HomeMy WebLinkAbout0098 CARDINAL LANE - Health 98 Cardinal Lane
Marstons Mills F/R
A 013 010
TOWN OF BARNSTABLE
LOCATION 9� 1f X9r1_?,H,0 L144z� SEW E # 100�/ —094
VILLAGE IA;1i1o,S rO j ASSESSOR'S MAP & LOT D/ 3—o lid
INSTALLER'S NAME&PHONE NO. ✓osc�l
SEPTIC TANK CAPACITY 1400
LEACHING FACILITY: (type) 0-Say (size) /.3 X 2.S''
NO. OF BEDROOMS
BUILDER OR OWNERUi�
PERMITDATE: 17, 10,G y 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 facili ') Feet
Furnished by L�'
r
� ae)41 ;,
No. Fee
THE COMMONWEALTH OF MASSACHUSETTS, Entered in computer
Y
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
01pplitation for Mizpossar *pztem Conttruttion Permit
Application for a Permit to Construct( . )Repair(vrupgrade( )Abandon( ) ❑Complete System k1ir dividual Components
Location Address or Lot No. ?(r Cow&tea( LV, ^41 Owner's Name,Address and 1.No.
Assessor's Map/Parcel b/O G /t p 14 d
Installer's Name,-Address,and Tel.No. Designer's Name,Address and Tel.No.
\1� �����2�� �- Gar.•t ,.�t-�-�, �.S,
Type of Building: _
Dwelling No.of Bedrooms Lot Size�/�V sq.ft. Garbage Grinder .(jYd
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow 710 gallons per day. Calculated daily flow 7 S gallons.
Plan Date 2 Y' D `( Number of sheets / Revision Date
Title
Size of Septic Tank l= ), /Grp 9 OL� Type of S.A.S. Z — h a e"s
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) r��A.G( 4`� L�tA le"/°,,r� 4,
,V 0-7 J/ry 4/f A-L h d, C zr-x t 7,x 2)
Date last inspected:
DESIGNING ENGINEER MUST SUPERVISE
INSTALLATION AND CERTIFY IN WRITIN
Agreement: THE SYSTEM WAS INSTALLED INA
The undersigned agrees to ensure the construction and maintenance of the afoeUr� ss�� system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in opera n until a Certifi-
cate of Compliance has been' sued by this Board of Hea .
Signed Date
Application Approved by Date 0
Application Disapproved for a following reasons
Permit No. Date Issued
{ °w
Fee
� ° THE COMMONWEALTHOF MASSACHUSETTS Entered in computer: e\
'1 `` 4', PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS Ye
application for Zigo'gal *p.5tem Congtruction Permit
Application fora Permit to Construct(` )Repair( �<Pgrade( )Abandon( ) El Complete System krndividual Components
Location Address or Lot No. C/,?'CAtidt4,Q ( `N ,44/4li Owner's Name,Address and Tel.No.
Assessor's Wp/Parcel
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
420
-3?6Z t
Type of Building: _
Dwelling No.of Bedrooms Lot Size �/0(V sq.ft. Garbage Grinder3,rY�//¢/ .
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow ?O gallons per day. Calculated daily flow 3 S`3 gallons.
Plan Date 2 — Y— D N Number of sheets `/ Revision Date
Title
Size of Septic Tank /�;7 ?C /C/r'O a a Type of S.N.S. a / G ar G,1'
Description of Soil A
Nature of Mr—S
or Alterations(Answer when applicable)* ci J,
7 — 0 zr-x ? 2�
Date last inspected: -� —_-
Agreement: { t 1
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 issued by this Board of Heal
Signed Date ! i
Application Approved by 7. �, ���.v .�'�i ( Date JCv
Application Disapproved for&following reasons 1- /
Permit No. r Date Issued
---------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
p O BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded( )
Abandoned( )by
at s-? has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No.. ted
Installer Designer
The issuance of this permit shall not be construed as a guarantee thattthe ssyste-hi it un to n as designed.
Date 3� 5r/� Inspecto � 7�r-- .c
l
Fee
No.
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS
Migaar *pztem Con5tructton Permit
Permission is hereby granted to Construct( pep ir( L�grade( )Abandon( )
System located at (-"6t'� .l �, -Y7
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. �-
Provided:Construc°on must be co pleted within three years of the date of this ernut, ,
Date: �� / Approved by i � � �S
Town of Barnstable
��ptHE r � Regulatory Services
* Thomas F. Geiler, Director
BARNSTABLE,
y MASS. �o Public Health Division
�p 163,90. �0
iOlEn Mai°i Thomas McKean, Director
200 Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Installer & Designer Certification Form .
