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0068 INDIAN SPRING ROAD - Health
68 Indian Spring Rd. Barnstable A= 133 036 TON�T1 OF BAftNSTABLE L'CATION A 9J SEWAGE # V'Ii >LAGE ASSESSOR'S MAP & LOT ,9.3-60 46 pig NAME&PHONE NO. C -,0 k) . �e SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BL-F BFI�OWNER Ste- PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet Furnished by ` t G �7 141-= ly 13 /_ , 17 i33s /z ' C3 = 3q'�I A-4 50\ A-2 A-3 HIGH p O —7 �O 26-4 m ?Q as W I --26 < 0 £ 3P MEAB _ C'-1 I� LOCUS MB NE C A-8 I LTAHUN LOCUS MAP N.T.S. DEER JUMP A �a NC O 50 �- C_2 HILL ROAD �� OVE `�9u BRUSH ROPOSED I /� PROPOSED snHo PaR FENCE �� SEPTIC C A BUILT \ h SEEMD OOIL A—g i BY ojtu 7/q REMAIN a o s- 2 BY OnlERs / siRAW soar �� 1t� QQ ANK i OR BALES RAfOVE 3 4'•OIDLN STAKENTH SLT FENCE l OAK TREES 33 FABRRATTACHED P ,1111 I i Al BRN STAPLES �� Ili III A-12 s BURY FENCE B'DEEP UPLAND ,. METIAMIO \ ii III �� ill i1i' ti to S. A-11 / 52'TO AETLaND i'i EX. III EX. pQcR NC �T A 3 J >� DWELLING,1 DECK ro f AIN �y� i SILT FEN EROSION CONTROL �j�O I I I tip . 84 / / !I 1 EX. Q� ET OSED A-1 R/w Y OTH SPOOL 30.73• DECK I$34 30 a —28 PROP. 18•z32' —26 EX. INGROUND. DWELLING POOL �O`n'}•�&� `24�-0 ce p 22 �$ / � III -1� /1,� ,, POOL DETAIL O A- A Kfu 20 �Zo� / FLAN �'" _ J� _26— ACCOMPANYING � A- 1 � z O MBLU 113-36 SEPTIC FROM ASBUILT 68 INDIAN SPRINGS ROAD ON FILE AT THE TOWN \� BARNSTABLE, MA HEALTH DEPARTMENT DATE: 9-27-2018 DRAWN: RBS BUILDER TO CONFIRM J08 /{: 5486 � �3p �� \ i / 5 SCALE:1"=20' DING. 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"fc, vVy L IN y 14q'e '"` 4£ -5-'A1�ftyi.a•.F- 7,.t F:r �a a .uy y], 4. ,,.: �. �5 EGi, . .. hftps://mail.google.com/mail/u/0/#search/erin.logan%40town.bamstable.ma.uc/FMfcgxvzKkwmjLnwGLVZQfNH[NvFnmZC?projector-1 1/1 Commonwealth of Massachusetts u - Title 5 Official Inspection Form p 3 -�5� Subsurface Sewage Disposal.System Form - Not for Voluntary Assessments 68 Indian Spring Road Property Address Sean Takeuchi Owner Owner's Name information is required for ev4✓West Barnstable MA 02630 05/17/2012 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms on the computer, use only the tab 1. Inspector: key to move your cursor-do not Ricky Wright use the return key. Name of Inspector B & B Excavation,I nc. rQ Company Name 14 Teaberry Lane Company Address Forestdale MA 02644 Cityrrown State Zip Code 508477-0653 S 14595 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 5/18/12 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. � I t5ins•11/10 Title 5 Vfficialporm:Subsurface S wage Dispo I System•Page Vil Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 68 Indian Springs Road Property Address Sean Takeuchi Owner Owner's Name information is required for every West Barnstable MA 02630 05/17/2012 page. City(rown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. 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): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 68 Indian Springs Road Property Address Sean Takeuchi Owner Owner's Name information is required for every West Barnstable MA 02630 05/17/2012 page. City,Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 68 Indian Springs Road Property Address Sean Takeuchi Owner Owner's Name information is required for every West Barnstable MA 02630 05/17/2012 page. City;Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply 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 cdliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow t5ins•11/10 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts M W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M SVBy'e� 68 Indian Springs Road Property Address Sean Takeuchi Owner Owner's Name information is required for every West Barnstable MA 02630 05/17/2012 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 68 Indian Springs Road Property Address Sean Takeuchi Owner Owner's Name information is required for every West Barnstable MA 02630 05/17/2012 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No i] ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ ® Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 i Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 68 Indian Springs Road Property Address Sean Takeuchi Owner Owner's Name information is required for every West Barnstable MA 02630 05/17/2012 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage d n/a 9 ( Y 9 (gP ))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: February 2011 Date Commercial/industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 68 Indian Springs Road Property Address Sean Takeuchi Owner Owner's Name information is required for every West Barnstable MA 02630 05/17/2012 page. CitylTowr State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ❑ No If yes, volume pumped: gallons How was quantity pumped.determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 68 Indian Springs Road Property Address Sean Takeuchi Owner Owner's Name information is required for every West Barnstable MA 02630 05/17/2012 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 2006 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 18"feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: >20feet Comments(on condition of joints, venting, evidence of leakage, etc.): At time of inspection building sewer appeared to be in working order-no sign of leakage or blockage. Septic Tank (locate on site plan): Depth below grade: 6"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ® No Dimensions: 1500 gal Sludge depth: 211 t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 68 Indian Springs Road Property Address Sean Takeuchi Owner Owner's Name information is required for every West Barnstable MA 02630 05/17/2012 page. CityrFown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 34" Scum thickness 5" Distance from top of scum to top of outlet tee or baffle 4" Distance from bottom of scum to bottom of outlet tee or baffle 10" How were dimensions determined? scour stick Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): At time of inspection septic tank appears to be structurally sound - no sign of back-up. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 0 68 Indian Springs Road Property Address Sean Takeuchi Owner Owner's Name information is required for every West Barnstable MA 02630 05/17/2012 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is co attached? Yes No P 9 PY ❑ ❑ t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 68 Indian Springs Road Property Address Sean Takeuchi Owner Owner's Name information is required for every West Barnstable MA 02630 05/17/2012 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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.): At time of inspection d-box appears to be in good condition. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 68 Indian Springs Road Property Address Sean Takeuchi Owner Owner's Name information is required for every West Barnstable MA 02630 05/17/2012 page. CityiTown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 3 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): At time of inspection leaching was dry and appears to be in good condition. No sign of hydraulic failure Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments GSM , 68 Indian Springs Road Property Address Sean Takeuchi Owner Owner's Fume information is required for every West Barnstable MA 02630 05/17/2012 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Tithe 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments , 68 Indian Springs Road Property Address Sean Takeuchi Owner Owner's Name information is West Barnstable MA 02630 05/17/2012 required for every page. City/Town State .Zip Code Date of Inspection D. System Information (cont.) 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 C g o R O 00 III" �q l �a" gl DY- �a C3=3`� 1 I C.4, 3 V �° I t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 •� Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments c,M 68 Indian Springs Road Property Address Sean Takeuchi Owner Owner's Name information is required for every West Barnstable MA 02630 05/17/2012 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to 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: Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 • Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 68 Indian Springs Road Property Address Sean Takeuchi Owner Owner's Name information is required for every West Barnstable MA 02630 05/17/2012 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file a t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 I 05/18/2012 FRI 14: 34 FAX 5083627103 Barnstable CTY HealthLab --- Barnstable Health 0001/001— 3 CERTIFICATE OF ANALYSIS Page: 1 of 1 �i Barnstable County Health Laboratory (M-MA009) 4r3�crru Report Prepared For: Report Dated: 5/18/2012 .Amanda Kundel Oyster Real Estate Order No.: G1267671 a 829 Main St. Osterville, MA 02655 Laboratory ID#: 1267671-01 Description: Water-Drinking Water Sample#: Sample Location:,- 68 Indian Spring West Barnstable,MA Collected: 0 5/1 712 0 1 2 I Collected by: A.Kundel Received: 05/17/2012 0 l Routine ITEM RESULT UNITS RL MCL METHOD# TESTED Nitrate as Nitrogen 0.16 mg/L 0.10 to EPA300.0 5/17/2012 Copper 0.40 mg/L 0.10 1.3 SM 3111 B 5/1712012 Iron 0.14 mgfL 0.10 0.3 SM 3111 B 511712012 pH 6.1 PH AT 25C NA 6.5-8.5 SM 4500-H-B 5/17/2012 s Sodium 9.1 mgfL 1.0 20 SM3111B 5/17/2012 s Total Coliform Absent P/A 0 0 SM9223 5/1712012 Conductance 60 umohs/cm 2.0 EPA Ilki 6/1712012 i Water sample meets the recommended limits for drinking water of all the above tested parameters Attached please find the laboratory certified parameter list. Approved By: _ (Lab Director) s y i pP i p� f ((` i i [ y(t r ND=None Detected RL = Reporting Limit MCL=Ma)amum Contaminant Level Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605 I - Commonwealth of Massachusetts , Title 5 Official Inspection Form ° Not for Voluntary Assessments Subsurface Sewage Disposal System Form Inspection results must be submitted on this form or on the official Title 5 Inspection Form dated 6/15/2000. Inspection forms may not be altered in any way. A. Certification ' Important: When filling out 1. Property Information: forms to the 68 Indian S ring Road computer,use p only the tab key Property Address O to move your Sean Takeuchi cursor-do not Owner's Name C)34 use the return ��✓✓ key. same Owner's Address West Barnstable MA 02668 City/Town State Zip Code Date of Inspection: Date 2. Inspector: David D. Flaherty Jr., R.S. Name of Inspector Flaherty Environmental Services Company Name P.O. Box 81 Company Address Yarmouth Port MA 02675 City/Town State Zip Code 508-362-1657 Telephone Number :v Certification Statement: I certify that I have personally inspected the sewage disposal system at this address,and thatAhe information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and mairitenance of on:site sewage disposal systems. 1 am a DEP approved system inspector pursuant tocSection 1:5 340 of r,. Tile 5(310 CMR 15.000).The system: ;.. ® Passes ❑ Conditionally Passes ❑ Falls i ❑ N ds Furthe v at' n by 7WMarch ving Authority 1 • 19,2006 lnsp or's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc.doc.11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 1 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form A. Certification (cont.) 68 Indian Springs Road Propeaty Address W.Barnstable MA 02668 City/Town State Zip Code Takeuchi 3/19/06 Owner's Name Date of Inspection Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® it 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: B) System Conditionally Passes: ❑ One or more system components as described in the"C ditional Pass"section need to be replaced or repaired.The system, upon completion o e replacement or repair, as approved by the Board of Health,will pass. Answer yes, no or not determined (Y,N, ND)in t for the following statements. If"not determined,"please explain. ❑ The septic tank is metal and over 20 y ars old*or the septic tank(whether metal or not)is structurally unsound, exhibits subst tial infiltration or exfiltration or tank failure is imminent. System will pass inspection if th xisting tank is replaced with a complying septic tank as approved by the Board of He *A metal septic tank will ss inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicati that the tank is less than 20 years old is available. ND Explain: t5insp.doc.doc•1112004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System. Page 2of16 I Commonwealth of Massachusetts Title 5 Official Inspection Form ° Not for Voluntary Assessments Subsurface Sewage Disposal System Form A. Certification (cont.) 68 Indian Springs Road Property Address W.Bamstable MA 02668 Cityrrown State Zip Code Takeuchi 3/19/06 Owner's Name Date of Inspection B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution x due to broken or obstructed pipe(s) or due to a broken,settled or uneven distribution box ystem will ;pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than Xthe ar due to broken or obstructed pipe(s).The system will pass inspection if(with approvard of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed / ND Explain: C) /rthaaluatio s Required by the Board of Health: ❑ exist hich require further evaluation by the Board of Health in order to determine if is f ling to protect public health,safety or the environment. ill pass unless Board of Health determines in accordance with 310 CMR )that the system is not functioning in a manner which will protect public health, the environment: sspool or privy is within 50 feet of a surface water sspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5insp.doc.doc•11l2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 3 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form A. Certification (cont.) 68 Indian Springs Road Property Address W. Barnstable MA 02668 Cityr town State Zip Code Takeuchi 3/19/06 Owner's Name Date of Inspection C) Further Evaluation is Required by the Board of Health(cont.): 2. System will fail unless the Board of Health(and Public Water Su tier,if any) determines that the system is functioning in a manner that pro the public health, safety and environment: ❑ The system has a septic tank and soil absorption syste (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface wa r supply. ❑ The system has a septic tank and SAS and th SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and S and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic to and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply ell**. Method used to dete ine distance: '*This system passes if a well water analysis, performed at a DEP certified laboratory,for coliform bacteria and v a He organic compounds indicates that the well is free from pollution from that facility and the pr sence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that o other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other. 1 t5insp.doc.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System- Page 4 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form A. Certification (cont.) 68 Indian Springs Road Property Address W.Barnstable MA 02668 Cityrrown State ZipCode Takeuchi 3/19/06 Owner's Name Date of Inspection D)System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No El ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool El ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. El ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] Yes No ❑ ® 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. t5insp.doc.doc•1112004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 5 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments �` Subsurface Sewage Disposal System Form A. Certification (cont.) 68 Indian Springs Road Property Address W.Barnstable MA 02668 Cityrrown State Zip Code Takeuchi 3/19/06 Owner's Name Date of Inspection E) Large Systems: To be considered a large system the system must serve a facil' 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 ition to the questions in Section D. YES NO ❑ ❑ the system is within 400 feet of a surface drinking ater supply ❑ ❑ the system is within 200 feet of a tributary to surface drinking water supply ❑ ❑ the system is located in a nitrogen sens' ' e area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of public water supply well If you have answered "yes"to any question in Section the system is considered a significant threat, or answered'yes"in Section D above the large syst has failed. The owner or operator of any large system considered a significant threat under Se n E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. T e system owner should contact the appropriate regional office of the Department. t5insp.doc.doc•1112004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System- Page 6 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form B. Checklist 68 Indian Springs Road Property Address W. Barnstable MA 02668 City/Town State Zip Code Takeuchi 3/19/06 Owner's Name Date of Inspection Check if the following have been done.You must indicate"yes"or"no"as to each of the following: YES NO ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? Have large volumes of water been introduced to the system recently or as part of ❑ ® this inspection? ® ❑ Were as built plans of the system obtained and examined? (if they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid,depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example,a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] t5insp.doc.doc•11f2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 7 of 16 I • Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information 68 Indian Springs Road Property Address W. Barnstable MA 02668 Ciity[Town State Zip Code Takeuchi _ 3/19/06 Owner's Name Date of Inspection Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 3 Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): U F LL Sump pump? ❑ Yes ® No present Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): ons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Z Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharge o the Title 5 system? ❑ Yes ❑ No Water meter readings, ' available: Last date of o ancy/use: Date Other ciibe): t5irup.doc.doc•1112004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 8 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form NEW Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) 68 Indian Springs Road Property Address W. Barnstable MA 02668 Cityfrown State Zip Code Takeuchi 3/19/06 Owner's Name Date of Inspection General Information Pumping Records: owner Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes,volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank,distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (f yes, attach previous inspection records, if any) ❑ Innovative/Altemative technology.Attach a copy of the current operation and maintenance contract (to be obtained from system owner) ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components,date installed(if known) and source of information: 2004 Were sewage odors detected when arriving at the site? ❑ Yes ® No t5insp.doc.doc•11/- Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 9 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cost.) 68 Indian Springs Road Property Address W. Barnstable MA 02668 City/Town State Zip Code Takeuchi 3/19/06 Owner's Name Date of Inspection Building Sewer(locate on site plan): 1.5 Depth below grade: feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: >30feet Comments(on condition of joints,venting, evidence of leakage, etc.): joints in good shape, venting adequate, no evidence of leakage, exterior cleanout noted. Septic Tank(locate on site plan): 1.5 Depth below grade: feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of ❑ Yes ❑ No certificate) 1 Dimensions: 500 gallon 2 inches Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 32 inches 1 inch Scum thickness Distance from top of scum to top of outlet tee or baffle 7 inches Distance from bottom of scum to bottom of outlet fee or baffle 13 inches How were dimensions determined? tape measure, sludgejudge t5insp.doc.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 10 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) 68 Indian Springs Road Property Address W. Barnstable MA 02668 Cityrrown State Zip Code Takeuchi 3/19/06 Owner's Name Date of Inspection Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): inlet tee pitched slightly back but functioning well,gas baffle&tees ok,tank seems to be structurally sound and liquid level appropriate, no evidence of leakage. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethyle ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffl Distance from bottom of scum to bottom of outl ee or baffle Date of last pumping: Date Comments(on pumping recommendaf ns, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet inve ,evidence of leakage, etc.): Tight or Holding Tan (tank must be pumped at time of inspection) (locate on site plan): Depth below gra Material of nstruction: ❑ co ete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): t5insp.doc.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 11 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) 68 Indian Springs Road Property Address W. Barnstable MA 02668 Cityrrown State Zip Code Takeuchi 3/19/06 Owner's Name Date of Inspection Tight or Holding Tank(cunt.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order. ❑ Yes❑ No Date of last pumping: Date Comments(condocan of alarm and float switches, etc.): i Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert n/a 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.): box is level with equal distribution to all outlets, no evidence of leakage or solids carryover. Pump Chamber(locate on site plan): Pumps in working order: / ❑ Yes ❑ No Alarms In working order: / ❑ Yes ❑ No t5insp.doc.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 12 of 16 I Commonwealth of Massachusetts Title 5 Official Inspection Form ° Not for: Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) 68 Indian Springs Road Property Address W. Barnstable MA 02668 Cityrrown State Zip Code Takeuchi 3/19/06 Owner's Name Date of Inspection Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System(SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 3, 500 gal. El leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/altemative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding,damp soil, condition of vegetation,etc.): vegetation normal over leaching (lawn), no ponding or signs of hydraulic failure, chamber was dry t5insp.doc.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 13 of 16 f Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont.) 68 Indian Springs Road Property Address W. Barnstable MA 02668 City/Town State Zip Code Takeuchi 3/19/06 Owner's Name Date of Inspection 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 hydra 'c failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction Dimensions Depth of solids Comments(n a condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.): L t5insp.doc.doc•1112004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 14 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments 5 � Subsurface Sewage Disposal System Form C. System Information (cont.) 68 Indian Springs Road Property Address W. Barnstable MA 02668 CityrFown state Zip Code Takeuchi 3/19/06 Owner's Name Date of Inspection Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. J , '=1 ®c ifs, 0,rr C3 = 3q ' C t5insp.doc.doc•11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 15 of 16 0 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cunt.) 68 Indian Springs Road Property Address W. Barnstable MA 02668 Cityrrown State Zip Code Takeuchi 3/19/06 Owner's Name Date of Inspection Site Exam: Slope Surface water Check cellar Shallow wells Estimated depth to ground water. 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 ®j 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: hand augered to 12', no water t5insp_doc.doc.11/2004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System. Page 16 of 16 TOWN OF B TABLE LOCATION SEWAGE # VILLAGE ASSE SOR'S MAP & LOTISIC INSTALLER'S NAME&PHONE N0. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) X NO. OF BEDROOMS BUILDER OR OWNER PERMTTDATE: y O COMPLIANCE DATE: Separation Distance Between the: r Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) ,� 7 "� Feet ,dge of Wetland and Leaching Facility(If any wetlands exist thin 300 feet of leaching facility) :-� Feet 1 by I I a . 3 i W I.0Q 3' Fee-----:-- No.-----__--------- BOARD OF HEALTH TOWN OF BARNSTABLE ZIppIication Ar Well Congtruct ion Permit Application is hereby rqade for a permit to Cons uct Alter ( ), or Repair ( )an individual Well at: Location — Address Assessors`Map and Parcel S/"4—j l - Address Owner _ r I1�� �1�/ - -------- --- -�_��6/ ------------ — Installer — Driller Address Type of rtg-1 Dwelling- ----- - -- -- - - Other - Type of Building------------- - No. of Persons--------------------------------------- Type of Well ------- Capacity---- -- - --—-- —- --— Purpose of Well-----------------------— Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation until a Certificate .of Corn liance has been issued by the Board of Health. Signed - ate Application Approved By — -- --------- 2 2 -��-3- date Application Disapproved for the following reasons:— ------- - - ----- - — -- date 2 03 Permit No. 2�_v3.0�1� -- Issued----� - --------- _---_ date BOARD OF HEALTH * r06fij�w n q TOWN OF BARNSTABLE � C p�II (A restou'u( -le Certificate of Compliance THIS IS TO CERTIFY, That the Individual Well Constructed (,-<, Altered ( ), or Repaired (by ) --------------------------------- �,�, a nstaller at- - --------has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Private We Protection -OVRegulation as described in the application for Well Construction Permit No.L--------Dated ?7 THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE----- -- - - Inspector----------------------------------—--- ----- No.- Gv� T Fee--- ! ' BOARD OF HEALTH TOWN OF BARNSTABLE Applicat ion-*r Well CootructionPermit Application is hereby,made for a permit to Construct V. , Alter ( ), or Repair ( )an individual Well at: - - Location - Address -— — Assessors Map and Parcel // -- ---- Owner - _ Address r . �_ ,P�1��/ -------------------- -------------------- i! Installer - Driller Address Type of.uildring Dwelling —--- -- — --- - Other - Type of Building------------ No. of Persons.---------------- ------ I Type of Well � �`�"� — ----- Capacity---- - -------- — Purpose of Well--------------------------- Agreement: CThe undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The t Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation until a Certificate .of Com liance has been issued by the Board of Health. r o f 4., Signed ate Application Approved By --_-- 2 2 - ---- date i Application Disapproved for the following reasons: ------ ------ - ---—----- - -- — - ------------------------ - - - — _e - date Permit No. 2-00'S-Oq y ---- Issued-----( � dare-- - -— --- -- i f BOARD OF HEALTH >9 C06'�wp-QC Y n r_ TOWN OF BARNSTABLE ILL` it fes�a�..��►�� ►1 e Certificate Of Compliante THIS IS TO CERTIFY, That the Individual Well Constructed Altered ( ), or Repaired ( ) by---- --------------------------------------------------------- a nstaller has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private We 1 Pr tection ��,// 9 2 2 Regulation as described in the application for Well Construction Permit No. 43-0�1--Dated °3 0_ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE----------------- - - - Inspector----- --- - - ------------ BOARD OF HEALTH TOWN OF BARNSTABLE Well Construct ion Permit No. --------------- r Fee- ---- Permission is hereby granted ------------ to Construct /�, Alter - ), or Repair ( ) an Individual Well at: Street j as shown on �th2e application for a Well Construction Permit No.-_____- yO 3-6L --_----- Dated- c1 2 2 G 3 � 2 2 D'3 Board of Health DATE 4J�F sp �ksA '` �j Pa : 1 CERTIFICATE OF ANALYSIS Barnstable County Health Laboratory Report Prepared For: Report Dated: 10/14l2003 Order Number: G0322980 Michael Aucoin 15 Sunset Drive South Yarmouth, MA 02664 Laboratory ID#: 0322980-01 Deseri_Q Water-Drinking hater Sample#: 2298001 Sampline Location: 68 Indian Spring Dr.West Barnstable Collected: 04/25/2003 Collected by: E Meehan Received: 01/26/2003 Routine ITEM RESULT UNITS MDL MCL !Method#i Tested LAB: IC Lab Nitrates 0.7 mg/L 0.1 10 EPA 300.0 09/29/2003 LAB:Metals Copper <0.1 mg/L 0.1 1.3 SM 3111B 09/26/2003 Iron <0,1 mg& 0.1 0.3 SM3111B 09/26/2003 Sodium 16 mg/L 1 A 20 SM 3111 B 09/26/2003 LAB: Microbiology Total Coliform Absent P/A 0 Absent P/A 09/2612003 LAB: Physical Chemistry Conductance 117 umohs/cm I EPA 120.1 09/26/2003 pH 6.4 pH-units 0.1 EPA 150.1 09/26/2003 :vote: Water sample meets the recommended limits for drinking water of all above tested parameters. Superior Court blouse, P0. Box 427, Barnstable, MA 02630 Ph:508-375-6605 - i ,M1<ff aqua. Page. 2 CERTIFICATE OF ANALYSIS L Barnstable County Health Laboratory Report Dated: 10/14/2003 Report Prepared For_ order Ntambtr: G0322950 Michael Aucoin 15 Sunset Drive j South Yarmouth, MA 02664 4 I Laborator'r ID#: 0322980-02 IDeseriation: Water-IDrinkingWater Sample#: R307 313 jjap nx Location: 68 Indian Spring Dr.West(Barnstable Collected: 09 5/2003 Received: 09 6/2003 Collected by: E Meehan 1 EPA 524.2- Volatile Organics by GUMS s ITEM RESULT UNITS ®d 1tiA4.L MCL_ m th # Tented LAB. GC//11 1,1,1,2-Tetrachloroethane BRLUgn 0.5 EPA 524.2 10/07/2003 BRA. ug/L 0.5 200 EPA 524.2 10/07/2003 1,1,1-'Trichl®roethaine 1,1,2,2-Tetrachloroethane BRL. ug/L 0-5 EPA 524.2 10/07/2003 1,1,2-Trichloroethane BBB. ug/L 0.5 5.0 EPA 524.2 10/07/2003 1,1-Dichloroethane BRL Ugll 0.5 EPA 524.2 10l07/2003 1,1-Dichloroethene BRL ug/L 0.5 7.0 EPA 524.2 10/07/2003 + 1,1-Dlchlor pr®p ene BRL ug/L 0.5 EPA 524.2 10/07/2003 1,2,3-Trichlorobenzene BRL ug/L 0.5 EPA 524.2 10/0712003 1,2,3-Trichloropropane BRL ug/L 0.5 EPA 524.2 10./07/2003 1,2,4-Trichlorobenzene BRL uglL 0.5 70 EPA 524.2 10/07/2003 1,2,4-Trimethylbenzene BILL ug/L 0.5 EPA 524.2 10/07/2003 1,2-IDibromo-3-chloropropan BRL Ug/L 0.5 EPA 524.2 10/07/2003 1,2-Dibromoethane(B DB) BRL ug/L 0.5 EPA$24.2 1110711011 1,2-IDichlorobenzene BRL ug/L 0.5 600 EPA 524.2 10/07/2003 1,2-Dichloroethane BRL ug/L 0.5 5.0 EPA 524.2 10/07/2003 1,2-IDichloropropane BRL ug/L 0.5 EPA$24.2 10/07/2003 0,5-Trimethylbenzene RILL ug/L 0.5 EPA 524.2 10107/2003 1,3-Dichlorobenzene BRL u&fL 0.5 EPA 524.2 10/07/2003 1,3-IDichloropropane BRL ug/L 0.5 EPA 524.2 10/07/2003 14-IDichlorobenzene BILL ugli. 0.5 5.0 EPA 524.2 10/07/2003 2,2-IDichloropropane BRL USIL 0.5 EPA 5241 10/07n003 2-Chlorotoluene BRL ug/L 0.5 EPA 524.2 10/07/2003 4-Chlorotoluene BRL ug/L 0.5 EPA 524.2 10/07n003 I i _ Superior Court House, P®.Box 427, Barnstable, MA 02630 Ph: 508-375-6605 I 0.5 EPA 524.2 10/07/2003 Page 4 CERTIFICATE OF ANALYSIS � Barnstable County Health Laboratory - Report Dated: 10/14/2003 ReRort PrcRared For: G0322980 Order Number, Michael Aucoin 15 Sunset Drive South Yarmouth, MA 02664 Laboratory I D#: 0322980-02 Deserintioa: water-Drinking Water Sample#: R307 313 Sam at_Locatioo: 68 Indian Spring Dr.West Barnstable Collected: 0 25/2003 Received: 0912612003 Collected by: E Meehan tert-Butylbelnzzelne BRL ug/L 0.5 EPA 524.2 : 10/07/2003 ! Tetrnehloroetlaene BRL ug/L 0.5 5.0 EPA 524.2 10/07/2003 Toluene 0.5 ug/L 0.5 1000 EPA 524.2 10/07/2003 0.5 10000 EPA 524.2 10/0712003 Total%y1e11e9 BRL ug/L trans-1,2-1Dlchloroethene BRL ug/L 0.5 l00 EPA 524.2 10l07/2003 4 trails-1,3-IDichloropropeDe BRL ug/L 0.5 EPA 524.2 10/07/2003 Trichloroetheane BILL ug/L 0.5 5.0 EPA 524.2 1U/07/2003 'I'rislel®rafluorol$aethune BILL ug/1. 0.5 EPA 5242 10/07/2003 Vinyl chloride BRL, ug/L 0.5 2.0 EPA 524.2 10/07/2003 Note: j ,k Approved By: { b Director) +� i Superior Court.Douse, PO.Box 427, Barnstable, MA 02630- 'Ph: 508-375-6605 i mF a, A6 Barnstable County Health Laboratory Reoort Preosred For: deport Dated: 10/14/2003 i Order Number: G0322980 !� Michael Aucoin 15 Sunset Drive South Yarmouth, M.A 02664 Laboratory ID#: 0322980-02 Descrip ion: Water-Drinking Water Sample#: R307 313 Sw9alinjL Location. 68 Indian Spring or.West Barnstable Collected: 0 25/2003 Collected by.- E Meehan Received: 0 2612003 Y , Benzene BRI, ug/L 0.5 5.0 EPA 524.2 10/07/2003 Bronniobenaene BRL ug/L 0.5 EPA 524.2 10/07/2003 Bronnochloromethene BRL ug/L 0.5 EPA 524.2 10/0712003 Brornodichloroniethane BRL ug/L 0.5 EPA 524.2 10/07/2003 f Broinoforni BRL, ug/L 0.5 EPA 324.2 10/01/2003 Bromomethane BRL, Ug/L 0.5 EPA 524.2 10/07(2003 Carbon tetrachloride BRL ug/L 0.5 5.0 EPA 324.2 10/07/2003 Chlorobenzene BRL ug/L 0.5 100 EPA 524.2 10/07/2003 Chloroethan>ne BRL, ug/L 0 5 EPA 524.2 10/07/2003 Chloroform 5 ug/L 0.5 EPA 524.2 10/07/2003 Chloromethaine BRL, ug/L 0.5 EPA 524.2 10/07/2003 ei 4,2-Dichloroethene BRL ug/L 0.5 70 EPA 524.2 10/07/2003 Ii cis-1,3-®ichloropropene BRL ug/L 0.5 EPA 524.2 10/07/2003 i Dibromochlorowethane BRL ug/L 0.5 EPA 524.2 10/07/2003 Dibromomethane BRL ug/L 0.5 EPA 524.2 10/07/2003 , Diehlorodilluoromethane BRL ug/L 0.5 EPA 524.2 10/07/2003 Ethylbenzenie BRL ug/L 0.5 700 EPA 524.2 10/07/2003 r Hexachlorobutadiene BRL ug/L 0.5 EPA 524.2 10/07,2003 Isopropylbenzene BRL, ug/1 0.5 EPA 524.2 10/07,12003 Methyl-tert-butyl ether BRL ug/L 0.5 EPA 524.2 10/07/2003 Methylene chloride BRL ug/L 0.5 5.0 EPA 524.2 10/07/2003 nn-Butylbeanzene BRL ug/L 0.5 EPA 524.2 10/07/2003 u-Propylbennzene BRL ug/1 0.5 EPA 5241 10/07/2003 Naphthalene BRL ug/L' 0.5 EPA 5241 10/07/2003 p-Isopropyltoluene BRL ug/L 0.5 EPA 5241 10f07/2003 See-Butylbenzene BRL ug/L 0.5 EPA 524.2 10/07/2003 Styrene BRL ug/L 0.5 100 EPA 524.2 10/07/2003 Superior Court Mouse, MD.Box 427, Barnstable, MA 02630 Ph: 508-375.6605 m Page: 1 CERTIFICATE OF ANALYSIS yy ' Barnstable County Health Laboratory '•r'it:HtiS�' Report Prepared For: Report Dated: 10/14/2003 Order Number: G0322980 Michael Aucoin 15 Sunset Drive South Yarmouth, MA 02664 Laboratory ID#: 0322980-01 Description: Water-Drinking Water Sample#: 2298001 Sampling Location: 68 Indian Spring Dr.West Barnstable Collected: 09/25/2003 Collected by: E Meehan Received: 09/26/2003 Routine ITEM RESULT UNITS MDL MCL Method# Tested LAB: IC Lab Nitrates 0.7 mg/L 0.1 10 EPA 300.0 09/29/2003 LAB: Metals Copper <0.1 mg/L 0.1 1.3 SM 3111B 09/26/2003 Iron <0.1 mg/L 0.1 0.3 SM 3111 B 09/26/2003 Sodium 16 mg/L 1.0 20 SM 311113 09/26/2003 LAB:Microbiology Total Coliform Absent P/A 0 Absent P/A 09/26/2003 LAB: Physical Chemistry Conductance 117 umohs/cm 1 EPA 120.1' 09/26/2003 pH 6.4 pH-units 0.1 EPA 150.1 09/26/2003 Note: Water sample meets the recommended limits for drinking water of all above tested parameters. Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605 r v.pF N.1%Zk. Page: 2 ;off sir CERTIFICATE OF ANALYSIS Barnstable County Health Laboratory Report Prepared For: Report Dated: 10/14/2003 Order Number: G0322980 Michael Aucoin 15 Sunset Drive South Yarmouth, MA 02664 Laboratory ID#: 0322980-02 Description: Water-Drinking Water Sample#: R307 313 Sampling Location: 68 Indian Spring Dr.West Barnstable Collected: 09/25/2003 Collected by: E Meehan Received: 09/26/2003 EPA 524.2- Volatile Organics by GC/MS ITEM RESULT UNITS MDL MCL Method# Tested LAB: GUMS 1,1,1,2-Tetrachloroethane BRL ug/L. 0.5 EPA 524.2 10/07/2003 1,1,1-Trichloroethane BRL ug/L 0.5 200 EPA 524.2 10/07/2003 1,1,2,2-Tetrachloroethane BRL uWL 0.5 EPA 524.2 10/07/2003 1,1,2-Trichloroethane BRL ug/L 0.5 5.0 EPA 524.2 10/07/2003 1,1-Dichloroethane BRL ug/L 0.5 EPA 524.2 10/07/2003 1,1-Dichloroethene BRL ug/L 0.5 7.0 EPA 524.2 10/07/2003 1,1-Dichloropropene BRL ug/L 0.5 EPA 524.2 10/07/2003 1,2,3-Trichlorobenzene BRL ug/L 0.5 EPA 524.2 10/07/2003 1,2,3-Trichloropropane BRL ug/L 0.5 . _ EPA 524.2 10/07/2003 1,2,4-Trichlorobenzene BRL ug/L 0.5 70 EPA 524.2 10/07/2003 1,2,4-Trimethylbenzene BRL ug/L 0.5 -EPA 524.2 10/07/2003 1,2-Dibromo-3-chloropropan BRL ug/L 0.5 EPA 524.2 10/07/2003 192-Dibromoethane (EDB) BRL ug/L 0.5 EPA 524.2 10/07/2003 1,2-Dichlorobenzene BRL ug/L 0.5 600 EPA 524.2 10/07/2003 1,2-Dichloroethane BRL ug/L 0.5 5.0 EPA 524.2 10/07/2003 1,2-Dichloropropane BRL ug/L 0.5 EPA 524.2 10r07/2003 1,3,5-Trimethylbenzene BRL ug/L 0.5 EPA 524.2 10/07/2003 1,3-Dichlorobenzene BRL ug/L 0.5 EPA 524.2 10/07/2003 1,3-Dichloropropane BRL ug/L 0.5 EPA 524.2 10/07/2003 1,4-Dichlorobenzene BRL uW.L 0.5 5.0 EPA 524.2 10/07/2003 2,2-Dichloropropane BRL ug/L 0.5 EPA 524.2 10/07/2003 2-Chlorotoluene BRL ueL 0.5 EPA 524.2 10/07/2003 4-Chlorotoluene BRL ug/L, 0.5 EPA 524.2 10/07/2003 Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 r 'M Page: 3 CERTIFICATE OF ANALYSIS Barnstable County Health Laboratory Report Prepared For: Report Dated: 10/14/2003 Order Number: G0322980 Michael Aucoin 15 Sunset Drive South Yarmouth, MA 02664 Laboratory ID 0322980-02 Description: Water-Drinking Water Sample#: R307 313 Sampling Location: 68 Indian Spring Dr.West Barnstable Collected: 09/25/2003 Collected by: E Meehan Received: 09/26/2003 Benzene BRL ug/L 0.5- 5.0 EPA 524.2 10/07/2003 Bromobenzene BRL ug/L 0.5 EPA 524.2 10/07/2003 Bromochloromethane BRL ug/L 0.5 EPA 524.2 10/07/2003 Bromodichloromethane BRL ug/L 0.5 EPA 524.2 10/07/2003 Bromoform BRL ug/L 0.5 EPA 524.2 10/07/2003 Bromomethane BRL ug/L 0.5 EPA 524.2 10/07/2003 Carbon tetrachloride BRL ug/L 0.5 5.0 EPA 524.2 10/07/2003 Chlorobenzene BRL ug/L 0.5 100 EPA 524.2 10/07/2003, Chloroethane BRL ug/L 0.5 EPA 524.2 10/07/2003 Chloroform 5 ug/L 0.5 EPA 524.2 10/07/2003 Chloromethane BRL ug/L 0.5 EPA 524.2 10/07/2003 cis-1,2-Dichloroethene BRL ug/L 0.5 70 EPA 524.2 10/07/2003 cis-1,3-Dichloropropene BRL ug/L 0.5 EPA 524.2 10/07/2003 Dibromochloromethane BRL ug/L 0.5 EPA 524.2 10/07/2003 Dibromomethane BRL ug/L 0.5 EPA 524.2 10/07/2003 Dichlorodifluoromethane BRL ug/L 0.5 EPA 524.2 10/07/2003 Ethylbenzene BRL ug/L 0.5 700 EPA 524.2 10/07/2003 Hexachlorobutadiene BRL ug/L 0.5 EPA 524.2 10/07/2003 Isopropylbenzene BRL ug/L 0.5 EPA 524.2 10/07/2003 Methyl-tert-butyl ether BRL ug/L 0.5 EPA 524.2 10/07/2003 Methylene chloride BRL ug/L 0.5 5.0 EPA 524.2 10/07/2003 n-Butylbenzene BRL ug/L 0.5 EPA 524.2 10/07/2003 n-Propylbenzene BRL ug/L 0.5 EPA 524.2 10/07/2003 Naphthalene BRL ug/L 0.5 EPA 524.2 10/07/2003 p-IsQpropyltoluene BRL ug/L 0.5 EPA 524.2 10/07/2003 sec-Butylbenzene BRL ug/L 0.5 EPA 524.2 10/07/2003 Styrene BRL ug/L 0.5 100 EPA 524.2 10/07/2003 Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 CERTIFICATE OF ANALYSIS Page: 4 Barnstable County Health Laboratory ''ssnrxLSt^'' Report Prepared For: Report Dated: 10/14/2003 Order Number: G0322980 Michael Aucoin 15 Sunset Drive South Yarmouth, MA 02664 Laboratory ID#: 0322980-02 Description: Water-Drinking Water Sample th R307 313 Sampling Location: 68 Indian Spring Dr.West Barnstable Collected: 09/25/2003 Collected by: E Meehan Received: 09/26/2003 tert-Butylbenzene BRL ug/L 0.5 EPA 524.2 10/07/2003 Tetrachloroethene BRL ug/L 0.5 5.0 EPA 524.2 10/07/2003 Toluene BRL ug/L 0.5 1000 EPA 524.2 10/07/2003 Total xylenes BRL ug/L 0.5 10000 EPA 524.2 10/07/2003 trans-1,2-Dichlo roethene BRL ug/L 0.5 100 EPA 524.2 10/07/2003 trans-1,3-Dichloropropene BRL ug/L 0.5 EPA 524.2 10/07/2003 Trichloroethene BRL ug[L 0.5 5.0 EPA 524.2 10/07/2003 Trichlorofluoromethane BRL ng/L 0.5 EPA 524.2 10/07/2003 Vinyl chloride BRL ug/L. 0.5 2.0 EPA 524.2 10/07/2003 Note: Approved By: ( b Director) O � O Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 BOARD OF HEALTH TOWN OF BARNSTABLE Yell Construct ion Permit No. Z00 3—wd Fee_1 - ` f Permission is hereby granted 00, to construct � Alt ), or Repair ( ) an Inn ividual Well : No. —6.'�_��i�-�X" f __��_ �1��-- --//1141 —�1�------------- Stred as shown on the application f�o�r(a Well Construction Permit � No.__�!r� _00 — '_ ------ Dated— 2 2 0 3 -- -- ------------------------------ 22 03 Board of Health DATE— _ fYr\ c v, KXo�o, S�S � &4-er !V�I ��Q.dLS. 'Wed we-11 �4 f fjll#s_ i No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS Zipprication for Migogar &patent Construction Permit Rep Application for a Permit to Construct(V) air( )Upgrade( )Abandon( ) O Complete System ❑Individual Components Location Address or Lot No. ( p Owner's Name,Address and Tel.No. Assessor's Map/Parcel �� R��sv,� M4 / /3 gNN0,4) �A- Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. <SPD Fr 0kj) �CY�`t/ Type of Building: Dwelling No.of Bedrooms _ Lot Size 14 q.ft. Garbage Grinder( � Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures ,/ Design Flow gallons per day. Calculated daily flow ,S gallons. Plan Date Number of sheets 1 Revision Date Title Size of Septic Tank /5'0-6 C" Type of S.A.S. ' Gur.G< C 10 all ii i f Description of Soil n - i 12 1- 4 -IdL MEO 2 >r s r i /r r• a it ( G 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 issued by this Board of Health. Signed Date Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued S THE COMMONWEALTH OF MASSACHUSETTS = r BARNSTABLE, MASSACHUSETTSCD � Certificate of Compliance �- - THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired )Upg dedj ) Abandoned( )by at has been consAructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector --------------------------------------- - - - - No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Miopogar *pgtem Construction Permit Permission is hereby granted to Construct( )Repair( )Upgrade( )Abandon( ) System located at and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this permit. Date:_ Approved by No. 4 1 , �< Fee /y • in computer:,/• Entered co ute. 0 \ p -- F MASSACHUS TTS THE COMMONWEALTH O „ i ..•, ©. \ -.,,. Yes T! PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 0(ppYication for Mi4ogar *pgtem Construction Permit Application for a Pere it to Construct(1_ )Re"pair( )Upgrad ( )Abandon( ) El Complete`System ❑Individual Components Location Address or Lot No. //-?,u I/ll�,_ P (Owner's Name,Address and Tel No. Assessor'sMap/Parcel /� g/ /?A)N0� Installer's Name,Address,,and Tel.No. Designer's Name,Address and Tel.No. y �P ni/G �,e i L11. + Type of Building: Dwelling No.of Bedrooms _ Lot Size ft. Garbage Grinder((� Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow \ gallons. Plan Date /+h vd. ► 0 Number of sheets 1 Revision Date . Y Title Size of Septic Tank 5-" 4�.A Type of S.A.S. - ' /),-p C, o++-+ Description of Soil n - S r'1 t.A-t A \P T I Z L -P tr r--I ge M& C A Z I 7- C 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 issued by this Board of Health. Signed Date Application Approved by /-, y - ' - Date Application Disapproved for the following reasons i CD Permit No. Date Issued ------------------ ---- -------.--- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS .x Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired ( )Upggrradedr_ ) Abandoned( )by at has been conshcted in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector No. Fee THE COMMONWEALTH OF MASSACHUSETTS t PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS l Permission is hereby granted to Construct( )Repair( )Upgrade( )Abandon( ) System located at 't. and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. 'Provided:Construction must be completed within three years of the date of this permit. Date:_ Approved by TOWN OF B TABLES LO%ATION SEWAGE # VILLAGEJA , ASSE SOR'S MAP & LOT INSTALLER'S NAME&PHONE N0. SEPTIC TANK CAPACITY ,LEACHING FACILITY: (type) 0 NA A (size) 9 X 13 i. NO. OF BEDROOMS BUILDER OR OWNER PERMTTDATE: Ll P COMPLIANCE DATE: Separation-Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching.Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) - Feet 'dge of Wetland and Leaching Facility(If any wetlands exist . Whin 300 feet o"lea6hinOcility) Feet f ? 4 0 cv.4 No. Oleo Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC: HEALTH DIVISION -TOWN OF BARNSTABL,Ei MASSACHUSETTS Zipprication for Mi,5pozat 6potem Conztruction Permit Application for a Permit to Construct( . )Repair( )Upgrade( )Abandon( ) Complete System ❑Individual Components Location Address or Lot No. N 4K r�t►o� Owner's Name,Address and Tel.No. �"ice( ScIO —0%-a, Assessor's Map/Parcel v `J M R� eS'— AUe Rr�1�`cS A . Installer's N e,Add�resjs, dyTell,N3o. �- Designer's Name,AdWess and Tel.No. -77) 7 51 1,f"q/ Type of Building: Dwelling No.of Bedrooms Lot Size { \L\(.,, q.ft. Garbage Grinder( ) Other Type of Buildin To.of Persons Showers(d) Cafeteria( ) Other Fixtures --la t\e , '?2 S XVS Design Flow gika gallons per day. Calculated daily flow Lk A s: gallons. Plan Date "I ^\0—© `'S Number of sheets Revision Date Title Size of Septic Tank D?> Type of S.A.S. _'I \*,P,+�oJ`S Description of Soil f�SZ S 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 issued � Si a Date Application Approved by Date 022-5 3 Application Disapproved for the following reasons Permit No. !�;LQRO 3 — W 3 Date Issued �` -------------------------------------------- t , Al 4 No. �N J " `` ._ -t-- -. ���,.::_ : �. Fee �.. THE dk,"vJNWEALTH OF MASSACHUSETTS:. . --Entered in computer: Yes PUBL'IiC HE LTH DIVISION -TOWN OF BAR NeTA t , ,9SACHUSETTS{ ZIpplication for Miopogal &pztem Con.5truction Permit Application for a Permit to Construct( , )Repair( )Upgrade( )Abandon( ) Complete System O Individual Components Location Address or Lot No. -1N k A t+ Owner's Name,Address and Tel.No. e) - y Assessor's Map/Parcel '� Y\, �s Aye N\ Ar\0ls . Installer's Name,Address,and Tel No. Designer's Name,Add ss and Tel.No. Type of Building: t Dwelling No.of Bedrooms Lot Size`'{�_sq.ft. Garbage Grinder( ) Other Type of Buildings'\ �t M�No.of Persons Showers(0,) Cafeteria( ) Other Fixtures P '3 S\\,J\.t S Design Flow A ya gallons per day. Calculated daily flow 4A`) gallons. Plan Date 'S -\O-- O `� Number of sheets Revision Date Title Size of Septic Tank -- RISO_ e2> Type of S.A.S. Description of Son, C S Nature of Repair`s 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 issued7b,.this Board-of Health, Sig ted' r Date ! f Application Approved by Date t i )Gd-5k 3 Application Disapproved for the following reasons Permit No. �QO 7') g Date Issued 1 6 --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance � THIS IS TO CERUFY,that the On-site Sewage Disposal System Constructed( C-1 Repaired( )Upgraded( ) Abandoned( )by at $^ ��� /D'�1 J,YIj'Ir�a'9 !� lt/ . 4 5'�'/' has been constructed in accordance with the provisions of Ti tle 5 and the for Disposal System Construction Permit No. Zoo? SR 3 dated ► 1�� c;/o ? �� +, �. Designer % ,Installer u i � �� 1. �.r ��The issuance oflthis prmit shall not be construed as a guarantee that the system will unction tesigned. Date 11 t l Inspector 1 N . i --------------------------------------- No. 3 — 5R'3 Fee 00 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS ligoar 6 5tem Construction Permit Permission is hereby granted to Construct( Repair( )Upgrade( )Abandon( ) System located at and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construct/on must be completed within three years of the date of thisl�pe 't. Date: a �r U L Approved by � � MCOASTAL ENGINEERING CO.,INC. 260 Cranberry Highway,Orleans,MA 02653 Phone: 508-255-6511/Fax: 508-255-6700 Web Site: www.ceccapecod.com Transmittal To: Board of Health Date: 07-20-01 Project No. C15489 Town of Barnstable Via: ®1st Class Mail ❑Pick up ❑Delivery[]Fed Ex 367 Main Street Fax: ECE��Ep Hyannis,MA 02601 Phone: R Subject: Brendan Herbert No. of pages to follow: Towt4 OF 5A MS g�E Indian Spring Road _ DEPT West Barnstable,MA Assessor's map 133,parcel 36 ❑Plans ❑ Copy of Letter ❑ Specifications ®Other Soil Report We are sending the following items: Copies Date No. Description 1 07-20-01 Original Soil Evaluation Report These are transmitted as checked below: ❑for approval 171for your use ❑as requested ❑for review&comment ❑ Remarks: This form was not sent along with the check. (Check was mailed on 06-11-01.) Sorry for the inconvenience. Please call me if there are any problems cc: John G. Schnaible RS By: , JGS/emm NOTE: IF ENCLOSURES ARE NOT AS NOTED, PLEASE CONTACT US AT (508) 255-6511. Aug-04-00 12 : 39 BARNSTABLE HEALTH OEPT 5087906304 P _ 02 'own of Barnstable P,4 l�/ OO Department of Health,Safety,and Environmental Services - + �°'bt �EP 1 Public Health Division `, O I 367 Main Street,Ilyannis MA 02601 Date ewwverweri ur wad � Date Scheduled U �JLj� Z OD .a7� Time U !/ Fee Pd. Q Soil Suitability Assessment for ,Sewage Disposal Performed By: N,� t Witnessed By: LOCATION 3d G.ENERAL 1NF�DRMAT�OiV Location Address �Q07 S rat t.l� �G A A .. r .. .. G� n Q Owncr.s Name r/7�/\i VAr NL rA 5L,S Address Assessor's Map/Parcel: t l 3 3 1 P 3(o / CO gF31.�51"Oly �p� .SAM," , n 7 Engineer's Name NEW CONSTRUCTION (�`� `9 r��c --Rt-GP/A�I�R Telephone N Sd Land Use ._.�It.i7�0�/.!t } �►awt_ Slopes(%)- —_ Surface Stones Distances from: Open Water Body_ R 1'09sihie Wet Area ! R Drinking Water Well 0 Drainage Way It Property Line 0 Other R SKETCH: (Street name,dimensions of lot.exact locations of Icst hules ec pert tests,locate wetlands in proximity to holes) n �1 e vVX 4� ,Jm V) A n �IjA Parent material(geologic) // j Depth to[3edrock Depth to Groundwater; Standing Water in Hole: fff Weeping from Pit Face Lstimated Sensonal High Groundwater DETERN�NAfiION FUt2.SEASOIYAL ILGH WA:T'ER:TABLE Method Used: Depth Observed standing in obs.hole: in. Depth to soil[nettles:Depth to weeping from side of obs.hole; in. hvlex Well/t ._ Rcadintx pate; Index Well level t[t' Groundwater Adjustment fi -- —- ._.- Adj.factor..-_ _-_ Adj.Groundwater Level PERC.0,L ON TES T JD* Observation Flole b Time at 9" Ueplh of Pc re Time at 6" _ Start Pre-soak Time Time(9"-6-) find Pre-soak Rate Min./Inch Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(YM) Original: Public Ileallh Division Observation Hole Data To Be Completed on Copy Applicant q yg-04-00 12 : 40 BARNSTABLE HEALTH OEPT 5087SOG304 P _ 03 ,; DEE]E'::ORSER'VAT'IOiV H�7LE Y.;OG: o1le # Dc rlh from ::: ..... I Soil I lorizon Soil Texture 'Soul Color Soil Other Surlacc(In.) (t 1SDA) (Munscll) Mntlling (Structure,Stones, @nuldcrc S, ' enev.% rravcll DEEP,OBSERVATION H..OL.E LOG HWit Depth Imm Soil Horizon Soil Texture Snit Color Soil Other Surface(in.) (USDA) (Munscll) Mottling (Structure,Stones,13ouldcres. consistency Y. i bEEP;OBSERVATION 14OLF LOG I o1e# Depth from Soil}lorizon Suit TexUirc Soil Color Soil Other Surface(in.) (USDA) (Munscll) Mottling (Structure,Stones, r3ouldcres. nsistencv-%Gravel) DEEP..OBSERVATION HOLL.LO:G Hole Depth from Soil I lorizon Soil Texture Soil Color Soil Olhcr .Surface(in.) (USDA) (Munsell) Mottling (Structure,S(ones,13oulderes. p5islelicv.%Gravel) .Flood Insurance Rate Man: Ahovc 500 year flood boundary No_ Yes Wilhin 500 ycnr boundary No Yes Within 100 yenr tluud boundnry No_ Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughou( the area proposed for the soil absorption system? If not, what is the depth of naturally occurring pervious material? Certification 1 certify that on (date) 1 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 training, expertise and experience described in 310 CMR. 15.017. Signature Date • , Town of Barnstable P# ,�1 0,09 RECEI par ent of Health,Safety,and Environmental Services ofzI Public Health Division Date /a V/, 4 UG 0 6. 2001 367 Main Street,Hyannis MA 02601 ewruvsn►e MASS. W�0F NST �Arf H-A BAR9�dBIE r �� Ti .