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1067 MAIN STREET (COTUIT) - Health
1067 Main Street ,Y i Cotuit A= 034-015 _ C ow- . -1 ,e Town of Barnstable Board of Health P.O. Box 534, Hyannis MA 02601 Office: 508-862-4644 Susan G.Rask,R.S. FAX: 508-790-6304 Sumner Kaufman,MSPH Wayne Miller,M.D. July 11, 2005 Mr. John O'Dea Sullivan Engineering 7 Parker Road Box 659 Osterville,MA 3 �,y°✓a• �,�+�',� �,rrot rAc.,� Z her ..�s +� .a' � t t r Dear Mr. O'Dea, You are granted permission, on behalf of your clients,William and Paula O'Keefe, to construct an onsite sewage disposal system designed to be connected to six bedrooms at 1067 Main Street, Cotuit. The septic system shall be constructed in accordance with the submitted plans dated June 27, 2005. Sinc 1 yours, W e ller, M.D. Chairm BOARD OF HEALTH TOWN OF BARNSTABLE Q:HEALTH/WP/Odea6beds 1 DATE: \ $- FEE: t � a�xw�rwata xAsa REC. BY 'own of Barnstable Ste. DATE: Board of Health 367 Main Street, Hyannis MA 02601 Office: 508-862-4644 Susan G.Rask,R.S. FAX 508-790-6304 Sumner Kaufman,M.S.P.H. Ralph A.Murphy,M.D. VARIANCE REQUEST FOR.NI LOCATION C � Property Address: 1067- Mga,n �= ,- Assessor's Map and Parcel Number: ( 7;4-06 Size ofLot: ®a S9 A(ZE;5 . Wetlands Within 300 Ft. Yes V'� Business Name: No Subdivision Name: APPLICANT'S NAME: S,jT-y .ern 'Fv� m, Phone __$0t-4?-b- --33�! Did the owner of the property authorize you to represent or her? Yes No PROPERTY OWNER'S NAME CONTACT PERSON Name: . i' ��xl� A.&nnino rfl Name: So\\f, C bee,- �u jXk\y n Entire ee�'trl� r 7 P-,r\1.er �� Address: Address:063kecjllk. MAt. 0Z(65r Phone: ®A4 ?At. i7409 Phone: Sib 8--Liz �"�3efy VARIANCE FROM REGULATION(List P g.) REASON FOR VARIANCE(May attach if more space needed) • `_{ t y NATURE OF WORK: House Addition ®' House Renovation ❑ Repair of Failed Septic System ❑ - 2§,: _a il5 Checklisr fro be completed by office staff-person receiving variance request application) Four(4)copies of the completed variance request form _ Four(4)copies of engineered plan submitted(e.g.septic system plans) W C 1 Four(4)copies of labe!ed 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 ownerileasee 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 Susan 0.Rask,R.S.,Chairman NOT APPROVED r Sumner Kaufman,M.S.P.H. REASON FOR DISAPPROVAL, Ralph A.Murphy,M.D. Q:/o7P/VARIREQ William H. Simpson 2532 Hepplewhite Drive York, PA 17404 June 28, 2005 Town of Barnstable Board of Health 200 main Street Hyannis, Mass 02601 Re: 1067 Main Street, Cotuit Dear Board of Health, As owner of the premises located at 1067 Main Street, Cotuit, please be advised that John O'Dea or Peter Sullivan of Sullivan Engineering, Inc. has my permission to represent me before your Board in all matters relating to the septic system at my 1067 Main Street home. Since y , r William H. u psb"ri Town of Barnstable �6 Board of Health P.O. Box 534, Hyannis MA 02601 Office: 508-862-4644 Susan G.Rask,RS. FAX: 508-790-6304 Sumner Kaufman,MSPH Wayne Miller,M.D. July 11, 2005 Revised August 22, 2005 Mr. John O'Dea Sullivan Engineering 7,Parker Road Box 659 Osterville, MA .fib y`' ,,.' scns. @�,trpt, ' - ,Y^z, msW•,�-., _. ..,....,„,o-r ,T` Dear Mr. O'Dea, You are granted permission, on behalf of your clients, William H. and Judith A. Simpson, to construct an onsite