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HomeMy WebLinkAbout0037 CHIPPINGSTONE ROAD - Health "�7 �hippir���+tone Road Marstons INiills P A = 027 035 r Gob Socbello bog- W6- q23 f Cc,l/ LA c-7 ' �/ i Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 37 Chippingstone Rd. Property Address Ellen Browne Owner Owner's Name information is required for Marstons Mills Ma 026486 6/15/2011 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. General Information When filling out Ir forms on they computer,use 1. Inspector: � I only the tab key to move your Scott Campbell cursor-do not Name of Inspector use the return key. Cardinal Company Name 32 Ridgetop Rd. Company Address Cty/To Ma 02635 City/Town State Zip Code 508-420-1295 S1388 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. Tphp insaction was performed based on my training and experience in the proper function andjrnaintenance--of orlte sewage disposal systems. I am a DEP approved system inspector pursuant fiWSection4 5.34fff Title 5(310 CMR 15.000).The system: ° ® Passes ❑ Conditionally Passes ❑ Fa ifs ❑ Needs Further Evaluation by the Local Approving Authority ) u► rn 6/15/2011 Inspector's ignature 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. I t5ins•11110 Title 5 Official Inspection Form:Subsurface SewagjDp.sal System•P ge I 1 a 17 I , Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M , 37 Chippingstone Rd. Property Address Ellen Browne Owner Owner's Name information is required for Marstons Mills Ma 026486 6/15/2011 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated.are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 37 Chippingstone Rd. Property Address Ellen Browne Owner Owner's Name information is Marstons Mills Ma 026486 6/15/2011 required for every page. Cityrrown State Zip Code Date of Inspection IB. Certification (cont.) 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(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 -44 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M , 37 Chippingstone Rd. Property Address Ellen Browne Owner Owner's Name information is required for Marstons Mills Ma 026486 6/15/2011 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health and Public Water Supplier, if an. Y ( PP Y) 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 1/day flow t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 37 Chippingstone Rd. Property Address Ellen Browne Owner Owner's Name information is required for Marstons Mills Ma 026486 6/15/2011 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool 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 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 ❑ ❑ 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•11/10 Title 5 Official Inspection Form: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 37 Chippingstone Rd. .Property Address Ellen Browne Owner Owner's Name information is required for Marstons Mills Ma 026486 6/15/2011 every page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ 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): 220 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M ,•''r 37 Chippingstone Rd. Property Address Ellen Browne Owner Owner's Name information is required for Marstons Mills Ma 026486 6/15/2011 every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage (gpd)): Detail: 2009= 36,000 gallons 2010=42,000 gallons Sump pump? ❑ Yes ® No Last date of occupancy: Date Commercial/industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 37 Chippingstone Rd. Property Address Ellen Browne Owner Owner's Name information is required for Marstons Mills Ma 026486 6/15/2011 every page. CityrFown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: 2011 Date Other(describe below): General Information Pumping Records: Source of information: 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/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): 1000 gallon septic tank, 1000 gallon leach pit t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 r . 4 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 37 Chippingstone Rd. . Property Address Ellen Browne Owner Owner's Name information is required for Marstons Mills Ma 026486 6/15/2011 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1980 year built Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 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.): Septic Tank(locate on site plan): Depth below grade: 112"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 Dimensions: Sludge depth: t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 37 Chippingstone Rd. Property Address Ellen Browne Owner Owner's Name information is required for Marstons Mills Ma 026486 6/15/2011 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 4'3" Scum thickness 0 Distance from top of scum to top of outlet tee or baffle 0 Distance from bottom of scum to bottom of outlet tee or baffle 0 How were dimensions determined? vbisual inspection, 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.): Tank does not need to be pumped at this time. Inlet tees in place at time of inspection. Liquid level at proper working height. No evidence of leakage into or out of tank. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 37 Chippingstone Rd. Property Address Ellen Browne Owner Owner's Name information is required for Marstons Mills Ma 026486 6/15/2011 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: P Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•11/10 Title 5 Official Inspection Form: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 GSM , 37 Chippingstone Rd. Property Address Ellen Browne Owner Owner's Name information is required for Marstons Mills Ma 026486 6/15/2011 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): No box present Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �M 37 Chippingstone Rd. Property Address Ellen Browne Owner Owner's Name information is required for Marstons Mills Ma 026486 6/15/2011 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Course sandy gravel. No signs of hydraulic failure or staining above 3' mark from bottom of pit. No ponding or damp soil, normal vegetation. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 37 ChiPP 9 in stone Rd. Property Address Ellen Browne Owner Owner's Name information is required for Marstons Mills Ma 026486 6/15/2011 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 37 Chippingstone Rd. (Property Address iEllen Browne Owner Owner's Name information is required for Marstons Mills Ma 026486 6/15/2011 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately 3'3 O lr 15 40 t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 1 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 37 Chippingstone Rd. Property Address Ellen Browne Owner Owner's Name information is required for Marstons Mills Ma 026486 6/15/2011 every page. �Citylrown State Zip Code Date of Inspection D. System Information (cont.)v c Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 13+feet feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: You must describe how you established the high ground water elevation: Excavation at time of inspection right side of leach pit. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 l Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments °M 37 Chippingstone Rd. Property Address Ellen Browne Owner Owner's Name information is required for Marstons Mills Ma 026486 6/15/2011 every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments � 37 Chipping Stone Road N Property Address Tao Nguyen ' r Owner Owner's Name / ;:- information is Marstons Mills ✓ Ma 02648 10-18-18 f'? required for every page. City/Town State Zip Code Date of Inspection :;•; Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information 5`l*- /3qO on the computer, Brett Hickey use only the tab key to move your Name of Inspector cursor-do not B&B Excavation use the return Company Name key. 374 Route 130 m Company Address Sandwich Ma 02563 City/Town State Zip Code rmcv (508)477-0653 S113747 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 Brett Hickey �°"�"`°�"�"��" 10-18-18 :...ow:m•eren H.xw.o,o�,.�a.art�®®mmm.�am�.�i.pus �u�:roe.iorowv:ae n.m Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system 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. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 18 c Commonwealth of Massachusetts 1p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 37 Chipping Stone Road Property Address Tao Nguyen Owner Owner's Name information is Marstons Mills Ma 02648 10-18-18 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary 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: The system was in working order at the time of inspection. 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): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 ` c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments k 37 Chipping Stone Road Property Address Tao Nguyen Owner Owner's Name information is Marstons Mills Ma 02648 10-18-18 required for every page. City/Town 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): 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: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 18 < Commonwealth of Massachusetts �n p Title 5 Official Inspection Form 5 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 37 Chipping Stone Road Property Address Tao Nguyen Owner Owner's Name information is Marstons Mills Ma 02648 10-18-18 required for every page. City/Town 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 ❑ El clogged 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 i Commonwealth of Massachusetts Title 5 Official Inspection Form ~ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 37 Chipping Stone Road Property Address Tao Nguyen Owner Owner's Name information is Marstons Mills Ma 02648 10-18-18 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ 0 Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ a Liquid depth in cesspool is less than 6"below invert or available volume is less than Y2 day flow ❑ ❑ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ n Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ Q . Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ a Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ El Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ El 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.] ❑ El The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ [E] 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.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form I4 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 37 Chipping Stone Road Property Address Tao Nguyen Owner Owner's Name information is Marstons Mills Ma 02648 10-18-18 required for every 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 El ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ El Were any of the system components pumped out in the previous two weeks? E ❑ Has the system received normal flows in the previous two week period? ❑ O Have large volumes of water been introduced to the system recently or as part of this inspection? O ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ❑ E] Was the facility or dwelling inspected for signs of sewage back up? ❑ Was the site inspected for signs of break out? 0 ❑ Were all system components, excluding the SAS, located on site? El ❑ 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: ❑ R 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 18 Commonwealth of Massachusetts �e Title 5 Official Inspection Form r' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 37 Chipping Stone Road Property Address Tao Nguyen Owner Owner's Name information is Marstons Mills Ma 02648 10-18-18 required for every page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: no design plans 2Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): NA Description: There were no septic design plans or permits available at the Board of Health. Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes 0 No Does residence have a water treatment unit? ❑ Yes 0 No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes RI No information in this ireport.) Laundry system inspected? ❑ Yes E] No Seasonal use? ❑ Yes [E No Water meter readings, if available (last 2 years usage(gpd)): See below Detail: "`2016-44,000gallons 2017-40,000 gallons— Sump pump? ❑ Yes ❑■ No Last date of occupancy: currentDate 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 r- Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 37 Chipping Stone Road Property Address Tao Nguyen Owner Owner's Name information is Marstons Mills Ma 02648 10-18-18 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: NA 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: Owner- last pumped 2 years ago Source of information: Was system pumped as part of the inspection? ❑ Yes ❑■ No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc-rev.7/2 612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts �n Title 5 Official Inspection Form ISubsurface Sewage Disposal System Form -Not for Voluntary Assessments 37 Chipping Stone Road Property Address Tao Nguyen Owner Owner's Name information is Marstons Mills Ma 02648 10-18-18 required for every page. City/Town 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. 0 Other(describe): Tank, SAS Approximate age of all components, date installed (if known)and source of information: House built in 1980 Were sewage odors detected when arriving at the site? ❑ Yes ❑■ No 5. Building Sewer(locate on site plan): 2'6" Depth below grade: feet Material of construction: ❑cast iron ❑■ 40 PVC ❑other(explain): Distance from private water supply well or suction line: Town waterfeet Comments (on condition of joints, venting, evidence of leakage, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 L .. Commonwealth of Massachusetts r� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 37 Chipping Stone Road V Property Address Tao Nguyen Owner Owner's Name information is Marstons Mills Ma 02648 10-18-18 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): 1'6" Depth below grade: feet Material of construction: ❑■ concrete El 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 1000 gallons Dimensions: 4" Sludge depth: 32" Distance from top of sludge to bottom of outlet tee or baffle Orr Scum thickness NS Distance from top of scum to top of outlet tee or baffle NS Distance from bottom of scum to bottom of outlet tee or baffle measured How were dimensions determined? Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): The tank was in working order at the time of inspection. The tank is not in need of pumping at this time but should be pumped every two years for maintenance. t5insp.doc•rev.7/26/2016 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 10 of 18 I Commonwealth of Massachusetts �- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 37 Chipping Stone Road U� Property Address Tao Nguyen Owner Owner's Name information is Marstons Mills Ma 02648 10-18-18 required for every St page. City/Town ate Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): Depth below grade: NAfeet 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 Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: NA Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons M Design Flow: gallons per day t,insp,doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 37 Chipping Stone Road Property Address Tao Nguyen Owner Owner's Name information is Marstons Mills Ma 02648 10-18-18 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) 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 9. Distribution Box(if present must be opened) (locate on site plan): NA Depth of liquid level above outlet invert Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 37 Chipping Stone Road u= Property Address Tao Nguyen Owner Owner's Name information is Marstons Mills Ma 02648 10-18-18 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes No* Alarms in working order: ❑ Yes [E No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): NA * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: (1 ) 6'X6' 0 leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.R26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form !- Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 37 Chipping Stone Road u� Property Address Tao Nguyen Owner Owner's Name information is Marstons Mills Ma 02648 10-18-18 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS)(cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): The leaching was in working order and was dry with a high stain line 2/3 up for the bottom. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): NA 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 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 14 of 18 Commonwealth of Massachusetts �m ,@ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 37 Chipping Stone Road Property Address Tao Nguyen Owner Owner's Name information is Marstons Mills Ma 02648 10-18-18 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: NA 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=18 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,AP� 37 Chipping Stone Road u� Property Address Tao Nguyen Owner Owner's Name information is Marstons Mills Ma 02648 10-18-18 required for every 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 Asbuilt Ground water A1.13'5" 81-26' V Grade W A2.16' 82.20'5" y B3.291" C.40' 2'6" I L A , OO1611 2 6'x6'Plt 9 8 C >11'1>2'6" Ground water t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 I Commonwealth of Massachusetts �e Ti Sewage tle 5Official Inspection Form Susurface p System Form -Not for Voluntary Assessments 37 Chipping Stone Road L Property Address Tao Nguyen Owner Owner's Name information is Marstons Mills Ma 02648 10-18-18 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: 0 Check Slope ❑■ Surface water 0 Check cellar ❑■ Shallow wells Estimated depth to high ground water: No GW @ 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) 0 Checked with local Board of Health -explain: Topo Maps and perk logs for surrounding properties ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Information on abutting properties was used to determine groundwater in >11'. Bottom of SAS is 8'6" below grade showing the bottom of SAS in >2'6"above ground water. Before filing this Inspection Report, please see Report Completeness Checklist on next page. l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 18 c N Commonwealth of Massachusetts ' Title 5 Official Inspection Form (= Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 37 Chipping Stone Road v Property Address Tao Nguyen Owner Owner's Name information is Marstons Mills Ma 02648 10-18-18 required for every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: F■ A. Inspector Information: Complete all fields in this section. QQ 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 t t5insp.doc-rev.726/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 Town of Barnstable 1.39.,, Board of Health 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Susan G.Rask,R.S. FAX: 508-790-6304 Sumner Kaufman,MSPH Wayne Miller,M.D. Janu ary 25, 2005 Ms. Deborah Schilling 3860 Falmouth Road Marstons Mills, MA RE: 37 Chippingstone Road, Marstons Mills A= 027-035 Dear Ms. Schilling, You are granted permission on behalf of your client, Mary Denneny, to construct and utilize an innovative/alternative (I/A) nitrogen reduction system at 37 Chippingstone Road, Marstons Mills, Massachusetts. This permission is granted with the following conditions: (1) A professional engineer shall be hired to design an I/A system for the property in compliance with the State Environmental Code, Title 5. The system shall be installed in strict accordance with the engineered plans. (2) The applicant shall submit floor plans showing three bedrooms maximum of the proposed home to the Public Health Division Office prior to obtaining a disposal works construction permit. (3) No more than three (3) bedrooms maximum are authorized at this property. Dens, study rooms, offices, finished attics, sleeping lofts, and similar-type rooms are considered "bedrooms" according to the MA Department of Environmental Protection. (4) The applicant shall record a properly worded deed restriction, signed by the owner of the property, at the Barnstable County Registry of Deeds restricting the property to three (3) bedrooms.maximum. A copy of the recorded deed restriction shall be submitted to the Health Agent prior to obtaining a disposal works construction permit. . SchillingChippingstone t . � (5) A written monitoring plan for the I/A system shall be submitted to the Public Health Division Office prior to obtaining a disposal works construction permit. The wastewater effluent shall be tested quarterly for the first two years of operation for various parameters as determined by the Board of Health (usually for Nitrates, TKN, pH, CBOD, TSS, TN, and alkalinity). (6) The applicant shall submit a copy of the signed two-year Operation and Maintenance Agreement (O&M) between the contractor and the homeowner to the Board of Health. The engineer or O& M contractor shall conduct inspections to the I/A system a minimum of twice yearly. . The applicant testified that the home was purchase in 1980 as an unfinished three bedroom Cape style home. The home currently consists of two bedrooms on the first floor and a second "unfinished" floor. It is the opinion of the Board that the addition of one bedroom along with the proper use of a new innovative/alternative nitrogen reduction system at this site should not pollute the groundwater in the area. Sincer ly yours, Wa ne M�Ir, M.D. Chairman SchillingChippingstone Page 1 of 4 VMNSTATiU Logged InAs: a rce I Detail Tuesday, August 21 2007 Parcel Lookup Parcel Info Parcel ID 027-035 Developer Lot LOT 46 __ .. ._........ _ _ . __ ... ............. . .......... _ ... _........--------._.,.-_ ...._.. Location 37 CHIPPINGSTONE ROAD Pri Frontage .162 ........................__...__.. ......... ........ Sec Sec Road 'SPUR LANE Frontage 162 village ;MARSTONS MILLS Fire District C-O-MM Sewer Acct. Road Index 0301 4 Interactive , Maple a Owner Info _... .... ._...._ __._. ... .. _ .,_. _.._. .,... . .. .._ _._ . m .,_ .... owner.5ORBELL0, ROBERT T & MOLLY C co-owner Streets 37 CHIPPINGSTONE RD Street2 city!MARSTONS MILLS State MA Zip .02648 Country'' Land Info Acres 10.59 use Single Fam MDL-01 zoning RF Nghbd 0105 _......... __.. _ _ .. _.. __ _. ....__......._ _._.... __._. ..._.. Topography Level Road Paved _.... _. ........ _........... .......... Utilities;Gas,Septic Location file://C:\DOCUME-1\miorandd\LOCALS-1\Temp\2F7JV8HW.htm 8/21/2007 Page 2 of 4 Construction Info Building of Year f.. Roof .._.... Ext Built A980 struct Gable/Hip Wall ,Wood Shingle Effect Roof AC 1620 j As h/F GIs/Cm None Area 7 Cover p p Type s Int _ _. ._. _ _... Bed Style jCape Cod Drywall 4 Bedrooms Wall Rooms EtA� 'r4 Model Residential Int f Bath 1 Full h' Floor 1 Rooms ' Grade,Average Minus Heat Hot Water Total Type Rooms ._..�.__.._.__ ._._. Heat .... . ............ __...,,. _ Found- Stories Fuel Gas anon Typical Permit History Issue Date __. Purpose Permit# Amount Insp Date Comments 6/14/2005 Addition 84795 $15,000 12/14/2005 12:00:00 AM 3/1/1980 B22036 $0 1/15/1981 12:00:00 AM MM 1 STOR Visit History Date Who Purpose 12/14/2005 12:00:00 AM Paul Talbul Meas/Est 10/13/2005 12:00:00 AM Jason Streebel Drive by inspection only 4/28/2005 12:00:00 AM Paul Talbot Meas/Est 2/2/1999 12:00:00 AM Donna Dacey Meas/Listed Sales History ......... Line Sale Date Owner Book/Page Sale Price 1 5/31/2005 SORBELLO, ROBERT T& MOLLY C C176851 $298,500 2 3/7/2005 TESSIER, EDMOND E C176057 $258,000 file://C:\DOCUME-1\miorandd\LOCALSI\Temp\2F7JV8HW.htm 8/21/2007 Page 3 of 4 113 I I DENNENY, MARY E I C80634 I $011 Assessment History...... _. _.. _...._ .... __... ... Save# Year Building Value XF Value OB Value Land Value Total Parcel Value 1 2007 $138,700 $0 $0 $157,700 $296,400 2 2006 $101,800 $0 $0 $166,100 $267,900 3 2005 $97,500 $0 $0 $128,300 $225,800 4 2004 $79,100 $0 $0 $90,600 $169,700 5 2003 $71,000 $0 $0 $43,700 $114,700 6 2002 $71,000 $0 $0 $43,700 $114,700 7 2001 $71,000 $0 $0 $43,700 $114,700 8 2000 $52,600 $0 $0 $23,900 $76,500 9 1999 $59,500 $0 $0 $23,900 $83,400 10 1998 $59,500 $0 $0 $23,900 $83,400 11 1997 $56,900 $0 $0 $23,900 $80,800 12 1996 $56,900 $0 $0 $23,900 $80,800 13 1995 $56,900 $0 $0 $23,900 $80,800 14 1994 $59,000 $0 $0 $21,500 $80,500 15 1993 $59,000 $0 $0 $21,500 $80,500 16 1992 $67,100 $0 $0 $23,900 $91,000 17 1991 $66,100 $0 $0 $43,800 $109,900 18 1990 $66,100 $0 $0 $43,800 $109,900 19 1989 $66,100 $0 $0 $43,800 $109,900 20 1988 $43,100 $0 $0 $12,200 $55,300 21 1987 $43,100 $0 $0 $12,200 $55,300 22 1986 1 $43,100 $0 $0 $12,200 $55,300 11 Photos file://C:\DOCUME-1\miorandd\LOCALS-1\Temp\2F7JV8HW.htm 8/21/2007 Page 4 of 4 �r file://C:\DOCUME-1\miorandd\LOCALS—l\Temp\2F7JV8HW.htm 8/21/2007 �J � � %�� �oFzt+e ram, Town of Barnstable hhP �t Regulatory Services + ■pgNSTAM 9 '6SS. �' Thomas F. Geiler,Director i59. tea, pl�'0 MPi s Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 - TD NUMBER OF PAGES TO FOLLOW: TO: 6 U a FROM: 4�UA �,Efi T, PHONE: PHONE: (508)862-4644 FAX PHONE: `r' FAX PHONE: (508)790-6304 0 Vok cc: NOTES/COMMENTS: Q W x Form.doc Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 37 Chippingstone Road Property Address Robert and Molly Sorbello Owner Owner's Name information is Mills t Marsons MA 02563 June 21 2007 required for � every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. O Important: A. General Information When filling out forms on the computer,use 1. Inspector: only the tab key �j/f 63,5— to move your David D. Coughanowr �LL cursor-do not Name of Inspector use the return key. Eco-Tech Environmental Company Name VQ 43 Triangle Circle Company Address Sandwich MA 02563 '"a" City/Town State Zip Code 508 364-0894 Pending Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the w 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 Aintenar" of on;site sewage disposal systems. I am a DEP approved system inspector pursuant tojSection_•:.j5.3,&of Title 5 (310 CMR 15.000).The system: c_ ~ ® Passes ❑ Conditionally Passes ❑ hail's �' 11 El Needs Further Evaluation by the Local Approving Authority W June 21, 2007 ^' rr, Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5-2661.