Date: I z z a
Designer: Oe_ C jc� �v i i�5 �u i„. (G'•S� Installer:
Address: C1 L L;__ ZaS--e L Address: 7 0_a
vzGy�
On JJOe,/; f�, 'A z was issued a permit to install a
(da e) (installer)
septic system at Np,.T/r,,s 47 l/S based on a design drawn by
(address)
teAl F, G�tr�r.,i t7i�, P, dated -2lj VO
(designer)T
I certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank.
I certify that the septic system referenced above was installed with major changes (i.e.
greater than 10' lateral relocation of the SAS or any vertical relocation of any component
of the septic system) but in accordance with State & Local Regulations. Plan revision or
certified as-built by designer to follow.
GLEN
ar� u ERIC
Installer's Signature) o HARRINGTON in
No.1070
IV Mk
( esigner's Signature) (Affix Designer's Stamp Here)'
PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE
OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH' THIS FORM AND AS-
BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.
THANK YOU.
Q:Health/Septic/Designer Certification Form
TOWN OF BARNSTABLE .
LOCATION `�� �,�/"Or 1�G4G Lt4�l/ SEW GE # 00,41 _094'
VILLAGE 1 �STa�_ !mil!/r ASSESSOR'S MAP & LOT D! 3-410
INSTALLER'S NAME&PHONE NO._JOseoy ye g JD$-420 738
SEPTIC TANK CAPACITY /Dag
LEACHING FACILITY: (type) 0 S"oa C 4WA-6 lrr5 (size) /3 X 2.s°—
NO. OF BEDROOMS
BUILDER OR OWNER
PERMITDATE: 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 facili ) Feet
Furnished by
C
� jgnMjh `Z�i �
S ,o l Dr��� 1
�1�a
i
Town of Barnstable -----� _
�OFtNE rpw� Re,gulatory�S,miceS :._.
Thomas F. Geiler,Director
- sixriSTnsLE,
MASS. m Public Health Division
s639. �0
�'''lFn►r►A °' Thomas McKean,Director
200 Main Street,Hyannis,MA 02601 .
t "
Office: 508-862-4644 Fax: 508-790-6304
Installer & Designer Certification Form
Date:, e ��
Designer: (ev, (r f1vL rt-i pi,tc i,, C& Installer: :-9;3-e- 4-c- f • L
Address: .C? Address: 7 �� i•� ` �i
4/1 6y—n s ,0 r d/J </11Y,
On 3 O e_ � f .4 t �w,.z�e_- was issued a permit to install.a
(da e) (installer)
���2F �V�� 1//41�AWE based on a design drawn by
septic system at 62,
/g(address)
( � L;�t�Zvi( G:cAAn' N4 wd dated �> c�C)
r (designer)
I certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank.
I certify that the septic system referenced above was installed with major changes (i.e.
greater than 10' lateral relocation of the SAS or any vertical relocation of any component
of the septic system)but in accordance with State & Local Regulations. Plan revision or
certified as-built by designer to follow.
)A OF h3
MENERIC
GN
�- (Installer's Signature) v HA.RRINGTQN v,
No.107�0g`'
All
f` /TA.
esigner's Signature) (Affix designer's Stamp Here),
PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE
OF COMPLIANCE WILL NOT. BE ISSUED UNTIL BOTH THIS FORM AND AS-
BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.
THANK YOU.
Q:Health/Septic/Designer Certification Form
T
COMMONWEALTH OF MASSACHUSETTS
W EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
C y. MAP
FAILED INSPECTION PARCEL I
LOT
TITLE 5
+OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 98 Cardinal Lane RECE'
Marstons Mills MA 02648 9 2004
Owner's Name: David Clifford
Owner's Address: Same OF
Date of 1 nspection: January 23,2004
TOWHEALB ABlE
H DEP7
Name of Inspector: PATRICK M.O'CONNELL
Company Name: SEPTIC INSPECTION SERVICES CO.
