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HomeMy WebLinkAbout0041 LAKEVIEW DRIVE - Health 41YLa xvieWIDrrve Centerville s a 8 } tA._.214 038 X03 ,- .. ,. , z� k I Y Commonwealth of Massachusetts aid--e3g- X03 u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments .a••` 41 Lakeview Drive M Property Address 'V Michael Schulz IM Owner Owner's Name information is di required for every Centerville MA 02632 8/22/2016 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. Important:When A. General Information filling out forms s/ //9&3 on the computer, use only the tab 1. Inspector: key to move your cursor-do not James Ford use the return key. Name of Inspector Ford Septic Services LLC Company Name P.O. Box 49 Company Address Osterville MA 02655 Cityrrown State Zip Code 508-862-9400 S 12482 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 luation by the Local Approving Authority 8/28/16 Inspe 's Signature Date The s m inspector shall submit a copy of this inspection report to the Approving Authority(Board of Hea 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. ISins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 t 0 P td VS Commonwealth of Massachusetts a • Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 41 Lakeview Drive Property Address Michael Schulz Owner Owner's Name information is required for every Centerville MA 02632 8/22/2016 page. Cityrrown 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: 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): l5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 41 Lakeview Drive Property Address Michael Schulz Owner Owner's Name information is required for every Centerville MA 02632 8/22/2016 page. Cityrro`n'n 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): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 41 Lakeview Drive Property Address Michael Schulz Owner Owner's Name information is required for every Centerville MA 02632 8/22/2016 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 day flow l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 _ i Commonwealth of Massachusetts "MONW Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments '�A a 41 Lakeview Drive Property Address P Y Michael Schulz Owner Owner's Name information is required for every Centerville MA 02632 8/22/2016 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. 15ins•3/13 Title 5 Official Inspection 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 r 41 Lakeview Drive Property Address Michael Schulz Owner Owner's Name information is required for every Centerville MA 02632 8/22/2016 page. Cityrrown 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? E ® 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 Y � Residential Flow Conditions: Number of bedrooms 4 (design): Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 15ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a 41 Lakeview Drive Property Address Michael Schulz Owner Owner's Name information is required for every Centerville MA 02632 8/22/2016 page. City/Town State Zip Code Date of Inspection D. System Information Description: I Number of current residents: 2+ Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection information in this report.) Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: unavailable Sump pump? ❑ Yes ® No Last date of occupancy: currently Dale 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: l5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal system-Page 7 of 17 Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 41 Lakeview Drive Property Address Michael Schulz Owner Owner's Name information is required for every Centerville MA 02632 8/22/2016 page. Cityrrown 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: wears Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)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): l5ins-3/13 Title 5 Official Inspection Foim:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts U Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 41 Lakeview Drive Property Address Michael Schulz Owner Owner's Name information is required for every Centerville MA 02632 8/22/2016 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: system installed -5/1107 per as built Were sewage odors detected when arriving at the site? ❑ Yes ® 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.): i Tank locate on site plan): Septic ( p ) Depth below grade: 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: 2 l5ins•3113 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 •'•y 41 Lakeview Drive Property Address Michael Schulz Owner Owner's Name information is required for every Centerville MA 02632 8/22/2016 page. Cityrrown 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 22 Scum thickness 5 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 12 How were dimensions determined? measure Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): The tees were present and there were no signs of leakage. Grease Trap (locate on site plan): Depth below grade: n/a feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene El other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date l5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts u W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 41 Lakeview Drive Property Address Michael Schulz Owner Owner's Name information is required for every Centerville MA 02632 8/22/2016 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): N/a 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 l5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official I Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ." 41 Lakeview Drive Property Address Michael Schulz Owner Owner's Name information is required for every Centerville MA 02632 8/22/2016 page. CityrTown 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 even 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.): The D-box was normal PumpChamber locate on site plan): ( P ) 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 orders stem is a conditional P P g y pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: 15ins•3/13 Title 5 Official Inspectfon Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts v Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a .'r 41 Lakeview Drive Property Address Michael Schulz Owner Owner's Name information is Centerville MA 02632 8/22/2016 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 3-500 gal chambers ❑ 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.): The chambers had 6"of water on the bottom.The scum line was at the same level.There was no sign of failure. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration n/a 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 u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Vo luntary Assessments ssments •''t 41 Lakeview Drive Property Address Michael Schulz Owner Owner's Name information is required for every Centerville MA 02632 8/22/2016 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.): N/a t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 • Commonwealth of Massachusetts v W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Volu ntary Assessments ssments 41 Lakeview Drive Property Address Michael Schulz Owner Owner's Name information is required for every Centerville MA 02632 8/22/2016 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 BAUD A - - Q a D cck 0 3 1 a$ 3y o - a a ys yq L15ins•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 ^a,a 41 Lakeview Drive Property Address Michael Schulz Owner Owner's Name information is required for every Centerville MA 02632 8/22/2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 25'+/ 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: Topo and water contours map. ❑ Checked with local excavators, installers -(attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: see above 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 41 Lakeview Drive Property Address Michael Schulz Owner Owner's Name information is required for every Centerville MA 02632 8/22/2016 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 TOWN OF BARNSTABLE CL 60 / LOCATION Z 1 ZY-��#X, E'e./ l2e�-- SEWAGE #2,0()C VILLAGE e�—&<V,://-( ASSESSOR'S MAP & LOTZ YO 3�X-O 73 INSTALLER'S NAME&PHONE NO. ��ir�., G ct,✓ -� 34 Z C9 Z�7fi' SEPTIC TANK CAPACITY lJ 0(J LEACHING FACILITY: (type)(���``�ri��+c, (size) ? �� NO.OF BEDROOMS BUILDER OR OWNER `-r• r C,0�1X�J PERMTTDATE: 1 COMPLIANCE DATE: 91tL0 7 Separation Distaffice Befween the: ,,,May 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) /1w dr r Feet Edge of Wetland and Leaching Facility(If any wetlands exist. within 300 feet of leaching facility) / c%ry. Feet Furnished by 32 � e � Cot al'r7 t l No. Fee �ji THE C0MM0NWEALT A #CY-IU S ntered in computer: PUBIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZIppYication for �Digpogal *pgtern Congtru'ction j3ermit fib Application for a Permit to Construct W Repair( ) Upgrade( ) Abandon( ) ❑ Complete System El Individual Components Location Address or Lot No. Z /70 cJ d t y Owner's Name,Address,and Tel.No. �d ?CD 14 R!c*✓��u v/'. Gc-�- �: /!'7G• L—ol A-.-- �/G �•v/ J ce// 7- !o S�tl Assessor's Map/Parcel oo^r�� d 3 G a 7 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.�+ 9 e O&J .► c3 ' L✓ Type of Building: Dwelling No.of Bedrooms 1Z Lot Size J sq. ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 4/b gpd Design flow provided y L) gpd Plan Date L // d (.� Number of sheets Revision Date cJ Title T r�r' X r, �,✓ Size of Septic Tank �� d U Type of S.A.S. 2 1 V / Description of Soil 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 Certificate of Compliance has been issued by this Board of alth. Si e to '211dr/,If/ Application Approved by e Application Disapproved by: Date 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 (X) Repaired ( ) Upgraded ( ) Abandoned( )by �A^�"�/ / ,e ,le! ✓LA -f at ZjL �// Lc�t['��/itc./ ����,L,/ has been constructed i accordance with the provisions of Title 5 and the for Disp sal Sys inConstruction Permit No. dated Installer r Q Designer #bedrooms y Approved design flow — gpd The issuance of this permit shall not co tr d a a guarantee that the syste w� nc on as des ed. �-. 