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0091 ICE VALLEY ROAD - Health
01 91 lee Valley Road, Osterville A= 1 I I o a a o 0 o I I � o I No � � Fee 76 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS apphtation for Misposal 6pstem cottetCUttion Vertu Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. j:;?e V,&11"e y if&_, Owner's Name,Address,and Tel.No. Assessor's Map/Parcel (Q Dec)0A �� ,C lrl Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. D:V"Oeto S. 0 cc. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder`( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 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 r � Nature of Re airs or Alterations(Answer when applicable) /0.C�G 6A Date last inspected: ( b4A !LA�t Agreement: }- S e-M e ZQ 4,4`vs, ay G GG�7"'-f -e 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 not to place the system in operation until a Certificate of - Compliance has been issued by this Board of Heal / Sign Date Application Approved by Date Application Disapproved by _ Date for the following reasons Permit No. Date Issued No / V �i _ Fee 74/ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01ppIication for Disposal.6pstrin Construction 3pPrmit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. LILT ��� y Owner's Name,Address,and Tel.No. Assessor's Map/Parcel (D^ a ( ,' -1 luoi�l Installer's Name,Address,and Tel.No. (�V Designer's Name,Address,and Tel.No. tCJ rc.r.t Type of Building: Dwelling, No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) t 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 Nature of Repairs or Alterations(Answer when applicable) A01CL L JAI 1,4 1, 2d o Date last inspected: 1 2 G 1 F' I�t Agreement: Z 6✓1/t? ? P vH-kan The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Healt Signe Date 0/_ Application Approved by Date Application Disapproved by Date for the following reasons Permit No.>w )q Date Issued ��T- v Att/ THE COMMONWEALTH OF MASSACHUSETTS d�l a�,`� BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(41<Upgraded( ) Abandoned( )b rr�, 2 -•..•/ at has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 'O dated Installer D leW / �� Designer #bedrooms Approved design flow gpd The issuance o is pe all not be co. stru d as a guarantee that the system w'I fund' s designe . Date Inspector tAA ----------`----------------------------------------------------- ------------------------------------------------- No. t✓ q Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS Misposaf 6pstrtn Construction permit Permission is hereby granted to Construct( ) Repair( v'r q Upgrade( ) Abandon( ) System located at / t G yh//-� �✓ and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must a cor leted within three years of the date of this p rmie t. Date �// 9 Approved y 'HIV o��-i:c7-avZ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 91 Ice Valley Rd ,- u Property Address ' hen KELLER, DEVONIA M ? Owner Owner's Name +` information is c required for every Osterville Ma 02655 6/6/19 t. page. City/Town State Zip Code Date of Inspection L' Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. Inspector Information filling out forms on the computer, Michael DiBuono use only the tab key to move your Name of Inspector cursor-do not DiBuono Sewer And Drain use the return Company Name key. - 35 Content Lane r� Company Address Cotuit Ma 02635 City/Town State Zip Code 508-364-9587 S113522 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes . 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 6/11/19 Irispector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the.system has a design.flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: 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. rB f t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts ,F Title 5 Official Inspection Form r Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 91 Ice Valley Rd Property Address KELLER, DEVONIA M Owner Owner's Name information isequired or every Osterville Ma 02655 6/6/19 page. Citylrown State Zip Code Date of inspection- C. Inspection Summary J Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) 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 contains a 1500 Gallon septic tank as well as a New H2O Concrete Distribution box and two 1000 gallon leach pits. 2) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): l5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 91 Ice Valley Rd Property Address KELLER, DEVONIA M Owner Owner's Name information is required for every Osterville Ma 02655 6/6/19 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ 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): x 3) 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. a. 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: t5ins,.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts ,�p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments l; 91 Ice Valley Rd Property Address KELLER, DEVONIA M Owner Owner's Name information is required for every Osterville Ma 02655 6/6/19 page. Citylrown State Zip Code Date of Inspection C. Inspection Summary(cont.) ❑ 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 b. 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. c. Other: 4) 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 91 Ice Valley Rd ' �u Property Address KELLER, DEVONIA M Owner Owner's Name information is Osterville Ma 02655 6/6/19 required for every page. CitylTown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool El ® 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 water supply 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 coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ® The system is a cesspool serving a facility with a design flow of 2000 gpd- El10,000 gpd. ❑ ® 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. 5) 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 CA. 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 t5insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form is Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 91 Ice Valley Rd Property Address KELLER, DEVONIA M Owner Owner's Name information is required for every Osterville Ma 02655 6/6/19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes"to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must'indicate "yes"or"no"for each of the following for all inspections: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Fora' la Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 91 Ice Valley Rd Property Address KELLER, DEVONIA M Owner- Owner's Name information is required for every Osterville Ma 02655 6/6/19 page. Cityrrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 5 Number of bedrooms(actual): 5 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550 Description: Number of current residents: vacant Does residence.have a garbage grinder? ® Yes ❑ No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonaluse? ® Yes ❑ No Water meter readings if available last 2 ears usage 158 GPD 9 ( Y 9 (gPd))� Detail: Sump pump? ❑ Yes ❑ No Last date of occupancy: Date t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18' Commonwealth of Massachusetts Title 5 Official Inspection Form �m Ia Subsurface Sewage Disposal System Form - Not for Voluntary Assessments t 91 Ice Valley Rd Property Address KELLER, DEVONIA M Owner Owner's Name information is required for every Osterville Ma 02655 6/6/19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Not provided Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: l5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 91 Ice Valley Rd Property Address KELLER, DEVONIA M ' Owner Owner's Name information is required for every Osterville Ma 02655 6/6/19 ' page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: Original septic system. New leach pit added 6/18/1986 New distribution box installed at time of inspection. Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 3 feet Material of construction: ® cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): System is vented at the roof line t5insp.doc-rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 9 of 18 14*1 Commonwealth of Massachusetts ,(.,p Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -_Not for Voluntary Assessments 91 Ice Valley Rd Property Address KELLER, DEVONIA M Owner Owner's Name information is required for every Osterville Ma 02655 6/6/19. page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): 2.5 Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) 1500 If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: 3 Distance from top of sludge to bottom of outlet tee or baffle 24" Scum thickness 3" �I Distance from top of scum to top of outlet tee or baffle 4" Distance from bottom of scum to bottom of outlet tee or baffle 30" How were dimensions determined? Tape Measure Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts � Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 91 Ice Valley Rd Property Address KELLER, DEVONIA M Owner Owner's Name information is required for every Osterville Ma 02655 6/6/19 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) 13. Privy (locate on site plan): t ' Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form �o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 91 Ice Valley Rd Property Address KELLER, DEVONIA M Owner Owner's Name information is required for every Osteryille Ma 02655 6/6/19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. 