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Home My WebLink About4428 MAIN ST./RTE 6A(BARN.) - Health 04 s. �._.�.. _ ■■■■■■■■■■■■■eee■■■■■■■■■■ ■e■ ■■■�■■��■ eM■■e■ ■■ ■■■■■■■e■■■■e■■■■■ ■e■e MEN■e■■■■ ■■■■■■■■■■ ■■ ■■■e■■■■■■e■■M■e■■ ■■�e��e■■■e■■e■■■■■■■■■■■■eee■■■■■■■■■■■■�■■■e ■■■■�■eee■■■■■■■■ee■e■eeeee■e■eee■eee■■■■■eee■ ■■■eeeeeeeeee■■■e■eeeee■e■■■■ee■eee■eee■ee■e■■ ■■e■■�■■■ ■■■eee■ee■■■■eeeeee■eeee■ ■e■eee■ee■ ■■eeeeee■ ■eeeeeeeeeeeeeeeeeeeee■e■ ■■■eeeee■■ e■eeeeeeee■eee■eeee■eeeeeeeeee ■eee■eeeeeeeeeeeee■eeeeeeeee■■ ■■■e■E■■■■■■m■■eeeeeaeeee■■ee■eeeeeeeeeeeeeee■ eee■■■eee■■e■■■e�■■e■■e■e■■■■■■■e■■e■e■■■■■■e■■ eee■eee■eee■■■■■eeee■e■eee■■e■ee■■eeeeeeeeeeee ■■e■e■■■■■■■■■■■■■■■■■■e■■e■■■■ee■■e■■■■e■e■■■ ■eeeeeeeseeee■eeee■■■■■■eeeeee■■■�■■■eee■eeeee ■■■e■■eeeeeeeeeeeeeeee�eeeeeeeeeeeeeeeeeeeee■e ■■■■eeeeee■■eee■■■eeeeee■■■■■■■eeeee■■■■eeeeee eeee■■eee■■■eeeeee■eeeeeeeeeeee■eeeeee■eeeeeee e■eeeee■■■■■■■■ ■■■eeeeee■ee■eee■ee■■eeeeeee■ ■■eeeeeeeeeeee■ ■■■■■eeeeeeeee■eeeeee■■■eeee■ ■eeeeeeeeeeeeeeeeee■eeeee■eeeeeeeeeeeee■ee■eee eeee■■eeee■■eee■eee■■■■■eeeeeeeee■ee■■eeeeeee■ ■■■■eeeeee■■■eeeeee■eeeeee■ee■eeeeeeeeee■■ee■ ■■■■■eeeeeeeee■ _ ■ ■■ ■■eeeeeeeeee■■eeeeeee■ ■eee■■eeeeee■■■■ sqe -. o ■eeee■■■■eeee■e■ ■■■■■■■■eeeeee■■ - __ _ ___.__ _ _ _ . __ _ _ __:_ ■eeeaeee■■■■eee■ ■■■■■eeeeee■■■■■ ONE A� ■■■■■■■■eee■■■■■ ■eeee■■eeee■■eee■e■■■eee■■ �® ■e■e■ ■ e■■e■■e■■e■■ ■ eeeeeee■ee■■■e■eee■■■a■ - ■■■e■■e■■■■ee■■■ ■e■e■eee■■■ee■■■ r ■■ .. ■■■■ ■ ■■■■■■■■■e■■■e■■ e■■e■■■ee■e■e■■e ■■ ■e■■ ■■ ■■■■eeee■■■■■■■■ 0000mmommommoeeM■M■!■M■■■■e■e Mom-eeeee■■■■■E■ ME ommmmmoommomommommomm MENEM mommoommommommommmommmmomi MEN NONE No mommmmmoommmommommommm EMONSOMMMME MEEIN ME M M mmommoommmmmilmm INNS NNE MINEME MEME MONSOON NNE NOMEMENNE OMEN MEMO ONE mom mom mmmmmmmmmmmmmiii 111i moomm mom mmmmrmmimmmmmmmmmmmmmm MENNEN ME EMMIMMEM mom ommommmommmmmolimmmomm MENEM EMENE sommommommommoomm mommommommommom MENEM .,ME 0 ............... ...................... ::�C=. ■...... immom......�■.....■.....■.. � �� I, � — s �g��..,, C�- � by s n,�a- ;�. � n� -�G,�.� , i. 5 r�--� o n ��n �.s� � Commonwealth of Massachusetts 100243696 Asbestos Notification Form ANF-001 -- -- — --' i Asbestos Project# t E] Pro ject Revision ❑ Project Cancellation A. Asbestos Abatement Description 1.Facility Location: W. �y MICHAEL HENDERSON 4428 MAIN ST. Name of Facility Street Address p Instructions 1.All BARNSTABLE MA 02061 5083622430 sections of this form City/Town State Zip Code Telephone must be completed in SAME OWNER order to comply with MassDEP notification Facility Contact Person Name Facility Contact Person Title requirements of 310 Worksite Location: RESIDENCE CMR 7.15 and Department of Labor Building Name,W'ng,Floor,Room,etc. Standards(DLS) 2. Is the facility occupied?- p Yes ❑No notification requirements of 453 CMR6.12 3. Is this a fee exempt notification(city, town, district, municipal housing authority, state facility, or owner-occupied residential property of four units or less)? E Yes ❑ No MassDEP Use Only 4.Blanket Permit Project Approval,if applicable: Date Received Approval ID# 5.Non-Traditional Asbestos Abatement Work Practice Approval, 2.Submit Original if applicable: Approval ID# Form To: Commonwealth of 6. Asbestos Contractor: Massachusetts ASBESTOS MAN REMOVAL 929 STATE ROAD P.O.Box 4062 Boston,MA 02211 Name Address PLYMOUTH MA 02360 5082245500 City/Town State Zip Code Telephone AC000342 Contract Type: ❑Written Verbal DLS License# 7. El VIER E,PINEDA AS001291 Name of Contractor's On-Site Supervisor/Foreman DLS Certification# 8, JOHNNIE UTUMA AM000146 Name of Project Monitor DLS Certification# 9, GUERTIN&ELKERTON AA000173 Name of Asbestos Analytical Lab DLS Certification# 10. 