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HomeMy WebLinkAbout0146 DROMOLAND LANE - Health L\ A MOL' LANE , NS-TABLE. 334 035 , r I. .r „ .-.ram.-.—=zr'---.Y;n-r :!`:may:.c �.r. ....- - .,,{ ..-s•�.xT!•: t - t -.- - : C _ - r r a . � .. a • �: fit:. L p. - s .:.- r - +. . _ , s c o , { r .ar , t. tr V `� ,a.� ..� • � - � - �� ' r d . may. � _. 'p ,tw � � r � .:. -..r`{-, a e s ,.� } r � y t t n : - � r t v " Q v:r a{ , t i , ,.4 t, y .. + ,fir.: � ., {m.� .� - -. tr„ .t 6 + s • '''' •t,a '� � - , �i. -,a .. ti " , ., ;fit. '.`y `¢ .{� ! - i {4a ,:. r - ,..a o — . Y' vf v „ � x " t � .. f➢ '4 n. y . �` f:. , ,. L y - '`a I „� tI • a � Y J ,, , .I a a. r , " • i x yr F..,w. , e � .ela �u � .. L e e ., Wx:::'e$ .wr Y•� " h .� ...s' r c y _ 4 , r g 1 1 REC COMMONWEALTH OF MASSACHUSET I S R 2 7 2003 EXECUTIVE OFFICE OF ENVII?ON-ATENTAL Mr,AIR DEPARTMENT OF ENVIRONMENTAL PROTECTIO" o BARNSTABLE E H DEPT. u W � d V�v TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VCL NTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 146 DROMOLAND LAND CUMMAQUID 02637 M334 P035 L23 Owner's Name: DAVID PARRELLA Owner's Address: BOX 63 CUMMAQUID A�y � �e-v ewe l Date of Inspection: 3/31/03 3 Name of Inspector: (please print) JOHN GRACI,INC. I Company Name: SEPTIC INSPECTIONS Mailing Address: P.O. BOX 2119JEATICKE'1',rzA. 02536 Telephone Number: 508-564-6813 FAX 508-564-7270 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this,address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was pei formed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: X Passes _ CoInditionasses j _ Nevaluation by the Local Approving Au h,)rity, Fa Inspector's Signature: rater 3/3i/U3 The system inspector shall suf this inspection report to the Approvii.;Authority(Board of Health or DEP)within 30 days of completing this ine system is a shared system or has a deaign now of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments SYSTEM PASSES TITLE V INSPECT PUTAfP + -RY TWO YEARS.RECOMMEND THE S R ASPI IAUL D BOX WAS RAISING COVERS TO D-BOX AND INSPECTION PORT ON FIELD BO H UNDL VIDEO INSPECTED. /1 '!Q hCC��t2the it,AI W`^) �£1J`yt�Q � v� er I�✓Pwct�, **** describes conditions time of inspection and unde►'the conditions of use at that time.This• This report only ' inspection does not address how the system will perform in the future underAhe same or different conditions of use. Page 2 of 11 OFFICIAL INSP ECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 146 DROMOLAND LAND CUMMAQUID 02637 M334 P035 L23 Owner: DAVID PARRELLA Date of Inspection: 3131103 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: ' X 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: THE SYSTEM PASSES TITLE V INSPECTION.RECOMMEND PUMPING EVERY TWO YEARS.RECOMMEND RAISING COVERS TO D-BOX AND INSPECTION PORT ON FIELD-BOTH UNDER ASPHAULT.D-BOX WAS VIDEO INSPECTED. 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. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined"please explain. n/a 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. ND explain: n/a n/a Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): _ broken pipe(s)are replaced _ obstruction is removed _ distribution.box is leveled or replaced ND explain: n/a { n/a The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced _obstruction is removed ND explain: n/a r - Page 3 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 146 DROMOLAND LAND CUMMAQUID 02637 M334 P035 L23 Owner: DAVID PARRELLA