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HomeMy WebLinkAbout0034 NORTH PRECINCT ROAD - Health (2) L� 34orth Precinct Road rville P 148 122 �I No. 42101/3 ORA ESSELTE 10% • O O O I :f• ,,,.� .ice :' J - .% +w�•• �. f -41 r T v Q j F ZU` t_ �f� f2C� 71'-612' 13'-11 12' 4.4 V- 6--1 12" 1913- 28' . .�c." 3'-2,/4"�4'-171/4" 7'-1" 1; a 7,1 A 10'-9 3/4" 2 7.71 " 37" 1 ' - .�, rI---------�I GARAGE 27'4"x 21W 2-7 1/2• T-1"2 rI————————- I r - I I I I m F I I-------- I mmw���w -- - - m i T-6111. 7/16" B'-9 i2"-- 6'-9" 4'-1 9/16" 6'. 31 75H6" 26'S 12" 1T-612" 2T312" 1 71_12' First Floor Fran 71'd 112" ----- 11'-93/16' 2'-S" 12'-21/2" 1T-7 S t6" z7'-a 1n'• 6'-1 3/8" 5'-7 13/16" - 8' 3' - -11 9/16"� -2 15/16" 10'-2 7/16" -�7'-0 7/e" ZE I -- --------- S � " w ,� - ---------- -- ----------- i ----- f� _ m J 18•-91n" I ———— ---------"„.b�--- L--- --J -- _ ---- .R---�F T-6 SIB" n' e'a'• - 2T-8 in" 71 3 112" Second Floor Plan J � � t i 16'-01/2" 1-6" 77,7 16"1 2'1" 61/16" 3' 1 t in N. 4 12" 3'5^ 2x10 dormerridge w/2x8 dormer rafters(typ) Roof Framir-g 2x12 ridge _ 2x10 Rafters @ 16"o.c. - - 30 year architectural shingles Simpson H2.5 hurricane tips(typ.) _- MOO 2x8 ceiling joist @ 16"o.c. 2x10 Rafters 16"O.C.w/R-38 w/R-38 ball insulation -- °e ball insulation -_ 2x6 walls N!R-21 ball insulation , s` M - Simpson H2.5 hurricane clips(typ.) 13 risers @ 8-1/8",treads @ 10-12" 11-7/8 TJI 560 I-joists _ Bottom of run to be winders. _ Existing deck-- RIM MM ; Pr0 V�SLIT�i� t(Da Dad `. ' Dray the Sca 7V-81/2" 43'-6 1/4' .4'-3 1/2' 23'-10 3/4" I •z I _ ,: I I 16'-8'Ixl1b-9' i aATH I I xe•-21 I I I Line of new frost m al garage foundation � I ` I I cuosEr aosEr N I, I s-o•x r�m r.10-x z-r /" I:ti T .l GARAGE I T I I 26•-10•x 20•-6- II I* I Wh ay I'I I I I LIVING I I r I 1r-10 x 1as L I J CID r L - ---- - i. 43'-6 1/4' 53/4' 27'-6 1/2" 71'-81/2, LIVING AREA Foundation/Basement w f COMMONWEALTH OF MASSACHUSETTS " _ W EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS d DEPARTMENT OF ENVIRONMENTAL PROTECTION � w O,,M Syb TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART RECEIVE® CERTIFICATION Property Address: 34 North Precinct Road MAY 2 2 Z003 _ Centerville,MA TOWN OF BARNSTABLE Owner's Name: Ms. Nancy Bassett HEALTH DEPT. Owner's Address: P.O.Box 364 East Falmouth, MA 02536. Date of Inspection: 5/17/03 g MAP I Name of Inspector: (please print)•Mr. Carmen E.Shay PARCH, Company Name: Shay Environmental Services,Inc. Mailing Address: 34 Thatchers Lane LOT East Falmouth,MA 02536 Telephone Number: (508)-548-0796 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 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: XX Passes Conditionally Passes Needs Furth Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: 5/17/03 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. Notes and Comments 3' effective depth available at time of inspection in leach pit. Evidence of liquid level being 6" higher in Leach - Pit. 1 `ii ; y� ****This report only describes conditions at the time of inspection and under the conditions of use at thatr time.This inspection does not address how the system will perform in the future ut , vtheaamebr=different conditions of use. Title 5 Inspection Form 6/15/2000 page I Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 34 North Precinct Road Centerville,MA Owner: Ms.Nancy Bassett Date of Inspection: 5/17/03 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: XX 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. Answer yes, no or not determined(Y,N,ND) in the for the following statements. If"not determined"please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: . , .