6/4/2016 6/4/2016 Project Start Date(MM/DD/YYYY) End Date(MM/DD/YYYY) 7AM-2PM 7AM-2PM Work Hours-Monday Through Friday Work Hours-Saturday&Sunday 11. What type of project is this? ❑ Demolition R Renovation ❑ Repair ❑ Other- Please Specify: Revised: l l/13/2013 Page I of 4 J h Commonwealth of Massachusetts 100243696 Asbestos Notification Form ANF-001 � ..... Asbestos Project# ❑ Project Revision ❑ Project Cancellation A.Asbestos Abatement Description: (cont.) 12.Abatement procedures(check all that apply): ❑ Glove Bag ❑ Encapsulation ❑ Enclosure ❑ Disposal Only ❑ Cleanup Full Containment ❑ Other-Please Specify: 13.Job is being conducted: Indoors ❑ Outdoors 14.Total amount of each type of asbestos Containing materials(ACM)to be removed,enclosed,or encapsulated: 80 Linear Feet(Lin.Ft.) Square Feet(Sq.Ft.) Boiler,Breaching,Duct, Transite Pipe Tank Surface Coatings Lin.Ft. Sq.Ft. Lin.Ft. Sq.Ft. Pipe Insulation 80 Transite Shingles Lin.Ft. Sq Ft Lin.Ft. Sq.Ft. Spray-On Fireproofing Transite Panels Lin.Ft. Sq.Ft. Lin.Ft. Sq.Ft. Cloths, Woven Fabrics Other- Please Specify: Lin.Ft. Sq.Ft. Insulating Cement Lin.Ft. Sq.Ft. Lin.Ft. Sq.Ft. 15. Describe the decontamination system(s)to be used: REMOVE ASBESTOS IN FULL CONTAINMENT UNDER NAGATIVE AIR PRESSURE 16.Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2)(g): WET ASBESTOS AND DOUBLE BAG W/6MILL BAGS 17. For Emergency Asbestos Operations,the MassDEP and DLS officials who evaluated the emergency: Name of MassDEP Official Title of MassDEP Official Date of Authorization(MM/DD/YYYY) Waiver# Name of DLS Official Title of DLS Official Date of Authorization(MM/DD/YYYY) Waiver# 18.Do prevailing wage rates as per M.G.L. c. 149, § 26,27 or 27A—F apply to this ❑ Yes 0 No project? Revised: 11/13/2013 Page 2 of 4 Commonwealth of Massachusetts 100243696 L7-1 Asbestos Notification Form ANF-001 Asbestos Project❑ Project Revision ❑ Project Cancellation B. Facility Description 1.Current or prior use of facility: RESIDENCE 2. Is the facility owner-occupied residential with 4 units or less? F±] Yes ❑ No 3.SAME AS ABOVE SAME Facility Owner Name Address SAME MA 02061 5083622430 Cityrrown State Zip Code Telephone 4.N/A N/A Name of Facility Owner's On-Site Manager Address N/A MA 02061 5083622480 City/Town State Zip Code Telephone 5.N/A N/A Name of General Contractor Address N/A MA 02061 5083622430 Note:Temporary storage of Asbestos City/Town State Zip Code Telephone containing waste NA' material is only allowed at the place Contractor's Worker's Compensation Insurer of business of a DLS 99999999999999999999999999999999 9/9/9999 licensed Asbestos Policy# Expiration Date MM/DD/YYYY contractor or a transfer p ) station that is permitted by 6. What is the size of this facility? 2000 2 MassDEP and operated in Square Feet #of Floors compliance with Solid C. Asbestos Transportation & Disposal Waste Regulations p p 310 CMR 19.000 1. Transporter of asbestos-containing waste material from site of generation: [71 Directly to Landfill or To Temporary Storage Location/Transfer Station ASBESTOS MAN REMOVAL CO 929 STATE RD Name of Transporter Address PLYMOUTH MA 02360 5082245500 City/Town State Zip Code Telephone 2. If a temporary storage location/transfer station is used, list name of transporter of asbestos containing waste material from temporary storage location/transfer station to final disposal site: JOB ROLLOFF POB 609 Name of Transporter Address HAMPSTEAD NH 03839 6173871495 City/Town State Zip Code Telephone Note:Contractor must sign this form for DLS Revised: 11/]3/2013 Page 3 of 4 �! Commonwealth of Massachusetts F,002a3s9s _ Asbestos Notification Form ANF-001 Asbestos Project# ❑ Project Revision ❑ Project Cancellation nuun�auun NwNwca C.Asbestos Transportation& Disposal: (cont.) 3.Name and address of temporary storage location/transfer station for the asbestos containing waste material: ASBESTOS MAN REMOVAL CO 25 ADAMS ST. Temporary Storage Location Name Address BRAINTREE MA 02184 5082245500 City/Town State Zip Code Telephone 4.Name and location of final disposal site(asbestos