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4, TOWN OF BARNSTABLE
LOCATION L'o L-e4, 5 edrta / oytEWAGE## 0 f
VILLAGE CO f(4 f- ASSESSOR'S MAP&PARCEL 5
INSTALLER'S NAME&PHONE NO. El J o r707S
SEPTIC TANK CAPACITY / :S-O O
LEACHING FACILITY-(type) 1\ '500 C WAk13v,,S (size) /3 X i"-S X 2'FIC
NO.OF BEDROOMS..? I �� bra��L r 7✓
OWNER P OVAL '5-AMIJAP 60WA15
PERMIT DATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility(If any wells exist on
site or within 200 feet of leaching facility) Feet--
Edge of Wetland and Leaching Facility(If any wetlands exist within
300 feet of leaching facility) Feet
FURNISHED BY
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No. �v rl 1" , THE COMMONWEALTH OF MA! -IUSETTS FEE l�
BOARD OF HEALTH-/T)VN OF ARN STA1ULL_
APPLICATION FOR DISPOSAL,'Q-,vQ,,TEM CONSTRUCTION PERMIT
Application fora Permit to Construct ( ) Repair ( ) Upgrade ( ) Abandon ( ❑Complete System ❑Individual Components
Q �xn "DIE l b b l_ S PRV T-1� CA. jP.AL
LQ ,rul R �• 1 - 711 L- 11r`- l T IM
��L.L EPRL PE
C{-A JYJ'�1ti.L 1�A 1 sty
Telephone U Telephone N
Type of Building: DWELU N S Lot Size '37 17 Sq.feet
Dwelling—No.of Bedrooms _ Garbage Grinder ( /b
Other—Type of Building No.of persons Showers ( ), Cafeteria ( )
Other fixtures _
Design Flow min.required) d Calculated design flow 3 d Desi n flow provide/4 � � d
g ( q ) p g gp p gp
Plan: Date 2 T Number of sheets 1 Revision Date A > +
Title SEWRI&I S\Js—) IJA tl_ q
Description of Soil(s) d' L i�'�� L,S, a th ► j t IA., C,
Soil Evaluator Form No. Name of Soil Evaluator QAV'•10 �5aMate of Evaluation //'
DESCRIPTION OF REPAIRS OR ALTERATIONS RUIA W) _
w �iE i1
S N0
The understgnsd'Gorses to install the.:aboye described indwidual Sewage Disposal System in accordance with the provisions of
TITLES and further agroe ` ro place the system in operation until a Cert' We of Compliance has been issued by the:board of Health.
Signed &� Date
Inspections j 1 S d
FORM t - APPLICATION FOR DSCP DEP APPROVED FORM 5/96
.. =mow a
No. w T_K9*COMMONWEALTH OF MASSACHUSETTS FEE
BOAR(D� lOF HEALTH _
APPLICATION FOR DISPOSALS STEM NSTRUCTION PERMIT
Applicti'tinn for a Permit 1��C"unsl�u�t ( -);Rep it (. ),UIiEr.iJc ( ) AbanJon ( ❑C'ompl,tC System Individual Components
L ��rrc�l fk �.I Yb�i lresx;7 T
F L ELL I
LJ-\MP '`fLV1 PE
�„ 1 A ' FZtxinr. � G� QL�IAJ
drm
Telrphunc P i Telephone N
Type of Building: MAEL --� N r`' 37 "T �C
YP g ,Lot Size ) Sq.feet
Dwelling—No.of Bedrooms Garbage Grinder P
Other—1j+pe of Building � J No.of persons Showe" r�. (` ), Cafeteria ( )
Other fixtures q
Des1 n'FIow g ( r q red gpd Calculated designflow, gpd Des„'�n flow rovi 34q gpd
Plan. Date _ . u f ee Revision Date"!V 3 i f �!
� ��-Title -
�` p• l� ! . 5.
` Description of Soils L."5
) �- f, �q .,1�5----�A
Soil Evaluator Forrri No. Name of Soil--Eval for JDAYIb XIAS0TDate IOLE
' valuation //- 2—-� rf
_ _r rn _
DESCR I O RE AIRS OR ALTERATIONS RE E- CLIO SAS
r�
The undersigned agrees to instal!the above described indmdual Sawa a Dis sal S stem in accordance with the
. 3 Y, provisions of
TITLE Sand further, g' Po
agrees to place the system in operation unfit a kale of Compliance has been issued by the Board of HeaNh,
'Signed
Date �
^ - . 6 w
" y Inspections ; 5_ -
15
FORM 1 - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 r "
No. THE COMMONWEALTH OF MASSACHUSETTS FEE
L
• � 9P1BOARD OF HEALTH }
CERTIFICATE OF CO PLIANCE
Description of Work: [) Individual Component(s) Complete System
The undersigned hereby certify that the Sewage Disposal System;Constructed( ),Repaired( ),Upgraded Abandoned( )
by: T`/G i v
at `-4O L C W(S P' ND
has been installed in accordance wi the rovisions of 310 C� R-1-1�5.00 (Title 5) and the approved design plans/as-built
plans relating to application No. o`0 -1�0 dated �' t 7 - Approved Design Flow -.T 4� (gpd)
Installer L L L l S B R�S. ' i
Designer: �—� L LAN T t ICY P E Inspector Date-4/0-
The issuance of this certificate shall not be construed as a guarantee that.the system will function as designed.
