HomeMy WebLinkAboutB-04-253X
as
ONE & TWO FAMILY ONLY - BUILDING PERMIT
APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING
Town of Yarmouth Building Department
1146 Route 28 - Yarmouth, MA 026644492
Tel: (508) 398-2231 x261 • Fax: (,08) 398-2365 FAX ,5D9 s',
Office Use onN [ < pfanninn t;iviref wArm,f;pk -: Ace'ecc n r en s .6 i U. : q = -::. ::.:. _. /
t 6 }�}+ 4 I �� 4 ti Y
mltNo � O&S piartxvp ?
Permit Fee $124'y " Endor9i ment Date.
Pet
-
•' � Deposit Rea • r�' Retordirig OatO 7 14 f�iopert)7 bunensron5 °` , ,:" " `: ,� � i
c d $lDate p an No {` < t
Net Due..` ^ $1�1, ..' - `y `. ,. •.
Other . _ L6tAre'a(s@ - Ront3ge(ft), , LotCovPrege;;
- r '� ' 7fils;Sectlotl: f6tOffic2:
Buildin ,P.ermit-Number ' _,,,T;=i �.�. H.
.Da e'Issued'
3Y
Signature t�F y ,pax .��ii 2+`,2' �' ` ^ Certlticate of Occupancy`
[�
Bultling Ofl,cfap�,
Section* '1°=6te.Ihf6iTn"or
Use Group: R-4 Type: 5 8
1.1 Property Address:
1.2 Zoning Information:
� �r NaLI✓ �,��
_ . �Z z5 RCS.
Zoning District Proposed Use
1.3 Building Setbacks (it)
Front Yard :
Side Yards
Rear Yard
Required
Provided
Required
Provided
Required
`Provided
O�
30.7 3f)-6
/.r /;
zc.4 37X(�
1.4 Water Supply (M.G.L. c. 40. S 54)
Pu lic Private
1 5 Flood'Zon6Tnfomtatron ,: l L'pmmentS ; ` n >
Zone"_
Section 2'- F'tope:rty Ownership/Authorized-'Agent:
r
-
2.1 Owner of Recof (.or+A (e
`�:
/��lwao Al �leem -Trps' e� � �vS� Nlot barn ist
Name (print) Mailing Address O/ 7.6 Z
o� ? 6 -
Signature Telephone
2.2 Authorized Agent:
Name Mailing A
7-7y - 6-36-C7o9
Si nature Telephone h
Section 3;= Construction-SerVicee
Q
3.1 Licensed Construction Supervisor. juv
Applicable ❑
Z I U-iliawl S A vE� LvAnks- 6 Z
License Number
OG4pas6
Addres /t
Expiration Date
/d d�o3
Si atu ephone
3.2 Reoistered:.Horne Improvement Contractor.
Company Name
Not Applicable ❑
Address
License Number
Signature Telephone
Expiration Date
a-r5.99
Iof2
nvro
11
Workers Compensation Insurance affidavit must be completed and submitted with this application. Fa— it e
to provide this affidavit will result in the denial of the Issuance of the building permit. I
Signed Affidavit Attached Yes .&... No ..........
Sectioir 5Drip n :o ,proposed f1Vo`rk (theca a plfctitej
New construction No. of Bedrooms --!S—I No. of Bathrooms
Existing Bldg. ❑ 1 Repair(s) ❑ I Alterations ❑ 1 . Addition ❑ I .
Accessory Bldg. ❑ Type Demolition Other
Brief Description of Proposed Work:
Item Estimated Cost (Dollars) to be
. completed by permit applicant
1. Building
2. Electrical
3. Plumbing / Gas
4. Mechanical (HVAC)
5. Fire Protection M
6.Total =(1+2+3+4+5)
7. Total Square Ft. (new houses & adcoors)
U1
Specify:
Check Below
❑ Conservation-Commisslon Filing
(if applicable)
❑ Old Kings Highway & Historical
Commission approval
(if applicable)
as owner of the subject property
hereby authorize it/�11e/` /C/h� d'r�5�tr ir�� to act on
my behalf, in all matters relative to work authorized by this building -permit application.
u
Signature of Owner
Date
I,'d`�'�'�� , as Owner/Authorized Agent
hereby declare that the statements and information on the foregoing application are true and accurate,
to the best of my knowledge and belief.
Signed under the pains and penalties of perjury.
A�'TL /
Print name / w
of
D to
TOWN -'OF YARMOUTH
BUILDING DEPARTMENT
CONSTRUCTIONS SUPERVISOR FORM
PLEASE PRIM}
_job'Location: A W 4H6t' ZWD •
Number : Stre
Owner of Property:
Village
Construction Supervisor: �AazrT �C��Y b�f!x5>3 7�i•�-836—o7og
Name License No. Phone No.
Address:
Licensed Designee:
(if other than Supervisor) Name
2.15 Responsibility of each license holder: .
License No.
2.15.1 The license holder shall be fully and completely responsible for all work for which he is supervising.
He shall be responsible for seeing that all work is done pursuant to the state building code and the drawings
as approved by the building official.
2.15.2 The license holder.'shalI be responsible,to supervise the construction, reconstruction, alteration,
repair, removal or demolition'involving the structural elements of building and structures only pursuant to
the state building code.and,altother applicabfe,laivs of the commonwealth, even though he, the license
holder, isnot the permit holder but only a subcontractor or contractor to the permit holder.
2.15.3 Tlie license holder shall immediaiely notify the building official in writing of the discovery of any
violations:which are covered by the building permit.
2.15.4 Any licensee who shall willfully violatesubsections2.15.1, 2.15.2 or2.15.3 or anyother section of these
rules and -!regulations and any procedures,'as amended, shall be subject to revocation or suspension of
license by the board. ._..
2.16 Al building permit applications shall contain the name, signature and license number of the
construction supervisor who is to supervise those persons engaged: in construction, reconstruction,
alteration; repair, removal of demolition as regulated by section 109.1.1 of the code and these rules and
regulations. In the event that such licensee is no longer supervising said persons, the work shall immediately
cease until a successor license holder is substituted on the records of the building department.
2.17 The license holder shall be responsible for requesting all required inspections. Failure to do so may
be deemed a violation of the permit conditions.
I have read and understandmy responsibilities under the rules and regulations for licensing construction
supervisors in accordance with :section 109.1.1:of the state building code. I understand the construction
inspection procedures and'.the specific inspection as called for by the building official.
INSURANCE COVERAGE: ..
I have a current ' bility insurance policy or its substantial equivalent which meets the requirements of MGL Ch.152
Yes No (� i
If you have checked, please Indic'ple the type coverage by checking the appropriate box. I
A liability insurance policy 19 Other type of indemnity 1:1 Bond
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by
Chapter 152 of the Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
Signature of Owner or Owner's Agent Owner Agent
Signature: Buildinz Official Approval:
,for Office Use Only
Permit No.
Date TOWN OF YYA1RMOUTH
AFFIDAVIT
Home Improvement Contractor Law
Supplement to Permit Application
MOL c. 142A requires that the 'reconstruction, alteration, renovation, repair, modernization, conversion,
improvement, removal, demolition or construction of an addition to any pre-existing owner -occupied
building containing at least one but not more than four dwelling units or structures which are adjacent to
such residence or building' be done by registered contractors, with certain exceptions, along with other
requirements.
Type of Work: Est. Cost
Address of Work
Owner Name:
Date of Permit Application:
I hereby certify that:
Registration is not required for the following reason(s):
Work excluded by law
Job under $1,000 _
Building. not owner occupied
Owner pulling own permit
Other (specify)
Notice is hereby given that:
OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH
UNREGISTERED CONTRACTORS FOR APPLICABLE HOME
IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION
PROGRAM OR GUARANTY FUND UNDER MGL c. 142A.
Signed under penalties of perjury:
I hereby apply for a permit as the agent of the owner:
Date Contractor Name Registration No.
R'
Notwithstanding the above notice, I hereby apply for a permit as the owner of the above
property:
Date
Owner Name
The Commonwealth of Massachusetts
Department of Industrial accidents
®fJled cl/®vcsdfg��®s
600 Washington Street
Boston, Mass. 02111
Workers' Compensation Insurance Affidavit
cit%' Y—AAK= QVJ Iw W tl phone N 77�/-93fe-o7og
1 am a homeowner performing all work myself.
O 1 am a sole proprietor:rd have no one working in any capacity
am an eriiplover pro% iding workers' compensation for my employee's working on this job.
..
r
r
I am a sole proprietor. general contractor. or homeowner (circle one) and have hired'the contractors listed below mho have
the following workers' compensation polices:
comnanv name:
address,
city nhnn N•
insurance co. p4liev M
Failure to secure coverage as required moder Section 25A of MGL 152 eat lad to the imposition of criminal penalties of a flee ap to SI.S00.00 and/or
one years' Imprisonment as well as civil penalties to the form arm STOP WORK ORDER and ra tine of 11100.00 a day against me. I understand that a
copy of this statement may be forwarded to the Office or Investigations of the Du for coverage verification.
