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Home My WebLink About1151 MAIN STREET (COTUIT) - Health 1151 MAIN STREET, COTUIT 034 002 _ --- -- --- - - - ---- - - �l f Commonwealth of Massachusetts U Title 5 Official Inspectionform Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1151 Main St. IV Property Address MAITLAND, NANCY Owner Owner's Name information is required for every Cotuit MA 02635 . 7/22/14 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:when filling out forms A. General Information on the computer, use only the tab 1. Inspector: key to move your cursor-do not Robert Paolini use the return key. Name of Inspector Robert Paolini Septic Service K2LAI Company Name 17 Playground Lane Company Address Yarmouthport MA 02675 City/Town State Zip Code 508 362-3555 S14454 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: ' 0 Passes ❑ Conditionally Passes ❑;: F' ils ❑ Needs Further E aluatio the Local Approving Authority 7/22/14 pia Inspector's Signature Date �'' M 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. i ****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•3113 Title 5 Official Inspection ubsurface Sewage Disposal S m•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1151 Main St. Property Address MAITLAND, NANCY Owner Owner's Name information is required for every Cotuit MA 02635 7/22/14 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑x 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 i, Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1151 Main St. Property Address MAITLAND, NANCY Owner Owner's Name information is required for every Cotuit MA 02635 7/22/14 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 1151 Main St. Property Address MAITLAND NANCY Owner Owner's Name information is required for every Cotuit MA 02635 7/22/14 page. City/Town state Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ 0 Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ 0 Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ 0 Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/day flow t5ins-3/13 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 ,•�'¢ 1151 Main St. Property Address MAITLAND NANCY Owner Owner's Name information is required for every Cotuit MA 02635 7/22/14 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ 0 Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ❑x Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ 0 Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ O Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ❑X Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ 0 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. ❑ FSKI 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1151 Main St. Property Address MAITLAND, NANCY Owner Owner's Name information is required for every Cotuit MA 02635 7/22/14 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no" as to each of the following: Yes No 0 ❑ 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? ❑ 0 Has the system received normal flows in the previous two week period? ❑ 0 Have large volumes of water been introduced to the system recently or as part of this inspection? 0 ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) 0 ❑ Was the facility or dwelling inspected for signs of sewage back up? 0 ❑ Was the site inspected for signs of break out? 0 ❑ Were all system components, excluding the SAS, located on site? 0 ❑ 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? 0 ❑ 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: ❑ 0 Existing information. For example, a plan at the Board of Health. ❑ 0 Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms). 440 t5in3•W3 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 1151 Main St. Property Address MAITLAND NANCY Owner Owner's Name information is required for every Cotuit MA 02635 7/22/14 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ❑x No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ❑x No information in this report.) Laundry system inspected? ❑x Yes ❑ No Seasonaluse? ❑x Yes ❑ No Water meter readings, if available last 2 ears usage d na 9 ( Y 9 (gP ))� Detail: Sump pump? ❑ Yes ❑X No Last date of occupancy: NA Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 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 a 1151 Main St. Property Address MAITLAND NANCY Owner Owner's Name information is required for every Cotuit MA 02635 7/22/14 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: Was system pumped as part of the inspection? ❑ Yes 0 No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: O Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 L Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1151 Main St. Property Address MAITLAND NANCY Owner Owner's Name information is required for every Cotuit MA 02635 7/22/14 page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) Approximate age of all components, date installed(if known)and source of information: Were sewage odors detected