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0078 HIGH STREET - Health
78 High Street Cotuit I P A = 035 043 I I' No. . Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Y Zipplicatton for Oi5pozat *pgtem COttgtrurtion Permit Application for a Permit to Construct( ) Repair vie"Upgrade( ) Abandon( ) ❑Complete System [ Individual Components Location Address or Lot No. __7 k j4l C -t4 f/ lg Owner's Name,Address,and Tel.No. Vq —e—/f—E G Q4V C—/1C oo-rul Ti n?A 7d""10 4�4 S%.4pTci ?`it iA - Assessor's Map/Parcel ' C Installer's Name,Address,and Tel.No.c,:-_- 1 signer's Name,Address and Tel.No. Type of Building: welli No.of Bedrooms Z— 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 /�j(f� �'9"�I Type of S.A.S. I ujno 6-t4.} L,6�j4r.{ A'Ts, s, Description of Soil ature of Repairs or Alterations(Answer when applicable) t-Q Ill;& 14 (J �6fQ n \&Zo aV � 46 r-I(���t Y�-F i �r`I-�2 ��nNl l3 o U DA-L� 61D V Q 46-2 Date last inspected: 41 2 7 Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Sign - Date Application Approved by Date Application Disapproved by: Date for the following reasons Permit No. ® Date Issued :.,..,...m ...; Mom- �,._,.�...-.-4Ri«.,..,.r•'.co• �u ...•+..,3e►'� ""'.9a�.r.-•.-h..'.i`7,^y✓"'°'i`s'^`a y" ."^k.sk�a-'�''".''`"".' ...�.... .. . -+..:. ,.:��.. .;�•j:.. w,,.:. ^- � , `1� �•'-I No. r Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZIpplication for Migo!6ar 6p$tem Cow6trUctton Permit Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑ Complete System ©Individual Components Location Address or Lot No. —7 S- J4 1 C�/J- Owner's Name,Address,and Tel.No. -194 C- I T "I�DUGl� ®TfJI 7'� 61A 7J/Ch6:f4 Si, LpTc/i tic i>4 . Assessor's Map/Parcel 4 Installer's Name,Address,and Tel.No 6_5 )LI k,C44 esigner's Name,Address and Tel.No. C. IQ-7- J.",;4 MA Type of Building: r welling No.of Bedrooms Z-- Lot Size,.,. sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons 1 Showers( ) Cafeteria( ) Other Fixtures t, i Design Flow(min.required) gpd IDesign flow provided gpd Plan Date _ Number of sheets Revision Date Title r' T Size of Septic Tank /5 (Ja e- J4 `, Type of S.A.S. Q, 1„ n.�'•14 ) LAr-,j4r14 A J S' Description of Soil Nature of Repairs or Alterations(Answer when applicable) ��? {�- /��Q{[( (7 r 7 ' V0 0" P 21 t;6 y,/Ay C9—l0 L-6)40I to(Y) N 1--e) Le,0bI Mr, . (Troy (IQ IF" 7 17> \A/�✓.� G.�r-r t7l r/ y �/t r 1 1 ,G-'4r-'i`j4 1'�tii 13,0 M DA' -r-6 D 2 P2 ti�7 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. f Sign in Date ! O 7 Application Approved by. / f Date ! Application Disapproved by: Date for the following reasons r P ' Permit No. Date Issued —————————————————— THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded Abandoned( )b MID q.rs'1 at '? ( �� ("0 r has been constructed i ceco ance b'f with the provisions Title 5 and the for Disposal System Construction Permit No. _ — Ziocdated Installer lira v tp oA Gz.�jG,1~Q Designer — ^+ #bedrooms Approved design flow gpd The issuance of this/permit shall not be construed as a guarantee that the system will'functon as designed. Date l�j /O Inspector--� ' -------------------------------------------- Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS 4` wli5po5al 6p$tem (Con truction Permit Permission is hereby grante to Co struct ( ) Repair ( grade Ab ndon ( ) System locate&at �(9 v and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provide4,coqgtrudon /muust be completed within three years of the date of t pe Date Q Approved by > �j TOWN OF BARNSTABLE �1 L =CATION ��t i � �r-- SEWAGE# -VILLAGE (f®6,70 t 7 ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. te-t6121(2trqf-7 &—%P)--) SEPTIC TANK CAPACITY LEACHING FACILITY:(type) %!.%s2 1%660 f�(size) NO.OF BEDROOMS OWNER &Qpll -; PERMIT DATE: 7 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 f � , 0 _ �fi TOWN OF BARNSTABLE `LOCATION a ( >i(el;,l SEWAGE# VILLAGE CdrV ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY 5GO LEACHING FACILITY:(type) P./-S LX G (size) /0W - cZ"Sld ,- NO.OF BEDROOMS c OWNER PERMIT DATE: 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 J/'Iny yt � r(- ay o� C A B C 33 .Ili A g a GA 49 3 0 1�o 'r►vt, wAl a 3 Nook. , • • COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Signature item 4 if Restricted Delivery is desired. X ❑Agent ■ Print your name and address on the reverse Ad ssee so that we can return the card to you. g. ceived by(Printt? Name) C, a de M Attach this card to the back of the mailpiece, �rCc C cj-C - or on ttie..front if space permits. D. Is delivery address different from ftem 17 0 Y s 1. Article Addressed to: If YES,enter delivery address below: ❑ No Trade Grover&Patricia.Avallone 78 fligh`Street Cotuit, MA 02635 3. Service Type ❑Certified Mail ❑ Express Mail ❑Registered ❑ Return Receipt for Merchandise ❑ Insured Mail ❑ C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number :s (Transfer from service label) 7!0 0.5i:116 { 0 0 0 0 i 0191 2861 PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 . +i:?,�rvY�. ,dry k:ftFT}vi• UNITED STATlS"fX�L +`ffFdfiE* k;s'r;'. fM b,• NiV N^RPY Wi W+ 4 1 :. .Y-Z•L;.'G..•�.•f+Ya".N .l';'-'d` `r` :G. �:y y�, A!, .�'Y: y.'' • Sender: Please print your name, address, and ZIP+4 in this box • I PUBLIC HEALTH DIVISION TOWN OF BARNSTABLE I 200 MAIN STREET hYANNIS, mASSACHUSSETS 02601 lilt III d'fllli:fill*11f:f11ifi111litl/,,It1 11111111111011 6 ! - U S Postal ServiiceTM CERTIFI M`AILTM RECEIPT " a �_ r, �a� �tr•�a� =.�-� M'NPd . ©omest1c Mafl Only No_Insurance Coverage Provided) jIFlp� ,delKre information visd"our,;website at;www.us s.corn�,`"" , r PS Form 3800,June 2002 sSee.Reverse.for,lnstructions Certified Mail Provides: A mailing receipt asianay)ZppZ eunr`008£u„oJ Sd o c A unique identifier for your mailpiece " t a A record of delivery kept by the Postal Service for two years Important Reminders: n Certified Mail may ONLY be combined with First-Class Mails or Priority Mail®. o Certified Mail is not available for any class of international mail. . a NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. a For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required. o For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement'Restricted Delivery". o If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry. Internet access to delivery information is not available on mail addressed to APOs and FPOs. Y= Town of Barnstable OF1NE.Tp� o Regulatory Services AB Thomas F. Geiler, Director BAPNSr'$A MASS •�� Public Health Division TFD MA'S a Thomas McKean, Director .200 Main Street,Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 February 26 2007 Tracie Grover&Patricia Avallone 78 High Street Cotuit,MA 02635 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system owned by you located 78 High Street, Cotuit, MA was last inspected Januar. 27th 2007 b James M. Ford a certified septic inspector for the State of Y . � Y p p Massachusetts. The inspection of your septic system after further evaluation"Failed"under the guidelines of 1995 TITLE 5 (310 CMR 15.00)due to the following: The inspector noted that the leach pits are H-10 loading and under the driveway; they need to be made H-20 loading (kheavy duty) if they are to remain under the driveway. The Distribution box could not be located for inspection. You have 2 years from the date of the system failure to bring the system into compliance. If there are any questions about this reminder,please feel free to contact the Barnstable Health Department. BARNSTABLE HE TH DEPARTMENT omas A.McKean,R.S., C.H.O. Agent of the Board of Health COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF.ENVIRONMENTAL AFFAIRS. S' DEPARTMENT OF ENVIRONMENTAL PROTECTION cis-- TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 78 HiQh Street Cotuit, MA 02635 Owner's Name: . Tracie Grover&Patricia Avallone ' Owner's Address: 1 Date of Inspection: January 24. 