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HomeMy WebLinkAbout0408 SANTUIT ROAD - Health -408-34 ntuit Road Cotuit A = 020 115003 r.. Aug . 25 J2016 20:01 Jim The Inspector Man 5085349919 page 18 oaf-ps - M3 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary AssessmentsrM o _408 Santuit Road Property.Address _ _ a Margaret Murphy Owner Owner's Name information is required for every Cotuit J _ MA 02635 8-22-16 . � page. City/Town State Zip Code Date of Inspection W 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 �����t11101rr�►n�, on the computer, �����_s�jH OF Mq.91 y��� use only the tali 1. Inspector: =�vJ' 9�ti key to move your p • G cursor-do not James D.SearS � JAMES use the return Name of Inspector key. Capewide Enterprises, LLC 0 CompanyN me �' • RTIF Name 153 Commercial Street ���F s NEc e I Jill Company Address Mashpee MA 02649 CityjTown State Zip Code 508-477-8877 S1623 Telephone Number License Number B. Certification 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 CM 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 8-25-16 spector,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 has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This Inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins.doc•'rev:6116 Title 5 Official hspection Form:Subsurface sewage Disposal System-Page 1 of 17 i1 I Aug 25 ,2016 20:02 Jim The Inspector Man 5085349919 page 19 Commonwealth of Massachusetts. Title 5 Official Inspection Forirn Subsurface Sewage;Disposal System Form -Not for Voluntary Assessments w 408 Santuit Road Property Address Margaret Murphy Owner Owner's Name information is required for every Cotuit MA 02635 t3-22-46 page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary:.Check A,B,Cb 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: The system is a 1500 Gal. Tank D Box and four-chambers. .. - B) System Conditioni0y 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 replacementor repair, as approved by the Board of.Health, will pass. Check the box for"yes"„"no or"not determined" (Y, N, ND) for the.following statements.:If"not determined," please explain. e The septic tank is metal and over 20 years old*or`the septic tank (whether metal or not)is structurally unsound,.exhibits substantial infiltration orexfiltration or tank failure is imminent.System will pass inspection if the existing.tank,is replaced with a complying septic tank at 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 [I N ❑ ND(Explain below): t5ins.doc•rev.6/16 p Title 5 OHic al Irspection Forth:Subsulace Sewage Disposal System Page 2 0117 Aug 25 2016 20:02 Jim The' Inspector Man 5085349919 page 20 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 408 Santuit Road Property Address Margaret Murphy Owner Owner's Name information is Cotuit MA 02635 8-22-16. required for every page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumpslalarms not operational. System will pass with Board of,Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s): The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):. C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 15ins.doc-rev.V16 Title 5 Official Inspection Form:Subsurface Sewage Disposal Syslem-Page 3 of 17 Aug 25 2016 20:02 Jim The Inspector Man 5085349919 page 21 - r Commonwealth of Massachusetts T -: : . Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ` 408 Santuit Road Property Address Margaret Murphy Owner Owner's Name information is required for every Cotuit MA 02635 8-22-16 page. C4fTown State Zip Code Date of Inspection B. Certification (cont,) 2. System will fail unless'the Board of Health(and Public Water Supplier,if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has aseptic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form: f. 3. Other: 4 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 El ® Liquid depth in is less than 6" below invert of available volume is less than Y2 day flow e11/1v6� (5ins.doc•rev.6/16 Title 5 Official Inspection Farm:Subsurface Sewage Vsposa System•Pape 4 of 17 Aug 25 12016 20:02 Jim The Inspector Man 5085349919 page 22 F; =f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 408 Santuit Road Property Address w Margaret Murphy Owner Owner's Name information is i required for every Cotuit MA 02635 , 8-22-16 page. CityrTown State Zip Code Date of Inspection B. Certification (cont.) V r x Yes No Required pumping more than 4 times in the last year NOT due to clogged or ❑ ® obstructed pipe(s). Number oF times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. F' ❑ ® 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. El ® 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 butgreater 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. w ❑ ® 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 wilLbe Y 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. E 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 0 ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone ll 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 4 system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins.doc•rev.6116 - Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 -d j Aug 25 2016 20:03 Jim The Inspector Man 5085349919 page 23 Commonwealth of Massachusetts Title. 