when arriving at the site? ❑ Yes ❑x No Building Sewer(locate on site plan): Depth below grade: 2' feet Material of construction: ❑ cast iron 0 40 PVC ❑ other(explain): Distance from private water supply well or suction line: 10+ feet Comments(on condition of joints, venting, evidence of leakage, etc.): Joints appear tight.No evidence of Ieakage.System vented through the building vents. Septic Tank(locate on site plan): Depth below grade: 15" feet Material of construction: 0 concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 gl Sludge depth: 311 t5ins-3113 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 1151 Main St. Property Address MAITLAND, NANCY Owner Owner's Name information is required for every Cotuit MA 02635 7/22/14 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 33" Scum thickness 4" Distance from top of scum to top of outlet tee or baffle 5" Distance from bottom of scum to bottom of outlet tee or baffle 11" How were dimensions determined? Measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pump tank every 2 years.Inlet and outlet tees are in place.No evidence of Ieakage.Tank appears structurally sound.. 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1151 Main St. Property Address MAITLAND, NANCY Owner Owner's Name information is required for every Cotuit MA 02635 7/22/14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: , Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments SV.r 1151 Main St. Property Address MAITLAND, NANCY Owner Owner's Name information is required for every Cotuit MA 02635 7/22/14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert No Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Box is Ievel.Box has one outlet Iateral.No evidence of solids carryover.No evidence of leakage. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): *If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 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 1151 Main St. Property Address MAITLAND, NANCY Owner owner's Name information is required for every Cotuit MA 02635 7/22/14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑x leaching chambers number: 4 galleys ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/altemative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Sandy soil . No signs of hydraulic failureGalleys were dry at time of inspection. Cesspools(cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1151 Main St. Property Address MAITLAND NANCY Owner Owner's Name information is required for every Cotuit MA 02635 7/22/14 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): . Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 X Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Y 1151 Main St. Property Address MAITLAND, NANCY Owner Owner's Name information is required for every Cotuit MA 02635 7/22/14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ❑ drawing attached separately i ! . P V40 r t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Olsposal System-Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments rY 1151 Main St. Property Address MAITLAND NANCY Owner owner's Name information is required for every Cotuit MA 02635 7/22/14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: Check Slope Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: Bottom of leaching 21' 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) 0 Checked with local Board of Health-explain: As-Built ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: USED:USGS observation well data.USED:Technical bulletin 92-0001 annual ranges of groundwater elevations. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 I Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1151 Main St. Property Address MAITLAND, NANCY Owner Owner's Name information is required for every Cotuit MA 02635 7/22/14 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ❑x Inspection Summary: A, B, C, D, or E checked ❑x Inspection Summary D (System Failure Criteria Applicable to All Systems) completed N System Information—Estimated depth to high groundwater ❑x Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•W13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 c rr'r LO Cc �U �J4 �C s � Co. CPO z h /l�i� 01 qT Cti�N �(4 a �i � - u BEDROOM 2 AAJTESNIL11N. BEGONE MILK FOR NEON FIN.FLR ------ - LEI'I TREADS Ai tOF OF SruRS TO' BNLT INTO EAST.FLOOR SY5 I --------------- mWILD MALL Off 77 MEN RAILINR.BALJ! BATH.2 AND NpEL TO HATLN E%5T. LOFT EXISTIMR FEE5N FLOOR XNO �.' t TOREriEAcm"TN ND, LINEN ------ ..... ----------------------------------------- aiE-0 e FJE5TEi6 RARE HALL TO REMAIN ASLDIM BATH.3 ASLur-2471 4%2-5 3/1 REMOVE ILL A 6 FE NEEDED) IFATLH WALL A5 N®ml Y - - < - I"FLOOR TO 11 O FLL"W/EXISTIM BEDROOM 3 ° a o ' IRO..]-0 �• ♦x A3 W.I.G. a 13 Aix is Zi n ' --------------------------------------------------------------- Kx Rx EXISTINR ', S E G ON D F L O O R F L A N FRD,DDEEg ADDISTIM&�TIIOON(SECOND FLOOR)-Bb2 90.FT. SCALE, 1/D' • 1'-0' - TOTAL•1,026 .FT. F a F _O a a 8 O 0 Lu f I - scopq ��w�ocly( Ex�s-�►'r,� sL�Z��..