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0067 GOOSEBERRY LANE - Health
�- 67 GOOSEBERRY LANE,` '` A=102. 191 / nS {� L►-� I TOWN OF BARNSTABLE E LOCATION e e r SEWAGE# 3— 1 9,3 VILLAGE -acSy§AS M.` ASSESSOR'S MAP&PARCEL 2 tV d / 9K INSTALLER'S NAME&PHONE NO. Me k-ev &a,5, SEPTIC TANK CAPACITY h( 1 (size) LEACHING FACILITY:(type) �r� �(_ Wye NO.OF BEDROOM OWNER {vt GIY►-S PERMIT DATE: �-���a. COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Ch Al 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 o 300 feet of leaching facility) Feet FURNISHED BY �� r'1 C � � l %Sc No. AN — t Fee f yd THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01pplitation for Disposal �pst tri Construction j9Ermit Application for a Permit to Construct( ) Repair( ) Upgrade( Abandon( ) ❑Complete System Ellidividual Components Location Address or Lot No.61? R&w,7 Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 47 1 -' Install r' Name,Addrfss and Tel.No. Designer's Name Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size J sq.ft. Garbage Grinder( AY[ Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) // gpd Design flow provided •� gpd Plan Date b 61 Number of sheets Z Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Boar of Health. Signe Date 2Z \ J Application Approved by Date ) Application Disapproved by Date for the following reasons Permit No. / 1 �l? Date Issued No. rU�S' � ) Fee /JJ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ✓ PUBLIC HEALTH DIVISION- TOWN OF BARNSTABLE, MASSACHUSETTS Yes Rpplitatlon for Disposal .6pstetn Construction Permit Application for a Permit to Construct( ) Repair.( ) Upgrade( Abandon( ) ❑Complete System Individual Components Location Address or Lot No.(off C Owner's Name,Address,and Tel.No. Assessor's Map/Parcel r'1 102 'P I InstalpName,Add ss,and Tel.No. Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size C sq.ft. Garbage Grinder( � Other . Type of Buildingg ;No.of Persons Showers( ) Cafeteria( ) Other Fixtures 1F Design Flow(min.required) // gpd , Design flow provided 3 Z gpd Plan Date b \ J 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) / Date last inspected: Agreement: d The under�ned 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 d Compliance has been issued by this Boar of Health. Signe A Date 2'7- 1 Application Approved by , ( Date Application Disapproved by Date— for the following reasons Permit No. Date Issued Z ,/ --------------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( {� Abandoned( )by VA s e vC�p,�s'1�7 at _(,�] l�otsSe��c r.� \—e,_ 1�K.'lC has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. o y 3 dated Installer CV\C\4-X ODNs,;Z— Designer c h e #bedrooms Approved de sigfi 0 3 y Z gpd The issuance of this permit sh 11 not be construed as a guarantee that the system wi func 'on s design . e Date 1 I � Inspector \A , --------------------------------------------------------------------------------------------------------------------------------------- No. )a() 0 3 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Disposal 6pstem Construction Permit Permission is hereby granted to Construct( \\) Repair( Upgrade Abandon( ) System located at 6 7 CNO J. L-0— 1 `\. 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:Construe'on must be completed within three years of the date of this permit. Date �� ' \ Approved by ,,-' � ) � Town of Barnstable Regulatory Services Richard V. Scali,Interim Director * BARNSTABLE, MAS& ��� Public Health Division i0re1639. Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer &Designer Certification Form (� Date: �S l Sewage Permit# Assessor's Map\Parcel l 4 Designer: 1"� Ir�4 Installer: Address: �� 6T�G Address: 4'_*<V_ On 76 1� ,. � was issued a permit to install a (date) (installer) septic system at 6? based on a design drawn by (addre bn't-3 dated lC� X (designer)Q I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the system referenced above was construe ance with the terms of the IAA approval letters (if applicable) �• DAR Vol taller s Signature 11 (Designer's Signatur (Affix Des tamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:\Septic\Designer Certification Form Rev 8-14-13.doc Town of B b listable P# l q 72.5 Department of Reg tilatory Services • Public wealth Division Date xrrerxnr�, ; 16 `s$ 200 Main Street;Hyamur MA 02601. - 3 y �lfD My t N t F INJ Fn,. 00 Date Scheduled Tif- Fee Pd._� o. Soil Suitability AssessmAnt'for Sew ge isVU,posal Performed By: ��"�� :` Witnessed By: ��` �^ t LOCATION & GENERAL INFoRMA-TiON Location Address �Q �� yt Z Owner's Name M . f V 111 1 S I Address Z✓0(3 -64yLlPil4-� 0J Assessor's Map/P4rcel: 10 2-/I-4( I Engineer's Name�,4� 4 S6Aj I i. NEW CONS1RUt�iYON REPAIR Telephone# Land Use J(�E-,,M A-L Slopes(11b) 0"I Surface Stones N6 Nq ft Possible Wee krea��0 ft Drinking Water Well Oft Distances from: Open Water Body L i Drainage Way a ft Property Line ��U ft Other ft i SKETCH:($treet name,dimensiods of lot,exact locations of test holes&pere tests,locate wetlands in proximity to holes) JJAA A � i • I I I i i . i - I t 1 • / I Parent material(geologic) Depth to Bedrock Depth to Groundwa.ter. S ding Water in Hole:" j Weeping from Pit FA.e Estimated Seasonal iFiigh Groundwater iA D TERMINATION FOR SEASQ AL HIGH WATrl TA�Lr� Method Used: I In. Depth �bperved standing in obs.hole: in. Depth to still tl7tittlr s: ik Depth to weeping from side of obs.hole: i in. Groundwater Adf ugt1ncnt ! _ AclJ.factor Adj.aroundwaterLevel,,� Index Well# Reading Date Ltdex Well levr l - I PERCOLATION TEST ' Date '1i1?tse Observation Time at 9" .--- Hole# Time at 6" .----- Depth of Pere t ©-.b Time(9"-6") Start Pre-soak Time.