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0110 RASPBERRY LANE - Health
_ 110 RASBERRY LANE, MARSTONS MILLSu 1 I I c Commonwealth of Massachusetts y Title 5 Official-Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 110 Raspberry Ln. Property Address Austin &Sheila Jordan Owner Owner's Name ��?1 information is M. required for every Marstons Mills Ma 02648 3/17/2015 page. City/Town State Zip Code Date of Inspection t-P t� 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 A. General Information filling out forms I on the computer, I �� use only the tab 1. Inspector: key to move your cursor-do not Sean M. Jones use the return Name of Inspector key. S.M.Jones Title V Septic Inspection Company Name AA 74 Beldan Ln. Centerville Ma 02632 Cityrrown State Zip Code 774-248-4850 smjonestitle5@gmail.com SI4522 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 ocal Approving Authority 3/7/2015 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 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. LC �y516 A t5ins•3/13 Title 5 Official Inspection Form:S s rf ce Sewage Disposal Syst m•Page 1of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 110 Raspberry Ln. Property Address Austin & Sheila Jordan Owner Owner's Name information is required for every Marstons Mills Ma 02648 3/17/2015 page. City/Town 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: The dwelling located at 110 Raspberry Ln. Marstons Mills is served by a Title V septic system consisting of a 1500 gallon septic tank, distribution box and 3x500 gallon leaching chambers. The system was found to be in proper working condition at the time of inspection. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determinedl," 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 Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 110 Raspberry Ln. Property Address Austin &Sheila Jordan Owner Owner's Name information is required for every Marstons Mills Ma 02648 3/17/2015 page. Citylrown 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 110 Raspberry Ln. Property Address Austin &Sheila Jordan Owner Owner's Name information is Marstons Mills Ma 02648 3/17/2015 required for every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 'h day flow t5ins•3/13 Title 5 Official Inspection Form: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 110 Raspberry Ln. Property Address Austin &Sheila Jordan Owner Owner's Name information is required for every Marstons Mills Ma 02648 3/17/2015 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•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 110 Raspberry Ln. P ry Property Address Austin & Sheila Jordan Owner Owner's Name information is required for every Marstons Mills Ma 02648 3/17/2015 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 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 ® El available note as N/A ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 4 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 446.03 gpd provided t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 110 Raspberry Ln. Property Address Austin &Sheila Jordan Owner Owner's Name information is required for every Marstons Mills Ma 02648 3/17/2015 page. Citylrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 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: 2013=41,000 total = 112 gpd 2014 =41,000 total = 112 gpd Sump pump? ❑ Yes ® No Last date of occupancy: currentDate Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,M 110 Raspberry Ln. Property Address Austin &Sheila Jordan Owner Owner's Name information is required for every Marstons Mills Ma 02648 3/17/2015 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: 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 M , 110 Raspberry Ln. Property Address Austin &Sheila Jordan Owner Owner's Name information is required for every Marstons Mills Ma 02648 3/17/2015 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: system installed 12/6/2006 per town records Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2.5 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.): Joint were ok, no