HomeMy WebLinkAbout0265 OLD OYSTER ROAD - Health 265 OLD OYSTER ROAD, COTUIT k
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UPC 10334
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
A Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
265 Old Oyster Road
Property Address
Hurbert Dambrosia and Sandra Dambrosia
Owner Owner's Name
information is required for every Cotuit Ma. 02635 06/10/2013
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 Mike Bisienere
use the return Name of Inspector
key.
Cape Septic Inspections
�y Company Name
624 Old Barnstable Road
Company Address
Mashpee Ma. 02649
City/Town State Zip Code
508-280-3356 S13938
Telephone Number License Number
B. Certification
I certify that I have personally inspected the sewage disposal system at this address and that the
information reported below is true, accurate and complete as of the time of the inspection. The inspection
was performed based on my training and experience in the proper function and maintenance of.on site
sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of
Title 5(310 CMR 15.000).The system:
® Passes ❑ Conditionally Passes ❑ Fails
❑ Needs Further Evaluation by the Local Approving Authority
06/11/2013
Inspector's Signature Date
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board
of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or
has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the
report to the appropriate regional office of the DEP. The original should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving authority.
****This report only describes conditions at the time of inspection and under the conditions of use
at that time.This inspection does not address how the system will perform in the future under
the same or different conditions of use.
t5ins•11/10 Title 5 Official Inspect nV:Suburface Sewage Disposal System•Page 1 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
265 Old Oyster Road
Property Address
Hurbert Dambrosia and Sandra Dambrosia
Owner Owner's Name
information is required for every Cotuit Ma. 02635 06/10/2013
page. Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E/always complete all of Section D
A) System Passes:
® 1 have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
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•11/10 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
•'' 265 Old Oyster Road
Property Address
Hurbert Dambrosia and Sandra Dambrosia
Owner Owners Name
information is required for every Cotuit Ma. 02635 06/10/2013
page. Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
B) System Conditionally Passes (cont.):
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ 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•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17
Commonwealth of Massachusetts
. Title 5 Official Inspection Fora
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
.�° 265 Old Oyster Road
Property Address
Hurbert Dambrosia and Sandra Dambrosia
Owner Owner's Name
information is required for every Cotuit Ma. 02635 06/10/2013
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
i
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
❑ ® 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
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17
Commonwealth of Massachusetts
a Title 5 Official Inspection Form
R s Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
265 Old Oyster Road
Property Address
Hurbert Dambrosia and Sandra Dambrosia
Owner Owners Name
information is required for every Cotuit Ma. 02635 06/10/2013
page. Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
Yes No
❑ ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well.
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory,for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered.A copy of the analysis
and chain of custody must be attached to this form.]
❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd-
10,000gpd.
❑ ® The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CM 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•11/10 Title 5 Official Inspection Farm:Subsurface Sewage Disposal System•Page 5 of 17
I
f
Commonwealth of Massachusetts
Title 5 Official Inspection Form
i; Subsurface Sewage Disposal System Form Not for Voluntary Assessments
265 Old Oyster Road
Property Address
Hurbert Dambrosia and Sandra Dambrosia
Owner Owner's Name
information is
required for every COtUIt Ma. 02635 06/10/2013
page. City/Town State Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate"yes" or"no"as to each of the following:
Yes No
❑ ® . Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
® ❑ Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
® ❑ Were as built plans of the system obtained and examined? (If they were not
available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
® ❑ Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
❑ ® Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS)on the site has
been determined based on:
® ❑ Existing information. For example, a plan at the Board of Health.
® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)] .
D. System Information
Residential Flow Conditions:
Number of bedrooms (design): , 3 Number of bedrooms (actual): 3
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):
>330
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17
Commonwealth of Massachusetts
U
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
265 Old Oyster Road
Property Address
Hurbert Dambrosia and Sandra Dambrosia
Owner Owner's Name
information is required for every Cotuit Ma. 02635 06/10/2013
page. Cityfrown State Zip Code Date of Inspection
D. System Information
Description:
Number of current residents: 2
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No
Laundry system inspected? ❑ Yes ❑ No
Seasonal use? ❑ Yes ❑ No
Water meter readings, if available(last 2 years usage(gpd)):
Detail:
Sump pump? ❑ Yes ® No
Last date of occupancy: occupied
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•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17
Commonwealth of Massachusetts
. Title 5 Official Inspection Form
s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
265 Old Oyster Road
Property Address
Hurbert Dambrosia and Sandra Dambrosia
Owner Owner's Name
information is required for every Cotuit Ma. 02635 06/10/2013
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Last date of occupancy/use: Date
Other(describe below):
General Information
Pumping Records:
Source of information:
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped: gallons
How was quantity pumped determined?
Reason for pumping:
Type of System:
® Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ . Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner) and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank. Attach a copy of the DEP approval:
❑ Other(describe):
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17
i
I
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
265 Old Oyster Road
Property Address
Hurbert Dambrosia and Sandra Dambrosia
Owner Owner's Name
information is COtUIt
required for every Ma. 02635 06/10/2013
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components, date installed (if known) and source of information:
Were sewage odors detected when arriving at the site? . ❑ Yes ® No
Building Sewer(locate on site plan):
18„ .
Depth below grade: feet
Material of construction:
❑ cast iron ®40 PVC ❑ other(explain):
Distance from private water supply well or suction line: feet
Comments(on condition of joints, venting, evidence of leakage, etc.):
Septic Tank(locate on site plan):
Depth below grade: 12"feet
Material of construction:
® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain)
If tank is metal, list age: years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
Dimensions: standard 1000 gallon
Sludge depth:
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
265 Old Oyster Road
Property Address
Hurbert Dambrosia and Sandra Dambrosia
Owner Owner's Name -
information is required for every Cotuit Ma. 02635 06/10/2013
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 38„
Scum thickness
Distance from top of scum to top of outlet tee or baffle
4"
Distance from bottom of scum to bottom of outlet tee or baffle
12"
How were dimensions determined? field instruments
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Grease Trap (locate on site plan):
Depth below grade: feet
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping: Date
15ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments.
265 Old Oyster Road
Property Address
Hurbert Dambrosia and Sandra Dambrosia
Owner Owner's Name
information is
required for every COtUIt Ma. 02635 06/10/2013
page. Cityfrown State Zip Code Date of Inspection
D. System Information (cont.)
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
265 Old Oyster Road
Property Address
Hurbert Dambrosia and Sandra Dambrosia
Owner Owner's Name
information is
required for every COtUIt Ma. 02635 06/'10/2013
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Distribution Box(if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert
0"
Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any
evidence of leakage into or out of box, etc.):
Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No
Alarms in working order: ❑ Yes ❑ No
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
t5ins•11/10 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
265 Old Oyster Road U d
Property Address ..
Hurbert Dambrosia and Sandra Dambrosia
Owner Owner's Name
information is required for every Cotuit Ma. 02635 06/10/2013
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Type:
® leaching pits number: one
❑ leaching chambers number:
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
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-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
s Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
265 Old Oyster Road
Property Address
Hurbert Dambrosia and Sandra Dambrosia
Owner Owner's Name
information is Cotuit Ma. 02635 06/10/2013
required for every
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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17
i
Commonwealth of Massachusetts
. Title 5 Official Inspection Fora
a
A Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
265 Old Oyster Road
Property Address
Hurbert Dambrosia and Sandra Dambrosia
Owner Owner's Name
information is required for every Cotuit Ma. 02635 06/10/2013 "
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to
at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate
where public water supply enters the building. Check one of the boxes below:
® hand-sketch in the area below
❑ drawing attached separately
Qr
3 .y .,.
/4 - Z - a06 �
L/0
A - 3 = any
� - 3 y9.
