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HomeMy WebLinkAbout0190 SCHOOL STREET - Health 190 School Street . Marstons Mills �.. A= 046-004 ! - I f I II f B I Commonwealth of Massachusetts Title 5 Official Inspection Form I� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 190 School St. Rroperty Address Robert Cleary Owner Owner's Name information is ✓ required for every Marstons Mills Ma. 02648 5-6-21 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 filling out forms A. Inspector Information 5we(53(0s on the computer, use only the tab Michael Sears key to move your Name of Inspector cursor-do not Robert B Our Co INC. use the return Company Name key. Whites Path Company r� Company Address South Yarmouth Ma. 02664 City/Town State Zip Code 508-477-8877 S114430 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes p0N 2. ❑ Conditionally Passes �•��� 's9�'y'% MICHAEL '•:fi= 3. ElNeeds Further Evaluation by the Local Approving Authority x o: SEARS No.SI14430 4. ❑ Fails INS `` 5-6-21 Inspectors Signatur 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 190 School St. Property Address Robert Cleary Owner Owner's Name information is required for every Marstons Mills Ma. 02648 5-6-21 page. Cityrrown 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: ® 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 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. *A metal septic.tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts �R Title 5 Official Inspection Form to Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 190 School St. Property Address Robert Cleary Owner Owner's Name information is required for every Marstons Mills Ma. 02648 5-6-21 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 Commonwealth of Massachusetts Title 5 Official Inspection Form �1� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 190 School St. u� Property Address Robert Cleary Owner Owner's Name information is required for every Marstons Mills Ma. 02648 5-6-21 page. CitylTown 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 i Commonwealth of Massachusetts Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 190 School St. Property Address Robert Cleary Owner Owner's Name information is required for every Marstons Mills Ma. 02648 5-6-21 page. City/Town 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 '/z day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 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.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 18 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 190 School St. u- Property Address Robert Cleary Owner Owner's Name information is required for every Marstons Mills Ma. 02648 5-6-21 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes" to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate "yes" or"no"for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc-rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 Commonwealth of Massachusetts (,p Title 5 Official Inspection Form J. Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u, 190 School St. Property Address Robert Cleary Owner Owner's Name information is required for every . Marstons Mills Ma. 02648 5-6-21 page. C+tyrrown 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: 1 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage 2019-172000 gal 9 ( Y 9 (gPd)) 2020-272000 gal Detail: Sump pump? ❑ Yes ® No Last date of occupancy: PresentDate 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 1. Subsurface Sewage Disposal System Form - Not for Voluntary Assessments .............. 190 School St. Property Address Robert Cleary Owner Owner's Name information is required for every Marstons Mills Ma. 02648 5-6-21 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Nov 2017 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 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 190 School St. �V Property Address Robert Cleary Owner Owner's Name information is required for every Marstons Mills Ma. 02648 5-6-21 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: 4-15-14 #2013-436 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 24"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 Subsurface Sewage Disposal System Form Not for VoluntaryAssessm As sessments 190 School St. Property Address Robert Cleary Owner Owner's Name information is required for every Marstons Mills Ma. 02648 5-6-21 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): i� Depth below grade: 14"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) 1500 If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 gal Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle 28" Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 12" Distance from bottom of scum to bottom of outlet tee or baffle 17" How were dimensions determined? Sludge judge, tape, 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.): 1500 gal tank with inlet tee and outlet tees in place, inlet cover 10" below grade t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 Commonwealth of Massachusetts ,r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 190 School St. Property Address Robert Cleary Owner Owner's Name information is required for every Marstons Mills Ma. 02648 5-6-21 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 t5insp.doc-rev.7/2 6120 1 8 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4 190 School St. u Property Address Robert Cleary Owner Owner's Name information is required for every Marstons Mills Ma. 02648 5-6-21 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 2 outlet pipes, cover at 18" below grade t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 I Commonwealth of Massachusetts p Title 5 Official Inspection Form 1, Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 190 School St. Property Address Robert Cleary Owner Owner's Name information is required for every Marstons Mills Ma. 02648 5-6-21 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: ® leaching chambers number: 3 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: s ❑ 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 Commonwealth of Massachusetts Title 5 Official Inspection Form 10 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 190 School St. Property Address Robert Cleary Owner Owner's Name information is required for every Marstons Mills Ma. 02648 5-6-21 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 3- 500 gal dry wells, chambers are clean and dry with no sign of failure 12. Cesspools (cesspool must be pumped as part of inspection locate on site plan): ) ( P ) 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.): l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 i Commonwealth of Massachusetts :. ,p Title 5 Official Inspection Form l� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 9 p Y rY 190 School St. u� Property Address Robert Cleary Owner Owner's Name information is required for every Marstons Mills Ma. 02648 5-6-21 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 I Commonwealth of Massachusetts Title 5 Official Inspection Form �I' Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 190 School St. Property Address Robert Cleary Owner Owner's Name information is required for every Marstons Mills Ma. 02648 5-6-21 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately Oar O O � a 3 Al — 3qo- a- � 3-aL" Lt5,nsp.,doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 f Commonwealth of Massachusetts Title 5 Official Inspection Form le Subsurface Sewage Disposal System Form - Not for Voluntary Assessments I 190 School St. Property Address Robert Cleary Owner Owner's Name information is required for every Marstons Mills Ma. 02648 5-6-21 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 20'+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: Back yard drops off 20'+with no sign of ground water Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 18 Commonwealth of Massachusetts _. Title 5 Official Inspection Form I4 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 190 School St. Property Address p Y Robert Cleary Owner Owner's Name information is Marstons Mills Ma. 02648 5-6-21 required for every ---- - - - page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist)completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included SAS b� rye //o 6nV0,/wg7�r t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 TOWN',,�jOF BARNSTABLE LOCATION 11 �Y1 `< ��i SEWAGE # VILLAGEt�V�(n h�J ��� ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE N0.mPLAL , `774 SEPTIC TANK CAPACITY "G LEACHING FACILITY: (type) NO.OF BEDROOMS ' BUILDER OR OWNER PERMITDATE: tP 104 COMPLIANCE DATE: 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 3� 2 I �-3 �S3 jouten No. FeeHE COMMONWEALTH OF MASSACHUSETTS Entered in cPUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSE Yes Zipplication for Disposal 6pstem Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 19 b ( 6(. Owner's Name,Address,and Tel.No.1 tea' Assessor's Map/Parcel t f fp �Y`nA" -I- ofL'o" en � Installer's Name Addr ss, d Tel.No. "1"j�—� 33� Designer's Name,Address,and Tel.No. mo ajaAs Type of Building: Dwelling No.of Bedrooms Lot Size Lo!