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Home My WebLink About0109 BLUEBERRY LANE - Health L 0 9 Blueberry bane Marstons Mills A= 102 - 113 f c No. goo — 17f. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes application for Misposal 6pstetu Construction i3ermit Application for a Permit to Construct( ) Repair(-_�Upgrade( ) Abandon( ) [:]Complete System ❑Individual Components Location Address or Lot No./0 f li. Ur Z� - Owner's Name,Address,and Tel.No. Assessor'sMap/Parcel t.�s�riv� $ lyl�r�l S I/ A.f n L �6nCei�vts Installer's Name,Address,and Tel.No. 5-1311 /3 4' Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) N gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank�J 5 UJ Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) �e C, 4< 0, }014 C—e Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Healt r Signed Date �= _ J Application Approved by L..,�T �-S Date Application Disapproved by Date for the following reasons Permit No. 9 61`( I} Date Issued S s#Y ,"• i , No. Fee THE;COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01pplication for Oisposal &pstem Construction permit Application for a Permit to Construct( ) Repair(X Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No./V Ift�C �ti�� ZGw-e- Owner's Name,Address,and Tel.No. Assessor's Map/Parcel yyf�✓,lf�in S /�•'//S n L frd n C �v r S Installer's Name,Address,and Tel.No. 51mf 3 4e Designer's Name,Address,and Tel.No. .Type of Building: . Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) �. Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) /V/4 gpd Design flow provided gpd' Plan Date Number of sheets Revision Date =. Title Size of Septic Tank 1 t U y .,i Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) G /a u E � _IJ2C &G e-e- Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health Signed //�� .✓ Date 1S- Application Approved by - „�, e ' t J S Date Application Disapproved by ± Date for the following reasons Permit No. q 61 C( Date Issued --------------------------------------------------------------------------------------------------------------------------------------- � �^ THE COMMONWEALTH OF MASSACHUSETTS l� BARNSTABLE,MASSACHUSETTS VVf r f,n Certificate of Compliance . .THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) Abandoned( )by ±r.1 u J-7 t9 4-C Q/e% , .� at J e 6 e i/y GCc L► t has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.d?oi9 - I�6 dated S 1 S*t Installer Designer ^/ #bedrooms Approved desigows /V gpd The issuance of this permi shall not be construed as a guarantee that the system will f nchon sIdesigned. Date -I Inspector No. I Fee 7 5 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Misposaf 6pstem Construction i3Prmit Permission is hereby granted to Co truct( ) Repair( ) Upgrade( ) Abandon( ) System located at and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. . Provided:Construction must be completed within three years of the date of this permit. �,.-, Date S_ ( `7' r I Approved by �' J Town of Barnstable Barnstable AD-Amedca City Inspectional Services BA WrXSM M" . Public Health Division i63q. �� m prfi°1"0�s 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas A.McKean,CHO FAX: 508-790-6304 CERTIFIED MAIL#7015 1730 0001 4987 7763 May 14, 2019 ELAINE GONSALVES 16 UNION STREET FRAMINGHAM, MA 01702 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 109 Blueberry Lane, Marstons Mills,was inspected on 05/07/2019 by Michael DiBuono, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Conditionally Passes" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: C The main line needs to be repaired and the septic tank needs to be sealed. You are ordered to repair or replace the septic system before occupancy. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH c e n � S. CFIZT- Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Conditionally Passes Letters\109 Blueberry Lane Marstons Mills 2 of 2.doc Bk 31944 Pg98 #15748 04-10-2019 @ 03:06p QUITCLAIM DEED I,Lisa M.Fitzgerald,individually,of for consideration paid in the amount of ONE HUNDRED SIXTY-FIVE THOUSAND&001100 pp ($165,000.00)DOLLARS, o NT to Elaine Gon��6Uni�onSt,,et�Famii,�gha-,M�assa,-hu�settsOI7�02tts 01702 4 with QUITCLAIM COVENANTS, The land together with the buildings, if any, thereon situated in the Village of Marstons Mills, Town and County of Barnstable,Massachusetts,being shown as Lot(s)No.94 on a Plan entitled: R "Subdivision Plan of SAND SHORE,a Wooded Area in Marstons Mills, Barnstable,Mass. for E Hia Pearl Corp." dated October, 1957, Gerald A. Mercer& Co., Engineers, recorded with the a Barnstable County Registry of Deeds on October 17, 1957 in Plan Book 133,Page 25. Said parcel is subject to and has the benefit of all rights,easements,grants,restrictions, W reservations,covenants and encumbrances of record insofar as the same are now in force and applicable. m o� o Grantor hereby revokes any and all homestead rights in the property and certifies under the pains i and penalties of perjury that there are no other persons who are entitled to homestead rights in the subject premises. Q a a ° For title,see deed recorded with the Barnstable County Registry of Deeds at Book 27969,Page a 54. * MASSACHUSETTS STATE EXCISE TAX BARNSTABLE COUNTY EXCISE TAX .BARNSTABLE COUNTY REGISTRY OF DEEDS BARNSTABLE COUNTY REGISTRY OF DEEDS .Date: 04-10-2019 C 03:06pm Date: 04-10-2019 A 03:06pm :Ctl#: 989 Doc#: 15748 Ctl#: 989 Doc#: 15748 :Fee: $564.30 Cons: 9165.000.00 Fee: 9504.90 Cons: 9165.000.00 ��OF THE TOh�O� Town of Barnstable = aXMSTABr.E. 9�p b 9 ,�� Regulatory Services Department rfo�►�" Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 5/11/16 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An "x" marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ONE (1) YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑ Any portion of the cesspool within a Zone 1 to a public well ❑ Any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). l TWO (2) YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑ Any "conditionally passed systems" (broken cover, relocation of a pipe, relocation of a driveway due to H-10 components, etc) ❑ Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER Repair deadline: Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc c ; Commonwealth of Massachusetts y Title 5 Official Inspection Form is Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 109 Blueberry Lane t , Property Address P.7 Excel Building Owner Owner's Name information is required for every Marstons Mills Ma 02648 5/7/19 s" page. Cityrrown State Zip Code Date of Inspection'.''a 5.g 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 Sl - (39-9 cion the computer, Michael DlBuono use only the tab key to move your Name of Inspector cursor-do not DiBuono Sewer And Drain use the return Company Name key. 35 Content Lane r� Company Address Cotuit Ma 02635 Citylrown State Zip Code 508-364-9587 S113522 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 5/8/19 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 Commonwealth of Massachusetts Title 5 Official Inspection Form e Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 109 Blueberry Lane Property Address Excel Building Owner Owner's Name information is required for every Marstons Mills Ma 02648 5/7/19 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: ❑ 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: 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): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 coo, Commonwealth of Massachusetts Title 5 Official Inspection Form 1' a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,- � 109 Blueberry Lane Property Address Excel Building Owner Owner's Name information is Marstons Mills Ma 02648 5/7/19 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): System contains a 1500 Gallon septic tank as well as a concrete distribution box and 20 Arc 36 Infultrator units. Tank is leaking at the seem. Main line has been cut and needs to be replaced. Tank should also be pumped. ❑ 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): 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: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts e Title 5 Official Inspection Form 1 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 109 Blueberry Lane Property Address Excel Building Owner Owner's Name information equir for is every Marstons Mills required for eve Ma 02648 5/7/19 page. Cityrrown 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. t ❑ 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 ❑ ® 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Forums Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 109 Blueberry Lane Property Address Excel Building Owner Owner's Name information is required for every Marstons Mills Ma 02648 5/7/19 page. Cityrrown 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 '/2 day flow ❑ ® 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 water supply 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 2000 gpd- 10,000 gpd. ❑ ® 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 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form P. Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 109 Blueberry Lane Property Address Excel Building Owner Owner's Name information is every Marstons Mills required for eve Ma 02648 5/7/19 page. Citylrown 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 a//inspections: Yes No S ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u- 109 Blueberry Lane Property Address Excel Building Owner Owner's Name information is required for every Marstons Mills Ma 02648 5/7/19 page. City/Town State Zip Code Date of Inspection D. System Information 1. 