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0534 COTUIT BAY DRIVE - Health
534 Cotuit Bay Drive Cotuit p �---- — _ A = 055 041 4' t� J i� I i i i I r , { ji 1 -c OWN OF BARNSTABLE I, OCATION cJ J10 tu 0� `� # -dIL,LAGE p` ASSESSOR'S MAP&PARCEL 'S NAME&PHONE NO.061)'KL U SEPTIC TANK CAPACITY 1000 LEACHING FACILITY:(type) \ASS. (size) NO.OF BEDROOMS OWNER c Y PERMIT DATE: CMM=W@9PATE7r1 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 . ! f•/ryf\F\f\f\/\/\J\f\J\f\Jtf\F\/\F4}\{\f\f\{`f;�{ f f J•f�f\lkfkl4{\f\F\f\}\f\/\f,/\{\f\ftf\{\f*!\{\}tf`Ft/`ft f' F { 1 tf\F\F\ftJ4f4F\f\Fkf\Fkf4.F\F\/tt\>,f\J\},}\F\}\F\{\fkf4 F f F / f f J / J r^ \ , , , , , , , , 4 Fkf\/tf\f�•f 22 29 f�F4f\/4Fkf\f\/\f\f \ % ♦• k 1.8 25 f f f ! { f f F f f Back Yard Commonwealth of Massachusetts Title 5 Official Lnspecti.on, Form Subsurface�Sewage Disposal:System Form'- Not:for Volunfary Assessments 534 Cotuit Bay Drive Property Address Bigelow Owner Owners Name , information is required for Cotuit f, _'MA 02635 -July25, 2012" every page. City/Town r f•State ' Zip Code Date of Inspection ,v.t 'Inspectionwres'ults must be submitted on thiiform.'lnspection forms may not be altered in any way. Please see completeness checklist at the end of the form: Important: :..m.. ..=General-Inormaon When filling out A Y_ f ti .• , .Y, - forms the computer,use only the tab key 1. Inspector.y to move your Patrick M. O'Corinell'- cursor-do not Name of use the return Inspector key. Septic Inspection Services Co. " Company Name 189 Cammett Road Company Address Marston's Mills MA r 02648 Citylrown 508-4 r State Zip Code 28-1779 - SI 12855 Wa 'Telephone Number License Number , B Certification.r ' ° z I certify..that l have personally inspected.the;sewage`tlisposal sysfer _ {his address and that the ' information reported.below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience.in the proper function and maintenance of on site sewage disposal systems. I am.a DEP approved'system inspector pursuant to Section 15.340 of ,Title 5(310 CMR 15.000).,The'system: ®Passes , ❑ ,Conditionally Passes ❑ Fails ❑ Needs'Further Evaluation, by the.!_ocal 'pproving Autl�o-'iy � ' July 25, 2012 'Job# 12-119 pector' Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board Hof Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report,to the appropriate regional office of the DEP. The original should be sent to the system owner ,,and copies sent to the buyer, if applicable, and the approving authority. ------------------ ****This.report only desc'ribes'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. t5ins•11/10 a ; Title 5 0 ial pection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title -5 Official Inspection Form- Subsurface Sewage Disposal System Form Not for Volun4arypAssessments 534 Cotuit Bay Drive Property Address 4 Bigelow Owner Owners Name information is COtUIt f - required for MA 02635 July 25, 2012 every page. City/Town State r Zip Code. Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or.E/always complete all of Section D A) System,Passes: ® I have not found any information which indicates that any of the failure criteria described if! 310 CIVIR iZ.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: Tanks were not in need of pumping at time of inspection, one pit was @ 1/3 capaicty and other was - @ 1/2 capacity. 6 B) System Conditionally Passes: . ❑'One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health;will pass. - Check the box for"yes";"no,,or.'not determined!' (Y, N, ND) forxthe 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 c'orrlplying septic 'tank as approved by the Board of Health. f *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. x 0 Y ❑ N 0 ND (Explain below)' t5ins•11/10 g `Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 , Commonwealth of Massachusetts ` _ W ' Title 5 Official -Inspection. Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 534 Cotuit Bay Drive Property Address Bigelow , Owner , Owner's Name information is required for Cotuit MA 02635` July 25,.2012 every page. CItyrrown + State Zip Code R Date of Inspection B. Certification (coht.) , B) System Condition'ally'Passes (cont.): ❑ `Observation`of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if.(with approval of Board of Health): - ❑ 'broken pipe(s) are replaced �° ❑ Y ❑ N ❑ ND (Explain below): ` ❑ obstruction is,removed . . ❑^Y ❑ N ❑, ND (Explain belowj: 47 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): j ❑ broken pipe(s) are replaced' ❑ Y ❑ N ❑ ND (Explain below): t❑ . obstruction is removed ❑ Y` ❑ N ❑+ND (Explain below):. H Further Evaluation is Required by the Boardof Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if 'the"system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15:303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 r Commonwealth of Massachusetts - _ _ Title 5 Official Inspection` Form , Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 534 Cotuit Bay Drive Property Address Bigelow Owner Owners Name information is Cotuit MA 02635 Jul 25, 2012 required for �. - y • everypage. ' City/Town State Zip Code Date of Inspection' B. 'certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: - ❑ The system has a septic tank'and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. . The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. , ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more"from a private water supply well".. Method used to determine distance: This system. passes if the well water analysis, performed at a DEP certified laboratory, for fecal - coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: ., r D) System Failure Criteria Applicable to All Systems: . o You must indicate'"Yes" or"No" to each of the following for all inspections:" Yes No ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ® � Static liquid level in the distribution box above outlet invert due to an.overloaded or clogged SAS or cesspool ® Liquid depth in cesspool is less than 6" below invert or available volume is less - than day flow t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for=Voluntary Assessments M 534 Cotuit Bay Drive Property Address Bigelow Y Owner OwnersN_ame _ information is COtUIt ' required for MA 02635 July 25, 2012 every page. Cltylrown State Zip Code Date of Inspection B. Certification (cont.) Yes No Y ® 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 4 tributary to a surface water supply. , ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ y •® Any portion of a cesspool or privy,is within 50 feet of aprivate 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, a provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- , 10,000gpd. , ❑ ® `` ' .The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CM 15.303, therefore the system fails. The system owner should contact the Board.of Health to determine what will be necessary to correct the failure. E) Large Systems:'To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. ' For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section7D. } Yes No ` ❑ the system is within-400 feet of a surface drinking water supply El ;El the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area.(Interim Wellhead Protection _Area—,IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section'D above the large system has failed. The owner or operator of any large, . system considered a significant threat under Section E or,failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. l5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 t . i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface stem Sewage Disposal S 9 p y Form Not for Voluntary Assessments M 534 Cotuit Bay Drive Property Address Bigelow Owner Owners Name information is _ required for Cotuit MA 02635 July 25, 2012 r every page. City/Town f State Zip Code-0 Date of Inspection C. Checklist - 'Check if the following have been done. You must indicate"yes"or"no" as to each of the following: Yes No t ® ❑ 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? ®Y ❑ Were all system components,'excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example;a plan at the Board of Health. Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information'-. Residential Flow Conditions: Number of bedrooms (design). 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 t5ins•11/10 n Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form _ o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 534 Cotuit Bay Drive `• Property Address Bigelow Owner _ Owners Name information equir for C is otuit MA 02635 July 25, 2012 required for � « " • every page. ' City/Town State Zip Code Date of Inspection D. System Information 'Description: Number of current residents:. - 2 Does residence have a garbage grinder?. w I ❑ Yes ® No Is laundry on a separate sewage system?[if yes.separate inspection required] ❑ Yes ® No Laundry,system inspected? R . ❑ Yes ❑ No Seasonal use? - - ..�, ❑ Yes ❑ •No Water meter readings, if available(last 2 years usage (gpd))-. Detail:Y Sump pump? ❑ Yes ® No Last date of occupancy: i Currently ° t Occupied. Commercial/Industrial Flow Conditions.- Type of Establishment: Design flow(based on 310 CMR 15.203): • 'Gallons per day(gpd) , Basis of design flow (seats/persons/sq.ft., etc.): Grease trap.present?° r ❑ Yes ❑ No y industrial waste holding tank present? ❑ Yes;❑ No « Non-sanitary waste discharged to the Title 5 system? f. El Yes ❑ No ' f Water meter readings,if available: 15ins•11/10 ° Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 A Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments � 534 Cotuit Bay Drive Property Address . Bigelow Owner Owners Name information is required for Cotuit MA 02635 July 25, 2012 every page. Cityll own _ x.State. , Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: j a Date Other(describe below): ,. r f ° General Information Pumping Records: - Source of information: Tanks last pumped 12/8/08 - Was system pumped as part'of the inspection?` ❑ Yes ® No y If yes, volume pumped: ' gallons How was quantity pumped determined? Reason for pumping: Type of System: ; P ® 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 Y inspection of the I/A system by system operator under contract Tight tank. Attach a copy of the DEP approval Cl SOther(describe): !Sins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form 1 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 534 Co_tuit Bay Drive Property Address Bii elow Owner Owners Name , • information is COtUIt required for MA 02635 July 25, 2012 every page. Cltyrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date,installed(if known) and source of information: Unknown Were sewage odors detected when arriving at the site? El Yes ® No Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑ cast iron ®40 PVC " ❑ other(explain): Distance from private water-supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.):' Septic Tank(locate on site plan): Depth below grade: 1' y feet Material of construction:' ®concrete ❑ metal El fiberglass, ❑,pot eth lene y y ❑ other(explain) There are two 1000 gallon septic tanks If tank is metal, list age: ' years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 8.5' long x 5.2'wide.- 1000 gal. 0„ Sludge depth: l5ins•11/10 a Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 i Commonwealth of Massachusetts ' Title 5 Official Inspection Form 6 Subsurface Sewage Disposal System Form.- Not for voluntary Assessments .. 534 Cotu_it Bay Drive Property Address Bigelow Owner Owners Name information is required for Cotuit MA 02635 July 25, 2012 every page. CitylTown s - State :Zip Code Date of Inspection D. System-Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness 01. 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 determined? .-Measured, •j Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Both tanks had liquid only, no solids Liquid levels were at bottom of outlet inverts r' Grease Trap (locate on site plan): Depth below grade: . - feet Material of construction: . ~ ❑ concrete ❑metal ❑ fiberglass ❑ pot eth lene y y ❑ other(explain): Dimensions: ' Scum thickness r 'Distance from top of scum to top of outlet tee or baffle, Distance from bottom of Scum to bottom of outlet tee or baffle " - Date of last pumping:, - Date t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts . Title 5 Official InspectionForm Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 534 Cotuit Bay Drive . . Property Address Bigelow Owner Owners Name information is , required for Cotuit MA- 02635 July 25, 2012 F every page. City/Town State Zip Code , Date of Inspection ,-D Sy stem . y m Information (cont.) Comments (on pumping recommendations, inlet and outlet.tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tighttll or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth-below grade:` i Material of construction: ". ❑concrete ❑ metal ❑ fiberglass 9 ❑ poly ethylene ❑ other(explain): Dimensions: • Capacity: � � i . • , � - - 4, gallons, Design Flow: x �, gallons per day Alarm present: ❑ Yes' ElNo., 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 contract(required). Is copy attached? : ' ❑ Yes ❑ No t5ins•11/10 ' r Title 5 Official Inspection Form:.Subsurface Sewage Dis posal sposal System Page 11 0l 17 Commonwealth of Massachusetts y { Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 534 Cotuit Bay Drive Property Address _Bigelow Owner Owners Name information is , required for Cotuit MA _ 02635 July 25, 2012 every page. Cltyrrown State' Zip Code Date of Inspection- D. System Information (cont.) ` Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Comments (note if box is level and distribution to out 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 ❑ No Alarms in working order. ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): , Soil Absorption System (SAS) (locate on site plan,-excavation not required): If SAS not located, explain why: t t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 s • Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 534 Cotuit BaY Drive _ Property Address. _ Bigelow Owner Owners Name information is required for Cotuit MA. 02635 July 25, 2012 every page. Citylrown .State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pitsA number. Two 6x6 pits s leaching chamber's number: ❑ leaching galleries number: EJ leaching trenches number, length: } ❑1 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.): ` One leaching pit was at 1'/3 capacity and other was half full.r . Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth-top of liquid to inlet invert ' Depth of solids layer Depth of scum layer ' Dimensions of cesspool Materials of construction , Indication of groundwater inflow ❑ Yes ❑ No t5ins•11110 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 13 of 17 w1 Commonwealth of Massachusetts, Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w 534 Cotuit Bay Drive Property Address Bigelow Owner Owners Name information is required for Cotuit ` • r MA 02635' July 25, 2012' every page. City/Town ' - State Zip Code ' Date of Inspection . D. Systemllnformation Xcont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): , Privy (locate on site plan):. r ♦ y ' Materials'of construction: Dimensions - Depth of.solids Comments.(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.):. 15ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 a Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 534 Cotuit Bay Drive Property Address _ Bigelow .E ` Owner ------ ------- ..— --_.._:..-----=--- —._...-- --- Owner's Name. ,. information is -- required for, Cotuit _ _ Jul 25, 2012 MA 02635 y every page. " Cityrrown — -"---—" -" - -- State Zip Code Date of Inspection D. System lnformMion (coni.) 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 • \ \ \ \ ♦ \ \ \ ♦ \ \' \!\!\/ r / ! r / ! r / ! ! / fir / / / / / 18 .25 Back Yard { Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 534 Cotuit Bay Drive Property Address Bigelow Owner ' Owners Name information is a required for Cotuit MA 02635 July 25, 2012 every page. Citylrown State Zip Code Date of Inspection D: System Informatiow(cont.) Site Exam: ' ® Check Slope ® Surface water ® Check cellar ` ` -Shallow wells Estimated depth to high ground water: 20+ feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from,system design plans on record- If checked, date of design plan reviewed: pate ® Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -.explain: 4 4 - ❑ Checked with.local excavators,installers,-.