HomeMy WebLinkAbout0158 INDIAN TRAIL - Health Y 158 Indian frail
Barnstable
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No. lNwyl V l Fee
BOARD OF HEALTH
TOWN OF BARNSTABLE
Zipprication _for Yell Cow6truction Permit
Application its,hereby made for a permit to/ Con�s�truct'� Alter( ), or Repair( ) an individual well at:
L� /oos
Location-Address Assessors Map an4 Parcel
Owner Address SZV.i`
�� �Ue �yx IZ� 3irews�e�
Installer 115riller Address t
Type of Buildin
Dwelling
Other- ype of Building No. of Persons
Type of Well �V�� Capacity
Purpose of Well
Agreement:
The undersigned agrees to install the afore derAribed individual well in accordance with the provisions of the
Town of Barnstable Board of Health Priv to a ion Regulation-The undersigned further agrees not to place the
well in operation until a Certificat f c as een is ed by the Board of Health. n-
Signed
ate
Application Approved By
Dat
Application Disapproved for the following reasons:
Date
Permit No. ,(�/� / Issued gh 7
/u
Date
BOARD OF HEALTH
TOWN OF BARNSTABLE
(Certificate of compliance
THIS IS TO CERTIFY,that the individual well Constructed Altered(/), or Repaired( )
by I-.( `--f IAf.��IJ
Instaner
at
has been installed in accordance with the provisions of the Town of Barnstable B and of Health Private otection
Regulation as described in the application for Well Construction Permit No. WMY--4 Dated NX
V It
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORILY.
Date Inspector
No. Mall- O t � Fee
BOARD OF HEALTH
TOWN OF BARNSTABLE
0[pprtcation _for VeYY Co.w5truction Permit .
Application is hereby made for a permit to Construct�) er( ), or Repair( an individual well at:
,�- d � era , 1 - �
` Location-Address Assessors Map andrParcel
t - Owner nn % Address
E. Mc"ac a ko,Vcrr�r.V u r �1 l'r, 00 Rye�la�S
l; Installer-)Driller ' u Address
Type of Buildin
Dwelling
I � k
t Other Type of Building No. of Persons '� S
p Type of Well ��� . ``r!� Capacity
Purpose of Well ( y v►cj Q�1 t 0►)
6 .
Agreement:
The undersigned agrees to install the afore described 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 CoommpiiaucceC`has been issued by the Board of Health.r= +. 1
Signed
Date
Application Approved By
�+ Date
:i
Application Disapproved for the following reasons:
Date ..
�"
^� Cam)
Permit No. Ie{ , V, I `"CM / Issued C� ¢
Date
<4v« a--__am4« -_ maamm<eem—<o---------e<m_..._bd.._d_<__—<:..___..___<.. ----------
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate of Compliance
THIS IS TO CERTIFY,that the individual well Constructed,(Oes' Altered( ), or Repaired( )
by 1 (l �.� n .� 1A 69 0
er
� n`stall
at /S L/'i^If 1 01'1 /ra
has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection
! Regulation as described in the application for Well Construction Permit No. j/�. �( � Dated t;�, 1?./
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORILY.
3
Date Inspector
BOARD OF HEALTH
TOWN -OF BARNSTABLE
Very Cott,5tructtou Permit
No. V� (/l eta. V Fee
Permission is hereby granted to'� A-114�!_ /I
Installer"S r V
to Construct t�,' Alter( ), or Repair( an individual well at:
s' . Street t t J
assshown on the application for a Well Construction Permit No. � ' �f�l Dated ep// 1-41
Date t'i �� J ;a Approved By
F.D.M 'noun cape engineering inc FAX NO. :15083S2988O FeE. 05 2009 03:37AM `P1
ifs n1 E'VVi/
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FOUNDATION
CONCRETE TOP FNDN,
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FOUNDATION _ 1 S,
f TOP FN FLEV. 24 5 5
ELEV. =0 3.3' -
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S 15DD. 7 GKI. fiT
GAL ST /
G�. '. -+�
66
a
i. INVERT ,OUT GARAG= 21..<.<.
;s INVERT OUT :HOUSE 20.7`'
. INVERT IN ST
20.2'
INVERT OUT ,,I . 20:02'
cr,; INVERT IN 2nd ST 19,83'
- INVERT OUT
TO a INVERT IN O'gC)X S.91
INDII�N INVERT OUT 3'BOX 18./o,
/ rr:aiL WVERT IN SAS AVG 18 5,
-- `� CE f�07-05
1�1
.�C; TIC R NT .T -I�, Cum f r , l
SGA;LE 1.,. � '40` DATE f�f�'�EMBER 24, .2008
r �. �.CE . _A� '> 36 P-AAL CIEL 013-005 PREPARED `FOR:
—U ,fSTMY Fo LOT 15 LCP 106159G ROBE y y t[
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a1 wu-mm-o"i " OJftI.A in a= gas 39 _�esa
i No, .
0Cly✓.., Cape Engir��z�ing, inc.Xl
i LAbJD SJ,74�YOR5 _._.—._ �.m® e.v .®®�•. .� �...e.
F:•:3 Moir, Sheet — -YARWOJT,-(PORT;.MAS
DATE REG. SURVEYOR
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x _FGHi'-dOUn cape engineering inc FAX NO. : 15083629880 Feb. 05 2009 08:37AM P2
Town of Barnstable
Regulatory Services
Thomas Fa Geiler9 Director
'�''j �% AS•UE!1VL;il �
MAM Public Health Division
Thom.as .rdcKean, Director
t ; 200 Main Street,Hyannis,NA 02601
- , 04Mcc: 508-802-4644 Fax: 508-7�10-6304
'# Installer & Desitrngi°f erti4eeation Forte
t' Jl4.ateo J U Sewage Pca�it __.. . t�ssessair9k M�>ilO\Pa>rcel 3 � CV3- GLI)"'
A?`: 11"as>lgnero UvJ c^ CQ�� ,E3�I car 4ee rf ,t
r•
Address: Address:
Ya ell 0 Wqk 6X MFf N6 2Y
•
t' C):n was issued a permit to instaJI,, a.
(date) (installer)
r f; scptdc system at , a a' based oil a design drawn by
(address)
I C
v: e G y t ri e e�i dated
---
' k� (designer)
-C i 1 certify thafi the septic system referenced] above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation of the
a f distribution box and/or septic tank.
I certify that the septic system referenced above was installed. with Ma,
Jor changes (i.e.
great, s 0' lateral.relocation of the SAS or any vertical .relocation of Luny component
't e septic sy m.) but in accordance with State & Local Regulations. flan revision,or.
rimed as-built b designer to .follow.
DANlrl_A.
�r
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stalEer�s Sig h civil.. y
NO.4F;502
t •� '�,�.w, P 9 U ��
IST
(Designer's Signature) (AIrx Designer's Stamp Here)
E_
IRLEARIE, T7T 11tTT31®T 6(>r BAF8(Qi�•T'Ai33LE PUBLIC HEALTH 111VISl.(2J�T_ CFRTI _
.% 'ID.WL1ANCh WILL NOT BE ISSUM IJNTII., B0111 THIS FORM AND AS-T3 LI-E CARD AT31C
K�1
fir.. l r;CT IVED BY THE I�AIaN15'1'Al3LE PI.JTiT,T( HEALTH I91y1�[i)J+t. TT�[AI�I{��1[J.
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Et,
# ; (1 �eo-illh/Ss�?tie/I�csi�Zcr Certification Forin 3-26-04.doc
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VYes
No. � Fee
E COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
Rpplitation for M18t10saf Opstem (Construction Vrrmit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. S$ f I r� Owner's Name,Address,and Tel.No.K tuN
e��- Mohr
,��//\\�� a5 Ni kland PhrIC �
V"Od e- �e 3a9
Assessor's MapTarcel 3 3(O 0 f —(JCS !J Sa
Installer's Name, ddress,and Tel.No. �` Designer's Name,Address,and Tel.No. 5 ��
`� �ll�as> (�rleS
WKT cons '-uc-;�c'n Dovkn Cake Cn iil2erin
19 . Grl E 6991a 93 M4tn -e2-- Y A Md o V6
Type of Building: av�-ybR-foa 18 5 W_3t;, ._ y 541
Dwelling No.of Bedrooms Lot Size � --sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria
Other Fixtures
Design Flow(min.required) gpd Design flow provided gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure o ction and mai,tenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 -Env tal Code an not to place the system in operation until a Certificate of
Compliance has been issued by this Board f
0
Si a4 o Date
Application Approved by Date
Application Disapproved by Date.
for the following reasons
Permit No. ..� Date Issued
t
TOWN OF BARNSTABLE
r _
LOCATION '��� � �►r�A� �21A�L SEWAGE#�ds __3
VILLAGE vl e ASSESSOR'S MAAP&PARCEL 3s(0 613-00S
INSTALLERS NAME&PHONE NO. �170
SEPTIC TANK CAPACITY IS60 A l 0g6 62L
LEACHING FACILITY.(type) L�}GHt�6 e 9 (size) oS
NO.OF_BEDROOMS S
OWNER703kSZ7
PERMIT DATE: bo 0S 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)) ' (. V Feet
FURNISHED BY DOW'
Z7
Z-
3-- 1+L,
4t 147
7-S�
g-- 47a
l�oo .Gee
q- so �® : ►�� s
T4�►K
r eoo G(al.
t qzp 5'aric-
TPA4K
Q S 1-�rot�
(�, Z(
3
IRREGULAR .� � ''•A „-,. _� _ �.
_ R
NNv7 III+ —�I LANDING ,,•!" HYORAN
i
MBING
SI � W 2 RISERS)
7ROME1��� t� ��
RUBBISH
SSNH/7ARDCR'INK96RRY / V` E M1M Q ENMRE SSG
,pq'jgABRA'5NAAIROCF• 1k
EVER am V.
HYDRANGEA
yDR,AKf'A EEO 3KY
1 �vI
IPRA GYERRY L.AURE+• A-5 \\ I \
L y,MPXAEN95• �..—y
r- p �\� �� PROPOSED
uxt+ ' DWELLING
_ r
PLANT OT
`y '✓ ON LANPD F�ING
OWE
+SAE uE pgNCE55• rs ' _'• `� , ' ( , TOP FNO.=24.5
BLUE ENDLESS StWNEx HwwNGEA xa3
NNIRANCEA bmttss SuxaER' _ — PROPOSED - BLUEST SLAB I. t `�
Cuu G HYDRANGEA caN TRELLs) n.ESP. x \� GARAGE / Py
HIDRANGG ANPMAu PEROURAS SLAB = 22.5
LAW
UNM
+A
R ,/ UMBINC
C
� HYDRANGE
ANNUAL/PERENNIAL COLOR TO BE DISCUSSEDyII
` LAWN
pROP RIVEWAY
OSEO t
-STONE b .. `t{/-�}
�v LAWN
/fir ,1+��� / \ /I't,1�,'r� ,•O' ',✓•,""S`
I
OF
MEI
i \\
OLEJ
,,/APRDN�O��(,
No. Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
.,
- PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes
application for ]Disposal 6pBtem Construction 3pPrmit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
h Location Address or Lot No. i 5g M I 7 y) Owner's Name,Address,and Tel No. K c)b
r�� 15 4'-kic,ncl �u�iC U;066,L t�`fe q rrr
Assessor's Map/Parcel 3(o -(xjs G�1 (J ,11 n-, i X -1 5a
Installer's Name,Address,and Tel.No. 6j(t 11,0 j) F 1 ( Designer's Name,Address,and Tel.No.
WKT 6�,n54y) -on Dow) Car- togineer'i,,_�
iGa E Gri'6it1,d ME OH41a C139 mein Ma 63u15
' Type of Buflding: a 0-1-yic�j - loa 18.
Dwelling No.of Bedrooms Lot Size Q,y sq g ft. Garbage Grinder
J ( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures `J
y; Design Flow(min.required) gpd Design flow provided
gPd
I Plan Date Number of sheets Revision Date
Title
Size of Septic Tank. Type of S.A.S.
s" Description of Soil
`Nature of Repairs or Alterations(Answer when applicable)
• t.
j r�
Date last inspected:
"Agreement:
The undersigned agrees to ensur4thq-Envkohmeptal
e onriction and a" enance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 Code an not to place the system in operation until a Certificate of
i
i'
Compliance has been issued by this Board 6f H a t1v
Si Date
Application Approved by J t �/// ;.y. 'l: a" - �1 Date
Application Disapproved by f�h✓ f Date
for the following reasons`
+, Permit No. ' Date Issued
- - ----------------------
�_�', f �C THE COMMONWEALTH OF MASSACHUSETTS
- -BARNSTABLE,MASSACHUSETTS
- Certificate of Compliance
THIS IS TO CERTIFY t iatt the On/-'site Sewage wDisposal system Constructed(X) Repaired( ) Upgraded( )
Abandoned( )by , l / �/�i��� /// ,�rf 1, /_4 A,
at �� ( li�s.been constructed in ccor anc�e
with the provisions of Title 5 and the for
Disposal/System/Construction Permit No. fe"d� .0
Installer1l1G�1�fi I /( Li Designer
#bedrooms_�') / Approved design flow p N B r gpd
The issuance of this permit sha/l�rno bfe coiis�tru}e/d`•as a guarantee that the system will . cfioj as de�s/igned.
