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Home My WebLink About0241 SCHOOL STREET - Health 241 School Street Cotiiit - —_ - - - ---. - A= 020-099 ' I f� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 't 241 School St. Property Address Jeff Marshall Owner Owner's Name information is required for every Cotuit Ma 02635 2/22/2010 page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information - _ on the computer, use only the tab 1. Inspector: key to move your >, cursor-do not Sean M. Jones use the return Name of Inspector key. S.M.Jones Title V Septic Inspection ICI Company Name 74 Beldan Ln. Company Address t Centerville Ma 02632 Cityrrown State .'Zip Code 774-248-4850 S14522 Telephone Number License Number "" A B. Certification t Ij Co >'"rY 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 2%22/2010 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. ' _w "I ****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. JAD t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts lugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 241 School St. Property Address Jeff Marshall Owner Owner's Name information is required for every Cotuit Ma 02635 2/22/2010 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins-09/08 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments w o 241 School St. Property Address Jeff Marshall Owner Owners Name information is required for every Cotuit Ma 02635 2/22/2010 page. cityrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ' ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 i Commonwealth of Massachusetts Affim Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary.Assessments �< 241 School St. Property Address Jeff Marshall Owner Ownets Name information is required for every Cotuit Ma 02635 2/22/2010 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for 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 El ® or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/day flow t5ins•09/08 Title 5 official Inspection Fonn:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 241 School St. Property Address Jeff Marshall Owner Owner's Name information is required for every Cotuit Ma 02635 2/22/2010 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 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. t5ins•09108 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts lugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 241 School St. Property Address Jeff Marshall Owner Ownees Name information is required for every Cotuit Ma 02635 2/22/2010 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption.System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)(310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 5 Number of bedrooms(actual): 5 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 550 gpd t5ins-09/08 TiUe 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments „ t 241 School St. Property Address Jeff Marshall Owner Owner's Name information is required for every Cotuit Ma 02635 2/22/2010 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 I 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 Seasonaluse? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: 2008= 784 gpd 2009=942 gpd (includes irrigation system) Sump pump? ❑ Yes ® No Last date of occupancy: current Date Commercial/industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments yl 241 School St. Property Address Jeff Marshall Owner Owner's Name information is required for every Cotuit Ma 02635 2/22/2010 page. Cityfrown 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: 2007 Was system pumped as part of the inspection? ❑ Yes ® No If yes,volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 241 School St. Property Address Jeff Marshall Owner owner's Name information is required for every Cotuit Ma 02635 2/22/2010 page. Cityfrown State Zip Code Date of iInspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: System installed 1991-town records Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): runs below basement floor, cleanout Depth below grade: located near tank, cover to grade 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.): Joints ok, no leakage, vented through roof Septic Tank(locate on site plan): Depth below grade: 1feet 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 gallons Sludge depth: t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments yt 241 School St. Property Address Jeff Marshall Owner Owner's Name information is required for every Cotuit Ma 02635 2/22/2010 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 3.5' 1 Scum thickness Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 10" How were dimensions determined? Opened covers and took measurements 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 does not need to be cleaned now but should be done every 2 years as maintenance.Water level at bottom of outlet invert. Tank structurally sound and not leaking. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•09/08 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 241 School St. Property Address Jeff Marshall Owner Owner's Name information is required for every Cotuit Ma 02635 2/22/2010 page. Citylrown 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-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 241 School St. Property Address Jeff Marshall Owner Owner's Name information is required for every Cotuit Ma 02635 2/22/2010 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box was found to be functioning as intended. Water level was at bottom of outlet invert. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order. ❑ Yes ❑ No Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System(SAS)(locate on site plan, excavation not required): If SAS not located, explain why: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments t 241 School St. Property Address Jeff Marshall Owner Owners Name information is required for every Cotuit Ma 02635 2/22/2010 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 2 4x6 3'stone ❑ 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.): Soil was dry and no lush vegetation.Leach pit#2 had approx. 3' of available leaching and no sign of past hydraulic failure. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of.liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 241 School St. Property Address Jeff Marshall Owner Owner's Name information is required for every Cotuit Ma 02635 2/22/2010 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts e `Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ¢ 241 School St. Property Address Jeff Marshall Owner Owner's Name information is required for every Cotuit Ma 02635 2/22/2010 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 l V` j V ice• ►. , � c23 3S , LC-rkCH q y , #,; A li t5ins-0901 Title 5 official inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments y< 241 School St. Property Address Jeff Marshall Owner Owner's Name information is required for every Cotuit Ma 02635 2/22/2010 page. City/town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water. 20 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Groundwater elevation was determined by accessing Town of Barnstable groundwater contour map. Also the property is elevated high compared to low point of nearby golf course. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 241 School St. Property Address . Jeff Marshall Owner Owner's Name information is required for every Cotuit Ma 02635 2/22/2010 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 L <C�,` Commonwealth of Massachusetts Title 5 Official 'Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 241 School St. Property Address Jeff Marshall Owner Owner's Name information is required for every Cotuit Ma 02635 2/22/2010 - page. Cityrrown State Zip Code. . Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way.Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms on the computer, I a use only the tab 1. Inspector; C �� key to move your cursor-do not Sean M. Jones use the return Name of Inspector key. S.M.Jones Title V Septic Inspection Company Name 74 Beldan Ln. Company Address Centerville Ma 02632 Cityrrown State Zip Code 774-248-4850 SI 4522 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance.of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of, Title 5(310 CMR 15.000).The system: ® Passes _ ❑ Conditionally Passes ❑ FailsiZZ J co ❑ Needs Further Evaluation by the Local Approving Authority 3 ,, 2/22/20.10irn Inspector's Signature Date i: . � The system inspector shall submit a copy of this inspection report to the Appro ing Autlgity(W9ard 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. V r � t5ins-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 r _ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r' 241 School St. - Property Address Jeff Marshall Owner Owner's Name information is required for every Cotuit Ma, 02635 2/22/2010 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: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes" "no"or"not determined"(Y, N, ND)for the following,statements. If"not determined," please explain. The septic tank is metal and over 20 years old' or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board:of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form_ Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 241 School St. Property Address Jeff Marshall Owner Owner's Name information is required for every Cotuit Ma 02635 2/22/2010 page. Cityfrown State Zip Code Date of Inspection B. Certification (coot.) 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): 1 { C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a.surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of W Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments. 241 School St. Property Address Jeff Marshall Owner Owner's Name information is required for every Cotuit Ma 02635 2/22/2010 page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: i **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: I 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 '/2 day flow t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 r L _ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 241 School St. Property Address Jeff Marshall Owner Owner's Name information is Cotuit Ma 02635 2/22/2010 required for every page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ Required pumping more than 4 times in the,last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50.feet of a private water supply"well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet. from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must.be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 16,000 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 ❑z ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply El ET Area system,is located in a nitrogen sensitive area(Interim Wellhead Protection Area IWPA)or a mapped Zone 11 of a.public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department t5ins-09= Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts Title 5 Official • Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments y 241 School St. Property Address Jeff Marshall Owner Owner's Name information is required for every Cotuit Ma 02635 2/22/2010 page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period?,. ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as.N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions,.depth of liquid, depth of sludge and depth of scum? - ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil.Absorption System;(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design):. 5 Number of bedrooms(actual): 5 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms):. 550 gpd t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 J Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 241 School St. Property Address Jeff Marshall Owner Owner's Name information is required for every Cotuit Ma 02635 2/22/2610 page. City/Town State Zip Code Date of Inspection. D. System Information Description: 2 Number of current residents: 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? 1 ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: 2008= 784 gpd 2009=942 gpd (includes irrigation system) Sump pump? ❑ Yes ® No Last date of occupancy: current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r( 241 School St. Property Address Jeff Marshall Owner Owner's Name information is Cotuit Ma 02635 2/22/2010 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: 2007 Was system pumped as part of the inspection?. ❑ Yes ® No If yes,volume pumped: gallons , How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no)(if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract �I Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 241 School St. Property Address Jeff Marshall Owner Owner's Name information is required for every Cotuit Ma 02635 2/22/2010 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: System installed 1991-town records Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): „ Depth below grade: runs below basement floor, cleanout located near tank,cover to grade Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): i Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Joints ok, no leakage, vented through roof Septic Tank.