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HomeMy WebLinkAbout0158 DROMOLAND LANE - Health 158€De rviatarrdi'lai Te Barnstable P A = 335 080 — # . ; 0 o � I 4 COMMONWEALTH OF MASSACHUSETTS ExECU'I'i;VE OFFICE OF ENVIRONMENTAL, AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION RECEIVED J U N 0 6 2003 TOWN OF BARNSTABLE HEALTH DEPT. TITLE 5 OFFICIAL LYSPECTION FORINI-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORINI PART A C//ERTIFICATION Property Address: Owner's Name: Jeti to,�e Owner's Address: o 02 GL4 V-1�� Date of Inspection: a Name of Inspector. ( lease ri_ nt) Gtr�� /�1/� MAP Company Name: IVlailine Address: o p�t d, � PARCEL'; ®� -----,.. L�S• �'� O� 6 q.2 LOT Telephone Number.(50 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 performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Sec ' n 15.340 of Tide 5(310 CNIR 15.000). The system: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fai s Inspector's Signature: Date: S d9 The system inspector .� ,., -_.,.> . ..__.. peer hall submit a copy of µs. p, this inspection report to the Approving Authority-Board D ( of H E gal P)%vlthut 30 days of completing this inspection. If the system is a shared system or has a design flow of to 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 ""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. Page 2 of 1 t OFFICIAL INSPECTION FORNI— NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORK[ PART A CCERTIFI//CATION (continued) Property Address: D /✓% GMDIa" G/f, Owner- 9,10 U--v Date of Inspection: Inspection Summary; Check A,B,C,D or E/ALWAYS complete all of Section D A. Syst Passes: I have not found any information which indicates that any of the failure criteria described in 310 CNIR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass" or repaired.The system,upon completion of the replacement or ro section need to be replaced pair,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 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 enfiltration or tank failure.is imminent.System«ill pass inspection if the existing tank is replaced with a complying septic tank as a P g p ppr`oved by the Board of Health. I� 'A metal septic tars:will pass inspection if it is strucmrrll sound not t leaking and if a Certificate of C m ' indicating that the tank is less than 20 years old is available. o plrance ND explain: 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. Sy em will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced - _t obstruction is removed distribution box is leveled or replaced ND explain: 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: Page 3 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORIM PART A CERTIFICATION (continued) Property Address: l y 0-7,p7 .;9 C_,, oo Owner: &OC-t" Date of Inspection C. Fu er 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. Svstem will pass unless Board of Health determines in accordance with 310 CINIR 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 **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 3. Other: Page 4 of l l OFFICIAL INSPECTION FORNI-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORNI PART A CERTIFICATION (continued) Property Address: Owner: / Date of Inspection: ' D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no" to each of the following for all inspections: Yes No/ _ f(// Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool Liquid depth in cesspool is less than 6"below invert or available volume is less than�/:day flow _ quired pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(sj. Number Of times pumped _,Any portion of the SAS,cesspool or privy is below high ground water elevation. :L Any portion of cesspool or privy is within 100 feet of a surface%Vhter supply or tributary to a surface /water supply. portion of a cesspool or privy is within a Zone I of a public well. y 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, p:rformc• DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates u.". :ne 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.] (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 serge a facility with a design flow of IoJA0 gpd to 15,00o gpd. You must indicate either"yes" or"no"to each of the following: (The following criteria apply to lame systems in addition to the criteria above)' yes no the system is within 400 feet of a surface drinking water supply _ the system is within 200 feet of a tributary to a surface drinking water supply _ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a trapped Zone II of a public water supply well If you have answered"yes'!,to any question in Section E the system,is considered a significanf thieaL or`answered "yes" in Section D above the la_;e 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 3 10 CM 15.304.The system owner should contact the appropriate regional offs ofthe`De ": ,Nw e• °.:r_. partment Page 5ofL1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address OOd�U�q � [w ✓„h ,�, _ Od 67 Owner: Date of Inspection: la 7 Check if the following have been done.You must indicate"yes" or"no"as to each of the following: Yes o Pimping information was provided by the owner, occupant,or Board of Health Were any of the system components pumped out in the previous two weeks the system re ceived normal flows in the previous two week eek period ._ Have large volumes of water been.introduced to the system recently or as part of this inspection Were as built 1 p ans of the system obtained.and examined?(If they.were not available note as N/A) Was the facility or dwellinged f ' T utspect or stgns of sewage back up. ' v Was the site inspected for signs of break out Were all system components,excluding th Po g e SAS, located on site _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the es 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 aith 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 basi d on: Y__ lno —�' E:dsung information For example,a plan ai 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(3)(b)] Pagc 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ' ��SYSTEM;;INFO RINI ATI O N Property Address: C/�4 d"ZJla.� . ..L - _. Owner: r v Date of Inspection: FLOW CONDITIONS I0� S RESIDENTIAL Number of bedrooms de 'st ( gn):_7 Number of bedrooms(actual): -0 ` DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: a' Does residence have a garbage grinder(yes or no):�� Is laundry on a separate sewage systemwes or no):Z�Aif yes separate inspection.required] Laundry rystem inspected es or no): Seasonal use: (yes or no): �f , Water meter readin if aril =s, al7le(last 2 years usage(gpd)): Sump pump(yes or no): Last date of occupancy: ,//eNJL CONIMERCIAL NDUSTRLAL Type of establishment: Design flow(based on 310 CMR 15.203): end Basis design flow(seats/ rsons/ etc. Pe � ) Grease trap present(yes or no):_ Industrial waste holding tank present Cyes Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: O'TH2R Pumping Records GENERAL WFORM kTION / Source of information: Was system pumped as part of the inspection(yes or no): If Yes,volume pumped:_ tons—How was quantity ty pump ed deteMuned. Reason for T OF SYSTEM _Septic tank;distribution,.boX soil absorption systern _.- =t,� —Single cesspool 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): Approxite"age of all components,da (if kno O and urce of information s M - d- - Were sewage odors detected when arriving at the site(yes or no):�/ Page 7 of 1 l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY'ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTENI INSPECTION FORM PART C !SYSTEM INFORMATION(continued) Property Address: Sd �0 O ,�J c.+V0�0 lave . . Owner: /�n0(, ��' Date of Inspectioa� 7 ( : BUILDING SEWER(locate / o Depth below grade: ite plan) Materials of constructiocti n: (/cyst iron 4� 0 pVC_other Distance from private water supply well or suction line: (explain): Comments(on condition of joints,venting,evidence of leakage, etc,): SEPTIC TANK: (locate on site plan) Depth below grade: Material of construction: concrete metal , fiberglass polyethylene _other(explain) — —' _ _ If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no): certificate) _(attach a copy of certifi Dime nsions:ns. �' � ��o �► 0 . Sludge depth: /" /0 0 Distance from to of sludge to P g bottom of outlet tee or baffle: . Scum thi clat ess: 0 Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottoTc�,of tee owe. — w S� "A_7 How were dimensions determined Imo /e r<C7 Comments(on Pumping recommendations, P g cnmendauoas inlet . as r ted to outlet rove and outlet tee or baffle condition,structural integrity, liquid lev l rt,evi ace tYlevels of leakage et ): vt `2 'h 1/1 D l��c�e cj-�- e ` S � p © r D vti 1 t'0 tiJ GREASE TRAP: (locate on site plan) Depth _ below grade... Crete._+e� _... .. Material of metal __polyethylene other = construction con (explain): _ Dimensions: Scum thickness: Distance from top Of to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or b-aflle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural inte as related to outlet invert,evidence of leakage,etc.): Zesty, liquid levels Page 8 of I I • OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION ORrvf PART C SYSTEM INFORMATION(continued) Proeriv rc9s:A / P dd Owner. �/O(.