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Home My WebLink About0038 DANA COURT - Health 38 Dana Court - - - Cotuit 1 A= 056 `046,- a i I, .�u n 06 13 09:21 p p,1 � u i Commonwealth of Massachusetts . . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 38 Dana Court Property Address Estate OF Ruth Mitchell Owner owners Name information is required for every Cotuit MA 02635 6-5-13 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. General Information ``��ptnntnpllpi on the computer, �� tH OF A ..."'S' i use only the tab 1. Inspector. ```�� !S9''� 0 key to move your �.�, cy cursor-do not dames D.Sears __�:' JAMES ' u' use the return Name of Inspector •m key. _�,; SEARS -+e CapewideEnterprises,LLC =* ' Company Name s4%•. RT1F��4.•0 153 Commercial St. %,F S INS p'G P y Corn an Addressf1n7i11iir11tR��n Mashpee MA 02649 Citylrown state Zip Code 508-477-8877 S 1623 ' Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5 J310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 6-5-13 nspectors Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. *"This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under. the same or different conditions of use. CzWF : t5ina•3113 Title$QRael InspeAars Sewage Disposal System-Pagel of 17 Jun 06 13 09:21 p p.2 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 38 Dana Court Property Address Estate OF Ruth Mitchell Owner Owner's Name information is required for every Cotuit MA 02635 "A 3 page. Cityrrown State Zip Code Date of Inspection B. Certification (cost.) Inspection Summary. Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: . ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired.The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined"(Y, N, ND)for the following statements. If"not determined,'please explain. The septic tank is metal and over 20 years old"or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfittration or tank failure is imminent System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. 'A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): 15ins-3113 We 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 I Jun 06 13 09:22p p 3 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 38 Dana Court Property Address Estate OF Ruth Mitchell Owner Owner's Name information is required for every Cotuit MA 02635 6-5-13 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced Q 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 0 N ❑ ND(Explain below): 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 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 15ns•3113 - Title 5 Offid9l Ins pection Porten Subsurface Sawape Disposal System•Pepe 3 of 17 Jun 06 13 09:22p pA Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 38 Dana Court Property Address Estate OF Ruth Mitchell Owner Owner's Name Information is required for every Cotuit MA 02635 6-5-13 page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier,If any) deterimines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well"*. Method used to determine distance: This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Liquid depth in cmmp■d is less than 6"below invert or available volume is less than Y2 day flow Pi7— t5ins•3/13 Title 5 Official Irmpecdon Form:Subsurface Sewage Disposal System•Page 4 of 17 Jun 06 13 09:22p p.5 Commonwealth of Massachusetts Title 5 Official Inspection Form t< Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 38 Dana Court Property Address Estate OF Ruth Mitchell Owner Owner's Name information is Cotuit MA 02635 6-5-13 required for every .page. Cityrrown State Zip Code Date of Inspection B. Certification (cunt.