(locate on site plan): Depth below grade: 1 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 gallons 8„ Sludge depth: t5ins•09108 Title 5.0rfidal Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 official Inspection' Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 241 School St. Property Address Jeff Marshall Owner Owner's Name information is required for every Cotuit Ma 02635 2/22/2010 page. Citylrown 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' 3.5' Scum thickness Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 10m How were dimensions determined? Opened covers and took measurements 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 does not need to be cleaned now but should be done every 2 years as maintenance.Water level at bottom of outlet invert. Tank structurally sound and not leaking. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle / Date of last pumping: Date t5ins•09= Title 5 official Inspection form:Subsurface Sewage Disposal System•Page 10 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments a� 241 School St. Property Address Jeff Marshall Owner Owner's Name information is required for every Cotuit Ma 02635 2/22/2010 page. Citylrown 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.): � y 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•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 r ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 241 School St. Property Address Jeff Marshall Owner Owner's Name information is required for every Cotuit Ma 02635 2/22/2010 page. City/Town State Zip Code Date of Inspection. D. System Information (cont.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0" Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of.leakage into or out of box, etc.): D-box was found to be functioning as intended. Water level was at bottom of outlet invert. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes. ❑ No Alarms in working order. ❑ Yes ❑ No Comments(note condition.of pump chamber, condition of pumps and appurtenances,`etc.): J Soil Absorption System(SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 12 of W Commonwealth of Massachusetts. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments „ 241 School St. Property Address Jeff Marshall Owner owner's Name information is required for every Cotuit Ma 02635 2/22/2010 page. Citylrown State Zip Code. Date of Inspection D. System Information (cont.) Type: , ® leaching pits number. 2 4x6 3' stone ❑ leaching chambers number: . ❑ leaching galleries number. ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: Cl 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.): Soil was dry and no lush vegetation. Leach pit#2 had approx. 3' of available leaching and no sign of past hydraulic failure. Cesspools(cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ 'No t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 241 School St. Property Address Jeff Marshall Owner Owner's Name information is required for every Cotuit Ma 02635 2/22/2010 page. Citylfown State Zip Code Date.of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): ' Materials of construction: Dimensions Depth of solids Comments(note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation, etc.): h } t5ins-09108 Title 5 Official Inspection Fom1:Subsurface Sewage Disposal System Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 241 School St. Property Address Jeff Marshall Owner Owner's Name information is required for every Cotuit Ma 02635 2/22/2010 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view.of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately OoLp i 3 6,, ✓�. a 31 1. A• 72, 3S (j-3 • ate, r tCAu{ VU # 1 A-N: Y� l3- L+ 07-7 a -s: y7' 13 a� yo t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments y� 241 School St. Property Address Jeff Marshall Owner Owner's Name information is required for every Cotuit Ma 02635 2/22/2010 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells ' 20' Estimated depth to high ground water. feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on'record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ , Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: I Groundwater elevation was determined by accessing Town of Barnstable groundwater contour map. Also the property is elevated high compared to low point of nearby golf course. Before filing this Inspection Report, please see Report-Completeness Checklist on next page. t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments y` 241 School St. Property Address Jeff Marshall Owner Owner's Name information is required for every Cotuit ' Ma 02635 2/22/2010 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 J • ' Commonwealth'Of Massachusetts Executive Office Of Environmental Affairs . Department Of Environmental Protection TITLE 5 Official Inspection Form - Not For Voluntary Assessments Subsurface Sewage Disposal System Form Part A Certification Property Address: 241 School St.Cotuit Ma.02635 Owners Name: Jeff Marshall Owners Address:241 School St.Cotuit Ma.02635 C C) 1 Date of Inspection: 1/12/2008 Name of Inspector(please print)Sean M.Jones#S14522 - j Company Name: S.M.Jones Title V Septic Inspection Mailing Address: 74 Beldan Ln. Centerville Ma.02632 Telephone Number: 508-778-4597 CERTIFICATION STATEMENT = `' I certify that I have personally inspected the sewage disposal system at this address and that the info�a.t reppi'ted cu below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my,,) fv�. training and experience in the proper function and maintenance of on site sewage disposal systems.I a a DEP' approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: X Passes Conditionally.Passes Needs further evaluation by the Local Approving Authority Fails _ Inspectors Signature Date: /,3-0 a,� The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments: ****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. - Page 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(corrrmm) Property Address: 241 School St.Cotuit Ma.02635 r Owners Name: Jeff Marshall Owners Address:241 School St.Cotuit Ma.02635 Date of Inspection: 1/12/2008 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D. A. System Passes: X 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:N/A 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 