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HomeMy WebLinkAbout0046 FORSYTH COURT - Health 4.6 Forsyfh Court lip ` 0 r 061 F� No. Fee BOARD OF HEALTH TOWN OF BARNSTABLE ` 01ppricatiou ff or Vern Construction Permit Application is hereby made for a permit to Construct(vf, Alter( ), or Repair( ) an individual well at: 5�6 FofsNz7%c c ccTutT Location-Address Assessors Map and Parcel To JJ MGG e e Y6 f--ors�.7�e LT Co- Owner Address DeNJIV/S SC0"A.Je(/ /V& d(eaiass soJ /WA"k ee 44 4- o�Y9 Installer-Driller Address Type of Building Dwelling Other-Type of Building No. of Persons Type of Well 'Y' P(�C Capacity Purpose of Well e Agr ement: The undersigned agrees to install the afore described individual well in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation-The undersigned further agrees not to place the well in operation until a Certificate of Complia a ha een issued by the Board of Health. Signed A � ,8 a/ eVApplication Approved Byl 3 � Date Application Disapproved for the following reasons: Date Permit No. Issued �2 Date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Compliance THIS IS TO CERTIFY,that the individual well Constructed(pl-, Altered( ), or Repaired( ) by [)rNAvl 3 .SC410"e l/ Installer at 'V4 Fe e 77 has been installed in accordance with the provisions of the Town of Barnstable Raard of Health Private WeljPrOt9ctIOn Regulation as described in the application for Well Construction Permit No. VJ I- / /�( Dated 3 0 THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL[,f,{ UNCTION SATISFACTORILY. Date tD Z Inspector s ,4 %. No. y" Fee `( � •- BOARD OF HEALTH TOWN OF BARNSTABLE Lo Zfpp ication -for Yell Construction Permit � Co Application is hereby made for a permit to Construct(t4, Alter( ), or Repair( ) an individual well at: 4/6 �orsV7LI,,el c i cc,7-LAIT r Location-Address Assessors Map and Parcel ry T J�f /��(�6 e Y� Fo i s��7L,e <-7- C�7�LA ;7 ;. Owner Address /�Pti,.�.,5 �co.�.Le�/ �� c�c y.oss ��.( rNas`/�r•P �-t r� e�-'�y9 Installer-Driller Address Type of Building Dwelling Other-Type of Building No. of Persons Type of Well 4/ P!>C f Capacity Purpose of Well Agreement: _ The undersigned agrees to install the afore described individual well in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation-The undersigned further agrees not to place the t well in operation until a Certificate of Compliance haysbeen issued by the Board of Health. J Signed Date Application Approved By Date r Application Disapproved for the following reasons: Date Permit No. EIS Issued C Date me—ove------->eme i-my---- oe—esm— ------e.,----oemvee----- -----vewem----- ------o--- BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of (Compliance THIS IS TO CERTIFY,that the individual well Constructed(ems); Altered( ), or Repaired( ) by 5 Sc(j f,// Installer at 4/6 Ico,, S 1/T1 e c T. has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. j/U i6V OZ�' Dated r r THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. Date Z Inspector , BOARD OF HEALTH TOWN OF BARNSTABLE m lVerr ( ongtruction Permit No. �2 rUG Fee Permission is hereby granted to Oep-. n,i S Installer to Construct(v)' Alter( ), or Repair( an individual well at: No. I,L U14 c C 7— f Street as shown on the application for a Well Construction Permit No. Dated Date v' �Ut Approved By ,:=------ L Commonwealth of Massachusetts Title 5 Official Inspection Farm T 5ubsudface Sewage 0110100921 System Form=Not for Voluntary Assessments 46 Forsythe Court, Property Address David Leopla Owner Owner's Name^- Iftfarmtide is Cotuit Mai _ 02636 11-11-20 :---._- required for every State ,fade date of(n9peClian Pages cit rrowrl -.D. System fd6rlma-tion (cont.) 141 Sketch Of Sewage Oisposal System: lmvide 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 p drawing attached separately 1rA" i0 Frog+ �i ©t !b,a ' W e. 1 +� � , r MICHAEL 1 A 5 x, SEARS Na,S114430 ry "A".E,It 1 f� iraRs}1,9dC+P§V:71"ia TOO aifial Wpomn Pawn suit fteb sewage OWN syatw-1 W i6 of is f' � I �::�, �; �.-� � ��. �o,�s�Tr�f c�o �4��. v�7 �. --� I �/i ix _ .� i Commonwealth of Massachusetts �n- Title 5 Official Inspection Form . Subsurface Sewage Disposal System Form Not for Voluntary Assessments 46 Forsythe Court. � �l Property Address ` David Leppia Owner Owner's Name information is Cotuit Ma. 02635 11-11-26 required for every — --- — page. City/Town State Zip Code Date of Inspection. = D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 5 Number of bedrooms (actual): 5 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550 Description: . - 2 Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit?: ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system?(Include laundry system inspection 0 Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No 2019-249000 gal Water meter readings, if available (last2 years usage (gpd)): 2020-284000gal Detail: Sump pump? - ❑ Yes ® No Present Last date of occupancy: Date t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 i . Commonwealth of Massachusetts DES--D(0 - - Official Inspection Form Title 5 p l -- h Subsurface Sewage Disposal System form - Not for Voluntary Assessments 46 Forsythe Court. Property Address David Leppla _ __ ---' --- Owner Owner's Name information is ✓ a? required for every Cotuit _ Ma. 02635 11-11-20 page. City/Town State Zip Code Date of Inspection, Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. Inspector Information 5l 1501�- filling out forms on the computer, Michael Sears use only the tab _ - — -- - key to move your Name of Inspector cursor-do not Jim The Inspector Man use the return key. Company Name P.O.Box 784 fab Company Address West Yarmouth Ma. 02673 City/Town -. - -- State_..__._....._ Zip Code re<�n 508-364-4398 S114430 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and.complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems;After conducting this inspection I have determined, that the system: 1. ® Passes OF IM�SS 2. ❑ Conditionally Passes oS;.., q��� ag: MICHAEL ':m= SEARS 3. ❑ Needs Further Evaluation by the Local Approving Authority =o: * No.SI14430 4. ❑ Fails SP�O�`\`\p ' /////U1/11111111111U����` _ 11-1.1_-20 Inspector's Si ature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board -of Health or DEP)within 30 days of completing this inspection. If the system has.a:design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform. in the future under the same or different conditions of use. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 I °y Commonwealth of Massachusetts Title 5 Offic.ial- Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments , ! 46 Forsythe Court. Property Address David Leppla _ Owner Owner's Name information is Cotuit ( Ma. 02635 11-11-20 required for every ---- ----- -- page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated_are indicated below. Comments: 1500 gal tank, D Box, 4 Chambers 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no" or"not,determined" (Y, N,`ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal_or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the.tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below):, t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts , Title 5 Official Inspection Form �= � Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 46 Forsythe Court. _ — u Property Address David Leppla Owner Owner's Name information is Cotuit Ma. 02635 11-11-20 _ required for every — — — page. City/Town State Zip Code Date of Inspection C. Inspection Summary (conq' 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of.sewage backup or break out or high static water level in,the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box: System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below).- distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system-will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N '❑ ND (Explain below): ❑ obstruction-is removed. ElY [IN ❑'ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health_ in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: I l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form I� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 46 Forsythe Court. u� Property Address David Leppla Owner Owner's Name information is Cotuit Ma. 02635 11-11-20 required for every _ _ — - — D of Inspection page. CityfTown State Zip Code Date p C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has aseptic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This-system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. C. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool r ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form + _ I Subsurface Sewage Disposal System Form -Not.for Voluntary Assessments 46 Forsythe Court. Property Address David Leppla — Owner Owner's Name information is Cotuit _ Ma. _ 02635 11-11-20 required for every page. City(Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool El ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow El ® 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. El ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ Z Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] The system is a cesspool serving a facility with a design flow of 2000 gpd- El ®. 10,000 gpd., ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The. system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply 1. ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA)or a mapped Zone II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts Title .5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments t, s . � 46 Forsythe Court. u Property Address. David Leppla _ Owner Owner's Name information is Cotuit Ma. 02635 11-11-20 required for every _ — page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) Section C.5 the system is considered a significant to an question in Sect 9 If you have answered yes y q Y. threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes"or"no"for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? El ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® El available 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? ® 0 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 El ® 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)] 15insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts Title 5 Official, Inspection. Form � V Subsurface Sewage Disposal System Form Not for Voluntary Assessments + � ! 46 Forsythe Court. Property Address David Leppla Owner Owner's Name information is Cotuit Ma. 02635 11-11-20 required for every — - --- - - page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 4 — Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 1.5.203`(for example: 110 gpd x#of bedrooms): 440 Description: 2 Number of current residents: - — Does residence-have a garbage grirfder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: —Is laundry on a separate sewage system? (Include laundry system inspection Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No 2019-249000 gal Water meter readings, if available(last 2 years usage(gpd)): 2020-284000gal Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Da esent { I I t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts ��- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for.Voluntary Assessments 46 Forsythe Court. Property Address David Leppla Owner Owner's Name " information is Cotuit Ma., 02635 `11-11-20 required for every — — - page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commerciallindustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(9pa) Basis of design flow(seats/persons/sq.ft.,`etc.): - — Grease trap present?M ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank Yes No present? ❑ ❑ Non-sanitary waste discharged to the title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: - Source of information: 2019 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? -- -- Reason for pumping: — - _-- t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 I Commonwealth of Massachusetts 1.- Title 5 Official �lnspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 46 Forsythe Court. _ U Property Address David Leppla — — Owner Owner's Name information is Cotuit Ma. 02635 11'-11-20 required for every _ --- page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)'and source of information: 2004 #2004-278; D Box 2017 _. Were sewage odors detected when arriving at.the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): 28" Depth below grade: feet Material of construction: El 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.): t5insp.doo-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal system-Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form 1; Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 46 Forsythe Court. -- ------:-__ - Property Address David Leppla Owner Owner's Name information is COtUIt Ma. 02635 11-11.-20 required for every ----- .--- page. Citylrown State Zip Code. Date of Inspection D. System Information (corit.) 6. Septic Tank(locate on site plan): .1811 Depth below grade: feet Material of construction: ❑ concrete ❑ metal . ❑fiberglass, a❑ polyethylene ❑other(explain) 1500 gal 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 1„ Sludge depth: ` - — 29" . Distance from top of sludge to bottom of outlet tee.or baffle — - Scum thickness 0 - Distance from top.of scum to`top{of outlet tee'or baffle 8 Distancefrom bottom of scum to bottom of outlet tee or baffle 18 How were dimensions determined? Sludge judge, tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 1500 gal tank with in and out tees in place, both covers at 18" below grade T _ it t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 c � Commonwealth of Massachusetts Title 5 Official Inspection Form � 1; Subsurface Sewage Disposal System Form -Not for Voluntary Assessments l�� 46 Forsythe Court. _ Property Address David Le pla — -- Owner Owner's Name information is COtuit _Ma. 02635 11-11-20 required for every _ State Zip Code Date of Inspection page. City/Town D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of.scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc:): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete` ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain): Dimensions: _- - Capacity: gallons I � Design Flow: gallons per day t5insp.doc•rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 16 L— Commonwealth of Massachusetts Title 5 Official `Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 46 Forsythe Court. u Property Address David Leppla _ Owner Owner's Name information is Cotuit Ma. 02635 11-11-20 required for every — -- -- page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: --- =- Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D Box is 16x20 with 4 outlet pipes, cover is 9" below grade _ i t5insp.doc-rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 ii t\ Commonwealth of Massachusetts Title 5 Official Inspection Form i Subsurface Sewage Disposal System Form - Not for Voluntary Assessments .!j 46 Forsythe Court. _ Property Address David Le la - Owner Owner's Name information is Cotuit _ Ma. 02635_ 11-11-20 _ required for every - State Zip Code Date of Inspection page. City/Town D. System Information(cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): *If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: - i Type. ❑ leaching pits number: 4 ® leaching chambers number: -- ❑ leaching galleries number: ❑ leaching_trenches number, length: ❑ leaching fields -number, dimensions: - - ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: - - t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 13 of 18 Commonwealth of Massachusetts ,p Title 5 Official Inspection Form 1' i� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 46 Forsythe Court. Property Address David Leppla Owner Owner's Name information is required for every Cotuit Ma. 02635 11-11-20 --- - - — page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): SAS is 4 chambers, chambers are clean and dry with no sign of failure _. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer - Depth of scum layer Dimensions of cesspool Materials of construction — - Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts - -- , Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments N 46 Forsythe Court. u Property Address David Leppla Owner Owner's Name information is Cit Ma. 02635 11-11-20 otu required for every t — page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy (locate on site plan): Materials of construction: — Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/2 6120 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 k Commonwealth of Massachusetts Title S. Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 46 Forsythe Court. Property Address David Leppla _ 1 -- Owner Owner's Name information is required for every COtUIt Ma. 02635 11-11-20 --- — page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: ' Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately O A I O Frd�l•F 8 �NWIInUrrrpi C) �•" ems; MICHAEL .N ''o: SEARS *. No.SI14430 :c* _ '��T'�FRTIF��O•��` 15insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 46 Forsythe Court. — �� Property Address David Leppla _ - — Owner Owner's Name information is Cotuit Ma. 02635 11-11-20 required for every - -- - page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® .Surface water ® Check cellar ® Shallow wells : Estimated depth to high ground water: 10, 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: Daatete 4 . D ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: I You must describe how you established the high ground water elevation: No ground water per plan i - Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/2612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 18 . Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 46 Fo ythe Court. - --- - Y1.�I.,Gi ....-.-- -...._._. ... Property Address David Leppla--- - _ - --- -_ Owner Owner's Name information is Cotuit _ Ma. 02635 11-11-20 required for every — — page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist . I Complete all applicable sections of this form inclusive of: ® A. inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4(Failure Criteria) and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank-Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth-to high groundwater included S' t51nsp.doc•rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 i r t Commonwealth of Massachusetts5% Ole Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 46 Forsythe Court wu9 Property Address I+,, Francis Maycock Owner Owner's Name information is ? required for every Cotuit MA 02635 11-3-17 page. City/Town State Zip Code Date of Inspection 6r... 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 aquwttunpu on the computer, �����s��H OF M,q 1///��� use only the tab 1. Inspector: key to move your ;0 yG cursor-do not James D Sears JAMES m: use the return Name of InspectorSEAR key. Capewide Enterprises Company Name %' p�4`.T 153 Commercial Street °'''�,,�5�INN S�?,e"o Company Address few Mashpee MA 02649 City/Town State Zip Code 508-477-8877 S 1623 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority Ute-4�� 11-3-17 spector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original 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. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage)M?Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 46 Forsythe Court Property Address Francis Maycock Owner Owner's Name information is required for every Cotuit MA 02635 11-3-17 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The system is a 1500 Gal. Tank D Box and four chambers. 13) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): I t5ins.doc-rev.6/16 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 46 Forsythe Court Property Address Francis Maycock Owner Owner's Name information is required for every Cotuit MA 02635 11-3-17 page. Cityfrown 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 ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins.doc-rev.6/16 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 46 Forsythe Court Property Address Francis Maycock Owner Owner's Name information is required for every Cotuit MA 02635 11-3-17 page. Cityrrown 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: 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 El ® Static liquid level in the distribution box above outlet invert due to an overloaded I or clogged SAS or cesspool I ❑ ® Liquid depth in 912M is less than 6" below invert or available volume is less than %day flow F/a Q11v G t5ins.doc•rev.6/16 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 46 Forsythe Court Property Address Francis Maycock Owner Owner's Name information is required for every Cotuit MA 02635 11-3-17 page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 16,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 46 Forsythe Court Property Address Francis Maycock Owner Owner's Name information is required for every Cotuit MA 02635 11-3-17 page. CityrFown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 5 Number of bedrooms (actual): 5 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550 I t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 46 Forsythe Court Property Address Francis Maycock Owner Owner's Name information is required for every Cotuit MA 02635 11-3-17 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: 1500 Gal. Tank D Box and four chamber's. Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage (gpd)): 2015-256,000Gal 2016-107,000Gal Detail: Sump pump? ❑ Yes ® No Last date of occupancy: NA Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 46 Forsythe Court Property Address Francis Maycock Owner Owner's Name information is required for every Cotuit MA 02635 11-3-17 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: NA Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance"contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 46 Forsythe Court Property Address Francis Maycock. Owner Owner's Name information is required for every Cotuit MA 02635 11-3-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 2004 Permit # 2004 -278 2017 New D Box. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 3' 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.): Pipeing is 4" PVC SCH -40. Septic Tank(locate on site plan): Depth below grade: 27" feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 Gal.Pre Cast. H-10 I Sludge depth: 1" t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 46 Forsythe Court Property Address Francis Maycock Owner Owner's Name information is Cotuit MA 02635 11-3-17 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 29" Scum thickness 0" Distance from top of scum to top of outlet tee or baffle 8„ Distance from bottom of scum to bottom of outlet tee or baffle 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. Tank at 27" below grade. Inlet cover at 8"w/outlet cover at 16". In and outlet Tee's. No sign of leakage or overloading. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal El fiberglass ❑polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M ,•''y 46 Forsythe Court Property Address Francis Maycock Owner Owner's Name information is required for every Cotuit MA 02635 11-3-17 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 111 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 46 Forsythe Court Property Address Francis Maycock Owner Owner's Name information is required for every Cotuit MA 02635 11-3-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D Box is 16"x21"-16" below grade w/four lines out. 2017 New D Box w/cover at 6". 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: i t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 46 Forsythe Court Property Address Francis Maycock Owner Owner's Name information is required for every Cotuit MA 02635 11-3-17 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 4 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching is four 500 Gal. dry well chambers. Leaching at 27" below grade w/cover at 1'. Chambers are clean and dry. No sign of over loading or solid carry over. 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.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 46 Forsythe Court Property Address Francis May cock Owner Owner's Name information is required for every Cotuit MA 02635 11-3-17 page. Citylrown 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.): h t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form M Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 46 Forsythe Court Property Address Francis Maycock Owner Owner's Name information is required for every Cotuit MA 02635 11-3-17 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately repo s 'I - o g 3 � �- J 7 t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 46 Forsythe Court Property Address Francis Maycock Owner Owner's Name information is required for every Cotuit MA 02635 11-3-17 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells 10, lVO Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 5-20-04 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 5-20-04 10' no G.W at 10'.. Bottom of leaching at 4'-2" below grade. Bottom of leaching 5'-10" above T.H. Depth. Before filing this Inspection Report, please see Report Completeness Checklist on next page. l5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 L s Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 46 Forsythe Court Property Address Francis Maycock Owner Owner's Name information is required for every Cotuit MA 02635 11-3-17 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file I , t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments, 46 Forsyth Court Property Address Edward Dennen Owner Owner's Name information is Cotuit MA 02635 11/01/12 required for every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form.Inspection forms may not be altered in any way.Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms on the computer, use only the tab key to move your 1• Inspector. ✓ I cursor-do not Michael Kellett use the return Name of Inspector key. Aardvark Environmental Inspections —v Company Name PO Box 896 Company Address East Dennis MA 02641 Cityrrown State Zip Code 508-385-7608 SI 3742 Telephone Number License Number B. Certification Ui I certify that I have personally inspected the sewage disposal system at this addressAnd that the "rf 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 1640 of Title 5(310 CMR 15.000).The system: ; ® Passes ❑ Conditionally Passes ❑ Fails c ❑ Needs Further Evaluation by the local Approving Authority 11/02/12 Inspector's Signature Date The system inspector shall submit a copy of this inspection report-to,the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the'system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. ****This report only describes conditions at the time of inspection and underthe 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. L"Ow ( I I( q L ge t2, t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 46 Forsyth Court Property Address Edward Dennen Owner Owner's Name information is required for every Cotuit MA 02635 11/01/12 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary:Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: 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 exfdtration 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): t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments e 46 Forsyth Court Property Address Edward Dennen Owner Owner's Name information is required for every Cotuit MA 02635 11/01/12 page. Citylrown state Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cunt.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box.System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced - ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if . the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 5ns-1lilt Tile 5Official Inspection Form:Subsurface Sewage D"sposal System•Page 3 of V Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 46 Forsyth Court Property Address Edward Dennen Owner Owner's Name information is Cotuit MA 02635 11/01/12 required for every page. CityrFown 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: 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 cesspool is less than 6"below invert or available volume is less than day flow t5ins•11/10 Title 5Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth,of Massachwsefts ` Titl'ee, 5 Official Inspecti"6h Form Y Subsurface-Sewage Disposal System Form-Not'for Voluntary Assessments 46-17orsyth�Court :` Propeity"Address= Edward Dennen Owner} Oirvrters Name' m lnforrnatlonis Cotuit ___-- .- -_ _ _—. - _ . _.. MA- 02635 - 11/01/12_,..,n required for every page: re^a Cityrr6wm! 'State 'Zip Code Date of Inspection B. Certification (cont.) x F. ~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 �A 1 tax •h .