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HomeMy WebLinkAbout0067 HOLLINGSWORTH ROAD - Health 67 HOLLINGS'�ORT04STERVILLE MAP-140 PARZ071 SK V MQjMQg laws A, ax WON IS 7,p, Mnih -K ,IP,Rt, a 4 OMM %UWARk W-q Mi, h Mac t'4, z-,,T'y, VI-Ij Moll �N�iV, W, M 44- 1 T-1 TP, 4r _1411 ARE AS UN at a rjo 1 V4 3- r.A, V,;B PA—P OUR o, -,4�, of VA—M, .0-0 `j P IBM .0 M VT NEW, 23 RUM No VM� iip Nq TP5all , two tip, U 18 , MU NnE­ .juj A"j, ngi ;q n J a A 4 Nil 1, _,i 4 lama NO,"A j6 4111131 01PAk its M". V; ii 71Af4 Ilk !f R 4 try Pt"ISNN,�� 02 k low Mf VIb'PAP �W I WTI A V"A Q I W ,7,­,,� "Ek z W T'�xf­­_,i­ 1? Q, 51 '1 - WN101k5 10111falAW41 UA� W OEM,31151 Ri%,V F5 A' q F i gig ngwr 1P, lwel. Tim # 101, ju S A4 It RL RUM rdA. pa,Ax Ah"', ,941ANOPR"�0 3 UNA�,W NW, RL K WAD W. 4 �01 HOW; uwW AR V 'Nov P! 3 NIA, ........ ....... oh. SM .......... ................ ............. No. 0-57k Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: UBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes, ZIpplitation for dig ozal !gtemc Cou5truction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No.67 D/hTj Owner's Name Address,and Tel.No. Assessor's Map/Parcel Q l 0�__ !Y` ,�- — Installer's Name,Add r ss,and Tel.No. -Itt Z C V&+kP►'l Designe 's Name,Address and Tel.No. Type of Building: II Dwelling No.of Bedrooms Lot Size yl�Q sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 60y gpd Design flow provided /• /' gpd Plan Date tZ /Sf /LQ Number of sheets Revision Date Title Size of Septic Tank Yl, Type of S.A.S. / ►f rl Description of Soil — .r C r 1� r Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and mai e of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Enviro a Code and not to place the system in operation until a Certificate of Compliance has been issued by thi B ar of H - Si 9 Date Application Approved by t Date Application Disapproved by: Date for the following reasons Permit No. Date Issued No.r 051 >`1�" _ Fee r � THE COMMONWEALTH OF MASSACHUSETTS Enteied in computer: UBLIC HEALTH DIVISION - TOWN OF•BARNSTABLE, MASSACHUSETTS . Yes ,. 010pYication for t pour 6yztem Congtruction permit �. Application for a Permit to Construct Repair Upgrade Abandon "m'` PP O p O pg O O Complete System ❑Individual'Components ` ) A Location Address or Lot No.6� �klll rj�j�fO Owner's Name,Address,and Tel.No lz., U t Assessor's Map/Parcel `1. 1/( `�_ 671 �. go, 61-5 Installer's Name,A No. _S D j0'- G v` '` esigner's Name,Address and Tel.No. ddrss,and Tel.fitted 51. W H/,l l g � �t l v t f{SSo c: . Type of Building: Dwelling No.of Bedrooms 7 Lot Size ���Q sq.ft. Garbage Grinder ( ) i Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) �V C,41) gpd Design flow provided 9) 9.0-1 (III)ID gpd i Plan Date 2 l l 5/ C) 1 t p Number of sheets Revision Date Title Size of Septic Tant< �U/ t1 Type of S.A.S. f Description of Soil [ Q a r d, vo r Nature of Repairs or Alterations(Answer when applicable) Date last inspected: i n' Agreement: r The undersigned agrees to ensure the construction and_mal lewra ce oft,' the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Enviro al Code and not to place,the system in operation until a Certificate of Compliance has been issued by thi�,Board of H �f Si-ne ,y n' ' Date / Application Approved by / ✓�}.N ^� Date �� f Application Disapproved by: / r i V Date for the following reasons Permit No. ""� Date Issued t -�" THE tCOMMONWEALTH OF MASSACHUSETTS �, 'BARNSTABLE, MASSACHUSETTS :;. Certificate of Compliance { THIS IS TO CERTIFY,that the On-site Sewage Disposal System,Constructed (L-)`Repaired ( ) Upgraded ( ) i� Abandoned( by , w at }� -� ,�� llvorr (In J� pit A b has been co tructed i scordance with the provisions of Title 5/and the for Disposal System Construction Permit No.- dated Installer yUGe Designer `h 61 C #bedrooms / Approved design fl-w T�O gpd i The issuance of this perm, :shall not be construed as a guarantee that the system 'I un'cdon as d �ied ` J� i 7 Date . �0{ /� Inspector f No. \4.s Y/�v Fee• _ l_ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS 'wigpo!5a[ *p!5tem Construction Permit k Permission is hereby granted o Construct ) Repair ( Up rade ( Abandon )/ System located at (� �e and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to:comply with Title 5 and the followin�local provisions or special conditions. ` Provided: Construction must e c p�t d within three years of the date of this permit. Date �- Approved by I ,/� TOWN OF BARNSTABLE I a LOCATION . l►A 4 SEWAGE#. VILLAGE - r v ASSESSOR'S MAP.&PARCEL INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:`(type) - (size) -r t � NO.OF BEDROOMS OWNER 'Z UL i •,.J PERMIT DATE: 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 { i j 26 r r Town of Barnstable Regulatory Services t a Richard V.Scali,Interim Director + BARNSTABLE, MASS. Public Health Division t639• Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Dater �- - ZvL(o Sewage Permit# Assessor's Map\Parcel Designer: y X�E D K -f— S Installer: Address: ' Q�� '� Address: Ai) On (p—Z) was'issued a permit to install a (date) staller) septic system at V1 14oWn)jS I o$�M94.LC,based on a design drawn by (address) dated (designer)' I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral,relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required) was inspected and the soils were found satisfactory. certify that the syste enced above was constructe �bipli ith the term the I1A a etters if applicable) n ' p ( PP ) f3�F ? +1 h7: ? � F1 P 1140 filer's Signature) ^� ITARMW igner's Signature) (A ix Designer's Stamp 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. QASeptic\Designer Certification Form Rev 8-14-13.doc Town of]Barnstable . . P# �ViE Department of Regulatory Services NAaMNTAattJt„ i Public Health Division Date /D o2 r MANS. - �'OrfA 200 Main Street,Hyannis MA 02601 °? ,. Date Scheduled LU Time A Fee Pd.— Soil Suitability Assessment for Sew ge Disposal Performed By:�,rGl / 'Sts� Witnessed By: '►T�v1' � LOCATION&.GENERAL INFORMATION Location Address Owner's Name bg� vigil ems/`/i} . Address C�ys�b���/-,e i Assessor's/Ve— ro aC�7/ Engineer's Na Lc;e g NEW CONSTRUCTION _� REPAIR Telephone z_&�/fp Z Land Use t.1/�i1 Slo es 96 ,� G`�79 WLj'G�Cc3<e 9:2p d p ( ) Surface Stones ,�Ue2n� Distances from: Open Water Bodyft Possible Wet Area 7 ft Drinking Water Well�—ft Draihage%;�Zho ft Property Line _ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands{n proximity to holes) d i Parent material(geologic Depth to Bedr e k Depth to Groundwater. Standing Water in Hole: t Weeping*o1Tl Plt Face Estimated Seasonal High Groundwater DET RMINATION FOR SEASONAL HIGH WATER TABLE Method Used: gig Depth Observed standing in obs.hole: _ In, Depth to soil mottles, In. Depth to weeping from side of obs.hole: _ __ _ __ In, Groundwater Adjualment fr. Index Well-k Reading Date: Index Well level. ,. Ad),ftletor ,. Ac�.Groundwater Level m PERCOLATION TEST Dntt;,.,� �_, Thnis Observation: Hole# Time at 9" N 1 it Depth of Perk �37 — v Time at 6" Start Pre-soak Time @ fb+11 - Time(9"•6") End Pre-soak w .2 Rate Min./Inch Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back---------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Conservation Division at least one(1) week prior to beginning. Q:ISEPTICVERCFORM.DOC DEEP-OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Sdil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Stnucture,Stones;Boulders. Consistency.%'Q Ycl) A _7+1 ;+ 37"-13T Z. 71 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon ' Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency. % 711 ;U DEEP OBSERVATION HOLE LOG Hole# 3 . Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Con i to c + a" DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. consisto 3d'' iuq �'j Flood Insurance Rate Map: Above 500 year flood boundary No Yes Within 500 year boundary No Yes Within 100 year flood boundary No. Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervi us material exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pe vious material's .._..� Certification I certify that on (date)I have passed the soil evaluator examination approved by the Department of Envir me tal Protection and that the above analysis was performed by me consistent with . the requir tra i exper'se and exVerience described in 10 CMR 15.017 Signature �7 yr Date Q:WEPTIC`\PERCFORM.DOC v Commonwealth of Massachusetts 71 Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form a Not for Voluntary Assessments r� 67 Hollingsworth Rd. Property Address Melanie Bilazarian Owner Owner's Name (� ; requirnfon,required is Osterville MA 02655 10/21/�015 required for every page. Cityrrown State Zip Code Date of inspection �s 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. Imp°'ta" A. General Information 2 filling out forms I# `� 2— on the computer, use only the tab 1. Inspector: key to move your cursor-do not Paul Martin use key. the fir" Name of Inspector Cape Cod Septic Services Company Name 350 Main St Company Address W.Yarmouth MA 02673 City/Town state zip code. 508-775-2825 S15016 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 CINR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 10/22/2015 pector'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. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System• 1 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments i 67 Hollingsworth Rd Property Address --- Melanie Bilazarian owner Ownees Name information is Osterville MA 02655 10/21/2015 requiresl for every per. Cityrrown State Zip Code Date of Inspection B. Certification (cunt.) Inspection Summary:Check A,B,C,D or E I 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 in working condition. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for ayes',"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): I t5ins•3113 Title 5 offidal kq)ecbm Form:Subsurface Sewage Disposal System.?age 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 67 Hollingsworth Rd Property Address Melanie Bilazarian Owner Owner's Name information is Osterville MA 02655 10/21/2015 required for every page. cityfrown State ZipCode Date of Inspection B. certification (corn.) ❑ Pump Chamber pumps/alarms not operational.System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cunt): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment.. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1xb)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 t5ms,3M 3 Title 5 Offiaal Inspection Forth:Subsurface Sewage Disposal System•Page 3 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form i Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 67 Hollingsworth Rd Property Address Melanie Bilazanan Owner Owner's Name informations required for every Osterville MA 02655 10/21/2015 page Cityf rows State Zip Code Date of Irspedion B. Certification (cons.) 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 %day flow (Sins•3r13 Title 5 Official kgxxb n Form:&bwface Sewage Dmposd System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 67 Hollingsworth Rd. Property Address Melanie Bilazarian Owner Owner's Name information is OSterville required for every MA 02655 10/21/2015 page. Citylrown State Zap Code Date of Inspection B. Certification (corn.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ 0 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 Zane 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a.cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. (This system passes if the well water analysis,performed at a DEP certified laboratory,for fecal colifonn bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails, I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should.contact the Board of Health.to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems,you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply I ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins.W3 Title 5 Offidal Inspection Forth:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 67 Hollingsworth Rd Property Address Melanie Bilazanan Owner Owner's Name mfon.F n is Osterville MA 02655 10/21/2015 required for every 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 infomtation was provided by the owner,occupant,or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions,depth of liquid,depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example,a plan at the Board of Health. ❑ ® Determined in the field(if any of the.failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 2 Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 110x2= 220gpd t5ins.W13 Title 5 o(fidel hspechm Forth:& tafaoe Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 67 Hollingsworth Rd Property Address Melanie Bilazarian Owner Owner's Name information Osterville MA 02655 10/21/2015 o requireduired for every page. CityRown State Zip Code Date of Inspection D. System Information Description: 0 Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonal use? ® Yes ❑ No Water meter readings, if available(last 2 years usage(gel)): 2013=148Gpd2014--93Gpd Detail: Sump pump? ❑ Yes ® No 10/11/2015 Last date of occupancy: Date Commerciallindustrial 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 Tide 5 system? ❑ Yes ❑ No Water meter readings, if available: tf•3113 Title 5 olfic W Forth:&bw face Sewage Disposal System•Page 7 of 17 i Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 67 Hollingsworth Rd. Property Address Melanie Bilazarian owner owner's Name information is required for every Osterville MA 02655 10/21/2015 page- Cityrrown state Zip Code Date of Inspection D. System Information (cunt.) Last date of occupancy/use: tie Other(describe below): General Information Pumping Records: Source of information: No records Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank,distribution box,soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system(yes or no)(if yes, attach previous inspection records, if any) ❑ Innovative/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 1/A system by system operator under contract ❑ Tight tank.Attach a copy of the DBP approval. ❑ Other(describe): t5ins•3113 Title 5 Of foal hspecdon Fo=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 67 Hollingsworth Rd Property Address Melanie Bilazarian Owner Owners Name fOR"atiO0 is required for every Ostervilte MA 02655 10/21/2015 re page- Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) Approximate age of all components,date installed(if known)and source of information: 1997 Per BOH records. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building.Sewer(locate on site plan): 25" Depth below grade: feet Material of construction: ❑cast iron ®40 PVC ❑other(explain): Distance from private water supply well or suction line: +10' feet Comments(on condition of joints, venting,evidence of leakage,etc.): Line checked with sewer camera and was found to be clean, properly pitched with no sign of root intrusion. Septic Tank(locate on site plan): 1'6" Depth below grade: feet Material of construction: ®concrete ❑metal ❑fiberglass ❑polyethylene ❑other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No 1500Cal H-10 Dimensions: 8-10" Sludge depth: 3H8 ride 5 OffiaW Inspection Forth:Subad ee Sewage Omposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 67 Hollingsworth Rd Property Address Melanie Bilazarian Owner Owner's Name information is Osterville MA 02655 10/21/2015 required for every Page- Cityrrown State Zip Code Date of Impedion D. System Information (cont.) Septic Tank(cunt.) Distance from top of sludge to bottom of outlet tee or baffle 8-10" 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? Estimated Comments(on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 1500Gal H-10 tank in good structural condition. PVC tees in place. Tank at normal operating level. Strongly recommend service of tank Covers 1'6"below grade. 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 t5im•W 3 TNe 5 Mc&W k%pecbon Forth:Subs�Sewage Disposed System•Page 10 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 67 Hollingsworth Rd. -- Property Address Melanie Bilazarian der Owner's Name information is Osterville MA 02655 10/21/2015 required for every Cityfr wn mate Zip Code Date of Inspection page- D. System Information (cunt.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal ❑fiberglass El polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: ga#=per clay 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-3113 Title 5 of8tlal wpemon Forth:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 67 Hollingsworth Rd. Property Address Melanie Bilazarian Owner Owner's Name irtforynrequired fion � Osteryille MA 02655 10/21/2015 required for every Page. Citylrown Stale ZipCode Date of Inspection D. System Information (cons) Distribution Sox(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert o„ 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.): H-10 DB-3 with 1 line in and 1 line out in good condition. Some solids carryover but no sign of overloading or hydraulic failure. Cover 2'below grade. 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.): i *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.3113 Title 5 Otficd bispec Form:Subsurface Sawage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 67 Hollingsworth Rd. Property Address Melanie Bilazarian Owner Owner's Name inforation required,d,fo Osterville MA 02655 10/21/2015 required for every page. cityrrown State Zip Code Date of Inspection D. System Information (cunt.) Type: ❑ leaching pits number. ® leaching chambers number.. 2-Flowdiffusors. ❑ leaching galleries number. ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number. ❑ innovative/altemative system Typetname of technology: Comments(note condition of soil,signs of hydraulic failure, level of ponding, damp soil,condition of vegetation,etc.): 2-Flowdiffusors in a 12'x22'configuration were found with 2-3"of effluent at time of inspection. No sign of overloading or hydraulic failure. 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 t5iru-3113 Title 5 Official IrWecUmt Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Forth-Not for Voluntary Assessments 67 Hollingsworth Rd Property Address Melanie Bilazarian Owner Owner's Name required for is Osterville MA 02655 10/21/2015 required for every Page- Cityrrown State Zip Code Date of Insped D. System Information (cont.) Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.): t5ins-3113 Title 5 Off ual hrspection Forth:Subsmtace Sewage Dim System•Page 14 of 17 w f Massachusetts Commonwealth o a Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 67 Hollingsworth Rd. Property Address Melanie Bilazarian Owner Owner's Name 1Rf required " Osterville MA 02655 10/21/2015 is requuired for every page_ Cityrrown State Tp Code Date of Inspection D. System Information (coat.) 