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0536 MAIN STREET (COTUIT) - Health
536 Main Street I 037-002 Cotuit r I i 9 t 11PC 10230 � No.H163 MOTI004 Eta i � LM II 3 1 � �~ �i ` � i `� V � I t � 3 ��� � �; � � `� 3 � � �_ U `� C� o � _ . __� f > Town of Barnstable Barnstable �VE CftV Regulatory Services Department `a `"' MAS& Public Health Division ASS. 039. `0� 2007 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 SECOND NOTICE Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO r- CERTIFIED MAIL #7012 1010 0000 2851 088.E October 15, 2013 Ms. Ruth G. Bell, Tr. Bell Family Trust 58 Canyon Road Lyle, WA 98635 RE: 536 Main Street, Cotuit ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 536 Main Street, Cotuit, MA was last inspected on 4/01/2013, by Shawn Mcelroy, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the following: • System is in hydraulic failure. 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 within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTHa 4�T mas McKean, R.S. CHO --� Agent of the Board of Health 'Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\536 Main St Cot Apr 2013.doc fi Parcel Detail http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=2367 ANS r,Att7 r. 4 .. MASS f { ��'�tl4L lis3�t. ,.'.yi°"� � '`� .17�,;i•. �e� t�,, I A"^^+. ��a' �� � tilt,ielit Logged In As: Pa rCel ®etch ,Thursday, November 142013 Parcel Lookup Parcel Info Parcel Developer _.,__.—L— —____�_—_._ ID 037-002 Lot �PARCEL.B&UNNUM Location 536 MAIN STREET(COTUIT) -� Pri Frontage 185 Sec F _ I Sec —--— Road Frontage Village JCOTUIT Fire COTUIT District Town sewer exists at this Road I address`IVo , Index 0951 Asbuilt Septic Scan: 037002_1 Interactive lap 037002 2 :'i;t Owner Info Owner % BELL, RUTH G TR Owner Co- WHITMAN, JAMES N&EL EIN1,ANNA Streetl 11817 KENYON STREET NW Street2 City.WASHINGTON State FDC I Zip 20010-261 Country Land Info Acres Use Single Fam MDL-01 Zoning RF Nghbd 10109 Topography Level Road[Paved Utilities Public Water,Gas,Septic Locationm Construction Info Building 1 of 1 Year� ! Roof Ext — Built E i958 i Struct Gable/Hip �� Wall EEnyl Siding Living 1360 Roof�Asph/F GIs/CmpJ AC None Area-- Cover-�-� Type Style Ranch Wall Drywall Rooms j2 _.___ _ Bedrooms In t �— Bath Model Residential Hardwood2 Full Floor Rooms Heat Total Grade Below Average Type[Hot Water Rooms 16 Rooms x ear 1 Story Heat as Found- Mixed Stories �-�_— _- Fuel�G IMixed ation — a Gross http://issgl2/intranet/propdata/Parce]Detail.aspx?ID=2367 11/14/2013 of IKE Town of Barnstable U.S.POSTAGE>>PIrNEv soaves r. P Public Health Division I / ® BARN ABLE. • 200 Main Street �ptFO Mxlp Hyannis,MA 02601 ti ZIP 02601 $ 006.1 1 U 0001383424 OCT. 16. 2013. 7012 1010 0000 2851 0886'� FIRST NO'nC Ms. Ruth G. Bell, Tr. Bell Family Trust �d 58 Canyon : ., Lyle, WA 98 RETURN TO SENDER UNABLE TO FORWARD s {0zls70140 graz .�I ! 9 0pl s €� } !- r a -!y1 s!- .z '�'•+..' !....-•as'.,�•••'Y�-C• +2)iia '�'CS !1l 11�791��1iill9��14 1�13111i lilt, j'n97111l L _ I I ,y,-.... ..._. -_ s^. _.n•.,,,r, ... ....-x ..,, aye,. �' :• • ""s�'^}m p Yo Complete items 1 2,and 3..AIso complete A. Signature I item 4 if Restricted Delivery is desired. X ❑Agent I o Print your name and address on the reverse ❑Addressee I so that we can return the card to you. B. Received by(Printed Name) C. Date of Delivery I o .Attach this card to the back of the mailpiece, 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 , I k I Ms ;Ruth G. Bell, Tr Bell"'.-Family Trust 58 Canyon Road 3. Service Type I ❑Certified Mail ❑ Express Mail I -Lyle, WA 98635 ❑ Registered ❑Return Receipt for Merchandise I I, ` I " — — ❑ Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee)— ❑Yes I _ 2. Article Number — 7012 1010 0000 2851 0886 ` I (Transfer from service labeq PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1 sao ' p �, .: ,; /• I � i _ ro CD r=1 F I I Ln NPostage $ lo D4�917 0 Certified Fee M Retum Receipt Fee 0 (Endorsement Required) �OoRestricted Delivery Fee Np (EndorsementRequired) Qrr-3Total Postage&Fees . fl SIN rur, __ t C Ms. Ruth G. Bell; Tr- - �`, Bell Family Trust i 58 Canyon Road ula \AIA 98635 Certified Mail Provides: n A mailing receipt I • "'* o A unique identifier for your mailpiece a A record of delivery kept by the Postal Service for two years Important Reminders: a Certified Mail may ONLY be combined with First-Class Maile or Priority Mail®. a Certified Mail is not available for any class of international mail. o NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. a For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPSe postmark on your Certified Mail receipt is required. a 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 a 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 r t Barnstable .own of Barnstable VE Teti Regulatory Services Department RN MAM`E ' leath Division �E039. Public Health 2007 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 SECOND NOTICE Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL #7012 1010 0000 2851 0886 October 15, 2013 Ms. Ruth G. Bell, Tr. Bell Family Trust 58 Canyon;Road j Lyle, WA 98635 1 RE: 536 Main Street, Cotuit • ORDER TO COMPLY WITH STATE ENVIRONMENTAL,CODE, TITLE 5 The septic system located at 536 Main Street, Cotuit, MA was last inspected on 4/01/2013, by Shawn Mcelroy, a certified septic inspector for the State of -Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of the 1995 TITLE.5 (310 CMR 15.00) due to the following: System is in hydraulic failure. 