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17
' <LCommonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
•�' 265 Old Oyster Road
Property Address
Hurbert Dambrosia and Sandra Dambrosia
Owner Owner's Name
information is required for every Cotuit Ma. 02635 06/10/2013
page. City.rTown State Zip Code Date of Inspection
D. System Information (cont.) _
Site Exam:
® Check Slope
f'
® Surface water
® Check cellar ,
® Shallow wells
Estimated high depth to round water: 14 plus feet
p g g feet
Please indicate all methods used to determine the high ground water elevation:
❑ Obtained from system design plans on record _
If checked, date of design plan reviewed: Date
® Observed site(abutting property/observation hole within 150 feet of SAS)
❑ Checked with local Board of Health-explain:
❑ Checked with local excavators, installers-(attach.documentation)
❑ Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
I aguared a hole at a lower elevation and shot elevations with a transit.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17
Commonwealth of Massachusetts
MENMI
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
.�' 265 Old Oyster Road
Property Address
Hurbert Dambrosia and Sandra Dambrosia
Owner Owner's Name
information is required for every Cotuit Ma. 02635 06/10/2013
page. Cityrrown State Zip Code Date of Inspection
E. Report Completeness Checklist
® Inspection Summary: A, B, C, D, or E checked
® Inspection Summary D,(System Failure Criteria Applicable to All Systems)completed
® System Information— Estimated depth to high groundwater
® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
n
3 � '
JN
N � Hzv
t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17
DATE :1 /1 6/03_----
PROPERTY ADDRESS:265 Old Oxster Road
Cotuit,MaSS___ i1 ✓��d- '
-----------4Fi5------- U
On the above date, I inspected the septic system at the above addres
This system conslsts of the following: C
1 . 1 -1000 gallon septic tank.
2 . 1 -Distribution box. 14AV
3. 1 -1 000 gallon precast leaching pit. ( 6 'X1 0 ' )
Based on my inspection, I certify the following conditions: tiFg4 ti'�'�sr O�
4 . This is a title five septic system. ( 78 Code
5 . The septic system is in proper working order
at the present time.
6. House has had very little useage for .the past two years'.
SIGNATUR
Name : J . P . Macomber Jr .
Corripany:jq5pgh Son, Inc .
AddrQss :__@Qx _f_6 ............
-_C-e11SS'rYLLe,,_Na--QZ-632-0066
Ph one :__508- 775_ 3338 ----
THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY
10SEPH P. MACOMBER & SON, INC.
Tariks-Cesspools-Leach(lelds
Pumped & Installed
Town Sewer Connectlons
P.O. Box 66 Centerville, MA 02632.0066
775.3338 775.6412
,per r
�-\ COMMONWEALTH OF MA.SSACHUSETTS
= EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
r
i
TITLE 5
OFFICIAL INSPECTION FORM-NOT FOR,VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address:265 Old Oyster Road
Cottlit 'Macs_
Owner's Name: Tng3 T.11nr9bprg
Owner's Address:SamA
1
Date of Inspection: _1 /16/0 3
Name of Inspector: (please print)Joseph P.Macomber Jr.
Company Namej_ p_MArc)mhPr & Son Inc
Mailing Address 66
C 2632
Telephone Number: E;68-77-- 3*P
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
traiping 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:
/ asses
Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
Fails
Inspector's Signature: A � Date:
'
The system inspectors ubmit 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
j �•*"This report only describes conditions at the time of inspection and under the conditions of use afthat
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 I 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 265 Old Oyster Road
Cntu; t ,Mass
Owner: Tnn T.iinAhPrg
Date of Inspection: 1 /1 6/0 3
Inspectlon Summary: Check A,B,C,D or E/AL=complete all of Section D
A. Syste-. P.Zes: „
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:
m is in orpper working order at the
B. System Conditionally Passes:
Vb One or more system components as describcd in the"Conditional Pass"section need to be replaced or
repaired. The system, upon completion of the replacement or repair,as approved by the Board of Health, will pass.
Answer yes,no or not determined(Y,N,ND) in the for the following statemen
explain. ts. If"not determined"please
NO 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.
ID explain:
.1Lb Observation of sewage backup or break out or high static water level in the distribution box due to broken or
obstructed Pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection-if(with
approval of Board of Health):
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
ND explain:
��► The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will
pass inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
ND explain: ,
2
Page 3 of I I
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
PropeM Address: 265 Old Oyster Road
Owner:
Date of lospectioo:1
C. Further Eyaluatioo is Required by the Board of Health:
AJP 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.
I. S+stem will pass unless Board of Health determines In accordance with 310 CMR I5.303(l)(b) that the
system is not functioning in a manner wbich will protect public bealtb, safety and the environment:
,tfd 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. S,N stem will fail unless the Board of Health (and Public Water Supplier, if any) determines that the
system is functioning in a manner that protects the public health,safety and environment:
The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a
surface water supply or rributary to a surface water supply.
The system has a septic tank and SAS and the SAS is within a Zone I of a public water supple
i
/VQ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well.
All) The system has a septic tank and SAS and the SAS is less than 100 feel but 0 feet or more from a
pn�ate %�ater supple well�� Method used to determine distance
"This s\stem passes if the well water analysis, performed at a DEP certified laboratory, for coliform
bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and
the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other
failure criteria are triggered. A copy of the analysis must be anaehed to this form.
3. Other:
3
Page 4 of I 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 265 Old Oyster Road
Cotuit,Mass .
Owner:Iga Lundberg
Date of Inspection: 1 /1 6/BI
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or"no"to each of the following for all inspections:
Yes J
/�ackup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
3Discharge 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 , I-AA-140v 611 o)
Liquid depth'in se9spGQ4 is less than 6"below invert or available volume is less than ''A day flow
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number
of times pumped a
/
Any portion of the SAS,cesspool or privy is below high ground water elevation.
7ZAny portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
/ water supply.
y Any portion of a cesspool or privy is within a Zone 1 of a public well.
_ Any portion of a cesspool or privy is within 50 feet of a private water supply well.
7�Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water
supply well with no acceptable water quality analysis. [This system passes if the well water analysis,
performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds
indicates that the well is free from pollution from that facility and the presence of ammonia
nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria
are triggered. A copy of the analysis must be attached to this form.]
(Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as
described in 310 CMR 15.303.therefore the system fails. The system owner should contact the Board of
Health to determine what will be necessary to correct the failure.
E. Large Systems:
To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000
gPd.
You must indicate either"yes"or"no"to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
yes no J
the system is within 400 feet of a surface drinking water supply
V
e system is within 200 feet of a tributary.to a surface drinking water supply
•
the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped
Zone 11 of a public water supply well
If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered
"yes" in Section D above the large system has failed.The owner or operator of any large system considered a
significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR
15.304. The system owner should contact the appropriate regional office of the Department.
4
Page 5 of I 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 265 Old Oyster Road
Cotuit,Mass.
Owner: Tnqa T.tindbercr
Date of Inspection: 1 1 1 ti r()1
Check if the following have been done. Yod must indicate"yes"or"no"as to each of the following:
Yes No
-zPumping information was provided by the owner,occupant,or Board of Health
_zWere any of the system components pumped out in the previous two weeks
_/Has the system received normal flows in the previous two week period?
21-lave large volumes of water been introduced to the system recently or as part of this inspection ?
Z_ Were as built plans of the system obtained and examined?(If they were not available note as N/A)
-Z_ Was the facility or dwelling inspected for signs of sewage back up?
Y _ Was the site inspected for signs of break out?
Were all system components,�luding the SAS,located on site?
Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition
of tl ee baffles or tees, material of construction,dimensions,depth of liquid,depth of sludge and depth of scum ?