� �vas.� ►N4v ti/4w L.:.,,� / D F rr +f J x pi Mx yw°°J 16'5 i 2'4 314 27 27 3'4 2'3 IT N y l i W i N 1 � --------------------------- - i i � w N N i I o 2'3 6' 5'11 2'3 i 16'5 to 5vv covyy" j-� COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAI AFFAIRS John Grad DEPARTMENT OF ENVIRONMENTAL PROTECTION DEP Title V Septic Inspector ONE WINTER STREET BOSTON MA 02108(617)292-3500 P.O.Box 2119 TeaTicket,Ma. (508)564-6813 ' n TRUDY COXE Secretary ARGEO PAUL CELLUCCI DAVID B.STRUHS Commissioner Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM 8 ,9 PART A CERTIFICATION Property Address: 1161 MAIN ST. COTUIT MAP 034 PAR 002 Name of Owner DOUG AND KATHY JOHNSON IPA Address of Owner: 846 OENOKE RIDGE NEW CANNAN CT.06840 < Date of Inspection: 315/99 Name of Inspector:(Please Print)JOHN GRACI N~' I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) Company Name: John Graci Title V Septic Inspection Mailing Address: P.O.Box 2119 TeaTicket,Ma.02636 , Telephone Number: (508)664-6813 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.The system: X Passes The inpection is based on criteria defined In Title V _ Conditionally Passes code MO CMR 15.303.My findings are of how the system Is _ Needs Furtheribmit tion By the Local Approving Authority performing at the time of the inspection.My inspection does Fails not imply any warranty or guarantee of the longgevity of the septic system and any of its components useful life. Inspector's Signature: . Date:3117199 The System Inspector shalla copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(30)days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection.The original should be sent to the system owner and copies sent to the buyer,if applicable,'and the approving authority. NOTES AND COMMENTS THE SYSTEM PASSES TITLE V INSPECTION.RECOMMEND PUMPING SYSTEM EVERY TWO YEARS TO PROLONG THE SYSTME'S USEFULL LIFE. Page 1 of 11 revised 9/7J98 • F SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM " PART A CERTIFICATION(continued) Property Address: 1151 MAIN ST.COTUIT MAP 034 PAR 002 Owner: DOUG AND KATHY JOHNSON , Date of Inspection:3l5/99 INSPECTION SUMMARY: Check A, B, C, or D: A. SYSTEM PASSES: I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist.Any`failure criteria not evaluated are indicated below. COMMENTS: System passes Title V inspection B. SYSTEM CONDITIONALLY PASSES: na 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. Indicate yes,no,or not determined(Y,N,or ND).Describe basis of determination in all instances.If"not determined",explain why not. na The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank,whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure is imminent.The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. na Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken,settled or uneven distribution box.The system will pass inspection if(with approval of the Board of Health). _ broken pipe(s)are replaced _ obstruction is removed ° _ distribution box is levelled or replaced na The system required pumping more than four times-a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): _ broken pipe(s)are replaced obstruction is removed t revised 9/2198 Page 2 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 1151 MAIN ST.COTUIT MAP 034 PAR 002 Owner: DOUG AND KATHY JOHNSON Date of Inspection:3/5/99 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 the public health,safety and 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 ThE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER.IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE 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 soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well, The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,Method used to determine distance n(a.(approximation not valid). 3) OTHER, n1a revised 9 2198 Page 3 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM .PART A CERTIFICATION(continued) Property Address: 1161 MAIN ST.COTUIT MAP 034 PAR 002 Owner: DOUG AND KATHY JOHNSON Date of Inspection:316199 D. SYSTEM FAIL S: You must indicate either"Yes"or"No"to each of the following: ' I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303.The basis for this determination is identified below.The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No X Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. X Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow, X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped n&. X Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. X Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone I of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well, X Any portion of a cesspool or privy is less-than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis.If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic ompounds, ammonia nitrogen and nitrate nitrogen. X The liquid level in the SAS is over the invert