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 Description: Number of current residents: vacant Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ❑ No Water meter readings, if available (last 2 years usage (gpd)): N/A Detail: Sump pump? ❑ Yes ❑ No 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 Commonwealth of Massachusetts �e ,F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 109 Blueberry Lane Property Address Excel Building Owner Owner's Name information is required for every Marstons Mills Ma 02648 5/7/19 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 2. 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 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: Pumping is recommended Was system pumped as part of the inspection? ❑ Yes Z 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 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 109 Blueberry Lane Property Address Excel Building Owner Owner's Name information is required for every Marstons Mills Ma 02648 5/7/19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 4. 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): Approximate age of all components, date installed (if known) and source of information: installed 1/26/13 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 2 feet Material of construction: ® cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Main line needs to be replaced to tank t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form �a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 109 Blueberry Lane Property Address Excel Building Owner Owner's Name information is required for every Marstons Mills Ma 02648 5/7/19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 1.5 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) 1500 Gallon septic tank. Tank is leaking at the seem If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 Sludge depth: 3 Distance from top of sludge to bottom of outlet tee or baffle 24" Scum thickness 3" Distance from top of scum to top of outlet tee or baffle 4" Distance from bottom of scum to bottom of outlet tee or baffle 30" How were dimensions determined? Tape Measure Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form l Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 109 Blueberry Lane Property Address Excel Building Owner Owner's Name information is required for every Marstons Mills Ma 02648 5/7/19 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 7. 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 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): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 C Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 109 Blueberry Lane Property Address Excel Building Owner Owner's Name information is required for every Marstons Mills Ma 02648 5/7/19 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): Depth of liquid level above outlet invert level and at normal level 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 cam, Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 109 Blueberry Lane Property Address Excel Building Owner Owner's Name information is required for every Marstons Mills Ma 02648 5/7/19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(Cocate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): *If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Dry Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ® leaching fields number, dimensions: 14.2x20' ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 Commonwealth of Massachusetts ,� Title 5 Official Inspection Form la Subsurface Sewage Disposal System Form -Not for Voluntary Assessments V y 109 Blueberry Lane Property Address Excel Building Owner Owner's Name information is Marstons Mills required for every Ma 02648 5/7/19 page. Clty/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.): Dry at time of inspection 12. 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 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 Commonwealth of Massachusetts Title 5 Official Inspection Form �e Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 109 Blueberry Lane Property Address Excel Building Owner Owner's Name information is required for every Marstons Mills Ma 02648 5/7/19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 13. 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18 Commonwealth of Massachusetts �e Title 5 Official Inspection Form . Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 109 Blueberry Lane Property Address Excel Building Owner Owner's Name information is required for every Marstons Mills Ma 02648 5/7/19 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 5/812019 Assessing As-Built Cards TOWN OFBARNSTABLE Err � SEWAGE# IACATION Ip tD�f 11 ASSESSOR'S MAP&PARCEL IDS"II yELAGE INSTALLER'S NAME&PHONE NO SEPTIC TANK CAPACITY ! D� ,y, (size) LEACHINGFAC M No,OF BEDROOMS—, owe �o to /. COMPLIANCE DATE: I _� PERMITDATE: . 13 Separation Distance Between the: Fad" Maximum Adjusted Groundwater Table to the Bottom of Leac�ng tY l-- Feet well and Leaching FacilityV any wellseaston Feet Private water Supply �� rf site or within 2W feet of leaching tywetlands et. within Edge of Wetland and Leaching Facility any Fed 300 fed of leaching facility) FUSHED BY https://townofbarnstable.us/Departments/Assessing/Property_Values/HMdisplay.asp?mappar=102113&seq=2 1/2 cam, Commonwealth of Massachusetts Title 5 Official Inspection Form �o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 109 Blueberry Lane Property Address Excel Building Owner Owner's Name information is required for every Marstons Mills Ma 02648 5/7/19 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 1+ 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: 4/20/13 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: Test hole data on plan 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 109 Blueberry Lane Property Address Excel Building Owner Owner's Name information is required for every Marstons Mills Ma 02648 5/7/19 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ❑ 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 1 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 Town of Barnstable Barnstable kwltd ~° Inspectional Services ;esieaC i BA STABLE, A9.i639• �� Public Health Division 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas A.McKean,CHO FAX: 508-790-6304 CERTIFIED MAIL#7015 1730 0001 4987 9606 March 19, 2019 Lisa Fitzgerald PO Box 482 Campton,NH 03223-0842 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 109 Blueberry Lane, Marstons Mills, MA was inspected on 03/03/2019 by Chad Hathaway, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Conditionally Passes" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: Y The main line needs to be repaired and the septic tank needs to be sealed. You are ordered to repair or replace the septic system before occupancy. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH c ean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mail ing\Conditional ly Passes Letters\109 Blueberry Lane Marston Mills.doc Town ®f Barnstable • ,ntu„szne[�, • 1' ,+� Regulatory Services Department Public Health Division - - -- 200 Main Street,Hyannis MA 02601 Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 5/11/16 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An"x"marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ONE (1)YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑ Any portion of the cesspool within a Zone 1 to a public well ❑ Any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2) YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑ Any"conditionally passed systems" (broken cover,relocation of a pipe, relocation of a driveway due to H-10 components, etc) ❑ Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER Repair deadline: Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc Commonwealth of Massachusetts ,p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4 � 109 Blueberry Lane g . Property Address r 1 ;:? Fitzgerald C711 Owner Owner's Name information is ✓ t required for every Marstons Mills Ma 3/3/19 page. Cityrrown 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 fortes A. Inspector Information 6l-i- 1161e q a-.- on the computer, use only the tab Chad hathaway key to move your Name of Inspector cursor-do not HPS use the return Company Name key. rb Company Address Forestdale Ma 02644 City/Town State Zip Code �eaen 774 274 2581 12866 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 3/3/19 Inspector's Signal,Vafe Date The system inspector shall sub ' a co of this inspection report to the Approving Authority(Board of Health or DEP)within 30 day of pleting 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 109 Blueberry Lane Property Address -Fitzgerald Owner Owner's Name information is required for every Marstons Mills Ma 3/3/19 page. CityrFown 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: ❑ 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: 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): Septic tank has a seem leak. tank is half full to seem level. main sewer line from house to tank was cut during poilce investigation and needs to be reconnected and tested . t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts �d = Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 109 Blueberry Lane Property Address Fitzgerald Owner Owner's Name information is required for every Marstons Mills Ma 3/3/19 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 Z 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): 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: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts �a Title 5 Official Inspection Form 1 Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Y 109 Blueberry Lane Property Address Fitzgerald Owner Owner's Name information is required for every Marstons Mills Ma 3/3/19 page. CityrFown 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 Gpm, 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 ❑ ® 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 t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Mspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 109 Blueberry Lane Property Address Fitzgerald Owner Owner's Name information is required for every Marstons Mills Ma 3/3/19 page. Cityrrown 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 '/z day flow ❑ ® 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 water supply 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 2000 gpd- 10,000 gpd. ❑ ® 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 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 109 Blueberry Lane Property Address Fitzgerald Owner Owner's Name information is required for every Marstons Mills Ma 3/3/19 page. CityrFown 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 ❑ [Z Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? Z ❑ 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)) t5insp.