HomeMy WebLinkAbout0060 CARDINAL LANE - Health '60,CARDINAI:I:ANE,,-MARST.MILLS '
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Commonwealth of Massachusetts
Title 5 Official Inspecti n Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
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60 Cardinal Lane 01
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Property Address rv.�
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Richard & Diane McDonough X
Owner Owner's Name /
information is arsons Mills N Ma 02648 9-9-15
required for every =
page. City/Town State Zip Code Date of Inspection t.a
X,.
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,
use only the tab 1. Inspector:
key to move your
cursor-do not Matthew F. Gilfoy
use the return Name of Inspector
key.
Excavation
Company
� Company Name
14 Teaberry Lane
Company Address
Sandwich Ma. 02644
Cityrrown 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
9-9-15
Inspec s Signature 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.
****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.
kOW0
t5ins•3/13 Tille 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17
Commonwealth of Massachusetts
Title 5 official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
60 Cardinal Lane
Property Address
Richard & Diane McDonough
Owner Owner's Name
information is required for every Marstons Mills Ma 02648 9-9-15
page. Cityrrown 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 is metal and over 20 years old* or the septic tank(whether metal or not) is structurally
unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass
inspection if the existing tank is replaced with a complying septic tank as approved by the Board of
Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years old is available.
❑ Y ❑ N ❑ ND (Explain below):
l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
60 Cardinal Lane
Property Address
Richard & Diane McDonough
Owner Owner's Name
information is required for every Marstons Mills Ma 02648 9-9-15
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
t5ins•3/13 Title 5Ofricial 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 60 Cardinal Lane
Property Address
Richard & Diane McDonough
Owner Owner's Name
information is
required for every Marstons Mills Ma 02648 9-9-15
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
El Static liquid level in the distribution box above outlet invert due to an overloaded
® or clogged SAS or cesspool
❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less
than '/2 day flow
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
60 Cardinal Lane
Property Address
Richard & Diane McDonough
Owner Owner's Name
information is required for every Marstons Mills Ma 02648 9-9-15
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 11 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
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
60 Cardinal Lane
Property Address
Richard & Diane McDonough
Owner Owner's Name
information is
required for every Marstons Mills Ma 02648 9-9-15
page. City/Town State Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate"yes" or"no" as to each of the following:
Yes No
❑ ® Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
® ❑ Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
® ❑ Were as built plans of the system obtained and examined? (If they were not
available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
® ❑ Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
❑ ® Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS) on the site has
been determined based on:
® ❑ Existing information. For example, a plan at the Board of Health.
❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
D. System Information
Residential Flow Conditions:
Number of bedrooms(design): 3 Number of bedrooms (actual): 3
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 350
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
60 Cardinal Lane
Property Address
Richard & Diane McDonough
Owner Owner's Name
information is
required for every Marstons Mills Ma 02648 9-9-15
page. Cityrrown State Zip Code Date of Inspection
D. System Information
Description:
Number of current residents: 2
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
Seasonaluse? ❑ Yes ® No
Water meter readings, if available (last 2 years usage (gpd)):
Detail
Sump pump? ❑ Yes ® No
Last date of occupancy: current
Date
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
,M 60 Cardinal Lane
Property Address
Richard & Diane McDonough
Owner Owners Name
information is required for every Marstons Mills Ma 02648 9-9-15
page. Cityrrown 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: Owner- Last pumped 8-11-15
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped:
gallons
How was quantity pumped determined?
Reason for pumping:
Type of System:
® Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner) and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other(describe):
l5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17
Commonwealth of Massachusetts
w Title 5 official Inspection Fora
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
60 Cardinal Lane
Property Address
Richard & Diane McDonough
Owner Owner's Name
information is
required for every Marstons Mills Ma 02648 9-9-15
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components, date installed (if known) and source of information:
1996
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
2'
Depth below grade: feet
Material of construction:
❑ cast iron ®40 PVC ❑ other(explain):
Distance from private water supply well or suction line: feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
Septic Tank(locate on site plan):
1'4"
Depth below grade: feet
Material of construction:
® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain)
If tank is metal, list age: years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
Dimensions:
1500 gallon
Sludge depth:
0"
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
60 Cardinal Lane
Property Address
Richard & Diane McDonough
Owner Owner's Name
information is
required for every Marstons Mills Ma 02648 9-9-15
page. CitylTown 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 NS
Scum thickness
0"
Distance from tap of scum to top of outlet tee or baffle NS
Distance from bottom of scum to bottom of outlet tee or baffle NS
How were dimensions determined? measured
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
At time of inspection septic tank appeared to be in working order with liquid level equal with outlet
invert. Tank is not in need of pumping at this time.