�, 512`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 �rLf 1 2_12 '> Number of sheets Revision Date ki-t Title Size of Septic Tank Type of S.A.S. �►yJ4k� �L,d Description of Soil �+ LOWS 2_F_,4 ? Nature of Repairs or Alterations(Answer when applicable) Date last inspected: 1 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 this Bo d of He ,Q 1 Date Application Approved by a DateZWlYIN Application Disapproved by Date for the following reasons Permit No. Date Issued t " . + Fee No.42 w H COMMONVEALTH OF MASSACHUMETTS Entered in com uter: Yes PUBLIC HEALTH VISION!- TOWN OF`BARNSTABLE,.MASSACHUSETTS ri�ation for is osaY 6pstrm ednstrurtion Permit d�! f �. ( ) Upgrade( Abandon( ) ❑Complete System ❑Individual Components Application for a Permit to Construct( ) ;epair Location Address or Lot No. 19 b ( ZS( . Ow i s Name,Address,and Tel.No. $' 33_W7 2 Assessor,s Map/Parcel q61,4 �q Instal llers Nagte�A�old�rgss,end Tel.No. -11�(-�'�(v. � Designer's Name,Address,and Tel.No. Q1l0A.J�1 14.3-- 1nv_YS� rvvVA caGoy 1 �lai�S Type of Building: Dwelling No.of Bedrooms Lot Size 651 Z sq.ft. Garbage Grinder( ) Other. Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures 3 Design Flow(min.re uired) gpd Design flow provided'. ., �-(S�{ gpd ly Plan Date `Y ` (µ �(�C(�L� Number of sheets, r Revision Date Title Sl`i 2 VY�I►� ' f F r . Size of Septic Tank nI._ I Type of S.A.S. C�l YJ V1rt CG5 Description of Soil I r (OWS-e_?" Nature of.Repairs or Alterations(Answer when applicable) l Date last inspected: �' t 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 operationvantil a Certificate of Compliance has been issued this Bo d of He �.- - h Date -7 � E [ Application Approved by s Date Application Disapproved by Date for the following reasons Permit No: r Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS (Certificate of Compliance THIS IS TO C FY,th the On-site Sew a Disposal system Cons ructed( x) Repaired( ) Upgraded(` ) Abandon )b / ; at 6 A [ .has been cons ct d in a � . with the provisions of Title 5 and the for Disposa System Construction Permit No�� d '�% . Installer Designer #bedrooms Approved de i flow 01 �� gpd �. The issuance o t is pe it�shhAlll n t be construed as gu grantee that the system 'll fu cti de n Date "J Inspector v No. Fee r IE COMMONWEALTH OF MASSACHUSETTS — PUBLIC HEALTH DIVISION - BARNSTABLE,MASSACHUSETTS �iBtJ saI 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair( Upgrade C ) Ab4on( ) System located at b 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:Const c on t be ompleted within three years of the date of this permit. Date Approved by 1 1 5/4/2021 ShowAsbuilt(1700x2200) TOWN OF BAJRNSTABLE LOCATION � � ^ ` "''�{t SEWAGE#;16 13_44350 VILLAGE ASSESSOR'S MAP&LOT INSTALLER'S NAME&PHONE NO.r�01.r�bc 1<:. 774 SEPTIC TANK CAPACITY LEACHING FACII.I'I'Y:(type)�, t NO.OF BEDROOMS —3 BUILDER OR OWNEAMAk R PERMIT DATE: COMPLIANCE DATE: 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 v t Z3z a7 2- �,1 q 3V 3ys e K3 CS:4 C°-3 35 I https://itsgldb.town.barnstable.ma.us:8431/Home/ShowAsbuilt?mp=046004&sq=1 1/1 . Fee NO . THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS applitation for Disposal Epstein Construction Permit Application for a Permit to Construct(4 Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. i CA 0 SCE S i Owner's Name,Address,and Tel.No. SM'$T3-&7 V MARSTOOUS 1711,u-s 1P6gL��r Cttir� �t 3 6Awr Haag dA. Assessor'sMap/Parcel tjb t/ FS vu&NjcA MA Oo?SY7 Installer's Name..Add r and Tel.No. Designer's Name,Address,and Tel.No. S'0g V,ark o STC44€n- HA)q S qa3 sbu,E 6A Type of Building: Dwelling N .of Bedrooms Lot Size 6',5',O Q sq.ft. Garbage Grinder( ) Other Type of Building kr'S No.of Persons `I Showers(, ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date 111 yi-9613 Number of sheets Revision Date Nf l Title :5;7'@ PZA/l. o¢ jnN® Size of Septic Tank /$"00 Type of S.A.S. Cm4mGrits Description of Soil 0-Mr—A ^CoRPS5 .SAAj O +kAU 4, Nature of Repairs or Alterations(Answer when applicable) Date last inspected: jV A Agreement: The undersigned agrees to ensure the construction and maintenance of the afo described on-site sewage disposal system in accordance with the provisions of Title 5 of the Enviro ental Code and not to place a system in operation until a Certificate of Compliance has been issued b this Boar of Health #A6y--. Date Application Approved byDate Application Disapproved by Date for the following reasons r Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certifirate of Compiiante THIS IS TO CERTIFY that the On-s' Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) Abandoned( )by at 1W �, tllas5been cons ct d' Oor e with the provisions of Title 5 and the for Disposal System Construction Permit No d Installer Designer #bedrooms Approved design flow and The'issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector -1R -'J � .... -�ni'rlll�'w. � .., No. Fee ' d Entered in computer: r '1 THE COMMONWEALTH OF MASSACHUSETTS p PUBLIC HEALTH DIVISION - TOWN-OP BARNSTABLE, MASSACHUSETTS Pplitation for loisposaf 6pstem Construction permit Application for a Permitao C,oristruct( )' `Repair`( ) Upgrade( ) Abandon( ) ❑Complete-(System ❑Individual Components . 