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69 Valley Brook Road
Centerville
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
Inspection results must be submitted on this form or on the official Title 5 Inspection Form dated
6/15/2000. Inspection forms may not be altered in any way.
A. Certification
1. Property Information: I
69 Valley Brook Rd.
Property Address
Estate of Kathleen Doubleday
Owner's Name
267 Durrell Mountain Rd. Belmont N.H 03220
Owner's Address
Centerville MA 02632
City/Town State Zip Code
Date of Inspection: 3/18/10
Date
2. Inspector:
Matthew L. Childs
Name of Inspector
same
Company Name
4 Orchid Ln.
Company Address r.7 R
W. Yarmouth MA K' 62673 w
City/Town State Zip Code
508-989-1479 '
Telephone Number
w W
Certification Statement: .Wa
I certify that I have personally inspected the sewage disposal system at this address and that the r;,a
information reported below is true, accurate and complete as of the time of the inspection. The Inspection
was performed based on my training and experience in the proper function and maintenance of on site
sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of
Title 5(310 CMR 15.000).The system:
® Passes ❑ Conditionally Passes ❑ Fails
❑ Needs Further Evaluation by the Local Approving Authority
3/18/10
Inspector'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 th future under
the same or different conditions of use.
Doubleday.doc•11/2004 Title 5 Official Inspection Form:Subsu -Sewag Dtposal System
Page 1 of 16
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
G'M
A. Certification (cont.)
69 Valley Brook Rd.
Property Address
Centerville MA 02632
City/Town State Zip Code
Estate of Kathleen Doubleday 3/18/10
Owner's Name Date of Inspection
Inspection Summary: Check A,B,C,D or E/always complete all of Section D
A) System Passes:
® I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
passes
B) System Conditionally Passes:
❑ One or more system components as described in the"Conditional Pass" section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass.
Answer yes, no or not determined (Y, N, ND) in the ❑ for the following statements. If"not
determined," please explain.
❑ The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is
structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent.
System will pass inspection if the existing tank is replaced with a complying septic tank as
approved by the Board of Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate
of Compliance indicating that the tank is less than 20 years old is available.
ND Explain:
N/A
Doubleday.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System
Page 2 of 16
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
�M
A. Certification (cont.)
69 Valley Brook Rd.
Property Address
Centerville MA 02632
City/Town State Zip Code
Estate of Kathleen Doubleday 3/18/10
Owner's Name Date of Inspection
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
❑ obstruction is removed
❑ distribution box is leveled or replaced
ND Explain:
N/A
❑ 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:
N/A
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
Doubleday.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System
Page 3 of 16
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Not for Voluntary Assessments
iG^M SVB••o
Subsurface Sewage Disposal System Form
A. Certification (cont.)
69 Valley Brook Rd.
Property Address
Centerville MA 02632
City/Town State Zip Code
Estate of Kathleen Doubleday 3/18/10
Owner's Name Date of Inspection
C) Further Evaluation is Required by the Board of Health (cont.):
2. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well".
Method used to determine distance:
**This system passes if the well water analysis, performed at a DEP certified laboratory, for
coliform bacteria and volatile organic compounds indicates that the well is free from pollution from
that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5
ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached
to this form.
3. Other:
N/A
Doubleday.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System
Page 4 of 16
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
'G7M
A. Certification (cont.)
69 Valley Brook Rd
Property Address
Centerville MA 02632
City/Town State ZipCode
Estate of Kathleen Doubleday 3/18/10
Owner's Name Date of Inspection
D) System Failure Criteria Applicable to All Systems:
You must indicate "Yes" or"No"to each of the following for all inspections:
Yes No
❑ ® Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less
than '/z day flow
❑ ® 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 coliform bacteria and volatile organic compounds
indicates that the well is free from pollution from that facility and the
presence of ammonia nitrogen and nitrate nitrogen is equal to or less
than 5 ppm, provided that no other failure criteria are triggered.A copy of
the analysis must be attached to this form.]
Yes No
❑ ® The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
Doubleday.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System
Page 5 of 16
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
�M
A. Certification (cont.)
69 Valley Brook Rd.
Property Address
Centerville MA 02632
City/Town State Zip Code
Estate of Kathleen Doubleday 3/18/10
Owner's Name Date of Inspection
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.
Doubleda .doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System
Y P
Page 6 of 16
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
a Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
B. Checklist
69 Valley Brook Rd
Property Address
Centerville MA 02632
City/Town State Zip Code
Estate of Kathleen Doubleday 3/18/10
Owner's Name Date of Inspection
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(3)(b)]
Doubleday.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System
Page 7 of 16
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
'4M
C. System Information
69 Valley Brook Rd.
Property Address
Centerville MA 02632
City/Town State Zip Code
Estate of Kathleen Doubleday 3/18/10
Owner's Name Date of Inspection
Residential Flow Conditions:
Number of bedrooms (design): 3 Number of bedrooms (actual): 3
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 gpd.
0
Number of current residents:
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No
Laundry Y P system inspected? ElYes ® No
Seasonal use? ❑ Yes ® No
Water meter readings, if available last 2 ears usage d N/A
9 ( Y 9 (gpd)):
Sump pump? ❑ Yes ® No
Last date of occupancy: N/A
Date
Commercial/Industrial Flow Conditions:
Type of Establishment: N/A
Design flow(based on 310 CMR 15.203): N/AGallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.): N/A
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: N/A
Last date of occupancy/use: N/A
Date
Other(describe): N/A
Doubleday.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System
Page 8 of 16
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
M
C. System Information (cont.)
69 Valley Brook Rd.
Property Address
Centerville MA 02632
City/Town State Zip Code
Estate of Kathleen Doubleday 3/18/10
Owner's Name Date of Inspection
General Information
Pumping Records:
Source of information: previous inspection report
Was system pumped as part of the inspection? ® Yes ❑ No
If yes, volume pumped: 1000 gal.
gallons
How was quantity pumped determined? sight on truck
Reason for pumping: maintainance
Type of System:
® Septic tank, distribution box, soil absorption system
❑ Single cesspool e
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner)
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other(describe):
Approximate age of all components, date installed (if known) and source of information:
Installed in 1982 per disposal works construction permit on file>
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Doubleday.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System
Page 9 of 16
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
M
C. System Information (cont.)
69 Valley Brook Rd.
Property Address
Centerville MA 02632
City/Town State Zip Code
Estate of Kathleen Doubleday 3/18/10
Owner's Name Date of Inspection
Building Sewer(locate on site plan):
Depth below grade: 1.5'
p g 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.):
All in good working order at time of inspection.
Septic Tank(locate on site plan):
Depth below grade: 1
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 ❑ Yes ❑ No
certificate)
Dimensions: 8'x5'x5' outside 1000 gal.
A
Sludge depth:
Distance from top of sludge to bottom of outlet tee or baffle 2.7
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 4
How were dimensions determined? tape measure during pumping
Doubleday.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System
Page 10 of 16
Commonwealth of Massachusetts
W Title 5 official Inspection Form
Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
M
C. System Information (cont.)
69 Valley Brook Rd.
Property Address
Centerville MA 02632
Cityrrown State Zip Code
Estate of Kathleen Doubleday 3/18/10
Owner's Name Date of Inspection
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 showed no signs of leakage and was pumped as maintainance at time of inspection.
