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Home My WebLink About0102 ROSELAND TERRACE - Health 102 RO ELAND�'�`«'� f i TOWNo OF BARNSTABLE l LOCATION /0.2 SEWAGE# 2 0/3- 00 g =VILLAGE l�,ah,Sj`Dt93 !/1/Ii��t' ASSESSOR'S MAP&PARCEL /0:3 —//3 INSTALLER'S NAME&PHONE NO.SD 8—y10-9738 JZ404 Da/3ogrrrVS SEPTIC TANK CAPACITY 00 LEACHING FACILITY:(type)2-S DO LCpe,41 C ,e 4i j We) NO.OF BEDROOMS OWNER PERMIT DATE: /- /D I COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY .c �u 02 5S. 2,, 19 -3=38,7„ 0 No. ✓ -/ Y�, Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN-OF-BARNSTABLE, MASSACHUSETTS ftpritation for Misposat Opstem Construction Vermit Application for a Permit to Construct( ) Repair(44- Upgrade(4�- andon( ) ❑Complete System ❑Individual Components Location Address or Lot No./0 A o�'ELq�7 T8N!'� Owner's Name,Address,and Tel.No. t"ri"'Y5 mi/ pe_bor__. �a/per Assessor's Map/Parcel /p j_1/ 1 Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. f OB-�G2-24f 4t2 __Y �'t, e I 5V.C_r 6 Jrorlf, CNC Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer,when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signe Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. ` Z �� Date Issued d No. / � Fee / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOwWGF-26ARNSTABLE, MASSACHUSETTS Yes application for 33isp,osaY,*pstrm Construction 3pPrinit:' Application for a Permit to Construct( ) Repair((.)Upgrade(Z_)--A'Gandon( ) ❑Complete System ❑Individual Components. LocationAddress or Lot No./O 2 /�u 5�=L r9��,T�;Y Owner's Name,Address,and Tel.No. Assessor's Map/Parcel //.5 Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. j eo 2 --1-Q S (2,QA)C 59 Sahy, CN6- Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable). ZH, +t / =cy /)-/3i1,1 2 __5 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health.. Signe 1� Date Application_Approved by Date Q t ' Application Disapproved by Date for the following reasons Permit No. Ale)/ Date Issued ------------_-- -- ------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired Upgraded Abandoned( )by 5,6��G /L��t4YyYJ S at /U.2 fiN Q5�1ia4�A Ti Y/i/c/= �. ;�ys"f Y7t /Z////,has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit ol _FS'dated Installer J,iS ti�L jJ), 8,4,1` ,2 S Designer yJ✓1/"�1i-,� se j i�r/S, �/r #bedrooms 3 Approved design flow gpd The issuance of this permit.shal not be construed as a guarantee that the system func' n es�gned. ` Date T f0/�� Inspector No. Fee/,!-7) C) a THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal *pstem Construction j3Prinit Permission is hereby granted to Construct( ) Repair( �) Upgrade(I--)- Abandon( ) System located at and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction rnfist be completed within three years of the date of this permit. Date 211 -3 Approved b JAN/11/2013/FRI : l : 11 AM SandwichTownOff ices FAX No• 1 5C8 833 OC18 P• 001 Town of Barnstable Regulatory Services a Thomas F.Ge ler,Director ""M Public Health Division °?ea,atcs' Thomas McKean, Director 300 Main Street,Hyannis,xx n6oi Office: 503-362-4641A Fax: 503-790-6304 lrstaller& Desi ner Cert;fSca#ion konn Date: 11' r3 Sewage per nitre Assessor's Nlap'Tarcei Designer: s l�"G• Installer; Address: 120 OoX qb Addre 3 91176�8 On was issued a petrtit to install a idate) + (installer) septic System at ` b�� based or a.design dcawr.by (address) revkc-C� dated I rt �/ (desi�rer} �L I certify that the Septic system -eferenced above was installed substantially according to the desigrt, which May include minor approved charges such as lateral .elocatior, or rile distribution box and;or septic tank. I certify that :he septic system referenced above was installed with major charges (i.e. greater than 10- lateral relocation of the SAS or ant;vertical relocation o`anv compofiM of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to .`ollow. Of DA stalie s iMnature) I o MVITAR11`� (Designer'; Sicrtature) W ( ffis Designer's Stamp Here) PLEASE RETURN TO Br\RySTA$I8 PUBLIC HEALTH I?Iti'ISIOi�t, CERTIFICATE OF CONIPLIANCE WILL NOT BE ISSUEt) UNTIL BOTH TYiIS FORM AND AS-BUILT CARD ARE, RECLIVED BY T14E BAR NSTABLE PUBLIC IUALTH D) VISJOIv. THANI YOU, Q:Hcalth,'Septic.IIpcsignr Cmikar.on Form 3-264doc .. i i • Town of B di nstable P# Department of Regulatory Services • �exr Public Health Division Date AS& ,6 y tee$ 200 Main Street,Hyannis MA 02601 wFFD►M,t 6 t . Date Scheduled � Time Fee Pd. G V Soil Suitability Assess ent fog Sewage Disposal Performed By: DA ('4 el Witnessed By: LOCATION & GENERAL INFORMATION Location Address i Owner's Name ®� � 4 •� Kk � � ��k k�• `y'"k 0`2j,. k � Address q � Assessor's Map/P4rcel: ®a/ 3 Engineer's Name1 �/�� NEW CONSIRU(L.7`ION f REPAIR Telephone# tv P`i 3 n'/ Land Use tJ�ry Y'�� k) Slopes(90) Ny t Surface Stones Land V �' Distances from: Open Water Body / IZAD ft Possible Wee Area ZJO ft Drinking Water Well >Q ft Drainage Way f[ Property Line ' ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) . i i . i i i Parent material(geologic) r°�`�'t�'� gV " el's Depth to Bedrock Depth to Groundwater. Standing Water in Hole:' I Weeping froth Pit Rce � '" •—•- i Estimated Seasonal High Groundwater DtTERM NATION FOR SEASONAL RIIGH WATER,TALE Method Used: ! In. Depth Qb erved standing in obs.hole: _in. Depth h1 Sall nl9ttl9s; P ft. Depth toiweeping from side of obs.hole: in. ©ro,CtOr er Adjustment � ! A ,factor-..,..�� Adj.Clraundwaterlevel.,,,,e, Index Well#� Reading Date Index Well levdl - PERCOLATION TEST D$te------- Time Observation Time at 9" .. Hole# Time at G" Depth of Pere — Ito-* TImL(9"-6 Start Pre-soak Time.@ ") End Pre-soak Rate MinJInch Additional Testing Needed(YIN) Site Suitability Assessment: Site Passed _ Site Failed; Original:.Public iTe'alth Division Observation Hole Data To Be Completed on Back— i • ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conservation Division at least one (I) week prior to beginning. DEEP OBSERVATION HOLE LOG Hole#�_ Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistenc %Gravel 4011- -144►l mzd- .a'<v 2- 5 �� So' DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistenc %Gravel) Lr7�t vYtL4j, 'C': 3l� !