- Ztributary to a surface water supply. Any portion of a cesspool or privy is within a Zone 1 of a public well. v ❑ T' ® 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 ammonia nitroger�nd_nrtrate..nitm.gen is-equat-to or less-than b-ppm, µ=,` provided that no otherfailure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] �Cf� "'' i^° 4 The":system is a cesspool senfing a fafclllty wIth"a design flow'of 200'0gpd--.. C W r —1 or nr®ra r�i :•',C x....s t , �.. ti!;'a:t `u. ...c, '- The system_fatls L have determined that one or more &.th'a above failure ;criteria exist as described in 310 CMR 15.303,therefore the system fails.The 1-we 1-we" `'4`%`vsyste Wh6i should contact the Board of Health to determine what will be necessary to correct the failure. r=rx,F� E) Large.Systems: To_be'considered a large system.the,system must serve a facility with a design fib-*`o w f'1`0,000 gpd to''f5,000 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 i `"�0 �theTsystem> =within=400"feet of a`su'rface drinking water supply' Fes' or t f il-P11 Q1 t 41.x/V4i�4 u V. 44 �' #' _ ` ==th"e`sys`tem'is`wdt in=200-fe`etof'a'tributary'to�'a�surface dfinking wate�3supply-EJ El 3 the_systems..located-m-a-nitrogen sensitivearea-(Werim-Wellhead -Protection Area-IWPA)_or;a-mapped Zone-ll of.a ptiblic water-suppI well— — ' g}f.M'�Y${ '" 1 YZC t+t 1X+5'.f Rt 7 x•",$It:q- {...: �#!T.z. ':.: lJiu :,*,•..v€�st,..+<_ .:i, if you have answered"yes"to any question in Section E the system is considered a significant threat, or answered'fifes"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 Denartmenta a t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 ICI Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 46 Forsyth Court Property Address Edward Dennen Owner Owner's Name information is required for every Cotu it MA 02635 11/01/12 page. City/Town state Zip Code Date of Inspection C. Checklist Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner,occupant,or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components,excluding the SAS,located on site? ® ❑ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction, dimensions, depth of liquid,depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example,a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 5 Number of bedrooms(actual): 5 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 550 r t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 46 Forsyth Court Property Address Edward Dennen Owner Owner's Name information is required for every Cotuit MA 02635 11/01/12 page. Cityfrown state Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings,if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Current Date Commercialllndustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft.,etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings,if available: t5ins-11l10 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 I� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Forth-Not for Voluntary Assessments 46 Forsyth Court Property Address Edward Dennen Owner Owner's Name information is Cotuit MA 02635 11/01/12 required for every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes,volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no)(if yes,attach previous inspection records,if any) ❑ Innovative/Altemative 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 VA system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 46 Forsyth Court Property Address Edward Dennen Owner Owner's Name information is required for every Cotuit MA 02635 11/01/12 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components,date installed(if known)and source of information: 11/19/04 per BOH Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2.3 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.): u Septic Tank(locate on site plan): Depth below grade: 1.6 feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑polyethylene ❑ other(explain) If tank is metal,list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions:: 1,500 gal I Sludge depth: 2" t5ins•11/10 Title 5Offcial Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 46 Forsyth Court Property Address Edward Dennen Owner Owner's Flame information is required for every Cotuit MA 02635 11/01/12 page. Cityfrown 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 30" Scum thickness 2 Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 17" How were dimensions determined? measured Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): The tank was sound and tight with tees in place and liquid at outlet invert. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑fiberglass ❑polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle I Date of last pumping: Date t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 • E Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 46 Forsyth Court Property Address Edward Dennen Owner Owner's Name information is required for every Cotuit MA 02635 11/01/12 page. Cityfrown 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.): I Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order. ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches,etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s, Subsurface Sewage Disposal System Form-Not for Voluntary Assessments '< 46 Forsyth Court Property Address Edward Dennen Owner Owner's Name information is required for Cotuit MA 02635 11/01/12 every page. Citylrown 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 even Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): The box was level and tight with no sign of carryover. 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: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts lugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 46 Forsyth Court Property Address Edward Dennen Owner Owner's Name information is required for every Cotuit MA 02635 11/01/12 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number,length: ❑ leaching fields number,dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.): This system has four five hundred gallon drywells in a 42'x12'stone field.The drywells were dry with no sign off ponding failure. 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 I Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-11/10 Title 5 Offciar Inspection Form_Subsurrace Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form `s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 46 Forsyth Court Property Address Edward Dennen Owner Owners Name information is required for every Cotuit MA 02635 11/01/12 page. Citylrown 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.): J i t5ins-11/10 Trite 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 46 Forsyth Court Property Address Edward Dennen Owner Owner's Name information is required for every Cotuit MA 02635 11/01/12 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System:Provide a view of the sewage disposal system,including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building.Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately �Y l a. t5ins•11/10 Title 5 Official inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 46 Forsyth Court Property Address Edward Dennen Owner Owner's Name information is required for every Cotuit MA 02635 11/01/12 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: 20.0 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: 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: USGS maps show an elevation of over 20.0 feet. Before filing this Inspection Report,please see Report Completeness Checklist on next page. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 46 Forsyth Court Property Address Edward Dennen Owner Owner's Name information is required for every Cotuit MA 02635 11/01/12 page. Citylrown state Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A, B, C,D,or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•11/10 Title 5 official inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 L I . , r 1 - J ! 40 44 ( 48 LOT 44 I 1.. 48 J0� 80 49.80' 04 go � f - j 40 48 ( i Ex/slfn/ -r r 4E s0 l �I i / r 1 card e FO RSYTH Lo i Jd' 060 5045' -YOURT D:k A n+ueeeuen ro I i' �� ' � � �' i i.,., ., D+roDing Dirve<•AaYDr 1 6U.)7' _ 40 r .vote/".. ..aPProw•....... Proposed , \ . 1B00CeI/fenk td \ Se Ti Proposed �»l4 •. .....I '" BdR4 Froaeb .B'gCt$s-move ol zD' ' i � 41 4s Pero e 49 � B@ 4 d' `.__ r'• Remora(6 Pit ° Iona rntro e� 4Q 4' k i tr.{J a E !-� 1`E•5 t �►t�G�'+ Daniel E Braman. P.E. �P For-s �[ �'� G"C, m uid,Har M Point 7- Cummaquid MA 02637-0361 CT. 4o cs x t2 = 4 14-. t i i G.VLu ��'CcaL S j L�ea �s or y DANIEL E k`!6_,l B . tvulooz, 11 VG. V - �tavi�y licnu, vcoiy„ �,icensed to: Dan Braman, P.E. Job: Dennen Residence Cotuit Steel Code: AISC 9th Ed. SPAN INFORMATION: Beam Size (User Selected) = W14X26 Fy = 36.0 ksi Total Beam Length (ft) = 24 . 00 Top Flange Braced By Decking LOADS: Self Weight = 0. 026 k/ft Line Loads (k/ft) : Distl Dist2 DL1 DL2 Pre DL1 Pre DL2 LL1 LL2 0. 00 24 .00 0. 180 0. 180 0. 000 0. 000 0.480 0.480 SHEAR: Max V (kips) = 8 . 23 fv (ksi) = 2 . 32 Fv = 14. 40 MOMENTS: Span Cond Moment @ Lb Cb 'Tension Flange Comp F1ang( kip-ft ft ft fb Fb fb Fb Center Max + 49. 4 12. 0 0. 0 1 . 00 16. 79 24 . 00 16.79 24.0( Controlling 49. 4 12 . 0 0. 0 1 . 00 16. 79 24 . 00 --- --- REACTIONS (kips) : Left Right DL reaction 2 . 47 2. 47 Max + LL reaction 5. 76 5. 76 Max + total reaction 8 . 23 8 .23 DEFLECTIONS: Dead load (in) at 12 . 00 ft = -0. 217 L/D = 1330 Live load (in) at 12 . 00 ft = -0. 504 L/D = 571 Total load (in) at 12 . 00 ft = -0. 721 L/D = _ 399 a 36'"2" Oven —4-l' 44" I � w•.w•ro y f , "V " 1 A 4'.g"21,9'-1— ...... eL0" 2.9" 2'•9"-r--8'•9" '1, �y�raow.........r��11'.0"i��3g'0" ' �pc•j yn'f'N'��, C"�OcR��� T'- �1 n nen j es;a erect, 4- v s-�t* (>r !� (/ No � Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01pplitation for Misposaf *pstem Construction Permit Application for a Permit to Construct( ) Repair(X Upgrade( ) Abandon( ) ❑Complete System ,Individual Components Location Address or Lot No. [Po F&R W 14 eYr Owner's Name,Address and Tel.No. Assessor's Map/Parcel p'"s �� ' 01" { ��,p�� CQ 6 of T' Installer's Name,Address,and tel.No. ,j -477-Z58 1 I Designer's Name,Address,and Tel.No. Type of Building: Dwelling. No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) SIIJ�'��(� D`& A`g6k, Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by t ' oard of alth. ed Date , Application Approved by ; wDate Application Disapproved by Date for the following reasons Permit No. Z I— Date Issued _�.. ,i ..; �,� .r ..J,:*►'-�;*•.,�r' ..;r,-'.