leaks, vented through the roof Septic Tank(locate on site plan): Depth below grade: 2 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 gallons Sludge depth: 6" t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M , 110 Raspberry Ln. Property Address Austin & Sheila Jordan Owner Owner's Name information is required for every Marstons Mills Ma 02648 3/17/2015 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 3" Scum thickness 3" Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 10" covers How were dimensions determined? opened ' took measurements 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 does not need to be cleaned now but should be done soon and again every 2 years for proper maintenance. water level was even with outlet, tank was not leaking and was structurally sound. Access covers are on risers. 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 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M , 110 Raspberry Ln. Property Address Austin & Sheila Jordan Owner Owner's Name information is required for every Marstons Millis Ma 02648 3/17/2015 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•3113 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 M , t 110 Raspberry Ln. Property Address Austin&Sheila Jordan Owner Owner's Name information is required for every Marstons Mills Ma 02648 3/17/2015 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.): Distribution box was in good condition, no rot, water level was even with outlet invert. 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: 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 110 Raspberry Ln. Property Address Austin &Sheila Jordan Owner Owner's Name information is required for every Marstons Mills Ma 02648 3/17/2015 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 3x500 gals ❑ 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.): Leaching facility consists of 3 500 gallon precast leaching chambers in a 33.5'x12.5'x2'trench. s.a.s. was found to have no standing water and no visible stain lines indicating the system has never been hydraulically overloaded. Cover is on a riser. 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 i� Commonwealth of.Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 110 Raspberry Ln.up, . Property Address Austin &Sheila Jordan Owner Owner's Name information is required for every Marstons Mills Ma 02648 3/17/2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 I Commonwealth of Massachusetts ,p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 110 Raspberry Ln. P Property Address Austin &Sheila Jordan Owner Owner's Name information is required for every Marstons Mills Ma 02648 3/17/2015 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 �-644 F JJoJSt I l� LH I 'TANK I i 4 A-/: a(o` i II A-d I a-a= -33` O 0 ! I ,4a3' ?� 133� qY y y I 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 110 Raspberry Ln. Property Address Austin &Sheila Jordan Owner Owner's Name information is required for every Marstons Mills Ma 02648 3/17/2015 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 12'+ feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: Date 006 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: Groundwater elevation was determined by accessing Town of Barnstable groundwater contour map. 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 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments N 110 Raspberry Ln. Property Address Austin & Sheila Jordan Owner Owner's Name information is required for every Marstons Mills Ma 02648 3/17/2015 page. City/Town 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 TOWN OF BARNSTABLE LOCATION /lb r2�,s� /�y Lam, SEWAGE# VILLAGE ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO.Win•E 124ble750 -5-b7- 7292'7 0 SEPTIC TANK CAPACITY /5W LEACHING FACILITY.(type) 3X W brV Cll! (size) 3 s x/a s-x a NO.OF BEDROOMS OWNER .Jara�G,.