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0025 LEWIS POND ROAD - Health (2)
24 BAY ROAD COtuit � s A = 020 - 018T i 0 0 ra r- i C I A L IS 2Td 4 Postage $ruCertified Fee - J Retum Receipt Fee-O (Endorsement Required)C3Restdcted Delivery Fee p (Endorsement Required) r3 Total Postage&Fees F$ ra rui a' Francis X Shmid % 24 Bay Rod Cotuit, LLC .`. 11 Oakland Avenu"e ale. MA 02466 _ I Certified Mail Provides: o A mailing receipt if s A unique identifier for y ur mailpiece ® A record of delivery k by the Postal Service for two years Important Reminders: a Certified Mail may ONLY be combined with First-Class Mail®or Priority Mail®. s Certified Mail is not available for any class of international mail. ■ NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. s For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtpin"Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorsefnailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required. ■ For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". ■ if a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT.Save this receipt and present it when making an inquiry. PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 I E THE Town of Barnstable Barnstable T°k� °T Regulatory Services Department ;m"a`f "UWSTABM MAM � Public Health Division 'Dtfp Mp't a�� 2007 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL #7012 1010 0000 2851 0084 September 26, 2013 Francis X Schmid % 24 Bay Rd Cotuit, LLC i 11 Oakland Avenue Auburndale, MA 02466 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5. The septic system located at 24 Bay Road, Cotuit, MA was last inspected on 9/11/2013, by Patrick M. O'Connell, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Conditionally Passes" under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) Due to the following:. Pipe between tank and pit needs to be replaced. • A new outlet tee and gas baffle needs to be installed. You are ordered to repair or replace :the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system with the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH Tho ean, R.S. CHO ent of the Board of Health Q:\SEPTIC\conditionally passed\24 Bay Rd Cotuit Sept 2013.doc - Parcel Detail http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=945 I , r ,Iltx-, Li C71 Logged In As: Parcel Detail w Tuesday, September 24 2013 Parcel Lookup Parcel Info _. _ ......... Parcel 020-118 ( Developer LOT 24-A I D Lot Location 1-24 BAY ROAD P r i r25 Frontage Sec��_ _. ____ Sec Road! �� Frontage Fi re Village COTUIT District I`'OTUIT Town sewer exists at this Road address No �� Index 0085 Interactive I , w Map a� � Owner Info Owner ISCHMID, FRANCIS X Co %24 BAY RD COTUIT, LLC J Owner Streetl 111 OAKLAND AVENUE Street2�- - City UBURNDALE— -j State Zip[02466 Country j Land Info Acres 0.52 _ Use Single Fam MDL-01 Zoning RF J Nghbd 0 113 Topography Above Street Road Paved Utiliities FPubiic Water,Gas,Septic Location t,Marginal View �� Construction Info Building 1 of 1 Year . Roof Ext - 1973 � Gable/Hip � Wood Shingle Built Struct Wall _s. Living 1 116 Roof[A h�/F GIs/Cm A None i p p ��� PTd" . Area Cover Type � 9: e1 , OPINStyle Ranch I it Drywall Bed 5 Bedrooms to Wall Rooms Int Bath Model Residential Floor Hardwood Rooms 12 Full Total Grade Average Type H Heat[ ot Air Rooms 10 Rooms t' 1 Stories 11 Story � Heat Oil Found-I Poured Conc. Fuel ation Gross http://issgl2/intranet/propdata/ParceiDetaii.aspx?ID=945 9/24/2013 fYl � � �=f�i� :y Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 24 Bay Road Property Address Tia Lilly Owner Owner's Name information is p required for Cotuit MA 02635 September 11, 2013 — every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. General Information When filling out forms on the computer, use 1. Inspector: only the tab key to move your Patrick M. O'Connell cursor-do not use the return Name of Inspector key. Septic Inspection Services Co. Company Name rea PO Box 1487 Company Address Marstons Mills MA 02648 City/Town State Zip Code 508.428.1779 SI 12855 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. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: = 3 C> ❑ Passes ®_ Conditionally Passes ❑ >Fb 's w rµ�� t..^^Yj � ❑ Needs Further Evaluation by the Local Approving Authority u _n w September 11; 2013 Job W` 3-8Z" ector's SignatureUate :=•4- Ins The system inspector shall submit a copy of this inspection report to the Appro ng Autho tta y (Boa d 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. t5ins•3/13 _ Title 5 Official Ins#cnFarm'Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts qR W Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form- Not for Voluntary Assessments. - 4c 24 Bay Road Property Address Tia Lilly Owner Owner's Name information is P required for Cotuit MA 02635' September 11, 2013 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D.or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: F B) System Conditionally Passes: ® One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. - *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below).: Pipe between tank and pit needs to be replaced and outlet tee in tank is missing. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 24 Bay Road Property Address Tia Lilly Owner Owner's Name information is P required for Cotuit MA 02635 September 1,1, 2013 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): , ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N .'❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 'Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form`-'Not for Voluntary Assessments 24 Bay Road Property Address Tia Lilly Owner Owner's Name information is P required for Cotuit MA 02635 September 11, 2013 every page. Cityrrown State, Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has aseptic tank and SAS and the SAS is within,a Zone 1 of a public water supply. ❑ The system has aseptic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: `* This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 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 ❑ ® 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 day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 24 Bay Road Property Address Tia Lilly Owner Owner's Name information is required for p Cotuit MA 02635 September 11, 2013 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year 40T 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 if the well water analysis, performed at,a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure,criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.803, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ 'the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA) or a mapped Zone II of a public water supply well If you have answered"yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts y Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments, �M 24 Bay Road Property Address Tia Lilly Owner Owner's Name information is P required for Cotuit MA 02635 September 11, 2013 every page. City/Town State Zip Code. Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no as fo each of the following:' Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? El ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewLije back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank_ inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner)provided with 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. ® Fi 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): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example; 110 gpd x#of bedrooms): 330 . t5ins•3/13 Title 5 Official Inspection Form_Subsurface Sewage Disposal System•Page 6 of 17, i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 24 Bay Road Property Address Tia Lilly Owner Owner's Name information is p required for Cotuit MA 02635 September 11, 2013 every page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail Sump pump? ❑ Yes ® No Last date of occupancy: UnknownDate Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-.Not for Voluntary Assessments - 24 Bay Road Property Address Tia Lilly Owner Owner's Name information is Cotuit MA 02635 September 11, 2013 required for P every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): f i General Information Pumping Records: Source of information: Unknown Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy. ❑ Shared system (yes,or no) (if yes, attach previous inspection records, if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator,under contract ❑ Tight tank. Attach a copy of the DEP approval: Other r� , desc ibe : t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 24 Bay Road Property Address Tia Lilly Owner Owner's Name information is Cotuit MA 02635 September 11, 2013 required for p every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1970's Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 6' (under slab) feet Material of construction: ® cast iron ❑ 40 PVC ❑ other (explain): Distance from private water supply well or suction line: i feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): Depth below grade: .6feet Material of construction: ® concrete ❑ metal r ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank • a Is metal li st age.-' 9 years Is age confirmed by a Certificate of Compliance? (attach a copy of certifical_:) ❑ Yes ❑ , No Dimensions: 8.5' long x 5.2'wide - 1000 gal. Sludge depth: 011 l5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts - W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 24 Bay Road Property Address Tia Lilly Owner Owner's Name information is Cotuit MA 02635 . September 11, 2013 required for p every page. CityFrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 11 Scum thickness " 0 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? Measured I Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank was found empty at time of inspection and structurally sound. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal. ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet the or baffle . Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date - t5ins•3/13 Title 5 Official Inspection Form:Subsurface:Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 24 Bay Road Property Address Tia Lilly Owner Owner's Name information is Cotuit MA 02635 September 11, 2013 required for p every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: i Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ 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 switches, etc.): *Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 24 Bay Road Property Address Tia Lilly Owner Owner's Name information is required for Cotuit MA ' 02635 September 11, 2013 every page. CitylTown State Zip Code Date of Inspection D. System Information. (cont.) 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.): Pump Chamber(locate on site plan): Pumps in working order. ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and apptrtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS),(locate on site plan, excavation not required): If SAS not located, explain why: ; (Sins•3/13 Title 5 Official Inspection Form`.Subsurface Sewage Disposal System•Page 12 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments, 24 Bay Road Property Address Tia Lilly Owner Owner's Name information is P required for Cotuit MA 02635 September 11, 2013 every page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: One 6x6 pit. ❑ leaching chambers number: ❑ leaching galleries number. ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number.- El 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.): Pit was found empty at time of inspection, observed a high stain line at 50% capacity. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer- Dimensions of cesspool. Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 I ' Commonwealth of Massachusetts Title 5 Official Inspection Form. Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4c 24 Bay Road Property Address _ Tia Lilly Owner Owner's Name information is p required for Cotuit MA 02635 September 11, 2013 every page. CityFrown State Zip Code Datq of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (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.): t&ns•3/13 Title 5 Official Inspection Form..Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form ), Subsurface Sewage Disposal System Form Not for Voluntary Assessments 24 Bay Road Property Address Tia Owner Owner's Name information is required for Cotuit MA 02635 September 11, 2013 ____ ......n_ _. .. . ..-......_ _ ._ - _ _ every page. Civi flow State Zip Code Da::of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System. Provide a view of the sewage dispose' system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately !/ .. C/I Cover @ grade 36 32 Bay Road Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 24 Bay Road Property Address Tia Lilly Owner Owner's Name information is required for Cotuit MA 02635 September 11, 2013 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells i 12+ 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: pate ® Observed site (abutting property/observation hole within.150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database-' explain: You must describe how you established the high ground water elevation: Used elevations and benchmark from design plan. Found bottom of leaching pit to beat el. 7.9. Hlgh water is less than el. 1. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins 3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 L Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 24 Bay Road Property Address Tia Lilly Owner Owner's Name information is Cotuit MA 02635 September 11, 2013 required for p every page. City/Town State Zip Code Date of Inspection - E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information-Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Title 5.0fficial Inspection Form;Subsurface Sewage Disposal System•Page 17 of 17 No.e10 1?2 Fee ( O 0 " THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ✓ Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ftpliLatlon for Vsposal *pstem Construction permit Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 2—Li (341 k 8 CO'TO9 1'j' Owner's Name,Address,and Tel.No. Assessor's Map/Parcel // 2�-� 3{4 YZj©" c' Installer's Name,Address,and Tel.No. 5'0S^-_3&Lt -tf 7 S Designer's Name,Address,and Tel.No. Type of Building: �� �STDN� ► & $ o Zoo i{ Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building fZ Vte—k- No.of Persons Showers( 4 Cafeteria( ) Other Fixtures Design Flow(min.required) 3 3 C> gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title nn Size of Septic Tank 1 L9 f�C7 Type of S.A.S. Cone r F_r&_ Lwah tyt to(Y)6 9-( Description of Soil i it/A c 0_44( ,(il Nature of Repairs or Alterations(Answer when applicable) e Se:-It 140 r.t-VA ct_JA D^ av_ l ,l S � lam !yr 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 Date Application Approved by f% Date Application Disapproved by Date for the following reasons Permit No. Q013 , 370 Date Issued No. Fee t THE COMMONWEALTH.OF MASSACHUSETTS Entered in computer: ✓ Yes t PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS J v Fkp IOIY _f , -ispoBal *pstem Construction Permit Application for a Permit to Construct(")` Repair(4pgrade( ) Abandon( ) ❑Complete System ❑Individual Components t rLocation Address or Lot No. 2—q Owner's Name,Address,and Tel.No. ."ny �1L ` t . .1 Assessor's Map/Parcel 0240 t F t 2'T 3 W �CN C4 �-C Installer's Name,Address,and Tel.No. 50'6`_3&q` ! 7 H Designer's Name,Address,and Tel.No. Cveal Co� llllnGS�f p�►vE x Type of Building: M il rS-M h S OA013 o Ca l Dwelling No.of Bedrooms Lot Size Z 65"1 sq.ft. -,Garbage Grinder( `) Other Type of Building l� 4 N C_VI No.of Persons Showers( ✓) Cafeteria( ) Other Fixtures Design Flow'(min.required) 3J gpd Design flow provided gpd `r Plan Date Number of sheets Revision Date Title 1 Size of Septic Tank bd Type of S.A.S. Con e r F l`E. C�c l�l IDGY� H l Description of Soil �p ��C�t,VICJ�li► r, �,N Nature-of Repairs or Alterations(Answer when applicable) (° t ct e F_ t e T U gG�► i{ j jDate 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.r Signed Date Application Approved by �I^l `� � 7 �. Date Application Disapproved by Date for the following reasons Permit No. 0 y( 3 — 3 7 0 Date Issued TH F COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance • THIS IS TO CERTIFY t at the On-site Sewage Disposa system Constructed( ) Repaired X Upgraded( ) Abandoned( )by O � �n at v y has been cons cted) accor e with the provisions of Title 5 and the for Disposal System Construction Permit No. r2d�ted Installer Designer #bedrooms Approved design ow gpd. The issuance of this permit sh. 1, no2�b cons ruedara guarantee that the system 41 , ne'on-as as de signed.�� Date J Inspector ��Z`�'�_ p l ✓.� k Ay _ _ ____________________________ ________________ No. 0 1 3— 7� Fee 0 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS Misposal 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair( � Upgrade( ) Abandon( ) System located at t rf y c and as des ribed in the above Application for Disposal System Construction Permit. The applicant rgcognized his/her duty to comply with Title 5and the following local provisions or special conditions. d Provided:Cons �c�tio /st be completed within three years of the date of this permit. --y�� Date ol Approved by / r •��L �(� �� r TOWN OF BARNSTABLE �J Q LOCATION '? �I SEWAGE# r� O }�}y . VILLAGE CeAoi`)r ASSESSOR'S MAP&PARCEL ea2 INSTALLER'S,NAME&PHONE NO. Crz`G Can&40 SEPTIC TANK CAPACITY JWQ Q/p '\ LEACHING FACILITY:(type) ] ( 1 \ (size) j�q� NO.OF BEDROOMS OWNER 2 LLc. PERMIT DATE: COMPLIANCE DATE: t., Separation Distance' etween 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 206 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching f .1.ty) Feet FURNISHED BY 1 6 A.14 Ul�+ LA ff0 N L, A� 30 C 2, Health Master Detail Page 1 of 1 .! 'f i Logged In Ac; TOWN\health Health Master Detail Tuesday, November 18 2014 Application Center Parcel Lookup Selection Items Parcel Septic Perc Well fuel Tank i Parcel: 020-118 Location: 24 BAY ROAD, COTUIT Owner: 24 BAY RD COTUIT, LLC Septic changes have been saved. Septic 2, 9/24/2013 Septic.1, 9/5/2013 Septic 3 New Septic.:. 