„� 2 Page 3 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 34 North Precinct Road Centerville, MA Owner: Ms. Nancy Bassett Date of Inspection: 5/17/03 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(l)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier, if any)determines that the system is functioning in a manner that protects the public health,safety and environment: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility 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: W r Page 4 of 11 OFFICIALINSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 34 North Precinct Road Centerville,MA Owner: Ms. Nancy Bassett Date of Inspection: 5/17/03 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No XX Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool XX Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool XX Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool XX Liquid depth in cesspool is less than 6"below invert or available volume is less than 'h day flow XX Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped XX Any portion of the SAS,cesspool or privy is below high ground water elevation. XX Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. XX Any portion of a cesspool or privy is within a Zone 1 of a public well. XX Any portion of a cesspool or privy is within 50 feet of a private water supply well. XX 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility 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.] No (Yes/No)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• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) 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—I WPA)or a mapped Zone II of a public water supply well I 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. 4 Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 34 North Precinct Road Centerville,MA Owner: Ms. Nancy Bassett Date of Inspection: 5/17/03 Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No XX Pumping information was provided by the owner,occupant, or Board of Health XX Were any of the system components pumped out in the previous two weeks'? XX _ Has the system received normal flows in the previous two week period? XX Have large volumes of water been introduced to the system recently or as part of this inspection `? N/A Were as built plans of the system obtained and examined?(If they were not available note as N/A) XX _ Was the facility or dwelling inspected for signs of sewage back up`? XX _ Was the site inspected for signs of break out? XX _ Were all system components, excluding the SAS, located on site XX _ 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? XX _ 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: Yes no XX _ Existing information. For example,a plan at the Board of Health. XX _ 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(3)(b)] Page 6 of 1 l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 34 North Precinct Road Centerville,MA Owner: Ms.Nancy Bassett Date of Inspection: 5/17/03 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 1 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): No [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use: (yes or no): No Water meter readings, if available(last 2 years usage(gpd): 2002—74,000 gallons Sump pump(yes or no): No 2001 —79,000 gallons Last date of occupancy: Currently Occupied COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: None Available Was system pumped as part of the inspection(yes or 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 XX Overflow cesspool _Privy _Shared system(yes or no)(if yes, attach previous inspection records, if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank _Attach a copy of the DEP approval Other(describe): Approximate age of all components, date installed(if known)and source of information: house built in 1981, Per BOH as-built card Were sewage odors detected when arriving at the site(yes or no): No . ., . . .,..,. 