 2pplication -for 30eYY C ztrtiuctio' 'Permit c-'/ m Appl cat o s,-,hereby�madefor gip, rmit tom Conte c d,1(Alter( ); or�Repalr(,),v ,-;n,ndividual well at: -13 .. x -Location-Address /r / Assessors Map and Parcels-- _ Owner _Address. _. { �Yl: +✓,S ��ttwcvPl' 4� _�t�1 � vi?e� rfOr iYcfr.�/a �i` �U$' a s /t'1Cs ODGY� ' x Installer-Driller Address Type of Building / Dwelling IATi J , Other-Type of Building y No. of Persons 19 Type of Well `/ ��"t Capacity Purpose of Well Agreement:The undersigned agrees to install-thee afo e described individual well in accordance with the provisions of the k � s Town of Barnstable Board of Health Private Well Protection Regulation-The undersigned further agrees not to place the well in operation until a Certificate of Compliance has been issued by the Board of Health. Signed lJ-e��u.. ��,, : / 131( )-7 Date Application Approved By Date G a _ replication Disapproved for the following reasons: Date Permit No. / 174 27— 0 7. 2- Issued 7{�I7i0Z,'2 _ - -- ---j , Date ------------------------------------------------------------------------------------------------------- BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Compliance T THIS IS TO CERTIFY,that the individual well . Constructed Altered( ), or Repaired by Auvu Scvrv�vr'll t Installer at CUTU /T i has been installed in accordance wittithe provisions of-the Town of Barnstable Board of Health Private Well Protection N Regulation as described in the application for Well Construction Permit No. W °t 00L- Dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. Date Inspector ------------------ BOARD OF HEALTH r-TO WN OF BARNSTABLE � � � �eYY �ou�truction �ert'tYit _ - No. W 200, Fee 75 . Permission is hereby granted to jC'w.v/S -)C0 ry w e Installer — - - s' to Construct(v); Alter( ), or Repair( an individual well at: ---No. !o % C /Vy r Street as'shown on the application for a Well Construction Permit No. Dated Date Z /702 Z Approved By o JP`- 00 -�F i0 7 --------------------'-------------------------------------------.---------------- -- l T(ce P Y TOWN OF BARNSTABLE LOCATION 109 C-4F-M f -WEE Zo(�D SEWAGE # 700 VILLAGE COT U (T v ASSESSOR'S MAP & LOT (� INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 'k Soo LEACHING FACILrIT: (type) t :j (size) NO.OF BEDROOMS BUMDER OR OWNER 9)rl C4 h kph,5 Lev-nel PERMIT DATE: I I ®Z COMPLIANCE DATE: Separation Distance Between the: . Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility - 7 .t Feet Private Water.Supply Well and Leaching Facility (If any wells exist too + on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist D d within 300 feet of leaching facility) Feet Furnished by Teal rN v i R ow ME 1JT fit, l T(4wK 0 C- C K zN TANK o VT } �D-Box tkACNi�JG CH�t?,Z`f 0A �� - � - ;•. - '>_spa;-.�;-::.� :,.::.. 'DI � - - - oI - - •r 1 .____._�__.____.__ 1—_- 8.Map I IT T ....... N A. �c < 4 ¢r§ c - :, � �2 K 1• . qq ho. '.. : p I - 1 YiTifK COPSC.4W3� �. ..� �;O:O: _ ..