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HomeMy WebLinkAbout0190 CAP'N SAMADRUS ROAD - Health 190 CAP$W.SAMADRUd PROPERTY ADDRESS;•____....,--------------- 190 Capt. SaM,ddLV- „��,� RECEIVED Cotuit, Ma, — — — J U N 2 8 2000 On the above date, I Inspected the septlo ,system at the 868VAPJR` ABLE This system consists of the following; 1 1 . 1 -1000 gallon septic tank o 3 9- 0 9 a> 2. 1 -Distribution box 3 . 2-1000 gallon leaching pits Based on my Inspection, I certify the following conditlonat 4 . This is a tile five septic system. ( 78 _Code ) 5. The septic system is in proper working order at the present time.. 6. A variance was granted on the leaching area in 1997 7 . Both of the leaching pits were dry at time of inspection.SIGNATURE; , N a m e:_,L J-,- 1W.slattr_ LTA__—___ Company; Joae�h_P _ Hacomb.r_b Son , Inc . Address:— Box-66---------- __Centerville ` Ha .-02632-0066 Phone;--- 21.r775_3338_____—_ THIS CERTIFICATION GOES NOT CONSTITUTE A GUARANTY OR WARRANTY J6SEPH -P, 1MACOMBER & SON; INC, ' Tanks•Cesspools•LeachfIsIds Pumped L In;tslled Town Sewer Connections P,O, Box 66 CsnterYllle, µh 02632-0066. 775.3338 775.6412 N VIGOMM 62 COMMONWEALTH OF MASSACH7j8E71rS' 1Vj EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON MA 02108 (617) 292.6500 TRUDY COXE Secretary ARGEO PAUL CELLUCCI DAVM B. STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM TIO INSPECN FORM PART A CERTIFICATION Property Address: 190 Capt. Samadrus Road Name of owner Estate of Richard Anderson Cotuit, Ma. 02635 Address ofOwrwr: Dart.of inspection: 21 0 Neff *of Inspector:IPte,a•4QJoseph P. Macomber Jr. I em a DEP approved system Inspector pursuant to Section 15.340 of Thie 5(310 CMR 16.000) C"'p"q N"': Joseph P. Macomber & Son Inc. M,ingAd&*": ox 156, Centervii1e, Ma. 02632-0066 Telepr►ww Nurnbor:!)U 6—-/75—3 3 CERTIFCATION STATEMENT 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 4upectlon. The inspection was performed based on my training and experience In the proper function end maintenance of on-site sewage disposal systems. The system: Ly, Passes` Condldonally Passes _ Needs Further Evaluation By the Local Approving Authority _ Fails 4sspector's S;grurture: Data: The System Inspector hall submit a copy of this inspection report to the Approving Authority(Board of Haahh or DEP)witNn 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 end the system owner fiall submit the report to the appropriate regional otflci of the Department ot•£nvironmental Protection. The original should be sent toVw system owner and copies sent to the buyer, If applicable, and the approving authority. NOTES AND COMMENTS revised 9/2/98 page Iorii �ot Printed on R"kE Paper SU93URFAC9 SEWAGE DISPOSAL SYSTEbI INSPECT10N FORJ.1 . PART A CERTIFICAMN booerdnu*M PropwTrAddrsaa: 190 Capt, Samadrus Road, Cotuit Estate of Richard Anderson D.ta of trt#pwZson: 6/21 /0 0 oi3►*CT10N SVIAMAAY: Check A. B, C, a D: A. S Y STE7J►AS S E3: '? I hays not found any Informadon wNch lndlcates that any of the failure oortddoru described In 310 CMR 14.303 exist. Any fa& txttoria not ovoJwtsd sit IndlcoW below. t�Iiti3,t.FNT3: �. SYMNI CONDMONALLY PASSES: ` �V V Ono a more system components so dewortbod In the 'CondldwW ►sws' soodon need to be roplaood or repaired. The oy*tom. vp completion of the replacement w(spalr, as approved by the Board of HooAh, wW paws. tndcoto yet.no. or not dotsrrrJnod fY, N. w NO). Dosutbe bsalo of detwm4wdon In all Wtarwes, If'not dotsrm4ted', explain why rwt. The #optic tank is moW. writes the owner w opwstor hsa prov(dod the system Inapootw whh a copy of a CardBcato 0 CompUonco (onsched)Indcodng that the tank waw btwtaUod within twenty(201 you*prior to the date of Ow uvp+cvon the oopdc tank, whether or not mete. Is crooked, ovy~&My unwound, shows oub*tandal Inftivodon of oxfVvoton. o. 1 I#llvro Is ImrrJnont. The system will goo#Inap*ction If the existing copde tank Is (*placed wfth a comp►Ytnp •Optic tans #pproved by the board of H*&M. (� Sowego bockvp or bro#kout or high otatio water level observed in the distribution box It due to broken or obsvvct*d pip or dye to s broken, rotted or uneven dlstrtbutIon box. The system will past Irupootion If (wtdt approval of Vw Board or M9#lth)• brokon plpo(s) are replaced ob#Vucdon la romoved distribudon box It levelled w replaced AThe oyetom(squkod pumphig more to broilenw obetrvoto l plpols). the ttrrtrm ww-pwm^ Inspection If(with approved of the Board of Hoslth)t brokon plpo(s) sre replaced ob#Vucdon I* removed revised 9/2/98 ttiIe3erlt v , SUBSURFACE SEWAGE DISPOSAL SYSTFJA WSPECTIOM FORM PART A CERTIFICATION (con*xied) PmpwTyAd&*": 190 Capt. Samadrus Road, Cotuit o,WT►«: Estate of Richard Anderson Date of Inspection: 6/21 /0 0 C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to datermine If the system Is falling to protect the public health, safety end the environment. 1) SYSTEM WIU.PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WRIT 310 CUR 16.