HomeMy WebLinkAbout0326 BUCKSKIN PATH - Health 326 Buckskin Path
Centerville P
A = 191 127
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UPC 12534 '
No.2 OR .�,
HASTINGS,MN
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No. O Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:_-R
w Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
ZippYication for Mi!9pool *pgtem Conotruction Permit
Application for a Permit to Construct( )Repair(X)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. Q�. �LtA,S cQ• Q Owner's Name,Address and Tel.No.
Assessor's Map/Parcel n
L<�, v-1
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
C o 3S'O
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,
Nature of Repairs or Alterations(Answer when applicable) QtL Q b 0a%y
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 issu 's ar alth.
Signed Date
Application Approved by Date `'1
Application Disapproved for the following reasons
Permit No. Date Issued
Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer. >,
Yes
,p PUBLIC HEALTH DIVISION -:TOWN OF BARNSTABLES MASSACHUSETTS
, 2p rication' for ;Digpozal bpztemc Con!5truction Permit
Application for a Permit to Construct( )Repair(X)Upgrade( )Abandon( ) El Complete System El Individual Components
Location Address or Lot No. 3a to w�L(k S (�\�l°AT',Owner's Name,Address and Tel.No.
w7-9 CFyG6
Assessor's Map/Parcel
2 c��l� s , v.
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
S
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
Nature of Repairs or Alterations(Answer when applicable) m.,o cg'.v. Q a:.v-%
F �
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 issue b ttus and���He�alth.
Signed = �—MnJ.x.r.��.� Date
Application Approved by �. .�% Date G41&411
Application Disapproved for the following reasons
Permit No. Date Issued
i THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
�- Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( 1 Repaired f 1 Upgraded( )
Abandoned( )by G
at G, S �k',v,, (��i�n Ce—v-k e^ i'� a has been constructe#in a cordance
with the provisions of Title 5 and the for Disposal System Construction Permit No.-f - -LI- dated ( `f
Installer A DesignerR
The issuance o s e shall not be construed as a guarantee that the s ill function as designed.
Date��0 �'/ g Inspector� L '� g
-... d -_—— ——— ——————
No Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION . BARNSTABLES MASSACHUSETTS
tg ogar *pgtem Congtructtor� permit
Permission is hereby granted to Construct( )Repair( li�iade( )Abandon( )
Systemlocatedat c �ot�o ➢>Lkg_ u\����
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:Construcfton m st be completed within three years of the date of this-pe it.
Date: n 14 Approved by C_1
., TOWN OF BARNSTABLE
LOCATION ��MP vc ICbS %/l7 � SEWAGE #
VILLAGE C�149 1,11144E ASSESSOR'S MAP &LOT
INSTALLER'S NAME&PHONE NO. "15 CAA"
SEPTIC TANK CAPACITY
LEACHING FACILITY: (typ* (size)
NO.OF BEDROOMS ,
BUILDER OR OWNER
PFRMITDATE: 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
C ccftn, .e V 0
1 � y
1 _
c
C—C k
/rI A►N
I
_ TOWN OF BARNSTABLE
t<Gti ATIGv- o 6 tic kESA:&2 h SEWAGE #
VILLAGE C6A, UIL(.E ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO. A �'16 CA/yC-4d
SEPTIC TANK CAPACITY Adi?a
LEACHING FACILITY: (type) (size)
NO.OF BEDROOMS "'
BUILDER OR OWNER R? A CANCa ZZI;l =
PERMTTDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to.the Bottom of Leaching Facility Feet
Private Water Supply,Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
i � `-�
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e cc�n� ��, � � h
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`` � � ��� 1
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.M , bu ��
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Commonwe M of Mossochusetts Jolm Grad
Executive Office of ErMor mental Affairs D.E.P. Title V Septic hispector
Department of P.O. Box 2119
Environmental Protection TeaticketIIvIE1U2536
(508) 564-6813
SUBSURFACE SEWAGE DISPOSAL
ASYSTEM INSPECTION FORM ' - IVOV C 1996
CERTIFICATION
Property Address: 326 Buckskin Path Centerville Address of Owner:
Date of Inspection:11118/96 (If different)
Name of Inspector:John Grad Dianne Cooper Askew,Trust:109 Barnicle D'.M ssl Mills, IV
Company Name,Address and Telephone Number:
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate
and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and
maintenance of on-site sewage disposal systems. The system:
x Passes
_ Conditionally Passes
_ Needs Furt er Evaluation By the Local Approving Authority
Fails
Inspector's Signature: ' Date: 1mii196
The System Inspector shall su/mit copy of this inspection report to the Approving Authority within thirty(30)days of completing this
inspections. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit
the report to the appropriate regional office of the Department of Environmental Protection.
