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HomeMy WebLinkAbout0079 GUIMQUISSETT ROAD - Health 10 Guit iquissett Road, C;otuit ti - I 1` No. ® � s' ; Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes Applitation for ]Disposal 6pstem ConstTUttion Permit Application for a Permit to Construct( ) Repair( ) Upgrade W Abandon( ) Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address an el N /T v Assessor's Map/Parcel In, /9 f'/9RC• �1'3� D Ce/Z-O/�/ Ah -G'O T 2 2-3 � Installer's Ngme,Ad ressr apd Tel. o Des' ner's Name Address,and Tel.No.��JV_16762 j9� Type of Building: Dwelling No.of Bedrooms 3 Lot Size 2 3, 34. sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 33(' gpd Design flow provided gpd Plan Date �4-8 -/,3 Number of sheets / Revision Date / Title Gl/fsl fit- �//J��r /O1_ji✓,60A, , �BT /✓� � y�LLE/✓� ��1� iy Size of Septic Tank Type of S.A.S. 2 - Ti2EA/C/f�—r Description of SoilLO/Q/)q AA Nature of Repairs or Alterations(Answer when applicable) r, /q W RL E TZ: oo/C-/41 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 Healt'`Signed Date 4412,1 ,�r/ i24,z Application Approved by Date 5` Application Disapproved by Date for the following reasons Permit No. Date Issued11-5-7 No. r t ° Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH-DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Zipplitation for Disposal 6pstem Construction Permit Application for a Permit to Construct Repair Upgrade Abandon Com lete System Individual Components PP ( ) P ( ) Pg ��. ( ) � P Y ❑ P Location Address or L17.9 ot No. yl�*�,m ' N Address 1 0- p 8.3 p CH�a,�/ RA CoTvjT Z 8-39G 9_- Assessor's Ma /Parcel In, /9 /W;eC, Installer's Name,Address,and Tel Desiggner's Name Address and el. o. YA � C4� a� �C� ✓,1�DYGE �sSoL/ 'm Hua y- .S /729 C�ovE2�/��� w/�- �=.9�/77o417y _ Type of Building: Dwelling No.of Bedrooms .3 Lot Size 2.3, .34 1 sq.ft. Garbage Grinder( ) i Other Type of Building No.of Persons Showers( ) Cafeteria(. ) Other Fixtures Design Flow(min.required) 33 ,1) gpd Design flow provided 3 f4S gpd Plan Date `8 "�� Number of sheets / Revision Date WTitle S�Gr/A6r /LPG � r /�L�JNi=vim-- )&d 41V-4 /W2.Y �c �Ei✓1/YI_0 E;i✓ Size of Septic Tank �f�0 GAL- • .eE-NCh�c-r' •t f' -.,t p• Type of S.A.S. 2 ' T Deseription of Soil zf/D /LL /�7��—�$ �'/�/1(/,y .L Z8'- 33�� L D"9/"y_5i9 AIA Nature of Repairs or Alterations(Answer when applicable) Q9/LPL t< 7-,6: /I/E AV -S"X_3'7"Z , _ 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 er, F ` Compliance has been issued by this Board of Healt j Signed 1 Date �y Z S Application Approved by 'Date Application Disapproved by Date for the following reasons f Permit No. 20 13 Date Issued -------------- _ _ __..._... ..__ . .__ .. ,..- . ---- THE COMMONWEALTH.OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Complian THIS IS TO CERTIFY,�that �tthee On-site Sewage Disposal ystem Constructed ) Repaired( ) Upgraded( ) Abandoned( )by 1 /Y / ���i Xat � 1 (�, U Ill � U Ike t{ Qp Art t has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No aoO' dated l{ " 5 (3 Installer Designer #bedrooms Approved desi ow 0 J j01,/ gpd The issuance of this permit sha note copstrued as a guarantee that the system will tunoti n as designed. 1 1��/ /Date Ins ector %'�/' k ' . J p ; / y __ =_====-= 1 No. G J t Fee ��"(/ ` THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS Disposal *pstem Construction Permit Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon( ) 7L System located at V n OL) 5Z,6Ad (64L) l t ¢ 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:Construction must be completed within three years of the date of this permi t J roved /Date _f — �' Approved b y � .ten TOWN OF BARNSTABLE LOCATION �'1�V 11Y1 SEWAGE# 610 V!3 VILLAGE Q I ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. rrVP