Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0020 DAVID STREET - Health
20 DAVID S EE7, OS7��VILLe 4 �k I y� y l No. 4210 1/3 BGR LA p ESSELTE 10 r;4, kv � r M h� V ^` V if IGG y� 1 07We -7 a7-- Commonwealth of Massachusetts ` - a Title 5 Official Inspection Forin A ° w_. ' .al Subsurface Sewage Disposal System Form =Not.for Voluntary Assessments _ -ra 20 David St - Property Address Larry & Barbara Thomas Owner Owner's Name information is required for every Osterville MA 02655 6-20-18 I� page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. A. General Information -1. Inspector:., ,a;✓ tk r,t _ a' t 1. . r Ff !i a!r . ' !}f ij' ,F. i Shawn Mcelroyf•. Name of Inspector Upper Cape Septic Services Company Name P.O. Box 73 ,fr.t, t [I Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S13971 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage-disposal system at this address and that the information reported.below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function,and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000).•The system: I, ®,,Passes , a : I �„ ❑ pond itionally.Passes ❑= Fails- 7 3t'_ r•!.• t�tr' Sri: . - �aV, !I .. •1. fA ! .. ., ' 3 ❑ Needs Further Ev the Local Approving Authority s ; 6'20-18 . .. . nspector's Signature Date The system inspector shall submit a'copy'of this'inspection report to,the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time.of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts ii Title 5 Official Inspection Form N Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r.Vrtil ' 20 David St Property Address Larry& Barbara Thomas Owner Owner's Name information is required for every Osterville MA 02655 6-20-18 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: >. ' ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: System is in good working order with no sign of failure. B) System Conditionally Passes: ❑ •One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. . Check the box for"yes", "no"or"not determined" (Y, N, ND) for the.following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y . ON - ❑ ND (Explain below),: t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 I F Commonwealth of Massachusetts _ ,+ y Title 5 Official Inspection Form ' ry w.. Subsurface Sewage Disposal System Form-Not for Voluntary Assessments+.I a I. 20 David St Property Address f• Larry & Barbara Thomas r Owner Owner's Name information is Osterville ` required for every MA 02655 6-20-18 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired: `` 13), System Conditionally Passes (cont.): ❑ Observation of'sewage backup or break out or higli`static water:eve in the distribution box due to broken or'obstructed pipe(s)or due to a broken, settled or uheven'distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipes) are replaced ❑ Y ❑N E ,ND (Explain below): ' ❑ obstruction is removed' T_ ` ` ' ; g ❑ Y ❑N '❑''ND,(Explain below): r M 1 El distribution box is leveled or replaced Fly- El �N ❑ •NfD'(Explain below): , `, , , M. 1 ..� . fry • 1•L i � 1 -. ♦ 1 • .:f, .. i1 �„ f xJ ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑Y. ❑N ❑ ND (Explain below): ❑ obstruction is removed El ON ❑ ND (Explain below): C), Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. ' �1.``8ystem will'pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, ` `"fety,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 [t5,n..doc•rev.6/16 , Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 r Commonwealth of Massachusetts II Title 5 Official Inspection Form ,A i t Subsurface Sewage.Disposal System Form -Not for Voluntary Assessments > : 20 David St Property Address Larry & Barbara Thomas Owner Owner's Name information is required for every Osterville MA 02655 6-20-18 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ' 2. System will fail unless the Board of Health(and,Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: I . , a ❑The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑The system has'a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑The system has a septic tank and SAS and,the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: r D) System Failure Criteria Applicable to All Systems: You must indicate "Yes"or"No"to each of the following•for all inspections: Yes No El ® Backup of sewage into facility or system component due to overloaded or +clogged SAS or cesspool ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ® Static liquid level in,the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ �® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Foru *I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 20 David St ,+ Property Address r Larry& Barbara Thomas Owner Owner's Name information is Osterville f:. MA 02655 6-20-18 required for every page. Cityrrown ,.; State Zip Code Date of Inspection B. Certification (cont.) ; Yes., .. No ,{,j El ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: t •=~0,. • ®.r r+. -fAny portion of the SAS, cesspool,or,privy is below high ground water elevation. Any portion of cesspool or privy is within 100 feet of a surface water supply or ;. r r,, - ❑e ,t ® f tributary tofa surface water supply: . . , rr E,' ;❑ ;},s ® r �a,. Any portion of a cesspool or privy is within a Zone 1 of a"public well. �''T ❑ w ® � !iAny portion of a cesspool or privy is within 50 feet of a private water supply,well. ❑ ® Any portion'of a cesspool or,privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This w.,; 'system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence .,of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody,must be attached to this form.] The system is a cesspool serving a facility with a design flow of 2000gpd- +:❑ ® „t.10,000gpd:•., The system fails. I have determined that one or more of the above failure ❑ ® criteria exist as described in 310 CMR 15.303,therefore the system fails. The _„;, system owner should contact the Board of Health to determine what will be • •, •_ ~_necessary to correct the failure: E) Large Systems:To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. - . IT For large systems, you must indicate either"yes",or"no"kto each of the following, in addition to the t, questions in Section D:. t _ tti=2r'T`', 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(El Area IWPA) or a mapped Zone II of a public water supply well If you have.answered "yes"to an y y y question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins.doc-rev.6/16 _ Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 r Commonwealth of Massachusetts , ,'. Title 5 Official Inspection Form ';I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments } Yr 20 David St Property Address Larry& Barbara Thomas Owner Owner's Name information is required for every Osterville MA 02655 6-20-18 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components'pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been.introduced to the system recently or as part of this inspection? ® Were as built plans of the system obtained and examined? (If they were not available note as N/A) t®. ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ` ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® - ' 0 Wasthe facility owner(and occupants if different from owner) provided with information on the'proper maintenance'of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: a ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information . Residential Flow Conditions: Number of bedrooms (design): Number of bedrooms (actual): 3 i DESIGN flowbased on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 r Commonwealth of Massachusetts ,..:, ,`. Title 5 Official Inspection- Form > .'.a - i4 Subsurface Sewage Disposal System Form -Not for4Voluntary Assessments r 20 David St Property Address Larry& Barbara Thomas Owner Owner's Name information is OStervllle +"' .. required for every MA 02655 6-20-18 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection El Yes ® No information in this report.) ' �, . Laundry system inspected? r t.3, ❑ Yes ® No Seasonal use? ` - F. •,� ❑ Yes ® No Water meter readings, if available last 2 years usage Detail: .rl •p a Sump pump? - �,- , ,. , .r f,fF;, }: r. ❑ Yes ® No Last date of occupancy: , r 6-2018 Date Commercial/Industrial Flow Conditions: ,;t Type of Establishment: -r Design flow.(based on 310 CMR 15.203):. t ' Gallons per day(gpd)' ,, ,, • `,.; Basis of,design,flow(seats/persons/sq.ft.,.etc.): Grease trap present? r ,. a. , ❑ Yes ❑ No Industrial waste holding tank present? i - , .,, _tr i= hi }- ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? - ❑ Yes ❑ No Water meter readings, if available: t5ins.doc-rev.6/16 a. c Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form ! I, Subsurface Sewage Disposal System Form =Not for,Voluntary Assessments ,lcl ;> 20 David St Property Address Larry & Barbara Thomas Owner Owner's Name information is required for every Osterville MA 02655 6-20-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Owner--pumped 2015 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Moved Tank Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): - t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts .; Title 5 Official Inspection Form , � k i Subsurface Sewage Disposal System Form -Not for,Voluntary'Assessments , ,..._ . r.� 20 David St Property Address Larry& Barbara Thomas • , , Owner Owner's Name information is Cisterville .• MA 02655 6-20-18 . required for every v page. City/Town « State Zip Code Date of Inspection D. System Information (cont.) •�.t r; =. Approximate age of all components, date installed (if known) and source of.information: 1996 14 Were sewage odors detected when arriving at the site? Yes ® No Building'Sewer(locate on site plan):,-f ., •;,' �, d,.,a.,. „ Depth below grade: t' ► x, ,- . .� rr � ., 24�� feet t Material of construction: ❑ cast iron ® 40 PVC' ❑ other(explain):`'' kt .. L.eri.,%+ Distance from private water supply dell or suction`line:6� ' feet Comments (on condition of joints, venting, evidence of leakage, etc.): Good condition. Septic Tank(locate on site plan): . 18" Depth below grade: Material of construction: _. ;• ® concrete ❑ metal ❑ fiberglass r t.❑ polyethylene,'-' ❑ other(explain) If tank is metal, list age: yeas" Is age confirmed by a Certificate of Compliance? (attach'a,copy of certificate) ❑ Yes ❑ No 1500 gal_ Dimensions: , 1211 Sludge depth:. t5ins.doc•rev.6/16 k . Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts r� ,w Title 5 Official Inspection Form bi Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 20 David St Property Address Larry & Barbara Thomas Owner Owner's Name information is required for every Osterville MA 02655 6-20-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 20" Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 15" How were dimensions determined? Tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is in good condition with baffles installed and no sign of leakage. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle ' Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection, Form` , Subsurface Sewage Disposal System Form =Not.for Voluntary Assessmentsi l*.,,war 20 David St Property Address •.,- Larry& Barbara Thomas Owner Owner's Name R information is , required for every Osterville : MA 02655 6-20-18, C page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee orrbaffle condition, structural integrity, liquid levels as related to outlet invert, evidence of•leakage,'etc.):' `� "' ' i, t Tight or Holding Tank (tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: i ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons,' Design Flow: gallons per'day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 i t Commonwealth of Massachusetts ' Title 5 Official Inspection Form t r-i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 20 David St Property Address Larry& Barbara Thomas - Owner Owner's Name information is required for every Osterville MA 02655 6-20-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Good condition with water at working level and no sign of back-up from field. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order:, ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts ,w Title 5 Official Inspection Form /C�i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments—. 20 David St Property Address Larry & Barbara Thomas f= r. ,•a l Owner Owner's Name information is O SteNllle - ^r required for every MA 02655 6-20-18; page. City/Town state Zip Code Date of Inspection D. System Information (cont.) i •. F; i , . , Type:• ❑ leaching.pits number: ® leaching chambers number: 3-Recharger 330 s ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields ,,.-number;dimensions:I' ❑ overflow cesspool .number:,. ❑ innovative/alternative system � ,,w �• Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of.ponding, damp soil, condition of vegetation, etc.): , , Leach chambers in good working order and holding 8"of water with sign of back-up. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form t�l Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 9 p Y rY a •• �,:jr7 ,,r.•�-„, 20 David St Property Address Larry & Barbara Thomas Owner Owner's Name information is Osterville MA 02655 6-20-18 required for every ' page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments°(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts ,I . . ,•' f Title 5 Official Inspection Fora ` <i,.i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments, a. 20 David St Property Address Larry & Barbara Thomas Owner Owner's Name f .• information is required for every Osteiville,.'_ MA 02655 6-20-18:f ` page. City/Town State Zip Code Date of Inspection D. System Information (cont.) L r Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: y� 1 ® hand-sketch in the area below ❑ drawing attached separately 4CL , if A I I tt� 4 � + r e 4 .1 - f:s 't .. J '..C.rg ,..C r,.i'� °"ti<.3�..., r1 +1.l; r• 1. �.�' .. i r r� IT .. .xs t " f r r ..�.. . z f . y ;rr !'e r'i tt"..".... -r s f rat. rir 1 �('r - • � 'i t5ins.doc-rev.6/16 n , Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary r i Assessments 9 P Y rY 20 David St Property Address Larry& Barbara Thomas Owner Owner's Name information is required for every Osterville- MA 02655 6-20-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) . Site Exam: ❑ Check Slope } ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 12' feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: ® Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database- explain: You must describe how you established the high ground water elevation: Original design plans show no groundwater at 12'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 l Commonwealth of Massachusetts ,w Title 5 Official Inspection Form hi Subsurface Sewage Disposal System Form -Not for Voluntary f S 9 P Assessments r a r, 20 David St - - Property Address Larry & Barbara Thomas Owner Owner's Name information is required for every Osterville MA 02655 6-20-18 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 TOWN OF BARNSTABLE LOCATION 20 'bA V 9 l SEWAGE# QOT5-� VILLAGE '4+ r'I�M o""?ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. C � arN 1fi�f�'�r,✓ ��'z SEPTIC TANK CAPACITY �'+ � L'IZ�t,✓t l( '�Z� �_ ` (n�l.e✓ LEACHING FACILITY. (type) (s}z� G� NO.OF BEDROOMS OWNER PERMIT DATE: 17 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 feet of leaching facility) Feet FURNISHED BY C � j 'T'+D'Vt 0 $INSTABLE jNSTAL�.EXt'5 i+IAA��Pi~IOI�tB bIO. . c TAIL CAPA % fir Q/ os 44 T II TG 1P,�CAL'Try .Etyps) is $0 OtSPROOM :1UII,ippl�.QR ollAil R:::.. FBRNXiTiD�.T�i GOtl�C.YAt4TC,ir Sepuuattoa�tseunn�c3 Betvieen�:' ,,. tti Eslit icet e tl e$attpm o£iE►. Maximutm;A.d�us�Grputedw�tet'!'abl : , Y , 1'tv 8e w... r Stt iy vles t attd I. itiin� l'aalf�y`�fm�Y_yetis nufst otot sate or wltlt tt 200�e�tt a�laae1 f cilh}') jtet wetletws st Er cad ifltct�ttt ottd I. ►cihing Pc�Ity, y . Foe w}ttain: OQ fcef pf ear ifog lt:urnf sited iti �d' q,) Eo CIE] - - Cj � 1 � 1 n 1 �9,3 W W No. �e Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF. BARNSTABLE, MASSACHUSETTS fipritation for Nsposal §�pstetn Construttion i3ermit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components X Location Address or Lot No. �,p Owner's Name,Address,and Tel.No. Assessor's Map/Paicel 65f 1 1 �'b X ZAIR Installer's N Address,and Tel No. l Desig s Name,Address,and Tel.No. t. �j�' ;1&( c wtll �.�' n (i fir` f�{ et A - 6 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) N - gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 40 4�Z � 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 Compliance has been issued by this Board of HeafVh. Signed '" Date!S Application Approved by �^ Date �S Application Disapproved by Date for the following reasons Permit No. 6 Date Issued _ 01 � � llll No.;dl v Fee / SV THE COMMONWEALTH-OF MASS.ACHUSETTS Entered in computer: ,. 'P;UBLIC HEALTH DIVISION - TOWN OF, BARNSTABLE, MASSACHUSETTS Yes 2pplication for Disposal 6pstem Construction Permit � , r 5% Application for a Permit to Construct( ) Repair( -) Upgrade( ) Abandon( _) ❑Complete System ❑Individual Components X, Location Address or Lot No. 2,0 0/11//1Q S j/?g4-r1 Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 6C2+ 1 L 1 (� x Installer's Name,Address,and Tel.No. L , Designees Name,Address,and Tel.No. e�q-fl A 1 4 Type of Building: Dwelling Bedrooms tt Size sq.ft. Garbage Grinder( ) M Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) n/4- gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title d Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: I 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 issued by this Board of Heath. � 1 t *` \ SignedX �" Date Application Approved by -'�� - Date A Application Disapproved by Date for the following reasons f Permit No. 6 6 Date Issued ---------------------------=----------------------------------------------------------------'------------------------------------------ �IL, 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 X at D �t]✓��r t 1441,g hag been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.d O r5^ b dated Lf �� /5 . Installer Designer #bedrooms N Approved design flow gpd The issuance of thi!A it shall not be construed as a guarantee that the system wil ctio, as designed. Date 1 Inspector i No. a o 1 15 D O� _ Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon �( System located at Ro l�ArC "�- i1a!✓/�i� and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date Lf — t-( Approved by Commonwealth of Massachusetts , Title 5 Official Inspection Form R o . Subsurface Sewage Disposal System Form -Not for Voluntary Assessments yyea 20 DAVID STREET Property Address O`LEARY Owner Owner's Name information is required for OSTERVILLE MA 02655 0410212012 every page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way.:Please see completeness checklist at the end of the form_. Important: A. General Information When filling out forms on the computer,use 1. Inspector: only the tab key to move your A.RIKER cursor-do not Name of Inspector use the return key. R.L.C. —�, Company Name P.O. BOX 726 Company Address SOUTH YARMOUTH MA 02664 Cityrrown State Zip Code 508-776-6460 S14590 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information.reported below is true, accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 16.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 04/02/2012 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable,.and the approving authority. ****This report only:describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. 5 ib t5ins-11/10 Title 5 Official Ins on rtn:Subsurface Sewage Disposal System-Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 20 DAVID STREET Property Address O'LEARY Owner Owner's Name information is required for OSTERVILLE MA 02655 04/02/2012 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E!always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not.evaluated are indicated below. Comments: ON INSPECTION OF SYSTEM THE WERE NO INDICATIONS OF FAILURES OBSERVED. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system, upon completion.of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not determined (Y, N,ND)for the following statements. If"not determined,"please explain. , The septic tank is metal and over 20 years old' or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y. ❑ N. ❑ ND(Explain below): t5ins•11/10 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 20 DAVID STREET l Property Address O'LEARY Owner Owner's Name information is required for OSTERVILLE MA 02655 04/02/2012 every page. City/Town State Zip Code Date of Inspection B. Certification (coat.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ -broken pipe(s)'are replaced `❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain' below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below):. ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): S C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if' the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system.is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts a Title 5 Official Inspection Form Subsurface Sewage Disposal System form-Not for Voluntary.Assessments 20 DAVID STREET Property Address O'LEARY Owner Owner's Name information is required for OSTERVILLE AAA 02655 04/02/2012 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier,if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. . ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well.. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the.well-water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System failure Criteria Applicable to All Systems: You must indicate "Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged'SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® 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 Y2 day flow t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official lbspection Fora F Subsurface Sewage Disposal.System Form -Not for Voluntary Assessments M r•'' 20 DAVID STREET Property Address O'LEARY Owner Owner's Name information is required for OSTERVILLE MA 02655 04/02/2012 every page. CitylTown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS,cesspool or privy is below high ground water elevation. ® Any portion of cesspool or privy is within'100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ Any portion of a cesspool,orprivy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 6 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ Z The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary,to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone 11 of a public water supply well If you have;answered"yes"to any question in Section E the system is considered a-significant threat, or answered "yes" in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•11110 Title 5 Official Inspection Form:Subsurface Swage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,. 20 DAVID STREET Property Address O'LEARY Owner Owner's Name information is OSTERVILLE MA 02655 04/02/2012 required for every page. Cityfrown State Zip Code Date of Inspection C. Checklist Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health El 0 Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components,excluding the SAS,located on site? ® ❑ Were the septic tank manholes uncovered,opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has .been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field(f any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): $ DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms)-- 330 GPD t5ins•11/10 Tide 5 Official Inspection Form:,Subsurface Sewage Disposal System-Page 6 of 17 J Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 20 DAVID STREET Property Address O'LEARY Owner Owner's Name information is required for OSTERVILLE MA 02655 04/02/2012 every page. City£rown State Zip Code Date of Inspection D. System Information tDescription: PROPERTY WAS VACANT AT TIME OF INSPECTION Number of current residents: y 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available{last 2 years usage (gpd)): 2011= 36 GPD2010= 77 GPD Detail: RECORDS OBTAINED FROM COMM WATER DEPT. Sump pump? ❑ Yes ® No ' Last date of occupancy: 2011Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day'(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? '❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: tSins-11110 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 official Inspection Foram Subsurface Sewage Disposal System Form-Not for Voluntary Assessments s. 20 DAVID STREET Property Address O'LEARY Owner Owner's Name information is required for OSTERVILLE MA 02655 04/02/2012 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: UNK. Date Other(describe below): General Information Pumping Records: Source of information: WASTE WATER DEPT. Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? RECOMMENDED EVERY TWO YEAR FOR Reason for pumping: MAINTENCE. 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/Altemative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. El Other(describe): t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 •� Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form-.Not for Voluntary Assessments M 20 DAVID STREET Property Address O'LEARY Owner Owner's Name information is required for OSTERVILLE MA 02655 04/02/2012 every page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) Approximate age of all components, date installed (f known)and source of information: 02/1996 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints,venting, evidence of leakage, etc.): NO LEAKAGE OR STAINING OBSERVED ON INTERIOR SOIL PIPE CONNECTIONS. Septic Tank(locate on site plan): Depth below grade: feet Material of construction: .0 concrete ❑metal ❑fiberglass ❑ polyethylene ❑ other(explain) 1500 GALLON PRECAST CONCRET SEPTIC TANK If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 10'6"X5'8"X5'8" Sludge depth: 10" t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form-'Not for Voluntary Assessments 20 DAVID STREET Property Address O'LEARY Owner Owner's Name information is required for. OSTERVILLE MA 02655 04/02/2012 every page. Citylrown State Zip Code Date of Inspection D. System Information. (cunt.) Septic Tank(cunt) Distance from top of sludge to bottom of outlet tee or baffle .24" Scum thickness 4"4" Distance from top of scum to top of outlet tee or baffle 5° - Distance from bottom of scum to bottom of outlet tee or baffle ills How were dimensions determined? Sludge Judge/measure stick Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): No indications of failure observed,PVC tee ys were present and at correct invert elevations: Grease Trap(locate on site plan): Depth below grade: feet Material of construction: .❑ concrete ❑ metal ❑fiberglass • ❑ polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-11 J10" _ Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments s 20 DAVID STREET Property Address O'LEARY Owner Owner's Name information is, required for OSTERVILLE MA 02655 04/02/2012 every page. City/Town State .Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete El metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order. ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alamt and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 J Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 20 DAVID STREET Property Address O'LEARY Owner Owner's Name information is OSTERVILLE MA 02655 04/02/2012 required for every page_ City/Town State Zip Code Date of Inspection D. System,Information (cunt.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert at invert C 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.): No evidence of carry-over or high stain lines. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No . Alarms in working order: ❑ Yes ❑ No Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for'Voluntary Assessments , 20 DAVID STREET Property Address ULEARY Owner Owner's Name information is required for OSTERVILLE MA 02655 04/02/2012 every page. Citylrown State Zip Code Date of Inspection D. System Information (font.) Type: ❑ leaching pits number: ® leaching chambers number: U330 rechargers w/stone ❑ . leaching galleries number. ❑ leaching'trenches number, length: ❑ Teaching fields number,dimensions: . ❑ overflow cesspool number. ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure,level of ponding, damp soil, condition of vegetation, etc.): Soils above S.A.S.were free of odor or effluent staining. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer .Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 20 DAVID STREET Property Address ULEARY Owner Owner's Name information is required for OSTERVILLE AAA 02655 04/02/2012 every page_ Cityrrown State Zip Code Date of Inspection D. System Information- (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): r i J t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fora _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments s 20 DAVID STREET Property Address O'LEARY Owner Owner's Name information is required for OSTERVILLE MA 02655 04/02/2012 every page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately 5 � Q 0 A �ear A. y= y3 3 E �z 6� B 3 = 18 ©q tsiris-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments . 20 DAVID STREET Property Address O'LEARY Owner Owner's Name information is required for OSTERVILLE MA 02655 04/02/2012 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cost.) Site Exam. ' ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water. >15feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health-explain: C.O.C. DATED 02/21/1996 ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USG database-explain: You must describe how you established the high ground water elevation: ABUTTING PROPERTY ELEVATION GREATER THEN 15+ FEET.BELOW S.A.S.WITH NO STANDING GROUND WATER.THIS PROPERTY IS BUILT ON AN ELEVATED LOT. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11/10 Tine 5 Official Inspection Form:Subsurface Smage Disposal System-Page 16 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 20 DAVID STREET Property Address O'LEARY Owner Owner's Name information is required for OSTERVILLE MA 02655 04/02/2012 every page. Cityfrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A,.B, C, D, or E checked ® inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file I t5ins 11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal Systern•Page 17 of 17 TOWN OF BARNSTABLE ;LOCATION ® Z2 A f//6l' SEWAGE # / 4 `- Q VILLAGE CI .5'Te R Vi 1f C ASSESSOR'S MAP &LOT �"6 76 INSTALLER'S NAME&PHONE NO. Lrl"52 /✓/1 C O-Ai deif •- .0 SEPTIC TANK CAPACITY /.S o . LEACHING FACILITY: (type) 3 ` "C YA 9 G --,Z (size) S NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: Z—2-G8 V:K' COMPLIANCE DATE: 7/r �lg 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 Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by C b 9 � 1 � ♦ A i r s _ No.L4W Fee 0• 0� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01pplication for MigpOgal *pgtem Cungtructiun Permit Application is hereby made for a Permit to Construct( )or Repair YXXan On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. 4 2 8_9 4 4 8 20 David Street William Leary Osterville ,Mass . 02655 20 David Street Osterville Mass . Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 5 8_'�'�5—3 3 3 g 50 g_7 7 5s 333g J.P.Macomber Jr. J.P.Macomber Jr. Box 66 Centerville ,Mass , 02632 Box 66 Centerville ,Mass . 02632 Type of Building: Dwelling X No.of Bedrooms 2 Garbage Grinder f o ) Other Type of Building NONF No. of Persons 2 Showers(1 ) Cafeteria(0 ) Other Fixtures Wa t P r n l n P t 2---,1 n k s Design Flow 330 gallons gallons per day. Calculated daily flow 2 x 1 1 f,=2 2 Q gallons. Plan Date_2/2 02 96 Number of sheets 2 Revision Date none Title Description of Soil T am a mar s a n d t o m P d i »m .11 A M r9 Nature of Repairs or Alterations(Answer when applicable) Omit cesspools . Install. 1 --1 5 0 0 gallon tank and 1 Distribution box and 3--330 Rechargers ,Packed in stone with a pea stone cap. 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 ode and not to place the system in operation until a Certifi- cate of Compliance has been iss d by th' B d ealth. Signe 7 ° Date 2/2 0/9 6 Application Approved by g Application Disapproved for the following reasons Permit No. Date Issued_ 3' 'No. -Fee 40 00 THE COMMONWEALTH OF MASSACHUSETTS i OUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS t' Appritation for Migpool *p50m Cottgtructiott Permit Application is hereby made for a Permit to Construct( )or Repair XXXan On-site Sewage Disposal System at: Location Address or Lot No. - Owner's Name,Address and Tel.No. 428-�9448 20 David Street William Leary �., . . Osterville.Mass. 02655 20 David Street Ostervilla .Mass. a Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 508-775-3338 J.P.Macomber Jri r 508-775-3338 i J.P.Macomber. Jr. Box 66 Centerville,Mass. 02632 Botx66 CentervilleuMass. 02632yy l Type of Building: + Dwelling X No.of Bedrooms 2 Garbage Grinder No Other Type of Building. NONE No.of Persons 2 Showers(1 ) Cafeteria(0 ) Other Fixtures Water closet 2—.'inks i Design'Flow 330 gallon.g gallons per day. Calculated'daily.flow'-2x12 l-M gallons. Plan,Date 2f 2OZ96 Number of sheets 2 `` Revision Date none ,Title P Description of Soil Loamy san'c3 .to mp(hhum aqn8 , ���^���.ter„ �k•u Nature of Repairs or Alterations(Answer when applicable)"Om i t cesspools. Install..• 1'-1 5 0 0 gallon tank and 1 Distribution- box and,..3,=330 Rechargers,Packed in st&an with a pea stone cap. 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 ode and not to'place the system in operation until a Certifi- cate of Compliance has been iss ed by th• B, d ealth. Sig Date 2 20/96 Application Approved by g Application Disapproved for the following reasons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS. Certificate of Compliance r4 _ THIS IS TO.CERTIFY,that the On-site Sewage Disposal System installed( ),pr repaired/replaced( )on by J.P.Macomber Jr. for Will iN Leary is 20 David Street Osterville,Mass . has been constructed in accordance l with the provisions of Title 5 and the for Disposal System Construction Permit No. gs. dated Use of this system is conditioned;on compliance with the provisions set forth below: ` No. Fee $ 40,00 THE COMMONWEALTH OF MASSACHUSETTS r` PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS lwigpogal *pgtem Construction Permit Permission is,hereby granted to J_ads e ph P. Mae ombeorJr. to construct( )repairX(XX)an On-site Sewage System located at 20 David Street Osterville.Mass. and as described in the above Application for Disposal System Construction Permit.The applicant reco nizes his/her duty to comply with Title 5 and the following local provisions or special conditions. All construction ust be ompleted within two years of the date below. 0 e Date: Approved by / B i 3-330 Recharger 1 -Distribution b box 1 -1 500• gallon Tank. d William Leary 2/20/96 J.P.Macomber Jr . 20 David Street Box 66 Os-terville ,Mass Centerville ,Mass . 02655 02632 r CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) I, Joseph P. Macomber Jr. hereby certify that the application for disposal works construction permit signed by me dated 2/2 0/9 6 , concerning the property located at 20 David Strept. nsterviI l e 'Mass meets all of the following criteria: • There are no wetlands within 300 feet of the proposed septic system • There are no private wells within 150 feet of the proposed septic system • The observed groundwater table is .4 feet or greater below the bottom of the leaching facility • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. SIGNED : G DATE: .697' LICEN D SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER [Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. 1T-0" - 10'-0" *. 