Loading...
HomeMy WebLinkAbout0020 CAP'N SAMADRUS ROAD - Health 20 Cap'n Samadrus Road Cotuit P --— -- -- - - -- — — A _ 038 027 tf j TITLE 5 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL PART A ROMPED .D CERTIFICATION Property Address: 20 Cap-n-Samadrus Cotuit O C T 3 20 02 TOWN OF BARNSTABLE Owner's Name:_John Foley HEALTH DEPT. Owner's Address:_same Date of Inspection: 9/20/02 Name of Inspector: (please print)_Eric Stevens MAP Company Name: PARCEL : 2 Mailing Address: 20 Oriole In. - _Marstons mills LOT a ' Telephone Number:_508-776-9054 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: Passes Conditionally Passes. Needs Furth e Evaluation by the Local Approving Authority Fails ' Inspector's Signature: Date: 4 The system inspector shall submit a copy of this inspection report to Ithe 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. F Notes and Comments System passes title V inspection.recommend pumping now and every other year there after. ****This report only describes c Qntwns.at the time of inspecfioq and under tie condition§of use at that time.This inspection does not address how the system will perfoctn in tle future Wider the same or different conditigns.of use: " OFF14Q-1 L.,Il ISPECTION FO#M -NOT FOR VOLUNTW, MENTS �.; SUB U RFACE SEWAGE DISPOSALSYSTEM INSP ��` RM z - PART A CERTIFICATION(continued) Property Address: 20 Cap-n-Samadrus_Cotuit Owner: John Foley Date of Inspection: 9/20/02 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes.: X_ I have not found any information which indicates that any of the failure criteria described in 310 CM . 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: System is in very good condition. B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined" please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank'failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of, Compliance indicating that the tank is less than 20 years old is available. ND explain:- Observation of sewage backup or break out or high static water level in the distribution box due to - broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The- system will pass inspection if(with approval of the Board of Health):; broken pipe(s)are replaced . obstruction is removed ND explain: OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:_20 Cap-n-Samadrus Cotuit - f Owner: John Foley Date of Inspection:_9/20/02 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303 (1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ 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 cpli fprin bgocrja and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitraie nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis mast be attached to this form. 3. Other: OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 20 Cap-n-Samadrus Cotuit Owner: John Foley Date of Inspection:_9/20/02 D. System Failure Criteria applicable to all systems: , You must indicate"yes"or"no"to each of the following for all inspections: Yes No _x_ Backup of sewage into facility or system component due to overloaded or-clogged SAS or cesspool _x_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool _x_ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged . SAS or cesspool _x_ Liquid depth in cesspool is less than 6"below invert or available volume is less than '/s day flow _x ' Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe (s).Number of times pumped _x_ Any portion of the SAS,cesspool or privy is below high ground water elevation. _x_ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _ _x_ Any portion of a cesspool or privy'is within a Zone 1 of a public well. _x_ Any portion of a cesspool or privy is within 50 feet of a private water supply.well. _x_ 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:] nc (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as,described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility•with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either`yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of a surface drinking water supply _ the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or ' a mapped Zone H 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. OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ., PART B CHECKLIST Property Address: 20 Cap-n-Samadrus Cotuit , Owner:_John Foley Date of Inspection:_9/20/02 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes .No x _ Pumping information was provided by the owner,occupant,or Board of Health. _x Were any of the system components pumped out in the previous two weeks? _x — Has the system received normal flows in the previous two week period? t Have large volumes of water been introduced to the system recently or as part of this inspection? - _x " Were as built plans of the system obtained and examined?(If they were not available note as N/A) _x _ Was the facility of dwelling inspected for signs of sewage back up? _x _: Was the site inspected for signs of break out? I - Were all system components,excluding the SAS,located on site? x_ 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: Yes no x _ Existing information.For example,a plan at the Board of Health. _x_ 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)] I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 20 Cap-n-Samadrus Cotuit Owner:_John Foley Date of Inspection: 9/20/02 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 4_ Number of bedrooms(actual):_4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedro_oms):_440 Number of current residents: 2 Does residence have a garbage_grinder(yes or no): no_ Is laundry on a separate sewage system(yes or no): no_ [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use:(yes or no):yes_ Water meter readings,if available(last 2 years usage(gpd)): Sump pump(yes or no):_no_ Last date of occupancy:_every weekend COMMERCIALANDUSTRIAL 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: homeowner a 4 Was system pumped as part of'the inspection(yes or no):_no If yes,volume pumped:_gallons--How was quantity pumped determined? Reason for pumping: - TYPE OF SYSTEM _x_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,date installed(if known)and source of information: system was installed in August of 1979. Were sewage odors detected when arriving at the site(yes or no): nc OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 20 Cap-n-Samadrus Cotui� Owner: 'John Foley Lute of lnspection: 9/20/02 qv LAING SEWER(locate on site plan) Depth below grade:_18" Materials of construction: cast iron x 40 PVC_other(explain): A Distance from private water supply well or suction line: na Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: x (locate on site plan) Depth below grade:_24" Material of construction: x 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: 10'6"Lx5'8"'Wx5'7"H Sludge depth _5" Distance from top of sludge to bottom of outlet tee or baffle: , 22" Scum thickness:_1" Distance from top of scum to top of outlet tee or baffle:_8" Distance from bottom of scum to bottom of outlet tee or baffle: 15" How were dimensions determined: measured Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Tank,tees and baffle are all present and working correctly. GREASE TRAP:_na_(locate on site plan) Depth below grade: Material of construction:_concrete metal_fiberglass=polyethylene_other(explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): OFFICL.INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SU$SURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORtM PART C SYSTEM INFORMATION(continued) Property Address: 20 