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HomeMy WebLinkAbout0203 FLINT ROCK ROAD - Health E203 FLINT ROCK ROAD, BARNSTABLE A=315 031 mo o Y 1805 Service Rd., West Barnstable. GOULD DENTAL LAB. ir a TOWN OF BARNSTABLE 0 LOCP_1ION f ARK)TA _ Ie SEWAGE # 95- /q3(o VR;LAGE 26'3 t"11' 111 RnCkC fZOAND ASSESSOR'S MAP&LOT INSTALLER'S NAME&PHONE NO. w G RA c N S n P J .SCE, hL t 7 75-F-176 SEPTIC TANK CAPACITY -jj 6 y n S.1'. LEACHING FAcILTTY: (type) (size) 1+�'® $4 l NO.OF BEDROOMS 3 BUILDER OR OWNER e. PERMIT DATE: >JT COMPLIANCE DATE: /,Z/IZR S Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by CyRRR9� Aousw 77 � I -D6G�C, i 1 • f 0 � b - 8 8 COMMONWEALTH OF MASSACHUSETTS A EXECUTIVE OFFICE OF ENVIRONMENTAL RS g �® DEPARTMENT OF ENVIRONMENTAL C/TJOvP ? ONE WINTER STREET BOSTON. MA 02108 6,17-M-5 , 2 0 row • 1,,'� 31 WILLIAM F.WELD TRU'Y COXE Governor 031 , ` Secretary. ARGEO PAUL CELLUCCI AVID B.STRUHS Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM.INSPECTION FORM Commissioner PART A CERTIFICATION 203 Flintrock Rd. Property Address: Barnstab e Address of Owner Susan Ernst Date of Inspection: _ _ _: (If different) �3 s ° Name of Inspector: m Rd6 1riSOri Sr I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000) Company Name: WM E Robinson Septic Service �r Mailing Address: PO Box 1 089 , C _n f-r i 1 1 P� MA 02632 Telephone Numberry 5 08 ` 7 7 5_R 7 7 h CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal systern 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: amasses i _ Conditionally Passes ' Needs Further Evaluation By the Local Approving Authority ' Fails ' Inspector's Signature: Date: The System Inspector shall submit a copy of this inspection report to the Approving Authority 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. INSPECTION SUMMARY: Check A, B, C,'Or D: , A] SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. CO ENTS: B] SYSTE CONDITIONALLY PASSES. ne or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon c mpletion of,the replacement or repair, as approved by the Board of Health, will pass. Indicate y s, 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 conforming septic tank ' as approved by the Board of Health. (revised 04/25/97) Yage 1.of 10 DEP on the World Wide Web: http:/t www.magnet.state.ma.usldep *T j Printed on RegGed Paper '' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 20.3: F1intRock Rd. Barnstable Owner. -40% Susan Ernst Date of Inspection: 1-1:1-120-98 B) S STEM CONDITIONALLY PASSES (continued) 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). Describe observations: 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 C1 FURTHER I VALUATION IS REQUIRED BY THE BOARD OF HEALTH: „ Cond tions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the publ health, safety and the environment. 1) SYS EM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER W ICH WILL PROTECT THE PUBLIC HEALTH AND 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. 2) S STEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT T SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE EN IRONMENT: The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to 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 50 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) O HER (revised 04/25/97) Page 2 of 10 v `. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM . . . PART A ' CERTIFICATION (continued) t` Property Address: 203 FlintRock Rd` Barnstable , Owner: Susan' Ernst Date of Inspection: 12-20-98 D] SY TEM FAILS: • �` You mu indicate ei;,er "Yes" or "No" as to each of the following: have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis f r this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct th failure. Yes N _ 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",belo'w 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 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 l.of-a public we[l. Any portion of a cesspool or,privy is within 50 feet of a private'watersupply 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 yand nitrate nitrogen.' t ry E] LA E SYSTEM FAILS: e You ust indicate either "Yes" or"No" as 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 safetyand the environment because one or more of the following conditions exist: f s .. r .x 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 suppl -41 y ': the'system is located in a nitrogen sensitive area (Interim Wellhead Protection Area_•IWPA) or a mapped Zone`II of a public.,water supply we x : The own r`or operator of 'any such system shall bring the system and facility into full compliance with the groundwater treatment program; require ents.of 314 CMR-S.0 and 6.00.,Please,consult the local regional office of the,Department for.further information. $ F: .5 4 (revised 04/25/97) Page 3 of'10 SUBSURFACE'SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 203 FlintRock Rd. Barnstable Owner: Susan Ernst Date of Inspection: 22-20- 3 � r 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. LI/ _ 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. _ 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. _ 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: The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of 1 / Sub-Surface Disposal System. Existing information. Ex. Plan at B.O.H. V _ Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) [15.302(3)(b)] (revised 04/25/97) Page 4 of 10 SUBSURFACE_ SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 203 Fl_ntRock Rd. -Barnstable Owner: Susan Ernst �. Date of Inspection: 11-20-98 - FLOW CONDITIONS RESIDENTIAL: - Design flow: il,,6. o .p.d./bedroom for S.A.S. Number of bedrooms: '?