5 Official Inspection Form "s Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 408 Santuit Road Property Address Margaret Murphy Owner Owner's Name information is required for every Cotult MA 02535 8-22-16. page. CityrTown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You,must indicate"yes" or"no" as to each of the following: Yes . No (� ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for-signs of sewage back up? ® ❑ Was the site inspected for signs of breakout?. ® ❑ Were all system components, excluding the SAS, located on site? ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected forthe 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. El ® Determined'in the field'(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 . DESIGN flow based on 310 CMR 15.203 (for.example: 110 gpd x#of bedrooms): 330 t5ins.doc•rev.&16 Tille 5 official inspection Form:Subsurface sewage Disposal System•Page S of 17 Aug 25 2016 20:03 Jim The Inspector Man 5085349919 page 24 Commonwealth of Massachusetts MW Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments rT 408 5antuit Road Property Address Margaret Murphy Owner Owner's Name information is required for every Cotuit MA 02635 8-22-16 , page. Cityrrown State Zip Code Date of.inspection D. System Information Description: The system is a 1500 Gal. Tank D Box and four chambers. , Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No 86, Water meter readings, if available(last 2 years usage(gpd)): 201-100 OOGaIs , 2015100000Ga Detail Sump pump? ❑ Yes No Last date of occupancy: Present Commerciallindustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd), Basis of design flow(seatslpersons/sq.ft., etc.): Grease trap present? - ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑. No r Non-sanitary waste discharged*to the Title 5 system? ❑ Yes ❑. No Water meter readings, if available: 15ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Dlsposa System•Page 7 of 17 Aug 25 2016 20:03 Jim The Inspector Man 5085349919 page 25 Commonwealth of Massachusetts Title 5 official Inspection Form i; Subsurface Sewage Disposal System Form - Not for Voluntary,.Assessments 408 Santuit Road Property Address Margaret Murphy Owner Owner's Name information is required for every It Cotu• MA 02635 8-22-16 page. CityfTown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): - General Information Pumping Records: , Source of information: 2008 I201.1 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons s How was quantity pumped determined? Reason for pumping: Type.of System: ® Septic tank, distribution box,soil absorption system ❑ Single cesspool Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes,attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the IIA system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): _ l5ine.doo•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposa System•Page 8 of 17 Aug 25 2016 20:03 Jim The Inspector Man 5085349919 page 26 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System'Form -Not for Voluntary Assessments " 408 Santuit Road Property Address Margaret Murphy Owner Owner's Name information is Cotuit MA 02635 8-22-16 required for every , page. City/Town State Zip Code Date of Inspection' D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1998 Permit # 96-26. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑ cast iron ®40 PVC ❑other(explain): Distance from private water supply well or'suction line_ feet Comments (on condition of joints,,venting, evidence of leakage, etc.): Pipeing is 4" PVC SCH 40. Septic Tank (locate on site plan): 101. 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: 1500 Gal..Precast H-10 Sludge depth: t5ins.doc-rev.6r16 Title 5 Official lrspection Form:Subsu face Sewage Disposal,System-Page 9 of 17 I Aug 25 2016 20:03 Jim The Inspector Man 5085349919 page 27 Commonwealth of Massachusetts ' w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ® . V 408 Santuit Road Property Address Margaret Murphy Owner Owner's Name information is required fior every Cotuit MA 02635 8-22-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 28 Scum thickness 8" Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 17" How were dimensions determined? Asbuilt-Tape Sludge Judge ' Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, . liquid levels as related to outlet invert, evidence of leakage: etc.): Tank at working level. Tank and cover's at 10" below grade. In and outlet tees. No sign of leakage or over loading. 