pipe,is in Hydraulic Failure. E. LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.30412).Please consult the local regional office of the Department for further information. " revised 9/2198 Page 4 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 1161 MAIN ST.COTUIT MAP 034 PAR 002 Owner: DOUG AND KATHY JOHNSON - Date of Inspection:3/5/99 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: Yes No X Pumping Information was provided by the owner,occupant,or Board of Health. X None of the system components have been pumped for at least two weeks and-the system has been receiving normal flow rates during that period.Large volumes of water have not been introduced into the system recently or as part of this inspection. X As built plans have been obtained and examined.Note if they are not available with N/A, - s X The facility or dwelling was Inspected for signs of sewage back-up. X The system does not receive non-sanitary or Industrial waste flow. X The site was inspected for signs of breakout, X All system components,excluding the Soil Absorption System,have been located on the site. - X The septic tank manholes were uncovered,opened,and the interior of the'septic tank was inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum.The size and location of the Soil Absorption System on the site has been determined based on: X Existing information,For example,Plan at B4O,H, X Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) [1 5.302(3)(b)1 X The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of SubSurface Disposal Systems. revised 9/2/98 Page 5 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION ' Property Address: 1151 MAIN ST.COTUIT MAP 634 PAR 002 Owner: DOUG AND KATHY JOHNSON Date of Inspection:3/6199 FLOW CONDITIONS RFSIDFNTIAL: Design flow:-M g.p.d./bedroom Number of bedrooms(design): 3 Number of bedrooms(actual):.l Total DESIGN flow: 440 Number of current residents:Q Garbage grinder(yes or no):YE;z Laundry(separate system)(yes or no): NO If yes,separate inspection required Laundry system inspected(yes or no):M Seasonal use(yes or no): YES Water meter readings,if available(last two year's usage(gpd): n1a Sump Pump(yes or no): NO Last date of occupancy: nLa COMM ERCIALlIN13USTRIAL Type of establishment: nLa + Design flow: nLa gpd(Based on 15.203) Basis of design flow: nLa Grease trap present:(yes or no): NQ , Industrial Waste Holding Tank present:(yes or no): NQ Non-sanitary waste discharged to the Title 5 system:(yes or no):NQ Water meter readings.if available:nLa Last date of occupancy: nLd % OTHER: (Describe) nLa Last date of occupancy: nLa GENERAL INFORMATION . , PUMPING RECORDS and source of information: nta System pumped as part of inspection:(yes or no):NQ If yes,volume pumped nl& gallons Reason for pumping: nLa TYPE OF SYSTEM X Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no)(if yes.attach previous inspection records,if any) I/A Technology etc.Attach copy of up to date operation and maintenance contract,. ' Tight Tank Copy of DEP Approval Other: Wit APPROXIMATE AGE of all components,date installed(if known)'and source of information: NEW SYSTEM WAS INSTALLED IN 1991 PERMIT#91465 .. • - - Sewage odors detected when arriving at the site:(yes or no): �L12 r y revised 9/2/98 Page 6 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) , Property Address: 1161 MAIN ST.COTUIT MAP 034 PAR 002- Owner: DOUG AND KATHY JOHNSON Date of Inspection:315/99 BUILDING SEWER: (Locate on site plan) Depth below grade: Ll ' Material of construction:_ cast iron X 40 PVC other(explain) Distance from private water supply well or suction line: TOWN Diameter: n/a Comments: (condition of joints,venting,evidence of leakage,etc.)" r f SEPTIC TANK: X (locate on site plan) Depth below grade: i Material of construction:X concrete metal_ Fiberglass Polyethylene other(explain) Wa If tank is metal,list age Is age confirmed by Certificate of Compliance(Yes/No): No Wa " Dimensions: L 10'6"H 5'7"W 5'8" Sludge depth: 1" Distance from top of sludge to bottom of outlet tee or baffle: 3_ Scum thickness: Distance from top of scum to top of outlet tee or baffle:l Distance from bottom of scum to bottom of outlet tee or baffle: nla How dimensions were determined: MEASURED Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles;depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage, etc.) SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND RECOMMEND PUMPING SYSTEM EVERY TWO YEARS GREASE TRAP: (locate on site plan) Depth below grade: Material of construction:_concrete_ metal Fiberglass _ Polyethylene other(explain) Dimensions: n1a ' Scum thickness: nla Distance from top of scum to top of outlet tee or baffle:_nld Distance from bottom of scum to bottom of outlet tee or baffle nLa, Date of last pumping: Wa „ Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage, etc.) revised 9/2/98 Page 7 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1161 MAIN ST.COTUIT MAP 034 PAR 002 Owner: DOUG AND KATHY JOHNSON