—C ` Number of current residents: !v Garbage grinder (yes or no): Vi-, Laundry connected to system (yes or no):_, Seasonal use (yes or no):?-'0 April 98 8�, 000 gals Water meter readings, if available (last two (2) year usage,(gpd): Sump Pump (yes or no): o , April 97 87, 000 oct 96 29, 000 Last date of occupancy: //- o 9� COM CIAUINDUSTRIAL• Type of e.tablishment: Design flo gallons/day Grease tra present: (yes or no)_ Industrial aste Holding Tank present: (yes or no)_ Non-sanit waste discharged to the Title 5 system: (yes or no)_ Water me r readings, if available: Last date f occupancy: OTHER: Des e) Last dat occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System pumped as part of inspection:.(yes or no) a If yes, volume pumped: - >;allons Reason for pumping: TYPE OF YSTEM 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) I/A Technology etc. Copy of up to date contract? Other APPROXIMATE AGE of all components,'date installed (if known) and source of information: Sewage odors detected when arriving at the site: (yes or no) /1iZ> ` .(seviaed 04/25/97)` o } Paga 5 of. 20 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 203 FlintRock Rd. ' -Barnstable - Owner: Susan. Ernst Date of Inspection: 11-20-98 BUI ING SEWER: (I oca on site plan) Depth low grade: Materia of construction: _cast iron _40 PVC_other (explain) Distanc from private water supply well or suction line Diame r - Comm ts: (condition of joints, venting, evidence of leakage, etc.) SEPTIC TANK: 1/ - (locate on site plan) Depth below grader Material of construction: concrete _metal _Fiberglass _Polyethylene _other(explain) If tank is metal, list age _ Is age confirmed by Certificate of Compliance —(Yes/No) L » Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: `> Scum thickness: 3 ' x Distance from top of scum to top of outlet tee or baffle:_ .� Distance from bottom of scum to bottom of utlet to or baffle:_ -How dimensions were determined: ® - Comments: (recommendation for pumping, condition of inlet and outlet tep,,or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) /b n �"0� ).' - X h� /7'X s' I�~ a7I c C`' GREASE T P: (locate on s e plan) Depth below rade: Material of co struction: _concrete _metal _Fiberglass _Polyethylene _other(explain) Dimensions: Scum thicknes Distance from top of scum to top of outlet tee or baffle: Distance fro bottom of scum to bottom of outlet tee or baffler Date of last umping: Comments: (recommendatioi for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, eviden a of leakage, etc.) (revised 04/25/97) Page 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 203 FlintRock Rd. Barnstable .Property Address: Susan Ernst Owner: 11-20-98 Date of Inspection: TI T OR HOLDING TANK: (Tank must be pumped prior`to, or at time, of inspection) (Iota on site plan) Depth low grade: a Material f construction: _concrete _metal =Fiberglass _Polyethylene _other(explain) Dimensio s: Capacity: gallons ' W Design fl w: gallons/day Alarm I el: Alarm in working order Yes; No" Date o previous pumping: Comme ts: (conditio of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX: )/ (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.) /� �'z✓ 1 Z lit sl— PUMP HAMBER:_ (locate n site plan) • t Pump in working order: (Yes or No) Alan sin working order (Yes or No) Com nts: (note ndition of pump chamber, condition of pumps and appurtenances, etc.) (revised 04/25/97) s Page 7 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 203 FlintRock Rd. Barnstable Owner: Susan Ernst Date of Inspection: 11-20-98 _ SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number 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, condition of vegetation, etc.) ; CESSP OLS: (locate o site plan) Number a d configuration: Depth-top f liquid to inlet invert: Depth of s lids layer: Depth of sc m layer: Dimensions of cesspool: Materials of onstruction: Indication o groundwater: infl w (cesspool must be pumped as part of inspection) Comments: (note conditio of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY _ (locate on site plan Materials of constr ction: Dimensions: Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (revised 04/25/97) Page 8 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 203 FlintRock Rd. Barnstable Owner: Susan Ernst Date of Inspection: 11-20_98 SKETCH OF SEWAGE DISPOSAL SYSTEM: d include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house), VU a . . r 50— >2m d I C , P (revised 04/25/0) Page 9 of 10 d SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 203 F1intRock Rd. . Barnstable Owner: Susan Ernst Date of Inspection: 11-20-98 Depth to Groundwater. , f