The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority.
INSPECTION SUMMARY:
Check A, B.C, or D:
A] SYSTEM PASSES:
x I have not found any information which indicates that the system violates any of the failure criteria
defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below.
B] SYSTEM CONDITIONALLY PASSES:
_One or more system components need to be replaced or repaired. The system, upon completion
of the replacement or repair,passes inspection.
Indicate yes, no,or not determined(Y, N,or ND). Describe basis of determination in all instances. If "not determined", explain why not.)
_ The septic tank is metal, cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure is
imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved
by the Board of Health.
(revised 11115195)
One Winter Street • Boston,Massachusetts 02108 • FAX(617)556-1049 • Telephone(617)292-5500
1
f
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 326 Buckskin Path Centerville
Owner: Dianne Cooper,Askew,Trust:109 Bamlcle Dr.Marston Mills
Date of Inspection:11118190
_ Sewage backup or breakout or high static water level observed in the distribution box is due to a broken,
settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
The system required pumping more than four times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
Conditions exist which require further evaluation by the Board of Health in order to determine if the
system is failing to protect the public health, safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS
NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND
SAFETY AND THE ENVIRONMENT:
Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh.
2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER, IF APPROPRIATE)DETERMINES
THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE
ENVIRONMENT:
The system has a septic tank and soil absorption system and is within 100 feet to a
surface of water supply or tributary to a surface water supply.
The system has a septic tank and soil absorption system and is within a Zone 1 of a public water
supply well.
The system has a septic tank and soil absorption system and is within 50 feet of a private water
supply well.
The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private
water supply well, unless a well water analysis for coliform bacteria volatile organic compounds indicates that the well is
free from pollution for that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal or less than 5 ppm.
3) OTHER
D] SYSTEM FAILS:
I have determined that the system violates one or more of the following failure criteria as defined in
310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be
contacted to determine what will be necessary to correct the failure.
Backup of sewage in facility or system component due to an overloaded or clogged SAS or
cesspool.
Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged
cesspool.
SAS is in hydraulic failure.
(revised 111'15195)
2
a
i
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 326 Buckskin Path Centerville
Owner: Dianne Cooper,Askew,Trust:109 Barnicle Dr.Marstons Mills
Date of Inspection:11/18/96
D] SYSTEM FAILS(continued)
Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool.
Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow.
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Numbers of times pumped
Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation.
Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
Any portion of a cesspool or privy is within a Zone 1 of a public well.
Any portion of a cesspool or privy is within 50 feet of a private water supply well.
Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no
acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for
coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen.
E] LARGE SYSTEM FAILS:
The following criteria apply to large systems in addition to the criteria:
The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to
public health and safety and the environment because one or more of the following conditions exist:
the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area (IWPA)or a mapped Zone II of a
public water supply well)
The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program
requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information.
(revised 11115195)
3
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECLIST
Property Address: 326 Buckskin Path Centerville
Owner: Dianne cooperAskew,Trust:109 Bamlcle Dr.Marston Mills
Date of Inspection:11/18/96
Check if the following have been done:
X Pumping information was requested of the owner,occupant, and Board of Health.
x None of the system components have been pumped for at least two weeks and the and the system has been receiving normal
flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this
inspection.
Nags built plans have been obtained and examined. Note if they are not available with N/A.
X The facility or dwelling was inspected for signs of sewage back-up.
x The system does not receive non-sanitary or industrial waste flow.
x The site was inspected for signs of breakout.
x All system components,excluding the Soil Absorption System,have been located on the site.