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 109 Blueberry Lane Property Address Fitzgerald Owner Owner's Name information is required for every Marstons Mills Ma 3/3/19 page. Citylrown State Zip Code Date of Inspection D. System Information 1. 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 Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: water off Sump pump? ❑ Yes ® No Last date of occupancy: Date t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 109 Blueberry Lane Property Address Fitzgerald Owner Owner's Name information is required for every Marstons Mills Ma 3/3/19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 2. 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 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: unknown Was system pumped as part of the inspection? ❑ Yes ®. No. If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: l5insp.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 Subsurface Sewage Disposal System Form-Not for Voluntary Assessments v 109 Blueberry Lane Property Address Fitzgerald Owner Owner's Name information is required for every Marstons Mills Ma 3/3/19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. 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): Approximate age of all components, date installed (if known)and source of information: 2013 Were sewage odors detected when arriving at the site? ❑ Yes 0 No 5. Building Sewer(locate on site plan): Depth below grade: 2.25feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: 20+ feet Comments (on condition of joints, venting, evidence of leakage, etc.): sewer line was cut and piece romoved during police investigation. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 109 Blueberry Lane Property Address Fitzgerald Owner Owner's Name information is required for every Marstons Mills Ma 3/3/19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 2'feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) 1500 gal. H10 tak has a seem leak current level is at seam tees in place If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 gal Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): tees in place. Tank is half full to seam t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 109 Blueberry Lane Property Address Fitzgerald Owner Owner's Name information is required for every Marstons Mills Ma 3/3/19 page. Cityll own State Zip Code Date of Inspection D. System Information (cont.) 7. 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 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): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc-rev.7/2 61201 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 109 Blueberry Lane Property Address Fitzgerald Owner Owner's Name information is required for every Marstons Mills Ma 3/3/19 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): 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.): Dbox in good condition no signs of hydraulic failure in box box is solid and level t5insp.doe-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 109 Blueberry Lane Property Address Fitzgerald Owner Owner's Name information is required for every Marstons Mills Ma 3/3/19 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.): " 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: inspected through Dbox no evidence of past hydraulic failures stem is 20 Arc chambers Type: ❑ leaching pits number: ® leaching chambers number: 20 Arcs 20'x14.2 ❑ 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 - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 109 Blueberry Lane Property Address Fitzgerald Owner Owner's Name information is required for every Marstons Mills Ma 3/3/19 page. City1rown State Zip Code Date of Inspection D. System Information (cont.) 13. 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 15 of 18 cam. Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 109 Blueberry Lane Property Address Fitzgerald Owner Owner's Name information is required for every Marstons Mills Ma 3/3/19 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.): 12. 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 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 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 109 Blueberry Lane Property Address Fitzgerald Owner Owner's Name information is required for every Marstons Mills Ma 3/3/19 page. Citylrown 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 C la t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments . 109 Blueberry Lane Property Address Fitzgerald. Owner Owner's Name information is required for every Marstons Mills Ma 3/3/19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 35+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: 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: lot el. 86 low in direct area 50 You must describe how you established the high ground water elevation: 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 Y Commonwealth of Massachusetts - Title 5 Official Inspection [dorm � Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 109 Blueberry Lane Property Address Fitzgerald Owner Owner's Name information is required for every Marstons Mills Ma 3/3/19 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 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 o Complete items 1,2,and 3. A. i atu o Print your nam0'and ad Tess on the reverse X Agent so that we'can'return '.'card to you, T ddressee 13 Attach this card'to-:the'Sack of the mailpiece, d• Re1cejiv d nted Name) C. D to f D I' ery or on the front if space permits. 1. AM; D. Is delivery address di erent from item 11 ElYes if YES,enter delivery address below: DI'mo Lisa Fitzgerald PO Box 482 Campton,NH 03223-0842 i 3. II I�III�I IDI ICI I II II II I I I IIIII I III I I III III III Service Type ❑Priority Mail Express® 11 ❑Adult Signature ❑Registered MaiIT^" ❑Adult Signature Restricted Delivery ❑Registered Mail Restricted 9590 9402 1933 6123 1783 47 Certified Mau° Delivery ❑Certified Mail Restricted Delivery El Return Receipt for }, ❑Collect on Delivery Merchandise _2 -^-:Collect on Delivery Restricted Delivery ❑Signature Confirmation"' 7 0 L 5 17 3 0 0001 499 3 2 71 Insured Mail ❑Signature Confirmation Insured Mail Restricted Delivery Restricted Delivery (over$500) PSform 3811,July 2015 PSN 7530-02-000-9053 "Domestic Return Receipt USPS TRACKRVG# Irst ass Mail .SON s ees Paid ePermi o.G- Vj 9590 9402 1933 6123 1783 47 _9 201% United States •Sender:Please print your name,address,Ad ZIP+4®in this b°x• Postal Service \ Town of Barnstable USpS Health Division -— - ° 200 Main Street Hyannis,MA 02601 i oF�NE ro,,, Town of Barnstable Y Regulatory Services * BARNSfABLE. SASS. 1639• Public Health Division �� Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Certified Mail:7015 1730 0001 4990 3271 April 26,2018 Lisa Fitzgerald PO Box 482 Campton,NH 03223-0842 EMERGENCY CONDEMNATION AND ORDER TO VACATE Finding of Unfitness for Human Habitation and Determination of Immediate Danger In accordance with M.G.L. c.111, sec. 127A and 127B, 105 CMR 400.000: State Sanitary Code, Chapter I: General Administrative Procedures and 105 CMR 410.000: State Sanitary Code, Chapter H: Minimum Standards of Fitness for Humans, Timothy B. O'Connell., Health Inspector for the Town of Barnstable, on April 25, 2018 conducted an investigation of a dwelling unit located at 109_ Blueberry Lane MarstonMills- MA. The owner's name of this dwelling unit is "1 s. isa Fitzgerald. Based on the results of that investigation, the Barnstable Health Department finds that the dwelling is unfit for human habitation. Pursuant to M.G.L. c. 127B and 105 CMR 410.831 (D), (E)the Health Department further finds that the conditions within the-dwelling are such that the danger to the life or health of the occupants of the subject dwelling is so immediate that no delay may be permitted in making this finding. Conditions found within the dwelling, which give rise to the emergency finding of unfitness and determination of immediate danger; include: 410. 750: Conditions Deemed to Endanger or Impair Health or Safety 410.750 (F) Sewer pipe going into the septic tank has been cut which has rendered the septic system inoperable. 