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0453 OLD POST ROAD (CT & MM) - Health
453 Old Post Road Cotuit —" A= 054 - 025 - -- - - r" TOWN OF BARNSTABLE LOCATION 9pcdRA- SEWAGE# ®� _?42- ,VILLAGE c(A u C+ ASSESSOR'S_MAP&PARCEL '19 INSTALLER'S NAME&PHONE NO.Mtn'�pV� SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) �C 1� NO.OF BEDROOMS OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching faciI ) Feet FURNISHED BY � } Q ' � 1; yw i - i oNo. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: � Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS �iplication for Disposal *pstem Construction hermit Application for a Permit to Construct(* Repair( ) Upgrade()() .Abandon( ) [:]Complete,System AIndividual Components Location Address or Got No . Owner's Name, AddressR7/and Tel.No. SQ$- y42 7- 3 3 7 7 s,ju eG Po$T R-h, - GoTU/7' &.411- �9 B �✓i Assessor'sMap/Parcel /{� P .r� '61,0G-, gs" *5,1 oL..O PaT'% Ab - ee-IV17' Installer's Name,Address,and Tel.No. DesignoyG er �'s Name, �'Address,and Tel. 'oeC/.9 - nNPL1 ,vXlZZ2_ /,T.,D o c�d�rE /�L� �VA •�r�tir�ov�� Type of Building: ? — � Dwelling No.of Bedrooms 3 Lot Size :-6 sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow-(min.required) '33!P gpd Design flow provided 3 9L S gpd Plan Date y(/L y /9, 2,0/� Number of sheets Revision Date Title 61J, S ,5:1n lJ A-,w L E Size of Septic Tank 14a1,11) MZ L D�.f' Type of S.A.S. ,3D6 G-01,4MI 8e4S ul O Al Description of Soil �"/� ,Lo/f m ySxA64 Y Z o,9/yI �/d/1'1 Nature of Repairs or Alterations(Answer when applicable) Al /ST"6,0,j" /g/✓D Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued byW"o ' al . A4' Date %ld'16Iq Application Approved by mllmg& Date Application Disapproved by Date for the following reasons Permit No. Date Issued ` No. 601 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ` Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS application for Disposal *Pstem Construction 3permit Application for a Permit to Construct(X) Repair( ) Upgrade(X) Abandon( ) ❑Complete System AIndividual Components Location,Aj es r of Orsw���sNa�n�hr�s /an�d/el.No. S48" `94Z7' 377 Assessor's Map/Parcel A141- S�` "W c ZS", if 3 e" Pa.T T ,2U - Co TU/T Install`er'sName, ddress,and No. Debi er' Nam j Le, dd d o.Sv31 xl.3"/99� ./�,gDG C �Sl� iy Qb i PJX �2 Z. /�D CGdI�E,P /�4D h/Ay �i9� hlo vT� Type of Building: 7 -,F3G, 4 -1/ �,.. Dwelling Nd.of Bedrooms Lot Size �/ sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures r Design Flow(min.required) 3 '� gpd Design flow provided 3 9'8 gpd Plan Date / Revision Date Number of sheets Title SEW, 5'157E1n Il>°6/1�,v F p�9 �O.e �ii /� f/, •��-���T/�/ _ Size of Septic Tank /440 "4 1-494s Type of S.A.S. -�rDdwG�G6/fI/��G��S J���✓� r Description of Soil �.,/0�� .L D/9 /D.��Z.S Jli9/✓-D D�� 2 5'���'f /���/d/YJ f��{/�G i s Is ..Nature of Repairs or Alterations(Answer when applicable) h A/ -01S7, ,eD,-r A/✓.0 -5,/ , -V, � r Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in V J'X accordance with the provisions of Title 5 of the E Oromnental Code and not to place the system in operation until a Certificate of Compliance has been issued by this r o alt . ,+ gne9 Date 7 /! Application Approved by / Date 4 Application Disapproved by Date for the following reasons ` Permit No. /� Date Issued'' - ....... ----_---..._.-._..._-- ........._.._........- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO Clc T F ,t at t ?en-isite Se ag iis,possaa rZ Constructed( ) Repaired( Upgraded( ) Aband ed by (!`�C/ at U11) [DI has been coM, dlin o ce with the provisions of Title 5 and the for Disposal System Construction Permit N ated Installer Designer #bedrooms Approved d signflow ,/ gpd I J. The issuance-oft is pe i s'all not be construed as a guarantee that the system fun des g(ne . �j Date Inspector r p � s No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS a Disposal 6psteltt Construction PerYtYit Permission is hereby granfedao Co struactt Re` _ U•,/�r�ad)e �) Ab bon )r System located at ( / •�J 0 / �i ' and as described in the above Application for Disposal System Construction Permit. The applicant recognized ihis/her duty to comply with . j Title 5 and the following local provisions or special conditions. We f ' Provided:Con ct/on" ust leec impleted within three years of the date of this permit. Date /! Approved by r , Town of Barnstable W'�kj,� Regulatory Services Richard V. Scali,Interim Director MAM Public Health Division 6g¢ Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer&Designer Certification Form Date: ZOIX Sewage Permit# 2 Ol -Z V*'Z-Assessor's Map\Parcel AM 5'34 Aq4Z. 2 S Designer: Installer• &446 t. Z 192617-6 Address: /70 Address: 1�y0- BOX /7 21 2` On � Nli:114 EL LA9UTE was issued a permit to install a (date) (installer) septic system at 53 04.D COST' XM-4 based on a design drawn by (address) J,,,�oYZ-e 4ssoC/97, s dated 7-1�'. Zo/ ,z (designer) ✓I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State &Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required)was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed in compliance with the terms of th \A approval letters(if applicable) Ui' �� (Installer s Signature) P. DOYLE,9It No.99F>89 esigner's ature) (A mp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. QASeptic\Designer Certification Form Rev 8-14-13.doc /7d t Town of Barnstable >P# Department of Regulatory Services . a M, r Public Health Division Date ��;q 200 Main Street Hyannis MA 02601 QED A Date Scheduled Time Fe lV- v S- ' Su9tability .Assessmentfor Se e-Ibis os �' e Performed By:. Witnessed By: f LOCATION& GENERAL INFORMATION / Location Address ' 0/— KD�QQ Owner's Name G/J/G /�G.