Date of Inspection:3/6/99 , TIGHT OR HOLDING TANK: NO (Tank must be pumped prior to,or at time of,inspection) (locate on site plan) Depth below grade: nla Material of construction:_ concrete_ metal_ Fiberglass _Polyethylene_ other(explain) Dimensions: n/A Capacity: WA gallons Design flow: n/A gallons/day y Alarm present: NQ Alarm level:j2t& Alarm in working order:Yes_No MS2 Date of previous pumping: n(a Comments: (condition of inlet tee,condition of alarm and float switches,etc.) DISTRIBUTION BOX: X (locate on site plan) Depth of liquid level above outlet invert:n/a Comments: ` (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) PUMP CHAMBER: NO (locate on site plan) v Pumps in working order:(Yes or No): NQ Alarms in working order(Yes or No): NO Comments: (note condition of pump chamber,condition of pumps and appurtenances.etc.) Wa �, r revised 9/2/98 Page 8 of 11 - SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1161 MAIN ST.COTUIT MAP 034 PAR 002 Owner: DOUG AND KATHY JOHNSON Date of Inspection:3/6199 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain: " nla •, Type: leaching pits,number: nLa leaching chambers,number: jVa , leaching galleries,number: 4-GALLERIES leaching trenches,number,length: nLa leaching fields,number,dimensions: nLa „ overflow cesspool,number: n(a Alternative system: Wa Name of Technology: .nta Comments: " (note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) THE GALLERIES ARE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY THERE HAS NOT BEEN MORE THAN 6"OF WATER IN THEM -CESSPOOLS: (locate on site plan) s Number and configuration: nla Depth-top of liquid to inlet invert: n(a t Depth of solids layer: nla Depth of scum layer. nLa Dimensions of cesspool: n!A Materials of construction: nLa Indication of groundwater: n& inflow(cesspool must be pumped as part of inspection)n(A - Comments: K (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) D/A PRIVY: _ (locate on site plan) Materials of construction:WA Dimensions:nLd Depth of solids: nLa Comments: - (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) R nla revised 9/2/98 Page 9 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ' PART C, SYSTEM INFORMATION(continued)" x • Property Address: 1161 MAIN ST.COTUIT MAP 034 PAR 002 Owner: DOUG AND KATHY JOHNSON ' Date of Inspection:3/5/99 SKETCH OF SEWAGE DISPOSAL SYSTEM: a include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) n/a • 4 S��eQ/1 0 A patch K 43 14 " a , revised 9/2J98 Page 10 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1151 MAIN ST.COTUIT MAP 034 PAR 002 Owner: DOUG AND KATHY JOHNSON Date of Inspection:3/5199 NRCS Report name: n1a Soil Type: nla Typical depth to groundwater: nla USGS Date website visited: n/a Observation Wells checked: MQ Groundwater depth:Shallow _ Moderate _ Deep _ SITE EXAM _ Slope _ Surface water _ Check Cellar _ Shallow wells Estimated Depth to Groundwater 12 Feet Please indicate all the methods used to determine High Groundwater Elevation: . _ Obtained from Design Plans on record _ Observed Site(Abutting property,observation hole,basement sump etc.) _ Determined from local conditions _ Checked with local Board of health _ Checked FEMA Maps _ Checked pumping records _ Checked local excavators,installers X Used USGS Data Describe how you established the High Groundwater Elevation.(Must be completed) USGS MAPS AND CHARTS , revised 9/2198. Page 11 of 11 TOWN OF BARNSTABLE LOCATION r/OFt SEWAGE VILLAGE ASSESSOR'S MAP & LOT ��' U INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY —S-6 O LEACHING FACILITYAtype) (size) NO. OF BEDROOMS_ OR PUBLIC WATER BUILDER OR OWNER .9Gy` DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: /0 —,6- VARIANCE GRANTED: No J a yee- �� P L ASSESSORS MAP NO: U PARCEL NO: 0® oL, THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Allpfiration for 14"mial Vorkri Towitrnrtiun ramit Application is hereby made for a Permit to Construct ( ) or Repair ( } an Individual Sewage Disposal System at: ............ _ �. - d............... ..............------ --------------.........---............---- Location-Address orage Lot No. aywc / ------------.................... .JZ-------------------------------------------- caner- - ----•--------------------•---...Address a ------------------------- ---.--------- �-•----•-------------.---.---•- -..._....-- .....-•---•••-••----•...................... Installer Address d Type of Building Size Lot............................Sq. feet U U Dwelling—No. of Bedrooms................................ .....Expansion Attic ( ) Garbage Grinder ( )`PL44 Other—T e of Building No. of persons............................ Showers — Cafeteria Otherfixtures -----------------------------------------------------------••••••--•••-•--•••••-••--•.....--••---•---••-•-••-•••---•-•-.....-•-•-•••-•-...--•-•....... W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid*capacity/.5?N?gallons Length---------------- Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter..........