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HomeMy WebLinkAbout0050 NICKERSON DRIVE UNIT #A - Health �50 Nickerson Drive Cotuit P A = 035 065 Now -. - —�L.. :C&.TION : SEWo,GE PERMIT Mo. __—LN.ST LL.ER_5_IJ�t�IE_�_ADDRESS �.U1.L_ _E.R-5_KJ h, /lE_ _AD_DRE SS QATE_P-_ERN�1T_ISSUED - ---� ----_----- - O ATE_COMPLI&&ICE -ISSUEE) - � III �` I r ;�� r f �_ / 1 t- ,�'� -`,�, � �, ..._ ��:. Commonwealth of Massachusetts Title 5 Official Inspection Form _ /I, Subsurface Sewage Disposal System Form -Not for Voluntary Assessments . � 50 Nickerson Drive 01 -' Property Address [ A Ct Dana Arrighi and Lara Alden '`'3 ry F A Owner V Owner's Na"}e ' ! Information is Cotuit ✓ MA 02635 11/06/2020 requirediforevery 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 A. Inspector Information out f on the computer, use only the tab Michael T Bisienere key to move your Name of Inspector cursor;-=&not Cape Septic Inspections use the return Company Name key..:: ... 52 Rivers End Road <a`•,' Company Address Teaticket Ma. 02536 - Cityrrown State Zip Code 508-280-3356 S13938 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function- r"t flr and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined ti that the system: 1. ® Passes - 2. ❑ Conditionally.Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails ,,v:, ... _ L/-/�i���i7 / � — _�20 ,vii'f;i'YC=.i 'fl f;`1•.:�'i 1" Inspector's Signature Date 7. The system inspector shall submit a copy of this inspection report to the Approving Authority.(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow'of'"" 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form iIa Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Is- 9 p Y rY µMS 50 Nickerson Drive Property Address Dana Arrighi and Lara Alden Owner Owner's Name information is required for every Cotuit MA 02635 11/06/2020 page. City/Town State, Zip Code Date of Inspection C. Inspection Summary t.. Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. r �$ t. 1) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: This report is for the 2 structures on the property that share one system. There are 5 bedrooms total (4/ 1). The system has an H-20 1500 gallon septic tank with an H-20 D-Box feeding (4) 500 gallon r.-. chambers with stone. At the time of the inspection the leaching was dry and no visible failure criteria was found. r 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System,will pass.c t, 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): -B-oard r:- . t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form + i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4 50 Nickerson Drive Property Address Dana Arrighi and Lara Alden Owner. Owner's Name information is Cotuit MA 02635 11/06/2020 required for every page,> '' City/Town State Zip Code Date of Inspection +' C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box.due. OJjre, . 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(sy 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): 3) Further Evaluation is Required by the Board of Health: m ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: l5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts d Title 5 Official Inspection Form - � xiYw�� 1. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 50 Nickerson Drive Property Address Dana Arrighi and Lara Alden Owner Owner's Name information is required for every Cotuit MA 02635 11/06/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) - ❑ Cesspool or privy is within 50 feet of a surface water r. .,; ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh - b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has 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. c. Other: iu,feel, jr 4) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No 0 lre,�J or, El ® 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 t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form I a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ............ ; 50 Nickerson Drive Property Address Dana Arrighi and Lara Alden 3; Owner:'F'' Owner's Name tnformatlon is ��a required for every Cotuit MA 02635 11/06/2020 page Cityfrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded - or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is,less than '/2 day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: r Page, ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation:.-- El ® 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 water supply 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 DEPcertified ` laboratory,for fecal coliform bacteria indicates absent and the�presence r 4 r of ammonia nitrogen and nitrate nitrogen is equal to or less than-5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facllity4`iffi e,d 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 hti". r questions in Section CA. -- 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 t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page"5 of'18�t Commonwealth of Massachusetts �v Title 5 Official Inspection Form+- t .. I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 50 Nickerson Drive Property Address Dana Arrighi and Lara Alden Owner Owner's Name information is required for every Cotuit MA 02635 11/06/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) Y.F If you have answered "yes"to any question in Section C.5 the system is considered a significant -� threat, or answered "yes"to any question in Section CA above the large system has faded.FTher,..�: °t owner or operator of any large system considered a significant threat under Section C.5 or3faled , under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The systemAown"er. should contact the appropriate regional office of the Department. T 6. You must indicate "yes" or"no"for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? El ® Has the system received normal flows in the previous two week perio"d, ~ Have large volumes of water been introduced to the system recently or as part of El Z " > 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 constriction ;.. ,y dimensions, depth of liquid, depth of sludge and depth of scums " ® El Was the facility owner(and occupants if different from owner) provided With y �y_ 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)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments I� 50 Nickerson Drive Property Address �- Dana Arrighi and Lara AldenX;;,As ?p'�t Owner _ Owner's Name information-is Cotuit MA 02635 11/06/2020 required for every page: ''' City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 5 Number of bedrooms (actual): 5 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 55plus GPD Description: -•— _3ea !'1T0,;T1Ia.iICi' , r:: fi:d'i wf ry' : sr-. Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: r r Is laundry on a separate sewage system? (Include laundry system inspection information in this report.) Yes Z: No-.