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1109 MAIN STREET (COTUIT) - Health
1_n9 A►I1�T STREET g;� �OtUlt •. 034:- 009t .., ,. ,1 I i I i TOWN OF BARNSTABLE rr / LOCATION !0 M A I tl Sr• SEWAGE# VILLAGE C[��Vi'� ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. � SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) NO.OF BEDROOMS 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 �00 feet of leaching facility) Feet r> FURNISHED BY A v� �os< (044 4 O nstructic yInc f C� IIs,MA 02648-0704 )-428-8926 Fax:(508)-428-9399 12560 ECTRIC ST OOD ROAD As C LD MA 02050 Pagi Due Date Description Invoice Amount Credit I 0:102111:F.ervice Charge $6,164.20 6,164.20 M ' TOWN OF BARNSTABLE LOCATION 1 J64q P'J,!� t 4 SEWAGE# 16 t .L. VILLAGE � i Li `+' ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. t SEPTIC TANK CAPACITY CA-L LEACHING FACILITY.(type) 7>► (size) NO.OF BEDROOMS � Lf OWNER _LO`f PERMIT DATE: ,&. -7- IS— 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 a tiod kl 10 O 0 G-3 �� No. Fee / 0/O THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS RppliLation for Disposal *pstrm Construction Permit Application for a Permit to Construct( ) Repair(1� Upgrade( ) Abandon( ) ❑Complete System Paindividual Components Location Address or Lot No. I/Q (n C Owner's amp,Ass an Tel.No. oS�o O pO .3o x Assessor's Map/Parcel U3 L609O Installer's Name,Address,and Tel.No. 9399 Designer's Name,Address,and Tel.No. bar4kotob, �r,btnx. on,'Zne- .0. 0o is a ( °v�� Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria(' ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd . Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil , Natu a of Repairs or Alterations(Answer when applicable) "- 9 r 0 e 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 provisions of Title 5 of the Environmental Co t to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. gned Date ���� Application Approved by Date 3 Application Disapproved by Date for the following reasons Date Issued Permit NoO ` —1 / t No. �J S / v C7� Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: -= PUBLIC HEALTH DIVISION - TOWN Of BARNSTABLE, MASSACHUSETTS Yes application for Disposal *pstim Construction Permit = Application for a Permit to Construct( ) Repair(_� Upgrade( ) Abandon( ) ❑Complete System individual Components Location Address or Lot No. //05 /Varn Sf , . r Owner's Name,Address,,and Tel.No. P,, // oZCS� Assessor'sMap/Parcel Q �- fc-tc�` �.� �z.�?������s ,tA 0.-Ce_ -S'- Installer's Name,Address,and Tel.No. w 93 Designer's Name,Adclress,and Tel.No. bor�olott c>v,,5 c,ruc#-dory ,fin - o it ��A gu;d y Type of Building: -Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. e Description of Soil .4� Nature off Repairs or/Alterations(Answer when applicable) n` A40/4n Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore descbe_d on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code ax of to place the sy tem in operation until a Certificate of Compliance has been issued by this Board of Health. .gne Date Application Approved by Date 3 Application Disapproved by Date for the following reasons Permit No. 0 — Date Issued --------------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the /On-site Sewage!Disposal system Constructed( ) Repaired(A") Upgraded( ) Abandoned( )byr,rca � ( "ehSfi z' 1-iCJY_T,c at C39 HA I n S4• �r' ' t a has been constructed in accordance J J with the provisions of Title 5 and thhe��for Disposal System Construction Permit NoD NS `/ t)-dated Installer r ( (fin$CY Designer #bedrooms n Approved design flow. )\j�Q gpd The issuance of this permit shall not be construed as a guarantee that the system w In tibh as desig ed. Date I Inspector No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal *pstem Construction Permit Permission is hereby granted to Construct( ) Repair(/) Upgrade( ) Abandon( ) System located at Mt ;y.�Sf and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction mu t be co pleted within three years of the date of this ermit. Date 1n Approved by 1 n e /fib NooU`' R THE COMMONWEALTH OF MASSACHUSETTS FEE • BOARD OF HEALTH C41 �q la of APPLICATION FOR DISPOSA"YSTEM CONSTRUCTION PERMIT e Application for a Permit to Construct ( ) Repair Upgrade ( ) Abandon ( -) -- ❑Complete System ❑Individual Components gal v � Loca[io a arcel# Address pay f Y� �//�)�/J � �y g-� Bp ca�C E 6AW ��/�X J�J/(L_Jelep�hore# %�i) t� 1t isN`a'� �Jp Designer's Name 1_ s /� Telephone# Telephone# Type of Building: Lot Size Sq.feet Dwelling—No.of Bedrooms Garbage Grinder ( ) Other—Type of Building No.of persons Showers ( ), Cafeteria ( ) Other fixtures Design Flow(m,}n reclui ed) gpd Calculated design flow gpd Design flow provided gpd Plan: Date ry Number of sheets Revision Date Title Description of Soil(s) Soil Evaluator Form No. Name of Soil Evaluato Date of Evaluation DESCRIPTION OF REPAIRS OR A TERATIONS The undersigned agrees to install the above des ribed Individual Sewage Disposal System in accordance with the provisions of TITLE S and further agrees t to place th in o eration until a Certificate of Compliance has been' su by the Board of Health. Signed Date �y Inspections FORM t — APPLICATION FOR DSCP DEP APPROVED FORM 5/96 No.dol � � THE COMMONWEALTH O'F MASSACHUSETTS FEE r 'k. -• BOARD OF HEALTH OF i "#_ t. APPLICATION FOR DISPOS� .SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct ( ) Repair ( Upgrade ( j Abandon ( ) - ❑]Complete JSystem ❑Individual Components � AN Locatio 14.1 l � � a arcel# Address 'z t Telepho e# LL�- G:1 1 I [a is Na Designer �7 t Telephone# f Telephone# Type of Building: �. .'f >` Lot Size Sq.feet Dwelling—No.of Bedrooms " Garbage Grinder ( ) Other—Type of Building N' .No.of persons Showers ( ), Cafeteria ( ) Other fixtures.- Design-Flow(m'n e ui ed) gpd Calculatedtdesign flow gpd Design flow provided gpd Plan: Date "Y 5 Number of sheets Revision Date Title _ Description of Soil(s) �✓'?r' �� Soil Evaluator Form No. Name of Soil Evaluat Date of Evaluation DESCRIPTION OF REPAIRS OR A TERATIONS The undersigned agrees to install the above des ribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and Furth agrees t to place th m in o eration until a Certificate of Compliance has been' sue ,byy the Board of Health. Signed Date / Inspections OZ� FORM 1 - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 �._...� ——�No. / 5 THE COMMONWEALTH OF MASSACHUSETTS FEE ® �{ ��G i''BOARD OF HEALTH - h' CEIFICATE OF COMPLIANCE Description of Work: ndividual Component(s) ❑Complete System The undersigned hereby certify that the Sewage Disposal S—ys�tem;Constructed( ),Repaired(kr-5--pgraded( ),Abandoned( ) has been installed in accordance with the provision�of 3t CM 15.00 (Title 5) and the approved design la s-built plans relating to application No. dated Approved Design Flow ,gpd) Installer ?��. f Designer , 4Mc-50 Inspector _ Date SI)• 7 �/t' ,l The issuance of this certificate shall not be construed as a guc0antee that the system will function as designed. FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96 q � No. G/�'`// / THE COMMONWEALTH OF MASSACHUSETTS FEE BOARD OF HEALTH DISPOSAL-.SYSTEM CONSTR CTION PERMIT Permissiori; s hereby granted to Construct ( ) Repair p Wade ) Aban on ) an individual sewage disposal system at -- as described in the application for Disposal System Construction Permit No. C'�,C dated 5 A �.: Provided: Construction filiall e completed within three years of the date of t is per 't.All al c ditions must be met. Date 5 �S Board of Healt —J FORM 2 - DSCP DEP APPROVED FORM 5/96 r FORM 1255 (REV 5/96) H&W HOBBs&WARREN TM PUBLISHERS- BOSTON 6 , t Town of Barnstable �oEtNEtoh'L Regulatory Services ` NAP O Richard V. Scali, Interim Director w sntaysMBU, MASS. �0 Public Health Division lEo►��° Thomas McKean, Director 200 Main Street, Hyannis, 1VIA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: ��� Sewage Permit# ��� I Assessor's MapTarcel Z� Designer: 'QL10 a Installer: Address: 1 .