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HomeMy WebLinkAbout0117 DROMOLAND LANE - Health 117 Dromoland Lane A= 334—030 Barnstable i FORANRESIDENCE - ADDITION ABOVE EXISTING GARAGE CONTACT _ GENERAL CONTRACTOR m F"'�`•Co°� DESIGNER . _ A 6.. rewecorsrnu can _ WINDOW SCHEDULE - ANDERSEN 400 SERIES DOUBLE HUNG SIZE INTERIOR EXTERIOR - MARK WIDTN HEIGH TYPE FINISH - FINISH HARDWARE. INSECT SCREEN GRILLE GRILLE PATTERN - . DRAWING LIST' SHEET NAME K - • - - - DOOR'SCHEDULE THERNA—TAU DOOR 'EP m SIMEINTERIOR EXTERIORMARX TYPE INISH FINISH GRILLEWIDTH _ A.M.PM.DESIGN BONUS ROOM HISTORIC REVIEW SET:4:8.16 COVER SHEET P.O BOX 586 508-400-6093 I17 DROMOLAND LANE CD SET:5:5:16 6/30/16 WEST DENNIS WWW.AMPM.DESIGN BARNSTABLE MA 02670 A-1 AREA OF EXISTING . ~.RENOVATION EIISIg� nTG nEleG�ni� earn ' 2 n Fffi �WK 0000 0000 I I I I. DOTTED LINE INDICATES BASEMENT _ DOTTED LINE INDICATES - BASEMENT - - BASEMENT - I I I I L_______i_________________ - l.--------------L-----------------—---------- __�__J ________________________-- WEST NORTH SCALE:1/8" = 1'-0" SCALE:1/8".= 1'-0" A.M.PM:DESIGN BONUS ROOM HISTORIC REVIEW SET:4.8:16 ELEVATIONS P.O BOX 586 508-400-6093 117 DROMOLAND LANE. CD SET:5.5.16 6/30/16 WEST DENNIS WWW.AMPM.DESIGN BARNSTABLE A ` MA 02670 MA -J 03 L � � N _ Sill.,-S' Sill '-8' STAIR VERIFY- 'v f LOCAT ON OF - EXISTING BATH OOM - PARTIOTN o KNEE WALL �m�EC • ' iv . .FULL HEIGHT WALL . . 4' 4-x47COLUMN ON _ FLt OFFICE AREA -a(2)1 3/4"X14"LVLTO CARRY CEILING JOISTS USE JOIST HANGERS FOR CEILING JOISTS a°xa"coLU ON N jJ Pe - HDW 'Sil 2' .Sil .,.. sill . Sill 1_8" Sil 2':' iV V iV iV iV N N N - N O ADDITION ABOVE EXISTING GARAGE FOOTPRINT or oz 1 � - E ADDITION EXISTING TO REMAIN AS IS A-5 -n 2nd FLOOR M. A. PM.DESIGN BONUS ROOM HISTORIC REVIEW SET:4.8.16 2nd FLOOR PLAN P.O BOX 586 508-400-6093 117 DROMOLAND LANE 6/30/16 . CD SET:5.5.16 WEST DENNIS WWW.AMPM.DESIGN. BARNSTABLE A A_� MA 02670 MA NOTE:SEPARATION OF DWELLING/GARAGE NOT LESS THNA 5/8"TYPE X GYPSUM BOARD.INCLUDING UNDERSIDE OF STAIR. 20 MINUTE FIRE RATED DOOR BETWEEN GARAGE AND LIVING SPACE. DN 7 23'-5• EXISTING DECK 3X3X7 CON0 PAD r-V �l I E:l I -------71 / E r l o l-1v ;7( i 0 1 / / I 1 1 1 1 � t/ I EX / I `� REMOVE EXISTING 10 IR �------- - - -- - AND FRAME OUT OP NG 8r/ _-__-__-__- 3'-7"- -4.2- . �y TILE 71 v \ /I q -- EXISTING O CAR GARAGE II / AREA FOR COAT HOOKS / � I -------y DN AREA OF WORK/EXISTING GARAGE EXISTING TO REMAIN AS IS s AS A.M.PM.DESIGN BONUS ROOM HISTORIC REVIEW SETA.8.16 1 st FLOOR PLAN P.O BOX 586 508-400-6093 117 DROMOLAND LANE CD SET:5516 6/30/16 . . WEST DENNIS WWW.AMPM.DESIGN BARNSTABLE �_� MA 02670 MA EXISTING AREA OF _ RENOVATION _ ® ® ® ® nEAµo Fill Effi Milli 111111111111111 IIIIIIIIIIIIIIIIIIIIIillillilillillp ll--===""To I , I o I I I DOTTED LINE INDICATES BASEMENT I I I I EAST SOUTH SCALE:1/8" = A.M.PM.DESIGN BONUS ROOM HISTORIC REVIEW SETA.8.16 Layout P.O BOX 586 508-400-6093 117 DROMOLAND LANE CD SET:5.5.16 6/30/16 WEST DENNIS WWW.AMPM.DESIGN BARNSTABLE MA 02670 MA A-5.1 (q03 U] Sul -C Sill 'A' STAIR KNEE WALL BATHROOM FULL HEIGHT 2 e•-r a• BATH 4'%4'COLUMN ON OFFICE AREA 2 _ II I I Si 2• sin•-a- sill .