�E/E?7"/�✓/ C .D 'A65 7, D, Address Assessor's Map/Parcel• /)? S /�.9�2 C• 2 h' Engineer's Name T,�DyL e'As�soe/�9TGS NEW CONSTRUCTION REPAIR Telephone# Land Use 6.V_J t NC Slopes(%) 7 1 Surface Stones NbT DBSEkf/i✓ Distances from: Open Water Body ft Possible Wet Area�_ft Drinking Water Well ft Drainage Way�/19 _ft Property Line zY ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&pere tests,locate wetlands in proximity to holes) oG �4 0e,5 / i /SZ• la /G B-a/ -I . , N o 0�9 d O 3 cuss Parent material(geologic) Depth to Bedrock Nd Depth to Groundwater. Standing Water in Hole: Weeping froth Pit Face 4w/11p Estimated Seasonal High Groundwater SST/!21 i9 J"E�1 .�T �LEy% �:o DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: in, Depth to 5911 mottles. itt: Depth to weeping from side of obs.hole: __ in. Groundwater Adjustment Index Well# Reading Date: Index Well level Adj.factor Adj.C3roundwater Level A �l 12 PERCOLATION TEST mute7- -/ Time ll;dRAAJ Observation Hole# TP_/ Time at 9" y. � Depth of Perc Zg �.��'( Time at 6" Start Pre-soak Time Time(9"-6") End Pre-soak Q �aoWs-SATd��D - Rate Min./Inch MIA) / � /it/C1.1 Site Suitability Assessment: Site Passed_—lam Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Conservation Division at least one(1) week prior to beginning. Q:\SEPTIC ERCFORM.DOC DE)EP.OBSERVATION MOLE LOG Dole# 7T -/ Depth from Soil Horizon Soil Texture .Sdil Color Soil Other Surface(in.) (USDA) (Munseli) Mottling (Stnucture,Stones;Boulders. �� orisistency,%Gravel) 0 —/Z �O�In'! ioy.,e3/� 2� '� � MEN•54- A 4- /Dyx 6:i W., DEEP OBSERVATION DOLE LOG Hole# Zv- Z Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munseli) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) /,0 y e 3/Z 2.l y-/y�6 C M,.0 5: 9AA ` A129 6•W 11 r art CI-4 DEEP OBSERVATION HOLE LOG Hole# LL- Depth from Soil Horizon Soil Texture Soil Color Soil Other Sur.ace(in_) (USDA) (Munseli) Mottling (Structure,Stones,Boulders. _ Co i to c O f H DEEP OBSERVATION MOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soll Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency, Flood Insurance Rate Map: Above 500 year flood boundary No— Yes Within 500 year boundary No Yes Within 100 year flood boundary No:✓/ Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pervious material? Ceftification I certify that on /99r (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required training,expertise and experience described in 10 CMR 15.017. Signature Date r �0/ Ze/ 4 Q:WEPTiCkPERCFORM.DOC 897Town of Barnstable Barnstable �°pYHE rp�y Regulatory Services Department �"a.j j 1AnNSCA6LE, T MASS. m01 Public Health Division i659. Tf0 MaY a. 200 Main Street, Hyannis MA 02601 200� Office: 508-862-4644 Richard V.Scali,Director. FAX 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL # 7012 1010 0000 2851.2729 June 20, 2014 Gail Albertini 453 Old Post Road Cotuit, MA 02635 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 • The septic system located at 453 Old Post Road, Cotuit, MA, was last inspected on 5/19/2014, by Shawn Mcelroy, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system" Fails" under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the following: 0 Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool. You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action.. PER ORDER OF THE BOARD OF HEALTH Thomas McKean, R.S. CHO Agent of the Board of Health • Q:\SEPTIC\Letters Septic Inspection Failures or Future Evl\453 Old Post Rd Cotuit Jun 2014.doc Parcel Detail http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=3512 MAS �oRG,, °" ! r LF Logged In As: Pa rce I Deta I I Wednesday, June 18 14 Parcel Lookup Parcel Info . ......... ......... ....... Parcel)—__. __. _ __ _ ._.—_ _ ._ Developer 1 ID i054-025 ( Lot T 27 Location�453 OLD POST ROAD(CT&MM) Frontage Pri 325 Sec _. _ _ ______, Sec 4 ——.__._, Road Frontage Fire __. V i I I a g e,COTUIT COTUIT District Town sewer exists at this Road r� address No ! Index l'165 Asbuilt Septic Scan:p Interactive 054025 1 Map " ° Owner Info Owner IALBERTINI, GAIL H ICo- Owner Street)1453 OLD POST RD I Street2 City ICOTUIT State MA Zip 02635 Country Land Info Acres 11.04 Use ISingle Fam MDL-01 I Zoning IRF _ j Nghbd 0110 Topography Road Utilities Location Construction Info Building 1 of 1 Year --- Roof Ext 1979 Gable/Hip Wood on Sheath Built Struct - — -- — Wall --- Living[1248 Roof Asph/F GIs/Crop AC Central Area Cover Type Int Bed Style Ranch ( Wall Drywall_ ( Roorps 3 Bedrooms ' __ Model jResidential Int Hardwood _ Bath 1 Full+ 1 HF ' — Floor Rooms a ia:- 14 otal Grade Average Minus ( Type[Elec Baseboard Rooms 5 Rooms s`' — = Stories1 Story I Heat Electric Found- Typical" Fuel ation ., Gross http://issgl2/intranet/propdata/ParcelDetaii.aspx?ID=3512 6/18/2014 G��1 �fi ��i�� Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 5 453 Old Post Rd Property Address Gail Albertini Owner Owner's Name information is required for every Cotuit MA 02635 5-19-14 , page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. A. General Information 1. Inspector: Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name P.O. Box 73 Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S13971 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 Furt r Evaluation the Local Approving Authority ' 5-19-14 