�1 1N�i�� Address: On �e was issued a permit to install a (date) (installer) septic system at I L based on a design drawn by ry 1�lr� (address) �;0 ,L ' dated Z"T (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the system ref ced above was constructed ' lnce with the terms of e IAA approval lette applicable) AOFr�,I , /J/Z, DAVID (In Iler' i a re) I MASONNo.1066 r�» (D s Signature) (Affix Desib v& p Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF CONIPLIANCE `VILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:\Septic\Designer Certification Form Rev 8-14-13.doc TOWN OF BARNSTABLE LOCATION,�O�/%C?i�o �T i3a.+d SEWAGE#All Z VILLAGE ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY /Sw® e L b4w LEACHING FACILITY:(type) (size) I L2; 7I i" X.9 NO.OF BEDROOMS ' OWNER GL PERMIT DATE: 3/9-f2-1 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 BYCQ/r Al/b, el a3G d fi ti 9J 72' i` I. TOWN OFBARNSTABLE CATION 1107 1 M/91/1 S 1- l/M.41J I45e)SSE#r-M0 S/0 ILLAGE ASSESSOR'S MAP&PARCEL Imo'S NAME&PHONE NO. �'r'C o✓l i'll rl.7 SEPTIC TANK CAPACITY ( ?30 LEACHING FACILITY: (type) qq (size) COK(O NO.OF BEDROOMS �O OWNER PERMIT DATE: C DATE: p-5P /o�t3 ll0 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 1 fffff 18 f f f f f \ff\!\}r\r\r 45 • F\f\!\!\f\f\f +`.� � t . f f r ! f r f w ! f f f f r ! f f f f f t 16 \f\!\f ` airaf el 35 \f\f\f\f\ 4 f f f f f I 4 \ 4 \ \ 14 14 - ' f f f f r f ! r r ! f r \"1, \ \ \ f ? f f f f f f f f f f f f J ! f f f f f f f i f No. 1 sUh 7 THE COMMONWEALTH OF MASSACHUSETTS FEE -� BOARD OF�►,,HEALTH f OF APPLICATION FOR�.DISPOSAL SYSTEM CONS RUCTION PERMIT Application for a Permit to Construct (�/) Repair ( ) Upgrade ( ) Abandon ( ) - omplete System ❑Individual Components Location wner's Name � /Parcel# Address h k Lot# ]1 leph ne# bje4ji ,tL� 6�a i Installer's Name Designer's Nam Address O D Address Telephone# Telephone# Type of Building: Lot Size 0',i1 C-ow," Sq-felt Dwelling—No.of Bedrooms -11C Garbage Grinder ( ) Other—Type of Building No.of persons e Showers ( ), Cafeteria ( ) Other fixtures Design Flow(min.required) Wom gpd Calculated design flow,44b gpd Design flow provided 4(02:)gpd Plan: Date `Z-1- I-L Number of sheets )i Revision Date Title 3 34 , CL4-4 Description of Soil(s) d & S tocu s—,L Z2`=i2o''KQIl SO—,IL Soil Evaluator Form No. Name of Soil Evaluator . A, Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and fu rees not to place the system in operation until a Certificate of Compliance has been issued by the Board of Health. Sig Date Inspections / z— FORM t - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 :1 s y 7.G11 '�� NO. ,THE COMMONWEALTH OF MASSACHUSETTS Fee --�� BOARD O H E A LT H OF �4 4 APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT a ppli N Com cation for a Permit to Construct ) Repair ( ) Upgrade ( ) Abandon ( ) - plete System ❑Individual Components c Ct �►-, S 1 C � �r Ll 1, ocation /` wer's Name moo 3y `nit L r)bot n /Parcel# Address 4rf F� i Lot# �� +��elepf�ne Wpr1- , y Installer's Name Designer's Nam Address ,, II Address �-1 J-5, -I Telephone# Telephone# Type of Building: Lot Size U"-Al C-al, Rrfmt Dwelling—No.of Bedrooms Garbage Grinder ( ) Other—Type of Building No.of persons Showers ( ), Cafeteria ( ) Other fixtures Design Flow(min.required) WHO gpd Calculated design flow A 4Q gpd Design flow provided 4(D3 gpd Plan: Date E-1. Number of sheets Revision Date Title:2 --s!U A x 7-� Description of Soil(s) �-1u��Orr So 1�"'ZZ"�o s^ d ,Z'� 1 Z.0` K&A SCsI Soil Evaluator Form NO. Name of Soil Evaluator .W0kKX-2-r% Date of Evaluation t DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further grees not to place the system in operation until a Certificate of Compliance has been issued by the Board of Health. Siped� �" Date Inspections b FORM 1 - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 NO. �° 1) 'Ub C THE COMMONWEALTH OF MASSACHUSETTS FEE Sv f04D,-b C-,c.- BOARD OF H E A LT H CERTIFICATE OF COMPLIANCE Description of Work: ❑ Individual Component(s) EVomplete System The undersigned hereby certify that the Sewage Disposal System;Constructed(vf Repaired( ),Upgraded( ),Abandoned( ) F by: �n at C� 1 1CLVY) ^/� has been installed in accordance with the provisions of►310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No. ?tiff -V&Vdated 3+/h�/y Approved Design Flow (gpd) Installer { t�U,�`ri �(,1n� ! % Designet';Alit 4l�CV\-dO Inspecto Date e 7 f// The issuance of this certificate ts gall not be construed as a guarantee that the system will function as designed. r FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96 No. d ( �� (�� THE COMMONWEALTH OF MASSACHUSETTS FEE bw,,oitbt1- BOARD OF HEALTH W DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to Construct (V ) Repair ( ) Upgrade ( ) Abandon ( ) an individual sewage disposal system at b C1--LyY Ck ,r. Cv'i,,;k as described in the application for Disposal System Construction Permit No. o ^a b / dated Provided: Co struotion shall be completed within three years of the date of this permit.All local onditionns must be met. Date ' / Z f Board of Health r 0� FORM 2 - DSCP DEP APPROVED FORM 5/96 FORM 1255 (REV 5/96) H&W HOBBS&WARRENTm PUBLISHERS- BOSTON Jul 30 12 09:00a Cape and Islands Engineer 508-477-9072 p.1 Town of Barnstable Regulatory Services Thomas F. Geder,Director ` g Public Health Division Eo " Thomas McKean,Director 200 Main street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: 12 SewagePernnit# %' 12�� L4 Assessor's 1M�daplParcel 0 06CI i Designer: �Q�¢ 1p�G4,t��� �L Installer: Address: `,;;�0. P,� .� � _2�61 G Address: C b b6 0 (M ",4 On was issued a permit to instal}a (date) (installer) I� septic system at��o�� M .L�; tC1� og%l U�� based on a design drawn by ( dressy dated f (designer) > I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State& Local.Regulations. Plan revision or certified as-built by designer to follow. _1t1 OF Installer's Signature) �� L DAV { g ) � cHAREs- SANICKI 2®©85 A p ItLA 4 SU�y (Designer's Signature) (Affix Desi p.Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DMSION. THANK YOU. Q:Health/Septic/Designer Certification Form 3-26.04.doc Town of I1arns-table Department of Health,Safety,and Environmental Services NTH Public Health Division Date-Z�-��Z, 367 Main Street,Hyannis MA 02601 BARMABr.E,,p` . sa 639.� /�rfDMA't� Date Scheduled � � Time A lo Fee Pd. 1��./10-0 Soil Suitability Assessment for Sewage Disposal Performed By: i((Y-�fJl U v W� i{'1 Witnessed By: .1�3�A 2� �S i LOCATION & GENERAL INFORMATION Location Address Owner's Name Uo tk l i I Address 2,0 �� 14 oC W ea vvtk)(11y_t Assessor's Map/Parcel: inrt-f U-3,\ \wq Engineer's Name Cap., t Uptkj 5 619. NEW CONSTRUCTION REPAIR Y Telephone N 5$- -r) 1-- n-L Land Used Slopes(%) Surface Stones Distances from: Open Water Body ft Possible Wet Area R Drinking Water Well ll Drainage Way R Property Line R Other R SKETCH:(Street name,dimensions of lot,exact locations of test holes&Pere tests,locate wetlands in proximity to holes) � s r 9 " Parent material(geologic) ),gc4,A uu� Lei w vz__� Depth to Bedrock Depth to Groundwater: Standing Water in Hole: 164 Weeping from Pit Face Estimated Seasonal High Groundwater DETERMINATIONTOR SEASONAL HIGH WATER TABLL Depth Observed standing in obs.hole: in. Depth to soil moides: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. Index Well N Reading Date: Index Well level Adj.factor Adj.Groundwater Level_ PERCOLATION:,TEST Date 3 /Z Time Observation Hole N 1 l Time at 9" Depth of Pere Time at 6" Start Pre-soak Time chi 7;) 1�, 1 r- Time(9"-6") End Pre-soak Rate Min./Inch �,,Z Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Ilealth Division Observation Hole Data To Be Completed on Back---� Copy: Applicant DEEP.OBSERVATION HOLE LOG Hole #4 Depth t}om Soil I lorizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency, Gravel) 6A 1»1 SA�� is y � ^s1� �° j,6)c 3-z'v� DEEP OBSERVATION HOLE LOG Hole # L Depth from Soil Horizon Soil Texture I Soil Color Soil Other Surface(in.) I (USDA) (Munsell) Motlliny (Structure,Stones,Boulderes. Consistency,%Gr vel r0- ti.3 /8iu sw. rn y 1z 4)2 0.3- )12D iO DEEP OBSERVATION HOLE LOG ' ` Hole # Depth from Soil I lorizon Soil'texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. on i tenc °o ravel DEEP OBSERVATION HOLE LOG Hole# Depth from Soil I lorizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency.°o ravel y9 I �quiff i J2 J" D . �1_.a� a� �aAa��'�� is t`'Z-'��• N� 1fe.a�-`/�°r,�r�=� I i Flood Insurance Rate Map: year fl-od --- Within 500 year boundary No— Yes Within 100 year Flood boundary No_ Yes Depth of Naturally occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? If not, what is the depth of naturally occurring pervious material? Certification / 1 certify that on (date) I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training,expertise and a erience described in 310 CMR 15.017. Signature Date .1 ` 8 `Q0) I b (p IV No. / / Y' Fee C�- THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 4plication for Misposal *pBtem Const union Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon w6l❑Complete System ❑Individual Components Location Address or Lot No. //O %0(;in S Owner's Name A dress and Tel. o. :i a�-'S!�?- d> Assessor's Map/Parcel 63 Cf -� :Jr' U Installer's Name,Address,and el.No. `i U c1$- c (p Designer's Name,Address,and Tel.No. o. e 19a Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) ' 00 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 He Si ed Date Application Approve Date T Application Disapproved by Date for the following reasons Permit No. - I c`�-' Date Issued No. .� L/ 49 Fee d 5 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftplication for disposal 6pstem Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( )`Abandon W/❑Complete System ❑Individual Components Location Address or Lot No.//04� %Ujlj iYl S Owner's Name,Address,and Tel.No. 5 0Ir -IV9 9• o'/9 Assessor's Map/Parcel 6�CJ 0 t &e6�� 14011 y 'LSO yc( t"/o .4rc. 4k=c .f In7staller's Name,Address,and fel.No. 5 -Va - o?(o Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required)- , gpd Design flow provided gpd Plan Date r r Number of sheets Revision Date Title t. Size of Septic Tank Type of S.A.S. Description of Soil t A Nature of Repairs or Alterations(Answer when applicable) �,�. %.�_ ^ �c�4, CZAJ,p6 J 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! t ed Date -_.- Application Approve r Date VJ I Application Disapproved by Date for the following reasons Permit No. PO J /^ L1`� Date Issued f THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certifirate of Compliance THIS TO CERTIFY,th/att the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) Abandoned y I-kIe 5 ( lrv) 7.1C. at L°1 /�i�7 �1 /J7Y.I/ has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.�%//—y:;L�k dated Installer Designer #bedrooms Approved design flow gpd The issuance of this permit shall not be construed as a guarantee that the systewill f bnction,as designed. Date Inspector,- No. /I" ��"'(�� �. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal 6,pstem Construction Permit Permission is hereby granted to Construct( ) Repair( ) Upgrade( Abandon System located at�� g' / ��n �u- � and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date Approved by, Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1109 Main Street *Main House* Property Address Bets O'Boyle Owner Owner's Name information is Cotuit MA 02635 October 13, 2010 required for every page. Cityffown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form.- - Important: A. General Information When filling out forms on the computer,use 1. Inspector: only the tab key to move vour Patrick M. O'Conne!!; cursor-do not Name of Inspector use the return key. Septic Inspection Services Co. Company Name 189 Cammett Road _ Company Address Marstons Mills MA 02648 rerun Citylrown State Zip Code 508.428.1779 SI 12855 Telephone Number License Number tw B: Certification - I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs F!!rther'Evaluation by the Local Approving Authority October 13, 2010 Job# 10-242 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal system-Page 1 of 117 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments .' 1109 Main Street *Main House* Property Address Betsy O'Boyle Owner Owner's Name information is Cotuit MA 02635 October 13, 2010 required for State Zip Code Date of Inspection every page. CityrFown B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: Tank is not in need of pumping at this time Leaching pits showed no signs of surcharge. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be y upon completion replaced or repaired. The system, of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND_ )for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if.the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): 15ins-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1109 Main Street *Main House* Property Address Bets O'Boyle Owner Owner's Name information is Cotuit MA 02635 October 13, 2010 required for State Zip Code Date of Inspection every page. Citylrown B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ` ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh posal System•Page 3 of 17 t5ins•09/08 Title l5 Official Inspection Form:Subsurface Sewage Dis Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1109 Main Street *Main House* Property Address Bets O'Boyle Owner Owner's Name information is Cotuit MA 02635 October 13, 2010 required for State Zip Code Date of Inspection every page. City/Town B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑, The system has.a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.. 3. Other: Systems: D) System Failure Criteria Applicable to All S y You must indicate "Yes" or"No" to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool El ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than_day flow t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1109 Main Street *Main House" Property Address Betsy O'Boyle Owner Owner's Name information is Cotuit MA 02635 October 13, 2010 required for every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. 0 9 Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1109 Main Street "Main House" Property Address Bets O'Boyle Owner Owner's Name information is Cotuit MA 02635 October 13, 2010 required for State Zip Code Date of Inspection every page. Cityrrown C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health �i Were any of the sys ern components pwimp:ed out iri the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field,('f any of the failure criteria related to Part C is at issue approximation of distance is.unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: ' Number of bedrooms (design): 6 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 660 t5ins-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1109 Main Street *Main House* Property Address Betsy O'Boyle Owner Owner's Name information is Cotuit MA 02635 October 13, 2010 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: * 1 Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Currently Occupied. Commercial/industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1109 Main Street *Main House* Property Address Betsy O'Boyle Owner Owner's Name information is Cotuit MA 02635 October 13, 2010 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: tank pumped 2-3 years ago. Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ' 1 ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): 15ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1109 Main Street *Main House* Property Address Betsy O'Boyle Owner Owner's Name information is required for Cotuit MA 02635 October 13, 2010 every page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Compliance date: 6/26/92 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 1 Depth below grade: feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): 1' Depth below grade: feet Material of construction: concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No 10.5' long x 5.8'wide- 1500 gal. Dimensions: 2" Sludge depth: l5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 117 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1109 Main Street *Main House" Property Address Betsy O'Boyle Owner Owner's Name information is Cotuit MA 02635 October 13, 2010 required for State Zip Code Date of Inspection every page. Cityfrown D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 29" Trace Scum thickness 6 Distance from top of scum,to top of outlet tee or baffle 14" Distance from bottom of scum to bottom of outlet tee or baffle Measured How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is not in need of pumping at this time. Tees were intact and clear and liquid level was at bottom of outlet invert. Tank is H-20 load rated. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-09108 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 10 of 17 ,_<L\ Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M ' 1109 Main Street `Main House* Property Address Betsy O'Boyle Owner Owner's Name information is Cotuit MA 02635 October 13, 2010 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on.pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No `Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments lug 1109 Main Street *Main House* Property Address Betsy O'Boyle Owner Owner's Name information is Cotuit MA 02635 October 13, 2010 required for every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): No solids or high_stains present. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments .'( 1109 Main Street `Main House" Property Address Betsy O'Boyle Owner Owner's Name information is required for Cotuit MA 02635 October 13, 2010 every page. City/town State Zip Code Date of Inspection D. System Information (cont.) Type: •® leaching pits number: Two 6x6 pits. ❑ 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.): Pits showed no signs of surcharge into d-box. Area of pits was probed with no signs of saturation found. Cesspools(cesspool must.be purl ped as part of inspection) (locatz on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No l5ins-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1109 Main Street *Main House* Property Address Betsy O'Boyle Owner Owner's Name information is Cotuit MA 02635 October 13, 2010 required for every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions .J Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 15ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1109 Main Street *Main House' — Property Address Betsy O'Boyle — Owner Owner's Name information is Cotuit MA 02635 October 13, 2010 required for City/Town State Zip Code Date of Inspection every page. D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ❑ drawing attached separately 18 45 QM� 16 M ♦�drage , i i to 35 ♦ \ , \ , 4 \ 14 14 , ! ♦ \ , ain street . • Commonwealth of Massachusetts L Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments r 1109 Main Street "Main House' Property Address Betsy O'Boyle Owner Owner's Name information is required for Cotuit MA 02635 October 13, 2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells 30+ . Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: . ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you estat!ished the high ground water elevation: Low area on opposite side of road is con§iderably lower.than SAS. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 116 of 17 . \ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1109 Main Street *Main House" Property Address Betsy O'Boyle Owner Owner's Name information is Cotuit MA 02635 October 13, 2010 required for every page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or.attached in separate file t5ins-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 1. Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1109 Main Street *Guest House* Property Address �(.^ � �.� �'� Bets O'Boyle t l Owner Owner's Name information is Cotuit MA 02635 October 13, 2010 required for State Zip Code Date of Inspection every page. Cityrrown Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. General Information When filling out - - forms on the computer,use 1. Inspector: only the tab key to move your Patrick M. O'Connell cursor-do not Name of Inspector use the return key. Se tic Inspection Services Co. Company Name . 189 Cammett Road Company Address Marstons Mills MA 02648 run City(f own State Zip Code 508.428.1779 SI 12855 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority t I October 13, 2010 Job# 10-242 v ` In pector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 � I r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1109 Main Street *Guest House* Property Address x Bets O'Boyle Owner Owner's Name information is Cotuit MA 02635 October 13, 2010 required for State Zip Code Date of Inspection every page. CitylTown B. Certification (cont.) Inspection Summary: Check A,B,C,D or E!always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 117 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1109 Main Street `Guest House* Property Address Betsy O'Boyle Owner Owner's Name information is Cotuit MA 02635 October 13, 010 required for every page. City/town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): - broker, piO sI are replaced- r 1. Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s).,The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1109 Main Street 'Guest House* Property Address Betsy O'Boyle ` Owner Owner's Name information is Cotuit MA 02635 October 13, 2010 required for every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in.a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within-50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: "This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ® Backup of sewage into facility or system component due to overloaded or El clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or.cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than_day flow t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1109 Main Street *Guest House* Property Address Betsy O'Boyle - Owner Owner's Name information is required for Cotuit MA 02635 October 13, 2010 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. Any portion of cesspool or privy is within 100 feet of a surface water supply or ❑ E tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems,you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,- or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 I ` �\, Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1109 Main.Street *Guest House* Property Address Bets O'Boyle Owner Owner's Name information is Cotuit MA 02635 October 13, 2010 required for State Zip Code Date of Inspection every page. Cityrrown C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ _0 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? ® El available as built plans of the system obtained and examined?(If they were not available note as N/A) ❑ ® Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ❑ ® Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: - Number of bedrooms (design): N/A Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): Unknown 15ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 • Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 1109 Main Street *Guest House* Property Address Betsy O'Boyle — Owner Owner's Name information is Cotuit MA 02635 October 13, 2010 required for every page. City/town State Zip Code Date of Inspection D. System Information Description: 4 Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ® Yes ❑ No Water meter readings, if available(last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Currently Last date of occupancy: Occupied Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1109 Main Street *Guest House* Property Address Betsy O'Boyle Owner Owner's Name information is Cotuit MA 02635 October 13, 2010 required for every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Unknown Was system pumped as part of the inspection? ❑ Yes ® No. If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ❑ Septic tank, distribution box, soil absorption system ® Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): 15ins•DBMS Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 o117 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1109 Main Street `Guest House' Property Address Betsy O'Boyle Owner Owner's Name information is Cotuit MA 02635 October 13, 2010 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Unknown Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(Locate on site plan): Depth below grade: feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: 15ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,.' 