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HomeMy WebLinkAbout0523 WHISTLEBERRY DRIVE - Health f 523,WHISTLEBERRY 7 �Vt A= 0 9 b� n Town of Barnstable M Board of Health 200 Main Street, Hyannis MA 02601 Office: 508-8624644 John Norman,Chairrman FAX: 508-790-6304 Donald A.Guadagnoli,M.D. F.P.(Thomas)Lee,P.E. Daniel Luczkow,M.D.Alt March 1, 2022 Nason King Trust c/o Mr. Sean O'Brien 98 Whistle Berry Drive Martons Mills, MA 02648 w Whistleberry Dnve Marstons Mills. _ :_ .. _ :�_.�.-_a: A 061 040 Dear Mr. O'Brien, On January 18, 2022, you submitted a request for a determination in regards to the number of bedrooms at 523 Whistleberry Drive, Marstons Mills. As part of the request you provided correspondence indicating there were two real estate transfers in the past and the owners of the property considered this house as a four (4) bedroom home. You provided septic system inspection reports and floor plans showing four (4) bedrooms within the home. A public meeting of the Board of Health was scheduled and held on January 25, 2022 to hear this request. During the hearing, our Health Agent Thomas McKean, testified that he recently conducted a site visit within the home and observed four bedrooms on the first level of the home. The four rooms each afforded privacy, provided adequate floor space (square footage), contained electrical outlets, window(s), adequate ceiling height and all of the other requirements of the State Sanitary Code in regards to meeting the definition of"bedroom." The Board reviewed the submitted floor plans and septic system inspection reports. After some discussion, the Board unanimously voted in favor of granting you permission, on behalf of the Nason King Trust, to replace the onsite sewage disposal system designed for a four (4) bedroom home at 523 Whistleberry Drive Marstons Mills. Sincere) yours, ohn Norman Chairman Q:WP/OBrien 523 Whistleberry Drive Marstons Mills Bedroom Determination 2022.docx MEMORANDUM TO: The Barnstable Board of Health FROM: Sean O'Brien for the Nason King Tru .. DATE: January 18, 2022 RE: Bedroom Number 523 Whistleberry Drive Please let this memorandum serve as a request for the Board of Health to consider 523 Whistleberry C'[ ifi a 4-bedroom single family dwelling. The current owners of the property had considered the house a 4 bedroom when it was purchased by Nason and Barbara King in 2000. 1 have provided copies of the last 2 real estate transfers and a floor plan of the house where it shows,!, The Health Director was able to do a walk-through of the property. I will be availrabl^ for`jour next board of health meeting. Thank You for your consideration. 2 A7'H �� gyp'^' � .Y �ry'� � <<fi�,.�M1.��� � �..> �ur.4?s--- Y\ p 6 0� — - CO.IL�iO-����I.TH OF NLASSACHI:SETTS _ EhECL Tn E OFFICE OF F-N- RO-\-CIE\T .I. AFFAIRS F DEPARTMENT OF ENVIRONMENTAL PROTECTION OXE R'I.\'TER STREE'.ROSTON RSA 0210c t61"i 242-550a+ TRUDY COI- Secretary ARGEC,PAIL CELLLCCI DAVID R STP 'tic COnUM355:0ne7 Govemo: - SUBSURFACE SEWAGE DISPOSAL SYSTEM IWSPECTID9t1 FORM PART'A CERTIFICATION PropertyAddress523 Whistleberry Drive NowofOwner- Paul D. DeCenzo Marstons Mills Addrassof Ownw: Date of Inspection: Name of atspector:(Please Print)VI M. E . Robinson Sr. 1 mn a DEP approved s etrl ittspecior to Section t5340 of Title 5(370 CENR 15.000) �,pmy�1e: Wm. E . Robinson Septic Service MaiLngAddress: PO Box 1089, Centerville . MA Telephone Number: 2 2 5—,9 7 7 0 CERTIFICATION STATEMENT r and that the information reported below is true. accurate I certify that I have personalty inspected the sewage disposal system at this address p and complete as of the time of inspection. The inspection was performed based on my training ond•experience in the proper function and maintenance of on-site sewage disposal systems. The system: _v Passes _ Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature: : I ! Date: lj�>' �L The System Inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty (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 Department of Environmental Protection. The original should be sent to the system owner and copies sent to the'buyer. if applicable. and the approving authority. NOTES AND COMMENTS =P1%�s"^. 9�L��� Pa�clofll o-Rea-core Pan, L;LK 1 JHL;^r RM tearranuea I",VertyAefdress: 523 Whistleberry Drive, Marstons Mills awner a � Paul D. DeCenzo Date of J i t�. WSPECTION SUMMARY: B, C, or D: A- 4STEM PASSES: I have not found any information which indicates that'any of the failure conditions described in 310 CMR 15.303 exist. Any failure icriteria not evaluated are indicated below. COl4lIfi EWS: i 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 Fompletion of the replacement or repair,as approved by the Board of Health,will pass. Indicat/yes,no, or not determined(Y, N.or ND). Describe basis of determination in all instaices. If"not determined'.explain why not. _ The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection: or the septic tank.whether or not metal,is cracked,structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection H the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. f _ Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipelsl / or due to a broken, settled or uneven distribution box. The system will pass inspection if{with approval of the Hoard of / Health(. 1 broken pipe(s)are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four 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 revised 9/2/98 Page 2 of 11 PART A r CERTIFICATION Icorrtinued) Property Address: 523' Whistleberry Drive, Marstons Mills Otivner: Snernanza Date of Irupk ion _iy(p ,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 the public health, safety and the environment. 3 I SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES tN ACCORDANCE WITH 310 CMR 15.303 11)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVJRONMENT: — Cesspool or privy is within 50 feet of surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 1 - f f i I I `e 2) S STEM 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 AND SAFETY AND THE 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 soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less jthan 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER <L- rL /G` Page 3of11 prop"Address: 523 Whistleberry Drive, Marstons Mills Ownppernan a Date ofImpec0on:� R_d) D. SYSTEM FAILS: l)ou must indicate either "Yes" or "No" to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure Yes � No Backup of sewage into facility-or system component due to an 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 j cesspool. /J. Static liquid level in the distribution box above out invert due to an overloaded or clogged SAS or cesspool. j; Liquid depth in cesspool is less than 6" below invert or available volume,is less than 112 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipelsl. \, Number of times pumped_. _ Any portion of the Soil Absorption System. cesspool or privy is below the high groundwater elevation. _ Any portion of a 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 I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. i L _ 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria. volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E. RGE SYSTEM FAILS: You m st indicate either "Yes" or "No" to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a faciffty with a design flow of 10,000 gpd or greater(Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: YLS No �•.. the system is within 400 feet of a surface drinking water supply 1 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 11 of a public jwater supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional o e of the Department for further information. I _o`_—s'u C/G /GE Page4of11 Pro,erty address: 523 -Whistleberry Drive, Marstons Mills 'Dw I- N? ernanza DatIrtspection: Check if the followinghave been done:You must' t indicate either "Yes" or "No" as to each of the following: YeJJs No J _ Pumping information was provided by the owner, occupant, or Board of Health. V _ None of the system components have been pumped for at least two weeks and the system has been receiving"mmal flow rates during that period. Large volumes of water have not been introduced into the system recently or as pan of this inspection. _ As built plans have been obtained and examined. Note if they are not available with N/A. The facility or dwelling was inspected for signs of sewage back-up. J _ The system does not receive non-sanitary or industrial waste flow. The site was inspected for signs of breakout. All system components, excluding the Soil Absorption