nspector'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. L&It5ins•3l13 Title 5 Official In :Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 453 Old Post Rd Property Address Gail Albertini Owner Owner's Name information is required for every Cotuit MA 02635 5-19-14 page_ City/Town State Zip Code Date of Inspection B. Certification (cost.) y Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 453 Old Post Rd Property Address Gail Albertini Owner Owner's Name information is required for every Cotuit MA 02635 5-19-14 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y' ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50.feet of a bordering Vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 y Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °G Ms0 453 Old Post Rd Property Address Gail Albertini Owner Owner's Name information is required for every Cotuit MA 02635 5-19-14 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes"or"No"to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® 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 ❑ 0 Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments. 453 Old Post Rd Property Address Gail Albertini Owner Owner's Name information is required for every Cotuit MA 02635 5-19-14 page. City/Town State Zip Code Date of Inspection ` B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ` ❑ ® Any portion'of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The -,system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply El 0 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 453 Old Post Rd Property Address Gail Albertini Owner Owner's Name information is required for every Cotuit MA 02635 5-19-14 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No ® ❑ 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form . o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 453 Old Post Rd Property Address Gail Albertini Owner Owner's Name information is required for every Cotuit MA 02635 5-19-14 page. City/Town State Zip Code Date of Inspection D. System Information Description: I Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) 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: 5-2014 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 453 Old Post Rd Property Address Gail Albertini Owner Owner's Name information is required for every Cotuit MA 02635 5-19-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Owner--pumped fall 2013 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Maintenance Type of System: ® . Septic tank, distribution box, soil absorption system Single cesspool 9 P �i ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 453 Old Post Rd Property Address Gail Albertini Owner Owner's Name information is required for every Cotuit MA 02635 5-19-14 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: 1979 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 48"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.): Good condition. Septic Tank(locate on site plan): Depth below grade: 40"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: 1500 gal Sludge depth: 6" t5ins•3113 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 �M 453 Old Post Rd Property Address Gail Albertini Owner Owner's Name information is required for every Cotuit MA 02635 5-19-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 26" Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 16" How were dimensions determined? Tape Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is in good condition with baffles installed and no sign of leakage. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts = W Title 5 Official Inspection Form • Subsurface Sewage Disposal System Form -Not for Voluntary Assessments t ,M 453 Old Post Rd Property Address Gail Albertini Owner Owner's Name information is required for every Cotuit MA 02635 5-19-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete El 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•3113 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 g p y o o Voluntary Assessments 453 Old Post Rd Property Address Gail Albertini Owner Owner's Name information is required for every Cotuit MA 02635 5-19-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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.): Good condition with water at working level and stain lines above inlet invert. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form • �; Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M •°� 453 Old Post Rd Property Address Gail Albertini Owner Owner's Name information is required for every Cotuit MA 02635 5-19-14. page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1-1000 gal ❑ leaching chambers number: J ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leach pit was holding water at 18" below inlet invert with stain lines above inlet invert. Cesspools (cesspool must be pumped as part of.inspection) (locate on site plan): Number and configuration Depth top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 453 Old Post Rd Property Address, Gail Albertini Owner Owner's Name information is required for every Cotuit MA 02635 5-19-14 page. City/Town 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 453 Old Post Rd Property Address Gail Albertini Owner Owner's Name information is required for every Cotuit MA 02635 5-19-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately old Pe5i_f p t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ' �M 453 Old Post Rd Property Address Gail Albertini Owner