--........ Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box (4,-j Dosing tank ( ) � Percolation Test Results Performed by.......................................................................... Date........................................ 04 Test Pit No. 1................minutes per inch Depth of Test Pit------.............. Depth to ground water-..--.-.-------.--.----- 44 Test Pit No. 2................minutes per inch Depth of.Test Pit.................... Depth to ground water........................ a Descriptionof Soil --------------------------•-•----•-----------------......---------------------•-----------------------------------------•••.---•-----•--••••- x U -••••-•••••••-•--•••-••-----••-•••••-••..............•-•••------•-•--••••-•-••••-•••••----•••••-•••••---•---••-----••--••--•--•......---••--••-•--••-•--•--•----•••••--...-•-----•-.............-----••. w ...................................................... -------•-•--•--•------•--------•-•--•-----••• --•••••- U Nature of Re i or Alterations—Answer when applicable.-.- .. •---------- --------------= - ----- -.- .. -----------------------------------------------------------•------------------------------•-----------•------------------•-------.....--•--•........._..._..•••. Agree lent: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has beep issued y th bard of health. Signe - - ----------------------------------------- ---------------- ..... Dare �y ApplicationApproved By ............. . ....... ..'. - .......................................................................... ..--- na`Z'-�'.-</ Application Disapproved for the ollowing reasonr- ------------------------------------ - - -------------- -------- 99 U / / Dace - Permit No. L/ 7--6- ...... ............. - - Issued 1 -19--�--------T ............ Dace FimNo. Y.._.v THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratiou for Diipusa1 Works TlaustrnrtUan 1hrutit Application is hereby made for a Permit to Const;t ( ) or Repair ( ) an Individual Sewage Disposal System at: xr • t Location-Address r or Lot No. _�,� •-- ^4e4: .......... ..........'-'•--__.. ....................................._..... .. ..= Owner Address Installer Address Type of Building Size Lot............................Sq. feet U Dwelling No. of Bedrooms.............................. .....Ex Expansion Attic � g— --------- p ( ) Garbage Grinder ( ) aOther —Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) d Other fixtures . W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. W Septic Tank—Liquid capacity./54?gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box (,�4 Dosing tank ( ) ,. aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... .Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit---:................ Depth to ground water-----___--:-.-----------. P ODescription of Soil; --------------•----•-----•----•----'--•-•---'--'......'---------------•----'-------•-- - - - - - - ----- •----. --•--. - - -•- --- ------- x UW ---------------------------------------------------------------- ................................................ -- -7f -- ••. . Nature of Repairs or Alterations—Answer when applicable.--- ................... ---------- '--•--•-------------•--.....--------------------------•--------------------------•---------"'-----'-•-------••-••••-••""---"-••-•...... Agreem nt: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee issued y the b and of health. Signedt��-�f - _ _ .. ............. . .......--------. ........................... Date Application Approved By ��- .tc,tr -^^= ..................... Date Application Disapproved for thePNOu00-2ing reasons: ........--`------.......................................................... ...............................-------------------- ------------------------ -------------. -------- ............./�....................-----........----- ---.---..:......--. .------------------------------------------------- ..--......-- ......................... -....----.......... Permit No. --------- 1-------/. Issued /d..-- �-- q(..------....Date ---- ......................... Date THE COMMONWEALTH OF MASSACHUSE17S BOARD OF HEALTH TOWN OF BARNSTABLE Tez#ifi a e of C110mytianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by----------------------A..-----.......Ir+ 6�--------------------------------------------------- ------------------------------------------------------------------------------- �A �^.............. Instal r --------------------------------------------------------------------------------------------------------------- has been installed in accordance with the provisions of TITLE 5 of he State Environmental Code as described in the application for Disposal Works Construction Permit No. ............/...1.-..��,!a:`�...... dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........................................................... ...------............:------------------- Inspector .......... .................................................. ....................