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 tSins.doc rev.6116 TRIe 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 s Aug 25 2016 20:03 Jim The Inspector Man 5085349919 page 28 Commonwealth of Massachusetts Title 5 Official Inspection Form R Subsurface Sewage Disposal System Form-.Not for Voluntary Assessments . 'r 408 Santuit Road Property Address Margaret Murphy Owner Owner's Name information is required for every Cotult MA 02635 8-22-16 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.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins.coc-rev.6/16 Title 5 Official.Inspection Forth:Subsurface Sewage Disposal System-Page 11 of 17 Aug 25 2016 20:04 Jim The Inspector Man 5085349919 page 29 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 5 , 408 Santuit Road Property Address Margaret Murphy Owner Owner's Name information is required for every Cotuit MA D2635 8-22-16 page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) Distribution Box(if present must be opened)•(locate on site plan)` Depth of liquid level above outlet invert: 0 Comments(note if box is level and distribution to outlets equal, any evidence of solids,carryover, any evidence of leakage into or out of box,etc.): D Box is 15"x21"-22"below grade wlfour line's out. No sign of over loading or solid carry over. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition.of pumps and appurtenances,etc.): *If pumps or alarms are not in working order, system is a.conditional pass. Soil Absorption System (SAS)(locate on site plan,excavation not required): If SAS not located, explain why: 15ins.doc•rev.6116 Title 5 Official Inspection Form:SubSVIBCe Sewage Disposal System-Page 12 of 17 Aug 25 2016 20:04 Jim The Inspector Man 5085349919 page 30 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1 408 Santuit Road Property Address Margaret Murphy Owner Owner's Name information is Cotuit MA. 02635 8-22-16 required for every page. CityrTown State Zip Code Date of.inspection D. System Information (cont:) Type: ❑ leaching pits - number: ®. leaching chambers number: 4 ❑ leaching galleries number: ❑ leaching trenches number, length: " t - ❑ leaching fields number, dimensions: . ❑ overflow cesspool number: ❑ innovativelalternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): (Leaching is four flows. Flow's are 20" below grade. No sign of over loading or solid carry over. No sign of holding water. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer x Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No tsinsAcc•rev.6116 -. - Title 5 0lficial Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Aug ,25 2016 20:04 Jim The Inspector Man 5085349919 page 31 Commonwealth of Massachusetts Title 5 Official Insp action Form Subsurface Sewage Disposal System form-Not.for Voluntary Assessments 408 Santuit Road Property Address Margaret Murphy Owner Owners Name information required for every ormation is Cotuit MA 02635. 8-22-16 _. ' page. CitylTown ;a State Zip Code T Date of Inspection D. System Information.(cont.) _. Comments(notecondition( of soil, signs of hydraulic failure level of ondin condition of Vegetation, 9 Y P 9, etc.'): Privy (locate on site plan); Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of,hydraulic failure, level of pondingi condition of vegetation, - etc.): µ l5ins.doc-rev.We - - - Tille 5 Official Inspection Form:_Subsurface Sewage Disposal System-Page 14 of 17 Aug 25 2016 20:04 Jim The- Inspector Man 5085349919 page 32 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not,for Voluntary Assessments 408 Santuit Road Property Address Margaret Murphy Owner Owner's Name information is required for every Cotuit MA 02635 8-22-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont,) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately SANK �RRA�f , V a a �8 S Q G_ jo � � 14 S t5ins.doc-rev.6/15 - TRIe 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 a Aug 25 2016 20:04 Jim The Inspector Man 5085349919 page 33 l t Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments -UV 408 Santuit Road 0 Property Address Margaret Murphy Owner Owner's Name Information is Cotuit _ MA 02635 8-22-16 required for every page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope , ❑ Surface water • S ❑ Check cellar ❑ Shallow wells N° Estimated depth tW�— igh ground water. 