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-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
60 Cardinal Lane
Property Address
Richard & Diane McDonough
Owner Owner's Name
information is required for every Marstons Mills Ma 02648 9-9-15
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? ❑ 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 60 Cardinal Lane
Property Address
Richard & Diane McDonough
Owner Owner's Name
information is required for every Marstons Mills Ma 02648 9-9-15
page. Cityrrown 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
0"
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 is in working order with no sign of back up or carry over.
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
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
M 60 Cardinal Lane
Property Address
Richard & Diane McDonough
Owner Owner's Name
information is required for every Marstons Mills Ma 02648 9-9-15
page. CitylTown State Zip Code Date of Inspection
D. System Information (cont.)
Type:
❑ leaching pits number:
® leaching chambers number: (4) infiltrators
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions: j
❑ 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 appears to be in working order with no sign of hydraulic failure.
Chambers were dry at time of inspection.
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
60 Cardinal Lane
Property Address
Richard & Diane McDonough
Owner Owner's Name
information is required for every Marstons Mills Ma 02648 9-9-15
page. City/Town 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
1_
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
°M 60 Cardinal Lane
Property Address
Richard & Diane McDonough
Owner Owner's Name
information is
required for every Marstons Mills Ma 02648 9-9-15
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 system, including ties to
at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate
where public water supply enters the building. Check one of the boxes below:
® hand-sketch in the area below
❑ drawing attached separately
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t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17
I
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
60 Cardinal Lane
Property Address
Richard & Diane McDonough
Owner Owner's Name
information is required for every Marstons Mills Ma 02648 9-9-15
page. City/Town 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 132"
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: Nov-13-1995
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 with BOH
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
f
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
60 Cardinal Lane
Property Address
Richard & Diane McDonough
Owner Owner's Name
information is required for every Marstons Mills Ma 02648 9-9-15
page. CitylTown State Zip Code Date of Inspection
E. Report Completeness Checklist
® Inspection Simmary: A, B, C, D, or E checked
® Inspection Simmary 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
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17
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VILLAGE. Mar S 6ti s 111 11S ASSESSOR'S MAP&LOT40j 6► o-/
INSTALLER'S NAME&PHONE NO.
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SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) T� l -4 rV,'-4 ""/S'44 P (size) 7
NO.OF BEDROOMS 3
BUILDER OR OWNER ke 8ree Iy
PERMIT DATE: `9'`I_96 COMPLIANCE DATE: -90olo,
Separation Distance Between the:
Maximum Adjusted Groundwater Table and 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
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No. -- (j Fee
-3 C1, THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACZUSETTS
01pplication for Mig ool *pgtem Cun.5truction Permit
IVApplication is hereby made for a Permit to Construct( )or Repair( )an On-site Sewage Disposal System at:
Location A dress or Lot No. Owner's Name,Address and Tel.No.
L-b 1 CAV.- JAt, ►->A�l -sos�F'H I3�
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
/Sv f�/ Zoo ► tA�K4 sT�
Type of Building:
Dwelling No.of Bedrooms Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow 5S gallons per day. Calculated daily flow --,'I V gallons.
Plan Date l t I i 3 Qj Number of sheets Z Revision Date Z 6
Title
Description of Soil TCS i 4Dt.7m- 1 O-+�� 1� "1 O� A Av%&-- D 4!
t o'- 'z°!"- i3- SAµn - yiz- 5100 - -t3z" t� 1�oGy�tyw- sfl►•�A - to VlZ Z/�-1
- Z sS-r N C�c.F_' # Z- SAtM.0 Pis vk_ats .
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 Certifi-
cate of Compliance has been i ued i oard ealth �y /
Signed Date 41
Application Approved by A -
Application Disapproved for th follow ng reasons
Permit No. ! G Date Issued Z -76
... .,+.. , � ,.,w.�' 4f 7-. �•`.. X�. .,f' .1.. . � '�` ••..e�.,'1�` .L.. _y, y,. '._.`nrrvr...�.�.,�....y„-.� ti� p�. ,,r.:
Fee E
f
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSAZUSETTS
ZIPPr cation for Migpogar *pgtM Congtruction Permit
1
Application is hereby made for a Permit to Construct( )or Repair( )an On-site Sewage Disposal System at:
Location Apdjss or Lot No. Owner's Name,Address and Tel.No.