✓ • ,A.A DEEP OBSERVATION HOLE LOG Hole# , Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel DEEP OBSERVATION HOLE LOG Hole#L Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency. ra I Flood Insurance Rate Map: Above 500 year flood boundary No Yesl Within 500 year boundary No Yes Within 100 year flood boundary No Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious nuaterial exist.in all areas observed throughout the area proposed for the soil absorption system? &i If not,what is the depth of naturally occurring pervious material? Certification I certify that on ,o I (date)I have passed the soil evaluator examination approved by the Department of Environ ental Protection and that the above analysis was performed by me consistent with the required t g eexppert�ise and experience described in3..10 CMR 15.01 . Signature G� IV Date l Q:\.SEPTIC\PERCFORM.DOC i ROSEL,41,VD TE RR. eon 4=71018'04" R=110.0 L=136.9 0 N HOUSE NO.102 r LOT 4 25,248 SF. N 32.21 N � p�D�IpN `o 60.1 DE�g 20X12' 9 op3 1772 SHED �50 S,9o11/10 e � �s�A oF��9C�c� 10-1 o DAVID CHARLES SANICKI o $ o e 28085 0.9v g SS��NA L ENO ocff Vi certify that the dwelling shown on PLOT PLAN OF LAND this plan is as it actually exists on the LOCATED IN ground and that it conforms to the town of MARSTONS MILLS,MASS. Barnstable zoning re ulationsregarding PREPARED FOR yard setbacks." BRODERICK BUILDERS date. DATE:SEPT.11,2007 SCALE: 1"=30' fl000dod wnzon.11,2007e c[non-hazard] CAPE & ISLANDS ENGINEERING roseland MASHPEE,MASS. 1 y0�?�.'N�O�rnEARNSTABLE LOCATION A02 ��C�1..1�lVCy �9 � SEWAGE VU-LAGE ASSESSOR'S MA.p & LOT &I 4 W, _ INSTALLER'S NAME dz PHONE NO. SEPTIC TANK CAPACT'Y IWO Ci 0' S(I LEACHING FACILITY: (size) NO.OF BEDROOMS BU -DER OR OWNER �-iDATE: C,C, COMPLIANCE DATE: _ Separation Distance Between the: . Maximum AdJjusted Groundwater Table �4 F- , Private Water Supply Well and Leaching Facility (If any wells exist - on site or within 200 feet of leaching facility) �`'� F-, Edge of Wetland and Uaching Facility(If any wetlands exist within 300 fee f le ping facility) Fe=• Furnished by ' t fA � o 31 INN- 0 �- 331` h' 4 5 L O�C Al ION � � /7'dr�iC� S E W A G E PERMIT NO. sd3 -/-C3 VILLA,CE INSTALLER'S NAME A ADDRESS JOHN A. AALTO BACKHOE SERVICE a nu ree WestBarnstable, Mass. 02668 UILDE R OR OWNER DA T E P ERMIT ISSU E D 12 -2 � �® DATE COMPLIANCE ISSUED � ' 50� � � •3y C No.------..(�.. FwE..... D............ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH r4l 4VN..............0F.....j31V1?1V5.1 B1,4 ........................... Appliration -fur Uhipwial Works Tote frnr#iun Vatuit Application is hereby made for a Permit to Construct (X or Repair ( ) an Individual Sewage Disposal System at: AM4S ... _1P'P--...77-�Rl.l. 6 -------------------- ------------ '. ...---------------------.....---------------------------------------------- Location-Address or Lot No. Owner Address W ---.'6,lylu-------/.}%9,LTO---------------------•-•---------------------- �=. .1. ,1 13!'�l►i` '?� .E -------------------------------- Installer Address Q Type of Building Size Lot--------------------------_Sq. feet U Dwelling—No. of Bedrooms-------- _.3--------------------Expansion Attic Garbage Grinder WO aOther—Type of Building -----------_............... No. of persolis---------6--------------- Showers Cafeteria ,V d Pa Other fixtures --------------- -------------- - - W Design Flow.............---!r._...................,gallons per person per day. Total daily flow----��r. -_--.-.._.........._..._gallons. WSeptic Tank—Liquid capacity/00d.-gallons Length................ Width_----------.._. Diameter_----_....._--- Depth---...._.....-. x Disposal Trench— o--------------------- Width_-._......_......_.. Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit N If. - _.4iAl6er---I---- ,7VAt6epth below inlet____________________ Total leaching area------- ----------sq. ft. Z Other Distribution box (K) Dosing tank ( ) ~" Percolation Test Results Performed by----A4.A. .._----17 ........................... Date...V. 40_4�'/ Q......_-. W Test Pit No. 1.._.__ _._--minutes per inch Depth of Test Pit---1;A ....... Depth to ground waterAO-4VR7- LT. Test Pit No. 2................minutes per inch Depth of Test Pit...........____._._- Depth to ground water-._......_...------..__. p; ------------------------------------------------------------------------------------•------•--------........................................................ 0 Desc iption of Soil_e A.'_4GfiM_�FS i ®_f��- _° S' -_ i9C1_S' ....-s Vs .faz_�.._�'�U *�' �! /zl� G '------------------------------------------------------------------ -------------------------- W VNature of Repairs or Alterations—Answer when applicable................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b issued by the rd of health. Sie --------- ----------------- ° �1 Date Application Approved By......---�'� ---1-- -- 7` '----- .. ... -•-f Date Application Disapproved for the following reasons----------- ----•-•------------------•---------................-•-•-----•-----...-----------....--------------- --...----.--•----------------•--•---•---------------•-----------.---------------•---•--------•-------------------------•-•--------•---------------------------------------------------------•---------- Date Permit No......................................................... Issued...'`... ....'.. ------ Date z- l.r/ No. -... P. ....... FE....... ...................... THE COMMONWEALTH OF MASSACHUSETTS t BOARD OF HEALTH .W/.V....... ....... f�/�f yr , e .............................. Applirtttion -fear Biipuitt1 Norkg Towitrurttott rrni t Application is hereby made for a Permit to Construct (X or Repair ( } an Individual Sewage Disposal System at: ` RF AAC ..................... ............ ---------•----•-•--•---------------------------•------------------. . y Location-Address or Lot No. Owner .,. A*yd-ddrress Installer Address d Type of Building Size Lot---------------------------Sq. feet U Dwelling—No. of Bedrooms----.--- .- -Expansion Attic Garbage Grinder40 « � Other—Type of Building ---------------------------- No. of persons--------�--_-.-.------- Showers ,(41e) — Cafeteria A. d) QOther fixtures --•-------------------------------•------------------------------•--••------------------------------------------------------------------------------- w Design Flow...._....... ---------------------gallons per person per day. Total daily flow---- d------_-___-_--_.-..------gallons. WSeptic Tank—Liquid capacit3le4l --_gallons Length................ Width---------------- Diameter---------------- Depth---_-_.-_------ x Disposal Trench—No- ------------------- Width........------------ Total Length--------............ Total leaching area--------------.-----sq. ft. Seepage Pit N A[5 o.._..&i4er...'S;0N4Vepth below inlet---------------_-.. Total leaching area...... -----------sq. ft. Z Other Distribution box K) Dosing tank ( ) aPercolation Test Results Performed by.-_f- /19✓V--.--..Z !!��........... -. Date_ _.--_-__. Test Pit No. 1...-- ......minutes per inch Depth of Test Pit...l92_--.-_----- Depth to group- .water,vo._t t4.7 (14 Test Pit No. 2----------------minutes per inch Depth of Test Pit---..............--. Depth to ground.water........_.._...----..... 9 ......................................................... •-----------------------------------------.......................................------------------ Description of Soil4�'.. �� ✓8 S4 � "" �"" ." --------------------------------------------------------------------------------------- ---- - ---- w V Nature of Repairs or Alterations—Answer when applicable.