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HomeMy WebLinkAbout0212 STRAWBERRY HILL ROAD - Health �F 212 STRAWBERRY HILL RD., CENTERVIL�. i� i Illl e UPC 12534 No.2„^ 15�,3LOR `�9�►�0 HASTiNQ:.UN I i� I 1 i I Q _ S86'40'30"E O 1� 103.00' S r— — Cd I APPROXIMATE LOCATION OF I W C3 JI SUBSURFACE EWERAGE� a ►��, � cYil DISPOSAL SY-MM I p a m I °)f ^ CV wl 26 13' l O a m Z I PROP SED rn � ADDITION o / I O O a Ezisting.h.-Y Z Prop. 25.4' 0 24.3' 45. I 212 WOOD FRAME PROPOSED 10.0' p rn DWELLING rn SHED LU I 1 PROPOSED ' m PORCH 24.3' A w I m$ / l rn PROP4S -n 8— ----\ ADDITION 0 I 24.\ 24.0' i o_ � O / 2 3Q'�:-�O/ 6 t Current Zoning Information Zoning Classification:RB Nod CON Zoning Definition: Residence B District The lot is within the Wellhead Protection Overlay District (WP) .Building Setback Requirements _ .. _ --_-------__-_-- _Observed.____--- _._._- Required--.__ __PROPOSED_ Front Yacd Setback 35.0 Feet 20 Feet 20' Side Yard Setback 58.0 Feet 10 Feet no chonge Rear Yard Setback 45.4 Feet 10 Feet 10.7 Feet MAXIMUM BUILDING HEIGHT: 30 FEET OR 2.5 PLOT PLAN STORIES, WHICHEVER IS LESSER 2_ 12 STRAWBERRY HILL RD CERTIFY THAT THE STRUCTURE SHOWN ON THIS PLAN IS LOCATED As C E NTE RV I LLE SHOWN AND TO THE BEST OF MY KNOWLEDGE COMPLY WITH THE DIMENSIONAL REGULATIONS OF ZONING BY-LAWS OF THE TOWN OF BARNSTABLE, MASS. BARNSTABLE AND IS LOCATED IN FLOOD ZONE C (NOT A SPECIAL FLOOD HAZARD AREA) AS SHOWN ON THE F.E.M.A. FLOOD INSURANCE RATE MAP NUMBER;70008 D, WITH A REV 1992 SCALE: 1"-30' DATE: 06/03/2009 DATE: FL BENNETT ENGINEERING BENNETT LAND SURVEYING,ENGINEERING,&DEVELOPMENT SERVICES No.36856 ► Q Ea PLAN REF: 210 PG. 85 F-2 —1 PO BOX297 TEL.(508)888.4868 DEED REF: 5534-203 L SAGAMORE BEACH,MA02562 FAx.(508)688,4867 JOB NO: 1300 �� 0 40 80 120 r ,. Commonwealth of Massachusetts —W Title 5 Official Inspection Forte a Subsurface Sewage.Disposal System Form - Not for Voluntary Assessments �.� 212 Strawberry Hill Rd Centerville Ma Property Address Bill Landers Owner Owner's Name information is required for Center ville Ma Ma o2632 3/30/09 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. Important:When filling out A. General Information forms on the 0—I computer,use 1. Inspector: only the tab key to move your ,lames D Sears cursor-do not use the return Name of Inspector key. Blue Water Company Name rob 350 Main St Company Address West Yarmouth Ma r 02673 City/Town State Zip Coder 508 775 2800 S1623 Is Telephone Number License Number r t B. Certification .I-certify:that l have personally inspected the sewage disposal system at this address nd that`t�� " co information reported below is true, accurate and complete as of the time of the inspec ion. Th6ispe on was performed based on my training,and experience in the proper function and maint nance of on site sewage disposal systems. I am a DEP approved system inspector pursuant t4\Stt lo,),�15.340 of Title 5 (310 CMR 15.060).The system: `���.����HOFMgs'Y Passes ❑ Conditionally Passes ' : sdms .:m =L L) SEARS �_ ❑ Needs Further Evaluation by the Local Approving Authority * :*; 'o�l •FRTIF�� ��.�� `1/z, ySfl N SPt-G� 4/3/09 ,06"pector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. L� r 9 / off Title_V Inspection Report.doc 03108 Title.5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 Commonwealth of Massachusetts zw Title 5 Official Inspection For Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 212 Strawberry Hill Rd Centerville Ma Property Address Bill Landers Owner Owner's Name information is required for Centerville Ma Ma o2632 3/30/09 every page. CitylTown 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: ❑x 1 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-cif Heaith,-will pass.-,- Answer yes, no or not determined (Y, N, ND) in the❑ for the following statements. if"not determined," please explain. , The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank fallure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed Title v Inspection Reportdoc•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15. Commonwealth of Massachusetts = W Title 5 Otfidia1 Ins �cti�n For , Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 212 Strawberry Hill Rd Centerville Ma Property Address Bill Landers Owner Owner's Name information is required for Center ville Ma Ma o2632 3/30/09 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced - ❑ obstruction.is removed ND Explain: 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 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. Title V Inspection Report.doc•03/08 Title'5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts m Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 212 Strawberry Hill Rd Centerville Ma Property Address .Bill Landers Owner Owner's Name information is required for Center ville Ma Ma o2632 3/30/09 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ 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 ❑ ❑x Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool 1-1Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ElStatic liquid level in the distribution box above outlet invert due to an overloaded FS or clogged SAS or cesspool Liquid depth in cesspool is less than 6" below invert or available.volume is less El 7X than '/a day flow Required pumping more than 4 times in the last year NOT.due to clogged or ❑ obstructed pipe(s). Number of times pumped: 0 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. Tdle V inspection Report.doc 03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 4 of 15 Commonwealth of Massachusetts Tide 5 Official S-nspecti®n Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 212 Strawberry Hill Rd Centerville Ma Property Address Bill Landers Owner Owner's Name information is required for Centerville Ma Ma o2632 3/30/09 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ E Any portion of a cesspool or privy is within a Zone 1 of a public well. El 0 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.] ❑ 0 The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. _... ❑. 0 y .the system fails. 1-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 systpm 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 ❑ El 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. Title V Inspection Report.