the 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 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 4 times a year due to broken or obstructed pipe(S). The system will Pass inspection if(with approval of the Board of Health): r - broken pipe(s)are replaced obstruction is removed ND explain: R OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) _ Property Address: 241 School St.Cotuit Ma.02635 Owners Name: Jeff Marshall Owners Address:241 School St.Cotuit Ma.02635 Date of Inspection: 1/12/2008 C.Further Evaluation is required by the Board of Health:N/A _ 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 310CMR 15.303(1)(b)that the, System functioning in a manner that protects the public health,safety and the environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a Surface water supplyor tributary to a surface water supply. k _ The system has a septic tank and SAS and the SAS is within a Zone 1 of public water supply. _ 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 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 241 School St.Cotuit Ma.02635 Owners Name: Jeff Marshall Owners Address:241 School St.Cotuit Ma.02635 Date of Inspection: 1/12/2008 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No X Backup of sewage into facility or system component- due to overloaded or clogged SAS or cesspool X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/Z day flow X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped X Any portion of the SAS,cesspool,or privy is below high ground water elevation. X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of cesspool or privy is within Zone 1 of a public well. T Any portion of cesspool or privy is within 50 feet of a private water supply well. X Any portion of cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 pp,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] X (Yes/No)The system fails.I have determined that one or more of the above 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:N/A To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of the following: 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 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 CM15.304.The system owner should contact the appropriate regional office of the Department. t OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 241 School St.Cotuit Ma.02635 Owners Name: Jeff Marshall Owners Address:241 School St.Cotuit Ma.02635 Date of Inspection: 1/12/2008 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No X _ Pumping information was provided by the owner,occupant,or Board of Health X_ Were any of system components pumped out in the previous two weeks?, r X _ Has the system received normal flows in the previous two week period? X Were as built plans of the system obtained and examined?(If they were not available note as N/A) X_ _ Was the facility or dwelling inspected for signs of sewage back up? X _ Was the site inspected for signs of break out? X _ Were all system components,excluding SAS,located on site? _X_ _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tee,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? _X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on:. Yes No X _ Existing information.For example,a plan at the Board of Health. _X _ 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)] r OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 241 School St.Cotuit Ma.02635 Owners Name: Jeff Marshall Owners Address:241 School St.Cotuit Ma.02635 Date of Inspection: 1/12/2008 FLOW CONDITIONS RESIDENTIAL - Number of bedrooms(design):_5_ Number of bedrooms(actual):_5_ DESIGN flow based on 310 CMR 15.203 (for example): 110 gpd x#of bedrooms):_550 gpd Number of current residents: 2 Does residence have a garbage grinder(yes or no): no_ Is laundry on a separate sewage system(yes or no): no_[if yes separate report required] Laundry system inspected(yes or no): n/a } Seasonal use: (yes or no) no_ Water meter readings,if available(last 2 years usage(gpd):2006=291000-2007=297000(includes irrigation system) Sump Pump(yes or no): no_ Last date of occupancy/use: current COMMERCIAL/INDUSTRIAL: N/A Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping records Source of information: Was system pumped as part of the inspection(yes or no): If yes,volume pumped: gallons--How was this quantity pumped determined? Reason for pumping: TYPE OF SYSTEM X 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 the 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. 1991 town records t, OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 241 School St.Cotuit Ma.02635 Owners Name: Jeff Marshall Owners Address:241 School St.Cotuit Ma.02635 Date of Inspection: 1/12/2008 BUILDING SEWER(locate on site plan) a Depth below grade: runs below basement floor,cleanout located outside near tank,cover to,grade Materials of construction: cast iron_X_40 PVC other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): Joints were in good condition,no sign of leakage. SEPTIC TANK: X (locate on site plan) Depth below grade:_12" Material of construction:_X_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: 1500Gallons Sludge depth: 8" Distance from top of sludge to bottom of outlet tee or baffle: 3.5` Scum thickness: trace 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:Opened covers and took measurements 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 was cleaned in Spring of 2007,should be cleaned every 2 years to maintain the useful life of system.Inlet and outlet tees intact.Water level was at bottom of outlet invert. Tank was not leaking and is structurally sound GREASE TRAP: N/A (locate on site plan) Depth below grade: Material of construction: concrete metal - fiberglass_polyethylene other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels As related to outlet invert,evidence of leakage,etc.): t • OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 241 School St.Cotuit Ma.02635 Owners Name: Jeff Marshall Owners Address:241 School St.Cotuit Ma.02635 Date of Inspection: 1/12/2008 " TIGHT or HOLDING TANK: N/A (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: X 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 was old but still functioning as intended.Water level was at bottom of both outlets.D-box was not leaking PUMP CHAMBER: N/A (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): " Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): . r OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 241 School St. Cotuit Ma.02635 Owners Name: Jeff Marshall