e t Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record " Observation of Site (Abutting property, observation hole, basement sump etc.) Determine it from local conditions Check with local Board of health. Check FEMA Maps Check pumping records Check local excavators, installers Use USGS Data Describe in your own words how you established the High Groundwater Elevation. (Must be completed) (revised 04/25/97) Page 10 of 10 :i 3 Commonwealth of Massachusetts i Environmental Executive Off ce of Ennmental Affairs o DEC 5 1995 ► EQOFl1 HEALTH DEPT. William F.weld. r TOWN OF BARNSTABLE . A. Governor s Trudy t3oxe s..MuY.EOEA David Bm Struhs r.Y „. r Comiaioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM k D G K R 9 -PART A ' �s CERTIFICATION Property Address: - Address of Owner: f F Date of Inspection: (If different). ®M Name of Inspector: W.E. Robinson sr. ,* Number: Company Name, Address and.Telephone W.E. Robinson Se tG .'Sex'ViCe P . P.O B0x-`1089. RTIFICATION STATEMENT f~ _ Ce77nt( rrv77ille MA CE I certify that I have personally inspected the sewage di p6s�l spsiert t 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 se ge disposal systems The system: _ Passes - - Conditionally Passes — Needs Further Evaluation By the Local Approving Authority {' Fails,: " Inspector's Signature: `' - Date: —.41 The System Inspector shall submit rya copy of this inspection report to the Approving Authority within thirty(30)days of,completing this inspection. If the system is a shared system or has a design flow of 101'000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protectiom The original should be sent to tne'system owner and copies sent to the buyer,if applicable and the approving_authority. , INSPECTION SUMMARY: y Check A, B,C, or D: A] SYSTEM ASSES: I have not found any information which indicates that the`system violates any of the failure criteria-as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below.'. B] SYSTEM CONDITIO11 LY,PASSES: one or more syste components need to be replaced or repaired The system, upon completion of the.replacement or rept*,. passes inspection Y ` -' Indicate'yes, no, o1r.not determ ned (Y, N, or ND). 'Describe basis of determination in all instances. If"not determined", explain why Holy The septic-t nk is_metal, cracked, structurally unsound, 'shows substantial infiltration or exfiltiation;.or tank failure is AN -1VD imminen`t`� h' system will pass inspection if the existing'septic tank is replaced with a conforming septic tank as approved b the Board of Health. (revised 8/15/•95)+ 1 �•3 One Winter Street; a Boston,Massachusetts 02108 a FAX(617_)5W1049 ? o ' TOlophOno(017)2924560 0 Printed on Recyded Paper 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: C;LO3 f- yit rack p 9,9P11 S t;9ZI'e Owner: 4Q, IC rz t y di Date of Inspection: B]SYSTEMr DITIONALLY PASSES (continued) _ Sewage backup or breakout or high static water level observed in the distribution box.is due to broken or obstructed ipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the and of Health): broken pipe(s)are replaced w " obstruction is removed distribution box is levelled or replaced _ T e system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass spection if(with approval of the Board of Health):. broken pipe(s) are replaced obstruction is removed C] FURTHER EVALUATIO, IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist whi h 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. T 1) SYSTEM WILL PAS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PRO CT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ Cesspool or p ivy is within 50 feet of a surface water - Cesspool or pri y is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLE THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIO ING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ The system has a s tic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a surface water suppl . _ The system has a s ptic tank and soil absorption system and is within a Zone l of a public water supply well. The system has•a eptic tank and soil absorption system and is within 50 feet of a private water supply well. _ The system has septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well,�nless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from poly n from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. . D] SYSTEM FAILS: I have determined that the syste violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identifi below. The Board of Health should be contacted to determine what will be necessary to correct i the failure. Backup of sewage int facility or system component due to an overloaded or clogged SAS or cesspool. _ Discharge or ponding f effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool; ' (revised 8/15/95) _ 1r ti 2 • y �. _ - r` r SUBSURFACE;SEWAGE DISPOSAL SYSTEM INSPECTION FORM .; PART A CERTIFICATION (continued) Cl ;rkn t/Oar�w �Z t7 j'JGt r n S Property Address: f' Owner: n`//' Date of Inspection: D)SYSTEM ILS(continued): s ` 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' 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 ofa surface water supply