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of.15 Commonwealth of Massachusetts Titte 5 Official Inspection For' =� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 212 Strawberry.Hill Rd Centerville Ma Property Address Bill Landers Owner Owner's Name information is required for Center ville Ma Ma o2632 3/30/09 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 0 ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ❑x 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) 0 ❑ Was the facility or dwelling inspected for signs of sewage back up? ❑ Was the site inspected for signs of break out? '0 ❑ Were all system components, exchadirig the SAS, Iocated:on site? 0 ❑ 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? ` 0 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: ❑ 0 Existing information. For example, a plan at the Board of Health. ❑ 0 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)] Title V Inspection Report.doc•03/08 Title 5 Official Inspection Fond:Subsurface Sewage Disposal System•Page 6 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Fort Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �.0 212 Strawberry Hill Rd Centerville Ma. Property Address Bill Landers Owner Owner's Name information is required for Center ville Ma Ma o2632 3/30/09 every page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 2 Number of bedrooms (actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): na Number of current residents: 0 0 Yes Does residence have a garbage grinder? ❑ No ' separate Yes laundry on a sewa e LIf es ins inspection 'required], ❑ No ❑X Yes ❑ Laundry system inspected? No Seasonal use? El Yes 0 No Water meter readings, if available last 2 ears usage d na 9 ( Y 9 (9p ))� .Sump pump? ,._._:.- _,. .._ .. Yes-7 No na Last date of occupancy: Date Commercial/industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CM 15.203); Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trapresent? P ❑ Yes El No ❑ Yes ❑ Industrial waste holding tank present? No Non-sanitary waste discharged to the Title 5 system? 1-1 Yes El No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): Title V Inspection Report.doc-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts Title 5 Official for Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 212 Strawberry Hill Rd Centerville Ma Property Address Bill Landers Owner Owner's Name information is required for Center ville Ma Ma o2632 3/30/09 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: na Was system pumped as part of the inspection? ❑ Yes ❑x. No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ❑x soil absorption system lb/9JN cesspool- 0 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): Approximate age of all components, date installed(if known) and source of information: Pit installed 1988 Were sewage odors detected when arriving at the site? ❑ Yes 0 No Title V Inspection Report.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts. ^W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 212 Strawberry Hill Rd Centerville Ma Property Address Bill Landers Owner Owner's Name information is required for Center ville Ma Ma o2632 3/30/09 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building.Sewer(locate on site plan): Depth below grade: 2- feet Material of construction: ❑cast iron 0 40 PVC ❑ other(explain): orange burge Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Cameraed lines clean &solid no sign of roots or brakes Septic Tarok (locate on site plan): Depth below grade: feet Material of construction:_ .. ❑:concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: - years Is.a e confirmed b a Certificate of Compliance? attach a co ❑ Yes .❑ g y p ( py of certificate) No 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? Title V Inspection Report.doc-03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 15 Commonwealth of Massachusetts Title 5 Official In pettillon Forte Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 212 Strawberry Hill Rd Centerville Ma Property Address Bill Landers Owner Owner's Name information is required for Centerville Ma Ma o2632 3/30/09 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Grease Trap (locate on site.plan): Depth below grade: feet r Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions:`- Scum thickness Distance from top of scum to top of outlet tee or baffle n , - Distance from bottom of scum to bottom=of outlet tee or baffle Date of,last pumping: Date 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. El polyethylene ❑other(explain): Title V Inspection Report.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts = u . Title 5 Official Unspectibh Form' Subsurface Sewage Disposal System Form m Not for Voluntary Assessments M 212 Strawberry Hill Rd Centerville Ma Property Address Bill Landers Owner Owner's Name information is required for Center ville Ma Ma o2632 3/30/09 every page. City/Town State Zip Code Date of Inspection Do System Information (cont.) Tight or Holding Tank (cont.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes❑ No t 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 Distribution Box (if present must be opened) (locate on site plan): s - Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes❑ No Alarms in working order. ❑ Yes❑ No Title v Inspection Report.doc•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System^Page 11 of 15 Commonwealth of Massachusetts Title 5 Official Ins OCtloh Fof Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 9 !� Y ry 5 212 Strawberry Hill Rd Centerville Ma. Property Address Bill Landers Owner Owner's Name information is required for Centerville Ma Ma o2632 3/30/09 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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: Type. x❑ leaching pits number: 4 x6 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Pit dry pit @30" below grade with cover 16"4'x6' pit/3' stone no sign of overloading or solids Title V'Inspection Reportdoc•03/08.' Title 5 Official'Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 5 M 212 Strawberry Hill Rd Centerville Ma Property Address Bill Landers Owner Owner's Name information is required for Center ville Ma Ma o2632 3/30/09 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration 2 Depth —top of liquid to inlet invert dry Depth of solids layer dry Depth of scum layer dry Dimensions of cesspool 6'&7' Materials of construction block Indication of groundwater inflow ❑ Yes x❑ No Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): main pool 66"with cover@4"-dry two lines out overflow pool-7W'with cover@4" dry 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.): Title