(attach documentation) ❑ Accessed USGS database-explain: Y You must describe how you established'the high ground water elevation: Low areas of adjacent properties are-lower than SAS - Before filing this Inspection Report, please see Report Completeness Checklist on next page. + . t5ins•11f10 ` P Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 . Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 534 Cotuit Bay Drive Property Address _ Bigelow. Owner Owners Name ' r si t• information is Cotuit - _ MA 02635" July 25, 2012 required for +� e every page. Cityrrown 'State Zip Code Date of Inspection E. Report�Completeness Checklist# , R a Inspection Summa6$'A, B, C,`D, or E checked , ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information." Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file a • _ All e ... # - _ s . • .,. sue. 15ins•11/10 L Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 + 4 SEWAGE INSPECTIONS \ I rr I DATE 6 VII_' ,=.C' i — ASSESSOR'S MAP & LOT SEPTIC TfWK CAPACITYi/C 4� a LEACHING FACILITY: (ty' L0 'NO. OF BEDROOMS BUILDER OR OWNER `�% GT 3 OWNER MAILING ADDRESS 53y co , r6cW �� . --- " F DATE 11112iO4 RECEIVED PROPERTY ADDRESS 534 Co.tu.i.t Bay Da.ive NOV 1 9 2004 Cotu.it, Ma.1 rOVVNOFg HEALTH RNS7-A6LE EPT, 02635 On the above date, the4eptic system at the address above'was inspected. This system consists of the following: MAP 1. 2-1000 gaiion Zept.ic tanks.- PARCEL ""�'^ ems► 2..2- 1000 ga-eion -eeach.ing p.its.1 ®�l L0 71 Based on inspection, I certify the following conditions: 3.,7h.i6 .ie a t.itie dive zept.ic zyztem (78code) 4.,7he zept.ic byztem .iz .in paopea woak.ing oadea at the paeseat time. 5.-Both ieachh.ing pit had 52" watea to .invent p.ipe.� SIGNATURE � Name: Robert A. Paolini Company: Joseph P. Macomber & Son Inc . Address: P. O. Box 66 Centerville Mass 02632 Phone: 508-775�3338 or 508-775-6412 LSE P. MACOMBER & SON,: INC.. Tanks-Cesspools•l.eachfieldsPumped .&.InstalledTown Seger Conne0tlonsx 66 Centerville, MA.0.2f.32-0066 7754330 . -775.6412- COmmONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRO WNTAL AFFAIRS d DEPARTMENT'OF VNV11t0N* T pROT CTION . Y TITLE 5 OFFICIAL INSPECTION FORM—.NAT;>E`OR.VOLVNTARy ASSESSl1+IENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART•A CERTIFICATION . Property Address: ..5 3 4 C o tli i t Bay lea i e Cotu.it. Na.,- Owner'sName: ld.i-e.e.iam [3igp Pot>> Owner's Address:S am o Date of Inspection: 11 12104 Name of Inspector: (please print) Company Name: ? l►]n n n mB 2/t' .SAn L hC. Mailing.Address: an eavt e, abb.•02632 Telephone Number: 5 0 8-7 7 3 338 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system,at this address and that the.iitformation 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. ite sewage disposal systems.I am a DEP approved system inspector pursuant to,�Section.15340.of-Title 5(31.0 CMR•15:000). The system: _XjXPasses Conditionally Passes Needs Further Evaluation by the Local Approving.Authority Failt Ze . e. Dater Inspectors Signgt'ar : . The system inspector shall submit a copy of this inspection repori-toatlhe.Apdp���,ethos i d���W Health0,000 DEP)within 30 days of completing this inspection.If the system is .. Y gpd or greater,the inspector and the system bwner.shall submit�e report to the appropriate`regional•office of DEP.The orig'mal should be sent to system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments ` me of ins ectibn-and under the conditions of use at-that conditions at the time p . ** describes con d�tio «* des This report only �^ time.This inspection does not address how the system will perform in the future under the same or different conditions of use. -r..,e c Tnenontim Rnrm 6/15/2000 page I Page 2 of 11 OFFICIAL;INSPECTION;FORM—NOT F-MVOLUNTARY ASSESSIVMNTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOTM : PART'A CERTIFLCATION(continued) Property Address: 534 C o.t a i Bay Da i v e o u.i , t7at Owner: W-ei iam ^B i ae P_ow Date of Inspection: I I/12 0 4 Inspection-Summary" ChOck A;B;C,D of E/AZ,M, Y_seomplete4tll of Section;D A. System Passes: n o 1 have not found any information which indieates`that any of the failure criteria described an 310 CMR 15.303.or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: - B. System Conditionally Passes: n o One or more system components•as described in the"Conditional'Pass =sections need to be teplaced.or. repaired.The system,upon completion of-the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements.If"not determined"please explain. n a.The septic tank is.metal.and.over20 years old*or the septic-tank(whether•metal-or not).isaracturally unsound,exhibits substantial!infiltratiam or exfiltration.or-tank.•failwre-is inent:System-will pass inspection ifthe existing tank is replaced with'a complying septic•tankes-approved by.the•:Beard of Health. •A metal septic tank will pass inspection if it is structurally sound,not•leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ' ND explain: a o 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. . obstniction is removed'-.. distribi fienboils leveled-or.replaced ND explain: no 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 te Board of Health): broken pipe(s)are replaced obstruction is removed ND explain. • 2 Page 3 of 11 O1 iCIAL)EIV IxECTION FORM-3�T iV'fJLUN'F�Ry AS E&SMENTS -� SUgg�TRFACE g W A CE IXSROS*L SYSTEM.INSPECTIONTORM PART°A . . •C�R,TIP'I�Ar•TIbN.''(�oritint�ed) : �. Property Ad dress: 534 COLuG;L Baq. D2ive Owner:. 611 P Li n,. Date of Inspection: 1 9 � �, A C. Further Evaluation-is.Required by the Board of Health: n o Conditions.exist which require fiuther•.evaluatign by-the•Board:oi!jHeaith;in or$erto;detertriine if-the system. is failing to protect public•health,safety or the environment. "f O(b) 1, System will bass unless,Board gfJFIealth detezminestih a�aordFM► a with 310.CMlit 15:3031 at the system is•not fuvetiontag in.a•manueriwhiehwlll•protect public health,safety•atttl•tbe.enYironmeat: n o Cesspool or privy is-within,50 feet of astaface water n o Cesspool or privy is within 50 feet of•a bordering vegetated wetland or a salt marsh. 2. System will fail unless the Board-of Health{and Public Water Supplier;•tf any),dbtermines:that the system is functioning in a mariner,that proteets the public health,safety and environment: r. rLQ The system has aseptic tahk and soil absorption'system•(SA•S).and the SAS is.within 100 ur fe.et.ofa surface water supply or-tributary to a surface water.supply. , n o The system-has•a•sepiic tank and SAS and the;SAS is-wid,jin a Zone I ota•public water.-supply. n o' The system has aseptic tank and.SAS:and-the SAS is within, faet 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 oritore from a ,� private water supply well".Method used to determine distance- **This system passes if the well water analysis,performed at a DEP certified laboratory,,for coliform bacteria and volatile organic compounds indicates that the well is free from-pollution from that facility and itrogen and nitrate nitrogen is equal to or.less than 5 ppm,provided that no-other the presence of ammonia n failure'�criteria are triggered.'A cop} of the analysis must be,attached to flits form. °�i 3. Others Page 4 of 11 MMENT- 4FmmL•INSPECTIA'N FORM-NOT JFO OL INSPECTION FORMs .SUBSURFACE SEWAGEDISPOS�cL SST PART A CERTi4I�'IC-A (gontinued) Property Address: 5 3 4 C o Lu Lt Ba a�i v e Owner:1v 0 0:n m /'?i- Date of Inspection: D. System Failure Criteria applicable to all systems:. You must indicate."yes"or"no"to.each.of-- :following for a- Il inspections: Yes No _ . overloaded or Backup.of sewage;into-f'at'gty-orsystem-component•due•:tooverloaded-.oi clogged-SA x .Discharge:or ponding of effluent to the.surface ot;the.. round gr..surface:waters due to.an clogged SAS or cesspool ' outlet invert due to an nve x Static liquid level in.the distribution box above rlbaded or dogged SAS or —' cesspool x Liquid depth in cesspool is less than.6"below invert or,availablesvolume is less than'AAay flow _ x Required pumping more than-4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped x Any portion of.the SAS,cesspool-or privy is below high ground water elevation. Ariy.portion of cesspool or privy is within Ioo feet of a surface water supply.or tribunary to a surface water supply: x Any portion ofa cesspool-or•privy s'within a:Zone:l.,of•a;public.well. . x Any portion of a cesspool-or privy is within So-feet of a private water supply well. '— x Any portion of a.eesspool•or-privy is less-than 100 feet but•greater..than 50 feet from a.private•water supply well with no acceptable water quality.analysis,IThis;aystem.passes if the well wateranalysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic.compounds Indicates:that the well is free from pollutlow-ftom4bat.facility. and:thg 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 aiust be attaehed'.to this foriq.] n o .