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0036 CARDINAL LANE - Health
36 Caidinal'Lane' A = 014'�016 Marstons Mills -- I Town of Barnstable P# Department of Regulatory Services . annnsreat.e,: Public Health Division Date 200 Main Street,Hyannis MA 02601 fJ� tRinte Date Scheduled �(' .Q9�' FeejN'Pd. IV _ 1 4. Soil Suitabi 'ty Assessment for Se osal Performed By:�DW Witnessed By: LOCATION&GENERAL INFORMATION Location Address e � Owner's Name 1 ' Address Asses�yI/ a[Parcel- AlL/� Engineer'sNamedJ,. NEW CONUCTfOVbX1 REPAIR �� Telephone# �- Land Use Slopes(%) Surface Stones Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft Drainage Way ft Property Line ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc t s,locate wetlands in proximity to holes) � I r b— Parent material(geologic) Depth to Bedrock Depth to Groundwater: Standing Water in Hole: Weeping from Pit Face Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level PERCOLATION TEST Date Time Observation Hole# Time at 9" Depth of Perc y� Time at 6" Start Pre-soak Time @ i Time(9"-6") End Pre-soak Rate Minllnch u Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y�N) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100'of wetland,you must first notify the Barnstable Conservation Division at least one(1)week prior to beginning. Q:SEPTIC\PERCFORM.DOC DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel Q:-:4 YI 1 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other - Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) Flood Insurance Rate Mao: Above 500 year flood boundary No VXYes Within 500 year boundary No// es Within 100 year flood boundary No Yes Death of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pery b aerial exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the d of turally occurring pervious aterial?NA Certification I certify that on 4�cpffi (date)I have passed the soil evaluator examination approved by the Department of EA4and t the above analysis was perf rme by me consistent with the required enc s 'bed in 310 CMR 15.017. Signature Date 2by;7 i Q:\SEPTIC\PERCFORM.DOC v Town of Barnstable Barnstable. SHE Regulatory Services Department `n i V MA�`Er Public Health Division 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F. Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL #7012 1010 0000 2851 0817 October 2, 2013 George O'Rourke 36 Cardinal Lane Marstons Mills, MA 026484 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5. The septic system located at 36 Cardinal Lane, Marstons Mills, MA was last inspected on 8/21/2013, by Matthew Gilfoy, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "fails" under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) Due to the following: • System is in hydraulic failure You are ordered -to repair or replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system with the deadline period will result in future enforcement action. PER�ORDER OF THE BOARD OF HEALTH Thomas McKean, R.S. CHO Agent of the Board of Health Q:\SEPTIC\conditionally passed96 Cardinal Ln NIIvI Sept 2013.doc Parcel Detail http://issgl2/intranet/propdata/ParcelDetail.aspx9ID=431 »t= rt wt,tss Logged In As: Pa I'CC I ®eta I I Tuesday, October 1 2013 Parcel Lookup Parcel Info Parcel 014-016 { Developer;LOT 67 ID Lot' Location 136 CARDINAL LANE �) Frontage Pri 125 Sec Sec Road I Frontage F� Village IMARSTONS MILLS ) Fire C-O-MM District Town sewer exists at this Road addresslNo Index30243 Interactive Map u Owner Info Owner;OROURKE, GEORGE T SR Co Owner Streeti 136 CARDINAL LN Street2 City IMARSTONS MILLS ( State MA I Zip 102648 Country Land Info Acres 10.48 Use Isingle Fam MDL-01 Zoning IRF Nghbd 10105 Topography Level i Road Paved Utilities I Septic,Gas,Public Water Location Construction Info Building 1 of 1 Year 1978 Roof Gable/Hip �� Ext Wood Shingle Built Struct Wall LArea 1248 CRoofover Asph/F GIs/Cmp TYpe None Style I Ranch I Int Drywall �� Bed 3 Bedrooms PTO Wall RoomsInt Bath Tere Model Residential) Floor Carpet Rooms 2 Full Grade Average ( Heat Hot Air Total�5 Rooms ) s Type Rooms — Stories 1 Story Heat f2as I Found- Poured Conc. Fuel I" ation Gross http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=431 10/1/2013 e* Town ofisarnstable Barnstable Regulatory Services Department -;edca i BARNSCABLE. 