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HomeMy WebLinkAbout0076 WILLIMANTIC DRIVE - Health �0VILATNCCNTICl ,MARS MILLS A = 103 056 i Commonwealth of Massachusetts /03-Oslo Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Fit 76 Willimantic Drive Property Address 1 C: .Owner Owner's Name v>> information is arsonsMillsa required for every Mt Mill M 02648 11/20/18 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 on the computer, use only the tab Chad hathaway key to move your Name of Inspector cursor-do not H PS use the return Company Name key. P.O.Box 151 r� Company Address Forestdale Ma 02644 City/Town State Zip Code 774 274 2581 12866 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ FafiIs 11/20/18 Inspector's gnature Date The system inspecto6g�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.7/2 612 01 8 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 76 Willimantic Drive Property Address Owner Owner's Name information is required for every Marstons Mills Ma 02648 11/20/18 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: !� I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: Septic in good working condition. No failure criteria was encountered during inspection. Recommend pumping tank every 2 years under normal use. 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 76 Willimantic Drive Property Address Owner Owne's Name information is required for every ar M ..tons Mills Ma 02648 11/20/18 � page. Cityfrown 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: F 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 Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 76 Willimantic Drive Property Address Owner Owner's Name information is required for every Marstons Mills Ma 02648 11/20/18 page. Cityrrown 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 76 Willimantic Drive Property Address ' Owner Owner's Name information is required for every Marstons Mills Ma 02648 11/20/18 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %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.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection. Form I f~ Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 4 76 Willimantic Drive Property Address Owner Owner's Name information is required for every Marstons Mills Ma 02648 11/20/18 page. Cityr,own 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.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts h - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 76 Willimantic Drive Property Address Owner Owne:r's Name information is required for every Marstons Mills Ma 02648 11/20/18 page. Cityrrown 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: 5 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 years usage(gpd)): Detail Sump pump? ❑ Yes ® No Last date of occupancy: current Date t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 c Commonwealth of Massachusetts ,lp Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments � I 76 Willimantic Drive Property Address Owner Owner's Name information is required for every Marstons Mills Ma 02648 11/20/18 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 p�esent? ❑ 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: pumped summer 2017 owner 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 Commonwealth of Massachusetts Title 5 Official Inspection Form. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 76 Willimantic Drive Property Address Owner Owner's Name information is required for every iMarstons Mills Ma 02648 11/20/18 page. Cityrown 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: 2000 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 2'6"feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: 25+ feet Comments(on condition of joints, venting, evidence of leakage, etc.): no signs of leaks or poor venting t5insp.doc•rev.7126/2016 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts qt.