Owners Address:241 School St.Cotuit Ma.02635 Date of Inspection: 1/12/2008 SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: t Type X Leaching pits.Number:_2-4x6 Leaching chambers,number: Leaching galleries;number: Leaching trenches,number,length: —leachingfields number,dimensions: overflow cesspool,number: innovative/alternitave system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): System is served by 2 leach pits that are piped individually from the d-box.Leach pit# 1 has seen more flow throughout the lifetime of the system.Leach pit#2 had 3 feet of available leaching at time of inspection. CESSPOOLS: N/A (cesspools must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: ' Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: N/A (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.): K. OFFICIAL C INSPECTION FORM-NOT FOR VOLUNTARY ASSESS MENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 241 School St.Cotuit Ma.02635 Owners Name: Jeff Marshall Owners Address:241 School St.Cotuit Ma.02635 Date of Inspection: 1/12/2008 SITE EXAM Slope XX Surface water Check cellar Shallow wells Estimated depth to ground water_5++_feet Please indicate(check)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: Groundwater elevation was determined by accessing Town of Barnstable Groundwater Contour Map. Also property is situated high compared to low section of adjacent golf course. OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 241 School St.Cotuit Ma.02635 Owners Name: Jeff Marshall Owners Address:241 School St.Cotuit Ma.02635 Date of Inspection: 1/12/2008 - SKETCH OF SEWAGE-DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent referencelandmarks or Benchmarks.Locate all wells within 100 feet.Locate where water supply enters the building B rear 0 0 3 E. TANK .2 a-4=23' B-2=2 0-BOX At-3-3: ' B 3=2[ LEACH Pri S B-4=:2T { TOWN OF BARNSTABLE LOCATION 241 56601 SX. SEWAGE # 91 - 11 VILLAGE ASSESSOR'S MAP & LOT pAcc, INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY 1 @ Q LEACHING FACILITY:(type) �J_ 3 Stogy(size) 4 f X 4 ' NO. OF BEDROOMS 4 PRIVATE WELL OR PUBLIC ATER BUILDER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE.GRANTED: Yes No • 9 At�►.^ems�`�! , ., ? 2 PI • ®r r No............ ....._�j Fus.......l...C..lA.- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH - D TOWN OF BARNSTABLE AVVftrafilan for Disposal Iforks Tonstrnrtinn Permit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at: } Location-Address pr Lot N�..2� c . Al 2Lll ....................... . t . .... .---._ .�5-�----- Owner Address i CTO$�La�Qt C G�1`CK M� Installer Address dType of Building , ` Size Lot............................Sq. feet U Dwelling-No. of Bedrooms...__._.`_J..................................Expansion Attic ( ) Garbage Grinder ( ) `4 Other—Type T e of Building No. of persons............................ Showers Pa YP g ---------------------------• P (2..) — Cafeteria ( ) a' Other fixtures ..........................-----------------------------------------------------------------------•------------------- ------------------W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid*capacity............gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--_---------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) - Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date....................................... a Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2...............minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ •---•-•--------•----------------------------------------------------------------•---•......•------••................ --------- _.... ---------------------- ODescription of Soil...............................................................................-------------------------------•------------•------------------------------•--••-••••... x V ......-----•------••••••-----•-•----•-••-•------...--•--------------•---•--•-------•---------------••--.................. x --------••••-------• .............•......•--•-•---••-...... 1 .... --------- ---�'-------------_•---------------------------- ••-----••---.............. --------- --- ----- -- U Nature of Repairs or Alterations t Answer when applica e_.._.�ow1 C. ___flfew...:S.e,p.;/�.4_.__S,I ..".ek4a.-----._�X�S�?�rl�....... e�a��aca-�� , ��J�!�LS �`�cl t �---/-CMavrcX c� t Agreement: �� r n The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environm to Code—The undersigned further agrees not to place the system in operation until a Certificate of Complia ce h been issued by athboWf health.Signed ----- ------- --------------- ------- ------------------`' ................ �1/16 cl to Application Approved B �(O ................ PP PP Y ---- f ' Date Application Disapproved for the following reasons- --------------------------------------------------------------------------------...............................---------------------- --------------------------------------------- ------------------------------------- -------------------------------------- ------------------------- Permit No. l-`--- ..... 3 Issued . ��. . -- ---................ Date ---- ................ ............................--..-- ...-.--......... Date y 1a+ V/t FEic THE COMMONWEALTH OF MASSACHUSETTS C�G� . BOARD OF HEALTH ' - U 0 TOWN OF:BARNSTABLE Applirtt#inn for Disnns�tl orks Cann #xnr#inn rani# Application is hereby made for a Permit to Construct V/ror Repair ( ) an Individual Sewage Disposal System at: Ca4L. ', MA �d�-5 25 � � ? .....-- - _-____............. ._._........ ......_.....-- -- .... --• -- ... .............-----..... Lecation-Address or Lot o. �2 c y.... _. 1 l Son, t,,�1�.�, -21I I C c no u\ S�. •t+i-i� Y`�°� ..................... _.........._.._...._ ...._........... -------•-•----------------------------------------------------------------- --........_.. Address W r Owner.....................................................�Mo ..\�•o� -----------------••--•--- .......................................................5 Coo raw 2�� p.. Jqc t�,o�t Yti, Installer Address Type of Building ,/ Size Lot----------------------------Sq. feet U Dwelling—No. of Bedrooms____.........................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers (Z) — Cafeteria ( ) a4Other fixtures -------------------------------------------------------••--------------•----•-•----•-•--------------••••••--•--------------------••-------------••.... W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid'capacity.._..._..._.gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.__.___.