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH.WILL.PRQIECT THE PUBLIC UMTHAND SAFETY AMD THE EIiMONMENT: Cesspool or privy Is within 60 feet of surface water Cesspool or privy Is wlthln 60 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF ANY)DIETi:RMWI S THAT THE SYST13A tS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE EINMONMENT: Ay 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. _47d The system has a septic tank and soil absorption system and the SAS Is within a Zone I of a public water supply wall. The system has a septic tank and soil absorption system and the SAS Is within 60 feet of a privet*water supply well. The system has a septic tank and soil absorption system and the SAS Is less than 100 feet but 60 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 then 5 ppm. Method used to determine distance -AA4 _(approximation not vaUd).- 3) OTHER revised 9/2/98 Page 3orii SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM t PART A r CERTIFICATION (continued) Property Address: 190 Capt. Samadrus Road, Cotuit Ownet: Estate of Richard Anderson Date of Inspection: 6/21 /0 0 D. SYSTEM FAILS: You-must Indicate either "Yes" or "No" to each of the following: / �� I heve determined that one or more of the following failure conditions exist as described In 310 CMR 15.303. The bask 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 o4 sewage Into 4aci8ty"er•a,eterrt cornponertt•due go an overloaded orclagged•6flSorceaspool. •�--`' ' Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Jel Static liquid level in t a ov outlet invert due to an overloaded or clogged SAS or cesspool. � 9rs .� �Vy 9 ` Liquid depth inaeoapeel is less then V below Invert or available volume Is less than 112 day flow. _ (J Required pumping more than 4 times In the last year NOT due to clogged or obstructed pipe(s). Number of times pumped Q. 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. _ Any portion of a cesspool or privy Is less then 100 feet but greater then 50 feet from a private water supply wall 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. LARGE SYSTEM FAILS: You must Indicate either "Yes" or "No" to each of the following: The following criteria apply to large systems In addition to the criteria above: /f 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 put health and safety and the environment because one or more of the following conditions exist: Yes No �Z the system Is within 400 feet of a surface drinking water supply the system-ls-within 200 reet of-+-tutary�o eurfaoe-drk►kiwg watM+u'ply••'• 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 region+ office of the Department for further Information. revised 9/2/98 Page 4orII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM : PART B f CHECKLIST Property Address: 190 Capt, Samadrus Road, Cotuit Ownw: Estate of Richard Anderson Date of k6poctkm: 6/21 /0 0 Check If the following have been done: You must Indicate either 'Yes' or 'No' as to each of the following: Yes No , Pumping information was provided by the owner, occupant, or Board of Health. None of the systemcom%poaanu hawbaan pwnp�-toast two•waaka*Adtbe7Ystam haabaaoaecal "Gnaw floe rates during that period. Large volumes of water have not been Introduced Into the system recently or as part 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. 4/ The system does not receive non-sanitary or Industrial waste flow. _ The site was Inspected for signs of breakout. _ All system components,'."luding 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 baffle or tees, material of construction, dimensions,depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System orr 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) / (15.302(3)(b)l _ The facility owcw(and.ocr­panU Jf diffwaat from.oaw&r),w&r&4wauidad,with Inforinntoaon the •t T rso _sntr^ ^t SubSurface Disposal Systems. revised 9/2/98 Palit5of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM �. ., PART C f SYSTEM INFORMATION PropertyAddre,": 190 Capt. Samadrus Road, Cotuit Owrw: Estate of Richard Anderson D`°a of Irapectkm: 6/21 /0 0 FLOW CONDITIONS RESIDENTIAL: Design flow:a_g•p•d./bedro Number of bedrooms(deal n)• Number of bedrooms(actual): Total DESIGN flow Number of current residents: Garbage grinder(yes or no): Laundry(separate system) es or�o _ If yes, sepaws Impaction,required Laundry system Inspected a or not Seasonal use(yes or no):� Water meter readings,If eve lable (last two year's usage(gpd): Sump Pump(yes or n-) l 1��d �s� S Lest date of occupancy: COMMERCIAL/INDUSTRIAL Type of establishment: A Design flow: d ( Based on 16.203) Basis of design flow Grease trap present:(yes or no) Industrial Waste Holding Tank present: (yes or no)" Non-sanitary waste discharged to the Title 6 system:(yes or no)AL4 Water meter readings,If available:A)A Last date of occupancy:- OTHER:(Describe) Last date of occupancy: J GENERAL INFORMATION PUMPING RECORDS and source pf Information: System pumped as part of Inspection: (yes or WAD If yes, volume pumped: gallons Reason for pumping: TYPE 0,WSYSTEM yl 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) I/A Technology etc. Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other �tJen�AATE AGE of all components. date Installedilf known)-and source a44odon adon: _a4,ot i ' � 'a2&6 PPj,0 1lt Sewage odors detected when-arriving at the site: (yes or no)Ado revised 9/2/98 Page 6of 11 SUBSURFACE SEWAGE DISPOSAL'SYSTEIM INSPECTION FORM �• ' PART C SYSTEM INFORMATION(condnued) Property Address: 190 Capt. Samadrus Road, Cotuit Owr«: Estate of Richard Anderson Data of kupection: 6/21 /0 0 BUILDING SEWER: (Locate on site plan) Depth below grado:.x Material of construction:_cast Iron t"40 PVC"other(explain) Distance fro private water supply well or suction line Diameter411, Comrpon s: (condition of joints, venting, evidence of leakage,-etc.) Joins appear ti ht.No evidence S s em i SEPTIC TANK: -4e (locate on slit plan) Depth below grader Material of construction:/ncrettp�+metaW�lFiberglassd/�Polyethylenm&other(explain) If tank Is (notal, list age A[Q Js.ago.confumed by Certificate of Compliance_(Yes/No) Dimensions: ! fv v Sludge depth:7-4Aa �— Distance from top�oLslud/pa to bottom of outlet toe or tra flr.