HomeMy WebLinkAbout0007 WINGS LANE - Health 7 WINGS LANE, C®TTUIT
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COMMONWEALTH OF MASSACHUSETTS
z EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
d DEPARTMENT OF ENVIRONMENTAL PROTECTION
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TITLE 5
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: ' 7 Wings Lane —
Cotuit, MA G
Owner's Name: Olaf Thorp 1
Owner's Address: 117 Marlborough Street -_
Boston,MA 02116 '
Date of Inspection: 04/23/08 ` � {
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Name of Inspector: (please print) Mr. Carmen E.ShaV t::G :.,
Company Name: Shay Environmental Services, Inc. u
Mailing Address: 185 Ashumeet Road
Mashpee, MA 02649
Telephone Number: (508)-539-7966
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported
below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my
training and experience:in the proper function and maintenance of on'site sewage disposal systems. I am a DEP
approved system inspector pursuant to Section115.340 of Title 5(310 CMR 15.000). The system:
XX Passes ��;��a0� ,/vs,� Zwiq
Conditionally Passes
Needs Further Evaluation by the Local Approving Authorit)" Rtvil2 C
'
Fails
14 S` '
0 SHAY �
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Inspector's Signature: Date: 04/23/08 �NTlF-\
f1�5INS?
The system inspector s1.all submit a copy of this inspection report to the Approving Authority(Board of Healt
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
No evidence of hydraulic failure from leach pit. Excavated Pit Cover and noted 36" Stain line in pit.
****This report only describes conditions at the time of inspection and under the conditions of use at that
time.This inspection does not address how the system will perform in the future under the same or different
conditions of use.
Title 5 Inspection Form 6/15/2000 page I
Page 2 of 1 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 7 Wings Lane
Cotuit,MA
Owner: Olaf Thorp
Date of Inspection: 04/23/08
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. System Passes:
XX I have not found any information which indicates that any of the failure criteria described in 310 CMR
15.303 or in 310 CMR 115.304 exist. Any failure criteria not evaluated are indicated below.
Comments:
B. System Conditionally Passes:
One or more system components as described in the"Conditional Pass" section need to be replaced or
repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass.
Answer yes,no or not determined(Y,N,ND) in the for the following statements. If"not determined",please
explain.
The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally
unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the
existing tank is replaced with a complying septic tank as approved by the Board of Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance
indicating that the tank is less than 20 years old is available.
ND explain:
Observation of sewage backup or break out or high static water level in the distribution box due to broken or
obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with
approval of Board of Health):
broken pipe(s)are replaced
obstruction is removed
distribution box.is leveled or replaced
ND explain:
The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will
pass inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
ND explain:
Page 3 of 1 1
OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 7 Wings Lane
Cotuit, MA
Owner: Olaf Thorp
Date of Inspection: 04/23/08
C. Further Evaluation is Required by the Board of Health:
Conditions exist which require further evaluation by the Board of Health in order to determine if the system
is failing to protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the
system is not functioning in a manner which will protect public health,safety and the environment:
Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
2. System will fail unless the Board of Health (and Public Water Supplier, if any)determines that the
system is functioning in a manner that protects the public health,safety and environment:
_ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a
surface water supply or tributary to a surface water supply.
The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply.
The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well.
_ 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:
Page 4 of 1 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 7 Wings Lane
Cotuit,MA
Owner: Olaf Thorp
Date of Inspection: 04/23/08
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or"no"to each of the following for all inspections:
Yes No
XX Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
XX Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
clogged SAS or cesspool
XX Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool
XX Liquid depth in cesspool is less than 6"below invert or available volume is less than '/2 day flow
XX Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number
of times pumped
XX Any portion of the SAS, cesspool or privy is below high ground water elevation.
XX Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply.
XX Any portion of a cesspool or privy is within a Zone 1 of a public well.
XX Any portion of a cesspool or privy is within,50 feet of a private water supply well.
XX Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water
supply well with no acceptable water quality analysis. (This system passes if the well water analysis,
performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds
indicates that the well is free from pollution from that facility and the presence of ammonia
nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria
are triggered.A copy of the analysis must be attached to this form.)
No (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as
described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of
Health to determine what will be necessary to correct the failure..
E. Large Systems:
To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000
gpd•
You must indicate either"yes"or"no"to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
yes no
_ 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—I WPA)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.
. — .,..,..,.,.,. 4
Page 5 of I I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address:. 7 Wings Lane
Cotuit, MA
Owner: Olaf Thorp
Date of Inspection: 04/23/08
Check if the following have been done. You must indicate"yes"or"no"as to each of the following:
4
Yes No
XX Pumping information was provided by the owner,occupant, or Board of Health
XX Were any of the system components pumped out in the previous two weeks`?
XX Has the system received normal flows in the previous two week period `?
XX Have large volumes of water been introduced to the system recently or as part of this inspection
N/A Were as built plans of the system obtained and examined?(If they were not available note as N/A)
XX _ Was the facility or dwelling inspected for signs of sewage back up`?
XX _ Was the site inspected for signs of break out?
XX _ Were all system components, excluding the SAS, located on site `?
XX _ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition
TT t he baffles or tees, :material of construction,dimensions,depth of liquid, depth of sludge and depth of scum ?
XX _ 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
XX _ Existing information. For example,a plan at the Board of Health.
XX _ 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)]
Page 6 of 1 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 7 Win2s Lane
Cotuit, MA
Owner: Olaf Thorp
Date of Inspection: 04/23/08
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design):3 Number of bedrooms(actual): 3
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330
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 inspection required]
Laundry system inspected (yes or no):
Seasonal use: (yes or no): No
Water meter readings, if available(last 2 years usage(gpd):
Sump pump(yes or nc): No
Last date of occupancy: Currently occupied
COMMERCIAL/INDUSTRIAL
Type of establishment:
Design flow(based on 310 CMR 15.203): gpd -
Basis of design flow(seats/persons/sgft,etc.):
Grease trap present(yes or no):
Industrial waste holding tank present(yes or no):
Non-sanitary waste discharged to the Title 5 system(yes or no):
Water meter readings, if available:
Last date of occupancy/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information: None Available
Was system pumped as part of the inspection(yes or no):
If yes, volume pumped: gallons-- How was quantity pumped determined?
Reason for pumping:
TYPE OF SYSTEM
Septic tank, distribution box, soil absorption system
_Single cesspool
XX Overflow cesspool
_Privy
_Shared system(yes or no)(if yes, attach previous inspection records, if any)
Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be
obtained from system owner) `
_Tight tank Attach a copy of the DEP approval
Other(describe):
Approximate age of all components,date installed(if known)and source of information:
house built in 1975, Per BOH as-built card
Were sewage odors detected when arriving at the site(yes or no): No
Page 7 of 1 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 7 Wings Lane
Cotuit,MA
Owner: Olaf Thorp
Date of Inspection: 04/23/08
BUILDING SEWER(locate on site plan)
Depth below grade: 12"
Materials of construction:___cast iron XX 40 PVC_other(explain):
Distance from private water supply.well or suction line:
Comments(on condition of joints, venting, evidence of leakage,etc.):
SEPTIC TANK: XX (locate on site plan)
Depth below grade: Cover 6" below Grade
Material of construction: XX 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: 5' x 5' x..8'—1,000 gallon tank
Sludge depth: 4. 0'
Distance from top of sludge to bottom of outlet tee or baffle: 2'
Scum thickness: ''A inch scum laver noted
Distance from top of scum to top of outlet tee or baffle: 9"
Distance from bottom of scum to bottom of outlet tee or baffle: 18"
How were dimensions determined: Measured
Comments(on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity, liquid levels
as related to outlet inv-.rt,evidence of leakage,etc.):
Structural integrityl was ok.4" Baffle present at inlet end. Outlet Baffle present and in good condition. Liquid level equal
with outlet invert.