�w. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 76 Willimantic Drive Property Address Owner Owner's Name information is Marstons Mills Ma 02648 11/20/18 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 2.25 feet 'Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) 1500 gallon tank H10 with risers on inlet and outlet If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 gallon Sludge depth: 3" Distance from top of sludge to bottom of outlet tee or baffle 31" Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 5" Distance from bottom of scum to bottom of outlet tee or baffle 18" tape and sludge judge How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): PVC tees in place. no evidence of leaks no visable concrete decay or cracks. Tank is H10 and of designed to be driven on by autos or construction equipment i t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 10 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 76 Willimantic Drive Property Address Owner Owner's Name information is required for every Marstons Mills Ma 02648 11/20/18 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.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 Commonwealth of Massachusetts t� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a 76 Willimantic Drive Property Address Owner Owner's Name information is Marstons Mills Ma 02648 11/20/18 required for every page. Cityfrown 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.): Dbox is solid with no visable leaks or major decay. Box has riser in place and has 2 outlets with equalizers in place. water level is at bottom of equalizers t5 nsp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts - Title 5 Official inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 76 Willimantic Drive Property Address Owner Owner's Name information is required for every Marstons Mills Ma 02648 11/20/18 page. Ciq 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.): n/c * 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: 2 500 gallon L.0 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 76 Willimantic Drive Property Address Owner Owner's Name information is required for every Marstons Mills Ma 02648 11/20/18 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.): Chamber cover was dug up has a riser to with 2'of final grade. chaber has 3" of water in bottom of chamber. sidewalls over current level are clean with no staining 12.. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/201:8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 76 Willimantic Drive Property Address Owner Owner's Name information is Marstons Mills Ma 02648 11/20/18 required for every page. Cityrrown 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 l Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 76'Willimantic Drive Property Address Owner Owner's Name information is required for every Marstons Mills Ma 02648 11/20/18 page. Q4-mown 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 w Doi.,e y to 2 G 3 Al - 31`3" a- 3s' .2- 3b'(�" 3 -38' ''3 s- t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4 76 Willimantic Drive Property Address Owner Owner's Name information is required for every Marstons Mills Ma 02648 11/20/18 page. Cityrrown 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: greater then 12'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: 2000 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: town GIS mapping lot el 70 low area is Shubael pond at el. 46 You must describe how you established the high ground water elevation: existing engineering. bottom of leaching at 5'. 