I do -hereby cerrify� anftAe pains �n�e s o ury that the information provided above is true and correct
Print name
ofricial use only do not write in this sees to be completed by city or town official
city or town: YARMOUT$
check if immediate response is required
contact person:
permiNieense N nBuilding Department
❑Licensiog Board
261 ❑Selectmen's OMce
(508 3 ❑Health Department
phone N; _ 98-2231 eat. nOther
TOWN OF YARMOUTH
BUILDING DEPARTMENT
1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 260
PLEASE PRINT:
DATE:
JOB LOCATION:
. NAME
"HOMEOWNER"
NAME
PRESENT MAILING ADDRESS
HOMEOWNER LICENSE EXEMPTION
STREET ADDRESS
HOME PHONE
SECTION OF TOWN
WORK PHONE
CITY OR TOWN STATE ZIP CODE
The current exemption for 'Homeowner' was extended to include owner — occupied dwellings of one or two units
and to allow such homeowners to engage an individual for hire who does not possess a license, provided that such
homeowner shall act as supervisor. (State Building Code Section 108.3.5.1)
Definition of Homeowner.
Person(s) who owns a parcel of land on whichche / she resides or intends to reside, on which there is or is intended
to be, a one or two Family attached or detached structure assessory to such use and / or farm structures. A peison
who constructs more than one home in a two year period shall not be considered a homeowner; such "homeo Wner"
shall submit to the building official, on a foam.acceptable to the building official, that he / she shall be mWgnsa'ble for
all such work performed under the building permit. (Section 108.3.5.1) .a
The undersigned 'homeowner' assumes responsibility for compliance with the State Building Code and 'other
applicable codes, by-laws, rules and regulations.
The undersigned 'homeowner' certifies that,:he / she understands the Town of Yarmouth Building Department
minimum inspection procedures and requirements and that he / she will comply with said procedures"'and
requirements:
HOMEOWNER"S SIGNATURE
APPROVAL OF BUILDING OFFICIAL
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent, which meets the requirements of MGL Ch.142.
Yes ❑ No ❑
If you have checked yes, please indicate the type coverage by checking the appropriate box.
A liability insurance policy ❑ Other type of indemnity ❑ Bond ❑
OWNER'S INSURANCE WAIVER I am aware that the licensee does not have the insurance coverage required
by Chapter 142 of the Mass. General Laws and that my signature on this permit application waives this requirement.
Signature of Owner or Owner's Agent
Check one:
Owner ❑ Agent ❑
h:homeownrlicxxemp
TOWN OF YARMOUTH
1146ROUTE28 SOUTHYARMOUTH MASSACHUSETI'5026644451
Telephone (508) 398-2231, EXL 261 — Fax (508) 398-2365
BUILDING DEPARTMENT
DEMOLITION DEBRIS DISPOSAL AFFIDAVIT
BUILDING
ELECTRICAL,
GAS
PLUMBING
SIGNS
Pursuant to M.G.L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 111.50
I hereby certify that the debris resulting from the proposed work/demolition to be
conducted at 4 w HALF- Rpn,0
work Address
is to be disposed of at the following location; b1� C_
ki Said disposal site shall be a licensed solid waste'. facility as defined by M.G.L.
Chapter 111, Section 150A.
fJ o
Signature of 'cant to
Permit No.
� oo�� gf•�l
BOARD OF BUILDING REGU
Ueense: CONSTRUC11ON SU ;ULATIO
e Number. CS ERVISoR
066858
I ; Blrthdate: 10t01/1962
Expires: 10/01Q003 Tr. no: 7051 '
BART FOLEY Restricted 00
27 SLEEPY HOLLOW DR
f PLYIUOUTH tyiq 02360�
I Administrator '
J
TOWN OF YARMOUTH
Building Department
Tam Hail
Yarmouth, MA 02664
(508) 398-2231 e*261
BUILDING PERMIT
APPLICATION RECEIPT
Temp Permit No.:
T-04-083
Applicant Name:
Bart Foley
Location:
00004 WHALE RD
Owner's Name:
Marcello Mallegni
Owners Addres
894 Boston Post Road
Marlboro MA 01752
Owners Telephone: (508) 786-1899
(OFFICE USE ONLY)
Recorded By:
Ic
Permit Fee:
$0.00
Deposit Rec:
$100.00
Payment Type:
Check ChkNo.: 10042
Net Owed:
($100.00)
Application Date: 8/5/03
Issue Date:
Expiration Date
Comments:
new construction:
0
ZONING APPROVED
72-
f c/,7
This is NOT a building permit. Application subject to plan review. Contact Building Department for permit status. Official
Building Permit will be issued upon plan review completion, approval, and complete payment of Net Owed on Permit Fee.
Date Printed: 8/11/03
Building Site Location:
Proposed Improvement:
Address:
0 TOWN OF YARMOUTH
BUILDING DEPARTMENT
BUILDING PERMIT APPLICATION DEPARTMENTAL SIGN OFF
TRANSMITTAL SHEET
Map No: Lot No: �•��•
17Z /F
19Y Date Filed: S $ U
1�a is
The Building Department will be responsible for assisting the applicant by d spatching your plans and or application to the following
applicable departments.
RESIDENTIAL AND/OR COMMERCIAL BUILDING
WATER DEPARTMENT.
Determines Compliance of Water Availability and or existing location.
ENGINEERING DEPARTMENT:
Determines Compliance for Parking and Drainage.
CONSERVATION COMMISSION:
Determines Compliance to Wetlands Acts; i.e., If Lot(s) Border any Type of
Wetlands, Streams, Ponds, Rivers, Oceans, Bogs, Bays, Marshland, Etc
HEALTH DEPARTMENT:
Determines Compliance to State and Town Regulations; i.e., Requirements
For Septage Disposal and other Public Health Activities.
FIRE DEPARTMENT:
Determines Compliance to State and Town Requirements for Personal
....................................................................................................................................
Safety, Property Protection; i.e., Smoke Detectors, Sprinkler Systems, Etc.
REVIEWED BY:
f
1�. WATER DEPARTMENT:
DATE: N/A
2. ENGINEERING DEPARTMENT :
DATE: N/A
V/ CONSERVATION: Y
DATE: N/A:
(HEALTH DEPARTMENT%
DATE: N/A. -
INDUSTRIAL AND/OR COMMERCIAL PERMITS
S. WIR NG INSPECTOR DATE: N/A:
6. PLUMBING INSPECTOR DATE: N/A:
7. FIRE DEPARTMENT: DATE: N/A:
COMMENTS:
RECEIPT OF COPY:
PLEASE, NOTE
SIGNATURE OF APPLICANT: DATE:
White copy - Building Dept - Pink cops - Water Dept. - Yellow Copy - Heahh Die - Pint Corr - Engineering DepL - Goldenrod - Fie Degneommradfon
Building Site Location:
TOWN OF YARMOUTH
BUILDING DEPARTMENT
BUILDING PERMIT APPLICATION DEPARTMENTAL SIGN OFF
TRANSMITTAL SHEET
Map No: / Li Lot No: /% *
Proposed Improvement: /LZt J ll/gzf4je� .
Applicant:
077y
Address: CC." fi-if '�v Z./d el.No.: �f3�e d 76Y Date Filed: 8 A U
,�a 5o
The Building Department will be responsible for assisting the applicant by dispatching your plans and or application to the following
applicable departments.
RESIDENTIAL AND/OR COMMERCIAL BUILDING
WATER DEPARTMENT: Determines Compliance of Water Availability and or existing location.
ENGINEERING DEPARTMENT: Determines Compliance for Parking and Drainage.
CONSERVATION COMMISSION: Determines Compliance to Wetlands Acts; i.e., If Lof(sZ order
any Type of
Wetlands, Streams, Ponds, Rivers, Oceans, Bogs, Bays,141arshland, Etc
HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements
For Septage Disposal and other Public Health Activities.
FIRE DEPARTMENT: Determines Compliance to State and Town Requirements for Personal
Safety, Property Protection; i.e., Smoke Detectors, Sprinkler Systems, Etc.
---------------------------------•----------..........-----...-----------------..-.......--.......---__........................-------.....----------
REVIEWED BY:
xl' WATER DEPARTMENT: DATE: N/A:
ENGINEERING DEPARTMENT: 1/ DATE: N/A. -
CONSERVATION: �� �DATE: ' N/A:
/HEALTH DEPARTMENT: (%p6y"z DATE: V1f 110-3 N/A:
INDUSTRIAL AND/OR COMMERCIAL PERMITS
S. WIRING INSPECTOR: DATE: N/A:
6. PLUMBING INSPECTOR: DATE: N/A:
7. FIRE DEPARTMENT: DATE: N/A:
PLEASE NOTE
COMMENTS:
RECEIPT OF COPY: SIGNATURE OF
Whitt ropy - Budding Dept - Pink mpy - Water Dept - Yeaow Copy - Health Dept - Pint Copy - Engmdving DepL - Goldenrod - Fire DeptCCoasvvuion
TOWN OF YARMOUTH
w BUILDING DEPARTMENT
Building Site Location:
Proposed Improvement:
BUILDING PERMIT APPLICATION DEPARTMENTAL SIGN OFF
�j TRANSMITTAL SHEET
bJ /LMap No: Lot No: /LS• 2-
v, '/'/t/
Address: ',f-4.;QAel.No.: 931, 6 76y Date Filed: X 5 D
a ss,1The Building Department will be responsible for assisting the applicant by di patching your plans and or application to the following
applicable departments.