or tributary to a surface water supply. . Any portion of a cesspool ivy.is within a Zone I'of.a publicweli: Any portion of a cesspool or pnvy,is within 50•feet of a private water supply well. _ Any portion of 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 SY TEM FAILS:, The fo owing criteria apply'to large systems in addition to the criteria above:,•,. The desi flow,of system is 10,000 gpd or'greater (Large System)and the system•is.a significant threat to public,health and safety and the a vironment because one or more of the following.conditions exist:` t e system is within 400 feet of asurface diinkmg`water supply ' t e system is within 200 feet of a tributary to,a surface drinking water supply. the system is located in a,nitrogen sensitive area'Onterim Wellhead'Protection Area (IWPA)or a mapped Zone II of a p blic"Water supply well) The owner or operat r of any such system shall bring'the system and facility into full'.compliance`w•ith the groundwater treatment program requirements of 31 CM 5.00-and 6.00. Please consult the local,regional office of the Department for further-.information. 3 (revised 6/15/95) s - Y -SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM " PART B CHECKLIST OZ t33 f=1rh'�`ra G�� f0 A Property Address:Owner: (rnll�a o9 Date of Inspection: / �► .C' y: Check if the following have been done: . Pumping information was requested of thei owner,occupant, and Board of Health.,- "one 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 sthey are not avail able ywith N/A.µ u- he facility or dwelling was inspected for signs of sewage back up., 1/The system does not receive non-sanitary or industrial waste flow i/he site was inspected for signs of breakout. . t/All system components, excluding the Soil Absoption System, have been located on the site. . ✓Yhe septic tank manholes were uncovered;opened; and the interior.of the septic tank waslinspected.for condition of baffles,or tees, material of construction, dimensions, depth of liquid,depth of sludge, depth of scum.. a one size and location of the Soil Absorption System on the site has been determined based on existing information.or approximated by non-intrusive methods. (/the facility owner (and occupants, if.different from°owne'r) were provided with information on the proper maintenance of Sub- Surface Disposal'System. ~` M - ` (revised 8/15/95) - �4 {.SUBSURFACE SEWAGE..DISPOSAL SYSTEM INSPECTION`FORM , PART C SYSTEM INFORMATION Property Address: 02,d L3 �/in-' Fa C K Owner. Date of Inspection:` FLOW.CONDITIONS RESIDENTIAL +^ , Design flow: 33 r� ttallons _ e Number of bedrooms: 3 Number of current residents: Garbage grinder (yes or no): 'N 4 Laundry connected to system (yes or no): Seasonal use (yes or no): /v c Water meter readings, if available. Last date of occupancy: , COMMERCIAL NDUSTRIAL: Type of establish nt: Design flow: allons/day Grease trap presen : (yes or no)_ , Industrial Waste olding Tank present: (yes or no) Non-sanitary wash discharged to the Title 5 system: (yes'or no) : .f. Water meter readings, if available: Last date of occu a - P ry� OTHER: (Describe) Last date of occupancy: —,,GENERAL INFORMATION s PUMPING RECORDS and source of information ' System pumped as pan of inspection: (yes^,or no) If yes, volume pumped,, 'allons Reason for pumping: 7 ' TYPE OF TEM Septic tank/distribution boxAoil absorption system Single cesspool_- 1 Overflow cesspool «" Privy - . " �=' ,' ;t :4 .. � .•• - Shared system (yes or no)-(if,yes,attach previous inspection records, if any),., Other(explain) APPROXIMATE AGE of all components, dateinstalled (if known) and source of information: 1 -.y R S ' t•, _ �A. . Sewage odors detected when arriving at the site: (yes or no) /A/ (revised 8/15/95) �• . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM'-,,.,, PART C SYSTEM INFORMATION (continued) Property Address: Owner: 6?. n i9 ti Date of Inspection: % �..z S f SEPTIC TANK✓ _' ' (locate o site a n i I n _A < Depth below grade: Material of construction: _vconcrete 'metal _FRP_-ther(explain) - ,� Dimensions: `4 i E Sludge depth: %(� i , : ,• . . Distance from top of sludge to bottom of outlet tee or baffle �3 V. 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: ' = Comments: (recommendation for pumping',`condition of inlet and outlet tees'or baffles,-depth of liquid level in relation to outlet•inyert,structural integrity, evidence of leakage, etc.) %•� 7C' t✓ l`' °° 't- += ld <�%fZ /a j GREASE TRA 1 y (locate on site platy - A Depth below grade: , Material of construction: _\ncrete _metalY_FRP ) •other(explain) ► r• Dimensions: Scum thickness: Distance from top of scum to t p of outlet tee"or baffle: Distance from bottom rn Frum to bottom of ou?jet tee or baffie: Comments: (recommendation for purnpmg, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural,_ ` integrity, evidence of leakage, etca ' ' •q Al jW Y (revised.8/15/95) 6 'g f SUBSURFACE,SEWAGE DISPOSAL SYSTEM INSPECTION FORM,, PART C SYSTEM INFORMATION (continued) " Property Address: . a� d !in-j-r V 'e Owner: Date of Inspection: S TIGHT"SIR HOLDING TANK: . (locate on ite plan) Depth below rade: a, Material of con ruction: concrete —metal —FRP othw(eOlain) `{ Dimensions: 4� Capacity: allons P Design flow: allons/da}` Alarm level: Comments: + (condition of inlet to condition of alarm and float switches, etc) DISTRIBUTION BOX:✓ - (locate on site plan) Depth of liquid level above outlet invertq Comments: w (note if level and distribution is equal,'evidence of solids carr)-o)-over, evidence of leakage into or out of box etc.). /vim Aeno) PUMP CHAMBER:(locate on site plan)Pumps in working oComments: n n s e tc.