HomeMy WebLinkAbout4240 MAIN ST./RTE 6A(BARN.) - Health / Main Street
,
Barnstable
F �:
r
$. 026 State 136d, Plymouth, MA 02360
Phone 508 224-5500 Fax 508-224-8883
License No,AC00342
Mr. Thomas McKean
Barnstable Health Department
200 Main Street
Hyannis, MA 02601
Dear Mr. McKean:
We are notifying you about an asbestos removal job to be done
at
. ke start up
date is and the end date is S
Enclosed please find a copy of the Asbestos Notification Form (ANF-001)
for your files.
If you have any questions, please contact us at (508) 224-5500. -
Sincerely,
Paul Ilacqua
Enc: ANF-001 form
Commonwealth of Massachusetts
- 100124925
Asbestos--Notification Form ANF-001 Decal Number
B. Facility Description cont
5.
a.Name of General Contractor
tddress,c.Cit /Town d.Zi Code telLephone Number area code and extension
f.Contractors Worker's Comp.Insurer .Policy Number'
h.Ex .Date mm/dd/
6. What is the size of this facility? 2000 2
a.Square Feet b.Number of floors
C. Asbestos Transportation,and`Disposal ,
1. Transporter'of asbestos-containing material from site to temporary storage site(if necessary)`
ASBESTOS MAN REMOVAL CO 929 STATE RD
Note:Transfer a.Name of Transporter b.Address
Stations must PLYMOUTH 02360 50 Address 00
comply with the C.City/Town
Solid Waste d.Zip Code e.Telephone Number
Division 9
Regulati ons 310 2. Transporter.of asbestos-containin waste material from removal/temporary site to final disposal'site:
CMR 19.000 JOB ROLLOFF POB 6037
a.Name of Transporter b.Address
CHELSEA 02150 5082245500
c.Cit /Town d.Zip Code e.Tell e hone Number
3.
a.Refuse Transfer Station and Owner b.Address'
�__ _. _
C.Cit /Town - d.Zi Code e.Telephone Number
4. TURNKEY LANDFILL`(WASTE MGT NH)
a.Final Disposal Site Location Name b:Final Dis osal Site Location Owner's Name
7 ROCHESTER NECK ROAD ROCHESTER
c.Final Dis �salliteAddress d.Cit /Town
NH 03839
_m e.State f.Zip Code g.Telephone Number
00
v
D. Certification
N
The undersigned hereby states,under the PAUL ILACQUA
penalties of perjury,that he/she has read the PAUL ILACQUA
a.Name ______
b.Authorized Si nature
o Commonwealth of Massachusetts'regulations 4/25/2011 PRESIDENT � � .
•—�.� for the Removal,Containment or D
Encapsulation of Asbestos,453 CMR 6.00 and C.Positionrritle d.Date(mm/dd/vvwl
310 CMR 7.15,and that the information 5082245500 AMR CO
�o contained in this notification is.true and correct e.Tale hone Number f.Re resentin
- to the best of his/her knowledge and belief. 929 STATE RD
0
Address
u_ PLYMOUT H 02360
h.City/Town i.Zip Code
N.anf001ap.doc•_10/02
Asbestos Notification Form•Page 3 of 3
f
Commonwealth of Massachusetts M
100124925
Asbestos Notification Form. ANF-00f.. Decal Number
Important:When filling out A. Asbestos Abatement Description
forms on the
computer,use 1. a. Is this facility fee exempt-city,town, di strict,.municipal housing authority, owner-occupied
only the tab key residence of four units or.less?❑✓ Yes ❑No
to move your
cursor-do not b.Provide blanket decal number if applicable:
use the return Blanket Decal Number
key.
2. Facility Location:
TOM SHANAHAN 4240 MAIN ST.
a.Name of Facility b.Street Address
BARNSTABLE Mq
02637 617500789
c.City/Town d.State e.Zip Code f.Telephone Number,.
INSTRUCTIONS 3. Worksite Location:
1.All sections of this RESIDENCE �Locatio�n
form must be a.Buildmg Name/Building b.Building#' c.Win
completed in order g d.Floor e.Room
to comply with 4.' Is the facility occupied? [✓ Yes ❑No .
DEP notification
requirements of 310
CMR 7.15 5. Asbestos Contractor.
and the Division
of Occupational ASBESTOS MAN REMOVAL 929 STATE ROAD
Safety(DOS) a.Name _
notification b.Address
requirements of 453 PLYMOUTH �,�� 02360- 15082245500
CMR 6.12 a City/Town d.Zi Code e.Telephone Number
z000342
f.DOS License Number g. Contract Type: []Written Fv Verbal
LP;:U:L
cilit Contact Person is Contact Person's Title
A ILACQUA
6. AS050350
a.Name of On-Site Su ervisor/Foreman b.Su ervisor/Foreman DOS Certification Number
7 ASBESTOS CONSULTANTS AM051114
a.Name of Pro'ect Monitor b.Project Monitor DOS Certification Number
8' ASBESTOS CONSULTANTS AA000173
a.Name of Asbestos Analytical Lab -
- •- b.Asbestos Anal tical Lab DOS Certification Number
5!7/201 1
� 10 9' a.Project Start Date mm/dd/ 5/7/201"A
b.E nd Date mml dd/ i
�0 7AM-3PM 7AM-3PM
IN c.Work hours Mon-Fri. d:Work hours Sat-Sun.
0 10. a. What type of project is this?
0 ❑Demolition 2 Renovation
❑ Repair ❑ Other, please specify: b.Describe
11. a. Check abatement procedures:
° ❑Glove bag
--�0 El Encapsulation
❑ Enclosure ❑Disposal only
U_ ❑Cleanup ❑Other, specify:
�— - M'Full containment Z b.Describe
�Q 12: Is the job being conducted: 0 Indoors? ❑Outdoors?
•anf001 ap.doc-10/02
Asbestos Notification Form-Page 1 of 3
Commonwealth of Massachusetts
100124925'
Asbestos Notification Form ANF-001 Decal Number
A. Asbestos Abatement Description (cont.)
13.-Total amount of each type of Asbestos Containing Materials (ACM)to be removed, enclosed,or
enca sulated:
a.Tota pipes or ducts linear Co;a ofher surTace�sgq�uare
c.Boiler,breaching,duct,tank
surface coatings Lin.ft: Sq.{� d.Insulating cement
Lin Sq�
e.Corrugated or layered paper
pipe insulation Lin.ft. gp-- f.Trowel/Sprayer coatings Lin.ft. Sq.ft.
g,..Sera;=on.fireproofng h.firansite board,wall board
• Lin.ft. . (Sq.ft. f Lint ft J Sq
.;.=
I.Cloths,woven fabrics C L—_�i L—�
Lin.ft. g ,ft. ).Other,please specify:
Lin.ft.. S .ft.
k.Thermal,solid core pipe
insulation Lift I1 Sq.ft. A Specify
14..Describe the decontamination system(s)to be used: f
REMOVE ASBESTOS IN-FULL CONTAINMENT UNDER NEGATIVE AIR PRESSURE
15. Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453.CMR
WET DOWN ASBESTOS AND DOUBLE BAG USING 6 MIL MARKED AND LABELED-BAGS '
16. For Emergency Asbestos Operations, the DEP and DOS officials who evaluated the�emergency:
a.Name of DEP Official D.Title
c.Date(mm/dd/yy )of Authorization d.DEP Waiver#
e.Name of DOS Official D aal Tit e
�N g.Date(mm/dd/yyyy)of Authorization h.DOS Waiver#
--��0 17. Do prevailing wage rates as per M.G:L.'c. 149, §26, 27 or 27A—Fapply to this project? []Yes.R]No
�.o
B. Facility Description
o I. Current or prior use of facility: RESIDENCE
2. is the facility owner-occupied residential with 4 units or less? 171 Yes []No
TOM SHANAHAN 4240 MAIN ST:
3' a.Facilit Owner Name D.Address
o BARNSTABLE 02637 61751007W
o c.Cit /Town d.Zi P.Code e.Telephone Number area code and extension
II LL 4 r
a.Name of Facilit Owner's On-Site Mana er
Z 9� b.On-Site Manager Address
�Q c.City/Town d.Zip Code e.Telephone Number(area code and extension)
anf001ap.doc•10/02
Asbestos Notification Form•Page 2 of 3
Q .