18'+ feet Please indicate all methods used to determine the high groundwater elevation: ❑ Obtained from system design plans on record. - `f If checked,date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: Past report on file at B.O.H.. - t q, Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc-rev.6116 Tille 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Aug 25 2016 20:04 Jim The Inspector Man 5085349919 page 34 t. Commonwealth-of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form -,Not for Voluntary Assessments g 408 Sa ituit Road Property Address Margaret Murphy Owner Owner's Name ' information is required for every Cotuit MA 02635 8-22-16 page. City/7own State Zip Code Date of Inspection E. Report Completeness Checklist f a ® 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 i A t5ins.doc•rev,6/16 - _ - Title 5 Official Inspection Form:Sutnurface Sewage Disposal System•Page 17 of 17 _ COMMONWEALTH OF MASSACHUSETTS ExECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS IVED a DEPARTMENT OF ENVIRONMENTAL PRO E.CfTGW a . r JUN. 1 2 .2002 .. . • . 4 TOWN OF BARNSTABLE • '. HEALTH DEPT. .. TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION MAP Property Address:. PARCEL ' .i�JO03 Owner's Name: LOT — Owner's Addr Date of Inspection: • Name of Inspec r: please ri t). �►"L Company Name. , Mailing Address: '7 , 4- ®� Telephone Number: +- CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported' below is true, accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and.maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: Passes Conditionally-Passes Nee s.Further Evaluation by the Local Approving Authority. / Fai 9 Inspector's Signature: -� Date: 6 ' 0 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. —77 Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will.perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page I Page 1of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: � p L?l Owner: Date of spection: Inspection Summary: Check A,B,C,D or E%ALWAYS complete all of Section D: lystern Passes: %I have not found any information which:indicates that any of the failure..criteria described in 310 CMR • — �15:303 or-in=310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health, will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined"please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound,exhibits substantial infiltration or exfiltrationor 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 distribution box is leveled or.replaced ND explain: The system required pumping more than A times a year due to broken or.obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health):. broken pipe(s)are replaced ' obstruction.is removed ND explain., 2 r Page 3 of 1'1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE-DISPOSAL.SYSTEM INSPECTION>FORM PART A CERTIFICATION(continued). Property Address: v� Owner: Date o spection: . lJU 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.. L. 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.willprotect 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 _ I surface water supply or tributary to a surface water supply. The system has.a septic tank.and SAS and the SAS is within a Zone 1.of a public water supply. The system has a septic tank and SAS.and the SAS is within 50.feet of a private water supply well. _ The system has a septic tank and SAS and the.SAS is less than 100,feet but.50 feet or more from.a private;water supply well"..Method used to determine distance "This system passes if,the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the„well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A-copy of the analysis must be attached to.this form. 3. Other: a 3 I Page 4 of 11 OFFICIAL.INSPECTION FORM=NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION;FORM PART A, CERTIFICATION(continued) Property Address: Voe pl�� Owner: Date of I pection: D. System Failure Criteria,applicable to all systems: You must indicate"yes"or"no"to each of the following for`all inspections: Yes N 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 Jclogged'SAS or cesspool V Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool Liquid depth in cesspool is less than 6"below invert or available volume is less than '/2'day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped _ Any portion of the SAS,cesspool or privy.is below high ground water elevation. Anyportion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone 1 of a public well Any portion of a cesspool or privy is within 50.feet of a private water supply well. Any portion of a cesspool or.privy is less than 100 feet but:greater than 50 feet from a private water supply well-with no acceptable water quality analysis `[This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform.bacteria and volatile organic compounds indicates that the well is free from pollution from thaffaeility and the:presence of ammonia nitrogen and nitrate nitrogen.is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] (Yes/No)The system fails. I have determined that one.or.more of the above failure criteria exist as described in 310-CMR 1.5.