•___-__--__- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) 04 Percolation Test Results Performed by.......................................................................... Date........................................ 1.4 Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water-----_.................. t ------••-••••--••-------------•--••-•---••------•-----•-----------..............---•-•-•-•--•--_........-------•-------....--•••---••-•--•-------••-----••••. 0 Description of Soil........................................................................................................................................................................ W V --------------- ---------------•---------•-------------------- -.--- ..._.._...---•-•-------•----------------------•--*---------•----•------------------------•---•-------------------•----------- W J---�.�_1�...C?ca-l-n ------kt ---------------------------- q ----J -• -•-- ,�tC.. x COM C\etJ S e }�G S s e---� U N ture of Repairs or Alterations Answer when applicable_________________�__...._._.._._._ ......-__---�_._•_•-_._._...`�_--------...__. .. ...... t �'�rc.C'_- exd r;L ��..... `r tSS .................t .. � .-4-?J0��5 ... ��s re aia;:yQ ar Agreement: -A((Qj _f`n The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environm taI Code—The undersigned further agrees not to place the system in operation until a Certificate of Complia ce h, been issued byj/tth boar f-health. Signed ....- ......1- 1.1- ......-�`.c.. ............ Date Application Approved BY _ q °, .....-..`- Application Disapproved for the following reasons- ---------------------------------------------------------------------------"-'----............---.................................... - ---------------------------- ----- - C.� I / Date Permit No. ...............d-1- ...�.� . ...--.-... Issued ............... ems{ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE (aerti iett#e of Gutylianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repairedby ( ) .._--------- .�. r / .� Installer at ---...- -/........ .c,( .�� F -----..� :....... .?L 17-4--•---------- "q------------_---------__----------------------------------------'----------------------------------------------- has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code,,as described in the application for Disposal Works Construction Permit No. �... �.......... dated .---... 1�`....f. .. .r......... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTR ED AS A GUAR NTEE.THAT THE SYSTEM WILL FUNCTION 1 SATISFACTORY. DATE---------Jar--....-�-...4...1.........................................------------------ Inspector ......... � ............-'------...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE FEE....1.. �- 14spnsal Works Tnn#rnr#inn famit Permission is hereby granted.........A-y p�t—I--T 3�j....--.---•-•--•-••.........................•-••-•---.................--•---.......................... to Construct ( ) or Repair ( ) an Individual Sewage Disposal System Street as shown on the application for Disposal Works Construction Permit Dated.......c� ,� � � ..l......... ........•-......................... ............................ I Board of Health DATE --•................. FORM 36508 HOBBS&WARREN.INC..PUBLISHERS r , 200. 00' 100. 00' LOT 23 LOT 25 LOT 27 LOT 29 � o o o QS o o Of i ti3 N ISoo -� i. 60 171 �I i ' 100. 00' - 200. 00' - SCHOOL STREET ( C UIMQ UISSET A VENUE RES. ZONE.- " RF This MORTGAGE INSPECTION Plan is For FLOOD ZONE. " C " Bank Use OnI TOWN: _COTUIT _________________ REGISTRY OWNER: _JEFFREY & IS ALLOIV MARSHALL DEED REF: __2898,___ ___________BUYER: �?E'F- ---- -_-______-__-_____-_ ------------- DATE: —jZ2VZ91---------------- PLAN REF: _1�67 —__--__ SCALE:I"= 40FT. I HEREBY CERTIFY TO STEVEN_J._PIZZU -- TI_______ Y j�i — THAT THE BUILDING H F �"9 :?:. :w. YANKEE SURVEY SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS SHOWN AND THAT ITS POSITION DOES ____ CONFORM pAUL CONSULTANTS TO THE ZONING LAW SETBACK REQUIREMENTS OF THE �9ERI7114V TOWN OF BARNSTABLE-------------AND THAT NO. 320s8 143 ROUTE 149 IT DOES_ NOT _ LIE WITHIN THE SPECIAL FLOOD HAZARD ��s '�Fr,StFe�o r; MARSTONS MILLS, MA. 02648 AREA AS SHOWN ON THE H.U.D. MAP C DATED 19,�85 _ 'p4 S;,•rry,''y TEL: 428-0055 munit —Panel ;,250001 0021 C I LA14D, *'2a it THIS PLAN NOT MADE FROM AN INSTRUMENT PAUL 1ERIT EW PLS ------ SURVEY NOT TO BE USED FOR FENCES ETC. 6744 KJH IL t e VEtp A a o`Ea3 m�aw� f V V-c w00 � 3v I s._o" s%•_�„ S m oFoa3�,�ans m // 4'_4" 4._5 _g• Z I— 0 3o yam N W I, d� E� ES of (O'y x 4-O'honot ubem/p��gfootm 2 4 " 0 (� - _ 1 ` �paur¢d Gan¢rate GdUmn footing s - �. (� V—• anA oi�mpsonm AI7Ulalo f-4-17 bws V• - Pin new founds}ion}o dA w/4ew C67 } - r bld faundwfi'on wnd poured into new.' O J------ J-- ` •'' ---------- —Pourae of-Gr�}a fro --- — • C r �, O 7 - --- ------- ----- -------------, ' z a I q I WC,"x l o AnG#or bol}>w/ >hawir - i a I I o" , I % %^x o•x I/4 Ph+e wa>her> 0 V 0 '. _ I I %B•o G.wnd B'from>ill pla}e—1- LU . I Aodersano A Q - 1O"m x 4'-0"oiono}ubem/p�'Igfootm 2 9 —� p r. 9".Poured Gowr¢te-lab .,I �_ P P ' poured Gonere}e cdumnfoo}inq � I i w/!a mil.poly v,pr b,u-tier I ,'1 above.(oYea#-v¢n};q,sl n ' _ _ dnA yimpsonm AbUfilo po>#base. I I , I I � I • TFrae new shower>ta05 I i �' \ I Gu}¢xvet'nq Fwndat on wnd reframe ne large stroll w/9 shower I I v — � $ .r a o heads wnd d-wins. I I., wall. I ' r_______________�__-_________—______� 1 1 roll poured Gonave#eretan'nq wall may Ander>anmA%I -om I v E m / � o ' •io xmim^ ere9wre ore anexi>+�nq fdln a}on I 1 r.o %'-O I 2"x 2'-OS B" — Q sv. _ I _ --------------_ - - r rr - - , I I I !d-7^ 1 I - R-aloaw+a washer/Amer I ''1 4 to ab drill d fio n � F �° I L..___--_____. I I hook-up I of found ro d r d + ke wnd sho - d wtlon n ou a Cam'' i 1 G eG+new tole+,sin I L_____ _________ _ ____— __________ P _ (10 0 R m it to¢aistinq plumbing'n conareta flodr. l "" --- b - I •_ _ w u 3p _______ _ ------- Q No 3m � ,•- ��. + I �l I ' I I l — ._ n hT�-AGE I I' — ' rY___________________ FO UNI7A'rION CLAN 8 a im x mim ------------------ New 2x4 wall>,insulated. NA— New basem¢nt>fia�wwY Addl+ion AspaG#.R-a}io(L/W1- 1.9 .. s I ' I I drvwalled wnd pro nted - , l 'Ii GAf=A4E i ' G I- #e verfied>,O mans ono are to - p I !g9el.1 %r1! Ft. by General Gan}raator .. - • .I i j' - N• �' .rot+ima of con>truGFion m I i I I remove ox a#nq s},�r> ., m�2.v � Wall>+obe removed �,.00� ' • ° v ! LxlhTlN4 P�Ah�MENT ;." Exv.