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HomeMy WebLinkAbout0324 STRAWBERRY HILL ROAD - Health 324 STRAWBERRY HILL RD. CENTERVILLE A = 248 239 4 t UPC 12534 0 �� No. 2153LOa HASTINGS. UN i eti Commonwealth of Massachusetts. -- Title 5 Official Inspection ..Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 324 Strawberry Hill Rd.. Property Address Marcia Rafte Owner Owner's Name information is 5/13/2013 Centerville: Ma 02632 required for every page. Citylrown 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 Informafiion on the computer, use only the tab 1. Inspector: key to move your I �J cursor-do not Sean M. JoneS /L I use the return key. Name of inspector —•__�.__ �. ,. S.M:Jones Title V Septic Inspection Company Name _ 74 Beldan Ln. Centerville Ma 02632 City/Town State -- Zip Code' 774-248-4850 smonestitle5@grgail.com Sl4522: Telephone Number License Number B. Certification 1 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 orl site sewage disposal systems. l am a DEP approved system inspector'pursuant to Section 15.340 of Title 5(310 CMR 15 000).The systern:> Passes n Conditionally Passes El; Fails El Needs Further Evaluation by the_Local Approv proving Authority 5/13/2013 _ Inspector's Signature: -- Date: The.system inspector shall submit a copy of this inspection reportto the Approving Authority(Board Of Health or DEP)within 30 days.of completing this.inspection. Ifthe system is a shared system or. has a design flow of 1.0 000"gpd"or greater, the inspector and the ystem 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.: thins-3113 Ti, 5 o. ion Form:Subsu� IrfaIce Sewage Disposal System+'Page,1 of 17 I ' Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 324 Strawberry Hill Rd. Property Address Marcia Raftery Owner Owner's Name information is required for Centerville Ma 02632 5/13/2013 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 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: The dwelling located at 324 Strawberry Hill Rd. Centerville is served by a Title V septic system consisting of a 1000 gallon septic tank and 4 Infiltrators in a 30'xl0'trench. The system was found to be in proper working condition at the time of inspection. 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 324 Strawberry Hill Rd. Property Address Marcia Raftery Owner Owner's Name information is required for Centerville Ma 02632 5/13/2013 every 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 W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 324 Strawberry Hill Rd. Property Address Marcia Raftery Owner Owner's Name information is required for Centerville Ma 02632 5/13/2013 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool El ® 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 1/z day flow t5ins-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 324 Strawberry Hill Rd. Property Address Marcia Raftery Owner Owner's Name information is required for Centerville Ma 02632 5/13/2013 every 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. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 324 Strawberry Hill Rd. Property Address Marcia Raftery Owner Owner's Name information is required for Centerville Ma 02632 5/13/2013 every 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): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 gpd t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 324 Strawberry Hill Rd. Property Address Marcia Raftery Owner Owner's Name information is required for Centerville Ma 02632 5/13/2013 every page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ 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 M 324 Strawberry Hill Rd. Property Address Marcia Raftery Owner Owner's Name information is required for Centerville Ma 02632 5/13/2013 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: 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �nM 324 Strawberry Hill Rd. Property Address Marcia Rafte_ry Owner Owner's Name information is required for Centerville Ma 02632 5/13/2013 every page. CityrFown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: system installed 5/19/2000 per town records Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 3 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.): Joint were ok, no leaks, vented through the roof Septic Tank(locate on site plan): Depth below grade: 2 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: 1000 gallons Sludge depth: 611 t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 324 Strawberry Hill Rd. Property Address Marcia Raftery Owner Owner's Name information is required for Centerville Ma 02632 5/13/2013 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 3" Scum thickness 3" 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 10" How were dimensions determined? opened covers, took measurements 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 should be cleaned soon and again every 2 years for proper maintenance. water level was ok, tank was not leaking and was structurally sound. Inlet cover is to grade, outlet is under sunroom. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 324 Strawberry Hill Rd. Property Address Marcia Raftery Owner Owner's Name information is required for Centerville Ma 02632 5/13/2013 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.): 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 r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 324 Strawberry Hill Rd. Property Address Marcia Raftery Owner Owner's Name information is required for Centerville Ma 02632 5/13/2013 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert N/A 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" 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 324 Strawberry Hill Rd. Property Address Marcia Raftery Owner Owner's Name information is required for Centerville Ma 02632 5/13/2013 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 4 Infiltrators ❑ 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.): Soil and stone surrounding s.a.s was probed and found to be dry with no sign of past hydraulic overloading. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 324 Strawberry Hill Rd. Property Address Marcia Raftery Owner Owner's Name information is required for Centerville Ma 02632 5/13/2013 every page. Cityrrown 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts u Title 5 Official ;inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 324 Strawberry Hill Rd.. Property Address Marcia Raftery Owner _ Owner's Name. information is. Centerville Ma 02632 5/13/201`3. required for every __...... page. Cityfrown State _._ Zip Code Date of Inspection D. System Information (cost) Sketch Of Sewage Disposal System. Provide a view of the sewage;::disposal system,including ties to at least two permanentseference 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 1 z _A 2a 3`? 'Qi �3r2 t5ins•3113 Trtle 5 Otfiaal inspection Form:.Subsurface:Sewage.Disposal System•Page l5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments wM '' 324 Strawberry Hill Rd. Property Address Marcia Raftery Owner Owner's Name information is required for Centerville Ma 02632 5/13/2013 every page. Citylrown 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: 12'+ feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Groundwater elevation was determined by accessing Town of Barnstable groundwater contour map. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M ,•' 324 Strawberry Hill Rd. Property Address Marcia Raftery Owner Owner's Name information is required for Centerville Ma 02632 5/13/2013 every page. Citylrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 TOWN OF BARN//STABLE LOCATION �✓ Z s J'"r�' 1��r1�/ �/9// / SEWAGE # ,VILLAGE CPSxeyllle ASSESSOR'S MAP & LOT Zy9— Z,Y INSTALLER'S NAME&PHONE NO. !7�/ � �� C-e,5�, 7 7 SEPTIC TANK CAPACITY LEACHING FACILITY: (type).JrPAN,44 (size) /D'x3a �c9 NO. OF BEDROOMS I //'' BUILDER OR OWNER 11 e� PERMITDATE: S �S_�Q COMPLIANCE DATE: 5M000 Separation Distance Between the: s:'`r Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet^. Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by b!t ��y 4 �._�• s Rear � ' , / �Y ��, Z��� u ���b 30 �; r �o• ery Fee >&�e THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: s PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zipprtcation for Migonl *pf tem Construction Permit Application for a Permit to Construct( )Repair(ds)upgrade( )Abandon( ) ❑Complete System L Individual Components Location Address or Lot No. 2_1owner's Name,Address and Tel.No.�1 Assessor's Map/Parcel Installer's Name,Address,and Tel.No. f� y� Designer's Name,Address and Tel.No. 7/ —47 Z Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( Z' Other Type of Building f No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow J3Z9 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank &,V,69�'�� ,��i��5�`J'�� Type of S.A.S. /,0 Description of Soil /1�1q�",7 4rW" ; /�y�bb�,S Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issue y this PAard of Health. Signed Date Application Approved by Date `o�n '2 Application Disapproved for the following reasons Permit No. `' Date Issued ® '` - No. .� '"� y Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: s PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Zipprication for �Digpooal 6pgtem Conotruction Permit Application for a Permit to Construct( )Repair(/)Upgrade( )Abandon( ) ❑Complete System "dividual Components Location Address or Lot No. Z� Owner's Name,Address and Tel.No. Assessor'sMap/Parcel �•L'i� v�J/ // ""'�i C � �� �r Installer's Name,Address,and Tel.No. / Designer's Name,Address and Tel.No. B©r 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 zlz2 f gallons per day. Calculated daily flow ✓.?d gallons. Plan Date Number of sheets- Revision Date Title 1 Size of Septic Tank /l,/���®� �!'%S.j`i Type of S.A.S. Description of-Soil Nature of Repairs or Alterations(Answer when applicable) r";Z: 1i0_4F__ ✓ 4 -Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issue ,y this B ard. f Health. f Signed r Date �5 Cam' Application Approved by % Date Application Disapproved for the following reasons Permit No. Date Issued ----------------------- --------------- THE COMMONWEALTH OF MASSACHUSETTS Z yg6 Z ,3 BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired (t/)Upgraded( ) Abandoned( )by /il at .3' Z/ S _ ui has been constructed in accordance with the.provisions of Title 5 and the for Disposal System Construction Permit �40f_ e_ Installer Designer The issuance of this permit sha 'not be construed as a guarantee that the sy tem will function as,,/dLeL�ignedr Date � '1 Inspector V.. --------------------------------------- No.�3"r �� 6" � / U ��/Fee THE COMMONWEALTH OF MASSACHUSETTS - . PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS 'wi0po0al *pOtem Construction Permit Permission is hereby granted to Construct( )Repair( b4/Upgrade( )Abandon( ) System located at 3 L G/ . and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of thi rmit. Date: _Approved b ' Q V L'699 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH A.YD APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PEIMT (WYrHOL'T DESIGNED PLANS) "Or 4A04 her ebv certify that the anolication for disaosal xorks constl-uction permit signed by me dated 5_!/'LAD' concerr=sz the property located at �� ✓��/�11�jGjP�"a'y hi�� �*1'111 eels ail of the followina criteria: The failed system is connected:o a.esidenuai dwe:ling oniv_. :aere are no commer=ai or bus:aess y 'ces associated with the dweilinz. Ise Soli i C: ': r s assiued as C.��„ :and:ne e::cianon:ate:s ess :.=or equai :o minutes:e:mch. V"here are no wetlands within 100 fee:of*he orcuosed septic s:stem The:e are no orivate wells within 140 feet of:he crowsed septic s y stem i here is no increase in flow and/or chance Ln use crop_user +Y he:a are no variances requested or needed. I./Theborrom of the proposed leaching facility will riot be located less than five feet above he ma.x¢mum adjusted groundwater table-ieaticrL 'adjust the curdwater able using:he=nmutcr method when applicable, if the S.A.S. will be located with_40 fee:of any vegetated wetlands, the bottom of the-�ror:ose leaching facility will not be located less than fourteen(14) feet above the maximum adjusted groundwater table elevation. Please complete the following: - A) Top of Ground Surface Elevation(using GIS information) B) G.W. Elevation —the W. JC High G.W. Adjustment. DIFFERENCE BETWEEN A and B Z Z, SIGNED : /[ DATE: [Sketch proposed plan of system on back]. q:health folder Derr " ,.