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0015 PUTNAM AVENUE - Health
rutnam Aveniwi. . Cotuit _ A= 036—043 1't i I Commonwealth of(Massachusetts 6 .3 W Titl.e 5 ,Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 15 Putnam Ave , Property4Address';' Scott BIIZard - y Owner. Owner's Name-: _. ay information is IttU required for every CO Ma 02635 4/12/16 page. Cityrrown.i State Zip Code Date of Inspection IL1 CA 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 .Michael DiBuono use the return key. Name of Inspector ' DiBuono Sewer and Drain Company Name 8 Johns path Company Address S Yarmouth Ma 02664 City/Town; State Zip Code t t508.=364=9587 S103522 j.E ;:_Telephone•Number License Number _. .___..._..........._._____...._. ....__...._- - ?. B. Cei°tifcation a 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 4112/16 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. (Sins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 4OW I Commonwealth of Massachusetts `4 '° Title 5 Official lnspecti®n)`Fbrrr #` - Subsurface Sewage Disposal System Form- Not for VoIUhta'ry Assessments '':"` �• 15 Putnam Ave • I Property Address. Scott Blizard Owner:-', - 'Owner's Name information is required for every Cotuit '`. '` Ma._ _.02635.. ._ _.4/12/16' page. f1 CitylTown.Irir•.i 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: ® 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: System contains.a.1,500 Gallon septic tank, Dbox and 4 H2O 500 Gallon chambers in stone. B) System Conditionally Passes: II __ ❑ One or more system components as described in the "Condition_ al 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. r.. 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 septib`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)%" Eil�1`�1<�ilt riA i;.l'_)Il fil ( .,_i`?; In ju ti'n.'.rt ^I!. ` _ !,` N t:�`, ?'��i;l: r .... • ,. , xr1 �rlf:lo l an_a ?.. •D. FINMI . !ii{;y� L�9 Y* �A�9:A...1" iSF ?,_d' •t,,. Ai •Su>: .r,q.. . '{iJt- 1 t5ins•3/13" ° "` Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 c - Commonwealth of Massachusetts Title 5 Official, Inspection Form �.. Subsurface Sewage;,Disp(?sal System Form - Not for Voluntary Assessments; .,•= i:; 15 Putnam Ave Property Address Scott Blizard Owner Owner's Name information is required for every Cotuit Ma 02635 4/12/16 page. Cityrrown 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): 0 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): l ❑ broken pipe(s) are replaced 0 Y ❑ N ❑ ND (Explain below): f❑j :,� obstruction.is removed, ❑ Y + ❑ .N, ❑. iVD (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 envilronmeht. __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'W"' ❑ 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 Commonwealth of Massachusetts Title .5 -Official lnspecti®.nForr - SubsurfacetS.ewage Disposal System Form-Notfor Vdl'6ntary Assessments`' 15 Putnam Ave Property Address Scott Blizard wrier- Owner's Name information is required_ for-every_ Cotuit'':, '"i %'' Ma -_026.35.. _ page. Cityrrown:i State Zip Code Date of Inspection B. Certification (cont.) ly 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 S'AS 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. t 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:sv Ern x, 3 ��4 � i , ° cpl �1, .a ,:✓y' A>sTi.- �.. _ � ?'Bf;JF���";: **.This system passes if.the well water analysis, performed at a DEP certified laboratory, for fecal coliform,bacteria,indicates absent and the prese'nce;;of ammonia nitrogen and nitrate nitrogen is equal S • ,w fir a:,r egg ytb- s ..._ to;or,less_than 5`.p°prn,.provided that no other•failure;criteria are triggered. A copy of the analysis must his be attached to t form . .. is ,... . .. �� 3. :Other: E, D) System Failure Criteria Applicable to All Systems: i i',You=must indicate;"Yes" or"No"to each of the following for alFinspections: es,: Na: ; ;:.y'^•,�� I-!;E'I lll�7�:rJ iY�l'["'rl l•i i�",-r p� r'j�1 fj;. t. r� r--. Backup of sewage into facility or system component d Rto 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 clogggd,SAS;or,cesspool , Static liquid level in the.distribution box above outlet invert due to an overloaded or clogged SAS or cesspool . . ❑ ® Liquid depth in cesspool is less than 6":below invert or available volume is less than '/day flow t5ins•3l13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 �. Commonwealth of Massachusetts Title 5 Official.. nspecti®n. Ft a Subsurface Sewage,,Disposal-System Form Not for Voluntary. Assessments-;-,: wM 15 Putnam Ave - Property Address _ Scott Blizard Owner Owner's Name information is required for every Cotuit Ma 02635 4/12/16 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No . . 5 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 DIEP certified laboratory-;-for fecal coliform bacteria-Indicate,S absent and the presence �, • ;,> ' i :� of ammonia nitrogen and nitrate'nifrogen is-equal to,or less than 5 ppm, ..pro4ided'that no other failure criteria aie t,rlgge�ed::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 roust 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 toga,surface,drinking water supply the system is-located in a nitrogen sensitive area (Interim Wellhead Protection "'❑ " ❑ '' t` Area—IWPA) or a mapped Zone II of a public water supply well '.If you;hav"e 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 orfailed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system•bwner should contact the appropriate regional office of,the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Ff .. Title 5 Official Inspection"'form# _ Subsurfa cV6"td'wvage"Di'posal System Form -Not for Vofi;fnta'ry Assessments ---15-Putnam-Ave c' Property Address ------- .Scott Blizard-- - Owner Owner's Name information is required for every Cotuit" Ma 02635-- 4/12/16 page. _._. City/Town... :' State-- Zip Code- Date of Inspection C. Checklist Gheck:if the following have been done. You must-indicate'\"yes'Jor'`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'toithe'system recently or as part of this inspection? - , ., , , , ®' '` Were as built plans of the system obtained-` d an examined? (If they were not available note as N/A) ' Coy !cr�i ` i)9101j(jPrIi .riC-f<yP t( IiILIG i ® ❑ 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: 4 4 Number of bedrooms (design): Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example:' 110''gpd x�#of bedrooms):1f 440 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official,Inspection. Fora Subsurface Sewage Disposal System Form.-Not for Voluntary,Assessments..•.. . ,M 15 Putnam Ave Propert-y-Address--- __-_ _ .__ - _ Scott Blizard Owner Owner's Name- .. information is required for every Cotuit Ma 02635 4/12/16 page. City/Town' State Zip Code Date of Inspection D. System Information Description: System contains.a 1500 Gallon septic tank, Dbox and 4 H2O 500 Gallon chambers in stone Number of current residents:. 2 Does residence have a garbage grinder? :R . El Yes ❑ No Is laundry on a separate sewage system? (Include laundry.system inspection El Yes ® No information in this report')' Laundry system inspected? ® Yes ❑ No Seasonaluse? - ❑ Yes ® No Water meter readings, if available last 2 ears usage d 189 Gpd ( Y 9 (9P ))�. , Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): '-_66116ns per day(9pd) Basis of design flow(seats/persons/sq.ft., etc.): r . Grease trap present? El 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 Tille 5 Official Inspection form:Subsurface Sewage Disposal System•Page.7 of 17 Commonwealth of Massachusetts r ,r F Title 5 Official Inspection F.Grrn a Subsurfa*6b)S'd big`e`Disposal•System Form'- Not'for Voluntary-Xssessme'nts; ' k M t - vA �{snJl1 l'� c' 15 Putnam Aye e r ------ _._..._._ Property Address Scott Blizard Owner Owner's Name information is 1 A 1,.