WATER DEPARTMENT:
ENGINEERING DEPARTMENT:
CONSERVATION COMMISSION:
HEALTH DEPARTMENT:
FIRE DEPARTMENT:
REVIEWED BY:
WATER DEPARTMENT,%�7 ✓1L
RESIDENTIAL AND/OR COMMERCIAL BUiLDtNG
Determines Compliance of Water Availability and or existing location.
Determines Compliance for Parking and Drainage. 'T
Determines Compliance to Wetlands Acts; i.e., If L8t(s)g6rder eny Type of
Wetlands, Streams, Ponds, Rivers, Oceans, Bogs, Bays, Marshland, Etc
Determines Compliance to State and Town Regulations; i.e., Requirements
For Septage Disposal and other Public Health Activities.
Determines Compliance to State and Town Requirements for Personal
Safety, Property Protection; i.e., Smoke Detectors, Sprinkler Systems, Etc.
.............0------------------------------------------------------------------------------
l.Y ENGINEERING DEPARTMENT: DATE: N/A:
3!CONSERVATION: DATE: N/A
4!/HEALTH DEPARTMENT: ✓ DATE: N/A. -
INDUSTRIAL AND/OR COMMERCIAL PERMITS
S. WIRING INSPECTOR: DATE: NIA-
6. PLUMBING INSPECTOR: DATE: N/A:
7. FIRE DEPARTMENT.
COMMENTS:
RECEIPT OF COPY:
SIGNATURE OF
PLEASE NOTE
N/A:
03
Wh➢lecmy-Bu3ftgDmt - Pb*w"-WdwDML - YdlowCo"-HahhDcpt - Pi kc "-En&"DWk - Goldmrod-FimDe WwwvKioe
A
TOWN OF YARMOUTH
WATER DEPARTMENT
99 Buck Island Road
West Yarmouth, MA 02673
Telephone: (508) 771-7921 • Fax: (508) 771-7998
Date of Issue : Aug 14, 2003
Letter of Water Availability
1. Single Family Dwelling X 2. Duplex Family Dwelling
3. Condominium Dwelling 4. Commercial / Industrial
5. Other (Specify)
Reference; Massachusetts General Laws Chapter 40, Section 54
To : Town of Yarmouth Building Inspector
Please be advised that the Town of Yarmouth Public water supply
is available to service lot/parcel(s) 128.2 Street 4 WHALE RD
as shown on Assessors sheet/map # 14
Issuance of this Letter of Availability is subject to the
following provisions/restrictions.
(1) The property owner agrees to comply with all Federal, State,
and Local Laws, Rules and Regulations as they pertain to the use of the
Public water Supply.
(2) The Yarmouth Water Department shall have exclusive rights as
to the size, number, type and location of all water service lines, fire
service lines or appurtenant items connected to the water distribution
system.
(3) The Yarmouth Water Department reserves the right to require,
at the property owners expense, the installation of water mains and
appurtenant items to meet water demand requisites within any structure
relevant to this Letter of Availability.
(4) This Letter of Availability will expire 180 days from
the date of issue.
I have read and understand the provisions/restrictions of this Letter of
Water Availability.
Owner (Sign)
Reference
: BART FOLEY
: 2 WILLIAMS AVE
: POCASSET, MA 02559
g3
/, q 0 TOWN OF YARMOUTH
BUILDING DEPARTMENT
BUILDING PERMIT APPLICATION DEPARTMENTAL SIGN OFF
TRANSMITTAL SHEET
Building Site Location: Li Gy fL rtX.e /C QC �lJ Map No: Lot No: lo?df. a
Proposed Improvement:
Applicant:
QQ ���`1J�c./� �w 17Z /,F
Address: Gt%L�Q1J &.g a �! r 4edAre I'e1No.: M676Y Date Filed: 8 $ U
�a
The Buil ssy
ding Department will be responsible for assisting the applicant by dispatching your plans and or application to the following
applicable departments.
RESIDEN IAL AND/OR COMMERCIAL BUILDING
WATER DEPARTMENT: Determines Compliance of Water Availability and or existing location
ENGJNEERING DEPARTMENT: Determines Compliance for Parking and Drainage.
CONSERVATTON COMMISSION: Determines Compliance to Wetlands Ads; i.e., If Lot(s) Border any Type of
Wetlands, Streams, Ponds, Rivers, Oceans, Bogs, Bays, Marshland, Etc
HEALTH DEPARTMENT: Determinm Compliance to State and Town Regulations; i.e., Requirements
For Septage Disposal and other Public Health Activities.
FIRE DEPARTMENT: Determines Compliance to State and Town Requirements for Personal
Safety, Property Protection; i.e., Smoke Detectors, Sprinkler Systems, Eta
REVIEWED BY:
1. WATER DEPARTMENT: DATE: N/A:
2. ENGINEERING DEPARTMENT:
3.;
N/A:
4. HEALTH DEPARTMENP`. — DATE: N/A
1 � �_�_ �►1� � ' � ' L1PL
S. WIRING INSPECTOR: DATE: N/A:
6. PLUMBING INSPECTOR: DATE: N/A:
7. FIRE DEPARTMENT: DATE: N/A:
COMMENTS:
RECEIPT OF COPY:
PLEASE NOTE
SIGNATURE OF APPLICANT: DATE:
white copy - DIft DOPL - Poi apy - WOW DepL - Ydbw Copy. Haft Dept - Pink Cagy -Enoncw* Dep - Ookknwd- Foe DcOACowawfim
I CERTIFY THAT THIS SURVEY AND PLAN WERE MADE
IN ACCORDANCE M/TH THE PROCEDURAL AND TECHNICAL
STANDARDS FOR THE PRACTICE OF LAND SURVEYING IN
pG�'
F, F sir' �llElf EJI� P.LS. MAZE ^
�• fN�V t�'1)�J�I H I
r, O
wir�,,.s.. •.
J/
Q
� o0
DEC
0
20
� 44
NOTES:
THE HOUSE SHALL HAVE NO BASEMENT.
A 40 MIL LINER SHALL BE INSTALLED ALONG
THE INSIDE OF THE RETAINING WALL
STRIPOUT ALL UNSUITABLE MATERIAL BELOW
AND WITHIN 5' OF THE EDGES OF THE
LEACHING FIELD AND REPLACE WITH MATERIAL
THAT CONFORMS TO TITLE 5 STANDARDS.
p IL
Q
�• -Y�,.. III /�\�
P 32 0,
CS %� GARAGE �.
I 1
1 �
D4 C%
CB
E NCHMAR .
TOP OF WATER GATT
EL = 6.4'(NGVD) `S'6'8•
GRAPHIC SCALE
10 20 40
( IN FEET )
1 inch. = 20 M
iL
t�� O�.00
16.0 29.0, V�N
o_ o_
0
D
4 HOUSEoM
T.O.F.=11.0'
"NO BASEMENT105
W a
I \� Uo 1,,VO GCL
SEFTI
TANK \
� D go
T
I.2,g�9, 6p�A d°C,D
\
\
.lm
h
so,
rc
40 MIL POLY LINER
TO BE CONTINUOUS
LOCUS MAP I
ASSESSORS MAP.• 14.128
PLAN REP 14426H SH2
ZONING: "R25"
FLOOD ZONE- "Al2 ; EL 10
COMM. PANEL#
250015 0005 D
DATED.• 9/2/92
r.
OHN
/ > R '-
/ 0. 101
SITE E
O D
VANIM
LOCATED AT
LOT 84 4 WHALE ROAD
YARMO UTH, MA.
PREPARED FOR
GEORGE MA UNTANER
4' TALL
CONCRETE WALL
JUL Y 22, 2002
YANKEE SURVEY CONSULTANTS
UNIT 4 40B INDUSTRY ROAD
P.O. BOX R65
MARSTONS MILLS, MASS. 02648
TEL• 428-0055 FAX 420-5553
JI53184A DCB
I. EL. = 11.0'-
7bP OF FOUNDATION
EL=10.2'
INVERT
EL. =_9.13 __
10' MIN.
20' MIN.
CONCRETE COVERS
8 MAX
10" 14
MIN.
QAS V `ur rc�ci
INVERT BAG" EL. = B. 54'
EL. =_8. 79
(M BE PLACED ON,"" BASE)
MFClfANICALLY COMPACTED OR 8" OF STONE
_-lIM-_GALLONS
SEPTIC TANK
PROFILE
SEWAGE DISPOSAL
NOT TO SCALE
GENERAL NOTES
OF
SYSTEM
4" CAST IRON PIPE
(OR EQUAL' MINIMUM
P/7ti'H 1/4 PER FT.
4" SCHEDULE 40 P. VC
MIN. PnrH 1116 PER FT.
