HomeMy WebLinkAbout0475 WHISTLEBERRY DRIVE - Health 475 Whistleberry Dr:'v e -
�� Marstons;Mills.
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TOWN OF BARNSTABLE
LO(:j.TION T�� Ly /'5�� ��/'�Y 34 SEWAGE #
VILLAGE /l1'I- IV/I-L S' ASSESSOR'S MAP& LOT
IN—' -*S NAME-&PHONE NO.,?Q
SEPTIC TANK CAPACITY ��� /�����'-7—ti
LEACHING FACILITY: (type) (size)
NO.OF BEDROOMS
BUILDER OR OWNER
PERMITDATE: CeNff�E DATE: .
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
1. within 300 feet of leaching facility) Feet
a Furnished by
L,
�dAVI� `
3
30 s
,1031
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COMMONWEALTH OF MASSACHUSETTS
�M d
Title 5 Official Inspection Form
Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
Ins ection results must be submitted on this form. Inspection forms may not be altered in any way.
A. General Information 07 5-__-I
1, Property Information: MAP 061 — PARC 039
475 WHISTLEBERRY DRIVE — MARSTONS MILLS, MA 02648
Property Address
ROMEISER, DAVID & ASHLEY
Owner's Name
47,5 WHISTLEBERRY DRIVE
Owner's Address
z
MARSTONS MILLS MA 02648
City/Town State Zip Code
MARCH 19, 2007
Date
2. Inspector:
JAMES D. SEARS
Name of Inspector
A & B CANCO
Company Name
350 MAIN STREET
Company Address
WEST tARMOUTH MA 02673
'City/Town ' State Zip Code
`508-775-2800
-Telephone Number
S. 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 16.340 of Title 5(310 CMR 16.000). The System:
Ir
lasses! Conditionally Passes Fails
I
eds Further Evaluation by pe Local Approving Authority / �7
pector'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 6-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 conditioris at the time:of.inspection and under the conditions of use at that time.
This inspection does not address how the`system will perfornf in the future under the same or different
conditions of use.
Title 5 Official Inspection Form:Subsurface Sewage Disposal System
Page 1 of 16
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COMMONWEALTH OF MASSACHUSETTS
N Title 5 Official Inspection Form
d
Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
D. Certification (cont.)
475 WHISTLEBERRY DRIVE
Owner's Address
MARSTONS MILLS MA 02648
City/Town State Zip Code
ROMEISER, DAVID & ASHLEY
Owner's Name
MARCH 19, 2007
Date of inspection
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: N/A
❑ 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.
Answer yes, no or not determined (Y; N, ND)in the for the following statements. If"not determined,"
please explain.
❑I 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.
ND Explain:
Title 5 Official Inspection Form:Subsurface Sewage Disposal System
Page 2 of 16
COMMONWEALTH OF MASSACHUSETTS
a
Title 5 Official Inspection Form
Not for Voluntary Assessments
i0„M SVOJW
Subsurface Sewage Disposal System Form
B. Certification (cont.)
475 WHISTLEBERRY DRIVE
Owner's Address
MARSTONS MILLS MA 02648
City/Town State Zip Code
ROMEISER, DAVID & ASHLEY
Owner's Name
MARCH 19, 2007
Date of inspection
B) System Conditionally Passes (cont.): N/A
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
obstruction is removed
distribution box is leveled or replaced
ND Explain:
In 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
obstruction is removed
ND Explain:
C) Further Evaluation is Required by the Board of Health: N/A
❑ 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)
Ib)that the system is not functioning in a manner which will protect public health,safety and
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
Title 5 Official Inspection Form:Subsurface Sewage Disposal System
Page 3 of 16
COMMONWEALTH OF MASSACHUSETTS
Title 5 Official Inspection Form
9 C
Not for Voluntary Assessments
,�M Jew t
Subsurface Sewage Disposal System Form
B. Certification (cont.)
475 WHISTLEBERRY DRIVE
Owner's Address
MARSTONS MILLS MA 02648
City/Town State Zip Code
ROMEISER, DAVID & ASHLEY
Owner's Name
MARCH 19, 2007
Date of inspection
C)�Further evaluation is required by the Board of Health (cont.): N/A
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 coliform bacteria
indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less that 5 ppm,
provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.