� required for every. Cotuit' _ Ma- __02635. _ _ -4/12/16 page. "`Cityg0wn'""`i State Zip Code Date of Inspection D. System Information (cont.) • Last date of occupancy/use' ,; .;;, Vacant Date - Other(describe below): - - t General Information'T ----- _ -Pumping Records:-. I;<; , I Source of information: None,provided,di;;; f vr'; .,• ; r:r.. Was system pumped as part of the inspection Yes ® No 3 ' , — - 7f yes; volume-pumped: - gallons How was quantity pumped determined? - - _- Reason for pumping: j Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool - I ❑ ' 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.at copy of latest -- -- --- -- --- -"-"-R'4 ,. inspection of the I/A system by system operatorunder'contract li eY "-'i�' }''Tigh!tank. Attach a copy of the DEP'approval=� r"'�Y'ry�'''''=' 9�''' - - - ❑ 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 r m � F Subsurface Sewage.Dispgsal,System Form Not for Vol untaryAssessments _. 15 Putnam Ave ,< . Property Address- Scott Blizard Owner Owner's Name information is required for every Cotuit Ma 02635 4/12/16 _ .. page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Approximate-age of all components, date installed (if known) and source of,information: r 8 Years Were sewage odors detected when arriving at the site? ❑ Yes ❑ No Building Sewer(locate on.site plan): Depth below grade: 2.5 feet Material of construction:-. ® cast iron ® 40 PVC ❑ other(explain): _ ....._Distance from_private_•watersupply well or suction line: z. Comments (on condition of joints, venting, evidence of lea kage; System is vented through the roof Septic Tank (locate on site plan): , 1 Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) 1500 H2O If tank is metal, list age: Y q years Is age confirmed by a Certificate of Compliance? (attach a copy,-of certificate) ❑ Yes ❑ No ` Dimensions: Sludge depth:. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title Official I�specti®a� 'F r Subsurface`S®wage�Disposal System Form'-'Not for•'Volunfary`Assess�ments• 15 P_utnam.Ave 4 Property Address Scott Blizard Owner Owner's Name information is 1 j,� c .. ' Cotuit'``` Ma - 02635- --- - -- 4/12/16, required for every ; page. City/Town'""-`' "."' '" State.. Zip Code -- -- Date of Inspection D. Systems Information (cont.) ,Septic Tank (cont:), :~ ,24 — Distance from top of sludge to bottom of outlet tee or baffle cum thickness Distance from top of scum to top of outlet tee or baffle 42" - Distance from bottom of scum to bottom of outlet tee or baffle 1" Sludge stick Hbw'were'dimensions�determined? " - Nape Measure Comments-(on pumping recommendations, inlet and outlet tee or baffle-condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): No evidence of leakin ,Tees and or baffles in place at time-'of inspection , - -j 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 bbttom-bff'kum to bottom of outlet tee or baffle Date of last pumping: Date (Sins•3/1`9. Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Off gia•l Inspection Form , Subsurface Sewage Disposal System Form - Not for Vol untarycAssessments= wM 15 Putnam Ave - - Property-Address - - - -= Scott Blizard Owner Owner's-Name information is required for every Cotuit Ma 02635 4/12/16 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle..condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc:) Tees are in place and levels are normal. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below,.grade:.,. Material of.construction I : ❑ concrete ❑ metal ❑ fiberglass. .,_ ._ . ❑ polyethylene . ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes .. ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy_attached?, ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Offi-c`ial lnspecti®* `Fiorrri Subsurface'•S'dWd§'&'D'isposal System Form = Not for-'Voluntary Assessments wM I.X- 15 Putnam_Ave ...--,. Property Address aa •'," '" Scott.Blizard -__.. . __. . .._. Owner Owner's Name - information is ,; ,,, 4 Cotuitl .Ma _ __02635--- .._._ 4/12/16 required-for--every, - page. l'-Cityrrown'"^ } State Zip-Code. _Date of Inspection D. System Information (cont.) a Distribution Box (if present must be opened) (locate on site plan): i. Depth of liquid level above outlet invert Level and at normal level _ Comments (note if,box is level and distribution to outlets:egaal,�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.): *,If pumps or alarms are not in working order, system is a'conditional pass. -Soil As System (SAS) (locate on site plan, excavation'not`required):i If SAS not located, explain why: t5ins•3/13 i Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 ®ff%cia0 inspection otr a Subsurface Sewage Disposal,System Form - Not for Voluntary Assessments;,,, :Y,,_ i': 1 15 Putnam Ave Property Address - — Scott Blizard Owner Owner's Name information is required for every Cotuit Ma 02635 4/12/16 page. City/Town State Zip-Code Date of Inspection D. System Information (cont.) Type: El leaching pits number: ❑ leaching chambers `- %ntam 4 ❑ leaching galleries . number: ❑ leaching_trenches number, length: ❑ leaching-fields __number, dimensions_ 0_ -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. , .I< .�s ., k .'.1 ii1t 1t+.1.^�" w.:., :';. - �' .. C'..• 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 4 Commonwealth of Massachusetts 71 Title 50Yfficial Inspectio"n SubsurW&"S6iW9d6-D_19posal System Form Not for V6[uR'f LAssessments' 15..Putnam__Ave.__ Property Address Scott Blizard Owner Ownel's Name information is required for every Cotui,t --Ma 02635 4/12/16 page. llooity/Tb- 1�,u:. wn-, State-_ -.--Zip-Code Date of Inspection D. System Informatio' n (cont.) 10'r Com' 'ftibhts'(ndt6'd6riditi'o'n of soil, signs of hyd,raUlid failure, levill of ponding,-condition of vegetation, etc.): .No pondirig no break out Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 i Commonwealth of Massachusetts Title 5 Official -Inspection For a - Subsurface,Sewage Disposal,System Form - Not for Voluntary,Assessrpents �M 15 Putnam Ave w W Property Address _ Scott Blizard Owner Owner's Name information is required for every Cotuit Ma 02635 4/12/16 page. CitylTown' 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 t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts Title 5 fficial''Inspection rm Subsurface Sewage Disposal"System Form -Not forVoluntary Assessments . 1'5�Putrian'Ave._ .a .> _r,� �c✓�: Property Address Scott BIIZ'ard;i` Owner Owner's Name ; ti;., j;,,• information is required for every CoWit Ma-.`.'; '; 02635 f,. 4/12/16 page. -City/Town _f - - State, Zip Code .,, Date of Inspection D.'System Information (cont.) Site Exam: El Check Slope ' Surface water_ ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 10+ ft feet Please indicate all methods used to determine the high ground water elevation: i ® Obtained{from system design plans'on-recofd' 10/1/08 If checked, date,of design plari reviewed: Date t � i ❑ Observed.site (abutting property/observation hole within 150 feet of SAS) ❑ Checked'with local Board of Health -explain: El Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: Test hole data on plan. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 r 4/12/2016 Assessing As-Built Cards TOZ OF BARNSTABLE r: . LOCATION SEWAGE# MC�f�`/� VILLAGE ,� ASSESSOR'S MAP&PARCEL Q INSTALLER'S NAME&PHONE NO. ey�,�j i ��5 �:J G/�g ti-2� r_- - SEPTIC TANK CAPACITY LEACHING FACILITY:(type) Cl NO.OF BEDROOMS OWNER i:• „ . PERMIT DATE: COMPLIANCE DATE: - t� 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 _e 3$ � 1 http://www.town.barnstable.ma.us/assessi ng/H Mdispl ay.asp?mappar=036043&seq=1 1/2 4/12/2016 Assessing As-Built Cards , l ' p�.le27 h�G pis tt�`.