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HomeMy WebLinkAbout0228 COTUIT BAY DRIVE - Health 228 COTUIT SAY D R,) ✓E I F II, or5- Commonwealth of Massachusetts os(o Title 5 Official Inspection Form = Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 228 Cotuit Bay Drive u Property Address Frank McKone Owner Owner's Nam information is- Cotuit Ma 02635 8-20-2020 required for every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information on the computer,. use only the tab Daniel Hawkins key to move your Name of Inspector cursor-do not B&B Excavation use the return key. Company Name 374 Route 130 cia Company Address Sandwich Ma 02563 City/Town State Zip Code rxf (508)477-0653 S114324 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 Dan Hawkins Digitally signed by Dan Hawkins -Date:2020.08.2409,43:24-04'00' 8-20-20 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of;Health or DEP)within 30 days of completing this inspection. If the system 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 c1� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 228 Cotuit Bay Drive u Property Address Frank McKone Owner Owner's Name information is Cotuit Ma 02635 8-20-2020 required for every page. City/Town 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: The system was in working order at the time of inspection. Dwelling does have a garbage disposal and system is not designed for it. It is recommended the grinder be removed to prolong life of SAS. 2) System Conditionally Passes: ❑ one or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for'yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 228 Cotuit Bay Drive Property Address Frank McKone Owner Owner's Name information is Cotuit Ma 02635 8-20-2020 required for every page. City/Town 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 15.303(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 �m Title 5 Official Inspection Form ±= Igo Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 228 Cotuit Bay Drive u— Property Address Frank McKone Owner Owner's Name information is Cotuit Ma 02635 8-20-2020 required for every page. City/Town 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 ❑ Q 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 Offdal Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts ip Title 5 Official Inspection Form 1� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 228 Cotuit Bay Drive Property Address Frank McKone Owner Owner's Name information is Cotuit Ma 02635 8-20-2020 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ E Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ O Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow ❑ O Required pumping more than 4 times in the last year NOT due to,clogged or .obstructed pipe(s). Number of times pumped: ❑ 0 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. ❑ R Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ El Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ El Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ Q The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ a 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 C_4. 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 Forth:Subsurface Sewage Disposal System•Page 5 of 18 c Commonwealth of Massachusetts �v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 228 Cotuit Bay Drive V� Property Address Frank McKone Owner Owner's Name information is Cotuit Ma 02635 8-20-2020 required for every page. City/Town 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 ❑ El Pumping information was provided by the owner, occupant, or Board of Health ❑ 0 Were any of the system components pumped out in the previous two weeks? ❑ 0 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? 0 ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ❑ 0 Was the facility or dwelling inspected for signs of sewage back up? El ❑ Was the site inspected for signs of break out? 0 ❑ Were all system components, excluding the SAS, located on site? El ❑ 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? ❑ 0 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: El ❑ 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 p Title 5 Official Inspection Form w Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r 228 Cotuit Bay Drive V� Property Address Frank McKone Owner Owner's Name information is Cotuit Ma 02635 8-20-2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: 5 5 Number of bedrooms (design): Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 560/GPD Description: 0 Number of current residents: Does residence have a garbage grinder? R Yes ❑ No Does residence have a water treatment unit? ❑ Yes rol No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes 0 No information in this report.) Laundry system inspected? ❑ Yes 0 No Seasonaluse? ❑ Yes [g No See below Water meter readings, if available (last 2 years usage (gpd)): Detail: 2018- 164,000gallons 2019- 333,000gallons Sump pump? ❑ Yes ❑� No Fall 2019 Last date of occupancy: Date t5insp.doc•rev.7/2 612 0 1 8 Y 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 .......... / 228 Cotuit Bay Drive u� Property Address Frank McKone Owner Owner's Name information is Cotuit Ma 02635 8-20-2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: NA Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No 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: Owner- date of last pump is unknown Source of information: Was system pumped as part of the inspection? ❑ Yes ❑■ No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 228 Cotuit Bay Drive Property Address Frank McKone Owner Owner's Name information is Cotuit Ma 02635 8-20-2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: , El 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): Approximate age of all components, date installed (if known)and source of information: 2005 per plans Were sewage odors detected when arriving at the site? ❑ Yes 0 No 5. Building Sewer(locate on site plan): 214" Depth below grade: feet Material of construction: ❑ cast iron ❑■ 40 PVC ❑ other(explain): Town water Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): t5insp.doc•rev.7/26/2018 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18 p Commonwealth of Massachusetts Title 5 Official Inspection Form ±= io Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u- 228 Cotuit Bay Drive Property Address Frank McKone Owner Owner's Name information is Cotuit Ma 02635 8-20-2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): 11411 Depth below grade: feet Material of construction: ■ ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No 1 Dimensions: 500gallons % 511 Sludge depth: 3111 Distance from top of sludge to bottom of outlet tee or baffle 311 Scum thickness 611 Distance from top of scum to top of outlet tee or baffle 1411 Distance from bottom of scum to bottom of outlet tee or baffle measured How were dimensions determined? Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): The tank was in working order at the time of inspection. The tank is in need of pumping at this time and should be pumped every two years for maintenance. l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 Commonwealth of Massachusetts �- Title 5 Official Inspection Form w Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ........... 228 Cotuit Bay Drive u— Property Address Frank McKone Owner Owner's Name information is Cotuit Ma 02635 8-20-2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): Depth below grade: NAfeet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date 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: NA 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 228 Cotuit Bay Drive Property Address Frank McKone Owner Owner's Name information is Cotuit Ma 02635 8-20-2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) i 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): 0'r Depth of liquid level above outlet invert Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): The d-box was in working order at the time of inspection. t5insp.doc•rev.7/26/2018 Title 6 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 228 Cotuit Bay Drive V� Property Address Frank McKone Owner Owner's Name information is Cotuit Ma 02635 8-20-2020 required for every 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.): NA 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: (4)500 gallon chambers Q : leaching chambers number: ❑ leaching galleries number: leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2016 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 l; 228 Cotuit Bay Drive u� Property Address Frank McKone Owner Owner's Name information is Cotuit Ma 02635 8-20-2020 required for every page. City/Town 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.): The SAS was in working order at the time of inspection. Chambers were dry when viewed. 12. Cesspools(cesspool must be pumped as part of inspection) (locate on site plan): NA 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.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form �= Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Al (� 228 Cotuit Bay Drive Property Address Frank McKone Owner Owner's Name information is Cotuit Ma 02635 8-20-2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: NA Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t ' t5insp.doc-rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form += 1. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 228 Cotuit Bay Drive u� Property Address Frank McKone Owner Owner's Name information is required for every Cotuit Ma 02635 8-20-2020 page. City/Town 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 Rear I I L — — — — AUS Al-9' A2.13' � (1 81.18' 82.11' 0 0 0 0 t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts ,p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 228 Cotuit Bay Drive Property Address Frank McKone Owner Owner's Name information is Cotuit Ma 02635 8-20-2020 required for every page. City/Town 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: No GW @ 144" feet Please indicate all methods used to determine the high ground water elevation: 0 Obtained from system design plans on record 1-4-2005 If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers -(attach documentation) ❑ Accessed USGS database -explain: I r You must describe how you established the high ground water elevation: A plan on file at the local Board of Health was used to determine high groundwater. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 l - cam, Commonwealth of Massachusetts �. Title 5 Official Inspection Form ii Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 228 Cotuit Bay Drive Property Address ` Frank McKone Owner Owner's Name information is Cotuit Ma 02635 8-20-2020 required for every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ❑N A. Inspector Information: Complete all fields in this section. 0 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 n.- t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 4� r I!( TOWN OF BAMSTABLE CC 'LOCATION -?�$ 644 /�9 DI.- SEWAGE # �G6S-�z7 VILLAGE o�"u%� ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. � " I� ���>< ®^� 0-2 W-7e SEPTIC TANK CAPACITY /fdP> Gee L r LEACHING FACILITY: (type) S`dw 4144- 6•) M (size) /3 +X 4.'j NO. OF BEDROOMS, BUILDER 0 OWNER PERMITDATE: et- COMPLIANCE DATE: Separation Distance Between the: �^ Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 7 7 4- 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 maw,!✓ -C441 t 3� y3 ' -71 _ h, No. ��1 — 02.7 'r^ r Fee / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ' Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZippYtcation for 3W.5poar *psstem Con!5truction Permit Application for a Permit to Construct( )Repair( )Upgrade( /Abandon( ) T(omplete System ❑Individual Components Location Address or Lot No. �2 to Owner's Name,Address and Tel.No. As es or' Ma /P7rceL_ Ce lam/ ) 4 aC x®iv p Installer's Name,Address,and Tf1.No., Designer's Name,Address and Tel.No. iz- Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( O Other Type of Building . No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow _ gallons per day. Calculated daily flow 5-6!51 gallons. Plan Date Number of sheets Revision Date Title kr S�7`t° QfI Size of Septic Tan [S—®� Type of S.A.S. 5-04 Q i Description of Soil In _CAD Nature of Repairs or Alterations(Answer when applicable) 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 thi Bo d ofjAealth. Signed Date Application Approved by Date I o Application Disapproved for the following reasons Permit No. 20 0 7 Date Issued 0 No. �(JS J Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLES MASSACHUSETTS Zippficatiou for �Digogar 6potem" Cott!6tructiou Permit Application for a Permit to Construct( )Repair( )Upgrade( V�Abandon( ) IJ Complete System ❑Individual Components ,y Location Address or Lot No. J r,s MUP Own er's Name,Address and Tel.No. o • A�' Installer's Name,A dress,and T��1.No / Designer's Name,Address and Tel.No. ��! Z, 419/�E'r",v`/ Type of Building: '\ Dwelling. No.of Bedrooms Lot Size 2?W sq.ft. Garbage Grinder( 0 Other Type of BuildinP �y��No. of Persons Showers yp g ( Cafeteria( )� 3 Other Fixtures Design Flow kkra gallons per day. Calculated daily flow gallons. Plan Date �� 5~ Number of sheets Revision Date »Title Size of Septic Tank /S�a Type of S'A.S. `y SDO io- " z Description of Soil Nature of Repairs or Alterations,(Answer when applicable) 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-:*;-­.x. cate of Compliance has been issued . this,B_ d Signed s c_ r s Date 6 Application Approved by <' �•._. ��� � Date Application Disapproved for the following reasons Permit No. �� S Q� 7•, Date Issued UV O .. . ... .- ..... ... ...3.. .v . THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CER FY that th O - ite S wa e Dis osal System Constructed Repaired Upgraded ( ) ( ) ( ) Abandoned b >5G'/' O�Sp Y p pg ( ) Y at Z C� ��r �Ja�/ /� �d�u/^ has been construe ed i 'accordance with the provisio s-of Title 5 and a r0isposal System Construction Permit No. 2U S--aa-7 dated IbS Ins taller Designer Ca, The issuance of.t/hd rrrmit sh ll not be construed as a guarantee that the ystem wi f n iron as designed. Date f'( E Inspector No. 0 ----- ------------.