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HomeMy WebLinkAbout0834 SHOOTFLYING HILL RD - Health (2) 834 Shootflying Hill Rd Centerville F/R A = 192 041 nn UPC 12534 19-v No.2�OR ,` , NASTlN9S.YN a Q 0 g� LZ , 1 C � �l � •. ` � P r q� .f��l Commonwealth of Massachusetts Title ,5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 834 Shoot Flying Hill Road Property Address Greg M ette Owner Owner's Name information is Centerville Ma 02632 6-17-15 required for every 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 filling out forms A. General Information on the computer, �[ ! O use only the tab 1. Inspector: ` I 9 DO key to move your cursor-do not Matthew F. Gilfoy use the return Name of Inspector key. Excavation Company � Company Name 14 Teaberry Lane Company Address Sandwich Ma. 02644 City/Town State 3•7.-7 , C P a a� (508)477-0653 S113640 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 Local Approving Authority 04 h, 6-17-15 Inspector's Sig ature "V 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 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 834 Shoot Flying Hill Road Property Address Greg Myette Owner Owner's Name information is required for every Centerville Ma 02632 6-17-15 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: 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 834 Shoot Flying Hill Road Property Address Greg Myette Owner Owner's Name information is required for every Centerville Ma 02632 6-17-15 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments M 834 Shoot Flying Hill Road Property Address Greg Myette Owner Owner's Name information is required for every Centerville Ma 02632 6-17-15 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 El ® 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 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface.Sewage Disposal System Form - Not for Voluntary Assessments 834 Shoot Flying Hill Road Property Address Greg Myette Owner Owner's Name information is required for every Centerville Ma 02632 6-17-15 page. Cityrrown 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- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 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. l5ins•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 834 Shoot Flying Hill Road Property Address Greg Myette Owner Owner's Name information is required for every Centerville Ma 02632 6-17-15 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? ❑ ® Was the facility owner(and occupants if�different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 J Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 834 Shoot Flying Hill Road Property Address Greg Myette Owner Owner's Name information is required for every Centerville Ma 02632 6-17-15 page. CityrFown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 5 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 ears usage d see below 9 ( Y 9 (gp ))� Detail: 2014- 122,000gallons 2013- 82,000gallons Sump pump? ❑ Yes ® No Last date of occupancy: current 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 W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 834 Shoot Flying Hill Road Property Address Greg Myette Owner Owner's Name information is required for every Centerville Ma 02632 6-17-15 page. Citylrown 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: pumper-driver Was system pumped as part of the inspection? ® Yes ® No If yes, volume pumped: 1500 gallons How was quantity pumped determined? tank size 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 834 Shoot Flying Hill Road Property Address Greg Myette Owner Owner's Name information is required for every Centerville Ma 02632 6-17-15 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: 2003 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 2' 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.): At time of inspection building sewer appeared to be in good working order no sign of leakage. Septic Tank(locate on site plan): 1' 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 gallon 5"Sludge depth: t5ins-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 834 Shoot Flying Hill Road Property Address Greg Myette Owner Owner's Name information is required for every Centerville Ma 02632 6-17-15 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 31" 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? 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.): At time of inspection septic tank appeared to be in working order,Tees present no sign of back- up.Liquid level equal with outlet invert. Tank was pumped for maintenance. 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-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 834 Shoot Flying Hill Road Property Address Greg Myette Owner Owner's Name information is required for every Centerville Ma 02632 6-17-15 page. Citylrown 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M , 834 Shoot Flying Hill Road Property Address Greg Myette Owner Owner's Name information is Centerville Ma 02632 6-17-15 required for every , page. Cityfrown 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 0 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.): At time of inspection d-box appears to be in working order no sign of carryover. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* r 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 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 834 Shoot Flying Hill Road Property Address Greg Myette Owner Owner's Name information is required for every Centerville Ma 02632 6-17-15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: (3) 500 gallon 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.): At time of inspection leaching appears to be in working order with no sign of hydraulic failure. Chambers had 5 of standing water 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 ❑ 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 834 Shoot Flying Hill Road Property Address Greg Myette Owner Owner's Name information is required for every Centerville Ma 02632 6-17-15 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 Title 5 Official Inspection Form 11. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 'Y 834 Shoot Flying Hill Road Property Address Greg Myette Owner Owner's Name requir atio r e Centerville Ma 02632 6-17-15 required for every page. CitylTown 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 0 drawing attached separately A READ ROUSE O USE­T7 B a. m 0 0 3 A i - 42.' Az.- aat 49%41' 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 834 Shoot Flying Hill Road Property Address Greg Myette Owner Owner's Name information is required for every Centerville Ma 02632 6-17-15 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' No Gw 156" 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: 5-15-03 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: Plan on file. Before filing this Inspection Report, please see Report Completeness Checklist on next page. l5ins•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 .�' 834 Shoot Flying Hill Road Property Address Greg Myette Owner Owner's Name information is required for every Centerville Ma 02632 6-17-15 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 .4 -- Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments yY 834 SHOOTFLYINGHILL RD Property Address CURLEY Owner Owner's Name information is required for CENTERVILLE MA 02632 11/28/09 every 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. '"'P°'`a"` When filling out A. General Information forms on the I computer,use 1. Inspector: only the tab key to move your DOUGLAS A BROWN cursor-do not use the return Name of Inspector key. DOUGLAS A BROWN INC CD Company Name tab P.O. BOX 145 m" - fi 3 Company Address ; M CENTERVILLE MA 4.. '8D1' City/Town State 02632 Zip Code 508-420-4534 S14297 Telephone Number License Number a I i,'t1 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 Local Approving Authority 11/28/09 nspect ature 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•osroe Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 834 SHOOTFLYINGHILL RD Property Address CURLEY Owner Owner's Name information is required for CENTERVILLE MA 02632 every page. City/town D1 State Zip Code Datea of 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): t5ins•09M Titre 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonw ealth of Massachusetts ,p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 834 SHOOTFLYINGHILL RD Property Address CURLEY Owner Owner's Name information is CENTERVILLE required for MA 02632 11/28/09 every page. Clty/Town State Zip Code Date of Inspection B. Certification (cont.) 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•09= 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 834 SHOOTFLYINGHILL RD Property Address CURLEY Owner Owner's Name information is required for CENTERVILLE MA 02632 09 every page. City/Town 11 State Zip Code Datea o of f 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 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 %z day flow t5ins•09)08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 834 SHOOTFLYINGHILL RD Properly Address CURLEY Owner Owner's Name information is required for CENTERVILLE MA 02632 11/28/09 every page. city/town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® 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- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 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•09i08 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 834 SHOOTFLYINGHILL RD Property Address CURLEY Owner Owner's Name information is required for CENTERVILLE MA 02632 11/28/09 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the 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)] D. System Information Residential Flow Conditions: Number of bedrooms 3 (design): Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 t5ins-09M8 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 '< 834 SHOOTFLYINGHILL RD Property Address CURLEY Owner Owner's Name information is required for CENTERVILLE MA 02632 09 every page. Cityfrown 11 State Zip Code Datea o of f insnspection D. System Information Description: ACCORDING TO AS-BUILT CARD SYSTEM CONSISTS OF A 1500 GALLON TANK D-BOX AND 3 500 GALLON CHAMBERS Number of current residents: Does residence have a garbage grinder? ❑ Yes No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: 2007--189 2008--167 Sump pump? ❑ Yes ❑ No Last date of occupancy: 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•09)08 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 834 SHOOTFLYINGHILL RD Property Address CURLEY Owner Owner's Name information is required for CENTERVILLE MA 02632 11/28/09 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: Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1500 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): t5ins•09M Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 834 SHOOTFLYINGHILL RD Property Address CURLEY Owner Owner's Name information is CENTERVILLE required for MA 02632 11/28/09 every 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 IN 2004 ACCORDING TO AS-BUILT CARD 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.): Septic Tank(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene El 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: Sludge depth: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 834 SHOOTFLYINGHILL RD Property Address CURLEY Owner Owner's Name information is CENTERVILLE required for MA 02632 every page. City/Town 11/28/09 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 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 How were dimensions determined? 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 WAS PUMPED ON 11/30/09 BY SCOTT FRANK FOR MAINTENANCE 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•09/08 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 10 of 17 l Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 834 SHOOTFLYINGHILL RD Property Address CURLEY Owner Owner's Name information is CENTERVILLE required for MA 02632 11/28/09 every page. Clty/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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 834 SHOOTFLYINGHILL RD Property Address CURLEY Owner Owner's Name information is CENTERVILLE required for MA 02632 every page. Cdyrrown State Zip Code Date of bate of 09 Inspection D. System Information (cont.