HomeMy WebLinkAbout0055 BLUEBERRY LANE - Health 55 Blueberry Lane
Marstons Mills
A= 102 - 108
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
v
55 Blueberry Lane
Property Address
Lori Humphries
Owner Owner's Name
information is Marstons Mills Ma 02648 Y 7-3-19
required for every
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary
Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6.
1) System 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.
Comments:
The system was in working order at the time of inspection.
2) 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):
i
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18
c Commonwealth of Massachusetts
/0a-/08
�m Title 5 Official Inspection Form
ry r Subsurface Sewage Disposal System Form -Not for Voluntary Assessments i
r ;
55 Blueberry Lane
u=
Property Address ,
Lori Humphries '.a
Owner Owner's Name c)
information is Marstons Mills Ma 02648 7-3-19 *.;9
required for every
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. Inspector Information a �M3
on the computer,
use only the tab Brett Hickey
key to move your Name of Inspector
cursor-do not B&B Excavation
use the return Company Name
key.
Co Route
130
c,+ Company Address
Sandwich Ma 02563
City/Town State Zip Code
rra (508)477-0653 S113747
Telephone Number License Number
B. Certification
I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5
(310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address
listed above; the information reported below is true, accurate and complete as of the time of my
inspection; and the inspection was performed based on my training and experience in the proper function
and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined
that the system:
1. ■❑ Passes
2. ❑ Conditionally Passes
3. ❑ Needs Further Evaluation by the Local Approving Authority
4. ❑ Fails
Brett Hickey
Rale:2919.9).9811:19.2a LIW
7-3-19
Inspector's Signature Date
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board
of Health or DEP)within 30 days of completing this inspection. If the system 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 form should be sent to the system owner and copies sent to
the buyer, if applicable, and the approving authority.
Please note: 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.
\t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18
c Commonwealth of Massachusetts
�x Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
55 Blueberry Lane
V�
Property Address
Lori Humphries
Owner Owner's Name
information is Marstons Mills Ma 02648 7-3-19
required for every
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
2) System Conditionally Passes (cont.):
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
❑ 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 pipes) are replaced ❑ Y ❑ N ❑ ND(Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below):
3) 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.
a. 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:
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c Commonwealth of Massachusetts
Title 5 Official Inspection Form
_ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
55 Blueberry Lane
v
Property Address
Lori Humphries
Owner Owner's Name
information is Marstons Mills Ma 02648 7-3-19
required for every
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
❑ 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
b. 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.
c. Other:
4) System Failure Criteria Applicable to All Systems:
You must indicate"Yes" or"No"to each of the following for all inspections:
Yes No
El El clogged
of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ O Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
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Commonwealth of Massachusetts
�n Title 5 Official Inspection Form
ii Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
55 Blueberry Lane
Property Address
Lori Humphries
Owner Owner's Name
information is Marstons Mills Ma 02648 7-3-19
required for every
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
4) System Failure Criteria Applicable to All Systems: (cont.)
Yes No
❑ ❑ Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ ❑ Liquid depth in cesspool is less than 6"below invert or available volume is less
than '/day flow
❑ O Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ El 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.
❑ El Any portion of a cesspool or privy is within a Zone 1 of a public water supply
well.
❑ 0 Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ El 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.]
❑ El The system is a cesspool serving a facility with a design flow of 2000 gpd-
10,000 gpd.
❑ El 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.
5) 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 CA.
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
t5insp.doc•rev.7/26/2018 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18
Commonwealth of Massachusetts
�o Title 5 Official Inspection Form
�= Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
55 Blueberry Lane
V
Property Address
Lori Humphries
Owner Owner's Name
information is Marstons Mills Ma 02648 7-3-19
required for every
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
If you have answered"yes"to any question in Section C.5 the system is considered a significant
threat, or answered "yes"to any question in Section CA above the large system has failed. The
owner or operator of any large system considered a significant threat under Section C.5 or failed
under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner
should contact the appropriate regional office of the Department.
6. You must indicate"yes" or"no"for each of the following for all inspections:
Yes No
El ❑ Pumping information was provided by the owner, occupant, or Board of Health
❑ El Were any of the system components pumped out in the previous two weeks?
❑ El Has the system received normal flows in the previous two week period?
❑ 0 Have large volumes of water been introduced to the system recently or as part of
this inspection?
El ❑ Were as built plans of the system obtained and examined?(If they were not
available note as N/A)
❑ 0 Was the facility or dwelling inspected for signs of sewage back up?
0 ❑ Was the site inspected for signs of break out?
0 ❑ Were all system components, excluding the SAS, located on site?
El ❑ 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?
❑ El 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:
El ❑ Existing information. For example, a plan at the Board of Health.
❑ 0 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)]
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5
Commonwealth of Massachusetts
Title 5 Official Inspection Form
'= 1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
55 Blueberry Lane
v
Property Address
Lori Humphries
Owner Owner's Name
information is Marstons Mills Ma 02648 7-3-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information
1. Residential Flow Conditions:
2 2
Number of bedrooms(design): Number of bedrooms (actual):
228/GPD
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):
Description:
0
Number of current residents:
Does residence have a garbage grinder? ❑ Yes E No
Does residence have a water treatment unit? ❑ Yes ral No
If yes, discharges to:
Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes EI No
information in this report.)
Laundry system inspected? ❑ Yes n❑ No
Seasonaluse? ❑ Yes [0 No
See below
Water meter readings, if available (last 2 years usage(gpd)):
Detail:
***2018-47,000gallons 2017-48,000gallons*'k*
Sump pump? ❑ Yes a No
1 month
Last date of occupancy: Date
t5insp.doc-rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18
c Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
55 Blueberry Lane
Property Address
Lori Humphries
Owner Owner's Name
information is Marstons Mills Ma 02648 7-3-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
2. Commercial/Industrial Flow Conditions:
NA
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
Water treatment unit present? ❑ Yes ❑ No
If yes, discharges to:
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
Last date of occupancy/use: Date
Other(describe below):
3. Pumping Records:
Source of information: Owner- last pumped 3 months ago
Was system pumped as part of the inspection? ❑ Yes ❑■ No
If yes, volume pumped: gallons
How was quantity pumped determined?
Reason for pumping:
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18
c Commonwealth of Massachusetts
�- Title 5 Official Inspection Form
I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
55 Blueberry Lane
u
Property Address
Lori Humphries
Owner Owner's Name
information is Marstons Mills Ma 02648 7-3-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
4. Type of System:
El 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):
Approximate age of all components, date installed (if known)and source of information:
2005 per plans
Were sewage odors detected when arriving at the site? ❑ Yes ❑0 No
5. Building Sewer(locate on site plan):
1'311
Depth below grade: feet
Material of construction:
M cast iron ❑13 40 PVC ❑ other(explain):
Town water
Distance from private water supply well or suction line: feet
Comments(on condition of joints, venting, evidence of leakage, etc.):
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c Commonwealth of Massachusetts
Im Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
55 Blueberry Lane
Property Address
Lori Humphries
Owner Owner's Name
information is Marstons Mills Ma 02648 7-3-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
6. Septic Tank(locate on site plan):
311
Depth below grade: feet
Material of construction:
W 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
1
Dimensions: 500gallons
211
Sludge depth:
3411
Distance from top of sludge to bottom of outlet tee or baffle
On
Scum thickness
NS
Distance from top of scum to top of outlet tee or baffle
NS
Distance from bottom of scum to bottom of outlet tee or baffle
measured
How were dimensions determined?
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
The tank was in working order at the time of inspection. The tank is not in need of pumping
at this time but should be pumped every two years for maintenance.