't vlR�ts r Address, n �elLocation Address or otNo 4 0 W_^'Si l Owner's Name No. Sb$ Tc0� M -s d Per� �`�A3PFATN./u� Assessor's Ma /Parcel CS aow1ch P E-4 A, Q3R S6,73'37�Insta Iler's Name,Address ,an d�Tel.No.-�` Designer's Name,Address,and Tel.No. SOfS-3(p2'S13� S-rEPAZ$a HAA'S y,23 P_av!F &A ', G?yE M a�eMourt s�Rt fl 4� '7S Type of Building: Dwelling No.o Bedrooms Lot Size S c(1 a sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons N Showers(3 ) Cafeteria( ) s Oth r,Fiztures Design Flow(min.required) 94l U gpd Design flow provided �s4 gpd tip"*Plan Date 14��G/'S Number of sheets _' I Revision Date M Title S t 7-E PLRa. OF LAND P,: r Size of Septic Tank /$W Type of S.A.S. C14igrnarl?S Description of Soil 0^E 6 "GOAR Q65 SAN,O +knu& Nature of Repairs or Alterations(Answer when applicable) ti Date last inspected: /J A Agreement: The undersigned agrees to ensure the construction and maintenance of the afo described on-site sewage disposal system irr accordance with the provisions of Title 5 of the Environmental Code and not to place e system' operation until a Certificate of Compliance has been issued b this Board of Health. i d ; Date f, Application Approved by Date Application Disapproved by Date for the following reasons Permit No. Date Issued ---------------------------------- ------------------ -- ----- -- ---f -------- ------------ ---------------------------------- THE COMMONWEALTHbF*IMA SSACHUSETTS BARNSTABLE,MASSACHUSETTS�r 4. , Certificate of Compliance THIS IS TO'CEVTIFY that the On- •e Sewage Disposal system.Constructed-( ) Repaired( ) Upgraded( ) Aband ned.(. )by i °_ s t( _ -• r at t la-' r �, I �"'""�'`` tasSbeen con uct d'n ac ord ce with the provisions of Title 5 and the for Disposal System Construction Permit No ed i Installer Designer #bedrooms Approved design flow gpd The issuance of this permit shall not be construed as#a guarantee that the system will function as designed. a , Date f,. r t/ �` Inspector/_ 3 f' ----- - No. 77 ?6 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS - j Mi osal *pstem Construction 13ermit Permission is hereby gr Re o Construct( Repair�) Up ade( 1/Ab c}o' ) j System located !f I i I 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 ust a co leted within three years of the date of this permit.Do Date Approved by r Town of Boarnstable ..�TME Regu atory Services .�. Richard V. Scali, Interim Director Public Health Division 039. rFa Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-8624644 Fa:: 508-790-6304 Installer & Designer Certification Form Date: -7 l3 20l`� Sewage Permit# W 4 ,3 ssessor's Map\Parcel 41-Iq Designer: STZPf+ A. PE Installer: rn , Address: IZ3 + — ,& 7f' Address: On was issued a permit to install a (date) (installer) o septic system at 190 SC. � 5� , ® based on a design drawn by (address) `JT t-P KN--�, k. ► -A- S, PE- dated It o-f /zc>13 (designer) ` KI certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed ' ance with the terms of the IAA approval letters (if applicable) Cf (Ins er's Signature)C� (Designer's Signature) (Affix esign is Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. QASepticTesigner Ceitification Form Rev 8-14-13.doc Town of Barnstable P# /S Department of Health,Safety,and Environmental Services oF� Public Health Division Date 367 Main Street,Hyannis MA 02601 HARNSTABM • . 1639. ,+� r 2 Ifio/ c.0_uz,Date Scheduled 3 Time�_ Fee Pd. Soil Suitability Assessment for Sewage Disposal Performed Bv: � �� `�� p- � � �� .Witnessed By.: - "' ,0 LGCATIQN & GENERAL;IIVFORMATION �. a A#=0� Si m 6 Location Address � �' d Owner's Name A,�—y-SE`" ye5�j A4 Address Assessor's Map/Parcel: cEiG,f �cfi Engineer's Name NEW CONSTRUCTION y/ REPAIR Telephone# Sc>k 34Z 8iJ2r Land Use /��59 '+—''n of—e Slopes(%o) l.0 61e3 Surface Stones A--Y Distances from: Open Water Body ft Possible Wet Area It Drinking Water Well ft Drainage Way ft Property Line ft Other -- It SKETCH:(Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands in proximity to holes) .,..meµ`„'*n,�"+r.»..,:..ry -"."r.\„Oe ��t✓ � �^n'+v� "'a'"• w....,,x`y� �v'.-� ,pr..•w....-..v: _ .. . + � `�e".^-a...w^4i,q � �4..�'` e.°"...n.,,. ��Y„y��•w�`,,,.� `++..e..: ham./ M..