Mailint; Address: 189 CAMMETT ROAD
MARSTONS MILLS MA 02648
Telephone Number: 509-428-1779
CERTI FICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported
below i 3 true,accurate and complete as of the time of the inspection.The inspection was performed based on my
training F.nd 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: `01111111111111
IN OF
-- Passes �y��;,;" •. ����
Conditionally Passes O yG
Needs Further Evaluation by the Local Approving Authority RIC (n
rn
X Fails — :
IC L
Inspector's Signature: Date: _1/23/04_ , '"� .•Q,'�
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or����Im ill%%
DEP)m it hin 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.Tb;original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving
authority.
Notes and Comments: Leaching pit liquid level currently 2"below inlet pipe,has been full to top of structure.
****Tlii.,;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.
Title 5 Inspection Form 6/15/2000 page 1
Page 2 :)f 11
CoFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 98 Cardinal Lane,Marstons Mills
Owner: David Clifford
Date of Inspection:Janu23,2004
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. Sysf em Passes:
1 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.
Commelits:
B. Sys:fem 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.
Answea .yes,no or not determined(Y,N,ND)in the for the following statements.If"not determined"please
explain
Elie 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, :ank 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 exx Lain:
Observation of sewage backup or break out or high static water level in the distribution box due to broken or
obstruc x d pipe(s)or due to a broken,settled or uneven distribution box.System will pass inspection if(with
approval of Board of Health):
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
ND exFLtin:
The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will
pass ins pection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
ND exf l0n:
f
Page 3 if 11
OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL. SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 98 Cardinal Lane,Marstons Mills
Owner: David Clifford
Date of 1 nspection: January 23,2004
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
ristem is not functioning in a manner which will protect public health,safety and the environment:
Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the
system is functioning in a manner that protects the public health,safety and environment:
The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of
stir€ace water supply or tributary to a surface water supply.
The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply.
The system has a septic tank and SAS and the SAS is within 50.feet of a private water supply well.
The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a
private water supply well".Method used to determine distance
*"This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform
b icteria 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
ftiiiure criteria are triggered.A copy of the analysis must be attached to this form..
3. Other:
Page 4 )r 11
43FFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 98 Cardinal Lane,Marstons Mills
Owner: David Clifford
Date of 1 nspection: January 23,2004
D. System Failure Criteria applicable to all systems:
You mu,%t indicate"yes"or"no"to each of the following for,all inspections:
Yes lJ
_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 '/s 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
X_ 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.
_X:_ Any portion of a cesspool or privy is within a Zone I 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 forma
__Yes__(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. La rj;e Systems:
To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000
gpd•
You must indicate either"yes"or"no"to each of the following:
(The following criteria apply to large systems in addition-to the criteria above)
yes no
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"iii 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 shalt upgrade the system u1 accordance with 310 CMR
15.304.The system owner should contact the appropriate regional office of the Department.
A
f
Page 5 jf'11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL' SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address:98 cardinal Lane,Marstons Mills
Owner: David Clifford
Date of 1 nspection: January 23,2004
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
Were any of the system components pumped out in the previous two weeks?
_X_ __ Has the system received normal flows in the previous two week period?
Have large volumes of water been introduced to the system recently or as part of this inspection?
_X_ __ Were as built plans of the system obtained and examined?(if they were not available note as N/A)
_X_ ___ Was the facility or dwelling inspected for signs of sewage back up?
_X_ __ Was the site inspected for signs of break out?
X_ __ Were all system components,excluding the SAS,located on site?
_X _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the
condition i 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 Cis at issue approximation of
distance; is unacceptable)[310 CMR 15.302(3)(b)]
Page 6 jt'11
OFFICIAL INSPECTION FORM=NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Propert3 Address: 98 Cardinal Lane,Marstons Mills
Owner: David Clifford
Date of Inspection: January 23,2004
FLOW CONDITIONS
RESIDENTIAL
Numbe-of bedrooms(design): 3 Number of bedrooms(actual): 3
DESIG N flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms):330
Numbe•4 current residents:5
Does residence have a garbage grinder(yes or no): No
Is laundr y on a separate sewage system(yes or no):No [if yes separate inspection required]
Laundr*�system inspected(yes or no):
Seasonal use:(yes or.no):No
Water rao�ter readings,if available(last 2 years usage(gpd)): 2002-110,000 gal.2003.-103,000 gal.=291 gpd.
