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HomeMy WebLinkAbout0151 GREAT HILL DRIVE - Health 71512reat Hills Drive ills A= 174— 021 — —— —- --- i f Town of Barnstable P 0 f / Department of Regulatory Services ) ti►xrtsTAets, Public Health Division Date MA9a. lFU 39.A�� 200 Main Street,Hyannis MA 02601 Az- Date Scheduled / Time ) Fee Pd. oil Suitability Assessment for Sewage Disposal Performed$,: r Witnessed By: LOCATION& GENERAL INFORMATION Location Address I 4'PEVVIF,I.LL vv, Owner's Name 1"(A2�0+ S 11-11ULZ Address t5L �e -�i�r�.� YLI Assessor's Map/Parcel: 17$10-2-1 Engineer's Name 1, QJ.4e'_2 A S$OC- NEW CONSTRUCTION REPAIR Telepiione# v5 6o` ,3 Land Use _ �� �. ( y Slopes(9'0' Surface Stones ` Y-tsu_8 (e co Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft Drainage Way ft Property Line ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) r Parent material(geologic 4 Cat vLe, Depth to Bedrock r� Depth to Groundwater. Standing Water in Hole: ` A Weeping from Pit Fpce T/►eA, Estimated Seasonal High Groundwater i DETERMINATION FOR'SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: in, Depth to soil mottles: in. Depth to weeping from side of obs.hole: in, Groundwater Adjustment & Index Well# Reading Date: Index Well level Adj.factor— Adj.Groundwater Level PERCOLATION TEST butt: , Thner____ Observation Hole# Time at 4" tl fl Depth of Pere Time at 6' v�l � M I�— Start Pre-soak Time @ Time(9"-6") End Pre-soak Rate Min./Inch Site Suitability Assessment: Site Passed Site Failed:_ Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back---------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Conservation Division at least one(1) week prior to beginning. Q:\SEPTICtPERCFORM.DOC DEEP-OBSERVATION HOLE LOG Hole# f Depth from Soil Horizon Soil Texture Sdil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Stnucture,Stones;Boulders. onsisten ravell ' Fit I Vj 30 DEEP OBSERVATIO N HOLE LOG Hole# 'Y Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) • D�r� tr . A0 M-f— , t DEEP OBSERVATION HOLE LOG Hole# t Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color' Soil Other Surface(in.) ` (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency. a Flood Insurance Rate Maa: Above 500 year flood boundary No_ Yes Within 500 year boundary No= Yes Within 100 year flood boundary No. Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? 5 If not,what is the depth of naturally occurring per ions material? Certification l "l a I certify that on ` (date)I have passed the soil evaluator examination approved by the Department of Enviro mental Protection and that the above analysis was performed by me consistent with . the required t atn' /e�xpertike and experience described in 310 CNM 15.017. Signature Date N , Q:IS.EP'1'iCVERCFORM.DOC ��-- TOWN OF BARNSSTABLE \ LOCATION SEWAGE# VILLAGE ASSESSOR'S MAP & LOTS 0� in ON.o 7X2-� INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPA rf LEACHING FACII rrYf,:(ype) 0`���I�� (size) 1-1 too ,.NO. OF BEDROOMS BUILDER OR OWNERS R �PERMTTDATE: 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 Fac' -ty(If any wetlands exist within 300 of leaching ac• ) Feet Furnished t r -sl Y f .t 23 S N' • �` q t LG7� TOWN OF BARNSTABLE LOCATION 151 Great Hill Drive SEWAGE # VILLAGE w-a s-t R rn c t a h 1 p ASSESSOR'S MAP & LOT INSPECTED BY: &PHONE NOT.P.Macomber & Son, Inc 775-3338 SEPTIC TANK CAPACITY 1000 gallons '`'LEACHING FACILITY: (type)Leaching pit (size)1 000 coal O. OF BEDROOMS BUILDER OR OWNER Jeffrey Crug VERMTTDATE: 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 cyfleac 'ng facili ) Feet Furnished by e ' 3 -62- Town of Barnstable Barnstable Regulatory Services Department 0AMatcaft B, N"ABA Public Health Division I F 659�- 6. 2007 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL #7012 1010 0000 2850 7602 April 8, 2013 Mr. & Mrs. Robert Bodurtha 151 Great Hill Drive West Barnstable, MA 02668 . ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 • The septic system located at 151 Great Hill Drive, Marstons Mills, MA was last inspected on 3/23/2013 by Ricky L. Wright, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Failed" under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the following: i • The system is in hydraulic failure You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH as McKean, R.S. CCH0 Agent of the Board of Health Q:\SEPTICU.etters Septic Inspection Failures or Future Eval\151 Great Hill Dr Cent Mar 2013.doc Parcel Detail http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=12204 "S BARN57ABL t'V Logged In As: Parcel Detail Monday,April 1 2013 Parcel Lookup Parcel Info Parcel I 174-021 _l Developer LOT 14 — — Lo Location 1151 GREAT HILL DRIVE 'l Pri Frontage l Sec Road Sec l Frontage Village IMARSTONS MILLS �I Fire District C-O-MM i Town sewer exists at this address NO Road Index W 0 F . Interactive Map Owner Info Owner[BODURTHA, ROBERT C&WHITNEY V— l Co-Owner Streetl 151 GREAT HILL DRIVE _ l Street2 _ l City WEST BARNSTABLEl State 1MA Zip 10 668 Country Land Info Acres1.01 use Single Fam MDL-01 l zoning RF Nghbd0105 Topography Above Street Road Paved i Utilities Public Water,Gas,Septic Construction Info Building 1 of 1 Year 1985 Roof Gable/Hi Ext Wood Shingle f Built��Struct p Wall g J Living 1663 `� Roof[AS h/F GIs/Cmp, AC Central Area Cover: p p Type _ ` N�, Style Ca e Cod Int D II Bed 3 Bedrooms P l Wall ry ) Rooms - 3 Model Residential l Int Carpet Bath Full+ 1 H J Floor Rooms GAR Grade Average l Heat( Type Hot Water l Total Rooms 6 Rooms I 4 -a __ _ n. .sue' Stories 1 3/4 Stories Heat FGas __ ^�Found-[OUred Conc. Fuel{ ation�' Gross 3284 l Area - Permit History http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=12204 4/l/2013 m � s. /�� Commonwealth of Massachusetts Tit e 5 Official Inspection Form Subsurface Sewage Disposal System Form=Not for Voluntary Assessments 151 Great Hill Dr. s Property Address . Whitney Bodurtha Owner Owner's Name information is ('V �a�.tD1'1 j ( ;j II S required for every. MA 02668 3/23/13 page. City/Town State Zip Code. Date of Inspection �L OZ� 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; use only the tab key to move your 1. Inspector: _.. cursor-do not RickyL. Wright. use the return key. B & B Excavation,Inc. I Company Name ..14 Teaberry Lane.. Company Address Forestdale MA: 02644 . City/Town State Zip Code 508-477-0653 S14595 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). Thesystem: F1 Passes, 0 Conditionally Passes ® .Fails n Needs Further Evaluation by the Local Approving Authority 00, t 3/23/13 - Inspector's 5 natur Date : - The system inspector shall submit a copy of this inspection report.to the Approving Authority(Board of Health or:DEP)within 30 days of completing this inspection. If the system is a shared system or has a design.flow of 10,000 gpd or greater,the inspector and the-system owner shall submit the... report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving:authority.: . ""This report only:describes conditions at the time.of inspection and under the conditions of use at that time..This inspection does.not address how.the system will perform in the future under the same or different:conditions:of use. t5ins•11/10;:: Title 5 Official Ins on rm:Subsurface Sewage Disposal System:-.Page 1 of 17 .. Commonwealth ;of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -. Not for Voluntary Assessments 151 Great Hill Dr. 5 .... ... .... .... .... .. -... Property Address:. ... _. _. Whitney Bodurtha ..Owner Owner's Name .. information is West.Barnstable MA 02668 3/23/13 required for every page. City/Town::, State Zip Code.: Date of Inspection B. Certification (cont.) - Inspection:Sum mary`.Check.:A,B,C,D or:E/always:complete:all of Section D A) System Passes:... .. ❑ f have not found any:information:which indicates that any of the fail ure.Criteria described in 310 CM 15.30.3 or in 310 CM 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally.Passes: El 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. b. 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•19/10; Title 5 Official Inspection Form:Subsurface Sewage Disposal System;•;Page 2 of 17 Commonwealth of Massachusetts . w. W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 1M 151 Great Hill Dr. Property Address Whitney Bodurtha ,.Owner Owner's Name .. information is required for every West.Barnstable MA 02668 3/23/13 .. page. City/Town State Zip Code Date of Inspection B. Certification (cont) B) System Conditionally Passes (coat.): 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 ass ins with a royal of Board of Health P inspection if P ( PP ):: . El broken pipe(s)are replaced Y ❑ ❑ ND (Explain( p below): ❑ N : obstruction is removed Y N ND (Explain below)`. distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): q on Ej:The system required um in more than4 times a year due to broken or obstructedpipe(s)':The Y q p P� 9 Y 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 wilt 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. El Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. t5ins•11/10.: Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 3 of 17 : Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments ,M 151 Great Hill Dr. Property Address:. .... _.. _. ..... _ _. _. . . Whitney Bodurtha Owner Owner's Name information is required for every West.Barnstable MA 02668 3/23/13 page. - ity own_ State Zip ode 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 hasaseptic tank.and SAS:a.nd the:SAS is within.50 feet.of.a private:water supply well. ❑ The system has a septic tank and:SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". ....Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal col iform 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_AII 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 e❑ .. ffluent 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 .. ... _. orclogged SAS or cesspool ... ❑ ® Liquid depth cesspool is less than 6" below invert or.available.volume is.less than Y2 day flow l5ins•11/10._: Title 5 Official Inspection Form:Subsurface Sewage.Disposal System;-Page 4 of 17 Commonwealth .& Massachusetts - u w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 151 Great Hill Dr. Property Address Whitney Bodurtha Owner Owner's Name information i e required for every West Barnstable MA 02668 3/23/13 .. page. City/Town State .:.:Zip Code Date of Inspection B. Certification (cont) Yes : No ._. ._ Required.pumping more than 4 times in the last year NOT due to clogged or El 1Z obstructed pi.pe(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 orprivy 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._. ® El system fails. I have determined that one or more of the above failure criteria exist as described in.3.10 CMR .15.303, therefore the.system fails. The system owner should contact the Board of Health to determine whatmill 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 El ... 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"Jo 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-:Page 5 of 17. Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form _Not for Voluntary Assessments 151 Great Hill Dr. Property Address - Whitney Bodurtha Owner .. Owner's Name .. - .. information is West Barnstable MA 02668 3/23/13 required for every page. City/Town: State Zip Code Date oflnspection C. Checklist Check if.the following.have been done: You must indicate"yes" or"no"as to each:of the following: Yes .. No - El ® Pumping information was provided by the owner, occupant, or Board of Health ❑ Z 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? 0 El 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? El ® 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.: ® 0 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.lnformation Residential.Flow Conditions: Number of bedrooms(design)::: 3 Number of bedrooms (actual.):. 3 DESIGN flow based on 310 C M R 15.203,(for example: 110 gpd x#of bedrooms): 330 t5ins•11/10 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System:-Page 6 of 17 Commonwealth :of Massachusetts . a Title 5 Official Inspection form. Subsurface Sewage Disposal System Form _Not for Voluntary Assessments 151 Great Hill Dr. Property Address . Whitney Bodurtha Owner Owner's Name information is required for every West Barnstable MA 02668 3/23/13 : page. City/Town State Zip Code - Date of Inspection D. System Information .. _.. Description: Numberof current residents: Does residence have a garbage grinder?- ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes Z No Laundry system inspected? . ❑ Yes _Z No Seasonal use? Yes No n/a Water meter readings, if.available-(last 2 years usage(.gpd)): Detail: - _ . 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-sanitarywaste discharged to the Title 5 system? Yes ❑ ::No _ 9 y 0 Water meter readings, if available: t5ins•11/10 .... Title 5 Official Inspection Form:Subsurface Sewage Disposal System-_Page 7 of 17 Commonwealth .& Massachusetts F Title 5 Official Inspec ion Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 1M 151 Great Hill Dr. S .... .... ... .... ..... ... .... .... .. Property Address Whitney Bodurtha Owner Owner's Name information is required for every West.Barnstable MA 02668 3/23/13 page. Cityrrown State - Zip Code Date of Inspection D. System Information (60nt.) .. Last date of occupancy/use: ::: . Date Other.(describe below): General Information Pumping Records: Source of information: pumped p p _. Was system stemas art of the inspection?. El 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 El Shared system (yes or no) (if.yes, attach.previous.inspection.records, if.any) _ . E.I. 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): I, l5ins•11/10;:: Title 5 Offclal Inspection Form:Subsurface Sewage Disposal System-:Page 8 of 17 Commonwealth of Massachusetts . v Tit e 5 Official InSpection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 151 Great Hill Dr. Property Address: Whitney Bodurtha Owner Owner's Name information i e required for every West.Barnstable MA 02668 3/23/13 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: 25 years est. Were sewage odors detected when arriving at the site?: :: Yes No Building Sewer(locate on site plan): 2 Depth.below grade.: . _.. feet Material of construction: El cast iron Z 40 PVC: 0 other(explain): >20 Distance from private water supply well,or suction.line: feet . Comments (on condition ofjoints, venting, evidence of leakage, etc.): At time of inspection, building sewer appeared to be in good condition with no signs of leakage. Septic Tank(locate on site plan): Depth below grade: 1 feet Material of construction: ® concrete El metal fiberglass polyethylene El other(explain) .... ._ -- If tank is metal, list age: years:..'. _. Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ® No 57'x 57'x 8'6„ Dimensions: 6" Sludge depth: t5ins•11/10_: Title 5 Official Inspection Form:Subsurface Sewage Disposal System-.Page 9 of 17 ... ... ... ... ... ... .. .. .. Commonwealth of Massachusetts Tit e 5 Official Inspec ion Form Subsurface Sewage Disposal System Form .- Not for Voluntary Assessments 151 Great Hill Dr. c; M Property Address Whitney Bodurtha Owner. Owner's Name information is West Barnstable MA 02668 3/23/13 required for every- page: Cltyrrown 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 31 .. Scum thickness 4" .. 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 scour stick How were dimensions determined? Comments (on pumping recommendations,.inlet and outlet tee or baffle condition, structural integrity, liquid levels:as related to outlet invert, evidence of leakage, etc.): At time of inspection, septic tank:appears to be structurally sound Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass El polyethylene _.. El 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 um in Date i t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-:Page 10 of 17 .... Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form6. Not for Voluntary Assessments 151 Great Hill Dr. Property Addrass . . Whitney Bodurtha Owner Owner's Name information i requir d for every very `' West Barnstable MA 02668 3/23/13 e page: Clty/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee.or baffle.condition,.structural.integrity, liquid levels as related to outlet invert,:evidence Of leakage, etc:): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: concrete 0 metal El fiberglass El polyethylene El other(explain): Dimensions: Capacity: on.gall s: . Design Flow. ... gallons per day Alarm present: ❑ Yes ❑ No Alarm level:: Alarm in working order: ❑ Yes ❑ No Date of last um in P P. .g Date _ . Comments (condition of alarm and float_switches,.etc.): a. ... Attach copy of current pumping,contract(required). Is:copy attached? ❑ Yes::: ❑ No:: ... t5ins•11/10; Title 5 Official Inspection Form:subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts . H Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 151 Great Hill Dr. Property Address. .... ... .... .. . Whitney Bodurtha Owner. - Owner's Name information is required for eve West.Barnstable MA 02668 3/23/13 ry.. page:" CltylTown: 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.): At time of inspection liquid level in d-box was equal with outlet. D-box shoves.no sign of.leakage: 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•11/10 TiUe 5 Official Inspection Form:Subsurface Sewage Disposal System•.Page 12 of 17 Commonwealth of Massachusetts I .Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments o 151 Great Hill Dr. M Sye Property Address _ .. Whitney Bodurtha Owner Owner's Name information is West Barnstable MA 02668 3/23/13 required for every.. page - City/Town - State Zip Code Date of Inspection D. System Information (cont.) Type: . .... .. ® 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: At time of inspection leaching is in hydralic failure water level is above invert and backing up into pipe. _.... Cesspools (cesspool must be pumped as part of inspection) locate on site Ian Number and configuration _ _. Depth—top of.liquid to inlet invert ._. _. _.. Depth of solids layer Depth of scum layer. DimerTsions of cesspool Materials of construction:: _.._ ....... ....... __.. _.. ow Indication of groundwater inflow: - ❑ Yes ❑ No t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-.Page 13 of 17 Commonwealth of Massachusetts ._ Tithe 5 Official Inspection. Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 151 Great Hill Dr. Property Address .... ... __.. _._. Whitney Bodurtha Owner:... Owner's Name information is West Barnstable MA 02668 3/23713 required for every . 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:coristruction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic:failure, level of ponding, condition of vegetation, etc.): t5ins•11/10 Title 5 Official Uispection Form:subsurface Sewage Disposal system-:Pe 14 of 17 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 151.Great Hill.Dr: Property Address.:.::::. Whitney Bodu--tha Owner Owner's Name information is required for every West Barnstable _ . MA.... 02668. .... 3/23/13....pager 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 -_ drawirg attached separately l,3/ 3`'1 . ..... .... p 33 -39 3 :l5ins•11/10 Title.5 Official Inspection Form:Subsurface:Sewage Disposal System•Pagel of 17 i Commonwealth of Massachusetts .. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 151 Great Hill Dr. ^M Property Address: Whitney Bodurtha Owner Owner's Name information is required for every West.Bar-istable MA 02668 3/23/13 .. page. City/Town - - State Zip Code Date of Inspection - D. System Information (cont.) ..:Site Exam: s. ® Check Slope:' . :Surface water ... C,-ieck cellar Shallow wellsw. - _. >12 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).. . i ❑ 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: _. _. Dwelling is up on large hill. i Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-:Page 16 of 17 i Commonwealth of Massachusetts H Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 151 Great Hill Dr. Property Address:. Whitney Bodurtha Owner. Owner's Name information is West.Barnstable MA 02668 3/23/13 required for every:: page'. City/Town - State .:.:Zip Code Date oflnspection 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•11/10.:: Title 5 Official Inspection Form:Subsurface Sewage Disposal System•:Page 17 of 17. .. TOWN OF BARNSTABLE LOCATION /4"- D" SEWAGE# 2-0 13 VILLAGE ASSESSOR'S MAP&PARCEL ( -7#—Z— INSTALLER'S NAME&PHONE NO. )A✓/ SEPTIC TANK CAPACITY /0 o U G-7;1-11 a--5 LEACHING FACILITY:(type 2-)SLy (- n (size) 13 Z r NO.OF BEDROOMS 3 OWNER 13 0 D V^--n-4.9 PERMIT DATE: A ( 3 COMPLIANCE DATE: L I )-3 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) n Feet FURNISHED BY 6J' ZI � v 3zi I Zt I No. / / Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN 00 BARNSTABLE, MASSACHUSETTS Yes Zipplication for Misposal ipstem, Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. IS( G�eO11 1J i 11 'V' Owner's Name,Address,and Tel.No. NorSFo.,s 11;Its , / 4 ozms `RJ'E 4 Assessor's Map/Parcel 11 �Rr-cR,l 2- Installed s Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. NN++nN-•+c.-1 .00!�n �'�b,.r.r. 5�8-311a,9 Loa.A%&A—4 ASSot.. nn a A Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) s3O gpd Design flow provided - — gpd Plan Date 4 Number of sheets I Revision Date Title Size of Septic Tank j&Do Ab.,,1\orll� Type of S.A.S. 2 S-0 0 O Description of Soil 1�'i�I LoA.M�j �0.rK� M i y✓''1 Sw n Nature of Repairs or Alterations(Answer when applicable) /NJ Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of HeA. Si Date n, Application Approved by ' Application Disapproved by Date for the following reasons Permit No. Q5"1 I Date Issued ZA No. J / J Fee O ram! THE yCOMMONWEAUTH#OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTFk DIVISION - T6AN 0# BARNSTABLE, MASSACHUSETTS �Wiration• for Bisposaf 6pstem Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components I Location Address or Lot No. 1 S 1 Gr10.? 1 'Ex- Owner's Name,Address,and Tel.No. Ma-rsk,-s N ��5 . Nd cZ64Fj 'I2�ky� wti:�.m i �odvcF��c.. Assessor's Map/Parcel Ij �&r-cA Z.I ` Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. ►.�,�I+.4.c.. roof; c F3N•r-`T Low_►t,a_r -+ ASSac p- 3 yti9� � ° `A 5G8-39S•q4oq 4, IA A Type of Building: i Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) i Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 33o gpd Design flow provided gpd Plan Date LI- S-?nl�S Number of sheets Revision Date Title Size of Septic Tank i soo Type of S.A.S. Z S O 0 L� 1 Description of Soil Loki ^� S'A"A H Yd;U✓✓1 nCT i r Nature of Repairs or Alterations(Answer when applicable) U V� /\J ;� S Date last inspected: Agreement: _ The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in - , accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of jCompliance has been issued by this Board of Hea . Sig ed Date 3 Application Approved by Date y \ 113 I Application Disapproved by Date for the following reasons I Permit No. !'