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 within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH • 4�T mas McKean, R.S. CHO M Agent of the Board of Health Q:\SEPTIC\Letters.Septic Inspection Failures or Future Eval\536 Main St Cot Apr 2013.doc Town of Barnstable Barnstable P�°F THE Tp�y Regulatory Services Department e"aC fty RARN.FrA m Public .Health Division �A i639• rf0MAtA, 200 Main Street, Hyannis MA 02601 200? Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL #7012 1010 0000 2850 7695 April 22, 2013 Ms. Ruth G. Bell, Tr. Bell Family Trust 58 Canyon Road Lyle, WA 98635 RE: 536 Main Street, Cotuit ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 536 Main Street, Cotuit, MA was last inspected on 4/01/2013, by Shawn Mcelroy, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the following: • System is in hydraulic failure. C 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 within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH s McKean, R.S. CHO Agent of the Board of Health Q:\SEPTICIetters Septic Inspection Failures or Future Eval\536 Main St Cot Apr 2013.doc J Town of BA nstable. . P# Department of Regtatory Services ., ' srestA = P Date Public Health Division .�. rr.,se. $ Y, . , V 200 Mam Street,Hyannis MA 02601 t s Date Scheduledr w 4 ! Time + Fee Pd. rlVjl I � r � �. Soil'-`& tabili AAssessmefit or Se :Dig" os `` Performed By ✓a %� Witnessed By: LOCATION&,GENERAL INFORIYIATION Location'Address. SOwner's Name tt C� Q-(® p y - Address v Assessor's Map/Prcel: ,,++fi�t) I ; Engineer's Name NEW CONSIRU�'I'ION REPAIR I Telephone# u V o b. f' - -3 l l i ►�lk Y�1 I xC�J L/ fi , n Surface Stones ° Land Use 1`-1�,-��� - . 'Distances from: 'Open Water Body ft Possible Wec Area Deft°` Drinking Water Well L_- b ft ' r Drainage Way ft Propsrty Line 1 Other ' �`• ,SKETCH:($treet name,dimensions of lot,exact locations of test holes&°perc tests,locate wetlands in proximity to holes) .': or he 4 CD n. „ r ' u r e p ,e N5 is • J ,"�•r�.+�¢ LZ' - _ ram' P 4. Cal Depth to Bedrock PaMt malal l;(gedlogrc rn g Water in Hole: ;� I Weeping from Plt FpCe �!/ D to Gdwaker. r 44, t •- w�" Estimated Seasonal iHigh Groundwater. DtTlll: TION FOR SEASONAL HIGH WATT �T,A�LE` _ Method Used ' td sell mottles. M ' Depth_Observed standing in obi.hole in. Depth i in... ©roundwitter Adjustment tt: Depth to weeping from side of obs:hole p ,flexor;, , ..- AdI Orvundwater Level,R e "Index Well# Reading Date: Index Well level ' y. PERCOIaA.TION T,'EST a ' ObservaWk tion, 1 I Tltne lit 9" Hole# ® t.` °' F € 1 r p '` ',Time atTime(9 6' f �....�. # - Depth of Perc b 4 Start Pre-soak Time.@' /t -_ k " , ' End Pre-soak ` . Rate Min finch 7, Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(YIN) e.Completed on Back-- Original:.Public Health Division • Observation Hole Data To B - ***If percolaibn testis to be co nd*acted within 100' of wetland,you must first notify the ervation t'�i ision at least one (1)wedk prior to beginning. Barnstable Cc� DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture• Soil Color Soil Other Surface(in.) (USDA) (Munsell),. Mottling (Structure,Stones,Boulders. Consistenc 4'a Gravel 0 -iy n t t y -3 '' 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) IS i 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 t . �1 ��, � C, I � Z •� 1 _ LIN DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency, ra I IDh— 141° b tp,l 1" — $Lt d t"G� 3B11 ID�, /V Dom; f -4 SQ Flood Insurance hate May: Above 500 year flood boundary No Yes 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? If not,what is the depth of naturally occurring p.er ious material? Certification I certify that on (date)I have passed the soil evaluator examination approved by the DepartmentPf Environmental Protection and that the above analysis was performed by me consistent with the requiratraw ;experti Meand experience described in 3.10 CMR 15.017. Signature Date ,i 3 F ' - n Q:\,SEPTICIPERCFORM.DOC 013- 1[ [ No: Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in cornputer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ftphtation for Misposal 7Abandon MConst rtion hermit Application for a Permit to Construct( .) Repair( ) Upgrade ( ) ❑Complete System ❑Individual Components X Location Address or Lot No f-f6 yIiI,4W ,ST O er's Name,Address,and Tel.No. Assessor's Map/Parcel 57 f Installer's ,gdress,and Tel.No.s'pb'-l/Q p-975 8 Designer's Name,Address,and Tel.No.slog'- Jof,C� %J�(7/9`'l^d5/ / dYli�y��" Sri/6�S �s9d11 /0), Type of Building: Dwelling No.of Bedrooms Lot Size G , y sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures !!ll /�- Design Flow(min.required) 1, V gpd Design flow provided —I L-1 ro gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 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. (GAT �Signed Date r Application Approved by Date C s (3 Application Disapproved by Date for the following reasons Permit No. 1 [ Date Issued --------------------------------------------------------------------------------------------------------------------------------------- No. Fee ' ``ti. THE COMMONWEALTH OF MASSACHUSETTS THE in computer: Yes PUBLIC HEALTH.DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS � .r application for Misposal 6p m Construction i3ermit Application for a Permit to Construct( ) Repair( ) Upgrade Abandon( ) ❑Complete System ❑Individual Components X Location Address or Lot No f f(i M,4//I Y7- Ow Is Name,Address,and Tel.No. Assessor's Map/Parcel .5 7- �v 'L I7O �taller's ame,A dress,and Tel.No.,fd,?-y`l O-97 3�' Designer's Name,Address,and Tel.No.,Sbp,-,?G e-Z 92 2 J ,f Gr✓ /./2/,�19 /4 SST Ss3�,o/CviC�i Type of Building: i Dwelling No.of Bedrooms Lot Size , � sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) Ll U gpd Design flow provided Ll Ll fo gpd Plan Date Number of sheets Revision Date ` Title ,a Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) S"e 'L t 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. / N A,Signed. Date a 2 Application Approved by Date Application Disapproved by Date , for the following reasons " Permit No. U Date Issued d ---- --------------- -------------------- --------------. -_-.