�v�— Scum thlcknoss:_Z^ Distance from top of scum to top of outlet tee or baffle:C Distance from bottom of scum to botiop of outlet t e or baffl How dimensions were determined: Comments: (recommendation for pumping condition of Inlet and outlet toes or-baffles, depth of liquid lovtl in relation to outlet invert, structuraHntogrity, evidence of leakage,etc.)• Pump septic tank annually- n t & outlet ruieve a ou e i ve i es. e tank 3.8 structurally "oieakage. GREASE TRAP: (locate on site plan) Depth below grade: Material of Construction: oncrott;0notal4/fViborglassif/ folyothylonq�b othorloxplain) A; Dimensions: /1N Scum thickness:--'&—/'4 Distance from top of scum to top of outlet too or baffie:_" Distance from bottom of scum to bottom of outlet too or•bafflo:-" Date of lost pumping: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level In relation to outlet Invert, structural Integrity. tvidence of leakage, etc.) Grease trap is nnt present revised 9/2/98 hgt7of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM . PART,C SYSTEM INFORMATION(cont4rHd) Propwty Adav": 190 Capt. Samadrus Road. Owner; Estate of Richard Anderson Dots of tnapocton, 6/21 /0 0 TIGHT OR HOLDING TANK.AAJWTank must be pumped prior to, or at time of, Inspection) Roost• on site plan) Depth below grsde:AL4 Material of cons truction:,aconcroto4: meta!ioMbergIass edPolyethylene.f,&other(expI&In) A/A — AlJf Dimensions:_ AM Capacity: AM gallons Design flow: A gallon0day Alarm present Alarm level: Alarm In working order:Yes.1y NoA0 Ogle of previous pumping: Comments: Icondldon of Inlet tee, condition of alarm and float switches, oto.) 14 or 9 1-antrc are n6 present— DISTRIBUTION BOX:Z/ (Iocsts on site plan) Depth of ligvid level above outlet Inven: 41e Comments: (note If level and distribution Is equal, evidenoe of solids carryover, widenco of leakage Into or out of box. etc.) — - No evidence of solids v n 0 PUMP CHASASER:,/�"I- (locate on site plant Pumps In working order:(Yes or No) d Alarms in working order IYes or No) Comments: mots condition of pump chamber, condition of pumps and appurtonances, etc.) revised 9/2/98 of It SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORMA ` PART C t r ` a SYSTEM INFORMATION(cortHnwd) Property Address: 190 Capt Samadrus Road, Cotuit Owrw: Estate of Richard Anderson oet.of Mvspectiort: 6/2,1 /0 0 SOIL ABSORPTION SYSTEM(SAS): (local#on sit*plan, If possible;excavation not required,location may be approximated by non-Intrusive methods) If not located, explain; Typo: loaching pits, number: 9 leaching chambers, number: leaching galleries, number: leaching trenches,number, length: leaching fields, number, dime Ions: overflow cesspool,number: Alternative system: Name of Technology: le Five ( 78 Code Comments: (not@ condition of soil, signs of hydraulic failure,level of ponding, damp toll, condition of vegetation, etc.) L o No signs of hydraulic f fs ae at; on iG normal _Rnth of f-ha loarhin7�;ng aretc are dry at thp princzent time CESSPOOLS: (locate on site plan) Number and configuration: ell Depth-top of liquid to Inlet Invert: AM Depth of solids layer: AM Depth of scum layer: Dimensions of cesspool: AIRE Materials of construction: Indication of groundwater: WAY Inflow (cesspool must be pumped as pan of Inspection) Cesspools are not prPSPnt _ Comments: (note condition of soil, signs of hydraulic failure,level of pending,condition of,vogetation, etc.) Cesspools are not present (locate on site plan) Materials of construction: 41� Dimensions: .4Ae Depth of solids:-& Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation;etc.) riyy is not DrPsPnt - revised 9/2/98 page 9orit 3V93URFACt SEWAGE OLSPOSAL 5Y9TD4 INSPECTION FORM PART C �. .. }. ., SYSTVA INFOPU.tAbO?; P,o�syAaa�.r,: 190 Capt. Samadrus Road, Cotuit 0wrwe: Estate of Richard Anderson Dou of ruw"sa." 6/21 /0 0 SKETCH OF SEWAGE OtSPOSAL SYSTEM: IncJvde des to $t leset two permsnsnt reference Iandmuks or benchmuks locate NI wells wlWn 100' (Locsts where publlo water supply comes Into hoUss) ♦9 Fln:m+ revised 9/2/98 ► p10of11 SUBSURFACE SEWAGE DISPQM SYSTEM INSPECTION FORM H p ► PART C c '• SYSTEM YiFORMAMN( r 1 PropwTyAd&o"-. 190 Capt. Samadrus Road Cotuit Owner: Estate of Richard Anderson Date of tr►apecti m: 6/21 /0 0 NRCS Report name Soil Type_ Typical depth to groundwater USOS Date webslte vlsited Observation Wells checked Groundwater depth: Shallow Moderate- SITE _ SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to Groundweter,941—Feat Plesse Indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record 30 �t.,min.d butting pobservation hole, basemeot sump etc.) 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. ftz be completed) Used water contours Map. Gahrety & Miller Model 12/16/94 revised 9/2/98 Page 11ofIt ,.....r..-n rr.r t,--,n►rww•n..n..-.....,.x,....n�.•.+.....,..++nn..,..+s.0 i..r.n.n v.