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 t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts ILN Title 5- Official Inspection FormY :N Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,. 67 Hollingsworth Rd. Prope"Address Melanie Bilazarian • :w Owner Owner's Name information is wired Osterville MA 02655 10/21/2015 � for every ry page. Cityrrown State Zip Code_ Date of Inspection D. System Information (corn:), , Site Exam: ® Check Slope ® Surface water ® Check cellar F ® Shallow wells Estimated depth to high ground water: 11` 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: t ❑ Checked with local excavators, installers-(attach documentation) El Accessed USGS database-explain: You must describe how you established the high groundwater elevation; Hand auger near leaching observed water at 11'.Bottom of teaching at 4'_T Separation. 3 Before filing this Inspection Report,please see Report Completeness Checklist on next page., t5ins•3113. Title 5 official ftpeCUon Forth:Subsurface Sewage Dispose)System•Pap 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Po,rm; , Subsurface Sewage Disposal System Foam-Not for Voluntary Assessments 67 Hollingsworth Rd Property Address Melanie Bilazarian Owner owners Name information is required for every Osterville MA 02655 10i21f2015 page- C4fTown State lip Code ; Date of_Inspectiort 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 1 t5ins x 3/13 Title 5 official Impectimiform Subsurface Sewage Disposal System•Page 17 of 17 Assessing As-Built Cards Page 1 of 2 / ff►t TOWN OFF ARNSTABLE *` LOCATION �07 J°701�-I��d woo SEWAGE x Dill 330 VILLAGE S7—eN�l�t ASSESSOR'S MAP&LOT INSTALLER'S NAME&PHONE NO, SEPTIC-TANK CAPACITY ��fA LEACHING FACILITY:(type) 1619 014 (size) /Ix as 4 NO.OF BEDROOMS'a BUILDER OR OWNER VigneCt O PERMTTDATE- 'COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Tabie to the Bottom of Leachini 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'o within 300 feet of leac ' g facility) ' Feet furni _ t shed . . y =asn I.." 'Aug a&s , a d 3a' SS ` 3 O j 3 sir G r` http://www.town:barnstable:ma.us/assessing/HMdisplay.asp?mappar=140071&seq=1 10/19/2015' TOWN OF BARNSTABLE A :: &TION �� + �01�� S t+�0/ SEWAGE # lw , VILLAGE DSTt/�� ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. r SEPTIC TANK CAPACITY LEACHING FACILITY: (type) ""(size);I-'X a*% NO.OF BEDROOMS a" BUILDER OR OWNER (V/90,r+0 PERMITDATE: COMPLIANCE DATE: Separation Distince Between the: Maximum Adjusted,Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well 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 �A Q, r• a a 34 SS jA 3. O 3 q1 GI y y Sa �7 TOWN OF B STABLE I:OCATION C 7 #0 lilm 4AJ SEWAGE # !2 7- VILLAGE �1` U �� ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. U2�I 0O t� SEPTIC TANK CAPACITY LEACHING FACILITY: (type) U a(G - G/� (size) NO.OF BEDROOMS 'BUILDER OR OWNS d (50e G e PERMIT DATE: COMPLIANCE DATE: 4 Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility N Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) U Feet Edge of Wetland and Leaching Fa ' ' wetlands exist p within 300 feet chin Feet r Furnished by r D ' Ta �� r=r-Ce rry c ,s o �l`r cro.c, M�4rJ�R►K er�-1 Cc�Z rv400 S e �- Cd/!ca�-e er tuo��- No. / 7 - 33o Fee�— THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppYication for �Di!5pogal bpztem Congtruction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Own 's Name,Address and Tel.No. Assessor's Map/Parcel No Installer's Narlie,Address,and T .No. ( / ` Designer's Name,Address and Tel.No. 71 vd �o ��C� Type of Building: Dwelling No.of Bedrooms Lot Size ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers()00 Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank �f Type of S.A.S. Description of Soil �� ' c5�� Nat f Repairs t A tions(Ans er when applicable) cv -6 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 TitlersBoard the Environme d not to place the system in operation until a Ce 'fi- cate of Compliance has been issue" of e Signed Date rl',,A� IF;7 Application Approved by C1.w�.....,.� Date Application Disapproved for the ollowi g reasons Permit No. 7 Date Issued No. 7� Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 2pprication for Mf!5pogal *p5tem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 47 Z vv Ow 's Name,Address and Tel.No. CAW � Assessor's Map/Parcel /4© 67 7 / �� Installer's N e,Address, d Te.No. ( //� Designer's Name,Address and Tel.No. v� ��0 �S C�UC�CAf Type of Building: �'] Dwelling No.of Bedrooms Lot Size O� ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic TankC� Type of S.A.S. Description of Soil Na f Repaff11r, ::tV A l�tio s( tswer when applicable) �v ✓— 0 0XIS Date last inspected: Agreement: The undersigned agrees to ensure the co struction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title the Environme d not to place the system in operation un '.l a Ce ' t- cate of Compliance has been issue Board of e ('3/,�&/ F 7' Signed Date Application Approved by - Date —�. —9 � Application Disapproved for the ollowi g reasons Permit No. Y 7- Date Issued --------------------------------------- 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 at has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer Designer The issuance of this ermit shall not b construed as a guarantee that the syste i•Zcl ion as designed. Date^ Inspector ----------------------------------------- No. 220 — 0 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE: MASSACHUSETTS i wf 6po�,al *p.5tem �tCon.5truction Permit Permission is hereby gry'tiftt to�tru 1(,,I)�$,ep�r,( ��grad )/AV don(C)) ` Ile— System located at (p ((��1/�=-J ( ) and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of thins permit. Date: o� CO _ !y 7 Approved by „V. . D TOWN UN }3 4u STABLE — 411 SEWAGE # LOCATION VILLAGE ASSESSOR'S MAP & LOT/�✓ IIVS PALLER'S NAME&PHONE NO. t/C'�l"�` S 6OZ SEPTIC TANK CAPACITY p K—UO 4 S (size) /2 )C 2 2$�'''',$�( _� , LEACHING FACILITY: (type) N6..,bF BEDROOMS 'BUILDER OR OWNE PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Feet ,.INaxim ►Adjusted Groundwater Table and Bottom of Leaching Facility Private Water Supply Well and Leaching Facility (If any wells exist N C) Feet on site or within 200 feet of leaching facility) Edge.of Wetland and Leaching Fa ' ' wetlands exist N© Feet ;within 300 feet chinu/f F.itcnished by v O 50 SCvF1 C, C/ WC •r �� Wi�� d- o v 'y NOTICE: This Form is to be used for the Repair of Failed Septic Systems Only CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL ' WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS). I, hereby certify that the application for disposal works construction permit signed by me dated concerning the property located at r, meets.:all of the A ro�-! 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 v • The observed groundwater table is 14 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. �22 SIG DATE: ` LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBED [Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. " f r .. . �CA s rvec r� a 5 g f�Ucvav V� I f ---- -- -- — --- �� �s w oAT No. Fee ` '�5 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Rpplication for �Bigoal �bpgtem Cottgtructfon Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon 6 ❑.Complete System 11QIndividual Components Location dress or Lot No. 47 Te®�J�9rj�Q r7 Al Owner's Name,Address,and No. iyDl®7 / /,4C/A, Assessor's Map/Parcel 43 tn1 ill e- Installer's Name,Address,and Tel.No. 771`Q,� Designer's Name,Address and Tel.No. /�D —) 6L19 y— Type of Building: Dwelling No.of Bedrooms Z Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 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 c, Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board f He lth Z �j S' ne Date Application Approved b Date d Application Disapproved by: Date for the following reasons Permit No. Date Issued No. .p`�"� ���✓ Fee THE COMMONWEALTH OF MASSACHUSETTS. Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes pplication for �Digogal �&pgtem Construction Permit Application for a Permit to Construct O Repair O Upgrade O Abandon(V( ❑.Complete System I ndividual Components Location A dress or Lot No. I„ P7"j� Owner's Name,Address,and Tel.No. IyDo7 l V ) i/ /U�/� 71 Assess.is Map/Pamel Installer's Name,Address,and Tel.No. 7 7/ ` / Designer's Name,Address and Tel.No. /Or Type of Building: Dwelling No.of Bedrooms Z Lot Size sq.ft. Garbage Grinder ( ) _ i Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required)} � � �gpd Design flow provided gpd Plan Date ; :y) {- Number of'sheets Revision Date Title Size of Septic Tank Type of S.A.S. -r ,Description of Soil f Nature of Repairs or Alterations(Answer when applicable) it r 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 pf Health. Sigrfe`d-" Date Z/— Application Approved b Date Application Disapproved by: Date for the following reasons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS m - BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS T CERTIFY,that th�e/On- it Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded ( ) Abandoned(IS /` /> at / /�/� i has been constructed in accordance with the provisions of Title 5and the for Disposal System Construction Permit No. dated Installer Designer #bedrooms Approved design flow r\ .