47 _ Was the facility owner(and occupants if different from owner)provided with information on the proper
maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS)on the site has been determined based on:
Yes no /
� Existing information. For example,a plan at the Board of Health.
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 I5.302(3)(b)]
it
S
Page 6 of I 1
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address:265 Old Oyster Road
Cotuit,Mass.
Ownergnga Lundberg
Date of Inspection: 1
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): Number of bedrooms(actual):
DESIGN Flow based on 310 CMR 15.203 (for example: 1 10 gpd x N of bedrooms): =All
Number of current residents: '—
Does residence have a garbage grinder(yes or no):&O
Is laundry on a separate sewage systems or no):�� [if yes separate inspection required]
Laundry system inspected (yes or no):
Seasonal use: (yes or no):
Water meter readings, if available (last 2 years usage (gpd)):2001 —1 0, 000 gal lops=27. 40 GPD
Sump pump (yes or no): AM 2002-22, 000 Gallons=60. 28 GPD
Last date of occupancy:
COMMERCIAUINDUSTRIAL
Type of establishment:
Design Flow (based on 310 CMR 15.203): gpd
Basis of design flow(seats/persons/sgft,etc.):
Grease trap present (yes or no): v_14
Industrial waste holding tank present(yes or no):,f1,/�
Non-sanitary waste discharged to the Title 5 system (yes or no):4*
Water meter readings, if available:
Last date of occupancy/use:
OTI4ER(describe):
GENERAL INFORMATION
Pumping Records
Source of information:
Was system pumped as part of the inspection (yes or no): _
If yes, volume pumped: !f_gallons -- How was quantity pumped determined? its
Reason for pumping: d2A
TY E OF SYSTEM
,diSeptic tank, distribution box, soil absorption system
Single cesspool
,(2y) Overflow cesspool
/1J 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 systeW owner)
Tight tank Attach a copy of the DEP approval
/UU Other(describe): /lJ�
Approximat age of all components, date installed (if known) and source of information:
Were sewage odors detected when arriving at the site (yes or no):le�j
6
Page 7 of 1 I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: _265 Old Oyster Road
rni-Ili 1- ,M;; _
Owner.Incra Lundberg
Date of Inspection:
BUILDING SEWER(locate on site plan)
4" lite weieght PVC pipe
Depth below grade: Seh. 35
Materials of construction:_cast 'iron .4 40 PVC ✓other(explain):
Distance from private water supply well or suction line:/B't'
Comments(on condition of joints, venting, evidence of leaka e,etc.):
Joints appear tight.No evidence oy leakage.The system is
vented through the house vents.
SEPTIC TANK:2(locate on site plan)
Depth below grade: /%I�1
Material of construction: concrete•fJd metal.�/UfiberglassLf olyethylene
��other explain)
If tank is metal list age:4p Is age confirmed by a Certificate of Compliance(yes or no)4�O (attach a copy of
certificate) �" 1
Dimensions: OLb-,04 �/}�11 �i , ��7��1 A
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 bonom of outlet tee or baffle:
How,were dimensions determined: AD�/1L1JJ'
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels
0as related to outlet invert,evidence of leakage,etc.):
Pump the septic tank every 2-3 .years. Inlet & outlet tees are in
place.The tank is structurally sound and shows no evidence
ce o�
of leakage. Liquid level at the outlet invert is 51
GREASE TRAPlocate on site plan)
Depth below grade:,
Material construction:F1concrety meta40 fiberglas�polyethylene�Qi other
(explain):: ,
Dimensions: 114
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bonom of scum to bonom of outlet tee or baffle:
Date of last pumping: 1-)A
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,liquid levels
as related to outlet invert,evidence of leakage,etc.):
tirease trap is not present
7
Page 8 of 1 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 265 Old nystPr Road
GOtu}tTMass.
Owner:Inga Lundb g
Date of Inspection: 1 j 1 ti j fl'1
TIGHT or HOLDING TANKA /4"must be pumped at time of inspection)(locate on site plan)
Depth below grade: X69
Material of construction:A concrete meta l,1&!tfiberglass,4.0polyethylene f other(explain):
Dimensions:
Capacity: 140 eallons
Design Flow: gallons/day,
Alarm present(yes or no): 1
Alarm level: /I d Alarm in working order(yes or no): �lQ
Date of last pumping:-,d2d-
Comments(condition of alarm and,float switches,etc.):
Ti qhf nr hnl rjinq tanks arP not i rPcarf
DISTRIBUTION BOX:Zif present must be opened)(locate on site plan)
Depth of liquid level above outlet invert: .(»
Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of
leakage into or out of box, etc.):'
Ili$$-t-ri huti nn hnx has nnP 1 AtPral Nn Pvi dPnr ,P of sot i ds rarry over.
No -evidPnrp of 1PakagP intn or nut of the hnx
PUMP CHAMBETWzWe,(locate on site plan)
Pumps in working order(yes or no):N
Alarms in working order(yes or no);NZ,_
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):
Pump chamber is not present
8
a
Page 9 of.11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 265 Old Oyster Road
rr)t11i t 'Mass
Owner:T-nga T,una•iherg
Date of Inspection:
SOIL ABSORPTION SYSTEM (SAS): ;7(locate on site plan,excavation not required)
1 -1000 gallon precast leaching pit. ( 6 ' X10 ' )
If SAS not located explain why:
Located- See page 10
T�s eaching pits, number:
I
eaching chambers, number: O
leaching galleries,number:
leaching trenches,number, length:
leaching fields,number,dimen ions: C9
Afoverflow cesspool,number:
irutovative/alternative system Type/name of technolo :%�' G A'-O L
Comments(note condition of soil, signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,
etc.):
Loamy sand to medium fine sand.No signs of hydraulic failure
or ponding.Soils are ry. ege a ion is normal.waste water is
58" to the invert pipe.There is no visible stain line.
I
CESSPOOL e,(cesspool must be pumped as part of inspection)(locate on site plan)
Numbet and configuration:
Depth—top of liquid to inlet invert:
Depth of solids layer:
Depth of scum laver:
Dimensions of cesspool:
Materials of construction:
Indication of groundwater inflow(yes or no):
Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.):
C esspocil s are not present
PRIVWy/e, (locate on site plan)
Materials of construction:
Dimensions:
Depth of solids:
Comments(note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation, etc.):
Privy is not present
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: 265 Old nystPr Road
C'ntni t�Macc .
Owner:Inga LundbercL
Date of Inspection: 1 /1 6/0 3
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or
benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building.
ZGg old Oyer c�� �o�,,,'k
WArfR
/56'
/
10
Page I I of I 1
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:265 Old Oyster Road
Cni-ni t Marc
Owner:-Tnga Lundberg
Date of Inspection: _1 /16/01
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water t feet
Please indicate (check)all methods used to determine the high ground water elevation:
UU L Obtained from system design plans on record-if checked,date of design plan reviewed:N A
y_ S Observed site(abutting property/observation hole within 150 feet of SAS)
ts�Q_ Checked with local Board of Health-explain:
Y_P�rsChecked with local excavators, installers-(attach documentation)
�F,,S Accessed USGS database-explain:httA: //town,barns tab le.ma.us.
You must describe how you established the high ground water elevation:
sed: Gahrety & Miller Model. 12/16/94 Ground water elevations above
sea level _
Sed: USGS- Observation well r3af a Time 1907
Sed: USG2_ - ettiA 99-QQQ-1 Plate fi? Annual ranges of ground
water elevations. January 1992
:Leaching
96 �l
Pit J�.eet
l
Groundwater: t•eet Below Bottom of Pit High Groundwater Adjustment 1.8 ft per Frimpter Method
Therefore, the vertical separation distance between the bottgm�
of the leaching pit and the adjusted groundwater table is
feet.