3.Other:
Title 5 Official Inspection Form:Subsurface Sewage Disposal System
Page 4 of 16
COMMONWEALTH OF MASSACHUSETTS
w Title 5 Official Inspection Form
9 C
Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
B. Certification (cont.)
475 WHISTLEBERRY DRIVE
Owner's Address
MARSTONS MILLS MA 02648
City/Town State Zip Code
ROMEISER, DAVID & ASHLEY
Owner's Name
MARCH 19, 2007
Date of inspection
D) System Failure Criteria Applicable to All Systems: N/A
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 pits is less than 6" below invert or available volume is less than
'/2 day flow
Required pumping more than 4 times in the.last year NOT due to clogged or obstructed
pi'pe(s). Number of times pumped:
Any portion of the SAS, cesspool or privy is below high ground surface water elevation.
N/A Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary
77_ to a surface water supply.
N/A Any portion of a cesspool or privy is within a Zone 1 of a public well.
N/A Any portion of a cesspool or privy is within 50 feet of a private water supply well.
® N/A 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.]
YES No
The system is a cesspool serving a facility with a design flow of 2000 gpd—10,000 gpd.
Yes No
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.
Title 5 Official Inspection Form:Subsurface Sewage Disposal System
Page 5 of 16
COMMONWEALTH OF MASSACHUSETTS
d
Title 5 Official Inspection Form
Not for Voluntary Assessments
'Yee Subsurface Sewage Disposal System Form
B. Certification (cont.)
475 WHISTLEBERRY DRIVE
Property Address
MARSTONS MILLS MA 02648
City/Town State Zip Code
ROMEISER, DAVID & ASHLEY
Owner's Name
MARCH 19, 2007
Date of inspection
E) N/A-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.
Title 5 Official Inspection Form:Subsurface Sewage Disposal System
Page 6 of 16
COMMONWEALTH OF MASSACHUSETTS
y Title 5 Official Inspection Form
d
Not for Voluntary Assessments
ip, yey
Subsurface Sewage Disposal System Form
C. Checklist
4175 WHISTLEBERRY DRIVE
Property Address
M.ARSTONS MILLS MA 02648
City/Town State Zip Code
ROMEISER, DAVID & ASHLEY
Owner's Name
MARCH 19, 2007
Date of inspection
Check if the following have been done. You must indicate "yes" or"no" as to each of the
fol;owing:
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?
I
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, including 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?
® 0 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)].
Title 5 Official Inspection Form:Subsurface Sewage Disposal System
Page 7 of 16
COMMONWEALTH OF MASSACHUSETTS
Title 5 Official Inspection Form
e� Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
D. System Information
475 WHISTLEBERRY DRIVE
Prooerty Address
MARSTONS MILLS MA 02648
CityfTown State Zip Code
ROMEISER, DAVID & ASHLEY
Owner's Name
MARCH 19, 2007
Date of inspection
Residential Flow Conditions:./
Number of bedrooms(design): 4 Number of bedrooms(actual): 4
DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 440
Number of current residents: 4
Does residence have a garbage grinder? Yes No
Is laundry on a separate sewage system?[if yes separate inspection is required] ® Yes No
Laundry system inspected? 0 Yes ® No
Seasonal use? ❑ Yes ® No
Water meter readings, if available(last 2 years usage(gpd)): 2005—213,000 GAL.
2006—223,000 GAL.
Sump pump? Yes 0 No
Last date of occupancy: PRESENT
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:
Last date of occupancy/use:
Date
Other(describe):
Title 5 Official Inspection Form:Subsurface Sewage Disposal System
Page 8 of 16
COMMONWEALTH OF MASSACHUSETTS
a Title 5 Official Inspection Form
Not for Voluntary Assessments
V V
Subsurface Sewage Disposal System Form
D. System Information (cont.)
475 WHISTLEBERRY DRIVE
Property Address
MARSTONS MILLS MA 02648
Cityrrown State Zip Code
ROMEISER, DAVID & ASHLEY
Owner's Name
MARCH 19, 2007
Date of inspection
General Information
Pumping Records: ./
Source of Information: N/A
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:
F1 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)
® Tight tank. Attach a copy of the DEP approval.
Other(describe):
Approximate age of all components, date installed(if known)and source of information:
1986—NEW D-BOX 2007 PERMIT#2007-093.
