Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0050 GERALDINE ROAD - Health
50 GERALD001: ROAD C;OTUIT A 040 a010 r I I , 1 Town"of Barnstable Inspectional Services BARNSTABLE, =�pr6' A�`� _ Public Health Division E0"` Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 August 10, 2018 TEJADA, MAXIMO & VILMA E 73 Surf Road Nantucket, MA. 02554 Dear Mr. And Ms. Tejada, The Health Division received several complaints regarding discharge of swimming pool wastewater from your property located at 50 Geraldine Road Cotuit. Apparently, there is a pipe which directs the pool wastewater from your property directly onto a neighboring property. Please call me at 508 862-4640.to discuss this issue at your earliest convenience.. Sincerely, Mc Van, C.H.O. Director of Public Health OFURF Tow Town Of Barnstablecs: " :a){ . .f. v` do x, ` U.S.POSTAGE»PITNEY BOWES Public Health Division F BARNSTARLE. ` 200 Main Street iu n1 it•..'�}`b"p�+ � 00 rFD MPS&` Hyannis,MA 02601 A ZIP 02601 02 4VY $ 000.47' 0000.336455 AUG. 10. 2018. TEJADA, MAXIMO & VILMA E tin_rFRAI_DINF ROAD: � e...�,�.mar/ 1 0 RETURN TO SENDER � NOT DELIVERABLE AS ADDRESSED UNABLE TO FORWARD �UTF. 'BC: 026014100200 *992 2-0197 8—'1.0-42 f r �tf r_ , Town of Barnstable 4 Inspectional Services + BARNSTABLE, Mom. Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 August 10, 2018 TEJADA, MAXIMO & VILMA E r , 73 Surf Road Nantucket, MA. 02554 Dear Mr. And Ms. Tejada, The Health Division received several complaints regarding discharge of swimming pool wastewater from:your.property located at 50 Geraldine Road Cotuit. Apparently, there } is a pipe which directs the pool wastewater from your property directly onto a neighboring property. Please call me at 508 862-4640 to discuss this issue at your earliest convenience. Sincerely, Mc .ean, C.H.O. Director of Pub.lic Health TOWN OF BARNSTABLE cJ f1 LOCATION 7 O d UthOSEWAGE# �0� VILLAGE �. G�" SESSOR'S MAP&PARCEL aLJ0 1616 INSTALLER'S NAME&PHONE NO. V D6tAotlo SEPTIC TANK CAPACITY /SOO er� LEACHING FACILITY. (type) � J�0,0�a\ ti }(size) �'�°V� r✓' NO.OF BEDROOMS OWNER �, G d • {�@ � , � PERMIT DATE: J— ' l 7 COMPLIANCE DATE: 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 )91 ' ' �, Q1 ; 31 � Qe►C6 6 A hI No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes litation for Mis 08al strm Construction Vermit Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. loci%--e 2 O Owner's Name,Address,and Tel.No.?9 zj J14C41tt'r Ca r Assessor's Map/Parcel ®/ Installer's Name,Address,and Tel.No , Designer's Name,Address,and Tel.No. be qc Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder ( ' ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 336 gpd Design flow provided 336 gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. 2 S00 &ff07 Lh�c�i��� ty► S Description of Soil Nature.of Repairs or Alterations(Answer when applicable) &,Yerq 6A 4-4� >Zt SAI, Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued byjWs Board of Health. 166g'n AA n Date '" Application Approved by ® Date Application Disapproved by Date for the following reasons Permit No. Date Issued V No. ���� Fee ` Entered in computer: . THE COMMONWEALTH OF MASSACHUSETTS Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yitation for Mis osar Opstem Construction Permit Application for a Permit to Construct( ) Repair(/Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. c ,Su 6 vac lot.-e 2 a Owner's'Namd;:Address,and Tel.No.y9�j F C4 4 y Ca r,4 Assessor's Map/Parcel 44, 6l jJ Installer's Name,Address,and Tel.No �� S Designer's Name,Address,and Tel.No. _Tlc-+In vtof*4 m1f 0% --?G`/-95 "I Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Griner( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 336 gpd Design flow provided 3ffd gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. 2 Soo 6a//®h elix,4 vs t`,n s�v► Description of Soil Nature of Repairs or Alterations(Answer when applicable) //or7 6A a•,`,'t-S /2, Skl)e° Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed / ,�/ /} /�/( y �/ � �'?!" Date Application Approved by �i //( //�1,OUf / F /l/�C /J/Z Date 5 P_)( / G1 161 Application Disapproved by Date for the following reasons Permit No. v J/ V '"'� �� Date Issued (2 I «: THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Cote Yiante THIS IS TO CERTIFY,that the On-site Sewage Disposal syste Constructed( ) Repaired Upgraded( ) Abandoned( )by ��/�� �vra -- at tr3'UA 1 dt t•c e 1 Gcl�'t7t-�-t- has been conystructJed in accordafl a ---. - ---. - - with the provisions of Title 5 and the for Disposal System Construction Permit No. //��°��-�d ted ' Installer DOn 1) !JL,J�✓ ti,,2�( �� t"1 Designer /;, s,/�! w �i j-, ; /jt �`- #bedrooms Approved design flow _ gpd The issuance of this permit shaU,not "e construed as a guarantee that the system will f ifi t n as�designed}. Date � "2 Inspector -_ -_ - - - - .` ------------------------------------------------------ o. /1 fi/17" f - N 1 Fee / ✓�� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair(✓- Upgrade( ) Abandon( ) System located at av/�� 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:Constru t on ust b completed within three years of the date of this permit. j� J G _ Date C / Approved by ,�' , f �fn afar �S abbe:. Ufift r eP iCeS y Y' hard S:c dt,Int�rf Jp�rectat' _ � saxxscnste � , M a Piublie health D visan "t homas< Itl Qa"Ir& 4r Ufl Ma.n Str..eet,H�<annrs,Y1�1UtiC%Ol' afhcc Spy 3624b44 rax.° SfIS= tl b3;0 Instatlex & Dest�net Cerh'ttc�tidn WA i Date . 5 f It !11' Se� h a 'e mil## f`1 / g , ..e.. , Assessos's'Mapi "arcet, Destgn°er Address t2 (�`, C�, s ,e ! Adttres �--- S , 7, y o �euttr �7c'aw , issued a P to:instQI' (date}; (installer) t,c stun ,�u Cre.