Loading...
HomeMy WebLinkAbout0025 DEEPWOOD CIRCLE - Health 25 DEEPWOOD CIRCLE LCRVILLE A 013 008 No. 42101/3 ORA Q� •� , foi m ;, 10%~ O 0 O O Commonwealth of Massachusetts To tv -A Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 25 Deepwood Cir Property Address Elizabeth Baxter Owner Owner's Name information is required for every. Centerville MA 02632 5-20-14 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. A. General Information 1. Inspector: d �'413) Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name P.O. Box 73 Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S13971 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340:of Title 5 (310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the cal Approving Authority 5-20-14 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 that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 Title 5 OfficijInspec1bonVSubsurfa,e Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 9M 25 Deepwood Cir Property Address Elizabeth Baxter Owner Owner's Name information is required for every Centerville MA 02632 5-20-14 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: System is in good working order with no sign of failure. B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. * A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 4 Commonwealth of Massachusetts W Title 5 Official Inspection Form m Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 25 Deepwood Cir Property Address Elizabeth Baxter Owner Owner's Name information is required for every Centerville MA 02632 5-20-14 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 staticwater,level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: I ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments G'aM 25 Deepwood Cir Property Address Elizabeth Baxter Owner Owner's Name information is required for every Centerville MA 02632 5-20-14 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within -100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: "* This system passes if the well water analysis, performed at a DEP certified laboratory, for 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 ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts _ F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 25 Deepwood Cir Property Address Elizabeth Baxter Owner Owner's Name information is required for every Centerville MA 02632 5-20-14 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: ❑ ® Any portion of the SAS, cesspool or privy is below high..ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 1 0,000g pd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be. necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D'above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official tnspecton Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 7M 25 Deepwood Cir Property Address P Y Elizabeth Baxter Owner Owner's Name information is required for every Centerville MA 02632 5-20-14 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) 310 CMR 15.302 5 PP P ) [ O] D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts 9 F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 25 Deepwood Cir Property Address Elizabeth Baxter Owner Owner's Name information is required for every Centerville MA 02632 5-20-14 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? R. Yes ® No Last date of occupancy: 5-2014 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 25 Deepwood Cir Property Address Elizabeth Baxter Owner Owner's Name information