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HomeMy WebLinkAbout0162 CLAMSHELL COVE ROAD - Health 162 Clamshelltove R6ad cotuit A=005 0.09 UPC 12834 Vo.22.1533LLW "4crco NANTINQB.WN 7 \l ���� �� c�� , 9,���>> J cam r 4 po9 Commonwealth of Massachusetts �s Title 5 Official Inspection Form /� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments •u 162 Clamshell Cove Rd. Property Address Fitzgerald Owner information is Owners Name required for every Cotuit MA 02635 12/1/20 page. Cityrrown 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. A. Inspector Information 61 , PS UU Frank Nunes III Name of Inspector saa Company Name Box 841 Company Address East Falmouth MA 02536 Cityrrown State Zip Code 508.272.6433 13010 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in-the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 12/1/20 Inspec SignaP<f 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 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 form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 i Commonwealth of Massachusetts re Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 162 Clamshell Cove Rd. Property Address Fitzgerald Owner information is Owner's Name required for every Cotuit MA 02635 12/1/20 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) 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: 2) System Conditionally Passes: Y ❑ 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): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 r Commonwealth of Massachusetts �. ,,p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �a 162 Clamshell Cove Rd. Property Address Fitzgerald Owner information is Owner's Name required for every Cotuit MA 02635 12/1/20 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ 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): 3) 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. a. System will pass unless.Board of Health determines in accordance with 310 CMR 16.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u 162 Clamshell Cove Rd. Property Address Fitzgerald Owner information is Owner's Name required for every Cotuit MA 02635 12/1/20 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 b. 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. c. Other: 4) 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 r Commonwealth of Massachusetts ,F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments o 162 Clamshell Cove Rd. Property Address Fitzgerald Owner information is Owner's Name required for every Cotuit MA 02635 12/1/20 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool El ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply 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 2000 gpd- 10,000 gpd. ❑ ® 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. 5) 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 CA. 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 cam, Commonwealth of Massachusetts �s ,p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 162 Clamshell Cove Rd. Property Address Fitzgerald Owner information is Owner's Name required for every Cotuit MA 02635 12/1/20 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered"yes"to any question in Section C.5 the system is considered a significant threat, or answered"yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes"or"no"for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments •u 162 Clamshell Cove Rd. Property Address Fitzgerald Owner information is Owner's Name required for every Cotuit MA 02635 12/1/20 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Description: 4 bedroom permit and engineered plan on file Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: 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 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: seasonal Date t5insp.doc•rev.712612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u 162 Clamshell Cove Rd. Property Address Fitzgerald Owner information is Owner's Name required for every Cotuit MA 02635 12/1/20 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CM 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: unknown Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts �e Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 162 Clamshell Cove Rd. Property Address Fitzgerald Owner information is Owner's Name required for every Cotuit MA 02635 12/1/20 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 4. 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): pump chamber Approximate age of all components, date installed (if known)and source of information: 2003 Were sewage odors detected when arriving at the site? ❑ Yes ❑ No 5. Building Sewer(locate on site plan): 18,E Depth below grade: feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: >10'feet Comments (on condition of joints, venting, evidence of leakage, etc.): t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts 6g Title 5. Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments -a 162 Clamshell Cove Rd. Property Address Fitzgerald Owner information is Owner's Name required for every Cotuit MA 02635 12/1/20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site.plan): Depth below grade: 12"feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ® polyethylene ❑ other(explain) Polytank with steel cover at outlet, use caution when digging an irrigation line is over the outlet cover 99 9 9 If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500g Sludge depth: 1" Distance from top of sludge to bottom of outlet tee or baffle >12 Scum thickness trace Distance from top of scum to top of outlet tee or baffle >2" Distance from bottom of scum to bottom of outlet tee or baffle >2" How were dimensions determined? measured 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 suggested every 3yrs to prolong the life of the system L15m.p.doc•rev.7/26/2018 Title 5 Official Inspection Fonn:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments •u 162 Clamshell Cove Rd. Property Address Fitzgerald Owner information is Owner's Name required for every Cotuit MA 02635 12/1/20 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: other [I concrete El metal El fiberglass Elpolyethylene ❑ of a (explain). Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 162 Clamshell Cove Rd. Property Address Fitzgerald Owner information is owners Name required for every Cotuit MA 02635 12/1/20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holdingi Tank(cont.) 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 9. 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 3' below grade, it was video inspected, no adverse conditions observed t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments u 162 Clamshell Cove Rd. Property Address Fitzgerald Owner information is Owner's Name required for every Cotuit MA 02635 12/1/20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. 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.): Pump chamber has cover to 6" of grade * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: 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 Type/name of technology: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 162 Clamshell Cove Rd. Property Address Fitzgerald Owner information is Owner's Name required for every Cotuit MA 02635 12/1/20 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Chambers are damp at this time, no indication of past hydraulic failure, cover to 12" of grade, bottom of chambers is 5'6" below grade 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7126/2018 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 14 of 18 Commonwealth of Massachusetts (P Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments .% 162 Clamshell Cove Rd. .V Property Address Fitzgerald Owner information is Owner's Name required for every Cotuit MA 02635 12/1/20 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 13. 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.): { t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts 'Title 5 Official Inspection Form / Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4Ki o u 162 Clamshell Cove Rd. Property Address Fitzgerald Owner information is Owner's Name required for every Cotuit MA 02635 12/1/20 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 14. 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 q L__F 3 1 `c \ Q C_ s l Lk t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts re Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 162 Clamshell Cove Rd. Property Address Fitzgerald Owner information is Owner's Name required for every Cotuit MA 02635 12/1/20 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: >99 1. 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: 2003 NGW 99" Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health-explain: 4 ft seperation per 2003 compliance ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: TOPO mapping shows the site at 39'msl and nearby surface water at 2'msl You must describe how you established the high ground water elevation: See above Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 t Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 162 Clamshell Cove Rd. Property Address Fitzgerald Owner information is Owner's Name required for every Cotuit MA 02635 12/1/20 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria)and 6 (Checklist)completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 - 1 ---31q J No. Fee 0-0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2ppYicat%on for Disposal *pstem Construction 3permit Application for a Permit to Construct( ) Repair W Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. j(p C/q-gh e4/ (_avr a D Owner's Name,Address,and Tel.No. Assessor's Map/Parcel p o g p p Installer's Name,Address,and Tel.No. 1 5-3 60,.,t...