Date of Inspection: 3/31/03 C. Further Evaluation is Required by the Board of Health: . ;. _ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 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 n/a ' "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or;less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form:: v 3. Other: n/a Page,4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 146 DROMOLAND LAND CUMMAQUID 02637 M334 P035 L23 Owner: DAVID PARRELLA Date of Inspection: 3/31/03 , D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for.all-inspections: Yes No X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in cesspool is less than 6"below invert or available volume is less than ''/z day flow X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped NOT IN THE,LAST YR.. X Any portion of the SAS,cesspool or privy is below high ground water elevation. ` y _ X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _ X Any portion of a cesspool or privy is within a Zone 1 of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well. X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from'a private water supply well with. no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] z. NO (Yes/No)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. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no _ X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply X the system is located in a nitrogen sensitive area(Interim Wellhead Protection.Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes" in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. A Page,5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 146 DROMOLAND LAND CUMMAQUID 02637 M334.P035 L23 Owner: DAVID PARRELLA Date of Inspection: 3/31/03 Check if the following have been done.You must indicate"yes" or"no"as to each of the following: Yes No X _ Pumping information was provided by the owner,occupant,or Board of Health X Were any of the system components pumped out in the previous two weeks? X _ Has the system received normal flows in the previous two week period? x X Have large volumes of water been introduced to the system recently or as part of this inspection X _ Were as built plans of the system obtained and examined?(If they,were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up? X _ Was the site inspected for signs of break out X _ Were all system components,excluding the SAS, located on site'? ; X _ Were the septic tank manholes uncovered, opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? X _ Was the facility owner(and occupants if different from owner)provided with information on'the proper maintenance of subsurface sewage disposal systems The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no X _ Existing information.For example,a plan at Board of Health.' _ -X Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] a S Page 6 of 11 e OFFICIAL INSPECTION FORM ' NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C - SYSTEM INFORMATION Property Address: 146 DROMOLAND LAND CUMMAQUID 02637 M334 P035 L23 Owner: DAVID PARRELLA Date of Inspection: 3/31/03 FLOW CONDITIONS . RESIDENTIAL Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example:,110 gpd x#of bedrooms): 440 Number of current residents: 4 Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no):NO Seasonal use: (yes or no): NO Water meter readings, if available(last 2 years usage(gpd)):isia a „. 