�, gpd The issuance of this permit shallmot be construed as a guarantee that the system will function A designed. Date G � / � Inspector' No. � b v�/ Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS lwigpogal *pgtem Construction Permit Permission is hereby granted to Construct ) Repair ( ' Upgrade ( ) Abandon System located at �^ ! T Al/ �l and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date--of p it. Date �'/a-�/D Approed by SENDER- COMPLETE THIS SECTON COMPLETE THIS SECTIbiNl 6N . ■ Complete items 1,2,and 3.Also complete AyogignnOure item 4 if Restricted Delivery is desired. ❑Agent ® Print your name and address on the reverse ,Oki ❑Addressee so that we can return the card to you. ived by( ranted Name) C. Date of Delivery ® Attach this card to the back of the mailpiece, or on the front if space permits. D. Is delivery add �I rrt from ke,_ Wryes I 1. Article Addressed to: / 1 If YES,enter el�fery address bolo° c� ❑No II 0 L,O' p2 l0 5 5 3. Service Type I IS Certified Mail ❑Express Mail I ❑Registered 0 Return Receipt for Merchandise ❑insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number - (Transfer firim service label ; 11 j7jOG1 11;6 0 ;0 Q p 0 jq 1iT1 0 6 07 PS Form 381.1,`February 2004 l ; ; Domestic Return Receipt toasss o2'M-isao: UNITED STATES„P. S?AL,S1�lC ,�.= x n Ag '& ye�esl��1� • Sender: Please print your name, address, and ZIP+4 in this box • it I I Town of Barnstable I OY Health Division 200Main Street Hyannis,MA 02601 II r i{1i31iJil111iillt:It! Hill!lilt 11111H11111111!!111H111131 11' 1 1 1. 1 1 1 'I1 Town of Barnstable Barnstable `I it ' a rtmen- t AAmeirc a sC Wity i gulatory Services Dep;RARTABI E 55 Public Health Division p6 39. 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO January 3, 2008 r w Paul Mullen .67 Hollingsworth Road Osterville, MA'02655 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 67 Hollingsworth Road Osterville, MA was'inspected on August 8, 2007 by James Ford, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system FAILED under the guidelines of 1995 TITLE V (310 CMR.-15.00) due to the following: A single cesspool system is an automatic failure with the Town of Barnstable. You are ordered to repair or replace the septic system within Two (2) years from the date of this notification. Failure to repair/replace the septic system within the deadline.period will result in fixture enforcement action. S PEZZHO OARD OF HEALTH Agent of the Board of Health - Q:\SEPTIC\Letters Septic Inspection Failures\67 Hollingsworth Road.doc r 7005 1160 0000 0191 0607 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL,AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION 4 TITLE 5 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM . PART A CERTIFICATION Property Address: 67 Hollinesworth Road 2 SYSTEMS Osterville. MA 02655 Owner's Name: Paul Mullen Owner's Address: Date of Inspection: August 8, 2007 Name of Inspector: (Please Print) Janes M.Ford Company Name: JamesM. Ford �(� �J. t^lC) ' 9� I Mailing Address: P.O.Box 49 Osterville,MA 02655-0049 Telephone Number: (508)862-9400 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ✓ Passes (Title'VSystem). t Via. Conditionally Passes N s Further Evaluation by the Local Approving Authority ✓ F it (Single Cesspool) ` Cf• :l Inspector's Signature: Z J.^"z Date: August 14:Y007 =f' :P1 The system inspector shall sub ' a copy of this inspection report to the Approving Authority(Boar of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design ow of fo,000 gpd or greater,the inspector and the system owner shall submit the report.to the appropriate regional office of the. DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future_under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page I f • Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: . 67 HollinQsworth Road Osterville. MA Owner: Paul Mullen Date of Inspection: August 8. 2007 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: ✓(Title V System) I have not found anyinformation 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: 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 detennined(Y,N,ND)in the for the following statements. If"not deterinined";please . explain. The septic tank is metal and over 2- years old* or the septic tank(whether metal or not)is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by.the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system.will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of 1 i OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 67 Hollingsworth Road Osterville, MA Owner: Paul Mullen Date of Inspection: August 8. 2007 C. Further Evaluation is Required by the Board,of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b).that the system is not functioning in.a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,it 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 aseptic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this fonn. 3. Other: 3 Page 4 of 1 I OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address:. 67 Hollingsworth Road Osterville, MA ` Owner: Paul Mullen Date of Inspection: August 8. 2007 D. System Failure Criteria applicable to all systems: You must indicate either"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 %2 day flow _ ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped— ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation. ✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. s ✓ Any portion of a cesspool or privy is within a Zone 1 of a public well. ✓ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ✓ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia. nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] Yes (Cesspool) (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15,303,therefore the system fails. The system owner should contact the Board of Health to detennine what will be necessary to correct the failure. NOTE.Single cesspools automatically fail in the Town of Barnstable Laundry seems to be going to this drywell E. Large System: To be considered a large system the system must serve a facility with a design flow of 1000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to eachof 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-1WPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 s OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 67 Hollingsworth Road Osterville, MA Owner: Paul Mullen Date of Inspection: August 8. 2007 Check if the following have been done: You must indicate"yes"or"no"as to each of the following: Yes No ✓ Pumping information was provided by.the owner,occupant, or Board of Health _ ✓ Were any of the system components pumped out in the previous two weeks ? ✓ Has the system received normal flows in the previous two week period? ✓ Have large volumes of water been introduced to the system recently or as part of this inspection? ✓ — Were as built plans of the system obtained and examined?(If they were not available note as N/A) ✓ Was the facility or dwelling inspected for signs of sewage back up? ✓ Was the site inspected for signs of break out? ✓ Were all system components,excluding the SAS, located on site? ✓ — Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions, depth of liquid, depth of sludge and depth of scum? ✓ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been detennined based on: Yes No ✓ _ Existing information. For example,a plan at the Board of Health. ✓ Detennined 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 1 I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 67 Holliusworth Road Osterville, MA Owner: Paul Mullen Date of Inspection: August 8. 2007 RESIDENTIAL FLOW CONDITIONS Number of bedrooms(design): 2 Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 220 Number of current residents: 0 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): n/a [if yes separate inspection required] Laundry system inspected(yes or no): Laundry appears to be going to the drywell Seasonal use(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Unknown COMMERCIAVINDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow o seats/ e r sons/s ft g ( P q ,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Unavailable Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: gallons--How was quantity pumped ed detennined? 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 Other(describe): Approximate age of all components,date installed(if known)and source of information: Septic tank installed on 6127197(per as built card) Were sewage odors detected when arriving at the site(yes or no): No 6 ' Page 7 of I I OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 67 Hollingsworth Road Osterville, MA Owner: Paul Mullen Date of Inspection: August 8. 2007 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: Conments (on condition of joints,venting, evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: IS" 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: 1500 gal. Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 3" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 12" How were dimensions detennined: Measuring 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.): Tees were present The liquid level was even with the outlet invert There did not appear to be any signs of leakage NOTE The washing machine seems to be going to a drywell Could not run washer to verify Needs to be piped to the septic tank GREASE TRAP: . None (locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: ! Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Continents(on pumping recommnendations,inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): i 7 i Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 67 Hollingsworth Road Osterville MA Owner: Paul Mullen . Date of Inspection: August 8, 2007 TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last um in p P g Commments(condition of alann and float switches,etc.): DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Even 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.): . The D-box was level and clean. No solids were present. PUMP CHAMBER: None (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no) Connnents(note condition of pump chamber,condition of pumps and appurtenances, etc.): 8 r Page 9 of 11 OFFICIAL INSPECTION FORM=NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: _ 67 Hollinvsworth Road Osterville MA Owner: Paul Mullen Date of Inspection: August 8 2007 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: . Type leaching pits,number: ✓ leaching chambers,number: 2-500 gal. drvwells(12'x 22' ner as built cad) leaching galleries;number: leaching trenches,number, length: leaching fields,number, dimensions: overflow cesspool,number: Innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure, level of ponding, damp soil, condition of ve etation etc.): g The chanbers were dry and clean. There did not agpear to be an si ns OL failure. CESSPOOLS: . None (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth -top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Coininents (note condition of soil,signs of hydraulic failure,level of ponding, condition of vegetation,etc.): PRIVY: None. (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.): 9 I Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: . 67 Hollingsworth Road Osterville MA Owner: Paul Mullen Date of Inspection: August 8 2007 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. k . /4u-,� 3a 10 it Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 67 Hollingsworth Road Osterville, ALA Owner: Paul Mullen Date of Inspection: August 8. 2007 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 25 +/- feet Please indicate(check)all methods used to determine the high groundwater 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: Topographic and water contours maps Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Using Barnstable topographic and water contours maps the maps were showing approximately 25'+/ to groundwater at this site. This report has been prepared only for the septic system and components described herein. This septic system has been inspected as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no'warranties'or guarantees,either expressed, written or implied, relating to the septic system, the inspection, this report and/or any components of the septic system which have not been located and inspected. 11 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION i �65Es69R�MAP M0 _ PARCEL N0: _ TITLE 5 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENT SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 67 Hollingsworth Road Osterville, MA 02655 Owner's Name: Carmine Vigorito Owner's Address: Date of Inspection: June 26, 2004 Name of Inspector: (Please Print) James M. Ford Company Name: James M. Ford Mailing Address: P.O. Box 49 Osterville,MA 02655-0049 Telephone Number: (508) 862-9400 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ✓ Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: ' Date: June 28, 2004 The system inspector shall subm' 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 10,060 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system.owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 67 HollinQsworth Road Osterville, M4 Owner: Carmine Vigorito Date of Inspection: June 26, 2004 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: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes, no or not determined(Y,N,ND)in the for the following statements. If"not determined",please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of 1 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 67 Hollingsworth Road Osterville, MA Owner: Carmine Vigorito Date of Inspection: June 26, 2004 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of I 1 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 67 Hollingsworth Road Osterville, MA Owner: Carmine Vigorito Date of Inspection: June 26, 2004 D. System Failure Criteria applicable to all systems: You must indicate either"yes"or"no"to each of the following for all inspections: Yes No ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than '/z day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s.). Number of times pumped . ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation. ✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ✓ Any portion of a cesspool or privy is within a Zone 1 of a public well. ✓ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ✓ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate.nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] No (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large System: 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 II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 67 Hollingsworth Road Osterville, MA Owner: Carmine Vigorito Date of Inspection: June 26, 2004 Check if the following have been done: You must indicate"yes"or"no"as to each of the following: Yes No ✓ _ Pumping information was provided by the owner,occupant,or Board of Health ✓ Were any of the system components pumped out in the previous two weeks? ✓ _ Has the system received normal flows in the previous two week period? ✓ Have large volumes of water been introduced to the system recently or as part of this inspection ? ✓ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ✓ Was the facility or dwelling inspected for signs of sewage back up? ✓ _ Was the site inspected for signs of break out? ✓ _ Were all system components,excluding the SAS, located on site? ✓ _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum ✓ _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: Yes No. ✓ _ 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 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 67 HollinQsworth Road Osterville, MA Owner: Carmine Vigorito Date of Inspection: June 26, 2004 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 2 Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 220 Number of current residents: 1 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): n/a [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Currently occupied COMMERCIALANDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): pd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings, if available: ' Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Never pumped-per owner Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: _gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM ✓ Septic tank,distribution box,soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records, if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Installed 612 719 7-per as built card Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of I 1 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 67 Hollingsworth Road Osterville, MA Owner: Carmine Vigorito Date of Inspection: June 26, 2004 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 of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 15" 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: 1500 gal. Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 2" 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: 12" How were dimensions determined: Measuring 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.): Tees were present. The liquid level was even with the outlet invert. There did not appear to be any signs of leakage. GREASE TRAP: None (locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page 8 of I 1 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 67 Hollingsworth Road Osterville, MA Owner: Carmine Vizorito Date of Inspection: June 26, 2004 TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: _concrete _metal fiberglass _polyethylene _other(explain): Dimensions: Capacity: gallons Design Flow: Gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): I DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Even 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.): The D-box was level and clean. No solids were present. PUMP CHAMBER: None (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.): 8 Page 9 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 67 Hollingsworth Road Osterville, AM Owner: Carmine Vigorito Date of Inspection: June 26, 2004 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: ✓ leaching chambers,number: 2-500 gal. drywells 12'x 22'-per as built card leaching galleries,number: leaching trenches,number, length: leaching fields,number,dimensions: overflow cesspool,number: Innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation, . etc.): The leaching chambers were dry. No scum line was present. There did not appear to be any signs of failure. CESSPOOLS: None (cesspool must be.pumped as part of inspection)(locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): PRIVY: None (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.): 9 - 7 • Page 10 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 67 Hollingsworth Road Osterville, MA Owner: Carmine ViQorito Date of Inspection: June 26, 2004 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. � a � a�sSS a _ a 3b SS 3 O 3 ell c, Y � 10 Page I I of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 67 Hollingsworth Road Osterville, MA Owner: Carmine Vigorito Date of Inspection: June 26, 2004 SITE EXAM Slope Surface water Check cellar ' Shallow wells Estimated depth to ground water 25 +/- 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: Topographic and water contours maps Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Using Barnstable topographic maps and water contours maps the maps were showing approximately 25'+/-to ground water at this site. This report has been prepared and the system inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied, relating to the system, the inspection andlor this report. 