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18
c Commonwealth of Massachusetts
I , Title 5 Official Inspection Form
(� 1. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
f F'
55 Blueberry Lane
Property Address
Lori Humphries
Owner Owner's Name
information is Marstons Mills Ma 02648 7-3-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
7. Grease Trap(locate on site plan):
NA
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
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan):
NA
Depth below grade:
Material of construction:
❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain):
Dimensions:
Capacity: gallons
Design Flow: gallons per day
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Commonwealth of Massachusetts
�m Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
55 Blueberry Lane
u
Property Address
Lori Humphries
Owner Owner's Name
information is Marstons Mills Ma 02648 7-3-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
8. Tight or Holding Tank(cont.)
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
9. Distribution Box(if present must be opened) (locate on site plan):
0'r
Depth of liquid level above outlet invert
Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any
evidence of leakage into or out of box, etc.):
The d-box was in working order at the time of inspection.
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18
c Commonwealth of Massachusetts
Title 5 official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
55 Blueberry Lane
Property Address
Lori Humphries
Owner Owner's Name
information is Marstons Mills Ma 02648 7-3-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
10. 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.):
NA
* If pumps or alarms are not in working order, system is a conditional pass.
11. Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
Type:
❑ leaching pits number:
(2)500 gallon chambers
0 leaching chambers number:
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18
Commonwealth of Massachusetts
�n Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
l;
55 Blueberry Lane
Property Address
Lori Humphries
Owner Owner's Name
information is Marstons Mills Ma 02648 7-3-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
11. Soil Absorption System (SAS) (cont.)
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
The SAS was in working order at the time of inspection. Chambers were dry when viewed.
12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
NA
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
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5insp.doc-rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18
4N, Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
u
55 Blueberry Lane
Property Address
Lori Humphries
Owner Owner's Name
information is Marstons Mills Ma 02648 7-3-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
13. Privy (locate on site plan):
NA
Materials of construction:
Dimensions
Depth of solids
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18
c Commonwealth of Massachusetts
- Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
. � 55 Blueberry Lane
Property Address
Lori Humphries
Owner Owner's Name
information is Marstons Mills Ma 02648 7-3-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
14. 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
Lisbl3ssir�y As-Buitt Caret:;
,w✓�+'' / au rr.err nxxrf�a n,zsue.`
i. LOCATION•�=1�! ✓,b"'�- .�--.-- SEWAGE fl C'GYX. + j
I VILLAGE_ ass sra
TNSTAt_LF_A'S N FAY-W&PHONE NC1_
SEPTIC TANK C:AFrtiCI'i'YY �,, ,�' ✓'
NO.OP.HEDROOMS_
Bbu.DER OR O ' isC'
j PaPiAifDAT'E ._._._._..COMPLFANCE DATE:
'separadon Diutsnce Between the:
Maximum Adjusted.GToundwater Table to the.Bottom of l'.,eaching Facil ity ' Feet.
-PO -te Water Supply Well and I.As ing Facility (Irai;y_tus-exist ..
ten site or within 2W feet of reactung facility) Fnet
� _Edge of Wetland and LA-aching Facility(If any.wctlAhds eusc
.. within 300 feet oftj ping f-ni F liry�p y/ , ..-_ ..eeet,..
I Furnished by �.G, .�Via
_ $
0 os`
zS
t5insp.doc•rev.7f26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
1. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
u-
55 Blueberry Lane
Property Address
Lori Humphries
Owner Owner's Name
information is Marstons Mills Ma 02648 7-3-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
15. Site Exam:
0 Check Slope
0 Surface water
0 Check cellar
0 Shallow wells
4' below SAS
Estimated depth to high ground water: feet
Please indicate all methods used to determine the high ground water elevation:
0 Obtained from system design plans on record
2-10-2005
If checked, date of design plan reviewed: Date
❑ Observed site(abutting property/observation hole within 150 feet of SAS)
❑ Checked with local Board of Health -explain:
❑ Checked with local excavators, installers-(attach documentation)
❑ Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
A plan on file at the local Board of Health was used to determine high groundwater.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18
cf Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
\ 55 Blueberry Lane
V
Property Address
Lori Humphries .
Owner Owners Name
information is Marstons Mills Ma 02648 7-3-19
required for every
page. City/Town State Zip Code Date of Inspection
E. Report Completeness Checklist
Complete all applicable sections of this form inclusive of:
❑N A. Inspector Information: Complete all fields in this section.
❑■ B. Certification: Signed & Dated and 1, 2, 3, or checked
❑■ C. Inspection Summary:
1, 2, 3, or 5 completed as appropriate
4 (Failure Criteria)and 6 (Checklist)completed
❑■ D. System Information:
For 8: Tight/Holding Tank—Pumping contract attached
For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached
For 15: Explanation of estimated depth to high groundwater included
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18
-Q:WP/St(?nePanton
u E
Town of BarnstabRe
3
9. ]Board of Health
P.O.Box 534,Hyannis MA 02601
Office: 508-8624644 Susan G.Rask,R.S.
FAX: 508-790-6304 Sumner Kaufman,MSPH
Wayne Miller,M.D.
Mr. Edward Stone May 10, 2005
EAS Survey
P.O. Box 1729
Sandwich, MA 02563
RE 55 Blueberry Lane,'MarstonS Mills A d1U2 108':;
Dear Mr. Stone:
You are granted a variance on behalf of your clients, Bud Panton, Louise Panton, and Abbie
O'Brien, from several provisions of the State Environmental Code,Title V, to construct a septic
system at 55 Blueberry Lane, Marstons Mills. The variances granted are as follows:
310 CMR 15.212: The soil absorption system will be located four feet above the maximum
adjusted water table elevation, in lieu of the five feet separation distance required.
Section 360-1: The soil absorption system will be 90 feet away from the bordering vegetated
wetland, in lieu of the 100 feet setback separation distance required.
These variances are granted with the following conditions:
(1) No more than two(2)bedrooms maximum are authorized at this property. Dens, study
rooms, offices,finished attics, sleeping lofts, and similar-type rooms are considered
"bedrooms"according to the MA Department of Environmental Protection.
(2) The applicant shall record a properly worded deed restriction, signed by the owner of the
property, at the Barnstable County Registry of Deeds restricting the property to two(2)
bedrooms maximum. A copy of the recorded deed restriction shall be submitted to the
Health Agent prior to obtaining a disposal works construction permit.
(3) The septic system shall be installed in strict accordance with the engineered plans dated
February 10, 2005.
(4) The designing engineer shall supervise the construction of the onsite sewage disposal
system and shall certify in writing to the Board of Health that the system was installed in
substantial compliance with the submitted plans dated February 10, 2005.
These v riances are granted because the physical constraints at the site severely restrict the
locati of the soil absorption system due to location of wetlands and the.small size of the lot.
Sin y yours
Whyrie 41ler, M.D.
Chairma
I`
� e
,
,
THE rp� DATE:
K
FEE
DARNSCA3r.B, a
MASS_
9�ATE01rWy64,
TownREC. BY
Town of Barnstable SCHED. DATE:
Board of Health
200 Main Street, Hyannis MA 02601
Office: 508-862-4644 Susan G.Rask,R.S.
FAX: 508-790-6304 c Sumner Kaufman,M.S.P.H.
Wayne A.Miller,M.D.
