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0205 BLACKTHORN ROAD - Health
205 Blackthorn Road Marstons Mills l A = 047 010001 r P" Message Page 1 of 3 McKean, Thomas From: McKean, Thomas Sent: Friday, April 12, 2013 10:39 AM To: 'Matt Eaton' Cc: mgardner23@aol.com; dnunheimer@me.com; 'Darci Gervais'; 'jcaprio@oldecaperealty.com' Subject: RE: heating repairs Good Morning, No, I wasn't aware of this information. Health Inspector James Parziale is absent today; he was the health inspector who was originally assigned to this matter. I noticed that the tenant was not copied on your e-mail. This information will be printed-out and placed into the file regarding this matter, available as part of the public record. Sincerely, Thomas McKean -----Original Message----- From: Matt Eaton [mailto:cccomfortsolutions@comcast.net] Sent: Friday, April 12, 2013 10:08 AM To: McKean, Thomas Cc: mgardner23@aol.com; dnunheimer@me.com; 'Darci Gervais' Subject: RE: heating repairs Good Morning-Mr. McKean Just wanted you to be aware that I have contacted Mr. Caprio by phone,text and email regarding getting into the home this morning to take a look at the heating system and have not heard back from him. Also I wanted to you to be aware that we were out to the house on 4/5 to take care of the repairs that were necessary to get the heat up and running.Also of note,when we arrived to the house that day,the heat was functional. Since those repairs were made,the tenant has had his own HVAC contractor out to look at the furnace and the tenant revealed to me that his contractor had "pulled apart" the entire furnace and the entire furnace needed to be replaced.As to my knowledge,the tenant had not been given prior approval to have any outside contractor come in and pull apart the heating system.I was also out to the home on 4/10 and replaced the furnace control board and when I left the home the heat was fully operational after being manually cycled on and off 8-10 times to try and duplicate what the tenant is describing. My concern is one,whether you were aware that we have responded to the initial complaint and two that we have been out twice and we have had another contractor that has been in and done work without the owners approval and without explanation as to their findings other than the furnace needs to be replaced.Please do not hesitate to call or email me regarding this matter and I will continue to try and get access to the home to check out the heat once again. Thank you very much for your time in this matter and I look forward to resolving this issue very soon. Best Regards, Matt Eaton Owner: Cape Cod Comfort Solutions,LLC Office: 508.771.0365 Mobile: 508.815.9121 Fax: 508.771.0525 4/12/2013 Message Page 2 of 3 MA Master Sheet Metal License#1204 NATE Certification#5205397 Email: cccomfortsolutions(a,comcast.net Web: www.cccomfortsolutions.com „comfort... your way!" From: McKean, Thomas [mailto:Thomas.McKean@town.barnstable.ma.us] Sent: Friday, April 12, 2013 8:38 AM To: Jesse Caprio; mgardner23@aol.com Cc: Matt Eaton; Parziale, Jim; Christopher Kirrane; Wadlington, Ellen Subject: RE: heating repairs Good Morning, I attempted to contact the owner(s) by telephone this morning, leaving a message on their answering machine. I am awaiting a phone call back and action by the owners of this property immediately. Failure to comply with an order of the Board of Health may result in the issuance of non-criminal ticket citations. Each day's failure to comply with an order shall constitute as a separate violation. Sincerely, Thomas McKean Director of Public Health -----Original Message----- From: Jesse Caprio rmailto:icaprio@oldecaperealty.com] Sent: Wednesday, April 10, 2013 6:07 AM To: mgardner23@aol.com Cc: Matt Eaton; Parziale, Jim; McKean,Thomas; Christopher Kirrane Subject: RE: heating repairs Melinda, Enclosed is another video with better sound. As you can hear, the heating unit is still not operable. Thank you, Jesse Jesse Caprio REALTOR13 Principal/Broker Olde Cape Realty, Inc. PO Box 857 Osterville, MA 02655 Telephone: 508-420-7900 x 13 Toll Free: 877-682-3200 x 13 4/12/2013 ' Message Page 3 of 3 Mobile: 508-509-9157 Facsimile: 508-420-7327 icavio@oldecaperealtv.com www.OldeCaoeRealty.com This email and any,fa.les transmitted within are confidential and intended solely for the use of the individual or entity to whom they are addressed. If you have received this email in error please notify the.system manager at The Olde Cape Companies at (877) 682-3200 and delete this email immediately. If you are not the intended recipient you are notified that disclosing, copying, distributing or taking any action in reliance on the contents of'this information is strictly prohibited. **Note: This correspondence may not be forwarded or a copy given to another party without the express permission of the sender.** From: mgardner23@aol.com fmailto:mgardner23@aol.com1 Sent: Tuesday, April 09, 2013 10:53 AM To: icaorio@oldecaperealty.com Subject: heating repairs Hi Jesse, I'm attaching the invoice for the heating repairs that were completed on Friday as well as some photos of the repairs. Melinda 4/12/2013 • W. • • o Cbmplpte items 1,2,and'3.Also complete A. Signature �— item 4 if Restricted Delivery is desired. to Print your name and address on the reverse., ss so that we can return the card to you. g;; iv ;by(P' t Name) Dat of Delivery to Attach this card to the back of the mailpiece, or on the front if space permits. s delivery address different m item 17 13 Yes 1. Article Addressed to: �, aa ;j enter delivery address below: ❑No r Melinda &David Gardner 2210 Seven Oaks Dr. Kingwood, TX 77339 3. service Type 3 Q11 Certified Mail ❑Express Mail ❑Registered ❑Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. of 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number. I: : 7 012 1010 0000 284 3 2 4 61 : (Transfer from service label) I Ps Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 