FORM 3- CERTIFICATE OF COMPLIANCE _ DEP APPROVED FORM 5/96 3
No. u?'vim( LIQ
THE COMMONWEALTH OF' MASSACHUSETTS FEE
s' —.
f a 131�1R/�1 -.11ABU BOARD OF HEALTH '
DISPOSAL SYSTEM CONSTRUCTION PERMIT
-� Permission is hereby granted to Construct ( :)_ Repa'r,. ( ) Upgrade ( ) Abandon an individual sewage
disposal system`at ' �' ( ) g
as described
in the application for Disposal System Construction Permit No. a �d / - j
.. --� .dated
Provided: Construction shall be completed within three years of the date of this pe_ IAconditions must be met.
I Date Board of Health_
r r` ..
FORM 2- DSCP . DEP APPROVED FORM 5/96
pF; FORM 1258 (REV!s/98) H&W Hoses WARREN PUBLISHERS'-BOSTON
It
May 16 20,00:49 ELLIS BROTHERS CONST. 508-362-6266 p.1
Town of Barnstable
Regulatory Services
• Thomas F. Geiler,Director r,
' MAM ' �
Public Health Division
Thomas McKean,Director ,
200 Main Street,Hyannis,MA 02601 u 4
t�
01{c� _508-862-4644
Fax: 508-790-6304
Installer&Designer Certification Form
Date: 6® (�
Designer: ''L re iqSS Q C l,q installer. 2 G tS
Address:
Address: °�. !��!" f✓�./�
was issued a permit to install a
(date) (installer)
ed on a design drawn b
y
signer)
- = jai the septic system referenced above was installed sub
Bich may include minor shay according to
=---=-�'n andfor septic tank.
appro� changes such as lateral relocation of the
he septic system referenced above
bo was installed with major changes (i.e.
_ - ED iateral relocation of the SAS or any vertical relocation of any component
===-_ but in accordance with State&Local Regulations. Plan revision
--'_--_ --by designer to follow. or
N OF,yAs
HARRY
EARL
` A Here)
P LIC HEAL . CERTIFI
of '_''�' �i �L NUT $ CATESUED UNTIQ,
j- FORM AND AS-
? 1TECl It�D B�-THE B_aRtiSTABLE PUBLIC HEALTH DIVISION.
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40 Louis Pond Road,...
FOOTPRINT
BACK
65'y^ /
SV N �ClU1M
16'
13'7'
IV
W
-
2g 2"
S '
' L
Number of Stories: 1
Footprint Perimeter: 244'
Footprint Area: 2614 ft2 Ail-
22'fi' — IS'10"
26'3'
FRONT
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02 NO 2018 Page 5
USPS TRACKING# sa.Mail
-
9590 9403 0922 5223 8276 87 .3 ,
United States •Sender:Please print your name,address,and ZIP+4®In this box*
Postal Service
E
Town of Barnstable
I O Health Division
200 Main Street
Nvann s—MA 02601 iJ
itl31i11illiillli�llii�i=i11illi1ili Ili Jill I111111iitilifflilIli s`
SENDER COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
■ Complete items 1,2,and 3. A. Sig
■ Print your name and address on the reverse X0 Agent
so that we can return the card to you. 0 Addressee
■ Attach this card to the back of the mailpiece, E. Received by(Printed Name) C. Date of Delivery ,
or on the front if space permits: 17—&f6
1. Article Addressed to: D. Is delivery address different from item 1? ❑Yes
If YES,enter delivery address below: ❑No
f I
lt,cn Gately
r PO BOX 2O8
:,-..over,MA 020 0
_ I 3. Service Type ❑Priority Mail Expresso
ii I�IIIII I'll III I I I l l I'I I�III'I I II II II'll I'll ❑Adult Signature ❑Registered Mail
❑Adult Signature Restricted Delivery ❑ R Registered Mail Restricted.
❑Certified Mail® Delivery
9590 9403 0922 5223 8276 87 ❑Certified Mail Restricted Delivery; ❑Return Receipt for
❑Collect on Delivery Merchandise
❑Collect on Delivery Restricted Delivery ❑Signature Confirmation*""
i i i ❑Insured Mail ❑Signature Confirmation
014 1200 1000111 0 3 5 8 414 5t t i; t I ❑Insured Mail Restricted Delivery Restricted Delivery.