-s...,lR �F�- ., �n_: .,.,w r....•:_a ..b+�•..-r r »' Ott :�._. a3aP:. � -. �.��. ram,.;,. � 3�.. �;..,. SIR tQn k" i EO Lill Je l �ly�Cq�s TOWN OF BARNSTABLE 7 I LOCATION SEWAGE # VILLAGE CP-�'�c������ ASSESSOR'S MAP & LOT z�/�-- 7-39 INSTALLER'S NAME&PHONE NO.col�Lol ,/ 4 5�- 7 7/ SEPTIC TANK CAPACITY LEACHING FACILITY: (type),rv&s2�4 ��_ (size) /0'x3Q'>U NO.OF BEDROOMS BUILDER OR OWNER l/le� PERMITDATE: S fS_—®� COMPLIANCE DATE: O� Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility S'f Feet Private Water Supply Well and Leaching Facility (If any wells exist i on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by t, f I. I of q Ls- ri j 'fit I 1 1;?31.5 Fizic.,.Mo No. 'a APPROVED THE COMMONWEALTH OF MASSACHUSETTS wn%abie conwrvabw Departmeq3 O A R® OF HEALTH 1- `t'-3- 7OWN OF BARNSTABLE g Date vlirativn for Diripwial Hfurk,6 Tomitrur#ion rnmit Application is hereby made for a Permit to Construct ( ) or Repair ('*-4 an Individual Sewage Disposal System at: ig ------------------------------------------•........•---•----•-•-•---•-••-••--•••• ••_..�.. .................................••••••---•--------•---••••-•--.- ... Location- , ' .� .............. .. Ogy ...- . . A ... � -------- - ►`� . - sG A rGss •.... Ouncr ----••-• -•- o Installer Address U Type of Building Size Lot............................Sq. feet ., Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) 04 Other—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Ga Other fixtures ... . W Design Flow................. _....__.__ 111ons er erson er da Total dail flow . ��.... g ... ....--• - g� P P P Y• Y � --•----..-•-gallons. fx Septic Tank—Liquid capacity .gallons Length._.............. Width------,I...__..... Diameter................ Depth................ Disposal Trench—No. ........1........ Width.._..._......... Total Length.=?Uvb.-57Total leaching area....................sq. ft. 3 Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) ." Percolation Test Results Performed by............ ---------•------------------------------------•-•-•---•••• Date..................................... a Test Pit No. 1................m inutes per inch Depth>of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 •----------------------------------------------------------•--------------------•-•--•--••..._................................................................ 0 Description of Soil..................................................................... ----------•-----------------------------------------------------------.............--•----••...... W V .....•-•----•--•••----•--••••-•--.....••••••----......-••---•----••••-•••-•-••--•--••-•-••-•••••-----•----•••••--•-------•--•----••••••--•--•-------•..._..---•••-•-••-••-•.............................. W x ---•-----•..........................................•----------...----•-•--- ---......_......•-••--•---------•---------------•••------•-----•-•--•--•-------•--•••... ••-------------- ..... U Nature of Repairs or Alterations—Answer when applicable.-__.� ...f�".._,/CICKJ!_ t ..T�14 j--..--_-- ..._D ......a., �e......... ------1N=/. �X ej------------ ........................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Complianc s en issu by t oard of health. -- Signed .... .. :...... .................-----------..... ............. ApplicationApproved By ..::...1......1 .... ....... .................... .............................................. ... ..... .. + � Dace Application Disapproved for the following reasons: . ................................................................................... . .............................. .................... ... .......................................................:............. ..........................