UNITED STATES'POsfXL SERVICE First-Class Mail ram, Postage&Fees Paid uses Permit No.G-10 • S fender:Please prA your name, address, and ZIP+4 in this box • ` Town of Barnstable c''ublic Health Division 200 Main Street Hyannis,MA 02601 i 'ii ;1 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 205 Blackthorn Rd. - a Property Address David Gardner Owner Owner's Name information is required for every Marstons Mills ma 02648 3-23-13 page. City/Town - State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, use only the tab 1. Inspector: �I Key to move your cursor-do not Matthew Gilfoy.. use the return key. Name of Inspector B & B Excavation Inc. ps r� Company Name 14 Teaberry Lane Company Address Forestdale MA 02644 City/Town State Zip Code 508-477-0653 S113640 Telephone Number License Number B. Certification I certify that I have personally inspected d 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: N Passes ❑ Conditionally Passes ❑ Fails El Needs Further Evaluation by the Local:Approving.Authority . 3 - 23 - 13 Inspect is 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. t5ins•11/10: Title 5 fficia spection Form:Subsurface Sewage Disposal System•Page 1 of 17 t Commonwealth of Massachusetts W Title 5 Official Inspection Form " Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 205 Blackthorn Rd. Property Address David Gardner Owner Owner's Name information is required for every Marstons Mills ma 02648 3-23-13 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: System in good working condition at time of inspection. 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): t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts W Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 205 Blackthorn Rd. Property Address David Gardner Owner Owner's Name information is required for every Marstons Mills ma 02648 3-23-13 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 r Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 205 Blackthorn Rd. Property Address David Gardner Owner Owner's Name information is required for every Marstons Mills ma 02648 3-23-13 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No" to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ®I Liquid depth in cesspool is less than 6" below invert or available volume is less than Y day flow t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 205 Blackthorn Rd. Property Address David Gardner Owner Owner's Name information is required for every Marstons Mills ma 02648 3-23-13 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts W Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 51 205 Blackthorn Rd. 1M Property Address David Gardner Owner Owner's Name information is required for every . Marstons Mills ma 02648 3-23-13 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done..You must indicate"yes" or"no" as to each of the following: Yes No EJ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ E 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 El 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) 330 t5ins•11/10.:: Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 205 Blackthorn Rd. Property Address David Gardner Owner Owner's Name information is required for every Marstons Mills ma 02648 3-23-13 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 4 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: 2011-364 gpd 2012-550 gpd Sump pump? ❑ Yes ® No Last date of occupancy: currentDate Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts W Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 205 Blackthorn Rd. Property Address David Gardner Owner Owner's Name information is required for every Marstons Mills ma 02648 3-23-13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ❑ No If yes, volume pumped: 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): t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 official Inspection Form - Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 205 Blackthorn Rd. Property Address David Gardner Owner Owner's Name information is required for every Marstons Mills ma 02648 3-23-13 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: 2005 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 12"feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: >20feet Comments (on condition of joints, venting, evidence of leakage, etc.): At time of inspection building sewer appeared to be in working order no sign of leakage or blockage. Septic Tank(locate on site plan): 6" 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: 1000 gal Sludge depth: 5" t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 205 Blackthorn Rd. Property Address David Gardner Owner Owner's Name information is required for every Marstons Mills ma 02648 3-23-13 page. Cityrrown 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 25 Scum thickness 2" 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 15" How were dimensions determined? scour stick Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): At time of inspection septic tank appears to be structurally sound. No sign of back-up. Tank should be pumped for maintenance. 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection dorm Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° M 205 Blackthorn Rd. Property Address David Gardner Owner Owner's Name information is required for every Marstons Mills ma 02648 3-23-13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth, of Massachusetts W Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 205 Blackthorn Rd. Property Address David Gardner Owner Owner's Name information is required for every Marstons Mills ma 02648 3-23-13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 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 appears to be in good condition. 