_�c / _ 1 Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) Abandoned( )by ///01 1 --7at c--r 14, t-, has been constru ted in accordance f with the provisions of Title 5 and the for Disposal System Construction Permit No. 1 dated / 3 Installer iJo ck f ��2 n ;., +`RV,r1 cr Designer #bedrooms Approved des' fllw 3 3� gpd , The issuance of thi pe it shall not be construed as a guarantee that the system ill funct on as desig ed. Date � 17 � Inspector ��� h-. i No Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Nsposai *pstem Construction permit Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon( ) System located at S 1 Q--Lay 4;11 'De- • Mar's 4n!-�, H;►1 S MA and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. I Provided:Construction mu t be completed within three years of the date of this ermit. Date 1 ) ApprovedC Town of Barnstable ti Regulatory Services Thomas F. Geiler,Director BAMSTABM * Public Health Division AtFp�°i Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-8624644 Fax: 508-790-6304 Date: —/2--IS- Sewage Permit# Z'9��®//&Assessor's Map/Parcel/2/— OF/ Installer& Designer Certification Form Designer: S�J47'� Installer: "2 ��Zd Address: Address: z?;>,,<- On 1/ � was issued a permit to install a (date (installer) septic system at 1�1 /�� f�,�, based on a design drawn by (address) L�LGGG��Z . SD�JJ�} dated (designer) 1, I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. �I certify that the septic stem referenced above was installed with major cha es i.e. P Y J ( greater than 10' lateral relocation of the SAS or any vertical relocati67ff'6f any component of the septic system) but in accordance with State & Local Re an revision or certified as-built by designer to follow. Stripout (if require �� d the soils were found satisfactory. �o� DARREN y� Ma o. 14 Installer.'s r � �GfSTE" of� .r Sq'N I TAR (Designer's Signature) (Affix Designer's Stamp Here) t PLEASE RETURN TO BA STABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. gAoffice formsWesignercertification form.doc Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 151 GREAT HILL DR lug - Property Address BODURTHA d Owner Owner's Name 1 information is CENT c l 6 required for I MA 02632 6/10/09 every page. /Town I State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important:When filling out A. General Information forms on the q 1 computer,use 1. Inspector: v�j only the tab key to move your DOUGLAS A. BROWN cursor-do not use the return Name of Inspector key. DOUGLAS A BROWN INC Company Name P.O. BOX 145 Company Address CENTERVILLE MA 02632 City/Town State Zip Code 508-420-4534 S 14297 Telephone Number License Number B. Certification . 8 I certify that I have personally inspected the sewage disposal system at this addres ;and thinhe information reported below is true, accurate and complete as of the time of the inspection. TLte ins%ction . was performed based on my training and experience in the proper function and mkratenanc7f on*}ite sewage disposal systems. I am a DEP approved system inspector pursuant toy l ction 1%340 of Title 5(310 CMR 15.000). The system: ® Passes QI ❑ Conditionally Passes ❑ Fails'r ❑ Needs Further Evaluation by the Local Approving Authority , 6/10/09 4ectsture Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. L-0 D Title V Inspection Form.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 151 GREAT HILL DR Property Address BODURTHA Owner Owner's Name information is CENTERVILLE required for MA 02632 6/10/09 every page. Cdy/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: SYSTEM MEETS MINIMUM PASSING REQUIREMENTS AT THIS TIME 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 Title V Inspection Form.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 151 GREAT HILL DR Property Address BODURTHA Owner Owner's Name information is CENTERVILLE required for MA 02632 6/10/09 every page. Cltyrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes(cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed ND Explain: C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. Me V Inspection Forrn.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 151 GREAT HILL DR Property Address BODURTHA Owner Owner's Name information is required for CENTERVILLE MA 02632 6/10/09 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SAS is less than 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 or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/z day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Title V Inspection Form.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments < 151 GREAT HILL DR Property Address BODURTHA Owner Owner's Name information is CENTERVILLE required for MA 02632 6/10/09 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cunt.): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. t 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. Title V Inspection Form.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts AIR Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ' 151 GREAT HILL DR Property Address BODURTHA Owner Owner's Name information is CENTERVILLE required for MA 02632 6/10/09 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ 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)] Title V Inspection Form.doc•08108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 151 GREAT HILL DR Property Address BODURTHA Owner Owner's Name information is required re uired for MA 02632 6/10/09 every page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 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 ❑ No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage (gpd)): 07-216/08-290 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: Last date of occupancy/use: Date Other(describe): Title V Inspection Form.doc-0&06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 15 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 151 GREAT HILL DR Property Address BODURTHA Owner Owner's Name information is required for CENTERVILLE MA 02632 6/10/09 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: 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) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed(if known)and source of information: INSTALLED 1985 OFF AS BUILT CARD Were sewage odors detected when arriving at the site? ❑ Yes ® No Title V Inspection Forrn.doc-0&06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Fo rm orm Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 151 GREAT HILL DR Property Address BODURTHA Owner Owner's Name information is required for CENTERVILLE MA 02632 6/10/09 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑ cast iron ❑40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 2 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: 1000 Sludge depth: 8-101, Distance from top of sludge to bottom of outlet tee or baffle Scum thickness 211 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? WODDEN POLE Title V Inspection Form.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 151 GREAT HILL DR Property Address BODURTHA Owner Owner's Name information is CENTERVILLE required for MA 02632 6/10/09 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): TANK LOOKS STRUCTURALLY FINE, COULD USE PUMPING Grease Tra p(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Title V Inspection Form.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 151 GREAT HILL DR Property Address BODURTHA Owner Owner's Name information is CENTERVILLE required for MA 02632 6/10/09 every page. Crty/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cont.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No h Title V Inspection Form.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments °< 151 GREAT HILL DR Property Address BODURTHA Owner Owner's Name information is CENTERVILLE required for MA 02632 6/10/09 every page. Ctty/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System(SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: 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.): STAIN LINE AT LIQUID LEVEL ABOUT ONE FT FROM INLET INVERT Title V Inspection Form.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 151 GREAT HILL DR Property Address BODURTHA Owner Owner's Name information is required for CENTERVILLE MA 02632 6/10109 every page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) 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 ElYes ❑ 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.): Title V Inspection Form.doc-08/06 Title 5 Official Insp ection form:Subsurface Sewage Disposal System•Page 13 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 151 GREAT HILL DR Property Address BODURTHA Owner Owner's Name information is required for CENTERVILLE MA 02632 6/10/09 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. r(mN i 3 t3 32 3 S2 Tide V Inspection Form.doc•08/06 Title 5 Official insp ection Form:Subsurface Sewage Disposal System•Page 14 of 15 i Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 151 GREAT HILL DR Property Address BODURTHA Owner Owner's Name information is required for CENTERVILLE MA 02632 6/10/09 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cunt.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to 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: Title V Inspection Form.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 75 of 15 C. COMMONWEALTH OF MASSACHUSETTS (� EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE HINTER STREET. BOSTON, MA 02108 617-292•5500 WILLIAM F ELD '9A� l't , coy Goscmor ARGEO PALL CELLUCCI ''Oo D.al l STRI H Lt Goscmor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOR lr ''ly^9yllq� 7iss PART A ���U� \�• ��� CERTIFICATION f Property Address: 151 Great Hill Drive ` D• Address of Owner: Date of Inspection: 4/20/98 (If different) Name of Inspector: ,TnGPDh P Macomber Jr. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000) Company Name: J.P.Macomber & Son Tnc- Mailing Address: Rc,)x FF Centpryille, Mass . 02632 Telephone Number: 508 775 3338 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 iunR,on anc maintenance of on-site sewage disposal systems. The system: Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature: ' L,4 ( Date: ____��� The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing (n,s 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 be sent to the syszem owner and copies sent to the buyer, if applicable, and the approving authority. INSPECTION SUMMARY: Check A, B, C, Or D: A) SYSTEM PASSES: 2j I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 C.mR 13 303 Any failure criteria not evaluated are indicated below. COMMENTS: BJ 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. Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. if "not determined", explain wh,, no; Al'� The septic tank Is metal, unless the owner or operator has provided the system inspector with a co of a Cenif,cate of _ PY Compliance (attached) indicating that the tank was installed within twenty (20) years prior to the date of the inspection, or the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration. or tan: failure is imminent. The system will pass.inspection if the existing septic tank is replaced with a conforming sep;rc tanK as approved-by the Board of Health. (revised 04/25/97) Pay 1 of 10 DEP on the Wortd Wide Web. hnp twww magnet state ma us/dep CJ Printed on Recycled Paper i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOR.. PART A CERTIFICATION (continued) ➢"oprr.1 ACCress: 151 Great Hill Drive West Barnstable,Mass . O-net Arne R. Olsen Ddlr Ot Inspir 0"':A/20/98 B; SYSTEM CONDITIONALLY PASSES (con(inued) Sewage backup or breakout or high static water level observed to the dtslrtbvt'on oo= pipets) or due to a broken• sealed or uneven distribution box The system will pass ns 2c.•- Board of Health) Describe observallons: broken pipe(s) are replaced obstruclion is removed distribution box is levelled or replaced The system required pumping more than (our times a year due to broken or obwu ',I&C p•1r > -e s.s'>' ,nspeCj�on if I_ah approval of the Board of Health) broken p,pe(s) are replaced obstruclson is removec n fuRTHER EVALUATION IS REQUIRED BY THE BOARD Of HEALTH: ,(, ConC.(10n5 exist wn,cn requ,re lusher evaluation by the Board of Health in order to deie•r-nr ! '^r o c nealtn, safety and the environment u SYSTEN% WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: '.1 AS Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 5o feet of a bordering vegetated wetland or a salt rr.arsn N I ?) SYSTEM WILL FAIL UNLESS THE BOARD Of HEALTH (AND PUBLIC WATER SUPPLIER, IF APPRC�;R:AT; THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND Ski ", ;,-,D ENVIRONMENT: The system has a septic lank and soil absorption system (SAS) and the SAS is w.(r,r. >_`-- tr,butary to a surface water supply. Tne system has a septic tank and soil absorplon system and the SAS is within a Zone The system nas a septic tank and soil absorption system and the SAS is within 50 tee: a The system has a septic tank and soil absorption system and the SAS is less than 100 le-. =_ . . .. - pr-ate water supply well• unless a well water analysis for coliform bacteria anC o'3—e the well is free from pollution from that lacrliry and the presence of ammonia niUOZer. ess than 5 ppm Method used to determine distance Z/.* (approximd("Un not 3) OTHER Alf .r.�:..�'0s/7>/f71 Yip• ) of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 151 Great Hill Drive West Barnstable,Mass . 0%.ner: Arne R. Olsen Date of Inspection: 4/20/98 D) SYSTEM FAILS: Y ou must indicate el: er "Yes' or "No" as to each of the following: —VZ) i have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 13.303 The bans for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correc the failure. Ye �o 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. Static liquid level in the di i ribution box above outlet invert due to an overloaded or clogged SAS or cesspool Y t Liquid depth in eenpvol is less than 6" below invert or available volume is less than 1/2 day (low. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipets). Number of times pumped C. 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. E) LARGE SYSTEM FAILS: You must indicate either "Yes" or "No" as to each of the following: The following criteria apply to large systems in addition to the criteria above: ,6,1 Ll The system serves a facility with a design flow of 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: Yes No /,4 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. (rav:aad 04/25/97) Page 3 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 151 Great Hill Drive West Barnstable,Mass . Owner: Arne R. Olsen Date of Inspection: 4/2 O/9 H Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes No Pumping information was provided by the owner, occupant, or 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 during 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 they are not available with N/A 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. _ All system components,&Iuding the Soil Absorption System, have been located on the site. X _ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or material of construction, dimensions, depth of liquid, depth of sludge, depth of scum — The size and location of the Soil Absorption System on the site has been determined based on: The facili(y o.vner (and occupants, if cjfferent from owner) were provided with information on the proper maintenance of Sub-Sunace Disposal System. _L/ Existing information. Ex. Plan at B.O.H. Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unaccepta:)le: (1 5.302(3)(b)] (revised 04/25/97) Page 4 of 10 f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORrv1 PART C SYSTEM INFORMATION Propene Address: 151 Great Hill Drive West Barnstable,Mass . O"ner: Arne R. Olsen Daie of Inspec"on:4/20/98 FLOW CONDITIONS RESIDENTIAL: Design flow JZAD R/p�.d./bedroom for S.A.S Number of bedrooms. :9N ,,umber of current residents. 1 /l Caroage gander tyes or no)i 10r16 0 /�� Launcry connected to system (yes or no) ;y9 �Gl Seasonal use (ves or no) ti'd / r /. aier meter readings, if available (last two (2) year usage (gpo): / ���-(��C iL�i��[��VYI /���C'q V-�• `� Sump Pump lyes or nol/�!_ r ,aSi Cale of occupdnn� �' 6 6-jy- COm vtERCIAUIN'DUSTRIAL: Tvpe of establishmfent ,ax 'Design flow ��allons/day Crease trap present (yes or no)44 a Industrial Waste Holding Tank present: (yes or no)� ` Non sanitar, waste discharged to the Tale S system (yes or no),6/ a:er mete: reaoings, if available ti/4 _ ,as: Cate of occupancy. OTHER: :Descnbei 'IA .as; Caie o' occuoann- GENERAL INFORMATION PUMPING RECORDS and so e of Infor ation �VME— , System pumped as pan ( ,nspe on (yes or no) "> li yes, volume pumped a� gallons C Reason for pumping YSTEM T�P� Sepuc tank/distribution box/soil absorption system Single cesspool ,6)Cy Overflow cesspool �jj Priw Shared system (yes or no) (if yes, artach previous inspection records, if any) I/A Technology etc. Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed (if known) and source of information _//V Sewage odors detected when arriving at the site: (yes or no),e�Az t:•v:••C C�/15/571 Fag. 5 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 151 Great Hill Drive West Barnstable,Mass . O.ner: Arne R. Olsen Date of inspection:,1 /20/95 BUILDING SEWER: .ocate on site plan; Depth below grade. Material of construction cast iron 240 PVC — other (explain) Distance iro yp lo'1L private water supply well or suction line Diameter Comments (condition of )oil venting, evidence of leakage, etc.) Zt '' SEPTIC TANK:le"Iec�/� 5 •G3u:e on site plani Depin oelow grade Material of construction: zc/oncrete _metal _Fiberglass _Polyethylene _other(explain) t: ;an, is metal. list age t1,4 Is age confirmed byCen,itcc`ja1te of Compliance V.4 (Yes/No) D:menS,Ons � e,tlr� 'Yl L6i 7 �_ Sl�cge depth Distance from top of sludge to bonom of outlet tee or baffle: Q Scum thickness ill_ 0 Distance from top of scum to top of outlet tee or baffle: Distance from bonom of scum to bono of outle tee or baffle. How dimensions were determined: Comments trecommendatron for pumping, conditi of inlet and outlet tees or baffles, depth of liquid level in elation to outlet inven, suuctura. .ntegrrty, evidence of lease, etc., ' CREASE TRAP;d�& tocate on site plan; Depth below grade/L/� ti�ater al of construct ion h! concrete(1AmetaLfJ�JFiberg!ass��Pulsethylene'�i other(expla n) Dimensions. Scum thickness. A Distance from top of scum to top of outlet tee or baffle: 164 Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping A Comments: :recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet inven, struc.�ra lntegory, evidence of leakage, etc.) * � it 1� Sr.l P.9. 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOR." PART C SYSTEM INFORm.ATION (continued) Propert, Address: 151 Great Hill Drive West Barnstable,Mass. O ne. Date ct Inso,,,.onArne R. Olsen 4/20/98 TICHi OR HOLDING TAN'K�j7ank must be pumped Pt-v to. or at I'me, of 'nsaeeiion) (loc.3:e o.) s"e plan) Dep:n o21ow grade Ma:e�a; o' con$ttuaton:AZ-4concreieW metal,lJ2FtberglassA//)Polyethylene.tAother(explainl Aw 0-men$,ors Ah4I Capac'rr 41A gallons Des,gn i O.. , ,�u4 gallonVday m.Alar .e.el ' .� AlarmI,rnn working order/t! 1'e5:i{i�/ t, Date o pte­ous pump.ng. COmmen:s tcone,t,cn of -nlet tee, cond,uon of alarm and float switches, etc 1 DISTRI9'_)110•N BOX:Z .o<a:e _, r:e plan) De::- _ .. C level above oullet -ven tno:e .t le.el and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box. e:c, ' //�� �o z PU."P Cr1A,'-sBER:�� tloc.3:e c-) si:e plan) P mp, .r „o,k ng order (Yes or No) XO Ala,ms .,ork'ng order (Yes or No)� Co.m.T,e-:s ,note :OrCG:•on of pump chamber, condrtwn of pumps and appunanances, e(c.) P.9. 7 of 10 i SUBSURFACE SEWACE DISPOSAL. SYSTEM INSPECTION FORns PART C SYSTEM INFORMATION (continued) Propeny Address: 151 Great Hill Drive West Barnstable,Mass . o»ner: Arne R. Olsen Date of Inspect Ion: A /20/98 SOIL ABSORPTION SYSTEM (SAS):Zm�a✓ ;locate on s,te plan, If possible. excavation not required, but map be approximated by non-intrusive rnet-ccs u not determined to be present, explain 7Y✓e l leaching pits, number. leaching chambers, number: leaching galleries, number:_ leaching trenches, number length. d leaching fields, number, dimennnJJsions, overflow cesspool, number: v Alternative system: _p Name of Technology: T' ' Lv'- `c.mmen:s rote cor'cition of soil, signs of hydraulic failure, level of ponding, condit,on of vegettation, tc., p CESSPOOLS:,,.ve oc ;e on site plan) -,umc�er and configuration: [� Depth-cop of liquid to inlet Invert 4A Depth of solids layer: kiQ Depth of scum layer: Dimensions of cesspool: ti'aterials of construnion: Indica(,On of groundwater inflow (cesspool must be pumped as pan of inspeci,on) Comments no;e cone,t,on of soil, signs of hydraulic failure, level of pond�ng, condition of vegetation, etc.) PRIVY:/ /L ;locate on site plan) materials of construalon: Dimens,0",i Death of solids Commens inote condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, e(- i D.9. 1 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) PropertlAddress: 151 Great Hill Drive West Barnstable,Mass . Owner: Arne R. Olsen Date of Inspection: 4/20/98 SKETCH OF SEWAGE DISPOSAL SYSTEM: ,r.:;ude ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) �J (revised .4/25/97) Paq• 9 of 10 SUBSURFACE SEWAGE DISI' SYSTE.�� iNSPECTION'' FORa SYSTEM INFOI ;continued) PrDper., dress: 151 Great Hill Drive West Barnstable,Mass . 0-net Arne R. Olsen Date of ins'�ectlon 4/20/98 r Depth to Groundwater Feet Please indicate all the methods used to determine High Groundwaw Eli: a.ion: C;D:atned from Design Plans on record C:DSer.anon of Site lAbun,ng property observation hole, bserrx Or s.,mp etc.1 Dz:erm ne n from local conditions C•nzc. .,,:n local Board of health C-•ci .n'� maps /C p-;-,p.ng records acal excavators. nstallers e _SCS Data Desc,De ow own words how you established the High Grouric)-,rzr:;evat,on. Must be comple:e'd; Used Water Contours Map. Gahrety & Miller Model 12/16/94 - 1 r.-.rr--r. rr-rt- nrr!r.•n rc'rr—..n.*rs..rr,:•.r•.Ta.r:�rr.�-+.�ens--�c.:*rcvrrn rr- - ... .. . _. - *s-*.-�-.