Date / Inspector
f
------------------------------------- - -------- - r ----------------------------------------------------
-------------
No. Fee.----���—
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
30tsposal &pstem Construction permit
Permission is hereby granted to -onstruct( Repair( ) Upgrade(,0) Ab don( )
System located at L I ) /
and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
Title 5 and the following local provisions or special conditions. 7
Provided:Construction it st be c7/7
pieted�..`thin three years of the date of this permit. i fl ✓ 1`t
( pp ( 1
Date / dl$ / 1 Approved by
DATE 8119106
PROPERTY ADDRESS 158 Indian 72a.i2
Cummaqu.id Ma
On the above date, the septic system at the address,above was
Inspected.
This system consists of the following:
1. 1-1000 gaUon .aept.ic tank. /
2.i 1-Di st2.igut.ion Box.,
3. 1-1000 gaiion .eeach.ing pit,
Based on inspection, I certify the following conditions:
4., 7h.iz .iz a 7.it 2e Five .6ept.ic zyztem (78Code)
5., Septic zyhtem .is .in paope2 wo2k.ing ozdea at the paezent t.imeo
Glaste watelt .in ieach.ing pit .i.6 18" C?eeow
SIGNATURE : ?;
fT
Name: Robert A. PaolinirQf
Company: Joseph P. Macomber & Son Inc
Address: P. O. Box 66
Centerville Mass 02632
Phone: .508-775.3338 or 508-775-6412
•
JOSEPH P, MACOMBER & SON, INC.. ,
Tanks-Cesspools-Leachfields
Pumped & Installed
Town Sewer Connections
P.O. Box 66 Centerville, MA 02632-0066.
775-3338 775-6412
0
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT.-OF ENVIltONMENTAL PROTECTION
r
ti
TITLE 5
OFFICIAL INSPECTION FORM,.NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PARTA _ .. .
CERTIFICATION
Property Address: ..158 Indian 7aa.i.e
Cummagu.icd
Owner's Name: 1 ame. nNcCaa.thu
Owner's Address: Box 125
Cu
Date of Inspection: 8119106
.
Name of Inspector: (please print) R21 art- A Pao.IW
Company Name: 1. l..hlacom&.ea -� .S:o.n Inc.
Mailing Address:
_ en zavi e, a 6 .-026 32
Telephone Number: 5 0 8-7 7 5-3 3 3 8
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 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.13:340 of Title 5(310 CMR 15:000). The system:
XXXPasses — —
°Conditionally Passes
lqeeAt Further luation by the Local Approving Authority
a
10 Inspector's Signature: Date: `? 7
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.
Notes and Comments
I
""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.
Title 5 Inspection Form 6/15/2000 page 1
Page 2 of 41
OFFICIAL INSPECTIONYORM—NOT FORIVOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION-FORM.
PART'A
CERTIFICATION(continued)
Property Address:15 8 Indian 7/7 a1.0
Cummaqu.i-d
Owner: %am.e& NnCaA hU.
Date of Inspection: 8/1 9/o A
Inspection Summary: Check :A,B,C,D or.E/ALWA rtompleteall of Section:D
A. System Passes: qES
NO I have not found any information which indicates'that•any of the failure criteria described 3.10 CMR
15.303.or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below.
Comments: Se .tiC .s ,6-tem -.i�. .in/� y /220/2e2 wo.2k.ing
o2de2 a n t cem.
B. System Conditionally Passes:
NO One or more system components as described in the"Conditional Pass":section need to bit.replaced:Or
repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass.
Answer yes,-no or not.determined(Y,N,ND)in th'e for the following statements.If"not determined"please
explain.
NO The septic tank is metal.and.over-2'years old*or the septic tank(whether metal or:not)is:strticturaIly
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.tanks,.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.
ND explain: ,...
NCI 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
obstruction is removed
distribution box is leveled'dr replaced
ND explain:
NO 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
obstruction is removed
ND explain':
F
Page 3 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A..
CERTIFICATION(continued)
Property Address:15 8 Indian 72a.ii
ummaqui
Owner: %ame ea NcCa2thy-
Date of Inspection: 8/19 0 6
C. Further Evaluation is Required by the Board of Health:.
NO 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:
no Cesspool or privy is within.,50 feet of a surface water
no 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,safety and environment:
a o 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.
a o The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply.
no The system has aseptic tank and.SAS and the SAS is within 50 feet of a private water supply well.
_aD 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 v.i h u a i
"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.
3. Other:
I� k
3
f
Page.4,of 11
OFFICIALINSPECTION FORM—NOT FOR:VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAcL SYSTEM-INSPECTION FORM -
PART.A ..
CERTIFICATION(continued)
Property Address: 158 Indian Taa.i$
ummaqui
Owner: lame-id (7cCanthu
Date of Inspection: 8179106
D. System Failure Criteria applicable to all systems:.
You must indicate"yes"or"no"to each of the following;for al inspections:
Yes No I.
_ X Backup of sewage into facility.or system component due to overloaded.or clogged SAS or cesspool
X Discharge or ponding of effluent to the surface of the ground or.surface waters due to an overloaded or
clogged SAS or cesspool
X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool
_ X Liquid depth in cesspool is less than 6"below invert or,available volume is less than'%•day flow
_L Required pumping more than 4 times in the last year.NOT due to clogged or obstructed pipe(s).Number
of times pumped
X Any portion of the SAS;cesspool or privy is below high ground water elevation.
_ y Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply.
_ X Any portion:of a cesspool or privy is within a Zone 1 of a:public well..
_ X Any portion of a cesspool or privy is within.50 feet of a private water supply well.
X 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.] .
NO (Yes/No)The system fails.I have determined that one or mor6of the above failure-criteria exist as
described in 310 CMR 15.303,therefore the system fails.The system owner.siLould 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 1.0100.0 gpd.to 15,000.
gpd.
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)
yes no
v the system is within 400 feet of a surface drinking water supply
_ X the system is within 200 feet of a tributary to a surface drinking water supply
_ X 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.
4
f
Page 5-of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUB'SURFACEJSEWAGE DISPOSAL 2 SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 158 Ind.idn. 72a.iP
Cummauu-id
Owner:%ameia NcCaathy
Date of Inspection: 8179106
Check if the following have been done You must.indicate`yes"or"no"alto each of the following:
Yes No
x Pumping information was provided by the owner,occupant,or Board of Health
X Were any of the system components pumped out in the previous two weeks.?
X _ Has the system received normal flows in the previous two week period?
_ X 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)
X p Y
X Was the facility or dwelling inspected for signs of sewage backup?
X Was the site inspected for signs of break out ?
X Were all system components;ww1uding the SAS,located on site?
x _ 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?
X_ _ 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:
Yes no
Existing information.For example,a plan at Ehe Board of Health.
X _ 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)]
5
Page 6 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION.FORM
PART C
SYSTEM INFORMATION
Property Address: 156 Indian 71ta.i e
Cummagu.id
Owner:%ame& flr_Cd,i,fhU.
Date of.Inspection: 8/19/0 h
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): 3 Number of bedrooms(actual):' 2
DESIGN flow based on 310 CMR 15.203(for example:.116 gpd x#of bedrooms):220
Number of current residents: 1 -
Does residence have a garbage grinder(yes or no):n o
Is laundry on a separate sewage system.(yes or.no)4_a__ [if.yes separate inspection required]
Laundry system inspected(yes or no)j o
Seasonal use! (yes or no):a o 2004=22, 000 ga22onz FD=
D=60.,27
Water meter readings,if available(last 2 years usage(gpd)): 20 0 5=5 2, 0 0 0 qa e_0 o n s 14 2.4 7
Sump Pump(yes or no): no
Last date of occupancy: 122 e.6 e n t
COMMERCIA.L/INbUSTRIAL N/A
Type of estabohment:
Design flow(b'asd on 310 CMR 15.203): gpd
Basis of ddsign`flow(seats/persons/sgft,etc.):
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/use: .
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information: 8121106 a.,l (7a e o m 9 e lt
Was system pumped as part of the inspection(yes or no): q 0,6
if yes,volume pumped:ILO 0 0 gallons--How was quantity pumped determined?m e-a s u z e d
Reason for pumping: h e-a v,41 z o i id in tanko
TYPE OF SYSTEM
X 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)
—Tight tank _Attach a copy of the DEP approval
—Other(describe):
Approximate age of all components,date installed(if known)and source of information:
1986
Were sewage odors detected when arriving at the site(yes or no):n o
6
Page 7 9f H. y
OFFICIAL INSPECTION FORM—NOT FOR.VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL`S-YSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 758 Ind.iah. 72a.i_p
Cummaqu.id
Owner: %ameea .McCaathy
Date of Inspection: 8119106
BUILDING SEWER(locate on site plan)
Depth below grade: 4 Z" ,
Materials of construction:_cast iron X_40 PVC- other(explain):
Distance from private water supply well or suction line:
Comments(on condition of joints,venting,evidence of leakage,etc.):
o.int no evidence Vented thorough
ouze vent,1
SEPTIC TANK:y e(locate on site plan) 1000 ga i i o n z
Depth below grader 3 6"
Material of construction: concrete_metal_fiberglass_polyethylene
_other(explain)
If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_.(attach.a copy of
certificate)
Dimensions: 8.' 6"X5 8"x4' 10"
Sludge depth:_ t a a e e
Distance from top of sludge to bottom of outlet tee or baffle: 0 -
Scum thickness: .t a a c e.
Distance from top of scum to top of outlet tee or baffle: 0
Distance from bottom of scum to bottom of outlet tee or baffle: 0
How were dimensions determined: t a d c e
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels
as related to outlet invert,evidence of.leakage,etc.): _
Pump tank eveay Z yea2zoo Intet 9 ouln_,t
Tian zz z auc AuaUy zoun
GREASE TRAP: NO(locate on site plan)
Depth below grade:
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:
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels
as related to outlet invert,evidence of leakage,etc.):
Gaeaae taap .iz not paeZent
7
Page 8 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 1 5 R T n di_r7 n H I 0 0
Owner: Fame a McCaath.y
Date of Inspection: 819106 I
TIGHT or HOLDING TANK:NO (tank must be pumped at time of inspection)(locate on-site plan)
Depth below grade:
Material of construction: concrete metal fiberglass polyethylene othe-r(explain};
Dimensions:
Capacity: gallons
Design Flow: gallons/day
Alarm present(yes or no):
Alarm level: Alarm in working order(yes'or no):
Date of last pumping:
Comments(condition_ of alarm and float switches,etc.):
light oa hoid.ina tanks aae not Raezen.t;
DISTRIBUTION BOX: y(SS(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.):
Box i.6 ie-ve-e has I ate/td-eo No ao-iid caaaovea oa .leakage .in
oa out o ox.1
PUMP CHAMBER: NO (locate on site plan)
Pumps in working order(yes or no):
Alarms in working order(yes or no):
Comments(note condition of pump chamber,condition of pumps and appurtenances,.etc.):
P umI2 ehameea iz not /2ae6eat
8
Page.9 of l l
OFFICIAL INSPECTION FORM—'NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE-SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
_SYSTEM INFORMATION(continued)
Property Address: 158 Ind-Zan 7aa i e ,
Cummac4uid
Owner:. %ame a Mr-ralif
Date of Inspection: 8/19 l 0 h
SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required)
If SpS not 1 cat d explain why:
Loca�eaF see /gage 10.,
Type.
x leaching pits,number: 1
leaching chambers,number:
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.):
^� Kazd ceag to modium Ag r/ , No Ajg.LA n' 4hibino nn !nn'n_d.ng .
SoiP�s nnP r/ng Vogotntian 1A nnamez
CESSPOOLS: N0 (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 or no):
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
Ce.6.312oo,ez ate not aezent
PRIVY:N(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.):
l2.iu11 j.6 not rzae�ent
9
f
.Page,1•1 of
` OFFICIA.L INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS
SLTBSUPTACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued). .
Property Address: 9 5., ' Indian 72a li .
Owner:
Date of Inspeclioo: "
SITE EXAM
Slope
Surface water `
Check cellar'
Shallow wells r
Estimated depth to ground water 3W fee!
Please indicate (check)all methods used to.determine the high ground water elevation:
Obtained from system design plans on record-If checked,date of design plan reviewed:
Observed site(abuning property/observation hole within 150 feet of SAS)
_Checked with local Board of Health explain,
Checked with local exca.vators, installers.(attach documentAtion)
Accessed USGS database-explain:
You must describe-how you established the-high rou d ter a evatlon:
ll�ed: ahaet & ('tilje2 �odeQ �2I�6��4 �jaoand watea a&ove aea level
ll��d. � �n2v¢x�on well data une
ll
&,Llle;jn 92-000-7— ate #2 gandaay
2
.Qeva.t.ion�.