-------------------------------------------------------------------------------- Dare Permit No. v ................ Issued .......Q......... -911—............-. Dace Fizz............... ...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH '�!3 -4/JTOWN OF BARNSTABLE A liration for Di�� niul Work,i ( omitrurtinrt r�� � � runt Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal System at: ----- -- ......----•--•---.--•------•--------=------- Location- X(li or 4ot o. i� ............... ---------------------------------------------•----•--•--•----._...... .......... .....�-5....C- W Owner Address i . ...o�i 7 .Z �J -7! 5 Installer Address UType of Building Size Lot____________________ Sq. feet Dwelling—No. of Bedrooms___________________�___________._-.__Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) d Other fixtures W Design Flow..................5 .............gallons per person per day. Total daily flow.............. ................gallons. WSeptic Tank—Liquid capacity:/r '_gallons Length________________ Width---_------------ Diameter................ Depth................ x Disposal Trench—No. ......./........ Width_._.._..2_....... Total Length__ �,7f:�,.7 Total leaching area....................sq. ft. 3 Seepage Pit No_____________________ Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) .-I Percolation Test Results Performed by.................................. .............. Date........................................ a Test Pit No. 1................tnmutes per inch Depth of Test Pit-------_............ Depth to ground water........................ f= Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ DDescription of Soil........................................................................................................................................................................ U ......................................•--..._...._....__......-•----•---•--•-•-•----..._...-•---._._.____.._._._._..---------•--•-----•-•-------•-----•-•---•----•--•---••---._._._......._•-••••---•---• -------------------------------- -•-•-•--------_..----•-•-•-------..___...-•-------••-•--•---._._.-----•---------------••--------•---._...........--••••......-- ...................................... Nature of Repairs or Alterations—Answer when applicable.. i ala.-_-____A ..........__. ! '........................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental 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. Signed . J,............... l.. ` C.....................: .....R ..-. ......:...... oa I...... /.� .... Application Approved BJ Dace Application Disapproved for the following reasons.• ............... ... ......---- -- ............................ .................................... .............................................. . -- . ............................... ... . . -- .................---.................. �� fir /� /�'/ Dace Permit No. Issued ."'"-._-- '�'�............................................... Dace 'a THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE (ger#iftrate of Tompliance THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (� ) b 2 e e v I -7 6t�veS � L2_ 7a^-J Insrdlcr + , c� --------�,-/1---- ✓> 2�/_ -��:1..�......�......--..... ._.-/�� .� at ... ............................................................. has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. .'�..�1. ....._1- dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT Bt-eONSTRUEA AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE ........ - ... q. __. Inspector .............. .-� �.............................................................. d-�3 ______,________ ---___.__,_--_-_,__-„_---__®e_.-,-------____,__--------- ,__,�u_,:_,_,_.___ THE COMMONWEALTH OF MASSACHUSETTS a BOARD OF HEALTH -p- TOWN OF BARNSTABLE No.---••-•................. FEE..1?G.. �iu�rusttt urk� �.uu�tr�rtuauprutit Permission is hereby granted � .�G � 1 5 in Ica%GAd---•------------------ ---------- _ ' to Construct ( ) or Repair (�) an Individual Sewage Disposal System 6777/ c- ` at No......................................................... I /lhl ., /2/1 `. - ljl �....