1!
>•Arnert-ntrlrT-rnrmr•mn111Tnlsttre*.nr.T7lrsr►rtnr*+.+Rn rt*ra�it�atAT TR`T1•T-7-•n-:..--,r•t.
TOWN OF Rarnstabl a WARD OF 11EALTII
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPRCTION FORM - PART D - CERTIFICATION I«•TT•t«T••. t:t�ttt7.«.�TT.T T.TIT.TlITn►1R7f111'f11TT.r«R•i r1lRRlt 71T1T1't�f art AT .Tt1•T'T•1r•�..A
-TYPE OR PRINT CI.EARLY-
PROPERTY INSPECTED
STREET ADDRESS 265 Old Oyster Road Cotuit,Mass
ASSESSORS MAP, BLOCK AND PARCEL # 021 -082
OWNER' s NAME Incra Lundliercr
PART D - CERTIFICATION r
NAME OF INSPECTOR Joseph P.Macomber Jr.
COMPANY NAME J P Macomber & Soin Inr` '
COMPANY ADDRESS Box 66 Centerville,Mass. 02632
Street Town or City state lip
COMPANY TELEPHONE ( 508 ) 775 -3338 FAX ( 508 ) 790 - 1578
>z
CERTIFICATION STATEMENT
0I certify that I have personally inspected the sewage disposa'1 system at
this address and that the information reported is true , accurate , and
omplete as of the time of ,inspection . The inspection was performed and any
recommendations regarding upgrade , maintenance , and repair are consistent
with my training and experience in the proper function and maintenance of on-
site sewage disposal systems .
Check one: t
' dJ System PASSED r
The inspection which I have conducted has not found any information
which indicates that the system fails to adequately protect public
health or t)Ie environment as defined in 310 CMR 16 . 303 . Any failure
criteria not evaluated are as stated in the FAILURE CRITERIA section of
this form.
System FAILED*
The inspection which I have con toted has found that the system fails to
Protect the public health and the environment in accordance with Title
.5 , 310 CMR 15 . 303 , and as specifically noted on PART C - FAILURE
CRITERIA of this inspection form .
Inspector Signature Al. ldlDate
ne copy of this c ification must be provided to the OWNER, the BUYER
( where applicable ) and the BOARD OF HEAL1'II.
* If the inspection FAILED, the owner or"roperator shall u d
within one year of the date of the inspection, unless allowed ortrequiredm
otherwise as provided in 3.10 ChIR 16 , 306 .
partd.doc -
FILE#MIP 29794 CENSUS TRACT# 132
CLIENT: DUNNING&KIRRANE, L.L.P. DEED BOOK 9677 PAGE 193
NGA M. PLAN 1900K 271 PAGE 5V LOT 4
APPLICANT: HUBERT A.&SANDRA M. D'AMBROSIA ASSESSORS PLAN 021 PLOT 082
(MORTGAGE INSPECTION PLAN OF LAN 1
(LOCATED AT
265 OLD OYSTER ROAD
BARNSTABLE, MASSACHUSETTS
SCALE: 1"=50' February 24, 2003
�T 46
4+o MIN
•��4
y'8�
LOT 42 X�� s,,,,�
^ � o CRAwFoRD
N
f�D f o 1%asrr 14.o I l a:l0
s
OLD . OYSTER "AD
I CERTIFY TO: DUNNING&KIRRANE, L.L.P., CAPE COD BANK&TRUST COMPANY,N.A., AND ITS TITL
INSURANCE COMPANY,THAT THERE ARE NO VISIBLE ENCROACHMENTS OR EASEMENTS EXCEPT A
SHOWN AND THAT THIS PLAN WAS PREPARED UNDER MY IMMEDIATE SUPERVISION.
THE LOCATION OF THE DWELLING AS SHOWN HEREON IS
IN COMPLIANCE WITH THE LOCAL APPLICABLE ZONING OF�e
BY-LAWS WITH RESPECT TO HORIZONTAL DIMENSIONAL
REQUIREMENTS.
THE DWELLING SHOWN HERE DOES NOT FALL WITHIN'
A SPECIAL FLOOD HAZARD ZONE AS DELINEATED ON A
G
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J
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I
r BORTOLOTTI CONSTRUCTION, INC.
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
Address Prop
_ . -
Date of Ins c _ Ma Parcel Owner
PART A — CHECKLIST
CHECK IF THE FOLLOWING HAVE BEEN DONE:
PUMPING INFORMATION WAS REQUESTED OF THE OWNER,OCCUPANT,AND 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 COLUMES OF WATER HAVE NOT BEEN INTRODUCED INTO
THE SYSTEM RECENTLY OR AS PART OF THIS INSPECTION.
l AS—BUILT PLANS HAVE BEEN OBTAINED AND EXAMINED. NOTE IF THEY APE NOT AVAILABLE WITH N,A.
THE FACILITY OR DWELLING WAS INSPECTED FOR SIGNS OF SEWAGE BACK—UP.
THE SITE WAS INSPECTED FOR SIGNS OF BREAKOUT.
i,. ALL SYSTEM COMPONENTS,EXCLUDING THE SAS,HAVE BEEN LOCATED ON THE SITE.
v 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 SAS ON THE SITE HAS BEEN DETERMINED BASED ON EXISTING INFORMATION OR
APPROXIMATED BY NON—INTRUSIVE METHODS.
__C-__THE FACILITY OWNER(AND OCCUPANTS,IF DIFFERENT FROM OWNER)WERE PROVIDED WITH INFORMATION ON THE PROPER
MAINTENANCE OF SSDS.
PART B — SYSTEM INFORMATION
_RESIDE_NTIAL FLOW CONDITIONS.
No of Bedrooms 2 _No of Current Residents Garbage Grinder
y^S Laundry Connected to System Use
NON RESIDENTIAL:
Calculated tlow
WATER METER READINGS,IF AVAILABLE:
___ __ ____ _ I GALLONS
Pumping Records and Source of Information:----------------- ---,----------- ------—/�----- — -- ---
SYSTEM PUMPED AS PART OF INSPECTION? IF YES,VOLUME PUMPED = _ _GALS
Reason for Pumping:
TYPE OF SYSTEM:
_Septic tank/distribution box/soil absorption system
Single Cesspool Overflow Cesspool -----Privy
Shared system (if yes, attach previous inspection records, if any)
Other(explain)
Appr ximate age of all components. Date installed,if known. Source of information.
a���_
SEWAGE ODORS DETECTED WHEN ARRIVING AT THE SITE? /A/
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
r
PART B — SYSTEM INFORMATION (Continued)
SEPTIC TANK:
Depth below grade: Dimenslons'F "1� X , / -5-
iVlaterial of construction: Concrete Metal FRP Other}
Sludge Depth 6 e Distance from top of sludge to bottom of outlet tee or baffle
Scum Thickness/O/� Distance from Top of Scum to top of outlet tee or baffle
Distance from bottom of Scum to bottom of outlet tee or baffle
Com . : ;i5 Q /000
DISTRIBUTION BOX: V DEPTH OF LIQUID LEVEL A13O_VE_OUTLET INVERT_
Comments;, -/'
PUMP CHAMBER: Pumps in working order?
Comments:
SOIL ABSORPTION—SYSTEM—(SAS):
IF NOT PRESENT,EXPLAIN: /
TYPE: — 1006
Comments:
CESSPOOLS: Q Number and configuration
Depth-top of liquid to inlet invert Depth of solids layer Depth of scum layer
Dimension of cesspool Materials of construction
Indication of groundwater inflow(cesspool must be pumped)
Comments:
PRIVY:
Materials of construction
Dimensions Depth of solids
Comments:
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B — SYSTEM INFORMATION (Continued)
SKETCH OF SEWAGE DISPOSAL SYSTEM:
INCLUDE TIES TO AT LEAST TWO PERMANENT REFERENCES, LANDMARKS OR BENCHMARKS.