GREASE TRAP:_,(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.):
.,..,, 7
Page 8 of 1 I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 7 Wings Lane
Cotuit, MA
Owner: Olaf Thorn
Date of Inspection:, 04/23/08
TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan)
Depth below grade:
Material of construct'on: 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(conditions of alarm and float switches, etc.):
DISTRIBUTION BOX: Present (if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert:_
Comments (note if bcx is level and distribution to outlets equal, any evidence of solids carryover, any evidence of
leakage into or out of box, etc.): _One outlet to Leach Pit
PUMP CHAMBER: (locate on site plan)
Pumps in working ord.-r(yes or no):
Alarms in working orc.er(yes or no):
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):
9
Page 9 of 1 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 7 Wings Lane
Cotuit, MA
Owner: Olaf Thorp
Date of Inspection: 04/23/08
SOIL ABSORPTION SYSTEM (SAS): XX (locate on site plan,excavation not required)
If SAS not located explain why:
Type
X leaching pits, number: 1
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.): No evidence of hydraulic failure, ponding damp soil or stressed vegetation. Excavated Pit Cover
and noted 36"stain line in pit.
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 constructi:)n:
Indication of groundwater inflow(yes or no):
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.):
T .. . . .,..,� 9
Page 10 of 1 1
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 7 WinEs Lane
Cotuit,MA
Owner: Olaf Thorp
Date of Inspection: 04/23/08
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or
benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building.
I
I
Water;Line
1
1
I
I
Swint Ties:
A- Tank In-41'
C B Tank In—23'
Exist House A -Tank Out—49'
(3 Bedroom) B -Tank Out—17'
A B I A- D-Box—59'
B- D-Box—10.5'
B- -Leach Pit-61'
C—Leach Pit—70'
O 1000 gal
septic tank.
D-Box
O
Leach Pit
10
Page I 1 of 1 I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 7 Wings Lane
Cotuit, MA
Owner: Olaf Thorp
Date of Inspection: 04i23/08
SITE EXAM
Slope
Surface water - %2 mile+/-
Check cellar -Yes
Shallow wells—None_
Estimated depth to ground water Over 75' feet
Please indicate(check)all methods used to determine the high ground water elevation:
Obtained from system design plans on record- If checked,date of design plan reviewed:
XX 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)
XX Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
Checked with Quadrangle of USGS Map,MA GIS and performed GW adjustment calcs.
Per Barnstable GIS:
Elev.of Ground= 17 feet
Elev. Of Groundwater=2.5 Feet
Elev.Of Bottom of Leach Pit=10 Feet
Therefore: 10—25 =T5 feet separation between Bottom of Leach Pit and Groundwater.
Groundwater Adjustment using Index Well MIW29,ZONE A: 1.3 feet
Adjusted Groundwater,Separation =7.5' — 1.3 =6.2 feet
Grade= Elev. 17feet
Leach Pit
Septic Tank
Bottom of Leach Pit= Elev. 10 feet
Adj. Groundwater= Elev. 3.2
• • y a
Town of Barnstable
op1HE
ti
yip o .Regulatory Services .
Thomas F. Geiler,Director
• saxxsresi•e, �
prFa ,�A Public Health .Division
Thomas McKean, Director
200 Main Street, Hyannis, MA 02601
Office: 508-8624644 Fax: 508-790-6304
This septic system inspection report was completed by a private inspector who is certified
by the State of Massachusetts; Department of Environmental Protection.
Although the Town of Barnstable Health Division received the original/copy of this
report; this Division does not warranty the functionality of the septic system in the future
not does this Division agree with any technical observation s and interpretations
contained within this report.
In addition, by receiving this report the Town of Barnstable Health Division does not
automatically approve the number of bedrooms listed within this report. The actual
number of bedrooms approved at a particular property would-be listed on the"Disposal
Work Construction Permit".
If you should have any questions regarding this report,please contact the certified Septic
System Inspector who conducted the inspection.
• DA7Et� 10/2/00--- '
PROPERTY ADDRESS;_,,____, —
7—Winds _Lane___________
_-Cotuitr Ma._ 02635______
On the above data, I Inspected the septlo system at the above address.
ThIl system con3lsts of the following;
1 . 1 -1000 gallon septic tank
2. 1 -1000 gallon leaching pit
3. 1 -Distribution box
Based on my In3pectlon, I certify the following condltlonat �p ��•-
4: This is a title five septic system. ( 78 Code )
5. The septic system is in ,proper working order
at the present time.
6. Wastewater is 59" below the ivert pipe of the
leaching pit.
• 7 . Pumped septic tank at time of Jif�
inspection. SIGNATURE;., .,...L:
N a m e :_,i,_P ��SsaZt-Lr-.,U--______
Company;�o���h_P . Macomber—b Son , Inc ,
Address;_ Box-66-
CenterYilleL Ha ._02632-•0066
Phone S08_77S_3398____-__
THIS CERTIFICATION ()OES NOT CONSTITUTE A CIVARANTY OA WARRANTY
JOSEPH P. MACOMBER & SON, INC•
Tanks•09sspools-Loachtl#Ids
Pumped Installed
Town 3ewor Connootlons
P.O. Box 66
75.333 tirY1114, A 02632.0066
RECEIVE®
OCT 1 9 2000
TOWN O ABLE
LTH DEPT.
I
. c
COMMONWEALTH OF MASSACHUSETTS 3
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
ONE WINTER STREET, BOSTON MA 02108 (617) 292.6600
TRUDY COKE
Sec»terry
ARGEO PAUL CELLUCCI DAVM B. STRUHS
Governor Commissioner
SUBSURFACE SEWAGE DISPOSAL SYSTEM WSPECTION FORM
PART A
CERTViCATION
Property Addrsa,: 7 Wings Lane Na"W of Owns Paul Camilleri ,
Cotuit Address of Ownw: Game
Dau of inspection:
N,r„a of tea:(AW.; r/A9oseph P. Macomber Jr.
I am a DEP apprvved system 4sspector pursuant to Section 16.340 of Thie 6(310 CIA 16.000)
Joseph P. Macomber & Son Inc.
M,XngAddnss: ox en ervi e, Ma. 02632-0066
T @✓'ep►wne Number' — —
CERTIFICA ION STATEMD4T
I certify that I have personally inspected the *@wage disposal system at this address and that the Information reported below is true, accurate
and complete as of the time of Inspection. The Inspectlon was performed based on my training and experience In the proper function and
ms,ntenance of on-sits sewage disposal systems. The system:
��Passss
Conditionally Passes
_ Needs Further'Evaluation By the Local Approving Authority
_ Fails
upsctor's SiQnatu»: ,
D+rta: N ��
Ir
The System Inspector kil submit a copy of this Inspection report to the Approving Authority (Board of Health or DEP)whtvn thirty (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
1rhall submit the report to the appropriate regional off(ce of the Department cKnvironmenttd fsrotection. The original should be sent tobw
system owner and copies sent to the buyer, If applicable, and the approving authority.
NOTES AND CONIMENTS
revised 9/2/98 Page Iof11
4
�, Printed on RKytkd Paper
SU0.fURFAC9 SEWAGE DLSP03JLL SYSTEM INSPECTION FORM
• PART A >
CERT71,CATION (oorrdr64*-7
Prop✓ty Adas": 7 Wings Lane, •Cotuit
o.rtwr.. Paul Camilleri
sxsr£CTtON SUbAMARY: Ch«k A. B, C, cw D.
A. S�ASSES:
_ I have not found any Informadon wNch Indicates that any of the feuurs conatdoru dsscr(bod In 310 CMR 14,303 exist. Any fall"
criteria not ovalusted aro Indicsted below,
cow-WD Tb:
B. SYST'EU CONDMONJLLLY PASSES:
. A one a more syetsm somponsnts as doowtbod In the 'COrt 4WW Fsaa'*oodon nsod to be roplaood or repalted. The syetwn, vp-
compledon of the reptsosmont a rop.L, &a approved by the Sowd of HeaJth, will paws,
wdcatw yet„no, or not det•rrrin•d(Y, N, or NO). Doaeribe bags of dotsrm4►adon In all Uutsnoes. If 'rot detorminsd', sxpWn why rwt.
rho ••pdc %" is meta!, unfeso the owner w opwow has prov{ded the system Impactor whh s sopy of a COr""%# or
CompUanc• (attached) Indlesdnp that the tank wave bwtallod wlthJn twonty(20) years prior to the data of the WpKvon
the sepdc tank, whether or not metal. Is cracked, svtretunAy unwound, show# eubetandaJ InNvsdon w exAry V on��
fallur• Is Imrnlnent. The system ww pass bupsctJon If the oxIcUng sopdo tank Is replaced with a comp►Yinp
approved by the Board of Health.