LAJ ., SEPTIC TANK CAPACITY LcSOVI,_ LEACHING FACILITY:(type) 2"�I (size) NO.OF BEDROOMS 3 OWNER -L ,; ► PERMIT DATE: �S 13 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 fa ' ity) Feet FURNISHED BY i I max, �.t 426- B ps A_y qql62- A `� Bfo SfB� �? (g 0 Z 'gam a a 4 � 3 0'-T6*n of Barnstable �WE Regulatory Services Thomas F. Geiler,Director ^� Public Health DivisionMAW _ ►`� Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-8624644 Fax: 508-790-6304 Date: AM Y 2 24 f3 Sewage Permit# Z 013'I V-y Assessor's Map/Parcel In, /y RhRC• S- Installer& Designer Certification Form Designer: Installer: R/C,A1,fEG Address: /7a &W Address: On 2 was issued a permit to install a (date) (installer) septic system at 7,1? based on a design drawn by (address) ,_r dated " (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Stripout (if required) was inspected and were found satisfactory. �� N OF AH of & p JOHNi s� � (Installer's Signature) g P. YR DOYLE,fit -' No. 1140 No.33589 GISTE17 P, l GIsn Q' 84N1TARN (Desi e s Signature) �t � C (Af p Here) j LEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. gAoffice fomnsWesignercertification formdoc v LK ; � �, . _._. .._ c� o - { 4' ,.t .. i 1 ..:. 1't _ (i f ►� ,� k Ll oz 41 6€ :6 WV I E AVM �IOZ 1 � � .✓ /41 � o Nmol o � � p poems. AOM Aw �. �. C i � �1 � � � _. �� � � �� � �� ��� " . .. :Town of Barnstable: Deportment of Regulatory":Services. ! P' W H AIll Division Date G lam . "mow 1• °". ZDO main$treat,Iiyannl9 MA 0Z601 r , ee Data Scheduled 'time / ' Soil SMlitt ,Assesst�er�t for,Setvage Disposal 'Performed By. IJ Lt��"AiTIC�I 8c 4 MURAL ll�11UR1NATIb ,v Locatio6 Address , `i 7 l>�L J mCZI;s � . ' R� ' Address.Yw .: 0•C.g e1�17 AasessoPsMap/Pamt 6gtneetsNatrte�t3l�l�l 7 1�1�7Pin .2?+c NEW Ct7N5TRUC$lON ;REPAIR "•!_ Teleplfono N i min r Ck l Slopes(%} f 1c+ sutthca Stones 1'L Land Use ' :n g Water Well ft Distances ftom:'Open Water Body R Possible Wet Area ,Dtitiktr g DrainagbiYay n >PropertYLine _lt 00rer; A�IL1 tt ' SI{ETCII:.(street name,dimensions of lot,�lrabt Iocmaons or test holes: Pero tests,locate wetlands in proxlmlty to holes} { y r, ` GU/MQU/SSETT KRO t , . bepth to 0edrock Pment tnatetiai(geo�egic) " `� ` {'i ` � dhi'Water In Hole. '` "Weepill ibm Pit Face "Stan r g va to.dti Oro un De pth to , c' 1� EstWated Seasonal lLgh arawrdwater DE St AS BC li A131;E Ivtediod Used ""�-;= I t { in;. De ih toil tuottle9:' in Depth Observedstending m obs.Buie. . n t iii ifom side{bf oUs.note i.' ln, .D undwater AdJustment i — Dep0lto'weep B A� }actor:__--AdJ OroundwaterLovel Index Well R ! Readi ig Date! �n ec Well level J I' tCOTIbN BLS' Dsfte ! Time at 9" Observation { f . Hole# ���dl �-- 17ep of Pero Start Pre-soak Dime® . . I t.v i Etld Pre soak z t Ad Itlonai Tesling Nedded(Y!N) Sit Failed `__ Site 5uilability Assessmebt :Sd Pesslgd�I i leted on l3ack = '• ! Observation Hole P"A o e Comp Original: Public HealthDivision I r * on Ite�t is"to b�coaidu�ted w thin,100'.of wedandi YOU iniust firbt notify rile ** ff peccpiad �' week rior to beginning. f3arnstabie Conseirv>ltitq Divisiutl dt least�ne(1) 1? Q:\SEP-ncvERCFORkDOC I)eptlt from 5nii Horizon : Snip`Texture Sod Color soil Surface(in.) (U,4f)A) (Mansell) Mottling (Structlae Stnhtls,gouldets.' � . .., ' Consisiehc4 %titflvell.". , ©y' F L 41 Depth ftGtn " Soil Hbiimati' S6i texture Soil Col'i 3011 OlUer i STIA unse 1 mottling. (Sea lure,Stones,Boulders. Surface(in.).,, 1. )`. (M. ) c Coils;'le ' ° 77 t IIL :. I.I ; llCneiollr' So Soi b 011 iSetrn, hes,$nuldera.tingsnotre,cor(in.) N5 bioll j. Copsistette���'°(3ravo1l I I Ij Z ! t 2 v o ,. :..I I I y u czc 3 ,OCiI I` �Iol�# ':••t." tber Sbil� xtuie ollColor 1. sod LD from Soil Horiibn US)iA (Mansell) Molding' : (SWctute,Stones,$ouldets. surface bt. t ) Co Iston t ) i. v a t I ` 1 )�In—L1S • ` :'' :AboVel5tlt5;yeai fio fct:too ft d�y �ol Yes_t_ wi i 5W year b0ild t� i No Yei ear ilo'..