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 t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 6/12/2019 Assessing As-Built Cards L� 11 SOR'S MAP NO. PARCEL LOC TION �SIW GE ,PZ R M I T NQ. VILLAGE INS.T A LLE 'S� ME i ADDRESS ��fr G BUILDER OR OWNER DATE PERMIT IS U E D, „Ig- DATE COMPLIANCE ISSUED V 4A https://townofbamstable.us/Departments/Assessing/Property_Values/HMdispl'ay.asp?mappar=096007002&seq=1 1/2 i cam, Commonwealth of Massachusetts ,OF Title 5 Official Inspection Form la Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 91 Ice Valley Rd Property Address KELLER, DEVONIA M Owner Owner's Name information is required for every Osterville Ma 02655 6/6/19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 10+ 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: 8/8/83 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) El Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: test hole data on plan Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form to Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 91 Ice Valley Rd Property Address KELLER, DEVONIA M Owner Owner's Name information is required for every Osterville Ma 02655 6/6/19 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ❑ A. Inspector Information: Complete all fields in this section. ❑ B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ❑ C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ❑ D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 ty. 112/ �I Commonwealth of Massachusetts r� 4 Executive Office of Environmental AffairsDepartment: of , Environmental Protection s 96 Wllllam F.Weld Oonmor Trudy t;oxe , Secretary.EOEA David B. Struhs Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION ` Property Address: 9/ Ice LA,jl — 9 GST Address of Owner: Date of Inspection:, ` $—9— c/6 / (If different) Name of Inspector: Company Name, Address and Telephone Number: I-S*VW41,', - 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 inspection. ,The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: _asses Conditionally Passes , _ Needs Further Evaluation'By the Local Approving Authority _ Fails Inspector' Si slur : r Gres / Date: !� Fo The Syste nspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the.system owner shall submit. r' the report to the appropriate regional office of the Department of Environmental Protection. r The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: _ A) SYSTEM PASSES: t, I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B) SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair; passes inspection. Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not) The septic tank is metal, cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 8/15/95) One Winter Street a Boston,Massachusetts 02108 a FAX(617)3WI049 a Talephone(617)292-WW 0 Printed an Rse KW P@W SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: cj/, act ���ldy /?,j nFoy"'Ile A4, Owner: C1.2e t Date of Inspection: Y B) SYSTEM CONDITIONALLY PASS (continued) _ Sewage backup or breakout o high\\e r i h static water level observed in the distribution box is due to broken or obstructed or due to a broken settled or uneven distribution box. The system will pass inspection if(with approval of the pipe(s) , Board of Health): .- br�ken pipe(s) are replaced obstP��ction is removed distribu't•on box is levelled or replaced The system required.pumping more than- r times a year due to broken or obstructed pipe(s). The system will pass _ Y inspection if(with approval of the Board of lth): broken pipe(s) are replaced obstruction is removed",,,,. C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: j Conditions exist which require further evaluation by the Board of Health'/in order to determine if the system is failing to protect the public health, safety and the environment. f - 1) SYSTEM WILL PASS UNLESS BOARD OF'HEAl.TH DETERMINES'THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTFI AND 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 APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ The cvstem has a septic tank and soil'absorpuon system and is within 100 feet to a swfaLe water supply or tributary to a surface water supply. ' _ The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. _ The system has a septic tank;and soil absorption system and is within 50 feet of a private water supply well. _ The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply I y well unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution)rom that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 PPm D SYSTEM FAILS: 1 , I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. (revised 8/15/95) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 9/ he Lla 11d y Owner. CQ7 /3/oke Date of Inspection: DJ SYSTEM FAILS (continued): 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 1/2 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 Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is with-in 100.-feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy.is within a Zone I of.a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well., Any portion of a cesspool,or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be'acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the;criteria'above: The design flow of system is 10,000 gpd or greater l arge,System) and the system is a significant threat to public health and safety and the environment because one or more of the foll wing conditions exist: " 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) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 6/ls/9s) .3 , y SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 41/ 4" t/011i Owner: Gov y ��ake _ Date of Inspection: Check if the following have been done: Pumping information was requested of the owner, occupant, and Board of Health. ,None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. t�As built plans have been obtained.and examined. Note if they are not available with N/A. 2The facility or dwelling was inspected for signs of sewage back-up. ZThe system does not receive non-sanitary or industrial waste flow t/The site was inspected for signs of breakout. d All system components, excluding the Soil Absorption System, have been located on the site. ZThe septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on existing information or /approximated by non-intrusive methods. , ✓The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub- Surface Disposal Svstem. (revised 8/1S/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION ' Property Address: Owner: 6—.,l Date of Inspection: 8-S'-96 FLOW CONDITIONS RESIDENTIAL: Design flow:_LIE gallons Number of bedrooms: I Number of current residents: 2 Garbage grinder (yes or no): Wo Laundry connected to system (yes or no):-.9y Seasonal use (yes or no):_ 7 Water meter readings, if available: Last.date of occupancy: COMMERCIAUINDUSTRIAL• Type of establishment: Design flow:_gallons/day Grease trap present: (yes or no)_ _ Industrial Waste Holding Tank prese y or no Non-sanitary waste discharged t e Tit 5 s tem: (yes or no)_ Water meter readings, if av ' le: Last date of occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System pumped as part o inspe ion: (yes or no)46�S If yes, volume pumped: 5I OO gallons . Reason for pumping: N/ai H /H6NLo 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) Other(explain) APPROXIMATE AGE of all components, date installed (if known) and source of information: 10-/7 Sewage odors detected when arriving at the site: (yes or no) v (revised 6/15/95) 5 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ,1 SYSTEM INFORMATION (continued) Property Address: 9/ /ce Ild1l.