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HomeMy WebLinkAbout0025 DEBBIES LANE - Health Debbies Lane, Marstons Mills = c�11 � �13 f' k f� i r Commonwealth of Massachusetts Dl — b13 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 25 Debbies Lane Property Address Christopher Leonard & Melissa Ashton Owner Owner's Name / information is required for every Marstons Mills V Ma. 02648 2-16-21 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 A. Inspector Information r filling out forms on the computer, Michael Sears use only the tab key to move your Name of Inspector cursor-do not Robert B Our Co INC. use the return Company Name key. 363 Whites Path r� Company Address South Yarmouth Ma. 02664 City/Town State Zip Code � 508-477-8877 S114430 Telephone Number License Number B. Certification 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 '\H OFIM"ss''%% A 2. ❑ Conditional) Passes .`����' �C' Y ti . ' MICHAEL '.fin= 3. ❑ Needs Further Evaluation by the Local Approving Authority o: SEARS * No.SI14430 4. ❑ Fails 5,►I N S q�G�`````` 2-16-21 Inspector's Si 3,wlre 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 Title 5 Official Inspection Form �I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments c � 25 Debbies Lane u— Property Address Christopher Leonard & Melissa Ashton Owner Owner's Name information is required for every Marstons Mills Ma. 02648 2-16-21 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: System is in working order 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. j *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): i l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 AM, Commonwealth of Massachusetts �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 25 Debbies Lane V� Property Address Christopher Leonard & Melissa Ashton Owner Owner's Name information is required for every Marstons Mills Ma. 02648 2-16-21 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 f Commonwealth of Massachusetts Title 5 Official Inspection Form I� I; Subsurface Sewage Disposal System Form Not for Voluntary Assessments �� g u 25 Debbies Lane Property Address Christopher Leonard & Melissa Ashton Owner Owner's Name information is required for every Marstons Mills Ma. 02648 2-16-21 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 ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form III Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 25 Debbies Lane Property Address Christopher Leonard & Melissa Ashton Owner Owner's Name information is required for every Marstons Mills Ma. 02648 2-16-21 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® 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 groundwater elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 18 f Commonwealth of Massachusetts �w Title 5 Official Inspection Form �0 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 25 Debbies Lane Property Address Christopher Leonard & Melissa Ashton Owner Owner's Name information is required for every Marstons Mills Ma. 02648 2-16-21 page. Citylrown 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 Sectior CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes"or"no"for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 25 Debbies Lane V Property Address Christopher Leonard & Melissa Ashton Owner Owner's Name information is required for every Marstons Mills Ma. 02648 2-16-21 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d NA 9 ( Y 9 (gP ))� Detail: I Sump pump? ❑ Yes ® No Last date of occupancy: Present Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form �I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u— 25 Debbies Lane Property Address Christopher Leonard & Melissa Ashton Owner Owner's Name information is required for every Marstons Mills Ma. 02648 2-16-21 page. CityTrown State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: July 2020 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.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 f AN, Commonwealth of Massachusetts Title 5 Official Inspection Form I, Subsurface Sewage Disposal System Form - Not for Voluntary Assessments .......... � 25 Debbies Lane u— Property Address Christopher Leonard & Melissa Ashton Owner Owner's Name information is required for every Marstons Mills Ma. 02648 2-16-21 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: New SAS 2-3-97 #97-44 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 42"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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18 I . Commonwealth of Massachusetts Title 5 Official Inspection Form �I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u 25 Debbies Lane Property Address Christopher Leonard & Melissa Ashton Owner Owner's Name information is Marstons Mills Ma. 02648 2-16-21 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 32"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) 1000 gal If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gal Sludge depth: 1" Distance from top of sludge to bottom of outlet tee or baffle 29" Scum thickness 0 Distance from top of scum to top of outlet tee or baffle 8" Distance from bottom of scum to bottom of outlet tee or baffle 18" How were dimensions determined? Sludge judge, tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 1000 gal tank with baffle in and tee out, inlet cover 8"outlet cover 32" below grade t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 I . cam, Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 25 Debbies Lane Property Address Christopher Leonard & Melissa Ashton Owner Owner's Name information is required for every Marstons Mills Ma. 02648 2-16-21 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. 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.): 8. 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): Dimensions: Capacity: gallons Design Flow: gallons per day l5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 r cam, Commonwealth of Massachusetts �n ,p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 25 Debbies Lane Property Address Christopher Leonard & Melissa Ashton Owner Owner's Name information is required for every Marstons Mills Ma. 02648 2-16-21 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): 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.): D Box is 16x16 with 1 outlet pipe, cover at 28" below grade t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 r cam, Commonwealth of Massachusetts �v Title 5 Official Inspection Form w Subsurface Sewage Disposal System Form - Not for Voluntary Assessments >r; ...........cj 25 Debbies Lane t.— Property Address Christopher Leonard & Melissa Ashton Owner Owner's Name information is required for every Marstons Mills Ma. 02648 2-16-21 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 ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: 11 ® leaching chambers number: - 4 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 r c Commonwealth of Massachusetts p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 25 Debbies Lane Property Address Christopher Leonard & Melissa Ashton Owner Owner's Name information is required for every Marstons Mills Ma. 02648 2-16-21 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.): SAS is 4 Cultex infiltrators in trench pattern SAS is clean and dry with no sign of failure 12. 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.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 r Commonwealth of Massachusetts p Title 5 Official Inspection Form (= iI Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 25 Debbies Lane Property Address Christopher Leonard & Melissa Ashton Owner Owner's Name information is required for every Marstons Mills Ma. 02648 2-16-21 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. 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.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments !% 25 Debbies Lane Property Address Christopher Leonard & Melissa Ashton Owner Owner's Name information is required for every Marstons Mills Ma. 02648 2-16-21 page. Citylrown 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 6ac�t 6 J Ol 0 Al 3 a-a1: 3--qj g I_qq 3-65 • ````O`����OF tMgSS�'''', gam: MICHAEL N 0 No.S114430 - 5 IN t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 r Commonwealth of Massachusetts �n Title 5 Official Inspection Form �Ia Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 25 Debbies Lane Property Address . Christopher Leonard & Melissa Ashton Owner Owner's Name information is required for every Marstons Mills Ma. 02648 2-16-21 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water 6 ® Check cellar ❑ Shallow wells Estimated depth to high ground water: 14' 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 table You must describe how you established the high ground water elevation: No ground water per GIS table Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts �n Title 5 Official Inspection Form �I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 25 Debbies Lane u Property Address Christopher Leonard & Melissa Ashton Owner Owner's Name information is required for every Marstons Mills Ma. 02648 2-16-21 page. Cityfrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or checked ® C. Inspection Summary: 1, 2, 3, or a 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 Vs 64 SAS 8 . NO t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 r ENVIRO.TECHLABORATORTES, INC. IVA CERT. NO.:M MA 063 (f 8 Jan Sebastian Drive Unit 12 Sandwich,jVA 02563 (508)888-6460 1-800-339-6460 FAX(508)888-6446 Client Name Hobill, Gregory Location 25 Debbie's Lane Address Berry Hollow Dr Marston Mills, MA Marstons Mills, MA 02648 Sample Date 04/02/13 Collected By Envirotech Sample Time 15:05 Sample Type Well Date Received 04/02/13 Lab Order Number DW-130587 Well Specs NA Zocatron Source Date Collected- Tune Gollect>�d E'oanmet+is Analysis Requested Units Recommended Limits Analysis Result rYfetlrod DnteAnalv-ed� Analv7ed By Total Conform /100ml 0 0 SM9222B 4/2/2013 RS PH -------- Specific _.. __. .. -- —- - Conductancen umhos/cm 500 135 EPA 120.1 4/2/2013 LL Nitrite-N mg/L 1.00 <0.004 EPA 300.0 4/2/2013 LL ----- --- Nitrate-N mg/L 10.0 1.32 EPA 300.0 4/2/2013 LL Sodium mg/L 20.0 13.1 EPA 200.7 4/4/2013 MC Total bona mg/L 0.3 0.06 EPA 200.7 4/4/2013 MC Manganese= mg/L 0.05 0.11 EPA 200.7 4/4/2013 MC Lead mg/L 0.015 <0.006 EPA 200.7 4/9/2013 MC -- -- -----------— — - - - --- - _....- Comments: Low pH indicates high corrosive characteristics. Manganese is not a health hazard,but may cause staining and/or give water an odor or taste. Water meets EPA standards s suitable for drinking for parameters tested. --77 Date Ro ald J.Saari L boratory Dit'e or r BRL=Below Reportable Limits *See Attached Page 1 of 1 ❑Certification is not available for this analyte for non potable water samples.. ENVIRO TECH LABORA TORIES,INC. MA CERT. NO.:M-MA 063 8 Jan Sebastian Drive Unit 12 Sandwich,MA 02563 (508)888-6460 1-800-339-6460 FAX(508)888-6446 Client Name Hobill, Gregory Location 25 Debbie's Lane Address Berry Hollow Or Marston Mills,MA Marstons Mills,MA 02648 Sample Date 04/02/13 Collected By Envirotech Sample Time 15:05 Sample Type well Date Received 04/02/13 Lab Order Number DW-130587 Well Specs NA Location Sotuce aP .Date Collected Time Collected �,Co'n enfs Analysis Requested Units Recommended Limits Analysis Result Method Date Analyzed Analyzed By Total Coliform /100ml 0 0 SM9222B 4/22013 RS pH pH units 6.5-8.5 5.61 SM4500-H-B 4/2/2013 LL Speck Conductancen umhos/cm _ 500 135 EPA 120.1 4/2/2013 LL _ Nitrite-N mg/L 1.00 _ _ <0.004 _ EPA 300.0 4/2/2013 LL Nitrate-N i mg/L 10.0 1.32 EPA 300.0 +4/2/2013 LL y Sodium _ mg/L 20.0 13.1_ EPA 200.7 _4/4/2013 _ MC _ _ Total Irona _ mg/L T 0.3 0.06 — EPA 200.7 4/4/2013 MC _ Mangan_esen _ mg/L 0.05_ 0.11 EPA 200.7 4/4/2013____MC _ Lead mg/L 0.015 <0.006 EPA 200.7 4/9/2013 MC _ Comments: _.—. Low pH indicates high corrosive characteristics. Manganese is not a health hazard,but may cause staining and/or give water an odor or taste. Water meets EPA standards 's suitable for drinking for parameters tested. — - — — —`--- - Date ` /1 I� Ro ald J.Saari L boratoty Die or BRL=Below Reportable Limits 'See Attached Page 1 of 1 ❑Certication is not available for this analyte for non potable water samples.. y r' t � � BAYBERRY BUILDING COMPANY JACQUEs N. MoRiN BUILDER&CONSULTANT bayberrybuilding@comcast.net 1597 FALMOUTH ROAD•SUITE 4•CENTERVILLE,MA'02632 I'EL 508-775-8822•FAX 508-771-2116 CELL 508-776-2953 •www.bayberrybuilding.com Or 6?cl Town of Barnstable Barnstable � i CRY lARNSi'A$LE, 9Tf M Board of Health 1 1 c► 200 Main Street, Hyannis MA 02601 2007 I i Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi Mr. Jacques Morin June 28, 2013 104 Berry Hollow Drive Marstons Mills, MA 02648 RE: 25 Debbies Lane, Marstons Mills "` A=`011 013' Dear Mr. Morin, ' You are granted permission on behalf of your client, Gregory Hobill, to utilize four bedrooms at 25 Debbies Lane, Marstons Mills with the following conditions: 1) The existing septic system must be evaluated by a person who is certified and is competent to make such an evaluation (i.e. registered sanitarian or professional engineer) to determine whether the system has sufficient capacity for four , bedrooms. This evaluation must occur before obtaining amnesty and/or approval for construction of a fourth bedroom at this property. 2) If it is determined that the existing septic system is of insufficient capacity for four bedrooms, it shall be upgraded to comply with the State Environmental Code, Title 5 for four (4) bedrooms. Failure to upgrade the septic system will result in revocation of this permission and a requirement to reduce the number of bedrooms to three bedrooms maximum at this property, as listed on the official disposal works construction permit. The current on-line Town of Barnstable Assessor's records list this property as containing five bedrooms. Although the disposal works construction permits issued by the Public Health Division in 1986 and in 1987 were both issued for three bedrooms, the applicant testified that this home contained five to six bedrooms when his client recently purchased this property. In addition an affidavit signed by Matthew J. Dacey, was submitted to the Board indicating that this home was originally constructed with three bedrooms on the second floor and two bedrooms on.the first floor, totaling five bedrooms, back in 1985 prior to adoption of the Regulation limiting wastewater flows within this groundwater protection districts. Sinc ely yours I�Iwe it er, M.D. QAWPFI SvWorinFourBedroomsDebbiesLane20l3.doc i� AFFIDAVIT I, Matt Dacey,hereby do depose and say as follows, to the best of my recollection and knowledge: 1. On or about the summer of 1985,as vice president of my late father, William Dacey,Jr. doing business as Barnstable Holding Co,Inc., Dacey Homes construction company, we constructed several homes for Ike Hi Won Park,one of which was at Lot 110, house#25 Debbies Lane, Marstons Mills, Massachusetts. 2. During this time we were building about forty homes in the same development some with finished second floors and some without finished second floors. 3. At that time there had been discussions about limiting bedrooms based upon a to be developed ground water protection zone. To our knowledge at the time of construction and for two years following there had been no town'approved legislation limiting bedrooms which did not come into affect until sometime in 1987. 4. At the time of construction the Parks desired the upstairs to be completed with three bedrooms. We finished the second level with all of the same trim features of the two bedrooms on the first floor. The second level was completed with a full bathroom. This style home was quite popular during this era and commonly built in this area. Subscribed and sworn to under the pains and penalties of perjury this day of 2013 Yz,-4- -�`� a I s 1 Commonwealth of Massachusetts w . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 25 Debbies Lane Property Address Cape Cod Homes, LLC et al Owner Owner's Name information is Marstons Mills MA 02648 February 22 2013 required for every rY page. City(rown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 14+ 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 14 feet above groundwater table. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of..Massachusetts. Title 5 .- ficia.l lns.pectian Fora SutisUlft a Sewage Disposal System Form..; .6!untary,Assessments f 25 Debbies:tane Property Address CapeCod, Homes,;:LLC et al_ Owner - 0wn`er's Narrie tnformatton is {equtred for every: Marsfons Mills.. MA `_ 02648 February.2.' =2 13 page. C>ty/Towri Stater' Zlp Code Date,of Inspection: D System [ for mat (c-ort.) Sketch Of.Sewage Disposal°'System Provide a View,'df,;tl a sewage disposal system, including ties t--o a_t least>two permanent,referencerlandmarks.or;benchmarks. Locafe'all wellswithin'100 feet Locate where pubic=water supply eriters;the building Check orie:of'the boxes below: ,hah i9ketch°ih the area below drawing attached separately_ S�pTtC L`E�CN..(f16 LACY t5iris•111M1t) 7dlo 5 Offic(el Inspection Form Subsurface Sewag e Disposal Systems Page 15'of 17- Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments GSM 25 Debbies Lane Property Address Cape Cod Homes, LLC et al Owner Owner's Name information is Marstons Mills MA 02648 February 22, 2013 required for every rY page. Cityfrown 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 w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 25 Debbies Lane Property Address Cape Cod Homes, LLC et al Owner Owner's Name information is Marstons Mills MA 02648 February 22 2013 required for every rY page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ® leaching galleries number: 1 ❑ 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 gallery appear unsaturated. No evidence of surface ponding, breakout, lush vegetation, or other evidence of hydraulic failure was observed. An observation hole was dug into leaching gallery stone and no standing effluent or effluent contact staining was observed in the stone or overlying soils. 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•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments w 25 Debbies Lane Property Address Cape Cod Homes, LLC et al Owner Owner's Name information is Marstons Mills MA 02648 Februa 22 2013 required for every ry page. Cityrrown 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 at 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 appears structurally sound and functioning as intended. No evidence of leakage in or out was observed. Some solids in sump. 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 25 Debbies Lane Property Address Cape Cod Homes, LLC et al Owner Owner's Name information is ry Marstons Mills MA 02648 February 22 2013 required for every � ' page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ 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 W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 25 Debbies Lane Property Address Cape Cod Homes, LLC et al Owner Owner's Name information is Marstons Mills MA 02648 February 22, 2013 required for every rY page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 20 in Scum thickness 2 in 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 Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Maintenance pumping is recommended now and every 2-4 years. Tank and tees/baffles 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 t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 25 Debbies Lane Property Address Cape Cod Homes, LLC et al Owner Owner's Name information is Marstons Mills MA 02648 February 22 2013 required for every ry 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: Age: 16+ years. Certificate of Compliance issued 2/3/1997. (permit#97-44). Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2 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.): Sewer line appears structurally sound with no evidence of leakage or backup into dwelling. Septic Tank(locate on site plan): Depth below grade: 1 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 x 5 x 6 - 1000 gallon tank Sludge depth: 14 in t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 25 Debbies Lane Property Address Cape Cod Homes, LLC et al Owner Owner's Name information is rY Marstons Mills MA 02648 February 22 2013 required for every , page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: owner 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): t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 25 Debbies Lane Property Address Cape Cod Homes, LLC et al Owner Owner's Name information is Marstons Mills MA 02648 February 22 2013 required for every ry page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage d n/a-well in use 9 ( Y 9 (gP ))� Detail: Sump pump? ❑ Yes ❑ No Last date of occupancy: 3 weeks ago 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 W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 9 p Y ►Y ,M 25 Debbies Lane Property Address Cape Cod Homes, LLC et al Owner Owner's Name information is Marstons Mills MA 02648 February 22, 2013 required for every ry 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? ® ❑ 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): n/a Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): n/a-no plan t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 l Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 25 Debbies Lane Property Address Cape Cod Homes, LLC et al Owner Owner's Name information is required for every Marstons Mills MA 02648 February 22, 2013 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 11 of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 25 Debbies Lane Property Address Cape Cod Homes, LLC et al Owner Owner's Name information is Marstons Mills MA 02648 February 22 2013 required for every rY 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 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 weYl. ❑ 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 W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 25 Debbies Lane Property Address Cape Cod Homes, LLC et al Owner Owner's Name information is Marstons Mills MA 02648 February 22 2013 required for every rY page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditional) Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 t Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 25 Debbies Lane Property Address Cape Cod Homes, LLC et al Owner Owner's Name information is required for every Marstons Mills MA 02648 February 22, 2013 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==> The septic system described herein is deemed to pass this Real Estate Transfer Inspection if it does not meet any of the failure criteria enumerated in Section D on pages 4-5. The scope of this inspection is limited to health and environmental compliance and 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. Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. t The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally c 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): l5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 25 Debbies Lane Property Address Cape Cod Homes, LLC et al Owner Owner's Name information is Marstons Mills MA 02648 February 22 2013 required for every rY 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 A. General Information filling out forms on the computer, use only the tab 1. Inspector: key to move your cursor-do not David D. Coughanowr, R.S. D use the return Name of Inspector key. Eco-Tech Environmental ICI Company Name 43 Triangle Circle Company Address Sandwich MA 02563 City/Town State Zip Code 508 364-0894 1328 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of)on site sewage disposal systems. I am a DEP approved system inspector pursuant t Section 15,::3;40 of Title 5 (310 CMR 15.000). The system: ® Passes r ❑ Conditionally Passes ❑ Fans: ❑ Needs Further Evaluation by the Local Approving Authority �• �� February 22, 2013 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. t5ins•11/10 Title 5 Official Inspection m:S bsurface Sewage Disposal System•Page 1 of 17 Barnstable of sH r Town of Barnstable AlAmicaCft ELARuvsrnsLe. Board-;of Health �fa++►i►'�'` 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi November 13, 2013 Mr. Jacques Morin 104 Berry Hollow Drive Marstons Mills, MA 02648 Dear Mr. Morin, The