S•wape backup or bto&kout or Nph*fade water level observed In the c9strlbutJon box Is due to broken or obwvvcud pip
or due to a broken, setded or uneven dJstrlbution box. The system wUl paws"pscdon If(wtth ►pprovaJ of Vw Board of
H•aJth).
broken plps(s1 we replaced
obswcdon Is(*moved
dlsvtbudon box Is IsvoUod w replaced
• The eyitsm fsquksd pum*VTr-M titan iourdrnes yeardue to broKenw ob-0 t*d plpe(wl. The TrFu r+ wW-Vq:"^
InspecOon It (with approved of the Board of Heaith)f
broken pipe(sl ue roplscid
obstruction la removed
►ac•3*fit
revised 9/2/98
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM l
PART A
C:IRTIFICATION (continued)
hrogarty Addrw: 7 Wings Lane, Cotuit
Owr4w: Paul Camilleri
D.os of Inap.csson: 1 0/2/0 0
C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
_ Conmons exist which require further evaluation by the Board of Health In order to determine If the system I+ falling to protect the
public health, safety and the environment, -
1) SySTEM WILL PASS UNLESS BOARD OF HEALTH DETVWLNES IN ACCORDANCE WfTH 310 C34R 16.303(1)(b)THAT THE SYSTEM
a NOT FUNCTIONING IN A MANNER WHJCKYAU-PROIECf THE PUBLIC kJEALT)iAND IIIAFETY AXD THE BCZ3O`NM8siL-
Cesspool or privy Is within 60 feet of surface water
Cesspool or privy Is within 60 feet of a bordering vegetated wetland or a salt marsh.
21 SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF ANY)DE'TERUZ40 THAT THE SYSTEW IS
FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
The system hes a septic tank and soil absorption system(SAS) and the SAS Is within 100 feet of a surface water wpplY or
tributary to a surface water Supply-
The system has a septic tank and soil absorption system and the SAS Is within a Zone I of a pobUc water supply weU.
410 The system has a septic tank and.&oll absorption system and the 3A3 Is within 60 feet of a private water wpplY well.
4b The system has a septic tank and soil absorption system and the SAS Is less then 100 feet but 60 feet or more trom a
private water supply well, unless a well water analysis for collfo(m bacteria and volatile organic compounds Indicates 0'at tl+e
well Is free from pollution from that facility and the presence of smo annivste Nvogen Is oval to or less
then 6 ppm. Method used to determine distance A�� (appo mation net d)
r
J) OTHER
r
e
revised 9/2/98 Page,3of11
SUBSURFACE SEWAGE DISPOSRA LSYSTEM WSPECTION FORM
PA
v
CERTtpCATION (cor*-*d)
Property Adana': 7 Wings Lane, Cotuit
owner: Paul Camilleri
Dow of 4+sP-cdon: 1 0/2/0 0
D. SYSTEM FAILS:
you must Indicate either ''yes' or 'No' to each of the following:
��LICL1 I have determined that one
bel more
of the
following
all should nbetfcontacted to dete►ons exist as l l O
min whatwlU be necessary to t orrect v+e fuly
ed
w.
determination Is Ident
Yet No / ootnponent doeto an ovetio+d+d orv1e99od SAS,'of'Cs"Pool•
Backup o+$$wage Irrw hclN"•+Tetartt
Discharge or ponding of effluent to the surface of the ground or surface waters due to on overloaded or dogged SAS or
cesspool.
Static llquid level_ln.t a diatr ytlon box bpve o tist Invert due to an overloaded or clogged SAS or cesspool.
C .
Liquid depth'In'*v1*PQel
Is lees than 8' below Invert or available volume Is less than 1/2 day flow.
Required pumping more than 4 times In the last Year EM due to clogged or obstructed pipe($).
Number of times pumped
Any portion of the Soil Absorption System, cesspool or privy Is below the high groundwater elevation.
Any pxtion of a cesspool or privy Is within 100 fast of a surface water supply or tributary to a surface water $UPaY•
Any portion of a cesspool or privy Is•wlthin a Zone I of a public well.
Any portion of a cesspool or privy Is within 60 feet of a private water supply well.
Any portion of a cesspool or privy is Ieaa'than 100 feet but groats with
r than 60 feet from a private water Supply welt—' acceptable water quality analysis. If the h�mmonla analyzed
nlu psnt�denluate nluacceptablogen.ach copy of wwell water analyais o
-collform bacteria. volatile organto•compounds,
E. LARGE SYSTEM FAILS: '
you must Indicate either"Yes' or IN to loge syste s each of eInoalddltlon to the criteria above: '
The following criteria apply riftcsnt Mueat to
The system serves a fecllity with a deelgn stow of 10,000 gpd or greater(Large System) and the system I• a sig
ecause one or more of the following conditions exist:
health and mutely and the environment b
Yet No
the system is within 400 fast of a surface drinking water supply
er -te wriaw�slrJc�4�"r+�"wl►f+Y ...
the s•yetem�l►-with 200 fHto1-r•Ml�ut Y Zorw II o1 • p
the system Is located in a nitrogen sonaltive area(Interim Wellhead Protection Ana.IWPA) or a mapped
water supply well)
The owner or operator of any such system shall upgrade the system In accordance with J10 CMR 16.904121. Plsaas con"tf+e Ioul rK
otffce of the Department for further Infognsdon.
Pagr 4 of It
revised 9/2/98
SUBSURFACE SEWAGE DISPOSAL SYSTDA INSPECTION FORM
PART 5
CHECKLIST
Propwty Aden": 7 Wings Lane, Cotuit
Ownw: Paul Camilleri
Deu of Inapacts,on: 1 0/2/0 0
Check If the following have been done: You must Indicate either 'Yes' or 'No' as to each of the following:
Yet No ,
Pumping Information was provided by the owner, occupant, or Board of Health.
None of the ay&temcoav4&&nU ha+wb&an powwod4oa4Nau1iwo•ww"4A&4belry6tom h"J)6"gac*I gw..d 11
rates during that period. Large volumes of water have not boon Introduced Into the system recently or a& pan of vtvs
Inspection.
As built plans have been obtained and examined. Note If they are not available with N/A.
The facility or dwelling was Inspected for signs of&#wage back-up.
The system does not receive non•&&nitary or Industri&J waste flow.
_ The she was Inspected for signs of breakout.
_ All system components,�luding the Soil Absorption System, he been located on the site.
_ The septic tank manholes were uncovered, opened, and the Interior of the septic tank was Inspected for condition of bat
or to#s, material of con&tructlon, dimensions,depth of UQuld, depth of sludge, depth of scum.
The size and location of the Soli Absorption System orr the site has been determined based on:-
_. / _v Existing Information. For example, Plan at B.O.H.
_ Determined In the field(If any of the failure crlterl&related to Pan C Is at Issue, approximation of distance Is unacceptatr
115.302(3)(b))
_ The f&CIUty owtur (artd.ore—p■n■,Jf dLdw&tst froat_nwn&j).w&rs.pzaytdadwUh laingmarloaon th,Prap—M,;Q? ^•M
SubSurface Disposal Systems.