X The septic tank manholes were uncovered,opened, and the Interior of the septic tank was inspected
for condition of baffles or tees,material of construction,dimensions, depth of liquid, depth of sludge, depth of scum.
x The size and location of the Soil Absorption System on the site has been determined based on existing information or
approximated by non-intrusive methods.
x The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Sub-
Surface Disposal System.
(revised 11115195)
4
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 325 Buckskin Path Centerville
Owner: Dianne Cooper,Askew,Trust:109 Bamicle or.Marstons Mills
Date of Inspection:11/18/96
RESIDENTIAL: FLOW CONDITIONS
Design flow: 0 gallons
Number of bedrooms: 3
Number of current residents: 0
Garbage grinder(yes or no): No
Laundry connected to system(yes or no): Yes
Seasonal use(yes or no): No
Water meter readings,if available: Na
Last date of occupancy: none year ago
COMMERCIAL/INDUSTRIAL:
Type of establishment: FVa
Design flow:0 gallons/day
Grease trap present:(yes or no) No
Industrial Waste Holding Tank present: (yes or no) No
Non-sanitary waste discharged to the Title 5 system:(yes or no) No
Water meter readings,if available: nla
Last date of occupancy: nla
OTHER: (Describe) nla
Last date of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and source of information:
System was last pumped In 1995
System pumped as part of inspection:(yes or no)No
If yes,volume pumped: 0 gallons
Reason for pumping: n1a
TYPE OF SYSTEM
Septic tank/distribution box/soil absorptions system
X Single cesspool
X Overflow cesspool
Privy
Shared system(yes or no) (if yes,attach previous inspection records,if any)
Other(explain)
APPROXIMATE AGE of all components,date installed(if known)and source information:
1972
Sewage odors detected when arriving at the site:(yes or no) No
(revised 11115195)
5
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 326 Buckskin Path Centerville
Owner: Dianne Cooper,Askew,Trust:109 Bamicle Dr.Marston Mills
Date of Inspection:11/18/96
SEPTIC TANK:
(locate on site plan)
Depth below grade: nla
Material of construction:X concreate_metal_FRP_other(explain)
Dimensions: Na
Sludge depth:nla
Distance from top of sludge to bottom of outlet tee or baffle: nla
Scum thickness:nia
Distance from top of scum to top of outlet tee or baffle:nla
Distance form bottom of scum to bottom of outlet tee or baffle:nia
Comments:
(recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,
evidence of leakage,etc.)
nla
GREASE TRAP:
(locate on site plan)
Depth below grade: nia
Material of construction: _concrete_metal_FRP_other(explain)
Dimensions: nia
Scum thickness:rVa
Distance from top of scum to top of outlet tee or baffle:nfa
Distance from bottom of scum to bottom of outlet tee or baffle: nla
Comments:
(recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert,structural integrity,
evidence of leakage,etc.)
nla
(revised 11115195)
6
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
. PART C
SYSTEM INFORMATION(continued)
Property Address: 326 Buckskin Path Centerville
Owner: Dianne Cooper,Askew,Trust:109 Bamlcle Dr.Marstons Mills
Date of Inspection:11/18/96
TIGHT OR HOLDING TANK:
(locate on site plan)
Depth below grade: n/a
Material of construction:_c one rete_metal_FRP_other(explain)
Dimensions: n/a
Capacity: n/a gallons
Design flow: n/a gallons/day
Alarm level: n/a
Comments:
(condition of inlet tee,condition of alarm and float switches, etc.)
n/a
DISTRIBUTION BOX:
(locate on site plan)
Depth of liquid level above outlet invert: n/a
Comments:
(note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box etc.)
n/a
PUMP CHAMBER:
(locate on site plan)
Pumps in working order:(yes or no)
Comments:
(note condition of pump chamber,condition of pumps and appurtenances, etc.)
n/a
(revised 11/15/95)
7
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 326 Buckskin Path Centerville
Owner: Dianne Cooper,Askew,Trust:109 Bamicle Dr.Marstons Mills
Date of Inspection:11/18/96
SOIL ABSORPTION SYSTEM (SAS):
(locate on site plan,if possible; excavation not required,but may be approximated by non-intrusive methods)
If not determined to be present,explain:
nla
Type:
leaching pits,number: n1a
leaching chambers,number:n1a
leaching galleries,number: n1a
leaching trenches,number, length: n1a
leaching fields, number, dimensions:n1a
overflow cesspool,number:one 5'x6'
Comments:(note condition of soil,signs of hydraulic failure,level of ponding, condition of vegetation, etc.)