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either'yes'or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ . ❑ the system is located in a nitrogen sensitive area(interim Wellhead Protection Area—IWPA)or a mapped Zone 11 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 t5ina•3113 Title 5 Official knpecdon Form:Subsurface Sewage Disposal System•Page 5 of 17 Jun 0613 09:23p p,6 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 38 Dana Court Property Address Estate OF Ruth Mitchell Owner Owners Name information is required for every Cotuit MA 02635 6-5-13 page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following. Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) 0 ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and.location of the Soil Absorption System JSAS)on the site has been determined based on: ® ❑ Existing information. For example,a plan at the Board of Health_ El ® 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): 3 Number of bedrooms(actual): 4 DESIGN-flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins-3113 - Title 5 Oftial Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Jun 0613 09:23p p 7 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 38 Dana Court Property Address Estate OF Ruth Mitchell Owner Owner's Name information is required for every Cotuit MA 02635 6-5-13 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: The system is a 1500 Gal_ tank D Box and one pit. Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection El Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ® Yes ❑ No Water meter readings, if available(last 2 years usage (gpd)): 2011-158,000Gal 2012-173,00OGal's Detail. Sump pump? El Yes ® No Last date of occupancy: NA Date Commerciadindustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft,, etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: [Sins-3113 - Tltle 5 Official Inspection Form:Subsurface Sewage olsposm system•Page 7 0117 Jun 06 13 09:23p p.g Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 38 Dana Court Property Address Estate OF Ruth Mitchell Owner Owner's Name information is Cotuit MA 02635 6-5-13 required for every page. Citylrown state Zip Code Date of Inspection D. System Information (cunt.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: 05108 Capewide Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank,distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system(yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t&ns 3113 Title 5 Official Inspection Foam:Subsurface Sewage Disposal System•Page 8 of 17 Jun 06 13 09:24p p,g Commonwealth of Massachusetts Title 5 Official Inspection Form , Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 38 Dana Court Property Address Estate OF Ruth Mitchell Owner Owner's Name information is required for every Cotuit MA 02635 6-5-13 page. Cityrrown state Zip Code Date of Inspedion D. System Information (cont.) Approximate age of all components,date installed (if known) and source of information: 1977 Permit # 77-704 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade:, 3'feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Pipeing is 4" PVC SCH 40 Septic Tank(locate on site plan): Depth below grade: 26' feet Material of construction: ®concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) F If tank is metal, list age: _ years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 Gal.Precast lip Sludge depth: t5ins•.3113 TiUs 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 0 of 17 Jun 06 13 09:24p p.10 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 38 Dana Court Property Address Estate OF Ruth Mitchell Owner Owner's Name information is Cotuit MA 02635 6-5-13 required for every page. Citylrown 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 29" 0„ Scum thickness Distance from top of scum to top of outlet tee or baffle 12" Distance from bottom of scum to bottom of outlet tee or baffle 