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HomeMy WebLinkAbout0063 CARDINAL LANE - Health 63 Cardinal Lane Marstons Mills A= 014-020 I co��l 1����-.���r� �n � � � Town. of Barnstable Regulatory Services IN ilk A BARNSTABLE 4 t flULY5fr1BLE•WRfiIVILLE•mNR•HYmis . 1F ! W10.5i0[tSWu•OSf&V11F•153T 6CVISTA&E ' MAE& * Public Health Division 1639-Zo1Q 1639. a��� 200 Main Street, Hyannis, MA-02601 �llg Office: 508-862-4644 Richard V. Scali,Director Fax: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7014 1200 0001 0358 0260 December 15, 2014 F Mary C. McDonnell 63 Cardinal Lane Marstons Mills, MA 02648 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 63 Cardinal Lane, Marstons Mills, MA was last inspected on 11/24/2014,by Jeffrey M. Wall, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Conditionally Passes" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: 0 Must repair or seal septic tank. Need confined space entry certification to do this job. • Must replace Distribution box. You are ordered to repair or replace the septic system components within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. S PER ORDER OF, OARD OF HEALTH omas McKean, R> S>, CHO Agent of the Board of Health QASEPTIC\Conditionally Passes Ltr\63 Cardina Ln MM Dec 2014.DOC a� Commonwealth of Massachusetts ns ection Form Official I l � Title 5 O p 0 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r-n w� r� Ftoperty Address „� Ow ner Cw ner'fa Mrne r inforrretion is required for every ��. State Zip Code Date of Inspection ro page. Qly/Town CO 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. tnportart:'Men A. General Information on the computut f� on the computer. ` use only the tab 1. Inspector: key to move your cursor-do not use the return Name of inspector p key• Co any mime V� rripa ny Address SimL.� Z Cityffown ate Telephone Nu r 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 teased 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 16.340 of Title 5 (310 CM 15.000). The system: ❑ Passes Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority n4o line 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. 49r• 11J Title 50ftdd inpectlon Form Subsurface Sevwpe Diepceef S1"m•Pope 1 of 17 f - Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form •Not for Voluntary Assessments J Cam/i iiluc� yu�i � Property Address information is �'nerner s Name required for every hweLm � Sy, a ® Date of pect n �— page. 51 /Town B. Certification (cont.) Inspection Summary: Check A,B,C,D or E I alwayscomplete all of Section D ysbam assess ❑ not found any information which indicates that any of the failure criteria described in 310 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are I ndicated belo Comments: B) System Conditionally Passes: �KOne 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 forges', "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 J 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 indica 'ng that the tank is less than 20 years old is available. ❑ Y N ❑ ND (Explain below): t5rg,Yl3 T10*50 Tidal IrrpeceonFamt Surxvfarn S8VNeDl6pa6al SAtem•Page 2017 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Ad ress — Cw ner 5 rier's Name information is ✓ �� ,r'ate �� required for every page, /-'own State Zip Cod Date of h§pecti n B. Certification (cont.) ❑ Pump Chamber pum al. System will pass with Board of Health approval if pumps/alarms are repaired. B) S stem 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): ❑1 obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): (y'/ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): G eh�sri C stem required pumping more than 4 times a year due to broken or obstructed pipe(s). The system ass inspection if(with approval of the Board of Health): ❑ broken pipe a replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ Conditions exis ch require further evaluation by the Board of Health in order to determine if the system is failing t tect public health, safety or the environment. 