1109 Main Street *Guest House" Property Address Betsy O'Boyle Owner Owner's Name information is Cotuit MA 02635 October 13, 2010 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 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.): Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1109 Main Street *Guest House* Property Address Betsy O'Boyle Owner Owner's Name information is Cotuit MA 02635 October 13, 2010 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1109 Main Street `Guest House` Property Address Betsy O'Boyle Owner Owner's Name information is required for Cotuit MA 02635 October 13, 2010 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts ' Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1109 Main Street *Guest House* Property Address Betsy O'Boyle Owner Owner's Name information is Cotuit MA 02635 October 13, 2010 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ Teaching 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.): "Cesspools'(cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration One single 3' Depth—top of liquid to inlet invert 4 Depth of solids layer 2" Depth of scum layer 6x6 Dimensions of cesspool Block Materials of construction Indication of groundwater inflow ❑ Yes ® No t5ins-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 r Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1109 Main Street "Guest House" Property Address Betsy O'Boyle Owner Owner's Name information is required for Cotuit MA 02635 October 13, 2010 � every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Single cesspool fails per town standards. Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 C .. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 1109 Main Street *Guest House* Property Address Bets O'Boyle Owner Owners Name information is Cotuit MA 02635 October 13, 2010 required for Cotuitwn State Zip Code Date of Inspection every page. D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least bf permanent sut reference ply enters the building. Check on or e of the boxesks. Locate l wells belowWithin 100 feet. Locate where public P ❑ hand-sketch in the area below ❑ drawing attached separately Drop in ♦,♦;r ♦, ♦, Foundatio ♦,♦,•,., ♦, r ,�, � r r♦r♦ r r r r r r r r r r r r r r r r r r r r ♦r♦�♦r♦r♦r♦r♦r♦r♦r♦r♦ ♦�♦�♦r♦�♦r♦,♦,♦,♦,♦,♦ r r r r r r r r r r f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1109 Main Street "Guest House" Property Address Betsy O'Boyle Owner Owner's Name information is Cotuit MA 02635 October 13, 2010 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells N/A Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ¢ ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 I Commonwealth of Massachusetts Inspection Form ... . Title 5 Official p Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1109 Main Street "Guest House* Property Address Betsy O'Boyle Owner Owner's Name information is Cotuit MA 02635 October 13, 2010 required for every page. Citylrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file l5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 '- TOWN OF BARNSTABLE LO+: 1;TtC;N /A19 jilt e S? SEWAGE # 7- _ 1.AGE .11, ASSESSOR'S MAP & LOT -0,3 y- 0!1? 'I �f77tb.t� INSTALLER'S NAME PHONE NO. SEPTIC TANK CAPACITY 6-AL LEACHING FACILITY:(tgpe) arf (size)_a�l NO. OF BEDROOMS 4 PRIVATE WELL. OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COLIPLIANCE ISSUED: VARIANCE GRANTED: Yes ��rNo loub 19, 1 SNE� C Al 10N S E A G E PE RMIT N VILLAGE ' I I N S T A IIER'S NAME i ADDRESS III I IDEIII OR OWN DATE PERMIT ISSUED DAT E C01M9lIANCE ISSUED o� Cl + I t THE COMMONWEALTH A! :OF MASSACHUSETTOS BOARD OF HEALTH ....fir. . ............._0F....... �7� A.I_R:>Z �.............................. Appliration fur i'Dispaual Morkii Tomitrurtiall Vantit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: A 3.Y., Z'o r q ......... ... ...... Location Add re s qr j1t No. Addr ......�_4..... Cj....................... qMWOMA...AA ....VA.510_95 .................. Installer Address Size Lot.� Type of Building _5LO...Sq. feet U a Dwelling—No. of Bedrooms.........a................................Expansion Attic Garbage Grinder ( ) Other—Type of Building ............................ No. of persons............................ Showers Cafeteria ( ) Pa Otjh �fifi*ures ......................................................................................................... - - --- - ------------- ..... gallons per person per day. Total daily flow....____._.Design Flow...... j X......0, , 0V A/ Ai;j 0� Septic Tank—Liquid capacitVl:�p---gallons LengthiA.9...... Width.5.2.*...... Diameter................ Depth....7.......... Disposal Trench—Ao..................... Width ....... Total Length....... Total leaching area-------------------sq. ft. Seepage Pit No.__......__..__.. Diameter.....6.. ......... Depth below inllet.6_5........ Total leaching area.-!55.(q......sq. it. Z Other Distribution box Dosing tank ( ) Percolation Test Result x Performed by.................................... Date.....:__.__..___..._..._.._. ..............;?,*......*......*------ as Test Pit No. I......Z.....minutesperinch Depth of Test Pit...../Z1......... Depth to ground water-----IVA------------ f14 Test Pit No. 2.......Z,....minutes per inch Depth of Test Pit...... Depth to ground water----NA----------- 9 ............................................................................................................................................................ 0 i-,5 - � . -T 0 Description of Soil../ .......xjpr...... .0t..t.510B.5:---VC. ............ CVK_P....... --------- r-- ---------------------------------- ..................................................................................................... .... ---------------------------------- ......... f R airs or Alterations—Answer 1* U Nature o e er when app ical�ie..&,A%fi;...&...... ............... < . ..... ...... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of of the State Sanitary Code—The undersi Pd further rees not to place the system in operation until a Certificate of Compliance has been issued e bo r 4A Signed.... .. .......... . ............I----------------77-----#------------- .... Date Application Approved By...- ..... .......... ........................................ Date Application Disapproved for the following reason ............................................................................................................ ...................................... .. ........../;--------------�_a._;,e--------------- Permit 4.4�........ Issued-_. .. . .. .. ....... No... "---------- [CIO No Fizz THE COMMONWEALTH OF MASSACHUSETTS _ n +BOARD OF HEALTH ....----. 0.�.!J....------..O F........a�d)S.Tfi&. ............................ J ApplirFa#ion for Uiipos al Works Tonstrur#ion Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at /.��.. . p1�.N !v.s►: --h--...---- A>>r AP #_3 e- Go 1 �J Location-Address J o Lot No. dres�5f 9 ................... Cj f� !�t Kt T I. ... i 1:..................................... Installer Address d Type of Building Size Lot..� � .-r_1� ..Sq. feet aDwelling—No. of Bedrooms...... ---•........................Expansion Attic ( ); Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ------------•-----------------------------------------.