�r-v r-,-r-T---r- _. ._. TOWN OF Rarn-tile BOARD OF 11EALTII SOBSURFACF SEWAGE DISPOSAL ,SYSTEM INSPECTION FORM - PART D - CERTIFICATION r- r- -TYPE OR PRINT CI.EARLY•- PROPERTY INSPECTED STREET ADDRESS 151 Great Hill Drive West Barnstable,Mass . ASSESSORS MAP , BLOCK AND PARCEL # / G - ®top/ OWNER ' s NAME Arne Olsen- PART D - CERTIFICATION NAME OF INSPECTOR Joseph P.Macomber Jr. COMPANY NAME J.P.Macomber & SoTf 'Inc. COMPANY ADDRESS Box 66 Centerville,Mass . 02632 Street Town or City Scat. ZIP COMPANY TELEPIIONE ( 508 ) 775-3.338 FAX (508 790 _ 1578 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true , accurate , and complete as of the time of .-inspection . 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 : —Zsystem PASSED The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15 , 303 , Any fail�lre criteria not evaluated are as stated in the FAILURE CRITERIA section of this form . System FAILED* \ The inspection which I have conducted has found that the system fails to Protect the public health and the environment in accordance with 'Title 5 , 310 CMR 15 , 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . Inspector Signature Date One copy of this c rtification must be provided to the OWNER, the BUYER ( where applicable ) and the I30ARD OF IIEAL'I'JI. * If the inspection FAILED, the ot-rner or `operator shall upgrade the eyatem within one year of the date of the inspection , unless allowed or required otherwise as provided in 310 CMR 15 , 305 , partd . doc ' r w s THE COMMONWEALTH OF MASSACHUSETTS DEPARTMENT OF ENVIRONMENTAL PROTECTION BE IT KNOWN THAT Joseph P. Macomber, Jr. Has satisfied the Department's qualifications as required and is hereby authorized to use the title CERTIFIED TITLE 5 SYSTEM INSPECTOR as provided in 310 CMR 15 .340 and Section 13 of Chapter 21 A of the General Laws. Issued by The Department of Environmental Protection. June H. 1995 Acting Dirmor of the L iuti of Water Pollution Control �\ COMMONWEALTH OF MA.SSACHTJSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON MA 02108 (617) 292.6600 TRUDY CORE Sec»tiry DAVID B. ARGEO PAUL CELLUCCI �l Com STRUHS rttissioaer Governor SUBSURFACE 7�E C SY TEM WSPECTION FORM ART A ' e CER T10N " > Jef f rey - Crug Property Addre": 1 51 Great Hill Drive KaTM of Oww West a Ad&*"ofOwner: Daru of Inspection:. V06pect,r: l PJoseph P. Macomber Jr. PA I am a DEP approved sYstsm Inspector pursuant to Section 16.340 of Tftle 6(310 CMR 16.000) car,p,rr NaTa;Jose h P. Macomber & Son Inc. Ox en ervi e M 632-0066 TaLophorw µurnber — CERT1FkCAMN STATDIEM certify that I hays personally Inspected the sewage disposal system at this address and that the Information reported below Is true, accurata I' complete as of the time of inspection. The inspection was performed besad on my training end experience In the proper function and muntenence of on-she sewage disposal systems. The system: �— — Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority Fai s \ Dete: vupector's s4mrtu re: � The System Inspect shall submit a copy of this Inspection report to the Approving Authority (Board of Health or DEP)whhin thirty (30) days of completing Na Inspect)on. If the system Is a shared system or has a design flow of 10,000 gpd or greater,the Inspector and the system owner !Hall submit the report to the appropriate regional office of the Department cKnv{ronmental f'totectlon. The original should'ba sent to V1V system owner and copies sent to the buyer, If applicable, and the approving authority. NOTES AND COMMENTS t KII 5 EP 1 8 2000 Page I or i i ' r "I. revised 9/2/98 Printed on Recycled Paper SU&SURYACI SEWAGE DISPOSAL SYSTDd INSP£CMN F0" ` PART A CFAT1FiCAMN (oon*w*41 151 Great Hill Drive, West Barnstable Jeffrey Crug Dww °d VuP ct—: 9/5/0 0 µSr£CTWN SUI MARY: CN ck A4 0, C, a D: A:`SYSTDJ r:lssEs• T�. I have not found any informadon which Indicates that any of the faUur• cortddons described In 310 CMR 1a.303 eziat Any fa0u artur(a not evaluated are Indicated below. CO MUE) : i. Syrrn1 CONDMONALLY PASSES: ALOne a more #yetem sompononts w doeorlbsd In the 'Cw4d" Paws' ssodon Mod to be repleaod or repalred. The syvtam. ua completion of the repiaaem•nt w repair, as approvod by the &card of Health,wW Paws. of clottrml-AtIon In 4111 v+Qlo•te y• no, O1 not The eepde�tank I ned Ymetal, unie#s the Owns/r wsopwotw haw provldod the sty tem UuPwor with, copy OOf C-4rVAca el of CompUanc• (attached)Indlowdng that the UM waw tnataUod within twenty (20)yews pr(a to the data of the tnapecvon the •epdc tank• whether or not metal, Is stocked, ewowraUy unwound, shows subetaMIW Infuvodon or •rf tv"Q`. Of failure I Imminent. The eyetem will Pese kuP•adon If the exledng eepds tank is replaced with a eomp►Ytnp eepdc tans approved by the loud of Health. Sewage backup or breakout or high eudc weter Isysl observed In the Woulbudon box It due to broken or obsvucud pip or due to s broken, #ettod or uneven dletjIW%lon box. The system wUl pass trupsodon If (whh apP(ovaJ of the So-ud of Health)• broken pips(#) we roploced obawcdon is romovod dl#vibudon box Is IeveUed or replaced • The eynerrt requked p wnph17Tr- v d%&A• ^es-%"&rdue to broHonol obstroated pipo(a). TIh vyvtrm ww-Pwav— Inapecdon II(with approved of the lloud ofHesith)t broken pipe(#) are repiacid ob#wedon le removed revised 912/98 hie 2 of 11 f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOR14 PART A cER,nFICATION (con*wodl) P,wwty Ada..,: 151 Great Hill Drive, West Barnstable Owrw: Jeffrey Crug Do%* of tnspecroon. 9/5/0 0 C. FURTHF31 EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conc tfons e:Ist which require further evaluation by the Board of Health In order to determine If tM system Is faMn9 to protect the public health, safety and the environment, 11 SYSTY1r1 WILL PASS UNLESS BOARD OF HEALTH DETERMINES W ACCORDANCE WR'H 310 CMA 16.303 11)(b)THAT THE SYSTEM u NOT FUNCTIONING IN A k"AINER WFUCJi yAU.PRa1EC1'THE PUBLIC FlMrriAND SAFETY AkO THE ft CZ80IlMEWT—' IVD Cesspool or privy Is within 60 feet of surface water Cesspool or privy is within 60 feet of a bordering vegetated wetland or a sell marsh. 2) SYSTEM WU1 FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF ANY)DETERMOtE3 THAT THE SYSTEW tS FUNCTIONING W A mANNFR THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIsiONAAFNT: The system has a septic tank and soil absorption system (SAS) and the SAS Is within 100 feet of a wrtace water supply or �1. tributary to a surface walsr supply, .Vp The system has a septic tank and soil absorption system and the SAS Is wltNn a Zone I of a public water supply well. The system has a septic tank and-&oil absorption system end the SAS Is within 60 feet of a private water supply weu. The system hes s septic tank and soil absorption system end the SAS Is less than 100 feel but 60 feet or mo+e from a private water supply well, unless's well water analysis for coliform bacteria and volatile organic compounds Indlcatas trot tr.e wall Is free hom pollution from that facility and the presence of•mmonla nitrogen end rJusts nhrogon Is equal to or less than 5 ppm. Method used to determine distance�_ (etpWoxjrnrton not vaUd),- 71 OTHER e revised 9/2/98 File 3of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM . PART A CEATUiCAnON tcwvdnu*d) property A6&*": 151 Great Hill Drive, West Barnstable ownw: Jeffrey Crug of" 9/5/00 D. SYSTEM FAILS: + either 'Yos' or 'No' to each of the following: zlat�><described In 310 CMR 16.303. The b"s for This You mus t Indicate conditions e �� I have determined that one or more o}the following failure determination Is Identified below. The Board of Health should be contacted to date rmine what will be necessary to cortect the ar Yet N g•Irw lt -o• ►t+ �apmponant 4o@to an overfwdod vrvWggd 81Sac•+sPod• �/ Backup o+ewSh .�--• - " Discharge or ponding of effluent to the surface of the ground or surface water+due to an overloaded a clogged SAS or cesspool Static liquid Ievel In 00 dis,ibutlo=_.SAX above outlet Invert due to an overloaded or clogged SAS or cesspool. elvkviquld depth ln`seetp�Is less than 6' below Invert or available volume Is less than 112 day flow. _- Required pumping more th� 4 times In the last year No due to clogged or obstructed plDelal. —' Number of times Dumped Any portion of the Soil Absorption System, cesspool or privy Is below the high groundwater elevation. Any portion of + cesspool or privy Is within 100 feet of a surface water supply or tributary to a surface water wDWY Any portion of a cesspool or privy Is•witftin a Zone I of a public well. Any portlon of s cesspool or privy Is within 60 feet of a private water Supply we"' Any portion of a cesspool or privy Is lespthan too feet but greater than 60 feet from a prlvste water supply w*u wive n —" acceptable water volatile�aorg+nlocof the wellmpou ds hammonls nlu 9en end nitrate nluas been analyzed to be iogen.ach copy of wall wets( analysis to -collform bactarle, ola E LARGE SYSTEM FAILS: You must Indic$%$ either 'Yes' or 'No' to each systems In addition to the criteria above: of the following:system The following criteria apply to large nlficant tiveat to The system serves the environment because one ,000 gpd the eater(Large SYSons sal a; a system is a sJg health and safety and Yet No , the system is within 400 feet of a surface drinking wets( Supply - �/h syet•m•I�wit sr -lo�aurlw�•dslr�kleW'M'�sM+u►►IY ... . e � 200 (�etof-a-�t Y he system Is located Ina nitrogen 2oM II of • p sensltl m ve area(Interim Wellhead Protection Area.IWPA) or a aPD� water supply well) The owner or operator of any such System shall upgrade the system In accordance with 310 CMR 15.30412). Please consult local rK offlce of the Department for further Inforpadon. refit 4 or If revised 9/2/98 SUBSURFACE SEWAGE DISPOSAL SYSTIDA INSPECTION FORD PART 5 CHECKLIST Property Add,eu: 15 Great Hill Drive, West Barnstable Own..: Jeffrey Crug oev of tnap«tlon: 9/5/0 0 Check If the following have been done: You must Indicate either 'Yes' or 'No' as to each of the following: Yes No i Pumping Information was provided by the owner, occupant, or Board of Health. None of the system compoaarAs 6&kw•b m poenpad+baat•Jaast3wo•waaka en64be7ystam haabawvecalgoq...d 1 rates during that period. Large volumes of water have not been Introduosd Into the system recently or as pan of we Inspection, As built plans have been obtained and •xemined. Note If they are not available with N/A. The facility or dwelling was Inspected for signs of sewage backup, The system does not receive non•sanit"or Industrial waste flow. _ The eke was Inspected for signs of breakout. _ All system components,� luding 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 concation of bar or tees, material of construction, dlmenslons, depth of liquid, depth of sludge, depth of scum, The site and location of the Soil Absorption System orrths alte has been datermined based on:- Exlstlnq Information. For example, Plan at B.O.H. _ Determined In the field (If any of the failure criteria related to Part C Is at Issue, approximation of distance Is unacceptab I11,302131(bll _ The f►clllty owcw (.".oczALp&aU,Jf dldaraat prauldad,wlth laiarmatloaon 0-A' p • m �,.�.