+ .rr.-.rr-.-•nr--,...-...' 'I'UHN OP BARNSTABLE s UOARD OF IIEALT11 ` -n^ •'.-"�_SUIISUIIFACF 9F.WACF DISPOSAL SY9TF,M IN9!'F�CTION FORM - PART D •- CERTIFICATION ^^ - -TYPO 01 PRINT CLEARLY- • Y PI1OPERT Y INSPECTED STREET ADDRESS 190 Capt. Samadrus Road, Cotuit ASSESSORS MAP, BLOCK AND PARCEL I OWNERRIs NAME Estate of -Richard Anderson PART D - CERTIFICATION NAME OF INSPECTOR _ Joseph P. Macomber Jr. COMPANY NAME Joseph P. Macomber &"tbn, Inc. COMPANY ADDRESS Box 66 Centerville MA. 02632-0066 street Town or City State iIP COMPANY TELEPHONE ( 508 ) 775 - 3338 FAX R CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposa&1 system nt ID his address and that the information reported is true , accurate , and omplete as of the time of .inspection , The inspection was performed and any ecommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and mai"ntenance of on- site sewage disposal systems . Check one : Systeci PASSED ' The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public he•alLh or the environment as defined in 310 CMR 16 - 303 , Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form , System FAILED* The inspection which I have conaVioted has found that the system fails to Protect the ilublic health and the environment in accordance with Title 6 ,' 310 CMR 15 , 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form , Inspector Signature Date /L Csa copy of this certification must be provided to the OWNER, the BUYER Dne where applioeble ) and the 130ARD OF HEAL1'II, • If the inspection FAILED, the owner or""operator shall upgrade ' the system within one year of the date of the inspection, unless allowed or required otherwise as provided in 3.10 CNR 16 . 305 , partd , doc _ NO. tF1! � Q DATE taAMgrjkB ! FEE s639� �� EDrytI. Town of Barnstable REC. BY Board of Health 367 Main Street, Hyannis MA 02601 Susan 0.Rask,R.S. office: 508-790-6265 Brian R.Grady,R.S. FAX: 508-775-3344 Ralph A.Murphy,M.D. VARIANCE REQUEST FORN� All variance requests must be submitted at least firleen(151 days priorto the scheduled Board of Health meeting. NAME OF APPLICANT<rAA=t•! TEL.NO. c : ADDRESS OF APPLICANT Cq * '`` NAME OF OWNER OF PROPERTY �'%C gnu j SUBDIVISION NAME DATE APPROVED ASSESSOR'S MAP AND PARCEL NUMBER LOCATION OF REQUEST l22 SIZE OF LOT SQ.FT WETLANDS WITHIN 200 FT.YES NO yX_ VARIANCE FROM REGULATION (List Regulation) o �T �r���)CJC�� Y✓�i.tJ�.�t� �`cx�/ `� J `�t/' U.i/.CJ� �•4. �tY�" I ll REASON FOR VARIANCE (May attach if more space is needed) PLAN - FOUR COPIES OF PLAN MUST BE SUBMITTED CLEARLY OUTLINING VARIANCE REQUEST. VARIANCE APPROVED Susan G. Rask, R.S., Chairman NOT APPROVED Brian R. Grady, R.S. REASON FOR DISAPPROVAL Ralph A. Murphy, M.D. No. DATE - 1 A� 65 Town of Barnstable REC. BY Board of Health 367 Main Street, Hyannis MA 02601 Susan 0.Rask,R.S. Brien R.Cindy,R.S. office: 508-790-6265 Ralph A.Murphy,M.D. FAX: 508-775-3344 VA>RJANrF R1vOUEST FORDI All variance requests must he submitted it Icast fifteen(f 51 days prior to the scheduled Board of Health meeting. T\�lnu fc�� l t�����;o -� TEL.NO.�l�is NAME OF APPLICAN ADDRESS OF APPLICANT_C'15, NAME OF OWNER OF PROPERTY SUBDIVISION NAME DATE APPROVED ASSESSOR'S MAP AND PARCEL NUMBER LOCATION OF REQUEST r �— 517E OF LOT---. SQ.FT WETLANDS WITHIN 200 FT. ES NOS_ VARIANC E FROM REGULATION (List Regulation) REASON FOR VARIANCE(May attach if more space is needed) PLAN - FOUR COPIES OF PLAN MUST BE SUBMITTED CLEARLY OUTLINING VARIANCE REQUEST. VARIANCE APPROVED __ Susan O• Rask,R.S.,Chairman NOT APPROVED Brian R. Grady,R.S. REASON FOR DISAPPROVAL Ralph A. Murphy,M.D. existing pit 00 Proposed Master Bedroom o (handicap accessible) ao 2Vi O" 0 C) CD /Y Existing Home existing pit Proposed Master Bedroom o (handicap accessible) oo 281 On 0 0 0 c� 00 Existing Home William Liimatainen, Builder 541 Flint Street Marston Mills,MA 02648 (508)428-9303 17 June 1997 Town of Barnstable Board of Health 367 Main St. Hyannis,MA 02601 Dear Board Members, I am seeking this Title V variance for Mr. Richard Anderson, 190 Cap'n Samadrus Rd., Cotuit to accommodate a new master bedroom which would be located per the submitted plan. The reason for the request is to provide Mr. Anderson, who has suffered a stroke and is limited in his physical abilities,to have a bedroom on the first floor. Presently he has two bedrooms, both of which are located on the second floor. The proposed addition, which he had drawn to provide future handicap access, has already be downsized twice from the original plan to gain as much space as possible from the existing pit and still maintain handicap accessibilities. Your consent to provide relief from the setback requirement would benefit Mr. Anderson immeasurably. Thank you. Sincerely, William Liimatainen William Liimatainen, Builder 541 Flint Street Marstons Mills,MA 02648 (508)428-9303 17 June 1997 Town of Barnstable Board of Health 367 Main St. Hyannis,MA 02601 Dear Board Members, I am seeking this Title V variance for Mr..Richard Anderson, 190 Cap'n Samadrus Rd., Cotuit to accommodate a new master bedroom which would be located per the submitted plan. The reason for the request is to provide Mr. Anderson, who has suffered a stroke and is limited in his physical abilities, to have a bedroom on the first floor. Presently he has two bedrooms, both of which are located on the second floor. The