-•-•--------•-••••......-••-•-----•-••-•-- W Design Flow--------. -- -- ��_ gallons per person per day. Total daily flow--%--' Q..... ------•--...gallgns. WSeptic Tank—Liquid capacity.,a . allons LengthJ42.,6.._.. Width..S.' __.. Diameter................ Depth...__��.._...... x Disposal Trench—.L o. .................... Width ............. Total Length.................. Total leaching area.......;.... sq. ft. Seepage Pit No------- ......... Diameter...... j 6-_.._..... Depth below inlet... .-3....... Total leaching area..S "L.....sq. ft. Z Other Distribution box ( Dosing tank ( ) Percolation Test Results Performed by................................................... .... Date....____.__.__........_---_ _ ►4 j.... .... Test Pit No. I........Z,....minutes per inch Depth of Test Pit....../. i....... Depth to ground water......NA--•----_-. Li, Test Pit No. 2-------.Z,---minutes per inch Depth of Test Pit........ Depth to ground water------Al.A.......... ............... .............•------•--- --•-•----•-••..........................---•-••-•------_-•.......................................................... - - O Description of Soil .._ T U '..l. .0 U k��PM- z�?�...t........... if � -#-�----------------------------------------------------- W ---------------------------------------- --•--•-•••••---•--•--•••-•-••••••••••-•--•-•----------......--••••... •- "; cl U Nature of Repairs or Alterations—Answer whenplicable_._ y.�^P '....8;1...... , G � �!____ 1__._.. '14--... J� _r:s ±r------ -- �, 1 = 't'clN's�................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT L L 5 of the State Sanitary Code—The undersi d further agrees not to place the system in operation until a Certificate of Compliance has been issued boa d.of 111Y Signed--_ ........ --- ..... Application Approved BY; r ,:.-- ` ,: ' r ae Date Application Disapproved for the following reasons... .....................:_.._._....___...._.___..._.__----••..........................•. .........._... . Date Permit No.-------- ---- Issued. ¢ � ... --......... Date THE COMMONWEALTH OF MASSACHUSETTS �. �OARD OF HEALTH r � �, �, / .................................... Titr#ifirtt#r of ToutpliFamr THIS I TO CER�IFY, Th t e nd: I al Sewage Disposal System constructed ( ) or Repaired ( ) by .........._ ... d' ;,.. � ••--------------- •------------ at Y.......... ------ -•-- t ---- ------------------------------------------ ---- ................. application installed for i accordance with the provisions of TITd- iof e Ie Sanitary Co e /d&edr;b n e pp osal Works Construction Permit No....... ' dated 1/? ! " as been I . • 1- �r . 7 1--� THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONST UED AS,!A GUARANT E THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE...................................................•-•--------•--•••-••.:.-•--_. Inspector....------------------------•-•-•-r---•------------••......---..................--- - - - `~"TFIE COF4M'ONWEALTH-OF--MASSACHUSETTS r ARD ....................... e.... .. ......: No:.-: .. ... FEE..... . __... ....... f Permission is/hereby granted..'_C ' ..... ............................. _ to Construct R a r ( ) n I divy al Se e'D>s sal S3�stem - , .�� • ) �- - y / _�==;=•'.•.-- Street c++ as shown on the application for DI posal Works Construction Eerm `1Vo::: ._ _ e F'" _ ... _....� .•------•....... n�,.• Board of Hea h ~ DATE.................. .. _ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS N sT 5 OZ 21.-G' m,n Q g 7:-2' 7'-2' T-2' WINDOW&EXTERIOR DOOR SCHEDULE 100''oAl CONCRETE SONG UBE5 0 4 t IA B5 ON 24•D .•NG FOOD CONC.FOOTINGKEY ROUGH OPENING WxH ITEM# STYLE MATERIAL - (z)2nD 0. O7-53/4'x 4'-113/4 2059 PELLA ARCHITECT DOUBLE+NNG wBmGW WHITE ALUMPAIM CLAD © 2'-5 3/4'x 4'-9 3/4' 2957 PELLA ARCHITECT DOUSLE+NNG WINDOW WHITE ALUMINUM CLAD I I p n © 2'.53/4'x T-113/4' 2947 PELLA ARCHITECT CASEMENT WNDOW WHITE ALUMINUM CLAD m O 26'-O' d 6'-O' I U a O2'-5 3/4-X T5 3/4- 2941 PELLAARCHITECT CASEMENT WINDOW WHITE ALUMINUM CLAD OPELLA ARCHITECT CASEMENT WINDOW WHITE ALUMINUM CLAD i ® NI f O9-87/8'XB'-10' 11782 PEUAARCHITECT&IDINO PATION DOOR WNSTEKUMNUMCLAD IF O wl PROVIDE AROUND NEW FOUNDATION WALL PERIMETER: 7282 PEUAARCHTTECT SUDINGPATIDN DOOR WM1LITE ALlMNL1M CIAO Ia - ril ENDOfLPIATE OR3-.YSI MA%. O.L.t6'-12'FROM U $2 END OF PLATES,USE 3'.3'.I/4'PLATE WASHERS OV-0 3/4'x 6'-1(r 3682 PEU.n ARCHITECT HINGED PATIO DOOR WHITE ALUMINUM CLAD i __ BOLT EMBENTMEM IN.T — ----------P.T.200lEDGER---- --- ------ -� O T-23/8-xV-11' 3'0'x 6'6' ENRTY DOOR-3 PANEL II LIGHT I+. II a f I 10 THICK.B'O'HIGH POURED CONCRETE O 3•-2 3/8'X W-11' 3'0•X 6'3' ENRW DOOR-6 PANEL I I (- CONFOUNCRETE FOOTING DATION WFlL -TYPICAL 101.20 CONTINUOUS Iq Ir W HOUSE..-C. W/1?BOLTS®16.O.C. I STAGGERED Iu RJ06T5 2 ROW' . 'T --BOUT=FLOO -- I I I T. 2H0 ---- -- .39. 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SIMPSON L5TA 19 STRAPS®EVERY RAFTER 20 ROOF RAFTERS®16'O.C. ®ROOF RIDGE: W/5/5'CDX.PLYWD.SHEATHING t NMP50N L5TA 16 STRAPS®EVERY RAFTER 2.B ROOF RAFTERS g 16.O.C. 12 2.1 O RIDGE BD. - ASPHALT ROOF SHINGLES TO MATCH IX15T. 2.1 O RIDGE BD. Wl5/B'CDX.RYWD.SHEATMING t - ASPHALT ROOF SHINGLES TO MATCH EXIST. TO ELATING(4+/-)E7 AMTCH R.PITCH AT EACH END OF RIDGE BD.: 2.$CEIUNG JCXSTS(9 16'O.C.. TO EX15TING 2 (4+/-) 2.B CEIUNG JOISTS Q I G'O.C. - - DOUBLE LEIUNG JOISTS SMFSON H 2.5 BETWEEN TWO RAFTERS, SIMPSONH 2.5 , PLATE H_EI_OH T/MATCH MIU. WT(4)SW DIA THRU BOLTS@ EA END HURRIUWE CUPS PLATE 7ffIGHT/MATCH EAST. HURRIUNE CUPS MATCH D� MATCH DORMER TRIM DETAI TO EXIST ANG M WINDOW MDR.HT./MATCH EAST. DETAIL TO MISTING ) WINDOW IrOH.M./MATCH EAST. 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(3)i 3'4'x 11 7I5'LVL HDR BALLOON FRAME FLOORS: ___ _____ _ WINDOW HDR.M.MATCH EAST. P.T.2.12 LEDGER FASTEN FLOOR J015T5 VATH (2)2xlp HEADER M15TS HPNGER5 ON 2.O EMEND MST.PORCH ROOF PELIA ARCHITECT SIMPSON AG POST CAP BAND NNLED TO STUDS PASS NEW CONNECTOR I I DOUBLE-HUNG WINDOW _ CUSTOM SLRFPNES ®TOP OF POST fRAME t ROOFING TO MATCH Dn5l. - BETWEEN P.T.POSTS EMEND MIST.PORCH ROOF } - CASED IN I.TRIM PELIA ARCHITECT FRENCH sed extended + PASS NEW CONNECTOR I I extended- 5UDING PATIO DOOR PXoPo FRAME t ROOFING TO MATCH EXIS. proposed DINING PORCH I I PORCH BATH SCREENED IN PORCH - I I - P.T.2.6 51U PLATE W7 ANCHOR EMEND MIST.DECK PA55 NEW CO NECIOR 2.6 EMER STUD WALLS W) 2.4 STUD WALL. BOLTS®MAX. 'O.C.t -12'FROM FRAME<DECKNG TO MATCH IX15T I 1 IN5L 1/2'RYWD -- \V/I/2'D=5HEATHING t END OF PLATES,USE 3Y3 IM'PLATE 1 I S/4'TW PL SLIOFLOOR ON 5HEATHING,HW5E WRAP t W-C.SHINGLES TO MATCH EXIST. 3M'T.G PLYWD.SVBFLOOR p7 WASHERS.BOLT EMBE M MIN.T I 1 9 1/2'AJ520 UOST5 010 O.L. 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I ' 4xG POST D - r (2)13/4•i 1 1/2-LVL oST DN 4x6 , I z i i w r I I , o PORCH ROOF cD I W `] EXISTING U E RO F REMAIN ) P O z. o 1 I I m I LL w m - W I I I w ? o w p CD - I = ~ =O a Cf I I 1 O i x ir = I I I = I w o ro ~ I exist O C7 PORCH CEILING/ROOF n Z �, Z PORCH ROOF Lcl) I - In G W I I X z w 0 Z d Lu _ d- --n------ N a Z I - p 4� w a J 0 LL I o r m J r LL _ O ti L---------J � --- 8�1.3 DATE: 08/08/2014 IT ! SCALE: AS NOTED ROOF FRAMING PLAN a y W SECOND FLOOR FRAMING PLAN DRAWING# 1/4•=V-0 IXISTING ROB • c• F�1 �r'E 1/4'-1'-0• WSTING WALLS �� NEV!WALLS A6 - 6 NEW ROOF ��'P ;�, - �. DO z z 3 -a� P.T.2(10 DECK JOISTS @ 16"O.C. 3" 3" cc 6'-0" 4'-1 O /2" 4'-1 O I/2" A'-I O I/2" 4'-I O I/2" I uuDER w00D DEac: f Va< Ip or 12'DIP.CONCRETE BGdCRUBE9 , d P.T.2 D110 P.T. 2110 UNDER SCREENED IN PORO1: I P.T.l2)91I0a we - PT.(379:tGn`/ `/ ON 2W DIA.N IG SON CONC. I U ON 24'DIA.'BIG FOOT'CONC.FOORNG {I I I I 1 I r I 1 I I � I I I • I I I I 12 12" 121 112 I P.T. IB DCE P,T.a1B JDJ I —————— RErawucwAU, ip PKT. DFP—T.O.FWD.Wa a,l 5'C• UK STUD WAl1DTflCPI•, I UN1E99 CRHFR ID NOIID B I 14'-I 1 1/2' 2$'-O 1/2' I z•_Au m IIN (Z1912'LVL N FRAMC FDR FLU9H.HGRR1 I % I . x �' B'CONCRETE 5—CHIMWEYWAl ON GO I I TOP OF D•GONG,FOUNDATION GOAL + v P N ti,l .. I UT ILITY ROOM ; I2'cc,, Ee5Ase O hG BEARING WALL ON 1Z},4PROJECTION @ FI UNNISHED CONTINUOUS CONCRETE FOOTING Q id LOU. HOU6 .