LD► �,f��Dc>`I fit. �. ►.i� -ro s� 3er�
-
Insialler's Name,Address,and TeltNo' Designer's Name,Address and Tel:,No.
� V fRIH.. / S NI i �LNLov`t'� ZS4o
Type of Building:
Dwelling No.of Bedrooms 3 Garbage Grinder( )
' Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow E S - gallons per day..Calculated daily flow 33 O gallons.
Plan Date 1 i i 3 q5 Number of sheets 7- Revision Date z R G
Title
Description of Soil 7*C-97 1 O-+e ti i� 10` A- Sp t.A f L-bAvv--l o y2
1...OAVK`( SA+yr-N -10YiL5 0 - ''-13Z.,", MG7tvw- sA,.sA - to j4�
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected
;�i Q
Agreement: t t .'` `.,y'
The undersignedagrees to ensure the constructioind maintenance of the afore described on-site sewage disposal system_
in accordance with the provisions of Title 5`of the Enviment4Code and not to place the system in operation until a Certifi-
cate of Compliance has been i ued i oard /
Signed Date 41
Application Approved by
Application Disapproved for th follow ng reaso
Permit No. Da ssued p�J / 6
THE COMMONWEALTH'OF M ' ACHUSETTS
PUBLIC HEALTH DIVISION - BQ RNST LE, MASSACHUSETTS
t Certificat� of Compliance - -
r
THIS IS TO CFgRTT Y,that tln�i`n's_ite Sewage Disposal System instal d( �or repa'red/re la��d( )on
by 1� " for G�d A,t
as has been constructed in accordance
with'the provisions of Title 5 and the for Disposal System Construction Permit No. dated
Use of this system is conditioned on compliance with the provisions set forth below:
"
No. We Fee—/
THE COMMONWEALTH OF MASSACHUSETTS
.PUBLIC HEALTH DIVISION - BARNSTABLE MASSACHUSETTS
` ligpoal *pgtem Congtruction Permit
Permission is hereby granted to 34 4 1�1 19 44 /f
to construct( repair( )an On-site Sewage System located at _rta A.,
�..
I '
and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to
comply with Title 5 and the following local provisions or special conditions. w.
All construction s be 71 ed within two years of the date below.
Date: Approved by
J
t
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
a
m
� d
TITLE 5
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 60 CARDINAL LANE MARSTONS MILLS,MA 02648 M014 P018 L069
Owner's Name: KERR
Owner's Address: 60 CARDINAL LANE MARSTONS MILLS,MA 02648 1-3
Date of Inspection: 11/20/00 NOV z 9
2000
Name of Inspector: (please print) JOHN GRACI
Company Name: SEPTIC INSPECTIONSAQ as
Mailing Address: P.O.BOX 2119 TEATICKET,MA.02536 :��„ /�.-�
1`1,
Telephone Number: 508-564-6813 FAX 508-564-7270
CERTIFICATION STATEMENT
I certify that I have personally inspected ttie 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:
X Passes
_ Conditionally Passes
_ Needs F her Evaluation by the Local Approving Authority
Fails
Inspector's Signature: Date: 11/20/00
The system inspector shall sub it 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.
Notes and Comments
THE SYSTEM PASSES TITLE V INPECTION.RECOMMEND PUMPING SYSTEM EVERY ONE YEAR TO
PROLONG THE SYSTEM'S USEFULL LIFE.
****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.
Titla 5 TncnPrtinn Fnrm F/i s/,)nn l 1
Page 2 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 60 CARDINAL LANE MARSTONS MILLS,MA 02648 M014 P018 L069
Owner: KERR
Date of Inspection: 11/20/00
Inspection Summary: Checkt A,B,C,D or E/ALWAYS complete all of Section D
A. System Passes:
5
X I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 3I0
CMR 15.304 exist.Any failure criteria not evaluated are indicated below.
Comments:
THE SYSTEM PASSES TITLE V INPECTION.RECOMMEND PUMPING SYSTEM EVERY ONE YEAR TO
PROLONG THE SYSTEM'S USEFULL LIFE.
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.
.11
Answer yes,no or not determined(Y,N,ND)in the for the followingstatements. If"not determined" lease explain.
P �
n/a The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally unsound,exhibits
substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced
with a complying septic tank as approved by the Board of Health.