410.750 (P) Large holes on roof covered by tarps. Soffit boards have been removed and which has dwelling exposed to outside elements. Q:\Order Letters\Condemnations\109 blueberry 4-26-18.doc Based upon these findings any and all occupants are hereby ordered to vacate and the landlord/owner is ordered4o secure the subject dwelling within 48 hours of receipt of this order. If any person refuses to leave a dwelling or portion thereof, which was ordered vacated she may be forcibly removed by the local Board of Health(Massachusetts General Laws C. 127B), or by local police authorities at request of the Board of Health. Furthermore, anyone who fails to comply with any order of the board of health may be subject to fines ranging from$10-$500. Each day's failure to comply with an order shall constitute a separate violation. Once vacated this unit may not be occupied without the written approval of the Board of Health. Any person needing access to the inside of the dwelling must get permission from the Board of Health prior to entry. Note: This is an important legal document. It may affect your rights. PER ORDER OF LCHO\RS ARD OF HEALTH as A. MclLean, Director of Public Health Town of Barnstable Q:\Order Letters\Condemnations\109 blueberry 4-26-18.doc Certified Mail#7015 1730 0001 4990 3271 rqy, Town of Barnstable 'THE Regulatory Services MAsa Public Health Division F1639. Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 April 26, 2018 Lisa Fitzgerald PO Box 482 Campton,NH 03223-0842 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE II—MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION. The property owned by you located at 109 Blueberry Lane Marstons Mills, MA was inspected on April 25, 2018 Timothy O'Connell, R.S., Health Inspector for the Town of Barnstable. This inspection was conducted on the basis of a complaint received by our department. The following violation(s) of the State Sanitary Code were observed: 105 CMR 410.550—Extermination of Insects, Rodents and Skunks Observed evidence of rats on said property due to the large amount of garbage located behind dwelling unit. You are directed to correct the violations listed above within seven (7) days of your receipt of this notice by exterminating rodents with a MA Licensed Exterminator. You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the order is served. Non-compliance will result in a fine of$100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. Should you have any questions regarding the above violations, please contact the Town Health Division and ask to speak with the inspector who performed the inspection. ;PER ORDER OF HE BOARD OF HEALTH Thomas cKean, R.S., CHO Director of Public Health Town of Barnstable QAOrder letters\Housing violations\109 blue beny lane.doc --citizen Web Request Page 1 of 2 o rift-lir Y� t`✓ �� w '+� s i w Logged In Citizen Request Management Tuesday,Apri1242018 TOWN\oconnnnelt Route to Users Search Requests Create Requests 9 C Request Information Request ID: 59433 Created: 4/20/2018 11:04:18 AM Status: Assigned To Staff Assigned To: O'Connell,Timothy d Health Office Anonymous: No Request Category: Chapter 54-5 : Rubbish and Garbage edit Routine work: No Estimate: No edit Date scheduled: edit Estimated 5/4/2018 Change Estimated AAr May 2018 Jun Completion Completion Date: Date: Sun Mon Tue Wed Thu Fri Sat 29 30 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2Q 21 22 23 24 25 26 27 28 29 30 31 1 2 3 I 4 1 5 1 6 7 8 9 Created By: Soto, Kathryn Priority: Medium edit Health Office Citation Numbers: edit Ot Requestor Information Requestor Request Parcel Map: 1102 I Block: 113 I Lot: 000 Neighbor is calling about Number ...-..... trash on property. (Tim see note below) Parcel Lookup Email: r� Edit Requestor Information Track Request Progress Request Work History: Internal Note History: Entered on 4/24/2018 9:06:40 AM Entered on 4/20/2018 11:04:18 AM by O'Connell,Timothy by Soto, Kathryn Last modified on 4/20/2018 11:48:31 AM Talked with Sgt Ellis of Barn. PD.She said _-http://issgl2/intemalwrs/WRequest.aspx?ID=59438 4/24/2018 Fitizen Web Request Page 2 of 2 she will call me back when I have permission to Talk to TM first before doing anything with this go to property.Until then I will not go to complaint,need police permission first. He will be property. working with you on this. Neighbor states there is upda e delete food trash on property that needs to be cleaned up and other garbage.The neighbor fully understands this will be a difficult and long process. He gave System entry on 4/20/2018 11:04:18 AM: Assigned to O'Connell,Timothy Enter work progress: Enter internal note: (Viewed by everybody) (Viewed internally only) nl n I vl v� Spell Check I Spell Check Add document or image link: Browse... *You can also type in a folder name to see everything in the folder Current Links: Time worked on request: 1.00 _ Response time: 1�00 1 *Time entries are in hours. Examples of time entries: 1.25,0.5,0.75, 1, 3.5, 0.25,0.10 *Response time: Measured from the creation date to your first actions on the request, *Do not include nights,weekends,and holidays in response time for most departments. *Save Changes 0 Check to notify town employee below to review this request. O Save Changes and notify Health Office v i citizen* OClose request neck,Vanessa OClose request and notify citizen* Brief message to reviewer: n�*notify works if email address was given Update ___ _ Spell Check Public Use: Printer Friendly Version Y Internal Use: Printer Friendly Version http://issgl2/internalwrs/WRequest.aspx?ID=5943 8 4/24/2018 O'Connell, Timothy From: Ellis,Jennifer <ellisjen@barnstablepolice.com> Sent: Tuesday, April 24, 2018 3:51 PM To: O'Connell, Timothy Cc: Jenkins, Brian Subject: 109 Blueberry Lane Hi Tim—You are all set to go out to this property. I am off the next few days. Please call the police watch commander at 508-778-3807 and request that an officer meet you at the property. I will advise the dayshift supervisors. Also—I spoke with Detective Lieutenant Mark Mellyn and he confirmed that the property was infested with rats last week and that there were large amounts of household trash thrown in the yard. All debris from the search warrants has been removed from the property—the only remaining trash is the household trash. I hope this is helpful. Sgt.Jennifer Parkas Ellis Barnstable Police Department Community Impact Unit elhsjen(2barnstablepohce.com 774-994-7299 (phone) 508-778-3822 (fax) Confidentiality Notice I This email message,including any attachments,is for the sole use of the intended recipient(s)and may contain confidential, proprietary, legally privileged and/or CORI information.Any unauthorized review, use,disclosure or distribution is prohibited. If you are not the intended recipient or have received this email in error,immediately contact the sender by reply a-mail and destroy all copies of the original message.This email message may be monitored by the Barnstable Police Department. 1 �,r PEST CONTROL BY EcoGeek Pest Control 508-280-1108 ecogeekpest@gmail.com : eco eek estcontrol. C; ek 9 P com SAFE HOME. HAPPY PLANET, One Time Service Agreement Target pests: Client-N.ame: �: Service Address; to qL phone 603 3 4 73[ email:_ r� Z f �6162 �-�''� C�VN oer 00M Billing Address:(If.different) Service Details:;. .. x ��'wL4� ✓L `C Customer agrees to P, EcoGeek Pest Controi the sum of$ payable tivheri'the service is rendered, If additional.service is necessary for the control of the above fisted pest within. days frarri the date of the initial service such sprviee shall lac performed of no'cost.This agreement.dies not guarantee against present or f_utitre pest. ama&to buildinc or contents or provid . ep,'rs or.compensation thereafter:. EcoGeek pepr sentative Custo ,,er Signature n- J Invoice # 10382 EcoGeek, Inc. �flnvoice a t1 [2tJ�1$ 19 Clipper Circle g �" Da'tet g- Sandwich, MA 02563-5403 � � p ossr coxrxos er `tx 4atur �rtGeek 508-280-1108t� �y day �py SAFE NOME.NAPPY PLANET. 0 -4 Time��0 , q 3 PM �� ` SIU to d. iq: 300 36 Location 10[l13 >� Paul Fitgerald Paul Fitgeraldr�� F � � h 109 Blueberry Ln 109 Blueberry Ln �TechnlCIWUA47W. ael fr veFs} � Marstons Mills, MA 02648-1910 Marstons Mills, MA 02648-1910 NK � ��AL 0t14786� a Service Description Quantity Price GENERAL PEST CONTROL TREATMENT(mice/rats) 1.00 400.00 SUBTOTAL $400.00 TAX $0.00 AIVIT PAID ($400.00) TOTAL $0.00 PRIOR BAL $0.00 AMOUNT DUE $0.00 } Account#: 100136 Date: 5/12/2018 Bill-To: Paul Fitgerald PO Number: Invoice#: 10382 109 Blueberry Ln Terms: COD Technician: Michael Travers Marstons Mills, MA 02648-1910 Amount Paid: Check No.: Remit-To: EcoGeek, Inc. 19 Clipper Circle Sandwich, MA 02563-5403 508-280-1108 1 �^ 1 ,�J/ �� -3 _ , �� - McKean, Thomas From: McKean, Thomas Sent: Friday, May 18, 2018 12:16 PM To: gallantt@barnstablepolice.com' Subject: Occupancy at 109 Blueberry Lane Marstons Mills Good Afternoon Therese, As you are aware, the above-referenced property was recently condemned by the Health Division (Board of Health). According to 105 CFMR 410.950(C), if any person refuses to leave a dwelling or portion thereof which has been ordered condemned and vacated and has been placarded in accordance with 105 CMR 410.830 and 410.950, may be forcibly removed by the board of health, or by local police authorities on request of the board of health. Officially, I am the agent of the Board of Health. Please consider this e-mail to you and any other local police officer as such a request from the Board of Health, if or when the need arises. Please keep in mind that an occupant is defined as every person over one year of age living or sleeping in'a dwelling. Thus, If an owner or other person is at this property making repairs or collecting belongings,this activity would be allowable. However if an owner or other person is sleeping at this dwelling overnight, this activity is not allowable and that person needs to be told to leave the premises. Sincerely, Thomas McKean, IRS, CHO Agent of the Board of Health NOTE: I understand one may not wish to "forcibly" remove a person from a dwelling. Therefore,we are exploring other options including the issuance of a $100 non-criminal ticket citation each day of non-com pliance,.if a person refuses to leave the dwelling. 