@ End Pre-soak e Rite MinJInch Additional Testing Needed(Y/N) site Suitability Assessment: Site Passed _ Site Failed: -- . Observation Hole Data To Be Completed on Back— Original:.Public 1e'alth Division J ***If percolalibn testis to be conducted within 100' of wetland,,you must first notify the Barnstable C41�servation Division at least one (1)week prior to beginning. DEEP OBSERVATION HOLE LOG Hole# Other Depth from Soil Horizon Soil Texture Soil.Color Soil Surface(in:) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. I Consistent %Gravel Al f " �` 44)A DEEP OBSERVATION HOLE LOG Soil Other # other Depth from Soil Horizon Soil Texture Soil Color Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistent %Gra el 71 DEEP OBSERVATION HOLE LOG Hole# _ Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munscll) Mottling (Structure,Stones,Boulders. Consistent %Gravel DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color $oil Other Surface(in.) '. (USDA) (Munsell) Mottling (Structure,Stories,Boulders. Consisten ra. I ti Flood Insurance Rate Map: / Above 500 year flood boundary No_ Yes Within 500 year boundary No Yes Y n' Within 100 year flood bounds No- Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring perv' us material exist.in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pe ious material? , Certification q I certify that on �� 1 (date)I have passed the soil evaluator examination approved by the Department of Enviroi6ental Protection and that the above analysis was performed by me consistent with the required t to xpertis a d experience described in 3.10 CMR 15.017. Signature f Date c&�.t Q:ISEPTICVERCFORM.DOC `' Town of Barnstable Barnstable Regulatory Services Department Public Health Division 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scalli,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 70141200 0001 0358 3964 June 8, 2015 Donald G. Duruneyer 293 Carriage Lane Barnstable, MA 02630 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE,TITLE 5 • AND/OR SECTION 36-9.1 OF THE TOWN OF BARNSTBLE CODE The septic system located at 67 Gooseberry Lane,Marstons Mills, MA was inspected on 5/13/2015 by Chad Hathaway, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic "s ti system showed that the system failed under the guidelines P P Y Y of 1995 TITLE V (310 CMR 15.00) AND/OR SECTION 360-9.1 due to the following: • Leaching pit or cesspool with high liquid level, <12' below pit (per Town Code 360-9.1) You are ordered to repair or replace the septic system within Two (2)years from the date of this notification. Failure to repair./replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH Thomas McKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Evl\67 Gooseberry Ln MM Jun 2015.doc Parcel Detail G 6 � Issgl2 itj rlpt�pr rd� �� t�l � � I� ���r Apps Bookmarks 01 http--www.town,barn.. Application Center Q suggested sites Imported From IE`'®Parcel Lookup [ New Tab Bing `' » .( Other bookmarks . E r ' r c loall € T` Parcel Info g . Parcel ID 102.191 J Developer Lot LOT 38 Location 67 GOOSEBERRY LANEI Pri Frontage 108 Sec Road J Sec Frontage village MARSTONS MILLS Fire District C-O-MM Town sewer exists at this address No J Road Index 0615 Asbuilt Septic Scan, ' flf� Interactive Map102191 1 • Owner Info . owner DUNMEYER,DONALD GI co- Owner streetl 293 CARRIAGE LN Street2 city BARNSTABLE State MA (Zip 02630 T Country 1 Land Info R Acres 0.24 use Single Fam MDL-01 Zoning RF Nghbd 0106 Topography Level J Road Paved Utilities Septic,Gas,Public Water Location • Construction Info a i gi Year Roof Ext 1984_ I�. . Gable/Hio ( „Wood Shinale ' � 5tert ��il Parcel Detail GoogleCh,,, �- _ A,� v p 11:51 AM 3 Computer name : HEALTH899JF User name : flvnnl Operatinq Svstem : Windows NT,(5.1) s rr Town of Barnstable BARNSTABLY. Regulatory Services Department TF�►� 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. 4/28/15 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) 0"'Leaching pit or cesspool with high liquid level, <1.2"below pit(per Town Code §360-9.1) OTHER Repair deadline: Q:ISEPTICIDEADLINES TO REPAIR FAILED SYSTEMS.doc Commonwealth of Massachusetts P Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments '- 67 Gooseberry Lane Property Address Dunmeyer Owner Owner's Name information is t M t Barnsable farsons a 02648 5/13/15 required for every Mills)� page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the forma Important:When filling out forms A. General Information on the computer,use only the tab 1. Inspector: 6 1 * V/-�9 O(n 1 `�' key to move your cursor-do not Chad Hathaway use the return Name of Inspector key. H.P.S. � Company Name P.O.Box 151 Company Address sf;Qmyft Ma 02644 City'/Tow`n L % State Zip Code 774-274-2581 12866 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function.and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority 7 5/13/15 limped-or's Sign re Date The system inspector all submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. �0))(�0 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 67 Gooseberry Lane Property Address Dunmeyer Owner Owner's Name information is t M bl t arnsae arsons Mills)required for every B ( Ma 02648 5/13/15 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist..Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no'° or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old"or the septic tank(whether metal or not) is structurally unsound exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. "A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): t5ins-3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments G1M ,•' 67 Gooseberry Lane Property Address Dunmeyer Owner Owner's Name information is t M bl t Barnsae arsons Mills)required for every ( Ma 02648 5/13/15 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments � 67 Gooseberry Lane Property Address Dunmeyer Owner Owner's Name information is required for every Barnstable (Marstons Mills) Ma 02648 5/13/15 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliformbacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ® ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ® ❑ Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow t5ins-3/13 Title 5 official Inspection Forth:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 67 Gooseberry Lane Property Address Dunmeyer Owner Owner's Name information is t M bl t Barnsae arsons Mills)required for every ( Ma 02648 5/13/15 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ❑ The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 67 Gooseberry Lane Property Address Dunmeyer Owner Owner's Name information is Barnstable Marstons a 02648 5/13/15 required for every ( Mills)) page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health Were an s components El ® y of the stem y ponnets 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 an of the failure criteria related ® ❑ ( y a e cited to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �M 67 Gooseberry Lane Property Address Dunmeyer Owner Owner's Name information is t M bl t Barnsae arsons Mills)required for every ( Ma 02648 5/13/15 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 4 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (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: I Sump pump? ❑ Yes ® No Last date of occupancy: 2 weeks ago Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments GN , 67 Gooseberry Lane Property Address Dunmeyer Owner Owner's Name information is M bl t arnsae arstons Mills)required for every B � Ma 02648 5/13/15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: owner pumped last year Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 67 Gooseberry Lane Property Address Dunmeyer Owner Owner's Name information is t M bl t arnsae arsons Mills)requrlred for every B ( Ma 02648 5/13/15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: tank and pit#1 1983 Dbox and pit#2 1996 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 18"feet Material of construction: ❑ cast iron . ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: 30+ feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 114"feet Material of construction: ®concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) 1000 gal tank with concrete baffle If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 Sludge depth: 4" t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 5 67 Gooseberry Lane Property Address Dunmeyer Owner Owner's Name information is Barnstable (Marstons Mills) Ma required for every 02648 5/13/15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 28" 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 20" How were dimensions determined? tape and sludge judge Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): TAnk will need to be pumped at time of new SAS. pump every 2-3 years as maint. to protect leaching Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 67 Gooseberry Lane Property Address Dunmeyer Owner Owner's Name information is required for every Barnstable (Marstons Mills) Ma 02648 5/13/15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 67 Gooseberry Lane Property Address Dunmeyer Owner Owner's Name information is t M bl t arnsae arsons Mills)required for every B ( Ma 02648 5/13/15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Carry avers Recommend replacement of Dbox at time of new leaching Dbox staining and scum over outlet. 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. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Dug up pit#2 newer pit installed in 1996 Pit was full above invert and scum stain line in riser. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,M 67 Gooseberry Lane Property Address Dunmeyer Owner Owner's Name information is (Barnstable Marstons required for every Mills) Ma 02648 5/13/15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 2 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M ,•'' 67 Gooseberry Lane Property Address Dunmeyer Owner Owner's Narre information is Barnstable Marstons required for every � Mills) Ma 02648 5/13/15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 67 Gooseberry Lane Property Address Dunmeyer Owner Owner's Name information is Barnstable Marstons a 02648 5/13/15 required for every Mills)) page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately l I -2b r C4 3 ► t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 67 Gooseberry Lane Property Address Dunmeyer Owner Owner's Name information is bl t Barnsae Marstons required for every ( Mills) Ma 02648 5/13/15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: i ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 15'+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: usgs You must describe how you established the high ground water elevation: Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 v ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 67 Gooseberry Lane Property Address Dunmeyer Owner Owner's Name information is (l Barnstable Marstons required for every Mills) Ma 02648 5/13/15 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 r Town of Barnstable Office: 508-862-4644 Regulatory Services Department Fax: 508-790-6304 . $a isrnRM Public Health Division MASS. Thomas A.McKean,CHO 59..