System, have been located on the site. The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. / The size and location of the Soil Absorption System on the site has been determined based on: Existing information. For example. Plan at B.O.N. Determined in the field(if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) j� 115.302(3)(b)i _ The facility owner (and occupants,if different from owner) were provided with information on the proper mainte-naace of SubSurface Disposal Systems. Page 5 of 11 'ropent Address:523 Whistleberry Drive, Marstons Mills owner: aSpernanza. Date of Inspec6cn:a 7 FLOW CONDITIONS RESIDENTIAL: Design flow: /� /O_g.p.d.lbedroom. Number of bedrooms Idesign):a� Number of bedrooms(actual):_ Total DESIGN flow .C-"O Number of current residents: Garbage grinder(yes or no):j10 Laundry(separate system) (yes or no):11`0 ; If yes,separate inspection required Laundry system inspected I es or no) Seasonal use (yes or no): Water meter readings, if available (last two year's usage (gpd): 1999 204 , 000 gal. Sump Pump(yes or no): tAO 1998 new Last date of occupancy: rfIZ `COMMERCIALANDUSTRIAL: Typ�of establishment: Design flow: qpd ( Based on 15.203) Basis of design flow Gr ase trap present: (yes or no)_ I dustrial Waste Holding Tank present: (yes or no)_ No • annary waste discharged to the Title 5 system: (yes or no)— Wate meter readings,if available: Last date of occupancy: OTHER:(Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System pumped as part of inspection: (yens or no)_ If yes. volume pumped: gallons Reason for pumping: TYPE O�SYSTEM �/ Septic tank%distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or nol fif yes, attach previous inspection records, if any) IIA Technology etc. Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components, date installed(if known) and source of information: �� • Sewage odors detected-when arriving at the site: (yes or no) ( •ropertyAwress: 523 Whistleberry Drive, Marstons Mills °wine}` ernar;_z D�ete of InsAOn: ( •� S\ ILDING SEWER: ( cafe on site plan) epth below grade:_ terial of construction:_cast iron_40 PVC_ other}explain) > -stance from private water supply well or suction line iameter Comments: (condition of joints, venting. evidence of leakage,-etc.) SEPTIC TANK-4 (locate on site plan) Depth below grade: I_i` Material of construction:_concrete metal_Fiberglass _Polyethylene_other(explain) If tank is metal,list age_ Is.age confirmed by Certificate of Compliance_ (YesiNn) Dimensions: X R Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle:�L Scum thickness:_ ar Distance from top of scum to top of outlet tee or baffle: G Distance from bottom of scum to bottgir of outlet tee or baffler How dimensions were determined: ::omments: (recommendation for pumping, condition of inlet and outlet tees or baffles,e rf� _de of liquid level in relation to outlet invert. structural integrity, � evidenc of leakage. etc.! i, ��� ��, (!,-�n1,��r��. y�i y� g 1 -�i GREASE TRAP: (locateion site plan) Depth below grade:_ Material of construction:_concrete_metal_Fiberglass _Polyethylene_other(explain) ;'`Dimensions: 1 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: CoFment:s: (reco mendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evident of leakage. etc.) •mil I / [/ Sc Pagc7of11 ^ Owner:. Date•of,. ` JJ an 4 ( t OR HOLDING TANK: (Tank must be pumped prior to, or at time of. inspection) (Iota a on site plan) De h below grade:_ M terial of construction:_concrete_metal_Fiberglass_Polyethylene_other(explain) Dimen ions: Capac ty: gallons Desi flow: gallons!day Al m present a level: Alarm in working order: Yes_ No_ Date f previous pumping: Corn eats: (c dition of inlet tee, condition of alarm and float switches,etc.) DISTRIBUTION BOX:_ (locate on site plan)) Depth of liquid level above outlet invert: Comments: Incite if level and distribution is equal. evidence of solids carryover,evidence of leakage into or out of box, etc.) PUMP CHAMBER: (locate on site plan; Pumps in working order: (Yes or No) arms in working order (Yes or No) Comments: (note'gondition of pump chamber. condition of pumps and appurtenances, etc.) Page 8 of 11 TO Dy, "Add.es5_ 523 Whistleberry Drive, Marstons Mills 'ITtrtepflrt" �n�,,�?,�J� j J SOIL ABSORPTION SYSTEM(SAS):f/ (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located, explain: Type: leaching pits; number:_ leaching chambers, number: 7-7 leaching galleries, number:- leaching trenches, number, length: leaching fields. number, dimensions. overflow cesspool, number:_ Alternative system: Name of Technology: Comments: Inote condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.) � ' J� .N o CESSPOOLS._ (locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: /')epth of solids layer: Depth of scum layer: Dimensions of cesspool: ,Materials of construction. titdicatron of groundwater: inflow (cisspool must be pumped as part of inspection) I i Col ments: (n'It e cond Lion of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) ORIVY:_ Locate on site plan) Ma;�rials of construction: Depth of solids: Dimensions: Yn. e ' ents: ondition of soil. signs of hydraulic failure, level of ponding, condition of vegetation, etc.) Pdp[9 of I I r i� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 523 Whistleberry Drive, Marstons Mills, MA 02648 Property Address Barbara I&Nason F King Owner Owners Name infomation is Marstons Mills MA 02646 12/08/2021 required for every page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way.Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information on the computer, Reid C. Ellis use only the tab key to move your Name of Inspector cursor-do not Ellis Brothers Const. Co. use the return Company Name key. 23 Enterprises Road, P.O. Box 59 J_ Company Address Yarmouth Port MA 02675 CitylTown State Zip Code 508-362-6237 S12189 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 16.000); 1 have personally inspected the sewage disposal system at the property address listed above;the information reported below is true,accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. ❑ Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ails Ins ctors Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note:This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/2612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 L• C Commonwealth of Massachusetts Title 5 Official Inspection Form la Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 523 Whistleberry Drive, Marstons Mills, MA 02648523 Property Address Barbara I&Nason F King Owner Owner's Name information is Marstons Mills MA 02646 12/08/2021 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1,2, 3,or 5 and all of 4 and 6. 1) System Passes: ❑ I have not found any information which in cates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 2) System Conditionally Passes: ❑ One or more system components as de 5cribed 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 determ ed" (Y, N, ND)for the following statements. If"not determined,"please explain. The septic'tank is metal and over 20 years Id*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or iltration or tank failure is imminent. System will pass inspection if the existing tank is replaced wilh a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if R is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less t ian 20 years old is available. ❑ Y ❑ N ❑ ND(Explai i below): i i t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 Commonwealth of Massachusetts Title 5 official Inspection Form �a Subsurface Sewage Disposal System Form Not for Voluntary Assessments 523 Whistleberry Drive, Marstons Mills, MA 02648 Property Address Barbara I&Nason F King Owner Owners Name information is Marstons.Mills MA 02648 12/08/2021 required for every page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ,��// ❑ Pump Chamber pumps/alarms not operatic nal. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break o or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a Droken, 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 replac Bd ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): 3) Further Evaluation is Required by the Boarc of Health: ❑ Conditions exist which require further evalt ation by the Board of Health in order to determine if the system is failing to protect public healt , safety or.the environment. a. System will pass unless Board of He ilth determines in accordance with 310 CMR 15.303(1)(b)that the system is not func oning in a manner which will protect public health, safety and the environment: i"I"i t5insp doc•rev.726/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form r Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 523 Whistleberry Drive, Marstons Mills, MA 02648 Property Address Barbara I&Nason F King Owner Owner's Name information is Marstons Mills MA 02648 12/08/2021 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ElCesspool or privy is within 50 feet krface water ❑ Cesspool or privy is within 50 feet c f a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health(and Public Water Supplier,if any) determines that the system is functioni in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil a 3sorption system (SAS)and the SAS is within 100 feet of a surface water supply or tribute ry 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. I c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes/ No ❑ Backup of sewage into facility or system component due to overloaded or U clogged SAS or cesspool El �/ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5inspXoc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 523 Whistleber Drive, Marstons Mills, MA 02648 ry Property Address Barbara I&Nason F King Owner Owner's Name information is Marstons Mills MA 02648 12/08/2021 required for every page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Liquid depth in cesspool is less than 6"below invert or available volume is less than Y2 day flow ❑ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ [ Any portion of the SAS, cesspool or privy is below high ground water elevation. Any portion of cesspool or privy is within 100 feet of a surface water supply or ❑ tributary to a surface water supply. ❑ Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ['' Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. /04 A14. 5) Large Systems: To be considered a large sys em 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" r"no"to each of the following, in addition to the questions in Section CA. Yes No I ❑ ❑ the system is within 400 fee 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 Fone II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 18 Commonwealth of Massachusetts 1: Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 523 Whistleberry Drive, Marstons Mills, MA 02648 Property Address Barbara I&Nason F King Owner Owners Name information is Marstons Mills MA 02648 12/08/2021 required for every State Zip Code Date of Inspection page Cityrrown C. Inspection Summary (cont.) If you have answered"yes"to any question in Section C.5 the system is considered a significant threat, cr answered"yes"to any question in Section CA above the large system has failed.The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for aH inspections: Yes h No [1 ❑ • Pumping information was provided by the owner, occupant, or Board of Health ❑ - Were any of the system components pumped out in the previous two weeks? ❑ [ / Has the system received normal flows in the previous two week period? Have large volumes of water been introduced to the system recently or as part of ❑/ this inspection? ❑ Were as built plans of the system obtained and examined?(if they were not -' available note as N/A) v ❑ Was the facility or dwelling inspected for signs of sewage back up? ❑ for signs/" ❑ Was the site inspected of break out? �l ❑ Were all system components,g chiding 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 I_l 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)1310 CMR 15.302(5)] t5insp.doc•rev.712612018 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts : Title 5 official Inspection Form r; Subsurface Sewage Disposal System Form Not for Voluntary Assessments ..... ` 523 Whistleberry Drive, Marstons Mills, MA 02648 Property Address Barbara I&Nason F King Owner Owner's Name information is Marstons Mills MA 02648 12/08/2021 required for every page. City/Tom State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: � Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): L� Description: f �� J 4 Number of current residents: Does residence have a garbage grinder? ❑ Yes L� N Does residence have a water treatment unit? El Yes ` No If yes, discharges to: Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes [5/No information in this report.) Laundry system inspected? ❑ Yeso Seasonal use? ❑ Yes 1 No Water meter readings, if available(last 2 years usage(gpd)): Detail: , . Sump pump? �1 ❑ Yes No Last date of occupancy: _ l/U >` t/ Date t5in3p.doc-rev.7/2612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 523 Whistleberry Drive, Marstons Mills, MA 02648 Property Address Barbara I&Nason F King Owner Owner's Name information is Marstons Mills MA 02648 12/08/2021 required for every page City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 sy tem? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: , Source of information: �9" Yes O/N o Was system pumped as part of the inspection? ❑ If yes,volume pumped: gallons � quantity pumped How was uantit determined? Reason for pumping: t5insp.doc•rev.7/2612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments ry 523 Whistleber Drive, Marstons Mills, MA 02648 Property Address Barbara I&Nason F King Owner Owner's Name infonnation is Marstons Mills MA 02648 12/08/2021 required for every State Zip Code Date of Inspection page City,Town D. System Information (cont.) 4. Type o, System: i Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: �s6/`i - - a r Were sewage odors detected when arriving at the site? ❑ Yes F No 5. Bug ildin Sewer locate on site plan): Depth below grade: LCr/l 3? feet Material of constructiV40 ❑cast iron PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints,venting, evidence of leakage, etc.): ' b pp "R t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts is Title 5 Official Inspection Form Subsurface Sewage Disposal system Form -Not for Voluntary Assessments 523 Whistleberry Drive, Marstons Mills, MA 02648 Property Address Barbara I&Nason F King Owner Owners Name MA 02648 12/08/2021 information is Marstons Mills required for every Cityrrown State Zip Code Date of Inspection page. y D. System Information (cont.) 3rzlo�a ��r � Y 6. Septic Tank(locate n site plan): Depth below gra e: � :� ��,i,iPli. �a7 4 l r r+'"_ feet, i� �� d`.!� �,v�"fir ✓ f.J-A Material of construction: fiber lass ❑polyethylene ❑other(explain) th concrete metal ❑ 9 , + • n A OR k 0 (if tank is metal, list age: years Yes ❑ No Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) Elo Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, ' liquid levels as related to outlet invert,evide ce of leakage etc.): �\ 1 tx Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 t5insp.loc•rev.7262018 I Commonwealth of Massachusetts �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 523 Whistleberry Drive, Marstons Mills, MA 02648 Property Address Barbara I&Nason F King Owner Owner's Name information is Marstons Mills MA 02648 12/08/2021 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): " " W Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑ Iberglass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness j Distance from top of scum to top of outlet tee r baffle Distance from bottom of scum to bottom of ou let 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, eviden a of leakage, etc.): . i N 8. Tight or Holding Tank(tank must be pumped t time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fi ierglass ❑ polyethylene ❑other(explain): I l t Dimensions: Capacity: i� p �' gallons Design Flow: Q11; gallons per day l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 l c � Commonwealth of Massachusetts Title 5 Official Inspection Form r Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 523 Whistleberry Drive, Marstons Mills, MA 02648 Property Address Barbara I&Nason F King Owner Owner's Name information is Marstons Mills MA 02648 12/08/2021 required for every page. City/Town Satet Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of'last pumping: Date Comments(condition of alarm and float sA itches, etc.): i Attach co of current pumping contract required). Is co attached? ❑ Yes ❑ No PY P P 9 � PY 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert $, Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Y , .S 2,01' - � t5insp.doc•rev.7/262018 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form is Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 523 Whistleberry Drive, Marstons Mills, MA 02648 Property Address Barbara I&Nason F icing Owner Owner's Name information is Marstons Mills MA 02648 12/08/2021 required for every page_ City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): W14 Pumps in working order: ❑ Yes ❑ No' Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, ondition of pumps and appurtenances,etc.): *If pumps or alarms are not in working order,system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: ,,J-45 I �J SOe-e 9 P Type: ❑ leaching pits number: leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5inspAoc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 523 Whistleberry Drive, Marstons Mills, MA 02648 Property Address BAR I&Nason F King Owner Owner's Name information is Marstons Mills MA 02648 12/08/2021 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS)(cont.) Comments(note condition of soil,signs of hydraulic failure, level of ponding, damp soil, condition of vegetation,etc.): r � Ax, 74 x ox-vIL4 t XV7,1r Ae eo6>a '—'12. Cesspools cesspool must be pumped' s 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 l i Indication of groundwater inflow ❑ Yes ❑ -No Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.): i 4 i i t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 ti Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 523 Whistleberry Drive, Marstons Mills, MA 02648 Property Address BAR I&Nason F King Owner Owners Name information is Marstons Mills MA 02648 12/08/2021 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of ydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts It Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 523 Whistleberry Drive, Marstons Mills; MA 02648 Property Address Barbara I&Nason F King Owner Owner's Name information is Marstons Mills MA 02648 12/08/2021 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: [hand-sketch in the area below , ❑ drawing attached separately ' � 0 lJ I1� 7 6- 3 �. Y% I } 1 S t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Fbrk Subsurface Sewage Disposal System-Page 16 of 18 Commonwealth of Massachusetts Q. Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 523 Whistleberry Drive, Marstons Mills, MA 02648 Property Address Barbara 1&Nason F King Owner Owner's Name information is Marstons Mills MA 02648 12/08/2021 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: Check SlopeF����l dsurface water/ / C7ke 1fAA1 Z�4"-6' [Check cellar ✓ �� Et dShallow wells j fees Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: r,7--->L li,e, Ode/ -�ZA / 144 You must describe how you established the high ground water elevation: n j m = : Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 r Commonwealth of Massachusetts Title 5 Official Inspection Form I a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments *� / 523 Whistleberry Drive, Marstons Mills, MA 02648 u Property Address Barbara I&Nason F King Owner Owners Name information is Marstons Mills MA 02648 12/08/2021 required for every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete,al'J applicable sections of this form inclusive of: WA. Inspector Information: Complete all fields in this section. B. Certification: Signed& Dated and 1, 2, 3, or 4 checked L�J C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4(Failure Criteria)and 6(Checklist)completed E�J D.,System Information: For 8:Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 � •. • cU Q r1-- OF FIC cD Certified Mail Fee Er $ �l Extra Services&Fees(check box,add fee as appropriate) ❑Return Receipt(hardcopy) $ []Return Receipt(electronic) $ Postmark ❑Certified Mall Restricted Delivery $ -Here `J p ❑Adult Signature Required $ []Adult Signature Restricted-Delivery$ Ln KING,BARBARA L&NASON F TRS 11-9 0 523 WHISTLEBERRY DR r` MARSTONS MILLS,MA 02648 J J Certified Mail service provides the following benefits: ■A receipt(this portion of the Certified Mail label). for an electronic return receipt,see a retail e A unique identifier for your mailpiece. associate for assistance.To receive a duplicate ■Electronic verification of delivery or attempted return receipt for no additional fee,present this] delivery. USPS®-postmarked Certified Mail receipt to the, u A record of delivery(including the recipients retail associate. -41 signature)that is retained by the Postal Service— Restricted delivery service,which provides _b for a specified period. delivery to the addressee specified by name,or to the addressee's authorized agent. 11 Important Reminders: Adult signature service,which requires the ❑tom ■You may purchase Certified Mail service with signee to be at least 21 years of age(not L First-Class Mail®,First-Class Package Service, available at retail). or Priority Mail®service. Adult signature restricted delivery service,which^ ro Certified Mail service is not available for requires the signee to be at least 21 years of age, international mail. and provides delivery to the addressee specthe(h 1 ■Insurance coverage is notavailable for purchase by name,or to the addressee's authorized agent') with`Certified Mail service.However,the purchase (not available at retail). G of Certified Mail service does not change the 0 To ensure that your Certified Mail receipt is insurance coverage automatically included with accepted as legal proof of mailing,it should bear a 3 certain Priority Mail items. USPS postmark.If you would like a postmark on C'r" ■For an additional fee,and with a proper_ _ this Certified Mail receipt,please present your -q endorsement on the mailpiece,you may request Certified Mail item at a Post Office—for t', the following services: postmarking.If you don't need a postmark on this Return receipt service,which provides a record Certified Mail receipt,detach the barcoded portionkr of delivery(including the recipient's signature). of this label,affix it to the mailpiece,apply F You can request a hardcopy return receipt or an., appropriate postage,and deposit the mailpiece.L-T electronic version.For a hardcopy return receipt, r; complete PS Form 3811,Domestic Return Receipt,'attach PS Form 3811 to your mailpiece; UNPOITrAIT11 Save this nicelpt for your records. PS Form 3800,April 2015(Reverse)PSN 7530-02-000-SC47 - COMPLETEi' SENDER: •N COMPLETE THIS SECTIONON DELIVERY ■ Complete items 1,2,and 3. A. S�gatj;2e l ■ Print your name and address on the reverse -= Cs7-Agent so that we can return the card to you. �- Addressee ■ Attach this card to the back of the maiipiece, B. eceiv by(Printed Na ) C. Date of De'very or on-the front if space permits. Q, l ( I If �y 1. Article Addressed to: 1-Tx_Is deiA address different from item 19 ❑Yes delivery address below: ❑No _ � I KING,BARBARA L&NASON F TRS AM 523 WHISTLEBERRY DR MARSTONS MILLS,MA 02648 < �7� ❑Priority Mail Express® II DI�IDL.I�II IDI(III I I II II I I II II �I i I II II I I III �C ifled Malt®Rest �eirredRricted Delivery Ma1Rasrictedl 9590 9402 7037 1225 8086 01 ❑Certified Mail Restricted Delivery gna ure Connrmatti ❑Collect on Delivery ❑Signature Confirmation .2_—ArticJe Number(Transfer from service label) ❑Collect on Delivery Restricted Delivery Restricted Delivery s r ❑Insured Mail 7015 ],7301'00�1 4'987' Bf96t8 .i' ' °';all Restricted Delivery PS Form 3811,July 2020 PSN 7530-02-000-9053 Domestic Return Receipt USPS TRACKING# First-Class Mail Postage&Fees Paid USPS Permit No.G-10 I 9590 9402 7037 1225 808L 01 I I United States •Sender:Please print your name,address,and ZIP+4®in this box• Postal Service j TOWN OF BARNSTABLE I HEALTH DIVISION 200 MAIN STREET J III � HYANMS,MA 02601 � I I I l TOWN OF BARNSTABLE A0 LOCATION .SEWAGE VILLAGE M41-8 4 ASSESSOR'S MAP&PARCEL. O yo INSTALLER'S NAME&PHONE NO. 115 &0 �'-t6 C-017 SEPTIC TANK CAPACITY LEACHING FACILITY:(type) Soo CB44m( *'0 (size) /3X 33 SXa xFr� NO.OF BEDROOMS 7Z-aaEt /NED OWNER PERMIT DATE: COMPLIANCE DATE: 1 eZ Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY S _ � r � r 36.3 13- Z 1.705l' r Q- 3 '33.s r r3-�{ - 37,3 t o o r,/x . _ No. l�V � 1� Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01pplicatlon for I6 ""' 6pstem Construction Permit Application for a Permit to Construct( ) Repair ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. �3 �.' 1'S Owner's Name,Ad ess,and Tel.No. Assessor's�M�a Map/Parcel 6 I (1 o tV F" 1e Aw p D ✓ S®$ 732 - Li Ilk �'e�1� Installer's Name,Address,and Tel.No. $'OF' b, YY Designer's Name,Addres , d Tel.No. '2 7 zy— 3 F j$ C04p, /Dl Cbeh lJ�r/j��'�~► J `J' LreZI 4, 7 Type of Building: ��� Dwelling No.of Bedrooms [YPLot Size sq.ft. Garbage Grinder(Ald Other Type of Building �-�> No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date G 3 a, a) Number of sheets Revision Date Title i �.. ?JP,r Size of Septic Tank r3 ype of S. Description of Soil L..P�;e Nature of Repairs or Alterations(Answer when applicable) Se-e `G p-e j�'4 !