HomeMy WebLinkAbout0164 ANNABLE POINT ROAD - Health 164 ANNARLS ' POINT P.D.
CENTERVILLE
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BSC GROUP
1'htiyhti,ilfy ttansForminri atr'e'tvirunu ;iE:
349 Main Street
(Route 28), Unit D
February 6, 2020 West Yarmouth
MA 02673
Town of Barnstable Tel: 508-778-8919
- Board of Health 860-288-8123
Attn: Tom McKean, Health Director Fax: 508-778-8966
RE: 164 Annable Point Road,2015 Perk Test.
www.bscgroup.com
BSC Job No.48905.03
Dear Mr.McKean,
On March 24 of 2015 I personally performed the percolation test at#164 Annable Point
Road.Ms.Donna Mirorandi from the Barnstable Board of Health was the town's
representative to witness the procedure. It was a sunny day and 30 degrees Fahrenheit.In
conformance with Massachusetts DEP Title 5 the percolation rate was timed.
The depth of the perk test was 60". Once the pre-soak was completed the perk rate was
timed for the next 3 inches. It took 11.36 minutes to drain through those next three inches _
and as the rate was more than 3 mpi and less than 4 mpi,the perk rate observed and
submitted is listed as 4 mpi.
Very truly yours,
BSC GROUP,INC4S �
-
r
ieran J. ealy, E#13589
Senior Associate,Project Manager
cc: Files
Engineers
48905.03/submissions/164-Percolation-Test-Affadavit.doc
Environmental
Scientists
GIS Consultants
Landscape
Architects
Planners
Surveyors
i
/ 'TOWN OF BARINSTABLE
LOCATION l,�'� A h[3 b�L' �D > e�, SEWAGE#
VILLAGE ASSESSOR'S MAP&PARCEL '�;L1
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY t b^MC)
LEACHING FACILITY:(type) (size)
NO.OF BEDROOMS
OWNER �D A,o`S ^�5�� f'
PERMIT DATE: ,_
COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility(If any wells exist on
site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist within
300 feet of leaching facility) ` Feet
FURNISHED BY
a- `n �
�� 1
No. r l.r 1!91� Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in comp r:
- Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
appliLation for Bispo8al *pstrm Construction Permit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon ❑Complete System ❑Individual Components
9
Location Addr s or Lot No. �(�`� QV\WCoj � s rL� Owner's Name Address,and Tel.No. 611 7"S.`1E`1 `'` 'ti 17
Assessor's Map/Parcel � e:�G r v
=Mr's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
Type of Building: 5b 9- al ! _ i� o
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd Design flow provided gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank `Oer', �j Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer w.en app'cable)
4; i r s� L� f ilf5
r
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 Enviro ental Code and not to lace the system in operation until a Certificate of
Compliance has been issued by this Board o ea
G
Si/ Date
Application Approved by / Date �� v
Application Disapproved by Date
for the following reasons
Permit No. 20 Z.C-�-- 0 os- Date Issued j�/2-a 2 U
4.
No. V�V�74D D� Fee
THE COMMONWEALTH OF MASSACHUSETTS -EnieTed in computer:
PUBLIC HEALTH DIVISION - OWN OF BARNSTABLE, MASSACHUSETTS Yes
2[pplitatlon for Mispo8al 6pBtem Construction permit
Application for a Permit to Construct O Repair( ) Upgrade( ) Abandon ❑Complete System ❑Individual Components
Location Addre s or Lot No. \(.Q1 flti��1C1� 0:>j y, Owner's Name,Address,and Tel.No. 61`I—'5-j8`j
Assessor's Map,//Parcel '���t�rtP u o
" 's Name,Address,and Tel No: 6 Designer's Name,Address,and Tel.No.
�UYic�rS•
Type of Building: $''aL! — T o
Dwelling No.ofB_edrooms'_ Lot Size sq.ft. Garbage Grinder( )
Other Type of Buildmg ':,:6 No.of Persons Showers( Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd Design flow provided gpd
Plan Date �" {" l Number of sheets;,'(,,' Revision Date
Title ,t /
Size of Septic Tank 1t-)df. A. Typ o S.A.S.
Description of Soil n 1
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
. Agreement: te
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 lace the system in operation until a Certificate of
Compliance has been issued by this Board of ea Ki.
;Signed'" Y --
_.. Date
Application Approved by Date 7� �p ,
Application,Disapproved by �/ + p� Date
for the following reasons
' Permit No. 2,o>r2 0 2 5 Date Issued
- ---- ------ ------ ------------------------- --- ----------- -------------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliartr>e
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded
Abandoned(�A by'
p
AhA4G&L 2 t 1 - Q has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No MZU
Insmi er +* M r 0,1,6D I. Af� 6 ("Designer
#bedrooms Approved design flow,,,.. gpd ,
t.
The issuance of this permit shall not be'construed as a guarantee that the syste will Rinction as desi ed.
Date r 7 Inspe(tor
No. � /l Fee w; rz�
THE COMMONWEALTH OF MASSACHUSETTS
.PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS
Misposat 6pstem ConstrUrtlon 3p ermit
Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon c
System located at / 644 P 11r1
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.
Provided:Co struction must be completed within three years of the date of this permit.
Approved by.
i
s
4
7�
oFTHE Tpy� Town of Barnstable
Board of Health
BMWWABIX
'"`"SS.
639• 200 Main Street - Hyannis MA 02601
i �0
Agreement to Extend Time Limit
for Acting Upon a
Variance Request
In the Matter of a variance request form received on 0✓� � cW hhe Petitioner(s),
regarding the property at /0� t h(/ � oah�Wthe petitioner(s)
Q�
and the Board of Health agree that the Board of Health has until (insert date) to act
upon the Petitioners' completed application for a variance. 20
In executing this Agreement, the Petitioner(s) hereto specifically waive any claim for a constructive
grant of relief based upon time limits applicable prior to the execution of this Agreement.
Board of Health:
Petitioner(s): Signature:
fChairman
Signature: Print: John Norman, Chairman
etitioner(s or Petitioner's Representative
Print: '/L�,/,✓/r,✓i.� ��C��G'l Date:
Date: ' 14Town of Barnstable
Board of Health
Address of Petitioner(s)or Petitioner's Representative Public Health Division
200 Main Street
Hyannis, MA 02601
Phone: (508) 862-4644
Fax: (508) 790-6304
Q:\AGENDAS BOH\FORMS TO BRING TO BOH MTGS\let to EXTEND-CONTINUE ITEM Nov 2010 mtg.DOC
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BOARD OF HEALTH October 22, 2019
ITEM: 164 Annabelle Point Road, Centerville
Septic Inspection from Scott Campbell will be emailed to s.crocker 10am—10/16/19
Verbal from Scott Campbell:
• Groundwater: There is 28" below bottom of flow diffuser to groundwater
• The overall depth to overall observed groundwater is 59"
• The Tank is in working condition with zabel filter in place on outlet line
Per builder: Sewer is due in two years.
Tit f3 ' rr
" V Subsurface Sowitge.Disposal , Stam Palm-Not for%Muntaryv As 6s—sments r
! 3
1 q Annable Point Read
_ _.......,,.w...
76m
wFisher.. ........ _ _.....
Yr�f t5aan r tl�rne
fo�nn is t �
regWre,forevery CenterVille.__ _ MA . ,� 0�2
rtv? av ie 6iSki dap cd k0 0:1 di
Inspection results Mmtst be ss bmItted an this form Inspection torms may not be alteref in any
tray.Please see Completemsischecklist'at thiD and of the fay:;
iron na:: n A. General t
ern the .m.- er:,
use aayIhL-,4 1 Inspector
kelyto rn ovevujr
cvmr mot' Cott a.rrtpbell", g.
use 6a wum _..... . . __
key.
Card lnap °rr�G.............6r?,.. _.. __.._.,....._�. ........,
....._. T_M ,._...
risn{� rpl 1[fil r
n7lr�'aSS§Tl SIMe Zip Code
B. Certfcatloln
I cartify that N have person-ally inspected the savage ispr at system at this.addrests and that the.
inforrrta"tior rpart�d alw trai�ra .anl 4rif5let �fh tit f iniatir, Tire Irteiirt
was perf rrr*d basil br my fd :inir a riprt In ftw1mroperfunction and mairrtenarace of on site
i e c3i r �l sy tefns t a a F�e p veca ti ter , ci pe it r pursum"t;to,Section 1 .M of
Thle S(1110 CMR 11.tf )t The Sy'sWirm."
es 0 nditionally.Passes . ❑. Fails
Neods offer Ewatuatidre l tfie twat A r r g Acuth ity
1��3r�9
rc Lat
The"system inspector shall"submiit a Pf this ins�pe�tior�retsort to ttie Appgoving Aut ortty(Board,
of Heaft1h or DEP)within<30 dam jof c4=pletlr ls- inspen,an. It thb ssysterm is a:sfiared system c
hes e desloh fl v cif M'001 gpd or greater, tha impector and th.a ssysteen c ri ner shall subtnft the
reaport•too the a praphate r kariai office-of the DER The oTi it l should be servt to the syst:erra owner
End cools semtto.tha 40 or,, if Applicable,and the approving,'duthor .
,This report only rdesprIbe condition's at the tlrr4e I'm p tibn and under the conddiliohs of s.tso
m " dM that time his fr�p tiondoes nort:AdW � e t r'
the sate"ter diffamil conditiots oaf"ute.
.. Tide . II Iner �i Form.
Subsurface Sewage Dlsposal System Form n ld for'Voluntary Assessments
rents.
164 Annable Point Road
Tarsi Fisber
6 '�1rr8118
irewmauan Gs
rgju fir awry Cerit Mile,. ,, _. m.____ r_ ._.__.... „ 0263 .... 0 t
page- it- era S1 to Zv &de Qie.&(6ijiio7i4i
Ce.
Inspection Summary, Chock A ,C,D cT E i atwa s complete all, of 5eotion
A) gystem Bassos:
I have mot found.wry information MiCh iindi tes thW arty of ft f f hire criteria described
in 31 0CMR 5.303,or in 310'C<T A,15-:104 exist.And faller Sri r neat ev?9vatod are
indicated beta:
8) system cono-jt*inally pass;
171 One or more s�4tem components as deserlt d err the"Con,ditional.Fp s."&eation need tQ be
replaced vT repa'ired. The.sryste,m; Upon co plat n of the replacement or repair,as approved by
the Board of HezM,will pass:
Check the tapx for"ices',"W or'.not determined (Y,N, PAC)for the fdito inn:staternents: If'neat:
tiete�r�ir�e�N ptoase expldir�.
The septic:tank is metal and over.20.yea.m obd.'or the septic tanx(vehether metal ar not)is sIMCAUrallyr ,
unsound, exhibits bs ftba'I infiltret.o or exfi retiar or taInIt faiIJUM is Ir' FtviMnt. &ystoM Wltl Pass
inspection if ifie e istirn tank is repleoed With:4 rplying septic,tahk as zpproved by the Board of
Health;
"; metal eepti>r tarok WMA pays Inspecfion if it-is siructural r sound, not leaking and if a Ceftcate of
Carripii rree itt tlr 108,t the,tank fs less than 20 years old is mitabl`e:
[� 1° FI N fit[ (Explain, be ovi)-
fi s.u fi r;ua E i)fla3dd rr w Eam.9%marato SeAmne Dowmi vy 7
COrtn +On wealth of Massachuse.fts
is Title 5 Offilcial trot Form
;.f ubsurfaoe sswoge Disposal Syste Foom-Not for Volvintary Assessments
" r 164 Annable RcAnt Rwd
r•
Tom Fisher
Owner
m ___. _ . .....
�xran�P'�iu�
fifurniatim is
recraired far every MA.. 02632 1013-1i419
;;� �, ��ka�•cnra� ��a dip�o�`e [�� 'irr���irs�,
B.
..........
Certification (oont.)
C Frump C-Inamt r p rnps aWrrri. riot oeraf*nal_Systern will pass w h 0oard.of H alth approyall tf
p*urnpslalarms are repaired..
system Candltlenallyips ms(cont4l
Observation of sewage backup or break out or high s be wet level in the distribution box due
to broke;, or obstructed pipe(s)or duelo,a I gDken,settled or uneven disiribulion box., ysteffl:wi[
past i speotion iif(w tfr appTNal of 6aerql;of He ltl )~
0 bro rt pipe(s)=ark rep ced. 0 Y 17-1 N 11 NO�( xplalp balmv'y
obstruction is removed J Y L❑. N ND,(Explaiin belmvj
❑' distribution box is:levmeled or reel l 0 Y 0 N FLI hi (. xplalri bt-1 W):
The systerrr reqWred purnpiq more than 4 tim as a year due to broken or ob tructedp p ( ). The
systemwillrss in ectiarr if(With pprova'a1 ttt €iaard of.Health j;;
txodken pipefs7 are.re0laced Q 01, 4 0 ND,(Explain,below,;:
r-! b.stn ction fired ❑ Y N 13 N:D(Explain below).:,
09 Further Eualuatii6n is Rbquiredi by the ward of.Health
Conditiors axiel,�h h rectutre fu tit r _jUalion by the Soard of!Heafth in ardor to d errrirt#if'
th��sv'stein is,fai!linq.to protect public heaitb; safes or the envlr�ahnnent
1. System.will pass unless Board of Health,determines in sccoordeaace.wO. 310 CMR
1S1303(1-i;b.)'l .t the systern is not furwtioning in a Mdrine(+►hb6h wRI protect,pubfic'he tth
sa,faNy,and.the en1vir.an tt.
,0 Cesspool or pr` y is within r€ac
l feet of a sue water
Cesspool:of privy is w,'itVtrir) 50 feet of a b rderiq..Veget d V&dand or a salt.m rsh,
Td a 5 Off'vat I wpoo5on Fcmm 5:t s a 0` rot Sw Ht tiaf 17
COMM'Of wooft Of Mass4chusetft
TRIO r i l Inspecti on Foam
-Subsurface Sewage Disposal System Fort-Not for Vtoluni". ,Assessments'
164 bleirct,Road _.......
Frwerty,Address
_
Terms Fishier
... R .._ ._ __.._ ,...._,,.. _._...,._
NMI
irftmOum- is
r q .far r Gent nVl le_: . ,_._ 632: `Otll;19___. ._ ...... ....__.._ ...._...
page. City. i`MM §t � bFie OR Insp iOn
.. CeIrtif call h (cant:)
2. Sysftm.wrvtti fall unless the Board of Heattth (arid Pobk blanker Supplier, If a nV)
s tar Min that the,"Ste to!,Li cti.auing to ti.r rrri.er tlxat.proects.the tau liac heatth;,
safety and etwi�►110 eint
Tina astern has is septic kersk,artd sod bstlrpli system rise}and the A is with n
100 feetof a surface wader supply or tributary,to a urfate vvati.r su 'ply:.
The syste.M has aseptic tank and SAS.and,the-SAS is within a Z6rv. 1 of a:public waler
supply
El The system has a seprirc tank AM Sri.and the SAS isvithin 50 feet ref a pri a-te:water
Supply,well,
The system Fins septic tm'k and SAS and the SAS is less than 104.feet but. ,feet or.
more from a;private watef suppFy Nvell',
Meth d Used to deteri'n:irte d108,me:
Ihf
is,systeml passes if the well vater anaiysils, perfb=ed at a DEP certified laborat , for,fecal.
cQUorrrt bacteria Indicales absent:and,the presence of ammonia nilrogen and nitrate nitrogen is equal
to of less than 5 ppurn, provided that no other failure criteria are triiggered. A copy of ft analysis rust
be,attached to this form..