sewage disposal system designed to be connected to six bedrooms at 1067 Main Street, Cotuit. The septic system shall be constructed in accordance with the submitted plans dated June 27, 2005. Sincerely yours, Wayne Miller, M.15. Chairman BOARD OF HEALTH TOWN OF BARNSTABLE Q:HEALTH/WP/Odea6beds SULLIVAN ENGINEERING INC. 7 PARKER ROAD/P O BOX 659 OSTERWLLE, MA 02655 Peter Sullivan P. E. Mass Registration No. 29733 psullpe@aol.com phone 508-428-3344 fax 508-428-3115 August 17, 2005 Wayne Miller, M..D., Chairman Town of Barnstable Board of Health 200 Main Street Hyannis, MA 02601 RE: 1067 Main Street, Cotuit A=034-015 Dear Board of Health, We are in receipt of your letter dated July 11, 2005 with regard to the above referenced project, (copy attached). Please note that the clients names are William H. & Judith A. Simpson. We would appreciate a new letter with their names on it for our files. Thank you in advance for your efforts. Very truly yolKs, T Peter Sullivan , P. E. Sullivan Engineering Inc. C) Members of American Society of Civil Engineers, Boston Society of Civil Engineers � r Town of Barnstable nnruvscai�s:>~, NAS& Board of Health M P.O. Box 534, Hyannis MA 02601 Office: 508-862-4644 Susan G.Rask,R.S. FAX: 508-790-6304 Sumner Kaufman,MSPH Wayne Miller,M.D. July 11, 2005 Mr. John O'Dea Sullivan Engineering 7 Parker Road Box 659 Osterville, MA RE: 1067 Main Street, Cotuit A=03470145 Dear Mr. O'Dea, You are granted permission, on behalf of your clients, `u=' r�rl ;�i�-tee, to construct an onsite sewage disposal system designed to be connected to six bedrooms at 1067 Main Street, Cotuit. The septic system shall be constructed in accordance with the submitted plans dated June 27, 2005. Sinc 1 yours, W ne ller, M.D. Chairma BOARD OF HEALTH TOWN OF BARNSTABLE Q:HEALTH/WP/Odea6beds Towle of Barnstable 0 f 1NE r Department of Regulatory Services 1 6Aafrar OLK Public Heillth•D1vIS1011 llnlC G MASS. t6J9• .e$ 100 Main Sircct,Ilyannis MA 02601 : ."DIG SAC7•t r i °rfo rlucl" `, ZOOS- Z9C)o &s ?2 Date Scheduled U / Time • +R r Soil Suitability Assessment for ewage Dispasal 7 Performed Dy: ��'/llt ✓a Ldaas�c'�r�n1. Witnessed Dy: LOCATION& GENEIUL INFORMA.T'ION Location Address 1 L(p"j r7�LIr S�•e e-V Owner's Name/ W.w wn kk,A. Qu�+• Address Z5 3L t pep f\zwn��f .t7r'. Assessor's Map/Parcel: C jc( ' (34S I Engineer's Name NEW CONSTRUCTION I✓ REPAIR °Telephone It ° Surface Stoncs AIDNE Land Use Distances from: Open Water Body CLOD R Possible Wet Arca 17() _Il Drinking Watcr Wcll 360 It t D Drainage WayyVuE Il Property Line __ft Other SKETCH:(Street onme,dimensions of lot,exact locations of test holes&pere tests,locate wetlands in proximity to holes) / NIF Richard C. &Ann P. Leahy 64 29021245 S 73"07" E ON 294.75'w 0 GB d o 2s7' a � I- ---—------L z Nn o a N 4 58 OI � I I p Porch I. I �I 3 ty�o� o i I �° m o IJ I bj,OPPdJ � C:?I�p, Parent material(geologic) Ou ash Depth to Dcdrock sOt) Deptlt to Groundwater: Standing Water in(tole:N/p/J(r Wccping from"it Face MbAr r' +t Estimated SensorialIIigh Groundwater'Doi)kI 97_S DETERMINATION FOR SEASONAL IIIGIIWATER TABLE Method Used:R. 6Pe°.,dls�GC I�aP Depth Observed standing in obs.hole: in. Depth to soil mottles: itr• Dcplh to weeping fiorn side of obs.hole: in. Groundwater Adjustment Il. Index Well# Reading Date: Index Well level Adj.faclur Adj.Groundwater Level— PERCOLATION TEST Dale 7 Z OT Time I : Observalion I IoIC N Time At 9" Deptlr of Pere 33" 17-0" lime at 6" Start Pre-sonk Tame© ZS 4A1. Thile(9"-6") End Pre-soak Rate Min./Inch Site Suilability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data•Ib Be Completed on (lack----------- ***If percolation test is to be conducted Withi11100' of jvetl:uulr yoll 111I1st first Notify the Barnstable Conservation Division at least one(1) week prior to beginning. Q:I IFALTI IMP/I'GRCr•ORM ' I`LLI.' OBSETIVA'I'ION MOLL LOG Hole It_I__ Ucptlr lium Soil I lot izon Soil Texttnc Soil Col,ir ;;oil Vthcr 5urfaco(In.) (USDA) (Munsoll) Molding (S(rueUua,SkIncs,Moldcls. C(111S1St4ll9Y�.°ie_SJ"aVCI ._ 0-7— O IMIQ 3/3 Z—c0 ( -SAN r t-o" 10)0, 4)1 ► _ colarrly —4AAjh Ing eel DEEP OBSERVATION HOLE.LOG hole # Z Depth iron► Soil Iloriwn Soil Texture Soil Color Soil Othcr Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Molders. Consislcncy %Gravel L_ t 611K 31 --.— 1-1D E loAvn15AIJD IU`t12 6IZ Ind ZS-I Zo, MED. SAWP LS-Y4 O DEEP OBSERVATION HOLE LOG hole It Dcpth from Soil Itoriwn Soil Texture Soil Color Soil . Othcr Sat Met:(in.) (USDA) (Moused) Mottling (StrucUnc,Stones,huuldcrs. CtLsstcnys�i aycl)__ DEEP OBSERVATION MOLL LOG Molt ll Depth From Soil llot iw n Soil'fcxture Soil Color Soil Wier Surfnce(in.) (USDA) (Munscll) Mottling (Stucture,Slums,ttouldus. e 'unsistcncy,Ja Qtavcl) Flood Insurance hale May.: ' Above 500 year flood bowrdary No tf Yes Within 500 year boundary No f Yes car flood bottndar ✓ Yes•—____- within tau y y No Depth of Nalurilly Occurring Pervious Material Does at(cast four feet of naturally occurring pervious material exist in all areas observed throughout(lie area proposed for the soil absorption systcm7 YE5 If not,what is We depth of naturally occurring pervious matcria17 y Ccrlificnlion • I certify that on NOV_ 7-009 (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that file above analysis was performed by me consistent with the required training,expertise and experience described in 310 CMR 1.5.017. Signature_ Date •Z OS Q:l ICALTI Uwr/f IMCFOtM may, TOWN 0"BARNSTABLE FLOCATION /��'� 'z`�-P� S4 SEWAGE # ^VILLAGE ASSESSOR'S MAP & LOT.3�t 115 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 5 00 LEACHING FACILITY: (type) (size) rj�j'K IZ- NO. OF BEDROOMS i BUILDER OR OWNER r,&X.9_f PERMITDATE: �� 1r 5 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 f t of leaching acility) Feet Ftunished by I C 35 --'i`' D-c 21i-8" v n 2 Z% i-LAP 3ai-1®`, 4 3 No. (}�-7`r/ 1 /ov�4� ?IS a'1Fee T� COMMOaEALTH OF ACHUSETTS v�`� Entered in computer: HEALTH DIVISION -TOWN OF BARNSTA4BLE¢MASS CHUSETTS Yes ZIppYication for Mqual *p5tem Con5truction Permit Application for a Permit to Construct( Repair( )Upgrade( )Abandon( ) -Complete System El Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. C_A- �(la�n U ;1�t,j M A, Assessor'sMap/Parcel 253Z V�ep\-(WAAle, l�tti�'Z 0-4A'ok�;- 4 Ypr�< .jo Inst filer's Nagm�e,e�g�{dre and Tel.No.�°�C(^ 3 ,' �j� �Designer's Name,Address and Tel.No. 0 02�1 C�u� '�, o, ios9 5a y s�erv' ozvss" C a -�IZ�-�� � Type of Building: Dwelling No.of Bedrooms (o Lot Size O Sc, AC., Garbage Grinder(era) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow G87 gallons per day. Calculated daily flow G'(00 gallons. Plan Date r �Z-71057 Number of sheets Z_ Revision Date '7 106S- Title PIU n '7r4qD! 3_-rnQrw eyrie ri .S Size of Septic Tank tS'00 0A(-- Type of S.A.S. to—SO4 G,,t PI`rrn x--, f S% .