HomeMy WebLinkAbout0190 SCHOOL STREET - Health 190 School Street .
Marstons Mills
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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:
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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-
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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
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[� � :!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
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'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 ##
-
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— — — — — — —=12"x 48"CONCRETE FILLED 50N0 TUBE
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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
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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
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