1. System will pass unless of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not ctioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface er ❑ Cesspool or privy is within 50 feet of a bordering vegetate land or a salt marsh fts,3A3 71tleSofflddlrepecGonFormSubsWooeSewage Sptem•Pago3of17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments Property Address Ow ner Information is Om ner s Name required page, tatyffown State ZipCDde Date hspe ion page, B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier,if any) rmines that the system is functioning in a manner that protects the public health, safe nd environment: ❑ The sys has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a sur water supply or tributary to a surface water supply. ❑ The system has a tic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic to and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method t:.sed to determine distance: **This system passes if the well water analysis, performed at a D ertified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia pit nd nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A 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 ❑ M--11' Static liquid level/in the distribution box above outlet invert due to an overloaded or clogged SA or cesspool ❑ [2,;��� Liquid depth i cesspool is less than 6" below invert or available volume is less than'/z day ow UN.yM 3 Tltle 5 afldel Ine pecdon F am Subu0aoe Se%wge Dlapoed System-Pape 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address ON ner ON r required for every page. iNyrrown State Zip Codef Date of Thspecforr 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: ❑ L�' Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ��/g Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ d1vp Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ t!d i I$Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ WJ�j� 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 wateranalysis, 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 6 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ e�m-The system is a cesspool serung a facility with a design flow of 2000gpd- ` 10,000gpd. li ❑ L=�,/ The system bjjo. 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. Large Systems To be considered a large system the system must serve a facility with a n ftow of 10,000 gpd to 15,000 gpd. For large sys s, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Sectl Yes No ❑ ❑ the system is 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 fe f a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sitive area (Interim Wellhead Protection Area— IWPA)or a mapped Zone II of a p is water supply well If you have answered"yes"to any question in Section E the system is c idered a significant threat, or answered "yes"in Section D above the large system has failed. The owne operator of any large system considered a significant threat under Section E or failed under Section D s upgrade the system in accordance with 310 CMR 15.304, The system owner should contact the app ate regional office of the Department. (�1n9�31t 3 TIGB 50tfld811i6pectlm F aitc Sutaurl aoe Sevape Dlepoeel 8yetem•PeQe 6 of 17 l� n n l � V4"1 ) r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Froperty Address L ' Ow ner Cw ner's Name �� / infom-ation is 2J required for every l�,1 _/� page crown State Zip Qorde Date of InSpectidh 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 ❑ LId Were any of the system components pumped out in the previous two weeks? ❑ Has the system y ceived normal flows in the previous two week pehod?(Ndr- ❑ ®/ 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 WA) I; ❑ Was the facility or dwelling inspected for signs of sewage back up? Cg' ❑ Was the site inspected for signs of break out? ❑ Were all system components, ding the SAS, located on site? (Jd ❑ 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: ❑ 2 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: �o ��►��� a Number of bedrooms (design): �' Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 0— 15irls 3113 Tile 50f11dd ire pectlonForm:SuDsurfaoe Sewage Dlepoed System•Page 6of17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Forth -Not for Voluntary Assessments Property Address ON ner 15 nees Name information is / required for every �S page. /Town State Zip Cocre Date of specti n D. System Information Description: , Number of current residents: 0: 101"No Does residence have a garbage grinder? ❑ Yes Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes F3 No information in this report.) ol Laundry system inspected? ❑ Yes [ No Seasonal use? ❑ es Ii No Water meter readings, if available last 2 ears usage d ��f�-= g4/� /3_ o 9 ( Y 9 (gP ))� Detail: d 12 1­ G6'ra. i 42 Sump pump? ❑ Yes ' No Last date of occupancy: ©�7t� orateFlow Gendiilie­ t i Type of 'shment: Design flow(based on CM R 15.203). Gallons per day(gpd) Basis of design flow(seats/persons s etc.): Grease trap present? ❑ Yes ❑ Na Industrial waste holding tank present? ❑ Yes ❑ No. i Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No' Water meter readings, if available: Or h9,3n 3 Title 5 official Ire pecbon F orm Subeuf ace ISe"Oe.Dlepoed Stetom-fage 7 of 17 I Commonwealth of Massachusetts For m Inspection Title 5 Official Subsurface Sewage Disposal System Form •Not for Voluntary Assessments Rope Address Ow ner information is Cwner's Name