18" How were dimensions determined? Asbuilt-Tape Sludge Judge Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc,): Tank at working level w/outlet baffle. Tank and outlet cover at 26"below grade, wl inlet cover at 6". No sign of leakage or over loading Grease Trap(locate on site plan): Depth below grade: feet` Material of construction: [I concrete []metal ❑fiberglass F1 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 Gins 3113 Title 5 Oflicial trtspedion Pomr.SU)%eare Sewage Disposal System-Page 10 of 17 Jun 06 13 09:24p p.11 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 38 Dana Court Property Address Estate OF Ruth Mitchell Owner Owners Name required for is Cotuit MA 02635 6-5-13 rewired for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑concrete ❑metal ❑fiberglass ❑ polyethylene ❑other (explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches,etc.). 'Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No dins 3113 Fills 5 Oflida!InsPeeU on Form:Subsurface Sewage Disposal System•Page 11 at 17 Jun 06 13 09:25p p.12 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 38 Dana Court Property Address Estate OF Ruth Mitchell ` Owner Owners Name information is required for every Cotuit MA 02635 . 6-5-13 page. City/rown State Zip Code Date of Inspection 11 ulvi D. System Information (cont.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert' 0 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover,any evidence of leakage into or out of box, etc.)-. D Box under old brick walkway, D Box located on site not opened 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.): If pumps or alarms are not in working order,system is a conditional pass. Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located,explain why: One•3f i 3 Title 5 01Feiat ht spe66n Form:Subsurfaoo Sewage Disposal System.Page 12 of 17 Jun 06 13 09:25p p.13 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 38 Dana Court Property Address Estate OF Ruth Mitchell Owner Owner's Name information is required for every Cotuit MA 02635 6-5-13 page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) Type: ® leaching pits number. 1 ❑ 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.): Leaching is one 1000 Gal. Precast Pit w/2' stone. Pit and cover at 3' below grade. 4"water in pit stain line at 2'. No sign of overloading or solid carryover. 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 t5irn-3H3 Title 5 Official Inapeiyion Form:Subsurrace Sewage Disposal System-Page 13 of 17 .Jun 06 13 09:25p p.14 Commonwealth of Massachusetts . I .U Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 38 Dana Court Property Address Estate OF Ruth Mitchell Owner Owner's flame information is required for every Cotuit MA 02635 6-5-13 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): ?5inS•31t3 Title 5 Offidal Insoadon Forth:Subwrfece Sewage Disposal System•Page 14 of 17 f Jun 06 13 09:26p p.15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 38 Dana Court Property Address Estate OF Ruth Mitchell Owner Owners Name information is required for every Cotuit MA 02635 6-5-13 page, CiWrown Slate Zip Code Date of inspection D. System Information (cont.) . Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately p 11 33� OP1,10 � !r ❑ o 0 o Gins-3l13 Title 5 Olfidal Inspection form:Subsurreoe Sewage Dlsposel System-Page 15 of 17 Jun 06 13 09:26p p.16 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 38 Dana Court Property Address Estate OF Ruth Mitchell Owner Owner's Name information is required for every Cotuit MA 02635 6-5-13 page, City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: et Meeet 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: 10-31-77 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: You must describe how