V Inspection Report.doc•.03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15. Commonwealth of Massachusetts —W Title 5, Official Inspe�tlon F®r Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 212 Strawberry Hill Rd Centerville Ma Property Address Bill Landers Owner Owner's Name information is required for Centerville Ma Ma o2632 3/30/09 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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. - -3 = 3301 C 14A1 t1 uf:� l`Lvc, tr - ��r �3- 3 30 -3 Title V Inspection Report.doc•03/08 : Title 5 Official Inspection Form:Subsurface Sewage Disposal.System-Page 14.of 15 Commonwealth of Massachusetts Ate: Vitae 5 Official Inspection Forte s� Subsurface Sewage Disposal.System Fora e Not for Voluntary Assessments ,M 212 Strawberry Hill Rd Centerville Ma Property Address Bill Landers Owner Owner's Name information is required for Center ville Ma Ma o2632 3/30/09 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑x Check Slope ❑ Surface water no ❑ Check cellar Y2 basement ❑ Shallow wells no Estimated depth to high ground water: 15 + feet Please indicate all methods used to determine the high groundwater elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date x Observed-site obuttin roe /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: Took grades with transite lower grade @7' below bottom of pools&pit Title V Inspection Report.doc•03/08 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 ---------- • ............. , l as Miv,x ---------- ! } I I i ! I 1 �' j.. ------ ------- --------------- .......... ------ ---- ---------- ------------- ---------- -------- ------ --- r .�. �► BARNSTABLE COUNTY z DEPARTMENT OF HEALTH, HUMAN SERVICES AND THE ENVIRONMENT > SUPERIOR COURT HOUSE O aF ,. •J "' - BARNSTABLE,MASSACHUSETTS 02630 •` �' Phone:(508)362-2511 Ext.330 A S S Public Health Administration 333 Environmental Health 383 Water Quality Analysis 337 11 Human Services 330 ./ TDD 362-5885 --October 19, 1993 ORDER TO CORRECT VIOLATION Mr. Mrs. William-Landers 35 Firglade Street Worcester, MA 01514 Own -r--e or--=agent=-of , the— property located at i 212—S.trawber_r_y—Hi.11_Road—_ Centerville, 1MA 02632 Be advised that an agent of the Board of Health has determined certain portions of the aforementioned residential-property to be -in. violation of the - State' Sanitary Code' Chapter II, "Minimum Standards of Fitness for Human Habitation," 105 •CHR 410.750 (J) . This violation also constitutes a violation of the Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000, and Massachusetts General Laws, Chapter III, section 197. _ Conditions exist in this residence which may endanger : and/or materially impair the health of the occupants of these premises. DECLARATION OF EMERGENCY The Director of the Childhood Lead Poisoning Prevention Program and the Board .of Health declare-that'the presence of the aforementioned violation presents an immediate danger of lead poisoning to-.one or more occupants of the premises and,: that this constitutes - an emergency pursuant to Massachusetts General .Laws (MGL) , - Chapter 131, section 198, within the meaning of the Sanitary Cade,- Chapter 1, -Section 400.200 (B) . ABATEi�IT OF LEAD VIOLATIONS •-. . M.G.L. C.1111 ss.190-199A and the Department_ of Labor and Industries Deleading Regulations, 454 CMR 22.00, as well as the Regulations for Lead Poisoning Prevention and Control require that only licensed deleading contractors conduct residential lead abatement. This means that you, 'cannot conduct lead abatement yourself or hire anyone other than a licensed deleading contractor. Violations of this requirement shall be punished by a fine of not less than five hundred nor more than 1500 dollars for each offense. Of B'9R .� 'I'�► BARNSTABLE COUNTY �` }" DEPARTMENT OF HEALTH, HUMAN SERVICES AND THE ENVIRONMENT SUPERIOR COURT HOUSE O V BARNSTABLE,MASSACHUSETTS 02630 Phone:(508)362-2511 Ext.330 1�A 5 S Public Health Administration 333 �7 Environmental Health 383 Water Quality Analysis 337 Human Services 330 TDD 362.5885 October 19, 1993 Mr. & Mrs. William Landers 35 Firglade Street Worcester, MA 01614 Dear Mr. & Mrs. Landers I have inspected the property at 212 Strawberry Hill Road in Centerville, MA owned by you , and I have found lead paint in violation of Massachusetts General Laws , Chapter 111 , section 197. I urge you to contact me as soon as possible to discuss your responsibilities in this case, the violations included in the report and the material enclosed. You may reach me by calling ( 508 ) 362-2511 x371 Massachusetts Lead Poisoning Prevention Regulations require that you provide to me, within 60 days of your receipt of this letter, a written contract with a licensed deleader to abate the violations cited on the enclosed inspec- tion report. The contract must be signed by the contractor and by you; it . must specifv that all violations on the interior and interior common areas will be deleaded within 90 days from today, and that all exterior vio- lations and/or window replacement will be complete within 1.20 days from today. If I do not receive a copy of the contract by the61st day, I must by law file a criminal complaint against you in court. You may be fined by the court up to $500 each day, for each day of non-compliance. Effective January 1 , 1990, only contractors licensed by the Department of Labor and Industries (DLI) may engage in the removal , liovering or replace- ment of known lead hazards. Neither you nor anyone in your employ nor the occupants of this unit may remove or cover any lead paint cited in the en- closed report unless that person is a licensed deleading contractor. The contractor must provide written notification to DLI , all residential occupants, the local board of health and us , at least five days before any deleading work begins. It is your responsibility , as the owner of the premises , to make sure that the contractor sends the completed forms to all parties (blank form enclosed) . OWNER RESPONSIBILITIES per 105 CMR 460.000 460.100 The owner of a dwelling must delead whenever 1 ) there is a child under six residing there, 2) the owner receives an order to delead or 3) a court or MCAD has determined that discrimination has occurred 460.150 The deleading contractor must provide written notification to CLPPP, DLI , all residential occupants and the local board of health at least five days before any deleading work begins. It is the owner's responsibTTTty