2007 `Name of Inspector: (Please Print) James M. Ford Company Name: James M.Ford z Mailing Address: P.O.Box 49 Osterville.MA 02655-0049 rb r-- Telephone Number: (508)862-9400 rQA r_; CERTIFICATION STATEMENT I certify that I have,personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time.of the inspection. The inspection was performed based on my training and experience in the proper function and.maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: Passes ✓ Conditionally Passes Ps Further Evaluation by the Local Approving•Authority Inspector's Signature: Date: January 24, 2007 The system inspector shall su4 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 Cornments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will,perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 78 High Street Cotuit, MA Owner: Tracie Grover&Patricia Avallone Date of Inspection: January 24, 2007 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: The leach pits are H401oading and in the driveway,need to be H-20 loading(heavy duty) 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: 2 - Page 3 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 78 High Street Cotuit, MA Owner: Tracie Grover&Patricia Avallone Date of Inspection: January 24, 2007 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 aseptic tank and SAS and the SAS is within a Zone 1 of a public water supply.x 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 colifonn 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: 3 Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 78 Hieh Street Cotuit, MA Owner: Tracie Grover&Patricia Avallone Date of Inspection: January 24, 2007 D. System Failure Criteria applicable to all systems: You must indicate either"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 ''/z day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped Any portion of the SAS,cesspool or privy is below high ground water elevation: ✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply: ✓ Any portion of a cesspool or privy is within a,Zone 1 of a public well. ✓ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ✓ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private 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 System: 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, _ the system is within 200 feet of a tributary to a surface drinkingwater 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. 4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 78 Hikh Street _ Cotuit, MA Owner: Tracie Grover&Patricia Avallone Date of Inspection: January 24, 2007 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 backup? ✓ 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: Yes No ✓ _ Existing information. For example,a plan at the Board of Health. ✓ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)]. 5 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 78 High Street Cotuit, MA Owner: Tracie Grover&Patricia Avallone Date of Inspection: January 24. 2007 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 4+ Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203 (for example:110 gpd x#of bedrooms):. 440 Number of current residents: 1 Does residence have a garbage grinder(yes or no): Yes Is laundry on a separate sewage system(yes or no): n/a [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Currently occupied COMMERCIAL/INDUSTRIAL 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 Source of information: Pumped yearly ger owner 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 ✓ 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: Installed on 1982-per as built card Were sewage odors detected when arriving at the site(yes or no): No 6 o' ' Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 78 High Street Cotuit, MA . Owner: Tracie Grover&Patricia Avallone Date of Inspection: January 24, 2007 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron _40 PVC other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting, evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 55 Material of construction: ✓ 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: 1500 ag 1� Sludge depth: 2„ Distance from top of sludge to bottom of outlet tee or baffle: :30" Scum thickness: 6" 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: 10" How were dimensions determined: Measuring stick Continents(on pumping recommendations,.inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.). Tees were present. The liquid level was even with the outlet invert There did not appear to be any signs of leakage The inlet cover was 12"below grade. GREASE TRAP: None (locate on site plaan): Depth.below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet.tee or baffle:. Distance from bottom of scum to bottom of outlet tee or baffle: Date 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.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 78 High Street Cotuit, MA Owner: Tracie Grover&Patricia Avallone Date of Inspection: January 24, 2007 TIGHT or HOLDING TANK: None (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: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: - Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover;any evidence of leakage into or out of box,etc.): Unable to find no measurements and very deep. PUMP CHAMBER: None (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.): 8 ` 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: 78 High Street Cotuit, MA Owner: Tracie Grover.&Patricia Avallone Date of Inspection: January 24, 2007 SOIL ABS ORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits,number: 2-6'x 6'(1000 gaL) 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.): leach pit#1 had Y of liquid on the bottom'. The scum line was app. 40"un froin the bottom; The cover was 4'below Leach pit #2 was not dug up. Note. Both pits are in the dirt driveway and H-10 loading(see design plan) need to be H 20 loading CESSPOOLS: None (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.): 3 PRIVY: None (locate on site plan) Materials of construction: - Dimensions: Depth.of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 9 ,.' Page 10 of l l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 78 High Street Cotuit, MA Owner: Tracie Grover&Patricia Avallone Date of Inspection: January 24. 2007 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. °O '9 ca o , d (: Z� Q � 7 10 i Y Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:. 78 High Street Cotuit, AM Owner: Tracie Grover&Patricia Avallone Date of Inspection: January 24, 2007 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 30+/- feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: topographic and water contours maps Checked with local excavators,installers-(attach.documentation). Accessed USGS database-explain: You must describe how you established the high ground water elevation: Using Barnstable topographic and water contours maps, the maps were showing approximately 30'+1-to ground water at this site. This report.has been prepared only for the septic system and components described herein. This septic system has been inspected and conditionally passed as of the date of inspection: This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees,either expressed, written or implied, relating to the septic system, the inspection, this report and/or any components of the septic system which have not been located and inspected. 11 20217 MAR --9 Pfl 34 33 l tt 1. 1, S I f 1 E I'f ` � I V 7 Town of Barnstable Regulatory Services - .. . Thomas F. Geiler,Director * BARNSrABM 9� 6� Public Health Division �Ev�a Thomas McKean,Director 200 Main Street,Hyannis, MA 02601 Office: 508-8624644 Fax: 508-790-6304 February 26 2007 Tracie Grover&Patricia Avallone 78 High Street Cotuit,MA 02635 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system owned by you located 78 High Street,Cotuit, MA was last inspected January 27th,2007 by James M.Ford, a certified septic inspector for the State of Massachusetts. The inspection of your septic system after further evaluation"Failed"under the guidelines of 1995 TITLE 5 (310 CMR 15.00)due to the following: The inspector noted that the leach pits are H-10 loading and under the driveway; they need to be made H-20 loading (kheavy duty) if they are to remain under the driveway. The Distribution box could not be located for inspection. You have 2 years from the date of the system failure to bring the system into compliance. If there are any.questions about this reminder,please feel free to contact the Barnstable Health Department. BARNSTABLE HE TH DEPARTMENT omas A.McKean,R.S., C.H.O. Agent of the Board of Health f !S V a r A CME ' PRECAST 52 0 THOMAS B. LANDERS RD., h►A TCHVILLE, MA. 8� ~L! Q 8" J "J• -Hv .co�_ERs I 3 24"-DIA. COVER ' pe♦ 24"-DIA• COVER ::ram r•. OFF-SE OP6w4a - 8N .24"DIA. CCVEf do SPECIFICATIONS ` CONCRETE MINIMUM .STRENGTH; 5,000 p.I,s, at :28 days --•-- STEEL REINFORCEMENT: ASTM-A- 615- fib. GRADE 60 DESIGN LOADING: STANDARD UNITS - AASHO - H2O NV . Fee 7HECOMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZippYication for Migozar *p5tem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot o. Owner's Name,Address and Tel.No. Assessor'sftt, 3 /P� �3 Installer's Name,Address,9d Tel.No. esi Type of Building: - Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Oth rere Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 4410 gallons per day. Calculated daily flower d gallons. Plan Date 0 6 2%Z �M Number of sheets I Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil A145 .d/i11, Nature of Repairs or Alterations(Answer when applicable) 77ZIF��_ �A_ 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 proA' ue 'tle 5 of th nvironmental Code and not to place the system in operation until a Certifi- cate of Compliance has be t oard e Signe D Dated c Z Application Approved by Date Application Disapproved or the following reaso Permit No. Date Issued �'�;� ���� ••r• �`�'r Fee/// ��✓_.. NJ. *q�"T'L'r� Entered in computer: -!