. :other:
�.� `Y term Fa Lure Onteria,.A�pltca le t. All s�r4toMe
You iA49 Wdicato I`Npslk,air'�Pl l to each of the following,for, insp0cfianc
Yes No .
81 1 a ckjup,6f sewrage iryt0461.it or stern component due to overl 6ded or`
cloggedSAS or eesrpcdl
6:9�`h:arge or pending of eftent to the surface of the'vmgodi surface%voters.
due to an dvarloaded or cicgggRd SA ar cesspool
Statie t}euW.i ' fin the distribute box ativ>e b o t`hVet du tc rrtca6 l
ic� gedAesspt
n
t.tquid,depth in s cal is few hart "t aww Invert ar avaitab4r;v�liarrie is
than At da flc�r
'.eta ;7 i3 _ T:1h5 .. c9:AIrf$. `Mtt=Q>9 ::%a,$aS .asStang I;� rkw�1R'y^a 'tt+PjW)4di7
Comimo ealtth of Mossa.chu
w y Tithe 5 Official Inspection For
Subsurface Sewage DWposat System Form -Not for I/oluntlipy Aasessrnents
., 115114 r nnablt Point Road
TM Fisher
Owner
inforrr?awn is
A 02,632„ 1 d3ar1
praa. ik 3state llaGMe Dsteatin e �i
B. Certification (cortt.)
Yes No
Required pion. it snore than 4 tines:n fie last,year NO due to clogged or
obstructed p10(s), hlvmbar of times paarn,pedr . _
E ED ,any 06r;ol of the SAS,or sspcol';or privy is below higft ground water 16af on.
0Any por i oe sp l o pTiay is within 100 feet of a surface water sur'pply.or,
tributary too surfatz. veat,�r su ppiy:
El 0 Any porter of,s Osspool or privy it wit hin a Z`arm 1 ofa.pu blio well
Q ® Any portion of a cen pool or, rivy is W in %f t cf a private:Water supply w€fl
Arry portion of a cesspool or",Privy is less than 100 feet but greater than:50 feat
from a private water supply well wiffi no acceptabla water-quality analysis, [This.
system passe's If the wall wizteranalysis,parformad at a DEP certified
laboratory; for fecal coliform.bacteria lndicates absent and the pres:mat
of a rtao to nitrogen and nitrate nilrogen is equal to or less than 6 ppen]
provided that no Queer failure crlteria are triggered, A copy of the analysis
and chain of 6ustedy:must be aattached to this ford,]
The system Is a cesspco`:rel ng a facility w nth=a design flow of2m Ocgpo-
Ths,syst.er fa:lls.;1.havedelermiined that one or more of the ate failure
witer .exist as des lbod gin. t-0 OMR 1513030 therefore,the systern,fails, The
system o rmer should contact tt Board of He nth. determirve.what will tie
necessary to:correct the ifuure
E) Large Systerns To be.considered a large sytstea the system must serve.a facffityr with a.
design fli t of 10-000 grad to 15g000 gpd.
for large-4.$ ,ydiu rraust cn diCato hither°'yes"cr' o' to each of th6 follo it , in addition to the
questio s to Section 0
Y'es- No
0 th.4 system is woithir, 00 fit of at:surface drin`kir g- ter%uppIV
r the system is Within2M feet of tributarya. to a turfa drrnl�fct u t���uppiy.
tho syrst6m:it:Ic a.tad i a nitrogen sensifive area (Interim VVetlhead Rrotacti n
Area—IWPAO +ar a mapped one fi of a=purtAo winter stj ly well
If you have answered s'to any quae 3tiara i[y Cectn E the Wyttefn is considdri e nifroant tl�retirt
or answered'yes" in Section D above the Varga system has failed. The or wner or operator of any,laqpe
system, considered a signifa--ant threat iu nrser Soction E or failed under Section D shall Up,r io tt1e
syss'tern in accordance with 310 CMR 1 6>304, 1he stem_oviner should contact the appropriate
regiorOOMOD.of the Department.
Commonwealth of Mass'achusetts
Title 5 Official ! t11" Form
Subsurface Sawa Disposal System wren -Notfor Vsatuntary Assessments,
.;, 164 Annable Point.Road.. . ....._ ... , _.. _.
repeshy
Tani Fisher
Owner
#nfirsnaWn
rCW i red f&ever+ __....__ ...._ .,....._.. M �1 2. i0'��a19
P302,
C� Checklist
Check if no 6t iioa ng , t Oerf d e:YOQ must iodtdete., "or"rt s'. ,to each crf tt'ie:"follov`rng;;
Yes No
I Pumping inf ma.b n was provided teiy.the owner;occupant, 6r Board'of Health,
t "ere any of ttte system do nponents pumped out in the pW. JoU*M o weeks'
Has e system rec6lve l normal fl -s in the previous two week perms?
H ave large woi�M ,of v�ater been i trode ed t the ,yr�9em. recer yr or ae pad f
this inS��ti��k
ElWert a bunt pl'�r s.of the sy0e, tairiod and armed?f if their e not
av�ila�le rite ��f+itAj.
1 0 Was the facility or d.welling inspected for signs of: wage back uv
9 0Was the site inspected for signs of break,out?
Were all 5ystetn treeing the Spa trrtts s?t '
C Wore the Septic tangy:marsh s iir7oovered,opeged, and the int-eri of the tAnik:
inspected for the condo n of the b fffe _e tees,re7ateeiai of cen trvitiort,
dimenSibns, depth of liqu d,'depth of sludge and dept€y of scum
�: Was th*f000lty rnvntr(and. upants if di `erorit fforn owner)pro 01 with
information on tl-e proper rnairtftananc4 of subsurface s8'lrrago
The aiize aind locat~lan of the Soil Abeorptl pn,System (SAS).On the site has
been;determined based on:
C EXIsljh,g infDrm,aftn, For exarnOla., a plan at the'Berard at Health,
Det,ftimi"d in tt*,f a J (if any of the tauure crider a related to Par&CJS at issue
e�pre�e�nietdr�of drror�is ur�aoc� ble� �9� f+�tFt ��.����
D., Sated InformUtIon
t esG a mlal Flow Coai liibore
Nurr�bet,oi 100droS Nrarnhe of bediros( . iaa:,)`:
laSSIGN flaw,basW on 310 MR, 16.203(for example; 11 Q qpd )e Of br4d r orns)' 3 j
,°T.'imwpx C.li✓✓..
Commonwealth ea th of Massachusetts.
s Title 5 Official Inspection rorm
Subsu.00,00 Sowage Disposal al System,Fom-Not f Voluntary,Asses�r kts
164 Annablo P6nt Read
ort�pert�r'iires _... _
Tom Fisher
regi&wx;f revery Centendle MA 012-632 1013119
0 co Dow of 1hvWiah
D. System Information
Des ipt on_
Number ot.curvent residents. 0 __..,__._....
Does res ence 6ava a pf ge go r? 'I Yes M No
is laundry w 8,se ra1o:sewage sy.ateml fln.oluide laud y s inspection YOS
0 No
irvf6rmation in this reporta..
Laundry,syslern rispected?: C7 Yeg 0 No
a nal use? Yes Nb
W ater meter rings,A ava7lsst ,(last: "Oers te..�9�d�
2017 6,W,0 Bell0r4.:. 2018 .11-;00 llons,; .................... .... __ -. . .... ...._.._. _ ......... ................
Last date of ouparry4" - 019!.._�� . . __..w. .
o merciallindustriisl Flom Condttiafus
Tpeof Establishment:
Design II`ow{based on 310 CMR;16,20 )}
Basis of,design f aw(wWpersonsts0t, etc-)..
Gteaml rap prosbrvt 71 Yes .No
IndLP'Strial east (holding tarltc prese0t. 01 Yes ❑ No
Non-ssarillary wasto diwcharged to the dle system? 10 ''es ❑ No..
Vilafier mater readings,'if::M i^ x=
ommonweaIIth of Massarchus.
13 Title 5 Official Inspection rorm
Subsurface Sewage Ms sa:l System Form=Nat'1'or Voluntw,y Assessments
164 Annabite:Pont Road
Propefty Mcirese
Tom Fisher
�Sre�r�t`�i�n is
required tvever{ MA 0202. '10410
.Paso �ih�rr��� st�r� zip cbde �Or 116 v 1pm
D. System Information (cont)
Lost date of oc. rpancylus
(dither�descrjb bel i):
C enteral.Informatfoiiii
Pumping Records
Pr + d � pe ns ..
Source of inf rmatcvrr. .
Was 5ystam. pumped as part of the inspection?
Noy+`Yras�UsrltttY pu pE4 detefmi(wd' _..__._µ_ __ _ _._ __-_ .................
_.
Reason far pumping
TYPe of System
peptic rrk, d stribUtiOn IXIX,,5411 ab$0rgt n s r
❑' singlecesspool
��er�a�a �esep
u. .
Privy.
17 trar d: astern" V n } if yps,.attackprovibus inspection woords, if any)
!nr W#/,A ternadve 16q 'Wlogy'. Attwoh.a o y of the current Operotion ems.
it dint arrce.centract to be obbined,from syste'-rn amen and a cis �f to ke
irrSpe�cm of fhe U �ystam key.i tem opera I r uni r corl°tract..
i "f!*tarok_attach a copy of 4irie fD P approval,
Other(dr&crih ;
f
Commonwealth of Massachusetts
Tit Title .5 Official I nspection Form
Subsurface Sewn D" ppospl System Form m Not for Voluntapy Assessmeiits
T164 na a point Road
Prope-M Address
.._
Tom Fishef
Owner �dJfft�r�N�rri
vYirt)raTt;76 n i5
-faquired for em Centerville _... ....,_... 1013
• ea�y�l �,�in state zip w~�3 -i-ksj n
Approximats ego,of all o mporients, dale installed(lfk oven)and source of in,nformation:
C3aE c�r�plianpe issued.Insllar A&f3 C-a-rice
Were selirege odors det ted v hen arriving et e site" Yes ® N
Building.Sewer(locate—ory site plan);
De
L oast iW. ® dG PVC other(axpWf n);
Distance from private water suppty evell w suction line ray'._.. � _ _._.......
Comments (on comdit n of joints, uenring.evidence of leakag:ie etc_)*
Sepitit Tank(Locate on stt6 plan)
De b�v grade, iq�ies
pgh ..........
Mat rirf oi'constructions.
9 corLcrete Cf ru e#el 0 ttb_orgla , C "polyet yrlene 0 other(ex n)
If t`an 7s metal,risk ago.-,
J
is agen-frrtliy� e Crt"ticat of C�, piianze!(attach e copy O oerklficate) C1 Yes 171 N'
sludge dept-r:
COMMOnwealth Of Maw uset,ts
Title 5 Official I Form
.
°r bsurfaee to 0'`t3I SP OS al S to tt Form Noi:fcr Volunlarys
`. 184 Anneble,Point Road_
Tom Rmher
s�+tr�r r3�atir�r`s Ns�r-oa
Onfor al do it'
requ wery Gentemilefv9A 0 S1 1�+t?���
__ .M_ _ .
pogo, 6tyfrv�" St-ate Zip CLAD DabD of.Ine t on _...._. _...__�: ......
D. System Inkrl at On ( an .y
oc Tank(cant,):
Di tance from tap of slo—' ti ottom,T of outlet.`tt a or bi�,ffle 35 inohes,.:
ud tl ... ......
fickrie :. ... _... .
l i t r�c frori ts�R oaf scuTn to top of o tlot or baffle ...._�._._
D18.1ance from bottom, of srourn,to bot. -orn of outl t tee or bo-Ifle rta:�
How,ware,di..Mertsign's-(f terrn�ned?
G �r ont ion a rr franc r err *nct ons Wet an,d outlet tee or baffto t"Ond.t O•,Orurturaj integrit`,
fiquikl 1ev relat l t out'-at invert;evidence oft ka e,: :
Tank does not feed to be pumped at K's tirm `ees ln:place at time of irtspection. uotur irk ril
or tank is good. L uld levef at propw worlkiq height, Bottom of outl r:in v rt. No�vlden of leek e'
into or out of box: Ronwoecl ands-Im zabel fitter outlet.side of-Conk,
Grease Trap (Dote on sltw plan):
Depth below grade',
Mate ial oaf cvnstruc on:
1 MOW. 'fiberglass polyethylene bter(ex et)
Dnerisivrrs:: _.__,
Scum thie nes's
DLstajce ftnom trj,P:of,ScUM.to tots 01,01i of t000r tl�fmo
?et n from t ttcrfl of wOi t*.bott ar7 of outlet:tee or badffl
Date of. : t ptari+g> its
eic. 3143. -Mw5G#AWi[^Ei,aGJ.2a.s1Fewf':.S..aw1 9::,., LkSVsLad Sys*P*Pv�0'0a17
Title Official Inspection Fora
Saab ur -ce Sawage Disposal Sywtem Form-Not for,Vakunit ry Assessments
-nt Road
drs .`
TqM Fish
..........
Owner
...w
page, ivity c n state Zp odF b�ta of lr pt+s ton
D. System Inforniatiow(p060
Corr meats ton pympinq recorromenda.tions, inlet and out et laq,orbafFA condition;5tr r ral`:;nt,�prifi
liquid levels as.ielated to awtlet invert id. n `o leak;ige,et .):::
fitgl o.r tHolding:Tank(tanks must be pumOed at tirne'oflinsp .tion)(ec t on site plan):,
De'h belaw grade, _..
L Crete fibuglassEl polyethylene :0 other�, xplairt)_Qapacily
h� ltY pliona per day
Alarm precept; Yes,: No.,
lor�m level _.._ ....... karrr in workin r, � ��� � fed.
Oa
a,last prarnirDate. "
Co moms(Conctatrorr& la grid bat swftches, etc,)'
attach Copy of urrQnt purriph contra-tV(regttired): is Copy oohed"?: L 'Yes o
. Ts ti 1,orwmm,Peru `vatsrmi sa':t CkY. °SAY"fi 11 W IT
COMMOnwealth of Ma sachus.O
Tit Titte, 5 Official Inspect or
S bsurialce;le OWO a Disposal System Forms -,,Not for Wuritairy Assessments
164Annab4e Point Road
_..
Tom Rahn
rdT r t barCar`�NI�on8
Pea�naG�art i&
Tequired eyofy. : entervil€e M� 01 32. C� J
& ZP Code Dato of Irspac ri
D. System 1nf rniat ( rit,
Di trtbutlion Sox cif pr�rnt rrtu.st be opened)(focate on,sits lan
th of rklc€id levelabove oulfet invert 0
Cbmrn .n (note if box is level and distribution to oulleelz equal, ariy evidence of solids cagwetrz any
,&widen ce of feakage Into or,out of tvx,etc.
vx is.sef-1evel.. Biel amount of s_ol s carryo er. o eWdtince of leakage ifita or out of lbox,.Equal
flsr� .
Pump Chamber(Ic�Ote oii site pia );
-Purn.ps in working crdIar n yes Ids
A firms an work in g 0rd 6 r: yes 0' -0*. .
Comments J.nvte corr"ddicin of pump cft"amber, cond'itidn of.pu tps and appurtenances, eto.')"
if pumps or at r ar tin+t€i it it or 9er, syst m:ts i onditlmat piss.
Soil Abso rol,Qn S.,yOt i 'i;locate on'-sit ,plan, excavatidn mat mquIf ) .
ff.SA.S.not is eted, expfein why;
Via' ,102 r1w. €r a 4?a2€ twa i"f5a{a t n 32a:F"
Commonwealth of MassAchusefts.
w Su urfac 8:#wa0s Dii fposal System Form -'Not for Vblurttttasy Assessments
16A AnnWe"Point Road
RropervAftess
_�, _ _:.... ._... _.._. ...... , .,
Tom Fishof
ovinar
rt'iraffr-AvOr
rKuUed ter evvy. 015TIterwill ._..._. 10 A;._..,.,; 02632 I��M
page,. 6Sitjh`Tc;il state ZiD do'cia DWe OF 1ft ae; on,._ .,..,,.....