� 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 syst in in operation until a Certificate of Compliance has been issued by this Board of H alth. Si Date ���✓� Application Approved by Date Application Disapproved by Date for the following reasons Permit No. �,p�? n�� Date Issued T --------------------------------------------------------------------------------------------------------------------------------------- W. No. �V{i l� f l 1 - Fee �LiV �• THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes } PUBLIC,,HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS m49. 4plication for -Misposal �bpstPin Construction Periitit Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components . Location Address or Lot No. 5:7 ti f " 11 �ri 1 r j, f,�.5✓ 3 �!i',� ..o`� Owner's Name'Address and T.e ��'a„� �'t-+►i p Assessor's Map/Parcel �6� G) f.10 �`�. v�! P..t C: �.. sa8.1 .23. 14 Installer's Name,Address,and Tel.No. bot 17 Designer's Name,Address,and Tel.No. 7 7 y - 9 1 HIS ,0/'c•To�e,-s C`c,p- 6; 144 4-�y r 7�1 ! .a r ► L rr,I4 'I'veL g.x., f Type of Building: �I �jy !� S ,te,� s*, .y7) � I Dwelling No.of Bedrooms -.- Lot Size .5 `j� sq.ft. Garbage Grinder(A10 Other Type of Building i+ d a.l0 No.of Persons Showers( ) Cafeteria( ) I Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date' { L , .3 o 2 o i9 1 Number of sheets . Revision Date - � p r Title . D J'� 'ft j�t•r J_ f Size of Septic Tank �r � K S �'Type of S.A.S� � � / ��tf :3 Sf J 3 Description of Soil ip.{ So / L,Q.r t Nature of Repairs or Alterations(Answer when applicable)' Date last inspected: :r 'rl Agreement: Y 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 oy Compliance has been issued by this Board of Health Si �� ��,,._•_ �. Date Application Approved by / )� Date 2/ ; 21)7- - , Applicat on Disapproved by ( Date for the following reasons Permit No. ��y7. -- /} () Date Issued THE COMMONWEALTH OF MASSACHUSETTS .� BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) Abandoned( )by 0 1,S /&0-rk rS at J�o� �'�/ ! 54 L--° &irr) /3r7'ilheas been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.7�� --Y0 dated Installer r 116 ArOT,4 h CGY1V' Designer (e t, rn Nr(it r #bedrooms L4 Approved design flow gpd 1 Il T The issuance of this permit shall not be construed as a guarantee that the sysieM will function as designed. Date Inspector No. 20 ZZ Q V Fee THE.COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS K%P`7j Misposal *pstr Construction Permit t Permission is hereby granted to Construct( ) 2 Repair( ) Upgrade( ) Abandon( ) n System located at v�+1 t 5/ / bri,1/`{ , M h r5t.&.h S and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply_with Title 5 and the following local provisions or special conditions. Provided:C n tructiorl must be completed within three years of the date of this permit. Date 7 - Approved by _ ! ' a Town of Barnstable ° '"E' Regulatory Services Richard V.Scali,:Interim Director snniasrng1L.E.. Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA:02601 Office'. 508-862-4644 Fax; 508-700-6304 Installer&Designer Certification Form Date: .s Z?- Sewage Permit#0 9q2 — L Assessor's MaplParcel Designer: C�f c>o 6. &e�� ," f� Installer: Lei-r y. Address: 7_ L edz: i2yj-e L- Z 3 Address. fL�Ia'u ) 'tC1�ISy >f :f' �`�'QLl✓y ' 1Ca�lt:+rc1% 1if`1'l`6�1/ 62Cr S On �� 24 was issued a permit to install a (date) ;(installer) septic system,at 5`17 based on a design drawn by (address) dated 12,LcV' (designer) I certify that the septic system referenced above was installed substant%ially according io the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. L certffyr that the septic system referenced above was installed kith major changes (,e. greater than 10' lateral relocation of the.SAS or any vertical relocation of any component of the septic system)`but in accordance with State&Local Regulations. Plan revision or certified as-built by designer to follow: Strip out(if required)was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed in� liance with the terms of the I1A approval.letters(if applicable) - �� A It:- 1W 4; ell (Installer's Signature)' G rm. ".00 �P (Design "s 'Igna,u e) (Affix De �p.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 THE'BARNSTABLE PUBLIC:HEALTH;DIVISION. THANK YOU. QASept c\Designer Certifimion Form Rev 8-14-13.doe DE %GjN1ATNG ENGINEER MUST"SUPERVISE 1 INS F�ION AND CERTIFY IN WRITING� � TF-''E'SIEM WAS INSTALLED IN STRICT .. No...._. ACCORDANCE TO PLAN, """""'� THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH .....................I��n..0F...... --..r4a.. 4&tio! 1iration for Eli-spnsa1 .arks Tonstrnrtion Prrmi# hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal Sys L�Mr, b�v- A. - -� r,5...m1 tb ......... .1............................................................... Loa mVdrf p v ��:... ....or Lot No. a Owner Address /.. .. ----------•--------••----- ... ............ ............ nstalleI Address I ' Type of Building .rj - Size Lot...G_...-+�... 4... ...... q. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtu s --•---------•-----•....................................- --... . Design Flow...................)...................gallons per person per day. Total dal flow._........._33..0.............._gallons, WW ._(P.. Width...4._.0.. Diameter................ Depth...��.8... Septic Tank—Liquid capacity.�.��✓.=allons Length.. x Disposal Trench—No. ........I........... Width.............. Total Length....a-&....... Total leaching area.. 73:LP-.sg+& �p Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ()C) Dosirig tank ( ) 6 Percolation Test Results Performed b �� .-\J�Jt.1t moo_ ............. Date......._1..�-.-�.o�........... Test Pit No. 1....� ..minutes per inchY Depth of Test Pit...._ Depth to ground water... ..... 3. ... f=, Test Pit No. 2..._La.niinutes per inch Depth of Test Pit.......10....... Depth to ground water......LO............ -------------------------------- -------•...... .--------------------------------- .._...---------- ---------- -........... ...-------- .... ..... •.............. Description of Soil-------------------------- ...................... - f .._.................. :. W . .............: ' .� ...---- UNature of Repairs or Alterations—Answer when applicable_.._ .-. ._.... 4 �._........ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITHE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be n issued by th board of heal h. Signe -----•-- ---- Date Application Approved BY — =•-'•- ---- ----------•---_----_---•---•----•- � Date Application Disapproved for the following reasons:-----•--------------•-•---------••--•----------..._......---------------•------..._............-•-•-...---...... ....................•-----•--......---..............----.......-----------•---------•-••--••--•--------.......-•---------•----•--•--•------------------------ ........................................... Date Permit No:........�� Issued....................................................... ...--------•-- .. \ Date 1 _'lk Nro.� .. ...... / ., ;� .. THE COMMONWEALTH OF MASSACHUSETTS L?P0BOARD OF HEALTH - Appliration for 11ispooal - orks Tonstr1rdion ramit Application is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal ` System at ............ ..................... Loeati n address .r Lot No. W J _ r'Owner_,,; Z Address Installer Address �� ��(� Type of Building r1 Size Lot_._._.------e.:-------z-:�Sq. feet ►., Dwelling—No. of Bedrooms........ ..................................Expansion Attic ( ) Garbage Grinder ( ) `4 Other—T e of Building No. of persons............................ Showers Cafeteria a Other fixtures ...._....--••--------•----••••.. . ........... •... W Design Flow...............5 ---.-_--.-------gallons per person per day. Total daily flow............. �U...............gallons. WSeptic Tank—Liquid capacitv.).00Lgallons Length... L. .. Width.. Diameter''":___............. Depth...`�j�> x Disposal Trench—No. ........1........... Width.....IC ....... Total Length....;F7 ........ Total leaching area.--2 c sq. ft. •?C 3 Seepage Pit No...................... Diameter.................... Depth below inlet.................... Total leaching area................... ft. Z Other Distribution box OO Dosi g tank ( ) '-' Percolation Test Results a Performed by. `�.... .l,.IP�..:?�............... Date.... .. _I......................... Test Pit No. l....L...._._minutes per inch Depth of Test Pit......1.3........ Depth to ground water---A)J)f...... f� Test Pit No. 2.....!�:.c�'...minutes per inch Depth,of Test Pit.......1.0._..... Depth to ground water.....'_1..a........... •---•----------------------------------------------•-----•-••---....--------------•---- ----.---.-.-.......-- ........... .-••..