HomeMy WebLinkAbout0061 MAIN STREET (COTUIT) - Health 61 Main Street
Cotuit
A= 009 014
TOWN OFBAMSTABLE
LC�ATION�
It6 11.1"n �� SEWAGE #
VD-LAGE ( �0 d ASSESSOR'S MAP & LOT oo PO
INSTALLER'S NAME&PHONE NO. A ,
SEPTICLA TANK CAPACITY !d �!�%/t9)Z i eI
I
LEACHING FACILITY: (type) (size)
NO.OF BEDROOMS 3'
BUILDER OR OWNER
J a o
PERMITDATE: �//,�'7/O COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 fe t o eaching fac ) Feet
Furnished by
' R
13
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U. (6LO 5
�C 3)3 y "7
M Log. �-
�
r
No. Fee z6o
THE COMMONWEALTH ACHUSETTS Entered in computer:
PUBLIC HEALTH;DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
Zipplicat OYC.,'for igpO!6Ar bpotem Cuff.5truction Permit
Application for a Permit to Construct:r• ) Repair O Upgrade jj Abandon O ❑ Complete System ❑Individual Components
Location Address or Lot No(,/ � ��-��%f Owner's l)ame,Address,and Tel.No.
Assessor's Map/Parcel L (� SQ_ �_
Installer's Name,Address,and Tel.No. � "SOO /'A` ^^'IVF Designer's Name,Address and Tel.No.
Cava e,y 46C 1441f�, e
7 /3576 C-eiql,
Type of Building:
Dwelling No.of Bedrooms �� Lot Size 7, / Q sq.ft. Garbage Grinder ( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) j Liq gpd Design flow provided L� gpd
Plan Date '_/ ZS4d 3-- Number of sheets i Revision Date
Title
Size of Septic Tank /3 Type of S.A.S. f%'2 e2
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) 41e,0
Date last inspected",,',
. :.,
Agreement:
r.
The undersigned'agrees to ensure the-construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been isgu this Board o ealth.
Signe Date yl a
Application Approved by ® Date
Application Disapproved by: r Date
for the following reasons
Permit No. Date Issued
...;.x•:•+d,, .d--..•r+t-- -*. ' y..:r..r¢gapMp. .. -.,.,•��,:.•{:wr r,.:.., /,....+,.•n-i.w "'F. i _ n - ,>. .
No. � uh-�m.:� r v l 4 Fee
THE COMMONWEALTH OF-MASSACHUSETTS Entered in computer:
f
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE MASSACHUSETTS Yes
ZIpprication for i oar *pgtemc Con5tructton Permit
Application for a Permit to Construct 7) Repair,(/) Upgrade Abandon O ❑ Complete System ❑Individual Components
Location Address or Lot N0,6/ /na1�? ,_Cp fvi Owner's ame/Address,and Tel.No.
Assessor's Map/Parcel
Installer's Name,Address,and Tel.No. 01,450" -S�V7 Designer's Name,Address and Tel.No.
<ln rcy I-ea Al f f1, e
Type of Building: a
r Dwelling No.of Bedrooms J Lot Size 7, / Q sq.ft. Garbage Grinder ( )
Other Type of Building No.of Persons 2 Showers( ) Cafeteria( )
Other Fixtures � 1 I iJ
Design Flow(min.required) 3 /nf gpd Design flow provided •�g~/r� il f ~?n/ j 1N11, -
i f lgpd I�' f
Plan Date Z�w �— Number of sheets �' Revision Date i
' Title a�
Size of Septic Tank /.7 a0 Type of S.A.S.; `i"P r . /.2 )J,;).S"
Description of Soil
`Nature of Repairs or Alterations(Answer when applicable) ,(J��✓ ' �� /�/�.
. i `= Date`last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Com }r pliance has been issu this Board of Health.
°A Signe` . -'e"/' �v� 11� n Date L� Zp? d
06
Application Approved b
pP PP Y s �lif/l D. / �, �� Date
Application Disapproved by: i i f Date
for the following reasons _
Permit No. Date Issued r
——— ————=l ———— ——————————————
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
.Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded (. )
Abandoned( )by ��S�/l'� _ Shc r zC.__ -
at `o / G. has been constructed in qccordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. '' � dated
Installer Designer �,S C.
#bedrooms J� Approved design flow , q gpd
The issuance of this t shall not be construe/as a guarantee that.the system will funfction as desig/n�d.
Date �. 014,917 / 1 ! Inspector
-----------_— --T-- ------ --——---------j
No. L90 Fee
' THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS {
w.igpogal *p�tem Congtruction ertnit
Permission is hereby granted to Construct ( ) Repair ) Upgrade ( ) Abandon
System located at / ��, n .�-/. C✓ '--f z,,,.,,,,
i
y�
and as described in the above'Appl-cation for Disposal System Construction Permit.The applicant recognizes his/her duty
I to comply with Title 5 and the follawing local provisions or special conditions. y
Provided: Cons t ctio ust b completed_w e o ithin three years of the date this :'
. ,,. p r/
Date Approved by )
JUN-2e-2007 22:43 FROM: TO:15oe77ee966 P.2
Town of Barnstable
Regulatory Services
Thomas F. Geiler,Director
• Beansrnar.E, e
M" Public Health Division
tb39'
+ � Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Installer&Designer Certification Form
Date: 7 e 7 Sewage Permit# 7 -"Assessor's MaplParcel 9 l�/
Designer: _A �ia�0�, ,, Installer: J_&5 0 Y? _SG(/ZIq
—T
Address: Address: P 7 C.aUAT1�t W
IV, `l a�t�'�oy1� �1/l�d Zd 7
On /-//cZ7/6 --�CSSyJ �. 2a�/Z c,Q was issued a permit to install a
(date) �`� (installer)
septic system at `a. 6—ftlf`�'" based on a design drawn by
(address)
,g N
S C dated
(designer) '
c
I certify that the septic system referenced above was installed substantiallvaccordi t ,to
the design, which may include minor approved changes such as lateral relocation o the
distribution box and/or septic tank. Stripout (if required) was inspected-''d the soils .
were found satisfactory.
co
I certify that the septic system referenced above was installed with major c anges Fie. M
greater than 10' lateral relocation of the SAS or any vertical relocation of any omponent
of the septic system)but in accordance with State &Local Regulations. Plan revision or
certified as-built by designer to follow. Stripout(if required)was inspected and the soils
were found satisfactory. H OFMAR
�► �oy
(Installers Signature) DIR DivIL �
No.45937
,9,
�SS�ONAL ECG
LL (Designer's ignature) (Affix Design tamp Here)
PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE
OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-
BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.
THANK YOU.
Q:1Septic\Designer Certification Form Rev 03-09-06.doc
TOWN OF BARNSTABLE
- ATION SEWAGE # -
:JLLAGE ASSE OR'S MAPS& LOTV�I O/
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) 0 size)
NO.OF BEDROOMS_
WNER w `'����-,DOCLL
PERMITDATE: IC09OMPLIANCE DATE:
Separation Distance Between the: 1%ip
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist.
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility (If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
TOWN OF BARNSTABLE,
L'A'ATION SEWAGE #
VILLAGE �� T ASSESSOR'S MAP & LOT
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type)/ � (size)
NO.OF BEDROOMS
BUILDER OR OWNER \,berod&
PERMITDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Le 'ng Facility(If any wetlands exist
within 300 fef le ky) Feet
Furnished b e o '
s
r �
a e
ti
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SENDER:�CWPLETETHIS • . . . DEL IVERY
■ Complete items 1,2,and 3.Also complete A. Si atu
item 4 if Restricted Delivery is desired. X ^ ' ❑Agenn.
® Print your name and address on the reverse v V ee
so that we can return the card to you. B. Received by(Printed Name) Date of Delivery
s Attach this card to the back of the mailpiece,
or on the front if space permits.
D. Is delivery address different from item 1? ❑Yes
r-
1 Article Addressed to: If YES,enter delivery address below: ❑No
.� .. 025�5
Mr&;Mrs Edward Wysocki
61 Main Street. Servi`
J
Cotuit,'MA 02635 `� E3 'YP Mall O Express Mail
'"'❑ i ered ❑Return Receipt for Merchandise
y--O=Insured Mail ❑C.O.D.
4. Restricted Delivery?(Extra Fee) O Yes
Z Article NOmber
(f'ranster from service labeo s 700 5' 1'1;6 `0 0 0 0
0191 3134
PS Form 3811,February 2004 Domestic Return Receipt
WK
UNITED STATE ep-
�• $��R7/iC,iE iv om;+ r r.• .."'+w.�w asu. -++�K
• Sender: Please print your name, address, and ZIP+4 in this box•
PUBLIC HEALTH DEPARTMENT r:
TOWN OF BARNSTABLE
200 MAIN STREET
HYANNIS, MA 02601
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o Certified mailing ip MaeProvides: y�Zooz aun d sd
asrana �ooes w,o
o A unique identifier for your mailpiece
n A record of delivery kept by the Postal Service for two years
Important Reminders:
o Certified Mail may ONLY be combined with First-Class Mail®or Priority Mail®.
o Certified Mail is notavailable for any class of international mail.
o NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For
valuables,please�g"onsider Insured or Registered Mail.
o For an additionaMee a Return Receipt maybe requested to provide proof of
delivery.To obtain Return Receipt service,please complete and attach a Return
Receipt(PS Form 3811)to the article and add applicable postage to cover the
fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for
a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is
required.
n For an additional fee, delivery may be restricted to the addressee or
addressee's authorized agent.Advise the clerk or mark the mailpiece with the
endorsement"Restricted Delivery".
o If a postmark on the Certified Mail receipt is desired,please present the arti-
cle at the post office for postmarking. If a postmark on the Certified Mail
receipt is not needed,detach and affix label with postage and mail.
IMPORTANT:Save this receipt and present it when making an inquiry.
Internet access to delivery information is not available on mail
addressed to APOs and FPOs.
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Cotuit,MA Massachusetts License#20237 r
1
1
Edward P. Wysocki
Electrician
ewyso@aol.com 508-428-9975
4� �� �
TO; Town of Barnstable >
Regulatory Services
Thomas F. Geiler, Director
Public Health Division J
Att;Thomas McKean,Director
200 Main Street,Hyannis,MA 02601 n
FR; Edward Wysocki ,l
U
61 Main Street
Cotuit, MA 02635
DT; April 6,2007
REF; Request of hearing to the Board of Health. -kr)
The atiached order to comply,has been noted. However,in order to comply with (�
the building permit procedure,it requires the applicant to start with"determine map and
parcel number and enter it on the application".
I started the procedure by hiring a Surveying and Engineering Service,BSC
G up,to determine the property characteristic and an architectural design company,
CHI-TECH, (Tim Luff)to design the proposed addition.
I have received a plot plan to determine the placement of the new septic system
but I have not received any prints at this time to determine the location of the addition,
and where the new plumbing will be placed. So,I hope to have the architect prints soon
and I will hire a septic system company when I know where the added plumbing will be
installed.
The existing septic system has failed,however,there is no leakage,odor or
surface issues. I will comply with any decision the board will make but I would like to
have some extra time to receive the architectural prints.
Please notify me of your decision.
Thank you,
Edward Wysocki
s Thomas F.Geller,Director
�• ` Pubfc Health Division
Thomas McKean,Director
200 Maim Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
FINAL ORDER
April 4,2007
Mr<:Mrs Edward Wysocki
61 Main Street
Cotiut,Ma 02635
ORDER TO LOWLY WITH STATE EWIRONMENTAL CODE,TITHE 5
The septic system owned by you lomted at 61 Main Streets Cotuit, MA was last
inspected March P.2007,by Robert I.Bortolotti,a certified septic inspector for the
State of Massachusetts.
The inspection of your septic system showed that your system"Failed"under the
guidelines of 1995 TITLE 5(310 CMR 15.00)due to the following:
Leaching pit with cover to grade and top of pit 6"to grade and had 51"of liquid at
time of inspection.
The cesspool was pumped following inspection.
On September 2e,2006 you were ordered to bring the system into compliance;however
the System was not repaired as required. You are again ordered to repair the failed
system within the next 90 days.
Any person who shall fail to comply shall be fined not less.than$10.00 nor more
than $500.00. Each day's failure to comply with an order shall constitute a separate
violation.
You may request a hearing before the Board of Health,with a written petition
requesting a hearing on the matter,within seven(7)days after the day this order
was served.
If there are any questions about this reminder,please feel free to contact the Barnstable
Health Department.
`'-BARNSTABLE HEALTH DEPARTMENT
- 1
COMPLETE •N COMPLETE THIS SECTIONON DELIVERY
■ Complete items 1,-2,and 3.Also complete A. a re
item 4 if Restricted Delivery is desired. JZ3 Agent
■ Print your name and address on the reverse ddressee
so that we can return the card to you. B. Received by(Print d a c 19�t of , livery
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
D. Is delivery address diffe m item Ye�
1. Article Addressed to: If YES,enter delivery ad J b ❑N
3. Service Type
C� /�/ 14 oA 63 5 ❑Certified Mail ❑Express Mail
❑Registered ❑ Return Receipt for Merchandise
❑Insured Mail ❑C.O.D.