�l,oitn -- ,{ I Witlilu lOtl y 'icy 1`10 Yet ?° I I t I at>�trail U�chl r1t4 I�c�vltt CI`( I : 'st hi all afeas obselwed throug>iout the De th o I : terial exl Does 1)t beat Dour't`eet b r;nal bLt;tS log P erblous ana area ro osed�for the still;; di ldl�t3�s em7 p P I: I, ,:. ►' cc iti [yious tnatertal7 I 1 d�- ,b dP Wot`n, Y 'e s th If not,what 1 i P I I I ;. , GertJu!tl i ;. have sed the soil a al a o oxamintttloft appcovedby the :� �'. Lceitif}�that t�11 1 beptltt�ttt v. Env otxnleh f�tbtetld adti t1i t the aUove mealy is was per°ntied by me cvnsist�nt wt{h the rt:ywted ttaltiittg,i;itertit a�hcl 'xp let�ce d sc#lbed Itt 31tl C 15 017, Date 1 ` 5�. Z�'v l• i Q:1St'sVTjC\VERCFuRM.DOC, Town of Barnstable I"ElO"�o Regulatory Services Thomas F. Geiler,Director R, ASS. * Public Health Div M ision y Mass. �, 039. Thomas McKean Director rEo nnn�°' � 200 Main Street Hyannis, MA 02601 Office: 508-862-4644. Fax: 508-790-6304 February 9, 2012 Robert Hayden F 60 Cheoh Road Cotuit, MA 02635 As of October 1, 2006.a new rental registration ordinance was put into affect requiring all property owners of rental units to register their rental units with the Town of Barnstable Health Division. According to our records, you own the rental property at 79 Guimquissett Road, Cotuit, MA. Enclosed is an application. Please use a separate application for each rental unit you own. Should you need more applications, they are available online at www.town.bamstable.ma.us. �Go to the Health.Division page by looking in the.Department Menu. There is a;link to the Rental Registration information on the Health Division page. You may print out as many as you need, and return them to the Health Division with the appropriate - 2010 fees included: This must be completed within (14) fourteen days of your receipt of this letter. Failure to comply with this ordinance will result in-the"issuance of a non-criminal ticket citation in the amount of$100. Each day of non-compliance is considered a separate offense. Should you have any questions, please feel free to call 508-862-4644. Thank you in advance for your_cooperation. Jim Parziale, R.S. Health Inspector Health Division 6 7 Commonwectth of Massachusetts y Executive Office of Environmental Affairs ti Department of Environnmental Protecti ���� 1 co Wlftm F.WeW 9`9� T >n F AM" Pal Gllueel LL oene+v r y� SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address 79 Guimquissett `� • Cotuit Address of Owner: Arhtur Colchester Date of Inspection: (if different) 731 Sherman Ave. Name of Inspector. Ferderiek :Kiely mpany Name, Address and Telephone Number. Queensbury NY 12804 Co Environmental Reclamation, Inc. 446 Waquoit Hwy. Waquoit MA (508) 457-5020 CERTIFICATION 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 compete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: LuPasses Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority _ Fails Inspector's Signature: Date: April 18,1997 7?'?S—W�7 The System Inspector shall submit a copy of this ins eport to the Approving Authority within thirty (30) days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: A] SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. e] SYSTEM CONDITIONALLY PASSES: One or more System Corthponents need to be replaced or repaired. The system, upon completion of the replacement or repair, passes inspection. Indicate yes, no, or not determiney (Y, N, or NO). Describe basis of determination in all instances. If"not determined", explain why not) The septic tank is metal, cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 11/03/95) 1 One Winter Street • Boston,Massachusetts 02108 • FAX(617) 558.1049 Telephone(617)292.5= w 10 Pnnled an