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 Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 76 Willimantic Drive Property Address Owner Owner's Name information is required for every Marstons Mills Ma 02648 11/20/18 page. City/Town State Zip Code Date of Inspection ,c! 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 t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 PARCEL ID: 103/55 165.00 r=;� Ili ' PARCEL IQ: I C056 #76 .. O O N - O Ld Q CV PARCEL ID: —1 ———- 103/136 STORAQE SHFO 165.00 PARCEL ID PARCEL ID: 103/137 NOTE: 103/57 TO CROSS SHED AND OVERHANG APPEAR OVER THE LOT LINE CANFM TO THE LWAL ZONING _ _ Rum g REGULATIONS FOR 111E PRACTICE OF uwDM MSURVEYNM WE BUWKG SI10"IS �►2L������A'� HAZARD AREA AND UPS�u�� ACTION UNDER MASSM BY-LAWS IN EFFECT AT THE TIME OF CONSTRUCTION WITH RESPECT TO SETBACK REQU MENTS OR IS OU PT FROM VIOLATION Q T M- ROMA7100 AND GEN m AND VATH THE FIT OF ALL RFSERAL LAWS S OF , IF CHAPTER A SECTION E THERE REFERENCED D DEED ASSU�SAME ARE OF LEGAL BE14EE AND EFFECT. M RIOTS OF WAY- RESTRICTIONS i. TOWN: MARSTONS MILLS DATE: 11/20/18 _ APPLICANT(S): DEAN F. STANLEY SCALE: 1"=30' CERTIFY TO: EMERALD FUNDING, INC. er �t TITLE REF: 13775/18 MacDougall Surveying PLAN REF: 157/97 & Associates EDW.,%RD �� FLOOD ZONE X" P.O_ Box 2428 A- CaM250C54 `` COMMUNITY Mashpee, Ma. 02649 DATED: 07/16/14 PH. (508)419-1086 CELL (774)327-0617 email: macdougallsurvey JOB# 11237 �comcast-net L ti (, . � A oatastahte recommands tha� t fhF-anpIo=a of seek legal advice to prepare a property worded deed restriction document. DEED RESTRICTION WHEREAS, ' I� `' �} �� of (owner's name) _;74 �l��r�IA�ul i C i ' II'IA, �i�y� ✓1�fS MA (address). is the owner of 77�, �,,,. ���,���} i� �� located (address) MA hereinafter referred tc a's 1��✓o A115 and being shown on a plan entitled "Subdivisio of Land in _ Sd'S a � lS A)5 � MA, Property of? 114 et al.; duly recorded in Barnstable County Registry of Deeds :n Plan Book S"7 Page 7 ; Or on Land Court Plan Number WHER-AS, 1 (� �S � - as the owner of said lot has (owner's name) agreed with the Town of Barnstable Board of Health to a restriction as to the number of bedrooms which can be included. in any home built on said lot as a pre-condition to obtaining a disposal works construction permit in compliance with 310 CMR 15,000 State l=rivironmental Code, Title V, Minimum Requirements for the Subsurface Disposal. of Sanitary Sewage;. WHEREAS, the Town of Barnstable Board of Health, as a precondition to granting a disposal works construction permit for a septic system in compliance with 310 CMR 15.200, State Environmental Code, Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage, and authorizing the issuance of a building permit for the construction of a-single family home on this property, is requiring _hat the agreement for the'restriction on the number of bedrooms in any house constructed on the lot be put on record with the Bamstable County Registry of;Deeds by recording this document, doedr i J NOW THEREFORE ty�C ��1Cz-.does hereby place the (owner's name) following restriction on his above-referenced land in accordance with his aQrev arrant ymifh the Tnwn 0 Rarnctahla Sm2rd of LJ&a1thTWhiah' StFi,.r.on sha[r run with the land and be binding upon all.successors in title: 1. .: 11� ;,M,4AAK;c C R (1 e_,I S5 4f'6S (�7A c�`ftiay have constructed (address) upon the lot a house conning no more than T rye (3) bedrooms. _'7 . N06NkS -- In agrees that this shall be-permanent deed (owner's name) restriction affecting3 ,located on•Zdiu))lim, si c MA, and . being shown on the,plan recorded in Plan Book_ 157; Paged 7 Or on Land Court Plan Fo r r title of see the following deed: Book /.07-76- , Page 3.W Or Land Court Certificate of Title Number N/�+ Execute s a ale strume g�, day of Owner'Wgna ` Owner's signature Owner's signature COMMONWEALTH OF MASSACHUSETTS o�l c , 20 J �. Than personally appeared the above-named ti J ' known to me to be the..person who ex cuted the foregoing instrument and "M acknowledged the same to be k) S free act and deed, before me,Public � My commission JEAs A �" BARNSTABLE REGISTRY OF DEEDS N commis My d�a @zp _seF Z017 !. 