� SubSurface Olsposal Systems, revised 9/2/98 P.tesof11 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM >_5 PART C SYSTEM INFORMATION Propwty Address: 151 Great Hill Drive, West Barnstable OWT : Jeffrey Crug Dau of kup—don. 9/5/0 0 Flow colyomoNs RESK>er 1AL: Design flow:17g•p•d•roedro rJ Number of bedrooms gig 1 Number of bedrooms (actual):— Total DESIGN flow Number of currant residents: Garbage grinder(Yes or no): _ Laundry(separate system) ( or go , If yes, sepawaImpaction.requlred Laundry system Inspect,d or no) Seasonal use )yessor or ne nol: Water meter readings,It available (last two year's usage(gpd). Sump Pump(yes or no):—A&.a Lest date of occupancy: COMMERC1AL02ATRIAI: WO Type of establishment: Design flow: d ( B d on 16.203) Balls of design flow 14 Glossa trap present: (Yes or no) Industrial Waite Holding Tank present: (yes or no11&& Non•sarutary waste discharged to the Title 6 system (yes or no)/ Water metal readings,If available: Lost data of occupancy: OTHER:(Describe) l Lost date of occupancy: • GENERAL INFORMATION PUMPING RECORDS and source of Informstlon: System pumped as part of Inspection: (yes or no),_ If yes, volume pumped: gallons Reason for pumping: TYPE 0 SYSTEM Septic tank/distribution box/soil absorption system Single cos+pool Overflow cesspool Privy Aff Shared system IYe$ or no) (if yes, attach previous Inspection records,If any) I/A Technology et Attach copy of up to date operation and maintenance contract Tlght Tank Copy of DEP Approval Other L APPROXIMATE AGE of all components. date Inetallediif known)-and sour**ofJwfoematlon: $*wage odors detected when-arriving at the site: (yes or no) (/ revised 9/2/98 Page 6of11 SUBSURFACE SEWAGE DISPOSACSYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (con&KA41) f'ropwtyAd&*": 151 Great Hill Road, West Barnstable pwr«: Jeffrey Crug Dart' of ktspecdon: 9/5/0 0 BUILDING SEWER: (Locate on site plan) d Depth below grade: Material of construction: cast Iron Z/40 PVC Et)other (a;plaln) Distance homgivete waletsupply well or suction line W 701' Di moist�_ }�aaka+�� Comments: (condition of Joints, venting, 1 eto4kalevidence f leaks e Joint s em is ve sU IC TANK: (locate on she plan) N Depth below grade- Material of construction: ZC/0ncrex@Ak4m*t&IA aPolyethylen*V4Dthar(ezplaln) if tank Is fnstal, Ust agodff 1s.age.conArmed by Cer-uticate of Compliance (Yes/No) Dimensions: Sludge depth: Distance hom top o go to bottom of outlet tee or baMr Aid.-A, Scum tNckness:, �— Distance hom top of scum to top of outlet tee or baMe Distance from bottom of scum to bolt of outlet ee baffle: Mow dimensions were determingd- � Comments: r� (recommendation for pumpin conditlon of Inlet and outlet tees or•baffles, depth of liquid IevinrL1e@t o8tto0Utlet srei-�ntegrrty, evidence of leakage, etc.) lump septic tank — 1 in plac-p iqui eve a is tees are i Lanx is s ruc ur t vi ence o GREASE TRAP: (local$ on site plan) Depth below grade Material of construcU n.(1concretavei}4netal��Fiberglasa Polyethylene other(exDlain) Dimensions: PW Scum thickness: A Distance hom top of scum to top of outlet tee or baffler . Distance hom bottom of scum to bottom of outlet tee or,baffle:,df& Data of last pumping: Comments: and outlet tees or baffles, depth o}Ilquld level In relation to outlet invert, etructursJ integrity. Irecommendation for pumping, condition of Inlet evidence of leakage, etc.) Glease trap revised 9/2/98 hgt7of11 SU&$URfACt SEWAGE DUPIOSAL SYSTEU tN3f`ECT10N FOR)d ►AAT C SYSTDd INFORMATION (c40dnu44 ftoqw,rj Agar..+: 151 Great Hill Road, West Barnstable 0-w-r-w: Jeffrey Crug O.c► 71 In►�: 9/5/0 0 n0KT OA MOLDING TANK; (Tank must be pumped prior to, or at time of, In►pccdon) 1104819 On site plan) Ospth below gr►ds:4✓/ Mstsrtsl cf conswcuon,l(1�conciele rneW t4Flb►rpl&&o4A1OIY$thyl►n�oth►r(oxpl►lnl 109 Dimensions:, All CepeclTY: , gellons Design Ilow: g►llons/d►y Alotm present ,' Maim level: Alarm In (king order:Yes N9AV 0►14 of pr►vfovs pumping, Commonu: ,condcon of IrJgt 194, condition of el►rm and float switches,cto.) 11 .. n prPcPnt Ot nistlnON sOX:� I,o<ete on site plan) Depth cf lipuld level above ovdet Invert:_ Ale Comments: Ina►If level and distribution Is equal, evidenoe of solids oarryover, wldence of leakage Into or out of 1Oi, etc.) IJTS7Cr:IgU as one 1 No. PVi He ca p-F � d .y - erez='1dLT aence Of 1 r�akaap iii%O Or Out of ffie boX_ pijmp I104610 on she plenl pumps In working order:)Yes or No)JA� Alarms In working order lYes Or No) Comments: mots condition of pump chamber. condition of pumps end eppurten►nees. Otc.) Paitip-cnamber icz nni- Present- revised 9/2/98 nfe�erll SUBSURFACE SEWAGE DISPOSAL SYSTEM WSPECTION FORM PART C ' SYSTEM INFORMATION (corttirwood) PropwtyAddreas: 151 Great Hill Drive, West Barnstable Owner: Jeffrey Crug Dav of Inspection: 9/5/0 � SOIL ABSORPTION SYSTEM(SAS): M0 (local* on site plan. If posslbls:excavation not required,location may be approximated by non-Intrusive mard►oda) If not located, explain: Type: leaching pits, number: leeching chambers,number: leaching galleries,number:_-9 leaching trenches,number, length:—r�• leaching fields, number, timepa{on7v (J overflow cesspool, number_(/ Alternative system:_ CJ Name of Technology: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.) No signs of hydraulic or p re >_na of s a r VPgAtA♦-inn ; c normal e CESSPOOLS: e (locate on site plan) Number and configuration: Oepth•top of liquid to Inlet Invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Allf Materials of construction: indication of groundwater: Inflow (cesspool must be pumped as part of Inspection) essiDoo s are not present Comments: inote condition of soil, signs of hydraulic failure, level of ponding,condition of-vegetatlon, etc.) ess oo s are-not PRIVY: we, (locate on site plan) Materials of construe on: /U� Dlrr►e�alona: �� Depth of solids: Comments: Inota condition of soil, signs of hydraulic failure, level of ponding, condltIlon of vegetation;etc.) Privy is nnt prPcjzQf- revised 9/2/98 PaQe9of11 3VL3VR/ACt ItWAOt 04POSA1 5Y9TVA WiPt=ON FO" PART C ' IYITVA WFORJdAT1ON (eon*woa) rtiogeM Aaa..,: 151 Great Hill .Drive, West Barnstable OWTW: Jeffrey Cru Dou 9+�a«,+ 9/5/00 g SKETCH Of SEWAQE DLSPOSAL SYSTEM: Inclv4o dos to &t lo&il two permanent reference landmarks or bonchmarkA loc�t� all wells wlthln 100' NOW$ whore publlo water supply comes Into hour) \ ,2. .. revised 9/2/98 ni�loerll �L SUBSURFACE SEWAGE=109 Al SY3TDd INSPECTION FORA PART C SY3TENI WFOR1,tAT10N (condrwd) ►rop*MAddra.s: 151 Great Hill Drive, West Barnstable Owrw: Jeffrey Crug Dou of vwpect-: 9/5/0 0 MRCS Report name Soll Type_ Typical depth to groundwater USOS Date websits visited Observetlon WeUs Checked Oroundweter depth: Shallow Moderate Deep SITE EXAM Slope Surface wslef Check Cellar Shallow wells I Estimated Depth to OroundwaloV, Feet Pteese Indicate all the methods used to deternJne High Groundwater Elevetlon: _ Obtained hom Design Plane on record b erved Site (Abutting property, servatlon hole, basement sump etc.I Determined Irom loc►I conditions Checked with local Board of health Checked FEMA Maps _ZChecked pumping records Zhecksd local sicavrtors, Instillers Used USOS 0016 Oescrib• how you established the High Groundwater Elevation, (Hgg be completed) Used; Water Contours Map. Gahrety & Miller Model 1 2/1 6/94 it 1 revised 9/2/98 Polls it of l) .�......... ....,....-- .-�...,...�... BOARD OF 11EALT11 '1'UHN OF 9UIISURFACF 99WAOF 1)19f'USALSYSTEM INspFCTION FORM - PART D - CERTIFICATION ,-�.i,.-...TT r+ww•n n.I�w A'�Tr r.�n,r.+.��-'P'w►�I�►+��� ^^ -TT/C OA PAINT CI,CAAI,Y- PROPERTY INSPECTED STREET ADDRCSS 151 Great Hill Dr ' ASSESSORS HAP , BLOCK AND PARCEL I OWNER' s NAHE Jeffre Cr PART D - CRSRTIFICAT10H NAHE OF INSPECTOR Joseph P . Macomber Jr, COHPANY NAME Joseph P. Macomber & Son Inc. Centerville MA. 02632-0066 COMPANY ADDRESS Torn orelty A�+�• I ► tr�.t COHPANY TELEPNONC ( 508 ) 775 - 3338 FAX ( 1 CERTIFICATION STATEHCNT I certify that I have personally inspected the sewage dieposa`1 system nt ted is Drecoinme"da his address and that the il) formation rTherinspectionewasoperformednand any omplete as of the time of . inspection , nt tlo►Is iegardXlleriencedin thenproperefunction ancepair are and mainteneof on- witli my training and e ep site sewage disposal systems Check ne : (/VS7,steoi PASSED _ The. inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public jjeaj �jjcrater of oils valu�tedclit AreaAs defined Stated in the FAILURE303 . Any CRITERIAfailtire section of criteria not e this form , System FAILEU= ails The inspection whIC11 I hlivendon doted hanmentfounintaccordancehat the s with tem iTitle tc protect the j)ublic Iten1C 5 , 110 CHR 15 , 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form , Date Inspector Signature ne WW . of t1lis c tification must be provided to the OWNER , the BUYER ( wh•r. •Vplloebl• ) •nd th• pOARD OY HEALTH. rade ' the system . I ( the Inspection FAILED , thv owner or operator shall upg te of the inspection , unless allowed or required within one year of the do otherwise as provided in 3.10 CHR partd , doc [Added 2-19-2008] Septic systems consisting of a leaching pit with a liquid depth of less than six inches below the invert and/or with the available volume less than 1/2 of one day's flow shall be upgraded to conform to 310 CMR 15.00, the State Environmental Code, Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage, and Town of Barnstable Board of Health Regulations. LO C �'r ION SEWAGE PERMIT NO. Lo VILLAGE INSTALLER'S NAME A ADDRESS s U i L D E R OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED L 0 +--------------- s 3 •v Z yam. R -v. No. Fim THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ZP_( ,...v. .....--.--.0F.........134 A,-,K..5..j .......................... 451 Aplifiration for Uiopooal Works Tonstrnrtion ramit Application is--hereby made for a Permit to Construct �( ) or Repair ( ) an Individual Sew Disp o sal 0 system at• L .1._..........1 .... �p , 7R_!L .._. ... ------ ----- •••. S O. - ocation/J Addddr�� 0 A ® f or Lot N / /J wner O Address --•--------------------------------=` moo.......... .--- ----•-----•----- =vac........ ------------ Installer ddress � d Type of Building Size Lot__9_�,________________Sq. feet U Dwelling—No. of Bedrooms---- _________________________________Expansion Attic ( ) Garbage Grinder ff!/D `4 Other—Type of Building No. of ersons____________________________ Showers — Cafeteria a YP g P ( ) ( ) Other fixtures ..--•--------------------------------------------- --------------------------------------- W Design Flow.................5�!"...................gallons per person per day. Total daily flow...............��._, p_____._.__.____.__.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-------------------- 1 ' .dam`�7 --- Date.............. '� Depth to ground water_.____ _____ Test Pit No. L_�Z'35_minutes per inch Depth of Test Pit_.__._�_� p gr �IMM f=, Test Pit No. 2..__ ._._`minutes per inch Depth of Test Pit____________________ Depth to ground water................_....... P4 ..................................................Description of Soil----._...---••------------------------••--_�.� 4 o-el� * 0 - --- x fin,---�-•••............... ••..... . �� v� V W ---------------------------------------------------------------------------7 .---- ---------------om ----------! =-�-=--�'r---------------------------- 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 TITLE 5 of the State Sanitary Code—The undersigned further agr es not to place the system in operation until a Certificate of Compliance has been issued -- the board health. �' � s� Signed....... ........