� PERMIT DATE: /d/ 6 COMPLIANCE DATE: /9 (o/0 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility /1 ��" 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 /S D{S►yN /u,., j)r s he Q �0 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Application for 33i5po!5al *p!gtem Cott.5truction Permit Application for a Permit to Construct( ) Repair�/Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. J 1,0 S/ Owner's Name,Address,and Tel.No. rN rAj-1-&w S m f l i-S A&5 tc h JUr-d,4 t) Assessor's Map/Parcel /0,01, Q ,t Installer's Name,Address and Tel.No. V/, L ltU SG Designer's Name,Address and Tel.No. t_e c, �1�C �0 �Ux �v�Q W3 to^BA�y ' cLed'? 1 , 1 715 �77 w`L� 3f®q ®�r�y Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder .( /)0 Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil SA n o Nature of Repairs or Alterations(Answer when applicable) // _rk- 6 At a..,—, ��S 4QM �o P)a y, a n 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 Environmen 1 Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of He Si Date � J 6 Application Approved b Date Application Disapproved by: Date for the following reasons / Permit No. QP0 � Date Issued /. �' rw-,.a+e+,r- "� � V •• �+, , (`...fir�' �, .� 1�- �Y...a..wt�s� � $ r r .No. THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes f Zlppticatton for Digaat q§p.tem Con5truction Permit Application for a Permit to Construct( Repair( Upgrade( ) Abandon'( ) ❑ Complete System ❑Individual Components Location Address or Lot No. //10 'r 1 Owner's Name,Address,and Tel.No. YHUrsfvpS l'Yli`1/S /44stt'1 SprdAh Assessor's Map/Parcel � Q � Installer's Name,Address,and Tel.No. 14/, L- R(1 ql h Son Designer's Name,Address and Tel.No. IUkG ` 14- tNrAIl� IE Ct✓��t Type of Building: '-! Dwelling No.of Bedrooms 1 Lot Size sq. ft. Garbage Grinder (,(/)0 Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic,Tank Type of S.A.S. Description of Soil to SA Nature of Repairs or Alterations(Answer when applicable) 1/ f-/C- S /Q a.0 !it S1/S tool Date last inspected: y 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 Environment 1 Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Hea h! Sign 1 Date Application Approved by Date Application Disapproved by: Date for the following reasons yy { 1 Permit No. n 00 G , Q-Q _ Date Issued 1� THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that thee On-site Sewage Disposal System Constructed ( ) Repaired ( � Upgraded ( ) Abandoned( )by I Al C.1.C�11 f _ at 110 R A SP k.,re r/ A /1 /Yw r l 7fa -s M 1 As Aen constructed in accordance J with the provisions of -2 Title 5 and the for Disposal System Construction Permit No. 00 6 5a O dated n Installer I/ F �!ii n Svh Designer /_=,A_C, 'r®t^ #bedrooms Approved design flow /?Ivt G gpd The issuance of this permit shall not be ''onstrued as a guarantee that the system wlill tio,func as designe. Date �-2 / ��� Inspector 1 �- —————————c—r--——————————— -- ————-——————-—— No. °�.00 Fee lef,11, QUi. THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS Migpo.5al 6p9tem Construction Permit Permission is hereby granted to Construct ( ) Repair ( ' Upgrade ( ) Abandon ( ) System located at // 17 A4 �p hvr(/ k r? { and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must b/completed within three years of the date of thi p.t Date t 15 Approved by l o,�. 4 L MOM D wog wey9ylw0j!)J' AkM LLOI-4Z496 VM'VWOOVl 'dUOO ONIlHVO'l T ZS£ON 1 � Towri of Barnstable ,,�4TME'ati Regulatory-Services Thomas K Geiler,Director . snxivsT�i.E. MAB&a639, Public Health Division En °' Thomas McKean _Director 200 iVIam:Street,Hyannis,MA 02601 off r . Office: 508-8624644 Fax:F 08-790-630 5 4 Installer.&Designer Certification!Form Date: 1.2-6=2 0 0 6: Sewage Permit# ` _� .�7 Assessor's Map\Parcel 1 0 2-9 2 Designer: Eco Techinstaller: _-. er ga Installer: W.E. Robinson SR Address: " .43 Triangle. Circle P.O. Box 1 089 g Address: Sandwich MA Centerville MA On W,.t. Robinson SR was_issueda permit to:installa (date) - (installer) septic system at :11 0 Ras.pberry Lane:. Marstons. Mbdsbd on a design drawn by (address) Ewa-2'g 'h dated:: -r (designer) I certify.that the septic.system referenced above was installed substantially:according to the design,-which may`include minor.approved changes.