required for every City page, !Town State Zip Date of Inspe do D. System Information (cont.) Last date ancy/use: Date '— Other(describe below): i General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes 910 If yes, volume pumped: o� 9all How was quantity pumped determined? Reason for pumping: Type of System: CD Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool I ❑ Privy ❑ Shared system (Yes or no) Cif yes, attach previous inspection records, if any) ❑ Innovative/Altemative technology. Attach a copy of the current operation and. maintenance contract(to be obtained from system owner)and a copy of late;t inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other (describe): t5is-3113 TWO 501naaiinspecoonFomsubarfecesevspeotaposalsWtem•PGgeeof17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address n 0 Ow ner ON nets Name information is required for every �a Zip Date of specti page. tatyrrown D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: tip Were sewage odors detected when arriving at the site? ❑ Yes W NO Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑ cast iron 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet ' i Comments (on condition of joints, venting, evidence of leakage, etc.): .2i I i Septic Tank(locate on site plan): / I Depth below grade: feet 7Mate� of construction: concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) I I years Is age confirmed by a Certificate of Compliance? (attach a copy o ce 1 I No Dimensions: C�00d Sludge depth: t5ins,3113 Title S Olfldal Inspection Form Subswace Sewage Disposal System•Page 9 0 t 7 ����-I,�l �11L Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Forth -Not for Voluntary Assessments Property Address h Ow ner Ow ner's Name information is required for every Sta� Zip Code f Date of Inspection page. CItyrrown D. System Information (cont.) Septic Tank(cont.) et Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to utle invert, evidence of leakage, gtOF c.): , e C6/ry11 e Cl/A' /l�e /L GG S SSG L�-ee�ir��c ,�Y f ral, (loeate en site plan); Depth be rade: feet Material of construc ❑ 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: Dete t9ro 3M3 TIUe30f9tlel WepeoeonForM Subeufwe Sevage0lapaad SWtem•Pape 10 of V Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Prope Address Ow ner Ow"—Narffneinformation isdy�I /�/ _ //% (:s�Z�; required for every ! State Zip Cod Date of spec ion page. Qty/Town D. system Information (corn.) �Orrta�enntts (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid leve lated to outlet invert, evidence of leakage, etc.): iolding Tank at time on site PI-n%- --�---- Dept h el ow grade: Material of c struction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Ala 'n 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 t ns-W3 Title5010cid In5poodonF—Suba iam SowogeDlepoad SAtem•Pepe 11 d 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System For -Not for Voluntary Assessments 10w ps Address ON ner ner's Name ►y� /✓ information is required for every State Zip Lme Date of k1sp6ction page. Cityrrown D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any elide ce of leakage into or out of box, etc.): Pum ' working order: ❑ Yes ❑ No* Alarms in working ❑ Yes ❑ No* Comments (note condition of pum amber, 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 plaD4xcavafion not requ d): If SAS not located, explain why: tJim-3113 Tine90MOW In*pectonForm:Subewfaoe Se"a DlepaW SAWA-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Forth -Not for Voluntary Assessments Property Address �. Owner Ow tier s Name �33 /� / information Is -r required for every � Tip Date ofhspec n page, Down D. System Information (cont.) Type [� leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ Teaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/altemative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation,-etc.): 1 'l t C,�G_��z�a S�Gi'I D � dr�lczc�G� ci r Ali oletn!Z /s - o • 7 f i'GLea � r1 C"WUPUM110 (cesspool ...List be ptlij1ped as part of (locate em site Number and con ation Depth—top of liquid to inlet in Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No tans•3/13 TWO 5OfAdid Ins peo don Fwm Subeurfem SovopeDispoed S Ate m•Pipe 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address G O Ow ner owner's Name information is required for every page. ZipCodd crown State Date of Insoectio, D. System Information (cont.) COPr megjs (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): -sate-plaq);- - Materials o struction: Dimensions Depth of solids Comments (n:te condition of soil, sMgns aulic failure, level of ponding, condition of vegetation, etc.): t5 ns-3113 TiAe 5 Offldal Ins peCbcn Form SUDSWme Sev"e 01epaed system•Page