414
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9 ter. �k•��-=�.T,.� �, �,���u;.�nr:,��� ,,.'�,>�-
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'
®Boise Cascade Double 1-3/4" x 11-7/8" VERSA-LAM® 2.0 3100 SP Roof EeamkBeam01
¢C CALQ@)3.0 Design Report- US 1 span No cantilevers, 0/12 slope Monday, July 02, 2012
Build 517
File Name: BC 4479
Job Name: Shanahan/Stacy Renovation Description: Beam01
Address: 4240 Main Street, Route 6A Specifier: Paul W. Swanson, P.E.
City, State, Zip: Barnstable, MA Designer:
Customer: Burbic Custom Building Company: Swan son'Structural, Inc. .
Code reports: ESR-1040 Misc: job 4479
�°
12
r vow t A
WNO
10-00-00
BO, 5-1/2" B1,5-1/2„
DL 621 Ibs
DL 621 Ibs
SL 1,125 Ibs SL 1,125 Ibs
Total Horizontal Product Length=10-00-00
-Live Dead Snow Wind Roof Live Trib.
Load Summary
Tag Description Load Type Ref. Start End 100% 90% 115% 133% 125%
1 Standard Load Unf. Area(psf) L 00-00-00 10-00-00 15 30 07-06-00
Controls Summary Value %Allowable Duration Case Span Disclosure
Pos. Moment 3,701 ft-Ibs 15.1% 115% 3 1 - Internal Completeness and accuracy of input must
End Shear 1,240 Ibs 13.7% 115% 3. 1 -Left be verified by anyone who would rely on
Total Load Deft L/1,911 (0.058") 9.4% 3 1 output as evidence of suitability for
Live Load Defl. L/2,965 (0.037"). 8.1% 3 1 particular application.Output here based
Max Defl. 0.058" 5:8% 3 1 on building code-accepted design
properties and analysis methods..
Span/ Depth - 9.3 n/a 1 Installation of BOISE engineered wood
products must be in accordance with
%Allow %Allow current Installation Guide and applicable
Bearing Supports Dim.(L x w) Value Support Member Material building codes.To obtain Installation Guide
BO Wall/Plate 5-1/2"x 3-1/2" 1,746 lbs 21.3% 12.1% Spruce Pine Fiior ask questions,please.call
B1 Wall/Plate 5-1/2"x 3-1/2 1,746 Ibs 21.3% 12.1% Spruce Pine Fir(800)232-0788 before installation.
BC CALCO,BC FRAMERO,AJS-,
Cautions ALLJOISTO,BC RIM BOARDTM,BCI®,
For roof members with slope (1/4)/12 or less final design must ensure that ponding instability. BOISE ,VE MTM SIMPLE FRAMING
will not occur. SYSTEMS, VERSA-RIM
PLUS@,VERSA-RIM@,
For roof members with slope (1/2)/12 or less final design must account for Rain-on-Snow VERSA-STRAND@,VERSA-STUD@ are
surcharge load. trademarks of Boise Cascade Wood
Products L.L.C.
Notes
Design meets Code minimum (L/180)Total load deflection criteria.
Design meets Code minimum (U240) Live load deflection criteria.
Design meets arbitrary (1") Maximum load deflection criteria.
Connection Diagram
OF
ji
C �f
co
l - !l ic�Ir ,iI.rAL a
a'minimum = 2" c= 7-7/8" "
b minimum = 3" d= 24" �
Member has no side loads.
Connectors are: 16d Sinker Nails
Page 1 of-1
®Boise Cascade Double 1-3/4" x 9-1/2'" VERSA-LAM® 2.0 3100 SP Floor Beam\Beam02
,BC CALCO 3.0 Design Report- US 1 span No cantilevers 0/12 slope Monday, July 02, 2012
Build 517
File Name: BC.4479
Job Name: Shanahan/Stacy Renovation Description: Beam02
Address: 4240 Main Street, Route 6A Specifier: Paul W. Swanson, P.E.
City, State, Zip: Barnstable, MA Designer:
Customer: Burbic Custom Building Company: Swanson Structural, Inc.
Code reports: ESR-1040 Misc: job 4479
3 i
I
I r y
rr kh, s aP � dyi
in G -a
�F �� rax,;.. °siy' i'.ta2'<T.
06-06-00
BO, 3" B1,3
LL 260 Ibs LL 260 Ibs
DL 539 Ibs DL 539 Ibs
SL 562 Ibs SL 562 Ibs
Total Horizontal Product Length=06-06-00
Live Dead Snow Wind Roof Live Trib.
Load Summary
Tag Description Load Type Ref. Start End 100% 90% 115% - 133% 125%
1 Standard Load Unf.Area (psf) L 00-00-00 06-06-00 40 12 02-00-00
2 Wall Unf. Lin. (plf) L 00-00-00 06-06-00 40 n/a
3 Beam01 at bearing B1 Conc..Pt. (Ibs) L 03-03-00 03-03-00 601 1,125 n/a
Controls Summary Value %Allowable Duration Case Span Disclosure
Pos. Moment 3,352 ft-Ibs 20.9% 115% 2 1 - Internal Completeness and accuracy of input must
End Shear 1,202 Ibs 16.5% 115% 2 1 -Left be verified by anyone who would rely on
Total Load Defl. U1,921 (0.038") 12.5% 2 1 output as evidence of suitability for
Live Load Defl. U3,105 (0.024") 11.6% 2 1 particular application.Output here based
Max Defl. 0.038" 3.8% 2 1 on building code-accepted design
properties and analysis methods.
Span/Depth 7.7 n/a 1 Installation of BOISE engineered wood
products must be in accordance with
%Allow %Allow current Installation Guide and applicable
Bearing Supports Dim.(L x 1N) Value Support Member Material building codes.To obtain Installation Guide
BO Post 3"x 3-1/2" 1,361 Ibs 17.9% 17.3% Spruce,Pine Firor ask questions,please call
B1 . Post 3"x 3-1/2" 1,361 Ibs 1719% 17.3% Spruce Pine Fir(800)232-0788 before installation.
BC CALCO,BC FRAMER@ AJS-,
Motes ALLJOISTO,BC RIM BOARD TM,BCI@,
Design,meets Code minimum (L/240)Total load deflection criteria. BOISE GLULAMT"" SIMPLE FRAMING
Design meets Code minimum L/360 Live load deflection criteria. SYSTEM@,VERSA LAM®,VERSA-RIM
9 ( ) PLUS@,VERSA-RIM®,
Design meets arbitrary(1") Maximum load deflection criteria. VERSA-STRAND@,VERSA-STUDOare
trademarks of Boise Cascade Wood
Connection Diagram Products L.L.C.
b d
a
04
> rlUC TUr L '
a minimum = 2" c= 5-1/2" �j' t No 353 `',:> cr��
b minimum= 3" d= 24"
'h
Connection design assumes point load is'top-loaded'. For connection design of'side-loaded' �!0NA F�
point loads, please consult a technical representative or professional of Record. Syr
Member has no side loads.
Concentrated loads are not considered in side load analysis.
Connectors are: 16d Sinker Nails
Page 1 of 1
Boise Cascade Double 1-3/4" x 11-7/3°" VERSA-LAM® 2.0 3100 SP Roof BeamXBeam03
BC CALCO 3.0 Design Report- US 1 span I No cantilevers 1 0/12 slope Monday, July 02, 2012
Build 517
File Name; BC 4479
Job Name: Shanahan/Stacy Renovation Description: Beam03
Address: 4240 Main Street, Route 6A Specifier: Paul W. Swanson, P.E.
City, State, Zip: Barnstable, MA Designer:
Customer: Burbic Custom Building Company: Swanson Structural, Inc.
Code reports: ESR-1040 Misc: job 4479.
10
12
� w
� y + a z, a� ism r_� �j', .
14-06-00
130, 3-1/2" B1,3-1/2"
DL 820 Ibs DL 820 Ibs
SL 1,433 Ibs - SL 1,433 Ibs
Total Horizontal Product Length= 14-06-00
Live Dead Snow Wind Roof Live Trib.
Load Summary
Tag Description Load Type Ref. Start End 100% 90% 115% 133% 125%
1 Standard Load Unf. Area (psf) L 00-00-00 14-06-00 15 30 04-00-00
2 Beam01 at bearing BO Conc. Pt..(Ibs) L 07-03-00 07-03-00 601 1,125 n/a
Controls Summary 'Value %Allowable Duration Case Span Disclosure
Pos. Moment 10,784 ft-Ibs 44.1% 115% 3 1 - Internal Completeness and accuracy of input.must
End Shear 2,007 Ibs 22.1% 115% 3 1 -Left be verified by anyone who would rely on
Total Load Deft U485 (0.348") 37.2% 3 1 output as evidence of suitability for
Live Load Defl. U758 (0.222") 31.7% 3 1 particular application.Output here based
Max Defl. 0.348" 34.8% 3 1 on building code-accepted design
properties and analysis methods.