„C C"'.,.. r,,r•' ` . http://www.town.barnstable.ma.us/assessing/H M displ ay.asp?mappar=036043&seq=1 212 i Commonwealth'&Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 15 Putnam Ave Property Address Scott Blizard Owner Owner's Name information is required for every Cotuit Ma 02635 4/12/16 page. Cityfrown 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 No. -THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Zippricattou for �Di.5ponl *pgtem Cou6tructiou Permit Application for a Permit to Construct(/Repair( ) Upgrade( ) Abandon( ) 1K Complete System ❑Individual Components Location Address or Lot No. 15-/%e�-eaAq Q Owner's Name,Address,and Tel.No. < n Assessor's Ma Tarcelem— t/ Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 47or, e _ Type of Building: Dwelling No.of Bedrooms Lot Size Z Srs- sq.ft. Garbage Grinder ( ) Other Type of Building s ti'�1G� No.of Persons Showers( ) Cafeteria( ) Other Fixtures ��+,J ® � 7 Design Flow(min.requi ed) 1 70 gpd Design flow provided "T `�s gpd Plan Date 911 Z-10'9� NurnTber o;4f eets Revision Date Title C A c 5; W Plt2 Size of Se tic Tank 00 Type of S.A.S. ®l>'f��i'l c lye�%�el!::S Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of He It rj�ned _ Date Application Approved Date �{ Application Disapproved by: Date for the following reasons Permit No. C> -R-1 Date Issued L___--.-----_---------r— ——————— No., /L �.-r . Fee - THE COMMONWEALTH OF VASSACHUSETTS� Entered in compute# PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes application for 0i!6p0-5ar ,p$tem Congtructiou Permit Application,for a Permit to Construct/ Repair O Upgrade O Abandon O ® Complete System ❑Individual Components Location Address or Lot No. I f� � I�a(/ Owner's Name,Address,and Tel.No. - µ f y 00 'rt /2 zp-Gl4l7 Assessor'sMaffarceloh PPG13 6 ;7,6 / �a Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms 7 _ Lot Size /� � � y sq.ft. Garbage Grinder ( ) Other Type of Building /T rp No.of Persons Showers( ) .Cafeteria( ) Other Fixtures .� Design Flow(min.r//e��qui ed) 0ya� gpd Design flow provided `7 ,/ . gpd Plan Date 7117 yyak�'`�! Number of sibeets Revision Date �. Title ' re t e*$1 /ir Alt?e AClr 15 /` C!' W4-1'," Size of Septic Tank f QQ Type of S.A.S. A>Ao,� Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewageydisposal system in accordance-with the provisions of Title 5 of the Environmental Code and not to place the system in operation uniil a Certificate of Compliance has been issued by this Board of Health. ( `11 vle Date Application Approved by Date �� T Application Disapproved by: Date c for the following reasons Permit No. :• - Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE;MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed (i/ ) Repaired ( ) Upgraded.( ) Abandoned( )by rr � at j ,/"�/�`?QA�`1 �Ci �"/�1`L l f 2``� h been constr/u'�' accordance de with the provisions of Title 5 and the for Disposal System Construction Permit No. "'/ dated Installer A%/`�(�"�® ,/ r Designer #bedrooms Approved design flow gpd The issuance of this permit sh o be co st led as a guarantee that the system�.t'��fPasd/essiig�ned� 0 Date �/ Inspector U `2/t-. 0 -------------------------s------ —yj No. ��-'�� r Fee--� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS i5po!gaf *pgtCM Construction Permit Permission is hereby,granted to Construct (V/) Repair ( ) Upgrade ( ) Abandon ( ) System located at /� o6m7-0,017 C/14, `s and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Construct�io�njust be/completed within three years of the da e of this ermit. Date +`/ 1 ( L// ,. Approved by s_ Town of Barnstable •.°�I" l°�o Regulatory Services P Thomas F. Geiler,Director * snxxsTABM M^ Public Health Division i630. �0 Thomas McKean;Director 200 Main Street,Hyannis,MA 02601 Office..508'862-4644 Fax: 50&790-6304. Installer &Designer Certification Form Date 40- 1~G ' Sewage Perm it# 7 V Y Assessor's Map�Parcel 40 36 Desi g ner:' AN !d di LiInstaller: � � Address 0 6 r 2 Address: RIX Ile On P was issued a ermit to install a (date) // (installer) septic system at /St� �z� Cd � based on a design drawn by (address) dated' 7' .2'o V < (designer T , tify 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. Stripout (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' laterallrelocation 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. Stripout (if required) was inspected and the soils were found satisfactory: CP (Installer's Signature) : � r FQt9��y (Designer's Signature) (Affix 's Stii}li Here) � sf. IT PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH alv 'CERTIFICATE OF COMPLIANCE WILL NOT: BE ISSUED UNTIL BOTH S. FORM :AND AS- BUILT CARD ARE RECEIVED BY THE'BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. QASeptic\Designer;Certification Form Rev F03-09-06.doc Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 15 Putnam Avenue '� ���0� r, Oy3 Property Address Alice Turner Owner Owner's Name information is required for Cotuit MA 02635 July 16 2007 every 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. Important: A. General Information When filling out forms on the computer,use 1. Inspector: only the tab key to move your David D. Coughanowr cursor-do not Name of Inspector use the return key. Eco-Tech Environmental Company Name mb 43 Triangle Circle ompany Address andwich MA 02563 noun ty/Town State Zip Code 5 8 364-0894 1328 -- y Telep2phone Number License Number CD (^S aL f ��- CO •/1 B. Certification I certif�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 peIirformed 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 1W �� - A�� July 16, 2007 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. t5-pass_cp.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 15 15 Putnam Avenue Property Address Alice Turner Owner Owner's Name information is required for Cotuit MA 02635 July 16, 2007 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 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: Inspector's Note 4 This system, in its present condition and with the current state of occupancy, has been found in this report not to be a threat to the public health or the environment, However, in my professional opinion, as a part of any renovation or reconstruction project, or before the dwelling is occupied in its current condition, I would strongly recommend that the septic system be replaced with a complying title 5 septic system. David D. Coughanowr d.b.a Eco-Tech Environmental shall not be held liable for any incident resulting from the operation of the current septic system, or any collapse incident that might occur due to future destabilization of the cesspool's concrete blocks. 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 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 t5-pass_cp.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 f Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 15 Putnam Avenue Property Address Alice Turner Owner Owner's Name information is required for Cotuit MA 02635 July 16 2007 every page. City/Town . State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ 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: 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 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. t5-pass_cp.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 15 l Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 15 Putnam Avenue Property Address Alice Turner Owner Owner's Name information is required for Cotuit MA 02635 July 16, 2007 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SAS is less than 1.00 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or 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. t5-pass_cp.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 L_ Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 15 Putnam Avenue Property Address Alice Turner Owner Owner's Name information is required for Cotuit MA 02635 July 16, 2007 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (corl Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the.system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5-pass_cp.