to make sure that the contractor sends the coveted forms to all parties. Owners of property listed in the State Register of Historic Places must notify the Massachusetts Historical Commission imme- diately when they receive an order to delead or at least 30 days before starting preventive deleading 460.750 The owner is required to provide written notice of the presence of lead paint to all occupants of the building. The owner must send a copy of the inspection report to all mortga- gees . and lienholders of record. The owner must correct lead violations within 60 days of receiving an order to delead unless the owner has a written contract with a licensed. deleader which specifies that all interior work will be completed within 90days and all exterior work and/or replace- ment windows will be completed within 120days ; the enforcement agency must receive a copy of the contract within the 60 days. r Commonwealth of Massachusetts Pg Of INSPECTOR/AGENCY .e�ntv Hwal•h CHILDHOOD LEAD POISONING METHOD USED Uarngaws and PREVENTION PROGRAM �Na 2S - Environmental Department 305 SOUTH ST., JAMAICA PLAIN, MA ---- upenor OUtt OUS@ INSPECTION FORM Expiration date - ___Ba> s30 ,04UORESCENCE Registration/ � Model -3 Serial / a APT f Addmss - 5LJd IT--� -��� CITY C -- •. ���/ ���V 7 / 1. __....- il.e,lTm: I ASI NAME Of CI OLD FIRST NAME 1 MIA OD YY Sex - ------- - --- r� o n1 Proem Guardian's last Name Parent/Guardiali s First Name - _ DWELL OWNER OWNS j/,/�� I 1 T h < I/ 8 2.DAY CARE ® Oct 5 V/ I� L/�I I i i I I�J I/�I I��I s F'� SCHOOL Y OR N UNITS L-1 3.OTHER Y OR N 8 1.SINGLE NO.OF ROOMS / 2.2.4 APTS INCLUDE BATHROOMS 3.6 OR MORE BUT NOT HALLS OWNER'S NAME: !)`' I 1 OWNER'S ADDRESS: FIC q la de- 'moo.�c Book No. REMARKS: OW17 f, = ,pA o n 2 .S v8 -7SS -7 "1 7 Page G,/ G,6 C._S 0, 0 C'a .. 6,! Date recorded _-_ VIOLATION INSP.DATE 1.VICTIM 4.REPAIR 7.OTHER 2.PAR HEO, 5.VACANCY / C, / (/ C/ Y OR N 3. HIGH INC. 6.INSTITUTION FLOOR f_-L_-_ FLOOR 1 �oo� Ra:�Nr► Kr��h�.n g D A (STREET SIDE) A (STREET SIDE) Pb MORE THAN 1.2 mg/cm, with x-ray fluorescence or positive with Na2S is ILLEGAL. INSPECTOR REINSP.GATE I. IN COMPLIANCE REINSP.DATE 1.IN COMPLIANCE REINSP.DATE 1.IN COMPLIANCE -A" 2.WORK L PROGRESS H2.WORK IN PROGRESS 2.WORK IN PROGRESS 3.NO WORK 3.NO WORKH 3.NO WORK REINSP.DATE 1.IN COMPLIANCE REINSP.DATE 1.IN COMPLIANCE REINSP.DATE 1.IN COMPLIANCE 2.WORK IN PROGRESS 2.WORK IN PROGRESS 2.WORK IN PROGRESS 3.NO WORK 3.NO WORK 3.NO WORK COMPLIANCE DATE INSPECTOR Pb = lead cov = covered Nag = Negative scr = scraped ` Pos = Positive rep = replaced na = not accessible rev = reversed i INSPECTOR/AGENCY Commonwealth of Massachusetts _ Barnstable County Heat h a LAILDHOOD LEAD POISONING PREVENTION PROGRAM Environmental Department 305 South St., Jamaica Plain, MA 02130 su Ou S a 'INSPECTION FORM Barnstab ,MA 026 0 qPp 9 of -- --__ Registration/ , - APT./ ADDRESS Of INSPECTION � ���� ������� ¢ �- 4 �h e �- ,� , � / IIL—III—III—III C Ciry KITCHEN — PANTRY Camp Camp - Comp Comp EO SOURCE Pb Loose Dare Method— SIDE _SOURCE Pb Loose oar. Mernad Ut er Walls allsLo er Walls alls --- Lo it rail Ba aboard d Q 9 Do r Door Casing-Jamb Do r Casing-Jamb Door - - Do r Door Casing-Jamb Do r Casing Jamb Wi dow Sill/Apron D or D or Casing-Jamb Wi dow Casing/Header/Stops Wi dow Sash/Mullions or D or Casing-Jamb Ext rior Sill/Parting bead area Ext rior Side Sashes D or D or Casing-Jamb Up er Cabinets D or Up er Cabinets Walls D or Casing Jamb Up r Cabinets Shelves indow Sill/Apron d.� Lo r Cabinets G1 Window Casing.Header/Stops Z L. r Cabinets Walls indow Sash/Mullions Lo r Cabinets Shelves Cj xterior Sill/Parting bead area _ _ __ She es J Wind Sill/Apron Dra ers Windo Casing;Header/Stops Floo Windo Sash/Mullions Ceili g Exteri Sill/Parting bead area Wind Sill/Apron Wind Casing:Header/Stops Wind Sash/Mullions Ex. Sill/Parting bead area BATHROOM C/ xterior Side Sashes pr 0 v Upper Cabinets Upper Cabinets Wall Upper Walls Upper Cabinets Shelves ler-VlVatls Lower Cabinets Cbak'Fail Lower Cabinets Walls Baseboard Lower Cabinets Shelves Door Shelves _ Door Casing Jamb Drawers —_ p — Door LI S Cl et Walls _ _ _ } Door Casing-Jamb CI et Door Interior Wi ow Sill/Apron_ CIO et Casing Jamb - Wi ow Casing/Header/Stops CIO et Baseboards Wi ow Sash/Mullions Clo et Shelves _ Ext for Sill/Parting bead area Floor Ext for Side Sashes Ceiling Upp r Cabinets Lower Cabinets D 5 Q Lower Cabinets Shelves O• - Closet Walls Closet Door Interior <f Closet Casing-Jamb D.3 Closet Baseboards II,R Closet Shelves A • floor Ceiling Pb MORE THAN 1.2 mg/cm' with x-ray fluorescence or positive with Na2S is ILLEGAL. REMARKS INSPECTON _..__ .- v Inspection Dale [�EO 1 '� I �Lc/ - INSPECTOR/AGENCY Commonwealth of Massachusetts Rarnstahle t htrOILDHOOD LEAD POISONING PREVENTION PROGRAM qgp) Environmental Depart ent 305 South St., Jamaica Plain, MA 02130 uperior Court How a •INSPECTION FORM Rarast-ab e, MA 02s o 9- � of_`-5 Registration I 'r"2 0 0-9Z7 A__._._ AVI./ ADDRESS OF INSPECTION city ROOM Comp Comp Comp Comp SIDE SOURCE Pb Loose Date Method SIDE SOURCE Pb Loose Dee Merhod Upper Walls Wi ow Sill/Apron Lower Walls Wi ow Casing/Header/Stops Chair rail Wit dow Sash/Mullions Baseboard Exti rior Sill/Parting bead area Door t13 Wit dow Sill/Apron Door Casing-Jamb Wit dow Casing/Header/Stops . Door Wi dow Sash/Mullions Door Casing-Jamb 3 Ext rior Sill/Parting bead area Door Exterior Side Sashes Door Casing-Jamb Closet Walls Window Sill/Apron (f n 3 Closet Door Interior I Window Casing/Header/Stops .Z Closet Casing-Jamb Window Sash/Mullions 0,q Closet Baseboards Exterior Sill/Parting bead area /7e L Closet Shelves C I Window Sill/Apron Floor C&r r e 01/ Window Casing/Header/Stops ill Ceiling /),4 Window Sash/Mullions (c Exterior Sill/Parting bead area L-- C Window Sill/Apron 0 Window Casing/Header/Stops Window Sash/Mullions p. Exterior Sill/Parting bead area ROOM a Win w Sill/Apron Win w Casing/Header/Stops Upper Walls Win ow Sash/Mullions Extelior Sill/Parting bead area Ghak-Fail U CZ Exterior Side Sashes 1.6 Baseboard Clo t Walls Cedin leilh ^)4 j Door CIO et Door•Interior Door Casing-Jamb Clo et Casing-Jamb Door Clo et Baseboards Door Casing-Jamb Clo et Shelves Door Floor Q. .- Beer.Cacing-laRTb Ceiling NfY = Window Sill/Apron .S CZ Window Casing/Header/Stops 04 Window Sash/Mullions Cl .Z Exterior Sill/Parting bead area L— G 0. Window Sill/Apron . 3 u E, s� 0,5 C Window Casing/I leader/Stops 0.5 ROOM # Window Sash/Mullions 0- Exterior Sill/Parting bead area nns Upper Walls ,J Win ow Sill/Apron uw'"-Walls Wit ow Casing/Header/Stops Cbei.