4. Restricted Delivery?(Extra Fee) ❑Yes
2. Article Number
(Transfer from service label)
PS Form 3811,February 2004 Domestic;Return Receipt 102595-02-M-1540
I
UNITED STATES POSTAL SERVICE First-_glass Mail
Postage&Fees Paid
USPS
PermplysNo.G-10
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I • Sender: Please print your name, address, qrd ZIP+44I5—this box •
I
PUBLIC HELATH DIVISION j
TOWN OF BARNSTABLE
200 MAINSTREET
HYANNIS, MASSACHUSSETS 02601. I
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Ciry State,
Certified Mail Provides:a A mailing receipt (asjanab wad
)ZOOZeun�'oose� sd
o A unique identifier for your mailpiece
a A record of delivery kept by the Postal Service for two years
Important Reminders:
m Certified Mail may ONLY be combined with First-Class Mail®or Priority Maile.
e Certified Mail is not available for any class of international mail.
o NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For
valuables,please consider Insured or Registered Mail.
e For an additional fee,a Return Receipt may be requested to provide proof of
delivery.To obtain Return Receipt service,please complete and attach a Return
Receipt(PS Form 3811)to the article and add applicable postage to cover the
fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for
required to return receipt,a USPSe postmark on your Certified Mail receipt is
e For an additional fee, delivery may be restricted to the addressee or
addressee's authorized agent.Advise the clerk or mark the mailpiece with the
endorsement"Restricted Delivery".
n If a postmark on the Certified Mail receipt is desired,please present the arti-
cle at the post office for postmarking. If a postmark on the Certified Mail
receipt is not needed,detach and affix label with postage and mail.
IMPORTANT:Save this receipt and present it when making an inquiry.
Internet access to delivery information is not available on mail
addressed to APOs and FPOs.
` Town of Barnstable
1p��
Regulatory Services
L � �
MUxxsras Thomas F. Geiler,Director
.�r Public Health Division
Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
September 26, 2006
Mr&Mrs.Edward Wysocki
61 Main Street
Cotuit,MA 02635
ORDER TO COMPLY WITH-STATE.ENVIRONMENTAL CODE,Title 5
The septic system owned by you located 61 Main Street, Cotuit,MA was last inspected
September September 7t'.2006 by Robert J. Bortolotti,a:certified septic inspector for the
State of Massachusetts..
The inspection of your septic system showed that your system"Failed"under the
guidelines of 1995 TITLE 5 (310 CMR 15.00) due to,the following:
.Leaching pit with cover to grade and top of pit 6"to grade and had 5'2" liquid at
time of inspection.
You have.90 days-from the date of the of the system failure to bring the system in to
compliance.
If there are any questions about this reminder,please feel free to contact the Barnstable
Health Department.
BARNSTABLE HEALTH D PARTIMENT
Thomas A. McKean,R.S., C.H.O.
Agent of the Board of Health
I
-� COMMONWEALTH OYMASSACHUSETTS
x EXECUTIVE OFFICE'OF ENVIRONMENTAL.AFFAT:RS.
y DEPARTMEIN-OF.ENVIRONMPNTAL`PROTECTION
TITLE 5
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY.ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: n
�4
Owner's Name: 7 �i�la�-i Ct�ySOC� n'
Owner's Address: I / �- 7 0�
Date ofinspection � �
_ - �l3
Name of Inspector. (p,ease*print ,4-�j. .p rtole) � a
Company Nam I
Mailing.Address:
Telephone Number: 1GO ;► ' �. C
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 in 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 inspectors pursuant to Section 15.340 of Title (3.40 C.MR 15.000). The system:
Passes
Conditionally Passes
Needs Further Evaluation by the Local Approving'Authority.
Fails ,
Inspector's Signature;. Date: T O�n
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health o"
DEP)within 30 days of completing this inspection'. If the system is.a shared system or has a desi'n flow of�l_0,000ta
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 applicablerand 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 611512000 page I
Page 2 of l 1 ,1..
•lJ
OFFICIAL-INSPECTION:FOR1lI-NOT I+OR VOLUNTARY ASSESSMENTS :
SUBSURFACE SEWAGE"DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 0
Owner:
Date of Inspection:
InspectionSummary: 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.in310:CMR
15.303 or in 310 CMIZ 15.304 exist. Any failure criteria.not evaluated are indicated below.
Comments:
B. System Conditionally Passes:
One or more system.components:as described in the"Conditional Pass" section need to be replaced or
repaired.The system, upon completion of the replacement or repair; as approved by the Board of Health; will pass.
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 taril: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 than20.years old is available.
ND explain:
Observation of sewage:backup or break out or high static water level in the,distributi.on 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.vear 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:
r
Paee" 3 of I
OFFICIAL INSPECTION FORM -:NOT FOR VOLUNTARY ASSESSMENTS
SUBS7JRF'ACE SlEWAGE.DISPOSAL; SYSTEM INSPECTION'FORM
PART A
CER.TIFICATIO ,(continued)
Property Address:
.Owner: �
Date of Inspection:
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 systein
is failing to protect public health; safety or the environment.
1. System will pass unless Board of.Health determines in accordance with 31`0 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 finless the Board of Health (and Public Materf Supplier, if any).determines that the
system is functioning in a mannerthat.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 an"d the SAS is within a Zone ]:of a.public water supply.
The system has,a septic tank and SAS and the SAS.is within 50,fe-et 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 nitroeen•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:
3
J
J
Page 4 of. 11
OFFICIAL INSPECTION FORM .NOT F OR-YO)LUNTAR ':ASSESSIYIENTS
SUBSUR:I+ACE SEWAGE n.ISPOSAL:S.YSTEM-INS.PECTION:FORM
PART A
CERTIFICATION:(continued)
Propert.y.Address:( /
P
Owner'
Date of Inspection: C. -/A/C)0 �
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 pond na' of effluent to the surface of the ground.or surface waters due to an overloaded or
s clogged SAS or cesspool
,i 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
I!. Any portion of.the.SAS,,cesspool or privy is.below high ground water elevation.
Any.portion of cesspool or privy is within 10Meet of a surface water supply or tributary. to a.surface
/ water supply.
V. Any portion of a cesspool'.or•privy is within a Zone 1 of a,puolid well.
Any portion-of a cesspool br privy is within.50 feet of a.private water supplywell.
Any portion of a cesspool or-privyis:less than 100 feet but greater than.50 feet.aom a private water.
supply well with no acceptable.-water quality analysis..[Thissystem passes if.the-well water analysis,
performed at:.a DEP certified laboratory, for.colifor.m bacteria and:volatile organic compounds
indicates that the.well is free from pollution from that..fa6lityand the.presence of aninionial
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 systenr;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 correctthe 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 11 of a public water supply well
If you have answered".yes"to any question in Section E the sysietrr 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 3..10 tmR
15.304.The system owner should contact.the appropriate regional office of the Department.
Page of 1.1
OFFICIAL INSPECTION FORM-NOT FOR''VOLUNTAI2Y ASSESSMENTS
SUPSURFACE SEWAGE DISPOSAL SYSTE&I TNSP.ECTION FORM
'PAET F
CHECKLIST
Property Address:
/ A
Owner:+ rL.c.✓
Date of Inspection: -QJbl-- v
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
- ere any of the system components pumped out in the previous two weeks ?
Has the system received normal flows in the previous two week period ?
_ fV 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 ? '
V 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
maintenan
ce of subsurface sewage disposal systems?
The size and location of t.he,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)]
5 .
Page 6 of I I.
O.I`FICIAL-INSPECTION F.O.RM NOT FOR VOLUNTARY.ASSESSMENTS
SUBSURI'ACE SEW.AU*DISPOSAL.SYSTEM IN.SI?ECTION FORM
PART.C
SYSTEM. INFORMATION
Property Address:
Owner:
Date,of Inspection:
FLOW CONDITIONS
RESIDENTIAL
Number o bedroom
s
n . ,Q Number of bedroorns .actual
DESIGN flow based on 310 CNIR 15.203 (for example: 11.0 a x#of bedrooms):Q
Number of current residents:._
Does residence have.a garbage grinder(yes or no);.
Is laundry on.a separate sewage systein (y or no):. ' if yes separate inspection required)
Laundry system inspected(y .or no): O
Seasonal use: (yes or no):&(,�
Water meter readings; if ava,4 able (last 2 years.usage.(gpd)):
Sump.pump(yes or no):
Last date of occupancy: � fJ G 'Oke/b
COMMERCI I.AL/IND USTRIAId
Type of establishment:.
Design flow(based on 310 CMR 15.203): gpd
Basis of-design flow(seats/persons/s.gft,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 r ` �/
Source of information:� 711/)x'bu-a� id/o i "
Was system pumped as part of the inspection(yes or no): .
If yes, volume pumped: gallons--How was quantity pumped determined?
Reason for pumping:
TYPE OF SYSTEM
Septic tank, distribution box,soil absorption,system
Single cesspool
Overflow cesspool
Privy
Shared system (yes or no)(if yes, attach previous inspection,records,if any):
Innovative/Alternative technology.Attach a copy of the.current operation and maintenance contract(to be
obtained from system owner)
_Tight tank _Attach a copy of the.DEP approval
o`) r
_.Other(describe): 'DAA ' -
A ximate age f all components, date;nstalle (if known) and source of information:
j
Were sewage odors.detected when arriving at the site(yes or
Pace 7 of H
OFFICIAL INSPECTION FORM -NOT FOR'VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM-INFORMATION(continued).
Property Address:
Owner:
Date of Inspection:
BUILDING SEWER(locate on 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 ofleakage, etc.):
SEPTIC TANK:"Walocate'on.site plan) '
Depth below grade:
Material"of construction:_concrete_metal_fiberglass_polyethylene
—other(explain)
If tank is metal list age:_ Is age confirmed by.a Certificate of Compliance(yes or no):_(attach a copy of
certificate)
Dimensions:
Slud6e"depth:
Distance from top of sludge to bottom of outlet tee or baffle: Q
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
How were"dimensions determined:
Comments ('on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,.liquid levels
as related to outlet invert, evidence of leakage, etc.):
GREASE TRAP:dolocate on site plan) r
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 oflast.pnmping:
Comments (on pumping recommendations; inlet and outlet tee or baffle condition, structural integrity, liquid levels
as.related to outlet invert, evidence of leakage, etc.):
Page 8ofl.l
'OFFICIAL.;INSPECTION FORM NOT-FOR VOLUNTARY ASSESSMENTS;,
SUBSURFACE SEWAGE.DISPOSAL SYSTEM INSPECTION FORNI
PART C
SYSTEM INFORMATION(continued)/Ileu
Property'Ad. ress:
ko
^�--)
Date of Inspection: Ord/r a.°y�
TIGHT'or HOLDING TANK: (tank rpust be pumped at time of inspection)(loc.ate,on:site plan)
Depth,below grade,.
Material of construction, conCrete petal fiber-lass polyetfivlene of er
(ex lain).:.
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: (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.):
PUMP CHAMBER:. (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 11
OFFICIAL INSPECTION FORM.—NOT 10R. VOLLTN TARP ASSESSMENTS
SUB SURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOMM
PART G
SYSTE1y1 C_NFORl'VIATION(continued)
Property dress:
Owner:
Date of Inspection: /iJet& ,
SOIL ABSORPTION SYSTEM (SAS): ocate on site.plan,.excavation not required)
If SAS'not located explain why:
• TYPe J V •.' ,
t . leaching pits,number:f_
leaching chambers,number::
leachi ia.:gaileries,'number:
leaching trenches, number. leneth:
leaching fields,number, dimensions:
overflow cesspool, number:
:innovative/alteinafi.ve system. Type/name of technolo6y:
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation;
e
CESSPOOLS:_Z(eesspool•must be pumped as part of inspect ion)(locate on site plan)
Number and configuration: S. .
Depth'—top of liquid.to inlet invert:
Depth of solids laver:
Depth of scum layer: .
Dimensions of cesspool:. .X "
Materials of construction: {
Indication of.., ndwater inflow(yes or'no): . -
mments (note condition-of soil,.signs of hydraulic failure, level of ponding, condi 'on of vegetation, etc.):
-44
of Io', ' f
(r "f
/O il
PRIVY) (locate on site plan) 1i�9'
Materials of consMiction:
Dimensions:
Dep.th'of solids:
Comments (note.condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation,etc.):.
9
Page 1.0 of 1,1
OFFICIAL INSPECTIONTORM ! Off' FOR VOLUNTARY ASSESSMENTS .
SUBS RFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM.
PAIN C.
SYSTEM INFORMATION(continued):
Property Address: lze,�ar ,�'Q
-
,s n
Owner• � �'Ia � A ,
Date of Inspection:.'° -� a/ �� JOCC c
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the.sewace`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.
E
O 'l
r` 4le-
. ►.
ac,
C
Page l l of l l
OFFICIAL INSPECTION FORIM —NOT FOR VOLUNTARY.ASSESSMENTS
• SUBSURFACE SEWAGE DISPOSAL_SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: P
Owner:d F JJ
Date of Inspectio
SITE EXAM
Slope ;
'_Surface water
Check cellar
Shallow wells jj-
Estimated.depth to grouild water 2•'1,feet,� --..
Please indicate(check):all methods used to determine the high ground water elevation:
Obtained from system design plans on record-If checked,'date of design plan reviewed:
Observed site (abutting property/observation hole within 150 feet of SAS)
Checked with local Board of Health-explain:
Checked with.local excavators, installers-,(attach documentation)
Accessed USGS database-explain:
You must describe how You established the high ground water elevation:
0 12 bo rd r
i
I .
11
Pe
rmit Number: Date:
Completed by:
HIGH GROUND-WATER LEVEL COMPUTATION
Site Location: �( /mil �� C9 �!� Lot No.