Cap- n-Samadrus Cotuit . P _ Owner: John Foley Date of Inspection: 9/20/02 TIGHT or HOLDING TANK:_na_(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: x (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): D-box is sound and in good working order PUMP CHAMBER:_na_(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.): I I I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:_20 Cap-n-Samadrus .Coti it Owner: John Foley ` Date of Inspection: 9120/02, SOIL ABSORPTION SYSTEM(SAS):_x_(locate on site plan,excavation not required) If SAS not located explain why: Type _x_leaching pits,number:._2 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.): both leach pits are working 6"liquid in pit 41 and 3"liquid in pit#2.No signs of staining above the 1"mark in either pit. CESSPOOLS:_na_(cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration- Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure;level of ponding,condition of vegetation, etc.): 4 PRIVY: na_(locate on site plan) Materials of construction: Dimensions: r Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc.): OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 20 Cap-n-Samadrus Cotuit Owner: John Foley Date of Inspection:_9/20/02 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmar s.Locate all wcllswithin 100 feet.Locate where public water supply enters the .building. ® il A,. Zsl JD 3Z- 16 3= 3® C. : `� y OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 20 Cap-n-Samadrus Cotuit Owner: John Foley Date of Inspection:_9/20/02 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to groundwater >12 feet Please indicate(check)all methods used to determine the high ground water elevation: x Obtained from system design plans on record-If checked,date of design plan reviewed:_6-26-79 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) _x Accessed USGS database-explain: on internet You must describe how you established the high ground water elevation: USGS database and original plans. ,L c, T o %1 LO CAT I" J� � SEWAGE PERMIT NO. Q T Sa-vk&J P Q VILLAGE INSTALLER'S NAME i ADDRESS Y C BUILDER OR OWNER 3 DATE PERMIT ISSUED. � 7 DATE COMPLIANCE ~:SS_UED _. � �I �o- v\� o . O , �� �� i , �6 � y- 35 � o ��� No......................... FRz... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ------- ............T­ '"'........OF........ Appliration for, Uispwial Works Tonstrurtion ramit Application is hereby made for a Permit to, Construct or Repair an Individual Sewage Disposal System at: '? .... ..16-1�................................................................................................. zo V=*7 Loca�i -Address Lot I iebsr Owner , Address .V C. 1177...................................... ......... ......................................... Installer Address Type of Building Size Lot..._ ...Sq. feet Dwelling—No. of Bedrooms........._..A........................Expansion Attic Garbage Grinder ( PL4 Other—Type of Building ............................ No. of persons............................ Showers Cafeteria ( Other fixtures ... ----------------------------------------*-------------------------------*................................. ------------------------ '5 15�............ ..gallons per person per day. Total daily flow.__........._ 410................gallons. Design Flow...............L L #* .......... 04 Septic Tank Liquid capacity/2$.&-.gallons Length................ Width.._.._...._..... Diameter......_.._...... Depth................ Disposal Trench—No..................... Width.....r............... Total Length------- :;;7-... Total leaching area....................sq. ft. 4 - Seepage Pit No.......2—------- Diameter....16.......... Depth below inlet.....'W.......... Total leaching area...Z,5�....sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed.by......................