• 1*4-Sc Designer's Na e,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil I f Nature of Repairs or Alterations(Answer when applicable) P p �rofc,� ws�4►� 2-1 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 Certificate of Compliance has been issued by Board of Health. gne v Date � ' (� 1 Application Approved by Date Application Disapproved by Date for the following reasons Permit No. Date Issued i No. ' Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01ppYication for Disposal .pst'em Construction i3ermit Application for a Permit to Construct( ) Repair(V) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. /(p Z C/,a.,,5,4 el/ Lo vF rz Owner's Name,Address,and Tel.No. e_o7,.O;T Assessor's Map/Parcel ©o 5' d p 1 S` Installer's Name,Address,and Tel.No. 1 T3 S{ Designer's Name,Address,and Tel.No. N�7-86 "1 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) r Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil I Nature of Repairs or Alterations(Answer when applicable) 'RE?,p tfUl 1�e_ Vk),q t-ZA 7-t /Ra+-, } Date last inspected: Agreement: t 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 Certificate of Compliance has been issued by 's Board of Health. gne / n _. O Date Application Approved by / �/ i Date Application Disapproved by w Date for the following reasons r ` Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS r Certificate of Compliancr THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired Upgraded( ) Abandoned( )by oli9�tJC( 6A7 kn0r.),ei CL— at I to 2 L�►'+15�- Co VE Z) has been cons t n ac r ce with the provisions of Title 5 and the forDisposal System Construction Permit No ated Installer � ,,, 1�Gyy�' S Designer pol. Y #bedrooms Approved desi ow ,� /� , _ gpd The issuance of this.•e ipha P not be construed as a guarantee that the system wtIncti,n designed. ly ILI/ Date Inspector i � -----------=-------j ' ----------------- -------------------------------------------------------- ---------------------------- No. _/ _ Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS Misposal 6pstrut Construction Vermit Permission is hereby granted to Construct( ) Repair( Upgrade( ) Ab ,do ) System located at (02 G14", 4e.Q� CocJ�' /tern and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. 4 �r Provided:Constructio u t co eted within three years of the date of this permit. Date / Approved by 1 No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes ,PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 0[ppliLatlon for Misposal *pstem Construction permit Application for a Permit to Construct( ) Repair(X Upgrade( ) Abandon( ) ❑Complete System individual Components Location Address or Lot No. 16a eLAMSWI_g-U,, c tee RQ> Owner's Name,Address,and Tel.No. C W U-4-i AAA S k*4- k t.etTJ 1=t Tr-GGP,4 U' Assessor's Map/Parcel 00 y4 �p, t(,jjnEjM Installer's Name,Address,and Tel.No. 509-471"8 91-1 Designer's Name,Address,and Tel.No. dAvad b a Ewe s LC.C, Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd 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) L- 1J G Fft A4 C e &k!� ;E 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 Certificate of Compliance has been issued by this Board of H Sigmd, Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. 2s-( } - 1 Date Issued G ?� y No. 1r, l 3111 / F ' !� Fee r i THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF_BA/RNSTABLE, MASSACHUSETTS 4pfiration for Misposal 6pstem Construction Permit Application for a Permit to Construct( ) Repair X Upgrade( ) Abandon( ) ❑Complete System %Individual Components Location Address or Lot No. � 5�� , �V 1+i, Owner's Name,Address,and Tel.No. C)`t j I"�°' W tc.44 Awt g kA'M tiJ F a TZ. QM c,.l"j Assessor's Map/Parcel Oo ® 1 Installer's Name,Address,and Tel.No. 508-471-*g&J-1 Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil 6 e Nature of Repairs or Alterations(Answer when applicable) L I tJ G Moi&4 Gj4r� -Im Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in wr accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliancelas been issued by this Board of Health. t Signed. Date s,y 11 Application Approved by t )dl �A, 0 f Date Application Disapproved by 4 Date for the following reasons Permit No. Date Issued ( Y ---------------------------------------- Th E COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS �tCertifirate of Compliance THIS IS TO VE�RTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( Upgraded( ) Abandoned( )by (_ A p G= xA pIQ i �••t"'�,. at / �+ye,sdM$E(�1(, Gcau r t�D e'-g�y "r has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. ao r i- dated Installer dApe dtAG OjTla �t mS LLIC-6. Designer #bedrooms A J A_ Approved design flow gpd The issuance of this permit shall not be construed as a guarantee that the system willrfunction as2esig ed. Date 1/ � , Inspector _ --------------------------------------------------------------------------------------------------------------------------------------- No. _o, — Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal *pstem COnstrurtion Permit Permission is hereby granted to Construct( ) Repair()() Upgrade( ) Abandon( ) System located at (6'3_ e!:(.,4AW ['0t r_—P'n C( ) I -r-O and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date u , L Approved by, Page 1 of 1 j ,, � +TUWN ur it bA NS�lAt3 �L�OCATION IL 0 Y l-C7he I I C 41— E$EWAGE tt d "33t o. VILLAGE B ASSESSOR'S MAP &LOT c�05—OBI INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY /600 C LEACHING FACILITY: (type) (size) NO.OF BEDROOMS ,BUILDER OR OWNERAH PERMTTDATE: COMPLIANCE DATE: J41(011)3 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by B 2 'Pump D c 5 [7tS�rib�t{-io�1�� 3- 16' A.- lid http://issgl2/intranet/propdata/prebuilt.aspx?mappar=005009&seq=1 3/7/2012 V 1 O er rJ J QL CO�Iti10N�EAL;TH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONNIENT_AL AFF_AIR:S. DEPARTMENT-OF ENVIRONMENTAL PROTECTIONT TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION fjQj—z:-09 Property Address ✓ v c /i'Y: �l l' C �,3 Owner's Name: Owner's Address: 11,1,E rV L t,/1 Date of Inspection: (1 ��:�, d �'Z On(0 Name!of Inspector ple.a._,sJa p Innj nP. .Company Name: 17iTa�� . )' 1�t Mailing Address:. ktVA .;217) . Telephone Number: 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(3.10 CMR 15.000) ;The system:. Passes Conditionally Passes'. . Needs Further Evaluation by the Local Approving Authority Fails baspector's Siahature:. ,, 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 completina 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. y Notes and Comments- . ****� This report only describes conditions at the time of:inspeetion and under.the conditions of use at that. time This.inspection does not address"how the system will perform in the futufe under the same or;different conditions of use. ! r, Title Inspection Form 6/1.5/2000 page 1 Page 2 of I 1 . OFFICIA.L INSPEC T IOCN FOR I '-NFOR VOLUNTARY ASSESS MEN SUPSURFA.CE SEW:A.GE'DISPOSAL SYSTEM INSPECTION FORM'. PART A CERTIFICATION continued Property Address. �" , � (24",�v Owner- Datel of Inspecfioir .; Irspection'Summary: Check A,B,C,D or E/AL.WAYS complete.all of Section.1) 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 CNIR 15.304 exist.Anv failure criteria.not evaluated are indicated below. Comments: B. System Conditionally Passes: Y Y 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 ofHealth;will pass. Answer yes, no or not determined(`i`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 indicatins 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 o-f.Health): broken pipe(s),are replaced obstuction is removed ND explain: Page 3, of 11 OFFICIAL INSPECTIOIN FORM -.NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEVIAGE DISPOSAL SYSTEM INSPECTION FORM PAR'i, A CERTIFICATION(continued) Property.Address: lb,� L�t'&I ;A-1 Owner: Date of'>'nspection:'/I A..va R. % .-1'` �✓✓� C. Further.Evaluation is Required by the Board.of Health: Conditions exist which require further evaluation by the:Board of Health'in orderto determine if the system is failing to protect public health. safety or the environment. 1. System wiII pass unless Board of.Health determines in accordance with 310 CMR 15303(i)(b) that the system is not functioning in a manner which will protect'publk 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 f2i3 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 l 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 aDEP certified laboratory;for coliform . bacteria and volatile organic compounds indicates that the well is free from pollution from that facilityand the presence of ammonia nitrogen:and nitrate nitrogen is equal to or less than 5 ppm,provided thatno other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: Paoe 4 of.I 1 QFFICIAL INSPECTION FORI'vII-..,NOT FOR VOI_,U dTARYASSESSMENTS SUBSURFACE SEWAGE"DISPOSAL.SYSTEM INSPEC`I'ION.FORM PART A CERTIFICATI0 (continued) Property.Address.. 120 (/ L;t�� j� P -p, Owner• a���' 3 Date oflnspection �9 l Vc)C�6 D... System Failure.Criteria applicable to all systems: You must indicate"yes"or"no"to each of the fallowing for all inspections: }Yes N — Backup of sew,a6e;.