Type:
(� facing pits" number:
eaohfng"ohar hers number,, fto tt>J�
(� #each,kng galleries number
leaching Inariches n:urriber& length-,
CQ leiching Aerds number,dimensions:
urtlar "pdi number.
lrgrtio�f-sti ,,r�lt�rt��tly�efs
lypeMarro of technofogy-,: ..,,m. .
Comments erot ond ki n of sail.t s"ir ris.af hydrauli f ilure, wol of p00._ink demfr i9,0, ditif�rl'p�
vogetation,etc.)-
Excavated and o ni.-d f rv"diffuzo_rs.Flowd ras,-mrs dry at tirne of inspection, No visual-signs of
drat li€faWre Gn insideflowd0k Na pr n lira = Nei
OL ti i sca, Norma +��� CiQr� 1 �� �..� awdWu��r� 29„
cest o is ,"msspqqI mint.be p 'ad as part of Inspection).(Eb a'on sits
NvroOrstd4o ur ti
ptwi m�.fpp of l it id to,Inlet invert
Depth,of sctAm,Wyer
_ . ._,
gavials of construction
la rai fiar crF ra are au te:r%n aw 0 Yes . C] No
y
Commonwealth of Massachuset
T� t Official Insp Form
Subsurface` ewage'Daaposa,f System Form. Not:,fix Volvnwy.Assessmanjs
164 AhnabiL Rolint Road
Tom richer
.....,_.._ _, _._._�___x_,_ _.__
ww's game
regUMed'fOTever en uit4e ? .�._ fa 2 1 T3�'1
4 3 .,,,. ..
x3ttTQ"vd�& 1a�'E Z G�,at Irf;�iµa
D. Systom' triformatioin ( rat_
Com eRt (note condition of soil; signs of hyd`pulio faltu:m, l€val of ond' q, 0011dition of u��etettrsn.
Privy ( ate,oni site plan),-
Material of construct m _...., _...w_,.... __...... __._._..
Oftnnemsions _.... . ._..... . ....
Depth of colds.
CWTI 7 nts (note�conditton of sd 1, Signs cf ti�d.ra�, failure,level cif prl�di�ig; :�onditibn.of+�ege'fatir�tt;
� �'{ T09`;OfI iO 1r7R'PW:I+f a .,AbUift fv, e D 441 oti JOIA PW 14 K?';x''
Commonwealth of Massachusotts-
Title 5 Official Inspection Form
Subsurface Sewage Disposal System For-Not for` Oluntary essr ent
Tom Rs '
near 15wi6infiatrNWn is
r�s M1I
papa. �"ity,If t5iwtt tat* Zip Coda, We of Impect an
D. System Information' . (cant.)
Sketch Of Sewage Disposal Systim-ProAde,a view of the'sewage disposal system,�ncjuding ties to'
at 4east two per after t reference-lerrdhaarks,or ;-enchwAs_Waate alli.welis wfthiA feet
'Where pv tc water supply enivs thi buiHing CbeCk orve of t box-es:billow
har+uI sketr,,h in the area belc
sE�.:ately
i
0
it
Commonwealth of Massachusetts
achu
Ti
t iiIn Form
V� Subsu face sewa0e Disposal System Form m Not W V lurilary Assess eras
164,ATInWe P&M Road
Pra�aar�eldr
Toni Rshwi
��Yf6CeY�t'it'rbC�Es
Pie, City-'Tvm -9titeImceci rs
D. Systbm I nform at on (cont.).
Sits Exarr!i:
1h i
Surfacejuater
C hed cellar
Shallow wpII
Estimated,depth to high r�u�� water_ �"t��t r�+�ri;Ar un water
w
'Neas.o indicate atl to detdrrnine the igh'graund urat&etevatior:
0W.i ed from *em desi rr plays"o.r record
If ohecced, ate cf d ign plan reviewed: _ .------
Cat d site(abuttinc pro �'¢�tserv.atii n bol' rrititln 1,50 P t o �,AS
Gh> ked with local oa;Td of Hea ' -explain
:,:Checked with:local.excavators,, instal fs cfi.�pouiti or n
You. must destribe bvvp u-est blished the sigh ground water eleva io ;
(n to)2 "frog botom off so � mtiwa H� ngered e� r r � of d
fl> udiftser `..'ep. f f�lftuss.
` filino this lrispeovort Report,pla --o R. port Completeness Checklist on next page....
@.^dt8•TrE1 TO) •X ' �k,A+.fGCF' YOVp nk'Z r a„f -"Pi&le c7'...Ny
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Title i� i l IinspectionCommonwealth of Massachluseft
►rr n
S bsuirfac'e Sewage Disposal SystomFo''fM-Not for v 1tsnlary Nssessmots
bq 164 Annable Print Ru.d
�`�ra er�y R��1rc Kam_ _ _ .._. __ _ _. .. .�.�. .�...._...._...�.... ._.._µ.m__�._. ... .... .___..._�..._..
Tarn Fisher
is
requbkitcrevery q 2 2 Lea' f
PRO, chyi1qwn ,01 Ude Dame'o'(€o'Spedr'sn.
E. Report Completenless Chercklist
E Inspection,Sure m y: A, B,C, Ot ar E ch ck l
Insp6ction&ummaq D ystam Failure Ceiteria A plicable to Afl ys rasp compbeled'.
S�+etl tr�f�rrri�ti�r�_ ��t�m� d..d��th`tQ:high gr�i�pd'; ter
Sketub of Sewige Disposal System eilter drawn on page,1 a or 6ftached in. crate file
i
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APPEARANCE AND NOT MEANT TO BE AN EXACT RENDITION.PLEASE REFER TO BUILDER CONTRACTS FOR PRODUCTS INCLUDED. w S Z
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30 REAGANS MILL RD. WINGDALE,NY 12594
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PE/RA THIRD PARTY INSPECTION AGENCY
�FR3 MCNABOLA_ CUSTOM HOMES TOM FlSHER50E 'ram�MnauoM
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1)THE FOUNDATION PLAN IS PROVIDED FOR FOUNDATION DESIGN PARAMETERS ONLY.COMPLETE FOUNDATION E
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21THE BUILDER/PURCHASER SHALL B RESPONSIBLE FOR DESIGN,CONSTRUCTION AND CODE COMPLIANCE OF ALL
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CONSERVATION AND FIRE SEPARATION.
31 MINIMUM COLUMN FOOTING 512E SHALL BE 2'-V x 3'-V x 10"DEEP,
41 CONCRETE STRENGTH TO BE A MINIMUM WOO PSl m p
51 LALLY COLUMN SHALL BE MINIMUM 31/2.91 STEEL PIPE, 01
6�FOUN DAHON SILL SHALL BE PRESERVATIVE TREATED LUMBER(SUPPLIED AND INSTALLED BYB/P PRIORTO HOUSE. p H
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Commonwealth of Massachusetts
isle 5 "Official Inspection F.or
( — 19 Subsurface Sewage Disposal System Form -. Not for Voluntary Assessments
Property Address
Ow nor Cw ner's Nlarns
inforn-ation is.
required foravgy ..- '=
page. Qtyr-mown State Zip Code.% Date of Inspection.
�n
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:Men filling out forms A. General Information
S� #
on the computer, -5 11238
use only thetab 1. Inspector
key to rmve your
cursor-do not 41 Al 7-4V1,14 kl14�P41eG/t v
use the return nld�of Inspector
key.
T N/ rN e/Z o s cf
g�i1 II Company Narre
L_7__
Company Address
A �s���s�t �ss- o�Q j�'
Citylrown ��� Stale. Zip Code
!00'?.Z372-rf' SU/4�/
ieiephone Ibmher License Number
S. C'�erdficaltlon
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 15.34D of
'title 5(310 CIVIR 15.000). The system:
Passes ❑ Conditionally Passes ❑ Fails
❑ Needs Further Evaluation by the Local Approving Authority
Inspector's Signature Date
The system inspector shall submit a copy of this inspection report to the Approving Authority (Board
of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or
has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the
report to the appropriate regional office of the DEP. The original should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving authority.
****This report only describes conditions at the time of inspection and under the conditions of use
at:mat time. This inspection dews not address how the system will perform it the future under
i<e same or different condi�Jof use.
w:n 1113 TWe5OffidallnsoecaoriFarm:Subsurface Sev,ageuisoosal Susfem- Page i ol?;
_ - -- - -- -- -- ° V6
l�l��
f •
Commonwealth of Massachusetts Y
Tithe 5 Official Inspection Fora
Subsurface Sewage Disposal System Form -Not for Voluntary.Assessments
Property Address
f,,O;a /�a AU e-f-C
Can+ner C w ner's Name
information is �����j� >dlZell(—
required for every f Q Z
page. Cityfrown State Zip Code mate 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 indicats:�that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 ex:-:t. Any failure criteria not evaluated are
indicated below.
Comments:
B) System Conditionally Passes:
❑ one or more system components as described in the "Conditional Pass"section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass.
Check the box for"yes", "no"or"not determined" (Y, N, ND) for the following statements. If"not
determined," please explain.
The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally
unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass
inspection if the existing tank is replaced with a complying septic tank as approved by the Board of
Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years old is available.
❑ Y ❑ N ❑ ND (Explain below):
tins- 3113 Title 5Official Inspection r orm:Subsurface Sewage Disposal S ystenn-Page 2 of 17
I
' Commonwealth of Massachusetts
L Title 5 Official.. Inspection Form
Subsurface Sewage Disposal Sysste`m.Form -Not fur Voluntary Assessments
Property Address
Cw ner Ow ner's Narre
information is IIILLf joss, Q�3� JD/Ly1/�
required for every
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
B) System conditionally Passes(cont.):
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND(Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below):
❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below):
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND(Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
No
C) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determi ne 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 pdW is within 50 feet of a bordering kegetated wetland or a salt mars h
t5ins-3/13 Title 50fndal Inspection F omz.Subsurface sewage Disposal S item• Paae 3 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form'
I- a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
Ad
Property Address
5r,#Al /✓o 41L G f;-&
ON net Ow ner's Narre
inforrrationis L1�Nl��LLf �1Sf 024$� /DIZ 11y,
required for every
page. CityfTown State Zip Code Date of Inspection
B. Certification (cont.)
2. System will faiunless the Board of Wealth (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 -o.a surface water supply.
❑ The system h2s a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50,feet or
more from a private water supply well**.
Method used to determine distance:
"*This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal
coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal
to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must
be attached to this form.
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
❑ �j 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
❑ �t�jy Liquid depth in cesspool is less than 6"below invert or available volume is less
than '/ day flow
Sins all Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17
r
Commonwealth of Massachusetts
. Title 5 Official Inspection Form :
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
Property Address
Ow ner ON ner's Nairte
inf ormation is G1 t 'P ;z /0/20I/�
required for every
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
obstructed pipe(s). Number of times pumped:
❑ I Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑ ❑ NG Any portion of cesspool or privy is within 1 OD feet of a surface water supply or
tributary to a surface water supply.
❑ hW Any portion of a cesspool or privy is within a Zone 1 of a public well.
❑ ❑ NA Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ ❑ Mb 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 DEEP 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 sening 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.
�A
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the
questions in Section D.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
❑ ❑ the system is located in a nitrogen sensitNe area (Interim Wellhead Protection
Area— IWPA) or a mapped Zone II of a public water supply well
If you have answered "yes"to any question in Section E the system is considered a significant threat,
or answered "yes" in Section D above the large system has failed. The owner or operator of any large
system considered a significant threat under Section E or failed under Section D shall upgrade the
system in accordance with 310 CMR 15.304. The system owner should contact the appropriate
regional office of the Department.
t5ins 3/13 Title5 Official Ins pectlonForm:Subsurface Sev✓ageDisposal System•Pape 5of17
4 Commonwealth of Massachusetts y
Title 5 Official Inspection Form
a a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
Property Address
Sfr�� �3vyL 6�s2
Ow ner ON ner's Narre
inf orrnation is �¢�c/j�/L v%L L� Jg5'✓� ` Z�G 2 ✓U/Zy//�
required for 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 hollowing:
Yes No
l ❑ Pumping information was provided by the owner, occupant, or Board of Health
❑ E� Were any of the system components pumped out in the previous two weeks?
Has system received normal flows in the previous two week eriod?
❑ H thep p
❑ 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)
y� ❑ Was the facility or dwelling inspected for signs of sewage back up?
G� ❑ Was the site inspected for signs of break out?
Z ❑ Were all system components, excluding the SAS, located on site?
❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS) on the site has
been determined based on:
❑ Existing information. For example, a plan at the Board of Health.
® ❑ Determined.in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
D. System information
Residential Flow Conditions:
Number of bedrooms (design): 3 Number of bedrooms (actual): 3
33a
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):
tans•3113 Title 5 Official Inspection Form:Subsurfaoe Sewage Disposal S}stem•Page 6 of 17
i
' Commonwealth of Massachusetts
M Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
Property Address
C✓v ner Cuv ner's Narre
information is
required for every
page. Cityri'own State Zip Code Date of Inspection
D. System information
Description:
Number of current residents:
Does residence have a garbage grinder? ❑ Yes [2 No
Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ER No
information in this report.)
Laundry system inspected? ❑ Yes ❑ No A//
Seasonal use? ❑ Yes ® No
Vta_er meter readin s, if available last 2 ears usage d
g ( Y g (gR ))�
Det��il:
Sump pump? ❑ Yes 2 No
Last date of occupancy: OCC46al
Date
Commercial/industrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CM R 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:
5'ns•Y3 Tifle50ffaallnspactonForm Subsurface Sewage Disposal System-Page 7ofi7
Commonwealth of Massachusetts
Title 5 Official Inspection Fora
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
Property Address
�r�'I�-y �T�Gl�•GFi!
Ow ner Ow ner's Narre
information is
required for every
page. City/Town State Zip Code Date of Inspection
D. System informnation (cont.)
,A/A
.Last date of occupa ncy/use: Date
Other(describe below):
General Information
Pumping Records;
Source of information: As
-
Was Was system pumped as part of the inspection? ❑ Yes E? No
If yes, volume pumped: gallons — ---�
How was quantity pumped determined?
Reason for pumping:
Type of System:
Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract (to be obtained from system owner) and a copy of latest
inspection of the VA system by system operator under contract
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other (descri be):
tS,ns-3!'3 Tifle 5 Official Ins peclion Form:Subsurface Sewage Disposal System•Page 8 of 17
i
' Commonwealth of Massachusetts
Title 5 Official Inspection Fora
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
Property Address.
Ow ner Cw ner's Narm
information is
required for every ���? n��L� f��f� G IL4
page. QtylTown State Zip Code Date of Inspection
D. System Information (cost.)
Approximate age of all components, date installed (if known) and source of information:
Were sewage odors detected when arriving at the site? ❑ Yes EJ No
Building Sewer(locate on site plan):
Depth below grade: feet
Material of construction:
❑ cast iron ❑ 40 PVC ❑ other(explain):
Distance from private water supply well or suction line: feet
Comments (on condition of-joints, venting, evidence of leakage, etc.):
Septic Tank(locate on site plan):
Dept h bell ow g ra de:
feett
Material of construction:
concrete ❑ metal EJ 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: 3 • x 3''x�'
Sludge depth: S r
t5ins•3/13 Title 50ffidal Inspection Form:Subsurface Sevage Disposal SNstem-Page 90117
Commonwealth of Massachusetts
Zj Title 5 Official. Inspection Form
Subsurface Sewage Disposal System Form -Not�for Voluntary Assessments
Property Address
O,v ner Cw ner's Nam
information is
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Septic Tank (cont.)