Span/Depth 14.2 n/a 1 Installation of BOISE engineered wood
products must be in accordance with
%Allow %Allow current Installation Guide and applicable
Bearing Supports Dim.(L x W) Value Support Member Material building codes.To obtain Installation Guide
BO Post 3-1/2"x 3-1/2" 2,253 Ibs 6.1% 24.5% Versa-Lam 1.7 (800)232-0788 before installation.
ask questions,please call
B1 Post 3-1/2"x 3-1/2 2,253 lbs 6.1% 24.5% Versa-Lam 1.7
BC CALCO,BC FRAMER@,AJSTM,
Cautions ALLJOISTO,BC RIM BOARD'",BCIO,
For roof members with slope (1/4)/12 or less final design must ensure that ponding instability BOISE GLULAMTM SIMPLE FRAMING
will not occur. SYSTEM@,VERSA-LAM@,VERSA-RIM
PLUS@,VERSA-RIM@,
For roof members with slope(1/2)/12 or less final design must account for Rain-on-Snow VERSA-STRANDO,VERSA-STUDO are
surcharge load. trademarks of Boise Cascade Wood
Products L.L.C.
Motes
Design meets Code minimum (L/180)Total load deflection criteria.
Design meets Code minimum (L/240) Live load deflection criteria:
Design meets arbitrary (1") Maximum load deflection criteria.
r -V S�' lil
4 o JS1"RtJCf URAI f+ -
f 35334
may , � .• , k:.
Page 1 of 2
Boise Cascade Double 1-3/4" x 11-7/8" VERSA-LAIC® 2.0 3100 SP Roof Beam\Seam03
BC CALCO 3.0 Design Report- US 1 span I No cantilevers 0/12 slope Monday, July 02, 2012
Build 517
File Name: BC 4479
Job Name: Shanahan/Stacy Renovation Description: Beam03
Address: 4240 Main Street, Route 6A Specifier: Paul W. Swanson, P.E.
City, State, Zip: Barnstable, MA Designer:
Customer: Burbic Custom Building Company: Swanson Structural, Inc.
Code reports: ESR-1040 Misc! job 4479
Connection Diagram Disclosure
�i b d Completeness and accuracy of input must
L be verified by anyone who would rely on
a xoutput as evidence of suitability for
• • • particular application.Output here based
on building code-accepted design
c properties and analysis methods.
Installation of BOISE engineered wood
® ® products must be in accordance with
current Installation Guide and applicable
building codes.To obtain Installation Guide
or ask questions,please call
a minimum =2" c= 7-7/8" (800)232-0788 before installation.
b minimum = 3" d= 24"
BC CALC®,BC FRAMER®,AJSTM,
Connection design assumes point load is'top-loaded': For connection design of'side-loaded' ALLJOISTO,BC RIM BOARD TM,BCIO,
point loads, please consult a technical representative or professional of Record. BOISE GLULAMT"^ SIMPLE FRAMING
Member has no side loads. SYSTEM@,VERSA-LAM@,VERSA-RIM
Concentrated loads are not considered in side load analysis. PLUS@,VERSA-RIMO,
Connectors are: 16d Sinker Nails VERSA-STRANDO,VERSA-STUD@ are
trademarks of Boise Cascade Wood
Products L.L.C.
Page 2 of 2
®Boise cascade_ Double 1-3/4" x 11-7/3" VERSA-LAM@ 2.0 3100 SP Roof Beam\BeamN
.BC CALL®3.0 Design Report- US 1 span No cantilevers 0/12 slope Monday, July 02, 2012
Build 517
File Name: BC 4479
Job Name: Shanahan/Stacy Renovation Description: Beam04
Address: 4240 Main Street, Route 6A Specifier: Paul W. Swanson, P.E.
City, State, Zip: Barnstable, MA Designer: .:
Customer: Burbic Custom Building Company: Swanson Structural, Inc.
Code reports: ESR-1040 Misc: job 4479
10
12
on
fi .w^r�4 .< ... r',x�`�" '7", ,{ £NAY, ., �v la
z.,a uo>.z's„-,.xi„�, +xf„ �Y.w,z.,,.a, 'Z Iwl,-,-.. -,.:._<, -
17-00-00
BO,5-1/2 B1,3-1/2"
DL 1,002 Ibs DL 982 Ibs
SL 1,803 Ibs SL 1,768 Ibs
Total Horizontal Product Length= 17700-00
Live Dead Snow Wind ' Roof Live Trib.
Load Summary
Tag Description Load Type Ref. Start End 100% 90%° 116% 133% 125%
1 Standard Load Unf.Area (psf) , L 00-00-00.17-00-00 15 30 07-00-00
Controls Summary Value %Allowable Duration Case Span Disclosure
Pos. Moment 10,950 ft-Ibs 44.8% 115% 3 1 - Internal Completeness and accuracy of input must
End Shear 2,331 Ibs 25.7% 115% 3 1 - Left be verified by anyone who would rely on
Total Load Deft U363 (0.541") 49.6% 3 1 output as evidence of suitability for
Live Load Defl. U565 (0.348") 42.5% 3 1 particular application.Output here based
Max Defl. 0.541" 54.1% 3 1 on building code-accepted design
properties and.analysis methods.
Span/Depth 16.5 n/a 1 Installation of BOISE engineered wood
products must be in accordance with
%Allow %Allow . current Installation Guide and applicable
Bearing SupportS Dim (L x 1N) Value Support Member Material building codes.To obtain Installation Guide
BO Wall/Plate 5-1/2"x 3-1/2" 2,804 Ibs 34.3% 1.9.4% Spruce Pine Firor ask questions,please call
B1 Post 3-1/2"x 3-1/2" 2,750 Ibs 7.5% 29.9% Versa-Lam 1.7 (800)232-0788 before installation.
BC CALCO,BC FRAMER@,AJS"m,
Cautions ALLJOISTO,BC RIM BOARDTM,BCIO,
For roof members with slope (1/4)/12 or less final design must ensurethat ponding instability BOISE GLULAMT" SIMPLE FRAMING
SYSTEMO,VERSA-LAME),VERSA-RIM
will not occur. PLUS@,VERSA-RIM@,
For roof members with slope (1/2)/12 or less final design must account for Rain-on-Snow VERSA-STRAND@,VERSA-STUD@ are
surcharge load. trademarks of Boise Cascade Wood
Products L.L.C.
Notes
Design meets Code minimum (L/180)Total load deflection criteria.
Design meets Code minimum (L/240) Live load deflection criteria.
Design meets arbitrary (1") Maximum load deflection criteria.
Connection Diagram
® eX ,,jF V�1t 15 y`�
•.fq n� •5'':n
JJ334,'
a'minimum = 2" c= 7-7/8
b minimum = 3" d= 24" '
Member has no side loads. Z �Y
Connectors are: 16d Sinker Nails
Page 1 of 1
Boise Cascade Triple 2 x 10 SPF #2 Floor BeamSe=04A
$C CALCO 3.0 Design Report-US 1 span No cantilevers 1 0/12 slope Monday,July 02, 2012
Build 517
File Name: BC 4479
Job Name: Shanahan/Stacy Renovation Description: Beam04A
Address: 4240 Main Street, Route 6A Specifier: Pau!W. Swanson, P.E.
City, State, Zip: Barnstable, MA Designer:
Customer: Burbic Custom Building Company: Swanson Structural,-Inc.
Code reports: NLGA Misc: job 4479
2 '
B1,
BO, 3" .3;
LL 100 Ibs LL 100 Ibs
DL 538 Ibs DL 538 Ibs
SL 893 Ibs SL 893 Ibs
Total Horizontal Product length=02-06-00
Live Dead Snow Wind Roof Live Trib.
Load Summary
Tag Description LoadType Ref. Start, End - 100% 90% 1150% 133% : 125%
1 Standard Load Unf.Area(psf) L 00-00-00 02-06-00 40 12 .02-00-00
2 Beam04 at bearing BO Conc. Pt. (Ibs) L 01-03-00 01-03-00 992 1,785 n/a
Controls Summary Value %Allowable Duration Case" Span Disclosure
Pos.Moment 1,522 ft-Ibs 25.7% 115% 2 1 - Internal Completeness and accuracy of input must
End Shear 1,415 Ibs 32.8% 115% 2 1 - Left be verified by anyone who would rely on
Total Load Defl. L/10,478 (0.002") 2.3% 2 1 output as evidence of suitability for
Defl. U16,221 0.002" 2.2% 2 1 particular application.Output here based
Live Load
( ) on building code-accepted design
Max Defl. 0.002" 0.2% 2 1 properties and analysis methods.