---.---------_---,. - . . ---.------------------------------------------------ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance 4 THIS IS TO ERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( � Abandoned( )by 7s e 5 -)4-at J 5,1,i 114ell/ 51' C D%/// r has been constructed in accordance with the provisions of/Title 5 and the for Disposal System Construction Permit No.o?013-KI dated Installer S �! D-C I f4�/'YJ.S Designer _ f SCJl1S #bedrooms L. Approved design flow L- 1. pd The issuance of th'is 'pe it shajj not be construed as a guarantee that the system ct'q -as fd1esii ned.. Date Inspector '✓GT/` -� - ---------- - -------- -- -------- ------------ ---- ------------ = - ---- --------------------- No. go - Ll I:7— Fee` - - THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal 6pstetn Construction Vermit Permission hereby granted to Construct( ) Repair( ) Upgrade( Cam" Abandon( ) Syste ocated at S�6 1041 11y J_rr/�:15 7- and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with �.s 'Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permi. Date G ./ Approved by Town of Barnstable Regulatory Services Thomas F. Geiler, Director •k snaxsr UZ WAS& Public Health Division Thomas McKean, Director 200 Main Street,Hyannis,NI_=1, 02601 Office: 08-862-464 4 Fax: 03-'9076304 Installer & Designer Certification Form Date: 1 �� Sewage Permit# ,10/3 `l/7 Assessor's MaplParcel 37-0 2. a L / Des�Z.-J ' oty- DEr�� Installer: Vos-e, 40 Address: 0 Address: %/ On _/0 was issued a permit to install a (date) r / (installer)septic system at J�j�o S (�714 tT based on a design drawnt y A. . (address) f Val _ dated 7 fzhl I: ' designer) J I certify that the septic system referenced above was installed substantially-according to the design, which may include minor approved changes such as lateral reiocatlor, of the "�- distribution box and,'or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than I lateral relocation of the SAS or an- vertical relocation or any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. OF MAssc { �(Istal�lesignature) " No:, 1140 REGISiF � SAN I TA11�P� �b bGl3 Qsigner's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNST rBLEPUIBLIC HEALTH DIVISION, CERTIFICATE OF CONIPL1ANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q: Health/Septic/Designer Certification Form 3-2674doc r Town of Barnstable Barnstable Board of Health 1 r r r >MAsa g 200 Main Street, Hyannis MA 02601 t6yq. 2007 rfD IAA't A Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 JunichiSawayanagi Paul Canniff,D.M.D. June 28, 2013 Ms. Merriam Bell 58 Canyon Road Lyle, WA 98635 RE: 53&Main Street, Cotuit Dear Ms. Bell, At the June 18, 2013 public meeting of the Board of Health, the Board voted unanimously to grant you an extension"to replace or upgrade the hydraulically failed septic system owned by you located at 536 Main Street, Cotuit. This extension is granted for three months beyond the sale of the property date (ninety [90] days after the transfer of real estate date). This extension is granted because you indicated in your letter dated May 13, 2013 that the home is currently unoccupied. The Board is of the opinion that the septic system should not pose a threat to public health or to the environment if/while the home remains unoccupied. F Sin rely yours ne it , M. , Chairman Board f Health Q:\ExtensionMerriamBellMainStreetCotuit2Ol3.doc ' I �. 61 Merriann Bell j �•, '[• . 58 Canyon Rd. ,, ' W Lyle, WA 98635-9509 "MAY' r 201 Am . Zoo o Mq/1.7 Si n _ • .. ->�,::,, •y.a•;�•M,-'% ��llfl:il###€i�'�°, t � #:��##s' �f�Jl''.`����.`;?�ii'I�:�F�irl� lJ'�#1 QUALITY PARK 11117 100%PCC �, o2-013 - Adm T Y-e {v�� �r �vvc ��Of� ,,� , ems ✓Psrde�c� , .56 Mob, 5�,aS Ag_ �owre se 2I� /VL h1' P�flame Vajo �/Lir�i a � ilk. 421e,017 PIK . zz J114e, -49 ' re lacz- Ae f - T wovId l D �2��5� qv2 PrxlP0 519011 Off' Y7 u Ilt a b ik) 0� �pj ,�ry� 6gfew Ok7 e se w v7e��r r�se�f�� ��� ��e s /� Pie, Z vl�( �� i� f I o� 7' o�cs�lvsu� a ��� s 4�1 e �� cd Sl . `see/ r. a�rn h o vse f eq� g fie s �eqr. � - ,� ��f �s� � Cow( _` ✓r W, OI cap 0a� s� ! vlr�, o� ie vvov�ol �!o r s he? OT! p = be � IV � ado p l ,: f 1 ° Will AllS� Y ► ' 6e& 1"he, Sell ��(b �r�s� y07 ��6�5 r SHE Town of Barnstable Barnstable Of rp� Board of Health AFAmeficaCity :9 na SS. o! 200 Main Street, Hyannis MA 02601 O D 039• ATfD MAt A 2007 OFFICE: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul canniff,D.M.D. Junichi Sawayanagi ACKNOWLEDGEMENT OF RECEIPT: June 4, 2013 We.'have received your submission to the Board-of Yfeafth."' lie 536.Main Street, Cotuit asking for an , nsion.on IDeacffine forSeptic Repair. Thankyou Your,item will be heard at the Board of Health Meeting on the: Date of: Tuesday, June 18, 2013 You, or a representative for you, is expected to be present to answer questions the Board may have. y Meeting Location: Town Hall, 367 Main St, Hyannis n= Hearing Room, Second Floor Time: 4:00—7:00 P.M. ; Approximately three days prior to meeting, an agenda will be sent out to you— once'it is available. It will also be available on line at the town website: www.town.barnstable.ma.us Go to ..."Boards & Committees > Board of Health - or- Go to Official Agendas QAAGENDAS BOHUet Receipt of BOH Submission Jun 2013.doc Town of Barnstable Barnstable �Op SHE Tp� Regulatory Services Department BARN : public Health Division �e MASS. - -tj ib3q• �� ArfD Mai A. 