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 15 Putnam Avenue Property Address Alice Turner Owner Owner's Name information is required for Cotuit MA 02635 July 16, 2007 every 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? ❑ N/A 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? No Tank ❑ ❑ 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)] t5-pass_cp.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 15 Putnam Avenue Property Address Alice Turner Owner Owner's Name information is required for Cotuit MA 02635 July 16 2007 every page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): n1a Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): n/a—no plan Number of current residents: 0 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 ears usage d 14 gpd 9 ( Y 9 (gpd)): Sump pump? ❑ Yes ® No Last date of occupancy: unknownDate 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: Last date of occupancy/use: Date Other(describe): t5-pass_cp.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 15 Putnam Avenue Property Address Alice Turner Owner Owner's Name information is required for Cotuit MA 02635 July 16 2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: Pumping history uncertain. 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 Two ® Single cesspool Two ® 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: Age unknown. Dwelling was constructed in 1900. No design plan found at Board of Health. Were sewage odors detected when arriving at the site? ❑ Yes ® No t5-pass_cp.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts . W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 15 Putnam Avenue Property Address Alice Turner Owner Owner's Name information is required for Cotu►t MA 02635 July 16 2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 1 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.): Sewers appears structurally sound with no evidence of backup or leakage into dwelling Septic Tank (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? t5-pass_cp.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 f Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 15 Putnam Avenue Property Address Alice Turner Owner Owner's Name information is required for Cotuit MA 02635 July 16 2007 every 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.): 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 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): t5-pass_cp.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 15 Putnam Avenue Property Address Alice Turner Owner Owner's Name information is required for Cotuit MA 02635 July 16 2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank (cont.) 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 Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No t5-pass_cp.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 • Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 15 Putnam Avenue Property Address Alice Turner Owner Owner's Name information is required for Cotuit MA 02635 July 16, 2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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: Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ® overflow cesspool number: 2 ❑ 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.): Soils above cesspools were unsaturated. No evidence of breakout, surface ponding, damp soils, lush vegetation or other evidence of hydraulic failure was observed. Cesspools are constructed of concrete blocks. NOTE ON BLOCK CESSPOOLS—Block cesspools consist of concrete blocks arranged in a beehive formation and are held in place by gravity and soil pressure. Driving vehicles over or near block cesspools could potentially destabilize the structure and lead to collapse.DO NOT DRIVE VEHLICES OF ANY SORT NEAR CESSPOOLS. See inSDector's on note Daae 2. t5-pass_cp.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 15 Putnam Avenue Property Address Alice Turner Owner Owner's Name information is required for Cotu►t MA 02635 July 16 2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration 2 primary and 2 overflow Depth—top of liquid to inlet invert 5 ft for cesspools 1 & 3, 0 for cesspool2 Depth of solids layer See comments Depth of scum layer See comments Dimensions of cesspool 4 ft x 5 ft approximately Materials of construction Concrete block Indication of groundwater inflow ❑ Yes ® No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Cesspools 1 and 2 each had a sewer line running in and were also interconnected. Cesspool 3 was dry and had a line running out,presumably to cesspool 4 which was not uncovered due to its proximity to water, gas, and electric lines. Cesspool 4 is likely under driveway. NOTE ON BLOCK CESSPOOLS—Block cesspools consist of concrete blocks arranged in a beehive formation and are held in place by gravity and soil pressure.Driving vehicles over or near block cesspools could potentially destabilize the structure and lead to collapse.DO NOT DRIVE VEHLICES OF ANY SORT NEAR CESSPOOLS.See note pg 2 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.): t5-pass_cp.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 • Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 15 Putnam Avenue Property Address Alice Turner Owner Owner's Name information is required for Cotuit MA 02635 July 16, 2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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. A CESSPOOLS ARE MADE OF CONCRETE BLOCK. 2 B EXISTING / DWELLING / w f J w w LOCATIONS # 15 Z r �3 A B C D p 1 25.5 f t 30 f t 4 2 26 ft 14 ft 3 26 ft 14 ft i ry I CESSPOOL PUTNAM AVENUE NOT TO SCALE NOTE ON BLOCK CESSPOOLS—Block cesspools consist of concrete blocks arranged in a beehive formation and are held in place by gravity and soil pressure.Driving vehicles over or near block cesspools could potentially destabilize the structure and lead to collapse.DO NOT DRIVE VEHLICES OF ANY SORT NEAR CESSPOOLS t5-pass_cp.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 I� • Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 15 Putnam Avenue Property Address Alice Turner Owner Owner's Name information is required for Cotu►t MA 02635 July 16 2007 every 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 ground water: 40+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: Barnstable GIS Department records You must describe how you established the high ground water elevation: Town of Barnstable GIS Department records indicate that the property is over 40 feet above groundwater table. t5-pass_cp.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 / 2 2'-O" g_O - --�-rIIIIIII IIIIII iI II II N III n+ N-W_ N.CSD=FI OFW IL WINDSAT J V— L----- O I 46"VANITY 4'6"VANITY 0mm m O _ Il- _ D-p�tl F m 4'- 0 7-3 I/2" 3-0" " 0 � b IM w D 2'O U) IM m D IL =L z DNTrZ:` .. LI J ----- W �--- W -_- — �-3 gZ< I I I a $N I ----------------- - J 4'- - 1 2'-4" EXISTING HOUSE 51 tsi 4U4,d1A,1DDITION k 5�� l�'�� Ave . Coy U � 1� r TOWN OF BARNSTABLE LOCATION S DOT Pr SEWAGE # VILLAGE C6T V l ASSESSOR'S MAP&LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) � p 5 (size) SE 4 04AWY NO.OF BEDROOMS._; BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by R tj2 —Ttc l-I TO OF BARNSTABLE rr LOCATION SEWAGE#� / (J VILLAGEri/ ASSESSOR'S MAP&PARCEL 0 -3 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) .S?0F�G`ek&4-y ysize) .NO.OF BEDROOMS .OWNER PERMIT DATE: YLlahl" COMPLIANCE DATE: D D Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility ` feet Private Water Supply Well and Leaching Facility(if any wells exist _ on site or within 200 feet of leaching facility) feet Edge of Wetland and Leaching Facility(if any wetlands exist within 300 feet of leaching facility). feet FURNISHED BY �, /riG 3$ ' 1 ` �� Iq Health Master Detail Page 1 of 1 Longed I:a As: TOJiN\miwar.d^I Health I Master Detail V•ledne<.day,Nair 5 2010 Application Center Parcel Lookup Selection Iterns Parcel Septic Perc (._. well Fuel Tank Parcel:036-043 Location: 15 PUTNAM AVENUE,COTUIT Owner: BLIZARD,SCOTT A&LAURIE S Septic changes have been saved. Septic 2,09/04/2009 Septic 1,04/14/2008 New Septic... .... ........... ............ .. ... ... .... .... Permit number 2009 285 Permit type: New Construction Complete system: F. ya I Issue date : 09/04/2009 Complete date Septic tank size 150OX Type/Size of SAS NA Installer: Bortolotti,Robert J.,Bortolotti Construction Card on file: r I/A service type Select service Innovative/Alternative Technology type: Select IA type . Variance date : Abandon complete date : Abandon permit number: Repair deadline date iMi Repair notification date : Keyword: Comments: 1 ' Delete Se+++Installer Must Sign+++Building Sewer from new garage to existing Sep ptic ................... ..................... New Inspection... Number Date Inspector Result 0 ' Select Inspector Select result 1 Comments: 1 .... ..... ..... Save Septic Changes Return to lookup _ _.........._.. _ http://issgl2/intranet/healthMaster/HealthMasterDetail.aspx?ID=036043 5/5/2010 3,rJ te A iff Nor No. ZOO Fee :THE COMMONWEALTH OF MAJ111S((v//NHZUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Rpplication 7Repai, goml *patentCow6tructiou Permit Application for a Permit to Construct( O Upgrade O Abandon O ❑ Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address,and Tel.No. ee:rvi7- 24-415 Assessor's Map/Parcel C3� �(� �� Fl-f�a/ D l 3 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms —[ Lot Size sq. ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria Other Fixtures Design Flow(min.required) k1114 gpd esig flow pro 'ded A/4 gpd Plan Date lilu mber f sheets Revision Date Title Size o epfic Tank l QUO Type f S.A.S. Description of oil Nature of Repair orAlterations(Answe when applicf!90 e) i Ip r .4 � °L(L IF12ca A°2�A --VO F,< CS"( a N O LaiAl Sas►P-C L �\ Date last inspecte Agreement: The undersigne agr es to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the pro is ons of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been iss d by this B o a] s Signed Date Application Approved by S. Date Application Disapproved by: Date for the following reasons Permit No. 2 G D g-- Date Issued `� 4 ---------------------------------- - ---------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( Repaired Upgraded ( ) Abandoned( )by at A w,9 « Co '7c.,1 7 has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer 't:�p Z-'tc3 L O-C-c' Designer N4 AA #bedrooms �? Approved design flow /(lfT^ gpd The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector ; 4 iA ' No. .00 Z i . t S +/ I / +11( Fee w4 T THE'COMMONWEALTH OF MASS&,SETTS Entered in computer: �r----- PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ip ` 1giction f;Repair i� OgaIY *pqten� COTC$trUCtiOYCerInit Application for a Permit to Construct( O Upgrade O "Abandon O ❑.Complete System ❑Individual Components Location Address or Lot No. �S l .vAdt 1 /�(/LS Owner's Name,Address,and Tel.No. Assessor's Map/Parcel �3� ©(� �l � � �' 1— , t. Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage,Grinder L. Other Type of Building No.of Persons Showers( ) Cafeteria( ) f Other Fixtures n \ ` Design Flow(min.required) WA gpd esig flow pro ided /t/Z gpd 4 Plan Date umber f sheets Revision Date v Title Size o eptic Tank / 5-aO Type f S.A.S. Description of oil Nature of Repair or Alteratio s(Answer)J when applica le) I L-0 N !_ r,w It 2 �►Z —r0 >< ;S"f lI N UO� GA.L• SF T'L wC�w1 1 Date last inspected Agreement: The undersigne agryes to ensure the construction and maintenance of the afore described on-site sewage disposal system in r accordance with the pro is ons of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been iss d by this Bo d of tal Signed 9LfG:/6 i Date ��� � —604 Application Approved by Date '�9 CS 9 Application Disapproved by: Date for the following reasons Permit No. Date Issued ��,—n..�¢s��s5+ �e't�.a�dia:�3�5ii•_�rap� .�.��.�» '.3 THE COMMONWEALTH OF MASSACHUSETTS ` $ BARNSTABLE, MASSACHUSETTS ` Certificate of Compliance 4 THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( Repaired ( ) Upgraded ( ) Abandoned( )by e-\,ein I at PU T ta4 6,1 A\/o5 eD iri) T has been constructed in`a�ccorda9ce7 � With the provisions of Title 5 and the for Disposal'Sysfem Cofistructio' Permit No. dated Installer �Z�c� L.UT�`. Designer AJ4 #bedrooms Approved design flow /1 /A- gpd The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector (�-- '�—�--•----=-'�sz�a�si :—��a�"r�.ec,E'ee'+irauia 's#g'��aa �� No. Zoo/i� — Zec- k.�U t 1. IO 1 IJ k S 2 Lu 1f✓L d N L��--(( Fee ,�/�_�--• THE COMMONWEALTH OF MASSACHUSE'�TS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS ;I5pozat q§pztem Con5trUction Permit Permission is hereby granted to Construct (L-< Repair ( ) Upgrade ( ) Abandon ( ) System located at �/�!� T/VA rN \J 15— �U-7U/7 X, - 71 and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty_ to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this pe' it. Date ��� © � Approved by Y° Bk 24496 PS 81 0.19104 04-20---2010 a 12 '52P. DECLARATION OF RESTRICTIONS Scott A.Blizard and Laurie S.Blizard,husband and wife,both of 115 Greenlodge Street,Dedham,MA, (hereinafter referred to collectively as the"Owner") being the record title holder of the real estate known and numbered as 15 Putnam Avenue, Cotuit, MA,being more particularly described in a deed recorded with Barnstable County registry of Deeds Book 2905, Page 276 (hereinafter referred to as the "Property") at the request of and in agreement with the Town of Barnstable Board of Health hereby makes and declare said Property to be subject to the following restrictions and provisions: 1. So long as said Property is serviced by an on-site subsurface sanitary sewage disposal system under the State Environmental Code, Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage, any dwelling constructed or to be constructed on said Property shall contain no more than four (4)bedrooms. 2. Nothing contained herein shall prohibit or prevent said Property"from connecting to any public or private sewer system. 3. In the event that said Property is connected to any public or private sewer system this restriction shall automatically lapse and shall otherwise be null and void and unenforceable by YP party. art . For title see deed recorded with Barnstable County Registry of Deeds Book 23905,Page 276. WITNESS OUR BANDS AND SEALS THIS_ DAY OF APRIL 2010. Sco A. Bi Laurie S. lizaW r' t� COMMONWEALTH OF MA.SSACHUSETTS Norfolk, ss April , 2010 On this�day of April 2010,before me the undersigned notary public,personally appeared Scott A. Blizard and Laurie S. Blizard,proved to me through satisfactory evidence of identification,which were Massachusetts Driver's Licenses, to be the persons whose names are signed on the preceding or attached document, and acknowledged to me that they signed it voluntarily for its stated purpose aI I-,. A• 4 Notary Public My Comm. Expires: 12/10/10 �' �1•"'°`• PETER A?AHKA.H �. Z NOTARY PtL' CgO�A,�ISONWEALTH OF ''a •m°... :'�s 7 see", MyCOmm.EXp=D80.1Q° r� GG4g�,sJp 4• e oA ,A4Ay911!? . �r WMISTASIE REGISTRY OF DEEDS r i ` 20'-0' 1 a-O' G'-3" I 4'-8'1/2' - ^ fff o WOOD DECK in I ,•-9. m 1 r--� ----� o KITCHEN 1 ^eW OA= m of Z BRE KFAST 5`3' O O I I 2 W 8x35 STLBEAM_ F Q 1 , W _ Z 1 8'-9' 3'47 112' - a 5_ARING N.•A_ (l i W 8X21 STL BEAM J W 2 C AT5 t; I N FAMILY ROOM o new M -- — ------------ N C LAUNDRY I N I � I Ou I "� • cAn. I 2 T-T a nl POWDER RM. � Z rn ,A5!N5,`RT — ?VAroI" — N 5'4Y k-10' . 