you established the high ground water elevation: T_H. on design plan no G.W.at 12'+. Bottom of pit at 8'-6"below grade. Bottom of pit at 3'-6" above T.H. depth. Before filing this Inspection Report, please see Report Completeness Checklist on next page. (Sine•3M3 Tftle 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 r Jun 06 13 09:26p p.1 7 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 36 Dana Court Property Address Estate OF Ruth Mitchell Owner Owner's Name information is Cotuit MA 02635 6-5-13 required for every page. City/Town state Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A, 9, 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 LNns•3113 Ties 5 Otfiaat hapec km Form:Subsurface Sewage Disposal System-Page 17 of 17 r . -'' JOB INVOICE JOE LAPRIORE r PLUMBING - HEATING 2102 U RADIANT HEAT 26 Lambs Grove CUSTOMERS ORDER NO. DAT OR ERED SPENCER, MA 01562 MISED f P a ORDER TAKEN BY DATE PR { x (508) 885-3021 FAX (508) 885-2032 ❑ A.M. ❑ P.M. R�i BILL TO ,i. .� - r MECHANIC ADDRESS HELPER CITY N ❑ DAY WORK k �•, " � T�'a: ' '� y�• JOB NAME AND LOCATION ❑ CONTRACT 4 rye-: DESCRIPTION OF WORK ❑ EXTRA L; � e-- - i e PRICE AMOUNT y QUANT. DESCRIPTION OF MATERIAL USED 3 i n'✓ ',N. Ly �11 k 1 k i o 1 3�-- 5 ' � <h 101 AMOUNT "r 44 5 ' HOURS LABOR TOTAL T ' MECHANICS @ MATERIALS TOTAL HELPERS QO LABOR �F k I hereby acknowledge the satisfactory TOTAL LABOR TAX completion of the above described work. ,« SIGNATURE DATE COMPLETED TOTAL rj ell .`k t } THE COMMONWEALTH OF MASSACHUSETT BOARD OF HEALTH 33 ..tom:AL................0 F.......�rL .�RVTO � ..................................... Appliratiall fur 'Uiipuiitti Workii Towitrurtinn Vrnnit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ........... 1a.----��:� ._._-...�`-� t -------------- ----------------�-�..... � �� .---•-------•--•--------- -_.----..--------- ocatio -Addre or Lot o. �•-- --------- ----1 a .......`!4_0 .. � v'�' P C7 ---.... ....r_ta/5(r Owner ddress ---------------------- `� a Fy— .........................••-----•---------....-•------- . K tpcc�`i�t 1. �. t �Ee' �--�11. ................ ------- Installer Address U Type of Building Size Lot..__�Of�_fi-Sq. feet «-, Dwelling—No. of Bedrooms..............2..........................Expansion Attic Garbage Grinder aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) 0.' Other fi- tures ---------------------------- W Design Flow-------- . .............................gallons per person per day. Total daily flow............................---------------- WSeptic Tank-I—Liquid capacity_�QOgallons Length---------------- Width................ Diameter................ Depth.-..--.--.-.__. x Disposal Trench—No..................... Width-------------------- Total Length.................... Total leaching area-____-_.____...__._.sq. ft. Seepage Pit No..10-00-_______ Diameter.L_X1O.__ Depth below nlet....... ........... Total leach Ig area._--_._-.__.__---sq. ft. Z Other Distribution box ( ) Dosing tank �� 77 Percolation Test Results Performed by."_ . .. ......__.._ .-__--_ Date.... _ '._ ._ ------- Test Pit No. 1_ _ _--minutes per inch Dept 14 of Test Pit.................... Depth to ground water..._-_.--.-_.._.--.----- 1:14 Test Pit No. 2----------------minutes per inch Depth of Test Pit.................... Depth to ground water........................ - -------------- -- ---- ----- - - O Description of Soil----d--- -- ------ - ----- x p 4 - ------- U 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 fur r agrees not to place the system in operation until a Certificate of Compliance has been issue e btd f ea h. Signe `•-•- __ ....... -- ----------- -- ----•-.-•_.. ate Application Approved By..----- -- ` jr - � - Date Application Disapproved for the following reasons:..............................