-S- sal •-s' Sil 2. L: - Rv rvn Nn e�ih �Y - ADDI ON VE XIST G GARAG FOOTPRINT m oz oz oz m 1 E ADDITION MSTING TO REMAIN AS IS M A-S (D__jj-0--FL00RA (4) D 4 a 2 A.M.PM.DESIGN BONUS ROOM HISTORIC REVIEW SETA.8.16 Layout P.O BOX 586 508-400-6093 117 DROMOLAND LANE CD SET:5.5.16 7/7/16 WEST DENNIS WWW.AMPM.DESIGN BARNSTABLE A-S MA 02670 MA 03 ft 1 A-5.1 CK Sal •-a• BEDROOM-2 STAIR7PART,.TN KNEE WALL BATHROOMFULL HEIGHT WALL MASTER z BATH EXISTING MASTER BED /1E'COLUMN ON OFFICE AREA 2 4 CLOSET A-s (2)1 3/4"X14"LVL TO CARRY CEILING JOISTS USE JOIST HANGERS FOR CEILING JOISTS a•.a'coLu oN II I II I I I OPEN TO II ' BELOW L BEDROOM-1 HDW Sii 2' Sill'-S' Sal'-S' Sill '-S' Sil T D.ITIQ.AZ.11 XISTM.GAR.AG FOOTPRINT m oz oz oz m 1 E ADDITION EXISTING TO REMAIN AS IS A-5 2nd FLOOR (4) 1 SCALE: 4' 12• A.M.PM.DESIGN BONUS ROOM Y HISTORIC REVIEW SET:4.8.16 Layout P.O BOX 586 508-400-6093 117 DROMOLAND LANE CD SET:5.5.16 7/7/16 WEST DENNIS WWWAWM.DESIGN BARNSTABLE A-5 MA 02670 MA Commonwealth of Massachusetts Title 5 Official Inspection Form"f _ o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 117 Dromoland Lane, Cummaguid -M --334 P-30 Property Address " Donna Clough _ Owner Owner's Nameinformation required is 29 Boxwood Lane, Duxbu MA' 02332 °Janus 30, 2014 required for every ry � — ry page. Citylrown State Zip Code Date of Inspection " Inspection results must be submitted on this form. Inspection forms may riot be altered in any way. Please see completeness checklist at the end of the form. , Important:When filling out forms A. General Information t : on the computer,use only the tab 1, Inspector: key to move your, cursor-do not Troy Williams use the return Name of Inspector y « g Try Williams Septic Inspections w Company Name , 19 Hummel Drive- •; • Company Address _ w South Dennis f 02660.. t MA. City/Town State -Zip Code (508) 385- 1300 `• • F. S1682 r Telephone Number License Number T 'f• ! 1 B. Certification ' u � I certify that I have personally inspected the sewage disposal system,at this address and that the- 6 information reported below is true, accurate and complete as of the time of the inspection. The ingpecti'lo was performed based on my training and experience in the proper function and mainte0ance of aesite 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 '. 0 Conditionally Passes E] Falls ❑ Needs Further Evaluation by the Local Approving Authority r' ` January 30, 2014 Inspector's Signature „ Date f 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 1_cia�lln'sp�Volm". surface Sewage Disposal Sys m•Page 1 of 17 Commonwealth of Massachusetts --- Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 117 Dromoland Lane, Cumma uid M -334 P-30 Property Address Donna Clough Owner Owner's Name information is required for every 29 Boxwood Lane Duxbury MA 02332 January 30, 2014 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 x 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: System meets minimum standards set by Massachusetts DEP at the time of inspection only.This inspection is not a guarantee or warranty on the future working conditions of leaching, pipes, components or the future structural integrity of said components and only represents conditions found at the time of inspection only. 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 Commonwealth of Massachusetts Y .F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary,Assessments �? J _ P 117 Dromoland Lane, Cummaquid M -334 P-30 Property Address — _--- Donna Clough Owner Owner's Name information is required for every 29 Boxwood Lane, Duxbury MA a;02332, January 30, 2014 page. City/Town State Zip Code Date of Inspection- B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if um s/alarms are repaired. P P . . , B) System Conditionally Passes (cont.): E 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 ❑ A ❑ ND (Explain below): ❑ obstruction is removed' p'.' f ❑ 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( PP 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): n C) Further,Evaluation is"Re4uired'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: r II ❑ Cesspool or privy is Fwithin 50 feet of a surface water k 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 r c Commonwealth