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 37 Chippingstone Road Property Address Robert and Molly Sorbello Owner Owner's Name information is required for Marstons Mills MA 02563 June 21 2007 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: Inspector's Note==> A septic system is deemed to pass this Real Estate Transfer Inspection if it does not trigger any of the failure criteria listed below. The septic system has been evaluated according to the conditions observed on the day it was inspected. No estimate or guarantee of system longevity is made or implied by a passing determination. 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 t5-2661.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �^M 37 Chippingstone Road Property Address Robert and Molly Sorbello Owner Owner's Name information is required for Marstons Mills MA 02563 June 21 2007 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ 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: 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: 'I ❑ 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. t5-2661.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 37 Chippingstone Road Property Address Robert and Molly Sorbello Owner Owner's Name information is required for Marstons Mills MA 02563 June 21 2007 every page. CityFrown State Zip Code Date of Inspection_ B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ 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 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 'h 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. Lt5-2111.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 37 Chippingstone Road Property Address Robert and Molly Sorbello Owner Owner's Name information is required for Marstons Mills MA 02563 June 21 2007 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® 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 fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 1 0,000g pd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone 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. t5-2661.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �nM 37 Chippingstone Road Property Address Robert and Molly Sorbello Owner Owner's Name information is required for Marstons M►11s MA 02563 June 21 2007 . 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 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? SAS also inspected ❑ ® 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)] t5-2661.doc•.08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 15 I , Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 37 Chippingstone Road Property Address Robert and Molly Sorbello Owner Owner's Name information is required for Marstons Mills MA 02563 June 21 2007 every page. Cityrrown State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 gpd Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage 114 gpd 9 ( Y 9 (gpd)) Sump pump? ❑ Yes ® No Last date of occupancy: current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): Lt5-2661.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 37 Chippingstone Road Property Address Robert and Molly Sorbello Owner Owner's Name information is required for Marstons Mills MA 02563 June 21 2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Owner Source of information: 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/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: Age: 28+years. Design plan in owner's possession dated 9119178. Were sewage odors detected when arriving at the site? ❑ Yes ® No t5-2661.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection i n Form p 0 _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 37 Chippingstone Road Property Address Robert and Molly Sorbello Owner Owner's Name information is required for Marstons Mills MA 02563 June 21 2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 2feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Sewer appears structurally sound with no evidence of backup or leakage into dwelling Septic Tank(locate on site plan): 1 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 Dimensions: 8.5 ft x 5 ft x 5 ft(1000 gallon) Sludge depth: 4 in Distance from top of sludge to bottom of outlet tee or baffle 30 in Scum thickness 2►n Distance from top of scum to top of outlet tee or baffle 9 in Distance from bottom of scum to bottom of outlet tee or baffle 13 in How were dimensions determined? Design plan t5-2661.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 r Commonwealth of Massachusetts W Title 5 Official Inspection Form of Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 37 Chippingstone Road Property Address Robert and Molly Sorbello Owner Owner's Name information is required for Marstons Mills MA 02563 June 21 2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumping not required at this time but maintenance pumping is recommended within and every two years. Tank and tees appear structurally sound and functioning as intended. No evidence of leakage in or out was observed. 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 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 ❑ polyethylene ❑ other(explain): t5-2661.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 15 Commonwealth of Massachusetts . Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 37 Chippingstone Road Property Address Robert and Molly Sorbello Owner Owner's Name information is required for Marstons Mills MA 02563 June 21, 2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank (cont.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box not found where indicated on as built, or by probing or snaking. System has instead been evaluated on the condition of the leach pit which was located and examined(see page 12). Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No t5-2661.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 37 Chipp 9 in stone Road Property Address Robert and Molly Sorbello Owner Owner's Name information is required for Marstons Mills MA 02563 June 21, 2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Soils above leaching pit appeared unsaturated. No evidence of surface ponding, breakout, lush vegetation, or other evidence of hydraulic failure was observed. An observation hole was dug into leaching pit stone and no effluent contact staining was observed in the stone or overlying soils. No standing effluent was observed to a depth of 2 feet below the top of the leaching pit. t5-2661.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 37 Chippingstone Road Property Address Robert and Molly Sorbello Owner Owner's Name information is required for Marstons Mills MA 02563 June 21, 2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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 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.): 1:5-2661.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 37 Chippingstone Road Property Address Robert and Molly Sorbello Owner Owner's Name information is required for Marstons Mills MA 02563 June 21 2007 every page. City/Town State Zip Code Date of Inspectiori D. System Information (cont.) 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. LOCATIONS A B C 1 13.5 FE 26 Ft 2 16Ft 20.5fL 3 29.5 Ft 40 FL l A SEPTIC EXISTING TANK o DWELLING 2 # 37 B C w Z J LEACH O PIT a 3 CHIPPINGSTONE ROAD NOT TO SCALE t5-2661.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 37 Chippingstone Road Property Address Robert and Molly Sorbello Owner Owner's Name information is required for Marstons Mills MA 02563 June 21, 2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to ground water: 30+feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers- (attach documentation) ® Accessed USGS database- explain: Barnstable GIS Department records You must describe how you established the high ground water elevation: Town of Barnstable GIS Department records indicate that the property is over 30 feet above groundwater table. t5-2661.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 15 r Page 1 of 2 06 Miorandi, Donna From: Ann Quinlin [annquinlin@yahoo.com] Sent: Tuesday, August 21, 2007 3:40 PM To: Miorandi, Donna J Subject: RE: Question on 37 Chippingstone Marstons Mills Hi Donna: If you want I can come in in person but if you can help via email, that would be great -(and much appreciated)! I have a buyer who is interested in this property but she has a question on the septic. Here's the town link http://www.town.barnstable.ma.us/assessing/assess06/displqyparcelO7map.asp? ma-Dpar=027035 The town calls this house a 4 BR, the listing agent calls has it as a 2 BR, the seller purchased the house as a 2 BR, the septic apparently is sized for 3 BR's. Here's the big question - could this house legally become a 3 BR? f` If so, what would have to be done? A Thanks! Ann "Miorandi, Donna"<Donna.Miorandi@town.barnstable.ma.us>wrote: Hi Ann, It is in the Zone of Contribution on .2 acre. If the septic system is good for three then they are stuck at 3 bedrooms. If somehow they can prove they legally added on with a permit to 4 bedrooms or they were ALWAYS 4 bedrooms they they will have to do an upgrade on their septic system to upgrade to a 4 bedrooms system. Hope that answers your question. Bye for now. Donna -----Original Message----- From: Ann Quinlin [mailto:annquinlin@yahoo.com] Sent: Thursday, May 17, 2007 12:14 PM To: Miorandi, Donna Subject: RE: Question Hi Donna: I wonder if you could answer a question for me! I have a listing at 426 Scudder Ave in Hyannis Port and the assessor's department has it listed as a 4 BR. I remember you once telling me that the health dept and the assessors dept have different definitions of what constitutes a bedroom. Thank God I came to check out the septic at the health dept because I discovered it was a 3 BR septic and the permimt when the current owners added on called it was a 3 BR. Here's my question... Could this house (based on the size of the lot and where it is) ever 8/21/2007 r Page 2 of 2 be able to be called a 4 BR? Here's the link to the assessors page - http://www.town.bamstable.ma.us/assessing/assess06/displayparcel.07mV.asp? maip- ar=288010 It seems doubtful to me but I just need to verify! Thanks, Ann Ann Quinlin, ABR,CPS,SRES Broker Associate RE/MAX Classic 167 Lovell's Lane Marstons Mills, MA 02648 508-776-4486 Bored stiff? Loosen up... Download and play hundreds of games for free on Yahoo! Games. Ann Quinlin RE/MAX Classic 167 Lovell's Lane Marstons Mills, MA 02648 508-776-4486 Cell 866-770-8361 Fax www.realestatecape.com !Need a vacation? Get great deals to amazing places on Yahoo! Travel. 