••-•------......._._.....------------...................... _............ •----------------•-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- / Date Permit No.--------•••-•------•------•-•--•--••------•-••----•_._.. Issued------/A.-.1-t �y Date No.. r Fay. wM-:.-- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH , : . . . ........OF......... .M-4"01. ...................................... Applirtt#ion -for BWVvottl Works Towi#rur#ion Prrnti# Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ocat'l Add re s or Lot o j Owner /� ddress Installer Address CLl a Type of,Building ,, 1 Size Lot.... 41: 3 -_Sq. feet .-� Dwelling—No:, of Bedrooms _ _-.-_..__ .........................Ex pansion Attic -X) Garbage Grinder (X Other—Type of Building ---------------------------- No. of persons ____...._ ....... ..___ Showers`( ) — Cafeteria (Z } P4 Z, Other tures _ W Design Flow-_ _ ............... gallons per person per day. Total daily flow--........ .... ...gallons. WSeptic 1 ink j—Liquid'capacity _gallons Length................ Width................ Diameter_.._.. Depth---------------- Disposal Trench No....................... Width-------.------------ Total Length_-_.___---...__.__.. Total leaching area..................Vsq. ft. `Seepage Pit No.1(;14'�."? ___.= Diameter. ..K. �3._. Depth below inlet..... Total leaching ire l._ --- _sq. it. f ' Z Other Distribution box Dosing tank ( �"" 7 Percolation Test Results Performed by.!t Dater_ `' _____ a ' 3 • Test Pit No. 1 _'�"*_,v__mr#xtes per inch;.,. Dep of Test Pit-------:------------ Depth to ground water _ -------- fs, Test Pit No 2..... .... minutes per inch Depth of Test .Pit----------= ----- Depth to ground water ; =..__.................. G Description Of Soil-,"" ` 4....... ,F "` .i" .l. r�� rl jy i +4j✓'� x U , W x. Nature of Repairs.or.Alterations—Answer when applicable:U P: PP - 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 issue y eb r o e th Sign ........ -•--• ......................................... - /.. . -----•-- 1*6 ate Application Approved By---:.. ,. ,.. ------- ----- -----'-aj:R�� .�r ' .-•--- -��-•- _ Date Application Disapproved for the following reasons------------------ �!'-t...--==---------------...............-----....................... .•---------------------------------------------------------------------------------------•---.__•___...------------------------_---------------......-_.--.--___--_----_-_s_-:--- ----_-___-_-_---___-___-_--. Date PermitNo...................................................:..... Issued.................................----•-••--•--•••••... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....... W. Al...........OF.... �1 ':T[.�6. .......................................... �rrtifira#le of felaut hattre THI IS TO CERTIFY, That the Individual Sewage Disposal System constructed ) or Repaired ( ) by.........-.I-k.... ,.0:k4 4-....--------------------•-----•--------•------------............._...................................................................................... Installer at . t.... !+ pl . ' ""` '" .1 +" =------------------------------•--------•-----------•------------------- has been installed in accordance. with the provisions`of : XI of The State-,Sanitary Code as described in the application for Disposal Works Construction Permit No.___ ___-.zeo.................. dated--14 .,4;4e_.-,?_��__'-_____----_.._- THE ESSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM'WILL FUNCTION SATISFACTORY. f DATE................................................................................ Inspector................................................--.................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �p " 0. .. ...�.. . .. ..OF.... ... : 1 ++ �iw.. ............................ [� ...C... 1.... FEE.