*A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating
that the tank is less than 20 years old is available.
ND explain: n/a
n/a Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed
pipe(s)or due to a broken,seftled or uneven distribution box. System will pass inspection if(with approval of Board of
Health): t
_ broken pipe(s)are replaced
_ obstruction is removed
_ distribution box is leveled or replaced
ND explain: n/a
n/a The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass
inspection if(with approval of the Board'of Health):
_broken pipe(s)are replaced
_obstruction is removed
ND explain: n/a
Page 3 of I 1 F
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
� PART A
CERTIFICATION(continued)
Property Address: 60 CARDINAL.LANE MARSTONS MILLS,MA 02648 M014 P018 L069
Owner: KERR
Date of Inspection: 11/20/00
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
�xfF,
�4,
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 I of a public water supply.
_ The system has a septic tank Arid SAS and the SAS is within 50 feet of a private water supply well.
_ The system has a septic tank and'SAS and the SAS is less than 100 feet but 50 feet or more from a private water
supply well". Method used to determine distance n/a
"This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and
volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia
nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy
of the analysis must be attached to this form.
3. Other:
n/aiyR
Page 4 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 60 CARDINAL LANE MARSTONS MILLS,MA 02648 M014 P018 L069
Owner: KERR
Date of Inspection: 11/20/00
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or"no"to each of the following for all-inspections:
Yes No
X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
X Discharge or ponding of.effluent to the surface of the ground or surface waters due to an overloaded or clogged
SAS or cesspool
X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool
_ X Liquid depth in cesspool is Less than 6 below invert or available volume is less than /z day flow
_ X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times
pumped 1999.
X Any portion of the SAS,cesspool or privy is below high ground water elevation.
X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
X Any portion of a cesspool or privy is within a Zone 1 of a public well.
X Any portion of a cesspool or privy is within 50 feet of a private water supply well.
X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with
no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP
certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free
from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or
less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be
attached to this form.]
(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'tlie system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd.
You must indicate either"yes"or"no"to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
yes no
X the system is within 400 feet of a surface drinking water supply
X the system is within 200 feet of`a tributary to a surface drinking water supply
X the system is located in a nitrojen 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.
d
Page 5 of l l
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 60 CARDINAL LANE MARSTONS MILLS,MA 02648 M014 P018 L069
Owner: KERR
Date of Inspection: 11/20/00
Check if the following have been done(You must indicate"yes"or"no"as to each of the following:
Yes No
X _ Pumping information was provided by the owner,occupant,or Board of Health
X Were any of the system components pumped out in the previous two weeks?
r
X _ Has the system received normal flows in the previous two week period?
X Have large volumes of water been introduced to the system recently or as part of this inspection ?
X _ Were as built plans of the system obtained and examined?(If they were not available note as N/A)
X _ Was the facility or dwelling inspected for signs of sewage back up?
Lx4
X _ Was the site inspected for signs of break out?
X _ Were all system components,excluding the SAS,located on site?
X _ Were the septic tank mamol les-uncovered,opened,and the interior of the tank inspected for the condition of the
baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum?
X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance
of subsurface sewage disposal systems?
The size and location of the Soil Absorption System(SAS)on the site has been determined based on:
Yes no
X _ Existing information.For example,a plan at the Board of Health.
X _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is
unacceptable)[310 CMR 15.302(3)(b)]
i.
!!i
?J
Page 6 of I 1
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 60 CARDINAL LANE MARSTONS MILLS,MA 02648 M014 P018 L069
Owner: KERR
Date of Inspection: 11/20/00
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design):3 Number of bedrooms(actual): 3
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):330
Number of current residents: 5
Does residence have a garbage grinder(yes or no): NO
Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required]
Laundry system inspected(yes or no): NO
Seasonal use: (yes or no): NO
Water meter readings, if available(last 2 years usage(gpd)): n/a
Sump pump(yes or no): NO
Last date of occupancy: n/a
COMMERCIALANDUSTRIAL
Type of establishment: n/a #
Design flow(based on 310 CMR 15.201): n/agpd
Basis of design flow(seats/persons/sgft,etc.): n/a
Grease trap present(yes or no): NO .