Were sewage odors detected when arriving at the site? Yes ® No
Title 5 Official Inspection Form:Subsurface Sewage Disposal System
Page 9 of 16
COMMONWEALTH OF MASSACHUSETTS
� d
Title 5 Official Inspection Form
Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
D. System Information (cont.)
475 WHISTLEBERRY DRIVE
Prcperty Address
MARSTONS MILLS MA 02648
City/Town State Zip Code
ROMEISER, DAVID & ASHLEY
Owner's Name
MARCH 19, 2007
Date of inspection
Building Sewer(locate on site plan): ✓
Depth below grade: 8"
feet
Material of construction:
F1 cast iron 40 PVC ® other(explain)
Distance from private water supply well or suction line:
feet
Comments(on condition ofjcints, venting, evidence of leakage, etc.):
GOOD
Septic Tank(locate on site plan): ✓
Depth below grade: 1'
feet I
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-GALLON PRE CAST
Sludge depth: 2"
Distance from top of sludge to bottom of outlet tee or baffle 28"
Scum Thickness 1"
Distance from top of scum to top of outlet tee or baffle 8"
Distance from bottom of scum to bottom of outlet tee or baffle 17"
How were dimensions determined? ASBUILT—TAPE—SLUDGE JUDGE.
Title 5 Official Inspection Form:Subsurface Sewage Disposal System
Page 10 of 16
COMMONWEALTH OF MASSACHUSETTS
d
Title 5 Official Inspection Form
Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
D. System Information (cont.)
475 WHISTLEBERRY DRIVE
Property Address
MARSTONS MILLS MA 02648
City/Town State Zip Code
ROMEISER, DAVID & ASHLEY
Owner's Name
MARCH 19, 2007
Date of inspection
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 AT WORKING LEVEL, TANK & COVERS AT V OUTLET TEE.
NO SIGN OF LEAKAGE OR OVERLOADING.
Grease Trap (locate on site plan): N/A
Depth below grade:
feet
Material of construction:
❑ concrete1:1 metal ❑ fiberglass ❑ polyethylene ❑ other(explain)
Dimensions:
Scum Thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping
Date
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid
levels as related to outlet invert, evidence of leakage, etc.):
Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): N/A
Depth below grade:
Material of construction:
® concrete ® metal ® fiberglass polyethylene other(explain)
Title 5 Official Inspection Form:Subsurface Sewage Disposal System
Page 11 of 16
COMMONWEALTH OF MASSACHUSETTS
Title 5 Official Inspection Form
Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
D. System Information (cont.)
475 WHISTLEBERRY DRIVE
Property Address
MARSTONS MILLS MA 02648
City/Town State Zip Code
ROMEISER, DAVID & ASHLEY
Owner's Name
MARCH 19, 2007
Date of inspection
Tight or Holding Tank (cont.) N/A
Dimensions:
Capacity:
gallons
Des^gn 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 a copy of current pumping contract(required). Is copy attached? ❑ Yes No
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.):
D-BOX IS NEW 3/19/07 — PERMIT #2007-093.
D-BOX IS 16" X 16" —24 BELOW GRADE WITH COVER AT 6".
ONE LINE IN — TWO LINES OUT.
Pump Chamber(locate on site plan): N/A
'Pumps in working order: Yes No
Alarms in working order: ® Yes ® No
Title 5 Official Inspection Form:Subsurface Sewage Disposal System
Page 12 of 16
COMMONWEALTH OF MASSACHUSETTS
w Title 5 Official Inspection Form
d
Not for Voluntary Assessments
J v
Subsurface Sewage Disposal System Form
D. System Information (cont.)
475 WHISTLEBERRY DRIVE
Property Address
MARSTONS MILLS MA 02648
City,Town State Zip Code
ROMEISER, DAVID & ASHLEY
Owner's Name
MARCH 19, 2007
Date of inspection
Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.):
Soil Absorption System (SAS) (locate on site plan, excavation not required): ✓
If SAS not located, explain why:
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.)-
LEACHING IS TWO 1000-GALLON PRE CAST PITS.
PIT ONE 26" BELOW GRADE WITH COVER AT 4".
PIT TWO 40" BELOW WITH COVER AT 18".
BOTH PITS HAVE WATER AT 36, NO HIGH STAIN LINE OR SOLID CARRY OVER.
NO SIGN OF OVERLOADING.