8/21/2007 TOWN OF BARNSTABLE �a LOCATION 37 Ch1PP;k**S*0Ke 20Qcr •� SEWAGE # VILLAGE �AQO 5Y�OhS µ; 11 S ASS1✓SSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY •� LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: 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 6f0-feeh Ur15jCC jtoh LOCATION, A B C 1 13.5 FL 26 Ft 2 16 FL 20.5 Ft 3 29.5 Ft 46 Ft ,;;;,• A SEPTIC:I o EXISTING TANK o DWELLING 2 # 37 13 C IS w Z LEACH rw O PIT s l 3 CHIPPINGSTONE ROAD NOT TO SCALE, COMMONWEALTH OF MASSACHUSETTS v EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS nl r d DEPARTMENT OF ENVIRONMENTAL PROTECTION �e AP Z�n -ItiRCEL. DEC 2 1 20 04 - TOWN OF gF„Y'JS1 ABC E TITLE 5 "E 'WENT. OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 37 Chippingstone Road Marstons Mills MA 02648 Owner's Name: Elizabeth Denneny Owner's Address: Same Date of Inspection: October 29,2004 E= — Name of Inspector: PATRICK M.O'CONNELL ' Company Name: SEPTIC INSPECTION SERVICES CO. f' ± =_ Mailing Address: 189 CAMMETT ROAD v; MARSTONS MILLS MA 02648 Telephone Number: 508-428-1779 r.a r� 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 DIW approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: �����H pF Passes Oti Conditionally PassesATRIC N Needs Further Evaluation by the Local Approving Authority = M ;M Fails 5 Inspector's Signature: Date: 10/29/04 pF51 SPEG����`� The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health I III 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. Notes and Comments: Observed liquid level in leaching pit 30" below inlet pipe with no high stains. Recommend pumping tank. ****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: 37 Chippingstone Road,Marstons Mills Owner: Elizabeth Denneny Date of Inspection: October 29,2004 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: _XX_ 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: Titles 2 Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE, SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 37 Chippingstone Road,Marstons Mills Owner: Elizabeth Denneny Date of Inspection: October 29,2004 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: se_ The systemp o has a tic tank and it absorption system(SAS)and the SAS is within 100 feet of 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 organi .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: Titla r,Tnenartinn Rnr All ai1000 3 r Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 37 Chippingstone Road, Marstons Mills Owner: Elizabeth Denneny Date of Inspection: October 29,2004 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No _X_ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _X_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool _X_ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _X Liquid depth in cesspool is less than 6"below invert or available volume is less than '/2 day flow _X_ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _X_ Any portion of the SAS,cesspool or privy is below high ground water elevation. _X_ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone 1 of a public well. _X_ Any portion of a cesspool or privy is within 50 feet of a private water supply well. p p �'Y P PP Y _X_ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. (This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this forma _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 Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply _ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone 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. T41A C rnonantinn 17-411 rPWIA 4 Page 5 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 37 Chippingstone Road,Marstons Mills Owner: Elizabeth Denneny Date of Inspection: October 29,2004 Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No _X_ _ Pumping information was provided by the owner,occupant,or Board of Health _X_ Were any of the system components pumped out in the previous two weeks? _X_ _ Has the system received normal flows in the previous two week period ? _ _X_ Have large volumes of water been introduced to the system recently or as part of this inspection _ N/A Were as built plans of the system obtained and examined?(If they were not available note as N/A) _X_ _ Was the facility or dwelling inspected for signs of sewage back up? _X_ _ Was the site inspected for signs of break out? _X_ _ Were all system components,excluding the SAS, located on site X _ Were the septic tank manholes uncovered opened, and the interior f_ P p o o 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? _X_ _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no _ _X_ Existing information. For example,a plan at the Board of Health. _X_ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] Titles G i»cncntinn Rnrm!/I 5 Page 6 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property p y Address: 37 Chi in stone Road Ma pp g rstons Mills Owner: Elizabeth Denneny Date of Inspection: October 29,2004 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 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): No [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use:(yes or no): No Water meter readings,if available(last 2 years usage(gpd)): N/A well water. Town water just installed. Sump pump(yes or no): No Last date of occupancy: Currently Occupied COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no):_ Non-sanitary waste discharged to the Title 5 system(yes or no):_ Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records: Tank pumped years ago. Source of information: 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 _X_Septic tank,distribution box, soil absorption system _Single cesspool _Overflow cesspool Privy _Shared system(yes or no)(if yes,attach previous inspection records, if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank _Attach a copy of the DEP approval —Other(describe): Approximate age of all components, date installed(if known)and source of information: 1980 Were sewage odors detected when arriving at the site(yes or no): No Tit1P S Tncnp�tinn T:nr Ail siinnn 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: 37 Chippingstone Road,Marstons Mills Owner: Elizabeth Denneny Date of Inspection: October 29,2004 BUILDING SEWER: XX (locate on site plan) Depth below grade: 1' p Materials of construction:_cast iron _X_40 PVC_other(explain): Distance from private water supply well or suction line: 8' Comments(on condition of joints, venting, evidence of leakage,etc.): SEPTIC TANK: XX (locate on site plan) Depth below grade: 1' Material of construction:_X_concrete_metal_fiberglass_polyethylene _other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: 8.5' long x 5.2' wide—1000 gal. Sludge depth: 4" Distance from top of sludge to bottom of outlet tee or baffle: 26" Scum thickness: 2" Distance from top of scum to top of outlet tee or baffle: 7" Distance from bottom of scum to bottom of outlet tee or baffle: 11" How were dimensions determined: STICK WITH HINGE FLAP. Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Baffles intact,liquid level at bottom of outlet pipe.No evidence of leaks or backup GREASE TRAP: No (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.): Titla G inonartinn Fnr A/15/')Ann 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: 37 Chippingstone Road,Marstons Mills Owner: Elizabeth Denneny Date of Inspection: October 29,2004 TIGHT or HOLDING TANK: No (tank must be pumped at time of inspection) (locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: XX (if present must be opened) (locate on site plan) Depth of liquid level above outlet invert: 0" Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): Single outlet Dipe.No solids or high stains present PUMP CHAMBER: No (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.): Title C incnartinn 17Ar All VIMA 8 Page 9 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 37 Chippingstone Road,Marstons Mills Owner: Elizabeth Denneny Date of Inspection: October 29,2004 SOIL ABSORPTION SYSTEM(SAS): XX (locate on site plan,excavation not required) If SAS not located explain why: Type _X_leaching pits,number: One 6x6 pit. leaching chambers,number: leaching galleries,number: leaching trenches,number, length: leaching fields,number, dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil,condition of vegetation, etc.): Liquid level in pit is 30" below inlet with no high stains CESSPOOLS: No (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: No (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.): Titla i Tnenantinn Rnrm All ShInnn 9 I f - Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 37 Chippingstone Road,Marstons Mills Owner: Elizabeth Denneny Date of Inspection: October 29,2004 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. Chippingstone Road WAS 3 Z7 3� i ZO O 1000 gal tank 1000 gal pit Titla G Tncnantinn Rn—Ail crnnnn 10 Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 37 Chippingstone Road, Marstons Mills Owner: Elizabeth Denneny Date of Inspection: October 29,2004 SITE EXAM Slope None Surface water None Check cellar Dry Shallow wells None Estimated depth to ground water: More than 40 feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record- If checked, date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators, installers-(attach documentation) _X_Accessed USGS database-explain: USGS topo map and town GIS. You must describe how you established the high ground water elevation: Town Groundwater contour map shows water below el.50 and topo map shows property above el.90. Tit1. C Inennntinn Fnrm 4/1 VIOi O 1 1 ��FTHE 1p� DATE FEE: � IiARNSTABLE, � ' 9 MASS. g, 1639. REC. BY Town of Barnstable SCHED. DATE: Board of Health 200 Main Street,Hyannis MA 02601 ' Office: 508-862-4644 Susan G.Rask,R.S. FAX: 508-790-6304 Sumner Kaufman,M.S.P.H. Wayne A.Miller,M.D. VARIANCE REQUEST FORM LOCATION r� PropertyAddress: / Assessor's Map and Parcel Number: Size of Lot: _0 Wetlands Within 300 Ft. Yes Business Name: No II < Subdivision Name: p APPLICANT'S NAME: 2 r10 YGt f u G i I' t i�y' Phone., 5 0? 0 -2 3 0 b Did the owner of the property authorize you to represent hi4or her? Yes _ No PROPERTY I � �4!/�OnWNER'S NAME CONTACT PERSON 1 Name: I 0 QNN(N`y Name: D E 3 D R A Il- J C 1I Lil/N 6— Address: 3) 01 1 NARV,4J I Address: 3�6 dfl Phone: Jot l J0 3 S-�2% Phone: 5-0? LIvZ? a 3 0-0 VARIANCE FROM REGULATION(Listxe&) REASON FOR VARIANCE(May attach if more space needed) 3J0 em iS 011 NATURE OF WORK: House Addition 13OEDOO House Renovation ❑ Repair of Failed Septic System ❑ Checklist (to be-completed by off ce staff-person receiving variance request application) Please submit copies in 4 separate completed sets. Four(4)copies of the completed variance request form G L__ Four(4)copies of engineered plan submitted(e.g.septic system plans) .S6�JG R- Fc7 Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) Signed letter stating that the property owner authorized you to represent him/her for this request Applicant-understands that the abutters must be notified by`cectified mail at least ten days prior to meeting date at applicant's expense t` (for Title V and/or local sewage regulation variances only) " Full menu submitted(for grease trap variance requests only) Variance request application fee collected (no fee for lifeguard modification renewals, grease trap variance renewals [same owner/leasee only], outside dining variance renewals [same owner/leasee only], and variances. to repair failed sewage disposal systems [only if no expansion to the building proposed]) Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Wayne A.Miller,M.D.Chairman NOT APPROVED Sumner Kaufman,M.S.P.H. REASON FOR DISAPPROVAL Susan G.Rask,R.S. Q:\HEALTH\Application Forms\VARIREQ.DOC �j,•u j 0& I January 3, 2005 To: Barnstable Board of Health From: Mary Elizabeth Denneny RE: Variance request I hereby authorize Deborah Schilling, my Realtor to represent me in the request for a variance on my property located at 37 Chippingstone Road, Marstons Mills, Massachusetts. I am requesting the variance from 310 CMR 15.214 to finish a 3rd bedroom in the unfinished 2nd floor of my 11/2 story Cape Cod style home. The first floor has 2 bedrooms and one bath. The house was bought as an unfinished 3 (or 4)bedroom Cape in 1980, and we have the following documents from the Town of Barnstable files: Application for Building Permit, for"4 room"house ("5 room"was crossed out), Occupancy permit dated May 23, 1980, and certified plot plan, showing house location. Upon a thorough search of Health Department files, no records were found, even though we have the Sewage permit number(80-57). We cannot document that a system was built as a 3 bedroom