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0 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.): D-BOX AND CHAMBERS NEED RISERS INSTALLED 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.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: NO RISERS INSTALLED t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Deposal 8system•Page 12 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 834 SHOOTFLYINGHILL RD Property Address CURLEY Owner Owner's Name information is CENTERVILLE required for MA 02632 11/28/09 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 3-500 GALLON ❑ 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.): 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 a Commonwealth of Massachusetts ,p Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 834 SHOOTFLYINGHILL RD Property Address CURLEY Owner Owner's Name information is required for CENTERVILLE MA 02632 11/28/09 every page. Ci Town State ZipCode 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-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 e q Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 834 SHOOTFLYINGHILL RD Property Address CURLEY Owner Owner's Name information is CENTERVILLE required for MA 02632 every page. Cltylrown 11/28/09 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 t5ins-09M Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 n � Commonwealth of Massachusetts upTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 834 SHOOTFLYINGHILL RD Property Address CURLEY Owner Owner's Name information is CENTERVILLE required for MA 02632 every page. Cltyrrown 11/28/09 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: GREATER THAN 5 FT 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: 11/27/09 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: OFF DESIGN PLAN AT B.O.H Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•09/08 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 rw 834 SHOOTFLYINGHILL RD Property Address CURLEY Owner Owner's Name information is required for CENTERVILLE MA 02632 11/28/09 every page. Cltyrrown 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-09/08 Title 5 Official In spection Form:Subsurface Sewage Disposal System-Page 17 of 17 TOWN OF BARNSTABLE LOCATIONSEWAGE VI VILLAGE ASSESSOR'S MAP & LOT �`�� -6 Ll .INSTALLER'S NAME & PHONE NO. A & B CANCO 77 -6264 i pp i SEPTIC TANK CAPACITY 123 3 LEACHING FACILITYi(type)3,,q;go Dfwc-e ,5(size)idX3C`J,,; ' NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER rt' BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED• S - '0`l VARIANCE GRANTED: Yes No �A9"0 08 aticoc a 7 , ©p 0 �. Li V7 '3�; �6 2, i i I i i No. f Fee �Q THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: I es ./ PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZIpprication for Migooal *p5tem Conotruction Permit Application for a Permit to Construct( . )Repair( �pgr�e( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 8,3q�S oa Y�"�j i 0w�N?mee,Addce�s and Tgel.No. / l,( C v►2 ly Assessor's Map/Parcel 1 Installer's Name,Address, I. o. Designer's Name,Address and Tel.No. a9 X CANCO �U e, &I, I I 350 Main Street nMA 09673 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3 3 gallons per day. Calculated daily flow 3 d gallons. Plan Date / / Number of sheets / Revision Date Title CC✓ Size of Septic Tank /_5 on Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 11n 4/--7 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 Env3iponipental Code and not to place the system in operation until a Certifi- cate of Compliance has been issuedMB and o e 1 h. Si(ned Date t AD Application Approved by Date Application Disapproved for the following reasons Permit No. r)-OO 7—0 t{ Date Issued '� Fee No. "7,.„ Entered in com uter: .THE COMMONWEALTH OF MASSACHUSETTS �,,,,,,Y p _ es PUBLIC HEALTH,DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Y - i IR-plicatior'-for M000l *p*tent Construction Permit Application lication for a-Permit to Construct �rade pp ( , )`Repair( �'Upg ( )Abandon( ) O Complete System El Individual Components Location Address or Lot No. Owner's Name,Addre s and Te.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. 1 l Designer's Name,Address and Tel.No. �-n /1 C v Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3' gallons per day. Calculated daily flow �3 U gallons. Plan Date ///3/5," Number of sheets / Revision Date Title Size of Septic Tank /S w Type of S.A.S. Description of Soil ` Nature of Repairs or Alterations(Answer when applicable) /f' /' %7 i ? t t 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 issued by-this B and ofi-Meal h. / Signe Date Application Approved by--�.-A�� Date � 1 a . Application Disapproved for the following reasons Permit No. -oG`a 0 S y Date Issued 4 --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired-( L_-)-Upgraded( ) Abandoned )by n at has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. �!UPI �s c�—dated ��3�u f Installer Designer The issuance of this permit shall not be construed as a guarantee that the sytem will function as d 's'igned. Date s Inspector No. �1 �G`� J— 1 --------------------------Fee THE COMMONWEALTH OF MASSACHUSETTS ry PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Mizpool by.5tem C�on.5truction Permit i Permission is hereby granted to Construct( )Repair( L.rUpgrade( )Abandon( ) e r_- System located at �5��riD f �Yi�t ��7 r,L7�/ . e`i 1 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 m st be completed within three years of the dateo�his permit. Date: / 3 O�� Approved by---_ 1 r - TOWN OF BARNSTABLE C. LOCATION SEWAGE#2j:974t-0 VILLAGE ASSESSOR'S MAP & LOT .INSTALLER'S NAME & PHONE NO. A & B CANCO 775-6264 SEPTIC TANK CAPACITY 013 .3 LEACHING FACILITY:(type)3,, f (size)JdX34 44 ` NO. OF BEDROOMS_ PRIVATE WELL OR PUBLIC WATER "* BUILDER OR OWNER C.vrl e ✓l DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: 3--d 'y Ll VARIANCE GRANTED: Yes No /4 6 �+ ® I 3 TOWN OF BARNSTABLE C_ ' LOCATION cS " SEWAGE #2,le' � VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. A & B CANCO 775-6264 SEPTIC TANK CAPACITY ���®®�i9'i ®I� LEACHING FACILITY:(tyPe)_7� Vrrefc-elktsi hg&3641 NO. OF BEDROOMS _PRIVATE WELL OR PUBLIC WATER ` BUILDER OR OWNER C v,l e DATE PERMIT ISSUED: -13-O