(Yes/No)-The system fails.Ihave determined that one ormore of:the:above.failure:criteria exist as described in 310 CMR 15.303,therefore thesystetu-••fails.The-system owner.should contact the Board of Health-to determine what will be-necessary to correct the failure. E. Large Systems: d to 15i000. 'To be considered a large system the:system must.serve.a<.faeility,with a design flow of 1A�000 gp 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 1 x the-system is withirr400 feet of a surface water su drinking PP Y x the system.is within 200 feet of a tributary to a surlac�drinking Water'supply x. the:system is located is a nitrogen sensitive areas(Xnterirn wellhead Protection Area-IWPA)or a mgpped Zone Il of a public water supply well If you have-answered"yes"to any question in Section E the system operator of any large ystem threat dered aid "yes"in Section D above the large system has failed.Th significant threat under Secrion E or.failed under Section D'shall upgrade the•system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional.office of the Department. 4 Page 5 of 11 OFF ICI'AL INSPECTION FORM—NOT FOR-VOLUNTARY ASSESSMENTS �— St�$SURFACESEWAGE DISPOSAL---SYST£M INSFEC'PI(IN FORM PART CHECKLIST Property Address: 534 C•otu.i.t, aazi [7a give o u c , a.: Owner: ,P i n m i3 v o w Date of Inspectio$:: " 1 1 1h 2 4 n i Check.if the following have been dgne You'must indicate"yes"or"no'!as,_to each.of the following: Yes No x — pumping information wa_:s prgvided-by the Qwner,occupant,or Board.of Health x Were any of the system components pumped out in the previous two weeks? x Has the system received normal flows in the previous two week period? — — , _ x Have large volumes of water been introduced to the system recently or as-part of th�inspection? x Were as built plans of-the system'obtained and examined?(If they were not available!tote is N/A) x Was the facility.or.dwelling inspected for signs of sewage back up? x Was the site inspected for signs of break out? X. _ Were all system components,excludiDg the SAS;located on site.?- _x• _ Were the septic tank manholes uncovered;topened;and the interior of the tank inspected for the conditioi of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? _x _ Was.the facility'owner(and occupants if diff6rent 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 detem ted based on: Yes no x Existing information:For example,a plan at the Board of.Health. _ x Determined in the field(if any of the failure criteria related to Part C is at issue approxirt%tion-d distan is unacceptable)[310 CMR 15.302(3)(b)1 Page 6 of 11 OFFD IAL 94SPECTION::1itORK NOT FOR VOLUNTARY ASSESSMENTS SUBSU"ACE-SEWAGE DISRO.$ALrSYSTEKINSPEETI0N FORM PART.0 -SYSTEM INFORKATION Property Address: 534 C o t u i t Ba_D i v e Coi_ui Owner: ld.t-2iigm B i ae eo w Date of Inspection: 1,t1.1210 4 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):•;r6 N=ber of bedrooms.-(actual): 4 DESIGN'flow based on 110 .101:(for example:'I I0 gpd ii#•bfbedroomsy-'1.10x 6=6 6 0 gpd Number of current residents: ., I7oes.vesidence have a garbage grinder(yes or no):y-e-6 Is laundry on a separate sewage.sXsiem.(yes-or.no):. n n [if yes separgte inspection required] Laundry system inspected(yes or no):U_e__6 Seasonal use:(yes or no):pLCL D'i Q T& Water meter readings,if available(last 2 years usage(gpd)):o g Sump pumR(yes or no):_n • s S 1 o wO a;Z y o Last date of occupancy: Rn 12 A 9 n f_ COMMERCIAI�fl;1'!�bUSTRIAL Type of estallt: n_ Design flgw. �' on 310 CMR 15.203):. na apd- Basts.of d�gigatow(seats/.persons/sgft,etc.): na Grease trap•present(yes or no):n a Industrial waste holding tank present•(yes or no): na Non-sanitary waste discharged to the Title 5 system•(yes or no):n Water-meter readings,if available: n n Lasi dite of occupancy/use: .n n . OTHER(describe):. GENERAL INFORMATION. ' Pumping Records Source of information: . Was system pumped as part of the inspection(yes or no):_ If yes,volume pumped:_gallons--How was quantity,pumped determined? Reason for-pumping: �,;•.. TYPE OF SYSTEM x Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool _Privy _Shared system('yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative technology,Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank Attach a.copyof the DEP.approval Other(describe): Approximate age of all components,date installed(if known)and source of information: 1977 Were sewage odors detected when arriving at.the site(yes or no):no 6 Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM a PART C SYSTEM INFORMATION(continued) Property Address: 5 2 4`� Date of Inspection: BUILDING SEWER(locate on site plan) Depth below grade: 7 4" Materials of construction:_cast iron x x40 PVC other(explain): Distance from private water supply well ousuction liner j Q' f Comments(on condition of joints,venting,evidence.of leakage,etc.): 7n.:nLi a nnvaa # ' hf_•N co evidence o, leakage Sy s.t t em ven ed thorough house ven.tz. s, SEPTIC TANK: (locate on site plan) Depth below grade: 16" Material of construction:y x concrete_metal, fibergl fiberglass polyethylene _other(explain) • _ If tank is-metal list age:_aQ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: 4, R",,i-ido/5 R'h gh18' 6".long Sludge depih• 14 n"12 Distance fr m top of sludge to bottom of outlet tee or baffle: Scum thic e�ss• e¢AA Phan Z" Distance from top of scum to top of outlet tee or baffle: 7 n Distance from bottom of scum to bottom of outlet tee or baffle: 1 3- How were dimensions determined; m o n A i i n n d Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): - •Tanks "a eat .stoructuora.l.ly .6ound TnpnI and outlet tees aore -irn 12 ace GIREASE TRAP: g(locate on site plan) Depth below grade:r Material of construction:_concrete metal_fiberglass--Polyethylene_other (explain): n a Dimensions: n a Scum thickness: f ,. »u Distance from top of scum to top of outlet tee or baffle: n a Distance from bottom of scum to bottom of outlet tee or-baffle: n a Date of last pumping: n a Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): ' 6orea se taaR not Raez•ent.- Ti+la S Tnwu►rtinn Rn,,,,#;n;ionnn 7 Page 8 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS : ORWRF;A,CE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continues}) Property Address: 534 Cotu.it Bau DIt.ive Owner- g e m Date of Iispection: TIGHT or HO•I,DING TANK:n° (tank must be pumped at time of inspeotion)(locate on site plan) Depth below grade: no- Material of construction: concrete metal fiberglass _polyethylene other(explain). Dimensions: n'n Capacity: nez .gallons Design Flow: na gallons%day Alarm present(yes or no):_aa_ Alarm level: . n n Alarm'in working.order(yes or no): n e7 Date of last pumping: na Comments(condition of alarm and float•switches,etc,): 7.ight oz hQ ed.iaa .t_anki n,o.t 121zp,.Svn}_'. DISTRIBUTION BOX: no (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: na Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of akage into or out of box, etc.): Di.etaigut.ion eox not an_P.sn_n_.t." r PUMP CHAMBER: no (locate on sife.plan) Pumps in working order(yes or.no): n"a Alarms in working order(yes or no): na* Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): l uml2 ehameelt not /a2e.5ent: • 8 Page 9 of 11 OFFICIAL INSPECTION FORM—'NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE.DISPOSAL:SYSTEM INSPECTION FORM PART SYSTEM INFORMATION(continued). Property Address: 4 ra t tt i. bra sib bve Owner:. Date of Inspection: x x SOIL ABSORPTION SYSTEM(SAS):„-(locate on site plan,excavation-not"required) If SAS not located explain why: /nrnf¢r/ aaa Q. -a TO Type teaching pits,number:_2 leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: innovative/altemative'system Type/name-of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.). .