00 a Sump pump(yes or no): NO �� � ()00 Last date of occupancy: n/a OW COMMERCIAL/INDUSTRIAL Type of establishment: n/a Design flow(based on 310 CMR 15.203): n/agpd Basis of design flow(seats/persons/sgft,etc.): n/a Grease trap present(yes or no): NO Industrial waste holding tank present(yes or no): NO Non-sanitary waste discharged to the Title 5 system(yes or no): NO Water meter readings, if available: n/a Last date of occupancy/use: n/a , OTHER(describe): n/a . GENERAL INFORMATION Pumping Records Source of information: NOT IN THE LAST YR. Was system pumped as part of the inspection(yes or no):-NO If yes,volume pumped: n/agallons--How was quantity pumped determined? n/a Reason for pumping: n/a TYPE OF SYSTEM X Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool §- _Privy _Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank Attach a copy of the DEP approval Other(describe): n/a Approximate age of all components,date installed(if known)and source of information: 11/19/01 INFO FROM ASBUILT Were sewage odors detected when arriving at the site(yes or no): NO ,h 6 Page,7 of 11 OFFICIAL INSPECTION FORM'—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM N PART C SYSTEM INFORMATION(continued) Property hAddress: 146 DROMOLAND LAND CUMMAQUID 02637 M334 P035 L23 , Owner: DAVID PARRELLA Date of Inspection: 3/31/03 1 ` . Y • BUILDING SEWER(locate on site plan) Depth below grade:30" Materials of construction:_cast iron X40 PVC_other(explain): n/a Distance from private water supply well or suction line: n/a Comments(on condition of joints,venting,evidence of leakage,etc.): TOWN WATER SEPTIC TANK: X(locate on site plan) Depth below grade: 24" Material of construction: Xconcrete_metal_fiberglass_polyethylene other(explain)n/a If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) Dimensions: H 10' 6" H 5' 7" W 5' 8"" Sludge depth: 0" Distance from top of sludge to,bottom of outlet tee or baffle:34" Scum thickness: 1" 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: 17" How were dimensions determined: MEASURED ' i levels as related recommendations,inlet and outlet tee or baffle condition structural integrity,Comments(on pumping recomme g ty, liquid d q to outlet invert,evidence of leakage,etc.): SEPTIC TANK AND ALL SEPTIC TANK COMPONENTS ARE STRCTURALLY SOUND AND FUNCTIONING PROPERLY.RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. GREASE TRAP: _(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a 9 Distance from bottom of scum to bottom of outlet tee or baffle: n/a Date of last pumping: n/a Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity;liquid levels as related to outlet invert,evidence of leakage,etc.): n/a z Pagq 8 of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C' SYSTEM INFORMATION(continued) r Property Address: 146 DROMOLAND LAND CUMMAQUID 02637 M334 P035 L23 Owner: DAVID PARRELLA Date of Inspection: 3/31/03 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): n/a Dimensions: n/a Capacity: n/a gallons Design Flow: n/a gallons/day Alarm present(yes or no): N/A Alarm level: N/A Alarm in working order(yes or no): NO _ Date of last pumping: n/a Comments(condition of alarm and float switches,etc.): n/a DISTRIBUTION BOX:X(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: LEVEL WITH BOTTOM OF PIPE 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 VIDEO INSPECTED AND APPEARS TO BE STRUCTURALLY SOUND AND SYSTEM SHOWS NO SIGNS OF FAILURE.RECOMMEND RAISING COVER PUMP CHAMBER: _(locate on site plan) 1. # Pumps in working order(yes or no): NO Alarms in working order(yes