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.): Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts W Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 205 Blackthorn Rd. Property Address David Gardner Owner Owner's Name information is Marstons Mills ma 02648 3-23-13 required for every page. City/Town State Zip Code Date of Inspection D. System Information (coat.) Type: ❑ leaching pits number: ® leaching chambers number: 2 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): At time of inspection leaching appears to be in working condition. No sign of hydraulic failure. 12'x25'x2' leaching size 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-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 205 Blackthorn Rd. Property Address David Gardner Owner Owner's Name information is required for every Marstons Mills ma 02648 3-23-13 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-1 Ill 0 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts W Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 205 Blackthorn Rd. Property Address David Gardner Owner Owner's Name information is required for every Marstons Mills ma 02648 3-23-13 page. Cityrrown 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 A r A (� A zq' AZ. 3C4, Aq 6� As" (3 - 36' az- '35' 0 Q3 " (A' b 9. I l I I I i t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 205 Blackthorn Rd. Property Address David Gardner Owner Owner's Name information is required for every Marstons Mills ma 02648 3-23-13 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: >12' 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: 4/30/03 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: Taken from design plan Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11/10 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 205 Blackthorn Rd. Property Address David Gardner Owner Owner's Name information is required for every Marstons Mills ma 02648 3-23-13 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 �� , TOWN OF BARNSTABLE �\ BOARD OF HEALTH ARTICLE IL MINIMUM STANDARDS FOR HUMAN HABITATION Date 5 f q IZ Time: In Out Owner 4gaj Lhgk 04mo ck Tenant Address Z.Zto 5L.—J \� 0A�5 Address ZO5 "F-)LAcK-rHoem �n INC-,c�c�y X, imiqQSTorJ6 M%LA-5: MA Compliance Remarks or Regulation# Yes NO Recommendations 2. Kitchen Facilities V/ 3. Bathroom Facilities V/ �t 4. Water Supply 5. Hot Water Facilities 6. Heating Facilities 7. Lighting and Electrical Facilities J 8. Ventilation J 9. Installation and Maintenance of Facilities 10. Curtailment of Service 11. Space and Use 12. Exits 13. Installation and Maintenance of Structural Elements 14. Insects and Rodents 15. Garbage and Rubbish Storage and Disposal 16. Sewage Disposal 17.Temporary Housing 18. Driveway Width 19. Number of Tenants Observed I PART II 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition Number of Bedrooms 3 Number o7Ve Tesled (max) Number of Persons Allowed (max) Person(s) Interviewed lott�-A Inspector If Public Building such as Store or Hotel/Motel specify here • f � ti TOWN OF BARNSTABLE BOARD OF HEALTH c ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION Date 1 ( Time: In Out Owner %U 08-A DW o GAf?.-Dtj Tenant \.)AC N Address-1,21 94M DA K-S ��+_ Address g.9M- AUACKT1 , AM `�• Compliance Remarks or Regulation# Yes NO Recommendations 2. Kitchen Facilities 3. Bathroom Facilities 4. Water Supply 5. Hot Water Facilities 6. Heating Facilities f/US ELT 7. Lighting and Electrical Facilities 8. Ventilation / 9. Installation and Maintenance of Facilities V 10. Curtailment of Service 11. Space and Use ✓ - 12. Exits 13. Installation and Maintenance of Structural / Elements v 14. Insects and Rodents 15. Garbage and Rubbish Storage and Disposal 16. Sewage Disposal 17.Temporary Housing 18. Driveway Width 5Q I _r 19. Number of Tenants Observed PART II 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition Number of Bedrooms 3 Number of Vehicles Allo ) Number of Persons Allowed (max) 5 Person(s) Interviewed OWN Ef'- 9ECP Inspector If Public Building such as Store or Hotel/Motel specify here � TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION Date -7" 1�-/v Time: In Out Ownerftk-� ^ Tenant Address 9-�(o © r'/,J Address d 00 Complia a Remarks or Regulation# Yes NO Recommendations 2. Kitchen Facilities 3. Bathroom Facilities �ppmvea" '"a ^- . 4. Water Supply 5. Hot Water Facilities 6. Heating Facilities 7. Lighting and Electrical Facilities 8. Ventilation 9. Installation and Maintenance of Facilities 10. Curtailment of Service 11. Space and Use 12. Exits 13. Installation and Maintenance of Structural Elements 14. Insects and Rodents 15. Garbage and Rubbish Storage and Disposal 16. Sewage Disposal b - 3� 17.Temporary Housing 18. Driveway Width 19. Number of Tenants Observed 3 ^ c{p� ( 50 rW Y PART II 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolifon Number of Bedrooms Number of Vehicles Allowed (max) Number of Persons Allowed (max) Person(s) Interviewed Inspector If Public Building such as Store or Hotel/Motel specify here I TOWN OF BARNSTABLE �L p LOCATION Z,c 6 SL:Aei477Wo)� 1W SEWAGE # 7,00 VILLAGE A'/, ASSESSOR'S MAP & LOT q:2-10 01 INSTALLER'S NAME&PHONE NO. PA514I�6 Z6 110-70: �3 SEPTIC TANK CAPACITY f��O 6 LEACHING FACILITY: (type). .