Distance from top of sludge to bottom of outlet tee or baffle D I
t• 2',
Scum thickness
G °
Distance from top of scum to top of outlet tee or Daffle
Distance from bottom of scum to bottom of outlet tee or baffle
�G r
How were dimensions determined? f fiefS6l�l��/6 5T/Ck
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
pZ�cG �'.��1�'�g��krpfal��?�.-� �M /.w�e�►'�d��fr T 6ao�
5T2�lCTr!/L>!GY CD o n 1 i�r/JvL�r�fL �Ug.ci,���"�+'G1�v1�T?'
S/V j
f�f4 jl--�/.�� /� T`s' nF�cv�y�.��2°av
ZVZa D 01f��5r
Grease Trap (locate on site plan): 6 C` / /��Sd yZSG� �,A" t.31 AVAVl F'>
Dept h bel ow g ra de: tee(
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other (explain):
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping: Date
t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System- Page 10 of 17
Commonwealth of Massachusetts
N Title a Official Inspection Farris
Subsurface Sewage Disposal System Forhn -Not for Voluntary Assessments
Property Address y�
Cw ner Cw ner's Narrie
information isrequiredore very
page. (atyaown 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.):
/✓O�j
Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan):
Depth below grade:
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other (explain):
Dimensions:
Capacity:
gallons
Design Flow, gallons per day
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in w.orbng 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
t51ns-3113 Title 5 Official lnsp5c bon Form:Subsurface SewapeDisposal System-Page 1lei 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
s Subsurface Sewage/Disposal System Form -Not for Voluntary Assessments
vo
Property Address
��1�-�✓ �DGIL 6�ir
Cw ner CW ner's Hama
information is
required for every
a State Zi
page. City/Town 9 �Y p Code Date of hspectfon
D. System Information (cont.)
Distribution Box (if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert
j
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.):
72� QAerL t>s J"W.d!
Pump Chamber(locate on site plan)-
Pumps in working order: ❑ Yes ❑ Now
Alarms in working order. ❑ Yes ❑ No'
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):.
" If pumps or alarms are not in working order, system is a conditional pass.
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
t5ins-3/13 Tille5Official Inspectim F orm:Subsurface Sewage Disposal System• Pape 12 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection form
R Subsurface Sewage Disposal System Form Not for Voluntary Assessments
IGy J3.s%�s�/3sl�r G�oi�•T did
Property Address
am ner Owner's Name
requiredfo is ���2��LL�required for every ,S$• p�...G 72-
page. Crty/Town State Zip Code Date of Inspection
®. System Information (cont.)
Type,
❑ leaching pits number:
❑ leaching chambers number:
I leaching galleries number: -3 yz
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
C_l inno vat!ve/aftemati\e system
Type/name of technology:
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.): 1) I1 `, �� llf.�/Ti�?7'4�
SD12 /•5 S,r1,tl®`) e"I'zAaZG fn/SGI/Z�•dR�f
�aNf
Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration
Depth—top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
trans•313 - Title50ffidallnsp-tionForm:Subsurface SevageDisposal System•Page 13of 17
Commonwealth of Massachusetts
Title 5 Official "Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
Property Address, 5,040,41
Cw ner C w ner's Name
i
f' - ,informations
required for every
page. C ityfTown State Zip Code Date of Inspection
D. System Information (cont.)
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
Privy(locate on site plan):
Materials of construction:
Dimensions
Depth of solids
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation;
etc.):
t5ins>3113 - TiUe5Official Ins pactian Form:Subsurface Sewage Disposal System• Page 14 17
C
Commonwealth of Massachusetts
Title 5 Official Ins
pecta Farm
Subsurface Sewage Disposa( System Form -Not fir Voluntary Assessments
Property Address
Sfil�y /�DL6�2
Cw ner Cw ner's Narre
requir required
is G!'S,r,/ /Lt'6GGs djWss �,�,G3T
required for every
page. City/Town State Zip.Code Date of Inspection
D. System information (cont.)
Sketch Of Sewage Disposal System: ProVde a view of the sewage disposal system, including ties to
at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate
where public water supply enters the building. Check one of the boxes below:
❑ hand-sketch in the area below
drawing attached separately
l
t5ins•3/13 TiUe5 Official Ins pc bon Form:Subsurface Sewage Disposal System-Page 15of 17
i
Commonwealth of Massachusetts Y ,
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
�U/A19'
y
s
Property Address
P
Ow ner Owner's Nam
information is
re i
uired f or every
->,/lf/LVILGr iZ1 d�3Z �
4 gY
page. Chy/Town State Zip Code Date of Inspection
D. System Information (cont.)
Sibs Exam:
fb�lb
S
� . Check Slope �y11T
l� Surface water �H ��� C f AW
® Check.cellar 11PAI K
Cl� Shallow wells
Estimated depth to high ground water. feet
Please indicate all methods used to determine the high ground water elevation:
I$ Obtained from system design plans on record
If checked, date of design plan re\iewed: pate
❑ 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:
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins-3113
TitIe50Fficial Inspection Form:Subsurface Sevage Disposal System• Page 16 of 17
"Commonvuealtti of Massachusetts
Titie 5 Official. Inspection" Form
Subsurface Sewage Disposal System Form - Not fix Voluntary Assessments
Property'Address
ON ner CW ner's Narre
information is
required for every C �?fn1��lL� � G,.(.,� Jd120�/
page. City/Tgwn State Zip Code Date of Inspection
E. Report Completeness Checklist
fl 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
Dins•3/13 TIUe50ffidallns pectionForm Subsurface Sewage Disposal System- Page 17 of 17
Your
Septic
System and How
i ',, Works c. _
It is important to understand how your system works and how this treatment affect's it iri order'to protect yours
investment. The typical system consists of three.(3)main components.
The Septic Tank The Distribution Box The Drainfield
The Septic Tank
Waste exits the House and enters the septic,tank where solids`settle to the bottom, grease and scum from the
household detergents float to the top, and liquids stay in between. The solids that settle create their own bacte-
ria which decompose the solids naturally. There is no need to add additional.enzymes and bacteria to the tank.
The tank eventually fills with solids and scum requiring it to be pumped. A septic should be pumped every two
(2) years.
The Drain field
.f
The liquid(gray water) flows to the distribution box where it is evenly dispersed into the
drainfield. Finally, the drainfield begins treating the gray water: Microorganisms in the soil consume organic
pollutants in the gray water and the pure water is absorbed by the ground
below.
How Problems Start
From the first day of use, the drainfield of your septic system begins to deteriorate. Some
solids, grease, and scum always pass through the septic tank into.the laterals. This is because of natural solu-
bility or the lack of setting time in the septic tank during periods of heavy use. Problems especially arise
when the septic system is not maintained and the septic tank fills with solids and scum that overflow into the
drainfield. As the drainfield becomes clogged, the water flow becomes restricted. Since the water cannot
drain into the soil, it filters upward'eausing ponding, foul odors, wet spots in the yard, and an unhealthy envi-
What Causes Problems
What you don't read a waste called biomat and the also create a as bacteria eats
y bout is that bacteria has a s y g ,
human waste. It does not eat, hair, wool, polyester and other particles. The biomat is like grease. The gas cre-
at
es bubbles and this causes...particles to float up the T and into the distribution box and into the leeching fa-
cility,plugging up the stone.`
Septic tanks should be pumped every two (2) years.
Cesspool
Cesspools were made by digging a hole in the ground and walls were made of stone then later on they were
built with concrete blocks. The waste entered the cesspool, and solids settled to the bottom, the liquids seeped
out the sides into the soil.
Cesspools should be pumped every year.
State Environmental Code Title V Chap. 5 Inspection Procedures
li Guidance on Completing Inspection Form Part A Certification.
The Certification Section has two principal functions. First it provides identification information on the property being
inspected and the inspector. Second, it presents the results of the inspection relative to the failure criteria outlined in 31 0
CMR l 5:303. In.the certification statement,the inspector is certifying that the conditions existing at the time of inspection
are accurately presented in the inspection report. The inspector is not certifying that the system is adequate for the current
use of the system nor for the future use of the system.
TONY CAPONIGRO
216 North Main Street
Mansfield, MA 02048
Title V Inspections
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10,,'14,,2015 15:15 FAX W C P H AND D LIT Vj 002
Septic Services FREPARF0 POP: �04Q
PurnpIng &
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MOM.MA
6�4
rj
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Fu 5 f S
A 534
IT
T,K s1
DESIGN _:;�. 15PROOM HOUSE
NO
PEFIC RATE MIN/K CHSPOSER olspo$ep
FLDW RATE I I C
SEPTiCTANK 3:;0
REOT SEPTIC TANK SIZIE
LEACH FACILITY
16"�-_
SIDE. WALL (4LIZY, -— (zc_
BOTTOM, 4 G/D.
TOTAL ��97 -a fq5
USE:
Eat
No. Fee
Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
ZippYication for Mie;pooar *p5tem Construction Permit
Application for a Permit to Construct( )Repair( grade( )Abandon( ) ❑Complete System 10ividual Components
Location Address or Lot No. / �/�N £ �. .('� Owner's Name,Address and Tel.No.
C C.NT I`1511ne <7-,
Assessor's MapTarcel ! !�/ /t L /q Ov
Installer'A
gAdressiand Tel C O �'D 9 9 Designer's Name,Address and Tel.No.
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Sdil
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issM by this Board of Heal .
Signed Date
Application Approved _ Date �� f
Application Disapproved for the following reasons
Permit No. > 04:5 /" Jd. Date Issued " ebb/
No. ����- _ �d Feei
4
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS S
ricatiori for Miopooar *pgtem Construction Permit
Application for a Permit to Construct( )Repair pgrade( )Abandon( . ) O Complete System 492ividual Components
Location Address or Lot No. 4'.� Owner's Name,Address and Tel.No.
Assessor's Map/Parcel �/ �G y 14 d"',," F LG
Installer's I�,ame A dress�anc�T Co. 77 S'p�Q u Designer's Name,Address and Tel.No
' Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder
Other ; Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
` Title
Size of Septic Tank Type of S.A.S.
Description of Soil 1 L)
Nature of Repairs or Alterations(Answei when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been isstwd by this Board of Heal -
Signed Date Y'g 421
Application Approved y.• Date ^ 2e 4
Application Disapproved for the following reasons
ti+b
Permit No. Date Issued .9- 2Cbb�
---------------------------
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 2(,d 0. ti'C o3 S /j1.,>g/.__
at / 4 N11/I�44,eEL £ 1100/-1-7 ?P-2 C s"�c-r- has been constructed in accordance
with the i
isions of Title 5 and for Disposal System Construction Permit l�0OZ- ;9 X dated
Installe � Designer
The issnce of this p t shall not be construed as a guarantee that the sy will�nc 'o as desig ed.
Date Inspector _
------------------
No. Fee
/�� Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION . BARNSTABLES MASSACHUSETTS
Mopool bpgtem Conotruction Permit
Permission is hereby granted to Construct( Rf pair(Upgrade( )Abandon( )
System located at (.� �}�/� lJ ALL �d/�7 C , 'ti'T
and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to
comply with Title 5 and the following local provisions or special conditions.
Provided:Construction must be completed within three years of the date of thi 'rrmit.
` Date: Approve � ,,. �r/'
TOWNS OF BARNSTALE Y
�21ON 41VAIA a/.v7' l+-D SEWAGE # 21r .. ZIO
VILLAGE C ASSESSOR'S MAP & LOT Z. 11-0>�I
INSTALLER'S NAME & PHONE NO. A & B CANCO 775-6264
SEPTIC TANK CAPACITY X I U
LEACHING FACILITY:(type) (size)
NO. OF BEDROOMS PRIVATE WELL OR.PUBLIC WATER
BUILDER OR OWNER l/
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED: 1r //j _ 11,04�4 f
d N 5 L -7
VARIANCE GRANTED: Yes No
L'
�Rv�r �`1•a
N
f
/,Gow �_(�
TOWN OF BARNSTABLE I
LOCATION__C,, YhNAIHBELL-f P01,.7' SEWAGE # z D
i
j VILLAGE C £Wr ASSESSOR'S MAP 6i LOT Z !1 a l`!
INSTALLER'S NAME si PHONE NO. A & B CANCO 775-6264
i -
SEPTIC TANK CAPACITY X )
LEACHING FACILITY:(tope)
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER 1! Sf T,Yti
DATE PERMIT.ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE.GRANTED: Yes No
PC,
.
i
YA-16
iT
f r
N --,X D...a_ _,. Fxs... O:.`...............
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
.w. ....................OF.... 7 LE
Appliration for Uhipoii al Works Tomitrurltinn amit
Application is hereby made for a Permit to Construct ( ) or Repair (L,,�'an Individual Sewage Disposal
System at
e �/CLocation-Address �,A or Lot No.
._.1 �_2(l.�r- -- ------------------------------•------•---------- ------••---••---------5A/�!� ......................--^......--^................
Owner Address
r_Q..................................................... 35'o_Mf IN_. "T ��T.�_1N ?-_-MA!!!!U`�-T±4---
Installer Address
d ' Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms._....... _---_Expansion Attic ( ) Garbage Grinder ( )
-
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
aOther fixtures ----------------------------------
W Design Flow.__ 1..Q.........................---gallons pet n per day. Total daily flow__-___-•:�'•-Q-._.....•......_......._gallons.
Ra Se tic T n —Li4��i�dd capacity/O.O._gallons"` Length-_ �.�2"___ Width---q'11S���___ T eter_____ Depth...C-_4----
W u �is_'VL O. ...a........... Width.......8.1....... Total Length----Z.8........_ Total leaching area..7_nd....sq. ft.
Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box (&4 Dosing tank ( )
Percolation Test Results Performed by__________________•---...-_----•--•--•-•-__---•----------•_ -•-- Date............................
Test Pit No. 1................minutes per inch Depth of Test Pit-__-__-_---__---___ Depth to ground water..t--___•-_-__-.
r Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
W .............................................................................................................................................................
0 Description of Soil................................................-......
x '
U ..........................................................
------------- ------------------------ = -- -----------
UNature of Repairs or Alterations Answer Vhen applicable.__V1��r1�rR�
1_fl oS�.(r•.S l4.T! U :►- �_" 4.X.�_.> __. 'I'h�Q E pi FfuS zS �t Z!.ST0). jF----------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of iITL s 5 of the State Sanitary Code=The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
h Signed_ � ��r1�1 '_......... .?3' 0�
Date
Application Approved By._ ���_ :_ ..__.... ._-__-
Date
Application Disapproved for the following reasons-----------------------------------------------------•------------------------------------------------•--•-_...--
....---•--•••----•-•......•---------•......-•---•••...••-••...........•••................•-••••------•--•-•••-•------•-------------•-•••--••---•-•-••--•---------------- --------------------_----•---
Date
PermitNo......................................................... Issued---------•-—------..............----------------•--.
,A 'SSGR'S .MAP NQ-. PARCEL
L ?) C A T ION SEWAGE PERMIT NO.
VILLAGE
INSTALLER'S NAME , i ADDRESS
B U I L D E R OR OWN ER
DATE PERMIT ISSUED
DATE C • MPL IA N C E i FUED
SS C-
� ��-
r
C� o
w
',,� :tip • 4,�/ �� % r`�.
...........