15'-3" 9'-9" 12'-0" 5'-3" Of o TW24310.2 co EXIST SUN ROOM _ BEDROOM#3 �, t cl, GARAGE DINING J KITCHEN = BEDROOM#2 00 Oo nn ' 0 LIVING ROOM BATH MASTER BEDROOM 0 r aO - F MASTER BATH WIC " 17'-0" 12'-0" 20'-0" 20'-3" 01 EXISTING FIRST FLOOR FOR: LARRY&BARBRA THOMAS SUNROOM PLANS OSTERVILLE DATE 917/19 DRAWN BY JOEY JOHNSON SCOTT PEACOCK Al BULDING&REMODELING SCALE 1/8"=1'-0" PROPOSED SUN ROOM 19'-0„ 5'-0" 01- " 5'-01, 0'- 5'-0" V-6" ' 11 TW24310-2 c� EXIST SUN ROOM - BEDROOM#3 F RE-USE EYEBROW WINDOW GARAGE PROPOSED SUN ROOM o DINING al KITCHEN __ _ BEDROOM#2 En ol LIVING ROOM BATH MASTER BEDROOM —.101/ ' 15'—3" '—1041, 101 MASTER BATH WIC PROPOSED FIRST FLOOR FOR: LARRY&BARBRA THOMAS SUNROOM PLANS OSTERVILLE DATE 9/7/19 DRAWN BY JOEY JOHNSON SCOTT PEACOCK BUILDING&REMODELING SCALE As indicated 12" EXIST ROOF CO 7" 6112 1 v io CV � M PROPOSED LEFT ELEVATION PROPOSED RIGHT ELEVATION FM 4:p �H:R 9 FOR: LARRY&BARBRA THOMAS SUNROOM PLANS OSTERVILLE PROPOSED REAR ELEVATION DATE 911119 DRAWN BY JOEY JOHNSON OTT PEACOCK SCALE 118"=1'-0" A3 BULDING&REMODELING r 20'-4" lr 8"O.H-� r ROOF PLAN FOR: LARRY&BARBRA THOMAS SUNROOM PLANS OSTERVILLE DATE 9/7119 DRAWN BY JOEY JOHNSON OTT PEACOCK SCALE 1/8"=1'-0" A4 BULDING&REMODELING f ors oZ ,O �• 313/�,,d a� 68SE6'ON NHOr .off /yo/..L b,J0-7;7y �n- o/Yy �✓/1io�P - q�7sodoa�� + a r f7r'o7--,' 60 'v/Y -zo7 SSO/OZ ON °� I � j �o soy I z � I p p I o0 N ,-71 ,t /yl 0 /v 7 S ✓� •s s �ZbW/,klay'la y s7,d`� 7.w0 /WO/N ns .sioz `E-1 'a,�d , oZ =„/:� dos fisr:a *ON 1I1`3'IAoo o 'd 3 ! NHoo av� f 11 'odder //i/ db'1�ti �was25,ass6' /yo/1 bYJ ??x/vd 9.V/ j ` OMIY7 -;eP /1v7d -ZO7� r � � f I • �/>'OZ P�fiZb�iY c7`no7�' 6� /Y/ c?�16'J07 �O/�/ S/ 6Z �_ 9�•�8/ /yid _LYi70.7 0' Y7 l r AA r Q�r ,OS oLs S & ' r • ' 9 N/,Y y I � , o•oZ v Olt 41 �► ,p N Af5WC31 P3s'OdOd'd 0 •6 6/ .SZ/ "E/ -7dv 'oos% 0 7. ' 9/V/1S/X.� 's� _ • Al 7w-;:w at 1 c-O/ , 's •�s �1�i�/xod�da� 6 �7 , D 9 T I _l I I a II m �• 0 F----------- • o �x o��:� � °1.m E.9 +Z 3.ro q' �� 1 Anderoena'PWG 1 OOGb O-4 < ii i c S 0 3 C a- ' � ++ +>3 0 � I JI o l°oo ° i 0+0 le;Qf2 II s v nr- Pion ' --- ------ a v! �u o is O d m o O Anderrer-T'W2 4 4!a !i Ot• _ yy11 •" Z 1 J J 0 F R ok ��DO eR R A P O And artand"(yW 2 4 4& f. I I X y 9'-6 7/ell v t F 1 � c X i O;'� O i o f 7,s II 27 n += E. m v V ' � VVV 111 (I) T to Copyright 02012 by KSA design..: ' PRAWN BY: m •j A These plans are protected underPederal Prvjcct # 1690 PROJECT: �addikionand�enovxakionfor: m A y These Laws.The original purchaser of this Y -NNETH hAIOLE�JF y + plan is authorluc to con or Professional Building Designer struct one and Only -1 Irpt Z T Z one some using this plan.Modification C � � reuse i9 prohibited without express written - N z 0 j permission of the Designer. , O A •Q 1\/SA designs Any discrepancleB,errors and/or omissloce to PROFESSIONAL BUILDING OE51GN LOCATION: Ingss`oonces,contained er Ina and/or drawls tthese documents O REVISIONS: - shall be brought to cheattennonof COMMERCIAL•RESIDENTIAL the Designer prior co the commencement -preliminary pesigns lo/f/f 2 2 O of o-stmotiom Proaaedrig with fJavid hhreei constructionconstltutes the acceptance Gons�rua+ion plansfo/7/( 2 GapeGcaste- o5ta ica ofthesedocumentsandany 6uanacaste•Gosta ralca 04,kervflle,MA ' dlscre les.errors and/or cmlaaions pan capecod®ksedesign.com•wwwk sad esign.com become the responslbllity of Ghe P.O.BOx 1149•Hyennls,MA 02601•505.'i90.3912 - bul lding cgntractor, Y . i a I 1 N S s • P N G p S 3 0 s e g „ S -- — -- -- -- -n --- b p -------------- i I p i P a A p O D 0 S'n1 n • N - x _ A � n� • OWNa a Ix 3 •r • - 3. i n � j 'P- 8 L �_3 • P ^ n v9 n 0 9 HAkeh axis+lnq plate height ,. — ,i b CN p p C A c P p ° 0 A m y*HE • V � n 0 + s + n i6 0 + o i _ T i � • V "` n L� � t � n p s ° A i n o � a D_ + 1 � p S n ° c + +^ p n � I N yy ly 0 copyright®2ouby IcSAae.ign..: DRAWN BY:. = c, 'al TheseplansareP12 tadu,da,Fadarai P�o,JCGt # 890 PROJECT: ?tdd'ikion and —enova�idn for: p. Copyright Laws.The original purchaser of this fn y plan Is authorized to construct one and only �e�NEr h�DLE�- -i y yo Professional Building Designer one se home using this plan.express ri or S S reuse Is prohibited without express written permission of the Designer. i� +t _ KSA design O m > > S.d. Any disc the notes.arroreane.and/or aalotre !� m LOGATIQN:. Inmenotae.eimenthese documents A PROFE95IONAL BUILDING DESIGN _ dramm concemedo the attention O REVISIONS: e - , am a beer prior to the attentionm COMMERCIAL•RESIDENTIAL the Designer prior co the commencement preliminary rJ'eslyns to/d/I'2 of conarucuon Proceedng with Gans4-ru6han tans 6V7/1 2 Gape God•Massachusetts 2 17a�IGl�'Freek - conetruf,lon constitutes the acceptance p Guanacaste•Coate RIG. of these document.and any Osi-arv11e,M� dlecrepanciss.erroreand/oromisslons capecodoksadeslgn.com•w—kesdaslgn.com become the responslbllity of the P.O.Box 1149•Hyannis,MA o2601•505.990.3922 - building contractor. J F ri---------- Ir -t---------.-- rZ----- - 1 I I I I k ° L P 4 I I : r II ®® Z II Il ®® r ,• rF------ KA u I ®® I I'- MM ILIA I I .III J-___ p 1I II Ili � - z II ®® I I e ®® I I I I I I .I ,I I I (p d Copyright 02012by KSAdesign..a.< DRAWN 5Y: 2 A These plans are protected under Federal PrO�'IeGt,#.� 8'JO PROJECT: ,deli-han And P—etnovai'ion for: m R p Copyright Laws.The original purchaser of this �eHHeTFi h�4lOLE:'�-J�. A IT plan is authorized to construct one an only _ "t - Z -�- Z one home using this plan.Modification or Professional Building Designer e 0 reuse is prohibited without express written - - (� I ❑ permission of the Des gner: _ - • v KSA design y p O M -0 S.a. A dl ae enGles errors and/or omlaslona A rn LOCATION: the notes dimensions,and/or REVISIONS: - PROFESSIONAL BUILDING DE516N d e g-ont edonthe edocume is O. COMMERCIAL•RESIDENTIAL o ilb br gore thecc nu th D o p to thecommencement .Preliminary Designs!v/f/f 2 `- .p of construction.Proc ern q Irn • Gons-'r U64-ion tans eO/7/f 2 Gape Cod Ma55achusett5 2 0 1'JaV•I constructlon—stitutes the acceptance P 6uanacaste•costa Rica of these documents and any Oskerville NJA � _ - discrepancies,errors and/or omisaone ' capecod®ksadesign.com•www.ks n.com become the respons bl0ty of the P.O.Box 1149•Hyannis,MA o7601.50a.02.T90.397� builCing contractor.' II m II � II n N II m > 1 I _ � I P 0`......._.. 3 I z � � Z A D . ^3 °a + ------------ 0 m e foundw+ion oen+ I I I I � I ' a I I I I I __0. A 0 0 __ ti I y I I i x E I I I / I I�,I • o n I l a o 0 a o I mS I 3 r I _ __ _ _ _ _ __ � � s � s � i a a r h 3 o+x In Is ------------- t? +o r P + ra T Copyright 02012 by KSA design.n: DRAWN BY: = 0 5 A TheseplansareprotectedunderFederel Pro I�Ct $� g9O PROJECT: Addikianand�enovakionfor: m + A Copyright Law..The original purchaser of this J - - plan Is authorized to construct one and only I�ENNErFI h,B.DLE�J�. 1 T t' a Professional Bullding Designer + one home riled this plan.construct one and or 3 p reuse Is prohibited without express written permission of the Designer. O m A>n KSA design=<l. - Any dlscrepanclee error.and/or omiselone oM LOCATION: n the notes almanslonssnd/or PROFESSIONAL BUILDING DE BION erawlbga contained on the. e documents O - 'a REVISIONS: shall be brought to the attention of a COMMERCIAL•RESIDENTIAL the of sonar.prior to the commencement Preliminary Designs!o/f/12 (iOns'I'r Ubl'iOn 11ans to/7/1 2 Cape Cod•Ma568ehu5et t 5 2 I�aVld�kreek of construction Proceeding the acceptance, construction constitutes the ecce Lance, P Guanacaste•Costa Rica ,of these documents and any Osi ery ilia,MA escrepanaes,errore andiar oml..lons capecod®ksads.ign.com•www.ksadesign.com - - become the re.pon.ibility of the P.O.Box 1 149•Hyannis,MA o2601•508.190.8922 building eontfaGLof. FT71 E E �IFTT0 0 CO 00 C,q aNi "0 I I I H I b E Cb 0 cc 'D GENERAL NOTES: r A. 1, Before final Drawings and Specifications are issued for as construction,they shall be submitted to all governing building PROPOSED RIGHT ELEVATION agencies to Insure their compliance with all applicable local and national codes. If code discrepancies in Drawings and/or Specifications appear,the Designer shall be notified of such B. All contractors,subcontractors,suppliers,and fabricators,shall be discrepancies in writing by Builder or building official,and responsible for the content of Drawings and Specifications and for allowed to after Drawings and Specifications so as to comply the supply and design of appropriate materials and work with governing codes before construction begins. performance. REFER TO 2009 IRC 2. Upon written receipt of approval from the governing official, C. All manufactured articles,materials and equipment shall be applied, & 8TH EDITION MASSACHUSETTS CODE approved final Drawings and Specifications shall be submitted installed,erected,used,cleaned and conditioned in strict to the Builder by the Designer. accordance with manufacturers recommendations. m r CL 3. If code discrepancies are discovered during the construction D. All alternates are at the option of the Builder and shall be at the Il W process, Designer shall be notified and allowed ample time to Builder's request,constructed in addition to or in lieu of the REFER TO WFCM 110 MPH remedy said discrepancies. typical construction,as Indicated on Drawings. 