-Mil Wi ow Sash/Mullions Baseboard Ext for Sill/Parting bead area D Door Win ow Sill/Apron ID Door Casing-Jamb _Win ow Casing/Header/Stops Door } C S Wi ow Sash/Mullions Door Casing-Jamb Q q Ext rior Sill/Parting bead area Deer L Exterior Side Sashes L DaQ&ZaciAg—Jamb A Closet Walls _ Windw.v Sill/Apron �. _ Closet Door-Interior d•3 Window Casing/Header/Stops LL/ R Closet Casing-Janib Window Sash/Mullions /} Closet Baseboards R Exterior Sill/Paving bead area � (� /'? Closet Shelves (� Window Sill/Apron Floor .to A Window Casing/Header/Stops Ceiling 6 Window Sash/Mullions e r x Exterior Sill/Parting bead area Pb MORE THAN 1.2 mg/cm: with x-ray fluorescence or.positive with Na.S is ILLEGAL. REMARKS INSPECTOR Inspection Data � / G INSPECTOR/AGENCY Commonwealth of Massachusetts arns a e ounty ealfgyWHOOD LEAD POISONING PREVENTION PROGRAM __� p rtment 305 South St., Jamaica Plain, MA 02130 *INSPECTION FORM Superior Court H use py of ----- arnsta-be, 9A 2630 _ - ^ egistration / Cap AN I - / Will:�:1 rIl IN:�1'11�11nN -_- -__-_ _ __. ___l � eev� ra,y S-der GARAGE — _- XT E R I O FZ _ — — — -- --- ---- ----- Comp cam;,p cOlnp cn^ro SIDE SOURCE Pb Loose Del. M.woe SIDE — SOURCE PI) Loose Dala MuUrod_ - --- Siding Q ----- Gard 114i�lrd Skiu Skirt Cornorbowds #IL Comerboards Q D r Door �'� — Do r Casing/Jamb Door Casing/Jamb liltshold Threshuld 0. -- Du r -Do i Casing/Jamb -- _ Dom_ nl' Tilt shold ThresFr°ld 182- _14-ZWindow SillWindow Sill L�-. Window CasingA Window Casing Lam.. �- Window Sash/Mullions rf' .------Window Sash/MullionsWindow Sill- ------- Window Sill (/ ___�• .. - -- Window Casing Az .Window Casing— --- Nrl„duw Sash/Mullions — _�2---. .-._._- ---- -�--indow ----- Window Sash/Mullions '• .5 -- Wind Sill — A2 — _ - — Wind w Sill --- wind IV Casing_— - -- Will w Casing - wind c Sash/Mullions \Hind w Sash/Mullions _ Wind( N SIII - --- Will w Sill t -- Wind w Casing — Will w Casing_ -- --— Wind w Sash/Mullions will w Sash/Mullions — — Upper Trim AA I- Upper Trim cl L Cellar jndow Units Cellar `.":indow Units / --_ Cellar indow Units Cell r Window Units --- — Cellar indow Units Cell r_Window Units -- - Collar indow Units - -- Cell iF Wjncfow Units Dulkll d — B_u_ head — - — _ — �ewees- Fen es Foundation n -- Foundation — - — Pb MORE THAN 1.2 Mg/cm z with x-ray fluorescence or positive with Na,S is ILLEGAL. REMARKS INSPECTOR t.opection Uale INSPECTOR/AGENCY Commonwealth of Massachusetts CHILDHOOD LEAD POISONING PREVENTION PROGRAM Barnstable County Healthand 305 South St., Jamaica Plain, MA 02130 E ►virenm"t"eparr ent S� "INSPECTION FORM Superior Court Hous pg of Barnstabl , MA 026 0 - ----- — -- Registration I API t7 Je Icc l��. �b Ir I, �-I , 1 f e cIY EXTERIOR C S t / Q� _ - G*�`G'E 0 ''; d z --- ✓ C?_ L, _ Comp Comp SOURCE Comp comp SIDE SOURCE Pb Loose Date Method SIDE Pb Loose Date Method — —'--" --- — Siding — — Sidinq__ —_ -- — Bflpbe�erd -- — --_ — 4ktpbeard — ----- Skirt S*Trt- ------ ——- Cornerboards - �(� Cornerboards Door 0•Sy �vr-easlrRJTJamb O Door Casing/Jamb d -- —� Threshold—_ D. Dery Beer -- - �r�asirrtJtJ�iftb -- — Doer�ar>iw�-,iamb — - Tlft-sheld TMwcl+dd _ _ C^ Sill /-- Window Sill Window '.S Window Casing _ �„ Window Casing C� Window Sash/Mullions Window Sash/Mullions Q (� Window Sill ----_ p — —__ ,Z Window Sill (� Window Casing — — Window Casing f Window Sash/Mullions Window Sash/Mullions C� Window Sill — — , Wind w Sill �— Window Casing -- Wind)w Casing Window Sash/Mullions —_ — Wind)w Sash/Mullions Win w Sill in �w Sill -�-- Wind 3w Casing Wind w Casing Win w Sash/Mullions — Wind wSash/Mullions Upper Trim Upper Trim AM- L Cellar i-dow Units D Cellar Window Units Cellar iodow Units Cell r Window Units Cellar Window Units Cell r Window Units Cellar Window Units Cell Window Units Bulkhead Bul ead — ■�_. — Fen es ----- ---T-- ----- ----- ---- --- -- Foundation — Foundation � _ �_.-- — Pb MORE THAN 1.2 mg/crn2 with x-ray fluorescence or positive with. Na2S is ILLEGAL. REMARKS INSPECTOR Inspection Date / aF/I '7 f Vol TOWN OF BARNSTABLE LOCATION � SEWAGE # ! � VILLAGE � C'�ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. C Aw)o Sw/ K6-r, SEPTIC TANK CAPACITY �mlv� t�N G-es LEACHING FACILITY:(type) �IG�3�""�l�" (size) NO. OF BEDROOMS �� $� PRIVATE WELL O IC r BUILDER OR OWNER DATE PERMIT ISSUED: fo--7 -re- DATE COMPLIANCE ISSUED• VARIANCE GRANTED: Yes No �/ �% ,�3' a,� P� ��,� �¢,� G ,�► �� I F � . � � � � A M • I 1Z � No.... .:r ..7 a ,� Fz�s...... .,�-- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............ .. OF......... .�S.N>>2.1t-b`1- �� ............:................... Appliratiun fur lliupuuttl Works 1nutrixr#iurt Permit Application is hereby made for a Permit to Construct ( ) or Repair ( C.)—am Individual Sewage Disposal System at: .......... ...Vs.Q............. ........................... � u'.'....._........._.................... 11 - Location-Addres or Lot No. ----•----•-----U:!�l.`�41t.9rtn........1_fn�! r:s -- mac !` .......................................................... -owner . �s.kb-1ll.L_: Installer Address Type of Building Size Lot............................Sq. feet aDwelling—No. of Bedrooms..._�t�. .-------------------------=---•--Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria. ( ) d Other fixtures --•-----------------------••---------------------------••••--••------------------------- --------- W Design Flow..........`?�..� .......................gallons per person per day. Total daily flow__`.�.T.a.........................gallons. WSeptic Tank—Liquid'ca.pacity........_...gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length..................... Total leaching area....................sq. ft. Seepage Pit No.......I............. Diameter.....h>.......... Depth below inlet..... ........ Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) a Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.............1...... Depth to ground water...........:............ f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ x --------------------------------------------- ----....-------•--------------------........-----:....._... , ...... ODescription of Soil..................................................................................................................................... W ...•••-•--•-...•---•••••••..._....--•---•--•--•--....•---------•--•.................•••••-•-•................................................................