Grease Trap (locate on site plan):
Depth below grade: N/Afeet
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
N/A
' Dimensions:
N/A
Scum thickness N/A
Distance from top of scum to top of outlet tee or baffle N/A
Distance from bottom of scum to bottom of outlet tee or baffle N/A
Date of last pumping: N/A
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.):
N/A
Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan):
Depth below grade:
N/A I
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
N/A
Doubleday.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System
Page 11 of 16
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Not for Voluntary Assessments
co Subsurface Sewage Disposal System Form
G7M
C. System Information (cont.)
69 Valley Brook Rd.
Property Address
Centerville MA 02632
City/Town State Zip Code
Estate of Kathleen Doubleday 3/18/10
Owner's Name Date of Inspection
Tight or Holding Tank(cont.)
Dimensions: N/A
Capacity: N/A
gallons
Design Flow: N/A
gallons per day
Alarm present: ❑ Yes ❑ No
Alarm level: N/A Alarm in working order: ❑ Yes❑ No
Date of last pumping: N/A
Date
Comments (condition of alarm and float switches, etc.):
N/A
Distribution Box (if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert 0.0'
Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any
evidence of leakage into or out of box, etc.):
d-box is level with no leakage or solids carryover at time of inspection. t, LAJ
Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No
Alarms in working order: ❑ Yes ❑ No
Doubleday.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System
Page 12 of 16
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
M
C. System Information (cont.)
69 Valley Brook Rd.
Property Address
Centerville MA 02632
City/Town State Zip Code
Estate of Kathleen Doubleday 3/18/10
Owner's Name Date of Inspection
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
N/A
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
Type:
® leaching pits number: 1
❑ 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.):
1 6'x6' precast pit with 1' of stone was dry with stain lines at 1.5' at time of inspection. SAS is not in
hydraulic failure
Doubleday.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System
Page 13 of 16
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Not for Voluntary Assessments
iGgM
Subsurface Sewage Disposal System Form
C. System Information (cont.)
69 Valley Brook Rd.
Property Address
Centerville MA 02632
City/Town State Zip Code
Estate of Kathleen Doubleday 3/18/10
Owner's Name Date of Inspection
Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration N/A
Depth —top of liquid to inlet invert N/A
Depth of solids layer N/A
Depth of scum layer N/A
Dimensions of cesspool N/A
Materials of construction N/A
Indication of groundwater inflow ❑ Yes ❑ No
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
N/A
Privy (locate on site plan):
Materials of construction: N/A
Dimensions N/A _
Depth of solids N/A
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
N/A
Doubleday.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System
Page 14 of 16
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
�M
C. System Information (cont.)
69 Valley Brook Rd.
Property Address
Centerville MA 02632
City/Town State Zip Code
Estate of Kathleen Doubleday 3/18/10
Owner's Name Date of Inspection
Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties
to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet.
Locate where public water supply enters the building.
VaUey Brook JRdl.
/S
A 1-25' B-1-21'
A 2-29' B-2-23'
A-3-34' B-3-25'
A4-59' B4-23'
O
Doubleday.doc-11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System
Page 15 of 16
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
M
C. System Information (cont.)
69 Valley Brook Rd.
Property Address
Centerville MA 02632
City/Town State Zip Code
Estate of Kathleen Doubleday 3/18/10
Owner's Name Date of Inspection
Site Exam:
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water:
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: 7/14/82
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:
Checked test hole data from system design plans. System was installed within reasonable limits and
has adequate groundwater seperation.
Doubleday.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System
Page 16 of 16
COMMONWEALTH OF MASSACHUSET'I'S
w EXECTJTAE OFFICE OF ENVMONMEl\TTAL AFFAIRS
r d DEPARTMENT OF ENVIRONMENTAL PROTECTION
e�
TITLE 5
OFFICIAL. INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PANT A
/ CERTIFICATION
Property Address: 69 (/ ol/P dl-oo�- A
(Loi4ferv,'Ile, Oa
Owner's Name: T®14 L A'to.1
Owner's Address: /,5- oG a s .S
Date of Inspection: �— —
p p )'� �/
Name of Ins ector: lease a-ant �d• D S Pi111
Company Name 6/i 0 — T
Mailing Address: O /d
�s a 14 0164�� (l�
Telephone Number• ,,5 —
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported
below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my
training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP
approved system inspector pursuant to Sec ' 5.340 of Title 5(310 CMit 15.000). The system
Passes
Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
F s
Inspector's Signature: Dates
The system inspector shall suTta y of this inspection report to the Approving Authority(Board of health or
DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000
gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the
DEP.The original should be sent to the system owner,and copies sent to the buyer,if applicable;and the approving
authority.
Notes and Comments
****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.
Title 5 Inspection Form 6/15/2000 page I
Page 2 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENT'S
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PARS'A
CERT'IFICAT'ION(continued)
Property Address: 11,011e &ak- Rol
v► rv-I Od-6.,49--
Owner• t c ✓tea
Date of Inspection:
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. S em Passes:
I have not found any information which indicates that any of the failure criteria described in 310 CMR
15.303 or in 310 C_MR 15.304 exist.Any failure criteria not evaluated are indicated below.
Comments:
B. S tem Conditionally Passes:
�7One or more system components as described in the"Conditional Pass"section need to be replaced or
repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass.
Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined"please
explain.
The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally
unsound,exhibits substantial infiltration or enfiltration or tank failure is imminent.System will pass inspection if the
existing tank is replaced with a complying septic tank as approved by the Board of Health.
*A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance
indicating that the tank is less than 20 years old is available.
ND explain:
Observation of sewage backup or break out or high static water level in the distribution box due to broken or
obstructed pipe(s)or due to a broken,settled or uneven distribution box.System will pass inspection if(with
approval of Board of Health):
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
ND explain:
The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will
pass inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
ND explain:
Page 5 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSIPECITON FORM
PART I3
CHEC/IMIST
Property Address: 69
/ _ Oa
Owner: G c^'+On
Date of Inspection: /Z{-09'
Check if the following have been done.You must indicate`yes"or"no"as to each of the following:
Yes o
Pumping information was provided by the owner,occupant,or Board of Health
v Were any of the system components pumped out in the previous two weeks ?
6/<Hathe system received normal flows in the previous two week period?
r/ Have large volumes of water been introduced to the system recently or as wart of this inspection
r/ Were as built plans of the system obtained and examined?(if they were not available note as N/A)
d Was the facility or dwelling inspected for signs of sewage back up?
Was the site inspected for signs of break out?
v Were all system components,excluding the SAS,located on site?
t/ _ 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 S on the site has been detern€ined based on:
rP System(SAS))
Yes
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(3)(b)]
Page 6 of 11
OFFICIAL. INSPECTION FORM-NOT FOR VOLUNTARY ASSESSIMEN TS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPEC7170N FORM
PART C
�/' /SYSTEM INFORMATION
Property Address- 69 V G�I�11 WOo4, P
Owner:
Date of Inspection: — Af— O-e
FLOW CONDITIONS
RESIDENTIAL. �` 0
Number of bedrooms(design): Number of bedrooms(actual):
DESIGN flow based on 310 CTMR 15.203(for example: 110 gpd x#of bedrooms): 14
Number of current residents: 0
Does residence have a garbage grinder(yes or no):
Is laundry on a separate sewage system(yes or no):&,o [if yes separate inspection required] le
Laundry system inspected or no):/�
Seasonal use: (yes or no):0
Water meter readings,if available(last 2 years usage(gpd)):
Sump pump(yes or no):
Last date of occupancy:_V
Type of establishment:
Design flow(based on 310 CMR 15.203): gpd
Basis of design flow(seats/persons/sgft,etc.):
Grease trap present(yes or no):—
Industrial waste holding tank present(yes or no):
Non-sanitary waste discharged to the Title 5 system(yes or no):
Water meter readings,if available:
Last date of occupancy/use:
OTHER(describe):
GENERAL,INFORMATION
Pumping Records
Source of information: �,�� S �✓S ��°'�'"��
Was system pumped as part o thee` inspection(yes or no):—
If yes,volume pumped: gallons--How was quantity pumped determined?