°y �d Owner: 60 a 9I`4ke Date of Inspection: SEPTIC TANK:_ (locate on site plan) Depth below grade: � Material of construction: �concreteJ metal _FRP —other(explain) Dimensions: /O`8' Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: 2y" Scum thickness: '3" Distance from top of scum to top of outlet tee or baffle: 3�� Distance from bottom of scum to bottom of outlet tee or baffle: 12., Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, dept of liquid level in relation to outlet invert, structural . integrity,evidence of lea e, etc.) Vf, Ida k GREASE TRAP:_ (locate on site plan) Depth below grade: Material of construction: _concrete metal _FRP_other(explain) Dimensions: Scum thickness: / Distance from top of scum to top of outlet p'or baffle: Distance from bottom of scum to bottom of uflet tee or baffle: Comments: (recommendation for pumping, co ition of inle and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, et .1 (revised 8/15/95) 6 r I��✓G� .�i4Mi��' -3-aF.�2�! . 49 5 330 x 200 ' p/Sa2SAG �/T USA SrO�vc- S/1�c LL A46.4 � ZZGX 2 •S SG5 G��, jl 7o-7;4L Z;4 4 G v*',c-LoYr/= i IA OF Ai V� /WILLIAM \�'r}i ALAN y� �I N T E u 1 NFS ~� .1 Nu 19134 `1 �o. 2' 1 'rE">T �Z/9� Od •4 TOP FNU=Ioo. .c.�yg INS. Svg,SO�(_ DIST. INV. En G 96.9 Z� /aoo 1uq. SQL Le_AC. PIT INV. INV. u/I T l) 9G 3 's �D V•/A�,11 G D 6 Tu 1.1 fc yo• � G62TIFICD PLOT F L.A.►a /Z - ,./o �447: P 4Z U F I L L o 4 A'� 10 tJ OS�,�✓/L L�- NO SCALE SCALE A .c%7F� T�ATE /f��3 p L./�.t�.l REF 61ZE N GE• C E RT I r-Y -f N AT T N E=ppol S� >r►p. 5NO 1�N NEREO►,1 COMPL` 6 yJITN THE S I o1=LIti �oT 99 AQP 56T�GK 26Q�IR->✓MENY> of T1�E- -To W N op-- ,A W D I S OC1i— .L GG , o�ZJ _ /7 / LOct,,TED WITNIW T141& Gl OOD PLtiIN . dATE,�83 BAxTEQ.e. (\JYE INC• RE615�1~26� t-Au D 5 u iz.v E`(oe�S Tull PLa►� ► 5 Ncrr (3n'>r_n o� aN oSTE2vILLE- - S >J TR.UMEtiT ;vIZvE`( F -rNF �?1-rSETS 6W ULT> _i i .. I,I-r T2!2. r - u SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 9/ -..,?�t (/tr�/?y /(�� �s�v� lie Owner: Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: . , include ties to at least two permanent references landmarks or benchmarks ' locate all wells within 100' on u 0-3 2 .20 6 30' DEPTH TO GROUNDWATER t Depth to groundwater.1, ± feet method of determination or approximation: new r 4 A - (revised B/15/95) 9 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:_ y/ /c'i Ile,���7 �.4 t Owner: 6-c,r 1Y/a/Fc Date of Inspection: - SOIL'ABSORPTION SYSTEM (SAS):_ (locate on site plan; if possible; excavation not required, but may be approximated by non-intrusive methods)' ; If not determined to be present, explain: 6 .Type: leaching pits, number: leaching chambers, number:_' w , leaching galleries, number: leaching trenches, number,length: ' leaching fields, number, dimensions: overflow cesspool, number: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition vegetation,etc.) ,� Go c ' �rvs� /� O-/oOd of W ' 51.—.r r ry el -l000 lv )c ti CESSPOOLS: _ (locate on site plan) !mil 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 (cesspool must be pumped,as'part of inspectio I1 Comments: (note condition of soil, signs of hydraulic failure, Igvel 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 h raulic failure, level of ponding, condition of vegetation, etc.) (revised 9/15/95) 8 r _ t SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: -9'/ Ice 6/,, '® Owner: G.7 y / �C,t Date of Inspectio . B�q -gc TIGHT OR HOLDING TNK:_ (locate on site plan) Depth below grade: Material of construction: _concrete metal IRP_other(explain) Dimensions: Capacity: gallons Design flow: gallons/d Alarm level: Comments: (condition of inlet tee, co ition of alarm and float switches, .) DISTRIBUTION BOX:_ (locate on site plan) Depth of liquid level above outlet invert: O�� Comments: a-FR s (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of b r o e J c elt s c over t �+P s F C coyty 9� d��o�✓ nrk t ' PUMP CHAMBER:_ (locate on site plan) .. Pumps in working order:(yes or no) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 6/15/95) 7 r r r' VA G s 9e A _ GE Can . vp 9� •9 � � � � � 9B.c � i ;A rr .t r1i ltN Of A(44- rr CLANAv c� w. No. 2, AS-�' SOR-S MAP N0. PARCEL 1. 0 CAT I O N W A G E PERMIT NO. 1 /v//V v1✓y„ (n �� VILLAGE INST LLf 'S ME i ADDRESS a � ® U I L D E R OR OWKER DATE PERMIT IS, UED DATE` COMPLIANCE ISSUED x - V .,�.r=- t . � .��� �� ._ �� .. - � �Si�(1 �, _ t ``` a __� __ _ t� p � ' ,� �_ - _ ASSESSORS MAP N0: � Rt ® PARCEL NO.: No. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH F.:�✓fs. .........OF........... ..._...-•........................ y Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal i System at: .:.....P."--a:��....... �re f-:! .................. .. ......................................... Location-Addresl or t . .. �/ �+'t� — ... r ............................•---.._... �..._x__..t .-......-------•-- ... ............... .................. owner ,pry A,dress � e Building Installer Address T d yp Of BUt g Size Lot............................Sq. feet DwellingNo. of Bedrooms.... ~i.�!.........................Expansion Attic ( ) Garbage Grinder ( ) '4 Other—Type e of Building ............... No. of ersons__................._.______. Showers — Cafeteria a YP g P ( ) ( ) 04 Other fixtures ---------------------------------- W Design Flow............................... <�__.gallons per person per day. Total daily flow......................4.e _ ..........gallons. WSeptic Tank—Liquid capacity/ -.gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No. .................... Width.................... Total Length...................... Total leaching area....................sq. ft. Seepage Pit No-----------------_-- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box (Y<') Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ t (� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------------4........... j a x 0 Description of Soil.........................................................:.....-•-------------------------------------------.....-•------------------------------------...?.......Z.- V ---------------------------------------------------•---------•------------------------------..._......------------......--..........-••--•---•------------•j-•..--.--.•. W •---•----------- -----------------••-------•--•----•----------•-•-------•----•-------•••----•------•...--••-•-• • . . --........................................ U .Mature of Repairs or Alterations— nswer when applicable______.. - .....----- ...................................................... . f i Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iIT114 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been i sued b the bond of health. f Signed f, f Date Application Approved By..................... t..... . _ ate....................... .........!-�---- D ate Application Disapproved for the following reasons-------------------------------------------------•-----------------------------------------------•-------.-•--•- •-••••-••---•...................•...•-----•---••---•-•-•----••---•----•-......•-••---•-•••••---••......•.-•-----••----•-------------•------••-•-•---•---•----•----•----•--•----•------•--•---------_._.. Permit No.••------- E�u.._.� .. Issued....... ... Date Date ....... ASSESSORS MAP NO: PARCEL NO.: - Fa _.......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH <;_ _ / -...........OF.......... ,ter..^..� :.-x ..-��----•............................... Appliration for Di-npoiiai Works Towitrnrtion "amit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: Location-Address or Lot No. / .......... --__' �?Z-..-.................................------........---......................Owner ry Address . ............................. ...._,1`� i %[r> ..d r/' Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms----1::J -.........................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) fi.a r-fixtures ..---'--•-----•...............___._ _ Design Flow.:......:::..................,.. .. gallons per person per day. Total daily flow.....................W , WSeptic Tank—Liquid capacltyh __gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No. .................... Width.................... .Votal Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box (x,") Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ � Test Pit No. 1................minutes per inch Depth of Test Pit________..-__------- Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.-._-______._-_-_-_.__,_. 04 •'••"----'-•--- -----------•-'•-'•-••••-•-••--•--•-•••---•--'--••--"••..._._................_............................................................... 0 Description of Soil............................................................................................................................. --•------------------------•--••-••'--'.... x V ----------•-----------------------------•--------------•-------------------------...._..-----•••••. .............._.......I -----N........................................ .......... 0 '-Nature of Repairs or Alterations—Answer when applicable......./'��z(__...�1�s�__-�r' �.f �?__-��.r.7-��r ...... -='�Y l 7•S,e =r -•--•-----•------------------------------••---------------------....