CONCRETE COVER
2"LAYER OF
1/B -1%2•
WASHED STONE
EL = 9. B'
CLEAN SAND 9.
LEVEL o eo 0 00 ° o = t o°0 00 o 00 a om o 000
00
INVERT 0-0
6 S INVERT o 00 0 0 00 000 + 0 m 0e o °° e o 000 � o° = i
EL. =_8. 37' _ EL. =_B_20 _
INVERT
"DE- 9 " DISTRIBUTION .
BOX "H-20 » 30' X 20' LEACH FIELD
71?F BE WATER TESTED 3/4" 7D !-1/2- SOIL ABSORPTION
!F MORE THAN ONE OUTLET I{'ASHED S7t�NE
PLACE ON 6" STONE SYSTEM (SAS)
OBSERVATION HOLE I ELEV =_ 5.4 _
PERCOLATION RATE �_ MIN./ INCH AT _3&.'_ INCHES
1) ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D. E. P.
TITLE 5 AND THE TOWN OF _YARY-O.UM ----- RULES AND
REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE.
2) ONE COVER ON SEPTIC TANK SHALL BE BROUGHT TO
WITHIN 6" OF FINISHED GRADE, OTHERS WITHIN 12"
3) ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF
WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN
10 FT. OF DRIVES OR PARKING AREAS. H-20 LOADING SHALL BE
USED UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS.
4) ANY MASONARY UNITS USED TO BRING COVERS TO GRADE SHALL
BE MORTERED IN PLACE.
5) NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH
DEEDED OR ZONING REGULATIONS. OWNER/APPLICANT IS TO
OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY.
6) UTILITIES SHOWN ARE APPROXIMATE ONLY, EXCAVATION CONTRACTOR
IS TO CALL "DIC- SAFE" AT 1-800-322-4844 AT LEAST 72 HOURS
PRIOR TO COMMENCING WORK ON SITE.
7) CONTRACTOR IS TO VERIFY GRADES AND ELEVATIONS AS WELL AS
SITE CONDITIONS PRIOR TO COMMENCING WORK ON SITE.
8) PARCEL IS IN FLOOD ZONE ___=A_ Iz"
9) LOT IS SHOWN ON ASSESSORS MAP 14 _ AS PARCEL
USGS PROBABLE WATER TABLE ELEV. =2 Q*__
OBSERVED WATER TABLE (01123102) ELEV. =LV---
nDJUSTED TO MHW AT 2. 0
DEPTH
HORIZ
TEXTURE
COLOR
M07T.
OTHER
0-8"
0/A
LOAM
8 =22"
B
LOAMY SAND
10YR5-8
22 =78"
C
FINE 71? MED. SAN
IOYR5-6
PERK
H2O 0
4 =5"
NO MOTTLING
Ii
OBSERVATION HOLE 2 F.I.F. V = 4.3
DEPTH
HORIZ
TEXTURE
COLOR
MOTT.
OTHER
0-6"
0/A
LOAM
6 =14"
B
LOAMY SAND
10YR5-6
14 -120
C
INE TO MED. SAND
IOYR6-4
N OF
OHN
SOIL TEST
DATE OF SOIL TEST I/2312002 SOIL TEST DONE BY J.E LANDERS-CA .F
WITNESSED BY:
DESIGN CALCULATIONS.-
NUMBER OF BEDROOMS . . . . . . . . 4
INSTALL 30' X 20' X 6" GARBAGE DISPOSAL . . . . . . . . . NO
LEACH FIELD TOTAL ESTIMATED FLOW
TIE ENDS TOGETHER ( 112--CAL/BR/DAY x _4__ BR) 440 CAL/DAY
REQUIRED SEPTIC TANK CAPACITY 1500 CAL
SOIL CLASSIFICATION. 1
DESIGN PERCOLATION RATE < 2 MIN./IN.
EFFLUENT LOADING RATE . . . . . . • 74 CAL/DAY/S. F.
LEACHING CAPACITY (AREA X RATE) 444 CAL/DAY
RESERVE LEACHING CAPACITY . . . 444 CAL/DAY
(30 X 20 X. 74)
SHEET 2 OF 2 JOB NUMBER 52jdd
MAP/LOT -1 41'R 8_ . ADDRESSA _VVKA l.E __R]-> ,----------
PLAN INFORMATION
PLAN TYPE -- S 8=-------- -----------------
ENDORSEMENT DATE --
- -----------------
RECORDINC DATE _�� 2� _`o (a L_C_-- eltlr �3
AssEssoRs PLAN _Z4�----;�.c�l44?�"} E h,�
,o
PLANNING BRD. _II--Ps1---------------
PLAN. BRD. RELEASE ____ 5 24 G3___________ _
M 1
3
.00 TOWN OF YARMOUTH
BUILDING DEPARTMENT
O y
`�,`- ^•s1 BUILDING PERMIT APPLICATION DEPARTMENTAL SIGN OFF
TRANSMITTAL SHEET
Building Site Location:
Proposed Improvement:
Address:
Map No: Lot No: !• a
17Z
on y %06LY Date Filed: 8 S U
The Building Department will be responsible Got SS
ding Dep ponsble for assisting the applicant by d patching your plans and or application to the following
applicable departments.
RESIDENTIAL AND/OR COMMERCIAL BUILDING
WATER DEPARTMENT. Determines Compliance of Water Availability and or existing location
ENGINEERING DEPARTMENT: Determines Compliance for Parking and Drainage.
CONSERVATION COMMISSION: Determines Compliance to Wetlands Acts; i.e., If Lot(s) Border any Type of
Wetlands, Streams, Ponds, Rivers, Oceans, Bogs, Bays, Marshland, Etc
HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements
For Septage Disposal and other Public Health Activities.
FIRE DEPARTMENT: Determines Compliance to State and Town Requirements for Personal
Safety, Property Protection; i.e., Smoke Detectors, Sprinkler Systems, Etc.
REVIEWED BY:
1. WATER
3. CONSERVATION: DATE: N/A:
4. IIEAI TH DEPARTMENI` DATE: N/A:
3. WIRING INSPECTOR DATE: N/A
6. PLUMING INSPECTOR. DATE: N/A
7. FIRE DEPARTMENT: DATE: N/A:
COMMENTS:
RECEIPT OF COPY: SIGNATURE OF APPLICANT: DATE:
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TOWN OF YARMOUTH BUILDING DEPARTMENT
9
PLAN REVIEW &BUILDING PERMIT APPLICATION REVIEW NOTES
ADDRESS: ? wy,4L 0- /?,Z,
Map / Lot: /h/127, y
Date of Initial Review: Isht, A L
Inspector..1,-J9i2
Other. �/� 2/ 0-3 AppTaval Date:
NOTE& VOA-fs r� r t b's ijq i FG ao.es )9Fn. -bl 5S 4 36 Oss T60W7> t?"crj.0eta
i Av0 Gov ba r/o.v VX Vr-s
acAu-&. siaut FGooZ zS /�- tcaw �/lr?aiz- orr AcG ,5'ioAcs
GZ'97fi-xc k�.rN«t 3�/"QF ,q'Doo�'4�0 lf8oy,c #1
!?Pw -rue /11vs. 84 72:0pe,"a
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PP4 / /fsitc,'� Q,gTp/ fa 2
IAEaM►, r Rcda) AtN Olt ,�/r��n ve Sysr,+Ein
f7-4-Ti�.
9� ADD GUI K D tv,- ifAr Rg.4-le4o Ov ToP Orr
7"oP ; Pz.ATts-S
b/) ir AtOAC et t>� sO,/cE fc " w ?"e fit. /a � re r/1ur � 9!
RdF.1� � f/Sav�
Zoning Denial (if applicable):
Section 104.32, pars. Change, Extension or Alteration (pre-existing.
nonconforming)
The proposed
Other
_.. . . requires a Spe ,41?• ermit fivm1J -ZonmgBoard-of Appeal&
Building Code Denial (if applicable)
Rm l l-01
PROPERTY ADDRESS:
LCULATION FOR PEI
SSX17} C795—
S—/r12— G6
/ tf73
7 ,Y /o = 76
/lxq = `�
//A 7= /Z,
.2wv f6t4
A7, SXl6 =
# t/0
1 -X
eo
-7.33 X/Z =
ITS
/73
// X q
3TMR?2
//,x /1S= /38''
t-21y -
%%I,
/y /9-?, L
)ST TYPE OF ROOM9 NO
ADDITION
ALTERATIONS =
BATH
BED ROOM
CERTIFICATE OF OCCUPANCY
DECK WITH ROOF
DEMOLITION
DEN
DINING ROOM
FAMILY ROOM /
FIREPLACE
FOUNDATION ONLY
GARAGE NO. OF BAYS
GREAT ROOM -
KITCHEN
LAUNDRY ROOM
LAUNDRY ROOM
LIVING ROOM
MUD ROOM
OFFICE
PORCH CLOSED
/p39 i
/ 8o P
/3S, z
s-7;f
i_
racks a gr:
69- Sr.-
�' 9 y;-
PORCH OPEN
REROOFING
SHED
STORAGE AREA
SUN ROOM HEATED
SUN ROOM UNHEATED
SWIMMING POOL ABOVE GRO
37 V'rX 99-- = 30j 3(a0. - SWIMMING POOL INGROUND
soc x kQ - tqy >49• � WINDOW REPLACEMENT
Y`'�9y UT���r (gym
MECcheck Compliance Report
Massachusetts Energy Code
MECcheck Software Version 3.2 Release la
TITLE: AMERICAN REST
CITY: Yarmouth
STATE: Massachusetts
HDD: 6137
CONSTRUCTION TYPE: 1 or 2 Family, Detached
HEATING SYSTEM TYPE: Other (Non -Electric Resistance)
DATE: 07/31 /03
DATE OF PLANS: 73103
PROJECT INFORMATION:
LOT 83
YARMOUTH
COMPANY INFORMATION:
MAP INS. CO.