Recwiee Plpw it e SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM s PART A s CERTIFICATION (continued) Property Address: 79 Guimquissettt Owner.! Date ofiInspection: '^ 61 SYSTEM'CONDITIONALLY PASSES'(continued) Sewage badwpfo out or high static water level observed in the distribution box is due to broken or obstructed pipe(s1-or*dt a to arbroken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Heaitli): broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed C1 FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: NSA Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THEENVIRONMENT: _ Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and is within 50 feet of a pnvate water supply well. The system tic tank and soil absorption system and is less than 100 feet but 50 feet or more from private r _ yst has a septic rp yst a p vate ware supply well, unless a well water analysis for conform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm• 3) OTHER (revised.11/03/95) 2 f M / SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM 1 PART A CERTIFICATION (continued) Property AddresJ9 Guimquissett Cotuit Owner: Date of Inspection: Dj SYSTEM FAILS: N/A I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. _ Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _ Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 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. 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: N/A The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area(IWPA) or a mapped Zone II of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. �. ;revised 11/03/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ' PART B CHECKLIST Ply Address: 79 Guimquessett Cotuit Owner: Date of.lnspection: Check if the following have been done: X Pumping information was requested of the owner, occupant, and Board of Health. X None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. X As built plans have been obtained and examined. Note if they are not available with N/A. X The facility or dwelling was inspected for signs of sewage back-up. X The system does not receive non-sanitary or industrial waste flow X The site was inspected for signs of breakout. X All system components, excluding the Soil Absorption System, have been located on the site. X The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles oC tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. X The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. X The facility owner(and occupants, if different from owner) were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 11/03/95) 4 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 79 Guimquissett Cotuit Owner: Date of Inspection: SEPTIC TANK: N/A (locate on site Tian) Depth below grade: Material of construction: _concrete _metal _FRP —other(explain) Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) GREASE TRAP:-�-N/A (locate on site plan) Depth below grade• Material of construction: _concrete _metal _FRP—other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) (revised 11/03/95) 6 �r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 79 Guimquissett Cotuit Owner. Date of Inspection: FLOW CONDITIONS RESIDENTIAL: Design flow: 330 gallons Number of bedrooms: Number of current residents:2 Garbage grinder(yes or no):No Laundry connected to system (yes or no): Y Seasonal use(yes or no):_L[Q Water meter readings, if available: minimum for the last 3 years Last date of occupancy: COMMERCIAUINDUSTRIAL: N/A s Type of establishment: Design flow: gallons/day Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non-sanitary waste discharged to the Title 5 system: (yes or no)_ Water meter readings, if available: an date of occupancy: l OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and.source