+inq walls _ FvLL A m 0 4%4 yy.F+. I New walls 11 I irL -_______________; ' I _ _.., Exa�ptioro wood }uNUr Ip,nals withw �w ay 30 p 0 p I Ili ... mimU th 4knas>aF�/1 to inGh(1 I.l mmland� bs�m�Wt.c JiNl B mml shall be rwo-s}ory buildings.Panels shall ba praau#providad in waawrdanae.wi+h 7ao eHtpw Table t u°• 0 dn901.f.1.8 o->hwll be deigned#o reoistthe � moNN'�lassing loads dater mined in__________________________ _____ P accordance wi}h+heF—'v ions of}he n Dulldinq Gode bu+u+illzinq}h¢ -----------• ----------------------- wind load>>at for+h in 7 bo Gt•�.ni 9.00. FY_______ 1 r__ _ _—___ G�AWLh AGE I I _____________________________________J DRAWING TYPE: - Preliminary Pound,+ion Plan SHEET NUMBER: }f A ( 0 0 • r 7 l• • y L a"Of 4 asps"safe m �� d ono` � � • �� 4ry� m = � m.m.��o�mo�°s Z 4 m p000v9m=a m AN Ks Q 7 o aS�na3�og° W a` a A==O"`° z Lu • a .� ' l P.T.g-2x1O'>for qir} • • ' .5, r +' r. 2 x 1 O P.T. kn II height#0 1 1/9"�imboa-dm •� 11 Q - . .. ..t .. .. allow for -+hnq of floes- LU 2Bh I-Maz C L�— S r oiimpsmn H 2.5 hurr acne -. elcod#ions angers J J-. I"bGK-imboa-dTM P.T.g-2xB's -____ I _ 4 7 Jr I ' �� ,. I Attach 2 x 1 O ledger w/oilmpsanm 'Q I j aiimpsonm LMaxo I mJ179>Lrews per code. C Uoi2 LB han Epp o1 - I New roimpsonm Luce 2 B-2 I INew 2 z I O Fla#-roof o,s#> c c I q"Auoi2 Om Fla#-rmof rafters a I!o"o.L. O p w/}a Bred slee ers "y � - I I Lu • I I - ¢ 6 � g 1/2"z9 I/2"Vet>aLamm I '� I � � 117/B"Ailoi 20 Joist>®I to"o.L.i 1 q"A-1ai 2 Om Flat-rooF rafters® I�"o.c. w _'¢ I yimpzono LuoJ2Bhangers 9 3• 9impsonm lUO 2.�i Co/1 9 hangers0 I!a"o.L: _ I %/9"x I 17/B"LYL ledger I g/41'x 14 Vcr ,aLamm —II/2'VereaLamm fir— —_-- I•/2"VersaLamm A}tach zl Oledger w/oiimpsmnm - ,� zst:nq framfnq' j - - 1 _ - - roOoi suews pu code. In 1 ri •- l I - hj p>ono lug 2.5lo/9."i ' � Ili II�— — -,. _. -. ..,,< • - t _ __ __ _____ ___ _ _ m _ I g• g^ e{ rnm ♦ • l -' _ _ ® 12"o.L. 00 m - I - 12 x_blocking der dormer wall l 0 3 i n • 1 I I I r -' I I- !.. I ��FI�J'r FLOOD FAME a, # i 4— W N EI II II 9 AJro2O Jois Note. J I I II II_____.'l I >: ter d# floes-J #s I - All Mmeur¢men+e/ :men>ians..re towi II II it I _s1 Ji q - b #ite ve ifed by General Contractor . 7_rl �• Fqmm�L_ _ al ' _ _� • l l � I i � l I I I I. - 8 d i Ill - I I I I � --�1 Existlnq Framing II .. II II II' I I II II II I I I ll. " • --_ ____ _ it it ll 0 1/2'AJh20 Jo",ts l it _ "� �0 .II II ,. U I istered}m exis+'nq floor.foists I tI �`�.,"¢� • I I I I 11 <�a u o�m � 0— ` 1 �v,a• nt.. � . I I , I I 2 x_blocking undo-dormer wall I I I � O o o�r'3 o S a"'�' ll � II I i I. Il .. Onto tea° F\ �— ll ll it I Il °°.a Od�n.s3 Z ' II � e II of mp•>onm lUh 2.ei to/9.�i hangers(}YP'1 Exis#in9% I/2"z 117/B"VersaLamm � - Il ��a"vv N �� ________J II ad`o Lu q3 io E J • II II U K<li d.Q J r�\h�GONfJ FLOOD F�Z.p.l'�� j i i I . DRAW ING TYPE: - � Note: Firs+Floor Fra me Plan All Me>Urcmcnts/rJimen>lons are+o - be si+e verified by General Gmntractcr 2econd Floor Frame plan at time of Lon>}r ULtion z ` SHEET NUMBER: R e 1 • � o °o3V£o�go� e am egos"°asp m �_0. 2._� �..o B'-10" �i'-1 O" %'-I I/2" m = o maim-•'=eato Ul Z 1- `o �000a�SUO �s W b d Q z o e�c,n�s�aV Iv Z =m @ Q T P e m E n 0 f n a u s c ( / sWZ @ ' . s CD 12'Woodand.4 �t�M f `- •'�' P.T.9.1 o J,i.t,e I P�T�4 x4 dcck r,il'm6 Pon#n - � - rve railing and bolus#er system '4 lL S s a Avdersenm PWNB o�B - ',,; o •- Aod.rneom TW 2452 - Z ' - r o 5 0•x -B" wITGNEN - O O v I I; I' I�' B"xB"mitructw-¢I fiberglass coWmns LU ® Andersenm Tw 2 4 9 2 i - ® e � r o.2'-G I/B"x�i'-9 7/B" a . • ,. rl PI .. O O m T Z m i eP -' - - °m P •— w�l Q Z �V u u0i Q W m V o _ Andersenm AW 2 ei 1-2(4"mull) O b �, : ,.z.:...•>>.o- s-o iia• o'� oia„ � � � gam m '47 V8 pxnYry chalvac � ° : v O ova dos-nnI y O O a & oPFIGC �p1 FIR/oT FLOOD PLP.N u - - a•-o 5ia^ v va^ 5-m via,. . - I - AlI n+s�o�mens�o�s are to - -------- I H ur u, I be s} er f d by General Gon}raetor = UP I NEW I-NTFy Payer- UP `r. ro a a++ of c n+ructw° o o a w , .. .:,8 . �ePlwu.xro#mq door o a � 0- w/oiimpnono P-722B� d 9 j �•"�` New walls t` `�vQ \O\m : � - Ex.eptiom wood s+roc+oral paneb with a ��ma�t� O P�-� - mi .mum+hlcknss of 7/I v ieeh(I I.1 mml aid i a maximum span of eight feet(2 4%B mm)shall be p n m g S Per mi}#ed for opening Prates#ion in one-and • 0 W w N h k(L.� " two-story buildngn.Panels shall be precu}+o m 3 x�t: Jl �D� t o.r.r the glwscd opcningn with attachment` s E Z <a o E - p�E1�ooH'I hardware prooided.Attachments shall be m't�n �d t p•ovided in accords-.with 7Bo ov-TAwa BOOf.2.I.II or shall be designed+orcnin+#hc ac ��.E.�J} ' • - comporen+s and Uaddinq loader do#ermined in ~U°'°` K ' . a-dance with the p-ouisions of}he W<d`uL d1 J '- Interns#ional I!luil dinq God.but Wllyinq the hem czin+Inq dos-and wind loads s.#forth in 76o G1-�B O.00. replace w/°¢w wiedow+o DRAWING TYPE: match existing.Patch+o match Firs+Ploor Plan SHEET NUMBER: A200 ia c Et^ �u ILI s },! a 3oa Q - d d �,. �CpQ`IS•f�V �44 Q � � n .. `s - W • S. r • _ � 'n�. - P P P P 4 / ^ \2EGONfJ fal-OOR.PLAN a c hk hx 6 '�,{, °- m- All i-(eaur¢menta/Oimenaion-,ara Yo . � �p �� ,'S$ be site verified by Gcnerwl Gontrwctor qQ- - 'a= - v= at+imc of cons+ruction ' ✓ It, - � Ezia#inq walla ____ ____ ________-_____ _ _______________ __ ___ r.}urwapwnea w,tha C�o.Ptbn vJ datru 1 14 __-- m}h Lk zs of 7/I lo,nch(I 1 I mm)anda 11` L ., � max mum apron of sigh+fee}(2 4%B mml-,hell be � ,h w : - perm:tt¢d for dpeninq pro+¢ction n one-wnd 0 • r two-ata-r buildmga.Pwnela ahall be grew# ` • � cover the glwzed opan'nga w:th atYwehmenY. hwrdwarb provided.At}wal,men}a.,hall be '�R p provided n wccardance w:}h 160 e-jr-r.:bl. '4 , Expand exia}inq deck aver new porch - 390 1.2.1.2 or ahwll be dea geed}a rea:at the J r . componcn#a wnd alwddmq lowda determined,n , - - ordwwe with+he prw atone of the f _ • wind lowda se#Forth n 7D0 G1•�39.00. � •- ] ' m N r4 n� v LU , , , , i sa , , • , , , , , , a , l F i W Q m N o 4"mull) PF4 a P Uv \ � I i � Z W Vim• 30 Anderaena AX2�i I 9( 1 - pox m• : ; 1 � I I .-- --� -4 - I / I oM 5 ��, w cs+ - Q• �I\ 4 � �,=a O�Ehq,WG hoots mull � I II 1 I ;; `•.. i opedra ou.ow� p � _ __ J i o i � 06 P p , ° d • * 2_�y/q DRAWING TYPE: 4 � � hacond Ploar Plwn I /�) SHEET NUMBER: z 3 93i ;a m w ' r fit$► � �`�'�,,, Ir f QISTfQ'� lit - - R-eframe roof whore nc.�.,e.,arr. s . !I' . ,. - .. ________.. __-______-,1 L _ - _ - _ I w . _ :q: I oiimp�on H 2.5 h°rnLanc o I I •. IL ,,,,J. }iea®I G"o c.(}yP.J I:::::: � I I r�Jlmpaon H 2.5 hw•rlGAne - O ' 2 x0 pormer raf Z £m e6 d, i ,. ... I- • W < o 00 77 is 0 • - 1" 3 N I O Winq raf}er l .. .1. it �'w m 1Y • - I ! l I I Z � �Q � ' .:. -.EN #inq Prammq EN:atinq Pra q ° + 4- L I r U� • ::::j: �iimpaon N 2 s harricanc ... J. \\I I .