1 Town of Barnstable Building Department Services Brian Florence, CBO Building Commissioner BABSTABLE 200 Main Street Hyannis, MA 02601 xM510.Y5"1u5•MIFAVLLIF•�t OnYn51I01F Y 1639-2014 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 July 24, 2018 Lisa M. Fitzgerald 109 Blueberry Lane Marstons Mills, Ma 02648 Re: Enforcement Order— 109 Blueberry Lane, MM Dear Ms. Fitzgerald, Please be advised that the Building Department staff has been trying to reach you in order to discuss your request to prepare and re-inhabit your property at 109 Blueberry Lane. It is my understanding that that property may have been structurally compromised as a result of a search warrant executed in April 2018. 1 am informed that several holes have been cut into the roof and that the plumbing and septic systems have also been severed in multiple areas. As you are aware,these conditions have rendered the property uninhabitable. At this juncture, it is necessary for us to perform a site inspection in order to determine the exact course of action essential to correct the matters and re-establish your ability to reside there. You may contact my office at 508-862-4038 to arrange for a mutually convenient time and date prior to August 2, 2018. I must also inform you that should you chose not to respond; I will be obligated to seek an administrative search warrant to confirm that there are no safety violations or hazards present that may endanger any person or persons on site. Be assured that it is my intent to offer you my assistance in navigating the code requirements that must be satisfied in order to legally re-occupy the dwelling. I look forward to hearing from you and anticipate your willingness to work together in order to remedy this matter for the best of all involved. Si rely Brian Florence Building Commissioner Mf ..+ +►_. �"` — ,:. 711F, Op THE SOW Town of Barnstable. ;; U.S.POSTAGE��PirNev soWEs v` ~o Public Health Division rC o < 2S -R 18 B"B"STABLE. 200 Main Street _ y mAss. g e � ^, '639. Hyannis,MA 02601 F'-Ali 3 1 ZIP 02601 $ 000.470 02 4YY 0000336455JUL. 24. 2018, LISA FITZGERALD 109 BLI NY XIE 015 FE MARST RETURN TO 5ENDER �ry 0T wELI VER" ®3LE n5 AP E55ED UNABLE TO FORWARD UTE SC, GZ603. 400200 1022- 502'54-2:5-•35 -&1: 93270000363 961E 5 4'=1 ;4�.�Z ,111111 Jill It III Ill-dIMITI'IIIIl Jill I III 11111111111111'1]Ilil' ��+A. , �, � rir� � � 1ii 11I �I, � � I� i� �r � 1► 1 iIl �!I I� 1 !1l�I� I� � � ., , _ rJ.«..,.. .w..� �q. � � ..��`, .. ��THE?h Town of Barnstable Regulatory Services BARNSTABLE, + MASS. Public Health Division plEDh` A Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 July 19, 2018 Lisa Fitzgerald PO Box 482 Campton, NH 03223-0842 109 Blueberry Lane, Marstons Mills Time Restriction — Limited Access to Premises This notice is to inform you that you are granted permission to access this property not for living purposes but strictly to make necessary repairs to the dwelling between the hours of 7:00 a.m. until 9:59 p.m. on any partic•alar day No person shall enter the premises after 9:59 p.m.. Any and all persons must vacate the premises before 10:00 p.m. each evening. Reasonable progress and improvements must be made weekly and all necessary permits must be obtained prior to commencement of work or permission to access shall be revoked. On April 26, 2018, the Barnstable Health Division issued you a finding that the dwelling owned by you located at 109 Blueberry Lane, Marstons Mills, Massachusetts was/is unfit for human habitation. Pursuant to M.G.L. c. 127B and 105 CMR 410.831 (D), (E) the Health Department further finds that the conditions within the dwelling are such that the,danger to the life or health of the occupants of the subject dwelling is so immediate that no delay may be permitted in making this finding. The written order notified you that any and all occupants were ordered to vacate and the landlord/owner was ordered to secure the subject dwelling within 48 hours. Once vacated, you were notified this dwelling may not be occupied without the written approval of the Board of Health. The April 26 order also notified you that any person needing access to the inside of the dwelling must get permission from the Board of Health prior to entry. Attached is a copy of the letter addressed to you dated April 26, 2018 entitled : EMERGENCY CONDEMNATION AND ORDER TO VACATE, Finding of Unfitness.for Human Habitation and Determination of Immediate Danger Anyone who fails to comply with any order of the board of health may be subject to fines ranging from $10-$500.00. In addition, you are subject to non-criminal disposition of$100.00. Each day's failure to comply with an order of the Board of constitute a separate violation. Note: This is pan important legal document. It may affect your rights. PER ORDER OF THE BOARD OF HEALTH Q:\Order Letters\Condemnations\109 blueberry 4-26-18.doc �� of 2 i �' � i i -- O ui -__ iu iii i --- i i -- i i - i i ui ui i u i�� - _. i i i r� i i i i i ii i ii i i i i u u 6001 8bIz I S--6 �y i � l lr[ •11�71A` W- a .. ' m OF ICIAL USE t~ cO Certified Mail Fee Ir Extra Services&Fees(check box,add fee as appropriate) rq ❑Return Receipt(hardcopy) $ � ❑Return Receipt(electronic) $ Post1n3f,�C O ❑Certified Mali Restricted Delivery $ Her 0 []Adult Signature Required $ ❑Adult Signature Restricted Delivery$ O Postage . 'v m $ M1 r� Total Postage and Fees � Sent To r C3 StreetandApt. ---" " o z---------------------- Ciry$tafe,ZIF+4® �� "----- "" #� 03 _Z3 :.r r CertifiedMail service provides the following benefits: ■A receipt(this portion of the Certified Mail label). for an electronic return receipt,see a retail ■A unique identifier for your mailpiece. associate for assistance.To receive a duplicate ■Electronic verification of delivery or attempted return receipt for no additional fee,present this delivery. USPS®-postmarked Cepified Mail receipt to the ■A record of delivery(including the recipient's retail associate. 4. ? signature)that is retained by the Postal Service- Restricted delivery service,which provides for a specified period. delivery to the addressee specified by name,or to the addressee's authorized agent. Important Reminders: Adult signature service,which requires the ■You may purchase Certified Mail service with signee to be at least 21 years of age(not First-Class Mail®,First-Class Package Service®, available at retail). or Priority Mail®service. Adult signature restricted delivery service,which •Certified Mail service is notavailable for requires the signee to be at least 21 years of age International mail. and provides delivery to the addressee specified- ■Insurance coverage is notavailable for purchase by name,or to the addressee's authorized agent. with Certified Mail service.However,the purchase (not available at retail). of Certified Mail service does not change the •To ensure that your Certified Mail receipt is insurance coverage automatically included with accepted as legal proof of mailing,it should bear a certain Priority Mail items. USPS postmark.If you would like a postmark on h •For an additional fee,and with a proper this Certified Mail receipt,please present your _ endorsement on the mailpiece,you may request Certified Mail item at a Post Office'for the following services: postmarking.If you don't need a postmark on this -Return receipt service,which provides a record Certified Mail receipt,detach the barcoded portion of delivery(including the recipient's signature). of this label,affix it to the mailpiece,apply You can request a hardcopy return receipt or an appropriate postage,and deposit the mailpiece. electronic version.For a hardeopy return receipt, complete PS Form 3811,Domestic Retum Receipt,attach PS Form 3811 to your mailpiece; IMPORTAtM..Save this receipt for your records. Ps Form 3800,Apra 2o15(Reverse)PSN 7530-02-eee-9047 r FZHE, Town of Barnstable Regulatory Services BARNSTABLE. MASS. 1639• Public Health Division �� PrEDN1�A Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 July 19, 2018 Lisa Fitzgerald PO Box 482 Campton, NH 03223-0842 109 Blueberry Lane, Marstons Mills Time Restriction — Limited Access to Premises This notice is to inform you that you are granted permission to access this property not for living purposes but strictly to make necessary repairs to the dwelling between the hours of 7:00 a.m. until 9:59 p.m. on any particular day No person shall enter the premises after 9:59 p.m.. Any and all persons must vacate the premises before 10:00 p.m. each evening. Reasonable progress and improvements must be made weekly and all necessary permits must be obtained prior to commencement of work or permission to access shall be revoked. On April 26, 2018, the Barnstable Health Division issued you a finding that the dwelling owned by you located at 109 Blueberry Lane, Marstons Mills, Massachusetts was/is unfit for human habitation. Pursuant to M.G.L. c. 127B and 105 CMR 410.831 (D), (E) the Health Department further finds that the conditions within the dwelling are such that the danger to the life or health of the occupants of the subject dwelling is so immediate that no delay may be permitted in making this finding. The written order notified you that any and all occupants were ordered to