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correctthe failure. E. Large Systems: To be considered aaarge`system the system must serve a facility with a-design flow of 10,000 gpd to:15,000 6Pd• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no _ the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply _ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone 11 of a public water supply well If you have answered"yes"to any questibn in Section E the system is considered a significant threat,or answered "yes" in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. ,4 . f' Page 5 of 1.1 {' OFFICIAL`INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION'FORM - :.,;PART B :, CHECKLIST Property Address: Owner Date of I pection: 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? . C.-' Has the system received normal flows in the previous two week period? (/"Have large.volumes of water been introduced to the system recently:or as part of this inspection? Were as built plans of the system obtained and examined?(If they were not available,note as N/A) _ Was the facility.or dwelling inspected for signs of sewage back up? i/_ 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 SoilAbsorption System(SASj on the site has been determined based on: Yes no Existing information.For example,a plan.at the Board of Health.. Determined in the field(if any of the.failure criteria related to Part C.is at issue.approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] 5 . 1 f Page 6 of 11 OFFICIAL,INSPECTION-FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION.FORM PART C SYSTEM INFORMATION Property Address: � Owner:. Date of (y0 FLOW CONDITIONS RESIDENTIAL ✓ Number of bedrooms(.design):3: Number of bedrooms(actual): DESIGN flow based'on 310.C*MR 15.203 (for example: 110 gpd x#of bedrooms): (D Number of current residents: Does'residence have.a garbage grinder(yes or no) e- Is laundry on a separate sewage system (yes or no): [if yes separate inspection required] Laundry system inspected(yes or no)lAh- Seasonal use:(yes or no .. Water meter readings, if available(last 2 years usage(gpd)): Mope �f`� � Sump pump(yes or no Last date of occupancy: a (� PieQ/U 1�� L�1�JGe�C �G�� COMMERCIAL/INDUSTRIAL Type'of establishment: Design flow{based on 310 CMR.15.203): gpd Basis of design flow(§eats%persons/sgft,etc,): : . Grease trap present(yes or no):— Industrial waste holding tank present(yes or no):— Non-sanitary waste discharged to the Title 5 system (yes or no):_ Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records - Source of information: 4n Was system.pumped as part of the inspection(yes or no : If yes,volume pumped: gallons--How was quantity pumped determined? Reason•for_pumping: . TYPE OF SYSTEM e tic tank,distribution box,soil absorption system - _Single cesspool _Overflow cesspool Privy Shared system.(yes or no)(if yes,attach previous inspection records, if any) Innovative/A Item ati ve 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 —Othe'r'(describe): proximate age of all eom��ents,da ip tailed(if known)and source of information•: • r, Were'sewage odors.detected when arriving at the site(yes or no)`� f Page 7 of 11 OFFICIAL INSPECTION FORM.—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: Date of I pectiOn: Qa. BUILDING SEWER(locate.on site plan)1'14 Depth below grade: Materials of construction:_cast iron _40 PVC_other(explain): Distance from private water supply well or suction liner Comments(on condition of joints,venting, evidence of leakage,etc.) t ' SEPTIC TANK: on site plan) Depth below grade: 'Material of construction: a---concrete metal_fiberglass._polyethylene other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a.copy of certificate) Dimensions: )0,6,y(p°X,5 Sludge depth:1(� Distance from top of sludge to bottom of outlet tee or baffle: ZO Scum thickness: Distance from top of scum to top of outlet tee or baffle: Al Distance from bottom of scum to bottom of outlet tee or baffle' How were dimensions determined; LG,,tQ��i� Ply/J Comments(on pumping recommend&ions, in and outlet tee or baffle