6 f Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 34 North Precinct Road Centerville,MA Owner: Ms. Nancy Bassett Date of Inspection: 5/17/03 BUILDING SEWER(locate on site plan) Depth below grade: 12" Materials of construction: cast iron XX 40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints, venting, evidence of leakage,etc.): SEPTIC TANK: XX (locate on site plan) Depth below grade: Cover 4" below Grade Material of construction: XX concrete_metal_fiberglass_polyethylene —other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: 5' x 5' x 8'—1,000 gallon tank Sludge depth: 4.0' Distance from top of sludge to bottom of outlet tee or baffle: 2' Scum thickness: '/4 inch scum laver noted Distance from top of scum to top of outlet tee or baffle: 9" Distance from bottom of scum to bottom of outlet tee or baffle: 18" How were dimensions determined: Measured Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): Structural cesspool was ok. 4" PVC Tee present at inlet end. Outlet Baffle present and in good condition Liquid level equal with outlet invert. GREASE TRAP:_(locate on site plan) Depth below grade:_ 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: Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): . . .,. 7 Page 8 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 34 North Precinct Road Centerville,MA Owner: Ms.Nancy Bassett Date of Inspection: 5/17/03 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/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: Not Present (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.): PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances, etc.): f Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 34 North Precinct Road Centerville,MA Owner: Ms.Nancy Bassett Date of Inspection: 5/17/03 SOIL ABSORPTION SYSTEM(SAS): XX (locate on site plan,excavation not required) If SAS not located explain why: Type X leaching pits,number: I leaching chambers,number: leaching galleries,number: leaching trenches,number, length: leaching fields, number,dimensions:_ overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation, etc.): No evidence of hydraulic failure, ponding damp soil or stressed vegetation. Excavated cover and inspected pit—3'effective depth available in pit. No evidence of past hydraulic Failure noted Liquid level has been 6" higher than at time of inspection. 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 or no): Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.): PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,etc.): 9 I Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 34 North Precinct Road Centerville,MA Owner: Ms. Nancy Bassett Date of Inspection: 5/17/03 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. North Precinct Road a t e r L i n Swing Ties:� e A- Tank In—43' B- Tank In—23' Exist House (3 Bedroom) A- -Leach Pit-35' B—Leach Pit--46' B Deck 0 0 1000 gal septic tank O Leach Pit Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 34 North Precinct Road Centerville, MA Owner: Ms. Nancy Bassett Date of Inspection: 5/17/03 SITE EXAM Slope Surface water - '/z mile+/- Check cellar -Yes Shallow wells—None Estimated depth to ground water Over 15' feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked, date of design plan reviewed: XX 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) XX Accessed USGS database-explain: You must describe how you established the high ground water elevation: Checked with Ouadrangle of USGS May,MA GIS and performed GW adiustment calcs. Per Barnstable GIS: Elev.of Ground=52 Feet Elev.Of Groundwater=30 Feet Elev.Of Bottom of Leach Pit=41.50 Feet Therefore: 41.5—30 = 11.5 feet separation between Bottom of Leach Pit and Groundwater. Groundwater Adjustment using Index Well SDW 253: 6.9 feet Adjusted Groundwater Separation=30' +6.9=36.9' feet (Refer to attached work sheet) Grade=Elev. 52 feet Leach Pit Septic Tank Bottom of Leach Pit=Elev.41.50 feet Adj. Groundwater=Elev. 36.90 Permit Number: Date: Ar Completed by: HIGH GROUNDWATER LEVEL COMPUTATION Site Location: 'Or' OC f al Lot No. Owner: �4 C� � Address: ` ® MPS Contractor: `? 