Owner's Name information is required for every Cotuit MA 02635 5-19-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 20 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: USGS and town maps show groundwater at greater than 20'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 I , Commonwealth of Massachusetts W Title 5 Official Inspection Form • Subsurface Sewage Disposal System Form -Not for Voluntary Assessments G'M Svey'o� 453 Old Post Rd Property Address Gail Albertini Owner Owner's Name information is required for every Cotuit MA 02635 5-19-14 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 R COMMONWEALTH OF MASSACHUSETTS EXECUTIVE QFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 453 Old Post Road Cotuit, MA 02635 Owner's Name: Susan Herrnstein Owner's Address: 986 Memorial Drive, Unit 604 'T Cambridge: MA Q138 Date of Inspection: January 26, 2007 Name of Inspector: (Please Print) James.M. Ford Company Name: James M. Ford Mailing Address: P.O.Box49 Osterville.MA 02655-0049 Telephone Number: (508) 862-9400 ' 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:c approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: , Ei i ✓ Passes cz Conditionally Passes Nceds Further Evaluation by the Local Approving Authority 3 r F ils Inspector's Signature: Date: January 30, 2007 The system inspector sha\sub�ia copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 . gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer;if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time ofinspection 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 5Inspection Form 6/15/2000 page 1 i ` Page 2 of 11 ` OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM 5 PART.A CERTIFICATION (continued) Property Address: 453 Old Post Road Cotuit. MA Owner: Susan Herrnstein Date of Inspection: January 26, 2007 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: ✓ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional.Pass" section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of.Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined",please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will.pass-inspection if the existing tank is replaced with a complying septic tank as.approved`by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is.available. ND explain: Observation of sewage backup or breakout or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution.box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 453 Old Post Road Cotuit, MA Owner: Susan Herrnstein Date of Inspection: January 26, 2007 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to'detennine if the system is failing to protect public health,safety or the environment. 1. - System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines.that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria 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: 453 Old Post Road Cotuit, MA Owner: Susan Herrnstein Date of Inspection: January 26. 2007 D. System Failure Criteria applicable to all systems: You must indicate either"yes"or"no"to each of the following for all inspections: Yes No ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or. cesspool ✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than ''/z day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped ✓ Any portion of the SAS, cesspool or privy is below high ground water elevation. ✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary.to a.surface water supply. ✓ Any portion of a cesspool or privy is within a Zone 1 of a public well. ✓ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ✓ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a.DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is'free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] No (Yes/No)The system fails.'I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No _ the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface 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 15.3.04. 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: 453 Old Post Road Cotuit, MA Owner: Susan Herrnstein Date of Inspection: January 26, 2007 Check if the following have been done: You must indicate"yes"or"no"as to each of the following: Yes No ✓ _ Pumping information was provided by the owner,occupant,or Board of Health ✓ Were any of the system components pumped out in the previous two weeks? Has the system received normal flows in the previous two week period? ✓ Have large volumes of water been introduced to the system recently or as part of this inspection? ✓ _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) " Was the facility or dwelling inspected for signs of sewage 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: Yes No _ Existing information. For example,a plan at the Board of Health. Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)]. 5 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 453 Old Post Road Cotuit, MA Owner: Susan Herrnstein Date of Inspection: January 26, 2007 FLOW CONDITIONS RESIDENTIAL 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): 33.0 Number of current residents: 0 Does residence have a garbage grinder(yes or no): n/a Is laundry on a separate sewage system(yes or no): n1a [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): Unavailable Sump.Pump(yes or no): No Last date of occupancy: Unknown COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Unavailable Was system pumped as part of the inspection,(yes or no): No If yes,volume pumped: _gallons--.How was.quantity pumped determined? Reason for pumping: TYPE OF SYSTEM ✓ Septic tank,distribution box,_soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records,if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Installed in 1978-per as built card Were sewage odors detected when arriving at the site(yes or no): No 6 I Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 453 Old Post Road Cotuit, MA Owner: Susan Herrnstein Date of Inspection: January 26. 