°I: THE COMMONWEALTH OF MASSAbHUSETTS " _ Yes (PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS:- 01ppYication for �Dizpogar *pgtem Cons�truction Permit Application for a Permit to Construct( )Repair( )Upgrade.( )Abandon( ) El Complete System ❑Individual Components, ' Location Address or Lot No. / Owner's Name,Address and Tel.No. Assessor'10,710 r 3 / Installer's Name,Address,and Tel.No. esi v Y�Ar C'o 'i��'l o a63s Type of Building: � r 1'� Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ), Ili' Other Fixtures Design Flow 4z10 gallons per day. Calculated daily flow 41410 gallons. Plan Date C G -2 91 g?— Number of sheets 1 Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil A5 zear&0 Nature of Repairs or Alterations(Answer when applicable) !cA rn ti p„ f.} u !e V►r<h�U SICK hl . 7-77-►_ 5L.... 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 itle 5 of the nvironmental Code and not to place the system in operation until a Certifi- cate of Compliance has been' ue y t hoard e Signe ::�e r7�_- Date D 0 Z. Application Approved by �� ,� �1//! / Date Application Disapproved for the following reasogif f V i Permit No - Date Issued ------- --� -----------------� —————— THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded( ) Abandoned( 11`` )by at R Fh a 5' , r has .p7-ated onstructed f in accordance of with the provisions Title 5 and the for Disposal System Construction Permit No. Installer Designer 11 The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date )a I�2 3 U7 Inspector I No.------ — ---------------------------- THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Mizpoar *pgtem Con.5truction Permit Permission is hereby grant o�Con c ( )Repair Upgrade( Abandon'(�y System located at and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must e com/ppledd ittun three years of the date oft ' ,pe it. Date:_ 7/ Approved by To;vn of Barnstable Assessors Division Page 1 of 3 EDd ' 8 A RIN y de �' r F I Your Location : Home : Town Departments : Administrative Services : Assessors Division :Property Results <<Back-Forward>> Tuesday, September 24, 2002 Assessors Division- Property Results Data is based on Fiscal Year 2002 Assessor's Fiscal Year 2002 Assessed Values database and is provided for information Tax Information purposes only. Sales History Land and Building Description <<Search AgaiL Construction Details Out Buildings& Extra Features Building Sketch 78 HIGH STREET Map/ Parcel/Parcel Extension: Mailing Address: 035/043/ GROVER, TRACIE E &AVALLONE, PATRICIA M Owner of Record: GROVER, TRACIE E &AVALLONE, PATRICIA M P O BOX 991 Property Location: COTUIT, MA 02635 78 HIGH STREET Parcel ID:035043 Map; t Fiscal Year 2002 Assessed Values ^Top Appraised Value Assessed Value a Building Value: $81,900 $81,900 Extra Features: $ 5,200 $ 5,200 Outbuildings: $900 $900 Land Value: $ 117,800 $ 117,800 Totals: $ 205,800 $ 205,800 Tax Information ^Top Town Tax $ 1,905.71 Tax Rates (per$1,000 of valuation) Cotuit FD Tax $347.80 Town 9.26 Fire District Rates Land Bank Tax $ 57.17 Barnstable 2.61 C.O.M.M 1.38 Cotu it 1.69 Total: $ 2,310.68 Hyannis 2.54 W. Barn. 1.54 Total does not include special assessments- Other Rates http://www.town.bamstable.ma.us/ComeOnIn/Departments/Administrative_Services/Finan... 9/24/2002 Town of Barnstable Assessors Division Page 2 of 3 Land Bank 3% of Town Tax Due to rounding differences these values are approximate. Sales History ^Top Owner: Sale Date: Book/Page: Sale Price: GROVER, TRACIE E &AVALLONE, 10/10/1997 11000/271 $ 175,000 PATRICIA M GALLAGHER, HILLERY J 2967/328 $0 Land and Building Description ^Top Land Building Lot Size (Acres): 1.76 Year Built: 1982 Appraised Value:$ 117,800 Living Area: 924 Assessed Value: $ 117,800 Replacement Cost: $92,052 Depreciation: 11 Building Value: $81,900 Construction Details ^Top Style: Cape Cod Interior Walls: Drywall Model: Residential Interior Floors: Pine/Soft WoodCarpet Grade: Average Grade Heat Fuel: Oil Stories: 1 1/2 Stories Heat Type: Hot Air Exterior Walls Wood ShingleClapboard AC Type: Central Roof Structure: Gable/Hip Bedrooms: 2 Bedrooms Roof Cover: Wood Shingle Bathrooms: 2 Bathrooms Total Rooms: 5 Rooms Outbuildings& Extra Features ^Top Code Description Units/SQ FT Appraised Value Assessed Value BRR Bsmt Rec Room 555 $2,500 $2,500 SHED Shed 120 $900 $900 FPL2 Fireplace 1 $2,700 $2,700 Building Sketch ^Top http://www.town.bamstable.ma.us/ComeOnIn/Departments/Administrative_Services/Finan... 9/24/2002 I_ Town of Barnstable Assessors Division Page 3 of 3 �✓'3y �e"6;'' i7r��f� �yli i �,r�a bY13�33�y y ................. Sketch Legend BAS First Floor, Living Area FST Utility Area (Finished Interior) UAT Attic Area (Unfinished) BMT Basement Area(Unfinished) FTS Third Story Living Area (Finished) UHS Half Story(Unfinished) CAN Canopy FUS Second Story Living Area (Finished) UST Utility Area (Unfinished) FAT Attic Area (Finished) GAR Garage UTQ Three Quarters Story (Uni FCP Carport GRN Greenhouse UUA Unfinished Utility Attic FEP Enclosed Porch PTO Patio UUS Full Upper 2nd Story (Unfi FHS Half Story (Finished) SFB Semi Finished Living Area WDK Wood Deck FOP Open or Screened in Porch TQS Three Quarters Story(Finished) >- Back -Forward Home I Departments I Town Information I Contact Town Hall Website Developed and Maintained internally by the Town of Barnstable Information Systems Department Town Hall-367 Main Street- Hyannis,MA-02601 -508-862-4000 DISCLAIMER: Although we strive to provide accurate information,we are only human. Please consult directly with the appropriate department if there is a question of accuracy. Many Files Require Adobe Acrobat Reader PDT Click Here to download free Copyright 20010 Town of Barnstable. All Rights Reserved. http://www.town.bamstable.ma.us/ComeOnIn/Departments/Administrative_Services/Finan... 9/24/2002 DATE: 8/23/02 PROPERTY ADDRESS:78_High_Street L 02635 t'�� V ------------------------ On the above date, I inspected the septic system at the above adBECEIVED This system consists of the following: 1 . 1 -1000 gallon septic tank. SEP 3 2002 2. 1 -Distribution box, 3. 2-1000 gallon precast leaching pits. ( 6 ' X10 ' ) TOWN OFBARNSTABLE HEALTH DEPT. Based on my inspection, I certify the following conditions: T 1 4 . This is a title five septic system. ( 78 Code) 5. The septic system is in proper working order at the present time. 6. #1 pit. Waste water is 42" below the invert pipe. 7 . #2 pit. Waste water is not present. The pit is dry. SIGNATUR Name:_ J .- P. -Macomber_Jr RECEI Company:Joseah Pam_ Macomber !_ Son, Inc. RECEV Address:__soX _��----- - --- AUG 2 8 'Z00't TOWN OF BARNSTABLE _Q�632-0066 HEALTH DEPT. Phone: 508-775-3338 THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY re W-WI, JOSEPH P. MACOMBER & SON, INC. Tan ks-Cesspools-Leachflelds Pumped & Installed Town Sewer Connections P.O. Box 66 Centerville, MA 02632-0066 775-3338 775-6412 fi COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 . OFFICIAL INSPECTION FORM— NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 78 High Street Cotuit,Mass. Owner's Name:Tracey Grover Owner's Address: $f 2 3/0 2 dame Date of Inspection: Name of Inspector: (please printgoseph P.Macomber Jr. Company Name: J.P.Macomber & Son Inc Mailing Address:Box 66 Centerville,Mass: 02632' Telephone Number: 5(1R-77S-3338 CERTIFICATION STATEMENT I certify that 1 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 Needs Further Evaluation by the Local.Approving Authority w Fails g Inspector's Signature Date: The system inspector shaILZbmit 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 ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different' conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Paee 2 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 78 High Street Cotuit,Mass. Owner:TrArp)z Grover Date of Inspection:8112 3/0 2 „ Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A System Passes: ' IW� I have not found any information hich indicates that any of the failure criteria described in 310 CMR 15.303 or to e-7s . ny failure criteria not evaluated are indicated below. Comments: The septic system is in proper working order at the present time. B. System Conditionally Passes: 4,0 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 existfig 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: 41b 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 obstruction1s removed ND explain: 2 Page ) of I I r OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Propem Address: 78 High Street Cotuit,Mass. Owner: Trarpy CrnyPr Date of Inspection: g�23/02 C. Further Evaluation is Required by the Board of Health: d Conditions exist which require furtherevaluation by the Board of Health in order to determine if the system S falling to protect public health, safety or the envuorurtent. I.