9n\ lkK MC6.11X1ddress: Notes: STEP 1 Measure depth t water table f 3 tonearest 1/10 t. .............................................................................. .Date month/day/y ar STEP 2 Using Water-Level Range Zone and Index Well Map locate site and determine: OAppropriate index well.................................................... © Water level range zone ..................................................... STEP 3 Using monthly report "Current Water Resources Conditions" determine current depth to O water level for index well ........................... month/year STEP 4 Using Table-of Water-level Adjustments for index well (STEP 2A), current depth to water level for index well (STEP 3), and water-level zone (STEP 26) determine water level adjustment ........................................................................................... 10 STEP 5 Estimate depth to high water by subtracting the water- level adjustment (STEP 4) from measured depth to water levelat site (STEP 1) .................................................. ........................... Figure 13.--Reproducible computation form. , 15 No.........Z a— Fsa.._12......... THE COMMONWEALTH OF MASSACHUSETTS BOAR® O HEALTH ...................OF............/ ... .: 5���.r...........----•------------------ Appliration for Disposal Works Tonstrudion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at:, ��' ..dneU � -----...-G� �:l.v!/k... ..`-0,.. ....�................................... . Loca'o -Addr s i^ or / / f D �� J) C....!J..��.......nt:L .f.✓..�:.: .....zl.Q.� �!l.:e.��..... amn,,, ..�T:=........ s Fo.hZek.4 .-----.(1 - -------------------------------- ..........................--,�.�...c�............-•.-•••........ Installer Address Type of Building Size Lot..,29,_®7._`d.....Sq. feet �., Dwelling—No. of Bedrooms.............3.........................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building WaO a� No. of persons........... '........... Showers a YP g .... .. .. -P ( ) — Cafeteria ( ) dOther fixtures .... •.................•--•---•--------------•-•-------•----..............--••--•-•-•-••-•-•--•---• Design Flow............. .5....... ,I W pgn q p�'1/}�.. .. ..gallons per person fie; d1y. Total daily flgyv--------------- ----_-- --.----.-.--gallons.�� WSeptic Tank—Li uid ca ci .../dWgallons Length... w/.... Width.....YZk Diameter................ Dpth._.S.._ x Disposal Trench—N�..._ .. /�....... Width...: :..... Total LengthTotal leaching / — q. Seepage Pit No..................... Diameter._..r0.......... Depth below nlet__..4......... Total leaching area .q. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by......... VAV. rf....�..�?�.!i�!-r�. ......... Date......7.��7.���.... Test Pit No. 1.......:........minutes per inch Depth of Test Pit........I 7...... Ilepth to ground water.......�_._^' fs, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ w .................f •----•------•.............:....,.... ® Description of Soil.._.......Q 4 rG Q . Q.. .S'�7a.. .....................•--..-•..................---•-•-•........•..-_.. x ..... .... ..---.5''&Y..0...........................•--.. VW ---------------------------------------•---�--.--"."-L....---..hz. _f �� '� `�D---------.....--------....----.......------------.............-------•---•------. J Nature of Repairs or Alterations—Answer when applicable..................................................................................__.......... .............. ........ ................---------------------- •------------------ ------- -....... .------------------------ .......... ---------- -...... . Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary C e—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be i sued by thoboar(df th. -----•• • - ..A lication A roved B C�P PP Y.._.. -...