**.................................................. Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit..........._......._ Depth to ground water..._.................... (T,, Test Pit No. 2................minutes per inch Depth of Test Pit..............._.... Depth to ground water...................._... P4 ...... . ...... .................................................... 0 Description of Soil................ ....... ....................................................................................... W - ...................................................... M ­ --' ---------------------------------------------- -----------------------------------------------------*---------------------------------------- . ....................... ...... . ....................................................................................................................................................................... U 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'L'LTL, - 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signe ..... .......................................... ................................ 'Date Application Approved By........./ ................ ... Date Application Disapproved for the following reasons:................................................................................................................ .............................................................................................................................................. ... ------------- p - Z.,Date PermitNo......................................................... IssuedL.......(j--------------------- ............. Date ZO NO......................... w It im ................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .............. ..._....... OF........; ;.•• ....................... ................_.._....._. h ,Appliralwi n for Disposal Works Tomitrnr#inn Vnmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at ... ... "? ..Aeziwary �--------------------------- 'a ...................................................... Lo` Address ? a/ f / or Lot No} ... � 4"O¢f__?'� /... ?5 r?19f..6�J�lk! f!_lYa+iZ?EQ..._....... ...(.E.rtfr.'��ig.. ? .� ..� .:..... Owne; Address `.................................... � Installer Addressf.. -•-----•-•............................... U Type of Building Size Lot.... ...Sq. feet �.� Dwelling—No. of Bedrooms............" ........................Expansion Attic. ( ) Garbage Grinder ( ) a'4 Other—T e of Building No. of persons............................ Showers YP g ---------------------------- P ( ) — Cafeteria ( ) Other fixtures , ........ ...--------- ----- W Design Flow.............. -- ..._......._.____gallons per person per day. Total daily flow..............'i..`! ' ............_____gallons. WSeptic Tank—Liquid'capacitj 4-..gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length............ ... Total leaching area....................sq. ft. Seepage Pit No...... ......... Diameter...f 0...__..._. Depth below inlet......&.......... Total leaching area...e���..sq. ft. +C"03 Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by-•-------------------------•--------...._. ..... Date----------- •-----•---:---•-•---------- � Test Pit No. I................ininutes per inch Depth of Test Pit.................... Depth to ground water........................ fst Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ pa' -^-- - .f .. ''�' ................................................... 0 Description of Soil...............MgE6....... fad l 1.T..ZA_D...t- •----•-• -•_•-- --••••-•---...-•-••-•........••----•----••-•---•----•-•--•-. , V ................. :-----••----•-•---•----••--•............. W U 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 TIT`E 5 of'the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Sign `.'