or no):NO Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): - n/a . R Pago 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 146 DROMOLAND LAND CUMMAQUID 02637 M334 P035 L23 Owner: DAVID PARRELLA Date of Inspection: 3131103 . L n t required) locate on site plan,excavation0 SOIL ABSORPTION SYSTEM(SAS): X ( p If SAS not located explain why: n/a Type t: n/a leaching pits, number: n/a 500 GALLON CHAMBERS leaching chambers, number: - 4 n/a leaching galleries, number: , n/a . : 0 leaching trenches, number, length: n/a, . n/a leaching fields, number: n/.a n/a overflow cesspool, number: n/a n/a innovative/alternative system T e/name of technology:9Y � na Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.): THE LEACH FIELD IS FUNCTIONING PROPERLY.RECOMMEND RAISING AN INSPECTION PORT IN LEACH FIELD-SYSTEM SHOWS NO SIGNS OF FAILURE.BOTTOM AT 6' ' CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) . Number and configuration: n/a - Depth—top of liquid to inlet invert: n/a 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 or no): NO 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 . Q Page 10 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION.(continued) Property Address: 146 DROMOLAND LAND CUMMAQUID 02637 M334 P035 L23 Owner: DAVID PARRELLA Date of Inspection: 3/31/03 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a'sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet.Locate where public water supply enters the building. Lj 5►� d � I�C AA t (� ITi� I�• Rc ►y AD S6 PA M ° 66. M Pags I 1 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) ' Property Address: 146 DROMOLAND LAND CUMMA QUID 02637 M334 P035 L23 Owner: DAVID PARRELLA Date of Inspection: 3/31/03 , SITE EXAM _Slope _Surface water _Check cellar Shallow wells Estimated depth to ground water 12+feet Please indicate(check)all methods used to determine the high ground water elevation: NO Obtained from system design plans on record_If checked,date of design plan reviewed:n/a YES Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain: n/a NO Checked with local excavators, installers-(attach documentation) YES Accessed USGS database-explain: n/a You must describe how you established the high ground water elevation: GROUNDWATER WAS DETERMINED BY VISUAL AND USGS MAPS AND CHARTS- 12+FT ^ r � �JN OO B A RAAB LE 3 LOCATION - SEWAGE # 0® .���� VILLAGE 5 ASSESSOR'S MAP & LOT° . INSTALLER'S NAME&PHONE NO. IZ//4;41 SEPTIC TANK CAPACITY LEACHING FACILITY: (type) V (size)14 G�� �,� NO.OF BEDROOMS �A- X" '�j BUILDER OR OWNER '�-- PERMTrDATE: COMPLIANCE DATE: / Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Pri vate Water Su 1 Well and Leaching Facility an wells exist PP.Y� g tY � Y � on site or within,;2'00 feet of leaching facility) Feet Edge of Wetland and'Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by 4 13d - 3 ,000,4 -3 v J No. 6 v THE COMMONWEALTH OF MASSACHUSETTS Fee BOARD OF HEALTH PO�R1fll of �i CM5 rh6L6 APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct ( ) Repair ( ) Upgrade ( ) Abandon ( ) XComplete System ❑Individual Components Localion owner's Nam' q e L�� Map/parcel# %8 171 i 1/q4 Address �., Lot# L 11 "fdcphonc# Installer's Name -� ,J2esi mer's Name 21,b I�Ai�l i'�t D u I N Address Address Telephone# Ic1cphone# Type of Building: l DEMTlAtl Lot Size '�i Sq.feet Dwelling—No.of Bedrooms Garbage Grinder ( ) Other—Type of Building No.of persons Showers ( ), Cafeteria ( ) Other fixtures Design Flow(min.req fired) `-f gpd Calculated