-------'---......_........------------------..... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITU4 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been i sued by the board of health. Signed .r..............................................._ Date Application Approved B at Application Disapproved for the following reasons:---••-------•------- '--•-'•--------------------------------------••-------•----•----------••-------'•-•--•-•-•. ....................................................... --••-•---••-•-• ................................................................................................................................ Date PermitNo.-------- ._.. Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........... ..................................... Trrtif iratr of Tomplittnrr THIS I .T0. CERTIF•�-F-7-That the Individual Sewage Disposal System constructed ( ) or Repaired by:. rl. ✓... ::-1--•••, X'//�f-----•.--. ---.- ---------------------- --------•-------------.--- .............................................. , l� Installer ! '�• °� l S ^ ie C � E'.1_.f_,._r L= -f. di-----•'- --.................. -----•--•------- has been instalLd in accordance with the provisib'is of TITLE 5 o The State Sanitary Code as described in the application for Disposal Works Construction Permit Now�___-�'j { _... dated_...:((-./__�. ,�.F/6-1 ............. . THE ISSUAN E OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A Gi1AIANTEE THAT THE f SYSTEM WI L FONCTION SATISFACTORY. 1 DATE--......0 7�0 ........................................... Inspector---•.......... 1----------------•-------------------------------................... ' THE COMMONWEALTH OF MASSACHUSETTS ��— BOARD OF HEALTH FEx�-` �`....... vi �to�oott ork� ���irttrtion �rrmit . Permission is hereby granted...... :fl . ::::.enj----- C_.:�./��• t '----•--•--------------•--•------•-------•---...........------........--•-••----•-•--- to Construct ( ) or Repair. (.A-)�a*,, Individual Sewage Disposal S�y*5t. at No.-•---_.-�jl....... __...�rl;,���,_.,.�rf j�.r�.=,��- ---- _�' .��:_..�==----•/�'-----•--------•--------------••-•--•-•----.... street j as shown on the application for Disposal Works Construction Permit Datee/ !................. ................... - -------------- --- Boa Health DATE ] -----•-•------ FORM 125 M. SULKIN, INC., BOSTON `` i LOCATION a S E W � E 6 3�PERMIT NO. VILLAGE 1 I N S T A LLER'S NAME i ADDRESS 0 U I L D E R OR OWN ER Y, ems' flp a %v.sT- DATE . PERMIT ISSUED DAT E COMPLIANC,E ISSUED . (3 q THE COMMONWEALTH OF MASSACHUSETTS BOARD--QF HEALTH Application is hereby made for a Permit to Construct ( Z�-dKRepair an Individual Sewage Disposal ZA Add Installer Address e Type of Building Size L ----- --------Sq. feet Type of Buildin ....T _!........... No. of persons............................ Showers Cafeteria Z Other Distribution box ( ) Dosing tank ( ) 1:4 ........................................... -.' �� Description of _--'-'-'___-_-___'__''_'-'_----_'--------_---_---'---'-'--__---_ ---`--- ``—`---' -----' .-------'---_.----.-----.---''_—.—.-'_-_-_---'--__---'------- —__—___-__ U Nature cf Repairs or Alterations--Answer when applicable............................................................................................... ........................................................................................................................................................................................................ Agreement: . The undersigned agrees to install the aforedescribed. Individual Sewage Disposal System inaccordance with Permitthe provisions of 5 of the State Sanitary Co�e_�— The Tun �signed further agrees not to place the system in operation until a Certificate of Compliance has been ssued by the bo d of lie I Application Approved By�.... Application Disapproved for e win reasons: Date Date ~ N . »"u No ._ .. FEs.. ............... THE COMMONWEALTH OF MASSACHUSETTS BOARD-Of HEALTH - O Kr........OF.........ejn,T+rir /; .> Avv iration for Disposal Vurkg Tuumtrurtiuu Prrutit Application is hereby made for a Permit to Construct ( [> r Repair ( ) an Individual Sewage Disposal system Location• s Lot No. 100 J�/..'f� Add a .................. K4�.............t:.:.�!Cl `--.....----------••-•--•----•- ...............................................C . " �� .. i�l �,�, --....... Installer Address / Q Type of Building Size Lot. _ ._.._. r.._._Sq. feet Dwelling No. of Bedrooms Expansion Attic ( ) Garbage Grinder p`ll Other—Type of Building ....9_.......... No. of persons............................ Showers ( ) — Cafeteria ( ) 04 Other f3xtur,r,------ --------•---------------•.-----•-----_. �_.. .AM?...............-----•-- W Design Flow......... gallons per pFrson per day. Total r ly flow...._.... :...____.gallons. WSeptic Tank—Liquid capacityfgall`ons Length... ^,._ Width.': ....... Diameter__-_-____-._s: Depth................ x Disposal Trench—. o_ ____________________ W;idth______j....._...... Total Length..____._. .__r... Total leaching area....................sq:'ft. r,- Seepage Pit No......__-_._-_____-- Diameter._.. 9 _'..... Depth"below inlot.... ............ Total leaching area.....—.........sq. ft. Z Other Distribution box ( ) Dosing tank ( ) `-' Percolation Test Results Performed by................... ...........................•--•----•-•-•--------------- Date----.....---•-----------------....._.... aTest Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water..................... rX4 Test Pit No. 2................minutes per inch Depth of Test Pik.................. Depth to ground water...................... 9 ._.._-•--•--•=-••-•-•........••--------------------------------•--------.............---•---•------......_.....-------•-----......_-------------------_•---. Description of Soil ..............:. . - , ,. •-•---.....----•-•-•--•-•--•••••••••••----•-------------••--......--------- -• ----• ......... •-----------•--------•-•----..._..-•-----•-....._........---........--•-•------.._.......... x ------------------------------------------------------------------------•----------------=-•----....------------------......----....-------••-••--•----•----------------------..._.....--•-----•-------- U Nature of Repairs or Alterations—Answer when applicable............................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITIZ 5 of the State Sanitary Co� Th�e nder)signed further agrees not to place the system in operation until a Certificate of Compliance haWbee Assued by the bo d of lieEl .... -' �... ---------------- � . Application Approved By ... Date Application Disapproved forYewing reasons:---/. • '/ �..... /,.. . ......-••---•-----------•-------•--•---••• •.............. .................................•-----------------••---•-----------------.... ! 0 0. 1 S Date r PermitNo......................................................... Issued_....................................................... Date t� THE COMMONWEALTH OF MASSACHUSETTS BO -0--Of HEALTH /A d-A ....................................OF.............. 'r��C.. .................................._... Trrtifiratr of (Snutpliattrie THIS IS TO C IFY,/That the idual Sewage Disposal System constructed �) or Repaired ( ) by -----------------------------...........-•------------ I uer at.............AT.......f._1•......... �r��........�d9-A<P. ���""'.............................................. .. has been installed in accordance with the provisions of LF 5 f Tpe-State Sanitary / "e r ed in the application for Disposal Works Construction Permit No.._�3..n.4..�_................. dated___-_' �.��. ................. THE ISSUANCE OF THIS CERTIFICATE SHALL'N'OT BE CONSTRUED AS A UARANTEE THAT THE. SYSTEM W1,Lf FYACTION SATISFACTORY. DATE...I�.. ' ..d .................................................... Inspector.......- --------- ----•--....................................................... �i. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .......................................OF..................................................................................... G No.. -.. ............ FEE.... .............. Rapp rku Tonstrudw fautit Permission is eby granted......................... to Construct or Repaire• ) ivtr�u Sew ag }sp Sy ate' .... !.. .a........... No............. reet 1 as shown on the application for Disposal- orks Constructio Pe it No_............... �Dated...1�., _._ _._Q__ ....__._.._._.... oard of Health DATE / :,7------. ' FORK 1255 A. M. SULKIN, INC., BOSTON , I I .oA/G.�,c•�yf/ = //o X.3 = 3.34 �` 50 v '• Lj 9 5 6� ! GAL . O/S�25AL ,oil- USA /UGb G-'A L . _Si c Ls/.4L L Aeg5;4 = Z ZZGX 2•S = SGS G��. A o = //3 G;•� D I' Zti aF hlq C ;a� �jµ OF M4S WILLI-AM fi rs �2 ALAo N y� N Y E wit v J Nf_S �) . 