Span/Depth 2.8 n/a 1 Installation of BOISE engineered wood
products must be in accordance with
%Allow %Allow current Installation Guide and applicable
Bearing Supports Dim (L x W) Value Support Member Material building codes.To obtain Installation Guide
BO Post 3"x 4-1/2" 1,530 Ibs 3.8% 26.7% . Versa-Lam 1.7 or ask questions,please call
B1 Post 3"x 4-1/2" 1,530 Ibs 15.6% 26.7% Spruce Pine Fir(800)232-0788 before installation.
BC CALCO,BC FRAMER@,AJSTM,
Notes
ALLJOISTO,BC RIM BOARD TM,BCI@,
n meets Code minimum (L/240 Total load deflection criteria. BOISE MO,VE S SIMPLE FRAMING
Design ) SYSTERA-LAM@,VERSA-RIM
Design meets Code minimum (L/360) Live load deflection criteria. PLUS@,VERSA-RIM@,
Design meets arbitrary(1") Maximum load deflection criteria. VERSA-STRANDO,VERSA-STUD@ are
The analysis of solid sawn wood members is in accordance with the NDS and is limited to the trademarks of Boise Cascade Wood
output shown above. All other support and design for these products, including but not Products L.L.C.
limited to notching, connections, installation, and engineer/architect certification is the.
responsibility of the project's design professional of record.
.
c."r '
NV
1 V
Page 1 of 1
I
®Boise Cascade Triple 1-3/4" x 11-7/3" VERSA-LAM® 2.0 3100 SP Floor l3eam\l3eam05
BC CALCO 3.0 Design Report- US 1 span 1 No cantilevers 1 0/12 slope Monday, July 02, 2012
Build 517
File Name: BC 4479
Job Name: Shanahan/Stacy Renovation. Description: Beam05
Address: 4240 Main Street, Route 6A Specifier: Paul W. Swanson, P.E.
City, State, Zip: Barnstable, MA Designer:
Customer: Burbic Custom Building Company: Swanson Structural, Inc.
Code reports: ESR-1040 Misc: job 4479
I 1 I
I 13 I
M1,1120
r�.. ham,„
17-00-00
B1
BO LL 1,360 Ibs
LL 1,360 Ibs
DL 1,747 Ibs DL 1, Ibs
SL 1,020 Ibs SL 1,02020 Ibs
Total Horizontal Product Length= 17-00-00
Live Dead Snow Wind Roof Live Trib.
Load Summary
Tag Description Load Type Ref. Start End 100% 90% 115% 133% 126%
1 Standard Load Unf.Area (psf) L .00-00-00 17-00-00 40 12 04-00-00
2 Wall Unf. Lin. (plf) L 00-00-00 17-00-00 80 n/a
3 Roof Unf. Area (psf) L 00-00-00 17-00-00 . 15 30 04-00-00
Controls Summary Value %Allowable Duration Case Span Disclosure
Pos. Moment 17,113 ft-Ibs 46.6% 115% 2 1 - Internal Completeness and accuracy of input must
End Shear 3,566 Ibs 26.2% 115% 2 1 -Left be verified by anyone who would rely on
Total Load Defl. L/340 (0.593") 70.6% 2 1 output as evidence of suitability for
L 0.342" 61.1% 2 1 particular application.Output here based
Live Load Defl. L/589
( ) on building code-accepted design
Max Deft 0.593" 59.3% 2 1 properties and analysis methods.
Span/Depth 17.0 n/a 1 Installation of BOISE engineered wood
products must be in accordance with
%Allow %Allow current Installation Guide and applicable
Hearing Supports Dim (L x 1A) Value Support Member Material building codes.To obtain Installation Guide
BO Hanger Load 2"x 5-1/4" 4,127 Ibs Unspecified 52.4% Hanger or ask questions,please call
B1 Hanger Load 2"x 5-1/4" 4,127 Ibs Unspecified 52.4% Hanger (800)232-0788 before installation.
BC CALCO,BC FRAMER@,AJS-,
ALLJOISTO,BC RIM BOARD TM BCIO,
Notes BOISE GLULAMT"^ SIMPLE FRAMING
Design meets Code minimum (L/240)Total load deflection criteria. SYSTEM@,VERSA-LAM@,VERSA-RIM
Design meets Code minimum (L/360) Live load deflection criteria. PLUS@,VERSA-RIM@,
Design meets arbitrary (1") Maximum load deflection criteria. VERSA-STRANDS,VERSA-STUD@)are
trademarks of Boise Cascade Wood
Connection Diagram Products L.L.C.
b d—
a
• e e
o T o777
c
e . o o 0
kNOFNfI�j _,
a minimum =2" c= 6-7/8" ® r'/ SIl'AP!S01!
b minimum = 3" d = 24" `
e minimum = 3" ` P a 35<3rt /
Nailing schedule applies to both sides of the member.
sr7 �
Member has no side loads. `J ` . .
Connectors are: 16d Sinker Nails r `
Page 1 of
®Boise Cascade Triple 1-3/4" x 11-7/8" VERSA-LAM®2.0 3100 SP - Floor Beam\13eam06
BC CALCO 3.0 Design Report- US 1 span No cantilevers j 0/12 slope Monday,July 02, 2012
'Build 51'7
File Name: BC 4479
Job Name: Shanahan/Stacy Renovation Description: Beam06
Address: 4240 Main Street, Route 6A Specifier: Paul W. Swanson, P.E.-
City, State, Zip: Barnstable, MA Designer:
Customer: Burbic Custom Building Company`. Swanson Structural, Inc.
Code reports: ESR-1040 Misc: job 4479.
� I y � I I
Mr
�a .�.s
17-00-00
BO B1
LL 1,360 Ibs LL 1,360 Ibs
DL 1,747 Ibs DL 1,747 Ibs
SL 1,020 Ibs SL 1,020 Ibs
Total Horizontal Product Length= 17-00-00
Live Dead Snow Wind Roof Live Trib.
Load Summary
Tag Description Load Type Ref. Start End 100% 90% 115% 133% 125% `.
1 Standard Load Unf. Area (psf) L OOLOO=00 17-00-00 40 12 - 04-00-00
2 Wall Unf. Lin. (plf) L 00-00-00 17-00-00 80 n/a
3 Roof Unf. Area(psf) L . 00-00-00 17-00-00 15 30 '04-00-00
Controls Summary Value %Allowable Duration Case Span Disclosure
Pos. Moment 17,113 ft-Ibs 46.6% 115% 2 1 - Internal Completeness and accuracy of input must
End Shear 3,566 Ibs 26.2% 115% 2 1 Left,' be verified by-anyone who would rely on
Total Load Defl. U340 (0.593") 70.6% 2 1 output as evidence of suitability for
Live Load Defl. U589 (0.342") 61.1% 2 1 particular application.Output here based
Max Defl. 0.593" 59.3% 2 1 on building code-accepted design
properties and analysis methods.
1 Installation f B I E engineered wood
17.0 n/a - Installat o 0 0 S
Span/Depth g
products must be in accordance with
%Allow %Allow current Installation Guide and applicable
Bearing Supports Dim (L x lV Value Support Member Material building codes..To obtain Installation Guide
BO Hanger Load 2"x 5-1/4" 4,127 Ibs Unspecified 52.4% Hanger or ask questions,please call
B1 Hanger Load 2"x 5-1/4" 4,127 Ibs Unspecified 52.4% Hanger (800)232-0788 before installation.
BC CALCO,BC FRAMERS,AJSTM,
Notes ALLJOISTO,BC.RIM BOARDTM,BCIO,
Design meets Code minimum (L/240)Total load deflection criteria.. .- BOISE GLULAMT"' SIMPLE FRAMING
Design meets Code minimum L/360 Live load deflection criteria. SYSTEMS,VERSA-LAM®,VERSA-RIM
g ( ) PLUSO,VERSA-RIM®, .