VARIANCE REQUEST FORM
LOCATION
Property Address:
Assessor's Map and Parcel Number: 102110,0 Size of Lot:
Wetlands Within 300 Ft. Yes Business Name:
No Subdivision Name: C504/0 l,UIPL-
APPLICANT'S NAME: [��� �f�RJTd Phone ��j8/
Did the owner of the property authorize you to represent him or her? Yes No
PROPERTY OWNER'S NAME CONTACT PERSON
Name: � Name: ��.•,q-��J�1, c5.7z,,v�- ctii�C/�S '�L�»=
//�S•Cs' �/�vo �;1/��/ �/il%!GL/Q—^� Gl��C�7Z��l�illz397�
Address: �GvF8�22 ��'✓�� Address: P,�2 /S/ -7 ZG)
ez
Phone: �� �Z9` 7P�G Phone: �A7
VARIANCE FROM REGULATION(LW Rog) REASON FOR VARIANCE(May attach if more space needed)
1 TU �v1 A✓/f S 6W4-,'/ZC /rad/
�W�1/ c��vU• / / U '�E�U/�C� 7y�.Sq.SJ /�7�TS lo/L��/mot/ D'7> ��1�/l�sZj/ ''T�.��'G�'
-�'TL�N�S. 9D �/' adi��, /v� �-w� �s �'w� L✓�Tz.�-,��1 �LsS 5��73;
P4,e i g, C6 A gV d&sr DLL/�;o:•%9G�y S9f'�/ OS yv Si d�/�o aT' 6�IA�i.✓l�
NATURE OF WORK House Addition 0 ????? House Renovation [ Repair of Failed Septic System
Checklist (to be completed by office staff-person receiving variance request application)
Please submit copies in 4 separate completed sets.
v I:our(4)copies of the completed variance request form
"Four(4)copies of engineered plan submitted(e.g.septic system plans)
_ ✓Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans)
—"Signed letter stating that the property owner authorized you to represent him/her for this request
✓ Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense
(for'ritle V and/or local sewage regulation variances only)
Full menu submitted(for grease trap variance requests only)
C:\Documents and Settings\decollik\Local. Settings\Temporary Internet Fi1es\0LR3\VARIREQ.D0C
+ Business: (508) 888-3619
E S Home: (508) 398-6813
VOW-
SURVEY, INC. Facs: (508) 888-2496
141 ROUTE 6A
SALT POND BUILDING
P.O. BOX 1729
SANDWICH, MA OZ563
2-15-OS
SITE: 55 Blueberry Lane
Marstons Mills, MA 02648
Map 102 Parcel 108
TO: Abutter and whom it may concern:
RE: Variance(s) to the proposed construction of a septic system repair/upgrade at the
above referenced site.
A public hearing will be held at the Barnstable Town Hall, 367 Main Street,
Hyannis, conducted by the Board of Health on Tuesday, 3-15-05, at 7.00 PM.
Applic s gent s}
EDWARD A. STONE, RPLS
WILLIAM LIEBERMAN, RPE
Direct & Across the Street Abutters to Map 102 Parcel 108
This list by itself does NOT constitute a certified list of abutters and is provided only as an aid to the determination of abutters. The requestor of this
list is responsible for ensuring the correct notification of abutters. Owner and address data taken from the Town of Barnstable Assessor's database
on 12/2/2004
Mappar Ownerl Owner2 Address 1 Address 2 City State Zip Country
,102096001 !SIMSER,DAVID H P O BOX 767 E FALMOUTH MA 02536 ;USA
I �
102096002 '.ORLANDO,THERESA A ET AL 'C/O MAROIS 167 BLUEBERRY I MARSTONS MILLS tMA 02648 USA
102097 ;BACON,JEFFREY L&M CONNIE 160 RASPBERRY IMARSTONS MILLS MA .02648 USA
(LANE
102098 ,NELSON,CYNTHIA A&LINDA E 150 RASPBERRY � �MARSTONS MILLS AMA '02648
1.. iMEDFIELD ;MA 02052-1652 USA
102107 UATROMONI,FRED P UATROMONI,BARBARA A ,20 PRENTISS
Q Q
!102108 i0BRIEN,ABBIE M IPANTON,LOUISE C&ONEIL ABBIE �49BLUEBERRY MARSTONS MILLS MA 02648 USA
LN
102119 SAND SHORES ASSOC INC IP O BOX 342 'MARSTONS MILLS MA 02648 USA
!102120 iSTATHOPOULOS,GEORGE J TR C/O STATHOPOULOS,JAMES r50 OLD M[LL RD E SANDWICH MA 02537 USA
Friday,December 03,2004 Page I of'I
d
J
------ 2 8' 10' 0
0
J
O
BATHo
H
B.E.D. B.E.D.
--
m
24' _ E,E,P
KIT, CD
IU
O
SS BLUEBERRY LANE
MARSTONS MILLS
t
FF.A 5 Business: (508) 888-3619
. Home: (508) 398-6813
_ SURVEY, INC. Facs: (508) 888-2496
141 ROUTE 6A
SALT POND BUILDING
P.O. BOX 1729 2-]5-OS
SANDWICH, MA 02563
SITE: 55 Blueberry Lane
Marstons Mills, MA 02648
Map 102 Parcel 108
TO: Barnstable BOH and Conservation Commission
We give permission to EAS Survey to represent us at the public hearings
concerning the above referenced site.
W.R. (Bud) Panton
Louise Panton
'Q:WP/StonePanton
Town of Barnstable
UAM
Board of][health
P.O.Box 534,Hyannis MA 02601
Office: 508-8624644 Susan G.Rask,R.S.
FAX: 508-790-6304 Sumner Kaufman,MSPH
Wayne Miller,M.D.
May 10, 2005
Mr. Edward Stone
EAS Survey
P.O. Box 1729
Sandwich, MA 02563
Dear Mr. Stone: _
You are granted a variance on behalf of your clients, Bud Panton, Louise Panton, and Abbie
O'Brien, from several provisions of the,State Environmental Code, Title V, to construct aseptic
system at 55 Blueberry Lane, Marstons Mills. The variances granted are as follows:
310 CMR 15.212: The soil absorption,'system will be located four feet above the maximum
adjusted water table ele: ation, in lieu of the five feet separation distance required.
Section 360-1: The soil absorption system will be 90 feet away from the bordering vegetated
wetland, in lieu of the 1 O64eet setback separation distance required.
These variances are granted with tt`e following conditions:
(1) No more than two(2) bedroom's maximum are authorized at this property. Dens, study
rooms, offices, finished attics;";sleeping lofts, and similar-type rooms are considered
"bedrooms" according to the.MA Department of Environmental Protection.
(2) The applicant shall record,as.properly worded deed restriction, signed by the owner of the
property, at the Barnstable'County Registry of Deeds restricting the property to two (2)
bedrooms maximum. A copy`of the recorded deed restriction shall be submitted to the
Health Agent prior to obtaringa disposal works construction permit.
(3) The septic system shall b&-installed in strict accordance with the engineered plans dated
February 10, 2005.
(4) The designing engineer shall-supervise the construction of the onsite sewage disposal
system and shall certify in venting to the Board of Health that the system was installed in
substantial compliance with"the submitted plans dated February 10, 2005.
These variances are granted because-the physical constraints at the site severely restrict the
location of the soil absorption system`..:due to location of wetlands and the small size of the lot.
Sincerely yours,
Wayne Miller, M.D.
Chairman z `
q
3�1J I--
- 7"'; a
�QFZHE Tp � DATE:
P FEE:
• BARNSTABLE,
y MASS.
�p i6S9. `m REC. BY
Town of Barnstable
SCHED. DATE:
Board of Health
200 Main Street,Hyannis MA 02601
Office: 508-862-4644 Susan G.Rask,R.S.
FAX: 508-790-6304 Sumner Kaufman,M.S.P.H.
Wayne A.Miller,M.D.