-------Fee �OU THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Mi2;Poga1 *pgtem Congtgction rmit Permission is hereby granted to Construct(, )Repair( �)Upgrad ( )Abandon( ) System located at 2, 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 o this t. n Date:_._ ' ' °S Approved by JAPR-05-2005 11 :46 AM DOWN CAPE ENGINEERING 508 362 9880 P. 01 z Town of Barnstable Regulatory Services _ Thomas F. Geiler, Director Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-8624644 Fax: 308-790-6304 Installer& Designer Certification Form , Date: Sewage Permit# lr• D Z Assessor's MapTarcel Salk Designer: 0 W &41 1120el Installer: Address: /l -- Address: y✓ �� s / r&�o�� On I 1 9ti 4'w f,7'. was issued a permit to install a ( te) >> (installer) septic system at �a'C� n Abased on a design drawn by (address) 0- _ dated `� 4 ( esigne I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. �t�1 OF'lits.s - ARNE H c (Ins 's Signature) OJALA CIVIL, N No. 30792 r ' 0a/S T E (Designer'sSignature) (Aix tamp Here) t PLEASE RETURN TO BALE PUBLIC HEALTH DIVISION CERTIFICATE OF COMPLIANCE WILL 1MOT BE ISSUED UNTIL BOTH THIS FORM AND A&BUILT CARD ARE RECEIVED BY THE BA RNSTABLE PUBLIC HEALTH DIVISION. THANK YOU Q:_Health/Septic/Designer Certification Forth 3.26-04.doc ,per ° \ COMMONWEALTH OF MASSACHUSETTS �� EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS n\6 DEPARTMENT OF ENVIRONMENTAL PROTECTION ` � t v TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 228 Cotuit Bay Dr. Cotuit, MA Owner's Name: Robert Allen Owner's Address: Date of Inspection: Name of Inspector: (please print) Wi 11 i am E. • Robinson' sr. Company Name: William E. Robinson Septic Service Mailing Address: P O Box 1089 Centerville, MA" Telephone Number: (5 0 8) 7 7 5—8 7 7 6 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: asses Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature:�4, L�a d--Icz: ✓.�— Date: X—3 •-i� The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of HeaKh"or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments ****This report only describes conditions'at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 i Page 2 of 11 o OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 228 Cotui t Bay Dr. Cotuit Owner: Allen Date of Inspection: .7.^e3—C, 1 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. Syst Passes: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repair d.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answe yes,no or not determined(Y,N,ND)in the for the following statements.If"not determined"please explain. e 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 me 1 septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicatii ig that the tank is less than 20 years old is available. ND exp ain: bservation of sewage backup or break out or high static water level in the distribution box due to-broken or obstru ed pipe(s)or due to a broken,settled or uneven distribution box.System will pass inspection if(with appro al of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND plain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass 'ispection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND plain: Page 3 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 228 Cotuit Bay Dr. Cotui�t Owner: Allen Date of Inspection: —C> I C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is fail g to protect public health,safety or the environment. 1. yytem will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the ystem is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2. yytem will fail unless the Board of Health(and Public Water Supplier,if any)determines that the syst 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 froni 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. Other: . 3• Page 4 of 11 r OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: { µf Owner: Date of Inspection: A — 3—C7 1 D. yytem Failure Criteria applicable to all systems:. You ust indicate"yes"or"no"to each of the following for all inspections: Yes No Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool Liquid depth in cesspool is less than 6"below invert or available volume is less than%2 day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped Any portion of the SAS,cesspool or privy is below high ground water elevation. Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone 1 of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private wader 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.] (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. La ge Systems: To be c nsidered alarge system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gPd. You mu t indicate either"yes"or"no"to each of the following: (The fol owing criteria apply to large systems in addition to the criteria above) yes n 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. a If you h ve answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in ection D above the large system hm failed.The owner or operator of arty large system considered a signific t threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. he system owner should contact the appropriate regional office of the Department. 4 I � r ^, Page 5 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 228 Cotuit Ba Dr. o ui Owner: Al 1 Pn Date of Inspection: —"3 —n Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes o 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? v 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? r✓_ 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. E 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)], 5 Page 6 of 11 , OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 228 Cotuit Bay Dr. C()tui t Owner• A 11 en Date of Inspection: 2 —3 —6 � FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms):_3 L 0 Number of current residents:_; Does residence have a garbage grinder(yes or no):'d'c) Is laundry on a separate sewage system(yes or no):,j_o [if yes separate inspection required] Laundry system inspected(yes or no):dr.O Seasonal use:(yes or no): L v Water meter readings,if available(last 2 years usage(gpd)): 2000 78, 000 gal. Sump pump(yes or no): A., 6 1999 127, 000 gal. Last date of occupancy: -3 d® 1 CO MERCIAL/INDUSTRIAL Type f establishment: Design flow(based on 310 CMR 15.203): gpd Basis o design flow(seats/persons/sqft,etc.): Grease ap present(yes or no): Industri 1 waste holding tank present(yes or no):_ Non-s itary waste discharged to the Title 5 system(yes or no):_ Water eter readings,if available: Last d to of occupancy/use: OTH R(describe): GENERAL INFORMATION Pumping Records Source of information: Was system pumped as part of the inspection(yes or no): X 0 If yes, volume pumped:_gallons--How was quantity pumped determined? Reason for pumping: TnTYP F SYSTEM eptic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records, if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank _Attach a copy of the DEP approval _Other(describe): Approximate age of