of information: none System pumped as part of inspection: (yes or no)_ If yes, volume pumped: gallons Reason for pumping: TYPE OF SYSTEM Septic tank/distribution boxisoil absorption system Single cesspool XXX Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) Other(explain) APPROXIMATE AGE of all components, date installed (if known) and so` of info mtation: The house was constructed i 1960s and the second pit was added n the last years Sewage odor detected when arriving at the site: (yes or no) None i (revised 11/03/95) 5 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 79 Guimquissett Cotuit Owner. Date of Inspection: TIGHT OR HOLDING TANK. _N/A (locate on site plan) Depth below grade: Material of construction: _concrete _metal _FRP—other(explain) Dimensions: Capacity: gallons Design flow: sralions/day Alarm level: Comments: (condition of inlet tee, condition of alarm and float switches, etc) DISTRIBUTION BOX /A (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) PUMP CHAMBER: N/A (locate on site plan) Pumps in working order:(yes or no) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 11/03/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 79 Guimquissett Cotuit. Owner. Date of Inspection: SOIL ABSORPTION SYSTEM (SAS):_ (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number: leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.) Pit No 1 serves as a tank and pit No 2 serves as the SAS Both of the pits were dry at the time of t-hP i n.-,Ue t-i nn CESSPOOLS: _ (locate on site plan) Number and configuration: 2 Depth-top of liquid to inlet invert: no liquid touncl Depth of solids layer: non Depth of scum layer: none Dimensions of cesspool: 7r3PPn x 7 rji a Materials of construction: hl o -k Indication of groundwater: nnnP inflow (cesspool must be pumped as part of inspection) both cesspools were dry at the time of the inspection Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) There were no sings of any failures at the time of the inspection PRIVY: N/A (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition-of vegetation, etc) (revined.11/03/95) 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 79 Guimquissett Cotuit Owner. Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: N- include ties to at least two permanent references landmarks or benchmarks locate all wells within 100, l N G ly P1'r DEPTH TO GROUNDWATER Depth to groundwatec-2.Q-_f w method of determination or approximation: The groundwater depth was calculated using a monitoring well —1 neaten at 119 Ghpl 1 T.n aD roxi mat-al y ';00 fimpt, away (revised 11/03/95) 9 „ L TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION Date a ' ^ Time: In Out Owner I Tenant f n e Address (20 I��-- Address Compliance Remarks or dN-� Regulation# Yes A0 Recommendations 2. Kitchen Facilities 3. Bathroom Facilities 4. Water Supply " v M In C.rt Y 5. Hot Water Facilities + 6. Heating Facilities 7. Lighting and Electrical Facilities 8. Ventilation 9. Installation and Maintenance of Facilities 10. Curtailment of Service 11. Space and Use 12. Exits N 13. Installation and Maintenance of Structural Elements 14. Insects and Rodents 15. Garbage and Rubbish Storage and Disposal 16. Sewage Disposal 6-v" ^- 17. Temporary Housing !0 �S 18. Driveway Width 19. Number of Tenants Observed �-- — PART II 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition Number of Bedrooms _ Number of Vehicles Allowed (max) Number of Persons Allowed (max) Person(s) Interviewed Inspector If Public Building such as Store or Hotel/Motel specify here I . SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ 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 rpaddressee so that we can return the card to you. B. R c ived by.