proposed addition, which he had drawn to provide future handicap access,has already be downsized twice from the original plan to gain as much space as possible from the existing pit and still maintain handicap accessibilities. Your consent to provide relief from the setback requirement would benefit Mr. Anderson immeasurably. Thank you. Sincerely, William Liimatainen TOWN OF BARNSTABLE Of THE OFFICE OF t PA"STM BOARD OF HEALTH WAS& pj op 039. \� 367 MAIN STREET HYANNIS, MASS.02601 June 19, 1997 William Liimatainen 541 Flint Street Marstons Mills, MA 02648 Dear Mr. Limatainen: You are granted a variance on behalf of your client Richard Anderson, in order to construct an addition with a foundation wall only two (2) feet away from an existing leaching facility located at 190 Cap'n Samadrus Road, Cotuit. This variance is granted with two conditions: (1) A test hole shall be excavated to determine whether or not any wastewater effluent is leaching into the area where the foundation is proposed. (2) The outside foundation wall shall be water-proofed to ensure wastewater effluent will not enter the foundation in the future. This variance is granted because you testified that the proposed addition is needed because your client is limited in his physical abilities and a handicapped accessible master bedroom addition with a ramp is needed on the first floor. Also, the Board members are of the opinion that wastewater effluent would not travel laterally from the leaching pit, rather the effluent should be leaching downward through the bottom of the leaching pit. Therefore, the proposed addition should not impede the leaching capability of the existing soil absorption system. Sincerely yours, Susan G. Rask, R.S. Chairperson BOARD OF HEALTH LIIMATAI/WP/Q 1-0 TOWN OF BARNSTABLE LOCt'i;T10N f 9v SEWAGE # VILLAGE ASSESSOR'S MAP 6z LOT INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) '% (size) NO. OF:BEDROOMS13 PRIVATE WELL OR PUB IC WATER BUILDER :OWNER C DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No i 4 t 7 `ti Est�ar Of Richard Anderson 190 Captain Samadrus Road Cotuit�' as.�. 026-3 ` System Consists of; 1 -1000 gallon septic tank. 1 -Distribution box. 2-1000 gallon septic tanks. � ZODzJ _ o � cn c w Ito 1 C-A ' . 1 • rn&;J/ ervat onDemmissi.on Fss.......................... _ THE COMMONWEALTH OF MASSACHUSETTS 4 ARD OF HEALTH Signed Vate TOWN OF BARNSTABLE Appliratinn for Di-4pnttl 19orko Commune#inn ramit Application is hereby made for a Permit to Construct ( ) or Repair P) an Individual Sewage Disposal System at: 190 Samadrus Captain) Cqu;, ,,,,,,,,,,,, . ......... - ..__........... -- ...................................................... .- Location-Address or Lot No. DickAh . - .................................................. .......-------------•-•••...........---------••-•••-----........•---------•----•--•--............. J.P.Macomber Jr. owner Address Installer Address Type of Building Size Lot............................Sq. feet DwellingX No. of Bedrooms............. .............................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures -------------- ----------------•-......-•-•-••-••••-•-' WW Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid'capacity........___.gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No-----_-------------- Diameter.................... Depth below inlet.................... Total leaching area....f......_.....sq. ft. Z Other Distribution box ( ) Dosing tank Percolation Test Results Performed by.......................................................................... Date............. ......................... Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ f: Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a' •----------------------------------•----•-••--•-------•--....--•------.......---•--......--------•--......................................................... 1 0 Description of Soil.......................................... x Sand W UNature of Repairs or Alterations—Answer whe lap ll o licaple...___ .._.__. ...................................................... - 000 gan leach pit ...............................................---.....------------•---••-•---------•----....................---------------...---..........--------..................------------------•••--.......__. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compli /ceas ben issued b the oard of health. f - - - Signed ��i ... 9�5�91 -- - Application Approved B ,i Date Application Disapproved for the following reasons- ---------------------------------------------------------------------------------------------------------- -----------------------' -----------------------------------------•-•---------------. •. ................... ----------.-----------------------......-------------....----.........------------.......------------.........-•-------,.-- ----------...--- ......... ec�� Dare PermitNo. ......./.'1--- 3.3 ...........--.......... Issued ------------..........------..............------..............----- Dar• i THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE (fez#ifi ate of %lUumyXianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (XXX) by....J.P.Macorrlbe_r Jr. ...............................................................................................................................