6 9 Public Health Division 200 Main Street, Hyannis MA 02601 2007 - Office: 508-862-4644 Thomas F. Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL #7012 1010 0000 2851 0060 September 18, 2013 George O'Rourke 36 Cardinal Lane Marstons Mills, MA 02648 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5. The septic system located at 36 Cardinal Lane, Marstons Mills, MA was last inspected on 8/21/2013, by Matthew Gilfoy, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "fails" under the guidelines of the .1995 TITLE 5 (310 CMR 15.00) Due to the following: • System is in hydraulic failure You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system with the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH Z!;o�ma!�sM&MeZ, R.S. CHO, Agent of the Board of Health Q:\SEPTIC\conditionally passed\36 Cardinal Ln MM Sept 2013.doc Parcel Detail http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=431 Logged In As: Parcel Detail Monday, September 16 2013 Parcel Lookup Parcel Info Parcel -- -- Developer ID 014-016 ( Lot[LOf 67 Location 136 CARDINAL LANE ( Pri Frontage Sec; Sec Road Frontage Village WARSTONS MILLS Fire C-O-MM District Town sewer exists at this Road I address FNo Index 0243 Interactive Map 14 * Owner Info Owner,OROURKE, GEORGE T SR Co-Owner �- Streetl 136 CARDINAL LN Street2 City,,I RSTONS MILLS ! State FMA I Zip[02648 Country FF_ Land Info Acres 10.48 Use ISingle Fam MDL-01 Zoning RF Nghbd 0105 Topography Level Road Paved Utilities I Septic,Gas,Public Water Location ---� Construction Info Building 1 of 1 Year Roof II Ext i"_._ _- Built 1978 J Struct iGable/Hip t Wall(Wood Shingle Living Roof AC - 1248 � !Asph/F GIs/Cmp None Area Cover Type f Int Bed�— ! PT_o Style]Ranch Wall'Dr—ywal� Rooms I'Bedrooms ' T Ts ie Model Residential Int Floor€Carpet Bath Rooms 2 Full pA Grade Avera a Heat• Total T ! + g f Type{Hot Air 1 Rooms 5 Rooms Stories 1 Sto Heat Found- `� ry Fuel Gas ation Poured Conc. Gross http://issgl2/intranet/propdata/ParcelDetaii.aspx?ID=431 9/16/2013 0 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments r M 36 Cardinal Lane Property Address George O'Rourke Owner Owner's Name information is required for every Marstons Mills Ma 02648 8-21-13 page. City/Town State Zip Code. Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, D use only the tab 1. Inspector: - - key to move your cursor-do not Matthew Gilfoy_ use the return key. Name of Inspector B&B Excavation, Inc. Q Company Name 14 Teaberry Lane Company Address Forestdale MA .02644 City/Town State Zip Code (508)477-0653 S113640 Telephone Number License.Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ❑ Passes ❑ Conditionally Passes ® Fails Needs Further Evaluation by the Local Approving Authority i 8-21-13 Inspector's SignaturE.f Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if.applicable, and the approving authority._ i ****This report only describes conditions at the time of inspection and under the conditions of use at that time..This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 Title 5 Official Inspection Vbsurf.ce Sewage Disposal System•Page 1 of 17 V • • Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments GSM , 36 Cardinal Lane Property Address George O'Rourke Owner Owner's Name information is required for every Marstons Mills Ma 02648 8-21-13 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. • The septic tank its 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 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 i i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 36 Cardinal Lane Property Address George O'Rourke Owner Owner's Name information is required for every Marstons Mills Ma 02648 8-21-13 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 pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 15ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ��M s 36 Cardinal Lane Property Address George O'Rourke Owner Owner's Name information is required for every Marstons Mills Ma 02648 8-21-13 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ® ❑ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ® ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than % day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 �i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 36 Cardinal Lane Property Address George O'Rourke Owner Owner's Name information is required for every Marstons Mills Ma 02648 8-21-13 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 I Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 36 Cardinal Lane Property Address George O'Rourke Owner Owner's Name information is required for every Marstons Mills Ma 02648 8-21-13 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 El ® 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 occupant&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. E ® 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): 495 l5ins•3/1& Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth & Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 36 Cardinal Lane Property Address George O'Rourke Owner Owner's Name information is required for every Marstons Mills Ma 02648 8-21-13 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 4 Does residence:have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: 2011- 183gpd 2012-225gpd Sump pump? ❑ Yes ® No Last date of occupancy: currentDate Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 36 Cardinal Lane Property Address George O'Rourke Owner Owner's Name information is required for every Marstons Mills Ma 02648 8-21-13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 2500 gallons How was quantity pumped determined? sight glasses on pump truck Reason for pumping: system backed up 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 36 Cardinal Lane Property Address George O'Rourke Owner Owner's Name information is required for every Marstons Mills Ma 02648 8-21-13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 1978 per plan Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer{locate on site plan): Depth below grade: 1'2"feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: >10'feet Comments (on condition of joints, venting, evidence of leakage, etc.): At time of inspection building sewer appears to be in good working order with no signs of leakage. Septic Tank(locate on site plan): 8" Depth below grade: feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, Iiist age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gallon Sludge depth: 4" t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 I� Commonwealth of Massachusetts 4 - Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M ,•''a 36 Cardinal Lane Property Address George O'Rourke Owner Owner's Name information is required for every Marstons Mills Ma 02648 8-21-13 page. City/Town 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 30" Scum thickness 2" Distance from top of scum to top of outlet tee or baffle V. Distance from bottom of scum to bottom of outlet tee or baffle 17" How were dimensions determined? scour stick Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): At time of inspection tank appeared to be in good working order with no evidence of leakage. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 36 Cardinal Lane Property Address George O'Rourke Owner Owner's Name information is required for every Marstons Mills Ma 02648 8-21-13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? El Yes ❑ No t5ins•3/13 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 ,M 36 Cardinal Lane Property Address George O'Rourke Owner Owner's Name information is required for every Marstons Mills Ma 02648 8-21-13 page. City/Town 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 over invert 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.): At time of inspection d-box was backed up over outlet pipes. 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.