of Massachusetts W Title 5 Official -inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 117 Dromoland Lane, Cummaquid M -334 P -30 Property Address Donna Clough _ Owner Owner's Name information is 2g Boxwood Lane, Duxbu MA 02332 January 30, 2014 required for every ry ry page. City/Town 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: 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 '/2 day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 , Commonwealth of Massachusetts Title 5 official , Inspecti®� Fo'r Subsurface Sewage Disposal System Form-Not for Voluntary Assessments *M ,. 117 Dromoland Lane,Cummaquid = M -334 PX-30 Property P Pro a Address --- Donna Clough X Owner Owner's Name information is required for every 29 Boxwood Lane, Duxbury MA .E 02332 ; -January 30, 2014 page. Cityrrown 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 ' round water elevation. ., ` ❑ r ® Any portion of cesspool or privy is within 100 feet of a surface water supply or, X: tributary fo a surface water supply. 4 , 4 An portion,of a cesspool r❑ ® y p pool o privy y 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.] El The system is a cesspool'serving a facility with a design flow of 2000gpd t. ❑ 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. f For large systems, you must indicate either"yes" or"no".to each of the following, in addition to the questions in Section D. b• �,. Yes No t X ❑ ❑' 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 ❑ : Ej, the system is located in a nitrogen sensitive area(Interim Wellhead.Protection j F Area—IWPA) or a mapped Zone'll 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 Commonwealth of Massachusetts -- - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 117 Dromoland Lane, Cummaquid M -334 P-30 Property Address Donna Clough Owner Owner's Name information is 29 Boxwood Lane, Duxbury MA 02332 January 30, 2014 required for every .— 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): 3 — Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts : 4 W Title 5 Official Inspection F®rm Subsurface Sewage Disposal System Form-Not for Voluntary Assessments wM 117 Dromoland Lane, Cummaguid 'M 334" 'P -30 Property Address Donna Clough Owner Owner's Name t . information is required for every 29 Boxwood Lane Duxbury MA 02332 .1 . "January 30, 2014 page. Cityrrown State' Zip Code Date of Inspection D. System Information Description: t ' r ,. ,. . • .i ' .. L' a 'L , " ., Number of current residents: 0 Does residence have a garbage grinder? ® Yes ❑ No Is laundry on a separate sewage.system? (Include laundry' system inspection El Yes ® No information in this report.) Laundry system inspected?' 3 . "k' ® Yes ❑ No Seasonal use? '' ❑ f Yes ® No Water meter readings, if available last 2 ears usage d s 13=7,000 gals. , 9 ( Y 9 (gP )) 12=48,000 gals: Detail: ' } 2 �- Sump pump? ❑ Yes No • Last date of occupancy: - -� � ��" r vacant appx 1 yr. :Date Commercial/Industrial Flow Conditions: Type of Establishment k Design flow(based*on�31 0 CMR 15.203);' + � N/A Gallons per day(gpd) Basis of design flow.(seats/persons/sq.ft., etc.): . N/A E ' Grease*trip present? ❑'Yes ❑ No Industrial waste holding tank present? ❑ 'Yes ❑ No . Non-sanitary waste discharged to the Title 5 system? t s r ❑ Yes ❑ No Water meter readings, if available: N/A ; 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 117 Dromoland Lane, Cummaquid M -334 P-30 Property Address Donna Clough Owner Owner's Name information is 29 Boxwood Lane, Duxbury MA 02332 January 30, 2014 required for every ry page. City/Town State Zip Code Date of Inspection D. System Information (cont.) ; Last date of occupancy/use: N/A Date Other(describe below): N/A General Information Pumping Records: Source of information: No pumping info was available. Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts , 4 Title 5 Official Inspection FoTm Subsurface Sewage Disposal System Form-Not for.Voluntary,Assessments 117 Dromoland Lane, Cummaquid ' M-334 P=30. X Property Address — - Donna Clough _ � t+ Owner Owner's Name - information is 2g Boxwood Lane , required for every , DuxbuN MA 02332 January 30, 2014 page. City/Town State Zip Code Date of inspection D. Sy stem Information (cont.) �Approximate age of all components, date installed (if known) and source of information: Tank, d-box and leaching were installed on 7/22/88 per compliance. Were sewage odors detected when arriving at the site? ' ,• ❑ Yes ® No Building Sewer(locate on site plan): De th'below grade' P feet Material of construction: " t ❑ cast iron ®40 PVC ❑ other(explain): private water su I Distance from P pp y well or suction line: feet - . • �" Comments(on condition of joints, venting, evidence of leakage,•etc.): Lines were found clear at the time of inspection. Septic Tank(locate on site plan): 2'with riser to 6' _Depth below grade: . • - feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene, ❑ other(explain) If tank is metal, list age y� — 1 , years Is age confirmed by'a Certificate of Compliance? (attach a copy,of certificate). ❑` Yes '❑ No ,.6'X10.5'X6' 1500 gallon ` Dimensions: -- --- 4„ r Sludge.depth:, .. _. = t5ins•3113 va i 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 117 Dromoland Lane, Cummaquid M-334 P-30 Property Address Donna Clough _ Owner Owner's Name information is 29 Boxwood Lane, Duxbu MA 02332 January 30 2014 required for every rY ry + page. Cityrrown 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 2' 8" Scum thickness none Distance from top of scum to top of outlet tee or baffle 6„ Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? probe/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.): Pvc inlet and outlet tees were found present and in working order. No evidence of leakage or damage was found. Tank was not in need of pumping at this time. Grease Trap (locate on site plan): Depth below grade: N/A feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: N/A Scum thickness N/A Distance from top of scum to top of outlet tee or baffle N/A Distance from bottom of scum to bottom of outlet tee or baffle N/A Date of last pumping: N/A Date l5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 I N Commonwealth of Massachusetts 4 Title 5 Official Inspection dorm F Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 117 Dromoland Lane, Cummaquid 4 M 334 P-30 Property Address ;t Donna Clough Owner Owner's Name information is every 29 Boxwood Lane D uxbury MA - 02332 January 30, 2014 required for eve page. Citylrown State Zip Code Date of Inspection D. System Information cont. ` y (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.): - ; . • is , Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade:: N/A --- Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene'' ' ❑ other(explain): Dimensions: N/A — --- ' a• , s Capacity: .N/A gallons Design Flow: _ N/A -- ". gallons per day. Alarm,present: - ❑; Yes ❑ No Alarm level: * N/A Alarm in working order;} El ❑ No '+ Date of last pumping: 5' N/A' -- r. Date . Comments (condition of alarm and float switches, etc.) N/A w . a Attach copy of'current pumping contract(required).'Is copy attached? s❑. Yes ❑, No t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments .' 