-such as lateral.relocation of the distribution box and/or;septic tank.... . I certify that the septic system referenced above was.installed with major changes_(i.e. . greater than 10' lateraixelocation of the SAS or any vertical relocation of any component of the septic system)`but in accordance with State &-I;oc9 Regulations. Plan revision or : certified as-built by designer to follow. �N OF 4f, S9 DAVID D. (Installer's Signature) COUGHANOWR .N No. 1093 ST EVL SgNI TARS (Designer's Signature)_ (Affix Designers Stamp Here) PLEASE .RETURN. TO : BARNSTABLE PUBLIC HEALTH.. DIVISION. .. . CERTIFICATE OF COMPLIANCE..WILL.NOT..BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form 346-04.doc L _ AsBuilt Page 1 of 1 TOWN OF BARNSTABLE LOCATION 111) &.sPbr/�v SEWAGE#' 6 VILLAGE �:r.�}nnc .MJt( ASSESSOR'S MAP&PARCEL q, i INSTALLERS NAME&PHONE NO;iMn.F l2ab, �,,. 3r .vyt 3DT >cF 77% SEPTIC TANK CAPACITY LEACHING FACILITY:(type) .3XSaD brvr..r//1 (size) 3T r X IAr x d NO.OF BEDROOMS y OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: I Maximum Adjusted Groundwater-Table to the Bottom of Leaching Facility y r/ Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet 1 Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feefof leaching facility) Feet FURNISHED BY Tog 40/S . � Ds S Jy N R/,� IANx ' A-/: �10` a ' 3AP I �' • D D O �q' B3Z, 43 q" http://issgl2/intranet/propdata/prebuilt.aspx?mappar=102092&seq=1 3/17/2015 �� i N a TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION Date �" t Time: In Out Owner Tenant ' p i Address Address l Compliance Remarks or Regulation# Yes VNO Recommendations 2. Kitchen Facilities 3. Bathroom FacilitiesC 4. Water Supply 5. Hot Water Facilities 6. Heating Facilities 7. Lighting and Electrical Facilities , 8. Ventilation 9. Installation and Maintenance of Facilities 10. Curtailment of Service 11. Space and Use 12. Exits 13. Installation and Maintenance of Structural Elements 14. Insects and Rodents 15. Garbage and Rubbish Storage and Disposal 16. Sewage Disposal 17. Temporary Housing 18. Driveway Width �� 19. Number of Tenants Observed ( t 16 ( U �L PART 11 50 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition Number of Bedrooms Number of Vehicles Allowed (max) S Number of Persons Allowed (max) Person(s) Interviewed Inspector If Public Building such as Store or Hotel/Motel specify here FORM30 C�&w HOBBSBWARRENTM THE COMMONWEALTH OF MASSACHUSETTS s BOARD OF H I CIT /TOW W 1 DEPARTMENIf, � ADDRESS G„M 5 By`eW TELEPHONE Address ' — Occupant Floor Apartment No. No. of Occupants No. of Habitable Rooms No.Sleeping Rooms No.dwelling or rooming units No.Stories Name and address of owner Remarks Reg. Vio. YARD Out Bld s.: Fences: Garbage and Rubbish 1 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: Obst'n.: Hall, Floor,Wall,Ceilin : Hall Lighting: C, " Hall Windows: 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 Pantry Den Living Room Bedroom 1 Bedroom 2 5 Bedroom 3 Bedroom(4) 10,k'> Hot Water Facil. Sup.Ten.,Gas, Oil, Elect.: Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink Stove Bathing, Toilet Facil. Vent., Plumb.,Sanit'n.: WasO Basin. Shower or Tub: f 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 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR.(See Over) "THIS INSPECTION P R IS SIGNED AND CERTIFIED UN DE T PAINS AND PENALTIES OF PE U INSPECTOR TITLE A DATE 2 � TIME A.M. THE NEXT SCHEDULED REINSPECTION P.M. to 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 II, 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 CMR 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). t- (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105.CMR 410.550. (P) Any other violation of 105 CMf3 410.000 not enumerated in 105 CMR_410.750(A)throuh (0)shall be deemed to be_a con- dition which may,endanger or materially impair the health or safety and well-being of an occx�pant upon the failure of the owner to remedy said condition within the time so ordered by the Board of Health. DIM Ujf\ n ! � L��k * FORM 30 HOBBSS WARREN'M THE COMMONWEALTH OF MASSACHUSETTS BOARD OF H LTH CITY/TOW DEPA TMENT ADDRES L15©0 g(P)-— Li 4VH y {�f C TELEPHONE Addres 0 __. Occupant___._ Floor Apartment 14jo._ No.of Occupants No.of Habitable Rooms5- No.Sleeping Rooms No. dwelling or rooming units_ No.Stories _ Name_Sand addrss of ner_ —_ Remarks Reg. Vio. YARD Out Bld s.: Fences: Garbage and Rubbish CI -5" Containers: Drainage { Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: a Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: Roof Gutters, Drains: Walls: 47> Foundation: Chimney: BASEMENT Gen.Sanitation: Dam ness: Stairs: iA Li htin STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: Central ❑ Y ❑ N Equip. Repair TYPE: Stacks, Flues,Vents.