.___.., +:....... Application Approved B / Yr✓ .y ,Date ' , •z �r�r �• Date- - I Application Disapproved for the following reasons----------------------------------•--------------------------••--------- .....................Da.t e..---......._ ......................................................-.................................................................................................................................................. Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS Y�- BOARD O HEALTHY .. jf-•"�'•�........OF........ rt�� ...':.......... ��e✓,d:'a 1rK Tn#ifira a of f omplianre _ THIS IS T CERTIFY, That the Individual Sewage Disposal System constructed (� or Repaired ( ) by......::. � ... ---------------•---•-... _.....-._.. i D Install has been installed in actor ance with the provisions of TI 5 T e State Sanitary Code as described in the application for Disposal Works Construction Permit No.. ..__1� ___ f� _'.________ dated__v_"..% .�t _' '______________ THE ISSUANCE OF THIS CERTIFICATE- SMALL NOT BE CONS UED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY.. r DATE...........�C".`. j `�.............. ............. Inspector_......... -_..... _... THE COMMONWEALTH OF MASSACHUSETTS: 7Q BOARD O HEALT � j:: � ...........OF..... Q!' '.. !....... ; rk-. .. .. ..:. No......... ..... FEE....-•--=...--.......... 'Disposal orkV onstrndinn ernti# Permission is ereby granted.` ..••--... . .......::.... ................. .... ........................................................ to Const ct O.L � . ) Ind vu..al . . --•--Se vc� > o lS+ ysf at No.. � -•�'fd y - re@r r .�.I f -as shown on the application for Disposal Works Construction Per., No... 6_1....._Z ated. 1 � `..�-1.---.----. ---------------- a ;? _ r .a �:_,7� Board of Health DATE. ` ......................................... Ir FORM 1255 HOBBS & WARREN, INC., PUBLISHERS o - , N U C AeBAc.F-- t � 0A o L•7-t Low s 1 to A Q- : Q G.P.D• s EPn G T AN tL - 440 t l5U •�(, Ls�GG G t�D tilsPosa.L PiT S v;F 2- 4lA-46� — _ �.Sr tp �51T>E1.VALL_ AP-GA = -Z,S'b SF r" z IGO nv xz,s G!v taz5 GPI 1"z s c,�qt l;�;,�,� 1 `loegp BoTToAA AlZeA = ►b f& `7 P'f• 'ft�►dK-- l _ 15Z c71: K { .0 LID -., 154. GPI to` `l 10 To-rAL pES�GN { "lam t G i� Z''' PQG�• 2-tr1:-�c� � _tY_>l A%L PEZGVLAT 1o►.J �,TC 1, 1 u 4 0CIO .o. [2 1 'J 'i AD 'SST1GV� U►JS V+fi ToP F�.ro too. AIZ ,�..r lk 4"A, s© 4 11J�t 01�•5 �f PE Z 1NV• ,•� GLA/17 �PC lYN CtAL• ,# i t ► DlST r7s f1G r' Gu0 TLb 1Uv. qGg GAL. P1 T }'Q 314 WAilJ D 2 • C V-=2-T 1 F 1r.D pQo Fr tom- LocA.T-1O6.J HA 16 �Jo SSA SGAt..6 ` ++` GD V AT rr-- . 1 WA re- t GER'TiF`( TµAT Ta4E. ti 4 2Eo►J GoMP+-Y S w1TH T"e- SMF-L1 AWD SETBACK Q�U1eEMEuTri OF TWe Tow-/ .c of D L1TE. - � t.n-�..+'-l�.d" �- � 8 A X T E 2 �, �►`i E 1�.•1C.- ___� TZGLtSTG- QEo LA 4r> COevEyoery T64K 'PL&W 14 "OT l5A5ETD OW AU t"4TZ)ME-►tT OSTE2VI LLB AA LC.,S• 5uZva( 4 T"& o5=F5G-T; 5"OULI> UOT SL USFJj APP�-4GAuIr ©A IN1/SaoO 7�00 PM V � , _______________________________ u &Aj All, r D h � Sk y Z rn jq jig Z ,1 s D Z n I „ e-0• s•-n la.. .x .�' d•-la le• r<ve• ------ N a , : •.,. , , I i g _____ ______ ___________ ___ _ _ ________ _ _____ • k, , ' A r s'e x IT • c 5 I� �afq v I• - ----------- SW yyII � ----------------------- ---------------- ----------- gig � to- ---------------------------------------------- .. -- O Fit 3' � y I _ _____________ i . r 20'-3 1/4• 14'.D 1/2'M• II'-0 I/4'./- m d 155(W FOR FMMIT 8 g ADDITIONS d ALTERATION5 TO THE actfTechneeocelee,k.vmoq E'OLE,r RESIDENCE e)w-4r°°"°'the e. of ARCH—TECH A550CIATE5 tiro'A•chitectural h'brlm 20 CAPTAIN 5AMADRU5 RD. Lepfynl ptele<lbn Acl of o ,qqo. e„mod,• �rrcFil'tactural daslgr�, inc u GOIlJIT, MASSAGHUSETTS ,ePr *.tbo daelrEutbn of y mesa P&".0 ut the OVI.. g�1 lltleh 1-1,1 W llhl-lh 0 ecFtool etreee Oel-606-420-6386 FOUNDATION/BASEMENT PLAN A—latro.bx.1. """ ooeuft,tnw oz6PSB flax-�o8-4zo-6SO4"mN of that mt. ID•-R I/J• .