117 Dromoland Lane, Cummaquid M -334 P-30 Property Address Donna Clough Owner Owner's Name information is ry 29 Boxwood Lane, Duxbu MA 02332 January 30, 2014 required for every ry page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert level 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 was found level and in working order with equal distribution to outlet lines. No evidence of backup in the past were found at the time of inspection. 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.): N/A * 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 I Commonwealth of Massachusetts 11 Title 5 Official Inspection dorm Subsurface Sewage Disposal System Form -.Not for Voluntary Assessments 117 Dromoland Lane, Cummaquid i M -334 -P-30 Property Address -- Donna Clough f Owner Owner's Name ------- information is 29 Boxwood Lane, Duxbu MA 02332 9 January 30, 2014 _ required for every rY _ ry page. CityrTown - State Zip Code Date of Inspection D. System Information (cont.) , Type. ❑ leaching pits i number: : -- El [each ing'chambers number: ----- ❑ leaching galleries- number: '❑ r leaching trenches,',' • number]length;r -- ® leaching fields number,'dimensions 1 -24'X24'X12" ❑ overflow cesspool number: =-- ❑ innovative/alternative'system Type/name of technology: y Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Soil was sandy. Checked stone and found dry and clean. No evidence of hydraulic failure or problems in the past were found at the time of inspection: Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):. = 1 Number and configuration N/A Depth—top of liquid to inlet invert — Depth of solids layer ' N/A Depth of scum layer N/A, — --- Dimensions of cesspool N/A Materials of construction N/A Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 • y, t.• Title 5 Official Inspection Form:Subsurface Sewage Disposal System•-Page 13 of 17 f Commonwealth of Massachusetts --- Title 5 official Inspection Form' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 117 Dromoland Lane, Cummaguid M -334 P -30 Property Address Donna Clough _ Owner Owner's Name information is 29 Boxwood Lane, Duxbu MA 02332 January 30 2014 required for every ry. ry page. Citylrown 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.): N/A Privy (locate on site plan): Materials of construction: N/A Dimensions N/A Depth of'solids N/A Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): N/A t5ins•3113 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 14 of 17 ommonw 4 eI ,athofM assachusetts _ ,t Title 5 official Inspection Form : Subsurface Sewage Disposal System Form -Not for Voluntary Assessments .' 117 Dromoland Lane, Cummaguid M-334 P 30 Property Address Donna Clough Owner Owner's Name - y information required is 29 Boxwood Lane, Duxbu MA 02332 ...Janus 30, 2014, required for every rY _ ry page. CityrFown 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 n ❑ drawing attached separatelyVj ` T. VCI 7 ya + s LIT,- q, s (Sins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts --- . Title 5 official Inspection form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 117 Dromoland Lane, Cummaquid_ M -334 P-30 Property Address Donna Clough _ Owner Owner's Name information is 29 Boxwood Lane, Duxbu MA 02332 January 30 2014 required for every ry — ry page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope P ❑ Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: 13.0'+ 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. 2/2/88 Date ® Observed site(abutting property/observation hole within 150 feet of SAS) t ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database -explain: AIW 247 Zone C 24.3' 4.8'adjustment You must describe how you established the high ground water elevation: Test hole recorded on plan showed a perched water found at 11.0'and no water found at 13.0'. Hand augered 5' below bottom of leaching (leaching area grade is raised higher than original testhole by approx. 