L/ DATE COMPLIANCE ISSUED: 3-d -O LI VARIANCE GRANTED: Yes No 0 0 �19Z 6: 1 Town of Barnstable SHE? Regulatory Services i hamas F. Oeiler, Director BARNSTABLE, MASS. a ]Public Health Division 039. ArFD N1°�� Thomas McKean,Director 200,Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: Designer: 7-0M113(f /k./LL C /b-G Installer: Address: G'$ fcJpQ-er &40 yi,i% 3 Address: 3 CANC � 50 Main Street W. Yarmouth, MA 02673 On cD 3 was issued a permit to install a (date (installer) ) septic system at �� //1 // )—)d. based on a design drawn by ( ddre s) --'/(�1in Mdl dated a (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 certified as-built by designer to follow. H0F Cal I J (Installer's Signature) P. JAMEs STROKE y No.2:3uu3 ( s rIRN Signature) (Affix Desigrnt's Stamp Here) PLEA TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE .ISSUED UNTIL BOTH THIS FOR-NI AND AS- BUILT ARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q: :;ealth/Septic/Designer Certification Form f COMMONWEALTH OF MASSACHUSETTS ` 8 V EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS a DEPARTMENT OF ENVIRONMENTAL PROTECTION `d� RCEL�E5 NOIJ.03dSNI a311 FAILED INSPECTION . APR 15 2003 TOWN OF BARNSTABLE TITLE 5 HEALTH DEPT. OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTENI FORNI PART A CERTIFICATION Property Address: ?T3�f ��too-E F/ �h N-,// A MAP C) 2 �' CeN rv,//e �7�4 O G 3� `� PARCEL. Owner's Name: o,t er�nL Li's d LOT Owner's Address: -- e.v •-v./c /17A Oa&Sot Date of Inspection: 41 io p Name of Inspector• lease print) Company Name: Mailing Address: O X s Gt� 05 Oa C u. Telephone Number(S49J 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 CivIR 15.000). The system: Passes Condidonallv Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: �la 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 (0,0t)0 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The orig authority. inal should be sent to the system owner and copies sent to the buyer, if applicable,and the approving Notes and Comments a-4 1le _/vt, 4 )1�Q�S 5"/ 05/e ****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. f Pagc 2 of l l OFFICIAL INSPECTION FORM— NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTENI INSPECTION FORM PART A CERTIFICATION (continued) Property Address: en e ✓a�� Owner: /—%S Date of Inspection: /0 0 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System System Passes: �1/S I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CNIR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: ZOne or more syrepair, components as described in the"Conditional or repaired.The system,upon completion of the replacement or re Passe section need replaced,as approved by the Boardd off Health,will pass. Answer yes, no or not determined(Y,N,ND) in the for the follo�ving statements. If"not determined"please 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«ill pass inspection if the existing Link is replaced with a complying septic tank as approved by the Board of Health. ��i *A metal septic tank- ll 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%%ill pass inspection if(«ith approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property p _ Address: Owner: Si Date of Inspection: p C. Fu her 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 sxstem is failing to protect public health safety or the environment. I. System will pass unless Board of Health determines in accordance with 310 CNIR 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 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 s<'stem(SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The S. stem 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: I Page d of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSiN1ENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: � 400o �x 10015N��� /Qj Owner: —� �� �/aG?ol Date of Inspection: io p 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 v iquid depth in cesspool is less than 6"below invert or available volume is less than' v Re uired um ins V day flow q pumping J more than �F 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. portion of cesspool or privy is within 100 feet of a surface Water supply or tributary to a surface / water supply. ✓ y 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, performe.' DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates c:..:. zne well is free from pollution from that facility and the presence of monia nitrogen and nitrate nitrogen is equal to or less than 5 m 'provided that no other failure criteria are tribgered.A copy of the analysis must be attached opthis form.] (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 s-stern the system must serve a facility with a desi;n flow of l OO) gpd to 15,04W 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 drinlang 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. Page 5 of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTENI INSPECTION FORM PART B / / CHECKLIST Property Address:' �� ��ICbT FX In /-/il/ Xd ` ti �' G3o1 Owner: GISdp Date of Inspection: �p Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes Nq/ 1/ ,Pumping information was provided by the owner,occupant, or Board of Health ere anv of the system components pumped out in the previous two weeks Has the system received normal flows in the previous two week period ZHave large volumes of water been introduced to the system recently or as / part of this utspectton ,.