� �._'ll . N, LV /p. w"A' �.f+j9' A1� mw.+as • R Ate✓ .-`•,` may Ua 44 . .00 4n: X 99.24 �y M �Wit;,a �.: � � r� �%x*. �. �'.� �,.. ,�e��w►� �. Parent material(geologic) 4:5 77 4S 14 Depth to Bedrock1. Depth to Groundwater::Standing Water in Hole: /� . Weeping from Pit Face AVA Estimaied Seasonal Hig i Groundwater : Ae)14 DE'TERMIlYATIUN FIDR SEASONA GIi V ATER`t`A l, ... Method Used: Depth Observed standing in obs.hole: in. Depth to soil mottles: in. --Depth to weepirg from side afobs.Bole: in. Groundwater Adjustment ft. Index Well#_ Reading Date: Index Well level ._-__ Adj.factor Adj.Groundwater Level PT+.R+COLAfiIEIN TE T Hate i.. ; f Time ` Observation Hole# � � Time at 9" Depth of Perc Time at 6" Start Pre-soak Time@ Time(9" End Pre-soak 1 J Rate Min./Inch GZ_ Site Suitability Assessment: Site Passed_ Site Failed: Additional Testing Needed(YM) t Original: Public Health Division Observation Hole Data To Be Completed on Back j Copy: Applicant DEEP OBSERVATION HQLE LOG HDIe Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. `, p 2/ Consistency,%Gravel) 70 • •w DEEP OBSERVATION MULE LOG Hale . Depth from' Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure;Stones,Boulderes. Consistency.%Gravel) V A DEEP QBSERVATIO. HOLE LOG Hole Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency.%Gravel Co " A if A DEEP . OBSERV ATION H(1LE LQG . . Hole , .. Depth from Soil Horizon Soil Texture Soil Color Soil Other #^ -Surface(in.) ' (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. ` Con iste c ° ravel 5 24- • E, Flood Insurance Rate Maw Above 500 year flood boundary No Yes Within 500 year boundary No Yes Within 100 year.flood boundary No Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? ' If not,what is the depth of naturally occurring pervious material? Certification I certify that on (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required trainin , xpertise and experience described in 310 CMR 15.017. Signature �`, Date-1A1_5LZ_�j (qc r, — t it Z { (-;xv ti to f a� Ole-, -------- — i 1 SCALE: APPROVED BY: DRAWN BY DATE: r) REVISED DRAWING NUMBER Z >r + �7 ,. .: 4 x k L ?o5T 7— uf4rto 71. -� �er�. DLTo ; T+4 9 8 1 }' rd-6sr w Ac.c. vaT/N&.. SCALE: APPROVED BY: DRAWN BY- ' DATE: rj I REVISED Q r - _ DRAWING NUMBER ACCESS COVERS MUST BE WITHIN 9" MINIMUM, 6" OF FINISH GRADE 3' MAXIMUM COVER INVERT ELEVATIONS : DES I GN CR I TER I A : GENERAL NO TES : 103.0 FIRST 2' TO INVERT AT BUILDING: 91.0 DESIGN FLOW: MIN 2" OF PEASTONE INVERT IN SEPTIC TANK: 90.25 4 BEDROOMS AT I10 G.P.D. PER 1. THIS PLAN IS FOR THE DESIGN AND CONSTRUCTION BE LEVEL OR F I L TER FABRIC PaQ�y�P 92.5 MAX INVERT OUT SEPTIC TANK: 90,0 BEDROOM EQUALS 440 G.P.D. OF THE SEWAGE DISPOSAL SYSTEM AND PERMITTING 4 DIAM PIPE 89 s PURPOSES ONLY.LOCUS 3/4 1 I/2" DIA. INVERT IN DIST. : . NO GARBAGE GRINDER p o INVERT OUT DIST. BOX: 89.2 2. VERTICAL DATUM IS ASSUMED. FOR BENCH MARKS �- DOUBLE WASHED STONE N o� 9/.2 v �aS 89.3 ��3) 88.5 2' �� 86.5 INVERT IN LEACH CHAMBER: 88.5 SEPTIC TANK REQUIRED: SET. SEE SITE PLAN. 90.25 89.37 88.5 c BAFFLE BOTTOM TOM OF LEACH CHAMBER: 86.5 -' scHoot sr o 3 OUTLET 3-500 GAL LEACHING CHAMBERS 440 G.P.D. X 200% - 880 GAL. a D-BOX W/4 ' STONE AROUND. 12,8 'w x 33,5'J x 2 'd ADJUSTED GROUND WATER: N/A SEPTIC TANK PROVIDED: 1500 GAL. MIN. J. ALL CONSTRUCTION METHODS AND MATERIAL 5 AND 1500 GAL OBSERVED GROUND WATER: lV/A MAINTENANCE OF THE SEPTIC SYSTEM SHALL m SEPTIC TANK 6" CRUSHED STONE OR BOTTOM OF TEST HOLE #4: 81.0 SOIL ABSORPTION SYSTEM REQUIRED: CONFORM TO MASS. D.E.P. TITLE 5 AND LOCAL - o COMPACTED BASE DESIGN PERC RATE ( 5 MIN/I NCH BOARD OF HEALTH REGULATIONS. DER RpAD PROFILE : NOT TO SCALE SOIL TEXTURAL CLASS - / EFF,L UENT,LOADING RATE - 0.74 GPD/SF 4. ALL SEPTIC SYSTEM COMPONENTS LOCATED UNDER 440 GPD / 0.74 GPD/SF - 595 S.F. REQUIRED AREAS SUBJECT TO VEHICULAR TRAFFIC OR GREATER THAN 3' IN DEPTH SHALL BE CAPABLE OF WITH- PROVIDED: 3-500 GAL LEACHING CHAMBERS STANDING H-20 WHEEL LOADS. W/4' STONE AROUND, A-614 S.F. LOCUS MAP 614 S.F. x 0.74 - 454 G.P.D, 5. ALL .SEWER PIPE SHALL BE SCHEDULE 40 PVC OR APPROVED EQUAL. SOIL TES T P I T DA TA s 6. SEPTIC TANK AND D-BOX SHALL BE REINFORCED INDICATES l CA TES !ND I CA TES PRECAST CONCRETE OR APPROVED POLYETHYLENE. � PERCOLATION _ OBSERVED BOTH SHALL BE WATERTIGHT. D-BOX SHALL BE WATER \\ \\ s TEST - GROUNDWATER TESTED FOR LEVEL WHEN THERE IS MORE THAN ONE �• I \ sr. �,�>. P#13844 OUTLET. \ %/ ° \ \\\\ �'Q Fo TP #l TP #2 7. BEFORE CONSTRUCTION CALL "D 1 G-SAFE". HORIZON TEXTURE COLOR HORIZON TEXTURE COLOR 0" 95.0 0" 94.5 /-888-D l G-SAFE AND THE LOCAL WATER DEP T. LOAMY IOYR A LAMY IOYR FOR LOCATION OF UNDERGROUND UTILITIES. \ \\ \ \ SAND 2/2 SAND 2/2 I \ 12" - - - - - - - - - - - - - - - - - - - - 94.0 8" - - - - - - - - - - - - - - - - - - - - 93.8 8. SEPTIC SYSTEM INSTALLER SHALL NOTIFY THE B LOAMY IOYR B LOAMY IOYR DESIGN ENGINEER TWO DAYS PRIOR TO CONSTRUCTION SAND 4/6 SAND 4/6 \ \ _ - - - OF THE •SYSTEM TO ALLOW FOR SCHEDUL 1 NO OF THE CONSTRUCTION INSPECTIONS. 