----------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---_----------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place.the system in operation until a Certificate of Compliance hasb ued by th j)Rand of health. Si ned� -- a f%ay"�""''r�,,r .' ----------- - .e-A ,- , .I,� Date Application Approved BY Gf - '^ ..... ...... - '-- --- 67 Date Application Disapproved for the following reasons:--------- •--------------------•--•-------•-------•---------.............................................. ---•--------------------------------------------------------------------------------------•----------••....-------------•-----------•---••-•---•-•-•--------------------•-•--•-----------------•--•--... Date Permit No......................................................... Issued.`;- '� - --••--•----------- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ✓. ............oF... �!t!- ........................ Tntifirate of Tompliatta THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed X) or Repaired .� ( ) bY•---: W....9h-/_ ?--------------------------------------------.-------------------------------------------------------------- ------------------. Installer at. r -V nm�R - - r }. 1C = lv, ..-./ 1�_/44..3--------... has been installed in accordance with the provisions of c e I of The State Sanitary CA,as described in the application for Disposal Works Construction Permit N .....d� /� Lr` 6.-✓ k.............. dated..- ...1�_..-.1.1r'�t.. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE......... --------- �Ih� --------------- Inspector-- --, �(✓_... ..---- ------- ----- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH C'J'.. ... ..�. �...1U..... ...of ' 3 .$.-------------------------- No G� FEE. ... DisVgtittl Norkii Tontitrurthin ramit Permission is hereby granted/✓ ... 7 to Construct O or Re air ) an Individual Sewage Disposal System at No../_d.r.: _`�___---- `- ...'-4h-fil .._r ^` ".:4}- "" ✓ Street as shown on the application for Disposal Works Construction P y._ ...-`' -_ Dated.. _ _ .:�. -- -- ---- � j.(' `- ---------------------------_ Board of Health&- DATE................................................................................ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS - �",tt.1G•t_� i=nMi[_� '=' 3 'i"�t�tzr�oM �� ::So,. !mac % • 4-9 4.P.o. U ,S- d..sS.. Bc-ll`rom ,oet ._ 5.;o t3G,,� t 1� r, TOT'Al_ VESIGl.I ' �2S G.RD. O, ToTp t_ v,�_:��t' 1-t.s;w - 330 6 P.t�. �� 'Z� g•�� fi'-�r- P>ud R 3 ,�i 5 b �� TANW— 1 I LOAM G✓"PPE l�c� 1►.lv` 77.`00 6 J eI $oI L a <3oX 4G.40 Snc f Z ta1V. ! 'f anlK 1� i WIC IC&O SANDY I C7pt.. �F,5.94 9G.�0 Q A GRAve-L. PIT VI/lr" a WA,I.ikY� I MANrrY C.nSZ-TIFiED PL(!> 1' --�---- L OC A T'10 t-4 M Arc S-ro)A 5 Lam. uo p NO WA TM P- 8/LG/ep ! /z C C I Z T 11=-( T N A T` T!-A C. P'L_131.t`t z iac 11 C L 0 Auto �-L>hCt_ S'CCJcat�'E u.iy O TF-+tZ P-:iw:./K.tad 'RGGtS('L'�PZi_D 1Js.t�lt;1 /sU�'.v'GYc.,s�� Tt-�l5t� Apt t!, 4:lCS`C i�rZir,CU tJ4.1 A� o?Tif~'Vtl..t.l` li-dy!'[�:J.f✓1t�k,4' �tJ-t:�lt�� . �(tai. C i=::�F._C�i 'S��Glz1[L7 A.p L—i GA. Ev F--P,e T'r W+ it t,NA�Jj 4,.1�r t;t: U tz >c, li r�i.► �trt t ill`= 1 o'Y' [_t tiii: 5 - - t is Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for VoluntaryAssessments '( 102 ROSELAND TERR Property Address PALMER Owner Owner's Name information is MARSTONS MILLS required for MA 02648 7/15/07 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. ` "t When filling out A. General Information When forms on the computer,use 1. Inspector: only the tab key to move your DOUGLAS A. BROWN Cj� y`s -i 1 cursor-do not use the return Name of Inspector key. D.A. BROWN Company Name P.O. BOX 145 c Company Address ^� CENTERVILLE AM MA E02632 €�, Citylrown State - Z•Ip Code 508-420-4534 r S14297 .� Telephone Number License Number L'i t-- . B. Certification F- I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 7/15/07 41nspectgnature 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. Title V Inspection Fonn.doc•OWN Title 5 Official Ins pection Form:Subsurface Sewage Disposal System•Page 1 of 15 t 4 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form- Not for Voluntary Assessments F 102 ROSELAND TERR Property Address PALMER Owner Owner's Name information is MARSTONS MILLS required for MA 02648 7/15/07 every page. City/Town State Zip Code Date of Inspection B. Certification (cunt.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 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 ONLY MEETS MINIMUM REQUIREMENTS B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y, N, ND) in the❑for the following statements. If"not determined," please explain. ❑ The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed Title V Inspection Form.doc•Gatos Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 r ♦ A Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 102 ROSELAND TERR Property Address PALMER Owner owner's Name information is MARSTONS MILLS required for MA 02648 7/15/07 every page. Cftyfrown State Zip Code Date of Inspection B. Certification (cunt.) B) System Conditionally Passes(cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed ND Explain: C) Further Evaluation is Required b the q y Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. Title V Inspection Form.doc•08/OB Tide 5 official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 f a / A Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments „ .•�'" 102 ROSELAND TERR Property Address PALMER Owner Owner's Name information is MARSTONS MILLS required for MA 02648 7/15/07 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: ' **This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Title V Inspection Form.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts Title 5 Official Ins pection ecti on lug p Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 102 ROSELAND TERR Property Address PALMER Owner Owner's Name information is MARSTONS MILLS required for MA 02648 7/15/07 every page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 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 16,000 gpd. For large systems, you must indicate either"yes"or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ® the system is within 400 feet of a surface drinking water supply ❑ ® the system is within 200 feet of a tributary to a surface drinking water supply ❑ ® the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. Title V Inspection Form.