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
...................oF.. }�2��I S-(', 13L�----------..................----------
Appliration for Bispniia1 Vorhfi Tnnitrnrtinn Prrmit
Application is hereby made for a Permit to Construct ( ) or Repair (e,oj an Individual Sewage Disposal
System at:
164 ftjA-FELL. Pe/N7 ►zvA1' �FN 1E► -VILL�
......... ....Location-.Address..............................•... ....................•-5A M E...... Lot No.
--•--------..............................
........�?o�l 7..................................................... ..........--......................................................................................
W 1_ %..�?� V owner ...... .................................................3SU MAIM S 1VE 'dire IFS i `Ai _MOUT+4
a .......... € �`l� a---------....------------------------------
Installer Address
U Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms.........,--�.'................................Expansion Attic ( ) Garbage Grinder ( )
'4 Other—T e of Building No. of persons___-•_______________________ Showers — Cafeteria
al Other fixtures .. I - " -----------------------------------
DesignJ ;4
d UDU_- allons Length.` u�(A�...--_ Width._�!4___... Piatet�er__-_ .. De th....._.._...__.
W Flow.................. . .................gallons per lyerso per day. Total daily flow----IIU 3 0
t� Se tic Tank—Liquid capacit `..
��I�o. ...3............ Width.......9........... Total Length...Z.�.......... Total leaching area..�.�3:_�....sq. ft.
Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box (Il.� Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date----------------- ��-----••---
Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water.........._.............
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
a .....-•-••-•----------------••-•-•------••---•--••-••---•----•••--•------•-••-•---•--•-•••----•-•••---•-...............----................--••--••----••••--
0 Description of Soil---------------------------------------------------------------------------------------------------------------------------------- .....................................
W
V .....-----•-•--••-•------•-•-----•-••--....••-•••.....•-••--•--•••••--••--••-•••••••-•-•••---•-------••••••-•.-••--••--•••-••-----••••••-------•--••----•-••--•-••---•..........................•-•••...
W ------------------------ ----------------------------------------------------------------------------------- ------------------------------------------------------------------------
VNature of Repairs or Alterations—Answer when a licable_!�-.F'A D E.... )K! __ �% s�`STC►�1 I U I N Cu►fit
./o ov is SE PT I c 7A KI Y.,....P--box , � �-t!------c- f'to v,l pi FTLjS�VS W l-rN y l STD�1
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TIT1E 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has b ued y a�rheboari of health.
yro Sig -- --------------- -�---------------------------------------- ---'�3:_8�------------
--•-------. ...
1{ Dat�
Application Approved By`=::_�=_<!� :. _. ...._.._ � -',�'a7
---------------------------•--•......•-•---• ......� --
Date
Application Disapproved for the following reasons-----------------------------•-----------------------------------------------------------...---••-•---••......---
•••-•-•-•••--•...-•-•••--••----•---•--••...•----••-••.........................•--•--•--••••••--•----•-•.....-•••----•--••---•-----•-••-••--••----•--•--••-•----•••--••-----••--•••--.--------- --------
Date
PermitNo.-6...................................................... Issued.......................................................
Date
�5her THE COMMONWEALTH OF MASSACHUSETTS
BOAF2WF TLTH
Gtv� M5 r✓
..........................................OF....... ......................................................I..................
11 - �rr�ifir�t#r laf f�nnt�li�nr�e �
THIS;,IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
-.--- - ----- ----
I staller
at-••-••.... E}1 = . Ylr� = -4------C----------------------------------------------------------------------------
has been installed in accordance with the provisions of TITLE 5 of The -State Sanitary as d$scri ed in the
application for Disposal Wotics Construction Permit No.__.._. ____�..... ..... da.ted_... 2.. . ct3�
THE ISSUANCE OF THIS,,CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE........................................................... Inspector........:..........
G
�e�Jlar THE COMMONWEALTH OF MASSACHUSETTkj�
BQAF c7F HEALTH ,�- a� IC
/ocor.....................OF..--........C�rh QG —
ae ...................... .... .............
No..........r:...y :. I FEE........................
�i��n.��t1 nr�� �uri���ur#uan, lernti�
Permission is hereby anted.. J ... - ....
to Construe ) or Re aIr ( ) n Individual S . i `osal yst
L
atNo. -----------------------------------------------------------•.......•.
`'. Street I
as shown on the application for Disposal Works Construction Permit No..�.....11 Dated.... _ .................
- •-•-.......tr—.!....G ------•-••................
DATE.......
�.... -' �............................ Board of Health
FORM 1255 HOBBS & WARREN, INC., PUBLISHERS
BUILDING INFORMATION
MODEL: COLONIAL—CTM, #19212 SPECIAL USE PROVISIONS, APPLICABLE BUILDING CODES:
PROJECT SITE: 164CEN RVLBEE PO1 T ROAD CONDITIONS OR LIMITATIONS —780 CMR, MASSACHUSETTS STATE
632 -BUILDING MAY NOT BE LOCATED WITHIN FIRE LIMITS
McNABOLA HOMES, BUILDING -5-0' MINIMUM CODE REQUIRED SETBACK FROM LOT LINES WITH 0 RESIDENTIAL CODE 9th EDITION
BUILDER/PURCHASER: AND REMODELING LLC HOUR EXTERIOR WALL-BCP SHALL BE RESPONSIBLE FOR HOUSE LOCATION ON LOT —248 CMR, THE MASSACHUSETTS STATE
TURNKEY. TOM FISHER -WHOLE H TO BE OUSEWHO E VENTIILATION SYSTEM TO BE DESIGNED, SUPPLIED, PLUMBING and GAS CODE
AND INSTALLED ON SITE BY B/P WITH A MINIMUM CONTINUOUS FLOW
USE GROUP: SINGLE FAMILY RATE OF PER TABLE M1507.3. (1). —2017 NEC W/MASSACHUSETTS
-FANS USED FOR WHOLE HOUSE VENTILATION MUST HAVE A SOUND —
CONSTRUCTION TYPE: WOOD FRAME(VB) RATING OF MAXIMUM 1 SONE AMENDMENTS
DUCT TIGHTNESS AND BLOWER DOOR TESTING BY HERS RATER ON 2015 INTERNATIONAL MECHANICAL
AREA: First Floor 1,480 SQ.FT. SITE BY B/P 50
Second Floor =1,193 SQ.FT. Total= 2,673 SQ. FT. —DWELLIN IS SOLAR PANEL READY
*Meets MA Code exception #2 107.6 -SITE CONNECTIONS TO BE VERIFIED BY CONSTRUCTION SUPERVISOR CODE W/AMENDMENTS
VOLUME: 35,801 C U.F T.(1&2 Family) for construction control BUILDING HEIGHT: 28'-0 5/8" THIS HOUSE IS REPLACING —2 015 I E C C W/AMENDMENTS O
EXISTING HOUSE THAT IS TO BE
NUMBER OF STORIES: 2 Z A 48 hour notification is required
& REMOVED. EXTERIOR ENVELOPE THERMAL
DESIGN OCCUPANCY LOAD: 13 1 ST FL= 6 prior to the set.The CSL on record will relay this to PERFORMANCE (U VALUES�
the local building authority. If any connections have been concealed prior to
inspection, the building official may request having the removal of elements that
SPECIAL SYSTEMS
conceal the connections to provide access. This would not constitute"Destructive SEE ATTACHED R E S C H E C K
FIRE ALARM PHOTO ELECTRIC Dis-assembly".All connections on site must be inspected by the local authority.
SYSTEM TYPE: SMOKE & CO DETECTORS HEATING SYSTEM TYPE:
COMPLIANCE REPORT
FIRE SUPPRESSION NA HEAT INSTALLED ON SITE BY B/P DRAWING INDEX REVISIONS
SYSTEM TYPE: HEATING SYSTEM FUEL: PAGE # DESCRIPTION N/A
RESCHECK— 10 PAGES
OTHER: N A SHALL BE THE RESPONSIBILITY TRUSTRUCTURALSS CALCULATIONS-GEE- AGESS PAGES
DESIGN LIVE LOADS (PSF� OF BUILDER/PURCHASER 0 COVER PAGE
HEATING SYSTEM CHIMNEY 1 ELEVATIONS
WALL (WIND VUit) 140 MPH 2 FOUNDATION PLAN
OR VENT TYPE: 3A FIRST FLOOR PLAN
FLOOR: 1st = 40 2nd = 30 3B SECOND FLOOR PLAN
ROOF (SNOW): 40 SHALL BE THE RESPONSIBILITY 4W CROSS- WALLS
SECTION
ECTON
OF BUILDER/PURCHASER 5A FIRST FLOOR PLUMBING PLAN
CORRIDORS: NA I 6A I FIRST FLOOR ELECTRICAL PLAN
THIRD PARTY INFORMATION 8 STANDARD NOTES AND DETAILS
STAIRS: 4O TOTAL # OF PAGES IN SET = 30 PAGES
BALCONIES NA PFS Corp.
O TH E R: N A 1115 0 I d Berwick Road '9 Ism"ter Seat. da s�a�ti�bIe'°
he mociutT portion ea the tr.Al�cg buu"`,in itas
Etorir,and is,nrk ID roe taken as FiecwdlDesign•
Bloomsburg PA 17 815 rotessionat fx to pr¢jeci ifiams nadY�B4O,b,,
> > T'_` Vr'_-•ethers, o, Folder,en Sits n. e.are to be
TPIA #2, 04/30/20 esgdbvaregis�eufpotess�ao"�.�d
aE not C'hestriaJ in Ihi_:a i3f rxal.
STATE LABEL LOCATIONS MASSACHUSETTS
1st FLR 'A' Box
LL —
HA CLOSET
st FLR — , ,,N C O V E R SHEET
Underr kitchen sink on
N right side PFS CORPORATION JOHN A
2nd FLR 'C' Box — Approval Limited.to Factory Built Portion Only WAiLEN +
MBDRM CLOSET N0.fig, Westchester Modular Homes Inc
D 2nd FLR D Box - State: Massachusetts
i 'Fc�� Offices and Manufacturer Plant
m G.BTH LINEN Signature: �%„'o/dam„/�. �' " 30 Reagan Mill Road, Wingdale, NY, 12594
* Inspection Agency Label Title: Staff Plan Reviewer a Tel (845)832-9400 Fax (845)832-6698
* Data Plate is under Date: 2/10/20
kitchen sink on right side
(one per unit) 21712020 Manufacturer No. MCI 16
i
THIRD PARTY INSPECTION A EN Y AR ENe Expiration Date: 04130120
II
the Erd6irLeer Seal or.Dxrw drdmitags is,apr.+1cable 11D
NOTES FOR SOLAR-READY ZONE: he modules portion rA the•.b Wk9 buM in:the
1. SEE ROOF SECTION(S) DESIGNATED AND RESERVED FOR THE FUTURE INSTALLATION OF A SOLAR PHOTOVOLTAIC OR SOLAR THERMAL SYSTEM. (300 SF ncdoulr,and is,no(?to be taken as Fleconj 113ersign
MIN.) ro lessional fi3 the Of0jer.�i.11tems nabs BfoJ,bV
2. SOLAR READY ZONES SHALL BE FREE FROM OBSTRUCTIONS, INCLUDING BUT NOT LIMITED TO VENTS, CHIMNEYS, AND ROOF-MOUNTED EQUIPMENT. TP',•Iby athers,.[by folder .on site,e1C.:ale to:be
3. SEE COVER SHEET (PAGE 0) FOR ROOF DESIGN LOADS. esgr&d try a regstF ad amok-sssorej on szbe,'andin
U
(NOTE: THESE LOADS ARE FOR THE ENTIRE ROOF AND HAVE NOT BEEN REDUCED), raE59d 'approval.
4. A 2"PVC CONDUIT SHALL BE INSTALLED FROM THE BASEMENT TO THE ATTIC, LOCATED IN THE VICINITY OF THE ELECTRICAL SERVICE PANEL. LZ
5. THE MAIN ELECTRICAL SERVICE PANEL SHALL HAVE A RESERVED SPACE TO ALLOW INSTALLATION OF A DUAL POLE CIRCUIT BREAKER FOR FUTURE SOLAR (3
ELECTRIC INSTALLATION AND SHALL BE LABELED "FOR FUTURE SOLAR ELECTRIC." THE RESERVED SPACE SHALL BE POSITIONED AT THE OPPOSITE Q
(LOAD) END FROM THE INPUT FEEDER LOCATION OR MAIN CIRCUIT LOCATION.
6. A PERMANENT CERTIFICATE, INDICATING THE SOLAR-READY ZONE AND OTHER REQUIREMENTS OF THIS SECTION, SHALL BE POSTED NEAR THE ELECTRICAL ZO PFS Corporation
DISTRIBUTION PANEL, WATER HEATER, OR OTHER CONSPICUOUS LOCATION, BY THE BUILDER OR REGISTERED DESIGN PROFESSIONAL. U Northeast Region
w APPROVED
+r-o• +a-0• - H Raup-3
Z 2/10/20
12 Approval limited to
7 Factory Built Portion
(L
REVERSE GABLE
12
® 12
2 Q 3.5 ti
PORCH BY B P -RETURN BY B/P JOHN A
_ HHII IIIIIII WALLEN
® ® ® ®+ NO.l6$7
LLJ
li I i i II d {l
............... ...:.:. a.......a [ 21712020
�_ _
ALL XT.STAIRS, STEPS, RAILS& GUARDS t BE m rT
DO IGNED, SUPPLIED AND INSTALLED BY 8
I 1 I I I I I I I I I (�'
' `� 0
FRONT ELEVATION RIGHT ELEVATION ^�' N
c�C a \ a
0 0 0
s
*ALL SIDING, CORNERS, PICTURE FRAME, Z 0
SOFFIT & FASCIA ON SITE BY B/P* N w
5 x 0
� U j
aa-o• I �LO
5 on _ 1
Y
PLUMBING VENT
STACK a0
Z0 UGO
i� 00 gym"
B//pp IS RESPONSIBLE FOR WEATH Z O_m
ROTECT x
NOTE: ION,PITCH OF FINISH RDOF W p,O
PORCH ROOF TO BE STRUCTURALLY MATERIAL @ SCUPPERS TO DRAI lv p L,_
WATER TO EXTERIOR C.7 m� -CJ 3
INDEPENDENT, DESIGNED AND = a O
SUPPORTED LATERALLY ON SITE BY vI15
B/P. ON-SITE ROOF TO BE 0 I` < c
APPROVED AND INSPECTED BY THE 2 ROOF BY B//P TO M .t Z L o Ol
LOCAL BUILDING INSPECTOR ® ACCOMMODATE ISRIFT LOAD ® I' J o N `O ® �_
N—_
12
Q N G
HIJCD GO
Ci _ RETURN BY B/P Q Z N
W�
to Ld N Q N
MA
_ I'_ �
ti
_ _ DECK BY B Z =D O i
0 O ,� ®®. .
II II II I of � Q �
z o �
I LEFT ELEVATION 1 REAR ELEVATION o o z ry
I I Z
M Q
-- --�
N J_J CCT ..� � O
w Z� cc) 00 O .
NNLLL 0V N oo
LL
al
r- — — — — — — — — — — — — — — — — — — — — — — — — — — . . . . . .