Industrial waste holding tank present(yes or no): NO
Non-sanitary waste discharged to the Title 5 system(yes or no): NO
Water meter readings, if available: n/a
Last date of occupancy/use: n/a
OTHER(describe): n/a
GENERAL INFORMATION
Pumping Records
Source of information: 1999
Was system pumped as part of the inspection(yes or no): NO
If yes,volume pumped: n/agallons--How was quantity pumped determined?n/a
Reason for pumping: n/a .. `.
TYPE OF SYSTEM
X Septic tank,distribution box,soil' sorption system
_Single cesspool
_Overflow cesspool
_Privy
_Shared system(yes or no)(if yes,attach previous inspection records,if any)
_Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from
system owner)
_Tight tank Attach a copy of the DEP approval
Other(describe): n/a
Approximate age of all components,date installed(if known)and source of information:
1996
Were sewage odors detected when arriving at the site(yes or no): NO
Page 7 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 60 CARDINAL LANE MARSTONS MILLS,MA 02648 M014 P018 L069
Owner: KERR
Date of Inspection: 11/20/00
BUILDING SEWER(locate on site plan)
Depth below grade:30"
Materials of construction:_cast iron X40 PVC_other(explain): n/a
Distance from private water supply well or suction line: n/a
Comments(on condition of joints,venting,evidence of leakage,etc.):
THERE IS TOWN WATER
SEPTIC TANK: X(locate on site plan)
Depth below grade: 24"
Material of construction: Xconcrete_metal_fiberglass_polyethylene other(explain)n/a
If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate)
Dimensions: 150OG L 10' 6" H,5'6" W 5'8""
Sludge depth: 1"
Distance from top of sludge to bottom of outlet tee or baffle: 33"
Scum thickness: 1"
Distance from top of scum to top of.outlet tee or baffle: 6"
Distance from bottom of scum to bottom of outlet tee or baffle: n/a
How were dimensions determined: MEASURED
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related
to outlet invert,evidence of leakage,etc.):
THE SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND.RECOMMEND PUMPING
EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE.
GREASE TRAP:_(locate on site plan)
Depth below grade: n/a
Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a
Dimensions: n/a
Scum thickness: n/a
Distance from top of scum to top of outlet tee or baffle: n/a
Distance from bottom of scum to bottom of outlet tee or baffle: n/a
Date of last pumping: n/a
Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related
to outlet invert,evidence of leakage,etc.):
n/a
r,
7
Page 8 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE"SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 60 CARDINAL LANE,MARSTONS MILLS,MA 02648 M014 P018 L069
Owner: KERR
Date of Inspection: 11/20/00
t�
TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan)
Depth below grade: n/a
Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a
Dimensions: n/a
Capacity: n/a gallons
Design Flow: n/a gallons/day
Alarm present(yes or no): N/A`
Alarm level:N/A Alarm in working order(yes or no):NO
Date of last pumping: n/a
Comments(condition of alarm and float switches,etc.):
n/a
� f
DISTRIBUTION BOX:X(if present.must be opened)(locate on site plan)
Depth of liquid level above outlet invert:,OVER PIPE
Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into
or out of box,etc.):
THE DISTRIBUTION BOX IS STRUCTURALLY SOUND.
PUMP CHAMBER:_(locate on site plan)
Pumps in working order(yes or no): NO
Alarms in working order(yes or no):NO
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):
n/a
'el
e
t�
ll�
P
Page 9 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 60 CARDINAL LANE MARSTONS MILLS,MA 02648 M014 P018 L069
Owner: KERR
Date of Inspection: 11/20/00
SOIL ABSORPTION SYSTEM(SAS): % (locate on site plan,excavation not required)
If SAS not located explain why:
n/a
Type
n/a leaching pits, number: n/a
INFULTRATORS leaching chambers, number: 4
n/a leaching galleries, number: n/a
n/a leaching trenches, number, length: n/a
n/a leaching fields, number: n/a
n/a overflow cesspool, number: n/a
n/a innovative/alternative system
Type/name of technology: n/a
Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.):
THE LEACH FIELD APPEARS TO BE FUNCTIONING PROPERLY,THE SYSTEM SHOWS NO SIGNS OF
FAILURE.SOIL PROBED DRY.
CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan)
ti;A
Number and configuration: n/a
Depth—top of liquid to inlet invert: n/a
Depth of solids layer: n/a
Depth of scum layer: n/a
Dimensions of cesspool: n/a
Materials of construction: n/a
Indication of groundwater inflow(yes or no): NO
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
n/a
PRIVY: (locate on site plan)
Materials of construction: n/a
Dimensions: n/a
Depth of solids: n/a
Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.):
n/a
Q
Page 10 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 60 CARDINAL LANE MARSTONS MILLS,MA 02648 M014 P018 L069
Owner: KERR
Date of Inspection: 11/20/00
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.