Owner: ��� 1 Address:
Contractor: A Address:-_
-
NOfeS
STEP 1 Measure depth to water table
to.nearest 1/10 ft. ��� ... ............................. ........................................ .Date
-month/day/year
STEP 2 Using:Water Level Range Zone
and.Index-.Well,Map locate
site and'determino: " n�
OApp`ropnate index well................................................
Water-level range zone .....................................................
STEP 3 Using monthly report"Current
Water Resources Conditions"
determine current depth to ,r�
water.level forindex well ........................... o��/
month/year -
STEP 4 Using Table of Water-level Adjustments
for index well (STEP 2A), current depth
- to water level for index well (STEP 3),
and water-level zone (STEP 213)
determine water-level adjustment ........ ......... ....... 1,7
........................................................
STEP 5.: Estimate depth to high water
by subtracting the water-
level adjustment (STEP 4)
,from measured depth to water
=..... level:at site (STEP 1) .
Figure 13.—Reproducible computation form.
.15
x
rD /m u -e
--7qt7 a lei vaea
T
own Ot Barnstable P#
Department of Regulatory Se
rvices
Public Health Division
�169. 200 Main Suet Date
,Hyannis MA 02601
Date Scheduled
:Time Fee Pd. •� :
Soil Suittubili Assess : S. �
tJ' ment for rSe a e is `
Performed By: b - p al.
Witnessed ey; WPT
_ --
Location Address VOCATION & GENERA,L INI+OT'ION
6l Main Street, COtU;] t.., Owner'aName
. . - ward & Marilyn
Address 61 Main St„ Wysocki
Assessor's Map/Paroel: 0 0 9%014. .. C o to is Engineer's Name
NEW CONSTRUCTION X BSC :Grou
REPAtR P r IIiC
�// Telephone# .5.08-778-8919
Land Use �eS G�Ct�7ic 4 Q
Slopes(% _!� - b'�
Surface Stones
Distances from: Open Water Body /�/).'
----_____R .Possible.Wei Area !I-A R Drinking Water Well N�
Drainage Way IVA ft
R` Propertji Line $1"
. �h Other
SKETCH:(Street name,dimensions of lot;exact locations of test holes et pert tests,locate wetlands proximity o holes)
• t and in pro unit t es
W.
_
ON tom'
Parent material(geologic)_IJi:7Ft.J[d,Sv�
t Depth to Bedrock . A 4
Depth to oroundwaler. Standing Water in Hole:_!:V" '
Weeping gain Pit Pace A161v_
Estimated Seasonal High Oroundwater /V�
DETERM NATION FOR SEA ONAL HIGH WATER TABLE
Method Used: /�/ONK 2 QJ _. , t'7 a
Depth Observed standing in obs.hole: cr:
Depth to weeping from side of obs.hole: " "" '`-I"' Depth to soil mottles: ifl
Index Well M Reading Date: Index Well level In, groundwater Adjustment t
Ad),factor Adj.Oroundwdter Level
PERCOLATION TEST'.,. vale i o "' �,�q,r� >
Observation -
T���
Hole B ` ..
Depth of Pero
Time at 9"
Time at 6..
Start Pre-soak Time® D'eo D'.9� Time(9"•6")' 171
--�.
End Pre-soak rPt'� .6.2C>O
Rate MinJlnch L_Zi'tP1. : . G_Zro�► :
Site Suitability Assessment: Site Passed k_ Silt Fail$4:
i_ Additional a ded(Y/N),__;_.
. . to Testing Needed e
t
Original: Public Health Division
HbserVat�On Hole Date To Be Copleted on sack-----------
In '
***If percolation test is to be conducted withiri"100'of welland,you must first not the
Barnstable Conservation Division at least one(1)week prior to beginning.
Q:SEPTICIPERCFORM.DOC
,.
DEEROBSERVATION 1107�,E LOG Hole#
Depth from Soil Horizon So{I Texture Soil Color Soil• Other
Surface(in.) (USDA) i�AMunseip Mottlln g .(Structure.Stones;Boulders' .
Z /10� L
y7" —176" C �• 5��1/D O yes qX i
DEEP 0USERVATION HO E LOG Hole# Z
Depth from ' Soil Horizon Soil Texture " Soil Color Soil Other
Surface({o.) (USDA) (Munsell). Mottling (Structure,Stones,Boulders.
u s to 96
r
t,5 IND
3.
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture . Soil Color Soil Other _
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Avg �� Y o�v✓ �t/o Grp.
77—
`0
7,0
0
DEEP OBSERVATION HOLE LOG . Hole# L�
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA). (Munsell) Mottling (Structure,Stones;Boulders.
e
)gND v y j Zr/3 aAIr No G. w,
5,qw lJ D rC 5
V.
3 n_ 120,
Flood Insurance Rate Map:
- Above 500 year flood boundary, No
Within 500 year boundary . ' No Yes '
Within 100 year flood boundary No Yes . i
--�
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring pervious material exist in all areas observed throughout than
area proposed for the soil absorption system? a 5. I;
If not,what is the depth of naturally occurring pervidus material?
Certification
I certify that on / Z vo (date)I have passed the soil evaluator examination approved by the
Department of Envi onmental Protection and that the above analysis was performed by me consistent with .•' ;:.. .,:;:.°'
the required training,expertise and experience described in 10 CMR 15.017. ° " •S
Signature b ` ' Datb
Q. wrickpaRcmitm.Doc
_......
.. .. ..
oX Barnstable
Depart n P# .I..� .
4 P e t of Regulatory Services
$ .ear+arearr~ i 0000
Public Health Division
Date
�Eo 200 Main snn;et,Hyanofs MA 02601 .
D e ��
Date Scheduled L�
:.Time
Fee Pd,
Soil Suitabili Ass �� ,v�. s ,, Ax
essment for Sea e
Performed.By 8 -lsP al.
Witnessed By:
Location Address -VOCATION& GENERAL INFO
61 �Z•ION Main Street, Cotu;it Owner's Name E-d
ward &
M ari lyn
Address 61 Main 'S;t.* . W-Y
soc.ki
Assessor's Map/Parcel. 0 0 9/014. (�' Co to i t, MA .,0 2 b 3 5
Engineers Name
NEW CONSTRUCTION X REPAUt BSC Group•, Inc;
/ Telephone N 5.0.8 7 7 8—8 919
Land Use eS, CK GY� � t
Slopes(%) Surface Stones
Distances from: Open Water BodyNA.
----_._R Possible We Area /✓14 g Drinking Water Well 1V1q
Drainage Way /tfA fi
R Propettji line a T R Other
3 Oth n
SKI•;TCH:(Street name,dimensions of lot exact locations of test holes et perc tests,locate wetlands in Proximity to holes)
la'
TO
'O
D
Parent material(geologic) "
Depth to Bedrock Ti4h��
Depth to Groundwater. Standing Water in Hole:
t Weeping t'rom Pit Race
Estimated Seasonal High Groundwater /VA
DETERIMIyATION FOR SEA ONAL HIGH WATER TABLE
Method Used: _- PN,O,�/�-,�- �,/�0.
Depth Observed standing in oba.hole:
Depth to weeping from side of obs.hole ` Depth to soil mottlas: In.
Index Well N Reading Date: index Well level In. .'Groundwater Adjustment fr.
.�......,..., Adj.factor,,� -_Adj.[Jroundweterlevmi,,,,�,
PERCOLATION TEST'.:. Date i o T M Observation
Hole M �..
` Time at 4" .
Depth of Perc
-- Time at 6..
Start Pre-soak Time Q D=Gt� D'00 Time(9"•6") "_
End Pre-soak rPC7 tS 'pp
Rate Minllnch LZi'tPl. GZrN
Site Suitability Assessment: Site Passed�_ Site Pallid
Additional Testing Needed(Y/N)
Original: Public Health Division ,•`.
ObserVat�On Hole Data To Be Completed on Back----------
***If percolation test is to be conducted withhjl 100'of wetland,you must first not the.
Barnstable Conservation Division at least one(1) week prior to beginning.
Q:\SEPTIGIPERCFORM.DOC ;+
DEEP.OBSERVATION HOSE LOG Hole# /
Depth from Soil Horizon Soil Texture Sdil Color Soil. Other
Surface(in.) (USDA) (Munsell) Moulin g .(Structure,Stones;Boulders.`
Alwr
19 L 5AN0 w`vlQyly
�/)o yQ 9XV
DEEP OBSERVATION HO E LOG Hole# Z
Depth from Soil Horizon Soil Texture i Soil Color Soil Other
Surface(in.) (USDA) (Munsell). Mottling (Structure,Stones,Boulders.
Consistency,%
S�tA)o /0 2 y �f
12 �3a LDS ND o 2 d
DEEP OBSERVATION HOLE LOG Hole# _
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consist ncy..%Gravel)
Y Orlll� V0 (�o.
i DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA). (Munsell) Mottling (Structure,Stones.Boulders,
consistC AND U y2 e
Y 3 Vf IVO 6. W.
0
_ /Zo 7 .
Flood Insurance Rate Map:
Above 500 year flood boundary No Yes
Within 500 year boundary ' No' Yes '
Within 100 year flood boundary No Yes i
Depth of Naturally Occurring Pervious Material''
Does at least four feet of naturally occurring pervious material exist in all areas observed throughout thti
area proposed for the soil absorption system? t,5.
If not,what is the depth of naturally occurring pervious material?
a�
Certification
I certify that on zDt? (date)I have passed the soil evaluator examination approved by the
Department of Envi onmental Protection and that the above analysis was performed by me consistent with
the required training,expertise and experience described in 10'CMR 15.017.
Signature_ l Datb / lS�ub6
ti
Q.WEPr7CWJ3RCP0RM.D0C }..
.
....1".._..__"_._. ._._...:...__:........................._.
t
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
z DEPARTMENT O {IRONMENTAL PROTECTION
ONE WINTER ST E 2a108 617.292.5500
3�9d SNHtl6 ONtv�Oi _
WILLIA.N1 F.WELD TRUD1'COX
Govcmor 1 Sccrcta
ARGEO PAIL CELLUCCI � 7 DAVID B STRUN.
Lt.Govcmor SUBSURFACE 5 AGE DISi Q3USTEM IN-$ ECTION FORM Commission:
PARTYA
,e CERTIFICATION�4k�
Property Address: 61 Main Street COtuit -S. t dress of Owner:j0e Pennell
Date of Inspection:9/2 9/9 7 (If different) Brastow Ave
Name of Inspector:Joseph P.Macomber Jr. Somerville Mass
I am a DEP a proved system inspector pursuant to Section 15.340 of Title 5 (310 CM 15.000) 0 21 4 3
Company Name: J.P.Macomber & Son Inc.
Mailing Address: BOX 6 CEnterville,Mass . 02632
Telephone Number: 508-775-3338
CERTIFICATION STATEMENT
I cenify 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 Inspection. The inspection was performed based on my training and experience in the proper function and
maintenance of on-site sewage disposal systems. The system:
ZPasses
_ Conditionally,Passes
_ Needs Further Evaluation By the Local Approving Authority
_ Fails
Inspector's Signature: Date:
The System Inspecto all submit a"copy of this inspection report to the Approving Authority within thirty (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 Department of Environmental Protection. The original should be sent to ttse system owne
and copies sent to the buyer, if applicable, and the approving authority.
INSPECTION SUMMARY: Check A, B, C, Or D:
AI SYSTEM P SES:
I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303.
Any failure criteria not evaluated are indicated below.
COMMENTS:
B] SYSTEM .CONDITIONALLY PASSES:
One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upor
completion of the replacement or repair, as approved by the Board of Health, will pass.
Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If "not determined", explain why not
�11Illf.The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of
Compliance (attached) indicating that the tank was installed within twenty (20) years prior to the date of the inspection, o
the septic tank; whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank
failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank
as approved by the Board of Health.
(revised 04/25/97) Page 1 of 10
DEP on the World Wide Web. http:1twww.magnet.state.ma.usr0ep
Printed on RecyrAed Paper
f
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 61 Main Street Cotuit, Mass .
Owner: Joe Pennell
Date of Inspection: 9/29/9 7
e1 SYSTEM CONDITIONALLY PASSES (continued)
N Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed
pipe(s) or due to a broken, sealed or uneven distribution box. The system will pass inspection if (with approval of the
Board of Health). Describe observations:
broken pipe(s) are replaced
obstruction is removed -
distribution box is levelled or replaced
The system required pumping more than four 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
C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
U Conditions exist which require funher evaluation by the Board of Health in order to determine if the system is failing to protect the
public health, safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER
WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
Cesspool or privy is within 50 feet of a surface water
re) 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 APPROPRIATE) DETERMINES THAT
THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE
ENVIRONMENT:
The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or
tributary to a surface water supply.
The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well
The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well
The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a
private water supply well, unless a well water analysis 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. Method used to determine distance Wl�— (approximation not valid).
3) OTHER r�
c� r S ail"
�-
(rsvisod 04/25/97) P&ge 2 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 61 Main Street C6tuit Mass
Owner: Joe Pennell
Date of Inspection: 9/29/9 7
D) SYSTEM FAILS:
You must indicate ewer "Yes" or "No" as to each of the following:
XA) I have determined that the system violates one or more of the following failure criteria as defined in 310 CmR 15.303 The bass
for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to cor.ea
the failure.
Yes No i
y Backup of sewage into facility or system component due to an 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.
AvoA-<- Static liquid level in the, dis ibutron box above outlet invert due to an overloaded or clogged SAS or cesspool
,kE
Liquid depth in cesspool 1is less than 6" below invert or available volume is less than 1/1 day floe`.
_ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipets)
Number of times pumped 0-
Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation
Any portion of a 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 I of a public well.
Any portion of a cesspool or privy is within 50 feet of a private water supply well.
f� 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. If the well has been analyzed to be acceptable, anach copy of well water analysis for
coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen.
E) LARGE SYSTEM FAILS.
You must indicate either "Yes" or "No" as to each of the following:
The following criteria apply to large systems in addition to the criteria above:
oo / The system serves a facility with a design flow of 10,000 god or greater (Large System) and the system is a significant threat to
public health and safety and the environment because one or more of the following conditions exist
Yes No
�i the system is within 400 feet of a surface drinking water supply
the system is within 100 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)
The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program
requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Depanment for further information
(rovirr*d 04/25/27) Dray• 3 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
e.
Properly Address:61 Main Street Cotuit Ma
Owner: Joe Pennell
Date of Inspection: 9/2 9/9 7
Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following:
Yes No
-K/ Pumping information was provided by the owner, occupant, or Board of Health.
None of the system components have been pumped for at least two weeks and the system has been receiving normal
flow rates during that period. Large volumes of water have not been introduced into the system recently or
as part of this inspection.
As built plans have been obtained and examined. Note if they are not available with N/A.
The facility or dwelling was inspected for signs of sewage back-up.
The system does not receive non-sanitary or industrial waste flow.
_ The site was inspected for signs of breakout.
_ All system components,'eluding the Soil Absorption System, have been located on the site.
The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of
baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum.
— The size and location of the Soil Absorption System on the site has been determined based on:
The facility owner (and occupants, if djfferent from owner) were provided with information on the proper maintenance of
Sub-Surface Disposal System.
Existing information. Ex. Plan at B.O.H.
_ Determined in the field (if any of the failure criteria related to Pan C is at issue, approximation of distance is
unacceptable) 115.302(3)(b))
(revised 04/25/97) Pegs 4 of 10
SUBSURFACE
'�EWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 61 Main Street Cotuit Ma
Owner: Joe Pennell
Date of Inspection: 9/2 9/9 7
FLOW CONDITIONS
RESIDENTIAL:
Design flow:�.p.d./bedroom for S.A.S.
Number of bedrooms:
Number of Current residents:ot
Garbage grinder (yes or no)A&f
Laundry connected to system (yes or no):WC'
Seasonal use (yes or no):-% 6� ' ��jj�b�fL ` A` c1— bg°'�
Water meter readings, if available (last two (2) year usage (gpo): /7 `` /t,�
Sump Pump (yes or no):4-0 ` �� / = 4,7'
Last date of occupancy:
COMMERCIAUINDUSTRIAL:
Type of establishment: ,t>/4
Design flow: VA Rallons/day
Grease trap present: (yes or no)�f1
Industrial Waste Holding Tank present: (yes or no).Zp
Non-sanitary waste discharged to the Title S system: (yes or no)'dEo
Water meter readings, if available: /1/*
Last date of occupancy:
OTHER: (Describe)
Last date of occupancy: 4111
GENERAL INFORMATION
PUMPING WORDS and source f infor a gn:
40
System pumped as part of inspection: (yes or no)
If yes, volume pumped: allons
Reason for pumping: Ifl,2Aaaz
TYPE OF SYSTEM
Septic tank/distribution box/soil absorption system
Single cesspool
CNerflow cesspool
Privy
Shared system (yes or no) (i(yes, attach previous inspection records, if any)
_� /A Technology etc. Copy of up to date contraaf
Ocher
APPROX T AGE of all compone , date installed (if known) and source of information: -V
Sewage odors detected when arriving at the site: (yes or no)
(revised 04/25/97) Fag• 5 of 10
I
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION'(continued)
Properly Address: 61 Main Street Cotuit Ma
Owner: Joe Pennell
Date of Inspection: 9/29/97
BUILDING SEWER:
(Locate on site plan)
r)
Depth below grader
Material of constructio _ cast i kn _ 40 PVC _other (explain)
J _
Distance from"prry to water supply well or suction line —,V14
Diameter JV
Comments: (condition of joins venting, evidence of leakage. tc.)
S s►� .�
SEPTIC TANK:&O<,�
(locate on site plan)
Depth below grade: .W
Material of construction;,�oncrete42,*netal��Fiberglass4/ PolyethyleneN�other(explain)
1/1�
If tank is metal, list age ZJ/p Is age confirmed by Certificate of Compliance A(Yes/No)
Dimensions: A119
Sludge depth: A11
Distance from top of sludge to bonom of outlet tee or baffle:�/�
Scum thickness AW
Distance from top of scum to top of outlet tee or baffle:�/�
Distance from bonom of scum to bonom of outlet tee or baffle. 4-14
How dimensions were determined: A2*
Comments
(recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural
integrity, evidence of leakage, etc.)
Div k 19 ll)D J facer 12&Z
GREASE TRAP;,t& i
(locate on site plan)
Depth below grader
Material of construction:lc�oncrete,{metal,(f iberglass,i�MPolyethylenWZother(explain)
Dimensions:
Scum thickness.
Distance from top of scum to top of outlet tee or baffle:422,t
Distance from bonom of scum to bonom of outlet tee or baffle:-"
Date of last pumping:
Comments:
(recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural
integrity, evidence of leakage, etc.)
(revised 04/25/97) Psgs 6 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYS�FEM INFORMATION (continued)
Property Address:61 Main Street Cotuit Ma
Owner: Joe Pennell
Date of Inspection: 9/2 9/9 7
TIGHT OR HOLDING TANK:AJ (. ;Tank must be pumped prior to, or at time, of inspection)
(locate on site plan)
Depth below grader
Material of construction,{91:oncreta metaY�&iberglasvv Polyethylene4.&ther(explain)
dl)?L
Dimensions: VA
Capaciry: gallons
Design flow: gallons/day
Alarm level: Alarm in working order Yesk- ,4 No
Date of previous pumping: _
Comments.
(condition of inlet tee, condition of alarm and float switches, etc.)
DISTRIBUTION BOX:,
(locate on site plan)
Depth of liquid level above outlet invert:
Comments:
(note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.)
PUMP CHAMBER• -e-t
(locate on site plan)
Pumps in working order: (Yes or No)�
Alarms in working order (Yes or No)L&,e
Comments:
(note condition of pump chamber, condition of pumps and appurtenances, etc.)
r
(revised 04/25/97) P.ge 7 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address:61 Main Street Cotuit Ma
Owner: Joe Pennell
Date of Inspection: 9/2 9/9 7
SOIL ABSORPTION SYSTEM (SAS):
(locate on site plan, if possible; excavation not required, but may be approximated by non intrusive methods)
If not determined to be present, explain:
Type.
leaching pits, number:
leaching chambers, number:
leaching galleries, number:
leaching trenches, number,length:
leaching fields, number, dimensions:
overflow cesspool, number:
Alternative system:
Name of Technology: r
Comments:
(n Condit n of soil, signs of hydraulic fail re, le el of pond ng, condition of egetation, etc.)
e
l
CESSPOOLA _/
(locate on site plan)
Number and configuration: J y
Depth-top of liquid to inlet inv
Depth of solids layer:
Depth of scum layer:
Dimensions of cesspool:
Materials of construction: G>
Indication of groundwater:
inflow (cesspool must be pumpe as part of inspection)
.1.y � C S.�Od J
Comments:
(note co di 'on of soil, ns of hydraul f 'lure, evel 9f ondi co dition of vegetation, etc.)
PRIVY
(locate on site plan)
Materials of construction: .lJ/� Dimensions:
Depth of solids:W/,49-
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
Lei /
(revimed 04/25/97) ➢&gr 8 of 10
�I
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Properly Addressgl Main street Cotuit Ma
Owner: Joe Pennell
Date of Inspection: 9/2 9/9 7
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100' (Locate where public water supply comes into house)
0 0oil �
(yvived 04/25/91) Page 9 of 10
SUBSURFACE SEWAGE DISP(: L SYSTEM INSPECTION FORM
t. C
SYSTEM INFOI; .. !ION (continued)
Property Address: 61 Main Street Cotuit Ma
Owner: Joe Pennell
Date of Inspection: 9/2 9/9 7
Depth to Groundwater,p�}Feet
Please indicate all the methods used to determine High Groundwater EIC�'ation:
Obtained from Design Plans on record
Observation of Site Abutting property, observation hole, basemtnf'sump etc.)
Determine it from local conditions
Check with local Board of health
Check FEMA Maps
Check pumping records
/heck local excavators, installers
—�T�- Use USGS Data
Describe in your own words how you established the High Grouncj�/,rer-Elevation. Must be completed)
Used Cape Cod Commissiom Map. September 95
Cape Cod
Water Table Contours
and
Public Water Supply
Wellhead Protection Areas.
(r•via•d 04/25/97) ?as, of 10
I }
l
TOWN OF Barnstable WARD OF HEALTH
SOUSUNFACF, SFHAGF DISFUSAL ,SYSTEM IN911FCTION FORM - PART D '- CF.Ic'ffFICATIO�1'
F...-...T.....r-�.!.��-r..re.-T•rt:mTT.sT7.)T'T'.r•.7.1.m.-I RTnf TV'.Ta7p'�ni!�TY.TT� Tnnl.Arrnrr T+�*�� -r•r•- r...�- �. .
—TYPO OR PRINT CLEARLY—
PROPERTY INSPECTED
STREET ADDRESS 61 Main Street COTUIT,Mass
ASSESSORS MAP , BLOCK AND PARCEL #
OWNER ' s NAME JOE PENNELL
PART D - CERTIFICATION I
NAME OF INSPECTOR Joseph P. Macomber Jr .
COMPANY NAME Joseph P. Macomber & 'Stun , Inc .
COMPANY ADDRESS Box 66 Centerville , Ma . 02632-oo66
Street Tovn or City Stat. (!P
COMPANY TELEPHONE (508 ) 775 -3338 FAX ( 508 ) 790 -1 578
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposa`1 system nt
this nddress and that t)Ie information reported is true , accurate , and
complete as of the time of .inspection . The inspection was performed and any
recomrnendaLions regarding upgrade , maintenance , and repair are consistent
with my training and experience in the proper function and maintenance or site sewage disposal systems .
Check one :
:XXXXXXXXXX System PASSED
The inspection which I have conducted has not found any information
which indicates that the system fails to adequately protect public
healLh or Lhe environment as defined in 310 CMR 15 , 303 , Any failu !-e
criteria not evaluated are as stated in the FAILURE CRITERIA section of
this form .
System FAILED*
The inspection which I have con ilcted has found that the system f,jils to
Protect the public health and the environment in accordance with Title
5 , 310 CMR 15 , 303 , and as specifically noted on PART C - FAILURE
CRITERIA of this inspection form .
Inspector Signature Date 9/29/97
One copy of this certification must be provided to the OWNER , the BUYER
( -hero applicable ) and the BOARD OF ItZALTJl .
• IC the inspection FAILED , the owner or operator shall upgrade the eyotem
- ithin one year oC the date of the inspection , unless allowed or requires+
otherwise as provided in 310 CMR 16 , 305 ,
par td . doc
�C9
�G
W
tJl TJ
7 -1
y
S �
_ SbyV ��ti
THE COMMONWEALTH OF MA.SSACHUSETTS
DEPARTMENT OF E ONM:ENTAL PROTECTION
BE IT KNOWN THAT
Joseph P. Macomber, Jr.
Has satisfied the Department's qualificatigns as required and is hereby
authorized to use the title
CERTEMD TITLE S SYSTEM INSPECTOR
as provided in 310 CMR 15.340 and Section 13 of Chapter 21A of the
General Laws_ Issued by The Department of Environmental Protection.
Junc 8. 1995
Acting Dirccior of the ton of Watcr Pollution Control
i.
r k 22151 P:g l5 —V343764
06-29-2030:17 of 10 = 1 1 c>t.
NOTICE: The Town of Bamstable
recommends that the^nnlir^n4
seek legal advice to prepare a
property worded deed
restriction document.
DEED RESTRICTION
WHEREAS, �U/��r cl YSaC�� ( of
(owners name)
i IV A( S-f reef � Q, �u i� MA
(address)
is the owner of 1. MA t ry 15 f r1:!!C1 located
(address)
at (� G L't c �'
MA (hereinafter referred to as
and being shown on a plan entitled "Subdivision of Land in
C v�� l 1- MA, Properly of A16& W.57' --'5 o C-V 7y Sa
et al, duly recorded in Barnstable County Registry
Of
Deeds in Plan Book /to 91 ., Page
Or on Land Court Plan Number
1
WHEREAS, `-caw a v c�. �3v`�,�CUc, c' as the owner of said lot has
(owner's name)
agreed with the Town of Barnstable Board of Health to a restriction as to the
number.of bedrooms which can be included in any home built on said lot as a
pre-condition to obtaining a disposal works construction permit in compliance
with 310 CMR 15.000 State Environmental Code, Title V, Minimum
Requirements for the Subsurface Disposal of Sanitary Sewage;
WHEREAS, the Town of Barnstable Board of Health, as a pre-condition to
granting a disposal works construction permit for a septic system in compliance
with 310 CMR 15.200, State Environmental Code, Title V, Minimum
Requirements for the Subsurface Disposal of Sanitary Sewage, and authorizing
the issuance of a building permit for the construction of a-single family home on
this property, is requiring that the agreement for the restriction on the number of
bedrooms in any house constructed on the lot be put on record with the
Barnstable County Registry of Deeds by recording this document,
dm&
NOW, THEREFORE, E8u)A�c w YSCdV does hereby place the
(owner's name)
following restriction on his above-referenced land in accordance with his
agreement with th.T_owa.of Ramstable Board of HeaW, whieh FestHetion s ra
run with the land and be binding upon all.successors in title:
• - N j ice may have constructed
(address)
upon the lot a house containing no more than ( ) bedrooms.