� ` 200 Main Street, Hyannis, MA 02601 Payment Receipt !Septic Inspection Payment received: $25.00 (Check) on 5/28/2015 Permit number: 10906 Check number: 761 Check amount: $25.00 Name on check: Hathaway Property Services IBusiness: Hathaway Property Services Owner: DONALD G JR&PAMELA DUNMEYER Address: 67 GOOSEBERRY LANE, Marstons Mills I 3 ����� � u j�Il� Ifl= Z�' i COMPLETE •N COMPLETE THIS SECTIONON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Si at re item 4 if Restricted Delivery is desired., ❑Agent ■ Print your name and address on the reverse X l/vV'Y ❑Addressee so that we can return the card to you. B. Received by(Printed Name) CJ24b oipelivery ■ Attach this card to the back of the mailpiece, or on the front if space permits. D. Is delivery address different from Item 1 Y 1. Article Addressed to: `` If YES,enter delivery address below: No -.- � 3. Service Type J Z L? d U Certified Mali ❑Express Mail ❑Registered M Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number ?i =i 7.0 Oi 3 16`8 0A 0 0 0 4; 5 4 5 8 A7,22 i : alansferfrom.seMcelabeQ' I PS Form 3811,February 2004 Domestic Return Receipt 102595-02--M.-11540! UN►TED STATE t Y Gr2 • Sender:Please print your name, address,and ZIP+4 an this box.• I I E 3„ Town of Barnstable I Health Division 200 Main Street Hyannis,MA 02601 E _ I et �:S::122 tt ttt{S SISi 2t tl E�St'Sf :132 �Si i�• 2 .•ifji I •' ' Certified Mail#7003 1680 0004 5458 4722 Town of Barnstable Regulatory Services • BARNSTABLE. Y MASS. Thomas F. Geiler, Director Qj 039• 0 ' Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 June 28, 2007 Donald& Pamela DunmeY er 293 Carriage Lane Barnstable, MA 02630 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE II — MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE CODE CHAPTER 170. The property owned by you located at 67 Gooseberry Lane Marstons Mills, was inspected on June 7, 2007 by Timothy O'Connell, Health Inspector for the Town of Barnstable. This inspection was conducted on the basis of the rental registration in accordance with Chapter 170 of the Town of Barnstable Code. The following violations of the State Sanitary Code were observed: 105 CMR 410.351 —Owner's Installation and Maintenance Responsibilities. Open wiring observed in bathroom. 105 CMR 410.500—Owner's Responsibility to Maintain Structural Elements. Dining room ceiling in need of repair; bedroom door in need of replacement. The following violations of the Town of Barnstable Code were observed: 170-10—Smoke Detectors and Carbon Monoxide Alarms. No CO detectors within home. QAOrder letters\Housing violations\Rental ordinance\67 Gooseberry Lane.doc ' You are directed to correct the violations listed above within twenty-four (24) hours of your receipt of this notice by installing CO detectors on every habitable floor within ten (10) feet of bedrooms in accordance with Mass State Fire Codes. You are directed to correct the violations listed above within thirty (30) days of your receipt P of this notice by correcting open wiring, repairing ceiling and replacing bedroom door. 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 O OF HE BOARD OF HEALTH s A. McK ean,, R.S., CHO Director of Public Health Town of Barnstable Cc: Timothy O'Connell, Health Inspector QAOrder letters\Housing violations\Rental ordinance\67 Gooseberry Lane.doc i FORM 30 c&W HOBBSE WARREN TM THE COMMONWEALTH OF MASSACHUSETTS BOAR OF HE TH • CITY OWN it — '' DEPA T ENT ., ADDRESS c5 � GSM SvO�`0� ,�/� 1 V I Y A TELEPHONE Address 07 Occup Floor Apartment No.of Occupantsan No.of Habitable Rooms No.Sleeping Rooms No.dwelling or rooming units_—yam No. tor s Name and address of Remarks Reg. Vio. YARD Out Bld s.: Fences: Garbage and Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: Roof Gutters, Drains.- Walls: Foundation: Chimney: BASEMENT Gen.Sanitation: Dampness: Stairs: Lighting: STRUCTURE INT. Hall,Stairway: Hall, Floor,Wall,Ceilin ..,�, Hall Lighting: Hall Windows: o SC HEATING Chimneys: Central ❑ Y ❑ N Equip. Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusing,Grnd.: AMP: Gen. Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom 351 Pantry Den Living Room VA Bedroom(1). bU Bedroom 2 �{1de S Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten.,Gas,Oil, Elect.: S s, Flu V s, f Kitchen Facilities ink ove Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin,Shower or Tub: Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: General Building Posted Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMF: 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR.(See Over) "THIS INSPECTION REPORT IGNED AND CERTIFIED UNDER HE PAINS AND PENALTIES PERJURY." INSPECTOR Lf�_ TITLE P A. DATE 6� TIME P.M. A.M. THE NEXT SCHEDULED REINSPECTION P� P.M. r TL? 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions, when found to exist in residential premises, shall be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises. This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter 11, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to_fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B)and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash,which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish,filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof,foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CUR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2)and 410.150(A)(3)or any defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the Board of Health. t9� oaf . '. TOWN OF BARNSTABLE OCATlON 4. SEWAGE # - 3 ,"�ML, G /391+GS 2 Al I /l► ASSESSOR'S MAP &LOTJ/ Z"/ / 2 INSTALLER'S NAME&PHONE NO. 111Z!XZ54 (!a SEPTIC TANK CAPACITY "0 LEACHING FACILITY: (type) P!7— (size) NO.OF BEDROOMS —� BUILDER 0 OWNER Ill > C� T��jatS PERMTTDATE: L Z`� COMPLIANCE DATE: CFAAA Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facili ty (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 leacbing facility) Feet Furnished by 3�bd �y - ^31� A7 c a 7�rb'o TOWN OF BARNSTABLE k,OCLA ATION /_ �' St'�11r L.4- SEWAGE # %0 Al /lv ASSESSOR'S MAP & LOT/10,"-n! ! �INST4. LER'S NAME&PHONE NO. 1 eo SEPTIC TANK CAPACITY l�� LEACHING FACII.ITY: (type) 1017— "(size) Ii t NO.OF BEDROOMS BUELDER