Leaching
Pit %ct
Gioundwater. Feet Below Bottom of Pit High Groundwater Adjustment 1.8 ft per FHmpter Mcthod
'therefore,the vertical,separation distance between the bong m
of the leaching pit and the adjusted groundwater table is . ®,
'h
11
i
Page 10-of 11 l
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY.ASSESSMENTS .
SUBSURFACE SEWAGE:DISPOSAL SYSTEM INSPECTION FORM i
PART C.
SYSTEM INFORMATI.ON.(continued)
Property Address: 158 Indian 7aai2
ummaqui
Owner: %)ri m o in l7 .. a#it y
Date of Inspection: 8/1 9/0 6
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at Ieast two permanent reference landmarks or
benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building'. .
' II
t
,� '•ems
10 .
Page I Lof 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 158 Indian Taa.i-e
ummac/u.c
owner; lame-Oa c as hy
Date of Inspection: 8 177 6
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water 20 feet
Please indicate(check)all methods used to determine the high ground water elevation:
'NO Obtained from system design plans on record-If checked,date of design plan reviewed:
Observed site(abutting property/observation hole within 150 feet of SAS)
cue i,Checked with local Board of Health-explaimaz guLftn d no Checked with local excavators,installers-(attach documentation)
ezAccessed USGS database=explain: tt/2:.town.,gaan,3.ta .ee.,ma.,u s
You must describe how you established the high ground water elevation:
11.6ed Cape Cod Comm.izzon Natea 7gaee Coritouaz And 1 u&i.ic ldatea Suppiy
Oeii head /zaotec.tton aaeaz map., Sept 1995
Natea aezouace,6 o-1,1-ice cape cod comm.ie.ion.,
Top of Ground
Leaching 'f
Pit 4feet
•
I
QpS
Groundwater: Feet Below Bottom of Pit' High Groundwater Adjustment 1.8 ft per Frimpter Method
Therefore,the vertical separation distance between the bottom
of the leaching pit and the adjusted groundwater table is
feet. )P
N �
11 '
fi
low 0%
rw
'Toim OF / ARNSYABL'E_—. ,' BOARD QF 11HA'LT11
j9UOSURFACR 14t;w;x DISPOSAL SYSTEM T OPFCTION FORM - PART D.•, CERTIFICATION
-TYPE OR PRINT.CLEARLY-
PROPERTY ZL SPFCTHV
158 Indian 7aaii
STREET ADDIIES$
A•SS•ESSORS MAP, BLOCK AND 'PARCEL 3 3 6.,013-00 5
OWNBR1s NAME ? meted• McCaathy '
PART.D 0H1?TIFI0AT-ON :
Rob$rt A:'-Pao3.i:n
NAME 'OF •INSPECTOR —=--
COMPANY NAME ,_Jo'spFh s jaMh9.n •ion"TUC..
R 1•i�.w �r•T..
COMPANY ApD SS f,: 4 fox:."6S Cc a 6rvill6• MA:'"Q 3-2-b068 w
Stro k' TOW-or City. ,6tato L P
` COMPANY TEL$PHONE 508. 1 �7.5 3338 FAX 508•, 190 f 57$ ,
CERT•hFICATION. STATEMENT
I certigy that I have personal-iy ,ins•peoted .the Qewaee 'digpoAa�1. system at
this address and t hat• �th$• information reported .is true,. gcofta•te•, grid
omplete. as of the time if sinspectiony The inspevti.on was per•tormed and any*
recommendations regarding .upgrade•, .ma•intenctnce 1`. and irepa•ir ,afie• consistent
with my trainip,g and experience in th@ Ypoper functi-on' avid paintenance of on-
site sewage disposal. systems,
Check one.
XXXX System PAS92D -
The inspection which J. have .•oonduoted has ,n-ot 'found any information .
which indicates' that. :the system' fails to ' adeclua;-tely., protect .publiv =
health or the env i.ropmen t as defined its• .310 CMR. 1 g 30.3•, -Any fAiittre
criteria o6t ••evalua'i ed' are as stated in the 2AILURA -CRI'i'RRIA -section e•f
this, form.
System FAILED's`
The inspecttioh which I have 06h'ditr6ted has found that the :system fails to
protect the public health and tho en4roTtmen•t * in acgoicdance with Title
61 310 CMR 15 ► 34S 1 and as-specifically noted on .PA'RT' C . FAILURE
CRITERIA of this. inspect n .fo ►
Ins.p ecto Signature -Date
Vn copy of this oertlfics;t•iat► tnu'st •be rovided *to • the .QWN9II.1 a BU'fER're &ppli.aablo) and tehb f3QARD OH' 11EA T1t► „
If the inspection FAIL•Eb,, 'th* 6Wne$'.0r"p9Aorator �Ihdll . upgxasie'•the eyatem•
within one year of the da't•e of the inapeotion, unless. allowed pr- requ4,•red
nt.harw{ae. as Provided ini qJ0 CMR 15 r 306
f
DATE_ --- -- -_
PROPERTY ADDRESS:_158_Indian 7aa"ii
O
F Cummaqu.id, Na.
• —=--- 02637
k
On the above date, the septic system at the, above address .was
Inspected. . -
This system consists of the following:
1. 1-1000 gaiion zep.t.ic tank.
2. 1-d.iz.ta igut.ion Sox- FZ: C m
3. 1-600 ga ion eeach.ing pit. � 0Based on Inspection, I certify the following condition: D m
oZ ,
W�
4. 7h.is "ins a tit�e rive ze.12t.ic -zotem (78 code) t, �D o M
5.-7he ze/21.ic zyztem .iz .ih j'zopea woak.ing oadea W -�
at- the'paezent time. - m
6. The wazte wate2 wa.3• 24' r9"e eow the -invent ,p.4,Pe "in
.2each"ing 12"it.
SIGNATURE:
-----
Name: /3n ii r
Company: -Tnc�—jaii$__.MaCgmb4=—&—Sen, Inc.
'Address:- e Q._B�x_ ---------
MA n7632-006.6
"Phone:--_1.�4$
THIS CERTIFICATION DOES NOT CONSTITUTEr A GUARANTY OR
WARRANTY -
k
JOSEPH P. MACOMBER & SONIL INC.
Tanks-Cesspools-Leachftelds
Pumped & Installed
Town Sewer Connections
P.O. Box 66 Centerville, MA 02632-0066
775.3338 775.6412
r
T
.\ COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE'OFFICE OF ENv R4NMFNTAL AFFAIRS
DEPARTMENT OF RNVIRONMFNTAL pROTMION
TITLE 5 -
OFFICIAL INSPECTION FORM—.NOT'FOR.VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART•A
CERTIFICATION
Property Address: .. 158 1ncican . 71ta.i-P
�'nmmaru� lrin_ .
Owner's Name: F f h n n Nn Qom/o n
Owner's Address: 19 /3n n n k h n ii A g 7)a_
n 19 5
Date of Inspection: 7 i n 1 i n 4 `
Name of inspector: (please print) [acre. la,ca_2 :�t 2.a ,
Company Name: ..- P.Aacomie2 & .S.on Inc.
Mailing Address:
Cen Z P-,s v Ty e, t7a.6,3..02632
---� Telephone Number: 5 0 8-7 7 :3 3 3 8 -
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 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'l itle 5(310 CMR•t5:000). The system:
Passes
-Conditionally Passes,
Needs Further Evaluation by the Local Approving Authority
Fails
Inspector's Signotare: Dater
The system inspector shall submit a copy of this inspection report to the-Approving Authority.(Bom-d of Health or
DEP)within 30 days of completing this inspection.If the systeII 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.
Notes and Comments
""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.
T:rla Tnenorrtinn Rnrm 6/1 S/2000 page 1
Page 2 of 11
a
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL.SYSTEM_INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 158 Indian 7aa"i$ . p
Cummagu.id...Ma.
Owner: Ffhan- Or,anan
Date of Inspection: 7/0 1/0 4
Inspection Summary: Check A;I3,C,D or.E/ALWAYS-complete�all of Section D
A. System Passes:
no I have not found any information.which indicates thnf 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:
7hv- .6v_/2#is 3y.31 e-m ib in /l/zope/t wo zking o2delt a.t
f h o n n v.s P_a;t- ;t is m P..
B. System Conditionally Passes: r
no One or more system components as described in.the"Conditional Pass":section need to be replaced,or
repaired.The system,upon completion ofthe replacement or repair,as approved by the Board of Health,will pass.
Answer yes,no or not.determined(Y,N,ND)in the for the following statements.If"not determined"please
explain.
no The septic tank is metal.and.over 20 years old*or the.septie-tank(whether metal.or not),is:structurally
unsound,exhibits substantial infiltration or exfiltration.or tank failure:is irnrninent. 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.
ND explain: r y t
n o 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
obstruction is removed ,
distribution box is leveled or replaced
ND explain:
n o 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
obstruction is removed
ND explain:
2
f
Page 3 of I 1
6.
OFFICIAL INSPECTION FORM'NOT.FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION.-PORM
PART A
CERTIFICATION(continued) :,
Property Address: p 5 R T nrl n n 7 n n,f_P '
Owner:.
Date of Inspectton: i_ ,
C. Further Evaluation is Required by the Board of Health:
_ Conditions.exist which require further.evaluation.by.the.Board..of Heaith,in order.to.determine ifthe system
is failing to protect public,health,_safety or the environment. -
1. System will pass unless Boa rdof.Health determines.in accordance with 310.CMR 15:303(l)(b)that the,
system is not functioning in-a manner which:witl protect public health,safety and the.environmen#:
_a4 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. System will fail unless the Board of Health(and Public Water Supplier,if any)determines:that the
system is functioning in a manner that proteets the public health,safety and environment:
4%-Q 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.
no The system has aseptic tank and SAS and theSAS is within a Zone l of a-public water.supply.,
no The system has a septic tank and.SAS and the'SAS is withim.50 feet of a private water,supply well.
.aD The system has aseptic tank and SAS and the SAS is less than 100 feet.but 50 feet or:more frorn 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 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.
3. Other:
None
3
r
Page 4 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATIO.. (continued)
Property Address: 15 R T n d a n 7 a 0 « '
rummaqu id. Rn > f M Y
Owner: F f 61c:��e n
Date of Inspection: 7/01 1(`l,
D. System Failure Criteria applicable to all systems: - y
You must indicate"yes"or"no"to each of the:following:for all inspections:.
Yes No
_x 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
x Static liquid level in the distribution box above outlet invert due to an overioaded or clogged SAS or
cesspool
x Liquid depth in cesspool is less than 6"below invert or available.volume is less than'%..day flow
_y Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number
of times pumped
x Any portion of.the SAS,cesspool'or privy is below high groundwater elevation.
_X_ 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 l 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 uo other failure criteria
are-triggered:A copy of the analysis must be attached to this forv@.]
no A
(Yes/No)The system fails.I have determined that one or.more ofahe 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:
QTo be considered a large system the:system must.serve.a>facility,with a design flow of 1.0,00.
gpd. A. 0 gpd to 15,000
,
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)
yes no
_ X the system is within 400 feet of a surface drinking water supply
• _ z the system.is within 200 feet of a tributary to a surface drinking water supply
_ x the system is located'in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped
Zone 11 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.
4
Page 5 of I 1 s
OFFICIAL INSPECTION FORM-' NOT'FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST' -
Property Address: 158 Indian Tzar�
Cummaquid, lea.
Owner: (E.ihan 61aa2erz
Date of Inspection: 71014,04
1
Check if the'following have been done.You must indicate"yes"or"no'.as to each.of the following:'
Yes No
z Pumping.information was provided by the owner,occupant,or Board of Health
x Were any of the system components pumped out in the previous two weeks
x _ Has the system received normal flows in the previous two week period
x Have large volumes of water been introduced to the system recently or as part of this inspection?
x Were as built plans of;fhe system"obtained and examined?(If they were not available note as N/A)
x _ Was the facility or dwelling inspected for signs of sewage back uj?
x _ Was the site inspected for signs of break out
x Were all system components,excluding the SAS,located on site
x _ 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?
x _ 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:
Yes no `
x Existing information.For example,a plan at the Board of.Health.
_ x 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))
'Z •
5 ;..
Page 6 of 11
OFFICIAL.iNsPEcTIGN F0RX-NOT-FOR VOLUNTARY ASSESSMENT'S
SUBSURFACE S+EWAGE DISPOSAL SYSTUMINSPECTION FORM �
PART.0
SYSTEM INFORMATION
Property Address: 158 Ladian 72ai
Cij maqu t_d, /Ia.-
Owner: F I A n n No/7 7 o n + "
Date of Inspection:�Z/n i/a4
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): :<3 . .: Number of.bedrooms(actual): 3
DESIGN flow based on'S I0 CIGI 15.203(for example:'1 I0 gpd x#'of bedroom ):3X 1.10=3 3 0 gl2 d.