32" 92.3 2B" 92.2 \ I C / LOAMY MED IOYR C2 MED-COARSE IOYR SAND 5/8 SAND AND 6/4 9. ALL ,UNSUITABLE MATERIAL (A & B HORIZONS) 52' GRA VEL ENCOUNTERED BELOW THE I NVER T OF THE Z EACH I NG FACILITY\ I I \ \ \ \\ \ " _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 89.2 58" ANCE OF 5' AROUND AND OREPLACED BE V WITH SAND ED FOR A D IN T ACCORDANCE 70 C2 WITH TITLE 5. \\ \\ \\ \\ \\ \\ \ G I I \ \ \ \\ MED-COARSE IOYR " LOT -- 66----__ SAND AND 6/4 - GRAVEL l0. NO DETERMINATION HAS BEEN MADE AS TO 65. 9/2+ S .F. COMPLIANCE W 1 TH DEED RESTRICTIONS OR ZONING cl \ \ \ \ REGULATIONS. IT SHALL REMAIN THE CLIENTS \ \ \ \ \ \ !32" 84.O !20 84.5 NO WATER NO WATER RESPONSIBILITY TO OBTAIN ALL PERMITS. SPECIAL " CB/ON FND PERMITS, VARIANCES ETC. FOR THIS PROJECT. \\ \\\ \ \ \ \ \ \ W \ \ \ �4\ \\ \ \ 64 _ ANY RETAINING WALL SHOWN ON THIS PLAN IS FOR HORIZON TEXTURE COLOR HORIZON TEXTURE COLOR LOCATION ONLY AND SHALL BE DESIGNED IN LOAMY l D YR A L DAMY I OYR ACCORDANCE W 1 TH STANDARD PRACTICE. SAND 2/2 SAND 2/2 J6" - • - - - - - - - 91. 7 28` - - - - - - - 89.7 /2, IT SHALL REMAIN THE CLIENT'S RESPONSIBILITY - - - - - - - - - - - - - - - - - - - - - - \ \\ B LOAMY IOYR B LOAMY IOYR TO HAVE THE PROPOSED BUILDING FOUNDATION SAND 4/6 SAND 4/6 DESIGNED TO ACCOUNT FOR THE EXISTING GRADE \ \ I 32- - - - - - - - - - - - - - - - 90.3 50" - - - - - - - - - - - - - - - - - - - - 87.8 AND SOIL CONDITIONS AT THE LOCATION OF THE \ o \ \ \ 3 \ \ \\ \\\ \\ \\ \ \ \ I MED-COARSE IOYR MED-COARSE IOYR PROPOSED BUILDING. \\ 4 \ } \ \\ \\ \\ \\ _ C2 SAND AND 6/4 C2 SAND AND 6/4 \ \ Y -------- \ \ \ \ v \ \ \ \ \ \ GRA VEL GRA VEL ?0� 3-300 GALLON-- _-___ D_� \ \ E\ \ LEACNJNad CHAMBERS // \ ��a� */4' STONE AROUND TPs4 // 1 1 1 \\ ..... %............. _RESERVE*EA NO WATER NO WA TER 120" 83.0 /32" 81.0 TP+►2 ::::a 1500 GALLON \\ \ \ \� \\ \ \\ \\ �\ ,>2 �\ D-BOX �9 ' \SEPtiC TANK, DATE: JANUARY 29, 2013 / ` \ TEST BY: STEPHEN HAAS \YPr/ N // �O \\ \\\ \\\ ° \\\\ \\\ \\\\ ' \\ \�'�6 \� \\ � f _ ^\ ��\ \\ \ \\ � WITNESSED BY: DAVID STANTON / \ \ DECK \ PERC RATE: C 2 MI N/1 NCH / EXISTING SHED \ \ \ \ / / G TO BE REMOVED \ \ / 6 / I AY \m e PROPOSEDz6WELLING TOP OF FOUND - 103.0 I 5E G WALL _/ i RETAININ _ PORCH \ I BM. C8/DH FNd EL-/06.4110 t 14 1 103.5 o� ------ - __------ ,°�- -- ' S / T E F L ,A N U )= L ,A N D 102,0 / 90 SCHOOL STREET MAP 45 . PARCEL 4 _ BAR-NS TABLE . { MARSTONS MILLS ) MA 99.3 � PREPARED FOR : 95.9 LEGEND B O B C L E ,A R Y & DONNA B I R C H 3 GREAT H / L L S DR / VE . EAS T SANDW / CH . MA 02537 ■ CB CONCRETE BOUND -W WATER LINE SCALE / 20 NOVEMBER 4 . 2013 O HYDRANT BM. CB/DH FND -G GAS LINE S T E P H E N A . H A A S EL - 104.88 OHW- OVER HEAD WIRES w LIGHT POST E N G I N E E R I NG I NC -E-- UNDERGROUND ELECTRIC LINE s i r 1 923 Route SA T- UNDERGROUND TELEPHONE L I NE /// ����,/ /��'� Y a r mo u t h p o r t , MA . 02675 CTV-- UNDERGROUND CABLEV I S I ON L I NIE GCc,�, �/i ( 5 0 8 ) 3 6 2-8 1 3 2 +40.4 SPOT ELEVATION f ........40....... EXISTING CONTOUR 0 10 20 40 n PROPOSED CONTOUR JOB N0: 13-407 KA I I To the best of my knowledge these plane were `- drawn to comply with the owner/s and /or builder's CAFE C D HOME DE51GN epecification5 and any changee made to them _ aster prints are made will be done at the owner's RESIDENTIAL HOME DE51GN EMAIL and /or builder's additional ex enoe and RENOVATION DESIGN 'a (oca ecodhomedeoi n.net P J 5 p 9 . re5ponoibility. The contractor ehall verify all 0­(�� ENERGYCALC'5 LNEC>'5jTE dir^ n5ions ano en5clooed drawings. Cape Cod I 1T Home Design is not liable for errors once KITCHEN DE51GN www.capecodhomede5ign.net 1 construction has begun. '10 rrph.CHECKL15T - PHaNE ® r Eli! [� � :!t � 1 II While every effort has been made in the STRUCTURAL CEJ1GiJ (F08)?76-%4ro6 TIT preparation of this plan to avoid mistakes,the 3D VIEWS(INT.&EXT.) maker can not� gua Lantee against human error. The PHOTOREALI5TIC RENDERING5 contractor must check.all dimensions and other _ - deta'Is prior to construction and be Solely - recponoible thereafter. - AREA FOOTAG 1 � 11 _ Hill TOTAL AREA I,N DER ROOF 5A5EMENT LIVING AREA 554 �_ DO NOT SCALE THE z 15T FLOOR LIVING AREA 1240 u I DRAWINGS 4TLWII Ill tva 1 2ND FLOOR LIVING AREA 554 .