` itiAw, GiQ. Description of Soil(tt ;Dt1!5 C� Zv U Cy--�rhtc5 Z-V �-ley�� - .�rvcl i lec.;-n (o-tt" E lcjxa^ - ugjnti Sq ck , lI-?A" P, LdizW - COAM-y S"k!s 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 Certifi- cate of Compliance has b issued*th* Boardf Health, Signe Date f3 0Application Approved bys DateApplication Disapproved r t e fo Permit No. f7®�� �� Date Issued ' a l• ' z' No. /vt f - [7 G FT !J o� �-()f wa , Fe SD . `TdiE,COMMONWEALTH OF MASSACHUSETTS ,,I,`t Entered in comput r:%00" \` „P PUBLIC HEALTH DIV:I�SIO•N - TOWN OF BARNST.A' MA_ SACHUSETTS'�' r Yes rication for Digogar stem CCon!6tructiott erm,it./ Application for a Petmit.to Construct(�Repair( o-)Up grade( )Abandon,(,i Complete SSystem��a•O Individual Components' 1 Location Address or Lot No.1067 MAv\S\-fc�e� Owner's Name,Address and Tel.No. Assessor's Map/Parcel �3Z F12Qta1Zw�I �IV 2 b -ot5" or 4 Ins_taller's Name, ddre`$$' and Tel.No.'s Designer's Name,Address and Tel.No a'1 k4-st dl t�rnp"q--- ozvss' (Soak-LIZcg-3`3y _ y ,Type of Building: Dwelling No.of Bedrooms_(g_____ Lot SizeOSS Ak- -sq-ft. Garbage Grinder 0a) �f Other Type of Building No.of Persons Showers( ) Cafeteria(Y ) Other Fixtures n Design Flow G97 gallons per day. Calculated daily flow Co.(00 gallons. ar Plan Date -jlr,c' Number of sheets 7 _ Revision Date -71ZT10S Title G,�c on o. 1�cn .Pi S n,n�a►�m�.., r"r Size of Septic Tank tsno (,At_: Type of S.A.S. (c-Soo GA 0 6 rn rr� � IZ'�c�S^ Ge �: (�*_I1�;Description of So j01- O-Z1 U (�,.er-Ur�nK s �x _ . _r S C 'Zrn�1 :v Q :YS NN Nature of Repairs or Alterations(Answer when applicable) d Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has Nc issued by this Board of Health. Signed Date t; U Application Approved by\ �__ ;2�' Date Application Disapprovevoror`tl e following reasons ;r '( Permit No. X1( Date Issued F_— ————— ————————————————————————————— '%�JS �`���^ b� THE COMMONWEALTH OF MASSACHUSETTS y BARNSTABLE, MASSACHUSETTS S. T CCertificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed(ijRepaired( )Upgraded( ) Abandoned( )by a — M at I f o�i, _ has been constructed in accordance ti with the provisions of Title 5 and the for Disposal System Construction Permit No.o2 U)S -?S/ dated Installer Designer A The issuanc of thi permit shall not be construed as a guarantee that the s ste will nction ,s designed. Date 00,11 f1 D Inspector t � _ No. Dw C`— I qL Fee S� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Di!5po!5a1 *pgtem CCow5truction Permit Permission is hereby granted to Construct Repair( )Upgrade( )Abandon( ) System located at 10G-7 h'la,.,k Vi�- and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date ofTrpeut. Date:_ _ r) Approved by kAA tr ..I Town of Barnstable �OFiME Tpw y�P ti* Regulatory Services Thomas F.Geiler,Director URNSTABM 9 MASS. Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601. Office: 508-862-4644 Fax: 508-790-6304 A Installer& Designer Certification Form Date: 3JZ-- Designer: �U �'I JC`v� CGI�t� �e e �'l1 Installer: p� ^ Sd jZA- D 1 1�5 Address: T 00 51- (1 Address: 2-7 C oun u . nn � r�-2-6 u On �1�S�y� �`�► .