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M ,•''V 36 Cardinal Lane Property Address George O'Rourke Owner Owner's Name information is required for every Marstons Mills Ma 02648 8-21-13 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 2 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): At time of inspection leaching was in hydraulic failure. Lush green vegetation over leaching. Cesspools (cesspool must be pumped as part of inspection) (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 ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 i Commonwealth of Massachusetts • Title 5 Official Inspection Form Subsurface Sewage!Disposal System Form -Not for Voluntary Assessments a 9 p Y rY 36 Cardinal Lane Property Address George O'Rourke Owner Owner's Name information is required for every Marstons Mills Ma 02648 8-21-13 page. Citylfown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note:condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Tale 5 Official Inspection Form) Subsurface Sewage Disposal System.Form Not for Voluntary Assessments 36.Cardinal Lane Property.Address George O'Rourke Owner 'Owners Name information is required for every. `Marstons Mills Ma 02648 8-21-13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view.of the sewage disposal sys#em; 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 El drawing attached separately � I O +o O I O Cake" 3 O At- 1'�° A3 - a 3 - Z► _ t5ins•3113 Title 6 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 ;M 36 Cardinal Lane Property Address George O'Rourke Owner Owner's Name information is required for every Marstons Mills Ma 02648 8-21-13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: no gw 144" 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: 1-3-1978 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Plan on file @ BOH. I 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 Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 36 Cardinal Lane Property Address George O'Rourke Owner Owner's Name information is required for every Marstons Mills Ma 02648 8-21-13 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file (Sins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 i y Town of Barnstable Barnstable Regulatory Services Department `�'�; LF- MHARNgrAgr Public Health Division 039. 2007 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Thomas F. Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL #7012 1010 0000 2851 0817 October 2, 2013 George O'Rourke 36 Cardinal Lane Marstons Mills, MA 02648 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5. The septic system located at 36 Cardinal Lane, Marstons Mills, MA was last inspected on 8/21/2013, by Matthew Gilfoy, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "fails" under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) Due to the following: • System is in hydraulic failure You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system with the deadline period will result in future enforcement action. PER-ORDER OF THE BO RD OF HEALTH Thomas McKean, R.S. CHO o S� Agent of the Board of Health Q:\SEPTIC\conditionally passed\36 Cardinal Ln MM Sept 2013.doc rI'own of Barnstable Barnstable Regulatory Services Department ;edac► i RAMUrABU, Public Health Division �j 1639• ��+ �_ AlEo a 200 Main Street,.Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL #7012 1010 0000 2851 0060 September 18, 2013 George O'Rourke 36 Cardinal Lane Marstons Mills, MA 02648 • ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5. The septic system located at 36 Cardinal Lane, Marstons Mills, MA was last inspected on 8/21/2013, by Matthew Gilfoy, a certified septic inspector for the State of Massachusetts-. The inspection of the septic system showed that the system "fails" under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) Due to the following: • System is in hydraulic failure You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system with the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH u omas McKean, R.S. CHO Agent of the Board of Health j QASEPTIC\conditionally passed\36 Cardinal Ln MM Sept 2013.doc I i f U.S.POSTAGE" ITNEY BOWES Town of Barnstable � '' (�� � Public Health Division _ BARNSTABLE Street.�! 