- Laundry system inspected? ❑ Yes ® No Seasonaluse? ® Yes ❑ No Water meter readings, if available last 2 years usage d town water Detail: In 2020-259,000 gallons were used. In 2019 no accurate reading, meter was broken. Sump pump? ❑ Yes No Last date of occupancy: seasonal use Date t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page.Z of,.18'_ a- - ;, 5r• 'F Commonwealth of Massachusetts i- ��_ Title 5 Official Inspection Form Ala Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 50 Nickerson Drive Property Address Dana Arrighi and Lara Alden Owner Owner's Name information is required for every Cotuit MA 02635 11/06/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): canons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes--O No If yes, discharges to: Industrial waste holding tank present? ElYes ❑ No •, Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): s•:. _ +� :9 i'21i 3. Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: ai ,01,E t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 cam, Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments c !% 50 Nickerson Drive Property Address Dana Arrighi and Lara Alden - Ownq� ;, Owner's Name Informations required for every Cotuit MA 02635 11/06/2020 page.- City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system : : _-' ❑ Single cesspool ❑ Overflow cesspool ` El Privy s"mouii- d{' ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: 4 ! � New Leaching 2006 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 32 _- feet Material of construction: ❑ cast iron ®40 PVC 2 pipes-1 from each structure other(explain): Distance from private water supply well or suction line. town water feet Comments (on condition of joints, venting, evidence of leakage, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 i":?C'rC71.c"i U Commonwealth of Massachusetts Title 5 Official Inspection Form .: I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 50 Nickerson Drive Property Address Dana Arrighi and Lara Alden Owner Owner's Name information is Cotuit MA 02635 11/06/2020 required for every page. City/Town State Zip Code Date of Inspection T;' . D. System Information (cont.) 6. Septic Tank (locate on site plan): O 24" Depth below grade: feet _.. _- -- Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) > If tank is metal, list age: years FR Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: H-20 1500 gallon Sludge depth: 1" Distance from top of sludge to bottom of outlet tee or baffle 35" Scum thickness *`Y ; Distance from top of scum to top of outlet tee or baffle ti Distance from bottom of scum to bottom of outlet tee or baffle 13 How were dimensions determined? sludge judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): I recommend the new owner put the septic tank on a maint. plan with a local septic pumping co. based on the future use of the home. At the time of inspection the liquid level was at working level and the tee's were in place. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 50 Nickerson Drive V� Property Address Dana Arrighi and Lara Alden �• Owner Owner's Name Inform -atlon-is Cotuit MA 02635 11/06/2020 ~ required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: El concrete El 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 - ,a Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural�rifiegify, liquid levels as related to outlet invert, evidence of leakage, etc.): - --" ?a .. 8. Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.d6c-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page l,fisof 1j8% ,v;': j ;. a Commonwealth of Massachusetts tr�. Title 5 Official Inspection Form g10 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments V � 50.Nickerson Drive Property Address Dana Arrighi and Lara Alden Owner Owner's Name information is required for every Cotuit MA 02635 11/06/2020 page.x City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) f F Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" t 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.): f At the time of the inspection the liquid level was at working level and there were no visible signs of— leakage or solids carryover. Y t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 cam, Commonwealth of Massachusetts r� Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 50 Nickerson Drive V _ Property Address Dana Arrighi and Lara Alden �i, Owner..,, ° Owner's Name - information is Cotuit MA 02635 11/06/2020 required"for every -------- --- page. City/Town state Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ -Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances,`ietc:j:'" '`' t . * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: (4) 500 gallon-. :' ❑ leaching galleries number: emu,a1'€e Pi•• .._______. .— ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t' .,PJti �j d,iiuiI_.. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page,3;of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 50 Nickerson Drive Property Address Dana Arrighi and Lara Alden Owner Owner's Name information is required for every Cotuit MA 02635 11/06/2020 page. _ City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) .r.r Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of f+=: r vegetation, etc.): At the time of the inspection the leaching was dry and no visible failure criteria was found. 1 - 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): rdiiiorl of T . Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool ka Materials of construction - K�L{ i.i i Indication of groundwater inflow ❑ Yes ❑ Nott.�iA, I r. �r Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 0 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts rn Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 50 Nickerson Drive uProperty Address Dana Arrighi and Lara Alden Owner ,': . Owner's Name mformatiori'is ;� ��+ }. e); requlred for every Cotuit MA 02635 11/06/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: Dimensions Depth of solids :a;r:er Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation; etc.): w.. .. S1"ai1tF/t::.. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18 Commonwealth of Massachusetts � Title 5 Official Ins Form Not for Voluntary ection Form Subsurface Sewage D isposal System - sAssessments 50 Nickerson Drive Property Address '.;Owner Dana Arri hi and Lara Alden information is Owner's Name required for every Cotult ram: • Page ,,.. Citylrown MA 02635 11/06/2020 ®. System Infortnatiorl State Zip Code Date of Inspection cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference,, landmarks or benchmarks. Locate all wells within 100 feet. L �^ the building. Check one of the boxes below: F Locate where public water supply enters ® hand-sketch in the area below ❑ drawing attached separately � � c I ~� Q. � :*,�� 3 r3 37 37 YG, � • . ��:, ` . �. . r.J y{f S IX 0 7- it .. . -,°Rues ... �a,.,,s• .wc.�a.,.�•.•�.:•...,. - ^ t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•page 16 of 18^ U 1F _,....:._._.... Commonwealth of Massachusetts Title 5 Official Inspection Form I; Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 50 Nickerson Drive Property Address il "�• Dana Arrighi and Lara Alden I Owner 1; Owner's Name y Infom aipri is ' t cmifem requPred for every Cotuit MA 02635 11/06/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water "r • ® Check cellar Z Shallow wells fF,�.