COMPLIANCE: Passes
Maximum UA = 689
Your Home = 649
5.8% Better Than Code
Permit Number
Checked By/Date
Gross
Glazing
Area or
Cavity
Cont.
or Door
Perimeter R-Value
R-Value
U-Factor ILA
Ceiling 1: Flat Ceiling or Scissor Truss
2040
30.0
0.0
71
Wall 1: Wood Frame, 16" o.c.
3820
19.0
0.0
175
Window 1: Wood Frame, Double Pane
858
0.340
292
Door 1: Solid
42
0.350
15
Floor 1: All -Wood Joist/Truss, Over Unconditioned Space
2040
19.0
0.0
96
Furnace 1: Forced Hot Air, 85 AFUE
COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans,
specifications, and other calculations submitted with the permit application. The proposed building has been designed
to meet the Massachusetts Energy Code requirements in MECcheck Version 3.2 Release la.
The heating load for this building, and the cooling load if appropriate, has been determined using the applicable
Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no
greater than 125% of the design load as specified in Sections 780CMR 1310 and J4.4.
Builder/Designer Date
MECcheck Inspection Checklist
Massachusetts Energy Code
MECcheck Software Version 3.2 Release la
DATE: 07/31/03
TITLE: AMERICAN REST
Bldg.
Dept.
Use
Ceilings:
[ ] 1. Ceiling 1: Flat Ceiling or Scissor Truss, R-30.0 cavity insulation
Comments:
Above -Grade Walls:
[ J 1. Wall 1: Wood Frame, 16" o.c., R-19.0 cavity insulation
Comments:
Windows:
[ ] 1. Window 1: Wood Frame, Double Pane, U-factor: 0.340
For windows without labeled U-factors, describe features:
# Panes_ Frame Type Thermal Break? [ ] Yes [ ] No
Comments:
Doors:
[ ] 1. Door 1: Solid, U-factor: 0.350
Comments:
Floors:
[ ] 1. Floor 1: All -Wood Joist/Truss, Over Unconditioned Space, R-19.0 cavity insulation
Comments:
Heating and Cooling Equipment:
[ ] 1. Furnace 1: Forced Hot Air, 85 AFUE or higher
Make and Model Number
Air Leakage:
[ ] Joints, penetrations, and all other such openings in the building envelope that are sources of air
leakage must be sealed.
[ 1 When installed in the building envelope, recessed lighting fixtures
shall meet one of the following requirements:
1. Type IC rated, manufactured with no penetrations between the inside of the recessed fixture
and ceiling cavity and sealed or gasketed to prevent air leakage into the unconditioned space.
2. Type IC rated, in accordance with Standard ASTM E 283, with no more than 2.0 cfm (0.944
Us) air movement from the the conditioned space to the ceiling cavity. The lighting fixture
shall have been tested at 75 PA or 1.57 lbs/fl2 pressure difference and shall be labeled.
Vapor Retarder:
[ J Required on the warm -in -winter side of all non -vented framed ceilings, walls, and floors.
Materials Identification:
[ J Materials and equipment must be identified so that compliance can be determined.
[ ) Manufacturer manuals for all installed heating and cooling equipment and service water heating
q vyHaL15� Z9
equipment must be provided.
Insulation R-values, glazing U-values, and beating equipment efficiency must be clearly marked on
the building plans or specifications.
I
Duct Insulation:
] I Ducts shall be insulated per Table J4.4.7.1.
Duct Construction:
All accessible joints, seams, and connections of supply and return ductwork located outside
conditioned space, including stud bays or joist cavities/spaces used to transport air, shall be sealed
using mastic and fibrous backing tape installed according to the manufacturer's installation
instructions. Mesh tape may be omitted where gaps are less than 1/8 inch. Duct tape is not permitted.
The IIVAC system must provide a means for balancing air and water systems.
Temperature Controls:
Thermostats are required for each separate JIVAC system. A manual or automatic means to
partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided.
Heating and Cooling Equipment Sizing:
Rated output capacity of the heating/cooling system is not greater than 125% of the design load as
specified in Sections 780CMR 1310 and J4.4.
Circulating Hot Water Systems:
[ ] I Insulate circulating hot water pipes to the levels in Table 1.
I
Swimming Pools:
[ J I All heated swimming pools must have an on/off heater switch and require a cover unless over 20%
of the heating energy is from non-depletable sources. Pool pumps require a time clock.
I
Heating and Cooling Piping Insulation:
[ ] I HVAC piping conveying fluids above 120 °F or chilled fluids below 55 °F must be insulated to the
levels in Table 2.
/ wlf a►C�� 'R..17
Table is Minimum Insulation Thickness for Circulating Ilot !rater Pipes.
Insulation Thickness in Inches by Pipe Sizes
Heated Water Non -Circulating Runouts Circulating Mains and Runouts
Temperature ( F) Up to 1„ Up to 1.25" 1.5" to 2.0" Over 2"
170-180 0.5 1.0 1.5 2.0
140-160 0.5 0.5 1.0 1.5
100-130 0.5 0.5 0.5 1.0
Table 1: Minimum Insulation Thickness for IIVAC Pipes.
Fluid Temp. Insulation Thickness in Inches by Pipe Sizes
Piping System Types Ran e F 2" Runouts 1" and Less 1.25" to 2" 2.5" to 4"
Heating Systems
Low Pressure/remperature
Low Temperature
Steam Condensate (for feed water)
Cooling Systems
Chilled Water, Refrigerant,
and Brine
201-250
1.0
1.5
1.5
2.0
120-200
0.5
1.0
1.0
1.5
Any
1.0
1.0
1.5
2.0
40-55
0.5
0.5
0.75
1.0
Below 40
1.0
1.0
1.5
1.5
NOTES TO FIELD (Building Department Use Only)
_ • - a�am
Air Commands 80SV
Rom
e � If I
cJ s�-�6
mom®,
•
GUID 459000 - 115,000 Stuh Input
80°o Gas Fumaca 80% AFUE
• AFUE Efficiency Ratings of so%
• Limited Twenty Year Warranty on Heat Exchanger
• TWO Year Lmmited W8n" on Parts
• 40" Height and Ze1D-Slde-Clearance Allow Easy Installation in light Spaces
• Induced Draft Blower Motor System
• Integrated Self -Diagnostic Electronic Ignition Control Allows Addition of Air Condi-
tioning, Humldifier, and Electronic Air Cleaner Without Extra Transformer.
U.S. Approves Installations Up To 6,000 Feet Without High Aft
hude Kit
• Mutt' Postfion Design Allows Upflow or Horizontal Lett or Right Applications
• Inshot Bumers With Inserts for NOx Emission Reduction
• Qulet 4-Speed PSC Blower Motor
• Convertible to Propane Gas
• Left or Right Electrical Service. Internal Quick -Connect Wiring
• Left or Right Gas Pipe Entry
• AGA and CGA Cedried (CGA approves /nstaUatfons in Canada to an/v 4.SDO ho.,,r
GUID UPFLOWMORIZONTAL FURNACES
model
Number*
Btuh
InWA
Btuh
Output
ides
CFM"
box. Tons
CmIng
Dimensions
I D. H. . W.
Shipping
VVf Ibs.
AF.U.E.
%
Unit
P
GUID046CA30
48.000
36.800
120D
3.0
28M x 40 x 18%
140
80
GUID070CA30
00.000
65.200
12M
3.0
281A X 40 Y 18%
151
80
GUIDW0CA40
69.000
55,200
1.529
4.0
282A x 40 x 18%
152
80
GUIDO90CA30
92,000
73AUD
1,380
3.5
28;4 x 40 X 2D%
169
80
GUID090CA50
MOOD
73.f100
1,975
5.0
28%X40x2DH
178
80
GUID115^..A.SO
GUID045CX30
115.000
46.000
92.Don
36.800
1.985
1,200
5.0
3 00
2844 X 40 x 24%
283A X 40 x 18K
194
140
80
80
GUID070CX3D
W000
55.200
1.290
3.0
28% x 40 x 16N
151
80
DO
GUID070GX40
GUIDOROCX30
89,000
P2 000
55,200
73.WO
1.529
1,380
3.5
3w
28Mi X 40 x 1151A
2814 X 40 X 20i1
153
169
80
80E4
00
0
GUIDOVCXt50
GUID115CXSO
92.000
115.000
73,800
02,000
1,975
1.955
5.0
5.0
2834 X40 x20%
281ix40x24%
178
194
6011111111111111100
B0.