O OWNER dgeA) I l T yTL/,a1.S PERMITDA /Z n , C�'! COMPLIANCE DATE: Q Separation Distance Between the: .Maximum Adjusted Groundwater Table and Bottom of Leaching Facility 11 :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 le ac 'nag facility) Feet Furnished by 1i r No. Fee L' � THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSA/HUSEETTS 2pplicatton for Mtgpogal *pgtem Comaructtou Vermtt Application is hereby made for a Permit to Construct( )or Repair 4.1 an On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. Co�? e.00svv-iA'Rl'l "44 f__ `� Af��2<9 `Stk►ktw� S-AW U, Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 78 Type of Building: Dwelling No.of Bedrooms =3 Garbage Grinder(#q Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Description of Soil Nature of Repairs or Alterations(Answer when applicable) d%D b 6 a1t�, 1 t Ooa C-4L"* t.FAet{ P 1 y- Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been iss ed by this Board of Health. Signed Date fd)`t'd Application Approved by - - Application Disapproved for th followl g reasons Permit No. 9& - l S�) (-If Date Issued ri9:oi ar Ems., .. f / << �No. Fee THE COMMONWEALTH OF MASSACHUSETTS - fit, PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS -� application for Migogar &p.5tem Congtructioupermit Application is, hereby made for a Permit to Construct( )or Repair( - an On-sife Sewage/Disposal System at: � t Location Address or Lot No. Owner's Name,Address and Tel.No. G`7 C:oosE4�-C�-4 c.�w� °��..wt�2.� Z'L-�►tvw�, ' V- . 0-X.1kN L.bT 13$ Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. r`cvti� �'ovus�' '?7 I-4-1 /7- N4 kni w� Y�R G J Type of Building: `,� Dwelling No.of Bedrooms Garbage Grinder(r l Other Type of Building j No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Description of Soil r Nature of Repairs or Alterations(Answer when applicable) %6, U 1) 0 v3*_., t,ooa G Lora c,�E*t21+" P�r cam• gX�s�t�► SP?Zc.. S 4- if.-w1 4,0 a' s7b w r-- r Date last inspected: Agreement:-. The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in,accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been iss ed by this Board of Health. Signed ry `�:,--=® Date t/ // 9d Application Approved by �- - r- Application Disapproved for th followmg reasons Permit No. 9 - 1 2) L Date Issued �_ —�aa-----�._—�- — ----- -----------.— - .�—o . THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE. MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System installed( )or repaired/replaced( P-5"on by /cam (b S for _13Fw^a_1ts ':P-cN1-1w-S aT^ C 001 LS &1!Yf t t�o�f/ N� has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. G- t dated Use of this system is conditioned on compliance with the provisions se orth below: i ----_—_—_--== ---------- -- ---_==�=-- No. _ l Fee ^--_ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS x1h5pogar *p5tem Construction Permit Permission is hereby granted to to construct )repair( V�a_ �n On-site Sewage System located at 6T) � iZnLNLp-4 L-AW 1-1VA . TA, k5 and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. All construction must be completed within two years of the date below. �(Date: - 7 Approved by LOT 2-5 sue /00 7 7 •' ti� t` Sao %o �•xPANsro ✓ \0 1 1 {p \G•x io' pir 0 �1 ` SE/yTr c f�J pe5e]l C r { Tp NK P"uuSa 20" 1 37 dam, }II 0R M Ilk ( j 07, qD V I . Opv�0— %ems!✓e N"T `. _�j}Y 'j.+ k i II zvNc 4qF 1 � T R r v�r 7E l su fR ..��•, 4. OF G ` = A c MORSH A N 0 No.10951'0 Is FFS370NI1L�a0 LEGEND EXISTING SPOT ELEVATION 010 CERTIFIED PL.OT'� PLAN EXISTMO CONTOUR --- - 0 - - -- i �S Assam• FINISHED SPOT ELEVATION , ROBERT yG, FINISHED CONTOUR 0 eRucE M'� F' S -T-ol'�S �`'� ELpREDG APPROVED , BOARU OF HEALTH DATE AGENT i.�5 . � .SCALE, / "-3Ur GATE , L DREDGE ENGINEERING CO. IN %-rC k1t.=oN --- --_-- _------- - --_- CLIENT.,_,.._____. I CERTIFY THAT THE PROP08M., EGISTERE �E--iOITEHED JOb N0. 3 BUILDING SHOWN ON THIS PLAN CIVIL LAND DR. A ::I CONFORMS TO THE ZONING LAWS ENGINEER �$URV OF BARNSTABLE , MASS. 712 MAI N STREET CH. BY, HYA NN I S$ I,AASS. j� 2 I SHEETS OF �.. A LOCATION 1 voS� 13E -IZ L�}n3E curs NO.. ...._ VILLAGE �'1��42 rotes S DATE I APPLICANT_"-- IC.Q, 'C FEE ADDRESS (Non-refundable TELEPHONE NO. ` ENGINEER rj`nQE,yr �c„��,Lv L,ct,n� TELEPHONE NO*-- �S�zz.,V DATE SCHEDULED, `-f 19� 3 - k — i (Applicant' s, signature).* .',. • • • • • e • • • • o_• • • • • • •-•. . • . • • .. • • • 0 e e • 0 0 0 0 • • • 0 • 0 • • • • •-• • 0.0 0 0 * !Do*-* 0. 0 0 0.0 • 0.0-0,•.0 4 • 0 *.0 00 !}e • • ♦ �. SOIL LOG: SUB-DIVISION NAME S"+wo -:DATE _TIME la-`o0. EXPANSION A7REE.. YES�NO '.3 ��7>�s p<� ENGINEER TOWN WATER I/ PRIVATE WELL c�3 yW J BOARD OF HEALTH J I&I 2,<c©L-1- EXCAVATOR ( SKETCH: (Street name,etc. ,dimensions of lot exact location, of test holes and percolation tests, locate wetlandstin proximity to test holes) NOTES;. �.L4 39 T ZSDt IV . �v fci _ oT 3 D6 goo • � 37 PERCOLATION RATE.. "� v� �^`� ✓� TEST HOLE NO: ELEVATION: TEST HOLE N0: ELEVATION: 2 la! S st/,3sa�2 3 3 4 4 5 5 6 6 9 � � 9 i 10 10 11 11 12 12 13 13 14 14 15 �,./U �,/WA 15 lb 16 / L. SUITABLE FOR SUB-SURFACE SEWAGE: LEACHING FIELD LEACHING PITS�,� LEACHING TRENCHES (/ UNSUITABLE FOR SUB-SURFACE SEWAGE. REASONS: r .NOTE: ENGINEERING PLANS MUST SHOW NUMBER ASSIGNED Z;�TOBOARD TEST APPLICATION i t ORIGINAL: COMPLETED N ENT P. AND T OF HEALTH COPY! RETAINED BY APPLICANT TOWN OF BARNSTABLE �cOCATION L0 :3&Q0A5.Sp0, c SEWAGE VILLAGE /4A45Tand'— , , ASSESSOR'S MAP & LOT INSTALLER'S NAME & 'PHONE NO. R013 .- Owt SEPTIC TANK CAPACITY 1(�® LEACHING FACILITY:(tVpe) (size)` (gip--v NO. OF BEDROOMS 3 PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER Limos DATE PERMIT ISSUED: / Z DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No �, ,� _. �� � � �a ��� �� THE COMMONWEALTH OF MASSACHUSETTS _ BOARD OF HEALTH ..................OF....... Appliration for Di-spacial Vorkii Tomitrurtinn Prrutit Application is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal System at: ...... ....................................... .. .... ____ y Location-Address or Lot No. --------------------------------------------- --�!