2007 BUILDING SEWER(locate on.site plan) Depth below grade: Materials of construction: _cast iron _40 PVC other(explain): Distance from private water supply well or suction line: Comments(on condition of joints;venting,evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 30" Material of construction: ✓ concrete._metal _fiberglass polyethylene _other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1000 a� l• Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 3" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 10" How were dimensions determined: - Measuring stick Continents(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.). Tees were present. The liquid level was even with the outlet invert There did not appear to be any signs of leakage A riser was installed on the outlet side to bring the cover within 6"ofQrade 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: Continents(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert, evidence of leakage,etc.): 7 Page 8 of 1 I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 453 Old Post Road Cotuit, MA Owner: Susan Herrnstein Date of Inspection: January 26, 2007 TIGHT or.HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene'_other(explain):' - Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Conments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan). Depth of liquid level above outlet invert: Even 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.): The D-box was level. No solids were present. PUMP CHAMBER: None (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no) Continents.(note condition of pump chamber,condition of pumps and.appurtenances,etc.): 8 Page 9 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 453 Old Post Road Cotuit, MA Owner: Susan Herrnstein Date of Inspection: January 26, 2007 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required), If SAS not.located explain why: Type ✓ leaching pits,number: 1 -6'x 6'(1000 gal.) leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: Innovative/alternative system Type/naive of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.): The leach pit had 1'ofliauid on the bottom. The scum line was approximately 2'up from the bottom There did not appear to be any signs offailure. The cover was 18"below-grade. The bottom to grade was 9'. CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments (note condition of soil,signs of hydraulic failure,level of ponding;condition of vegetation,etc.): PRIVY: None (locate on site plan) Materials of construction: Dimensions: Depth of solids: Continents(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: 453 Old Post Road Cotuit, MA Owner: Susan Herrnstein Date of Inspection: January 26, 2007 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.-Locate all wells within 100 feet..Locate where public water supply enters the building, O A - 8 0 y a 1 II A l3 a 3a 3a- 3 3a ya.. y 33 �l 10 I ' Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 453 Old Post Road Cotuit, MA Owner: Susan Herrnstein Date of Inspection: January 26, 2007 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 20+/- feet Please indicate(check)all methods used to.determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: ' Observed site(abutting property/observation hole within 150 feet of SAS) ,; ✓ Checked with local Board of Health-explain: topographic and water contours maps Checked with local excavators,installers-(attach documentation) �•,. Accessed USGS database-explain: You must describe how you established the high ground water elevation: Using Barnstable topographic and water contours maps the maps were showing approximately 20'+/-to groundwater at this site. This report has been prepared only for the septic system and components described herein. This septic system has been inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied, relating to the septic system, the inspection, this report and/or any components of the septic system which have not been located and inspected. 11 TOWN CIE'BARNSTA,BL.0 D WAGE#� v .c� Gc Ca � sFssow)5 n�� LOT �. plc �'�rx cc�r�r ts�ov l (side)Ll N0 r)1R EOR2 ovrlv�� �ep�acatAon tf9i8tA8iC�Betvr�en tire: .. j Maximum lt�}listed,G�puttclwutev bole to tW,Bpttom of Loch'nfWai ility , 1 -Wmc,Waxy r Supply V1e91 mid LeWc. as: opy�rdt9s cxlst �� � ate site ar`.vU�tltiti 200 fee¢o�lact4ctiiet fuci�ty) l?.el�ri r,�.'bq/etAan tid Leacittn�l~�ciiey(Yt`any wetlands exist iviP.hic� 00 fc etat enGliing lucility) r uti�6sbod::tfy Post ,Pd } DD . TOWN OF BARNSTABLE L(';CATION 4153 61J PGST R1• SEWAGE# FrOa- VILLAGE CUrUt ASSESSOR'S MAP&PARCEL 65q- OaS INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY /GW LEACHING FACILITY: (type) P;! (oX�� (size) /Wb NO. OF BEDROOMS �/ 3 +. OWNER r)GrrASh,A PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY T�I*t ji n„ j For l i IaC�O� it o « ' _0 - 0 A f3 a 3a 3 L 3� 3a `►.�. y 33 l., TO N OF BARNSTABLE -r• LOCATION .