2' making perched water approx. 13.0' below leaching grade.)with no water found at a depth of 11.0'. Groundwater adjustment at the time of inspection was 4.8'. Bottom of leaching at 7.0'was found not to be located in the high groundwater elevation at the time of inspection. System installed to plan. ----- - 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 `. R Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 117 Dromoland Lane, Cummaguid'• M -334 'P-30 Property Address x _ Donna Clough A Owner Owner's Name -- — information is required for every 29 Boxwood Lane, Duxbury MA _ 02332 January 30, 2014 _ page. Cityfrown 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 c - t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17, O^to1-,lN0- TOWN OF BARNSTABLE LOCATION )—or tat _����-�N� j.K SEWAGE., VILLAGE ASSESSOR'S,MAP & LOT INSTALLER'S NAME PHONE NO. gu.16 ib gAS : Ga 34;.--k 37 SEPTIC TANK CAPACITY ) S® LEACHING FACILITY:(type)_ (size) x NO. OF BEDROOMS :3 PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER ,o DATE PERMIT ISSUED: r l 3 > S�s DATE COMPLIANCE ISSUED_ :2 1 A- Ty VARIANCE GRANTED: Yes No ✓. T 6 a4 e i f A ' THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH S OW/t/...........OF.........9/0! /-573�-43'64 ................ Appliratiun for Diapniitt1 Workii C mitrnrtion ramit \ Application is hereby made for a Permit to Construct (ram or Repair ( ) an Individual Sewage Disposal System at: ;D210r10GA-7ve L��' ��vtiiMt9v L,7 / Z ............. -•--•---••---•---.....__.......#..._._.....•------._........---------•---•------•- Location-Address or Lot No. .... 5� -'`'�••--`!?GsIC�&iZv ...- ........----- _. ...............------. ---- - -----. gr �/ �y �,�/�/f�%Ld/0,s Addresses 7' --------- - I staller Address d Type of Building Size Lot.... ®do...Sq. feet U Dwelling—No. of Bedrooms................ ....................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria rZ' Other fixtures --------------------------•----------------------------•••-•••-•-•-•••••••--••••••-•-••--••-•-•-••-•---•----....._....---•••--•--•--•................ W Design Flow..............._Sr_----_-_---_..__._gallons per person per day. Total dailyflow.............33a___...___.__._____gallons. WSeptic Tank—Liquid capacity.6s9.gallons Length.A 'j�.'.'. Width.!K�'.. Diameter................ Depth...s'.....`.. x Disposal Trench—No. ......./.......... Width.... Total Length...... Total leaching area.._..-576...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.___.�...`..!�!�......Gs. /��� �� z ly,68 . --........ Date--•••-•-•-•'•- Test Pit No. L.L_..Z_---minutes per inch Depth of Test Pit-----t-�.� Depth to ground water_.__. .......-_. Test Pit No. 2..L._Z...minutes per inch Depth of Test Pit..... Depth to ground water----- ......... a .....................--••---•-•.............••-•....••••••-•---•-••---......-••-••-•---•------•--•--........................................................ 0 Description of Soil-----©%�-4Z":Wood1 ,9-yy ..§�...�5'uB_=Soil------.Q (xj 1> p®...:../O Z"--7� �s4.-----P `6a si4 !� G°rC /�2�� � _`�__'_..`�... -------------------- •-----------....------------------------------•---------•-------•----------------•----------------------.....•-•-_.... e. U Nature of Repairs or Alterations—Answer when applicabl ................................................................................._._...._...... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iIIL LE 5 of the State Sanitary Code—.The undersigned rther agrees not to place the system in operation until a Certificate of Compliance has been• ss�h t� " L.G/ Signed_ �'�`�G._........ � �� •- •--.._...... v Date APPlication Approved By._......--f --�r�.- 'D� rY.._.. Date Application Disapproved for the following reasons:.............................................................................................................. ---•---•-----------------•---•--•-•-----..............--------------------•-----..........-----........--'--------------------------------------•---•••-•--......----•------------... ........._.._. Date PermitNo........ L2........................... Issued....................................................... Date s" S7 No....Sl.�Z--•2=/.2 Fzs.....21 5. . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .................oWN-----.....O F........................................--------._........_.............................•. Appliration for Disposal Works Tonstrurtion rrrutit Application is hereby made for a Permit to Construct (v) or Repair ( ) an Individual Sewage Disposal System at: 7�2aHoL�•iD LA-^"E CG'�MAPI// 0 LoT 1&/ Z .....•••- ---------_.......... ...� .................... ............. ......................................--.... ... -..............._..... .......... moo Loc ti viz Address or Lot No. �� ...... . r� ------------ --- -----. . -.-...... Owner Address W C��/1 S .STAY/G L- CCriiMr�i9�i v !� ,.a ..... ----------------------------•••-••----_...._ ....-• ................................................... pq Installer Address VType of Building Size Lot............................Sq. feet ,.., Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building ....... No. of persons............................ Showers ►fir YP $ ....................• P ( ) — Cafeteria ( ) d Other fixtur •-••--•------------------------------- Design Flow----------------�_._.:.._................gallons per person per day. Total d�3ly�flow..............._..'��___........ s. • /Soo ,v G ' �4 Septic Tank—Liquid capacity............gallons Z�Length................ Width Z.�...._.. Diameter................ Depth.�............ x Disposal Trench—No..................... Width........--.......... Total Length.................... Total leaching area..... ........... ft. Seepage Pit No............:........ Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing ttank ( ) a Percolation Test Results Z Performed by.......................................................... ........ Date____.._.....:..-,-.-�-------. a Test Pit No. 1.__...... - minutes per inch Depth of Test Pit......:....- Depth to ground water...................__. Li, Test Pit No. 2...L......_._minutes per inch Depth of Test Pit....... a...... Depth to ground water........................ D De i tion of Soil.. ..���:_�Z" kioo oG�A-� � .S'�..E3-Soil •�1 " -fro .... ;%��f� ................ . o . ..................... �` ..- . Jr"c '= . ........................... AclL�� .S�ia .eac/G Z.. -/J�%i 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 issued by the board of health. Signed...................................................................................... ................................ Date Application Approved By............. .... - ........................................ Date Application Disapproved for the following reasons:.........................................................................................................._.._ ..............••---.....-•---........-----.......---...-•----..............--•--...--------------......-•.•-----•--------------•-----...----•-•-•--....------------.............-----•--............_.... Date PermitNo........���� - =� ---------•----------. Issued---------------.................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TO wAi 'Z?