•-----........................---------...........------.... Installer ; at ----190 Captain Samadrus Cotui t . .. . .. ...................•---...........----------......._................................----................------.........-----......----.................-----------................ has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ......... c. /...--.. __ .... dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED S A GUARAN E THAT THE SYSTEM WILL FUNCTION SATIS AC OR r c DATE-------.................................................. f..�'f Inspector �!',�. � L ------...... ...............0 r0 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ,.3 TOWN OF BARNSTABLE Disposal lVarks Tons#rudinn Prrntit Permission is hereby granted. J!. coinber Jr. -•---...P.Ma.....-•-----••---•......_...........•••••---••................................................................•--...... to Constr cxx ( �) or RepairX) an Individual Sewage Disposal System at No...... `�:)...Captai_n amad.rus Cotui.t .......... Street CC�� as shown on the application for Disposal Works Construction Permit No..213E5. Dated.......................................... _. ..)....................................................... DATE cy .. Board of Health DATE.............1..:...J�....'.-1.,�.......................................... FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS 30.00 ea st onDommission Fxs..„ „_ ..._..... THE COMMONWEALTH OF MASSACHUSETTS AW..'"� — llf�ARD OF HEALTH Signed Vate 16q b TOWN OF BARNSTABLE Allpfiration for Dtspa0al Marks Tons rnr#tun Vrrutif Application is 1 eJ�y�made r a Permit to Construct ( ) or Repair R an Individual Sewage Disposal System at: t�'``��,, r- M G._d ra' s , 190 Samadrus Ca tain� _Cgtu�=t__•-________ Location-Address„ or Lot No. Dick Ahderson _... - - Owner Add- •---•------------------------------------- ------------................................._....res_•--s........................................... W J.P.Macomber Jr. .........--•-----••-•-•••---•-•-•-••-••--•••--- -----------------------•- - 9 Installer Address Type of Building Size Lot.................... ......Sq. feet DwellingX No. of Bedrooms___...___.__3 ..............................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building g ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No_____________________ Width.................... Total Length.........._......... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area.. _______.._.sq. ft. Z Other Distribution box ( ) Dosing tank ( ) a Percolation Test Results Performed by.......................................................................... Date....................... Test Pit No. 1................minutes per inch Depth of Test Pit____________________ Depth to ground water......................... 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 9 --------•-----------•-----------------------------------------------------------•-••--••-•-•-•---••......................................................... 0 Description of Soil.......................................... v ...........................................................---------------Viand.................................................................................................................. w x ------- ---------------------------------------------------=.................................................... V Nature of Repairs or Alterations—Answer whe a i-p lieaple..___ _p ____-__________-_-______-__-____________________- 000 a17on leach i . ----------------------------•-----------------------------------------------------------•- -----------------------------------------------------.................................................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compli ceas b en issued b the oard of health. Signed -. ..�.j"./��/-.1�1�. ... ... 9�5�91 / - Bute Application Approved BY --- . ...... . .......... ............................................................. --�=,:!s-e_/-------- Application Disapproved for the following reasons- --------------------------------------------------------------------------------------------------------------------------------- --------------------- ----------------------------------------------- --------------------............. ---------------- ---------------------- ------------------------- -- --------- ....................... .. ---Dace Permit No. ....... ----------------------- Issued Date 30-00 Ak' THE COMMONWEALTH OF MASSACHUSETTS 1 �V 'BOARD OF HEALTH TOWN OF BARNSTABLE -w- i Application for Disposal Works Tonstrurtion Prrutit Application is hereby made for a Permit to Construct ( ) or Repair (XX) an Individual Sewage Disposal System at: j c I r t r / C( . 190 Samadrus ( Captain) Cotuit ................__ _..---.....- -•• -------......... .........•--......._..._.._.... ...............................................Lo ........ •- .............._. Location-Address r or t No. Dick Abderson Owner Address w J.P.Macomber Jr. Installer Address � Type of Building S g Size Lot___________________________ q. feet Dwelling—No. of Bedrooms____._______3_____________________________Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons____________________________ Showers — Cafeteria d Other fixtures ---------------------------------------` ---------•-------__-......... -•-------------------------- w Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptie*'Tank—Liquid'capacity___.