�yvz was issued apermit to install a date) (installer) septic system at based on a design drawn by (address) dated — / (designer) , I certify that the septic system referenced above Y was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. OF PETER AAI "�b(Installer's i ature �.2 CIVIL ALA (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DMSION. TIV OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM IANDAAS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form TOWN OF BARNSTABLE GGJ& Jp LOCATION /'-tQ.L.fv �-1 SEWAGE # VILLAGE ASSESSO 'S MAP & LOTS— 4 . mvcPermer NAME&PHONE NO. 04F_ SEPTIC TANK CAPACITY elu kS� .LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER O OWNER PERMITDATE: 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 -_ t ����- �� ��� r \ � . , \ . ' . i , E.j 4' "`>' 'r' BORTOLOTTI CONSTRU ,INC. 765 WAKEBY ROAD,MARSTONS M 026 y 508-771-9399 ' 508428-8926 FAX: 5Uyy� 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTIO PART A 8 CERTIFICATION ` 9 Property Address:-na A" Date of Inspection: Inspect Name: 'Ole e N e and dress: of CERTIFICATION STATEMENT: I certify,that I have personally'inspected the'sewage disposal system at this address and that the informa- tion repotted below is true,accivate`and complete as of the time of inspection:'I'lte inspection was per- formedbased on my training and'experience'in the proper funciion'and maintenance ofon-sitewage se disposal systems. The System ' ' Passes - Conditionally Pas -'Needs Furt6iEav do a Local Aproving Authority ' 'Inspoctot's_Signature- `� Date:---�lB��� v y ,The,Systemilnspoctor -submit copy of thus inspection report to Apprrn�p�ig authority w thtn thir- ty(30)days of completing this inspection' If the system is a'shared systera� design ow of 10;000 jpdtor greater;`the`inspector'and the system'owner'shall'submit the report'to thi appropriate;regional oMce of the Department of Environmental Protection. The original should;be)9ent,to the system owner " and eopi6s`sent to the.buyer,if applicable and the approving authority N' d INSPECTION SUMMARY: ,x` `+,A)SYSTEM PASSES: " i `l-have not found any information which indicates that the system violates any of the failure i criteria as defined in 310 CMR 15.303. Any failure criteria not aluated are indicated below. B).SYSTEM CONDITIONALLY PASSES;, r , One or moreTsystem components need to be replaced or repaired. The system,upon comple don of the replacement or repair-passes inspection. Indicate yes;nor;or not'determined(Y N,OR ND). Describe basis of d�—rmtnatton in all.instances. If. "not determined".explain why not. e septic tanlr is metah"cracked;`structurally unsound,shoes s substantial infiltration or exfiltration,or tank failure is imminent. The system will pass inspection if the existing se "" 'tic tank'is replaced with a'conforming septic tank as approved°b .the Hoard of Health. Sewage backkup or breakout or high static water level observed in the distribution box is due; i to broken'or obstructed pipe(s)or due to a broken,settled or•une'ven-distribution box. The system will pass inspection if(with approval of The Board of Health); ' - 1- .s�r$, '�r'�G,a. .p;�•X-7` tti '"Je�3 Oak`" .b:.l"'•f h 'Ky Ct�3l a"i'� 'ftA'-Pf' Y�Y s' XgWj• _ (''i y.. g C- t +"C, p£- ' (f Ir,„r..,`�'4!