F
revised 9/2/98 Paie5ofII
I_
SUBSURFACE SEWAGE OISPOSAL SYSTEM WSPECTtON FORMA
PART C
SYSTEM WFORMAATION
Address:
P,•oq•arty 7 Wings Lane, Cotult
Owrw: Paul Camilleri
D�m,fv%spocd«,: 10/2/00
FLOW CONDITIONS
RESIOEMTIAL:
Doslgn Aow:_LlQ 9•P-d•roedro m•
Number of bedrooms (deal Number of bedrooms(actual):,,
Total DESIGN flow
Number of current resldonts:
Garbage grinder(yes or no): _
Laundry(separate system) + or q : If yes, sepa"LeIruspacdon,requlmd •
Laundry system Inspected�esJbr no
Seasonal use (yes or no): '
Water moist readings,I1 available (last two year's usage(9pd): — is��y G&
Sump Pump(yes or no): qq�
Last date of occupancy:_(Aa:'C 16
COMM ERC%AL 1NDV$TRIAL:
Typo of sotabllshment• ZIA
Design flow: .1( and 1 Based on 16.2031
Basis of design flow
Grosse trap present: (yes or no)
industrial Waste Molding Tank present: (yet or no)
Non•san)tary waste discharged to the Tlde 6 System: yes or no)
Water motor readings,If avail lo:
Lost date of occupancy:
OTHER:(Describe)
Last We Of occupancy:
' GENERAL INFORMATION
PUMPWG CORD and s ice of Infer adon: ��d
k �T a 4 ,VAC7 y
System pumped as part of Inspection: (yes or no)
If yea, volume pumped: gallons
Reason for pumping: e&
fYSTEMA
opdc tank/distribution box/toll absorption system
ingle cesspoolverflow ces+pool
rivy
hared system(yes or no) (If yes, attach previous Inspection records,If any)
A Technology etc. Attach copy of up to doe operation and maintenance eonuact
Tight Tank V/9 Copy of DEP Approval
Other
AP9fiOX17.t.4TE AGE of all components, date InstaYodilf known)-and aour4e e(J,wformetJon:
Sewage odors detected when-striving at the site: (yes or no)
Paee6orll
revised 9/2/98
Imo_
SUBSURFACE SEWAGE DISPOSACSYSTEM INSPECTION FORM
PART C
SYSTEM WFORMAT)ON(con*wed)
Propw y Add..": 7 Wings Lane, Cotuit
owner: Paul Camilleri
Darts of ktsp.ctlon: 1 Q 2/0 0
BUILDING SEWER:
Routs on site plan)
r/
Depth below grads:
Material of constructi :✓ca Iron 0 PVC other (explal)1) a �'
Distance hom �vate wa r supply well or we on(ins /J
Diameter� _.
mme t►: (condition of joints, venting, evidence of toakage,-rtc.) 1 e
Joints appear ti ht
e s s em
SEPT)C TANK:
(locate on she plan)
Depth below grader
Material of construction: concreteNImstolA&Flbergla►►Al Polyethylene/4other(sxplaln)
if tank Is Instal. list age
J4.a-0e•confVmed by Certificate of Compliance� (Yes/No)
Dimensions:FG�.SI.D49
Sludge depth:
tattle-
Distance from top of sludge to bottom of outlet too or
Scum tNckness:-_
Distance from top of scum to top of outlet tee or battle:�
Distance from bottom of scum to bo m of o tit ee r battle'
Mow dimensions were determinad:
Comments:
(recommendation for pumping• condition of Inlet and outlet,tees o(•baeVs, depth of liquid level In relation to outlet Invsm strum rol,4ntegrity.
svidence of leakage, etc.) PumpT
he
Inlet
tank is -st-r1j-:W-r-a4jy Sol
and shows
ORUSE TRAP:
Notate on site plan) A
Depth below grade:�A
Material of construc on:A&concrstaQ�tmetaLJA Fibs rglaa*/l�1 Polyethylene 4jother(exploln)
Dimensions:
Scum thickness:_ R
Distance hom top of scum to top of outlet its or baffler
Distance hom bottom of scum to bottom of outlet tee or balls:
Date of last pumping:
Comments:
(recommendation for pumping, condition of Inlet and outlet less or baffles, depth of Uquld level In relation to outlet Invert, structure)Integrity.
evidence of leakage, etc.)
Grelse trap
revised 9/2/98 Paee7orll
SVS3VRFAC9 SEWA09 Dt31003A1 SYSTEM WSrECMN FOPWU
►ART C �
SYSTUA WFOR1.lAMN (con*W4`d)
Progwty Adav": 7 Wings Lane, Cotuit
a'rwe: Paul Camilleri
Dwu of tnsPac+son. 1 0/2/0 0
710MT Olt MOLDWO TANK:J,�A&ITank mu#t be pumped prior to, or at dme of, inapecdon)
(locals on site plan)
Oepth below gf#de: A9
Meted#j of cons'vycUon:aeonerot@4m4tiJ*AFIbotglxxx,�1►dr�th�l�no {othor(�xplaln)
Olmenslons:
Csp#cITY; gallons
O*sign Row: A>A gallons/day
Alarm present 1)17
Alarm level: Alarm In working order;Yss& NoAN
Oil• of prevlous pumpingl
Comments:
lcondldon of Intel tee, condltlon of alarm and float ewltchea, etc.)
T±,4irt or Plol s,,t
OtSTRISVn0N lox: Z
liocetr on Ills plsn)
O*pth of liquid level above outlel Inven:
Comments:
Ina*II level and distribution Is equal, evid*noe of #gilds ca(ryover, r Adenee of leakage Into or out of►oa, etc.)
The ldtSr i u ion
o e
leakage into or out of the box.
Pump CMIAIBER-Ak"
Ilocals on site plan)
pumps In working order,(yes or Nol_,d&
Alarms In working order(Yes or No)--4J0
Commenn:
mole condltlon of pump chamber, condlt)on of pumps and appurtenance#, etc.)
er i
of
revised 9/2/98 '
nir�
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C '
SYSTEM INFORMATION (contintHd)
P*op«tYAd►*": 7 Wings Lane, Cotuit
OwT1 : Paul Camilleri
Dana of lrmpect w: 1 0/.2//0 0
SOIL ABSORPTION SYSTEM(SAS):.J
liocate on site plan, If poselbla: excavation not required,location may be approximated by nonantrualve methods)
If not located, explain:
Type.
loathing pits, number:IL
leaching chambers, numbs
leaching galleries, number:
leaching trenches,number, length:
leaching fields, rumber, dimensions:
overflow cesspool,number:
Alternative system:
Name of Technology: (ll +
Comments:
(note condition of soil, signs of hydraulic fallure, level of pondinjt, damp.soil, condition of vegetation, etc.)
Loamy s No signs of hydraulic failure
or pore inq. 50116 dre ury. yegetation is normal.
CESSPOOLS:
(locate on site plan)
Number and configuration:
Depth top of liquid to Ihiat Invert:
Depth of solids layer:
Depth of scum layer:
Dimensions of cesspool:
Materials of construction:
Indication of groundwater:
Inflow (cesspool must be pumped as part of Inspection)
esspOOls are not p rpgpni-
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding,,conditlon of.vegetation, etc.)
Cesspools are not present
PRIVY:
(locate on site plan)
Materials of construction: /1//9 Dimensions:
Depth of solids:
Commenu:
inote condition of soil, signs of hydraulic failure, level of ponding; condition of vegetation;etc.)
Privy is not rpgani-
revised 9/2/98 rag,9orIi
SUL3UR►ACE SEWAOL Ct3POSAL iYiTDA WSPECnON FORM
• MAT C '
SYSTVA Wf0P.WAT1ON l@-Ydr-4t
►,op.M Addfe": 7 Wings Lane, Cotuit
Paul Camilleri
Dfu of 1 0/2/0 0
SKETCH Of SEWAGE OtSPOSAI SYSTEM:
lncJuda daa to at laait two permanent reference landmarks or benchmarks
locate NI walls wlWn 100' (locate whore publlo water supply oomss Into house)
i
3
PaplOofll
M revised 9/2/98 •
SUBSURFACE SEWAGE WSPQSAL SYSTEM WSPECTION FORlA
PART C s
' SYSTOA pFORMATION (con*w*4)
P►oparty Addrw: 7 Wings Lane, Cotuit
Owner: Paul Camilleri
Deu of hap--Oon: 1 0/2/0 0
NRCS Report name
Sou Type_
Typical depth to groundwater
USOS Date webslte Aslted
Ob+srvstlon Wells checked
Oroundwater depth: Shallow Moderate Deep
SITE EXAM Slope
Surface water
Check Cellar
Shallow wells
Estimated Depth to Oroundwater/�Feet
Please Indicate alf the methods used to determine High Groundwater Elevation:
_Obt&Insd from Design Plans on record
e♦ s 1 Slte IAbutdn ro a observation hole, basernect Pump*to.)