- � • Estimated depth to high ground water: 12 plus feet --_ifeet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record , Y 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: _. I augered a hole at a lower elevation and shot it with a transit to show 4.plus feet of seperation. I illy s•'•31:i0 A t01 Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 18 1 _ = = �17011 Commonwealth of Massachusetts n Title 5 Official Inspection Form `+ �i� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u � 50 Nickerson Drive Property Address Dana Arrighi and Lara Alden Owner Owner's Name information is required for every Cotuit MA 02635 11/06/2020 page., ,•;, City/Town State Zip Code Date of In E. Report Completeness Checklist ;F:,;;;ttton• Complete all applicable sections of this form inclusive of: "'`p7'`' C.- .... ® A. inspector information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ® D. System information: 1 7 C'f i For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg..16 or attached For 15: Explanation of estimated depth to high groundwater included - i lI t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 TOWN OF BARNSTABLE _ r ,LOCATION SO Z41C SEWAGE# ,[VILLAGE ASSESSOR'S MAP&PARCEL 035--OG,- f C "d INSTALLERS NAME&PHONE NO. �, Ati h SEPTIC TANK CAPACITY LEACHING FACILITY:(type) `1'Sboy e-A AY5 (size) 4107,X 1.?.k3 X. NO. OF BEDROOMS OWNER PERMIT DATE: COMPLIANCE DATE: J/ (ems Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200.feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY L�rh PrS w o Nit NZ u C N 4p n r O .ram-- r- No. V U 4' Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Application for Migpool *pgtem Construction Permit Application for a Permit to Cons ct( v�Repair(�)Upgrade( )Abandon( ) M Complete System El Individual Components Location Address or Lot No. �� .` Owner's Name,Address and Tel.No. Assessor's Map/Parcel /v t:.tJL1ii"l' MAn/1 Installer's Name,Address,and Tel.No. Designer'6WHF esJ.aRCftfIffiAN):ASSOCIATES _ 42 CANTERBURY LANE. EAST FALMOUTH,MASSACHUSETTS 02536 608/540-2534, Type of Buis- Zer n No.of Bedrooms Lot Size 1, sq.ft. Garbage Grinder( ) Type of Building No.of Persons' Showers( ) Cafeteria( ) Other Fixtures Design Flow 3� gallons per day. Calculated daily flow 40 gallons. Plan Date Number of sheets Revision Date 10 L Title 5 L Size of Septic Tank Type of S.A.S. c%� Va11MIZ, Description of Soil: sc 1 1*,vrm-� C_ Nature of Repairs or Alterations(Answer when applicable) 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 Certifi- cate of Compliance has been issued b s oard of Health. Signed C Date 7 �� Application Approved by f Date a� G Application Disapproved P r the following reasons Permit No. Q Dom S Date Issued-1 1 a o o f 4. No. �d�� '� U �� Fee # w ,t.. �'`• T44E-GQM,MONWEALTH OF MASSACH�EjTS Entered in computer: PUBLIC HEALTH-DIVISION - TOWN-OF BARNSTABLE, MASSACHUSETTS Ye ` Y� A ZIpplication for Mi$pogal 6p.5tem Con5truction Permit T' Application for a Permit to Construct(�)Repair Upgrade(t )Abandon( ) dU Complete System O Individual Components 4� Location Address or Lot No. �7n Owner's Name,Address and Tel.No. Assessor's Map/Parcel 3;/� / Go�W�"r �jjj Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. �rt— STFPHEN J.D017LE AND ASSOCIATES 42 CANTERBURY LANE ' EAST FALMOUTH MASS 1~ 608/540-2634 �- 'Type of Buililftrg,, - Dwellin No.of Bedrooms J Lot Size t�G (psq.ft. Garbage Grinder( )� r Type of Building No.of Persons' Showers( ) Cafeteria( ) Other Fixtures Design Flow Aeeo _gallons per day. Calculated daily flow gallons. Plan`Date A 4 ••® Number of sheets Revision Date 10 'L 0 B r-, _ V Title a " 5 t.. Size of Septic Tank Type of S.A.S. r�.t;• lQ. ^�"�`7A1t� ' Description;of Soil r--�_ 1r0ATT Ai - r Nature of Repairs or Alterations(Answer when applicable) Date last inspected: r 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 Certifi- cate of Compliance has been issued b t is Board of Health; Signed C. Date Application Approved by t N. Q Date # Application Disapproved r the following reasons Permit No. ::)DU S= S Date Issued i l _ 0 --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certif irate"of Compliance THIS IS TO CERTIFY, that th Ont-s'te Sewage Disposal System Constructed(?()Repaired ( )Upgraded( ) Abandoned( )by T C at �o-.t�,L��,C >AI 4-4^rA- elk 711 s i has been constructep in ccordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Ir P Installer a, Designer—'---. e,is ' The issuance of this perqutshoallll rt.,be construed as a guarantee that the syste fu ctiori as-desi d. Date D v -A Date Inspects '--1----------------------------- l No. a(rl,�_�n O Fee / THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS ligpogar *p!gtem Construction Permit Permission is hereby granted to Construct( )Repair.( )Upgrade( )Abandon(' ) System located at 7C'b fV. rr V.,, � e and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply witl'Title 5 and the following local provisions or special conditions. r Provided:Construction must be completed within three years of the date of772 �Le�l Date: I u 1' _ Approved by '` t G ��LrG��" Q 1Xl�Slt Pj off' Cc �0 � �. Town of Barnstable r# Department of Ro Watory Services ;// J� • lOII Date 5 / 3 / Public Health Divis $ 200 Main Street,Hyannis MA 02601 %63¢ �� 1 i lJ D 0� 1...A. 0 Fee Pd. / a Date Scheduled b Time j soil Suitability Assessment for Sewage Di osal / r G Witnessed By:. Performed By: � LOCATION &GENERAL INFORMATION Owner's Name . Location Address•.� Address • Assessors Map/P$tcel: �(y I Engineer's Nam �V NEW CONSTRU�'I lO1V REPyQt j Telephone# i T.nud Uset `' Slopes(%) - Surface Stones /t ft Possible Wec Area, 3 —ft Drinking Water Well ft Distances from: Open Water Body 1 .�._— 1 Other ft Drainage Way ft Property Liae —7 _ SKETCH:($treet name,dimensiod6f lot,exact locations of tot holes&perc tests,locate wetlands in proximity to holes) 1 .• F- � rt,�tlr�`� 44 i 1 Depth to 13cdfoek Parent material(gedlogic) Standen Water in Hole:' Weeping from pit Face Depth to Grouudwaldr. g Estimatr..d Seasonal�jighGroundwater D TF.R1yIINN TI N FOR SEASONAL HIGH*ATER T'ADLE Method Used: r --in. Depth to soil MOWN, In. Depth Gibserved staadingp obs.hole in. _Groundwater A ustrrteat fr Depth toiweeping firm side of obs.hole: i fat)tOr,,,,.e� Adj.dt�tin6waterLeVul,.._ Index Well# Reading Date Index Well levCl I PERCOLATION TEST ' late Observation I Time at 9" Hole# ! �, Time at 6" ------ Depth of Pere Time Start Pre-soakTime.00 End Pre-soak Rite Min.Mch Site Suitability Assessment: Site Passed Site Failed; Additional Testing Needed(Y/N) Observation Hole Data To Be Completed on Back �. Original:.Public HOM Division ; ***If percola ion testis to be conducted within 100' of wetland,-you must first notify the Barnstable C >�servation Division at least one(1)weaik prior to beginning- Barnstable DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soii er Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. siGravel) 0-4 DEEP OBSERVATION HOLE LOG Hole# Lf Depth from Soil Horizon Soil Texture Soil Color Soil er Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency, ID— A" zE +—� 11 I , �. � J C.��mot_ q .. DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency. e DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Flood Insurance Rate Man: Above 500 year flood boundary No— Yes 1L Within 500 year boundary No _ Yes.,.v,..._ ' Within 100 year flood boundary Nor. 