(over$500)
PS Form 3811.JUIy2015 PSN 753.0-02-000-9053 Domestic Return Receipt A
_4
Town of Barnstable
Y Y
'" MAS& Regulatory Services
Public Health Division
Thomas McKean, Director
200 Main Street, Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
July 15, 2016
Helen Gately r
Po Box 208
Dover, MA 02030
NOTICE TO ABATE VIOLATIONS OF TOWN OF BARNSTABLE BOARD OF
HEALTH REGULATIONS, NUISANCE CONTROL REGULATION NO. 1
The property owned by you located at 40 Lewis Pond Road was inspected on July 8, 2016
by Timothy B. O'Connell, R.S., Health Inspector, because of a complaint.
The following violations of the Town of Barnstable General Ordinances Chapter 54 were
observed:
04-4. Stagnant Water. Observed pool with stagnant water within it and a ripped pool
cover.
V
You are directed to correct the violations within fifteen (8) days-of receipt of this
order letter by pumping stagnant water from said pool and replacing cover.
You may request a hearing before the Board of Health if written petition requesting same
is received within ten(10) days after the date the order is served.
Please•be advised that failure to comply with an order could result in a fine of$100.00. Each
day's.failure to comply with an order shall constitute a.separate violation.
PER ORD;Mc
OF T7R.S.
OARD OF HEALTH
J
Kean,
Director of Public Health
Town of Barnstable
CERTIFIED MAIL: 7014 1200 0001 0358 4145
e
Q:Health/orderletters/refuse/6-11-16 40 lewis pond rd.doc
Citizen Web Request Page 1 of 2
TIM; k�
DAR'S7AttLE.�. 7i 1 ,
MASS. '4� b
Logged In As: Tuesday,July 5 2016
TOWN\oconnelt Citizen Request Management
Route to Users Search ReClUests Create Requests
Request Information
Request ID: 56641 Created: 6/30/2016 10:24:14 AM
Status: Assigned To Staff Assigned To: O'Connell,Timothy
lux t-� Health Office
Anonymous: No Request Category: Chapter 54-4 : Stagnant Water edit
Routine work: No 'Estimate: No edit
Date scheduled: edit
Estimated 7/15/2016 Change Estimated Jun July 2016 AAcu
Completion Completion Date:
(� /Q Date: Sun Mon Tue Wed Thu Fri Sat
r--9
26 27 28 29 30 1 2
3 4 5 6 7. -8 9
10 11 12 13 14 15 16
�( 17 18 19: 20 21 22 23
24 25 26 27 28 29 30
n 31 1 2 3 4 5 6
0� Created By: Soto, Kathryn Priority: Medium edit
Health Office
Citation Numbers: edit
Requestor Information
Requestor
Request Parcel
Neighbor states property is Number Map: 020 Block: 015 _ T Lot: 000
abandoned and pool is left
uncovered with stagnant Parcel Lookup r
water causing many
mosquitos.A tree fell in pool
and caused cover to come off.
Email:
Edit Requestor Information
Track Request Progress /
Request Work History: -Internal Note History:
System entry on 6/30/2016 10:24:15 AM:
Assigned to O'Connell,Timothy
http://issgl2/intemalwrs/WRequest.aspx?ID=56641 7/5/2016
Health Master Detail Page 1 of 1
Logged In As: TOWN\oconnelt Health Master Detail Friday,July 8 2016
Application.Center Parcel Lookup Selection Items
Parcel Septic Perc Well Fuel Tank
Parcel: 020-015 Location: 40 LEWIS POND ROAD, Cotuit Owner: GATELY, HELEN C TR
Business name: Business phone:
Rental property: ❑ Deed restricted: ❑ Number of bedrooms
Contaminant released: ❑ Fuel storage tank permit: ❑
Save Parcel Changes Return to Lookup
Parcel Info Parcel ID: 020-015 Developer lot:LOT 1
Location:40 LEWIS POND ROAD Primary frontage:174
Secondary road: Secondary frontage: -
village:Cotuit Fire district:COTUIT
Town sewer exists at this address: No Road index:0888
Asbuilt Septic Scan: 0200151 Interactive map: s-r
Town zone of contribution:AP (Aquifer Protection Overlay District) State zone of contribution:OUT
Owner Info owner: GATELY, HELEN C TR Co-owner:'HELEN C GATELY TRUST 2006
Streeti:PO BOX 208 Street2:
City:DOVER State:MA zip: 02030-0208 Country:
Deed date:8/2/2006 Deed reference:21239/341
Land Info Acres: 0.87 use: Single Fam MDL-01 zoning:RF Neighborhood: 0108
Topography: Above Street Road: Paved
Utilities:Public Water,Gas,Septic Location+
Construction Info 16WHIncl NdYear BL l Gross ArealLiving Are Bedrooms Bathrooms
1 11970 398 P012 13Bedroorri 3FJ-0 Half'
Buildings value:$139,600.00 Extra features: $42,40.0.00 Land value: $225,200.00
r
• t .