-• •- ------- ............................................ --� .........-.... ' ate Application Approved By........... ----------- -------------- _-- - ..._•--•----•------ �.. _, J----------- Date Application Disapproved for the flowing reasons:_..____•___________________________________________________________________________________________________.... --••-----•-----------------------••----------•---....._-----•----------------•------------.._..._....-•-•••---------------------------------•-•---•---------------------------------------••------------ Date Permit No....... �..e-�...----------------................--.... Issued.------- ................- Date // 0 N®.. ._..5.�..... FEs....:. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -..`". ............OF......... 4..A.: Appliratiaau for Disposal Works Cnono rurtiuu Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sevj.ape Disposal' System at: :: . .......... l _ ................__. .. .. ..._._.... ...__..._. ... r ....._.... . ----. ...._.............. on ocatidrass 1Aay" §tor Lot ...................... Owner 1 dress w •......... • ----• ....• ............................... •---•-•-------------------------------- + Installer Address U Type of Building Size Lot__��_.. ' -----------•-•--Sq. feet �-, Dwelling—No. of Bedrooms........... ..............................Expansion Attic ( ) Garbage Grinder '" a4 Other—T e of Building .............. No. of ersons.........._...._............ Showers YP g --------•----• P ( ) — Cafeteria ( ) dOther fixtures -----•--•-•-------------•-•--------------------..•..--.•---•-•---•-•-•••-••-•--•---•---•-•---•-•-•....... W Design Flow................. t ...._...•.•........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 b ... Y ... Date............. `. • Test Pit No. 1.. r .minutes per inch Depth of Test Pit..... _._ Depth to ground water...... .................. f=, Test Pit No. 2.... `.minutes per inch Depth of Test Pit.................... Depth to ground water......................... a --•••--•---•--------••• ---•- • . .... D Description of Soil-•--------••----•-••..............• ""° # .. W ! ---------- ------------- c.� ----- ... ._... °� x -•--•--•--•-------------•...•-----•----•-•---•--------•-•-•---•-- •---•-. "�- ..Z.....-- --•-••• • . - U Nature 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 TITaj 5 of the State Sanitary Code—The undersigned further a r es.not to place the system in operation until a Certificate of Compliance has been issued he board ealth Sit ed.............•... - ............ .................................... 1 ._ ajj�� Application Approved By.......................... .-- �- --- --- - - •-------•........................ �.///y� � �S�_....... ._ .• ,..... mate Application Disapproved for the follow g reasons: ----------•--•--:•----•--- ---------------------------------------------------------•-------••--•.-. ................................------------------------------------------------- ----•---..... ... .............. Permit No.............. CS ) 4' / ... issued. 1.7 0 •..................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............. 0� .....OF........ PAA .................................................. Tatifirtt#r Of T.uutpliFaurr THIS IS TO CER IFY, That the In id 1 Sew e Disposal System constructed (11or Repaired a at.................................................... - ... .._ Inst�s �a¢p^� has been installed in accordance with the provisions of TITLE" 5 of. TTr/he State Sanitary Code as described in the i application for Disposal Works Construction Permit No...._......s�S-��••••-_�._-•-_--- dated-..... ................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE C NSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION.S TISFACTORY. DATE.........�...�!' ---•.:.................•---•---••--•--_..... Inspector... ._ �. ... ............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF AL , . 5_5 ................. J: O F......... air---- No....................... FEE........................ Roplaittl u kii Taangtr Uau r it Permission is hereby granted........................ ✓ - to Construct ( orkRepair ( ) a n i ual S sae D posa � ram' �'" ,. at No.---- ..... _ --•---• •. ----------- •--------•---• ......... .............................. Street as shown on the application for Disposal Works Construction ermit No.a�.._�_I.... Dated.._..�'_j 'g� ---- -•--� • . • ---••-----------------'....: _ Boar o Health DATE........ .k FORM 1255 A. M. SULKIN. INC.. BOSTON - 11lOTt° //'� �i7•iYER TN:tt .SEPTIC T.^�/Vk �iQ ?O FT Ins/N. LEACH/MG P/T AN& NOR& TNA" /Zw&ZLO- /c pf !►t�N. aAAA�,.A Z4'O1AA4F7'.ER C'o,5 CR.,d7,M COPWAP N-- SJVALL OAF APR006.4 7 TO 6RAl0E.&4/V .EX'T.@'.A . GOKCACt'7Z' 9'oVC ?!Pt JAY ZrAVY.CAST/e 01V CoYd-. - SHALL BE USED M/N. P/TCIV /F/N OR/VEJVA y C�GYC/�S �,6�Q��-T . -i 2�G Nay. CONC.�LrTG� y + _ C3R-4aB CO rER I CLEAN .SAND 2 -AYER •. •` V o ► •e %o -.'T�d MIN.P174# OAL. D/ST. ,.p t • • • • . • • • p •+ WA5H-=O STONE := %a•P�/t P7. a�PT/C TANK • • • s • • • • • • • o e • r ®aX o t o • • 8 • • • •• • .••� • : . ♦ • • •• L PTJSI • • t • • 14 ASNEO STOiYE i I o f 00 7 8' "` • ' • e • • • e • • ► s•r PRE�'AST SE. QGF j� %? ,_/ 'T ! 5 c` ,'s /o•.� • • • • • • sea d -OR P17 R ZVVIV t IMYe�Kir Z,4&VA'7`IAV S �. /A►Y.ERT AT Sl/ldeA/MG la 9•� FT. 'PTo C' T.4A/K fT y/�4M. N C( rIOA� { "7LE7'S&'T/C TAA►K !c.s,S FT /N 7"O/STR>s3dlrlD.�/ BOX 2 3 r GROVA10 J,47.CM .TA W E - - f S&FCT/ON 4F D�„ETDl37)VA07`-MY AOX- 2z.Fs ITT /A/L.6T LEAC! iml, lowr I&r eS�b4�ACat�. O/eS i t .S'Y.STi�M "rA4WI-AT/ON LEACHItVa AYT o//tENs1oA/ A /e'T. wu�dER Of a�L oa s D/afwSiCH C FT. CAROAGED/Sd�O.S•'1L- UX/T �✓,,;= SOIL LOG TOTAL E97/1,%4rED FLo*4V 33 v 6.44.1DAV S4/1- TEST IIF/ SO/L 717S7-*,Z SDAL 7AF57 NUMOER 0,C L,EACRUYG PATS._(_ fECeV ll8.•6. J^'AL1WY. PATE QF SOJL TEST S/�AFL,CACH/IVG PERP/T I�� . Sg PT. „{ L- RESUL.TS.h//TNESSED BY k�` (QOTTQ/H LJ,-4CM/NG PeR P/T 7 S �, �T.. G ✓ •"�/�CQ.GAT/ON /CRTE#I 7'07',41 I-eACH//1'G AREA 2C: lU_S4) fT. L ,E P oVCOA770H RA A %ff�" ^1 PliNV/NCH RESERIiE LEAC'N/NE,4REA 2 1,b .7 2_ _v Z. OF AS `c ALSF1`t� sfi h.'li' ( j EL"U"EC •, cn.i p RSE ti ..� No.10951-O EL OREO6E AENCHMAZA' W CQ,/NG. / P c1 1 7!Y MAIN -5 - F;;`t1��%�- °q FG15T� �a<` Cam. /� G .6 , NYANNl9, MA /!n Ec ScION�� NG GROVNP ;-Y,4T-wR CrNCOUNTER1.c0 �Z.o% LET�E., IJ w _3R / E L !� "OB _ / sa/�T_. Of z.— ` L) T ��> > 2 9 v 43 9� 3 000 J .011 All s 0 �. ry 43 71. y ell ti pI -7� �� CERTIFIED PLOT PLAN RCN OF L- V T % .i/ I-:��l✓E. AL ' ROBEnT / �: F --- 0 SE vi E 7E , No.10951 O ` ! I N � FSSIONALF'� Ati, �.; �� 5,, Rc-Yiso i//7/Bs SCALE g=' DATE 712 9. WEDGE ENGINEERING CO. INCCLIENT.. Ir - 1 CERTIFY THAT THE PROPOSED ~' BUILDING SHOWN ON THIS PLAN EGISTERE REGISTERED JOB NO. ... CIVIL LAND ,n. /14 CONFORMS TO THE ZONING. LAWS DR.BY Ek9INEER R EY OF BAR14STABLE MASS. 712 MAIN STREET CH. .BY, / �' HYANNIB, MAS;S. ' SHEET: OF / A E REG. LAND SURVEYOR i:y PIPE TO BE LAID LEVEL FOR INSTALL 2" LAYER OF DOUBLE WASHED PEA5TONE DEEP OBSERVATION HOLE LOGS N N 2 OVER X2' DOUBLE WASHED STONE ALL AROUND OUT OF DISTRIBUTION BOX s/4 _ 1 I WATER TEST D-BOX FOR RAISE APPLICABLE COVERS TO WITHIN DATE: 04-04-201 3 P-13J 17 Y U G" OF FINISH GRADE (SEE PLAN VIEW) TEST BY: D. MEYER, R5 CSE Cn Q EQUALIZATION LOW WITNE55: D. DE5MAKAI5, HEALTH AGENT PERC RATE: < 2 MIN. / INCH LOCUS EL I2I_6 —EL. 121.0 —EL. I2I.0 T.O.F. @ DEEP OBSERVATION HOLE#I EL. 120.5 err,a.. O 4"scn @ SOIL SOIL SOIL COLOR SOIL 0 EL. 122.5 4"9CH 40 PVC 40 PVC 4"scn 4o PVC ) TOP EL. 118.0 DEPTH Q 10 4" '2 500 GAL. PRECAST DRYWELLS FROM HORIZON TEXTURE (MUNSELL) MOTTLING OTHER z 1 1 8.30 BOTTOM @ EL. 1 15.30 SURFACE Q INSTALL GA5 BAFFLE — "g 47 n _ n 1 rp ' - PERCITEST @ IN OUTLET TEE 110.0 I I7.. 0 O 24 FILL FILL (EXIST.) 24 30 A LOAMY SAND I OYR3/2 50 66 �4 1 30" - 1 32" C MEDIUM SAND 2.5Y7/4 24 GAL. < 15 MIN. DB-5 _ W INSTALL D15TR15UTION BOX 5 NO WATER ENCOUNTERED ON G"LAYER OF CRUSHED O Q 5TONE BOTTOM OF TEST HOLE 1000 GALLON PRECAST @ EL. 100.5 DEEP OBSERVATION HOLE#2 EL. 120.5 SEPTIC TANK (EXISTING) DE H SOIL SOIL SOIL COLOR SOIL FROM HORIZON TEXTURE OTHER " SURFACE (MUNSELL) MOTTLING 0" - 20" FILL FILL 20" - 32" A LOAMY SAND I OYR3/2 SEPTIC 5Y5TEM PROFILE 32" - 132" C MEDIUM SAND 2.5Y7/4 NO WATER ENCOUNTERED 1 DE51GN DATA i I DAILY FLOW: (3) BEDROOMS x 110 GPD = 330 GPD SEPTIC TANK: 330 GPD x 200% = GGO GPD USE: EXISTING 1 000 GAL. PRECAST SEPTIC TANK D15TR15UTION BOX: USE: (5) OUTLET D5-5 SOIL ABSORPTION SYSTEM: U5E:-,(2) 500 GAL. PRECAST DRYWELLS W/^' ^F DOUBLE WASHED STONE ALL AROUND CAPACITY: 259.p4, 51DEWALL: 7G x 2 x 0.74 = 1 12.5 GPD �O BOTTOM: 13 x 25 x 0.74 = 240.5 GPD TOTAL: 353.0 GPD .►� ! O ""__ — — — / N / THS. r TH 0 / #2 i 111 .5/ // / + GENERAL NOTE5 / -I- L\ �— EXISTING LEACH PIT NN 12I .G • / / / O REPLACE Ex15T. Co /, TO BE PUMPED DRY EXI5T. 1000 GAL. D-BOX w/NEW//j h / �; REMOVED i . SEPTIC SYSTEM IS TO BE INSTALLED IN ACCORDANCE WITH I I I I 1 tv SEPTIC TANK DB-5 n // / 3 1 0 CM R 1 5.00: TITLE V wareR�_ __� �_ �' 2. THIS SEPTIC SYSTEM IS NOT DESIGNED FOR THE USE OF A \ _ sERv1c GARBAGE DISPOSAL. 3. TH15 PLAN 15 NOT TO BE USED FOR PROPERTY LINE DETERMINATION. 4. CONTRACTOR SHALL PROVIDE 48 HOUR NOTICE TO DESIGN \ \ ENGINEER FOR ANY REQUIRED INSPECTIONS. 5. CONTRACTOR TO BE RESPONSIBLE FOR THE LOCATION OF ANY % UTILITY, ABOVE OR UNDERGROUND, PRIOR TO ANY EXCAVATION OR CONSTRUCTION. SITE SEWAGE PLAN FOR 1 5 1 GREAT HILL DR., MAR5TON5 MILLS, MA PREPARED FOR + Io9.4 ROBERT WHITNEY ODURTHA / tN OF MAS B p RREN y� scALE: DATE: Dr�awN BY: III = 30' 04-05-201 3 TMW JOB NUMBER: 1 3-009 PEVI5ION: 5HEET NUMBER: 5P— I No. 1140 'c'GIST WELLER * A550CIATE5 'A4NFTAR\Pa I G45 FALMOUTH RD., SUITE F9 -- P.O. BOX 417 CENTERVILLE, MA 02G32 2 WINDY WAY, #232 NANTUCKET, MA 02554 / `I TELEPHONE: (508) 328-4G92 EMAIL: trl5weller@comca5t.met ' REGISTERED LAND 5URVEYOR5 ENVIRONMENTAL CON5ULTANT5 Tr•aver•5e PC I I 46'-a't (EXISTING) (ADDITION) Q � �aa�D 3 o 3'4' 6'0 �cJ, n21 , EXIST. DECK - � A - � A5 ANDERSEN ANDERSEN EXIST. EXIST. EXIST. I AN 31 AN 31 J L � �w to J o X (V� t EXIST. ii EXIST. EXIST. i BATH KITCHEN I :O O s � NEW zo LOB. x MASTER N �+sr BEDROOM (VAULTED CEILING) 1 h EXIST. § III ANDERSEN Z b EXIST. HALL I� 4,a, 6'-9 a'z' Tw 2442 ��° GARAGE - � � � _ �+�` DN. 3'-2" Q LOS BUILT-IN CABINET LINEN in CABINET (D_- x x la (V EXIST. I 42" NEO- iv CLOS. EXIST. , I SHOWER EXIST. LIVING L _ NEW I DINING W.I.C:I MASTE n i u Uh I I BATH �1 I b b ANDERSEN ANDERSEN (V N TW 2442 TW 2442 EXIST. EXIST. EXIST. A5 � I I 5'-g- 7'-0" 5'-3" 14'-B"t 32'-a't (EXISTING) (EXISTING) (ADDITION) NOTES:• 6. ALL SHEETS OF PLYWOOD WALL SHEATHING TO BE INSTALLED VERTICALLY FIRST FLOOR PLAN- &1.) CONTRACTOR IS TO VERIFY ALL EXISTING CONDITIONS )DIMENSIONS IN THE FIELD 7.) THE NAILING SCHEDULE ON SHEET A5 TO BE FOLLOWED WITH NO EXCEPTIONS. I 2.) CONTRACTOR TO VERIFY ALL INTERIOR & EXTERIOR MATERIALS, DEVIATION FROM THIS SCHEDULE WILL REQUIRE ADDITIONAL METAL HOLD DOWNS & STRAPS LEGEND. DETAILS, & FINISHES IN THE FIELD WITH OWNER 8.) FOLLOW ALL MANUFACTURER'S SPECIFICATIONS FOR INSTALLATION OF ALL EXISTING WALLS SIMPSON COMPONENTS 0 j' 3.) ROUGH OPENING HEAD HEIGHT OF WINDOWS AT 9.) ALL CONCRETE USED FOR FOUNDATION WALLS, FOOTINGS & SLABS �_—� CONSTRUCTION TO BE REMOVED FIRST FLOOR TO BE 6'-8" ABOVE SUBFLOOR TO BE 3000 PSI NEW CONSTRUCTION 4.) ALL CONSTRUCTION TO CONFORM TO 780 CMR MASSACHUSETTS 10.) VERIFY ALL PLUMBING & ELECTRICAL DETAILS W/ OWNERS ON THE SITE STATE BUILDING CODE, SEVENTH EDITION DURING FRAMING CONSTRUCTION Q SMOKE DETECTOR 5.) 