-V- Wcre 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 sewag e 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 battles or tees, material of construction, dimensions,depth of liquid, of the tank inspected for the condition p quid,depth of sludge and depth of scum Was the facility owner(and occupants if different from owner)provided%ith 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 E 'sting information. For example,a plan at the Board of Health. Determined in the field(if any of the failure cnteria related to Part C is at issue approximation of distance is unacceptable) [310 CNiR 15.302(3)(b)] Page 6 of l l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORINIATION Property Address: �� S`jpp �l Owner: L /s -417 Date or Inspection: �o p FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):2— Number of bedrooms(actual)3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): .1-Ta Number of current residents:_a Does residence have a garbage grinder(yes or no):�T/'V Is laundry on a separate sewage system eve or no): eklif ves separate inspection required] Laundry system inspected a or no): Seasonal use: (yes or no):A Water meter readings,if av ' ble(last 2 years usage(gpd)): SumP Pump(yes or no):_ Last date of occupancy: CO NI IERCIAL/IND USTRIA.L Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgfl 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 x): Pumping Records GENERAL INFORINIATION �i Source of information: /v Was system pumped as part of the inspection(yes or o): 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) current_Innovative/Alternative technology. Attach a copy of the operation and maintenance contract(to be obtained from system owner), _Tight tank _Attach a copy of the DEP approval _Other(describe): Appro..dmate ageof all components,date ingtalled(if kno )and source oj,inform tion:/ Were sewage odors detected when arriving at the site(yes or no): 4110 Page 7 of 11 OFFICIAL INSPECTION FORM— NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: 17 Date of Inspection o BUILDLYG SEWER tlo on site plan) Depth below grade: �� Materials of construction:_cast iron _40 PVC (,�6ther(explain): o / Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: (locate on site plan) Depth below grade: Material of construction:_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: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: 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: How were dimensions determined: Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): GREASE TRAP: (locate on site plan) Depth below grade: -. ... Material of construction:_concrete metal fiberglass_.polyethvlene 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, as related to outlet invert,evidence of leakage,etc.): liquid levels Page 8ofII OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address �� SLj ,. 0 Owner: LtS Date of Inspection: �p O 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.): DISTRLB(;1 Wr flv`::p✓ if ( present must be opened)(locate on site plan) Depth of liquid level abo,._ .. invert: Comments(note if box is 1c•.cl ar;d distribution to outlets equal,arry 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(ves or no): Comments(note condition of pump chamber,condition of pumps and appurtenances. etc.): Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART C Q !/ SYSTEM INFORiv1ATION(continued) Property Address: Owner: /—/,410 " Date of Inspection: o p SOUL ABSORPTION SYSTEM(SAS):/Vaocate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number:_ 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 veetation, etc.): g CESSPOOLS: Z*('Cesspool must be pumped as of inspection)(locate on site plan) Number and configuration: ,� Depth—top of liquid to inlet invert: C �_ / /' UePui of solids layer: — �/M/J`�vl �/c� /e C.QjEY00� Depth of scum layer: / o� Dimensions of cesspool: �C &X (o /�/D CO//OLOC Materials of construction: 0c (j/�� Indicadon of groundwater inflow(yes or no . Comments(note condition of soil,signs of ydra�lic�adure, el of pon condido of}, getatipn.etc.) P��: (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.): Page 10 of l I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: ✓ 1�007' t� ���� �.� Owner: Date of Inspection: 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. ,l'c�--^ �� ��- j> Page 1 I of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: S4001 F/yF�••�� //5 Owner. �l S 4 [� Date of Inspection: 0 G SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water/31.5 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: 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 st describe how you established c high ground water elevation- j'O F �� .fie%�,✓ G�-�.c�e . I AL✓d 0- 200e - C s F C B 5 z 1'-3" V WW X— Z ' BUILDING CODE WVZ 3 -1 MA 8th EDITION RESIDENTIAL CODE UP LANDG INTERNATIONAL BUILDING CODE -�2009 J O3 RISERS D02 42 X 42 3'-0"X 6'-8" 7.9 RISE ENERGY CODE DOOR INTERNATIONAL BUILDING CODE - 2012 U U o 101-9 STAIRS: W01 u W 13 RISERS > Z s o = CONCRETE SLAB 7.9 RISE w LL 18'-17" PITCHED 2" w~ Jz � n 9 -3 aW�- a �' � A BACK TO FRONT A o=Q co 00 UU LL J " < C) M. 3 W01 DOWN 24' w Wo1 Q O 3-0 X 6-811 0 DOOR w 0 O w W01 D02 O D01 D01 4'-611 8' 8' , �{f�--- 5'-6 16' 11 C-M� ; Z Q fir, No.37 C IN �, w r Ld L- J W � � � Z,s �S 28' mow DOOR SCHEDULE NUMBER QTY FLOOR DESCRIPTION MFR/MODEL# (L Z D01 2 1 GARAGE OVERHEAD CLOPAY COACHMAN COLLECTION CF12 ()f C'7 w D02 2 1 13/4 X 3'-0"X 6'-8"ENTRY 9 LITE (D 00 U GROUND LEVEL FLOOR PLAN WINDOWSCHEDULE QTY FLOOR DESCRIPTION MFR/MODEL# RO 1��=11-011 4 1 DBLHUNG ANDERSEN 400 SERIES TW2636 2'-8 1/8"X 3'-8 7/8" 4 2 2 DBLHUNG ANDERSEN 40DSERIESTW2636 21-81/8"X 3'-87/8" I 3 2 D81.HUNG AN DERSEN 400 SERI ES TW3046 3'-21/8"X4'-87/8" 0 LI ~W 28' W W ANCHOR BOLTS W�A ' I 3-0 DOOR 1' IN FROM CORNERS J® 3'-8" II II I ' 5' O.C. CD z N P.T. 2X6 BOTTOM PLATELu ; o ZF � I I I W� o= O� W WOLj Z� M ~Q' < CM M p =Qf— a0a0 U u. CO W N Q O O - Q— WLoLo 8" CMU FOUNDATION WALL 4"-5" SLAB 16" X 10" CONCRETE FOOTING, PITCH 2" DOW BACK TO FRONT I MIN 48" BELOW GRADE w TO BOTTOM OF FOOTING <olf w 19'-8" I II II � cu w 0 II II 7„ I O o 3-0 DOOR I 1—t I I I Q elf 1 -7„ 1,-7„ ' 11 O 4-6 J — 8-0 OVERHEAD 8-0 OVERHEAD 81-6" 81-61' 56 ---4 z 5 2'-3" 1' 2'-3„ -1 w O > FOUNDATION PLAN of w co 2 BOTTOM a EDGE LINE DORMER ROOF RIDGE BOARD RIDGE EGRESS I) 2x10 CLG JOISTS 16" O.C. QUALIFYING II II WINDOWS II Z_ N TI W W Q M C7> �O W� VOti W U W Z F2 M Q�� QWafQcoco UH < (n ri co Oco m Q=QHcco W Uu. cno6 .6. 3'—% W <N Q.- W �n QO in J ILE i J] I ILLWI LLl 3'-6" -7' cr- > Q c W10x30 STEEL I BEAM 1 1-211 17'-7" 1 2" , -------- 1'-4" I � O 3 3-1/2 IN LALLY COLUMN a ,6 _" Q 3'-$7" 3-1/2 IN LALLY COLUMN 6—14 3'-01 r $ 2x10 FLOOR JOISTS 8 tl Q fY uj J J_ 3-1/2 IN LALLY COLUMN u- J 24X12 CONCRETE LALLY COLUMN LU F- � PAD WITH 2 -#4 BARS EACH WAY _. `.;'___ e } O > TOP AND BOTTOM - `�` °'� � O 2 W t: �ryG cif Is!N �' i � � W .373 C� oMo U SECTION A ``�¢ 1„_1 ,_o„ 3 4 16' 98L Z V-72 N ry WW 12 4 �Z � H- „ / 71 4 12 ^vZ WrY� 12 J� V 2" DBL 2X10 HEADER TYP ALL WINDOWS Z N / � r 7'-84"/ 2X12 RAFTERS 16" O.C., >[Ell o W y i o r W U W z m m NOTE - STAIRWAY SHALL Q U) HAVE 10 INCH TREADS 6" SEE SHEET 5 DETAIL 1 0 < � co c) 00. FOR THIS CONNECTION W N Q AND 7 INCH RISERS. 