-Z CNA t" (size) jZA 7f NO. OF BEDROOMS BUILDER OR OWNER i 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 facility) Feet Furnished by i At A3 � �� 1 � 3a Z "135 ,hw Cif iiA� Page. CERTIFICATE OF ANALYSIS 1 rrgl Barnstable County Health Laboratory ' � .: Report Prepared For: Report Dated: 6/I0/2003 NN 11 Order Num er• 1 UG031q99Y,,nn 03 Cynthia Brewster TOWN OFHEAL B RNSDEPTABLE 205 Blackthorn Road _ � h Marston Mills, MA 02648 Laboratory ID#: 0319971-01 Description: Water-Drinking Water Sample#: 19971 Sampling Location: 205 Blackthorn Rd Marstons Mills MA Collected 5/29/2003 Collected by: Cynthia Brew Received 5/29/2003 Routine ITEM RESULT UNITS MCL Method# Tested LAB: IC Lab Nitrates 2.4 mg/L 10 EPA 300.0 5/30/2003 LAB: Metals Copper 0.1 mg/L 1.3 SM 3111B 6/3/2003 Iron <0.1 mg/L 0.3 SM 3111B 6/3/2003 Sodium 16 mg/L 20 SM 3111B 6/3/2003 LAB: Microbiology Total Coliform Absent P/A Absent P/A 5/28/2003 LAB: Physical Chemistry Conductance 138 umohs/cm EPA 120.1 5/29/2003 pH 6.4 pH-units EPA 150.1 5/29/2003 Note: Water sample meets the recommended limits for drinking water of all above tested parameters. Approved By• / (Lab Director) o Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605 TOWN OF BARNSTABLE �L Ai 10N Z a J ,c3LALV4079 1W, SEWAGE # ifti law 11 'ILL Pt��� [ AGE Alf, /L1/1' ASSESSOR'S MAP &LOT INSTALLER'S NAME&PHONE NO. �r 70Z 2j. WAS SEPTIC TANK CAPACITY 16Z 0 6 z' LEACHING FACILITY: (type) _Z GWA1�48G;(L (size) 17-A 7f i NO.OF BEDROOMS BUILDER OR OWNER A PERMITDATE: COMPLIANCE DATE: /5 0 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 �3 .61, 119 Li I 3a z -ems R 3- 60 TOWN OF.BARNSTA.BLE L:00%.TION C.Ckv� SEWAGE # Z=3 ',J.LLAGE NNCSc'skYNs M,\\S ASSESSOR'S MAP & INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY ,,b co Go.\ LEACHING FACII.ITY: (type) (size) kp-14�4-AS 7(2' NO.OF BEDROOMS 3 BUILDER OR OWNERS PERMTTDATE: [03 COMPLIANCE DATE: S 1 03 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility g't 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 Lea Facility(If any wetlan xist I within 300 feet of lea hin facility) N Feet Furnished by A M t/v ,4,5 &5 10 g1 � 3c� z � r� �- do i No. /16 A- FEE (5,) " Board of Health, MA. APPLICATION FOP, DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) - ❑Complete System ❑Individual Components Location nomM,W.IN5, Owner's Name Map/Parcel#• -- Ott, _ c�nl Address Zps Lot# 46 ` Telephone# Installer's Name Designer's Name n Address Address 1,b ox , i Telephone# 20 0 Telephone# 5c)8'CS4 Type of Building +,a ��[�"'C�(1\ Lot Size 4(e,s� 6(n sq.ft. Dwelling-No.of Bedrooms -vVic-'ec C'3�) Garbage grinder (A A Other-Type of Building T-l Ong— No.of persons 4 Showers (vj Cafeteria (V� Other Fixtures `\ Le,tjC A=5!6, `,_Zs1l t Design Flow (min.required) ?> d Calculated design flow Design flow provided 3� S gpd Plan: Date 4A e6o,0 3 Number of sheets I Revision Date —" 1 Title Description of Soil(s) '3?lC 4%1 Soil Evaluator Form No. Name of Soil Evaluator Date of Evaluation 4 1IR0 3 DESCRIPTION OF REPAIRS OR ALTERATIONS -��Or, The undersigned agrees to inst a above 'bed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agree of to pl., system in ope on un' a Certificate of Compliance has been issued by the Board of Health. Signed '� Date_ o Tons /C. l �� ,No. ., -_Board of Health, MA. r APPLICATION FOP, DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) - ❑Complete System, E Individual Components Location Owner's Name t _0 S '"�tcc� c:c t� t� M • 1�� hn F C,c,-Kn,c ce•w.Sc' Map/Parcel# "� -- (� (._ _ 1 Address ZCS f �S C� c Me Lot# 4- , Telephone# Installer's Name �R 'P'v. Designer's Name Address 2 �le / �+ Address _Z)O ✓a-4 T. ►a Telephone# (�� ?o J Telephone# cs_Sy _p-49(, S3v Type of Building (-A-i rX Lot Size 46,5`J' (- sq.ft. Dwelling.-No.of Bedrooms A" C'�.�- � - Garbage grinder (4 v) Other-Type of Building oc,,e No.of persons Showers (V<Cafeteria (r' Other Fixtures Design Flow(min.required) 3�d gpd Calculated design fl,w '2) Design flow provided gpd Plan: Date 4` ''�c) 0 3 Number of sheets R — evi �sion Date yl Title e t�C� 1+ QV'',UC�GC..QCS�? JJtSPQSG\ Description of Soil(s) �k Cd', r 1 x ! Soil Evaluator Form No. Name of Soil Evaluator � emon ��Date of Evaluation � 4 3 DESCRIPTION OF REPAIRS OR ALTERATIONS \C� The undersigned agrees to install the above desc 'bed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and � , further agreesto/not to place a system in operation until a Certificate of Compliance has been issued by the Board of Health. Signed �/ �. Date ._ _S -I ectionfAla- VG �p V \\ 4 �,...:�,._�<+ti�zc �_.:,.>>«-u.-��..�r.....;v....,..:,., -.:.. _.,,.�.--.. .-. ::.- -_'�.-.a.:rw -.-:-�.,'--�-: _ ..--=�..��:-•e=:.,._..__x. —>-�c-�.,..__.c._�.. .�r.:;2-.b..r•r,:�.:..� .�--.,.,-.. .-.a`.S:__.:...-:..c._-�'`�:�. -- No. FEE COMMONWEALT14 ®F MASSACHUS ETTS Board of Health, MA. e.,,�CIRTIFICATE OF COMPLIANCE Description of Work: ❑Individual Cornponent(s) ❑Complete System The undersigned hereby certify that the Sewage Disposal System; Constructed ( ),Repaired ( ),Upgraded ( ),Abandoned ( ) by at has been installed in accordant/ce with the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No. A)�-I,- dated Approved Design Flow (gpd) r r� Installer Designer: Inspector: Date: V'-."..'f r w ,�r The issuance of this permit shall not be construed as a guarant4 that the system will function as designed. ` No. 1 �_.J� FEE COMMONWEALTROFMASSACHUSETTS �O Board of Health, PAN fi 17 , MA. DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission ')isJheereby r�an�tje{d' to;;; C�oj►'nstruct(('� )) /Re/jp�aiirr( ) U�/pggrade�(�/)� 2 ban/don( ) an individual sewage disposal system at ( `",/ Lif`11.�.1'1 / /� !1! 1T—f)® �, r� T ;� .11�1�1_�as described in the application for , ) ; e.i r .� Disposal System Construction Permir No. / !- dated IN J / - Provided: Construction shall be completed within three years of the date o thi perm . All locca.1conditions must be met. Form 1255 Rev.5/96 A.M.Sulkin Co.Boston,MA Dat �&_Board of Health �- U / a Sep:; 20- 01 13 : 52 BARNSTABLE HEALTH DEPT 5087906304 N • u� ,NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM CorQ_tAT__-1 C- 'f hereby certify that the engineered pian sig ed by me tletee 30 O , concerning the property located at ZOS meets all of the fcl".owmg . feria This failed system is connected to a residential dwelling only. There are no _ommarc1a.1 o- business uses associated with the dwelling. TT.e soil is ciass! ed as.CLASS 1 and the percolation rase is less than or equai to -Ttnut!s per inch. "T'he applicant may use historical data to conclude this fsc: or may ,,onduct pre!r!rurary tests at the site without a health agent present • T here :s no rncrrel:;e in flow and/or change in use proposed • Thete are no vanances requested or needed. • The bottom of the proposed leaching facility will not be located less than Fourteen leer aoove the maximum adjusted groundwater table elevation. fAdiust 'he Mundwa,cr table using the Frimp(or method when applicable) Please complete the following: 'a.j "fop •�f Ground Surface: Elevation (using GIS information) _��'�� E; G.w' "c vat:or, �� , ad;ustmen( for high G.W.. .._����— )F-TRENCF BETWEEN A and B TD ( r�� q S:ca'arED PATE: 3d o3 ------------ ._ _— NOTICE �aseC J,Qn tit move information, a reoalr permit wil! be Issued for Sedrooms bedrooms are authorized to the future without en;tni erec =epoc �y.,(cm plans �c_�N!r,Act pc,cc.t,n9 11 �p • Permit Number: Date: Completed by: HIGH GROUNDWATER LEVEL COMPUTATION Site Location: 2015kick Lot No. s* Owner:�1 Address: Contractor:f4T Address: ��n�l a� Z.