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 I certify that on (date)I have passed the soil evaluator examination approved by the Department of Environmental Protec 'on and that the above analysis was performed by me consistent with the required training,exp rtise an a erience described in 3.10 CMR 15.017. Signature Date Q:�SEPT MERCFORM.DOC William E. Robinson Septic Service ✓ THIS FORM IS A FACSIMILE OF THE STANDARD SEPTIC INSPECTION FORM ISSUED BY THE MASSACHUSETTS DEPARTMENT a OF ENVIRONMENTAL PROTECTION(revised 6/15/2000) TITLE 5 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION RECEIVED Property Address: 50 Nickerson Drive Cotuit Owner's Name: Ann Hoffman MAR 3 12004 Owner's Address: 50 Nickerson Drive Cotuit,MA 02635 TOWN OF BARNSTABLE Date of Inspection: March 8, 2004 HEALTH DEPT. Name of Inspector: (Please Print) David D. Coughanowr,R.S. MAP S Company Name: William Robinson Septic Service .,_,.,,q Mailing Address: P.O. Box 1089 PARCEL 0 ( 15 Centerville,MA 12632 LOT ^� Telephone Number: (508)775-8776 CERTIFICATION STATEMENT: I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. I am a DEP approved system inspector pursuant to section 15.340 of Title 5(310 CMR 15.000).The system: X Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature W—s Date: Mapcil to, 2,004' The System Inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority NOTES AND COMMENTS Inspector's Note—> A septic system is deemed to pass this Real Estate Transfer Inspection if it does not trigger any of the failure criteria listed below. The septic system has been evaluated according to the conditions observed on the day it was inspected. No estimate or guarantee of system longevity is made or implied by a passing determination. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 ' 'Page 2 of 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 50 Nickerson Drive Cotuit Owner: Ann Hoffman Date of Inspection: March 8, 2004 INSPECTION SUMMARY: Check A,B,C,D or E/ALWAYS complete all of section D: A] System Passes: Yes I have not found any information which indicates that any of the failure criteria described in 310 CUR 5.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. COMMENTS: B] System Conditionally Passes: One or more system components as described in the "Conditional Pass" section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no,or not determined(Y,N,or ND). in the_for the following statements.If"not determined"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not),is structurally unsound,exhibits substantial infiltration or exfiltration, or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved b the Board of Health. pP y *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or breakout or high static water level 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 Board of Health). broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced. ND explain The system required pumping more than 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 ND explain 2 Page 3 of 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 50 Nickerson Drive Cotuit Owner: Ann Hoffman Date of Inspection: March 8, 2004 C) Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety and environment. 1 System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2) System will fail unless the Board of Health(and public water supplier,if any) determines that the system is functioning in a manner that protects the public health,safety,and environment The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**.Method used to determine distance **This system passes if the well water analysis,performed by a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form 3) OTHER 3 Page 4 of 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 50 Nickerson Drive Cotuit Owner: Ann Hoffman Date of Inspection: March 8, 2004 D)System Failure Criteria applicable to all systems: You must indicate either"yes"or"no"to each of the following for all inspections: 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 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 X Any portion of the SAS,cesspool or privy is below high groundwater elevation. X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone 1 of a public well X Any portion of a cesspool or privy is within 50 feet of a private water supply well X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis.(This system passes if the well water analysis, performed by a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form) No (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CUR 15.303,therefore,the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E)Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of a surface drinking water supply 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. 4 Page 5 of 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 50 Nickerson Drive Cotuit Owner: Ann Hoffinan Date of Inspection: March 8, 2004 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: Yes No Y _ Pumping information was provided by the owner,occupant or Board of Health. N Were any of the system components pumped out in the last two weeks? Y _ Has the system received normal flows in the previous two week period? N Have large volumes of water been introduced to the system recently or as part of this inspection? Y _ Were as built plans of the system obtained and examined?(If they were not available as N/A) Y _ Was the facility or dwelling inspected for signs of sewage back-up? Y _ Was the site inspected for signs of breakout? including Y — Were all system components,exeluding the SAS. located on site? n/a Were the septic tank manholes uncovered,opened,and the interior of the septic tank inspected for the condition of the baffles or tees;material of construction,dimensions,depth of liquid,depth of sludge and depth of scum.? Y _ Was the facility owner(and occupants,if different from owner)provided with information on the proper maintenance of subsurface disposal systems? For information on the proper maintenance of subsurface disposal systems please go to: WWW.ECO-TECH.US The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Y _ Existing information.For example,Plan at the Board of Health. Y _ Determined in the field(if any of the failure criteria related to part C is at issue,approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] 5 Page 6 of 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 50 Nickerson Drive Cotuit Owner: Ann Hofftnan Date of Inspection: March 8, 2004 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): n/a Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): n/a—No plan on file at Health Dept. Number of current residents 1 Does the residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): no :(If yes, separate inspection required) Laundry system inspected (yes or no): n/a Seasonal use(yes or no): no Water meter readings,if available(last two year's usage(gpd): 210 gpd Sump Pump(yes or no): no Last date of occupancy: Current COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow(based on 310 CMR 15.203):: gpd Basis of design flow(seats/persons/sqft/etc.): Grease trap present: (yes or no) Industrial waste holding tank present: (yes or no): Non-sanitary waste discharged to the