1 f I � tP TOWN OF BARNSTABLE C, ✓7 LOCATION 74 )2-t'ye SEWAGE # �2 000- o2 o21 VILLAGE /VI, ASSESSOR'S MAP & LOT Q(3 v 6d INSTALLER'S NAME&PHONE NO. J� C A-+ Its SEPTIC TANK CAPACITY LEACHING FACILITY: (type) a' 9009 (size) /a•k3x RsX-2 NO.OF BEDROOMS 3 BUILDER OR OWNER PERMITDATE: 4/ /` -, 000 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 � ,yk --�- 13 L 3 31-3.. 33 g33-- 3 No. d;IL/ r_ a Fee / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Zipprication for. biopoear *pztem Construction Permit Application for a Permit to Construct( )Repair(✓)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components 1 Location Address or Lot No. 7G .�'�� t p�f Owner's Name,Address and Tel.No. ' Assessor's Map/Parcel ,�fp/'Sfe�+f M�(/s �� TGs�►!ts f74 /7 0 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. S Ak !to Con s41v67', Po. 33 9 Mom• stems�1, /fs � f sys� Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq. ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 330 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank /5-OOy Type of S.A.S. a-505 eLc P Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issue Board'of Health. Signed Date Application Approved by Date t f_I Application Disapproved for the YollowAg reasons Permit No. )=c= aZ-;L Date Issued r' No. a- a-y ` �a Qft Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes - PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS itt Zippfication for Migpogar *pgtem Congtruction Permit Application for a Permit to Construct( )Repair( ✓)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 71/ W.'/ti•��nf C ar Owner's Name,Address and Tel.No. .M�� T�.rnct A4 /1�� Assessor's Map/Pazcel /a 3 , 6 7� by/u y,� 7-3 3� Installer's Name,Address and Tel.No. Designer's Name,Address and Tel.No. .� L AN � � e"" slrC,c�! P^ 3 //s -A Z7 self k Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 33 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank y Type of S.A.S. a'3f7�y ��=..e%►-s �/y S>��P Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issue y t s Board of Health. Signed Date �/3-a?4 Application Approved by v �i 4- Date -l Y Application Disapproved for the Yoiiowijng reasons n Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CER � that the On- ite S,e. a e Disposal ystem Constructed-(- )Repaired(, )Upgraded Abandoned( )by e � © � f`-� l� ��U�� )t'� y at 76 �✓�/ �Gu+ r, has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. a22_2�L.Lj dated Installer Designer 14, enu i' ' N /f' /` 1 t/1 a The issuance of thisrt ape i all dot-be as a guarantee that the s, tent-will unction as?designed Date �! IIt; rll /( Inspector % e!� V No. :.1,zabo Fee c) 1 � THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Migpogal *pgtem Congtruction Permit Permission is hereby granted to Construct( )Repair(,>)Upgrade( )Abandon( ) System located at —16- W =C' Z , and as described in thea6ve Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this permit. Date: Approved by < i c 1, IN" NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS) I, Jgl r, 194. /A, ,hereby certify that the application for disposal works construction permit signed by me dated Y-/3 - ,2Do 0 ,concerning the property located at meets all of the following criteria: • This failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. • The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. • There are no wetlands within 100 feet of the proposed septic system • There are no private wells within 150 feet of the proposed septic system • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. • The bottom of the proposed leaching facility will not be located less than five feet above the maximum adjusted groundwater table elevation.[Adjust the groundwater table using the Frimptor method when applicable] • If the S.A.S.will be located with 250 feet of any vegetated wetlands,the bottom of the proposed leaching facility will not be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation(using GIS information) 7 B) G.W.Elevation +the MAX.High G.W.Adjustment,. _ 30 DIFFERENCE BETWEEN A and B Y SIGNED'. DATE: `1-/3-2040 0 [Please Ske posed plan of system on back]. NOTICE �--' Based upon the above information,a repair permit will be issued for bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. q:health folder.cert 1 l ' Fr i I O � ti Jr F - o , c �^ TOWN OF BARNSTABLE LOCATION 7 SEWAGE # 0 0 V a2L1 { VILLAGE A4, 10, ASSESSOR'S MAP & LOT DJ INSTALLER'S NAME&PHONE NO. J. 0 f' SEPTIC TANK CAPACITY 13 0?,, LEACHING FACILITY: (type) a 50f7 G4,,4rr.j (size) NO.OF BEDROOMS 3 BUILDER OR OWNER PERMITDATE: 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 G , 74 S� ' G avG A oS 3 � j j J ' i i I 34'-0" 36%0" .. rTli __________,_______- N.) . I - c7l) A6 i C_ A. a A3 3'-2" 00 ial NEW O� o O I I I BATH D O I REMOD. I I 1 16"x5'0" W BAT LED S REMOD. f l NEW FIRERA I ^ FiAFtVEY O I < FIRE RATED A261 LI °° El KITCHEN' g' MU ROOM DOOR I AWNING 0 4'-4" ..TJ,o'l .II I I DO PKT. '6"I?I90F:� ANDERSEN DOOR FOLDING. CLOS. m q NEfALBEAM AB-YE(FL11Sb EBP.b1ED)-- ON. .: -- NENLBEAA6 ABOYE(FLUSH ERAb1E - ----- --�—=------ _--_ v- Y o o v HARI II - 16'-2„ GAS 2442 JEY.. I _ 6.. NEW �I XPAND D 6'-1" 3'11" .7-0" G BEDROOM `--- GARAGE W I HARVEY DO" R PASS A AWNING DOOR O REMOD. FPS As of LIVING o � o 0 ce ANDERSENUP A2A A Y^A - A6 9'0"x TO"O.H.DOOR I 9'0"x_TO"O.H.DOOR 6 .. CONC. APRON A A3 i I FIRST FLOOR PLAN j LEGEND_ 0 EXISTING WALLS CONSTRUCTION TO BE REMOVED IECC2015 RESIDENTIAL ENERGY EFFICIENCY DETAILS ® NEW CONSTRUCTION I CLIMATE ZONE 5(USE EITHER PRESCRIPTIVE VALUES OR RESCHECK CALCULATION 1 TABLE 402.1.2(MINIMUM PRESCRIPTIVE INSULATION&FENESTRATION REQUIREMENTS) t' FENESTRATION I SKYLIGHT CEILING WOOD FRAMED WALL FLOOR: BASEMENT WALL BASEMENT SAB CRAWL SPACE WAL U-FACTOR U-FACTOR R- LUE R-VALUE R-VALUE R-VALUE R-VALUE R-VALUE 0 00 MASS. p.55 C9 20 ar 13•5 30 15I18 1014 FT.DEEP) 15/18 AMMEND. . NOTES: 1.R-VALUES ARE MINIMUMS&U-FACTORS ARE MAXIMUMS. 2.15119 MEANS R=15 CONTINUOUS INSULATED SHEATHING ON THE INTERIOR OR EXTERIOR j OF THE HOME OR R=19 INSULATION CAVITY AT THE INTERIOR OF THE BASEMENT WALL 3.REFER TO IECC 2015 CHAPTER 4 FOR ALL INSULATION&ENERGY REQUIREMENTS 4.13 t 5MEANS R5 CONTINUOUS INSULATED SHEATHING ON THE WALL EXTERIOR &R73 CAVITY INSULATION j THE DESIGNER SHALL BE NOTIFIED IF PNY COTUIT BAY DESIGN, LLG NEW REMODELING/ADDITION FOR: I;ERRORS OlION,TEBUILDINGCONRIONS ARE FOUND SCALE : (DRAWING NO.; 1 Ir THESE DRAWINGS PRIOR TO START OF I 43 BREWSTER ROAD, Ill WI LSBE RESPONSIBLE FOR THE CONIEN 1/4" = 1'-0" MASHPEE ,MA. 02649 STANLEY RESIDENCE iDESIGNIN E OFAN ERROS IF R OROMISSI li COMMENCES WITHOUT NOTIFYING THE DESIGNER OF ANY ERRORS OR OMISSIONS. PH. (508 274-1166 THESE DRAWINGS ARE SOLELY U FOR THE USE DATE . %I OF THE OWNER NOTED ANY OTHER SE OF THESE DRAWINGS REOUIRES THE WRITTEN FAX (508) 539-9402 i CONSENT TU ARCHITECTURAL PROTECTION 12/18/2018 [ Al I 76 WILLIMANTIC DRIVE MARSTONS MILLS, MA - - .ACT OF 1880. .. NAILING SCHEDULE 12'-01, 1 y-o" - 12'1' 110 MPH EXPOSURE C WIND ZONE A HARVEY JOINT DESCRIPTION NO.OF COMMON NAILS NO.OF BOX NAILS NAIL.SPACING 2442 ROOF FRAMING: A6 TEMPERED BLOCKING TO RAFTER(TOE NAILED) 2-8d 2-1Dd EACH END RIM BOARD TO RAFTER(END NAILED) 2-16 d - 3-16d EACH END WALL FRAMING: TOP PLATES AT INTERSECTIONS(FACE NAILED) 4-16d 5-16d - AT JOINTS UP STUD TO STUD(FACE NAILED). 