Design meets arbitrary(1") Maximum load deflection criteria. VERSA-STRANDS,VERSA-STUDS are
trademarks of Boise Cascade Wood
Connection Diagram Products L.L.C.
b d
a
• • • ..
o o
c
b Pb,E3S z¢A f
.e O
'v
a minimum =2" c= 6-7/8" �^f itU HJi�F,i 1l i
b minimum = 3" d = 24
e minimum = 3"
Nailing schedule applies to both sides of the member. u >/011W �,h
Member has no side loads. j6
Connectors are: 16d Sinker Nails
k
Page 1 of 1
Boise Cascade Triple 1-3/4" x 11-7/8" VERSA-LAM@) 2.0 3100. SP; Floor Beamkl3e=07
,BC CALCO 3.0 Design Report- US 1 span No cantilevers 0/12 slope Monday, July 02, 2012
Build 517
File Name' BC 4479
Job Name: Shanahan/Stacy Renovation Description: Beam07
Address: 4240 Main Street, Route 6A Specifier: Paul W. Swanson, P.E.
City, State, Zip: Barnstable, MA Designer:
Customer: Burbic Custom Building Company: Swanson Structural, Inc.
Code reports: ESR-1040 Misc: job 4479
4 3
I 2
1
s s, �- # $ N a5 3n a- 6r x ': ff:. t�5 c��
14-06-00
BO,5-1/4" $1,3-1/2"
LL 1,813 Ibs LL 2,067 Ibs
DL 2,320 Ibs DL 2,646 Ibs
SL 1,799 Ibs SL 1,981 Ibs
Total Horizontal Product Length=14-06-00
Live Dead Snow . Wind Roof Live Trib.
Load Summary
Tag Description Load Type Ref. Start End 100%o 90% 115% 133% 125%
1 Standard Load Unf. Area (psf) L 00-00-00 14-06-00 40 12 02-00-00
2 Roof Unf. Area (psf) L 00-00-00 14-06-00 15 30 04-00-00
3 Beam05 at bearing B1 Conc. Pt. (Ibs) L 09-00-00 09-00-00 1,360 1,747 1,020 n/a
4 Beam06 at bearing 61 Conc. Pt. (Ibs) L 07-00-00 07-00-00 1,360. 1,747 1,020 n/a
Controls Summary Value %Allowable Duration Case Span Disclosure
Pos. Moment 31,939 ft-Ibs 87.0% 115% 2 1 - Internal Completeness and accuracy of input must
End Shear -6,307 Ibs 46.3% 115% 2 1 - Right be verified by anyone who would rely on.
Total Load Deft L/240 (0.694") 99.9% 2 . 1 output as evidence of suitability for
Live Load Defl. L/401 (0.415") 89.7% 2 1 particular application.Output here based
Max Defl. 0.694" 69.4% 2 1 on building code-accepted design
properties and analysis methods.
Span/Depth 14.0 n/a 1 Installation of BOISE engineered wood
products must be in accordance with
%Allow %Allow current Installation Guide and applicable
Bearing SupportS Dim.(L x" Value Support Member Material building codes.To obtain Installation Guide
BO Post 5-1/4"x 5-1/4" 5,933 Ibs 7.2% 28.7% Versa-Lam 1.7 or ask questions,please call
B1 Post 3-1/2"x 5-1/4" 6,693 Ibs 12.1% 48.6% Versa-Lam 1.7 (800)232 0788 before installation.
' BC CALCO,BC FRAMER@,AJSTM,
Notes ALLJOISTO,BC RIM BOARDTI9 BCIO,
Design meets Code minimum (L/240)Total load deflection criteria: BOISE GLULAMT^^ SIMPLE FRAMING
Design meets Code minimum L/360 Live load deflection criteria.. SYSTEM@,VERSA LAM®,VERSA-RIM
9 ( ) RLUSO,VERSA-RIM®,
Design meets arbitrary(1") Maximum load deflection criteria. VERSA-STRAND),VERSA-STUD@ are
trademarks of Boise Cascade Wood
Connection Diagram Products L.L.C.
b d
a
a 0
o � o
• o ti OF jf r I q
e o o ° ��e ~• �rj
J��'line)r�ii '
a minimum = 2" c= 6-7/8"
_ -
b minimum 3" d - 24"
e minimum = 3" N.'=,';
Connection design assumes point load is 'top-loaded'. For connection design of'side-loaded' `ON;
point loads, please consult a technical representative or professional of Record. 9 �
Nailing schedule applies to both sides of the member. 0 //
Member has no side loads.
Concentrated loads are not considered in side load analysis.
Connectors are: 16d Sinker Nails
Page 1 of 1
Boise cascade (quadruple 1-3/4" x 11-7/8" VERSA-LAM® 2.0 3100 Sh Floor Bearn\EeamO8
,BC CALL®3.0 Design Report- US 1 span No cantilevers 0/12 slope Monday, July 02, 2012
Build 517
File Name: BC 4479
Job Name: Shanahan/Stacy Renovation Description: Beam08
Address: 4240 Main Street, Route 6A Specifier: Paul W. Swanson, P.E.
City, State, Zip: Barnstable, MA Designer:
Customer: Burbic Custom Building Company: Swanson Structural, Inc.
Code reports: ESR-1040 Misc: job 4479
5 q
_._.
I I
I
r
r 17
3 �
� P t
%`�' ✓�".. �nW f�� �.v= ;.� •�. � r;� �"'�w .� ",„ � �.,. �a :� 3x,.-:. �`�..,,,�^,,,�#', � ��:"€ ,.�,::.�d,.a,..'.'.."+ was
Yr/..../a {L�6./y{�Y.ksu%k:•F�'h��lJu�.eu„u'S i/.fl2. :+�i . ..,:.. .,,,M,.i�'•.H1ix✓ u.l. .ewl .,�b ,:,. ..i,..is..o .,,.,-�
13-06-00
B1,5-1/4"
BO,5-1/4" LL 2,167 Ibs
LL 1,633lbs DL4,367lbs
DL 3,682 Ibs
SL 3,655 Ibs SL 4,055 Ibs
Total Horizontal Product Length=13-06-00
Live Dead Snow Wind Roof Live Trib.
Load Summary
Tag Description Load Type Ref. Start End 100% 90% 115% 133% 125%
1 Standard Load Unf.Area (psf) L 00-00-00 13-06-00 40 12 02-00-00
2 Wall Unf. Lin. (plf) L 00.00-00 13-06-00 80 n/a
3 Roof Unf. Area (psf) L 00-00-00 13-06-00 15 30 14-00-00
4 Beam05 at bearing BO Conc. Pt. (Ibs) L 09-00-00 09-00-00 1,360 1,747 1,020 n/a
5 Beam06 at bearing BO Conc.,Pt. (Ibs) L ._,07-00-00 07-00-00 1,360 1,747 1,020 n/a
Controls Summary Value %Allowable Duration Case Span Disclosure
Pos. Moment 38,968 ft-Ibs 79.6% 115% 2 1 - Internal Completeness and accuracy of input must
End Shear -9,394 Ibs 51.7% 115% 2 1 - Right be verified by anyone who would rely on
Total Load Defl. U281 (0.544") 85.4% 2 1 output as evidence of suitability for
0.319" 75.1% 2 1 particular application.Output here based
Live Load Defl. U480
( ) on building code-accepted design
Max Defl. 0.544" 54.4% 2 1 properties and analysis methods.
Span/Depth 12.9 n/a 1 Installation of BOISE engineered wood
products must be in accordance with
%Allow %Allow current Installation Guide and applicable
Bearing Supports Dim (L x W ) Value Support Member Material building codes.To obtain Installation Guide
BO Post 5-1/4"x 5-1/4" 8,970 Ibs 10.8% 43.4% Versa-Lam 1.7 or ask questions,please call
B1 Post 5-1/4"x 5-1/4 10,589 Ibs 12.8% 51.2% Versa-Lam 1.7 (800)232-0788 before installation.
BC CALCO,BC FRAMER@,AJSTM,
Cautions ALLJOISTO,BC RIMBOARDTM,BCIO,
Member is not full supported at post BO. A connector is required at this bearing. BOISE GLULAM SIMPLE FRAMING
Y pP P q g SYSTEMO,VERSA-LAME),VERSA-RIM
Member is not fully supported at post B1. A connector is required at this bearing. PLUS@,VERSA-RIM@,
VERSA-STRAND@,VERSA-STUDO are
Notes trademarks of Boise Cascade Wood
Design meets Code minimum (L/240)Total load deflection criteria. Products L.L.C.
Design meets Code minimum (L/360)Live load deflection criteria.
Design meets arbitrary (1") Maximum load deflection criteria.