--------•---- ----- -_ ..._.............--------.........._._.. Date Application Disapproved for the following reasons:--------•...............•--------.........---...---.........------------•------•------------...............----. ---•--•--....----•-----------------•------•----••--•----------.......------...---------.......----------.---...-•-••...-•-.....--•-•-------••---•-----------•-•••••••----------•----.............-•--- Date PermitNo........................................................ Issued..................................................... Date No........./:�Q__.... Rzz..._3..d.......... THE COMMONWEALTH OFp�MASSACHUSETTS BOARD OF HEALTH App.lira#gou for Disposal Works Tanstrudian Vamit Application is hereby made for a Permit to Construct ( ) ,or Repair ( ) an Individual Sewage Disposal �n System at J ` C [ /. --. &t!_LE f(!i /_...--------. -- ---------.................. .. ati 6z1 / �.u•PLoc6-;Adds --or ' /.o!? �....:` ? ........ .11 'N/� 'f . _.. .. ... t.�. -... . .. ..... ... Owner Address a 1...Y..._..... �, �l .................. // ._.E..._ ............................ Installer Address if Type of Building Size Lot--JU:U.7 ---..Sq. feet .-� Dwelling—No. of Bedrooms............: ..........................Expansion Attic ( ) Garbage Grinder ( ) a Other—T e of Building t Mfg 17 6"! p ( ) ( ),. a Other—Type g _..:...:......... ..... No. of ersons._.___...._.__.__..___._._.. Showers — Cafeteria ••_-----. 04 Other fixtures ------•-•---------------------------------------------•----------•--•--------•--------- ------••-•--......•-•............ W . t . Length w.............. p................gallons. Design Flow----..--.--•t t` 1j. &-----gallons per person peI day. Total daily fiy WSePtic Tank—Liquid capacity---1n.�gallons -_- -... Width....` P_ Diameter................ Depth.... x Disposal Trench—No.... Width.....tr-....... Total Length.....-::._-........Total leaching area........--.........sq. ft. Seepage Pit No.........I.......... Diameter.._:1. 1........ Depth below inlet.....,tit........... Total leaching area,V--_ALSq. ft. Z Other Distribution box ( ) Dosing to ( ) Percolation Test Results Performed by......... ,:t.l�l�_ Ls... � .yir�:zf......_..... Date___.._. ./_�Z..� p r Test Pit No. L:7:2:........mindtes per inch Dept of Tyest ......�Z...... epth to ground water............. ^'.F 44 Test Pit No:';22.............minutes per inoli /Dep of Test Pit.................... Depth to ground water........................ Description of Soil :.. --P-•---:-fi R.��_ .......� J.n.__...- W f= - *-----�=-------- a l�-(=�;s' 't"'' !'�I - VNature of Repairs or Alterations—Answer when applicable............................................................................................... T •------•-••------•-------------•-•----------•------•------•--------...-••------•--••----•••........----------•----•--•-------------------...........--•---............-•--•............-----••--•----- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board:of heal'th�. } S ....... A /1`l'J_;� �� �........ - �!l �1 /...............................� 1•GJ / / - .. . ..._.. . .._.............................. i �,1 .` (,/ d lC'�&'vS Date Application Approved BY----------------•------. - ,.. . '...............� -.................. Date Application Disapproved for the following reasons:...................................:. Date PermitNo...................................................--- Issued--.. ---------------------- Date THE COMMONWEALTH OF MASSACHUSETTS t BOARD OF HEAT' >:{ ..........................................OF............................:........::......,..................................... Trrtff ratr of Tl� .plia a T S ISAA`� CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (` ) by .... .: s,E„�C.: r= _... ^. „\ al] f` has een installed in accordance with the provisions of T ! '' S of The State Sanitary Co . as described i the application for Disposal Works Construction Permit No. �_... __ ...