1 Permit number: i l Permit type: I Select type v� ` Complete system: El Issue date : -� Complete date Septic tank size: Type/Size of SAS: ..: Installer: i Select Installer v Card on file: ❑ I/A service type: Select service Innovative/Alternative Technology type: Select IA type v .. .. Variance date : Abandon complete date : Abandon permit number Repair deadline date Repair notification date : � Keyword Comments: �] r " created for septic inspection t` Delefe Septic ..-p " ( Inspection 9/11/2013 New Inspection l Number Inspection Date Inspector Result 8114—�� 9/11/2013_ O'Connell, Patrick M. v CP/R (CP/Repaired) r Received Date Comments 9/23/2014 ( replaced pipe to Sch 40 and added D-Box. In Title V.Compliance '; Delete Inspect on a���' 3�. x Save pti e c Cha ng "s r,Returnnto Looku Se p li ff� r DEED RESTRICTION WHEREAS 24 BAY RD COTUIT LLC, a Massachusetts Limited Liability Company, having a mailing address of 11 Oakland Avenue, Auburndale, MA 02466 is the owner of 24 Bay Road located in the village of Cotuit, Barnstable, MA and being shown on a plan entitled "Revision of Lots #19 through #25 and Lots#45 and #48, also relocation of a portion of Bay Road as shown on a plan entitled "Cotuit Highground record in Plan Book 19, Page 143 (See also Plan Book 94, Page 47) drawn by Edward A. Kellogg, C.E., dated January 2, 1957 and duly recorded in Barnstable County Registry of Deeds in Plan Book 132, Page 143. WHEREAS, 24 Bay Rd Cotuit LLC as the owner of said property has agreed with the Town of Barnstable Board of Health to a restriction as to the number of bedrooms which can be included in any home built on said lot as a pre-condition to obtaining a disposal works construction permit in compliance with 310 CMR 15.000 State Environmental Code, Title 5, Minimum Requirements for the Subsurface Disposal of Sanitary. WHEREAS, the Town of Barnstable Board of Health, as a pre-condition to granting a disposal works construction permit for a septic system in compliance with 310 CMR 15.200, State Environmental Code,Title 5, Minimum Requirements for the Subsurface Disposal of Sanitary Page 1 of 3 Sewage, and authorizing the issuance of a building permit for the re-habitation of the dwelling- currently located at said address, is requiring that the agreement for the restriction on the number of bedrooms in any house constructed on this lot be put on record with the Barnstable Registry of Deeds by recording this.document. NOW, THEREFORE, 24 BAY RD COTUIT LLC does hereby place the following restriction on the above referenced property in accordance with the agreement with the Town of Barnstable Board of Health, which. restriction shall run with the' property and be binding upon all successors in title: . 24 Bay Road, Cotuit, MA shall be restricted.to no more than three (3) bedrooms and agrees that this shall be a permanent deed restriction affecting said property. For title of 24 Bay Rd Cotuit LLC, see the following deed: Book 27253, Page 198 recorded in Barnstable Registry of Deeds. Page 2 of 3 f WITNESS the execution hereof under seal of this 3A,4-day of 2013. OA— Grantor: Nick C. Wan, Manager for 24 Bay Rd Cotuit LLC i COMMONWEALTH OF MASSACHUSETTS Barnstable, §§ 2013 Then personally appeared Nick C. Wan of 24 Bay Rd Cotuit LLC as aforesaid, proved to me through satisfactory evidence of identification, which was L�Riuejjs G,czn� to be the person whose name is signed above, and acknowledged the foregoing instrument to be his free act and deed before me, the undersigned notary public. Notafy Public My commission expires Ap// a3. C",V 0 `f S r) h. Page 3 of 3 BARNSTABLE REGISTRY OF DEEDS Town of Barnstable P# � Department of Regulatory Services Z/A , ABM 'r Public.Health Division DateNAM �, l 639. - 200 Main Street,Hyannis MA 02601 Date Scheduled / Time�= Fee Pd. Soil Suitability Assessment for Sew a e Disposal j° Performed By: Robin W. Wilcox Witnessed By: LOCATION&:GENERAL INFORMATION Location Address Owner's Name 24 Bay Rd Cotuit L C 24 Bay Road, Cotui.t 11 Oakland Avenue Address Auburndale, MA 02466 Assessor's Map/Parcel: 2 0/118 Engineer's Name Swe e t s e r Engineer'ng NEW CONSTRUCTION REPAIR XX Telephone# 5 0 8-3 8 5-6-9 L`Z) Land Use �'� �� Slopes(%) Z Surface Stones '4-162 Distances from: Open Water Body O ft Possible Wet Area D ft Drinking Water Well fl U ft i Drainage Way ft Property Line 1�2 ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) F .2ZI v t ao • � cr7 I Parent material(geologic) o T j Depth to Bedrock N 1 111 Depth to Groundwater: Standing Water in Hole: Weeping from Pit Face OCR l Estimated Seasonal High Groundwater �� 3•� DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: 6lfSc✓L//yTlD.✓ Depth Observed standing in obs.hole: in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment_w._ Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level PERCOLATION TEST bate. Time Ab ! � Observation V Hole# Time at 9" Depth of Pere Time at 6" Start Pre-soak Time @ Time(9"-6") End Pre-soak / Rate Min./Inch f— Site Suitability Assessment: Site Passed (/ Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conservation Division at least one(1)week prior to beginning. Q:\SEPTIC\PERCFORM.DOC DEEP OBSERVATION`HOLELOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other. Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistenc %Gravel DEEP O$SERVATION`HOLE LOG we# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) P (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel 'P 1- 5 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) DEEP OBSERVATION$OU LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) Flood Insurance Fate Map: Above 500 year flood boundary No- Yes f✓ Within 500 year boundary No_ Yes (/ Within 100 year flood boundary No_ Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all,areas observed throughout the area proposed for the soil absorption system? IVO If not,what is the depth of naturally occurring pervious material? Certification �� I certify that on t/ (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that Bove analysis was performed by me consistent with the required train ,exp se d expen in t ed in 3 CW 15.017. Signature Date. Q:\SEPTIC\PERCFORM.DOC l U.S.POSTAGE>>PITNEY BOWES DF��E TDwh Town of Barnstable Public Health Division ; ' RARNSTARLE. ' 200 Main Street y MASS. g• Hyannis,MA 02601 ? 