•.,-1.+�r""'• ��y'.j�`rL+f,.r.v...., . ..*n..„-..•r-..�.�...n- .n,r^::y,,..+ti3r.�. .. i No: F� ee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ; 2pplitation for Misposal.6pBtem Construction 3pPrmit Application for a Permit to Construct( ) Repair(X Upgrade( ) Abandon( ) ❑Complete System Kf Individual Components Location Address or Lot No. [ 4, F&R.WTP e.-j" Owner's Name,Address and Tel.No. <�O'T r" V t- Assessor's Map/Parcel 45S �� FOX &tT COTv+T Installer's Name,Address,and el.No.,7dg-4-7-�&"i 1 Designer's Name,Address,and Tel.No. ear�e�vtiD . �� . t�3 sz �,e�&ass `'-�-- Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) T&1S7.4C,(_ D—PQ lu!T4 PttS Date last inspected: & Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by tthis.Bloard of Health. ed/_ J J/` / Date Application Approved by ( ��/ / !/ �i I �•.�Date AR ication Disa roved b ' _ / Y v Date r for-the following reasons.: - Permit No. Date Issued / THE COMMONWEALTH OF MASSACHUSETTS f) BARNSTABLE,MASSACHUSETTS DV Certificate Of Compliance THIS IS TO CERTIFY that the On-site Sewage Disposal system Constructed Repaire d(x) Upgraded( ) Abandoned( )by CA P & at .-44�, FQ 5S-Y-r44- (264T, �OTurT has been conskucted in acc d e with the provisions e 5 and the for Disposal System Construction Permit NO. / � at2 Installer 64026ao(66 Designer WA #bedrooms Approved design flow gpd The issuance of this permit shall not be-construed as)a guarantee that the system will func it on as designed. _ Date / .�u j/ f Inspector --------- - ---------------------------- ----------------------------------------------- ----------- - No. / � Fee / �~ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Zisposal Epstein Construction j3Prinit Permission is hereby granted to Construct( ) Repair( Upgrade Abandon( ) System located at (.� and as described.in the above Application for Disposal System Construction Permit. The applicant'recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be lomplt- wit i three years of the date of this permit. Date Approved by y I - Town of Barnstable vy�TME Regulatory Services Thomas F.Geiler,Director RAILWABM Public Health Division 1639• h o„ " Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: ///y"0q Sewage Permit# .1,P IP f-.2 79 Assessor's MapTarcel Designer: Installer: c7 e g CIATES 42CANTERBURYLANE Address: AST FA MOUTH,IWeccnGNUSE 'S 024ddress: leg soa/sao-��.s� On //'/�/—Oy 1. C �� � was issued a permit to install a (date) (installer) septic system at `T 'oT7 '`4 Ce based on a design drawn by (address) L �sh I Ppy/e ASSoc dated (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. or z m ® STEPHEN (Installer's Signature) .4 J. 4 DOYL• A - o (De 'finer' Signature) (Affix FeVipeftgamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form 3-26-04.doc The Dennen Residence Area of new construction-950 Sq Ft addition 48 Pbraythe Court,Cotult,MA 02635 Renovatlon and small addition �s p� gW -^� p REQUIREMENTS p g. �e ++ Charlene and Eii Denrie K•-+ �.... ..K. Walls-2x4 16"oc Phone:508 42 PfEay..ae0,M. VT1A � EVEN T y E ADDITION F q � Floor -2 oc Roof-2x I0 10 16 JB'oc T1E-- VV BEDF1 OM WILL TRIGGER AN Wall Insulation -R13 IJ P G�'yS,s�D'E C d,�F m� Fi ES�,I O K E D I T E C T RS y MhsT.ER kEovcaM Ceiling Insulation-R30 c 4'—ro —ra k 4 n/• 31111 +•-`-3 1 r ra .w.- - y I-ra -d MMrfA 4 4 • •§ 1 h 6 1�� 1l y. re a o ra• 4a• 31 FAHILY RGbH 2--rvi ; o _..K IT CHEu i nvpRcaM . _. DEO�M 1. . ti _J,IYLhISi . H •' r•fo• re• re• a-x•—,Ire• •, ti 1p Area of new construction ,a„ ea +au=1+ 4•e + ' 950 sq.ft,addition ea• --..Y... +ne ae• e•r T sa-e• SMOKE DETECTORS REVIEWED .The Dennen Residence 46 Forsythe Court, Cotuit, MA 02635 Second Floor G, v� 3,-2„ io vL y r -17H HRO I ,� -11'-7" a " r> 1n00'Od X 2l61 c MnZP L dg 4=1" •- 2'-3" 64 14'-8" 13= fie Demon Reeldence re Fmyft Cart CdA MA 02035 Area ornew construct/on Renovatlon erM emaa adNdOn Fetrtdadan AM-Notes: mtr•— North 1.New kundean haw-ra' Paw ro mefoh tdeveaon of edaWtp dweMnp I PYcHda walkout basement Opening on eoudfweaf 810"Yon of new addklon 3.vend/aaon Per MA oode rvarnoe ar Pwy. .. 4.307t307t12'Lelly f0Ofts aar.aAo t.yt.roe Q b•Waf an 1dk12'fooft keyed a Pd code Full walkout r.slneokaao.c.1ropeaomomtero(ryp) " 8aeement P1etd ve*a6 meememente wkh owner borate conarucdon Scale:1/I'a 1 Fba t. itxfPawn sr — y 4 b P•rxn ewe 6 .— _ _ _.—..—_ ----._ _.- ._._. __. 4 k � b EaJ rwsieltua._—_ Hal/81 tement ranJD�TON Md.LI wouoveN FxWls fng FoundeNon k4 IV-to, q rr t afar _ TOWN OF BARNSTABLE LOCATION �� �/ySy72(f C f SEWAGE # VILLAG ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. c)� AG f2to SEPTIC TANK CAPACITY /L002 EACHING FACILITY: (type) �_`'�T 4 "Ll (size) `YA X 1A-t 3 xa 0.OF BEDROOMS BUILDER O OWNE ge n 1P PERMITDATE: 1//a-vy COMPLIANCE DATE: //4 V I 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 cr. � � J l -��" No 4 FEE COM, M®NWFALTR OF MASSACRUSFTT$ Board of Health, �p�S�,�J�, MA. APPLICATION FOR ICI P®S�L SYSTEM CONSTRUCTION PERMIT (Application for a Permit to Construct Repair( Upgrade( Abandon( - ❑Complete System ❑Individual Components Location At,. rVIL4,, Owner's Name Map/Parcel# _ (o Address Lot# Telephone# Installer's Name Designer's Na E AND ASSOCIATES Address Address EW FALMOUTH,MASSACHUSETTS 026M Telephone# Telephone# Ty wilding Lot Size 16 sq.ft. welling- o.of Bedrooms Garbage grinder ( ) ype of Building No.of persons Showers ( ),Cafeteria( ) Other Fixtures Design Flow (min.required) gpd Calculated design flow Design flow provided. gpd Plan: Date �5 - 1 QJ 0 d' Number of sheets Revision to j Title Description of Soil(s) s� Soil Evaluator Form No. Name of Soil Evaluator S- t Date of Evaluation - 1 DESCRIPTION OF REPAIRS OR ALTERATIONS The undersi agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agr e o4 to place the system in o eration until a Certificate of Compliance has been issued by the Board of Health. Signed Date ,ibis / n No. 5,., --.t. FEE a € Board of Health, �� pz�, MA, a ' ®.� C SST CONSTRUCTION P°LT' MITPPLICATI®N Application fora,Prmit to Construct• Rep-air Abandon ❑Complete System ❑Individual Components t,, ..... _ / Location A(* A-a 25 Owner's Name (I (G Map/Parcel# .► �' � r Address " Lot# AA Telephone# Installer's Name Designers NarSTEPHEN J.DO1'LE AND ASSOCL-iTES Address Address 42 ANTERBURY LANE EAST FALMOUTH,MASSACHUSETTS02536 Telephone# Telephone# 506/540-2534 \ Type-of-B,rLrilding Lot Size 4 110 sq.ft. ( welling- o.of Bedrooms1 Garbage grinder ( ) 1 �tlal cr"Ty e of Building ` No.of persons Showers Cafeteria P ,, ...,. P O),Cafeteria ( ) f. Other Fixtures (\ (� Design Flow(min..required) 7 gpd1 Calculated design flow Design flow provided 4 L gpd .,,Plan: Date 5� 1� 'D�' Number of sheets Revision�Date Title �.�'t"t..us' �u ; '� �. won— `�'olLl; Ze"K Description of Soils) �tf �>► C, ' r Soil Evaluator Form No. Name of Soil Evaluator t Date of Evaluation t DESCRIPTION OF REPAIRS OR ALTERATIONS The undiersi // agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agr es to 00 to place the system in operation until a Certificate of Compliance has been issued by the Board of Health. Signed ��� / / Date7/4 e / d 1 f 411� j�i ti f' No. FEES_ COMMONWLALT14 OF MASSACHUSETTS Board of Health, "J AtA ar t r:. MA. � 1 �� CERTIFICATE OF COMPLIANCE Description of Work: O Individual Component(s) O"Complete System _i The undersigned hereby JJceeyrtify that the Sewage Disposal System; Constructed ( ),Repaired ( ),Upgraded ( ),Abandoned ( ) by: � � 17 O �! at !�n ro r, r4 r r_ A, , �— C• has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5)`and the approved design plans/as-built plans relating to 'l application No. oZ f.�L �o77t�, dated (/ Approved Design Flow .5SV (gpd) Installer , r Designer: Inspector: � � ,,' e4Q a t Date: The issuance of this permit shall not be construed as a guarantee that the system will function as designed. No. � < FEE C®MM®NWEA T ®F M SSACHUSETTS Board of Health, DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is/hereby granted to; Construct( ) Repair( ) Upgrade( ) Abandon( ) an individual sewage disposal system at C[ as described in the application for Disposal System Construction Permit No. )WV dated � y� t/ Provided: Construction shall be completed within three years of the date of er it. All local A;ondituions must be met. 4Form 1255 Rev.5/96 A.M.Sulkin Co.Boston,MA Date 1� 1()q Board of Health _ ) TOWN OF BARNSTABLE LOCATION ��y /yS�'7X� r' SEWAGE # 2 py`/ VILLAGE G�`�:+ ASSESSOR'S MAP & LOT INSTALLER'S IJAME&PHONE NO. c)••e �� SEPTIC TANK CAPACITY.. /5-00,2 LEACHING FACILITY:(type)�SVF.s A `"t 4el (size) ` A z/;L,t x a NO.OF BEDROOMS BUILDER OFJOWNE PERIv&DATE: /l/2-oy COMPLIANCE DATE: 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 L 4�uc4.'7 l . 2 7 �. 0 1 A i f P cr COMMONWEALTH OF MASSACHUSETTS a W EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS d DEPARTMENT OF ENVIRONMENTAL PROTECTION ©� :FAILED INSPECTION , cEL - .OT •��u��. . TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 46 Forsythe Court Cotuit MA 02635 RECEIVED Owner's Name: James Rockett Owner's Address: Same Date of Inspection: March 30,2004 APR 1.6 2004 TOWN OF BARNSTABLE Name of Inspector: PATRICK M. O'CONNELL HEALTH DEPT. Company Name: SEPTIC INSPECTION SERVICES CO. Mailing Address: 189 CAMMETT ROAD MARSTONS MILLS MA 02648 Telephone Number: 508-428-1779 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a D11i1111111t approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: Ng*-'p� oFpAl Vol Passes °° Conditionally Passes �+� Needs Further Evaluation by the Local Approving Authority M. X Fails • �� Inspectors Signature: ��C - VAA Date. ^3/30/04_ !N 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. Notes and Comments: Leaching pit had previously been full to top of structure under normal flows.Existing 1500 gal.septic tank is in good condition and can continue to be used with a new leaching system. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection p n Form 6/15/2000 page 1 Page 2 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 46 Forsythe Court,Cotuit Owner: James Rockett Date of Inspection: March 30,2004 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. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a.Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: Page 3 of 1 I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 46 Forsythe Court,Cotuit Owner: James Rockett Date of Inspection: March 30,2004 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 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. — The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: III Page 4 of 1 I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 46 Forsythe Court,Cotuit Owner: James Rockett Date of Inspection: March 30,2004 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No _X_ _ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _X_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool _X_ _ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _X_ Liquid depth in cesspool is less than 6"below invert or available volume is less than day 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. _X_ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone 1 of a public well. _X Any portion of a cesspool or privy is within 50 feet of a private water supply well. _X_ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. ]This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] _No,(Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. 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• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to;large systems in addition to the criteria above) yes no the system is within 400 feet of a surface drinking water supply T _ 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 shalt upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. Page 5 of 1] OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 46 Forsythe Court,Cotuit Owner: James Rockett Date of Inspection: March 30,2004 I Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No _X_ Pumping information was provided by the owner,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 this inspection".) _X_ Were as built plans of the system obtained and examined?(If they were not available note as 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,excluding the SAS, located on site? X_ _ Were the septic tank manholes uncovered, opened,and the interior of the tank inspected for the v 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 fi•om 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 P Y (SAS) d e mined 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 approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] Page 6 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 46 Forsythe Court,Cotuit Owner: James Rockett Date of Inspection: March 30,2004 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 5 Number of bedrooms actual : 4 DESIGN flow based on 310 CMR 15.203 (for example: 1 10 gpd x#of bedrooms):550 Number of current residents: 0 Does residence have a garbage grinder(yes or no):No is laundry on a separate sewage system(yes or no): No [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use:(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): 2002—77,000 gal.2003—55,000 gal. =ISO gpd. Sump pump(yes or no): No Last date of occupancy: November 2003 CO M M ERCIALANDUSTRIA L Type of establishment: _ Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no):— Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records: None Source of information: - Was system pumped as part of the inspection(yes or no): 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 copy of the DEP approval _Other(describe): Approximate age of all components, date installed(if known)and source of information: 1978 Were sewage odors detected when arriving at the site(yes or no): No Page 7 of 1 l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 46 Forsythe Court,Cotuit Owner: James Rockett Date of Inspection: March 30,2004 BUILDING SEWER: X (locate on site plan) Depth below grade: V Materials of construction:_cast iron X_40 PVC._other(explain): Distance from private water supply well or suction line: 20' Comments(on condition of joints, venting,evidence of leakage,etc.): SEPTIC TANK: X (locate on site plan) Depth below grade: 1' Material of construction:—X—concrete_metal_fiberglass.`polyethylene --other(explain) If tank is metal list age:_ is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: 10.5' long x 5.8'wide— 1500 gal. Sludge depth: 3" Distance from top of sludge to bottom of outlet tee or baffle: 29" Scum thickness: 1" Distance fiom top of scum to top of outlet tee or baffle: 7" Distance from bottom of scum to bottom of outlet tee or baffle: 13" How were dimensions determined: STICK WITH HINGE FLAP. 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 in good condition had previouslv been full over outlet tee GREASE TRAP: No (locate on site plan) Depth below grade: Material of construction:_concrete—metal fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance fi-om 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: Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): 17 f Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 46 Forsythe Court,Cotuit Owner: James Rockett Date of Inspection: March 30,2004 TIGHT or HOLDING TANK: No (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/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: X (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.): Box located under trees,observed excessive roots growing into box Recommend replacing when new leaching system installed. PUMP CHAMBER: No (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber, condition of pumps and appurtenances,etc.): Page 9 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 46 Forsythe Court,Cotuit Owner: James Rockett Date of Inspection: March 30,2004 SOIL ABSORPTION SYSTEM (SAS): X (locate on site plan,excavation not required) If SAS not located explain why: Type _X_leaching pits,number: One 6x6 pit. _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.): Liquid level currently below inlet pine due to no use nit has previously been full to too of structure under normal flows. CESSPOOLS: No (cesspool must be pumped as part of inspection) (locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,etc.)`. PRIVY: No (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.). I n Page 10 of 11 OFFICIAL INSPECTION FORM--NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 46 Forsythe Court,Cotuit Owner: James Rockett Date of Inspection: March 30,2004 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Forsythe Court ,>31� O in Page I 1 of I l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 46 Forsythe Court,Cotuit Owner: .Dames Rockett ! Date of Inspection: March 30,2004 SITE EXAM Slope None Surface water None Check cellar Dry Shallow wells None Estimated depth to ground water: More than 20 feet Please indicate(check)all methods used to detennine the high ground water elevation: Obtained from system design plans on record- If checked, date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health.-explain: Checked with local excavators, installers-(attach documentation) _X__Accessed USGS database-explain: USGS topo map and town GIS You must describe how you established the high ground water elevation: USGS Cotuit quad map shows property above el.30.Town groundwater contour map shows water below el. 10. 1. 0C'A 'T° 10'N rN SEWAGE PERMIT NO. 1 L /e/ VILLAGE h INSTA LLER'S NAME & ADDRESS B U I L D E R OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED 1 , r ' �� y d No.........-l..S•-••-- r= FEB............................. 5 THE COMMONWEALTH OF MASSACHUSETTS BOARD H E LT ............../.. .l-.......--OF....... AV41 iratiun for IlhOogal urkX' o C�unitrnrtiun amit Application is hereby made for a Permit to Construct ( Repair ( ) an Individual Sewage Disposal System at: .....�� ....... «� . <.5.r.-�------------------------ ... '.�.--------- Location-Address or Lot No. ......................—.......................................................................... ..........__...................................................................................... Owner Address a ny....... . ..........Q__C..r ... ................................ -........_.....------------.....---------...... Installer Address Type of Building Size Dwelling—No. of Bedrooms...... _-.................._..........Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building No. of persons____________________________ Showers — Cafeteria Other fixtures .. -----------------•-----,�S�Te� W Design Flow......A.. ___________________________gallons perms perMy. Total daily flow.................. .?..=._'�—_-___.._......gallons. WSeptic Tank—Liquid capacity!"' '4-gallons Length__._._ ._._ Width....l�___...... Diameter________________ Depth__r,K______----- x Disposal Trench—No.'.................:.. Width..................:_ Total Length................... Total leaching area....................sq. ft. Seepage Pit No..../............ Diameter_._ Depth below inlet.__ Total leaching area_Z;;21 ..sq. ft. " Z Other Distribution box Dosing tank ( ) '—' Percolation Test Results Performed bye••-•= -- ------ Date.6. _ .._... ........ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground wat r........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ------------------------------------------------•----•- --•---..__......._..-- - •.....-----........•••---••-•••--.....•-•.....-- O Description of Soil.......© 4 .._Z... . - ---- U Nature of Repairs or Alterations—Answer when applicable................................................................................................ ------------------------------------------•------------.....