Locate all wells within 100 feet.Locate where public water supply enters the building.
A 6 cltIND
g
�ec�l
ell
13
tea►
D� 3°
in
Page 11 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 60 CARDINAL LANE MARSTONS MILLS,MA 02648 M014 P018 L069
Owner: KERR
Date of Inspection: 11/20/00
SITE EXAM %
_Slope
_Surface water
_Check cellar
Shallow wells
Estimated depth to ground water 10+feet
Please indicate(check)all methods used to determine the high ground water elevation:
NO Obtained from system design plans on record-If checked,date of design plan reviewed: n/a
NO Observed site(abutting property/observation hole within 150 feet of SAS)
NO Checked with local Board of Health-explain: n/a
NO Checked with local excavators,!installers-(attach documentation)
YES Accessed USGS database-explain: n/a
You must describe how you established the high ground water elevation:
USGS MAPS AND CHARTS- 10+FEET
11
LO C rT SEWAGE)OP1E RMIT NO.
VILLAGE
IN.STA L LJLR'S NAME & ADDRESS
BUKDER OR 0
JAs
a ,
DATE P E RIA IT ISSUED t
DAT E COMPLIANCE ISSUED �/_ ��-
r
' _ �, ` .
��
t
s
. .
&�
n► $�,`
.r,.�,...,,wnir..
�i-�. '
�'"f�'
,. +I rp -
0.
Q
O
O r F
, . CIQ
LOT 68
0
8
OCa
9 a
6 t
\ � r
LOT 69
20,000 S.F. r
, � o
9 � co
�-
e
o , e�
2 t Q Q
4- INFILTRATORS TH
Ta#,
4 OF STONE AT SIDES, �(
2 OF STONE AT END P839B
p GARAGE
AND 1 OF STONE BE W
1 0 0�
�Pi1C
A
o.
:., x `moo
+ o
4
NOTES.
1
HOUSE NUMBER...
. = o � 2. ASSESSORS NUMBER. 14-18
O o _ 3. ZONING DISTRICT. RF
00
A
s� . c
S, • .. o _ / 4. FLOOD HAZARD ZONES.
5. `TOPOGRAPHIC INFORMATION COMPILED ON CO LED FROM
�, sF
TOWN OF BARNSTABLE TOPOGRAPHIC MAPS.
F (( 6. ELEVATIONS SHOWN ARE BASED ON THE NATIONAL
_ l ;
o GEODETfC VERTICAL DATUM.
/ 7. REFERENCE. PLAN BOOK '284
LOT '70
J � PAGE91
0
077C
TH CONTRACTOR SHALL EXCAVATE 5 `A[_ :AROUND E G E C E L ` Unless and until such time as the original (red) stamp of the
- - ` 1 I THE AN A responsible (Professional Engineer, or Professional Land Surveyor
. THE LEACHING F`AC L TY AND DOWN TO , E SAND LAYER. � � P 9 yo
<'a ears on this Ian:
REMOVE ALL `UNSUITABLE MATERIAL AND REPLACE- WITH Q PP P
1
(A) no person or persons, including any municipal or other
CLEAN GRANULAR SAND -CONFORMING TO THE SPECIFICATIONS -
G U D public officials may rely upon .the information- contained herein- and
P Y Y P .
SET FORTH IN 310 CMR 15.255 3 .
' ( � (B) this pion remains the property of Holmes & McGrath, Inc.
V
.REVISE HOUSE AND SEPTIC .SYSTEM LOCATION MJB
t
LEGEND:
/ DATE ` DESCRIPTION - Drawn hecked
x99,0 DENOTES PROPOSED SPOT ELEVATIO/V
REVISIONS
DENOTES DRAINACE FLOW DIRECTION
PLOT PLAN
OF PROPOSED SEWAGE DISPOSAL SYSTEM
PREPARED E FOR
JOSEPH BREEN
.. R FOR LOT 69, ; CARDINAL LANE
_ - IN
MARSTONS MILLS
BARN STABLE MA
SCALE: :� 20 TE. NOV.NOv13 1995
�� OF
GRAPHIC SCALE
Ss 9
�
o MICHAEL J. �.
holrnes and me(�rath inc �.
g ! � BORSE I
. 20 io 0 20 so
o r-
civil engineers and :.land surveyors r.�.