02 1 VV $ 006.1 10 r 0001.383424 SEP.. 26. 2013. — _ 7012 1010 02o2 2851 0084 1J ❑Mov R�e ,r Now EKED Francis X Schmid #Fo „ �',� E* �n Bay.Rd COtuit LLC Oaro/0 24 y. of Known i Oakland Avenue ' AeLuse Auburndal UNCLAIMED git�l 1t i}1,1111� jl..�i Ins Ny i�VyI i�0))4.4219sAA•r..s$;% 1.3 - z �i111111I111.I�hfi d�111-1111 ..I11 ijll III 1111111191ii.7'i91I_IYl � l �. J �I A. Si nature ■ Complete items 1,2,and 3.Also complete g ❑Agent item 4 if Restricted Delivery is desired. I '+ X ee I ® Pr_int your Name and address on the reverse ❑Address I i I so that we can return the card to you. B. Received by(Printed Name) C Date of Delivery I ® Attach this card to the back of the mailpiece. I I I or on the front,if space permits. D Is delivery address different from item 1? ❑Yes 1, Article Addressed to: If YES,enter delivery address below: ❑ No I Francis X Shmid I ; °0 24 Bay Rod Cotuit, LLC nd Avenue 0 3. Service Type 1T O I I ❑Certified Mail ❑Express Mail l ubudldale, MA 02466 o Registered ❑ Return Receipt,for Merchandise I �� ❑ Insured Mail ❑C.O.D. I I 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Art idle Number 1 � p (transfer from service label) 1 7 012 1010 0000 2851 0 0 8 4 ±I PS Form 3811. February 2004 Domestic-Return Receipt A 10259e-02-M-1e4o i= ! WH i VE Town of Barnstable Barnstable Regulatory Services Department aC 1 `MAS&`ter Public Health Division m f0 MPS Aye 2007 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL #7012 1010 0000 2851 0084 September 26, 2013 Francis X Schmid % 24 Bay Rd Cotuit, LLC 11 Oakland Avenue Auburndale, MA 02466 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5. The septic system located at 24 Bay Road, Cotuit, MA was last inspected on 9/11/2013, by Patrick M. O'Connell, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Conditionally Passes" under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) Due to the following:. • Pipe between tank and pit needs to be replaced. • A new outlet tee and gas baffle needs to be installed. You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system with the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH °V Tho ean, R.S. CHO �- ent of the Board of Health QASEPTIC\conditionally passed\24 Bay Rd Cotuit Sept 2013.doc "f l5' IKE Town of Barnstable Barnstable Board of Health mminimcam B"PNH M$ 200 Main Street, Hyannis MA 02601 'OfE1 59. " 2007 Office: 508-8.62-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi August 21, 2013 Mr. Robin Wilcox, R.L.S. Sweetser Engineering 203 Setucket Road P.O. Box 713 South Dennis, MA 02660 RE '; 24 Bay Road, Cotllt kY . _- o.,.aG r „ ' .,r Ra `_�°+., y020 1;18 Dear Mr. Wilcox, You are granted variances on behalf of your clients, 24 Bay Road Cotuit L.L.C. and the owner's representative Tia Lilly, to construct an.onsite sewage disposal system at 24 Bay Road, Cotuit. The variances granted are as follows: Section 360-1 of the Town of Barnstable Code: To install the soil absorption system 65 feet away from the top of coastal bank, in lieu of the minimum 100 feet separation distance required. 310 CMR 15.248: To design and install a septic system without providing an area for a future reserve area. These variances are granted with the following conditions: (1) No more than three (3) bedrooms are authorized at this property. Dens, study rooms, offices, finished attics, sleeping lofts, and similar-type rooms are considered "bedrooms" according to the MA Department of Environmental Protection. (2) The applicant shall record a properly worded deed restriction, signed by the owner of the property, at the Barnstable County Registry of Deeds restricting the property to three bedrooms maximum. A copy of the Q:\WPFILES\W i lcox24BayRoad2013.doc recorded deed restriction shall be submitted to the Health Agent prior to obtaining a disposal works construction permit. (3) Renovations to the home shall strictly adhere to the proposed floor plan marked "Exhibit A" submitted to the Board of Health on August 20, 2013. (4) The septic system shall be installed in.-- strict accordance with the engineered plans dated revised July 1, 2013. (5) The designing registered sanitarian shall supervise the construction of the onsite sewage disposal system and shall certify in writing to the Board of Health that the ,system was installed in substantial compliance with the engineered plans dated revised July 1, 2013. These variances are granted because the proposed plan appears to meet the maximum feasible design standards contained within the State Environmental Code, Title 5 and local Health Regulations. The registered sanitarian designed the septic system to be located in an area to attempt to maximize setbacks to the coastal bank and wetlands. Sincere ours, � D Wayne l `r, M.D. Chairm QAWPFILES\W ilcox24BayRoad2013.doe �if1E DATE:(,� -/ Q, FEE: ./ + BARNSPABIE. MASS. 039- � REC. BY Town of Barnstable (L-S CITED. DAT Board of Health �1�_ �o 200 Main Street,Hyannis MA 02601 Office: 508-862-4644 GT )Wayne .Miller,M.D. FAX: 508-790-6304 Junichi Saw agi Paul J.Canniff,D.M.D. VARIANCE REQUEST FORM LOCATION Property Address: 24 Bay Road, Cotuit Assessor's Map and Parcel Number: 02 0/118 Size of Lot: 2 2, 7 8 0 Wetlands Within 300 Ft. Yes X Business Name: Ed Kellogg, Civil Engineer � _n No Subdivision Name: Cotuit Hi h round K� 'T t APPLICANT'S NAME: Robin W. Wilcox i4w&phone 5 0 8-3 8 5-6 4 7 8 l Did the owner of the property authorize you to represent him or her? Yes X No r 0 ? � S3� n?63 PROPERTY OWNER'S NAME CONTACT PERSON Name: 24 Bay Rd Cotuit LLC Name: Nick Wan Address: 11 Oakland Avenue, Address: 11 Oakland Avenue Auburndale, MA .02466 u urn a e; MA 02466 Phone: Phone: 5 0 8-2 8 0-5 7 2 8 VARIANCE FROM REGULATION(List Reg.) REASON FOR VARIANCE(May attach if more space needed) 15 . 211 & 360 . 