'l�M Date Or Inspector ACC ��� ✓""' ��,a%' Fee � - cz.._CCL�� r ` THE COMMONWEALTYOF MASSACHUSETTS Entered m computer. PUBLIC—HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Application for Migaal �§pztem Cou5trtfeN_ft Permit Jal Application for a Permit to Construct Repair Upgrade Abandon pp (� p O pg O O ❑ Complete System ❑Indtvtdual Components Location Address or Lot No. / o u f `-/ Owner's Name,Address,and Tel.No. re 4C Z & y Assessor's Map/Parcel L� A�f<r ' d 3 ' �G o'l4 SU /..r. Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. G P C`G., " r . / c> C'/ v e �1`i r�c.� w r /Zi r.+/O �✓� Type of Building: 6 I/Dwelling No.of Bedrooms Lot Size JX 'sq.ft. Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria Other Fixtures ! Design Flow(min.required) �/ ��C� gpd Design flow provided �-� �/ (� gpd Plan Date V11,rZ el [., Number of sheets Revision Date — Title fii / '% 4 /r h.a Size of Septic Tank / 0 C Type of S.A.S.r I f e ri Description of Soil Nature of Repairs or Alterations(Answer when applicable) I . 4 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of alth. Sig ed C-'" d - � -,,Date ' / _ Application Approved by . r D e Application Disapproved by: / ` Date for the following reasons Permit No. "" - Date Issued �/(119/6ZP THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed (y) Repaired ( ) Upgraded ( ) Abandoned( )by -Z-1!i `/ ^X C u A ...f atZ,_a '?� Z 411 ,/e?e ' ( 6-s-1//• has been constructed in,accordance with the provisions of Title 5 and the for Disposal Sy tem Construction Permit No. dated Installer `,_I �/ Designer T /gzn, 0- #bedrooms Approved design flow gpd The issuance of this permit shall not be constr•ed a a guarantee that the system will-function as desighed. G [ a1/I �-7 p U Date �p ,-j y / �r� InspectorV` �� -------')—�--=—=— --- -------- ---_------r ----- No. ///a � Fee /��/�✓ THE COMMONWEALTH OF MASSACHUSETTS 1 PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS lwig o.5al � !tem ConsStruction Permit p t�,. p Permission is hereby granted to Construct (/e ) Repair ( ) Upgrade ( ) Abandon ( ) System located at L�� /° i u� r• �.., /'/' /��r ��� /r�' ��' 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: Co must Be co k1 mpleted within three years of the date of thi ,ermit. C/ Approved b � , Date //.� pp y —�_� ;, Town of Barnstable Regulatory Services .� Thomas.K.Geiler,Director ` * SSBAMAJ Public Health Division 9�p tbp1 `fp Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-8624644 Fax: 508-790-6304 Installer& Designer Certification Form Date: 6 D Sewage Permit# 06 ?46/ Assessor's Map\ParcelJ�0,7 R,�-cr 3 Designer: 06 yL E Installer• L. 4,el Address: /7D CG D t�E.e�/��-.d W-V Address: /�D A x SD 7 E,�i9L�lo yTh; l�•9, DZS3� A/411,1/s�i�,QL� On P G �G/'y /���/lG�f was issued a permit to install a (date) '(installer) septic system at w based on a design drawn'by t (address) �:J1 o YG �9SSo�i/fT�s dated (designer) I certify that the septic system referenced above was installed substantially according to the design; which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or ce ified as-built by designer to follow. ( ller s Signature) JORW P. r,� DOYLE, if -: No.33589 v, (Designer's ature) (A, i ! . " re) PLEASE RETURN TO BARNSTABLE PUBLIC HEAL WISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Fonn 3-26-04.doc ' s 4 i • - - ;�.�,N.. � YoPr7E - � - %'� - .ram' —+'�.