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 102 ROSELAND TERR Property Address PALMER Owner Owner's Name information is MARSTONS MILLS required for MA 02648 7/15/07 every page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ❑ ® Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] Title V Inspection Fonn.doo•OWN Title 5 Official Inspection form:Subsurface Sewage Disp osal posal System•Page 6 of 15 f - Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 102 ROSELAND TERR Property Address PALMER Owner Owner's Name information is required MILLS re wired for MA 02648 7/15/07 every page. City/Town State Zip Code Date of Inspection D. System Information 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 Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): 05/173 06/126 Sump pump? ❑ Yes ❑ No Last date of occupancy: CURRENT Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): Title V inspection Fonn.doc•0=6 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments '( 102 ROSELAND TERR Property Address PALMER Owner Owner's Name information is MARSTONS MILLS re wired for MA 02648 7/15/07 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed(if known) and source of information: 1999 OFF AS BUILT CARD Were sewage odors detected when arriving at the site? ❑ Yes ® No Title V Inspection Form.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments y` 102 ROSELAND TERR Property Address PALMER Owner Owner's Name information is MARSTONS MILLS required for MA 02648 7/15/07 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑ cast iron ❑40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene El 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: 1000GALLON Sludge depth: HEAVY Distance from top of sludge to bottom of outlet tee or baffle Scum thickness HEAVY Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Tide V Inspection Form.cloc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 102 ROSELAND TERR Property Address PALMER Owner Owner's Name information is MARSTONS MILLS required for MA 02648 7/15/07 every page. Cftyfrown 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.): TANK COULD USE PUMPING Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene y El other(explain): Title V Inspection Form.doc•08/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r� 102 ROSELAND TERR Property Address PALMER Owner owner's Name information is required for MARSTONS MILLS MA 02648 7/15/07 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cont.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Title V Inspection Form.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments y` 102 ROSELAND TERR Property Address PALMER Owner Owners Name information is required or MARSTONS MILLS MA 02648 7/15/07 f every page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System(SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): PIT HAS ABOUT 10" OF USABLE SPACE LEFT Title V Inspection Form.doc•08106 Title 5 Official Insp ection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments '( 102 ROSELAND TERR Property Address PALMER Owner Owner's Name information is required for MARSTONS MILLS MA 02648 7/15/07 every page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of Liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Title V Inspection Form.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 , Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 102 ROSELAND TERR Property Address PALMER Owner Owner's Name information is required for MARSTONS MILLS MA 02648 7/15/07 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cunt.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. IV z 2- � c 3 31 � -3 f Title V Inspection Form.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 102 ROSELAND TERR Property Address PALMER Owner Owner's Name information is required for MARSTONS MILLS MA 02648 7/15/07 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ❑ Check cellar ® Shallow wells Estimated depth to ground water: 15' feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: OFF AS BUILT CARD FROM B.O.H Title V inspection Forrn.doc•08M Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 - 1 Town of Barnstable ` °F THE 1p� Regulatory Services snxxsrnsLE Thomas F. Geiler,Director 639. Public Health Division ArFp��p Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original/copy of this report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observation s and interpretations contained within this report. In addition, by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would-be listed on the"Disposal Work Construction Permit". If you should have any questions regarding this report, please contact the certified Septic System Inspector who conducted the inspection. TOWN OF BARNSTABLE LOCATION 1QZ k)�°e- TJ -2- SEWAGE It i VILLAGE irl) ASSESSOR'S MA.p & LOT O2 is INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACTi YLEACHING FACILn Y: (type (size) NO.OF BEDROOMS BUILDER OR OWNER5�.�_ - -PL-feO. DATE: COMPLIANCE DATE: _ Separation Distance Between the: Maximum Adjusted Groundwater Table Private Water Supply Weil and Leaching Facility (If any wells exist on site or within 200 feet of]caching facility) Edge of Wetland and Leaching Facility(If any wetlands exist i within 300 fcc�Lqf le ping faeiliry) Fe�c Furnished by I 311 I i l �. _.__�- � ,,• COMMONWEALTH OF bLkSSACHL;SETTS ;-o EXECUTIVE OFFICE OF ENVIRONMENTI F.��TF.Sl�o = = C DEPARTMENT OF ENVIRONMENTAL PROECTIO ' - ui ONE NNINTER STREET. BOSTON 1L4 02108 (617) 29 SE�, 17 1999 N TDJhMOFrBAANSTABLE: S HOHi{L Tit DY COXE Secretan �`r'r.i �'ID B STRUHS ARGEO PAUL CELLUCCI Conur ssicner Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM r` PART A CERTIFICATION p �� PropertyAddress: �d7 `�- CQ.�CivxX \r_ Name of Owner Se.p 1V '�\1Wddress of Owner: r Date of Inspection:% � -t� Name of Inspector:1PleaselPrSnt)/ ! I a a�Dt,cc-AC) am a DEP approved system inspector pursuant to Section 15.1I340 of True 5(310 CMR 15.000) Company Name: tgtl r l'2 F L r�r 6%.s e- r^+� F Marring Address:-�,Q A'ni 2 � 7C� F-I��N(�Ft= N� oZ��1 Telephone Number: /4 Z-cQ 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 By the Local Approving Authority FiVs �r Inspector's Signature: � J Date: The System Inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)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 ttre system owner and copies sent to the buyer, if applicable, and the approving authority. NOTES AND COMMENTS revised 9/2/98 P.geIorn h i C� Pr:nrrd on Recycled Pjper .�{ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A ''"` CERTIFICATION (continued) op Address: Address: 'v Vl1{i1 r Jwner: Date.of Inspection: INSPECTION SUMMAR i:• r Check'A, 8, C. Or D: A. SYSTEM PASSES: _AVI have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist. Any failure criteria not evaluated are indicated below. COMMENTS: B. SYSTEM CONDITIONALLY PASSES: One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. 