___.____gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No_____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank aPercolation Test Results Performed by.......................................................................... Date.............i.......................... Test Pit No. 1----------------minutes per inch Depth of Test Pit____________________ Depth to ground water........................ 44 Test Pit No. 2._`.............minutes per inch Depth of Test Pit.................... Depth to ground water........................ 0 -------------------------------------------------------------------------------------------------•-......................................................... 0 Description of Soil........................................................................................................................................................................ x Sand U ---------------------------------------------------------------------------------------------------------------------------------------------------••------- W --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•••---•------••_-- U Nature,of Repairs or Alterations—Answer when applicable................................................................................................ -------------------------------------------------------------------------------------1-.1.0'..n gallon leach pi-t•'- ---••--•......•---••••-••••••-.._....•----•- Agreement: . ,,. The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not,to place the system in operation until a Certificate of Compliance has been issued by the board of health. �. Signed ` ��N: !�c ...... U 4... ---... 9/5191 --- -- Dare Application Approved BY -------------`J� , ---- t! ,, tom. ^Y-O------------------------------------------------------------ ... �� /� ... Dare Application Disapproved for the following reasons: ----------------------------------------------------------------------------------------------------- ......-----..:..... ---------------------------------------------------------------------------------.............................. ---------------------------------------- Date ec�� g Permit No. /� - 3.. _ Issued ........................ ---------------..._.. .......... ........... /-...-..- ---...-....--.......... ...............Dare THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE d O'blex#tfi. ate of (110mislian e THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (XXX) by....J P Macomber Jr. .........'..-----....-.:.............----------------------...........----. ...........---------------....------.-----------------...........------..........................................--_---------- ............... Installer at .....190 Captain Samadrus Cotuit . ...................................................................................................................................... ................. has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ......... 5.;. ........ .-3.... dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED-AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. may/ DATE.................................................... -1113 ' Inspector ........ ...-_---- // ------... ... ............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Disposal Works Tonu#rudiun Errant . . Permission is hereby granted-------J P Macomber -----------•----------------••-•----.Jr..._........_................ .-• •---..........................._..............._........ -•-----•--- to Construct ( ) or Repair (�X) an Individual Sewage Disposal System at No....... 9`'--Gapta. n oi ...................•--•--..Samadrus.._._.C...-•--•tu....t........... Street pp as shown on the application for Disposal Works Construction Permit No..21- 31?3. Dated.......................................... ............................. -• _ J d - __- Cj Board of Health DATE............./ - FORM 36508 HOBBS&WARREN.INC..PUBLISHERS L,O�C'ATION r- u 1qa SEWAGE PERMIT NO. VILLAGE I N S T A LLER'S NAME & ADDRESS V_� ja e BUILDER OR 0 ER DATE PERMIT ISSUED ' DAT E C0M.PLIANCE ISSUED a � A :4 Of- THE COMMONWEALTH OF MASSACHUSETTS j� BOARD E HEAL H T.G�tolfv`.............OF......... .. . ---------------------- --......--.-----..-.-.--..------ Alip ira#ion for Disposal Works Tonstrurtion Permit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System a .......... ......ive........ Locat' Add or Lo��' _ .. - .7................. ................ aw ---- . wner - Address --------- - •----• ,... ........-. .-•-•----...----------•--•----•--•- - --- • --.......---•.---• • - .... ..-•----•-••------.... .................. In 11 Address U Typ of Building Size feet �-, Dwelling—No. of Bedrooms.......�...............................Expansion Attic ( ) Garbage Grinder ( ) a Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures __ -- ---...- w Design Flow..............EQ...................gallons per person per day. Total daily flow..AU_..0..............__.........._gallons. WSeptic Tank—Liquid capacity/..-____�'�° "11__ga ons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No. .................... Width................... Tot ength......._.._........_ Tptgl lea Ing area.._.....___._..