* . E U) � V o N v ( E ' EO. � � {p U EO. 20'-0' N A - A---------- - — —------ --- -— —------------------------ �• (2)2x6 P T.SILL W/5/6'XI2' ANGNOR BOLTS®21-O' O.L.MIN(2)PEE SILL l 12' FROM CORNERS iY?ILAL; MIN.(2)BOLTS PER '',, j OROP TOP 0-r F0AN0. ' i ►/� •N WALL TO EOT.OF Q 5LAB(LOI.'L.FROST d _ WALL BaO/U ZUNE%LAVATEO�--y 11 MAINTAIN 4' MIN. (// ( •11^}+ X FROM GRAEDE TO noM A4 �-S U ` • eo of FoonNS A `. 10'LONO.WALL i Ir WITH X24 GGNG. b � 11 � GRILL N R®AR a•INTO JC LONG. �rA WALL/FOOTING®6 T FRO E W/2'MN.INTO N A C TO L 4 f;LT 12'MiN.INTO NEW LONG. J WALL 1 FOOTIN6 NOT, y Z1111 LONG.SLAB� Z EXIST.L IAL SPACE Y` Corr 2m5aiq 0 N (D �` rn o U > N EX15T.GONG.WAllS t O Q �y BASEMENT FLOOR PLA-N N�— �_JZ o a(// C Q 0 U . job no.: 16o2 . date 2q AMIL 2016 SCSIe AS NOTED drawn: MM aUq� ,coo - rev. r:- �`::~ rev. Q 1. ^:. A- 1 ISSUED FOR PERMITTING ant I of e o E as O M UI l0 � U O (p m H •V WALL/DEMO 6ENERAL PLAN NOTES L O to H -PLL EXT.WALLS TO BE 2%45 a Ib' .d. (p -------' M L5 AND ITEMS TO O.0 ME%NOTED OTHERWISE) BE REMOVED L) -ALL IM,wPLLS i0 6-c 2%45 m�6' us i Ex15TING WALLS TO 06.NW E55 NOTED OTHERWISE) < W REMAIN L -WINDOWS TO SE ANDEREEN'400 5ERIEV C L NEW WALL5 AI NON-IM -RE515TAYT GLASS ANDD LY PWOODD PANELS AND FASTENItYa SYSTEM AS SPECIFIED IN THE 6 ED,OF MASS.OT LODE DEMO NOTES (REE FER TO ELEVATIONS FOR MIMTIN y •" PATTERNS) c EXISTING DASHED WINpOWS E WALLS -REFER TO 5 ABO1 E aFOR WINDOW O E t0 BE REMOV-D MD PATLHED A5 R.O.HEIGHTS ABOVE SUBFLOOR NEEDED OR RPLAGED AE NOTED. p V U � GO m o t0 U °31UIIA = C1 Ea. 20'-0" N b A i A4 DD C T-O%T-O CgAOWHAN O -c STYLE O.X.GARAGE WOR ____ BY OLOPAYVFER TO ELEVATIONS) GARAGE -------------------- A A4 r=tr as mr�, me_t E ------------ -------------- ------- _ o9V �'Fm o �T PANTRY QOFOR. PANTRY REPLACE EX15T.OH. DOOR w NEW 9-O X 6-0 LOAOHMAN STYLE OH.6ARA6E OCR BYGLOPAY(REFER TO ELEVATIONS) GARAGE cqB. J, +- C 2 7 ----------------------' _-_______= SEAT Ye N ^`•L- ----------------------------------------------" Y/ G,BB1EiP', N x — — O (0 m .� N - - REMAVE E%ISi.WALLS HALL NEw SJILT-S As SHOWN L Q (D o RPLACE Exl5i.O.H. DOOR YV NEW P-O X 6-O GOAOHMAN 5TYLE OH.GARAGE DOOR �( 6Y OLOPAYTREFER 0 1 V �✓ �� TO ELEVATIONS) LL O L) ., - �w� c Ck_ ___ _____ ________ __________ __ ___ __- �_ a U job no.: 1602 date 16 MAY 2016 Scale AS NOTED drawn: MM F I R 5 T F LOOR PLAN rev. 5 C A L E 1/4 = •-0" rev. m A-2 0 ISSUED FOR CONSTRUCTION Ent :2 of a e am vi N `Q d v o io ~ U) A 10 L Z v � � o ` l ALL/DEMO 6ENERA_PLAY NOTES M 4 EmSTIN& -ALL EXT.WALLS TO BE 2"S 6 16' yN OL UU115 NOTED OTHERNISE) ` w EO E0 ____-___ WILLS AND ITEM5 TO o BE REMOVED .ALL INT.WALLS TO BE 2X45 6 16' - '�__ OL.&LESS NOTED OTtt-RN95EJ mx EXI5TINS WALLS TO O x REMP.IN -KNOCKS TO BE ANOER5EN'400 S_ERIW O � WITH NON-IMPALT-RESISTANT GLASS y y� i• FEW WALLS AND PLTW000 PANELS Alm FASTEWN6 p ST5TEM AS SPECIFIED IN THE Ip p FYI Q BTH ED.OF MISS.STATE BLDG.CODE DEMO NOTES PREFER TO ELEVATION5 FOR KNTIN fi PATTERNS EXISTINS DASHED KNOCKS 4 WALLS -REFER TO ELEVATIONS FOR WINDOW A .0 BE REMOVED AND PATCHED AS RD.HEIGHTS ABOVE SIE.FLOOR f A FIEEMP OR REPLACED AS NOW. V J A4 ry� 1�1 W C o �x 'O ROOF,DECK w! y y , IBM, A ON , r r , BATH LAUNDRY Si0RA6E O STORME------------ r , • , , p -0X6-B POCKET POOR r , by - 'ALI6N WALLSALI6N WALLS ^b - ` :WITH©SE pN MTH EDGE OF STAIRS 'r OF STAIRS "m , BONUS ROOM --------- ------ SLIDING . 