landfill): TURNKEY LANDFILL WASTE MANAGEMENT Final Disposal Site Name Final Disposal Site Owner Name 90 ROCHESTER NECK RD Address ROCHESTER Ni 03839 6033390039 City/Town State Zip Code Telephone D. Certification "I certify that I have personallrm examined the foregoing and PAUL ILACQUA PAUL ILACQUA familiar with the information Authorized Signature contained in this document and PRESIDENT 5/23/2016 all attachments and that, based on my inquiry of those ��822 Date(MWDD/YYYY) individuals immediately AMR CO responsible for obtaining the Representing information, I believe that the 929 STATE RD PLYMOUTH information is true,accurate,and Address City/Town complete. I am aware that there MA 02360 are significant penalties for submitting false information, State Zip Code including possible fines and imprisonment. The undersigned hereby states that I have read the Commonwealth of Massachusetts regulations governing asbestos abatement (453 CMR 6.00 promulgated by the Department of Labor Standards and 310 CMR 7.15 promulgated by the Department of Environmental Protection), and that I am aware that this permit application or notification shall not be deemed valid unless payment of the applicable fee is made." Revised: 11/13/2013 Page 4 of 4 Commonwealth of Massachusetts _ W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 4428 Main Street Property Address Michael Henderson Owner Owner's Name information is required for every Ctrmm�a Td 0 Ma 02637 9-20-16 page. City(Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information sly �I g�j on the computer, use only the tab 1. Inspector: key to move your cursor-do not Brett Hickey use the return Name of Inspector key. B&B Excavation _ kCompany Name 374 Route 130 Company Address Sandwich Ma 02563 City/Town State Zip Code (508)477-0653 S113747 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ❑ Passes ❑ Conditionally Passes ❑ Fails ® Needs Further Evaluation by the Local Approving Authority 9-20-16 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage,Disposal System•Page 1 of 17 \I Commonwealth of Massachusetts L Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4428 Main Street Property Address Michael Henderson Owner Owner's Name information is Cumma uid Ma 02637 9-20-16 required for every q page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 s Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 4428 Main Street Property Address Michael Henderson Owner Owner's Name information is required for every Cummaquid Ma 02637 9-20-16 page. CityTTown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ® Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines.in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 4428 Main Street Property Address Michael Henderson Owner Owner's Name information is Cumma uid Ma 02637 9-20-16 required for every q page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal 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 must be attached to this form. 3. Other: A permit dated 6-27-84 shows the septic system at 4428 Main Street to be permitted for 4 bedrooms and the dwellings have 6 bedrooms. The system appears to be large enough to accommodate 6 bedrooms but this must be decided by the Town (per conversation with Board Of Health Agent). D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts v Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 4428 Main Street Property Address Michael Henderson Owner Owner's Name information is required for every Cummaquid Ma 02637 9-20-16 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ' ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system'must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply .❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA)or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 I Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °w 4428 Main Street Property Address Michael Henderson Owner Owner's Name informatifor every qon is required Cumma uid Ma 02637 9-20-16 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ❑ ® Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 (permit) Number of bedrooms(Actual) 6 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): No design flow given bins-3f13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 4428 Main Street Property Address Michael Henderson Owner Owner's Name information is Cumma uid Ma 02637 9-20-16 required for every q page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage See below 9 ( Y 9 (gpd))� Detail: 2014-26,000gallons 2015-20,000gallons Sump pump? ❑ Yes ® No Last date of occupancy: Current Date Commercial/Industrial Flow Conditions: Type of Establishment: NA Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M5 4428 Main Street Property Address Michael Henderson Owner Owner's Name information is Cumma uid Ma 02637 9-20-16 required for every q page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Pumper driver Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1500 gallons How was quantity pumped determined? Tank size Reason for pumping: Maintenance after inspection Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4428 Main Street Property Address Michael Henderson Owner Owner's Name information is Cumma uid Ma 02637 9-20-16 required for every a page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1984 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 13" feet Material of construction: ❑ cast iron ❑40 PVC ❑ other(explain): Distance from private water supply well or suction line: Town feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): Depth below grade: 3"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 Sludge depth: 9 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 4428 Main Street Property Address Michael Henderson Owner Owner's Name information is Cumma uid Ma 02637 9-20-16 required for every q page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 27 Scum thickness 4 Distance from f 6 to o scum to to of outlet tee or baffle P P Distance from bottom of scum to bottom of outlet tee or baffle 11" How were dimensions determined? Measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank was in working order at time of inspection with liquid level equal to outlet invert. Tank was pumped after inspection for maintenance. Grease Trap (locate on site plan): Depth below grade: NAfeet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle. Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4428 Main Street Property Address Michael Henderson Owner Owner's Name information is Cumma uid Ma 02637 9-20-16 required for every 4 _ page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: NA Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 4428 Main Street Property Address Michael Henderson Owner Owner's Name information is Cumma uid Ma 02637 9-20-16 required for every q page. CitylTown State Zip Code Date of Inspection D. System Information (cost.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 11 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.): D-box is in working order at time of inspection with liquid level equal to outlet invert. No sign of back up present. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No" Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): NA * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4428 Main Street Property Address Michael Henderson Owner Owner's Name information is Cumma uid Ma 02637 9-20-16 required for every q page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number. (2) 6'x6' ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: El 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.): Leaching was in working order at time of inspection with no sign of hydraulic failure. Both pits had 2' of standing water when inspected with not high staining. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration NA Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 1.Z Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 4428 Main Street Property Address Michael Henderson Owner Owner's Name information is Cumma uid Ma 02637 9-20-16 required for every Q page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: NA Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 4428 Main Street Property Address Michael Henderson Owner Owner's Name information is Cumma uid Ma 02637 9-20-16 required for every q page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately HOUSE e. c Al,18' 131 17 C4=27. A2-24' B2 2i` A3-44' 03-6W BM45' 2 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4428 Main Street Property Address Michael Henderson Owner Owner's Name information is Cumma uid Ma 02637 9-20-16 required for every Q page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 18 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: No perk test was on file for property but adjacent properties perk test shows GW at 18' with and adjustment of 11' showing bottom of SAS is above GW elevation. ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Information at Board of Health Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4428 Main Street Property Address Michael Henderson Owner Owner's Name information is Cumma uid Ma 02637 9-20-16 required for every 4 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 Health Master Detail Page 1 of 1 x`Y �, Logged In As: TOWN\health Health Master Detail Monday,September 26 2016 Application Center Parcel Lookup Selection Items Parcel Septic Perc Well Fuel Tank Parcel: 351-043 Location: 4428 MAIN ST./RTE 6A(BARN.), Barnstable Owner: HENDERSON, MICHAEL S Business name: Business phone: J Rental property: ❑ Deed restricted: ❑ _ Number of bedrooms : _ 7 Contaminant released: ❑ Fuel storage tank permit: ❑ I Save Parcel Changes ( � Return to Lookup) Parcel Info Parcel ID: 351-043 Developer lot: Location:4428 MAIN ST./RTE 6A(BARN.) Primary frontage:261 Secondary road: Secondary frontage: village:Barnstable Fire district:BARNSTABLE Town sewer exists at this address: No Road index:0949 351043_1 '" Asbuiit Septic Scan: Interactive map 351043_2 � ' Town zone of contribution:AP (Aquifer Protection Overlay District) State zone of contribution:OUT Owner Info owner: HENDERSON, MICHAEL S Co-owner: streets:PO BOX 301 Street2: city:CUMMAQUID state:MA zip: 02637 country: Deed date:9/29/2010 Deed reference:24867/145 Land Info Acres: 1.50 use: Two Family zoning:RF-2 Neighborhood: 0108 Topography:Level Road:Paved utilities:Public Water,Gas,Septic Location: Construction Info[Budding NdYear Buil Gross Areaklvinq Are Bedrooms Bathrooms 1 11660 K867 P424 18 Bedroom 3 Full-1 Half Buildings value:$219,500.00 Extra features: $16,200.00 Land value: $256,300.00. http://issgl2/intranet/healthMaster/HealthMasterDetail.aspx?ID=351043 9/26/2016 NoVzv... Fmc en.00......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ` ........O F....................................... I � liration for Bispvii al Works Tonstrnr#tnn unit# Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: 1hivAl J-'A .....--•---.....-_ ...........................•----............................ ..........•-•--•---•--------.........---....-•--•-.......--•----•---......------......----....-•-- �/� Location-Addrea 0 or Lot No. ............................................. Owner Address -- ---•--- �t rs�ri - N. ............ ................. ----..•.......---------------........-----........... Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria fixtures ........................................................... Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter------------_--- Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fs. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a' .....................................................................................................•----•.....-----•.... D Description of Soil S"420_.."' 1y.t .---• .0 ---------'"`�"rr's=tl.----�Alt p {I"ti............................ x U .-------------------•---••-•----•-••---•--•...---...•--••-•-••••---•-•-----.........-----------••--....--•--•-------•-••-•--•--•--•••-------•-----••----••-...-•-•-•••-•-•-•-••.........-•-••-•-•------- w 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 TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issu d by the board of health. .. 'i Date Application Appro . i Date Application Disapproved for e f ollo ng reasons---------- -----------------------•-------- ------------------------------------------------------------- .............................................................. .................................. .................................. .............................................................I Permit 140.................. ....................... Issue&.....---•-----•••.Date------------------Date...... THE COMMONWEaLTH MASSACHUSETTS BOARD O Q EALTH ,. ..........................................OF..................................................................................... Tnrtif iratr aaf Toutpfittnrr TI 4�1 OICARTIFY, That the Individual,Sewage Disposal System constructed ( ) or Repaired 4r Inst er at.......... •• ....•-- .............. . //�� has been installed in accordance with the provisions of T F r f The State Sanitary Co„e as bed in the application for Disposal Works Construction Permit No.. ---------------- dated--'p-�---- -- - - ........--------------• THE ISSUANC OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARAN E THAT THE SYSTEM' 19l11 F�J TION SATISFACTORY. DATE = ....... _ ................................................. Inspector THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 'I' { OF................... 00p, No....................1 FEE._•✓.................. Fat? r Tonstrnr�tnn rrnttt Permission is herebyranted 1 .-_- � .... g .................... to Construct ) or.Repair 9; n Individu Sewag iszu_w.si� atNo. .....-• --------------------------------------------•---•-........--.... Street as shown o/2�/; lica for Disposal Works Construction Permit ............. Dated.......................................... -----------•---• -- -------------...-...................................................... _ DATE--- A- ............................................. Board of Health FORM 1255 A. M. SULKIN, INC., BOSTON No..... S.... ... Fxs....... 5............... THE COMMONWEALTH OF MASSACHUSETTS ,oJ3 BOAR® OF HEALTH �5 OF.. Appliraativaa for Diupuual Works Tomitrurtion runfit Application is hereby ;nade for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: $ M,4,,ry SV, #A/4, "/Y;9 P,1--7�N 5—X,4�C F ................... .........................•...._...................••....._ Location-AddreiA O -- ..... ...... or Lot No. -�/- / �C i.Ji GLshry m .................................•---•--............-•----•--••-•--- -•-••----.......-----...--------•--._.....--••-----------..................•••....•-----......... Owner Address a ----•'--'-'........... .�.._..-_x- .......................................... .....................................•--------------............................................. Installer % Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............. ..............................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............... ........... No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ------------------------- ---------•------------------.------------------------------------. w Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter.........---.... Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter....---...--........ Depth below inlet.................... Total(,leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date------------------....--------.......... Test Pit No. 1................minutes per inch Depth of Test Pit--.................. Depth to ground water......---.---........... 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water----.........--......... C+ --------'------------------------------"--------.......... ..... .......------•••• f O Description of Soil .� d® ?.f° '�----- Z1vv.... /�`•......................... x w UNature of Repairs or Alterations—Answer when applicable............................................................................................... ----------------------------••-------------------------------------•------------------------------------'-.....••-••-''----. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with Tithe provisions of L I L of the State Sanitary — p S S Sa tary Code The undersigned further Y place agrees not to lace the system in operation until a Certificate of Compliance has been issu d by the board of health. _m ��... ---------------------- ze . Application Appro ---- --------- ---- --• ----- - ` ,�-••-.- Date Application Disapproved for e f ollo ing reasons:----•----------------------•-•--•----------------------. -------------------------------------------------------------------------------------------------------------------- DateNo......................................................... Issued....................................................... A--q �4 5clit--L ' s6 •40'46" - 76 „� ssss' LOCUS Notes: - ASSESSORS MAP 351 PARCEL Z ],All work to be performed in accordance with Massachusetts State Building Code , LOCUS IS WITHIN FEMA FLOOD ZONE C AS 780 CNM Seventh Edition,or as directs b authorities SHOWN ON COMMUNITY PANEL#250001 d y having local jurisdiction. i0001D DATED 7/2/1992 i ZONING SUMMARY 2.Contractor to secure all permits,and to arrange for all required inspections on site. ZONING DISTRICT: RF-2 RESIDENTIAL DISTRICT MIN. LOT SIZE 43t560 S.F. 3.All debris to be disposed of legally off site.Completed work to be in usable and 1 I MIN. LOT FRONTAGE 20 1 o clean condition. I 1 MIN. FRONT SETBACK 30' MIN. SIDE SETBACK 151 v 4.Patch and all 1 MIN. REAR SETBACK W. Replace all components here tem temporarily removed ed duringdingwhere affected Refinish areas as _I I MAX. BUILDING HEIGHT 30' I 1 SITE IS LOCATED WITHIN THE OLD KINGS P P P Y 1 I required to match existing. 1 MAP 351 PCL 43 wcHwnY wsroRlc DISTRICT - / 70,883f SF OR 1.62 AC SITE IS LOCATED WITHIN THE AQUIFER 1 1 PROTECTION DISTRICT 5.Contractor to coordinate his work with utility companies and other third patties I I which may need to become involved in the completion of the work. I ' OWNER OF RECORD. 1 � 6.Cost of all permits and utility company back charges to be by the Owner,unless • I 1 - MICHAEL S. do PATRICIA F. HENDERSON otherwise specified in the Owner-Contractor agreement. I 1 4428 MAIN STREET 1 1 CUMMAOUID. MA 02637 ....:.__...__ j 1 DECK I li REFERENCES / 1 - DEED BOOK 8024 PAGE 279 I BARN"G PLAN BOOK 354 PAGE 81 1 � 1 27'a NOTE ExisT. I f m POOL PLAN TO BE USED FOR PROPOSED WORK ONLY,NOT TO ° BE USED FOR LOT LINE STAKING OR ANY OTHER PURPOSE. z M loci y PORCH N PLAN OF LAND 1 / 1 / SHOWING ADDITION I I PROPOSED ADDITION - IN - � I I i CUMMAQUID MA 1 I DECK PREPARED FOR - +I 1 1 1 I WETINc DWELLING MICHAEL HENDERSON � l - .a / y4428 A .. .. I I 2 6o•m DATE:' JUNE 23, 2010 / 1 1 1 Seale:l'-20' 1 I 1 0 10 20 30 40 50 FEET / - off 508-362-4541 I IOz 508-362-9860 1 I downco e.com 1 � JI p /M�o List of Drawings: `DANIE 9 WO cape e,Idineering,14C . / 0A civil engineers Site 1 - Site Plan t a,.409s) land surve ors N77.15'52"w "�,4ao Y Al - Plans and Sections ' S72'ai'37'E 112.96' 939 Main Street ( Rte 6A) ! 148.23' (i t3-%a YARMOUTHPORT MA 02675 - Elevations ROUTE 6A — MAIN STREET DATE DANIEL A. OJALA, P.L . A3 - Balluster Details DCE IDs-zts VARIABLE WIDTH - STATE HIGHWAY 09-219 t+ENnEasoa.Dwc -- _ I i yJ;t 1y50l;D= B-II-10 Y _.._...