The overflow was empty at time of inspection.It is structurally sound.Did not inspect system under normal use.
CESSPOOLS:x
(locate on site plan)
Number and configuration: one
Depth-top of liquid to inlet invert: empty
Depth of solids layer: 0
Depth of scum layer: 0
Dimensions of cesspool: 5'x6'
Materials of construction: block
Indication of groundwater: n1a
inflow(cesspool must be pumped as part of inspection)
nla
Comments:(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
Main cesspool and all components are structurally sound.Recommend pumping system every year for maintenance.
PRIVY:_
(locate on site plan)
Materials of construction: n1a Dimensions: n1a
Depth of solids: n/a
Comments:(note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation,etc.)
PrivyComments
(revised 11115195)
i
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 326 Buckskin Path Centerville
Owner: Dianne Cooper,Askew,Trust:109 Barnicle Dr.Marstons Mills
Date of Inspection:11118196
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100'
A
�N
DEPTH TO GROUNDWATER
Depth to groundwater:12 feet
method of determination or approximation:
USGS Maps and Charts
(revised 11115195)
9
.r• -L.�� s'`•_ 'tip
Fis...` ...�..-
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.......................
Appliratinn -fur Bi,ipuiitt1 Marko Tons#rnrfiun Prrutit
Application is hereby made for a Permit to Construct ( ) or Repair ( an Sewage Disposal
System`s��1 �-----,
------- -------------- ---------
Loc ion-Address or Lot No.
........ ...........
Owner Address
Inst er Address
dType of Building Size Lot----------------------------Sq. feet
U Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building No. of persons............................ Showers — Cafeteria
P4 Other fixtures --•--------•------------------ -
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacitv._---------gallons Length................ Width................ Diameter................ Depth-.-.-------_----
x Disposal Trench—No--------------------- Width.................... Total Length-------------------- Total leaching area.............-------sq. ft.
Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area------------------sq. It.
z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed bY-------------------------------------------------------------------------- Date----.-------------------------------....
Test Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water..-._----_-.---.-.-_-_-
G14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water--.-_._..__--__.-_-____.
Ix -----------------------------•----•------------------------------------------------------------------------------------------------------------------------- .
ODescription of Soil------------------------------------------------------------------------------------------------------------------------------------------------------------------------
x
V ------------------------------------------------------------------------------------•----•---------.....-••-••.C....•--•-•-•••----•---•---••-•-••-••-••-•-•-•-•--••----------•------------------- ---
W -------------------------------------------- -------------------•--------------------------------------------- ----- --- ----------
U Nat e of Repairs or Alter tigns—Answer when applicable _ _ _._ _ ._ ..... ....-_-----.Q.Q . _.. �_.....___.-.
------------------------------------•-------------------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article \I of the State Sanitary Code—The undersigned furth agrees not to place the system in
operation until a Certificate of Compliance has *e_ iied ��he b of g
Sign d.
Date
ApplicationApproved By.................. --------------------........................................................... ---------------------- .---------------
Date
Application Disapproved for the following reasons---------------------------------•---------••-•-•-•-•-----------••--•----•---------------------------•-----------
......................•----•••-•-••-•-•------•----------.....--•--------------------------.....-•-------------......•----•-----•--•---•-•-•--------------------------------------------•.--------..----
Date
PermitNo......................................................... Issued........................................................
Date
r ,s;
.......................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEAL H
.
.....................