36-W6H HALF WILL BARN E— sz LOFT -ata=�`L'aa r =�:c��me��3m r - " dma Eis - m_m' ,• m °_� �= • STORAGE EO. r r ' r en me , r mcvmc , r c�-u �,=cT• ac 2:-.-gym Et"c�cm =—`Rmme4- ---------------------------- ,___ ________________________________ '^ DESCS I VI O ----------- -- -f-` J,------'� O L) ; fll 7 C 0 U N iowl — N I I I 0 ml m m„I$ mml �/ LL %I xl �xlx H mix �mlx Q70 � II I- IFF EXISTING EXI51% C Q W U _ job no.: I6o2 date 29 AFRIL 20"' 5 E G O N D F L O O R F L A N scale A5 NOTED 5 C A L E, 1/4 1 -0" drawn: F;M V F 16 d ' rev. rev. fit;i IC A-3 R • ISSUED FOR PERMITTING sht 8 Of 8 a z r._ Olt -'5-�r— -----'------' —gal -- - I L-I fir I . - -�—-- ; -a 7 J. I } x,a0' act nr� ��lti5 '34,- '4,A ff 4 r , 7�MP I I I 1 ✓/ --- ' c eta-3 '�—- �-- -- - - �� � I �, .J c�1 •�;x I V�`�`y 11 --- -i�'" it I ,� 3,1y rt 1 � ; Gu�FC ' I d -: a � 1 II 1 vTir�iL P�r9r«t "._ —x 0a� a°� „9 . C/o I, (l��' I _ ,•� �i y D R.�D �, _ = r--- I I .� 13 ter l,ti wf,9leGuUn t, u� I r'.drttL _ -sirL�S1E a v u YY i �� ecuNa Aua T i=i v T'E.P AV r L'c -O„ G-�rr r!-fir, L-!.H i � ^' � �� '�� 7' .----- -- .. o V _ •ri Y ^r ry �'vz 4c ' 'N e ` E pia. l �tv-r 11_ 7 t 311 i . I _rzry j T•CAp Um I "I _ t I y;Wr�'i 71 IN K.w «ti�Lv ell CY) � �-n L(5 to i . , ice O a� No 00 0- N EX15TING DECK REMOVE LALLY COLUMN AND REINFORCE BEAM O O REMOVE LALLY COLUMN AND REINFORCE BEAM v✓I TWO STEEL CHANNEL5 C I OX20 EACH BIDE, x w/TWO STEEL CHANNELS C I OX20 EACH SIDE, EJECTOR PUMP THRU BOLT W/3/4"DIA.AND 1 2"O.C. THRU BOLT W/3/4''DIA.AND 12 O.C. NEW 2X4 STUD WALL(TYP) (STAGGER TOP AND BOTTOM AT G") (STAGGER TOP AND BOTTOM AT G") ACCESS PANEL 5' 9' 9'_4" KACCE55 CL05ET N 4" 2'_4" 48 x 34 0 2'-G 2'_G" u POW CRAWL 5PACE PANELHW URNACPROP05ED AIR EXCHANGER 2a EXISTING GARAGE p 'g"FE� A- Lp 2'-8" EY15TING(3)9 5/6"LVL BEAM N � Hr� EXISTING(3)9 5/5"LVL BEAM r3 H NOTE: EXISTING 2X 105 AT 15T FLOOR W NOTE: - FRAMING(RIGHT SIDE OF STAIR) ~ EXISTING 2X 105 AT I ST FLOOR W FRAMING(LEFT SIDE OF STAIR) PATIO Q' UP Q EGRE55 DOOR o� M ELECTRIC i F4 N 24' 22' 42' (, C� FINI HED BASEMENTPI N PROPOSED FINISHED SPACE 1085 5.F. e SCALE: 1/O" _ 11_011 DRAWN BY: CBH DATE: 1/8/13 a. c� ........---......---- �-- ----t—._ ---_�—� _—__—_ 3�'/ fir, S`,a rr — 19'_�_.._.__.___._• _—_. _— _ - C�:o:` �-- i I I I ! I ( Via`. -•^' TJf--.K- N, (-1-ILte�' ! , j &yc _— T Z _. ---- - --- _ --- — 44 j _._ — _ —t. j � �—J� — I I�_L hDo i- -•.- A./. 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O ` »t `o ` �sT P/TS Th/ �11� AYE (31 ,,.. �, e!'C3/1/'�/c'AC 7"c'3/C SHrS►Lt NUT//cY �/G- .5`'.�9�',E .��E' �0 7 V i5- V'--XX1�/Ci4 T/O�/ 0� UT/L/T/ES' a- 06•5/GN/-' AO,&05' C- W177-1 ND G�Re-, 645 ` 7• '404/Z Ce7/VTOlJi2 .�/�/ES lRii5zc ,aeOPosE.er�, i �♦ � , 'ti -::,' ,Zc�y, �c.f,� '.� cat �� � ♦ U r 't '♦ h` ', Q Gpcc,rs /�'�QP 52 i~ ♦ N Q h ,,� ♦ h 1 ` tits c �\ p",. SCAGe� 1� 1 0 0 io' `•OPTIC ` ` ` I���� ►oNN ` PR'EF'AR�'OA/4 " `♦ Dry i', �� v� ,e T'+$JV/°K ♦ k ,` „;. . 2 p/ ` `` P. ri., t�OYLE,to �, L. .9h'R Y• /�,�/C.r'�u.�,.4 5" kA ` +� ` ` ` ` `♦ `h �'yfj tQSTI�l `'RpPv.s�p 5R- F 1a/20D,^'J DJ-V'-G L lAoo'G '43 it ' , �' G O 2 Sh�l�OT L /i'VG h'lL.L f�'dAL7 s x 2 T /COY �j• ,' T- � ,g ' � f o `lZI, A 11, LA �j P 4�1�� tr R) � � C6 " ' 3. 7?.�i� 4.0 srWV 45 G , � ! N OF W G ,� .! 1 DARKEN G• w E ER C z ti\ A7'L�,+ SCR Vt�* F � . © � No. 1140 BCAAif 1A.1 FELT S�A/iTAR\CP �� /70 CG o Y�, '�/ L.� WA y • 1 c,4.4 d t/7W .s'©eg- v�'G 3. J 9 9 54 . �i