design flow q I'V gpd Design flow provided gpd Plan: Date I)b Number of heets aZ Revision Date Title r dA p &7U)A GE PIS S46TM Description of Soil(s) 0 1l= g _00r�= Soil Evaluator Form No. Name of Soil Evaluator E UY Date of Evaluation 5 DESCRIPTION OF REPAIRS OR ALTERATIONS r� :r The undersigned agrees to install the above described Individual Sewage Dispo al System in accordance with the provisions of TITLE 5 and further agrees not to place the system in operation un i Certificate ofyCompliance has been issued by the Board of Health. Signed Date FORM I - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 � r . '� � .--^swr.-:.,..r 'Vy .n � .-�ti r ✓ _ � ..new.- y�•.r J� �•-nrc.....Y".''FY',-fir.....-_..,�n-, . .r�,+',-�. .c .:,.r.<^. t 5 No. �, G. THE COMMONWEALTH OF MASSACHUSETTS FEE f UV# BOARD OF` H EALTH APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct ( ) Repair ( ) Upgrade ( ) Abandon ( ) -XComplctc System ❑Individual Components 17ROW(Aun W46 ��VID i�fiR1�EFU( A - Location e►O�wncr's Nam r 33 q -35 a?b ° 1,� ► 301+g�ky�NAS R Nliili/PNurrl# Lot# / 6 C /telephone# + Installer's Nano: si cr's Name - r' l Address Address i 5N) 549 eY(.J - _ Telephone# Telephone# - Type of Building: � 1 e ,��_ Lot Size 1 XW�- Sq.feet Dwelling—No.of Bedrooms L Garbage Grinder ( ) Other—Type of Building No.of persons Showers ( ), Cafeteria ( ) � Other fixtures _ i Design Flow min. re fired 1440 d -Calculated design flow y� d Design flow provided ,�(00 d g ( q ) gP g gP g p gP Plan: Date d�� Do Number of sheets aZ Revision Date -Title ?(AT MAC OF WOV05FO SL U)A�asPOSAL SY6TE(Y1 Description of Soil(s) Soil Evaluator Form No. Name of Soil Evaluator b0pSe UY Date of Evaluation 3 qjob l Y _ DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of + TITLE 5 and further agrees not to place the system in operation unfiha.Certificate of Compliance has been issued by the Board of Health. Signed 1 1^SS Fons- 100, I4 xr T i FORM I -#APPLICATION FOR DSCP DEP APPROVED FORM 5/96' 1 "oy i Nosozo -6 X THE COMMONWEALTH OF MASSACHUSETTS FEE /)G+t�'hs�RGGx BOARD `OF HEALTH t CERTIFICATE OF COMPLIANCE •' L 4 � I Description of Work " ' E] Individual Component(s) Complete System », The undersigned hereby certify that the Sewage Disposal System;Constructed( ),Repaired( ),Upgraded( ),Abandoned( ) rj A ` has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and the approved design tans/as-built / plans relating to application No e'�dated /.1r� Approved Design Flow (gpd) 1 � p Installer &*atpe Designer: Inspector i /k.00L�r vI I ii The issuance of this certificate shall not be,construed as a guarantee that the y tem will function as designed. FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVE , FORM 5/96 No. THE COMMONWEALTH OF MASSACHUSETTS FEE SC- BOARD OF HEALTH r DISPOSAL SYSTEM CONSTRUCTION PERMIT l Permission is herep� granted to Construct (� Re air ( ) Upgrade ( ) Abandon,( ) an individual sewage disposal system at 7G (�✓ouvfy fed Lam+ CCU till as described in the application for Disposal System Construction Permit No. Ott -e5"dO dafed i Provided: Construction shall be completed within three years of the date of this pe-r-miit.A_11 10cal conditions must be met. Date l Board of Health �1 P 1 F i FORM 2 - DSCP DEP APPROVED FORM 5/96 TM FORM 1255 (REV 5/96) H&W Homs&WARREN PUBLISHERS - BOSTON i i '---OF B ABLE . �07 �� p LOCATION SEWAGE #�©6 0 D d VILLAGE— ASSESSOR'S MAP & LOT. INSTALLER'S NAME &PHONE NO. �� — SEPTIC TANK CAPACITY d LEACHING FACILITY: (type) ✓/(size)^ /�G�'I� / NO.OF BEDROOMS RT-TTT. ER OR OWNER A — 'L PERMITDATE: 114 COMPLIANCE DATE: I Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility L/ Feet Private Water Supply Well and Leaching Facility (If any wells exist I on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility) Furnished by r. J/ - IV -y �Yfl) n. _,_ ., -. - -, .. - _ _ -- l a�r.., F__ 7 ..,. , «.. , - ..r,,, ., , .. - ,. ,�r,«. -ram .