- i _ Iz)9,.r� _ I ,• I lA'-7s/4• z 41 TR•ROD 1ST fIDW BOX G �I/4' H93TeEL GOWMN I - � m I O}SO'GONG.FOOTING(7 y I ( O FAMILY ROOM CB: I o HDUB PORT UP.DN. _ (�(�j Ifs 0 E!ryOryf.1Nn P05T UP N °-'- AIf IIIII .•.•_ IIII PODT PRIII K1 4•mIc r,POUD CW ae O B(oBR mR 3Ku'1iII 3 2 _; + XR. GE c E GKANUA9A N OpaQ_q_ CONTINUOUS ONTINUO NOUUS 291 mO 26BEARNGON2}1B uA CONTINUOUS CONCRETE FOOTING N HDuS D3 .1 O sT LAUNDRY Et D CB RQ) Vl - 7 I 6 9 I _ 5 1/2' ( I z I --- sKu $ DETAIL IIA,I n. a)9,nw I I I oFnPna I sa•I'a -L --J CLOSET ' DEPRE%T.O.FND.WAL--+. Z I . LI Jr RETa NING Wal � - la LL ' P.T. B LE GER —I— P FOUNDOATIONWa10N ION20'COfTINU— O V I • / cmOtETE FOOTING-TiRCAL O LL I Pi.(2)Dte'�Wf I I P D.A.CONCRETE 5CNONBE9 ON 2W DIA•BIG FOOT CONC.FOORNG PROVIDE AROUND FOUNDATION Wa1 PEWMETFR: � N ' 52•GPEVO ANCHOR BOLTS®MA%.AT O.C.t 6•-I P FRCM L P.T.2X8 DECK JOISTS® 'O.C. - TES,use B•.B•.I/a'eND OF RA RATE wABHFR9 r 5 ,L. 4'-3" Bar--EN"M1N,r ' PRONDE(6)CWTIKU0I5 OWZOWTALf5 RI'EaLl: 40'-0' (2)®TOP,MIDOIE•BOTTOM OF FWNDA=W', ^W F ZQ II�wwI W J V W d N O CHECK LIST REOUIRhiENTS = Q FIRST FLOOR FRAMING PLAN *OF KING FOUNDATION/BASEMENT PLAN XK XJ USE2K.JIFNOT8JACKSNOS®OPENINGS Z U SE 2K,,J IF NOTNOTED 1/4" 1.•D. NJ O 1/4"-Ill. EDGE NaUNG J OF N 12 SH EATHING FIELO NNONG lllVVV`YYY�\iii�\Y lVVVV�'0�� (''fi A. /' HDUOMOLD OPNNS PER DETAIL'A'ABOJEARK A. fu•/ Q W/BST1326ANCHORBO.TS y P cK g ' DATE: 02/28/2012 — - l •-'1 �/ SCALE: AS NOTED DRAWING a GIST ��s/ONAL ��� Al - 7 0 Fa MEN Ell6 - USETWICPLPQ3CH/DECKCONNECHCNS: -CONTWUOUSHFADER3 -AC6/ACE6PCGTCMS -ABU66POST BASES -6x6 PGS AIAD EBAREINDD SC ENEO PORCHES AND DO NOT NEED TO MEETWIND CODE PER I I 1 I I B TH EOITION.I400 S F OR LESSUNCONDMMEDSPACE) I - ROOF SCREENED IN PORCH ®® WOOD DECK SCREENED IN PORCH Q DECK - A'-LY' 11 35'-d' 1 I'- O 12" 7'-O' qbN m 1I �9�sK—"o.°•—x oNe—e wa—i JII Ov i1 3O"4J OL $b3 K,U® � �II IIl m� .II V IIiI©3©- O Om- • Dm L-➢ 31z 3K.2 1 '7' 99 K'1,1JY ¢QsK SS O?xJA x TAP 4mFv, 10-01 " scvI 3" 1 W ELM.HD H % 3KE ® \G K,2 C1 3K,1J BATH O2883�� 0� 16-4 I/z" a-I I/2 B BEDROOM LIVING ROOM FAMILY ROOM TTmY- YLD O oL, LNEN a MASTER PATIO BEDROOM O AFT O "4�7 L OG 0 BEDROOM L WALK IN I OF FICE FFICE 4'-7 /z" 14'-6" r I _ CUBBIES/HOOKS CLOSET I m ----- r----- f - 6 ----- _ B I --- 'a 1/2* FOYER 1 66•KneewNl BATH 2 i A Oj w sK,zJ O O PO R DN W I toe S I 50'KneewNi _ MUD ROOM - _ 6'-101/z" '3'-G^ 14'-91/2" 3 it i� 4a Q SENC—STORAGEUNDER ll®ES m W i� Y OD m QA _ I PaE I v Q I I 6 = O 1z I AdL COVERED PORCH 9'-G" I.-G" r I 11'-6" g•_I . s'-I^ 6'4 'T-4" 3'-1 I" Z d 40-0' 4d-a" Q Q1 `VS O O ALL SEC..FLOOR WALLS LL 61] CNECKUSTSHE---PANELNA1l1NGn WpreliminarySECOND FLOOR PLAN preliminary FIRST FLOOR PLAN DATE: 02128/2012 1/4"=1'-0" SCALE'AS NOTED DRAWING V. 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FLUSH STEEL BEAM BEYOND (9)2x I O HEADER AROUND la, n.n PCQa1 PERIMETER T.wca: window header ht. 2x e%rEwoR STUD Wass M9 I IN9UTATCW,1/2'PLTWD. 9H NGIE9 NO.,6 5.I EWRPP R W.C. • F1 CUSTOM 9CREENP9 � 9MpROBURE I I 97112. litLVD.9UBFLO 1,OJ _ EHIIOW.ER FOYER 91/2'Tp'9 FUL.I9T9 g16'a.c. ul CEN PTPOBT9 WET BAR DINING W4'T.RI5VD.9UBFLCgR ON LIVING SCREENED IN PORCH ' 9 I/2'TJI`9 FIR.J9T9 g 16.O.C. IW DECKING CW P.T.2a4 DIVIDER CABEDIN I•TRIM IWDELKI 50 P.o.c. Q tflocr. 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(SCREENED IN) xa P.T.R09T9 CASED A Ix59 IN9TALLT0 FORM 9UJPE POr[ORNNAGE W.C.SHINGLES III a DECCQATIVE WOW CAP,BAW9TER9 V1 T I/2•RIWD.SHEATHING OVER&B'LDx RYNK)C091ffAfHING ON 14'-0' Z? �6.O.L W/TOP IBOITOM RgL9 Y 2x IO VEOU -G JOISTSN 16'O.C. SeCOntl fkJ(If (2)91/YL 1� ♦W.C.41INGl£9 - GeCOYKI floor -- - top ofroofcleck fop of roofdeck -- FW5H 5TEEL BEAM BEYOND M.IO HEADER AROUND r PORCH PFFDMETER -- (a)—PT WntlOW heatlerhi. WBx 215TL 8M.MEADER .At TW RIWD.911BROOR p! Y CUSTOM 9CREBIE9 BEfW®d O m 91/2'TA9 flR J9T9�ICO.C. CIN ETWEEId P.T—PL9T9 200 R OFFICE FAMILY ROOM SCREENED IN PORCH - '9 SCREENED IN PORCH - . P.T:2a4 DIMDER CASED IN la TRiM xa—NNG ON P.T.2s10 4 DECNNG ON P.T,Z+10 DER.JOISTS®16.O.L. IL-1 (2191/2'LW r DEQ(J010T9®16.O.C. 9 Itst floor _ C)� IN Ix TRIM 1pp Of WOOd d2G1( -- P.T.y210 - OROPPED STEEL BEAM BETa11D �91MP9pJ ABU P09T 60.9E USE TYPICALPORCH/DECHCONNECT— *- II II-11 _ _ 11_ -CONTRuousHEADErs — '�- - 10`VIA.CONCRETE -AC6/ACE6PO.STCPPS I I I C I - �r — II 90NOfIJBE9 CM -ABU66POST I—ES za•D1A ac POOP -9x6P Ts I I I I I I • - couc.Foonuc a>_AssuMETHEPoacxESAREmTENOEoscREENED FAMILY ROOM OTTHHEOEn��(4-P oN��uwcoua—MI3PACT)r L L L_� S4 SECTION THRU SCREENED IN PORCHES,DECKS W 6 ,/a=r-0 301P CT i f 2r10 RB. 53 SECTION THRU l� � T BEDROOMS, PORCHES &FAMILY ROOMS 2 2bR.RAFER9 � y�NOF4gq%g W S \ � ,per plate ht.0porch' z,Bc��l6•o.c. � AAARK A. $� I I I 0 M NAPE Q Z Z �CC�N' 3� �� �� t !/ J_ W j IxaDECNNGLI I FS �ST C O.C. N P.T.2aO i SRO AL C�V W first flacr ®I ' 4 �w/' F DATE: 02/28/2012' rl `�AppS56 SECTION THRU FRONT COVERED ORCH 6 UP=11-W SCALE: AS NOMD L_� DRANAND>< - A6 - 7 1 rn w� oz < 03 Z 2x10 DECK JOISTS @ 16"O. 2 ROOF RAFTERS 16"O.C.� a (over sc(eene0ln porch) I&' BorrTr 1� d ' 3 2x10FEADER ' - (2)2110 . I h A s A ' v� • 41-0" 35'-0° SHED DORMER 12" ,' �.•. �^Bur r our RAxe a 2.6 OUTLOOKERS a 70'O.C. °' (®MAIN GOBIP ROOF dJ09' a� ��� I ° DI10 D R Y NOR ' . _ UiQvONOD) V• '' gm><� �2 131a•x 9 1 2CE m��•�� 8 x 21 SEEL W HEADER POT DN. H (E)1 Wx912 Q (]) / L— 'jeb5�ee Q CY (E)15x92LM NB LOOVNG 81'MJ. IIIIIIIIII IIIII .ce n -C 111 / X Oe 1n/gA•wL V1L1 oPocD GIEk gBfO AR/ D fm I III IIIII 1II1iII 1I1IIiIIIII acing II1I a—1 III 2x6(®O UTLO GOAKB EIP. R RSO @OF TOON'L YO.C. MN I ?8 W I4,1' t 0 l ; , W � 2x6 CEILING JOISTS @ 16'O.C. (ev f=t porctl) 2x8 ROOF RAFTERS @ 6"O.C. .. (overfmnt poll:h) Qd QZ 7'-O° 29-0"SHED DORMER O2 OF Aqq.`e'tn�,g^ J o SECOND FLOOR FRAMING PLAN MARK GN MIKE !E ROOF FRAMING PLAN a F vs=ra DATE: 02/26/2012 SCALE: 1/4'=1'-0° S�0'N�11 DRAWMS'. A7 - 7 u J N ASSESSORS MAP: Z� PARCEL: TEST HOLE LOGS ' l � . — -- l �Ul� � ���� I) The installation shall comi�ly Mill Title V and Town of��G�1��j13uard of :w SOIL EVALUATOR : FLOOD ZONE: �,/� � '�� .� 1 Iealth Regulations. -L --- WITNESS : �:J �(� c�'� 2) The installer shall verify the location of utilities, sewer inverts and septic . Po l r REFERENCE: � c�jC�? _ � -'T 731g7 T DATE. " L ZZ Ul S- components prior to installation and setting base elevations. 4 � "i2TJ � PERCOLATION RATE: ..G Z 3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8" per foot. The first two feet out of the d-box to the leaching shall be level. , Y. [ 4) This plan 1s not to be utilized for property line determination nor any other I- - - - - - ----- TH- 1 TH-2 purpose other than the proposed system installation. 5) All septic components must meet Title V specifications. 8 f --- B 6) Parking shall not be constructed over I-I10 septic components. c�/ 3/ 1 7) The property is bounded by property corners and property lines. 23 7 __ ���� _ Olt 8) The property owner shall review design considerations to approve of total LOCATION MAP design flow and number of bedrooms to be considered for design. Receipt DP of payment for the plan and installation based on the plan shall be deemed 1 approval of the design flow by the owner. c oy9-1 9) The existing leaching or cesspools shall be pumped and filled with material per Title V abandonment procedures. Those within the proposed SAS shall i be removed along with contaminated soil and replaced with clean sand per qo efiwo w�,f.E. l,a� �v !/>t 1�D Title V specs. j A) 1 10)System components to be 10 feet from water line. Sewer lines crossing the water line shall be sleeved with 4 inch SCII 40 PVC with ends grouted if f �EX►�-j7� - applicable. The proposed SAS is being installed below the water service y , 3-98w- line. The line is to be sleeved as aforementioned and maintained in place. SEPT] C SYSTEM DES I GN ) g g 11 If a garbage render exists it is to be removed and is the responsibility of the t owner to ensure such. FLOWN EST1 MATE 12)The installer is to take caution in excavation around the as line if such g exists. ' � BEDROOMS AT //0 GAL/DAY/BEDROOM - 30GAL/DAY 13)Tne installer shall verify the location, quantity and elevation of the sewer 1 � _" lines exiting the dwelling prior to the installation. SEPTIC TANK 14)This plan is representative only that a system can fit on a property meeting \ Title V requirements. GAL/DAY x 2 DAYS -660 GAL _ USE ./� GALLON SEPTIC TANK �_ —.a<.