---•--------------------................_....---•-•-----------------------------.-..-•-----•--------------.._--•-----•-•------...........__. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITL E 5 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 boaxd of health. / A;Z at �APPlication Approved By... ✓ 2.... Y'A Date Application Disapproved for the following reasons_____________________ --••-----•----------•--•---••----•-•-•------•-•---•------------------ ....-- _..... .............................•--•--•-........._......-------...---•-•........-•--•---•-••••-•--.._......_---•--•-•--••-•------•-•-•-------••----•-•••----•-•-•------•--------------------•-•••------•••- Date Permit No......................................................... Issued.---- f� If- .--•----•------•-------.. ------•_... Date No--------- -- •-•-- Fs$......................... THE COMMONWEALTH OF MASSACHUSETTS— BOARD, Off H E LT �.Tc. ,>f 1..........OF....... r . Appliration for 11iopuial Works Tomitrurtion Prrutit Application is hereby made.for a Permit to Construct ( ) ,or Repair ( ) an Individual Sewage Disposal System at: .................._................................. ....._._._..._......--•---•---••••--•••--- •-....-•-........_.._...._....._•--•-•-•---•-•-•-•--•-•-•--•---•----•-•---------•--...........••-- Location-Address or Lot No. ...----•---•--•-------...............•...-..-----... ........... -••-•--••-•-•-_...........•-••- Owner Address a ....-••- -•..............•-••--._..._.._.....:................. Installer Address dType of Building Size Lot............................Sq. feet aDwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) p I Other—Type of Building ............................ No. of persons............. ........... Showers ( ) — Cafeteria ( ) P 1 Other fixtures ---------------------------------------------- W Design Flow..2.........................................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 Test Pit.................... Depth to ground water......................... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 ----------------------------------- •••------------------------------- _........... -........... --••-•..... ------ •------------------ _............ . 0 Description of Soil......................................................................................................................................................................... x W ••-•----•--•---------------------------------------------•----•---•----•-------------•-•----•-----------------------...---------------------------------------------•--------..._.................--•-- UNature 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 TITT.; 5 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. Siged...... ........................................................••-............_------ ................. Date Application Approved By...... ----- ?/,{ .•-----------------------•-•-----•• ------..7. Date Application Disapproved for the following reasons-----------------------------------------------------------------------------------------------------------••••- ••-•-•--•••-------------•--•-------•----••--•---------•----------•----------------------•-----------...•--------•...._..-------------••-•--•----••--•-----•----•---------•----------•----•------.....__. Date PermitNo................'-...--•------------------•-••--•--•-_. Issued_....................................................... Date fi THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .............t.... .. OF........ ..(..!/. .. .............................. (Irdif iratr of Tu pliana ginstAled ISCE IFY, That the Individual Sewage Disposal System constructed ( A<r Repaired ( ) by .-w -------•----------------•---------------- ------- --..............•--•--••-•-------•......................-•••-•--_:.ns ,:at.--- dhasn accorda e with the provisions of TIT 5 of The State Sanitary Code as descr}'bed in the application for Disposal VVo s Construction Permit No------ !' 'y .__._. dated..- 7... y. �_____________ THE-JSSUANCE OF THIS,CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE...... �~. ..: ? ........................................ Inspector.- = --------- •--- - THE COMMONWEALTH OF MASSACHUSETTS BOARD OA HEALTH JA1 .......O F........../ .ate! ....................... e�c-•d�,�,,, No.Q5 FEE.....r�............... Disposal orki Tonstrttrtiort rrntit Permission i hi granted.:...�'._ ---•-- ............................................................... to Construct or Repai ) an I d Sev�rage ispo at No__01. x,, Street as shown on the application for Disposal Works Construction Perm' o.-___ :., ated__..__ _'� � 7 .....70 Board of Health DATE............................................... . . FORM 1255 HOBBS-& WARREN, INC., PUBLISHERS 't, The Dennen Residence 46 Forsythe Court, Cotuit, MA 02635 Garage Addition-Foundation Plan N 1. New foundation height-4'on North and west elevations, 7'6"on South(rear) Pour to match elevations of existing dwelling/garage 2. Ventilation per MA code 3. 30'5c30'Sc12"Lolly footing 4. 8"Walls on 16"x12"footing keyed 5. Damp proofed per MA code 6. Sill bolts 6'on center, 1 foot from comers(TYP) 7. Field verify all measurements with owner before construction Charlene and Ed Dennen Phone:508-420-2934 38=051 m Existing foundation Area of new construction A d i `7 Wb+►?01D 1 Y'P+C.POFD Od+RSOID I 10'-4" �i 1o=s• 10•-6• 8-8 38'0 The Dennen Residence 46 Forsythe Court, Cotuit, MA 02635 Garage Replacement-Fis►t Floor 20 11" Charlene and Ed Dennen 3'1--,r-3-1- f 7 5' Phone:508-420-2934 Fax:508-420-5061 - ro+°an TdlsrR rO+rCR 1. Area of new construction - Garage Replacement N Approx 600 sq ft heated Walls-2x4 16"oc 4 Approx 800 sq ft unheated Floor - 2x10 16".oc N Roof-2x 10 16"oc m ' Wall Insulation -R13 N Ceiling Insulation-R30 10'•3'�j .� -s•-o- 8-5- � N � Td+°dPD N 2=6' Right Hinge casement v RO 2'1-W4'X 2'11-W 4t1,—� �? Extedorpoor CO RO-To be determined o " 36'-0" b 5 r' ti 4 ' 4 4 4 � 2 Double Hung 3 r%,°s RO 2'5-Y4'X 4'5,V4" s-V 13 _ b � 15=9' "g_ 4 use Existing Extedor Door $ 12 ;i RO 2'1av4'x 6'9-1n' S 11 - co co N - 16 ' 15 cD � y0''B't °d jfpow , x 38'A" 5'-g- 2-6' 2-6' W-9" 5 9" 2'-6' 2-6' 6' 1' 14 y0' NN+IA• T{ri{ M+IA' rd+°dYt! 2+M• SI+PA' N+f�" 4'�"' ``'1 VI 1 b 2 10' o� cA + 3 Wide Double Hung RO-7'33r4"X 4'113/4" 3 Wlde Transom in gable above RO-T 3,V4"X 2'1-V4" Existing To match existing gable qF lot C' - A - 0001, ozo _ 10 X 5 d �on - L, ?e" 0c Z x , -�- 1 STAwn 6 I k p i. The Dennen Residence 46 Forsythe Court Cotuit, MA 02635 Garage Replacement-Second Floor 20_11. Charlene and Ed Dennen 7-4' *-3=1 Phone:508-420-2934 sv,raw ro,raw ro,rrw a Area of new construction - Garage Replacement. Approx 800 sq ft`unheated Walls-2x4 16"oc Approx 600 sq ft heated Floor - 200 16"oc Roof- 200 16"oc Wall Insulation - R13 N Ceiling Insulation -R30 Tr1j*Double Hung RO-7 3-&4"x 3'113r4" 810, - 8-5' Skylights 2'4"x 46" �l RO 2'5-1/4"x 3'11' centered on btple wile windows 7 'r-0" 4 b 2 6" Verily exact placement with owner 2 a" 38Ar 6 m 58 y'8 3'As .ar 2.6. lu 6-0" � - �, p 8 Double Double Hung - d, c b RO-4'10,V4"x 3'll-V4" i6-2" 10 a 11, 12 N g 13, 14 b Cupola-open to be ow o RO-To be determined 8 $ 14-10" b m A' 0- Open to below A x 00" 5-9" 2 r 2t8" 5-9. F. 2 8" 2 8. 0 8 N rr•,r�• r�,rr :{,r :o,rrwe z,rr >r,u• rr,nv b > a !a 3 Wide Double Hung Existing RO-7'3-3(4"X 4'11-3r4' 3 wide Transom In gable above RO-7'33/4'X 2'13r4" To match existing gable The Dennen Residence 46 Forsythe Court, Cotuit, MA 02635 Garage Replacement-Second Floor Framing Plan 20-11" r-a" 3-1—f-3+1_ r-5 Calne and Ed O-Dennen Phone: zr:crq zraorw zr.arq .p I do Area of new construction - Garage Replacement Walls-2x4 16"oc N Approx 800 sq ft unheated Floor - 2x 10 16"oc Approx 600 sq ft heated Roof- 2x 10 16"oc Wall Insulation - R13 •N m Ceiling Insulation -R30 m —s-0• a 5" w zr,erw p o ' a 5r, 2-8• Rb'o-r 4 2-G' s-o• �. '•IC_ A 1s-2" C 1-10 siTt w{! m Open to below w A x 33- 1" 5--9 2'-6" 2-6• 5-9" 5- 2-6" 21-6• 0 6' n? zrarr zr,�r zr:er zrsrau xr�r zr:zr zr.M to > OD Existing r ! jis J I 177L : 7 3 ! r i f=i LlI_ L -L_ ! _i� i-�I T(-li f I ! "C6 I I ' - ._ i. ✓fin-�� f--I�`\ I - KIC;R i µ ELEVA-10q G�r����LN ��ICENCE >.ecwE.e.: DAT —slo ov.m..c w�µeEa _.:GtlP•�L.4.t.11�N SIZE _.TD BE..DET•ERMINbpD /IE to� .. � 12 i ' �.a I L - OFEW, -.Z-I 'TRsu ScH porm1 SLAD FouNCsrnoKI VNDEfZ 6A41iC-r� .• i . 1.cwaiJ P�E b.uN i FR 7 . a� R� OEST ELCVAT1oN cTIoN `(++Rv HUDRCOM. WWIK'MUMRER THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I M A�C(, I "J L DATA a 4 SL 8S'o+c. ' 3,D• It CA � � l .. •� Spa"✓� g`•3Sg TES T H0LE RESULTS E-l-eo Z:)ES / G:�� ! C7 = v !/li`� ' TS ciSEL� P,2c���OSFD LEHCf-I f E'Ef) c��� S �Z 7r- Ffl ,A2CC)L. FIT/.'�,�.' TES i ('Df�� r=C? �/�,• -T-,J ^_� y_S �; �_ ��, �, 2 c� w,;. �7 �- ,U �--F? s:.. ,r`-'FS �L%'-S �. � �` . 'l..': i ,1!C'f' D E a 4 T E 77 ,qND TO�'Al oc ��-- /4'F -9 ,L 7-f; -EG Ul- F? 710/V9- 7h r_!_.':✓. ;Z7 ,3E F . ,�y,�3u�'' - . BAD ✓5 T"�9� ' � ��A N t� U:, E:� CO�t- re -TO �.-x.Tr ,`.� r�� • �'� � •,�_� •� i � ". t /C H✓iTNIN QF` F%Ai/SHED G. :> A:',-, ^7 �` + 5 , _ �- ✓ ''Y CC7V E P$ � �._ L7/.S7 �a__ �Q ----� ! ✓!-a'� l!,• ) Box -- ff r �111II/ Ft-,4 e4903 . D1 r9 v kv"ll5/If-1 Uo Lil /F t t l - y _ M/,J ��'o zBG� act b I F f,• ' `� 4a � ,.n/VL: C,,�LL.0,A i ti v• ,t /f.• j�j�`_ ` ff e� u�,r. /VVc.- I{. G z70249 C (v ,�- � RT a � r_ e ' N v'16� C'7 a �� L ✓<)l' H_ :1 �t2c- 98 "'�'q '`. �, er �V- GGaRBAGE GRDE�' t P4 O T" P L q l`l L O C fq T L.j t; .&,Ag'�!�� '"i`� �.,c...� � ARONALD R H U R le C. - �'f. n!�� E. F '^ - ' T No.603 f) 2.A, /STER�� ,j 'i`-? 3,e- C. O .! ,""/ ?` r�.= c:� SqN/TARP • p - - I L- re LJ :S i./A) Of {l. `) ` ) '�'� f ,L' C.) ,` / (i CAN T r i E C .42' O UN t� �� 5 S , . -T P_ `Q� , /Jt ,-�-� � /�' 7-•G' U F7 -)k 7r- ,. f S • D r�'•7- f•: �.' _in ..�,.