Delsrminsd from local condlDons
Checked with local Board of health
Chocked FEMA Maps
1/Checked pumping records
j/ Checked local excavators. Installers
Used V303 Data
Describe how you established the High Groundwater Elevation. (HUB be completed)
Used;
Water contours Map.
Gahrety & Miller Model
12/16/94
r,
revised 9/2/98
ncellorll
- � J
+.wnp.�nit�T.- rwr u.r•wTT+.�n.w�wnw+w...w�..+..+..��V n►��w�vn �w•t►-•r•��.w- .. .-. .
TOWN OF ARATST&8LE BOARD OF HEALTH
SUIISUfiFAGF 9EkA(;P I,I f'USAL�SY�9TF.M INS CfION PURM -' PART D .- CERTIFICATION � - I
-TYIC OA PAINT CLCAALY- 1
PROPERTY hNSPECT'ED
+
STREET ADDRESS 7 Wings Lane, Cotuit
ASSESSORS HAP, DLOCK AND PARCEL #
OWNER' s NAME Paul Caitilleri
PART D - CEIiTIF.ICAT r0H
NAME OF INSPECTOR Joseph P. Macomber Jr,
COMPANY NAME Joseph P. Macomber &"Son, Inc.
COMPANY ADDRESS Box 66 Centerville MA. 02632-0066
street — Tovn or C ty State t F
COMPANY TELEPHONE ( 508 ) 775 - 3338 FAX
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposa`1 system at
this address and that the inrormation reported is true , accurate , and
omplete as of the time of �inspectiom. The inspection was performed and any
recommendations regarding upgrade , maintenance , and repair are consistent
with my training and experience in the proper function and maintenance of on-
site sewage disposal systems .
Check one ;
System PASSED
The inspection trhich I have conducted has not found any information
which indicates that the system fails to adequately protect public
healLh or the environment as defined in 310 CHR 16 , 303 , Any failure
criteria not evaluated are ,as stated in the FAILURE CRITERIA section of
this form )
System FAILED'
1 Y
The inspection which I have con 'acted has found that the system fails to
protect the })tiblic health and the environment in accordance with Title
5 , 310 CHR 15 ,303 , and as specifleally noted on PART C, - FAILURE
CRITERIA of this inspection forme
Inspector Signature Date 4Ld
1,7
ae copy of this certification must be provided to the OWNER, the BUYER .
here appl.loable ) and the DOARD oY HEAL'I'III
• L,f' the inspection FAILED , the owner or operator shall upgrade ' the eyetem
Within one ,year of the dnte of the inspection , unless allowed or required
` otherwise as provided in 3.10 CHR 1613061
partd + doc
-- 1
I y+.
f
Commonwealth of Massachusetts c
Executive Office of Environmental AffairsVK1A
®epeartment ®f G. `�, t
Environmental Protection .�
Wllllam F.Weld
Governor 49
Trudy t,oxey
Secretary,EOEA
David B. Struhs
Commissioner
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION
Property Address: —7 LL.11 K)2�S Vxkv-e, CO Address of Owner:
Date of Inspection: �- Q-y(p (If different)
Name of Inspecto� � �/�€�— j
Company Name, Address and Telephone Number: r
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate
and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and
maintenance of on-site sewage disposal systems. The system:
_V'Passes
_ Conditionally Passes
Needs Further Evaluation By the local Approving Authority
Fails
Inspector's Signa Date:
The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (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 Department of Environmental Protection.
The original should oe sen; .L. the system owner and copies sent to the buyer, itilappiicable and the approving au,hori;y.
INSPECTION SUMMARY:
Check A, B, C, or D:
AJ SYSTT PASSES:
7e/ 1 have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303.
Any failure criteria not evaluated are indicated below.
e) SYSTEM CONDITIONALLY PASSES:
One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair,
passes inspection.
Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not)
The septic tank is metal, cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is
imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as
` approved by the Board of Health.
(revised 8/15/95)
One Winter Street a Boston,(Massachusetts 02108 • FAX(617)556-1049 • Telephone(617)292-5500
`�,Printed on Recycled Paper M
`t
's
c
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: '7 W j"- GC7�fC)tom'
Owner: r4W�°6k�f V
Date of Inspection:
B] SYSTEM CONDITIONALLY ASSES (continued)
Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed
pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the
Board of Health):
broken pipe(s) are replaced
obstruction is removed
distribution box is levelled or replaced
_ The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass
inspection if(with approval of the Board of Health):
broken pipe(s) are replaced
obstruction is removed
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 the
public health, safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER
WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh.
2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT
THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT TJiE PUBLIC HEALTH AND SAFETY AND THE
ENVIRONMENT: 1
_ Ihp sv5tem na,, a septic tanK anu soil absorption system and ib wlthili 00 fcEi 10 a SullaKc vwa,ci zupp:) of trl utar) to a
surface water supply.
_ The system ha, a septic tank and soil absorption system and is within a Zone I of a public water supply well.
_ The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well.
_ The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water
supply well, unless a well water analysis 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.
D] SYSTEM FAILS:
I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis
for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct
the failure.
Backup of sewage into facility or system component due to an 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.
(revised 8/15/95) 2
f�.
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: —7 W N 8 s
Owner:
Date of Inspection: /
Dj SYSTEM FAILS (continued):
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 1/2 day flow.
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Number of times pumped
Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation.
Any portion of a 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 I 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for
coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen.
El LARGE SYSTEM FAILS:
The following criteria apply to large systems in addition to the criteria above:
The design flow of system is 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety
and the environment because one or more of the following conditions exist:
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
The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program
requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information.
r
(revised 8/15/95) 3
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: -7 &V 1(I a S k-w ��v
Owner: 1•- A-V%4 CL -1
Date of Inspection:1,,
Check if the following have been done:
Pumping information was requested of the owner, occupant, and Board of Health.
None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates
ring that period. large volumes of water have not been introduced into the system recently or as part of this inspection.
As built plans have been obtained and examined. Note if the are not available with N/A.'
P Y
The facility or dwelling was inspected for signs of sewage back-up.
(✓ The system does not receive non-sanitary or industrial waste flow
The site was inspected for signs of breakout.
✓AII system components, excluding the Soil Absorption System, have been located on the site.
•The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or
tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum.
t/ The size and location of the Soil Absorption System on the site has been determined based on existing information or
a roximated by non-intrusivemethods.
The foci i;y o.,r ;� .I occupants, frog-: ov,ne-; �,ere pr�vided with information on the proper maintenance of Sub-
Surface Disposal System.
I
(revised 8/15/951, 4
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: -I WI s L—C•0e—
Owner:
Date of Inspection:
�L 7 FLOW CONDITIONS
RESIDENTIAL:
Design flow:' y eallons
Number of bedrooms:
Number of current residents: d
Garbage grinder (yes or no):
Laundry connected to system (yes or no)�
Seasonal use (yes or no):--�/— f
Water meter readings, if available: f V�
Last date of occupancy: m4e, o� Cri
COMMERCIAL/INDUSTRIAL:
Type of establishment.
Design flow:_gallons/day
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:
OTHER: (Describe)
Last date of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and source of information:
System pumped as part of inspection: (yes or no)_
If yes, volume pumped: gallons `
Reason for pumping: "
a
TYPE OfWSTEM t
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)
Other(explain)
APPROXIMATE AGE of all components, date installed (if known) and source of information:
Sewage odors detected when arriving at the site: (yes or no)
(revised 8/15/95) S
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Aldress: W`&'"vS �� C tit
Owner: N, WvV,+ .�[
Date of Inspection: r
F,t1so
SEPTIC TANK:_✓
(locate on site plan)
Depth below grade:�� �
Material of construction: Zconcrete _metal _FRP —other(explain)
Dimensions-.-
Sludge depth: t9"
Distance from top of sludge to bottom of outlet tee or baffle:
Scum thickness: 6', c!