4. All work performed shall comply with all applicable local,state E. ARCHITECTURE by SPB LLC is not responsible for any plan discrepancies. EXPOSURE B WIND ZONE GUIDE and national building codes,ordinances and regulations,and z Builder&Homeowner to review plans before start of construction, to all other authorities having jurisdiction. Following is a partial list of applicable codes in force: Q Q 12 LO W 04 z CD LI I I W W Cr cn r C:) Q) 0 PROPOSED REAR ELEVATION. Al 14'-0" o a 7-0" 7-0" 3'-0" 4) TW24310-2 RE-USE EXISTING WINDOW 10'-0" ----- ------------------------------------- -------- -- 0. 3'-0" 7'-0" a BEDROOM #3 EXISTING N N WINDOW VAULTED CLG. of o NOTE:HEADERS TO BE v v (3)2X8 UNLESS NOTED. N EXISTING DEN coco TW243 0 Lo L tb w C C @ o V 3 a 'T CL J Q p II DINING EXISTING ROOM s DN 3'-2" BEDROOM #2 s o m 2-6t T '�CL/� _I I V) T ' 3'-2" 5'-10" (2) 11 1/4"LVL BEAM ABOVE 41 j Z Q 11 -------------------- ---^-- 2'"8 w 1214" 2$ N Q Cl NEW STANDARD SIZE TUB/SHOWER EXISTING o EXISTING LIVING ROOM MASTER BEDROOM VAULTED EXISTING Lo BATH Lo w � U N Z W Q W 1- W � � J to p > � <t w EXISTING V EXISTING p p M.BATH WIC cw O PROPOSED FIRST FLOOR PLAN o a v o a EXISTING DEN E o � ) U a co oo r -0 c CC) AM LO +, E 00 0 _ � 8 3 � EXISTING GARAGE EXISTING EXISTING f=JJ U EXISTING DINING BEDROOM #3 u EXISTING KITCHEN BEDROOM #2 N 00 o m ;- a ,n U) r a1 M J 4 � EXISTING 0 EXISTING Q LIVING ROOM MASTER BEDROOM EXISTING BATH uO to co EXISTINGV EXISTING z O M.BATH WIC WQ W CCCD J CD L] 2 Q W OoI- F — N O EXISTING CONDITIONS LAYOUT SCALE: 3/16"=V-0" A3� ANCHOR BOLTS TO BE 5/8"AT 71"MAX.SPACING. 14'-a' BOLT EMBEDMENT TO BE 7"MINIMUM. WASHERS TO BE3'X3'Xi/4"THICK. ( I BOLTS TO BE 6"-12"FROM END OF PLATES 1 1 • I I I 1 , ♦----------------------------------. 1 1 8"CONCRETE WALL W/MIN. 4 1 4'-0"BELOW GRADE W/20"X10" p CONT.CONC.FOOTING 4 Li 101 -0" t 1 I • I I I 1 a V I I 1 I 1 C I 1 CRAWL SPACE , Q *- 1 • 1 1 I t 1 I 1 1 1 I I 2"CONCRETE DUST COVER OR 6 MIL VAPER BARRIER i p ' D• ' W/4"OF 3/4"AGGREGATE I 4 1 1 Q 1 N EXISTING OPENING i c i i i TO BULKHEAD 3141 ; I % co 1 I I I rr — — — — _, — — — — •—_—_• o w i UP ACCESS/LOCATION TO CRAWL SPACE 00 co PER FIELD CONDITIONS 0 @ v w IA 3 OC Li 1 CIO a m O I ' cn I 1 1 ttlal H 1 I I I 1 x� T 'C'L^ W I' VJ T EXISTING BEAM ` T cA Q A EXISTING BASEMENT Lo Lo U N Z o 0 Q w u) 2 Q cc O 0 F- C!� ENO FOUNDATION PLAN Si o • -10 ------------------ ----------------- Cn ul 1 "I" , r 1 1 r i i I BLOCKING V Q 1 r Lim 11 1 I T W 1 i t 1 I 1 1 I r i t U V 1 1 1 1 V1 r 1 0 a c 11 N � c I I 1 I 1 --------------------------- ------------- -------------------- cm -------------------------- r , V 1 i co m 1 V 1 ' 3 � 1 a y 1 1 i 1 1 p 1 iitUi 1 O 0 ' AC LL 1 --------- EXISTING BASEMENT O - z 03 I 1 D 1 1 u v! T EXISTING BEAM - - ----- EXISTING BEAM---------------------- 11 N M i cV Q A 2X12 RIDGE 2X10 RAFTERS 12 1/2"CDX ROOF SHEATHING FLOOR FRAMING PLAN 6� HURRICANE TIES H2.5A HURRICANE TIES H2.5A i I 1X3 STRAPPING R-38 — - - ` R-49 @ 16"O.C. 2X10 CEILING JOISTS W/1/2"GYPSUM = W Lo 3 V N Z BEDROOM #3 w 2X6 WALL(DBLE.TOP PLATE) W uj @ 16"O.C.W/1/2"ZIP WALL ~ w CD EXT.SHEATHING APPLIED VERTICALLY. J 3/4"T&G 1/2"GYPSUM W/R 21 MIN. INSULATION. — r — FLOOR SHEATHING Q j 2X10 FLOOR JOISTS Q W R-30 e° O CRAWL SPACE b D F- N 0 .a •a a; a: SECTION A S2.p'v0e p'vs^ o q�- m -------------------- ------------------- ' •------------- ' ' �1 ----------- I O FRAMING NOTES ; ; ------ -----------� co ` ---- d FLOOR BRACING , , BLOCKING&CONNECTIONS SHALL BE PROVIDED AT PANEL ------------ ---------2X12 RIDGE - EDGES PERPENDICULAR TO FLOOR FRAMING MEMBERS , , , cn IN THE FIRST TWO TRUSS OR JOIST SPACES AND SHALLcn BE SPACED AT A MAXIMUM 4 FEETON CENTER.NAILING ' ------------ -----------' REQUIREMENTS ARE:BLOCKING TO JOIST--2-8d FOR Q v v COMMON NAILS&AT EACH END, ' ' ' ; ' ' Q ------------ ----------- FOR FURTHER INFORMATION REFER TO PG.7 TABLE 2 , cn OF THE WFCM 110 MPH EXPOSURE B WIND ZONE(GUIIDE). ------------ ------------- co' FLOOR SHEATHING FASTENING 4------ --- ; ; U Lo NAILING REQUIREMENTS ARE:3/4"T&G CDX PLYWOOD OR EQUAL. ---------------------- -___-_ ______ = o --------------------- ------------------- ------------------- -------- NAILING TO BE 8d FOR COMMON NAILS WITH SPACING AT 6"EDGE/12"FIELD. " , , C6 v p FURTHER INFORMATION REFER TO PG.7 TABLE 2 ' co OF THE WFCM 110 MPH EXPOSURE B WIND ZONE(GUIIDE). W Lo O o WALLS N CL LOAD BEARING WALLS TO HAVE A MAXIMUM HEIGHT OF 10'-0" ; ; co � NON-LOAD BEARING WALLS TO HAVE A MAXIMUM HEIGHT OF 20'-0" WALL SPACING TO BE 2X4 @ 16"O.C. WALL AT GARAGE DOORS TO 2X6 @ 16"O.C. N EXTERIOR WALLS , N } Ul WOOD STUDS:LOAD BEARING WALLS TO HAVE A MAXIMUM HEIGHT OF 9'-9" i NON-LOAD BEARING WALLS TO HAVE A MAXIMUM HEIGHT OF 9-9" ' ' - WALL SPACING TO BE 2X4 @ 16"O.C. ' ' Q m WALL AT GARAGE DOORS TO 2X6 @ 16"O.C. i i +-' 0- STUDS IN GABLE END WALLS:ADJACENT TO CATHEDRAL CEILINGS ; Ii � +� SHALL BE CONTINUOUS FROM THE CEILING DIAPHRAM OR TO THE ROOF DIAPHRAM. DOUBLE TOP PLATE:SPLICE LENGTH =4FT.MINIMUM WITH 14-16d COMMON NAILS EACH SIDE OF SPLICE. ; C6 WALL OPENINGS:HEADERS TO BE 2X10 WITH 3-FULL HEIGHT STUDS(UNLESS NOTED). z EXTERIOR WALL SHEATHING:SHEATHING TYPE TO BE 1/2" NAILED 4"O.C.EDGES/12"O.C. C d IN FIELD.SHEATHING(FULL SHEETS)TO SPAN FROM RIM JOISTS/BOTTOM PLATE TO TOP PLATE. ROOFS ' ' Q Q ROOF OVERHANGS TO BE 1'-0"OR LESS. HURRICANE TIES TO BE SIMPSON H2.5A. RIDGE STRAP CONNECTION TO BE SIMPSON LSTA15 1/2"CDX PLYWOOD FASTENED WITH 8d COMMON NAILS @ G'EDGE-1 2"FIELD. " GABLE END WALL RAKE W/LOOKOUT BLOCKS TO BE 8d COMMOM NAILS @ 4"EDGE-4"FIELD. BLOCKING TO BE PROVIDED IN FIRST TO RAFTERS/ROOF TRUSSES @ 4'-0"O.C.. NOTE:THIS CHECKLIST SHALL BE MET IN ITS ENTIRETY.IF THE CHECKLIST IS MET IN ITS ENTIRETY THEN THE FOLLOWING METAL STRAPS AND HOLD DOWNS ARE NOT REQUIRED PER THE WFCM 110 MPH GUIDE: A.STEEL STRAPS PER FIGURE 5 i i L0 LO B.20 GAUGE STRAPS PER FIGURE 11 ' ' (ji C.UPLIFT STRAPS PER FIGURE 14 CO D.ALL STRAPS PER FIGURE 17 V N E.CORNER STUD HOLD DOWNS PER FIGURES 18A AND 1813 Z O ui 0_ cQc cn G ROOF/CEILING FRAMING PLANuj IC fn J (n 0 = O � F- N O o a m 780 CAR: STATE B{}ARl?OF BUILDING REGULATIONS AND STANDARDS 13 780 CMR: STATE BOARD OF BUILDING REGULATIONS AND STANDARDS THE MASSACHUSETTS STATE BUILDING CODE APPENDICES Ld ATi'C G irs T�ond Cons otr in High l�l'lrtdtkrectt:110 mph Wtxrd 2.ow — 19 msa lst etfs Ckt for Compliance(780 5301.11.1)1 .. ._.r-- �� .'