vacate and the landlord/owner was ordered to secure the subject dwelling within 48 hours. Once vacated, you were notified this dwelling may not be occupied without the written approval of the Board of Health. The April 26 order also notified you that any person needing access to the inside of the dwelling must get permission from the Board of Health prior to entry. Attached is a copy of the letter addressed to you dated April 26, 2018 entitled : EMERGENCY CONDEMNATION AND ORDER TO VACATE, Finding of Unfitness for Human Habitation and Determination of Immediate Danger Anyone who fails to comply with any order of the board of health may be subject to fines ranging from $104500.00. In addition, you are subject to non-criminal disposition of$100.00. Each day's failure to comply with an order of the Board of Health shall constitute a separate violation. Note: This is an important legal document. It may affect your rights. PER ORDER OF TH BOARD OF HEALTH r Thomas A. McKean, C.H.O., R.S. Director Public Health Q:\Order Letters\Condemnations\109 blueberry 4-26-18.doc �pTME Tph, Town of Barnstable r r Regulatory Services r + BAMSTABLE, Ass. Public Health Division l639• �� ArED N1P� Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Certified Mai1:7015 1730 0001 4990 3271 April 26,2018 Lisa Fitzgerald PO Box 482 Campton,NH 03223-0842 EMERGENCY CONDEMNATION AND ORDER TO VACATE Finding of Unfitness for Human Habitation and Determination of Immediate Danger In accordance with M.G.L. c.111, sec. 127A and 127B, 105 CMR 400.000: State Sanitary Code, Chapter I: General Administrative Procedures and 105 CMR 410.000: State Sanitary Code, Chapter H: Minimum Standards of Fitness for Humans, Timothy B. O'Connell., Health Inspector for the Town of Barnstable, on April 25, 2018 conducted an investigation of a dwelling unit located at 109 Blueberry Lane, Marstons Mills, MA. The owner's name of this dwelling unit is Ms. Lisa Fitzgerald. Based on the results of that investigation, the Barnstable Health Department finds that the dwelling is unfit for human habitation. Pursuant to M.G.L. c. 127B and 105 CMR 410.831 (D), (E) the Health Department further finds that the conditions 'within the dwelling are such that the danger to the life or health of the occupants of the subject dwelling is so immediate that no delay may be permitted in making this finding. Conditions found within the dwelling, which give rise to the emergency finding of unfitness and determination of immediate danger, include: 410. 750: Conditions Deemed to Endanger or Impair Health or Safety 410.750 (F) Sewer pipe going into the septic tank has been cut which has rendered the septic system inoperable. 410.750 (P) Large holes on roof covered by tarps. Soffit boards have been removed and which has dwelling exposed to outside elements. Q:\Order Letters\Condemnations\109 blueberry 4-26-18.doc Based upon these findings any and all occupants are hereby ordered to vacate and the landlord/owner is ordered to secure the subject dwelling within 48 hours of receipt of this order. If any person refuses to leave a dwelling or portion thereof, which was ordered vacated she may be forcibly removed by the local Board of Health (Massachusetts General Laws C. 127B), or by local police authorities at request of the Board of Health. Furthermore, an. who fails to comply with any order of the board of health may be subject to fines ranging from $10-$500. Each day's failure to comply with an order shall constitute a separate violation. Once vacated this unit may not be occupied without the written approval of the Board of Health. Any person needing access to the inside of the dwelling must get permission from the Board of Health prior to entry. Note: This is an important legal document. It may affect your rights. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, CHOIRS Director of Public Health Town of Barnstable Q:\Order Letters\Co:idemnations\109 blueberry 4-26-18.doc FISE1i ,0 Town of Barnstable "�. Regulatory Services . * BARNSfABLE, +% . MASS. Public Health Division i639• �b PrE° Thomas McKean, Director 200 Main Street,Hyannis, MA 02601 Office: 50.8-862-4644 Fax: 508-790-6304 July 19, 2018 Lisa Fitzgerald PO Box 482 Campton, NH 03223-0842 109 Blueberry Lane, Marstons Mills Time Restriction — Limited Access to Premises This notice is to inform you that you are granted permission to access this property not for living purposes but strictly to make necessary repairs to the dwelling between the hours of 7:00 a.m. until 9'.59 p.m. on any particular day No person shall enter the premises after 9:59 p.m.. Any and all persons must vacate the premises before 10:00 p.m. each evening. Reasonable progress and.improvements must be made weekly and all necessary permits must be obtained prior to commencement of work or permission to access shall be revoked. On April 26, 2018, the Barnstable Health Division issued you a finding that the dwelling owned by you located at 109 Blueberry Lane, Marstons Mills,' Massachusetts was/is unfit for human habitation. Pursuant to M.G.L. c. 127B and 105 CMR 410.831 (D), (E) the Health Department further finds that the conditions within the dwelling are such that the danger to the life or health of the occupants of the subject dwelling is so immediate that no delay may be permitted in making this finding. The written order notified you that any and all occupants were ordered to vacate and the landlord/owner was ordered to secure the subject dwelling within 48 hours. Once vacated, you were notified this dwelling may not be occupied without the written approval of the Board of Health. The April 26 order also notified you that any person needing access to the inside of the dwelling must get permission from the Board of Health prior to entry. Attached is a copy of the letter addressed to you dated April 26, 2018 entitled : EMERGENCY CONDEMNATION AND ORDER TO VACATE, Finding of Unfitness for Human Habitation and Determination of Immediate Danger Anyone who fails to comply with any order of the board of health may be subject to fines ranging from $10-$500.00. In addition, you are subject to non-criminal disposition of$100.00. Each day's failure to comply with an order of the Board of Health shall constitute a separate violation. Note: This is an important legal document. It may affect your rights. PER ORDER OF TH BOARD OF HEALTH Thomas A. McKean, C.H.O., R.S. Director Public Health Q:\Order Letters\Condemnations\109 blueberry 4-26-18.doc �pTHE Tpy, Town of Barnstable Regulatory Services EA"STnat,E. "t"3S.1639. Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Certified Mai1:7015 1730 0001 4990 3271 April 26,2018 Lisa Fitzgerald PO Box 482 Campton,NH 03223-0842 EMERGENCY CONDEMNATION AND ORDER TO VACATE Finding of Unfitness for Human Habitation and Determination of Immediate Danger In accordance with M.G.L. c.111, sec. 127A and 127B, 105 CMR 400.000: State Sanitary Code, Chapter I: General Administrative Procedures and 105 CMR 410.000: State Sanitary Code, Chapter H: Minimum Standards of Fitness for Humans, Timothy B. O'Connell., Health Inspector for the Town of Barnstable, on April 25, 2018 conducted an investigation of a dwelling unit located at 109 Blueberry Lane, Marstons Mills, MA. The owner's name of this dwelling unit is Ms. Lisa Fitzgerald. Based on the results of that investigation, the Barnstable Health Department finds that the dwelling is unfit for human habitation. Pursuant to M.G.L. c. 127B and 105 CMR 410.831 (D), (E) the Health Department further finds that the conditions within the dwelling are such that the danger to the life or health of the occupants of the subject dwelling is so immediate that no delay may be permitted in making this finding. Conditions found within the dwelling, which give rise to the emergency finding of unfitness and determination of immediate danger, include: 410. 750: Conditions Deemed to Endanger or Impair Health or Safety 410.750 (F) Sewer pipe going into the septic tank has been cut which has rendered the septic system inoperable. 410.750 (P) Large holes on roof covered by tarps. Soffit boards have been removed and which has dwelling exposed to outside elements. Q:\Order Letters\Condemnations\109 blueberry 4-26-18.doc Based upon these findings any and all occupants are hereby ordered to vacate and the landlord/owner is ordered to secure the subject dwelling within 48 hours of receipt of this order. If any person refuses to leave a dwelling or portion thereof, which was ordered vacated she may be forcibly removed by the local Board of Health (Massachusetts General Laws C. 127B), or by local police authorities at request of the Board of Health. Furthermore, anyone who fails to comply with any order of the board of health may be subject to fines ranging from$10-$500. Each day's failure to comply with an order shall constitute a separate violation. Once vacated this unit may not be occupied without the written approval of the Board of Health. Any person needing access to the inside of the dwelling must get permission from the Board of Health prior to entry. Note: This is an important legal document. It may affect your rights. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, CHO\RS Director of Public Health Town of Barnstable Q:\Order Letters\Condemnations\109 blueberry 4-26-18.doc 5/18/2018 Citizen Web Request o I is I t r �ap 1454 am f - - Logged In As: Citizen l Request Management Friday,May1S201S TOWN\miorandd Route to Users Search Requests Create Requests Request Information Request ID: 59503 Created: 5/18/2018 8:24:31 AM Status: Assigned To Staff Assigned To: Miorandi, Donna Health Office Anonymous: No Request Category: Chapter II : Housing Substandard edit Routine work: No Estimate: No edit Date scheduled: edit Estimated 6/1/2018 Change Estimated May. June 2018 Jul Completion Completion Date: Date: Sun Mon Tue Wed Thu Fri Sat 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 it 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 1 27 28 29 30 1 2 3 4 5 6 7 Created By: Miorandi,Donna Priority: Medium edit Health Office Citation Numbers: edit Requestor Information Requestor Request Parcel _ __ ..., Map: 102 I Block: Lot i Sgt.Tynan called Donna Nu _... _ ._ _.