VARIANCE REQUEST FORM
LOCATION
Property Address: r
Assessor's Map and Parcel Number: J�Z l Size of Lot: Z
Wetlands Within 300 Ft. Yes Business Name: -V/#-
No Subdivision Name: 'V0 ,4e1?6--
APPLICANT'S NAME: �[i'o �/gk✓�/t/ Phone �S�g 4 7,6'96
Did the owner of the property authorize you to represent him or her? Yes - No
PROPERTY OWNER'S NAME CONTACT PERSON
Name its` Name: 2`0c-4"?,2�, S7aa/�
�J/s'� � v� .Q�f vat �Gt/���lg-.7 Gl�:f�cr/Z•ti�t/�Lrz397�
Address: �2� �Gv�aER2 C�✓�� Address:
J �r/t/1 /�'1 r � o� � �}s9-.try �✓i�r�, �!� ��.��3
Phone: � �Z 7'egG Phone: JvJ
VARIANCE FROM REGULATION(List Reg.) REASON FOR VARIANCE(May attach if more space needed)
o f 7Z->
T wn/ �Go• ! u -��iai� r�('S/�s) /✓vlTs 6/d4D�.v 721 ��vt��,/ '�✓��'.r2����
---G�'TL��✓as. 90 �� Ud/�,�'_lU� �-�'/� L�3S �w�-� dr6r?z,g-,✓�f ��sS S����/[73
1�94'%S•+•t.b d�fr�� DAJ/r; �
NATURE OF WORK House Addition 0 ????? House Renovation Repair of Failed Septic System
Checklist (to be completed by office staff-person receiving variance request application)
L Please submit copies in 4 separate completed sets.
_ vtrour(4)copies of the completed variance request form
_ ,,"'Four(4)copies of engineered plan submitted(e.g.septic system plans)
- 1/Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans)
X _ ✓Signed letter stating that the property owner authorized you to represent him/her for this request
^t/Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense
(for Title V and/or local sewage regulation variances only)
�✓ Full menu submitted(for grease trap variance requests only)
C:\Documents and Settings\decollik\Local Settings\Temporary Internet Fi1es\0LK3\VARIREQ.D0C
G
REQUEST FOR DET
ERMINATION OF APPLICABILITY ;7. 70 p
ABUTTER NOTIFICATION LETTER
DATE:
RE: Upcoming Barnstable Conservation Commission Public Hearing
To Whom It May Concern,
As an immediate abutter of a proposed project,please be advised that a Request for Determination
of Applicability application has been filed with the Barnstable Conservation Commission.
.APPLICANT:
PROJECT ADDRESS OR LOCATION: 1-53 '941112� Telfd�j �Alule
ASSESSOR'S MAP&PARCEL: / MAP lUZ PARCEL lOg
PROJECT DESCRIPTION: �.lS✓` T10��d/= �rTC��i� �i2
APPLICANT'S AGENT: CS�y�yL'ry �
� 13 17 z�
PUBLIC HEARING: Barnstable Town Hall,367 Main Street, Hyannis
Hearing Room-2nd floor
x DATE:
/ TIME: '7:3d�
NOTE: Plans and application describing the proposed activity are on file with the Conservation
Commission(508 8624093)
Barnstable Request for Determination of Applicabiliy Package rev:08DEC04 Page 5 of 6
BIKE Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands Barnstable
; � WPA Form 1 - Request for Determination of Applicability To n
1639. `0 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
and Chapter 237 of the Code of the Town of Barnstable
D. Signatures and Submittal Requirements
I hereby certify under the penalties of perjury that the foregoing Request for Determination of Applicability
and accompanying plans, documents, and supporting data are true and complete to the best of my
knowledge.
I further certify that the property owner, if different from the applicant, and the appropriate DEP Regional
Office (Southeast Region;were sent a complete copy of this Request(including all appropriate
documentation)simultaneously with the submittal of this Request to the Conservation Commission.
Failure by the applicant to send copies,in a timely manner may result in dismissal of the Request for
Determination of Applicability.
Name and address of the property owner:
Ms, Abbie O' Brien&Mrs Louise Panton
Name
120 Blueberry Lane
Mailing Address
MArstonst ills
cityiro
MA 02648
state Zip Code
Signatures:
I also understand that notification of this Request will be placed in a local newspaper at my expense
in accordance with Section 10.05(3)(b)(1) of the Wetlands Protection Act regulations.
I further certify under penalties of perjury that all abutters were notified of this application, pursuant to the
requirements of Chapter 237 of the Code of the Town of Barnstable. Notice was made by 1st class mail
to abutters whose property touches on the subject parcel.
/1 Signature of Applicant Date
ry
OS—
X S' a Repr entatfve(if any) I Dale
E. Submittal Fee
Include Town submittal fee of$50.00. Check made payable to Town of Barnstable.
Barnstable Request for Determination of Applicability Packa¢e rev:2n1m .—A of(,
oF ,�w Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands Barnstable
Town
• BAMSTAB
M = WPA Form I - Request for Determination of Applicability
�''°.Eot►`e�' Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
and Chapter 237 of the Code of the Town of Barnstable
C. Project Description
1. a. Project Location(use maps and plans to identify the location of the area subject to this
request):
55 Blueberry Lane Marstons Mills
Street Address Village
102 108
Assessors Map Number Assessors Parcel Number
b. Area Description (use additional paper, if necessary):
c. Plan and/or Map Reference(s): Sketch plan or GIS plan Date of plan
Site& Sewage plan,Repair/Upgrade 2/10/05
Title Date
Title Date
Title
Data
2. a. Work Description (use additional paper and/or provide plan(s) of work, if necessary):
641S GZUc.To,t 1 a1-- ��ic%1F-PA
?ntns Pao.I Of 6
' -�� '�b �Zr�,►��"' � •,. �jr� � •�\ lam^
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ill � it• r, •
agg
IMF Mv,
'# •rr. I`�"�'�-4-�,,��� �`� / _ . fir,°�. ;� ,�• '� 1.�.
Moil
All
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t3 Complete items 1,2,and 3.Also complete A. Signature
Item 4 if Restricted Delivery is desired. ❑Agent
X
G Print your name and address on the reverse ❑Addressee
so that we can return the card to you. B. Received=rsy`(;Prin d N� rne • CO,�te of Delivery
toAttach this card to the back of the mailpiece,
or on.the front if space permits. C�
D. Is delivery a �, ��' Yes
1. Article Addressed to: %,) If YES,a add�� No
�.9� fo,�= ��1�//��/vYr�•�C — FEB i
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071 V27Z f/0 GJ �rr2< </f-- Service PS
/ ��3 ¢�j Maid nos Mail
v/ / ❑Registered ❑Retum Receipt for Merchandise
O Insured Mail ❑C.O.D.
4. Restricted Delivery!(Extra Fee) ❑Yes
2. ----
7004 07.50 , 0002 •2564 5812
PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1'540
UNITED;STATES POSTAL SERVICE. First-Class Mail
Postage&Fees Paid
USPS
Permit No.G-10
• Sender:'Please print your name, address, and ZIP+4 in this box •
S 3U�U��C
P
EA4J NO (CA, MA
�� 111111t III III JitIIl4lt III iII III If fit IIf1111111111111111 Ili III
� r -
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n Complete items 1,2,and 3.Also complete A i natu
Item 4 if Restricted Delivery is desired. ❑Agent
n Print your name and address on the reverse ❑Addressee
so that we can return the card to you. - R eiv b ( ' t ame) Date of Delivery
io Attach this card to the back of the mailpiece, ' �` I
or on.the front if space permits.