00
nU I W At true IXna, es Mnane BOX FUmeces (r3UIC. GUID. GUIS. GUN, GC1C, GCIS), are appmved for Cetepery 1 Venting ONLY.
GUID"CA" a Stenderd, wltna1 NOx Insert GUID"Cx" - W6h Wit insert
" At 0.5 ESP
Accuscrles Used With
Modsi
Ntimw
D"aipWn
gU$ $$
0 0
unit
Prue
CVK4
Common Vent IUt (4' Vent)
Common Vent Kits in sve9sble for 191 Units. Spech1c Idt Is
demmuned by common vemirtp rewwoment.
CVK5
Common Vent Kit IS' Vent
CVK5
Common Vent Kit 96' Vent
CVK7
Common Vent KK "Vent
EFRO7
Extend Finer Reelt
✓
✓
✓
✓
FTKOJA
FurnaceednN KIt
✓
✓
✓
✓
✓
L►TK09
Propane Gas Convanion Kit
-s
✓
✓
✓
NOTE: TM t Idle MUST ve Installed on VMS
above a OW
annuls. A
roved for Cavenco,
1 Vannne,
ONLY.
HALPOB
✓
r
✓
.
✓
✓
NANf-0)HIUMAIttliiji,1
✓
MACIPS11
I High K I ✓
✓
i
✓
✓
MACIPS12
I High AMite Press" ' ✓
✓
✓
✓
✓
Available to We model I Up to e,00o' s From 6.001 to I1,000' 4 From 0.001 to 8,500 ' From 64M to 11,000'
Thermostats
Tft w wi
MWAub
Prabranm
Cod
M•t
am Poaaeo1
een. B ansPP
Loror
Unx Aka
Mom"IMn.
urr
Gpsovs ji
No
1
1
No
No
RapsrlpMF
Balpe
m«e1
11sn.Caarosewr
Y«
1
1
V«
No
R.MVVUW
WVW
tnnol
Aum Cnereawar
rn
1
T
No
V«
WNts
P-r• Y« aw•o•rar bo mai is Lamp" Trw-aPM lanns
PBGUID990D 2.1 Prices ENeel•ve 12101t99
This price list is sub)ect to change whhM notfee and supersedes all previously issued prfees
Important:
When filling out
forms on the
computer, use
only the tab
key to move
your cursor -
do not use the
return key.
- I�
IIMMOR
CI
A
Massachusetts Department of Environmental Protection F-5)�U% CoLr
Bureau of Resource Protection - Wetlands U
WPA Form 2 — Determination of Applicability
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
A. General Information.
From:
YARMOUTH
Conservation Commission
To: Applicant
Property Owner Of different from applicant):
Robert Bradley
Name Name
1287 Old Post Road'
Malling Address Mailing Address
Marstons Mills ma 02648
Cay/rown State Zip Code CityfTown State Zip Code,
1. Title and Date of Final Plans and Other Documents:
Site & Sewage plan of land in 4 Whale Road 7-22-02
Tide Final Date (or Revised Date If applicable)
2. Date Request Filed:
10-24-02
B. Determination
Pursuant to the authority of M.G.L c. 131, § 40, the Conservation Commission considered your Request
for Determination of Applicability, with its supporting documentation, and made the following Determination.
Project Description (f applicable):
Construct single family dwelling.
Project Location:
4 Whale Road West Yarmouth
'Street Address Cftyrrown
14 128
Assessors Map/Plat Number Parcel/Lot Number
WPA r e 2 Page 1 of 5
Rm roe)
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands
WPA Form 2 — Determination of Applicability
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
B. Determination (cunt.)
The following Determination(s) istare applicable to the proposed site and/or project relative to the
Wetlands Protection Act and regulations:
Positive Determination
Note: No work within the jurisdiction of the Wetlands Protection Act may proceed until a final Order of
Conditions (issued following submittal of a Notice of Intent or Abbreviated Notice of Intent) has been
received from the issuing authority p.e., Conservation Commission or the Department of
Environmental Protection).
❑ 1. The area described on the referenced plan(s) is an area subject to protection under the Act
Removing, tilling, dredging, or altering of the area requires the filing of a Notice of Intent
❑ 2a. The boundary delineations of the following resource areas described on the referenced
plan(s) are confirmed as accurate. Therefore, the resource area boundaries confirmed In this
Determination are binding as to all dedsions rendered pursuant to the Wetlands Protection Act
and its regulations regarding such boundaries for as long as this Determination is valid.
❑ 2b. The boundaries of resource areas listed below are pot confirmed by this Determination,
regardless of whether such boundaries are contained on the plans attached to this Determination
or to the Request for Determination.
❑ 3. The work described on referenced plan(s) and document(s) is within an area subject to
protection under the Act and will remove, till, dredge, or alter that area. Therefore, said work
requires the filing of a Notice of Intent.
❑ 4. The work described on referenced plans) and document(s) Is within the Buffer Zone and will
alter an Area subject to protection under the Act. Therefore, said work requires the filing of a
Notice of Intent.
❑ 5. The area and/or work described on referenced plan(s) and document(s) Is subject to review
and approval by:
Name of MuNclpallty
Pursuant to the following municipal wetland ordinance or bylaw:
Name Ordinance or Bylaw citation
WPA Form 2 Am W= Psye 2 d 5
.
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands
WPA Form 2 — Determination of Applicability
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
B. Determination (cont.)
❑ 6. The following area and/or work, if any, is subject to a municipal ordinance or bylaw but RoA
subject to the Massachusetts Wetlands Protection Act:
❑ 7. If a Notice of Intent Is filed for the work in the Riverfront Area described on referenced plan(s)
i and document(s), which includes all or part of the work described In the Request, the applicant
•must consider the following alternatives. (Refer to the wetland regulations at 10.58(4)c. for more
information about the scope of alternatives requirements):
❑ Alternatives limited to the lot on which the project Is located.
❑ Alternatives limited to the lot on which the project is located, the subdivided lots, and any
adjacent lots formerly or presently owned by the same owner.
❑ Alternatives limited to the original parcel on which the project is located, the subdivided
parcels, any adjacent parcels, and any other land which can reasonably be obtained within
the municipality.
❑ Alternatives extend to any sites which can reasonably be obtained within the appropriate
region of the state.
Negative Determination
Note: No further action under the Wetlands Protection Act is required by the applicant. However, if the
Department is requested to Issue a Superseding Determination of Applicability, work may not proceed
on this project unless the Department fails to act on such request within 35 days of the date the
request is post -marked for certified mail or hand delivered to the Department. Work may then proceed
at the owner's risk only upon notice to the Department and to the Conservation Commission.
Requirements for requests for Superseding Determinations are listed at the end of this document
❑ 1. The area described in the Request is not an area subject to protection under the Actor the
Buffer Zone.
❑ 2. The work described in the Request is within an area subject to protection under the Act, but will
not remove, fill, dredge, or alter that area. Therefore, said work does not require the filing of a
Notice of Intent.
® 3. The work described in the Request is within the Buffer Zone, as defined in the regulations, but
will not after an Area subject to protection under the Act. Therefore, said work does not require
the filing of a Notice of Intent, subject to the following conditions of any).
❑ 4. The work described in the Request is not within an Area subject to protection under the Act
(Including the Buffer Zone). Therefore, said work does not require the filing of a Notice of intent,
unless and until said work alters an Area subject to protection under the Act.
WPA Forth 2
Am mmn Page
Massachusetts Department of Environmental Protection
Bureau of Resource Protection -Wetlands
WPA Form 2 — Determination of Applicability
Massachusetts Wetlands Protection Act M.G.L. c. 131,. §40
B. Determination (cont.)
❑ 5. The area described in the Request is subject to protection under the Act Since the work
described therein meets the requirements for the following exemption, as specified In the Act and
the regulations, no Notice of Intent is required:
Exempt Activity (ads applicable statuatory/regWatory provisions)
❑ 6. The area and/or work described in the Request is not subject to review and approval by:
Name of Municipality
Pursuant to a municipal wetlands ordinance or bylaw.
Name Ordinance or Bylaw Citation
C. Authorization
This Determinatlon is Issued to the applicant and delivered as follows:
❑ by hand delivery on
Date
$] by certified mail, return receipt requested on
11-12-02
Date
This Determination is valid for three years from the date of issuance (except Determinations for
Vegetation Management Plans which are valid for the duration of the Plan). This Determination does not
relieve the applicant from complying with all other applicable federal, state, or local statutes, ordinances,
bylaws, or regulations.