-�-- OLD SEWAGE# VLLLAGE ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY t LEACHING FACILITY:(type) (size) NO.OF BEDROOMS OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet"of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist p within 300 feet of leaching facili ) Feet FURNISHED BY /� r � , - FIAI �0 1 c� LEractl svcq,e ,r per n�env sued r6169 AIN. J 6of _ LoT�• "Z7 I�F rueE LOT�2G NoTE; ECBVgT/oNs Bg36D o v iJ�Rw SEq LtVEZ 'LO° CATION ®�� � � SEWAG� PERMIT NO. �d V`11LAGE mass i- 1NST LLER'S N ME & ADDRESS 0 BUILDER OR OWNER tot-�ab cue G4 . GATE PERMIT ISSUED DATE COMPLIANCE ISSUED .. ++ ;� a .,_,��_ T `` c _ �. fit' �� ���-.� � �Q ���` �� No......................... Fps..........I................... THE COMMONWEALTH OF MASSACHUSETTS BOAR® E HEALTH 4/P 0S Y_w5 ................OF....... -._--_---------- Applira#ion for Dispnou1 Works Tomtrnrtinn Vamit Application is hereby made for a Permit to Construct (le<or Repair ( ) an Individual Sewage Disposal System at: 01,0._Phr.2.�.... r_60720'1.) ...............................710t.427............................................... Location or Lt No.......&V � .... ZA .....4.AI AIZ.......... _ Ownerd��p �p^ (� �q" Adddrressss� ,D gyp/ �r .....14*W*. AiX.1114Aj+..._ �/l/�i.:!�11K�'J!`.!7lZrAddr�e���A/.�y....Gf(Q��IJ... Installer d Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms.............. �........_...._.....Expansion Attic ( ) Garbage Grinder (007AI Other—Type of Building ............................ No. of persons_._.._a 2._............. Showers (X) — Cafeteria ( ) Other fixtures ---........-•-•--•-•--•--------- W Design Flow.......... -40........................gallons per person per day. Total daily flow--.--.... .........._.........gallons. WSeptic Tank—Liquid capacit 0Q_gallons Length................ Width---------------- Diameter---------------- Depth................ x Disposal Trench—No..................... Width ------- Total Length..............._.. Total leaching area....................sq. ft. Seepage Pit No........J---------- Diameter.......9--------- Depth below inlet..... ____........ Total leaching area/0.....sq. ft. _0 Z Other Distribution box Dosing tank0-4 ) .a Percolation Test Results Performed by- A..K............ Date__900/77-•------------- Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water-____-__-____-_------_.. i, Test Pit No. 2................minutes per inch Depth of-Test Pi .._..._.__._.. Depth to ground water........................ a ---- ............. _4•• . --- ............... - t- -----. O Description of Soil..... d 'l Ltd_ 7d�t 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 TIT :^,. y g g p y 5 of the State Sanitary Code—The undersigned further agrees not to lace the system in operation until a Certificate of Compliance has been issued by the board of health. Sied--••-•- •---••--•-••-•----••-••••-••-•-•-•--------•----••-•:_......-•••-••--••••••. --••........Dat................•••- �� 7 ... Application Approved BY L� �1 3�-7 Date v Application Disapproved for the following reasons- -----------------------------------------------------•----------------....................................... ---------------------------------------------------------•--•------------....----•----------•---------------•-•-•-•--••••-•......•-•--------••-••-••-••-••--•......-•----•-----•-••-•••---•--------•---- f Date Permit No......................................................... FIssued........................................................ .•-3......... -.....`------•-----....------------.. �'` Date u cJ........ .. Fmc.............. THE COMMONWEALTH OF MASSACHUSETTS BOAR® F HEALTH ...... ..... OF..... a ?.. t. ...................• Application for Dispati al Warko Cfoaiptrttrtion Vamit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: -•- -- kA9_.. -Z -.... fJ. t '. . .............................. ................................................ . L anon d s or Lot No Al Ai ress Add_ )6 / E°�_: Ste! ..... .._.. 3 Installer Address Type of Building Size Lot_..........................Sq. feet U Dwelling—No. of Bedrooms.............: ..........................Expansion Attic ( ) Garbage Grinder #A JAJ aOther—Type of Building ............................ No. of persons............................ kX ( )..____._. Showers — Cafeteria dOth r -fixtures ........................................................................�-----------------•------- Design Flow...... .._.--•""••.._ ......gallons per person per day. Total daily flow_...._. ........................gallons. W " WSeptic Tank—Liquid capacit 'w..gallons Length................ Width---------------- Diameter...----_-------- Depth................ x Disposal Trench—No..................... Width ....... Total Length..................... Total leaching area....................sq. ft. Seepage Pit No........ ----------- Diameter......6------------ Depth below inlet.... ?_........... Total leaching areal q. Z Other Distribution box (PI Dosing tank (� I e r -- `-' Percolation Test Results Performed by �� 1e ,1=- __ � '._ ._ ti' _____________ Date f//�/ aTest Pit No: 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test,Pit No. 2.................minutes per inch Depth of Test Pit f................... Depth to ground water........................ f ., D Description of Soil--- '� _ ?° _......_ : . ....... :t2 -�_. x U ------------------- ---•""""""""""""- ------------- .