D. Is delivery address drffereM from Rem 17 ❑Yes
1. Article Addressed to: If YES,enter delivery address below: ❑No
SAND SHORES ASSOC INC 102119
P O BOX 342 r'
MARSTONS MILLS Mq 3. Service Type
❑certified Mail ❑Express Mail
❑Return Receipt for Merchandise
_ 389 O410
2. Article Number
(Transfer from service label)
PS Form 3811,February 2004 Domestic Retum'Receipt 102595-02-M-.1540
UNITED,.STATES'POSTAL SERVICE. `, First-Class Mail
Postage&Fees Paid
USPS
a Permit No.G-10
• Sender; Please print your name, address, and ZIP+4 in this box •
IBC ,
III till till III III III III III III III i11l
0 Complete items 1,2,and 3.Also complete A. Sig
Item 4 if Restricted Delivery is desired. ❑Agent
e Print.your name and'address on the reverse X Addressee
so that we can return the Card to you. B. ecei y(Printed Name)( C: pate of livery
o Attach this card to the back of the mailpiece, J .
or on the front if space permits. 7r7 �' �1
1. Article Addressed to: D. Is delivery address dffQAt�ftdm(itej��1? ❑Yes
If YES,enter delivq,address belowa�� ❑No
102096002 LTL
ORLANDO,THERESA A ET AL <'6*oS
i C/O MAROIS
67 BLUEBERRY LN
3. Service Type ` paAA
M ❑Certified Mail ❑°Express Maii
M'ARSTONS MILLS MA 02648 ❑Registered ❑Return Receipf for Merchandise
❑Insured Mail ❑C.O.D.
4. Restricted Delivery?(Extra Fee) ❑Yes
2. Article Number 7001 1140 0002 9389 0397 Y
(liensfer from seMoe IaW
PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540'
UNITED STATES POSTAL SERVICE' 4
�,!',.( First=Class M'aif
Postage&Fees'Paid
.• '4 USPS
Permit No.G-10
is 1,0 .
Sender:.Please print yoi,&rrarYte, ress, and ZIP+4:in this box •
D 8D DC 1-7al�
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item 4 if Restricted.Delivery is desired. ' ❑Agent
n Print your name and address on the reverse X� ��'.�❑Addressee
so that we can return the card to you. B. Received by(Pri etl°Nanie)�` Aat of Delivep-
io Attach this cans to the back of the mailpiece, - S
or on the front if space permits. y
D. Is delivery address d! ent from`itemy�?j❑Yes
. 1. Article Addressed to: If YES,enter delivery address below: ❑No
BACON,JEFFREY L&M CONNIE
60 RASPBERRY LANE + 3. Service Type
MARSTONS MILLS MA 02648 ❑certified Mail ❑Express Mall
❑Registered ❑Return Receipt for Merchandise
❑Insured Mail ❑C.O.D.
4. Restricted Delivery?(Extra Fee) ❑Yes
2. Article Number
(ltansfer from sendice labeq ( 4 ;i 7 DO,4. 0 7 5 2 0 0 2 R 2 5 6 4 {5 8 2 9' '
Ps Form 3811,February 2004 Domestic Return Receipt-T 102595-0241540
UNITED,STATES'POSTAL SERVICEavL, !7/ Flrst- Ir rr
Pds P d
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II$p':
Per 1Q,'
Sender; Please prfn't YoNf4ii,me' dress, and ZIP+49n this o�`x' ---
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fiH! ! ! i IffilifilMft 11! 13 t ! !!I! ! t t!I'll f
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item 4 if Restricted Delivery is desired. X Agent
13 Print your name and address on the reverse �"� �� Addressee
so that we can return the card to you. 4=4�,
ed by(Printed Name) C. Date of Delivery
c Attach this card to the back of the mailpiece, �.f-yp 3 l0 O�
or on the front If space permits. k ,.
� D. all ry address different from Item 12�3es
1. Article Addressed to:
14 If nter delivery address below: ❑No
I QUATROMONI,FRED P 102107 /�a A- 5�"
QUATROMONI, BARBARA A SPX
20 PRENTISS PLACE 3. Service Type.
❑Certified Mail ❑Express Mail
MEDFIELD MA 02052-1652
❑Registered ❑Return Receipf for Merchandise
❑Insured Mail ❑C.O.D.
4. Restricted Delivery?OFxtra Fee) ❑Yes
2. Article Number 7001 ,1140 0002 9389 0427
(Transfer from service label, - ---- —. —.
Ps Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540'
01� :I•,
UNITED STATES POSTAL SERVICE:
V� ics40VO S FR M
P M t< I
St
� � n
CC
Ci G.�
Sender:.Please print your na' , address, and ZIP+4 in this box
p, o . BOY, ��aq
,5A4JDWtC,4 HA
1 a ���liil��t�t�l�li��tlil��}111���11l�IIIi1�iFlltll4��f�!!t�!!��
a Complete items 1,2,and 3.Also complete A. S`igna re
Item 4 if Restricted Delivery is desired. X ❑Agent
o Print your name and.address on the reverse ❑Addressee
so that we can return the card to you. Received by(Printed Name) C. D e of eliv�
io Attach this card to the back of the mailpiece, 3 9
or on the front if space permits.
D. Is delivery address different from hem 1? ❑Yes
1. Article Addressed to: If YES,enter delivery address below: ❑No
f 102096001
SIMSER,DAVID H
P O BOX 767
E FALMOUTH MA '02536
. ... . � 3. Service Type
❑Certified Mail ❑Express Mail
---- -- ---- -- ❑Registered ❑Return Receipt for Merchandise
❑Insured Mail ❑C.O.D.
_ -4. Restricted Delivery?(Extra Fee) ❑Yes
2. Article Number 7001 1140-0002 9389 D4D3
(Transfer from service label) —
e
PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540
UNITED STATES,POSTAL SERVICE: First-Glass Mail
Postage&Fees Paid
USPS
Permit No.G-10
• Sender: Please print,your name, address; and ZIP+4 in this box •
S �SU�V Tljc.
---------------
to Complete items-1,2,and 3.Also complete A. Signatu
item 4 if Restricted Delivery is desired. X ❑Agent
Io Print your name,and address on the reverse ddressee
so'that we can return the card to you. B. Iv d by(Printed Name) C. Date of Delivery
n Attach this card to the back of the mailpiece,
or,on the front if space permits.
D. Is delivery address different from item 1? ❑Yes
1. Article Addressed to: If YES,enter delivery address below: ❑No
102098
NELSON,CYNTHIA A&LINDA E
' 50 RASPBERRY LN
MARSTONS MILLS MA 02648 3. Service Type
r I ❑Certified Mail ❑Express Mail
❑Registered ❑Return Receipt for Merchandise
❑Insured Mail ❑C.O.D.
'4. Restricted Delivery!(Extra Fee) ❑Yes
2. Article Number
(Ranter from service labeq j j7 0.0 4' ;O i7 5 0 0002 25634 'S 8'3 6°; i
Ps Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540
UNIYED STATES.PosTAL SERVICE;_ �J�M4 First-ClassMail
F�osYage�&*`Ogs PfiPd i Usps
Permit No.G-10
• Sender: Please print yourr; ie,lad ess, and ZIR+4 in this box •
i5'A S s vPUL1�-7Y --lvc.
sAu Dui rc4+ tit A
1t!►����t�l�l�l,�t!l���li�„�i1l,��l��t�tt►t��„t�t1�t,��t��t1
TOWN OF BARNS LE °
LOCATION c.� v� ,�j P.r -� SEWAGE #'e00J_0?3:5'
VILLAGE/l�l�►" / ASSESSO 'S MAP & LOT
INSTALLER'S NAME&PHONE NO. zl,�
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) (size)
NO.OF BEDROOMS
BUILDER OR OWNER _4
PERMITDATE:� Z 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 11'
within 300 feet of leaching facility ! = Feet
Furnished by zgve
o � �3 zS .