Number of current residents:,�_
Doesresidence have a garbage grinder(yes or no):�p
Is laundry on a separate sewage.system.(yes or.no):..,,a [if yes separate inspeption required]
Laundry system inspected(yes or no): ,�
Seasonal use:(yes or no):an
Water meter readings, if available(last 2 years usage(gpd)): Z O O Z:3 3', 000 o a 6 e nt.�y connected to
o n t h
�2ec
Sump pum (yes or no): n o
.
Last date of occupancy: n a o a o n t W n tv rl t e 2.
COMMERCML USTRIAL r
Type of estab .�.:. at: n n:
Des€gn flgw on 310 CMR 15.203):: n rz apd
Basis.of dot o ow(seats/persons/sgR,etc.):, a
Grease trappresent(yes or no): n n
Industrial waste holding tank present(yes or no):n a L /"
Non-sanitary waste discharged to the Title 5 system-(yes or no)-,LL.
Water-meter readings,if available: na
Lasf date of occupancy/use: . n n
OTHER(describe):. n a
GENERAL INFO)W—TION
Pumping Records
Source of information: _ P_ Nnre-)MARR R son Inc.-
Was system pumped as pat of the inspection(yes or no):jj P
If yes,volume pumped: 100 allons--How was quantity pumped determined? N a a,6 a ll n_d
Reason for.pumping: a?�,i n f n irn.r o w .
TYPE OF SYSTEM = a
rye zSeptic tank,distribution box,soil absorption system
_aoSingle cesspool
n o0verflow cesspool
-axPrivy .
n 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)
_plight tank _Attach a.copy of the DEP.approval
_apMer(describe):
Approximate age of all components,date installed(if known)and source of information:
1986
Were sewage odors detected when arriving at.the site(yes or no): n o
6
0
* Ptgc7ofII
pFFI I L• NAP` e"PIQN VDR. I,. .-NQT FOR VOLUNTARY ASSESSNMNTS
` 3TjR* ,kCZ ftWAOIZ DISPOSAL SY$TEM INSPLGTFI®N FORM
PA-RT-C
SYSTEM.•INFORMATION(continued.)
�To►e ty��tdress: 158 Indian 7/ta i-g
r�/mmnriu 1�7r
Qwwcr:
Dit•e of 14P—ittt0tr 71,,_ 01 04 ...._„
BU-11XING SEW1SA(baste-att'sitc plan)
Depth irFlp�r grate: "
Matcrialt of consttroct one , ,,,ct<st Von „�.40 PVc,;�4.a of(cxPlslna:. '
Diswssee tr+r>t.prtvt<tr W#4r iuppty well ar suction line-:
commems(pR r."01119n 91 y90tts,vcniing,yvidSAca of lc ;;e,e.tc.): ,
Vented thao'ugh houhe' vend.
SEPTIC?'.04 y�,,419cate on site plui)
DVA bcl8w gn4c:1,8"„
t>a�setiit.of conswction:�,con�reto-�,,"„mctal;_,,,frbargt�sa,,.,,,,polyethylene• ''
olbcrtcxlyitlGt� ,
u lc is tAetaf I#st.igs;_,_,_ 's ado conf'u�rtc by a cct ltictctc c Cotnpl•.aRce(yes or noj; (atfnch a copy of
pimcnylon.s 8' -6".tong 4' - 10"wide 5 ' -8" high
$-Iud;s depth; ,�:.,�„�,
01stt w hem 1;*of s ud$c to laotwtn o Ou•blat tac or b&Mc: 0
$cum tltiemcw. B,,,,, '
Disslanec.tpm to. tsf scuFtt c .-1Qp of outlet tee or baffle;0_
Diswcc.0om.bonom:o f scum to bottom of outlet Ice or bsfflc:, 0
How W fc-dimcmion$determined; tgg4 aL Llgf. Q4e c i o n
C.awr'a.m.(ost.pusnpin.�,reeommcrlditit7ni, .act tied qut.ct lee or baffle eondlkion,Mcturtil integrity,liquid levels
:s rclita4.t�ovtFct invcit,avldcnea af,tcskagc.,etc;). .
_ t ee.3 ate in
ge,
GREASE TRAP:n0(locate on she plws 0tr
S
Depth lreipw grastch,�
Mucrial.of consovctiott: concrete—tMtal fiberglass„_polyethylene_.other
Dimcn;Ions; n a
Scum thttkstess: na
Dim.cc bram top•or s�m o top flf outlet.t`c'c yr baffle ?,,_, n�,.,,_
pYsunce Both bor4m of strum to bottom of outlet tee or baffle: n _
Due of tut.putnptt9g;.,,,n-a-
Cotstttt.ersts(an pWmpl)aS.re Inlet and outlet tee or baffle eondidon;structttral Integrity;liquid levels
uf-date�d^tc�outltt�iv11�c�i eve(d»eRCCof:Ieaka:�6�p�ec��C.,�: '
I
Page 8 of 11
.OFFI.CIAL INSPECTI.ON FORM:—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM.
PART C r +"
SYSTEM.INFORMATION(continued) e
Property Address: 158 Indian 7sa.iQ ,
Owner: Ffhon Idnan-o-n- '
6
Date of Inspection: 7/01/0
TIGHT or HOLDING TANK:N o (tank must be pumped at time of inspection)(locate on site plan)
Depth below grade: na
Material of construction: concrete - metal fiberglass polyethylene other(explairi):
Dimensions: n n
Capacity: na : gallons
Design Flow: n a gallons/day
Alarm present(yes or no): na
Alarm level: na Alarm in working order(yes.or no): na
Date of last pumping: na
Comments(condition of alarm and float switches,etc.): -
71ght �a hnPdinc� tankh not ent
DISTRIBUTION BOX:4&,6(if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert:. n o
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 hays 1 iateaai. No evidence o.� .leakage 'into oa out
o,P &ox r -
PUMP CHAMBER: n o (locate on site plan)
Pumps in working order(yes or no): na
Alarms in working order(yes or no):�na
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):
Pump ehamgea not pae sent. "
r .
Page 9 of 11
OFFICIAL INSPECTION FORM—'NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION,FORM
PART—C.
SYSTEM INFORMATION(continued)
Property Address: 158 Indian T2a.i e
Cummaau.id..Ma.
Owner: Ethan Oaaaan
Date of Inspection: 7/n 9 1 n 4
SOIL ABSORPTION SYSTEM(SAS): y e-3(locate on site plan,excavation not required)
6Q0 as tion L,jO,
If SAS not located explain why:
farated .too Faye 9Q
Type
yez leaching pits,number: 1
no leaching chambers,number:
na leaching galleries,number:
no leaching trenches,number,length:
n o leaching fields,number,dimensions:
nQ overflow cesspool,number: .
no 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.): ,
Loamy nand .to medium /.ine .6and. No i .ignz ' o� hydaaue.ic
a c aAe. Vigitation .cry no zma .
CESSPOOLS: no (cesspool must be pumped as part of inspection)(locate on site plan)
Number and configuration: na
Depth—top of liquid to inlet invert: n a ,
Depth of solids layer: na
Depth of scum layer: na
+ Dimensions of cesspool: na E
Materials of construction: na.
Indication of groundwater inflow.(yes.or no): na
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
Ce6.6/206.b3 not 122e'3ent
PRIVY: n o (locate on site plan)
Materials of construction: na "
Dimensions: na
Depth of solids: n a
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
P2ivy not paesent.
Page 10 of 11
GM.CnIAL.INSPECTION FORM.`.NOT FORVOLUN -AR YASSESSMENTS -�
SUES,URFA:CE SEWAGE DISPOSAL SYSTEM,-INSPECTION:FORM
PART C
SYSTEM INFORMATI.ON(continued)'
Property. Address: 158 Indian 72ai i � }
Cammaaaid fa.,
Owner: Ethan (Jn__lzlzv_n
Date of Inspection: 7/0 9/0,4`"
,.SKETCH OF SEWAGE-DISPOSAL SYSTEM `
P*ide 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.
u;
f�\1 x
i
10
f
Page 1.1 or I I
OFFICI.AL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued). -
Property Address: 15.8 Indian 7aa-i e . -
Clim Lau.id, Ra. ,
Owocr:_94hr,Q 41c4 n n»
Date of lnspectioo: '-rwn�l��i j•,
SITE EXAM -
Slope
Surface water -,
Check cellar' s _
Shallow wells -
Estimated depth to ground water ` reel `
Please indicate (check)al-1 methods used to,dctcr-mUic the high ground.water elevation:
Obtained from system design plans on record - If checked,We Odesign plan reviewed:
_Observed site(abutting property/observation hole within 150 feet of SAS)
Checked with local Board of Health-explain;
T Checked with local excavators, installers. (anach documentation)
Accessed USGS datsbase-explain: -
You must describe-how you established thc•high ground w ter a evatlon: `
Used: ahzet & Ni-eierc Nodee 5116/�4 aouncl wate2 'move yea 10eve2
11Avd: n0Av_g_vat.ion weee data dine
114orl! 7anha cat gaiiet-en 92-00— 0- 7 P a e E2—�anua2y 1992 71 i[r1aU:e--'
1zria .6 n �� w/,tP2 eeevat.ionz- -
'(up U' y1QU noi
Leaching 4,
Pit
a
A _
Groundwater. Fcct Below Bottom of Pit High Groundwater Adjustment 1.8 ft per Frimpter M4thod ,
Therefore,the vertical.separation distance between the bonom
f f Lhe-Icaching pit and the adjusted groundwater table is _` '0.�
rmnr•I.-n,•rr�,�"r• m:mr•n�nrr.r:n*•rs+.n,•.m:r-.n�:-,-r..r:r- nr-..-v rrn-arrc.r+t!
I'UNN (fir Barnstable UOARD OF 11EA.LT11'
Stlfl, tUHFACE SENAOE I>18r1JS,,L SYSTEM INSPECTION FORM - PART D;:,- CERTIFICATION
i+trt r•nrr�nr.rr�mn•.�rrr•r•�• -•
;...s.n_T••.-:: -r.„=-•>.rnmrm•n.nrr+tn•nmrm:+��'r-•.�^.-ns..rim*rYPe OR PAIHT C�IEAALI'-
PROPERTY INSPECTED -
STREET ADDRESS 15
ASSESSORS MAP , D ,QCK A-N>+` j�RCEL # 336-013-005
OW.NER' s NAME Ethan
P,, T'1' D - CERTIFICATION
NAME OF INSPECTOR 13auce
COMPANY NAME Joseph P . Ma"c,),1>er &-Son Inc
COMPANY ADDRESS Box 66 Cen'_�e,.lvi lle Mass. -02'632
Streat T—. Tovn yr Qity scat• CIP
COMPANY TEUEPHONE ( 508 ) 775- 3-8 FAX ( 508 ) 790-1578
CERTIFICATION. STATEMENT - r
I certify that I., have p •r3-orally inspected the sewage dieposa7 system nt'
this address and that the iI) ,o,� Nn:tion reported is true., accurate , and
complete as of the time of .} :.sroctioR, The inspection was per-formed and any
'recommendations regarding up i''".cje , maintenance , and repair are consistent
with my training and experience in the proper' function, and 'maintenance of on-
site sewage disposal systems , -
Check one :
XX Systeoi PASSED -
The inspection +4hich 1 .`tr,,e'conducted has not found any information
which indicates that tree system fails to adequately protect public
health or the environ,wlnu as defined i.n 310 CMR 15 , 303 . Any. failure
criteria not evaluated as stated. in the FAILURE CRITERIA section of
this form ,
System FAILEll* j
The inspection which 1 A°,ve cond"ircted h.as found that the system fails tc
protect the j)ub.lic het!lrr� and the environment in accordance with Title
6 , 310 CMR 15 , 3Q3 , ano' ,us specifically noted on PART C - FAILURE
CRITERIA of this ins4:ttf'.ioh foje
rm ,
Inspector Signature . � c. i'« Date
ne copy of th is cpr c.t f i c a t : !s t be provided to the OWNER, the BUYER
'( where a�Pllcoblej and the _11 _) OF HEALTH.
* I .0 -the inspection FAILED , owner or'11,op.erator shall upgrado ' the ayetem
within one year of the date -he inspection', unless allowed or required
oth'erwise' as Provided in 3.. 15 , 305
purtd .,doc
ASS�UOR, 'AP NO. 3..3� PARCEL l �� D rj
I-0CAT10, dfl %eaiL SEWAGE PERMIT NO.
�+dT ®"
VILLAGE
� INSTA LLER'S NAME A ADDRESS
IIt
4i0
D U I L D E R 0R OWH ER
DATE PERMIT I3. S,U.ED
DATE C0MPLI'ANCE ISSUED 41
l �
>��� .
'.,
:.,,.
S,�
�- �lC�
\ � . ;
� t
f �. �•
4�
� \ 3s1 ;
..` '
� .\ ,`
� ��!
�t .
___-- __
Fim
` 3 THE COMMONWEALTP, OF MASSACHUSETTS
BOARD OF HEALTH
:....%v 1• /.....:OF........... ! ST j..�......................
�.