�� '" r - � _ - • i 1 rv: yi P i r f Ca)e,.fz w�z•°tv. L b1nES P.P.F_yUN2. f v7��r- A:- t f �f �r if bc. 4 z.xz"xt"TNfcFraFoaa1rrL � D O --- - PC011C-RUED LALLY CO m—t---•-- - - =_ ---- - _-- - � .. .- o I � _ r � �. � �508 428 dl9h -- I wr�(1 PS t © -, Y p I a �S IOS i ism,. cL.c 'u?,.a 2 t'•. ce ace era Ftr.. ..,s i..f E � � � H'DIA C7:C.FRlEO"3LVt]7D3ES � � .. •. f t • a. a.-0- f6 0. �--- .28-0'• 3 9 2 t p _W1 io Prel...nary grans and.Layouts by D.C.D.are for the use of their Customers onfy,Any other use i3.:s[/iC try"pro h(.Cit _ t - - Yet••.': s I 0. S� SCIZEClA pOZCH _. c:, 4:0 5--� -2 o-. I _o�• _�� is `' � ? v`- - - r .o - z° _ IL �i VIIVX .. . .. till F.Ca SuEF7S:Cx s e.. I A=4":. :Z•o' 2.4' ri of .. � � � •N' I. � `,'S08�428��619T;=- . in • i' �. - N �� SIT .�ESveoocny""—'f , �ilB�OfYi.. �. _ 1 s•c �, e:o' . � a'o 3:c.�� 1 9:0• � '�:� 4:0� � a:o a:o----• — C.-o.. - ze 11 o el. N . . E1ZST_.rL�r..PZ4rJ.. .. '� • PrCPmfndry pldn3 ahtl Iay0ut5'ny D.C.D.are.tOF-Itfe uSe Of their.(us4C,meM Ohty.Any'Oihtr.use is SViflly„PIOhiOile -i I`.' • j .Val tat L z. • _ j���MaSTE�.'.SUI?E.' 141 ar L. = 10 o. Al evl itt • j �` -- i � is i� 11 `� - r — . r►st m� _ If j a�fc of ` - ---- •l a r _ rt_.ra:. si2=.a:'s _ ' a �AD Re .O� : Rkjhls F`:SEI7QOO ! 6ED 20fJn� ! _ f 1 3' + � r t J - s• - A -e r.4 z:s"� e:o. ,_:. i B:o; 3:� 4:6- - i.: c.•.o 4.�.. r -.:o" - - � .:'�; I , �o + Pr ehm�nary Olani'a na rayoucs Oy-D.C.O:are for[ne use of Their customers only.Any orher.use is srncpy.Pron D F' —201-711 I— - - - - -- - - - - - - - - - - - - - - - - - - t'...: 2468 0 03 I 6'4" IO2 I i � (D '0 31r V 10'-8" rn I I ' a �a 12' 3068 281BAW lagg0I� - - u ilt-in C I un er stair 4' + + + IN t o N I I N = N Ei. 3 � rt } I I I I I I . I I I L�L -- - — ,- 4 ' I'—' — - - - - - L"� -- - - - - - - -- - - -LiJ L ! — 6068 2836DH a p7 _a �. CL m � N. 0 32'-711 o n o 1 o' 3 w o = n n T o O . a c o' 0 o ' I w Dorfman Residence Basement Plan betsyiaugnton.com F� 0 109 Cherry Tree Road Custom Home Design. Cotuit, Massachusetts East Orleans, Massachusetts Scale: 1/4=1-0 508 240 1242 Al j E pUS d r + 21-811 E q storage �+. o i o 2-11 1 _ - 1 1 1 _ o• 42 3c421 L K „ comer- 0 1- _, hover. E _ _ 1 11 -101 a a � 0 to tread tit �=a _ $3 cV 10 - e _ length of stair wall o ref _ (V o under 17- v • . . .. m o V _ xm I r Z new hung/3-0 3s n db � f high @ existing opening oc ;M Theat6r Room i x S . : 38 .. .} I - - ' + + " -Date. shift eodsting add window 122- - 0 window. match e)dsdng : . C I '��L.Eu1T�ePrc�Si+S GLC - - - r s� ' pp o 3 S 08- y77 2 4 t0 Floo r Plan .: scale: 1/4"=1'-0"� . 5T Tiort) !. ve - �' COO �c 1-3-1 01�. `77 Builder to confirm all:conditions and dimensions prior to construction. 1 41 - � - t .I �.KELINEI..b4io• ; � — ---•�—' --.._--'---- --s''� �:o �:o" .' � .: Sun r t I _ I C:!E:ZSOCx LP ! 1 - ® .Za.. .j I '� ',/\/•3' Qf.Ctrs-�enc._ __._ � � _ � I tt � �- � r r I . oQiin.. ei 9 ram, I AJI h& i 1 Resrned:. i .o t a•-c�-!—" 9--�•----11�- �.` re:o- _ a:o j 8. ', t_ � .. �� �L�i: 1,. . -_— Pr chminarY vlaris anal2yaurs ey 4C.D.are for cite us'c of ttsei rc ustom<rsoui - •- - :'\O - ,.,Q ' � �y'Any-otn[r.ui[is 3i rit fly.,Prod:Ci; � .I j='• � - 1 1 t _.1 ,]j�,� _ •� _:tans �_'.svr - ( oPrt K -VT,7'F.L'J al _-I �'-_. .. � � f - ell_..