Title 5 system: (yes or no). Water meter readings, if available: Last date of occupancy/use:_ OTHER: (Describe): GENERAL INFORMATION PUMPING RECORDS Source of information: System not pumped in recent past(Owner) Was system pumped as part of the inspection: (yes or no) No If yes,volume pumped: gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM: Septic tank,distribution box, soil absorption system Single cesspool X Overflow cesspool Privy Shared system(yes or no)(if yes,attach previous inspection records,if any) Innovative/Alternate technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight Tank Attach a copy of the DEP approval Other(describe) APPROXIMATE AGE of all components,date installed(if known)and source of information: Age: 28+years. Certificate of Compliance for overflow cesspool issued 1/5/76(BOH permit#8) Were sewage odors detected when arriving at the site: (yes or no) no 6 Page 7 of 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 50 Nickerson Drive Cotuit Owner: Ann Hoffman Date of Inspection: March 8,2004 BUILDING SEWER_(Locate on site plan) Depth below grade: 1.5 ft Material of construction: X cast iron _40 PVC other(explain) Distance from private water supply well or suction line 20+ Comments: (on condition of joints,venting,evidence of leakage, etc.) Sewer is vented through roof and appears structurally sound with no evidence of leakage or backup into dwelling_ SEPTIC TANK:none (locate on site plan) Depth below grade: Material of construction:_concrete_metal_fiberglass_polyethylene other(explain) If tank is metal,list age— Is age confirmed by Certificate of Compliance_(yes or no):_(attach a copy of certificate) Dimensions: Sludge depth: 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 dimensions were determined: Probe to top of tank 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: none (locate on site plan) Depth below grade: Material of construction:_concrete_metal_fiberglass polyethylene other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle:_ Date of last pumping: Comments: (on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Wage 8 of 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 50 Nickerson Drive Cotuit Owner: Ann Hoffman Date of Inspection: March 8, 2004 TIGHT OR HOLDING TANK: none (Tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction:_concrete_metal _fiberglass_polyethylene_other(explain) Dimensions: Capacity: gallons Design flow: _gallons/day Alarm present(yes or no):_ Alarm level: _ Alarm in working order(yes or no):_ pumping:Date of last Comments:(condition of inlet tee, condition of alarm and float switches,etc.) DISTRIBUTION BOX: none (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 is equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.) PUMP CHAMBER: none (locate on site plan) Pumps in working order: (yes or no) Alarms in working order: (yes or no) Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 Page 9 of 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 50 Nickerson Drive Cotuit Owner: Ann Hoffinan Date of Inspection: March 8, 2004 SOIL ABSORPTION SYSTEM(SAS): Yes (locate on site plan;excavation not required) If SAS not located,explain why: Type: _leaching pits,number _leaching chambers,number _leaching galleries,number _leaching trenches,number,length _leaching fields,number,dimensions X overflow cesspool, number 1 —innovative/alternate system Type/name of Technology Comments: (note condition of soil, signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.) Soils above overflow cesspool appeared unsaturated.No evidence of surface ponding,breakout,lush vegetation,or other evidence of hydraulic failure was observed. Cesspool contained 10 inches of effluent in a 6 foot pit. CESSPOOLS:yes(primary) (cesspool must be pumped at time of inspection)(locate on site plan) Number and configuration: 2—one primary and one overflow—overflow details above Depth-top of liquid to inlet invert: 14 in Depth of solids layer: 4 in Depth of scum layer: 2 in Dimensions of cesspool: 6 It x 4 ft (beehive configuration) Materials of construction: block Indication of groundwater inflow(yes or no): no Comments: (note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.): Soils above overflow cesspool appeared unsaturated.No evidence of surface ponding breakout lush vegetation, or other evidence of hydraulic failure was observed. PRIVY: none (locate on site plan) Materials of construction: Dimensions:_ Depth of solids: Comments(note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 9 'Page 10 of 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 50 Nickerson Drive Cotuit Owner: Ann Hoffinan Date of Inspection: March 8, 2004 SKETCH OF SEWAGE DISPOSAL SYSTEM: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100'(Locate where public water supply enters the building) LOCATIONS A B WATER LINE 1 1 1.5 ft 20.5 ft 2 26 ft 22 ft EXISTING DWELLING W # 50 0 z A /O^, V PRIMARY e OCESSPOOL W i U_ OVERFLOW z CESSPOOL 2 NOT TO SCALE 10 /' 'Page 11 of 11 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 50 Nickerson Drive Cotuit Owner: Ann Hoffman Date of Inspection: March 8, 2004 SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to groundwater: 35+ feet Please indicate(check)all methods used to determine high ground water elevation: Obtained from system design plans on record-If checked. date of design plan reviewed Observed Site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of health-explain: _ Checked local excavators,installers-attach documentation) X Accessed USGS database You must describe how you established the high ground water elevation. Barnstable GIS department records indicate that property is over 35 feet above groundwater table. 4 . 11 Page 10;of 11 . OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 50 Nickerson Drive Cotuit Owner: Ann Hoffman Date of Inspection: March 8, 2004 SKETCH OF SEWAGE DISPOSAL SYSTEM: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100'(Locate where public water supply enters the building) LOCATIONS A B WATER LINE 1 1 1.5 f t 20.5 f t 2 26 f t 22 f t EXISTING DWELLING W # 50' o z . PRIMARY e OCESSPOOL W I U OVERFLOW z UCESSPOOL 2 NOT TO SCALE 10 0 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTEC :4 5 ONE WINTER STREET, BOSTON, MA 02108 617-292.5500 1b � 16sr -Yo 4o! ., V�ILLIAM F.WELD - t9 r T�tR'UD - XE Governor ���/j�j 4O'v S 00 ARGEO PAUL CELLUCCI AVID B. Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM C stoner PART A �f 6 CERTIFICATION Property Address: 150 �j'���r�`�� �"IC" �t v Address of Owner: OWL L G120JC 2 Date of Inspection: 10 —l v— cl—7 (If different) Name of Inspector: am a DEP approve system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000) Company Name: �1—cl X �" r Mailing Address: -Li% c0l� •Z S Telephone Number: 0 CERTIFICATION STATEMENT I certify that I 'have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: Y' Passes Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority _ Fails Inspector's Signature: Date: C)—�J �1 The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30) days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to•the system owner and copies sent to the buyer, if applicable, and the approving authority. INSPECTION SUMMARY: Check A, B, C, Or D: A] ,SYSSTEM PASSES: V I have not found any information which indicates that the system violates any of the failure criteria a5 defined in 310 CMR 15.303. 