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, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tank was installed within twenty (20)years prior to the date of the inspection: or the septic tank, whether or not metal, is 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 complying septic tank as approved by the Board of Health. _ Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(sl 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 revised 9/2/98 Page 2or11 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: Date of Inspection: C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to deter ine if the system is failing to protect the public health, safety and 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 THE PUBLIC HEALTH/AND SAFETY AND THE ENVIRONMENT: j _ Cesspool or privy is within 50 feet of surface water j Cesspool or privy is within 50 feet of a bordering vegetated wetland or'a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE 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 soil absorption system and the SAS is within a Zone I of a public water supply well. _ The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and soil absorption system and the SAS 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 is of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER revised 9/2/98 Page 3of11 C j SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) property Address: Owner: r Date of Inspection: D. SYSTEM FAILS: You must indicate either"Yes" or "No", to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this determination is identified"below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No \ Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. _ Discharge or ponding f effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS c 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-han 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E. LARGE SYSTEM FAILS: You must indicate either "Yes" or "No" to each of the following: The following criteria apply to large systems in addition to the criteria above: 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: 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) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further information. revised 9/2/98 Page 4ofII ' b SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: Owner: Date of Inspection: Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes No Pumping information was provided by the owner, occupant, or Board of Health. 1( _ None of the system components have been pumped for at least two weeks and-the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. i As 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. 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. 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. The size and location of the Soil Absorption System on the site has been determined based on: Existing information. For example, Plan at B.O.H. _ Determined in the field Of any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) 115.302(3)(b)1 The facility owner land occupants, if different from owner) were provided with information on the propertnaintanaars-0f Subsurface Disposal Systems. revised 9/2/98 Page 5oru SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM. PART C SYSTEM INFORMATION property Address: It)? �r Owner: Date of Inspection: FLOW CONDITIONS RESIDENTIAL: Design flow: �g•P•d.lbedroom. Number of bedrooms (design): Cf Number of bedrooms (actual(:0 Total DESIGN flow Number of current residents: Garbage grinder(yes or no): Laundry (separate system) ( s or no):90: If yes, separate inspection required Laundry system inspected Qjsjbr no) Seasonal use (yes or no): Water meter readings, if available (last two year's usage (gpd): E3 Sump Pump (yes or no):� Last.date of occupancy: COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow: 9pd ( Based on 15.203) Basis of design flow Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non-sanitary waste discharged to the Title 5 system: (yes or no)_ Water meter readings, if available: Last date of occupancy: OTHER:(Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECOR DS and source of.information: ,System pumped as part of inspection: (yes or no)�� If yes, volume pumped: gallons Reason for pumping: F 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) IIA Technology etc. Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components, date installed(if known) and source of information: Sewage odors detected when arriving at the site: (yes or no) revised 9/2/96, Page 6of II SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(confirmed) 'roperty Address: Qz&vr�r-� Owner: Date of Inspection: BUILDING SEWER: VIA (Locate on site plan) Depth below grade:_ Material of construction:_cast iron_40 PVC_other (explain) Distance from private water supply well or suction line Diameter Comments: (condition of joints, venting, evidence of leakage, etc.) SEPTIC TANK: (locate on site plan) Depth below grade:1lQ Material of construction: concrete _metal_Fiberglass _Polyethylene _other explain) If tank is metal, list age_ Is age confirmed by Certificate of Compliance_ (Yes/No) Dimensions: Sludge depth:_ Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: t_�— rj Distance from top of scum to top of outlet tee or baffle:_L_ S. Distance from bottom of scum to bottom of outlet to or baffle: \� 1 How dimensions were determined: MQ Cu, Jomments: (recommendation for pumpin , condition of inlet and outlet tees or baffles. depth of liquid level in relatio to out in art, structural jrftegrity. evidence of leakage, etc.) c t 1 GREASE TRAP: pocate on site plan) Depth below grade:_ Material of construction: _concrete_metal_Fiberglass _Polyethylene_other explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments: (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.) revised 9/2/98 rAgc7ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) 'roperty Address: 't b-Z Owner: Date of Inspection: �' TIGHT OR HOLDING TANK: i' ,V(Tank must be pumped prior to, or at time of, inspection) /1 (locate on site plan) Depth below grade:_ Material of construction: _concrete_metal_Fiberglass_Polyethylene _other(explain) Dimensions: Capacity:___gallons Design flow: gallons/day Alarm present Alarm level: Alarm in working order: Yes _ No_ Date of previous pumping: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:' , (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if Ltvel and distribution 11 eq al, evidence of solids carryovers, evidenc(A1 leakage into or out of box, etc.) PUMP CHAMBER:—L�_-o (locate on site plan) Pumps in working order:(Yes or No) Alarms in working order(Yes or No) Comments: (note condition of pump chamber,-condition of pumps and appurtenances, etc:)_ revised 9/2/98 Page 8ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Yoperty Address: Owner: Date of Inspection: SOIL ABSORPTION SYSTEM(SAS): S (locate on site plan, if possible; excav ion not required, location may be approximated by non-intrusive methods) If not located, explain: Type: leaching pits, number::ld leaching chambers, number:_ leaching galleries, number:_ leaching trenches, number, length: leaching fields, number, dimensions: overflow cesspool, number:_ Alternative system: Name of Technology: Comments: (note condition of soil