200 Main - }' �;• ZIP 02601 0 0 MASS. t 079• �0 Hyannis,MA 02601 s. 2 $ 006. A 1383424 SEP. 6 2013 ' I iI J • V _ 7012 1010 0000 2851 0060 A George O'Rourke 36 Cardinal Lane Marstons 6ulills..MA 02648 RETURN TO ,SENDER NOT DELIVERABLE AS A.ODV..E.SSED ► UNABLE TO FORWARD BC. 0`601400200 *0369-03655 - 17-44 02601-04002 ' • • • Fla • • • .p'' k ! I e Complete items 1,2,and 3.Also complete 7- iture I j I item 4 if Restricted Delivery is desired. ❑Agent w ® Print your name and address on the reverse ❑Addressee I so that we can return the card to you. B. Received by(Printed Name) C Date of Delivery I ® Attach this card to the back of the mailpiece. I. or on the front.if space permits. ! D Is delivery address different from item 1? ❑Yes � 1 Article Addressed to: If YES,enter delivery address below: ❑No I I I I George".':Rourke 36 Catdina'l Lane 3. Service Type I.Marstons-Mills, MA 02648 ❑Certified Mail ❑ Express Mail I ❑ Registered ❑ Return Receipt,for Merchandise ❑ Insured Mail ❑4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number 7012 1❑1❑ D❑❑❑ 2851 11060I i I; '(Transfer from service label) I HIM{i :.� tt PS For m__3�y81t1`. Fe_bru_ary 2004 _ _Domestic' Return Receipt_ io2sss'-o2-M-tsao I:I(�� __; -- `3 3 ! e� j i ilk t • �� f f` �i �i J _-. _ 4 _A Town of Barnstable Barnstable Regulatory Services Department Y MASS. s �'i639. Public Health Division 9• �� A'f0N1A�p 200 Main Street, Hyannis MA 02601 200� Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL #7012 1010 0000 2851 0060 September 18, 2013 George O'Rourke 36 Cardinal Lane Marstons Mills, MA 02648 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5. The septic system located at 36 Cardinal Lane, Marstons Mills, MA was last inspected on 8/21/2013, by Matthew Gilfoy, a certified septic inspector for the State of Massachusetts. • The inspection of the septic system showed that the system "fails" under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) Due to the following: • System is in hydraulic failure You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system with the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH omas McKean, R.S. CHO Agent of the Board of Health I Q:\SEPTIC\conditionally passed\36 Cardinal Ln MM Sept 2013.doc TOWN OF BARNSTABLE Z� LOCATION—.31, CcarA i n,,-1 LrJ SEWAGE# � VILLAGE rn. (n , 1 S ASSESSOR'S MAP.&PARCEL INSTALLER'S NAME&PHONE NO. B+S3 E)(CaVciA ioA,3 417-OL53 SEPTIC TANK CAPACITY /000 LEACHING FACILITY.(type) Z-Tres*Nc�z S (size) Z x 3 x 33 NO.OF BEDROOMS 3 OWNER Ccors1c O'Rourkc- PERMIT DATE: 111'Z- 13 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on'<" site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY Az C33_ 3 C3-�� Cy -T4`I-Ii n c A REA R 7 No. C.Tt/( 1 Fee f THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS es NpliLation for Disposal *pstrm Construction Permit Application for a Permit to Construct( ) Repair(upgrade ) bandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 36 Cpr(l i fla t L r l wner's Name,Address,and Tel.No. Assessor's Map/Parcel cl erry O,20ok-c Installer's Name,Address,and Tel.No, t yl7-oc��3 Designer's Name'Address'and Tel.No. Soggy 0.'3J—Zl�7 ��g- d Scxcw►c an- �'A Teotoerc Ln �or*sUaL AN O04,d, kosori OQ.si ns EasE snay o, Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building —�65iCle4l f, No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3,30 gpd Design flow provided j �. �p� gpd Plan Date 1( "r I I Number of sheets ( Revision Date Title f Size of Septic Tank e�16i Type of S.A.S. 4/,h -j 3 X 3f Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date t1 11 1 Application Approved by m Date s I 3 Application Disapproved by Date for the following reasons Permit No. p� (f 6�j / Date Issued �. ----------------- -- No. - 013 1 w '� , Fee •l D(J ' THE COMMONWEALTH OMASSACHUSETTS Entered in computer. F' Ye PUBLIC HEALTH DIVISION TOWN OF BARNSTABL�EJ`MASSACHUSETTS 2pplication for Mispoidl *pstrm ConstrUdion jOErmit Application for a Permit to Construct( ) Repair(�pgrade, ).Albandon( ) El Complete System ElIndividual Components Location Address or Lot No. 36 CO rCj 1(ICA Lj o r Owner's Name,Address,and Tel.No. 1ac Assessor's Map/Parcel t ) a Installer's Name,Address,and Tel.No'90%_1u'17_6(c s Designer's Name,Address,and Tel.No. (EoS) �3 b 4xCcvc_V'an- 1'1 Teoherc Ln Frj"SWOJL MI Dov4 Acc5on UAC �nv,ro - N2 Ic\0S Eo.s1 Sa`ndU CI, Type of Building: Dwelling No.of Bedrooms Lot Size .`�M sq.8. Garbage Grinder( ) Other Type of Building �f'Si d E:n/t No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 330 gpd Design flow provided 3.� C'G y gpd Plan Date Number of sheets, Revision Date Title -Size of Septic Tank e'�15 i & Type of S.A.S. -3 -3 Description of Soil L di Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. 