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. Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not. 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 conforming septic tank as approved by the Board of Health. (revised 04/25/97) Page 1 of 10 DEP on the World Wide Web: http:/Avww.rmgnet.state.ma.usrdep �"j Printed on RecycJed Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A n\ CERTIFICATION (continued) Property Ad ess: Owner: Cax� Date of Inspection: -{ v 1 0 - q . a BJ SYSTEM CONDITIONALLY PASSES (continued) ILI Sewage backup or breakout or high static-water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). Describe observations: broken pipe(s) are replaced obstruction is removed distribution'box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed C] FURTHER EVALUATION 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 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 feei of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has aseptic tank and soil absorption system (SAS) and.the SAS is within 100 feet to a surface water supply or tributary to a surface-water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. _ The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm: Method used to determine distance (approximation not valid). 3) OTHER (revised 04/25/97) Page 2 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property dres �G' '�1 i e`�Sah LAAk- OwnertyQU�� Date of Inspection: D] SYSTEM FAILS: You must indicate ei;T,er "Yes" or"No" as to each of the following: _ 4 1 have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below..The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No/ _/ Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. _ Y 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. v Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. _ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe($). / Number of times pumped _. V Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a 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 I of a public well. v 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. El LARGE SYSTEM FAILS: You must indicate either "Yes" or"No" as to each of the following: The following criteria apply to large systems in addition to the criteria above: 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 beccause one or more of the following conditions exist: Yes No the system is within 400 feet of.a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply _ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area-IWPA) or a mapped Zone II of a public water supply well)` The owner or operaItor'of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 04/25/97) ,' Page 3 of 10 A SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property dres Owner: Date of Inspection: 1 0— j Check if the following have been done: You must indicate either "Yes",or"No" as to each of the following: Yey No Pumping information was provided by the owner, occupant, or Board of Health. — None'of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. — As built plans have been obtained and examined. Note if they are not available with N/A. — The facility or dwelling was inspected for signs of sewage back-up. JL — The system does not receive non-sanitary or industrial waste flow. _ The site was inspected for signs of breakout. V _ All system components, excluding the Soil Absorption System, have been located on the site. — 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: The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub-Surface.Disposal System. 'Existing infornation.'Ex. Plan at B.O.H. I/ Determined in,the field'(if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) (15.302(3)(b)] , (revised 04/25/97) Page 4 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION - Property Miresk: r N rcke $OyN L 4v^e,� C'Owner: -V O1J�r Date of Inspection: I, J 1 O q FLOW CONDITIONS RESIDENTIAL: Design flow: 4yOg.p.d./bedroom for S.A.S. Number of bedrooms: Number of current residents: a Garbage grinder (yes or no):_ Laundry connected to system (yes or no): Seasonal use(yes or no): c U Water meter readings, if lilable (last two (2)year usage (god): ( 1� /O Mro 77iMZ� Sump Pump(yes or no): 7 ` - . � " �� 4S o Y►nu j Y►a K'�f�.�n4 Last date of occupancy: 5)e 1 "COMMERCIAUINDUSTRIAL: Type of establishment: Design flow: Gallons/day Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non-sanitary waste discharged to the Title 5 system: (yes or no)_ Water meter readings, if available: ` i Last date of occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: Nb ot, 1 ceCo r System pumped as part of inspection: (yts or no)_ If yes, volume pumped: Gallons 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) I/A Technology etc. Copy of up to date contract? Other ` APPROXIMATE AGE of all components, date installed (if known) and source of information: 6 . Sewage odors detected-when arriving at the site: (yes or no)/= (revised 04/25/97) Page S.of 10 J SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C i1 SYSTEM INFORMATION (continued) Property A dyes Sb N l CyaVSav\ L'a—h� Owner: �Q r Date of Inspection: BUILDING SEWER: F e (Locate on site plan) ii Depth below grade: Material of construction: aSt iron _40 PVC other (explain) Distance from private water supply well or suction line Diameter Comments: (condition of joints, venting; evidence of leakage, etc.) SEPTIC TANK: rc (locate on site plan) Depth below grade: Material of construction: concrete _metal _Fiberglass _Polyethylene _other(explain) If tank is metal, list age _ Is age confirmed by Certificate of Compliance _(Yes/No) Dimensions: Sludge depth: 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 dimensions were determined: Comments: Y (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.) GREASE TRAP:Z, (locate on site plan) Depth below grade: Material of construction: concrete _metal _Fiberglass _Polyethylene —other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) (revised 04/25/97) Page 6 of 10 -SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 5/U aYN Owner: P Ctu` l?-�( 044-V. Date of Inspection: 0 — l'0 cl ; TIGHT OR HOLDING TANK: (Tank must be pumped prior to, or at time, of inspection) (locate on site plan) Depth below grade: Material of construction: - concrete _metal _Fiberglass _Polyethylene —other(explain) Dimensions: Capacity: gallons' Design flow: gallons/day Alarm level: Alarm in working order_Yes; _ No Date of previous pumping: Comments: (condition of inlet tee, condition of alarm and float switches, etc.)'