r e Centerville MA 02632 5-20-14 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Owner--pumped 3yrs ago Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Maintenance Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe)_ t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts T Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 25 Deepwood Cir Property Address Elizabeth Baxter Owner Owner's Name information is required for every Centerville MA 02632 5-20-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1999 permit Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 24"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.): Good condition. Septic Tank(locate on site plan): Depth below grade: 16"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 gal Sludge depth: 12" t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 25 Deepwood Cir Property Address Elizabeth Baxter Owner Owner's Name information is required for every Centerville MA 02632 5-20-14 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 20" Scum thickness 1" @ outlet Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 15" How were dimensions determined? Tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is in good condition with baffles installed and no sign of leakage. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form 1R Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 25 Deepwood Cir Property Address Elizabeth Baxter Owner Owner's Name information is required for every Centerville MA 02632 5-20-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins•3113 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -'Not for Voluntary Assessments ,M 25 Deepwood Cir Property Address Elizabeth Baxter Owner Owner's Name information is required for every Centerville MA 02632 5-20-14 page.e. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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.): Good condition with water at working level and no sign of back-up from chamabers. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): 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 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form m Subsurface.Sewage Disposal System Form -Not for Voluntary Assessments �M 25 Deepwood Cir Property Address Elizabeth Baxter Owner Owner's Name information is required for every Centerville MA 02632 5-20-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 3-500's ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leach chambers in good condition and holding 3" of water at inspection with no visible stain lines. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert. Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 25 Deepwood Cir Property Address Elizabeth Baxter Owner Owner's Name information is required for every Centerville MA 02632 5-20-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts _ W Title 5 Official Inspection Form m o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 25 Deepwood Cir Property Address Elizabeth Baxter Owner Owner's Name information is required for every_ Centerville MA 02632 5-20-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: hand-sketch in the area below ❑ drawing attached separately I -- ' � . C � � •�q..r� "'— � 'ram 5f +. d a t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 25 Deepwood Cir Property Address Elizabeth Baxter Owner Owner's Name information is required for every Centerville MA 02632 5-20-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water r ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 12 feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: ® Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database- explain: You must describe how you established the high ground water elevation: Original design plans show no groundwater at 12'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts T Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 25 Deepwood Cir Property Address Elizabeth Baxter Owner Owner's Name information is required for every Centerville MA 02632 5-20-14 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 T VV1 f�I~BAPMTABILE: LOCp�'�'ION . �ec SEWAGE VILLA ' Ce Kc r� %lf A SSssOlt! M�aa(' ATE Ihla' A J . E'S I;IAt dY�P�IOI TE NO. SEMIC .AI lqK C:A .lam*NI►!. (size) oe :. �74J3lT.+11�FJ14 l:/Jii VV 1 lly ...+. .. .u._.+.... :..:w.....�e+_.......n.'....... CE PEIUWXTD Se�niratiot► ��,enrarc;Between S1n0: Ivin�clttnumkcl�usic�lCstau�AJwtei.'!.' ble�ot{�cl3atlntr�olachtnL?��c{ULy lily ac; 1ns.t�ul�iily'UJc:iI Atd FadHiy M any Y, �v+:I9s cicts� k7oc 9 ais sitr,c�c.vv�t�in:?t7p feat uE lair ixitt(;f�triUq) � ._�.-•- F?ci,(^c� Vvt4aatl said lLeacdtin�r l�aciiity.�l[f9y wetAand4 exis¢ ee 1��i4h�ca.14(1 fc e2 ptoac�iing fariliry) -- Fro-+ �C;je -p- al ° 6 D- 3a;� �- �a19 9^Fr 09 TOWN OF BARNSTABLE LOCATION Zs- QwCA Gc. SEWAGE # VILLAGE ASSESSOR'S MAP & LOT A 1�-3 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) / _�x1(. >(I' NO. OF BEDROOMS BUILDER OR OWNER Co PERMITDATE: '?5>61! COMPLIANCE DATE: oZ 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 M(_.-S�tC y. l C on CJ . L At It LG D az: 23 cZ_ Z 3'1Z1 Cy01 _ 3� 'e / ' INNo. ' Fee J THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 3pprication for lmiqoml * ten Construction Permit Application for a Permit to Construct( Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 16 1DGE:pwc)0,p el+z rt,(_-. Owner's Name,Address and Tel.No. C:�►J1�> tub r!-9ZA8c37-0 `�3-� `$A)(T9 . I `�ji 2v 5`PL--E Assessor's Map/Parcel . tic a i Ph1✓ I3 PO �V� A All -6102, Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. TA-)(`TtyZ + O,JLr- /W_ L/7mwIL4Z 47,0 g131 Type of Building: Dwelling No.of Bedrooms �l Lot Size 2 q. ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow _ '6 L/L�0 gallons per day. Calculated daily flow Ll 4 V gallons. Plan Date 1 eB 1-7. 1 Number of sheets Revision Date Title 6� PC, Pe— _, CL94rM0LL&_ 1��$46 +146'Joe—, Size of Septic Tank I501p Type of S.A.S. LmA-,A Pleg np Description of Soil C-LEA 14 /utS-Z I Jv►n 40 'T iN� �d 93►� 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 issuedrUy t ' oaroo Health. Signe Date Application Approved by Date Application Disapproved or the following reasons Permit No. Date Issued 46 0. =• �"' Il Fee ` ✓ Entered in computer: / THE COMM�Ia1WE�LTH OF MASSACHUSETTS, Yes PUBLIC HEALTH DIVISION -`MOWN OF BARNSTABLE., MASSACHUSETTS V J r 01pprication for fgpogal *pgtem Congtruction Vermit Application for a Permit to Construct( Repair( )Upgrade( )Abandon( ) ❑Complete System O Individual Components Location Address or Lot No.* De.EpwOov C12GLe Owner's Name,Address and Tel.No. Ceti 1L►Z.allt.t-E ELIZ.AQ6'f Yl t3.. -6,44TM , T2v5ME Assessor's Map/Parcel PO -NOX 4'Z ncaP I6 Pal, 13- B � 4-7'1 -6fZ02, Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. f XTC2 j- aye- IW_ CDSTB)?_V,Lc_S 4z0- g1131 Type of Building: Dwelling No.of Bedrooms Lot Size 2 S�7 q.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3-3<7 LILI y gallons per day. Calculated daily flow LM) 3'� gallons. Plan Date R-B 1-7 . 