1 Septic system less than 100 ' from Top of bank, , 15 .248 No°reserve- area provided "7 NATURE OF WORK: House ddition ❑ House Reno ation Repair of Failed Septic System Checklist (to be completed by office staff-person person receiving variance request application) Please submit copies in 4 separate completed sets. _ Four(4)copies of the completed variance request form _ Four(4)copies of engineered plan submitted(e.g.septic system plans) _ Completed seven(7)page checklist confirming review of engineered septic system plan by submitting engineer or registered sanitarian _ Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) _ Signed letter stating that the property owner authorized you to represent him/her for this request _ Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense (for Title V and/or local sewage regulation variances only) _ Full menu submitted(for grease trap variance requests only) _ Variance request application fee collected(no fee for lifeguard modification renewals,grease trap variance renewals[same owner/lessee only], outside dining variance renewals[same owner/leasee only],and variances to repair failed sewage disposal systems[only if no expansion to the building proposed]) Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Wayne Miller,Chairman NOT APPROVED Junichi Sawayanagi REASON FOR DISAPPROVAL Paul J.Canniff,D.M-D. C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\BAJ9P9B7\VARIREQ.DOC t� DATE: �l 1L1JQ , FEE �* BARNSMIZ MA SS. 9�139 6g9. � REC. BY Town of Barnstable �� 9 SCHED. DATE: Board of Health 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Wayne A.Miller,M.D. FAX: 508-790-6304 Junichi Sawayanagi - Paul J.Canniff,D.M.D. VARIANCE REQUEST FORM LOCATION Property Address: 24 Bay Road, ,Cotuit Assessor's Map and Parcel Number: 2 0/118 Size of Lot: 22, 780 Wetlands Within 300 Ft. Yes X Business Name: Ed Kellogg, Civil Engineer No Subdivision Name: Cotuit Highground APPLICANT'S NAME: Robin W. Wilcox Phone 5 0 8-3 8 5-6 4.7 8 Did the owner of the property authorize you to represent him or her? Yes X No PROPERTY OWNER'S NAME CONTACT PERSON Name: 24 Bay Rd Cotuit LLC Name: Nick Wan Address: 11 Oakland Avenue, Address: 11 Oakland Avenue Auburndale, MA 02466 u urn a e, Phone: Phone: 508-280-5728 VARIANCE FROM REGULATION(List Reg.) REASON FOR VARIANCE(May attach if more space needed). 15 . 211 & 360 . 1 Septic system less than 100 ' from Top of bank, 15 . 248 "OHck No' reserve area provided NATURE OF WORK: ouse Additiotenovati n t Repair of Failed Septic System Checklist (to be completed by office staff-person receiving variance request application) Please submit copies in 4 separate completed sets. _ Four(4)copies of the completed variance request form _ Four(4)copies of engineered plan submitted(e.g.septic system plans) _ Completed seven(7)page checklist confirming review of engineered septic system plan by submitting engineer or registered sanitarian _ Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) _ Signed letter stating that the property owner authorized you to represent him/her for this request _ Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense (for Title V and/or local sewage regulation variances only) _ Full menu submitted(for grease trap variance requests only) Variance request application fee collected(no fee for lifeguard modification renewals,grease trap variance renewals[same ownerflessee only], outside dining variance renewals[same owner/leasee only],and variances to repair failed sewage disposal systems[only if no expansion to the building proposed]) Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Wayne Miller,Chairman NOT APPROVED Junichi Sawayanagi REASON FOR DISAPPROVAL Paul 1.Canniff,D.M.D. C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\BAJ9P9B7\VARIREQ.DOC TH 'down of Barnstable �OpE rOtyti Barnstable Board of Health All-A,e;caCfty narus-raeLe, 9 MASS. 200 Main Street, Hyannis MA 02601 039. PTFD MAt A, 2007 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Junichi Sawayanagi Paul Canniff,D.M.D. Agreement to Extend Time Limit For Acting Upon a Variance Request In the Matter of a variance request form received onL the Petitioner(s), 4, b �f Ll!il �- r%) regarding the property at v�y zq:�, Im the petitioner(s)and the Board of Health agree that the Board of Health has until o?p (insert date) to act upon the Petitioners' completed application for a variance. c;20 3 In:executing this Agreement, the Petitioner(s) hereto specifically waive any claim for a constructive grant of relief based upon time li its applicable prior to the execution of this Agreement. Petitioner(s). Board of Health: Signature: Signature: L /fPetitf*4(Y,/0r\-efion'vjs koese tative Chairman (f Print: Print: Wayne Miller, M.D. Date: "3 Date: 3 Address of Petitioner(s)or Petitioner's Representative Town of Barnstable Board of Health Public Health Division 200 Main Street Hyannis, MA 02601 Phone: 508-862-4644 Fax: 508-790-6304 Q:WGENDAS BOH\BOH Agreement to Extend Time Limit to Act on Variance.doc Ssessorts map::and ;lot number ..... /./..: SEPTIC SYSTEM MUST BE :INSTALLED IN COMPLIANCE Uc yam, { cliL�C�..:::� t �� Sewage Permit number . .. :. �..� ....,. .. . � >/� WITH A„19 I_E 11 STATE d/� SIV ITARY CODE Ri TOWN. . G O�THEtO r :a �A;R 1L. ' Z BABHSTAIILE.1639 { B`VILD.I INSPECTOR O� �® t, . Y ......, . ......: ... .. ... ... ....... APPLCATION FOR')PERMIT TO: .: � ... ...... .. TYPE OF "CONSTRUCTION ...... ..... .... .................... .... .........19.70..; TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following .information: Location .... .. . r. ...... ............... L�.�.(. .......�nCl ........................................................:...:...... ProposedUse ......... �': .......... . .—..................................... . ...................................................... Zoning District : Fire District .....Cot! .it •••••••••••••••••• • ; ...................................%............... n c.�•�a!.Wddress ., . ........ ..... ....... ... cduir Name of Owner ........ I .. ........................... �FA: f!V!_...�,........Address ...... 5.�C'-6Ur J l d/l Name of Builder .... ••.... l iAddress ............:.....:........:....................:.....................:.............. Name of Architect .. .