. I , DISTRIBUTION BOX: , (locate on site plan) Depth of liquid level above outlet invert: Comments: , (note if level and distribution is equal,evidence of solids carryover, evidence of leakage into or out of box, etc.) PUMP CHAMBER: (locate on site plan) Pumps in working order: (Yes or No) Alarms in working order (Yes or Not Comments:. (note condition of pump chamber, condition of pumps and appurtenances, etc.) } 4 (revised 04/25/97) Paga 7 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Vdresa5 C7 O- Sc�Y� LC_'y%-z_Owner: 0. OJQ�!', c Date of Inspection: 1 J 1 ' 9 r ` SOIL ABSORPTION SYSTEM (SAS):_ (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number: leaching chambers, number._ leaching galleries, number: leaching trenches, number,length: Teaching fields, number, dimensions: overflow cesspool, number:1_ Alternative system: - Name of Technology: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) C2 D 0 CESSPOOLS: �— (locate on site plan) Number and configuration: Depth-top of liquid to inlets rert: Depth of solids layer. Depth of scum layer: t' Dimensions of cesspool: Materials of construction: Indication of groundwater: N inflow (cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, ondition 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.) r (revimed 04/25/97) Page 8 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM r PART C SYSTEM INFORMATION (continued) Property Address: Cn> 1 v t'O� rsa 1-\ Lq�Q C dr Owner: \.A� Date of Inspection: 9 t ' SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) r , t (revised 04/25/97) Pago 9 of 10, SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property A dress: 5b N t c�Cear Save La.y\ � U l Owner: ' CLV G sc-6 0-lut. Date of Inspection: �.� _ 1 ...CI Depth to Groundwater l� et " Please indicate all the methods used to determine High Groundwater. Elevation: Obtained from Design,Plans on record Observation of Site (Abutting property, observation hole, basement sump etc.) Determine it from local conditions 4 .. a • , Check with local Board of health Check FEMA Maps Check pumping records Check local excavators,'installers —zUse USGS Data< M Describe in your own words how you established the High Groundwater Elevation. Must be completed) 5vv� o Ge S S Poo (revised 04/25/97) Page 10 of 10 REV. By DATE DESCRIPTION bed, os mo i hwed 4 hcloGe., - as as �� � ► - _ - � •a ❑ uC1 c.1 Lea a0� -- a as a1 � as a a 1 50 J�I;cke.rsov� Dr.� Cutvii- tlrr�h ,44Ain Mont EIIV h0i, — T2LERANCE s lE-�i=�,,Di, nEo. owwmc ra. aEv. DEC. FRACT. ANG. � 7• B0.[w M �2 jam_ 5 5 . S N 13' 7= " \\ cj , O 8 s 4 n I Pq,y I , / i- IJ 3 R±a 1-1�D l_"QJ (Yj - �1 w za O u GLj � N I u!) IT �o • z"m n A �a I+=oN Od , _ p . 5 rl R A C C � n D C s =� v N Pp � 5 Z a Pam° S�ys t 1"-z- c3o Vi i:e vv- IV 7'� S� "arsh Grade F.l. srf 1/8' r/z' 111 see ®s' sex COTUIT 6., 6" 1 Ill 6"1 / 11l/I Ill, Ankh Gmde M s7!t Inv. Ele v 95.49' "Die RISER Ora RUHR 6" ® r _. _ ©coo 401, " e a°a'. m e m ®®® a El. 91.17' Inv Ele v 94.64' 10 third 14 Min. INV EL S'�'p NV EL INV EL /- Inv Ele v 94.40' 94.1' 93.17 / A' COTUIT �Be,r0W no Line 94.3' B"Stgge; 4, 3 4" - 1 1 hashed Slone 4, it BAY Liquid Lew] 48" 4 � gChtOOL STREW � 5 HOLE DISTRIBUTION BOX PRECAST REINFORCED CONCRETE T I$TRIBUTION BOX i 42 � Install on a level base PROPOSED LEACH TRENCH 1500 GALLON REINFORCED CONCRETE SEPTIC TANK Minimum wall thickness = 2. Minimum Construction Materials Per 310CMR 15.226(2) Minimum inside dimension = 12" Bottom of Soil Log El. 86.0' � Tees shall be constructed of Schedule 40 PVC and shall extend a Outlet inverts shall be equal to each other and at r� Ad High Ground Water <EI. 86 minimum of 6 above the flow line of the septic tank and be on 2 minimum below inlet invert. .�� the centerline of the septic tank located directly under the The distribution lines from the distribution box shall all have +-� 1,2.83 ►) clean-out manhole. equal inverts as determined by flooding the distribution box to The inlet pipe elevation shall be no less than 2" nor more than 3" the height of the distribution ling invert after all lines have 34" INVO'•• "' A PLAIN REP- 573/77 above the invert elevation of the outlet pipe. been sealed in place. 0-4 4 24 DEED REP- MAP 3z43 Septic tank shall be installed level and true to grade on a level, Invert adjustments shall be made by filling with durable and --� 58" �- ASSESSORS MAP 35 PARCEL 65 stable base that has been mechanically compacted and on which nondeformable material permanently fastened to the line or Number of Trenches - 1 ZONING.• "E 6 of crushed stone has been placed to ensure stability and reconstructing the lines until all inverts are of equal elevation. Number of Chambers - 4 OVERLAY DISTRICTS• AP & RPOD to prevent settling PROPOSED LEACH TRENCH - END VIEW N.T.S. SEMACW 30-15-15 Septic tank shall have a minimum cover of 9': Two 20" manholes with readily removable impermeable covers Install Four 500 Gallon Units FEMA DATA ZONE "C" of durable material shall be provided with access ports 1 with Four Feet of Stone at Sides and Ends LOT COVER BY STRUCTURE'S:- The outlet tee shall be equipped with gas baffle. Septic Tank Remove AM 35 PAR 103 EMS'TING = 8Z AM 35 PAR 43 PROPOSED = 14.67. pump and Remove Exist cesspools �� ►�246.20' 35.00 '' \ ti 5 Aie +r. N85 08,550E 9/ footprint os o � �'� on rn 1 proper » #TP �°1 r / /adoo' o, Ss„yDA i a M. 35` P�R. '65 - ,, a .. , � �, � cn I � pR;bP05� t _.. � Alf. 35 PAR ss '�-�. �''�• Footprint �. 11 AARr{EZ9. SFI� , `� G H USE / � ` Prof Proms \\ `� ,�ProP�°d Dvwfia GRAVEL \ +r prop pj oposed pal .».»..»......... »..»»..... a \ Deok 1 \ cS> Sim � � i3RIVE �? OF \ A5 Reserve ' \ - ORAVEL DRIVE' 1�UDA77 N \ \ \ I �`. i i 41' W \ l ,Be --- __ __ _ -- -- RIGHT WAY) -- ---------- IC.KERSON DRIVE GRAVEL DRIVE p r _------- _-___ -- t Q o, � rn l i2' RIGHT OF -WAY \� / 118.00' m -2`B/DH Add 35 PAR 61 t \. \J CB/DH mod' '00 \ N87'78 "E eaovs aAnrmmi S8778'000W 152.00 \ GRAPHIC SCALE proposed SAS Trench \ Note: AM. 35 PAR so Remove all unsuitable material 5' around SAS 30 0 15 30 60 120 down to the "C" layer (.E1 93. 42) and replace with clean Design Data.• granular sand(__`� er 310 CMR 15.255 (3), (4), (5). Five Bedroom = 5 X 110 gpd = 550 gpd Required Flow (6). ( IN FEET ) an d (Increased Flow from 4 Bed to Five Bed) M� A14 NJ ��` i I�aa� i inch = 30 ft No Garbage Disposal Use: Chamber Trench 421 x 12.83'W x 2' Eff/Depth GENERAL CONSTRUCTION NOTES Site and Septic Plan of Land [42' f 42' f 12.83 f 12.83] x 2.0 = 219 (SAvo Ca/Dlsx 1. All the workmanshr;o and materials shall conform to D.E.P Title 5 42' x 10.83 = 538 RV and the Town of Barnstable rules and regulations for the subsurface Prepared For.• 757 x 0. 74 = 560 GPD Total Design Flow disposal of sewage. THE ARRIGHI RESIDENCE ►NCE, ( 2. At least one accesz port over tank tees shall be accessible Soil Logs l within 6" of finish grade. '►►��OFMASr���� Depicting Performed By S. Doyle 3. All components of the sanitary system shall be capable of ;oa�'�`Q�°`STERFOcy� THE PROPOSED DWELLING EXPANSION Date. 06 28 05 withstanding H-10 loading unless they are under or within 10 ft ssEPHEN a , AND SEPTIC SYSTEM UPGRADE Perc Rate: <2 Min/Inch (C ) of drives or parking. H 20 loading shall be used under or within i �' OpYLE ► P 11011 10 ft of drives or : In # parking unless noted. Plastic equals may be • � �� ? � �"� � ZIZ t, Massachusetts TH-I El. 97 0 0» TH--2 -- El 97-0 0„ used in lieu of all precast units ; °�_s ° 0�„4 A A 4. The excavatorontractor shall verify the location of all site ,"��� � ,, IOyr 312 10 3/2 u tili ties prior to any excavation, and shall be responsible for o 7 Ar_04� Scale: 1„ - 30 Date. July 14, 2005 SL 4„ SL 4» all matters relating to electric easements Prepared Bp. 5. Sewer pipes shall he 4" Schedule 40 PVC laid at a min. 0.02 slope. Stephen J Doyle and Associates "B" IOyr 314 "B" 1Oyr 314 6. Any masonry units used to bring covers to grade shall be ����or MAs 42 Canterbury lane, E. Falmouth, MA 02536 43 oa42) 43 p342) mortared in place. �yati s9 Telephone. 