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 cloased SAS or cesspool .Static liquid-level in the distribution:box above.outlet invert due to an.:overloaded or.clogged SAS or cesspool Liquid depth in cesspool is'less.than 6"below invert or available volume is less than %day flow Required pumping more.than 4 times in.the last year.NOT due to clogged or obstructed pipe(s).Number of times pumped Any portion of the-SAS,cesspool or privy is.below high around 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 ceisspcol.or.privy.is within.a Zone 1 of a.public well. jt. Any portion of a cesspool oz privy is within 50 feet ofa.private water supply:well: Any portion of.a'cesspool or privy is:less than 1.00 feetbut.greater.than.50 feet.from a private water supply well with no acceptable.-water quality analysis:.[This system p"asses,if.the well water analysis, performed at.a DEP certified-laboratory, for:colifor"m.bacteria and volatile organic' compounds indicates that the well"is"free from pollution from that.facility-and the.presence of ammonia nitrogen and,"nitra.te nitrogen.is equal:to or less than 3 ppm,.provided that no_other failure criteria are triggered:A.co-py of the analysis:must be attached to this form.] (Yes/No)The system fails. I have determined.that one or more of the above failure criteria exist as" described-in-5,10 CMR 15.303, therefore the system fails.The.system.owner should contact the Board of Health to determinewhat will be necessaryto correctthefailure. E. Large:Systems: To be considered a large system the system must s.erve.A facility with a design flow of 10,000.gpd to 1.5,000 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."Lirface 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 3.10 CMR 13.304.The system owner.should contact.the appropriate regional office.of the Department. Page 5 of I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSUR.FACE'SEWAOE'I)ISPOSAL SYSTEM INSPECTION-FORM PART B . CHECKLIST Property Address: (�. a Owner: iz Date of`fnspection: --,L d�cl.k Check if the following haye.been done.You must indicate"yes"or"no" as to each of the followine:.- Yes. 0 Pumping.information was.provided by the owner,occupant, or Board of Health / ✓ Were anv of the system components pumped out in the previous two weeks ? V Has the system received normal flows in the previous two week period? V Have large volumes of water been introduced to the system recently or as part of this inspection? V _ 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 backup Was the site inspected for signs of break out? Were all system components, excluding the SAS,,located.on site v 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 deterinined`based on: Yes no 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)] Page 6 of 11 OFFICIAL,INSPECTION FORM. NOT FOR:VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM SYSTEM INF.ORIMATIOi`t Property Addressc /Vov AX &W r Owner: Date,of Inspection.. , i/ FLOW CONDITIONS RESIDENTIAL Lam. Number of bedrooms(design): - Number of bedrooms(actual): DESIGN flow based on'310 CMR 15.203( example: 11.0 gpd x T of bedrooms): C Number of.current residents -- , � Does residence have a garbage grinder(yes or-no): j 16 Is laundry on.a.separate sewage system(y s or no) O.fif yes separate inspection required]: Laundry system inspected( es.or no):,/ { Seasonal use: (yes or no): Water meter readings, if iv able last 2 years usage Sump.pump (yes or no); , Last date of occupancy: COMMERCIAL/INDUSTRIAL I� Type of.establishment:. Desian flow(based on a 10 CMR 15.203): Qpd Basis of-design flow(seats/persons/sq.ft,etc.):. Grease trap present(yes;or.no);_ Industrial waste holding tank present(yes or no):— Non-sanitary waste discharged to the.Title 5 system(yes or no): Water meter readings, if,available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source-of information: /V/O Was system pumped as part of the inspection(yesk no); If yes,volume pumped:: gallons --How was quantity pumped determined? Reason for purnping- TYYE OF SYSTEM Septic iank,'_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 froth system owner) _Tight tank. Attach.a copy.of the.DEP approval .Other(describe): 'Approximate age of all components date ins ]led(if wn,)and source of information: (y Were sewage odors.detected when arriving at t e site es or J Page 7 of Y] OFFICIAL INSPE_CTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE:SEWAGE DISPOSAL SYSTEM.INSPECTION FORM PART:C SYSTEM.INFO`RMATION (continued) Property Address: W / / f wLZ �:�/ G �✓ Alp Date bf.Inspection,:" J BUILDING SEWER(locate on site plan) Depth below. grade: Materials of construction:_cast iron _40 PVC other(explain): Distance from private water supply well or.suction line:. Comments (on condition`of joints, venting, evidence of leakage, etc.): SEPTIC TANK: �locate on site. lan —( P ) i Depth below grade:�, q,' ', + 69f Material of construction:. /concrete_metal fiberglass polyethylene _other explain) If tank is metal list age:_ .Is age conf=ed by a Certificate of Compliance(yes-or no):`_(attach.a copy of certificate) Dimensions: Sludee depth: d Distance from top of sludge to bottom of outlet tee or baffle: 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: , , How were dimensions.deternired: 11y _ Comments (on pumping reconme ations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evid nce of leakage, etc.): _ GREASE TRAP: t (locate on s te.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 oflast.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 8 of 1.1 OFFICIAL,INSPECTION-FORM-NOT`FOR:VOLUNTARY ASSESSMENTS SUBSURFACE SEW-AGE DISPOSAL, SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued), Property Address: 0 _ Owner �':'�? y ICU r,9 Date of Inspections 'Z AP14 . TIGHT or HOLDING TANK:/A.L� (tank must be pumped at time of inspection)(Ioc.ate on.site plan) Depth,below Bade: Material of construction:: concrete metal fiberglass polyethylene other(explain);. Dimensions: Capacity: aallons Design Flow: gallons/day. AIarm present.(yes-or no):: Alarm level: Alarm in working order(yes or no): Date of lastpumping: Comments (condition of alarm and float switches, etc.): DISTRIBUTION BOX: / (if presents must-be opened)(locate�on,Jsite.plan) Depth of liquid level above outlet invert: /X. Comments(note;if box is level.and distribution to outldequaI,.any'evidence of solids carryover,any evidence of Leakage into or out of box,et PUMP CHAMBER:: (locate on site.plan): Pumps in working:order(yes or no): UV Alarms in working-order(yes-or no): (� C-mments .note condition of purrip char' er,conditio/ rOf pumps and appurtenances. tc.): 3 Page 9 of I 1 OFFICIA.L.INSPECTION FORM.—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEW.ACE DISPOS:AL:.SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: / ._,e��.w 7' Owner: �L_ ��, 1 .J Date of Inspectig: Q, '�.r�ss�• ��/� (��� o J SOIL ABSORPTION SYSTEM (SAS): a 1 {locate on site plan, excavation not required). If SAS-not located explain why: Type . eaching.pits,number: leaching chambers,number: leachinc'.calleries, number: leaching trenches,number, length: leaching fields,number, dimensions: overflow cesspooi;number:. innovative/alternative system Type(namt of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil,:conditionh of vegetation, etc.) V 600 ��tLi'! �r�� , �t�rt�t8r r�S�%�•'� f tJ�1 � . _,��') /� �� J I /`,!�� °� ,� ' -,1 J�p,,, P>./' `� 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 or no): . Comments (note c-ondition-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.): 9 Page 10 of-I.1, OFFICTAL INSPECTION FORM—NOT FOR VOLUINTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTE.IM INSPECTION FORIYI PART-C. SYSTEM INFORMATION(continued). Property Address:. 1 >� Owner: . Jl Date of Ins f ry' p ection ` 6 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the'sewage disposal system including ties to at Ieast two permanent reference landmarks or benchmarks. Locate all wells within 100 feet.Locate.where public water supply enters.the buildin1g. 'z)- R-O f 3 . C ara l doo NAI coo 10 Paae I 1 of I 1 OFFICIAL INSPECTION FORIM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM.INSPECTION FORM PART C SYSTEM INFORMATION(continued) PropertyAddreSs: �7r'3ai� .✓ �. �� Owner: r �%�1 , Q� '� Date of nspection z,, ,1y 0 SITE EXAM SIope Surface water Check cellar Shallow wells Estimated depth to ground water feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked, date of design plan reviewed: Observed site(abutting property/observation hole within.150 feet of SAS) Checked with local Board ofHealth-explain: Checked with.local excavators; installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Alp / � `!°��':®1 d.� iL �� ���fi�� �� ���' I'll�'';9.,/tr�''� ���� G�s G✓'r�'r,j, i 11 Permit Number: Date: Completed by: 6d,51r HIGH GROUND-WATER LEVEL COMPUTATION Site Location: Lot No. Owner: �g Re Address: Contractor: — Address: �/', ✓ral ✓!`"` !'G STEP 1 Measure depth to water table - tonearest 1/10 ft. ............ Date......:....................................... . ................ month day/Year STEP 2 Using Water-Level-Range Zone and Index..WeIIs.Map locate site and determine: O.Approorlate index well............ ..................................... OB Water-level range zone ................................. STEP 3 Using monthly report "Current _.. _. . -:::Water Resources Conditions' determine current depth to /676 water level for index well ........:.................. month/year _ _,... :... — .... STEP 4 Using Table of Water-level Adjustments for index well (STEP 2A), current depth to-water level for index well (STEP 3), and water-level zone (STEP 213) r S_ determine water-level adjustment .......................................................................................... STEP 5 Estimate-depth to high water .;..:.:_.:.- by subtracting the water Level adjustment (STEP 4) from;measured depth to water level at site (STEP 1) ............. ......... a� Figure 13.—Reproducible computation form. .15 i F2i 4 fr w 33(�. No. �O3 r Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 0[pplicatiou for Migool *potem Construction Permit Application for a Permit to Construct(.Al Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 16.1 4fXAM S/ftZC 00✓d-- .Qb Owner's Name,Address and Tel.No. Assessor's Map/Parcel �/_ gJpg A Z4,.Ws' 37' fAf a G.7�0�, /M o Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. IP. -77 'aE 1C--#CG?afa �OW4r /V-,a �trRfifS VWri tS—Xt jeJeGeS�, /1t/J `5V 9 /h~41 mn _:PwAp rn &7=r, ov.4 e—v �) s33 r,', Type of Building: Dwelling No.of Bedrooms _ Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 'ILL 0 gallons per day. Calculated daily flow 4.S q gallons. Plan Date 211 S�/0 a Number of sheets ! Revision Date Z/ 03 Title 7izcE' s SiTt Pc o—A/ Size of Septic Tank /s"csO Type of S.A.S. Description of Soil d,41ey4!57_fZ n©ski'-SE s'4-"c > -- Nature of Repairs or Alterations(Answer when applicable) �✓/-7/ f�v0 7'/�•tl.� fflLr2f° L'�f s4���? ,�� ••o d(r i�-.t!!f S� C GGs�"-'� !�i zw T oY TONE EIS csr-r c9 W AI Odl Pe-4•l� Date last inspected: d A//0,-5 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 ued,b is BQ of Health. Signed 'b�v Date?- Application Approved by S Date 1_Z2-D 3 Application Disapproved for the following reasons Permit No. 2oD 3-33to Date Issued 7- Z2.-03 �(No. 411J � Fee Entered in com -ter: V T iTHrE COMMONWEA`LT OF MASSACHUSETTS p PUBLIC HEALTH DIVISION TOWN OF BARNSTABLE,, MASSACHUSETTS Yes Zpprication ffor 30igegg(l *pgtem Construction Permit Application for a Permit to Construct(.dkf Repair( )Upgrade( )Abandon( ) O Complete System ❑Individual Components Location Address or Lot No. /61 &A/riSKt e4 4Ve-W Qh Owner's Name,Address and Tel.No. 0orccrr �4.wfv t ,a;n aww'm s Assessor's Map/Parcel 41.. Q v'l;?;d AZ404 'Tr Al Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. R, 4 P�«F�ACC)GiA coarsrekerraV �Qcdl( C tss� vec.t -ra�.ciG, iAe0, 14-.0 ,rna/v is !!,a , es�+.v��/Gr fr,�s/A y 94 9 �rR,v ar y�a.,,,,o�/�, /+s•.a area-) 8s a a'9 0-0 a) Type of Building: - F Dwelling No.of Bedrooms 4< Lot Size 3/Ova sq.ft. Garbage Grinder( ) Other ' Type of Building No.of Persons Showers( ) Cafeteria( Other Fixtures ' Design Flow 4(y O gallons per day. Calculated daily flow d1s'9' gallons. Plan Date Ir 3 Number of sheets / Revision Date �LZI 03 Title Ti rt S' 6/772f mac,0-4/ Size of Septic Tank /a'v o Type of S.A.S. G,a Description of Soil eF14 e 006-t-7 i+a a.-,r..s c-c- ,S.,a.Al Nature�of Repairs or Alterations(Answer when applicable) 2e,o&cA ocg sue?c 7a�/ .aroo T Tr}.y,c 144+/QI/� cis F. 1C'72 "� „a i • T c `tom S Tptc/c 45 ae-, o a41 At 4141 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 issued-by,this�Board of Health. :J �j a Signed K -1. i l0 C�.C�l.C'..... Date Application Approved by Date 7 22-0 3 Application Disapproved for the following reasons Permit No. Date Issued 7` Z 2---o 3 --------------------------------------- - -- L 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 R, -7, 3&-v/e/a 0,V a,ex �'d%ii s T•�u CI 77®.c f at i G e-14A-1W z C_ 7- has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 7cU3-33(6 dated `r- Z$-' U3 Installer X, 7-, a 4e ,9 67o%r-5 x_1 alp;PWsDesigner /�yr�A1 l►,�-1. ��rc�.tr ��'�fi �,(/Q The issuance of this pe it s all not be construed as a guarantee that the system will • '4as des'g'e . Date a icy Inspector ---------------------------------------- No. 'too 3."3 .. . ._ ` ...: : _ _.- _ ._ - Fee-- THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE,,-MASSACHUSETTS Bigpo5al 6p.5tem Construction Permit Permission is hereby granted to Construct( ko)Repair( )Upgrade( )Abandon( ) System located at il. 4 L��+d 2 0-,Tze/ 7- 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 must be completed within three years of the date of this permit. Date: 7- *Z-L- 03 Approved by SG5A7: NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. PERCOLATION TEST AND SOIL. EVALUATION EXEMPTION FORM hereby certify that the engineered plan signed by me dated 3 ,concerning the property located at 1 z C-�.�.risttL-tom c o0 meets all (if the following criteria: • This failed system is connected to a residential dwelling only. There are no comrnercial or business uses associated with the dwelling. The soil is c;assified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. The applicant may use historical data to conclude this fact or may conduct preliminary tests at the site without a health agent present. • There is no increase in low andlor change in use proposed • There are no variances requested or needed. # The bottom of the proposed leaching facility will not be located less than fourteen (14) feet above the maximum adjusted gtvundwat„r table elevation. LAdjust the groundwater table using the Frimptor method when applicable] Please complete the fallowing;: 12 A) Top of Ground Surface Elevation (using GIS infurmation) � B} G.W. Elevation +1/- + adjustment for high G.ti'V. 0 DIFFERENCE BETWEEN A and 13 SIGN ED : DATE: , �t 6 O 3 f NOTICE Bt::>ed upon the above information, a repair permit will he issued for bedrooms maximum. No additional bedrooms arc authorized in the future without engineered septic system plans. y:hclith rolder,petcczmp Title-5: Drlaft Printed September 20,•19Q3 Appendix 4 Page I Date Z! Q No. - Commonwealth of Massachusetts r r ys7�4-3ce-� , Massachusetts Site Suitability Assessment for On-site Sewage Disposal Performed By: ...rtirr �.......... ✓.. :song .c. ............................ , ���v .... .. .:.��.. �t/ C'. S: t'............................................................._.............. WitnessedBy: .......................... ........................... Location Address or Lot No. Owner's Name. Address and Tel. 9 00 Ttt d Zvi /yIRP S Gc�r 9 New Construction ❑ Repair Office Review Published Soil Survey Available: No ❑ Yes 11� Year Published A?3. Publication Stale Soil Map Unit .. . ..... od'4 DrainageClass ....A......... Soil Limitations ..............................................................................:........................................ Surficial Geologic Report Available: No ❑ Yes M Year Published /9?,-7" Publication Scale Geologic Material (Map Unit) ........... m/�' �s. P . Landform ... ....... . ....... ... .................... .. Flood Insurance Rate Map: Above 500 year flood boundary No ❑ Yes .S s s Within 500 year flood boundary No ❑ Yes ❑ Within 100 year flood boundary No ❑ Yes ©(� n Wetland Area: ...... . %.. - . .....�.� � National Wetland Inventory Map (map unit) - ......... 7PVc F16 Wetlands Conservancy Program Map ,map unit) ... ....... .. .......... ......... Current Water Resource Conditions (USGS): Month ,v zcro3 Range : Above Normal W019) Normal ❑ Below Normal ❑ Other References Reviewed: ........ .. ............ . . ................... .... ............... ..................... ..... ..... ........ I ule 5: Draft Printed September 20, 1993 4 Appendir 4 Page 1 On-site Review Deep Hole Number .. ....L..... Date:....`?`3 Time:..... Weather Location (identify on site plan) ......TP................/... Land Use Slope M . .:- : Surface Stones . . Vegetation ��` Landform 04C:40,-?-6t,( 10614W Position an landscape (sketch on the back) Distances from: i Open Water Body �..:�. feet Drainageway .. ^C!`E... feet d=5 _ &V,00At s 8.4yy Possible Wet Area .......11.A... feet Property Line .... ......... feet Drinking Water Well N4 feet Other DEEP OBSERVATION HOLE LOG Depth from Surface Sail Horizon Sail Texture Sail Color Soil Mottling Other (Inches) (USDA) (Munseil) (Structure. Stones. Boulders, Consietene % Gravel) n A /y2 6/6 --��"t s�-it�J /a/ / — Parent Material (geologic) S&A[ Depth to Bedrock: Zvv `�— Depth to Groundwater: Standing Water in the Hole: Al&?XIC Weeping from Pit Face: Azo�67 Estimated Seasonal High Ground Water: 0-7 t� ° TOWN OF BARNS`T�AB E $EWAGE # LOCATION Z0©��3( - I VILLAGE �13 -—� ASSESSOR'S MAP& LOT _ INSTALLER'S NAME&c PHONE NO. '� ' - SEPTIC TANK CAPACITY / © (size) LEACHING FACILITY: (type) ` NO. OF BEDROOMS i ,- BUILDER OR OWNER PERMITDATE: 7 _ COMPLIANCE DATE: 0 fo o Separation Distance Between the: Feet Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Private Water Supply Well and Leaching Facility (If any wells exist Feet on site or within 200 feet of leachig facility) exist Edge of Wetland and LeachingFacility (If any Feet within 300 feet of leaching facility) Furnished by I i 2- pump D c Gil DES 2. � - �1sFr►bu�on� oy , TOWN OF BARNSTAB E ATION 0 �2 l VILLAGE (._D ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO.Je l&AIlio—CmA 0a125&,106L0 SEPTIC TANK CAPACITY 1500 LEACHING FACILITY: (type) (size) 15 V NO. OF BEDROOMS BUILDER OR I"L OWNER AM Wl1 I �� �C `,( _0K)V I [Le, PERMITDATE: / — COMPLIANCE DATE: Dko[l)3 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility . Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet Furnished by z 61A,z4l� C S SI` D5 - 52- 2 (,-SKI 4, - 1 11 3-31 _�z ile I-41' °Ft T Town of Barnstable Regulatory Services h * BARNSTABLE, v MASS. g, Thomas F. Geiler,Director _ �p .i6gq ♦0 rEn 39 Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 June 16, 2003 - Hertha McConville 352 Adams Street Milton, MA 02186 RE: 162 Clamshell Cove Road Septic System Inspection Your septic system was inspected on June 4, 2003 by Troy Williams of Troy Williams Septic Inspections. Upon request of the Public Health Division, Mr. Williams submitted his inspection report with a "Needs Further Evaluation by the Local Approving Authority" finding. A component of your septic system (the overflow cesspool) was found to be located forty-seven (47) from a coastal embankment. As per The State Environmental Code, Title V: Minimum Requirements for the Subsurface Disposal of Sanitary Sewage, the edge of a leaching area must be at least fifty (50) feet from a watercourse. This deems your septic system yfailed and must be repaired/upgraded within 2 years of the date of the inspection. If you have any questions, please feel free to contact the Public Health Division at (508) 862-4644. Respectfully, Thomas A. McKean, R.S. Director of Public Health cc: Troy Williams r - °Ft► r°,,,� Town of Barnstable °^ Regulatory Services BnxNSTAB[e, v Mnss i Thomas F. Geiler,Director �ArFD +ADO Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 June 16, 2003 Hertha McConville 352 Adams Street Milton, MA 02186 RE: 162 Clamshell Cove Road Septic System Inspection Your septic system was inspected on June 4, 2003 by Troy Williams of Troy Williams Septic Inspections. Upon request of the Public Health Division, Mr. Williams submitted his inspection report with a "Needs Further Evaluation by the Local Approving Authority" finding. A component of your septic system (the overflow cesspool) was found to be located forty-seven (47) from a coastal embankment. As per The State Environmental Code, Title V: Minimum Requirements for the Subsurface Disposal of Sanitary Sewage, the edge of a leaching area must be at least fifty (50) feet from a watercourse. This deems your septic system failed and must be repaired/upgraded within 2 years of the date of the inspection. If you have any questions, please feel free to contact the Public Health Division at (508) 862-4644. Respectfully, Thomas A. McKean, R.S. Director of Public Health cc: Troy Williams f Az -z TROY WILLIAMS _ 5 SEPTIC INSPECTIONS Certified by MA Department of Environmental Protection -1300 19 Hummel Drive RECEIVE® South Dennis, MA 02660 -\ COMMONWEALTH OF MASSACNUSETI'S UUN 0 9 2003 EXECUTIVE. OFFICE OF ENVIRONMENT LT`�4i'�� I �cPT. DEPARTMENT OF ENVIRONMENTAL PROTECTION "TITLE 5 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION p �+ Pro ert. Address: F©i' ED 'NS[—INSPECTION p 162 Clamshell Cove Road !� Cotuit,MA Owner's Name: Hertha McConville Owner's Addres,: 352 Adams Street Milton,MA 02186 Date of Inspection: June 4,2003 O Name of Inspector: Troy M. Williams Company Name: Troy Williams Septic Inspections '�'+� Mailing Address: 19 Hummel Drive Telephone Number: South Dennis,MA 02660 (508)385-1300 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. 1 am a DEP approved system inspector pursuant to.Section 15.340 of Title 5(310 CMR 15.000). The system Passes Conditionally Passes Needs Further Fvahration by the Local Approving Authority _VFails _ '%AS LiUS DiAtJ Cy) FT F1241wN WATCk WA\1 Inspector's Signature: sue„ _ Date: b /y/o3 The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of i leallh 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 Although system meets the minimum requirements set forth by the Massachusetts Department of Environmental Protection,certification Is not to be construed as a guarantee of future working condition of system,piping or components. This Inspection represents the conditions of the system on the Date of Inspection noted above. ****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 saute or different conditions of use. Title 5 Inspection Form 6/15/2000 paee 1 of I I c Page 2 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 162 Clamshell Cove Road Owner: Cotuit,MA Date of Inspection: Hertha McConville June 4,2003 !Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: 1 have not found any information which indicates that an the failure criteria described in 310 C-N1R 15.303 or in 310 CMR 15.304 exist. Any failure criteria not a uated 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 det mined"please explain. The septic tank is metal and over 20 years old* or the septic tank(whether me or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent vstem will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Boa of Health. •A metal septic tank will pass inspection if it is structurally sound,not lea A g 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 • static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or tut n distribution box.System will pass inspection if(with approval of Board of Health): broke tpe(s)are replaced o ction is removed istribution box is leveled or replaced ND explain: The syste quired pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspectio (with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: i€ 4 2 Page 3 of l l OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ' PART A CERTIFICATION(continued) Property Address: 162 Clamshell Cove Road Owner: Cotuit,MA Date of inspection: Hertha McConville June 4,2003 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health ut order to determine if the system is failing to protect public health. safety or the environment. 1. S)-stem rill 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(t:-.6a„k .a�..r- -�. --f, ,.. — Cesspool or privy is within SO feet of a bordering vegetated wetland or a salt marsh .su�w,'. } Y�po✓•}- �.S Fuv{-1, �r Guu. (vc.-1•jay. , 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: ,Ar The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface %pater supply or tributary to a surface water supply. _1,(_ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. L__ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supple well. /v The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more front 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: �►�Lt� /ow LcSS r7Gya / w c ta'.,tiA lue— +cct `/� tYo», ct-, 6 4- M e< snnn A/a Als6 �uve O a� P%i6, sJrp Ic-aA ov.i >C�ow c�1j�,uol i S loc-h+ 1, t, y� / I^aoi / ww7i. c.✓ace a+�J, c S ) S h f OU l 1. % rc� / �•h� D fOVL r.4L—% c.cedt: .� Oil9 17 r<- L 'J M ��....��-.�. j2�r t�,�. h Q�( O Y4.N �j•� 1�`��4 / S 4_' k A. g. /k/o I h (s.-F -�c W U- Yl i -� �' O i. Mh/%►� !. M c. /� �. Poo I , 3 �•.. V f Page 4 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 162 Clamshell Cove Road Cotuit,MA Owner: Hertha McConville Dale of Inspection: June 4,2003 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No t Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool -AL- Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool i� Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool Ai Liquid depth in cesspool is less than 6"below invert or available volume is less than%day flow 1l/ Required pumping more than 4 times in the last year VVUdue to clogged or obstructed pipe(s).Number of times pumped Any portion of the SAS,cesspool or privy is below high ground water elevation. Al Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. N Any portion of a cesspool or privy is within a Zone I of a public well. 111 Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. (This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well Is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen Is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form-1 Ao_(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 s%,stem 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 desi 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 criter' above) yes no — _ the system is within 400 feet of a surface drinkin ater supply — _ the system is within 200 feet of a tribu a surface drinking water supply the system is located in a nitrogen nsitive area(interim Wellhead Protection Area-IWPA)or a mapped Zone 11 of a public water sup p ell If you have answered"yes"to an uestion in Section E the system is considered a significant threat,or answered "yes"in Section D above the l ge system has failed.The owner or operator of any large system considered a stga -t threat under Se .,on E or failed under Section D shall upgrade the system in accordance with 310 ChM 15.3 Q4 The_system q r should contact the appropriate regional offof ce' the Department 4 ri Page 5 of I 1 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 162 Clamshell Cove Road Owner: Cotuit,MA Date of inspection: Hertha McConville June 4,2003 i Check if the following have been done.You must indicate"yes"or"no"as to each of the followine: Yes No information was provided by the owner. occupant,or Board of I iealtl, _._ Were any of the system components pumped out in the previous two weeks^ j 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? A/ 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? _ Nip Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? ✓ _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on.the site has been determined based on: Yes no Existing information. For example,a plan at the Board of