(Printed Nae) C%Date of Delivery ■ Attach this card to the back of the mailpiece, or on the front if space permits. D. Is delivery address different from item 1? 0 Yes 1. Article Addressed to: If YES,enter delivery address below: /Rpo 7 3. ,S,ee ice Type M b�6 3 S . ertifled Mail ❑Express Mail ! ❑Registered turn Receipt for Merchandise I ❑Insured Mail ❑C.O.D. f 4. Restricted Delivery?(Extra Fee) ❑Yes + fi 2. Artici%t4ymber (transfer from service label) .7 0.0-6. 0 81.0, 0000 3524 5300 Q PS Form 3811-,February 2004; 1 i i I Domestic Return Receipt 102595-02-M-1540 i UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid USPS Permit No.G-10 I' I • Sender: Please print your name,address, and ZIP n this � I c�J v�7 coLAJ 'I 4! Town of Barnstable ,� LA_ `� Health Division GJ 200 Main Street I Hyannis, MA 02601 I 0 lii►,,,,1,i,ii„ii,,,,,,li,i,�lii„,ii,,, ,i,li1,„1�,,,,I,i�i - SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Sign at item 4 if Restricted Delivery is desired. f ❑Agent 1111[ Print your name and address on the reverse X ❑Addressee so that we can return the card to you. B. Rec ive y(Pri ed Name) C. Date of Delivery ■ Attach this card to the back of the maiipiece, /7Gl or on the front if space permits. D. Is delivery address differen'' rff em 1? Yes 1. Article Addressed to: ��°° \— If YES,enter delivery�d Mess bgow: QMo 4 0- Robert Hayden j Cheoh Road Cotuit, MA 02635 3. Service Type --� certified Mail ❑.Express Mail ❑Registered eturn Receipt for Merchandise ❑Insured Mail O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Numberli; ill 11(( I(70061 0810 (0000 (35j2i4'15294(1 '�� `(transfer from service label) PS Form 3811,February 2004 . Domestic Return Receipt 102595-02-M-1540 j 4 ' 4 i I !!! r 4li3 I i I I I UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid USPS Permit No.G-10 I � I 1 ' Sender: Please print your name, address, and ZIP+4 in this box • I I I I M s Town of Barnstable Health Division I 200 Main Street I Hyannis,MA 02601 I 111!If fill,lL.11.rii��]���r� s Town of Barnstable Barnstable Regulatory Services Department AMmlicaC j saxwsrnst.e, + "'"SS i639. Public Health Division �� 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTTIFIED MAIL 7006 0810 0000 3524 5294 February 21, 2012 Robert Hayden Cheoh Road Cotuit, MA 02635 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE II—MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION The property owned by you located at 79 Guimquissett Road, Cotuit, MA was inspected on February 21, 2012 by Timothy B. O'Connell, R.S. Health Inspector for the Town of Barnstable. This inspection was conducted on the basis of the Town of Barnstable rental. registration. The following violations of the State Sanitary Code were observed 105 CMR 410.450- Means of Egress: Observed room within basement being used as bedroom without second means of egress You are directed to correct the violations listed above within twenty four hours,(24) of your receipt of this notice by removing all beds from the bedroom lacking proper egress and ceasing and desisting from using this room as sleeping quarters. 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. Non-compliance will result in a fine of$100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. Should you have any questions regarding the above violations, please con ct the Town Health Division and ask to speak with the inspector who perfo d the ins ection. -T BOARD OF HEALTH ` Thomas A. McKean, R.S., CHO Director of Public Health Town of Barnstable Cc: Fritz Haubuer I ! �C,-TT vL- Alm ,t'G ODR 5L E V, All. /iVS7;4L G �~� Rk'e 1,VS?EC77,OW P0,e7' 7a ,W?�Y/.1 3' F/// GRAl�.E O'r �'/ 3'f 2 S D n 7 2 el-.34.o R/.SER ANd COVEK SEl+/.4G� .5'YS�,�M /�'�'CF/L,E OM5 /'E/' ���/�Cy /an �/L L To W/TN/N 6"FiN. CA'. 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