condition,structural integrity, liquid levels —as related to outlet invert, evidence of leakage,etc. T GREASE TRAP (locate on.s►te plan) " . Depth below grade:_ Material of construction:—concrete metal_fiberglass Polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet,tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage;etc.): 1 Page 8 of 11 OFFICIALINSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM .PART C SYSTEM INFORMATION(continued) Property Address: rl2/ Owner:• 4 u Date of pection:. TIGHT or HOLDING TANK (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass polyethylene. other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: _ Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches, etc.): DISTRIBUTION'BOX:y (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: 1"V-/ Comments(note if box is Ievel.and distribution to outlets•equal,any evidence of solids carryover,any evidence of, IC kage into or out of box, c.): PUMP CHAIVIB (locate on•site plan) Pumps in working order(yes or no): Alarms in working order(yes or no):. r Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 I Page 9 of 11 OFFICIAL,INSPECT,ION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE.SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART.C SYSTEM INFORMATION(continued) Property Address: Owner: Date of pection: C SOIL ABSORPTION SYSTEM (SAS): L_'0ocate 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: 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.): CESSPOOL(cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum laver: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of,vegetation,etc..): PRIVYY (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): ' 9 Page 10 of 11 OFFICIAL INSPECTION FORM=NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM.INFORMATION'(continued) Property-Address: Owner: Q0124AVj Wr",�,A Date of spection: a� 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. D4" �ol 10 Page I 1 of l l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 9 Owner: Date of .f ection: 6co SITE EXAM. Slope _ Surface water Check"cellar. Shallow wells Estimated depth to ground water 1 i' feet Please indicate(check).all methods used to determine the high ground water elevation:' Obtained from.system design plans on record-If checked, date of design.plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) .Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You.must describe how you established the high ground water elevation: ' /Ale ,v 11 Permit Number: Date: Completed by:. HIGH'GRO-UND-WATER LEVEL COMPUTATION Site Location: ` 0' r 6rli�4111 Lot No.. r 0vvner:__ J01?,# Address-- 15CT/y1 Contractor:_ - &/`7V*)�e / Co�$� Address` Notes: STEP. 1 . Measure depth xo water table . to nearest'.1./i Tt......._......... • :.....:........:...:.:........::.........: ... Dated month/day/year STEP 2 Using.Water-Level.Range Zone and Index WeiI:Ma.p:locate site and determine: 2 OAppro.priate.index well....................,..........................:..:.... Y/�Z (� Water-level range zones ...,._......................... ' STEP•,:3:: Using monthly.repo.rt;:"Current - Water Resources Conditions" determine current-depth to = water level for index weld month/year STEP. 4. Usin :Table of-1Nat�r,l.e�e 9 _I Adjustments for index well (STEP 2A:)_current depth I to water level for. index well (STEP 3):, and water-level zone (STEP 2B) determine water level adjustment ................................... 3 'Z ST.E,P. 5 Estimate depth to:hfgh water by subtracting the water level adjustment.(STEP 4) from measu.red:.depth to water level-at site.(STEP l y.............:....:. l� .............. ....... .................. . ......,........:............................... Figure. 411-- 2Pro- UCIJlB i.oil1pU%uiluP�iCr1tl: 15 C :5 OD I� p 1rrPi`f Fad Z 4 1, TOWN OF BARNSTABLE �c t LOCATION � Jj "� �� SEWAGE # ` VILLAGE LbArk1` ASESS0R'S & LOT (510 ,11,1'003 INSTALLER'S NAME&PHONE N0. T���t'C� �IJS SEPTIC TANK CAPACITY LEACHING FACILITY: (type2%t lS (size) /a x _ o� 1 NO.OF BEDROOMS P BUII,DER R OWNER PERMTTDATE:_ 3 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by kq' r \ \� y No. Fee Ida THE COMMONWEALTH OF MASSACHUSETTS ' PUBLIC HEACTHDIVISION -TOWN OF BARNSTABLE., MASSAC--HUSETTS 9pplica$ion for Miqaal 6p!5gem Con5tructi®n Permit zV f l5 Application is hereby made for a Permit to Construct( )or Repair( )an On-site Sewage Disposal System at: 6 pwl Location Address or Lot No. "G�g Owner's Name,Address and Tel.No. Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. ��_���p r�CT� X �jIle t p Type of Buildin Dwelling E—No.of Bedrooms Garbage Grinder Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3 gallons per day. Calculated daily flow `�7�l gallons. Plan Date • Number f sheets Revision Date Title 5 1 ( (!