COMMONWEALTH OF MASSACHUSETTS
4 Title 5 Official Inspection Form
d
Not for Voluntary Assessments
p� Vev
Subsurface Sewage Disposal System Form
D. System Information (cont.)
475 WHISTLEBERRY DRIVE
Property Address
MARSTONS MILLS MA 02648
City7own State Zip Code
ROMEISER, DAVID & ASHLEY
Owner's Name
MARCH 19, 2007
Date of inspection
Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): N/A
Number and configuration
Depth—top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow Yes ❑ No
Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation,
etc.):
Privy (locate on site plan): N/A
Materials of construction:
Dimensions
Depth of solids
Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation,
etc.):
COMMONWEALTH OF MASSACHUSETTS
Title 5 Official Inspection Form
a� Not for Voluntary Assessments
Subsurface Sewage Disposal System Form
D. System Information (cont.)
475 WHISTLEBERRY DRIVE
Property Address
MARSTONS MILLS MA 02648
Cityrrown State Zip Code
ROMEISER, DAVID & ASHLEY
Owner's Name
MARCH 19, 2007
Date of inspection
Sketch of Sewage Disposal System: Provide"a sketch of the sewage disposal system including ties to at
least two permanent reference landmarks or benchmarks. Locate ail wells within.100 feet. Locate where
public wat r supply enters the building.
Fed 11r
I p
I,
30r
4?`
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Tak t 'M11 141 lnapeawn F,nn --ubvurtxe v'N.xW ap aaI�Wtei1
Pale 15 JI:0
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COMMONWEALTH OF MASSACHUSETTS
d
Title 5 Official Inspection Form
Not for Voluntary Assessments
Ip1 Vey
Subsurface Sewage Disposal System Form
D. System Information (cont.)
475 WHISTLEBERRY DRIVE
Property Address
MARSTONS MILLS MA 02648
Cityrrown State Zip Code
ROMEISER, DAVID & ASHLEY
Owner's Name
MARCH 19, 2007
Date of inspection
Site Exam:
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water: 25'+
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:
You must describe how you established the high ground water elevation:
LOT HIGH ABUTTING PROPERTY 25'+ TO WATER.
USES WELL SDW 253 AT 25 .
Title 5 Official Inspection Form:Subsurface Sewage Disposal System
Page 16 of 16
f
Town of Bamstable 7/31/07
Board of Health
200 Main St
Hyannis, MA. 02601
Re: 475 Whistieberry Dr
Marston Mills, MA 02648
Dear Sir:
I am a resident of Whistleberry and it has come to my attention that construction work has begun
on the area above the garage.
According to the building inpectors office a permit has been granted for a bath and living
space????
1 have been told the new owners plan on using that space for an apartment and will be renting
out the main house which I believe is against the Town's zoning. I do not believe the contractor
has given you the exact usage for this space when he pulled the permit. Please investigate this
situation.
Thank you for you diligence,
A concemed resident
TOWN OF BARNSTABLE
LC'CAMDN. �� �(� /� STD B f�rr'i�S� .a R SEWAGE #
v,AgAGE /ti L L S ASSESSOR'S MAP & LOT
Ilr'YrALLER'S NAME&PHONE NO. / if id e9l;XIC p r
SEPTIC TANK CAPACITY 04
LEACHING FACILITY: (type) (size)
NO.OF BEDROOMS t
BUILDER OR OWNER Cj M
PERMPTDATE: `I ' COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
_Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
M Furnished by
IrR o/V-r
e
�o 0
P
59 �
o
No.. Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
Application for Migonl *Vmem Con.5truction Permit
Application for a Permit to Construct( ) Repair(e pgrade( ) Abandon( ) ❑ Complete System [A ndividual Components
Location Address or Lot No. 1 ITL£'e Elp'rY
Owner's Name,Address,and Tel.No.
��w�
Assessor's Map,Parcel - G Aq. /bl_/yj/G S
-
Installer's Name,Address 1)95-
,and Tel.No.soy Designer's Name,Address and Tel.No.
�� � NC,6
33-a InI4>ti ST w-�/aR
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder ( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 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
Nature of Repairs or Alterations(Answer when applicable) JT 4 C C f� /1. /,f og
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 t 's Board of Health. �7
Signe Date
Application Approved by Date
Application Di.approved b Date
for the following reasons
Permit No. Date Issued
————--—————————— ————————————- — — --.
D0qNo. Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
Zfpplication for Wgponl *p!9tem Cow5truction Permit
'-Application for a Permit to Construct( ) Repair(Upgrade Abandon( ) E Complete System U Individual Components
Location Address or Lot No. ,/ Q �RY Owner's Name,Address,and Tel.No.jQ 8 y�0'O 6�Y
?7S W lS'TLF f AO/►7E�SFit'
Assessor's Ma /Parcel /h /;'I/L./_S
p D� yes w /;J)4 s.
sas-�'IS�a2 boo
Installer's Name,Addres ,and Tel.No. Designer's Name,Address and Tel.No.