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL #7012 1010 0000 2850 7695 April 22, 2013 Ms.. Ruth G. Bell, Tr. Bell Family Trust 58 Canyon Road Lyle, WA 98635 RE: 536 Main Street, Cotuit ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 536 Main Street, Cotuit, MA was last inspected on 4/01/2013, by Shawn Mcelroy, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the following: • System is in hydraulic failure. 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 within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH s McKean, R.S. CHO Agent of the Board of Health QASEPTIC\Letters Septic Inspection Failures or Future Eval\536 Main St Cot Apr 2013.doc Town of Barnstable Barnstable P�°pSHE Tp�� Regulatory Services. Department e' I to MASS.3LE, k public Health Division y Hass. � m 039. Alf°MAC a 200 Main Street, Hyannis MA 02601 ?oo� Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL #7012 1010 0000 2850 7695 April 22, 2013 Ms.. Ruth G. Bell, Tr. Bell, Family Trust 58 Canyon Road Lyle, WA 98635 RE: 536 Main Street, Cotuit ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The.septic system located at 536 Main Street, Cotuit, MA was last inspected on 4/01/2013, by Shawn Mcelroy, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the following: • System is in hydraulic failure. 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 within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH s McKean, R.S. CHO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\536 Main St Cot Apr 2013.doc i Parcel Detail http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=2367 I - o 3N to M m. 3 Logged In As: Parcel Detail • Thursday,April 18 2013 Parcel Lookup Parcel Info Parcel ID 037 0 2020 -I Developer PARCEL B&UNNUM Y Location 1536 MAIN STREET(COTUIT) . Pri Frontage 185f Sec Road . .FrontaSec ge Village iCOTUIT Fire District JCOTUIT Town sewer exists at this address No � ��' Road Index 0951 Asbuilt Septic Scan: Interactive ,' ' 0370021 Mapi Owner Info Owner BELL, RUTH G TR Co OwnerjBELL FAMILY TRUST Streets 158 CANYON ROAD ( Street2 City�LYLE State IW zip[98635 . _ Country f Land Info . Acres 11.58 Use Single Fam MDL-01 zoning IR�F Nghbd 0109 __ _,_ w . _ Topography Level Road Paved _m Utilities Public Water,Gas,Septic I ,.Location Construction Info Building 1 of i Year _ Roof Gab Ext Built Struct Wall Sidn g I_ Living 1 1308 J j Roof As h/F GIs/Cm AC(None Area Cover P P TypeInt Bed l —_ Style FRanch 1 wall DrywallFJ�) Rooms 2 Bedrooms _ ,! f� `-: Model Residential Int Bath Floor[Hardwood - Rooms I`Full J Grade Below Average Neat Hot Water- Total Rooms 6Rooms ,. Type Heat Found- stories stories 1 Story __-.__ Fuel IGas ation lroured Conc. Gross L1888 Area 1 Permit History http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=2367 4/18/2013 1�y�1�� i � c f Commonwealth of Massachusetts o, Y• { .. L Title 5 Official Inspection . Form Subsurface Sewage Disposal System Form.-Not for Voluntary Assessments - ,M 536 Main St Property Address a Merriann Bell ,• Owner Owner's Name information is M required for every Cotuit MA 02635 4-1-13 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. A. General Information 1. Inspector: Shawn Mcelroy.. Name of Inspector Upper Cape Septic Services Company Name P.O. Box 73 Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S13971 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this addW s and thahthe --j information reported below is true, accurate and complete as of the time of the a ection. -e ins ction was performed based on m training and experience in theproperfunction an intenance of ora�slte Y 9 P sewage disposal systems. I am a DEP approved system inspector pursuariffi ectionB- 340nof Title 5 (310 CMR 15.000).The system: k v. 3- ❑ Passes_ T ,. ❑ -Conditionally Passes, ,® Fai s- FTNeeds Further Evalu ion;by the Local Approving Authority c, Inspector's Signature Date " The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner,shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable,-and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under ' the same or different conditions of use. t5ins-11110 Titl"Official on Form:Subsurface Sewage Disposal System-Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 536 Main St Property Address Merriann Bell Owner Owner's Name information is required for every Cotuit MA 02635 4-1-13 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: 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. El Y ❑ N . ❑ ND (Explain below):, t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary'Assessments 536 Main St Property Address Merriann.Bell Owner Owner's Name : information is required for every Cotuit ,; { ?t ,•," ,;.r MA 02635 4-1-13 page. -City/Town •{ State Zip Code Date of Inspection f B. Certification (cony) R. A°t_ j �. B);System Conditionally,Passes (cont.): r .{ ❑ 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):,' Al ❑ broken pipes) are'replaced f" ❑ Y' ❑ N'' ❑ ,ND (Explain below): ' ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): r ❑ ` : 'distribution box is leveled or replaced ❑"Y ❑ N El" (Explain below): t t a ,.s � _. ! '#! �" �,: {r • •,Eft, ' ,•i ❑ 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. 41. 