1 ci-I< Number of sheets 7— Revision Date Title CtELIT PL. P4, C6Wrr�V1L4Z- I _ 1'SAXTer-+ g'jNv ; Size of Septic Tank I sbU Type of S.A.S. LeA%0 F exr> 1? / 4 Description of Soil CLEA hJ MS-9)I Uvv\, 420 1--i0€ CiA/J► ) l Nature of Repairs or:Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the constructTon animaintehance of t5i afore=dgcri ,gt�:,,site.sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code em n o`pp and not to place the systeration until a Certifi- cate of Compliance has been iss Gy tna oar f Hea,�t, g I Signe S� r �'� Date Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed ( tom)Repaired( )Upgraded( ) Abandoned( )by at C12ctA3 INN 1 Cd.0 ha een constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated "" . Installer Designer The issuance of this permit shall not be construed as a guarantee that the sy,,S,t c � � .11 fRn-to' de 'edui " * Date Inspect a No. r �^ r Fe� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS �Digogal *pgtem Congtruction Vermit Permission is hereby granted to Construct( �Repair( )Upgrade( )Abandon( ) System located at 2ti 'Dtr7°o./ye n Gt 2 e Lz Ct5 i4reyuli_� 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 this it. Date: "` �y �'-' y/ Approved b ��,?��A�� ;A P 4463 D155j:Gm DATA IL Sr•►�Ic Farn�.l� �. Bcdroory _...-� . .... __. �a 6a rba�c GriY+dc,r�. LvT lJgily Flotu = . x I1O yper •� 44 6PD C'E�•11-Elz�/iL.L�- Se",-7a.,1c =. '14,7 x 200To USE 1 500 G A%L o1V TA u It LEhCHtUG SYsT�M DESIGN 3. ¢,�g Applicattorn Arca RclyirccJ2 'DIFFu ar-i 4-4-0 GPA 95174 GPD/sr - 7 SF Appltcafoa A-rea Srdcwall Ar-a l!7 � X2�= l42 `�� r y �. Bo *ov i Arcs To+el Arca... aw- Pereslsf'�ar► R��c � S wwNflwcf� 3L Glsra = S.,Is T LA�- U�� � ?C AS nME. oH OF MgSs9cOF w�a►ate p� STEPHEN 4 . 4' 4, STC►►c RA. EM uxmm �• 5 "101 No.30216 Na=" 08roN� ell T.F a=38 TAT' L�ot.>; �. ►5 �S r6 = 3� LcAvA ` n Lam_ _ A 1 33•'liowg4,� 15oe • sox r L 3� CAI- SA►JD �pM 5�lJE }E TA%3k a i ILI DeVeLa PEP PRe Ft UE I Cer-IK Tl,a4 The Pr.pesc.t DwellrwA Zkow►l SITE SEPTrC PLAN N<e+eon Gea.pl�s Wi� Tlvc 5%.tcimc A►-xA Set- LOCATION C,E7n11-JE2Uit-LE bnctc Rctv%rci"cA+s Of 7c 1'o 1% caM uI�. o f- SCALE �.��- ' DATE : � e �o,2col Bnrnstable And ZzdvrLoco+=ce W!i-Dirt A PLAN REFERSNGE LOT.B RAY- 381 PG.eoq �Ce�al. Fleo� Na�wef Zor„ ASSESSORS MAP : «�. PARGEI..: .l'7�-g, A PPLTCANT:,DIEpwvcm 25 &ALry I riX BARTER j NYE, INC. LAND SURveYoraS • CIUtt- SWGIOEMPS C)sT*cRVILr.E, MAs3ACHUSETTS O!j�sats fr-arn buildinc4szkovl.l not be u:scJ Tob No '� G f,�b 1�S k �roPer� l 1►1 G3. l va Lot- 8 � Cart. • C6►3 f��..�0a i.1.�c- D►4Ts'JvNE G, .2vo 1 d , 11 Iv / VIN- L o � 's 34 / T.c,.F ° 3t.0 30 o � / dot io \ LOT 8 Up A, 25,7S4.SF3---- o it,we 2( /I OF u1f:.FiHhN IL f� BIIXTEA �• ";��' i, IpNO.2/60 Nc,30216 •. � �G 'ol O/. ,u TOWN OF BARNSTABLE LOCATION �� Qwod�1 Gc. SEWAGE #. VILLAGE �h�er'v�` AS MAP & LOTI INSTALLER'S NAME&PHONE NO. �� C, <4--A-n!� '776 10 5 q . I oc .. SEPTIC iTANK:GAPACITY \ (size..,.: I - LEACHING FAGILTTY:. (type) f� ) NO. OF BEDROOMS BUILDER OR OWNER Cc PERMFTDAIEaG COMPLIANCE DATE;: v� Separation Distance'Between the:. Maximum Adjusted Groundwater Table to the Bottom of Leaching:Facility Feet Private Water Supply Well and Leaching Facility .(tf any wells exist ... . _: on site or within 200 feet of leactung'66utyl) Feet Edge of Wetland and Leaching Facility (If any wetlands.exist within 300 feet.of.leaching facility) Feet Furnished by MC_ - 5 p vcwl.M1�a ' - M, - r4 7 �i ijs.it•twi 1ln1cc10 Iifl-0►7 Im!