1 ' Signed Date t1/11 1 Application Approved by Date Application Disapproved by. Date for the"following reasons Permit No. go �j Date Issued ------------------------------- - ------------------------------ ------- --------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS l BARNSTABLE,MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(x) Upgraded( ) Abandoned O by Bt a � 4,c[t V n f I n n at 3& CG ru I n cd L r_- n e has been const /cited�W, ccor a/te with the px�34i 'ons of Title 5 and the for Disposal System Construction Permit No /J date Installer T ? Lno if Designer J #bedrooms �� Approved design wofl ,., gpd The issuance of this permit shaidlnot/�be hd construed as a guarantee that the system will nctio�n as�d!esijg/ne A7 - �V J %�? Date !�( Inspector /+/J 1 , ✓ Y! l !.��1 fj ------------------------------------------- ----------------------------------------------- - - ---------- No. Fee- THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal 6pstrm (Construction Vermit Permission is hereby granted to Construct( ) Repair( V� ,Ugrade( ) Abandon( ) System located at 36 C o t'D I no t- L.ct,Rp�A n(6+a n<, i I�, and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. F Provided:Construction must be completed within three years of the date of this permit. t�,� Date / �>/ Approved by r Town of Barnstable Regulatory Services Richard V. Scali,Interim Director w RARNWABL& 9� MAS& � Public Health Division 1639�Eo 3+s Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer &Designer Certification Form Date: �,��`F�13 Sewage Permit# Assessor's Map\Parcel Designer: Installer:;; Address: Address: 1 On was issued a permit to install a (date) 2r (installer) septic system at lt • based on a design drawn by �, r� (address) � �v �' �;D 01-, dated 0� (designer) Y I certi that the septic stem referenced above was installed substantially according to fY p Y Y g the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required) was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed ' liance with the terms of the 11A approval letters (if applicable) �""h OF,41 1V o DAVID B. (Installer's Sign re MASON i'I7 -j No.1QfiG (De ner's Signature) (Affix De p Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:\Septic\Designer Certification Form Rev 8-14-13.doc No.66.... d Fxs... ............ . COMMONWEALTH J 1 h\� THEBOARD OF FHEAc TH Ts 0-t047................OF....... � - 4�. o� ApplirFatiun for Disposal Works Tonstrurtiun ramit Application is hereby mad<'for a Permit to Construct or Repair ( ) an Individual Sewage Disposal Sys at 1 .. ... S K �. 1 Off,/L O ....41.1...................................................... ....X.CPY......Ll................................................................ �j•---- --•----....J�....�� ..Loca� ��'..�-`�..��-^----------•--••^---^-- -•---••-•---.......-•-----�1..�:..�..........�.O��---.�Y..d_...��.�Sat Owner .................••..........•.Address ......_... ... F-I Installer Address d Type of Building Size Lot_ [.A.. _� ._._Sq. f t aDwelling—No. of Bedrooms____________________________________________Expansion Attic Garbage Grinder Q � P4 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) 0.' Other fixtures d ---•----•••-•-----•---•---------- W Design Flow.............. ' ................gallons per person s�ay. Total dai17 flow....... __..�_ WSeptic Tank—Liquid capacity/e? gallons Length................ Width._......... Diameter................ Depth..__._....... x Disposal Trench—No. .................... Width.................... Total Length............... ..... Total leaching area...._...............sq. ft. Seepage Pit No....../............ Diameter..... _......... Depth b low inlet_....?..--....... Total leaching area...cW.©1..sq. ft. Z Other Distribution box ( A Dosing tank ( Percolation Test Results Performed by.............................................. ........................ Date..................�.i------- Test a Pit No. 1.... ......minutes per inch Depth of Test Pit....... .......... Depth to ground water.___..._.... . (N Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.........._............. a O Description of Soil........... .f . x 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 TI M 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be n issuedty of health. Signed. ..