- 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 bealth, safety and the environment: I)b Cesspool or privy is within 50 feet of a surface water 10 Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. Sy stem 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: 40 The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or rributary to a surface water supply. WO The system has a septic tank a,nd SAS and the SAS is within a Zone 1,of a public water supple We) The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well to The system has a septic tank and SAS and the SAS is less than 100 feet bu 50 feet or more from a prl\ate �Sater suppl\ \yell•• Method used to deter-mine distance "This system passes if the well water analysis, performed at a DEP cenified laboratory'; for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facilir) and the presence of ammonia nirrogen and nitrate nicrogen is equal to or less than 5 ppm, provided that no other failure criteria are rriggered. A copy of the analysis must be anached to this form. 3. Other: 3 Page 4 of I 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address 178 High Street Owner:Tlao� G1 :0 Date of Inspection, D. System Failure Criteria applicable to all systems: You must indicate "yes" or"no" to each of the following for all inspections:. Yes No/ n/ ckup of sewage into facility or system component due to overloaded or clogged SAS of 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 Q, 1f't S c6lper` —!� iquid depth in se" 9l is less than 6" below invert or available volume is less than ''A day flow �/ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number f times pumped 8 ' 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. _ 4/Any Any portion of a cesspool or privy is within a Zone 1 of a public well'..My portion of a cesspool or privy is within 50 feet of a private water supply well. 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 qualiry analysis. [This system passes if the well water analysis, performed at 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.) �D (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� tthe system is within 400 feet of a surface drinking water supply _ /th, e system is within 200 feet of a tributary to a surface drinking water supply /the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area= IWPA) or a mapped Zone 11 of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 1 I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 78 High Street Cotuit,Mass. Owner: Tracey Grover Date of Inspectioo: 8123/02 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 4 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 ofwater 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 ? 1/ _ Were all system components;4*cluding the SAS, located on site ? z — Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition. of theffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum ? ,., /'ba_ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems ? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: Yes no Existing information.For example, a plan at the Board of Health. Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) (310 Cv1R 15.302(3)(b)). 5 Page 6 of 1 1 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 78 High Street Cotuit,Mass . Owner:Tracey Grover Date of Inspection: 8/2 3/0 2 FLOW CONDITIONS RESIDENTIAL Number of bedrooms (design): Number of bedrooms (actual):�_ A DESIGN flow based on 310 CMR 5.203 (for example: 110 gpd x 9 of bedrooms):'94-//'F ✓�� 0 Number of current residents: Does residence have a garbage grinder(yes or no):Z_) Is laundry on a separate sewage system s or no):� [if yes separate inspection required] `�er 9 � Laundry system inspected(yes or no):l.—t; Seasonal use: (yes or no): 4 Water meter readings, if available (last 2 years usage (gpd)): 2 0 0 0—3 0, 000 gal lons=82. 20 GPD Sump pump(yes or no): (/d 2001 —33, 000 gallons=90. 41 GPD Last date of occupancy: � COMMERCLAL/INDUSTRIAL - 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):,1)4 Non-sanitary waste discharged to the Title 5 system (yes or no):W1.4, Water meter readings, if available,: AV Last date of occupancy/use: OTHER(describe): . /Q GENERAL INFORMATION Pumping Records Source of information: 4_441;7— Ig Was system pumped as part of the inspection (yes or no): If yes, volume pumped:_gallons-- How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM OF tank, distribution box, soil absorption system Single cesspool ,�Overflow cesspool ,424 Privy �AtShared system (yes or no)(if yes, attach previous inspection records, if any) /CO Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from syst m owner) Night tank Attach a copy of the DEP approval . /0 Other(describe): Approximate age of all componentsdate installed (if knoo i)and source of information: (1L1��� �yS%G'�J 7�xe1' �•�j' l�s'� /�j' G��i� .sue—�,�` �yr�y�: Were sewage odors detected when arriving at the site(yes or no): 6 Page 7 of 1 1 OFFICIAL INSPECTION FORM—`NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 78 High Street Cotuit,Mass. OwnerTracey Grover Date of Inspection:8/2 3/0 2 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction:yL-)cast iron ✓40 PVC�oother(explain): i11� Distance from private water supply well or suction line: ,dam Comments (on condition of joints, venting, evidence of leakage, etc.): - .Tni ntc appear_ti ght Nn avi rlanrP of 1 eakage Thp System i s vented through the roof vents. SEPTIC TANK: ✓ (locate on site plan) Depth below grade: Material of construction: oncretewzemetal fiberglass t/' olyethylene Ae other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance (yes or no):. (attach a copy of certificate) Dimensions: Sludge depth: Distance from top o fudge to bottom of outlet tee or baffle: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: -- How were dimensions determined: Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of-leakage, etc.): Pump septic tank annually, Garbage disposal is present The tank is structurally sound and Rhows no PvidPncP of leakage The liquid depth at the outlet invert is fifty one inches. - GREASE TRAP�(locate on site plan) Depth below grade: Material of con struction:rJ�concretetn eta l.jWfi berg lasss6/ polyethylene4&other (explain): loii� Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: le* Distance from bottom of scum to bottom of outlet tee or baffle: ' Date of last pumping:,- ,Pf//y Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage', etc.): Crease trap i .s not nr—�Pnt. 7 Page 8 of OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:78 Hight Street Cotuit,Mass, Owner: Trarpy Groy r Date oflospectioo: 8/23/02 TIGHT or HOLDING TANKA&/E'(tank must be pumped at time of inspection)(locate on site plan)- Depth below grade: Material of construction: ,LA concrete,Gi4 metalfiberglass olyethylene,40other(explain)` ,t0i4 Dimensions Capacity: 14,14 gallons Desien Floµ: 44 gallons/day Alarm present (yes or no): Alarm level: I#W Alarm in working order(yes or no): Date of last pumping: ,JIA Comments (condition of alarm and float switches, etc.): Tight or holding tanks are not present. DISTRIBUTION BOX: (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Distribution box has two laterals.No evidence of solids carry over-No evidence of leakage into or out of the box. PUMP CHA:MBEU" (locate on site plan) . Pumps in working order(yes or no): A�y Alarms in working order (yes or no): Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Pump chamber is not present. 8 Page 9 of I I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Add ress:78 High Street Cotuit,Mass , Owner: Tracey Grover Date of Inspection: _8 23102 SOIL ABSORPTION SYSTEM (SAS): y (Locate on site plan, excavation not required) 2-1000 gallon precast leaching pits. ( 6 ' X10 ' ) If SAS not located explain why: Located: See Page 10 Ty�leaching pits, number: leaching chambers, number: leaching galleries, number: d leaching trenches, number, length: 1�> leaching fields, number, dimensions: overflow cesspool, number: A�L innovative/alternative system Type/name of technology:*—_ Ar< G7f Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Sandy loam to medium sand to sand.No signs of hydraulic fai1lira nr nnnrlinq_ Sni1c art- r1ry Vegetation is normal #1 pit. Waste water is 42" below the invert pipe. #2 pit. waste wet r is not present.Pit is dry.Set up to be this way. CESSPOOLS$ (cesspool must be pumped as pan of inspection)(locate on site plan) ';umber and configuration: 0 Depth —top of liquid to inlet invert: Depth of solids layer: Depth of scum laver Dimensions of cesspool: Materials of construction: IVY9 Indication of groundwater inflow(yes or no): Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Cesspools are not present. PRIVYeq (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.): Privy is not pr _s nt _ 9 Pagc IO 0( OFF'ICLA1. INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFOR.YATION (conlinuco) pfcptrry A00fc), 78 High Street CQtuit,Mass. Owocr:Tracey Gro Dllc o! Inlpcclioo��� Sy—ETCH OF SEWACE DISPOSAL SYSTEM Piorioc I tkcuh of chc Icw diIp011I lyltcm inclvd{ng tics tort Icttst twopermcncnt rc(crcncc IanCmukti �, ocncnmvkc Loccrc cu ..cfll within 100 (cc1. Locccc whcrc public wstcr avpply cnlcrs the bviloin6. 