`:�......... .............�.................... Number of .Rooms ....... � .. .....................Foundation ..��...........` .'"i•••..... C/ ............................:. ........C..I:..�..f:: .r........... ly. .W .. ..-` .F.1 ':..Roofing ....e': p 1 ......... .......................... Exlerior .. 1 "•`••� f.'b. +1 Interior ...:C ... ............ ..0� . .. ........:: .I... ..... Floors ....... ........ ........................Plumbing ........ Q � Heating ..... .............................. rem(..... . . .........�-........ Fireplace ......... ® ....................................................Approximate Cost ....... ....................................................... ..................... Definitive Plan Approved by Planning Board --------------------------------19--------• Area ...... ./.•::- -•-•..... Diagram of Lot and Building with Dimensions,W Fee ............1.... ............. - SUBJECT TO APPROVAL OF BOARD OF HEALTH ®� " , T3,00, ` _. ._ S�� �✓ach. �r raj,�.S' � � s sp1�'i'� t i � Regulations of,the Town of Barnstable regarding the abo I hereby agree to conform to all the Rules and c construction. l N Name ........�...... ..... .. . ........................... ...... .... ... Assessor's map and lot number .........�............... . - ..... SEPTIC SYSTEM MUST BE �I�STAI..L.:D I�„ Co,,j'LIAIVCE �G^ l�r s =_4 it Si ATE Sewage Permit number .............. -t.. .............................. S g .,J.: )TA CODE AND REGUI ATIQ — 7HETO b �r F AR s A' 0 BARISTADLE, 1639 O0 MPY�` V l/LI/ti� a APPLICATION .FOR PERMIT TO .......................................\.......�......................^.................................................... TYPE OF CONSTRUCTION ..................... ......................................................... . ...:........................................:.... y .........................` ...............19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a.permit according to the following information: la Location ............... .. ..... .. .........:....... 1 ........................ ....... .........:........ . . ProposedUse ....................... ...............................:................................................................................................................... ZoningDistrict ..................................� .... .....................................Fire District .................................... ...... . ....... ... ............... Nameof Owner ......................................... ........................Address ............ ...............:.................................................... Name of Builder .....?.��.%......:f:....�..`.'.'.c ........ ..Address ....... ......:1........................................... Name of Architect O vG............C..... Address y .�..... y 1rZG C'�c{.......�..1..�......... ..................... .............................................................. Numberof Rooms ...................................................................Foundation .............................................................................. Exierior ....................................................................................Roofing ..................................................................................... Floors ..:...................................................................................Interior ............................................................................... Heating .............Plumbing ........................... ...................................................... 000Fireplace ..................................................................................Approximate Cost ....................../ Definitive Plan Approved by Planning Board ________________ _____19________. Area -------- ................:......... ..........- ff ca� Diagram of Lot and Building with Dimensions Fee ...... ...!'.......... SUBJECT TO APPROVAL OF BOARD OF HEALTH '� w� y a 419.1 /O 0-7 �es� �piell I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ............................... ................. Schmid, Francis & Frances 18362 add to frame .,Permit:_for dwelling................................. a Bay Road Location .... ..... Cotuit .............. ...... ..................... ..................... Owner Francis & Frances Schmid Type.of Construction .........f gameJL ................ ................... ............ Plot ..... Lot ................................. Permit Granted M X..4 19 76 - Date of Inspection .1.. (. ..7G +....19 . F4 Date Completed �.1.. !� , �...: 19 >- PERMIT REFUSED cw- .......... ... Approved .................................. . ...... 19 a............................................................ ......... .................... .......................................................... v,. 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WOQbtN,,DE Mo�, :CW BINUHIE TREP R THE' INV ARE 10 BE-RE 'OVE! 2 WITA $ ,SMALL rRO _OOMPO,�NC� :TH� ' 4:�ASTA UNI�Np 15 Pp 7,v 6",tF �Ajl A )NENTS TtM tMAL' Olt F,,Nl %WlTHVAkf wo P-��b LOA INLO., EOTED �ANQ,: IEPL�CED I -:Cli�$ARY. R AS( Tp'BRING�.�OVEJS Oi� RADE-'��A 6. THE,LO CK': A71 ANP RA tYO�E W�Ll< IRE. 16 BEltPXIRE�. NARI,��ill' U ED LL 4' eE ��So .... .. "MORTA 71.. STLNMP. DJACEN P PH T N�PL CIE IR D 4ar 'A 00 S ��EEN *D� AS TO 'COMPLIAK FqUNDA ON OF, PO CH Isj bE%R Al I A NA 1O.Q , - i I I I ; . I I 11 ., A C-GU PLI�ANT IS �00-`ZONINO r TI )N§. 0 AlN CH bN A 'PP( ATE !7 P AfEltR JNA� PTHOR114, J 'AR 'AP -MOV DiAD ES � 40' ONLY,; AVATION CON AC OR, E VA AP I . ............ _:TC r T:72 -HbuRs 'A 10-��SAF`r A AT'�LEAS OOMENCING RK ON 0 YIN 0-P-44E,60 rTO OF 6ANK Sl A *��L I60NS N 4ACf VA 7 -ON �fpl' E T�'A -TEN IJON F:,THF PR,',T WORIf ON'SITE-AN "t-SITE PON 4T 0 M�NC N G OF TO, 2 OF IYMF IATE Y.� ZO E EL-4 IN fLOP� SSEC $�Oli ON lls�p A U Te REPVP �5 TS, , , N TABLE' MA Rl;L,.,'§ A�L e R MOMtT0 OM�NPER AN� S: 0. ALL I 'UM OF,',�' -1 - AND R A MIq% UUNR 5P �AFIJORPTIO M -AS SP P A L AN POFLAR 6 ATIERIA�� L(;1"ILP !IN 3 0' FU P �AND, q"�E C '40fAVLITIES ARr.