� r T. ED TOTAL LIVING AREA L ` r GENERAL NOTES L- 2348 �T L: GARAGE AREA 265 r c5T ADOPTED — — --- ( DECK AIKEA 156 c ,ILL WORK 15 TO COMPLY WITH THE LAT� VERSION OF THE PIA.BUILDING CODE(EDITION 8)AND ANY COUNTY OR TWON BUILDING REQUIREMENT5. COVERED PORCH 411 2: WRITTEN DIMEN510N HAVE PRECEDENCE OVER SCALED - - -_- - DIMEN510115-20 NC T SCALE THE DRAWING5. UTILITY 5A5EMENT AREA 354 Cd) 00 3: DESIGN LOADS:. � I CEILING5 25 p5f 00 T ITLE PAGIE NOT T%C)11 SCALE j ROOF 25 50 p5f r � FLOOR 40 pof PAGE INDEX o O DECK 40 pof L 5TAIR5 40 p5f _ ---� BALCONIES 40 p5f 1 a -- -+i INSULATION(MIN.REQUIREMENT5-SEE RESCHECK) TITLE PAGE � 'WALLS R-19 rL00R5 R 30 2 FOUNDATION PLAN CEILING R-58 I 5:j,ALL EXTERIOR WALL OFENING5&BEARING WALL 3 1 ST FLOOR PLAN & WIN./DOOR SCHEDULE � OPENINGS TO HAVE STRUCTURAL HEADERS. 6: TYPE X"5.0 F!RECODE 5HEETRCCK INSIDE GARAGE HCU5E. 4 2ND FLOOR PLAN & WINJDOOR SCHEDULE %. rP.r' 3EDKJ:)P TO HA,'E A P,1INIMUM WINDOW OPEP4lNv •>. F 2 ' Or.:.'�5Q.FL WITH A MIN.GEAR OPENING 0. 20 x�4 IN w 5 F REAR ELEVAT11ONS µ FRONT & E��-iFR DIRECTION AND A 5!LL HEIGHT I_E55 THAN 44"OFF i _ _THE FLOCK, 5: 41LL l`t!B OR 5HOWER ENCL05URE5 1f GL/\ED ARE 70 - 6 - LEFT & RIGHT ELEVATION USE TEMFERED 5AFETY GLAZING. � ? 9:i `; LL EXTERIOR w'INCOWS ARE TO BE DOUBLE GLAZED 7 CROSS SECTIONS - A B & C - —-- -- = - FAll H A J VALUE OF LE55 THAN.50. , 1C; ALL EX`I'ERICR DCOK5 ARE TO BE 50LID COKE WITH 1 I o], I I WEATHER5TRIPPING. 8 110 n h WIND ZONE DETAILS 0 L` A ) T AL rr_ oiv - _ 11: CON 5MJKt DETECTOK5 TO HCU5E ELTC R C 5Y5TEM AND INTERLOCK EACH 5O THAT WHEN ANYONE 15 T 7 - 9 110.m h WIND ZONE DETAILS I 1 .RI. PED THEY ALL WILL SOUND. p T 12: PRO✓IDE COMBU5710N AIR bEN i5(W/5C.,REEN)FOR ANY T �3. B.� - APPLIANCE WITH AN OPEN FLAME. 10 - _ - `_HROOfvlS ANDiT CHF 5 T 3E VENTED TO THE r.., �N�ARE 0 - FEET u Ii I r, CUT51DE WITH A MINIMUM OF"i NE FOLLOWING CUBIC FcE _ _►_ 11 r MINUTE CAPACITY. C/l� f I p L KITCHEN 1CC-INTERMITTENT ( , s4 - r. .T it 2� ON IN,.OUS ® � u BATH 12 1 .,u - iNTERNiTTENT _ 20 �ON,LlUOL.. 14:` rOOTiNGS P,RE TO E-EAR ON UNDISTURBED LEVEL 501L 13 I DEVOID OF ANY ORGANIC MATERIALS AND`5TEPPED A5 REQUIRED TO MAINTA!N THE REQUIRED DEPTH BELOW THE DATE OF ,- - 14 FI;"JAL GRAJc.. S,�I�BCARIiJ�PRCS.��JRE A75UtJ��C TO B� -- _ — _ -- — --�— — 'OTC FINAL ISSUE p 15 O Z 15; r rr.r',.'=T ESIGN VALUES ARE TO 8E P,M.!N�MUM OF W 1„P��E D c �. L'STEJ VALUES THAT FCI LC'uv: i 1 0/6/1 3 — 3A5 MENT5LAB5 2,500p5I 1 6 _�� DA5EMENT,VALL53,000 poiuu -- GARA E 5L.A65 3,500 poi PORCH 5LA55 3,500 poi 17 a � w 'Co; _:NCO iNCONTP,CTVv'ITHCONCRETET05EPRE55URE Q ® DATE PRINTED ;EA?ED. 18 e I 17: WATERPROOF 5A5EMENT WALL5 BEFORE BACKFiLLING. V la: BEAM POCKETS W CONCRETE TO HAVE 1/2`.AIK5PACE AT 10/6/2013 uP 51DE5 AND END5 WITH A.MINIMUM OF 3' BEARING. 19 19: BA5EMENT5 TO HAVE AN ACCE550RY EXIT(DOOR OR BULKHEAD)TOOUT51DE. ~ SCALE _ 20: PROVIDE IN51JALTION 3AFFLE5 AT EAVE VENTS. 20 W — 21: ALL ATTIC5MU5TBEVENTED. Z UNLESS 21 Q coOTHERWISE NOTED 22 ui 0 1/411 1 ' TH15 5TRUCTURE 15 LOCATED IN A 110 mph EXF'05URE CATEGORY "B" AREA. TH15 5TRUCTUKE SHALL BE CONSTRUCTED IN o O COMPLIANCE WITH THE AMERICAN FORE5T AID PAPER A550CIATION WOOD FRAME CON5TRUCTION MANUAL FOR ONE 00 `�' U AND TWO FAMILY DWELLING5. 110 mph EXFOSIURE "B"WILL U5E THE COMMONWEALTH OF MASSACHU5ETT5 VER51ON OF z U � THE CHECK1_I5T PER (750 CMR 5501.2.1.1 DE510N CRITERIA). TH15 STRUCTURE 15 ALSO REOUIRED TO MEET THE FROVISION5 OF (750 CMR TABLE 5301.2.1.2 WIINDP>ORNE PEBRI5 PROTECTION) � ._ PAGE ## - -------- ___T_ i i — — — — — — —=12"x 48"CONCRETE FILLED 50N0 TUBE (2.)PT 2 x 10'S FOR GIRDER BIGFOOT BF20 CONCRETE FILLED -FOOTING w/CONCRETE FILLED 50NO n TUBE OVER I o I 46' X N � z , 21, CIS, 19'-81/2" 2,_6 12'-9 1/2" Z 0 o J15'-2, I 4�_g 4'-6 5/5" 3'-31/8" Z= 5' ��- 5 10 LL LL e C CD ' U o � 2 o TOP OF FOUNDATION j 00 5' 0" BATH # 1 0 0 „ IIII _ u k� 13EPRooM # 1 I o � N IIII. {� LINEN O 00 CV 1�EC. DOOM I BEAM 183� (3)1 3/4'' C) N x 91/4"VER5ALAM5 N n , IIII BETWEEN JOISTS - 00 0 5 1/2 3-3 � 5 - � O O . ��co 111E u ' III 24"x 10"POURED -- CONCRETE 5TRIP FOOTING —J F, CV STEEL LALILY COLUMN niJNF — - - - - - - - --- — — — — — — — — — — — — — — — — — CV 5 1/4"x 7' VEK5ALAM CQ1LUMN — — — — — --� BEAM 1B1-(2)15/4" — — — — — — —N — — — — — — x 11 7/8"'VER5ALAM5 I - - - - - - - - - - BEAMPOCKET- - X 4"tl x 12"h r/� — —22' — — — — — _ I A. -10"x 30"x 12' POURED _ I CONCRETE FOOTING 5,8"-,Yi'E..Xv'FIRFUODE 5HEETROCK ON ALL WALLS/CEILING IN GARAGE I P4 �<9 GEAM 1B2-W8x18 _ IUTILITY F,OOM 5TEELII-13EAM I I J I t N ISM r 1 CAS' GARAGE t\ 16"x 10"POURED CONCRETE CV I I I = I FOOTING UNDER WALL t._ P OF FOUN PA I ION 5'-6"x 13'-0"x 12"THICK '.. 0 • p.-POURED CONCRETE PAD FOR -- ®; r 20"x10 POURED \l I I MASONRY LALLYCOLLMN rF coI.. ••j C9 0 i I I i ❑ I CONCRETE FOOLING :•. c - C9 - - - - � P J ,. .. 