---------------------------------- ---"---------------------------------------------------- W ---------------------------------------------------------------------------------------••-----•------------------------------------------------------------------------------------------------------•-- VNature 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 TI.TLE 5 of the State Sanitary Code—Thee undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. / S ned •-•--•........................ ......__...•- r > r Date Application Approved B ----• !� _ - i"--4-! - PP PP Y •--- -•-• r- ,�� ................ ! ................................ l Date t Application Disapproved for the following reasons:.............................................----------------------------•------------.--._..............----- Date PermitNo......................................................... Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH � .............oF.... ? .:a '. :. ................. Trrtifiratr of Tompli anrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (k"• ) or Repaired ( ) b ....... .....------""-•-"-"--...."........:.............•-----"-•-•---"--"•-"---.............."•-•--....--••-•---...... Installerw at........... .............._ �....... -"----�F-I ., ."...... ........... o �"-•f/"?_7.--"-""""-•-"""--"-"--"-"""""-------"...............""""------... has been installed in accordance with the provisions of T�.mJ 5 of The State Sanitary Code as described in the ..., .. 'x'G € . . application for Disposal Works Construction Permit iTo.r..................................... dafed..-.. — ' THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONST� ED ASaGUANTES THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE......... ..`..�"� �-{C••-•--•---•.................................. Inspector.....•. ••I••----•.__._......_ ................----•- .... THE COMMONWEALTH OF MASSACHUSETTS PI " VBOARD OF HEALTH � ' „ �� No..... . _ FEE. ............ - %pant Workii Tonstrudion Virrmit Permission i hereby granted.... ....... /..VOW...................................................... to Construc r Re air ( ) an Individual Sewage Di os d System at No.. ....._. .. ._..._ ° Street -as shown on the application for Disposal Works Construction Permit No r Z Dated.r------- .............................. s .Z 7 , . Board of Health DATE----------------------- ----- '' � FORM 1255 -HOBBS & WARREN. INC., PUBLISHERS ' t e. c �o i ti 1 POST ,'' -- - _ �i _ 00/-7D - Iz' �.. �oQgp 38 050 -sip. fT Y Sid A PC. 8jl. 279 19C 3/ 1 CAa,acE I ' 23_s L'5ac.4 xvcq.e F Jolt I !' D O t to '�szB.►grs/ sum r� ��o' `1 �� ���p ( I � ' � / / � > to 3' %�. 0 O — / c c e I — r�4 is LoT ".Z7 - 7 040 .50 FT I 01 �- — s WR h P _ � 3 d I Ito �or 6',2G 1 NorE: Ec�VgT/oNs Bgssa o.v H.&--,gn/ S6-q Zrve-z- CERTIFIED PLOT PLAN LOCATION . ?-�'�7-. .,. . Mgss... . . . . . .. . . . . SCALE . DATE i✓ov. .z9 /977 Lt 1'�:'. is l) L 1•:,t l PLAN REFERENCE f�!/iry doo e •Z78 PACE 3/ .4Np 7o7_"'ZG /�' �' S.S/ot�/N•oN Ls1,v/) Coc-,eT , I�l�v!.. B.S!L. . . I CERTIFY THAT THE \\ SHOWN ON THIS PLAN I THE GROUND AS SHOWN HEREO CONFORMS TO THE SETBACK REQJ&4 OF THE TOWN OF WHEN CONSTRUCTED. c 9 ,r 7 GQEAT rJE?gDOW L•4Nc;' DATE . . . .� �• i . i AZM1,VGTON WOODS �ti:sZ r.�. ~1- 'tYOR 7 ETITIONER: F oGoB,� ' =^ - F�92H/NC TON, G�aNN. �:3=_.. • L • t TOP OF FOUNDATION CONCRETE COVER ' CONCRETE COVERS VVr7n4"CAST IRON nT � ` ' ; 12"MAX. � 12"MAX. PIPE (OR ' 4°ORANGEBURG(OR EQUIV.) EQUIV.) — MIN. PIPE - MIN, LEACH PITCH 1/4"PER.F7 PITCH 1/4"PER.FT. PIT PRECAST •' INVERT ° -J LEACHING L'O EL../�;Q7,., INVERT INVERT � . a PIT OR SEPTIC TANK DIST. yr4 w ';'. EQUIV. EL../-547 . . EL/471 .. >s ,•o INVERT Soo BOX EL./. 84.,. !. . . . . . .. .. GAL. INVERT INVERT U°' o: ::�. 3/4 TO I I/S ELI.s•SZ. ••: u.a v ELljoft.. %. Z WASHED STONE DIA N°y o ' '• �• �' PROR LE OF GROUND WATER TABLE SEWAGE DISPOSAL SYSTEM M NO SCALE i ' f SOIL LOG WITNESSED BY : i DATE !9": . !o,(977 TIME. . !!:oo.A,!7. PAuL C. /412.eAy BOARD OF HEALTH ' TEST HOLE I TEST HOLE 2 Tf/oy,ys �-• L!Ezcr�/ P.�. ENGINEER i ELEV. ./7.60 . . . ELEV. .. .. . . . . . . ,,, �-�wgap• �. .t�Ezcry 2L.s, . i DESIGN DATA : NUMBER OF BEDROOMS 3. . . . . . . . o TOTAL ESTIMATED FLOW . .-330, .. . GALLONS/DAY BOTTOM LEACHING AREA SO.FT. /PIT Cot.,i r /8B, .�o sAN� SIDE LEACHING AREA . , . . . . SO.FL/ PIT GARBAGE DISPOSAL .'YP"��`. . .(50% AREA INCREASE) t TOTAL LEACHING AREA . .'2670. . SQ.FT Ile PERCOLATION RATE 1 ESS RA-AY • 2 ;• MIN/INCH LEACHING AREA PER PERCOLATION RATE .:TSB.. SO.FT. .IYP. .WATER ENCOUNTERED NUMBER OF LEACHING PITS . . . . . . . . . . , . . . . . . . . . . BOARD OF HEALTH' PRELIMINARY )ATE . . . . . _ . . . . . . . . . . AGENT OR INSPECTOR � 1�OF M�ss9 r 3� - =0? THO WiGL/Ary E; �/oGAn/ 3 o K E .7Cc&,9T /4-lef7Dow Lq,ve- TNOMAS E.KELLEY CO: 1 O A ��2/7i.vG 13 NEERS—SURVEYORS 1, ToN Woo/�s. . . . 3A5 'LON-: Fo'' UR1yF p r rslC+�At =a ' PETITIONER a--, 1 A fir• �; \4:�::�. ; 'sr„« :E REAR DECK REMOVE POOR. 8 REMOVE CABINETS L. L_ AND APPLIANCESREMOVE DOOR TO G HANGE.SWING M. 13,4TH TILE II REMOVE ALL I=DCT11RE5,CABINETS 71LE Remove CLOSETS .. .... .4MA.DOO R3 '10 z . .. .... vx: LIVING ROOM HARDWOOD IF03 : — HEN 4 KHARD OD - - - - - - - - - - — o— � LAUNDRY M, BEDROOM TIE HARDWOOD. W00p REMOVE TILE — STOVE:: HEARTH .. . — — — — — REMOVE DOORS c — — — — — — — — — — — — — — — — — — — POWDER — — — �f04 — - - — TILE.. .. : — �O,f ENTRY HAR D REMOVE ALL REMO VE DOOR t0 FDC TIJRES:.CA811'IETS C ffi t9:E.. I-IAncE sWnIG MAW i mrir INDICATES WALLS OR FINISHES TO BF. REMOVED - - NOTE - ALL. FLOOR FINISHES .AND WINDOWS TO BE REMOVED AND REPLACED WITH NF-W- CONTRACTOR ENTi2Y TO REFER TO WINDOW SCHEDULE pEGK SULLIVAN RESIDENCE BAYSIDE BUILDING 453 OLD POST RD,COTUIT, MA ISSUED FOR PERMIT—24 SEPT 2014. 