�urte a cefpumps and a ) ii no ond t o ,(note condition of p PP e N 4 e ' 4 r .. (revised 8/15/95) .. _ 7. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner: Date of Inspection: SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type. leaching pits, number: leaching chambers, number:_ leaching galleries, number: leaching trenches, number,Iength: leaching fields, number, dimensions: overflow cesspool, number. Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.) CESSPOOLS: _ (locate on site p n) Number and configu lion: F Depth top of liquid to nlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: °. Materials of construction: Indication of groundwater: inflow (cesspool usr be pumped as part of inspection) Comments: (note conditi 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, si ns of hydraulic failure, level of ponding, condition of vegetation, etc.) :y _ (revised 8/15/95) 8 F SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) , Property Address: ,I- `I�'/'6 c K 0,9PI7.5- 7.4 6, Owner: <521, Kr//9'li 7- Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' 0�� s Pjb" DEPTH TO GROUNDWATER Depth to groundwater: feet -T P %1 � method of determination or approximation: o I�7 G �i WIG wised 8 15 fre 95) 9/ / ASSESSORS MAP NO. 25( PARCEL NO: ` Fee 30 .00 1 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS application for Migoat *p aem Com5trUCtion Vermtt Application is hereby made for a Permit to Construct( )or Repair(x )an On-site Sewage Disposal System at: Location Address or Lot No. 203 F 1 i n t r o c k Rd Owner's Name,Address and Tel.No. G. . Kn i gh t Barnstable MA 14 Mt Pleasant S Randolph MA Installer's Name,Address,and Tel.No. W.E. Robins On SP Designer's Name,Address and Tel.No. P.O. Box 1089 Centerville 775-8776 Type of Building: Dwelling No.of Bedrooms 3 Garbage Grinder(nc) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title a Description of Soil gravel Nature of Repairs or Alterations(Answer when applicable) install a 1 ,0 0 0 gal precast stonepacked leachpit (as to the oringinal plans ) 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 Zodnd not to place the system in operation until a Certifi- cate of Compliance has been issued b this Boar f alth. Signed 2J Date Application Approved by Application Disapproved for the following reasons Permit No. 'g'/ Date Issued / � �� �rtyw.„n„wr+.`y�`i"��,„� .w,�'ti.:--.. ._.,. N"w.y-a...,✓'^s...�-fr,. �.� /"�` :,- ,.::x:�, ,. -, J,,�.. +r "�. JNo. . J V _ a j Fee" 3 0.0 0 C' THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS pplicatipA jor ;Di9;poga[*p!6tem Com6truction V ermit Application is hereby made for a Permit to Construct( )or Repair(x )an On-site Sewage Disposal System at: Location Address or Lot No. 203 Flintrock Rd Owner's Name,Address and Tel.No. G. Knight Barnstable MA 14 Mt Pleasant S Randolph MA � X Installer's Name,Address,and Tel.No. W.E. Robinson SP Designer's Name,Address and Tel.No. tiP.O. Box 1089 Centerville `775-8776 Type of Building: Dwelling No.of Bedrooms 3 Garbage Grinder(T7� Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures ; i Design Flow gallons per day. Calculated daily flow 71 1gallons. Plan Date Number of sheets Revision Date ! Title Description of Soil gravel Nature of Repairs or Alterations(Answer when applicable)`' install a 1 ,000 gal precast stonepacked leachpit (as to the oringinal plans) r 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 nd not to place the system in operation until a Certifi- cate of Compliance has been issued b this Boaraof_Uaalth. S Signed Date Application Approved by Application Disapproved for the following reasons Permit No. Date Issued ==__ -------------- THE COMMONWEALTH OF MASSACHUSETTS (U'BLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS �--'° Clertificate of Comphance - _f. THIS IS TO CERTIFY,that the On-site Sewa e Dis oral System installed( )or re aired%re laced( X)on by W.E. Robinson Septic Spervic�r ' G. �Cni- 203 Flintrock Rd Barnstable ,. has been constructed in accordance with-tote provisions of Title 5 and the for Disposal System Construction Permit No. Vddated Use of this system is conditioned on co puce with the provisions set forth be o / �. n 41 °' J. 14 zlKW7 Fee30.00� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS lwtgpoar * item Con5tructton ermit p � Permission is hereby granted to W.E. Robinson Septic Service to construct( )repair(x )an On-site Sewage System located at 203 Flintrock Rd iBarnstable and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to complyrith Title 5 and the following local provisions or special conditions. All,construction must be completed within two years ofthe date below. Date: ��`' '''%,6 A roved b � PP y CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS) I, hereby certify that the application for disposal works construction permit signed by me dated concerning the property located at 0 3 r�� 1'R d 6G� meets all of the following criteria: • There are no wetlands within 300 feet of the proposed septic system ` • There are no private wells within 150 feet of the proposed septic system • The observed groundwater table is 14 feet or greater below the bottom of the leaching facility • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. ,t - _ • .. n :. 