Distance from top of scum to top of outlet tee or baffletit
Distance from bottom of scum to bottom of outlet tee or baffle:_
Comments:
(recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid I vel in relation to outlet invert, structural
integrity, evidence of leakage, etc.) cs•t'i/ -�
GREASE TRAPJq
(locate on site plan)
Depth below grade:
Material of construction: _concrete _metal _FRP —other(explain)
Dimensions:
Scum thickness.-
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom ro From M hnnnm of oltle? tee or bartle-
Comments:
(recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural
integrity, evidence of leakage, etc.*
(revised 8/i5/95) 6
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION.FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: lR S u-&-Y-P, co-W
Owner: tA�W--'
Date of Inspection: J t
TIGHT OR HOLDING TANK:
(locate on site plan)
Depth below grade:
Material of construction: _concrete_metal _FRP —other(explain)
Dimensions:
Capacity: gallons
Design flow: gallons/day
Alarm level:
Comments:
(condition of inlet tee, condition of alarm and float switches, etc.)
DISTRIBUTION BOX:_✓
(locate on site plan)
Depth of liquid level above outlet invert: N�YLirn�,
Comments:
(note ii ievei ano distnbut.c, - tyuai, e�lcirnce of soli, carr�o•,er, evidence of�leakage into or out of box, etc.)
PUMP CHAMBER:
(locate on site plan)
Pumps in working order(yes or no)
Comments:
(note condition of pump chamber, condition of pumps and appurtenances, etc.)
(revised B/15/95) 7
- C
t
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address:'Z uU%"s L-et�,_<, C&-Le
Owner: VVC-V-1N%.y_v
Date of Inspection: I
7-
SOIL ABSORPTION SYSTEM (SAS):
(locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods)
If not determined to be present, explain:
Type:
leaching pits, number:
leaching chambers, number:_
leaching galleries, number:
leaching trenches, number,length:
leaching fields, number, dimensions:
overflow cesspool, number:
Comments: (note condition of soil, signs of h draulic failure, level of ponding, condition of vegetation,etc.)
u'" L LAG
CESSPOOLS:
(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 grouncly ate7.
inflow (cesspool must be pumped as part of inspection)
Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
PRIVY: I
(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.)
(revised 8/15/95) 8
k
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: --7 �
Owner:
Date of Inspection
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100'
L� I LL I r
DEPTH TO GROUNDWATER y
Depth to groundwater: t,U
method of determination or approximation: -
t
(revised 8/15/95) 9
TOWN OF BARNSTABLE
LOCATION t t t7C" s R ' SEWAGE#
VILLAGE -T'L t `S' SSESSOR'S MAP&PARCEL .5
INSTALLERS NAME&PHONE.NO. '1•• tAaCUn -"S- 3:3.
SEPTIC TANK CAPACITY 000 Q QNX CAN6
LEACHING FACILITY:(type) `Cs` (size) r 1 ��S,
NO.OF BEDROOMS
OWNER
PERMIT DATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility (4 Feet
Private Water Supply Well and Leaching Facility(If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leachi ty) /�► Feet
FURNISHED BY ?IJAIZAEK1 �f�►v
I �LAMNL
i
G� ei xks
1�3 e- TIA
T11 41 ,a3
4cil I�-
TOWN OF BARNSTABLE
1
Lt CAT ni1014 7 Wings Lane SEWAGE # a.
VILLAGE Cotui t ASSESSOR'S MAP & LOT
TNSi'EC'1'FD BYE&PHONE NO.J.P.Macomber & Son Inc 775-3338
SEPTIC TANK CAPACITY 1000 gallons
LEACHING FACILITY: (type) Leaching pit (size) 1 000 gallons
NO.OF BEDROOMS
OWNER Paul Camilleri
PERMITDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
t
�6;' •��
:.�
`���
,,
s�,, `\ � .
�" 3
r
o-
LO`C&TION 5EW&(:�EPERMIT UO.
on
IWS`TaLLER5 U&ME ,- ADDRESS
ID
BUILDER 5 /1J &M ADDRESS
DtS,TE PER"VT
D &TE COKAPLI WACE ISSUED ;
f e,
VP
Fs� .��.... . r�l�
No... 6� ... ...............
THE COMMONWEALTH OF MASSACHUSETTS
ABOARD OF HEALTH
- .............OF.......... .�."...... ---...... .--..... ------------
Appliratal n for Disporial Works Tinuitnutivit Vinutit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
• ....... ...................................... ....................................................
cation-Address
a
or I of N
. w
•
can . Address
............. ---••-••-•--• ............................................
o
Installer Address
Type of Building Size Lot-_._7Pej_1U._.Sq. feet
aDwelling—No. of Bedrooms................. .......................Expansion Attic ( ) Garbage Grinder ( )
pi Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
PL4
.: ;: Other fixtures --------------------•---------------------•---------------------------•--••--•------._....--•-------------- -••--•••-••••----------•----•--•----•--
W Design Flow...................... _...................gallons per person per day. Total daily flow........r_-_'_. ..................gallons.
WSeptic Tank-L Liquid -::apacityJ? _gallons Length................ Width................ Diameter____---__-_--_-_ Depth................
Disposal Trench—No_____________________ Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No----------I......... DiameterZV__ 01�6MDepth below inlet .._ ....__.__ _ g q._. Total leachin area__________________s ft.
Z Other Distribution box ( ) Dosing tank ( ) 0 1.," -`�� `'
Percolation Test Results Performed by-------------------------------- .................... Date........................................
aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................
Test Pit No. 2................minutes per inch Depth of Test Pit...................... Depth to ground water........................
..........................- .._ - -
_._...... .......
O Description of Soil-------- --- .....
s sz_
)----------------------
�.
...........
UNature of Repairs or Alterations—Answer when applicable___________________________________________________________________________________________-_--
-•----•-------------------•----••-•--------•.._.....--••---•------.......•-•---•----------•-••-•-•--•-----•---•••-•••-•----•--••--•...--•-••----------•-------•-----------••------•---•---•----••••-•--
Agreement:
The undersigned. agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
ignedZI
(�
-- , -------.... -•---•-----•-.. AD,-e•--------
A licat;on Approved B / 0Q�Zo
_. , .cz:'._:�- --`__�_�_
PP PP Y '' '; t/ Date
Application Disapproved for the following reasons:-------•-----------------------------•-•------------•--•--•--•-••-------.._.....----•••-------•---•••--------••-
..--•--•---•....................••---•-•--------•-•-----------------•---•-•-•-•--•---------•-•--------...•--------------•---•••----•--------•--•-•---••--•---••------------•-•--•----------••-----_.....
- -- Date
PermitNo......................................................... Issued------•--•-•---____------------•-----•--•---•--•-•------
- _ — - - - --- - --- �.�....� -- - �-�•_ - - - -•_u Date
3. A J
No.. � ... FER1 ................... .
i
THE COMMONWEALTH OF MASSACHUSETTS
f
BOARD OF HEALTH
.�...*- -------.oF.......... .. .... � -A' t, '-
Application for Mopmal Works Tons rurtion Prrutit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
J%ie)6"1_4A.W.
..4 ....... ............. ....................................................
cation-Address or Lot No
wne Address
-------------- �•----
y ..... :....
Installer Address
Type of Building Size Lot....... j_Jl ...Sq. feet
Dwelling—No. of Bedrooms................___-_._...- __•____Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building ............................ No., of persons............................ Showers ( ) — Cafeteria ( )
P-4 Other fixtures -----------------------------------••-
WDesign Flow................... .0 ........gallons per person per day. Total daily flow....... Q-4..................gallons.
WSeptic Tank J-Liquid capacity .gallons Length................ Width................ Diameter................ Depth................
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No.......... ......... Diameter Dos i epth below inlet s- - Total leaching area..................sq. ft.
Z Other Distribution box ( ) ing tank
'-� Percolation Test Results Performed by--------------------------- ---•--•-----•-----........................ Date----..................................
aTest Pit No. 1............::...minutes per inch Depth of Test Pit.................... Depth to ground water........................
Test Pit No. 2..:....:........minutes per inch Depth of Test Pit.................... Depth to ground water........................
Q+' ..................................
_--•- --•• •----- .....