all components, date installed(if known)and source of information: Were sewage odors detected when arriving at the site(yes or no): ��Z:) 6 s* 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: 228 Cotuit Bay Dr. ` Cotuit Owner: Allen Date of Inspection: 2 3 6 BUM.DING SEWER(locate on site plan) Depth elow grade: Materi Is of construction:_cast iron _40 PVC_other(explain): Distan a from private water supply well or suction line: Co ents(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: /-(locate on site plan) Depth below grade: �- / Material of construction: oncrete_metal_fiberglass polyethylene —other(explain) If tank is metal list age:— Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: z> T Scum thickness: 1 ' 1%, Distance from top of scum to top of outlet tee or baffle: r Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensions determined: 6 6ev- T. (- Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of.leakage,etc.): GRE SE TRAP:_(locate on site plan) Depth elow grade: Materi I of construction:_concrete_metal_fiberglass_polyethylene_other (expla ): Dime sions: Scu thickness: Dis nce from top of scum to top of outlet tee or baffle: Di nce from bottom of scum to bottom of outlet tee or baffle: D it of last pumping: Co ents(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as r lated to outlet invert,evidence of leakage,etc:): r 7 Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 228 Cotuit Bay Dr. Cotuit Owner: Al 1 Pn Date of Inspection: Z—*3—6 I TI T or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth elow grade: ' Materi 1 of construction: concrete metal fiberglass_polyethylene other(explain): Dimen ions: Capac' gallons Desig Flow: gallons/day Al present(yes or no): Al level: Alarm in working order(yes or no): Date of last pumping: Co ents(condition of alarm and float switches,etc.): DISTRIBUTION BOX: t (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: 6 Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): ] PUMP CHAMBER: (locate on site plan) Pump in working order(yes or no): Al s in working order(yes or no): Co ents(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 228 Cotuit Bay Dr. Gets i-t - Owner: Allen Date of Inspection: -�-^3 -6 � SOIL ABSORPTION SYSTEM(SAS): .(locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: leaching chambers,number: leaching galleries,number: leaching trenches,number, length: leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): ' - - CE SPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Numbe and configuration: Depth—top of liquid to inlet invert: Depth o solids layer: Depth o scum layer: Dimensi ns of cesspool: Materials of construction: Indicatio of groundwater inflow(yes or no): Comme s(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PR (locate on site plan) 1 F' Mat ials of construction: Dim sions: Dept of solids: - Co ents(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 9 r 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: 228 Cotuit Bay Dr. Cotuit Owner: Allen Date of Inspection: g.--22- i' 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. 10 n Page 11 of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 228 Cotuit Bay Dr. Cotuit Owner: Allen Date of Inspection: ^'3—e,l SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to groundwater dd) feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ,/Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must des ribe how you established the high ground water elevation: �jdb� FZ4d2S Gh j'lz 11 19CAT10 �` :WA. CE PERMIT N0. IILLACE l c~ 7 [i l t INSTA LLER'S NAME '' & ADDRESS 4i B U I L D E R OR OWNER DATE PERMIT ISSUED 4; DATE COMPLIANCE ISSUED _2J7 �� I L Ines,, r,<oo►% L �a io S,.S-i� .......... THE COMMONWEALTH OF MASSACHUSETTS. BOARD OF HEALTH ...............1..0LZ.Vk1­.....0 F.......... ..................................... AvOration for Uwvviial Works Tomotrurtion Prrmit Application is hereby made for a Permit to Construct -K) or Repair an Individual Sewage Disposal �N System at: _6=�m 1 L-0A qq ........................... ................................................................................................. L cation-Address or Lot No. ....................................................... own Address $4 ...... ........................... ... ................................-------------------........ I-,,fa/er Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............S...............................Expansion Attic Garbage Grinder (Nop) Other—Type of Building ............................ No. of persons........................_... Showers Cafeteria 04 Other fixtures ........................... ......... .< rti5m------------------ Design Flow.............U.0.......................gallons per-pal4o per day. Total daily flow------------W I ..................p1lons. 9 Septic Tank—Liquid capacity tCC.O.gallons Length..6L(Q.!. Width.4-1& Diameter................ Depth..5-4- .. Disposal Trench—No..................... Width............._...... Total Length.....................Total leaching area--- sq. ft. Seepage Pit No--------------------- Diameter......19........ Depth below inlet........(10.1....... Total leaching area. ...sq. f t. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by...K.K. ....I.....em,.................................... Date... ...%.jQ .1.60..... Z Test Pit No.*&Z......minutes per inch. Depth of Test Pit...4.!?044-!Depth to ground water_._®_._----io rX4 Test Pit No.a...............minutes per inch Depth of Test'Pit.................... Depth to ground water-.__- --___.......... .. 0 ---------------------_---.1................ . ...... ....t...... :::j __;-------:W,---------Vis_-------------- PA. Descriptionyf Soil.... . ....... --------- A...............4�........ . ................... r ........fln ..................................................................... I ........................................................................................................................................................................................................ U Nature of Repairs or Alterations—Answer when applicable._............................................................................................. .................................................................................................................................................:....................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'JITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in o I operation until a Certificate of Compliance has been is ued by the board e_I ealth. .......... S;igned./4�. ......................../............D..t................ Application Approved By._____._cz2o ................. ................................................. ........_ )_2 2; .. ......................... Date Application Disapproved for the following reasons:................................................................................................................ ............................................7.............