5'0•R i1T C'J5TOV SHOWER 3 I t DINING RM. A WALK IN IF O CLOSET F O L I FP II / I � 11 i7 1 0 0 Z . I O ew 1 W BEDROOM -- exsn,�g FOYER ur 0 exrsting PORCH NOT' R`.'AR i'RAV!NG/TR-V ON P..W,, FRONT COV-R_`7.'ORCH A51 J. S(!5T!NG 7_5;NTO R_`V A!N FIRST FLOOR PLAN PDF Created with deskPDF PDF Writer- Trial :: http://www.docudesk.com za-o ROOF DECK a� 4'.10" _.l a-21 to 1 a.2" - A'-I CP. 1:-144- B 0 B BATH 0 — �? MASTER BEDROOM j Z I M - ----------- WALK IN - CLOSET ^? r — ;r \------------- ---- I I • �L J IL I I 5'ruelsnwrt .Ns, I I I LOFT 2 BATH B _ � a !I • I c var:x:r>rix Boa: I I O 1 t`N JRG:r0 N-W 9 N.V: b I I II I = ue LI I L1J BUI Li 11 ❑ CL B I D I p Y I z I� I I F— ., E,eeng 2 I x g BEDROOM I X W I I I I L nev. I R!VoveRp.5 WALK IN i I :xrWNGG xl I CLOSET ---------i I I I: I I L-------�--- -----.-----.------------- SECOND FLOOR PLAN PDF Created with deskPDF PDF Writer -Trial :: http://Www,docudesk.com 3a o 10'-0" I. . new . ROOF DECK 4'-10' 1 d-2° I d-2° 4'-10' - a b L r v I I `a I Z 2� I O a BATH �� ~ 3'- 112' N I I N new - W b MASTER BED OOM Z �r------- --- I '. O II WALK IN CLOSET (D i o =�----- --- O r-------J\ 1 1U8/SHWR. 7N`N I I J existing. 2 BEDROOM BATH B I I I, I 1 1 I I I I uP o I BUILT IN C.L —� U B I I p IL-r I Z IJ 1 I F- exntng 2 i B BEDROOM Xo W I , II I I IL new I !vov_m's l I WALK IN I wi7ovi 7rl I CLOSET /L______—_, I I I - I I I L—————————— ---------------------- 4 SECOND FLOOR PLAN t� 1/4.'=I.-U. PDF Created with deskPDF PDF Writer- Trial :: http://www.docudesk.com i t Town of Barnstable P# l a1 c Department of Regulatory Services Public Health Division Date 9 t MASS. 200 Main Street,Hyannis MA 02601 Date Scheduled /! L/<" U Time Fee Pd, Soil Suitability Assessment for Se e Disposal Performed By: Witnessed By: b AIA LOCATION& GENERAL INFORMATION / f Location Address �j Owner's Name 1 t( 11 �O KYGC vo dried Address �� t/C o . Assessor's Map/Parcel: 4-3 b?SLo N+la�u� ►. Engineer's Name NEW CONSTRUCTION REPAIR Telephone# 6Oa 631 1$6 3 e Land Use t tG«.� Slopes(%) Surface Stones 966J 0� erg-41 Distances from: Open Water Body 1M@a ft Possible Wet Area l t�C'} ft Drinking Water Well q0 ft Drainage Way ft Property Line ft" Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands to proximity to holes) f 0. - -- - - - C�l Y 3 � �F7 > M, Parent material(geologic) Depth to Bedrock 9 Depth to Groundwater. Standing Water in Hole: Weeping from Pit Face Estimated Seasonal High Groundwater A'1Jil_l DETERAGNATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: in. Depth to soil mottles: in, Depth to weeping from side of obs.hole: in, Groundwater Adjustment €[. Index Well# Reading Date: Index Well level , Adj.factor, ,q� Adj.droundwaterlevel,,,o PERCOLATION TEST Uatt: 0 'line slily. Observation Hole# Time at 9" Depth of Perc _/047 Time at V Start Pre-soak Time @101 � 'rime(9"41) End Pre-soak RateMinJlnch A, YV �I� yto+ k04 Site Suitability Assessment: Site Passed 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. v Q XSEPTICIPERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture .Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. i toGravel) 0 . r 27' S FI M Mel ,0 DEEP OBSERVATION HOLE LOG Hole Depth�froto .. Soil•Horizon Soil Texture Soil Color ` S61' Other Surface(in.) (USDA) (Munsell) Mottling .*(Structure,Stones,Boulders. - 3" M * . SctiM Sy y P1 Al a DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. onsi en Flood Insurance Rate Map: Above 500 year flood boundary No_ Yes Within 500 year boundary No= Yes._.� Within 100 year flood boundary Nor, Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervi material exist in all areas observed throughout the ` area proposed for the soil absorption system. -; u ma terial? what is the dep th of naturally occurring s If not, P Y gervio p Certification I certify that on �c t- (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 3 10 CMR 15.017. D� • r Signature Date • QA$EPT1CIPERCF0RM.D0C ' �P MAP 36 LOT 43 �P P AREA = 12,854. 7 `Owe<< QPUTNAM AUE ( VARiABLE) S. F. 9Z y� SS N89°01'20"E LOCUS a /yYYW YY`/vV YY 1 r - tj r 11 8' r ` �' BND. COOLIDGE ST o � 70 RVE � I EXISTING 12.0'— r~ ' CESSPOOLS `w � � RESERVE � ,�`J ��-"� TO BE REMOVED r n GENERAL NOTES: - LOCUS NTS1 10.83 x 40 SAS AREA � /�so� ' SYSTEM O O L RECORD OWNERS, GOODSPEED FLORENCE DC r- I C/❑ EGAN THERESA 3 I _ 29. O r i 1.220 MAIN STREET 1 N/F CDTUIT, MA 02635 O s� MAP 36 LOT 50 DEED BK: 11640, PAGE 312 �� �0 MOORE PATRICIA O p EXISTING �i v N 2: PROPERTY IS SHOWN AS LOT 43 ON ASSESSORS MAP 36: N/F z L o -i FND TO BE I MAP 36 LOT 34 REMOVED _ 3: PROPERTY LINES DEPICTED HEREON ARE BASED ON A o rn FIELD SURVEY BY EXISTING GRADE, INC, IN FEBRUARY OF PERRY ARTHUR �L 0 21.0 1.0 EXISTING 2008 AND COMPILED FROM PLANS ON RECORD AT THE 22.4 6.33 N GAS LINE TO BE BARNSTABLE COUNTY REGISTRY OF DEEDS: +�:, ::E � � I 6. RELOCATED ' PROPOSED p _ - -- �...I �1 4. ORIGIN OF BEARINGS IS BASED ON PLAN RECORDED IN 1500 GALLON p 40> PRO. EXISTING c PLAN BOOK 281, PAGE 51, SEPTIC TANK O AD N N SHED TO BE 11. 10.0 � RAZED 5, DATUM IS BASED ON BARNSTABLE GIS SYSTEM AS o I� -� N SPLIT INTERPOLATED AT THE INTERSECTION OF MAIN ST. AND EXISTING r 20.0 RAIL PUTNAM AVE. CESSPOOLS FENCE • TO BE REMOVED b PRO. Aso\ t 6: SITE LIES WITHIN THE C FLOOD ZONE PER FEMA MAP REFERENCES DECK o� -� J 2500010018D LAST REVISED 7/2/92. DEEDS, 9541 217 6 STOCKADE _ J � 9541 68 FENCE TO BE — �" 28.3' c-- <9_ 7, DIMENSIONS SHOWN ARE FROM OUTSIDE FACE OF 9838 68 RAZED I 1 WALL TO P❑INT CLOSEST TO LOT LINE DIMENSI❑NED TO: 14.1' 18945 348 I �^ y 21208 1990 _ v r 11'P ' F ' ,�v', of 8. ALL SETBACK DIMENSIONS ARE PERPENDICULAR To -> " = - _ �, �1 BND a PROPERTY LINES: LC: C176852 - r` - i\ - / � �/ - PLANSI y FND. BND FND. ' 1a 9. ALL BUILDING DIMENSIONS SHOWN ARE OUTSIDE FACE OFWALL. L:C 31395A EL = 49.6 ARBORVITAE'S SHED L.C. 31395B N/F BK. 103 PG. 59 10, SITE IS LOCATED WITHIN THE RF, RESOURCE BK, 281 PG. 51 M AP ,-36 cbQ,T 35 PR❑TECTI❑N ZONE AND WELL HEAD PROTECTI❑N ZONE PER 4u LEUi + ' 'L�E R THE BARNSTABLE GIS DATA BASE: K 0 BK. 201 PG. 17K:S H. _ BK. 582 PG. 08 QLESS, JR. Cn/?l � f; 1L EXISTING SEPTIC _SYSTEM PER BOARD OF HEALTH AS BUILTS: ' EHG 1345 EXISTING GRADE INCORPORATED ,��,sT�s� , . SCALE CLIENT SEPTIC DESIGN PLAN i 345 No. Civil Engineers and Land Surveyors ." , �A1 5 10 20 i ARCHITECTURAL INNOVATIONS FOR DATE: 04 12 08 P.O. BOX 682 PO BOX 2056 15 PUTNAM ADDITION SHEET No. FORESTD7303 MA (50 0264 7305 (FAX) V Y���O� CO'I'UIT'MA COT, MA 1 OF 2 # DATE REVISIONS SOIL LOG TEST HOLE 1 - ELEV.=50.0' NOTES', DESIGN FORMULA: DEPTH FROM OTHER (STRUCTURE, 1, ALL SYSTEM COMPONENTS SHALL BE INSTALLED IN COMPLIANCE WITH THE STATE SANITARY CODE SYSTEM REQUIRED PROVIDED SURFACE ELEVATION SOIL SOIL TEXTURE SOIL COLOR SOIL MOTTLING STONE S,BOULDEIRS, TITLE V AND THE TOWN OF BARNSTABLE HOARD OF HEALTH REQUIREMENTS, (FEET) HORIZON (USDA) (MUNSELL) CONSISTENCY, % GRAVEL) pAILY F� (INCHES) OW: 2, ANY CHANGE TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND DESIGN ENGINEER. 0'-10, 49.17' A SANDY LOAM 10 YR 2/2 NONE 4 BEDROOMS ® 110 GPD/BEDROOM 440 GPD 10'-27' 47,75' B LOAMY SAND 7.5 YR 5/6 NONE 3, HEAVY EQUIPMENT SHALL NOT TRAVEL OVER DISPOSAL SYSTEM DURING OR AFTER CONSTRUCTION. 27'-121' 39,92' 1 C MED. SAND 10 YR 7/3 NONE 4, TIGHT JOINT (T,J.) PIPING SHALL CONSIST OF POLYVINYL CHLORIDE (PVC) PIPE, SCHEDULE 40, SEPTIC TANKS: ALL PIPES TO BE LAID ON FIRM BASE AND TO BE WATERTIGHT, ALL CONNECTIONS AND JOINTS 440 GPD X 200% 880 GAL 1,500 GAL SHALL BE MECHANICALLY SOUND AND TIGHT, LEACHING AREAS: 5, DISTRIBUTION BOX SHALL BE WATER TESTED FOR LEVELNESS, 4 CHAMBERS @ 8.5' LONG x 4.83' WIDE S❑IL LOG TEST HOLE 2 - ELEV,=50,0' 6, NO GARBAGE GRINDER IS ALLOWED. 2' EFFECTIVE DEPTH — 3' STONE DEPTH FROM OTHER (STRUCTURE, 7. DISTRIBUTION BOX SHALL HAVE AN INLET TEE EXTENDING TO ONE INCH ABOVE THE SIDEWALL:.