<m } 4C•�Cr, �'AA 64: Lo Description of Soil 1> 2� LG gm ¢ SU&�;yg . W-OcA16 )44 _ Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued b his f H h. Signed Date Application Approved by L Application Disapproved for the following reasons 26 Permit No. �,s '� Date Issued ——————————————————————————————————————— �i.-a..r. .t'y) +.1.�i h y ir�".'& Y;j�t�.rJr'�..�4s a � Yt'� '.z`.r-.�.�� y s• ,s.„l,�a "+i- �Y y.-A?c.jr. � �Y,�'�,_. /1• .rt.,. �..`4 ....a.i.''° .t��,,' i ,£yX,�,,,;,.1�" i--�:.t:'-.^a�...:�+T�i.` ......�' `��` xi - No. �t� Fee ft�/ ©o k r F THE COMMONWEALTH OF MASSACHUSETTS PUBLIC 4-A, fiFtDIVISION -TOWN OF BARNSTABLEs MASSACH 'ETTS 01pplication for-Mi!5pool *pgtem Con!5trnction Pert pit J,,5,t / ! - 01 Application is hereby made for a Permit to Construct( )or Repair( )an On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. k t ;. ' 2 ► +�► .1 � 1. I�J c vc`F-- t+f - Installer's Name,Address,and Tel.No. Designer's Name,Address and T .o. 77) ! Type of Building: Dwelling L•''No.of Bedrooms Garbage Grinder Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow ` - gallons per day. Calculated dai y flow r�? gallons. j Plan Date 3 Number of sheets 1 Revision Date. 1 '1'�—i( { 0 Title 1 yl- 1 fir, f v t `'1M!f= l — L46 1 Description of Soil ZG.Mm W4 LkLJQ— Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by is B f HeAh. Q Signed DateFag Application Approved by Application Disapproved for the following reasons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH.DIVISION - BARNSTABLE, MASSACHUSETTS certificate of (Compliance _ . THIS IS TO CER .FY,tha the On;site Sewage Disposal System installed( )orfrepaire&replaced(. )on by / _�1� for (21. ,,i r,� � • c'C>�1�- ar v I has been lconstructe in acc dance with the provisions of Title 5 and the for Disposal System Construction Permit No. I t Co dated Use of this system is conditioned on compliance with the provisions set forth below< No. � o�� Fee �O ua THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS �Mi!5poal 6petem (tongtrnction Permit Permission is hereby granted to Lef;�q ZJ.4-1 8 to construct V )repair( )an On-site Sewage System located at f c ` ' C7, .r I� 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. All construction must be completed within two years of the date below. Date: Approved by �' TOOWN` OF BARNSTABLE OCATION QtPI'"N�� Q.� SEWAGE # tv VILLAGE-' etT A ESSOR'S ITY: S & LOT 610 • kl, ao;3 °INSTALLER'S NAME&PHONE NO. 6 IT o SEPTIC TANK CAPACY AD LEACHING'FACIL (type �s (size) l� X X a -:NO.OF BEDROOM BUII DER R OWNER PERMIT DATE:�=� �� COMPLIANCE DATE: �'3 — MIR Separation Distance Between the: .Maximum Adjusted Groundwater Table and 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 t4TP Within 300 feet of leaching facility) Feet Furnished by ± r i r. AA9 y f os.�. r-... .. ".Yivnw...u+.yM.Jr '. - .w....a v..x.-w. N ✓ M. - n. N ` Lolo o 1(5— Jf 96 � CONT.Rx7GE VEM NEW RAKE S TRRABOAROS TO MATCH EMST '� ® ® 1x<tRIMWI KEYSTONES ROOF IL ASPN S 2 FOACIRCLE WINDOW ROOF SHBaGLES 12 NEWFASCL 6FRIEZE 1I BOARDS TO IMTCH EMU 6 TOP OF PIAtE Cl ❑ ® NEW WINDOW UATC T)6 � MAFQ 1ST0 1 F on I TO WTCII—M. ORNEREXIST AROS NEW Sx NG TO MATGH IR EXIST FIRST FLOOR I SUBFLOOR NEW WAYERTABLE FRONT ELEVATION T°'"" TING ,ra 156 NAILING SCHEDULE s-e er 110 MPH EXPOSURE 8 WIND ZONE PT6,sPosr=WrA2EI: NOTES: JOINT DESCRIPTION NO.OF COMMON NAILS NO.OF BOX NAILS NAIL SPACING I CASING 61x86A.E ROOF FRAYING. 1.) CONTRACTOR IS TO VERIFY ALL EXISTING CONDITIONS Momw-To RAFTER POE NAILED) 2-m 2-10d EAntom &DIMENSIONS IN THE FIELD RLM BOARD TO RAFTER IEKDNAM1HII 2.wd 31m EACH END I I y 2.) CONTRACTOR TO VERIFY ALL INTERIOR&EXTERIOR MATERIALS, wA PLATES A I A TOP STUD TO STUD D AERSECTIOPLS(FACE NAAED) 4-,m S.Ifid AT JOINTS DETAILS,&'FINISHES IN THE FIELD WITH OWNER srwrOsiuDSArENAxBD) a16d 2.,m 24' A3 NEW 30 ro°ft FADER TO HEADER lFACE NA&M w ,m 1S os.ALMG EDGES SCREENED 3.) ROUGH OPENING HEAD HEIGHT OF WINDOWS AT FIRST FLOOR TO BE 6'-1(-ABOVE SUBFLOOR FLOOROSMLT JOIST TO SR.L TOP PLATE OR GIRDER POE NAILED) ASd 4Tm PER—ST e PORCH I G 4.) ALL CONSTRUCTION TO CONFORM TO 780 CMR MASSACHUSETTS BLoc1UNG To�o sTS POE NARFD) 2-m zOd EACHM b I BLOCKMG To GR OR TOP PLAtb PDE NApED) 3,6d 4-t61 EACH BLOCK a� A3 IVAYLrEIi CEawGi I "' STATE BUILDING CODE,SEVENTH EDITION LEDGER STRIP TOBEAMOR GLWERIFACERIaEDI T-,rb a1m EACH XXST I S.,r 6.) ALL SHEETS RMST ON LEDGER TO BEAAC(FOE HARED) 3m 31m PER JdbT EXPOSURE eAND+rnstioJ U(EIIDWRED) n-,m a-,m PERmU "I ) 110 MPH EX BAND) T TO SiLL OR TOP PLATE POE FWLEDO 2.16, 3tm PER FOOT OF PLYWOOD WALL SHEATHING TO BE