1 TOP Fwu = too. _7 � •- , Ste- �� � /SG o � 6 INS suglip/L DIST. INS G^AL,. 9L.9 Dint SEnT�G ,wv. 9G TANK I Lcacu PIT- INV. INV. WITQ 9G 3 ` •S .S�f ND VJMW, ;D 670 tii E CE2TI �IGD PLOT Pl..A.Q Ala N/w> PRUFILG- I.oCA"� IotJ NO SCALE ScALaa, E2EN C, I C E R?I F Y T N AT 'T N 5 K o W N NEQ'EoW C0MPL`(S YJIT0 ZHE S I of L I W �p7- qp )CI, S6TeAC1 26gv1R_EMENT� oF -CN� // -To w N A W D ►s �C�ri-- LOGp.TED -\NMAIW THE G1..00D PLNIN DAT E3 BAxTEcz.e t..IYE IFIC• REGIS�r,-Z&D�LAWD5uIzvEYoes TuI5 PLaIJ IS KltrT C3�'> r� ob nN :. v3•r-E2vILL� - MASS ( , IuSTR•uMEN•T ;vIZ���`( � -rNF n►:FSET5 .5uvu� �: ,.. ., p ,ELT �TL�. f..IAT r�.� <G f� Tb o E-T ER'^I I�t✓ 1. o'r 4 PLQ� 5c,4L,== VA 9e .10 93•7 7 3 9B G M E2 s _V R3,3 V Tic#c` VViLL iArl \c C. •i� .Of Alq� r gALA i NES No. 25�t� •� C, OrvAl ti'� L� RENOVATION TO INTERIOR, EXTERIOR SIDING & PARTIAL WINDOWS & DOORS: ZAMMER RESID NC 91 ICE VALLEY ROAD, OSTERVILLE , MA ARCHITECT: YAROSH ASSOCIATES, INC. ARCHITECTS- PLANNERS 10 CAPE DRIVE MASHPEE, MASSACHUSETTS 02649 _-__-_----_--__- -__-._ _- --_-----------___ (508) 477-4731 -----------____-- aoLEE J LIST OF DRAWINGS A-1 ELEVATIONS A-8 SECTIONS A-2 ELEVATIONS A 7 SECTIONS A-3 FIRST FLOOR PLAN Aa EASEMENT PLAN &SPECIFICATIONS A-4 SECOND FLOOR PLAN A-8 EXISTING FLOOR PLANS A-5 SECOND FLOOR FRAMING A r-1 O EXISTING ELEVATIONS CODE CLASSIFICATION PLANS DRAWN TO CONFORM WITH 2015 IRC USE GROUP: R-3CONST. TYPE: 513 AND MA RESIDENTIAL CODE 9TH EDITION EXPOSURE: B PLAN # 1238 • PERMIT SET 7/25/2019 036W WYK air HNwww6P=avorfroPE _--.---------------.__.__._..__.._-------__-_. njksrm w/vraaz n w mr AREm 5W BtVAT1aN M'FOR B,J=YATYJN ftASI D,MO MWAMMRS Off _...__....................._.-......_....-...._-•_• -���__ - _._ BftT i ROOF Dasrm PAT EMrM9 RjW BMW R" - - - - - - - - - - - - - - - - - - - - - - - - - - ow. oLAE KW a®AR aAWAFM NEN aDAR a#WAM 9U nRS MATO ON a t alPWAM911 .r ro WLArrw a To WEAT18t ,y TRM owl4 70 WYATt$t MAT01 EpSflJfi,TYP. 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FRAMM PLAN —�—d OSTERVILLE,MA PROJECTN.MBER MASHPEE,MASSACFIUSETTS DRAWINGNL @ER PAT RAFTERS PAM cam SEE WZ4M fmR JOSTS FLAN POR UTAT POW N5V cELNS tTr.:�60 'r R-49A Boma Tap TE5 TO REI" woww / ELEVATION ----- ----- --- -- -®- - ----- --- --- -5TRAPPN69li'OG. -------------- ' OL. la •yYp DOA NOTE: OLOSM CELL SPRAY FOAM .-W W/y LAYERS • PROVIDE HURRICANE CLIPS AT ANY VISIBLE RAFTER TO NRLATIRJ WPROeP FOR PORTION Gr SYp. CONTRACTOR K RE'PON5mLE PM PRAWW or I � � PLATE CONNECTIONS THAT DO NOT HAVE THESE NfERIOR AIR"T�45)W/ eel"JOSTS TO / Z CONNECTIONS. �RETAFWANr PANT AT RET!A�C9 Ib1 PRWIIX A SAFE AW SEA SITAMM WKN TW- u IL TEWORARY QM N ALL WAYS HE SEES Mr TO �-07(5LL5 PLUS ACZESSM ARFAS,Tlp.PLL filER t3JrRE CAM,MN R-�49 4T m EIOSrW Fe~WALL IS MMM. WNIRAOTOR S VLL REVEW ALL pasnN6 fGfDRIOIIS PRIOR TO eA �GILL PLATES fVR HSAEL WeAmm ON WIN TO am IF TM +1 PM"OPENIND P*SrN6 Sr"TLM Eft7M 2* IDITERIOR WALL X1#LA.LEADER PEW 77N WALL LP T&6 PLYW PEW 00MM O RDAW ai#ft NEW CEIL16Te FOR WALL r u.m,FISTS 9 HEW 9 1 TZ JOISTS E7oSTIN6 T*PEW R-19 NRL 0 r OG. �W5x19 STEED. �S DLLLKN6 / KNOVALL LIP To O LYL — ------------------------- DLLirICN6 ---- --` - ----- ----- ------------------- WA.L SM5 TO eE air b - - �----- _/ 1X4 STRAPPM6 Elo3t lOW PORTION OP EXISM 6 eeAM 606LP M�FE)TO WJR ON NEW JJt5r5 ONCE PALsv E>05rN6 ntATmI I TO DE fl1A7R T�REMOVt� Tewat RY S)TORT K IN ' I I REMOVE PIKE TO GARB/E7fKTR46 I I I I STRIL'TLPE �"\ / I I III I I II I I FAMILY ROOM i U4 WALL I I POORS/w I FLOOR PLAN L ZATIONS I I I I II Wane ca.u�4 SUPPORT re/Rro REMOVE Eks" peyow I I I I 1 I II -- I t W JOIST N'LL IN I I SAJD W" I I wRN Eb5TN6 I I MTWMN I I i JOISTS E130W I I Eosin,STLPS ----- ------------- ------------------------------------- -------- -------- ------------------------ Dosrm mw imrs ALL GA.IMK To PME ------ ------------- PRA E R-W AT ANY Bass ,OA`3434r EXPSTR46 A�84T SOLD WOt7D PLO~ Wq�FRANE RQRLATEO NOTDETW�O FftaW YADDATIONS SEE tM5E1� STR1LTtl�&ANY PLAN Port PT.W N5V RAISED PATW, ORl'W uwm NEW eA5 SECTION I P:T.S� SECTION SCALE „=I d' SCALE STEI3 em EXISrW 2*EXTERIOR WALL eAL Aon3ts rn k LVL MADE R SOLD msoax%f� Tab R.YWOOD NEW 5LL RATE I A^' LW LET Nf0 WALL i 7dL 2°1O JOKfS 9 tt'fill. TEIC DOLTS NEB"/JOKT5 9 p"fill. — NEW W5x19 STEEL DEAM WALL STLp �_5MP5aPT ft95 t1FJWY 74 . 7 5EE fgtAA9N6 PLAN t------- — ---- ANEIe \ STRAPPIM LL PR post \ IPDER EXI5rN6 9 41Q2 TO REMAN I Z L� r M:,, - � a; — — , I ''DL fiAL 9— -- — �— — EXI5TN6 rAFPERE�RAPTELS —' — — — — — — u'fill. � STRAPpNr� 9 fill. 2 \ \ I I Ywav ELR WINN I I I I I AMMEr1P�rfi 1X4 TOP Pu SEE PRISE DE1M SLALE I I s .T04 1 F R T 1L �_ — — - - - - - - - — PtYWOG9 I 12 201f9 _ WALL SnDs ro DEDe cur a, — — — — 1 4�y�L� PORna4s� WOOFED TO DEAR ON PEW JASrS OWE TEMPORARY I X �imLow JA5r5 TO eQ RE Y/QP�08H 6" CYi�►� SPPORT 5 r RtAA44b PLAN ARCH Ao TO W- MEN SCALE: AN DATE: hd9 io- o- oRa ov:G 6 K5 DETAIL BEA L L1JI J @ M DETAIL@ FLOOR FRAME DETAIL @BEAM zAMMER RESIDENCE ^ SECT10N8/ DETAB.S 91 ICE VALLEY RD. PROJECT".N.WR t4AgFIpEE,MASSACHISETTS DRAW NG NUMEER i� SCALE I =1—d' SCALE 12=1—d SLALE I =1'—d' OSTERVILLE, MA �g ASWEE.MASSAq p„ p � go Mae Was R�4°RAPTBis _ 5�5'lOPD ROCR PL/M FOR UTABT / NEW CELINB pTf. Di.OGK�Jb ! _j ----- --------- DO STRAPPING® - -- DRtTO WNL U'To - 015f1N6 021N5 ADS c91 SPRM FOAM EXISTS TO RBNIN Wow )PWOR/ PORTION OF P]OsRNG flip. Fm FuARDANf PANE AT CEI 0 JASTs TO AZESSM AREAS,TYP.PILL �fOV® ow"EYT�IOR - - ------ ---- ---- ENTTRT?CAVITY,MN.R-49 EXISTING WAL — — CLOSET on PORTION Cr Emff NG FLXR TO Pe FOOO 0 1,8V STAR B 0 s" 01151110 & Y E>DSTNGo 5 exsfNG wAL ro u a WW ME'WAL Ul TO EE RBNWi� 0 _-- -----=---- -=--- -- -- ------- ------- ------ --------------- - — - - - . _ — — -- - B � --paiw6----------------------------- - �wsTrr�F+ asrs I B B PUTe ro Raw+ CiJ�tt B j PEW MAO ST®_ / PEADBt p CLAM B 5/4 RATE l \ p B 'GYP.HOARD T$ NEW KITCHEN NEW NOOK NM CLOS. HALL EXISTING LAV = v o p � B B B PGRT)GW GF E74511N6 B O nXM TO OE FaVAW B PEW STARalDm B EIQSTNG M.LL'R,NISTs S exam RA9R xtsrs IMT yapoi F]05TN5 DArEI,Bdf EXISTING BASEMENT rm WALL P.T.2M*M eft-I'm c rrum 2 CROSS SECTION -- 140 3 CROSS SECTION JOKTS®Ii"OG. sG&E , 5 Al E R-49 SPRAY POM1 N�DAM A If O6.NOT.nim W/ (APn?AW FCR NERIOR D mil m m PEW! rla4s)wIIRE RETARDANT _ PANT®ANY AV-AS CP ACGE55,TYP. FILL RAFTER CA 2x RAFTER \ Zx RAFTER 5TRIL'Tu;r 1x Cl.OY.BCNb yyD t SEAM F�QSTQ46 TM PLATE r0 NOTE: MATG1 pQST Hf. I PCRTICN W • PROVIDE HURRICANE CLIPS AT ANY VISIBLE RAFTER TO PLATE Ra10VE LOMI[R WALL To PLATE CONNECTIONS THAT DO NOT HAVE THESE \ MY 2%4 WA-IFI I D STpAqIIa CONNECTIONS. TOE• I I OA RAPT[3ts I I -OW.WARD �� ..c4a''►A. I.^�ej''.L ' I I W.DOAW ON Ix' N D TOP PEW Wixkf STMIM ROOM EXISTING LIVING NEW KITCHEN Q4G A STRAPP Oc PLATE. WM MLM �z � z PEW D-7pA WA LAYERS �y�P� NSLATP NIT3tIGR I I as C} NO.7041 #� CP PLYWXP LPAPM ADlYaT RtElE® WA15 TiGR I I m« RBdOVE OusTB4G If�DPR� U BUS"wlrvnw Q.M POW MY PM E Ai8ET 712�120�9 YA�ROS 4'p IA -'ANC. BEAM DETAIL BEAM DETAIL �T-- IT-��--Il f1-11—�I---fl�— "' �cH _ O ZAMMER RESIDENCE iii SC�.E: AN o4T�: ,, anwH ev:L6IW sc,E 1�"4-d' ,E I =r_d SECTION @KITCHEN 91 ICE VALLEY RD. SECTIONS OSTERVILLE, MA MaecT K PIBEa M!gH oaawiNc N�seF PE9r�MAS CH g A-7 SPECIFICATIONS coordnat.his work with that of the other trades. Framing members shall be located so as to 20. PAINTING: clear plumbing fines,mechanical ducts,etc. A Cleaning and preparation of surfaces. F. At header sizes shown on framing plans as minimums. Contractor may use larger sizes far B. Per irg and finishing of all woos shaetrock,unfinished famous metals and an other surfaces 1. GENERAL CONDITIONS: General Conditions am as per OwnerrCcntrecor Agreement. In the went of standardization at his discretion. through interior and exterior of construction area of building unless otherwise specified,apply a conflict between Suggested Specifications and OwnerlContractor Agreement the OwnedContractor G. Haddam shown as having'V2"plywood"w drawings shall have one continuous sheet of three(3)coats on all surfaces,except ceder shingle siring will be natural no finish. Exterior trim Agreement shall rule. plywood,full height and length of header,sandwiched between dimensional lumben to get two(2)coats 2. LAWS,ORDINANCES AND PERMITS: Contractor shall give all notices,obtain ell permits.licenses, H. Plywoodsheathing: C. Protecting and cleaning of finished work. certificates of inspection,of approval,of occupancy and other such instruments required for his work,and 1. Sub-Floors,Exposure tit.314"APA"Sturdl-Floor plywood 24-23132"glued and meted D. Painting-Colon selected by Owner. pay all costs and fees for same.Contractor to make all necessary arrangements for connection to utilities construction. E. Flooring and trim shag have a color stain treatment and be finished with one(1)coat of clear and pay at charges fa same.Contractor shag obtain and pay for the building permits. 