---• ------------------•-•-•--------•----•-•- •--•-•-------••-------•--------------------_-----
O Description of Soil...._.__ _ ad .=_`"'
44....IG ._.. p�i_ __ w+ �^ • .............
f Y
-------------------
x
U Nature of Repairs or Alterations—Answer when applicable................................................................................................
Agreement
The undersigned agrees to install the aforedescribed.Tndividual'Sewage Disposal System in accordance with
the provisions of"Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
igned-• .... ...... ..... ..... .7 ------------•-------------•-•---
Application Approved By------..... , • ►'R
Date
Application Disapproved for the following reasons--------------------- .....------. ---==•------•................................................
.........................................................................................................................................................................................................
Date,�
PermitNo............................... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD O HEALTH
. ,.. . .............OF..... ..... .... .( , ... ..............
TV'rtifiratp of TLIMPlianrr
THIS IS T . C ERTIFY, T the tdividual Sewage Disposal`System constructed ( 4or Repaired ( )
r � \ 6 r
y/ n alle
at.i — ` '� t ..�1rt�4. d. -�i;,;�_; . .......... 4r ...
has een installed in accordance with the pr visions of Article XI of The State Sanitary Code as described in the
application for Disposal Works Construction Perrilit No......... +! ------------------- dated__:_._r_ ._ _ '". ..........
'
THE ISSUANCE OF THIS CERTIFICATE SMALL NOT EE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM. WILL FUNCTION SATISFACTORY.
DATE.............. -- ... . Inspector..........,.........................................................................
THE COMMONWEALTH OF MASSACHUSETTS
.,BOARD .O HEALTH �g
� ..... OF.... ...................* t'�... ........... .G� ....
..
No.. "..�"".
Dispaval vrko Ton trU ivit rjoIrwit
Permission is-hereby granted.............. t""'�." ...
to Constr or Reppair an I dividual Sew ispo 1' •ys
at No �}u� p {
Street r
f
as shown on the application for Disposal Works onstruction P it No. ._ ..*Dated_.. x ". "...:.. .........
-------------------•--
Board of Health
DATE............:::........................:-......-- ..................:.-••_•.,.
•
FORM 1255 HOBBS & WARREN,+-INC.,.PUBLISHERS-
' 13ARNSTABLB COUNTY HEALTH DLPARTMRNT
BARNSTABM MANS. 02630 Tc.craor+tu
362-2511
Ext. 331
r
Date- December 27., 1974
Too Mr. Norman MadAin
178 Springer Lane
W. Yarmouth, KA 02673
On the basis of a sanitary survey and a laboratory examination on
the sample of water taken from a .. .wea ... . . ..... . .. . . . .. ..located on
the premises of . . ti. .... .,. . . .. .. . . . . ..,.. . .. ...located at
. . . . � ftA=PZy. 00tu".. .... . .. .... . .... .. P . on .,Voc r'.26,.1974. . .
(Place) (Date)
this supply is approved for domestic purposes at the time the examination
was made.
If you wish further information regarding this. supply, please contact �
us .at the County Court House, Barnstable, Massachusetts (Tel- 362-2511
Ext. 331), and we will be glad to assist you in any may possible.
Signed..... . . ...... .. . ... .. .... ..........
Public Health Sanitarian l
. r
aQ L O1I ?16 .Board of Health.
H681ii tt; Well Drillers -�'
EXIST.— EXIST.
L I EXIST. KITCHEN DINING EXIST, EXIST. I "
I ! .- -...._._�— BATH
�+ HALL DN. i o O, _ BEDROOM r C�
-- L
EXIST. CJ f--. — EXIST. - - - C) ❑,�'
ANDERSEN 6¢- EXIST. I 0 EXIST. EXIST. EXIST. EXIST.
A 2i FOi.GING — I OUTDOOR
6 —INSTALL HINGED HATCH y-
N 3'0"-.o'B" ,
--- CLOS. ,;� IN CLOSET FOR ACCESS +,NEVV SHOWER
3•-�. ---'I I TO CRAVILSPACE (UPPER (�—
rq 'DECK / _ —..J I t�I C— c O Q
_v
z ANDERSEEN 2Fi":t 6'8" Cz��Xg�,r- "� SOREL.NS I -
F 21 s.l PKT.DOCD
A OR
�-
NEWy h ---
BATH
A4 CI A4 ! °
r1 ` � i
i �- a'n^xs'�' �p�
ANDERSEPI i � !VELU." -1 �VF.LUX NE�Vptl�
AN,ERS - �i p b I SKYLIGHT (. I SKYLIGHT I LOWER
lI 4_r 4-a ABOVE LABOVE
DECK
lADDiIIO II ____ NEV V - -
SCREENED
/�q➢ 1 PORCH NEW DN.
FIRST FL'iA� �i...A� (VA.UCI'cD CE,L!NG) , UPPER
DECK F
LEGEND: A4 A4 —
_ i
C7 EXISTING WALLS \\---- --NEVI P.T.POSTS Wi j `+
- CONSTRUCTION TO BE REMOVED I FOR ELECT ICALCASING 1
L--J T-D" T-(Y' L FOR ELECTRICAL I I N001 EW CONSTRUCTION 'I OUTLETSILIGHT!NG ^
(VERIFY INFIELD VIII
OWNER) 9'-Icr+
-- I DITTO 'I (AU�TIGIV) --7. iT ON)
® U
CONT.RIDGE VENT f/ �\ i
- .�\ --- ;JEW ASPHAL 12 TO MATCH EXISTINGT SHINCLES
EXIST.
�/ � \\` � •�I '°o' V l
11
NEW CP,iL! F
BOARDS MATCHCH EXIST. � I
TOP Or PLATE
II11t�If`�11 � � i � ✓r �r �c����kk i
OVERSIZED CASiNG
'{,�,✓:,f ,� v"�;•. ys; FOR ELECTRICAL SCALE:
------'_." x "�"" ✓ ;;,,��!$''k" �+j'. OUTLETS.^_I:HTiNG i� ---- (�
(VERIFY IN FIELD'Nt 7
x 1/4 — -l1
! Q
-------- yA rE:
SLIBFLOO FAMILY ROOM 0
1 0 5
- NEW V;:RTiCAL SIDING JOB NO.:
G
GENERAL NOTES: _ THORP
"— - - THE DESIGNER SHALL BE NOTIFIED IF ANY _
1.) CONTRACTOR IS TO VERIFY EXISTING CONDITIONS AND DIMENSIONS NEW CORNER BOARDS ERRORS A LNG OMISSIONS STARTFOUN ON
NEW W.C.SHINGLE SIDING THESE DRAWINGS PRIOR TO START OF
DRA`'V.INU NO.:
IN THE FIELD PRIOR TO THE START OF WORK TO MATT H EXISTING— TO MATCH EXIST. CONSTRUCTION.THE BUILDING CONTRACTOF
WILL BE RESPONSIBLE FOR THE CONTENT
2.) ALL NEW CONSTRUCTION TO MATCH EXISTING IN MATERIAL, 21'-Z' L IN THESE DRAWINGS IF CONSTRUCTION
DETAIL,AND FINISH. COMMENCES WITHOUT NOTIFYING'THE
RIGHT S 1 D ELEVATION DESIGNER OF ANY ERRORS OMtSS{Oh5.
3.} VERIFY ALL NEW MATRIALS, FINISHES, &DETAILS W/OWNER THESE DRAWWNGS ARE SOLELY FOR THEI
OF THE OWNER NOTED..ANY OTHER USE OF
THEE DRAWINGS REQUIRES THE WR!TTEN
CONSENT OF,tt IE DESIGNER. —
J71-
z
I I
� NEW RAKE.R TRIM BOARDS
MATCH
z ?O MATCH EXIST,
s Exls'r_
MATCH
EXIST' I 1 ` r^�Q
—__ ----— !...-. c
TOP OF PLATELo
,--.