Health. ✓ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)J I e: s ka li �tr Page 6 of I I OFFICIAL INSPECTION.FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART O SYSTEM INFORMATION Property Address: 162 Clamshell Cove Road Owner: Cotuit,MA Date of inspection:Hertha McConville RESIDENTIAL June 4,2003 FLOW CONDITIONS Number of bedrooms(design):—Y_ Number of bedrooms(actual): 41_ t!2 p �N d�w� %h uwl ko�t- DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x N of bedrooms): yyo Number of current residents: 04 Does residence have a garbage grinder(yes or no):YcS is laundn on a scl)arate sewage system(yes or no):po (if yes separate inspection required) Laundry system inspected(yes or no):�i La Seasonal use:(yes or no): YE S Water meter readings,if available(last 2 yearsltsage(gpd)): I y 000 So.l►�Ns o t ; ,2z ��o S to Sump pump(yes or no):Lro --�-- , y s. Last date of occupancy: t J� t��. s f _M,. COMM ERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gl,d 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 s ur no): Water meter readings, if available: _ Last date of occupancy/use:_ OTHER(describej: GENERAL INFORMATION Pumping Records Source of information: b Was system pumped as pan ins ection(yes or nu): No If yes, volume pumped: gallons-- liow was quantity pumped determined'?Reason for pumping: -- TYPE OF SYSTEM Septic tank,distribution box,soil absorption systettt 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: Were sewage odors detected when arriving at the site(yes or no): Ato 4 t 6 s f ; Page 7 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 162 Clamshefl Cove Road Owner: Cotuit,MA Date of Inspection: Hertha McConville June 4,2003 BUILDING SEWER(locate on site plan) Depth belu�% grade: ' f Materials of construction: _Zcast iron _40 PVC other(explain): rc--n /Ou a Distance iron; priN ate water supply well or suction line: __VA Comments(on condition of joints, venting,evidence ul leakage,etc.): u YOB..Jk /c.-%__�� /r 1 h�. t✓c I tl ,�e SEPTIC TANK: _(locate on site plan) Depth below grade: Material of construction:_concrete_metal_fiberglass__poly ylene _other(explain) If tank is metal list age: _ is age confirmed by a Certificate o ompliance(yes or no):—(attach a copy of certificate) Dimensions: _ Sludge depth_ Distance from top of sludge to bottom of outlet tee or aftle: Scum thickness: Distance from top of scum to top of outlet tee o afllc: Distance from bottom of scum to bottom of tlet tee or baffle: How were dimensions determined: — Comments(on pumping recommendat' ns, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence leakage, etc.): GREASE TRAP:_(locate on site plan) Depth below grade:— Material of construction:_concrete_metal_fiberglass—P yethylene_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 r baffle: Date of last pumping: Comments(on pumping recommendations,isle d outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leaka ,etc.): S Y T,.. r Page 8 of I I OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 162 Clamshell Cove Road Owner: Cotuit,MA Date of Inspection:Hertha McConville June 4,2003 TIGHT or HOLDING TANK: (tank must be pumped at time of in ection)(locate on site plan) Depth below grade: Material of construction: concrete metal fibergl ____polyethylene other(explain): Dimensions: Capacity: gallons Design Flo%+: gallons/day Alarm present(yes or no): Alarm level: Alarm in workin rder(yes or no): Date of last pumping: Comments(condition of alarm a float switches,etc.): DISTRIBUTION BOX: (if present must be opened)(loc on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to o is equal,any evidence of solids carryover. any evidence of leakage into or out of box,etc.): PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,co ttion of pumps and appurtenances,etc.): 8 r ., Page 9 of I I OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 162 Clarnshell Cove Road Owner: Cotuit,MA Date of Inspection: Hertha McConville June 4,2003 SOIL ABSORPTION SYSTEM (SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain wh)- Type leaching pits, number:_ leaching chambers,number: leaching galleries,number: leaching trenches,number, length: _ leaching fields,number,dimensions: _ —Z overflow cesspool,number: I— e X S"' 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.): �rL � �s� CESSPOOLS: ,L/ (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: a ���ea.( Depth—top of liquid to inlet invert: 3 Depth of solids layer: a '' Depth of scum layer. Dimensions of cesspool: _G 'k s—' Materials of construction:Ct ,a I S/„`k— Indication of groundwater inflow(yeg or no):_/V;a v,y. Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): A-I& 4- t+ 't e t,C (--0-e r vc.4 e n r- P u��e•, c..� �,��' �y eCV �. �rr\, PRIVY: (locate on site plan) Materials of construction: _ Dimensions: Deptb of solids: Comments(note condition of soil,:signs of hydrauli ailure, level of ponding,condition of vegetation,etc.): n 9 Page 10 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 162 Clamshell Cove Road Cotuit,MA Owner: Hertha McConville Date of Inspection: June 4,2003 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. ol i InJ'' t ('.ham �VLIti I l I �r LV� 1 � l y6 b�bf lo' 4�aI0AY. nlAti . � (N z +fit yJ0-�✓II: j0 Page I I of 1 I OFFICIAL INSPECTION FORM— NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 162 Clamshell Cove Road Owner: Cotuit,MA Date of Inspection: Hertha McConville June 4,2003 SITE EXAM Slope ✓ Surface water ✓ Check cellar ✓ Shallow wells Estimated depth to ground water 9-6 4 feet Adjusted high ground water elevation — feet Please indicate(check)all methods used to determine the high ground %sate[elevation: - Obtained from system design plans on record- If checked,date of design plan reviewed: _1 Observed site(abutting property/observation hole within 150 feet of SAS) -- Checked with local Board of I lealth-explain: Checked with local excavators, installers-(attach documentation) __/ Accessed USGS database-explain: You must describe how you established the high ground water elevation: U S � S G✓JJ.�r( ,.JG,+�✓.._ !�yc. �.o / ^ , �___ .-... ---..-..t�C+L�.2-t_�__�J�s.r�.�._S�_.1�..�_�f'�f! �•.-o,.r.c t..��-tip /tom..`f, f1. � 12,5 o crdy. TL r T-T(a w4+w -ov�.� . IV This report has been prepared and the system inspected as of the date of inspection. This report is not a WAR811ty or guar>lintee theft the systrrt will function properly In the future. There have beers no warratius of � x guarantees,either expressed,written or Implied, relating to the systbtrt,the Inspedlon and/or this feport , s 18'40• 6'-9' ti A A2 CENTER DORMER ON WINDOWS - 10'-6' LINE OF OVEF HANG ABOVE —————I—————————— ——————— I CLOS. LI----------- EXIST. REMOD. KITCHEN BEDROOM DN. (VAULTED) 0 lE 00 EXIST. 00 4 0 :D BATH EXIST. EXIST. BATH BATH 0 m REMOD. LIVING REMOD. (VAULTED) BEDROOM (VAULTED) CLOS. rl-----------I1 rl-----------11 II II II II II I II II I II II I II II I II CENTER DORMER CENTER DORMER ON SLIDING DOORS - I ON SLIDING DOORS —————————I———————— ——— ——.———--�————— ————— 10'-W LINE OF OVERHANG ABOVE 10.$. A MEW DORMER ABOVE) A2 FIRST FLOOR PLAN DECK IF ANY E RRORS ORE OMISSIONS ARE FTHE S�LIOUND ON SCALE : DRAWING NO. : COTUIT BAY DESIGN, LLc NEW ADDITION FOR: THESE DRAWINGS PRIOR TOSTART OF WALL W RESPONSIBLE FORT E CONTEHT CONTRACTOR 1/4" Vet 43 BREWSTER ROAD IN THESE DRAWINGS IFCOISTRUCTgH — FITZGERALD RESIDENCE DESIGNER SWITHOUT RSOROMTHE M . (508) M-1 02649 THESEERDINGSARRORSOYFORT10N5. DATE o cam+ THESE O—ER NOTED SOLELYFOR THE USE - PH. (5O8) 274-11 VV - OF THE OWNER NOTED.ANY OTHER USE OF ' FAX (508) 539-9402 THESEDRA—WREQUIRE$THE—EN 11/4/2016 162 CLAMSHELL COVE ROAD COTUIT, MA ACT HITECTTU THEDESIGNERFUGH UNDER OTECTI A3 CONS NT OF THE PROTECTION 106 .r A TYPICAL ASPHALT - A2 � ROOF SHINGLES 'CENTER DORMER 5/8"CDX PLYWOOD SHEATHING ON WINDOWS 2 x 10 RAFTERS 15#FELT PAPER 10-6" WIND WASH - SIMPSON H 2.5A HURRICANE CLIPS BARRIER TO"WIDE ICEMIATER SHIELD —————————I—r _______ ALUMINUM DRIP EDGE - 1 x 8 FASCIA BOARD I 1 x 3 STRAPPING W/ 1 x 4 SOFFIT BOARD - 1/2"GYPSUM BOARD 1 x CONT.VINYL SOFFIT VENT - I 1 x 3 SOFFIT BOARD TYP.2 x 4 WALLS 1 3/4"CROWN 1 x 6 FRIEZE BOARD . -- -- - - ®r- DETAIL AT.WALL SCALE:1/2"=1'-0" Al CC 00 RD O Oo - EXIST.2 x 10 RIDGE BOA - - - - - 0 oil L11 1 —1-1 L CENTER DORMER - CENTER DORMER. - ON SLIDING DOORS - I ON SLIDING DOORS - --------------.------------ - 10 111: MEW DORMER ABOVE) _ .. A2 _ .. 42-0" .. - ROOF FRAMING PLAN NOTES: 1.) ALL ROOF RAFTERS TO BE 2 x 10's UNLESS OTHERWISE NOTED 2.) USE SIMPSON H2.5A HURRICANE CLIPS AT ALL RAFTERS ENDS 3.)VERIFY GUTTER TYPE/LAYOUT W/OWNERS ANY ERRORS OREONUSSIIOLNS MET'FOUNDO SCALE : DRAWING NO. : COTUIT BAY DESIGN, LLC NEW ADDITION FOR: . THESEDRANANGSPRIORTOSTART OF CONSTRUCTION.THE BUILDING CONTRACTOR 1/411 — 11-OII t` 43 BREWSTER ROAD NTHSEOR NISI F�sHEC SENT — F I TZ G E RA L D RESIDENCE DOMtNER O ANY ERR NOTIFY NG THE MASHPEE MA. 02649 THESE DESIGNER OFDATE 7 66 OFTEOR ERGSARES y TFOTHEUSE A4 PH. (508) 2/4-11 VV THESE THEONMENOS REGIME OTHER USE $od THESE SENT OF THE REQUIRES THE NRRTEH 11/4/2016 w FAX (50 > 539-9402 162 CLAMSHELL COVE ROAD COTUIT, MA C�Ofl�NTC THE DESIGNER UNOTECTI ARCMrtECTURAL COPYRIGHT PROTEC110N I 1 I Cp Ir NOTE:3"STUD POCKET r ' l', BUILT- cm IN BETWEEN EACH WINDOW R) i DNEXISTING DECK DW co � I CV N I I O I I �„ ,,� . BEDROOM I 2-8 _____________ ___________________T.________ , { I I q FJULL-VIEW DOOR I I "I +, w FLAT:SLOPE cm c O _ . 