26d18 d 2-6d 24:o.c:ALONG EDGES HEADER TO HEADER(FACE NAILED) - FLOOR FRAMING: :. :. .. JOIST TO SILL;TOP PLATE OR GIRDER(TOE NAILED) 4.8d 4.10d PER JOIST j BLOCKING TO JOISTS(TOE NAILED) 2-8d 2-10d EACH END - - BLOCKING TO SILL OR TOP PLATE(TOE NAILED) 3-16d 4-i6d EACH BLOCK LEDGER STRIP TO BEAM OR GIRDER(FACE NAILED) 3-16d - - 4-16d EACH JOIST JOIST ON LEDGER TO BEAM(TOE NAILED) 3-3d- 3-10d PER JOIST - - BAND JOIST TO JOIST(END NAILED) 3-16d 4-16d PER JOIST BAND JOIST TO SILL OR TOP PLATE(TOE NAILEDO 2-16 d 3-16d PER FOOT ROOF SHEATHING: WOOD STRUCTURAL PANELS(PLYWOOD) - RAFTERS OR TRUSSES SPACED UP TO 16"o.c. Bd 10d 6"EDGE/6"FIELD RAFTERS OR TRUSSES SPACED OVER 16"o.c. 8d 10d 4"EDGE14"FIELD GABLE END WALL RAKE OR RAKE TRUSS W/O OVERHANG 8d 10d 6"EDGE/6"FIELD GABLE END WALL RAKE OR RAKE TRUSS 8d 10d 6"EDGE/6"FIELD V W/STRUCTURAL OUTLOOKERS GABLE END WALL RAKE OR RAKE TRUSS W/LOOKOUT BLOCKS 8d 1Gd a"EDGE/4"FIELD CEILING SHEATHING: _ _ _ - -- j GYPSUM WALLBOARD 5d Z".EDGE/10"FIELD WALL SHEATHING. ( L STUDS SPACED UP TO 2a^o:c. 8d 10d 6"EDGEH2"FIELD 1/2"&25/32"FIBERBOARD PANELS 8d 3"EDGE/6"FIELD 1/2"GYPSUM WALLBOARD 5d -- 7"EDGE/10"FIELD A A6 FLOOR SHEATHING: iq WOOD STRUCTURAL PANELS(PLYWOOD) i"OR LESS THICKNESS Ed 10d 6"EDGE/12"FIELO GREATER THAN 1"THICKNESS 10d 16d 6"EDGE16"FIELD A A A6 6 HARVEY 2442 17 0" 12'-0" 12'-0.. 24'-0" NOTES: SECOND FLOOR PLAN PVC RAKE BOARDS TO MATCH EXISTING 1.) CONTRACTOR IS TO VERIFY ALL EXISTING CONDITIONS &DIMENSIONS IN:THE FIELD FRONT TO MATCHGAT FRONT TO MATCH BOTTOM OF EXISTING .. CEILING JOISTS 2.) CONTRACTOR TO VERIFY ALL INTERIOR&EXTERIOR MATERIALS, DETAILS,&FINISHES IN THE FIELD WITH OWNER 3.) ROUGH OPENING HEAD HEIGHT OF WINDOWS AT FIRST FLOOR TO BE 6-11"ABOVE SUBFLOOR 1z 4.) ALL CONSTRUCTION TO CONFORM TO 780 CMR MASSACHUSETTS I STATE BUILDING CODE,9TH EDITION AMENDEMENT&IRC2015 1z 5.) 110 MPH EXPOSURE B WIND ZONE f SECOND FLOOR I 6.) ALL SHEETS OF PLYWOOD WALL SHEATHING TO BE INSTALLED VERTICALLY, SUBFLOOR OR HORIZONTALLY W/BLOCKING AT EDGES,3"EDGE/12"FIELD NAILING 7.) ALL LVL LUMBER/BEAMS TO BE 1.9e L/360 LOAD TOP oFPLATE roaoFPuirE 8.) SEE CERTIFIED PLOT PLAN FOR ALL EXISTING&PROPOSED DETAILS 9.) FOLLOW ALL.MANUFACTURER'S SPECIFICATIONS FOR INSTALLATION OF ALL SIMPSON COMPONENTS 10.) ALL CONCRETE USED FOR FOUNDATION WALLS,FOOTINGS&SLABS TO BE 3000 PSI 11.)VERIFY ALL PLUMBING&ELECTRICAL DETAILS W/OWNERS.ON THE SITE a a��a �aaa Im DURING FRAMING CONSTRUCTION FIRSTFLOOR SUBFLOOR 12.)TIMBER FRAMING TO BE SPRUCE/PINE/FIR NO.2 GRADE - TOP OF FOUND. 13.)FOLLOW ALL REQUIREMENTS OF THE 110 MPH CHECKLIST SUPPLIED ERIFY O.H.DOOR STYLE,MFR.& 14.)FOLLOW ALL REQUIREMENTS OF THE IECC2015 RESIDENTIAL ENERGY AI I DFTAII S Wl OWNER j EFFICIENCY REQUIREMENTS&VERIFY ALL DETAILS WITH THE INSULATION FRONT ELEVATION . I NSTALLER/CONTRACTOR. 15.)ALL HEADERS TO BE 3-2 x 8's UNLESS OTHERWISE NOTED .. II THE DESIGNER.FIQ-ISHALL BE NOTIFIED N.ONYj. SCALE �IDRAWING NO. . ERRORS OR OMISSIONS ARE FOUND ON �7T. 1 CONSTRUCTION.THE PRIOR TO CONTRACTOR 1/41I � 11 OII 1 COTUIT BAY DESIGN, LLc T OF NEW REMODELING/ADDLTION FOR. R WILL BE RESPONSIBLE FOR THE CONTENT 43 BREWSTER ROAD i IN THESE DRAWINGS IF CONSTRUCTION COM MASHPEE ,MA. 02649 STANLEY RESIDENCE THSEDAMNGSARESOELYINGTHE FORTH t I DESIGNER OF ANY ERRORS OR OMISSIONS. f.OF THE OWNER TOF1�iR NOTED.OLELYFER THE USE _ DATE : iI THESE / �� ' I�ARCHITECTURAGCOPQRpGMTPROTECTIONE 12/18/201 ! A2 8 PH. (508 274-1166 FAx 5Q 539-9402 76 WILLIMANTIC DRIVE MARSTONS MILLS MA OF HE DESIGNER UNDER HE ?j 0 ,}1ru .___....._I (ici/ivD o ti 5�i9 T '� i r" I .....G�//✓O o u� 5�—,a T ( ` � Sr Cj Al I • 1 _ i r -