Sump pump(yes or no): No
Last da::e of occupancy: Currently Occupied
COMM&RCIALANDUSTRIAL
Type of establishment:
Design flow(based on 310 CMR 15.203): gpd
Basis o f 4esign flow(seats/persons/sgft,etc.):
Grease trap present(yes or no):_
Industrial waste holding tank present(yes or no):—
Non-sanitary waste discharged to the Title 5 system(yes or no):_
Water ranter readings,if available:
Last da::e of occupancy/use:
OTHE R(describe):
GENERAL INFORMATION
Pumping;Records: Last pumped 12/1/03
Source of information: Owner
Was syd-.m pumped as part of the inspection(yes or no): No
If yes,volume pumped: gallons--How was quantity pumped determined?
Reason f)r pumping:
TYPE OF SYSTEM
_X Sepi:ic tank,distribution box,soil absorption system
_Single cesspool
_Ov.-rflow cesspool
_Privn!
_Shar.-d system(yes or no)(if yes,attach previous inspection records, if any)
_Inn vative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be
obtaine 3 from system owner)
—Ti€,h t tank —Attach a copy of the DEP approval
_Other(describe):
Approx ir.iate age of all components,date installed(if known)and source of information:
Permit date: 12/28/94
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)
Propert3 Address: 98 Cardinal Lane,Marstons Mills
Owner: David Clifford
Date oi'I nspection: January 23,2004
BUILIN YG SEWER: X (locate on site plan)
Depth tie low grade: 1'
Materia h.of construction:_cast iron X_40 PVC other(explain):
Distance from private water supply well or suction line: 30'
Comments(on condition of joints,venting,evidence of leakage,etc.):
SEPTIC TANK: X (locate on site plan)
Depth below grade: 1011
Material of construction:—X concrete metal_fiberglass polyethylene
_other(explain)
If tank s metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of
certificau.).
Dimens ions: 8' long x 5.2'wide—1000 gal.
Sludge d,-pth: 0"
Distance from top of sludge to bottom of outlet tee or baffle: -
Scum thickness: 0"
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,A ere dimensions determined: STICK WITH HINGE FLAP.
Commc nts(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels
as relatod to outlet invert,evidence of leakage,etc.):
Tees intact and clear.Tank had been recently bumped,no scum or sludge built up.
i
GREA:3.E TRAP: No (locate on site plan)
Depth below grade:Material of construction:_concrete_metal_fiberglass_polyethylene_other
(explain):
Dimens ions:
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 List pumping:
Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels
as relato(I to outlet invert,evidence of leakage,etc.):
I
Page 8 if 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property-Address: 98 Cardinal Lane,Marstons Mills
Owner: David Clifford
Date of 1 nspection: January 23,2004
TIGHT or HOLDING TANK: No (tank must be pumped at time of inspection) (locate on site plan)
Depth he low grade:
Material of construction: concrete metal fiberglass_polyethylene__other(explain):
Dimens ions:
Capacity: gallons
Design Flow: gallons/day
Alarm present(yes or no):
Alarm level: Alarm in working order(yes or no):
Date of 1 ast pumping:
Comme r.ts(condition of alarm and float switches,etc.):
DISTR I BUTION BOX: X (if present must be opened) (locate on site plan)
Depth of liquid level above outlet invert: 0"
Comm rits(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.):
PUMP CHAMBER: No (locate on site plan)
Pumps iii working order(yes or no):
Alarms i a working order(yes or no):
Commc r:ts(note condition of pump chamber,condition of pumps and appurtenances,etc.):
0
Iva
Page 9 .31 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 98 Cardinal Lane,Marstons Mills
Owner: David Clifford
Date of']nspection: January 23,2004
SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required)
If SAS not located explain why:
Type
_X_leaching pits,number:One 6x6 pit
leaching chambers,number:
leaching galleries,number:
leaching trenches,number,length:
leaching fields,number,dimensions:
ov(rflow 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.): Liquid level in pit 2"below pipe at time of inspection,has been full to top of structure.Also observed
heavy staining on cover seam and a small amount of stained soil over cover.
CESSPOOLS: No (cesspool must be pumped as part of inspection) (locate on site plan)
Numbe- and configuration:
Depth-- :op of liquid to inlet invert:
Depth of solids layer:
Depth of scum layer:
Dimensions of cesspool:
Materials of construction:
Indication of groundwater inflow(yes or no):
Commcr is(note condition of soil,signs of hydraulic failure,level of ponding,condition.of vegetation,etc.):
PRIVY: No (locate on site plan)
Material::of construction:
Dimens inns:
Depth of solids:
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
i
Page 10 of I 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 98 Cardinal Lane,Marstons Mills
Owner; David Clifford
Date of Inspection: January 23,2004
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or
benchrr iirks.Locate all wells within 100 feet.Locate where public water supply enters the building.