Board of Health is in receipt of an affidavit from William Robinson, Jr. dated November 11, 2013 and a letter from David D. Coughanowr, R.S. dated-November 12, 2013 which states that the existing septic system exceeds the 440 gallons per day capacity required for a four bedroom dwelling. This information was required by the Board as part of their conditional approval for four bedrooms at 25 Debbies Lane, Marstons Mills. r Thus, both conditions #1 and#2 contained within the Board of Health permission.letter to you dated June 28, 2013 were satisfactorily completed and adhered to. Therefore, you are granted permission, on behalf of your client, Gregory Hobill, to utilize four bedrooms at 25 Debbies Lane, Marstons Mills. Sincer y 1 Wayne M' ler, M.D. Chairman Q:\WPFILESWorinDqoiesLane4Bedrooms2Ol3.doc B. Jacques Morin representing Gregory Hobill, owner— 25 Debbies Lane, Marstons Mills, Map/Parcel 011-013, existing five (5) plus bedrooms, affidavit submitted, requesting grandfather number of bedrooms. Jacques Morin representing owners, Katelyn and Gregory Hobill. Mr. Morin, along with Mr. and Mrs. Hobill, were present. Mr. Morin said the house was built in 1986 with a finished upstairs as per the agreement made with the buyer. He had submitted an affidavit stating this, from the builder Mr. Dacey. Mr. Dacey was not aware of when the apartment was added but by the condition of it, it was clear that it was not much later than the original construction. Mr. Morin's package included the existing floor plans with six bedrooms and a revised floor plan removing two bedrooms and leaving three bedrooms in the main house and one bedroom in the apartment. They do believe the property qualifies for more bedrooms but the owners (1) do not have a need for them and their priority is to be allowed to continue having the apartment which provides additional income to assist in the refurbishing and (2) would like the matter cleared up with the Building and Health Divisions Mr. McKean said the staff reviewed and noted there is conflicting information in t records. The original septic was permitted for three bedrooms and was over-designed as a 488 gallons/day system which handles four bedrooms. In 19 e ays no engineering plans were submitted. There are no calculations available to show what the system is designed for. The system has four 330 Cultec Infiltrators with stone around them. Mr. McKean said he has asked Mr. Morin to hire an inspector find out how much stone is around the infiltrators so the flow calculation can be determined. There was an inspection done in 1997 but it was done prior to the new system. There was also a well test done recently and it was fine. Dr. Miller said there are two things he is looking at: (1) what should be allowed and (2) what can the septic system handle. He said the affidavit goes along with Board has accepted as proof of prior existence. a would like Mr. Morin to do the work ecessa�so-the_systemrean-have tlre�f ow design calculated. An inspector will have to dig around the chambers to measure the amount of stone. If there is not adequate stone, then adding a chamber may be all that's needed to bring it to a proper four bedroom. Mr. Morin also mentioned there is 100 acres of conservation property which backs up to property. He said the Town has assessed it as a five bedroom. He also said the system had a_ cre ent inspection and passed--RMr--Mor is working wi a ui d�in Department regarding proper egress to the apartment. Rnot be a problem. Upon a meson du y made by Dr. Miller, seconded by Mr. Sawayanagi, the Board voted to grant the house as a four bedroom existing grandfathered house with the following condition: must show design flow is adequate to provide the 440 daily flow. (Unanimously, voted in favor.) ECOJECH Environmental 43 Triangle Circle Sandwich, MA 02563 (508) 364-0894 November 1.2, 201 Re: Clarification Letter 25 Debbies Lane Marstons Mlls, MA Barnstable Board of Health Barnstable, MA Esteemed Members of the Board, Based on an Affidavit of William Robinson Jr. dated November 11, 2013 in which he attests to the specifications oFa septic system installed at the above. address, I have calculated the design Clow for the soil absorption system he describes, and have Found the design capacity to exceed the 440 gallons per clay required fa'a four bedroom dwelling. The calculations as well as a sketch are in a separate document. Please contact me i f you have any further questions. of�d4'9''s. so DAVID D. Sinc .COUGHANOWR No. 1093 N!7hR1!" David D. CollghanoWI', R.S. DESIGN FLOW: 4 BEDROOMS X 110 GPD = 440 GPD SOIL ABSORBTION SYSTEM: A 41.5 ft x 12.33 ft x 2 ft LEACHING GALLERY AS DEPICTED BELOW IN A CLASS 1 SOIL WITH A PERC RATE OF 5 MINUTES PER INCH OR LESS CAN LEACH: Abot = (41.5 x 12.33 ) = 511.7 sf Asdw = ( 41.5 + 41.5 + 12.33 + 12.33 ) x 2 = 215.3 sf Atot = 727.0 sf Vt = 0.74 x 727.0 = 538.0 GPD LEACHING CAPACITY = 538.0 GPD ) 440 GPD REQUIRED DRYWELL 41.5 ft UNIT41 41 c co 0 I F N to r . t ra STONE 3.75 8.5 ft 8.5 ft 8.5 ft 8.5 ft 3.75 ft ft OFsS p DAVID D. COUGHANOWR No. 1083 Ip"GISTER�� \ r -� 43 TRIANGLE CIRCLE Q U 2-0 SANDWICH 4 A 02563 `v 508 36 0894 AFFIDAVIT I, William Robinson Jr., hereby do depose and state as follows: 1. For many years I had been a licensed installer in the Town of Barnstable doing business-along with my father William Robinson, Sr. as W.E. Robinson Septic Service of Centerville, Massachusetts. 2. In February of 1997, myself and father installed a septic system at 25 Debbies Lane, Marstons Mills, Massachusetts. 3. The septic system consistent of a 1,000 concrete tank, D-box to which was added 4 new precast stone packed 500 gallon leach chambers. As with any of the systems we were installing at that time, including 25 Debbies Lane, we always used an average of 3 Y2 to 4 feet of stone around the leach field. Our objective was to Y always oversize a system in order to ensure proper design flow. Subscribed and sworn to under the pains and penalties of perjury this - 1 day of November, 2013 \J William Robinson, Jr. Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 25 Debbies Lane Property Address Cape Cod Homes, LLC et al Owner Owner's Name. information is Marstons Mills MA 02648 February 22 2013 required for every rY 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 I No. Fee------9-'-!&------ BOARD OF HEALTH TOWN OF BARNSTABLE Zipplicat ion-*r Vell Cow6truction Permit Application is hereby made for a permit to Construct Alter or Repair (/<an individual Well at: -----�5-- 0 1.1 - 0,27 Location - Address Assessors Map and Parcel O Address -------------—---------------------------------—--------------—-----—------------- Installer - Driller Address Type of Building Dwelling----- --------------------------- Other - Type of Building ------------------- No. of Persons--------____-___________-__—___________ Type of Well -/' ro -I - Capacity------------------ Purpose of Well---- 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 Certificate of Compliance has been issued by the Board of Health. Signed C date Application Approved By- date Application Disapproved for the following reasons: ---------------------- ----------- ——--------------------------------------------------------------------------------------------------------- date Permit No. 0 Issued —----------- date -------------------------------- -------------------- -- BOARD OF HEALTH TOWN OF BARNSTABLE Certificate (Of Compliance THIS IS TO CERTIFY, That the Individual Well onstructed Altered or Repaired nstaller ------------------------------------------------- at ---------------------------------------------------------------------------------- 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---------------------------------------------------------------------- --` -----No-- - D �- _ Fee-------- ----------- BOARD OF HEALTH TOWN OF BARNSTABLE Application-*rVe[C CongtructionPermit t tApplication is hereby made for a permit to Construct ( ), Alter ( ), or Repair� ,fan individual Well at: Location — Address Assessors Map and Parcel Own ie Address ------------------------------------ Installer — Driller l J Address Type of Building Dwelling - Other - Type of Building--------------------------------- No. of Persons----------------------------------------------- Type of Well— Purpose of Well Agreement: y` 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 Certificate .of Compliance has been issued by the Board of Health. Signed- 1 j T -f" .