Apphratioo -for RBVoottl Workii Tote; ' rortion Vaniff
N;
Application is hereby made for a Permit to Construct ( ) o Repair ( ' ) an Individual Sewage Disposal
System.at � "'
nt
Loc . on-Address or Lot No.
Owner Address
Inst er Address
U Type of Building fit.. ,t Size Lot,;'_________________________Sq. feet
:. i
Dwelling—No. of Bedrooms---------...................................Expansion Attic ( ) 'Ga;bage Grinder ( )
_______________ Showers — Cafeteria p.., Other—Type of Building --.------•--•------•--_-.... No. of persons--,=__-:-- ( ) ( )
Other fixtures r -- - .._.. ---•--------
W Design Flow------------------------------------------ g llor per person per day. Total daily flow:_____ :__ gallons.
9 Septic T:uik—Liquid capacity gallons Length ___ ,Width.._................ Diameter --_ _ Depth ---------
W Disposal Trench—No. ......_..__ � , ��idth.__ i__ TotalaLeri th___.__
x p K g Total leaching area ._ -__sq. ft.
Seepage Pit No_____________________ Diameter De th below inlet...........
Total leaching tr`ea:.' _.----.-sq. ft.
P '
z Other Distribution box ( ) Dosing tank ( ) +
a Percolation Test Results Performed by. ....... -_____-- Date___ _-_.-___-_----- ---`
a Test Pit No. 1----------------minutes per inch Depthro_�, est Pit Depth to ground wa-ter
�1
f� Test Pit No. 2----------------minutes per inch Depth of 'Test Pit _._...........__. Depth to ground water �:___ _ �____....
--
O Description of Soil--------------------------------------- -
':::
x ----------------------------------------------- -------------------
-
-------------------_----- ------------- - --- - -------- -- --------------------------------- 4--1
--- ---
-?
V =N at f ep--airsrAlter tious—Answer wh: applicable ---------
---- . -- ---------•------------------•-------------------------•--------.----
A reement:
The undersigned agrees to install the aforedescribed Individual Sewa e Disposal System in accordance with
'the provisions of Article \I of the State Sanitary ode—The undersignedurthe agrees not to place the system in
operation until a Certificate of Compliance has2ee. ssued e b ofSign d. -- •-----
Date
ApplicationApproved By------ ------------------------------------------------------------------------------------------ ----------------------------------------
Date
Application'Disapproved for the following reasons:----••---------•-------•-------•`-------- -------------•------:-------------------------------•---------------
.............•'--------•'-•-•---•-'-•-------••--..--•• -------• --• -- ----- ----------- -----------
Da• ;' - .�. 4 to
n Z�
PermitNo.................................................. -Issued'._ r
w,x Date hz
_THE COMMONWEALTH OF-i:M SX tHUS 'TTS ,t
>' BOARD F HEALTH
.. �
_
v .... -
`�. IWIT'rrtifiratr of 0,11w aurr
THIS IS 0 CER- FY, That the Individual Sewage Disposal System constructe ) or Repairedk,( )
by r`` f--!_ .....
QI stiller Y
ai
has been installed m accordance with_the provisions of -I Rf The State Sanitary Coo as described in the
application for Disposal Works Construction Permit No____ _____________F-1y......_. dated...... "_ ...............
THE ISSUANCE OF THIS CERTIFICATE SHALL. NOT RE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL ;FUN,CTION -,SATISFACTOR•Y. �.
DATE - ............................................. Ins pector....................................................................................
,Y
x'7
r' THE COMMONWEALTH OF MASSACHUSETTS
°w BOARD 9f HEALTH
7'
t. ..........t........................OF.........P ...................................................
. FEE_y+�' �...�
No.. --• 'ter�........
r
���• �r�"�- �i��o�ttl ' rk�. oo�trortioat �rrutit
Permission,is hereby rante ------------- -- ------------------------------------------------•-- .............................................
to Construe ) o R pair ` an Individual Sewage Disposal System
atNo._` ----- 0------ - •---.. z! ------------------------------------------------ -----------------------------..-------------------
--- ---- ----
`. 4` Street
as shown on4he application for Disposal-Works Construction Per i No. ___�___. ted____= ~`----------------------------
Board of Health
DATE---- .: 1. 1---------- --------4:�:--- ///
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS -
LO,'C At ION SSE G E PERMIT NO.