Cardinal Lane
i
wls
i
i
Ak ox
160
' Ol:A
Page 11 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 98 Cardinal Lane,Marstons Mills
Owner: David Clifford
Date of Inspection: January 23,2004
SITE EXAM
Slope None
Surface water None
Check c ullar Dry
Shallow wells None
Estimated depth to ground water: More than 25 feet
Please ir.dicate(check)all methods used to determine the high ground water elevation:
Obtained from system design plans on record-if checked,date of design plan reviewed:
Observed site(abutting property/observation hole within 150 feet of SAS)
C iecked with local Board of Health-explain:
C iecked with local excavators,installers-(attach documentation)
_X_Accessed USGS database-explain: USGS topo map and G1S
You mu it describe how you established the high ground water elevation:
Town ground water map shows water below el.55.USGS map shows property above el. 100.
J
LOCATION / SEWAGE PERMIT NO.
7,;2- / Z- % L
VILLAGE
I N S T A LLER'S NAME a ADDRESS
7 7s--- l 3
B U I L D E R OR OWNER
DATE PERMIT IS UED
DATE COMPLIANCE ISSUED
7filf�le —
cf-
t
3s
a
No.----...... 21 s I1
._.. Fss... ........................
THE COMMONWEALTH OF MASSACHUSE17S
BOAR® OF HEALTH ' ` ;.
.......................OF.-...-...-.............................
Appliratiun for Disposal Works Tonstrnrtiun Vrrmit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
•• 4o.tion- ydd. es'
a
W •..... - ... - Ow- -----•---t� ' �----•-.......... &9 1 fl K0. aCl--iv.A re�....................
M Y
.. N�..........
Installer Address V Type of Building Size Lot..�Q,,,0 -----------Sq. feet
Dwelling—No. of Bedrooms...................... ....................Expansion Attic ( ) Garbage Grinder V/9
per, Other—Type of Building Smv+-..�.°._.rRMt y- No. of persons............................ Showers (/ ) — Cafeteria ( )
Other fixtures ............................
W Design Flow...........11_(,________________________gallons per person per11day. Total daily flow...........
----------
_..gallons.
WSeptic Tank—Liquid capacity.l40.6 .gallons Length............. Width................ Diameter................ Depth................
x Disposal Trench—I�o. ..e ............ Widt_Y�.,,......_._.. Total Length.................... Total leaching area....... : w _sq. ft.
Seepage Pit No-------_/----------- Diameter.........._......... Depth below inlet...-----.__......._ Total leaching area........�__....sq. ft.
z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed b -_.._ ....... Date... A.�_-3 8
Test Pit No. 1...A..........minutes per inch Depth of Test Pit..f�`�_,,....... Depth to ground water--- /5/f/
Lz, Test Pit No. 2.... .......minutes per inch Depth of Test Pit../.y�.......... Depth to ground water.-,A.
T.�
F._ . �____________ _ Of___...j_..__........_.._.__._______....__.._ __....------___.........._.._. �c �6 ...._.____.
f�
Description of Soil•---- 3 SH/s!Dy....... .... � o/�-- (�
U ....... /1...- �-------
------ -
VW --------------------�-------- I---Y..........................................................�. --------------------------------------------...------•-•-..
Nature of Repairs or Alterations—Answer when applicable...............................................................................................
.----•-------------------•----.....-•-------------------•----------•--------------•---------.....----•-•-•------------------------------••--------•-••••.f='......-................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Sanitary —The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has be)4sued by t / as d Qf ealth._
igned-- ------ .... f-,�
....• •. ----.....
Dat
Application Approved BY• •--_. • . . .................................... � ...........
Date
Application Disapproved for the following reasons:----•--------------------------•-----------------------------------------------------------------•---•------.._
.--•-------•-----•-------------------------------- ----------••--------------••-•----------••• -•---------•-----------••---
�� Date
PermitNo........... ---........ Issued---------------------------•-----••---••--•---••--•----
Date
w
r ,
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH L+�
:.... .............. ... .............OF.....................--........._..__...
Appliration for Ditipos al Workii Tonotratrtiun Frranit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
................................................................................................... •-••-...._.....................••-•-•-•-•••--•-•-••-•--•-•----•--••------...--•-••._....-•-----•--
Location-Address or Lot No.