✓v7 Date of Ino- r o?7 O� speMio TIGHT or HOLDING TANK: (tank must be u . p mped at time of inspection)(iocatc on site plan) Depth below grade:_ Material of construction: concrete metal—fiberglass_,polyethylene other(explain): . Dimensions: Capacity: Design Flow: gallons gallons/day Alarm present(yes or no): Alarm level: last Date of last Alarm in working order(yes or no): ' pumping: Comments(condition of alarm and float switches,etc.): DISTRIBL iiv^ �Gv;V�(_Lfpresent must be opened)(loate on site plan) , Depth of liquid level abo,._ invert / Comments(note if box is zjr,1 d distribution to outlets equal,anv eNidence of solids carryover,any evidence of leakagcbnto or out of box,et��``): / �/� cf Ikp / PUMP CHAMBER:i � (bate on site plan) Pumps in working order(yes or no): Alarms in working order es or no): - ( f Pump chamber,condition of pumps...and a Comments note condition o ,, Ppurtcisanccs..etc.):. Page 9ofII OFFICIAL INSPECTION FORM'—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORiV1 PART C SYSTEM INFORMATION(continued) Property Address: L4 L'�ol owner Lv �9 .6 � Date of Inspection. p SOIL ABSORPTION SYSTEM(SAS); (locate on site Plan,excavation no t required) 9 ) If SAS not located a cpiain why: T P / leaching pits,number [ 61 S leaching chambers, number. — leaching galleries,number leaching trenches,number, length: leaching fields,number,dimensions: overflow cesspool, number. innovativrJaiternative system Type/name of technology Cowmen (note condition of soil,signs of hydraulic failure, level of ndin ., etc.): J , Po ,! damp soil,condition of vegetation, /Z1L' CESSPOOLS: ' (cesspool must be pumped as part of i ion aspects )(locate on siteplan) Number and configuration: Depth—top of liquid to inlet invert: Leptn of solids layer: Depth of scum layer. Dimensions of cesspool: Materials of con struction. Indication of groundwater inflow(yes or no): Comments(note condition .tion of.soi 1,signs of hydraulic failure, leve l of pondtttg,condition of vegetation,etc.): PRIVY, &Oocate on site plan) ) . Materials of construction: Dimensions: Depth of solids: Comments(note condition 0 f soil , sig ns of hydraulic failure, level of pondtng,condition of vegetation etc.): Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTENI INSPECTIONFORM PART C SYSTEM INFORMATION(continued) Property Address: �O /©G�'IO�a vt� Owner: /�J�0 G✓vl 01 r�ac Q /�/� ��� 3� Date of lnspertion: SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including des to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building, d' I/OC,rSL 17d, -l� 3 -31 0 Page l l of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFOR1NIATION(continued) Property'Address: �rl 0 0,1016, U, (A wrw,� =,f 3 ��o W Owner. Date of Inspection: SITE EXAM Scope Surface water Check cellar Shallow wells Estimated depth to ground water % ?q feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record--If checked,date of design plan reviewed: Checked site(abutting property/observation hole within 150 feet of SAS) Checke d with local Board of Health-explain: Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must n ow you establi ed the hi h 9round_w:xter'e1ev do a w► e�o G C/G- l6 v� r — , �9�wa30 e 7-0 F 00 - 3 ,t 00 a 1 O Ll ,�lwa 30 --C i. III BORTOLOTTI CONSTRUCTION, INC. SUBSURFACE SEWAGE DISPOSAL SYSTEM PECrION FORM Address Of Property �/`On- Owner's Name Date Of Inspection PART A C HBCKLIST Check if the. following have been done: Pumping information was requested of the owner, occupant, and Board of Health. None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large columes of water have not been introduced into the system recently or as part of this . inspection. As-Built plans have been obtained and examined. Note if they are not avail- able with N/A. !/ The facility or dwelling was inspected for signs of sewage back-up. -- The site was inspected for signs of breakout. All system components, excluding the SAS, have been located on the site. !/ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the SAS on the site has been determined based on exist- ing information or approximated by non-intrusive methods. The facility owner (and occupants, 'if different from owner) were provided with information on the proper maintenance of SSDS. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION FLOW CONDITIONS If residential number of bedrooms l number of current residents garbage grinder, yes or no laundry connected to system, yes or no seasonal use, yes or no If nonresidential, calculated flow: Water meter readings, if available: airle y1 Last date of occupancy GENERAL INFORMATION Pumping records and source of information: System pumped as part of inspection, yes or no if yes,. volume pumped Reason for pumping: . Type off. system V 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) Other .(explain) Approximate age of all components. Date installed, if known. Source of informatio 16 Sewage odors detected when arriving at the site, yes or no F SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION CONTINUED SEPTIC TANK: (locate on site plan) depth below grade: f� /r material of construction: _—/concrete metal FRP other(explain dimensions: g,SC X^ 5—W- 6/ sludge depth distance from top of sludge to bottom of outlet tee or baffle scum thickness distance from top of scum to top of outlet tee or baffle Ibl' distance from bottom of scum to bottom of outlet tee or baffle Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, recommendations for repairs, etc. ) S /c2 / �7,ece, ����/4�/{ �`�i�� C✓dUE'i-' %�e /6'�� �J4� DISTRIBUTIONBOX: — (locate on site plan) r y1 P/depth of liquid level above outlet invert Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, recommendation fro repairs, e c. ) �A �GV l Q y�' Gtxar-e�rrK3 L,Pol�./ �i?�� `/J'R�- PI�Y� 2- PUMP CHAMBER: /"A — ----_---- (locate on site plan) pumps in working order, yes or no Comments: (note condition of pump chamber, condition of pumps and appurtenances, recommendations for maintenance or repairs, etc. ) r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART. B SYSTEM INFORMATION CONTINUED SOIL ABSORPTION SYSTEM (SAS) : (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type leaching pits and number f—�60 �'01 /Y� 4694l_D`� leaching chambers and number leaching galleries and number leaching trenches, number, length leaching fields, number, dimensions overflow cesspool, number C uments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs, etc. )//// C) �- '� /� �? ' Vic. CESSPOOLS (Locate on site plan) : number and configuration depth-top of liquid to.inlet invert depth of solids. layer depth .of scum layer dimensions of cesspool . materials of construction indication of groundwater inflow. (cesspool must be pumped as part of inspection) Cbmments: (note .condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs, etc. ) PRIVY: A/(> (locate on site plan) materials of construction dimensions depth of solids Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs, etc. ) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION CONTINUED SKETCH OF SEWAGE DISPOSAL SYSTEM; include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' O Y1 DEPTH TO GROUNDWATER 7© depth to groundwater method of determination or approximation: p SUBSURFACE .SEWAGE:DISPOSAL.SYSTEM INSPDCPION FORM PART C FAILURE CRITERIA . Indicate yes, no, or not determined (Y, N, or ND ). Describe basis of determination in all instances. If "not determined", explain why not. Backup of. sewage into facility? Discharge or ponding of effluent to the surface of the ground or surface waters? Static liquid level in the districution box above outlet invert? Liquid depth in cesspool, 6" below invert or available volume, 1/2 day flow? Al Required pumping 4 times or more in the last year? number of times pumped Septic .tank is metal? cracked? structurally unsound? substantial infiltration? substantial exfiltration? tank failure imminent? AIs anyy portion of the SAS, cesspool or privy, below the high groundwater elevation? Within 50.feet of a. surface water? Within 100 feet of a surface water supply or tributary to a surface water supply? Within a Zone I of a public well? Within 50 feet of a private water supply well? A/ Within- 50 feet.of. a bordering vegetated wetland or salt marsh (cesspools and privies only, xgt the SAS)? Less than 100 feet but greater than .50 feet from a private water supply well with no acceptable water quality analysis? If the well has been analyzed to be acceptable, attach copy of well water analysis for.coliform bacteria, volatile organic compounds, amonia nitrogen and nitrate nitrogen. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART D CERTIFICATION Name of. Inspector: W 6ew- S 'a3v4 64 Company Name aas YcaclY00' /C . Company Address `,�lo s ` Certification Statement I certify that I have personally inspected the sewage disposal system at j this address and that the information reported is true, accurate and complete as of the time of inspection. The inspection was performed and any recommendations regarding upgrade, maintenance and repair are consistent with my training and experience in the proper function and maintenance of on-site sewage disposal systems. Chec One: - I have not found any information which indicates that the system fails to. adequately protect public health or the environment as defined in 310 Cat 15.303. Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. I have determined that the system fails to protect public health and the environment as defined in.310 CMR 15.303. The basis for this deterudnimation is provided in the FAILURE CRITERIA section of this form. Inspector's Signature Date Original to System Owner Copies to: Buyer (If applicable) Approving authority N ��� �� LOCATION R SEWAGE PERMIT NO. /at) UOA&M AtSA// lyr IV VILLAGE 1 INST L 's NACRE `A ADDRESS � au ER 0 ER DA E PERMIT ISSUED DAf E C 0 M P L I A N C E ISSUED ��� Q 77- i i 33 o yam` , 4f �� 7._.�,z`..._ T F.Ri3_No. ............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...---.....-- .....................OF.........................------.......... -----•-----................ Appliration for Disposal Vorks Tnnstrn.rtinn amit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: .Z-- / e Location-Addrress y�, or ,LD�t,No. .r Owner Address a -----------------•-----` ...................................................... .....-............................................................................................ Installer Address d Type of Building Size Lot............................Sq- fee U Dwelling—No. of Bedrooms.._.__:................................Expansion Attic ( ) Garbage Grinder Other—T e of Building No. of persons............................ Showers — Cafeteria a' O r fixtures -------------------------------- . -- ------ W Design Flow____. ..3®..........................gallons per person r ay. Total da'y flow.....�3.__..�-�___.....•..................._gallons. WSeptic Tank—Liquid*capacity/..gallons Length............... Width_-�_--�_._..... Diameter................ Depth.., -........ x Disposal Trench—No..................... Width_ _.._.__.___•_-- Total Length.................... Total leaching area.. ' __rgq. ft. Seepage Pit No.....__t-_._.____-_- Diameter... Depth below inlet____________________ Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fZ4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ W ----•-----•------------------•-----•---------------------...-•-•--------•----........----•----------......................................................... 0 Description of Soil........................................................................................................................................................................ x U -----------------------------------•--•--••------•-•-------.............-----......------•-------•---•----------------•----•----....•-----------•---•---•-•••------•-.....-----------------••------••--- W ? U Nature 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 iITI:> 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance h y e board f health. Sig ----• ..----- �'= ....... 1 ••---..... !T �'.. . Application Approved By..__ l......._ � y �V Application Disapproved for the following reasons-----------------------------------------------------------------------------------------------------------••--- ---------------------•-------•--...._................--•------------------------•---•--...-•-•••--------•--....._...•----•-•-----•----------•-----..............................•-'- ......------. Data PermitNo...................................................-- - Issued....................................................... Date --.y— ----- -- --------------------------- ........................... THE COMMONWEALTH OF, MASSACHUSETTS BOARD OF HEALTH ........................................-.OF....................................... Appliration for Dispmal *Voika Tonotrurtion rnmit Application is hereby made for a Permit to Construct or�Repair an Individual Sewage Disposal System at: ..... .......... ........ ..... . ... .. .................................. Lo t* AXress or Lot No....t4 ............................. Owner Address .......................e. , — ................................................ ................................................................................................. Installer Address Type of Building Size Lot............................S .'f t U Dwelling—No. of Bedrooms...... .....Expansion Attic Garbage Grinder -----­---------------- 04 Other—Type of Building -------------- ........... No. of persons............................ Showers Cafeteria 7" w 04 0 ----------------- Design Flow__: _fixtures ........ ............ ons. 9§-RIV person R�eK day..Total dajl fl i . , jy ow--- ofis Len th-.-.Y....... Width. ........ 9 Septic Tank—Liquid capacityl/mv—g afi` . �K� ..... Pt ,9 ......... Diameter________________ Disposal TrenchLf—,­'To.............. :,.Width........... Total Length.________ Total.leaching area_„ -J'-?sq. ft. Seepage Pit.,,N'&......I............ ........Depth below inlet.................... Total leaching area___...............sq. ft. Other P *Vo, i `� Z _i9fribution box Dosing stank os g a Percolation Tbst Results Performed by.. - --••--•-•---••----••--•--.......................................... Date----------............................... Test Pit No. 1________________minutes per inch Depth of Test Pit_.__._.__..____.____ Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of 'Test Pit__.____..._________. Depth to ground water .......I.......... P4 ...........................................................I........ ...............................................................r............................ 0 Description of Soil...................................................................................................................................-.1..................................... --------------------------*-------------------- ------------------------------- ................................................................................................................ ............................................................................................. .... .......................................................................... U Nature of Repairs or Alterations—Answer when applicable N ....................................................................................... ...................................................................................7 .......... . .....................................---_--_-----------_--------------------... - Agreement: The undersigned agrees to ins ,th'4:a, 6'redescribed Individual Sewage Disposal System in accordance with the provisions of TIT IL4 5 of the K'afe Sanitary.,Code The',undersigned further agrees not to place the system in operation until a Certificate of Compliance vthe.*board of health. Si 9 - ------- .............. . ------- Application Approved By. ............. .. ............ . ............. .... ......... D/t .............. e Application Disapproved for the following reasons:...........;=............................................................................................... ........................................................................................ ............................................................................................................ Date PermitNo......................................................... IssuedL....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... AT THIS IS TO CERTIFY, That the'Ind,* idual Sew ge Disposal System constructed ( or Repaired by... ........ Z, A........ . ...... ----:.............................................................................................................. Installer at.Z,.-,-t. ....i&2 ...... .... ...... ln4 . ... ...... . .................... ---------Cod as d ed in the has been installed in accordance with the provisions f TIT-------------------------------------------- 0 ... LE 5 The State Sanitary /Cr-i I N _40 2............r................... ......�7 application for Disposal Works Construction Permit I o.- .. )Pp? ----------*------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONS�T AS A GUARANTEE THAT THE SYSTEM WILL U (C ION SATISFACTORY. yU to .... ............. .. DATE--- lor. ......................................................... Inspecto ..... ............................................................................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........................................OF...................................................................................... .............. FEE........................ Permission is hereby granted---------.at No. �,:.... ..................... f. ..... .f.�..-.