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 mannerrwhich will protect public health, safety and the environment: y ❑ 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 536 Main St Property Address Merriann Bell Owner Owner's Name information is required for every Cotuit MA 02635 4-1-13 page. City/Town 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 a septic tank a_nd SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic 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 ® Q 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 El ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 . t Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 536 Main St , - Property Address Merriann Bell Owner Owner's Name information is required for every Cotuit t ' r, MA 02635 4-1-13 page. City/Town ` State Zip Code Date of Inspection f B. Certification (cont.) -;.. . Yes tNo, ,, • s : t ., , „ ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or • obstructed pipe(s). Number of times pumped: ❑ ® ,Any portion of the SAS, cesspool or privy is below high ground water elevation. It ti. a 1. El ® 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 ,r and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,0000pd. ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The t system owner should contact the Board of Health to determine what will be a 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 11 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M Say' 536 Main St Property Address Merriann Bell Owner Owner's Name information is Cotuit MA 02635 4-1-13 required for 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 to 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? ❑ ® 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 NIA) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ 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 A been determined based on: ❑ ® Existing information. For example, a plan at the Board of Health. ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions:' Number of bedrooms(design): 2 Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203.(for example: 110 gpd x#of bedrooms): 220 t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17' Commonwealth of Massachusetts _ Title 5 Official Inspection Form m Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 536 Main St Property Address Merriann Bell !c, „s! ,r , Owner Owner's Name Q information is '" v required for every Cotuit g � g MA 02635 4-1-13 page. City/Town• _ State Zip Code Date of Inspection D. System Information F r: a Description: - Number of current residents: 0 Does residence have a garbage grinder?,- ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] - ❑ Yes ® No, Laundry system inspected? s:,'• 4 , .; ❑ Yes ® No Seasonal use? 7 El Yes ® No Water meter readings, if available (last 2 years usage (gpd)):. - Detail: Sump pump?. I;-; El Yes ® No ► a Last date of occupancy: ,, , r• , 3-2013 ` Date Commercial/Industrial Flow Conditions: Type of Establishment: r t Design flow(based on 310 CMR 15.203): canons per day(gpd) f 3 . Basis of,design,flow(seats/persons/sq.ft., etc.): ; Grease trap present? .•. .- - .- . • .';.:r,, ❑ 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•11/10,. c Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts a Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 536 Main St Property Address Merriann Bell Owner Owner's Name information is required for every Cotuit MA 02635 4-1-13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: N/A 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(describe): t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 I - Commonwealth of Massachusetts - W Title 5 Official Inspection Form m Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 536 Main St Property Address .r . Merriann Bell , J Owner Owner's Name 4+ information is Cotuit ,] MA 02635 4-1-13 required for every page. City/Town w State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source-of information: 1980's, �. + Were sewage odors detected wheri arriving at the site? r ;-a ❑ Yes ® No Building Sewer(locate on site plan): : .r , Depth below grade: ir f 24" feet I Material of construction: ` ❑ cast iron+ ® 40 PVC a;`" ❑ other(explain):' Distance from private water supply well or'suction line: '1 I ' `` ' r feet Comments (on condition of joints, venting, evidence of leakage, etc.): Good condition. Septic Tank(locate on site plan): Depth below grade: ,r a ,, feet " Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene, ❑ other(explain) If tank is metal, list age: years ' Is age confirmed by a Certificate of Compliance? (attach a.copy of certificate) ❑ Yes ❑ No Dimensions: 6x6 Sludge depth: 1211 t5ins-11110 r Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts a Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 536 Main St Property Address Merriann Bell Owner Owner's Name information is required for every Cotuit MA 02635 4-1-13 page. City[Town 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 4011 Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 16" How were dimensions determined? ape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 6x6 block cesspool acting as main tank with baffles installed. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete metal fiberglasspolyethylene other(explain): ❑ ❑ 9 ❑ ❑ 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 Date of last pumping: Date t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection ForM - Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 536 Main St Property Address Merriann Bell Owner Owner's Name t information is required for every CotUlt ." ; r'.-`""r , MA 02635 4-1-13 , 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 ofleakage, etc.)` r "' ate e - Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fora o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 536 Main St Property Address Merriann Beli Owner Owner's Name information is required for every Cotuit MA 02635 4-1-13 page. City/Town 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 N/A 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 appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 official Inspection. Form ," Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ` w, 536 Main St Property Address Merriann Bell Owner Owner's Name information is required for every. Cotuit .:r : :� t` =4 MA 02635 4=1-13 page: 1City/Town State Zip Code Date of Inspection D. System;lnf&mation (cont) :F',: "�" . 