w of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address Owner Owner's Name requiredfoInfomietion is requiredforevay !? page. Qtyrrown State Zip Caftle Date of Inspect' n D. System Information (corn.) Sketch Of Sewage Disposal System: Pm ide 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 wher public water supply enters the building. Check one of the boxes below: hand-sketch in the area below ❑ drawing attached separately Desk B I 5C lG rAWA o aq-ce f eou.et� see !PIc 7nljk ouZeT s��fa ra e �•r- y8'q 3 9'_3 ans 3113 TIse5OM NI Ins pectionForm Su KOWe Sevage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address Ow ner Ow ner's Na Information is �t en _ O; required for every page. Clryrrown State Zip CDdd Date of Inspedloff D. System Information (corn.) Sites Exam: M Check Slope O Surface water 7LJ' eck cellar Shallow wells \� Estimated depth to high ground water: ` feee t 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: 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: MA,X-e 10 Before filing this Inspection Report; please see Report Completeness Checklist on next page. nns•Yn Title 50rndA trRPsOtlai Form Sub3W1aW Sewage D1$Po*d System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Prope Address I'1 Cw ner Ow ner's Name information Is required f or every n ��page. Cily/Town State Zip Code Date of specU n E. Report Completeness Checklist LU' Inspection Summary: A, B, C, D, or E checked Winspection 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 65i11s 3/13 TI0501fldal IrispectlonForm Subsurface Sevs9e01e90%al Syetem-Page 17of 17 Table 3-2 Do's and Don'ts of private Septic System Management DO... DON'T... Do have the on-site system inspected and pumped by Do not use the toilet or sink as a trash can by a licensed professional approximately every 3 to 5 dumping non-biodegradable material(cigarette butts, years. Failure to pump out the septic tank cap cause diapers,feminine products,etc.)or grease down the system failure. If the tank fills up with an excess of sink or toilet. Non-biodegradable material can clog solids,the wastewater will not have enough time to the pipes,while grease can thicken and clog the settle in the tank.These excess solids will then pass on pipes. Store cooking oils,fats, and grease in a can to the leach field,where they will clog the drain lines for disposal in the garbage. and soil. Do know the location of the on-site system and drain Do not put paint thinner, polyurethane,anti-freeze, field,and keep a record of all inspections, pumping, pesticides,some dyes, disinfectants,water repairs,contract or engineering work for future softeners,and other strong chemicals Into the references. Keep a sketch of it handy for service visits. system.These can cause major upsets in the septic tank by killing the biological part of the on-site system and polluting the groundwater.Small amounts of standard household cleaners,drain cleansers,detergents,etc.will be diluted in the tank and should cause no damage to the system. Do grow grass or small plants(not trees or shrubs) Do not use a garbage grinder or disposal,which above the on-site system to hold the drain field in feeds Into the on-site tank. If there is one, severely place,Water conservation through creative limit its use.Adding food wastes or other solids landscaping is a great way to control excess runoff. reduces the system's capacity and increases the need to pump the on-site tank. If a grinder is used, the system must be pumped more often. Do install water-conserving devices in faucets, Do not plant trees within 30 feet of the system or showerheads and toilets to reduce the volume of water park/drive over any part of the system.Tree roots will running Into the on-site system. Repair dripping faucets clog pipes,and heavy vehicles may cause the drain and leaking toilets, run washing machines and field to collapse. dishwashers only when full, and avoid long showers. Do divert roof drains and surface water from driveways Do not allow anyone to repair pr pump the system and hillsides away from the on-site system. Keep sump without first checking that they are licensed system pumps and house footing drains away from the on-site professionals. system as well. Do take leftover hazardous chemicals to an approved Do not perform excessive laundry loads with a hazardous waste collection center for disposal. Use washing machine. Doing load after load does not bleach,disinfectants, and drain and toilet bowl cleaners allow the on-site tank time to adequately treat wastes sparingly and in accordance with product labels. and overwhelms the entire on-site system with excess wastewater.This could flood the drain field without allowing sufficient recovery