110 MPH EXPOSURE B WIND ZONE, 1.25 ASPECT RATIO FOR 10.) MASONITE OR EQUIVALENT INTERIOR DOORS W/SCHLAGE LOCKSETS © CARBON MONOXIDE DETECTOR NEW ADDITION ONLY THE DESIGNER HALL BE NOTIFIED IF ERRORS OR OMISSIONS ARE FOUND ON Y SCALE : DRAWING NO. : COTUIT BAY DESIGN, LLC NEW ADDITION FOR: CONSTRUCTION. DRAWINGS B TO UILDING START OF - - CONSTRUCTION.THE BUILDING CONTRACTOR 1//�`2 j _ 1 _O 11 WILL BE RESPONSIBLE FOR THE CONTENT A DD L' 'T'Ej� ROAD IN THESE DRAWINGS IF CONSTRUCTION MASHF'EE 1' 1A 026 � O 4RESIDENCE COMMENCES WITHOUT NOTIFYING THE DATE : DESIGNER OF ANY ERRORS OR OMISSIONS. THESE DRAWINGS ARE SOLELY FOR THE USE �i T• /�O�\ �Z�. G� OF THE OWNER NOTED.ANY OTHER USE OF FAX 1508) 539-9402 T T ROAD MARSTO �T T A CO SENTOFT EDE UIRESSIGNER NDERHE TTTEN7/3O/2oOQ 51 G R E A ILL f� LL v A CONSENT OF THE DESIGNER UNDER THE 1 J � ARCHITECTURAL COPYRIGHT PROTECTIONACT OF 1990 • I I I 46 4'1 (EXISTING) (ADDITION) A A5 EXIST. EXIST. EXIST. � coos. C Los. EXIST. BATHco 0 _j 5LRU LIN. EXIST. �s� EXIST. BEDROOM #1 BEDROOM �, Z EXIST. o b EXIST. HALL � � -ATTIC EXIST. ___��_ NEW Q DN. ANDERSEN AW 251 v I CLOS. � EXIST:....................... x I N A A5 14'-CY't 32'-(Y't (EXISTING) (EXISTING) (ADDITION) SECOND FLOOR PLAN- CONT. RIDGE VENT NEW ASPHALT SHINGLES TO MATCH EXISTING NEW FASCIA&FRIEZE BOARDS TO MATCH EXIST, TOP OF PLATE ❑ ❑ NEW CORNER BOARDS TO MATCH EXIST.L-H lifl I M z f NEW SHUTTERS X TO MATCH EXIST. w c.> Q NEW SIDING TO MATCH EXISTING ., FIRST FLOOR SLIOFLOOR FRONT ELEVATION_ THE DESIGNER SHALL BE NOTIFIED IF ANY ERRORS OR OMISSIONS ARE FOUND ON SCALE : DRAWING NO. : COTUITBAY DESIGN, LLC NEW ADDITION FOR: CO STRUCTION. PRIO I TO LDING RTOF — -CONSTRUCTION.THE BUILDING CONTRACTOR 1 //��� 1 � O�� 43 BRE W STER ROAD WILL BE RESPONSIBLE FOR THE CONTENT 1 -I 1 c�,ji) T T RESIDENCE ICOMMENCES N THESE DRAWINGS IF CONSTRUCTION MAS II'EEAMA. U2649 BODURTHA DES!GNEROF,A ANY ERRORS DESIGNER W ANY ERRORS OR OMISSIONS. DATE u ( �7 THESE DRAWINGS ARE SOLELY FOR THE USE Pl.1. 10(3��� 2( 4-(�l 1Q66 HILL OF THE OWNER NOTED,ANY OTHER USE OF (� FAX (508) 539-9402 151 GRE AT ROAD MARSTONIS MILLS MA CONSENT OF EDE SIGNERUIRES ND RRIHTEN 7/30/2009 A2 CONSENT OF THE DESIGNER UNDER THE ARCHITECTURAL COPYRIGHT PROTECTION _ 12 EXIST. NEW CRICKET& FLASHING AT EXIST. CHIMNEY 12 EXIST. 12 NEW RAKE&TRIM BOARDS 5 TO MATCH EXIST. TOP OF PLATE - NEW CORNER BOARDS z TO MATCH EXIST. F w NEW SIDING TO MATCH EXISTING FIRST FLOOR SUBFLOOR 1 RIGHT SIDE ELEVATION- CONT. RIDGE VENT -."-NEW ASPHALT SHINGLES Ll TO MATCH EXISTING NEW FASCIA&FRIEZE BOARDS TO MATCH EXIST. TOP OF PLATE _ I F-1 Z I f= � I x ; U FIRST FLOOR _�fl Tfl SUBFLOOR ELEVATION- THE REAR EDESIGNER SHALL BE NOTIFIED I ANY SCALE : DRAWING NO. : COTUIT BAY DESIGN LLC NEW ADDITION FOR: CONSTRRORS CTION. HEBUIDINGCONTR1THESE DRAWINGS PRIOR TO START OF � CONSTRUCTION.THE BUILDING CONTRACTOR �/�I r� _ �r^/err 43 BRE ST R ROAD WILL ES RESPONSIBLE FOR THE CONTENT ``} v �/( /� upN/ �Li/�A `� C� BODURTHA IN THESE DRAWITHOUT WINGS IF CONSTRUCTION 1••1 15+it EE 1"1 '. 0"6 RESIDENCE CDESIGNER OF OMMENCES ANYERRORSORO THE 7 r THESE DRAWINGS RE SOLELY OMISSIONS. THE USE PH. \5OH) 21 4_1 1�6 OF THE OWNER NOTED.ANY OTHER USE OF DATE : 11 M THESE DRAWINGS REQUIRES THE WRITTEN 7��p�2009 A3 FAX (508) 539-9402 151 GREAT H ILL ROAD MARSTONS M ILLS, MA ARCHITECTURAL E DESIGNER IGHT PROTECTION ARCHITECTURAL COPYRIGHT PROTECTION ACT OF JQW. P.T.2 x 10 LEDGER BOARD LAG BOLTED TO — _ SOLID BLOCKING W/(1)LEDGERLOK BOLTS STAGGERED EVERY 16"o.c.W/JOIST HANGERS AT BOTH ENDS OUTLINE OF EXIST.DECK (ADDITION) 18'-0° (ADDITION) NEW 10"DIA.CONCRETE 2-P.T. 2 x 117s SONOTUBES TO 4'0" BELOW GRADE.USE 5„ 5'40 5'-11" 5'-11" $IMPSON ABU 44 - POST BASE P.T.2 x 8's 16"o.c. a _A A SOLID BLOCKING VERIFY ROUTING OF A5 - EXIST. SEPTIC LINE A5 IN THE FIRST TWO E JOIST BAYS IN THE FIELD 48"o.c: 0 REMOVE EXIST. BASEMENT WINDOW INTO NEW 2 x 10's 16"o.c: I FOR ACCESS W/MID-SPAN BLOCKING 7 NEW CRAWLSPACE (VERIFY WHETHER BASEMENT A LARGER OPENING I (WINDOW IS REQUIRED IN THE FIELD) NEW NEW CRAWLSPACE o CRAWLSPACE (2„CONC.SLAB) NEW 8"CONCRETE 1 FOUNDATION WALLS 18 CON RETE EXISTy �+ 6'-0" 6'-a 6 Imo`-NEW Q x . EXIST. . I FOOTINGS DE a 0 Z BASEMENT BELOW GRADE BASEMENT o I 3-2z10GRT - - Tpil I - -o- - - -e-- - - TYP. BEAM v I POCKET NEW 2 x 10's 16"o.c. I W/MID-SPAN BLOCKING I I ° NEW 3 1/2"DIA. STEEL LALLY COLUMN NEW 30,'x 30"x 12" °' BASEMENT CONCRETE FOOTINGS I WINDOW I b 0 0 0 o i Lim j, _ — — — — — — — — — — — — — — — - - _ NOTE: DROP TOP OF NEW FOUNDATION N A N TO MATCH NEW SUBFLOOR W/THE A5 EXISTING SUBFLOOR,(VERIFY IN FIELD 5'-0" 5'-11" 5'-11, DRILL&PIN NEW FOUNDATION A IF REQUIRED), TO EXIST. FOUNDATION WALL 5' TOP&BOTTOM A5 18'-0 18'-0 L (ADDITION) (ADDITION) FOUNDATION PLAN ANCHOR B LAN 15' INSTALL 5/8 ANCHOR BOLTS AT 71"o.c.MAX. W/SIMPSON BPS 5/8-3 BEARING PLATES 9. PLACE BOLTS WITHIN 6"-15"OF EACH CORNER AND TO A 8"MINIMUM DEOTH DEPTH INSTALL TWO FULL HEIGHT STUDS&TWO JACK STUD AT EACH SIDE OF ALL ROUGH OPENINGS to in a, [] INSTALL 5/8"ANCHOR BOLTS AT 71"o.c.MAX. W/SIMPSON BPS 5/8-3 BEARING PLATES WINDOW -- 71"o.c. CORNER AND TO A SN MINIMUM EACH DEPTH 2 x 6 WALL 0 z — P.T.2 x 6 SILL W/SEALER O (ROUGH OPENING) JACK STUD ANCHOR BOLT DETAIL STUD DETAIL. AT ALL R.O. ANCHOR BOLT DETAIL - SCALE:SCALE: 112" = 1'-O" r • THE DESIGNER SHALL BE NOTIFIED FANY Tr FOR: ERRORS OR OMISSIONS ARE FOUND ON SCALE : DRAWING NO. : COTUIT BAY DESIGN, LLC NEW ADDITION CONSTRUCTION. N.TPRIOREBUILDI TO NG START OF CONSTRUCTION.THE BUILDING CONTRACTOR j /��� _ �t-O" D - t p WILL BE RESPONSIBLE FOR THE CONTENT 1 43 BRE WSTER ROAD IN THESE DRAWINGS IF CONSTRUCTION T,� SH E 9 1V1A�7� 1�EIr � A. 02647 COMMENCES WITHOUT NOTIFYING THE BODURTHA RESIDENCE DESIGNER OF ANY ERRORS OR OMISSIONS. DA�Enu / Q7A THESE DRAWINGS ARE SOLELY FOR THE USE I i 1. 1500� 21 `t l 66 OF THE OWNER NOTED,ANY OTHER USE OF FAX ( p\ ,�j �TR u t R RC C A4 15001 39-9402 151 �„II1 �,�AT 1 lLL� 1 VOAD �A1 �►.JTONLJ �IL�ILJ� �A COTHESENTOFT EDEIGNERQUIRES NDERHE RHEN7/30/3009CONSENT OF THE DESIGNER UNDER THE ARCHITECTURAL COPYRIGHT PROTECTION 2-1 34'x 14"WL N E Y V ROOF CONST. (ADDITION) CONT. RIDGE VENT RIDGEBEAM 2 x 6's Q 15'o.c.W/ -2 x 10 ROOF RAFTERS 0 16"o.c. 5- 1Od NAILS EACH END -5/8"COX PLYWOOD ROOF SHEATHING FASTEN RAFTERS TO RIDGEBEAM -ASPHALT ROOF SHINGLES W/SIMPSON LSU26 HANGERS -15LB. FELT PAPER 12 -8" HI-R BATT INSULATION SOLID 2 x 8 BLOCKING IN THE OUTSIDE 5t @ SLOPED.CEILINGS(R=30) /q TWO RAFTER&CEILING JOIST BAYS -9" BATT INSULATION FLAT CEILINGS(R=30) `. A5 @ 48"o.c.,ALLOW SPACE FOR AIR FLOW ON THE UNDERSIDE OF ROOF -(2)SIMPSON H2.5 HURRICANE CLIPS SHEATHING AT ALL RAFTER ENDS ICE/WATER SHIELD AT BOTTOM TOP OF PLATE 3'0"OF ROOF&VALLEYS NEW 117 GYP.BD.ON PRO P-A VENT BETWEEN RAFTERS �p� WALL � t �+ 1 x 3 STRAPPING @ 16"o.c. CONT,ALUMINUM IY EY Y Y VALL CON�7T. 2 x 4 STUDS Q 16"o.a SOFFIT VENT$ Z 1.2 x 6 STUDS @ 15'o.c. W/112'GYP.BD. 2. 1/2' PLYWOOD SHEATHING 3.6"(R=19)BATT.INSULATION h��Eq V Y NEW /� �+ GABLE END WALLS TO HAVE = 4. 1/2"GYPSUM BOARD MASTER MASTER FULL FLOOR HEIGHT RAFTERS FROM 5.W.C. SHINGLE SIDING BEDROOM BATH 6.TYVEK VAPOR BARRIER NEW 3/4"T&G PLYWOOD FIRST'FLOOR SUBFLOOR-GLUED&NAILED SUBFLOOR NEW 2 x 10's @ 16"o.c. NEW 2 x 10's Q 16"o.c. NEW W BATT. 3-2 x 10 GIRT z INSULATION(R=30) 3- 1 3/4"x 14"LVL RIDGEBEAM _ N E V V FULL NEW 3 1/T DIA. NEW 8"CONC Q - - Tl NEW 2"CONC.SLAB BASEMENT STEEL LALLY COLUMNS FOUND.WALLS Q L_ - NEW 30"x 30"x 12" CONC.1FOOTINGS CONCRETE FOOTINGS A BUILDING SECTION NEW MASTER BEDROOM/BATH A5 APPLY CAULK OR TAPE AT ALL SHEATHING SEAMS AND THE TYVEK I E VAPOR BARRIER ' P APPLY CAULK OR i5 APPLY CAULK OR ADHESIVE UNDER iv ADHESIVE WHERE PLATE INDICATED A P.T.2 x 6 SILL W/ A5 FOAM SEALER& ADHESIVE 1814" (ADDITION) . .NAILING SCHEDULE ROOF 110 MPH EXPOSURE B WIND ZONE 1 p LJi� JOINT DESCRIPTION NO. OF COMMON NAILS NO. OF BOX NAILS NAIL SPACING ROOF FRAMING: NOTES: BLOCKING TO RAFTER(TOE NAILED) 2-8d 2-10d EACH END RIM BOARD TO RAFTER(END NAILED) 2-18 d 3-IN EACH END 1.) ALL ROOF RAFTERS TO BE 2 x 10'S / Y WALL FRAMING: DETAIL AT FLOOR VALL UNLESS OTHERWISE NOTED TOP PLATES AT INTERSECTIONS(FACE NAILED) 4-16d 5-16d AT JOINTS 2.) USE (2) SIMPSON H2.5 HURRICANE CLIPS 16d D TO STUD(FACE NAILED) 2-18 d 16d IS"o.c.HEADER NOTES. AT ALL RAFTERS ENDS HEADER TO HEADER(FACE NAILED). IN16"o.c.ALONG EDGES FLOOR FRAMING: 1. SEAL ALL JOINTS,SEAMS, & PENETRATIONS IN THE 3.) VERIFY GUTTER TYPE/LAYOUT JOIST TO SILL,TOP PLATE OR GIRDER(TOE NAILED) 4-8d 4-10d PER JOIST BUILDING ENVELOPE TO REDUCE AIR LEAKAGE W/ OWNERS BLOCKING TO JOISTS(TOE NAILED) 2-8d 2-10d EACH END BLOCKING TO SILL OR TOP PLATE(TOE NAILED) 3-16d 4-16d EACH BLOCK SEE SECTION 6106.3.3 IN THE STATE BUILDING CODE TYPICAL ASPHALT LEDGER STRIP TO BEAM OR GIRDER(FACE NAILED) 3-16d 4-16d EACH JOIST ROOF SHINGLES JOIST ON LEDGER TO BEAM(TOE NAILED) 3-8d 3-10d PER JOIST BAND JOIST TO JOIST(END NAILED) 3-16d 4-16d PER JOIST PER FOOT PLYWOOD/OSB PERCENTAGE PER WFCM 110 MPH EXPOSURE B GUIDE, 2x 10 RAFTERS \ 15#FELT PAPERODSHEATHING BAND JOIST TO SILL OR TOP PLATE(TOE NAILEDO 2-18 d 3-1 6d ROOF SHEATHING: o 0 2 x 8 BLOCKING TO (2)SIMPSON H 2.5 HURRICANE CLIPS WOOD STRUCTURAL PANELS(PLYWOOD) BLDG. DIMENSION BLDG. SIDE REQUIRED fo PROPOSED /o �—.,._ � PREVENT WIND 3'0"WIDE ICEIWATER SHIELD RAFTERS OR TRUSSES SPACED UP TO 18"o.c. Sd 10d 6"EDGE/6"FIELD W FIRST FLOOR FRONT 26% 47% WASHING RAFTERS OR TRUSSES SPACED OVER 16"o.c: 8d 10d 4"EDGE/4"FIELD GABLE END WALL RAKE OR RAKE TRUSS W/O OVERHANG 8d 10d 6"EDGE/6"FIELD W FIRST FLOOR REAR 26% 72% ALUMINUM DRIP EDGE GABLE END WALL RAKE OR RAKE TRUSS Sd 10d 6"EDGE/6"FIELD W/STRUCTURAL OUTLOOKERs 1 x 3 STRAPPING W/ MATCH EXIST.SOFFIT GABLE END WALL RAKE OR RAKE TRUSS W/LOOKOUT BLOCKS 8d 10d 4"EDGE/4"FIELD L FIRST FLOOR RIGHT 17% 68% 1/2"GYPSUM BOARD &FASCIA DETAILS CEILING SHEATHING: GYPSUM WALLBOARD 5d COOLERS 7"EDGE/10"FIELD NOTES: WALL SHEATHING: 1. USE 3 EDGE NAILING & 12" FIELD NAILING SPACING ON ALL WALLS TYP.2 x 6 WALLS 1 x CONT.VINYL SOFFIT VENT WOOD STRUCTURAL PANELS(PLYWOOD) STUDS SPACED UP TO 24"o.c. W 10d 6"EDGE/12"FIELD 2. 1.00 ASPECT RATIO 1/2"&25/32"FIBERBOARD PANELS 8d -- 3"EDGE/6"FIELD 1/2"GYPSUM WALLBOARD 5d COOLERS — 7"EDGE/10"FIELD FLOOR TRU SHEATHING: NOTES: - DETAIL AT WA L L WOODLESS THICKNESS PANELS(PLYWOOD) 1. SEAL ALL JOINTS,SEAMS, & PENETRATIONS IN THE 1"OR LESS THICKNESS 8d 10d 6"EDGE/12"FIELD GREATER THAN I"THICKNESS 10d 16d 6"EDGE/6"FIELD BUILDING ENVELOPE TO REDUCE AIR LEAKAGE SEE SECTION 6106.3.3 IN THE STATE BUILDING CODE SCALE: 1/2" = l'-0" THE DESIGNER SHALL BEO IF ANY SCALE : DRAWING NO. : ERRORS OR OMISSIONS AREE FOUND ON COTUIT BAY DESIGN LLCNEW ADDITION FOR: CO STRUCTION,THE NGSPRIO I TO LDING RTORi WILL BE RESPONSIBLE FOR THE CONTENTCONTRACTOR 1 //I" _ 1 1_Or1 43 B �E " S 1 L l� ROAD IN THESE DRAWINGS IF CONSTRUCTION 1 `i J�p � {A 4 BODURTHA RESIDENCE DESIGNER O WITHOUT NRS OR O THE DMuA/S�"IQEE7,1V1" O26 `9 THESE DRAWINGS ARE SOLELY OMISSIONS RSTHE USE DATE : 1 1 1. 1508) 21 4—1166 OF THE OWNER NOTED.ANY OTHER USE OF p 151 GREAT HILL ROAD MARSTONS MILLS, MA THEE DRAWINGS REQUIRES THE WRITTEN A5 FAX (508) 539-9402 CONSENT OF THE DESIGNER UNDER THE 7/30/3009 ARCHITECTURAL COPYRIGHT PROTECTION