LOCATE ALL WELLS WITHIN 100'
Or 06GSt-
0
DEPTH TO GROUNDWATER: DEPTH TO GROUNDWATER
METHOD OF DETERMINATION OR APPROXIMATION:
io a I1'reof f-r S A 'l- 4c M(Jal- ep�o
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C — FAILURE CRITERIA
(Indicate Y—yes N—no ND—not determined.Describe basis of determination.If"not determined",explain why not.)
Backup of Sewage into Facility?
Discharge or ponding of effluent to the surface of the ground or surface waters?
/Static liquid level in the districution box above outlet invert?
Liquid depth in cesspool, 6"below invert or available volume, 1/2 day flow?
/y Required pumping 4 times or more in the last year? Number of times pumped
Septic tank is metal?cracked?structurally unsound?substantial infiltration?substantial exfiltration?
tank failure imminent?
Is any portion of the SAS,cesspool or privy, below the high groundwater elevation?
Within 50 feet of a surface water?
I Within 100 feet of a surface water supply or tributary to a surface water supply?
Within a Zone I of a public well?
IV Within 50 feet of a private water supply well?
,/,Y// Within 50 feet of a bordering vegetated wetland or salt marsh (cesspools&privies only, not the SAS)?
_,Al—__ 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,amonia nitrogen and nitrate nitrogen.
PART D — CERTIFICATION
INSPECTOR: ROBERT J. BORTOLOTTI ADDRESS: 765 WAKEBY ROAD, MARSTONS MILLS
COMPANY: BORTOLOTTI CONSTRUCTION INC. MA 02648 (508)771-9399
CERTIFICATION STATEMENT
I CERTIFY THAT I HAVE PERSONALLY INSPECTED THE SEWAGE DISPOSAL SYSTEM AT THIS ADDRESS AND THAT THE INFORMATION
REPORTED IS TRUE,ACCURATE AND COMPLETE AS OF THE TIME OF INSPECTION. THE INSPECTION WAS PERFORMED AND ANY
RECOMMENDATION REGARDING UPGRADE,MAINTENANCE AND REPAIR ARE CONSISTENT WITH MY TRAINING AND EXPERIENCE
IN THE PROPER FUNCTION AND MAINTENANCE OF ON—SFFE SEWAGE DISPOSAL SYSTEMS.
CHECK ON :
I HAVE NOT FOUND ANY INFORMATION WHICH INDICATES THAT THE SYSTEM FAILS TO ADEQUATELY PROTECT PUBLIC
HEALTH OR THE ENVIRONMENT AS DEFINED IN 310 CMF 15.303. ANY FAILURE CRITERIA NOT EVALUATED ARE AS
STATED IN THE"FAILURE CRITERIA"SECTION OF THIS FORM.
I HAVE DETERMINED THAT THE SYSTEM FAILS TO PROTECT PUBLIC HEALTH AND THE ENVIRONMENT AS DEFINED IN
310 CMR 15.303. THE BASIS FOR THIS DETERMINATION IS PROVIDED IN THE"FAILURE CRITERIA"SECTION OF THIS
FORM.
INSPECTOR'S SIGNATURE:
DATE: Q�
ORIGINAL TO SYSTEM OWNER,COPIES:BUYER(if applicable),APPROVING AUTHORITY
�CEV o
1 Mq y � 6 1995
�
If
/ , I Kitchen
I / I
I / Step down
GARAGE/ - _ - - -
12'-6"i21''-4"—
Step down
� I
Usiing flat ceiling � I
C)
- - -
- - - - - - - - - -_- - - - - - - -
�✓ S ICE I C
C) o
JAM Asb"
bo
�' y (2✓�C`1/'- I —Vaulted ceiling '�•�,/ I 'r�
--
�,,� -4-Q S ee4 ` Unheated 3-Seasons Room
t 13 e 12'-2 3/4" Addition Floor Plan
Home.Improvement Specialists Sandra & Hugi D'Ambrosia Page # 1
25 lyanough Road Hyannis, MA 02601 265 Old Oyster Road
508-775-2815 Cotuit, Ma. 02635 Date: 4l12l2004
SEWAGE INSPECTIONS
31
1.0"A7izN 265 Old Oyster Road DATE 1 /1 6/03
VT?,..AGE Cotuit,Mass. ASSESSOR'S MAP & LOT 021 -0 8 2
-I" SF-ECTOR Joseph P.Macomber Jr.
SEPTIC TANK CAPACITY 1 000 gallons
LEACHING FACILrN: (type) 1 =LP-1 000 (siZ6 ,X1 0 '
NO. OF BEDROOMS 3
BUILDER OR OWNER Tnga Lunc9berg
OWNER MAILING ADDRESS
Tina Plount
385 South Avenue 1 -203-972-3626
New Canaan, Conn. 06840
vJA7FR '
l
IP
L0C'ATI0)1 _SEW GE PERMIT NO.
VILLAGE
z P
INSTA LLE -S NAM j ADDRESS
Z4�- C-o/c
BUILDERR--�MIFN-
DATE PERMIT ISSUED 4_ 9 - gam
ODATE COMPLIANCE ISSUED
r
��
?;
�O� �� ��
i
�o
I
��\
O
��
` �on
• No. 3 _
THE COMMONWEALTH OF MASSACHUSETTS
4.
BOAR® OF HEALTH
6 11 D0v r® 1 ..............oF....... litST D...............................
Applira#iou for Dispaii al Vork,5 Tonstrurtinn ramit
Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal
System at: l
d —tom.----- 6
--------------------------------------'--
Lo9ndress oar Lot�N1 lie! _7 COk \k
caner ....................Address
a -•--••--•............... + .lz....I-staller ---... ......................
Installer � Address
� Type of Building Size Lot_. __45�.....S q. feet
�-, Dwelling—No. of Bedrooms..........Z.............................Expansion Attic ( ) Garbage Grinder ( )
'4 Other—Type T e of Building ............... No. of ersons.....__._.__................ Showers
Ga YP g ------------- P ( ) — Cafeteria ( )
a' Other fixtures ......................................................
-------•-----••------------
W Design Flow.......................................................................gallons per person per r day. Total gaily flower�``�®__=._. 30......Olons.
WSeptic Tank—Liquid capacity% allons Length_8-.S`__- Width._..._...!_. Diameter................ Depth_..._..I�...
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No.._.____-_.______--- Diameter.._...!a....... Depth below inlet...5-§�....... Total leaching area..2 S f.....sq. ft.
Z Other Distribution box ()C,) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. 1.. -_...minutes per inch Depth of Test Pit.....1.Z-a........ Depth to ground water. -...._
f? Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.�._...�Q
-----------------------------•-- --•-•--•--•-•----•--•..t...........--......... ...----
O Description of Soil......................... .'_ 4?....____.l.s --.�---�b...��
----------------------------------------------------------------•---
wx ...................................................... ..`3`-" ,_..-- �i,-"-c ,s - � �? ---------------------•------------
V Nature of Repairs or Alterations—Answer when applicable...............................................................................................
1P _.
..------•---------------------------------•--•---•---------•--------•--......----------•-...----••------...-----------------------------------------•--•--------------•------•-••-•-••-•-•-----------•--
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of iITLij 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
ned� nL�fi ............. DL
.
'/*i pproved BY-----------------------------•----••--........ = `!/(�` -, -
Date
Application Disapproved for the following reasons---------------------•------••---------------------------------•----------------------------•••-•------...._.....