1 . �•:t°. °; �n "-�i�. ts+ .°;""`tt +� :il�, t :$,' rA3 y. ,. : _;er � , Type.` leaching pits number: 1-1000 gal, ❑ leaching chambers ,�3 number: , ,� ❑ leaching galleries ' number: ❑ leaching trenches number, length: ❑ leaching fields i �= number;.dimensions:' . . ❑ overflow cesspool ti.number: r 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.): b Leach pit had water at inlet invert with stain lines above invert. x Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration See septic tank-pg 9 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 11/10. Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection .Form s Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M °y 536 Main St Property Address Merriann Bell Owner Owner's Name information is required for every Cotuit MA 02635 4-1-13 page. City/Town, State Zip Code Date 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.): t5ins-11/10 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 536 Main St , Property Address Merriann Bell ` Owner `, ' Owner's Name r� information is• MA 02635 4-1-13 r � required for.every Cl)tUit � ._�' � t r�^•;,;r." ,.4 • . T F , page. City/Town, . . . . .. a e = ' . x �'.1} " State Zip Code Date of Inspection D. System Information (cont.) 3' Sketch Of Sewage Dlsposai'System Provide a view of the sewage disposal system, including ties to -' at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately q.a A. trot f . �. f,ui'.4•`' �. '�r , x vi`d Y L �.i fF� ' nR.rr�•Ae 9' •` . y '. L x .•:v, P.' .i"d�`t9 aR•° M- t t:' ° .. t5ins•1.1110 i` Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Y 536 Main St I A, Property Address Merriann Bell Owner Owner's Name information is required for every Cotuit MA 02635 4-1-13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) fi Site Exam: } ❑ Check Slope ` ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: x 20 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed- Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: ® Checked with local excavators, installers- (attach,documentation) ® Accessed USGS database- explain: You must describe how you established the high ground water elevation: USGS and town maps show groundwater at greater than 20'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-J1/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 536 Main St Property Address Merriann Bell Owner Owner's Name information is Cotuit MA 02635 4-1-13 required for 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 r T � t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 4 �1.:Q(T d��A � OF BARNSTABLE LOCATION 3� JV'Q ; n S� SEWAGE VILLAGE C fw ASSESSOR'S MAP ,j 1 INSTAL)XWS NAME&PHONE NO. L $ iTANK-CAPACITY !�LEA CliThiCi ,ACIILnT' (type) (size) �Q D NO,OF'BE®ROOMS i bUILDER OR OWNER. PERMIT)DATE:r._., .., �__...COMTLIANCE DATE: ' Sep=6on Distoce Between the; Maximum Adjustcc!Groundwater Table to the Bottom of Leaching Facility Fee! I'rlvate Water Supply Well and Leaching Facility (If any wells exist on site or Within 200 feet of leaching facility) --w-- eel Edge Edge of Wedand and Leaching Facility(if any wetlands exist Within 300 feet of bins fsacility),� / � C �_C __;_Fge Furnished by QQ � � �' '� p ;1 � � � w � � o n O �? �_ _ [ :�, r � �� LQCATION SEWAGE PERMIT N0�\ VILLAGE C cry I N SJLA LLLER'S NAME A ADDRESS B U I L D E R OR OWN ER DATE PERMIT ISSUED t DATE COMPLIANCE ISSUED r— G i Q' C/ sg a � n A 7.,No... r,�:_�f6 FEs.....lf� o0 THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ....................................•----..OF................... ApplirFation for DiupuuFai Works Tonstrurttun ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: �`v� �va� .........5..E_4 ...... .•- -- ----....d.... �a.......:..�..•.. �..............................................•- Location-Address or Lot No. �:`Y�'N .�,. ��. : ..0(............................................... ..................... --- Address Installer Address d Type of Building Size Lot......................:.....Sq. feet U Dwelling No. of Bedrooms............ .Expansion Attic Garbage Grinder aOther—Type of Building ............................ No. of persons....-....................... Showers ( ) — Cafeteria ( ) dOther fixtures ..--••-----------------------------•--------------------------------••---•-......------ ............................................................. w Design Flow............................................gallons per person per day. Total daily flow.............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width..................... Total Length.....................Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.........---........ Depth below inlet......--............ Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) t Percolation Test Results Performed by -----------------•••-••• Date aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water..--------------..--.--- (z, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water......---............... ................•-----•-----•-•................••-•-------..........----.............._...-----.............................................................. ODescription of Soil........................................................................................................................................................................ x c., w UNature of Repairs or Alterations—Answer when applicable-...AN.Q D--....\-Uv?t-.--�;f4Au A ....f.;;'. ........ --•-----•------------------------------------------------------ .......-•----................----•-------------------------------------.....------------------------•---.......---------......... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITI.F, 5 of the State Sanitary Code-The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b ed by the board of health. • Signed-- ...... .-- ---•------••••---- -----7-`16� D to Application Approved BY----•-- l� ......: �6 Date Application Disapproved for the following reasons-------------•-----------------------•--------------•----------•---------------------...••-•-•--•-----........._ ..--•-•-•--•--.....-•------•-•-------•------•------•-------------•-......--------.....-----•---....---..............-•----------------................................................................. Date Permit No.... C�'. �/-`......................... Issued. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..............................---• -....OF.............-----....................----------..-.....................................•- Applirtttiun for 0iipuottl Works Towitrurtiun rrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ................__......_..............•---................................................... ..........._._.............................----•...------•-----•--•--•-----------.......-----••--- Location-Address or Lot No. Q .i .......... _- -------------•----..........----...............-_._..._......_......._ _.._....-••---------••---•.............----..___..__.......___'----•••-'----------.........-----•. W Owner Address .................................•'-•--------•-••------.........................-••---"••-----•- '-----•-•-----------------•---•-•-•-------•' ......_._..........-------------......---- Installer Address Type of.Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) a`4 e of rBuildin Other—T yp g ____________________________ No. of persons............................ Showers, ( ) — Cafeteria ( ) Otherfixtures -------•----------------------------------------------.•••--•----••............----•-••. W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test.Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fs, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ W .--•---•-•••-------••••••••••----••••-•••-•-•••••--•---••--••••....•-•••-....-••-----•------••............................................................... 0 Description of Soil.................................................................................-------------•------------------•-------------------------------------.........-•••-•- x c.� --••••••--•-•••--•••-••---•-•••-•--•--•--•--•--•...----••-•-•-•-•--•----•••'••--•-•••.........-•--••--•----•-•---••-•-••••-••-•-••-••••----•---•--•-••...----•--•-•-•-••••.._...••--••--••---•-•--...•-- W VNature of Repairs or Alterations—Answer when applicable................................................................................................ --------•---------------------------------------------------------------------------------------•--•--•••----------•---•••-. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITI,;». 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed...................................................................................... Date , Application Approved By......_..`Y �:----------=----•---... .......----..•..-•--------------------------------•---•- ....................................... Date Application Disapproved for the following reasons----------------------------------------------------------------••---------------•---•............-•----......--- ---•-•-••••••-••••••••-------••-•••-••••••-••-••-•-••-----••----••--------•---••---•---•--••--•-•-•---....•••-••••-••---•--------••-•••••••---•-----••••••••-•-••------•••-••----•...................... Date Permit No......................./ r.. .•.. Issued... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF............ ..............................:....................................... �prtifirtt�r of f�uut�littnr�e �', THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by................. ........ .............. =`. .----- ---•-•......-•.....• ---•--•---••---•'----••---.........----•--'-'---••----•--------...........----•-----------•-•-- Installer at ( / 9/1,. r has been installed in accordance with the provisions of TIT E 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No---- /'. .................. dated....._....%__._%!_..._�-'/_...._....._.-•-- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE. - r__ j Inspect -_ ...... /.................................. or .s THE COMMONWEALTH OF MASSACHUSETTS BOARD OF ' HEALTH No............`.....•. FEE.......:.' Dispooal Vorkn %'-punoirudiun rrutit Permission is hereby granted..............c=r �'��2�''.`= T _' to Construct ( ) or Repair an Individual Sewage Disposal System at No — r— > Street -9 d_ i./ i > as shown on the application for Disposal Works Construction Permit No......:...•`...:____ Dated.................. ..........._.........' ........................................................ =- --- J�................................_ Board of He, h DATE............----•-••••..•=. '!....-'•-- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS r s�% COTUIT sT CB/DH 56.8 LOCUS PARCEL ID: s� vent 37/02 OFF J� 56.7 AREA=1.58 ACRES o Iwo Q PAR CEL 01 ID Opp �� ° '`� LOCUS MAP / O - ° " LOCUS INFORMATION PROP. 1,50OG O SEPTIC TANK 56.6 n 56.5 PLAN REF: 118/33 TITLE REF: 26474/296 ate. IE L PARCEL ID: MAP 37 PAR. 02 4 ZONING: "RF" PROP. NOT IN NITROGEN SENS. AREA AWIL FLOOD ZONE: "C" TH—3 ` CB OH $ / COMMUNITY PANEL: 250001-001 8—D DATED:07/02/92 ,A 57.0 56.7 SEPTIC SYSTEM 56.5 - REPAIR PLAN 56' i r LOCATED AT: 536 MAIN STREET COTUIT MA. PREPARED FOR • TBM: - ���,,, 56.61- RUTH P� G. BE TR. COR. STEP BELL B D H 536 EL 57.00 GENERAL`NOTES: ' OCTOBER 17 2013 TOF=56.68 I. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL- BOARD OF HEALTH AND THE DESIGN ENGINEER. 2. ALL WORK AND :MATERIALS SHALL CONFORM TO THE REQUIREMENTS OF �qS r �6� OF THE STATE ONMENTAL V. AND ANY - , S .. CODE. E ELLOCAL RUL -A REGULATIONS, AS REQUESTED BOW: D ARREN M.- 310 CMR 15.405(1) (B):56.2 9�ys}� MEYER E 1) A 1.15 FT. VARIANCE FROM 310CMR15.221(7) TO ALLOW LEACHING o� TO BE 4.40 FT (MAX) BELOW GRADE VS REO'D 3 FT. (H20/VENT PROVIDED c•' N 0. 3 E PAGE N�NSAL OLTH NOT DCH PRIOR TOISECTIOAD APPROVAL BYEBOARD OFHEALT AND THE O DESIGN ENGINEER. ��$TF 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERINGNI TAR�a� FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN d �� 56 Lr s l' ENGINEER BEFORE CONSTRUCTION CONTINUES. 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. i err- ii /r 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF / W 'G r r-' /' HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION.7. WATER SUPPLY PROVIDED BY PRIVATE DRINKING WATER WELL. MEYER & SONS INC. 8.ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE P.O. , B 0 X 981 THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING CONSTRUCTION. PARCEL I D: 10. EXISTING LEACHING TO BE PUMPED, CRUSHED AND REMOVED PER TITLE 5. EAST SANDWICH, M A. 02537 37/03 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY (5 0 8) 3 6 2—2 9 2 2 AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY 13. NO ABUTTING PRIVATE WELLS WITHIN 150' OF PROPOSED LEACHING. 14. NO WETLANDS WITHIN 100' OF PROPOSED LEACHING. 15. ALL PIPING TO BE 4" SCH 40 0 1/8"/FT (UNLESS SPECIFIED) SHEET 1 OF 2 J 1583 NOTE: MAGNETIC TAPE TO BE PLACED OVER ALL COVERS 4, NOTE: PLACE RISERS OVER ALL COVERS W/IN 6" OF GRADE FINISHED GRADE 56.50) '•TOF = EL 56.68 F.GEL: 56.5 ( F.G.EL: 56.5 F.G. EL: '56.5 VENT MAINTAIN 2% MIN SLOPE OVER LEACHING AREA a -* 2" OF 3/8» DOUBLE WASHED TOP TANK=EL. 54.25 3/4" - 1-1/2" - STONE OR FILTER FABRIC DOUBLE WASHED STONE A 6:, iet.7� 04„ SCH 40 PVC 1o»I MIN. ®®®® O ®®®® 6 ®®®®®®®®®®®SM A s ' TEE'S ARE TO BE 14 INV.52.50 © 'S= 1% ( � NEF®®®®®E3E3E3 4 SCH 40 PVC t . 2 EFF. DEPTH ®®®®®®®®®®® INV.52.93 INV.52.30 q' 3 X 8.5' 4' GAS: _ 3 5' OUTLET ELEV.. . µ $AFFLE' _ PROPOSED � DB 3 DISTRIBUTION BOX ' EFFECTIVE LENGTH 3 EL: 54.18 oor�pp c788� ' INV. 53,18 INV. ELEV.= 51 .10 } ROPOSED 71;500 GALLON' SEPTIC TANK. GAS BAFFLE TO BE INSTALLED ON ������` of M�s�gcy BREAKOUT r t OUTLET TEE AS MANUFACTURED , BY DA REIN M. �;� n ELEV.= �2.!a TUF-TITE, . ZABEL'; OR EQUAL ' N 14\0 "A T =OP CONC. ELEV. 52.10 �V R lcn� _ •®®f a E3 NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING �1 • -. INV. ELEV. 51 .1.0- PIPE INVERTS PRIOR TO-CONSTRUCTION a E3E3® 2) TANK AND D-BOX SHALL BE SET LEVEL AND TRUE ' C/SSEO ®®®®®®® ®®®®®®® L7� TO GRADE ON A MECHANICALLY COMPACTED SIX SANITAR�a� BOTTOM EL.= 49.10 ®®®®®®® INCH CRUSHED STONE BASE,,AS SPECIFIED IN. tO '� ' 3.75' 5 FT. 3.75' 310 CMR 15.221(2) 2 5' 3) INSTALL INLET & OUTLET TEES W/ . , ` '. SEPARATION. 5.00 FT. EFFECTIVE WIDTH 1 GAS BAFFLE AS REQUIRED , SEPTIC :SYSTEM . PROFILE : BOTTOM OF TESTHOLE EL: 44.10 4 SOIL ABSORPTION SYSTEM (SECTION (500 GALLON H2O LEACH CHAMBER)` - * N A • SOIL LOGS ' P#: ;412$_ Y DESIGN CRITERIA *NOT IN ZO E II/ESTU RIES PROT DIST** NUMBER OF BEDROOMS: 2 'BEDROOOM EXISTING/4BEDROOM DESIGN DATE: T.i SEPTEMBER 18, 2013' Y SOIL TEXTURAL CLASS CLASS I (0 74 GP0/SF) , r - _ N RA < MIN IN SOIL EVALUATOR:. DARREN MEYER,' CSE 1614 O 2 / . _ . . OW �n110 G.P.O: X 4 BR •.= DESIGN 'FLOW: 440 G.P.D.. DESIGN PERCO _ " DAILY FL ' WITNESS: DONNA .MIORANDI; BARNSTABLE.,HEALTH ° A GARBAGE GRINDER: NO (not designed for garbage grinder) EP 440 pd x 200% = 880 gpd, USE PROP. 1,500 GAL_ SEPTIC TANK Elev. TP-1 Depth ti Elev. �_ T P=2 Depth Elev. . S TP-3 Depth ' . Elev. ` TP-4 De th JC g 56.70 A 0' S6.60 A 0" 56.70 A 0" 56.60 A _ �" I AREA REQUIRED: (440) = 594.59 S.F. LEACH NG LOAMY. SAND LOAMY SAND LOAMY SAND ' LOAMY SAND 74 ` • 10YR 3/2 - 10YR 3/2 10YR 3/2 "' 10YR 3/2 , 55.54 14 55.44 14" 55.54 14" 55.44 14" USE THREE (3 500 GALLON H2O PRECAST LEACH CHAMBERS W 4 c, B'LOAMY SAND B LOAMY SANG ". B / IOYR 6/6 1OYR s 8 LOAMY SAND B LOAMY SAND STONE ON ENDS & 3.75' STONE ON SIDES: 33.5' L x 12.5' W x 2'D 10YR 6/8 10YR 6/8 53.54 38" 53.44 38 53.54 38" 53.44 38" C1 C1 C1 C1 BOTTOM AREA: 33.5 x 12.5'= 418.75 SF LOAMir SAND LOAMY SAND LOAMY SAND LOAMY SAND SIDE AREA: 33.5 + 12.5 X 2 X 2 = 184 SF 2.5Y 6/6 2.5Y 6/6 10YR 6/6 10YR 6/6 ( ) 52,54 50" 52.44 50"51.20 C2 66" 51.t0 C2 66" C2 y C2 TOTAL SQUARE FEET PROVIDED = 602.75 vs. 594.59 REQ'D PERC ® EL. 49.70 MEDIUM-COARSE MEDIUM-COARSE L25Y 6/6 L26Y 6/6 D DESIGN FLOW PROVIDED: 0.74(602.75 S.F.) = 446.0 G.P.D. vs. 440 G.P.D. req'd SAND 51.20 66" 51.10 66" PERC 0 EL 49.75 MEDIUM MEDIUM 2,5YY 7/3 2,5Y 7/3 C3 SAND C3 SAND SEPTIC SYSTEM REPAIR PLAN 45.70 132" 45.60 132" 44.20 2•5Y 7/3 150" 44.10 2.5Y 7/3 150" 536 MAIN STREET, COTUIT, MA PERC RATE <2 MIN/IN. (*C" HORIZON) PERC RATE <2 MIN/IN. (-C- HORIZON) Prepared for: Bell NO GROUNDWATER.OBSERVED NO GROUNDWATER OBSERVED Engineering by: Surveying by: SCALE DRAWN I, Darren M. Meyer, R.S., CSE, hereby certify that I am-current) a y p MEYER BOX98 SONS,INC. A(ScBo aB Sruve N.T.S. DMM y approved b MAOEP pursuant to 310 CMR 15.017 �BOX 981 � � to conduct soil evaluations and that the above analysis has been performed by me consistent with the (508) 419-1086 DATE CHECKED SHEET NO. requirements of 310 CMR 15.017. :1 further certify that I have passed the Soil Evol. Exam in October. 1999. EAST SANOW/CH,MA 02537 50&362-2922 10/17/13 DMM 2 of 2