Reason for p - g:
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)
_Tight tank _Attach a copy of the DEP approval
_Other(describe):
Approximate age of all components,dale installed(if known)anour of information:
O
Were sewage odors detected when arriving at the site(yes or no):N v
Page 7 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY A.SSESSMWNTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
Q SYSTEM INFORMATION(continued)
Property Address: (>/ l a/4, �5lao� �r"i
Owner: 04 le
�V-1'07
Date of Inspection: - rf
BUILDING SEWER(locate�n site plan)
Depth below grade: /
Materials of construction:_cast iron _40 PVC_other(explain):
Distance from private water supply well or suction line:
Comments(on condition of joints,venting,evidence of leakage,etc.):
a
SEPTIC TANK:_((locate on site plan)
Depth below grade: /�
Material of construction: v concrete_metal—fiberglass_polyethylene
_other(explain)
If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of
certificate)
Dimensions: .x
Sludge depth: 311
ii
Distance from top of sludge to bottom of outlet tee or baffle:I
Scum thickness: /// ,i
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bott9pi of outlet tee or baffle:
How were dimensions determined: 11,11,9% 9ra.1
Comments(on pumping recommendations,inlet an utlet tee or bale condition,structural integrity,liquid levels
as r ated to outlet invert,evidence of le ge,etc.):
l/Ie�ularf -ill -10 tee. T-
it o C-J • so 0 " 1
GREASE TRAP:k(locate on site plan)
Depth below grade:_
Material of construction:_concrete_metal_fiberglass_polyethylene_other
(explain):
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
Date of last pumping:
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structin-A integrity,Liquid levels
as related to outlet invert, evidence of leakage,etc.):
Page 8 of 11
OFFICIAL, INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL,SYSTEM INSPECTION FORM
PART C
Q SYSTEM INFORMATION(continued)
/
Property Address: (O 7 l �° e'lly-f1-
era �3�-
Owner: CAPS o."
Date of Inspection:
TIGHT or HOLDING TANK:I (tank must be pumped at time of inspection)(locate on site plan)
Depth below grade:
Material of construction: concrete metal fiberglass_polyethylene other(explain):
Dimensions:
Capacity: gallons
Design Flow: gallons/day
Alarm present(yes or no):
Alarm level: Alarm in working order(yes or no):
Date of last pumping:
Comments(condition of alarm and float switches,etc_):
DISTRIBUTION BOX: I if resent must be o P�ed)(locate on site plan)
( P
Depth of liquid level above outlet invert: 494"'1"?�--
Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of
leakage int or out of box,etc.): �l � �G�f
eve(, �b s
PUMP CHAIMBER:N (locate on site plan)
Pumps in working order(yes or no):
Alarms in working order(yes or no):
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):
Page 9 of 1 I
OFFICIAL nTSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENT'S
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: v/ !/ �f ,6rov k,, Rcl
Owner: t G 4 Y,0'
Date of Inspection: OV
SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required)
If SAS not located explain why:
Type
leaching pits,number: [ 0
leaching chambers,number: `_0
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.): i/ /��,,117 J C/ .i
/Y V e4 t o 0e
CESSPOOLS: 4y (cesspool must be pumped as part of inspection)(locatte on site plan)
Number and configuration:
Depth—top of liquid to inlet invert:
Depth of solids layer:
Depth of scum layer:
Dimensions of cesspool:
Materials of construction:
Indication of groundwater inflow(yes or no):
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation;etc.):
PRIVY: locate on site plan)
Materials of construction:
Dimensions:
Depth of solids:
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
Page 10 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSWNTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: e?Ile 60 h/
/ � ✓iii � 0�6��,
Owner: Le!n o✓
Date of Inspection: —�
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or
benchmarks. Locate all wells within 100 feet.Locate where public water supply enters the building_
l=J
i
Page 11 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSI [ENTS
SUBSURFACE SEWAGE DISPOSAit,SYSTEM INSPF+C'ITON FORM
PART C
SYSTEM INFORMATION(continued)
Property Address• 0 v /4 k V
vL v .0014 3.4
Owner: Ple W►o r/a
Date of Inspection:
SITE EXAM
Slope o?-00 /�
Surface water
Check cellar �i l
Shallow wells/ �� i �c f7
Estimated depth to ground water�9-7feet �O^
Please indicate(check)all methods used to determine the high ground water elevation:
Obtain om system design plans on record-If checked,date of design plan reviewed:
served site(abutting property/observation hole thin 150 feet of SAS)
Checked with.local Board of Health-explain: Gr✓!s
Checked with local excavators,installers-(attach documentation)
Accessed USGS database-explain:
You Esttscribe how ou established the High gr n water elevation:
/�So v-7 Nr �� t/ de , �� .� �r
oce- oPA, 073:9. ffe
f X1 ro — ,,�
5dw(# .•c-. FAMILY BC012-00 i
uo GAct®A(,E 692-IM0E12.
C>AIA..y FLOW s do X 3 m Z306.PP .
SEPTIC. T WK o Z30xi5a®/® _-49! 6.P o
use 1000 CA%-. y�
ot5Po5AiL rr' vgt~ t000 6AL.. �. 92-e,
5 I VSWALIJ AV-SA. s t>a SA g , Io®'
BOTTOM AREA m �O 5 F
'TOTAL.
TC,TA%- pA I LY F%-c) [ = 330 G PO•
a\ t� •° !
PEQGot-ATtoN ;ZATEj t"'to.t ZPIN 31?
i
t1F 41i� g14 0F
RlCHARO $ ALAl1 ti
BAXTER aJo
Na 24m 2 /
4�
f a A4 Eh� - .. . .
• I
-ro P FktCs 1%g.4-
fit.• 3G tt,,. zF ---z,6•4-
. , twq.
Svziot(- DUST. INV.
�` �aL.
3!0
•0 SrPTIC.TANK ,
Costi�a t„teACA
INV. INV.
WITU
d
SA�,D C<=wrIr-IGC) Qt_oT Pi-A- J
Z0P!Lr=
L o C A•T 10
Q L.Al,
i{EREOhd GoMPto�{� �JtTN�'ME �1��t,.ttJ� L o"i' I4
AWP
,TOWN AND If.
LOCATED -WIT9 °T"S oo® L,6•1N
B6�.x''E Z a M YE I N c.
'T%11 S pt_B.N t�i t1 OT BA15 r=to 01d Am 6�.EG t ST>sP��.`U'�Rl�S u 2N EYoi�S
1 lv,5TV-u M F--NT ;u ev G o s't-t=�.dt Ltd - MASS
Town of Barnstable
1HE Tp�
y�P ti� Regulatory Services
BARNSTABLK ; Thomas F. Geiler,Director
MAS&
1639. Public Health .Division
prED MA'S p
Thomas McKean, Director
200 Main Street,Hyannis, MA 02601
Office: 508-8624644 Fax: 508-790-6304
This septic system inspection report was completed by a private inspector who is certified
by the State of Massachusetts, Department of Environmental Protection.