---... .................. ODescription of Soil.......................... ....................................................••-••-••----•-------...-•--••-•-•••-----------•......•-•--••----- ...........__.. V .......................................... . _�1... ._....... --••---•••-••---------------�•-•-�-----•----•--•----......-•----•-•---. .+� -••----- ,►, . . U Nature of Repairs or Alterations—Answer when applicable ----•""`°�''^ �. ", ------. .. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage_Disposal System inaccordance with the provisions of TIT1E 5 of the State Sanitary Code— The undersigned further agrees not to place1the system in operation until a Certificate of Compliance has been issued by the'board of health. - �1.---''"" Signed _ D to Application Approved By.............. - ......................................... - . Date Application Disapproved for the following reasons:....... t_____________________{.._..._........__...___...........:. -------------------------------------------- y Date PermitNo...-------... ...............................1.. Issued------•--•------------- ...................... 4 Date t THE COMMONWEALTH OF MASSACHUSETTS BOARD OF , HEALTH Tnrtif irtttr of Tomplittnrr CTHIS � TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by -••----------------•-,••----:...-- -----------••----....._..................••---- J taller /� ti _ has been installed in accordance with the pf@e is of TIT of T t t Sanitary oc e as d r" ed in the application for Disposal Works Construction Permit No _ . dated--- _. .............................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION,.SATISFACTORY. 4 ........ ..........................................................DATE........... Inspector........---........................a... E 'F`� _.........._._._.. THE COMMONWEALTH OF MASSACHUSETTS . BOARD OF HEALTH ... I... ...:...OF....._.. ........... o No... -- �� FEE........................ �i;�� s , orko-�rrn;�tritrtion �rrmi# Permission is hereby granted.•. ................................................................................... to Constru jt ( ) or Repair ( � Indivi al Sewa-e Disposal Sy tern at.No. �-'�?!....._..°^I . ............ ....t,. .C�— ----- 1 n'tL street as shown on the application for Disposal Works Construction Permit No ..�r � Dated.._.�G� ........................ ................... --------•.........�............ '. ---- --•-----------------------------------••-- DATE. .�f to _�� I C( � Board of health TOWN OF BARNSTABLE j LOC"noN d Ll 5-T Ok-41= Or MML6 SEWAGE # 2S 7 VILLAGE 45 ASSESSOR'S MAP & LOT - LC ,INSTALLER'S NAME 6r,PHONE NO.�GLt//�,�-si -7 S 1.3 i1J . SEPTIC TANK CAPACITY /s o o 6 y LEACHING FACILITY:(type) 3 (size) NO. OF BEDROOMS 3 PRIVATE WELL OR PUBLIC WA TER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: r / VARIANCE GRANTED: Yes No i J w G� 2A�� al �� �� �� w L� �,� r - { Cc�n�lcicd, by ---- (00 HIGH GROUND-WATER LEVEL CONPUTA11014 G- Site Location:ion:�-7 1 `�' � ^ ` Lot No. Owner: Address: Address: Contractor: Notes: STEP 1 Measure depth to water table IDr to nearest 1/1.0 ft. . . . . . . . . . . . . . . . . . • - • • • . . . . . _ . . date STEP 2 Using Water-Level Range Zone- and Index :lel1 Hap locate site and. determi ne: 2 3 A) Appropriate index well --- - - - - - - - . - - B) Water-level 'range zone . - - - • - - - - - - - " STEP 3 Using monthly report"Current Water Resources Conditions" 2 determine current depth to water level for index well . - - - m yr STEP 4 Using Table of hater-level Adjustments for index well -(Adjustments 2A , current depth to water level for index well (STEP 3) , and water-le.vel y45 zone (STEP 2B) determine water-level adjustment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . STEP S Est inate depth to high water by subtracting the water- level adjustment (STEP 4)from measured depth to water level at site (STEP 1 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . f "Figure 3 �( � `� LOW & WELLER, 17VC. "Fiddler's Green Plaza" 714 Main Street, P.at Box 119 Yarmouth Port, Massachusetts 02675 362-6868 362-8131 Registered: George Low, Jr., R.L.S. Land Surveyors A. Paul Simard, P.E. Professional Engineers William G. Weller, Consultant May 21 , 1987 BOARD OF HEALTH John Kelly - Agent Town of Barnstable Hyannis, MA 02601 RE: Lot 74 - Whistleberry Dr. Marstons Mills Dear Mr. Kelly: Please be advised that we have located the sewage system for the above referenced location. We find that the system was installed in accordance with the plan dated May 1, 1986 and the recommendations by the Board of Health which required one additional flow diffusor. This certifies the location and units and not installation procedure. If you have any questions, please do not hesitate to contact US. Very truly yours, Of 9 A. PAUL I N A. a , cmt. APS:kew 9CO3.\n10.\-NvE.ALTH OF MASSACHL;SETTS A EXECUTIVE OFFICE OF E:N'VIR0N-ME\TAL. AFFAMS F _ DEPART ME TI NT OF ENVIRONMENTAL PROTECON ' OXE WLCTER STREET. BOSTOA hL4 0210c 161' 242-550te TRU DY CO\L Secrets_.• ARGEO PALL CELLtiCC! DAVID B STP.:.'v5 Governor Conunsssioner SUBSURFACE SEWAGE DISPOSAL SYSTEM NSPECTION FORM PART A CERTIFICATION PropertyAddress523 Whistleberry Drive No W ofOwnw—Paul DeCenzo Marstons Mills Address of Owner: Date of Inspection: Name of Inspector:(Please Print)WM. E. Robinson Sr. 1 am a DEP approved s err)inspector to Section 15—W of Title 51310 CMR 15.000) Company N,rne: Wm. E . Robinson Sep sic Service MaiingAddress: PO Box 10 8 9, Centerville M1� Telephone Number: CERTIFICATION STATEMENT I certify that 1 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 inspection. The inspection was performed based on my training and-experience in the proper function and maintenance of on-s=Passes disposal systems. The system: Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails J Inspector's Signature: b Date: The System inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty (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 Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer. if applicable. and the approving authority. NOTES AND COMMENTS 10 S EP 2000 PaprlofII - A SUBSURFACE SEWAGE DISPOSAL SYSTEM NSPECTION FORM PART A CERTIFICATION(continued) 'ropeRyAddress_S2_ -Whistleberry Drive, Marstons Mills -)-ne*: DeCenzo Date of h:spectFo =T NSPECTION SUMMARY: B, C, of D: A. S STEM PASSES: 1 have not found any information which indicates that•any of the failure conditions described in 310 CMR 15.303 exist. Any failure criteria not evaluated are indicated below. CO MEWS: „t • -,n-. •,,? r• tea: 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 ompletion of the replacement or repair,as approved by the Board of Health,will pass. Indicate yes,no, or not determined(Y, N, or NO). Describe basis of determination in all instances. If"not determined'.explain why not. The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance !attached)indicating that the tank was installed within twenty 120)years prior to the date of the inspection; or the septic tank,whether or not metal,is cracked,structurally unsound. shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection If the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). broken pipe(s)are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipelsl. The system will pass inspection if!with approval of the Board of Health): broken pipe(s)are replaced \ obstruction is removed r revised, 9/2/58 Page 2of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Icontinued) P-pertyAdd►ess:_ 523 Whistleberry Drive, Marstons Mills own°': DeCenzo Date of Insphction _Ili, (P „ r 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 the public health, safety and the environment. 1I SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES W ACCORDANCE WITH 310 CMR 15.