system,but in review of a substantial percentage of the homes in this immediate neighborhood (and also within the nitrogen sensitive zone), the homes are predominately 3 or more bedrooms. It is our understanding that the system that was installed qualified for 3 bedrooms (at least) in 1980. The practice of building an expandable Cape was very common at that time that finishing the upstairs meant additional bedrooms was understood. Because of financial constraints, the upstairs was never finished since it has been occupied. The house is located within a nitrogen sensitive area, and since the lot size is .59 acre(25,700 s.f.), it qualifies for only 2 bedrooms under 310 CMR 15.214. Rationale: When the current(original owner) bought it, she fully intended to finish additional rooms upstairs, and always believed she would be able to add at least 1 additional bedroom. She is now selling the house due to her inability to maintain the property, and to move closer to her part time job. She has already lost 2 potential Buyers due to the inability to represent this as an expandable (to at least 3 bedrooms) house. We believe that the missing records would show the 3 bedroom capacity(possibly 4?) would have been intended in 1980. We contacted the engineering firm who prepared the plot plan, and they cannot locate the septic design in their files. They may not have done that part of the engineering in 1980. We have tried every conceivable means to avoid asking for a variance, in recognition of the Board's valuable time, and in the interest of expediting approval of this,but without written documents in the Board of Health, we understand this variance is the only option. It is extremely urgent that she obtain this variance, as she is contracted for a reduced rent apartment in Falmouth, which she will lose if she is unable to sell her house quickly. As her Realtor, I know her house will sell quickly at a fair market price if she is granted a variance for the additional bedroom. If she is denied, we have a Buyer who will only pay 75% of its market value, due to the limitation of bedrooms. This will result in a loss of over$50,000, a considerable sum to a single elderly woman, who still works to provide herself a continuing income. We respectfully submit this request and reiterate the extreme hardship that will befall Miss Denneny if it is not approved. This letter has been prepared by Deborah Schilling. Respectfully submitted, Mary E. Denneny ;%7 & -\ COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS } a DEPARTMENT OF ENVIRONMENTAL PROTECTION a . eW TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART-A CERTIFICATION Property Address: 37 Chippingstone Road Marstons Mills MA 02648 Owner's Name: Elizabeth Denneny Owner's Address: Same Date of Inspection: October 29,2004 Name of Inspector: PATRICK M.O'CONNELL Company Name: SEPTIC INSPECTION SERVICES CO. Mailing Address: 189 CAMMETT ROAD MARSTONS MILLS MA 02648 Telephone Number: 508-428-1779 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 Dntttrr►r approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: OF I{qq __X_ Passes Conditionally Passes : ATRIC N Needs Further Evaluation by the Local Approving Authority — M ;M Fails s Inspector's Signature: Date: 10/29/04 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. Notes and Comments: Observed liquid level in leaching pit 30"below inlet pipe with no high stair. Recommend pumping tank. ****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 Page 2-of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 37 Chippingstone Road, Marstons Mills Owner: Elizabeth Denneny Date of Inspection: October 29,2004 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D --A.- System Passes: _XX_ 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: Tit1. 9 Tncnortinn T+'nrm /.ii tnnnn 2 Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 37 Chippingstone Road,Marstons Mills Owner: Elizabeth Denneny Date of Inspection: October 29,2004 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: Tit1. Tncn.Pt;— P— 411'�/7nnn 3 L Page 4 of 11 u OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 37 Chippingstone Road, Marstons Mills Owner: Elizabeth Denneny Date of Inspection: October 29,2004 D. System Failure Criteria applicable to all systems: You must indicate' yes or Yes No X_ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _X_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool _X_ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _X_ Liquid depth in cesspool is less than 6"below invert or available volume is less than '/z day flow —X_ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _X_ Any portion of the SAS,cesspool or privy is below high ground water elevation. _X_ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface Water supply. _ _X_ Any portion of a cesspool or privy is within a Zone I of a public well. _X_ Any portion of a cesspool or privy is within 50 feet of a private water supply well. _X_ Any.portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this forma 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 Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(interim Wellhead Protection Area—IWPA)or a mapped. Zone 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. T;NA c i—...f;- Rn-411;nnnn 4 I Page 5 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 37 Chippingstone Road,Marstons Mills Owner: Elizabeth Denneny Date of Inspection: October 29,2004 ... ..,w Check if the following have been done. You must indicate"yes"or"no"as to each of the following: 4 Yes No _X_ _ Pumping information was provided by the owner,occupant,or Board of Health _ _X_ Were any of the system components pumped out in the previous two weeks? _X_ _ Has the system received normal flows in the previous two week period ? _ _X_ Have large volumes of water been introduced to the system recently or as part of this inspection? _ N/A Were as built plans of the system obtained and examined?(If they were not available note as N/A) _X_ _ Was the facility or dwelling inspected for signs of sewage back up? _X_ _ Was the site inspected for signs of break out? _X_ _ Were all system components,excluding the SAS, located on site? _X _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? _X_ _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: Yes no _ _X_ Existing information. For example,a plan at the Board of Health. X_ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] Titlo C Tncncnt nn T nrm�iT si�nnn 5 f Page 6 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 37 Chippingstone Road, Marstons Mills Owner: Elizabeth Denneny Date of Inspection: October 29,2004 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design)`. 4' Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 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): No [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use:(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): N/A well water. Town water just installed. Sump pump(yes or no): No Last date of occupancy: Currently Occupied COMMERCIALANDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no):_ Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records: Tank pumped years ago. Source of information: 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 _X_Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool Privy Shared system(yes or no)(if yes, attach previous inspection records, if any) _Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) - -Tight tank _Attach a copy of the DEP approval _Other(describe): Approximate age of all components,date installed(if known)and source of information: 1980 Were sewage odors detected when arriving at the site(yes or no): No Title C Tncnnrtinn P: ,_All C/7nnn 6 L Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 37 Chippingstone Road,Marstons Mills Owner: Elizabeth Denneny Date of Inspection: October 29,2004 BUILDING SEWER: XX (locate on site plan) Depth below grade: 1' Materials of construction:_cast iron _X_40 PVC_other(explain): Distance from private water supply well or suction line: 8' Comments(on condition of joints, venting,evidence of leakage,etc.): SEPTIC TANK: XX (locate on site plan) Depth below grade: 1'. Material of construction:_X_concrete_metal_fiberglass_polyethylene —other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: 8.5' long x 5.2' wide— 1000 gal. Sludge depth: 4" Distance from top of sludge to bottom of outlet tee or baffle: 26" Scum thickness: 2" Distance from top of scum to top of outlet tee or baffle: 7" Distance from bottom of scum to bottom of outlet tee or baffle: 11" How were dimensions determined: STICK WITH HINGE FLAP. Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): Baffles intact, liquid level at bottom of outlet pipe. No evidence of leaks or backup. GREASE TRAP: No (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.): Titic G rncncrtinn Fnr Ail VIAAA 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: 37 Chippingstone Road, Marstons Mills Owner: Elizabeth Denneny Date of Inspection: October 29,2004 TIGHT or HOLDING TANK: No (tank must be pumped at time of inspection) (locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass_polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: XX (if present must be opened) (locate on site plan) Depth of liquid•level above outlet invert: 0" Comments(note if boz is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): Single outlet pine.No solids or high stains present PUMP CHAMBER: No (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.): Title C Tncns+rtinn Pn All 8 Page 9 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 37 Chippingstone Road, Marstons Mills . Owner: Elizabeth Denneny + Date of Inspection: October 29,2004 SOIL ABSORPTION SYSTEM(SAS): XX (locate on site plan,excavation not required) If SAS not located explain why: Type _X_leaching pits,number: One 6x6 pit. leaching chambers,number: leaching galleries,number: leaching trenches,number, length: leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation, etc.): Liquid level in pit is 30" below inlet with no high stains CESSPOOLS: No (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: No (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.): Titla G Tnenartinn Pr% m 4/1�;/')nnn 9 Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 37 Chippingstone Road, Marstons Mills Owner: Elizabeth Denneny Date of Inspection: October 29,2004 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. Chippingstone Road _ 33 Z1 3' t O 1000 gal tank 1000 gal pit T:tlo G Tnc—ti— 17-- ail snnnn 10 I Page 11 of 1 l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 37 Chippingstone Road, Marstons Mills Owner: Elizabeth Denneny Date of Inspection: October 29,2004 SITE EXAM Slope None "•: ; Surface water, None Check cellar Dry Shallow wells None Estimated depth to ground water: More than 40 feet Please in (check)all methods used to determine the high ground water elevation: Obtained from system design plans on record- If checked, date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators, installers-(attach documentation) _X_Accessed USGS database-explain: USGS topo map and town GIS. You must describe how you established the high ground water elevation: Town Groundwater contour map shows water below el.50 and topo map shows property above el. 90. Titlo C lncnant;nn P—m 411;i,)nno 1 1 THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I A , �-, m / IL DATA �jHtq g,Ig BUILO.ASi>8 F.: i 1O9 70O II8. -771Ly 1.386 13 DE1I]SI, YIHCE.a— J Y.I C]�r. ra 7• :.:�. - e�I' ],:,� �. r,. :.:� ;17Os�LI1i2 ';�",""- _. 9 IR s s r ._ r a zc3'.ceo s a J8 NI13N 32F88T'f msDATB so F7 =- -- -- 1LL O 3903/2-_---- x�+s to�itw 7"7 Mp 8OO7C/PAG8' .,�7695 32744/155 12/23/1999 17860 ---- ----- - -- ---- -- No BMR/PAG6 ____ ------------ ------------- _ --------------- - r 312.73I 290 �73 OOR79 3/2 2 _ ___ ______- 362,100 COMM FD P_. 0 3 1020 97944 LAND 122 200I LAND BANK i6.38 DENNis, JAMES R q41. 012-009 L BUILD- 1.879.22, 110 WEST MAIN ST. UNIT I,k7JNR11Y, TOTAL VALUE 284,300 RE TAX 44 CHERYWOOD Ia DEFERMENT 01 TOT ACTUAL 2,248.33 HYANNIS, MA 02601 MA]<STONS MILLS, MA 02648 EXEMPTION O1 NET VALUE 284,300� LOC: 110 WEST MAIN STR: BILL •n :,7C: 4a CHEFRYWOOD LANE EI LL No 77 BOOK/PAGE 15099/064 h RFS BILL NO 06 BOOK/PAGE DEED DATE � 7696 $210/175 09/15/1992 1--- ---------------- ____,_ D----- ------------- . --- 339.C]I 196-G23 --------------------- Oi H':FDRE 290-173-00£---_----- 1020 204471 I LAM BUILDING 167,000 LAND BANK 33.12 DENNIS, KEITH 6 LYNETC DENNEHY, MICHELE M TOTAL VALUE 167.0001 RE TAX 1: . 