__...-• � �I�.. 1�ndre s R. Architect a5 River View lane. Cent-aL M.—.cI uls m M632 •T leph—(508)79049M Site Plan Henderson Kesi4ence Site 1 4428.-aim Street,Cummaquid,MA 02637 --:(ai:arr¢Ee::�nMs:TYv- __ 3_TANQIN4' SEAM....ERPPEZ ea?F 16 fit,MIa.:. ' —... ' '_:rszte€N_Rc2pE...�L615HIN4 -litTACN"..-V,/6-6'CaiNLEis 52E4G= ^-=4.c.. n --EXISTING WAW 51D.ING .` r '4 he's@-EIaEQG LIt•Li BAD'.. --}- - 6-H2-31Gfi __INStALL-HEWN-°.WAtER AND IGE': MOI SfURG: "' __Z,�'[��13l.1=1�.�I.Q ,,, :-HACitLg:_.:IBSt=E¢ 4NIttGI:£s; R-t uP-$XISTNG - �� :1bli'l :L 7'2=L'AYi¢5:..`o'+lEE- 'NEW:_RUOR. 15-T.6&.E.B___. _SNEATak1a.G-.._ 4LIlNP�S"UP f -- - GDY_P.nOE"SNBATHING:'_.. _ ---- x�'-=-@4 WMOTFIARV POST -- -- Ix3---6`0 G• ------=CITtN=�b=1ELIZ- .. .. + I-PAy.E6- @oIKQ: @0 ED •- . 14' New .XDRIt100 - r I _ 1.1(�_-_---_-_-_-__I�MW-91Z-.SCA-__--_ , II (n 5S0" -.12�Plk. '¢ONO TUBE'riep, 1. 'I Yo 4'-O' DELOW 6CNaE.Ttr. A GUt EMIStIN4 V6UC'Ai:0.E0'R I 10!O° SYa¢E..b.EeH EDGE AFTEn. IHSUGAa0µ. JARO¢_,RETA0.DANY ' _ .. -. _ WH.TFr HEW WALL INS'rAU.ED y3 .510E ORWH' --- .y� � N,OQyI 'TTZIM ! 1 NEW.WAI.l_LIVE ,O - :EXI5TIN4 LEIANG I +. .. - � -�OP.:B&Ast (3c 2�10l _ =}�y=GXeSUN WALLBOAR0�4µ15H.-PALN:fHQ.-StP - i= t- EYIf.11NG' OPENING. 'f9.Kl:tLN EIJ A"12 is W v. � �.E%16TING WALL _LAO-----PIEf2— FOU"12ATIQN_--.-".--- X41 � III __:RELOL,iYE DOO Ii _.... :Zxlo=l cns¢ h0[SD_ 6oLTE0 - -. 19_'2" --3nlir+-E$=T6 �c,sra4GEaED r - �.F��=Mtq!� IN"5114R�F! CU16TING �kRA�5,i/F141$7 EIN76N ELm 2-: � .: � r-5•nmc _16-0.G' - >BHfnpStllNr< a LEH -:"k)<Il�Q-.ANR NAiI�.Q.' �L"n�n r�,..•c+s_—_3xP:-- .`NASE��hat�$ •—_.•.NEW U4120NL.: "BA2L_Ui 2u1.At10N- YAPOe=¢(ilAEQPN_C_i1DE_UP. U11 PLAN. 'FI.C)O� FIZAti'IING _.KBAET.PhPE2.51RE;=6tAPkED I - _ ?a-:1015T. .W/"W.IRE -SOPPoe {'LAN . NEW AP_DITI'ON .T0 KIT-Q4W �C�1-Ez__:%4"=!'-0� 6.M11. .P_Ol_YE$YLENIA--_SHEbt $ZON[..:MCID:SLkH - - - --- - - - - -•— s�P9tc1TEP wH!-r& —— -Iill�iPil ..WALL. BELOW O ;_4u7tER DOWNfPOUT' o �' ILOOF .1014T3® 16'a.G., yam.. ^`' AA- .«�47q�O aT 6AN EI VYLTION• . ..��ID�I ��.k?._.�_ _ _ LaNCRT3�=1,8 RAY ill'G-G61 LING JOISTS,'-. INC, Andrejs R. $trikis Architect ' - 85 River vew lane, Centerville,Mnssachusetts 02632 •Telephone(508)790.Okb Plans and Sections . Henderson Residence A 1 4428 Main Street,Ctlmmaquid,MA 02637 63 NOT$D B�11-10 hRS r' j i .'.. - _-a"ovE::-.-tA6NT=cAa Rca o rEm TTA 'MF - I 71 ------------- EM Iml - - �IE6TWINDoaJ.=BDRED-=::TO'.4AAT[N"�EXISTIRG-1:8�ii-%{=0-NON• `t ' South Elevation (Facing Old King's Highway) East Elevation (Facing Driveway) Scale:V4"=1'-0" Scale:%."=1'-0" 15.fING"=Y1INDTYU-TQ-BE-REFUR81lJiED='-1=A 4_O_NicN;'NON i I ® f 1 i DY_Hb. I FFMFFM II�II �2lTi2El =E1t15"fl N G .DooR_ 'C6"BE=RE--PCF- - _hbbt 1 i 21e T'0.1 L 4ft-RELOCATED.__.__ -.__u G.0 ADD_Tf0-K1—__ I n . North Elevation "-P""-- _ West Elevation D Scale:'A"=P-0" N4CER"': 'GF_/.NQI:E D. 1 , __ - __ _ —. _ Scale:''/d'=P_0„ - :_nEYLlAPPER_'RoaF07LN 2Yl--LEaot�wHl-tE ... ► IWIN f±OW Z�6�><4=0�NOM, PELLA_OC'CL7•• .. ___ -AIEW Si":-4 P1:'_feEWM DOOR;WOOF, - PX1ERIOR viNIT.E._.NVLUDNf'r_-..'G/L_9E51GN,.TtP• � 7.2EL�R-��.fTLE'TO"AIAfCN.._EKIS.rI N_G-' ASA nd r kis ` - OAc" SNIN4LES�.NATUKfi'L,_'EO NA'[EN`EX.ISTING" A r A chR.c$t i r --OF WORK .. _: t • - .. River View Iatle, CentervUle,Muad,ueetld 02632 •telephone(SORT 79lL09N�' ... - - �-P_3.KI¢f.'.T4=.COVER:CONce&TE'FouN0 At10N • ...:,- 85 ' • -' .P.A_W_L=£PAGE_YEKT_.P.Egldi_DE - _ Elevations ° t Elevation of Addition Elevation of Addition Henderson Residence A2 ; 1 4428 Main Street,Culnma uid,MA 02637 Scale:''/e"=1'-0" Scale:/d'=1'-0" q 4'--1'0' 6.24•10 4%" 7 4 i • i �a LN �i 2A hm IT all i t Aq q 19 r Z V i ' I y I � n I{ I I` N L.' I i i I If � I , . b • = 4 � to N A M� i k i i I i i i I I II I 1 I I - � yae,es 1.6 A n _ p „ a � N N• S 4g� C Q ,iy y N T ,Q W � J W