G�wrvc u) YSQc,�-, agrees that this shall be permanent deed
(owner's name)
restriction affecting, located on _�.I MAIN 5-{ C oj,.1j MA, and
being shown on the plan recorded in Plan Book i!r , Paged V1
Or on Land Court Plan
For title of seethe following deed: Book I I yG S , Page
4 N . Or Land Court Certificate of Title Number
Executed as a sealed instrument _,_gev C day of �7 _ o?6 G -7
t
Owner's signature `
Owner's signature
Owner's signature
COMMONWEALTH OF MASSACHUSETTS
201'
Then personally appeAred the abov -nameCl /m�✓�
known to me to be the person who ecuted the foregoing instrument and
acknowledged
the same to be free act and deed, before me,
a Notary
Public
ELIZABETH 1% WADAMS Y commission expires:
NOTARY PUBLIC
Commonwealth of Massachusetts (date)
My Commission
Expires � J
Juns.7, 2013 Y
dwdr y
BARNSTABLE REGISTRY OF DEEDS �� '
'fj • '
IP
FN D
lI.t S4: BENCH MARK (
TOP OF CONCRETE BOUND
ELEVATION 86.34 (ASSUMED DATUM) FND OFF $ o
- UP
L DRIVEWAY o �' 1'i
GR A� 16
S 52 26 0„ W
I CB/TIPPED %p
' FND OFF / o
II I rrn
FND OFF
a6�5 31.7' F, I 11 I gEl
PROPOSED 26.5' X 12' 61 �'I 1 1.0' I II
SOIL ABSORPTION SYSTEM
}- m
f 1 #2 26.2'
I i F+y rn
� f BED BED �
L 1- Go
_ CO ,n 00 LR V / v
� 22.6' � BATH HOUSE N
, FF=92.3 Itv
TP#1 20.0' N TOF=91.4 ' rn I '
� m M ~
J N INV=85.6 w "� 48.1 r
41.8' V
70.7' 1 OFFICE 8.0' PORCH I I O w
WWITH OVERHANG �.LEACHING PIT , — — —" V
DECK SUN W I (/,
1 PORCH KITCHEN/�' s
PROPOSED D-BOX CES DINING c I
PROPOSED 1,500 POOL 18.3' S 0' ---� cc
GALLON SEPTIC
TANK ♦ /�j% o
oy m
I
BI NM►NOUS DRIVEWA I c
�w �/PROPOSED/ � C
CONNECT EXISTING ADDITION �-- Z 0
NlF : SBUILDING EPTIC TASEWER TO #4 /�/ % oy£ 0 I o � I
IOST OF SANTUIT & COTUIT / Qn
ASSESSORS MAP 9 F � N
PARCEL 15 PROPOSED �# r / \ I I o p
RESERVE / o'`y£ o I mo" r-5
PROPOSED BUILDING
z SEWER FOR ADD171ON oy I i
o I I £ " v � U
cn
I o VI -4- N
N
UPL
III I � �� A
� N/F � g1 I I
I
125.9'
EDWARD WYSOCKI I 0 Q (Q 4=
ASSESSORS M4
SS SSORSA4 P 9PARCEL 1
32,517±S.F.
I I I
I I II job
111 I dace
scale 111 z zc)1-
6! I 11 �H YD drawn !J.,&, L
f I
�� ��� �►-fie �'I � - � 111 �
,, a 20l - 0 „ I it
r mew add;+ion exis�in
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it oFF��e. O P 1Tn. 3NO
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4- 0 -�
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heY�l addi�'�on exis�-�n htxls� ,obno.: o (o--1
e
4
date
` scale
} drawn J A
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£ e a e
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'V
- I01-0' 16I-0"
3•-4 LQ- 2'-0' 4•-3' 2•fi, 3--4 V2' •a
- I 4w • A
A
O
_
____
ww
MAIN.P.T.5ILL N V2
ANCHOR BOSo b O.G.
RL BILL 1 2-
FROM CORNERS YICAL:
-
- - -
t'O
MIN.,(2)BOLTS PER SILL '1 P.T.2X8 !3)P.T.2XB (31 P.T.2%8 (31 P.T_3%B— � - I �) t✓
- 10'CONCRETE W4LL _ - 11-4 _
ON 24-X 12 CONCRETE
B-------------------- 6 W/POPTINKEY
V
ALIGN WITH WOW CON',1U6E
" AS - - WINDOW ABP/E ON a 20'DIA."BIGFOOT'
" U FOOTING .�i
TRTFal (n
. —.�T•i%4%TI/2' 'ITi�L0v7�- E(NAL EOUAL
(31 P.i.1%10 (31 PT 2XIO -
10 0'-7 BEAM POCKET
AS REOJIRED _ - !D**
ALIGN WITH- - - Q 'Q U
.NPOW ABOVE —
;� I'e BASEMENT
ry � - Il
k D
---------------
( 4°X91/2'LVL FLII511/BELOI'✓,'YIALL - ---- ---- -- --
. •' 36 x 36 X I] I �
10 fi
EXISTING FOMDATION WALLS - -
8E61NNG OF EXIST.
r IP
n�oia „cam Ya
'x DRILL e4 REBAR 4'INTO EX.CON'I `e
I WALL FOOTING 0 12.O.C.VERT.
B'VIA.LONG.TUBE ---am h� I SECURE N EPOM 6RpR;REBA BA5EMENT �' v
F,y TO PROFLT 12'MIN.INTO IEW f „
�OPENINS IN EXIST. WAIL FOOV% •'
—' ' L TO LEVEL OF m
'I - -aa_.
3/4'%9 I/2'LVL(FLUSH/BELOW WALLI EXIST SLAB(AT R S ATION 'F'S „— -
- OF E%UST.CELLAR SASHES) -
F�L.4e
• '3vX�vzr� - -- Zz�
r'.ima�m
' I VERIFY EXIST.FRAMING LONDITIONS __ _
' ry PRIOR TO ESTABLISHING TOP OF
FOUND.WALL(ADJL*1 CONC.
WALL HEIGHT AS NEEDED) _ _ - —
BEbININ60FEXI5T � O'i =' +�
------
MEN
CELLAR-SASH--
m BEAM POCKET
A5 'Q 'i e. AS REWIRED +1
O N
-- -= a
----- --- ---- ------ -
ALIGN O'p N CL
WPLLs (�•N N U
c
n
L
_ 4S
L2S V
OrL O
(n(D ti
O v
FOUNDATION 6ENERAL NOTES,
-CONCRETE WALLS TO BE 10'THICK -AREAS BELOW WOOD FRAMED PORGff5 TO Q
ON 24'XI2'MLE`h NOTED)WNTINUOV5 NAVE b'W'ELL-6RADED GRAVEL
• CONC.FOOTIN6 N KEY(HEIGHT OF WALL
TO BE BASED ON Ex15TIN6 FRAMING TO job no. 0104
- FOUNDATION CONDITIONS.TOP OF WALL -CELLAR SASHES TO BE ANDERSEN e1B11
TO VERY AS NEEDED TO MATCH EXISTINS (100 SERIES)R.O. 1'-6 5/B'%I'-T I/4'
FLOOR IEIGHTI VERIFY INFIELD date II JJNE 2001
-COWMl6 TO BE 3 I/1'DIA.CONCRETE
-SILLS TO BE P.T.2X6 5ILL N 1/2' FILLED STEEL PIPE(UNLE%NOTED)
ANCHOR BOLTS 0 6'-0.O.G.MIN.AND b 11' SCd�e AS NOTED
FROM CORNER5,TNERE SMALL BE A MIN,OF
1 BOLTS PER SILL -ASSUMED MINIMUM BEARING CAPACITY
OF 50IL5 20o0 FSP drawn KMW
F O U N D A T I O N P L A N BASEMENT SLABS TO BE 4'CONCRETE
5 G A L E: /4" e -O' _ (3000 PSI/N IN•dM 6X6 WI 6%WI.4 WIRE -NO FOOTING TO BE RACED IN WATER rev.
MESH ON 6 MIL.VAPOR BRRI AER OR FROZEN SOIL
OVER 6'WELL-GRADED 6RAVEL
COMPACTED TO g5%MAX.DRY DENSItt rev.
f AT 8 PAYS NTH MIN F'G•9A00 PS
8
ISSUED FOR CONSTRUCTION 5be I of a
L '
IOW
N V
C ryWry N
3'-5 V4' b'-3 3/4' 3'-4 1/2- 2'-b- 6'-1. 2'-b' 31-4.In, v •Op fO
01
d< v CZdSI
R� �p
ti �n e
E
E
0
v � u
' Ex15r1NG
-
�d d � ELYJAL EDJAL �� C
'u�x IJ,'x 3 PLLDH 1959
nd
,m$ •...... ....,�
•�__________H _____________________ REtAININ6 WALL
�ry .. �x 5 •BY LA.ND5CAPER ►T7 N
-- _- •114 IFE DECKING
ssON P.T.FRAME
(10'TREADS) _
M5TR.BEDRM. to $
'BILLO,r PE,C. ;q q�q -.
- W/12'EXTENSION �i'i1.4
DECK
. _ A _. PLLDH 2959 O .-
2- /4 x -11 'Lv U r
VJ
rv.
3. ----------------
m
--- - -- R ------- o ��`{ HERS PLCDH 2959 EGK 3 .
o I;
2 x „
S'-O' 2'-9 I/ 4'-0' 9 5'-B• 1 f
4 2-5 3/4
2X545 3/4 s ; PLLDH 2959
EDGE OF FLAT/ ________________ 2-53/4X411 /4
FLLTRDH Pill ABODE) SLOPED CLG. HAL - "' P-CFS 1 4(%O _
2i 3/4 X 1-5 3/4 b-O%%b-
- M5TR..BATH. 9 ,I
-------------------------------- 2- /a zoH 2459 D :$UNROO III 5/-5 3 x t li m
MqK�
UP SEAT LINEN HI5 AS i; EQUAL EQUAL
_
$ I
t
-
;i•N
P-cDH 2541r__ �ATH.
2-1 3/4 x 35 3/4 3'-0' S'-7
,
ry
h »o
m - m aQ-ate`- y9
,
,
Q
cDFtTiVE _ _� m � �O ___.______ ._____. - - oc.u�'e_Fci -
m ..................: ------
m ~__________ 9U-
CAI; BEDRM:2 c`
oIx4 In DEcw 3-0--- L VING
ry ON P.T.FRAMEd m4- ♦ —_—
ii Po d
(14-TRFAD) �"
GENERAL F!"NOTES PLLDH 2591 DESK ;;•;e� NO SILL AT INTERIOR ry'�`^d a oL 6c 8.
2-I 3 4 x 3-5 3/4 �iniW .WINDOWS(THIS LaATION .,vm-o m nd<<^_G G
- 3'-4 KITCHEN,�•�� oraY) `a'm
-ALL WALLS TO BE 2x45 o Ib-OL. ----------- ---- mom• ^-^H-a`"
Ye
(LNLE55 NOTED OTHERWISE) EDGE OF FLAT/ ALIGN WALLS
„T piny
-WALLS WIM POCKET DOORS 10 `.A-OPEO LL6- q `5'OTHERS
BE 2"5 m"cAL) THENIA_
-WINDONEXTERIOR DOORS TO BE FELLA- SMOOiIi TSAR LITE150-BEF 6-B) A ON. MUD HALL EDGE
EEO FLL T/ }I
PROLINE IMIT5 YV REMOVABLE GRILLES RA.]'-10 'x b-I 2 -
MEFER TO ELEVATIONS FOR GRILLE (PLUSH GLAZING) m ; '>•P iING IIOUSE�
PArn3xus) NTRY --------------- -- •, O � �.
-FRONT.0 SIDE ENTRY DOORS '^ m -_-_ DINING (A
-REFER TO ELEVATIONS FOR WINDOW - - - 0-0 C) : C
R.O.HEIGHTS ABOVE SL.9FLdOR - - BEDRM. _ L L cis
AND GRILLE PATTERN5 PO H � RLDH 3953 N^ V
3T�4-5'3Tr v I
a1 ro
(n o+��.� � o
LL
Y
do �n do mdn do fan dmn� rc do C.)�_+•;
4'-1 3/4' 4'-4 IM' b'-9' 6'-9" T-O' l'-0' EQUAL EQUAL N,^ LL V)
WALL/DEMO I 4 O �1A O
EMETING L..)
------ - WALLS AND ITEM5 TO -• _ _______. 8E REMOVED 36 W L IPE DECKING(ON
(ON
EXI5TING WALL5 TO EXISTMG FRAMING)
REMAIN
EXIST,NW POST$
TO REMAIN(REMOVE
HEW WALL5 POST AT CENTER) fob no. 0104
DEMO NOTE5 - date 11_uNE 2001
MET( DASHED WINDOWS+i WALLS
scale AS NOTED
TO BE REMDVED MCI PATCHED AS
NEEDED OR REPLACED AS NOTED.
drawn : KMW
F I R S T F L O O R P L A N EXISTING HOV5E,1.251 50.FT.
rev.