This Determination must be signed by a majority of the Conservation Commission. A copy must be sent
to the appropriate DEP Regional Office (see Appendix A) and the property owner (if different from the
applicant). 0 0Signatures:
11-07-02
Date
WPA Form 2
Rw rVM Page4d5
Massachusetts Department of Environmental Protection
' Bureau of Resource Protection - Wetlands
r 5 WPA Form 2 — Determination of Applicability
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
D. Appeals
The applicant, owner, any person aggrieved by this Determination, any owner of land abutting the
tand'apon which the proposed work is to be done, or any ten residents of the city or town In which
such land is located, are hereby notified of their right to request the appropriate Department of
Environmental Protection Regional Office (see Appendix A) to Issue a Superseding Determination of
Applicability. The request must be made by certified mail or hand delivery to the Department, with the
appropriate filing fee and Fee Transmittal Form (see Appendix E: Request for Departmental Action
Fee Transmittal Form) as provided in 310 CMR 10.03() within ten business days from the date of
issuance of this Determination. A copy of the request shall at the same time be sent by certified mail
or hand delivery to the Conservation Commission and to the applicant if he/she Is not the appellant.
The request shall state dearly and concisely the objections to the Determination which is being
appealed. To the extent that the Determination is based on a municipal ordinance or bylaw and not
on the Massachusetts Wetlands Protection Act or regulations, the Department of Environmental
Protection has no appellate Jurisdiction.
..
VVPA r v 2
Rm wKn . Papa5d5
4
J
EL. = I1.0'_
7OP OF FOUNDATION SEE PACE I FOR RETAINING
r� 20' MIN. WALL DETAIL
10' MIN. CONCRETE COVERS 4" CAST IRON PIPE 4" SCHEDULE 40 P.VC
EL=10.2' (OR AV U41 MINIMUM
PER FIN MIN. P/7L'H I/18 PER FT. 2"LAYER OF
1/8 =1/2"
/ / ♦ CONCRETE COVER WASHED S7OXE
/4"CAST IRON PIPE B 1/AX//♦� � �♦♦/ ♦ ♦ � �♦♦/ /♦� � ♦♦// � EL=98�♦/
pOI7CH 1141 PER FT. [., CLEAN SAND 9"
FLOW LINE p MIEN 4
INVERT ! 1O" - 4
9.13' MIN.. 14 / �zO• � 00 o 00 00 oa o 000
EL. ------- CAS INVERT 6 S LEVEL 0 /."00 ' 0 0 0 0 o t0 0� 0000 o e° o 0 0 0 o p0 0BAFM 8 54' INVERT 0 ° 0 o 0 o°o o EL. -%5
INVERTEL. __ INVERT o0 0 0 0 m e o 0
EL. =-B. 79' EL. = 8.37 _ EL. = B 20 _ INVERT
(M BE PLACED ON KRM BASE) EL - 8.1
MEMAN/CALLY COMPA=D OR Q" OF MNE " "
DB- 9 DISTRIBUTION
CALLONS BOX "H-,20.. 30' X 20' LEACH FIELD
SEPTIC TANK 70 BE WATER TESTED "
IF MORE THAN ONE OUTLET 314 WH 7107
I— NE SOIL ABSORPTION
PROFILE OF PLACE ON 6 STONE SYSTEM (SAS)
SEWAGE DISPOSAL SYSTEM USGS PROBABLE WATER TABLE ELEV.=2,2'__
NOT TO SCALE OBSERVED WATER TABLE (01123102) ELEV=L11___
OBSERVATION HOLE I ELEV.=5.4 _ ADJUSTED TO MHW AT 2.0
PERCOLATION RATE c2 _ MIN./ INCH AT _3a= INCHES OBSERVATION HOLE 2 ELEV.=_ 4.3_
GENERAL NOTES
1) ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO DEP.
TITLE 5 AND THE TOWN OF-YARMf111T,bC----- RULES AND
REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE.
2) ONE COVER ON SEPTIC TANK SHALL BE BROUGHT TO
WITHIN 6" OF FINISHED GRADE, OTHERS WITHIN 12"
3) ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF
WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN
10 FT. OF DRIVES OR PARKING AREAS. H-20 LOADING SHALL BE
USED UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS.
4) ANY MASONARY UNITS USED 719 BRING COVERS 719 GRADE SHALL
BE MORTERED IN PLACE.
5) NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH
DEEDED OR ZONING REGULATIONS. OWNER/APPLICANT IS 70
OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY.
6) UTILITIES SHOWN ARE APPROXIMATE ONLY, EXCAVATION CONTRACTOR
IS 717 CALL "DIG- SAFE" AT 1-800-322-4844 AT LEAST 72 HOURS
PRIOR 717 COMMENCING WORK ON SITE.
7) CONTRACTOR IS 719 VERIFY GRADES AND ELEVATIONS AS WELL AS
SITE CONDITIONS PRIOR 717 COMMENCING WORK ON SITE.
8) PARCEL IS IN FLOOD ZONE___=4_-M " _
9) LOT IS SHOWN ON ASSESSORS MAP 14 _ AS PARCEL
DEPTH
HORIZ
TEXTURE
COLOR
M07T.
OTHER
0-8"
0/A
LOAM
8 -22"
B
LOAMY SAND
I0YR5-8
22 =780
C
FINE 717 MED. SAND
10YR5-6
PERK.
H2O 0
4 -5"
NO MOTTLING
DEPTH
I HORIZ
TEXTURE
COLOR
MO7T.
OTHER
0-6"
0/A
LOAM
6 -14"
B
LOAMY SAND
10YR5-6
l4 -120
C
FINE TO MED. SANL
10YR6-4
SOIL TEST
DATE OF SOIL TEST 112312002 SOIL TEST DONE BY
WITNESSED BY.
INSTALL 30' X 20' X 6"
LEACH FIELD
TIE ENDS 719CETHER
J. E LANDERS-CAULEY, RE
DESIGN CALCULATIONS:
NUMBER OF BEDROOMS . . . . . . 4
GARBAGE DISPOSAL . . . . . . . . . NO
719TAL ESTIMATED FLOW
( He--CAL/BR/DAY x _ 4-_ BR) 440 GAL/DAY
REQUIRED SEPTIC TANK CAPACITY 1500 GAL
SOIL CLASSIFICATION . . . . . . . . 1
DESIGN PERCOLATION RATE . . . . . < 2 MIN./IN.
EFFLUENT LOADING RATE . . . .74 CAL/DAY/S.F.
LEACHING CAPACITY (AREA X RATE) 444 CAL/DAY
RESERVE LEACHING CAPACITY . . . 444 CAL/DAY
(30 X 20 X . 74)
.J,
0
I CER77FY THAT THIS SURVEY AND PLAN WERE MADE
IN ACCORDANCE WITH 771E PROCEDURAL AND TECHNICAL
STANDARDS FVR THE PRACTICE OF LAND SURVEYING IN
THE COMMONWEAL771 OF MASSACHUSE77S
EDWARD A. S7DN$ P.LS
y�P
INSPECTION SCHEDULE.`
WPWMN RI NZALM DEPL SHAM AWPECT _
IA6PWMN /2I LAND SL WMR SNAf6 SUAT
RdPEC770M /JI MCIA E7P SHALL /ASPECT RAT. IAU
4' RETAINING MALL DETAIL
DATE
/. BARS CON77NU01US O
ON YO•
CEMSR
\`J1
O
HOR2 AlIDD/a Of• MALL
4ML PO
2D INSIDE OP RETAINING MALL
loo
/
O P� C�
/
5• zrr`.,�,SAS
�
C
�
�OOD"
ft7UNDA1fON
MIX
OFF
I
6\
Nye
1 6'
L T
N
DE��,
w o_
ARR4, 5
S. .
c� MAL v~i
Na s5tm
CB
9fC/STEaEG��4�`�
_
�J
AL E B NCHYARK.
TOP OF
r�„�,,, EL =
WATER CAT
6.4'(NCVD)
-
C
\�fG
• 'NOTES. • .
THE HOUSE SHALL HAVE NO BASEMENT.
A 40 MIL LINER SHALL BE INSTALLED ALONC
THE INSIDE OF THE RETAINING WALL
STRIPOUT ALL UNSUITABLE MATERIAL BELOW
AND WITHIN 5' OF THE EDCES OF THE
LEACHING FIELD AND REPLACE WITH MATERIAL
THAT CONFORMS TO TITLE 5 STANDARDS.
�%9
\ •1
15.029.0
PROPOSED,::
P 32' 0, 4 NO U EOM
® T.O.F.=1L0' „
GAgAGE "NO BASEMENT
,
0 10,5 0
`s.15� ��� 5•il�
h
GRAPHIC SCALE
20 0 10 20 40 80
( IN FEET )
1 inch = 20 M
w �
1 \� ,S O CAL
0 TANK \
D-eo
CC
40 MIL POLY LINER
TO BE CONTINUOUS
V
1'
so;
LOT 8
LOT 84
4' TALL
CONCRETE WALL
YARMOUTH
ROUTE 28
LOCUS MAP
ASSESSORS MAP.• 14.128
PLAN REF` 14426H SH2
ZONING."R25"
FLOOD ZONE- "Al2 , EL 10
COMM.. PANEL#
250015 0005 D
DATED.- 7/2/92
DL 9
AUG 81
003 D
8y
-SITE & SEWAGE PLAN
OF LAND
LOCATED AT
4 WHALE ROAD
YARMO UTH, MA.