� ��, 2-� c � ,tom �,'�� k' jf -4r Ir E` 3Q Z. o eq 40 FC TE S T- H o L E RESULTS r TC.r✓�i',�, �til� . ,1',' 7_S rfS� .L) ��J�GSED LEf�C'f/ A '�f� Z70 'JI TES T (,.� 1./�"� 4f /�/ J � .'�f .'-Y C <� �.. ',�. / .G; �� ''V •��J C� �Vl ��7 L.. ,: _i ?--f--Y kE UL 7 / O/VS' T p / C' L P R. O F / L E M M/+tJ Ff?:U N 13,14 T'/0 Ad' � 32•e►o .\ S C' � L E ��.E' .; - A�Atif Je- F-� :'ov 7 E X-r-,E AJ1) Tp yJ �. r ---- � /C "�._�►.+ L��. NJ,�, i OF FiJI�JsH'F_ .� u,Q4')r- }-.[- - -- /O,Mrtil//�1(J•17- c�' 7-.I 4V, rr, L7f. L?f-S? , ---►� ' ! J11 (� ,. i ✓y'' �7,1 j �C7 X /' �' --ram 4' CAST/ _ rL11m �, �A/rG'f`r 1 �-�-f-C O t,i• ��i N� 1 M JN p; ,CN -r".,., -` _ ®Q� � �� -l i�2 `7J MJ� ! � `groar ; ,f %: von fL � � C,f) :. L c�/1 ° hif�Sflf L> . ;iJti'L F'n u,^1. i S� P T i� -�-.•�,ti ,�\�'�� � j �Zt?.85 28.��''a� ,E lc�.3. _, �_� In�J �{-4- - ' �.;�„`,' L Z- f4(-7 f 48- �� !•c_�.fi P/ / / P�tN F AJ RONALD ems, ARTHUR =` OFFORD 7 No.643 f 1 R 4- ,QECI �p s STER r FARE /�J HOC A.v ,�o o•JC ��Z� �? Z�. � �e,,/ —� - ✓ L� ��/��Jig i �+' � / 1Y�e Oaf J""%V�.� •� •n.-J l 1. J �-� l 4 f7 o A,! -r.H / �F'i . '�" ', 7 c ' `� k' /a: • GEC�G� y� , e fV D 7 f-r =3 /., _f:. V LOW, 1R -- --. T3 U / C. b SUR V r The ®ennen Residence 46 Forsythe Court, Cotuit, MA 02635 Second Floor I V-90" 3-2 I M 1„00'O6 X 8Ck M„Zip o dn Aa5 ------- 4'4' 2� w 9X- i. c s any— MOM, r, r .............. ' t .- .,. ..� .... ., }.. ...»:., ..,..,....:,.� .. _..::.-..... ,", ::...: ......... :, ..r .:. ... ,..a ,...;,_. ..... ..•tea_ '>w..t 1 - ,max:./,. im , <l, .....:..., .... �v - r UM r max, m ......,. > .,., .. s ... ,..,. , t3 � . y .. ,. .. .,. . . .,a 2.. .'.f" n Y" y» a g g 211 rip >. S77x r,<Y .,..,.....,, ........ ,.. �i.5 -,3}v'.,i k:x. .� v _. ,t`�,> y .... ....,< .,a,.. 01 WIT a$. ,..,.o.,.'X• , < .,, ':K.E. .._ 'G_.... ... } Room ,..,.. .:. .. ....,.. c� ,.. ., E.. .� ,. ..,...,"4 1..,. .... -.u»,um�.um»mr,.a,fi„S'vnumEra>i»3- � d f ■ < 3, 7 � oil too 7 ...: .. ..._._ .. ....__.. ..�..........: ._...._ __.__. '4. T ON- > _r ,. ... ..... .. .. q� ., •h, n, ,2 , ,.'T, All A its,of 4 Jn MUM ,, ...< a• may,, ,. '�,_.<E' < ,, - + < k::.. <`d`, .. �<. .. Y.. Vim'' �n. •;•e .... ..,...: ;.,. v.<. .. .. ,•' : , ,..;:..,_ s ..,. WO w. , sm INTO V yj p. <.,. .<. '+ .. .. a_. .,... ,,,._ ..g > x. ;<. ... >.. a ar.:. :3,1 ..,... •... a. x.. .` , { ...... .. , ,... a .. ,.. ,.... _,4. .:. .... .. ........ x :,.. g .. .. ,....fir. ,.. .,...,. ... _a ,.... ,.: .,,, ,,. ,.,- t...,.,.>: xx t.e,xx„,,.<s,•r ,x+n ,... .,., ..<.,. ut.. ., >,e.. aF .«..«... f�, ...fi� �, q} E...,,,ia .,,,&�<...: .,,...,.., v. r....r,<�`rvx«r. x ,,.». .!, .,. _..zR% � ,,,,.. .. E ,5....,: { s t.. $^j�. n <s .,x.,..: Y,::,:,, ,,. Y•.':, .==i:.3,. ,� .�r. xm3 ' �' -....-<�� <-,J,�,`-� .. �ti�rw o. ...i. ..>,k�,ro .a am .«> .<ro_�. .o ,-ass,t•s. 'n''i'B,+,. tasty _..t 'xaiA ,<, ,.r.�•.,..<�> '>< ' .r I 1 1 h o Vi S.37� t 1 �e, TV IV T., �.s Top Foundation .El 52.2' ASSESSORS DATA- MAP 55 PARCEL 61 REFERENCE DEED. C74097 ZONING DISTRICP RF DVE'RLAY DISTRICT` GP do RPOD Fin/Grade El. 51 i� 1/e" to IA' A'ashed stone o s' Tbick 1777/ 17711 'In Finish Grade El. 50.0'f BUILDING 5ETBACIfs.• FRONT 30 SIDE_& REAR - 15' ' El. 47.33 FEMA DATA.: ZONE „C» - 8.5' ' 10,IWM 14'Aam r n��C� " • : -•---� INV EL A69 PRECAST REINFORCED CONCRETE DISTRIBUTION BOX a• a 0•4•'4' Below Flog Line••�- sump NV EL INV EL a' a'.• d �, o o A m .d., INV EL 47.30 INV EL 47:00' Install on a level base . 46.50' El. 44.50' 12.83 Liquid Lewr 48 47 20' .,; . . s/4 - 1 1/2 flashed Stone 47.55 Minimum wall thickness -- 2 4� 4 ('� inside e _ ,► DISTRIBUTION BOX Minimum in zd dimension -- 12 „ Outlet inverts shall be equal to each other and at 2" minimum -- -- 42' , 34 c4�. - _ e ,2a" below inlet invert. 5 4 1500 GALLON SEPTIC TANK The distribution lines from the distribution box shall all have PROPOSED LEACH TRENCH --•-{ 5a" �•�-- equal inverts as determined by flooding the distribution box to Number of ?drenches - 1 i the height of the distribution line invert after all lines have - Number of Chambers - 4 1500 GALLON REINFORCED CONCRETE SEPTIC TANK :' :: � been. sealed in place. El. 39.50' • Invert adjustments shall be made by filling with durable and PROPOSED LEACH TRENCH END VIEW N. T.S. Minimum Construction. Materials Per 310CHR 15.226(,2) 06 i nondeformable .material permanently fastened to the line or Tees shall be constructed of Schedule 40 PVC and shall extend a ! ; ; i P Y t � i reconstructing- the lines until all inverts,;are of equal elevation. Adj. High .Ground Water <EL 20' -- Mappers minimum of 6 x above the flow line of the septic tank and be on the centerline of the septic tank located directly under the clean-out manhole. 40 The inlet pipe elevation shall be no less than 2„ nor more than 3„ ; f . ► ; ; above the invert elevation of the outlet pipe. Septic tank shall be installed level and true to grade on a level, ; ; r design Data: stable base that has been mechanically compacted and on which 6 of crushed stone has been laced to ensure stability and 1 i / =3� ' Five Bedroom 5 X 110 gpd = 550 gpd Required Flow P 4' •/ to prevent settling. °� j ! ; 1 ! ; i No Garbage Disposal Septic tank shall have a minimum cover of 9': r ! ! j Use: Chamber Trench 42'L x 1,2.83'W x 2' Eff/Depth Three 20 manholes with readilyremovable impermeable covers r r P 42' + 42' + 12.83 + 12.83] x 2.0 = 219 of durable material shall be provided with access ports ( _ :-. _.-. 1 1 1 1 1 i ` �r 44 �a�'��, 42' x 12.83 - 538 being placed at the center and over the .inlet and outlet tees. p I i If r , 4 32 r r= ! 1 , 757 x 0. 74 = 560 GPD Total Design Flow The outlet tee shall be equipped with gas baffle. �� i ; i ` !, • � r: r I' i I 46 O� t � 1 GENERAL CONSTRUCTION NOTES �(.)T 4 1. All the workmanship and materials shall conform to D.E.P Title 5 p l � i � 48 and the Town of Barnstable rules and- regulations for the subsurface ; ; , ; ' 1 i 45,is4fsq.ft, i disposal of sewage. ,� . A one access port over tank tees shall be accessible 32 .tthremaining' , i r , ► , ��' 2 A least of finish grade, with any remaining° access ports brought 30 50 " to within 12" of'finish` grade. ` , 49.60'' � , 3. All components of the sanitary system shall be capable of . 34 withstanding H-10 loading unless they are under or, within 10 ft ` ' ,' / t 4 i r j I i ' `f� SO of drives or parking. H:20 loading shall be used under or within ; ; ; ; ti j ; i ► I 10 ft of drives or parking unless Hated. Plastic equals may be , i , r i r ► I , '..........:.: ......,....,.,. . used in lieu of all recast units :' % i�3 �G %' i 40 �' 44 / i �, Exist%ng 77.1' .�� q Lows � 4. The exca va torlontractor shall verify the location of all site i ; /. i ; I 48 ; Gra vel utilities prior to any excavation, and shall be responsible for ti ; j i t ,.i 1 ,' % Drive �ZG all matters gelatin to electric easements: 46 5. Se wer pipes shall be 4" Schedule 40 PVC laid a t 0.02 slope. , �° 32 Ile ;;' j: 1 i` 42 i 54 6. Any masonry units used to bring covers to grade shall be :, J F ! i , / / , I :<::•... mortared in place. .r 7. Finish grade shall have a minimum slope of a o2 ft per foot. ;' ',' � ;' 1 �' ; ; � '' lw >`,• EAGLZ DR ,�� ,: •, ' '' ; . / ! , / , Garage 1POND �� FORS.I'TX COURT rr �ert`r ` '� ' it ......... .. r i -_-F -0 RS 00, -11 -n ppw pos 0 r l 105 - / 01 / - _ GRAPHIC SCALE 381 :' .r --" �r� i r' Top Fotzndatloao 20 a 10 20 +a. so Existing Bd! EIeY 52.2` ` �Y ;, „/ • ' i Dwelling Datuzrs: NGYDt 50.07' ( IN FEET ) / rr / , :Si �yv. 0- �,� j , r > S 1 inch -- 20 it� j , t ter row Proposed 1500Gal/Tans e� Sewage System Repair' Plan 1 ► Pre ared,For.- -led Proposed Remove Exis 'tZg P • i 44 �/� ...► SAS Trench o Cesspool: 1 s �•6 .FO 1"'S t.�2 Co ZrZ�"' 50 20' 20, er`e, �� N •� f o 0 0S ,..1 id *' In TB E'1. 49.4' 46 64.e' R ��� o orb ry "'''�"' 48 ~�. 49.2 �1 k Barnsta ble, Massa ch use t is o „A" SL10yr 3/2 �0� �e1 Scale. I" = 20' Date: Ma7-18, 2004 Test Da te: May 20, 2004 »B" IOyr 5/4s�.�o, 5Q p Y' 4 �1 �., 9� ��� LS, ` ` Prepared B 42 .9� &AA Stephen J. Doyle and Associates 18 ¢yam `�.,,-_ -- Remove (6) '� ti r►'' � � 42 Canterbury Lane, E. Falmouth, MA 02538 Soil Evaluator.• Stephen Doyle a Pitch Pines � OF414 pero ti .� �, r► �p�G T Rssscy� Telephone: 5081540-•2534 �s r: tr Perc Rate: <2 M.in/.Inch `,� .4 STEPHEN N, '� 0 O • C �o .� 48. 7 e MED a � TO ads o oQ o FINE SAND z 5y 6/6lfb 48 5' _-. 48.4' El. 39.4 - ' DATE ns:-���,•• No 1Yater Encountered Na. The Dennen Residence 46 Forsythe Court, Cotuit, MA 02635 Renovation and small addition Area of new Construction Foundation Plan for New Addition North 1.` New foundation height - 7'6" 20-7" Pour to match elevation of existing 9'dwellin 2. Provide walkout basement opening on southwest elevation of new addition -- 3. Field verify all measurements with owner before construction Scale: 114" = 1 Foot Full walkout Basement 0 A N 4' 6" 6'-4" co - kb o .' 8_O" 1-0 4'-4" —20-2" FF I 10'-6" /L i 4 { t r p C �- Haff Basement G w N Existing Foundation ! o 20-6" 16-1" N v 30=9" The Dennen Residence Area of new construction - 950 Sq Ft addition 46 Forsythe Court, Cotuit, MA 02635 Renovation and small addition ----- 20-11" 7 2 r► 7 3-3"7r 3-3 r,_7�—7-3 rr� ---------- ------- - Charlene and Ed Dennen 3-o'x6-8'Pr 3'-0'x6.8'Fr 3=0'x6:8-Fr Walls - 2x4 16" Oc Phone: 508-420-2934 Fax: 508-420-5061 Floor - 2x 10 16" OC CO Roof- 2x 10 16" oc Wall Insulation - R 13 V Ceiling Insulation - R30 N r- b _r N 2-6'x 6'8'PD N r` 21411 24-2" 7r 3- 1 2-7 -7r 54-0 rf M (V 2-6'x5:2' 2:6'x5'-2' 3=0'x8'8'Fr 3=0'x6=8'Fr 2=6'x5-2' 2 6'x5•-2' _ � �J• v , , x ; , i 4-0" Cb fV r 11. 0 5-5rr 5-0" 4-8"- --4=3" -3- Z'-4'x4-4' 2'-4•x4'-4' •x3:0' 2r-8er ,� , 1 � 3 I 16-911 �1 I Cl) r x s co ` -12-5" z m ' w ;? 1 T-1 _ ------ ------- 4 ' --------- CO N ! CO --------- /7ft ^v 4 10 2-6 2-6 20�6 6-2 4-6 �Q Iff 11,-0 NZ 42w a I � ,r i I 1 ' N Area of new construction 950 � 6-6 5-91 4'-or, x 1o.00"r q. ft. addition >> = 3:0'x 6-8' 5-4'r k 11-8" 5-8" 8-1" 30 9 '