((10.83x2)'+(40.Ox2'))x2 203.3 SF ELEVATION OUTLET INVERT ELEVATION. BOTTOM: (10.83'x40.O') 433.2 SF SURFACE SOIL SOIL TEXTURE SOIL COLOR SOIL MOTTLING STONES,BOULDERS, (INCHES) (FEET) HORIZON (USDA) (MUNSELi) CONSISTENCY, % GRAVEL) 8, SEPTIC TANK SHALL BE EMBOSSED WITH SEAL STATING CONFORMANCE WITH ASTM C 1227-94. TOTAL: 6 36.5 SF 0'-18, 48.50' A SANDY LOAM 10 YR 2/2 NONE LEACHING CAPACITY: 18'-38' 46.83' B LOAMY SAND 7.5 YR 5/6 NONE 9, ALL SEPTIC SYSTEM COMPONENTS SHALL BE DESIGNED TO WITHSTAND H-20 LOADINGS. SIDEWALL: 203.3 SF x 0.74 GAL/SF 150.4 GAL 38'-121' 39.92' C MED.- SAND 10 YR 7/3 NONE BOTTOM: 433.2 SF x 0.74 GAL/SF 320.5 GAL 10, SEPTIC TANKS SHALL BE PROVIDED WITH AT LEAST THREE 20' DIAMETER MANHOLES WITH READILY REMOVABLE IMPERMEABLE COVERS OF DURABLE MATERIAL, I TOTAL: 1 440 GAL 470.9 GAL PERCOLATION TEST BYi THOMAS ROUX FOR, EXISTING GRADE, INC. 13, CONTRACTOR SHALL OVER EXCAVATE LEACHING PIT BOTTOM TO A DEPTH WITNESSED BY, DONNA MIORANDI, BOH 11, BEFORE BACKFILLING THE SYSTEM THE CONTRACTOR SHALL NOTIFY THE BOARD OF HEALTH TO INSPECT, OF FIVE FEET TO VERIFY THAT NO GROUNDWATER WILL BE ENCOUNTERED, DATE, 04/4/08 PERC RATE, <2 MIN/IN IN C SOILS HOLE 1 @ DEPTH=66' (EL=44,50') 12, CONTRACTOR SHALL COORDINATE WITH THE HOARD OF HEALTH TO OBSERVE THE .EXCAVATION OF 14, ALL UNSUITABLE -SOIL MATERIAL IN AREA OF AND BELOW PROPOSED SOIL NO GROUNDWATER ENCOUNTERED UNSUITABLE SOILS UNDER THE AREA OF THE PROPOSED LEACHING SYSTEM, ABSORPTION SYSTEM (S.A,S,) SHALL BE REMOVED AND REPLACED WITH CLEAN, COARSE SAND WITH A PERCULATION RATE OF 2 MIN/INCH TO TOP OF C2 LAYER, (NOTES 12, 13 & 15 D❑ NOT APPLY FOR THIS DESIGN) 15, AREA 5 FEET BEYOND LIMIT OF SOIL ABSORPTION SYSTEM (S.A,S,> SHALL BE EXCAVATED OF UNSUITABLE MATERIAL TO TOP OF Cl LAYER, THREE MANHOLE COVERS. BRING A MINIMUM OF ONE NOTES, 2' OF 1/8' -1/2' COVER TO WITHIN 6' OF FINISHED GRADE, BRING OTHER 1. SEPTIC TANK SHALL BE EMBOSSED WITH SEAL /DOUBLE WASHED PROPOSED -COVERS TO WITHIN 12' OF FINISH GRADE. STATING CONFORMANCE WITH ASTM C 1227-94. 3' (TYP) 3'(TYP) PEA GRAVEL TOP OF FOUNDATION TO CI) ROW OF (4) 4,83'x8,5' LEACHING CHAMBERS 7777/// MATCH EXISTING F. FLOOR ELEV=52.4' 2, CORROSION RESISTANT GAS BAFFLE SHALL BE WITH MINIMUM ONE ACCESS PORT PER CHAMBE/ INSTALLED ON SEPTIC TANK OUTLET TEE. INVERT n o 4 0 3/4" TO 1-1/2" F,G,=50,0't .35" ° 4, °� ° 4, DOUBLE WASHED STONE 24" 0 0 0 0 0 4 o O 0 4 0 4' PVC 2" OF 1/8°-1/2' SEWER LINE DOUBLE WASHED PEASTONE 3-0 �4'-10' = 3-0 I INV=47.91' 4'PVC @ 2% 2Y 61 SUMP TOP ❑F PEASTONE ELEV=47.00' 4"PVC @ F,G,= 50,0't of INV. IN 1,500 GALLON 3' U) 47,69' SEPTIC TANK INV. OUT 4'PVC @ 2X TYP, YP, 5' MINIMUM 47,44' SEPARATION , o Q o a � o D u o 0 0 0 0 0 0 0 0 0 DISTANCE 11' �ooAo a opo INV, IN ' o INV, IN soo 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 goo FROM o o ° o o ° 46.00' BOTTOM OF TRENCH = GROUNDWATER LEVEL STABLE 6' 46,5' INV, OUT 40.0' LEVEL FOR ENTIRE CRUSHED STONE BASE 47 4b,33' BOTTOM OF BOTTOM OF LENGTH 16,5' TRENCH 44.0' 3/4' - 1CRUS DOUBLE TRENCH 44,0' 3' MIN, f�----�I WASHED CRUSHED STONE MAINTAIN 10.0' TYPICAL LEACHING CHAMBER III III 120" MIN USE CONCRETE PRODUCT INC. 1500 GAL FROM CROSS—SECTION I —� SEPTIC TANK OR APPROVED EQUAL RESERVE (NOT TO SCALE) _2' MIN. CORROSION RESISTANT GAS BAFFLE BY TUFTITE OR APPROVED EQUAL '—�I7 0' MIN. MI TYPICAL SEPTIC SYSTEM PROFILE J t•yr EHG 1345 0 NO. j c@. CLIENT SEPTIC DESIGN PLAN 1345 EXISTING GRADE INCORPORATED tvt SCALE y �� 41,294 � ARCHITECTURAL INNOVATIONS FOR DATE: 04 12 08 Civil Engineers and Land Surveyors P.O. Box 682 = `H��,�/-9T�R �,' PO BOX 2056 15 PUTNAM ADDITION' SHEET No. 02644 �r COTUIT MA COTUIT,MA 2 OF 2 FORESTDALE, MA (508) 833-7303 (508)833-7305 (FAX) W `� E-x '�11 # DATE REVISIONS BULK REQUIREMENTS RF TO&4 OF B N= TA 8LE (PER ECDDE CHAPTER 240 ARTICLE III 240—.14 MAP 36 LOT. 43 REQUIRED MIN, AREA 43,560 S.F. ll9- 42 AREA = 12, 54. 7 REQUIRED MIN, FRONTAGE 150' REQUIRED FRONT SETBACK 30' PUTNAM AVE ( VARIABLE) s.F. ± 5- _ REQUIRED SIDE SETBACK 1 dE f�N11t€y, �„� � REQUIRED REAR SETBACK 15; LOCUS P�SNPM REQUIRED . HEIGHT MAX, 30 0 N 89'01'20" E d 110.78' j BND COOLIDGE S7 i FND. EXISTING SAS GENERAL NOTES, LOCUS 'NTS: SYSTEM � 1. RECORD OWNERS; BLIZARD SCOTT A, O PORCH /29.3' & LAURIE S. 115 GREEN LODGE STREET 02026 O N/F DEEDABK.M23905, PAGE 276 to MAP 36 LOT 50 O M OOR E PATRICIA 2. PROP ERTY IS SHOWN AS LOT 43 ON ASSESSORS MAP 36. ' N/F - J N z EXISTING o v! 3. PROPERTY LINES DEPICTED HEREIN ARE BASED ON A 1500 GALLON W! MAP 36 LOT 34 � � FIELD SURVEY BY EXISTING GRADE, INC. IN FEBRUARY OF o SEPTIC TANK rri TONKEN NEAL J. 1l O - 2008 AND COMPILED FROM PLANS ON RECORD AT THE _ 22.4' COUNTY REGISTRY OF DEEDS. SC J A N C Y � 0 N BARNSTABLE 14.8' 4, ❑RIGIN OF BEARINGS IS BASED ON PLAN RECORDED IN SHETTERLY ' PLAN BOOK 281, PAGE 51, 15.3' 5, DATUM IS BASED ON BARNSTABLE CIS SYSTEM AS 0 5 5 SPLIT INTERP❑LATED AT THE INTERSECTION OF MAIN ST. AND LPROPOSI RAIL PUTNAM AVE. ° FENCE REFERENCES � DECK 6, SITE LIES WITHIN THE C FLOOD ZONE PER FEMA MAP DEEDS 9541 217 ° IO al ' ` _ 2500010018D LAST REVISED 7/2/92. 9838 68 15.3' _ zo.o_ _ J 7, DIMENSIONS SHOWN ARE FROM ❑UTSIDE FACE OF 11640 312 28•3 18945 348 PROPOSED , WALL TO P❑INT CLOSEST TO LOT LINE .DIMENSIONED TO. 21208 1990 15.3' 10" SON A 14.1' L.C. C176852 .1 TUBES s 8. ALL SETBACK DIMENSIONS ARE PERPENDICULAR TO PLANS, 116.35' BND 4 PROPERTY LINES, L.0 31395A N87*36'12"W FND. 9. ALL BUILDING DIMENSIONS SHOWN ARE ❑UTSIDE FACE OF L.C, 31395B BND FND., BK. 103 PG. 59 EL = 49.6 ARBORVITA '` = SHE WALL. BK. 281 PG, 51 N/F �-�'A F Ssq` BK. 500 PG. 10 � E❑WIN �s� 10. SITE IS LOCATED WITHIN THE RF, RES❑URGE BK, 201 PG. 17 MAP 36 LOT 35 �� H. s� PROTECTION ZONE .AND WELL HEAD PR❑TECTION ZONE PER BK. 582 PG. 08 K 0 R N B LU M R YD E R GLESS inTHE BARNSTABLE GIS DATA BASE, ►4o.39045 11, EXISTING SEPTIC SYSTEM PER BOARD OF HEALTH AS Existing Grade Inc. & yfi..r ,v`; ` !q ESSN Ako� BUILTS. 15 PUTNAM-GARAGE PROJECT NO. Surveyors Clvil Engineers ' SCALE CLIENT GARAGE PLOT BUILT 1345 �- �*" max M �" DATE: 09 03 09 = PO Box G 12 ti s;'o 5 Io 20 ARCHITECTURAL INNOVATIONS OF / / _ Denni5port, MA 02G39 `` r•y,A P.O.BOX 2056 15 PUTNAM AVE SHEET NO. 08-G94-G501 Ph Fax «h�, <.. a SACHUSETTS 02635 COTUIT,MASSACHUSETTS 5 / COTUIT,MAS 1 of 1 � t 4.: "� a�.^��� !�+>,'.- # DATE REVISIONS SMOKE DETECTO SAEVIEWED BARNSTABLE BUILDING DEPT. D E- 2a-v 24-0' FIRE DEPARTMENT 3 D E z 6'-s' I I'4` 6'-3• 6'-3• I I'+9' �''H NATURES ARE REQUIRED FOR PERMI •§ a'�• 1 � z•cxca � I O a•-c• � � - v �- - ' - --� c o BATH s°r r DI! to i D_T i CARBON M OXIDE ALARMS IN12,26STEELBEa6lmawse _ 4 q MUST BEI STALLED PER two= - MASSACHUSE JBUILDING CODE o GA A m GARAGE 1 I r UP FOR pOLA 1 POR RHMRB9f19 - zrr to - . - • 6'-3' i I'�' 6'-3• 21•rORTAl9EGMBfT 9e Brt 21'rORTAl9°W.®lf 6'-9' 11 6'3• 24a SECOND FLOOR PLAN FIRST FLOOR PLAN • 1/4.._Lam. - tia••=r.a• Lu zao v OIA.mti7<ne W909.1TrOU�9T9R0fME Zu i I— WOMNOU w O w � \ WINDOW 8 EX-MMOR DOOR SCHEDULE I ---- I I I J a W KEY ROUGHOPENN3 WxM ITEMS STYLE MA7ENIAL 7-63W x4-93W 2957 PE—RWNE]2OW61EWUNGWWOON VaNTEAW..-CaAO • Y 1 ( .I I 1 Q 2'$W4-.4'S 3W 2993 PELLAPROAEarzow�UNGwwoG.v —ITEAWMINUM C 310 3R4•%@•TO' 3682 PELJAARCHIIECTIN SWWGMFNCH DOCK WHITE AtOMINUMCVtI - Yr----- • I' I O O3t23/6•%@-11' 3vx@r ORWCOIOREO.14 UPiTWOR EG�WSED METH-fPAYIT • QF----- ( I I O @-0-x 9'4Y @%@ 'OVERHEAD DOQI' snu s.•w+eA Vl F----- T LL 61EEl GARAff GOOK pc L---- _ _ � _ _ I - 4 NOTE:ALLPR04NE OH VnNDOxSTOHAVE OiWESOETVF£N-THE-0lA56%MMUTAtEOOMWOIIOIT MUNTW PATTERN i ' �L----- \ 4•THIQ.rOURtD(AN(A[IE 91A9AOCR ' "L---- J I wnr c4c•.Iodaw.w.M.wOaw I ; I � t � COMfAR®6RANVIAR 949E 3 5r----- I I I x m o ----- I I: I I a ----- I I I ® N 1 - 9 V DRE9G T.D.PND.IT I 0 gym . 0 � . W. . 18• 9'-G 2'� —9'-6' Ib• rmmac rouRm ea.aeere rdnmv,Tx�N wau O b ' ON 6'a IG'CONi1NDOD9 WIG PDOfWp K 240 BOTTOu TO nriav FRWT UNL(4 NW J a F /�I.�{ Al DATE: 08/25 12003 U� o• J SOUE: AS NOTED lot PLAN � NIEL . ��yP� Dw>WNGA Lz Al - 3 f r 24'O 24--a 6 i 6'-3' I I'-6' 6=8• 613, t I'9 6'-a i21 O 2 , 4'-6• V 21Wl o BATH I SHOWER W 12.26 STEEL BEAM*2W OFFICE L } GARAGE a - - ©I 1 1 I i0 UP fOR DOOR.POR 2FNRB.