--------'••---------•-•---•-----------------•-------------------•---------•----------••---...------....--.-----•----•---•--•------•--------•-----•-•------•-----•--•-----•-------•------------•••--••----
Date
PermitNo......................................................... Issued.......................................................
Date
FEB.. .
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF 6-1'EALTE-1 ;
Appliraiinn for DiopnoFal Works Tnni#rurtion Prrutit
Applr6iiori'is hereby made for a Permit to Construct ( ) or Repair ( .') an Individual Sewage Disposal
System at:
_ Location-Alldress
�o,-r,Lot No,
W 6a ner Address
a ••-•.....•--•-••...........................•-•...........--•---••-_..._....._........__........._ -----•....--•••...-••-----•---.........._...______--•....•-•--•'••-............________......---
Installer Address
d . Type of Building Size Lot_.Z- .,_ 5 ...__Sq. feet
a Dwelling—No. of Bedrooms........... Ex ansion Attic ( ) : ' Garbage Grinder ( )
aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
dOther fixtures -= ..............................-...........................................................
w Design Flow.......... ._________. ;_gallons per person per day. Total daily a Q.......gallons.
WSeptic Tank—Liquid capacityxi N=--galions Length.`!".. Width_4__}-�_. Diameter________________ Depth_5 __c7+�'_ _-
x Disposal Trench—No_____________________ Width.................... Total Length.................... Total leaching area....................sq. ft.
�y Seepage Pit No--------.!----------- Diameter......!SD........ Depth below inlet___.:_?_........ Total leaching ar'ea_J�;a_A......sq. ft.
Z Other Distribution box (),( ) Dosing,tank ( )
Percolation Test Results Performed by........ Date........................................
Test Pit No. 1_';__�,____minutes per inch Depth of Test Pit----!..Z,-__________ Depth to ground water_ +`=_______-
r=, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground
Description of Soil-----------•--•-••---•--•_J=" �' ,R•-----.!_ (� __ � '�i. •--•-
U -•-----------•--•---•--•-••--•••------•-------•----- , c� - + .1...'._.._ 5. ` \_...C�� .a -aft,-- t
w
UNature of Repairs or Alterations—Answer when applicable----------------------------------_............................................................
........................... = •-----------------•--------•--•-----•---•--•-------•---•-------------------------••------------------------------------------•-----------•-------•-•
Agreement
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITIE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has beenrissued by the board of health.
Lned d. 4 - A ------ --• ---A lication roved B _.
P PP Y `r _ � l�
--•-•-•-••-- Date
Application Disapproved for the following reasons:..........................................................................................._.....................
.......................•-•--•--•-•----•-•-•----...••-----•-•••-••••-....-•---•------•--•--...-•-._...__...--•--••-•-•--•-••••-----•---••-•--•••••...-•-•••••----•--•-••••••--•--•----•---•--•-----....-•-
Date
PermitNo................... =------------•--•-----•------------• Issued_.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
''
.................O F.....................................................................................
Trtlfiraty of TompliFaurr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (se•) or-Repaired ( )
bY----------------------------!!�lr z I� E
60 c wt�4 ll/'
-••-- •---....--•----••--------•--•-•----------•--...•---•-----••-•---------------------------•-------------------.........---------..____......_..._--•---•.•----
Installer
at....t__40 A3........0_4,4.-----Q.,e
has been installed in accordance with the.provisions of TITLE 7
p 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No,___ 1", _________________ dated_ --_
THE ISSUANCE OF IRIS CERTIFICATE SHALL NOT BE CO TRUED AS A is ARA�_TEE THAT THE
SYSTEM WI 'L FUNCTION SATISFACTORY.
,� Z� -��
DATE............
....... .:......................................••-••-------..._...._----_. Inspector ...... •-
t 1t'
THE COMMONWEALTH OF MASSACHUSETTS
BC3ARD -OF„tiHEALTH
NoW ........................... ®F FEE.4L"
park Tonstrriun rrutii f' a
Permission'is hereby granted........ «:...: .�M:!�_F! ______________ _
to Construct ( ) or,Repair ( ) an Individual Sewage ,Disposal System f
at No A f.3......... < SZ_X.?.........Akrt f r`r.�fi '� i •�..............................•-
Street
s shown on the application'for Disposal Works Construction .Permit No. d.! I___ ;Dated. t t
4 -' ----•..... ---• - ----............................................................
Board of Health`
DATE �' " •. a _ .
k,
FORM Y1255 A. M. SUL _N, I it'.. BOSS TON
� I
a ba c)td 0��e
".............
.CIA ............
(w, ('',............
"00
-3
NOTES:
24'-5'
1.) CONTRACTOR IS TO VERIFY ALL EXISTING CONDITIONS
17-8" 3'-3•• s•a" - &DIMENSIONS IN THE FIELD
2.) CONTRACTOR TO VERIFY ALL INTERIOR&EXTERIOR MATERIALS,
DETAILS,&FINISHES IN THE FIELD WITH OWNER
A3 A3 3.) ROUGH OPENING HEAD HEIGHT OF WINDOWS AT
HARVEY HARVEY FIRST FLOOR TO BE 6-10"ABOVE SUBFLOOR
21052 21052 0 - 4.) ALL CONSTRUCTION TO CONFORM TO 780 CMR MASSACHUSETTS
STATE BUILDING CODE,8TH EDITION AMENDEMENT&IRC2009
f 5.) 110 MPH EXPOSURE B WIND ZONE
CLOS. HARVEY
6.) -ALL SHEETS OF PLYWOOD WALL SHEATHING TO BE INSTALLED VERTICALLY,
I 24"x30 OR HORIZONTALLY W/BLOCKING AT EDGES,3"EDGE/12"FIELD NAILING
4 110•A• 1 7.) ALL LVL LUMBER/BEAMS TO BE 1.9e L/360 LOAD
m 1 ATTIC I1 1 0
IACCES� 2'6"x68•• 8.) ALL HEADERS TO BE 3-2 x 6's UNLESS OTHERWISE NOTED -
RELOCATED 9.) FOLLOW ALL MANUFACTURER'S SPECIFICATIONS FOR INSTALLATION OF
zs ss HARVEY BEDROOM ALL SIMPSON COMPONENTS
TWT2410
q TRANSOM NEW - 10_) ALL CONCRETE USED FOR FOUNDATION WALLS,FOOTINGS&SLABS
io ar'x,60•• BATH TO BE.3000 PSI
ROLL-N
SHWR. ._....,._..�...--- 11.)VERIFY ALL PLUMBING&ELECTRICAL DETAILS W/OWNERS ON THE SITE
O W ;o DURING FRAMING CONSTRUCTION
EXIS O 12.)TIMBER FRAMING TO BE SPRUCE/PINE/FIR NO.2 GRADE
O 2'0"><s•W NEW BATH 13.)FOLLOW ALL REQUIREMENTS OF THE 110 MPH CHECKLIST SUPPLIED
UDRY. i 14.)THIS SITE IS IN THE 110 MPH WIND BORNE DEBRIS AREA,EXPOSURE"B"
z•s•><s•s•• &WITHIN ONE MILE OF NANTUCKET SOUND PER STATE OF
O LI". (� ; QS 1 O MASSACHUSETTS WIND SPEED MAPS
CAB. �J
zo :sB; 0 ___=_� LIN. 15.)GLAZING PROTECTION PER 780 CMR 5301.2.1.2 TO BE IMPACT GLAZING
E 7 .I VERIFY ALL WIND BORNE DEBRIS PROTECTION REQUIREMENTS
W/OWNERS PRIOR TO START OF CONSTRUCTION
HARVEY HARVEY FORMER BEDROOM L----�'
zags zags � � ) , � � 16.)FOLLOW ALL REQUIREMENTS OF THE IECC2012 RESIDENTIAL ENERGY
A B EXPAND. s-1o• I EFFICIENCY REQUIREMENTS&VERIFY ALL DETAILS WITH THE INSULATION'
A3 A3 HALL ON. INSTALLER/CONTRACTOR.