�-�►�d k��- dra y E 'ic-� � t�-►e.�(R.t /K C Ste ' a, elated ctcs7 , c> - I'"certify that the septic system r�fetci�eel abarle vas installed sulastantraly accord�ntca= tkie destn, wlrclx iay iftclute nunar appraYed.changes sttc.h as lateral.re�acator� a#the: ysdistrtbuLiora box ancifar septac,ir` Stir otit;;(if,.iccj��red} vvas ni:ns .�c tad and nc� Ysas: u=ere found.satirsfactory.. " is x Tier i Y., tlxat the ' pt c 5ysty ai tc feac xc cd al nvc vv s rest lied tivit}� �ajc r ct a ,cs a: . sR greater than 10' tat"ral i locatMan til~tlxe:SAS at any v rt cal;relacat an afany eo nppnerit ' of tlxeeptYc system},hlt In"rag,cordance��7rtl� State & Local Rtrlatons Plaa�"tevisran,Yr ceitrfied;as bu'It vy designer to fc�lla�vtnp at(�f reclu�ied}«ras inspected a�ld tl�G soils q„x ..,.. ._. r' , ��ere fcitind s�;tsfactat-y., g I t ce`vtthice, 1fthAt he, SVStem O;eicnc , Aoe the terms a,#the R4 oral.lefite�s (�#apOkable,) a� (1'nstall,er's Sigiatu�c) : s y f A (T)esi �er'�s Stg� atur ) {Affix°Desigiei tamp Heie)� PLEASE RETtTR�f,M,8f1Rt�S:Tft�L +'.PLJ:S°LAC..HEr1IH IIVtS[C?N... CtRTtFfCAT (3 ' C,01'IPLI:A\TCEr`WI1,I. 1V T 1B.E ,TSS`UED. .U'N'TTL, "B(JTHi TITS FO.Riv1 ANt A5 , 1LT:: tRD Z I�.�CEm=BY`.`I`HE p& A BCETMCC,HEALTH D1VISM qs" Q.1ScptielDcsiner Cerhficatan Tant�::ltcv 14 F ::.clbc i Townlof Barnstable P# 1J 20 gyp' Department of Regulatory Services Public Health Division DateHAn �A t6J9 `6� 200 Mai Street,Hyannis MA 0260] , ` 9 Date Scheduled ��. '. , o I Q �'M � (;I�i Ctd r n 2 7 Time lee Pd. Soil Suitability Assessment for Sewage Disposal Performed By: M C E✓A 1-" S 1✓ IS`A—z- N. ` Witnessed By: LOCATION & GENERAL INFORMATION Location Address �U ` Owner's Name c� '3 c�►,n i1/�- aFlob Address Assessor's Map/Parcel: or g 0 — 0 10 Engineer's Name NEW CONSTRUCTION ! REPAIR i Telephone# l G T-U C1. - Land Use + Slope (8'0) Surface Stones_ Distances from: Open Water Body ft Poss�ble Wet Area "! ft Drinking Water Well G t Drainage Way t1�j ft Prop i rty Line �_S— -� ft Other SKETCH:(Street name,dimensions of lot,exact locatiQIns of test holes&pere tests,locate wetlands in proximity to holes) t G S't�t Z. i . Parent material(geologic) Depth to Bedrock Depth to Groundwater. Standing Water in Hole: / I Weeping from pit Pace Estimated Seasonal High Groundwater DETERMINATION FOR Sl�'SONAL HIGH'WATER 'I;M3trl,. Method.Used: Depth Observed standing in obs.hole: - I y in, Depth to soil mottles: Depth to weeping from side of obs.hole:- i in, aroundwater'Adjustment Index Well# Reading Date: Index Well,leyel Adj,factor— Adj,Croundwater Uval PERCOLATION TEST, Mte Time a Observation w t Hole# The at h" Depth of Perc Time at 6" T Start Pre-soak Time ,Time(9".6") _-___-_ End Pre-soak t Rate Min,/Incti. Site Suitability Assessment: Site Passed_( Site Fiiled: Additional Testinj;Needed(Y/N) Original: Public Health Division Obset''vation Hole Data To Be Completed on Back----------- ***If percolation test is;to be conducted within 100' of wetland,you must first notify.the.a Barnstable Conservation Division at least one (1) week prior to beginning. Q:\SEPTIC\PERCFORM.DOC ` . I , DEEP-OBSERVATION HOLD LOG Hole# . Depth from Soil"Horizon Soil Texture �dil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones-Boulders. I on istenc ravel Zq DEEP OBSERVATION HOL1 LOG Hole# " Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) ((Munsell) Mottling (Structure,Stones,Boulders, Consistency.% rave -- iEEE] DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture oil Color Soil Other Surface(in.) (USDA) ((Munsell) Mottling (Structure,Stones,Boulders. _ Consistency,%Gravel) DEEP OBSERVATION HOL)E LOG Hole# Depth from Soil lioHzon Soil Texture Soil Color Sell Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Con si ten ° I i v l Flood Insurance Rate M— Above 500 year flood boundary No_ Yes Within 500 year boundary No Yes Within 100 year flood boundary No Yes Depth of N ally Cdccu.rring Pervious Material Does at least four feet of naturally occurring perviou`(material exist in all areas observed throughout the area proposed for the soil absorption system.? _ j�- If not, what is the depth of naturally occurring pervious material? Certification I certify that onj (date) I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the labove analysis was performed by me consistent with the required tra' ' ,expertise and experience described in 310 CMR. 15.017. Signature _____ I Date Q:\S,BF'TICTRRCFOR M.DOC I i COMPLETE . COMPLETE ■ Complete items 1,2,and 3.Also complete A. Signature item 4 if Restricted Delivery is desired. X ❑Agent ® Print your name and address on the reverse ❑Addressee so that we can return the card to you. B. Received by(Printed Name) C. Daof very ■ Attach this card to the back of the mailpiece, Z -r -91-, ' / or on the front if space permits. T K 4; 1. Article Addressed to: D. Is delivery a dress different from item 1? ❑Yes If YES,enter delivery address below: ❑No Todd Mello 50 Geraldine Road T 3. S ice Type Cotuit,Ma 02635 Certified Mail ❑Express Mail ❑Registered ❑Return Receipt for Merchandise ❑ Insured Mail ❑C.O.D. _ 4. Restricted Delivery?