-x*n s.`-:A4,-` .ice+^ "'a -. yl.....,,r.,,,,amv'cS�^r �^.'" '. 's+—Fw-......-.- _�,:;.s°',1., , .. ,. ., n",v. .^z.... =...m,... .: ..va,..«..,•*, !e "-.:..,..s-r.m-,n.'-„^.., c,....: ,^s ,4..mmsq'c. .,..,...,-+ Y ... ' 5 r.. sr Y r.., 7n x— ..u— ,mrv^-n.....:. ..,n n W ,... : '.:p ::., a.rr. .... . :... f.. I I 1 .. 1,.: a r-., v ':, ,. 4... .:.. ,. .. , ,-. a h , ,a:y':, ., , ,. < r , .a - „ .. `.. . , . >I ,« , , o- -.. < , _ , ... , , P. .:.; ' ,II III�I,,I�II II�/.I.���-!�.,I r w ��,_-��"II�I I�I I,-.-"1 I1I����I'I.11�I\I II I I.I 1I I..I1 I1I I1 I�.-I��II,�.-11 I..II 1,-.I 1�.—�I 1 I_-II-,�I iI'--..�,__I�,.,.-—.—_�__,I II I,,I�I��I_��.I_I1.I I""._1II—_I_I,I_.I_�_III.I I-�II_�.�.-�_I,I-.-I I—I_1,I,..1.�I�_.I.I II_I_I.1.--­�."I,,_I"-..I,-IIII.II 1I.�I I1 I I�1II�.�..,.�I.II�I-II_�-��_I..I1I..I..�1,_I II�..I I-...I���—_I�I..1_I 1.I..��I._­10.�.-I I;.,.,.`I._,1IIII��.1.I I�`,_..,I3_.I...I�I�_T_I.I.� /II 1�If­I­���I-,"II p-I'�II�II-Ie e II.I I j-,,-I—�I�1,.I3 I_,".I I IIW*1 1r\1I' �II'­,�II I—,�1.1,��I`I I 1I A. �I1�I,�II I�I II 1 I I I1 111 I 1Ih,[I,1 rII��2:t�(t�.1k I,-,I� ­I"i I_,I-,I,I�I�I I[I-I ,.:. f; , : - ,:. ,j : , d , „ , ..,. - :1 '�° . - .. r ;: .,". {j : „'. _ , • NOT , - ­ , � II �` �-_� , oU. H SE ;NUMBER. 146 ti ...: ..: •.."'tiro. �}� i , �,, . : , . 2. ASSESSORS NUMBER• 334 35 II a 1-1 1. ,11 • _.. � - 3. ZONING S l RF . `� � TR CT, 2 "- ,.-- _ FLO HAZARDNES. C ro-� �`_-,._ _�� 5. BENIfiMARK. : AS NOTED �_..: - _•.. �____ _--,-, f. TOPOGRAPHIC INFORMATION- -_ H COIPtLED FROM AJ _._.., �, ... .._. - ,. ON THE GROUND INSTRUMENT U -- _. RVEY 7. E�.�VA�iIONS` SHOWN' ARE BASED ,� OIL 1)4E ,N ATI N AL G T _ "'�``o EODE IC VERTICAL DAT UM. O r , 8. REFERENCE. P o ��'' LAN BOOK 354, 'PAGE ' 4 O p o A o LOT 22 1. N , • ,� . , y S ��, o a ti 2 a ,. e 2 w y` �o , _.. . ti� 8 -9i ``y. '1� p `/ti - _ ~`\: if— a --- . ,�. iji `\ `. �,* ` . . y O p 3 r,, _ `�"__" 0 O `',:,, ry r. p �, __ N ,. -.,� 4, , , . r (7m 5 lT C► e- Q O L P s, : n \ Je ti; ., a f .. PAT/O YY �p f . �, . � _ / ,.F h G , f �\ VO k _ .. . :.. :. ::PROPOSED" . . . :. . PA 170 .,- ti., .. '' s h �, v A r w —f. O 4 1 rc Q r h � 2 ..., , . . . . . . :.. POOL. :, ..... . ,:.{{. � , J Q _" 5 s l Q �t d ? Z ,- I. ,, ,. : _ , : .. . . . . :. :. . . .: Q Un ess and until such time a h i i,, ,. 1 c s t e or nal'(r�id stam of .the y ti w 9 ) P 2 '.�` f- S . ,. � res onsibie P ofessi n i n �' p r , b a E qm er, or Profes_tonal fend Surve or / / Y E \ t o P ,, :�1t o 2 A no erson or ersons �nclud�n an i i I ` r t r o ( � P P 9 Y mup c pa o o he ( O 4 ubiic officals ma rel u on h in r . V ry : `IJ AIN�GE P Y Y P t e fo motion contained herein, and PAr/O q .a ` _ o oEzrr , , - Q i h � 11 � B . this fon rema:'tis he r . ' ( h ,o �' SENt�NT O p t p operty of Holmes & McGrath, Inc. .�' �cr � G3o � s� � - ., / - O .Q ; / t9 Pfr'Or�'OSEI? � � F < -, � IZ . 4 0 o c s I HOUSE �, s. r 2 , ' 5 F.F. - 81.CIO � , , a / -, 6 GRAPHIC C r, I SALE 4 > t t r 1 .. ,.:« .. I . o h / � , "� I. ,- k 1 ' 20 10 0 20 60 , � 1 II 3 o _ . L T 23 4 w �. Q, p f . 