--5 E_ .MR�� ...` r Owner ^Address cbmt1 Installer Address Type of Building Size Lot...__..11.1.5....___..Sq. feet Dwelling—No. of Bedrooms._.___��.... . . ..Expansion Attic ( ) (Garbage Grinder ( j 04 Other—T e of Buildin p, —Type g __LO_e_ ...____. No. of ersons_________................... Showers t — Cafeteria Q' Other fixtures ____________________•----_--------- w Design Flow........ fl.........._.............gallons per person per day. Total daiV flow.___._.. _..__.._._..............gallons. WSeptic Tank—Liquid capacityJQ9Q___gallons Length.... :__. Width.... ......... Diameter................ Depth..la_.......... x Disposal Trench—No. .......l............ Width_..._.(A_.......... Total Length......M........ Total leaching area.15.3 ....sq. ft. Seepage Pit No...........:........ Diameter.................... Depth below inlet...........:........ Total leaching area..................sq. ft. Z Other Distribution box (✓) Dosing tank ( ) / /. > aPercolation Test Results Performed by.... .................... Date... .......... Test Pit No. 1_.4:_2."_.__.minutes per inch Depth of Test Pit..`_jo______________ Depth to ground water.01-0.4. 44 Test Pit No. 2... Z_"..minutes per inch Depth of Test Pit____________________ Depth to ground water......................... x ------------------------------------------------------------------------------- ---------- O Description of Soil...o. `.... tAM..t t r�c'.�...s.�b .Q%�t_. ._z° ! ' e. it)M 5 a -A,-- .................. .... } Cst-fla.e°------------------•-`--------....--------------------------....------------------------------..__.._... w UNature of Repairs or Alterations—Answer when applicable............................................................................................... --------••••--•-••••----••--••••.......................••..._...._........•-•-••-•-----•-----••••-------••--..._._..••--•-•-•••••-•-••-----•----••••••••••••----•-•-•-•-•-•-•-----•------...-•••--••--•- Agreement: e undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with th pr L isioI of M LE 5 the State Sanitary Code— The undersigned further agrees not to place the system in er n til cat Compliance has been issued by the board of health. lgrie �..................•---•-•----...-•--••---•--........_......_ /gyp -_./___Date ......._..._ \14 A i Approved BY• t � � 1 ja �---__---•------------- icationDisapproved for the following reasons____________________________________________________________________________________.................••-••--........----•-•-_....._.....•--•-----._...--••-•-----•••-•--••--•-......--•-••--•.......--•-------------------•-•-----•-•-----•-•----•••------•-•--• PermitNo......................................................... Issued-.................. •- 4 FE$.._...�.�-•--......... �h�i't" THE COMMONWEALTH OF MASSACHUSETTS " BOARD OF HEALTH n..................OF....... - .l5k � Appliration for DioVu,sal Workii Tonuuurfion Urrmit Application is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal System at ..... ... --•--�=��- _�a�%....�:pc?S' _ r y ;( Si ......... �. .... ............................. G Location-Address f T, or Lot iIVo. .......10 '` - ....1�. can.... .:..................................... ..t4'� Cs c-�-� NiIca• -•-.._!( -:...CZ�.. .®.. Owner W �' iXC v� � r `t,+e Address �: 11�`wiC. � Installer Address Type of Building Size Lot__1 O,' ..........Sq. feet Dwelling—No. of Bedrooms._....�:____............................Expansion Attic ( ) (Garbage Grinder ( ) `4 Other—Type T e of Building ___p� yp g (.4-�f�i7_ ..____. No. of ersons_________................... Showers I — Cafeteria al Other fixtures ................................... w Design Flow.........33d........................gallons per person per day. Total dail'IV flow_.._._._. 5 .._._________.._______.gallons. WSeptic Tank—Liquid capacity!.b� :_:gallons Length___._....... Width..... ._..._.. Diameter................ Depth._Wit__.._... x Disposal Trench—No. .......1............ Width.....k.......... Total Length.......®........ Total leaching area._5 3 4n....sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box Dosing tank ( )tAC Percolation Test Results Performed by.._. �. _U. r�cC_` .................... Date__._!_ 'f.1' .1 .......... Test Pit No. 1...<_. ......minutes per inch Depth of Test Pit_ ............. Depth to ground water. a.!�__.__.._.... (� Test Pit No. 2---_________ __minutes per inch Depth of Test Pit.................... Depth to ground water........................ ----------------------- ---------------------......_.._.1..------------•••--------------•------_...-.................... O Description of Soil....`� `' La n .:?. _'S VAC+, s 0la� I ! }--• ` - 1 2., ("A,e-6 10� S t-A ......................... -.._._......_...._...--------------............---- U ----...-`-`A`1-....1----------- w ---------------------------------------------------------------------------------------•----------------------------------------------------------------...-•--------------------------------•------•--- V Nature of Repairs or Alterations—Answer when applicable_______________________________________________________________________________________________ ---------------------------------------------------••-••--••-•-•---•-•_..._.....---..........._._......-----•....•••-•-_.._..-------•-••---•-----------•---------•--•-_.._..----•-....----•--.......