Appliratiun for lliupulia1 Works Cnunitrurtiun Vamit
Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal
System at:
......_.._.__ ....-•••--•--- -----•---•--•-•-----------•-•----••-•--------•-• ........................
Location-Address or Lot No.
..............._..._....... ....... ................
Owner Address
nstaller Address
d Type of Building Size Lot--Z77_v 40 Sq. feet --;4-
�U, Dwelling—No. of Bedrooms..............3.........
.................Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building ............................ No. of persons............................ Showers — Cafeteria
G>i Other fixtures ............................ .
W Design Flow...............
............................. ............................................gallons.
WSeptic Tank—Liquid capacity_Ce. b.gallons Length... '6.':.. Width..¢.'Z.``.. Diameter................ Depth..-5 `g.
x Disposal Trench—No. .................... Width.................... Total Length...:................ Total leaching area....................sq. ft.
3 Seepage Pit No......./........... Diameter........ ...... Depth below inlet..... , .... Total leaching area..; '&0?..sq. ft.
Other Distribution box ( ) Dosing tank ( ) NoV /
''" Percolation Test Results Performed by..... ��!! �-_---��...�=��« �8�
Date ------.--- y-•---.........••--.
aTest Pit No. 1-4--. .....minutes per inch Depth of Test Pit..... : ..... Depth to ground water,........................
Test Pit No. 2..:�n.6.._._minutes`per inch Depth of Test Pit...../ ....... Depth to ground water........................
•--------------------------------------------------------------------------------------- ----------.........................................................
0 Description of Soil-----o-'—Z4"_..Gtloo�Co .•- -w.o.'._=So"e— 2_�"----7� -`i!✓ -.S`�'` o
....
7J�tS. YES F 5 ...v eL---- - /vB"/9C5�`� r-I�vN Si�a�D
U --...------•.........................•----•----•-----------
UNature 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 iITi Uj 5 of the State Sanitary Code—.The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
.................. ....... .-:
Date
Application Approved By............. & - •................................. ......... Q...64
Date
Application Disapproved for the ollowing reasons________________________________________________________________________________________________________________
.........................•--------.........--•--•-•------•----------------•----------------••-------•-•......---•----........-----•------------------------•----....-•••---------...- ..............
Date
PermitNo.......................................................- Issued-.......................................................
Date
— -.....-- .-...�... ..�.....�.... ..........—
No......................... ,i Fs$.........................
_
THE COMMONWEALTH OF MASSACHUSETTS ,
v.� BOARD OF HEALTH
.............. ......OF........... 4' G '".
Appliration for Biopoottl Works Tonilrurtion ramit
Application is hereby made for a Permit to Construct (� or Repair ( ) an Individual Sewage Disposal
System at:
-•hi�//1 / T12/3'I G- C�..H�i�1 tj:v i l� ...................................................o T 3 /-I r T� �o T' a...........................
�_....- ....... .....................•-----------------.................
Location- ddress or Lot No.
•-••� ,.At. 1� rGi .......----------------• . _.......•-------•--------..._....--••--••••-----•......••-••-------•-•----•................_.._..
Owner
Adds
G1- -, ...1............................•-----•--•------ .......�.. sr l�7�nis?- I3 G C" ~l/1 s s
•....
nstaller �-•.....................
� Address
d Type of Building Size Lot...Z77 `�v Sq. feet f
.....--..
U Dwelling—No. of Bedrooms................................ .....Expansion Attic ( ) Garbage Grinder ( )
`4 Other—Type of Building No. of persons............................ Showers
� YP g ------•--------------------- - •- --------------- ( � — Cafeteria
� Other fixtures .......:........
W Design Flow............................................gallons per person per. day. Total daily flow............._.33c gallons.
WSeptic Tank—Liquid capacity_!af!. gallons Length... Width..'¢. / Diameter................ Depth.......g...
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area.....................sq. ft.
Seepage Pit No........L_.......... Diameter......... Depth below inlet..... *-�..... Total leaching area..• !� 7 9.sq. ft.
Z Other Distribution box ( ) Dosing tank ( ) IUoV_ L
'-' Percolation Test Results Performed by...... a�"! ?"�_... r:__ -zee 1084
a Date
Test Pit No. 1..��_.�_-__-minutes per inch Depth of Test Pit----- ....I... Depth to ground water......... ..........
Test Pit No. 2... __6._..minutes per inch Depth of Test Pit.................... Depth to ground water........................
------------------------------------------••-----�-----....-------••-•--------•-•-•---•••--••--....---•-•--•-•------i-N-•--�-----•-S•------•-•v--•-c-••-----.-----
ODescription of Soil '-Z4 Sc.-,e:So,,G 24"" 72_ � ` - - -
7z"-/08 /[r j!v
U .............................. ........................................... ..... ., ..... ..............._..._..._...
......•....••.....••.......................•-_......•..............__.......................____.___........................•..._...______._....____.......................•............................
U Nature of Repairs or Alterations—Answer when applicable...............................................................................................
------------------------------------•--•-------------------•--------•---......-------•--•---•---...-----•------......-------------------•---•------------•-------------------------•-••----•---•••------
Agreement:
The undersigned agrees to install theeaforedescribed 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 issued by the board of health.
�f
F
Signed. 4 -�. trt! � --------------•--- - Date
Application Approved BY _ E:=#------Date
Application Disapproved for thewing reasons:---•----------•--•---------------------------------------------••--------------•-------•--••---•--•-••-•-....._
--•-----------------•-•--•-•-•-•---•----......------•----•---------........-----••----......------.......--•----------•--------•-...•---•------•-------------•-----•----•-•-••----•-------•----------•--
Date
PermitNo....................................................... Issued_.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........................................^ 0F........��9azs!i...sT��- G�'"
............... ....................................
CIrdif iratr of Toutplianrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (L--Y or Repaired ( )
by..-------•--•--•----••---•-----------------f t t•--.. !k !l P_t........._......................................................................................................
Installer
at...............................................L0."I...... ......... ----Lq_A o t
has been installed in accordance with the provisions of TIT F 5 of Th State Sanitary Code as described 'in the
application for Disposal Works Construction Permit No.. DI
- '�� ---........ dated............... -----------..._.........
.
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCT,10tf SATISFACTORY.
DATE................• y. ��.............................. Inspector....-af..,^l..................................................................
N16 L T"1E NJ THE COMMONWEALTH OF MASSACHUSETTS `•� r?v ,IUw� J.
i'VC, IL�rJ1N1�E
....�- 6 BOARD OF HEALTH
OF
` � T. ..OF............. G S_ ...4anr,�E
No. ...................... F$E. P.........
Disposal nrko Ton#rurtion rrrmi#
Permission is hereby granted ,:$,.......
to Construct ( iXor.Repair ( ) an Individual Sewage Disposal System
at No. ----- ------••-L-4 '� ........•-p...... -_®1•-• ------... x lr11�9! "� C:.t `.!.?� Ci.. ....:..;
Street as shown on the application for Disposal Works Construction Permit No--'VS------'a----1,7--------�D•ated.._..•_
Ha ....:::
oard eal
DATE........ --
ri. ...�•---•--•-••--••--------------
FORM 125 . M. ULKIN, INC.. BOSTON .•�.'
a
EDWARD E. KELLEY
REG. LAND SURVEYOR
CUMMAQUID, MASS. (, Y
02637
TEL : (617) 362-2266
August 4, 1986
Town of Barnstable
Board of Health
Hyannis,Mass.
Ref: Lot B and Lot # 8
Indian Trail,Cummaquid
The Sewage System was installed in accordance with
the approved plans Dated August 6 , 1985 and revised
October 28,1985 with the exception of the Leach Pit
being 103 feet from the edge of the wetland instead
of 110 feet.
w of
r14
u C , z� EDWARD
FCISTBA� y o N . 26 03
TRN Ask%* �� ��y r^•c��0
Reg. a n an Reg:. sProfessional
Land=,Surveyor
v
HIGH GROUND-WATER LEVEL COMPUTATION
Site Location: / 72?,og-96 �i�`y/� C}�✓i Lot No.
Owner: G��'� IA✓. IN �e%�Address: Cc.M�-jflcPv�D �7�5 S
Address:
Contractor:
Notes: Z Do A/,>7- 77/47- CI.aS 4--
STEP 1 Measure depth to water table //
to nearest 1/10 ft. . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . ..
date
STEP 2 Using Water-Level Range Zone
and Index Well Map locate
site and. determine:
w SDW ? Z
A) Appropriate index well . . . . . . . . . . . .
B) Water-level range zone p_Z
6,
STEP 3 Using monthly report"Current '
Water Resources Conditions"
determine current depth to 47 3
water level for index well ��/84L
-mo yr
STEP 4 Using Table of Water-level
Adjustments for index well
STEP 2A , current depth to
I�
water level for index well
(STEP 3) , and water-level
zone (STEP 2B) determine -3
water-'level adjustment . . . ... ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
STEP $ Estinate depth to high water
by subtracting the water-
level adjustment (STEP 4)
from measured depth to water /d�7
level at site (STEP 1) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.a
F L ur e 3
i
`'. _ -7-
:?47/6-s C&Y
LO'CAt10 SEWAGE PERE31T 930•
I�
VILLAGE
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1 N S T A LLER'S 0AUE b ADDRESS
q -
L-G i' `1,►► J\i Ll a i�
a, D UILDE Q OR 0013Ell
�-ea R-P
DATE PERMIT ISSUED
DATE C 0 M P L I A N C E ISSUED
S - _,
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD O HEA TH
..............rel—f ....OF......... s
Appliration for Eliipooaal Works Vula.ra�r ua a� fi
Application is hereby made for a Permit to Construct (✓) or Repair ( ) an Indivi'd � e Disposal
ystem a,�t. t: ��r� ���
nS
Location-Address or Lot No.
��d✓cy�<<.. �..:.. s.�. x 'C�`'!.........................
Owner Address
W
Installer Address
Type of Building Size Lot...........................Sq. feet
Dwelling No. of Bedrooms__:� �_...._a g— Expansion Attic Garbage Grinder (NO)
04 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
a' Other fixtures ----------------------------------
W Design Flow...2 5X_ll_0..........................gallons per person per�day. Total dail� flow---- __C���_ ._ ...........gallons.
W Septic Tank—Liquid ca.pacity_If�p�.gallons Length__s __.____ Width._ _ Diameter-_.g..---.___ Depth.._K__._�.iCl-r�icQ
------
x Disposal Trench—No..................... Width............ ..... Length.......... ...................No..................... Depth below inlet__w2_:/� T�1 in area_______...__._....sq. ft.
Z Other Distribution box ( ) Dosing ank ( ) 6 /.-
'~ Percolation Test Res lts Performed by.._ _��et__4vw.__.. �t........... Date..'... .........................
aTest Pit No. �..-_.......minutes per inch Depth of est Pit.................... Depth to ground water........................
Test Pit No. 2_._ __-_.....minutes per inch_- Depth of Test Pit.................... Depth to ground water........................
Ix .......... • ._.... /.... I............................. .. _--
Description of S il...•--� �-...... lJ`'-• 1�. --7••- ---�.L.........` V
x `. ' - -- . .--- --------- ------
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
operation until a Certificate of Compliance has been issued by the board of health.
Sig d__ ...a:._11�1lvrm .....................
Application Approved B
... Date
Ae .
PP PP Y �- :... ..
Date
Application Disapproved for the following reasons____________________________________________________________________________
---•--.......-- -----•-----...
...........................•----------•---•--•----•-----------------------•------•----.......--------------•--•-•-------------•--------•----••-•-------------------------•-.-----•-------------•-•--•---
Date
PermitNo......................................................... Issued..... ................................................
Date
-
--- ------- _ A e*
No................ : .... Fs .. _
* THE COMMONWEALTH OF MASSACHUSETTS
BOARD QF HEALTH
.. ; F.....-...
....... O
... 's ' 1pfiration for Disp nt Works Tonotrnrtton rrmtt
Application is hereby made for a Permit to Construct (✓) or Repair ( ,) an Individual'Sewage Disposal
System at
CQ_i a -------
Location-Address ,(r or Lot K
Owner Address
W
Installer Address
U Type of Building
Size Lot............................Sq. feet
�-, Dwelling—No. of Bedrooms..A:Wv.(Z)...................Expansion Attic (NO Garbage Grinder (NO)
`4 Other—T e of Building .__.._._ No. of persons............................ Showers —
a YP g •------------------- P ( ) Cafeteria ( )
W Design Flow.•.•Other fixtures ......................................................allons per person per day. Total daily flow....................:.f?.. ...........gallons.
x ► _ 2 ZC� G
WSeptic Tank—Liquid capactty_JvQI].gallons Length__`_..__._ Width__ ---..__. Diameter__. _-....... Depth...`!'--1-ill-i,.iX
x Disposal Trench—No..................... Width.................... Total Length.......... __�.... Total leaching area.................... ft.
Seepage Pit No.....!_____________• Diameter..... Depth below inlet-5 :_..... To I leaching area..............
----sq. ft.
Z Other Distribution box ( ) Dosing tank ( ) '"
a Percolation Test Res}�lts Performed by _., � ,, •--• •...._. Date_/ ..............