_ lib. 505"
200 main-,street '0
falmouth ma. 02540
s
( IN FEET j ,
' l i�ah 20 ' ft.
) ,
�In
DRAWN. SJS CHECKED:- n
74 61 2 .29 1
95374PP.DWG JOB NO: 95,3 DWG. NO.. SHEET of 2
W
,
I
i' I away at a min. of 2�a
Finish rode .above and adjacent to system shall slope e a
. g 1 Ys P Y
DEE OBSERVATION HOLE
.. . h . its .
4 dram. cast iron or.Schedule 40 PVC pipe (tight n
P P ( 9 joints).
n din to edge of leaching system)
m —
OTHER
20 min. distance (building 9 9 Ys ) SOIL SOIL TEXTURE SOIL COLOR SOIL sTriMluiEs,
STONE
DEPTH ELEV. HORIZON USDA Munsell M N S eoixs
(USDA) ( ) OTTU G
10, min. distance THE CONTRACTOR SHALL EXCAVATE 5 ALL AROUND x MA
..THE LEACHING FACILITYA.ND DOWN TO THE SAND
LAYER.
O 94.5
REMOVE ALL UNSUITABLE MATERIAL, AND '.
REPLACE WITH
CLEAN GRANULAR SAND CONFORMING TO THE SPECIFICATIONS
0 —4 94,2 0
First-floor ;
3—Removable-covers within SET FORTH IN 310 CMR 15.255 3 .
elev. 101.0 ( )
- f finished r de ' _ ,
6 o f s ed a s 0.02 » ,;
9
10 YR 4 3
Acces Holes In Tank to 4 10 93.T A SANDY LOAM /
be 20 in Diameter:
0.0 0 24 92.5 B LOAMY SAND 10 yp 518
1 Dist. box
4»->32 83.5 C MEDIUM SAND 10 YR 7 4
I r
2 aye of_7`7
1J8 to
2
s—
O.Q Clean Backfili i 2» washed stone
. 2
.. .. .: level
i ui eve r> 4 ft. of`3/4" to 1/2",washed
- - stone all around the infiltrator
CA C
_SEPTIC _
and 1' below the Infiltrator
TANK
Ci
Foundation o, 1500 GAL.
rn Elev. 88.67
design p - o
9 u _ DEEP OBSERVATION
b others > R tl
A N HOLE LOG N0. 2
a� > >
ai ur a� S t OTHER
__ — o SOIL SOIL TEXTURE SOIL COLOR SOIL SiRXW
> H--10 -o ( s
c > > DEPTH ELEV. HORIZON USDA Munsell sra+ES BOl4DERS
c Bottom of Test Hole Elev.= 83.5 CON95TENCY,x GRAVEL
_ II 0" 94.5
PROFILE
6" LAYER OFF CRUSHED COMPACTED STONE �' " "LA u SOIL TEST P8398 0 -4 94.2 0
Note to Scale d •
PROVIDE 12 LAYER OF >
c LOAM 10 YR 4/3 SANDY AN Y
COMPACTED .GRAVEL UNDER — Date of soil test: 10/31/95 4» 10 93.T A
'THE DISTRIBUTION BOX .
Test taken by: M. >BORSELLII 10"-24" 92.5 B LOAMY SAND 10 YR 518
Results witnessed by: ED B,ARRY
Y 4"-132' 83.5 C MEDIUM SAND 10 YR 714
Percolation rate: 2 min./inch
GENERAL NOTES
Ground water . NONE- ENCOUNTERED
1 No system change to this s tem shalt be made unless
approved in writing by holmes and mcgrath; inc.
2) Subject .to inspection during construction by the
>e
Board of Health and holmes and mcgrath, inc.
3 Heavyconstruction equipment shall not travel DESIGN CRITERIA
r • during afterconstruction." HOLE #1 HAD AN IMPERMEABLE LAYER FROM 5'-6'`DEPTH 10% AROUND HOLE
over disposal system du ng or
4 Disposal system to be constructed in accordance HOLE #2 HAD AN IMPERMEABLE LAYER FROM 5'-6' DEPTH 25% AROUND HOLE
) DsP � ° Number f ,
with Title 5 of the State Environmental Code. o bedrooms: 3 Equivalent to 330 gal. s/day
N unit:disposal dis ,
5) A .copy of these plans must be kept on the site Garbage p I o
during the time of construction. Leaching area - -capacity required: 330 9ai.'S d0
Y l
6) "A copy`of these plans must be furnished to the
• Side ,area proposed. _ 159 sq. ft.,
contractor constructing the disposal system.9 P Ys
. . Bottom area proposed: 314 s ft.