---• Agreement: Yq undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the r isiotl f TITLL 5 o the State Sanitary Code—The undersigned further agrees not to place the system in o er O u tl e 4 cat Compliance has been issued by the board of health. l jDate A is PProved By---_------- ---. -------•--•-------------•-•- lD. ........ f------ Date p .ication Disapproved for the following reasons:.............................................................................................................. -•----------------------------------------•------,------------....._......-•----------•---......._.._._.........---------...------•---------•-----•------------------------•. ............................ Date PermitNo......................................:.................. Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS R ` BOARD OF HEALTH OVA.`7V.................0F......... � {�`�.. ........ .. .................................. (9rdifira#r of Toutplittitrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (V� or Repaired ( ) by----2-. A `--�-----_o-v r.......................................................... ............. ----------------...----•- --------------...--------._...--•------------ at.-----i-=a� �e t'f --- ! 1........................................................... Installer �I�,.. .�:1��......� ...............................--------•- ' ` _. has been installed in accordance with the provisions of TIT 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No....... _... ......... dated................................................ THE ISSUANCE-OF THIS CERTIFICATE SHALL NOT BE CONSTRUED S A GUARANTEE.THAT THE SYSTEM WI L ,F. NCTION SATISFACTORY. ., Y� DATE....i A1.0_• V...................................................... Inspector..----- ...L.......__._.....•-•••----.....---..........._.........:-- `--._....._ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH J uU r-N..............I....OF...... �.. 5� FEE........................ Riipofittl Norkg Sono rttrtion rrnti� Permission is hereby granted.---1=-0��.,•---- Q 0� .-----••----•---------------•-------•-------•----------.._.......-- to Construct (✓) or Repair ( ) an Individual Sewage Disposal System atNO._._� _ 3 S G-o9S(.be(-rI_ ....... ----•-------........................................................ Street as shown on the application for Disposal Works Construction Permit No...................../Dated.......................................... r. A�oar� Health DATE H --• -------------------------•-------•--•-••----------._..... FORM 1255 A. M. SULKIN, INC., BOSTON y t 4 v`° 0 7.7.5 i nAia�lsieI✓ �o t L.e°A c M•.Di T O uv,"1 . 1 d Z•. . ao ?c 7 J O 4 R N; Ln T .3 y SE�Tic N � Tsq NK (�/Loo05ea7 r " E_PuuSs: 14 } Zp' r 36' Isrg'rn d)T /V p III / I� %o 3 ° oC)`00 ate, . t I� ,,�:: Z u ✓ F V 3 A N' . MO.RSE h No.10951'O C A9�FGIST��4;�t``` FFSciONAL�a� . LEGEND EXISTING SPOT ELEVATION 0x0 CERTIFIED PLOT PLAN Of EXISTING CONTOUR - - O -- - ,��` �ti FINISHED :SPOT ELEVATION ROBERT � LU r � ��o s _ FINISHED CONTOUR ---- ® - ' �RUc ` P "7`�� >^,/. E EIpREDG APPROVED , BOARD OF HEALTH A, DATE AGENT .SCALE, / �`=�0 GATE L DREDGE ENGINEERING CO. IN if r-ec-0A/ _ CLIENT.�..�,.,..,,._. I CERTIFY THAT TH E E Pa®P08Eb EGISTERE REGISTEing- J®B NA. 3 BUILDING SHOWN ON THIS PLAN CIVIL LAND CONFORMS TO THE ZONING L.AW �t • 8 ENGINEER U Ct .91(� .�„�..., ,, ,;; OF Be46iNSTAdLE , MASS. }.,1 712 MAI N STREET CH. BY, R�8 % 11 � H Y A QJ N I B, MASS. SHEET--L- OF .-?= AfE i r. ?O F7: /d!//M. /YO.TE : /F E/7NER Ti�1E SEPTIC 7AN�4C 010Q L---AcN/IVG P/p' ARE. / ORIE ' 7PIN q oV /d",&E.L0,PV • ' ' /O•�: /a9/�/•' G/tA®��A c��'®/AMET.EP CC),�Ia:"RET.E C'6i�.�J� SWAZL ®.G 0AP0 4SH7' 710 4RA0E',�AN EXT,�'Ai EL,to3 0 CONG4ETE M/N. P/7CN h�ER1/Y CAST /RO/V COV/FR S'�f{LL 8,= C1SEO •,•, coYE/�S �QE��. /F/N DR/VEyVA y =�• 2 M�a. CONCRL'�'TE t. CLEAN t -5*AIVIO BAC.JXF/L L 4'Cre57 - 1` C LAYER /RONP/PE (l1Oca0 vK vo • o �� 41F /✓8�-3/B` /o9Jjv:P/TC/y G.�SL, ' B e e • • a • • • > o �4 PEP/T. SEPTIC TANS D/S?' °ab e r • • • • • • a s s a+ OVA S/a+FD STONE Vie:. BtiJt p � o • B � ► r • • . a .°° a 0 ,; e v D B • •E.FFEC'T/vt ' ' : ; 3/a'- I /z" , a• • v D a • • p2PTi•d • t e ° pp !d/.4 SJ/iE0 STOiYtG �.: a a r • • ! s• e I BOaa ?� v u • e • • O • •t • mp � j... A 48 G,q��pa/ ► a. a a • ® • • • e • e ® ®• PREC.A57'SE.E Wae dAWAI- T EL�V✓.4T/a N5 �'/T ��� clTy s ° o o • • • s e s a a e• D P/7 OR £-LllV /N9/,E'/T7' A7. ®VII-P A/G l O/,0 Fr 6 PlAm. INLET .SEPr/C 7.4NA4 10o,3 FT, l D FP O/Ah'J. C SEE T.RSI/LATJOM,) OUTLET SEP7'/C 7A/NK /10°-6 FT. /JVLET D/SMAO& OM BOX It,o¢ F7 SECTION of GROc/ND sVATE/� TABLE OtITLETDJST'J�/®t/T/ON Bar /oo•Z ?.F //V4F7-LEACHIM 0=°iJ7- /ono Fr .. SEWA0E 01SJfl"A 1, SXSTWJ" 'T�q��a��9TdON L�ACHI VG ®/T JCAL-& : %ec" /=o" OJMENSJOl4/ A FT. DESIOTIV CN17'"E�/A o/�/rE>�rSla9N 6 FT. MUM SER OF 3 DJ�9E/�/S/oN C+ � FT./47�r✓• GAR45AGCPISPOSAI-uNJr Nu we SU/L LOG TOTAL ES?/NJA'T'ED F10AV. 3 3 0 6.41.140AY SO/L TEST A/ SO/L 7E'ST'**2 NUM&E,P OJc LEACHING P/TSB �FG S/DE LEACH/Nty PEJT PIT �� , JaT. O _ Z PSSULTS JV/TNESSED 8Y/z rs E �J�4 cy/3 BOTTO/�LE/iCN/NG PEJ?P/T $Q, T. PERCOLAT/ON /C,�T¢#d L=�� JyJ INGhf TOTAL LEACH/NG AREA Z� �' Sop FT. a ESERVE LEACH//Y<5 AREA SQ. FT. ! -2 I � M �r>� ur� � eA vSEt3 �r�y L�4NE 1 yqs Z-07 3 &� GQ (o� ROBERT - vi A ZPv/Li J L L.S M t BRUCE �� j rn q ELORE y� MO CI) / ra No.10951 O lei—®REDCrA'E/rt/ L°`/'��, vc. _ 6-L g0,0 Li7*2 MAIN ST' /-IYANu/9, MASS. �p su�'4a oNAL�N� NO60TOUNP YYRTEM ENColJN7-.--m4ea cL/.E//r: 90A/ A GiRO[l/vO �w.aTER /'1T ErLEt! � .� TOWN OF BARNSTA / BLE OCATION L d s L...` SEWAGE # VILLAGE - ASSESSOR'S MAP Cz LOT INSTALLER'S NAME Cr PHONE NO. RIO6e4- 7L- v SEPTIC TANK CAPACITY 0 � LEACHING FACILITY:(type) j —.