-�I p I�E�PU REM 1) Ex1`15 INU tA Hit oil I -P T AV W �ANY P NTE NC`Ci TH E INSTALLER AS Hot*'S f 0- R A�MINIIYUM'( 2,q F L 4 1 r 2 VORKING C F L.' PEC*ION IN"OMKIR touOft, 4 0AY$)LV 'T ULA'IONS 'AN),'REVEGEA D, A Ll bIST14 RPE, �,R As E TE A 4, VARIANCE� �ND,E A' -,OP (39ASTAL: 13ANK A.".SEPTIC,�SYS Y It VAFIANqE,:,QF f 2.0 A APE30 Ps A C OX -OF ALTR,,,.,iI 6 25 VEIR I G puf L? OL 5,7 2 '2. NYL IkLir IN Ep TI 24.4 2 e2. T ' 3 76 io 0 '00-'8AW T 2 .2 ?,V 5W �62 IDENNIS 60- EXISTING SPOT ELEVA11ON OOxO 6 500 85� -EGENP.- 31 i9 L 21.0 tEXISTING CONTOUR L FINAL SPOT,ELEVATION 2� FINAL CONTOUR 100 $01L TEST LOCATION 22.2 Q0 01� 233 UTILITY POLE -<> OP TOWN WATER —W A 1VK 'CATCH ASIN [fH ELE T,: 1, 0 F; GAS 014t AP -CLEAN OU TI 0 N TL �C.O. 25.2 . OL CESSPOOL C.P S.D WO 0?2013 �641 ING L L A& TEST aw= SOIL P#1 3930 VINIMUM PROM CELLAR OR OF FOUNDATI ON 20 ft CRAWL SPACE DATE OF SOIL TEST &P-R-L21 SOIL TEST DONE BY �ff_U5_QUL!qLNlWltLG 10'FT..' INIMUM "'ll 0 FT. MINIMUM FROM SLAB CLEAN SAND WITNESSED BY _%._aLA_NJ_QN 'CONCqTE INSPECTION_POPT S COVER s 23.2 LOAM AND EED OBSERVATION HOLE 1 ELEV.-_ 4 SCHEDULE 46 PVC, PIPE , 0 TO 1/2" PERCOLATION RATE MW NCH AT MIN. PITCH 1/8 �,PER FT. 2- LAYER OF ' INC ES 1/8 DEPTH HORIZ TEXTURE WASHED STONE NHO �A tk :COVER COLOR MOTT. OTHER OR�FILTER FABRIC 25.5 MAX 'NO VENT -15' Ap r kbN,PIPE: 0 '23.25,MIN., LOAMY SAND 10YR4/1 ROOTS REQUIRED jOR 100AL) MINI T 24.42 -28" , 8 LOAMY SAND 10YR6/6 ROOTS 15 'ME �ITCH 1/4" PER F"T'L L FRt, 2 SAND .5Y7/4, 28-132"' C - MEDIUM' 12.2 4 22.60 so FLOW LINE NO WATER ENCOUNTERED AT 132". ELtV. - C3 0 1:3 0 13 ri ED 0 o ELEV. 23 OBSERVATION' HOLE- 2 ,' ELEW c'm b TMI V. 40 ML VEL in,10 0 0 0 0 C3 E3 C2 rl'� VINYL 0 0 DEPTH HORIZ TEXTURE COLOR LEV MOTT. OTHER fiAb m r*l ['I C3 C3 0 0 C3 C3 C] C3 0 41 UNER M P, ELEV. ELEV. BAFFLE 0-14" Ap LOAMYSAND 10 NO, R OTS YR4/1 0 B LOAMY SAND 'LEV. C3 C3 0 rl 0 0 C3 0 010 ED -28 7 i�YR676 ROOTS: 14� LIQUID : -OUTLET ELEV. - 'BO -Z .28-126* C MEDIUM 1.5Y7/4 Ll��20), L2tm- .15 ptp TEE' X SAND J170, BE PLACED. ,ON FIRM BASE)� 500 GALLON GALLEYS WITH 17.00 ELEV. .4, FEET 14 IR�p TO 8 k TESTED NO WATER ENCOUNTERED AT� ELEV. 13.4 EET 0 IF'MORE !THAN ONE OUTLET 120" 19 INCHES STONE IN AN '24 INCHES EET 1 f 0 ALLOW F -FIRM BASE) 1�' 2W X 2# TRENCH FOMATION WELL NA EET7 29 INCHES (TO BE PLACED ON, -3 4 INCHES, FEET, SEPTIC TANK �3/4* TO 1 1/2' CLEAN M. 4DEX N'U SOII! ' ABSORPTION MBER 'OF BEDROOM$ DOUBLE WASHED STONE ADJUS� GARBAGE:DISPOSAL UNIT 'FREE OF FINES SILT- TOTAL ESTIMATED FLOW ELEV.r.! REQUIRED SEPTIC TANK CAPACITY 'DISPOSAL' SYSTEM'.�PROFILE 3 IDR.) GAL./DAY LEGE SNVMM' (SAS)(H 20) ND .USGS 110 GAL/W/DAY,X ROBABLE WATER TABLE OBSERVED IWATE 6� o6'-o SEWAE" EXISING,tp'oT'ELEVA RJABLE ELEV., ACTUAL SIZE OF SEPTIC TANK L !1XISTING CONTOUR NOT SCALE, BOTTOMI,OF, TEST HOLE ELEV. SOIL,CLASSIFICA115N �,_FINAL,'sP& ELEVATION 'FINAL, DESIGN PERCOLATION PATE 'EFFLUENT LOADING RATE GAL./DAY/S.F. TEST ullu A7 TY POLE LEACHING AREA Zffl so. FT, E ,*AT R W (13X25)+(38X2X2) - X RATE) 24 GAL./DAY A `�CA CFt:BASIN T LEACHING CAPACIITY (ARE GASLINE- .477.00 X 0.74 -CLEANOUT CONSERVATION -NOTES, ,. RESERVE LEACHING 'CAPACITY AQW, M'./DAY 'AND DECK'ARE TO,BE COVER WITH 8-10" OF AND CESSPOOL� -C.Pl.01 l. EXISTING ,POOL- 'BE REVEGETATED NTH 2.GALLON PLANTS.,6 FOOT ON ,CENTER, SPECIES NOTES: TO BE AGRLED-upot4 WITH�CONSERVATION. STAFF. 1. ALL WORKM`ANSHIP �AND MATERIALS SHALL CONFORM TO D.E.P. 2-THE EXISTING POOL AND D15CK COVER 926 S.F.:i AND THE PROP05ED TITLE:5 AND THE TOWN'S RULES AND REGULATIONS FOR' TIGATION)� . WOODEN DECK.COVERS r 500 S.F, (A 45.6% Ml THE SUBSURFACE DISPOSAL OF SEWAGE. 3� THE INVASIVE VINES CLIMBING-THE TREES ARE. TO BE REMOVED.L 2. ALL COVERS TO SANITARY UNITS SHAIJI BE BROUGHT TO 4-,'VISTA PRUNJN0,IS PROPOSEDAN COMPLIANCE WITH THE COMMISSION'S WITHIN 6'OF FINISHED ,GRADE. 20% RULE. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF DRYWELLS ,ARE TO BE,INSPECTED AND REPLACED IF NECESSARY, H-2o LOADING. WITHSTANDING 6.1HE LOWER DECK, PATIO AND FLAGSTONE WALK ARE TO'BE REPAIRED 4 ANY MAS ARY UNITS USED TO BRING COVERS TO GRADE SHALL 7. STUMP ADJACENT'TO'PORCH IS TO BE REMOVED. wrzm BE MORTARED IN�,PLACE. ON .0 10 DEEDED OR *ZONING REG NT IS TO 8. FOUNDATION OF THE PORCH IS TO BE REPAIRED OR' REPLACED. 5'. NO DETERMINATION HAS SEE ULATIO SUCH DETERMINATION FROM 'APPROPRIATE.AUTHORITY, OBTAIN U71LITIES SHOWN 'ARE APPROXIMATE ONLY, EXCAVATION CONTRACTOR kv 4) IS TO'CALL '"DIG-SAFE" AT 1 888-344-7233 AT LEAST 72 HOURS TE NC PRIOR'TO COMMENCING WORK ON- SITE. 770M 0) BAW --S AND ELEVAT!ONS AS YELL AS CA 7. CONTRACTOR,IS TO VERIFY GRAD' L9 SITE CONDITIONS PRIOR TO COMMLNCING WORK ON SITE. ANY VARIAION BROUGHT TO THE ATTENTION OF THE DESIGN ENGINEER IS TO BE 4.0 IMMEDIATELY,- ' B, B.' PARCEL IS IN .FLOOO ZONES ,All(mil, & C 'flVITAP0, 9.,LOT.IS SHOWN ON ASSESSORS,MAP -10- AS PARCEL' 118 tR 10. ALL UNSUITABLE MATERIAL SHALL BE REMOVED FROM LIND -AND AKS, A MAPLE ,AND POPLAR, FOR A MINIMUM OF 5' AROUND SOIL,ABSORPTION SYSTEM AND,,BE ', MATERIAL AS SPECIFIEDAN 310 CMR.15.255:(3)., REPLACED, WITH 11. EXIS71NG 'LEACHING FACILITIES AREJO SE *-PUMPED' AND REMOVED- . ............ ALONG WITH ANY POLLUTED SOILS ENCOUNTERED'. 12., THE INSTALL�R 18 TO.GIVE THE ENGINEER',A:MINIMUM Of 48 HOURS 110E FOR THE FINAL INSPECTION (NUMBER BELOW)., (2 WORKING DAYS) NO 13. ALL DISTURBED AREAS ARE TO BE, STABILIZED AND REVEGETATED. 14. VARIANCES TO TITLE 5 AND BARNSTABLE,REGOLAnoNs: eo� A. SEPTIC SYSTEM LESS THAN 100' FROM Top OF COASTAL'BANK (VARIANCE OF.62.1 :NO RESERVE- AREA. 25.1 2^f 152 L L ALPM D:c� '24.3 -APPROW . ,. BOARD. -OF , HE 15,5 *'25'6 2 OOL IT 256 IT DATE. AGENT 2 L NYL NT lu 0 DESIGN n^p At p SED' ,,SEPTIC, 21 j A 2 OR _�x �29 Y. IL 0 LOC. Tumu- #W,i -COTTMO 3 -,44j, iz wo 2 'BAY RO 76 NSTABIE H MASS 'BAR rop iodus 19.8 4 K,' 3 tswmsm? mGDv=wG 203. SETUCKET ROAD P. 0., BOX 713 508 , 29.2 �A R' .385-�-'6900 02660 SOUTH , DENNIS, ASS. ;21 0. oo� c� 25 201.3 PATE, -APRIL,, SALE20, 'c 29 20 -22.2 1233 ' 00 8 NO, E7E V, :�BANK V"JUNE 25, 201 REV. JULY 1 'LOCATIO 25,2 Y 29s 20 N MAR 201'5 j'-SHEET',' PLANW DETAIL .", L 'SER :ENGINEERING :DWG 0 2013 SWEET