__�. 0. _�_ �V�F�� Street as shown on the application for Disposal Works Construction Permit ,A7o,_._.`.__�`-.!`�' Dated-----rK._77._. ._.�. - �, Board of Health DATE .._.../. = FORM 36508 HOBBS h WARREN.INC.,PUBLISHERS ' a �' a �� TOWN OF BARNSTABLE LOCATION 5V_4W VWW/-111 t,40 SEWAGE # VILLAGE ���r��/aJs(-c. ASSESSOR'S MAP & LOT —d3'7 MINSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) NO. OF BEDROOMS 1-3 PRIVATE WELL O UBLIC WATER BUILDER 0165W DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No Nk NOTES: 5-6• T-to 2'-10• 4'd' 1.) CONTRACTOR IS TO VERIFY ALL EXISTING CONDITIONS &DIMENSIONS IN THE FIELD A 2.) CONTRACTOR TO VERIFY ALL INTERIOR&EXTERIOR MATERIALS, A3 DETAILS,&FINISHES IN THE FIELD WITH OWNER ANDERSEN ANDERSEN ANDERSEN )TW24310 A251 A251 3. ROUGH OPENING HEAD HEIGHT OF WINDOWS AT .. FIRST FLOOR TO BE 6'-8"ABOVE SUBFLOOR NEW 4.) ALL CONSTRUCTION TO CONFORM TO 780 CMR MASSACHUSETTS BATH STATE BUILDING CODE,8TH EDITION AMENDEMENT&IRC2009 r-0• Q• „-r 5.) 110 MPH ZONE EXPOSURE B, 1.00 ASPECT RATIO ANDERSEN 6.) ALL SHEETS OF PLYWOOD WALL SHEATHING TO BE INSTALLED VERTICALLY, _ QLOS•�� Y TW2842 OR HORIZONTALLY W/BLOCKING AT EDGES,3"EDGE/12"FIELD NAILING NEW NEW 7.) ALL LVL LUMBER/BEAMS TO BE 1.9e U480 LOAD © BEDROOM DECK 8.) ALL JOISTS TO BE SPRUCE/PINE/FIR NO.2 GRADE 24° 15' ° (AZEK DECKING)m W-3 (VAULTED CEILING) 9.) FOLLOW ALL.MANUFACTURER'S SPECIFICATIONS FOR INSTALLATION OF ALL — 3o I SIMPSON COMPONENTS 1 24. SINK I o 10.) ALL CONCRETE USED FOR FOUNDATION WALLS,FOOTINGS&SLABS -1 TV SO.x6'FULL TE TO BE 3000 PSI 127" 15 J G&ELECTRICAL DETAILS W/OWNERS ON THE SITE 1 NEW ©NEW DURING FRAMING CONSTRUCTION 1 KITCHEN LIVING 12.) THIS SITE IS IN THE 110 MPH WIND BORNE DEBRIS AREA;EXPOSURE"B" 1 I REF. 'q (VAULTED CEILING) &WITHIN ONE MILE OF NANTUCKET SOUND PER STATE OF I MASSACHUSETTS WIND SPEED MAPS 13.)GLAZING PROTECTION PER 780 CMR 5301.2.1.2 TO BE PLYWOOD PANELS VERIFY ALL WIND BORNE DEBRIS PROTECTION REQUIREMENTS W/OWNERS PRIOR TO START OF CONSTRUCTION EXIST. 2'8'x4TW2842 . EXIST. w AND. �'NDERSENA INSTALL TWO FULL HEIGHT KING STUDS&TWO JACK HOUSE- �� W2842 - - o O STUDS AT EACH SIDE OF ALL ROUGH OPENINGS A A3 WINDOW 6'-5" 3'-2' 6'-5" ' 2 x 6 WALL - 4'-0" 16'-0' (ROUGH OPENING), JACK STUD IF 20'-0" - ROUGH OPENING STUD DETAIL FLOOR PLAN LEGEND: O EXISTING WALLS TYPICAL ASPHALT - CONSTRUCTION TO BE REMOVED ROOF SHINGLES NEW CONSTRUCTION - .. 5!8"CDX PLYWOOD.SHEATHING . 2 x 12 RAFTERS 15#FELT PAPER SIMPSON H 2.6 HURRICANE CLIPS Q SMOKE DETECTOR WIND WASH \ �� 3'0'WIDE ICENMTER SHIELD CARBON MONOXIDE DETECTOR ALUMINUM DRIP EDGE FASCIA,SOFFIT,&FRIEZE 1 x 3 STRAPPING W1 BOARDS TO MATCH EXISTING IECC2009 RESIDENTIAL ENERGY EFFICIENCY DETAILS , /2•GYPSUM BOARD CLIMATE ZONE 5A(USE EITHER PRESCRIPTIVE VALUES OR RESCHECK CALCULATION TABLE 402.1:1 TVP.2 x 6 WALLS(MINIMUM PRESCRIPTIVE INSULATION&FENESTRATION REQUIREMENTS) ' FENESTRATION SKYLIGHT CEILING WOOD FRAMED WALL FLOOR BASEMENT WALL BASEMENT SLAB CRAWL SPACE WALL - r U-FACTOR U-FACTOR R-VALUE R-VALUE R-VALUE R-VALUE R-VALUE R-VALUE f 0.35 0.60 38 20 30 10I13 10(2 FT.DEEP) ,o,13 - DETAIL AT WALL - NOTES: SCALE:1/2"=1'-O" 1.R-VALUES ARE MINIMUMS&U-FACTORS ARE MAXIMUMS. 2.10/1.3 MEANS R=15 CONTINUOUS INSULATED SHEATHING ON THE INTERIOR OR EXTERIOR OF THE HOME OR R=13 CAVITY INSULATION AT THE INTERIOR OF THE BASEMENT WALL 3.REFER TO IECC 2009 CHAPTER 4 FOR ALL INSULATION&ENERGY REQUIREMENTS Y EK COTUITBAYDESIGN LLC NEW ADDITION FOR: THESEOORINGPIE DESIGNER S-ORTOOUNOOMY SCALE : - DRAWING NO.: THESE DRAWINGS PRIOR TO START OF CONSTRUCTION.THE BUILDING CO""CTDR R - I H WILLBERESPONSIBLEFORTHE CONTENT 1/4 - 1 -0 43 BREWSTER ROAD � � IN THESE DRAWINGS IFCONSMUCRON (� COMMENCES ANOUT YERRORS OROGTHE MASHPEE MA. 02649 RA FTE RY RESIDENCE DESIGNER OFANYERRORSOROMISSx)NS. DATE : THERE DRAWINGS ARE SOLELY FOR THE USE OF THE OWNER NOTED.MY OTHER USE OF PH. (508)274-1166 THESEDRAWINGSREOUIRESTHEWRRTEN 5/16/2013 FAX(508) 539-9402 324 STRAWBERRY HILL ROAD CENTERVILLE, MA CONSENT TECT RT DESIGNERIGHTUNDER ROTFCTE A OF TH COPYRIGHT PROTECTION