*------"....................................................................................................................................... Date PermitNo......................................................... Issued....................................................... Date THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I M A�C(, I DATA No.0...3 5.. ' Fmm.,10.`................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH _..................... .... f.Y ­2,,,.................................... Appliru#iun for Diiipuuttl Hlorho Tonotrnrtion ramit Application is hereby made for a Permit to Construct X) or Repair ( ) an Individual Sewage Disposal stesp at: Sy .......................... . •-•--- ----..........•--.............. ...... •--•-• aYion-Address oox�_L,00t No. .._ � ./.:°!.G�B.✓ G 41,0W awe. C-.4 k":.w.:1�"r wit�i1•IYlAAr.0,26y/ ......... ............. .............................. ------..... ... . Own Address W ................ ................................. ._._..... F� �I er � Address � Type of Building Size Lot___________________________S q. feet k., Dwelling—No. of Bedrooms... ............................Expansion Attic ( ) Garbage Grinder �p) � Other—T e of Building No. of persons............................ Showers — Cafeteria a Other fixtures ............................. W Design Flow..--._......L C?....................gallons per peFcoog r day. Total daily flow_...._....... �............._..Olons. WSeptic Tank—Liquid capacity gallons . Length.__ �P.. Width..4"..L.d' Diameter................ Depth..^..... x Disposal Treii2h—No. .................... Width.................... Total Length....:.........:......Total leaching area....................sgs ft. Seepage Pit No..... I_-_---__-- Diameter......j.v........ Depth below inlet........�P.......... Total leaching area...Lp�....sq. ft. Z Other Distribution box ( )" Dosing tank ( ) Percolation Test Results Performed by._.h��....kr....i.....Eplm. ............................... Date... -.'__�. `�1.•�' ..... ,.a Z Test Pit No.* -......minutes per inch Depth of Test Pit...I 14bepth to ground water...00...ft.40 (i, Test Pit No.*!...............minutes per inch Depth of Test Pit.................... Depth to ground water........................ ae1, _>,.............. ..........#...... . -.;....----.... q -- ................... Desc_ription9f Soil b � SUb�SD 1_ �` .._ .I ..Yy1 ll�ll�(1 -.---- � ...__r_.._.. .► . c r Uw --•-•-•---••-------•--•••--•---------•-•-••-•••••••••-••••------------•-----•-------•-•---•••---•••---•-•••••••------------------••••--•------•-••••---•-•-•----.....•••......_..---•----------------•-- Nature of Repairs or Alterations—Answer when applicable............................................................................................... ---............................................................................................................................................................................................... Agreement: The undersigned agrees to install the aforedescribed. Individual Sewage Disposal System in accordance with the provisions of TITIE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been is ued by the board o ealth. Signed. , .....-----•-•-........-- Date Application Approved By- '' ..... .. . -- .............................................. --- --------------- Date Application Disapproved for the following reasons-------------------•-------------------------------------------•------------------------------------.......-•---- --•-•-•--...._.:•---•-•-•----•--------•..............•--------------•-•--•-----•.......-•---•---•--------'•--------•----------------------------••---•••-••---------------....._...._ ......----•----- Date PermitNo.......................................................- Issued-....................................................... Date r;' THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF...... r ........................................................................ Trrtif iratr of Tompliunrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed .�Repaired g P �' ( ) ( ) by..._.... --..... -----r_...r If ..--.. ...---•-••-----...•--••--•••------- ---•--•--•-•---•---•-----•..............•-•-•-•---._.......----•-••----......------ Installer f ...... ' at --------------------------------------------------------------------------------•----••. has been installed in accordance with the provisions of��I F 5 of The State Sanitary Code as described' in the application for Disposal Works Construction Permit N .c9l.3S.......................... dated_.-.________._._----•___________-------____.__.. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........`-'.. .. ..... -•-�'�------------------------------------- Inspector........................ .................................................. THE COMMONWEALTH OF MASSACHUSETT- BOARD OF HEALTH Nrj3S . ........ _ FE A�.......... �i��u��l ur�u ��an��ruan rrntti Permission is hereby granted------------••�-.�..:�-........_..;//;." a-t._ ..(�-----------------•-------------........------..........: to Construct ( ()/or Repair ( ) an Individual Sewage Disposal System, at No :... == = " Street as shown on the application for Disposal Works Construction Permit No..................... Dated..........._.__....._....._._............. --• _---•-__---_--•---•-------•--•----------------•--•-- � ,� Board of Health f DATE------..2.----................... 1 1255 HOBBS & WARREN. INC., PUBLISHERS APPLI,CATI,ONL.FOR PERCOLATION TEST AND OBSERVATION PITS � aa� LOCA ION Qr, NO. P- VILLAGE _ DATE 5 �Q APPLICANT Zf,2 . 7- �j FEE IS Qi ADDRESS ,Cow ELEPHONE NO. bT on-refundable) ENGINEER�,7,'Z!) /, TELEPH E NO DA �.SGHIiDIILED .• 7j�'G, /b. /`�60 Q; 3o �J��%LN - (Applicant- s s ' ture) SOIL LOG ll SUB-DIVISION NAME CorL» �'GcoeEs DATE_ TIME EXPANSION AREA: YES4--'NO ✓- Z'..� ENGINEER. .:,,, TOWN WATER ✓PRIVATE WELL � /y BOARD OF HEALTH �c► .�LUSTic EXCAVATOR iSKETCH: (Street name,etc. ,.dimensions 'of lot, exact location of test holes and percolation tests, locate wetlands in proximity to test holes) NOTES: 9 y) . - n Q c o 77Z, i3,y 10,E PERCOLATION RATE: G Z /�✓ TEST HOLE NO: ELEVATION: TEST HOLE NO:ly-z ELEVATION: 2 2 3 — 3a " 3 4 4 -- 5 7 5 6 c L i=,¢.c. 6 7 7 8 S,¢-coo 8 9 9 10 10 11 11 12 _ 12 13 13 14 14 15 15 16 16 'SUITABLE FOR SUB-SURFACE SEWAGE: LEACHING FIELD LEACHING PITS LEACHING TRENCHES UNSUITABLE FOR SUB-SURFACE SEWAGE. REASONS: NOTE: ENGINEERING PLANS MUST SHOW NUMBER ASSIGNED ON PERC TEST APPLICATION ORIGINAL: COMPLETED IN ENTIRETY BY P. E. AND RETURNED TO BOARD OF HEALTH COPY: . RETAINED BY APPLICANT r .s 37 �° C oT u i r ,tsay CJ R 1 Q f . t��r * ,a 'tf' �' Y h � =~t�'ti. �», .•�4 'n { _3._ S a� ,f,.,�;, � is�`.,�,�", 3� �� � � �s �� - .. Y,. - fille ;� •ri fat- �. ;. { 37 r 0 r 14'4' w N O �� a 2 C 14-0 4 I' S10 4 6 a c r V v M ' o J�d°. `,N'oe� -off � +•+ 'Y jjSS y��My Py"l� SKI RTNBOARDINO AND FR MIIN65 y0 E za 4i / �RE BE REMOVED AND RE U LOCATED A5 SHOWN. '— .r ---------------- -------------- A Z2'OoNr", 7YY 4 A Ln A2 D,.5T COVER, - - - A2 '!