63
ZO
o �z Zq
.Bs 1 7
3b
No *ee
THE COMMONWEALTH F SACH�S S Entered m computer:
LT
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
® � 01ppriration for Mig ool mem Cott�truttior� Permit
� p
Application for a Permit to Construct(.✓)Repair(Y)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. �j��S0/1I-5 ems Owner's Name,Address and Tel.No.
"MI�E,� 'l2 j�,C�'' 61 L o iJ r 5 r x1 N To i�
Assessor's Map/Parcel
io _- 11 ,LD /' �'� /�� �v ep ek 2 y .C�✓/lA/1"57ZVs S
Instal Name,Address,ji4 Tel.-No. p Designer's Name,Address and Tel.No.
Type of Building:
Dwelling No.of Bedrooms Lot Size 1 40 sq.ft. Garbage Grinder(C3)
Other 'Type of Building No.of Persons 2 Showers Cafeteria( )
Other Fixtures
Design Flow -Vo gallons per day. Calculated daily flow ZZO gallons.
Plan Date /O U Number of sheets Revision Date
Title
Size of Septic Tank � Type of S.A.S. " 'n
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issue y this Board of eal
Signe Dat O
Application Approved by 4 Date 440
Application Disapproved or the following r s s
Permit No. Date Issued
3 No ee
com
Y THE COMMONWEALTH OF SSACHUS S e uteri p
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
hratton f r w.
o �tg�ogaY �pgten� �ongtrurttor� hermit
Application for a Permit to Construct(✓)Repair(ice)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Locatio ddress or of No. Owner's Name,Address and Tel.No. �"S(J�-4425—70�6,
Assessor's Map/Pazcel V 5 TO/?�
/0a2.— a8 iLD% �f9 / �<vebEER2y .CN, �IA/�Sio�r�56 S
Instal Name,Address, Tel a ! ,2 o Z 1�� Designer's Name,Address and Tel.No.
Type of Building:
Dwelling No.of Bedrooms�_ Lot Size Ov sq.ft. Garbage Grinder(0)
Other .Type of Building ,0S No.of Persons Z, Showers( /) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow Z Z U gallons.
Plan Date /O 0 Number of sheets Revision Date
Title
Size of Septic Tank f y 1 Type of S.A.S.
} Description of Soil ��iQ!/I(/�'Y� ��✓1 Cl' ,
1
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
,.,Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordant&with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- t `
cate,of,Compliance has been issue by this Board ofea .- r A
Signe r. Date) c e
Application Approved by Date
Application Disapproved or the following r l%t4s
Permit No. Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certtftrate of (Compliance
THIS IS TO CERTIFY that the On-site Sewage Disposal System Constructed( )Repaired (/r.)Upgraded( )
Abandoned( )by
at 55Lq PC) has bppjDconstructed in acco dance
with the provisions of Title 5 and the for -sposal System Construction Permit No dated d & 5
Installer Designer
The issuance of this permit hall not be construed as a guarantee that th�stem c'on s designed.
Date D Inspect((,
------------------------------
Fee_1522551
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
Mtzpooat bpgtetu Con0trurtton Vermtt
Permission is hereby gr ted to Constru t )Repair( pgr de A-bandon )
System located at , _
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 ' n mute co• pleted within three years-of the date ofWr
Date: / Approved by 4P Z3
DIwED RESTRICT 135-25-29305 a 03 m 19�
WHEREAS, ��U/S �/Z/ �y of
(owner's name) _
(address)
is the owner of ,�S_ ���J�, G / .C��2/ located
_ (address)
at ,�/��Si D Z22///...-Si�S
MA (hereinafter referred to as
and being shown on a plan entitled "Subdivision of Land`h
MA Property of
_ ►'. :Kr
et al, duly recorded in Barnstable County Registry
of
Deeds in Plan Book 9/ Page
Or on Land Court Plan Number �-
WHEREAS, ,��' /SC ,�� 11_,J Z 1� as the owner of said lot has
(owner's name)
agreed with the Town of Barnstable Board of Health to a restriction as to the
number of bedrooms which can be included in any home built,on said lot as a
pre-condition to obtaining a disposal works construction permit in compliance
with 310 CMR 15.000 State Environmental Code, Title V,--Minimum
Requirements for the Subsurface Disposal of Sanitary Sewage;
WHEREAS, the Town of Barnstable Board of Health, as a pre-condition to
granting a disposal works construction permit for a septic system in compliance
with 310 CMR 15.200, State Environmental Code, Title V, Minimum
Requirements for the Subsurface Disposal of Sanitary Sewage, and authorizing
the issuance of a building permit for the construction of a single,family home on
this property, is requiring that the agreement for the restriction on the number of
bedrooms in any house constructed on the lot be put on record with.the
Barnstable County Registry of Deeds by recording this document,
deedr
r
NOW, THEREFORE, 4p,_11.5 d �' ��I✓Yig n1 does hereby place the
(owner's name)
following restriction on his above-referenced land in accordance with his
agmem-eatwith_the_.To_wa ofBa.rnstable-Board--of-Heafth;-whieYr-r-estfietion-s-hall
run with the land and be binding upon all.successors in title:
1. "`—� !L&_ 2�-ele,2y /�J�/r may have constructed
(address)
upon the lot a house containing no more than (Z) bedrooms.
�vvis�C P,-)nfTd agrees that this shall be permanent deed
(owner's name)
restriction affecting located on MA, and
being shown on the plan recorded in Plan Book_7-761 f , Paged ZD Z .
Or on Land Court Plan
For title of see the following deed: Book , Page
Or Land Court Certificate of Title Number
Execute s a sealed instrument day of
wner's signature
Owner's signature
Owner's signature
COMMONWEALTH OF MASSACHUSETTS
�9PEtAInIL• , ss
Alay 20015�'
Then personally appeared the above=named
known to me to be the person who executed the foregoing instrument and
acknowled ed
the same to be free act and deed, before me,
Notary
: 4
Public,,"I Q;•NEIYp� `
No:'• •'g commission expires:
i
"s NEAL PMNESSEY, Notary Public
2'~• Commonwealth of Massachusetts
deedr R`•pv® My Commission Expires May 21, 2010
idols 411111110%Y. ,,1 AAPMgT R1, P RPMSTPY OF DEED,
2-15-05
SITE: 55 Blueberry Lane
Marstons Mills, MA 02648
Map 102 Parcel 108
TO: Barnstable BOH and Conservation Commission
We give permission to EAS Survey to represent us at the public hearings
concerning the above referenced site.
W.R. (Bud)Panton
Louise Panton
Town of Barnstable P#
nt of Regulatory
� Departtne Services
�WABI ,
Public Health Division. Date
MAq
1639• 200 Main Street,Hyannis MA 02601
Yw 1d�
ArED MPS�
Date Scheduled Time 1 l Fee Pd._/_�LU—
Soil Suitability Assessment for Sewage Disposal
Performed By �rD 2� Witnessed By: p4
LOCATION&GENERAL INFORMATION
Location Address �S / Owner's Name 1(�fy'eyl
�IJe�Z hk�� / ZD a'I'le t'"�
Address �QV✓ l-e ZG ,
Assessor's Map/Parcel:
Engineer's Name S �'ll�Gl/G`r rod 57�0VIAC
Al—
NEW CONSTRUCTION REPAIR Telephone# �' 36 / � � r,4,91,
o CUD
Land Use Z � G�(S/Gb�/�r6� Slopes Surface Stones /
/
Distances fro m: OpenWatcrBody 4 g p W nA ea 009 t ft Drinking Water Well
m Drainage Way � ft Property Line / "� # ft Other2 Z®
SKETCH:(Street name,dimensions of lot,exact locations of test holes&pere tests,locate wetlands in proximity to holes)
/ 7w
WSJ ry
G�ZC J
+ � re,
V J
I
rP''�Dw.lf w.t� _ ahe/ 6£i�/ tjLrc.1✓�84z7 F i- G 9
Parent material(geologic) epV 7-t-61 Depth to Bedrock
Depth to Groundwater: Standing Water in Nole: (�45 Weeping from Pit Face..:.._�--
e 2�A?1 Ne q✓O �®F5/�✓EC�✓?ivn/> �DI?/¢
Estimated Seasonal High Groundwater
DETERM NATION FOR SEASONAL HIGH WATER TABLE
Method Used:
/4• 166'1 In. De th M soil mower: %
Depth Observed standing in ohs.hole P
Depth to weeping from side of ohs.hole: 'yam ln. Groundwater Adjustment S
Index Well#49t ZrJ Reading Date/ Index Well level ✓ Adj.factor„� Adj.Groundwater level
PERCOLATION TEST Date 7t'Inte ��
It 7
Observation1 • lj
Hole# �a � ��^/ � / Time at 4"
Depth of Pere /�O�/ r^/_ o ^'� Time at 6"
Start Pre-soak Time @ Time(9"
End Pre-soak
Rate MinAnch
Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) y r�
Original: Public Health Division Observation Hole Data To Be Completed on Back
***If percolation test is to be conducted within 100'of wetland,you must first notify the
Barnstable Conservation Division'at least one(1)week prior to beginning.