OwnerAddress
a ........................•---==`.'----------.......--------------4-r "� --•---•----.....
Installer Address
Type of Building Size Lot............................Sq. feet
.-� Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
a Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
Other fixtures
W Design Flow............................................gallons per person per day. Total daily flow____________-_____________..................gallons.
WSeptic Tank—Liquid*capacity............gallons Length................ Width................ Diameter................ Depth................
Disposal Trench—No_____________________ Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No_ ___________________ Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
W -
Test Pit No. 1......... .....minutes per inch Depth of Test Pit____________________ Depth to ground water........................
44 ',,.,Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
=; -...................................................................................................................................................
Description of Soil.................O '
x =-----------------------------------------------------•------------------------------------------------------------------------•-••--•-.....-•-----•••-
V ---------------------- •---•----------•--------------------•-----------------.._..-----•--....----------------------------------r;...--:-----------------..---------------------------...•••----•--------
W
U Nature of Repairs or Alterations—Answer when applicable-----_---------------
--------------------•----------------------------------------------------------•-------......---------......-----------------------------------•-_.._-----•--•-----•-•--•-••-••-•-••---•-•-.....__••-•-
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE4 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
igned................... ............................................................... •-_---- --••--••-•__-•---------
Da
Application Approved By..... .____ _ -.-__ ...........
Date
Application Disapproved for the following reasons:................................................................................................................
-----------------•---------------••-••--...__....-•---•-•- -•--•--•-•--------•-•------•------------•--
Date
PermitNo................................................... Issued.......................................................
Date
a i
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH 4
..........................................OF....................................'it
,.................................................
�rr�i�irtt#�e oaf f�nnt�rliaanrr
THIS IS TO CERTIFY, That the vidu Sewage Disposal System constructed ( ) or Repaired ( )
by-------••--••- ------------•----•------ ....=-•--•••--•-•••-._...-- _•-- --------- ----••-...:: __---•----•----•--••-••-•---...........
r
Install �y
has been installed in accordance with the provisions of TITLE ` of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No._.______�__.�'"...5_:;L_y__. dated................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CO TRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE. - ..._.... ........................................ Inspector__... •-•- -------•-----------
THE COMMONWEALTH OF MASSACHUSETTS ;&
J BOARD OF HEALTH?
r
...............O F.............-......._. d
No. ........................ FEE........................
Rapos al Works TowAr wu rranit
Permissioni eby granted.................. ................ _ ••. ----•---•-•••--•••--••-•--•..._...•-••----•--------.-.--------••-•-•-....._.._..__---•--_..
to Construct Repair ( ) a .Individual-Sewage Dp'posal Systeru�
atNo. --- - S------- ---- ! f�1 +-----------------------------------------------
Street
as shown on the application for Disposal Works Construction Per i No..............
___-4 Dated..........................................
••••••--••...-•-•-••_....a. _.._. .
J�r� -----
of Health
DATE.. .........................._.........
FORM 1255 A. M. SULKIN, INC., BOSTON
4
"MARSTONS MILLS" N
N SITE PLAN Design Calculations
SCALE: 1"=20' 1 7'
Number of Bedrooms: 3
BENCH MARK ON Top OF c.B. FND. Garbage Grinder: NO, GRINDER NOT ALLOWED WITH THIS DESIGN
ELLV.-100.00' (ASSUMED) Leaching Capacity Required: 330 Gat./Day
Leaching Area Required: 330 Gal./(0.74 Gal./Sq.Ft.)=446 Sq.Ft.
<T i'roposeL Leaching Structure: 1-25'L X 13'W X 2'D Leaching Trench ice sh
t.
Proposed eaching Area qF Leaching Capacity. 3539P d > 330 9Pd. re 'd. g � I
Pon
s + LOT 72 P
-o
AREA 20,000t SO-FT. �6�,4 �
gP,itiq� a ke b
LOCUS
NO SCALE
2 GENERAL T.H. /2 SHED, 107.19 IOG34'
a, 1. ADDRESS: #98 CARDINAL LANE
+ 2. ASSESSORS NUMBER: MAP 013 PARCEL 010
107.36' 3. DEVELOPER'S LOT: LOT 72
~ 4. TOPOGRAPHIC INFORMATION WAS COMPILED FROM AN
X ' 4' 1-25' X 13'W X 2.0' D ON THE GROUND INSTRUMENT SURVEY.