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No.... .�.r/.:-..Lt.�.�-�.� FEE.. Disposal Workii CIun#rwtion rrnttt Permission is hereby granted...........2i•--1�.._,._...... .----------•------------•-"---'----------••..........................•••........... to Construct ( ) or Repair ( �,an Individual Sewage Disposal System at No............ x..J ....... Street as shown on the application for Disposal Works Construction Permit No.__-,��iZ" Dated.......................................... • ................................................. --•----- Board of Health DATE................ r?= -1----------------••-- FORM 36508 HOBBS&WARREN,INC.,PUBLISHERS t o b hi � t N aJ N y Y G � M c 5 Y O O O EwsBBrEElNppr,TREADS 15 a1p5LEas FOYER an ITWO NEYI(PR F0E A15R B'I IA g 14 M.a 9'•1'NOSING) lk �UNE%LAVATED� DEN/STUDY ----- .� NEW TREADS TO BE ________ V an { 7 BUILT WITHIN FLOOR w W SYSTEM ABODE co G 1 BEDROOM _ t to LIVING --------------- ---------- ------------0 NEW BEAM ABOVE NEW 3 1/1'LALLY LOWMN \. ON HE W 30X50%13 CONC. -� FOOTINGS NEW F%OOTIHS BELOW ml a ZMB%CAVATED +' COLUMN `I um-'i �' BASEMENT :o: xlx /�J `LPIE%CAVATED - mS j „ mccm WALL/DEMO GENERAL PLAN NOTES ALL WALL5 TO BE 2%45 a 16-OC. WALL5 AND ITEM5 TO BE REMOVED o n NNLES$NOTED i .L mmimw o'" dom c WALLS WI TN POCKET DOORS i0 B-m o`m c dm m c ---------------O------------O------------- EXISTING WALLS TO BE 2%65(ttPICAU as n_ REMAIN m -WINDOWS BY'FELLA",ARCHITECT NEW WALL5 SERIES(REFER TO ELEVATIONS ro FOR GRILLE PATTERNS) V,^, -REFER TO ELEVATIONS FOR WIN-A +� DEMO NOTES R0.HEIGHTS ABOVE SUBFLOOR 4-j AND GRILLE PATTERN$ O c: U �0) L— s } Lm A O /- ! E%ISnNG DASHED AND PATCHED 1 WALLS A\ O LONE%CAVATED TO BE REMOVED AND PATCHED D. (n \{J �- NEEDED OR REPLACED A$NOTED. �� 'Id Ou N. ro C (v i 0 ro C Lyr�� o Iry E%15TIN6 HOUSE(FIRST FLOOR)=1355$0.FT. O+,—-•� 5%15TIN6 SCREEN PORCH(FIRST FLOOR) 218 50.FT. -� r}I E%ISTIN6 HOJ5E(SECOND FLOOR) 644 50.FT. 0 = F O U N D A T I O N F L AN F I R S T F L O O R F L A N PROP05ED ADDITION(SECOND FLOOR)=583 SO,FT. U L0 SCALE: 1/4' 1'-0' SCALE: 1/4" = 1'-0" TOTAL=3b5B 50.FT. PERCENTA6E OF INCREA5E-19.1% job no. oelo date BE,w,2006 scale A5 NOTED drawn Knw rev. rev. a a A- 1 ISSUED FOR CONSTRUMON sbt: I of s f� i < "a A •V N Lt Z C ` M � A e -------------------------------------------------------------------------- g E O a0 u e .; s • BEDROOM 2 rn EXIST.FIN FLOOR AT HALL i0 BECOME `..UBFLR FOR NEW FIN.FLR. _ -__ /v� � Ln NEW TREADS AT TOP — IONTOE%IIST.TFOL BET MILT L - ' n r r fd ,______________ ___ ___ r___________ __- ,i ' SHELVES WILD WALL OVT ` - O •Q7 TO MATCH EXI5T. NEW RAILING.BALV5 - a V J t` BATH.2 AND NEWEL iO MATCH E%15T.QJ . LOFT ' EXISTING FINISH FLOOR- .I �7 2 .q- RE BE REMOVED AND REPEALED WITH NEW , i r ' LINEN i r O S OVE OO '-EXISTING GABLE WALL TO REMAIN ASLDH-1953 m BATH.3 ASCAW-E/4 ,RE�RALEIW RE-12E 2-5 3/a X]-5 3/4 PANEL(PATCH WALL A5 r� DED) I-5 3/4 X 4-5 3/4 REMOVE(PA EXISTING WINDOW "� 3'-0'm 5•.5•./- TCH WALL AS NEEDED) EXISTING GABLE WALL 6 - NEW FLOOR TO BE o Q i0 REMAIN _ FLUSN W EXISTING O BEDROOM 3 0�[ilp¢E�LQLY S ACCESS FROM BELOW _ (RD,2-0 X 2-b) m m z cci mem tuE- N i - � i F ATTIC ACCx55 _ - ATTIC N IRA,2-0 2-6) ASLD q-2953 1- X 4-S o ____________ ____________ __-_________________________________________________ _ i r r________________________________________________________________ r L">ic a`P_`o aue Cam m am_,d._m1-ems Ln u �4- cl- a o c Nay `o -�5 WALL/DEMO L _O WALL5 AND ITEMS TO C� � 7 LL. ldd( Yf EaAL at r^ �pL BE REMOVED O V)S V s-0 •++ EXISTING WALLS TO V'^l U REMAIN Q EXISTING L W _ EXISTING NEW WALL5 t-�lu � 1 ' � VI I DEMO NOTE5 ¢ CL f� --- —-----------------' ---- ----- EXISTING MOV WINDOWS 1 WALLS L TO BE REMOVED AND PATCHED - O NEEDED OR REPLACED A5 NOTED. C �r� LI_ o EXISTING ITION(SELOND FLOOR).552 50,FT, A T T I C / THIRD I R D FLOOR P L A N S E C O N D FLOOR PLAN PROPOSED ADDITION(SECOND FLOOR)a 3b2 50.FT. Q r( 1 SCALE: I'/B I'-O" TOTAL I.O2650.FT. 5G ALE. I/4- . I'-O" V N job no. : oblo date SEPT.w.2006 scale A5 NOTED drawn KMW rev. rev. a m A-2 s - ISSUED FOR CONSTRUCTION 5bt: 2 of 5 } � o 0 V a A V EXISTING HOUSE NEW ADDITION � NOTE, NOTE. w � NN EXISTING EAVE DETAILS, - EXISTING EAVE DETAILS, �d ep i0 MATLH�EXDIST�IN6 S REiU2N�AND R4KE5 t TO MATLN EXISTING U Y IJ w @)U SHINGLE5 TO MATCH TME. EXIST,% RED CEDAR XISTI.ES TO MATCH E . A %ISTIN5 WINDOW JAMB/1ffAD E CASINS MATCH INDOW JAMB/HEAO LASING TO MATCH y mEXISTING W e NEW LI6N W 60mEX15T A IX CORNERWARDSTCH AND TO ALIGN W/E%ISTINb o E DETAILS TO MATCH IX BOA H AND L E%ISTING - DETAILSTAILS TO MATCH EXISTNG � O IN.FLR�.91XIRD FLR, FIN.fLR„}_LVIIRD FAR_ _ fEX15TIN6) WL.SHINGLE 51DIN6 TO x15TIN6) SHINGLE SIDING i0 MATCH E%15iIN6 MATGM EXISTINb VJ � EWE OF EXIST.ROOF w •� TO BE REMOVED 0 co FIND SEC. FLR.— F(EXISTINGRI .)SEfgN�F�R. � EXISTING) µUGH LORAERBOARD 11—tY �) -- ------- ANDFRIEZE ff�L�l -„ 7 REMOVE EXIST. NEEDEE/FRIEZE: V J V PATCH WALL 51 NEEDED NEW HEAD CATo M AT DOOR AND WINDOW TO MATCH EXIST. 