�pm0 U/MuY11 •>M�M '"ON llmnTq*jv 4mm" SEl 00/OE/11 a s� � I J O q �; 3I n iO 6 t 1 , Own avid Ir pp �c►. _ J — ♦ O''�o" a _ ♦ ♦ n h + O OIL S► r 1 1 b .0-.�� 1 /� LION 11.L 1 310*4 L-�- ift 1 1 1 1 1 O 1 1 LA :I 1 , I W V 1 1 '1 ♦ co y,�1 81 O ..C/1 01-.f1 -.Orr .0,-.OL � t N, 20'-10' 14'- 1/2Z'-O" 5 - -O'Z' - —� alCO _ o Q e 9'- I/1' �e C% 1 O <tiii s I la 1 r F ; 1 0 1 I V l O O 3 O Lei 1 O 1 1 11.0P! 1 RAT KOR © / 1 1 �• 1 1 w 1 1p • `�f W w m 1^ i rn ls IP 1 1 �1f < --- ----- ZZa a � I ` II/30/0O Steven. C. He► ea Arobitect Notes (/12/OI 5. N,ur lute a1Alt- Sn SWAN 4,Lrt afawb4p 4twMi X"MWhM"W O1(M)248-te14 Onwjw wwF I..t w.&M M rylesea< w/ MIt M/I�Yd IA,MAWNr�n ill � '�:, .� r'. �• � ��. b j r Colo. ry . p �s - n51 •� s � Q•- � Z ���i HVI oil PRO fillloom -� Q to CL— (b P f t Y:• rr Da 38'-8 I/2" 16'-O" w w DECK — 1 I w I SF STANDAR 1 , o~ (WITH STEPS TO GRADE) OI - �f'- 3'-4 3/16" .-8" 3'-L" " ab n 2'-83'-pc 3/16" MASTER on. A REQRMM 42 .m VAULTED (7)I /4' 1 1/7' LVL I I E e ♦ _" E \ ♦ ' ° 1-O -1 it SLOPE I FLAT 'SLOPE 4 HALF \ ♦ I � a , �-♦ + � tY O W WALL ♦ w'� m I FLAT' P I LAT ',SLOPE FLAT 1 I ' _ O �1 y Gu ----- a GREAT ROOM g I ' -'w�u.K-t�-- ��i I CATHEDRAL '� __- , TRAY�CEILIN L 1 �oT e o i I ♦ \ ITRY/ LINENIL 1 I _' be I p It--------_ r--------- ' a J I " W BO P BROOM ® a. O SHE VES E E �- �� CLOSET © '�� � � o S. 0—V ----- �.¢ O zo10 -r---- -r- ----- --, . HALL 41. C4 t ej Ln � '`— '' GARAGE V- — w 0 o OSTANDARD 77'-0' X 77'-0' W/ONE 1&'-0' GAR. DR. N J m W ALTERNATE 74'-0' X 71'-0" W/TWO 1'-0- GAR. DRS. o O O I5'-2" 3 OP} �+ VAULTEDFRONT OR SIDE ENTRY AVAILABLE O P kc! COW BEAM --_----�Ep'MBEAM SIDTIL HTS " UU e it MASTER ' s w IBEDR001i #1 qs� Q i VAULTED 1 SLOPE ' FLAT 'SLOPE i I I 11 (7) 1 3/4 X 11 1/8 LVL HEADER O O_ 13'-8 1/2" 22'-0" O O t�l cV Ln 1800 STONYBROOK PRELIMINARY \ ` 40'-0• 4'-10' 1'-10• 8'-i' 9'-2• 6'-41 41-41 r y E-1 O To �$ I I an o �X $ = i • wn w°+ O °nu 1 II I pz n D O L»,n O =O I > E An O To J z � m O O n r D Oo , n -U]" zD �Ow m m Zr �� , °_; D x u °wu = o O ° fO • c DW L. LO pD N Ok; -4—� 1 — — I— -( _ to O -4 AND O N w ° m `" I �n v 1 o u � ,^ O m x = n 11 = • o u e� 1 o man 4. Z ii�,m ----- �r�" I , ° tox A I I I I I I I I I c cnt D-JODA 1 I I I I I I D=O I 0 DDZ O mmCPO < I I I I I I I mmP L1J I g w "�•- J J PC% ' Dr mi ( i O<O al O Az��, I — I I <m <n -DE m 0 1 I I oD �_1 1 1 ,m z I m U W D r r —� w ao iOm 1 I 1 I ; C > m0 z o ; 1 I I 'T ' 10 1 �E ' = O .01 T-s 1/2' 13•-6 3/4 nr- 13'-10 1/4• p 13'-4' m L 1 I �! 10'-0' Uir f — — — ► L— w — — r- i u *j x IL O m P 0 L i A3 O N ,— N mm I xp A N Z 20'-s' 4 1/2• L • OI 14•-O• e• xM �' J 14-0• o = u 1 °A n • , o I on m m A AO ° Dz X m I o �-q 1 m n o •� om > I u C� I AU, < — — — — om > >° H 1 1 e-o• 20'-0- 28•-0• 22•-0• 21'-9 1/2• 11/30/00 1/5/01 Steven C. Hagen., Architect Note: 1/12/01 15 Bay State Court P.O. x 521 Small format drawings are often used for preliminary checking purposes. 2/5/01 Brewster, Massachusetts 02631 (508) 240-1411 Drawings may not scale as Indicated. Final plans will be provided In scales shown. 12•-2 1/2 IO•-L- LT' s w OD I I o oTOP � 2•-8- 1-0 3/e- 2'-a" o WA L� I e Cb LIKEOF O I a„ CA TILEVERE 2XIO JOISTS • I O.C. r I e v A ABOVE x _ a, ,- ------, I O I I n • i 4 0. 2 L- I - 0 O D D G g BED W_ i i Ia 2X10 JOISTS • 1 ' O.C. ' ' _J FART 12' THICK. C 3 DOTING REPLACE ' V 3 1/2" CON ETE SLAB S K TCHE 2x10 J lsrs • 1r O.C. �a GREAT ROOM 1 - 3-2XIO GIRT FLUSH FRAME O � T ISH AREA p \ �O UP STEEL BEAM FLUSH FRAMED UP STEEL SEA FLUSH PRAM BE ROOM - - - - - - J I - .96� r. i I COLUMN 3 V2" DIA. LALL COLUMN m G a TOP OF OOT NG I YP) NC e 13- BAT — — xo O O I 2XIO JOISTS IL" O.C. 5. O I PROVI E SEWAGE Q ---- EJEC R IS'-8 II2" I I ~ 2X4 STUD WALLILI R-4'i 3 INSULATION 9QQ � UTILITYI C-4 N V-4" L'-4- 8 I4 1/2- 20--8' o POC ET m� it '" I I ( IOi •_NOT I I I O_ rm LL WALL POCK POCKET . 