5081540-2534 "C" "C" 7 Finish grade shall :have a minimum slope of 0.02 ft per foot, �° WILLIi y� R� va� i cam► n ..8I c� MED MED p LIES MAAN TO 2.5Y 5/6 pew 46" 4s" 8. Should water service, connection be located closer than ten NO, s 1 ; TO 2.5Y 5 6 Pere V FINE FINE feet from sewage components, service line shall be set in PVC and SAND 132" 120"SAND pressure tested. { } 0 Uv No Water Encountered No Water Encountered El 86. 0' El. 87 D' 1 10120105 REVISE LAYOUT NO. DATE DESCRIPTION 36'-0" 4'-10" 7'-9" 2'-i 0 11'-i" 6'-0" 3,-6., A B � TEMPERED A4 TEMPERED TEMPERED B A4 B GLASS B B GLASS l3 GLASS >: 4:,/flyddui,'le/+`69r',?gili..r/f^`r,.e. `.f,eri..,/,/�,{,.+,,,..y'�b. ,:fi✓�'H„ ,/fii`9;,�°^f,.:,�r �i/.l'., - np WINDOW SEAT — —— — cl 'f u) 0 p CLOS SLOPED (� / CEILING 5'TUB! SHOWE r,. _ — _ — — 8°ac 68 — — — - - - —�g q�— — — — — — -- — — — — 2,6„x 69 BYPASS C,fl BATH 2,6.,x 6,8„ M ��l w �p . n r L DRY ��� U) r12'-5' co q i 0'-4" 3'-4" 73l-4!' 5'-7'" q w F—(� N.) � CO Cj 2'6'x 6 8 ire ED D W BEDROOM N o ` �ed o N o tir N A DN. f (VAULTED CEILING} q c� LOFT BOOK r t SHELVES DUCT C� �� CHASE c /� ►h SLOPED I J d` `�• 80 r /CEILING - - - - W.I.C. - - - - - - - - - - IF g A g B WINIJOW buHEDULE A4 A4 2'-10 11'-1.1 6'-91 -6 TYP3' ' ' •• MANUFAGTURER S UNIT ROUGH OPENING REMARKS 36'-0" 4 A ANDERSEN WDH 2446 2'-6 1/8" x 4'-9 1/4" WOODWRIGHT DOUBLEHUNG ,_,.•� ►---� B it ifWDH 24210 2'-6 1/8" X 3'-1 114" WOODWRIGHT DOUBLEHUNG SECOND FLOOR P' LAN NOTE:CONTRACTOR TO VERIFY ALL WINDOWS WITH OWNER AND ROUGH OPENINGS 6'0 WITH WINDOW MANUFACTURER PRIOR TL 36'-CC ORDERING '�`F L^JIIv�`v`vVS 4'-10 7'-9" 2'-10" 11'-1" 6'-0 3'-5' w B � b A DNr TEMPERED q A4 q q q q A4 O� GLASS . ;r, !:. • /✓,,,s,�,!:,o,?.,. ,.^�,✓�i c,.,..+r�r:.✓>. ...,,r/f.;�iy/„.P.:+✓a,;:. 7;..:;�..�rN.�Pirf/sr!+a!� ,r.,;i � �'\ r (VERIFY CABINET GENERAL NOTES: 5'TUB/ O LAYOUT W/OWNER) sHowE TH Q wETBAR A 1.) CONTRACTOR IS TO VERIFY ALL EXISTING CONDITIONS x !z & DIMENSIONS IN THE FIELD W PATIO co N s (BLUESTONE} 2.) CONTRACTOR TO VERIFY MATERIALS, DETAILS & /(y FINISHES IN THE FIELD WITH OWNER 9'-0" 1'-5' 2'-0 7'-4" INTERNAL r' SLIDING 3'6°x6'8" 3.) ROUGH OPENING HEAD HEIGHT OF WINDOWS AT TRUSTILE q y,,M�r��(�, 0 SCREENS FIRST FLOOR TO BE 6'-11" ABOVE SUBFLOOR W (VERIFY WI c 10'4' 3'-4" " 3'4' 2'-z' 16-2 OWNERS) 4.) VERIFY ALL PATIOS, STAIRS, RETAINING WALLS IN LIVING J, b THE FIELD W/ OWNERS 0 N (V q BOOK- N. UP /: SCALE : SHELVES LIBRARY BUILT-IN 3'6`'x L 1/4„ _ 10„ r- TRUSTIE to CABINET m e w s DATE F 11/7/2005 DUCT b co CHASE 7A h o FIRST FLOOR PLA JOB No. : c' BUILT-IN m ALD M CABINET cn �� .I FIRST FLOOR = 720 S.F. THE DESIGNER SHALL BE NOTIFIED IF ANY �i ,r,✓fy /yr�,f; ✓N�r r;:an ,.,., sr .,;,, fi,�ut,..., nsir.i rfo, rr,asx .r� Ai,,;/, .�rfF: 69<, fl ✓„r,F�: ;: ERRORS OR OMISSIONS ARE FOUND ON A TEMPERED q q TEMPERED SECOND FLOOR — 72O S.F. THESE DRAWINGS PRIOR TO START OF DRAWING NO. : A GLASS GLASS q q B CONSTRUCTION.THE BUILDING CONTRACTOR WILL BE RESPONSIBLE FOR THE CONTENT A41 A4 IN THESE DRAWINGS IF CONSTRUCTION 114*11 Q SMOKE DETECTOR COMMENCES WITHOUT NOTIFYING THE 4'-10 T-9 2'-10 11'-1" 6'-0 3'-5' DESIGNER OF ANY ERRORS OR OMISSIONS. THESE DRAWINGS ARE SOLELY FOR THE US� OF THE OWNER NOTED.ANY OTHER USE AF 36'-U' 6'-0" THESE DRAWINGS REQUIRES THE WRITTEN CONSENT OF THE DESIGNER. 36-9' 4'- ' -11" -10 2'-7" F FI—I (� Iliill � 4 UP I i I I I I I A4 B B B �41 cn 3'9'x 6,9' �� ,, •--THISWALLTO ;� 3'6"x&a, i BE INSULATED I TRUSTILE00 cy) o MECHANICAL/ FULL x ��� �a b PATIO b x I BASEMENT STORAGE N N (BLUESTONE) I (NOTE:MECHANICALLY VENT of I UP �� THIS SPACE PER MASS.STATE .a. Q- BLDG.CODE,APPENDIX"A') 3'6"x 6'8" — — to TRUSTILE io a r �'%s°�;s',."a"a'A+a.'"4",±,:�e; .;✓,��'�;,N6,f/,c,`f,+°� !",r;F!f"✓�roar.�,,✓,,.""�°:o✓y„�!,'/1.�9,`�i.✓Oi,,'✓J . ... 4., - .. • •B . c.A g A4 4'-8" 13'-4" ol BASEIMIENT PLAN 10'0 36'-(Y' 36-0 18'-0" - - - -- - - - - - - - - -- - - - - - - - - - - - - - - - -- -- - - (- C -_ 1 ( 10"CONC. FOUNDATION I A 10"CONC.FOUNDATION ( B WALL,(FULL HEIGHT) 8"CONC. RETAINING Tit A4 WAti; STZ 50 �I 5 3�` -Z-� YotiED EA-SLAB' ( A4 wIa'SHELF WALLS, (VERIFY HEIGHT I _ _ _ _ — —— _ — —_ _ _IN FIELD) I ( ^X FOTINGONC. O I I I I I I I ww I I I I I ►� ►.� I I I I 17/8"ENGINEERED FLOOR JOISTS 16'o.c. I � I I I 1 (Tar FULL i I PATIO I I ! BASEMENT I � i r� I i(4"CONC.SLAB) I I (4"CONC.SLAB) I I I I b o i I I �J �•� I I � w I I I I I � � �• I I � � � I I I I 2-1.75"x 11.875'1.9 E LVL III I J I-•-- 10"x 20"CONC. SCALE I I I I ] I FOOTINGS I y i i w I ` 1/4" = l,_0" I 11 I II I I I I I I DATE : I I I I I I 11/7/2005 N N ( I JOB NO. — a I ALD A B DRAWING NO. : A4 A4 10'-0 36'-0 � FouNuATION PLAN- CONT. RIDGE VENT 4 2 x 6's @ 15'o.c. PARALLAM RIDGEBEAM ABOVE TYPICAL ROOF CONST. BEDROOM/LAUNDRY TYPICAL ROOF CONST. .�( Z Q 1.2 x 10 RAFTERS @ 15'o.c. 11 b- , N 2. 1/2 CDX PLYWOOD SHEATHING Cn Q O 3.ASPHALT OR RED CEDAR ROOF SHINGLES n W 12 12 4. 15#FELT PAPER ` [� 5.9"(R=30)BATT. INSULATION @ FLAT CEILINGS ^ 10 10 6.8"(R=30)HIGH DENS. INSULATION @ SLOPED CEILINGS {•-•I �'" CD 7.2 x 12 RIDGE BOARD w Q� Q0 TYP. 1/2"GYP.BOARD 8.SIMPSON H 2.5 HURRICANE CLIPS AT ALL RAFTERS W 2 x 10's @ 16"o.c. 9. ICE/WATER SHIELD AT BOTTOM 3'0"OF ROOF I N6 ON 1 x 3 STRAPPING 10. PROP-A VENT VENTILATION CHUTE BETWEEN RAFTERS �„ a ST►z-h pPr Nv ^ TOP OF PLATE TOP OF PLATE w^ O � � 2-2 x 6 HEADER Lf) Cz co LOFT °° BATH BEDROOM CONT.ALUMINUM o b SOFFIT VENTS b (D ifl iy (p 2 x 4 STUDS @ 15'o.c.W/1/2"GYP.BD. TYP.3/4"T&G ch PLYWOOD SUBFLOOR, SECOND FLOOR co GLUED&NAILED SECOND FLOOR SUBFLOOR N SUBFLOOR 11 7/8"ENGINEERED JOISTS @ 16'o. ,5� Z 3D� TOP OF PLAT r--I 11 7/8"ENGINEERED JOISTS @ 15'o.c. TOP OF PLAT fNS I- -5N�l..v� . + ---TYP. WALL CONST. TEMPERED J J � GLASS Y2. YP. WALL CONST. 4" rJ 2x6 STUDS @15'o.c. cn j J 14 R @ 1/2"PLYWOOD SHEATHING 6"(R=19)BATT.INSULATION - f ----- I 8.08"t1/2"GYPSUM BOARD LIBRARY BATH co= LIVING r TYVEK VAPOR BARRIER I l_ ANDERSEN cn L (.0 TW 2446 �o I L TYP. P.T.3/4"T&G o � I L_ PLYWOOD SUBFLOO SEE WATER I u TABLE DETAIL--- SUBFLOOR R TABLE DETAIL I L SLUED&NAILED n N VTS Ip ' C FIRST R 11 7/8"ENGINEERED JOISTS @ 15'o.c. SS�+� 11 7/8"ENGINE RED JOISTS @ 15'o. . r- A x 4 SILL W/SEALER L 9"(R=30)BATT.INSU-LATION 4"SHELF rJ �►,*�S,tPE �^�AGti TYP. 10"CONC. r-J �'T r•� FOUND.WALLS 44 zo FULL _____ co ucZ --► MECHANICAL/ E-4 BASEMENT 2 s —raP �wt, STORAGE �+ W `'-1 DAMPPROOF FOUND.WALLS o L_ 4"CONC.SLAB ® �� 1 TOP OF SLARI TOP OF SLAW b TYP. 10"x 20"of tPE ,�X v 2" RIGID INSULATION(R=10) CONC. FOOTINGS w W/2x6KEY ~J e SECTION LIVING W w SECTION LIBRARY/ A4 A aC� BATH A4 W w O W.C. SHINGLES ---►i W.C.SHINGLES ►� l.f� LEAD FLASHING I LEAD FLASHING 1 BLOCKING— BLOCKING I SCALE : W.C.SHINGLES �� r �,, � n r rr W.C.SHINGLES / SHAPED OUT TO ! QJl�X b f �� 1/4 = 1 -0 SHAPED OUT TO FORM WATER TABLE 'aOL M FORM WATER TABLE 1 CLASSICAL CROWN CLASSICAL CROWN ° DATE : L, 1, 5 P-im t,v.D 11/7/2005 RED CEDAR CLAPBOARDS —► CONC.FOUND.WALL JOB NO. : ALD DRAWING NO. : WATER TABLE DETAIL WATER TABLE DETAIL SCALE: 1/2" = 1'-0" SCALE: 1/2" = 1'-0"