` �G�mnc)A-(4• NKS3. Notes: STEP 1 Measure depth to water table to nearest 1/10 ft. .............................................................................. .Date A io3 F�•5 month/d /year STEP 2 Using Water-Level Range Zone and Index Well Map locate site and determine: OAppropriate index well.................................................... �53 OB Water-level range zone ..................................................... STEP 3 Using monthly report "Current Water Resourzes Conditions" determine current depth to 4103 water level for index well ........................... month/year STEP 4 Using Table cf Water-level Adjustments for index well (STEP 2A), current depth to water level for index well (STEP 3), and water-level zone (STEP 213) determine water level adjustment ..............................................:........................................... STEP 5 Estimate depth to high water by subtracting the water- level adjustment (STEP 4) from measured depth to,water L'�3 levelat site (STEP 1) ............................................................................................................. 1; Figure 13.--Reproducible computation form. 15 o sion. USGS Well Data - March 2003 Page 1 of 2 United States Geological Survey Observation Wells As a service to Cape officials, engineers and other interested parties, the Cape Cod Commission publishes monthly groundwater data gathered by its Water Resources Office. The water level measurements shown below are taken monthly from United States Geological Survey (USGS) observation wells and compiled during the last week of each month. They are published as soon as possible thereafter. Listed below are nine out of the 61 wells measured across Cape Cod by the Commission's Water Resources Office. These nine are employed as index wells to be used with Technical Bulletin 92-001 to predict high groundwater levels. For your convenience, we've also provided links to USGS national and state data. See the last column in the table and the footnotes below. For further information, please contact Hydrologist Gabrie le_Belfi_t at the Commission offices (508-362- 3828). .. .. . :.I . •-•. :•l!'9.... !...':ib}'..frKY. •ilY'{M,..Ii6:i.WNN1ivJIYa.Is..M ;;.I:Yi March 2003 USGS Site Water Record Record Departure from Number**" Location Well]No. Level* High* Low* Average** (links to USGS Monthly Overall national Nvater-level database) Barnstable A�� ��.3 20.5 26.6 0.8 1.4 413956070164-91 Barnstable A 7v �4.8 20.5 28.6 -0.5 -0.2 4.14154.070.165001 Brewster BMW 21 1 1.6 6.9 13.6 -1.4 -1.4 4145180700203O1 Chatham CGW 138 22.6 20.9 26.6 1.0 1.4 414 00001_l 1Q1 Mashpee M1 W ?9 7.I 5.6 10.0 0.9 IF-71-.477]1 413525070291904 Sandwich S�W 46.3 45.9 48.2 0.3 0.5 414418070241601 Sandwich S�W >2.1 45� 55.1 -2.1 -2.0 4141240702165901_ Truro TS W 89 11.3 ]0.2 13.0 0.4 0.8 420206070045901 Wellfleet WNW 17 9.7 7.3 12.8 0.4 0.7 435353069585401 htip://w\,\,\,v.capecodcoiiiniiss.oii.org/weIIs.htm 4/3/2003 .w'Ij p,i CERTIFICATE OF ANALYSIS L. 7 Mt Barnstable County Health Laboratory �9,Sy,1G1tV�'4�/ Report Prepared For: Report Dated: 4/7/2003 ; APR 16 2003 i Order Number: G�,�h9�S9AHNSTABLE Sharon Capen HEALTH DEPT. 47 Sea Marsh Rd. Centerville, MA 02632 Laboratory ID#: 0319254-01 Description: Water-Drinking Water Sample#: 19254 Sampling Location: 205 Blackthorn Rd.,Marstons Mills Collected 3/27/2003 Collected by: R.M.Capen Received 3/27/2003 Routine ITEM RESULT UNITS MCL Method# Tested LAB: IC Lab Nitrates 2.8 mg/L 10 EPA 300.0 3/29/2003 LAB: Metals Copper 0.3 mg/L 1.3 SM 3111B 4/3/2003 Iron <0.1 mg/L 0.3 SM 311113 4/3/2003 Sodium 14 mg/L 20 SM 3111B 4/3/2003 LAB:Microbiology Total Coliform Absent P/A Absent 307 3/26/2003 LAB: Physical Chemistry Conductance 139 umohs/cm EPA 120.1 3/26/2003 PH 6.5 pH-units EPA 150.1 3/26/2003 Note: Water sample meets the recommended limits for drinking water of all above tested parameters. Approved By: /Alwf 7 (Lab Director Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605 AsBuilt Page 1 of 1 1 V 1T1'1 Vl'at�lll�J 1l1.DLL'. LOCATION �� � SEWAGE#Z-003 -a?) VILLAGE �C',C"���� M;��S ASSESSOR'S MAP& LOT42- --1 tti—Ot INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY < <bcv , LEACHING FACILITY: (type_ Z—C�r,��!> (size) NO.OF BEDROOMS_ BUILDER OR OWNERS CSt�c�iC'� Cc•.pRl\ PERMTTDATE: S� �p3 COMPLIANCE DATE; Separation Distance Between the: t Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 4 Feet Private Water Supply Well and Leaching Facility (If-any wells exist on site or within 200 feet of leaching facility) .A- Feet Edge of Wedand and Lea Facility(If any wetlan gist within 300 feet of 1 hin facility) Feet Furnished by N 45 �i z_3 ,. http://issgl2/intranet/propdata/prebuill.aspx?mappar=047010001&seq=1 3/22/2013 �b 0 A MAa S E E PE RC 1 T p0• I L L A G E I `NSTA LLER'�, aAUE b ADDRESS V � D UILDE a Oil Oil DATE PERMIT ISSUED S �� DATE COMPLIANCE ISSUED ff 4.f _*., 31 3�, J� s s Notl: I!Yx- Fss. /v................. ' THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ` ...........OF........1.4 .................................. AVVIIration for Biopootti Works Tonotrnr#ton runfit Application is hereby made for a Permit to Construct ("') or Repair ( ) an Individual Sewage Disposal System at: -orxo m�--- ---- ---------------------------------------------•----.._..................