®(f9 2Pr AL FN 6'3' I t'-6' 6'-3' 21•PDATAL9tti.�lT 21'PORTAL2fiNBrt ' 6'-3' I I 6'-3• 24-a SECOND FLOOR PLAN FIRST FLOOR PLAN va••=r-v ua•=ra• iul o m —————————— ———— D IP DV\.W1XRe2 Lu — W/�M4P�OF9i9PBOFE lu Lw—J WINDOW&EXTERIOR DOOR SCHEDULE I r 1 I`i Z IEY PAl1OHOPEMM WsH ITEM• STYLE MATE. :/ s T�s I T53/4'x4'-93W 295T PELL PROIINENIOQIB UNGWMOQV —IMAW..UNCIAD IY53APx4'53P1' 2963 PEWAPROUNEYIODUBILWUNGWINO— WHITEAWIANUMCIAO3'SAY 3x6LTY 3682O 3�23ffx6'-71' 3Vw,Vr BROSCO(OREO)4L[ TOQR EMBOSBEO NETAL/P4WT b � - u x § W Li E 9'.Wxv-(r 9'x6' 'OVERHEADDOt '-smxxvwexrt STEELpARACED— 2L—___— mL___—_ NOtE'NLPRDUNE pH'MNDON8IOHAVE GRe1E56F1wEEN-1HECiA55851NUlATEp M'IpED UCi1TMUNrIN PATTERN - 4'TNICR rOVR®RR1OtFR9AD11DCK ` 4 =L__—_ , I WRNLS6'-IP.IP W.W.N.Q1 of 1 I I Y J CCNPACIID ORANUTAR B4X F a. gig 12z L----- ► I : I e 'v � o L----- 1 L_ OEPRe9•vT.O.Pap.IY J LL O U W ' IB' 9'-6' 2=, 9'-6' 1& 6'TmCx rOURtp LONdteie RUIDATIONwAu O F - DNbaiG•WNTD)000900NGfDOfPKi a' 24'!/ BOTTOM r06FUAVP� ,j d � OF_p`].� �/�.r�+ DATE: 03125/2909 SCALE: AS NOTED FOUNDATION PLAN o ANIE ,�. DRAW[W.$k. Al = 3 ry o ,eat oltm r O 2 TDT. 119TR1uGn«-)� - • , T ROOP 9fO1Glf9 < 5 6r•-4• '- 5•-4• TO TD MAT MAra MaN nq!!E 61 Z, 5,4, /r — MATOI ALL TRIM TOlMwMpl_•C ^� 1 NINUOW HDR M. ll WXDf MA.°YDRiEl WINDOW NORM. .�5 EXP09URP MATCH R.PRCH „ TO NNN 11pN£ PELLA De91GNER FT,= K1f( y DOOR W1G91NG TO MATOI tl12 y) 1 MAIN HQYve 1 8 OOUBIE-tOfUN6W B B m W/ TOMATO'TOI T.O.KNEE WALL MAw HQIY I.O.KNEE WALL - p _ w.ra AUTwM ro Maw ruaue 4 SECOND BOOR N � N4 1.1.f09T9 CA9®Wla%3 SCONDftOOR j: ♦MILLED WOOD GP/2iQ 9o1!l9f9L9 m --- '.®CO.0 W/TOPIBOfIC.1 RAA.57177 11,1,1 WINDOW NDR M. .IaU!CORNEfL9D. WlNDOw XDRIIL Q lag DfCR1NG ON P.T. , 2a10'G LANDINGJOST9 W/lalD PINE DPAc9KRi . 111 fV - - Uf b P.T.9a4 P09T9 in n ' wODD 9T.R TO OWE ---- ---- ---- ---- LOP Of fOUNDAM)PI WALL tOP OFFOUNDAiION WALL a•c,cr O.H.GARAGE EYdMIEG W!G9iNG TO MATO MATOi MAM F10{A9E LEFT SIDE ELEVATION FRONT ELEVATION 1/4—r1P T/4—ra• /n Z Ir MAT- z TOTING a R.PDO1 I� ANHALT ROOP 9fdQP! TO MATOI MAIN NOU9e . sue• s'-a• s•-Tr a•-r spa a. MATCH ALL TRIM TO MAW Ng19P T WICAL __ WINDOW NDR M. { m T.O.RNfE WALL i.O.KNEE WALL I.O.KNEE WALL -- MATCH ALL TRIM TO MAw Ngl9E b SECOND LLOOR N ` IaU4 CORNER�. ��' L C, `A� WINDOWHMW. _ q® 00 ' PEW PRQiNE nn --- -- la4 DECKING ON P.T. � 4 O .1_v-HUNG WNDOw9 Y 2al O6 LANDINGJP919 w�/u„NG TO MATOI (V w/IaIOPINf DEC%9RUR g _ Dula — _.__..._wNITe®AR 9HINGtE9 P.T.a,mPo91! m. N 6 Q ®!•earoeuRe b f TOP of FouNDAnoN wALL TOP oFrouNwnoN waLL TOP of folmoAnoN wAu U TO MA-MAN HLU9EG w' & F T OF RIGHT SIDE ELEVATION REAR ELEVATION ' �� S,�, va=ra a=)ate QA DAIS: os/zs/zoos IM^ter t. g� Fr'. SCALE: AS NOTED .®�f QISTPc� 'c�� A2 3 f / A \ NdV 2xB ROOP RPPTER9®ICO.L TO[109TX10 d iPX P9fMALT 0.00f 9XINOIE9 TOMAT0IFSF. —T.R.MOf 2 MM 2•5 MUNG J019T9 0 ICO.L a ' TO EKI9TING d W-)v W/Y gym-— EE�A 9n.1PB0M n 2.9A OA9 �O RPrtER TO PIA.TE PM)MIt TO WALL MICAL AT ALL R.R KM-RATE COM.ECnoI PWE/cE M. PLATE/CEILING M. MATU K.M01 -- TO MAIN XLV9E R Hj • WINDOW MDR.M. _ WINDOW NDRM. 12 R NEW Z+G EYTEIL.9TUD WAU91q • P[UA DC91 W[R FRE11W DDOR _ 91l4'FBGL N19L 12PlXMJ. PEIU rRCU@ BHGTXINOUIOU9LWRN•w.L 4xa P.T.P09T90\^..✓D DI omU -nuuGWRIDOW9 9NINGLP9 7BT09UR[ iil Ix9 fDIE•MMr m W0.(XP To b OFFICE BATH '� MAT--RV[TO MAw nouDE OFFICE BATH mDR urun 9TRN®w.uE CONNECTION 9EE WP TABIE9 M) N L.O.KNEE WALL __ - TA.KNEE WPLL tie BIDQC9 TO Ot64R r� IN D[CRING ON P.T. 2•BEOOl9 TO AFAR p� 6't/-90PPR•XpD Y 2xld6 LPNOINGJQ9T9 PIR[BTOP C+/-90PPIT•XOID Ix PA9W BD. � PIRE 9TOP -T NR[9TW Ia PA9M BD. � SECOND ROOK SECONDfl00(1 BLOQJNG-1W. ttiI ' _ -_ BALLOON PRPAR FlDOR4 PA9T[N PIOORJ-W10 r.T.2/2x 10 Wfh%GiL.BM.-4yvtl BALLOON RGLAff flf10R9: .i W1Z(26 SR.SM. J019T9 XANGEIL9 CN 1a10 BUwAU P09t W9 --------- ------ PA9T@I FLOOR JD919w1D1 (3)1314•x 11 T79"LVIFB:AOHi - BAND NAILED TO9 wINDOw/DR HDR M. nPNGER9OM 2x10 BPND NA1lED T09TUD9 f P.T,a•4 P09T &4'T•G PLYWp.912fltXR qpN1 x 91/4'PBGL.M9L.,12'PdWD. 2 x IO PLOOR J019T9®IPO.L �: N[W 2x6 ExTER.9TUD WAU9 W/ a � NEW 2K EXFER.9TUD WALL9 wT i 13 � � 9MR1 T«[9(1f Y EISO°J1R[WL Q 9I/4'FBG j1OU. , b A �• twO CGP - 9XEATXING,XOU9E.Il2'fLW/D WRAI'•W.L k.WO C}' � O GARAGE 9XING[9®Y e2oAxe GARAGE o P.T.zxc 91u rare wi qe GALV.AND+ne fB944 w PBU44� B01T9®MAK.9C O.C.•C-12`fltCM $ END OP P,1 TU9E 919'xVS PIAIC LOP OFPJINDANON WALL WA9nER9,FCO FMBEN Mw.T TOP OF TOWDAAON TOP Of COXC. WALL -- SLAfi RO BOOR -- 4'TXICR POURED WNCRER9IABPIOdt ' IP DIA.O:MQEIE 9ONODJBE WFTX 61C-IPx IP W.W.M.ON C1FAN COMPACT®GRANULAR BASE C TH—PWRPD CONQEIF POIAIDPTIO1l WALL ON BxIC CONTINUOUS OJNC.MOIING earTOM ro aeLow PR09T LwE LaMar 4•-W 24--a 2*-a S2 TYPICAL CROSS SECTION S-N 51 TYPICAL CROSS SECTION E-W iA«•=ra• 3 1At•=ra 0 co 2 x 8 ROOF RAFTERS @ IS'O.C. 2 x 10 SECOND FLOOR JOISTS Q 1 S" O.C. _ - I I PT.pECKFRAME J L Z i0 A co ° - gam A w 12R26 SMEL BEAM Z Q J L LL- Q 4 z I O I 9 D CNI - z °➢ i► 9 N e O a " 3 uj co (3)1314°x 111/4'LVLHEAD6R FOR DOOR•PORTALRftLRB.ID09 � < eI Q F DATE: Q812612M ROOF FRAMING PLAN SECOND FLOOR FRAMING PLAN � '`fSLgI STEP �� SCALE: AS NOTED S�pp� �� DRAwINcx 1/4-I'-a' IA3 - 31 BULK REQUIREMENTS RF kPER EC❑DE CHAPTER 240 ARTICLE III 240-14 �P MAP 36 LOT 43 REQUIRED MIN, AREA 43,560 S.F. pow AREA = 12,854. 7 REQUIRED MIN, FRONTAGE 150' f�c PUTNAM AVE ( VARIABLE) S F +— REQUIRED FRONT SETBACK 30' REQUIRED SIDE SETBACK 15' REQUIRED REAR SETBACK REQUIRED HEIGHT MAX. 30' LOCUS P0l" o N 89'01'20" E d 110.78' j BND COOLIDGE ST H x FND. EXISTING SAS GENERAL NOTES: L❑CUS NTS: SYSTEM d 1. RECORD OWNERS1 BLIZARD SCOTT A, 0 PORCH 29,3• & LAURIE S. 115 GREEN LODGE STREET N/F DEDHAM, MA 02026 D DEED BK 23905, PAGE 276 f o MAP 36 LOT 50. O . MOORE PATRICIA J N ` 2, PROPERTY IS SHOWN AS LOT 43 ON ASSESSORS MAP 36. N/F z EXISTING o �,+ 3, PROPERTY LINES DEPICTED HEREON ARE BASED ON A MAP 36 LOT 34 O 1500 GALLON . FIELD SURVEY BY EXISTING GRADE, INC. IN FEBRUARY OF TONKEN NEAL J. t� o JANCY O SEPTIC TANK 2008 AND COMPILED FROM PLANS ON RECORD AT THE 0 22.4' BARNSTABLE COUNTY REGISTRY OF DEEDS, 8c SH JANCY Y 0 148 0 4, ORIGIN OF BEARINGS IS BASED ON PLAN RECORDED IN 6.1' 'E PLAN BOOK 281, PAGE 51. 5, DATUM IS BASED ON BARNSTABLE GIS SYSTEM AS a o 5'5 �1 SPLIT INTERPOLATED AT THE INTERSECTION OF MAIN ST, AND PROPOSED RAIL PUTNAM AVE. �l GAf2AGE o FENCE REFERENCES '1 �° � I� DECK t� 6. SITE LIES WITHIN THE C FLOOD . ZONE PER FEMA MAP o �� 2500010018D LAST REVISED 7/2/92, DEEDS 9541 217 /�� o� 9838 68 za.o f 15.3' / zo.o _ ,J 7, DIMENSIONS SHOWN ARE FROM OUTSIDE FACE OF 11640 312 PROPOSED 28.3 WALL TO POINT CLOSEST TO LOT LINE DIMENSIONED TO, 18945 348 115.3' 21208 1990 10" SONA 14.1' " 8, ALL SETBACK DIMENSIONS ARE PERPENDICULAR TO L.C. C176852 �_ TUBES PROPERTY LINES. PLANS: 116.35' BND a LC 31395 L.C. 31395B BND FND. N87°36'12"W }' FND. 9, ALL BUILDING DIMENSIONS SHOWN ARE ❑UTSIDE FACE OF - BK, 103 PG. 59 EL = 49.6 ARBORVITAE' SHED WALL. BK, 281 PG. 51 N/F �y�N F s , BK, 500 PG. 10 z� �pWtN cy� 10. SITE IS LOCATED WITHIN THE RF, RESOURCE BK, 201 PG. 17 MAP 36 LOT 35 H �, PROTECTION ZONE AND WELL HEAD PROTECTION ZONE PER BK, 582 PG. 08 K 0 R N B LU M R YD E R v CLESS THE BARNSTABLE GIS DATA BASE, ,a No.39045 .; R �� 11, EXISTING SEPTIC SYSTEM PER BOARD OF HEALTH AS Existing Grade Inc. �� �'�o2 BUILTS. 75 PUTNAM-GARAGE r 5urveyor55 * Civil Engineers � � - ^ SCALE CLIENT GARAGE PLOT BUILT O1345 PO Box G 12 c��• ARCHITECTURAL INNOVATIONS OF DATE: 09 03 09 Denm5port, MA 02G39 o s 10 20 P.O. BOX 2056 15 PUTNAM AVE SHEET NO. 508-G94-G50 I Ph/Fax fl/8Tg� 4��@ GATE j REVISIONS COTUTT,MASSACHUSETTS 02635 COTUIT,MASSACHUSETTS 1 of 1 i Y .. zo'_a' °� V) a Z ,� g• 6'_6" G'-6. 3" a c� 0 a I O'DIA.CONCRETE m X Z UI SONOTUBg LQp G G@ ' u I FL a LL aO O v 2 I 4 I E I Q Oa za-a I l a-o^ U w � --- ----i I I ; C? m N BASEMENT WINOGW I � I I;. 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