SCREENED W
DECK IN PORCH I Q
ABOVE 62'-0" ABOVE o
Z PFS Corporation
O
I 48'-0" 14'-0" F Northeast Region
1 W=909p/LF W APPROVED
2'-11" ih 9'-6" 2'-4' '° 16'-6" -2"� 10'-0" 3'-7" N H Rau 3
CY P-
-8 1 4 ct 42'-7 1/2" o r n -8174 4'-0 1/4" 9'-11 3/4" Z 2/10/20
\ n II n u II n
5431 Z---------------a a a --a---------------� # ---- 945 Approval limited to
cNLj --- ---- -------------------------------
Factory Built Portion
----------- --- --------------------------------------------------------
3645 r O FOUNDATION WALL 44L `1
L- N \
— —————————————— —
I I O co
FOOTING
I I qC NqC S CRAWL SPACE BEAM DESIGNED BY THE BUILDERS -I 1945 N 1�
MA PE OR RA TO THE LOADS LISTED. N
I I > N
(ACCESS BY B/P) TO BE APPROVED AND INSPECTED BY I I I I Iv
THE LOCAL BUILDING INSPECTOR d I I
I I NOTE j14945 1
el 1 1 COLUMNS LOCATED FOR POINT LOADS ABOVE ARE DIMENSIONED; \� 1
'0 °N I I OTHERWISE, MAXIMUM SPAN BETWEEN COLUMNS IS * = 10'-4" 18 1
O I I m
I I I I iv 3 1 Im
I N
1 „ I' N 1 1 Q
1 4-3 6'-t3' 3'-11' 5'-9' 6'-0" 5'-6" 15'-11" 1 \ I I- w
I I W=676// LF W=1, 4// LF W=676// LF W=1,154// LF W=676 11 100
I I a ae a n * *
1 1 t N t0 n I co 1 I^ uj
O
r- --Ir� --I r a - r a -� I a I r- -� r� - - ------------------I I \_
iv 5431 1 I I I I l a I I I I I I I I 1 1 N
-O H 6 -
N 5431 I I I I I I I I I I I 1 45 6" 8'-2 1/4"
I I ---- 3
_ I L-- L---J L---J L---J L --J I I L---J I - ^^''
1 �LALLY COLUMN L-----� II/4 M DECK & ROOF of v N
5431 i COLUMN FOOTING 1 1 ABOVE
oo
I I I I
I I eei Ste!taco H-ees=+drawhIX,is apct �0
I I j �_ eaeodiitar,partion c,,the:t tOftc(troll.in 1hs \-ft
aclM,and is urul da be lawn as Reid Odes o Y
ih oe 1 1 494b I n xa� sionaJ for rnao, L Ilems u►oled Bfo,tv� 0 w
I I I 1 . ai o#heos,by Fi�ikt ,cea sita.r are to Lrs 5 x
7
a,r: used es5k[:7ia1 mn�. .ark1 W U
I I �9nHd IbY .>
I I 2 I I 'e nol destnedl in this,arfr<urral. "
I I
1 49 N C ,�'rn
\ 3645 I 1 O�PGON 441b 1 N to
1 L- ---------------------------------------------------------------------------- - o a I rn ^ I
W=909// LF I I `o M
o >-00
L21 - -------- / - ------------------------------- I -----------------= 945 O# NPORCH ABOVE ^eA
V = z
2 4" 10'-9" 26-1 1/2" 10'-11 1/4" 00 o< o X
EL v
Lo
v
48'-0" = z 5 �p 3 CD
v
-1 HOLDDOWN LOCATION o W 0 i er yr
{�yi 1
LOAD Ibs AND REQUIRED LOAD BY B P U.O.N _
04
FOUNDATION NOTES: - QCD fN_M
1) THE FOUNDATION PLAN IS PROVIDED FOR FOUNDATION DESIGN PARAMETERS ONLY. O — �00
COMPLETE FOUNDATION ENGINEERING BASED ON SPECIFIC SITE CONDITIONS, APPLICABLE W Z U
LOCAL AND STATE CODES, TO BE REVIEWED AND APPROVED BY A REGISTERED ARCHITECT O N 000
OR ENGINEER IN THE STATE OF HOUSE DESIGNATION. —� ®
��
2) THE BUILDER/PURCHASER SHALL BE RESPONSIBLE FOR DESIGN, CONSTRUCTION AND CODE m O N O M H
COMPLIANCE OF ALL FOUNDATION ELEMENTS INCLUDING (BUT NOT LIMITED TO) STRUCTURAL, In U) Q N
PLUMBING, ELECTRICAL, HEATING, ENERGY CONSERVATION AND FIRE SEPARATION. � 5 Z o ®®
O J W Q
3) LALLY COLUMN SHALL BE MINIMUM 3 1/2"0 STEEL PIPE WITH 6"x8" TOP PLATE. LLJo O O O
THICKNESS OF THE TOP PLATE SHALL BE DESIGNED BY PE/RA TO SUPPORT LOADS GIVEN. - Q O = ®®
0 z
4) MINIMUM COLUMN FOOTING SIZE SHALL BE 2'-6" x 2'-6" x 10" DEEP. - � m < O
5) CONCRETE STRENGTH TO BE A MINIMUM 3000 PSI. 0 u z(V
Z 6) FOUNDATION SILL SHALL BE PRESERVATIVE TREATED LUMBER (SUPPLIED AND INSTALLED � ¢ rneL
BY B/P PRIOR TO HOUSE DELIVERY AND SET). THERE SHALL BE NO PROTRUSION ABOVE � J J > c
TOP OF SILL PLATE. - .�
7) THE BUILDER/PURCHASER SHALL BE RESPONSIBLE FOR ENCLOSING THE BASEMENT STAIRS W
AND INSULATING THE BASEMENT STAIR WALLS IN ACCORDANCE WITH ALL APPLICABLE W NL� O yV N v
ENERGY CODE REQUIREMENTS
NOTE: PFS Corporation
PORCH ROOF TO BE DESIGNED & } Northeast Region
SUPPORTED LATERALLY ON SITE BY B/P U g
SCREENED Z APPROVED
DECK IN 0 C 0 H Raup-3
BY B P Q 2/10/20
BY B/P 62_p" 0I O Approval limited to
48'-0" 14'-0"
:2 Factory Built Portion
F
LLJI
U
1 1 2" 13'-10 1/2" a-
N
Z
4177# ((2)9 1/4 MICRO HEADER 5.O93q CTR6010 EXT 5,093# (2)9 1/4"MICRO HEADER �1
431# FWG6080" FWG3380S (a)2xs C335 (4)2x5 FWC10080-4 4177# 5# H
•SPECIAL L
2,701, 2708 2,708y 2 708 712# 712
3 45 (1)2x6 (1)2x6 Boaz J Bve ��2 29 -3842- (1)21 (1)2x6 4410 OD118 # N a
# II CAR MBT1 �DW PREP B78 O O BD36-3D 5118 \ 0
S836-UT I SL 1 4945# N •RAISE At; 2
DINING ROOM ® KITCHEN ollz
V30"� o �Z N
®17'-6" x 12'-8 1/2"
e36 L
o `o
aa o
� " o) 2 1 MICRO2ND d 14'-4" x 12'-8 1/2" S
NB24
5'-6" 4945# n
2187# n Y4*4
III Il LIVING ROOM to N I cV Q JOHN A .�
KITCHEN NOTES: 15'-2" x 26'-2" N O I w WALLEN
-RAISE CABS 3/4" ?
i -DELUXE CAB'S NO.4657
-2 3/4" CROWN MOLDING �i ~ x�
U I
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a��m m I o
CEI L L210-4 x Al
5 31# 2x sosz x
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A60 - ] D24 _(4)l 1/2'x 9 1/4"MICRO-2ND FLEA. MOD] `+�N --UA Jill
N 5 31# //// # 8,169yy - - ao 218 •SP CIAL 2738# 3032 2738#
(1)2x4 (1)2x4 (5)2z4 no�P 2)2z 945 DEAD LT*
^'
"V � _J DECK & ROOF vj v o
5 31# I °Jv<wo BY B/P '"aft
a3 U N
ut I o 12"PANTRY
3 I m o
I
BC-4 �d N SL I �\
o �¢ m O 4945 IEngine [a 41► e:dsaw��s:is a13 b18 to 2
I -RAISE V # I 1FE medA'ar tnartion crl tine bsilding lbidt in the: 5 x
ZLO -- _ co &WC 3/4t' IGN � eGrrF,ara1.is 001 to he then as F1accrxd Desna W c)
N OFFICE -- -J J EICM lessi�!lafoni �l.IYsrt mledwo� by nf
� UP z o ,EnY dfrnrns,l;M Bax7del-e pan s?r,Etc:.are:ta be. zi
13'-10" x 12'-8 1/2" r1t esiBnedl by a r�leiad pEofessional on,sits,and
4945 'E.Rat designed,In Otis 3 1No+51- LL rn rn
3 45# 4410# =2I
L
4714
100S S606 100S < E `o M
o 00
at3t# 3046-2 T,ea7# C14T C 4 1887# 3046-2 4945 pN J O 3:
PORCH /ROOF I N V ^ =z 00
T-7" 10'-5" 6'-O" BY P 6'-O" 10'-5" 7'-7" W o a
D_M a c v x
v v
CD w Lj r1/ O 3 O
?� N LJ_
*9'-0"1ST FLOOR CEILING HEIGHT* aZ O 0 CD
*ANDERSEN 400 SERIES WINDOWS W/GRILLES IN TOP SASH ONLY* J l 4 O =N
-5 PANEL MDF INTERIOR DOORS Q J aNi
-lx4 CASING & 1x6 BASE TRIM Li -Z, =i
z � V
o cn
-y
m M
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U J Q LO
I— f Z Q�
Q O J W
z = Q O_
LIGHT & VENTILATION SCHEDULE (SF) o o w a O ®®
< z 0 O
ROOM AREA LIGHT SUPPLIED VENT SUPPLIED Q a U) V
LIVING ROOM 397 77.3 45.59 0 0 z rn
DINING ROOM 182 Q m o Cn o
KITCHEN 222 18.2 9.20 11j>_ ••v Z, -I
OFFICE 176 35.6 15.66
c�- o rn
W Z< O �O O II
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0 U cV !A
N o ra ut
r-------------------------
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I I LLI
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48'-0"
z
I p
2'-6" 12'-6" 18'-O° 12'-6" 2'-6" U
I W
6'-3" 6'-3" 6'-3" 6'-3" PORCH ROOF TO BE STRUCTURALLY
a
INDEPENDENT, DESIGNED AND SUPPORTED I N
LATERALLY ON SITE BY B/P. ON-SITE I Z PFS Corporation
�/ 2 ROOF TO BE APPROVED AND INSPECTED
4177# 304 -2 2,9205 ,920!/ 304 -2 4177# BY THE LOCAL BUILDING INSPECTOR i r Northeast Region
(2)2x6 t-
_ _ _ _ _ _ � APPROVED
(2)11 1/4" MICROLAM DROP HEADER 1 ______ L_IN_E OF MODULE_BELOW _- ---___1 d H Raup-3
45 DECK BY WMH l
# 4410# MAX ALLOWABLE WALL LOAD 2/10/20
2xE WEATHER PRO W/X," PLYWOOD NI W1RO F M T REL&ELEV FOR If�Ic1,5DG LF I
I -I CRO PROEE 71 •PITON OF Fl ALLOW
ROOF MATERIAL E TIRE DE RAIL -- �_ Approval limited to
----------------------
I � ACROSS DECK 4 MINIMUM TO ALLOW DRAINAGE OFF ENURE DECK -
______ I L__ __ I S Factory Built Portion
MSTR BDRM • • BEDROOM 3 0
RAISE 1 1 4"• *RAISE 1 1�4"
PS61611 PS61611 n I I
14'-2" x 12'-8 1/2" 11'-8" x 12'-8 1/2" 0°
1
, Y4�4
m I
3 SITTING ROOM Q ALLEN
a
17'-11" x 11'-8"
OD N0.457
N I
a to o i Lv
Np r1 _ I �- N
W 1 500 LF
2,46
1 1 1 2" x 11 1 4" MICRO-ROOF EA. MOD. #/ I
DN / MAX ALLOWABLE WALL LOAD
=
N 2 2x
= _ (1)1 1/2" x 14" MICROLAM_-ROOF[EA._MOD.] ------------MAX
i� 4.4221 1,958 LINE OF MODULE BELOW I 2/7/2020
(2)2x (2)2x
N I ----- >____11
P DT.S m �)
�2" x i I N to I - `� O
N SiALC DIED
j0 O I �� �' w
-- o o
I - I D26 ----------------------- U o
D28 I
T R@wwIn
I
llllLJl z m SL 1 3n_IEngi .S�on these rrawiVs is apphcatia bo p Y
-RAISE V N .he mcrJ.Jar pardon cA the teiidiV�1 in�the: � w
;2 O wC a/V 3-0 I= O I aGcrF and is v►at ba be tr9cen as End lDa + w
fens aN filar a i»ie IPG31ts mcrledl W-0b by
3.> ; BEDROOM 2 ---- -- g� ¢b,l iAtier„on sue,e�are
O w DBX70 0 > !1a t�
> a -RAJSE AIt I try ��steredl pwfiEssanal-an sha,a d
3 45# �m ,n z We /� I 14 2 x 12 8 1/2" r nat degrteaf to totsypnvAal. �/ v 00
oz J o I o I �
I 7 S"o
I = N i�cNN I N 4410# cI Z cn I
I " �
L o M
304 T-2 1887# 2446T-3046T-2446T 1887# 3046-2 O U L
H w Z 00
5'-1" 16'-5" 16'-5" 5'-1" 00 o Q °� x
C
0
JW C LL
2'-6" 43'-0" 2'-6" z 5 O O 3 O
*ANDERSEN 400 SERIES WINDOWS W/GRILLES IN TOP SASH ONLY* a� � ��J
-5 PANEL MDF INTERIOR DOORS Q �M
-1 x4 CASING & 1 x6 BASE TRIM 1-
® N
m J Q O Z � c' H
LL) W U00
LIGHT & VENTILATION SCHEDULE (SF) o0a
z[if oZ W ®®
0 Z O
ROOM AREA LIGHT SUPPLIED VENT SUPPLIED Q a V) 2
MSTR BDRM 227 28.4 13.66
U Z N Q
Z :2a 0) L�
BEDROOM 2 157 30.9 17.19 Q m o o
BEDROOM 3 178 30.9 17.19 V j _j_j ••c~� -�
SITTING ROOM 165 64.8 31.12 W z_
� O coo o C
LU (nLato o�
J2e!Enganrr Seat xJ'hese Eia+xiws:[s applicatAe to
he mo&-tar portion cot the buiyr*bush in ttee
ectccy,and,is ooI to he traken as Po=d design
Iessioriall inr I'Ne Ip3eiec1.I Ens;Poled aide by
by dames,trr aid er•43n she.edc are:to by
stigned by,a regsteiedi pcofessianal,on;site,and
e not designed in this app4DwA.