-------.................................... ..-•------------ ------ ----•--------------•------------------------------------------••-•---------•----•-------------------------------------------•--------•----------------------........ U Nature of Repairs or Alterations—Answer when applicable.......1 ....___D1"y...___.. _5 �_. a_Y-..4- . ..................................-..............................................................................................................-.................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of i1TI.L 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance issued by e lth. r , Signed....---- :: ............ ----1D Date Application Approved By............. c ----• ................................. ..................•' ............ Date Application Disapproved for the following reasons:----•-------•-------------------------------••----.....------.......---••-------•--...._......_........_....... ....................•---•----•------.............-•----------........-----•-----------..........................----------------------------•----...--------------------.........•--••-••••.....-•--•-•- Date Permit No.......... �3 7----------•---..... Issued......=------------•-- = - . - Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Y..... .`'' `.......OF........�-�.1!��.«-c�k:c�h�-...-•.............................. Appltration. for DiSpoott1 orko Tanstrurtivit Vern it Application is hereby made for a Permit to Construct ( ) or Repair ( �_)a-n Individual Sewage Disposal System at: .........�.... _-r'.`j .......a ��..r f tl! ..Q ya�,t • ._... ----v............ -............ ---•......... ._..............- ........................................... •Location-Address .. or Lot No. ...............( :`tc = - \- r�.H;.Sl-e 1-C ...................... /`- '� ........ - ..........- .......---...._. • -•-- - - Owner Address a .L. �..�4v.../J S Mir L ,/ / �! •r l!S r'... .............................................. -----•••......._.. o..........-•^ �... -- ................... Installer Address Type of Building Size Lot.................... .....Sq. feet Dwelling—No. of Bedrooms...:..�...................................Expansion Attic ( ) Garbage Grinder ( ) pa, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ............................-•---•----•-. -- W 'Design Flow........ _J .......................gallons per person per day. Total daily flow.. _R'22........................ WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No......I-__._-__-___ Diameter..... �....... Depth below inlet.....yf......... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by..............................................................:........... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit..................... Depth to ground water........................ Lz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ................................ --------------•-----------.--------............ •............ •------- ------------------ •------------------ •••-.---- -.......... 0 Description of Soil...................:..........................•--------------•--•--....----•---••-•--------------------------.......--------....------------..........................-- a U i ....-------•--..................................................................... •-•--•--••--•••--••--•••••=------••---•----...----•-----•-•---••-----------••••••............................ - U Nature of Repairs or Alterations—Answer when applicable_......A!qq......_4)�_....... (::.. ✓.T.._� �:��. � ..r -•--••-----------------------••----------••--••-•... ---- Agreement: The indersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to,place the,system in operation until a Certificate of Compliance has-been issued by the board_of.health. l,. Signed---• -----•- --------e•-. .....--- --- ` ��^ f: �^ 't G' _✓ Date y y 'Application Approved BY............. ;_lam- __ . . �-V� � Date Application Disapproved for the following reasons:-------•--------------------•---•---.....---•-•------....----•--•-•---••--•------t-......... ............... ..............•-----••------•-------..............---------------•--.........---------...--•-•------•------...••--...__....-•--------•-•-----•••--•-•-•---•----....--••••-•••••---------.....•-----•-•-- Date � � - � `Permit No... :- •• ......•....--•-_.._.. Issued Date ---------..._----------- _....---------'--- —•---- ----�--e_-- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .......... ................................. Tatifiratr of Toutpliatta THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( L)� by................... ram +ai � ......... ... 5 ----------------•-•-•---------------•--•--... .---..........................-•••......._ Installer at.................., `7�. V1 �_�"Vy...L_\.` ( , t v has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No...... ..... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE...............................................................................`q- fgInspector ; ..� --------•-----------•........................... -------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .. .........OF...... .�.:.K..�n g\��: �-£� ............... NO.../)- :_ ./. FEE.... -; ............. Eliopooat Works Tonstrttrtiort "permit Permission is hereby granted........ •............................ to Construct ( ) or Repair (L—)-an Individual Sewage Disposal System at No............. =------�1_!�•�/ku�_�•✓v�l----�A1L_K...-----R•-.�---- ..`�.��_�w�S................................................. Street as shown on the application for Disposal Works Construction Permit No�S.���_._ Dated.......................................... •...........................•-im .................................................... v ` ............................. 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LkT_+EN '' , 1j1 ©RUCCEOEVJ4- �lnl©77z®oa59 . a ' ,..-,..- .-_ -_•.____-....I -F..-..-_, _. -___ - III - _ - --' - n _Re LJGZ_ �aaSOY .-ice 4 o_-_a 4.0rjr ^ A.o' , I g_� B�6" L 1b.0'. _ _.--__ - - 1-0UN1��_CION._ht/1-N +---------I-(��--I— � NJ-I- - - �• ' v.crx,�axRruee:ountq=c�3c,�-foe�+� , o,�a z<•<a'•rl.•uuK.�-f<..��nec�-�, 1 LOUt{ Pk_ of W. \-n-5-0N-Is4_'.n t5"'Ck N.F-(S: n9•'_rn�.i..PElo�.f r,Nlsl-1 c,a�i7E llCll�llJ4`TI+N,P4t1E U.f CR,5.ROER TGMLf,fR_kocKET. t30TE:SDUIP.J('.-1!tl�-Lv6l2lE•Y_ritl fJ1�EN510VS_O.N_6_rfE�F,Ovltjf.nTTlC nh�55-.�6UE K`F.i)T G�15'r-.-__ LANP ECi5- ,ROJT(O -NIZVCC DCVCtN DESIGNS .