#less ifo o.a(tvp.l ` ' W 2N I O W:nq raf}er I c I - E m _-----�I l - W w 1 II #cape Alnlo2oc.(}YP.J nc ... I �2 I II ��.oQ OJ •' it I� �LLb°.aN 0 • y _P N All Heaoremen}a/Ofinenafona Are to O o`o°j 3 0 � `c�'� - be si#e oerifled by General Gantrmta- `u \p. S At}ime of Lona}r L}ion r. I-°mu-m Z 6i1.O t 0 ♦ 'mra� D;�IL�� Asa ��dia� - DRAWING TYPE: SHEET NUMBER: _ 4. oa3o�� wou roimpsonm tA�TA I B straps e 1 m"o.c. Gp"yinuou>riAAe went • --1 O Arahi+ec+ural asphalt shinglas(+vP.l ' e ` m a°��r m . tu . I5•Pelt paper(#YP.I •' � e °�`o oo� �u � Q - � � I/2"GOXplywood shag#hinq(+yp.) � � m �°on`u�pE3 on W ''th Ice and wa+er sh eld(#yP.l Q u ma $ n ,,a?1 Pr opar wan+sa I!n"oc o�p Eoo °ya Z I o"ND.Insula#ion �9B OF.) It y 2'F-;gid foam inoulation a I eo"a.c. Q W H 2.5 1 ro"o.c. a` .2.k Aluminum qu#+ers#odrywells 1 x_pYG#rim boarAs 2/2xB Hcadars(+rp.l - Gon#inuous saffi+want(#yp.) - Wh;#a cedar shingl¢s B 5"t.w.(typ.l TywekTMhousawrap fi �. APA (4-yr.) axis#mg fro mq N 2x4 Wnllstuje 1!o"d.G. - SMIMr[9N . c hprwY"foam Insula+ion•R-19(+yp.) 'fA• i U . • r � ¢xis+�nq fr q • � 0 • amin � � ` gal ' existing framing • � 2 xlo oioild blotkinq under dorm¢r wall ftyp.l - rolmpsonm LuTA 1.2 o#raps®2 4 o.c. S LU • exist,nq padroom _ - "'.. � v • - , - v -z dubber membran ofinq ! - j I/2"P b board APA rated sh thing - Treza ei/4'x ro"decking V 2 x_ph.tapered sleepers - - #aAJO slec i-r - 'f-IA, membrane roofing Pi/G railing and baluster sys#¢m. 1 4"AJ�i 2 O joints - I/2"Piberbaard OL • , : I e 5/B"APA rated sheathing 2 x I O Plat roof rafters Ezi a I s#inA framing PYG bewded ling -• pane ZIE % 1/-2 1/2"i-.A.... ,al impsonm LlX 28-2 hangers �,,r� �I . - R-emw xis#mq wall and replace - .4 4 u CO V,� � t m y N w/struc+urAl flbergalss cdumns P T x s ppar#pos+s ,_ W, 3 O �� Q W �U 3 O r • - - - -I x_PYG#rlm V W m < u s Wood or me#al screens p m__ E� �stirS�,�.".aux•.akw:r:.sSox. rc.;�,�,z Y63.+`_o;3+ks_xr..'/,.:�il.3,....�.�'iA�,..�. .o-j,�.._.:1;:Wiz- �ITGHEN .� Z � Um o 8' 9/4"ApA,ra#ed subfloor Tre%m5/4"xro'Trezm decking ' �p - • _ (glued and nailed 1 = P�T�2%I O deck Jo sts �m . ��G }'.�'I�ILfJll�jla�EG•r101�°G" j' e-2xl oP.r.air# q 9 I/2"AJn�2 O ais#s rpimpsonm LMaxm N I 1 L tias Ezis#inq framing �- - I Naw bloGk''nq fq-girt �_ ?(. �m"oo —oiimpsona LMazo Wye B-9 gg 0-i Q 0 Existing frwminq ��: "�c�i P-- yimpsonmLMaxmAGE4 Y N On'OO 530 C M . NewMLr�FOOM •„ Q vN -des Z r oi'mpsono Lma%m A6U4 01 Y�p ` rcdJ.no O"mx 4'-0 yano#ubem/D'gfoo#m2 4 5- ..+..,kT r. I poured concrete foo+'nq w/5/B"treaded —�►y ,c" rod w/washers and nu+ I • � I DRAWING TYPE: g7`tp .y 47tas'� I I SHEET NUMBER: 00 • - -7 c�Ecw � 1 oa3os�,�go� e ae' asesma�W m - } Uwo Eo us ous LU g m I v 30 onat� w Ul z Archi+ec+oral asphalt shingles(typ,l ' �u ST y,r� lee and wa#er shield(+yP') 1�V[ Gon+inuauoridge v¢n} 6O%plywood rhea+hinq(+yp.l "��i� 9+,:pa �.�, - - - Ors �•P ,�pp 1 2"P 4.InaUla#ion s%B - _ "- �. � "'',u «•'-. - ryl g„a: kt Pry nH2.5 n !o Wrric !—e I 'o., •. T `�� I 2•'F•'qid foam maulntion e 1 G'o e. I ::d alLin"JAIL} a{:G.�;:'^n -L:. •^• j � 4 AluminumgUt+¢ra to drywella aJimpaon H 2.5 hurricane ties e 1 ra"a.c. •. - - 1 x_P/G#rim boards ' 2xB Ged,nq jo,,ytse I{o'�o.c. - ' - $ %xro Header Gon+inuoua gaff',# en#f}yp.l ' - iE - clapboard aid'nq 4"t.w. • W - TYvekTM houaewr p Oyp 1 ' • ,: _ - - - § I/2"APA ra+ed full-height"ahea#hinq(i!yp.l - y Gln boar q 4 d aid,n P #.w. 2 x 4 WA a+ud e 1/o'o c.(+yp.) ' TYv¢kTM Foos wrap(typ.l :. . - i 2 \ f APArated 1u11-hiight'anda#h'nq(#YP.1 �Exia+ingrafters#a remain m 2 X 4 Wnll Stud e 1!o"A.c.(#yp,l -' ' ' • hpr /-foam ins Ulat on Y-19( oof q n L -Q 0 +YP.1 v. ::' •' • 2 X Ia0 raf#era 8 1!o"o.c. �64—m¢ /2b P, b and r . Q rapr.y-foam ir,aulat'iAn• 19(+yp.l-: •. •.._ . 2xB#j¢redaalee kern#h q - +,n "- yimp H 2n +i—e al. '• r I 9 I/2 AJaJm20 j tsl G G - �,..a. • •• C � -�_ %/4 APAF-rated+Iq.aubfloa p ' J ("lull ledI -F• . • ' - .. -.- - f sister# ist,nq ce hn4lout here pooaiblel -_... q aim _ _ _„ _ + Jr Aluminum qu#tera}drywelle Q 51 i I x_pVG#rim bowrda Lx,st nq% I/2 x I I 7/B'Ver - ` ••aa4amm ��-�- � dry! Gapbaard aiding 4 2 X I O aio,ld blockinqunder dormer wall(typ.l 2 x I O aim Id blocking under darm¢r wall(+y 1 - raim IUra 2.5la/14 Fran e I G'o.c.•_ 12"P.G InaUla+ion �-%B V ra,mpaanm IUaJ 2.nilo/9N�i hanq¢ry(#yp.). - P paonm V La q a TrvekTM hauaewrap(+yp 1 - ra,mpaonm LaiTA I B straps e 1!a"a.c. raimpaonm Lr'JrA 10 a+rapo a 111 1 %/4 x 14 ¢raa m - W - % 1/2"Xy-I/2"Veraakam „� lUOJ2.'ila/9 ei hangers(}yp.) e m 1/2"APArated"full-height"•sheer+hinq(tYP.I � - - an}inuoua -. • - .,( ei 1/2"%9 1/2'V¢ranl-ram® r - 0 V . B"x0"ai+ruetural flberglaaa eloumr,a. .� 2 x4 Wnll-;tud e�I moo"o.c.(typ.l _ . r • • - . i ''y • raprnYiaam,naula#ion•R-19(typ.l p , V6 t - %/4"APA F-a#ed t.Iq.eubfloa Ul Q air . ^ .. ° - '�`• .. (glued and nailed) - .� ��Q Z uo e v,, m , u - WO V New I d raimpadnm IUra 2.5CD/1 I.8B hangers® I!o"o.G. -�-� // U R y- f1/2"APA raced"full-hegh+"'sheathing 0- x�Wall a+udaTIE x r 0"Avhor bol+s w/ °m _ ,.. " - •, L 0 %x%'X I/4 Plate—hereLJ - �,af • 9 D"o c.and B"from adl I #e e.+da. B"x2'P,ur.J eanre+e retwninq wall 'Kk{ _-'_3°>%i++'••� 5...,:,.-.,Is1 �`z.r,:;c -.c ri �� tf.-..J' t e+;.�.:a r ;•ca zv Mn.<_,rc� �f �. Y.:.ev k< '.O•'Fdured concr¢te founds+ion ,� - s -t xa;«. t$`._ ,-� • %"Poured cone¢#¢slab w/!o mil poly vapor barrier Ila • , _ � �.- � ,„ x 'y xy � Ilo,�.x)'Poured eon Lr¢+efoo+lnq �u-N�L� pP��O 0000r3o ��$s . •- I7 13UlLl�it.�l�r�EG-rlOt�j°f7" + �m� E� ., DRAYVING TYPE, F'�ufldin9 heai-ion"fJ" SHEET NUMBER, A4O '> W u c•..Ecw � oaoay��W_ o a=ma3os"saga ro � o «a°soi�v� ? _ a.a "•Sso°"s K w o q`oEM3 Van K =aNN-6- va z a a o y - W of `R mill I IL S ---------------------------------� ------------ -----r------+--- -------------- I I o et e rp ION ------------------------------- N LFT ------------------------------- ----1 .. z tu O - - L—J n O _ CL J - fl s . 1 ID E m p i to u uu -------REM �x .s o " Brl ® ® to 23 ' �av3�ao �d4s F - ♦m �h>6� S �C�� nm�ua� Z ad o.S � DRAWING TYPE: ' I I I I • Exlstlnq Eleva}ions ��LEFT ELEYATIOfJ - I oo �In. 1/4"- 1•-O" SWEET NUMBER: ul ul ul 4r flL -�- I14/J-4\ n�IaHr ELEVP.rIoN rL---------------------------J, ,, t=_� •• z hso, GjGal6: I/4"_ 1'-O" L____.____--_R________________J • •_ Ipw �� yo 6 _ m lu • _ �' U o U Ira m U Q U n F O•I El < Ofm x Uo ' d ` _ r iW oo El N o . ��56�vh No 0 OO OOy.�O w`�Q Ed`m Z 0'0 3'>J F L caL A J I f _____________ ___!-1- ___-_J-�._____-__________�l - - VRAWINGTYPE: ____________ _______ ___J— _—___ �__� ----------------- Z-- ----- E%is"Y'in9 Elevations ' • �17��EA�ELEVArIOIy ' �JLple: I/4"- I•-O" SHEET NUMBER: