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TROY WILLIAMS
SEPTIC INSPECTIONS
Certified by MA Department of Environmental Protectio �._„ (508) 385-1300
RECEIVED �;.
19 Hummel Drive
South Dennis, MA 02660
r-C 2000
TOWN OF BARNST COPY
HEALTH DEPT.
COMMONWEALT IUSETTS
EXECUTIVE-OFFICE OF ENVIRONMENTAL AFFAIRS
- DEPARTMENT OF ENVIRONMENTAL PROTECTION
ONE WINTER STREET,BOSTON MA 02108 (617) 292-5500
TRUDY CORE
Secretary
ARGEO PAUL CELLUCCI DAVID B. STRUHS
Governor Commissioner
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION
119 B0. b e.r-r' L��„
Property Address: Y Name of Owner Dot—o f�, P 1 CAC.>qN.,,� G. d Address of Owner: x
Date of Inspection: 02 / /00 C-v w,.,� a�„;J, A�lu� , D-Z 6 7
Name of Inspector:(Please Print) Troy Vlfilliams
1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000)
C«rWsuy Name: Tro lliams SeRtic Inspections
Mating Address: 19 Hummel"Drive, So. Dennis, MA 02660
Telephone Number: (508) 385-1300
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate
and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and
maintenance of on-site sewage disposal systems. The system:
Passes
Conditionally Passes
Needs Further Evaluation By the Local Approving Authority
Fails
Inspectoes Signature: is Date: -2119�oo
The System Inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(30)days of
completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner
shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the
system owner and copies sent to the buyer,if applicable, and the approving authority.
NOTES AND COMMENTS
Although.system meets the minimum requirements set forth by the Massachusetts Department of
Environmental Protection,certification is not to be construed as a guarant of future working condition
of system,piping or components. This inspection represents the conditio of em on the Date of
Inspection noted above. V
ECEIVED
r r 1 ?QUO
HEAL DcTd
TOWN OF BARNS EPTSTA E
HEALTH DEPT.
1. 5bL
revised 9/2/98 Page Iofit
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART'A
CERTIFICATION (continued)
Property Address:
Owner: 119 Bayberry Lane, Cummaquid,MA
Date of Inspection: Dorothy Place
February 9,2000
INSPECTION SUMMARY: Check A, B, C, or D:
A. SYSTEM PASSES:
I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist. Any failure
criteria not evaluated are indicated below.
COMMENTS:
B. SYSTEM CONDITIONALLY PASSES: A//j9
One or more system components as described in the "Conditional Pass"section need to be replaced or repaired. The system,upon
completion of the replacement or repair,as approved by the Board of Health, will pass.
Indicate yes,no,or not determined(Y,N,or ND). Describe basis of determination In all instances. If "not determined",explain why not.
The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of
Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or
the septic tank, whether or not metal,is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank
failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as
approved by the Board of Health.
Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)
or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of
Health).
broken pipe(s)are replaced
obstruction is removed
distribution box is levelled or replaced
The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass
Inspection if(with approval of the Board of Health):
broken pipe(s) are replaced
obstruction is removed
revised 9/2/98 Page 2of11
i
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 119 Bayberry Lane, Cunlmaquid,MA
Owner: Dorothy Place
Dace of Irupection:February 9;2000
C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: A1119
Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the
public health, safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303(1)(b)THAT THE SYSTEM
IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
Cesspool or privy is within 50 feet of surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh.
2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF ANY)DETERMINES THAT THE SYSTEM IS
FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or
tributary to a surface water supply.
The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well.
The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well.
The system has a septic tank and soil absorption system and the SAS is less than 100 feet but SO feet or more from a
private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the
well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less
than 5 ppm. Method used to determine distance (approximation not valid).
3) OTHER
revised 9/2/98 Page 3ofII
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PARt A
CERTIFICATION(continued)
119 Bayberry Lane, Cummaquid,MA
Property Address: Dorothy Place
Owner: February 9, 2000 '
Date of Inspection: w/
D. SYSTEM FAILS:
You must indicate either "Yes" or "No" to each of the following:
I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this
determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure.
Yes No
Backup of sewage into facility or system component due-to an overloaded or clogged SAS or cesspool.
Discharge or ponding 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.
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Number of times pumped_. I
Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation.
Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
Any portion of a cesspool or privy is within a Zone I of a public well.
Any portion of a cesspool or privy is within 50 feet of a private water supply well.
Any portion of a cesspool or privy is less-than 100 feet but greater than 50 feet from a private water supply well with no
acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for
coliform bacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen.
E. LARGE SYSTEM FAILS:
You must indicate either"Yes" or "No" to each of the following:
The following criteria apply to large systems in addition to the criteria above:
The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public
health and safety and the environment because one or more of the following conditions exist:
Yes No
the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area=IWPA)or a mapped Zone II of a public
water supply well)
The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional
office of the Department for further information.
revised 9/2/98 Page 4ofII
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 119 Bayberry Lane, Cummaquid, MA
Owner: Dorothy Place
Date of kupecti---February 9, 2000 "
Check if the following have been done: You must indicate either "Yes" or "No"'as to each of the following:
Yes, No
Pumping information was provided by the owner, occupant,or Board of Health.
None of the system components have been Pumped-for-at least two weeks and-the system has been-receiving normal flow
rates during that period. Large volumes of water have not been introduced into the system recently or as part of this
inspection.
As built plans have been obtained and examined. Note if they are not available with N/A.
]C/ _ The facility or dwelling was inspected for signs of sewage back-up.
The system does not receive non-sanitary or industrial waste flow.
_ The site was inspected for signs of breakout.
✓ _ All system components, excluding the Soil Absorption System, have been located on the site.
�C /1�1i9 The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles
or tees, material of construction, dimensions,depth of liquid,depth of sludge, depth of scum.
The size and location of the Soil Absorption System on the site has been determined based on:
Y _ Existing information. For example, Plan at B.O.H.
V _ Determined in the field(if any of the failure criteria related to Part C is at issue,approximation
pproximation of distance Is unacceptable)
�- _ The facility owner(and occupants,if different from owner)were.provided with information on the.
SubSurface Disposal Systems. propermaintenaace�f
revised 9/2/98 Page 5of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PARY C
SYSTEM INFORMATION
Property Address-.
Owner: 119 Bayberry Lane, Cummaquid,MA
Date of Inspection-Dorothy Place
February 9, 2000 "
FLOW CONDITIONSRFs RESIDENTIAL:
Design flow: / y g,p,d./bedroom.
Number of bedrooms(design): Number of bedrooms(actual): 3
Total DESIGN flow
Number of current residents:
Garbage grinder(yes or no):_/yo
Laundry(separate system) (yes or no):A/O; If yes, separate inspection required
Laundry system inspected (yes or no)
Seasonal use(yes or no):,fit)
Water meter readings;if available(last two year's usage(gpd):98-
Sump Pump(yes or no):NO v
Last date of occupancy: 6 c e, G d
COMMERCIAL/INDUSTRIAL: I/I/j
Type of establishment:
Design flow:_ qpd ( Based on 15.203)
Basis of design flow
Grease trap present:(yes or no)_
Industrial Waste Holding Tank present:(yes or no)_
Non-sanitary waste discharged to the Title 5 system: (yes or no)_
Water meter readings,if available:
Last date of occupancy:
OTHER:(Describe)
Last date of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and source of information:
Pu r,17 a 1 1, A16 V. y'7 pc-r 1 va74 ��n mil fl�tf v✓,
�J�H o JNcr.
System pumped as part of inspection. (yes or no)-_^!o
If yes,volume pumped: gallons
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)
1/A Technology etc.Attach copy of up to date operation and maintenance contract
Tight Tank Copy of DEP Approval
Other
APPROXIMATE AGE of all components,date installed Of known)and source of information: /��, _. ,,._�t 7 ,
��SS�Juo 1 v i.,µ� +V r'1oi«t. �ws f t)u�✓�/ /
S c.rc v �� ow p�' f c..Us o.d«. 4 6//S/Fly per
Sewage odors detected when arriving at the site:(yes or no)_,Ato
e
revised 9/2/98 Page 6of It
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
„wr. Address:119 Bayberry Lane, Cummaquid,MA
Date of Ins�D rothy Place '
February 9, 2000 '
BUILDING SEWER:
(Locate on site plan)
Depth below grade: /9
Material of construction: cast iron v/40 PVC Zother(,.plain)
Distance from private water supp y well or suction line F)
Diameter
Comments:(condition of joints, venting, evidence of leakage,etc.) OT/
k A/o.4c � cU Go w
Y 4 t N Ni /,
U�' 4 r0 c.J
SEPTIC TANK:it//,9 6/o c kc� c S Gn Jl o vn+�'c vti s c�4-
(locate on site Ian) �/ �+ 4`Y o� �' �"y "�f 61 0 c v:'
p I"
"�
Depth below grade:_
Material of construction:_concrete_metal_Fiberglass _Polyethylene_other(e.plain)
If tank is metal,list age_ Is.age confirmed by Certificate of Compliance_(Yes/No)
-------
Dimensions:
Sludge depth:
Distance from top of sludge to bottom of outlet tee or baffle:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle: r
How dimensions were determined:
Comments:
(recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structuralintegrity,
evidence of leakage,etc.)
GREASE TRAP; �
(locate on site plan)
Depth below grade:_
Material of construction:_concrete_metal_Fiberglass _Polyethylene_other(e.plain)
Dimensions
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle;
Date of last pumping:
Comments:
(recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert, structural integrity,
evidence of leakage,etc.) .
revised 9/2/98 Page 7of11
f
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:
Owner: 119 Bayberry Lane, Cummaquid, MA
Date of knpeuwonDorothy Place
February 9, 2000
TIGHT OR HOLDING TANK:)VA7 (Tank must be pumped prior to, or 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/day
Alarm present
Alarm level: Alarm in working order:Yes_ No_
Date of previous pumping:
Comments:-
(condition,of inlet tee,condition of alarm and float switches,etc.)
DISTRIBUTION BOX-- ///9
(locate on site plan)
Depth of liquid level above outlet invert:
Comments:
(note-if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box;etc.)
PUMP CHAMBER: Altl'9
(locate on site plan)
Pumps in working order:(Yes or No)
Alarms in working order(Yes or Not
Comments:
(note condition of pump chamber,condition of pumps and appurtenances,etc.)
revised 9/2/98 Page aof11
SUBSURFACE SEWAGE DISPOSXL SYSTEM INSPECTION FORM
PAI(T C
SYSTEM INFORMATION(continued)
Property Address:
Owner: 119 Bayberry Lane, Cummaquid, MA
Date of Inspectionflorothy Place '
February 9,2000 "
SOIL ABSORPTION SYSTEM(SASIy
(locate on site plan, if possible; excavation not required, location may be approximated by non-intrusive methods)
If not located,explain:
Type:. �
leaching pits, number:— /X4 / L��` r O;�S w p2 ,S7'Uyre.
leaching chambers,number:_
leaching galleries,number:_
leaching trenches,number,length:
leaching fields, number,dimensions:
overflow cesspool,number:_
Alternative system:
Name of Technology:
Comments:
(note condition of soil,signs of hydraulic failure,level of ponding, damp soil, condition of vegetation, etc.)
W
a J, ei Uf
A-- O -a c. r .o �i c✓ �o cJ /.ti/_ c -
CESSPOOLS: a LJ►�. (A- c�ro(locate on site plan) if h /, c S y �/ l �'►'c o n
Ih)✓Jtti/f�i�. W crt 7+s. .� �r�Gsc.��- csI-"ir,� 7I•z,LO ►-
Number and configuration:c�hc, h4",,„I r } ov 1 .
Depth-top of liquid to inlet invert: �/
Depth of solids layer: 3"
Depth of scum layer: /
Dimensions of cesspool: 6 re 6 ' u,a•,,
Materials of construction: PrL 0 „
Indication of groundwater:_ /S/o,v-
inflow(cesspool must be pumped as part of inspection)_
, h 3
Comments:
(note condition of soil, signs of hydraulic failure, vel of ponding, condition of vegetation, etc.)
" '� .c � c r. c.i w n c . /moo
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c+r-L rdt/ L -��-c�. i 4- fN•S 0-1 4- H I�-G�tk p
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.)
revised 9/2/98 Page 9of11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:
Owner: 119 Bayberry Lane, Cummaquid,MA
Date of 4'spe`tiorflorothy Place
February 9, 2000
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent reference landmarks or benchmarks
locate all wells within 100'(Locate where public water supply comes into house)
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Li
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revised 9/2/98 Page 10of II
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(coning
Property Address:
Owner: 119 Bayberry Lane,Cummaquid,MA
Dace of kupectionDorothy Place
February 9, 2000
NRCS Report name A1119
Soil Type_
Typical depth to groundwater
USGS Date website visited
Observation Wells checked
Groundwater depth: Shallow Moderate Deep
SITE EXAM Slope V
Surface water {/
Check Cellar
Shallow wells
r
Estimated Depth to Groundwater Feet
Please indicate all the methods used to determine High Groundwater Elevation:
Obtained from Design Plans on record
Observed Site iAbutting property,observation hole, basement sump etc.)
Determined from local conditions
Checked with local Board of health
Checked FEMA Maps
Checked'pumping records
Checked local excavators,installers
Used USGS Data
Describe how you established the High Groundwater Elevation. (Must be completed)
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revised 9/2/98 Par 11 of 11
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TOWN OF BARNSTABLE ;
HEALTH DIVISION
200 MAIN STREET
HYANNIS, MA 02601
Jill iihJiilnIffi,iillii,i1'PilliIiii.11)jjjjiijii
Nr, 3'. . FEE.. Z ............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
pws<_............oF... .v. ...................................
Appliration for Uiipu,ial Workii Tnnitrnrtinn Frrutit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
........................ T. ..... ------------------------------ --------------------------•-------------------
Location.Address or Lot No.
-.. 1 .C� T tY... 4�=!9LF................ ....................................... .................................................
W Owner2d� ...__Address
------------------------------- ... _.....---..-------------------
Installer. Address
dType of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
'4 Other—Type of Building ..... No. of persons............................ Showers — Cafeteria
a Other fixtures ..................................
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. ]................minutes per inch Depth of Test Pit.................... Depth to ground water........................
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
a ----------•---------•----•--•••.........................................................•-...................................................................
0 Description of Soil.....................................................................................----------------------------------------------------------•-•-----•--•-----.---...
x
U .................................................
x -----------•-------------------------------•----•--•----------------•••----•....--•----•------•---•--•--•-•-••---- ------ •----•-•-----•-••-••------•--••--•-••--•-•-•••--•---
U Nature of Repairs or Alteration —Answer when applicable...___.. _-__----`'Pgay....�,��5 �:-...../Z/.........
•--•---•----------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of iITi U 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issu d b the o d f h th.
..... .•---•------•---••-...._...... 0... ....� 1
ApplicationApproved By..... --• •--•---------•----... ..................................................... ....
Date
Application Disapproved for e f lowing reasons-........................................................._....-•--------------.......... .....................
...................................................... .............----•---•---...................._..... ............................... ......_..... ------........
Date
PermitNo......................................................... Issued........................................................
Date
F;ss..-../.&.............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
. -.�.... .....oF....�r �1 ..5.j �..� ...
Appliration for Uiipnttl Works Tontrnr#inn ramit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
/�i��72 T L�NL. ......... �J.. .... ......................••-•••....._.........___^__..............................
Location-Address or Lot No.
......................_... ( 1. .?.e .T.fl........_ ................ -••-----•--•---•--•----...........•---......._........•••••-•-•--•-•••..........._...._._.........
Owner Address
W9.r ld':V
Installer Address
d Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building ............... No. of ersons--..__•.__..____._._.--.--_. Showers
fll YP g ------------- P ( ) — Cafeteria ( )
G 1 Other fixtures ...-•--•-••----•-•------••--_...- -..
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No-------------,------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
~' Percolation Test Results Performed by.......................................................................... Date......................................
aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
----•--------------------------•--•--------•--•-------•---------._.....___-----......_..---•-----•--................................_......
_-•-•••........
_••-
0 Description of Soil.....................................................................................----------------...---••--•-----••-......-•-••--'--•--___......._.._............--
U -••--.....-•---•-•••----•--•-•--••--•--__....---•....•-•-•-•---•-------------------•------------••._.......---•---------------•------•--•----•-•-----•--•----...•-•_____.....------•--_...•------•--•---
------------------------------------•---•---------------._.......-------------------------------....--------------•---------••--------•--•-----•-- .....................................................
U Nature of Repairs or Alterations—Answer when applicable.._...-_--/�/M�..._.__.../ % _._. •_-��4-_.__. � .........
✓�-i2L U `=-•---•--------------------------------------------••--------•--•----•-•--•--------•---•••-•••-•••-•••--•-•••----...--••-_____._..
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issu b the a d f li 't-h— +
�i211.
Y"' 3
Vfowing
.A lication A roved B .......... 1PP PP Y----•- � ---' ` ate
Application Disapproved for,, reasons:---•--••--------•---•-•--------•---•-----•-------•-----••---.....•----------------------------•-------••-_______
...._....-•-•••---------•.....••-....-•••------0/••• ••-----••----------------------•.-----•------•----•------------------•-••------•-•.............................................
Date
Permit No......................................................... Issued.-----•--..._...•••-•-•-_-- ^
................... --•---
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........................................OF.....................................................................................
Trrtifiratr of Tlintpliatta
THISJ� FORTIFY, That the Individu 7 Sewage Disposal System constructed ( ) or Repaired
/, .., ;
�j Installer
at...................... ----..-......� _ I'll f -
has been installed ac dance wl the provisions of TITLEof e State Samtar Code s sc 'bed in the
application for Di posa V rks C nstructlon Permit No....Q-.-_�1_________ ____ ....... dated.-....-.----,.f_-.-.- ....................
THE ISSUANCE OF S CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE............................................... .. 1.-�1 ••.... Inspector.......................... ll .._._.._...__...........•--•-•.....---
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OF....................................- Cry ..................................... ..--.......--.-............ /D
No...............�...... FEE........................
Diego's�tl o ij Alnntrnrtion rrntit
Permission ' hereb ranted_.._ (`
y.g, . • -
to Construct V ,or Repair ( � ndividual Sewage Disposal System
atNo. - -----••-•-•---••-----.-•----------•-----•--------------•-----•--....----•••.....
Street
as shown on.the ap icati o isposal Works Construction Permit No..................... Dated..........................................
t -
' ----••---...---••--•.........................•••-•-•-
11
DATE- �f....................................... Board of Health
Y,}5
FORM 1255 A. . SULKIN, INC., BOSTON ))
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LOCATION SEWAGE PERMIT NO.
VILLAGE .ONmwd
191A., LC h7 �k, 33503�
-LmdvvVSH0SS3SSV
INSTA LLER'S NAME i ADDRESS
BUILDER OR OWNER
Ire AdvrT/I 14 CAE"
DATE PERMIT ISSUED / o - 7-7-3
DATE C0MPLIA-NCE ISSUED Mm
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DE51GN/BUILD CO. v '
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_ ENGINEER
PROPOSED FIRST FLOOR OVERVIEW 1 • PROPOSED FIRST FLOOR OVERVIEW 2 t
INTERIOR NOTES Kitchen Countertops:To be selected A 12
Tile:Tile flooring in hall and half bath by owner
floors.Tile on kitchen backsplash. Underlayment to be 3/8 plywood at 5'-8" 2'-10" 2'-1 T-1.1 1/16 8'4 9/16"
Wood Flooring: tile floor area UPQIFrG g f "
4 4 4 EXI INC,ING TI
EXI ING
White pine flooring toothed-in to match Interior painting to be two coats of
existing where removed on first floor, finish on pre-primed wood and one -"" floor to top RO eT 1/' _F
sanded,and finished with three coats of coat primer and two coats of finish on REMODELED KITCHEN
FLOOR:HDWD.
polyurethane.Finish main stair treads in unprimed wood.Primer and two coats -- efer W note
and ceilings.
same manner.-Refinish all existing of finish on drywall walls T_ I - T THISWOHEN LAYOUT.
CABINETRY,
m APPLIANCES.ETC.15 •' '"
areas on both first floor Paint all of first floor. -I I SUGGESTEDORLYAND REMODELED GREAT ROOM
MAY NOTACCURATELY 504�^
m REFLECT THE FINAL 0 - - ` -
Orywall:A"drywall on walls.and Finish Hardware: To be selected by -�� - DESIGN LAYOUT.R15 ■
m THE RESPON5151L OF _ ^ '
ceilings as needed taped and sanded owner a _ E RES' KTCHEN 92"P.F.H.s I DESIGNER TO
. COORDINATE FINAL 2 `-
Interior Finish: Closet Shelving:To be selected by _ s i I urour AND FLOOR:White pine flooring toothed-in to match
wSTALLAnoN YUTH THE existing where removed on first floor,sanded, X DECK lO
-Interior doors to be b-panel solid core owner. iL Vet 2 I I oWNeR and finished with three coats of pokjurethane w 89 so FT
A-13 -Reflnish all eAsting areas on 1 at floor O
masonite Toilet and Bath Accessories:All toilet ._ + J
-Interior trim to be 3-1/2"FJP Stafford and bath accessories furnished by a_ v O
casings with 5-1/4"FJP speedbase. owner and installed by Encore ^ zt
-Stair Parts:Oak newels and railings Mirrors:All mirrors 42"tall by the width m g I I` m
with primed pine balusters.Treads to be of each vanity/pedestal with polished 7 _ y
f- 4 ' 2'-2 13/16' r-
red pine with poplar skirt and risers. edges furnished and Installed r`+ LL ry w.
13'-8 1/2" . 110
-Kitchen Cabinets:To be,selected by Appliances:Furnished by owner and Det 2 tu
owner installed by Encore A-13 - 11'-6 1/4""
UP
m " Wos •
iY DINING 13'-81/2" Y
PROPOSED WALL SCHEDULE } s m 18650FT m A PWDR STUDY rii o 0
FLOOR:HDWD � FLOOR:HDWD _ � 234 sa FT %) CV Y"
refer to note FLOOR:HDWD - v " Z Z tit m
EXISTING CONCRETE FOUNDATION WALL it 3 °� 5'4" refer to note lw .ZP
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0
EXISTING 2X4 EXTERIOR WALL ;j 8'-8 13
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_ 11'-8 /Y 5, b'-61/8"5, b'31/4"--p+f-4'
EXISTING 2X4 INTERIOR WALL i» Q LLI
0,5
124
O PROPOSED 2X4 INTERIOR WALL ° Z Fxl TING t
° tu
6) M Q 3-101/8 V [LlT-8 3/8" 5'- " b b 1/8" 6'-3 1/4" 5'-2 3/4" o V �� ui
12'-.10 1/2" 20'-6 1/8" 2'-8" a a. e
SPECIAL NOTE: A t- LU V
ALL EXI5TING INTERIOR DIMENSIONS ARE FROM PLASTERED A-12 3b'-0 5/b" w � w
SURFACE TO SURFACE LU L'
ALL EXTERIOR DIMENSIONS ARE TAKEN FROM EXTERIOR WALL Qi
SURFACES TO EXTERIOR WALL SURFACES G C G C PLAN
a-
ALL PROPOSED DIMENSIONS ARE TAKEN FROM STUD TO STUD l'l PROPOSED 1 IRJT FLOOR PLAN SHEET:
UNLESS TAKEN FROM AN EXISTING WALL. IN THAT CASE THE '
DIMENSIONS ARE FROM FINISHED SURFACE TO STUD. 'r 5GALE: 1/4" = V-0"
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= PROJECT ADDRESS AND CLIENTS NAME: SHEET TITLE: `+. tl
rn BRUCE MCCUE&KATHLEEN GOOK ° m
11q BAYBERRY LANE PROPOSED SECOND 6z A
CUMMAQUID, MA 0263-1 do #'s OESfGN pgeMooel P
FLOOR PLAN -az Vii 103 Main Street
REV DATE:Thursday,December 11;2015. m �' Dennisport,MA 02639 P
(508)7b0-b900