Although the Town of Barnstable Health Division received the original/copy of this
report; this Division does not warranty the functionality of the septic system in the future
nor does this Division agree with any technical observation s and interpretations
contained within this report.
In addition, by receiving this report the Town of Barnstable Health Division does not
automatically approve the number of bedrooms listed within this report. The actual
number of bedrooms approved at a particular property would-be listed on the"Disposal
Work Construction Permit".
If you should have any questions regarding this report, please contact the certified Septic
System Inspector who conducted the inspection.
Page 3 of I 1
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESS1VI NTS
SU13SURF'ACE SEWAGE DISPOSAL SYSTF-M INSPEC TON FOPM
PART A
Q / CERTIFICATION(continued)
Property Address:
Owner: (`<< G h✓°raN
Date of Inspection: — y—
C.� Further Evaluation is Required by the Board of Health:
/V Conditions exist which require further evaluation by the Board of Health in order to determtine 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 Chill 15303(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 rash
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 wester supply.
The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well.
The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a
private water supply well".Method used to determine distance
"This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform
bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and
the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other
failure criteria are triggered.A copy of the analysis must be attached to this form..
3. Other:
I
Page 4 of I 1
OFFICIAL. INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUIBSURFACE SEWAGE DISPOSAL. SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 0 111 4&0®11--
2, e ,Ile IV 0L 6-?.?—
Owner: R G ,L-10,1
Date of Inspection: .3—A/-of
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or. "no"to each of the following for ail inspections:
Yes Nq/di
Dackup of sewage into facility or system corimonent due to overloaded or clogged SAS or cesspool
ischarge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
/clogged SAS or cesspool
V Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool
C-1 quid depth in cesspool is less than 6"below invert or available volume is less than 1,2 day flow
v Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Iqumber
/fit times pumped .
v y 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.
_ V y portion of a cesspool or privy is within 50 feet of a private water supply well.
�y portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water
supply well with no acceptable water quality analysis. [This system passes if the well water analysis,
performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds
indicates that the well is free from pollution from that facility and the presence of ammonia
nitrogen and nitrate nitrogen is equal to or less than 5 ppin,provided that no other failure criteria
are triggered.A copy of the analysis must be attached to this foruLl
(Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as
d--scribed 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 trust serve a facility with a design flow of 10,000 gpd to 15,000
gpd.
You must indicate either"yes"or"no"to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
Xes., 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.
L O CATION SEWAGE PERMIT NO.
1—o F*4 114 V,41 t F-y lzoor, IFo
VILLAGE
INSTALLER'S NAME i ADDRESS
BUILDER OR OWNER
im
DATE PERMIT ISSUED
DATE C0MPl,1ANCE 1SSt-ED � � �f
I
4f7 , h�
t S17 j�
I
No....d2.4!�A / Fes$.... . ..............
THE COMMONWEALTH OF MASSACHUSUTTS
BOAR® OF HEALTH
a .--".........OF........... --- -------....................
App iratiou for Uhivoii al Vorkfi Tnnitrnrtiun ranfit
Application is hereby made for a Permit to Construct (V or Repair ( ) an Individual Sewage Disposal
System $:
.....------. ..�.._ �d'oo�- ��.----��1�... ..A�................... �-... N�--------------........----------
- -----
-. Coca'o -Address _ or Lo No.
- --.- --.---... c ��•---------- ----- -..- ------.........---•--..............................
Owner ddre s
W .............: -�c. xa..t ...... s.---------------- ----- ...................................
Installer Address
dType of Building Size Lot. ..._..Sq. feet
Dwelling—No. of Bedrooms__........3.............................Expansion Attic 43a) Garbage Grinder (u�
pa, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Q' Other fixtures ..............................................-
W Design Flow..............�\Q....................gallons per person per day. Total daily flow........;- =..9.._......_..........._gallons.
WSeptic Tank—Liquid capacity........._gallons Length................ Width................ Diameter................ Depth................
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area--------------------sq. ft.
Seepage Pit No..................... Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tRk ( A '
'—' Percolation Test Results Performed by...... c�c.�c-en:_ ___e�._. __....__._ Date_... '3'�
--
Test Pit No. 1................minutes per inch Depth of Test Pit.__._.........__.__. Depth to ground water_-_______-___-_-___--__-
G%� Test Pit No. 2................minutes per inch Depth of Test Pit__-_____--_-______._ Depth to ground water........................
O Description of Soil------. ----------------M la. �.............. -4-0-�.a��--------------- ---------------
U -----•-------•--•-•----•--------------- ----------------..C.0 _.!r............_S_�r1..
W --------------- ---------------•------. '.. .........ryle....................5......CX .-----------------------------------------------------------------------------
UNature of Repairs or Alterations—Answer when applicable_______________________________________________________________________________________________
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the boa-d of health. C
Signed----=- -.............................. ..............-----�...... ............... o
Application Approved By......... A� ���.%�............................ -9................................� `�i 2�
2
Date
Application Disapproved for the following reasons----------------------------------------------------------------------- ......................................
_........-•-•........................•-....-----.....-----•----------------------•---••---•-----------------•----.._.._.......----•-------•--•--•--------.....-----------------------------•-•----------
Date
PermitNo......................................................... Issued.......................................................
Date
r
No. .................... • FEB...... s ....
` THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
�Q .. ..............OF............ •G t(1 �� V cam:
-----------.......................................
ApplirFation for Dhgp sal Workii Tnnitrnrtion ramit
Application is hereby made for a Permit to Construct (V) or Repair ( ) an Individual Sewage Disposal
System t
...............u ._
••••-- ... .. _..... ....... ................
Location.-Address ! 'S Lo N�
••••--..... °:rn.- C� .............t))........i.......--------- ......... .G�!1,..(.......- .............................................................
Owner ddre s
W ............. ..�.��r- f ` ............ ----------------- ...,� c �.............. .........................` -
Installer Address CA
Type of Building Size Lot.��. ...--...0.Sq. feet
Dwelling—No. of Bedrooms...............3
............................. Attic QJ q Garbage Grinder VC)
p,, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
04 Other fixtures ....................•-••-••--•-- -
W Design Flow............... ....................gallons per person per day. Total daily flow-------- ': ..................gallons.
WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................
xDisposal Trench—No. .:.................. Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No----------------_-- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
`" Percolation Test Results Performed by...... .................................� '-� V._.l _ t -_.__._.... Date._. .`_ . ...._..
a
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water.........................
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
a' .........................------------------------------•. ••-------• .....--••--•-----•-•••......--••••=.............................
... -----•---------
O Description of Soil------. --------------- ��M. .................� =��'�`� `�
U r = - � - -t '1•-: � .------------------------
.------_
... . ........--:.....---n'--�- `-----------------`�-- --'�-`�------.....----------------------------------i...............................
V Nature of Repairs or Alterations—Answer when applicable................................................................................................
•••----------•--------------------------••---••-••-----•-•••-•.....-••••-•------•--........-•-•----•--•-------•---------------•---•-•--•••----•----•-••••-••-••-••••••-••......--•--•-•------•••••.