0 B I co Q i v T I I rn i i w N I w I 1 I m I N C I N SLOPE: FLAT > 1 � I _ Iom CD - -------- ----- -- --- I I N Y co W O I I I I U Y uj N Y Cc, _ ; NOTE: BUILDER TO VERIFY 0 0 O I I EXISTING&NEW DIMENSIONS EL c\j T Z H Q I N N Z Cn ~ Z I T `� I FAMILY ROOM r N VAULTEDCLG. - FIRST FLOOR PROPOSED O w I i Z m ; I p\ I - I N I I V \ I I I I I (D DECK 1 , � I I 1 I ,l I °D I i NOTE: BUILDER TO VERIFY i io N ULL VIEW DOOR ' EXISTING&NEW DIMENSIONS I r A �I I c,) (11 I I I l I -9 1/ I I XLAUNDRY _� . Zq w� NBATH N J CV-------------- --- .'- _r_�_ RELOCATED m 6-0" OUTDOOR om 0" TD SHOWER m D co 'X3 o SHOWER `f) TW24310 TW24310 2'-10" 3'-11" 4'-91/2" 6'-6" 3-4 1/2" ol f 6'-9" 1 V-3 1/2" lo Ic 22'-0" o t a 61 a 7 la .a NOTES: NEW ASPHALTROOF SHINGLES 1. CONTRACTOR IS TO VERIFY ALL EXISTING CONDITIONS TO MATCH EXISTING ) &DIMENSIONS IN THE FIELD 2.) CONTRACTOR TO VERIFY ALL INTERIOR&EXTERIOR MATERIALS, DETAILS,&FINISHES IN THE FIELD WITH OWNER NEW 1 x 8 FASCIA&SOFFIT 3.) ROUGH OPENING HEAD HEIGHT OF WINDOWS AT W/1 x 6 FRIEZE BOARD FIRST FLOOR TO BE 6'-8"ABOVE SUBFLOOR 12 4.) ALL CONSTRUCTION TO CONFORM TO 780 CMR MASSACHUSETTS EXIST. ❑ STATE BUILDING CODE,8TH EDITION AMENDEMENT&IRC2009 5.) 110 MPH EXPOSURE C WIND ZONE 6.) ALL SHEETS OF PLYWOOD WALL SHEATHING TO BE INSTALLED VERTICALLY, OR HORIZONTALLY W/BLOCKING AT EDGES,3"EDGE/12"FIELD NAILING ❑ ❑ ❑ ❑ 8.) ALL LVLALLMANUFACTURER'S LUMBER/BEAMSCTO R' 1.9E U36CIFI LOAD ® ® o 0 0 8.) FOLLOW ALL MANUFACTURER'S SPECIFICATIONS FOR INSTALLATION OF ALL SIMPSON COMPONENTS 00 9.) ALL CONCRETE USED FOR FOUNDATION WALLS,FOOTINGS&SLABS TO BE 3000 PSI 10.)VERIFY ALL PLUMBING&ELECTRICAL DETAILS W/OWNERS ON THE SITE DURING FRAMING CONSTRUCTION 11.)TIMBER FRAMING TO BE SPRUCE/PINE/FIR NO.2 GRADE 12.)FOLLOW ALL REQUIREMENTS OF THE 110 MPH CHECKLIST SUPPLIED 13.)THIS SITE IS IN THE 110 MPH WIND BORNE DEBRIS AREA,EXPOSURE"C" - FRONT ELEVATION &WITHIN ONE MILE OF NANTUCKET SOUND PER STATE OF MASSACHUSETTS WIND SPEED MAPS 14.)GLAZING PROTECTION PER 780 CMR 5301.2.1.2 TO BE IMPACT GLAZING VERIFY ALL WIND BORNE DEBRIS PROTECTION REQUIREMENTS W/OWNERS PRIOR TO START OF CONSTRUCTION 15.)FOLLOW ALL REQUIREMENTS OF THE IECC2012 RESIDENTIAL ENERGY EFFICIENCY REQUIREMENTS&VERIFY ALL DETAILS WITH THE INSULATION INSTALLER/CONTRACTOR. IECC2012 RESIDENTIAL ENERGY EFFICIENCY DETAILS CLIMATE ZONE 5A(USE EITHER PRESCRIPTIVE VALUES OR RESCHECK CALCULATION TABLE 402.1.1(MINIMUM PRESCRIPTIVE INSULATION&FENESTRATION REQUIREMENTS) FENESTRATION SRYLIGHi CEIUNG WOOD FRAMED WALLFLOOR SIVSEMENT WALL 345EMENT SLAB CRAWL SPACE WAL U-FACTOR U-FACTOR R-VAWE R.U. R-VALUE R-VALUE R-VALUE R-VALUE D.D3 0.60 49 TO ]0 1&,. vpmDEEP) -1] NEW RAKE BOARDS NOTES: . TO MATCH EXISTING 1.R-VALUES ARE MINIMUMS&U-FACTORS ARE MAXIMUMS. 2.15/19 MEANS R=15 CONTINUOUS INSULATED SHEATHING ON THE INTERIOR OR EXTERIOR 12 OF THE HOME OR R=15 CAVITY INSULATION AT THE INTERIOR OF THE BASEMENT WALL 2.5 3.REFER TO IECC 2012 CHAPTER 4 FOR ALL INSULATION&ENERGY REQUIREMENTS 1' V� . NEW W.C.SHINGLE SIDING � 12 &CORNERBOARDS TO - MATCH EXISTING ` EXIST. V CP -7� RIGHT ELEVATION F COTUIT BAY DESIGN, ��c NEW ADDITION FOR: THE DESIGNER ORAWGSMDRT NOTIFIED STARTOF SCALE: DRAWINGAn'v'n� � ERRORS OR OMISSIONS ME FOUND OH THESECONSTRUCT N.TPRIOR TO STCO TRB ® 43 BREWSTER ROAD WLLBERESONSIBLEFHE ILDING RTHE GNTENTGR1/4" WILL ES RESPDN GS I FOR THE CONTENT MASHPEEMA. 02649 FITZGERALD RESIDENCE. HTHME ESEDR WINGS CANOR ISS CH SEDRESNGSARENOLELYINGTHE - Al p) OF THE EROF ANY OTED.ERRORS OTHER USED DATE V I(k g PH. (5O0yJ�`1 2�4(1-1166 - TNESE DRAWINGS MESOLELY FOR THE USE FAX (50$) 539-9402 THESE THE DRAWING RMUIRYOTHER USE OF 162 CLAMSHELL COVE ROAD_ COTUIT, I•,A CORSE RAVYNGSREOUIRE9 THE OTECTIEN 11/4/2016 CONSENT OFTNE DESIGNER UNOER THE ARCHDECTURAI COPYRIGNTPROTEC"ON ACT OF 1R90. NEW ASPHALT ROOF SHINGLES TO MATCH EXISTING , NEW 1 x 8 FASCIA&SOFFIT W/1 x 6 FRIEZE BOARD ANDERSEN AWNING . WINDOW ` 5 3^ 5 3" _ • 9 DORMER PLAN El REAR ELEVATION TYP.WALL CONST. 2 x 6's @ 16"o.c. 1.2 x 4 STUDS @ 16"o.c. 2.12^PLYWOOD SHEATHING i 3.(R=20)SPRAY FOAM INSULATION NAILING SCHEDULE ' 4.12-GYPNGM SIDING � � � 5.W.C.SHINGLE SIDING \ 2 110 MPH EXPOSURE B WIND ZONE 6.TYVEK VAPOR BARRIER JOINT DESCRIPTION NO.OF COMMON NAILS NO.OF BOX NAILS NAIL SPACING 2x10's@16^y.c' —2,Jl's@16"o.c. ROOF FRAMING: 12 2-1 314"x 7 1/4"LVL HDR. BLOCKING TO RAFTER(TOE NAILED) 2-8d 2-10d EACH END i / \ EXIST. RIM BOARD TO RAFTER(END NAILED) 2•i6 d 3-16d EACH END WALL FRAMING: �i 2 x 10's 16' TOP OF PLATE TOP PLATES AT INTERSECTIONS(FACE NAILED) 4-16d 5-15d AT JOINTS STUD TO STUD(FACE NAILED) - 2-16 d 2-16d 24^o.C. - HEADER TO HEADER(FACE NAILED) 16d 16d 16"o.c.ALONG EDGES FLOOR FRAMING: Y JOIST TO SILL,TOP PLATE OR GIRDER(TOE NAILED) 4-8d 4-10d PER JOIST BLOCKING TO JOISTS(TOE NAILED) 2-6d _ 2-16d EACH BEND LOCK MASTER MASTER - LEDGE NG T I SILL E TOP PLATE(TOE NAILED) - 3.16d 4-16d EACH BLOCK LEDGER STRIP TO BEAM OR GIRDER(FACE NAILED) 3.16d 4-16d EACH JOIST JOIST ON LEDGER TO BEAM[TOE NAILED) 3-8d 3-1 Od PER JOIST BEDROOM BATH BEDROOM BAND JOIST TO JOIST(END NAILED) 3-16d "6d PER JOIST BAND JOIST TO SILL OR TOP PLATE(TOE NAILEDO 2-16d 3-16d PER FOOT I ROOFSHEATHING: FIRST FLOOR WOOD STRUCTURAL PANELS(PLYWOOD) - - - SUBFLOOR RAFTERS OR TRUSSES SPACED UP TO 16"o.c. 8d 10d 6^EDGES-FIELD 2 x 10's 16'o.c. RAFTERS OR TRUSSES SPACED OVER 16"o.c. Bd 10d 4'EDGE/4^FIELD GABLE END WALL RAKE OR RAKE TRUSS W/O OVERHANG 8d 10d 6"EDGES'FIELD - GABLE END WALL RAKE OR RAKE TRUSS 8d 10d 6^EDGES'FIELD Wt GABLE END WALL RAKE OKERS ) TYP. ROOF CONST. GABLE END WALL RAKE OR RAKE TRUSS W/LOOKOUT BLOCKS Bd tOd 4'EDGE/4'FIELD - 1 - � - CEILING SHEATHING: i -2 x 10 ROOF RAFTERS @ 16-o.c. . -GYPSUM WALLBOARD Sd COOLERS — T SM"COX PLYWOOD ROOF SHEATHINGEDGE/10"FIELD FULL -ASPHALT ROOF SHINGLES WALL SHEATHING: BASEMENT -15LB.FELT PAPER O -11^HI-R BATT INSULATION STUDS SPACED UP TO 24'o.a Bd ,10d 3'EDGEM2"FIELD @ SLOPED CEILINGS(R-38) 12"8 25/32"FIBERBOARD PANELS Sd — 3"EDGES-FIELD - -11^BATT INSULATION 1/2"GYPSUM WALLBOARD 5d COOLERS — 7"EDGE/10^FIELD @ FLAT CEILINGS(R=49) FLOOR SHEATHING: -ALUMINUM DRIP EDGE -SIMPSON H 2.5A HURRICANE CUPS WOOD STRUCTURAL PANELS(PLYWOOD) _ AT ALL RAFTER ENDS V OR LESS THICKNESS 8d tOd 6^EDGE/12"FIELD ^ L -ICE/WATER SHIELD AT BOTTOM GREATER THAN 1"THICKNESS 10d i6d 6'EDGES-FIELD p \SECT ION @ 'BEDROOMS -PROP-A VENT BETWEEN RAFTERS ', 1 -NAND WASH BARRIERS A2 THE DESIGER SHALL BE NOTIFED(FANY ERRORS OOR WdISSIONS ME FOUND ON SCALE ®Q® COTUIT BAY DESIGN, LLC NEW ADDITION FOR: THESE DRAWINGS PRIOR TO START OF S. CONSTRUCTION.THE BUILDING DON TRACTOR 1/41I 11-OIL DRAWING NO.: 43 BREWSTER ROAD MALL BE RESPeNSIBLE MR THE CONTBHT IN THESE DRAWINGS IF CONSTRUD'ON MASHPEE ,MA. 02649 F CO MENCES WDHOUT NOTIFYING THE TZ G E RA L D RESIDENCE DESIGNER OF ANY ERRORS OR dAISSIONS. THESE DRAWINGS ME SOLELY FOR THE USE TOF HESEOWNINGSRED.MYOTHE—ITTE DATE �� PH. (508))274-1166 THESEDMWNGSRE°"WESTHEWRDTEN 11/4/2016 FAX (50$) 539-9402 162 CLAMSHELL COVE ROAD COTUIT, MA AR SENT OFTHE DESIGNERUNDER THE ARC SENTO TH COPYRIGHT NDERTHE A A2 CENTER DORMER ON WINDOWS - ,o'e LINE OF OVEI HANG ABOVE ---I---------- ------- II j CLOS. II � I LI----------- EXIST. 5-0 REMOD. KITCHEN BEDROOM DN. (VAULTED) ao 0 O EXIST. O o 4 DDBATH EXIST. oO EXIST. BATH -BATH O REMOD. LIVING REMOD. .(VAULTED) BEDROOM (VAULTED) CLOS. FI-----------Il FI-----------i� II II II II II I II II il• Ii I fI II , II CENTER DORMER CENTER DORMER ON SLIDING DOORS I ON SLIDING DOORS ---------I-------------------- 10•E- LINE OF OVERHANG ABOVE A (NEW DORMER ABOVE) A2 � az 0 I FIRST FLOOR PLAN DECK ERRORS OROMISSIONS ARE FOUND ON SCALE : DRAWING NO.: COTUIT BAY DESIGN, LLC NEW ADDITION FOR: TNESEDRAVNnGSPEBUIMIsrMroF RESPONSIBLECONSTR EFOR THE G CC NTRAGTOR 1/4' 11—OH 43 BREWSTER ROAD INT ESEDR—IGSIFONSTRUC IONNT IN THESE ORAN"N O IF OONSYRUCTHE F ITZG E RA L D RESIDENCE . THESE ENOEE WLT"°"'"DT FY"DTHE /� MASHPEE MA. 02649 /`'� 4 PH. (508 274-1166 DE&GNE—ER.ERRORSOROMISZ" DATE THESE DRAWMNGS ARE SOLELY FOR THE USE TH THE R—NOTED.ANY OTHER USE EN TO SENT OFT E REQUIRESTN UNDER RRH EN 11/4/2016 FAX (50 ) 539-9402 3 162 CLAMSHELL COVE ROAD COTUIT, MA CONSENT OF DESIGNER UNOTECTI ACT OFI TUMLCOPYRIGHT PROTECTION A A2 TYPICAL ASPHALT ROOF SHINGLES CENTER DORMER .I 2 z 10 RAFTERS 5/8'CDX PLYWOOD SHEATHING ON WINDOWS `��15#FELT PAPER 10-6• WIND WASH SIMPSON H 2.5A HURRICANE CLIPS I BARRIER r TO"WIDE ICE/WATER SHIELD ALUMINUM DRIP EDGE - 1 x 8 FASCIA BOARD I 1 x 4 SOFFIT BOARD 1!1• BOARD ' 1 z 3 STRAPPING W/ 1 x CONT.VINYL SOFFIT VENT GYPSUM 1 x 3 SOFFIT BOARD TYP.2 x 4 WALLS 1 3/4•CROWN 1 x 6 FRIEZE BOARD '-- -- - - DETAIL AT WALL 5'-0• SCALE:1/2"=1'-0" O Po EXIST.2 x 10 RIDGE BOARD O Q c 71 CENTER DORMER CENTER DORMER ON SUDING DOORS I �g - ---------I-------------------- -----'�-----;;—.————— - N SLIDING DOO. 1as• i 10•-6• I A (NEW DORMER ABOVE) � 42'-(• y . ROOF FRAMING PLAN ' NOTES: 1.) ALL ROOF RAFTERS TO BE 2 x 10's 1 UNLESS OTHERWISE NOTED 2.) USE SIMPSON H2.5A HURRICANE CLIPS AT ALL RAFTERS ENDS 3.)VERIFY GUTTER TYPE/LAYOUT W/OWNERS ������((/\J TERRORS SIOP OMiS5WN5 ARE FOUND ON SCALE : DRAWING NO.: ®1.�® COTUIT BAY DESIGN, LLC NEW ADDITION FOR: .I THESE RRORSAIMNGS PRN]R TO START OF 43 BREWSTER ROAD CONSTRU TH CONTRACTOR 1/4" WILL ESE ORAIAING*I fO NSTRCONTENT — C TNESE DRAYMNGS IF CONSTRUCTION �` 9 FITZGERALD RESIDENCE DDIGNER OF SANYERR RSORIOMISS M . (508) M-1 02649 THESE RAWN ARRORLELYFO THEE S. �� TNESE DRAVMNGS ARE SOLELY FOR THE USE � � PH. (5O8)274-1166 � � � � � GF THE ONNER NOTED.ANY OTHER USE OF DATE ' FAX (508) 539-9402 . 