signs of h draulic failure level of ponding damp so', co ition of vegetation etc.) C. � � CESSPOOLS:S�••L� (locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: )epth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: inflow (cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY:=`o (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.) revised 9/2/98 Page 9of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (contirxied) ''roperty Address: 102 QC)S1Z.Lr1.1j, )wrw: Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) � tOZ L 3 cl- P19 i J i P,7 r Lis revised 9/2/98 Page 10ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) roperty Address: [07, Itox 4,—aIIj Owner: Date of Inspection: NRCS Report name Soil Type_ Typical depth to groundwater _ USGS Date website visited P-u Observation Wells checked Groundwater depth: Shallow Moderate Deep SITE EXAM Slope Surface water t&4) Check Cellar tOAA Shallow wells N4Yi i Estimated Depth to Groundwater_i eet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observed Site (Abutting property. observation hole. basement sump etc.) Determined from local conditions Checked with local Board of health Checked FEMA Maps Checked pumping records Checked local excavators, installers Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) U cstu�c�l.� revised 9/2/98 Page 11of11 MARSTONS MILLS LEGEND —[ �--�- PROPOSED CONTOUR ® PROPOSED SPOT GRADE EXISTING CONTOUR A + 96.52 EXISTING SPOT GRADE W— EXISTING WATER SERVICE TEST PIT SG R +87.0 (op 8G LOCUS MAP i= I I11 LOCUS INFORMATION TITLE REF: 8K 25091 PG 027 I It PARCEL ID: MAP 103 PAR. 113 I It --r SEPTIC SYSTEM REPAIR PLAN LOCATED AT: 88 % it 102 ROSELAND TERRACE MARSTONS MILLS, MA. 1 PREPARED FOR It DEBORAH PALMER -�off• .0 '; I ��• 90 ' +gg I \ JANUARY 8, 2012 i OF Mqs L TH=y oyp � �Qy f9c •v, + I DA M. 15' j t• 1140 as00•� REGISTER .£4NITAR�I'� l j� T13M = EL. 90.5 I TOP OF STOOP +92.5 L(5151eTe 1 000 PIT MEYER & SONS, INC. Note 10) 000 GAL 90 EXIST. I , SEPTIC TANK P.O. BOX 981 EAST SANDWICH, MA. 02537 (508)362-2922 SCALE 1"=30' SHEET 1 OF 2 J 1491 Vzv - i al 13 ELEV. TOP FOUNDATION " NOTE: METAL RINGS AND COVERS TO GRADE OVER ALL COMPONENTS y (Existing) FINISHED GRADE (90.0) = 90.00 F.G.EL: 89.1 F.G.EL: 89.0 F.G. EL: 90.0 3 :d MAINTAIN 2% MIN SLOPE OVER LEACHING AREA VENT A' .Y F.G.EL: 87.75 2" OF 3/8" DOUBLE WASHED 3/4" - 1-1/2" STONE OR FILTER FABRIC DOUBLE WASHED STONE 4" SCH 40 PVC d 10"I jWE ®®®• 0 ®®®® 14" 6 @IINIV.85.80 1% (MIN.) ®®®®®®®®®® TEE'S ARE TO BE INV.86.0 F ®4" SCH 4o PVC 2 E F. DEPTH ®®®®®®®®®® INV.86.50 q' 2 X 8.5' 4' GAS PROPOSED DB-3 EXISTING ouTLET BAFFLE EFFECTIVE LENGTH = 25' DISTRIBUTION BOX INV. 86.75 INV. ELEV.= 85.65 PROPOSED 1,500 GALLON SEPTIC TANK GAS BAFFLE TO BE INSTALLED ON ��` OF �Assq BREAKOUT OUTLET TEE AS MANUFACTURED BY ``DA M. �y� ELEV.= . 86.65 TUF-TITE, ZABEL, OR EQUAL TOP CONC. ELEV.= 86.65 NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING 114 INV. ELEV.= 85.65 �®®� ®® ®13 13 I®®®® PIPE INVERTS PRIOR TO CONSTRUCTION ®®®®®®® 2) D-BOX SHALL BE SET LEVEL AND TRUE TO 'PEA/SjER ®®®®®®® GRADE ON A MECHANICALLY COMPACTED SIX NITAR\p� BOTTOM EL.= 83.65 0=10EBUS�UUM= INCH CRUSHED STONE BASE, AS SPECIFIED IN G` 3.75' 5 FT. 3.75' 310 CMR 15.221(2) L 3) REPLACE EXISTING 1,000 GALLON SEPTIC TANK EFFECTIVE WIDTH = 12.5' WITH 1500 GALLON SEPTIC TANK IF FAILED, SEPARATION 5.75 FT. DAMAGED, NOT H2O LOADING, OR UNDERSIZED. SEPTIC SYSTEM PROFILE SOIL ABSORPTION SYSTEM (SECTION) 4) INSTALL INLET & OUTLET TEES W/ BOTTOM OF TESTHOLE EL: 77.90 ) GAS BAFFLE AS REQUIRED (500 GALLON (H20) LEACH CHAMBER) GENERAL NOTES: SOIL LOGS DESIGN CRITERIA I. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL p : 13828 BOARD OF HEALTH AND THE DESIGN ENGINEER. NUMBER OF BEDROOMS: 3 BEDROOOM 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS DATE: DECEMBER 27, 2012 SOIL TEXTURAL CLASS: CLASS I (0.74 GPD/SF) OF THE STATE ENVIRONMENTAL CODE, TITLE V. AND ANY APPLICABLE DESIGN PERCOLATION RATE: <2 MIN/IN LOCAL RULES AND REGULATIONS, EXCEPT AS NOTED BELOW: SOIL EVALUATOR: DARKEN MEYER, R.S., CSE #1614 -310CMR15.405(1)(b): WITNESS: DONALD DESMARAIS, BARNSTABLE B.O.H. DAILY FLOW: 110 G.P.D. X 3 BR DESIGN FLOW: 330 G.P.D. 1) A 0.35 FT. VARIANCE FROM 310CMR15.221(7) TO ALLOW GARBAGE GRINDER: NO (not designed for garbage grinder) LEACHING TO BE 3.35 FT. BELOW GRADE VS. REQ'D 3 FT. (H20/VENT PROVIDED) SEPTIC TANK: 330 gpd x 200% = 660 gpd, USE EXISTING 1,000 GAL. SEPTIC TANK Elev. TP-1 Depth Elev. TP-2 Depth 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE 89 90 A 0" 90.10 A 0" (330) = 445.94 S.F. DESIGN ENGINEER. LOAMY 10YR/2 L tOAM�r S�o LEACHING AREA REQUIRED: 74 .4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING 89.15 9' 89.35 9' ENGINE ROBEFOREWCONSTRUCTIEREON ON CONTINUES.REPORTED TO THE DESIGN B LOAMY SAND B LOAMY SAND USE TWO (2) 500 GALLON (H20) PRECAST LEACH CHAMBERS W/ 4' 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. 86.57 10YR 6/6 40" 86.77 10YR 6/6 40" STONE ON SIDES & 3.75' STONE ON SIDES: 25' L x 12.5' W x 2'D 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF C C BOTTOM AREA: 25 x 12.5= 312.5 SF THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. MEDIUM- MEDIUM- SIDE AREA: (25 + 12.5) X 2 X 2 = 150 SF 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. COAR8. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED PC ® EL 85.23SANO COA RSE TOTAL SQUARE FEET PROVIDED = 462 vs. 445.94 REQ'D TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. DESIGN FLOW PROVIDED: 0.74(462 S.F.) = 342.25 G.P.D. vs. 330 G.P.D. req'd 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE 2.5Y 7/4 2.5Y 7/4 THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING CONSTRUCTION. PROPOSED SEPTIC SYSTEM UPGRADE PLAN 10. EXISTING LEACHING TO BE PUMPED, CRUSHED AND REMOVED PER TITLE 5. REPLACE WITH CLEAN MEDIUM SAND PER TITLE 5 SPECIFICATIONS. 77.90 144" 78.10 144" 102 R 0 S E LAND TERRACE, M. MILLS, MA 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION PERC RATE <2 MIN/IN. (*Cl' HORIZON) Prepared for: Palmer 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY NO GROUNDWATER OBSERVED AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY Engineering by: Surveying by: SCALE DRAWN 13. NO PRIVATE WELLS WITHIN 150' OF PROPOSED LEACHING. • I, Darren M. Meyer, R.S., CSE, hereby certify that I am currently approved by MADEP pursuant to 310 CMR 15.017 MEYER&SONS,INC. �� Assoc N.T.S. DMM to conduct soil evaluations and that the above analysis has been performed b me consistent with the PO BOX 981 14. NO WETLANDS WITHIN 100' OF PROPOSED LEACHING. Ne� y (508) 375-0735 DATE CHECKED SHEET NO. requirements of 310 CMR 15.017. 