- PLUMBING: Supply Line: — I -o ❑ 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 Pantry Den qr Living Room , I Bedroom(1). Bedroom 2 i I Bedroom 3 1z i W Bedroom 4 i 7- Hot Water Facil. Sup.Ten.,Gas, Oil, Elect.9 S;t41Qks, Flue Vents Kitchen Facilities in ve 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 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR.(See Over) "THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER TfJE PAINS AND PENALTIES OF PERJ Y." INSPECTOR.\ TITLE Q 2 ()� DATE I� ® �5 — 0 7 TIME l `' P.M. A.M. THE NEXT SCHEDULED REINSPECTION A P.M. ¢ s 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 heaith, 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 II, 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 CMR 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. P . L/(-r'y � p 09 q9 yn e,4-c- i i i Parcel Detail Page 1 of 3 Logged in As: Parcel Detail Friday,Octob- Parcel Lookup Parcellnfo Developer "ry" Parcel ID 102-092 _ I Lot l- Location 1110 RASPBERRY LANE I Pri Frontage[104 Sec Road I Sec r Frontage i village MARSTONS MILLS Fire District C-O-MM Sewer Acct I Road Index 11349 aka." Interactive f Map ' _ A 1 Imo: ......... ....... Owner Info Owner jJORDAN, AUSTIN T& SHEILA C Co-Owner� y Streetl 37 PARTRIDGE HOLLOW RD � Streetz City GALES FERRY I State Lj zip 06335 Country Land Info Acres 10.23 use ISingle Fam MDL-01 I zoning�RF rvghbd01 6 Topography Above Street I RoadPaved Y y Utilities Public Water,Gas,Septic I Location Construction Info Building 1 of 1 Year' Roof _ _.._ Ext i- _...-._..-.. Built 1 1969 struct Gable/Hip I wall Wood Shingle Effect ._ _-.�_ Roof AC. . _ _ . ..._. Area 1404 I Cover Asp GISlCmp I Type 1 NoneInt Be I Style Ranch wall Drywall Rooms 13 Bedrooms Model rResidential _ Int( Bath 1 Full I Floor IN _ _..______�___....�.I Rooms Grade;Average Minus I Type[Hot Air Rooms 7 RoomsLi http://lssgl/intranet/propdata/ParcelDetail.aspx?ID=5804 10/13/2006 f Parcel Detail Page 2 of 3 r� -- $14 Stories t Story Heat Gas Four d-_T ical Fuel- ation yP Permit History Issue Date Purpose Permit# I Amount Insp Date I Comments ............. Visit History Date Who Purpose 7/7/2006 12:00:00 AM Paul Talbot Meas/Est 7/6/1999 12:00:00 AM Donna Dacey Meas/Listed - Sales History Line Sale Date Owner Book/Page Sale P 1 12/16/2002 JORDAN, AUSTIN T&SHEILA C 16082/230 2 JORDAN, AUSTIN T 1408/50 Assessment Histo_y Save# Year Building Value XF Value OB Value Land Value Total Parce 1 2006 $105,800 $0 $0 $142,600 2 2005 $99,000 $0 $0 $160,100 3 2004 $80,100 $0 $0 $96,000 4 2003 $73,100 $0 $0 $41,900 5 2002 $73,100 $0 $0 $41,900 6 2001 $73,100 $0 $0 $41,900 7 2000 $50,100 $0 $0 $24,800 8 1999 $50,100 $0 $0 $24,800 9 1998 $50,100 $0 $0 $24,800 10 1997 $49,800 $0 $0 $24,800 11 1996 $49,800 $0 $0 $24,800 12 1995 $49,800 $0 $0 $24,800 13 1994 $49,000 $0 $0 $22,400 14 1993 $49,000 $0 $0 $22,400 15 1992 $55,800 $0 $0 $24,800 16 1991 $60,800 $0 $0 $43,500 http://issgl/Intranet/propdata/ParcelDetail.aspx?ID=5804 10/13/2006 Parcel Detail Page 3 of 3 1 17 1990. $60,800 $0 $0 $43,500 f 18 1989 $60,800 $0 $0 $43,500 19 1988 $43,000 $0 $0 $15,000 20 1987 $43,000 $0 $0 $15,000 21 1986 $43,000 $0 $0 $15,000 22 1985 $0 $0 $0 $0 ... - Photos e, I. 3 evH�u 1 1 11• http://issql/intranet/propdata/ParcelDetail.aspx?ID=5804 10/13/2006 Department of Regulatory Services s ta�artar�,.r; : Public Health Division DateV2� NA 200 Main Street,Hyannis MA 02601 �OMA�a Date Scheduled �t� � Time / � Fee Pd. , Soil Suitability Assessment for Sewage "Is osal Performed By. is"10 COO&H ANOW R ; L Se Witnessed By: LOCATION& GENERAL INFORMATION Location