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of'1'11 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 boa-d of health.
Signed _• ........... XqYXJ_ .
�Dp
Application Approved By.............................. ,
.. ...... '�-...'.. .... .....,. . ,p ......-••••-••--••. ,Elm Date
Application Disapproved for the following reasons---------------------------------•-----------------------------------------------------------------.....•--.--••-
...----••--------------------•--..............--•------------...-.---------------•-•--------------•--------••-•••----•••-••••---•••----------•--•••-•••-••-•---••-••----•------•-•--•-•---••---•--------
Date
PermitNo....................................................... Issued_.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Turn ifiratr of Toutptia.nrr
THIS IS TO CERTIFY,,.That the Individual Sewage Disposal System constructed ( Or/or Repaired ( )
.............................................................
l Installef �'`
at U ........----4� ;�.. t' ( �-- ---- L �`- ` = `_.,-.,! - "��1�;}4 -
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.B x.'l _.Q............... dated-...............................................
THE IS U NCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SY7. L FNCTION SATISFACTORY.
DA ... ...__...................... InswT ..
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH .
>! r�.�'...............OF............s.���'..`�...: b ,�..
No......................... FEE....-.;.. .............
Disposal nrkn Tontrnrtion rrntit
Permission is hereby granted--------�`>._ := ------....& .-S-------------------------------------......................................
to Construct ( ' or Repair ( ) an I ividu 1 Sewage Disposal S tern
at No......�- �........ \J :... f'� ►.�13V �
Street
as shown on the application for Disposal Works Construction Permit No..................... Dated......................._..................
DATE. v� `' d -- B/rd . Health
FORM 1255 HOBBS & WARREN. INC., PUBLISHERS
A
�jI1J�LL- �pMtL.�( -Y;b aEORooM
►.JO GARBAGE �jW1.lDER .. -
pAtL.-( Flow a 110 A 3 = Sao G.Pti?
SEPTIC, TAWK
u5c- ►000 COAL,
015PO-4AL.
6%VCLWALL
15o 5.F A 3?5 G.Po
BOTTOM AREAL • �o StF.
t
K I. O �. °0M
�•0 G.P C> / 9A/C>.
-T oT A L• E 51 GN s �-2 5 G.P D I / � `�r� 1
'T'oTAL.. pA1W'( 1
PE2GOL.ATtON RATE] I"IN �IIN o��E55 34_ r P; F
� P'T
�tH of M ZN of Wt
v� RICHARQ y6 0� ALAN ti
BAXTER Z,' JO
Na 24D48
�QtST
To p F kt,s IS9.4.
iw. I.
1. p►� Ioov INS• I;
+ DtST. INS G4t.. 3(.•Z
S�BSotL, 0VX •0 $6Pr►G
lovo tNY, TANK .
2 Gat..
CroAtthe .. INV. INV.
PIT
!►a.a�. w I T u
WASKGD
GEIZTIFtSo PLAT PLAN
Sa��D
PR.UFIL� l.oC4•T1oN CEI�Tl�LL6
2d I2 NO SGAI.E �jGAL.E It� CoO VP.TE 1.-1d"L3Z
o CVf�T6tL r P L-P•I•.I RE F S�E� GI✓
1 CERTIFY 'CHAT ?N6 1-oVt•�AT•to�1 SKowN ;. �
/1E.REa1.1 GOMFU- 6 WITN-THE S I D�Llt�l rc OT +d.
AWP SL-re ►GK fL6QO%9- 6N'f>
TOWN oF'1�a1zI�5TaPjL.(� AMID IS tJnr I.aIJb 60VO:C : 35S¢Qj i
LOGP.TED MITHI "rµE F OOp LAIN
DAT E.Z. . gp,XTE 2 e N Y E I Vic.
$LEG I S'T f�Q6U LAN 5 u tZ.Y E`(oes
TulS PL &KI Ifi Norr Bt�SE� pld A.N os'rEtZV►L.LJr - MA5$•
IN5-1->R.uMEN�' SuevGY -rHE OFFSETS Suou�
NoT t3� v>C.C>'CO OCTrc�-MINC �C." ulM��i aPPL1CA►-1T'
T-B 3/4' 8'-3 3/4- 7-5 3/4' 2'-6 3 4'DROPPED P.T.GIR ® (/,�V - ERT
� - - - - - -
. _ n
l
- —
gars K mr s
-e 3♦ X10.T. 6'0 C.
dS3 I Y� VA�
� sm
' 304M
DROPPED L WM.ERTARCIRTECMS
P.T.GIRT X1 P-1
LEI GER TIM ERL E
T W 2 O BO OF
MB F S S ER
7GSTTNG/PROPOSED CONDi'I'IONS
FOR
/ 4Iq _470
DENNIS&BARBARA
STACK
OUTLINE OF DECK ABOVE—;
TO BE REMOVED %% 69 VALLEY BROOK ROAD
CENTERVILLE,MA
vVWX
SPACES
OPENING //// ;// /.•/ / �� .
WALL LOCATION TO BE
DETERMINED
/ NTRAC7�RU.;. •CARE ' /// '
iOF�E WUC iF00 //, art PER111TTNGG OR TmN "ONN
EXI NG CO C. B / /,,. /J j /,. P11RPo5E5 uNLE55 scu1vm R 9CNm
FO ND ON B W / ,/ /: / / / / sow e"xo°sw"Ttm0O0O0:�ua—¢n
S T—w-mNsmurnw scr•.
NPINI AS // /''.
Op1OF 1NE IBBAS�CARRANGO1Q1T5,DE9(,1,S.NID
" / // ., / / // // // T'A nmElms M o O rA�aTM mEaEaRo n
�P[x�
/ PUNS 1lRIKATm THEREON OR RER63N1E0
,% BE uM By MY NF]LSON,FIRM.OR CORPoR Ym
Fa+un RUEwasE.ExarT ON s,Eoxlc ranw
OF mE cvaE EnT uxoOTECTs.
we
, / / /// / /%.• // j / / PROJECT p: 100510
`NEW 8"CMU FDN FOR NEW - -- / / / / ,-i,. / • /i / / i' __ ______ ______—_—__
FLOOR FRAMING / i / /`� / / �`/ i DATE ISSUED: 09.07.10
CONTRACTOR SHALL ADJUST / / /. / / /�� / ./ / ��/ / 'j / REVISIONS:
TOP OF NEW WALL TO ENSURE
THAT NEW FINISH FLOOR
//.• % ALIGNS W/EXISTING. � �- • - / / /. � /
/ CRAWL SPACE OUTLINE OF DECK ABOVE�E
.�
'/.% /% // / ! '/ ' /// i„/ //.%'•% `�% %/"/// /' •/ / _ PERMIT SET
PROGRESS SET
PRICING SET
EXISTING FOUNDATIONMRAMING PLAN DP PROGRESS SET
10"THICK FDN WALL
---------------- ci .
0
FULL UNFINISHED BASEMENT
CONC.SLAB ABOVE REGISTRATION
SCALE 1/4--1'-0-
-- -a-- --0-- -- o-------0------ - -----
302X10 DROPPED GIRT
0 1 2 4 EI
GARAGE SLAB UNLESS OTHERWISE NOTED.