55 CEDAR STREET 1476476.00 110 WEST MAIN ST X5 I DEFERMENT 01 TOT ACTUAL NEWTON CENTER, KA 0215 HYANNIS, MA 02601 EXEMPTION 0 NET VALE 167,000�-- I LOC; ill ACORN DRIVE LOC: 110 WEST MAIN STREET BILL NO BOOK/PAGE 33/348 BILL NO BOOK/PAGE DEED DATE ACRES f ---- - ------ 7697 13217/273 09/01/2000 ___-__--_________...___________________•------- __--- 121,400 COI414 FD RE 319.881 216-012 -- --•--_-- 1010 18i567 1 LAND 511.67 DENNIS. KEITH 6 LYNET: 030-030 BUILDING 167,4001 LAND BANK DENNEHY, SHAWN M S DEAN NA E I TOTAL VALUE 290,8001 RE TAX 1.922.19 55 CEDAR STREET 54 CRANBERRY RIDGE RD I DEFER" 'T 0 TOT ACTUAL 2,299.74 NEWTON CENTER, MA 02]` MARSTONS MILLS, MA 02648 EXEMPTION 0 NET VALUE 290,800 LOC: ill ACORN DRIVE : 54 CRANBERRY RIDGE ROAD I BILL NO BOOK/PAGE 48 F-ILL NO BOOR/PAGE DEED DATE SO FI 77-- ------- 7698 12094/187 03/01/1999 ----- ------------------------------• •---•-------"'--"-'_-- ______________�___-------------- 255.64 C54 024 004 ---_-0_________ 1010 171870 I LAID 124,900I LAND FD :E 228-105 BUILDING 124,600� LAND BAN]: 46.16 DENNIS, MARGUERITE V 6 DENNEN, DAWN D TOTAL VALUE 232,400. RE TAX 1:837.88 DENNIS, MARGUERITE J 473 PINE ST DEFERMENT 0 TOT ACTUAL 1,837.88 2 OLD TOWN ROAD CENTERVILLE, MA 02632 EXEMPTION 0 WELL£SLEY, MA 02181 SET VALUE 232.400 LOC 90 OLD POST ROA LOC. 473 PINE STREET BI1l NO BOOK/PACE SO FT BILL NO BOOK/PAGE DEED DATE -7709 9665/093 7699 5814/329 07/15/1987 91481 ------------ . -------------------------------------- �85 LAND 353,500 COMM FD RE 756.91� 268-044 1010 202922 1.2 157 136.45 DENNISON, ALLAN G BUILDING 334,600I LAND BANK 6 !' DE:7=iEN, EDWARD R 6 CHARLENE TOTAL VALUE 688,100 RE TAX 4,548.34 22 MOHAWK DR 6 TEA LN DEFERMENT 0 TOT ACTUAL 5,441.70 ACTON, MA 01720 OSTEAViLLE, MA 02655 EXEMPTION 0 NET VALUE 688,100 LOCI 5 PRAM ROAD LOC: 8 TEA LANE BILL NO HOOK/PAGE BILL NO BOOK/PAGE DEED DATE SO FT 7710 4179/329 7700 13310/224 10/20/2000 30O56 -- -------- ------------------------------------ 027-035 1010 177909 LAND 79,100 LANDCOMM FC RE 133.65 DENN1 1 DENNENY MARY E - BUILDING 69,700 LAND BANK 21.72 152 LAON, DAMN H 39 CHIPPINGSTONE RD TOTAL VALUE 169, 00 RE TAX 1,342.04 152 LAURIES LANE MARSTONS MILLS, MA 02648 DEFERMENT 0 TOT ACTUAL 1,342.04 MARSTONS MILLS, MA G EXEMPTION 0 NET VALUE 169,700 LOCI 152 LAURIES LAN LOC: 37 CHIPPINGSTONE ROAD BILL NO BOOK/PAGE BILL NO BOOK/PAGE DEED DATE. SO FT' I 7711 5736/329 7701 C8063/ 25100 ----------- --------------------------- r 1,057.02 249-145 311-027 3530 99246 ;38.300 HYFDR.. DENNIS F THOMAS POST BUILDING 20,700 LAND BANK 441.83 FERRANTI, GEORGE C 6 467 ROUTE 28 TOTAL VALUE 520,700 RE TAX 4,602.10 FERGLEAS ALTO S FR? ::Y•ANNIS, MA 02601 DEFE?MENT 0 TOT ACTUAL 4,602-10 24 GLEASON ST EXEMPTION 0 ,WATERTOWN, MA 02172 NET VALUE 520,700 LOC: `467 IYANNOUGHv:R6AD/RTE28. 00/PAGF LOCI 25 S BILL NO BOOK/PAGE DEED DATE ACRES _^_= BILL-NO; B --- 7712 'S670/304' 7702 3623/240 12/15/1982 1.34 __________ ___ 308-182 1010 192452 LAND 73,100 HYFDRE 330.28 310-422 DENNIS, DE3RA L BUILDING 89,600 LAND BANK 32.26 DENT, JOHN W TOTAL VALUE 162,700 SRCINT 2.23 169 COMPASS CIR 12 DARTMOUTH ST DEFERMENT 0 SRADDED 67.83 HYANNIS, MA 02601 :iYANNIS, MA 02601 EXEMPTION 0 RE TAX 1,075.45 ' 162,700 TOT ACTUAL 1,508.05 L• `. _ '.j .•" NET VALUE F. LOCI 169 COMPASS CI [,OC: 12 DARTMOITTH'STREET x.•� BILL NO BOOK/PAG BILL NO BOOK/PAGE DEED DATE ry SO FT I' 7713 15478/OG 7703 12715/339 12/10/1999 5663 ------------------- 055-011 1010 189754 LAND 218,800 CTFDP-E 702.54 297-04 :)ENNIS, DONALD A 6 SHERRI C BUILDING 243,400I LAND BANK 91.65 DENT, KAREN K 361 COTUIT BAY DR TOTAL VALUE 462.2001 RE TAX 3,055.14 PO BOX 205 D£FEP34ENT 0 TOT ACTUAL 3,849.33I CUMMAUID, MA 02637 OTUIT, MA 0205 XEM _ i 0. EPTION NET VALUE 462,2001 LOCI 193 PALOMINO i. :—C: 361 COTUIT BAY DRIVE BILL NO BOOK/PAC SILT. NO BOOK/PAGE DEED DATE ACRES, - 7714 12917/2: 7704 12235/143 04/30/1999 1.011 -'------' _______-_ ------- --- TOWN`OF BAS ABLE Permit No. Building Inspector uu Cash rsu� J' OCCUPANCY PERMIT Bond No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or .enlarged use without, a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by:the Building Inspector." Issued to 'C?C e r .� . I C� r: � Address q'r ;.�: ;;�4 -�,t-•-f�� ':late� °c•i4'l.�r'`+ . Wiring Inspector , �'" -' Inspection date y, r Plumbing I spedtor;` �, i, `' Inspection date Gas Inspector Inspection date 'Engineering Department Inspection date ... .f ! THIS PERMIT WILL NOT BE VALID, AND THE BUILDING. SHALL NOT BE OCCUPIER) UNTIL SIGNED BY THE, BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS. 19. j, ,Building.Inspector - L Page 3 of 6 C. Kieran Healy BSC Group, representing Donna and Jay Sweeney -43 Stetson Street, 12,309 square feet lot, eight (8) variances requested to repair a failed septic system. Mr. Healy explained the fourth bedroom was illegal and has been removed. A three- bedroom deed restriction has been submitted until sewer is available. The septic is located across the street on another lot. _ McKean stated bedroom 3 needs a larger window. Mr. Healy explained the new window will meet Code. Motion by Kaufman /Rask to approve with a three-bedroom deed restriction until sewer becomes available and the window will be built to Code. So Voted. D. Peter Sullivan: P.E. representing Kelly Family Realty Trust - 75 Pheasant Way Centerville, 15,678 sq. ft., new construction proposed, variances requested in regards to proposed SAS setback to wetland and vertical distance above the maximum groundwater table elevation. Mr. Sullivan explained a dormer was added to the attic to create a second bedroom and the basement will remain unfinished with no windows. Motion by Kaufman/Rask to approve with a two-bedroom deed restriction and the drainage easement is to be expunged or relocated. So Voted. V. Variance Requests: A. Edward Stone P.E. representing Ruth Boston and Linita Kinear- 18 Spruce Street, West Barnstable, lot size 18,500 square feet, variances requested to repair failed septic system. Mr. Stone explained the latest plan dated September 22, 2004 shows the tank'moved further from the house.The house contains two existing bedrooms and is in.8 well protection district. Michael Rabideau had concerns with the proximity to his property. Mr. Stone explained it will be 1.4 feet from the closest point to the wall. Motion by Rask/Kaufman to approve with a two-bedroom deed restriction. So Voted. %— B. James LeBoeuf representing Melvin and Virginia Reed--162 Cinderella- Terrace, lot size 0.46 acre, existing two bedroom home located within a nitrogen sensitive area, requests a variance from 310 CMR 15.214 to finish second floor for a total of four bedrooms. Mr. LeBoeuf explained the property was bought as an unfinished four-bedroom that was ,1 built in'-1983•and finished in"1984 ' McKean stated the building & health departments have no records on the property. p Rask explained the 330 ordinance exists. The home could be finished as a three- J. bedroom at most. One pit is adequate for a three-bedroom. Motion by Rask/Kaufman to approve the expansion to three bedrooms with a three- bedroom deed restriction. So Voted. 310CMR: DEPARTMENT OF ENVIRONMENTAL PROTECTION 15.213: continued (g) any portion of the soil absorption system that is within the velocity zone or regulatory floodway is a leaching bed or trench system or any other system constructed in accordance with the wetlands protection act and 310 CMR 10.00. 15.214: Nitrogen Loading Limitations (1) No system serving new construction in Nitrogen Sensitive Areas designated in 310 CMR 15.215 shall be designed to receive or shall receive more than 440 gallons of design flow per day per acre except as set forth at 310 CMR 15.216(aggregate flows)or 15.217(enhanced nitrogen removal). (2) No system serving new construction in areas where the use of both on-site systems and drinking water supply wells is proposed to serve the facility shall be designed to receive or shall receive more than 440 gallons of design flow per day per acre from residential uses except as set forth at 310 CMR 15.216 (aggregate flows) or 15.217 (enhanced nitrogen removal). (3) It shall be the duty of the owner of the system or proposed system to ascertain whether or not the facility to be constructed will be in a nitrogen sensitive area. The Department will. prepare and make available at locations generally accessible to the public maps portraying designated nitrogen sensitive areas within the Commonwealth. 15.215: Designation of Nitrogen Sensitive Areas The following areas have been determined by the Department to be particularly sensitive -. to the discharge of pollutants from on-site sewage disposal systems and are therefore designated nitrogen sensitive.The necessity of providing increased treatment of pollutants and reduction in nutrients discharged from on-site sewage disposal systems,*including nitrogen, nitrogen as nitrate, phosphorous and pathogens in these areas warrants the imposition of the loading restrictions set forth in 310 CMR 15.214. (1) Interim.Wellhead Protection Areas and mapped Zone Its of public water supplies as set forth in 310 CMR 22.21; (2) Nitrogen sensitive embayments or other areas which are designated as nitrogen sensitive for purposes of 310 CMR 15.000 shall be mapped based on scientific evaluations of the affected water body and adopted through parallel public processes in both 310 CMR 15.000 and in the Massachusetts Water Quality Standards-314 CMR 4.00. 15.216: Aggregate Determinations of Flows and Nitrogen Loadings The 440 gallons per day per acre nitrogen loading limitations imposed by 310 CMR 15.214 may be calculated in the aggregate in the following situations: (1) in identified areas within regions or communities that have submitted to the Department a plan to protect surface and ground-water supplies within the community or those designated areas from pollutant and nutrient loading and.a proposed mechanism for:implementing the . plan and where.the plan has been approved in writing by the Department. For areas that include Zone Its or Interim Wellhead Protection areas, the plan shall include, but not be limited to,a nitrate loading plan as specified in 310 CMR 22.21(2)(d);or 12/27/96 310 CMR-514 1— i Home: Departments: Assessors Division: Property Assessment Search Results 37 tCHIPPINGSTONELd 1R®AD Owner: DENNENY, MARY E Property Sketch Legend Map/Parcel/Parcel Extension 027 /035/ Mailing Address DENNENY, MARY E 4 39 CHIPPINGSTONE RD MARSTONS MILLS, MA. 02648 2005 Assessed Values: Appraised ValueAssessed Value Building Value: $97,500 $97,500 Extra Features:$0 $0 Outbuildings: $0 $0 Land Value: $ 128,300 $ 128,300 Interactive Property Map:Map requires Plu in: Totals:$225,800 $225,800 I have visited the maps before _ �tC�Lo First time Show Me The Maa M1 Click h April 2001 photos available Sales History: Owner: Sale Date Book/Page: Sale Price: DENNENY, MARY E C80634 $0 2005 REAL ESTATE Tax Information: Tax Rates: (per $1,000 of valuation) Land Bank Tax $40.98 Town Fire District Rates $6.05 Barnstable-Residential $2.12 Barnstable-Commercial $2.80 C.O.M.M.FD Tax(Residential) $228.06 C.O.M.M.-All Classes $1.01 Cotuit FD-All Classes $1.28 Town Tax(Residential) $ 1,366.09 Hyannis- Residential $1.52 Hyannis-Commercial $2.39 W Barnstable-Residential $1.44 W Barnstable-Commercial$2.10 Total: $ 1,635.13 Due to rounding differences these values may vary Land and Building Information I� Asses' .......... SEPTIC SYSTEM MUS7 LiU Assessor's map and lot number ....... INSTALLED IN COMPLIA THE Sewage Permit numb r ..::7... ... ........................ WITH TITLE 5 ENVIRONMENTAL COD 11AR3MIL 1TABLE, House number ..... ..... ................................................... TOWN, 0 WTI X2639 N TOWN OF BAR' N' STABLE BUILDING -INSPECTOR APPLICATION FOR PERMIT TO*............AV tke.&....................................................................................... TYPE OF CONSTRUCTION ..........WAN....... .M; ...................................................................... . 4 /j ,e ........... ../....... ...... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ..........C, .8.MA1Nz;, ......... 10. ......1.