SCALE, 1/4" . -O' PROP05EP ADDITION•1,05B 50.FT.
•. TOTAL 2,284 50.FT. rev.
a .
m A-2
0
0
W
ISSUED FOR CONSTRUCTION Bbe 2 of 8
� s o
c �
a
FASCIA 6VRER ON IX - u�
FASCIA(TM.EJ ON]% NEW ADDITION EXISTING HOVSE
BLOCKING:3/"PEKE.
VENT.
ARLHITECTLRAL ASPHALT <
ROOF SHINGLES 1X3/IXb RAKE X O
2aS
(r0 MATCH EXIST)
HATCH EII5TING
AS
TLONi MATCH S NNS,
AS
ao u
.,Ix9 NEAR/.WEB - -
LA51NG
1X5AAb C.OWERBOARDS
- (TO MATCH ExISTIN6) 0❑ ® ■ U rA •� .
W L. E SIDING
- (TO MATCH EXIST) _
IX3AX6 SKIRT.
FIBII
StFLOJR
1X6 APE DECKING ON -
67
P.T.FRAME(10'TREADS) .
EXISTING POSTS 4W. O
I%6 VERTICAL In IX WRAP i0 REMAIN •�
PECKING AT SIDES (REMOVE CENTER POST) _ U V J
CF DECK W//A'MIN.
AIRSPACE - TO BE�REARA�ED N�Et'IM V J lJ
RADIUS To BE 3PY•N- `
8'LONC.NBE. I%6 HEAD LASING to
tOP T IX5 JAMB LASING
XISTING
____ ___ ____ _ __ __ ____ ___ _____ ____---_r_ __ _f
V
IlaFRONT ELEVATI ON
SCALE: 11— I'-O' -
ARCHITECTLRAL ASPHALT
ROOF 5MINGLE5
(TO MATCH EXIST) -
LOM.MI E VENT LAP
TO MATCH EXI5TIN6 m
- 1 o9Ua c�c�o�tia �
1X3AXb RAKE ON _ m
I%BLOCKING TO
MATCH EXISTING
EXISTING HOJSE 2>.3 ac•u -
IX5 HEAD/JAMB l i a a—
CA51N6 q12
A5 CUSTOM 51RUCTSRAL - - _c 0
• DECORATIVE BRACKETS 2 u_.a n_m m_
-E.. AT WILT-0 OVERHANG
EXI5TING DOOR TO BE QJ
(FRAME OPENING,AND
ALUMNA GUTTER ON IX I.
INTERIOR/EXT.GF
FASCIA O;3/4 ON 2. WALL TO MATCH EXIST)
VEtR KING;3/'PERF. T E. - O ^`
A iJ 4J �
_ AL.5HINGLE SIDINK
(TO MATCH EXIST) Q W _O
L L a
(To MA.TCCH E%Es NGi ® Exi5TING P05M N N� j V >
O IX WRAP TO REMAIN ` y/ co Cu
.0 VI LU
TYPE'L'BILCO
ol
I"HEAD LASING
W 12'EXTEN51ON XS JAMB CASING V O
RST ISTIDR-� m O w
'—
N
1X3/I%6 SKIRT 0 0 CO
u
VERTICAL
' DECKING AT SIDES
- OF DELKEA'V4'MIN,
IXH In DECKING ON
P.T.FRAME(10'TREAD5/
job no. 0104
�._____ -`------______________________!__________ ____-------------- --________________ � date
II JNE 2001
--------------------------------`--------
--- --- --- ---
L E F= T E L E V A T 1 O N a CONc.TISEs scale AS NOTED
drawn KMW
SCALE, 1/4' c l -O'
rev.
- A-
3
N
ISSUED FOR CONSTRUCTION 5bt: 5 of e
;s E Eo
o N V
V N
V
C
� Y
EXISTING HOLrE NEW ADDITION c M
O
ARCHITECTURAL ASPHALT �yy
ROOF 5HINGLE5 C
(TO MATCH EX15TJ M d A
D G
AS AS TONMATfI"FIMEXWINS
B
ALIGN CIAEXIST
A FASCIA 1X3AXB RAKE ON A%
�I ITITA I-AT NpP�E IX BLOCKING TO p E
e MATLN EXISTING
ALLMN.U1T1ER ON I% L a
EXI5TIN6 DOOR L BE FASCIA S;3/1 ON]x 5{ u
RE AMEED r REPLACED 'LOCKING;3/'PERF,
!FRAME NTVZIOB AND VENT.
PATCH IM ATCH EX15 OF
J
' - WALL TO MATCH E%ISTJ
1X5 HEAD/JAMB
CASING
C
❑ ® ® ®
lu
!TO Raw MATCH E%ISTINGI
f'd
W.G.SHINGLE 5101% L
(TO MATCH EXISTJ
- 0 FI T TY S
W/ i1N6) v
-. ❑ ❑ ❑ PE' IO ID'EXTENS E%TENSION
� .:' :91X3nX8 SKIRT
r ___ •' '• DECKING AT 5IPEDE5
W/I/4'MIN.
R5PA4E '
r r i
r- TOP�SL
i ppgg��
Ix4 IPERA DELKIN6 ON
P.T.FME(10'TREAD5) ___________'______!______ ________!____ _'_____________________________ __________ •
REAR ELEVATION 't �
B'DIA CONr�RETE -
_ 11.9E ON A
SCALE, I/4' v I'-O' 'BIGFOOT' DI FOOTING
QcUa L_.5 moo
c ua L._
ARCHITECTURAL ASFHALT
(TO 5HINGLE5
i0 MATCH EXI5TJ .. m'��
(ANT.VENT CAP - 'L'm m m= -c m --
r0 MATCH E45TIN6 a m-m
I ALUMA GUTTER ON I%
BLOC
FASC (TMEJ ON]X N
VENT.
VENT. �
11 AT BA FASCIA Q /1
AT BAY HN A1! (n
� V
N C ++N N
. •® ® IMTGH E%IST N6/I �v�II N u(To >
CS NO
LASING
W.G.SHINGLE SIDING
(TO MATCH EXIST) (,Q
.. �-EXISTING HW�iE� I,pp N O T� }-!
y rvan%85KIHT 0 FIRE%IF5TIN6R N O JwC
IX4 VERTICAL In O V
DECKING AT SIDES
OF DECK W/1/4'MIN. IX4 In DECKING ON
AIRSPACE P.T.FRAME(10'TREA05)
B DIA.G N 5 R
O iETAINING WALL
TUBE ON P,
'8ISFC F 1% BY IAND5GP1'ER
-- r job no. : 0104
I
• _ ----- TOP 0 SL date n_UNE 200'1
r
Scale AS NOTED
RIGHT ELEVATION drawn : KMw
rev.
5 C A L E, 1/4' c 1 -0'
rev.
p A-4
a
ISSUED FOR CONSTRUCTION 5bt: 4 of e
s
0
u y V
O N
< q N
• ro
F N
RIDGE VENT LAP uc°i
OVER 9/4'X
LVL RIME BOARD N � �
< M
RIDGE VENT LAP PROVIDE 2X STRAFPINS h C
ARCHITECTURAL A T OVER 15W X q In- SLOPED GL6.TO ""I ES 4(TTCH E%1ST T
SWN6LE5(MATCH E%15T LVL RIDGE BOARD ALLOW R-30 Fb.WELL. M O lO
5/B'GDX PLYWOOD 5/8'COX PLYWOOD
2"s 0 16'OL. 2X55 0 16'OL.
ARCHRECTUR�L ASPHALT
12 SHINGLES`LYM N DXISiJ ROVER 3 M X V2-
SHIN LDS PLYWOOD 12
2X85 O lb,O.G. LVL RIDGE BOARD
N.E.
A '_ 2
i.ME. iA Np
_ SInILUtZ T L
.OYP.BOARD
- OP OF ML.
LATE OO MS1R.BATH: 2Xf5 GL..1O15T5 \1 — `i 1n 1X3$TRAPPING V
TOP OF pB1,I ALIGN AlY//EXIST. O lb,O..W/
��� 1CIIJ�E FA5GIA I/2'G .BOARD I 2X6 RAFTERS - 6.I T O
-PLATE O MUD l� I 2XB CL6.JOIST5 L 2XI0 CLG.JOISTS ON IX3 TRAPPIN6 I 2X4 GL6.JOISTS
0 16'O.G.W R-30 F .1N5ULATION 1
/ IF O.G. In,GYP.BOARD _ \ / - - LOAD BEARING
\ (2)2%5 HEADER R 30 F6.INSIL 1ON WL.SHINGLES - WL.SHINGLES `\ / N `LL
MUD HALL r I/2'GDX PLYWOOD m In,cox PL
m 2X45 a Ib'OL. 2X65•16'OL. 9 C
V1 COX Pw5 v - KITCHEN _ -x a-13 F6.INwL. - 3 R-13 F6.INGut, MSTR.BEDRM. - p�
2 LOAD BEARING WALL (2)1 3/4'X q I/2'LVL m MST .BATHRM. S -
R-13 Fb.INSU-. AT NEW CASED OPEN'S U
- (AT HOUSE WALL) 3/4'TIG PLYWOOD 5/4'Tr PLYWOOD 2X6 P.T.SILL W/In' 3/4'TT6 PLYWOOD
A.6- IT7 •�
q In' 20 FLOOR VERIFY EXIST.FRAMING CONDITIONS q I/2' 20 FLOOR ANCHOR LT q In'AJS-20 FLOOR u 1�1
JOISTS O I6'O.L. FRIOR TO ESTABLISHING TOP OF JOISTS 0 Ib'O.G. 0 6'-0'OL. .Y215T5 0 Ib'OL. W
$L9 PLR: R-30 Fb.INBILATION NEW POLHO WALL(APJ T LONG. - R-30 6.INS TION _ (ttPIGA1J W B/ t INSULATION L.
Al 3/4'LAM.LVL RIM WALL AS NEEDED) SUB PLR. W/3/4'CONT.LVL RIM YV 3/4'CONi.LVL RIM l�
9 FIRST FLOOR 0 FIRST FLOOR
F LION FO�ON WALL FOMekTIION'14 A L (d
(3)13/4'X q In'LVL _ - VERIFY EXIST.FRAMING LONDITIOH5 , ~I
2X6 P.T.SILL W/ f2) 3/4'X 9/2'.LVL
I/2'ANCHOR BOLTS 2%6 P.T.SILL W/V2 ((2J 3/4'X q 1/2'LVL (FLU5H/BELOW WALL) PRIOR TO ESTABLISHING TOP OF / 1
3 In'LAL1,Y L0.UMN - � ANCHOR BOLTS (BETONDI
F (TYPICAL) ON LLNC FOOTING O 60"OL NEW FOUND WALL NEEDED)
LONG..
m BASEMENT m rrrPGAu VERIFY EXIST.FRAMING CONDITIONS s BASEMENT WALL HEIGHT AS NEEDED)
BASEMENT �
GEASEMENT ANGRENE SLAM TO P51)BE 4- m PRIOR i0 ESTABLISHING TOP OF - m - O
BASEMENT SLABS TO BE 4 BASEMENT SLABS i0 of 4'
gg 6 MIL.VAPOR BARRIER OVER - EXISTING FOUND.WALL CONCRETE(30OO P IE ON NEW FOND WALL NEEDED)
LONG m CONCRETE(3000 F51)ON U
L - 6'YELL-6RPDED GRAVEL - - ' b MIL.VAPOR B4RRIER OVER WALL IIEIGHi AS IEEDEO) qX 6MIL.VAPOR BARRIER OVER y J •�
COMPACTED TO q5R MAX. HEW SLAB NEI6 6'OL VAP A0E0 GRAVEL .. b'WELL-GRADED GRAVEL _
WMPACMP TO q5R MAX. - �� COMPACTED TO qSR MAX.- DRY DENSITY TO MATCH EXIST. DRY DENSITY - - _ DRY DENSITY _ V
TOP OF FOOTING OF.. .. - -. .. .. TOP FOOTING TOP OF FOOTING
'..: 1O'CONCRETE WALL ------ 10'CONCRETE WALL
ON 24-X 12-
ON 24'x 11'
CIO W TE FOOnNi 60 YV KEYFOOTING
!D*O17-1
IS5EGT10N n SEGT10N
ECTION "
CALE I 4 I -O SCALE: I/4' I -O' SGAL E I 4 I -O II
-
RIDGE VENT LAP - - _-n
VENTQ-'e- o c
8--4 3/4'r/- O 1 3/4'X q U2' o cU t_ g9
VER
LVL RIDGE BOARD - o o e
5NGO EXISTL
/ 51W/B'Cox GDx(MAPLYWOOD 2
12 W// O.C.
ARCHITECTURAL ASPHALT E
T.M.E. ROOF SHINGLES R.M EJ ON ROOF EGTURAL ASPHALT
12 15 I.B.FELT ON 5/e'COX 12 15 LB.FELT ON 5/6'COX
_ RYVIp.SHEATHING
FLYWD.SHEATHING a..-,a 7=u „c'n o Y
A� �TM.E. _ _ �TME.
Ad
OF
AL16N W/EXIST. PLATE ,' 2xB RAFTER5 O 16.OL. I 2X8 RAFTERS O 16'OL.
HOUSE FASCIA (ERf5TIN5) I ( - XI 3;X/RR;3 AN ++
W/R-Iq/R-30 Fb INSA.