74 o �Q — w -Ln s 2x10 FLOOR JOISTS @ 16"OC 2x10 FLOOR JOISTS @ 16"OC 23'-77" 8 511 w 2 #1 CLEAR WC SHINGLES OVER AMOWRAP, < v-r OVER 2" OSB 3-OX6-8 ZIP SYSTEM SHEATHING �C ENTRY 3 3„ aLu LE DOOR HEADER: 9'-11$" 10-74 U) Ln 3 2X10's a 210" WX2" THK 0 o EXTERIOR PLYWD a BETWEEN EA 2X10 7'-8" X 8' CLO COMPOSITE HEADER COACHMAN FOR STAIRWAY OPENING C COLLECTION l USE 3 - 2X10 BOARDS OVERHEAD = ! GARAGE DOOR Z Q Lu 101, V-4" -j LLi ~ LL J_ 1 13'-6" LLI O 24, Y• xs4 � = Lu (D H 24X12 CONCRETE LALLY COLUMN RBERSINL � M W PAD WITH 2 -#4 BARS EACH WAY SECTION B—B CIV�L9 C� co U TOP AND BOTTOM 4 GNAI 4 2X12 RIDGE ASPHALT SHINGLES, STORM NAILED (6 NAILS PER SHINGLE), 2X12 RAFTERS 16" O.C., OVER 15LB FELT AND z' ZIP SYSTEM R40 INSULATION 12 a 12 z o z c° N � r WLLJ � Z_ Q z S) � � = 7$4 no � o� w U W Z M NOTE - STAIRWAY SHALL a �� U) M � HAVE 10 INCH TREADS SEE DETAIL FOR 1�� o=Qco co AND 7 INCH RISERS. THIS CONNECTION 74 w �Q � W C50 2x10 FLOOR JOISTS @ 16"OC 2x10 FLOOR JOISTS @ 16"OC 23�-78�� W Q HEADER: _ Q fill 'FT_T1 1 3 2X10's & ,a of A14 O ' 8 11 2 10"W X 2" THK aa�ROBERT L.a��� 0 #1 CLEAR WC SHINGLES 8 _ Lu 5, EXTERIOR PLYWD BERSIN (n OVER AMOWRAP, 8 BETWEEN EA 2X10 CIVIL O OVER 2" OSB N O ZIP SYSTEM SHEATHING - - BOX OUT 3 2" DIA ` a NT LALLY COLUMN DO R 2x10 FLOOR JOISTS @ 16" OC 7-8 O COMPOSITE HEADER J FOR STAIRWAY OPENING 4' -� ' I USE 3 - 2X10 BOARDS 6" JOIST OVERLAP Q Z � 2X6 JOIST SILL- BOLT TO W >- I-BEAM W 3/4"DIA BOLTS L 4'-6" ALTERNATING EVERY 4 FEET. W H ENSURE SPACING DOES NOT INTERFERE WITH JOISTS. � W 24 wU) z 3-1/2" LALLY COLUMN WITH PLATE - Lu � W SECTION C-C W10x30 STEEL IBEAM WELD PLATE TO I BEAM O ob U 24X12 CONCRETE LALLY COLUMN PAD WITH 2 -#4 BARS EACH WAY 111=1 1-011 TOP AND BOTTOM 4 I-BEAM JOIST DETAIL (not to scale) 5 Z ------------ == -- ------1f-------1, ---------�= c3---------j, ------------ ry 1 II 11 it II II W z � —, II II I L J , I -----� II II It ---------------------------- i II I I 11 .L w N�__ V�E $ M N w c a ��� u. Q m II II // II II_ � II _ �� i N J_ N I7 J Nd�m ��+ c 0 1- Y m=W cc� 0 N V 1/EC-3 EXISTING CONDITIONS — ROOF 1/4" = 1'-0" PLAN �a J Q 3 O W F ' i2 Z w v� U) z 0 z O U C7 Z s F-- X w Et'#w;A-3 3 of8 z W Ww �� cnyz ^VZ „ 12 0)�mo w Q mom � W�� iE _ ¢LL EXISTING TRUSS ROOF �w t a V)�O� a w GNU G Q Q EXISTING 2x4 STUD WALL i EXISTING 2.10s ®16" O.C. w t- O LXIS11NG SILL PLATE N a EXISTING BULKHEAD FONNBATI - 7" BELOW EXISTING HOUSE 5 FOUNDATION EXISTING 10` POURED CONC. aoa m Z FOUNDATION WALL I 1 O 0 z 0 _ U C� Z U) EXISTING POURED CONC. SLAB m x � W EC-4 4 of6 1/EC— EXISTING CONDITIONS — BUILDING 1/2" = V-0" SECTION ® MAIN HOUSE 0 Z �n-W W� Wz ¢y_ 3 8.1U7 E O�J WCho E N N 12 w— m W � w _j - EXISTING TRUSS ROOF ` QLL¢� \ LL a~W, W8z Y W / o / < 3 / J / Q EXISTING 2x4 STUD WALL ——— —————————— ———— Ll m � w o t- O z EXISTING POURED CONC. SLAB � cn w/C.T. FINISH < _ w EXISTING POURED CONC. FOUNDATION WALL (ASSUMED) U) Z 0 z O U (9 Z h- U) Iz 9 W EC-5 6 1/EC-5 EXISTING CONDITIONS — BUILDING 1/2" SECTION @ BREEZEWAY Z � W wW �� Wad � J® i\ App f � m . W zu I d m 93,6 12 4 = � w 5 s +/—� 7C) —w j :E V t Q L m EXISTING TRUSS ROOF g U � (D -0 / CD c0 z CC �O w C 0 9 EXISTING 2X4 ol \ STUD WALL W/ I Y2" LAYER pD PS \ DRYWALL EXISTING 2x4 STUD WALL $ Q w EXISTING POURED CONC.-SLAB O a z EXISTING POURED CONC. a FOUNDATION WALL (ASSUMED) _ U) Z Q f"- Z O U z k F— W ECFAQh MVJ 6 of6 1/EC-6 EXISTING CONDITIONS — BUILDING SECTION @ GARAGE A-5 A-4 y 2'-10" 13'-l)C 6'-5 SIP NOTE I LA+NG SIP'S TO BE PROVIDED FROM N Wi N W. SUPPLIER w/WAX SEALANT ON Wz BOTTOM SIDE OF PANELS. SIPS TO 36X80 SLIDER BE c w 40 LIVE LOAD. L/360 DEF.FCTION, (OVER CRANL 3 i I ;P SPACE ONLY). Z w � Z • 12._3 " in EAST,t \� i � I �Y z < I MASTTuER3� I �. NEW SIP FLOOR SYSTEM, 4' I I WIDE SIP SPAN CLEAR LEFT TO a $ RIGHT- SEE BEARING LEDGER am � I DETAILS & MANUF. PANEL JOINT � I m -NI ATTACHMENT DETAIL < '� KITCHEN I 8-7134 A�6 (3) COMPOSITE BEAM, 2x(?) @ CONTRACTOR'S SELECTION of I I w W E zl +0 T.O. F.F.. NOTE d 8 wi + �ti i'-3 " PROVIDE VAPOR BARRIER ON m al - I I EXISTING FLOOR UNDER NEW SIPS. Q ® oj I 1 m I MASTER TURN BARRIER LIP SIDE WALLS MIN. c o I BEDROOM 6"&TAPE TO VAPOR BARRIER ON "'w 2 a` Ui j N FOYER i I WALLa) E 0 a) `-oS I 1 I I I I I I I t I I EW NEW I m Q LL z l I x80 32x80 I I F I I I I WJW.i=C. I I I p 5_„ - - - m� N W N �pp r LANDING bdR to U= `�J 4=� `�J m x W N W A~� c O a00 ®` �' 3'-1" 3'-1" 4'-5h" 4'-O)J" 4'-5Xz" j,697A m 0 EXISTING a a 1/A_1 PROPOSED CONDITIONS - 1/4" = 1'-0" FLOOR PLAN a 0 O z rn - s � U) W Z co O Of l� LL�Ii � O DO - NEW ENTRY DOOR & TRELLIS BY NEW AWNING Aml WINDOW OWNER WINDOWS 1 of 6 2/A-1 PROPOSED CONDITIONS FRONT ELEVATION --------------------------------------�-I �.,. r - 12"x16" CONCRETE FOOTING SET 1 --------------------------------------- I ON 8" CRUSHED STONE BED. I I I I NEW 8" SOLID CMU FOUNDATION I j I '1'-4" ♦,wry WALL I T.O. BULKHEAD FDN. WALL CUT I i �r-s DOWN 7" BELOW BLDG. FDN_ WALL r--------------- I W 1 10 • I - ��' I I j i NEW CMU FOUNDATION WALL & FOOTING BELOW EDGE OF e EXISTING GARAGE SLAB Ol EXISTING 10" POURED CONC. FDN. �+ WALL EXISTING CMU BLOCK CHIMNEY BASE EXISTING BEAM ABOVE (BELOW JOISTS) 0 ;� o I I I II it u n II Ifa EXISTING LALLY COLUMN � I I I II ItII II 11 q1 mg E ro I II A 11 II II It II Itr EXISTING 2x10 JOISTS ABOVE ® w 'c - I I 1 11 11 11 II II 16" O.C. T.O. CONC. SLAB TO c 8 2_8" _ B.O. JOISTS - 813/a" - (nw2 -� —m-2 a N � €m p L 2.1 W EXISTING POURED CONC. SLAB FLOOR N i m d N < NOTE: d. T.O. EX. BASEMENT SLAB FLOOR TO T.O. BASEMENT FDN WALLcn- 8 'a" )c 03 'Jw c0F x. �mw m N V A a J O 3 J Q NEW ARCHITECTURAL NEW STANDING SEAM -- GRADE ASPHALT METAL ROOF - S SHINGLES o O iILIL J • ® 22'-5Y." +/- ADDITION \ �� (n �z W 6'-0" ADDI - 0 ~ 1 C 0Z NEW DOUBLE HUNG SHINGLE SIDING NEW SLIDING GLASS SHINGLE SIDING NEW DOUBLE HUNG WINDOWS TO MATCH TO MATCH DOOR TO MATCH WINDOW TO MATCH EXISTING EXISTING EXISTING EXISTING Amy= 2 of6 1/A-2 PROPOSED CONDITIONS — 1/4" = 1'-0" 2/A-2 PROPOSED CONDITIONS — REAR RIGHT SIDE ELEVATION ELEVATION STANDING SEAM z METAL ROOF fy ARCHITECTURAL W GRADE ASPHALT W 9 n SHINGLES L �r-------'7 t I I�— It ROOF FRAMING NOTE: tI EXISTING GARAGE ROOF TRUSSES 1 I I I I I I I I AND SHEATHING TO REMAIN. NEW G w I I M I I I I I ROOF FRAMING TO BE INSTALLED 1 1 III I� I I I I OVER EXSTING ROOF FRAMING PER o III { ♦ I I I DIAGRAM :--Yaney croepe+�a'le� IL �_� i .