__ ... .. ..... ....� Miorandi at home 113 mber (9:40p.m.Thursday Parcel Lookup 5/17/18)regarding owner of 109 Blueberry lane,Marstons Mills.She is drinking and living at the home despite the fact that it is condemned. Neighbors are complaining because lights are on and she is doing open burning in the back yard. Police are having her go to a hotel via a Email: cab because they feel it is unsafe for her to drive. Police want follow-up today(Friday, May 18,2018)and a DETERMINATION of when she can be on the property. http://issgl2/lnternalWRS/WRequest.aspx?ID=59503 112 5/18/2018 Citizen Web Request Edit Requestor Information Track Request Progress Request Work History: •Internal Note History: System entry on 5/18/2018 8:24:31 AM: Assigned to Miorandi, Donna Enter work progress: Enter internal note: (Viewed by everybody) (Viewed internally only) I, --.... .............. ... Spell Check Spell Check Add document or image link: Choose File No file chosen *You can also type in a folder name to see everything in the folder Current Links: ..._ .......... Time worked on request 10 j Response time: 0 ... ..... *Time entries are in hours.Examples of time entries: 1.25,0.5,0.75, 1,3.5,0.25,0.10 *Response time: Measured from the creation date to your first actions on the request. *Do not include nights,weekends,and holidays in response time for most departments. U Save changes 0 Check to notify town employee below to review this.request. O Save changes and notify Health Office • Citizen*O Close request Beck,Vane ssa •Bnef message to reviewer. OClose request and notify _ citizen* *notify works if email address was given Update Spell Check Public Use: Printer Friendly Version Internal Use: Printer Friendly Version http://issgl2/lnternalWRS/WRequest.aspx?ID=59503 2/2 V TOWN OF BARNSTABLE LQCATION 10q a31v� �-4 ►'� SEWAGE# VILLAGE M. m,t L S ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. WJ—O 3 L O I D F SEPTIC TANK CAPACITY /00 y LEACHING FACILITY:(type) (size) 1/06 o NO.OF BEDROOMS OWNER J5pt)r\ Mvyr\eh�,. PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY h q LW TOWN OF BARNSTABLE LOCATION / 6 ,h f L SEWAGE# Za " yGO 1- VILLAGE D i ASSESSOR'S MAP&PARCEL /a.;, �- //3 INSTALLER'S NAME&PHONE NO-52)9-y20 SEPTIC TANK CAPACITY 1.SaO LEACHING FACILITY.(type) 96)—l40Y #9C, G#;;,r$(size) 49x/12 NO.OF BEDROOMS J OWNER aAn l�YI�rP! PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility _ Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY GG� / � • �� ""� rn4PEct�on �'• z 33•�, ------� --�--_-�; soar Fee l©6 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS !appliLatlon for jMtsposal *pstem. Construction Permit Application for a Permit to Construct( ) Repair(-)r-Qpgrade(A Abandon Complete System ❑Individual Components Location Address or Lot No./0Q 61(1 b e Yr L/3 h/= Owner's Name,Address,and Tel.No. Assessor's Map/Parcel/OQ //310,wr`fra/��i/ls c�ohvJ G/6��h / J'. Installer's Name,Address,and Tel.No. s,�$-!r!1°O-q7 2 2 Desi ner's Names,Add essvov and Tel.No.sO$-!t/77s s�/ �Jo.�•c1�ti 17..z(3la.•r�®S �lt��iv�.uv�ticc °!:4 Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 gpd Design flow provided 3 , gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Z"k5r#& Ai� Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signe Date Application Approved by Date / a& / Application Disapproved by Date for the following reasons Permit No. Date Issued J (g l > /DO _ • N �. Fee THE COMMONWEALTH OF MAASSACHUSETTS Entered in computer: s, PUBLIC HEALTH DIVISION -T.OWN OF BARNSTABLE, MASSACHUSETTS Yes �pYitation for �isosaYpstem Construction Permit Application for a Permit to Construct( Repair(-r"Upgrade(k�Abandon(G)''�❑Complete System ElIndividual Components Location Address or Lot No]0 Q 1 Ue,b r rr L4 el Owner's Name,Address,and Tel.No. �,y,/grsl'v�s k1,1 11S y4 murpll Assessor's Map/Parcel/OQ-115 5,4 '1. Installer's Name, ddress,and Tel.No.SbS"'//20"g7 2� Designer's Name,Address and Tel.No..5-00_q/11— S 315 %lose/oti 11 c ��r�v5u l,�/G/ l e-errtiy u/o✓k,S /G6a �F1T �?�I,�rsTvh 2 �!/�="ST Cv'o5s � � Type of Building: Dwelling No.of Bedrooms .3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 © gpd Design flow provided 3 55 . o� gpd Plan Date Number of sheets Revision Date Title Y I Size of Septic Tank Type of S.A.S. . 1 j Description of,Soil Nature of Repairs or Alterations(Answer when applicable) Z/t/ST�1 /�DO C,�� S/-'/ rI6 IT4GI k D- 13vx S- leawS of y *05 !9rc .3(0. HC aol'rs u//j'l-, Ala Date last inspected: Agreement: ' The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signe �� Date Application Approved by Date ` oL jp / ' Application Disapproved by Date for the following reasons Permit No. a C) / 3 — / LQ b Date Issued J THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO //CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(C_} Upgraded(4—} Abandoned( ) V-1 at/vQ /3/�r6r��y L�� i�radStays t�Yl.//l as been constructed in accordance with the provisions /of Title's and the for Disposal System Construction Permit NO6/�> 4k dated j/ h) & I j 3 Insta11eN05 z5�/ 1,7 f l�ic�y5�"C>S Designer/; / .-_e wv!'/CS #bedrooms �3 Approved design flow 3 V gpd The issuance of this e -it s all not e co rued as a guarantee that the system wftnc as esi ned. Date Inspector ----------------------------- rr-__----------------------------------------------------------------------------------------- --------------- No.c)-(3/. ! C1�6 Fee /--Q THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal *pstetn Construction Permit Permission is hereby granted to Construct( ) Repair( ) /- Upgrade(y) Abandon( ) System located at and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. --� -Provided:Construction must be completeq.within three years of the date of this tb :� Date tD � Approved 06/10/2013 13:51 5084775313 ENGINEERING WORKS PAGE 01 Town of BmatmHe Regaletwy Se> eo Thomas F. der,Dhwtor ]Pubk Heim Mviln Thoom McKean,Dhtor 200 Main Street, Hynank4 MA 02601 Ofliae: 508-962.4644 FM 509-790.6304 Date: (o c1 i C3 Sewage Permit# O '49A.,.r'sI buPtParce, imamer_&De i=r CertiikagW Form Dearer; fir+� !1 i��'',riz W a r� l rf c + Instnllcr: UQ� ' IS v t Address: ii W. a &,t C.5'.. I OA , Address: t OZ(a" S * � was issued a permit to insW1 a (date) (installer) septic system at I M based on a design drawn by �n5;r,,e. ri e\L dated (designer) v4--I certify that the septic system referenced above was installed substantially according to the desivi, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed math 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-buiit by designer to follow. Stripout(if required) w i, ted and the soils were found satisfactory. ap RETER T. Z 1HiiaENTEF 8 2 CIM NO,Moo C iper's Signature (—AWN Desi� TO BARN T )I.ON. F COMPLIANCE WELL A9- T CARD ARE RECEMP, ABLE FUBLI N. THANK You. q:IoPRCe fornssldesig�ardfication&�rm.dos 11/22/2013 13:21 5084775313 ENGINEERING WORKS PAGE 02 L Town of Barnstable Regulatory Services $ Richard'V. Scali,Interim Director a a,►,war��a, 1 Public Health Division KAN. f619. �� Tbomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: SOB-790-6304 Homeowner Certification Form for AlternAtive SYSms Property Address: (O Assessor's Map\Parcel: 10 Z — 1 t-3 Property Owners Name-i—Ir�%11% L 4 v��` Carr L-6�, , 12 In accordance with Massachusetts DEP alternative system approval letters, the following certification information is required by the Owner of record. The Owner of record must place an "x" in the applicable box next to each line certifying the information. Yes N\A 0 ❑ I have been provided a copy of the Title 5 IIA technology Approvdl letters. (15 page Standard Conditions letter and the specific technology letter). ❑ 1 have been provided with the Owner's Manual ❑ ® I have been provided with the Operation and Maintenance Manual ❑ 9 For Systems installed under a Remedial Use Approval, I agree to fulfill my responsibilities to provide a Deed Notice as required by 310 CMR 15.287(10) and the Approval ❑ 2S For Systems installed under a Remedial Use Approval,I agree to fulfill my responsibilities to provide written notification of the Approval to any new Owner, as required by 310 CMR 15.287(5) ❑ If the design does not provide for the use of garbage grinders, the restriction is understood and accepted ❑ Whether or not covered by a warranty, I understand the requirement to repair, replace, modify or take any other action as required by the Department or the LAA, if the Department or the LAA determines the System to be failing to protect public health and safety and the environment, as defined in 310 CMR 1...303 ` I U-018AI �/i,�,9v2A RED«,,�Q4E -TRUST agree to comply with all terms and conditions above. Property Owners r ted name � � /3 Property Owners Signature to Note: This form must be submitted along with the se tic system dianosal works ermit aanplicatin fora systems includi�n�new construction, re airs\upgrades, with apd without aggregate (stone) and with conventions1. design criteria or credited dean crit ria. Q:\Scptie\IA homeowncr certification.doc 71 12(7 410 Town of Barnstable P# Department.of Regulatory Services u Public Health Division hate �- 1610. 