-0. „yam 12•-0• IY-9 1/1' I-w• s� ed n � �s C,in it 4 Ro.2'-v W x r I - b 34 a+r 3 r ---------ceo-ire use....' o ' Q -1 'r--0emy'xTH Q "�,�x 70 U[7 ; . 24 SW x r Yi 9/D• pI� + r 70 CAM R w.T-0rw•% ffi lP S u U m 2w; 3 A m 24]2 b D "°;,-0 % a A Rw.rbw•x � Z '•b' 2-0 9-D r ' I n ceaseLlE $ 7 m2432 2 R.w.7b w•x q 34'w• ------ J m 24a2\ r I _ I e w MU I + - ci,�o dFiaiRe r ------------ r , - Q. r r __5p_ �/Itbg1 GG �gj "..2'-V W x, MO..2'- •x U r , I , _ I Z , r 9 VD• _.'., z w r'O'omNe. w r�"o ve x Z ee�_______________ ___________ 24 W -. m.7-i o � R0.7-low•x Y�12• V I r I ' rl r 1 11 Comm"W& OW 2027 p _ �; Z Rw.7-10w'x -Rw.X10w'% "--------------- '�---------------- --- --- VZA 2.4 7/8 nl m.. -------- m2M ... RO 7.10 w•X ------ ------ 's'-/7AY OM ow y 1 ..................... ai!'� cat spy @ R01w'S�17 Rw,MY % I� Ili ;�5S001 ,`uS8# , V.wd I'�7/e• 2112 Ro.22110 wx tl I • I, r rr I : r i n kF 7 r L�Z7 > n r ---------------------- r _ J J O ° .................r.__.. j e e k _ � 2 e a•--RN4.OO/N S Q o I/2' 6'-4 1/4' T-0 1/4-N• N- r 34•-S 3/4'N- rn z d JSaW FOR PMMrc . c a ADDITIONS d ALTERATIONS TO THE MN-TKO AetmWft.ft.herept „ > ! COLEY iZE51DENGE e�we.ey.eaVeetk epgyl AiZCHI-TECH ASSOCIATES of else o-wMg,occwemq to the'A,Hit.,hrd 1.lorke 20 CAPTAIN 5AMADRUS �RD. -Wt Prete.tta AW or ° n 1 GOTUIT, MASSACHUSETTS q4p `""'"°}a""'�°^• arc t-�Itactu ra 1 - as tg r�, i n c_ L V U r��uorl or ehlrwurn or th—pL—HfthMA the e7{2r'eee A .rrteeo 60—t or:01-Teah 6 school ee ebroet tnl-60A-420-53'3B FIRST FLOOR PLAN w9ea12t .Inc,b s^ye- nnt a the at. cobult.1•na 02655 fax-508-420-M504 0200M 5,06 PM > rn 0 O Z ' r , O A Zf . r D z a`D p '` 1 4e t!e• f i i i :r� i i i i i f r rn O rn z d ISSUED FOR FE"T r i R E P 8 ADDITIONS IE ALTERATION5 TO THE A c aTe n Aeexwtee."e.ne ebg EOLE`r RESIDENCE eof th yfr.4Np`,ordMq"o ARCH[-TECH A5 0C1ATE5 of u�eee a��.-.1 H-to u � �• •• �• •� �• the'ArehNectvrpl Worke j Z g 20 CAPTAIN SAMADRUS RD. r R=teGtb^A-of jotqqOrc h Ite�et u rsi 1 d az�I g n, i n c_ G ° lw GOTUIT, MASSAGHUSETTS -p a,., ca dWrWN of tf pwe mMmA the exprM rtlen crx�sent of Aral-Teen 6 acFloot Eltf`O?C tei-60a-420-6386 5EWND FLOOR PLAN AD I -."C'b- caoutt;.me*02OZ5 fax-13015-420-5304 meM of that pal. HA?/gyp?!4,04 M m m = T m < a a _ m m -- D ----------------- r--r- ---------------- a 3 IS%D FOR PERMIT HctFTccn Axoti0lee,hc.hr� t� g d g a E @ ADDITIONS a ALTERATIONS TO THE e.pewtyre6eve,Necapyk� ARCH-TECH ASSOCIATES of fosse arawhge«car�^9lo FOLE ,r RESTDENCAE A i'140. Ny copg aNerdwn. a eprocOclbn a ceetrt�ulbn of o � � m 20 CAPTAIN SAMADRUS RD. ftlen corroent of Mchl-Tech cl t"G i'7 I"i✓GGfi U 1"el i d O S i g Yl� 1 MI G. GOTUIT, MASSAGHU5E'TTS �� "�qe 1) ent oP thot—t..K errors,omisbto or 1; ea•oi�be�txw�Tnt to t°a'i+e 6 sohool mtroert oel-508-420-5335 al erUoa of/rcnFTecn Aaex•' EXTERIOR ELEVATION aa.prbr to xq Mq—k. cooutt,met o2055 fox—BOB-420-5304 vimeroam,are[o bE wxa ao roe stole argwln �54 P" 8F SER 4 N \ � G i m r o m om r m o ° f--------.---- z D --------------- 13 HEffl I IN ------------- --------------- Q a-0• - ! 6 1 i Y ISSUED FOR FfRKT IrcRT.h bleq VG.weDY . a ADDITIONS a ALTERATIONS TO THE� ARCH[-TECH A550ClATE5 ` ` a EOLE'Y RESIDENCE t"°"�`R `" a a _ .. .. - - � ra,r,ONcrdbn, eprodclbn or obtrbutbn Z L 20 CAPTAIN SAMADRUS RD. PotK� u hitectur2l d�s�ign, inc_ ° r GOTUIT, MA55AGHUSETT!5 ^�•is `j' U TanC OP CMOt OGC.Ary errors.omisMons or rne- c��resspowiee on tteee araw- 6 maiTool obt'eet tel-308-420-5335 EXTERIOR ELEVATION T. oh�F�o��tte�wa. eoouro.ma 02035 Patx-e095-4-20-M50.4 Dimergbre are ao not 6GOIE GrOsnn ,m2A=Sae PM s FP e N m In n e•-,r D m u T ew• VE e n D m T-0 yr a at ZIt .d`. o,a t1 • O of °h 8 9 k. 2 c uv Y h r gq�� a cn Yyp1 D e.