2XIO GL6.W15TS 1X3 STRAPPING AND
/ 0 16'OL.W/ I In'GYP.BOARD —
I/3'6YP.BOARD //2�)
ON W 5TRRAAmNNG / O W
R-30 F6.INSJL4TION
_\ KITCHEN O ALUM.DRIP EWE r�ALUM.DRIP EDGE
WG.SMILES C � .1` v) (A .
m - - 1/2'CDX PLYWOOD - O VTJ Y�/ 7 •cO
2X45 0 16'OL. V L L ++
3/4'TI6 PLYWOOD R-13 Fb.INYL. ^� �••N' 4� V
q I/2'AJr20 FLOOR — ———— I"FASCIA W/ - ——
JOISTS 0 16.O.G. ALUMN.CURER F IAxIR L (n b
S)B FLR. R-3p F6.INSULATION 2X6 P.T.SILL W/1/2'
ppy n` \
W 3/4'CAM.LVL RIM ANCHOR.C. IL Z' W/E/ C
_ OFR�LOOR (iYP-0AUL� ¢¢¢¢� �� F •V Li..� � N
im
){ 2 2'XI I/2'BLOCKING AT 1 C
FOIRIDATION I16 a 2'%I 1/2'ELOCKIN6 AT Opp G
16,OL. �{ Ib'OL. O,x V
10,CONCRETE WALL
ON • a `V
24'X12'
W TE @ N O r
CONCRE FOOTING Of
1 W/KEY VERIFY EXIST.FRAMING CONDITIONS
PRIOR TO ESTABLISHING TOP OF 3/4'WIDE CAM.PERF. W ql FO N- 3/b'WIDE CONT.PEW. c (n W— (/)
VENT(BLACK/BY'CAR- q LLL pp VENT(BLACK)BY-COR-
m BASEMENT HEW FOUND.WALL(AO T CONC. A-VENT'(ON W.G.SHINGLES) K A•VENT'fON AL.SHINGLES) 0
m WALL NEI6HT AS NEEDED) Q
BASEMENT SLABS TO BE 4- 3 t ++ U
_ CONCRETE(3000 P51)ON m F O
b MIL.VAPOR BARRIER OVER WL.SHINGLES ATM E) IXb HEAD CASING
6'KELL APO'ED GRAVEL I/2'GDX PLYWOOD D C
COMPACTED TO q5%MAX. - 2X45 0 16'OL.
CRY DENSITY R•15 Fb.INSULATION
TOP OF FOOTING Q
WL.SHINGLE$fTNEJ
,-§' IXS HEAD CASIN6 2X45 0 19 04O.0D job no. 0104
_ - ON In.PLYWOOD R-13 Ph.INSULATION
ddlB II DUNE 2001
r(D
EAVE DETAIL AT MSTR. BATHRM./KITCHEN O EAVE DETAIL AT KITCHEN/MUD HALL
SCALE.1 1/2"-V- SCdIe AS NOTED
5 E G T 1 0 N o 5LA E,1 In'.r-o°
draw
C A L E 1/4 • 1 -O'C A L E: 1/4 • 1 - TBV.
S : KMW
eV.
- rev.
a - A- 5
a -
O
ry
ISSUED FOR CONSTRUCTION 5m: 5 of 8
8 Oy E
V
v A
fO
F IA
`•• ri7 V
N � �
v M
C y
Y r A
A5
c E
o �
� u
F STRUCTURAL DESIGN CRITERIA b
. - - (3)P.T.]XB (3)P.T.�XB (3)P.T.2%B (3)P.T.3%9
r ,
- FIR5T FLOOR 5 PSF0F LL
DL w o o v
B v�o ,co � � Ia O
- ATTIC/STO. 20 P5F
IO P5F a§
- ROOF 30 P5F — TIM/4 xm `0FM b
15 P5F
b
- EXT. WALL5 15 PLF IX (3)P..'XI )P..1XI
- INT. WALL5 50 PLF DL
11 �
- DECKS/PORCHES 60 P5F
10 P5F 3/6'X 9 I/4'RIM
_ s .Y115T(AT DECK AREA)
it
NOTES (3�4'X4I/2"LVL FLUSIVEELOM
- FIRST FLOOR JOISTS
TO BE BOISE GASGADE P
G 1/2" AJ5-20'5 @ 16" O.G. O RT 2X_
--
f3)P.T.1X6 v
W/5/4" RIM J015T,UNLESS =--P°SL —-=.__.
'e ' sV=%< = N oao
NOTED a,5TI�FLOMJ 5T5 BASEMENT y oF5: ca 2D
- ENGINEERED FLOOR JOISTS (I73-7%S71 LVL(FLLS4 LOW WAU
TO BE INSTALLED PER -------
mw�xvv- -.-:aod
MANUFACTURER'S GUIDELINES _ eXl5Tl W LV �' ass wo
Y' LEDGER BOLTED TO i
EXI5TIN611011.�E FRAM NG �
AND SPECIFICATIONS I ad,It
t
x - POINT LOAD(FROM ABOVE; (3)P.T.2xa
m _
PROVIDE BLOCKING A e
A5 NEEDED)
AS ..O®DECK O N c
o ++ V M
+-j N cl-
0-0 �
>`s
ro'En N c ca
ca
1, "L
v E O
Lzll _o
U� '0'^ LL-
Vl O V)
O�
F I R S T F L O O R F R A M I N G P L A N Q
50 ALE, 1/4" - 1-0• - job no. 0104
date II JUNe 2OO"1
scale A5 NOTED
• dram KM
rev.
rev.
o A-6
"
" ISSUED FOR CONSTRUCTION sM: 6 of a
• � V c
u�i l.J
v A
Id
F
_ p C
M • A
G
A5 b
E
2X4 Us.J015T5 t j
•16'O.G. yi
l0 V
2X6 JOISTS 'lit C
.a,w.O.G.
Ln
2XB OLG.JOISTS - F
0 16'O.G. fd
_ B
. - A5 2X8 GL.JOISTS -
n 1�1 s
X8 G I
'1
. - oXB GLG.JOISTS -
- A5
(2)1 3/4'XX 4 1/4'L—L HOR -
_ - - i 2XB GLb.JOISTS -
5TRUGTUIRAL DE516N GRITERIA o16 oG.
R
- FIR5T FLOOR 40 P5F LL
15 P5F DL
- 5EGOND FLOOR 30 P5F q c A o 3
10 P5F -- s s "3
--- --- o o -
- - ATTIG/STO. 20 P5F F �m``
XB
10 PSF 2 6—JOISTS
rv0 rv0 rv® i
o�
ROOF 30 PSF (� E
Illl im
15 P5F
- EXT. WALLS 15 PSF OL
AS 2XB LLG.JOISTS
- INT. WALLS 50 PSF DL
o c. --- --- --- --- --- --- --- --- --- --- O Q)
- DEGKS/PORGHE5 60 PSF n n n �1� n n o O O rtJ
L 0-0 � �
(.� m
NC
Cz
. r�MOV�t �y Pp5
t� —(�eRFGE E'K 9ilt�i�AOE� Q V C
' - M(3)1 3/4'X 4 1/4'L`/U ILz$ L
C
NOTES c V)l0 O v
a n O> v
- INTERIOR LOAD BEARING WALL C E ILI NO FRAMING PLAN
x - POINT LOAD (FROM ABOVE) s G A L E. '/° -O Q
job no. 0104
dale 11 JJNE 2001
scale AS NOTEO
dawn KMW
rev.
rev.
0
0
h
" ISSUED FOR CONSTRUCTION ebt: -7 of a
e
-------- ...
e, t�
� U V
v � �
6 �
C
s
E
0
r r
----------------------------
� Frl rn
AS T U
2XB RAFTERS [j]
- - VOL. - ^ N
�XB NIPS w
V
3XB RA RS - - ❑
a�RAF ERS a
]XG RAFTERS - - -
ROOF PLAN 0*111E]
RAFTERS
B r � SCALE. I/H' a 1'-O 't
"
AS
. 3X8 RAFTERS i - - - - .
0
_ - (31 1 3I 3;a'x i v4 4vL NORy
3X8 RAFTERS EXISTING ROOF
RAFTERS TO REMAIN
(I 3/4' 9 1 'LVL RI BE (NO 5 T)
U V c e 16'OL.
meymo - o`Fw
eeeea
�0
L
I�
(I 1 3/4 X 4 D'L RIDE M(N WS TJ TES V
NO
------------------
j - ALL POSTS @ ENDS OF BEAMS TO BE C
K (2) 2X4'5/(2) 2X6'S,UNLESS NOTED O-0 W
L L
g p m ALL WINDOW HEADERS TO BE(2) 2X6'S N N
- _
D e `er - I' W/ 1/2 PLYWOO NLE55 NOTED N vi
0 16 oL. �� `qa D,U ++ .c� f0 �
O- ---' ¢ G LL-
- X° ! - ALL RIDGES OVER 20'-0" LONG V _
n• 2xH RAF ERG _=. TO BE (1) 1 3/4" X 9 1/4" to O'—+J O
n ol6'OL. -
- PROVIDE 2X8 LEDGER BOARDS,3g: u
OVERLAY FRAMING FOR RAFTER "0
BEARING/SUPPORT -0
M, X14T1 T_ - ALL RAFTERS TO BE 2X8
w r3(1 3/4•X q 1/4•Lvu 5.P.F. NO. 2 OR BETTER AT job no. : o-roa
16" O.G. TYPICAL SPACING date 11.LNE 2001
---------- -----------------
- INTERIOR LOAD BEARING WALL scale AS Noreo
ROOF FRAM I NG PLAN drawn KMw
rev.
SL ALE 1/4 1'-0-
rev.
a A-8m
4 ISSUED FOR CONSTRUCTION sbt: a of e
y
SOIL TEST PIT DATA: P-11508 SEPTIC TANK DETAIL: 1 ,500 GALLON DISTRIBUTION BOX DETAIL: NOT TO SCALE LEACHING DETAIL: NOT TO SCALE REVISIONS
NO. DATE DESCRIPTION
NOT TO SCALE NO. OF OUTLETS : 5 22.5
TEST PIT -#]- TEST PIT #2- TEST PIT -#.3 TEST PIT #4._ NOTES: 1. SEPTIC TANK SHALL BE STEEL 5. INLET AND OUTLET TEES TO BE CAST IRON, FINISHED GRADE o0 0 0 00 0 0 0 000 0 0 0 0 0 0 0 0 0 0 0 0 0
GRD. EL. 86.0 GRD. EL. 86.9 GRD. EL. 88.8 GRD. EL. 87.3 REINFORCED CONCRETE. SCHED. 40 PVC OR CAST-IN-PLACE CONCRETE. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
EST. HIGH GW. NO G. EST. HIGH GW. NO G.W. NO G.W. NO G.W. 2. SEPTIC TANK TO WITHSTAND H-10 LOADING TEES TO BE CENTERED UNDER MANHOLE COVER. REMOVABLE 2" WALLS NOTES: 0 °EST. HIGH GW. EST. HIGH GW. COVER A- ° THIGHUDENSITY
ITS 0°
UNLESS UNDER PAVEMENT, DRIVES OR
TRAVELED WAYS, WHEREIN H-20 LOADING 2"FILL 10YR 4 4 10YR 4/3 10YR 4/3 SHALL APPLY. .ti:�v..+,�:� .. , � .... . '• 1. DIST. BOX TO WITHSTAND H-10 LOADINGo° 50" 12' GENERAL NOTES:
T TUNLESS UNDER PAVEMENT, DRIVES OR 4 PVC o° POLYETHYLENE INFILTRATOR 3050 ° l
LOAMY AND " LOAMY SAND " LOAMY SAND 3. ALL PIPE CONNECTIONS AND CONCRETE " TRAVELED WAYS WHEREIN H-20 LOADING PIPE 0° 0 1 1. THIS PLAN IS FOR DESIGN AND
24" 12 12 O CONSTRUCTION SHALL BE WATERTIGHT. 2-24 DtA CONCRETE MANHOLES
0°00 00000 0 0000 00 00 000000000 0 00 0 00 00° CONSTRUCTION OF THE SEWAGE
-ITT
A B B B W/ METAL HANDLES BROUGHT +. 15" SHALL APPLY. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
10YR 4 4 10YR 6/8 1OYR 5V4 1OYR 5/4 4. FILL ALL UNUSED KNOCKOUTS WITH T 6" OF FINISH GRADE T DISPOSAL FACILITY ONLY.
/ LOAMY SAND LOAMY SAND LOAMY SAND MORTAR. TEE TO BE UNDER 6" " A 8" 2. PROVIDE INLET TEE OR BAFFLE WHERE 26.5' 2. ALL CONSTRUCTION METHODS AND
LOAMY SAND 30 2$ 36 M.H. OPENING 12" MIN. 5,5 OUTLETS SLOPE OF PIPE EXCEEDS 0.08 FT./FT OR MATERIALS SHALL CONFORM TO MASS.
" v.... • PLAN VIEW - LEACHING CHAMBERS D.E.P TITLE 5 AND LOCAL BOARD
32„ EL = 84.4 EL = 86.5 EL = 84.3 ���� .�C •: „i " e+ a ea '' 'oe o �' ve+ oe. � IN PUMPED SYSTEM. OF HEALTH REGULATIONS.