•owEa ...... CHATHAH, HA. al. .� ,��t•ZO1°y7S0 .212 STKn;:�F3r;�z,�r ����_By,�r? P.JJIKI•JS(iCtit_E�/�JCiI•-- /J 3•ca E<I<nuS =ES*sitct S� . nO0 Tto1V'_ - nnvs�no41—_. - K1O4e vl'N'f _ I - EXIS'flyd BVIlnrNS Ui�E-_—_ I 9� i I Y � u i _ 24g2\v_(,� 'taaz•=;fit)_ ! ': � I 6 EM .I P>tHSE4 pep o y�,o-,n Eetts� puss PuWs LVL G-.Me l 6—;r)FALIc-K�wi�.. ou)A ._c L. — �� ! 2410 RIOSE 12, Sy R 1 Hmg w:Eq I — i- RI E - ! --��.rcTr-va��xfoC'43F�t.Tl+w cl — _ _I_—II- _- U n 1f25C_ — s ar) Rl S - - Jul )J-2r 97 0 —solo rswc a�S lU:i ate` n �IT t O p C-1125�1-LL)UI� F�/<�INS_�!J�N_ � -. ._ __:-2 _�'f•JOt i1 �a�.,_. _ N `I __— • )i31.J0�5{5 U4nEC' A L PM1RiW - • Wcl�IG'-G•c IN WEN,-Pn2(r1lUJ 5- 1—I - r 1mm y 6`��sn95_uausa_ � r CHATHAM, HA. e,nlz!,_s��f�irT..... i APPLICANT TO COMPLETE 6 SUBMIT WITH PERMIT APPLICATION r AII'C Gnidq In ll'pPd Cnn.t[nrNiorr in Nib/r IV'nr/Arens:1/0 nap/.1I'ind Zen I Ali'C'GRide•lp luml C'a,.br rjm,iNfngh IF7.,t Arens:110nrph IV d ZI., (V[assa_c6nsetts_ _,._•C11Cc1(listforCompliance(labcote,53-z.l.I)' Massachusetts Chccltlist For ComplixnccpgRCAlRa1nL:.Lq La;deea,S. "'• ' ------- - ' uo car.�ea ono Lateral,m.of I6tl cvnxpon nags)....._......_..._._.__...(rabes]).... £13m_1:):L,t�f2-_._.....L , I Blocking to Ratter(7'ae-nailed) 2-6d 2-10d each end Ohttk Non-LaeralI n9 Wad Gannee of Corryrlivhr< 4tenat(m.af lad common naifsl.._..._------.....__.._..(Table 81._-----------------__......._.__...._._......1- __� 1.1 SCOPE dSpeed l3-sec.9'rslJ-._....-._......._.........__....._..........___........._ Load Bearing Wall Openings(retard largest ePeNng but check aq openings Iw complla•.•--'a Tate g) ' end Rim Board to Flafler(Entl-nailed) 2-(ad 3 lGd each _.................... ......1I0 mph Header 5parts .__._.._.._....__..............__............_(Ta51c 9)_.._.....___ _ H_R()in.s 1,' ✓ . Wind Exposure Category......- _....__.....__..._.._._..-----..........._. ------...._.a Sid Plates 3 pans ._.__.....tuds._._......._.._._.....__..._ITohleflrFlale� (.Inl,-:PfaryiOn;,Z Cr:n•. 1Y.rf,Ifl n:r' :d'16U�Fee Heigh,Studs(no.of studs) .. I (' 1.2 APPLICAOILITY -----.-._...._..(Table 9) .7 IOSIG 1 - +'FI' 3 is 9 opemn ad cheek ad HH,, .h L Nan-Load Dcanng Wall Openrn95(record Wr es( --_ -"" -- S-r N-5l,f� I� / 2Ih(7 t 2�16� Number of Slodes(a rooTMdch exceeds fib,l2 slope shall he consideredaslorv)�_slwies 52 statics Header spares......_......._.._. _ _ 9 openings formmv'vhce' TaUc9) / (�c,, ,}q(tigt�, (1 !1;),^' n.,,- r.la6t(y: •-•t.ss�v l,•.,.1 tag'.plp y`d' ' Rvof Pifch........._.._......_._....._.._...._..._.._..._..........._.(F921.__...__.............._._.......... 51212 Sill Plata SP......._._........_..._..._.._...._....._._...._(Tama 9)._.._.____._._._.2,R5O In.s s2. V e Mean Roof Helgld..._....-.._...._..............._........__._......(F921..._......._.............__......... R533' _ Fan HcigMSWds(na.of nods).:_..-........._....._.......ITabla 9l__.._..._..._...._.........I�If_$rn.512 _ ......_ _ _ _ 1 Buldlrg Widlb,W__......_.._....._................_..................(Fig 31------.-..-----..--_.-._ R580 Exterior Wall Shcafhmgla Reslsl WPllfl and ShearSimWlaneousl' Joist Ill StI,Top Plate or Girder(Toamaled(Fig.Ill 4-ed 4-lOd OUIIdIn Len Ih l................. 9 9 ............._._...._.......-------(Fig 31_...................._........._......._7-<I R5g0' A4nimum Building Oimension.W Building ist 0.5Pec Rata(UW)......_......_....._...._.............(Fr9 q1.........._.............. .._...............(��53f Nominal Height of Tallest openingy ( 9 ) a Blocking to Joist(Tot-nailed) 2-Bad 2-t0d each IndNomloaf Height of Tallest Opening'._._..._......_...._.:......(Fig 4)..................... ._..�[1G6 Sheatl" 7 .....-..-..._.____._.__. ._._. G.6"'<6'a' �/ . ----- '" -�- kn'9 ype._---.-........--__.......__._._(na,e 4).. �!t�`q_4? - -� Blocking to Sill.,Top Plate(Toe-nailed) 3-I6tl 4-I Ed each block Edge Nall Spacing__ - Tal4c fe ornate d)less In. Led er Stri to Seem or Girtler Face-nailed t.3 FRAMING CONNECTIONS Field No.Span ( 1'-------^-- 3 9 P ( ) 3_16U 4-1 Ed ¢aeh joist I / ^9------ ...__......(Table 10)........__.___.. �_rn. a/ Jois,on Ledger la Ocarn(T nailed) _ General<wrhplience with Iramfng uvnnec8ans...-....._.......(Tade 21.-_..___..........._............... �L Shear CanneoVer,(nu.of led common n h "" joist ......__..._...... )Gable l0)_._..______.___.._._..__.� ✓ Oe" � 3 ee 3-IOtl per pest P_re FW-He,glh, ) Band Joist to Joist(End-paled)(Fig.14)2.1 FOUNDATION 5%Addfdanal Sheathi f "'Roble 10_.._........_..__--_....._'._.23 a% �� 3 I6tl 4 I6tl Per joist Fe-d.9-Walls meeting fequiremells at 760 CMR 5404.1 ng or Wan vdif Opening>6'0'(Design ConccPls Maximum B Inafg eight pion,L Band Joist to Sill or Tap Plate(Toe-nailed)(Fig.lq) 2-16d J-l6d Per foal Concele.................._....._......................-._...................._................_.._..._............................ Nominal Height of Tallest 0Peningr._._._._...........-...-.._......_.-.._................... a•O"6'e_Corlcrele Masonry.......................................-----------.._..........-_.------..._-..._._......................._ Sbwl ketT e. - I _..._.._(pale 4).._.._..__........___....._-_(,(L[yj$ 1.2 ANCUORAGE TO FOUNOATION•'s Edge NO Spacing..--.-..---------....__-------(Table 11 ornole d......l....__....._._. V � Wood Structural Panels Field Nag necSp-een._._- aura II)_ ,] M. 5/B'Bob Sp Bolts Imbedded ar5/8'Pmprielary Mechanical able Anch.m as an ell......ve..con-ele only Shear Conne�on rho.of I6tl common nails Table I1 I)_ _ ______ ________�-��-�M. � rafthnS or busses spaced u l0 16'o.c. edge/f.'field I. ( (Table c Pa e P Btl fOd 6 )( ) _ rallors or trusse^spaced over I6-o.e. Roll Spacing Igeneral_..._..._._......................._..(iablo 4)_.........._.......__..... g�Irt ') , Percent Fad-Heigh)Slnealhin9.._...._...____ h1e 11 ad led 4- I v Boll Spadng from endleint of Plate.__...._..........._..(fig 51..---...._...._.._........_..�%5,.-12' �,- SX Addlional SncaUing Tar Wan w1Un Opening'6'e'fOvslgn CancePL)....._....._-._ edge/0-held Embedment-wnwcle......_........_......._.........._(Fig 51-.--�...................._.._....._.......-9 Wall Claedinq � 9able endwall rake or rako tau^s w/o gable ovodhang 8tl lOd 8'etlgo/6'field , Bolt Embedment-masonry................._.................In.5)........_.................__..._...._1j_In.z 15' Rated for Wind SpeMT..........._............___..__......._.___._._......._. gable endwall rake or rake truss w/structural 8U /Od 6-edge/6'field ._............