61 • Y Io , Page 1 I of 1 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Propem Address: 78 High Street Cotuit Mass. Owner; Tracey rover Date of Inspection: SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 4 0 , feet Please indicate (check) all methods used to determine the high ground water elevation: NO Obtained from system'design plans on record - If checked, date of design plan reviewed: NA YesObserved site (abutting property/observation hole within 150 feet of SAS) ND Checked with local Board of Health-explain: NA ESChecked with local excavators, installers- (attach documentation) XFSAccessed USGSdatabase-explain:http: //town.barnstable.ma.us. You must describe how you established the high ground water elevation: Used: Gahrety & Miller Model . 12/16/94 Grond water elevations- above sea level. Used: USGS_ Observation well data. June 1992 Used: USGS- Techn let•in92-000-1 Plate #2 Annual ranges of noun ground water elevations.January 1992 Leaching GroundwaterX Feet Below Bottom of Pit W%h.Groundwater Adjustment"l r8 ft per Frimp`t'er e tfi d! , M, i 4 refore, the vertical separation distance between the bottom �f the leaching pit and the adjusted groundwater table is oWa fleet: 11 `7 rr rr—.-rr t-r.—srr.•nrrra-n-r..�er.rr.'r:•.�rr-tsrr:. .. .ITT_r„T _ -_ TOWN OF Barnstahl P NJARD OF HEALTH 0 3UIISU1?FACF SNAGE DISPOSAL SYSTF;M INSPFCTION FORM - PART D •- CERTIFICATION •••�••••�•••.••.'.t—�.f l•^�T.T.��I.1f:TT1 T>'r tTT'.I rlT,'l�•.'1-'i1Tn�f ti'1TlIIr�•r'1'TRRI'RT lS><'RrtTi'�'T'M1Tt liTT1 RTRrRT[T1I� -TYPE OR PRINT CI.EARLY- PROPERTY INSPECTED STREET ADDRESS78 High Street Cotuit,Mass. ASSESSORS MAP , BLOCK AND PARCEL # OWNER' S NAME Tracey GrcvPr PART D - CERTIFICATION I j NAME OF INSPECTORJo_ seph _P.Macomber Jr. COMPANY NAME J-P.Macomber & Son Inc,'.` COMPANY ADDRESS Box 66 Centerville Mass. 02632 Street Town or CSty State LIP COMPANY TELEPHONE ( 508 775 - 3338 FAX ( 508 790 - 1 578 R CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system nt this nddress and that the information reported is true , accurate, and omplete as of the time of -inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems , • u i ,I1:,,•1�• 2Chec one ; System PASSED The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public health or, the environment as defined in 310 CMR 15 - 303 , Any failure criteria not evaluated are as stated in the FAILURE• CRITERIA section of this form . System FAILED* The inspection which I have conducted has found that the system fails to Protect the public health and the environment in accordance with Title 5 , 3.10 CMR 15 , 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection for Inspector Signatu Z Date /<� an6copy of this cert.ification must be provided to the OWNER, the BUYER here applicable ) and the BOARD OF IiEAL111. * If the inspection FAILED, the owner or""o orator shall upgrade aYstem within one year of the date of the inspection , unless alloed re uired otherwise as allowed or required provided in 310 CPfR 15 . 3051 partd . doc 1 / COMMONWEALTH OF MASSACHUSETTS ' IDr EXECUTIVE OFFICE OF ENVIRONMENTAL AFFA DEPARTMENT OF ENVIRONMENTAL PR:OTECTION A� a ONE WINTER STREET. BOSTON, MA 02108 617-292,5500 fir- pri , NOV WILLIAM F.WELD 13 199? i DY COXE Governor TOWNOFgA Secretan P y a(Tyo PTTABLE ARGEO PAUL CELLUCCI D B.STRUHS Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION F R Commissioner PART A a9 CERTIFICATION 5 Property Address: 78 High St . Cotuit MA Address of Owner: Hillery.'Gallagher Date of Inspection: 9/2 9/9 7 (If different) PO B O X 3 Name of Inspector: Ferderi rk Ki Ply Chatham, MA 02633 I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000) Company Name: Environmental Reclamation..,—Inc ; Mailing Address: 446 Waguoit Hwy. Waquiot MA 02536 Telephone Number: ( 5 0 8) 4 5 7—5 0 2 0 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 inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: XXX Passes _ Conditionally Passes �^ _ Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature: Date: 10/04/9 7 The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (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 Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. , INSPECTION SUMMARY: Check A, B, C, or D: A] SYSTEM PASSES: i XXXI have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. "—. Any failure criteria not evaluated are indicated below. COMMENTS: The system is in good working condition and meets the requirements of 310 CMR 15 , 000 (Title 5 ) BI 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:iealth, will pass. Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determinate,)n in all instances. If"not determined", explain why not. The septic tank is metal, Udess the owner or operator has provided the system inspector -.with a copy of`a Certificate of Compliance (attached) indicating !hat the tank was installed wiih�n twenty (20) years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked, structurally i,nsu::nd, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing i?ptic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 04/25/97) Page 1 of 10 DEP on the World Wide Web: http:twww.magnet.state.ma.us/dep ej Printed on Recycled Paper r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 78 High St . C o t u i t MA Owner: Gallagher Date of Inspection:9/2 9/9 7 B] SYSTEM CONDITIONALLY PASSES (continued) N/A Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). Describe observations: broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four 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 C) FURTHER EVALUATION 15 REQUIRED BY THE BOARD OF HEALTH: N/A Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND 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 APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis 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. Method used to determine distance (approximation not valid). 3) OTHER (revised 04/25/97) Page 2 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 78 High St . C o t u i t MA Owner: Gallagher Date of Inspection:9/2 9/9 7 D] SYSTEM FAILS: You must indicate eit!,er "Yes" or "No" as to each of the following: N/A I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR-15.303, The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No X Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. XDischarge 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 1/2 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 Soil Absorption System, cesspool or privy is below the high groundwater elevation. X_ Any portion of a 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 I 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. EJ LARGE SYSTEM FAILS: You must indicate either "Yes" or "No" as to each of the following: The following criteria apply to large systems in addition to the criteria above: N4 A_ The system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: 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) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6,00. Please consult the.local regional office of the Department for further information. 1, M (revised 04/25/97) Page 3 of 10 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 7$ High St . C O t u i t MA Owner: Gallagher Date of Inspection: 9/2 9/9 7 Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes No X _ Pumping information was provided by the owner, occupant, or Board of Health. lyl- _ None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. $ _ As built plans have been obtained and examined. Note if they are not available with N/A. X The facility or dwelling was inspected for signs of sewage back-up. X _ The system does not receive non-sanitary or industrial waste flow. X _ The site was inspected for signs of breakout. X _ All system components, excluding the Soil Absorption System, have been located on the site. X _ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum.. The size and location of the Soil Absorption System on the site has been determined based on: X _ The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub-Surface Disposal System. X Existing information. Ex. Plan at B.O.H. 2L Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) (15.302(3)(b)) �0 I I (revised 04/25/97.) Page 4 of 10 . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 78 High St . C o t u i t MA Owner: Gallagher Date of Inspection: 9/2 9/9 7 RESIDENTIAL: FLOW CONDITIONS Design flow:44n g.p.d./bedroom for S.A.S. Number of bedrooms: 1 Number of current residents:1_ Garbage grinder (yes or no): n Laundry connected to system (yes or no): V Seasonal use (yes or no): ? Water meter readings, if available (last two (2) year usage (gpd): minimum Sump Pump (yes or no): n Last date of occupancy: COMMERCIAUINDUSTRIAL: N/A Type of establishment: Design flow:_gallons/day 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: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System pumped as part of inspection: (yes or no)_no If yes, volume pumped: gallons Reason for pumping: TYPE OF SYSTEM XXXX 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) 1/A Technology etc. Copy of up to date contracts' Other APPROXIMATE AGE of all components, date installed (if known) and source of information: 19 y r G _ i n s a l l a t i o n permit issued 7/8/82 Sewage odors detected when arriving at the site: (yes or,no) No (revised 04/25/97) Page 5 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 78 High St . C o t u i t MA Owner: Gallagher Date of Inspection: 9/2 9/9 7 BUILDING SEWER: (Locate on site plan) N/A Depth below grade: Material of construction: _cast iron _ 40 PVC_other (explain) Distance from private water supply well or suction line Diameter Comments: (condition of joints, venting, evidence of leakage, etc.) SEPTIC TANK:_ locate on site Tian) ) P Depth below grade:5 0 i n c h e s Material of construction: X_concrete _metal _Fiberglass Polyethylene —other(explain) If tank is metal, list age _ Is age confirmed by Certificate of Compliance _(Yes/No) Dimensions: 1 0 ' 6"x5 ' R"x5 ' 7" Sludge depth:2" Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: N/A Distance from top of scum to'top of outlet tee or baffle: N/A Distance from bottom of scum to bottom of outlet tee or baffle:�1A How dimensions were determined: measurements Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) The system has hppn =rn=ar 1 3 ma-„t s inad GREASE TRAP:—N.LA (locate on site plan) Depth below grade: Material of construction: concrete metal Fiberglass _Polyethylene —other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) (revised 04/25/97) Page 6 of 10 f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C / SYSTEM INFORMATION (continued) l Property Address: 78 High St . C o t u i t MA Owner: Gallagher Date of Inspection: 9/2 9/9 7 TIGHT OR HOLDING TANK:NJA (Tank must be pumped prior to, or 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 level: Alarm in working order_ Yes; _ No Date of previous pumping: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:_ (locate on site plan) Depth of liquid level above outlet invert:none Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) The D-Box is level and shows no evidence of solids rarrynupr PUMP CHAMBER: N/A (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.) (revised 04/25/97) Page 7 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 78 High St . C o t u i t MA Owner: Gallagher Date of Inspection: 9/2 9/9 7 SOIL ABSORPTION SYSTEM (SAS):_ (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: , leaching pits, number:2 leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length; leaching fields, number, dimensions: overflow cesspool, number: Alternative system: Name of Technology: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) excavations to the Di t nnvPrs ghnraarl no si of� azzs Trlrnil1in failure e CESSPOOLS: A (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 (cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRI VY:V..A (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.) (revised 04/25/97) Page 8 of 10 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 78 High St . C o t u i t MA Owner: Gallagher Date of Inspection:9/2 9/9 7 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) ' V a t ' 1 � e i I ♦, i � r 1 ; f i - E SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property.Address: 78 High St . C o t u i t MA Owner: Gallagher Date of Inspection: 9/2 9/9 7 Depth to Groundwater Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observation of Site (Abutting property, observation hole, basement sump etc.) Determine it from loyal conditions Check with local Board of health Check FEMA Maps Check pumping records Check local excavators, installers Use USGS Data Describe in your own words how you established the High Groundwater Elevation. (Must be completed) The high groundwater was established using information " obtained from the deep observation pits excavated on 6/10/82 s.1 , g (revised 04/25/97) Page 10 of 10 ""' ` No......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........ .... .. . .. .................OF......................................................................................... Appliratiou fur Dirpual 11-- hidw Tilmitrurtinu Prrntit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at• , . ........ . ` G.�. u.1..7`............... ......................... .. ............ ... .;.. �Lacation•Add o Lot No. �t��/1�- .... 62 c .1.1� r �r......................:....... 3.S.:c�/.. .r.�.�.P.l ......r! f4...� .e �.. '�..�ro rt. .. �C.. awn Add... n ...... . Installer Address Type of Building Size Lot............................Sq. ,f,�ft U .....Expansion Attic ( ) Garbage Grinder Dwelling— No. of Bedrooms............� . .............. Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) aOther fixtuUs . ................................................................................................................................................... d WDesign Flow..................6.......................gallons per person per day. Total daily flow...........`e. .Q..................gallons. Ix Septic Tank—Liquid capacity6.0.0.galIons Length................ Width................ Diameter................ Depth............ Disposal Trench— No. .................... Width................. Total Length.................. Total leaching area....................sq. ft. 3 Seepage Pit No... Diameter.................... Depth below inlet....(9............. Total leaching area........ q. Z Other Distribution box ( ) Dosing tank ( ) n- Percolation Test Results Performed b �'i�C�C].Q,..T - 5��. .�!5............... Date...�.� /.y..... �.� .... .....Z a Test Pit No. 14.1�......minutes per inch Depth of 'Pest Pit... ..... Depth to ground water......4. e!. !� Test Pit No. 2.. es per inch Depth of Test Pit.,;c?.�,Depth to ground water........................ ... ...... .. ......... ........ ..a O Description of Soil.......�.o. -S.a.i.�.... ...s'�......�oZ... -............ .. w .......................................�........................`.`�'"`'...-:::: ........................................................................................................ UNature of Repairs or Alterations—Answer when applicable............................................................................................... ........................................................................................................................................................................................................ Agreement: The undersigned agrees to install the aforedescrihed Individual Sewage Disposal System in accordance with the provisions of:ITLF. 5 of the State Sanitary Code — The midersigucd further agrees not to place the system in operation until a Certificate of Compliance has beAisd by the board of ealth. Signed...... D to Application APproved By........ -. (i�t..: art ..................................... .....,�, ��i�Lr........... Date Application Disapproved for the following reasons:.............................................................................................................. ........................................................................................................................................ ...................................... . ............ Date .. PermitNo......................................................... Issued................. .................................. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... Tprftfirutr of Touiptiana THIS IS TO EIi'TII Y, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by...........�.,1 ......` .fir:.r............. ................................. ....�.................................................. ................................. , J / I ncr at.............. .. ..T../.., ............ ....... ......... ,.: ....................................................................................... has hecn instnlled in accordance with the provisions of TM-TM-E j of The State Sanitary Cndc as described in the application for Disposal Works Construction Permit `'o...... ........... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONST D S A GUARANTEE THAT THE SYSTEM WILL FU ✓C�TMN SATISFACTORY. 2 DATE.................` ................................................. Inspector... .... .......... ..