SHEET NO.
d
FOUNDATION PLN
0
TOTAL NUMBER OF SHEETS
IN SET:
UP 4
THIS SHEET INVALID
EXISTING FDN UNLESS ACCOMPANIED BY
a A COMPLETE SET OF
WORKING DRAWINGS
fi
NO RAILINGS ERT
ARC
Amca=.]D.Dtl mmm.BIDI)TBiA
MAHOGANY DECKING w rim e%off s
MAY
ANT TO
30
s0
`NON W COMPARE ro ooec WDCO PRODUCTS)
fiddoe
DEci� -a
30-4 ea
A.3 WYACERTARCW ECISCQr
r -----------
e
-------------- -------
---------------•i- S nNG/PROPOSED CONDMONS
P
FOR.
HEAT PIECE I_ NEW WOOD
DENMS&BARBARA
p7
'gym.' .._......... FLOORING
EN ' STACK
cf _ _ F REMOVE EXISTING
. ... ___ .._.' DECK.SHOWN DASHED
3B•H ISLAND H i i 69 VALLEY BROOK ROAD
m
CENTERVILLE,MA
TABLE HEIGHT a /
c S._ I
I/2'
A.3
SHOWER ENLA E OPENING = ;
WR OUTDOOR IN EXISTN WALLAS SHOWN
D ft LPJING AREA
HANG IRO 'G NEW WOODTHESE FDRR vER�ilrrsm ON cTONS`RUUCTON
FLOORING i
BOARD ON OOR / PURPosEs UNLESS srAMPEO a SGNm
CLP / TN AN.W-.ANosTECTs
.f iUNDE G ///
BEAMS /,� „ ;� �/ / � STAMP AND BGNATLWE a u,wNm
BREEZEWAY /
iH0 LY/ u //� ! �, / As sErusr sET•a+-cwsmucnw str.
BINE � TO RAISE
SE THIS
W%HOR UP W SE mi OORINW // �. // // / �mlo ERT ARaOTEcrs,do THE oRAWNCS Arm
(SLATE FLOOR) 297 3/4•X9 1/2'LVL BEAM ABOVE N ;� f/ !�/ / / % / / � AND
P ANSSirmnA°ETETEo ARRANGEMENTS.DR�TED
l ..._ ID ..._.__. ...... .__.... - TNFAEBr.ARE DYNE➢BT AND REN—THE PROPERTY
REUSE OLD KITCHEN I FLATTENED ARCH OVER 1/2 WALL / ' ,.� / // / // / i - W ERT ARCHITECTS,do No PART THEREOF SHALL
do COUNTERTOP }I Ty-S' ; / ! / r¢Ummn En ANr Pinson.Foal.oR CORPORAnaN
/
FERMI PURPOSE.
Of 1.I RRY ERT AACMlEC1S INC.
�'IJE ALL / / FOR ANr wRPosE,ExcnT wTH"Eanc ATarTRI
,./
/UNVERE PORC
/ PROJECT#: 100510
S PS T GRADE
SEE SHEET /; / .y ,- - DATE ISSUED: 09.07.1 O
A.3 './ ! / / --_—
GUNROOM REVISIONS:
DECK
✓ �, 1/, _/ DEN REMOVE / / / /!•�'! •--_
NEW WOOD EXISTING
FLOORING CLOSET.AS L.�[T / �//
SHOWN
N/A
i — — -- —
/� PERMIT SET
PROGRESS SET
PROPOSED FLOOR PLAN o o BATH PRICING SET
-- PROGRESS SET
KITCHEN BEDROOM
Z
.. -
rc CLOSET
TYPICAL NOTES:
THE ARCHITECT SHALL NOT BE RESPONSIBLE FOR THE VERIFICATION OF
THE CONDITIDN OF ANY EASTING STRUCTURE.EQUIPMENT OR
APPLIANCE AS PART OF BASIC SERVICES UNLESS IT IS PART OF GARAGE
ARCHITECTS SCOPE STATED IN THE AGREEMENT AND VERIFICATION IS DN
MADE ONLY BY VISUAL OBSERVATION.IF THE ARCHITECTS DOCUMENTS
REGISTRATION
REQUIRE CHANGES DUE TO CONDITIONS NOT VISUALLY OBSERVABLE /
AT
BE TIMEADD OFNPREPARN�S.OF THESE DOCUMENTS,THE SERVICES /\.
STRUCNRAL ENGINEER OR ARCHITECT SHALL PERFORM FRAMING INSPECTION e
WHEN FRAMING IS COMPLETE AND PRIOR TO ENCLOSURE BY INTERIOR _ -""_"'\ SCALE:1/4-=1•-0'
WALL PLASTFA BOARO/iINISH.
CONTRACTOR SHALL SCHEDIRE AND PROTECT FROM WEATHER ALL
FASTING HOUSE COMPONENTS AND INTERIOR$DURING CONSTRUCTIW - —^ /� 1 4 B
AND CONSTRUCT TEMPORARY STRUCTIIRES/ENCLOSURES AS MAY BE BATH
NECESSARY TO INSURE SUCH PROTECTION. _________________
• � LIVING UNLESS OTHERw,SE NOTED.
CONTRAGRIR SHALL SITE INSPECT ALL FASTING VS PROPOSED I 1 BEDROOM
CONDITION$PPoOR TO ANp OUTING CONSTRUCTION AND NOTIFY ARGNTECT
OF ANY DESCREPANClES ANO/OR CHANCES THAT YAY BE ENCWNTFRED. I I I
SHEET NO.
CONTRACTOR SMALL CONSTR/UpgCT AND MAINTAIN TEMPORARY WALLS/ --•
SHORINTERIN ETC E1aSMAI XOUSE OTECT EXISTING HOUSE AND
STRUCNRAL I 1 CLOSET '
CONTRACTOR SHALL SITE INSPECT/VERIFY ALL EASTMG VS.PROPOSED I '
CONDITIONS PRIOR TO AND WRINGG CONSTRUCTION AND MANE ADJUSTMENTS FLOOR PLANS
HEW TO ENSURE COMPLIANCE W11H DESIGN PARAMETER$A$ 1 1
CL
WpRK PROGRE�, TOTAL NUMBER OF SHEETS
HATCHED AREAS INDICATE EXISTING CONDITIONS. - I I IN SET:
DASHED LINES INDICATED EXISTING CONDITIONS TO BE REMOVED/ALTERED.
AS USED IN THESE DOCUMENTS.'PROVIDE"MEANS"FURNISH AND INSTALL"
NNDiE AN NEM IS fTEFENRED TO d SINWLAR NUMBER IN THE CONTRACT THIS SHEET INVALID
DOCUMENTS,PROVIDE A$MANY SUCH NFL$AS ARE NECESSARY TO COMPLETE - EMSTING FLOOR PLlll,
1NE WORI( UNLESS ACCOMPANIED BY
A COMPLETE SET OF
WORKING DRAWINGS
A
A.3
ERT
............ --------- ARCHITECTS.,INC.
*a om#,%uw go
.......... .........................
YANOM"MMIM OWN
ft 00
4
.............. ...........
ie,l STING/PROPOSED CONDITIONS
FOR,
. ....................... ......
FV
............ ............ .... .. . ..... .... ..... ......... ..... ..... . .......... ...... ......... ......... DENNIS&BARBARA.. ......... .......... ..... .....
- STACK
L-jiLl----
STEPS TO GRADE
NEW WALLS TOJ PROPOSED FRONT ELEVATION 69 VALLEY BROOK ROAD
B A ENCLOSE LAUNDRY CENTERVILLE,MA
.3 .3 AREA,AS SHOWN
............-.......................................... .......... .........................................................