----.-.-.-...------------- 7­..- .-.-W.....-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.- ...................................... to Constru r�Re anbdivid I e'l e Disposal System . . or ........................ ...... Street as shown on the application for Disposal Works Construction Permit ;NK ........... Dated.+/4., ............. 1Z ........ . .......L��.... ......................................................................... DATE_ ... Board of Health ............. ..��e�rjXY................... FORM 1255 A. M. SULKIN,.INC., BOSTON ' r(/ �C�4TivN 8if�-NSTABL Lis/ /'ASS. STALE / a 4� D, 7;r....gjw. Zo /98¢ C 47AIG Go7- d ZZ .�NoWN D N fL•BBC. 3S4¢ Z- CE277,Cy 7;V47- 77,1E P�Posen CO n/Fo a hS 77D 77-16— SZ*7-- d%IC.AG ��ui,ebM�rS O� Tt1E" TDwT/ oc o� 1 . Si-,evICyoAr- li �. /1/o7L6- ��WfYr/oi✓s BAs�•a OA/ i 1 - "E y � i 74 oo a. + 1 i i� ED zN 130'DEY k261 Z ��aasueuEr� G a�� 888 �r Po q s. sN T- z oo Z 51/ �s TOP OF FOUNDATION CONCRETE COVER CONCRETE COVER$ o' 4"CAST IRON - 7nmrrnlr • PIPE (OR 12'MAX. ' ,12"MAX. EQUIV..) MIN. 4 ORANGEBURG(OR EQUIV.') ' PITCH 1/4'rPER. PIPE- MIN. LEACH PITCH 1/4"PER.FT. PIT PRECAST o'o - o' NVERT e i LEACHING ` o EL..LZ-�Z.. INVERT INVERT 'p� w I!.� PIT OR °'. SEPTIC TANK c, DIST. G �G EOUIV. EL.A:44t. . . EL. 484 >x INVERT /ado BOX �� . . GAL. INVERT INVERT �} L)a 3/4°TO I V2' o; EL..6Zr �.. ' ELGZ,a3; , ww fL.4�• e' u. �:� WASHED STONE ' 3z' _ i FROF I LE OF GROUND WATER TABLE SEWAGE DISPOSAL SYSTEM NO SCALE SOIL LOG WITNESSED BY : DATE f!PA-' .G�!/�8z TIME.?-3o.A.r2 ,�o.v C�/cFv2D .e.S. BOARD OF HEALTH TEST HOLE I TEST HOLE 2 ELEV. . .7/.00 ELEV. .7b.70 � i-44.ENGINEER DESIGN DATA : ¢_Ge,So mac.-_c8,7o NUMBER OF BEDROOMS -� Z'L[-So ez-cS7a TOTAL ESTIMATED FLOW . . -33c? . , GALLONS/DAY U�sEr CZ*4 _ l BOTTOM LEACHING AREA �`�•�•9. . SO-FT. /PIT16;P.D, a Gi,zo r SIDE LEACHING AREA . . . SO.FT./ PIT4-"9 P, GARBAGE DISPOSAL (50% AREA INCREASE) r�En/Ln/tr U ,A SAP-.a TOTAL LEACHING AREA 3Z1-�. . SQ.FT tNn 1+ PERCOLATION RATE o6SMA !,TINp. MIN/INCH LEACHING AREA-PER PERCOLATION RATE SQ.FT/� pp.... . .WATER. ENCOUNTERED NUMBER OF LEACHING PITS All. Ally. . , APPROVED . .. . . BOARD OF HEALTH a 7ZNE.a!I. .4`u- S/XWZ DATE . . . . . µ. . . . . . . . AGENT OR INSPECTOR OF � w d1gs� �7— �LZ �� AD ARD 's ; H ➢!�b�`l fs.i D . .�A-tt7 KE E ,QF Na 261M h P Bi9�NS�iBGE: �O . /�lAss. e G/STEM SANRARIPN PETITIONER AyOSUflVE�O . . . . . . . . . . . . . . . . . . � s, ,_� 2' 11'-0" Z 14•-2 1/2" B'CONCRETE r-—— FOVNOATION WALL TO °, • °' j )ABOVE A.M.P.M MATCH EXISTING' fF) ��� A� � �q wy y TRANSOM I DESIGN e EXISITNG DECK AREA i RO BOX 586 WESTDENNIS 0'CONCRETE BASE /� - U o _ _ _ _ - - � I� - I I MA02670 DRESSING TABLE ' L,I _ ROBE NOOK& FULL HEIGHT PARTITION , TEL: 508-400-6093 TOWEL RAILS TILED SHOWER W/GLASS OR F 3'-6 314" I 6'-61/4" — — — — — — — — — — — 12r2•X 12' I O 2X1 2 2 LVL I — - - — — — — — — — — - 2.k8.. (2)2 12 LVL T� 2'-/2' r _ ACCESS TO CRAWL " A 6-3" r SPACE IN ADDRION 3 - fi'-112" 3'-31/2" � ' WIDE PLANK LAUNDRY t ROOF FRAMING BASEMENT sCALE:,/4" _ ,. 4 3/4' 3'-7 1/4" 3�9" 3'-7 12"WIDE L4 K . I 1'-91/4" o ADDITION SMOKE/CARBON DETECTOR 158 DROMOLAND LANE VNDE PLANK BARNSTABLE .MA O SHAWN o MACINNES f " CIVIL No. 41328 • o I � 1st FLOOR 8 S SCALE:1/4" 0" // 1' R - 10 N A L WINDOW SCHEDULE Element ID SIZE TYPE NOTES Model WIDTH HEIGHT ' wD2 s-e• 4'<• ._ Tw3aaz W 3 2'-2• 4.1 -_ T 042 - I I - M. 2'.2' 1'-B• -- FIXED i{ 4 . ND4 2'-2• 4'4" — TW2042 'I —A 2'-21Q- 1'-e' -- FIXED 1 WOS T-T P<- -_ T .2 WOBA I'-2' 1•d' -- FIXED y MARK DATE DESCRIPTION X 2'-3' 4'-3" ._ X - X jl X 2'-n in• 4'-r -_ X PROJECT NO: #Pin x z-r 4•-s — u.aaR�.a • -- ------ DATE:- 2/23/18 X a'4,• s<• -- % U—In.a DRAWN BY:#CAD Technician x 1D s -- u„e.R�.e COPYRIGHT FLII1-flame KKK Window Schedule o J SHEET TITLE 1st FLOOR PLAN Q KEY PLAN A-2.0 SCALE:1/B" 0" I SHEET 4 OF 9 0 Groq�te L ocus y � � o Q r � h I Q � Dokmont Dr I 6) Route 6 LOT 2 96 S. F o 6� LOCUS MAP SCALE 1 =2000 f 5 6 gg 6a ; CP ASSESSORS MAP 335 PARCEL 80 O PATIO / 8 ROPOSED ADDITION ZONING SUMMARY a DECK ZONING DISTRICT: RF-2 DISTRICT t/ (0 �tK MIN. LOT SIZE 43,560 S.F. PAVED ° N ❑ 1 MIN. LOT FRONTAGE 20' EXISTING � MIN. LOT WIDTH 150 �DWF-LLING MIN. FRONT SETBACK 30, FFC.Z = 71.1 f'VliN. SIDE SE T BACK 1 5' MIN. REAR SETBACK 15' MAX. BUILDING HEIGHT 30' 41 N SITE IS LOCATED WITHIN THE AQUIFER PROTECTION OVERLAY DISTRICT DEC 1 3 2017 Tavn of Earnstab!e O Cid King's Highway Committee DD H� _ � � NOV 1 7 2017 12 / a PLANNING & DEVELOPMENT SITE PLAIN OF ' r - #158 DROMOLAND LANE