11 F �No. -��.------- FlzE........a�.�. . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH i � ........ �/'7w�✓. ----OF............. .. I . ppliration -for Uispsstti Works To strurtion Vrruift Application is hereby made for a Permit to Construct ( ) or Repair (A-<an Individual Sewage Disposal System at: "•= . -- ................................--........... tio ress. or Lot Ivy caner - Address ....................... -•---•-----•-- - Installer Address UType of uilding Size Lot-----------------------------Sq. feet Dwelling—No. of Bedrooms-----------------------------------------_Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) PaOther fixtures ------------------------0-----•---------------_--------- ------------------ ---------------------------------------------------- W Design Flow............................................gallons per person per day. Total daily flow----------------------------_...............gallons. WSeptic Tank—Liquid capacity------------gallons Length---------------- Width---------------- Diameter---------------- Depth---._._--.-.--. x Disposal Trench—No. .................... Width.................... Total Length-------------------- Total leaching area--------------------sq. ft. Seepage Pit No..................... Diameter-------------------- Depth below inlet.................... Total leaching area---------------.-_sq. It. Z Other Distribution box ( ) Dosing tank ( ) - �' Percolation Test Results Performed by---_---------- .......................................................... Date------------------------------ ------- W Test Pit No. 1----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ L14 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water---------------------... f4 --------------- --------------------------------•...•-••-•••--•---•-------•••---•••••••••••••---------•--•----••--•-••••••------------------•-•-•------ ODescription of Soil------------------ . •. -•--------•---•-•---•••---••-•••----------------------.........-----------------........------------......----------------- x V •••••--••---------•-----••...---•--•---------------•-......••-----•-- --•-••------••-••-•••-------•-•-•-••-••-••••-----------•-••---•••---•-------------••-•••-•-•----------------.......-------- -- W -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- U Nature of Repairs or Alterations—Answer when applicable______________________________ ._ r --------------------------------------------- Agreement: , The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has en issued by th bold/of health. J Signed.... -----• --•------------••--------•--- -------------- Application Approved By----- ......_ %��LYi,F F ...� ��- Date Application•Disapproved for the following reasons:--•-••..........................•---•--------•-•------•-•-••--•-•-----.......-------•..--•• •-•-r-------------- •-•-------------•-----••----------------•-•-•--•----._.....------•.•--•- Date PermitNo........................................................ Issued......................-................................. Date L_ No......25?�T....... ........................... THE COMMONWEALTH OF MASSACHUSETTS .__,,,, BOARD OF 7 HEALTH ... ........ ------ OF.............. ................ Appliration -for Biiipwial Workii Towitrurtion Vrrmft Application is hereby made for a Permit to Construct or Repair ( &<an Individual Sewage Disposal System at, ........... ......... --------------------------------------- --- ---------------­------------ --- ------------------------- ......... ................................................ io Tess or Lot ........................................t.. ............................................. . .....4��............ --------------- wner/h,-,.�� Address ................ ........ ­................................................................ ................................................................................................. Installer Address Type of uilding Size Lot----------------------------Sq. feet U Dwelling—No. of Bedrooms--------_--------•.........................Expansion Attic Garbage Grinder ( ) Other—Type of Building .............. ------------- No. of persons_.-___-__-_-_______--___.__ Showers Cafeteria ( ) Otherfixtures ........................................................................................... ---------------------------------------------------------Design Flow............................................gallons per person per day. Total daily flow.............. --------- ..........*........gallons. P4 Septic Tank—Liquid capacity..-:_-:--__-gallons Length________________ Width.-.--_-.------ Diameter_..___..-__--__- Depth.___-._-.-_-- x Disposal Trench=No_-------------------- Width-------------------- Total Length.._.___.._..__.__._. Total leaching area--------------------sq. f t. Seepage Pit No..'.................. Diameter..................... Depth below inlet__._._.___.____.____ Total leaching area------------------sq. f t. ,;Other Distribution box Dosing tank Percolation Test Results Performed by--------------------------------------------------------------------------- Date--------------_---------------------._.. Test Pit No. 1................minutes per inch Depth of Test Pit_-_-______________-- Depth to ground water_.:----._-_--_.--_-____. ri, Test Pit No. 2................minutes per inch Depth of Test Pit._______________:___ Depth to groun&water-..---------------------- P4 --------------- .......................................................................................................................................... 0 . '1, Description of Soil--------- -- -- .. . ........... ................................... ................................................................­­------------------ U ..................... ...................... .......................... .................................. ----------------------------------------------------------------------:---------------------- ------------------------------------­----------------------------------------------------------------------------------------------------------------------------------------------------------------- U,,� Nature of Repairs or Alterations—Answer when applicable.... --------------------------------------------------------------------------------- -- -------------------------------------- 4*4------- ---------------------------------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code— The undersigned fur'.ther agrees not to place the`system in operation until a Certificate of Compliance has en ssued b th oa/,dpf health. lvY Signed---- ­­-­- ---------------------------------------------------------------- -------------------------------- Date Application Approved By------- PQR16A81ve ------ -------------------*--- ---------------- Date Application Disapproved for the following reasons:................................................................................................................ ----------------------------------------------T-------------------------------*-------------------------------------------------------------------------------------------------Date---------- PermitNo......................................................... . Issued......................................................... Date T,H`E COMMONWEALTH OF MASSACHUSETTE,r BOARD OF ZH)�.ALIH ........... .. ........OF..........................;..................... .................................... AT Qwrtifiratr of, Tomptiana THIS IS(AO CERTIFY, Th the Individual Sew gp Disposal System cofisftcted'(. ) or Repaired .by*....*....... ......1------------------ ................ ........................................................ ............. • �'a I at......................................... .... . ............ ---------!--------------------­--- ------------------........................................................................... has been installed in accordance wit hl�rl�e provisions of Article X1 of The State Sanitary Codj$ as de§cribed in the application for Disposal Works Construction Permit No-----------------2-2/............. datec. Z;747�............. T-HE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A RAP(TEE TkAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE ................... Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS, BOARD QF HEALTH 4 ........... ......OF...... No...... ..........�A. .................................... .. .............. FEE....0? RnVaiial orkii To 'it Vamit r "I'll I U ;1 Permission is hereby gra d. ............ ............nte ... ... .............. ............ ............. or �jZjpir ate I vide ' Sei25! D1sposal yst to Construct <_ at No............Co ... .... ......... ..... ........ ............................. .............0--------------- ----------------------------------/-----------I------ Street d . as shown on the application for Disposal Works Construction Permit N( Dated......._.:.. ._ -T---------on-- -------R.t.0ftw -------rof .......................... .At Board of Health -if-------------------------------------- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS 4'-0" 62'-0" 12'-0" 12'-0" 2 4'-0" 14'-0". N m m A (0 co U N N X J�7 m I� O LA U m LA a m m V .4 ,v O )< .QLID a ry x ;ry �I CC�� x x �/ 1 Zz OO r W O n J Lh ® L H PI WALK IN x _ DW T s CLOSET - ry GEILIN6 EXTERIOR ;®I KITCHEN INING- I GA,1-IEDRAL m r F m m Q W SHOWER - OAK OAK I GREAT ROOM © I i ,v -- • 1 ,._... OAK x. .' j... .. .. ........ :9i. ._.� .. .. . � W 12'-3" `11'-6' 16'-5 1/4 ? T-6' .. . I--il U ISLAND a' - - - - - - - - - - - - - - � M� lal O io 10•_6" Itil Q TW 24470 GEILIN6 5-4" N AO= GEILING 30 /8"x60 7/8" - 2E' D 'BEDROOM OAK 4 -. 12'-31/2" I s Li O _ (7 v OD 4-5'1/4"�- - 2'-4" 4'-4 1/2" 15'-0" --6 0 - 14'-3 3/4" O O - - N _ T 6 ' PANTRY BINL _ F/L t- MICRO REF I 2-0 _ GLOS I '.. O m 4T0, T UP _ ® ® Z Q I R G m 4 xb'PST UP O STEP m PEF TO RIDGE LIN N T W m r m 20 E - TW 24410 N ^ M5: �i -.9 " 26 50 1/5'k60 T/5" LL .. • .. -. ,. Ni �1 - 6 - ' m ' 6'-4 1/2"i 4'-1'1/2" 3'-4 1/2" 26 5'-7 1/2" 5'-8 1/4' m 10-5/4 LALLY TO 5TEEL BEAM ABOVE LALLY TO m - �.. -....� CONCRETE' ------.-- CONCRETE - y GARAGE .,� .. s 6 <. i Fie 23,_3„ Fie TILE 1 5/4" - - - _ GEI NC 50 26 AN 251 I /`.... .... - 257/821 1. T r - 26 m 5 4 r1 GEILI 106 N6 x O GEILIN6 o ._. .. MASTER T t it v P4xTADIRS N q i i U� - STUDY - d BATH .� l~L W 7 =. � -i i I I m I I i A, F/L� OAK TILE FAN W J 442 •I ._........_..__A� - r PN1I7R• � 26 :. � r Q L - ( AK m ry 3 1/8"x52 T/5' r z OL i t - - - - - - - - - FA 4 o _ Y Vi o 4 o f I IX Of '...COVERED. I?.. ... IL LL N LL - /// - ......... ly- o n x x z W J r• r H � F m .(�� ry uI = X W r ry r z ry 2'-0" '-11/ 4'-111/2" 4'-111/2" 4--l" T'-T 3/4". 41_31. 2-1 1/4" 9'-11" 16-3 3/4" L 14'-0" SHEET NOTE' 1,6-11 50 FT A5 TV JACK= (1)RG6 FIRST FLOOR PLAN JOB: 1605 (2)GATS 5GALE: 1/4"=1'-O" DRAWN BY: KW DATE: 11/30/16 17-0" 24'-0" 14'-0" 10'-11" 5-7' r n ry m ry x d IN X Q z N ....................................................................... o „ w . �_ J 1s _ 11'-"1 5/4" 10'--!1/4" W-3" .............. ICI s I� UOU / J/ N / s,. _ ICI BED P_OOM i BED ROOM i w .� U 3 #2 I �- ' OAK I\ (V OAK \\ .. N Q N \ -.. - --- .. 4 0 y3'-51/4" 5'-11 1/2" �'3'-6 3_6„ �'-f-41/4" , — — — — — — — — — — — — — — — — — — - ' r O O I 26 b i/ O O OPEN TE3FLO .: 1 .I' I 'T 1 ; 1 1 I W l!') TM436 i ( II I 3 I I111 H W II !i f II I I - - y-.mow,::; 30 1/8 x44-1/H' •:::r.. ,., ..-�.- ..:. .. I Y 5TRUOTURAL Q O ..........__ ..____-._ .RIDGE ABOVE.......... ..._.... .....____.. ._. ... O - ... Q m Yi TILE LANDING c�v C� a m - - 'r OAK .. _ ON.. =77T Q l I � _ l 581/4 � 4 — I ` .. :. — — — I i I OPEN TO OPEN T I :. ..: BELOW O I I _ - --. _ _ 6ELOW _ _ . O _ o 0-6' W W - N I ..... - tV CEILING _ J J` w I li I it iI _ - - w I i - I 1 I � f^ I ' iI I � I II iI J it � O LL II jl I I :i I iI il I I i i Mill . ! [Q t!1 pZ Q i ! : II fl! LU ry i x W r n n 14'-0" SHEET 520 SQ FT SECOND FLOOR PLAN NOTE: A4 5CALE: 1/4"=1'-0" TV JACK= ' (1h2G6 ,XJB: 1603 (2)CAT5 DR'Nm BY: KW DATE: 11/30/16 24'-0" 7-113/4" 4'-5" Li N — — — — Q � W O - - - - - - I = , .J rs - - - - - - - BULKHEAD / } W Qicy.. W O PRO__V4ALL, L — — — LO TO 4b"6" — I I Q .. ,., e..' LP U UNFINISHED GLOSET I W o o I BASEMENT O N -___-_-_-_ _ - --- I I 26 I Q U) � TW24310-2ob �..M (I IG EL EGTRIG GLOSET I W - I I BOX I J - - r �My _ FIN15HFD ry BASEMENT BED ROOM DR W OP ALL Q Z - - � - - - - - - - - - - - - - - - , I #4 TO4(Y M m O CL o I L I . I 26 PKT .' 2r BATH u4 � I It 1 I LL W GARAGE I a W J J Ir - - - - - - - - - - - - I I I Q - - - - - - - COVERED 0 Z I I . I PORCH W L I ; - - - - - - - - - [El I ' ❑ d Z Z Cl) - - - - - - - - - - - - - - - - - - - - - - - - - — J CL 2'-1 1/4" W I- 1'-9" 16-5 5/4" 14'-O" . 5HEET 552 50 FT FINI514ED BASEMENT LAYOUT A5 5GALE: 1/4"=1'_O" JOB: 1603 DRAWN BY: KW DATE: 11/30/ib t , Lu Q W A , 29.0 PROPOSED (4) O BEDROOM O s mIL 140 00 DWELLING Q T Q .O.F.. @ EL. 32.5 Z Y LOT 2 A — B LO C K B 120 1 G.3 5. F.oTH �", b #4 i•,) o TH �W , ZONING D15TRICT: RC 30 #3 ,i 4 _, � MINIMUM FRONT 5ET15ACK: 20' ® --r-� / MINIMUM 51DE REAR SETBACK: 1 0' / #2 O 111 / �Q Q / / • / /'�Seo wArER H l SERvi�E- 2p. OR 1140. 9,,,, \\ ti 16 / cv I 4 32 �27p3 �� h SITE SEWAGE PLAN 30 v FOR ®!� . ,. G7 HOLLING5WORTH �RD., .05TERVILLE, MA EXI5TING • \ �• � � PREPARED FOR DWELLING , BAY 5 DE BUILDING, NC. O BE DEMOLI511ED)R 1 TBM = EL 320 SCALE: DATE: DRAWN BY: Of 32 . . 1 " = 20' 02- 1 5-201 G TMW LOT COVERAGE: " 1 HYDRANT JOB NUMBER: 15-008 REVISION: sr+EEr NUMBER: 5P- 22 10 5.F. / 1201 G.3 = 18.4% STEIN a WE LLE pp A FLOOR TO AREA RATIO � + � I\ * SSOCIATES FIR5T FLOOR: I G50 5.F. " w SECOND FLOOR: 520 5.F. ST'wR P.O. BOX 417 CENTERVILLE, MA 02G32 TELEPHONE: (508) 328-4G92 DATA EMAIL: tri5weller@cjmail.com TOTAL FLOOR AREA: . 2 170 5.F. / 1201 G.3 = O. 15 2 _Z S _ L REGISTERED LAND SURVEYORS ENVIRONMENTAL CONSULTANTS Traverse PC !''. INSTALL RISERS (COVERS TO PIPES TO BE LAID LEVEL FOR 2"LAYER OF DOUBLE WASHED PEA5TONE DEEP OBSERVATION HOLE LOGS WITHIN G"OF FINISH GRADE 2'OUT OF DISTRIBUTION BOX OVER 3/4"- 1%2" DOUBLE WASHED STONE (SEE PLAN VIEW FOR LOCATIONS) ALL AROUND DST: 10-D. -201MEYE 5 R-14 SSE WATER TEST D-50X FOR LEVELNESS FLOW WITNESS: D. STANTON, HEALTH AGENT EQUALIZATION PERC RATE: < 2 MIN./INCH EL. 3 1.5 EL. 3 1.0 DEEP 055EPVATION HOLE#I EL.3 1.0 T.O.F. @ 4°5CH DEPTH SOIL SOIL SOIL DOLOR SOIL 4°5CH 40 PVC EL. 32.5 a0 PVC 4'5CH 40 PVC OTHER TOP @ EL. 28.0 FROM O" (MUN5ELL) MOTTLING R I4" ` (3) 500 GALLON PRECST DRYWELLS HORIZON TEXTURE `29.00 28.75 O"-7° A LOAMY SAND I OYR3/2 7N5TALL GA5 BAFFLE 2g,1.7 28.00 BOTTOM @ EL. 25.30 7"_37• g LOAMY SAND I OYR�g PERC @ 37'-55". IN OUTLET TEE 28.50 27.3Q - 37'- - 24 GALS<15 MINS , 132° G MEDIUM-COARSE SAND 2.5Y7/4 DB-G (H-20) - INSTALL TANK! BOX ON ON 6'LAYER OF CRUSHED -. - 5TONE - 500 GALLON PRECAST. DEEP OBSERVATION HOLE#2 EL. 30.5 SEPTIC TANK BOTTOM TH @ EL. 19.0 DEPTH SOIL 501E FROM HORIZON TEXTURE SOIL DOLOR SOIL OTHER UREA E (MUN5ELL) MOTTLING p"-7" A LOAMY SAND I OYR3/2 7'-37" B LOAMY SAND I OYRG/8 SEPTICSYSTEM PROF I LE 37'- 132" C MEDIUM-COAR5E SAND 2.5Y7/4 DEEP OBSERVATION HOLE#3 EL.30.0 ) DEPTH SOIL SOIL SOIL COLOR SOIL OTHER SURFACE HORIZON TEXTURE ' (MUN5ELL) MOTTLING s' O"-9" A LOAMY SAND I.OYR3/2 DARREN � PERC @ 36'-54' - 9"-30' B LOAMY SAND I OYRG/8 30'- 1 26° C MEDIUM-COARSE SAND 2.5Y7/4 z4 GALS 15 Iv11N5 I`Q. DEEP OBSERVATION HOLE#4 EL. 29.5 'gWTs4t1•i*' DEPTH solL 501L FROM HORIZON TEXTURE SOIL DOLOR SOIL OTHER SURFACE (MUN5ELL) MOTTLING O 9" A LOAMY SAND I 0YR3/2 (/V 91-30 B LOAMY SAND I OYPG18 30"- 120 C MEDIUM-COAR5E SAND 2.5Y7/4 NOTE: NO GROUNDWATER ENCOUNTERED IN ANY OBSERVATION HOLE DESIGN DATA GENERAL NOTES DAILY FLOW: (4) BEDROOMS x I IO'GPD = 440 GPD 1 . SEPTi.0 SYSTEM IS TO BE INSTALLED IN ACCORDANCE WITH SITE - SEWAGE PLAN SEPTIC TANK: .440 GPD x 200% = 880 GPD FOR U5E: 1 500 GALLON PRECAST SEPTIC TANK 3 I O.CMR 15.0Y5 5. 5 TITLE v i G7 HOLLING5WORTH RD., OSTERVILLE, MA DISTRIBUTION BOX: DB-6 (H-20) 2. . THIS'-SEPTIC SYYSTEM IS NOT DESIGNED FOR THE' USE OF A 501L ABSORPTION SYSTEM: GARBAGE DISPOSAL. I PREPARED FOR USE: (3) 500 GAL. PRECAST DRYWELLS LINED 3. THI5 PLAN 15 NOT TO BE USED FOR PROPERTY LINE DETERMINATION. BAYSIDE BIJILDING, INC. w/4' OF DOUBLE WASHED STONE ALL AROUND 4. CONTRACTOR SHALL PROVIDE 48 HOUR NOTICE TO DE51GN SCALE: DATE: DRAWN BY: CAPACITY: ENGINEER FOR ANY REQUIRED IN,SPECTION5. I " 20' 02- 15-201 6 TMW 5. CONTRACTOR TO BE RESPONSIBLE FOR THE LOCATION OF ANY JOB NUMBER: REVISION: SHEET NUMBER SIDEWALL: 93 x 2 x 0.74 = 1 37.6 GPD 1 5-008 DETAIL- I BOTTOM: 13 x 33.5 x 0.74 = 322.3 GPD UTILITY, ABOVE OR UNDERGROUND, PRIOR TO ANY EXCAVATION TOTAL - 459.9 GPD OR CONSTRUCTION. WELLER * ASSOCIATES P.O. BOX 4 1 7 CENTERVILLE, MA 02G32 TELEPHONE: (508) 328-4G92 EMAIL: trl5Weller@gmall.com REG15TERED LAND 5URVEYOR5 ENVIRONMENTAL CON5ULTANT5 Traverse PC _. _ - - - • __..._ ZL ...._..._...._.._ _.._ __....._ _....._.... . _ _....._..__._._:.: ._ ---_---.._._. __.._ _.._...._....._ . __...__..__..._....- _-___._.-__- ..... - —.__..__..._. __- ._..--..----.---.--.-.---.__-.__ _ .... .............. ....... _........-_ - - - - - - - =_ - --_ -- _ ---_ _ _-=_=_-- .::=.�.:.... .. - - - - - - - - : ::. .....:: v ....__._..._..._............... _. ............................._................._...:.............. _ ._......._.... ..... ............................ ........_....... ._.................._ ..............._......_ - - - - _........ .--- . _..........._...._._.......__._ :.........::::::.. _::...: :::.: __........:_......._._......_: __..._..._ ...._.........._........ _.._...._...._....... _......_._..__....._.......__....._... __.._........__.._.._:.: _.. .._..__. _...._._......_..._......_........_..............:..._....._....__ _ ....._.......... _....._ _............................._...........__. _ _ _...... - _ ...._._.. .. _....._._..._..._.... ..........._.... _.-_.__ --- _..__._..._.....- --- ...__._...._.....__.._._....__._...- -- - _........._.- _.._..-- .._....._...._:_..._..........._.._.......__........_......_...--...__..............._..._...-_---...:__._......-...._...........__...._..._.._......._........_._,-...._..........._._..._......_....... ........._._..._...__...-._..---_._...__..._...