� I I '_,.,'•''.. ��, � � . Sp:Icn�:,C pine 9� I F I t I I \ I I 1 1 \ I I L___________________J I If W `��E � _ s I I _ I I I I I II Ceiiin9 iptst va,. Q C P JL_ _ _ W m _________________________� I I 1 1 II C---- -, �^W` —Uy W--------------------- jI lit r----�I ARCHITECTURAL r--�1 GRADE ASPHALT � SHINGLES m¢a N m Z 2/A-3 PROPOSED CONDITIONS - 1/4" = 1'-O" (D ;Y> ROOF PLAN w o� amyU BY" S.I.P. m 11 II II II II 2'-5Ya"II 4'-0^ II 4'-0" I 4'-0- 4'-0^ I 4—0^ o 11 3 II II II II II II II II � II II II 11 II II II II II II 11 II II II II II II II 11 II � _ z w II lYt N O II FOAM 11 FOAM I z II RELIEF RELIEF a a II H II m 0 I c LINE OF (2) 2x LEDGER ^ BELOW- SEE DETAIL3 ON -------------------------_ SHEET A-S Q > a LLJ Z 00 m NOTE: -------- °' O Z ALL ROOM DIMENSIONS ARE ---------------------- TO BE VERIFIED IN FIELD W 0 BY G.C. PRIOR TO �j C' U ORDERING SIP PANELS 'v NOTE: ______________________ PANEL LAYOUT TO BE REVIEWED & APPROVED BY PANEL MANUFACTURER AND/OR PANEL SUPPLIER FRONT OF HOUSE 3 of 6 1/A-3 PROPOSED CONDITIONS - 1/4" = 1'-0" S.I.P. LAYOUT Z W W� 1--z n%JZ oJ� ARCHITECTURAL GRADE ASPHALT SHINGLES y' 'M 0 NEW ROOF SHEATHING TO MATCH T EXISTING THICKNESS- NEW ROOF TRUSS, PITCH AND TAILS TO MATCH EXISTING GARAGE FRAMING �w �sz W � ME w w— o Y Q LL m NEW SPRAY FOAM ROOF IN9.A. PER 2012 IECC-MIN. R-30 SEE MANUF. PANEL ci ATTACHMENT DETAIL C SIP NOTE =a SIP'S TO BE PROVIDED FROM _ SUPPLER w/WAX SEALANT NEW 2x4 STUD WALL. N w ON BOTTOM SIDE OF PANELS. R-20 INSULATION MIN. PER 0) `>� SIP'$TO BE SUPPLED w/ 2012 IECC. PROVIDE (2) 40#UVE LOAD, L/360 2x8 HEADERS AT ALL NEW %O z DEFLECTION.(OVER CRAWL WINDOW®DOOR OPENINGS m w u SPACE ONLY), w/HOLD- DOWNS, CLIPS, >10 m NOTE ETC. PER WFCM 110mph PROVIDE VAPOR BARRIER ON 4 EXISTING FLOOR UNDER NEW 6'-OXz" ADDITION A-6 SI.P.'S. TURN BARRIER UP SIDE WALLS UNDER MIN. 6"& ¢ 3 TAPE TO VAPOR BARRIER ON PATIO BUILT IN PLACE WALL BY CONTRACTOR cc w � O Z CRAWL SPACE a b e oV ' - Qz A 1'-4' 2" DUST CAP W/PLASTIC Q- Q VAPOR BARRIER BELOW O Z 6" GRAVEL BED �O U a Ao4 4 ors 1/A-4 PROPOSED CONDITIONS — 1/2" BUILDING SECTION AT MASTER BEDROOM Z W� �V Z J I Om Y NEW SIMPSON HTP37Z STRAP TIES FROM NEW RAFTERS TO EXISTING, 16' O.C. ALTERNATE TO BE EN SIMPSON SIDS SCREWS UP INTO NEW 2x10s THROUGH EX. 2x6s ® .� 16" O.C. m W a Qc c ' 2 2 N tiu 2 2 M 3 1 n Q LL NEW 9�RAY FOAM ROOF INSUL `u`O PER 2D12 IECC-MIN.R-30 MATCH EXISTIN NEW 200 ROOF RAFTERS 16" O.C. p NEV 2x6 CEILING JOISTS®16"O.C. N m NEW 2x4 JACK STUD WALL 'p �_ NEW 2x4 STUD WALL. � z-"'+ R-20 INSULATION MIN. PER LL¢ 2012 IECC. PROVIDE (2) ~O F 2x8 HEADERS AT ALL NEW a p z WINDOW ®DOOR OPENINGS m m w w/HOLD- DOWNS, CUPS, 1 ETC. PER WFCM 110mph ^o NEW P.T. 2x4 SLEEPERS® A-6 NEW EX"S.I.P. FLOOR w/ g 16"O.C. W/(2)LAYERS 1/2" PLYWOOD&X"FINISH FLOOR PLYWOOD ON TOP. SI.P.'S w/ 3 MOISTURE PROTECTION UNDER BY MANUF. MIN. R-30 INSUL ——— ----------- ———— \ PER 20121ECC —— a O z m CRAWL SPACE a _ w Leom m v o Q Z 0 2" DUST CAP W/ PLASTIC 1-4" O " VAPOR BARRIER BELOW O Q 6" GRAVEL BED ._ Of O o dU Aw5 5 of 1/A-5 PROPOSED CONDITIONS - 1/2" = V-0" BUILDING SECTION AT MASTER BATHROOM & FOYER Z Pry w NEW M"SI.P R072 w/ FLYP.000&Y2-FlNSH RDCR +� (BY CAW SR)ON TCR SIP a ww (1) ROW 8d NAILS ®6" PANELSw/MOSRIR J ¢m $ O.C. EACH SIDE TO PROTECTION� �BY R• PANELH SPLINE INTO < NEW FINISH FLOOR, BY lz T.O. FIN. FLR. o, OWNER 1'-3 1/2" (2) ROWS 12d NAILS N (2) LAYERS PLYWOOD NEW(2) 2x10 P.T. LEDGER 6" O.C. STAGGERED TO DECKING FOR S.I.P. SUPPORT(OR AS ATTACH 2x SPLINES m NEW 6" S.I.P. FLOOR au _ E PER S.I.P. MANUF. SPECS) TOGETHER EX. CONIC FLOOR SLAB w o'g`'$ c �5 (2) PLY 2x SPF#2 OR P.T. SILL PLATE Q - . n u BETTER EDGE SPLINE i - I - (n a—u RIPPED TO FIT SNUGGLY FOAM FOAM "0 c W 5 m BETWEEN SIP WOOD RELIEF RELIEF STRUCTURAL PANELS NEW 8" SOLID CMU a TS E m FOUNDATION WALL. i N 2 2 Q X �6 m K E � d�a -O N ooZ = m=w AU'NU PROPOSED CONDITIONS — PROPOSED CONDITIONS — w 3/A-6 SECTION DETAIL 3" = V-0" 4/A-6 SECTION DETAIL a EX. 2x4 STUD WALL NEW(2) W FURRING w/ NEW CLOSED CELL SPRAY a X" GYP. WALL BOARD INSULATION, (MIN. R-20) ' NEW GYP. WALLBOARD NEW 8%4"SLP.PANG-FLOCK NEW 6"SI.P.FLOQ2 BASE TRIM. SELECTED BY / OWNER w/iy"FLYNO(A&)4"FlN91 PLYWOOD&Xz"FWSH FLOOR NEW 2x BLOCKING BETWEEN FLOOR(BY OVER)CN TO. (BY OANER)CN TOP. SIP w EX. STUDS TO RECEIVE SP PMt7.S w/husl,RE PANTS w/MOSU;E o NEW GYP. WALLBOARD AND PROLECTIOJ USER BY MMA.F. PROIFLRCN LNDER 13Y MAVI.F. Z BASE TRIMFIN. PLR. ?&T.O. FIN. FLR. NEW C.T. FINISH FLOOR 7'-3 1/2" 4 a (2) LAYERS PLYWOOD _ PROVIDE VAPOR BARRIER p a DECKING AGAINST INSIDE OF EXIST. NEW 2X P.T. SLEEPER ® >' WALL&ON SLAB 16"O.C. .+ EX. CONC. SLAB L0. SLAB. 0'-0" P.T. SILL PLATE E) EX. CONC. SLAB (ASSUMED W z NEW 8" SOLID CMU w/ TURNED DOWN Q FOUNDATION WALL PERIMETER)CRAWL O SPACE EX. 2x4 STUD WALL o- Q 0Z �O EII I Am FIR AK=6 6 of6 1/A-6 SECTONEDETOLDITIONS — 1 1/2" = 1'-0jEj�� SEOTIONEDETONDITIONS 1'-0" '`�, /jy\ t D UN C L"E'_ I" 10N ILE IL_C,), G(S_ P 1_ N] I F F"I LEGEND ASSESSORS MAP '192 PARCEL 041 EXISTING PROPERTY LINE DEEP OBSERVATION HOLE 1 EL. 72 EDGE OF PAVEMENT ------------ SOIL SOIL COLOR SOIL DATE OF TESTS: NOVEMBER 6, 2003 DEPTH FROM SOIL OTHER ABUTTING PROPERTY LINE -------- - -- -' ---- SURFACE HORIZON TEXTURE (MUNSELL) MOTTLING PERCOLATION RATE : LESS THAN 2 MINUTES PER INCH DROP IN THE C HORIZON IN DOH # 1 WATER SUPPLY LINE - — — -W- GRANULAR, — — - FRIABLE GAS SUPPLY LINE - — — -G- — — - 0" - 9" A SANDY LOAM 10 YR 3/2 NO GROUNDWATER ENCOUNTERED MASSIVE, ELECTRIC SUPPLY LINE - — — _E_ 9" - 42" B SANDY LOAM 10 YR 5/8 FRIABLE DEEP OBSERVATION HOLE } " - " MEDIUM TO 5 YR 6 6 NO MOTTLING LOOSE °� �� 42 156 C COARSE SAND 2 / PERC AT 64 UTILITY POLE ICJ KEY MAP ___ CLIENT I � D _ � r CA1_C1u' I,__AT1, 0N ',�_S �� �-�,N _ I I MIAP 192 DESIGN FLOW: 3 BEDROOMS AT 110 GAL, PER DAY PER BEDROOM = 330 GPD I I r PARCEL 042 '� - MICHAEL CURLEY 330 GPD X 200% = 660 GALLONS - USE 1500 GALLON SEPTIC TANK, MIN. ALLOWED M'�r 192 ING E-' C113 PARCL I I� T / T D. LEACHING CHAMBER CAN LEACH: A 29.5 L. x 10 W. x 2 Vt = € 29.5 ( 2 ) 2 � x .74 + � 29.5 ( 10 ) x .74 + € 10 ( 2 ) 2 � x .74 = 335.2 GPD I I INSTALL: ONE ( 1 ) - 29.5 L. x 10 W. x 2 D. LEACHING CHAMBER Vt = 335.2 GPD > 330 GPD REQ D. I ONE 1 - 1500 GAL. SEPTIC TANK, MINIMUM ALLOWED __. _ _.