-�. No 3.i n CESSPOOLS: no (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: • na Depth—top of liquid to inlet invert: n a Depth of solids layer: na Depth of scum layer:_ na Dimensions of cesspool: na Materials of construction: n n Inoication of genmdwatet.iwflow(yes oc nod. Comments(note condition of so11,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): CgzzPoo eb no"t nit of PRIVY: no (locate on site plan) Materials of construction: a a Dimensions: na Depth of solids: na Comments(note condition of soil,signs of hydraulic failure,level of'ponding,,condition of vegetation,etc.): y 9 Page 10 of 11. •Y�TARY SpFJC.3'-ION NO'1�'3�'OI"�VAI: �' 1�'EG'�0�4-ASSESSMENTS SbBSUMACE'BEWAGEM;SPO SA'� S�f$�}EA PART SYSTEM PMR14 AUON(pondwed) Property Address. 5 3 4' C o t u.i t [3c���2 e v e o u.c Owner: a �ow Date of Inspection: 9 9 !�•��'�"�— SKETCH OF SEWAGOISPOSA►L SYSTEM ties to at least two perinanertt refersnae lanc>utarks or Provide a sketch of the sewage disposal system including bencbmarlcs•Locate all wells w}thin 100 feet.Locate where publievopr supply entars.the building. CIOC�nt 10 Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNT E ASSESSMENTS SZJgSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM.INFORMATION(continued). Property Address: ('nfuif 1r7� — Owner: Date of Inspection: , SITE EXAM Slope Surface water Check cellar. Shallow wells Estimated depth to ground water feet Please in (check)all methods used to determine the high ground water elevation: •v Obtained from system design plans on record-If checked, 0 feet date f desig plan Mviewed: withiObserved site(abutting property/observation hole Qb,Checked with local-Board of Health-explain, TU;-' ecked*with local excavators,installers-(attach documental o ) 9 , AAA sed USGSdatabase=explain: ` -. You must describe how you established the 1 h ground water elevation: used;Gahert & Miller mo used.•USGS observation w used• Technical bull - wa er a eva ions. Leaching Pit ,eet r undwater: feet Below Bottom-of Pit High Cnoundwater Adjustment 1.8 ft per Fgirnpt%Method Z� Therefore,the-vertical.separation distance between the bottom of the lead ing pit and the adjusted groundwater table is feet: t,•nrnr+l•-n'Tsr'-+T- rn.-mNnmrrrKn+'n*.rerarn+.•++rm�1�r►'er+K*+nsrn•ar r+e'�T�K� I '1'ONN OF Barnstable BOARD OF HEALTH SU1l9b1?FACR SEWAGE I)ISPOaOAL SYSTEM I1iS[�FGTION FORM - PART D - CERTIFICATION ' mn�rrnernTan••T�•e�nT�nS..rT•r•�• .- t T.IIR^•ITT\tSrtK'KtrTI TITKT*7'R7flTT+�S'I r'{ITir'I�K7r� RR•KRfiT�r� _TiPt OR PRINT CLEARLY- PROPERTY INSPECTED STREET ADDRESS 534 Cotujt, BayB2cve l ASSESSORS MAP , D) OCK AND PARCEL # 055-041 (i,iii iam B•igeiOw OwNEW. s NAME PAR 7 U - cERTZFI CATION NAME OF INSPECTOR COMPANY NAME Joseph .P. Macombex • x, Son Inc COMPANY ADDRESS Box 66 Centerville' Mass 02632 state ctP Streit Town or Q COMPANY TELEPHONC ( 508 } 775-3338 FAX ( 508 ) 790-1578 CER'rI CICAT-ION. STATEMENT I certify that I .. have personally inspected the sewage dieposaY system t .this nddr.ess and that the information reported is tr.ue., 'accurate, and complete as of the time o€ ,inspection, The inspection was performed and any '/recommendatiOtis rega.rdiiig updr.ade', maintenance , an$ repair are consistent w,itlt my' training and experience in the proper function and maintenance of of site sewage disposal systems • Check one ; xx System .PASSED The inspection which I have conducted has not found any information which indicates that th,e system fails -to adequately protect public healClt or the envir•otiment`as defined i.n 310 CMR 16 . 303 . Any . failtire criteria not evaluated are as stated in the FAILURE CRITERIA section o this form . System FAILED* The inspection which I have cond'ncted. has found that the system fails protect the }iub.lic health and the environment in accordance with Title 6 , 3.10 CMR 1613Q3 , and as specifically noted on PART C - FAILURE CRITERIA of this inspe t ' r. fo Inspector Signature . F. ate „une copy of this p*rGt'ficatihe o^R�t1QF be provided to the owNER, the BUYER '( where appllcabla ) and t 1 . ion FAILED, �h,e. ow-nor oroperator. shal'1 upgrade ' the ayetem If the inspection within one year or the dnte of the inspection, unle9s allowed or required provided in 3.10 CNR 161:3.061 otherwise as pr partd . d 1 Y r 7 9 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Address of property S-341 Coi�,� , may ' C© / FAO \ Owner' s namera Co2nr//�v-� SAruer� Date of Inspection a P 5���. �8� 14�5 � f ik �Z51 PART A � CHECKLISTp Check if the following have been done : _ Pumping information was requested of the owner, occupant, and Board of Health. _Lx' None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period . Large volumes of water have not been introduced into the system recently or as part of this inspection. As built plans have been obtained and examined . Note if they are not available with N/A. _V'- The facility or dwelling was inspected for signs of sewage back-up. The site was inspected for signs of breakout . All system components, excluding the SAS , have been located on the site. The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. ✓ The size and location of the SAS on the site has been determined based on existing information or approximated by non-intrusive methods. �✓ The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of SSDS . r l 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ' PART B SYSTEM INFORMATION s 3 2+\ FLOW CONDITIONS 'I If residential number of bedrooms 0 number of current residents 14F-S_ garbage grinder, yes or no yES laundry connected to system, yes or no tVVo seasonal use, yes or no If nonresidential , calculated flow: Water meter readings ,- if available: O�Ll36S Sep_I Last date of occupancy GENERAL INFORMATION Pumping records and source of information: System pumped as part of inspection, yes or no if yes , volume pumped Ped Reason for pumping : Type of system (,'OM I-Ir _ Septic tank/distribution box/soil absorption system — s /cf,r Single cesspool Overflow cesspool Privy Shared system (yes or no) ( if yes, attach previous inspection records', if any) Other (explain) Approximate age of all components. Date installed , if known. Source of information: O Sewage odors detected when arriving at the site, yes or no 9 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SEPTIC TANK: a —J/00c' (locate on site plan) „ depth below grade: ao material of construction: concrete metal FRP other(explain) dimensions: X l� sludge depth distance from top of sludge to bottom of outlet tee or baffle O" scum thickness /M distance from top of scum to top of outlet tee or baffle distance from bottom of scum to bottom of outlet tee or baffle Comments: (recommendation for pumping , condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity , evidence of leakage, rec mmendatio s for repairs etc. ) /mil L/ '�pwn o.•r /�� Dv,� /,��3/1J � No��i• Tov�l.� /. 