(6dra`Fee) ❑Yes 2. Article Number- _ - i €i ;�0 E i3 2 3 01 0E0 0=2.i 5 W 8Y 0�3 7i� (transfer from'service labeQ t t i t ti.y ti n x x?r t M t pax l BPS Form 3811','February'2004 1 1 f i Domestic Return Receipt 102595-02-M-1540' UNITED.STAif,) 7leS . sSa +8„FearPaid P r it G- 1.. . WWj' • Sender: Please print your name, address, and'�'f�+4'in this box�4v''��"`''���� d^Q Town of Barnstable Health Division 200 Main Street Hyannis, MA 02601 r I I Town of Barnstable - r r BARN ` MAn CAB Regulatory Services '°�c►axi" Thomas F. Geiler,Director Public Health Division Thomas McKean,Director 200 Main Street, Hyannis,.MA 02601 Office: 508-862-4644 Fax: 508-790-6304 July.2 2012 Todd Mello 50 Geraldine Road Cotuit, Ma 02635 NOTICE TO ABATE VIOLATIONS OF TOWN OF BARNSTABLE BOARD OF HEALTH REGULATIONS,NUISANCE CONTROL REGULATION NO. 1 The property owned by you located at 50 Geraldine Road Cotuit, MA was inspected on July 2, 2012, by Timothy B. O'Connell, R.S., Health Inspector, because of a complaint. The following violations of the Town of Barnstable Board of Health Regulations.A A Nuisance Control Regulation No. 1 were observed`. 7�r Nuisance Control Regulation: Chapter 353, No. 1, Part VII, Section 1.00: Large pile of brush, shrubs, leaves and debris. 7 You are directed to correct the violations within'(30) thirty days of receipt of this order letter by removing all above items. You may request a hearing before the Board of Health if written petition requesting same. . is received within ten (10) days after the date the order is served. Please be advised that failure to comply with an order could'result in a fine of$100.00. Each day's failure to comply with an order shall constitute a separate violation. PER ORDER OF THE BOARD OF HEALTH �1—comFs4cKean, R.S. Director of Public Health Town of Barnstable Certified mail # 7008 3230 0002 5178 0370 Q:Health/orderletters/refuse/50 geraldine 7-2-12.doc I 4 " � izen Web Request Page 1 of 3 fir' ok „ m i Amy - 01 Logged In As: Citizen Request Management Monday,July zz°1z TOWN\OWN\ocoonconnelt Route to Users Search Requests Create Requests Request Information Request ID: 40592 Created: 7/2/2012 10:33:22 AM Status: Assigned To Staff Assigned To: O'Connell,Timothy Health Office Anonymous: No Request Category: . Chapter II : Housing Substandard edit Routine work: No Estimate: No edit Date scheduled: edit Estimated 7/17/2012 Change Estimated Jun July 2012 Aug Completion Completion Date: Date: • Sun Mon Tue Wed Thu Fri I Sat 24 25 26 27 28 29 30 I ' 1 2 3 4 5 6 7 8 9 10 11 12 13 14 ar24 18 19 20 21 25 26 27 28 1 2 3 4 Created By: Wadlington, Ellen Priority: Medium edit r Health Office Citation Numbers: edit Requestor Information Requestor Request Parcel Number F040 I r"'� Unregistered rental (not on list for y Map: 040 Block: 10�0i Lot: 000 Cotuit). Says neighbor is stockpiling - his landscaping clippings and Parcel Lookup materials up against the fence and the pile is in excess of 6 ft. All type of rodents are making homes there. Email: Edit Requestor Information http://issgl2/InternalWRS/WRequest.aspx?ID=40592 7/2/2012 { I � `�\ . i + f" i �' /'.�.,� f S 4 F �_ r*� f i I ealth Master Detail Page 1 of 1 Logged In As: TOWN\oconnelt Health Master Detail Monday,July 2 2012 Application Center Parcel Lookup Selection Items Parcel Septic Perc Well Fuel Tank Parcel: 040-010 Location: 50 GERALDINE ROAD, COTUIT Owner: MELLO,TODD M t Business name: Business phone: Rental property: r Deed restricted: r Number of bedrooms 31 I Contaminant released: r Fuel storage tank permit:'r Save Parcel Changes '�� Return to Lookup �� Parcel Info Parcel ID: 040-010 Developer lot:LOT 6 Location:50 GERALDINE ROAD Primary frontage: 170 Secondary road:EASY STREET Secondary frontage: 116 Village:COTUIT Fire district:COTUIT' - Town sewer exists at this address:No x. Road index:0598 7F— Asbuilt Septic Scan: 040010_1 Interactive map: " Town zone of contribution:AP (Aquifer Protection Overlay State zone of contribution:OUT District) Owner Info Owner: MELLO, TODD M Co-Owner: Streets:71 CEDAR STREET Street2: City:EVERETT State:MA Zip: 02149-1531 Y Country: Deed date:09/20/2010 Deed reference:24839 335 Land Info Acres: 0.46 Use:, Single Fam MDL-01 zoning:RF Neighborhood: 0105 Topography:Level Road: Paved Utilities:Public Water,Gas,Septic Location; Construction Info Building No ear Buil Gross Area Living Area Bedrooms Bathrooms 1 1968 3264 1324 3 Bedrooms2 Full ` Buildings value:tt110,400.00 Extra features: tt33,100.00 Land value: )%109,000.00 http://issgl2/intranet/healthMasier/HealthMasterDetail.aspx?ID=040010 7/2/2012 L I Someone should be checking on taking a good look at 50 Geraldine.Road in�Cotiut, MA. Too many.people live.in the house-=house.and garage.-Maybe'lG people=3 senior citizens; 4'other.adults; an;infarit and-a.little,girl an othersA geems at times. The yard is being used, as a brush dump for..the.landscaping business operated out-of theiresidenc'e. the REVER c r r P r • � A� e II 11H11 III IIfff11 Ill HIM I11IIf I II ,r. I �v. 1 1 ,, J o FA Commonwealth of Massachusetts ^ �OP� - Title 5 Official Inspection Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 50 Geraldine Road,Cotuit, MA Property Address LBB Rea Trust Owner owner's Name 02635 03/24/2010 information is Cotuit MA required for CitylTown State Zip Code Date of Inspection every page. 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: A. General Information 1 When filling out i fiomis on the computer,use 1. Inspector only the tab key to move your Reid C. Ellis cursor-do not Name of Inspector use the return key. Ellis Brothers Const Company Name 23 Enterprise Road, P.O.Box 59 Company Address Yarmouth Port, MA 02675 Slate Zip Code City/Touvn . •508-362-6237 S121891 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection . was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. 