1 OYR 6/8 3 " a xi�� �� �� L 2" 3. FlRST TWO FEET OF PIPE OUT OF GIST.
LOAMY SAND RAISE M.H W/-� 4 BOTTOM ON LEVEL LOAM & SEED DISTURBED AREAS 3. ALL PIPES LOCATED UNDER PAVEMENT
47" 10'-6" SEWER BRICK �. - -- <: STABLE BASE 6" MIN. 3/4" TO BOX TO BE LAID LEVEL. OR TRAVELED WAY SHALL BE SCHEDULE
' = 1 1/2" CRUSHED 40 OR EQUAL.
EL = 82.6 10'_p" & MORTAR " -� CROSS-SECTION 4. ALL PIPE CONNECTIONS AND CONCRETE " "
NORMAL WATER LEVEL 12 STONE BASE CONSTRUCTION SHALL BE WATERTIGHT. 3 MAX. COMPACTED FILL 36 MAXIMUM 12 MINIMUM 4. THERE ARE NO KNOWN PRIVATE WELLS
60" °0° °0° °0 pO ° ° ° LOCATED WITHIN 150 FT. OF THE
�: o 0 0 o i i
r 3" 5. FILL ALL UNUSED KNOCKOUTS WITH MORTAR. ° ° o0 0 0 0 00 0 0 3 LAYER
10" 14" PEASTONE PROPOSED LEACHING FACILITY NOR
C C PRECAST SEPTIC TANK i 0 OD HIGH O 00 0 ANY KNOWN WELLS PROPOSED WITHIN
60" 1OYR 7 4 1OYR 7 4 1OYR 7 3 r INLET TEE =� 5'-1" 30 1/2" 30" 24" Qg O DENSITY 0 C3 REMOVE 150' OF ANY KNOWN LEACHING FACILITY.
/ / / _ p O POLYETHYLENE O O UNSUITABLE MEDIUM SAND MEDIUM SAND MEDIUM SAND _ -
5'-2. 4'-6" 5'-8" EFFEC. Q7 0 INFILTRATOR 3050 O O O MATERIAL FOR 5. WITHIN LIMIT OF EXCAVATION REMOVE
C _ 4'-0" MIN. S _: 15 1/2" DEPTH �O LEACHING O O 5' ALL AROUND ALL TOPSOIL, SUBSOIL AND OTHER
1 OYR 8f 4 z =' LIQUID DEPTH O O
MEDIUM SAND ' " ` '�`�
Q IF APPLICABLE IMPERVIOUS MATERIAL
5-8 :r PRECAST DIST. \ CHAMBER O \ 6. REPLACE ALL EXCAVATED MATERIAL WITH
_;. BOX 3/4" - 1 1/2" CLEAN GRANULAR SAND, FREE FROM ORGANIC
NO G.WATER „ NO G.WATER NO G.WATER NO G.WATER 47" - 50" 47" MATERIAL AND DELETERIOUS SUBSTANCES.
� ::•.:� :. :;.:��.-:': �.:.:_.���:: WASHED STONE
12' OF SOIL SHAL MIXTURES DL NOT BE USED. THE FILL SH LAYERS OF DIFFERENT ALL
EL = 75.5 126 EL = 76.4 12E� EL = 78.$ 120 EL = 77.3 2t1 �c BOTTOM ON LEVEL STABLE BASE �� 3" � � NOT CONTAIN ANY MATERIAL LARGER THAN
PLAN VIEW 7 1/2 22' TWO INCHES. A SIEVE ANALYSIS, USING A #4
DATE: 6" MIN. 3/4" TO �'X` '� TWO VIEW y�� � PLAN VIEW CRC SS-SECTION OF CHAMBER SIEVE, SHALL BE PERFORMED ON A
11/15/06 1 1/2" STONE REPRESENTATIVE SAMPLE OF FILL. UP TO 45y,
TEST BY: INDICATES BY WEIGHT OF THE FILL SAMPLE MAY BE
THE BSC GROUP, INC. y ESTIMATED RETAINED ON THE #4 SIEVE. SIEVE ANALYSES
SEASONAL HIGH l ALSO SHALL BE PERFORMED ON THE FRACTION
WITNESSED BY: - FND OF FILL SAMPLE PASSING THE #4 SIEVE, SUCH
DAVID W. STANTON GROUND WATER TOWN OF BARNSTABLE REQUIRES AS-BUILT COUNTY BOUND DESIGN CRITERIA: ANALYSES MUST DEMONSTRATE THAT THE
MATERIAL MEETS EACH OF THE FOLLOWING
PERC. RATE: INDICATES CERTIFICATION. SOIL EVALUATOR TO E SPECIFICATIONS:
y OBSERVED DESIGN FLOW: 1007 MUST PASS #4 SIEVE
2 MIN./INCH - GROUND WATER INSPECT BOTTOM OF EXCAVATION PRIOR 3 BEDROOMS AT 110 G.P.B./D 330 G.P.D. 10% 00� MUST PAS EFFECTIVE SI PARTICLE
E SIZE)
SOIL EVALUATOR TO ANY INSTALLATION AND ALSO PRIOR (0.30 mm EFFECTIVE PARTICLE SIZE)
MARK DIBB INDICATES TO FINAL BACKFILLING
SOIL CLASS: PERC. (0.15 mm EFFECTIVE PARTICLE SIZE)
. - • MUST PASS #100 SIEVE PASS
0 SIEVE
ST
TEST REQUIRED SEPTIC TANK: �(0.075Umm EFFECTIVE PARTICLE SIZE)
1
330 X 200% = 660 GAL. 7. EXISTING UTILITIES WHERE SHOWN
L.T.A.R. INDICATES IN THE DRAWINGS ARE APPROXIMATE.
0.74 G.P.D./SQ.FT. UNSUITABLE SEPTIC TANK PROVIDED: = 1500 GAL. THE CONTRACTOR SHALL BE RESPON-
SIBLE FOR PROPERLY LOCATING AND
COORDINATING THE PROPOSED CON-
DATUM: ISIZE OF LEACHING FACILITY REQUIRED:
STRUCTION ACTIVITY WITH DIG-SAFE
AND THE APPLICABLE UTILITY
VERTICAL DATUM: ASSUMED DESIGN PERC. RATE: <2 MIN./ INCH COMPANY AND MAINTAINING THE
EXISTING UTILITY SYSTEM IN SERVICE.
FND LONG TERM APPL. RATE 0.74 G.P.D/S.F. DIG-SAFE SHALL BE NOTIFIED PER
BENCH MARK THE STATE OF MASSACHUSETTS
BENCH MARK SET: TOP OF CONCRET BOUND ELEV. 86.34 TOP OF CONCRETE BOUND CS D� _ STATUTE CHAPTER 82, SECTION 409
ELEVATION 86.34 (ASSUMED DATUM) FN OFF
_ 330 GPD 0,74 GPD/SF - 446 S.F. AT TEL. 1-888-344-7233. THE
„_._._ ---- _
GRAVEL RIVEWAY UP ENGINEER DOES NOT GUARANTEE
f, � --`' J
PROFILE: NOT TO SCALE ,r` THEIR ACCURACY OR THAT ALL
• / / S 862 -20 W UTILITIES AND SUBSURFACE STRUCTURES
EL.=A /�. 7 O� SIZE OF LEACHING FACILITY PROVIDED: ARE
IEVAHOWN OFO CATIONS AND UTILITIES
FIRST PIPE LENGTH ' i' ` FND�OFF o
USE HIGH DENSITY POLYETHYLENE
TAKEN FROM RECORD PLANS. THE
TOP FOUNDATION " / ; r I } z LEACHING CHAMBERS(3 UNITS) 12'X2'X26.5' CONTRACTOR SHALL VERIFY SIZE,
CONCRETE COVERS G DE. TO BE SET LEVEL s' r,
EL.=X 6 OF FINISHED GRADE. FOR MIN. 2 / � �;f' � N OFF �p � I
j I LOCATIC;ri AND INVERTS OF UTILITIES
AND STRUCTURES AS REQUIRED PRIOR
EL.FINIS85.4-6E0 / SIDEWALL = 2(12 +26.5 ) X `2` = 154 TO THE START OF CONSTRUCTION.
-_ 4 PVC SCH 40 BOTTOM = 12' X 26.5' = 318
. 4 PV 4" CHAMBER 1`E ` t 472 of S sY2T1=:.? ! rkd2T:iEY o !Ef3 F;)E :.
a CH 4 PVC SCH 4 LEACHING CHAMBER ,-,6 , � � O cow
__ E. , -
lp,e1-1
PROPOSED 25.5' X 12' 6 �'1 11-0' ` ` THE USE OF A GARBAGE GRINDER.
SON. g M: yQO' 1 .�..� ` ,_ >i3; 472 S.F X 0,74 GPD/SF = 349 GPD A GARBAGE GRINDER IS NOT
I-B �I=D I=G �.. I rn CpAgj� a RECOMMENDED DUE TO RECOGNIZED
I=E H INSPECTION PORT '7 1P#E I ss
I= .,� FIEF ADVERSE IMPACTS TO THE LEACHING
26.2 FACILITY.
Na 380�
o: C 5 OUTLET I-F 10 BED 1 BED e /
DIST. BOX SEPARATION N w i f-_4 u�o I of
SEPTIC TANK _- I
9. EXITING INVERTS ARE TO BE CHECKED BY
THE CONTRACTOR PRIOR TO CONSTRUCTION.
-- '
EST. HIGH GROUNDWATER � �`•r 22 6' BATMJ FHFOU9 3 LR •�• CONFIRM LOCATION & NUMBER OF INVERTS.
1 -
#1 20.0' N TOF-91.4 481' rn = . 0. THE ENGINEER IS TO BE NOTIFIED OF
• N INV-85.6 rn _ ANY FIELD CHANGES THAT MAYBE
41.8' 1 I +- ` y/z�/D7 REQUIRED.
OFFICE _8.0 PORCH x
INVERT ELEVATIONS: 7LLEACHINGI PIT) DE K SUN NTH
OVERHANG y LOCUS INFORMATION
PORCH KITCHEN/r� W
PROPOSED D-� CES DININGGROtR
TOP OF FOUNDATION 91.4 A PROPOSED 1,500 P 18.3' S.a ---� CURRENT OWNER: EDWARD WYSOCKI
4" INVERT AT BUILDING 85.6 B GALLON SEPTIC
I 0 TITLE REFERENCE: BOOK 11465, PAGE 194 349 Main Street, (RT. 28) Unit D
SHED C: W.Yarmouth Massachusetts
4" INVERT AT SEPTIC TANK (IN) 83.50 C ' �' 81VMINOUS DRIVEWAY
PLAN REFERENCE: BOOK 164, PAGE 89 02673
4" INVERT AT SEPTIC TANK OUT 83.25 D , ' �' Z " 5087788919
( } TP 4DNG SEW , - ASSESSORS MAP: 9
4" INVERT AT DIST. BOX (IN) 83.15 E N//FF � ,W °ro L9 �F `,f` I PARCEL: 14
„ HOLY GHOST OF SANTUIT & COTUIT f ,�:: w a PROJECT TITLE:
4 INVERT AT DIST. BOX (OUT) 82.98 F ASSESSORS MAP 9 ,�
PARCEL 15 f PRO SED �' o F' o W ZONING DISTRICT: RF
RE RVE C�F m SETBACKS: FRONT 30' DESIGN FOR
INVERTS AT LEACHING FACILITY: -4I �y(NOFMASs gc SIDE 15
,/ �-�SEWER FOR AMn __ y I �a �a=� MARK D. y�� REAR 15 SEWAGE DISPOSAL
4" INVERT AT BEGINNING o �, d CIVIL
,, / �'-'' ` ,4 �yF DIBB MINIMUM LOT SIZE: 87,120 S.F.
co
OF LEACHING CHAMBER 82.50 G BREAKOUT EL=83.00 , �' �� I ,I o A N°'45937� Q EXISTING LOT AREA: 32,517fS.F. SYSTEM UPGRADE
�D cn ,/ f UPL pF
ELEVATION AT BOTTOM o ,/ / �` /� ` FSQorsiTr►I�ti:�'G���' OVERLAY DISTRICT: GP
OF LEACHING CHAMBER 80.50 H � ,�` 91 ®.. •� I I NITROGEN SENSITIVE
r-
> N/F � --�--` I � ` ZONE: ZONE II #61
EDWARD WYSOCKI 1 •9
AS PARCEL MAP 9 ( I I FEM A FLOOD MAIN S TR E E T
14 ZONE DISTRICT: ZONE C AS SHOWN ON
NO OBSERVED GROUNDWATER r 32,517fs.F. y/ 7
I ` 25 ZO o PANEL #250001 0021 D COTU I T
BOTTOM OF HOLE 75.5 J 4 I I DATED JULY 2, 1992
LOCUS PLAN: NO SCALE
M ASSACH U SETTS
�HYD
VARIANCES REQUESTED: 28
I LOCUS
SCDONER RD PREPARED FOR:
NONE `� PICKET FENCE ) EDWARD WYSOCKI61 MAIN STREET
- w
COTUIT, MA 02635
\ S 8169.99' -- ✓� _ 508-428-9975
,J z DATE: APRIL 25, 2007
o COMP. DESIGN: K. HEATY
N F 0 CHECK: M. DIBB
PLAN VIEW ROBERT & FIAONA JENSEN 3 Z �y N
DRAWN: P. HAGIST
ASSESSORS MAP 9 3 J�� 4
PARCEL 13 f-� A FIELD: D. GAZZOLO / J. MCCARTIN
SCALE: 1 = 20 FEET FILE N0. 9180-SEP.DWG
0 10 20 40 FT. DWG NO. 5769-01
JOB NO. 4-9180.00 SHEET 1 OF 1