2. Walls and roofs,1P2"COX exterior grade plywood sealer primer and four(4)coats of polyurethane finish. Stain to be selected by Owner it I. Treated lumber shall be"Wefmanized"0.40 Ibs.1 cu.ft.retention.Treated lumber shag be used at; appf able. Plans and specifications provided by. 1. All wood in contact with masonry. 21. FIREPLACES: Architect J. Exterior siding to be white cedar shingles,(clear extrayceder clap boards over k16 felt(No A. To be constructed as per Local and State Budding Codes. Yarosh Associates,Inc. Tyvek). 22. CABINETS: 10 Cape Drive K Trim(union otherwise noted)to be square edge. All exterior trim replaced to be'Koma'. All A. Kitchen cabinet work allowance as per Ownw/Contractor Agreement. Builder to supply an Mashpee.MA 02649 window It door trim to be'Kama'. blocking required for installation of all cabinets and vanities. (508)477.4731 L Gypsum wag and ceiling boards to be 117 gypsum board except where noted as lire rated.Rated 23. PLUMBING: board to be Sr8"fire code gypsum wall boards. Ceilings and walls:tape ail joints with nylon salt A. All materiels and work provided shag be in accordance with the following codes and standards. 3. TEMPORARY FACILITIES, adhesive tape and ready for skim coat plaster smooth knish.Exterior corners to receive metal 1. Massachusetts Plumbing Code. Work Included: Temporary facilities and controls required for each Section shall be included by corner beads and exposed edge.to receive"L"mold. In at areas,tubs and showers,use 2. Massachusetts State Building Code. P.T.20 5TI,PS IR'Ptit Contractors requiring same. 'Wonderboard"a�Durock`waterproof boards. Screw wallboard with bugle head 1 114"type W 3. Occupational So"and Health Act AW& A Temporary utilities electricity. screws spaced a maximum of 12 O.C.at ceilings and 16"O.C.for walls. 4. Standards of the Underwriters'laboratories(UL). e. Sanitary Facilities. M. All Basement stairs to be drywalled finished,handrail finished,and statr tread and riser finish to a 5. Requirements of the Town. C. Enclosures such as tarpaulins barricades and canopies, minimum of 17 past the bottom tread,unless more information is indicated on the Plans. Risers B. Where the contract documents Indicate more stringent requirements than the above aides and EXISTING 4. SUBSTITUTIONS AND"OR EQUAL- Proprietary Specifications are used herein only to indicate style to be pine and treads to be%o hard pine. ordinances the Contract Documents shag take precedence. CRAWL SPACE and quality.Substitutions are acceptable but must be submitted in writing to the Owner for approval.The 13. FINISHED CARPENTRY: C. Be responsible for firing all documents,payment of all teem and securing of all inspections and Owner win respond with a mitten approval or disapproval. A Exterior trim(unless otherwise noted)to be square edge,'Kovi approvals necessary. S. SCOPE OF WORK:The scope of work is indicated on the drawings and includes but is not limited to the B. All interior wood trim to be dear poplar(finger jointed). D. All Water and Hest lines to be copper type L following Architectural and construction work; 14. CAULKING AND SEALING: E. Install erg pipe insulation par code. A Electrical work. A Sealants for joints noted on the drawings as'sealant"shag be'Dyrmhdi r as manufactured by 24. PLUMBING FIXTURES: e. Plumbing walk. Pecom or equal. A. Plumbing futures shall be seleced by Owner and installed by plumbing contractor. C. Heating work. E An sealant shag be in accordance with manufacturers spedfirations AN joints to be sealed shag B. The Owner and contractor shall select the futures tram contractor's numerous catalogs. D. Selective Demolish of existing house, be thoroughly cleaned before work commences.Prime all joints when required by manufacturers C. The contractor shag have prices accepted before installation of any items. E. This house is near the coast and it is the Contractor's responsibility to provide special attention to written instructions. D. All hot and mid water lines to be insulated through out. all gashing and water infiltration details due to its location. C. Joints to be sealed shall include but not be limited to: 25. PROJECT ALLOWANCES: 1. Exterior joints Construction allowance is far money held in contract for Items fisted as an allowance. The Contractor No Plumbing,Electrical,or Heating construction plans are provided,it is the Cwtractor's responsibility to 2. Windmvs and doom. should odd a 16%mark-up to all allowances in base bid. If the allowance is not used,a refund of all the FROM S"ifitvaw hire qualified experts to design and install such items and inform Architect of any structuml changes to 3. Between dissimilar materials. allowance plus 15%will be cradled or not Bled to the Owner. The allowance system anw s Owner the UNMER POT ADOYE T plans.Use Architect's Plans as the Specification for all work. 4. Under saddles and sins, right to purchase the allowance gem or decide what product win be used at a later date. TOP OF PAl' TOT Tw- S. COMPLIANCE:Ali walk shall comply with all applicable Federal,State&Municipal codes, laws, D. Caulking for joints noted on the drawings as"caulking"shell be as manufactured by PTI or SO. rotations,ordinances and covenants.Contractor is responsible to notify Architect of any discrepancies 158 as manufactured by Pecos or equal. Allowance backup paperwork will consist of a minimum of two(2)bids from subcontractor- Biting will be or non-conformities in plans and to bear all costs arising from rectifying work knowingly performed E. All caulking shag be in accordance with manufacturers specifications. All joints to be caulked done on an invoice slip from original subcontractor as a backup to the cost to Owner.. contrary to law or best practice. shag be thoroughly donned before work comment-, Prime all joints when required by 26. PROJECT CLOSE OUT: 7. QUALITY OF THE WORK An walk shag be in accordance with accepted trade practice,all materials manufacturers written instruction. Cleaning Up: Upon completion of the work,but prior to final acceptance of the building and the shall be suitable for their purpose. The Owner or their representative and contractor wig adjudge the F. Joints to be caulked shall include but not be limited to: Architect's Certificate of Completion, the contractor shag do,a cause to have done by trained, quality of the work and will have the right to reject any work that is not acceptable. Moneys wig be 1. Interior joints experienced and dependable specialists in the particular types of work required,the following: withheld until work has been installed as par contract document. 2. Door frames. EXISTING 8. GUARANTEE Except as otherwise noted,the Contractor shag guarantee at walk against defects for one 3. At areas affected by water or recommended by manufacture of the product All glass thoroughly cleaned inside and out,washed and polished,with all stickers,marks,labels and BASEMENT (1)year from date of substantial completion or occupancy permit Necessary repairs or changes to 15. ROOFING AND FLASHING(if rewired): stains carefully cleaned up,and no glass or surrounding materials shag be=etched a damaged by use include making good defective or inferior walk and all damage to property caused by such work or by A Roofing shall be red cedar roof shingles,war`Grxe'ice and water barrier,with cedar breather of harsh abrasives,tools of careless workmanship Protective coatings shall be removed from machinery, correcting it and copper valleys and copper flashing.Match existing size of existing house. hardware,fighting fixtures,plumbing fixtures and similar equipment,and all finished parts cleaned and 2-I ` RI3ZTE•DAS O N"v°�j�LALLY 9. CONDUCT OF THE WORK:Provide necessary enclosures,barriers, scaffolding,ladders,etc.,as S. provide and Insist concealed flashing at all intersections of root and wags,chimneys valleys, polished. Each trade will be responsible for their own trash and dean up. All trash and debris shag be F C41M required for safety.Unes,levels 8 grades:The General Contractor shag lay out all work and establish all doors windows,atc.and throughout the project to prevent any water leaks. - removed from the bundling and the site.Paint,putty,adhesive and similar markings shag be removed and 2. 