__. -•-•-•L cation-f.d ess s r No. •-•_.. a jCl.f�'Me ��--........� _M._.�..........._•- _ ,1�'_f�_,. .. ...:t----------------•-------•---••------- Ownez - A-dress...................a _._._._.v.C,� C_► A_-©__-•-----.._.a_�.:�.s_...__...--•------.._ � t r1 S -�tiJ1� �' InstaVer Address t� dType of Building Size ....Sq. feet Dwelling— No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( U Aa p Other—Type of Building ____________________________ No, of persons............................ Showers ( ) — Cafeteria ( ) 04 Other fixtures _________________________________ W Design Flow_____________�1�_l?____.__:.___._.__.___.gallons per person per day. Total daily flow__._._._.__ C7__.___...__-______..__..........gallons. l WSeptic Tank—Liquid capacity` .gallons Length................ Width................ Diameter................ Depth................ x 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 ( ) 11 11 �r a '~ Percolation Test Results Performed by.... ..... N.` ................. Date____________...... Test Pit No. 1________________minutes per inch Depth of Test Pit.................... Depth to ground water..................... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ •-•..._•-•-_-_•,•� _....----••••-...__.. . ..... O Description of Soil•-O:a' 1W 9`Xn._-•-_--A-_--�.....................................................- - cx.� - �\ .... •0.M ---------•-- 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 TITLE 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. �ign �r1.11�1'�:e-.......�h �'`^-.. .._.._..__ `i.� .Application Approve r•- -==- ••--•.-•••••_---• ll -- Date Application Disapproved rC a following reasons-------------•------•------------...•--------•----------•------•-------------------------..................... ---------------------•-----...---•••-•-••---•-•-•-••-----_•-•--•--•••-•-•-----••-._.........-•------•-••---••-•---•---•--------•-•--•-•----•-••---•••-••••-•-•--•---•••-•-•-•-•••---••••••-••-----....._ Date PermitNo......................................................... Issued....................................................... Date Not ..............-'�.��'�. Fss.✓...� _. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..r1...........0F........ j G n.= . :.< .�.....-.......................... Appliratiou for Diupuual Works Toustrurtiou Permit Application is hereby made for a Permit to Construct ( ") or Repair ( ) an Individual Sewage Disposal System at: L-cation-Address 1 \ Qr Lo No. 'Ty~ ------�...AC. �.�.:\�_.�.............................................. Owner - A dress Installer Address !, Q Type of Building Size Lot__= feet Dwelling—No. of Bedrooms............�J...............................Expansion Attic ( ) Garbage Grinder (P O aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) 44 Other fixtures............. .---••••--•--•-•-•--••••......---••-•-•••-•---•---•--........................... .•-•----•-••-••---....,�.. . Design Flow \.\..O..................... per person per day. Total daily flow...........-�................................gallons. W W Septic Tank—Liquid capacitv,A� gallons Length................ Width................ Diameter................ Depth................ x 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 ( ) aPercolation Test Results Performed by... C !�......�£.__.1�`�.1c -................ Date.._�`............................. Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ f=, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 .............................................................` �' ---......._..---- D Description of Soil...() .D..-•-.. O lM. =e C b � C)`--'�',' ...... - ......... ................. 4 x 1a-......_r -------------------------------- ----------------------- 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 TITIS 5 of :he 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. g Cam . ,�i 2 ApplicationApprove - ------ r--l .................•-------................................-----------•-- --f,� � ......... ' Date Application Disapproved 6r . following reasons: ..................... ------------------------------------------------------------------------------------------------------------------------------------------•-----...----------------------------...----------------.----- Date PermitNo......................................................... Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD 'OF HEALTH .. .W n...............OF............ �1d.C.iJt.(1.a �� . ...................................................... (grrtifiratr of Tompliattre THIS IS TO CERTIFY. That the Individual Sewage Disposal System constructed (L,-)""or Repaired ( ) by....... .11.E. ............ -------------------------------------------•-•--•--••-•--------------•--•------. .... -•-•- ---•------- n _ •, Installer. 1 .........4 .iC,C .: Y. ? ....--...... .G�. ..... Jf\,o..... has been installed in accordance with the provisions of T � �P�/T e State Sanitary Co ibed in the application for Disposal Works Construction Permit No. .... ........................_..._... dated -�_�_. ... ............................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED S A GUARANTEE THAT THE SYSTEM V111 FU TION 'SATISFACTORY. ................................................. Inspector------ -... ...................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1 /`/ ........ n..........OF............ � .":°..'"GAG ....`......... s 0 NJJ...--••- •-••-.... FEE.-•...................•• Diiyouttl Vorks Tonatr wart Permit Permissionis h bgted....... Je,-` ............. . ........�.................................................................. to Construct rr Repair .', an Individual Sewage Disposal Syst atNo. ��".. .s M. .