�.l ,� r ` ='------ — -- ----------- �� date Application Approved By-- -- C� - " ! ------------------ --- ---- date Application Disapproved for the following reasons:--------—------------—------------—------------_---_---__________—__________ ------------------------------ ------------------------------------------- ------------------------------------------------ date PermitNo. ------------------- Issued------ --- _ ✓l-' - ------------------------- date --------------------------------------------------------------------------------------------------------. BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired i /Installer 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-------------------—--------—---------- -------- --- 'r -- Inspector---------------------------------------------------------------------------- BOARD OF HEALTH TOWN OF BARNSTABLE Vell Con5tructionpermit wa,Ofl -Da ( No. --------------- Fee---- Permission is hereby granted-- )/,)�C to Const"ru)ct ( ), Alter ( ), or Rep it ( A)an Individual Well at: C/ �-- ------------------------------------------------------------------------------- Street as shown on the application for a Well Construction Permit No.11 -! - V U-(-------------------------------------- Dated —— ------------------------------------------------------------------------ - �� ------------- -— -VtA-,—--�---- DATE t / - Board of Health ------!_------�--�� r�-i 0 ea w Commonwealth of Massachusetts 19�� Executive Office of Environmental Affairs ti. Department of Environmental Protection G OM m F.Weld Trudy Coxs Argso 8-9my Paul Celluccl David B.Struhs U.GovernorC rimhNornr SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A - CERTIFICATION Property Address: 45 Debbies Lin, Marstons Mills, MAAddressofowner.. Jeremiah Silva Date of Inspection: s2 3-9 1) (If different) 1 0 0 9 Vass Rd Name of Inspector. W.E. Robinson SR Spring Lake, NC Company Name,Address and Telephone Number. ( 5 0 8 ) 7 7 5-8 7 7 6 28390 W.E. Robinson Septic Service P.O. Box 1089 Centerville MA CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: _ Passes _ Conditionally Passes _ Needs Further Evaluation y he Local Approving Authority — Fails Inspector's Signature:Z-t."� t Date: -3 The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Check A) 9 Y8 PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. Bl SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes inspection. Indicate yes, no,or not determined(Y,N,or ND). Describe basis of determination in all instances. If"not determined",explain why not) The septic tank is metal, cracked, structurally unsound, shows substantial infiltration or exfiltration,.or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a Fonforming septic tank as approved by the Board of Health. (revised 11/03/95) 1 One Winter Street a Boston,Massachusetts 02108 • FAX(617)556-1049 • Telephone(617)292-5soo ��i1 Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) PropertyAddrem 45 Debbies Ln, Marstons MIlls, MA Owner. Jeremiah Silva Date of Inspection: I-_ 3 1� Bl SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken,settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed Cl THER 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 the public health,safety and the environment. 1 SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. Z SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER,IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. 3) THER (revised 11/03/95) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 45 Debbies Ln, Marstons Mills , MA Owner. Jeremiah Silva Date of Inspection: Z DI YSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. El LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply _ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area(IWPA)or a mapped Zone II of a public water supply well) The owns or operator of any such system shall bring the system and facility into full compliance with.the groundwater treatment program requireme is of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information.. (revised 11/03/95) 3 I , SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST PropertyAddrsm 45 Debbies Ln, Marstons Mills, MA Owner. I Jeremiah Silva Date of Inapeetion: Check if the following have been done: V Pumping information was requested of the owner,occupant,and Board of Health. _t, Done of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates /during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. VAs built plans have been obtained and examined. Note if they are not available with N/A. /The facility or dwelling was inspected for signs of sewage back-up. v The system does not receive non-sanitary or industrial waste flow The site was inspected for signs of breakout. All system components,excluding the Soil Absorption System,have been located on the site. I,,/The septic tank manholes were uncovered, opened,and the interior of the septic tank was inspected for condition of baffles or /tees,material of construction,dimensions,depth of liquid,depth of sludge, depth of scum. V The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. /The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub. Surface Disposal System. (revised 11/03/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 45 Debbies Ln, Marstons Mills, MA Owner. Jeremiah Silva Date of Inspection: I—3,�a FLOW CONDITIONS RFSmENTw: Design flow:,zr y D moons Number of bedrooms Number of current enta Garbage grinder types or no): A d Laundry connected to system(yes or no):ILS Seasonal use(yes or no):_ Water meter readings,if available: N/A Well water Last LtUef occupancy:MCIAL NDUSTRIAI. Type o establishment: Des' flow:_gallons/day G trap present: (yes or no)_ Ind rial Waste Holding Tank present: (yes or no)_ Non tart'waste discharged to the Title 5 system: (yes or no)_ Water eter reading, if available: Last of occupancy: OTH •(Describe) Last to of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: -G /`10 -: 1 2--�-q7 System pumped as part of inspection: (yes or no)A—b If yes,'volume pumped: gallons Reason for pumping- ,L [;u j S TYPE OF'SYSTEM Septic taak/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records, if any) Other(explain) APPROXIMATE AGE of all components,date installed(if known)and source of information: �-.-'3 Sewage odors detected when arriving at the site: (yes or no),,A,d (revised 11/03/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) PropertyAddresx 45 Debbies Ln, Marstons Mills, MA Owner. Jeremiah Silva Date of Inspeotion: ,2^3- q SEPTIC TANK:_ (locate on site plan) Depth below grade: 0 ` Material of construction:-aA4ete_metal_FRP_other(explain) Dimensions: Sludge depth: -3'` t Distance from top of sludge to bottom of outlet tee or battle:L/D Scum thickness: , I Distance from top of scum to top of outlet tee or baffle: 11 Distance from bottom of scum to bottom of outlet tee or baffle: I Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage,etc.) ) G E TRAP:_ (locate site plan) Depth be ow grade: Material f construction:_concrete:_metal_FRP—other(explain) Dimens' ns: Scum ess: from top of scum to top of outlet tee or baffle: from bottom of scum to bottom of outlet tee or baffle: Comm to: (reco ndation for pumping,condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert,structural integrity, eviden of leakage,etc.) (revised 11/03/95) 6 • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) PropertyAddrbss: 45 Debbies Ln, Marstons MIlls, MA Owner. Jeremiah Silva Date of Inspection: aZ^3-4'rt TIGHT OR HOLDING TANK:_ ( on site plan) Depth low grade: Material construction:_concrete_metal_FRP_other(e:plain) Dime Capaci gallons Design w gallons/day Alarm evel: Cowmen : (conditio of inlet tee,condition of alarm and float switches,etc. DISTRIBUTION BOX:z_ (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) P CHAMBER:_ ( on site