__..._.._._.._...._._.._...__...._.__ _.._...._...._..................._._... __� _._............._ ...._ _ ............._.-.......... . - - -_..._....__. ....._........._._...._. __..:......_.. .:.:: ... _.._._... .. .. _,. _.............._ ...._............._ -- - --....._....._.........._....._.._......._ ._.._ _...... -- -- - -- -- _....._....._................ -........ -- - - ._...... _- -- - - 7 if 4f s u u � low 1� FRONT ELEVATION SCALE: 1/4" = V-01' i - -:-- - -- -- .. -.-.- - - _ _..- —: _ - - - - .. _ _. _ ................. BUBO z s SHEET F—A L--- L---J L---� Al FW,kR ELEVATION SCALE: 1/4" = V-0" JOB: 1408 DRAWN BY: KW DATE: 2/2/I6 • 12 12 to 4POEM w tis .. 7p I■■1 1■■I d„ ® w NEW Vl LEFT ELEVATION _ SCALE: 1/4" = I'-O" 12 F 10 12 a .. — 4 Flqllu ir 0 z _..... . m Q _ ..... tu p - SWEET A:2 , L --J M16HT ELEVAMON JOB: 1408' :SCALE: 1/4" = 1'-0" DRAWN 5Y:.1Cw DATE: 2/2/16 24i_0" 12'-0' 12'-0' 7'-0' 7'-0' 4'-1' -11'-11' 8'-0° 6'-0. 6'-0. 6'-0' 6'-0. ra m OMNI o NERS 17'_0• Psa N ® Dw c cArEiLING EoRAL GMM6 KITGN@1 © • _ 6REAT ROOM OAK _. OAK OAK -® .. .. 7'tu ® 16'-5 I/4' .. 11i_6. 12'_3' MINILo _ bO—— TW 24410 CEILING 8'- iv CEILING - 30 I 'x60 7/8 MASTM - CEILINNG_ 414r ®� w 23e CARPET i , — T —-m — ® P _ CARPET I 12'- 1/2" FROSTED 14'-3 3/4'- - - 6' 0° I8'-0' 4'-4 I/2° 2'-4" 4-8 I/ - 24 ' s r N Tv PANTRY f/L ICJ' UIL r _ 2$ IN r o Q REF. MICRO o m 4' P TO IDGE m STEP p m i 'x6' PS UP i 1O N TW 24410 —9 TO RIDGE 2-Q 'n 2B m -30 I 'x60 7/8' - .. 8!:`4' _ 9 24 2Q CEILINGUP 2� LITE Q M w 5'-8 1/4' � 8'-7 1/2" k. 3'- I/24'- I/2' .�Q 6'-4 I/2' 10' 0 3 4 ..- -....._ ....._..m. ._.._ ..._ ......._ ,-__......._..._......_._ _.- ..__ ._.......__...._.. .. ..._...._ ...._.._. _.............. _ .. ,_ _. y LALLY TO TEEL BEAM ABOVE _ LALLY TO CONCRETE NGRETE_. TILE 2 fz H'_4. . 2A AN 251 2- D CEILING — —— 14'-6 /4 23'-3' 7/8'x21' g�-4° -- gQ � � m a tL o o CEILING t� 2� 10'-E• &APA�tSE i MASTM _...... w CEILIN BATH F11t�ILO�K 51UGY Tv q . FAN TILE o OAK F/L — 0 24FROSTED GLASS 2-4 2� o TW244 PY'mli /@,�� N �-�, w F OAK 3Q ----- ------ . . IA"9) 1/8'x527H' _ ru :c Y � O LU 3'-9' 61-6. 3'-9" 2'-10' 8'-2' 10'-5 1/4" .7'-0 3/4" 2'-0' 9'-0. i_bu 9'-O. �21-0• 14'-0' 16'-6 3/4". 9'-II° '-1 1L4 23'-6' SHEET FIRST FLOOR P1.M � NOTE SCALE: 1/4° = 1'-O" N JACK • (1)RG6 JOB: 14011 (2)CATS DRAWN BY: K7 DATE: 2/2/16 62'-0' 14'-0' 241-0' 12'-0" 12'-0" 8'-0+ 8'-0. 8'-0' 5'-7' 10'-II I/ ' 5'-11 3/4' r r �in �C4 _....._.. ._...__. ... _._... . ........... ._._....._.._ I0'-7 I/4' II'-7 3/4' _..._.:.::...._......._.. -.. .......: - .._.................._...........................__.. . .........._ _ ......._......__....._._...... _..,,,... .. - _......_... .........._ -....__...- BPS Room ow ROOM r ..._....__._ .__...._ -- _...._._..._._... - _--...__. ._ - ----- -_.._._..- - - - —.._- _ i i IIZ i — _ - I CARPET N it 4 e CARPET Tv 9-._ _ ._....__.. ...._ - -- .:. . co ---- -- --"----- --- T-4 D4p. 3'-b /�7>l� W-11-1/2" 3'-8 I/4' wo ...._-_.....:...._...._....__....... ,..-_„...,._...............__....._---"--'-'... .._ .. ...... ._...... :. ' - LOW p OPEN TO � 2� �1 BE 2Q !Z � i 24 2Q w . _. __....._ ..... .....::W.... :-::: 2 ..._......_...._.......... __...._. .. _..__............._-----_...._----_...... -. - -.. _.. .. - _ ..._._.... _ _ _......._.._...._....._.... _ _. _ Lill�lllnlllllllln[ig III - --- - - -- -- 44 o ....___..__....._. -- 5TRUG p I' -...- --- RIDGE ABdVE BATH 02 - --- - w ------ - - . -_ TILE -- -- _- ZA _. _ ... ...._ ..::............. ..._........................................ ... ......... .: -�_„_,-,..,,_,_...._....:_:_"_-_.::.=:ram.._... _ _.__,.__.,._.._......_....:__._ - -------------- - ---- OPEN TO i. OPEN TO .. .. .. - _..... -_ - -------- - BELOW BELOW --- - _ ----- -- - - - CEILING J --- - --- -- -------- Cf __..__.._._......_.......__... _.._.._...._......._......_..--- - ................._.... - - _....._.........:.......... ._.:......_.........__ ir I m � O _ _ N LU x 8'-0. 3'-O' 5'-5 3/4' - 4'-11 1/2' 7'-0 514111, �- w-5 3/4' q'_II' -I 1/4 14'-0' 28'-(,' 23'-6' 5NEET Fwv� PLaaN NOTE, A4 SCALE: 114" = I`-0" TV JACK (1)R" JOB: 1405 (2)CAT-5 DRAWN BY: KN DATE: 2/2/16 14'-0" 24'-0" 12'-011 12'-0" W-0' . W-0' 11'-2' W-10' 6'-O' W-0' _ Z — 3 �� i m d -- — — -- ,, T L — — ,m, a su •.X' := 4�;rh� t r,,:. i:U+ �.y�9f ax'* hr`.i1{'�e3-»-7at�.`Is."��' t..W,furz3 I I :ire --"i.:aa"u§'1's� ' I s'"• I 1/2 �' I -------- ---------------J L-------- --- I z r. I BULKH -c t —— o I � I I u II Now v I I DROP I I I I 8'°!7,-q' CONCRETE WA� • a. 161xl0' CONTINUOUS FOOTING � `� xa I • �. n ;. (2) q 1/4'xl 3/4' LVL GIRDER • i —— —————— - 3 1/2' DIA. STEEL COLUMN a; . - I r - 36'x36'xl2' CONCRETE PAD TYP. - ea't I N I PKT I I m I 9'-4° 7'-40 71_4u J 71_4. 71_4o T_4o I ne w a I c x 6 o a■x7'-q' CONCRETE FULL BASEMENT 16'x10' CONTINUOUS FOOTIN4 ELECTRIC r Q MEN - 3 In, CONCRETE SLAB - m m n 6 MIL VAPOR RETARDER — o I h> I m 4'x6' PST TO RIDGE P ` 'rA4az s, a 1 ^a ———— +tini.:t 'mac.cw.. 21'-9 5/8° (2) 1 3/4 x q 1/4' LVL i ,u r——— — —— ——- :a 'v aDR 1 gI c. AWALL - T-0° T-O' T_p' ... �_p° '_ ° 6'-8' I � r—J AT DOOR P1 --- — BM atEM T 14 I I I (2) its COUNT TOP 4 I x I 8'x3'-10' CONCRETE WALL I -� �� 1' DEEP 16'xl0' CONTINUOUS FOOTING . I I 8'x7'-q' CONCRETE WALL c m I' CONTRACTION JO1 o O I '�y I EARLY ENTRY 16'x10' CONTINUOUS FOOTIN OPTIONAL - ° I CONTRACTION JOINT TYP. I o GARAGE acl, I 4' C.ONCRETE SLAB i I - K I x ; F I ————————— ———— ol I I I � I I . ,a1a � .ta>�;'o'f'*r3n� Ta34�ax„ n _ _ a .� EMBEDDED 7° I I I r z NOTE I 3 5/8 ANCHOR EfOLTS I 3 I DROP DROP , I � SPACED 32' O.G. I I WALL WALL I I 12" FROM GORNERS I AT DOOR AT DOOR I n WASHERS 3"x3'xl/4o I L----- ————— J . ---- ----- : 3 F2 € 3 2x10 a TOP 3 2x10's TOP Y W 14'-0° 16'-5 3/4' q'-II- '-I 1/4 1'-q' q'-6■ -O q'-6' 1'-q' .. 28'-6° 66'-0" SHEET FOL94DATICN P1M � 1 SCALE: 1/4" = 1'-0" JOB: 1408 DRAWN BY: KW DATE: 2/2/16 t�• V w TYP. ROOF (2) 1 3/4 x 16' _ \ _ 2xIOb 6 16' O.G. y .. RIGID WIND WASH BARRIER REQUIRED PLYWOOD F.G. INSUL./ / AT EXTERIOR EDGE OF EXTERIOR ED 5/B' PLYWOOD SHEATHING/ ASPHALT SHINGLES TOP PLATE 12 FASTENERS AT ALL - RAFTER /TOP PLATE JUNCTIONS TYP. ---- --------- R38 F.G. IN5UL. �1 ---- � . � 2x8s i 16 O.G. - � ■ .. Y� DORMER BEYOND SECTION i BRG WALL—> �y$ 12 12 1x3 STRAPPING �6• i 1/2' GYP. BOARDco — �p BLOCKING 4'-0'O.G. �' �' _ IN FIRST TWO JOIST AND RAFTER - .BAYS FROM GABLE WALL i iv IN TYP. EAVES 2xlOe F WO.C. FASCIA / IX4 SECOND MEMBER CO -- - —I-- ----- ----------- CONTINUOUS VENTING SOFFIT i Ix8 FRIEZE BD. W/ BED MOULDING it rrP_ ExTERIaR WALL O GREAT ROOM \ o STUDY 2x6 EXT. STUDS 6 I(" = — — 6' R21 F.G. INSUL./ 1/2' PLYWOOD SHEATHING/ TYVEK WRAP/W.C. SHINGLES `o 3/4' TfG OSB SUBFLOOR NAILED 4 GLUED TO JOIST F - _ IN75ULI (2) 1 3/4 x 9 1/4 LVL (2) 1 3/4 x 9 1/4' LVL iz 3 I/2' LALLY COLUMN 3 I/2' LALLY COLUMN TYP. FOUNDATION WALL P.T. 51LL ANCHORED 32' O.G. - ... 6'x7'-9' CONCRETE - DAMP PROOF BELOW GRADE ICJ 101xl6' CONTINUOUS FOOTING 3 I/2' CONCRETE SLAB \ 10 MIL VAPOR RETARDER . ,,.>... _ 1 Ell 13 1 ION UR SCALE: 114" = 1'-0" SHEET 5.2 JOB: 1408 DRAWN BY: KW DATE: 2/2/I6 • Kum r. w MEN w ` (2) 13/4 x 9 1/4' LVLjI ` r (2) 1 3/4 x 9 1/4' L)L'S .. .3 1/2' DIA N. STD CAP 0 5A5E PLATE (2) 6/6' DIA ANCHOR 50LT5 MIN. - .. GARAGE llJ s N Z m 0 pZ[[ w x FIRST FLOOR FRAMING PLAN SCALE: 1/4" = I'-0' SHEET JOB: 1405 DRAWN BY: KN DATE: 212116 • 1■■1 r., (3) 2x10'e .w • n w O 1We FLU BEARING ... - UP WI2x30 TEEL BEAM FLUSH — — ——— Y � O z J m � z r OL N LU x SECOND FLOOR MRAMIN6 PLM SCALE: 1/4" = 1'-0" SHEET 54 II JOB: 140E DRAWN BY: KW DATE: 212/16 • WINDOW DORMER ~ w ROOF RAFTERS EXTENDED BELOW RIDGE (3) 2xI0'e BREAK IN ROOF (3) 200'e HDR WINDOW DORMER WALL DORMER WALL M (2) 2Now x IOb a CA NNW w w ` w a IDLE 2x12 POST 4x6 4xb IRIDGE (2) 13/4 x I6' LVL'eI IPOST 4x6 . RIDGE 2x12 flIT .. BEARING WALL (2)2x 10'e tu (3) 2x10'e HDR z _zr RAFTERS 2x10 6 10 O.G. RIDGES 2x12 UNLESS NOTED OTHERWISE lIl W ROOF FRAMING PL W SCALE: 1/4" 1'-0" SHEET JOB: 1408 DRAWN BY: KW DATE: 2/2/16 of EXTEND NOR TO CORNER '- if�.7�/{AI■ , • 1 RAFTER .JACK STUD �. .. KAJL TOP PLATE TO BTT-0 OF NDR -' \ APPLY SIMP50N MSTA18 CONNECTOR ° ° .. H2.5®EA.RAFTER .. .� YV 2 ROWS OF Tbd NAILS ON THE INSIDE FACE OF HEADER °� w •5"O.C. TO EACH JACK 5TUD - - - . .. o o .. . - STRUCTURAL PANEL ° . NAILED ad COMMON _ HEADF7i CONTINUOUS HEADER u o TOP PLATE •3°O.G.EDGE AND FIELD CORNER TO GORN@i . - - OVER MULTIPLE ONNIN65 r 2 RAFTER TO PLATE CONNECTION .. O SCALE:N.TS. 9 2-5/6"ANCHOR BOLTS \\ - . W13"X3"PLATF-WASHERS II DOUBLE ROW . INTO BOTH PLATE _ ■ . - 2xb DEL TOP PLATE. VERTICAL . STRUCTURAL PANS . NAILED Sd COMMON OE NARROW WALL BRACING AT GARAGE DOOR SHEAR WALL COMPLIANCE:O �y�,scALe N.Ts. We 59% OF EACH WALL RUN FELD VERTICAL SHEATHING WITH 8d NAILS 3" EDGFA2" FIELD (4)16d NAILS PER FT BOTTOM PLATE L- 3I% OF EACH WALL RUN VERTICAL SHEATHING WITH Sd NAILS 3" EDGE/12" FIELD VERTKAL DOUBLE ROW - (4)16d NAILS :PER FT 50TTOM PLATE - STRUCTURAL PANELS - _ 5TA66ER NAL 40 — BREAK ON SECOND FLOOR NTO BOTH PLATES ... - RIM JOIST ..: F— .. .. 2%b DEL TOP PLATE .. ._ .. ..^^ V tu Mom 1 VORICJIL VatrIGAL STRUCTURAL PANEL STRUCTURAL PANEL.. NAILED 8d COMMON NAILED 8d COMMON •31 O.G.ED INY mm 6E m 9'O.G. AND t?N :(1 z - � YQD Mm 1� ID - lnvXL7 .. m -O DOUBLE ROW DOUBLE ROY4 . STA669R NAILING STAS6ER NMLN& .. NTO BOX AND SILL NTO BOX AND SILL ILI I �\ SHEET I OFULL HEIGHT SHEATHING -51NGLE FLOOR OFULL HEIGHT SHEATHING -MULTI FLOOR SCALE:N.T5. JOB: 1408' SCALE N.T5. DRAWN BY: KW DATE: 2/2/I6