4 WessmY PP5r5 AZdsE points,grades,lines and levels and assume all responsibility for some.Rubbish removal,owning up C. Provide`Grace'ice and water barrier at all valleys, the entire building left clean. The age shall be free of debris,with all areas adjacent to the construction - - -- - Clean up and remove each week all trash,waste and refuse materials of any nature resulting from any D. All new gutters to match existing;final locations to be determined by OwnerlBuilder. site,cleaned and raked as mquired bythe Architect to make the site neat and wdedy. work.At completion of building,leave"broom dun'.do all special cleaning including windows,stains, E Contractor is responsible to provide gashing to all areas throughout the job that may leek tram 27. GUARANTEE AND RELEASE OF DENS:(whh final billing) e gngerprinre,floor and wat tile,polish hardware,dust futures,etc. weather related conditions. Rubber,metal,a equal may be used. It will be the resphonsibgity,of A At the competion of the job and upon receipt of the gnat payment,the Contractor shag dsfiver to IIL.E SrM 10. PROTECTION AND INSURANCE:Continuously maintain adequate protection of at work and materials the Contractor to form up and inspect all areas prior to final enclosure and to supervise Warhol the Owner,a complete attested mines of liens for his and his Subcontractors'work under the 'fO�kdYi DOOR 4 4 . from dam age and protect Owners property from ss injury or lo arising in connection with this Contract subcontract=during installation Contract 6G.TO Maintain adequate insurance for protection under'Workmen's Compensation",claims for personal injury 16. INSULATION: B. He shall also deliver to the Owner,the various guarantees. 5�E &other insurance as required by lost codas and but practice. Fire Insurance will be carried by Owner, A Provide and install glees fiber insulation as shown on drawings or generally:in all walls. 1. All Subcontract guarantees shag be endorsed and signed. on 100%of insurable value of structure,not including Contractor's tools or equipment.Bah parties shall 1. In exterior walls: kraft faced/closed cell spray foam Insulation(approved for interior contact thew ohm insurance companies to review the necessary coverage, applications)as par plan. 'We(I)hereby endorse the above guarantees and do cattily that we(1)w9 coordinate and Prosecute to it. STRUCTURAL STEEL 2. In Calling framing:unfaced insulation as per plan. completion any collective work required thereunder." • aw A. Design,fabrication and erection of structural steel to conform to the fares A.I.S.C.specs. An 3. In root/ceiling: closed cell spray foam insulation with fire retardant paint(approved for steel to conform to ASTM A36.(ASTM A-63 forpipe sections).All steel to be 50 KSI value, interior applications)R-6.80 par inch min. Signed: e. An shop connections to be welded. (Min.weld VV). Work must be done by a certified welder 4. 3.112"at all interior walls. (Sub-Contractor,with date of Signature) LP and provide certification repot after at welds are done. S. Insulate all hot and cold water pipes with foam veep. C. Prepare Home Owner's Manuel with all photo information and details needed to enable repairs in the tEW W&L TO A ON 1X4 Wi4L W/ O C. Burning of hot"or cuts in steal members in the field are not permitted union specifically a. Insulate any ceilings floors,etc.,opened up during construction that are not insulated. future,including contact information for all subcontractors involved in construction. W�m P.T. 5 RIB approved by ArchitectOO 17. DRSANDHARDWARE 28. PAYMENTS: AWe D. Steel contractor to field check anchor bolt setting before erecting seal and general contractor to A All exterior Frenchwood sliders to ba'Andersen'ASeries with Low•E4. A Payment will be for percent of work completed correctly,per month.A 5%retainage will be held be responsible for salting same accurately. B. Sizes to be as shown on drawiri until substantial completion.A deposit of no more than 5%will be given at the start of the job.Use E. Contractor to field measure and be responsible far an dimensions affecting his work. C. Finished hardware including but not limited to closures,stops bins,cylinder locks overhead ALA G702 Form or similar and schedule of value farm for payment.All payments must be F. Ali steel to be shop primed except as noted to be galvanized tracks,closet pales and weather-stripping shaft be furnished and installed by the Contractor. He approved by Owner and a Owners Representative prior to payment. _ QI G. Field connections to be 314'baits and field welded after bolting by a certified welder. Unless shall allow for installing hardware. 29. DEMOLITION: h3 r oherwh noted on plans 1. All dons to be sized as shown on plan. A. All walk to be done in a safe manner and cleaned up at the and of each day. Provide protective H. Prwitle:Ilr holes,2'-0"O.C.max.at top and bottom up 2`gam flange for all wood blocking 2. All interior wood doe.to match existing. barricades and systems as necessary to do the work correctly and safe fa all persons attached to steel. 3. All exterior doors to be weather-stripped. I. Cum.holes copes,etc.,required in steel members to be made in the shop. 4. Finished hardware shelf be selected by the Owner.Installed by Contractor. J. AD beams to be fabricated with natural camber up 5. Provide door bumper at ell swing dome. K. AD beam intersections shad have web stiffeners above a below beam. S. LatchiLocksets selected by Owner.Installed by Contractor. 12. ROUGH AND FINISHED FRAMINGICARPENTRY: 7. Exterior doom to have aluminum a wood threshold and stainless steel hinges �1 PARTIAL BASEMENT PLAN A. An framing to be stick framedS in the field by qualified and licensed homing contractor. 18. WINDOW B. All framing lumber that is not engineered lumber,except whore otherwise noted on drawings to A Ali windows to be'Anderson'400 Series with Low-E4.Provide insect screens. be Eastern Spruce with the following minimum properties:Fb-1000,Fc=400,E-1,200,000 B. Windows to be as par plan of sizes and types as shown on drawings.Contractor to verify sizes /y,Z C. All engineered lumber,except where otherwise naiad on drawings to be Weyerhaeuser Tms with manufacturers fates specifications prior to construction of rough openings. Joist'LVL'with the following minimum properties:F6+2,600,Fc-750,E=2,000,000,Fv=250. C. Pack voids between window and rough opening with glass fiber insulation. Engineered joists to be Weyerhaeuser Trus Joist'TJI',and meet Me manufactures,minimum D. Bedrooms to have at least one(1)opening window or exterior door to permit emergency egress - design properties for the depth and Series as listed in the True Joist Specifier's Guide, or rescue. D. Use two(2)Simpson A35n framing anchors at each rafter to boom,header,or plate unless noted E. All windows and doors to be sealed with`Grace`Ice&Water Shield a approved gashing WRL T M KEY otherwise on drawings.Use Simpson"LU"jals hangers at an gush connections of joists to beam supplied and installed by contractor. PROVIDE SMOKE,HEAT& ��` �"- 9 Ps qe r (I rP�� CO2 DETECTORS AS unless noted otherwise on drawings. Use Sim w hurricane'tf"c at all lager to to 19. FLOORING:All finishes selected b Owner. 294 RAW WALL(.ONBr.AT W OG. connections.All exterior connectors to be stainless sleet. REQUIRED PER CODE "�.+��© Ytt�RA m WALL aiisr.AT w OG.trw)� E. Lumber and i4 fastenings to conform to the National Design Specs for Stress Grade Lumber P-3 Y/ i•". and its Fastenings"by the National Lumber Manufacturing.Association. Framing contractor shell W�0 19(I5IR'Ifi grip WN.L(,q.�T,AT -� f�s�`," ^d. • p Ek� �.�y r- 4Z SAWZ 17ETFf.TOR 0 a � ►eAT PErMTOR QK ' p NO col ceWOR ® 7 12 1 YAROS SATE Cis` iii ARCHITS , MMM SCALE: Al+ DATE: '� _ " gY"V KS ZAMMER RESIDENCE RENOVATION PLAN 91 ICE VALLEY RD. sAS�IT PLAN 8 sPEgFlCAT1oNS CISTERVILLE, MA Ro ECT NUMBER MASHPEE,MASSACHl1SETTS DRAWING M MBER 38 +��•«�� A-S 11 I 11 11 el II mom I I J��{MMRN 1 II I I I II 1 I I 1 II I 1 I li II it I "' I I I �Q l cr % WJAI i e I II Ii II t i a i O it 'i -------- �+ O 11 ----- uv I� a eee n 1 1 1 1 n mattwo immm1 1 - m rr ma-- EXISTING FIRST FLOOR PLAN a ■ O 00 a - RF T. s7 7/2 12nQ-19 EXISTING ... YAROS; r ,ANM. ARCM NERbs ZAMMER RESIDENCE . 5`"`E: An DAM � R°��: BRA_ :Z SECOND FLOOR PLANu ., 91 ICE VALLEY RD. ko 66 OSTERVILLE MA PROJEJili R I MASNPEE,MASSAC..SETTS D2 W,Ac_rvq 9ER /•+q+�•/WaonOA J ------------------- --- -------------7 — --mz -�m-- EXISTING EXISTING EXISTING EXISTING A FRONT ELEVATION SIDE ELEVATION SIDE ELEVATION ,_ELEVATION SCALE '=1'-d' SCALE SCALE — - ------- - - - s, FE3-ff TE-B—Mll M FB El --_ -_IFEUE�13 -_-_ ao-- ao EXISTING EXISTING EXISTING EXISTING RIGHT ELEVATION REAR ELEVATION /�REAR ELEVATION v REAR ELEVATION SCALE =1-d SCALE �,-I-d SGALF =1-d SCALE EXISTING EXISTING EXISTING EXISTING EXISTING EXISTING b-H) ELEVATION ELEVATION ELEVATION _ELEVATION ELEVATION A� ELEVATION SCALE $"=1'-d' SCALE g'=1'-d' U SCALE i`4-d' \ SCALE S"'=C-d" -SALE .'=C-d' �v� SCALE J-'4-d' E 9 Y. a ✓ F-D An- ELEVATION r ' �' � KEY PLAN z } M m t &AI IT 5/2019 ■■■ YAW A IATF�. . INC. A No ON S"�E: AN e E , °� .>,,+�i DF n M BY:Z 6 Ks ZAMMER RESIDENCE ■■■ .A. e- 91 ICE VALLEY RD. im EXISEL�/l� 'IOWS OSTERVILLE, MA H OJE�n M1 MSpR DRGWINC N MBER ff..