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: J = Cesspool or privy is within 50 feet of surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) S STEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF ANY)DETERMINES THAT THE SYSTEM IS NCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE 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 soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER y} _ev se P2ge3ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 523 Whistleberry Drive, Marstons Mills O-rm DeCenzo Date evuupecoon: _ D. SYSTEM FAILS: Y) u must indicate either "Yes" or "No" to each of the following: 1 have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct,the failure. Yes No Backup of sewage into facility-or system component due to an 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 112 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a 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 I of a public well. Any portion of a cesspool or privy is within 5)feet of a private water supply well. Any portion of a cesspool or privy is less-thar 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds. ammonia nitrogen and nitrate nitrogen. E. RGE SYSTEM FAILS: You m st indicate either "Yes' or "No" to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Y 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 11 of a public water supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional o e of the Department for further information. I revised 5%2/5t PaRriof11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM, PART B CHECKLIST Property Address: 523 Whistleberry Drive, Marstons Mills 'iSCicr: Ow DeCenzo Date dt Inspection:, --r -,," Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Ye� No JJ/ _ Pumping information was provided by the owner, occupant, or Board of Health. V _ None of the system components have been pumped for at least two weeks and the system has been-receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this / inspection. J _ As built plans have been obtained and examined. Note if they are not available with NIA. _ The facility or dwelling was inspected for signs of sewage back-up. J _ The system does not receive non-sanitary or industrial waste flow. _ The site was inspected for signs of breakout. _ All system components, excluding the Soil Absorption System, have been located on the site. The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions,depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: Existing information. For example, Plan at B.O.H. _ Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) The facility owner (and occupants,if different from owner) were provided with information on the propermaintenaar4i-0f SubSurface Disposal Systems. re,- sec 9,'2/56 Psgc 5 of I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C , SYSTEM INFORMATION 1rop"Address:523 Whistleberry Drive, Marstons Mills owner: (DeCenzo- f Date of Inspection:�l:�1q= _ ? GG FLOW CONDITIONS RESIDENTIAL: Design flow: 410 g.p.d./bedroom. Number of bedrooms Idesign):d!�� Number of bedrooms (actual):_ Total DESIGN flow Cyb Number of current residents: Garbage grinder(yes or no):� Laundry Iseparate system) (yes or no):I; If yes, separate inspection required Laundry system inspected (yes or no) Seasonal use (yes or no):� Water meter readings, if available (last two year's usage(gpd): 1999 204 , 000 gal. Sump Pump(yes or no):JL 1998 new Last date of occupancy:rn/rr� ",COMMERCIALfINDUSTRIAL: Typ of establishment: Desi flow: qpd I Based on 15.203) Basil of design flow Gr ase trap present: (yes or no)_ 1 dustrial Waste Holding Tank present: (yes or no)_ No • anitary waste discharged to the Title 5 system: (yes or no)_ Wate meter readings, if available: Last date of occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System pumped as part of inspection: )yes or no)_ If yes, volume pumped: gallons Reason for pumping: TYPE 0 YSTEM � Septic tank%distribution boxlsoil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records;if any) I/A Technology etc. Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components, date installed lif known)and source of information:�T9(a-• Sewage odors detected when arriving at the site: (yes or no) �cl'15AC 9�L,' Page 6orII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Icontimsed) 'ropestyAddress_ -5.23 Whistleberry Drive, Marstons Mills -- owner: DeCenzo Date of Inspecoon: c ILDING SEWER: I' cate on site plan) - epth below grade:_ terial of construction:_cast iron_40 PVC_other(explain) istance from private water supply well or suction line iameter Comments: (condition of joints, venting, evidence of leakage,-etc.) SEPTIC TANK: (locate on site plan) i Depth below grader Material of construction:_concrete Imetal_Fiberglass _Polyethylene_otherlexplainl If tank is metal,list age_ Is ageconfirmed by Certificate of Compliance_ (Yes/No) Dimensions: x VV Sludge depth:_ Distance from top of sludge to bottom of outlet tee or baffle:lq, Scurr.thickness: I I I a p Distance from top of scum to top of outlet tee or baffle: 0 ; Distance from bottom of scum to bon9T of outlet tee or baffler How dimensions were determined: ;omments: I►ecommendation for pumping. condition of inlet and outlet tees or baffles, d of liquid level in relation to outlet invert, structural integrity, evidence of leakage. etc.) _j,)s3l� N�, �'� .Alru� F �e`� GREA E TRAP: (locate on site plan) Depth below grade:_ Material of construction: _concrete_metal_Fiberglass _Polyethylene_otherlexplain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Disttce from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Cof ments: fte' a mendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evident of leakage, etc.) 9/2 9& Page 7of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Icontinued) 'roperty Address: _ ��.Z,Whistleber.ry Drive, Marstons Mills Owner: ( Decen�zo Date of Ins'p.tt!►�n � ' i,.. OR HOLDING TANK: (Tank must be pumped prior to, or at time of, inspection) , hoca a on site plan) De h below grade:_ M terial of construction:_concrete_metal_Fiberglass_Polyethylene_otherlexplain) Dimen ions: Capac ty: gallons Desi flow: gallons!day Al m present a level: Alarm in working order: Yes_ No_ Date f previous pumping: Corn ents: (c dition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:_ (locate on site plan) Depth of liquid level above outlet invert:` Comments: Inote if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) PU P CHAMBER:_ (loc to on site plan) P mps in working order: (Yes or Not larms in working order (Yes or No) C ments: (note ondition of pump chamber, condition of pumps and appurtenances, etc.) revise"' 9/2/SC Page 8orIi SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) t°pe`tyAdd`eSs: z-whistleberr Drive Marstons Mills Owner: De.enzo Y ' Date of Irts 1Jy r tom"���> e SOIL ABSORPTION SYSTEM(SAS):Y (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located, explain: Type: leaching pits, number:_ leaching chambers, number: leaching galleries, number. leaching trenches, number, length: leaching fields, number, dimensions. overflow cesspool, num5er:_ Alternative system: Name of Technology: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.) ?t c.c 4,ec_ P n a,w. p L—, g 7C t;2 V f'1 �EESSPOOLS:_ (locate on site plan) `Yumber and configuration: epth•top of liquid to inlet invert: 7epth of solids layer: Depth,of scum layer: Dimensions of cesspool: Materiels of construction: dication of groundwater: inflow Icesspool must be pumped as part of inspection) C:) ments: (n a condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (.IRVY: ate on site plan) . Ma�- pals of construction: Depth of solids: Dimensions: Com ens: (no a condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) J Pig(9 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Icontirwed) Noperry Address: 523 -Whistleberry Drive, Marstons Mills lwner: DeCenzo .' Jane of InSpc4tion—V 1q:'Q SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) PaRc 10 of I . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM r PART C SYSTEM INFORMATION(corttirn+ed) '°pe'tyA''' ---�?3whistleberry Drive, Marstons MIlls Owner: DeCe gnz_ , Date of Inz¢e'd� =D NRCS Report name Soil Type_ Typical depth to groundwater USGS Date website visited Observation Wells checked Deep Groundwater depth: Shallow Moderate SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to Groundwater6ipeet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observed Site (Abutting property, observation hole. basement sump etc.) Determined from local conditions 'Checked with local Board of health Checked FEMA Maps Checked pumping records Checked local excavators. installers Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) OT DES (✓`rya+ Y`'`^ revised 9/2/96 Page 11or11 t to st M. N a N SITE P LAN } 51.20' NOOCU SCASE L L0 © E 5g SCALE: 1�„ _ 20' �, © : .t `''.. ........52 N\S��o6�o o� B.M. = 50.00 (ASSUMED) ON N ►o : 505 RR / � Ln CORNER STE AT FRONT ENTRANCE Q II' a�i i o '53 � / M SITE ^ '; d 55.84 X a h n '�' o 100' OFFSET FROM SERVE Of R THE EDGE OF THE BOG R AREA ° W ONS ILLS fD rn > i::13; 51.$2 .... _ LIJQ h° ❑ (� p PROPOSED SAS m N 3 H` 20 500—gal char 54 bers : p o with 4' st"one all around : 1)in o :`.10: : 33.5' x 13' x 2' leach: trench. : O M:: SHED cis u7 CifLo 48 96' \ o T.H. #1 4„ .' T. 2 :Vent 2'ix I 0\ � 3'...::': 54.49' W \\ ,� v�NQ� 06�oL�e< c, O j `� _.