time. Consult with an on-site tank professional to determine the gallon capacity and number of loads per day that can safely go into the system. Do use only on-site system additives that have been Do not use chemical solvents to clean the plumbing allowed for usage in Massachusetts by MA DEP, or on-site system."Miracle"chemicals will kill Additives that are allowed for use In Massachusetts microorganisms that consume harmful wastes. have been determined not to produce a harmful effect These products can also cause groundwater to the individual system or its components or to the contamination environment at large. htlpJ/w,vv,mau.pov/depiwolarlrelotXCe�Jlmppulde,doC 3-17 July,2006 r • Health Master Detail Page 1 of 1 jo Logged in As: TOWN\miorandd Health Master Detail Tuesday, December 9 2014 Application Center Parcel Lookup Selection Items Parcel Septic Perc Well I Fuel Tank Parcel: 014-020 Location: 63 CARDINAL LANE, MARSTONS MILLS Owner: MCDONNELL, MARY C Business name: _ _ Business phone: Rental property: ❑ Deed restricted: ❑ Number of bedrooms Contaminant released: ❑ Fuel storage tank permit: ❑ [— Save Parcel Changes R Return to Lookup I Parcel Info Parcel ID: 014-020 Developer lot:LOT 77 Location:63 CARDINAL LANE Primary frontage: 125 Secondary road: Secondary frontage: Village:MARSTONS MILLS Fire district:C-O-MM Town sewer exists at this address:No Road index:0243 Asbuilt Septic Scan: 014020_1 Interactive map , ` Town zone of contribution:GP (Groundwater Protection Overlay State zone of contribution:IN District) Owner Info Owner: MCDONNELL, MARY C Co-Owner: Streets:63 CARDINAL LANE Street2: City:MARSTONS MILLS State:MA Zip: 02648 Country: Deed date:6/15/1993 Deed reference:8648/316 Land Info Acres: 0.46 Use: Single Fam MDL-01 Zoning:RF Neighborhood: 0105 Topography:Level Road:Paved Utilities:Public Water,Gas,Septic Location: Construction Info Building No ear Buil Gross Area Living Area Bedrooms Bathrooms 1 1979 2600 988 2 Bedrooms 1 Full Buildings value:$80,500.00 Extra features: $34,300.00 Land value: $109,000.00 I http://issgl2/Intranet/healthMaster/HealthMasterDetail.aspx.ID=014020 12/9/2014 TOWN OF BARNSTABLE LOCATION.0<3 �QL � SEWAGE# f — ' g VI'LLA4/229ZSS MAP&PARCEL INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY , DW-i 6A1a,1,- i LEACHING FACILITY.(type) ®/� (size) 6�;, NO.OF BEDROOMS DE3':a.J �}6 L OWNER PERMIT DATE: 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 C s � "Ooo/ 3 9�3 �> a �. 41 01 No. 444 Fee` Id-0, KTHOMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS application for �i�tl0 aY *pstem Construction Permit Application for a Permit to Construct( ) Repair( Upgrade( ) Abandon( ) ❑Complete System ❑Individual Compon Location Address or Lot No. 3�' (i?RC L Owner's Name Address and Tel.No. Assessor's Map/Parcel Installer's Napie,Address,and Tel.No. A-JI B. Designer's Name,Address,and Tel.No. e i c-f! Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) �- � D IL t 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 o ealth. ign 6 ate A "n Application Approved by ate Application Disapproved y Date for the following reasons Permit No. Date Issued No. - Fee .. _ � TH COMMONWEALTH OF MASSACHUSETTS Entered in computer: -PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes application for is o aY Opstem Construction Permit Application for a Permit to Construct( ) Repair( Upgrade( ) Abandon( ) -❑Complete System ❑Individual Compon px"s Location Address or Lot No. 3 C' _ (ttgL L Owner's Name,Address,and Tel.No.. d'1 Assessor's Map/Parcel Installer's Name,Address,and Tel.No.(��-r� G : Designer's•Name,Address,and Tel.No. �GJ01 'Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building. X. No:of Persons 08howers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil A 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 o ealth. ign d G' PPDate / Application Approved by v i ` ate Application Disapproved y \Date.— -. for the following reasons / i Permit No. Date Issued 67 r i ------------------------------------------------------c---------------------------------r------- ---------------------- Se� < �� i THE COMMONWEALTH OF MASSACHUSETTS BARN TABLE,MASSACHUSETTS Q�-7) VCR,,,,,,,e g rtificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(� Upgraded( ) Abandoned( )by IA' 41 50� S1i<11a1c1e at 3 /? L (��i�,fj!. 11 has been constructed in acc i with the provisions of Title 5 and the for Disposal System Construction Permit No. geyd Installer Designer #bedrooms - Approve esi gpd The issuance of this permit shal of be con rued a guarantee that the syste will nc'on s d si n Date C Inspector -----------f-------------- � - No. .� Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS ]Disposal 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair Upgrade( ) Abandon( ) System located at �� 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. Provided:Construction ust b�co pl ed w'hin three years of the date of this permit. Date Approved by 9 TOWN OF EARNSTABLE LOCATION � cc/�Q�- G�• SEWAGE# ( — g VILLAGE/ ��,! //ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE:N0.1�_���ti/ eq��11 SEPTIC TANK CAPACITY f LEACHING FACILITY. (type) e4 (size) d5; x� NO. OF BEDROOMS OWNER PERMIT DATE: / COMPLIANCE DATE: r 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, bec fc S Commonwealth of Massachusetts . Title 5 Official -Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M Property.Address �Gc G ON ner Ow ner's Name [ s information is e ��—_- required for every page, [Town State Zip Code Date of h pecti ya 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, ceived normal flows in the previous two week period?(�U- pGcuP�2 ❑ �/ Have large volumes of water been introduced to the system recently or as part of this inspection? UR/ ❑ Were as built plans of the system obtained and examined?(If they were not available note as WA) L� ❑ Was the facility or dwelling inspected for signs of sewage back up? ElWas the site inspected for signs of break out? p' ❑ Were all system component� re el�Gding the SAS, located on-site? Q/ ❑ 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: El2 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 (actual): Number of bedrooms (design): � � � DESIGN flow based on 310 CMR 15.203(for example:110 gpd x#of bedrooms): g IX-6 t5ns-3H 3 Tltla 5 orfldel Ins pectlon F am Subsuteoe Sevage Dispose!System•Page 6 of 17 L C1T 107 SEw sE PE�M1V—0' VIALAGE / h� get, INSTA LLER'S NAME & ADDRESS BUILDER OR OWNER DATE PERMIT ISSUED 7 DAT E COMPLIANCE ISSUED iF a No........................ Fes$..............`....... ..... THE COMMONWEALTH OF MASSACHUSETTS v BOARD OF HEA TH -7a.ta".................OF.....13 .......................... rt Appliration for Disposal Works Tonstrnrtinn Vrrmit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal Syr at: - -- ,................... 2.............�.. `..._. atwn-Address / ` o. � » ......1� ..... .. ��-�-e- 1':. -.ads tf? .--• � --.or ..^ Owner Address w ...........................................•-----------• v..,..--......-------- Installer Address d Type of Building Size Lo�® �.......Sq. U Dwelling—No. of Bedrooms.__.. --------------------------------Expansion Attic Garbage Grinder 6 a, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Pa Other fixtures •-•----•-------•--------•-•---•. . Design Flow.......... gallons per person Der day. Total d,ilyoflow........ W // WSeptic Tank—Liquid*capaci.y< . gallons Length. .�.> _._ Wldth__. a........ Diameter................ Depth... x Disposal Trench—No......... ..... Width__._.7............. Total Length........;......... Total leaching area....................sq. ft. Seepage Pit No--------/........... Diameter-- ........_. Dep/t�h/pelow inlet.... Total leaching area.0ZV...-/....sq:ft. Z Other Distribution box (�) Dosing t �'� / Percolation Test Results Performed by... �e.e- _••---- -------------••• Date_.._./�� � 1,1�»....__. Test Pit No. 1.... -____minutes per inch Depth of Te it...... ......... Depth to ground water..�-�'.-�!_._.. fi, 'Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ R♦ . Descriptionof Soil ^ ...�/...... r�.. ................................................................................. U ---------------------------------------------- •---------- ------------- .-----...------------------•---•----------- •-------------------------------------------- -...... . --------------•---- W ..........................................................�----••------•--•-••-------------••-------••---------•---•------....-----•--•--••----------•------------•---•----------•--....._......•- VNature 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 L ITIU 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance ha*ben ued by board of health. -- ----------------•-•-...._----•- I? a ....._ .---.... --- te Application Approved By........::.............. .. Date Application Disapproved for the following reasons------------------•--••-------•-•-------•----------------------------------------------------------------.•--•-- •---....--•-------- ---------•••-•-----•.....---------••--------••-•-----•----------.......................•--------.....-----._...------------•...-T---`------..-----•------•--••--------------- Date Permit No......................................................... Issued.