-/ii................ �i��o�ttl k,� n ' rliott �rrtni# , Permission.is hereby granted---`t"--- ---•- -•-- ---- -••--•--------.................. to Constru A) or, Rep v ( ) an I ivrdual S age D osa .Spt /� at No." 411 ---- Street Ifs. -�i./.... ............................ as shown on the;application.for Disposal Work Constructs on -Per o I..... --- ted �// s2�-� �•-•••.... . - ----------------------- �- Boar, of ealt*h�� _ DATE-- r FORM 1255 'HOBBS. & WARREN. INC.. PUBLISHERS - Stt.1,GU� FL�,A/\tl_`•( -, 3 'I3t��aM .r-'� -� / �,.� / w/ GArrs�� Glzl�ro 7 1 Da.I L�4 FLOIA/ = t Io X 31- 330 XSo%- 4456.PD. � E�F -tc. -ra k 495x lr,G % s-74Z.b,P.o. lG f 1 1215P05A.L PIT - tJsc--:. lcaoo' G&A . as �CL�.Wh,LL 1i2E.A = .I 8 8 s.t=': • `\ , ��, m �a I-iro�vt AeA r .7 8 t !� �gss�: ► .o 78 s.f?ri. . 7Z TOTAL Z?ESIGI:I -54B a TOTAL U/SIL�( l=Lro�i 4'95.b.Pv. 'PSI Tn° t , PMl-ZC-0 L&TIO /&Tr= 10 02 Q';`. 1 I ` IAA /V14 s, 4 S BAXTER It5li ' t �.' r W. `'F�b.j•aV�l � �y, wo Tt=ST FG.`f8.30 Top Fan �c+c•o G QG•7o .�; 9� T L6Art 6"Poi tuv- g�, o Z rep soft 4 pPB DlST l w CPAL. "Box 9d;25 Sc-Qric l o . tuv. j TcrtK fF4c. C-L-CAel GAL. ttED�uM . . LEACH A Pl-r , W/k4NED STOwl� EB,G$ • I CE.QTtFIEi� Pl.b'T' �'L./�.!•..I Przeo>`'1 L EL - LbGATIOW Co -ry 17- f 7,04.l0, ScQ.ti~.+i✓ SC.ALI= 1►ht.=100 '.u tz T I P T E-t A T T l-1 FO U.N j A C 1oN 5 uaw►.l SQL 4 tit R F R E►.t c: V4-,ot..1 •G04V�PLgG W I TI-A TI-G ;I D Cz L.I w� l_ O T G Z. •'. -rL,n� {'e4JlCENtcuTS TNT CoYV I`(` . 43A.`( S HoV"zS I : or-- " A R tea► S-r tS L RCGIS[LtZ�D 'L1��.ltj 5U2v.�,(vtZS T1-415 t7t.._At-1 I 'S-.IUT 0 5 T E Z V LLL o MAS�f;, I1-4 I-C J,AG-k l i ;Uc:.)c_l{ .>r ti`3t� UtaC-r> `1c, i?r'1-��Ml�llx LP'T l_I WE:5 t -33o XSO%= 4g56.PD. 3L r ! 4 9 5 x 15 C % = 7id Z 6.P.--------------------------- US tSoc-- 6�5L . ,f-r 115Po5,dt_ ACT CALL AZE.A = 1 8 8 188 SF �c 2.S ; .47 o G.P.p. t `i3cr-rom 7 8 sF. 7 Z 1 1 7 $ �.FD. �5 t q N P. TOTAL -VESIGtJ =5 f` 4B �•RD•. t TO"T-A L 4956.�. 43 11GDlQT10tJ (?I�TE I tQ 2-mlQlo2 LASS. 0 QT BAXTFR ' 1` 2-# A !IoL F1e.58,34 Tor F-w o l o c>.o G 96•7o - Z` roa G Poi 150'0. INV IIJV.',gGf.S'p s o I 4 QpE •D K7 Iw. GAt.. -Sox SEPnc iuv t F. g4.c8. Z-aK pE¢c. r-t•-eAt4 CsAL. INV. 1►Jd.'�S aS 99.E$ M DIvM 1:.�N i sA>va P-T A WAS►i1SD CEQTtF tEL7 PLC>T' PL /at.I LOCA.TI Ot-J "� T�f<;', SG.AL.t= IIN•_.IOu �•r ATE IG�(� I �7� �tiTtt=�{ '1`�IAT TWA FO(JN!>AtS.40N`SNaw�.l PLAt-1 TZr=p E' 1C:E l�p1J Ga,V%PLIFS ..W MA T14G: D�..LI W� .I '�,ET� AC1 �'CQ;�IE�titcTS o� Tt?� LOT G 2. 1nw►.� oT= BAR>vS'�-/ i3Lk, . Co-ru 1T' 16AY` S HU ES B A ATE>�. . ' CZEGIS�t'C-_tZ�`D 1_A.1.1('j 5U2v�.Yc?c`S . Tt-�l5 17LA+-! Imo,, ' �..1OT �Af,CC� Usn.y A�.J . 05TE2�/ILI..0 c� �1�CAS5. IIJ�,;T'�?JC=1J i !,U; ./E_I'{ S11ct I-.A l;C UrairO: TG i7i A1�PLfGA.I�I"�'yb Il I,p 2-00� U �� 77 7Yu b OREW ME DORSQig151 � 3/FI/ ._ .. I -I �e&U V LLLLp o ulp - I ' ll - — 0- EW 9w VORMER _ LLHN--- VM, �L�VAJ ION 1.��1" Sln� �I.�VA1'ION 2F8zO16"O.C. EXISfING COLLPR f�5 2 RAF fER @16"O.C. 16'-C"5(0CK 12 X15nN6RW6k W/COW.VEM - - - . FLAStIC If,5ULA(ION SfOP COKAWWWUM FLA5fIC IN-UL.5fO P PRIP wa SEE ftflCP1 ia��iFwcrnort EAVE PEfPr. vexes :: � 7.CF0.1Ni JOlif ei6"OC. —16b OL.W/EC } 16 FA50A W/ 5l'1lY.CRJ NeN 4EDDC�ALY 1011 ' WMA"VANMU : NEW5fOP,ACk AU0AWJMWfrW NE W GE DOOM HAI L cLosEr �? � .. SCALE:5/ .p, $ EXbnNGROa RAFfER5 IC"50fflr W/2' 3 -WAM1,WOOFN6(WAFER B ICE .E CONf.0fAVWVENT 0A;TreR,REOUVEO 24"UP MOM 1.2 ROCNtJG EAVE LVf RA rm FIE DOWKb REOulpev WHERE .101Nf CONNE00N5 AW RAFrW5 �s O` _ - - - �.. ARE ter PARALLEL(5PACINO N9 r _ 1f DOWN CO JNE Wf iREr)1RW EX. PATH �X. IIAT{) �� rps "+ A16EARI%WALL5 FOR RAF rEP5*V . _ ROOF rRU55E5 f0 PE%r WAD - .t.. FORCES EX. GASEME Nf { Park Street Center PROPOSED ELEVATIONS n B5=,Storeet,Suite 20 B DING SECTIO r ,MA 02703 �UILnING S�C1ION &/Lj Phone:(5082_255734 Date:07-17-2007 itchellResidence Al DesignAssociates,L.L.C. 38 Dana Court Cc lui MA Scale:1/4"=1'-0" A www.mandrdesign.com Drawn by L.Reyes Mellor Construction SHEET 1 OF 3 f �4 GENERAL NOTE5: CEILING FRAMINGNOTE5: Ze'@16"O.C. -Owners aid clentral contracts shall review all dais,notes and specifications, -5ee floor plans for cmawr' - 1o'•O"sroa - prior to construction, .. 