2x10 Jolsrs �y`" ILI O.C. L t— _j I °IT / f4- REINFORCED CONCRETE SLAB ABOVE N WALL FOR GARAGE PITCH TOWARD DOOR TO DRAIN) IaNC. FOTI 3 :Oo1 ON CONC. E. PROVIDE s5 LINE OF CANTILEVER REINF. RODS • r-0" ABOVE O.C. TO TIE IN CONC. w n I I p O UTILITY I ENTRY SLAB IF PROVIDED. TOP OP 0 WALL • 38 t 14•-0- O — — r- Door Dmw 19'-c- 1'- O 14'-0- II'-O- IV-8 1/2- 22•-0" O O O Ln STO YBROOK- 3 FOUNDATION FLAN Ln : SCALE: 1/8' = 1'-0" File (035BaXLr) b1m PRELIMINARY �3ASEM ENT PLAN q BAXTER RESIDENCE 2/5/01 DOOR SCHEDULE NO. LOCATION DOOR FRAME SILL LBL HDW REMARKS ELEV. SIZE MAT. FIN. MAT. FIN. 1 ENTRY 3'-0" X 6'-8" INSUL. W/STORM/SCREEN (SIDELIGHTS OPTIONAL) 2 BASEMENT 2'-8" 3 MASTER BDRM #1 2'-6" 4 BR#1 CLOSET 2'-6" 5 M. BATH #1 2'-6" j 6 M. BATH #1 2'-6" 7 1 BREAKFAST 1 12'-8" IINSUL. 9 LITE 8 PANTRY (2) F-2" j j DOUBLE 9 DEN 4'-0" X 6'-8" BI-FOLD 10 MASTER BDRM #2 2'-6" 11 M BATH LINEN 4'-0" X 6'-8" BI-FOLD 12 MBR#2 CLOSET j 2'-4" ! 13 1 MASTER BATH #2 2'-6" 14 LAUNDRY 5'-0" X 6'-8" i BI-FOLD 15 GARG/HOUSE ENTRY 2'-8" ;INSUL. FIRE CODE 16 GARAGE ENTRY 2'-8" I INSUL. 9 LITE 17 GARAGE j 16'-0" X 7'-0" OVERHEAD 18 GARAGE ENTRY ; 2'-8" 19 LITE IN BASEMENT BAXTER RESIDENCE 2/5/01 WINDOW SCHEDULE WINDOW I FRAME I COMMENTS R.O. SIZE _ MAT. _ FIN. MAT. FIN. QTY A DH 2846* 2'-8" X 4'-6" 3 B DH 2450* 12'-4" X 5'-0" 4 C OMIT D DH 2846-2* 5'-3 9/16"X4'-6" 9 E DH 2O40* 12'-0" X 4'-0" 2 F I OMIT G CSMT C235 BS 4'-0 1/2" X 3'-5 3/8" I I 2 H TBSMT H 2O30* 12'-0" X 3'-0" i 1 J 2817 2'-8 5/8" X F-7 1/4" 1 R VELUX FSF306 130 1/2" X 46 7/8" 1 FIXED W/VENT FLAP * ANDERSEN SERIES 200 WINDOWS j i i DN SR 2X4 STUD WALL WITH W060 SHELF TO COVER LOW FOUNDATION WALL. -----3tu NOTE: MANTLE MAY ALIGN WITH FOUNDATION SHELF t VERIFY CAP W/OWNER. ,; 1 OR STOP FNDN SHELF AT FIREPLACE AND PLACE LINE OF U 4 F y " MANTLE HIGHER. CANTILEVERED - 2X10 JOISTS _ IL _O_C.. . AY ABOVE Y. .. � �- I: __ DRAIN ------ p\i I BEDROOMo }-- '-O 9f-POCD I +j ---------------------------------------------- - ----- --------------- -------- - .. ___ 10 2xt0 JOISTS ,3 N." o.C. I. a CLO. - ' -4 - € DETAIL AT HEARTH/ 2X4 STUD WALL WITH 5 -O ,+ FIREPLACE TO DOUBLE 5 " � V WOOD SHELF TO COVER 4 -il / $ u� To `= BE DETERMINED DOOR w '`'" LOW FOUNDATION WALL. 2 4 y 3�-G y�" VERIFY CAS' W/OWNS MON RAISED HEATILATOR ------ ;'� FIREPLACE , 2XiO JOISTS s IG" O.C. GREAT .00M 7�2M TCHE«N o 1 a 2X4 STUD WALL '-O" 1'-rlfl "2 -i" �i , r + t - (`{� N I`" O.C. bD \^ + 11.E R-13 INSULATION J UP I y " B PPL. CLQ rn l -^ 2-� BEDROOM WIOX21 STEEL BEAM FLUSH FRAMED 3 - lCJXiS :1 F AM � Q ' sw1 LINEN + A\ N� �— 2X4 STUD WALL WITH N '4 WOOD' SHELF TO COVER Cl _ - s 5'-2s • 2._a. 2 1 2�-1" f0'-ilY4" Opp LOW' FOUNDATION WALL. - ------. _. VERIFY CAP W/OUJNER. r;; I - D O CX3 �- r 01 — z_ 2XIO JOISTS 16" O.C. _, _-{- + • B T i - - - FURNACE!., a. - r-, IPROVIDE SEWAGE i _ r „ " co EJECTOR - 3 L . ..II _ . _ VERIFY SIZE O co I� 2 y2" j -1�y=p. - -- -- - = UTC� fTY ;� LIME OF LOW v f O FOUNDATION itl STUD WALL ----- i i �— WALL 3-2X10 GIRT _ _ 3-2X10 �:CalRT HW 5 WER 2Xf0 JOISTS o IL" O.C. _ _ . • J ELECTRIC 3 PANEL NOTE: PROVIDE 45 REINF. RODS 9 1'_0" WORK0R I I O.C. TO TIE IN CONC. ENTRY SLAB IF PROVII?ED M CO r t0 O U 0 W S .. > . .. PROPOSED BASEMENT FLAI. SUGGESTED LAYOUT SCALE. 1/4" 1,-0„ File (328P1an)