7) Before backfilling, the contractor shall notify, P P q
• Total area proposed: 473 ft.
holmes and mcgrath, inc.; or ,the Board of Health p p sq. ,
Agent to inspect the system as constructed. Proposed leaching capacity: 350 gaI. s/day
f contractor encountersan v nation between 8) i .the cant acto y a .Water supply: TOWII ., INLET HOLE
i conditions h n l n
the existing cond t ons shown o the an and •thee
9 P
Precast concrete units. H 10 & H 20 load design
conditions encountered :on the site, Y or an sod loading g
, 1
condition different :than shown on the soil to or
an adverse soil the ontractor shall `immediate)
contact holmes and mcgrath, inc. Holmes and
g ,
mcgrath, inc. will,examine the soil condition
16
and report to the owner any suggested revisions. i—
� �C
10 —6
„
34» 6—3 �
3 20 Diameter Access Holes
.. 00
1
r ALL AccEss MANHOLE covERs FOR TYPICAL HIGH CAPACITY INFILTRATOR (H 20 LOADING
INLET t` OUTLET SEPTIC TANK DISTRIBUTION BOX, NOT TO SCALE
\ \� AND LEACHING STRUCTURE SET MORE NOTICE
- THAN 6 BELOW FINISHED GRADE, Unless and until such time as,the original red stamp of the
(red) P
HA B RAISED T WITHIN F responsible Professional Engineer, or Professional Land Surveyor
SHALL E ED 0 6 0 P 9 Y
FINISHED GRADE.
appears on this plan:
�-- - � A) no person or persons, including an municipal or other
_T ( P 9 Y P
` may public officials, rely upon the information contained herein; and
P Y Y P
FRAME & COVER
(B) .this :.plan remoras the property of Holmes & McGrath, inc.
STEEL REINFORCED PRECAST CONCRETE : OVER "T's" WHERE REQUIRED:
PLAN VIEW
1/2/96 REVISE INVERTS MJB Inn--1
PRECAST CONCRETE
3„ REMOVAlLE COVERS 3" TANK_RISER WHERE DATE DESCRIPTION Drawn Necked
REQUIRED
17-1
R E' V I S 1 0 N S
INSTALL "POLYLOK" FLOW EQUALIZERS
�_103"
ALL OUTLET PIPES FROM THEmm. clearance required c ON ALL OUTLET PIPES
r7 INLET T" DI T B TI N X A PLOT PLAN DETAILS
» S RI U 0 BO SH LL BE »_INLET2 mrn, inlet to outlet
SET LEVEL FOR AT LEAST 2 FT. t 6•5 ' � CONCRETE COVED,
- OUTLET -`
OF PROPOSED SEWAGE DISPOSAL SYSTEM
Liquid leve► PREPARED : FOR
» o , — 5 - 5 OUTLET
5 7 � ;t 5 —7-
KNOCKOUTS
.. _ 1
s +'
KNOCKOUTS
JOSEPH BREEN
Ea ,Ear �
v -i
TUF—TI TE
b t t » » R T CARDINAL AN
15,5 INLET 19.5 FOR LOT 69, CAR L LANE
GAS BAFFLE 0— 1 ! i LET .
v t OUTLETIN
T11.25- MARSTONS .MILLS MA
BARNSTABLE
_ 5 --8 20 »
1 Q Q 1.75
SCALE. AS SHOV'JN DATE. NOV.Nov . �3, 1995
PLAN SECTION CROSS-SECTION ,�,
CROSS—SECTION END SECTION holmes and me rath, inc. �' MICHAELJ." LiLv
civil engineers and Lan surveyors
BO RS ELLI
9 Y
o � , �
. IVY
TYPICAL 1500 GALLON SEPTIC TANK.
6 -. HOLE DISTRIBUTION BOX 200 main Street
c N
o�\35
'folmouth ma. � 02540
NOT TO SCALE
_ NOT .SCALE.. ..
S� •'`.i.. t. ,.
, DRAWN. . SJS ' CHECKED. r- JI
4 61_2i29 F
95374DFT.DWG JOB`` NO: 9537 DWG. 'NO.. SHEET 2 0 2