200 Main Street;Hyannis MA 02601 M1tl' J Date Scheduled Lli,6 / �/ Time Fee Pd. I CA Soil Suitability Assessment for Sewage Disposal Performed By:-&. L lac f, SK-z Witnessed By: LOCATION& GENERAL INFORMATION Location Address Owner's Name �,►�, 11 y IA 6. s 1��il� Address d Ci( S b.Q-V". L I Assessor's Map/Parcel: (0 2- I 1 3 Engineer's Name b� tiFz NEW CONSTRUCTION REPAIR Telephone# ---7 3-7 q ]C, Land Use > C st`h G Slopes(%) —�Z Surface Stones P ar1Q. Distances from: Open Waver Body r M ft Possible Wet Area NOYN� ft Drinking Water Well ;> ft Drainage Way Property Line f_ }/—{t Other` — ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands?n proximity to holes) 6b Z r ptaJ Parent material(geologic) �✓�'�T't�a Depth to Bedrock. Depth to Groundwater. Standing Water in Hole: Weeping from Pit Face Estimated Seasonal High Groundwater DETERMINATION FOR.SEASONAL HIGH WATER TABLE Method Used: Dcoth Observed standing in obs.hoie: in, Depth to Soil mottles: Depth to weeping=rom side of obs.hole: in. Groundwater Adjustment ft. Index Well# Reading Date: Index Well level Adj.factor,,.,,a-,.,__ Adj.Oroundwater Level PERCOLATION TEST Date . Thne Observation ' Hole# Time at 0" Depth of Perc 3.�,/%A5 7A S Time at 6" Start Pre-soak Time® .,^. L I f M^-, Time(9"•611) ...r ._ End Pre-soak Rate Mindinch Site Suitability Assessment: Site Passed 4( Site Failed: Additional Testing Needed(Y/N) 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:\SEPTICIPERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole#. Depth from Soil Horizon Soil Texture .Soil Color Soil then Surface(in.) (USDA) (Munsell) Mottling {Structure;Stones;Boulders: Consistenci d Y4.Vb b --� M--C DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,'Boulders., . Consistency, L DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. i e } DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,.Stones?Boulders. Flood im-mrance Rate Mao: Above 500 year flood boundary No_ Yes-2L Within 500 year boundary No Yeses Within 100 year flood boundary No Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas.observed throughout-the. area proposed for the soil absorption system? � -- If not,what is the depth of naturally occurring pervious material? Certification Icertify that on q t0 (date)I have passed the soil evaluator examination approved=^by the- Department of Enviro mental Protection and that the above analysis was performed by me con_sistent with .r the required training,expertise and experience described in�10 CMR 15.017. Signature Date 1 Z' Q:\SEFnCIPERCFORM.DOC a CONVENTIONAL S.A,S. LEGEND N LOCUS F STRATION ONLY-DO NOT INSTALL -- 98 -- EXISTING CONTOUR ALLON CHAMBERS W/4' STONE x 100.98 EXISTING SPOT GRADE, ' x 25.0 S.A.S. FOOTPRINT PROPOSEDTTOM SIDEWALL -W EXISTING WATER SERVICE � S.A.S. -B-H-bb�- OVERHEAD WIRES o A m = W REA AREA o 0 o 0 SF 152 SF ® TEST PIT ° F ITY = 0.74 GPD/SF(482 SF) = 357 GPD BENCHMARK 5hubael o o Pond EXISTING CESSPOOLS(.1PPROX.) TO BE PUMPED, FILLED WITH SAND AND ABANDONED. OR Lakeside Dr REMOVED. Calvin Hamblin Flint St Rood '00" W 103.57 1-04.00' BEAt OLE 102$0 x 103.65 PLAN BK 138 - PG 25 10' f 2p' = x PROPOSED LOCUS MAP L SEPTIC TANK NOT TO SCALE N AN 103,67 SPIKE + 103.20 + 103.60 BENCHMARK SET 1 J_-lit 3, 103,81 RT. OUTS/DE COR./BOTT. STEP GENERAL NOTES: N 10 3.7 EL.=104.29 (ASSUMED DATUM) 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL x 103,14 Alt PA 103,64 I BOARD OF HEALTH AND THE DESIGN ENGINEER. O 04,2 I 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS 'Of OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE w SLAB 103,43 LOCAL RULES AND REGULATIONS, 103 38 6 103.40 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE p O< 103.14 x EXIST. SEWER DESIGN ENGINEER. o o INV.=10�>� ��o I 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING 11 r O �EX�Sr�NG p O + FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN 00 ENGINEER BEFORE CONSTRUCTION CONTINUES. N HOUSE(#109) 103.84 ►/ m 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. T.O.F.=105.71 E x 102.06 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF J THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF / HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. 103\00 x 113,00 102.1 7. WATER SUPPLIED BY TOWN WATER SERVICE 103,25 103,41 i - 8. THERE ARE POTTABLE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S. i. 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS O? 103,44 �Z3/ /n AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE WATER SVC. BEEN X DIRECTED BY THE APPROVING AUTHORITIES. j, TR ET &JVCUSE o a PAVED..:, 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY .LOT 94 11 a THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING QQQfjj��AA,, \ A ,DRIVEWA , CONSTRUCTION. IYIBLU• `_1 HP RAMP / :.. 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS 10,400 .1✓t LAMP �' '< I IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND 104.00' / `" REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). �" 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE 102.78 x N 03'00'00" E x l(12 A-9 INSPECTED BY HEALTH DEPARTMENT PRIOR TO BACKFILL. _ --1-82------- ---- _ 100.84 ..'.*.::...: _ + 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND ------ - IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY. 100,28 edge of pavement 100.75 PK SET 14. THE CONTRACTOR SHALL BE RESPONSIBLE FOR OBTAINING A TRENCH 100.00 PERMIT FROM THE LOCAL MUNICIPALITY IN WHICH THE WORK IS BEING 0 F PERFORMED. �'�� Mgss BLUEBERRY LANE �P PETER T. G�O PROPOSED SEPTIC SYSTEM UPGRADE PLAN I M CIVIL EE N 109 BLUEBERRY LANE, MARSTONS MILLS, MA OWNER OF RECORD No. 35109 Prepared for: Joey's Septic Svc., 81 Cammett Rd, Marstons Mills, MA 02648 MURPHY, JOHN J TR o� SA Engineering Engineering by: SCALE DRAWN JOB. NO. JOHN J & MAURA R MURPHY ss 1"=20' P.T.M. 134-13 REV L 1 Engineering Works, Inc. PLAN REVISION - 11 223 MARSTONS MILLS, MA f ) 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET N0. %SILVIA, REGINA A CO TR SHOW CONVENTIONAL SYSTEM FOOTPRINT I 2z 1l (508) 477-5313 4/20/13 P.T.M. 1 Of 2 t rr NOTE: TO PREVENT BREAKOUT, THE PROPOSED SEPTIC TANK FINISH GRADE SHALL NOT BE < EL:100.8 F---20'—�I PROPOSED D-BOX FOR A DISTANCE OF 15' AROUND THE ————— INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & WATERTIGHT PERIMETER OF THE S.A.S. OUTLET AND SET TO 6" OF FINISH GRADE I 1 COVER SET TO 6" OF GRADE N PROP PROPOSED S.A.S. .� INSTALL INSPECTION PORT OVER END UNIT 11 S.A.S. T.O.F.=105.71 t —— �F.G. EL.=103.5f F.G. EL.=103.4t F.G. EL.=103.5t F.G. EL.=103.8(MAX.) 82S' E .9. MAINTAIN 2% GRADE (MIN.) OVER S.A.S. - Nopwwl � 77 6' S8 6' L = 27' ! L — MW 10' L 9' INSPECTION ry ® S=17 (MIN.) PORT 4"SCH40 PVC ® S=1% (MIN.) ® S=l% (MIN.) 4"SCH40 PVC 4"SCH40 PVC EXIST. SEWER o°I s• 10.7ERTOC INV.=103.02t is IN INV.=101.25 48" uaulD INV.=100.4 r "i SEX/STING LEVEL ADD INV.=100.67 PROPOSED INV.=100.50 (5 ROWS OF 4 UNITS AT 5.0'/UNIT) 20' GAS BA ., INV.=101.00 A-BOX /HOUSE(#109) SOIL ABSORPTION SYSTEM (PROFILE) PROPOSED SEPTIC TANK S.A.S. CONNECT TO EXISTING PLUMBING ESTABLISH VEGETATIVE COVER S•�•S• LAYOUT IAT HOUSE INV.=103.02 BACKFILL WITH CLEAN NATIVE OR PERC SAND TO TOP OF CHAMBERS 21„ 6-4" POLISEAL OUTLETS NOTES: 2" 2" -a• POLYSEA✓INLETS 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE BREAKOUT=TOP .:;:• ` L TOP ELEV.=100.83 INVERTS, PRIOR TO INSTALLATION. INV. ELEV.=100.40 Y 2) SEPTIC TANK & D—BOX SHALL BE SET LEVEL AND N ; 00 • TRUE TO GRADE ON A MECHANICALLY COMPACTED BOTTOM ELEV.= 99.50 f) SIX INCH CRUSHED STONE BASE, AS SPECIFIED IN 2.83� LO 310 CMR 15.221(2). 5' MIN. ABOVE BOTTOM OF 3) INSTALL INLET & OUTLET TEES AS REQUIRED. T.P. EXCAVATION OR G.W. EFFECTIVE WIDTH=14.2' 4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE EXISTING SUITABLE N Top view D—BOX Section AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. ESTIMATED DEPTH TO G.W. MATERIAL BELOW EL.=93.5 — UNITS SEPTIC SYSTEM PROFILE NOESEPARATION5 ROWSFBETWEENArc EACH6HC ROW & NOITH STONE 63.25" N.T.S. TYPICAL SECTION 1 s" SOIL LOG 34.5' DESIGN CRITERIA DATE: JULY 9, 2009 (REF#13,915) SOIL EVALUATOR: PETER McENTEE PE(SE#1542) NUMBER OF BEDROOMS: 3 BEDROOMS WITNESS: DONALD DESMARAIS R.S. HEALTH AGENT TOP VIEW SOIL TEXTURAL CLASS: CLASS 1 (0.74 GPD/SF) ELEV. TP— 1 DEPTH ELEV. TP-2 DEPTH 60" kid DESIGN PERCOLATION RATE: <2 MIN/IN 103.5 q 0" 103.7 q 0 END CAP END CAP DAILY FLOW: 330 G.P.D. SANDY LOAM SANDY LOAM FRONT VIEW SIDE VIEW 10YR 3/3 10YR 3/3 END CAP DESIGN FLOW: 330 G.P.D. 102.8 B 8" 103.0 B 8" REAR/TOP VIEW GARBAGE GRINDER: NO SANDY LOAM SANDY LOAM NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT SIDE VIEW 10YR 5/6 10YR 5/6 TO CHANGE WITHOUT NOTICE. PRODUCT DETAIL MAY LEACHING AREA REQUIRED: (330 GPD) = 445.9 SF 100.5 36" 100.7 36" DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE. VD 0.74 GPD/SF C 36E/48" C HIPUBHRC i LLARD, OHIO 30 6 Zk PROPOSED SEPTIC TANK: 1500 GALLON CAPACITY ADVANCED DRAINAGE SYSTEMS,INC.• Arc 36HC DETAIL PROPOSED D-BOX: 1 INLET, 6 OUTLET (MINIMUM), H-10 RATED M-C SAND { M-C SAND PROPOSED SEPTIC SYSTEM UPGRADE PLAN 2.5Y 6/4 2.5Y 6/4 USE 5 ROWS OF 4-ADS Arc 36HC UNITS WITH NO 109 BLUEBERRY LANE, MARSTONS MILLS, MA SEPARATION BETWEEN EACH ROW & NO STONE Prepared for: Joey's Septic Svc., 81 Cammett Rd, Marstons Mills, MA 02648 BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.80 SF/LF OF UNIT) 93.5 132" 93.7 132" Engineering by: SCALE DRAWN JOB. NO. (Arc36HC Units) 20 UNITS x 5.0 LF x 4.80 SF/LF = 480.0 SF' PERC RATE: < 2 MIN/INCH ("C" HORIZONS) Engineering Works, Inc. NTS P.T.M. 134-13 NO GROUNDWATER ENCOUNTERED 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO. DESIGN FLOW PROVIDED: 0.74 GPD/SF (480.0 SF) = 355.2 GPD (508) 477-5313 4/20/13 P.T.M. 2 of 2