http://issgl2/intranet/healthMaster/HealthMasterDetail.aspx?ID=020015 7/8/2016
u , 14. 2C16 1 :09PM Vo° 0146 P. 2
Sunday, July 10, 2016
w -
Thomas Seguin
29 Old Oyster Road c
Cotuit, MA'02635 r
tjseguin@comcast.net ,y
Helen Gately Trust
PO Box 208
Dover, MA 02030-0208
N
Re:40 Lewis Pond Road, Cotuit, MA o
am writing with a dual purpose. The first and primary is a health issue.
am a direct abutter to the above property. The house, grounds and especially the pool have
fallen into serious disrepair. This affects both the quality of the neighborhood and ospeelally the
health of those surrounding the pool.
The pool cover was breeched by one of two wind-fallen trees that have punctured it over the
past three years. The resulting stagnant water Is breeding mosquitos that are not only
annoying,but are a health hazard. The issues with the pool need to be addressed very soon.
01 do not hear from you on the pool by August 1,-20161 will be unfortunately forced to seek .
legal recourse to get the pool drained and in-filled.
The second purpose is a possible offer of sale of the property. It appears possible that the
property is ready for sale. l am a cash buyer and would take it as-is if we should come to an
agreement. It there Is any Interest In this offer, please respond by mail or email and we may
pursue this,
Either way,the pool issue must be addressed. Thank you.
Thomas J. Seguin
ce:Barnstable Board of Health
U.��ppP��9TAGE '
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14, 2C16 1 :09PM No, 0146 P. 1
RMNSTA)BL E COYINT`St•
U DFPARTMO�NT OF HEALTH tic EN'VMONMNT
o .
BARNSTABLE COUNTY COMPLEX-OLD JAIL BUMDING
3195 MAIN STREET-P.O.Box 427
�sACHYJ EARNSTABLE,MA 02630
FAx TRANSMITTAL '
M NISTRATION EMERQENC'i°'PREPARMNESS DIVISION
PHom:508-375-6614 6616 PHONE:5,08-375-6618
FAX:508-362-2 FAx:508-375-6880
SEPTIC MANACYF-MENx LOAN PROOF AM TOBACCO CONTROL DXVISIDN
PHONE:508-375-6610 PH(ON1E: 508-375-6621
FAx:508-375-6854 FAX:508-375-688.0
ALTERNATIVE SEPTIC SYSTEM TEST CENTER WATER QUALITY TESTING LABORATORY
PHONE:508-563-6757 PHONE:508-375-6605
FAx:508-563-6757 FAX:508-362-7103
MATE: TUTAL PAGES'
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MUSSAGE:
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TOWN OF BARNSTABLE
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LOCATION qO SEWAGE #
VILLAGE CASSESSOR'S MAP & LOT QJ®-OI
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SEPTIC TANK CAPACITY JOW
LEACHING.FACILITY:(type)Lr)n , L:g pAR jsize) 6�<(�
NO. OF BEDROOMS PRIVATE WELL O PUBLIC WATER v.,
BUILDER OR WNER
ED:
No
64,
. 3 'l
71
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14 LE Tom. ?r
NOTES:
Disposal System to be constructed in strict accordance with
P � � �� # � L N STE, Commonwealth of Mass. Environmental Code —Title V. ,
C - This plan is for the sole purpose of construction of a septic system.
• i j Contractor to calf Dig-Safe 72 hours prior to beginning of excavation.
�► ,c,` --------y Pump existing 1,500 Septic tank and pit, fill with sand and abandoned. !
ZxlsTb,CCSSDQ1C�L Use anew (H-10) 1,500 gal. septic tank. Install Tee's and gas baffle. q
RI�YE • '�—. �-''� `� Contractor to field check invert of outlet at foundation.
r- �,�,� �c r— ►o Bench mark is E
top of foundation elev. 100.0 (assumed). .
APN is 020/ 015 for the Town of Barnstable.
locus is served by Town water.
l The pan view is based on site plan by Nelson Bearse R. Surveyor and
5 WAVER L IN L
. —..w Y
recorded as plan 160-3 at Barnstable Reg. Of deeds.
Use 2 — 5'x8'x2' H-10 leach chambers with 4' of W to 1 %" double
washed stone with filter fabric on top.
a Q V > 1 Grade, loam and seed all disturbed areas.
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