. 16d common nails}. ..... (Tables 7} ..................... Loadbeadrig Wall 2 Lateral(no of � V N n- Wall Connections o Loadbeann g Chet Lateral(no.of 16d common nails)......... (Table 8) ......................... 2 CO lia Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9)� 1,1 SCOPE Header Spans........................ (Table 9) 4 ft 0 in.s 11, —�,� Wind Speed(3-sec,gust) ............................................ 110 h Sill Plate Spans ............ (Table 9) ............. 4 ft 0 t"n.s 21' Wind Expo Category..................................... .......... N but check all openings for compliance to Table 9 Fats Height Surds(no of studs)............(Table 4 Bean opening a ng Walt Openings(record largest 1.2 APPUCABILITI' HeaderSpans.......................... (Table 9) ............. 5 ft L in.s 12' p p Nu of Stories(a roof e 8 in 12 l be a .. ......... •.-.: " . '} Sill Piste S ..................... .('table 9) .... _ft 0 in.s 22" v y 1 storiess 2 Full Height Studs(no.of studs)...........(Table 9) ........................ 3 O c Roof Pitch ............................. (Fig 2) .................. 6 s 12:12 Exterior Wan Sheathing to Resist Uplift and Shear Simuhaneously° co fo F Mean f Height ........................ 2) ................... 12 im ft s 33' Minimum Building Dimension,W B W W .......................('fig 3) .................. 12 ft s W Nominal Height of Tallest 4 ft Opening'................................. s 6'8" 00 Bzaildirtg Length,L .. .................. (Fog 3) .................. — 3 80" !'►l sheathing Type., .... (note 4)...................... SB 00 Building ...............(Fog 4) .................... 1.25 s 3.1 Edge Nail Spacing .... .. ....... (Table Mar note 4 if less) ........ 4 in. to V Nominal Height of Tallest O g2 ......... (Fig 4) ................... s 6'8" ]G Feld Nail Spacing ...................(Table 10)..................... nr. *3 1y1PAMLNG CONNECTIONS Shear Connection(no.of 16d common nails)(Table 10 .... .... :..:..:: 1 UIJ 0 General compliance with framing connexions.. (Table 2) .........I........I.......... Percent Full-Height Sheathing ..........(Table 10)..... .... .. .. ... .`60% dp � L 5%Additional Sheathing for Wall with Opening>6'8"(Design Concepts). 10 @ 0 2.1 FOUNDATION N inmm Building Dimension,L C U Foundation Walls meeting requires of 780 CMR W4.1 Nominal Height of Tallest Opening'.................................. s 6'8" p Concrete ............................................................... Sheathing Type..................... (note 4)......................CDwoss Concrete my ....................................................I...... Edge Nail Spacing .................. (Table I 1 or note 4 if less) ........ 4 in. N Field Nail Spacing ...................(Table 11)...................... 2 in. 2.2 AN .f3ItAGI7 TO FOAITCDti'; 1 _ BobW Anchor as an a1 in oxY only Shear Connection(no.of I6d common nails)(Table 11) ....................... . a_ Bolt S (Table 4) .............. ,.. 71 Percent Full-Height Sheathing ........ (Table 11)..........................3 % N Bch r joint of p (Fig 5) .............. '6 in-s 6"-17" 5%Additional Sheathing for Wan with Opening>6'8"(Design Concepts)........ . • ° --�--- 7 Wall Cladding Bo}t (fig 5).... .................._., tn.a 7" Rated for Wind Speed? .� Molt Em - (Fig 5) .................. in.z IS" W .........................(Fig 5} ................... x 3"x 3"x W 5.1 ROOFS Roof framing member spans checked? (For Rafters use AWC Span Tool,see BBRS Website) V m 3.1 FLOM Floor frarstin trntnber ants oheeketl ........ (per T80 CMR 55.00} ,..... Roof Overhang .. ................. .(Figure 19) ..... 8_° ft s smaller of T or I.J3 g •••'• Truss or Rafter Connections at Loadbearing Was t n MvAmium Floor Opening Dimension..........(Fig 6) ......... 10 ft s 12, Proprietary Connectors r Pu1I lief Wall Studs at less dusa 2'from Exterior Wall�g 6) ............. _ ...........,............... _203 � Height •• Uplift ••.••(Table]2). U— If d,` Maximum Floor Joist sacks Lateral ....................... (Table 12)...............I.... L=� if }- r g L g Malls or SI I (Fig 7) ....................... —ft s d Shear................. (Table 12).................... S= 77 pif r fQ CM M Joists Ridge Stralp Conne:tion% collar of pa 21 a ..... ......T=138 If g g Walls or Shearwull.(Rg 8) ....................... —Aid Gable Rake Outlooks• ... 11 ties n �P�figure 20) ..... —ft s smaller of T or LJ2 wj � 13). _ FloorBracingarEadwalls ..................(Fig 9) ............._................. Truss or Rafter Connections at Non-Loadbearing Walls Q Q FlocirSheathingType (per 780 CMR 55.00) .............. ,/ Proprietary Connectors U QL Q Floor (per 780 55.E ......... 3/4 in V Uplift .............................(Table 14).................... 417 N Q Q . .. 6 •6 U= lh. F1not (T 2}d nails at_,._-in edge 112 in frekl � Lateral(no.of 16d common nails) ...... (Table 14).................... L=14.8Ib. 4.1 WA11S Roof Sheathing Type ......................(per 780 CMR 58.00 and 19 00)............ 1W'aIl Roof ShcaftgThicimess ....................................... Lin.27/16"WSP Loadbearingwalis (fig 10 and T 5)..--..... 8'-Oh a I(y Roof Sheathing Fastening ................. (Table 2) ......................... $d_ N .................(Fig 10 and Table 5)........... • -Oft s 20' Notes: Wan Sand Spacing ..... .,.,.•..,,.,_ ,(Fig 10 and Table 5)._,,,,. 16 in.5 24"o c, � r• 1. This checklist shall be met in its entirety, excluding the specific exception noted in 2, to comply with the ................•�ft s d and bold downs are not required per 1 Item). tem)CMt the checklistGuidesI mph et in its entirety then the following metal straps .. Mall ........................(Pigs 7�8) ... requirements,,....� 4.2 EXTMOR WA119 a, Steel Straps per Figure 5 Wood Studs b. 20 Gage Straps per Figure 11 Loaclbearing walls .....................(Table 5) ............2x-6 -..L ft.L in. c. Uplift Straps per Figure 14 Non4AYadbearin&walls .................(Table 5) ............2X-6--„ ft_Q,.in. d. All Straps perFigure 17 Gable End Mail Bracing t : e. Corner Stud Hold Downs per Figure 18a and Figure I8b FuNlIvigbrEndwallStads....... .•••••.(�g 10) •••••.••••••••'•••.•••••••°. --- 2. Exception.Opening heights of up to 8 ft.shall be permitted when 5%is added to the percent full-height sheathing w Atdc • (Fig 11) ....I.............. —ft aW13 requirements shown in Tables 10 and 11. CD Gypmmn Ceiling length Cif WSP not uw4(ft 11) ..................... —ft a 0•9W 3. The bottom sill plate in exterior walls shall be a minimum 2 in.nominal thickness pressure treated#2-grade. and 2 x 4 Continuous Lateral Brace 0 6 ft.o c._(Fig 11).............................. ....... � 4 a FromTab es lOand l and ionofwall shcatltingand BuildingAspactRatio,determine Percent Fuit Height C! t local �I x 3 16" g min.w�2 x 4 h ' g @ 4 ft. in end � . ..•. Spacing requirements joist or truss bays .......................................................... _ Sheathing and Nail i oubla Top ✓/ Cn G Splice Length.........................(Fig 13 and Table 6).............• 4 14 V Splice Cate (no.of 16d nails)(Toble 6)..... w CD 1054 780 CMR-Seventh Edition 12/28/07 (Effective i/V 12/28/07 (Effective 111/08) 780 CMR-Seventh Edition 1055 (n I- N O DI