7-5, Jr / DISTRIBUTION BOX: ( locate on site plan) depth of liquid level above outlet invert Comments : (note if level and distribution is equal , evidence of solids carryover, evidence of leakage into or out of box , recommendation for repairs, etc. ) PUMP CHAMBER: ( locate on site plan) pumps in working order, yes or no Comments : s and appurtenances, (note condition of pump chamber, condition of pumps recommendations for maintenance or repairs, etc. ) i 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued �?' �/t f�f l>c: �rCH2� c-7 EM SAcr lc but may be IL ABSORPTION SYSn1gexcavation not required, � ' ocate on site plan, possible; proximated by non-intrusive methods) not determined to be present, explain: - a ,pe — /poo Oil .aching pits and number :aching chambers and number eaching galleries and number eaching trenches, number, length number, dimensions nu eaching fields, number verflow cesspool , failure, level of ponding , omments: signs of hydraulic , airs, etc . ) note condition of soil , g ition of vegetation, recommendations for maintenance or re :ond . -CSSPOOLS ( 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 pumped as inflow (cesspool must be pum p part of inspection) draulic failure, level o'f ponding , Comments: signs of by airs, etc . ) (note condition of soil ' recommendations for maintenance or rep condition of vegetation, PRIVY : tan) ( locate on site p materials of construction dimensions depth of solids level of ponding , Comments : signs Of hydraulic failure, airs, etc. ) (note condition of soon recommendations for maintenance or re condition of vegetate , 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100 ' �ro T zr L� A1)L / �)) �,7A O 1 An h 2 a S-rSTcIvx �'nle`l °2 a 3y t DEPTH TO GROUNDWATER i _0_ depth to groundwater method of determination or approximation: }� U S. Ce��uctcA � .SV2vL�1 1lAA l V A D(z n 4 e.- 12 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C FAILURE CRITERIA Indicate yes, no, or not determined (Y, N, or ND) . Describe basis of determination in all instances . If "not determined" , explain why not) Backup of sewage into facility? — l/Sv�r/- nf�cc% af�"�%2�0� )V/ . Discharge or ponding of effluent to the surface of the ground or surface waters? Static liquid level in the distribution box above outlet invert? N 41q J4 Liquid depth in cesspool <6" below invert or available volume< 1/2 day flow? .• Required pumping 4 times or more in the last year? number of times pumped Septic tank is metal? cracked? structurally unsound? substantial infiltration? substantial exfiltration? tank failure imminent? Is any portion of the SAS , cesspool or privy : below the high groundwater elevation. within 50 feet of a surface water? within 100 feet of a surface water supply or tributary to a surface water supply? within a Zone I of a public well? / within 50 feet of a bordering the borderingor salt marsh (cesspools and privies only , not within 50 feet of a private water supply well? greater than 50 feet from a private water less than 100 feet but supply well with no acceptable water quality analysis? If the well pp y of well water analysi has been analyzed to be acceptable, attach copy ammonia nitrogen for coliform bacteria, volatile organic compounds, and nitrate nitrogen. r !0' A T ION S E GE PER-MIT NO. Ksc� .VlLLAGE -_-- ;:I`:NSTA LL R'S NAME. & ADDRESS U\I'L D E R OR OWNER c c: ,p>ATE PERMIT ISSUED 6 ZY 7 ;:`D'ATE COMPLIANCE' ISSUED 7 .L. 'J E1 � . I .. .... S 13 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART D CERTIFICATION Name of Inspector Company Name BRUCE MAC.ow►_LISTE SHORELINE CONSTRUCTION Company Address 8-7 POND STREET 4 Certification Statement I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true, accurate and complete as of the time of inspection. The inspection was performed and any recommendations regarding upgrade, maintenance and repair are consistent with my training and experience in the proper function and manitenance of on-site sewage disposal systems. Check one: __)z�- I have not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15. 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. I have determined that the system fails to protect public health and the environment as defined in 310 CMR 15 . 303 . The basis for this determination is provided in the FAILURE CRITERIA section of this form. Inspector' s Signature Date 4� Original to system owner Copies to: Buyer ( if applicable) Approving authority TUW'v GF BARNSTABLE LOCATION 3 COZE" r)q0'/1/C SEWAGE# 2s<-i_9"eT/uW VI;�LAGE: CQ I v - ASSESSOR'S MAP&LOT INSTALLER'S NAME&PHONE NO 'R.�� yee tc-U t' STe r SEPTIC TANK CAPACITY LEACHING FACILITY: (type) j/ (size) :P_ 6 X 8 NO.OF BEDROOMS 3 BUILDER OR OWNER CO &Ae t�S�ra�se�t PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feee pf leaching fa ' ) i Feet Furnished by 7,L a.9.f , fill t L{�� A � Trjn I F>��....../....................... THE COMMONWEALTH OF MASSACHUSETTS E ARD OF HEALTH l � ..... . .... .. -. --- .._0,A ................... ... .. . App irn#inn -for 11-4 uiittl lVaiks Tom4rnrtinn Vantit Application i ere y Imade for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal System at: 5,3�' C'0t �'' moo. ✓~ =�Y-- try e�P v .............................................. Location-Address _ Lot No. W � Owner � X p � Address a - nstaller Address d Type of Building OK Size Lot..3 __tf _ ---Sq. feet Dwelling—No. of Bedrooms---------- �;-_•----•___ __________ ttic (414) Garbage Grinder �m aOther—Type of Building ___________________________• No: of persons---------------------------- Showers (7) - Cafeteria ( ) Q' Other fixtures ------------------------------------------------------ Desi n Flow__........._ o ...................gallons per person per day. Total daily flow............ . ��......... Mons. W g �------ g� P P P „ ,Y �� ��---.._. ..-----g� WSeptic Tank—Liquid capa- -v"_OPPgallons__ Length__9_'_6__ __ Width=_!y_ - 1�Q_.. Diameter---------------- Depth.. Disposal Trench—No. ........._--------- Widt/hh................... Total Length_--________-____-.- Total leaching area---------------------sq. ft. Seepage Pit No------- -------- Diameter.___(,............... Depth below inlet--=_�-y. Total leaching area _ __sq. ff. Z Other Distribution box ( ) Dosing tank ( ) -O�- V_;0-- 7-6 Percolation Test Results . Performed bY------------- ------ -----------------------------•------•-------•....... Date--------------------------------------- Test Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water------_._.------._--__-- (i//, Test Pit No. 2......•---------minutes per inch Depth of Test Pit____________________ Depth to ground water--.------_----.-__-_-__: Fw .-__.--._________________________ ._._____..._._...._.._._....._.. / Description of Soil- ( �� t 't+ - ... .f - v ------------------------------- '-..../.-�...--- ' �- --- --- W ------------------ ------ ---------------------------------------------------------------------------------------------------------------------------------------- ---------- -------------------------- VNature of Repairs or Alterations Answer when applicable..-------------------------------------------------------------------...__.-------------------- ---------------------------------------------------------- ._.... --------------------------------------------- --------------------•--------------•-------------------------------------------------- Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b s U.,V y t oard of he ignOZ1 ---- Application Approved BY------ -- - ----- ._.__ Date Application Disapproved for the following reasons:.......................... ------------------------------------------------------ •---•---•-••----•-•-•--•- ......................----------------------------------------•-----•••-- ......................................................•------------------------------------------------------------------ Date PermitNo................................................ issued...................... ................................. Date --------------------------------------------------,---------------------------------------- --- - - ---- rk // J No........... /-------• FInc....<....................... THE COMMONWEALTH OF MASSACHUSETTS 4 BOARD OF HEALTH ............ ...... ... ....._...........OF....... ..................... .......... - ...... 4'- ApplirFation -fur 43iiputiaf Works Totmtrurtioaa Prrutit Application is hereby'made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ...................•--------••-----•-•----•-------------------------------......_••----•-••---••- •.....-•---•••-•-••••-•----•-•-•--•---••-•••--.....•-••--•-•-•-----•-.........---•-......-------- Location-Address or Lot No. ..• . -------------------••---------------..........---•---••--•---•--•-•••-............•-•-•--•-..._--- •W=� qa. a Owp er Address W Installer Address UType of Building Size Lot.............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) `4 Other—Type T e of Building Pa YP g -------•---••--------------- No. of persons............................ Showers ( ) — Cafeteria ( ) a' iOther'fixtures -------t-------•--------------------------------------------------------------------- W Design Flow.....................................!-------gallons per person per day. Total daily flow---------------------------------------.....gallons. WSeptic Tank—Liquid capacity------_-_--gallons Length---------------- Width................ Diameter------.--------- Depth.-._---._------- x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area--------------------Sq. ft. Seepage Pit"No-_-------_--------- Diameter.................... Depth below inlet.................... Total leaching area.__-._.-.--.---_-sq. ft. z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed bY------------- ------------------------------------------------------------ Date--------------------------•------------- Test Pit No. I................minutes per inch Depth of "Pest Pit_..--------------- Depth to ground water........................ IZ4 Test Pit No.'2................minutes per inch Depth of Test Pit.................... Depth to ground water--.--.---_-__..._--__- GY ------------------- ---- --------------------------------------•-----------------------••-----------------•-------------- --------------------------------- O Description of Soil............. ............ V ---------�y�= ---------------------------------------------------------------------------i•--•--------•------------------------------- ---------------------------------------------------- -"----------- W ....__..•--------------------------------------------------•_.-__-_--_-___---_-_--------_•-_-__-____-_.-__---.-._--_-._----..-.__-_-_-•__--.----___.-__-----_----._-.--.-.---.---_-_-__.•_...__--_-_---- V Nature of Repairs or Alterations—Answer when applicable_--------------------------------------------------------------------------------------------- --------------------------------------------- ------------------=--------------------•----------------------------------------------------------------------------------------------------- ----------.. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by,the board of health. tgn f. ._ -•-•--------- ' D e Application Approved BY----- ...�.- "' G''1 ----- '� - L.� -------- ------ � .v'9 1----------f--- Date Application Disapproved for the following reasons:......................-- - ----------------------------------------------------------------------------------- ---------•---------------------------------------------------------------------------•-------..................................................--------------------------------------------------------- Date PermitNo..................................................._..... Issued............=-`--------- ......................... = Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TrrtifirFatr of f�uanpIiaaur TH I TO C' TIFY, That the I ividu 1 Sewage Disposal System constructed.( ) or Repaired ( ) Y--•`-- ------------------•-------------------------------------- ---- b '- I at7._..�^ c ;,�J.4----------- --- ----------- has been installed in accordance with tb(rovisions of : tip XI of The State Sanitary Code as described in the application for Disposa-14vorks Construction Permit No.- ._ _.._____ t------_---------- dated...(�i..:__ _. '_7 ................. TH$ ISSUANCE OF THIS ,CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL.-FUNCTION SATISFACTORY. n©. Inspector. �DATE ------- i... --------- S--i-------- r x THE COMMONWEALTH OF MASSACHUSETTS BOARDff HEAL H 7Y °.:....... ... -'t-fit ........OF.. .......................... .�d No. / FEE----- u ............ �i� o tl on Cnoaaqtr rtiu a grunt Permissidm-•is hereby granted-- --- - -d -.------------------------ ................. to Construct �or Repair ivid '1t e s ste at No. -- ---- ° „ . ..... •- ,e s Street as shown on the application for Disposal:Works Construction Permit,,l2o.__--__---.!':._n_ D •ed----� .......... Boar-r --o-- - d f Health ,r DATE......... - .0 �a J . FORM 1255 yHOBBS & WARREN. INC.. PUBLISHERS T PLo 7- LoCi�JT/O N C'aTU�T Mi9SS . c4o' OArf- IPell- 4 '1977 r� �7 1- �� Z7 LoT ``�Z3 Sf�►nini ON l,q�vU COc.�T i 1`'`�o `\\�,Q�L SCCZr/F}r 7?V,9r 7XI-C P,eo oSC'D 13(i1CD)A1G S/,bWN ON Tip//S /WLAA/ /S 0 Lo oN /V �NN17 Tiyi9T./TCG�vFo�!'HS lea * , " V�.. 775IETo wN 4�C BA�'NSTA�Gt�, �I � qoAe14 4 /I'77 4�VO 5�t. .eO B��T .�f, CRAP/CC/LG�- pC"�/Ted�/�'�E'. ► ► � � I � ► i I Ar / ' II . ► I N i FvTu,e(% I Lo T "'`.23 I I 394iC8 FT.f coo I LeF,acN se°ron�'o rr+.<. I 1 /000 c-A.C- c� steno r,,,.,c o , I I � i I ► Furvet ! I c�AAnusiv N r I l I 3� id` LOCATION � SE E PERMIT N0. VILLAGE INS TA LL R'S NAME ADDRESS B U I'L D E R OR OWNER DATE PERMIT. ISSUED G ZY J . DATE COMPLIANCE ISSUED v-�to �� _ X i Nl S� i F-1 I I ABBREVIATIONS SYMBOLS ACT ACOUSTIC CEILING TILE DETAIL NUMBER lrhL}I13 = n� J ADJ ADJUSTABLE , AFF ABOVE FINISHED FLOOR BUILDING SECTION/ 2 r Hy ALUM ALUMINUM WALL SECTION ws a AR ABUSE RESISTANT TVP. SHEET NUMBER BIT BITUMINOUS . BO BOTTOM OF COLUMN LINE COL BOB - BOTTOM OF STEEL z<, % CB CATCH BASIN CJ CONTROLJOINT N CL CENTER LINE PARTITION TYPE �-- .--1 sz CLG CEILING 3'-B� HEIGHT MODIFIER CMU CONCRETE NCRET MASONRY UNIT t75tetvtll8 COL COLUMN yG7Lf69 a `. CONC CONCRETE WINDOW TYPE q sE '. - CONT CONTINUOUS CPT CARPET ' E CRS -COURSES 'J DETAIL NUMBER r\ CT CERAMIC TILE O $x 1 s LARGE DETAIL S ter; ✓, - DIM DIMENSION �' ..11 pj x OP = I - ON DOWN H NUMBER y, S EET U O D L T DETAIL C1J Oyster f'3AY�itlFS DETAIL NUMBER I•+-1 r gC' DS DOWN SPOUT DWG DRAWING •iti SMALL DETAIL 5 EA EACH OPP. IJ-1 SHEET NUMBER EL ELEVATION EQ Q EQUAL ETAI NUMBER534 C0TUIT BAYRD E ELECTRIC WATER COOLER EXP EXPOSED,EXPANDED EXTERIOR ELEVATIONCD L FD FLOOR DRAIN COTUIT MA . FEC FIRE EXTINGUISHER&CABINET SHEET NUMBER FF FINISHED FLOOR DETAIL NUMBER FIN FINISHED PROJECT TEAM FUR FLOOR INTERIOR ELEVATION TA., FIR FIRE RATED "��SHEET NUMBER OWNER GALV GALVANIZED GL GLASS CONTRACTOR FLOOR NUMBER MR.&MRS.RICHARD BARNES GC GENERAL CO S34 COTUIT BAY RD. GWB GYPSUM WALL BOARD DOOR DESIGNATION 32 DOOR NUMBER COTUIT,MA. HC HANDICAPPED MATCH LINE'A• HM HOLLOW METAL MATCH LINE CONTRACTOR HORIZ HORIZONTAL HP HIGH POINT MACALLISTER BUILDING LLC PHONE 508.428.6408 - �-ROOM NAME 64 EBENEZER RD INSUL INSULATION JANITOR-ROOM NUMBER OSTERVILLE,MA 02655 ROOM IDENTIFICATION 209 FLOOR PLANS JST JOIST WALL FINISHES JT JOINT FLOOR FINISH BASE ARCHITECT LAM LAMINTATED ROOM NUMBER ROOM IDENTIFICATION 209 CALLAHAN ARCHITECTS . PHONE 617.448.2245 � LP LOW POINT CEILING PLANS ,0'E• 68 HARRISON AVENUE MAX MAXIMUM MFR MANUFACTURER CEILING NEIGH BOSTON,MA 02111 MIN MINIMUM MO MASONRY OPENING ELEVATION OR TOP OF WALL LIST OF DRAWINGS MRL METAL MOISTURE RESISTANT WORKING POINT 3'ao A0.0 COVER SHEET NAT FIN NATURAL FINISH DETAIL NAME NIC NOT IN CONTRACT ROOM IDENTIFICATION �P. CABINET NTS NOT TO SCALE CEILING PLANS SCALE:1/8"=1'-0" OC ON CENTER DETAIL NUMBER X2.1 EXISTING PLANS AND ELEVATIONS OH OVERHEAD OPP OPPOSITE HAND A2.1 PROPOSED FIRST FLOOR PLAN PL PLATE PLUM PLUMBING P-LAM PLASTIC LAMINATE .. All ELEVATIONS PNT PAINT PT PRESSURETREATED FINISH MATERIAL LEGEND A6.1 DOOR&WINDOW SCHEDULE PTO PAINTED QT QUARRY TILE - NONE LOBBY—ROOM NAME S2.0 FOUNDATION PLAN R RISERS C CARPET L`ov2P R OOM NUMBER _ E EPDXY PAINT ROOM FINISHES RD ROOF DRAIN 'G HIGH GLOSS PAINT RM ROOM S2.1 FIRST FLOOR FRAMING PLAN&ROOF FRAMING PLAN R REQUIRED H CONCRETE HARDENER S4.1 BUILDING SECTIONS - SIM SIMILAR - P HEAVY- CONCRETE HARDENER-DUTY NT SQ SQUARE Q QUARRY TILE(OR STONE) STL STEEL R RUBBER TILE/BASE/TREADS _ SS STAINLESS STEEL S SEALER STRUC. STRUCTURAL T CERAMIC WALL/FLOOR TILE ` T TREADS _ V VINYL COMPOSITION TILE/BASE w WOOD TO TOP OF TOS TOP OF STEEL Z VARIES, TYP TYPICAL X EXISTING MATERIAL VCT VINYL COMPOSITION TILE UC UNDERCUT LINO UNLESS NOTED OTHERWISE VIF VERIFY IN FIELD • �� W/ WITH WD WOOD GENERAL NOTES WP WORK POINT WT WEIGHT SET NO. N sroaae r—� a. I I I U I I p 1 1 I I O h as v O 03 � o Existing First Floor Plan n Existing East Elevation Scale:1/8"=1'-0' Scale:1/8"=1'-0 O y.� 03 W ^^C� a^^-1 O ® + FLI 01 41 � vaw Scale:1/8"=1'-0" Drawn by: GDC Existing North Elevation Existing West Elevation issue date Scale:1/8"=V-O" 3 Scale:1/8"=1'-0" 4 Permit 5-14-14 X2. 