__.._sq. ft. Seepage Pit No...... 1a . t ching area..................sq. ft. z Other Distribution box ( ) Dosin to ) �� aPercolation Test Results Performed by. aS?._ ............. . .-._ ........._.. .... . Test Pit No. 1................minutes per inch Dep h of Test Pit..........._........ Depth to ground water--_----.----_-__---__--. 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Ix ----•-•--- ----------- - . O Description of Soil----..__ ............2-•'=-�- 11_ i� '...-- ? vi w UNature 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'ITL E 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued y he bo rd of healt r gne -- • ..•..... . ..................... .............-.................. Application Approved By......... .. _ Hate Date Application Disapproved for the following reasons.'\.----------••------------------------------------------................................................. .. Date Permit No.................................................. -• Issued . __. °�: �.� - f w Date No..........(r_!C.:.... ass...---�'�..'.-r-..�.�d.. .... THE COMMONWEALTH OF MASSACHUSETTS �k,r.. BOARD OF HEALTH -••---".. ------------- oF..... ...::�:!'e`.................................W---•••-----•--.........._......_. Appliration for Uiipuual Works Tomitrnrtion ramit Application is hereby made for a Permit to Construct (_1-1_<Or Repair ( ) an Individual Sewage Disposal System at: /� - Location-Address or Lot No. / F Owner Address Installer Address 2 Q Type of Building = "' Size Lot__ :_=:___= ...Sq. feet Dwelling—No. of Bedrooms...........................................Expansion Attic ( ) Garbage Grinder ( ) '4 Other—T e of Building No. of persons____________________________ Showers — Cafeteria Otherfixtures ----•--••-•-•-- •--•-`--"••-••-••--••--•••••••---•-------------•--•-••---•••••-•-•-•••-••-•••-••-------------------------.._...----------------•--- w Design Flow............................................gallons per person per day. Total daily flow___'_".{!________......................gallons. W Septic Tank—Liquid capacity___._'`_ gallons Length................ Width................ Diameter-_-__-_______.__ Depth................ x Disposal Trench—No_ ____________________ Widthr.................. Total,Length.......____......... Total leaching area....................sq. ft. Seepage Pit No_____________________ Diameter................ Depth lielowinlet___.:dw "'-_''�Total�leaching area..................sq. ft. Z Other Distribution box ( ) Dosin t ) /�ls f6•Q•i -• '~ Percolation Test Results Performed by e '---------•----'C-.. ........... Date---� .`'' ,--•--------- a Test.Pit No. 1................minutes per inch Depth of Test P P Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit_._.._.__._________. Depth to ground water........................ Description of Soil -- * ` r" A_� ". j. (� ----------------------- ----------------------------------------•-----• ------•----------------•-__-_----------------..,.-- - 7777 - ---- - W UNature 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 been issued by the board of health. rgn =" - Date Application Approved By........ - --------- ------ ---- Date Application Disapproved for the following reasons:-------•-----------------------------------------------•------------------------------•---. •-•-----......_..._ ___----•••-----•-----•-----.....•-•--------•••-------•-••---------•••-•-•-----•.............................•-------------------•-----••------•-•--••-••-•-----•---•---•---•-----•-•--------------......_ Date PermitNo....................................................... Issued•--•--------------•-•-- -----------•-- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .�..:-.�-K ... OF....:..--<•'•,d..........-^ .. .r+ Q1 rrtif irtt r of To Haurr /�� THIS IS TO CERTIFY, That the,,,Individual Sewage Disposal System constructed,/ or Re aired _ g P �' ( ) P ( ) / r_ Installer at............................--••--_. :----------_---- =--.. ...... ..,.-z ___._., `....tom. / �ti-�•�.sr��l has been installed in accordance with the provisions of0 Y r o T e State Sanitary Code s des 'b irythe application for Disposal Works Construction Permit N ___. ___ ____._.____ {da.ted_.- �_... „� :"'__ _____________ THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNC N SA FACTORY. DATE................. 2 5 �L.?:...... Inspector i THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH/ ............. FEE..:':`-:__............. �tu�outtl �arku �o�a�#rilanfrranit Permission is hereby granted = --.---•...•••. ••--•-•---•-------•----•---•--------•-••-•._....-•----•............:............•- to Construct' ( -)--.or Repair ( ) an Individual Sewage Disposal System / u.a- ` / at No ................... �- ./ j Stre /� as shown on the application for Disposal Works Construction Per No. :'.____ ___ Dated__A�r�'".47d 7 Board of Health DATE. la-- d FORM 1255 HOBBS & WARREN,-INC.. PUBLISHERS �t�:�-tc -r'�k. = 33a,+ ►�0 9'e � 4.s~'t�6.r�v. '. l47•al ; r�u•6_ U SC t oOti 6At., - use (000, (SAL., o '' „ �'• -� r' 1+" 3 SF �c 2.S •. S77S G.P.V. zs iVt A�QA.a cep taT=. ' `Q ,►,.:c�_ .rt; , Tc rrAL. "1DE•Si6w *—rsS &.Rt>. r•t i Tt>TA L 't>.W t-K .�cDt•QTtOU RbTr~ : �,.tu 2.MIQ 021". FW1� I , 41 'MST mod. .a .;, '1'af► 1`Wv •iba�.e 17 ' •c c C 4. L-.TSJ:ccc � r a f �CaC IfJV. . Zvi 'box 9l. 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