� leach ngg trench using 1o7.eo'
2 H 10 Ten gal. chambers with 5. TOWN WATER do WELL WATER IS PROVIDED TO SITE do SURROUNDING PROPERTIES.
4' stone on sides do ends. 6. RRE��RENCE r "S e p s osal S s{e For Lot 72, Cardi al Lan ,
Mars c Flills, Barns a 9�, Ni�.p preps ed for Home Creations,�nc. da ed May 3, 1984,
10&4
�. ', 0 DECK by Charles L. Rowley do Assoc.
O 8 m 6' 7. NO WETLANDS ARE LOCATED WITHIN 100 FEET OF SAS.
T.H. #1 V 8. NO POTABLE WELLS ARE LOCATED WITHIN 150 FEET OF SAS.
. 10114' CONSTRUCTION NOTES
N 0 1. Contractor is responsible for Digsofe notification
v and protection of all underground utilities and pipes.
2. The septic"tank onj distribution box shall be set
O ,gyp e eo level on 6 of 3/4 -11/2 stone.
'e 3. Backfill should be clean sand or gravel with no
a stones over 3" in size.
ofjfya°�a 4. This system is subject to inspection during installation
by Glen E. Harrington, R.S.
°I►, �p 5. The contractor shall install this system in accordance
with Title V of the Massachusetts Environmental Code
and the Regulations of the Town of Barnstable.
6. Provide an Acme Precast H-10 5-hole D-Box and
fO� 2 H-10 500 gal. chambers or equal.
ec 7. No vehicle or heavy machinery shall drive over the
SOIL TESTS °° �`o' e'� septic system unless noted as H-20 septic components.
N Q 8. in-tall gcs ✓cffiC; cr equal an i;jJ ta; t nk -uti:.t tc C; `nd
Date of Soil Test.: April 26, 1984ep e° 9. All existing inverts and site conditions shall be verified by contractor.
Test Performed By. Charles L. Rowley, P.E. do Assoc. 6 10. Existing leach pit to be pumped and backfilled.
P3237 r)R�6 ��p
Test Hole Test Hole 00 10329 101.19'
No. 1 No. 1
TH SOILS ELEV. DEP SOILS ELEV.
o� \ 1-ao•owe Acass MASHW
0 108 0 107.2'
8' wood lown 07.5' 8' 08.7' 100.02'
sandy sandy
38• Mer 105 38" silly, Jed 104.2'
sandy sandy
60' •O M 103 84' 01.8 +
/'eland stones and ndee +8 O 0 O O 24. 134"
to 2• tar ca �,� B.. THE SSA ION AND CERTIFY IN RffoSTEEL REINFORCED PRECAST CONCRETE
f!V.�T;^€ ; rp IN PLAN VIEW 2 H-10 500 gal. chambers
NO GROUNDWATER EN(XWNTEREo ACCuRuA ICE T►Ap PLAN. TRH' END-SECTION
USE PERK RATE C2 Min FOR DESIGN PURPOSES
H-10 500 GALLON CHP�MBER
NOT TO SCALE
USE ACME PRECAST OR EQUAL
�_1NOFMgS PROPOSED SEPTIC SYSTEM UPGRADE
PREPARED FOR
N
R T DAVID CLIFFORD
1070 AT
LEGEND F-ISIT #98 CARDINAL LANE
Existing Dwelling Sq/��T A F;�P
10' min. from NOTE: ALL PIPES ARE TO BE 4' DID. SCHEDULE 40 P.V.C. 1 EXISTING LEACH PIT BARNSTABLE (MARSTONS MILLS), MA
house to septic tank *NOTE: INSTALL GAS BAFFLE OR EQUAL ON SEPTIC TANK OUTLET TEE.
cellar ;";T R must�rae`e Finishedoverarod• ► wAtem-2X al" away PREPARED BY:
wall I HOLE °°10" pT1�00,GAL
K GLEN E. HARRINGTON, R.S.