- .......................................................... =1 Date Application Approved By---------- ............... ............................................ .....c'=17_7.f........... Date Application Disapproved for the following reasons-------------•---------------------------------------------------------------•----------------------------..._. •...............................•----------•--------....._...---••--------------•••••••---•------•-•••-....------------------------..........---••-•------------------------•--•---- .........----- Date .Permit No......................................................... Issued ....._....--••-••--- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEA TH GP./�t.7f ......... ....OF......-... .........5.... .---.a......../........_.............. Appliratiun for Disposal Works Tonstrnr#ion rnmit Application is hereby made for a Permit to Construct 06 or Repair ( ) an Individual Sewage Disposal Syst at: � // C .2......---•------a'-'-„•�........................... ...........`-------------------------------------------Q-v-------'-` .._...!...._s S Locatio ddress / / or�lbt/No. / LIB 1 �a a 0 V.P S Address Owner Address `.. ................. ... -----------------• ----•---------------•• / Installer Address Type of Building Size Lot. .1d..0 tb._..Sq..A;, .............................Ex Garbage Grinder ansion Attic Dwelling—No. of Bedrooms............................................ p �/�V aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures ............................ .Design Flow.............�u�...............gallons per person er day. Total dail flow.......19.�r.....................gallons. WSeptic Tank—Liquid*capacityl©PPgallons Length................ Width..l�?............ Diameter---------------- Depth.. ....-....... x Disposal Trench—No...................... Widthh....-� .4......._..__.. Total Length......._...._..... Total leaching area....................sq. ft. p... Seepage Pit No ............ Diameter..... .......... Depth b low inlet..... . ....... Total leaching area...c7.D_I_.sq. ft. z Other Distribution box ( � Dosing tank (/Y& ~' Percolation Test Results Performed by.............................................. Date.__.______________...__ ....... Test Pit No. I....0, ......minutes per inch Depth of Test Pit....... ........ Depth to ground water..� L?-.�. (s, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water._""................ ........ . ODescription of Soil.....----.. -----•-..;'e P-a-V --------------------------•- ---------------------------------------------........--- x xt •---• •. --•------------------•-----------------------------------......------••-•------------------------•----•------...---•----•---..._..----------•----------------------------•-••-••------•-. 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 TITL L 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee issued by of health. ...... o �....Signed------ .. . .......... Date Application Approved BY .... . .....? V. :: � :Z •---•--------------------- Dt Application,Disapproved for the following reasons':----•--- `--••------•----•-------•-•---------------------------•--•---.....•----------•----•-----......... --....-•-•-•--•------------------------------------•----....................--------------.......---•-•--......-------------------------------------•---------------------•---------•------•----------•- Date PermitNo......................................................... Issued_..................................................... Date . j` t THE]COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ,. ........ ...... OF........ "'Zcr..................................... y Vo Trr#ifirttte of f -ampliFanrr �,,,---- T vs -.- THECERTIFY That the Individual Sewage Disposal System constructed ( q) .or,Repaired ( ) by � ----------------•---•---•------•-- ..:... OU Installer --•- hasieen installed in accordance with the provisions of T 1 5 of The State SanitaryC e as described in the ff application for Disposal Works Construction Permit No.................7-7-d..._......... dated ... ',,�:..