PREPARED FOR
GEORGE MA UNTANER
JULY 220 2002
REV. NO V. 18102
REV. A UC. 13103
YANKEE SURVEY CONSULTANTS
UNIT 1, 40B INDUSTRY ROAD
P.O. BOX 265
MARSTONS MILLS, MASS. 02648
TEL• 428-0055 FAX 420-5553
SHEET 1 OF 2 J1 53184A
I
n / CERTIFY THAT THIS SURVEY AND PLAN MERE MADE NOrTg'S.- YARMO UTH
V IN ACCORDANCE MITH THE PROCEDURAL AND TECHNICAL THE HOUSE SHALL HAVE NO BASEMENT. ROU
HE COMMONWEALTH OF FVR ME PRACTICE
HUSls7N/ 5. SURVEYING IN A 40 MIL LINER SHALL BE INSTALLED ALONG TE 28
THE INSIDE OF THE RETAINING WALL
EDWARD A SMNA: P. L S DATE STRIPO UT ALL UNSUITABLE MATERIAL BELOW Q
P� AND WITHIN 5' OF THE EDGES OF THE Q
LEACHING FIELD AND REPLACE WITH MATERIAL W
THAT CONFORMS TO TITLE 5 STANDARDS.
19 0f �,r '�.► �y6'e3LEWIS BA Y
.OHN
U
50tj35101
ND
LOCUS MAP
MMPvapwm UR+aro S�NAU STT." (/� / \ p LOT 8
MC,W N SNAU 11CPSM W rut
\ cU ASSESSORS MAP.- 14.128
PLAN REF 14426H SH2
�.0 p \ • ZONING. R25
FLOOD ZONE- "Al2 , EL IO
4' RETAIN/NC WALL DETAIL 1500,E O \ I i COMM.. PANEL#
y 29 r O ,250015 0005 D
1O CENTW Uous o zo• /i �' o_ O
4' � �- °. DATED.• 7/2/9,2
HORT6 O MIDDLE OP WALL O_ (�
74V I=DOLY E OF RETAINING WALL 4� � Qa, • � PROPOSED
IO• 04 BEDROOM
H W10"CA M Fi 9 P 32 HOUSE , 6�'
a 24 ON csrrsR 'T. 0. F. =11. 0
4�. SAS AGE ''NO BASEMENT"/ 8 S D U
::.:. ! %` GAR t- 5' c �g AUG 1
fn ND 0V O_ lbI 9 � G� 1OO D
MLY \ \ 1 5 - 1 G 0 P� �g n�' BY
I e\ ,
fvonNC L T vlLD.iy� \ ? I C 3y I8
wv
w ARC 5 S `' ; �ti p SITE & SEWAGE PLAN
CB \' � OF LAND
0 TANK \ LOCATED AT
B NCHYARK. q�� \ o' ° .h° 4 WHALE ROAD
TOP OF WATER CAT �: '9 0_ ��O' ti0 LOT 84 YARMO UTH, MA.
EL = 6. 4'(NGVD) ` S+
PREPARED FOR
s
sT �o GEORGE MA UNTANER
JUL Y 22. 2002
F p�v� f�`9�'9• soo• �U.I�'d' REV. NOV. 18102
GRAPHIC SCALE l� \ jf¢. REV. AUG. 13103
Q so o +o ao so so �/� YANKEE SURVEY CONSULTANTS
�7 \ '? O' UNIT 4 40B INDUSTRY ROAD
\ \ \ P.O. BOX 265
O MARS719NS MILLS, MASS. 02648
IN FEET) 40 MIL POLY LINER 4' TALL TM 428-0055 FAX 420-5553
I inch = 20 M TO BE CONTINUOUS CONCRETE WALL SHEET 1 OF 2 J# 53184A
9N PIPE 40 SCHEDULE 40 P. VC
1 PER MIN. PITCH 1/I8 PER FT
CONCRETE COVER
• or. i
� 2.0•.
LEVEL
EL. = d. J7 - EL. = B 20--
_
-9" DISTRIBUTION EL.
BOX "H-20 "
70 BE WATER TESTED 3�
IF MORE THAN ONE OUTLET WASH
PLACE ON 60 STONE
SEE PAGE I FOR RETAINING
WALL DETAIL
2'LAYER OF
1/8 =1/2'
4SHED SYME
El, =9.8'
CLEAN SAND
0/0,
° oo ° o f o 0 00 0 00 ° om o 00o
000
0�° o ° �0°�000°��° o 0 0000 o a°°o ( B e d ° o 0 0°o 00
30' X 20' LEACH FIELD
SOIL ABSORPTION
SYSTEM (SAS
USGS PROBABLE WATER TABLE ELEV. =_? Q*__
OBSERVED WATER TABLE (01123102) ELEV =LD---
ELEV.__54_
ADJUSTED TO MHW AT 2.0
INCH AT _,2a7_ INCHES OBSERVATION HOLE 2 ELEV. =_ 4.3 _
COLOR
NOTT.
OTHER
lN,D
10YR5-6
10YR5-6
PERK
.1i
DEPTH
HORIZ
TEXTURE
COLOR
NOTT.
OTHER
0-6"
O/A
LOAN
6 =14
B
LOAMY SAND
I0YR5-6
14 =120
C
INE 70 HIED. 5ANL
IOYR6-4
SOIL TEST
EST 112312002 SOIL TEST DONE BY
J.E LANDERS-CAULEY, RE
DESIGN CALCULA TIONS:
NUMBER OF BEDROOMS . . . . . . 4
GARBAGE DISPOSAL . . . . . . . . . NO
X 6" TOTAL ESTIMATED FLOW
ER HO--CAL/BR/DAY x _4-_ BR) 440 GAL/DAY
REQUIRED SEPTIC TANK CAPACITY 1500 GAL
SOIL CLASSIFICATION . . . . . . . . I
DESIGN PERCOLATION RATE . . . . . < 2 MIN./IN.
EFFLUENT LOADING RATE . . . . . . • 74 GAL/DAY/S. F.
LEACHING CAPACITY (AREA X RATE) 444 GAL/DAY
RESERVE LEACHING CAPACITY. 444 GAL/DAY
(30 X 20 X. 74)
SHEET 2 OF 2 JOB NUMBER__ 0ld!5 -------
EL. = 11.0'_
7t�P OF PoUNDATION
ro A PWA 0 mo.
o
00
INVERT
EL.=_9.13'
10' MIN.
PIPE
FT.
SEWAGE
20' MIN.
CONCRETE COVERS
4" CAST
POREV
-7
,VAX / i . .
u L;17 J4 1V
OAS INVERT
INVERT BAHM EL. = 8.54
EL. =_8. 79'
(7V BE PLACED ON 17RM BASS)
RECHAN/CALLY COMPACTED OR C" OF STONE
PROFILE
GENERAL NOTES
__1 0-0 -_GALLONS
SEPTIC TANK
DISPOSAL
NOT TO SCALE
OF
SYSTEM
D.
OBSERVATION HOLE 1
PERCOLATION RATE c2 — MIN.,
ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P.
TITLE 5 AND THE TOWN OF _YARANflZbC---__ RULES AND
REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE.
ONE COVER ON SEPTIC TANK SHALL BE BROUGHT TO
WITHIN 6" OF FINISHED GRADE, OTHERS WITHIN 12"
ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF
WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN
10 FT. OF DRIVES OR PARKING AREAS. H-00 LOADING SHALL BE
USED UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS.
ANY MASONARY UNITS USED 719 BRING COVERS TO GRADE SHALL
BE MORTERED IN PLACE
NO DETERMINATION HAS BEEN MADE AS 717 COMPLIANCE WITH
DEEDED OR ZONING REGULATIONS. OWNER/APPLICANT IS TO
OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY.
UTILITIES SHOWN ARE APPROXIMATE ONLY, EXCAVATION CONTRAC719R
IS TO CALL "DIG— SAFE" AT 1-800-322-4844 AT LEAST 72 HOURS
PRIOR TO COMMENCING WORK ON SITE.
CONTRAC7VR IS TO VERIFY GRADES AND ELEVATIONS AS WELL AS
SITE CONDITIONS PRIOR 717 COMMENCING WORK ON SITE.
PARCEL IS IN FLOOD ZONE—__ "A_ 12 =_—•
LOT IS SHOWN ON ASSESSORS MAP 14 _ AS PARCEL
DEPTH
HORIZ
TEXTU
0-8"
0/A
LOAM
8 =22"
B
LOAMY S
22 =78"
C
FINE 70 MED
H2O 0
4 -5"
NO M077L
DATE OF SOIL
WITNESSED BY:
INSTALL 30' X
LEACH FIEI
TIE ENDS 719CI,
MEMO
To: Jim Brandolini
Building Inspector.
From: Matthew Zurowick
Deputy Assessor
Subject: 10 Whale Rd., West Yarmouth
Date: November 15, 2001
The parcel known as Lot 83 & 84 on Assessors Map 14 parcel 128 was combined for tax
purposes only.
MJZ/cgo