(size)_�UO C� NO, OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER 669Af ,,,,—b S DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No_� -- 38 k MARSTONS MILLS LEGEND 1AKESIDE"DR. PROPOSED CONTOUR o ® PROPOSED SPOT GRADE r$, EXISTING CONTOUR 0 r C m + 96.52 EXISTING SPOT GRADE SITE $, m AJ A SHUBAEL W— EXISTING WATER SERVICE POND TEST PIT z r 99 98 4 N8T00'001'W \ �AICESIDE DR. � 100.0 100 \ I LOCUS MAP \ I LOCUS INFORMATION \ PLAN REF: 8K 138 PG 025 TITLE REF: BK 19465 PG 262 PARCEL ID: MAP 102 PAR. 191 EXIST. 1 ,000 GAL I � Lr DRIVEWAY \ SEPTIC TANK ( w m -----_ Li o N-) 0 ---`------__- __ Z 100 I z o �-W-� . 98, Q SEPTIC SYSTEM W Z o In z „ o0 �\ \ \ W REPAIR PLAN zo O O \ \ m u \ o ^ }- LOCATED AT: _ o °W M o 67 GOOSEBERRY LANE w Li MARSTONS MILLS, MA. LOT 38 i m PREPARED FOR 10,775f SF (\ DUNMEYER K 0.24f AC \ JUNE 18, 2015 I TN 2 N p r I D REN — s I ' �, I� R OAKS I ; SCALE 1"=20' N87-00'00"W I STE I 100.0 'NIT0, 99 HOUSE EXIST. 1 ,000 PIT (see Note 10) 2k 9 ;46.9 MEYER & SONS I INC. IF' tk N �1 P.O. Box 981 E. SANDWICH, MA 02537 PH. (508)360-3311 fax (774)413-9468 i meyerandsonstitle54gmail.Com SYSTEM TIES k SHEET 1 OF 2 J 1491 a ELEV. TOP FOUNDATION NOTE: PLACE MAGNETIC MARKING TAPE OVER ALL COVERS (Existing) BRING ALL COVERS TO WITHIN 3" OF FINISH GRADE FINISHED GRADE (99.0) S. = 100.0 F.G.EL: 99.0 F.G.EL: 99.0 F.G. EL: 99.0 } MAINTAIN 2% MIN SLOPE OVER LEACHING AREA :s �a : 2" OF 3/8" DOUBLE WASHED 3/4" - 1-1/2" F.G.EL: 97.33 STONE OR FILTER FABRIC DOUBLE WASHED STONE .• { 4" SCH 40 PVC 4. 1o"I 14" 6 © S= 1% (MIN. ®®®®®®®®®®® ' TEE'S ARE TO BE INV.95.175 ) ®®®®®®®®®®® 4" SCH 40 PVC 2 EFF. DEPTH ®®®®®®®®®®® INV.96.05 INV.95.55 4' 2 X 8.5' 4' GAS - EXISTING OUTLET BAFFLE PROPOSED DB 3 L. ...• , ... . . DISTRIBUTION BOX EFFECTIVE LENGTH = 25' INV. 96.30 i (1-120) INV. ELEV.= 95.30 EXISTING 1,000 GALLON SEPTIC TANK GAS BAFFLE TO BE INSTALLED ON �0N �F MAssq BREAKOUT OUTLET TEE AS MANUFACTURED BY D , Sys ELEV.= 96.30 TUF-TITE, ZABEL, OR EQUAL �^ TOP CONC. ELEV.= 96.30 NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING o. 11 0 "' INV. ELEV.= 95.30 ®®o PIPE INVERTS PRIOR TO CONSTRUCTION ® ®®®®® ®®®®®®® 2) D-BOX SHALL BE SET LEVEL AND TRUE TO S(E ®®®®®®® GRADE ON A MECHANICALLY COMPACTED SIX QNITAR\P� BOTTOM EL.= 93.30 ®®®®®®® INCH CRUSHED STONE BASE, AS SPECIFIED IN �/ 3.75' 5 FT. 3.75' 310 CMR 15.221(2) - (5 3) REPLACE EXISTING 1,000 GALLON SEPTIC TANK EFFECTIVE WIDTH = 12.5' WITH 1500 GALLON SEPTIC TANK IF FAILED, SEPARATION 5.30 FT. DAMAGED, NOT H2O LOADING, OR UNDERSIZED. SEPTIC SYSTEM PROFILE SOIL ABSORPTION SYSTEM SECTION 4) INSTALL INLET & OUTLET TEES W/ BOTTOM OF TESTHOLE EL: 88.0 (SECTION) GAS BAFFLE AS REQUIRED (500 GALLON LEACH CHAMBER) GENERAL NOTES: SOIL LOGS DESIGN CRITERIA : 14725 NUMBER OF BEDROOMS: 3 BEDROOMM 1• ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL P# BOARD OF HEALTH AND THE DESIGN ENGINEER. 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS DATE: JUNE 16, 2015 SOIL TEXTURAL CLASS: CLASS 1 (0.74 GPD/SF) OF THE STATE ENVIRONMENTAL CODE, TITLE V. AND ANY APPLICABLE DESIGN PERCOLATION RATE: <2 MIN/IN LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW: SOIL EVALUATOR: DARREN MEYER, R.S., CSE #1614 - 310 CMR 15.405 (t) ( ) WITNESS.B: DAVID STANTON, BARNSTABLE B.O.H DAILY FLOW: 110 G.P.D. X 3 BR = DESIGN FLOW: 330 G.P.D. . 1) A 6.5 FT. VARIANCE FROM 310CMR15.211 To ALLOW LEACHING GARBAGE GRINDER: NO (not designed for garboge grinder) TO BE 13.5 FT (APPROX.) FROM OWELUNG VS 20 FT REQUIRED (LINER PROVIDED) 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR Elev. TP-1 Depth Elev. T P-2 Depth SEPTIC TANK: 330 gpd x 200% = 660 gpd, USE EXISTING 1,000 GAL. SEPTIC TANK _ TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE I DESIGN ENGINEER. 99•0 A O"LOAMY99.0 0" (330) = 445.94 S.F. 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING S/1 A LEACHING AREA REQUIRED:LOAMY SANG 74 FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN 98.50 6" 98.50 10YR 3/2 6„ ENGINEER BEFORE CONSTRUCTION CONTINUES. B LOAMY SAND 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. IOYR 5/8 1 B LOAMY 6/8 USE TWO (2) 500 GALLON PRECAST LEACH CHAMBERS W/ 4' 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF 96.0 36" 96 0 toYR 6/s 36" STONE ON SIDES & 3.75' STONE ON SIDES: 25' L x 12.5' W x 2'D THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF C 1 C HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. BOTTOM AREA: 25 x 12.5= 312.5 SF 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. SIDE AREA: (25 + 12.5) X 2 X 2 = 150 SF 8.ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED PERC ® EL 94.8 MEDIUM SAND MEDIUM SAND TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. 2.5Y 7/4 2.5Y 6/4 TOTAL SQUARE FEET PROVIDED = 462 vs. 445.94 REQ'D 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE DESIGN FLOW PROVIDED: 0.74(462 S.F.) = 342.25 G.P.D. vs. 330 G.P.D. req'd THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING CONSTRUCTION. 10. EXISTING LEACHING TO BE PUMPED, CRUSHED AND FILLED PER TITLE 5. PROPOSED SEPTIC SYSTEM UPGRADE PLAN 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION 88.0 132" 88.0 132" 67 GOOSEBERRY LN, MARSTONS MILLS, MA 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY PERC RATE <2 MIN/IN. ("C" HORIZON) Prepared for: Dunmeyer 13. NO PRIVATE WELLS WITHIN 150' OF PROPOSED LEACHING. NO GROUNDWATER OBSERVED Engineering and Survey by: SCALE DRAWN 14. NO WETLANDS WITHIN 100' OF PROPOSED LEACHING. MEYER&SONS,INC. N.T.S. DMM 15. ALL PIPING TO BE 4" SCH 40 ® 1/8"/FT (UNLESS SPECIFIED) ` 1. Darren M. Meyer, R.S., CSE, hereby certify that I am currently approved by MADEP pursuant to 310 CMR 15.017 PO BOX981 to conduct soil evaluations and that the above analysis has been performed by me consistent with the EAST SANDWICH,MA 01537 DATE CHECKED SHEET N0. requirements of 310 CMR 15.017. 1 further certify that 1 have passed the Soil Eval. Exam in October, 1999. 508-362a922 06/18/15 DMM 2 of 2