�•-0 - SHEAR WALL DESIGN:2015WFCM(ENCANEERmET MHOD) SERIALP 19212
LOCATION Main House Fjao, 2
11
DFSIGNCRI AA
3 45 44I wirm s (voil 140 mpn Rpm Aldo Ion 12) T
Expa.arecmagarY ,w_ e nberm tim
ed , U PFS Corporation
r I Exposure Facto 1.0 was/At n) 6 Z
n LLj
N ----J L- SHEAR WALL SPEDIFICATONS wRIISbm h( P 1•sltlePl 2aitle Northeast Region
Tr1TWSPw1th I-UyPsum[Per Teble3V0J 6•Edge nrainr0 a% wA Q APPROVED
Min.Sagmenl Ratio Ito 1) 3.5 W Edge Mellil0 590 f 080
Mtn.Seqn,ml Length n 2.29 3 idlips Nalfing Z H Raup� -3
Load Parellm Load POryendiCWhe Z/t O/LO
SE6MFD7ED TYPEI SHEAR WALL DESIGN to tld on. tots e
BWMi. ElBletion Flora Rem Len Right V Approval limited to
L ndvreu-Leal a) 48 4e 27.2 27,2 LILJJ Factory Built Portion
ERecleeL hmfNl 511aathi Lm n 18.3 123 IS'S 15
CL
11Nt lmerel load fm Ram IIM er Table 2.6eAA 121 121 190 -19D IN
Writ Lmerm Load b Flom gbs)floor
Tabla 2.6BAA IN 10 219 219 Z
Total Shear Wall Loads per Side psi) 1646 1616 456(1 4560
I Re hed Snaar Well Stren h I 90 13a 276 304
O
h W9n Height Adlusi l[Per Footnote 21 1.000 1s000. -1000�. 14WU_
-- I OK O ON OK
Holddown Capacity 1 -Se mend Wall. 2nd Floo 719 1070 2211 2432 Q
I Parimelm streer aW In Ear-Hat-( so 134 277 3g4 0-
--- I PonmILV Snem Nellin on mmtere lbr uN nollAcdenelletl 20 14 r 6
h10 W nails In eedi end of l 114•steal strops 4E•o... 3 9 9 10 O
No ild null,In each end o111N•.1eel.t 3Y o.c. '2 3 6 7
O
I O O I . PERFORATED E11 SHEAR WALL DESIGN Load Paratl.1 Load Perpendcular
Nmimum 1tr"MIn 4.7 47 4,7 4.7
• II P a 0.38 0.211 0,61- -0.55
bS .Iw 436 .. 730
A4astad Shinnied Value Fw Po*,d ed Wns 153 140 330 371O * _
OK OK OK OK
NOLDDOWN CAPACITY Ilea-PoIcated Wall$ 21d Floa 1887 4177 38.5 Mto
3 45 '�NFI r---- Penmelar snow and 9e eetwoen aWOae (pen 2% s23 45e 552 +`.1M
I I Pe anlm Shear Haling on cenfere b tad nor ls-Tacna led 6 4 5 9 ,
O I 410# No W nails m a$cn end of I III atom.1 46•Ad. s n 5 m
No W"is in each and of 1114•stem atreps l8•b.c.. 3 6 s
JOHN A �
1887 J SHEAR WALL DE410N:201E WFCIA ENGINEERED METHOD SERVLL0 19212 WALLEN
#�, 9'-2 1/4' I- �, 9'-2 Ile I188717
XXXff � LOCATION -MBIR H0080 Flow:. 1 NQ,(657
48'-0'
f- p
WindDESIONC-(Vidt4 W '`QI
V✓.p Speed(Vutt) 14D mph Rpm ptic.(an 12) 7
-O. Exposure C tego y 8 lumber m Stands Braced 2 �' �L
'-11 7/8' f�5'-5 5/8' 10'-7 7/8' }•_8,/B• Exposure Fnctw t.o wml ln:' n)
�I SHEAR WALL SPEGRCATONS V401 StRn P I-side Ry 2aids
431 77# 41 # 9 5 Ille•WSP wt.Ii7 GYpsmn[Per Teals 3.1701 ur Edge Histi 1p 4- WA
Mtn.Segment Ratio(to 1) 3.5 4!!!!..". 590 1060 2n12020
3 45# - -_ Mot.5 me t n Lnl 2.57 3 Ed Netu 730 1380
-J ® 4410# H
ad
GO
Imd Parallel Load PerpeodlcWar ` N
# seGMFM® E I SHEAR WALL DESIGN to to nape
BWdi Elevmion F- Rear Len RI 1
.dWag-Lovell e) 46 48 21.2 27.2 Q N Q
EdelL of Full t Shemni •Lot fll 21.3 227 18.3 W.1 O \ O
\ 49 Unit Let-,Load Ire Rom(IDs er Tabb 28Bul 121 121 190 S O
Unit L.-Land la Floor Ip$) er Table 2.1 1as 198 219 219
Tmri Sheer Well LaaO Ske WI 4338 43M NIS BB18
h Pedaled She au Well$ 1 6 229 215 603 549
• PmidedSeearWall Steen .Id --436 -438_. _731) _.590
W.II Hsi hl Atl WMA Pm Footnote 2 1.125 1.125 1.125 1.126 Z
OK OK ON OK O_ Y
HolddowRG d 1 -Sa mood Wall. 1st Flow 2OW 1935 843/ 45411 W
r Pmtmelm Sn nr and Llplin Sawtwn Hdtlpowe 204 102 07 469 W U
Pmimlm Shear NaiOrg on centma b 18d nala-Toenai1.- 10 10 4 4 a.
r 31 IVY I - 49 No80t1elmmeaehandid •stem.tra�� as•A.e. 7 7 17 to
• II No ad nails in cede end m 1 1/d•Clem atr.ps 37 o.c. 5 5 12 11
N 31 ® 49 #N Holatlswnw d1Y test-ssgmenmd Weus-Both 27U 3005 9076 93% /'�/
Yf I PERFORATED 11 SHEAR WALL DESIGN Load PareBel Load PeMenlicular L..� U on
• Maximum Opening HetgM(n) 3.7 4.7
31# I Percwa Fail Haight Sheath 0.44 5A7 q
I PmJtl.tl Seem Wall.Suen nl 10 _..580 -.Slo_
I
i j Measles Shemwall Value For Penitential Walls 241 257 N
N
OKOK
HOLODOWN CAPAgT/Ibs•PaHwaMd WAIIa lri f 4131 3B37 ` E �OPelar Shad,a ten -M 18 .(romemlad 459 .05 <t.l • O 3 Lr)
mim $.ear NeilsSTRAP STUDS ABOVE TO y NamvJl6ineecherwmlv4•etaelel �de•o.c. 15 13 w� U = z••t
# I!o Btl realis in each mM of 1 1✓4•steel al 16'o.c. 5 5 H N 00
HEADER & HEADER TO HOL�D"W PAOW(lb -P.r .dWell.-Total me 7814 ZO
JACKS W/[3] C518'S W/[8] a -20 X
10d'S EA END # SHEAR WALL DESIGN:2015 WFCM(ENGINEERED METHOD) SERIAL a 19212 C
4410# (� ¢ m-1 -� C l�
an 645 N LOCATION sumpout Floor t _ a-1 1 3 O
N
4131 1887 1 87 494 DESIGN CRITERIA
0 c 1 0�
# # 8 # V 7
# Wmtl S u01 140 mpn Root pitch(an 127
4'_y 6'-2 5/e' 8'-2 5/8' 1'-5' Exposure Category B Numberot Stariea Erecee - 1 N W L c
Ex ure Fectg 1.0 Wall Height n 9 J 1- ��t/✓✓11NII U
48'-0' d7 -N
SHEAR WALL SPECIFICATIONS Wml Stre th(ell) PM t-9ide Pit 2-side rn M
00
13'-10 1/2' 7/18•WSP with 1/2 Gypsum[P..T....2.1701 6'Ewe Naillrg 636 NIA Q� N
Min.Segment Ratio(to 1) 3.5 4•Edge Natlirg 590 1080 (� C
Min.Sepmenl Length,(fl) 2.w 9'Edgar Nails I. 13M L•L� Z V O d
00
12 12 Load Pamlel Load PeryaMicilar < (N m
SEGMENTED PE 1 SHEAR WALL DESIGN la n e to r e _y � C=
14 0 MPH WIND ZONE Length
ength Ele elmn Front Ram Lan R2.5I
U
Len not Wall-Lwml(nl 14 14 12.5 t2.5 '^ m J Q M
Edecliw L h of Full Heigm Seralhi -LM In) '5.2. 10.2 7.1 9 V 7 N �J
SHEARWALL LEGEND - Unit L.leral L0Wde Roof llba)IPor TIl at -91 94 149 219 O ®®
O Untt Lele Shear
load Lo Floor Side or T.lo 2.8B8A 588 IN 2i9goo NO 0 0 Z Q' O
ALL FIELD NAILING IS 12'OC 0 7 3# Total SMar Wan Loan r Side jibs) 588 588 960 990 O
IN GN9 FASTENED VATH ADHESIVE PER 2187# R ubed Shear wan Slrengm 1 127 65 155 I36 M W
MANUFACTURER'S LOAD
RESISTANCE.
G1YB Pmetled$near V✓.Il Btmngth( 435 -12 .636 _ 636_. z Q O O A
ADDITIONAL LATERAL LOAD RESISTANCE t00PlF I . i wa$MeigM Adluslmenl[Pm AlFoottOle 21 1.125 t.t2S t.t2s 1.125 Q O = TC qq
OK OK OK pK Q J Z
SHEAR WALL-436 If I \ PERFORATED TYPE 11 SHEAR WALL DESIGN Land Perellel Loaf Perwwoc�ler O W Q
® P m .-mud,L3perung Ha m(it) 6.7 6.7 g.o 4.7 (Y m X O
EDGE NAILS:ed COMMON NAILS O 8'o.e. I
SHEAR WALL-590 If _ Pmceat FWI Heigh,SS, g 436 0.73 o57 o.e4 Q Q N � t `
I I m PmvlOotl 3nem Wml Slrelgth fall) -d%_.__4% 1%
Z J v
® P 1` I Adj.eled Sneamall Value For Penanuatl Walls 149 293 228 257 Q <EDGE NAILS:Bd COMMON NAILS O 4'o.e. I - OK ON OK oK z
HOLDDOWN CAPACIT'(lb -Portoralied Walla 1st Floor 2738 712 M97 1723
® SHEAR WALL-730plf ------ Pedmmmshomandu nn6.1-hH4loaoentpn 305 so 2ae 192 Q m O o
EDGE NAILS:Bd NAILS O}'o.c. t2l87# 2738 273 # PMmtm Shear Nalli on corms nr tsar"lees-roanaued s 20 a t6 (n J J v � -
-1 s 1/a '-e t/4 NpNo mneilem�cnabmiva•s� mrero®cap. 1c 3 3 3 U 4i CA
LOAD(lb.) AND REDUIRED LOAD BY B/P _13'-10 1/2' - LLJ
IJ..I NQ O O •�
•ems N Ln
SEE PAGES 2, 3A, 3B, 3W �
& 8 FOR ADDITIONAL CD
FASTENING REQUIREMENTS FASTEN RAFTER TO FACE
2x8 SPF/2 RIDGE BD WALL W/16d NAILS 0 16'O.C.
C520 STRAP W/(2) (3)18d RAFTER TO RIDGE CONNECTION ALONG TOP PLATE OF WALL
In (n
12d NAILS EACH END CONT RIDGE VENT 18 '/LF 2x8 SPF/2 RAFTER O 16'o.e. J V
�(2)
12de (3)12d NAILS O 12'0.C. 2x4 0180O.C.FACEWALL FASTEN TO
111"' RIDGE W/(2)1�K
8d NAILS EACH SIDE Q W
_ T (3)16d RAFTER TO PLATE CONNECTION (�
PRE ENGINEERED - W Q
INSTALL 2x4 BRAgNG CERTI ED RO�TRUSS DESIG MMHB STRAP FASTEN PLATE TO EA(21 CHTOP dCHORD Z
ACROSACROSS TOP OF BEAM& ���
S
KNEEWALLS FOR ALL LU210 O NAILS O
MIC20LAMS 14'&TALLER CLEAR SPAN
ROOF CLEAR SPAN DETAIL AIR BAFFLE BY MMHB STRAP CO W PFS Corporation
R49 INSULATIo MHB STRAP � a Northeast Region
W/VAPOR BARRIE - '�1x8 SUB-FASCIA REVERSE GABLE FRAMING VI
Z APPROVED
11e 5/B'YCEILINGY GWB Y Y TYP INTERIOR WALL x ---ALUMINUM
LUMINUM FASCIA _ Z } H Raup-3
MMHB STRAP [2]2x4 SPF#3 TOP LATES F-
2x4 SPF p3 016' . . STUDS VINYL SOFFIT 10.7 In'/ft' VENT 2/10/20
2x4 SPF LE PLATE
1/2' BOTH SIDES Q Q Approval limited to
'o p 0- factory Built Portion
R- RIGID FOAM INSULATICN m e Ert;)ineu Seeal cci arose diamIngs is appicaue tD Q
IN FLOOR PERIMETER N modtC3u*pcatkrt cA lix-building�l if the N
R21 GATT INSULATION n arKJ 6�43 itv taken;as Rome d Design
IN CEIUNG PERIMETER I leasieTvi�aue pipiee i.Items noted IWO,by
2x10 SPF_�12 O 1 OC FUt JST s--_- J''P.�"' rs.by Eftikler,on she'..e=,3�7a Lei W
_6-SPf_A2_ 6�4C_.CtG�Js�_ W-9--d by a r gis ad Lwale5S106Ta1,on:-J1e .avid W
5/8'CEILING GWB .trot desired:in diis.appro-raL (n
TYP MARRIAGE WALL
TYP EXTERIOR WALL 2x3[2]SPF/3 TOP PLATES C
(2]2x6 SPF#3 TOP PLATES g 2x3 SPF#3 0 12'O.C.(1at FUR)
2x6 SPF#3 O 16'OC STUDS
o ou 9' 2x3 SPF#3 0 16'O.C.(2nd FUR) tad COMMONS Q
2x6 SPF p2 SOLE PLATE w Ate" 1/2'AGENCY RATED SHTG.MAT.SIDE o 2ND FL _ 1M WL 012, WALLEN oc
1/2'CWB INTERIOR SIDE .o W I - 1/2'GWB INTERIOR SIDE
R21 INSULATION WITH VAPOR BARRIER = 2x3 SPF AlT SOLE PLATE \ 1ST FL CLG NO,4457
1/2'AGENCY RATED SHEATHING EXTERIOR SIDE �ad COMMONS
WEATHER - PROTECTIVE BARRIER 1p m a O 6'o.c.
NORTHWOODS SIDING n rc = LLI
.p AGENCY RATED SHTG. v
n TYP d
SUB-FLOORING 3 4' it
2x6 PT SILL PLATEWMW,2xlO SPF#2 O 16 OC FIR J m 24 SPF 2.(SUPPLIED&INSTALLED BY B/P) OUTRIGGER O 16'O.0 SIMPSON H3 CUP
(TYPICAL)
R19 FIBERGLASS INSULATION FASTENED TO DOUBLE (
LALLY COLUMN To COMPLY W/ENERGY CODE m TRUSS 21712020
FOUNDATION WALL >
(INSTALLED BY B/P W/VAPOR m (3)16d TOENAILED
BARRIER TO WARM SIDE) (2)16d
FOUNDATION FOOTING DOUBLE TRUSS FACENAILEO 0 m
CS20 STRAP W/
COLUMN FOOTING EACHaENDi� I O\ O\
SHIP LOOSE 0
JOIST HANGER CLG GAMBREL GABLE
PERIMETER TO DBL WALL
TRUSS
C520 STRAP W/(2)
12d NAILS EACH END (2)16d'a TO NAI 0
12 TYP ROOF (2)16d's O 18'O.C. ZO U =
7 30 YR SELF-SEALING FIBERGLASS SHINGLES do
OVER 15#ROOFING FELT 2x6 G/E WALL w U
2x6 SPF N2 OVER 5/8' AGENCY RATED SHEATHING L70 HANGER BELOW
OUTRIGGER 01 O.0 - BITUTHANE APPLIED CONTINUOUSLY RAFTER TO CLG O_
FASTEN TO DOUBLE
TRUSS W/(3)1 DOUBLE
TQ E(IVES FOR ICE SHIELD PERIMETER
2x6 SPFS2 3-8 2x6 SP_ _2
2x6 CEILING JOIST R49 INSULATION OR6'O.C. C C"CA
�i O 16'O.C. W/VAPOR BARRIER (2)16d'a FACENAILED I N
L7q 1'�NGER/ \`A22 AMING ANGLE 2.4 OUTLOOKS 0 24'0.C. 45
N I
[,-� 12 -� (1T2x6 STUD(,MIN] DOUBLE TOP PLATE N `r N
iiOCATED U DE
( L70 HANGER PERIMETER
102
12BD 2x4 SPF p2 STUDS Q O Q
2x8 SPF RAFTERs I R1S INSULATION R1S INSULATION O 16 O.C. ' ` = Z
O 1 00
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USE GROUP: BUILDER: HOMEOWNER: SERIAL No. 9212.