�A%0 Fee Pd. Soil Suitability Assessment for Sewage Disposal Performed B-: S1EAI3 kk .V_4 (,0A9A4 EO&. Witnessed By: rb 4ZKZ1- 11 LO+�ATION & GENERAL INFORMATION d Location Address . ��1 Owner's Name Address Assessor's Map/Parcel: X? 4 Engineer's Name 6:,.4 97�G �'� NEW'CONSTRUCTION /REPAIR Telephone# Land Use 'R,CS1 DE0 t 1► k r VAg4p Slopes(%) r g " 1 5 Surface Stones NDu>l, Distances from: Open Water Body 2,00+ ft -Possible Wet Area 1204 ft Drinking Water Well ISO* ft 1 Drainage Way I ZO + It ' Property Line I '.0 4 ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) I _ I , - r .j Ii -_ 3: 0 .. p Ilf I rn two � A 7.tO [7 t Parent material(geologic) '04'0&k A( L 9v'f WA5*i Depth to Bedrock 2o0 t Depth to Groundwater: Standing Water in Hole: PO VE Weeping from Pit Face 00 K)E, Estimated Seasonal High Groundwater 15 .........................................................._........_..........._........................ DET] NATION FOR SEASONAT,T tGH'VVATIJR TABEE . Method Used N 1� Depth Observed standing in obs.hole: 0DN5—; in. Depth to soil mottles: AN r`3 V_ in. Depth to weeping from side of obs.hole: 001aE_ in. Groundwater Adjustment ft. Index Well# ___..._._, .Reading Date: Index Well level..__ _ AdJ.factor___ Adj.Groundwater Level PERCOLATION TEST pate ,Time ............... ........::::.....:.. ...................... .. : .. . .. ....._........_..... _. ........:..:: Observation Hole# I Time at 9" Depth of Pere Time at 6" Start Pre-soak Time @. O'00 0:00 Time(9"-6") End Pre-soak 8: DO 13;00 Cl'i (YA1,. IQ I A614 Peal) Rate Min./Inch �4�h�a9 C �no►J Site Suitability Assessment: Site Passed X Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back j Copy: Applicant , „ , 1 _ GISN81. oO • r' t DEEP OBSERVATION ROLE LOG Hole 4 . Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency,%Gravel 0- >kSp, :5Au0 10 iR MED. tAtJ 1) T S1 K �ls IZ0 G MBA• SAGO 2.54 -7 IJ�►�� DEEP OBSERVATION HOLE LOG Hole Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency.%Gravel 0 � r 12- 3C� � t.�an►Y s�aN� ie Y2 s/� -12-0 G MHO. "OP 2,5 DEEP OBSERVATION HOLE LOG Hole Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) j' (USDA) (Munself) Mottling (Structure,Stones,Boulderes. Con istenc %Gravel . wX DEEP OBSERVATION;HOLE LOG Ifole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.)` (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consigency,%Gravel) Flood Insurance Rate Man: Above 500 year flood boundary No_ Yes X r c Within 500 year boundary No X Yes Within 100 year flood boundary No X Yes Dept) 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 r , I certify that on TALI, 1600 (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 trainfng,expertise and experience described in 310 CMR 15.017. Signature Date W612- 0 4 + - COASTAL ENGINEERING CO., INC. lt2.60 Cranberry Highway,Orleans,MA 02653 P;pe: 508-255-6511/Fax:508-255-6700 RE Web Site:www.ceccapecod.com TRANSMfflL AUG 0 G 2001 TOWN OF BARNSTABLE HEALTH DEPT. To: Board of Health Date: 8/3/01 Project No. C15489.00 Town of Barnstable Via: 01st Class Mail❑Pick up ❑Delivery❑Fed Ex 367 Main St. Fax: Hyannis,MA 02601 Phone: Subject: 68 Indian Spring Rd.,W. Barnstable No.of pages to follow: 1 ❑ Plans ❑ Copy of Letter ❑Specifications ® Other We are sending the following items: Copies Date No. Description 1 8/01 Soil Suitability Assessment for Sewage Disposal These are transmitted as checked below: ❑for approval ❑for your use ❑as requested ❑for review & comment ❑ Remarks: cc: Brendan Herbert By: Sean M. Riley I SMR/dlb NOTE: IF ENCLOSURES ARE NOT AS NOTED, PLEASE CONTACT US AT (508) 255-6511. T�. RTTPX i r cl �v 4 � o TIm- H[ d R.G.MPBCARDS - Q Q ADDMW 1 _ -FRONT -ELEVATi y � W CA be PIP SHEET i OF 4 ov JOB, 0302 J r 1�liAd°1N$l'+ i"1 / DATE, 1/20/04 N ni d Ve V FM P"TS TRIM Tl'P.. ... _ ... h4+11TE TRIM TTP. _ U RETAINING WALL - TO 1 DDETERRUmm _ ul. Q 1!a Q t_ Z - y 4E 2 OF 4 REAR"EL.E\/ATIOIV , qs C� , r JOBi { 'y .I a s f �51 WN .", " TE. $Y1/20/04 . • 1 .n y • , = V cillil ' L RIDGE V64T _ Ii✓6`CDX SHEATHING- tu ASP44ALT SMNGLES li F.G. INSUL. �} Q �1212fi NO FASCIA/ tXID SOFFIT/VENTED SOFFIT 12 OR DRIP EDGE/ALUMINUM GUTTER s li O.G.O DOWNSPOUTS TYP. u hC3 STRAPPING W 4GYP.BOARD dl moo . o � RIS F.G. INSUL. 0 2r4 li STUDS Y W 04. — 102' PLYWOOD SWEATWING v TYVBC KUP (OR EQUAL) s Apt BEDROOM pax.7614INGLES TYP. 3/4, TOG PLY U 2ct s o O. Q L---JEN i d _? BASEMENT y d pC - ADDITION - - -LEFT ELEVATION 1 l d_ SCALE: � O '/4 ul A Lu ADDITION SECTION zz SCALE, 1/4" - V._0. — M < SWEET 3 OF 4 �h a � r .a•. ��4 i�RA►�na 43Y: 154 DATE: 1/20/04 CIO 40'-0" 24-O g� 7i_gn V-4" 15'-10" >`5V 7'-10" 3'_b" 20i_6n DE 2< Z. H A7 A7 r "l 2052-3 —y CN235 �p ppppp� FWG tomit _ DW o o BREAKFAST n Io v IIV O O 6 KITCHEN O 6 2852 2 fe 4 6 "21k T-0" GARAGEW12)26STEEL BEAM ABOVE ___ _3'-O" ly IVIN N2' " o rt1 '2852 r 0 DINING c11 OY ER 2 2852 2852 N Q _— --- Q r 1 o O . 34 285 2852 2852 2852 1- Z 1 U lil Q/ B ICK CL ST O A H ac A7 A7 z Q Q fL z q'-2" 7i_2n T-10" 3'-11" 4'-2" 4'-2" 3'-11" 7'-10" SHEET 4 OF 8 15'-101, 24'-0" 40'-O° a. - FIRST FLOOR PLAN SCALE: 1/4" 1'-0" rI JOB: 0302 DRAWN BY: KW DATE: I I/IS/03 If- 40'-0" 24'-0" ems' Z 14'-2" 7'-10" B z A7 A7 2446 =2_ _= _—_- 2446-2 �(!� ct LL. ASTER 10,_3„ z'_4" =1 - — _ -----_ — BATH -1N BATH #2 2� — W A — -- ---- — - O � 5g BEDROOM #2 - — - -- -- — ------ ---- — o �9 2¢ 2846 v ME][=D ul 1� oi 2� 2gz 6i LAUNDR5IOrPr s - � rt�! BO US //'� o 4' 2n 3i_6n g'_p" 5'-10" _ Ig_2" -� 2846 N HALL 2� 1 m . cli MASTER --- __ 2� 6 Imo_ - v oom ` o 2846 -- - - - I�, �� BEDROOM #3 L21��O 24310 ------------ OPEN TO 59 O BELOW 1 2846 2846- � 2UI 2846- I 1 � Z W 1 O fL 0. z B A7 A7 Q Q Ll 7'-10" 3'-II" 7'-10" 15-10 8-4 15-10 5-5" 4'-0" 5'-2" 4'-0" 5'-2" SHEET 5 OF 6 64'-0" 0 - SECOND FLOOR PLAN SCALE: 1/4" I'-O" JOB: 0302 DRAWN BY: KW DATE: 11/15/03 U t�3 O DECK 6'-V V-2' �. — ———— — ———— — 1 s- ----- --- .. 24 IS 2446. Lu - I f W : T-W CONCRETE WALL T { 10'x*m CO MNUOM.FOC M . , 9PAIM334 YNLK-M ... - ia rtj � i L.t-JW7r zg Fi''-5 3X4" nn 1 � � 1 I r-- Z f t 2xlo'. I a Q !72'Ds f J a AND 2.U6 1 'f I ;1' s--art�IRrsr� f I 9 t1r DIA.STFi."1 COLA"RJ L T - W-jS&xW CONCRETE I-AD 1IR Al i I; i------------ - ——— iiFJ►DEit --------- ------( � L p w-0, o Q_ Z Q Q A . 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STEEL LUMN I I I ——I I �i I 30'x30"xl2" GONGRE E PAD V I DROP WALL UNDER 5LAB nI i AT DOORS I 0 8' I 15'_4u L 2c:_4" IEl 0 ----- � I c� I I I ------------ ------- I O I ll I I ---j I o 1� z L------J ------------ I v - o fL I I ; �- Z o B Z Q I BRICK STOOP I ' A - Q J = A7 A7 0 fL ' z IS'-10° 40'-O' 24'-0" SHEET 5 OF_ S 64'_0" Ans FOUNDATION PLAN SCALE: 114" 1'-O" JOB: 0302 DRAWN BY: KW DATE: 11/15/03 RIDGE VENT 5/8" CDX SHEATHING r ASPHALT SHINGLES Y 2x6 s @ R30 F.G. INSUL. 32 O.C. � 12 w G. ?+ q 9 M z RIDGE VENT s- - �C Ix8 FASCIA / IX8 SOFFIT / VENTED SOFFIT p� 6/5" CDX SHEATHING ATTIC OR DRIP EDGE / ALUMINUM GUTTER 0 DO OASPHALT SHINGLES WNSPOUTS TYP. R30 F.G. INSUL _ _ �/ O •CII 2x8's @ 16"O.C. I 2x8's @ b"O.C. 1 Ix3 5TRAPPI14G� 12 Ix3 STRAPPING t/2" GYP. BOARD 12 I/2" GYP. BOARD �\ p O `o IIIIL�'\1\JI W W i, SECOND FLOOR RIB F.G. INSUL. q� / .s 2x4 IXT. STUDS @ I6" O.G. �ll U I/2" PLYWOOD SHEATHING (� ® T_ 3/4" TtG PLY �4" TtG PL W 7 TYVEK RAP (OR EQUAL) \\UJ11 W.G. 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