�'�'' V w V ( EDG=OF FLA I VENT GW 255(TEMP) GYi 255(TENL)'^ b zXb WALL ON n)2%6 CRAWL TOP oP FouNP.WALL ro p n Dc sLP1=E0 as. :.vur WD_Ar TOP DECK m i.51!L PIP W 5/B'z I2• 9E 2'-l'./--"!OW E%1$T. _ F O.:4-9 X 5-5 3/8 GALV"EEL ANCHOR - — 9OLT5®4'-0'". WT 3'-O'VJDE OPNIIY - SITTING INTO E%15TIN6 WAL = _ _ O 1 f MAINTAIN 4'-0'MIN. Ov5TCOVE.R FOR ALGE55 - FROMGRADETO _ T FOUNDATION WALL 1 _____--_-_ • _ E011AL EPUAL . BOTTOM OF FOOTINb VENT; EPUAL EC]lAL — ———— ___ ____ CW 255(TEMP) (/ ) - GW 2B5(TEMP)- MMTNS:3 WIDE AT TOP • _ O.:4-9 X 5- /B ( ALIGN LL5 - _—: -- a - t . ALIGN WALLS i ...... DRILL a4 REBAR 4-INTO EX.GONG. - _CTR.IN EXIST. FNM 2R60 AL WALL 8 FOOTING®1ZOO.VERT. WIN'pOW OPENING NO MIATIN57— ---- - - -\L.1571-BAY ANDON TO BE - [SECURE W EPO%Y GRWT;REBAR R.O.2-9%6-8 DN. TO PROJECT 12'MIA INTO NEW LM. REMOVED;MEN ASED OPENING WALL 8 FOpil;�li TO BE BASED ON CENTERLINE ' .-■ OF NEW SITTING AREA \/ CRAWL DECK C W � ` �Exlsnn's H01.sE '-KITCHEN - EXISTIty FOMD DEN ATIOX p ��4 u. OmeO ____________________________ �__________ _________________________________________________________ - 6A5EMENT_ - FORMAL DINING a tea¢t' cLe y9 oo{-;m ' mm! ? coc Wi- Qcm mcP m q mo� F I'� 5 T FLOOR PLAN FOUNDATION i� L A N 5GALE: 1/4" _ -o" 5GALE: /4' 1 -O - - - LIVING AREA OF ADDITION=193 SO.FT. 4/ un (1 FOUNDATION/5TRKTURAL GENERAL NOTES: - p -CONCRETE FROST AA.L5 TO BE B'THICK C.M.L. -NO FOOTIN6 TO BE PLAOBD IN Gc'TERAL PLAN NOTES 'v T� •� ON 22'%12'-NT GONG.FGOTING W KEY;PROVIDE WATER OR FROZEN SOIL WALL. DFMO LEGEND Ln�.(/�� (_1 (2)2Xb P.T.51LL W 5/6'X 12" FEAR a 24'OG.VERT AT FOOTING GO,UUELTIOM - .� - W I� i GALVANIZED STEEL ANGNDR (HEISMT OF WA.L TO BE BASED ON GRADE -CONCRETE STRENGTH MIN PC=Bp00 PEI -ALL E%T.WALLS TO BE 2%6'S®16' BOLTS m 4'-0"0 G.MIN, CONDITIONS,4 O"MIN,TO BOTTOM OF FTC) AT 28 DAYS _ OL(UNLESS NOTED OTHERA15E) --- -- WALL5 AND ITEMS TO ,� LL 6 12'FROM CORNER5 BE REMOVED _ -ALL REINFORCING BEAMS TO 8E ASTM A615, to -SILLS TO BE(2)2x6(FRES`JJRE TREATED)W 5/B'%12' GRADE 60,DEFORMED BARE Q n� GALVANIZED STEEL AN—P BOLTS•A 0'O.G.MIN.AND - •WINDON5/FRENCH DOOR TO BE'ANVERSEN EXI5TIN6 WALL5 TO - � ( H-•� I 12'FROM CORNERS:BOLTS SHALL ENGAGE BOTH -SEE 5T. TURAL GENERAL NOTE5 400 SERIES. (REFER TO ELEVATIONS REMAIN _6 C BOTH F",5 AND BE FASTENED W 3"XS'PLATE WASHER5; AND ttP"AL DETAILS FOR OTHER FOR M NTIN PATTERNS) (n p THERE SHALL BE A MIN.OF 2 BOLT5 PER SILL;WA5HER REOUIREMENT5 C O V TO 51T ON UPPER SILL;SEE DETAIL5,NOTES AND 56HEWLE - +- NEW WALLS :0 M�./� ON D4*.5-9 FOR ANCHOR BOLT5 AND OTHER CONNECTORS UN -ALL WINDOWS TO BE TEMPERED W+� TOP OF FODATION FOR ANCHORAGE OF SUPERSTRULTURE TO BE EMBEDDED ALL �--. V _p �J- N FWNDATION. 't" DEMO NOTES EXISTING DASHED WINDOWS a WALLS .s- - -REFER TO ELEVATION5 FOR WINDOW TO BE REMOVED AND PATGgD AS ¢ p " KO.HEIGHTS ABOVE SUBFLOOR NEEDED OR REPLACED AS NOTED. "EMU.WALL _ LONG.FOOTING 2'OUST COVER f M s job no.: 1225 yGs date 10 COTOBER 2012 scale AS NOTED ..�ep,S'ICp drawn Unolj rev. rev. FOUNDATION DETAIL M1 5GALE: 1/2 = 1'-0' ESIONP�4 A- s n. 1 o _ - U o - - ISSUED FOR CONSTRUCTION sht of K E E o N aA io w gi VO V v � � Z - C V a+ s re RI0 6E VENT GA y o -'OVER N1 am%14"LVL RIDGE 50ARD(5TRUCT) a� r w E ' ARCHITECTVRAL — ASPHALTROOF SHINGLES TO MATCH EX15TINO - ARCHITECNRAL ASPHALT ` ROOF SHINGLES TO m a+ MATCH EXISTING � 5/0'GD%PLYWOOD � 2XI05 p l6'O.G. EXISTING HODS ®16"OCLA¢TIES x � I2 REMOVE PORT OF I] -- - '- - E%15iING. � ALUMINUM GUTTER, _ ------ N -- 9 FASUA6 ANP-T,FRIEZE B ALIGN FASCIAS MOLDING AND FRIEZE TO MATCH EXISTING w FIN151EP FLOOR AT - �ll�M GUTTER SECOND FLOOR(EXIST. - _-_ -__ �_— EOFFIT,MOLT0G iOP O MATCH EXISTING ALIGN.FAS.CIA --__PLATE®SJIIJNG -__ ' -- ---- 1/2"GYP EOARD ` GL6.J015T5 W/EXISi. ON IX3 STRAPPING ALIGN F?IEZF: _ Wf/E%1ST. - (5)1 3/4'X T 1/4' a- LVL HDR. V 1 ;: � �\ i X JA.MSMEAD GA51: �"rv � DF ISITTING x Q a� O �m WG 5HIN5LE5 ON R ,� /2'CPX PLYWOOD F V I A 2%65 p I6'OL. .p R-19 F G.INSULATION 5/4'Te 6 PLYWOOD V) L SOME £ (2)2X10 FLOOR V FIN15H 0 FLOOR AT -- JOISTS p 16'OC. IN�JJLATIONI -- It, A&AAAAAAAAAVVVVVVV%N%AAA/\AVVVVVVA FIRST FLOORTEX ST) — —_ =_ _ _-- _ ®wFIRSTFLOO,F t (MATCH E%I5TIN6) P.T.2x6 ABCs \ CRAWL .. _.... _.. WI NLAV=D wRNERS 5/a•x12"ANCHOR (M CAV,O'O.O. C.•LYwE¢.DJST A01.AwNGR 41 FoueD. 1t . Q WALL ON 24'X.12' 7 GONC FOOTING ' W/KEY R E A R E L E V A T I O N 5C ALE: 1/4'• = 1'-0• . - - _ 5 E G T 1 O N . - 5 G A L E 1/4" - •-C " NEW ADDITION EXISTING I 5E IX FA501A N - -69 ALLMI." -- - - 50-rFIT MOLDING AND FRIEZE TO - - V- - 12 MATCH Ex15TING 12 21 �EXISi - EXIST r'b= zi A¢CHITECT RA ASPHALT ROOF - - • SHINGLES TO ARGHITECTU24L .MATCH EXI5TING S5IHMH E5'iOros A A 12 w.rcH ExIsnN6 A2 A2 . E �E%IST I%FASCIA W/ ALUMINJM GUTTER SOFFIT,MOLDING ^ ALIGN FASCIAS .. AND FRIEZE TO N./ Ln MATCH EXISTING v � ExlSi a--� ' -: _ - - EXISTING O V) 12 12 _ _ C��� \ .t ��Ex15T '. _ \7F Ln _ - - •.N 11 0 0� CID M FINI5NED FLOOR AT W(J swNO FLOOR EXI5T) - -- Q.. "- SEwtvLFLwR(EXISiJ�✓ Q ^` (� - ALIGN FASCIAS V/ % 7yp�J �E%15TING HOUSE 0 '.,i M3 • w O X JA MEAD GA51N6 Lu •,0 IX JAMSMEAD CA51 _ FINI5HED FLOOR AT , _ — — FINISHED FLOOR AT&I _ vIP FIRST FLOOR(EXIST) r 1— -- FIRST FLOOR EXI5TT-W — — job no.: 1225 - WC.SHIN6LE5 W/ - �- -- : ----------- date 21 AJ&U5T 2012 rIr , ' WEAV-D CO - : Scale A5 NOTE _ - CEDAR SIDING NdraWdrawnKMyy WEAVED CORNERS - =S�P O CyG�A D N rev. rev. . •�Ru. RI G H T ELEVATION LEFT ELEVATION' SCALE: 1/4' = 1•-0" SCALE: 1/4' = 1'-0' v� A-2 o FSS10NAt `o ISSUED FOR CONSTRUCTION rht of GENERAL FOUNDATIONS MASONRY 3 CONNECTORS SHOWN ARE A5 0:ALL PLYWOOD SHALL BE APA o a o MANiJFAGTURED BY SIMPSON PERFORMANCE RATED PANELS CONFORMING Q 5TRON6-TIE GO. INC. 5UB5T17UTI0N5 „ TO THE FOLLOWING MINUMUM REGUIREMENT5: o _� I. 5TRUGTURAL DRAWINGS ARE I. THE ALLOWABLE PRESUMED 50IL I. MASONRY GON5TRUGTION SHALL MUST BE APPROVED IN WRITING TO BE USED WITH THE ENTIRE BEARING GAPGITY 15 5000 P5F, CONFORM TO THE REQUIREMENTS BY THE EN6INEER IN57ALLATION A. FLOOR-57URD-I-FLOOR 7&6, EXF05URE I, SET OF DRAWINGS. WHIGH IS TO BE VERIFIED IN THE FIELD OF SPEGIFIGATION5 FOR MASONRY OF ALL GONNECTOR5 SHALL BE 3/4" SPAN RATING I6". _ BEFORE GON57RUGTION. 5TRUGTURE5 (AG1 530.1/ASGE 6-88). IN STRIGT ACCORDANCE WITH THE a d 57REN07H OF MASONRY F'M=1500 P5I. THE MANUFACTURER'S IN5T1RUGTION5 B: WALL SHEATHING-EXPOSURE I, I/2 +� 2. ALL SAFETY REGULATIONS & MUST EMPLOY ALL REQUIRED SPAN RATING 16 . a s ARE TO BE STRICTLY FOLLOWED. 2. FOOTIN55 SHALL BE CARRIED - FASTENERS. :, m METHOD5 OF GON57RUG7I0N $ TO LOWER ELEVATION THAN SHOWN 2.VERTICAL REINFORGIN6 OF MASONRY G. ROOF SHEATHING-EXPOSURE ERECTION OF 5TRUGTURAL MATERIALS ON THE DRAWIN65 IF REQUIRED TO WALLS SHALL BE A5 INDICATED ON SPAN.RATING 16'. f N 15 THE GONTRAGTOR'S RESPONSIBILITY. REACH PROPER BEARING GAPGITY. THE DRAWINGS. ALL GORES OF 4. ALL GONNEGTORS SHALL BE �t� C a MASONRY UNITS SHALL BE FILLED HOT DIP GALVANIZED. _ WITH GROUT. REINFORCING BAR 3, THE GONTRAGTOR 15 RE5PONSIBLE 3. WALLS AG71N6 AS RETAINING WALLS ,LAPS SHALL BE 2'-6" MIN. + DESIGN CRITERIA o y FOR DISSEMINATION OF ALL SHALL NOT BE BAGKFILLED WITHOUT I 5. IN5TALL ALL CONNECTOR FA5TENER5 Zt 15Hop REVISIONS d REQUIREMENTS TO BRACING UNTIL ALL SUPPORTING SOIL BEFORE LOADING THE JOINT. 