1 further certify that 1 have passed the Soil Eval. Exam in October, 1999. EAST SANDWICH,MA 02537 15. ALL PIPING TO BE 4" SCH 40 0 1/8"/FT (UNLESS SPECIFIED) 508-3622922 01/08/13 DMM 2 Of 2 Rev _ d :p L`•B- . /�/�D/'OSE•1� � �-7• �41�1�/T/DN � P s'` N p,� I ! �D -z�- �E-iP .9S- B�//�• T I PL i?6c6f Eit/c 6 BODk 2,10 ,0K5;E 3,/ 1�EE.l� �PEfE,��c%E L30D�' 2Bs�3/ � 202 �L O7 /'L��/ F-^ L /4/1/0 ASS,•SS d R S f /14,4 03 Pf�9 fC ,5L //3 o P. k /�2 i9CE DOYLE,nr -. No.33589 so 2z2l<� sup ll/oh/ 160/4:15, Pis ,5,;019-S42-/99�4 F/I.�r�oUT/; /1�i9 OZS3G I" 24'. 10 .(ADDITION) (EXISTING) NOTES: 1.) CONTRACTOR IS TO VERIFY ALL EXISTING CONDITIONS .w tr.n• T'-0^ s•a• 5•-0'• &DIMENSIONS IN THE FIELD 2.) CONTRACTOR TO VERIFY ALL INTERIOR&EXTERIOR MATERIALS, DETAILS,&FINISHES IN THE FIELD WITH OWNER 3 3.) ALL CONSTRUCTION TO CONFORM TO 780 CMR MASSACHUSETTS A4 STATE BUILDING CODE,8TH EDITION AMENDEMENT&IRC2009 A ANDERSEN 4.) 110 MPH EXPOSURE B WIND ZONE I BAY WINDOW 5.) ALL SHEETS OF PLYWOOD WALL SHEATHING TO BE INSTALLED VERTICALLY, OR HORIZONTALLY W/BLOCKING AT EDGES,3"EDGE/12"FIELD NAILING EXIST. EXIST. EXIST 6.) ALL LVL LUMBER/BEAMS TO BE 1.9e U360 LOAD m _J� 7.) FOLLOW ALL MANUFACTURER'S SPECIFICATIONS FOR INSTALLATION OF ALL SIMPSON COMPONENTS 5 --- 8.) ALL CONCRETE USED FOR FOUNDATION WALLS,FOOTINGS&SLABS NEW O EXIST. TO BE 3000 PSI DINING OFFICE 9.) TIMBER FRAMING TO BE SPRUCE/PINE/FIR NO.2 GRADE II oc)jj EXIST. jA j lL------ Z' EXIST. KITCHEN IECC2012 RESIDENTIAL ENERGY EFFICIENCY DETAILS FIRE I EXIST. CLIMATE ZONE 5A(USE EITHER PRESCRIPTIVE VALUES OR RESCHECK CALCULATION RATED DOOR - TABLE 402.1.1(MINIMUM PRESCRIPTIVE INSULATION&FENESTRATION REQUIREMENTS) OPTIONAL HALL BUILT-IN = eMEnErrr wnu eaSK Sue �ntE oI NEW CABINET _ _ ON.w !}F tBOPFT.oEEvl "a GARAGE 2'9'x6.9• 4.ao e e m do NOTES: (4'CONC.SLAB WI6 x 6 W WF - MESH EMBEDDED,SLOPE T' 61.Ft-VALUES ARE MINIMUMS 8 U-FACTORS ARE MAXIMUMS. TOWARDS DOOR ON 2.15/19 MEANS R-15 CONTINUOUS INSULATED SHEATHING ON THE INTERIOR OR EXTERIOR COMPACTED SOIL W/6 MIL HOOKS OF THE HOME OR R-15 CAVITY INSULATION ATTHE INTERIOR OF THE BASEMENT WALL POLY UNDERNEATH) s 3.REFER TO IECC 2012 CHAPTER 4 FOR ALL INSULATION 8 ENERGY REQUIREMENTS A ~ TEMPERED AND RSEN EXIST.NEW ® ® N242 LIVING L S. y EXIST. PORCH BEDROOM O UP 5 - © Sr F�SrCiLOS. TT.T0^O.H.DOOR W/ RANSOM TO'.T(I'O.H.DOOR W/TRANSOM EXIST. EXIST. EXIST. A RO A APRON I A A4 2•-a• v-0• z-o•• s•-0^ 2•a- r-s•• 3.10^ 4'IV 24•4" a•-0. 32•-0'. NAILING SCHEDULE (ADDITION) (ADDITION) I ) 110 MPH EXPOSURE B WIND ZONE JOINT DESCRIPTION NO. OF COMMON NAILS NO. OF BOX NAILS NAIL SPACING FIRST FLOOR PLAN ROOF FRAMING: BLOCKING TO RAFTER(TOE NAILED) 2-8d 2-10d EACH END RIM BOARD TO RAFTER(END NAILED) 2-16 d 3-16d EACH END WALL FRAMING: TOP PLATES AT INTERSECTIONS(FACE NAILED) 4-16d 5-16d AT JOINTS STUD TO STUD(FACE NAILED) 2-16 d 2-16d 24"D.C. HEADER TO HEADER(FACE NAILED) 16d 16d 16"D.C.ALONG EDGES ®HEAT DETECTOR Q SMOKE DETECTOR FLOOR FRAMING: JOIST TO SILL,TOP PLATE OR GIRDER(TOE NAILED) 4-8d 4-10d PER JOIST QC CARBON MONOXIDE DETECTOR BLOCKING TO JOISTS(TOE NAILED) 2-8d 2-1 Od EACH END BLOCKING TO SILL OR TOP PLATE(TOE NAILED) 3-16d 4-16d EACH BLOCK LEGEND: LEDGER STRIP TO BEAM OR GIRDER(FACE NAILED) 3-16d 4-16d EACH JOIST JOIST ON LEDGER TO BEAM(TOE NAILED) 3-8d 3-1 Od PER JOIST 0 EXISTING WALLS BAND JOIST TO JOIST(END NAILED) 3-16d 4-16d PER JOIST CONSTRUCTION TO BE REMOVED BAND JOIST TO SILL OR TOP PLATE(TOE NAILEDO 2-16 d 3-16d PER FOOT NEW CONSTRUCTION ROOF SHEATHING: WOOD STRUCTURAL PANELS(PLYWOOD) RAFTERS OR TRUSSES SPACED UP TO 16"o.c. 8d 10d 6"EDGE/6"FIELD RAFTERS OR TRUSSES SPACED OVER 16"D.C. 8d 10d 4"EDGE/4"FIELD GABLE END WALL RAKE OR RAKE TRUSS W/O OVERHANG 8d 10d 6"EDGE/6"FIELD GABLE END WALL RAKE OR RAKE TRUSS 8d 10d 6"EDGE/6"FIELD W/STRUCTURAL OUTLOOKERS GABLE END WALL RAKE OR RAKE TRUSS W/LOOKOUT BLOCKS 8d 10d 4"EDGE/4"FIELD CEILING SHEATHING: GYPSUM WALLBOARD 5d COOLERS — 7"EDGE/10"FIELD WALL SHEATHING: WOOD STRUCTURAL PANELS(PLYWOOD) STUDS SPACED UP TO 24"o.c. 8d 10d 6"EDGE/12"FIELD 1/2"&25/32"FIBERBOARD PANELS 8d 3"EDGE/6"FIELD 1/2"GYPSUM WALLBOARD 5d COOLERS — 7"EDGE/10"FIELD FLOOR SHEATHING: WOOD STRUCTURAL PANELS(PLYWOOD) V OR LESS THICKNESS 8d 10d 6"EDGE/12"FIELD GREATER THAN 1"THICKNESS 10d 16d 6"EDGE/6"FIELD THE DESIGNER SHALL BE NOTIFIED IF ANY � OR OMISSIONS ARE FOUND COTUIT BAY DESIGN, LLC NEW ADDITION/REMODELING FOR• ERRORSCTION. HEBUIDINGCONTR SCALE : DRAWINGNO.: THESE DRAWINGS PRIOR TO START OF CONSTRUCTION.THE BUILDING CONTRACTOR 43 BREWSTER ROAD WILL BE RESPONSIBLE FOR THE CONTENT 1/411 _ 11_011 MASHPEE,MA. p02649 IN BUTLER RESIDENCE PH.(SOH)274-1166 CTHESE DRAWINGS MENCEWTT'HOIFCONSTRUCTION d`I �] COMMENCES WITHOUT NOTIFYING THEDESIGN Al FAX(508)539-9402 OF THE ER OF ANY ERRORS OR OMISSIONS. OWNER NOTED.ANV OTNERU EOF THESE DRAWINGS ARE SOLELY FOR THE USE DATE : 102 ROSELAND TERRACE MARSTONS MILLS MA ARC ITECTU NGS REQUIRES TREwRRTEN CONSENTOF THE DESIGNER UNDER THE 8/31/2015 1 ACT OF 1990.RAL COPYRIGHT PROTECTION EXTEND EXISTING CHIMNEY EXTEND EXISTING CHIMNEY III TO To"ABOVE NEW RIDGE TO SO"ABOVE NEW RIDGE CONT.RIDGE VENT • TYPICALASPHALT 12 ROOF SHINGLES FLASHING AT B tEXTN- ENDED CHIMNEY YTOP DF21AIE /\ i\ / \\\\ TQP oaL9 2 C 12� ti f` 1 x 8 FASCIA 8 FRIEZE BOARDS SECOND FLOOR S SEC NO FLOOR UBF_LOOR SUBFLOOUBFLOOR TOP O_F PLATE TOP OF PLATE ' AZEKix511 x6 O ❑ � ® � � ❑ O CORNERBOARDS EIE]DE F NEWCEDAR OR HARDIPLANK CLAPBOARDS TO 'S MATCH EXISTING L.RBT FLOOR ��E � 0 0 FIRST FLOOR F100R �a� =Ma SUBFLOOR VERIFY O.H.DOOR MFR.&STYLE W/OWNER FRONT ELEVATION RIGHT SIDE ELEVATION CONT.RIDGE VENT TYPICAL ASPHALT ROOF SHINGLES 12 I x8 PASDW& B� FRIEZE BOARDS TOP 9F.PL61F \ TOP OF PLATE AZEK 1 x4 WINDOW 12 &DOOR TRIM C 12 R I 9 R t` SECOND FLOOR SECOND FLOOR SUBF_LOOR SUB FLOOR TOP OF PLATE TOP OF PLATE ® ® , AZEK1x5/1 x8 t7 ❑ ❑ CORNERBOARDS T iflm a W.C.SHINGLE SIDING 8' TO WEATHER FIRST FLOOR a FIRST FLOOR SUBF�0� I SUBFIOOR OR REAR ELEVATION LEFT SIDE ELEVATION THE DESIGNER SHALL BE NOTIFIED IF ANY ®� ERRORS COTUITBAYDESIGN, LLC NEW ADDITION/REMODELING FOR. TION. HEBUILDNGCONTR SCALE : DRAWING NO.: THESE DRAWINGB PRIOR TO START OF 43 BREWSTER ROAD WILL BE I RESPONSIBLE FOR CONTRATTOR IL MASHPEE,MA. 02649 g U T L E R RESIDENCE C THESE DRAWINGS IF CONSTRUCTION 1/4" - 1'-0 PH.(508)274-1166 THESE RAWN S ARE SOLE Y FOR TH A2 FAX(50A)539-94 6 DESIGNEROFANYERRORSOROMISSIONS. THESE DRAWINGS ARE SOLELY FOR THE USE DATE : 102 ROSELAND TERRACE MARSTONS MILLS MA CONSOF ETOFTHEDESIGNE DTHERDBEGF THESE DRAWINGS REQUIRES THE WRITTEN CONSENT OF THE DESIGNER UNDER THE 8/31/2015 ACT ARCHITECTURAL COPYRIGHT PROTECTION ' In�uril r Inu.•iiv r I—I IN,) 2-0 22-0" .� (NEW SHED DORMER) A 6 A4 A4 I ANDERSEN ANDERSEN ANDERSEN TW2442 '^ 2 TW3442 O4ON D EXISACCESS VELUX MASTERPANEL VSMO4BATHSKYLIGHT( ABOVE-----NEW ---- �® 28 x68- SITTING ROOM $ rsuuTEoANDERSEN O PULDOWNTW2442 (STAIR EXIST. NEW ---J BEDROOM §y - UNFINISHED ---------- STORAGE FLUX l Iv:amo9 S{YLIGHT EXIST. %'nmcnxu nxa,aurm,c °�w'°r<"vnrl m,m�w¢n ACCESS A30VE W.I.C. PANE( I I rx --1-------------.� _ ._ -- ------I----- I �KYLIGHT I SKYLIGHT m,r.r,iy ru><v.nax mv. 4 - L----ABOVE _----J �BOVE I I ACCESS I ACCESS PANEL PANEL b iY lw ecu"'�oolml .