1 am a DEP approved system inspector pursuant do Sectton,15.34�of Title 5( 0 CMR 15.000).The system: a j e` Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by Local Approving Authority A rl�z �2 Inspector's Signature Date Fn The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10;000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in'the future under the same or different conditions of use. �D Mns•09M Title 5 offim rnspedm FOW S'utsurtace Sewage QisposaI System'Page 1 e117 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 50 Geraldine Road, Cotuit, MA Property Address LBB Realty Trust Owner Owners Name information is required for Cotuit MA 02635 03/24/2010 every page. Citylrown State Zip Code Date of Inspection B. Certification (cunt.) Inspection Summary:Check A,B,C,D or E/always complete all of Section D A) System Passes: have not foun any information which indicates that any of the failure criteria described In 310 CMR 15.303 or in 310 CMR 15,304 exist Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as describt in the"Conditional Pass"section need-to be replaced or repaired. The system,upon com letion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not determined" , N,ND)for the following statements. If"not determined,"please explain. The septic tank is metal and over 20 years old' the septic tank(whether metal or not)is structurally unsound, exhibits substantial infiltrate n or exfiltration or tank failure is imminent System will pass inspection if the existing tank is replace( with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is stucturally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 2 D years old is available. ❑ Y ❑ N ❑ ND(Explain bel ): t5im•09M Title 5 Official kvqecbon Forth:Subsurface Sewage Disposal Sy stem•page 2 of 17 - i s Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 50 Geraldine Road, Cotuit, MA Property Address LBB Realty Trust Owner Owner's Flame information is required for Cotuit MA 02635 03/24/2010 every page. Cityfrown state Zip Code Date of Inspedion B. Certification (cost.) B) System Conditionally Passes(cunt.): " ❑ Observation of sewage backup or break c A or high static water level in the distribution box due to broken or obstructed pipe(s)or due to broken,settled or uneven distribution box. System will pass inspection if(with approval of Board Df Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or repla md ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than I times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approi al of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the" rd of Health: ❑ Conditions exist which require further ev a uation by the Board of Health in order to determine if the system is failing to protect public heat , safety or the environment. 1. System will pass unless Board of H mIth determines in accordance with 310 CMR 15.303(1)(b)that the system is not fun coning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feel of a surface water Cesspool or privy is within 50 fee of a bordering vegetated wetland or a salt marsh tins•OM Tine 5 Ofndai n FOW Substuface Sewage Disposal System•Page 3 of 17 CommonweaM of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 50 Geraldine Road, Cotuit, MA Property Address - Ibb Realty Trust Owner Ownees Name information is required for Cotuit MA 02635 03124/2010 every page. Cityfrown Staten Zip Code Date of Inspection B. Certification (coat.) 2. System will fail unless the Board Health(and Public Water Supplier,if any) determines that the system is functio ing in a manner that protects the public health, safety and environment: ❑ The system has a septic tank an J soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or trib itary to a surface water supply. ❑ The system has a septic tank an J SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank an d SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS a nd 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 ana is, performed at a DEP certified laboratory,for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failu criteria are triggered.A copy of the analysis must be attached to this form. 3. Other. D) System Failure Criteria Applicable to All Systems You must indicate"Yes"'or"No"to each of the following for all inspections: Yes No ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ y 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 Y day flow t5ins.09M Title 5 Otfldat hWechm Form:SWmffjeoa Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 50 Geraldine Road, Cotuit, MA Property Address Ibb Realty Trust Owner Owner's Name information is required for Cotuit AAA 02535 03/24/2010 . every page. Cityrrown State Zip Code Date of inspection B. Certification (cont.) Yes No ❑ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ Any portion of cesspool or privy is within 100 feet of a surface water supply-or tributary to a surface water supply. ❑ Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ► Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes iif the well water analysis,performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ The system fails.I have determined that,one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contaf Board of Health to determine what will be necessary to correct the fai E) Large Systems: To be considered a largehe system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems,you must indicate either"y "or"no°to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 f et of a surface drinking water supply ❑ ❑ the system is within 2001 et of a tributary to a surface drinking water supply El El the system is located in nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a map Zone II of a public water supply well If you have answered"yes"to any question in ection E the system is considered a significant threat, or answered"yes"in Section.D above the larg system has failed.The owner or operator of any large system considered a significant threat under S ton E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. he system owner should contact the appropriate regional office of the Department t5ins-09= Title 5 Official U Fbw&ftof"Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments „ 50 Geraldine Road, Cotuit, MA Property Address Ibb Realty Trust Owner owner's Name information is Cotuit MA 02635 03/24/2010 required for every page. Cityrrown state Zip Code Date of Inspection C. Checklist Check if the following have been done.You must indicate"yes°or"no"as to each of the following: Yes No ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ V' / 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? I� v Were as built plans of the system obtained and examined?