/9-Z/1/STAl3G�' ..........................................OF..................................................................................... (Irrtif irate of T-autplianre THIS IS TO CEI TIFY, That the Individual Sewage Disposal System constructed (4--lor Repaired ( ) by...........••--....C...�...... .f_.. `: .........................................................-•---------•-------f-----------------................... . _.._..._ at-..............�_ ..._? ... .. i •-•................................................. ...............••... ... has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated..............,................................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........................7..r a:� ' .............................. Inspector............... ...--- ............................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH /�7 ................�a.LvA/........OF.----------U'A72!v-ST/9 ....................... No.. (L.. F$E .. .....-::. Disposal Yorks Tonstrurt' n erutit r Permission is hereby granted.........-li atl.�........` .... . C ' to Construct (� or Repair ( a an Individual Sewage Disposal System - ��~~� at No..................C. . _ ... ---.....---............•-••-----------........................................................................... c Street Qyj . as shown on the application for Disposal Works Construction Permit No................... ...... Dated.......................................... ----------------•-------•--•-------•-•--------•-••-----------•-••-•--•-----•••-•------...---..........._ -.-- Board of Health DATE...........................••---...................................... FORM 1255 A. M. SULKIN. INC.. BOSTON TOP OF FOUNDATION t •'' CONCRETE COVERS I ". �nnsfi► „m�nw, z•7. y/v Fi�viStlV C,t�S.BG ' "CAST IRON 12" aE- MAX. PIPE (OR 4"O RANG EBURG(OR EQUIV.) ter "' EQUIV.)- MIN. 1211 MIN. PITCH 1/4"PER.FT PIPE-MIN.PITCH I/4"PER.FT. LEACHING FIELD (.S .,REQUIRED) � I/8"- I/2" WASHED SNNE •F � INV� T WASHED STONE EL..... .:l .. I SEPTIC TANK INVERT DIST INVERT 3/4 II/2'i .i INVERT EL.`3,68 J BOX �-G3".3$ SSoo GAL. I INVEf�T 63- INVERT INVERT b EL.. ..•._... EL.� •.�°.. EL..c3:o z o _ I •: PROR LE OF Z¢ NZ s7,�o GROUND WATER TABLE SEWAGE DISPOSAL SYSTEM TYPICAL CROSS SECTION NO SCALE LEACH I NG FI ELD NO SCALE Moab - ,y vN sv/TA f' H,4f'a7e/19 4- /N 7�t ��•.��.N 4r/� DESIGN DATA . wvo 7T 13e acv� i/8=i/'2" , „ LD T / 3 i9+IU k•E` !'71t, WiT7y 3 12' MIN. WASHED 3 /o f ; pL4cNUMBER OF BEDROOMS STONE TOTAL ESTIMATED FLOW . . . . . . . . . . .. GALLONS/DAY 4" 4' RFO BOTTOM LEACHING AREA �� SQ.r%/TRENCH PLASTIC PI t VL k" SIDE LEACHING AREA . . .NO"��` SO.FT./TRENCH I, 43/4-1 V2" s GARBAGE DISPOSAL . .!`�O.^!E..(50°�o AREA INCREASE) WASSTONHED 1 / y f / / G' / 1^✓ TOTAL LEACHING AREA 5 C. . . . ... SQ.FT. 4� �9 io 14`/o' �¢io" PERCOLATION RATE .741" 7WO PER. INCH LEACHING AREA PER PERCOLATION RATE . `�?�a.. SO.FT � •� GROUND WATER TABLE�P6ecNEv) f — J t` ,Q (tm, ,> ! _____ _ �ti _ SOIL LOG \ ' fE Z 1 J���S � I M //? f./y DATE . . .. . .. . E . .. . . .. .. . . ' TEST HOLE I TEST HOLE 2 Tc �Vl \ ELEV Mj - - - - i - / A,,5 l� ` te' ELEV VET 4ow.v ✓ /ZE��N b �� /77, . I Rend/?w f/c""LC' u4'x r , Woo RT7 l�Rr� T_ � Sol it W Pr t / w b /hs[t Al ? U ! t�i Z,x �1�� Mkt t _�. .�ATJtJ Z Sonic 4d SA+..!d5 ic Liif� Imo--. %; /�s � i bn„�N Fi/iE <<�� \•' CL�►+/ hi7( 444 / - 4 TLN 1 �_� ,s;�„]«.�,,A,4„+—�....,... -^•��� K-.^""._.^e.Y..--w.«..,� _._..s �. / /5� I , '� / �7 SLyOa. 11444 �'5 tesI 5�.9v r .-..-.. —WATER ENCOUNTERED RED Z. WITNESSED BY I s. ! . . . . . f. . :x. . . BOARD OF HEALTH ENGINEER f � t i I I Z 7- b i I v rz a EDW!,\RD 0 6(21_LEY tA1N u M!-?A, Li26100 v w r'TclsI(Q���Z t s�/aNaL LANDS 11MIINt1�+ .9 SSE Sv�i S /JAB 5-¢ >A A.r- 'cue C4L