Q:\SEPTIMERCFORM.DOC
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders.
Consistent %Gravel
!a k `Y3
24„4z /DXX
yv
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
n isten % ravel
h
- a
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other,
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistent %Gravel
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
nsi to 13 I
Flood Insurance Rate May:
Above 500 year flood boundary No_ Yes
within 500 year boundary No— Yes
Within too year flood boundary No___•_ Yes
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring pervt k terial exist in all areas observed throughout the
area proposed for the soil absorption system? _ 1`
If not,what is the depth of naturally occurring pervious material?
Certification y /`'93J I have passed the soil evaluator examination approved b the
I certify that on � �_ (date) p pp y
Department of Environmental Protection and that the above analysis was performed by me consistent with
the required.training,ex ertise and a eri c escribed in 310 C1VIR 15.017.
• �. � d�� Date �� d.�
Signature
Q:GSEPTIOPERCFORM.DOC
Town of Barnstable
Regulatory Services
o*
Thomas F. Geiler,Director
• s�Rrisi`Ast.E,
M^ Public Health Division
Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Installer & Designer Certification Form
Date: �- Z - 02
Designer: G�/L�/<1�''I �'c% In
g staller: �l�✓r�d'/��f
Address: L S U2�icYPI, Address: 1 �� ✓1/cif G'o/ /�Gj
On k � was issued a permit to install a
(date) X (installer)
septic system at SS ge�E�fn�� L��/C�. based on a design drawn by
�S•10Z oV& 18 4/�c`nA,-01/ dated Z-
(designer)
� lo -Z-off
V 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.
....;�
o��fEALTo �e
�'9 e
( aller's Sign e) No FR M
? wy
��Oo �
:Fs CO
►.y�q�ENGINES
(Designer'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/Desiper Certification Form
DATUM4 SYSTEM PROFILE.
AIRPORT
NOT TO SCALE
VERTICAL DATUM: BARNSTABLE CIS MSL±
149
J
RACE LANE BENCH MARK USED: TOP OF FOUNDATION
ELEVATION 61.00
SYSTEM DESIGN
TOP OF FOUNDATION
RAJSE,COVERS TO W IN 6" OF FINISH GRADE
W
ELEV. 61.00 DESIGN FLO
CENTER OF ONE
LAKESIDE CHAMBER RISER � 2 BEDROOMS AT11Q. GPB/0 2211 GPD
DRIVE FINISH GRADE
FINISH GRADE 'RAISE ,TO 1MTHIN
GRADE'
ELEV. 60.1 ELEV.,59.80 , FINISH GRADE OF FINISH
GROUND ELEVATION 57.30
REQUIRED,SEPTIC TANK
N �,AA Z S ELEV. 58 30
SHUBAEL
P 59V
v-N�K,7 7, 1��7/1 11 M
POND
32'OS-0.03 IN.-3' MAX-COVER 220 x 2 440 GAL
" TOP ELEV'55.30 SEPTIC TANK PROVIDED -1t0-�.GAL
LOCUS 16,os=0.198
40 PVC SCH 40 TEE 16'oSwo.ol 0 2* MIN 1/8'-1/4"', DOUBLE WASHED PEA,STONE
60, 0 0 0,
SCH 40 "INV.- 2"MIN-S"MAX 0 0
10. - -- I SIZE OF LEACHING FACILITY REQUfRED
OJL 0
0
;C4 INV.= 8.90 57.90 100TEE 14"TEE INV.-57.70" 0 0 10060
OF, 0000 0 0 .3/40 DOUBLE WASHED STONE
0 OR] - 0 DESIGN PERC RATE < IN./INCH
-7w '0 " 800 0
59
GAS BAFFLE �5 OUTLET LONG TERM APPL. RATE-9--74 GPD/S.F.
-6 %3--Ow
41 TWO H---;20 4! '1 O*xS* 6
'42 IV-iw QUID VEL
D-BOX 500 GALLONS CHAMBERS -
LE 49 4" -54.53 INV. 54.30/
ELEV. �54± INV. SI ZE OF LEACHING SYSTEM PROVIDED:
Ll S.A.S. (9.0- x 210)
INV.-54.36
�IL w
ELEV
ir 52.30 0.74 G/S.F. -19-8S.F. MIN. REQUIRED
0 Gel 220 GAL
LOCU S M AP
53.4
NOT TO SCALE:
USING 2 CHAMBERS W TH 2' STONE AROUND
6" BASE OF CRUSHED STONE
P-10,882 OR MECHANICALLY COMPACTED TEST PI T #1 ELEV 48.3 ADJ. GROUNDWATER
SIDEWALL = 2(9'+21') x 2' 120S.F.
1.500 GALLON
D.T.H. #1 1 VARIANCE IS REQUESTED. BOTTOM - 9 , x 21' 189S.F.
PRECAST CONCRETE
JANUARY 7, 2005 SEPTIC TANK TOTAL LEACHING AREA 309S.F.
GROUND ELEV 56.50 309S.F x 0.74 G/S.F. 228GPD
GROUNDWATER 0 168"
228CPD PRbV`IDED > 220 GPD REQUIRED - 8 GPD RESERVE
A
NO (GARBAGE DISPOSAL GRINDER .ALLOWED)
LOAMY SAND
1 OYR 3/3 6 0 CAPE COD COMMISSION ADJUS 0
B
LOAMY SAND DEC 2004, WELL SDW253
LOT 90
102/96�2 LOCUS INFORMATION
24" INDEX 51.6 ADJ. 5.8'
ELEV 54.5 ORLANDO, ET. AL. OAK
N/F THERESA A.
ZONE B
C-1
LOT 77 #67 BLUEBERRY LANE
COARSE SAND
102/96-1 MARSTONS MILLS, MA 02648 PINE
10YR 6/6 CURRENT :OWNER Ms. ABBIE M. O'BRIEN
42" N/F DAVID SIMSER *N11
Mrs. LOUISE 'PANTO,N
N%
P.O. BOX 767
Q HOLLY
EAST FALMOUTH, MA 02536 >
bt %6 ADDRESS 55 BLUEBERRY LANE
to / �qil-, 4� I :
MARSTONS MIH S,
60
C-2 48.3 MA 02648
MEDIUM SAND 4RON PE
5.8 ADJ.
r
ol "W, DEED REFERENCE 7791/202
2,5Y 7Z4 -00'oo
<::I-= 42.5 N87
168
ELEV 42.5 r
138/25, LOT 89
CD
IRON IPE WF#A2 PLAN REFERENCE
B.O.H. IFOUN -7
DAVE STANTON
'Ile NITROGEN DISTRICT, YES- ZONE It
SOIL EVALUATOR.