Fastener Manufacturer: Simpson Strong-Tie, Inc.
kl'qs s>-q
V'dAN'S/Jid T,`
STR CTURM. j1,i3
No.35334 ,
Y9 '�ti l L
N{
Page 1 of 2
Boise cascade Quadruple 1-3/4" x 11-7/3" VERSA.LANMO 2,0 3100 SP Floor BeamXl3eamO8
PC CALF®3.0 Design Report- US 1 span ( No.cantilevers 10/12 slope Monday, July 02, 2012
Build 517
File Name: BC 4479
Job Name: Shanahan/Stacy Renovation Description: Beam08,
Address: 4240 Main Street, Route 6A 8pecifier: Paul W. Swansori, P.E.
City, State, Zip: Barnstable, MA Designer:
Customer: Burbic Custom Building Company: Swanson Structural, Inc.
Code reports: ESR-1040 Misc: job 4479
Disclosur
e
Connection Diagram
�{ b a Completeness and accuracy of input must
L k be verified by anyone who would rely on
a output.as evidence of suitability for
particular application.Output here based
® ® on building code-accepted design
i properties and analysis methods.
Installation of BOISE engineered wood
x products must be in accordance with
n current Installation Guide and applicable
building codes.To obtain Installation Guide
or ask questions,please call
a minimum = 1-1/2"c= 8-7/8" (800)232-0788 before installation..
b minimum =4" d= 24"
e minimum = 1" BC CALC® AJSTM,,.BC FRAMER®,AJST
ALLJOISTO,BC RIM BOARDT"",BCI®,
Connection design assumes point load is `top-loaded'."For-connection design of'side-loaded' BOISE GLULAMTM SIMPLE FRAMING
point loads, please consult a technical representative or-professional of Record. SYSTEM®,.VERSA-LAM®,VERSA-RIM
Beams 7 inches wide will be assumed to be either top-loaded only,�or equally,loaded from. PLUS®,VERSA-RIM®,
VERSA-
each side. VERSA=STRAND®,VERSA-STUD®are
Install screws from both sides, staggering screws b '/2 of the s acin to avoids littin trademarks of Boise Cascade Wood
99 9 y spacing splitting. ,_.Products L.L.C.
Member has no side loads:
Concentrated loads are not considered in side load analysis:
Connectors are: SDW22634 s
4
}
.Page 2 of 2
Boise Cascade Double 1-3/4" x 11-7/3" VERSA-LAM® 2.0 3100 SP Floor Beam\DearrII09
SC CALCO 3.0 Design Report- US 1 span j No cantilevers j 0/12 slope Monday, July 02, 2012
Build 517
File Name: BC 4479
Job Name: Shanahan/Stacy Renovation Description: BeamO9
Address: 4240 Main Street, Route 6A Specifier: Paul W. Swanson, P.E.
City, State, Zip: Barnstable, MA Designer:
Customer: Burbic Custom Building Company: Swanson Structural, Inc.
Code reports: ESR-1040 Misc: job 4479
12
l i I I a i I
I a I . ! I
a )' "�
- !,1 .. i•°;^n4 �«f. n�u y aer ..<s.re+<a - .. "us ..:r . . .2.�,. ,. , ;,T.t..... ..:. ,,.... ..,v,. a•w,.
12-06-00
B1,3-1/2"
BO,3-1/2" - LL 4,500 Ibs
LL 4,500 Ibs
DL 2,423 Ibs DL.2,423 Ibs
Total Horizontal Product Length 12-06-00
Live Dead Snow Wind Roof Live Trib.
Load Summary
Tag Description Load Type Ref. Start End 100% 90% 115% 133°/u. 125%
1 Standard Load Unf.Area(psf) L . 00-00-00 12-06-00 40 12 08-00-00
2 Wall Unf. Lin. (plf) L 00-00-00 12-06-00 80 n/a
3 Ceiling Unf. Area(psf) L 00-00-00 12-06-00 .20 10 08-00-00
4 Roof Unf.Area (psf) L - 00-00-00 12-06-00 30 15 08-00-00
Controls Summary Value %Allowable Duration Case Span Disclosure
Pos. Moment 20,077 ft-Ibs 94.4% _100% 1 1 - Internal Completeness and accuracy of input must
End Shear 5,504 Ibs 69.7% 100% 1 1 -Left be verified by anyone who would rely on
Total Load Deft L/269 (0.536") 89.1% 1 1 output as evidence of suitability for
0.349" 86.9% 1 1 particular application.Output here based
Live Load Deft U414
( ) on building code-accepted design
Max Defl. 0.536" 53.6% 1 1 properties and analysis methods.
Span/Depth 12.2 n/a 1 Installation of BOISE engineered wood
products must be in accordance with
%Allow %Allow current Installation Guide and applicable
Bearing Supports Dim (L x W) Value Support Member Material building codes.To obtain Installation Guide
BO Post 3-1/2"x 3-1/2" 6,923 Ibs 18.8% 75.4% Versa-Lam 1.7 or ask questions,please call
B1 Post 3-1/2"x 3-1/2" 6,923 Ibs 18.8% 75.4% Versa-Lam 1.7
(800)232-0788 before installation.
BC CALCO,BC FRAMER@,AJSTA°
ALLJOISTO,BC RIM BOARD TM,BCI@,
Notes BOISE GLULAM- SIMPLE FRAMING
Design meets Code minimum (U240)Total load deflection criteria. SYSTEM@ VERSA-LAM@,VERSA-RIM
Design meets Code minimum (L/360) Live load deflection criteria. PLUS@,VERSA-RIMO,
Design meets arbitrary(1") Maximum load deflection criteria. VERSA-STRAND),VERSA-STUDO are
trademarks of Boise Cascade Wood
Connection Diagram Products L.L.C.
�b d
a
c h:�
S c a
1 Ilk
.4 ;_1RIJCiliRAL
a minimum = 2" c= 7-7/8" ��� :.35134 f l7
b minimum= 3" d =24" o\
Member has no side loads. PYr s`/tllVAt.
Connectors are: 16d Sinker Nails
Page 1 of 1
e
BeamChek v2011 licensed to:Swanson Structural, Inc. Reg# 1194-67550
Shanhan Stacy 4240 Main St. Beam 09
job 4479 Date: 7/02/12
Selection T 8x 4x 1/4 50 ksi Steel Tube Lateral Support: @ Bearing Points
Conditions Actual Size is 4 x 8 in.
Min Bearing Length R1=0.5 in. R2=0.5 in. (1.0)DL Defl= 0.17 in
Data Beam Span 12.5 ft Reaction 1 LL 4500# Reaction 2 LL 4500#
Beam Wt per ft 19.02# Reaction 1 TL 6969# Reaction 2 TL 6969#
Bm Wt Included 238# Maximum V 6969#
Max Moment 21778'# Max V(Reduced) N/A
TL Max Defl L/240 TL Actual Defl L/310
LL Max Defl L/360 LL Actual Defl L/481
Attributes Section(in3) Shear(in2) TL Defl (in) LL Defl
Actual 11.30 4.00 0.48 0.31
Critical 8.71 0.35 0.63 0.42
Status OK OK OK OK
Ratio 77% 9% 77% .75%
Fb(psi) Fv(psi) E(psi x mil)
Values Ref.Value Fy 50000 50000 29.0
Adjusted Values 30000 20000 29.0
Adjustments YP Factor 0.60 0.40
Loads Uniform LL:320 Uniform TL 416 =A
Par Unif LL Par Unif TL Start End
H=80 0 12.5
160 1.=240 0 12.5
240 J=360 0 12.5
or
I�Al L
ON
J = ntJ1.TIJRAI ` �4
No 3'. .4d
H �WSrtJilAl ����°
Uniform Load A
0 0
R1 =6969 R2=6969
SPAN= 12.5FT
Uniform and partial uniform loads are.Ibs per lineal ft.
I
BeamChek v2011 licensed to:Swanson Structural, Inc. Reg# 1194-67550
Shanhan Stacy 4240 Main St. Beam 09
lob 4479 Date: 7/02/12
Selection C 8x 18.75 50 ksi Steel Channel Lateral Support: Lu=4.1 ft max.
Conditions Actual Size is 2-1/2 x 8 in.