plan) ps in working order:(yes or no) nts: ( condition of pump chamber,condition of pumps and appurtenances,etc.) (revised 11/03/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 45 Debbies Ln, Marstons Mills , MA Owner. Jeremiah Silva Date of Inspection: _-3-y e7 SOIL ABSORPTION SYSTEM(SAS):, (locate on site plan,if possible;excavation not required,but may be apprommated by non-intrusive methods) If not determined to be present,explain: Type: leaching pits,number:_ leaching chambers,number:L[ leaching galleries,number leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: Comments: (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.) _ L` A— �✓z �; C a S J C)o 005-t� �1 G /i/e �h✓z S -3-q '7 C LS:_ (locate on site plan) Numbs and configuration: Depth- p of liquid to inlet invert: Depth solids layer. Depth f scum layer: ns of cesspool: Ma of construction: Indica' of groundwater: inflow(cesspool must be pumped as part of inspection) Comme ts:(note condition of soil,signs of hydraulic failure,level of ponding, condition of vegetation,etc.) PRIVY: (locate site plan) Mate ' of construction: Dimensions: Depth of olids: Cowmen :(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) (revised 11/03/95) g Y 4 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(oontinued) PropertyAddresa: 45 Debbies Ln, Marstons Mills, MA Owner. Jeremiah Silva Date of Inspection: 7 J SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmar locate all wells within 100' O � ec I DEPTH TO GROUNDWATER Depth to groundwater•_L�-\4 feet method of determination or approximation: 1 Z S) H6 ,L 62—3—S (revised 11/03/95) 9 TOWN OF BARNSTABLE LOCATION SEWAGE # ' VILLAGE f �Cr�lC �/I�� IIS ASSESSOR'S MAP & LOT - Q INSTALLER'S NAME&PHONE NO. On E SEPTIC TANK CAPACITY LEACHING FACELITY: (type) U Cvt+�*'- (size) 104 76 NO.OF BEDROOMS 3 BUILDER OR OWNE f PERMITDATE: A COMPLIANCE DATE: a 3 Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by r ot t �s o a No. ` `T Fee $5 0 •0 O THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: es PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Z[pprtcation for rNoo.5al *p.5tem Cow5truction Vermit Application for a Permit to Construct( /kepair( x)Upgrade( )Abandon( ) ❑Complete System El Individual Components Location Address or Lot to �.�- D ebb i e s L�an e Owner's Name,Address and Tel.No. 91 0—4 9 7—1 4 3 6 Assessor'sMapTarcel Mar stons Mills, MA Jeremiah Silva 1009 Vass Rd, Spring Lake, NC 28390 Installer's Name,Address,and Tel.No. 5 0 8—7 7 5—8 7 7 6 Designer's Name,Address and Tel.No. Wm E Robinson Sr Septic Service PO Box 1089 , Centerville, MA 0263 Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder f10) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil sand Nature of Repairs or Alterations(Answer when applicable) Title 5 Leaching System repair consisting of four #330 stonepacked Cultex infiltrators . Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by thi Bo4 of Health. Signed Z, Date g "g — Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued o N1 Fee $5 0.00 a -` THE COMMONWEALTH OF MASSACHUSETTS.-/ {-Entered in computer: ii PUBLIC HEALTH DIVISION - TOWN OF BARNSTAB419., M SA SACHUSETTS Ye 3pplication for ;Di!6 ogar 4im Cone't ur ch n ` nit Application for a Permit to Construct( /Repair( )Upgrade( )Abandon( ) ❑Complete System E2Individual Components Location Address or Lot No. 45 Debb i e s Lane owner's N,,3nie,Address and Tel.No. Marstons A Jeremiah Silva f Assessor's Map/Parcel 1 Mills,, 1009 Vass Rd,,.Sgr g/"1471 NC 28390 Installer's Name,Address,and Tel.No. 5 0 8—7 7 5—8 7 7 6 Designer's Name,Address and Tel.No.L /�jr "i a Wm E Robinson Sr Septic Service t PO Box 1089, Centerville, MA 02, Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq. ft. Garbage Grinder Po) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures k Design Flow gallons per day.:Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil sand Nature of Repairs or Alterations(Answer when applicable) `"Title 5 Leaching System repair �- consisting of four #330 stonepacked Cultex inf trators. j Date last inspected: Agreement: ` The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system - in accordance with the provisions of Title 5 of the Environmental Code and not.to place the system in operation until a Certifi- cate of Compliance has been issued by thi BopA of Health. Signed _ Application Approved by Dater Application Disapproved for the following reasons Permit No. .f Date Issued ------ —————— THE COMMONWEALTH OF MASSACHUSETTS Sii va BARNSTABLE, MASSACHUSETTS t" Certificate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired( x)Upgraded( ) Abandoned( )by Wm E Robinson Sr Septic Srv. at 45 Debbies Lane, Marstone Mills, MA has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated I Installer Wm E Robinson Sr Septic Srv. Designer The issuance of this permi shall not be construed as a guarantee that the sys m will fu-n-cttion as designed. Date '� `7 / Inspector Y it � d _ I No. � � —=-------.----_,-------------==—Fee $50.00 THE COMMONWEALTH OF MASSACHUSETTS IF PUBLIC HEALTH DIVISION - BARNSTABLE MASSACHUSETTS s Silva Xigpoof 6p.5tem Construction Vermit Permission is hereby granted to Construct( )Repair( x)Upgrade( )Abandon( ) System located at 45 Debies Lane, Marstons Mills, MA by WM E Robinson Sr Septic Srv. and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this permit. ­141yy� i Date: Approved by t NOTICE: This form is to be used for the repair of failed septic systems only CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS) ` I,William E. Robinson,Sr. ,hereby certify that the application for disposal works construction permit signed by me dated A -3,q? , concerning the property located at 45 Debbies Lane,Marstons Mills,MA meets all of the following criteria: * There are no wetlands within 300 feet of the proposed septic system. * There are no private wells within 150 feet of the proposed septic system. * The obseved groundwater table is 14 feet or greater below the bottom of the leaching facility. * There is no increase in flow and/or change in use proposed. * There are no variances requested or needed. SIGNED:�- DATE LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER 60 (Attach a sketch.plan of the proposed system. Also if the licensed installer proposes a certification plot plan,this plan should be submitted). i J S e ��. r i TOWN OF BARNSTABLE Y vv LOCATION Er b6„P c SEWAGE # 76"G � VILLAGE_ �,, ` cs►onS " 1�-1 S ASSESSOR'S MAP & LOT � INSTALLER'S NAME & PHONE NO.(fcpQP_ Coy Sep-r)cs 20-6aq,11 SEPTIC TANK CAPACITY l000 �'9AA �f@CasT' LEACHING FACILITY:(type) IeCWti,,,Q P1:1 COocrM (size) 690 681 Ckv NO. OF BEDROOMS_ RIVATE WELL OR-iA C "� BUILDER OR OWNER ace korn A S DATE PERMIT ISSUED: M�.A)t '6, IQK 6 DATE . COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No �( I �� .. t i �. �ro� �6 w�I1 ,; BOARD, F H H Applicati is hereby made for a Permi to Construct (Vor Repair an Individual Sewage Disposal ys ��taller Address 1:4 Septic Tank—Liquid capacity/.=.�allons Length Width..Z:�Z.... Diameter......... Depth.. Disposal Trench—No Width......... ......... Total Length......... Total leaching area.. sq f t. ` � THE COMMONWEALTH OF MASSACHUSETTS The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions ofZLIL LE 5 of the S�� Sanitary Code—Th undersigned further agrees not to place the s stem 3an,,a '-o,,e I n /thes operation until a Certificate of Compliance h be ssued the board of health. I- /�ool6�t��oI) for the ---. ------------------.-----------------------_______ ----------'---_---_'-'_-_---'-_-----'-_---__'------_---'_---'-----------------'---------_----'------ | Date | Permit Date No.-------••-•-......... Fps................... ..... THE COMMONWEALTH OF MASSACHUSETTS �. 110A RD_ H H /04v� -------------------OF....(/` s'+v. a4^... .............................. Appliratiun for Disposal Worksffloustrudion "pamit Applicatio is,hereby made fora Permit to Construct ( Or Repair ( ) an Individual Sewage Disposal System4� .._ ..... -----•--- - f` 'Location-Address or Lot No. .... ..�i Ir✓ rry ..... -f -Gt .---------------------------•-•- t+°' aOwner < Address C`----------------------••-----...:.._ ------ .---- ............. I taller Address UType o Building ` ,.K Size Lot.16?7.rO .........Sq. fee 1—� Dwelling—No. of Bedrooms---,�,�r... :z...........................Expansion Attic (41$ Garbage Grinder Other—Type of Building .....Y ' .............. No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfix*res -----------------------------------•-----------------......------------------------------------------...------......•---•-----•-•••••-••.............. W Design Flow.......... ................d..........gallons per person per day. Total daily flow......v,� o.........................gallons. WSeptic Tank—Liquid capacity,�!O.V allons Length y/...... Width...?. Z.... Diameter________________ Depth.......... x Disposal Trench—No. ._; .--.----. --- Width_................... Total Length......... Total,leaching area........... ._ sq. ft. Seepage Pit No... '_.. lameter...__���!'_..... Depth b ow inlet............ Total leaching area...2,4,�.sq. ft. Z Other Distribution box ( Dosin to ( o~, �j� Percolation Test Results Performed b ... _, E.. .. ................................ .... .... a; Test Pit No. I................minutes pe .me epth of Test Pit..../.........._.._ Depth to ground water.......................... rX4 Test Pit No. 2................minutes r i Depth of Test Pit.................... Depth to ground water........................ ....................... -•..................................•-••-•---••-•.........-•-•••................•••••. ••---•...----.........--------- Descriptionof Soil....................................................................................... x w ---------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------•--............... U Nature of Repairs or Alterations—Answer when applicable............................................................................................... -----------------------------------------------------------•-----------------•---------------.................------------------•-------------------...------......-•----------------•--•••••••••-•••--. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITI:4 5 of the State Sanitary Code—Th ,undersigned further agrees not to place the s stem-in operation until a Certificate of Compliance h be ssued�,y'the board of health. Signed._. .. /. .............................................................. Application Approved By......... ---- '�.. -�----- ,� �. r�., •....... ..d- - .._.... ate Application Disapproved for the fof owi sons-------------.q.......................................... _.................................................... _ --------------------------------------•-----•-----------.._...--•-•-------•------•---------••-----.....-----•--------------------------------------------------•---------•----••---------------•-•...-•- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF I-IEA T ........................OF.k�rofas. r:.f .. ,........................................:........ Trdifirtttr of Tukt fi m 7H�S IS �O.- RV'X, yat the Individual Sewage Disposal System constructed ( }'or Repaired ( ) by .. IX °. cam, s ,a %... -------------------•-----------------------••---•-----. ---------.........------.......... at Ap/ .. -t�`- k .. r, ----------------------•--=-----------------------•-------------------------------------------- hae been insta led in accordance with the provisions of TITLE 5 of The State Sanitary Code s described in the application for Disposal Works Construction Permit No ...._ �. ......... dated__...____71l__`.�.................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FU CTION SATISFACTORY. DATE.............. �`�................................ Inspector._... .._......_!.."`........................•-------------------•....... DESI A A _ P PERVISE THE COMMONWEALTH OF MASSAj ` •• ITIh3 BOARD F HEAL C STRICT. U / s _ OF..... ................. NO..�6_./S>r, .................. .� FEE.... 00 ........... Dilivro IV unm wn frrmit Permission is re ranted .: .'iY ' g to Construct ( 6ir epai ( ) a Ii67 v' ewagposal System i /�' atNo.------.....�:.. r ----• > - •........................ ................. Street as shown on the application for Disposal Works Construction Permit No.... _...... � Z •----•-- Dated-- .--- --••-�----��........... ---------------•---•-•-----------•-•- �-• i— A------ --._._....-••._..... \ . .... G. Board of Health DATE............. ...•�_'�--•�•--C-�•---�--�------ U FORM 1255,�/, M. SULKIN,INC., BOSTON Ap � ✓f1 ci3.vT �V�J IRIS-t J LOT /D o' "� 'o lo° 3 a )3 ,'y .. qq 3 a 00 9,3 eD6,5- of PAVEA4£NT OF JR4A Zvi . o 0 m Gs J. JACOB 2 to 81.4 N V UPPERCAPE ENGINEERI G'A y:r P.O. BOX 616 5.: = E: SANDWICH, MA 025 Z 362-62 f A ° ►,a TOP OF FOUNDATION ; CONCRETE COVER :,• CONCRETE COVERS 4"CAST IRON 12"MAX n"m'pn f- ' OxoOR SCHEDULE 40 WMAX. P.VC. PIPE 4°SCHEDULE 40 P.V.C.(ONLY) PITCH 1/4"PER.FT. PIPE- MIN. LEA PITCH 1/4"PER.FT. PITINVERT �e �� GeyEL35X��..' SEPTIC TANK INVERT DIS . INVERTV,INVERTELJJYR6.. BOX E01KX . >...... GAL, INVERT EL. �XSINVERT ' w w I/, .. i. DEL.�.S.✓.b � w • • /y. DIA. y PROFILE OF ,r/o GROUND WATER TABLE SEWAGE DISPOSAL SYSTEM NO SCALE ISQI L LOG WITNESSED BY : DATE .�(��. .�.�.... TIME.. . . .... QF'1-.';;.�Ci./= r- R:t`�1a?lVE:L:4fiy BOARD OF HEALTH I TEST HOLE i `TEST HOLE 2 )''�� EY)X 616 ENGINEER ECEI V.`I°10 . . . . ELEV ..0a"(0 .. . E. SAI4� �'`I?>I ' 1' ;0 02532 . . f DESIGN DATA : ` NUMBER OF BEDROOMS �. . . . . . . . . . . . TOTAL ESTIMATED FLOW ram. .Q , . GALLONS/DAY �S BOTTOM LEACHING AREA .//3 . , . . SQ.FT. /PIT SIDE LEACHING AREA . . .����. . . . . SO.FT./ PIT GARBAGE DISPOSAL . . '. ..(50% AREA INCREASE) 2 Akt - TOTAL LEACHING AREA • a:C . . . . SQ.FT PERCOLATION RATE � 5 . . . MIN/INCH LEACHING AREA PER PERCOLATION RATE .. . SQ.FT. NP.WATER ENCOUNTERED NUMBER OF LEACHING PITS . .O�Y/�`�. . . . . . . . . . J APPROVED . .. . . . . . . . . . . BOARD OF HEALTH a: . !Y(3�� //3 DATE_ AGENT 'OR INSPECTOR • p`1H OF jr V OBI 4 PETITIONER:: ,� /V TARS _ This Desigrrx recorrnWds products by Shepley Urrber IHgF'L EXISTING HOUSE ADDITION m o E a - mm cvpp G� L oa gv . L P m a a N m• s� ogy � Em E ae�LL n�v� E ® Stu YKS � yG $g v m Y (Jl/(/ m � rE:a V r nmtiv mv-•� y ag S9 u 000 nu m 22 c E 3 F m v i c FRONT VIEW (FACES DEBBIES LANE) SCALE: 1/4" = 1'0" RIGHT SIDE VIEW l ce CA//"V-J.� r LL f CCA F Btu i a •t- � �' W C � f Lu ' I ADDITION I EXISTING HOUSE _ e. '< z o r • , rya N C N x a N 0 t 3� ® ® � z ���'�'� NOTE: t OUT ADDITIONAL SURVEY FROM =n a AN EXISTING CERTIFICATION PLAN W !1 m Z W �;;xi DATED 9/9JS6 Allen B.Osgood- � > J � O nOi Residential Designer• r9 3 ti T.F W f t `94 ry Z y N Ck ® zE' 0 w m a.� Zv ;o fm [m FM •f I I•+. o /� Q.. = W lu Fm FiT N Fm A . .................... >n' o❑❑ 000 LY nu 00 DATE: 01/04/2018 Nm ' O i ,.�x'?�^r v �X�k:•. o e 1 n �Ir �.1 rs F� 2 r'-' rL. "°,�,y,,° - a .7 w ADD Ida i n F xt �t: Y 1-Q•� K *! 4 , �' i3Z U o ova y j SCALE: MIgtf yVi�,a� `' sE ,1}0 r� ��'- _ :a s,s q 0•b I OL(Y a•�'i,•a`� `O2 E{ o'+ 1 q 1- q REAR VIEW SCALE: 1/4 = 1 0 4 � � r d q� HE o $ ET: I EXISTING HOUSE;ADDITION EXISTING HOUSE I ADDITION Thl5 Des jer recommends products by ehV ey I.aTtlxr EF L � e zm 74• 4'-0• 24'-0" 20 b' 4 4n •qio-s aq6- 3 IIIII I -9§b--"�I:l --•17'1-•1m-5T'-04e-0•x°tI-©6_.I4I�1-•1'3e-'`0 2--T- 31`�9s•.-03_r5x'-0•_1_'93y3=3—_x2ae'm-0e•=-03e'=_"-= r='=Jr a/��I °�1o�3'w-1_1•xb1 w 6=�-01'-0-1 3''4^�,5�41,I4iI 4°• `—4-b.q 6I''I I 3_2I III•--a•—x94-0---t-rD---B-�---§§-3—- ---F 5--"s•--"2t�`'4-OY-(1—'—,^'O�8®�--�N Fr-—-a—RG--F 1 II 0--'--3•--F-5 N0 rI3—1��-_8�LL®I—Nl__�IIiI '4'1-�-3 LiIU S�III EE§4II -_--.�_-_Qm IIIIIIIIIIII. 'IIrIIIIII-0--IIIIII_•c-_—�I--�--_-/-s—,t.,ffi-II n-.�IIII.e.v•--�._eII ab-'-0�U-—''IF --W-,an•o-u c S_-_——' ._ bI ..�. •3n9��ua§tEP"oo-.�OOI O DSOc�-0'aauv�r�1a/9 CA /�i��v1UVAT°i0 1tCO1 14'- 30'•6' 24 S��9vy oEL4g>N �WO�G°�oy@EugOHi�Qr2 of�95FQ 0cEEaEo� • 1ov-a�t fEE 10'-3• FLUSH BACK WALL � - 4-. ------ E ° --------------------- - _ `. 