Z yjt ' n y, 5y t��-1 I n < G
r= NEW CORNER 6OA:40S
X I)MATCH f:.XIST.. _ _— I yy,�`� '<'•��� .��', ,�.� �J — = C� 'J'�'G�
w u
NEW W.C.SHINGLE SIDING
70 MATCH EXISTRdGY
FAMILY ROOM _
SL'RFLOOR
I
NEW ACCESS DOORS
` (VERIFY SIZE IN FIEU)
REAR ELEVATION(
1
—CONT.RICGE'v`ENF
NEW ASPHALT SHINGLES
/ p
NEW FASCIA 8 TCH E
BOARDS TO MATCH EXIST,. -- �—_---
1
NEWS PT 4■4 POSTS W/ "W{�''�">�i v-,r(�'r j �'/' .G,' �iY y t1'r < try l
OUTLETSILIGHTING
O',/ERSIZED CASING
FOR ELECTRICAL
(VERIFY IN FIELD WI —
OWNER)
LQ
y I
j I i t I
NE'W VERT'IGALSIDING ( I - SCALE
1/4" - F-01,
Z,'-r DATE:
1.0/1.8/2005
JOB NO.:
Y THORP �
LEFT SIDE ELEVATION
DRAWING NO.:
A2
([Y.iSTtNG)
EXIST. P.T.2 x 10 LEDGER BOARD LAG BOLTED 70
DRILL&PIN NEW FOUNDATION BASEMENT
SOLID BLOCKING W1(2,LEDGERLOY.BOLTS
TO EXIST_FOUNDATION WALL EXIST.FOUND. 16"o.c.W1 JOISTS HANGERS AT BOTH ENDS
'FOP&BOTTOM \ WALLS TO REMAIN (SEE SUPPUED DETAIL SHEET),T MIN. �
EDGE DISTANCE r T!'
Ulm o
1 ACCESS HATCH _
TO CRAWLSPACE- I Q
L�J
ih
0 BASEMENTBASFMENfI
�
JPGWINDOW --___-- VVINDOWyNEb .T.2x 10's O� C�
o
a 4 A NEW 3 P.Ti.2 x 10's
—7—"----'-- iyF i NEW 2x 11'o.c.Wr FOIST FWIJGERs w
NEW S'CGNC.
FOUND.WALLS Zyd-
NLw8"x tff F� � ( � w N a
CONC.FOG'flNGS
.T.2x lUs d o Z
NEW S.P }
[o
FOUNDATION PLAN
U I n
I A4
NEW&P.T2x 10's NEW 2-P.T.2x'I U. —�—
1 I\—NEW is DIA.SONOTUBEC i
1 P.T.6.E POSTS ON 12'DIA. USE SIMPSON BC 6 POST CAPS TO 4'0'BELOW GRADE -
SONOTUBES All 26 DIA_ y,.0' r4r &ABU 66 POST BASES
BIGFOOT FOOTINGS UNDER TO /
1 4'1?BELOW GRADE_—__—J
'14'-a' 4'-0" 9'-10"x
-- i-�1
• {ADDIPOM { DCi71OMr (ABC DI'h0-Nf--•--
I _INSTALL NEW RAFTERS
OVER EXISTING ROOF Lti7 I I I I INSTALL NEW RAFTERS
I 2 X a R4F7ERS�I"i5 o.c. OVER EXISTING ROOF W! \\ ( y
I 1F` &S z 2 JALLF_Y 1 f. I 2 X 6 RAFTERS @ 16,
&Ex2 VALLEY
--�
Q Imo; CL
� I ♦I
1
— J- -------- --------- —.- _^---- -- --- i I TI L�
----------
2.a RAFTERS @NEW
< BATH ONLY `` o�:o
'
v m /"A., II i
7 V:
A A moo' ro
) i
y;0 SCALE
IC5 a aL�
4 K i �i� 1/44" -
Z 1.-0"
w> I ; i R
DATE
10/18/2005
ROOF FRAMING PLAN r . I, �1 � ► � ' ' JOB NO.:
THORP
NOTES: -
1.) ALL ROOF RAFTERS TO BE 2 x 10's ' ------
UNLESS OTHERWISE NOTED B �DIiAWING NO.--:.
2.) USE SIMPSON H 2.5 HURRICANE CLIPS
AT ALL RAFTERS ENDS - —..-----_ - —_ --..-
3.)VERIFY GUTTER TYPEILA.YOUT
W/OWNERS `--
((ADD MOM O D IO (ADOITfON)
A 3
60'-0" (EXISTING)
,2 NEW ROOF CONSTRUCTION
EAISTING ,.2 x G RAFTERS 016`o.c. �!I! �,} �f Q
f�22�x
2.12 CDX PLYWOODSHEATHING V3.ASPHALTROOF SHINGLES' A f I'S@16'o.c TQP OF ELATE 4,16xfELT PAPER - (-a5.9"(R=30)BATT.INSULATION @ FIAT CEILINGSW?tl"GYF'.BCA.RD 5.2 x 10 RIDGE BOARD(UNLESS 01HERVASE NOTED) 1.-.I - Q
1 x 3 STRAPPING �CONT.ALUMINUM7.SiMPSON H 2.5 HURRICANE CLIPS�il RAFTER CONPlECTIOtiS16"o.c. SOFF'11'VENTS T�W
NEW
BATHGo
[NEW 3/4'T&G � NEW WALL CONST. +f Q
PLYWOOD SUBFLOO, --�- I
GLUED&NAILED 'FAMILY fNJUMV 1 2 x 4 STUDS @
SUBFLOOR 2.12"PLYW000SHEATHING
2 x Ss @ 16'ac. -- 3.3- 12"(R=151 BATT.INSULATION )
4.12"GYPSUM BOARD
5.W.C.SHINGLE SIDING
6'(R=19)BA.T`,INSULATION
NEW 6.TYVEK VAPOR BARRIER I
CP.AWL- _
SPACE -
NEWT CONC. 2'CCNC.SLAB S
FOUND.WALLS o f
NEWS'x 1E'
CONC.F'OOIINCS
BUILDING SECTION NEW BATH'
NEW ROOF CONSTkUdTION
1.2 a 610RAFTERS @2.112 CDX PLYWOOD SHEATHING r
12 3.ASPHALT ROUE SHINGLES • -
--�MA?CH 4.'IS#FELI'uAPER
FASTEN TIES Wt 2-314"DIA. _ EXISTING 6.2 x',2 RIDGE BOARD -
BOLTS 4 WASHERS—�\ - _ 7.SIMPSON H 2.5 HURRICANE CLIPS�)RAFTER CONNECTIONS
NEW AZ GIRT SIZE
W1
VERIFY SI'F.WI MFR.
....._ 4z-TTFL"SVi'I`POS'CS
! --VERIFY SCREENS IN/MFR.
(' NEW RUWNF_R - t
SCREENED I '
�i PORCH
3
VERIFY DECKING NEW P.T.2x We @ 16"o.c. a
W/OWNER
NEW P.T.2x10' 47.
—NEVv P.T.2x 3's Q,5`ar,: _ —�_ NEW 2.P.T.2x 10's
---. - SCALE:
it SIMPSON SC 6 POST CA 1/4"
- 1'--0'
i . . x 6 POSTS
- - _ SIMPSON ABU 66 POST RASE m _ ._ • _ _ EW P.T.2x 6a @ 15"o.c. NEW 2-P.T.2 x 10'a DATE:—
10/18/2005
P.T.6 x 5 POSTS ON 12 DIA. NEW 12"DIA SONOTUBES
SONOTUBES Wi 26"DIA. TO 4'0"BELOW GRADE JOB NO.:
PIGFOOT FOOTINGS UNDER TO THORP
AT)"PE LOW GRADE---------
DRAWING NO.:
g BUILDING SECTION @NEW SCREENED PORCH/DEC_ KS NOTE: --
_ SEE ENCLOSED DETAIL SHEET FOR
-- NEW DECK TO HOUSE CONNECTION
a
n
t' v_ C
0
V
o� �
\7, o
17 ,
V '
U � J
r _
c _ �
LOT 3 ,U6.0
p � sett,
V C C T {.,. I— A jet
LOT .4 A
2 0) 183
l._., O T 7
1 6636,
EK. gOD E_ N T � 5
j T.
c+ r : A!.' F .
COTU/ T BAR / N S THB,L, ,E MASS.
.=O R
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