Test Pit No. j 2..=..._.__minutes per inch Depth of+ Test Pit___._..._••_..___.__ Depth to ground water.......................
fZq Test Pit No. 2___Z_..-......minutes per inch Depth of Test Pit.................... Depth to ground water........................
j .•.
Description of Spil �,.d^ ad.a ----•' ;...... 7` `,{ ,.� ,
................. ___JA .......................
U Nature of Repairs or Alterations—Answer when applicable..__..... ......... ......... ......... ..........:....................................
-------------------------------•---------------------------•---------------------------.....-•-------------------------- ------ ..................1...........
Agreement:• t
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 issued-by the board of health.
c .PVC
Sig i1 .. ....Q..- --------
... _.
Date
Application Approved By...... •--- •• � .
s
Date
Application Disapproved.f or the following reasons: ....-___. ---•------------------ - -- --------- ---•---............................
-------------------------------------•--...--•--------.....-•-----------•------•------••---•-•-------•_.... ....................................` " .....------------
------------------------
Date
PermitNo......................................................... Issued----••-•----•-----•••••---•..........................
Date
G
THE COMMONWEALTH OF MASSACHUSETTS, '
BOARD OF HEALTH '•:.
. ..:. .......OF........�y a d:.:........................................ ..
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired ( )
by.... ••-•........... ..........•-----.e....--.--••
at w
has been installed in accordance with the provisions of iE 5 of The Stffe Sanitary Code as described in the
application for Disposal Works Construction Permit N _ ___.... ....... dated {. .-. .-t ....0...........
THEASSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEHA VILL FUNCTION SATISFACTORY.
DATE................................................................................. Inspector...................................................................................
T
THE COMMONWEALTH OF MASSACHUSETTS `
BOARD OF HEALTH
..L .........0 F.........
1V ..' .... . :b.. I.. .... FE ..................' .
0.........................
Disposal Works Towitr ion anti#
Permission is hereby granted T ----------------------•-------------..................................................
to Cons ruct (�or Repair ( ) an Individ•al S �e isposal $hee
yst s
at
st ,,y
as shown on the application for Disposal Works Construction Per 't No.__.. ..........__p ated_. . ._ - ..............
T
• "'—Boar
ealth
DATE---1 v ----------------- ...............
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
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C w-,m-66000 P30ON - °. _. Will
dr5x91 Kj.p•L
TS"•�X'-O"OC. t9 a 4' Q040. p 'L
C014PALTED TO l4tl NAX MVICAW.BEYOND Ow cee� s
.SOP OFLTIN6 10•GOtY.REIE - - PR�'�re -
pp PR0a7 WALL L'6�•
FROST I ` y ON24'X LF'Wi1N6 COOR EI FOaWCCNCFZ
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s: SCALE, 1/4" D -
'�'
ME FOR PErimnNG am. q` of is
P
SHEAR KILL
EXTERIOR WALL ASSEMBLY - 1 DOUBLE TOP PLATE SPLICE I
(5EGOND FLOOR PLATFORM -ALL DOOR OR WINDOW HEADERS -
DOWN TO DOUBLE SILL) IN EXTERIOR WALL5 OR 2X6 BEARING THE DOUBLE TOP PLATE5'OF ALL Vi ALLS
WALLS TO BE(2)2X6'5 NV 1/2"PLYWOOD SHALL BE LAP-SPLIGEO WITH.END J6INT5.
UNLE55 NOTED. AL
L HEADERS
- SPACERS N
R AND GON
• - EXT.SHEATHING TO CONSIST IN INTERIOR 2X4 BEARING WALLS TO BE A MINIMUM OF b' O' APART CONTAIN F7'.577`
OF MIN. 1/2"COX PLYWOOD. (14) 16D COMMON NAILS FOR THE GARAGE
NAILED WITH 8D RING SHANK NAILS (2) 2X6'S W/I/2" PLYWOOD SPAGER5 WiES` PLY"ALsmucr.UNLESS NOTED. HEADERS SHOWN ON AND 8'-0" APART AND(2) 16D COMMON_' - Alm 6YP9N1•I PAN�6WO
AT 6"SPACING ON THE EDGES PLAN ARE IN THE WALL5 BELOW THE NAILS PER EACH SIDE OF THE SPLICE ANDPA6TENER6 VOLATE ° °AND b" SPACING ON THE FIELD = FRAMING IN QUESTION. FOR THE MAIN STRUCTURE. °°' el o
` -PLYWOOD SHEETS TO BE APPLIED -PROVIDE P05T AT EACH END OF ALL
HORIZONTALLY WITH VERTICAL JOINTS BEAMS AND AT OTHER LOCATIONS A5 - THE TOP PLATES SHALL OVERLAP AT ALL A-I3
JOINTS TO BE STAGGERED A MIN.OF HHOWN ON PLANS. ALL POSTS TO BE' CORNERS OF THE STRUCTURE AND ALL
JOI BETWEEN LIFTS(TWO.STUD BAYS). �2) 2X4 UNLESS NOTED INTERSECTIONS,OF INTERIOR OR EXTERIOR _ 8
PLYWOOD SHALL SPAN ACROSS LOAD BEARING WALLS.
THE BOTTOM AND TOP PLATES - ALL F05T5 SHALL BE GONT.DOWN FROM 1 °
TO EFFECTIVELY TIE THE PLATES floe Sm o
TO THE STUD WALL ASSEMBLY. THEIR TOP POINT TO FOUND.OR �6 80OLIS.iO a°
CARRYING(TRAN5FER)BEAM. POSTS EOLTSTOVESETAMN. Oo
ARE TYPICALLY GALLED OUT-AT'THEIR REQUIRED SOLID BLOCKING OF O MTNINPOO7N6 oo .
'TOPMOST POINT. /. o+
PROVIDE AME I INGS AND FLOORS 0
-HORIZONTAL BLOCKING FOR NAILING SOS D5B OBKL GWT�E U6 NOTED.�PSROVIDE (APPLIED TO ROOFS,GEL , ) a r ' _
` TO BE PROVIDED WITHIN 45"OF
L L51NO P216'OL.TO �° v �T�
OUTSIDE CORNERS OF MAIN HOUSE �' BEfIEATH ALL POST5.. • FASTEN STW TO AT SHEAR
Ar•3ff.AR RAIJS MlOI S OP ,G 0 .0 OO
- SHALL B BLOCKING AND CONNECTIONS BE, NLAR6EORNl•B+OVSOPBGN6s H
N RAGE.
o
AND GA '
' - -' BLOCKING
AT PANEL,EDGES PERPENDICULAR oo ' 1-4
EXT.5HEATHING TO CONSIST TO`FLOOR AND ROOF FRAMING>MEMBERS eO 4 b
-WHEN ELIMINATING ANY EXTERIOR WALL STUDS OF MIN. I/2"COX PLYWOOD W/ IN THE FIRST TWO BAYS OF THE FLOOR 1�1 0"4
FOR CREATING WINDOW5 AND DOOR OPENINGS A MINIMUM 24/0 SPAN RATING. AND CEILING JOISTS AND RAFTERS. THE BLOCKING. uO
LE55 THAN 3'-0"FROM ANY OUTSIDE CORNER NAILED"WITH SD COMMON NAIL'S SHALL BE SPACED AT A MAX.OF 4'-0"O.G. TYP.'EXT.•SHEAR WALL V_
OF THE STRUCTURE,OR HAVING ANY OPENING AT 6"SFAGING.ON THE EDGES" ` "' 1�y ?
N THE FIELD HOEDOWN DETAIL w
LARGER THAN 5'-O"WIDE- INSTALL(1)SIMPSON s c A e 1/2 I'-o^ — r
AND 12"SPACING O _ V
" 6516 ON ALL FULL HEIGHT STUDS LOCATED' ATTACHED PORCHES O RAFTE R/TRU55 HURRICANE TIE DETAIL s'
BETWEEN ANY OF.THESE CONDITIONS. '> I SCALP,1 IQ•=
-FLYWOOD.5HEET5 TO BE AFPLIED POST CONCRETE
T1J CONNECTIONS TO FOUNDATION WALLS/
.' HORIZONTALLY WITH VERTICAL JOINT5 ' CONCRETE TUBES �j:�;; °a
JOINTS TO BE STAGGERED A MIN.OF
- INSTALL(I)51MP50N HDUS HOLD DOWN AT•ALL 32"BETWEEN LIFTS(TWO STUD BAYS): - TOJOIST5 Am �
CORNER LOCATIONS: HOLD DOWN ASSEMBLIES SHALL TOJ TO OP TOE NA LEO s
PLYWOOD SHALL-SPAN ACROSS -(I) 51MP50N ABU66 PER POST,SECURED TO w IL TOP Pure vU Ore e
,0*111m
BE P051TIVE-LY CONNECTED TO THE FOUNDATION POSTS AND ANCHORED TO PIERS FOLLOWING oo Evaire m
ABD EXTEND CONTINUOUSLY,FROM THE'FOUNDATION 'THE BOTTOM AND TOP PLATES ALL MANUFACTURERS SPECIFICATIONS- ;4�TOP PLATE OPTION I:rcAr'slr PsoN 6in24
TO THE TOP FLOOR PLATE ASSEMBLY. TO CREATE TO EFFECTIVELY TIE THE PLATES norm STRAP a Et LY OVa°
TO THE STUD WALL ASSEMBLY. MOM AND NAILER TO ALL '
' A CONTIUOU5 POSITIVE CONNECTION,NAIL(2) I6D - PORCH BEAM TO J015T CONNECTION SHOULD V]6W eOARO RAPE5 PV 7T9.D OD NAILS
VFATILAL PAlEIs,ALL -
FOUR ED6PS PASTENEP y, -
COMMON NAILS(SPACED loll O,G.) TO THE OPPOSITE A BE REINFORCED WITH(1)51MP50N HIZ PER JOIST, (PROV m SLDC10N6
51PE OF THE TRIPLE CORNER STUDS,WHICH THE HOLD" '"AGED/
DOWNS ARE APPLIED TO - PORCH BEAM TO RAFTER'GONNECTION SHOULD at ci
ROOF FRAMING NOTES BE REINFORCED WITH(1)51MP50N H2.5 RAFTER 2X4a 16•oL.sm
" r--- E
r' GARAGE.5HEATHING e r o 'o 0 0 0 0 0
a -ALL POSTS @ ENDS OF BEAM5 TO BE • _ __ 9
(2)2X4'5/(2)2X6'5,UNLE55 NOTED a—'——-
-SHORT WALL 5EGMENT5 AT GARAGE 1ATE
SILL P
DOOR OPENINGS TO INCLUDE ADDITIONAL , . ALL WINDOW HE
ADERS`TO BE(2) 2X6'S STRUCTURAL DESIGN CRITERIA
3/4 COX PLYWOOD(VERT.) INSIDE W/ I/2" PLYWOOD,UNLE55 NOTED h
THE OVERHEAD DOOR WALL. PLYWOOD To`�"`f"m DOMTo, m°;T'Ivv
- TO BE FASTENED.TO BOTH SILLS AND,',, ALL`RIDGES OVER 20'-O" LONG s FIRST FLOOR 15 FSFF DL 1 NAIL o?MVO _
WALL 5TUD5 W/SD RING SHANK NAILS''`. �. OP,a�.;x6R,O6ena
` 5FAGED.AT NO MORE THAN 6" APART' TO BE A) l 3/4" X 117/8"
s' h - SECOND FLOOR 30 P5F * Naar NPEDIATIY eE on RE w 1 E
--. *IF JOCiT6 PIN PPRALLEL.TO °' '
(REFER TO DETAIL FOR MANUFACTURED 10 F5F SHEAR rWL THEN SLOCKINS A a PAsreNED ro ne�aPreas
GONNEGTIONS) -'PROVIDE 2XIO LEDGER BOARD SHALL BE A RLbR JMT w oP rel lODws
® OVERLAY FRAMING FOR'RAFTER - ATTIC/5TO. 20 P5F INTERIOR M.Ls DO
_. BEARING/SUPPORTrINS
°
• n. 10 PSF
? -r. ROOF AP TI N
NOT REWIRE HOLD
TYP.`INT..5HEAR WALL SECTION;* , `., TYPICAL RIDGE 5TR DETAIL',OP, ONS
' ALL RAFTERS TO BE 2XIO 5 P F. - OF 35 FSF 2 S� I,I,2,A 1.- ca
SECOND FLOOR FRAMING NOTES NO.2 OR BETTER AT 16 O.C. +; 15 P5F SCALE. 1/2'
' (UNLE55 NOTED) c'. a - EXT.WALLS T5 PSF DL i U— i
911•P50"NO AT LVEW CRIPPLE'
-5ECOND'FLOOR J015T5 TO BE I - INT.WALL5 50,P5F OL STW ASOVee+ OPENING cu 46
BOI5E CASCADE II 7B"AJ5-20'5
16'O.G. PROVIDE 1 1/4"OR DEGKS/PORCHE5,, 40 P5F 0B T0P ALE (a M Z
I I/8"LSL LVL,OR 055 RIM cu
Ned .