162 CLAMSHELL COVE ROAD COTUIT MA COSENTOFTEDESIGNERUNDERMEEN 11/4/2016 CONSENTOFTHE DE DRAWNGS SIGNER UNDER THE ARCNIECTURALCOPYRIGHTPROTECTION ACT OF IM. - I TOP FNDN. 36.1' SYSTEM PROFILE ACCESS COVERS TO WITHIN 6" OF FIN. GRADE (NOT TO SCALE) TEST HOLE LOGS ACCESS COVER (WATERTIGHT) TO PROP, INSPECTION PORT,WITHIN 6" OF FIN. GRADE �c►t Ev�yeur4Tle AM WILSON, SE MINIMUM .75 OF COVER OVER PRECAST WITHIN 6 OF FIN, GRADE rvla.R; { 29 SLOPE REQUIRED OVER SYSTEM s` " 39.5 WITNESS: Locus RUN PIPE LEVEL 2 DOUBLE W 3HED PEASTONE ' gIIR PROPOSED 1500 FOR FIRST 2' DATE: 7�21/03 ** GALLON SEPric as 3' MAX. PERC. RATE < 2 MIN/INCH I SLAB EL. 28.6' 26.25' TANK (H- 10 ) 26.0 � aEL , 36.5 { 'f S DAME 5.86' �' CLASS SOILS P# I -- 36.03' C] C7 CI C7 +Cl C7 0 C7 �6" CRUSHED STONE OR MECHANICAL 35. 7' p C7 0 [] (� C7 [� [� p [`�] ELEV. MIN COMPACTION. (15,221 [2}) C] C7 CJ CD C7 f� C7 0" 36J5' 1 ( 2 X SLOPE) MIN MIN 2' {� 0 0 (� U 1_! I� I� 33.67 DEPTH OF FLOW 4' ( i SLOPE) ( 1 x SLOPE) �� 0 3/4 TO t 1/2 DOUBLE WASHED STONE 2„ TEE SIZES: INLET DEPTH - 10" 36.58' Al LOCATION MAP NO SCALE OUTLET DEPTH s 14" FOUNDATION--- 13' ST 5' PUMP 98' D' BOX 21' LEACF ING SAND iOYR 4/2 ASSESSORS MAP 5 PARCEL 9 CHAMBER FA(,iLITY 4" 36.42' FLOODZONES A13 EL 12 & C * *THE INSTALLER SHALL VERIFY THE A2 LOCATIONS OF ALL UTILITIES AND ALL 5.17' BUILDING SEWER OUTLETS AND ELEVATIONS SAND PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM 7" 10YR 4/3 36.17' ALARM AND CONTROL PANEL , B TO BE INSTALLED INSIDE BUILDING. ALARM TO BE ON CLASS 150 SAND '9 INV. IN 2 . SEPARATE CIRCUIT FROM PUMP 5 ���� 1000 GAL. H-10 S/ � 2" PRESSURE PIPE TO D BOX � 28.5 11" 1QYR 6/4 ALARM ON 700 GAL.'+ SLOPE TO DRAIN BACK TO PC 35.8' FLOAT SWITCH RESERVE WEEP HOLE C SETTINGS, PUMP ON CHECK VALVE 4' WORKING RANGE 8. ZOELLER 'WASTEMATE' SAND 4 SUBMERSIBLE MODEL M282 1/2 HP PUMP PUMP OFF 8' SYSTEM (OR EQUAL) 10YR 6/6 coo noon 99" ' -�" 6" CRUSHED STONE OR 28.5 COMPACTION NO WATER ENCOUNTERED PUMP CHAMBER NOTEs: (NOT TO SCALE) SEPTIC DESIGN: (GARBAGE DISFOSER 's --_-.NOT A''-LOWED 1. DATUM IS NGVD BENCHMARK: USE TAP,FOUNDATION ' AT ELDf. 36 1' TH!S AREA •';r-���,^. 7� .-V� A Qc-Ar_:". 'i.AC' � '1 f,. 4 Lf; r'`r�l� ? MUNICIPAL WATER �.... ....M ....�..� - --- 2" PRESSURE LINE _.._ _ T 1 �, CROSSES GASLINE AND USE A 4Q� GPD DESIGN, FLOW 3. MINIMUM PIPE PITCH TO BE 1/8 PER FOOT. + .5o OVERFLOW CESSPOOL CESSPOOL PROPOSED 15W GAL WATERLINE - CAUTION! SEPTIC TANK: 440 Gpp ( 2 _) = 830 r n 4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO H-- 10 SEPTIC TANK ENSURE WATERLINE IS __ HALLO d_, OPOSED 1000 GAL CLASS 150 PIPE OR 5. PIPE JOINTS TO BE MADE WATERTIGHT, N PUMP c iArlaER"FOOTWAY" EQUIVALENT USE A 1500- GALLON SEPTIC TANK ° 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS. ' � ' 276,21' EXIST. WELL (IRRIGATION) LEACHING: ENVIRONMENTAL CODE TITLE V. 'Q wFa 15, 9 CQ;~ z2 z6 2�i tiO����+"; 3987 SIDES: 2r;39 + 10.$3) 2 (.74) 147 7, THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO BE co .68 ' / 2� ,2; ti � � .79 UT►L / USED FOR LOT LINE STAKING, 1 .2 + + 32 �;� ��' �, v POLE BOTTOM: 39 x 10.83 (.74) - 312 $. PIPE FOR SEPTIC SYSTEM TO SCH, 40--4" PVC, Lr,1 2692 Q "'� �^ fib/ �� oo� � WATER SHUT TOTAL: fi21_ S.F. 459 GPD 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED 0 c + ` / / E LED WITHOUT 0 OFF r INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED W +27,65 2.7 69 Q1N USE (4) 5flJ GAL. LEACHING CHAMBERS (ACME OR FROM BOARD OF HEALTH. Q r� Z 16 wF 14 + i�� 610� 2 G ���4' cQUAL) WITH 3' STONE AT SIDES AND 2.5' AT ENDS 10. CESSPOOLS TO BE PUMPED AND FILLED WITH CLEAN SAND OR O27.51 "' l ',," REMOVED AS NECESSARY. o 1 28.65 C G / LEGEND 13 G 3 `N 44 / j 39,44 a- 1. 2 Q � x►sr. ExtsT. / Q 100.0 PROPOSED SPOT ELEVATION 1W DECK DWELLING OR\y� Q) TITLE 5 SITE PLAN 3,7 (PATIO TF a 36.1' 27. 7UNDER) 36.02 S-10 4 d� / �.! .10OX0 EXISTING SPOT ELEVATION EXIST. PIER LIC F2 TH 36, +39,7 �ti / /�/ OF #1727 (RAMP +2 ,48 GARAGE 39,0 .,, 162 C LA M S H E L L COVE ROAD � 1 p0 -- EXISTING CONTOUR SHOWN) AND FLOAT NOT 2 '1 � / �6' /39�35 - 2 ,02 IN THE TOWN OF: 2A1' .79 35, ---- G GASLINE (COTUIT) BARNSTABLE 100' � 7 U WF WETLAND FLAG ` L / WF / <41 PROPOSED LEACHING PREPARED FOR: AM W I LS O N AS S O C /M c C O N V I L L E28'9 +3 .90E851 PARCEL 9 / FACILITY OF (4) 500 GAL 30,927f SF ;n +39.65 / CHAMBERS WITH 3' STONE AT SIDES AND 2.5 AT 201.22' ENDS BOARD OF HEALTH 3O 0 30 60 90 Feet EXIS'. FENCE MA �39.05 -APPROVED DATE PROP. VENT - FINAL PLACEMENT BY SCALE: 1 " 30' DATE: JULY 18, 2003 CONTRACTOR WITH HOMEOWNER CONSULTATION PROVIDE CHARCOAL FILTER & SUGSCREEN REV. 7/22/03 (TH) on 508-362-4541 roc 508 362-9880 down cape engineering, Inc. ��✓�oF 4�J�� �M U1�H, ARN E �4,. ARNE H. �G a� 1 CIVIL. ENGINEERS � OJALA � O ALP �� LAND SURVEYORS No.IVIL 30792 263A111 .o��� 939 main st. yarmouth, ma 02675 isr�R _ ARNtvvk, OJALA, P.E., P.L..S'. DATE 24'-0" A ------- 4'-0" 10'-0" 10'10" TW2446 i I 2'-8" O I V ' O ------ 5/8"TYPE"X":GYPSUM APPLIED O o wo -----`---- - , TO ALL WAL4S AND CEILING L cri w O ING RAGECOMMON D LIVING AREA o a � LANDING io cl) , , r` Pt ' O) IJONI : .cl) I I oCDI I co Q I t I t I 1 I I 1 I Q 1 1 I 24'X12' DECK --------------------; 2-CAR GARAGE 0 0 ------------------------STEELBEAMIABOVE o 0 9'-2"FROM TOP OF SLAB TO BOTTOM OF FLOOR JOISTS, I I 24'-0" I , 2'-0" 20'-0" 2'--0" I I I I 3'-6" 0 13'0" I 3'-6" i i z TW 446 6'-0" N TW 446 ' I NN F— O P� F� < LL o' I I z IY � z It M o jLn� co V V co 9 Li Y : Y (n : X z CISw 1 w (n Q O M g "' oz mU cmI - --------------- ----------- -----------------r--------, ' Q V O Q O ^ N i W r I i n TW2446 w TW2446 , 0 ---- �, I ----- T 0" 10'-0" ' T-0" I ----- U) I ART ST DIO : °° w 91VAULTE CLG, i FIRST FLOOR PROPOSED N M N o Nt v 14'-5 1/2" 8'-4 o RIDGE VENT `v '- `� 1 RIDGE 1/2"CDX ROOF SHEATHING 12 I O 3 2X10 RAFTERS N ; HURRICANE ,-2X10 CEILING JOISTS \ HURRICANE = TIES H2.5A TIES H2.5A r ----- ' ----- N RAPPING R-38 /\ -- -- @16"O.C. Q i SHOWER : in W/1/2"GYPSUM r I , N `O BATH R 21 12 I--------- -------� ------ Z- --------- ---- , _ r i w O W a , a ° "' ? N a _ BATH STUDIO ------------ -6" 14'-61 0 o> w , co Z I Z I ` `1 9op i 1 I i i HURRICANE HURRICANE A21 TW2446-2 A21 TIES H2.5A 3/4"T&G R 21 TIES H2.5A -— FLOOR SHEATHING 0 A -------- 2X8 FLOOR JOISTS w 2'0" 5'0" 5'-0" 5'- 5'-0" 2'-D" —- -— R-30 z w l 2 -0" LVL OR��� W W � STEEL BEAM wr w O < cp SECOND FLOOR PROPOSED w w z 2-CAR GARAGE w Q � I (o O Ia- LL r U 4"CONCRETE SLAB a4 �•; 2-2X6 P.T. °•; SCALE 1/4"=1'-0" c c e SILL PLATES P•e ., DATE 9/18/12 DRAWN BY PAB REVISIONS: •p•ce' -�•ve^ SECTION A DRAWING NUMBER COPYRIGHT SPB DESIGNS 2012 A2 LEGEND , , tiu I • —100 — -- — EXISTING CONTOUR NOTES: ZONING DISTRICT: RF ❑/H/W EXISTING OVERHEAD UTILI'IES ARE BASED N N.G.V.D. 1929 DATUM. - mill �1. ELEVATIONS O U ELEVATION F � Of op � � * • �E O O O 39.79 ESTABLISHED ON A SPIKE IN AN OAK TREE AS SHOWN ON PLAN. w✓ --_w._ EXISTING WATER LINE MINIMUM SETBACKS PROVIDED SETBACKS . FRONT = 30' FRONT = 48.0' 2.) LOCATION OF EXISTING SEPTIC SYSTEM WAS BASED ON AN "AS-BUILT" EXISTING GAS LINE • * • ; .� a CARD ON FILE AT BARNSTABLE BOARD OF HEALTH OFFICE. SIDE = 15' SIDE = 15.3' • ' REAR = 15' REAR = N/A EXISTING SEPTIC LINE • � �� * • r PROPOSED SEPTIC LINE ,r• . . ,i• fi I A' . . _ . . _ . . PROPOSED SILT FENCE ,.' vst? ti TOP OF COASTAL BANK ` 1 LOCUS . . , a a / PROPOSED SILT FENCE RIGHT OF WAY EXISTING SHED TO BE ,,• rl � 0 REMOVED & RELOCATED . "� ``> � .r J 4 (12'WIDE LAYOUT) 4 a"' • EDGE OF BIT. SIDEWALK LOCUS PLAN z 250'± PER P.B. UY WIRE �� /�ti /,�D �6/ ( 151, PG. 9b�}/ I SCALE: 1 = 1000 �. / / / / • �. GUY WIRE — / CO i / d t, -,. STONEWALL f /H/w OWNER OF RECORD: '; ! ' '' '! o/H/w / WILLIAM J & KATHLEEN FITZGERALD / C / E F 0 Ioc 30.9• —` 33 FATHER CARNEY DR D t E)IS T. oiH/ OiHiw XX/ / SEED ` n/H/w i X MILTON, MA 02186 FEMA FLOOD ZONE: jj _r1F.lrf_f_ f1RIVFV!AY- P.S - ��AS t ROPOSE r c, & A 1 ) FLOOD ZONE LINE DIGITIZED G 13 (EL 2 3 / 3 w 0/H/ GARAGE n/ ` :, c;a: z PER FEMA MAP 250001 0021 D I i \ STUDIO AB_iVE '�� I ':- i' ' _ / - � n/Hiw SLAB EL. = ;7.50' � \ �,fas � �' AS SHOWN ON COMMUNITY PANEL: \ { EXISTING WALL TO RELOCATED G AS if AWAY FROM EDGE OF GARAGE ""' % #250001 0021 D 24' � —w ASSESSORS MAP & LOT: x w/ SSA _ c�as _ w_____ MA w d P 5, LOT 9— _.. ... f / GAS Ara GAS w- --w- w n I w— DEE,., DEFERENCE: '--NEW SHFI LDRIVE 80. w #162 BOOK 21316, PAGE 210 x i M EXTENS(�.:shl+,lfi HATCH) U / PLAN REFERENCES: Cl) r EXISTING � / '` �`� 1 " l 1. PLAN BOOK 151, PAGE 95 O DWELLING __ SHELL DRIVE c,? r ,����!! � I �—LIGHT POLE (TYP) ) TOF=36.1'± EX"1 EI hION (IN HATCH) N O 1 DECK BRICK WALK \ 2.) PLAN BOOK 271, PAGE 19 0 0 ' / I �� / ' i` ' t';' ;! -EDGE_ :_�I NEW DRIVE �\� Benchmark 3.) PLAN BOOK 223, PAGE 39 O Spike in Oak tree ELEV. =39.79' ji NGVD 1929 � C / / GARAGE EDGE OF EXIST. DRIVE J Ib . �Qj PROPOSED SITE PLAN;hiELL DRIVEWAY o DECK I / 4 o° O AT �' �- 162 CLAMSHELL COVE ROAD �0 COTU IT MA 0 o PREPARED FOR: CAPEWIDE ENTERPRISES / rf, W/LLS NOT SURVEYED- / «7 k _ 1� r fati PREPARED BY: J C E V/,air �ssa / JoHNL. ENGINEERING, INC. �of�NL. ti MAP S ./ V CHURCHILLJR. >\ cfiu / �/ RCH - - / N .48066 2854 CRANBERRY HIGHWAY CIVIL n "' LOT9 'r / v I MHO / / / ��j F -"I NO. 41807 I 28,2°Os.F. , A is EAST WAREHAM MA 02538 p�t9 E N- s N87°32'50'W /{ n — P' SCALE: 1 — 10 OCTOBER 15, 2012 209'±PER P.B. 151, PG. 95) / � / MAP 5 GRAPHIC SCALE LOT 31 10 0 5 10 20 40 SITE PLAN 11111161% 1 SCALE: 1" = 10' ( IN FEET) JCE#2316