` — rr f`,k{�s dated,-...: `l'I -•-l------------ T�IE ISSUANCE OF T0�15 CERTIFICATE SIIAL ®T �E,:CANSTItUE® AS.'A GUARANTEE THAT VG,1E SYSTEM WILL FUNCTION SATISFACTORY. ................................ Inspector..,,r== THE COMMONWEALTH OF MASSACHUSETTS BOARD OF EALTH No ............... .. ...OF............. ..... ..(;!„Ali'Y1.......%................................ ��v...:.._ ..--- ... ' ,. FEE........ Permission is hereby granted.. x.. ... .1 ...:....- ...................................................... to Constri•f or ReV n Individual XV, ispos t at No.� r fY�1 )/'LG2�� _ .. "Street ...... as shown on the application for Disposal Works Construction Pe No._ �% ated.._.......:�..........................41 DATE �� / Board of Health / i-'_:...... ----•-•-•----------------------------------- FORM 1255 HOBBS & WARREN, INC.. 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Tsa - - k.,r' ,: -�,:a aF1'�': .i'•a :- s..,.,. s.: . i -. �• :.- �. .?s. _.'L.` s,. x -.a•"Y4:�= �iT' c +, �,1 .� w ._w #?. - ''..::cr.-.�R,z-- ,-,.` -,:iS'""'`�' N.Tr .c{ - :_g ny" �,. -- :• ,F -; ,., •':• ,. S ±sd fix- ..±.. • ._�.r �'!a '-x -s- _ - n �a ,; r ,f. : j6 - t _ f � > LOCATION SEWAGE PERMIT NO. LOTS �bm Recoic,-r VILLAGE C4U41M i t,tZ INSTALLER'S NAME i ADDRESS Rboelz ' S. duR, Co I m c. BUILDER OR OWNER ©cam► y Ylolo"% ss . D Z-ro DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED 3 d -Adr• o p�t 431 23t .p, 46" ` T'o ------ ilk iil��` xAVincent BUILDING & REMODELIP G 17 Still Brook Road South Yarmouth, MA 02664 Phone: 774-212-0938 FAX: 508-398-0550 email: info@cavincent.com www.cavincent.com 1 1. T L No. Description Date Front Elevation f . t IV0fT CrhC f l / �ct Hanrahan Elevations _ Project Number Date 8/10/2011 Left E I evati o n Drawn by 00 Checked byA- 1 N O N O Scale �4�� _ .-� 0 5 k.,AVincent BUILDING & REMODELING DECK 17 Still Brook Road 13-5 x 10-0 71'-81/2" South Yarmouth, MA 02664 Phone: 774-212-0938 13'-11 1/2" 10'-6" 19'- 28' 11'-4 1/4" 2-7 1/4 T-3 7/16" T-2 9/16" T-1" 8'-5 5/16" T-8 11/16" FAX: 508-398-0550 email: info@cavincent.com 304 DH 304 DH 304 DH 6C 38 o I www.cavincent.com O B24R I ®SB42® I 624R I m r - --L - - - - -- - - J ih BATH 10'-2" x 9'-9" I OFFICE I `° _ KITCHEN - 4'-10" 'm o rn " 11 I - 13-7 x 9-9 � 18'-11"x 9'-9" I m � 5'-1' o � I co I N 2468 I - 2'-2 1/2" N safifi I �—�I/ GARAGE N /+'� - 27'-4"x 21'-4" N N N C7 H 0? v to 1 w- cn X _ LIVING DINING 26'-1" x 13'-3" U N 16'-10"x 13'-2" 2'-10" I I I N �CD CV 8C 70 8C 70 1646DH 4046FX 1646DH 3 8 264 DH 164 DH 404 3FX 164 iDH 19'-1 7/8" T-3 5/8" 2'-7" 6-1 1/2" 2'-11" 2'-11" 3' 9' 11'-2 1/2" T-6" 26-5 1/2" 7 1 T-6 1/2" 2T-8 1/2" No. Description Date 71'-8 1/2" 71 First Floor Plan 44' -611 101-211 1 111 2-5 12 -4 1/211 16 -0 1/2 �✓ 1 11 3'-4 1/4" 21-811 4'-1 3/4" 6'-8 11/16" 5'-7 13/16" 21-8" '-6 1/16" 264 MH 264 DH 264 DH 264 DH 264 MH BATH l� Bedroom 2 r— — — — — 15'-3"x 8'-10" I Q42) I co 00 co 0 V J Y) ( V J 2668 1668 O O I � 1 11 11 -5 ® N I \J HALL S�co I CLOSET 14'-5" x 3'-7" � i 9'-7" x 8'-5" I M I 2668 _ I Bedroom 1 1 11 = 22'-7"x 18'-2" 3 -81/2 � © I — — — — — — — - - - - - - - - - - - - - - - - - - CO o � Bedr 3 - N I Line of ceiling I -- --- 5'-0" x 1�'-10" I I Hanrahan I I ► I If/ II/ o `I CLOSET I I I I I WE r I 9'-711 x 6'-411 2'-11"x 8'-10°' I Floor Plans - co I I I I I c' _� I_ = — 13040H �---- -- - - - - I I - - = I I - - - - - - - - - - - - - - - - - - - - - - - - - - - Project Number 304 OH 304 CH ' Date 8/16/2011 - - - - - - - - - - - �' - - -- - - - - - - - - - - Drawn by �O 3'-6" 6' 7'-10 1/2" 61 3'-4 1/2" 3'-5" 4'-411 6' 3'-6" Checked by LL 44' Second Floor Plan LIVING AREA 2x10 dormer ridge w/2x8 dormer rafters (typ) A�3 o 997 sq ft N "1 = 1 ' /4 Scale 00