4,, a :'.: r.:� .. -. {t{5s SIGNED: A& t ;DATE: G 4 Zt LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER , [Attach a sketch plan of the proposed system.Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. , Y 4 a i t r f ' v IN t [ S k` , i \ y l } 0 0 8 9 , If, 116 71 ,20 lot � ,y . k t �k s°�.,"�t aYC,�wu J ` '1 °}i' a -1.. •t- . J s�-e f t `#.�'�.� Y�Cdv .f` y-�1 1. •'l } i. .,s�y}'f..Y-t f +sr}+ c� E ,-..,�r , � `�1 : w/D/7/ e 3 0' F#•e,./T A -. •rz� /s�.�i�o�` � (��r� � i k "tr '}. �x &err #:,. .. . � ` r ss" LEGEND . -• ..ti, nF, EXISTING' SPOT ;ELEVATION "Ox0 CERTIFIED __PLOT PLAN EXISTING . CONTOUR ---* 0 - =-- r �i�ii..F FINISHED SPOT ELEVATION wtic.ecf,� 1 Of // i.✓T he G.k. i�� FINISHED CONTOUR . 0 e, No. 3c6 o/ ----.CEF��r .✓_cccGc.... - =— APPROVED BOARD OF HEALTH DATE AGENT aG � !' ``, SCALE /��= 9a� 3v� � � DATE� . LD RED GE ENGINEERING CO. IN CLIENT /����dlHas _ — I CERTIFY THAT THE PROPOSED EGISTERE REGISTERED J08 N0. ��D 9y BUILDING SHOWN ON THIS PLAN CIVIL LAND DR.BY� ��� CONFORMS TO THE ZONING LAWS ENGINEER URVEY R ., OF BARNSTABLE , MASS., 712 MAIN STREET CH- BY: HYANN I S, MASS. SHEET— OF ATE REG. LAND SURVEYOR .. .e..ef:+.. .. ..n . .F' 7 1 d; ,ry ,, 1, -,�_... .} �� 1 S 1. h, r , .. ,. CGNCI » 'HAL BROGGHT TO G4 � e . . �'e• �L'•= �i�lo�U COVERS ': M/N. PiTC%I 4 .'y'E.4vy CAST ,'ROiv •�,,•_ , �8 P,5R FT. %• � /N Oi4/VEvr4 Y- y ,+�;s�a ,�� 71 , , l Z WW NO ••DIA• __ LEVEL ,9 d �CHEDUC.b=� • vlw O O5 �� i4 PE/t SEP / a , . C TA/VK .. ` o/sT o' o. .. 1 • 's[+ • s • • f f q 04 1 i a ` BOX' • r •( •8 + . •: • . f f ° •f i'Y JY i { Ai O j --10 e.. e ` FELT E ♦ d _ - ti i .> - t • , C f 0 • QEpT/C/ • 0 1 • ° .A t s +l i !IV ..RT..ZL EVAT/ONS s v a . 'f i'•�•" • • • • • •� s•n /NYERT A SY� �.; D v : • • •. • - : a ar P/,T , �U/✓' r T BU/LD/NG //S,Z FT LEA04 PIT, 6 FT D/AM. �—,t► 3/NLET SEPT/C-.TANK //5.0 FT c4 a o c,?y lOtJTLET SEPT/C.TA/H/t / �S. pT _ FT_ O/.4M: - C 11 1T/oN> [/NLET D/STR/BU�1oN BOX /`f�, FT ;� rOUTLETO/5T.4/04/T/ON aox 'j1,Y Y ,gT SECT/Q/V OF GROUNO JtI�lTCr4 TABLE /NLET LEACAI IV4r- .CP'/T / Z FT, .SEW.4G� .O/SPOSAL SYSTE/y L EACf/lNG P/T 7"A BULAY/ON' SCALE -DES/GN G',4ITERlA A{, G.aRBAGEQ/SPO.SAL UNir._ oM= D/MENS/ON C �� *FT SO/L LOG .• iTOTAL EST/M,gTE4 F�O��- GAL•/DAY ciO/L TEST SO/L TEST#,� SOILTE$T • " ; ' , FA(UM3ER OF E.acN;,vG F�/T3_.- 1 _ // K Z . j �•,„� _.. E[EY. S/DE LEACH/NG PEK P/T. 2'Z G �. arc,. ,DATE OF SO/L TEST� " ESULTS i�//TNESSED BY P� CO�f� •+.• � TQTAL LEAG'N//vG AREA 3 .SQ FT• "% ERCOLAT/ON RAra:At _ '-s° MIS"�/ ?SSFRf!E G�.4CN/NG AREA f S V �S o;L �y YC q 33S SQ• FT. RCOLi4T/ON RATE2 �_ MIN. /NCH - --- _-- EL l7 __ RED NG/NEER/Jy i-... GEE G .1. NOG OU 7/2 MAlN _5T ,NyANNlS co � e Q O U�S/O v ,-Ii�TTER ENCOUNTE_2�0 _! NT:�Y•C �. r'es ✓.4TE•3 ''r 1'vA JOB No. % 7 a 9^ SHEET ia_Ol�- Z , 06 L_0,,C:ti T"10N � SEWAGE PERMIT NO. o-r 1& i Al iZc►f-is 2,I c4 I L L A G E 3 57t gx sl Al/,r- CQ fV, INSTALLER'S NAME A ADDRESS B U I L D E R OR OWNER 1V r eke I�� ��►-t c�� DATE PERMIT ISSUED � � � DATE COMPLIANCE ISSUED . `t L o`j' J y Q Af {� s'.� No.:.E�--:" � Fs$.... T COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ......7 :.....OF.................. Appliration fear lliapniai Works Tonstrnrtiun Frrmit Application is hereby made,for a Permit to Construct r�) or Repair ( ) an Individual Sewage Disposal System at: / Y 1 114 ...... ... . - ---------- Location- dress •--•---......_.�1:-'-T!.`= -•- --^=......""`-....•- ------•--------.. ................ ...... �---------lam------•• ---------... � � r W Owner J J � � / - Addr�s a ............. ......... : ....... - .......•......._........ ........... ---- • . ........... .l.l_...... ......... � Instal- �?��L�� - ess �/ / d Type of Building Size Lot...l.... --�------ feet U Dwelling—No. of Bedrooms............�.......................Expansion Attic ( ) Garbage Grinder ( ) �4PL4 Other—Type of Building ....... No. of persons............................ Showers — Cafeteria a' Other fixtures -----•-----------------•-.-.-.--_ . d ------------------------- W Design Flow............................................gallons per person per day. Total daily flow.---...........�S -......__......gallons. WSeptic Tank—Liquid capacity-J.00 allons 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.......................... __ .......6/- _ Date------------J .. � �--- Test Pit No. 1.� .0minutes per inch Depth of Test Pit.................... Depth to ground water........................ y Test Pit No. 2 ,k�......minutes per inch Depth of Test Pit.................... Depth to ground water........................ G4 -------•--•---••------------••••--- ........................ ._......_... .------ --•-----•------------ O Description of Soil............................................. ' . .------.....-� ----------- V ---••-•------------•------------------------------------------••---------------------------------........•-------••---•--•-------•--------------------------------......---••------------------------- W ---------------- --•----------•----•-------------------------------------------------.......-------------------•---------------------------•-----------------------...-•---••---•-----•----------------- VNature of Repairs or Alterations—Answer when applicable............................................................................................... Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT 4 5 of the State Sanitary Code The undersigned further a es not to place the system in oper t n until a Certifi to of Compliance has been i ued by the boa lOV tlf. Si ned = . .... ........ rr --..... ... to Application Approved By--------- s.-- ...._:.. -•-------•---- .............................. ..................--f S - Date Application Disapproved for the following reasons:---------------•------•------------.......--•-----------------•-•-----------•---------------------------......_ --••-•--•-•---------------------------------•----------------...---------............-----••---•----...............-----•--------------.......---------------------•--------------------............_._.. Date Permit No...... ... ....-L-"L3;-----D-......---•-.. Issued--------------•-------------------•---•--- -..... Date Ficis THE COMMONWEALTH OF MASSACHUSETTS BOARD OF !iEALTH .. .l...� e: .......OF.................. : ............... ~' ......-----...---- Appliratiun for Disposal Works Tonstrurtion Prrmit Application is hereby made for a Permit to Construct � ) or Repair ( ) an Individual Sewage Disposal System at• , s ,�. :..., ,. ter.. .. .Location-Address ✓ i, or No. G't'.1='�=' ��� `....../f'I .............. .!.... {! \�:�r� _f�...... ,.n Owner Pry y , �` Addr ss - L Installer" Address d Type of Building ,� Size"" Lot...... .jt.!��..........Sq. feet U Dwelling—No. of Bedrooms............ .......................Expansion Attic ( ) Garbage Grinder ( ) pal Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures ............................... d ;- ----------------•- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity.16E 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 Resultss l__ Performed by-------------------------- .. j.c1'' Date...... ,t Test Pit No. 1. minutes per inch Depth of Test Pit.................... Depth to ground water.....................--. LLI Test Pit No. 2 f ....minutes per inch Depth of Test Pit____________________ Depth to ground water..--------------.------. •---•----------------------------- = ......................................._.....- /- ---•--------- Description of Soil-------------------------------------------- �.._ V •---------------------------•---•--- ....................................................•--••-----------------.....---------•-----------------•------------------------------.........----•...---•-_.. W -------------------------------------------------------•------------------------------.....-------------------------•-----------------•----•-•-------------•-------------...-----------•------•-•-••--- U Nature of Repairs or Alterations—Answer when applicable............................................................................................... •••••••...•--- 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 oper ti)nuntil a Certificate of Compliance has been is ued by the boar,.d�df h ltM r i /4 �. : g � / ............................ , --fit�Application Approved BY--------- •-- ................. � Date Application Disapproved for the following reasons:---•-•--------------•-•--------•----•-------------------------•----------------------------••---------••......_ ..........................................................••--•-•----.....-----•------..........----•---........................................................................ ...................... Date PermitNo.---. ..... ................................. Issued-..............................................-------- Date THE COMMONWEALTH OF MASSACHUSETTS �•, - BOARD OFHEALTH ........... Z Gtc.?' :...O F.......... ..............................................................1 - ,f (9rdif irate of Toutpliatnrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed �') or Repaired byY ,�, = `. `1 - = '-=f" �c= .--.--: ...................••----•--------.................. (...... ° f Installer , r� has been installAd in accordance with the provisions of TITLE 5 of The State Sanitary Code as de cribed in the application for Disposal Works Construction Permit No........ _- .. dated--_...-.! {I'r„^.. �.............. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTIO AT FACTORY. DATE.......................... �I�! ..................... Inspector.....L�-•-----•-•--•---------•---------••----•---•........................... 80—THE COMMONWEALTH OF MASSACHUSETTS BOARD OFF EALTH ............ ................. ....... No..............OLP . � ,�` OF FEE. .... ...... Disposal Vnrk Tono#rluto r rrmi# Permiss>o Is hereby granted............... ...... -•----•• .._.. to Construct ( or Repair ( ) an Individual SeWage Disposal isposal System atNo. .�.------•---4 ............. • ..'._2 ' -� ,.......................................... .......................... Street as shown on the application for Disposal Works Construction Permit No Dated...1.. ..1..' .............. DATE....................... �b... 6...................................... Board of Health FORM 1255 A. M. SULKIN, I C.. BOSTON -r'1 > w..� a g ,. I .!! I. .I , S t i,r ..F 4 �:i, .. q K �l — s � ' / y Iv ar z r 0 a t �j a 'wE'�+ Q,. / - .. 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DATE O F SO'/L TEST Z i•SlDE EACH/n/G PEK P/7` _Z?� SQ ,+sT. �` RL�SULT.S h!/7'NESSED BY P/°4 G040403s , S:3C�.7TQM E,gCH/NG PER P/T_L3 Qa'�'e7 - P�`/�COLAT/ON RAY'E I M//V INCH -n5r. LEACN//YG AREA: 33 'SQ F7^ a 'PERCOL�4T/ON RATE 1�2. �- MIN.�/NCH r7�SFRE LL'.4CHING ARE/+ r•. • '$,y { S' �- _�_SQ ET. S o/L 2 EI-D�?. DG LNG/NE.�J�/NG CO,/NG. 4 " a,.Fi�� „�� 4 'a #:iA�' : ��4•_Z 7/2 'Nj/41N .ST� HY!aNNJj, MQ-- _ . q�� .F�s ; : NOG�OUNt7-'yt44TER E/VCOUiVTE:A25'0. Ci/ENT �1//C, , � JATE" -/2-£sCc - 3'- ' AND. AND. AND. AND. CXW 155 CXW 156 CXW 155 CXW 156 INSTALL NEW POST UP tv AND. REMOVE EXIST. �� TO EXIST,RIDGE BOARD C 1 4 x 4 POSTS ('12 NEW 2 x 6 CROSSTIES @ 16"o.c. 1 ..� A INSTALL NEW 2=2 x S HEADERS EXIST. AMo— BUILD OUT RAFTERS 4~TO AI EXISt:4 x 4 AT NEW WINDOWS!1.DOOR FIT NEW 11"BATT.INSULATION(Rne) POSTS EXIST.6 x$WOOD BEAM AND. — — ._._ — — — — _ CXW 155 -- -- — NEW — -- -- -" ' TOP OF PLATE EXIST.6 x 8 WOOD BEAM EXIST.HICKS VENTS TO REMAIN V NEW WALL CONST. ANDERSEN FAMILY FWG SM L ROOM ' ' ' 1.2 x 4 STUDS @ 18"c.c. 11 2. 1/T PLYWOOD SHEATHING AND. (FORMER SCREENED 3.3- 1/2"(R■13)BATT.INSULATION PORCH) NEW — — — — — 3'x S' ► b 4.1/7 GYPSUM BOARD — •— - —— — — — — S.W.C. SHINGLE SIDING— — — —EXIST.6 x 8 W OOD BEAM STEP i i S.TYVEK VAPOR BARRIER F. NEW GAS F.P. NEW 3/4"PLYWOOD SUBFLOOR VERIFY STEP MAIL (GLUED 4 NAILED) (VERIFY SIZE 3 MFR. Wt OWNERS SUNROOM to WI OWNERS) SUBFLOOR NEW 2"RIGID INSULATION(R-14) ZA, "718T.2 x 10 FLOOR JOISTS INSTALL TWO LAYERS FOR Rw28 BETWEEN EACH JOIST STEE am EXIST. NEW 6 MIL POLY VAPOR BARRIER -- -- INSTALL NEW P.T. 4 x 6 WOOD BEAM.' W/DUROCK FASTENED TO EXIST, 4'0"C.O 1 AT MID-POINT TO STIFFEN FLOOR POSTS&DUG INTO THE SOIL 8 W/NEW 1("DIA.CONCREMSONO TUBES f M / TO 47 BELO W GRADE INSTALL 2 NEW��ENTS tl �� (CONC. SKIM COAT IF DESIRED) kXf9T. HOUSE te-A BUILDING SECTION @ NEW FAMILY ROOM A FLOOR PLAN ' LEGEND: ' C� EXISTING WALLS --.J CONSTRUCTION TO BE REMOVED NEW CONSTRUCTION NOTES: 1.) CONTRACTOR IS TO VERIFY ALL EXISTING CONDITIONS & DIMENSIONS IN THE FIELD 2.) CONTRACTOR TO VERIFY ALL INTERIOR& EXTERIOR MATERIALS, DETAILS, & FINISHES IN THE FIELD NTH OWNER 3.) ROUGH OPENING HEAD HEIGHT OF WINDOWS AT FIRST FLOOR TO BE V-10" ABOVE SUBFLOOR THE DESIGNER SHALL BE NOTIFIED IF ANY ERRORS OR OMISSIONS ARE FOUND ON 4.) ALL CONSTRUCTION TO CONFORM TO 780 CMR MASSACHUSETTS THESE DRAWINGS PRIOR TO START OF i STATE BUILDING CODE CONSTRUCTION.THE BUILDING CONTRACTOR WILL BE RESPONSIBLE FOR THE CONTENT 5.) CONTRACTOR TO REMOVE EXISTING DOORS, WINDOWS, IN THESE DRAWINGS IF CONSTRUCTION ftmi�w COMMENCES WITHOUT NOTIFYING THE co WALLS, & FLOORING AS REQUIRED FOR NEW CONSTRUCTION. DESIGNER OF ANY ERRORS OR OMISSIONS. THESE DRAWINGS ARE SOLELY FOR THE USE OF THE OWNER NOTED.ANY OTHER USE OF THESE DRAWINGS REQUIRES THE WRITTEN CONSENT OF THE DESIGNER. CC�TUIT A DESIGN SCALE : DRAWING NO. .L. , . BAY NEW RENOVATIONS FOR: " = 43 BREWSTER ROAD 1/4 - 1 0 MASHPEE ,MA. 02649 1 �1 RALPH & VIRGINIA CAHOON r DATE PH. (508) 274-1166 ) FAX (508) 539 9402 � l 1/28/2006 A I 203 FLINT ROCK ROAD BARNSTABLE, MA ,. 12 12 EXIST, EXIST. ^ NEW ANDERSEN 400 SERIES D.H.WINDOWS TO REPLACE a EXISTING WINDOWS ❑ ❑ Sam NEW ANDERSEN AIM SERIES D.H.WINDOWS TO REPLACE FRONT ELEVATION EXISTING WINDOWS 12 EXIST. ® _ 12 EXIST. NEW ANDERSEN 400 SERIES O.H.WINDOWS TO REPLACE EXISTING WINDOWS TOP OF PLATE .. i NEW ANDERSEN 400 SERIES NEW CORNER BOARDS CASEMENT WINDOWS TO REPLACE TO MATCH EXIST. EXISTING WINDOWS SUNROOM SUBFLOOR NEW ANDERSEN CXW 156 NEW W.C.SHINGLE SIDING CASEMENT WINDOWS NEW DUROCK W/VENTS TO MATCH EXISTING LEFT SIDEELEVATION- SCALE : COTUIT AY D SIGN DRAWING NO.T _ 13 NEW RENOVATIONS F'OR: .. . 43 BREWSTER ROAD 1/4 1 -0 11 MASHPEE ,MA. 02649 RALPH & VIRGINIA CAHOON DATE PH. (508) 274-1166 FAX (508) 539-9402 FLINTROCK MA11/28/2006 203 ROAD I NEW ANDERSEN JIM SERIES IL D.H.WINDOWS TO REPLACE 17 EXISTING WINDOWS EXIST. TOP OF PLATE oe SUNROOM SUBFLOOR I ILI NEW ANDERSEN ON 155 NEW CORNER BOARDS CASEMENT WINDOWS TO MATCH EXIST. REAR ELEVATION NEW W.C.SHINGLE SIDING TO MATCH EXISTING NEW DUROCK W/VENTS 12 EXIST. 12 HEXIST. _ TOP OF PLATE 8 SUNROOM SUBFLOOR NEW ANDER8EN FWG OWS L RIGHT SIDE ELEVATION FR&NCHWDOD GLIDING DOOR CC?TUIT BAY DESIGN NEW SCE DRAWING NO. : RE NOVAT IONS FOR. „ _ , fl 43 BREWSTER ROAD 1/4 1 -0 MASHPEE ,MA. 02649 RALPH & VIRGINIA PH. (508) 274-1166 CAHOON DATE FAx (508) 539-0402 203 FLINT28/2006 ROCK ROAD BARNSTABLE, MA 11