EXISTING OF 8
SKYLJ
twESE GUNS MZ NOT row u
u
`T 4210 .�T
T-20 lbL 1 !!�I D
# a
@Wl.ENT
r
-- —AC=TS ONMKN
—
r
FY3158 Of'FAT Y�Y ANY.M4
�NO.-PMNT.OMEPER
W SK�t1
OmNIMON PURPOFLjF1Em —=..CmWTIEN
L-NEW DECK NEW AZEK— PROJECT k. 100510
OUTDOOR SHOWER
INFILL GRADE TO
CREATE DECK WITH NEW WALLS TO DATE ISSUED: 09.07.10
ENCLOSE LAUNDRY ONLY 2 RISERS
PROPOSED REAR ELEVATION AREA,AS SHOWN REVISIONS:
...........................................................................................
PERMIT SET
PROGRESS SET
PRICING SET
PROGRESS SET
0 0
ooao
............ ....................... ............................................ ................... ....................................................................................-................................................ ............. .....
........... ..............
EXISTING FRONT ELEVATION REGISTRATION
............. .............................. ....................................
0 1 2 4 a
UNLESS 0 ERINSE NOTED.
SHEET NO.
ELEVATIONS
A.2
TOTAL NUMBER OF SHEETS
.......... IN SET:
4
THIS SHEET INVALID
THIS
ACCOMPANIED BY
EXISTING REAR ELEVATION A COMPLETE SET OF
WORKING DRAWINGS
ERT
TABLE 9. WALL OPENINGS-HEADERS IN LOADBEARING WALLS&NON-LOADBEARING WALLS ARCH T.t. S,INC.
REQUIREMENTS-AT-EACH.END OF,HEADER`1 .�p�p�y��•g®y�a
HEADER SPAN(FT.) MINIMUM HEADER NUMBER OF
TYPICAL WALL NOTE SIZE FULL-HEIGHT STUDS UPUFT(LB)LATERAL(LB.) "7 FA 04 UM A
ALIGN NEW FINISH
FLOOR%�EXISTING ,.:r - p=30
EXISTING ROOF FRAMIN - _; HOUSE FNISH FUR. HEADERS IN'LOADBEARING WALLS
2 2-2X4 + 277 132 Y��M MA��
-.._..., EXISTING ROOF _ ______ ___ __ _
TJ RIM JOIST \ ---�
4 2 2X4 2 554 264
www.EnTANaBTEctscou
G qp 5 2-2X4 3 693 330
x
2 tOP.T.®16'O.C. .,I/ ',' \•�
•, .%.. -
\ CEIUNG JOISTS - 6 2 2%6 3 631 396
may!
EXISTING WALL DBL 2X6 P.T. SILL 7 2-2X8 3 970 462
STING BEAMS '' '.('
8 2-2X12 3 1,108 528
SILL SEALER - -' STING/PROPOSED CONDITIONS `
9 3-2X70 3 1.247 594
GW8 Pf��S CM
BLOCK SUPPORT :,•-:a1_- VAPOR BARRIE\ 10 3-2X12 4 1.385 660 FOR:
PAD WALL BD.PAST BOLT�� �?` pOf _ 2 FOR NEW FLOOR JOISTS It 11 4-2X70 4 1,524 726
HEADS G� 20#5 REBARS,CONT. N
1/2'CARRIAGE BOLTS O K STD ALIGN NEW FINISH FLOOR m &AROUND ALL OPENINGS �� o `'HEADERS 1N NON-LOADBEARING WALLS AND.WINDOW SiLL PLATES+ DENNIS tXG BARBARA
16'O.C.STAGGER SPACED _ ,_, _ R-30 FIBERGLASS INSUL W/EXISTING HOUSE FLOOR 5/8'DIAM. 12'GAW.ANCHOR + 2 1-2X4(FLAT) + fio +32 STACK
3/4"COX SUBFLOOR BOLT®4'-0.O.C. 11 3 1-2X4(FLAT) 2 90 198
DBL LVL PROVIDE POSTING %,`E•,,NG•C IUNG JQyST5: PT JOISTS016'O.C. DAMPROOFING tt
®BOTH ENDSUM;! f, 'E ao'sscM'rs-aCac2soaro��t s tso% I� 4 1-2X4(FLAT) 2 120 264
r .:.c'c.
".. i`_____ ,• CMU BLOCK
_._-._..............._.__.__................_._ . b�7
_- ---------.---.---------...-.---..-.-.-.. �� EXISTING CONC.SLAB FOUNDATION - � 5 1-2X4(FLAT) 3 150 330 69 VALLEY BROOK ROAD
_ GRADE 6 1-2X6(FLAT) 3 '180 396
VAPOR BARRIER
WILL
1 LL NEED To DRILL - CENTERVILLE,
�1DETAIL®1"=1'-0'KITCHEN HEADER EXISYG CONC.FD ANCHOR BOLTS INTO 7 1-2X6 (FLAT) 3 210 462
- EXISTING CONC. FDN. 8 1-2X6 (FLAT) 3 240 528
SCALE:
9 2-2X6 (FLAT) 3 270 1 594
A-SECTION @ NEW LAUNDRY O SILL DETAIL @ SLAB 102-2X6(FLAW 4 •300 660
11 2-2X6 (FLAT) 4 330 726
SCALE: 1/4"=1' 12 2-2X6 (FLAT) 5 360 792
'FOR NON-LOADING BEARING WALLS AND WINDOW SILL PLATES,
2-2X4(FLAT)CAN BE SUBSTITUTED FOR 1-2X6(FLAT) - -
•TABLE TAKEN FROM- AMERICAN FOREST&PAPER ASSOCIATION
AMERICAN WOOD COUNCIL, NO
~� GUIDE TO WOOD CONSTRUCTION IN HIGH WIND AREAS,
NEW LVL THRU BOLTED TO EXISTING Sf.�S P-f�S < 110 MPH EXPOSURE B WIND ZONE, 7NESE MANS ANE NOT To BE usm
RIM JOIST W/1/2'DIAM. (LPf CR - ( TABLE 9. WALL OPENINGS-HEADERS IN LOADBEARING WALLS& M gMEsern G OR�s gON
BOGNED
LTS STAGGER SPACED S G SIDING(SEE ELVS.) ...w NON-LOADINGBEARING WALLS - WiN•r anaN,u ANaBTECTs
ST—AND SICNATUNE a uAw�m
•( •CONSTRYCTpI SET'.
®16"O.C. f.� ATTIC. 'WS "TYVEK"HOUSEWRAP ' AS—T SET ON
x+SS+NG 1/2-CDX PLYWOOD
EXISTING CEILING JOISTS �� mro ENT allomE IN.ra BNA•wcs ANB
..._..__....._........_.__ ..._...._._..._-_.._.__._...._. ._........._...._ ..._ 2X6®16'O.C. ALL v uaN:Aitn THM.ON
N" E "'EO��'. Mues
((REMOVE EXISTING R-19 FIBERGLASS INSUL Oi ERT Mhc"+'�M0 PART �OF a�AiLr
DECORATIVE COLLARTIES) �. BE UMM BY ANY MENSON.FINN.cN m OAAMON
6 MIL POLY VAPOR BARRIER 1. M� �—MTN"� CM
TABLE 2.GENERAL NAILING SCHEDULE
IGTCHEN DINING/LIVING EXISYG LNING vz GYP.BOARD JOINT DESCRIPTION' NUMBER OF NUMBER OF PROJECT I¢: 100510
COMMON NAILS 80X NAILS NAIL SPACING
`ROOF FRAMING DATE ISSUED: 09.07.10
BLOCKING TO RAFTER(TOE-NAILED) 2-8D 2-10D EACH END REVISIONS:
BOARD TO RAFTER(END-NAILED) 2-16D 3-16D EACH END
EXISTING FLOOR JOISTS EXISTING FLOOR JOISTS .: .