3 STUDS DER NEW z 2 0 HR.
END OF H R. �'K- 5
24•-O" —s-0"` IECC2012 RESIDENTIAL ENERGY EFFICIENCY DETAILS
j(/� CLIMATE ZONE 5A(USE EITHER PRESCRIPTIVE VALUES OR RESCHECK CALCULATION
_ TABLE 402.1.1(MINIMUM PRESCRIPTIVE INSULATION&FENESTRATION REQUIREMENTS)
7.71711 FENESTRATION SKYLIGHT CEI4NG WOOD FRAMED WALL FLOOR BASEMENT WALL BASEMENT BLAB CRAWL SPACE WALL
4 U-FACTOR U-FACTOR R-VALUE R-VALUE R-VALUE R-VALUE R-VALUE R-VALUE
• _ - 0.32 0,60 1 49 1 W 30 15119 10(2 FT.DEEP) 10113
EXIST. NOTES:
1.R-VALUES ARE MINIMUMS&U-FACTORS ARE MAXIMUMS.
LIVING - 2.15119 MEANS R=15 CONTINUOUS INSULATED SHEATHING ON THE INTERIOR OR EXTERIOR
UP OF THE HOME OR R=15 CAVITY INSULATION AT THE INTERIOR OF THE BASEMENT WALL
ri 3.REFER TO IECC 2012 CHAPTER 4 FOR ALL INSULATION&ENERGY REQUIREMENTS
FIRST FLOOR PLAN
LEGEND:
EXISTING WALLS
CONSTRUCTION TO BE REMOVED
L__J •
00
NEW CONSTRUCTION
Q SMOKE DETECTOR
Q CARBON MONOXIDE DETECTOR
� BAY
COTUIT VA1 DESIGN, LLc NEW ADDITION/REMODELING FOR: CONSTRIGNEN.THE BUILDING
NDTGCONTRAC SCALE :IFIED IF MY
ERRORS OR OMISSIONS ARE FOUND ON v DRAWING NO. :
THESE DRAWINGS PRIOR TO START OF
WILLBERESPONSIBLEFORIT ECONTENTTOR 1/4"
43 BREWSTER ROAD IN THESE DRAWINGS IF CONSTRUCTION
MASHPoEE MA. 02649 BOYNTON RESIDENCE THESEDAWING AREOUT SOTIFYINGTHE
PH. (50CJ 274-1166 DESIGNER OF ANY ERRORS OR OMISSIONS. DATE
FAX (50 ) 539-9402 THESE DRAWINGS ARESOLETHEWRI USE
265 OLD OYSTER ROAD COTU IT, MA OF ITECTU RNOTED IGH PROTECTION
TI OF
CONSENT
OF
E REQUIRESTHEWRITTEN 9/19/2016
CONSENT OF THE DESIGNER UNDER THE
ARCHITECTURAL COPYRIGHT PROTECTION
ACT OF 1990,
12
TYP.RIDGEVENT ' 3
NEW RAKE BOARDS TO
MATCH EXISTING
NEW ASPHALT ROOF SHINGLES 12
TO MATCH EXISTING
12 12
NEW FASCIA,FRIEZE,&SOFFIT 8
BOARDS TO MATCH EXISTING
TOP OF PLATE TOP9F PLATE
w ® y NEW MATCH
ERBOARDS
ISTING
TO MATCH EXISTING
NEW W.0 SHINGLE
L) SIDING MATCH
EXISTING
FIRST FLOOR FIRST FLOOR
., !UBFLOOR - SUBFLOOR -
FRONT ELEVATION LEFT SIDE ELEVATION
NAILING SCHEDULE
110 MPH EXPOSURE B WIND ZONE
JOINT DESCRIPTION NO.OF COMMON NAILS NO.OF BOX NAILS NAIL SPACING
ROOF FRAMING: -
BLOCKING TO RAFTER(TOE NAILED) 2-8d 2-10d EACH END ,
RIM BOARD TO RAFTER(END NAILED) ".. 2-16 d 3-16d .EACH END
WALL FRAMING:
TOP PLATES AT INTERSECTIONS(FACE NAILED). 4-16d 5-16d AT JOINTS
® STUD TO STUD(FACE NAILED) 2-16d 2-16d "D.C.
16
HEADER TO HEADER(FACE NAILED) 16d 16d 16"o.c.ALONG EDGES
FLOOR FRAMING:
JOIST TO SILL,TOP PLATE OR GIRDER(TOE NAILED) 4-Bd 4-10d PER JOIST
BLOCKING TO JOISTS(TOE NAILED) 2-8d 2-1 Od EACH END
BLOCKING TO SILL OR TOP PLATE(TOE NAILED) 3-16d 4-16d EACH BLOCK
LEDGER STRIP TO BEAM OR GIRDER(FACE NAILED) 3-16d _ - 4-16d EACH JOIST
JOIST ON LEDGER TO BEAM(TOE NAILED) 3-8d 3-10d PER JOIST
BAND JOIST TO JOIST(END NAILED) 3-16d 4-16d PER JOIST
BAND JOIST TO SILL OR TOP PLATE(TOE NAILEDO 2-16d 3-i6d - PER FOOT -
ROOF SHEATHING:
TOP OF PLAM WOOD STRUCTURAL PANELS(PLYWOOD)
RAFTERS OR TRUSSES SPACED UP TO 16"o.c. 8d 10d 6"EDGE/6"FIELD
RAFTERS OR TRUSSES SPACED OVER 16"o.c. 8d 10
dFIELD
FM
® GABLE END WALL RAKE OR RAKE TRUSS W!O OVERHANG 8d 10d 6"EDGE/6"FIELD
(7 GABLE END WALL RAKE OR RAKE TRUSS 8d tOd 6"EDGE/6"FIELD
W/STRUCTURAL OUTLOOKERS
y GABLE END WALL RAKE OR RAKE TRUSS W/LOOKOUT BLOCKS 8d 10d 4"EDGE/4"FIELD
x
w CEILING SHEATHING: -
x
F GYPSUM WALLBOARD Sd COOLERS — 7"EDGE/10"FIELD
WALL SHEATHING:
WOOD STRUCTURAL PANELS(PLYWOOD)
FIRST FLOOR STUDS SPACED UP TO 24"o.c. 8d 10d 3"EDGE/12"FIELD
SUBFLOO_R 1/2"&25132"FIBERBOARD PANELS 8d - — 3"EDGE/6"FIELD
1/2"GYPSUM WALLBOARD 5d COOLERS — T'EDGE/10"FIELD
FLOOR SHEATHING:
WOOD STRUCTURAL PANELS(PLYWOOD) -
NEW WINDOW&DOOR 1"OR LESS THICKNESS 8d - 10d 6"EDGE/12"FIELD
TRIM TO MATCH EXISTING GREATER THAN 1"THICKNESS 10d 16d 6"EDGE/6"FIELD
REAR ELEVATION
COTUIT BAY DESIGN, LLc NEW ADDITION/REMODELING FOR: CONSTR°R�ssE UILDING ONTRAC SCALE
THESE DRAWINGS PRIOR TO START OF DRAWING NO.
' 43 BREWSTER ROAD WLLBERESONSIBLEF FOR
CONTRACTOR 1/4" = 1'-0"WILL ES RESPONSIBLE FOR THE CONTENT
IN
ON
MASHPEE MA. 02649 DESIGNER
OFAN E RORSOR UCTOMISSIONS.