VILLAGE
jel
INST LER' NAME & ADDRESS
BUI'LDER OWNER
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED _ �
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Rear
East. Elevation. _
WrS
Existing ridge
2 x 10 kA rafters
Existing Roof
.. 2 x 8 k.d.ceiling
joists @ 16"O.C. ...
Existing Roof
Closed cell spray
foam insulation R-38 \'
. Simpson H2
hurricane ties
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MVP 1P--
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_ L 6D 7'-7 1/8" t/iJ t 7 5 C_D,X, 7(t/Lv SRO c�
8'-21T4" Existing structure 6-9 sfa" ol / '
f'AS4CP►r wTT� w�c, 1 0
.: 2 x 6 k d.headers .. .. .. ,
with Simpson strap tie �L►1 '
Existing Sun room
Closed cell spray
foam insulation R-20
FE10
D AIR?
N C
HOFic r
ABU46Z adjust 12 x 48"Concrete 2 x10 P.T.floo 2r ��, x 4 k.d.wall studs - - �� : 9Q.•
Existing bulk head Finish grade q• Z-Max Post Base r� footing with.big foot joists P.16"O.C. 2 16"O.C. : C
With 518"Galy.
- - :.... ..: ... - £
Anchor bolt i .... `
No 50306
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MA
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O'REILLY&ASSOCIATES
11 Cotuit Cove Road
Cotuit,MA 02635
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S.ou+h Eleva il
11
al
Right Side
South El evation
12
Roof sheathing to be
. 5/8 c.tl.x.plywood with
6'-6 1/2" _ _ \\ _�- wfcm 110 nailing _
2 x 10 U.roof �" � \ Existing Roof
rafters @16"O.C. \\\ ... - 4'-31l2'. ..
- % N ode s .
0 �I��Prr7f WUI�S �'nff �$
ca:r S ecc(e
. - Exterior wall sheathing.
Existing Structure 1/2"c.d.x.plywood
- with wfcm 110 nailing ..:
I5/8" T-4 5!8" -
..
.. L Closed cell spray foam : .:. .. .. ...
insulation R-20
Existing Structure
... 7x 4 k.d.wall framing
- (81 16"O.C. :. .. ..
' 9 1/4"
i . 6'-31l2" 4' —8'-11/2"
2 ff .,
.. L
.. ' 12 x 48"Concrete footing - _ SjkCD A
5 j�z
2 x10 p.t.Floorjoists 'lac-t
.-. / 4' with big foot .. .. f
Finish grade
ABt146Z Post shoe
- with 5/8"anchor bolt '
0 No.5030� v�
i BOSTON
I MA
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O'REILLY&ASSOCIATES
11 Cotuit Cove Road
�} Cotuit,MA 02635
ft. 1R171 ROQ_RnFF
3a6 VLks }VI 4k .
C eder v /i, . 11 . OdC3
Closet Hall Bath
Bed Room 1
Kitchen
Bath
Ledgerlok lag screws
@ 16"O.C.stagered
2z10 p.t.floor joists
@16"O.C.
Nt
o_ e
LU$210 Joist hangers
every joist
10'41 112"
Subfloor to be 3/4" Insulation to 6e closed
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T&G plywood glued cell spray foam R-30
to joists Sun Room
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Hop
no No.5030f; cn
OSTON rr
MA Jy
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O'REILLY,&ASSOCIATES
I 11 Cotuit Cove Road
Cotuit,MA 02635
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Bedroom 3
2•.y
M Bedroom 2 Living Room
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F77777--
Hall 2 Garage
�24-
Hall Bath -
N N o+e s
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Master Bedroom - Kitchen - '(�
19ar i � t^2,
-_. 10-107/e -
Master Bates
to �
a sun RoomSREC
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. .. .. ..
0 .50 3N �u
� OST'O
MA Jc,,
SSP
O'REILLY&ASSOCIATES
11 Cotuit Cove Road
I Cotuit,MA 02635