2" 6-3" M N LL BAQE MENT STUDY KITGHENEATING mt I6 EXISTING FULL BASE I xmm 11'2'XT-11• • HT FA 4 -- epee DRILL,PIN&GROUT N5 REBAR 2"OG FOR NEW FND. LOSLQr HALL NNEGTIONS 2l0 ISLAND EXTENDED GL ET X3-1. - 'AE Eu°vE Ocaay2$48 �3 --------- -- --- FP ce BEDROOM LIVING10-11•x 11'-3 J —----- ° a a uF Z W LOS WZAP X . L__GK W 9v 20'-0° O 62§X1• 4-b 7-2 9-10 5-0 3-10 J ti'.5' 3 57-0• In NEW 8 EXST. FOUNDATION ce EXISTING HOUSE ADDITION _ EXISTING HOUSE ADDITION FIRST FLOOR PLAN F---- - i-—-—--> o f s F-------i------� � EXISTING HOUSE ADDITION ADDITION Lu LuZ o n uO 3-0. K in Lu 19Z G BATH T-5XT-77• FLU5HBACKWAL lu L Alt Iu — -I- — — J BEDROOM NO TERBDRM HALL z all NO L B 5 M N °N o — O tn -- ------------------ -----------— -- --- t5 R OC BLA D N ED NE TI T,FP WALL5 0'4• LP T H . ' \ - s EXISTING 2ND FLOOR PLAN (NO GHANGE5)-768 51= _ I I scALe SHEET - ------------- - ------ - A-2 ST L -1 -0 ROOF 1ST FLR ] LAYOUT SCALE. 1/4 LAYOUT .1 The Designer recorrrwicb products by Shepley U rnter r-- 20 D• .-.. - _ - _ .. r1 E P Lam..., Y�.to a m I. 101•0^- +I veNrzD wv6e LM - q u O e rg y•C SIMI.L9TA9STMP _1-T9N+r LK RIDGC HATE- - d t$ C n Y al oven loobeO,e•vc GENERAL NOTES: 'p� " Y E 3 o I OR LOL nE9 I b ,,�yT � V �. 1.) ALL MEMBERS TO BE CONNECTED,POSTS TO BEAMS, RAFTERS TO HEADERS,JOISTS TO PLATES OR BEAMS 66 u r m o I=/ a w I 2.) CONSTRUCT ALL DECKS&RAILING W 5 A5 PER AG RESIDENTIAL DECK CONSTRUCTION. "®` ""`�'� z o 1 al`� o: 0 ROOr A99eNe1Y:mb•cvx SNewTNMb' ,xa• ••~^'� '°' > +aLta I ` 3. WLL SHEATHING MIN. 1/2E AILED 8D @ 6 EDGES-12" E FIELD. a i 55`) ALL "CDX TO B N " " K,e La rar Roovlxb PAveRANo ewatT e'. "T s ' e 0 Y A9rNN.T 9NIN6lP9 A5 PPR NANr. ) I 5PCL5.NAWNb ap 4•eDbC54•rlpl.a 4.) ALL ROOF SHEATHING MIN-1/16"NAIL 8D 6p FIELD b"EDGES s 4 5.) ALL 51,15 FLR.MIN 3/4"T&G GLUE&NAIL 8D b"EDGE 12"FIELD 'E ' \ rRorA��r1i e4M9LIRda'" �.�tl INML51p�e LI.9 \ 6.) WALL TOP PLATE LAP NAILING 2'MIN."8 1bD g -t p AWNINUN6VRlR 5YSTlN � } �a II I wa • 1.) ALL CONCRETE WALLS,FOOTINGS,5ONO TUBES TO BE REINFORCED MIN.3,000# E§ wxT.vexrm vRP / Y i3 c a evGe DRwrrm 8.) ALL 50NO TUBES MIN. 12"DIA.ON 24"DIA.BIGFOOT n CC " E$ • PIR OPAM9 A4N-GL.F C t § v WINDOW SCHEDULE: 3u 6 fi TvrvcALr4AtL AssexeLn�9aime.r- - I 110 MPH WIND GEN.SPECS ANDERSON WINDOWS 400 SERIES TILT WASH FINE LITE GRILLS 616 STYLE HIGH PERFORMENCE LOW E GLASS 9 3+ a,roc,m cox Y9,YPAR N9tvRAP Axv aanxz.xPAu rxrewaR taus - FLOOR LOCATION OTY MODEL NO. U RATING I v 9CC ° 5 =L 5 0p1 MAWM6 aD 6'labG911•PIP1D I 6•Ixxag, . 20' 1 NEW FAMILY RM 4 ADH2650 -� � �s C Y W111re LID)AR 9NIN6LESASYbc I W=20' TYP.1ST FLR.HDR A55MB. 0 NEW BASEMENT 2 2813 .2 oO t "�! °�68, AND 00.K)OD GUP¢OAR09 O4• 0 o„ C 104 NATLN¢gT.91OINb ASPECT RATIO 1.00 (2)?�C12 NU(2)2X3&HARDBOARD INSL. Y 4'U •6 Y 9N•T8 SUg PLRbW¢Ig NAa •S% Y� O Y O rt as Sal TIN9t R-9a q 518"ANCHOR BOLTS @ 72"OG N.T.S. - DOOR SCHEDULE: S Y E s` M$6 SE ANDER50N FRENCHWOOD GLIDING FINE LITE GRILLS 15 LITE STYLE HIGH PERFORMENGE LOW E GLA55 a 5 Y a Y Vd0 U I_l l U ( l U __ _ TMlA6O MRH=19'+/-@REAR' FLOOR LOCATION QTY MODEL NO. U RATING v '9 n`I _ -- _ - -- 1 NEW FAM ROOM 1 FWGD1110611 4 27 F°ts'vD i c 5=8 -� O --Sle'%1P.VIWOR'vOLT9{}2_ ' oc wnxxa•sn ruTcs D) Rt. ,rnwan� �' ` _ 1 NEW FAM ROOM 1. 9068 9 LITE 2l e-xe'N-coxc.wu. L°"c.uu�rcaLz aRsoRN __ pANPROOFlNb +,NOQ��14 I 9Px30TnS(ANL.a„Y MSE9 I � dp.o MPTlIenODa Lx - rNO.eelowGMDe HDR.A55MB.FOR 11'9a SLIDER(2) . 4•.r-cDNca rtaaa Nave e•�m'.r-wxc. PaAW NM.9dOavYW)wJ 9.15X11 1/8"LVL WI(2)2X3 8 M.9,mla KtNd l , NOIIZ TOP 680T.gp srx tr coxr.PORNEv, /POLY eANIEa veRr.o9a•oc HARDBOARD INSL.N.T.S. coxc.rtb.Kce»N+Y,Rclxr. / KO003 5•raON ear. ce a a oZf SECTION AW)FOR FAM. RM.ADDITION (201 -, g J scALE IA LU M In W Omp Z Cd I Are In Cc ,soot AsseNatn yanot o+r aewn ''- „l7, V1 In a ,6'LDx sHEATItINb K+su PELT = 73DCMR.- STATE BOARD OFBUBDINO REGULATIONS AND STANDARDS - 790 CA4U SPATE BOARD OFBUIIDING REGULA77ONS AND STANDARDS In ~ ICOOrMb rAPeR ANDASPIMLr THE MASSACHUSETTS STATE BUILDING CODE W SMINbLl9 A9 PPA MANr.SPeGS. " APPENDICES REScheck Software Version 4.6.2 0 NNLIM6 aDreDGl9r rRLD.4'CDGD '�" j - I t._'. AWCGdde ro Waod Cprutrvrdon fn ,' r rleLv 04•or bAeL! i ariFh W : m ;• Lmebm eamacao"�a MassatSWalb CbeewT rl canpnDnea(780 cMR z301.2.l)t Lateral(-.r 16am -W......... bl"7).................... Compliance Q pliance Certificate . - ...... - ua un'roc aTTro ® Lvi ��6m L""v7NW fi p-w(..wd bno epohniM1Nv gl K I 1.ew)I�w.nDP�va=mal.rg�wm�am�mopmlr�rM •>i�maula� i Ll SCOPE R"doSpun.........................(T"9)..............1 nsin.s ll' X, ku W,dspaec3 Aea).............:....................................Ilampn smPlamsyon•.......................iTtNeq)..............1..Ln�n.t'{. x . Project New20x20'Addition wad FIqueow a M.......... ...........................B 1bIl lfdghtSmde 4ru Drmd,)...........(1tNa 9).........................• 2 / Na F- Bening Wv00prmngt0aewalv....(r gben..noes...... rm mTSb 9) 2 O 13 APPI1l:1B1IIT9 .............. able .... fl��17' Energy C. 20321ECC = -- Rodc pent............ 9)..... .._L FN I .. Hvmba afSmies(armf rhiab esaedr8in 12 alq,e ahN ba oomidvrdeaoryl SOPWa ................. le 9)... ... �flQIR. IT c,rstnc Si.gi-ns Mills,Massachusetts O �r.1 ,�aorW tl sodas - Poll Smd•(no dmW) ..�WIe 9) .................. 2 COnstrvctlOn ryPe: Sin91¢-family Cn RmfHab..............................tFV 2)................ (�t1Y11 ,)(„ Exlviv shewhagao Rmu,Dp+ifl ed3hen mu0mmodr'•• Project Type: Addition 6 O 0 lawo u•ao wnrPAaw - gfsm Roof lidgbl........................Wg2)...................,(�n t33' O$._ h lDir®dm >C 5(6137 HD ) • PaaYAMa MrW1T INlar BuOdag W_Kl4W.......................Oig3)...................x'It S(- a Tweal .................................QL«s6'8• Oimate Zone' U N Q i 9 _ IMncaLey..a Nralr. L Permit Date: X act \ BdldlugltagllL e(UrW............... o6g 3).................. a.L1 t°P ..................... 1t�1�iP X _ / , BaOGng AspenitedO(1J0V) •..............NFN 4).................... -.11 :3:1 Fnbe Nml sT®ag..........-:.::....(nbk mvmuafrm)•::::.:..�0'ie Permh Fn,mbRr: O an - `nr>A t Nmuad RdgheeTanm0pminj.......... .)............... r .. X U16 .... s6'g" �. RdeNdi bpacbg........... ...(hbk 10).............. Lb�•a. N 1.3 FRA)ANGCOrMC170NS ShoarCaarooth voel�daammmmue)(Itbla10)...................I....AS x Constr„ct1..Sit.; Owner/Agent Designer/Contractor. G P_ I Oawaleomp0av wiW honing mmcoiaa...CTabla2)............................. _X parser F.041d�tsboehin3..........(hMa lfl)........................�9• 1� 2s Debblestane ChAs6Nanssa Leowrd wu. e.Owood ^ W N LI FOUNDATION Sy Bag&dShemhivg,br Wei wrth 09mmg>6'8'�erigr anacga)........... Marstant Mills,MA 0264s 25 Debbie,usahnealCfiS n0 Otrnad8.eom YPO 11"OO11PIan5mm 563 Z ' c Fameadm Wdhvrdrlg agalavma d730 CMR S104.1 Mmam+BagdaNlYvrmdm.L -1.1 1-75-298-5 51 A SZI rviesl5treet G Nommvl RdebleTal OPWvg+.................................ev.�,6• COevrm................................................................ ShMba7ype................... fnola 9......................... `� antlwc A "'uNO•f",YOLawlnl 508-2fi4-536g02 +TrAa m•cmttvo Cavm Mvamal............................. or oom4R YO( PkIdWISpotivg....-...••..•...--•OZtNe 11 lea)......... - urplaruiore�.edzon.net �eNd4se aaw4 rov euxr. PIaR Na73 (11b6:II �� . n arc nurev Nnxr.erect 1A AN®e�tO87h bamad WP p pdng................... ).......-..............L . Y wmm�o<ednlabdadm3rl>rapda,aryMaalRalclAmhmtYwlauama.ammnRa"ar SemreamLedmw.orl m,mlmaasa) D......................... 6e k 1 rnbLu D),.T9N9.5LK9 EA.91DEOPP U j -.4-cbq-sEl-•••--•......••• (Teblal) �r,to. X •.•.•.•:.•..••-..-••. - 7�Adddloml Shmlh'v,gfac Wdl with Opmivg>6'8'W"ipl�spu)........... 11'-0• -,PwxOem. Boll6pealt M1,>mmNldm vrpNm.......MSS)............... In.s6"-17 X m I Boh6nbdlrmt-aovele............ ........ wog g3�7 •✓ Comg1a 2.2%1.wrTM d. 93 u W o 1"' 2'-0� � BMlEmbraaW-adaay..............(Fgs) 6Lx15" � Rtld ...................................................... •1- - nor c�a+u•usum.,a<ra..rvv.•.w ma.«.w.m.,^au..m.w.no..a. aaxma.o-Tms 14Ye walla.........................ffvsl...................a3-a3^:u• Y- s1 aODP8 t�.nw>wasa.wa raa wa.wti.a.b.,d. wmu --� 31 FLOORS Rmr6m6NrmMer4ae abac5edi(rvr BeOvamAWCSpeaTT�, EBBS WcOda) �gO� _ 1( R dOwAweg................. D-igum 19)....,,'/'>J®a mmllvary erlA x % ! yFl6.'"dlam Flo" padngoi�m'an..::.:::::w6 ,�au swm.........•.11'n:u. x 7>m"R.I�ra�amaml�:ngwdh Envelope Assemblies 0 Lu 0@ . 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