1 N LEGEND •. �E EXISTING WALL TO REMAIN A3.1 O NEW MATERIAL I S -�'f'f__B -- B Ti' ❑ !''-i' A4.1 A4.1 4 LLB 4 O N CEN,ERLINES OF WIN O C.q .2'-103'i 2'-10J4" ElE_ ..El 2 4 I I 4514�- A4't Q Q SUN ROOM - 1 _ I 1 OI `V U I I rL N r \ C 4 DEN/PLAY AREA v NING ROJ REMOVE EXISTING STAIRS,INSTALL NEW 6'CONIC w - I SLAB W/6'X6'W 1.9 W,.9 ON 6 MIL POLV VAPOR OW Oil .sx �AIER.ON COMPAC-11 FILL TYP ---- - o �J uJ a I REMOVE EXISTING WALL.PLACE BEAM ABOVE REMOVED WALL.POST BEAM TO ' I OUNDA7ION AT BOTH ENDS OF BEAM OO � DINING ROOM 00 9 I A3.1 I � GARAGE I I OVEN O No. AND W SHELFABOVE KITCHEN PROVIDE DOOR STO X I BENCH W/HOOKS AND I SHELF ABOVE I I REF K K, I p - i MUD OM P ' ��yr s 1 � A i-- - DP ED ED i'-6' t'E' ED ED ED 9'1' '-0 9'-0- EO O � p r� I I I � j 4-j w -c3 • I I I o � { .. UP Scale:I/4" Drawn by: GDC issue date Permit 5-14-14 Proposed First Floor Plan n Scale:1/4"=1'-0" A2. 1 — PIN15H UtILINU LIMIT OF NEW WORK�\ - ia- ■ ■-_ SECOND FLOOR ■ ■ MATCH EXISTING URI El (DING AND TRIM,TYP. ■ O 0 0 0 W ■ � � � � ; -_ FIRST FLOOR � o ■ Hi w ■ ■ 03 'o East Elevation 03 x we LIMIT OF NEW WORK �NISR"CERIR✓;—-— ®�® 1 I I I I II 8 �8 ~ 1 I I I i I I I I1-6 I lie ■ SECOND FLOOR ■ I I I I -� I I O FINISH ■ CEILING ■ I I I I I AFm FFT, Fm ■ ® ® I I I I I r�T�l ING SIDING AND TRIM,TTYP - W ■ ■ FIRST FLOOR -■ ■ ---------------------------------------------------------------------. h�"1 West Elevation p .Scale:1/4"=1'-0' F"� O cd4-4 . I I LIMIT OF NEW WORK O — U o I- --------------- ------ ----------� N ' M O � ■ U a h+1 ■ i Scale:1/4"Ak DrawD by: GDC SECOND FLOOR ■ -- ■ issue date permit 5-14-14 ■ ® ■ gEffli NEHIN ■ \ I FIRST FLOOR ■ ■ ■ L.................................J North Elevation ,/4"=,'_o" Scale: 3 A2. 1 LEGEND EXISTING MATERIAL TO REMAIN O NEW MATERIAL ' N z 1 ROTING), ARCH.ASPHALT SHINGLE(MATCH jq•-0• EXISTING),W/MIN 15 LB FELT.PROVIDE ICE AND WATER SHIELD MEMBRANE 18'WIDE AT ALL RAKES ROOF:NEW AR H.ASPHALT SHINGLE(MATCH AND 36-WIDE AT ALL EAVES AND VALLEYS,TYP C EXISTING),W/MIN 15 LB FELT.PROVIDE ICE AND D 2X70 RAFTER @ 16 O.C.B WATER SHIELD MEMBRANE 18'WIDE AT ALL RAKES 5/8'COX PLYWOOD AND 36'WIDE AT ALL EAVES AND VALLEYS TYP - 2X10 RAFTER @ 16 D.C.B 8✓ �B CEILING JOIST @ 16.O.0 5/8'COX PLYWOOD---------_____ EW HEADER AT T-6'A.F.F c WINDOW HEADER MATCH EX.HGHT.— �I TYP.NL U O TOP WALL PLATE TOP WALL PLATEr CEILING JOIST @ 16-O.0 RED CEDAR SHINGLE SIDING 0 IJ Z .rz. EW GARAGE ODOR WATER RESISTANT BARRIER w i RED CEDAR SHINGLE SIDING 5/8-CDX PLYWOOD rTl WATER RESISTANT BARRIER 2 X 6 WD STUD @ 16 O.C. r �( 5/D STUD LYWOOD DEN/PLAYAREA ® GARAGE R-19 FIBERGLASS GATT INSULATION 2%6 WD STUD@16 O.C. R-19 FIBERGLASS BATT INSULATION l o s 518'GWB II II II 3/4 PLYWOOD SUBFLOOR ON Pi 2%12@ 16 < 314 PLYWOOD SUBFLOOR ON PT 2X12@ 160.0 �i \ / Ah FIRST FLOOR VAPOR BARRIER ON TOP OF VAPOR BARRIER ON TOP OF SUN ROOM _ FIRST FLOOR 03 �+•( vim-'o JOISTS BENEATH PLYWOOD ________ r l Q JOISTS BENEATH PLYWOO v LJ OP OF FOUNDATIO OP OF FOUNDATION � (� ❑ > PROVIDE CRAWL SPACE VENTIN PROVIDE CRAWL SPACE VENTIN " y N CRAWL SPACE ; � � � ,� � � +, ,- F� CRAWL SPACE v VAPOR BARRIR OVER COMPACTED GRAVE k VAPOR BARRIR OVER COMPACTED GRAVEL - G N 10'WIDE REINFORCED '�, _ �3 a 10'WIDE REINFORCED TOP OF FOOTING CONCRETE FOUNDATION WALL /f ,,,., _______ R - T t CONCRETE FOUNDATION WALL ___ ____ ____ _—_— _____ �p3e y >al TOP OF FOOTING \� 4 4 1'-0'DEEPX7-0'WIOE FOOTING W/#5 ' - r 1'-0'DEEP X2'-O'WIDE FOOTING W/p5 3�'. OTTOM OF FOOTINGKEBABS @ 12'O.C.,TYP R Z ss. ,.'. io•', •?,f,D s - ,,. " . 3, ,.; Je ry! REBAR @ O. P OTTOM OF FOOTIN Den/Garage Sections Sun Room Section Scale:1/4"=r-0" Scale:1/4"=1'-0" 3 1 t Q 12•-0• �. 121 � ROOF:NEW ARCH.ASPHALT SHINGLE(MATCH EXISTING),W/MIN 15 LB FELT.PROVIDE ICE AND WATER SHIELD MEMBRANE 18'WIDE AT ALL RAKES AND 36'WIDE AT ALL EAVES AND VALLEYS,TYP ROOF:NEW ARCH.ASPHALT SHINGLE(MATCH .O EXISTING),W/MIN 15 LB FELT.PROVIDE ICE AND WATER SHIELD MEMBRANE la"WIDE AT ALL RAKES V AND 36'WIDE AT ALL EAVES AND VALLEYS,TYP 2X70 RAFTER @ 16 O.C.B `" E 2X70 RAFTER DX@PLVWOO I 8 8 5/8-COX PLYWOO �. ws, EW HEADER AT T-F A.F.F / 1 TOP WALL PLATEF CEILING JOIST @ 18'O.0 S2 TOP WALL PLATE CEILING JOIST @ 16-O.0 O WALLCONS 1. O I e --EW BEAM EW GARAGE DOOR / ♦ w REDWATER RCEDESISTANT BARRIER I SHINGLE SIDING // \\ r 51W COX PLYWOOD ® I I � - ' � RED CEDAR SHINGLE SIDING 2%6 WD STUD @ 16 O.C. ILTL�uI WATER RESISTANT BARRIER :4 W .'�-q 5/8'CDX LYWOOD R-19 FIBERGLASS BATT INSULATION P O R-19 FIBERGLASS BATTUINSULATION 5/8'GWB •C) (/] FIRSTFLOOR 4'CONC.SLAB W/6'X6'W 1.9W 1.9 ON 6 MIL —_—_—___ FIRST FLOOR r 1 Y C) POST DOWN(WITHIN WALL) PLOY VAPOR BARRIER,ON MIN.6-COMPACTED `/ r1 TO FOUNDATION FILL TYP.MATCH EXISTING CONIC.SLAB HEIGHT OP OF FOUNDATIO �F• O OP OF FOUND-[- I -,i 5 10'WIDE REINFORCED g . 10'WIDE REINFORCED "! ;i ; �' CONCRETE FOUNDATION WALL �; _ _____ TOP OF FOOTING TOP OF FOOTING a CONCRETE FOUNDATION WALL— y '� - R g Scale:1/4" 1'-0'DEEP%2'-0'WIDE FOOTING W/q6 f u S. vz a 1'-0'DEEP X 2'-0'WIDE FOOTING W/#5 - ----- OTTpM OF FOOTIN OTTOM OF FOOTIN '£ A ;y KEBABS F12 O.C.TYP k. ,M .; �. . x Drawn by: GDC KEBABS 12"O.C.,TYPZ' @ - issue date Permit 5-14-14 Garage Section GARAGE ADDITION SECTION n Scale:1/4"=1'-0" Scale:1/4"=1'-0" A4. 1 NOTE,ALL WWI_N_DDOOyWS ARE ANN,DER�SEN ALSERIES WINDOWS R.O. I 4 O 40 '¢ a z IF, 1 11 AIN U U w WINDOW ELEVATIONS �{ SCALE: 114" '-0' ` e _ c^ EXTERIOR WINDOW SCHEDULE wo rl > ID ANDERSEN# I R.O.WIDTH I R.OHEIGHTI UNIT SIZE U e v A ADH 2438 2'�" 3'-8" ALL UNIT SIZES ARE 3/4"SMALLER THAN THE R.O. - '~ B ACW 2650 2'-6' S'-0' a C' C ACW 2638 Y-0° 4'-8' x rl n �i FEE EEP 0 0 U 1.4 L) cz � O DOOR ELEVATIONS SCALE: 1/4"=1'-0" o EXTERIOR DOOR SCHEDULE U ID ANDERSEN# R.O.WIDTH R.0 HEIGHT UNIT SIZE/COMMENTS M O IK� 1 N.A. T-0" 6'-8" OOD/GLASS DOOR W/SIDELIGHTS TO BE SELECTED BY OWNER 2 FWHID 3168 T-0 7/8" 6-8 1/4" T-0 1/8"X 6'-7 1 2" 3 FWGD 8068 8'-0" 6-10 7/8" T-11 1/4"X 6'-7 1/2" Scale:1/4"=F-0" 4 N.A. 9'-0" T-6' GARAGE DOORS TO BE SELECTED BY OWNER,CONTRACTOR TO VERIFY HEIGHT Draw by: GDC issue date Permit 5-14-14 n A6. 1 N 3" LEGEND EXISTING MATERIAL TO REMAIN O NEW MATERIAL 2 PROVIDE CRAWL SPACE VENTING 14'-0' 2•8- _ ------�, U --------------------- Aan Aa.1 F-'-1 4 � 0 I I I I EO EO 3 I I 2 0 I 1 1 I I I r 03 � W 4'CON..SLAB W/6'X6'W I ZE4 F••C•{ o Q 1'-0'DEEPX7-0'WIDE I I CRAWL SPACE I 1.9 W 1.9 ON 6 MIL POLY fi'ER,ON MIN B U. bLt O CONT.FOOTING W/#6 I I COM VAPOR ARRI ARRI D FILL MIN I KEBABS @ 12 O.C.,TYP. I I 7 I I I 1 I I I I I I I I I I I I I ---- --- ____ I I I I 1 q I I � J 1 3 r ___ ______ _J __ _ _ x .;r"C/ ,. '�», .Da '' „ 3'.' ,r• ISITNG 4'CONC.S Ln&// p I ______ ___ ___ __ _ ___ ____ _____ ____ ________-1 i / I I I PROVIDE ACCESS TO NEW CRAWL SPACE THRU EXISTING I REMOVE EXISTING STAIRS.INSTALL NEW 4'CONC. e. 3 BASEMENT/FOUNDATION.INSTALL INSULATED DOOR I '€ I SLAB W/6'X6'W 1,9 W 1.9 ON 6 MIL POLY VAPOR A9.1 I I _BARRIER,ON COMPACTTED FILL TYP EXISTING BASEMENT GARAGE I ' + I I I 4'CONC.SLAB W/6'X6'Ww I EW STAIRS i �q I 1.9 W 1.9 ON 6 MIL POLY NEW SLAB IF EXISTING SLAB 1 VAPOR BARRIER,ON MIN 6' NOT IN GOOD CONDITION I COMPACTTED FILL TYP I Im I 7 I r ry w I -_J , I �0•1 1 I -- J F-^••1 CC3 y EO EO I '> EXISTING FOOTING FOR I EXISTING BRICK FRONT r+ ' 1 FOR CH,CONTRACTOR -- - --- - I TO REMOVE EXISTING o " I BRICK...ETERMINE F ____ __ __i__ J EXISTING FOUNDATION ----1 CONDITION O .. � Seale:1/4"=1'-0" 1 Drawn by: GDC Aa.1 issue date Permit 5-14-14 S2.0 2 LEGEND I I N EWTING ROOF 4 O NEW MATERIAL 4 4 EAM TO BE SIZED BY OTHER 3 Aa,1 2 --------------- - GARAGE C/) PT JOISTS 2x12 0 16 O.0 —_--- - -r --� W First Floor Framing Scale: CIS my Uz �m� loJ C B A Y 1a-G• tam• 1z-o• I � NEW BEAM TO BE SIZED BY OTHER POST DOWN TO 4 FOUNDTION AT BOTH ENDS OF BEAM Ti 3 - --- x-- o� 42(1G F� ,RS V1 NEW 1 M TO BE SIZED I BY OTH R,TO SUPPORT _ EXISTIN ROOF,POST DOWN FOUNDTION Old • I I I I I I I _—_—_y_—_—_ AT BOT ENDS OF BEAM ,�....II �I 5555 ga aii - - -f- - - r a G S � NEW ROOF OVERLAYED ON O O EXISTING ROOF,TYP. F ' a - Scale:1/4" Drawn by: GDC a c '` issue date Permit 5-14-14 NEW GARAGE DOOR HEADERS, O BE SIZED BY OTHER I I I 1 A3.1 n I Roof Framing I t