Min Bearing Length R1=0.9 in. R2=0.9 in. (1.0) DL Defl= 0.18 in
Data Beam Span 12.5 ft Reaction 1 LL 4500# Reaction 2'LL 4500#
Beam Wt per ft 18.75# Reaction 1 TL 6967# Reaction 2 TL 6967#
Bm Wt Included 234# Maximum V 6967#
Max Moment 21772'# Max V(Reduced) N/A
TL Max Defl L/240 TL Actual Defl L/302
LL Max Defl L/360 LL Actual Defl L/470
Attributes Section (in3) Shear(in2) TL Defl (in) LL Defl
Actual 11.00 3.90 0.50 0.32
Critical .8.71 0.35 0.63 0.42
Status OK OK OK OK
Ratio 79% 9% 79% 77%
Fb (psi) Fv(psi) E(psi x mil)
Values Ref.Value Fy 50000. 50000 .29.0
- Adjusted Values 30000 20000 29.0
Adiustments YP Factor, Lu 0.60 0.40
Loads Uniform•LL:320 --Uniform TL: 416 =A
Par Unif LL Par Unif TL Start End
H =80 0 12.5
160 1=240 0 12.5
240 J =360 0 12.5
Uniform Load A �{ _ "f''°t " t 7
3. r'''
R1 =6967 R2=6967
SPAN= 12.5 FTo—y . ' "
Uniform and partial uniform loads are Ibs per lineal ft. 7 Z!/4
r_
Pop—lop"—
LOCATION SEWAGE PERMIT NO.
TILLAGE
INSTA LLER'S NAME i. ADDRESS
A?I)m Rb)e- &s A46-Aru/L Mt"- Tf
6Ill LD-EIII OR aWNER
m S ac LAy C- )V� /4tJ
DATE PERMIT IS-S-UED,
DAT E COMPLIANCE ISSUED
c
c
'� UZ
v
. C
o
,r.
I i <
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
4240 Main Street Route 6A
Property Address
Thomas Shanahan
Owner Owners Name
information is
required for every Cummaguid (Barnstable) MA 02637 December 19, 2009
State Zip Code
page. Citylrown �
Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
Important:When
filling out forms A. General Information
on the computer, I r�rl
use only the tab 1. Inspector: V C� t �'
key to move your , :� co e3�
cursor-do not David D. Flaherty Jr., R.S.
use the return Name of Inspector -
key.
Flaherty Environmental services
Company Name r—
P.O. Box 81 vi r'
Company Address 2
Yarmouth Port MA 02675
Cityrrown State Zip Code
508-362-1657 S14713
Telephone Number License Number
B. Certification
I certify that I have personally inspected the sewage disposal system at this address and that the
information reported below is true, accurate and complete as of the time of the inspection. The inspection
was performed based on my training and experience in the proper function and maintenance of on site
sewage disposal systems. 1 am a DEP approved system inspector pursuant to Section 15.340 of
Title 5(310 CMR 16.000).The system:
® Passes ❑ Conditionally Passes ❑ Fails.
❑ Need Further Evaluation by the Local Approving Authority
December 21, 2009
Inspectors Signature Date
The system inspector shall submit a copy of this inspection report to the Approving Authority (Board
of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or
has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the
report to the appropriate regional office of the DEP. The original should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving authority.
****This report only describes conditions at the time of inspection and under the conditions of use
at that time.This inspection does not address how the system will perform in the future under
the same or different conditions of use. ( h
Vv
1b
t5ins•09108 Title 5 Official Inspection Form:Sub urface Sewage Disposal System•Page 1 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
4240 Main Street Route 6A
Property Address
Thomas Shanahan
Owner Owner's Name
information is
required for every Cummaguid (Barnstable) MA 02637 December 19, 2009
page. Cityrrown State Zip Code
Date of Inspection
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E/always complete all of Section D
A) System Passes:
® 1 have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
B) System Conditionally Passes:
❑ One or more system components as descr ed in the"Conditional Pass"section need to be
replaced or repaired. The system, upon mpletion of the replacement or repair, as approved by
the Board of Health, will pass.
Check the box for"yes", "no"or"not ermined" (Y, N, ND)for the following statements. If"not
determined," please explain.
The septic tank is metal and ov r 20 years old*or the septic tank (whether metal or not) is structurally
unsound, exhibits substantia nfiltration or exfiltration or tank failure is imminent. System will pass
inspection if the existing is replaced with a complying septic tank as approved by the Board of
Health.
*A metal septic tan will pass inspection if it is structurally sound, not leaking and if a Certificate of
Compliance indi ng that the tank is less than 20 years old is available.
❑ Y N - ❑ ND(Explain below):
t5ins•09/08 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 2 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
4240 Main Street Route 6A
Property Address ,
Thomas Shanahan
Owner Owner's Name
information is
required for every Cummaquid (Barnstable) MA 02637 December 19, 2009
page. Cityrrown State Zip Code
Date of Inspection
B. Certification (cont.)
B) System Conditionally Passes (cont.):
❑ Observation of sewage backup or break out or high static water level in the distri ution box due
to broken or obstructed pipe(s)or due to a broken, settled or uneven distribute box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipes)are replaced ❑ Y ❑ N ❑ (Explain below):
❑ obstruction is removed ❑ Y ❑ N ND (Explain below):
❑ distribution box is leveled or replaced ❑ Y ❑ ❑ ND (Explain below):
❑ The system required pumping more tha 4 times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with ap oval of the Board of Health):. '
❑ broken pipe(s)are replace ❑ Y ❑ N ❑ .ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
C) Furthe valuation is Required by the Board of Health:
❑ Co itions exist which require further evaluation by the Board of Health in order to determine if
t 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,
15ins•09108
Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
4240 Main Street Route 6A
Property Address
Thomas Shanahan
Owner Owner's Name
information is
required for every Cummaquid (Barnstable) MA 02637 December 19, 2009
page. CltyrTown safety and the environment: State Zip Code
Date of Inspection
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated w nd or a salt marsh
B. Certification (cont.) .
2. System will fail unless the Board of Health (and Publ' Water Supplier, if any)
determines that the system is functioning in a manne hat protects the public health,
safety and environment: .
❑ The system has a septic tank and soil absor ion system (SAS)and the SAS is within
100 feet of a surface water supply or tributary to a rface water supply.
❑ The system has a septic tank and SAS d the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and S and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS a the SAS is less than 100 feet but 50 feet or
more from a private water supply well"
Method used to determine distance:
This system passes if the well wa r analysis, performed at a DEP certified laboratory, for coliform
bacteria indicates absent and the esence of ammonia nitrogen and nitrate nitrogen is equal to or
less than 5 ppm, provided that n other failure criteria are triggered. A copy of the analysis must be
attached to this form.
3. Other:
D) Syste Failure Criteria Applicable to All Systems:
You must indicate"Yes" or"No"to each of the following for all inspections:
Yes No
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 cf 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
4240 Main Street Route 6A
Property Address
Thomas Shanahan
Owner Owner's Name
information is
required for every Cummaquid (Barnstable) MA 02637 December 19, 2009
page. Cltyrrown State Zip Code
Date of Inspection
❑ ® Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less
than '/2 day flow
B. Certification (cont.)
Yes No
❑ ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
El ® Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well.
❑ ® Any portion of a cesspool or privy is within,50 feet of a private water supply well.
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. '{This
system passes if the well water analysis, performed at a DEP certified
laboratory,for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered.A copy of the analysis
and chain of custody must be attached to this form.]
❑ - ® The system is a cesspool serving a facility with a design flow of 2000gpd-
10,000gpd.
❑ ® The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E) Large Systems: To be considered a large system system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large'systems, you must indicate eith 'yes"or"no to each of the following, in addition to the
questions in Section D.
Yes No
El El the s em is within 400 feet of a surface drinking water supply
t5ins•og/oe Title 5 Official Insp
ection Forth:Subsurface Sewage Disposal System•Page 5 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
4240 Main Street Route 6A
Property Address
Thomas Shanahan
Owner Owner's Name
information is
required for every Cummaquid (Barnstable) MA 02637 December 19, 2009
page. Cityfrown State Zip Code
ate of Inspection
❑ ❑ the system is within 200 feet of a tribut to a surface drinking water supply
❑ ❑ the system is located in a nitroge ensitive area (Interim Wellhead Protection
Area—IWPA)or a mapped Zo II of a public water supply well
If you have answered"yes"to any question in ction E the system is considered a significant threat,
or answered in Section D above the I e system has failed. The owner or operator of any large
system considered a significant threat u r Section E or failed under Section D shall upgrade the
system in accordance with 310 CMR .304. The system owner should contact the appropriate
regional office of the Depa nt.
C. Checklist
Check if the following have been done. You must indicate"yes" or"no"as to each of the following:
Yes No
® ❑ Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped,out in the previous two weeks?
❑ ® Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
® ❑ Were as built plans of the system obtained and examined?(If they were not
available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
® ❑ Were all system components, excluding the SAS, located on site?