20 lbs./sq.ft live load _Any alterations to plans must be taken under the acMsernent of M+R Pe5ig Associates,L.L.C. -10 Ibs/ sq,ft,dead load -M+R Peml ASsoclates,L.L.C.,Cralq C.Mitchell aid/or Lauren M.Reyes -K•R spruce 42lunber or better OUPLE5 a EM 05IV are not liable for structures Ludt fran these plans, w/NANCLRS 5�ROUW A6 RW'tl f -C.C.nust comply to all state and Taal codes,laws and regulations -A l dimensions to be verified In Field ROOF FRAMING NOTE5: ' -C.C.to ve-Ify l exlstarq site conditions. -Rafter sizes and roof pitch as noted -Any reproduction of plans wit mt written permission Fran M+R t?e5tgn Rooflnq 5hingles 5pecifled by general contractor 1 Aswclates,L.L.C.,Craig C.Mitchell,and/or Lauren M•Reyes Iz proh tilted -Roof vents as shown -All on site work to be overseen ha licensed cmtrator. _P*e vents as shown(set ri&g d7m 2"for proper air flow) Electrical,HVAC and plumbinq plans to be provided bar licensed crosukade. -Water&ice barrier to cover all lups,valleys aid one course up from eave CHIMNEY Q,o -AII paints and finishes provided N others. Save and gable end ore hags by qe e al contractor p - _ -Al speclficaGons to be verified by ovens ad contractor. mmu-Mm 35 Ibs/5q.ft.bad support w -Exterior window ca5mgs Fronded by desi4nated lumber yard 5ee typral eave details for roof tie down requlrement5 -F re stoppi q required-shall cut off all concealed opmi qs,minimum 2" nominal lumber required -5ee table 2305.2 of Massachusetts State Pjildvq Code for fasteimq schedile. FLOOR PLAN NOTE5: . 1154 4ilO,FLU41 .. - -. W/mu 75. W/H*aRS ZZxIO headers above all exteriorrouc{n open"unless noted otherwise . -Closet shelves and poles 64 G.C. 20 exterior cmztructo -Natural Ightrq for habitable aid xcuplable r=*stall have an exterior ' olazlnq area of rot less than 8 X of the flan area.Half the required area of olazinq shall be operable. OILING PPAMING PLAN 5YMDOL5LE6MV: OCombination carbon mm i&/eke detector ® Photosensitive woke detector - ® Fan/ hunt 2,es@16"O.C. - - I61-0"5f0IX NEW 5FE7 — — MULLIONUNr ACCESS WIL 12 3,5+/- EXISTBVG s-Zdo,ADOvt 11ROOF RAFTER5 Q FLus1w/NPNCF�25 �� -i-uucEawGteiar- -- - _ I mmooM owao I 9 y CL05Ef C1,05Ef cn NRSPA[E ¢•• CHIMNEY DAM aLw.Ev 2666 +66 2666 Z6 b CHIMNEY tl POORp O WALL POOR aFLYWOOP TO COVER EX15T 6Ears u o srAxwnr FRAMING FOR NEW 5TOPAa AREA ro REMWJ = Now OPEN WWV RAL 660�Ltl5 q MmooM - 5TODa FULL CELINC,mar FULL CELI 2&2 2892 MN.'SO"36" _ .. - j u 9 a 9 V .- PN.ON( tlN.ONIf `P A11,81 6 AIH',2" f?00F FPAMING PLAN (2)NEW t70GlbIlSE OORME, 2x%Qlb"O.C. 6•-0"5fOCK 5�CON12 PLOOp PLAN ;# Park Street Center OPOSED FLOOR PLAN FAssocia. s sank(tree>site 20 STRU LPLANCo Attleboro,MA 02703 Phone: 508 222-4734 Date:07-17-2007 Mitchell ResidenceL.L.C. F 9 508)222-5579 Drawn b4,L 1R vies38 Dana Court Cotuit MASfIEET 2 OF 3 1 Mellor Construction ndrdesi n.com y y Iwo MLE MU�ELI ITIT LLLIJ Ulu] U MD. Lfff 5112� �LFVMION FPONf �L. VAVON {I. LIU LLJ x Ex 5UNROOM A, �L�VAI10N -- ------ Ex OAM - I i I I EX.EAMLYROOM EX.DE17R00M j EX.KIfCWN � EX.PATH eX.2-CAR WWE EX.DEI71200M q EX.LNINGIZOOM II , II II , II 11 - Perk treetCeter EXISTING CONDITIONS 5 Bank Street Suite 20 Attleboro,MA 02703 G Phone:(508)222-4734 Date:07-17-2007 Mitchell Residence I� fING N 5r F 1 Design Associates,L.L.C. Fax: 508 222-5579 El 1.00p PLAN c ) Scale:1/4"=1'-0" 38 Dana Court Cotuit,MA www.mgndfde5igtl.COm Drawn by L.Reyes Mellor Construction SHEET 3 OF 3 i