� MASHPEE,MASSACHUSETTS T A 8 L E O F A R E A S LOT UPLAND ISOLATED UPLAND WETLAND TOTAL WC FM 180 88,989 SF - 2.04 Ac 1,042 SF 0.02 Ac 32,070 SF 0.74 Ac 122.101 SF - 2.80 Ac 181 95,800 SF - 2.20 Ac - - 95.800 SF - 2.20 Ac - 182 102.214 SF - 2.35 Ac - 20,024 SF 0.46 Ac 122,238 SF - 2.81 Ac ,, `� ICE ROB TOTAL 287.003 SF - 6.59 Ac 1.042 SF 0.02 Ac 52,094 SF 1.20 Ac 340,139 SF - 7.81 Ac ,,, \` PRECISION: IONAL34 UNEAR/DIRECTIONAL E/C: un .; LOTTING SEQUENCE 129' DO 5-FOOT MADE U71UTY EASEMENT PER ALL DISTANCES TAKEN WITH TOPCON 0.103' LOTS COMBINE TO CREATE �` 174 and 179 LOT 180 A8� Q' P DOCUMENT No. 116756 AS SHOMM ON GTS-702 TOTAL ELECTRONIC STATION ND 173 and 177 LOT 181 E -' - - R LA COURT PLAN No. 5715-41 �� EDM ACCURACY: f(2mm + 2ppmm) m.e.e. BOG 175, 176 and 1i'8 LOT 182 POND N �� ` ALL NAILS ARE MAGNETIC LOCUS LOTS 173. 174. 175. 176, 177. 178 AND 179 ARE ,-' ' �- ?4.7b• a EDM BASELINE CALIBRATION ATTACHED CREATED FOR CONVEYANCING PURPOSES AND ARE NOT TO BE CONSIDERED SEPARATE BUILDING LOTS. C 40 - FOOT WIDE PRIVATE WAY - VsI •� `� LOCUS MAP L�'ss' 00' - - N.T.S. L-274.81' Lr75• 10-FOOT MADE RIGHT AND EASEMENT IN FAVOR sec SET OF NEW ENGLAND TELEPHONE AND TELEGRAPH GENERAL NOTES • DENOTES CB/DH NOT FOUND CURING COMPANY AND COMMONWEALTH ELECTRIC DATES OF SURVEY - GROUND FROZEN COMPANY PER DOCUMENT 294769. THIS RIGHT � • ` WITH DEEP SNOW COVER N (TYPICAL) AND EASEMENT IS INTENDED PAS EASEMENT BEING TO SUN ENT 1•) ZONING INFORMATION ,� �+ 56 ZONING DISTRICT'S: RF-1 �^ OVERLAY DISTRICTS: W. RPOD do SALTWATER ESTUARY PROTECTION LOT MINIMUM CURRENT ZONING REQUIREMENTS `,ti BL1 ;, u� MINIMUM AREA: 43,560 S.F. �' MINIMUM FRONTAGE. 20 MINIMUM WIDTH: 125' r 0 FRONT YARD = 30' SIDE & REAR YARD = 15' _ 2.) A TITLE SEARCH WAS NOT PERFORMED BY THIS FRIM FOR THIS SITE; -` SHOULD ONE BE REQUIRED IT SHALL BE PERFORMED BY OTHERS. 3.) THE PROPERTY LINE INFORMATION SHOWN IS BASED ON In CURRENT AVAILABLE RECORD INFORMATION CONSISTING OF a/oa �o L 0 T 1 8 2 isa LAND COURT PLANS AND CERTIFICATES OF TITLE. LAND COURT PLAN REFERENCES: 1OZ214 90. FT. f » 2.35 ACRES f » UPLAND 121 20.024 90. FT. f » 0.46 ACRES A WETLAND tt LAND COURT PLANS 5725-16 (sheets 7 & 8) AND 5725-41 1 �� 122.238 SQ FT. t » 2.81 ACRES t �, 4.) COMMUNITY PANEL NUMBERS 250001 0018 D THE FLOOD INSURANCE RATE MAP DEFINES THIS AREA AS ZONE C g LOT AND A11 EL 11). 176 5.) LOCUS IS WITHIN C. 0. MM. FIRE DISTRICT. @hope factor N 1 20 S0. FT.1 t � ` 6.) BUILDING LOCATION PER BARNSTABLE Gm 87..1 0 ACRES t shape factor 15.9 aq w A. LOCUS IS COMPRISED OF. Z a, TO K SET ASSESSORS MAP 096 PARCEL 007-002 g ------ --- ;�' LOT 99 „► LAND COURT PLAN 5725-41 N/F BEATRICE E. GRALTON. TR. CERTIFICATE OF TITLE: 160531 • r-r OWNER/APPLICANT. DEVONIA M. KELLER CERTIFICATE: 137314 91 ICE VALLEY ROAD LOT 61 N L C. PI. 5725-23 ` B• ` OSTERVILLE, MA., 02655 LOT ,��•� LOCUS ADDRESS; 91 ICE VALLEY ROAD OSTERVIL E, MA., 02655 T ! RAIL FENCE ASSESSORS MAP 096 PARCEL 007-001 LOT 33 » LAND COURT PLAN 5725-16 (sheet 8) ` LOT 97 » LAND COURT PLAN 5725-41 CERTIFICATE OF TITLE 193620 as h+ no •ash" �o OWIVER/APPLICANT. DANIEL M. GRIFFIN, Jt., ET UX. DISTANCE ---------------- ---- �- -- ------- N 85_5N1_oe_ W _---174_11' �,� 5 ffL2 BEARING DIST �• 1 151 BUNKER HILL ROAD '--- -------- _ N 09.38 29 W 19.74 a/� --- - 1 OSTERVIL.LE, MA. 02655 S 44 54 24 E 1 0.83 am XTr i LOCUS ADDRESS: 151 BUNKER HILL ROAD _ , OSTERVILLE, MA., 02655 > ; ' - ------- S 85�03 11" E- 152.64_ ro K KT ASSESSORS MAP 096 PARCEL 007-003 N/F MARGARI:T SEGUR ;; AL ---- a/bN `;p��. a LOT 98 » LAND COURT PLAN 5725-41 - LOCAL VEGETATED wETLANp �r ;3 �•``�y, ' CERTIFICATE: 1184M � ^ �• ' CER11FlAlE OF TITLE: 164884 ,� •. w,� 1 ' WETLAND DELINEATION BY LON McDONALD. OWNER/APPUCANTS. DEVOMA M. KELLER LOT 61 » L C. PI. 5725-23 P.W.S.. WETLANDS SCIENTIST : o cv ;cA 91 ICE VALLEY ROAD 3 FIELD LOCATION: 12-16-10 OSTE RVILL& MA., 02655 LOCUS ADDRESS OSTERVILL E. M BUNKER � 02655 ;' ISSUED BY THE BARNS AB ROAD DETERMINATION OF �CON DSERVATION) COMMISSION AL ' ' • �' A s L 0 T 1 81 1 1 POST RAIL FENCE :' `. tp d s 0.I,' 000 90. FT. » UPLAND AREA MAN FMAL 2.20 ACRES t 1 E ;;j + shape factor » I&$ M i `` � � '� LOT 173 T'c s d- 51121 LOT � 175 �Zot� 1 1+ a LOCAL VEGETATED IAETLAND �%\` `� ` sR 0 wnA D DELINEATION BY LOIN MCDONALD.�`.� OMA N tno g i 4► P.W.S.. WETLANDS SM71ST ISOLATED UPLAND AREA 2 ,� FIELD LOCATION: 12-16-10 or 0.01 ACMES t � DETERMINATION of APPLICABILITY (DA-11028) ?�e`�• � N �� ISSUED BY THE BARNSTABLE CONSERVATION �;;�• �41 w J a COMMISSION W , I w AL �`�` - j M J _'3 LOT 173 LOT 177 I. 67.646 SF » 1.55 Acre@ 28,154 SIF N 0.65 Acne %% LINE WRING DISTANCE DISTANCE 2 i.► L1 N QW01 50 W 65..0 Lt N OWO1 50 W 14.13 w/bN no 92 ``� Z m i L2 N 205 31 E 23.49 L2 N 71 101 219.01 '� L3 N W42 18 E 162.45 L4 S W5818 W 180.84 * � w____ a/bN �o ` `��`, �ti _ j Qr L4 N W581 i E 160.64 L3 S 81742 18 W 162.4$ �'07'S�:-w i L5 N 71.1 1 38.79 ib s 24.5 31 w 23.49 ISOLATED UPLAND AREA 1 1�:ii: " LOT LOT 174 LOT 17N1 4849aL � t 88,181 SF » 2.02 Acre@ 118.714 SIF » 2.73 Acre@ 0.01 ACCRES t �` ly 7N, 4C i LINE BEARING DISTANCE LINE I BEARING DISTANCE ` ' sl• ' L1 N 18 30 E 1 106.18 L1 I S W58 18 W 80.34 `� �s 30� W ? ; L2 N 24.5 31 w E I 31.35 L2 I S 7110,11or W 219.01 - ' L3 S 4,V06 56 E 1 32.11 L3 S CWOI 50 E 14.13 L4 S24'S 31 w 108.N9 LOTTING SEQUENCE _ LOT 1 7 5 LS I N 44.08 58 w 1 131.01 4 ' 2.004 SF » 0.0$ Acre@ LOTS COMBINE TO CREATE ;rs�A 4,p• ;' L1 3 CV01156w E 1 65.34 L 0 T 1 7 9 .' 174 and 179 LOT 180 \ �� i L 173 and 177 LOT 181 L2 N 4COd 5N! W 7.81 33.920 9F » 0.78 Acne `� e 175, 1715 and 178 LOT 182 L4 N 24'S 31 E 108.8 LINE BEARINGDISTANCE LS S 44'O8 5d E 1 131.01 L 0 T 1 7 • L2 S 2,V57 31 0 w 1 31.35 LOTS 173. 174, 175r 176. 177, 178 AND 179 ARE 1.520 SF » 0.03 Acre@ L1 S 48'18 30 w I 10e.1• CREATED FOR CONVEYANCING PURPOSES AND ARE LINE I BEARIq I DISTANCE NOT TO BE CONSIDERED SEPARATE BUILDING LOTS. LS I S 71.1010 W 38.79 Lt I N 00r5818 E 1 80.34 S 8515'26' W---------- 101.72' Jt sec SET ' N/01r X.EUGENE C. H&L. Jt.. ET U SIIE LMTM CERTIFICATE 102572 91 Ice Valley Road LOT 96 N L C PI. 5725-41 ```�� �� �•:�.' ,.'� 151 Bunker IN Road 9 : 2= Bunker NIN Roar PREPARED FOR Cb � ��?�,• Devonla N. Keller Devonla N. Keller and Joseph P. Keller �'`� CNAM F,o !1 ke Valley Road N/F CHAR;Fs OLSON M OstervlN% NA., on" CERTIFICATE 1825M Danlel N. GrI1M1n Jr., et Mai LOT 95 N L C. PI. 5725-41 ` I'll Bunker HillRoar L 0 T 1 8 0 Ost&n0e, AM, 0USs • �`, ;% 88.989 90. FT. t » 204 ACRES t » UPLAND TIiIE 104WT WE RIGHT AN EASEMENT M FAVOR � 3V V shape factor » 16.8 OF NEW ENGLAD TELEPHONE AND TELEGRAPH { PIER UPLAND AREA: COMPANY AND COMMONWEALTH ELECTRIC DOCUMENT 204760. THIS RIGHT �, LAND COURT SUBDIVISION PLAN COMPANY ISOLATED UPLAND AREA 1: 4Nl4 SQ. FT t » ao1 ACRES t AND EASEMENT IS INTENDED TO SUPPLEMENT Jr ISOLATED UPLAND AREA 2: 556 S0. FT. f » 0.01 ACRES t PREVIOUS EASDAENT BEING DOCUMENT 11675M ,� .� Bel a Subdhrslon of L.ot n �\�,� TOTAL UPLAND AREA: Shown on L.. C. PI. 5725-1 i (sheet 8) 61 Being a Subdhrlslon of Lots 97, 98 and 99 .109 90,031 90. FT t 2oNi ACRES t 4. Shown on L.. C. Pl. 572541 �. �' "�T11ND ` CreaK $-FOOT WIDE UTILITY EASEMENT PER 3ZO70 S0. FT. t » 0.74 ACRES t DOCUMENT No. 116756 AS SHOMM ON LAND COURT PLAN No. 5715-41 TOTAL AREA LOT 3e s• r BAXTER NYE ENGINEERING & SURVEYING 12•t01 SO. FT " 2.80 ACRES s h Registered Professional Engineers and Land Surveyors h 78 North Street- 3rd Floor, Hyannis, Massachusetts 02601 w►a Phone - (508) 771-7502 Fax - (508) 771-7622 , ®` N I CERTIFY THAT AS OF THE DATE OF THIS SURVEY, THE MONUMENTS CONTROLLING PRIOR PLANS ARE IN THE GROUND BARNSTABLE PLANNING BOARD AS SHOWN AND DESCRIBED HEREON. r APPROVAL UNDER THE SUBDIVISION z 40 0 40 80 � I CERTIFY THAT THIS PLAN WAS DRAWN FROM AN ACTUAL SURVEY MADE ON THE GROUND IN ACCORDANCE WITH THE CONTROL LAW N E I D LAND COURT INSTRUCTIONS OF 2006 ON OR BETWEEN DECEMBER 16, 2010 AND FEBRUARY 3, 2011. I L f SCALE IN FEET o4 DA SCALE. Is' - 40' ' DATE. 03-28-2011 JOHN R. ENS, R/pL S N No. 29874 1 N ANR� I HEREBY CERTIFY THAT THE LOTS SHOWN ON THIS PLAN HAVE FRONTAGE ON A PRIVATE WAY THAT WAS SHOWN ON N0. BY DATE REMARKS PREVIOUS PLAN WITHIN LAND COURT CASE No. 5725 APPROVED IN ACCORDANCE WITH THE SUBDIVISION CONTROL LAW, NOTE: NO DElER1gNAT10N AS 10 COMPLIANCE WITH THE ZONING ORDNrANCE OF AT LEAST SUCH DISTANCE, IF ANY, AS IS THEN REQUIRED BY ORDINANCE OR BY-LAW OF SAID CITY OR TOWN FOR REQUIREINXIS HAS BEEN MADE OR INTENDED BY THE ABOVE m NUMBER ERECTION OF A BUILDING ON SUCH LOT, AND IF NO DISTANCE IS SO REQUIRED, HAS SUCH FRONTAGE OF AT LEAST DIDORSWIT. LOTS 173, 174, 175, 176, 177, 178 AND 179 ARE TWENTY FEET. CREATED FOR CONVEYANCING PURPOSES AND ARE NOT TO BE CONSIDERED SEPARATE BUILDING LOTS. Ln 2010 2010-056 surve worksht 2010-056-MR.dw 2010-056 Kw (D ' D 07 -0 cj -2- 1pffe 007 G o