PE RA THIRD PARTY INSPECTION AGENCY
SINGLE TOM FISHER
FAMILY McNABOLA HOMES, BUILDING
CONST. TYPE: AND REMODELING LLC SITE: PRODUCTION No. -n Z 9
WOOD 92 STANHOPE ROAD 164 ANNABLE POINT ROAD _ T C4
FgAMFDESIGNER, FALMOUTH, MA 02536 CENTERVILLE, MA 02632 REVISION DATE Q a .N`.. y � 0�1 G
V.GIORGIO o1/21/20 �� `-•- c p o
COL ONIAL CTM — R N�
12 09 19 1 st.FL ELECTRICAL PLAN V 'Z s a � `�' ° �
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PAGE: Westchester Modular Homes Inc CHECK DATE O
6' A ®®® 30 Reagons Mill Road, Wingdale, New York, 12594
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SEE STANDARD NOTES & DETAILS DWG #8
USE GROUP: BUILDER: HOMEOWNER: SERIAL No. PE RA THIRD PARTY INSPECTION AGENCY
SINGLE McNABOLA HOMES, BUILDING TOM FISHER O
FAMILY AND REMODELING LLC S1 �J/�,�
12.
CONST. TYPE: PRODUCTION No.
WOOD 92 STANHOPE ROAD 164 ANNABLE POINT ROAD
gAMF(VB) FALMOUTH, MA 02536 CENTERVILLE, MA 02632
DESIGNER: REVISION DATE Z
V.GIORGIO /21 Z �:� 0 y
C 01 /20 OLONIAL CTM — R o o s
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estchester Modular Homes Inco o6 Reagans Mill Road, Wingdole, New York, 12594 CHECK DATE3 2
(845)832-9400 Fax (845)832-6698
ANDERSEN WINDOW SCHEDULE EXTERIOR DOOR SCHEDULE
WINDOW SERIES STYLEFAVENT SF U VALUE SHGC ROUGH OPENING UNIT AREA SF THERMATRU DOORS
AR31 400 AWNING1.40 0.29 0.31 3'-0 1 2" x V-5 1 2" 4.2 DOOR TYPE SIZE CLASS(SP) VENT(SP)"U"VALUE MATERIAL REMARKS
AW251 400 AWNING2.10 0.29 0.31 2'-4 7 8" x 2'-4 7 8" 5.6
AW41 400 AWNING1.70 0.29 0.31 4'-0 1/2" x 2'-4 7/8" g5 DX302 S606 HINGED 3'-0 x6-8 N A 20 0.16 FIBERGLASS 2-PANEL 3-UTE
C14 . 406 CASEMENT5.60 0.29 0.31 2'-0 5 8" x 4'-0 1 8" g,p S100SL SIDELIGHTS V-2" x 6'-B" 2.60 N A 0.27 FIBERGLASS FULL GLASS
C335 400 CASEMENT9.20 0.29 0.31 6'-0 3 8" x S-5 3 8" 20.4DX30 5118 HINGED3-0 x6-8 10.92 20 0.37 FIBERGLASS FULL GLASS DOOR
2446 400 DOUBLE HUNG4.38 0.30 0.31 2'-6 1 8"x 4'-8 7 8" 11.70
3032 400 DOUBLE HUNG 6.9 3.85 0.30 0.31 1 S-2 1 8"x S-4 7 8" 3.82 SF
O 3046 400 DOUBLE HUNG 10.3 5.73 0.30 0.31 S-2 1 8"x 4'-8 7 8" 5.70 SF
ANDERSEN DOORS
DOOR TYPE SIZE CLASS(Sr) VENT(SP)KVA MATERIAL
PS61611 PERMA-SHIELD GLIDING 6'-1"x 6'-11" 32.40 15.56WOOD NYL
FWG10080 FRENCHWOOD GLIDING 9'-9 3 4"x 8'-0" 46.40 28.40WOOD NYL
FWG6080 FRENCHWOOD GLIDING 6'-0"x 8'-0" 29.80 17.85WOOD NYL
FWG3380S FRENCHWOOD STATIONARY 3'-3"x 8'-0" 14.90 N/A 0.30 WOOD NYL
O = THESE UNITS MEET OR EXCEED A CLEAR OPENABLE AREA OF 5.7 SQ. FT., WIDTH OF 20", & HEIGHT OF 24". r-_
ALL THERMATRU DOORS HAVE LEVERS W/KEY SET UNLESS OTHERWISE NOTED ON PLANS.
WINDOWS FOLLOWED BY "r IN FLOOR PLANS ARE TEMPERED ALL GLASS IN DOORS TO BE TEMPERED
FLOOR PLAN NOTES
1) THE BUILDER/PURCHASER IS NOTED AS B/P. 7) ALL AREAS TO BE FINISHED OR BUILT BY B/P ON SITE TO BE IN COMPLIANCE WITH ALL
2) SEE FLOOR PLANS FOR LABEL LOCATIONS, ABBREVIATIONS ARE AS FOLLOWS: APPLICABLE CODE REQUIREMENTS INCLUDING (BUT NOT LIMITED TO) GARAGE, ADDITIONS,
MSTATE LABELS ®INDUSTRIALIZED BUILDINGS COMMISSION PORCHES & FIRE SEPARATIONS. TO BE INSPECTED AND APPROVED BY LOCAL BUILDING
iq THIRD PARTY INSPECTION AGENCY fWnWARRANTY LABEL OFFICIALS
®DATA PLATE ®CONNECTICUT LABEL/THIRD PARTY INSPECTION AGENCY 8) ALL INTERIOR AND EXTERIOR HANDRAILS OR GUARDRAILS ARE INSTALLED BY B/P
HAVING SPINDLES SPACED 4" APART. HANDRAILS FOR STAIRWAYS SHALL BE CONTINUOUS FOR
3) MAXIMUM HEIGHT OF EGRESS WINDOW SILLS IS S-6" ABOVE FINISHED FLOOR. THE FULL LENGTH OF THE FLIGHT, FROM A POINT DIRECTLY ABOVE THE TOP RISER OF THE
4) REFER TO ORDER SELECTION FORM FOR SPECIFIC APPLIANCES SUPPLIED WITH THIS HOUSE. FLIGHT TO A POINT DIRECTLY ABOVE THE LOWEST RISER OF THE FLIGHT.
5) BATH ROOM FANS ARE RATED AT 70 CFM UNLESS OTHERWISE NOTED ON PLANS. 9) ALL FACTORY INSTALLED/SUPPLIED FIREPLACES ARE TO BE COMPLETED ON SITE BY B/P,
6) ATTIC ACCESS(ES) ON CAPE MODELS ARE TO BE DONE ON SITE BY THE B/P. INCLUDING FLUE PIPES AND FIRE STOPS. NOTE: NO COMBUSTION AIR TO BE DRAWN FROM
BEDROOMS.
SUPPLY NOTES DWV NOTES
1) MATERIALS ARE TYPE A PEX. 1) MATERIALS ARE PVC SCHEDULE 40.
2) WATER SUPPLY SHALL BE SECURELY ATTACHED TO THE BUILDING AT NOT GREATER DISTANCES 2) DRAINAGE AND VENT PIPING SHALL BE SECURELY ATTACHED TO THE BUILDING AT NO GREATER
BETWEEN SUPPORT INTERVALS THAN SPECIFIED: SUPPORT INTERVALS THAN SPECIFIED.
HORIZONTAL PIPE ® 32" HORIZONTAL PIPE ® 4'-0" FOR 2"0 OR LARGER v 3
VERTICAL PIPE AT MID-STORY (10' MAX) HORIZONTAL PIPE ® 3'-0" FOR 1 1/2"0 OR SMALLER
3) WATER HEATER SHALL BE SUPPLIED AND INSTALLED BY B/P. VERTICAL PIPE ® 4'-0" i)i jg
4) ALL SUPPLY LINES ARE STUBBED THROUGH THE FIRST FLOOR. SUPPLY LINES BELOW FIRST 3) ALL DRAINAGE CONNECTIONS HORIZONTAL TO HORIZONTAL AND VERTICAL TO HORIZONTAL PA w-G`
FLOOR SUPPLIED AND INSTALLED BY B/P. ARE LONG SWEEP OR DOUBLE 45' FITTINGS u7'W^
5) ALL HOT WATER LINES IN UNHEATED SPACES SHALL BE INSULATED BY B/P. 4) HORIZONTAL VENT PIPE CONNECTIONS TO VERTICAL VENT BRANCH OR STACK SHALL OCCUR
6) ALL TUBS AND/OR SHOWERS SHALL BE SUPPLIED WITH ANTI-SCALD VALVES.] AT LEAST 6" ABOVE THE FLOOR RIM OF THE HIGHEST FIXTURE SERVED BY THE HORIZONTAL
7) ALL DEVICES INSTALLED WITH SELF CLOSING VALVES (I.E. WASHER, DISHWASHER) SHALL HAVE A VENT. IR -�
WATER HAMMER ARRESTING DEVICE ON THE SUPPLY LINE SUPPLIED AND INSTALLED BY B/P 5) STAND PIPES SHALL EXTEND NOT LESS THAN 18 INCHES AND NOT GREATER THAN 42 INCHES T1T
ON SITE, IN ACCORDANCE WITH ALL STATE AND LOCAL APPLICABLE CODES. ABOVE THE TRAP WEIR.
8) ALL FIXTURE SUPPLY LINES 1/2"0 SHALL HAVE INDIVIDUAL SHUT OFF VALVES. P �
ELECTRICAL NOTES
1) ELECTRICAL PANEL IS RATED 200 AMPS (UNLESS OTHERWISE NOTED) AND LOCATED PER PLAN. 9) WIRELESS DOOR BELL TO BE SHIPPED LOOSE (INCLUDES 2 BUTTONS)
2) NON-METALLIC SHEATHED CABLE IS TYPE NM-B. 10) ONE GFI CIRCUIT SHALL BE INSTALLED IN BASEMENT BY B/P
3) WIRES ARE INSTALLED WITH INSULATED STAPLES. 11) WATER HEATER, FURNACE, BASEMENT GFI, BASEMENT LIGHTS, ETC. ARE THE SITE
4) ELECTRIC SERVICE SHALL BE GROUNDED BY B/P IN COMPLIANCE WITH NEC, STATE AND LOCAL RESPONSIBILITY OF THE B/P.
CODES. 12) A CLOTHES WASHER CIRCUIT SHALL BE INSTALLED IN BASEMENT BY B/P IF WASHER LOCATION
5) ALL ELECTRICAL COMPONENTS SHALL BE LISTED AND/OR LABELED BY A NATIONALLY RECOGNIZED IS NOT INCORPORATED IN HOUSE.
TESTING LAB AND SHALL BE INSTALLED IN ACCORDANCE WITH MANUFACTURER INSTRUCTIONS 13) RECEPTACLES SHALL NOT BE INSTALLED DIRECTLY OVER ELECTRIC BASEBOARD HEATERS.
AND LOCATIONS/USE INSTRUCTIONS. 14) CIRCUIT BREAKERS FOR ELECTRIC BASEBOARD HEATERS ARE ONLY INSTALLED IN PANELS OF
6) ELECTRIC PANEL SHALL BE LOCATED AND MOUNTED IN BASEMENT BY B/P, UNLESS NOTED HOUSES WITH ELECTRIC BASEBOARD SYSTEMS.
OTHERWISE. 15) SMOKE DETECTORS ARE INTERCONNECTED AND INSTALLED ON A LIGHTING CIRCUIT WITH NO
7) A SERVICE DISCONNECT SHALL BE INSTALLED AT A READILY ACCESSIBLE LOCATION NEAREST THE INTERVENING SWITCHES ON THAT CIRCUIT.
POINT OF ENTRANCE OF THE SERVICE CONDUCTORS. 16) SMOKE DETECTORS SHALL HAVE A BATTERY BACK-UP POWER SOURCE.
8) TELEPHONE, AND TELEVISION CABLES TO BE RUN TO THE ELECTRIC PANEL LOCATION. UNLESS 17) BASEMENT SMOKE DETECTORS ARE SUPPLIED BY WMH AND INSTALLED BY B/P ON SITE.
OTHERWISE REQUESTED/NOTED 18) ALL RECCESSED LIGHTS SHALL BE IC RATED AND ALSO RATED FOR WET LOCATIONS.
FHW (FORCED HOT WATER) BASEBOARD HEATING NOTES EBB (ELECTRICAL BASEBOARD) TYPICAL B/P FOUNDATION DETAIL
1) BASEBOARD RATINGS ARE BASED ON 190T WATER TEMPERATURE AT 1 GPM HEATING NOTES
FLOW RATE WITH 65' ENTERING AIR.
2) FIRST FLOOR BASEBOARD UNITS ARE INSTALLED WITH HEATING PIPES 1) ELECTRIC BASEBOARD HEATING CIRCUITS ARE _
TOP OF FDTN wqu
STUBBED THRU FLOOR. SECOND FLOOR HEATING PIPES BETWEEN BASEBOARD 20 AMP, 220 VOLTS WITH 12-2 NON-METALLIC a Z
UNITS ARE INSTALLED IN FLOOR AND/OR WALL PANELS. B/P IS SHEATHED CABLE TYPE NM-B. Uj a,
2x6 SILL PLATE a 0
RESPONSIBLE FOR INTERCONNECTION BETWEEN MODULES AND FLOORS. 2) MAXIMUM WATTAGE PER CIRCUIT SHALL BE A 01N 0
BALANCE OF HEATING SYSTEM IS TO BE DESIGNED, SUPPLIED AND 3750 WATTS $ co
p 0 I N
INSTALLED BY 8/P. 3) BASEBOARDS ARE RATED AT 250 WATTS PER FDTN WALL I c� a
3) ALL HEATING PIPES IN UNHEATED SPACES SHALL BE INSULATED BY B/P. LINEAR FOOT. LALLY COLUMN ^ �
4) MINIMUM THERMOSTAT RANGE IS 45' TO 757. 4) MINIMUM THERMOSTAT RANGE IS 45' TO 757. COLUMN FTG
5) ACCESS PANELS ARE FOR THE B/P TO USE IN THE INTERCONNECTION OF 5) GENERAL LIGHTING RECEPTACLES SHALL NOT BE TOP OF IMT
THE HEATING SYSTEM. THESE PANELS MAY BE PERMANENTLY ATTACHED AND LOCATED ABOVE ELECTRIC BASEBOARD HEATING
FINISHED OVER BY B/P AFTER HEATING SYSTEM IS COMPLETED. UNITS. FDTN FTG
USE GROUP: BUILDER: HOMEOWNER: SERIAL No. �� PE / RA THIRD PARTY INSPECTION AGENCY
SINGLE TOM FISHER
FAMILY McNABOLA HOMES, BUILDING
CONST, TYPE: AND REMODELING LLC SITE:
PRODUCTION No.
WOOD 92 STANHOPE ROAD 164 ANNABLE POINT ROAD „ Z 9
RAMF(VB) FALMOUTH, MA 02536 CENTERVILLE, MA 02632 01 D a N
DESIGNER: REVISION DATE 8 ma _
V.GIORGIO ° N n
DA • STANDARD NOTE Q .0
S, N Z o N ;
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(914)832-9400 Fax (914)832-6698