508=771 -1:040 SCALE: " = 1 ,=OII EXISTING FIRST FLOOR PLAN W/ DEMO NOTES X1 .1 y E SF N .. / REMOVE DOOR / OZ REMOVE BUILT-Q'1 OO'I O6 6EDROOM 2 / COMMON ROOM i BEDROOM 3. HARDWOOD HARDWOOD j HARDWO OD REMOVE BUILT-94 13 REMOVE CLOSET , REMOVE CLOSET - - REMOVE WALL PTD CONC 0 - - - _ MECHANICAL� O3 PTO coN STORAGE STOIZAG®ERC15E — S E. HARDWOOD Q� . R9M ALL BATH:2 : . FlXTURES, Y mlErs a TILE " TiLS 0 —INDICATES. WALLS OR FINISHES TO BE REMOVED NOTE - ALL FLOOR FINISHES AND WINDOWS TO BE REMOVED AND REPLACED WITH NEW, : CONTRACTOR TO REFER TO WINDOW SCHEDULE SULLIVAN RESIDENCE BAYSIDE BUILDING 453 OLD POST RD,COTUIT, MA 5�8-77� -�:04� ISSUED FOR PERMIT-24 SEPT 2014 SCALE: A' = 1 '-0" EXISTING BASEMENT PLAN W/ DEMO NOTES _ X1 .2 � E EA DECK _ new.SLOING DOOR I II -I06 w I M, BATH n E TILEN LOSET I Q s„ I I \ / 2 NEW iNF9L-L- FRAMING — Ic0 \ Lo J X:: 'fOb - - 'im / \ M B�D o00M OD — = - - - - - - - — - - I — \ I I _ Fan - -102 new Kire I I I I ,`00 new n L — I I v FRAMNG LIVING o00M E03 — — K FOOD CLOSET _ — - - - -.- - - - - - - - — — - - H D — _ ADWOD O O WOOD — STOVE — I: I I - - I I I �r04 �L_ -- - - - - - - POWDER TILE. .. AN — — 2 �fO�f QQ- En TRY HARDWOOD a TiHW CLOSET —INDICATES :NEW .WALLS OR OPENINGS IN EXISTING WALLS TO BE INFLLED - ENTRY. NOTE — ALL FLOOR FINISHES AND WINDOWS TO BE REMOVED AND DECK REPLACED WITH NEW, CONTRACTOR TO REFER TO WINDOW SCHEDULE SULLIVAN. RESIDENCE BAYSIDE BUILDING 508-771 -1040 . Fit/ 453 OLD POST RD,COTUIT, MA ISSUED FOR PERMIT—24 SEPT 2014 SCALE: /1/4'1 = 1 '-0" RENOVATED FIRST FLOOR PLAN A1 . 1 g m REPLACE EXISTING WITH aumfz FROM KITCHEN JE EGRESS _ � EG W ��,�� o COMMON ROOM: p � V. 0 p V. _ ^. - L 02 ® ( O 0. 1 BEDROOM 2 . _ HARDWOOD l Co S,D, I BEDROOM 3 HARDWOOD O 1 ch - — �N OOFJ Y B7TH HST WC i I � rI�W INFIL.L FrtaMo�L MEW INFIL aL W 4868 a — — _ PIEWNCO 266 LINEN N 03 HARDWOOD STORAGE/EXERCISE - — — Im L 004: MECH/LAUNO ll PTO CONC `D i F N Ilk Ilk NEW AyF1LL FRAMING 23`-28" 71_080 8'-78" 1O�_11aa. 0 —INDICATES NEW WALLS NOTE - ALL FLOOR FINISHES AND OR OPENINGS IN EXISTING WINDWOS TO BE.REMOVED AND SULLIVAN RESIDENCE WALLS TO BE INFILLED REPLACED. WITH NEW, CONTRACTOR TO BAYS I D E BUILDING 453 OLD POST RD,COTUIT, MA REFER TO WINDOW SCHEDULE 5OH-771 -7:040. ISSUED FOR PERMIT-24 SEPT 201.4 SCALE: %4" = V-0 RENOVATED BASEMENT PLAN A1 .2 se wA G E Sys7"EA�j PROF/L E :/n/57'AL A � R/S�J� A.v,c� " PVC /i./SPE C T/on/ PoR Ts To SD/G .S TES 7- �j�SUG T s F/N. FL UDR �'G. /9.8 y` ,� - 5` COVER To Lv/ ?'Rini 6" OF F/N• 6RA©E - oF F/N/sH 6AADE f' /5``!41-5 a U J<l g.5 vE✓/7' Tf' / E1-<1012 8 D" TP'2 E�. F/w J S N G OAM L OANI GRAa E V SCOPE of 2% 9^MiN< c0VSR W/7•H/N C. F/n/ GR. s 3 RisER AI /.A COVER To /2 /OR /z /O /O/t' /2 • � 36 M�9x, W 1 TN/N G<' Of F/hl- GLAD E. , SAN.G�'' f RISER Wi9TE.CT/6NT COVER �,G ' ANC t2� COVER OF I lj' GDAN/ /.OAM /Z STaNc PYC < tSERG./3 88 7 Sy/�,' G/3 �� 7 SY!' �3 ' /N V. 4/4v/D G.E✓EL "� SCN 'f0 PVC ScN• 5�o PtiG /NV /Z,j/ ZG EG ./G,// 25 EL./S<33 A /.V t� Cam) 500 Gam!G•H-20 G EACH G'NAMBE R••5' 1�4, io"MMN. l'}•" /NY' ivV'/3.23 /N1/•%3.a6 /z' C= I� Qx B�A Ff�E ctv�NEd ••: • D, 9 bovBLEE n� WASN ED L WS//ez srvNE/ , wS vM P. 'LID � BASE /2MM/N. EEF/°FTH. Lo0 5 /NNER /7` ti` MLsD/C/M C us,65 Ex/s 7'i1./ 'cows, /; 000 G 4 Z.Z- 0,1/ so/L_Is ABSORPTION sysT�tvJ /oYr % /oY,e /� S�PT/G TAN.'< w/TN /n/t-E�D t/TL E T TEES - coNST.ecJGT� D PER 3/0 CM/- /s- 227 - Z3 .607 OF ?E57 P/? SEWi46E SYSTEM DES/GN CAL. CUL,9T/01VS 41)ES/6/V bA/C.Y FLOW = 3 &,6,o AwA4,5 ,r //o 6PZ 3.30 G1,04. F/N/Sy aRA•o E M/N• SLOPE ,?Eq0/REh AB.SoRP T/oN AREA = CoVER wirN/N G" SI>lL, s 72. S T -p•972e- = v'UL Y 9, 2D/$4 2"COVER of / 330 G PO D. 7 54 F-I �/*'"—�2" STONE. �i9/�'f�ST+�,B� � USE TWO 6Z) SOO GAG. P,PEC. C"C. LEA C///n/G Ch1i9M8C,eS W/Tf/ .. - ._ So/G-5 3 , „ •.I, ... J '<";;'�Z�SDoG• CHAMBERS 3�`�'� � ,, OF DOC/8GE LV/TS/i�EJ� /f� -•//2 STDNE A/F'Duti/JO.Ch' 20 G/1.4Nt�ERJ> 3/y -l/2 L� Q C� C[ �y� -��L T., /�' . 'Cal-,f,T/c'W A;4T� '� .2 /l9J/e/% f'��' //UCh/ ABsoRPT/oN Ae,5A fo,Qo v/s/on/ ao v Q�EWAsHEo = C� CI 2EFF. b6P TN. 8o TTD M ARE,-! = 12 , 8,3 a' 2 5 = 920 , s F H 2.o a/AvG W A S fI E D p�,�C'�G', T, <.S-/"• .��",F-'7'"//•' 2,� sTon/t' Q CQ Q sroNE SO/G S 7 .�'T✓ ..�7G C.L:.9.5.5 = OrV� !/SE /.✓/T/V NO 6191?A6,46E a ejA/DE,P. f'AFi'G'E G G? 2s" /.S' lVaT_-Z/.?eX 7E o A!//77///t/ 4 5Ti9726' Z4•//4• 2 aX 19 - 2 - Y /i/7 TO BE 777Z- -6 IW,,6 [ A '/�✓ST�98G- " ,B/l./!.C',o C'i " /i're�'.,t�' / 'EGUGAT/� S- 4©Wl;'C�C Ce: iW7T.4c r . /�-s.�� s'}'� T �ls 22) 17,3 2 -�'; f1G/.. ..S'Et�/f16� ��'s`T�ivf ./r1.`A1`?-•5 =i%9G,�. .B� lt/�97"�/�'T/v.YT. `•�. . firE.G S,7f/it/� S/�'A'G G 8. /:.h'l E 4`sc-Z)645,7-i9l,/O �: THE x/sTrrv'G l5wl4,--,4 I-Z-4CI-111-/6 1017 -�, �'GL �� /''v�/,�'�� ��l.�T,y' � � �p/iD 1 ,W Xl'-Al0A -, p�5 t'� r2 to �3. /UD f.4'G,h'�/GL•/�L� .-5',S'r�G:�, PCCG//c' F`iP/4h' TD /�t/S,�',�'C`T/�JN �9rc%D �9i'i ,�'D1/.�G -�,,... �Q L o c r Q /�� /.s°T �l Elr` II 'f SEGt/AGE s%STZ/W UPS.r',91�.E �,�A/V Z/• , � < / �� ,(�toFPa,J is �� i r� 0 `, q rn ' P. tii `� o DOYL£,III - �.-t'/.sT/`N 3 ,8� �'D4/v10hi'EL L IA16 5'Ti"1'�C' P A� `Q � i S/ __ __ r' a' p No.33589 � .4. s "ssc� s /v1.41� s5� P.9kcEG s ST EAE� (J, YBo 4:72'Of o Al-s` �9 S\ P"�'T O V �r �/" �j�✓`-.3 4G 1? /c'U.5"T' PD�.L> fr t � .may j.'' � l �j -/f� SCALE= /"-5�v " ✓UL y /9 2D/� o. 8o' /E,! . .5"g •�y,4,r/Cr FP In /S, Z/ ..7) e /1/,r-r:� - s,4. s: 1,9N ��:' �. /=-9G iL/Ol/,7r`/, 1h�9, D2<6&G - _