(MXLQAW.....11VI4 1w.X ProposedUse ...... ..46S.............................................................................................. District .....Zoning District ......1. ..............................................................Fire C ..................................................... Name of Owner ....Address ........ ..A.At.......... Name of Builder A1.LL.,9................... Nameof Architect ...............N.ON.46............................Address .................................................................................... q Number of Rooms .....................A........................................Foundation .... .... Apvfiz-4.......C4.1vtom. .................. Exterior ...... ...........................Roofing ......pd!! ..#4/�.r....S#1N. Floors ..................................Interior ........... Heating ...Aot!! :..................................Plumbing .............. .................................... Fireplace ..............IOVOA4 .....:.......................................Approximate Cost .................oetv...41..... ....... Definitive Plan Approved by Planning Board ----------------------------- Area ........7 ......... Diagram of Lot and Building with Dimensions Fee .....................3.................... SUBJECT TO APPROVAL OF BOARD OF HEALTH q q I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name y4ad.,.... .............. I 45 o J o 6 Co Q LOT 4 6 -' 0 4 7 \STo RY WOOD HOUSE 4Z1+ ------------------ J 1 1 S i 1 112.00 1 = CNI PPI NG5TON E ROAD PR I YAT E - 40 ' WIDE I CERTIFY THAT THE POU5E /5 LOCATED 95 WE ,6 61 P 5URVEYdq REFERENCE: L.C. 348468 PLOT P L A N bolme s and mmgra th, inc. 5HOWING H005E LOCATION FOR c,v,j `nq;:7eers o,,»iond sur vt"L "" '$ ".41 P y 1N ' M A RSTON5 M 1 L L5, I TOWN OF BARNSTABLE LQCA 1'-'IS 32 &a '2,R d Y,�mL �'�Q SEWAGE #J i�S?K:i►'c?:� VILLAGE 0 0, 51v:A5 Milts ASSiv- .ORS JMAR& LO.T®2'7 035 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY I10C20 � a I LEACHING FACILITY: (type),,—�,,>�T (size) `+ NO. OF BEDROOMS Z BUILDER OR PERMTTDATE: C dhiC-E, DATE:.a- -lf 0:-\ 101Z910 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 a Z� 3�1 Lo �. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH H ............................Town..o F...Barns tabl e....... k .gip iration for %posal Vorkfi Tow1rurtivtt 1hrutit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System.;at: ._..Lot # 46 Chi�pingstone Road Santuit ....._�._.._.. ...... .... ...........•....• ••-•-...•----------------•.....•----•----•-•--................---•..................••••........... .Locat' Address or Lot No. .. Jordan Realty trust Hanover, Mass. ...................................................... •-----•-•---•..................................................-•-........_............. owner Address a M and B Builders Hanover, Mass . -------•--••---------------•-•-------•--....---. ............------....---•----•--..••-•-••...... ........-----...............•-•-•....•-----......---.................................... Installer Address UType of Building Size Lot............................Sq. feet �-, Dwelling—No. of Bedrooms...........................................Expansion Attic ( ) Garbage Grinder ( ) aOther —Type of Building ............................ No. of persons._...=..................... Showers ( ) — Cafeteria ( ) d Design Flow.Other fixtures•...5�.__...__gallons per person p r day. Total daily flow.........................3GO W -•--------•-gallons. W Septic Tank—Liquid capacityl+00�allons Length.. -------------- Width--------------._ Diameter................ Depth................ Pit No..................... Diameter..............._.... Depth below inlet................. Total leaching area ..................sq. ft. x Disposal Trench—1................ . Width............__._ Total Length...._..--.---• Total leaching area...................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ w Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ O Description of Soil ...PercoYatiori­tests .arid .soil...Io s on- iTe--wt....•..----'-------"•--•'•-•----•--•--...... ------------------------------------------------------------------------------- --........... --------------- x health--•of`�`io e....._....-•--.. W ...............................................•-••-----------•--••-•-••-------------------•---•----•-••-------••-•----•--•----•-------•-------•-•-----••--•------...----.._..----•---••-----------.----- ------•--------------------•-------------•---------------------------...-------------------------------------------------------------=------•--------------•---------...--------------.........--•----- V 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 Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has ben issued�y liu b �fe p Si ed �....................... x:..... :!1.."....`.... Da Application Approved By.. ".. . ,.... c, a Application Disapproved for the following reasons---------------------------------------------------------------------•----------------------...--••----••-•••.... ----------------------------------------------------------•----------------------•-------•----•---------------......----••-----------------------.-.---•----••••-----••-----1_- .................... Date PermitNo......................................................... Issued........................................................... Date ........ .................................................................... . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town Barnstable ..............O F..................................................................................... f9rdif irate of Tompliatur THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( X) or Repaired ( ) by....... I+_and B Build.ers : ............ --------------------------........... ------------------ -------•------------..----------- •-----•. ....... Ins ler at................Lot # 46 Chippingstone Ad. , `antuit . ..... . . .............••----••••---••---•------.....------••--------•••--------•••--------------••-------•-••-------••--•---•-----. has been installed in accordance with the provisions of Article XI of The State Sanitary Code a desc ibed in the application for Disposal Works Construction Permit No....._... ________________ dated___-. .-...--_---- THE ISSUANCE OF THIS CERTIFICATE SMALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. .... .. DATE................................................................................ Inspector.... .....---•-•- -----... ......----- ._..... ...........---- - .................................. ............................................................:....... ...................:... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF' HEALTH Town...&F.....Barnstable --------------------------------------•.......... No...�. ...... FEE...or�.............. Uisp anal Works Tonstrt iott ramft Permission is hereby granted.....1X.... 11d..B.....Bulld-e.n5......................................................................................... to Construct (X ) or Repair ( ) an Individual Sewage Disposal System at No.......La.t.. ...46...QW-ppingat.ome...hoad.....5antui-------------------------------------------tb�/ Street as shown on the application for Disposal Works Construction rmit No.. C ate •-•.- ---• ...... .. . .... Board of Healt DATE-.................................................................,..: .--•---- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS' LC a p 1 oco GA _ 1/ Q' W HOME Alo . N IIZ. oo il 4 � Sc�ic' -� l'' 4•G=' -- Sep �t-I��.�,�c� ���� � No...........�,.er....... Fxn..1P,....................._ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........................Town..OF....Barns.table............................................................ ,AppIirofion,for Disposal 10orkii Tonotrnrtioaa Permit Application is hereby made forda.,Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at: ..•...Lot ` 4h.-Ch p in stone Road. Snntuit .. ............. ....................................................-•--•---...................................._.; Location-Address or Lot No. ... .Jordan He€�;lty.Trust - Hanover, Mass. _.._.._.__..... --•-- - ---------------•• ---..........._.... .. Owner Address W M and B Builders Hanover Mass. a Instal ................................•......... •••_•_.... ............'---••-•--..._...-W es............•-•-.....................•••_.... � Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms................... .._._..__..._....._....Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............_............... Showers ( ) — Cafeteria ( ) Otherfixtures -•-----------------------------•---------------.._..--••-•-----•-•--•••••-•-•••--------------......•••-•-........._.•--•-- 0.0 Design Flow..............................�� ........gallons per person p r day. Total daily flow................ 3...............gallons. W4 WSeptic Tank—Liquid capacit} �__._._ allons 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 ( ) Dosing tank ( ) '-, Percolation Test Results Performed by.......................................................................... Date........................................ W Test Pit No. 1................minutes per inch Depth:of Test Pit.................... Depth to ground water........................ w Test Pit No. 2................minutes per inch Depth of w est Pit.................... Depth to ground water........................ rx Description of Sol l...Perco`La.t ori'•tests iiK3" s il---T6gs--•ori---file-•at•... ................................... xhealth.&rf is"e---------------------------------......---------------------------------------------................._..------- U .-•--.........••-•-••-•-•---......••---•••-•••....---••--•---•.........•-•••••-•---•-------------•---••..........-----•-•--------•••- UW •-•----••-••••----•----•-••----••--••--••--•••-••---•------•---•---•••••••••-•-•••----------•-•••-••••--•------•-----------------------••-•••-•-•---••-••-•-•._...•••--•-•-•._......••.................. 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 Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has beqn isptd�y e�i fe _ r 4 Signed _ ' rl � .................................... ., ............................... �°.` . rE . . D)a Application Approved B ......' � .................................. �Date Application Disapproved for the following reasons:------•••--- ----------------------•-----------------------------------------...-----..._.....•••......:_...... ......-•-._........-•••-••••-•-•••••-•-••.........•---•••..........-•••-•••••-••••-•-•••-•••••............---•-•----•------••----•-••••••-••••••-•••--•-•-•------•-•-•••-•-•-•-•-•----••---••-...:..-•-•- Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town Barnstable ........OF..................................................................................... Trrtifiratr of Tompliaanrr THISJS TO C- TIFyY, That the Individual Sewage Disposal System constructed ( X) or Repaired ( ) ;v and L,�j ld.ers by ............................ •........... *•-•....-•••- at Lot # 46 Chippingstone :tad . "S14tituit .._.. -•••----------•------- has been installed in accordance with the provisions of Article X'".�o The State Sanitary Code as des ribed in the application for Disposal Works Construction Permit No.__.__...v� .. .................. dated-__ !'1... /_s':`=:_._......... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE-CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.. - ...... .---•--------------------------•-_... Inspector..... ` .......... ..: _.`.."_.."."-....... ............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town Barnstable NO..°'.':_. ..... _ . .................................... OF................•--••-•.....-••-•-...................................._......-• FEE.: °.........` .. Ditipopa1 Works Tonstrnrtion Permit r M and F Builders >� Permissionis hereby granted.............................................................................................................................................. to Constr ct R ) an ndividual Se ages DIs o 1 System ' obip(pina sone rcoac .pan$ui t at No................................................................................................................................................................................ . Street as shown on the application for Disposal Works Construction. Kermit No ._/.� Patec.__..'',�'`_s . `••• "�:;- J ...... ...........h........ .... . DATE................................................................................ Board of Health �- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS a� Lot 45 V � V s 0 0 1-ot JA 47 IS e 60e t 3a� (n goo 24 ¢ Q N IIZ. 00 Chi PP<NGStoN R- ROAo Sc�►� - O= 401 — SeQ Aa4 c�,ed L�Q �►r r ---- Fee------------ -- ._... BOARD OF HEALTH TOWN OF BARNSTABLE Application forlVell Congtrurt ion Permit _ Application is,r hereby ]Cmade for a permit to Construct ( ), Alter ( ), or Repair ( )an individual Well at: — Location - Address Assessors Map and Parcel - - ---------------------------- /� Owner - n ' Address --- /:b c&Y �Gc� -"aS .� -vl,``� DD6 ---------------------- ----- --------- --------------------------- Installer - Driller Address Type of Building Dwelling ° s 2- --------------------------------- Other - Type of Building----------------------------------- No. of Persons---------------------------------------------------- Typeof Well--Y--19J( ------------------------------------------- Capacity ----------------------- ----- Purpose of Well 0�'_``�S?`=`- � i ---------------- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation until a Certificat .of Co pliance has been issued by the Board of Health. Signed -- ---- - - - - ------ JAI- date q Application Approved By- - Q - /� --- t ae Application Disapproved for the following reasons:----------------------------------------------------------------------------- ---------— -- — ----- -------------— --------------------------------------------------------------------------------date---------------- PermitNo. -— -- - -- ------------ Issued--------------------------------------------------------------------------- date BOARD OF HEALTH TOWN OF BARNSTABLE Certifirate ®f Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired bY------------ -- - A_S cc� �� l/ -------------------------------------------------------------------------------------- --- - -------------------------- Installer at- — = c of.,} S 7'0`.'� —'�—�—�' —— --— --------------------------------------------------------------------------------------------- has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. --------------------------Dated------------------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE-------------------- -—-- ----------------- -- Inspector-------------------------------------------------------------------------- i 9� 1 ---- Fee--�S---------- - BOARD OF HEALTH TOWN OF BARNSTABLE DPP Ica ton I[Con5truction3permit Application as hereb made-foj4yermitt to C�onstruc (° ), Alter( ), or Repair (")an indiv al Well at: ocahon Address Assessors pan Parcel — P Owner _' Address - n r S u w: r -----------------r--� -- ------ ---- ----- �"- j�G '``'s ue`- --- --�,:�6 ,/(_- t G Installer - Driller j' Address "'f` Type of Building -- Dwell.ng 1 f°� s F.2 ; - » ,,. _'l--,"Other - Type of Building---- -------- ------ ------ a �°No. of Persons--- ------------------------ ---------------------- Type of Well- Y -��G�_- -- --------- -- Capacity ------------ ------------- ----------------- Purpose of Well�o----- 7°` Agreement: 8 The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private--Well Protection Regulation - The undersigned further agrees not to _. I ' place the well"in operation until a Cert7;7 pliance has been issded-b -the-Board-of-Health: 4 Signed - date ` J AA a 71) Ap ion pprove y -�—- - -,,- T-T Ale ' Application-Disapproved Eor"the following.reasons: j -----------—-- ---- ------- — -------------------------------------------------------------------------------------------------- date Permit No. --- --- -�----- ---------------- Issued------------------------------------------------------------------ _ .. . ,. .. _. .>. date t19 e (l 3 � . . ,STvr C � i 14 BOARD OF HEALTH_- TOWN OF BARNSTABLE Certifuate Of Compliance ; . THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ), or Repaired (� , e�.��,� // -- - - — ------------- -------------- — y— D A S Installer !.. G , r ' m at- -`3_� P/V 7-6 - "� -�-- — - - — has been installed in accordance with.the provisions of the Town of Barnstable Board of Health Private Well Protection 1 Regulation as described in the application for Well Construction Permit No. ---------- =-Dated-------------------- :h,fFe..ir....:. - THE ISSUANCE-OF THIS.t CERTIFFk:ICATE SHALL NOT BE CONSTRUED AS A-GUARANTEE THAT THE WELL ' " SYSTEM WILL FUNCTION SATISFACTORY: -— - -----— -- Inspector- BOARD DATE------------------------—------ - �---------------------- BOARD OF HEALTH TOWN OF BARNSTABLE � ;F w VrIt Con9tructionPermit 1 No. W__ - ------ Fee-T--------------- Permission is hereby.granted----- -- - - to Construct ( ), Alter ( ), or Repair ( "I'an Individual Well at -= can -- - t , — Street as shown orl the anolicatiqq for a Well Construction Permit , Dated - - '° eJ Q . ------- --- ------------------------------------ - _/ —�,. -e+—. •�c,.q:_.� _-"'•-:».. -.-,5- - -'�-rmss�.oxs' M^...1..•-w''-�•...— .---s+�.-s.,..•.s.--e,_:-...x-. - — f HeaJ�t T rU o fe OF ExI5TIN6 WINDOW fL OF ExI5TIN 11.E6 WINDON - y _ YI Y1 I I "-------------------- N N X om U 61 Q N Y I i - g V! ' ---------•EXISTING ft1E LK LOCATION TO REMAIN _ EXISTING CELLAR SASH A5CCM-2149 ' 0 NS LOCATIO TO REMAIN e 4 x - 314 L NEW 3 In'DIA.STL. EXISTING Fp14DATION WALLS O W COL.ON ax2aX-2 cDNc. BATH. ASC N-B FoonNG�c A.A,ovE O ^ BEDROOM 2-q 9/ xa-I /a U Ex15TINb SLAB AS NEEDED) [111 - - - -EXSTING BEAM AND 9 COLLMNS TO REMAIN ISTING BASEMENT _,..••''J�� U LU (ALIGN W EDGE OF CO.ABG/E) -- 2-IO In%b'-10 V2 P. —o— o — 4 EXISTING WALL,DOOR E I 0 E • MOVED AND REPEALED NV NEW CA9ED•OPENIIRi PROVIDE(2113/4' L O J %II I/4'lVL POST DOWN O NEW CD. 1; z-a ASC z4n 3/a DINING LIVING ASLON-3359 8 2 34 X4-II / g _ ••�' REMOVE EXISTING MALL NEW;TREADS,RISERS, 3 -- O NAALPL TELL TO BE I EDA"D i x m � , i W pa FOUNDATION PLAN SCALE: 1/4 1'-0' is me n zm O I fE OF EXISTING WINDOWS fr aF Ex15TING WINDOWS ALIGN IN 4 OF ALIGN W/ OF WINDOW BELOW WINDOW BELOW FIRST FLOOR PLAN "ot-o-y o�d_rQ nn pQ�;c am A am s2�'�a�as��o6mu°'v=o n C Y ---ry jia��vQ°f =0- �ry J Up00 <�SsO Jn66 0 ao;r� � osLLEu_o '"m 5a ~m __-------- �� _________ _____ CJ-G.LINE 4 BATH. 9'-2 3/4' 1�-4 In' s'-b' Q 10'-T IM, - ---- -------- ------- - ---------------------- W N _ P -- OFFICE �;.p WALL/DEMO z Cl 10'-1114' 0.(� REMOVE EXISTINb WALL�m �'� = W 1-5 AND ITEMS TO WVW FIN.OECORATIVE LD. -----' BAWSTERS NEWEL POSTS.AND m BE REMOVED J =9 ON-33g3 HANDRAIL TO BE INSTALLED ° E BEDROOM 2 A5LON-3353 W j) 4 9 3/6 X 4-s 3/ EXI5TING WALL5 TO lNL P REMAIN i - V CLb.LINE a LLb,LINE � NEW WALLS Q Z In o DEMO NOTE5 CL Z'IJ a-t Q EXISTING OASIED WINDOW5 4 WALLS `�' r a -_-_-_-_ _______ TO BE REMOVED AND PATCHED AS NEEDED OR REPEALED AS NOTED. LL Q m LL ________ ____a___ _________ __________________-________ _________. Job no.: 0421 �c m� '/� ■^/ /'/t/1 AA G l/� dote -NNE b,2005 MN 2. scale AS NOTED /Y\��✓61�� YYY 1 !!! dreun KMW 112,•/- 9'-5 In, 3 W ev. ALIGN W/fe OF ALIGN W/CL OF °�-O Lo WINDOWS BELONI WINDOYS BELOW 0 O Lo SECOND FLOOR PLAN °ry O SCALE: 1/4' - I-0- w m m M,t: of A AND REPN IN REMOVE LACE W�NKalES V "1 O Q A-3 GAF TIMBERLINE ULTRA V• I(� �I� ASFNALT SHINGLE RI S W/ WNTINJOY ROSE VENT Ull I] NON-B)ILT-OUT II IX3A%B RARE tRJ QB•/- / e •/� REMOVE EXIST.SHINGLES IOD Ix BLOCKING , N U f\ AND REPLACE WITH OAF TIMBERLINE LLiitA ASPHALT SHINGLES W/ IXb CORHER50ARD5 ID LOMINLIO,15 RIDGE VENT ® ® \ , `�1(1 N.C.SHINGLE$ �10 IXb fSRNERBOARDS � :Y A-3 WWBJILI� J REMOVE EX15TIN6 5WNSLE5 1X5/IXb RAKE ON / AND REPLACE WITH L. IX 51.00KIN6 V REMOVE EXISTING SHINGLES c 10 I� SHINGLES AND REPLACE WITH C. 1/ SHINGLESJU SLE F��R e SECOND LOOK(E%ISTI�i'I— — SUSIfL ftR. , ' a1 REMOVE ALL EDOU56ININ S WINDOWS(FRAME TO FIT ® CUSTOM DECORATVE { EXISTINb RC,HEIGHT: BRACKET REMOVE Al-L EXISTING rvINDOWS 1: PATCH AS NEEDED) �-i 1 REPLACE W/DOUBLE-MRJG EXISTING RD.HEIG T FIT U 0 CORAERBOARD5 P1D REMOVE EXISTING(SAND PATCH AS NEEDED) S STEP$AND LIM PE ANp COPRtERBOM09I REPLACE N IX4 ICE L U 7 DECKING ON P.T.FRAME (a TREADS) CORNERBOAR�ANDA�REPLACE W/IX5/Xb `JB FLR O FIRST SU8 F R EXISTI — _ FIR i FLO 1-1 OR 1 O CUSTOM DECORATNE BRACKET _ EXISTING SLLKHEA[7 ._______ TO REMAIN REMOVE EXISTING CONIC. 5TEP5 AHD LANDING AND , _ REPLACE WJ 1X4 ICE EXISnNS CELLAR DECKING ON P.T.FRAME SASH TO REMAIN (I4'TREADS) FRO N T EL E VAT I ON R I G HT E L E V AT ION SCALE. I/4- 1-0- ��'Y U�UNiI T �"(iOUm 3`n��uox n-'am a zzoo „P�ogoN5�o0m °'o=`on REMOVE EXIST.SHINGLES A W; REMOVE EXIST.SHINGLES y m T9,0 m L c S 0 0 QQ AND REPLACE WITH -3 Y ��0�� a E 6AF TIMBERLINE ULTRA �; AND REPLACE WITH $I �.. yn O u 0 U=0 O ASPHALT SH 6AF TIMBERLINE ULTRA B _ cc CONTINXAfi RIDGE NT INGLES ASPHALT SHINGLES W/ r Q fr a Q y 0 GONTINXXY RIDGE VENT 12 I A4, _ KC.SHINGLES n-3 NpN-BIiLT<VTQ o o.L,V 5 i Q E 11 _O-O U IXBAXb RAKE ON IX BLOCKING IXB CORNERBOARDS IXb CORNERBOPRpS ID W WC.SHINGLES 11' REMOVE EXISTING 5HIN5LE5 •�. ,(� EH AND REPLACE WITH WL. I A•9 NX3/IXB RAKE ON ' IX BLOCKING \7 L J LU `�"FI FLOOR — 6..wFIRiT iIOOR W J REMOVE EXISTING 5HIN6LE5 \ , AND REPLACE WITH A.C. V REMOVE ALL EXISTING WINDOWS / SHIN6LE5 W 1 REPLACE W/DOLELE-NA16 O ,n W WINDOWS(FRAME TO FITFIM V 1 EXISTING R.O.HEIGHT: PATCH AS NEEDED) REMOVE ALL EXISTING WINpOWS �O�DEfSRATIVE 1 REPLACE W/OCLELE-WN6 REMOVE EXISTING IX4A%5 REMOVE EXISTING LOAN. W ISTINS RD.tFR HE TO FIT CORNERWARCS AND lNL \1 InL/ EXISTING RA.HEI6M: REPLACE W IXS/IXb PATCH AS NEEDED) CORNEREOARDS p STEPS E LANDING AND II IIIIrI�1111I RECLINE VU Ixd ICE �_S.UB FLR. LU DECKING ON P.T.FRAME O ^�( v Q e FIRST FLOOR SUB Fy2 (14'TREADS) 1 �l �o FIRST FLOOR m IL REMOVE EXISTING IXAAXS CORNERBOAROS EXISTING BUI�KIEAD b ro REPLACE W 1X5A%6 .__________. LO REMAIN _______ J- .. 0521 CORNERBOPRO` : EXISTING EULKIEAD -_-- date DAME Ob,2OO5 EXISTING BA.KHEAD i0 REMAIN EXISTING CELLAR tale q5 NOTED SASH TO REMAIN KMW REAR ELEVATION LEFT ELEVAT ION drown SCALE: I/4- a 1-0' V SCALE: I/4' I'-O- 3 V w j e. �O 01 ry O� gw A-2 N� Ott; of RIDGE VENT LAP 2X6 RIDGE BOARD 2X6 OILS,JOISTS 0 16'OO. GAF'TIMBERLINE'ULTRA I I INEIGNT TO MATCH EXISTING) ROOF SHINGLES ON IS FELT ON 5/B'OD% N WC.FOOF PLYWD.S SHIN5LE5 HEATHING 5/B•CDX FLYIN2OD I I 2%6 RIDGE BEAM WL.ROOF 5HIN6LE5 2X6 RAFTERS 0 V OL, j/X66 RAFTERS.6D O.C. I``�1 R-30 FG.INSULATION 2X4 CL R-3 &JOISTS OL6.JOISTS OL. Q 0 -30 FS.INSUATION �I� TIT 012'GYP.BOARD TO .�5 O ON MATCH EXIST,") IX FASCIAIA ON � uJ 12 I%BLOCKING �'^1 a1 _ W K�EE MA-Li 19 VO MER / MA LH EAASTING) , REMOVE EXISTIM SHINGLES AND REPLACE ATN WL. \ SHINGLES WC.SN"%LES TI 1p1F1 1/2,COX PLYWOOD 2%4 0 16'OL. EXISTING FASCIA/ "T 5 I LLL R-15 F.G.IN5AATION GUTTER TO REMAIN I/2'GYP.BOARD BEDROOM ? 4 1 REMOVE ALL EXISTING WINDOWS REP W/ v U LACE DO.BLE-WINS •9 WINDOVK IFRAFE TO FIT 1.1 EX15TIN6 R.O.HEIGHT• PATCH AS NEEDED) TOP OF 1` I�TV`1 Il\`fY11 VIAE V IX CAP SHELF 2 YV ALUM.DRIP EDGE m � � � LIVING R BEDROOM U s f °l iB AAOWN ON U I wB FLR l0 u O FIRS—TTLOOit I V4' I%6 EOGE 1 CM.BEAD BOARD EXISTING BEAM REMOVE EXISTING WALL BASEMENT EXI5TIN6 HOUSE NEVI TREA05,R15ERS, CISTOM BRACKET BALUSTERS.NEWEL FOST5. AND HANDRAIL TO BE INSTALLED NEW 31/2'DIA STL. COL.ON 24X24XI2 T T R INNCP%OOTIN6E LAB AS�NEEDED) S �OP OF FOOTING .1 1 1 1 (EXISTING) .... .... .. .. T K b Q SECTI ON SCALE, I/4' 1'-O" OEAVE DETAIL AT COVHD. ENTRY SCALE I I/T.I'-0' tp,-p•,�o Q`o Ptiyg Pas `pp0 ��.L Y'QD�lpma'C �p � <pio ' n'Y�p�ps�`Q`a➢Oo�Ocp - u O..W.p~QI"➢ $o�ooa o�<<6�o�$S�a➢ pU-p`cIN F p '^➢ 0 ra yr 12 6AF'1I1BERLINE'IATRA / GAF'TIMBERLINE'U.TRA LU ROOF 5HN6LE50N 10� / ROOF 5HINGLE5 ON I 12 6AF'TIMBERLINE'ULTRA ` fl J 15 LB.FELT ON 5/8'CDX / 15 LB.FELT ON 5/5'COX Q 3•/- I�FELT ON 5 IN&LES ON 8 COX Z RYWp.5HEATXIN6 / RYWD.$HEATMINS Q y Q PLLB.F LT ON NG L LU 12 W 2X10 RAFTERS 0 16.O.L. I� —— 2X6 RAFTERS O ib'O.C. 1O,n Q 2XB RAF .W OL. /'� ALUM.GRIP EDGE V'V�1 Z 2X4 US JOIST5 0 V 0 C. (\/1 I ALIM,"TIER(CANT) ONI%FASCIA _ ^ 1X3/IXB FASCIA O Z,n IX CAP SHELF V 1 W W/ALCM,DRIP EDGE a- (3E ¢ IX SOFFIT FFIT 2"/VIDE 1.(T Z IX SOFFIT W/CANT. •bOO5 GROWN ON— p m 0@S m LU ll I IX SOFFIT W/LOM. I%FASCIA Q p{ U( < p S •6003 CROWN ON w .B003 CROWN ON `y IX SOFFIT W/CONT. p t r IX FRIEZE 80ARD .("% IM ILL IX FRIEZE BOARD / S U� FERF.VENT 2'WIDE p Q t f- t- ON Ix BLOCKINS V \I 1 ON IX ELOCKINS T SZ 6• -8003 CROWN ON Job no.: 0521 ZX TAPERED OM J IX CA51%(3-EXP) Q I%NE cm— W/(4 1/2'EXPJ BOIb BED MOI,LDIN6 date JJNE Ob,2005 ' ON IX NEAR CASING (4 A/2'EXPJ 7 Ev91' acal0 A5 NOTED OEAVE DETAIL AT ENTRY O EAVE DETAIL AT GABLE DORMER O EAVE DETAIL AT BEDROOM/BATH./OFFICE KMW SCALE,1 1/2".V-O' 5CALE,1 1/2'.V. ' SCALE,1 1/2'.I•-0- 3 ems. . w j e.•. �O � OO w A3 8 �° a eM: Ol