`---C..................................................... THE COMMONWEALT.H OF MASSACHUSETTS BOARD OF HEALTH >1 No.Q.?.'" 67.... .........................................OF..................................................................................... FEs... .......... llftipmaul 3111nrfun Tntuitrurtiou PrrUitf Permission is,hereby grantcd.......�/ '......> ..C .. . . ...... ..................................................... . to Constrt ct r epair, �n divirlual Srw. - Dispos System at No...... r. .�..:......... .n fri.......... ........... li .................................................................................... street as shown on the application for Disposal Works Construction I'�nit No..................... Dated......... ,r .............................. i /_, c �� G 7 Board o(,Re/aA: TOWN OF BARNSTT—ABL`�E LOCATION ! _�/�' ✓ Ls!�!�" SEWAGE # VILLAGE_ _w ASSESSOR'S MAP & LOTC P(OV 'INSTALLER'S NAME&PHONE NO. SXi� SEPTIC TANK CAPACITY , LEACHING FACILITY: (type �� �� (size) Oad/' NO. OF BEDROOMS BUILDER OR OWNER PERMIT DATE: ell COMPLIANCE DATE: yid 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 Leachink Facility(If any wetlands exist + within 300 feet e ty) Feet Furnished b t �/ 1 t I ib� �d LOCATION SEWAGE 'PERMIT NO. -79f VILLAGE INSTALLER'S NAME ANq ADDRESS OWNER DATE PERMIT ISSUED /O - / DATE COMPLIANCE ISSUED r — �� 0 i r ,` 0` ��, :l • } ' e �� ..:��,; t No..........• 6 _ F>cs.3 S. .'............ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ...........................................OF...................................... ......................... Appliratiou for Uhipaii al Work.5 Tayat3uunion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: .[. .......5.e------•. ./. +- - ................ ---------•......-•--- ' - ..... ................-•- Location-Add res o Lot No. fill f..... .0 .r1.� �r.._--------------------------- IS &6'7 _r.� �j(� bwn TAddres;s,, a _.L2.A.D--.y ..w... ............•-•-•--•----------........ ....-.1....�.�.. .5�.�?.[..... ...!..=1...`................................... 11er Address < Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms_._.......... ..__.Expansion Attic ( ) Garbage Grinder ( C� Other—Type T e of Building ............... No. of ersons............................ Showers — Cafeteria a YP g ------------- P ( ) ( ) 04 Other fixturSs . ....................... Design Flow W �....................... allons er erson er day. Total daily flow---- ._gg P P P Y Y dons. WSeptic Tank—Liquid*capacityf3�.0.dgallons Length................ Width---------------- Diameter---------------- Depth................ x Disposal Trench—No. .................... Width........:........... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.__./ --- Diameter_.®.A-__._._. Depth below inlet...6............. Total leaching area..—YA...sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.... :i�C�4.e.�Z'__ �� _n ............... Date.__ . �.® .��._... as Test Pit No. lx,.�.....minutes per inch Depth of Test Pit.../14 ..... Depth to ground water...................... (i Test Pit No. 2._ es per inch Depth of Test Pit.',,S,.. epth to ground water........................ ----------------------------------------- ------------- - �._.... O Description of Soil------- ... U ----•--------- ............................................................................................................. 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 L 1 4, 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been is aped by the board of ealth. t L{/l� Signed...... . 7...- .l_.._ D to Application proved By. -/ ......................................... ....... ...'---•--•-•--- Date Application Disapproved for the following reasons:................................................................................................................ •-----•-•-•-•-•----•------.....-•••••-------••-•......--•-•-•--•-•---•-••....--•-•----........••----...•-•-----•---••-•-•-------•-•--------•--•-•-••------•---•---•--•-•--••---•-•••................... Date PermitNo......................................................... Issued....................................................... Date ' No.......... ... . 7 y FE$.. S . ............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH' ................... .. .............OF........................................ Apli irta#ion for Dhipaii al Works Towitrnrtion Trani# Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual':Sewage Disposal System at• - y i .,„�- ...........v ?� .._..... ®: &t.z.. ........ © ............................................................. /21-oeation-Addres o Lot No.. J //1�' - •-5a�._ _� :........................... P. ._... :.° .1►.L'S J ;; �i 0 �t F l. ....._..._.. Address ..--.-----•-•- Installer {"Address U Type of Building ( Size Lot...........................Sq. feet �(' �. .-, Dwelling—No. of Bedrooms..._:.:?______ _______ __________________Expansion-Attic ( ) Garbage Grinder aOther—Type of Building .......�.................. No, of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtu�s . --------------------------------•------------------•-•------------------- W Design Flow..................6... ...........gallons per person per day. Total daily flow...........�?��f_ .................gallons. WSeptic Tank—Liquid capacity/ 00gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.... _. .. Diameter-_�q----_---__- Depth below inlet....ik.._........ Total leaching area...:7Y�..sq. ft. z Other Distribution box ( ) -S` Dosing tank ( ) Percolation Test Results Performed by..... ?.F ...::X�4..__. ______________ Date_._.6.�� QZv�'�- Test Pit No. 1 z, .....minutes per inch Depth of Test Pit....4............ Depth to groun&water_..__ v�.' fs, Test Pit No. 2...Si�o es per inch Depth of Test Pit_,;�epth to groundwater........................ W ---------- --=------- ----------------------- a O r—r.+rN�..� 9 ��:..we � e✓�� '•.•..............`$�.�_._...__.. ...........___- Description of Soil------ -- / •-••---------- ------------------------------------------ U ........... UNature of Repairs or Alterations—Answer when applicable..................:............................................................................. ---------------------------------•--•--•---•---------------------•----------------......-----------------•-•---.....---•----•-----------•------------••--------•-----•-----------•----...............-- Agreement: The undersigned agrees to install the Individual Sewage Disposal System in accordance with the provisions of TIT1Z- 5 of the State Sanitary Code— he undersigned further agrees not to place the system in operation until a Certificate of Corr pliance has been is,sued b the board of lth. j �j tN f Signe .......--- . .. --- •.-- --- A Application roved .�_�- ` � -�* D�L . Date Application Disapproved for the following reasons---------------------------------------------------•----------------------------•-------------------•---•--•-••. •--------------------•-----------------•-----------------•---•--•-------.....•----------.....-------•--•----------------------------------------•--......-----------------------••------•--•------------ Date PermitNo......................................................... Issued-----------............................................. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... �rr�ifirtt�r laf ��ant�rli�anrr THIS IS TO ERTIFY� That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) b - ..._ ,/ ------------ -------------------------------------------•---------------•-•------------------•---••---•---------------------•------------------- InAaller e at........... --------23 - - -- --------------------------------•----•--•--•----------------------......----•----------- has been installed in accordance with,the`provisions of TITI.0 5 of The State Sanitary Code as described in the e 2 - 1(7 application for Disposal Works Construction Permit No.......................... ...__...... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONST D S,A GUARANTEE THAT THE SYSTEM WILL FU C,TION SATISFACTORY. 2 DATE.....=......... -•-�--------•---•........•.......................... Inspector... .... .--------- . ..................................................... r { i THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH p .......................................3 . ................................................................................ No.f. ''...6 .._ ...OF.. . .. FEE........................ Diapim a1 Works (gonfrndian rrmit Permission is hereby granted . � --•••- ---------------•--........-------------•-•-•-•-------......---................_.... to Constr ct Apy°r epair�( ) �n ndividual Sem e Dispos . System atNo. ---= ---- .... ........ N --------------------------------------------------------------------......... Street as shown on the application for Disposal Works Construction"Permit No............:........ Dated.......................................... DATE. A Irzl Board of x1 ealth r r" t5 FORM 125'5,,,HOBBS & WARREN. INC.. PUBLISHERS ` a. LOCATION SEWAGE PERNJIT NO. �30 - VILLAGE INSTALLER'S NAME ANY ADDRESS a -- g D OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED .00 I 4'-Cr 0---k 22'-T (ADDITION) (ADDITION) (EXISTING) pd r l (ADDITION) 1'-0 h - y ' t0'-6' 3'-4' 4'.tP O 0 cl ,- .t EXIST. C71 EXIST. A4 (F!1 CLl N LO C B B u3�OC C }F 1 ® o R m n.LL EXIST. I 00 to 15KYUGHTI ABOVE A EXIST A DINING NEW .- o0 MASTER _————————— ROOM . KITCHEN BATH NEW o MASTER Z A ti N6 BEDROOM 0 — —————— OS (VAULTED CEILING) CLOS iil ,� 4'7xss -4`0"xea r-T-u� - 1b lu O ZO �+ SIFOLD BIFOLD I 1 — ——__—————— 6 NEW r-1 w 1 CLOS. MUDROOM i 5 (VAULTED CEILING) ON. , L EXIST. - - A A A NEW ti 9'-11 7-10' 8.-1. Ln PORCH EXPANDED A _ _ LIVING B EXIST. ROOM A4 NEW 6 x 6 P.T.POST W/ HALL 1.711 x 8 CASING A b A4 20'a 4'-9' (ADDITION) w 4'_0. 10'-(r U �* EXIST. (ADDITION). EXIST. EXIST. - t � L 27 7 O (EXISTING) FIRST FLOOR PLAN o EXIST. FIRST FLOOR = 616 S.F. •. NEW ADDITIONS = 410 S.F. NEW GARAGE = 320 S.F. LEGEND: (4 0NEW SMOKE DETECTOR EXISTING WALLS ' '~ © CONST. TO BE REMOVED NEW CARBON MONOXIDE DETECTOR Ml NEW CONSTRUCTION w00 00 WINDOW SCHEDULE Z �" TYPE MANUFACTURER'S UNIT ROUGH OPENING REMARKS SCALE: NOTES: A ANDERSEN TW 2442 2'-6 1/8"x 4'-5 1/4" . DOUBLEHUNG 1/4" = 1'-0" 1.) CONTRACTOR IS TO VERIFY ALL EXISTING CONDITIONS B " A 31 2'-0 5/8"x 3'-0 1/2" AWNING &DIMENSIONS IN THE FIELD C A 21 2'-0 518"x 2'-0 5/8" AWNING DATE: 2.) CONTRACTOR TO VERIFY ALL INTERIOR&EXTERIOR MATERIALS, D VELUX VS 306 2'-6 1/2"x 3'-10 7/8" SKYLIGHT(VENTING) 1/1 1/2007 DETAILS,&FINISHES IN THE FIELD WITH OWNER NOTE:CONTRACTOR TO VERIFY ALL WINDOWS WITH OWNER AND ROUGH OPENINGS THE DESIGNER SHALL BE NOTIFIED IF ANY 3.) ROUGH OPENING HEAD HEIGHT OF WINDOWS AT WITH WINDOW MANUFACTURER PRIOR TO ORDERING OF WINDOWS ERRORS OR OMISSIONS ARE FOUND ON THESE DRAWINGS PRIOR TO START OF DRAWING NO.: CONSTRUCTION.THE BUILDING CONTRACTOR FIRST FLOOR TO BE 6'-8"ABOVE SUBFLOOR WILL BE RESPONSIBLE FOR THE CONTENT 4.) ALL CONSTRUCTION TO CONFORM TO 780 CMR MASSACHUSETTS IN THESE DRAWINGS IF CONSTRUCTION COMMENCES WITHOUT NOTIFYING THE STATE BUILDING CODE DESIGNER OF ANY ERRORS OR OMISSIONS. _ THESE DRAWINGS ARE SOLELY FOR THE USE OF THE OWNER NOTED.ANY OTHER USE OF THESE DRAWINGS REOU!RES THE WRITTEN - - CONSENT OF THE DESIGNER. _. z c� 0 0 Q N N >- 8211 17 Q � �� Li]N 00 CONT.RIDGE VENT - =�0 110 FF- cn 1n X 0 cn NEW ASPHALT SHINGLES _ TO MATCH EXISTINe M NEW FASCIA&FRIEZE F BOARDS TO MATCH EXIST. TOP OF PLATE NEW x 6 P.T.POST WI IE ❑ mi i x 71 1 x 8 CASING ml N W 2 F FIRST FLOOR S. FLOOR NEW LATTICE - FRONT ELEVATION REMOVE EXIST.WINDOW 7 ram\ iZ O - EXIST ' O � L) '® - - I t2 NEW RAKE TRIM BOARDS ' TO MATCH EXIST. ^ a! L Ca TOP OF PLAT 7!1 NEW CORNER BOARDS TO MATCH EXIST. Li NEW W.C.SHINGLE SIDING< r A TO MATCH EXISTING ¢ f FIRST FLOOR SUBFLDOR SCALE: TOP OF PLAT 1/4" = 1'-0" O® oOac TC DATE': 1/11/2007 FINISHED GRADE VARIES (VERIFY IN FIELD) DRAWING NO.: RIGHT SIDE ELEVATION TOO OFSLAB NEW O.H.DOOR.(VERIFY A 2 61FR.d TYPE W!OWNER) z Q Q N N Ca LL)� I � 3�N0 CONT.RIDGE VENT W 0-O Il') m��X �U cn NEW ASPHALT SHINGLES TO MATCH EXISTINS / \ NEW FASCIA 8 FRIEZE BOARDS TO MATCH EXIST. - TOP OF PLATE 70P OF PLATE - - i NEW CORNER BOARDS z y TO MATCH EXIST-- NEW W.C.SHINGLE SiDIN i' TO MATCH EXISTING o - f FIRST FLOOR - FIRST FLOOR SUBFLOOR .. SUBFLOOR ' TOP OF PLATE —- _ NEW OOROCK NOTE:DO NOT DISTURB EXIST. b RETAINING WALL NEW GARAGE TOP OF SLAB - - REAR ELEVATION WO 2 EXIST. - O - NEW RAKE 8 BOARDS " TO MATCH EXIST"IST- F`�1 rLTL,1 12 ~^� ►�+ MATCH 12 - r l EXIST. 4 .7 TOP OF PLATE _ti tr�11 Q � x _ NEW 6 x 6 P.T.POST W/ 1�1 w MM F1.711 x 8CASING W FIRSTFLOOR SUBFLOOR SCALE: -- 1/4" = F-0" DATE: 1/11/2007 LEFT SIDE ELEVATION DRAWING NO.: z 4'-(r ,0'd 22-0' 20'-0' (ADDITION) (ADDITION) (EXISTING) (ADDITION) 3'-4' S•S 3'-(r w 0 Q Sd Q <N N 0 NEW 2 x 6 WOOD B � to v' EXIST. EXIST FRAMED WALLS A4 Q Q=T cc � U)U3NLL I � t3J�z°poLLo Lo NEW 9 i1T ENGINEERED JOISTS @ 16'o.c. E.P. STEPDOWN i U v LL.L•.. NEW P.T.6 x 6 A c i 8' I PPRO i POSTS A4 NEW DOOR FO . \ ELECTRICAL PAN i cc m 3➢.T.2x tOs O l 78'x68" 002 EXIST. SAWCUT 3'0"OPENING I I b E?a BASEMENT © NEW 3 xgEr IN EXIST.FOUNDATION FOR F o 0 b — 7 BII � ACCESS INTO NEW NEW b I I a NEW 12 DIA SONOTUBES II BASEMENT GARAGE i b ry to 70 4.0"BELOW GRADE C�L:OS. °3 b F F a (� e NEW P.T.2 x 8rs @ 16"o.c. UNDER PT.6 x 6 POSTS I I (4-CONC.SLAB - q ry SLOPE T TOWARDS DOOR) z h DRILL 8 PIN NEW FOUND. I I (Y Z TO EXIS" CLOS. 15 BARS T&BOTT W14 b - 3P. .2x 1Os ., b O / NEW P.T.2x I's®I6"o.c. _ L -- ----------- ------ F NEW B"CONC. R �^ 0 - FOUND.WALLS NEW 8'x 18' CONC.FOOTINGS 3.P.T.2 x 10's - A NOTE:DROP TOP OF NEW FOUNDATION TO MATCH NEW SUBFLOOR W/THE A4 EXIST.FOUND.WALLS EXISTING SUBFLOOR,(VERIFY IN FIELD q a FOOTINGS TO REMAIN e IF REQUIRED). NEW.28"DIA'BIGFOOr FOOTINGS 5'4r UNDER 12 DIA SONOTUBES TO 4'0'BELOW GRADE,USE SIMPSON ABU 66&BC6 POST BASFJCAP 4'.()' 2Y-0" 20'17' Fri/�TO FASTEN P.T.6x6POSTS (ADDITION) (ADDITION) (EXISTING) (ADDITION) NEW ROOF CONST. CONT.-RIDGE VENT O 1.2 x 10 RAFTERS @ i6'EA BASEMENT/FOUNDATION PLAN 2.ASPHAl2 COXLT PROOF SHINGLES LNG IF T+M r 3:ASPHALT ROOF SHINGLES �I 2 x 6's @ 16 o.c 9"R FELT PAPER 5,9' O 5. (R=30)GATT.INSULATION @FLAT CEILINGS 12 6.8-(R=30)HIGH DENS.INSULATION @ SLOPED CEILINGS MATCH t2 NEW ROOF CONST. 9� 7.MUPSONLTILV 2.5 HURRICANE O v EXIST. B.SIMPSONH2.5 HURRICANE CLIPS AT RAFTERS r-, L 12 �..( 1(1'GYP.BOARD O TOP OF PLATE ` T ON 1 x 3 STRAPPING LL ~~ � `CONT.ALUMINUM 2x6's@16'o.c 4 LL SOFFITVENTS C~ O.C. TOP OF PLAT - r? NEW —NEW WALL CONST. y NEW MULTI LVL BEAMjjEW ' MASTER ,.2x46Tuos@,6•c.c. w NEW BEAD BOARD BEDROOM 2.112'PLYWOOD SHEATHING (_1 3. - 1?(R=13)GATT.INSULATION <NEW6x6P.T.POSTWI NEW c' 4.1/T GYPSUM BOARD E `/ 1 x 7/1 x 8CASING WALL = NEW 314'T a G PLYWOOD 5DING TYVEK TINGLEAPOR STARRIER FIRST FLOOR ~' ORCH MUDROOM CONSTd SUBFLOOR-GLUED&NAILED SUBFLOOR W NEW DECKING - P.T.2 x 6 SILL W/SEALER ob NEW 9 1!1'ENGINEERED JOISTS @ 16'o.c. NEW P.T.2 x Vs @ 16'o.c. 1. FIRST FLOOR - SVBFLOOR NEW S. FIRECODE GYP.BD. _`NEW WALL CONST. INSULATION(R=30) ON 1 x 3 STRAPPING @ 1G - SCALE: NEW 3•P.T.2 x fOs NEW DUROCK o.c.IN GARAGE 1.2 x 6 STUDS @ 16'o.c /�n c r_On NEW NEW P.T.6x 6 POSTS 1/2'DIA.ANCHOR 2.112,PLYWOOD SHEATHING Fo BOLTS @ 48'ox. 4.518"FIRECODE GYPSUM BOARD NEW 8'CONC. GARAGE 5.W.C.SHINGLE SIDING m r`OUND.WAL 6.TYVEK VAPOR BARRIER DATE: b NEW DIA.'BIGFOOT'FOOTINGS DAMPPROOF ALL WALLS ]/I 1/2007 UNDERR 12"DIA SONOTUBES TO 4'CONC.SLAB 8't BELOW 4'0'BELOW GRADE,USE SIMPSON BELOW GRAD EXIST.BASEMENT SLAB TOP OF SLAB TO 66 a N P POST BASEICAP DRAWING NO. TO FASTEN P.T.6 x 6 POSTS NEW 8'x 18' CONC.FOOTIN BUILDING SECTION @ NEW PORCH/MUDROOM BUILDING SECTION @ NEW BEDROOM FlERIFYI FIE VARIER oZ (VERIFY INFIELD) b Z A4 - z - Q N Lo In 0 2 N ?- J. ca Lu CCC) [JI 00 Ls7=O 27 101-9* 2Y-P Z0'4r E^ Q-•w 9 (ADDITION) (ADDITION) (EXISTING) (ADDITION) cn O m Q y,.< Uv�ac�. B A4 M Lj O A I Pp A4 lool 0 fI MULTI LVL- - - - 1 RIDGEBEAM b p 2x 12 RID � F I � U - B --- A4 NEW MULTI LVL BEAM b A4 tr-O' 20'-0" - (ADDITION) (ADDITION) \\\t 22'4r c! (EXISTING) - W V ROOF FRAMING PLAN 00 NOTES: SCALE: 1.) ALL ROOF RAFTERS TO BE 2 x 10's UNLESS OTHERWISE NOTED 1/4" = 1'-0" 2.) USE SIMPSON H 2.5 HURRICANE CLIPS AT ALL RAFTERS ENDS DATE: 3)VERIFY W/OWNERS ER TYPEILAYOUT 1/1 1/2007 DRAWING NO.: r CERTIFY THAT THIS SURVEY AND PLAN WERE MADE ASSESSORS LOT 41 BARAWFABLB IN ACCORDANCE ATTH THE PROCEDURAL AND TECHNICAL n STANDARDS FOR THE PRACTICE OF LAND SURVEYING IN - S8 `44 '18"W 138. 18' - T COMAfO F M CHUMV. s%OZi a IV IL PAUL HE , DATE A. ll Q0 .d r�p,�o� '% ASSESSORS � 9 ��Q' s�o.. 3 � ����a LOT 68 �� �.� �. 4� .�f'iQ'7 til�• ' J y' ASSESSORS LOT 42 N AA - � 1 �o � W j � �•o ;Z CO L0 W STR ET O Q S89°4 4 '18"W 239 33 SCHOOL STREET sww ss,M LOCUS MAP • (PW IMF�) � O 0 �� ` � ASSESSORS MAP.- 35, LOT 43 PLAN REF 466/78 .; ZONING: "RF" FLOOD ZONE.- "C" (`� ASSESSORS COMM. PANEL# '�I 1 o _s�srlNc= ; 250001 0018 D L07' 43 la _: B - Y �K DATED.• 7/2/92 a pro. - � AREA=76,503 S.F. -_�4o zo• 48.1' Q 152.� PROPOSED /\ ADDITIONS ASSESSORS J o LOT 103 PLOT PLAN 118. 13 -Q OF LAND e 8,10„E, LOCATED AT ,O 78 HIGH STREET ,. COTUIT, MA. PREPARED FOR cr � tj�? 3.36E 24 6• 20, TRA CIE GRO VER & PATRICIA A VALLONE ASSESSORS ASSE _ N85 oO LOT 44 IRE DEPT) ASSESSORS A UG UST 26, 2002 (COTUIT F LOT 65 GRAPHIC SCALE YANKEE SURVEY CONSULTANTS UNIT 4 40B INDUSTRY ROAD P.O. BOX 265 40 0 20 40 so 160 MARSTONS MILLS, MASS. 0264E TEL 428-0055 FAX 420-5553 ( IN FEET ) 1 inch = 40 ft. Jif 53135 DCB _ i � . .I% . I'm - . ' . . J . W v A:,,5;",E— o✓F-,E? . `-�/O rNv.t ----...__....._ - F"// i/SN C,,4-A70E" O YE'R "ill :IV.'. _ -:: ;:%.. - - L E+�7c^N/NS, F,/T -.00,.Sr/.R:/ 3d.0 1..4 2 . s, . . /:�:'%/_r/i+ta' .��///�///F//.'-'r/Y4,♦ +/.ir"/:i'i%Vel.i+, ,I.• rilE///rI///' Ir//!/- .•'///A// ..47//r-•.//it. / - .96 0 •RE//VFORCE-Q, --- - ';CIOWC.l'. y`" MO/f'T7.P Td r. 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