__� W 5� M I�o`Nr rn s O i E-- SITE P LAN Q A H-20 ..DB-3 SCALE: 1 " = 80' ALL OUTLET PIPES MGM THE D—BOX. T •• ' _J— DISTmeunoN BOX s ALL BE t2. ❑--GAS CONCRETE COVER 4 _ T 3 S-OUTLET •.,t..,,...:..c.,., SET LEVEL FOR AT LEAST 2 FT KNOCKOUTS I I I I •�I•v ••. .•• lli- 12' INLET :'r..'• "i' :;: _ ' OUTLET I EXISTING 49.85' ' • NO 55.15' >;.,;_ e. SAS LAYOUT .� pwELUNG ,. �:,�- 3 Scale: 1 "=20' t S1.34' '•';. 'r 55.�4: XO p A . ,� PLAN-SECTION CROSS SECTION I I deCk� I FIRST FL•= 'p B• IVI • ::. ; N; I O House Corners to SAS Corners DRAI AGE 3 HOLE H-20 DISTRIBUTION BOX I— — A-1 = 20'-0" B-1 = 31 '-4" CF1 LOT:: 7`4 EAS ENT NOT TO SCALE A_2 = 52'-3" B-2 = 59'-9" 0 . .1.. r : : LEGEND `AREA=4453;8±SF ` Test Hale Location PROPOSED SEPTIC SYSTEM REPAIR 49.11'':f: 49.28' —GAS— Approximate location PREPARED FOR gas line KING REALTY TRUST `'• lot— A roximat location .. . : AT wo er ?ine Ex stingt contour S�Jh < .....,..: E . u ta ...... ' .w:�'.,'. PA .p".::':;`..ndPr round el�c. #523 WHISTLEBERRY DRIVE • . & I O O O Ex. tol. H-10 _loading MA 'DRIVE .; ; '�;•. -.�� cab/ septic tank STONS MILLS), BARNSTABLE, n 55.49 3 .*. *:•.. Existing Leach Trench �,C •• '• :� - r PREPARED BY: '• ''' I (to be pumped & removed) LID _ — — — _ off` (; Glen E. Harrin ton, R.S. •, . g •.6.4 � •''~��: •� .� � 1 9 Leda Rose Lane • LO "' R G; Marstons Mills, MA 02648 LO LOCAL UPGRADE APPROVAL VARIANCE .sF° �� Tel: 7: gharr 80hot —1813 � r � Email: gharr88®hotmail.com ' S► G'1S'CE C� 310 CMR 15.211 & 15.405(1)(b) - A variance is requested to allow ITAM. the proposed SAS to be constructed great than 3 feet below grade in lieu of the required 3 feet. The proposed chambers are H-20 load— SCALE: 1"=20' DRAWN BY: GEHRS DATE: 30 DEC 2021 rated and vented as mitigation for the variance. DATUM: ASSUMED ILENAME: 523WhistleberryI SHEET 1 OF 2 4• i SYSTEM PROFILE 4" DIA. SCH 40 PVC VENT Existing Dwelling Not to Scale WITH BUG SCREEN & CARBON FILTER 3 PHOLE SE 20 i 36" min. DIST. BOX Existinq_Grade = 49't Finished _rode over system=2% slope awayExistin Grude = 49.5'-51.5'± CELLAR Septic tank covers must be D-Box cover shall be One chamber cover shall be Min. 2"-1/8"-1/2" Double-Washed Stone WALL S within 6" of finished grade within 6" of finished grade }___ I within 6" of finished grade or geo-textile filter cloth = 0.02'/ft. " S=0.01'/FT5. To of Peastone Elev.=47.2't 17' EXISTINGLevel for 2' S=0.01 ft/ft ::.::.-_._ AL. f20' Invert Ele .=46.08' � S PTIC TANK P=46.34' 26' ® ®®®®® 24" � .Sf7 H-10 ® ® Invert Elev.=44.08' Install Gas IBaffle 4' 3® 8'-6" = 25.5' 4' Ex. = 46.96' or a uo P=46.51' 33.5 3/4"-1$" 0ouble-Washed, Crushed Stone 3.5 PROVIDED 6" of 3/4"-11/2" STONE 6" OF 3/4"-11/2" STONE H-2 O Bottom of Test Hole #1 Elev.=40.59' LEACHING CHAMBERS lConfirm 5' of pervious soil to Elev.=39.08' at time of installation. Design Calculations ��rJ1�r GENERAL NOTES Number of Bedrooms: 4 EXISTING f q<� � 1. ADDRESS: #523 WHISTLEBERRY DRIVE, MARSTONS MILLS Garbage Disposal: Not allowed with this des* 2. ASSESSOR'S NUMBER: MAP 061 PARCEL 040 Septic Tank Capacity Required:. 1, on (min. per Title V) 3. DEVELOPER'S LOT: .LOT #74 CONSTRUCTION NOTES Septic Tank Capacity Provided: E fisting 1,500-gal H-10 septic Tank 4' GROUND TOPOGRAPHIC INSTRUMENT SURVEY. S COMPILED FROM AN ON THE Leaching Capacity Required: 440 gpd x LTAR= 595 SF Req'd Area 5. TOWN WATER IS PROVIDED TO THE SITE & SURROUNDING PROPERTIES. 1 . Contractor is responsible for Digsafe notification Long Term Application Rate for <2 min./inch = 0.74 gal/sq. ft. 6. WETLANDS/EDGE OF BOG WERE LOCATED GEHRS. and protection Of all underground utilities and pipes. Proposed Leaching Structure: 1-33.5'x13'x2' Leaching Trench 7. REFERENCE PLAN: PLAN BOOK 349 PAGE 60 2. The septic tank and distribution box shall be set Bottom Leaching Area Provided = 435.5 Sq.Ft. 8. UTILITIES LOCATED BY DIGSAFE. level on 6„ Of 3/4 -1 1/2 stone. Side Leaching Area Provided 186 sq. ft. 9. THIS DESIGN PLAN IS TO BE UTILIZED FOR SEPTIC REPAIR PURPOSES ONLY. 3. Backfill should be clean sand or ravel with n0 Total Leaching Area Provided = 621.5 sq. ft. > 595 sq. ft req'd. 10. THE PROPERTY IS LOCATED WITHIN A GP GROUNDWATER PROTECTION ZONE. 9 Leaching Capacity Provided =621.5 sq. ft X 0.74 gal/sq.ft.=460 gpd. THE PROPERTY IS LOCATED WITHIN A DEP ZONE II. stones over 3" in size. THE PROPERTY IS LOCATED WITHIN THE ESTUARY PROTECTION ZONE. 4. This system is subject to inspection during installation by Glen E. Harrington, R.S. SOIL EVALUATION & PERK TEST LOCAL UPGRADE APPROVAL VARIANCE 5. The contractor shall install this system in accordance Date of SOIL EVALUATION & PERK TEST: 8 DEC 2021 310 CMR 15.211 & 15.405(1)(b) - A variance is requested to allow `f with Title 5 of the Massachusetts -Environmental Code Evaluation Performed By. Glen E. Harrington, R.S. the proposed SAS to be constructed great than 3 feet below grade and local Board of Health Rules and Regulations. Witness: DON DESMARAIS, R.S., BOH Agent in lieu of the required 3 feet. The proposed chambers are H-20 load- Excavator: ELLIS BROS. 6. If, during installation the contractor encounters any Percolation Rate:< 2 mpi rated and vented as mitigation for the variance. soil conditions or site conditions that are different from those shown on the soil log or in the design, Test Hole Test Hole PERK RESULTS the installer shall halt installation and immediately notify DEPTH SOILS I ELEV. DEPTH NSOILS ELEV. DEPTH: 36-54" PROPOSED SEPTIC SYSTEM REPAIR Glen E. Harrington, R.S. 0 51.59 o START SOAK: 00:00 PREPARED FOR END SOAK: 05:20- 7. No vehicle or heavy machinery shall drive over the 14" FILL 50.42 12" FILL 49 59 septic system unless noted as H-20 septic components. A E A E UNABLE TO SOAK WITH KING REALTY TRUST P Y P P / 24 GALS APPLIED. 8. Install Tuf-Tite gas baffle or equal on septic tank outlet tee. 20" 10YR5/2 49.921 , 22" 10YR5/2 48.76 AT 9. All piping shall be SCH 40 PVC. Bw . Bw #523 WHISTLEBERRY DRIVE 10. No wells are located within 150' of proposed SAS. 33" I10YR5/6 48.84 36„ 34" I10YR5/6 7.76 (MARSTONS MILLS), BARNSTABLE, MA 11 . Provide 1 H-20 DB-3 distribution box and 3 H-20 500-gal. � Ho� q s9�, chambers by Wiggin Precast or equal. m-clsand X4' C1 y PREPARED BY: 15%GRAVEL n15%GRAVEL Glen E. Harrington, R.S. 12. The existing leach trench shall be pumped and removed. Replacement 2.5Y6/4 j 2.5Y6/4 A i 9 Leda Rose Lane soil shall meet 310 CMR 15.255 specifications. 132" 1 140.591120" 1 140.59 .1 0 Marstons Mills, MA 02648 -1813 13. Provide 4" SCH 40 PVC vent as shown on site Ian. No Observed Ground Water F �o Tel: 7: gherr88@hotmaii.com P Soil valuation C rtificotion �,9 G�STER � Email: gharr88®hotmail.com 14. Provide magnetic marking tape over components one-foot below V g 9 P P I, Glen E. Harrington, hereby certify that on October. 1995, 1 passed the soil evaluator STAR gra d e, to facilitate relocation of components. examination approved by the DEP and that the analysis was performed by SCALE: 1"=20' DRAWN BY: GEHRS DATE: 30 DEC 2021 P me consistent with the required training, expertise and experience described in 310 CMR 15.017. DATUM: ASSUMED ILENAME: 523WhistleberryI SHEET 2 OF 2 60 ToP ti6 - , = 50 52.3 q . 3 4(a 44 42 - i l•10 ti0TE EX7-&A JD RL L A PPL-/C BLE V E- )2T. SC +9LE- : / " _ /O' MA%VHOLE GOVE,25 7-0 w/rH/lV o f /2•" OF F/NlSHED 2,9DE . FLOi.,J --,► 6ck4E-D. 40 P V. C. Oe FLOW _ EQU19L T27 SSp-rlc Crr-mJnJrnurn /" �r foo-f-) 4a. A jS MASr-: 7HN�' ► —loll--r —. 45HEi7 5 O�.IE � — ALL AROL P , D/57- BOX _ !� - •�,'� •�\� �\ \ /000 Gi9L. SEPTIC Tf�J�-/K ' 44. 7 � ----�_---` woQ r 44 5 t sr ��\ to S C y L E _�V " I, O„ C ZD E S G /A/ 7—� S 7 ✓—/LEI O L L O G E3EL) e2oo/vl HOUSE DATE. �'1 ��� TEST BY• l J= �. A-4 — �j;�`•'. i �� 4q , �� J �� USE : GF�L. TA/VJ� LOAM G° I G I ` JJ k c,, `v, o o - ` _ ` �� \ �� ' t\ �," y . -7=6r�► - —_ coAt2s - Poe. N p r t L _TGP O Fr C•B9,r: \ ` ' 1I1 - E .4�o �RTE � C _ � v _ �c 'Ntf1d 0130NV(3,800DV , J NI a3'11V1SN1 SVM W31SAS 3Hl �'IV1Sr ON1118M NI 1.�I1>•!30 (7NV NO IlV ' 9 acaAV4q j 1S 1Sf1W ,. / cEJeT/FY THAT THE 13U/LDI,VG � OLF� ti �ta�� ; �/! dt��urb�� r,2r?QS P,20POSED Off/ THE G,2oClnI0 -�S - p�[ f-o r�lv�che�• $HO L,vA./ OA./ Tf-1/S JPLF?A/ DOES JC \/iARZ 1 Di., 4'.Ii'.LS \` GOn1FO,eM 7-O 7 -"E- BUILD/A/G SE7-- BAC,f A2EQC-/ A2SMEtilTS, OF' THE- AS ShOlti';'V" f!�( Pt �f.. .��; PG. !off 7•o L L ..u,.0,4A i �tilVtF?J,�\lMrt�.�.A Dc;!ELQa OF Z-V A-/ D H T E . A.Now- G� ; L ` ✓ PAUL IMA-i E- [/V 0 � /�dCov No.2470 f = yv R� CIVIL IST ONAL BLDG. SEF-TBF?c,e r--- , S a Y JA /`� O L,/ T /`�I r9 S S. _ 3c� DESIGNING ENGINEER MUST SUPERVISE 2 E Q u/J2 EE ti/T ` �r o n�' - INSTALLATION AND CERTIFY IN WRITING 0 rt 1 �. 0 V E D _' - - S t cue f ' T' THE SYSTEM WAS INSTALLED IN STRICT B OfqQD OF HEALTH ACCORDANCE TO PLAN. ,