• _ JOIST BY SAME,MANUFACTURER .;L 10 P5F sr�soN S C c
- ROOF DECKS 60 FSF
AS JOISTS. —v cu
ROOF ASSEMBLY 10 P5F t..00 9 --
-FOLLOW ALL MANUFACTURER'STOP PLATE NAB `�
RECOMMENDED DETAILS FOR *RAFTER TO PLATE CONNECTION rJMWMTwvw.Oe0Nn1L5
INSTALLATION OF JOISTS. TOTAL16NAILSPERHEADER Y E
- INSTALL 51MP50N "M5T30"HURRICANE u -WOOD P05T DOWN suOSON ULsrAOISRAr g1F 49 V
STRAP AT EACH RAFTER TO PLATE
PROVIDE BLOCKING USING SAME CONNECTION TO RE515T UPLIFT FORGES x - � OBE T N
-WOOD P05T UP AND DOWN O�
MATERIAL AS JOISTS OVER ALL ESR I�
BEAMS EXCEPT FLUSH BEAMS WHERE '` x -MOD P05T+UP S m II job no.: OT91
THERE 15 A WALL ABOVE AND UNDER RAFTER TO RIDGE CONNECTION QH6 POST STUD 77 �.AWAOR SOLO date : IS San 2WO
ALL BRACED H(ALL PANEL5 AS NOTED RAFTERS MAY BE TOE-NAILED,BUT INTERIOR LOAD BEARING WALL. ST�llt A,6 TOBe SET TNANh9Fo°R"6 spa
WALL5 ABOVE)NSEE DWG.A-12 FOR ADDITIONAL FASTENING 15 REQUIRED .Q @ 'AS HaTED
(REFER TO DETAIL 2) - � ��
drawn: K
-BRACED SHEAR WALLS(BEARING & (uSINa'SalD5PzsPAc®
AT VOL.ON STIMS Of-UNLE55 OTHERWISE NOTED,FLOOR OPTION A: APPLY 51MP50N LSTA STRAP NON-BEARING) OP \ # L J �•
SHEATHING SHALL BE APA RATED ACROSS THE TOP OF THE RIDGE`
"5TURD-I-FLOOR",EXP. I,COMBINATION `�' '
SHEATHING
AND UNDERLAYMENT OPTION B: 2X6 RIDGE LOCK BLOCK NOre'OETAL APFL6 TO ALL r
TONGUE-b-GROOVED,3/4"THIGH, ACROSS THE RAFTERS IMMEDIATELY 1,(�)
TYP. HOL.DOWN DETAIL ® EXT. SHEAR WALL �iOS MINIMUM 24"U.G.SPANRAT;NG. BELOW THE RIDGE AND FASTENING TYPICAL DOOR AND'G`. O. 1
' - i SCALE.112'=I'4'
GLUE AND NAIL FLOOR SHEATHING THEM TO THE RAFTERS 1^U A MINIMUM ,
' TO JOISTS. OF 51X(b) 100 RING SHANK NAILS HEADER STRAPfi'ING
- 6 A ALE, v a^ _ 1'-a`- - _ 1 ISSUED FOR PEBMIMUG eht 10 Uf 15
- .-• .
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FIRST FLOOR FRAMING'NOTES LR
zI ziI h - ALL POSTS® ENDS OF BEAMS TO BE t(2) 2X4'5 UNLE55 NOTED
-ALL WINDOW 8 EXTERIOR DOOR.
X s HEADERS TO BE(3)2X6'5 W/1/2"
PLYWOOD UNLE55 NOTED `
-ALL WALL5 WITH POCKET DOORS
. TO BE FRAMED A5 2X6 WALL N (Aa7
+ V�t CL
+ -SEE STRUCTURAL GENERAL NOTES (D F`- c
AND TYPICAL DETAILS FOR OTHER N cap eFA �E,
s } REQUIREMENT5. - -
G
WOOD P05T DOWN C-a • 0
A9
:WOOD P05T UP AND DOWN f. Ln
r
- x -WOOD POST UP E M
�(W UFO,
Job no.: o-mi
AO$EL 3 f= 5T FLOOR F dam RAMI NG PLAN DE G
BMW
6770 drawn
uc ruR,At K a"
ISSUED Fri PEIIf•IMNG atd n of I
- - .1 e cie..nlsis A
' e s - AQ �9 aeon A9 rFLL6
3 Q
19/4'X 1 Ve' VLH NW X]e 9 BEA (57PlXTI.RI.L
BK 0 'PLY t L 9/4 XII ,r.
cis
£ p4 rA fj
RO 1-,v.. A
Ix <I Ix DE S1ERS !K
36770 '
m TRU,_T�Jr.'s1
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6'X
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6. r
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h (� CC ;
# r] ..
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•
8
1 .
x •: SECOND FLOOR FRAMING NOTES
ALL P05T5 @ ENDS OF,BEAMS TO BE
4:411' ly (2)2X4'5 UNLE55 NOTED
N -_
„" „y .• (� L HEADEALL RS TO BE(5) 2X6'5 A/NDO
0112"
9i4'X II LVL nu PLYWOOD UNLE55 NOTED
AID eLx us Fws ALL WALL5 WITH POCKET DOORS
seen vo reR ww y TO BE FRAMED'AS 2Xb WALL
t
5 —
..�.N NOTES RA N TE. :�•s=r•.,�: UGTURAL'6ENE L
SE
E 5TR N
AND TYPICAL DETAILS FOR OTHER 'p C .,LV
REGUIREMENT5. N ctf LL
t3 WOOD POST DOWN.
A9 - } 00 = Li
YNOOD P05T UP AND DOWN p T
7 � O
x -WOOD P05T UP ,,•,
E N
_ INTERIOR LOAD BEARING WALL
. _ job no.: o-mi
SECOND FLOOR FRAM I N G FLAN -BRACED SHEAR WALL5(BEARING 8 655�r 2We
x SCALE, 1(4'., 1-0- NON-BEARING) SWIG as NOTED
rev.
R - 12
wzFoRpEmrmNGI sm 12 Of 15
r
im
+ ' ^N�M ALI•M YYT1 w08e O - � �. •
M.W105s
T T Aq B w. y
me,OF
A-[
so:
TO
. , i _ gs fie- � - -- _ -------- — -- -- -- - - :. .• � rw C1
-f
Po,bT (]J 19/6%11 'L \ T 2tl0 RAFlEP9 T •qj ..
• H
e f
O O •\ 1X10 RAFTERS � ]1(10 RAFTStS/ .
�..�
7%O RAF'B15 V
00
.70 OL. VL.
o -
QUg m/Evaj a 2X� s V O
' i 7ia rle - \ ______ _ __ _ __ .. =__YjNL UP TO PITtM
- ros X
• __b 6E ___ td
• 1 S]OL. TIES
ROOF PLAN "mumZ r
4CAL E: 1/5" ..
_ a
2.
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9/4 X II e L O
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m W'O 1 990 RM181S
•b'OL
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y ROOF FRAMING-NOTES
EL
M - WOOD P05T DOWN G e w oL N 0 S,
wax
Tat -WOOD P05T UP AND DOWN ------ 12
E
5-
x -WOOD F05T Uco
P
_ OTC
BEARING WALL BELOW C�
-BRAGED SHEAR WALL5(BEARING 8
NON-BEARING)
ROBE M- '
-5EE STRUCTURAL GENERAL NOTES DE G m: �,1
N
AND T'(PIGAL DETAILS FOR OTHER S RS -4 _
REQUIREMENTS. - o-r617A y scale ASRoreo
STW�U/ �[LIPAt"
dnFwn` KMW
ROOF F R A M I N'6 PLAN few.
rev.
. � u •� -- A_ 14
+ 50 FOR PERMnNG eM 14 Of 15
p
--- -- -------- - - -- - --- - -
-.�., 4% V4 .T.494 PoST � � - �-, - � � "C •
9 vvLEWHt A9 A9 µ 9ca
,
• - , i ., > IXIO RAFTERS . p'•
6.
e 1 Of, 1�1 V J t V a
i,
I� I I L O RAFTERS ]AO O ...
. d n : 7%0 fd6..GiSfl V ' .5 • e AT O.POIA
�0
a a -
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bo
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5 E G O N P FLOOR F R A M I N G P L A N GE I'L CN G 1 R A M I N.S P C A N r R O'O P FRAMING PLAN E.
(u5
SOALE, 1/4" 1' O°
• _ 4LALE, 1/4' . I:_.p• 9LAL,E. I/4' � 1' O.' C� LL _
._
O Ln c
122
E Cc
GENERAL FRAMING NOTES `. �PLjH OF R4q V,
CI - WOOD POST DOWN o RO
-ALL POSTS @ ENDS OF BEAMS TO BE g ERT m 5 o,s
(2)2X4'5 UNLE55 NOTED Mb
t� WOOD POST UP AND DOWN Z DE 5 ,N
-ALL WINDOW b EXTERIOR DOOR ~ ease 19 9EPTB
. 3677�p
HEADERS TO BE(3)2X6'S W/1/2" x 1 -WOOD P05T UP, UCTURAL = wale : AS ROTW I
PLYWOOD UNLE55 NOTED
y �f�r �Q^ drawn
-SEE STRUCTURAL GENERAL NOTES INTERIOR LOAD LOAD BEARING WALL ►
AND TYPICAL DETAILS FOR OTHER �'
REQUIREMENTS. - BRAGED SHEAR W4LL5(BEARING 6
NON-BEARING)
IV ED FOR PERMRTING sht 15 . Of is
1
E L
TOP OF FOUNDATION
_ CONCRETE COVER t
CONCRETE COVERS
4 CAST IRON 12' MAX '
12"MAX
OR SCHEDULE 40 SCHEDULE 40 PVC (ONLY)
---- `,, PVC PIPE PIPE - MIN (EACH
w��` 1 PITCH 1/4"PER FT PITCH I/4�PER FT
e I fPIT J PRECAST
INVER T, LEACHING
EL../7 / EQUIV.
INVERT INVERT : PIT OR
I . . r
E SEPTIC TANK EL ! QIST. EE/c.t3ti �_ !.;
INVRT 80X "5�_�' v :0,
7 ;` GAL IEL ERT v a
EL
f AAA -: ., > :� INVERT LL' G 3/S ONEI/2
- 1
11 EL ''
l� --� ---`�• ---- '.f+� �. • . .. La-0 WASHED
DIA
Z-,r �►G ) ,Rp — — \ 0 PROFI LE OF GROUND WATER TABLE
�n
SEWAGE DISPOSAL SYSTEM
(( N
/ 1 /,k 76 rt/6 LE�c h
ry t 1 �U'._w NO SCALE
'PC 'Fj Env G
•p 1 — —_
O Z`3 s / /?,1 PL ACE z, W/T?J 1-`e
SOIL LOG WITNESSED BY
C
° y -
k or. BOARD OF HEALTH
_ �; DATE Nov c r , z
TIME -- f' �//c�/`fsls /�. McIC
y y r` T -
fG' �--. /7. ` _ `_ I /l
' TEST HOLE 1 TEST HOLE_2 L T>l�.// i D E /ICELGt�
ENGINEER
"
3 G.QLyoas�•n /'I f / / � \"_ �11 ELEV. ELEV.
7514 �w000[e/kn 1;5/i,
� l „opA DESIGN DATA '
_ 7,
� '�'— 1e,i.. h�p• � I __ 1� ��^/t t�+yc �c3 �F NUMBER OF BEDROOMS
Cam/ C 7 ;/x 3- TOTAL ESTIMATED FLOW GALLONS/DAY
1pawzl�
$ pcu5t l4ye•re c r'
/ µ ^f swN� 4Cq y BOTTOM LEACHING AREA / SO FT /PIT le`t %•O�
Iry ,b '� SIDE LEACHING AREA /` SO FT / PIT,"25 6:Yp.
Oki.
sin GARBAGE DISPOSAL (50 % AREA INCREASE)
TOTAL LEACHING AREAS l SO,FT
i
MIN/INCHAT PERCOLATION RATE
C S CE3S 7'a/,L3,.� /r
1 _ LEACHING AREA PER PERCOLATION RATE 3 * SO.FT.,/ .P. ,
✓/ r44" WATER ENCOUNTERED
NUMBER OF LEACHING PITS
j '. `` r t' j / '✓ f ' / / �' / — ` y Fvl..2 l e e 7 Of
APPROVED BOARD OF HEALTH I
DATE
AGENT OR INSPECTOR
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TOP HOUSE A FNDN. AT EL. 24.5' SYSTEM PROFILE MAGNETIC TAPE REQUIREQ NOTES
O OVER ALL COMPONENTS IOR EQUAL
LEGEND TOP GARAGE (B) FNDN. AT EL. 23.33'
ACCESS COVER TO WITHIN 6" OF FIN. GRADE (NOT TO SCALE)
PROPOSED SPOT ELEVATION GRADE®FND A =23.5� ACCESS COVER (WATERTIGHT) TO (2) C.I. H-20 COVERS TO GRADE UNDER DRIVEWAY 1. DATUM IS NGVD BIIfdMBTABLE HAfiOOIFt
[23.50 GRADE®FND B =22.5 GRADE WITHIN 6" OF FIN. GRADE VENT
22.7 MINIMUM .75 OF COVER OVER PRECAST /�
+19.84 EXISTING SPOT ELEVATION " 296 SLOPE REQUIRED OVER SYSTEM 22 5' MAX. 2. MUNICIPAL WATER IS AVAILABLE I.