A �/5
Type of Building
Dwelling No.of Bedrooms J Lot Size sq.ft. Garbage Grinder ( )
r
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
Nature of Repairs or Alterations(Answer when applicable) �-I'F P-
A f' C 0 xJe /p/S G/F
Date last inspected:
Agreement:
' 4 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
7 Compliance has been issued by t 's Board'of Health.
Signe ) Date 7
Application Approved by Date
Application Disapproved by v Date
for the following reasons
Permit No. Date Issued
- - - --------1� ------ -------- -----�--ter ---------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO CER! that the On-site Sewage Disposal System Constructed ( ) �Uaded Repaired
P ( P8�' ( )
Abandoned( )by /7 �� M //C 0 3Sa W411t- ST 4-, -' -4/?
at 7 9 S Z</ Til F Q f/?/1' 0/P. M •Al/C L S has been constructed in accordance
with the pr isions of�Tilleand.the for isposal System Construction Permit No. r dated
Installer Designer
#bedro ms Approved design flow gpd
The issuance of this permitVnot be construed as a guarantee that the sys,te�unbtL- \ac�de igned.��
Date � 'C)-7 Inspector-___._ l� 1
——————————————————————————————————————
No. Fee �oD✓'
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS
Dioponl:6p.5tem Cou5truction Permit
Permission is hereby granted to Construct ( ) Repair ( 41 Upgrade ( ) Abandon ( )
System located at '72- 1 e f
3
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 be c ears m let wi three y of the date of this rnYit.
Date i p �� Approved by p /T
l OT" OF BARNSTABLE
aO----
HISWLEBRRY DR-
LOU, _87-
o
SEWAGE #
VILI;AGE BARNSTABLE ASSESSOR'S MAP & LOT
4&INSTALLER'S NAME & PHONE NO. BCK'778-0444
SEPTIC TANK CAPACITY 1500 GST
LEACHING FACILITY:(type) LEACH PIT (size) 1000
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER Public
BUILDER OR OWNER DAVID ROMEISER
DATE PERMIT ISSUED: j d - 7
DATE COUPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
mot.
r -
4Jf��s%/e
No.----.� �' --•---•• Fxs.....................
THE COMMONWEALTH OF MASSACHUSETTS
OAR® OF HEALTH
OF. / -_ lP.G!1.. �-..........................
1�C ApplirFa#uan for Dispoii ai Workii Tnnitrnrtann runfit
Application is hereby made for a Permit to Construct (Y) or Repair ( ) an Individual Sewage Disposal
Systemt • _. ...... - - - --•---------------------------• ---------- ... --------............-----
at ress o t No
.................... ............... .......................... .. .................
owner �................
Installer Address
Q Type of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms............................... .Expansion Attic ( ) Garbage Grinder ( )
PL4Other—T e of Building No. of persons............................ Showers — Cafeteria
.< Other fit s .............
W Design Flow........... ........................ gallons per person per day. Total daily flow........- -- ___--_-._._•-•------__-_ lons.
,i
WSeptic Tank—Liquid'capacity�. ..__..gallons Length.../l.._..... Width..�...__._ Diameter_____ _______ Deoth.___.___1
x Disposal Trench—No.......... ......... Width............. Total Length.................... Total leaching area._. .-sq. ft.
Seepage Pit No........j---------- Diameter......6__1....... Depth below inlet......4........... Total leaching area. .....sq. ft.
Z Other Distribution box (V< Dosing nk )
'-' Percolation Test Results, Performed by_______. . Date_..... ..............................�—
a ----- .._.. --
Test Pit No. 1..... .minutes per inch Depth of Test Pit..._, __...____ Depth to ground water-----------------.-____.
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
x •. .........
� .......�._ ------„ -
j
ii -----
Ox
-Description ...
......` /
_.� -S i•-- - ._
U / .........................................................................
W
------------•-----------••---•-•------••----------------------•-•--•-•--......--....................•----------•---------------------••--•--•-•-------•--••--•---------•••--........................•---
U Nature of Repairs or Alterations—Answer when applicable...............................................................................................
--------•----------------------------------------------------------------------------------------•••---•••--•-•-------------------•--•--------•-••-••------------------•------------------•--•------•--
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance4hhasb�y the board of health. /Sig ._....._.. ---------- ------ / /.e.1 ---- - ---- - ------ - Date .Q
Application Approved .BY--- --- --------------- - .-----------1'--="---
Date
Application Disapproved for the following reasons:..............................................................................................................