•� _ - .i-- _ - �srxe..:.a;���'. AMF D - Imo, Y• - •pI. \: _ ev.- irn d � --All Rl g IllshEs: -: F. 12MCVA 771 T Fj e _ r.n•�z a't 8:0. .. i B.o � 3:� 4:(e- ... ...... Cheif customeri Pfcllm.nary p1an5'.`1 n'd Iaybuls by D.C.D:afr far the usr of only.H�+y,OrMef.usr'ii'smerry;piofl7 DLiF `';t'c� • 26.5' i 719P OF INUNDATION 20 MIN. 2"LAYER OF 10' MIN. CONCRETE COVERS 4" SCHEDULE 40 P. V.C. 118"-112" VENT r _ 05 MIN. PITCH 1/8 PER FT. WASHED STONE / / / / � � / / / / � � � / / / / CONCRETE COVER "MAX. / / . ', , . . . / / d,6AIX EL= 22.5' EL= 24.5' PVC SCH. 40 2 RISERS / PnrH 1/4" PER FT. RISER 10 FLOW LINE INVERT f0" 'r -210' iMIN. 14 �20'-� o0 o O O O O O O o° ° ,�/cl�G1 EL.-___ GAS INVERT 6" SUMP LEVEL o o p o 0 0 0 0 0 0 0 0 °N _ 17.5' , INVERT BAFFLE EL.= 20.5 INVERT INVERT o o °o EL.-_-- EL.= 20. 75' EL.= 20_25' EL.= 20.0" 4' 4' INVERT (TO BE PLACED ON FIRM BASE) DISTRIBUTION EL,= 1_9.5'_ MECHANICALLY COMPACTED OR 6" OF STONE ��ER TESTED - 41.5' X 12.8' TRENCH FORMAT/ON 1500__GALLONS TO BE SEPTIC TANK PLACE ON 6•' STONE Lo 3/4" To 1-1 2•' SOIL ABSORPTION DOUBLE WASHED NONE S yS TEM (SA S) BOTTOM OF TEST HOLE #1 ELEV.= 11. 8 z (PERK <2 MIN/INCH) EDGE OF RUSHY MASH ROAD EL. = 7 85' PROFILE OF OBSERVA T./2AI HOLE 1 ELEV.=_24_8' OBSERVATION HOLE 2 ELEV. SEWAGE DISPOSAL SYSTEM DEPTH HOR/Z TEXTURE COLOR OTHER DEPTH HOR/Z TEXTURE COL OR OTHER NOT TO SCALE 0-3" 0 ORGANIC [30'�-12' -3" 0 ORGANIC 3"-B" A SANDY LOAM IOYR 6-1 "-B" A SANDY LOAM IOYR 6-1 8"-30" B LOAMY SAND IOYR 5-6 PERK -30" B LOAMY SAND IOYR 5-6 GENERAL NO TES 30"-13' Ct MEDIUM SAND IOYR 7-6 TOP 3.5) Cl MED/UM SAND lOYR 7-6 NO WA TER ENCOUNTERED®13' NO WATER ENCOUNTERED®f2' 1) ALL WORKMANSHIP AND MA TERIAL S SHALL CONFORM TO D.E.P. SOIL TEST TITLE 5 AND THE TOWN OF ��B1Y,�IABt;E RULES AND REGULA TIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE. P)�f 10,126 2) END COVERS ON SEPTIC TANK SHALL BE BROUGHT TO WITHIN 6" OF FINISHED GRADE. DATE OF SOIL TEST 1212412001 SOIL TEST DONE BY BRUCE G. MURPHY, R.S. 3) ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF WITNESSED BY: t DAVID STANTON - B.O.H WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN 5 FT OF DRIVES USED UNDER OR W�HINR5/FT. OFEDRIVES ORH-20LOADI PARKINGSHALL AREAS. E0, DESIGN CALCULA TIONS.' 4) AN Y MA SONAR Y UNI TS USED TO BRING CO VERS TO GRADE SHALL NUMBER OF BEDROOMS . . . . . . . . 5 BE MOR TERED IN PLACE. 100-19 L GARBAGE DISPOSAL . . . . . . . . . NO A 5) NO DE DEEDED OR ZONING REG BEEN TIONS. OWNER/APPLICANT/S TO NOTE � TO TA 1O SG L IBR./D Y x -_5_ BR.) 550 GAL/DA Y OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. INSTALL FOUR (4) ACME REQUIRED SEPTIC TANK CAPACITY 1500 GAL 6) UT/L/TIES SHOWN ARE APPROXIMA TE ONL Y, EXCA VA T/ON CONTRA CTOR 500 GALLON LEACHING CHAMBERS IS TO CALL "DIG- SAFE" A T 1-800-322-4844 A T LEAST 72 HOURS 4 FEET OF DOUBLE WASHED STONE SOIL CLASS/FICA TION . . SITE SIDES PERCOLATION RATE < 2 MIN.