�!".._.................. r THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. ylInspector..... .........................�.DATE...---•----•..... ............. .. .� ...........-----...-- •-........................................... COMMONWEALTH OF MASSACHUSETTS BOARD OF4HEALTH yf {{ .(/..... �a.. ...OF............. ._..................................... ,,cc. "�� �tu�ruo ku Cnono#riun rrmif �'�" Permission i her anted.._..`-.�!' :.�-t -t� ................................. to Constru�( �ofrr Repair/(] ) a ;Individ a Disp7�s?t Street as shown on the application for Disposal Works Construction -Per 'et o _ .._fir_.__ ed .:._ ...+.......... �f° Board of Health DATE........e.7-%•_. .�-'.`-�-----------------------•---•------••--•--•-- 4x FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS ASSESSORS MAP: PARCEL : TEST HOLE LOGS ,,� � «.__ ._._. _`�_._. j 1) The installation shall con,i.;, with Title V and "Town of)VJA50'&oard of FLOOD ZONE: SOIL EVALUATOR: Y� J C Ilea]th Regulations. eTL� REFERENCE: 2) The installer shall verify the location of utilities, sewer inverts and septic � i ��. 1NlE u t components prior to installation and settingbase elevations. % `'( DATE:WITNESS : 0 p �'J �--��� ►, e, PERCOLATION RATE: �`Z.111e�t 3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8" per foot. The first y{�,, a ► � two feet out of the d-box to the leaching shall be level. I h ( 04. NY/ I +/t� r ' 4) This plan is not to be utilized for property line determination nor any other _._ _ _ _. I TH 1 TH-2 purpose other than the proposed system installation. �AV 5) All septic components must meet Title V specifications. lb i L�l 6) Parking shall not be constructed over fl10 septic components. 7) The property is bounded by property corners and property lines. 4 tG / � �0 �� 8) The property owner shall review design considerations to approve of total LOCATION MAP / t - design flow and number of bedrooms to be considered for design. Receipt I of payment for the plan and installation based on the plan shall be deemed approval of the design flow by the owner. 9) The existing leaching or cesspools shall be pumped and filled with material Y 7iper Title V abandonment procedures. Those within the proposed SAS shall be removed along with contaminated soil and replaced with clean sand per b�O q ���, Title V specs. A 10)System components to be 10 feet from water line. Sewer lines crossing the nilk mo,M1 ` water line shall be sleeved with 4 inch SCI140 PVC with ends grouted if applicable. The proposed SAS is being installed below the water service — � L � line. The line is to be sleeved as aforementioned and maintained in place. 11) If a garbage grinder exists it is to be removed and is the responsibility of the SEPTIC SYSTEMFDESIGN owner to ensure such. 12)The installer is to take caution in excavation around the gas line if such FLOW ESTIMATE exists. 13)The installer shall verify the location, quantity and elevation of the sewer 41 BEDROOMS AT I IO 'GAL/DAY/BEDROOM 0F;0GAL/DAY lines exiting the dwelling prior to the installation. 14)"This plan is representative only that a system can fit on a property meeting SEPTIC TANK Title V requirements. / GAL/DAY x 2 DAYS -660 GAL USE WD GALLON SEPTIC TANK O I L ABS�RPT I ON SYSTEM MASON N0. 1066 Y o e X x SIDE AREA: -17 1C� BOTTOM TOM AREA: ?jam x -�-- EPTIC SYSTEM SECTION -aKICHP4 0W-! � — /O/ PTLU go IE5 too k iija W)v 'V > M ��% / GAL q�7 1 _ ► 10f )10t ; �JC �\jy- Nq 1111 w- SEPTIC TANK 126 DF3 31TE AND SEWAGE PLAN LocAT I oN : PREPARED FOR :, cy&k yel M O wf 01 0 CALE: t 1"a DAV I D B , MASON,RS DATE: I s DBC ENVIRONMENTAL DESIGNS EAST SANDWICH . MA W Z DATE I HEALTH AGENT ( 508 ) 833- 2177 rt 514 o w �77 D � L j a h / �C G.R 1 t_, lJ• J� .C�L9 / � � /V o tl.S /T /a ro VC /7 / 0-1 fit: L at '14C> _Aq f W 7 w v'4,r 1+4/ Al a zl c j" 'a / 1';Z' Ic /EYE 4 y'S!.S to to 5 sa OP ra r c,n 3Crir�r7 YJ .4K Al Zoo 24 '-�/P 7-f � No >ra , m r, 2` a dam ' vr. 40. aqC. .3 X // o X / - 9� 7 � =??-1 PLAN. LAN ,. -A OWNED BY OF 4 Z5 Aj FRANK -1 FRANK r` FRANK CONERY 5 T�RENTON ST. CONERY " � -+ ,p Ha. 6232 O o NONE R3 Q/ FI GISTERED ENWHEE'P a L04M SUSMEYCIM w• STD 4 I Cr G Gee ti��j♦ \ `n�F^ s T � s °�!o�,tti"- 2•.� /ji scx�LE tt ,2®F`. s 4 . -