-_,__�Q�.,..l1lC,,, " '_ ti \ " �_ 1 r r \ -V so I L ABsoRP I oN SYSTEM Z°-- fs -- M �\ 'D�2.L ti_ ' � '/ji,y'-- 'Fi��y(I�l ,� 1°�'�V�-1 ►�-li� C�'. i�1�-�t��,.� �t1 aF - SIDE AREA: 17-, Z5 )x2,xo, �( - IR7 DAvla m.. 1 d:R I.1ABOTTOM AREA:-- 0' Z D��7 =- Z�J7�J� o MASON �'M' ` � � ^ �� v ,� No.1066 0 may, O SEPTIC SYSTEM SECTION *67 f �o OF- (4- - -�0 '� _,00 �, e ,t bZ Ib0 GAL �jI, ►�1pd�, _� ' ^ 0 — Val _. Eu��y •° �� � �I � b - �, SEPTIC TA K SITE AND SEWAGE PLAN t _ LOCATION : 13 2u 311 l0 0 PREPARED FOR : --'--%-4 L M I 0 , ID fir,(. SCALE: 1 W DAV I D B . MASON RS DATE: 2 I� s DBC ENVIRONMENTAL DESIGNS DATE HEALTH AGENT EAST SANDWICH . MA Z ( 508 ) 833- 2177 r, SYSTEM PROFILE THE SOIL ABSORPTION SYSTEM SHALL HAVE A MINIMUM F(GjUESTOUSE t NOT TO SCALE OF ONE INSPECTION PORT CONSISTING OF A 4" PERFORATED PIPE PLACED VERTICALLY DOWN INTO THE STONETO TION FINISH GRADE FINISH GRADE OVER FINISH GRADE OVER THE NATURALLY OCCURRING SOIL OR SAND FILL BELOW THE EL. 72.0 EL. 71.0 -SEPTIC TANK 70.2 DISTRIBUTION BOX 70.5 STONE. THE PIPE SHALL BE CAPPED WITH A SCREW TYPE CAP AND ACCESSIBLE TO WITHIN 3" OF FINISH GRADE• FINISH GRADE OVER TRENCHES 70.5 "'-OF RISERS TO 6" 4 OF FINISH GRADE____,,,* RAD • ' PRECAST CONCRETE 500 GALLON DRYWELLS 31.MIN. _ RISERS TO 6 ° - OUTLET PIPES LEVEL H-20 REINFORCED LOADING MIN.SLOPE 1% 13" OF FINISH GRADE ( ) 6" MIN.SLOPE 1% o FOR 2'( MIN.1% SLOPE TRENCH LENGTH = 33'-6" BEYOND MIN. O i DRY"WELL LENGTH = 8'-6" i r oho_ 13"MIN. 14" L - - 68.02 67.54 MIN. 16- ,' .o j ���'. ®` r o Eo o . 67.29 SUMP '� • • '•r ,�O:r ' ' Q 67.11 o �� _ � ,. PVC OR CAST IRON TEE < :� L: 7 �,O:r 66.94 °'�.� �o �;^-'.�-' �r•� :�,�� .r ,o ,ram ,� ro GAS BAFFLE '0 b��O r , .; " ' �'.�0 r •ram DISTRIBUTION BOX 66.70 :> :• � - _ .I d 1500 GALLON W - ' _ _ EL.64.70 ..p � ->, H-20 LOADING 3/4 1 1/2 DOU3LE WASHED CRUSfIED 3/4"- 1-1/2" DOUBL 41 'EXISTING INVERT PRECAST CONCRETE '4 STONE 5' WASHED CRUSHED _�_ @BARN H-10 REINFORCED ` MINIMUM INSIDE DIMENSION 12" STONE J ,e., �6, o -� OUTLET U TM T INVERTS 2" BELOW INLET INVERT EL.59.7 BOTTOM TEST PIT#1 '" _ UM CONCRETE WALL THICKNESS 2" - Y h' -01 INSTALL ON COMPACTED LEVEL BASE TRENCH SECTION r ,�yOUIOU V, r ,�n.. :r`Qd :'1�• `r. a ar. SEPTIC TANK NOTE: EXCAVATE TO =C STRATUM IN ORDER TO REMOVE ALL =A= & =B= IMPERVIOUS MATERIAL INSTALL ON COMPACTED LEVEL BASE WITHIN 5' OF THE SAS. REPLACE WITH CLEAN, 9" MIN \ CLAY-FREE SAND [310 CMR 15.255] . 3" PEASTONE =: 4 DIAM. 6" MAX. �;. GENERAL NOTES: t, ,.• 1. ELEVATIONS SHOWN ARE BASED ON ASSUMED OBSERVATION PIT 2. ALL PIPES IN THE SYSTEM MUST BE CAST IRON `"' - OR SCHEDULE 40 PVC. o,.� .,o - �.,o'•�. r s • Cotuit 3. HEALTH AGENT/CAPE & ISLANDS ENGINEERING V,WARDEN,SOIL EVALUATOR = °: oil - o'o- 3/4"- 1-1/2" DOUBLE MUST BE NOTIFIED WHEN CONSTRUCTION IS P-13536 4 5'_2" WASHED CRUSHED EOFP vr��/ `SL COMPLETE PRIOR TO BACKFILLING. STONE 4 r� ' °, E PERCOLATION RATE: < 2 MIN./IN ° .` •, _ . 4. ANY CHANGES IN THIS PLAN MUST BE APPROVED WITNESSED BY: D.DESMARIASTRENCH WIDTH ' ew. .. a 3' BY CAPE & ISLANDS ENGINEERING AND THE BO RD 13'-2" BAR14STABI_E BOARD OF HEALTH ' OF HEALTH. DATE: FEB.3 2012 NUMBER OF TRENCHES 1 3q �';y. 5. MATERIALS AND INSTALLATION SHALL BE IN�g of NUMBER OF DRYWELLS 3 COMPLIANCE WITH THE STATE SANITARY CODE [TITLE VI AND LOCAL APPLICABLE RULES AND EL.69.7 EL.71.0 EL.72.0 Et-J3 ..o-.., ....... . TEST HOLE EST HOLE#2 TEST HOLE#3 TEST HOLE#4 6. NORTH ARROW IS FROM RECORD PLANS AND IS o° oil NOT INTENDED FOR SOLAR ENERGY PURPOSES. 0„ Olt A LOAMY SAND 10 YR 2/2 A LOAMY SAND 8. FLOOD ZONE NON-HAZARD 7.5 YR 2.5/3 i • \`'�� l6y , 7. WATER SUPPLY: MUNICIPAL WATER SYSTEM. , 10 �� FRIABLE 9 _ _ =BW= LOAMY SAND 7 9 ti .� //� _E=SAND \ n / 68 - \ - 7.5YR 4/6 1 =S !/2 DESIGN DATA 22" VERY FRIABLE 23" 10" 11" PERC HOLE =BW= LOAMY SAND \ 62° 7.5YR 4/6 NUMBER OF BEDROOMS 4 EL.64.5 GARBAGE DISPOSAL NO 69oos, =C1=MEDIUM SAND VERY FRIABLE DAILY FLOW 440 GPD. ' _ N 10YR 4/6 22 23 ,, \ so„ SEPTIC TANK REQUIRED 1500 GAL. ' 8 Nop #2 =C= MEDIUM SAND SEPTIC TANK PROVIDED 1500 GAL. 10YR;4/6 LEACHING REQUIRED 440 GPD. -s, \ �-- �\ o 29 � r-,--- pk SOIL ABSORPTION SYSTEM CALCULATIONS: { A ,( N 120" NO GROUNDWATER 120" NO GROUNDWATER �51 EL 59 120" 120" 7 SIDEWALL AREA = 186 SF. oo - ---- 186 SF. X .74 G/SF. = 137 GPD. 68 BOTTOM AREA = 441 SF. Ext 441 SF. X 0.74 G/SF. = 326 GPD. LEACHING PROVIDED = 463 GPD. LEGENDl�ool'sk'Ay / ! ' , 4 REVISION:MAR.13,2012 EXISTING SEPTIC,SALT WATER ESTUARY 52 PROPOSED CONTOUR i i / �60' I I% ` Qp EXIST NG ADJUST SAS,FINISH GRAIE,EXISTING WATER �, , DWELLING �. 1stFLR.IL.75.4 --- 52--- EXISTING CONTOUR PROPOSED SEWAGE DISPOSAL SYSTEM \ � w� s18, •. OBSERVATION PIT \ ` PREPARED FOR N\ 2863' 69 ` 3 GEORGE LLOYD ❑ H E DISTRIBUTION BOX °2020" ` h . N 11 w� o c4 �• •'• r 1. S 0. 09 a ,r, .• R MEMO, 1109MAINST. 0.97 ACRES ... �� 0 0 o SEPTIC TANK ��' cP = COTUIT AUSS. SOIL ABSORPTION SYSTEM PLAN NO. 020712 SCALE: AS NOTED NOTE: EXCAVATE TO =C= STRATUM IN ORDER TO 1A ti REMOVE ALL =A= & =El= IMPERVIOUS MATERIAL `S ,� ��, FILE NO. DATE. FEB.7 2012 RE SERVE RESERVE AREA WITHTN 5' OF THE SAS. REPLACE WITH CLEAN, ES �': �•'• SEPTIC FILE N0.7T PCS FILE:mainst1109 CLAY-FREE SAND [31 J CMR 15.2551 DAVIT) 22.26 PIPE INVERT ELEVATION CHAR)'4 5n�r►chi ., 280ti5 CAPE&ISLANDS ENGINEERING PLOT PLAN q 034 009 1109 ' +� 800 FALMOUTH ROAD, SUITE 301C SCALE: 1"= 30' MAP SEC PCL I ., LOT HSE MASHPEE,MA 02649 (508) 477-7272 TE PLANL: ES1 P4 C>ATA SC E11 TEST P1T� ) I ` SCALE 1 ., 40 (No Gkpe�-�r= TP 04 ReR FY-W ?,rA1,,, Qf�s: ►J F:Ww o ter Q�oOms X _ _. - _ - - _ -f— -� } ;orL s.ufbc j t\ MI: 1''y� S� wPu ► > z rr h 2"s ; rz 2 2 s rzS (2. R�2 pp ► I'� �R` A 3. C' (/.p /-T Z fl" (53 t 0 IS') COAL9/9 -TO i IL 11 LD cW� C' 1. r _ IM N M - Z fT .LOT 7 rn / 29 LOT 9 I 1117 �Gu � LOT IZ llJa (/tJR'f' -30 31 T / Pr\r NrP_c r Pt oRv---L) �. -� Pam- :L—IN to Y Mk. IL 01 / C� �l A0Y �Nr,= �. =L E f (?lit ro,A o (4 O ).T &.a;:- 0, cw S 22 . SLOB a)ck tfa H A =A - "3%0' = , 0,6? x ;so lo, f T ---r) - 30.0 IPrfff Msnt. 0. b�s-rAw-E TO 7 4 r ACTioz- smQr�kci5 gex-v y 32.D' musT /0. t 401 P' R t F" I L. ' l I E 1!"V INN Hr LOT 8 z�H 1 LOT IO ' S ,OZ SEJ'7+GTANK + OF x-J2 2:t+ 3z.a 6 „iz tj h , 33.o a. ¢ a :_P o- a n . .4 , ,n .: .4;r,�,.., a .4 `'C.N tl0 I N .-Z QVG a. M �? .az s4N k0 O O O O FLOW O O /fir. � � O O101� FwV i r w. 1 0 // q , _ a .. P .. \33,7 f. " 40 O O O Or-ly 000 O . 0000Q► � OOOO W 0o00 000 .J � � �� `ti � / , Z Z e .RAC L 3 p -`ep �own1 O � � � ,a 000 O ,. _� P��Hft � h�. V� ��A W waT�,aQ 0000 - t 0000 0 0 0 0 �,� p w TaJ (r- oM 30,00 ASSAM r 1 F rzVATroN 30-00 �iS y p 27a yy 'dp�r�/ �d err s y . G �+ f?rr # MAIN STREET - c . 1, Construction of this proposed septic system shall be in conformance with . Title 5 of the MA Sanitary Code. as-built ertifa.cata.on is: required pra.or to P1 ^ N NI/ backfill 2 . -- �. No changes are ,to be made to this lan or desa n without ,a rov 1 . f.10 a 1 (J :>c.A�� g - P 5 pP � Board of Health and the Design En sneer, 3 g 3 . The contractor is responsible to ensure that the se tic s stem i.s P constructed as per the design herein and location indicated. P g , 4 The septic tank should be checked annuall and ed' as to ired. s P Y P q0 �H y0 __ I certify that this r " I ( �-�DX � a p oposed sanitary peptic - o 0 system conforms to th€' regulations of 310 C) 15 Title t of the Stag Environmental Code. Pao S r°rs� Sys► '> - I101 S-r u� A 2A rH G�sr�m �leq/6 AJa M� t���NY ro DA►�e ST. C >-ron �r��car .s OF CIS y SGPL DATA 6 l.YC�C7a. S EGZ"CIVIL N0.3 2A01 g ttfl cnt.ion of this drawing is not valid unle r s a L s-r O D crics s'ttg'+ ,ahc`rve is .provided in red inlc. . o - 12