3, HORIZONTAL JOINT REINFORCING I. APPLICABLE BUILDING GORE u 5jR�GtVFtPa. THE SUBCONTRACTORS. SLABS ARE IN PLACE 8 AT ND Z041156 FOR MASONRY SHALL BE EQUAL - MA55ACHU5E7T5 57H EDITION v, ADEQUATE STRENGTH. TO DUR-O-WALL TRU55 MANUFAGTERED 6. SPLIT WOOD 15 NOT ACGEPTABLE � F*I �[ 4 TAKEHN ABTHE CPREPHA5 BON OF 4. COMPACT ALL FILL UNDER FOOTINGS . WITH WIRE GONFO WINS TO A5TM A 52 FOR ANY CONNECTION. 2. DE516N WIND SPEED: 110 MPH AQOcESSGON�P�c�G FV�1 V d GOATED FOR GORRO510N PROTECTION W `IO ALL DRAWIN65 AND SPEGIFIGATIONS. § SLABS TO THE SPECIFIED DENSITY IN AGGORDANGE WITH ASTM A 153, CIO HOWEVER THE ENGINEER DOES NOT d VERIFY. 'GLA55 B-2. ALL WIRE SHALL BE 7. ALL EXF105ED FRAMING MEMBERS o GUARANTEE A6AIN5T HUMAN ERROR q GAGE MINIMUM. PROVIDE MINIMUM 5HALL BE TREATED PER AWPA 5TRUGTURAL DESIGN CRITERIA - 8 FOR THAT REASON IT IS IMPERATIVE LAP OF 6" $ USE PREFABRIATED V5 G2/Cq GGA 0.25 8 MEMBERS IN THAT THE CONTRACTOR SHALL GHEGK OR CORNER 5EGTION5 AT ALL GONTAGT WITH SOIL SHALL BE ALL DIMENSIONS i DETAILS $ MUST WALL 1NTER5EGTION5. TREATED PER AWPA C23/G24 - FIRST FLOOR 40 P5F LL FBI VERIFY ALL CONDITIONS, DIMENSIONS, 5TRUGTURAL STEEL GGA 0.60. JOB 51TE FABRICATIONS 15 P5F DL & ELEVATIONS AT THE SITE. ALL GUTS $ 5ORE5 SHALL BE TREATED IN 1+y DI5GREPANGIE5 SHALL BE BROUGHT 1. DESIGN, FABRIGATION ERECTION 4. GOGNRETE MASONRY UNITS SHALL AGGORDANCE WITH AWPA STD.M4. - SECOND FLOOR 30 P5F LL DI TO THE ATTENTION OF THE ENGINEER SHALL BE IN ACCORDANCE WITH CONFORM TO ASTM G qO. • 15 P5F DL V�y V)THE A15G 5PEGIFIGATION FOR ATTIG/STO. 20 P5F ILL1�1 Cn 5TRUGTURAL STEEL FOR BUILDINGS,' 5. ALL,MANUFAGTURED LVL WOOD FRAMING 10 PSF bL k . 5. THE GONTRACTOR SHALL 5UBMIT LATEST EDITION. 5. CONCRETE BRICK 5HALL CONFORM - MEMBERS SHALL HAVE THE FOLLOWING Qr GOMPLETE SHOP DRAWIN65 FOR ` TO A5TM G55. PHYSICAL PROPERTIES AS A MINIMUM: - ROOF 05L 30 PS 5L ALL CONGRETE REINFORCING,ALL 15 P5F DL F 0*0 57RUGTURAL STEEL, $ BOTH 2. 5TRUGTURAL SHAPES SHALL CONFORM E=LgX106P51, FB=2500,FV=240. - EXT. WALLS/STOR. 75 PLF DL GALGULATION5 $ SHOP DRAWIN65 TO THE FOLLOWING: 6. GROUT SHALL CONFORM TO,THE FOR ALL ANUFAGTURERED LUMBER REOUIREMEN75 OF A5TM C 146 & - T. WALLS/STOR. 50 PLF DIL 1, M PRODUCT5 $ THEIR GONNEGTOR5 A. WIDE FLANGE MEMBERS A5TM SHALL HAVE A GOMPRE551VE' q. ALL FLOOR JOISTS SHALL BE AS FOR REVIEW PRIOR TO FABRICATION. Agg2 GRADE 50, STRENGTH OF 5000 PSI. MANUFAGTURERED BY B015E CASCADE - DECKS/PORCHES 40 PSF A5 SIZED ON THE DRAWIN65. ALL 10 P5F B. CHANNEL5 s AN6LE5 A5TM A36. 7. VERTICAL $ BOND BEAM FASTENING, BEARING,BRACING 8 5TIFFENIN6 SHALL BE IN'5TRIC7 ACCORDANCE G. H55 ROUND $ RE6TAN6ULAR TUBES REINFORCEMENT SHALL CONFORM ' WITH THE.MANUFAGTURER'5 REQUIREMENTS.a s GONGRETE TO THE REQUIREMENTS OF ASTM A615: O TO ASTM A 500, GRADE B.FY=46 K51. � x � � I. ALL GONGRETE WORK AND MATERIALS L SHALL COMPLY WITH THE SPECIFICATION5 3. ALL GALVANIZING SHALL CONFORM L5. MORTAR SHALL GONFORM TO THE 6ENERAI_NAILING SCHEDULE-11O MPH . W w L FOR 5TRUGTURAL CONCRETE FOR BUILDINGS TO ASTM A 123. REGUIREMENT5 OF ASTM C 270 JoiNTgEscRlPnoN NUMeEROF MMBERof NAILSPACIN6 AND SHALL BE TYPE M OR 5. COMMON NAILS EOx NAILS of (AGI 301-5q). ROOF FRAMING ro N CO 4. BOLTED GGNNEGTIONS SHALL BE WITH BLOCKING TO RAFTER(TOE-NAILED) 2-6D 2-IOD EACH END j q. QUALITY ASSURANGE TE5TIN6 d 2. ALL GONGREfiE SHALL HAVE A 20-DAY HIGH STRENGTH BOLTS IN AGGORDANGE RIM EOARD TO RAFTER(END-NAILED) 2-I6v 3-I6D `EACH END O COMPRESSIVE STRENGTH OF 3000 PSI, WITH THE SPEGIFIGATION FOR z IN5PEGTION 5HALL:5E PERFORMED IN - WITH MAXIMUM I INGH A66RE&ATE $ 5TRUGTURAL JOINTS USING A5TM A 525 N ACCORDANCE WITH THE MAXIMUM 6% AIR ENTRAINMENT FOR. OR A 4q0 BOLTS. REQUIREMENTS OF AC1 530.1/ASGE.6/88.'. TOP PLAres AT INr¢secrlONs(FACE nAILEn) a-Ibv SI6D' AT Jo1Nrs EXTERIOR CONCRETE EXPOSED TO. u ' - _f STUD TO STUD(FADE-NAILED) : _ - - .' 2-IbD s .. 24"O.G. + _ MOISTURE. _ .y.' ` -+ V HE-ER TO HEADER(FADE-NAILED) 'I6D I6D' 16"O.G.ALON6 ED6E5 r - 5. ANCHOR BOLTS SHALL BE ASTM A 507. „ FLOOR FRAMING 3. ALL REINFORGIN6 STEEL SHALL BE FRAMING LUMBER 8 GONNEGTORS :" Olsr 1O SILL E O GIRDER(TOE- TOP PLATE NAILED) a-aD a-IOD PER JOlsi DEFORMED BARS OF NEW BILLET STEEL 6. WELDS SHALL BE MADE BY OPERATORS € 5LDGKiN6 TO J015T(TOE NAILED) 24D 2-IOD "' EACH END'" N GONFORMIN6 TO A5TM A 6I5 GRADE 60 GERTIFIED BY THE'STANDARD- _ ALL FRAMING LUMBER SHALL BE BLOGKINO TO SILL OR roP PCAre(roE-NAILED) = 5-I6D a-I6D EACH BLOCK V QUALIFIGATION PROCEDURE OF THE KILN DRIED lq% MAXIMUM MOISTURE o N o LEDGER STRIP TO BEAM OR GIRDER(FACE-NAILED) - 3-I6D :' 4-IbD, .EACH JOIST r+ µ AMERIGAN WELDING SOGIETY. CONTENT. LUMBER 5HALL.MEET - V)� z JOIST OIN'LEPSER TO BEAM(TOE-NAILED) 3-BD 5-IOD �, PER JOIST 4. CONCRETE COVER OF REINFORCING BARS AS A MINIMUM THE FOLLOWING „ 'a ; SHALL BE A5 FOLLOWS: DE5I6N°VALUES FOR 5PRUGE-PINE-FIR BAND i015T TO JOIST(END-NAILED) 3-I6D 4-160 '3 PER Joisr I. WELDING SHALL BE IN AGGORDANGE Y BAND JOIST TO SILL OR TOP PLATE(TOE NAILED) 2-IbD 3-16D PER FOOT iY LL A. 3" AT GONGRETE PLACED DIREGTLY WITH THE AW5 DI.I CODE FOR WELDING A. 2X STUDS GON5TRUGTION GRADE ¢ n - a '... - _ ROOFSHEATHING AGAINST EARTH. N BUILDAG CONSTRUCTION. +- FB=800,FV=65,FG=750 ` s L ' WOOD 5TRUGTURAL PANELS - W 0` v� B. 2" AT ALL OTHER LOCATIONS. B-2X JOISTS/RAFTERS NO. I GRADE• i'=. "o.c FIELo o 0 l�J+_ _ RAFTERS OR TRUSSES SPADED UP TO 16 s BD - IOD 6"ED6'c/6' 8. CONNECTIONS NOT DETAILED SHALL FB=1150;FV=70 _ M�A/� RAFTERS OR TRUSSES 5PAGEO OVER I6"O.G. BD IOD 4'ED6E/4".FIELD - +� U W y BE DE516NED FOR THE LOADS 5HOWN -GABLE ENDWALL RAKE OR'RAKE TRUSS W/O GABLE OVERHANG 'BD' IOD b"EDGE/6"FIELD - : N O c 5. NO HORIZONTAL CON5TRUGTION JOINTS ON THE DRAWINGS OR FOR LOADS G. POST NO, I GRADE FB=800; ARE ALLOWED,UNLESS SPECIFICALLY GIVEN IN THE STANDARD LOAD• FV=65,FG=675 GABLE FNDWALL RAKE OR RAKE TRU55 W/5TRU-11AL OUTLOOKERS By IOD 6 EDGE/b"FIELD 5HOWN ON THE DRAWIN65 OR ALLOWED TABLES OF A15G FOR THE 5PAN, cc GABLE ENDWALL RAKE OR RAKE TRU55 W/LOOKOUT eLOCK5 eo IOD 4"ev6E/4"FIELD IN WRITING BY THE ENGINEER. 5EGTION $ STRENGTH 5P EDIFIED. PLATES,SILLS,SHEATHING 4 C2. ALL FA5TENIN6, OF &YP SHEATAHLLBOARD 5D COOLERS r"EDGE/10"FIELD sjob " OTHER WOOD MEMBERSSHALL' date v: Io20ctoeER 2OI2 6. REINEARaN6 EMeEDMENr sr.NVARD g. ELEVATIONS NOTED A5"TOP OF STEEL BE IN AGGORDANGE WITH THE - TH HOOK ,- WOOD 5TRUGTURAL PANELS '- REFER TO THE TOP FLANGE OF ROLLED scale As NOTED .4R LE� 2 5EGTIONS: DETAILS 51HOWN $ MINIMUM, 5TUD5 SPACED UP TO 24'O.C.'' C A� G C „ BD '' IOD 6"EDGE/12"FIELD a5 Ib 12" - - _ REGUIREMEN75 OF THE -I/2"AND 25/'32"FI5ER90ARD PANELS -. BD - 3"EDGE/6"FIELD - : drawn KMW ab 16 -"- 12" - MASSACHU5ETT5 STATE BUILDING " _ GODS 87H EDITION. .' • - -I/2 GYPSUM WALLBOARD � e SD COOLERS � - T"EDGE/10"FIELD L rev. _ FLOOR SHEATHING rev. .r Z -. :� •• WOOD 5TRUGTURAL PANELS - " R LESS B IOD 6'EDGE/2'FIELD . ry ' - •• ' •' -GREATER THAN I". IOD I6D .6"EDGE/6"FIELD . o " qS- 1 ISSUED FOR CONSTRUCTION sht of, - - (3)2XB HDR Q? o E O 2)2XIO FLR.J015T5016'OG.O - • ry-H/ ___ ___ __ \y o v 9 1/2'AJ5-205®I6"OC. �\ �'�' _ N lC f ram/ uo"s -0 A2 - P A2 - of 7.2X6 WALL BELOW - n 2XIO FLOOR X15T5 