48,000 S.F. o [� ? IN FEE r 1-�� T e , o O , GA�4AGE I p 1 inch = 20 ft.' . ? — i 1 , ! N IP h t .:/ 3 t -- FOUN ``) 1 ` . `, .�7 i 9 G '�O ,, E .. I rJ , 1 O LL N I . , . .' A GATE 5 O GA O a a t a r \ t SEPT/C TANK 1 I� V `. o JI _ 7.350x CZ t a I .� t • OIST, BOX l 1,11 1 �9 1 t �. 1. # ... o 1 -, 1 +< .. t t o ,,, ry ; v d v, 4 COBBLESTONE 00 ' CB H l es E.p l _ ( CB H FOUND to aD �" I APRON ID r DATE DESCRIPTION Drawn Checked k �F ry . , _ . A t. � s , (/? y y R E V I S I O N S ,. , 1 _ 0 _ P -�, OST,AND , I. i �_«--W---- �_ GA '--� i RAIL BEN " �� PLOT PLAN . \ . . o E __�_ 4 50o cALL cH� c � - . o t`_, +, , _�H MBERS NfTH �FEE OF , � � OF PROPOSED S W . Y ,_ E AGE DISPOSAL SYSTEM ~4-.... . - s w __�. sro AR N , . &,q _w r�fdLL OU D IF .� 7 ,. PREPARED ` FOR r a f, o ,� fi o OE L V S CE O 1 zzs - DAVID PARREL 3� �. I LA r �. f t P dN t�' � �+ � E FOR S LOT 23 DROMOLAND LANE 87 48 05 E , M N "_.._ ,. ____ CUM q . © M QUID " MA 2 �,..> � Q RF - DARNSTA T��cT BLE _ is __-__-- :: . , ,DING �� Q ON — Z ,: _ ...----�- ELEC I S RVI ry cn t TRIC _ 7R C E CE _, G c D S N tN _ ZO , ,... . _.., .. 4,. :1 o `SCALE. : � 20 DATE. OCT. '28'2000 , J :." ,.. :- 'airy� .•, ,•..\.,r s :,.. , ,- a P I,t N, P_L _ _ � i t h r ) ,. F , olm- �eI and me . I Inc. ,_.� 9 r.. , is, .l ,. . clvll en m er e sand land surve` ors . 6- x . 9 ., 3 LO r T 24 _ � main street '' 508 5 8 3564 PHONE �a � ': , :', ,. :.'. :.. ... .: .,vim ,... ,. .h` a 7. _ falmouth ma 0254 F g, 0 508 548 9672 AX $, �_ , „ m ��t.{,L ,.. : ,..." s... t. ♦ : k.i.. DRAWN. JR MJB CH. _ ECKED. � � b . _ , _ , J = _ ,y 2oon5apP�awG _ OB N0. ZaotJ58 DWG. NO..,_ _4 4 21 SHEET ,� ,OF 2 lI _, II , , - , . , _„ .. _. ,* .. _ ,. _ _ ..r { -e ^ , Y DEEP OBSERVATION HOLE LOG NO., "I OTHER. SOIL SOL TEXTURE SO L COLOR SOIL SOIL Munseil. ' MOTTLING ;. corrxsro+cw,z auva w a min. of 9a h grade above and od cent #o system,shall,slope n a at 2 Finis ad ja YsY Date of sail test: 3 9 00 .. 4p di " . cost Iron or Schedule 40 PVC pipe (tight join ts). Test taken by. M. Bor el i NN 79.3 Results witnessed by. Town Health Agent „ *':. . r in,-distance buildin to edge of leaching system) LOAMY SAND 10 YR 5 6 20 m _(building g g ys ) 12.83 Percolation .rate, < 2 min./inch 9 30 77.5 B / NO „ r water NONE ENCOUNTERED 5 Ground ate 0 E E CO TEREE7 p COARSE SAND _. NO _ G S ?.5Y74 10 _min, distance 30 144 68.0 `. / 4 83 4.0' 4.0 , First floor - -•R m bi covers within 3 e ova e Elev. a 8100 „ f of finished r de I Necessary) gg 9 Q l Y) iA ces oles in lank to c H - be 20 in Diameter Dist.:box VARI s 2 s ES s 0.02 .02 N level 0.01 MIN. OB VA ON `H LE LOG NO. 2 ul lave DEEP SER TI 0 L 0. OTHER 1� O I I R o ._ •....•. 0 , SOIL SOIL TEXTURE , SOIL catoR SOIL �-SEP C TANK �, m . • - m ,D to t� C7 DEPTH ELEV. HORIZON USDA (Munself MOTTLING srai�s eawExs Foundation r` 1500 GAL. 00 vi H-10¢ CI , Ct C7 E I e V.= 73.17 (USDA) ) sm+cT x say design n r n in p by others 0" 81.o>i > h 0 m 5 H 10 > r\ p, „ - 6 -32 78.3 8 LOAMY SAND f0 YR b 6 NO .- Elev. 68.00 / LAYER OF CRUSHED COMPACTED .STONE „ LOAMY SAND 2.5 Y 6 4 NO s L Bottom of ..test hate 32 132 70.o cr / 132 -144 69.0 C2 COARSE SAND .5 :Y 7 4 NO Not to SCCJIe 6 .LAYER OF CRUSHED COMPACTED STONE 2 / a� GENERAL NOTES 1) No change to this :system shall be made unless 4 KNOCKOUT approved in writing by holmes and mcgrath, inc. DESIGN CRITERIA - k . • : 2) Subject to inspection.during construction b the „ 1e 9 Y Igal.'s/dayf 4 PVC VENT PIPE : Board of Health'and holmes and'mcgrath, inc. Number of bedrooms: 4 Equivalent to 1-10 x • SCREEN � 3) .:Heavy construction. equipment shall not travel 20 DIAMETER Garbage .disposal unit. No p . • _ : N 4 KNOCKOUT- over disposal `system ::during or after construction: Leaching area capacity required. 