WALL FRAMING '. .'. .::...... .. .. ..: ..
CRAWL SPACE SAW CUT 36"WIDE TOP PLATES AT INTERSECTIONS(FACE-NAILED) 4-16D 5-16D AT JOINTS
OPENING FOR ACCESS - STUD TO STUD(FACE NAILED) 2-160 21 6D 24'O.C.
TO HEADER(FACE-NAILED)
TO EXISTING CRAWL SPACE HEADER16D 6D 16"O.C.ALONG EDGES
TYP. EXT.WALL DETAIL FLOOR FRAMING::, _
BASEMENT Lr scue I-�/Y•Y-B' JOIST TO SILL, TOP PLATE OR GIRDER(TOE-NAILED) 4-BD 4-+OD PER JOIST
BLOCKING TO JOIST((TOE-NAILED 2-8D 2-1 OD EACH END
BLOCKING TO SILLOR TOP PLA (TOE-NAILED) 3-16D 4-16D EACH BLOCK
LEDGER STRIP TO BEAM OR GIRDER(FACE-NAILED) 3-16D 4-16D EACH JOIST PERMIT SET
JOIST ON LEDGER TO BEAM (TOE-NAILED) 3-8D 3-10D PER JOIST
BAND JOIST TO JOIST(END-NAILED 3-16D 4-16D PER JOIST PROGRESS SET
TABLE 6. TOP PLATE SPLICE
BAND JOIST TO SILL OR TOP PLAT(TOE-NAILED) 2-16D 3-16D PER FOOT PRICING SET
.BUILDING.DIMENSION:OF WALL CONTAINING-TOP PLATE:SPUCE:(FT.). ROOF.SHEATHING. , I IPROGRESS SET
7��*�+ �+7�7 SPLICE LENGTH 12 16 20 24 28 32 36 40 50 60 70 80 WOOD STRUCTURAL PANELS
B-SECTION @ NEW ILL 1 CHG1V (�') NUMBEROF-i6D'COMMON NAILS PER.EACH:SIDE OF SPLICE RAFTERS OR TRUSSES SPACED UP TO 16"O.C. 8D IOD 6"EDGE/6"FIELD
RAFTERS OR TRUSSES SPACED OVER 16"O.C. 8D IOD 4"EDGE/4e FIELD
2 4 6 8 8 NP NP NP NP NO NP NP NP GABLE ENDWALL RAKE OR RAKE TRUSS W/O GABLE OVERHANG 8D 1OD 6"EDGE'/6"FIELD
SCALE: 1/4"-1'- GABLE ENO WALL RAKE OR RAKE TRUSS W/STRUCTURAL OUTLOOKERS 8D tOD fi"EDGE/6"FIELD
i8_9" 4 4 6 7 8 10 12 14 16 NP NP NP NP GABLE ENDWALL RAKE OR RAKE TRUSS W/LOOKOUT BLOCKS 8D +OD 4"EDGE/4 FIELD
FLATTENED 6 4 6 7 8 +0 12 14 16 20 24 NP NP CEILING.SHEATHING -
ARCH 8 4 6 7 8 10 12 14 16 20 24 28 32 GYPSUM WALLBOARD SO COOLERS - 7"EDGE/10"FIELD
NP= NOT PERMITTED
•TABLE TAKEN FROM: AMERICAN FOREST&PAPER ASSOCIATION WALL SHEATHING "
AMERICAN WOOD COUNCIL, 110
GUIDE TO WOOD CONSTRUCTION IN HIGH WIND AREAS, WOOD STRUCTURAL PANELS
REGISTRATION
110 MPH EXPOSURE B WIND ZONE,
TABLE 6. TOP PLATE SPLICE - STUDS SPACED UP TO 24"O.C. 8D 10D 6"EDGE/12'FIELD t
.....OPEN TO...:.........•
1/2" AND 25/32"FIBERBOARD PANELS 8D+ - 3"EDGE/6"FIELD
KITCHEN 1/2" GYPSUM WALLBOARD 5D COOLERS - 7"EDGE/10"FIELD SCALE 1/4"=1'-0'
BEYOND
^-.•.., TABLE 8. WALL CONNECTIONS FOR ENDWALL ASSEMBLIES FLOOR SHEATHING'S
_ O 1 2 4 e
-PAINTED WOOD STRUCTURAL PANELS
......' WD CAP a .. -WALL HEIGHT(F7) I ,
I UNLESS OTHERWISE NOTED.
'o UPLIFT 8 10 12 14 16. 18 20 Y OR LESS 8D tOD 6'EDGE /12 FIELD
TUD SPACING (Lg;)NOTE: PLATE-TO-STUD-NO.OF 16D'COMMON NAILS-'- (ENDNAILED GREATER THAN 1' 1OD 16D 6"EDGE /6"FIELD
SHEET NO.
CENTER ARCH ON -
NEW KITCHEN SINK 'CORROSION RESISTANT 11 GAGE ROOFING NAILS AND 16 GAGE.STAPLES ARE PERMITTED, CHECK IBC FOR ADDITIONAL REQUIREMENTS. SECTIONS
WINDOWS ;,� 16 O.0 169 2 2 2 2 2 2 2
24"O.0 2" 2 1 2 2 1 .3 13 3 4 NAILS- UNLESS OTHERWISE STATED, SIZES GIVEN FOR NAILS ARE COMMON WIRE SIZES. BOX AND PNEUMATIC NAILS OF EQUIVALENT E AILS OL NdTE
DIAMETER AND EQUAL OR GREATER LENGTH TO THE SPECIFIED COMMON NAILS MAY BE SUBSTITUTED UNLESS OTHERWISE PROHIBITED.
• TABLE TAKEN FROM- AMERICAN FOREST&PAPER ASSOCIATION
TOTAL NUMBER SHEETS
AMERICAN WOOD COUNCIL, 110 •TABLE TAKEN FROM: AMERICAN FOREST&PAPER ASSOCIATION AMERICAN WOOD COUNCIL, 110, IN SET::
-C NEW ARCH 3-6" 1-6A/ GUIDE WOOD CONSTRUCTION IN HIGH WIND AREAS, GUIDE TO WOOD CONSTRUCTION IN HIGH WIND AREAS.110 MPH EXPOSURE B WIND ZONE,
110 MPH
EXPOSURE B WIND ZONE, TABLE 2. GENERAL NAILING SCHEDULE /rr}
IN EpT�7rE.77�7/� TABLE 8. WALL CONNECTIONS FOR ENDWALL ASSEMBLIES
LlVlNlG�l l lA REA THIS SHEET INVALID
t�i\� UNLESS ACCOMPANIED 8Y
_ A COMPLETE SET OF
SCALE: 1/2"=1'-O' -
WORKING DRAWINGS