Address IU p Lq 5P ho w-/ Lf�] Owner's Name Q I N left? 11 U D'16 S Address (i i) �ciS I f y L p Assessor's Map/Parcel: �� Ravgpmn H, I�5 r / Engineer's Named NEW CONSTRUCTION REPAIR ✓ Telephone# 5.0q 364 Land Use. 4�e1�t'fl Slo es 35 p ( )— Surface Stones 6 h Distances from: Open Water Body 1001 ft Possible Wet Areapa_�i 0(>-� ft Drinking Water Well Do `} ft Drainage Way + ft Property Line Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&pere tests,locate wetlands in proximity to holes) T 100.00 Ft _ 1 i a i �2 �i ® ® GROUNDWATER ADJUSTMENT I EXISTING GROUNDWATER LEVEL _ I BASED ON TOWN OF" 1 a ( GIS DEPARTMENT RECORDS. I CORDS. , I + INDICATED GW 42.00 I INDEX WELL SDW-253 ZONE B 1 I READING DATE NOV. 2006 Z i I READING 47.2 ADJUSTMENT 1.4 I ADJUSTED GW 43.4 ' 'I 1eaae Fti t Parent material(geologic) P C{C{p 4 �v�W qS�J Depth to Bedrock 1 -19 e L Depth to Groundwater: StandingWater in Hole: 15 (�h Weeping from Pit Face X s Estimated Seasonal High Oroundwaterc2ee eqh D Uc DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used:! Depth Observed standing in obs.hole: In, Depth to soil mottles: Jn, Depth to weeping from side of obs.hole: .. in, ©mundwater Adjustment ft. Index Well# Reading Date: Index Well level ...w Adj.factor— Adj.f)twu Beater Level PERCOLATION TEST Date!-(,166 TiMe i M Observation - - . Hole# `- Time at 9" Depth of Pere 60 i Time at 6" Start Pre-soak Time @ "��- Time(9"•610) End Pre-soak Rate MinJInch WI'p I Site Suitability Assessment: Site Passed 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 Conseirvation Division at least one(1)week prior to beginning. Q:ISEPTICIPERCFORM.DOC SOIL TEST LOG DATE--OF--TEST: 'DECEMBER• 30-, 2006 SOIL EVALUATOR: DAVID D. COUGHANOWR. R.S. WITNESSED BY: DONALD DESMARAIS. HEALTH DEPT. TEST PIT 1 PAARENOTUMAATER AGRNDWATEL:ENCOUNTEE PROGLACIRALD OUTWASH I ELEVATION = 66.40 +- PERC- AT 66 In 2 MIN/INCH IN . C SOILS DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING 66.40 - 0-7 - Ap--- LOAMY SAND 1,0 YR. 3/3 NONE FRIABLE 7-45 B .- LOAMY SAND ,10 YR 4/4 NONE FRIABLE_ 64.65 _ y 45-128 C- - MEDIUM SAND 10 YR 6/3" NONE LOOSE 77.73 NO TEST PIT 2 2 AARENT ATE-MATTER AL:ENCOUNTE PROGLAC A LED OUTWASH ELEVATION. = 66.00 +- MIN/INCH IN C SOILS DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER 88.00 (INCHES) HORIZON TEXTURE - (MUNSELL) - MOTTLING 0-8 Ap LOAMY SAND 10 YR 3/2 NONE FRIABLE 84.6, 8-40 B LOAMY SAND 10 YR 4/6 NONE FRIABLET _ 1 78.00 40-120 C_ MEDIUM SAND 10_YR 6%3 NONE LOOSE Depth from Soil Horizon Soil Texture Soil Color. TSoil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. _Cgusistency.%Gravel) DEEP OBSE RVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color' Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones',Boulders, Cons' t n 1 Flood Insurance Rate Map: Above 500 year flood boundary No_ 'Yes Within 500 year boundary No '✓• Yes Within 100 year flood boundary No Z Yes Depth of Naturalk.0coming Pervious Material Does at least fo occurring perpous material exist in all areas observed throughout the area propose e q system? �G�S If not,what' depth natu cuffing pervious material? o . " COUGHANOWR Certificatio I certify th YOU te)I have passed the soil evaluator examination approved by the Department of Ir= andexperience ection and that the above analysis was performed by me consistent with . the required train described in 310 CMR 15.017. Signature �-s Date Dec Ct WO6 COMMONWEALTH OF MASSACHUSETTS Department of Labor 6 Industries and Department of Public Health NOTIFICATION OF DELEADING WORK � N a' b All sections of this form must be completed in order to comply with the notification requirements of M.G.L. c.111 5 197, 454 CHR 22.00 and 105 CHR 460.000 as most recently amended FILE NUMBER (AGENCY USE) Contractor performing project L7�� c_RwL0,AiVCense # 'X_• 000_5ly I Exp.date Lead Paint Inspector 1V License Date of Inspection i f If low-risk deleading work is being performed, complete the following line: Property owner Agent(s) Address of Project Building Name (if any) /N Floor /VQ Street Address "%Q�, (;rvtR_ Apt. No. City i Zip Deleading Method• Wet/Dry Scraping Heat Gun Caustics