COMMENCES W ITHOUT NOTIFYING THE
LA O cc B OY N T O N RESIDENCE _ THESE DRAWINGS
ARE ERRORS OR OMISSIONS. DATE :
PH. (508 274-1166 THESE DOWNER RAWINGS REQUIRES
THE WRITTEN
USE ��
FAX (508) 539-9402 THESE OF THE TOFTHEDESIGN MY OTHER USE OF
265 OLD OYSTER ROAD COTUIT, MA ACHITERAWINGSREOUIRESTHETECTION g/19/2016
CONSENT OF THE DESIGNER UNDER THE
ARCHITECTURAL COPYRIGHT PROTECTION
ACT OF 1990.
L—
TYP. ROOF CONST.
ROOF TRUSSES @ 24"O.C.PER MANUFACTURER'S
' - SPECIFICATIONS.&PLAN.USE ALL SPECIFIED -2 x 6 ROOF TRUSSES @ 24"o.c.
BRACING&INSTALLATION REQUIREMENTS TO -5/8"COX PLYWOOD ROOF SHEATHING
AVOID ANY FAILURES -ASPHALT ROOF SHINGLES
24'-6" -15LB.FELT PAPER
- -11'•BATT INSULATION
SOLID BLOCKING IN THE - 4•.0•
OUTSIDE TWO JOIST BAYS TYP.WALL CONST. @FLAT CEILINGS(RRIC
AT 48"o.c. 1.2 x 6 STUDS 24"D.C. -AT ALL N H 2.SA HURRICANE CLIPS
q B @ AT ALL RAFTER ENDS
A3 q3 2.112"PLYWOOD SHEATHING ICE/WATER SHIELD AT BOTTOM
BASEMENT 3.6.'(R=20)BATT INSULATION 3'0"OF ROOF
WINDOW 4.W.C.GYPSUM BOARD PROP-A VENT-WIND WASH BARRIERS N RAFTERS
__________ __ 5.W. SHINGLE SIDING
6.TYPAR VAPOR BARRIER 12 -ALUMINUM DRIP EDGE
r — ——_ — — 9-- —_— I PEAM — I I .
YW
12' " 12.-1. i TOP OF PLATE
UUUUUUUUUUQQQUDUUUUUUUo-
BASEMENT I I I I 4 1l2"GYP.BOARD
WINDOW d ON 1 x 3 STRAPPING
2-2 x 10's ° TYPICAL 3 1/2"DIA. Z @ 16"D.C.
STEEL LALLY COLUMN In
1-
2 x 8's @ 16"o.c. TYPICAL 30"x 30"x 12" - I � " NEW � NEW
3/4"
w
FOR SHOWER I o CONCRETE FOOTING I _ U
4 o ABOVE x I BATH W.I.C.
w L .J NEW000
SUBFLOORLGL GLUED&NAILED
Z
FIRST FLOOR
SUB FLOOR
P.T.2 x 8 SILL NEW 2 x 10's @ 16"D.c.
CONLPSLAB W/SEALER GATT INSULATION(R30) N E W
OLY
OI UNDERNEATH CRAWLSPACE
°f 6 8"CONC.FOUNDATION
I - W/8"x 1 B"CONC.FTG.
2"CON,.SLA
W/6 MI Y B
L POL
• -- TO 4'0"BELOW GRADE UNDERNEATH
°' BEAM (1)#4 HORIZONTAL BAR
PKT. SAWCUT TO"OPENING AT TOP&BOTTOM OF -
L—— ———__— — IN EXIST.FOUNDATION FOR - WALL WI 2 x 4 KEY r
ACCESS INTO NEW
________ -- BASEMENT
NEW 3 1/2"DIA.LALLY COLUMN a SECTION BEDROOM
8"CONC.FOUNDATION W/30"X 30"X 12"CONCRETE /43 W/8"x 18"CONC.FTG. DRILL&PIN NEW FOUNDATION
1 V-2" FOOTING UNDER END OF NEW
HEADER ABOVE
TO 4'0"BELOW GRADE TO EXIST.FOUNDATION WALL
(1)#4 HORIZONTAL BAR
AT TOP&BOTTOM OF q TOP&BOTTOM B
WALL WI 2 x 4 KEY A3 A3 -_ _
EST GIRT
----���TXI GIRT
.24'0" L I J SPLICEf
I+ I
FOUNDATION PLAN
o --
3
15" INSTALL 5/8"SIMPSON TITEN HD ANCHOR BOLTS AT
�6 12
C_.c.MAX.W/SIMPSON BPS 518-3 BEARING PLATES EXIST.
PLACE 9
6 9" TO A 8 BOLTS
MIN MUMWITHIN
DEPTH.I SBOLOT LENGTH I 10".AND N BASEMENT
UP
I] TOP OF PLATE
aEl
F
o
n
_ RELOCATED
o BEDROOM
FIRST FLOOR
SUBFLOOR
NEW2x10's@16"o.c.
NEW
CRAWLSPACE
P.T.2 x 6 SILL Wl SEALER
A SECTION BEDROOM
ANCHOR BOLT DETAIL a3
T T BAY
COIUI1 ✓A1 DESIGN, LLc NEW ADDITION/REMODELING FOR: CONSTRUCTION.
TH_g BE NOTIFIED
GCONTRAC Q�ALE �ERRORS OR OMISSIONS ARE FOUND ON V DRAWING NO. :
THESE DRAWINGS PRIOR TO START OF
M WILL BE RESPONSIB E FOR IT E CONTENT TOR 1/411 - 1,-OII
43 BREWSTER ROAD IN THESE DRAWINGS IF CONSTRUCTION
COMMMASHPEE MA. 02649 BOYNTON RESIDENCE THESE CES DRAWINGS HOUT
NOTIFYING THE
TH ��
PH. (508 274-1166 DESIGNER OF ANY ERRORS ORHERU USE
DATE :
THESE DRAWINGS ARE SOLELY FOR THE USE
�] OF THE OWNER NOTED.ANY OTHER USE OF
FAX (5O ) 539-9402 COTHESENTOFT EDEIGNER UNDER HE
9/19/2016
265 OLD OYSTER ROAD COTUIT, MA CON SENT OF THEDESIGNER UNDER THE
ARCHITECTURAL COPYRIGHT PROTECTION
ACT OF 1990.
24'-6"
a A B
SOLID 2 x 8 BLOCKING IN THE OUTSIDE A3
FAILUR'
TWO TRUSS&CEILING JOIST BAYS ROOF TRUSSES. 24"D.C.PER MANUFACTURER'S
• @ 48"o.c.,ALLOW SPACE FOR AIR SPECIFICATIONS.8PLAN.USE ALL SPECIFIED
Ly FLOW OH NG E UNDERSIDE OF ROOF AVOID BRACI NG ANY INSTAL STION REQUIREMENTS TO -
SHEA
T
� IIIII ,
�l
Li
IF71F �, f
0
L O
s_J
A B
24'-0"
ROOF FRAMING PLAN
NOTES:
1.) 2 x 6 ROOF TRUSSES @ 24"Q.C. -
2.) USE SIMPSON H2.5A HURRICANE CLIPS
AT ALL RAFTERS ENDS
f 3.)VERIFY GUTTER TYPE/LAYOUT
W/OWNERS
TYPICAL ASPHALT
ROOF SHINGLES `
5/8"COX PLYWOOD SHEATHING
2 x 6 TRUSSES \\� 154 FELT PAPER
SIMPSON H 2.5A HURRICANE CLIPS
WINp WASH
- BARRIER 3'0"WIDE ICE/WATER SHIELD
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