ED. STONE r "C" 8/15/85
/* FLOOD ZONE
PROPOSED
BACKHOE OPERATOR. 16' 9'x2l* ,S.A.S. c to 250001-15C
GENE FRIEH C-4
c)
SOIL TYPE: PUMP AND ABANDON/. D 1 ASSESSORS MAP 102
nc
<2 MIN. PER INCH f rr,'* m Q
PERC RATE: REMOVE EXISIING f )- ,-,-- PARCEL----
RELOCATE STEP . ,00
0.74 GAL/SF/MIN
ACOMPONENTS C5 lt
LOADING RATE:
SEPT"' TU ALLOWFO�,� x
4::�(q'0 -j
IN ACCORDANCE S 15 IN -PROPOSE ADING
0 C*4wm - LOT AREA 10,400± S.F.
WITH TI TLE 5. %0 O'N EV 54.3
INDICATES DEEP
DTH il a: z
0
TEST HOLE ADJUSTED EXISTING BITU
CONCRETE DRIVEWAY
MINOuS
GROUNDWAT ER
GROUNDWATER
10.7'
INDICATES 1 .5' got 73 f
1�. VAR.1 AN CES REQUESTED
P-1 A PERC .TEST z
DEC
60"
2 To
8 TBM IERS EXCAVATOR 3
10 CMR 15. TITLE 5: A TWO BEDROOM DEED RESTRICTION IS TO BE RECORDED
REMOVE E:xisnNG
ELEV OtE f WF#A3
AT THE BARNSTABLE REGISTRY OF DEEDS.
cu 61.00 CONCRETE: WALK
%D ENCL D
PORCH
GENERAL NOTES* UNEXCAVATED 310 CMR 15.212 5- OF SEPARATION REQUIRED. 4" OF SEPARAT10N PROVIDED
REPLACE PIPE I Fl u 310 CMR 15.405(i) A 1' VARIANCE IS REQUESTED
1. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. W114 SCH 40 CELLAR FOU DA71ON WF#A4
N OF BARNSTABLE RULES AND REGULATIONS z PVC 4"DIA 1 41
TITLE V AND THE r TOW #55 ,
FOR SUBSURFACE DISPOSAL OF SEWERAGE. EXISTING WA R SER VIC w
PROPOSED E
M z
TOM OF BARNSTABLE 360.1 100' MINIMUM SEPARATION TO WETLANDS. 90' PROVIDED
2. AT LEAST ONE ACCESS POINT OVER TANK TEES SHALL BE 2 BEDROO
FERNCO A 10' VARIANCE IS REQUESTED.
ACCESSIBLE WITHIN 6" OF FINISH GRADE, WITH ANY REMAINING IN
CONNECTOR DWELLING
ACCESS PORTS BROUGHT TO WITHIN 12" OF� FINISH GRADE. Co
WITH C.O. kD
3. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE TCF 61.00
CAPABLE OF WITHSTANDING H-10 LOADING UNLESS THEY ARE
UNDER OR WITHIN 10' OF DRIVES OR PARKING AREAS THEY INV.
58.90 ro
MUST WITHSTAND H-20 LOADING.
LOT 78
4. THE EXCAVATION CONTRACTOR SHALL VERIFY THE LOCATION
102/97
OF ALL UTILITIES PRIOR TO ANY EXCAVATION LOT 80
N/�' JEFFREY & CONNIE BACON
SrTO GRADE
5. ANY MASONRY UNITS USED TO BRING COVER
#60 RASBERRY LANE 109400± S.F.
OR WITHIN 6* ,OF GRADE SHALL BE MORTARED IN PLACE.
M�RSTONS MILLS, MA 02648
6. FINISH GRADE SHALL HAVE A MINIMUM eOFO.02 FEET PER GAS
AND DISTRIBUTION BOX. METER
FOOT OVER THE S.A.S. fy*l SI TE AND SEWAGE PLAN
WF#A5
SCHEDUI E 40 PVC AND SHALL EXTEND A 'MINIM
7. SEPTIC TANK SANITARY TEE'S SHALL BE CONSTRUCTED OF L I
UM OF 6" ABOVE REPAIR UPGRADE
THE FLOW LINE AND SHALL BE ON THE CENTERLINE AND
LOCATED DIRECTLY UNDER THE CLEAN OUT MANHOLES. IN. cn
8. THE INLET PIPE INVERT ELEVATION SHALL BE NO LESS THAN
55 BLUEBERRY LANE
c
2 INCHES NOR MORE THAN 3 INCHESIABOVE THE INVERT W
IN
ELEVATION OF THE OUTLET PIPE.
GAS
9. THE SEPTIC TANK SHALL HAW A MINIMUM COVER OF 9 INCHES
VICC MARSTONS MILLS, MASSACHUSETTS
10. THE OUTLET SANITARY TEE SHALL BE EQUIPPED WITH ,A GAS
BAFFLE, 4 INCHES IN DIAMETER AND 'CONSTRUCTED OF 4" P VC c SCALE 1 =10 DATE: 2/10/05
11. ALL PIPES SHALL BE SCHEDULE 40 PVC SEWER PIPE AND
SHALL BE SLOPED 1/4 INCH PER FOOT MIN. EXCEPT FOR THE A
FIRST TWO FEET OUT OF THE DISTRIBUTION BOX MICH SHALL
PREPARED FOR:
BE LEVEL
12. CHANGES OR REMSIONS TO SEPTIC DESIGN REQUIRE NOTIFICATION 0 Mr. BUD PANTON
TO EAS SURVEY INC. FOR B.O.H. AND DESIGN ENGINEERS REVIEW D
AND APPROVAL. 0 120 BLUEBERRY LANE
CL
IRONBAR MARSTONS MILLS, MA 02648
100.00 WF#A6
FOUND
N87*00'oo"W 0 C)
CONSTRUCTION NOTES: (508) 428-7886
to 0
LOT 79
S / 16 cl
1. CONTRACTOR INSTALLERS SHALL VERIFY GRADES AND 102/98 C.�w z
ELEVA71ONS AND SITE CONDITIONS PRIOR TO COMMENCING N/F CYNTHIA & LINDA NELSON LOT 88 cn PREPARED BY:
k#AA:4
0 0
WORK ON THE SITE. #50 RASBERRY LANE 102/167
o 63
0:
2. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE MARSTONS MILLS, MA 02648 N,,�� FRED & BARBA0A QUATROMONI EAS SURVEY, INC.
ED' ' j
WITH DEEDED OR ZONING REGULATIONS. OWNER / APPLICANT #20 PRENTICE PLACE ui
A.,
141 RT. 6A
IS TO OBTAIN SUCH ,DETERMINATION FROM APPROPRIATE AUTHORITY. im MEDFIELD, MA 02052 50
0
10 15 20 , 30 ON
3. VEHICULAR TRAFFIC, PARKING OF VEHICLES AND PLACING 0
P.O* BOX 1729
0
MATERIALS OVER THE SEPTIC TANK, DISTRIBUTION BOX AND
S.A.S. AREA IS PROHIBITED SANDWICH, MA 02563
z
-3619
PH. (508) 888
GRAPHIC. SCALE: 1 INCH 10 FEET
FAX (508) 888-2496
Nln9l NI'c 4GRADE
L
RE E
F
E'jV. 5 _80
Z_
L032
"ME
Z 6"
5 E
Wn T 'IN:V.-
D B X
I V
N 1504.53