Liquid Encapsulant Covering Demolition Replacement Other If "Other" selected, please explain Cheek One: dwelling is multi-family single family y Start date"_� (p il , Completion date (Q _ W eli will work Ltl- docie: A.M. �� P.M. Weekends? Project Supervisor's name i5�" License # Property Owner Address 3 7 Cit o State C ,7 Zip Tel �(,� • 7(o — 70O In case of emergency contact Phone: day SD� Li 3/ evening (over) In accordance with Massachusetts General Laws c. 111 4 197 CMR 22.00 and 105 CMR 460.000 notice of the date and methods(s) of removal or covering of paint, plaster or other accessible materials containing dangerous levels of lead is to be provided and must be received by the following persons, at least ten (10) days prior to beginning of deleading. 1. Occupants )f the dwelling unit 2. All oth"L ��cupants of the residential premises, if any 3. Director, Childhood Leading Poisoning Prevention Program Fax (617) 753-8436 Department .>f Public Health, 470 Atlantic Avenue, Boston, MA 02110 4. Director, Asbestos 6 Lead Program Fax (617) 727-7568 Department of Labor 6 Industries Room 11006, 100 Cambridge Street Boston, MA 02202 5. Local Board of Health/Code Enforcement Agency 6. Massachusetts Historical Commission (If premises is listed on the State Register 220 Morrissey Blvd. of Historic Places, this notification must be Boston, MA 02125 made upon receipt of an Order to Correct Violations or at least 30 days prior to initiating preventive deleading) Fax (617) 727-5128 Deleading Contractor The undersigned hereby states, under the pains and penalties of perjury, that he/she has read and understood the Commonwealth of Massachusetts Deleading Regulations, 454 CMR 22.00 and Leading Poisoning Prevention and Control Regulations, 105 CMR 460.000, and that the information contained in this notification is true and correct to the best of his/her knowledge and belief. 1� -1 /G}/(O Signed: Q4 `/ Title: Company: -� Property Owner (If owner or unlicensed owner's agent will be performing low-risk deleading work) I certify that I have complied with the training requirements of the Commonwealth of Massachusetts Lead Poising Prevention and Control Regulations, 105 CMR 460. 175, for owner/agent low-risk abatement and containment. I further certify that I or my agent will be performing %pie .00"OWing lot.-risk activities (T have circled all that apply) : applying liquid encapsulanr capping baseboards applying exterior vinyl siding -revering surfaces removing doors, -abin-:t ot.—ts, snutters ) •«-�rtify that all thF infutmarion •ontained in this norifi.'.+r.it,n is true and correct t":, the �•- f my knowledgF and bel i�f. I • . _. CONTOURS RP�E LPNE o BENCH MARK M EXISTING - - - - - - - 50 o L-p-e �E N PK NAIL IN DRIVE MINIMAL GRADING PROPOSED cl 0 wo ELEVATION = 22.3g l 89y� N Locus �m� BARNSTABLE GIS DATUM /��� m A A O<� J m°co m `r Fk. LDT 73 mA A L �00 ��� AREA = 10400 sf+-\a ` 'm C7� 88 1�/ \ 0 MARSTONS MILLS. MA iw - � � I v LOCUS MAP I_Z❑ y ]5 P NOT TO SCALE Ul O Z `� \ 14 C N \ z m ch <cn° 8� / .� : TP-1 LEGEND ch w � TP-2 o Ui :: J Z -- w \ �R1 E 10 1500 GA L L ON W= <w W w z � JEO / INE u \ 33.5 FL x 12.5 FL x 2 f t SEPTIC TANK wZ = W Z PP BPS ', LEACHING GALLERY o-eox ❑ �p 1—is x �p _j c TEST PIT w < wW v ' \ Z w `"� (� ❑ \ O �� \ EXISTING W W 0 m w \ �� X O \ CESSPOOL • CD p~O J ao �\ � �� �� \ TREE // W zl Z Gl \ R � \ O �/ 20 f ` -NUMBER REFERS TO ti♦- L� LCl WPTj Cp �� Z \ S. LETTER DENOTESIAMETER IN TYPE. 18-P U W X N �+ O 86 O-OAK M-MAPLE P-PINE O m WATER �- ,,z -ZOO WW w O m � W W U) w m u� GATE A-C., o *10 (n� w w 0 ao a \ \z z �} �� H DISTANCES p� � \ v z �w —\ 3 \ TO SYSTEM COMPONENTS j O X 0J FCD U ALLFEE DISTANCES T IN FEET AND DECIMAL ,q W O Z W tD m \ �� 8� 3 = dZ \ / W ~ m= \ \ �� �� A B c 381 Zu � 1� 1 19.0 19.5 37.8 O- w w � { �� _ 2 27.9 10.2 28.1 2 O m \ i 86 3 26.2 29.9 47.5 5 W w m \ ��� 4 50.4 23.0 27.2 4 > 4,11 �y vS W \u ODq5 �e� 5 57.4 34.4 39.5 Q ��� ��w 7z- P�vv�c@�c�+a� S w W 0-1 L Z Z �'VlG{+°e �lC N � � ®e T e SEWAGE DISPOSAL SYSTEM PLAN LL_ J m of < �� �� -TO SERVE EXISTING DWELLING 0 3 cnul Q Q W J EST. AUSTIN AND SHEILA JORDAN Z o CD 10 O U J OWNERS OF RECORD SNOFtilgss� � �"oF'I'"Ssq�y 110 RASPBERRY LANE n _ O i m cn ED i o`'� DAVID �yc �o DAVID GNP D. N� U D. ��� 19J5 ��� MARSTONS MILLS. MA p + co W PLAN(10 1 COUGHANOWR N COUGHANOWR �ON PROPERTY ADDRESS Z p No. 1.093 ASSESSORS MAP 10 2 PARCEL 9 2 Z SCALE: I in = 20 f L � ,p� �p 4/CENSE��0 43 TRIANGLE CIRCLE I GIST FVAL m 20 a 20 40 SqN 508 364-88g4 DATE. DECEMBER 2, 2006 Ln WOW ui � N 0 10 20 y JOB #E T E-2 512 PAGE 1 OF 2 VERSION.