INV.®FND(A)=20.82 2" DOUBLE WASHED PEASTONE
( ) �NV.®FND RUN PIPE LE1/EL 3. MINIMUM PIPE PITCH TO BE 1/8 PER FOOT.
PROPOSED CONTOUR INV.®FND B =20.82 FOR FIRST 2' OR GEOTIDMLE FABRIC
21 PROPOSED 1500 /fCHA
ROPOSED 1000 3' MAX. 4. DESIGN LOADING FOR SEPTIC TANKS TO BE AASHO c
- - 27 - - EXISTING CONTOUR GALLON SEPTIC 1 4'
H- 20 SAS TO BE H-20. v
' GALLON SEPTIC 19.61 20.09 TANK (H- 20 ) GAS 19.80' MBER H- 19.55 '
BAFFLE ( �� GAS
18.95' ��= \ 8.78 a o a p O p p O p 5. PIPE JOINTS TO BE MADE WATERTIGHT. >
w PROPOSED WATER LINE MIN. 18.61' p p p p p p p p p o
( 2.5x SLOPE) o p p p p p pppp 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH
s PROPOSED SEWER LINE 6" CRUSHED STONE OR MECHANICAL 2' pppp p pppp 16.61' MASS. ENVIRONMENTAL CODE TITLE V.
DEPTH OF FLOW = 4' COMPACTION. (15.221 [2]) p,
( 1 x SLOPE) ( 1 96 SLOPE)-
TEST HOLE TEE SIZES: ( 1 % SLOPE) 3/4" TO 1 1/2" DOUBLE WASHED STONE 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO o AI RO
INLET DEPTH a 10„ H-20 CHAMBERS BE USED FOR LOT LINE STAKING OR ANY OTHER PURPOSE. °
SYSTEM DESIGN" OUTLET DEPTH 14" "
8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4 PVC.
HOUSE (A) FND. 26, SEPTIC TANK 4' SEPTIC TANK 60' D' BOX 17' LEACHING 5.7' 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED
GARBAGE DISPOSER IS NOT ALLOWED GARAGE (B) FND. FACILITY WITHOUT INSPECTION BY BOARD OF HEALTH AND PERMISSION
DESIGN FLOW: 5 BEDROOMS 0110 GPD = 550 GPD OBTAINED FROM BOARD OF HEALTH.
USE A 550 GPD DESIGN FLOW BOTTOM TH 1 EL. 10. 10. CONTRACTOR SHALL BE RESPONSIBLE FOR CALLING
LOT 1 I DIGSAFE (1-888-344-7233) AND VERIFYING THE LOCATION LOCUS MAP
PRIMARY SEPTIC TANK: 550 GPD (2) = 1100 OF ALL UNDERGROUND & OVERHEAD UTILITIES PRIOR TO SCALE 1"=2000't
USE A 1500 GAL. PRIMARY SEPTIC TANK AREA = 1.9 AC ' NO GROUNDWATER ENCOUNTERED COMMENCEMENT OF WORK. ASSESSORS MAP 336 PARCEL 013-005
WETLAND = 0.5t AC ' I STATE COASTAL BANK
SECONDARY SEPTIC TANK:550 GPD (1) = 550 UPLAND = 1.4t ACBvw 9 Still P°E° 11. EXISTING LEACHING FACILITY" SHALL BE PUMPED AND LOCUS IS WITHIN FEMA FLOOD ZONE A3
t BEPCH�E� REMOVED OR PUMPED AND FILLED WITH CLEAN SAND. (EL 11) & C AS SHOWN ON COMMUNITY
USE A 1000 GAL. SECONDARY SEPTIC TANK I RR�ER P3 •-,.,-, - PANEL 25
O i NE OK BIX ova '� ..�'••Bvw 4 �• -��, # 0001-0001-D DATED 7-2-1992
0) I Bvw 7' Sgk1b" F�°pe /"'� -- - - o�'• TOWN COASTAL 12. ANY UNSUITABLE .MATERIAL ENCOUNTERED SHALL BE
o i •L F�°o 2°��`'Bvuv 5- - - - wW 3 0 BANK REMOVED 5' BENEATH AND AROUND THE PROPOSED ZONING SUMMARY
N ' . Bvw�s�• _ - ` _ _ - _ _ _ _ LEACHING FACILITY.
• - - ZONING DISTRICT: RF-1 DISTRICT
LEACHING: Bvw 8 :l::- _•� .�� _ _ _ _ _ _ _ _ _ \ 13. DRYWELLS PROPOSED FOR ROOF RUNOFF TO BE 25'
SIDES: 2 10.83 + 50.50) 2 (.74) = 181.5 GPD ••• VW 6A __ , - / BVW 2 '� ( REQUIRED: PROPOSED
( � ��`., o MIN. TO SAS, 10 MIN. TO :SEPTIC TANKS) MIN. LOT SIZE 43,560 S.F. 81,942f S.F.
BOTTOM 10.83 x 50.50 (.74) = 404.7 GPD / - - - - - - - - _ - ° o MIN. LOT FRONTAGE 20' 25.76'
v /' ' i' \/�oJ1 �,2 °� 14. WETLAND DELINEATED BY HAMLYN CONSULTING 4/10/07. MIN. FRONT SETBACK 30' 302f'
TOTAL: 792 S.F. 586.2 GPD \ / o / - _ _ , J '
0 3 / , - _ - / ���2 vw 1 MIN. SIDE SETBACK 15 17.5
I LIMIT OF WORK LINE o� �, 15. SEPTIC CONTRACTOR SHALL NOTIFY TOWN & OWNERS MIN. REAR SETBACK 15' 16.5'
USE (5) 500 GAL. H-20 LEACHING CHAMBERS (ACME OR EQUAL) & SILT BARRIER 1k , - - - - - `'�� `�� ENGINEER FOR INSPECTIONS OF SOIL REMOVAL AND SYSTEM '
WITH 4' STONE AT ENDS AND 3' AT SIDES \ b; a: - - C'`'� MAX. HEIGHT 30 27.3f
y3 � 1hi / _ _ � ����� � � �y�� �Q, � CONSTRUCTION. COMPONENTS NOT TO BE BACKFILLED
- J/ o��° o WITHOUT INSPECTION (24 HOUR NOTICE REQUIRED).or SITE IS LOCATED WITHIN THE AQUIFER
\ / `�° ° �' 's PROTECTION DISTRICT
\\ / o / / 1�1' /' _ /x x 7 ��CE� , \ �, '�w,6\\ 16. SITE IS SUBJECT TO ORDER OF CONDITIONS,
/ ,QWIC / * - ��r� ?o CONTRACTOR TO OBTAIN A COPY AND COMPLY WITH ALL SITE IS LOCATED WITHIN THE BARNSTABLE
MA �\ 1AE
s z/v 1$ */ x-� o� � CONDITIONS FIRE DISTRICT
APPROVED DATE BOARD OF HEALTH \\ / / $ w, 1g� /o _ \ \ \
/ / */�' / �Y � 17. REFER TO LANDSCAPE PLAN FOR COORDINATION. OWNER OF RECORD
If
18. FOUNDATION DRAIN TO DAYLIGHT SUGGESTED, SEE PLAN.
ROBERT R. MOHR ET AL
25 HIGHLAND PARK VILLAGE, SUITE 329- �� 19. CONTRACTOR TO COORDINATE ALL UTILITY CONNECTIONS
W' F�S , \ WITH APPROPRIATE VENDORS. DALLAS, TX 75205
' � ,i ` \ -2' REFERENCES
TEST HOLE LOGS � ,' /' /' /' � / ° � � /I 23 - ENGINEER20. ING, INC. DATEDPMAYLAN 30, BY DOWN
CAPE
DAVID D. FLAHERTY, RS. / /I J' S �' \
_ 22� / LAND COURT CTF. #181004
ENGINEER. FOUNDATION �� °j �� / / / `vim O ?4.0 / PLAN BOOK 577 PAGE 84
�; ^� �sIARI� DRAIN To / r00, i /� LAND'.COURT PLAN 20615-G
Wi r�ESS: -- - -_. DAYLIGHT./-\ bFF �,441� �/ / / / 1�• \ AV58DATE: 4/19/07y T` i IoPasf- .
LIMIT/OF D ��' / "/ DWELLING
PERC. RATE _ < 2 MIN/INCH / < �- x Wbw� / FF = 25.5
�x�X--;=x x� N /,VP FND.=24.5
I # 1 1715 / _ �J3.5'j 1`- �-1- _ _ _- -- (EX/ THIS AREA
CLASS SOILS P `1 500 �AL. / / I r � � _ _24 TO BE 15.5.
SEPTIC TANK/ / / CP DEMOLISHED) / RO ERT O'LEARY
#154 INDIAN TRAIL
//MAP 86 PARCEL 013 002
1,000 GAL. 3 P 16068
73
SEPTIC TAN
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ELEV. ELEV. / //0 O o 3 ` G
0" 41 2
23.6 0" 23.7 l / I PROPOSED �
GARAGE I � 21'
KAREN S. CORBEIT 11�,2' II SLAB =f22..5 rI PROP SED�`225 H-2TH-1 / 3 , lp
SS /
162 INDIAN TRAIL \ o �, GRAVEL \ -� �F - 3 W TITLE V SEPTIC
# / \ C� DRIVEWAY / /
MAP 336 PARCEL 013-003 � � \ � � �M
CTF. #140782
FILL FILL �\ �� / `� ' / / 2O / _ CATV
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RISER SITE PLAI`�
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60" 18.6' 60" 18.7' 1 Q ` s' 1 .83
// TEL IN
A A �) NO - / / EE/L,�C RISER
72" LS 17.6 73° LS 17.6' ,/ I �\�� ,/ �NDBOX ❑ ELEC CUMMAQUID (BARNSTABLE) MA
// /�� 0/ I� O QQ'�Gj�/ � // / / PAD
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B B / / #158 INDIAN TRAIL
80" LS 16.9' 8191 LS 17.0' / PROVIDE VENT WITH ) \ P /
CHARCOAL FILTER ) / / BENCHMARK: / PREPARED FOR
AND BUGSCREEN / N \ C3 r / / / SPIKE IN LAWN / do?
SILTCLOAM SILT,/LOAMC a (FINAL PLACEMENT �� S�sj N / / �� ELEV.=23.35 g �"o V.
96„ / 15.6' 96„ 15.7' cp WITH HOMEOWNER / ) I >! / /i FF ,�Q QW
CONSULTATION) , , /,- °bp;g. ROBERT R. MOHR
N v I / SLEEVE WATER & 10 ,
'VENT r h / �� SEWER PIPES W/IN c�k.� Q-�
PERC C2 C2 - I -V / /�3 / 10' OF CROSSING `R��GFo� MAY 30, 2008 V 1�
/ / �J
FMS FMS I \ / // ��' / / , � REVISED: 7-31 �-08 (FOOTPRINT CHANGE PER ARCHITECT)
�� (SUITA, O--_.- - .____�.__. // o / LIMIT OF WORK LINE
PERMIT SET - NOT FOR CONSTRUCTION
152 152 -...r. ,
/ & SILT BARRIER
NO OUNDWATER ENCOUNTERED
TE HOLES #3 & #4 WAIVED BY HEALTH
ENT DUE TO SITE CONSTRAINTS / I /l '22_ /� �� �o� S��CF Scale:1 20'
0 10 20 30 40 50 FEET
5' REMOVAL OF UNSUITABLE SOIL RELOCATE/RUN WATER AS SHOWN.
REQUIRED AROUND PERIMETER OF COORDINATE WORK WITH BARNSTABLE FIRE DISTRICTLEACHING , DOWN TO
\
WATERLIN '� SUITABLE SOILILITY LAYER. REPLACE WATER DEPARTMENT.
z -- WITH CLEAN MED. SAND. ENGINEER Off 508-362-4541 ( 1
t TO INSPECT AND CERTIFY fax 508-362-9880
REMOVAL.
o downcape.com
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WATER GATE A.
DANIEL 9�y°s y�kA ssgc civil engineers
� ELEV.=19.63 o A. o`' DANIELA. y°N
,- OJALA y 0 OJALA land surveyors
o.40980„ IVIL
�opess\o P q .465 939 Main Street ( Rte 6A)
� /� e�" m" �°IFS TE �� / ~`•' YARMOU THPOR T MA 02675
DATE DANIEL A. OJAL ., .L.S.
DCE #07-054 TO INDIAN TRAIL
(PUBLIC WAY)
07-054 MOHR.DWG