--------------•---•---•---•----•••-._....-•------••--------....•-•-•-•---•------.....-----•-•--------•-----------•--•---•----•----•----•-•---•----------•-•----••••••••-•------•----•--•------•-•-•-•---
Date
. � 11 7 Permit No............ ......... - ..K........... Issued........................................................
Date
No.....................•-•- FEs..........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
���f ..........OF....................r,�r., 1�7 ',....__....... .....
Appliratiun for Disposal Works Tonstrnrtion 'prrntit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at: / _
.............................................
........Loca----.--Address
-----•---
Location=Address y� ' or Lot f o. -•
r_1 . - ......... C. �{ _J.(�:!Q -
j'� Owner // Address — - -
! t. C • k. ........................./.• /, f /. 7,1 .�� ?T_
Installer Address
Type of Building Size Lot................ q. feet
,., Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type
of Building ............................. No. of persons............................ Showers ( ) — Cafeteria ( )
04 Other fixtures .----•------------------•--=---•----------------••-•----••----•-----•----•------ ...........
W Design Flow............. .._�t.......................gallons per person per day. Total daily flow......... f.................._........_..gallons.
WSeptic Tank—Liquid capacity............gallons Length.....Z........ Width............... Diameter........------ Depth_.�.__-r
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No................... Diameter--______?_......... Depth below inlet........?......... Total leaching area.... :n....sq. ft.
Z Other Distribution box ( v)� Dosing tank ( ) 11 ,
'-' Percolation Test Results Performed by._.....!_�:::_,:'`.:_t:.' _--�'..1I........_ ........................................f
W Date
a Test Pit No. 1-------- -_minutes per inch Depth of Test Pit..___�c_..Y....... Depth to ground water........................
f1 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
{......�. f....._..... -;----------------------------------------------------
O Description of Soil----f•• --=_.. ... i a , r ..,,tJ....!?...... ....t-------- '•.t� -------- --`t-
.__T f f l ''a 's� 1LL�
W
U Nature of Repairs.or Alterations—Answer when applicable.......................................•__...........__.._.___......_...._.........._........__.
-••------------------------------•--•--•----•------•----•--•------------•----•--•-----•••-•--.....__.-------•...--••-------------•---------•----------••-----•-•••-•••-•-------•---------••-••------•---
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has be is ,ued by the board of health.
IJ
Signed---• . ....................---. ..........2------...-•.-= //-, ZeFz
Application Approved BY l.y n ``' `....... �.= ---" }► .ham �,
V Date
Date
Application Disapproved for the following reasons_________________________________________________________________________________........... ...._.....
••...............................•----------•-----...------------•---•---•-----•---------••--------------••-----------------•----•-------•------••••••--------------------------•--•--------•••---------
Date —
PermitNo...............•-••-.............--- Issued..---------•--------------------------• .......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........................................OF.....................................................................................
(2111rdifirate of Toutplianrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( Yor Repaired ( )
w.
by-------••-------•-•--------------•-•-------------------------•--•--------------------------.----•----------------------.-----,--•-••----•---------.--.-------•------.------••---.-..------•-----•---
'.' I st lie..
•-•-------
at_... h �p ( -- 4�P M` '
has been installed in accordance with the provisions of TITIE 5 of The State Sanitary Cod; als defraaibed in the
application for Disposal Works Construction Permit No...... ------!�.b..... dated-------------- .............
THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY. QQ
DATE...........................3t-.`-- -p1..-. .1.................... Inspector--------
,r} - ..r�- ---- ------.•--.---•-•-----
';f THE COMMONWEALTH OF MASSACHUSETTS
,' BOARD OF HEALTH
p 4 ao
...........................................OF..................................................................................... S
No......................... FEE........................
Disposal Works Tono#r ion rrmi#
Permissionis hereby granted.............----------------------•---•--•-----------•---•----•-----------...._........------------•--........-••-•.......••...........•---
to Construct (Y-) or Repair ( ) an Individual Sewage Disposal System
t
f
Street p,
as shown on the application for Disposal Works Construction Permit No. a6^��_��ated.._.__._..�. ...��.__1.8.>�........
........-•--•--_...•• - �'�---------------••••. _
DATE................................................................................
Board of Health
FORM 1255 HOBBS & WARREN. INC., PUBLISHERS
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