5 �J .-.r . . ..:....v .. .. -!� • r..; •2 11/2 a RETAINING WALL M1. f +' Y t' - 'POURED 4 x 10'9'9' I P F D TI N :'! k a'• ., CONCRETE FOUNDATION ' r -2' DATE OF r ,_ OP OF T n TION Q -2° o � Q �.. o „ Z FINAL ISSUE 16"x 10"POURED CONCRETE FOOTING '` 1 /6/13 LL - HA ..F WALL COVERED I OKCH 1 OU N PATION ~ 3' 9"X 8"POURED CONCRETE FOUNDATION w O ♦/� s• N :.....- 5 (Dl►;.T FILL ONLY) d' = W Q 0 DATE PRINTED r e Ua' 10/6/2013 5 w SCALE 46' z UNLESS >- OTHERWISE co CD o NOTED 2 0 1/4" - 1 ' o m w z � a F0u DA ON PLAN i 0--L- /4 - 0 � PAGE # WINDOW CHEDULE H 1 0 24 10 241/8 " 24 5/8"X24 5/8" YE5 AWNING A 21 ANDER5EN 2 0 28 3/8 " 28 3/8 " 28 7/8"X28 7/8" AWNING AW 251 ANDER5EN 5 0 35 5/8 "' 52 7/8 " 561/8"X53 1/4" DOUBLE HUNG 21042 ANDER5EN 1 11 241/8 " 241/8 24 5/8"X24 5/8" AWNING A 21 ANDER5EN 1 1 241/8 241/8 " 24 5/8"X24 5/5" YE5 AWNING A 21 ANDER5EN 4 1 28 3/8 " 28 3/8 " 28 7/8"X28 7/8" AWNING AW 251 ANDER5EN 1 1 29 5/5 " 48 7/8 " 30 1/8"X49 1/4" DOUBLE HUNG 24310 ANDER5EN 2 11 29 5/5 " 52 7/8 " 30 1/8"X5 1/4" DOUBLE HUNG 2442 ANDER5EN ( C ) 1 1 40 7/8 " 40 3/4 " 41 3/8"X41 1/4" AWNING A 3535 ANDER5EN 2 1 41 5/8 52 7/8 " 421/8"X531/4" DOUBLE HUNG 3442 ANDER5EN g 3' 6 12' 2 1 41 5/8 " 56 7/5 " 42 1/ "X571/4" DOUBLE HUNG 3446 ANDER5EN 8 2 241/8 " 241/8 " 24 5/8"X24 5/8" AWNING A 21 ANDER5EN 2 12 241/8 " 241/5 " 24 5/8"X24 5/8" AWNING A 21 ANDER5EN DEICK 4 12 1 41 5/8 " 52 7/8 " 421/8"X531/4" DOUBLE HUNG 13442 1ANDER5EN e C c 13'-11 1/2" 9'-7" 6-(5 5 -9 1/2 2'-91/8" 10'-81/2" 6 3-9118 I� V) ® 00 4 2 co 3535 FWG 6061 t 342 3 I� r.M ��° W3336 I W3936 �64� I B21R I k321'f �/J � — -J-- — 5'SHOWER � CA KITCHEN ( I D(NING STUDY W.I.C. m - f _ II - - � B36 636 �" MA5TER I t, c� I _i BATH I - IN // Lc) FLU5H BEAM 2132-W8 x 24 STEEL 1-BEAMLL 1 4068 2668 — — — — 5 1/4"x 51/4"VER5ALAM F05T 4 x 6 F05T N 2668 U o i ��FL U H BEAM 2.51 W5 x24 NLAUND S O 22 5TEEL 1-BEAM u MA5TER BEDROOM _ Uu >< o FAMILY ROM 3'-81/2" d- M o �t EX �I IL N NILu coN DATE OF _ o - N OF 0 uj Z FINAL ISSUE FOWDEIZ coW N n `s' n ' >zooM z N V ('3 10/6/13 N m w O U) 2868 9-LITE r:AWl ( W2'-1 1/4 , AW 251 AW 251 3-11 3/4 , Q 0 DATE PRINTED 2 -10 5/ -9 7/8 2 -9 7/8 3-5 7/8 69-111 3 I 3 A , 10/6/2013 4' 7' 5'— 5%91 2.3 o w SCALE O 1 z 12 22 2 z UNLESS COVERED FORCH Q w OTHERWISE o NOTED BEAM 2E35-(3)2 x 8'S cD O 0 1/4" o o� m e w z Q 46' 4ST FLOOR PLAN Q 3 4/4°° _ 41 o � _ PAGE # ,I I i i I j IN DOW CHEPULE TY FLOOR WIDTH H E I G HT TEMFEKEP PE5GRIFTION COPE MANUFACTURER MM NT 1 0 24118 " 241/8 " 24 5/8"X24 5/8 YE5 AWNING A 21 ANDER5EN 2 0 28 3/8 " 28 3/8 " 28 7/8"X28 7/8" AWNING AW 251 ANDER5EN 3 0 35 5/8 " 52 7/8 " 361/8"X531/4" DO 13LE HUNG 21042 ANDER EN 1 1 241/8 " 24118 24 5/8"X24 5/8" AWNING A 21 ANDER5EN 1 1 241/8 " 241/5 " 24 5/8"X24 5/8" YE5 AWNING A 21 ANDER5EN 4 1 28 3/8 " 28 3/8 " 28 7/8"X28 7/8" AWNING AW 251 ANDER5EN 1 1 29 5/8 „ 48 7/8 " 301/81IX491/411 DOUBLE HUNG 24310 ANDER5EN 2 1 29 5/8 " 52 7/8 301/8"X531/4" DOUBLE HUNG 2442 ANDER5EN 1 1 40 7/8 40 5/4 " 41 3/8"X41 1/4" AWNING A 3535 ANDER5EN 2 1 41 5/8 " 52 7/8 " 42 1/8"X53 1/4" DOUBLE HUNG 3442 ANDER5EN 2 1 41 5/8 " 56 7/5 " 421/8"X571/4" DOUBLE HUNG 5446 ANDER5EN 8 2 241/8 " 24118 " 24 518"X24 518" AWNING A 21 ANDER5EN 2 2 241/5 " 241/8 " 24 5/8"X24 5/5" AWNING A 21 ANDER5EN 4 2 41 5/5 " 152 7/8 142 1/8"X531/4" I DOUBLE HUNG 13442 ANDER5EN 00 u w z � Q � Lu zz 00 z � un o 22' U 13'-81/2" 2,_6' 5'-91/2" LL w 1)z 5'-7 7/16" 3'-91/8" 4'-315/16" E/ Lu w w W W 3,42 3442 e 11 N C� 55"HEADER HEIGHT ° 5 0 � C9 s- s lC� 0 0 0 w 0 0 0 w www � w � Q � w � � oo 1.1.i o - d w � >z � � ms,z5z cz o � WmY I J 00o z � Q000c zo0UOooZ u O O O w — O O o w — w 0 0 0 0 — N c, c, o = wwow � � _ CSo � = � � DEPROM # 3 �' LL 21 21 L, � c o � ozwzw — � � � w l(� w wUw'Ul'1 = c� � w � �IJ � = f = � ILL, � �zzzzzX XQzzozx x xz —= = w = _ _ IN w t- I� Lu w w to C26 m o�_ _ . a0 00 � 0 � ' 04- o w w � � oW 10, 2' uww LU w � � u� � � ww w LU � � _ 2asa� Qzzozz _ _ � _ _ _ _ _ _ � A — - - - --- - - - - — - - - - - - \ d z N u NNNNN N NNN NNNN NNN N N N N N N N N N N N N N N N MM a� cz � a a � � � � T � S36) d) � co _ xXXXXX = XXxNXxXXN = XxXX N N N N N N N\ \` N N a CV N N _ X � — X � � xX � � � � � ON DATE OF I Nd �tc0 NNNd C90NN N � � � � N � FINAL ISSUE Z7 Lu Lu Xzz X Lu XXzz 0UJZ — — w 10/6/13 o 0 "< LIVING ROOMLD -N W 0 NNNNC� NNNNNt� �1 NNN _ a = W N Q 0 DATE PRINTED p p N N N N U 10/6/2013 N a 73 3/4' HEADER HEIGHT N � _ wSCALE di 75 3/4''HEADER HEIGHT( 85"HEADER HEIGHT z UNLESS N Q w OTHERWISE o NOTED OA l 3442 3442 A l 1/4„ , >M- 00 0 W � W 2ND FL OR PLAN 1/ v0 = V 3'-6" 5'-7 7/16" 3'-91/8" 5'-7 7/16" 3'-6" z v 22' Q PACE # i