INSTALLED VERTICALLY„ I OR HORIZONTALLY W/BLOCKING AT EDGES,3"EDGE/12"FIELD NAILING' ROOF SHEATHWG I QE ABOVE❑E abo QE AeovE 8.) ALL LVL LIIMBERAXAMS TO BE 1.9e L/480 LOAD RRAAFTERS OORCMMSSES S�PACED�S` c as m FEDGET FIELD RAFTERSORTRUSSES SFACEDOWRIT—. m lm CEDGEA Fm EXIST. Q 0 0 9.) SEE CERTIFIED PLOT PLAN DEVELOPED BY BSS DESIGN FOR ALL PROPOSED AND GABLE END w.uL RAKE—RAKE TRUSSVV OVERHANG 1M im S-EDGWFmD LIVING ' EXISTING DETAILS GABLE END WALL RlJLE OR RAI�TRl65 m tm 1i EDGFiE FHD ' - )'' W/STRUCTURALOUTLOOKERS l RSEN 10.)FOLLOW ALL MANUFACTURER'S SPECIFICATIONS FOR INSTALLATION OF ALL GABLE ENO WALL RAKE OR RAKE TRUSS IW LOOKOUTBLOCKS m ,m PEDGEW F1ELO FWH6O69 PISR SIMPSON COMPONENTS CEILWGSHFAT1 G. I I-)ALL CONCRETE USED FOR FOUNDATION WALLS.FOOTINGS&SLABS GYPSUTA WALLBOARD WCOOLERS rEDGE BREW TO BE 3000 PSI WALL 6HEATw b LT O O WDODSTRUCTURAL PANELS(KYW001A 12-)VERIFY ALL PLUMBING&ELECTRICAL DETAILS W/OWNERS ON THE SITE STUOSSPACEUUPTO24" w ,m s-EDCFnr Flan p © © � R " DURING FRAMING CONSTRUCTION ,rrnzsF.¢FIBERBOAROvalEis m — TEDGFJB'FmD 13.)THIS SITE IS IN THE 110 MPH WIND BORNE DEBRIS '?GYPsuN wuLeoaLO sd COOLERS — rEDGE(w FIELn {SOON AREA,EXPOSURE"B" _ ---- --------- -/ ------ �'" &WITHIN ONE MILE OF NANTUCKET SOUND PER STATE OF yv LVAWTEDCEWNGj t? p FLWDOD STRUCTURAL PANELS YW000) (PL p a MASSACHUSETTS WIND SPEED MAPS r OR LESS TwC SS tM xM SEOGENZ FIELD NEW 14.)GLAZING PROTECTION PER 780 CUR 5301.212 TO BE PLYWOOD PANELS GREATER THAN'-MCKNESS 1m 16d s-EDCOTFIE D SITTING VERIFY ALL WIND BORNE DEBRIS PROTECTION REOUIREMENTS \/ AREA 416 POST W WALL W1 OWNERS PRIOR TO START OF CONSTRUCTION /\ FROM FLOOR DGEMAN to 15.)TIMBER FRAMING TOBESPRUCFJPINE/RRNO.2GRADE W rvAULrED cEawG) © p EXIST- ray p BATH WINDOW SCHEDULE - 1ECC2009 RESIDENTIAL ENERGY EFFICIENCY DETAILS' I I t TILED p. - TYPEJ MANUFACTURERS.UNIT ROUGH OPENING. REMARKS I ) CLIMATE ZONE SA(USE EITHER PRESCRIPTIVE VALUES OR RESCHECK CALCULATION A ANDERSEN�TW 2446 2-6:1/8"x 4'-8 7Ar DOUBLEHUNG ro, 4 A A NEW NEW /� m TABLE 402.1.1(MINIMUM'PRESCRIPTIVE INSULATION B FENESTRATION REQUIREMENTS) 8 TWT 4210 4'3 7/8'x 1'-0 1J2' TRANSOM '^ ( 4 FEHE6TRATIOH SKYIIGHF CEKING =OO D FRAME°WILLL F100R BASEMEN WAl1 BABEMENT SLAB CRAWL SPACE WAIL - -.. W.I.C. _)3- BATH `J LLFACTOA LLFACTOR R-VALUE R-VILLUE R-VALUE R-VALUE R-VALUE R-vALL1E G TW 1846 E'-10 1/8'xw-8 7/8' .DOUBLEHUNG Ex¢T t I -- S • D. __ TW 2452 "x 5!2-6 iJ8 8 DOUBLEHUNG. C F > Pn B C A I NOTES: I E —TWT 2415 2-0 1/T x V-7 718" TRAN$ONI A3 ) 1.R-VALUES ARE MBSIMUMS&U-FACTORS ARE MAXWUMS. F TWT 5610 5-7,7186,x 1'-O N2' TRANSOM 2 lQfl3 6MAUS R 15 CONTINUOUS INSULATED SHEATHING ON THE INTERIOR OR EXTERIOR G -0 1. OR 20 Z' 51W x 7-0 W CIRCLE OF THE HOME OR R=t3 CAVFTY INSULATION AT 7HE WTERIOR OF THE EASEMENT WALt C REFER TO C 3. R IE C 2009 CHAPTER 4 FOR ALL INSULATION 8' MAP O CATION ENERGY R OUIRE11BdT f32 E S ' QA 1.CONTRACTOR TO VERIFYALL WINDOWS WITH OWNER AND ROUGH OPENINGS I— © A6OW WITH WINDOW MANUFACTURER PRIOR TO ORDERING OF WINDOWS 2.ANDERSEN 400 SERIES-WINDOWS WHITE EXTERIO R W/HIGH PROFILE EXTERIOR « z-to rr 4s } T'D' `1i LEGEND: GRILLES.LOW-E HP 4 GLAZING W/TRU-SCENE SCREENS&METRO HARDWARE- .„ C n•.c /�sa za Q EXISTING WALLS OO SMOKE DETECTOR FIRST FLOOR PLAN -:7 CONSTRUCTION TO BE REMOVED ©CARBON MONOXIDE DETECTOR . NEW CONSTRUCTION ®HEAT DETECTOR 7I1E DESIGNER MAU BE N0T6REDIF AN MISSwDNSpJEFDUND°N SCALE : DFv1V VINE No.: COTUIT BAY DESIGN, LL ERRORS°RO C NEW ADDITION FOR. THESEDRXW GSPR mI TOSTARTOF 43 BREWSTER ROAD CONS1gUCTRxl iHEBUiLOIM'CONTRACTOR MASHPEE,MA. 02649 R,THEESE R DERSPAWONNSGIBSL Eff FCOORN S`RCICON'1EN 114" y V-V N =sHdTHODTNDRn PH-(5C0�18)274--1F1,66 MAR RPHY THEMDwwwoSARE�Y�'1� DATE : Al FAX(508)539-9402 OC 1HE OWNER NOTED.ANV OTHER USE OF . THERE DRAWINGS REOURES THE WRITTEN ANTUIT D COTUIT, MA AR TOUR�G��I�TECTION 1v2/20zo ACTOFti6 NEW RAKE E TRW BOARDS TO MATCH EXIST, 12 12 t2 12 CRICKET CRICKET 12 S� TOP OF PLATE 6 NEW CORNER BOARDS F TO HATCH EAST ❑ ❑ +,# NEW W C SHMGLE SIDING — O TO MATCH EASING f FIRST FLOOR SUBPLOOR P.T.S.6 POSTS W AZEK CASING J,=BBASE REAR ELEVATION 12 12 RE MOVE EASTMG WNDOW EAST. �FJtIST. 1Z$ 1S8 RREPLACEMPAIDERSEN A21.VERIFY LOCATION M fd Sd P.T.B=B PoSTs ON 12'OM CONCRETE TIE FIELD M RELATION sONOTUBES W 2T DA-BRIFOOT FODTINOS TO NEW ROOF LOCATION UNDERNEATH TOl BELOW GRAM USE CONT RIDGEVENT SM,PSON A9USS POST BASE ay.r.1=11: � \ / INSTALLSl6ANCHORBOLTSAT7,-oc— _____T .� ____________ y h B PLACE BOLTS mSTHW-1 'S ACNS ei;-ioi TrPICAL-I—LTA A A3 coLa/ER AND TO Ae•bBNIML/M DEPTH,te_-_=�y,' `.RooF SHwGL{s A3 r 3 � / +-f so so• s--f sd s.f NEW FASCIA&FRIEZE BOARDS TO MATCH DUST. 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