440 gal.'s/day 3 4 .KNOCKOUT I _ 4) Disposal system to be constructed in_accordance MIN. INSPECTION N - Side area proposed. ;219 sq. ft. I SPEC 0 with Title of the State Environmental Code. FINISHED GRADE 5 a p f COVER = `. . Bottom area proposed, 538 sq. t. 5 A co of these tans must be kept n :the site • .. ) PY P m P o Total area proposed. 757 sq. ft, duringthe time of construction. Proposed Leaching capacity 560 gal. s/day e. 4 „ KNOCKOUT 6) A copy of these plans must be furnished to the Water supply. Town contractor constructing the disposal system. Precast concrete units. H-10<& H-20 loading design •. cas c 9 9 �� . : : 7 Before backfiliin , the contractor'shall notify, PITCH .. ,. , _. ,. ) g <4 holmes 'and mcgroth, inc., and the Board of Health 4 PVC VENT PIPE Agent to inspect the system as constructed. If the ontractor, encounters an variation between 8) c y t the existingconditions'shown on the Ian and the P conditions encountered n the site or "an soil . VENT PIPE DETAIL o v condition different than shown n e soil to or NOT TO SCALE t 0 O the g, an adverse soil the contractor shall immediately s - 4 y , Y contact holmes and mcgrath, inc. Holmes and ` a mcgrath, inc.' will examine the oil condition and report to the owner any suggested revisions. 10 -6 ® o = • 3-20 Diameter Access Holes 's t Ctl ® ® NOTICE C ALL ACCESS MANHOLE COVERS FOR Unless and until such time as the on inal red stom ofthe INLET OUTLET SEPTIC TANK DISTRIBUTION BOX " responsible Professional Engineer, or Professional Land Surveyor AND LEACHING STRUCTURE SET MORE N appears on this plan: rr _ 4 10 ,; 8 6 (A) no person or persons, including any municipal or other THAN 6 BELOW FINISHED GRADE, . . N public officials may ref upon the information•contained herein; and HA RAISED TO"WITHIN 6_ OF p y Y P SHALL BE B 'this ion remains the property of Holmes & McGrath,. Inc. . FINISHED GRADE WITH RISERS. t ) P P P Y .. '. --.-� .. : r �:..•... L 5 0GALLON FRAME & COVER NOT To scue R N p STEEL REINFORCED PRECAST CONCRETE R T' MERE REQUIRED. OVER s Q DATE DESCRIPTION 7FrawnlChecked PLAN MEW R E V I S 1 0 N S PRECAST CONCRETE „ TANK RISER WHERE REMOVA l.E--COVERS _ 3 3 REQ UIRED ED, PLOT PLAN DETAILS _... OF PROPOSED SEWAGE DISPOSAL SYSTEM „ _ INSTALL TUFTITE SPEED LEVELERS 3 min: clearance required ALL OUTLET PIPES FROM THE ON ALL OUTLET PIPES PREPARED FOR 4 _ ., M INLET ,, ` DISTRIBUTION BOX SHALL BE ao „ INLET2 min. inlet to outlet 16.5 - SET LEVEL FOR AT LEAST FT. CONCRETE COVER OUTLET DAMD PARRELLA _to level „ „ Liquid lee r FOR ROMO 'AN LANE .. a _ � � _ _ LOT 23 D L D 5 -7 x .. r 5 7 � � 5 5 OUTLET , r _ a a N.,, . . K OCKWTS ' I N .. :. ; N n F v TU TITE ,. ! N p MA -'GAS BAFFLE 15.5 , .- - OUTLET ' iNIET 19.5 ' 6ARNSTA6LE N [r7 9 ,, . .. � . .....� . . ., , .. .. �. SCALE. AS SHOWN [DATE: oC . _28,2000 � , . .., ,: -' 10 0 ,. 5 t.c r in holmes and mcgrath, ., c _ t ti 9 L -- civil en sneers .:and land surveyors CRASS SECTION END .... SECTION _FLAN SECTION , CROSS SECTION g al street v, r, 200 main TYPICAL 1500 GALLON SEPTIC ::..:TANK it 5 HOLE DISTRIBUTION BOX falmouth`, ma. 02540 � . k DRAWN. MOB CHECKED. f e NOT TO SCALE NOT TO SCALE r.' • 74--4— 1 x JOB N0. 200058 DWG. NO.. 2 SHEET '2 of 2 xxx xDET.awG - , a. r - .r