0 co XI FIN.5FPN6LR,)a FIRST FLR, FIN.FLR-A-LRET Fl R ❑w - -. - fE%15iIN61 \I D RIGHT / NORTH ELE VAT I ON REAiR / WEST ELEVATION 5 C A L E I/4- 1 -O" - 5 L A L E I/4 I'-O' NEW ADDITION �, EXISTIN&HOUSE 3 - ECUµ N ECUµ RED CEDAR ROOF 5NIN6LE$ W/LEDAR BREAiIER ON 5/B'CDX PLYY.F DXB RAFTERS B 16'OL. F=VENTLAP W o < NOTE: OVER DXIO RIDGE RETURNS AND EAVE DETAILS, (laV-STRWNRAU RENRllS AND RAKESa u o u TO HATGN EXIStiNG NOTE! � 1. __ RED CEDAR RAF E%ISTING EAVE DETAILS, X6 GLb.JOISTS - »±m 2- 0 m m u is a REIVAHS AND RAKESI6,OC.WI xnc<d. r 5HIN61.E5 TO MATCH O MATCH EXISTING 1/3'6YP.BOARD a m_ - EXI5TIN6RL.ROOF O OIBPLVTHEI T � -U N IX3 STRAPPING R-30 Fb.INSULATION ATTIC 'v Q) n�11 WINDOW JAMB/VEAD - 3/4'ieb PLYWOOD CA51%TO MATCH 9/]'AJS10 FLOOR EXISTING JDI5T5 m I6'OG. Q LONT.LVL RIM M--I o DEC. IX CORNERBOARDS AND (EXISPFIN N6�RD FLR. (�' POLATE O BEDRM.3 I/3'SyP.BOARD DETAILS i0 MATCH ON 1X3 5TRAPP�NG EXISTING1��YI EA15 I D % R-30 Fb.IN'�A-ATION O e/N '1 LOAD BEARING WALL W ro m M C.SHINGLES W C.SHINGLE 51DIN6 TO = 1/2-co X PLYWOOD MATCH E%ISTIIG - FA m Ig ]x45616.OL. - EXIST.RAFTERS.TO.. 6€DRM.OJ M�--I L1� ,"1 e/1 0 2X4$*.INSI.L. BE REMDVED.: ,v Ve Q 3/4'TK'El1'WODD > i �9 I/Y A.>ri-20 FLOOR ". -. CT JOIST$ 1 3/4'xLVL, L i SELONp FFLOOR .:We3/4'LONT.LVL RIM (FLUSH/EELOW WALU _ EXISTING LORNERBOARD y LRIM TO REMAIN,NEW WC. RO F[ATLH E%�5TJ C T+ W IIN6LE5-i9AL16N-fW-E%IST. .FLR,-g�OND F R _ (EXI5TIN6) 11/�1 TOP OF EXIST.DBL. O}) �+,•� Q PLATE®KITCHEN EXISTIN&7X6 LL6, JOISTS TO REMAIN -aEU LIP UP r 0 ruim _ BELYEEN EXIST.(TO PLATE G RT NE < T W/(4)EN EX•T.2 SUPPORT NEW Q U L1J 9 1/2,Ab105) c a LOAD BEARING WALL KITCHEN job no. 0610 i EXISTING]x W date : SEPT.M,2006 TOP OF FIN.FLR. STUDS TO REMAIN e FIRST FLOOR scaleFIN.FL T FLIt xl�) AS NOTED �i EXISTING FIRST FLOOR dram KMW $TRIICTURE 10 REMAIN E%ISi.FOUNDATION teV' ExI��51I(N6))BEAM/COL. Lev. 1�l 3 I/]I'NLY"x.O 90x ml O WA ]1 3 4%II ARN WI LONG.FOOTING A ■ 8 SOUTH / LEFT ELEVATION JJ SCALE: 1/5' • I'-O' _---__---1 ISSUED FOR CONSTRUCTION $be 5 of 5 v ie ie NOTES STRUCTURAL DESIGN CRITERIA .. x - POINT LOAD FROM ABOVE - FIRST FLOOR 40 PSF ILL (PROVIDE BLOCK'G A5 REO'D) 15 P5F DL r @b) - 5ECOND FLOOR 30 P5F 7 - ALL WINDOW HEADERS TO IO P5F BE (2) 2X6'5 N/ I/2" PLYWOOD, UNLE55 NOTED - ATTIC/STO. 20 P5F IO P5F - ALL DOOR HEADER5 @ INT. - ROOF 30 05F b LOAD BEARING WALL5 TO BE 15 P5F E (2) 2X6 W/ I/2" PLYWOOD, 8 UNLE55 NOTED - EXT. WALL5 l5 P5F DL a - INTERIOR LOAD BEARING WALL - INT. WALL5 50 P5F OIL - DECK5/PORCHES 6 PSF �I ul vi w v H C� ,-, ❑ �"l �y v 7 TSrTlAIFZ5TOBE TOP INTO I SYILT INTM Illul SYStE EEDED) cc _ ------_---------- ---_____________________________________ EXISTING FLOOR -------JOIn T?REMAINKe)Y:l _____________________________________________ nn q ---- -------------- ----------------------------- r • r --------------- ----------------------------------------------- )2x< r P05P r ------9 r r r i 9 I!2'AJS205 EXISTS T LEILINi ----------------v r VERIFY EXISTING LLG. 9 1/2'AJS205 , JOISTS TO REMAIN x TEAM IREA IOR TOO m . i _______________ ___________________________ _______________ , ' iN15 AREA PRIO--------------- ___ml i LONS}RLGTION i r i 9 I/2'AJS205 r r r 4)2Xb ________ .POSP ----- 9 I/2'AJi205 �m M i i i i 'LVL(FLUSIU -TyU -- (I)13/4'X 9 I/2'LVL IFLL5W r 9 I/Y AJ co .:m me u - A3 WSF A3 o Ib ol. m n3m W ?Q ammm r _ 9/2'A.fi205 (I)1 3/4'X 9 1/2'LVL fRLSfU r cr Nio w o o " nc- m S _ .2m ____ `_ -at6.o�avumom— •. m "� `n5`mk n M 3)2X4 _________________________ ___________ P05T _________________________________ 11)--_'__"_"-'-__""_______'-- C N Q) L V) ++ O.-(S [2 LL 4- (n U EXISTING CEILING A\ c (o Q JOI5T5 TO REMAIN O 0 LL 0+.,N o SECOND FLOOR FRAM INIS PLAN THIRD FLOOR F-RAM.ING PLAN f0 ¢� SCALE: / l job no. ot, . date SEPT.w,2oob scale AS NOTED drawn KMW rev. rev. E a r A-4 8 ry ISSUED FOR CONSTRUCTION sbt: 4 of 5 u Ou Ov - xro V w L N0N M � � � u V N N M r NOTES --------- -- b ALL P05T5 @ EN05 OF BEAMS TO BE 8 E (2) 2X4'5/(2) 2X6'S,UNLE55 NOTED - ALL WINDOW HEADERS TO BE (2) 2X65 W/ 1/2" PLYWOOD,UNLE55 NOTED M�y W� c � rn - ALL DOOR HEADERS @ INT. LOAD BEARING WALL5 TO BE w (2) 2Xb W/ 1/2" PLYWOOD, H UNLE55 NOTED F � a'� U - INTERIOR LOAD BEARING WALL W � vo J� 1%6 6.OL.OtG..glST6 ` ' r-- ------------------------------------------------------------•1 STRUCTURAL DESIGN CRITERIA r j - FIRST FLOOR 40 P5F ILL 15 P5F DL � XB RAFTERt_ , - - 5EGOND FLOOR 30 PSF 16'OL. 10 PSF ' �_-_____� _-______♦ �x8 RAFTERS .16.OL. - ATTIC/5TO. 20 PSF i 10 P5F ROOF 30 PSF - i D ott qo mr m„mm 15 PSF x -_<y ---------------- =�6R�ERS - EXT. WALL5 15 PSF DL a "` -oof`m3 A mi60L. ._U __ ohm As i-------- --------1 - INT. WALLS 50 PSF DL -- oa w.;m %B RAFTERb_ 16'oL- - DEGK5/PORGHE5 60 P5F ---------� 10 PSF mead a — }n,I U nWn1}J ` 0 W L to 0-- -C V1 � m � C: c c r+; LL ROOF FRAM I N G PLAN o r 0 O Q�TU SCALE: 1/4' = I—O- job no. o610 date se,19,20 & _ S ale AS NOTED drawn KMW rev. rev. a a m A- 5 8 - ISSUED FOR CONSTRUCTION sbt: 5 of 5