__ __- 1 "� \ _ _ y ABcE FIRM ONE 1 - DISTRIBUTION BOX 5 OUTLET P r, - g� yy , -- _ _ TURNING MILL 1 �. r 10 THE STATE ENVIRONMENTAL CODE, TITLE 5, REQUIRES INSPECTIONS) OF THE _-_..___ -- -- -----_-- " I j\ T`_ �� \ ( \ _ � �y i - CONSULTANTS INC SEWAGE DISPOSAL SYSTEM BY THE DESIGN ENGINEER. INSTALLATION CONTRACTOR I I`t \ ' '. `r I ' MAP 192 I ,.�`. ._. M1~ J _______` \ L" \ DEVELOPERS, ENGINEERS MUST NOTIFY THE DESIGN ENGINEER PRIOR TO THE START OF INSTALLATION FOR i ,`_.�---_. ___ --�-------------------- I I \ _ . ' • \ PARCEL 03:, �-i � � `� I � ` -T AND BOTUPPEROROAOD, NIT 3MANAGERS DISCUSSION ON REQUIRED INSPECTIONS. I \ ICI T I \ LOT 1 I \ ` r '� \ PO BOX 1159, SANDWICH, MA 02563 'PHONE: (508) 888-4383 - FAX: (508) 888-4246 G �6 56.0 _. E �.� _-_ _..__ ...__-... _....w-....___... _... _..__w ..._--_.. _ X MAP 19f I I - /i ARCr_L 01 I , j� / 60 1) GARBAGE GRINDERS ARE NOT ALLOWED WITH THIS DESIGN. 1 1 'rl , �/' / I 62 64 / f - I I \ i SITE ADDRESS 2) THE INSTALLER IS RESPONSIBLE FOR ASSURING THAT COMPONENTS OF THE SEWAGE 1 1 (n I / / AP R MA Z¢}CgTION CIF/ f�,1 66 , DISPOSAL SYSTEM ARE DESIGNED WITH SUFFICIENT TRENGTH TO SUSTAIN ALL LOADS TO BE I ; O II (tj f ( Xl f SEWAGE DI O ,<, PROPOSED \ IMPOSED ON THEM. ANY COMPONENT OF THE SYSTEM SUBJECT TO VEHICULAR TRAFFIC MUST ( -?500 GALLON I COMPLY WITH A MINIMUM STANDARD OF A.A.S.H.T.O. H-20 WHEEL LOADS. I +� 1 IYSTE �O BE-l1PGRAQf // 68 \ - 1 --� 1 \ . �._ L_ _%— 70 SEPTIC TANK p 3) PRIOR TO SETTING ANY SEWAGE DISPOSAL SYSTEM COMPONENT, INSTALLER SHALL VERIFY 1 EXfSTING 3 BEDR0Q1_.-.- ~~ r - - - -�- �. 834 SHOOT FLYING HILL ROAD EXISTING CONDITIONS INCLUDING ELEVATIONS OF EXIT INVERTS, AND REPORT ANY DISCREPANCIES 'r I r I ` DWELLING DOH #1 'l - -- I \ \ r- , D_BOX-,72- -5,� I CENTERVILLE, MASSACHUSETTS TO THE DESIGN ENGINEER. ''� � '� I :-'�`�.. T- `� i � c 4) ALL GRAVITY SEWER PIPE SHALL BE 4" DIA. SCH 40 PVC UNLESS OTHERWISE NOTED. THE / I G7 i' \1p�AP 192 / = r Q2632 MINIMUM SLOPE OF 4" DIA. SCH 40 PVC SHALL BE 0.01 FT/FT, / I , ,� - m I ` ' \ PA CO 5) NO PART OF THIS DESIGN SHALL BE ALTERED WITHOUT PRIOR APPROVAL FROM THE DESIGN 1 = \ f ENGINEER AND ,THE AGENT OF THE LOCAL BOARD OF HEALTH. ALL REQUESTS .FOR CHANGES — - SHALL BE MADE IN WRITING PRIOR TO CONSTRUCTION. r \ EXISTING,WATER I / 6) THE USE OF ALTERNATE MANUFACTURERS FOR SYSTEM COMPONENTS SHALL NOT BE \ ,`` EXISTING GAS LINE 1 D 1 �� / \ S / APPROVED IF THE USE OF THEIR EQUIPMENT REQUIRES CHANGES IN DESIGN. Y " y _ \ y ,�. 0 MIN. UND UTILITIES PRIOR _— _ C� \ / / PROPOSED 7 THE INSTALLER SHALL ASCERTAIN THE LOCATION OF EXISTING UNDER(GRO -- —" TO EXCAVATION, AND SHALL PROTECT UTILITIES WITHIN THE THE WORK AREA DURING —~—'" \ \ � ,�...W_�,; .... - ''G = _ - / 5'L. x 1f�'W X. 'D. SUBMITTALS . .-•CONSTRUCTION. _~ \. 1 ( �_�� —,r—J. LEACHINGICHAIMBER I I \ �- 8 THE EXISTING SEWAGE DISPOSAL SYSTEM (INCLUDING CESSPOOLS) SHALL BE PUMPED, FILLED \ \ „/ �T �// A�,^F 19.E ,. WITH SAND, AND ABANDONED; OR SHALL BE REMOVED WITH SURROUNDING CONTAMINATED SOILS \ � ,l � -._ �u �OPO5ED CATION � . �j � >� 74,6 PARCEL 039 �` \I _._, / _ ' OF UPGRADED SEWAGE ;I _. _ LOT 2 AND BACKFIL,LED WITH CLEAN COARSE SAND. -- _� , IF APPLICABLE: , \ \I i 'E StNG1NDER "DISPOSAL SYSTEM LINE T ROUND POWER 9) FILL MATERIAL FOR SYSTEMS CONSTRUCTED IN FILL SHALL BE CLEAN GRANULAR SAND,,;, FREE OF ORGANIC MATTER AND OTHER DELETERIOUS MATERIALS. THE SAND SHALL BE GRADED SUCH THAT NOT MORE ` EXISTING 1 T THAN 45% OF THE SAMPLE, BY WEIGHT, SHALL BE RETAINED ON THE #4 SIEVE. THE FILL SHALL NOT CONTAIN MAP 192 \ / � ANY MATERIAL LARGER THAN 2 INCHES. THE MATERIAL THAT PASSES THE #4 SIEVE%%u SHALL MEET THE IU 1 \ \ UTILITY POLE FOLLOWING GRADATION REQUIREMENTS: rAFr«,EL G.1 \ \ \\ sIEVE PERCENT i tilAl 1"�' C 02/10/04 REV 1 ADD UTILITIES \ PARCEL rC1 \ 71,\8 B 01 13 04 ISSUED FOR PERMIT SIZE PASSING \ i� \ / # 4 100% \ \ \ \ f # 50 10%-100% # 100 0%-20% - - - \ \' i A 05/15/03 ISSUED FOR REVIEW # 200 0%-5% \ \ ` PROFESSIONAL STAMP I AP� 9.� MAP 192 M g 1 \ PRCEf_ 010 ` \ caARCE_L 043 200 ONE (1)- 29.51 x 10'W x 2'D LEACHING CHAMBER I [-AN CONSTRUCT BY PLACING THREE 8'-6" x 4'-10" x 3'-0 DRAWN BY: A.P.C. TOP OF FOUNDATION LEACHING CHAMBER UNITS END TO END WITH I SCALE: 1"= 40' EL. = 72.0 RAISE COVERS TO WITHIN 2'-0" STONE ON ENDS AND 2'-7" STONE ON SIDES, 6" OF FINISH GRADE (USE 500 GALLON LEACH CHAMBER UNITS GRAPHIC SCALE CHECKED BY: M.F.J. AS MANUFACTURED BY SHOREY PRECAST OR EQUAL).', 40 0 20 40 80 120 FINISH GRADE D'B O x SHEET TITLE: IN FEET ) D'BOX 3' MAX. _l t ----� 1 inch = 40 ft. 4" DIA SCH 40 PVC PIPE -.-._. .a._ _,7_. ._. _.. . DROP:2" min. FLOW LINE 4" DIA SCH 4O PVC PIPE jT /7/ 7 /�� 4': DIA SCH 40 PVC PIPE 2" LAYER OF // 3' max. 1/8" TO 1/2" STONE �///" NOTE: THE INFORMATION HEREON HAS -BEEN SEWAGE DISPOSAL SYSTEM �1TT/T T 2-0 PREPARED ACCORDING TO THE REQUIR MENUS EXIT A 10 SEE BE 2 / ✓ -Q" -1- �-^ � �_.� _. _ _. _ LIQUID DEPT DROP PIPE OR FLOW ✓ 2'-0" 69.50 1500 GAL M LEVELER INVERT ALL `✓ °, s '; EFFECTIVE �I "' i r� / OF TITLE 5 OF THE STATE ENVIRONMENTAL UPGRADE FOR 69.50 69.25 SEPTIC TANK 69.00 68.75 68.50 68.25 3/4" To 1 1/2" STONE DEPTH b L-- CODE FOR SUBSURFACE DISPOSAL OF SANITARY EXISTING RESIDENCE EXIT B BOTH d W�SANITARY TEE - - ALL INV, / / j-j- - - - / SEWAGE AND LOCAL BOARD OF HEALTH •. / - - � REGULATIONS. THE MINIMUM SLOPE FOR LINE(S) EXITING D BOX MUST REMAIN 66.25 4 DIA SCH 40 PVC PIPE LEVEL FOR 2'-0" BEFORE PITCHING 2'-7" 4'-10" 2'-7" 5' IS 1/8" PER FT COMPACTED BASE GAS BAFFLE DOWN TO LEACHING FACILITY ALL REMOVAL 29'-6" W/ 6" LAYER OF USE 'TUF—TITE' CCRUSHED STONE OR APPROVED 10'-0" IF UNSUITABLE END VIEW MATERIAL IS EQUIVALENT ENCOUNTERED ---- —OUTLET TEE DEPTH 3 fq ! `` t s I / I SHEET NUMBER: A=15' LIQUID DEPTH BELOW FLOW LINE 10 20 T._T`.__L m_T - \ - ... ._ '_/ 1_ " 'T I-\. 3=15' - 4 FT 14 INCHES - LONGEST RUN NO SCALE 5 FT 19 INCHESs u 7 FT 29 INCHESFT 24 INCHES I I 4f6 � — .._w T�/ I W� �- F 1 1 _ �_. ALL INSTALLATIONS MUST CONFORM TO THE MINIMUM REQUIREMENTS OF TITLE 5 MC-3,01