(If they were not available note as N/A) ❑ Was the facility or dwelling inspected for signs of sewage back up? ❑ Was the site inspected for signs of break out? ❑ Were all system components,excluding the'SAS, located on site? Y Po , 9 ❑ 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? El Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on; ❑ Existing information. For example, a plan at the Board of Health. ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): ' t5ins.W= Tide 5 OfficW Wpadion Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 50 Geraldine Road, Cotuit, MA Property Address Ibb Realty Trust Owner Owner's Name information is Cotuit MA 02635 03/24/2010 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: Does residence have a garbage grinder? . ❑ Yes • Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes HNo Laundry system inspected? ❑ Yes- Seasonal use? ❑ Yes Water meter readings, if available(last 2 years usage(gpd)): Detail: _ 0 a� Sump pump? Yes No Last date of occupancy: /�fDate Commemiallindustrial Flow Conditions: ✓ " Type of Establishment Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.fk, etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 sy tem? ❑ Yes ❑ No Water meter readings, if available: t5ins-09M Tits 5 olfic wl hsecxion Fam:sowface Sewage oisposw system•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,..' 50 Geraldine Road, Cotuit,MA Property Address Ibb Realty Trust Owner Owner's Name information is required for Cotult MA 02635 03/24/2010 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cunt.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? t" ❑ Yes W/No If yes,volume pumped: gallons How was quantity pumped determined? s Reason for pumping: Type o yytem: 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/Aftemative 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 UA system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins•09M This 5 offices)nspediw Fomr Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,.• 50 Geraldine Road, Cotuit, MA _- Property Address Ibb Realty Trust Owner Owners Name information is required for Cotuit MA 02636 03/2412010- every page. Cltyrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components,date installed(if known)and source of information: Were sewage odors detected when arriving at the site? 0 Yes [�o- 9 9 Building Sewer(locate on site plan):. Depth below grade: feet Material of construction: ❑cast iron V40 PVC ❑other(explain): f� Distance from private water supply well or suction line: feet Comments(on.condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: :;en�" of construction: oncrete ❑ metal Q fiberglass ❑polyethylene ❑ other(explain) 0 tank iNnetal, 'st age: 1 1.4 y rs Is a confirmed Certificate of mpliance?(attap a copy of cer�cate) Yes N - . Dimensions: �� ` Sludge depth: t5ins•OM Title 5 Official kmpecfiw Forth:Subscafaoe Sewage Disposal System•Page 9 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 50 Geraldine Road, Cotuit, MA Property Address Ibb Realty Trust Owner Owner's Name information Cotuit MA 02635 63/24/2010 requ irled for every page. CitylTown State Zip Code Date of Inspection D. System Information (cont.)' Septic Tank(cunt) 4� ,- 14 l o 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? U��--L-� '� Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid le,y as rel tedto ou et inv_ evidence of Iepkage,etc.): ax l� d- A 4--- , Grease Trap(locate on site plan): Depth below grade: feet Material of constriction: ❑concrete ❑ metal ❑fiber ass ❑ polyethylene ❑other(explain): r Dimensions: Scum.thickness Distance from top of scum to top of outlet tee orb e Distance from bottom of scum to bottom of outlet t e or baffle Date of last pumping: Date t5ins•09108 TL 5 Orlidal Insp.%.F.S'Wmd oe Sewage Disposal System•Page 10 of 17 Commonwealth of Massachuseffs Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments , 50 Geraldine Road, Cotuit, MA. Property Address Ibb Realty Trust Owner Owner's Name information is Cotuit MA 02635 03/24/2010 required for every Page. Cityrrown state Zip Code. Date of lnspec6on D. System Information (cunt.) Comments(on pumping recommendations, inlet and outlet flee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): 7� c ry Tight or Holding Tank(tank must be pum�b a of inspection)(locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal ❑ ber glass ❑ polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order. ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float swit hes, etc.): E ` *Attach copy of current pumping'contract( uired). Is copy attached? ❑ Yes ❑ No tSms•09= Title 5 oKicud kq)ediw Forte:Sub zkm Sewage Disposal System•Page 11 of 17 'a Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments' , 50 Geraldine Road, Cotuit, MA Property Address Ibb Realty Trust Owner Owner's Name Information is Cotult MA 02635 03/24/2010 required for every page- City/Towrt State Zip code Date of Inspection D. System Information (cont.) y 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.): WT Pump Chamber(locate on.site plan): X144 Pumps in working order. E Yes ❑ No Alarms in working order. ❑ Yes ❑ No Comments(note condition of pump chamber, mndition of pumps and appurtenances,etc.): Soil Absorption System(SAS)(locate on site plan, excavation not required): If SAS not located, explain why: lr4 tm,0M rMe 6 owidw mWxfiw Form Subwrfaw S&A"a DmpwW SyAem•Pte 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 50 Geraldine Road, Cotuit, MA Property Address Ibb Realty Trust Owner Owner's Name information is required for Cotuit MA 02635 03/24/2010 every page. CityRown State Zip Code Date of inspection D. System Information (corn.) Type: -s ❑ 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: Comments(note condition of soil,signs of hydraulic failure, level of ponding, damp soil,condition of vegetation,etc.): , Sr Cesspools(cesspool must be pumped as part/tfis�pection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins.W= Title 5 official kMection Form:Sut face Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 50 Geraldine Road, Cotuit, MA Property Address Ibb Realty Trust Owner Owners Name information is required for Cotuit MA 02635 03/24/2010 every page. CityRown Sbft Zip Code Date of knspeWon D. System Information (cunt.) level f ndin condition of vegetation, Comments(note condition of sod,signs of hydraulic failure, eve o po g, g , etc.): Privy(locate on site plan); Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydrau lic failure, level of ponding, condition of vegetation, etc.): t5hs,09= Title 5 official Inspection Font Subsurraoe Sewage Disposal System•Page 14 or 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 50 Geraldine Road, Cotuit, MA Property Address LBB Realty Trust Owner Owner's Name information is required for Cotuit MA: 02635 03/24/2010 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cunt.) 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 whe public water supply enters the building. Check one of the boxes below. 4� hand-sketch in the area below f' f ❑ drawing attached separately tx 41 Of AF/ Y / 1 L . .. J !V 8 tsm,09108 Me 5 OMW h specbm Form Subsurface Sewage Dmposal.System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments " 50 Geraldine Road, Cotuit, MA Property Address LBB Realty Trust Owner Owner's Name information is required fOP Cotuit MA 02635 03/24/2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) Site Exam: ❑ Check Slope ❑ Surface water /IwN ❑ Check cellar ❑ Shallow wells 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: c-;? — 6/7 You must describe how you established the high ground water elevation: MaA Before filing this Inspection Report,please see Report Completeness Checklist on next page. t5ns•MM Title 5 OWWW kq) M Fam Stftmfaoe%map Mpossl System•Page 16 of 1T Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 50 Geraldine Road, Cotuit, MA Property Address LBB Realty Trust Owner Owner's Name require fix is Cotuit MA 62635 03/24/2010 required for every page city"M State Zip Code Date of Inspection E. 7jnspecbon ort Completeness Checklist Summary:.A, B, C, D, or E checked rIfnspection Summary D(System Failure Criteria Applicable to All Systems)completed ystem Information Estimated depth to high groundwater Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5im•OM Title 5 offiew kwpetlian Farm Stftwfaae Sewage Disposal System•Page 17 of 17 r _ . TOWN OF BARNSTABLE LOCATION SO 'G e R A L d l y e K P SEWAGE #!1 Om�� 7,41 YILLAGE �' (7'7'(// ASSESSOR'S MAP &.LOT © '/o-0 0 INSTALLER'S NAME&PHONE NO. /LI,4 C 0.0,6 eX f SEPTIC TANK CAPACITY LEACHING FACILITY: (type).2- AL®W C,-1,44/feW 5 (size) Soo G NO.OF BEDROOMS BUILDER OR OWNER 1 AV' r PERMITDATE: S 1C) O ( COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by i n JO ' y, �¢ sv 's Zurp� LOCATION SEWAGE PERMIT NO. O T `�lrrl L L A G E ASSESSORS MAP NO: d� ��rdt . 11�4• PARCEL DSO.: I N S T A LLER'S NAME A ADDRESS D UUvI L D E R OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED TAM a 11,F�r4 feu s /T ��t OOA G 1� t'f'/3'--� ivT SG G£Qj I,b /Ni m No. .ti,, Fee $ 5 0.0 0 T E COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS ✓/ ZippYication for Migpogar bpgtem Congtruction Permit Application for a Permit to Construct( )Repair(::)Upgrade( )Abandon( ) X®Complete System ❑Individual Components Location Address or Lot No-5 0 Geraldine Road Owner's Name,Address and Tel.No. Cotuit,Mass.02635 George & Angelina Weik Assessor'sMap/Parcel O !�16 c"9/® 50 Geraldine Road Cotuit,Mass.0263 Installer's Name,Address,and Tel.No. 5 0 8-7 7 5—3 3 3 8 Designer's Name,Address and Tel.No. 5 0 H—7 7 5—3 3 3 8 J.P.Macomber & Son Inc. J.P.Macomber & Son Inc. Box 66 Centerville,Mass.02632 Box 66 Centerville,Mass.02632 Type of Building: DwellingXX No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3 5 5 gallons per day. Calculated daily flow 3 X 1 1 0=3 3 0 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Loamy sand to notui t- sand Nature of Repairs or Alterations(Answer when applicable)Omit t ing c p s spao 1 s Instal ling 1 -1500 gallon septic tank, 1 -pis ribution box am two 500 gallon leaching chambers packed in 4 ' of 12i" stone_ 25 ' x1Vx2 ' 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 an not to place the system in operation until a Certifi- cate of Compliance has been issue.0 by this Bprdqf ea Signe a Date5/3/0 Application Approved by Date �_bL� / A Application Disapproved f r the following reasons Permit No. Date Issued �a � Fee 5 0.0 0 No. mn 9 T E COMMONWEALTH OF MASSS-ACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF.BARNSTABLE, MASSACHUSETTS Z(pprication for Migpogal *pgtem Cougtruction Permit Application for a Permit to Construct( )Repair�:X)Upgrade( )Abandon( ) XX Complete System ❑Individual Components Location Address or Lot No.5 0 Geraldine Road Owner's Name,Address and Tel.No. Cotuit,Mass.02635 George & Angelina Weik Assessor'sMap/Parcel yQ d/d 50 geraldine Road Cotuit,Mass.0263 Installer's Name,Address,and Tel.No. 5 0 8—7 7 5—3 3 3 8 Designer's Name,Address and Tel.No. 5 0 8—7 7 5—3 3 3 8 J.P.Macomber & Son Inc. J.P.Macomber & Son Inc. Box 66 Centerville,Mass.02632 Box 66 Centerville,Mass.02632 Type of Building: DwellingXX No.of Bedrooms 3 Lot Size sq.8. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures ' 3X110=330 Design Flow 3 3 8 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Loamy sand to cotuit sand Nature of Repairs or Alterations(Answer when applicable)Omitting c e s s noo i s Ins to 1 1 1 n g 1-1500 gallon septic tank, 1 -Distribution box and two 500 gallon leaching chambers packed in 4' of 1�" stone. 25'X13 'X2 ' Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issu by this B azdlf a 51310,Y Signe sr'' U / t' Date Application Approved by r` % p U Date Application Disapproved for the following reasons Permit No. 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(XX�l Abandoned( )by J.P.Macomber & Son Inc. x at 50 Geraldine Road' Cotuit,Mass. has beeA constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. i ted Installer J.P.Macomber & Son Inc. Designer J..P Macombe & Son Tnc. The issuance of t,�Fu peZ t shall not be construed as a guarantee that the sy will o as de ' ed Date -S , / Inspector 4 No. ------------------------ -- Fee$ 50.00 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE; MASSACHUSETTS mopogar Opgtem conotruction Permit Permission is hereby granted to Construct( )Repair( )UpgradeNlXX)Abandon( ) Systemlocatedat 50 Geraldine Road Cotuit,Maaa- and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Cons/tr-u—ctt n must e c pleted within three years of the date of s �"mit. Date: :J Approved by t ! v r � _ t'� a 1/6/99 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) I, Joseph P.Macomber Jr., hereby certify that the application for disposal works construction permit signed by me dated _5/3/01 concerning the property located at 50 Geraldine Road Cotuit,Mass meets all of the following criteria: ._The failed system is connected to a residential dwelling only. There are no commercial or business uses associated-with the dwelling. - ' The soil is classified as CLASS I and the percolation rate is less than or equal to S minutes per inch. ere are no wetlands within 100 feet of the proposed septic system There are no private wells within 150 feet of the proposed septic system There is no increase in flow and/or change in use proposed ere arc no variances requested or needed. The bosom of the proposed leaching facility will not be located less than five feet above the maximum adjusted groundwater table elevation. (Adjust the groundwater table using the Frimptor /ethod when applicable)._ ._._- Lf the S.A.S.will be located with 250 feet of any vegetated wetlands, the bottom of the proposed leaching facility will M be located less than fourteen(14) feet above the maximum adjusted groundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation(using GIs information) 7, B) G.W. Elevation`'.✓ +the MAX. High G.W, Adjustment.2,1—- �Z A D=RENCE BETWEEN and B SIGNED ; r DATE:5/3/01 (Sketc pr posed plan of system on back). ^ q:health rol Bert l 000 1 .:�.ARNSTABL 4,1 TO',"OF E L v SEWAGE LOCATION dl e VILLAGE.: aj I' : .ASSESSOR'S MAP'& LOT 0 y6?-C`/0 INSTALLER S NA 'k.PHONE NO. ZMAC 0 09,e/r TL S,6"v! J SEPTIC TANK CAPACITY IS-60 LEACHING FACILITY: (type).2. AZ a c&114,ifyex1 5 (size) NO. OF BEDROOMS h)(Jft:DER OR OWNER C PERMITDATE: COMPLIANCE D I/A ATE: 'Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet. Private any welh exist Water Supply Well and Leaching Facility (If s on site or within 200 feett of leaching facility) Feet Edge of Wedand and Leaching Facility(If any wetlands exist:! within 300 feet of leaching facility) Feet Furnished by J, q A f 71' 1�0 YOU WISH TO OPEN A BUSINESS? For Your Information: Business Certificates cost $40.00 for 4 years. A Business Certificate ONLY REGISTERS YOUR NAME in the Town (WHICH YOU MUST DO according to M.G.L. - it does not give you permission to operate). You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1s` FI., 367 Main St., Hyannis, MA 02601(Town Hall) and get the Business Certificate that is required by law. DATE Fill in please:APPLICANT'S YOUR NAME/CORPORATE NAME J,f o C C T1/06r w,v G ,ee- BUSINESS YOUR HOME ADDRESS: d ;eIZA10,Iyc /Z C•Ta%T /W1 dA63S S oy-J67-fils Suy 60 67S/ TELEPHONE.`# Home Telephone Number NAME OF NEW BUSINESS 7/C 77 1 /*, W Have you been given approval from the building division? YES NO iY ADDRESS OF BUSINESS 1,6e C ' J S' MAP/PARCEL NUMBER When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in' obtaining the information you may need. You MUST GO TO 200 Main St. — (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. . 1'. BUILDING COMMISSIONER'S OFFICE This individual has been informed of any permit requirements that pertain to this type of business. Authorized Signature` COMMENTS: 2. BOARD OF HEALTH This individual hasbqeE infort f he a itrreq ements that pertain to this type of business. A t orized nature * ,ts'N. "MUST�,:OMPLY WITH ALL COMMENTS: nAZARDOUS MATERIALS REGULATIONS 3. CO NSUMER AFFAIRS LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature" COMMENTS: �J ud J �A lAviAl Old. L7 cow( 541 r/e ry I J� 1�Ay/ GSe '^ � u� oar U U d M r 5 `u E Z 1�l A , - le I��flli 1� jd`3t' 41 L-7- J �C"�"`� 3VI\ v --98-- EXISTING CONTOUR N x 100.98 EXISTING SPOT GRADE 44 PROPOSED CONTOUR �a LOCUS —Wy EXISTING WATER SVC. o TEST PIT oa 2b BENCHMARK e LEGEND S � `oc Ra D 4 �a LOCUS O SC AP 00 NOT LE 64,87 x 64.23 INGROUND 1+� � POOL 64.64 (APPROXIMATE) \1 I x 64.45 63.72 EXISTING SEPTIC TANK TOP OF TANK, EL.