2%B GL6..YOISTS— STRWNRAL TRU55 _ t (2)2XI0 FLR.JOISTS®V OG.OR 0 16'O.G. qqq o I/2'Afi-205®I6"O G. - ) 2%B LLb.JOISTS R O 16, P.T.2XI0 LEDGER BOARD LAa BOLTED TO EXISTING FOUND. o a+ F=R STWGNRAI NOTE5 POST DOWN TOE%IST�N:i 2XB CL6.JOI5T5 1� y IF ACCEPTABLE MEMBER I ®16,OO, I LI o (2)2XIO FLR.JOISTS O lb,O.L.OR VERIFY AI TH MILDER• i 9 I/2'AJS-205®16'OC. - - _ (f2) 3/4'X II 1/5"LVL MIN) Ln y E o x o x,o x,° A2 __'_- i E%ISTIN'G FLOOR E—N - v ' S.STEM TOO REM41N r r r r i r i r i r r i r i i i ' i i .. i 7) ------------------------------------- ; 0 r r 8' 8 o x;o x;o n;o ry�o A: n�o n�o �o nio LL`io^� ' __,_ Ex15TIN63X FLWR r Nim �iE i i r , a � SYSTEM TO REMAIN -i i wiN ' i . ' wiN i RiN Ri� RiN FI n - WOOD P05T DOWN. ILI F I R5T FLOOR FRAMING PLAN ffi - WOODF05TUP AND DOWN GE I L I NG FLOOR FRAM I N6 PLAN 11 � 5 G A L E: 1/4 1•-O" - - X - WOOD F05T UP - 5 o A L E: 1/4" = 1'-O- 1 11 N6 RLE NV(4)3/4"DIA.TH +- 51PE 0LT5 ON J.G4 SIDE AS SHOm - BEARING WALL BELOW - (2)1 3/4'X 5/4'LVL - RAFTERS W/(1)15/4, - SEE 5TRUGTURAL GENERAL NOTE5 X o 1/4 LVL L 5.DIM, AND TYPICAL DETAILS FOR OTHER cf) . 3)2X Hq. REQUIREMENTS. pa bjo LO LO 2' w ALL F05T5 @ END5 OF BEAM5 TO BE p (p (3) 2X4'5 OR(3) 2X&'5 UNLE55 NOTED c\l cc 6 ALL WINDOW HEADERS TO BE (5) 2X&'5 s. 0 n)1 B/4'x R 1/4 LVL A2 i W/ I/2" PLYWOOD UNLE55 NOTED ` Lo GEILIN6 BEAM W/(B) N - TOTAL 99/4"DIA THRU 1 o SiRWRAI TRU55 STRUCNRAL TRU55 'LT5 f4 ON EACH 51DE) " • _ e 2XIORAFTER5 2XIORAFTER5 - PROVIDE CONNECTORS AT ALL DECK- _ _` RAFTER TO RIDGE,RIDGE TO POST/ TRu55 AT HIP ROOF 'I TRU55 P05T GAP5/BA5E5,RAFTER TO - - WALL/HEADER,HEADER TO POST IF OO AIZ ExunNG p LOCATIONS - ------------------ IF AGLEPTA3LE MEMBER � - VERIFY AI7H BV-L" - - - n` ((2) T/B'MINIMUM) 2XIO RAFTER5 2%10 RAFTER5 '�' - W � x r g ;2 Q� o.0 t0 2x10 w.FrERs � � r�;. - - _ ,. ` �m !� c/] E%ISTIN6 ROOF RAFTERS O Ib'O.L Li AT DEN ROOF TO BE REMOVED FOR NEW - x RAFTER5 AT 517TIN6 ROOM i "'' ,i 21f DECK 1� zoo to N Y 00 U = CC_ 2xlo RAFTERS W W v O C Nv [l LL i Job no.: 122B date 10 OCT05ER 2012 z P N MASSq scale . A5 NOTED N NIA ' Niy N cy tS (i drawn: KMW R;o R; W N O m W BISH, P rev- STRUCI RAL v' rev. • -NO.294as ry , • PO�cR�GISTEREO o ROOF F R A M N 6 P L A•N - R O O F 'PLAN - - SS G� S 2 n /ONAL f- I 0 5`A`E: 1'4 1 -o" ISSUED FOR CONSTRUCTION snt of .e. -ar 9� r r TOP :=>F G F3 a 0di n ; (11 �U�TE�- i To P ISL rn 73 r t� I 0 19 -i LEno (n Ex I`-rI nC4 SPOT EL.E\/aT l,015: a k — jY �xl-bTlnc4 conTovF;?-. o - -r� FInI,,:�+-} 5F=-c::>T E.L_Evc�T'IvrlS: ox t=iniz + connouw- p Ek r:>ri rlq .&ji D F i nA L. CtRADf!�6 7,0 p-F_M&I rl o D �,T EL 2t�' mirl l7 E5 oJ- _70 ALL dJe)RP-r17Rn-5Hl F Rno m —I -©p r _ mRTER,iRL � r -ro o EQE T1Tl.E. 5 RC7D_ _._. . _ , r�fE 5 RRr] r3LE C. (� ( - , _ , { + , ems; (zt1Les qn D REr d��TIoRS Fore. V, L _. .__. ._ ,1 + t t Sl1f3SUrzFRGi✓ b15Ra5flL of - 2 4 AV T Jf�' s' � f, ,, ... �, v� ;R 5PM7RrzY 5EdJEfz er e. c - /b7iN 3 a p1 ST14 r INf�. HECK S`" I 14 ly -�Si4ED STCiIV f — ISO R � % I F2CAn �� 7 -I O7R F iiili' Q INVERT ELEVATIONS - -C i E 1AIVER7- AT BUIL D;NG 70 —I INLET SEPTIC TANK 9-7, 5 FT (" OUTLET SEPTIC TANK 97 3 r-T INLET DISTP)BUTIDIV BOX 997, 0 FT SEWAGE DI SPOSAL SYSTE 4 OUTLET D/STR)aUTION BOX �•� L T 1 _ EAC',. Pi SOIL. TEST. ,e�7 0(71 LOW, !nip PIT 90 6 1-r cQ,St, DE - ; , ti 74 t_ CUL ATION S _ �')i TF S l �D ..:'� . A ,tip r R ,,r TNC il BY f-k, , s PEA-1CC1��'; ' ,'ON Fl- G Z- MIN ;IVCII ui CHAR BAGF Sri WAL A,r? _ ? Z, (3A` /S 1, %CJTAL �rySr,:1 ,A .TEs�> �[:caW 33O _ .'�,:. ; ';:�v F30Ttc�ru^ fa PEEL c '/RED SE_ OTl! TI A/V�< CA,vACITY �. ACTL/AL S/�E� ��" SFPT C 7A,Vl < I T-0 /3 F_ L. D S v v7F TF k. _3�oii Lo-r 7. 4TUiT - (` F 7- Ek',C-FC i DFPTNJ G q 15Ai?—n57-/�ej-61- . , MASS. "+ AC Tc:A 4._EAC�-a VG AREA �49 � �.�.�.`� rme, I im R[ N 49, 1 —144" EF L = f33 G' 80 919 A+�c.E rl T TOP FNDN. AT EL. 48.8' SYSTEM PROFILE 1L_E TEST HOLE LOGS ACCESS COVER TO WITHIN 6" OF FIN. GRADE (NOT TO SCALE) PROVIDE INSPECTION PORT WITHIN ACCESS COVER (WATERTIGHT) TO 6" OF FINISH GRADE ENGINEER: R.J. O'HEARN a 2.` 44.0't MINIMUM .75' OF COVER OVER PRECAST WITHIN 6 OF FIN. GRADE 2% SLOPE REQUIRED OVER SYSTEMWE 43.0' WITNESS: PAUL MURRAY 2" DOUBLE WASHED PEASTONE 12/10/80. �- RUN PIPE LEVEL ` DATE: FOR FIRST 2' PROPOSED 1500 3' MAX. PERC. RATE = < 2 MIN/INCH coRwwALL _ GALLON SEPTIC 40.75' 40.8' I 6 CT WATERFORD , TANK (H- 10 ) GAS CLASS SOILS P# conurr BAFFLE 40.36' o000 40.19 O O M 0 0 0 1=] og $ 000�00000�oc��000�oo oc � 40.0 0 r7 C] 4' AROUND ?� w"--6"` CRUSHED STONE OR MECHANICAL Ec = O � � = � r 0 C] $a Oocus OR COMPACTION. (15.221 [21) Sc=,- 2 0 71 O a � 0 E] p C] 0 38.0' DEPTH OF FLOW = 4 (2'6% SLOPE) ( 1 % SLOPE) ., o00 01 Q ELEV. , 0,� 42.5' TEE slzEs: 3/4 TO 1 1/2-. DOUBLE WASHED .TONE 43.0 INLET DEPTH = 10" OUTLET DEPTH = 14" TOP & TOP & SUBSOIL SUBSOIL LOCATION MAP NTS FOUNDATION LEACHING 3019 40.5' 30„ 40.0'EXIST. SEPTIC TANK 15' D' BOX 21' FACILITY ASSESSORS MAP 56 PARCEL 15 7.5' CLEAN CLEAN MED. SAND MED. SAND 8.7 30.5' 3g 39�� + 39. NOTE: LEACH PIT t�9.9 UNKNOWN LOCATION 4 40 _. 154 OO .5 + 41.2 41 2 1.1 + 41. 42.4 144 31.0' 144„ 30.5' 15.00 8" OAK + 1.8 3 I NO GROUNDWATER ENCOUNTERED NOTES: 42 + a2.1 12" OAK -I 43.5 SEPTIC DESIGN: (GARBAGE DISPOSER Is NOT ALLOWED ) 1. DATUM IS APPROX. NGVD 1 CA TH2 + a + 4.7 4 �' DESIGN FLOW: 5_ BEDROOMS (1 10 GPD = 550 GPD 2. MUNICIPAL WATER IS EXISTING + G� s3 5 to SEA 550 GPD uJIGNLO��' z �,�,.s���U��; PIPE .'IT"Ii TO BE 8,, PER r00T. u I C SEPTIC TANK: 550 GPD ( 2 ) = 1100 4. DESIGN LOADING iFOR ALL PRECAST UNITS TO BE AASHO H- 10 + 3 a6.a 5. PIPE JOINTS TO BE MADE WATERTIGHT. 46.1 USEi A 1500 GALLON SEPTIC TANK 0 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS. REPLACE EXISTING 1000 GAL SEPTIC TANK WITH (REPLACE EXISTING 1000 GAL. ST WITH NEW 1500 GAL) ENVIRONMENTAL CODE TITLE V. 1500 GAL. SEPTIC TANK LEACHING: 7. THIS PLAN IS FOR PROPOSED SEPTIC SYSTEM ONLY AND IS NOT � TO BE USED. FOR ANY OTHER PURPOSE. (INSTALL MIN. 10' FROM 4.9 2(42 + 12.83 2 74 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. DWELLING). EXISTING \ SIDES: ) (- � = 162 + 43 �`' 6 DWELLING ,o\ BENCH. MARK - HYDRANT ON 42 x 12.83 (.74 = 398 � �6 TOP DN \ �48.8' � 9L\ TAG BOLT #171 ELEV. = 44.2 BOTTOM: ) 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT \ Z;n\ INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED 47.0 TOTAL: 757 S.F. 560 GPD FROM BOARD OF HEALTH. USE (4) 500 GAL. LEACHING CHAMBERS WITH 4' 10. PUMP & REMOVE (OR FILL W/CLEAN SAND) FAILED LEACH PIT STONE ALL AROUND YO44.2 / �/ LEGEND W � ��'�� TITLE 5 SITE PLAN LOT 97 �9F i 1 U0.0 PROPOSED SPOT .ELEVATION OF > 29,128f SQ. FT. � ��'� 228 COTUIT BAY DRIVE 10Ox0 EXISTING SPOT ELEVATION IN THE TOWN OF: 0--MO PROPOSED CONTOUR. . .. (COTUIT} BARNSTAL7L.E / 100 EXISTING CONTOUR PREPARED FOR: BORTOLOTTI CONSTRUCTION/McKONE 30 0 30 60 90 / BOARD OF HEALTH APPROVED DATE MA SCALE: 1„ = 30' DATE: JANUARY 4, 2005 off 508-362-4541 fox 508 362-9880 s°�y\ H OF dOWn cape engineering, inC. � Ao A G�\ °'* ARNE `� $ CIVIL ENGINEERS � No 01�92 l�' �/ OJALA ; LAND SURVEYORS o,� ��� TE�� < ass 04-�354 939 ruin st, Yarmouth, ma 02675 ARNE H. OJALA, ., L. DATE