- ................................... Street as shown on the ap 'catio for Disposal Works Construction Permit_No.__.. ........ Dated.......................................... ............. -- -•-••-•----...•-•-•---••--...••-•-••-----•....--------•--.......----• Board of Health DATE -��/ -- FORM 1255 A. M. SULKIN, INC., BOSTON December 1% 1983 Mr. & Mrs. Gordon Chadbourne P.O. Box 1861 Cotuit, MA, Dear Gordon and Andrea, At the request of the Town of Bann:stabler Board of Health, I am making you aware of higher than recommended level of sodium in your well water, Enclosed is the .analysis of the water test. At the bottom you will note that the water is not recommended for consumption by persons on sodium restricted diets. Please contact me if you have any questions. Very truly yours, s K. 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Y .. 1. _. - ,..-0. .- �,. .,,....is - � . _ .. `, .. -.v -. �. rollm,nacy p s:�. y u y � r u -n y Pro 1 u O I � -L it It it Ill LEI HTI ® - - a - T ®� w v i o mQ Ln z 00 m FRONT ELEVATION 10 w a o UJ Ir _i LD FM El I e ® nT �I LD_ ¢ U Z to W J c-n z = tP lij W U Z a0 d Y m <' a U mN � OUTLINE OF DECK OUTLINE OF DECK i SCALE 114•-f•-W DATE 3I20/07 RDRAWNBV SPB/PAB EAR ELEVATION REVISIONS: DRAWING NUMBER Al i GENERAL NOTES: A. 1. Before final Drawings and Specifications are issued for construction,they shall be submitted to all governing building agencies to insure their compliance with all applicable local and national codes.If code discrepancies in Drawings and/or Specifications appear,the Designer shall be notified of such discrepancies in writing by Builder or building official,and allowed to alter Drawings and Specifications so as to comply with governing codes before construction begins. 2. Upon written receipt of approval from the governing official, appu—d f 1al Drawings and Spccificationa aholl bo submitted to the Builder by the Designer. 3. If code discrepancies are discovered during the construction process.Designer shall be notified and allowed ample time to remedy said discrepancies. 4.All work performed shelf comply with all applicable local,stale and national building codes,ordinances and regulations,and all other authorities having jurisdiction.Following is a partial list of applicable codes in force: a. Massachusetts Slate Building Code,760CMR,6th edition, 3/1198 B.All contractors,subcontractors,suppliers,and fabricators,shall be responsible for the content of Drawings and Specifications and for the supply and design of appropriate materials and work performance. z C.All manufactured articles,materials and equipment shall be applied, installed,erected,used,cleaned and conditioned in strict EXISTING DECK -z accordance with manufacturers recommendations. z < cc D.All alternates are at the option of the Builder and shall be at the I I 0Builder's request,constructed in addition to or in lieu of the Q CD typical construction,as indicated on Drawings. STEP Z W J Q1 SHOWER (n m Q � DO O Op >_ /1 zC) as Cl W 0 Y IAI w BREEZEWAY Q Z z Q Q z W N O"WW Q O C� Z w W Cn t � p a Wccc2 P Cr C) z Cf) W Z ir J p Z WO - Q _ STEP WW Q W U O F— d Y m Q ® ® � N FIRST FLOOR a m � SCALE 114'=14Y DATE 3/20107 DRAWN BY SPB/PAB REVISIONS: DRAWING NUMBER A2 W REMOVE a 31 EXISTING SCUTRE Li .________- TW2442 Z tE HALL N Un oQc nl L 6'-2'h• S'2'h• •I Z(D Q OD OFFICE/SITTING AREA 2-0 rn Lu inn(n 0 (o Lo ❑ wC we J Z m Q co --- � 0 Qo was a BEDROOM g REMOVE W BEDROOM W N�.,W % Bi TH MASTER BEDROOM SHOWER 8'41• T-6• a O � IJNEN ro O 4,8-h. ROOF BELOIIW 6'-4•WALL HT. It A41 4•_3,h• a-BW 9- z NEW WALLS= f'lT7-I _� M% NG WALLS= 0 O PROPOSED SECOND FLOOR PE U) Z E d �O a W 1- m UZU) ~ O uJ Z a:0 .� Z w0 - W 2 LU 0 WO w U Z H 00 d Ym [L Q d U m N� SCALE 114•ar-0• DATE 3/20/07 DRAWN By SPB/PAS REVISIONS: DRAWING NUMBER A3 y �y. • i I ,fl.4/G.y .C'l..�tp/_ //o X3 = 33o G.,cz,t�- � �-���3'• 9SG USA /oUo c .4 L S 0G.f? ?�� i - F i 91 7� 7.4�/,C +9 t i(l/ t /. CE2'T/r�"'Y T•5/.4T' 7"yE E.X/STit/� �i�s✓v. ,S�,ior�t/.(/. � ,y� �v Ca. PLys W17W Tti� s�2�c,<' A--Y2 > � / i� QC1/, iy�itCJ"s ram, 7".�,�L� T�f�i/.�/ �E' /,57�,U.L.Qi✓T.� Sve►�,�Y ' .. � tip. �� „� ��,• ALA RICHARD .W W. n A. <::�31/.AiV //V.S7% YJi"I /�/`�— v HAXTE:R t •t, " hio.24048. �t/o?- I��' U�S�D "Tp ,tom ✓ ` ' . 'T /�/LS. are` -- ti . iF = , . a AM. AccEssUANH LE 5 � R LOCU S MA P 2_ 8 e w q / Al C O F B" t O O 10 min. from` N *NOTE: i •� t F P e 4 V. .4 C PIP ARE T SCHEDULE 0 _ .. . /- house to septic nM NOTE. ALL ES E 0 BE S .. ..Sep c to ON A A . ... ... . .,. _ . .... .. Existing Foundation SECTI ..... ...: . .. , ..; / O o g Septic tail: covers must be, •_.�•� _...�- D ti e T.O.F.'dev, 100.00finished f vwlMn 6 n. O Ode � _ V W CHING :SYSTEM .� -k //NGrade ow Septic Yank - 9fL50 Grade over D-Box - 97.50 ode over SAS 97.50 ' PROFILE VIE OFQ t S / V . � � ... THE ACCESS COVERS FOR THE SEPTIC TANK. 3 4" tot t 2 " Washed Crushed Stone t DISTRIBUTION BOX AND LEACHING COMPONENT S 0.02 3 HOLE TOP OF SAS - 95.25 / _ - Washed Pe one INLET \ ET SET DEEPER THAN 6 INCHES BELOW FINISHED (H-,0)aST. BOX S MOximum Coax 3 of 1/8 t/2 os ed ost 'a ' RAISED T WI?HtN 6' OF / t S.p- t `. GRADE SHALL 8E SE 0 OS8 •• .. FINISHED GRADE. EXIST. PIPE 7 EXI T. 1 G - I rROm FOUNDATION ': rn S 000 �. Olo loot o+ SEPTIC.TANK _ lV Ih 20 .� INSTALL`TUF-TITE GAS BAFFLES OR EOUALS H 10 0 0 rn n r•y , v a CONCRETE FULL FOUNDAT > - B - _ :. d ; v �� ' C C3 0 0 C3 C3 STEEL REINFORCED PRECAST CONCRETE SITE a 3.5 3.5� 0 0 0 0 0 0 o PLAN VIEW 1' I - 12- o s SYSTEM PROFILE ` d H o 0 0 0 0 Not to Scale _, -6 ° [PFective vldtn 2 Un is a 8.5 M/2 Separation 19 ` > > e 9. 3-24 REMOVABLE COVERS f I GENERAL NOTES - " 1. Contractor is responsible for Di safe notification 6 n.of 3/4-f 1/2 c 25 r. ,. .•.,•. ,,• -'. .