=63.36 INV.(OUT)=62.00f 64,4 x 64,33\\ - x\6 ��4,01 S u'- LO 6 1 20,330 t 64.60 \� PARCEL ID: 0 -010 B ° \ H+ 63.35 shr 4.62 ' EXISTING \ 1 HQUSE(IfW) PATIO 64.55 x 4.04 T.O.F.=65.7t 64.61 \ 0 63.96 2 \ x 64,47 63 6 SHED 0% °- \\ GARAGE >/�64.05 64.12 / 62.44 ��P.. TP 1000, i \.. �ITP 3,38 CATCH BASIN Q .::::.. ' 63,60 O. i� 61.41 k6 EXISTING S.A.S. BENCHMARK 6 TO BE ABANDONED CTR. OF CATCH BASIN EL.=63.60 x 63.61 Jeieb edge Y,Q\50.86' 63,67 \�°tie 6 3.2 9 �+ 63.92 °Pp �,\� OF Mgss9 i PETER McENTEE G� PROPOSED SEPTIC SYSTEM UPGRADE PLAN —' o CIVIL No. 35109 50 GERALDI N E ROAD, COTU IT, MA £PSI Prepared for: DiBuono, Sewer & Drain, E`�`�� 8 Johns Path, So. Yarmouth, MA 02664 SI Engineering b SCALE DRAWN JOB. NO. OWNER OF RECORD 9� 9 Y� � TEJADA, MAXIMO & VILMA E. Engineering Works, Inc. 1"=20' P.T.M. 167-17 73 SURF ROAD 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET N0. NANTUCKET, MA 02554 (508) 477-5313 5/3/17 P.T.M. 1 Of 2 • t� NOTE: TO PREVENT BREAKOUT, FINAL GRADE SHALL NOT BE AT, OR BELOW, EL.=61.50 SEPTIC TANK FOR A DISTANCE OF 15' FROM THE EDGE PROPOSED D-BOX OF THE PROPOSED S.A.S. INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & COVER PROPOSED S.A.S. OUTLET AND SET TO 6" OF FINISH GRADE SET TO 6" OF.GRADE INSTALL RISER & COVER OVER EACH CHAMBER AND T.O.F.=65.7t SET TO 3" OF F.G. TO SERVE AS INSPECTION PORT F.G. .EL.=64.5t F.G. EL.=64.3f F.G. EL.=64.3t F.G. EL.=63.4t ��pp��pp.�� MAINTAIN 2% SLOPE OVER S.A.S. 7TI-6:13- . . . 7J7J'N. .� , . A .L = 74' L = 5' T® S=1% (MIN.) p S=1% MIN.4"SCH40 PVC 4"SCH40(PVC) 2" LAYER OF 1/8" TO 1/2"DOUBLE WASHED STONE io"I g B;5.2' aa (OR APPROVED FILTER FABRIC) aa - EXISTING 48" UOUID aa �-3/4" TO 1-1/2" DOUBLE LEVELWASHED STONE ADD INV.=61.27 PROPOSED 4' 4' GAS BAFFLE INV.=61.10 D. EFFECTIV = 12.8' - . . . . . j INV.=62.00t (EXISTING-VERIFY) 3 OUTLETS INV.=61.00 EXISITNG SEPTIC TANK 2-500 GALLON LEACHING CHAMBERS SURROUNDED WITH STONE AS SHOWN H-10 RATED TOP CONC. ELEV.=61.8t BREAKOUT ELEV.=61.50 i INV. ELEV.=61.00 ease NOTES: aaaaaaaaaaea 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPES & BOTTOM ELEV.=59.00 aaaaaaaaaaa INVERTS EXITING HOUSE, PRIOR TO INSTALLATION. 4' 2 x 8.5' = 17.0' 4' 2) D-BOX SHALL BE SET LEVEL AND TRUE TO GRADE 4' OF NATURALLY OCCURRING EFFECTIVE LENGTH = 25.0' ON A MECHANICALLY COMPACTED SIX INCH CRUSHED PERVIOUS MATERIAL STONE BASE, AS SPECIFIED 310 CMR 15.405(2). 5' (MIN.) ABOVE G.W. LEACHING SYSTEM SECTION 3) INSTALL INLET & OUTLET TEES AS REQUIRED. BOTTOM OF TEST PIT, EL.=52.3 =_ 4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. SEPTIC SYSTEM PROFILE SOIL LOG DATE: APRIL 13, 2017 (REF#15 320) GENERAL NOTES: SOIL EVALUATOR: PETER McENTEE PE(SE#1542) WITNESS: DONALD DESMARIAS R.S.HEALTH AGENT 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL ELEV. TP-1 DEPTH ELEv. TP-2 DEPTH BOARD OF HEALTH AND THE DESIGN ENGINEER. 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS 63.4 A 0 63.3 A 0" OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE LOAMY SAND LOAMY SAND LOCAL RULES AND REGULATIONS. 62 9 10YR 4/2 62 8 10YR 4/2 B 6" B 6.. 3. THE SEWAGE- DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE MED. SAND MED. SAND DESIGN ENGINEER. 10YR 5/6- 10YR 5/6 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING 61.4 24" 61.1 26" FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN C C ENGINEER BEFORE CONSTRUCTION CONTINUES. PERC 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. 20"/38" 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. MED. SAND MED. SAND 7: WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. 2.5Y 6/6 2.5Y 6/6 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S. 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE 52.4 132" 52.3 132" DIRECTED BY THE APPROVING AUTHORITIES. PERC RATE <2 MIN/IN. "C" HORIZON 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY NO GROUNDWATER ENCOUNTERED THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING CONSTRUCTION. 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). 1.2. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE INSPECTED BY DESIGN ENGINEER PRIOR TO BACKFILL GARAGE 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND NOT CONSIDERED TO BE A PROPERTY LINE SURVEY. 14. THE ENGINEER IS NOT RESPONSIBLE FOR ANY UNDOCUMENTED SEPTIC SYSTEM COMPONENTS NOT SHOWN ON THE PLAN i0 of CV C4 DESIGN CRITERIA NUMBER OF BEDROOMS: 3 BEDROOMS SOIL TEXTURAL CLASS: CLASS 1 (LOADING RATE=0.74 GPD/SF) 6=\ DESIGN PERCOLATION RATE: <2 MIN/INS I \ DAILY FLOW: 330 GPD DESIGN FLOW: 330 GPD GARBAGE GRINDER: NO-not allowed with design LEACHING- AREA REQUIRED: (330 GPD) = 4.45.9 SF da� .74 GPD/SF SEPTIC LAYOUT EXISTING SEPTIC TANK: 1500 GALLON CAPACITY ' PROPOSED D-BOX: 1 INLET, 3 OUTLET (MINIMUM), H-10 RATED USE 2-500 GALLON LEACHING 'CHAMBERS IN SERIES PROPOSED SEPTIC SYSTEM UPGRADE PLAN SURROUNDED BY DOUBLE WASHED STONE ON ALL SIDES 50 GERALDINE ROAD, COTUIT, MA , SIDEWALL AREA: 2(12.8' + 25.0') X 2 = 151.2 S.F. Prepared for: DiBuono, Sewer & Drain, 8'Johns Path, So. Yarmouth, MA 02664 BOTTOM AREA: 12.8' x 25.0' = 320.0 S.F. Engineering by: SCALE DRAWN JOB. NO. TOTAL AREA:.............................................................. 471.2 S.F. Engineering Works, Inc. N.T.S. P.T.M. 167-17 DESIGN FLOW PROVIDED: 0.74 GPD/SF(471.2 SF) = 348.7 GPD 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. ; (508) 477-5313 5/3/17 P.T.M. 2 Of 2 i