__._.........._...._- ,Isle asM1er_..__..__.._._..................._._............._.(Fi951-................_.............__..._.._z 3'x3'x V. ..__ 5.1 ROOFS o.Uookers 3.7 FLOORSrho i -/ Roof(ming memberspans chocked]_._...._„-..._._.(Far RaRers use AWC BnnnT)see BBRS Websile)Floor framing member spans checked..............__.._.._..(per]80 CMR Chapter 55).__......_.._................ V Roof Overhany -- Maximum Floor Opening Olmensi...._........._................(Fig 6)..._............ ..__......_.---.... / gable ale toss lookout blocks Otl tOtl 4'edge/M1'field ........_..(Fgure l9)...._...... E,4 a flat of 2'-VJ Vr a....._....._......-...._....._..512' SLp- Tmss or Ratter Ianneclm.alLw,lbeari,g Walls Z.asma Full HeightWall Stads a Floor Openingsless than Yfrom FJderiar Wall(Fig 6)........._.......... ni n1 3f_ d'----"- Pmlxletary Connectors Maximum Floor Joist Setbacks .r v 1 44'.�,3f '=�i Supporting loadbea,ing Walls-Shcmwaff...............(Fig 7)..............................._..._.n..__.... RStl ) UdiR._........._._........_..._..._..........(]able i2).._......._..._..._...__.............U='j�CgPl( ✓ .o .$i� HdiS:,." cmP�x..-�R Yha�',•dn�13j.'.rSipi:u.. `>� Lateral..._........_......._.........-.._._..(Table l2) _-L=�[_plr -1 lAaxiS u p Can L,,dee Flag Wall s -t �/ 1 ' SUPPartin9 Laadbcadng Wags or Shearvrdll..............(Fig B)......_...._......................_......... RStl ) snaar__`-_....-.._.._._.._.__..._..(rahlel2).._.....'__._._._._........_....s=�Mr - I Ridge Strap Connections,if collar Des not used per page 21._(Table 13). ............._......T=�p1l Wood Slruolural Panels Floor 0heathi at EypI---s._..._.._.............._........._..._......(Fag g).........._._..._..........__..............._.. ..._.... � Ga1Ae Rake Oullooker------._..._.........._............._.(Figure 20).......... --Asconag-pf2'or V2 � plurals spaced up to 24'o.c.• Fbor Sheathing Typa........._..._........._.._................_....{per780 CMR Chaptcr551........__._........ Otl IOd .6•edge/12'field Fbor Sheathing Tldokness .. .(per780 CMR Clla14er 55)._-...............:(J-� Tmss-Ratter Connec0ons al Non-Laadb-Mg Wals Floor Sheathing Fastening........_. PnlPdelary Convectors 1/2:and 25/32'Fiberboard Panels _--..-_._._.................._-(Tabla 2)..(J_d pals at l�_in edge in field .._._._. ...(TabIS i4):..__......_.._._._..._.._........_U-41;)Ib. _✓ - - 4 uai;R._._._._._..__. _... - 3"•edge%fi'Rcld Lat6a1(rro.of l6d common pals)-(Ta Td)__._..............................._.L= Ib. t tl t - 4.1 WALLS Ran(Sheathing T (perrt00 CMR Ch. 1 588gd 59 - ' Wall Hcighlt Roof$lhea0wg �� Z In-z]H6'WSP 1%S7G'ypsuiLl V}rall�g5�d,.�.'::.:. Loadbeadng walls........................................._..(Fig 10 and Table 5).._...-. � ftS10' V --`-------------- _ 1 N-4-all cerin.wals_._......... ..... Roof Slmalhfn Faslcnl _3 ........__...._:....._...-_(F1'70 and Tom. .__ ft.20' 9 ng_._.__._-�..._..-....-.(Ta o2j..__.__._.._.-._._ �-;/yy , "..'± rv".-- '°k�la,t:..�ry:aT r..y-.t"'»�m 4pT•h` - rxey_ ...,,, r v .v,'a•�,.?e4d., 9 ) (.� 1/_ �L ptryolr. i�'�k(r.F,:.:-.'1... AI..::;nY.,.�. .:,]Yi:b??�t_7rdirr.'•;'eTy f.. I -------- Wall St. Sp 9 ....Fl 10 and Table S..._......... YFi' S2T o.e Nolen' ! .s{ - a' "-:Y. - �Qg can __..-.__..............._.__._.__._. -1. This dveck6sl shah be at 7nlls entire exdnotn Oho ' .,.'acle55' :e ( g ) .... m. 1L cazaplfan noldb Io vole the uremenls of !1.: ....' .:'..:.: .•,9d r .IiP:;O':'C` watsmryrm7ra: ._.-_....-'----------._........-:..(Flga7ae-----...._........_..._.. Rsd N ty. 9 ape z aon,ply req ._-`3�-.,i. `..i-d'.:_:;�`_:. e,d'S:zfetdis - "-n- 790 CMIt 53oL2.1.1 Rem Lume<hecklblJs mat in Its en a el r:nmorou •. <fi`'^;a�•s.yS(, o'^TM+9 me1at sImpa ad hold downs am net realer Than. :tOd': 4.2 EXTERIOR WALLS' regt7d per fn,WFCM 110 mph Guide g -1 ,- _ - 'I Wood SWdlt a. Slcel Slmpsp-Flgabas -,an ,. I . : ;, dd - Loadbearings+'ells............._....._......_......................(Table'aj.._............_.._.......2x�-7 R in. � 2 Gage Strop.p-Fyure I 1 :or reslslanl ll gago roolin9 nails and l6 gage staples arc PerdLLd,check IBC for addilianal requiaements. O. 0 U ,R tm 5 wFl Nan-Laadbcarin9 wills......__.__....._..........._...._.._(Table 5)........_...._._..........Zx<j�-]_R in. [ d. SkasP-Fi.m 1Tld - alhcrwise staled,ofcas given far nails am cam_wire sires_Bax and ne da palls of at.lealent Gable End Wall Bracing P P 9 .- s P Full Height Edwall Studs................................._....Ingle).--.--..--.-------.._............._....-..__.. e- ComerSWd Haut Downs per Frgum l0a and Figure tab I equal or greater length to the speclffedcamman palls may be substituted unless otherwise Prohlefted. WSPAIfic Floor Leith...........__...._........_....__.__.(Rg 11)...................._. .........._-RnNI3 2 Exr<p0on:Open(ng he his Nip to BlL shall be peurdtfed vNnen s%is added to No percent fu0-hefgbt shoo*, r - nls shaven in Tables 10 ad I t. Gypsum.4 Co Length(if WSP not rrsed)-------_...._._Rg 111-..._..:.......................... 020.9W _aL] e.bottnc end 2 z 4 Cant' -• ---__, � 3. The bottom siU pole in axledor volts shale be a minimum 2 b.nominal Thickness pressum beald t2yrado 'Continuous Lateral Brace spa in omi-.(Fig 2 i-4 blocking IL Spacingin...._...... or Plot.ng fvnirg sldpsQ l6'spacirhg min.wiN 2z461acMngQ4Rspacing in entl lolslorlrussbays 1 " Double Top Plate SP Ii Length ._........._......_.. .....................Ft 13 and Table 6 _✓� !! �. Splice Connection(no.of led common nails)...........(Table 6)........------------_....__.._._......___...... �� ._S�LI:I.f3�8�-cscl�•.Lz<y____ _ ___.._ _ _ -� _ -.--. LGCI.RIP-r" ..-,5{E:. •' Zi�v PTd>3�C5i11p5 _._.- S- S CWCV dent--V 7hvrJ PLW.S •�- Cc?4=6v+1P565LPtzT'-r:.w_:. _ _ I I S<1J.�OJ3(ITCFUwiCI {?IJl 4'C�IJdbLS,LEs-_._. .___ __ .. - 1 SSmw�u_Lr_i113"ct?)]S >'•• c4rr 1_�5RlCEf35e-. - -I_ sue'�`1 esFs �9 I t._a3yFS'S•=Cyr-----.._ I t)flpT ------. I i I 1 I - lid:liC•rn.=b33CL�t=ERrs.Ctacr-- ITES".= k3_5Y[OtPPt QS [,LT6[aELr7"R2iC-!( F , 1 1 i; -- j R73-(uauL. , ra-`_rain.- - --�icYCK j'ABLE EL2oUfLO.N{r`Y�. .fa luStlC:'__ ... trIK-2CA Pot'( b t�� -� �--��-----� tJCE DEVLIN©77M209-9750 ?i,'.\� d( Zo �� 5 -_ _gpp�,iQ�-- comdpblmmtba REO 20C19 �, i - I a VI/nr5f141_cr-- -sn52_`- - BUL'($=12^f?_:y$Y�;ECEp___ 7 I IO�I�LZ•_ii[�'ti.l'a()L'13:1`/-�1t�LY•_�rl('.�._P..Lnt�-. j se I � d -_.NO:T<c CCJN(P.Lcfc+C.�p c.EE1FC'7LLf:hT1I/'EIJS 10lJS OM Si YE ..__. ... .... . - VRueE DEVUAI DES05 eve e_ ne coat. eHATHAM, MA. 774•201-1750