�. P Dig safe stone m ;..:, -.,., 4 EFfect,ve Lengtt, and protection of all underground utilities and pipes. - 3` min. clea;once .. ,Y I►aET'T- _ -- - - �" t to outlet 2. The septic"tank`onj distribution box shall be set Bottom of Test Hole t Elev. 85-50 Bottom -of INLET 8 mn.T 12- m mk 6 min. _ level on 6 of 3 4 -1 1 2 stone. SOIL ABSORPTION SYSTEM (SAS) -- ------ Liquid kvd OUTLET / / i 3. Bockfi9 should be clean sand or grovel with no a, 500 - C (H-10) LEACHING UNITS / WIGGINS PRECAST ` over s -7- ---- s 5 t s -7 4. Ths stones system s subject to inspection during installation Not to Scale T: E } 4-0 mn. Y 1 P 9 ' Liquid depth by Carmen E. Shay - Environmental Services, Inc. s 5. The contractor shall install this system in accordance NOTE: ALL COMPONENTS MUST HAVE RISERS TO WITHIN 6" BELOW GRADE with,Title'V of the Massachusetts state code, the approved plan ". . .: and Local Regulations. e-o" 4 -•10- 6. If, during installation the contractor encounters any soil conditions or site conditions that ore different CROSS SECTION END-SECTION from those shown on the soil log or in our design , I immediate notification be installation must hat & a made to Carmen E. Shay -- Environmental Services, Inc. N H 1 SEPTIC TANK 7. No vehicle or heavy machinery shall drive over the USE EXISTING.. 100n GALLON 0 FOUNDATION 22' SEPTIC TANK -f--35--� D-BOX f--$Q----� LEACHING FACILITY septic .system unless noted as H-20 septic components Install T f-Tite a baffles or equals on all outlet 'tee ends. . NOT TO SCALE 8. nstol u gas b q 9 AtI Distribution Lines shall be 4" diameter Sch. 40 NSF PVC pipes. 10. All solid piping, tees & fittings shall be 4 diameter PERCOLATION TEST • Schedule. 40 NSF PVC pipes with .water:tight joints. { 11. SITE and SurroundingProperties HAVE AVAILABILITY ITY • to Municipal Water.`PRIVATE WELLS ARE LOCATED AS SHOWN OR -' Dote of Percolotlorn Test, APRIL 18, 2003 P M IT Test Performed B c CARMEN E. SHAY- R.S., C.S.E. ARE OVER 150 FROM SITE. Y Results Witnessed iBy: UNWITNESSED N NTA RVI INC. Excavator- SHAY E_NV1R0 ME LSE CES, Percolation Rate: !Less Than 2 min./inch ® 40"'BELOW GRADE. NOTE R P R LINES ARE APPROXIMATE AND THE PROPERTY COMPILED FROM THE SURVEY PLAN GENERATED BY BAXTER & NYE OF. OSTERVILLE. MA ! Test Hole - ENTITLED. CERTIFIED PLOT PLAN OF 'LAND OF �/205 BLACKTHORN ROAD i -_. No. 1- .. A NOV. 1 _1983 LOTS MARSTON'MILLS. MA DATED 0 , DEPTH SOILS ELEv. AND IS NOT INTENDED TO BE A SURVEY PLOT PLAN OPEN SPACE 0 97.50 IT SHOULD BE USED FOR NO PURPOSE OTHER THAN Sandy Loam THE SEPTIC SYSTEM INSTALLATION. to YR 3/2_ 0_-6" As, 97.00 6 Sandy loom THERE ARE NO WETLANDS LOCATED WITHIN A 200 RADIUS 9 OF THE ,PROPERTY 10YR5/6 r B. 95-� r r Med-Cwse NOTE: ANY STRIPPED OUT SOIL CONTAINING LEACHATE N 43d 58' 22„ H' ,'� , end FROM THE EXISTING SEPTIC SYSTEM TO BE DISPOSED' 280.44 ' 2s Y 7/4 ,r r 30"-144" c, 65-50 � OF AS PER BOARD OF HEALTH SPECIFICATIONS. 195 /r I EXISTING LEACH PIT TO BE PUMPED DRY & FILLED WITH CLEAN FILL MATERIAL. 8 .5 25' , • ,, TEST HOLE T , / ► ► , N CO ASSESSORS MAP - 47 SEC-010 LOT - 1 . f '►., ' '. ; •.: .► - ELEV.= 97.50 / _ 4 r ..•..., -•.- sj ., / ZONING RESIDEN lAL x O LOT 1 r o � _ / - FLOOD �ONE`C Fa iled ed Pere t - ' f e to 5_ De pth h to c 36 I _ Leas h t � _ d Square Feet + / 6 556 S P R to <2:mI , inch _.9 erc a ) _. -,.1- ,. ,. _. . Groundwatert o rve_ o se d - _ ter. RA WITHIN A RADIUS N WETLANDS L CATEO �00 � _ THERE ARE 0 0 F T 1 v 144 E BOTTOM 0 EST tD E E e . SHED_ . L - � ADJUSTED H I " = Adjustment Required. OF .THE PROPERTY DJUS ED 20 E e, No dJust q r , nl r d , .� EXIST. 1000 go. / LOT #448 Septic Tank r / #- . , .. _ ALL OUTLET PP'ES fROM tIIE � t'- } I , , ###, _ - DISTROUTIM B(DX SHALL BE - ., L L_G L.-.N D - �� r 1 SET LEVEL FOR AT LEAST 2 FT. 1 CONCRETE COVER I (� r O ;� '-� .• 13cNoa5cau OUTLET •. DENOT S PROPOSED 1, r �. . 8X0 E DECK - -,ss- ' ,r INLET SPOT GRADE Qr `f DENOTES EXISTING x 104.46 r :.., :._ . ... 2 SOT GRADE ,' SHED I s - a- - SCH. 40 T I ► EXISTING - I 3 BEDROOM f PLAN SECTION CROSS-'SECTION PROJECT BENCH MARK PL PROPERTY LINE I' TOP OF FOUNDATION HOUSE O 1 - Porch r------ so. O I _ { - PROPOSED CONTOUR ELEV- - 100.00 (Assumed) #zo5 , / , 3 HOLE DISTRIBUTION BOX H-1 LOADING -�� rr NOT To SCALE - - - - - - EXISTING CONTOUR 97 97 0 LOT #110 Q�sign Calculations DEEP TEST HOLE & PERCOLATION TEST LOCATION CONECTED TO I ���'► a Number of Bedrooms: 3 Equivalent to 330 Gol./Doy; (330 Go!./Day Min. per Title V) ► MUNICIPAL WATER i FENCE ��,� ► m ► � .�� Garbage Grinder: No, � I ► a I Leaching Capacity Proposed: 330 Col./Day Minimum (Min. Per Title V) I 0 1 - p /D y - p PRIVATE DRINKING WATER WELL M ^'� ' �' ' Septic Tank - 2 x 330 Gol. a = 660 USE EXIST 1,000 GAL. Septic Tank. I FRO t a I SOIL ABSORPTION AREA: Using percolation rate of <'1 min./inch - R DVS -------- . pip O E. �•' ► � � ,�'" Bottom Area: 0.74 gal/sq. ft. x 300sq. ft. _ 522200.gallons � �50 ,/ ► ,' Sidewoll Area: 0..74 gal./sq. ft. x 148 sq. ft- -609.50 gallons REVISIONS /, ► I i'► I � Providing: _"331.50 gallons �•' ► ' Use: 2 PRECAST ',500-C UNITS, HAVING A 2' EFFECTIVE DEPTH, I NO. DATE: DEFINITION b ( ' TO BE USED WITH 3.!5' OF WASHED STONE ON THE SIDES AND b I i ► ► �' 3' OF WASHED STONEE ON THE ENDS AND`2 FEET IN BETWEEN 2 UNITS. I -_- � � L I _ , I - a' 127.62 71.99 r i ,, ' R '= 240.0 ' i I S' 44d 10 4 E ' 0 44 28 E : l\ L - 72.43, 9.05' S 47d 1 \ R z , r \ r PROPOSED C71< -1 H O� R UA B - PREPARED FO R WAGE DISPOSAL SYSTEM I (40 FOOT RIGHT OF WAY) r SUBSURFACE S E OF 9 JOHN& CYNTHIA BREWSTER ------------- _- 1oz #205 BLACKTHORN ROAD .. MARSTON -MILLS MA #205 BLACKTHOR N ROAD PREPARED BY: LOT #34 _ - LOT 2 LOT 111 ZN of bfq # �. # MARSTON MILLS MA CONECTED TO 0 _ '20 4O 50 ' �� o , CONECTED TO 2 o R, - 111�'N E. SHA Y MUNICIPAL WATER O CONECTED TO C� O MUNICIPAL .WATER ` E. ► MUNICIPAL WATER IA ENilIRONri ENTAL SERVICES`, INC. S . 1 a 34 THATCHERS' LANE GISTS. a EAST FALMOUTH, MA 02536 �NI ART T ! 4 - 7 8 9 - T FAX .. 508 5 0 6 � EL _ ... ., DATE.SCALE _1 20 DRAWN BY. CES AP I L 30, <003 419 FILENAME: SD41 PP. WGPROD CT SD SHEET 1 0F 1