•p. 7 m T-0VY 8 i r ^ M• 3 , --- - nq $ ^ a Y • {{1n' � o ' Sa"", 104' e'-n• r-0 va, I F-0' oil IUD FOR FERM{T h'LIF7exh Aewcdee K.hd R rs ADDITIONS a ALTERATIONS TO THE s.p esey reserve-tle A IZ C H I-TECH A`J�JOC l ATE s 5 i r or flees aonge«card o a i POLEY RE51 DENCE .. Prdeclbn Act'or i�MO. My copy aMcrdbn. � .. .. .. .. eproacton a arotrbNbn M 20 CAPTAIN 5AMADRU5 RP. „Ma o A $ GOTUIT, 1A55RGHU5ETT5 m r,t w t`•ea r��e ent of that act./+ny u errors.omleeI—ar z crepowbe on thee-arm+- 6 sol'rool Att'eeTC tOl-av08-4'LO-5S36 �e g1q,1 be bravest to the FRAMING SECTIONS Act, orattob�e rnorw mrT. aoaum.ms 02055 4wx-BOB-420-3304 Dimerobrro ere o ve-a •.e o rot scale ora.av� s. - .. . i i .. 02J=3 7:0e rM 1 a. 0 0 r s Z r —fir Z rn> 2XI00IV 2x 10/II'Ot. 4-4 • II. y ill I i --------- — s --------------------------- 1 ",t 0 2X I0/I6'Ot. Ir 7xto EV Ot. I I d l f.T.l X 1/6'Ot. I y LLLLLL c . l X" I lllll II \ � I I W : P.T.2X10E/'Ot. ' I i I I I 0 6 • y � n u u l 8 8 i P.T.2 X 1 TAPM AS Rt2/FOR RW h - d-- — —--- i --- ---I I-T. ---- --- --------- - L---L---L---L- E ISSUED FOR PERMIT ADDITIONS d ALTERATIONS TO THE AW-TeNAe�ocM[e.tr.nee0g EOLEY RESIDENCE "p ""'"°`""`""°p'� ARCHI—TECH A554CIATE5 .. Pt Ineee tro�Kp xcwc•g to the'A,cnttect r l Nork• 20 CAPTAIN 5AMADRUS RD. C,.Wl nt AW f PraKtb^ t L $ �o t a� �rchlGactur�l da�tgri, iris. y ° GOTUIT, MASSAGHUSETTS —p-dK'I,,,`a°alirc i-a v th�p �R'o ft'Ay1" 6 scFtool mtroet tet-608-420-G'S36 .rrtten concert of Arcnl-Teen FIRST FLOOR FRAMING PLAN •�au�oiemFk.ge oOtum.ma o2638 fox-508-420-t3304 „F{. t t IIA212W3!h06 F" • A 0 I -______-_--_; • z 3X 10r 16'04. ------------- 2 x lO r 16.O.G. � •, O u rr N -------- t. -tt I 2 X 10.16-04. , 3 I ---------------------- z °I 2X 10.16 0.0. r 2X100 WOZ.�� f._____________________ ,- ii ______________________. . ii i� �i - �� r(U I.TS'X 923' th i---t---i---I---1---t---i---t---I- . I T---1--j- a� 1 d I I i i I I I I f I I I •I I j_ i - I Ic le l I I I I I I I I I I I sl I I' ..--------•----------- ---------------------- I I I I I I I I I I I I I I I Tl r r I ~ I� to S=]C r-_= NU5•x 1.! LVL_]]C__C-- - IV 1.-5'X Ta'LVL -----' I -2%8•ID'Or,. r r ----------------------- N 0 0 U % N 6 t> h h I I I I , r ICSRW FOR PERMIT ! S s c a ADDITIONS d ALTERATIONS TO THE T y A ��" $ EOLEY RESIDENCE e,theeelwhy0ccw-r>gl0 ARCH[-TECH A550CIATE5 •' the'ArcNilrcturOi PlOrka 20 CAPTAIN 5AMADRU5 RD. Gq�rkpt PAOtecti-Act'of a rc t l itactu ra i d as t n, i n c. GOTUIT, MASSAGHUSETTS I`"o. Ag. alt<.atwn , 9 vej y ep o4 cl on w abt,&AF of mete pl"NRhDA the exprm wRleh&Or—t Of Archl-Tech 6 school mt lrvCt •tel-608-420-5386 SECOND FLOOR FRAMING PLAN #'deptlat"o 1i1rh9e- ooct,ro,ma 02�5 r.K-50a-.420-5aO4 A - --------- O41 ! 9� k 1= 2 lO RA%N241 ID'OL. _ ' ___ ii2%10 RAFTERS1 lb-of- - •: 3 --------------- j //Z a cn ° 2 K u 09 OQA6I -- - , E-- --- --- ---= z & O 2 X 10 RAFTM0 ID'OL. ' r 2%10 RInm0 ID'OL. n _ii I, is •, ,: ____________ t .. _ /1��1VV��'•ppt{ b .AYTAE{ED FONJ,TfM, ,LIIE 5I p1. u 6 1 U T - 2XDIID'OL. « Ni N �•' N I yg b b 6 u • x g e u g ____________�; ii �g b b b 6 - f]r �I i"- A� i __ --------------------- U - -------------- -- --------------------- 2),a/16-Of, =CCr ' x ' • ti I U � 7 X/1 16'OL. _JQ12 a _ - 21 2 a J3: U � • � U x Q'• � x a 2)2 0 15%W FOR PERMIT @ a ADDITIONS I ALTERATIONS TO THE AIc1,FrechAx«mee.ft. A 1, ARCH—TECH A550CIATES F ` FOLE,r RESIDENCE "�"""r`°`q..�W kqt of thee¢d' actor to • � > � the'Arehite<hrol eke 20 CAPTAIN 5AMADRU5 RD. A.t or rc!-zt itactu r�1 cl a�i rt, COTU I T, MASSACHUSETTS ISO A v`°�'°"`r°"°' A y repr°Ort i-w"t,wt of Meet plena hRhM aye eV,e d W*teh cor-1 Of Archi-Tech 6 ec{•tool shrew? tal-508-420-5386 ROOF FRAMING PLAN A 14 .t W. ootuFt,ma 026'J5 flax-508-420-5304. M of ttk