-/ �-- Date J THE COMMONWEALTH OF MASSACHUSETTS BOARD OF H EA TH ...............OF..... .......PC.......................... Appliration for Disposal Works Tonstrnrtiun Prrmit Application is hereby made for a Permit to Construct Y ) or Repair ( ) an Individual Sewage Disposal Sy,1T at J / +cation Address / or c" c_ 77 11 �" /�o Y .' Owner »_ Address W � '.c. ... ...................i.........._..................... / Installer Address O�(9� Type of Building �'YAW Size Lo ------•-------------------•-Sq. f eet Dwelling—No. of Bedrooms._..................................Expansion Attic Garbage Grinder Other—T e of Building No. of persons............................ Showers — Cafeteria Other fixtures ........................... --- y�}-- -------------------------------------- Design Flow..........��.. ....................gallons per person�er d�y.a�Tota1 4-ily�flow........__.F.�..�... .......__._....gallons. WSeptic Tank—Liquid capacity/O O allons Length. ._,AS,r�... Width..........:..... Diameter................ Depth... x Disposal Trench—No..................... Width.__..r_............ Total Length............4...... Total leaching area....................sq. ft. Seepage Pit No....... ........... Diameter.....:..;.... Depth elow inlet._.. g d.Q..1....sq. ft. Total leaching area_ _: Z Other Distribution box (�) Dosing t� 0 n / Percolation Test Results Performed by...l..S... ........ _Y_ _ `_ 'f Date............... a Test Pit No. I....1?Z......minutes per inch Depth of Tes it------&......... Depth to ground water-.6t............... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ -.O �-/- -i Description of Soil---------------- t `f------ • .................. --...----------------•----------•-----•--------•--•--•--•-•------......._.._.----- x U -----•---------••---••-•--•--------------------•--•------------._._.......---....._........--•----•-........-•••------------------------------•---------•------------.........-•--•-............---••-- w ------------------------------••------------------------- ••--•••-- UNature of Repairs or Alterations—Answer when applicable............................................................................................... ...-------•----------------•--............-----------....-•------------•--.....---••-•---•-----••-•-•-•---------------------------....--------•-------------------------..._......-----......_......... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iI'L.T � 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be issued by the board of health. Si ed - t" ' - . ` Date Application Approved By....... ---- '"'°- /A. P _r.... r Date Application Disapproved for the following reasons..- ...-- """'-'--"'•"""""--'-•""""""""""""""""'•------•------•-•-•--••......•» ----••---•-----•-•-•--.........-•---•-------•---•-----------•--------=---------------•------•-------•-----•-------------------•--••---------------•-•-•-------------••--------------•---••--------•---- Date f PermitNo........................................................... Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD •.OF HEALTH nOF.... ......... ...... Tirftfirtt D A3n Fanrr THLY IS CERT FY, That the Individual Sewage Disposal System constructed ( or Repaired J r � g P �' ( ) by !.... �-------------------------- ------------------ -• 't' - -=`.--- ••---.. �� � � Installer ,y has bee installed-m accordance with tie prbvisiidn� of1. ,�. f e--Yfgf'e a rtarry L ode as described in the applicatiop for Disposal Works Construction Permit No._ _ _._._:.'. ....... dated_. ___.__ ..R,-- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GLtANTEE THAT THE SYSTEM. WILL FUNCTION SATISFACTORY. DATE................................................................................. Inspector..................-..........................--................ =-----------•-----•---- THE COMMONWEALTH OF MASSACHUSETTS BOARD /JOF HEALTH ......... i..........OF....... }! ...`............................................ FEE. ... No 'AX Disposal or s �lanstrnrzion rmif Permissio is herebyanted.... .... .... . . .................................................... �' � to Construct or Repair ( an R. , u, Se age Disp sal Sy�fe .. • -•--- ;dam at Now-- ' - -- • --- -- ';'�;� -A •- -;--- ,� .........--•.............•-- as shown on the application for Disposal Works Construction Permit No..................... Dated... . -.-.---.•-.--.-.- I-A f Car- j- .............. ,,.v-- Or ;� FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH........ .. .... ........................OF........;9...... . ...................................................... ,/ f v v No........ ...a '.... FEE........................ i To no� ion emit Permiss on erebY granted. � :. -• to ConsquSp ( ) or Repaip ( �anllndividq "Se age Di sVok' System Street z... }l ............... ........................... 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