❑ ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
® Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
,The size and location of the Soil Absorption System(SAS)on the site has
been determined based on:
Z ❑ Existing information. For example, a plan at the Board of Health.
® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5))
t5ins-09/08
Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
4240 Main Street Route 6A
Property Address
Thomas Shanahan
Owner Owner's Name
information is
required for every Cummaquid (Barnstable) MA 02637 December 19, 2009
page. Cltyrrown State Zip Code
Date of Inspection
D. System Information
Residential Flow Conditions:
Number of bedrooms(design): 6 Number of bedrooms(actual): 6
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 660
D. System Information
Description:
Number of current residents: 0
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No
Laundry system inspected? ® Yes ❑ No
Seasonal use?
a ❑ Yes ® No
Water meter readings, if available(last 2 years usage(gpd)):
Detail
Sump pump?
-
❑ Yes ® No
Last date of occupancy:
Date
Commercial/Industrial Flow Conditions:
t5ins-og/o8
Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17
i Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments-
4240 Main Street Route 6A
Property Address
Thomas Shanahan
Owner Owner's Name
information is
required for every Cummaquid (Barnstable) MA 02637 December 19, 2009
page' Cltyrrown State Zip Code
Date of Inspection
Type of Establishment:
Design flow(based on 310 CMR 15.203):
Gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? El Yes ❑ No
Water meter readings, if available:
D. System Information (cont.)
Last date of occupancy/use: 2009
Date
Other(describe below):
General Information
Pumping Records:
Source of information: real estate agent
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped:
gallons
How was quantity pumped determined?
Reason for pumping:
Type of System:
❑ Septic tank, distribution box, soil absorption system
❑ Single cesspool
l5ins-09108
Title 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 8 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
4240 Main Street Route 6A
Property Address
Thomas Shanahan
Owner Owner's Name
information is
required for every Cummaguid (Barnstable MA 02637 December 19, 2009
ty
page. Ci /Town ---- State Zip Code
Date of Inspection
® Overflow cesspool
❑ , Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner) and a copy of latest
inspection of the I/A system by.system operator under contract
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other(describe):
D. System Information (cont.)
Approximate age of all components, date installed (if known) and source of information:
unk
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
Depth below grade: 2.5
feet
Material of construction:
® cast iron ❑40 PVC ❑ other(explain):
Distance from private water supply well or suction line:
feet
Comments'(on condition of joints, venting, evidence of leakage, etc.):
joints in good shape venting through dwelling adequate, no evidence of leakage
Septic Tank(locate on site plan):
Depth below grade:
feet
t5ins-09/08
Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 9 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Forth-Not for Voluntary Assessments
4240 Main Street Route 6A
Property Address
Thomas Shanahan
Owner Owner's Name
information is
required for every Cummaquid (Barnstable) MA ' 02637 December 19, 2009
page. Cityrrown State Zip Code
Date of Inspection
Material of construction:
❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain)
If tank is metal, list age: years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
Dimensions:
Sludge depth:
D. System Information (cont.)
Septic Tank(cont.)
Distance from top of sludge to bottom of outlet tee or baffle
Scum thickness
Distance from top of scum to top of outlet tee or ba
Distance from bottom of scum to bottom of outl tee or baffle
How were dimensions determined?
Comments(on pumping recommendati s, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet inve evidence of leakage, etc.):
t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
M . ' 4240 Main Street Route 6A
Property Address
Thomas Shanahan
Owner Owner's Name
information is
required for every Cummaquid (Barnstable) MA 02637 December 19, 2009
page. Cltyrrown State Zip Code
Date of Inspection
Grease Trap(locate on site plan):
Depth below grade:
feet
Material of construction:
❑concrete ❑ metal ❑fiberglass 9 polyethylene El other(explain):
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee baffle
Distance from bottom of scum to bottom of utlet tee or baffle
Date of last pumping:
Date
D. System Information (con .
Comments (on pumping recomm ndations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet vert, evidence of leakage, etc.):
Tight or Holdi g Tank(tank must be pumped at time of inspection) (locate on site plan):
Depth belo grade:
Material f construction:
❑ c crete ❑ metal ❑ fiberglass ❑ polyethylene
❑ other(explain):
Dimensions:
Capacity:
gallons
t5ins-09/08
Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17
f
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
4240 Main Street Route 6A
Property Address
Thomas Shanahan
Owner Owner's Name
information is
required for every Cummaquid (Barnstable) MA 02637 December 19, 2009
page. CitylTown State Zip Code
Date of Inspection
Design Flow:
gallons per day
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping:
Date-
Comments(condition of alarm and float switches, etc):
*Attach copy of current pumping contract(required). I copy attached? El Yes ❑ No
D. System Information(cunt.)
Distribution Box(if present must be open )(locate on site plan):
Depth of liquid level above outlet invert
Comments(note if box is level and i tribution to outlets equal, any evidence of solids carryover, any
evidence of leakage into or out of x, etc.):
Pump Cha ber(locate on site plan):
Pumps i working order. ❑ Yes ❑ No
ffiirn-roe
TdW 5 Of xxd hWecbm Fam:&bm.faoe sewage DEPOsW systwn.Page 12 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
4240 Main Street Route 6A
Property Address
Thomas Shanahan
Owner Owner's Name
information is
required for every Cummaquid (Barnstable) MA 02637 December 19, 2009 page. Cltyrrown State Zip Code
Date of Inspection
Alarms in working order: ❑ Yes ❑ No
Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.):
Soil Absorption System (SAS) Cate on site plan, excavation not required):
If SAS not located, explain y:
D. System Information (cont.)
Type: -
❑ leaching pits number:
❑ leaching chambers number:_
❑ leaching galleries' number:
❑ leaching trenches number, length:
❑ Aeaching fields number, dimensions:
® overflow cesspool number: (2)
❑ 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.):
t5ins-09/08
Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17
f
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Forth-Not for Voluntary Assessments
4240 Main Street Route 6A
Property Address
Thomas Shanahan
Owner Owner's Name
information is
required for every Cummaquid (Barnstable) MA 02637 December 19, 2009
page. Cltylrown State. Zip Code
Date of Inspection
Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration (1) primary
Depth—top of liquid to inlet invert 24"
Depth of solids layer o"
Depth of scum layer 0"
Dimensions of cesspool 6'x8'
Materials of construction fieldstone
Indication of groundwater inflow ❑ Yes ® No
D. System Information (cont.)
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
Privy (locate on site plan):
Materials of construction:
Dimensions
`Depth of solids
t5ins-09/08
Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17
is
• Commonwealth of Mas
sachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
4240 Main Street Route 6A _
Property Address
Thomas Shanahan
Owner Owner's Name
information is
required for every Cummaguid (Barnstable) MA 02637 December 19, 2009
page. Cityrrown State Zip Code
Date of Inspection
Comments(note condition of soil, signs of hydraulic failure, level of pondin , condition of vegetation,
etc.):
------------
D. System Information (cont.)
Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to
at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate
where public water supply enters the building. Check one of the boxes below:
® hand-sketch in the area below
❑ drawing attached separately
AL
t51ns•09108
Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
4240 Main Street Route 6A
Property Address
Owner Thomas Shanahan
information is Owner's Name
information
required for every Cummaguid (Barnstable) MA 02637 December 19, 2009
page' Cdyrrown State Zip Code
Date of Inspection
I
. C
Z�l' 0+
Z - Rot �.
! t r
B - 3 /21
D. System Information (cont.)
Site Exam:
® Check Slope
® Surface water
® Check cellar
® Shallow wells
Estimated depth to high ground water: '11
feet
Please indicate all methods used to determine the high ground water elevation:
t5ins•09108
Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17
• .:� Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
µ 4240 Main Street Route 6A
Property Address
Thomas Shanahan
Owner Owners Name
information is
required for every Cummaguid (Barnstable) MA 02637 December 19, 2009
page' Cityfrown State Zip Code
Date of Inspection
❑ Obtained from system design plans on record
If checked, date of design plan reviewed: Date
® Observed site(abutting property/observation hole within 150 feet of SAS)
❑ Checked with local Board of Health-explain:
❑ Checked with local excavators, installers-(attach documentation)
❑ Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
hand augered to 11' no groundwater encountered
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
E. Report Completeness Checklist
® Inspection Summary: A, B, C, D, or E checked
® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed
® System Information—,Estimated depth to high groundwater
® Sketch of Sewage Disposal System either drawn on page 15 or,attached in separate file
t5ins•0908 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17
3
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