//N. PR/OR TO COMMENCING WORK ON S/T 7) CONTRACTOR IS TO VERIFY GRADES AND ELEVATIONS AS WELL AS S/DES AND ENDS `I EFFLUENT LOADING RA TE . •74 GAL/DA Y/S.F. 12.8' X 41.5' X 2'EFF L)EPTH LEACHING CAPACITY (AREA X RA TE) 55J GAL/DA Y SITE CONDITIONS PR/OR TO COMMENCING WORK ON S(TE. k 8) PARCEL /S /N FLOOD ZONES__C B&A 11"__. RESERVE LEACHING CAPACITY . 553 GAL/DA Y 9) LOT /S SHOWN ON ASSESSORS MAP _18_ AS PARCEL __Z___. (41.5 X 12.8 X .74)+(41.5*41.5+12.8+12.8 X .74 X 2) SHEET 2 OF 2 JOB NUMBER __5J023_-_--_ 1 } BARNSTABLE BENCHMARK: TOP OF C.R SCHOOL STREET HYDDRA^✓T ELEV.= 26.36'(NCVD) CHERRY TREE ROA L/ BASIN EL=25.5 BASIN EL= 13.9 BASIN EL=25.5 C��G�G LOCUS U.POLE_ �— — — — — — E G 0 P A V M 1' N r — — I — — MERRY TREE -� N. T N711 10 W N \ �, \� NICKS ON R . 3 . 41 U.f'+7LE C.B (fnd) PINE a \RIDGE RD �v-- 1 �\ �� �\ �\ \ \ 42.0' Z 1 42,0 1 �. PRESERVE c, o 0 o ti j AS/LOT 7 — "� — —\ , °� \ LOCUS MAP `,ARE� �\ 51,483 S.F ` nt 00 0 1 \ �� `�\ �� ASSESSORS MAR-18, LOT 7 �� • \ \ o DECK ► / TP/! I i i PLAN REP 191143 \28.0 ® i LOT 220 \ 24.0' i ZONING »RF" PI�oPOSED16.0' 1 �\ o i op(� FLOOD ZONES: "C,B,A1#1(EL.11)" (�BEDROOM \ \ I GARAGE\ I o �6'\ COMMUNITY 0021ED T.OFUS65 � (ON SLae ® � u 68.' 1 , DATED.- 712192, \ 42 i0 OVERLAY DISTRICT AP Pow" \� ( AS/LOT 12 \ \` \\ \\ `\ \` \� \`� \` \ '\ \ \\ \� T� \ \� \� l?N n� \ \\ `\ `\ \ \� 1p� `� �� �\ `� C.B (fnd) SITE & SE WA GE PLAN OF LAND LOCA TED A T Of \moo \ �T \\\ �� \ �. \ \ ���� \, �� \ CHERRY TREE' LANE 0 ��' \mod \\ r\. `� �` \\ \� \\ �` \�. \`. -`" COTUIT, MASS. A. PREPARED FOR .N BRIAN & ROBIN TIE'RNAN AS/LOT 8 REV. AUGUST 12, 2002 SCALE 1"= 30 FEET 0 �_ U.POLE BFlG, \ `, N7110'10"W `181. 42' `� YANKEE SURVEY CONSULTANTS UNIT 1, 40B INDUSTRY ROAD MU.749 H ` - — P.O. BOX 265 74� — — — MARSTONS MILLS, MASS. 02648 gti�rAR�P il I1IDG'E ���D PINE TEL 42B-0055 FAX 420-5553 ` J# 53023 DCB 1 PERCENTAGE OF LOT COVERAGE SCHOOL STREET N LOT AREA 51483t S.F. o �p EXISTING STRUCTURES 5.8% d- DRIVEWAY 5.6% CHERRY TREE ROAD gol 3 613�t TOTAL COVERAGE 11.4% _ c � ^ 3 °�°G C" LOCUS EDGE OF P A V E M E N T S HERRY TREE RD. N71 °10'10"W 333.41' NEU — — IT — '� NICKER N RD NE y BRIDGE \ _. -GG \, A I41 � 06 LOT 220 �°� "' ` '. \ PLAN REF: 19-143 AREA = 51,483t S.F. PORCH DEED REF: 24580-154 _______ 47.8ft= LOT 12 ASSESSOR'S MAP: 018-007 ZONING: RF PROPOSED -__________________ G o SETBACKS: 30'-15'-15' ,ex3s ---- ¢ O FLOOD ZONE: C,B,AII \ F POOL =-====#109L� �. \ ------------ ---- ------------------------ ---------- DEC i o PANEL NUMBER: 250001 0021 D 'p - =-----= .. N DATED: 7/2/1992 F Cis \ K P A TI 0 ox� >1 \ PLOT PLAN LOCATED AT: <<Fa y \ ��'� 109 CHERRY TREE ROAD \�O \ s� COTUIT, MA o' SHED AAA PREPARED FOR. viOF/,4%,SS •, 00 ROBERT DORFMAN srEPHEr. r LOT $ FEBRUARY 27, 2013 G'-:; E REV: == REV: c vvly ' Z -i + REV: �Z� \ YANKEE LAND SURVEY CO,t INC. GRAPHIC SCALE ` N71 *1O'10"W 181 .42' - 119 ROUTE 149 30 0 15 30 so _ MARSTONS MILLS, MA — — TEL: (508)428-0055 FAX: (508)420-5553 PINE ankeesurve omcast.net www. ankeesurve .net Y Y� Y 1 inch = 30 f� RIDGE ROAD Y SHEET 1 OF 1 JOB#: 54892 JM