• A F- °D THIS PLAN IS BASED ON AN INSTRUMENT SURVEY AND IS INTENDED I ©ecemv er Z, 2-00C SOLELY FOR INSTALLATION OF THE PROPOSED SEPTIC SYSTEM DEPICTED HEREON. FOR ANY OTHER CHANGES TO PROPERTY INCLUDING PLACEMENT OF ADDITIONS. SHEDS. FENCES OR SWIMMING POOLS. OWNER 1 SHOULD CONSULT WITH A MASSACHUSETTS REGISTERED LAND SURVEYOR. �1 SOIL TEST LOG DESIGN CALCULATIONS DATE OF TEST: DECEMBER 30. 2006 DESIGN FLOW: 4 BEDROOMS X 110 GPD = 440 GPD SOIL EVALUATOR: DAVID D. COUGHANOWR. R.S. WITNESSED BY: DONALD DESMARAIS. HEALTH DEPT. SEPTIC TANK: 440 GPD X 2 DAYS = 880 GALLONS NO GROUNDWATER ENCOUNTERED USE EXISTING 1000 GALLON SEPTIC TANK IF IN SOUND STRUCTURAL TEST PIT I PARENT MATERIAL: PROGLACIAL OUTWASH ELEVATION = 68.40 PERC AT 66 2 MIN/INCH IN C SOILS CONDITION. IF NOT. INSTALL 1500 GALLON SEPTIC TANK (MINIMUM ALLOWED) +- In DISTRIBUTION BOX: USE 3 OUTLET D-BOX. DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER SOIL ABSORBTION SYSTEM: A 33.5 f t x 12.5 FL x 2 f't. LEACHING GALLERY CAN LEACH (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING A b o t. = (3 3.5 x 12.5 ) = 418.7 5 s f 66.40 A s d w = ( 33.5 + 33.5 + 12.5 + 12.5 ) x 2 = 16 4.0 sf- , 0-7 Ap LOAMY SAND 10 YR 3/3 NONE FRIABLE A t o t. = 602.75 s f 7-45 B LOAMY SAND 10 YR 4/4 NONE FRIABLE V t 0.74 x 602.75 = 446.03 G P D 84.65 USE , A 33.5 f t x 12.5 f t x 2 f t GALLERY. Vt = 446.03 GPD > 440 GPD REQUIRED 45-128 C MEDIUM SAND 10 YR 6/3 NONE LOOSE NO TEST PIT 2 PAARENOTUNDWATE MATERIAL: PROGLACIRALD OUTWASH ELEVATION = 88.00 +- 2 MIN/INCH IN C SOILS LEACHING GALLERY CONSTRUCTION DETAIL 500 GALLON DRYWELL SHOREY PRECAST CONCRETE DIMENSIONS AND DETAIL 500 GALLON DRYWELL USE H-10 UNIT DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER LEACHING UNIT oR EQUIVALENT I (INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING STON INSTALL ONE INSPECTION RISER TO WITHIN SIX 88.00 INCHES OF FINAL GRADE AN 0-8 Ap LOAMY SAND 10 YR 3/2 NONE FRIABLE 33.5 f t ONOAS-BUILTE CARD.LOCATION m 8-40 B LOAMY SAND 10 YR 4/6. NONE FRIABLE 4, m 84.6 4 40-120 C MEDIUM SAND 10 YR 6/3 NONE LOOSE m � 78.00 LF)"1 O O O� Q N oa� 00 n o 0 0��� N � � o0000000000 I m 0000aooa000 4.� 8.5 6.5 8.5' 4.0 3 3.5 f t 102 �n NOTES 1) GARBAGE GRINDER NOT ALLOWED WITH THIS DESIGN. 2) ALL LINES TO BE SCH 40 PVC AND PITCH AT 1/6 INCH PER FOOT MINIMUM. 3) ALL COMPONENTS INSTALLED SHALL MEET THE MINIMUM REQUIREMENTS OF MASSACHUSETTS TITLE 5 SEPTIC CODE (310 CMR 15). 4) INSTALLER TO VERIFY LOCATIONS OF ALL UNDERGROUND UTILITIES BEFORE EXCAVATING FOR SYSTEM. 5) EXISTING CESSPOOL TO BE PUMPED, COLLAPSED. AND REMOVED. 6) ALL STONE TO BE DOUBLE WASHED AND FREE OF IRON. FINES AND DUST IN PLACE. GROUNDWATER ADJUSTMENT Z) LINES EXITING D-BOX TO RUN LEVEL FOR 2'-0" BEFORE PITCHING DOWN.4 EXISTING GROUNDWATER LEVEL ,8) ECO-TECH ENVIRONMENTAL RECOMMENDS THE INSTALLATION OF LOW FLOW Fi.XTURES BASED ON TOWN OF BARNSTABLE SEWAGE DISPOSAL SYSTEM PLAN AND APPLIANCES. AND BIANNUAL PUMPING OF THE SEPTIC TANK. t ' . GIS DEPARTMENT RECORDS. 9) SYSTEM IS NOT DESIGNED . TO WITHSTAND VEHICULAR LOADING. DO NOT ,: ,tr INDICATED GW 42.00 -TO SERVE EXISTING DWELLING PARK OR DRIVE VEHICLES OVER SEPTIC SYSTEM. INDEX WELL SDW-253 10) INSTALLER TO OBTAIN DISPOSAL WORKS PERMIT BEFORE STARTING WORK." REEADING DATE NOV. 2006 AUSTIN AND SHEILA JORDAN 11) SEPTIC TANKS SHALL BE INSTALLED LEVEL AND TRUE TO GRADE ON �A 'LEVE,L READING 47.2 110 RASPBERRY LANE MARSTONS MILLS. MA STABLE BASE THAT HAS BEEN MECHANICALLY COMPACTED AND ON TO WHICH ADJUSTMENT ADJUSTED GW 434 SIX INCHES OF CRUSHED STONE HAS BEEN PLACED TO MINIMIZE UNEVEN SETTLING. . ECO-TECH ENVIRONMENTAL - 43 TRIANGLE CIRCLE SANDWICH MA 02563 ETE-2512 I DECEMBER 2 2006 1212 ,