••4 A4 O.H. DOOR DETAIL SIDE ELEVATIDN A 6'W L6'-0" A4 NO SCALE 24— 10'-0- 32-."x (ADDITION) (EXISTING( SECOND FLOOR PLAN 3T-0"t ) A4 A4 ------- --- — — — — DROP TOP OF FOUND. AT DOOR NEW 91I2"ENGINEERED JOI TS I I I I SAWCUT 31V OPENING IN EXIST.FOUNDATION FOR ACCESS INTO NEW NEW CRAW-SPACE I NOTE:DROP TOP OF NEW FOUNDATION I I - � EXIST. TO MATCH NEW SUBFLOOR W/THE I I CRAWLSPAC �° BASEMENT EXISTING SUBFLOOR,NERIFY IN FIELD Yo IF REQUIRED). I I (2'CONC SUB WI 6 MIL POLY VAPOR IxSi BARRIER UNDER) NEWS"GONG. I ' FOUND.WALLS I I cj �0NEW EXIST, GIRT -0--____ NEWSx18" 6b "< CONC.FOOTINGS GARAGE 19"CONC.SLAB W/6 x 6—F MESH EMBEDDED. LOPE 2 TOWARDS DOOR ON r COMPACTED SOIL WI6 MIL Lr POLY UNDERNEATH) — — — _ I I I L EW P.T.2 x 6's 016"o.c- 16" INSTALLS/S"ANCHOR BOLTS AT 24"c.c.MAX ® ® - WISIMPSONBPS HIN REARING PLATES I DROP TOP OF FOUND. I PLACE BOLTS WITHIN MI 16"OF EACH AT O.H.DOORS E -P.T.2 z 8 7EXIST.FOUND,WALLS A O 6" 9' CORNER AND TOAB"MINIMUM DEPTH I I Y FOOTINGS TO REMAIN UP I I l o - -- I —L-- ------- — ----------J J I I I A 2d"o.c. CONC. NEW 10" A DI CONC. APRON SONOTUSESTO D 2-P.T.2x6SILLWISEALER B 4'0"SELGWGRADE f SIMPSO STHO14 STRAP PER SIMPSON STM014 STRAP PER A4 - O.H.DOOR R DETAIL A O.H.DOOR DETAIL A4 24'-0" 10'-0" 37-0 x ANCHOR BOLT DETAIL SCALE:1/2"=1'•0" FOUNDATION PLAN THE DESIGNER SHALL BE NOTIFIED IF ANY ERRORSCOTUIT BAY DESIGN. LLC THESE D�WINGS WIN SSIONS ARE ORTOSTART F SCALE : DRAWING NO.: C� NEW ADDITION/REMODELING FOR: THESEDRAWN.THE PRIORDIS7ARTOF 43 BREWSTER ROAD WILLE RESPONSIBLE FOR ITHE CONTENTTOR MASHPEE ,MA. 02649 IN THESE DRAWINGS IF CONSTRUCTION 1/41I= 11-OIL ) BUTLER RESIDENCE COMMENCES WITHOUT NOTIFYING THE FAX(O8$)539-9402 DATE DESIGNER OF ANY ERRORS OR OMISSIONS THESE DRAWINGS ARE SOLELY POR THE USE A3 � 102 ROSELAND TERRACE MARSTONS MILLS MA OF ARCHITECTURAL NOTED.ANY ER - D THESE DRAWINGS REQUIRES THE WRITTEN CONSENT OF THE DESIGNER UNDER THE g/31/2015 ACT FE99U RAl COPYRIGHT PROTECTION I ------- -2.10 ROOF RAFTERS®16"o.c. -518-COX PLYWOOD ROOF SHEATHING -ASPHALT ROOF SHINGLES SOLID BLOCKING IN THE .15LB.FELT PAPER OUTSIDE TWO JOIST I I -HI-R BATT INSULATION e BAYS AT 48"o.c. 2.6'a®16"o.c. 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USE SIMPSON H 2.5 HURRICANE CLIPS AT ALL RAFTERS ENDS 24'-0" 10'-0" 324"i (ADDITION) (ADDITION) (EXISTING) 3.)VERIFY GUTTER TYPE/LAYOUT W/OWNERS THE DESIGNER SHALL BE NOTIFIED IF ANY � COTUITBAYDE$IGN, LLC NEW ADDITION/REMODELING FOR: ERRORS CTION. HEBUIDINGCONTR SCALE; DRAWING NO.: THESE DRAWINGS PRIOR TO START OF 43 BREWSBA ROAD CONSTRUCTION. ISL FOR CONTENTOR 1/4L — 1 -011 WILL BE RESPON518LE FOR THE CONTENT TRUCTION MASHPEE,MA. 02649 R IN THESE THEDES AA PH.(508)274-1166 BUTLER RESIDENCE THESE DRAWNGSARE SOLELY FOR THE USE �� FAX(50 )539-9402 OF THESE DRAWINGR OF ANYS ERRORS OR OMISSIONS. 102 ROSELAND TERRACE MARSTONS MILLS MA CONSE OMER TOFTHEOTED,ANY IGNERUNERTEOF DATE THESE DRAWINGS REQUIRES THE WRITTEN CONSENT OF THE DESIGNER UNDER THE g/31/2015 ' ARCHITECTURAL COPYRIGHT PROTECTION ACT OF 1990. A5 W a O �WGWC Haa NEW �D DECK as I I E_L U) 0000 Lo --t]7. O cr) -------- ANDERSEN . .. - A FWGGD6SL I I 'NEW - '� - 11 61N III 0 0 RANGE a-RI MOD. • W. RANGEE � NEW a NEW I°^ I; KI�fCHEN I;)k, L--W IFT KRCMEN I; ; OFFICE DINING I LAJOUTWIOWNEMII-;IF;I EXIST. Z . - - 111 ` _- '(FORMER BEDROOM) ry - - A - i I ISLAND � T- - L_ _ B L REF - .- STEEL FIRE j: i ----- XIST. RATED DOOR P_ OPTIONAL,I I ..N I HALL BU LTJN 4 F .. § NEW - s e GARAGE �.e9 - (4•CONC.SLAB - - - SLOPE Z'TOWAN05 - - DOOR) A� I - z - _ ... EXIST. TEMPERED A I EXIST. ) LIVING I I E"NEW PORCH UP - . - - 9W z ITT O.H.DOOR W/RANSOM W•rO-O.H.DOOR W/TRANSOM - B NEW NEW NEW . - APRON .. - .. Fz ��•-i (ADDITION) tAD ON) w O H 'FO.'il FIRST FLOOR PLAN Q EXIST.FIRST _y w EXPANDED SECOND FLOOR 830 S.F. - NOTES. WINDOW SCHEDULE - NEW FIRST SECONLOORFLO 185S.F. NEW SECOND FLOOR = 885 S.F. 1.) CONTRACTOR IS TO.VERIFY ALL EXISTING CONDITIONS .. ' - NEW GARAGE = 576 S.F. - &DIMENSIONS IN THE FIELD TYPEMANUFACTURER'S UNIT— ROUGH OPENING -- -REMARKS — - 2.) CONTRACTOR TO VERIFY ALLINTERIOR&EXTERIOR MATERIALS, W-I 11.4 A ANnFR-,r-N TW 11.7. 2'-6 1/8"x 4'-5 1/4" -_DOUBLEHUNG - DETAILS,&FINISHES IN THE FIELD WITH OWNER- B C 335 V-0 3/8"x T-5'3/8" i CASEMENT ©SMUKE DETECTOR 3.) ROUGH OPE14ING I ICAD I ICICIIT OF WINDOWS AT I• C VS 304 2'-6 1/2"x 3'-2 VT SKYLIGHT(VENTING) � � � � FIRST FLOOR TO BE 8'-Ur ABOVE SUBFLOOR - h� F••I--1 Q CARBON MONOXIDE DETECTOR O 1.CONTRACTOR TO VERIFY ALL WINDOWS WITH OWNER AND ROUGH OPENINGS 4.).'ALL CONSTRUCTION TO CONFORM TO 780 CMR MASSACHUSETTS W -WITH WINDOW MANUFACTURER PRIOR TO ORDERING OF WINDOWS - LEGEND. _ STATE BUILDING CODE' I—I 2.VERIFY ROUGH OPENING SIZES OF EXISTING WINDOWS TO BE REPLACED -. 5.) CONTRACTOR TO REMOVE EXISTING DOORS,WINDOWS, - ORDER ANDERSEN WINDOWS TO FIT THESE OPENINGS. 0 EXISTING WALLS WALLS,&ROOFING AS REQUIRED FOR NEW CONSTRUCTION. CONSTRUCTION TO BE REMOVED 0.) ALL CONCRETE USED FOR FOUNDATION WALLS,FOOTINGS&SLABS SCALE NEW CONSTRUCTION TO BE.3000 PSI&FIBER MESH EMBEDDED IN SLAB . 7.) VERIFY ALL PLUMBING&ELECTRICAL DETAILS IN THE FIELD W/ - - - CONTRACTOR,SUBCONTRACTORS,&OWNERS _ - B.) NEW ANDERSEN WOODWRIGHT WINDOWS TO BE INSTALLED AT DATE EXISTING ROUGH OPENINGS WHERE INDICATED .- 9.)'VERIFY ALL FLOORING MATERIALS W/OWNERS 2/16/2007 JOB NO. PALMER - THE DESIGNER SHALL BE NOTIFIED IF ANY DWG. N0. ' .ERRORS OR OMISSIONSARE FOUND ON C I THESE DRAWINGS PRIOR TO STARTOF - - CONSTRUCTION.THE BUILDING CONTRACTOR . INL ESRESPON GSI FOR THE C TtO Nf INTHESEDRAWINGSE CONSTRUCTION COMMENCES WITHOUT NOTIFYING THE DESIGNER OF ANY ERRORS OR OMISSIONS. REVISED: `/c p THESE DRAWINGS ARE SOLELY FOR THE USE A 1 REVISED: U/1/2007 THESE DRAWINGWNER NEOD.URE THE WRISEOF V THESE DRAWINGS REOUIRR,THE WRITTEN CONSENT OF THE DESIGNER. EXTEND EXISTING CHIMNEY - y Q �I�y CONT.RIDGEVENT . . TO OV MOVE NEW RIDGE H H NN TYPIOALASPHALT A . 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' - TYP.2x 4 WAUS 18 BED MOLD x 6 OR,x B RABBETED FRIEZE BOARD L---- PALMER c BUILDING SECTION Q BEDROOM/OFFICE DETAIL AT ROOFMALL A5 SCALE:112"=T•o" DWG. N O.AREVISED: 8/1/2007 5 l 1 tan sz.va - PAW-Al W�OMy W O Aa � A 6 C �E- V) -t Ct] W W W C\2 O 1 F O 0ce) Lo io Tll 4F Man LK MEAN - -- 4 - a w o s I U) 0 MULn LK BEANt• !-1 00 NEW MULn LKHEADERATO.I4 DDDR6 .B .. - (D .. - C _ A U) . SECOND FLOOR FRAMING PLAN . (ADDITION (ADDITION . (NEW SHED DORMER) A B E- . .. - - - - - ,� W 58 O _ Q 4 N E EW? SCALE — I — — — — — — — — — — DATE 2/16/2007 a ,�o JOB NO. B PALMER . A A NOTES: A5 _ A5 DWG• N O 1.) ALL ROOF RAFTERS TO BE 2 z 10'sUNLESS •� - za xan zn OTHERWISE NOTED 2.) USE SIMPSON H 2.5 HURRICANE CLIPS Tau � (NEw S1 ooRMER) AT ALL RAFTERS ENDS 24J �aW � -tvn sza.: .. - (ADDITION (ADDITION (EwsnNE> 3.)VERIFY GUTTER TYPE/LAYOUT W/DWNERS A6 ROOF FRAMING PLAN REVISED:. 8 1 2007 Fj