p ]f q6T. BOX Edetlsl Grade ENv�107 t O O O
D- ox oow must be min. r-1/a"-'/z' 1 chamber care,mast 9 LE DA ROSE LANE
wMiN, of N.hed Nlmde double washed.tone „ , e• nnNeh.d grade :� x 104.46 DENOTES EXISTING MARSTONS MILLS, M A 02648
Level roe r -104'
}` 1 EXISTING 11,130OG 3.43' 95 EXISTING CONTOUR
• SEPTIC TANK 13 L TEL: _ _3862
H_10 ea o 00 0 2`�"" Ten ev.� .43' O FAX: 508-428-3862
LEACH TRENCH e.r PRONGED(W*M94 RECAARM) EXISTING WATERLINE
s e•OF 31,C-11/2'STONE s " BOTTOM OF T.H. #2 EL.=95.2' -6---�- APPROX. LOCATION GAS LINESCALE: 1 "=20' DRAWN BY: GEH FEB. 18, 2004
EXISTINSYSTEM PROFILE 6'OF 3/e-11/2.STOW .ADJUSTED GW ELEV.-51't PER USGS MAPS
Not to Scale DATUM: ASSUMED FILE: CLIFFORD SHEET 1 OF 1
Foundation
Cem. Conc. Cover to Grade
Cem. Conc. Cover to Grade
INV EL.
min. INV. EL. I EL. IN . EL. _�- :yam11
p 21 +---- 1 -. �. I min.
911 1/ 8 to I/2
If I — I g_ 83 L - WashedCrushed Stone I �e'7 l-••I0LS 2
S= 1/8 / I min. -�. 4 0 PVC
2 2„ - -
- - - - - --- - - IN
I a
INV. EL. fi' _ �_ EL �9 Ca
�2 S - I/8 "/ I' min 5FL-. 02- Cp
j 17 a I,
it
L_ _ �� —
6 ump
•;
PVC Schedule 40 5 - 0 let
DY S I�.T--K S dtJ L)
t Pipe 8 Tees Di . Box r � � S0IL. Su65c>iL.
N
I: N
oT REQ FL)
5 Eff . Depth 3Co
--- 3/4" to I I/2
D Y G'1 r1�V E L
Washed Crushed' oIt
Stone - --- -
tZ S E
IO'min. g ' 6 _6„ ; 2 SdN SL5.t�►
i
i 20 ' min.
1000 ga 1. Precast Septic Tank Precast Conc Leac.r.ing Pit
SEWAGE DISPOSAL PROFILE WC-L+ ../G L-L 1
.vGl t. N T. 5 44' _ i 44 -
_� so' sue' �O WL\,T G 2 � C/-�)U N T e Zr- C)
LOT 40 �7 39 e�> L-C)
i }
Design Calculations as required by Title 5 of the State Environmental Code
2
102- Zc5t12vE) ) 1 _ ,N �s Design for ?' Bedroom House Use I I goIs ' bedroom
FLOW J Bdrms x 10 gal / bedroom = `.'JO gal required
sue , -Ed-'14 '-`��T SEPTIC TANK x 'V' gals. = �-9S . gals. Use IOOOga► Tank
1 GY> N 0 \ � i01
p �. �i� LEACHING AREA Perc Rate 2 min/ in.
I Bottom Area: ;
O gal /s f. x 8.co s f - .B.CLO. . gal
J J� J \
I
` .L�11J-( 7� °�, � \ \ � !o' � � Sidewall Area 2-5 gal . /s.f x ; CGS sF. = . .gal .
Total flow capacity =
� � Y - �-�8. . gal. provided
D�-eLL . _ .- Use 1 6 -6 dia. liner with ... ... effective depth and ... 2.. . of
LEI - 40 ` crushed stone erc of de ate l
. hole ..��. -:'.. deep.. o D f test
i -_ z0000 sQ•F_r. LOT ooDt� �orJa.� 2�c v►t2E�nch.1T:� F .�� o��rJ vF -,vtz Td3
y G3 �� _ �. SEWAGE DISPOSAL SYSTEM FOR LOT -?2
w ;-
v TAP OF
GL�2DINL�,L_
--
Vti
T 7 ,
i=L.t- SOFT ON 4-rUe.�T
S --S _ - -
L_G�7 -1
a SCALE E A NOTED _-__- I W.0. 131t--S I
OT -1 � i._C-DT � � , Date «. �34 FOLIO NO. -72z. .
EiAPTY L.aT f Drawn By ---- ----- P'_ AN NO. SD-zZ
CHARLES L . ROWLEY ASSOCIATES
P � PLAN
� ! � :' �,���� CIVIL EtiGI �! EER`z 8 SURVEYOR
Scale -40' + ' w, .. WEST WA-tEHAM , MASS . r