$ yA �., .•e cox ;y .C;#�ya,.x:._°�l ? -"°y. ,1?? r„S r,.C.-r,,. r�f i. S �' � � .� t�,rt ;,a„f✓ } .' �'w 4:�. ,3 %+ mil. � '� � 1�"� ,4 Ti:. � pis, +, a �SUBSURFA k8;SEWAGE`DISPOSAL SYSTEM'INSPECTION FORM ' PART A CERTIFICATION(continued) Ak arG. ,l Broken pipe(s)replaced Obstruction is removed + P Distribution Box is levelled or replaced The System required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of The Board of Elealth):',, Broken pipes)are replaced Obstruction is removed i C C)FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by The Board of Health;in,9*!ito,determirneMif s - a lathe system isfailing to.protect the public health,safety and the environmonG, 3,+ 4 ;,,;1 r �I=i 3� SYSTEMrWILL.PASS'UNLESS BOARD OF HEALTH DETERMINES,THAT,111&o. �{ J:,-<'w.FSYSTEWISi NOT,FUNCTIONING IN:A MANNER'WHICH'WILL PROTECT:THE 4j;�.y', PUBLIC HEALTH AND 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;saltmarsh. 2)SYSTEM WILL FAIL UNLESS THE BOARD OF?HEALTH, (AND.PUEILIC4W,ATER SUPPLIER,IF..-APPROPRIATE)DETERMINES THAT THE SYSTEM ISiFUNCTION- ING IN'A MANNER THAT PROTECT THE'PUBLIC HEALTH AND SAFETYANIjp,'HE . , ENVIRONMENTi s system,hasa,septic tank and soil absorption system and is-within 100 Feet to surface i z „•I :watersupply.outributary,to a surface water supply: A I_The system,has:a septic tank.and soil absorption system and is with a Zone I of;a publtc,,�ev };: rr�,. � �q,_ `water:supply well: The system has a septic tank and soil absorption system and is within,50 Feet'of:a private;' a water supply well. The system has a septic tank and soil absorption system and is less than100;<Feet,;but;50 + a Feet or more from a private water supply well,unless a well water.analysis for coliform bacteria and volatile organic compounds indicates that the well is free frompollutiofiftni —the facility and.the'presence of ammonia nitrogen and nitrate,nitrugewis equal.to.or,less D)$Y,Sr1'EM FAILS: 5, ,n::,. I have determined that the system violates one or more of the following failure criteria as defined. in 310 CMR 15.303. The basis for this determination is identified below:";The'Board4bf�llgd!h shoul ibe contactedto determine what will be necessary to correct the failure. ri'; Backup of sewage into facility or system component due to are overloaded or clogged'SAS or cesspool Discharge ouponding of efluent to the surface of the ground ar,surface�waters>due,,to an,9 overloaded or clogged SAS or cesspool. f,, „i rx`^Static liquid level in the distribution box above outlet invert due to an overloaded or clog- ,:' ,r, ;phi' r• �. ged.SA5;'or.oesspool. , • . .Y, ,�-„k., ,7: _� ,s ,t, :' =Ligt id`d6oth°an cesspool is less than G"below invert or available•volume is less than 1/2 Required pumping more than 4 times in the last year NMdue to clogged or obstructed pipe(s)., Number of times pumped -2- ji ° :SUBSU_RFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A ` CERTIFICATION(continued) Any portion of the Soil Absorption System,cesspool or privy is below heti high_groundwater elevation. Any portion of a cesspool or privy is within 100 Feet of a surface water supply or tributary to a surface}water supply. rAny portion of a`cesspool or privy is within a Zone I of a public Any portion of a cesspool or privy is within 50 Feet of a private water supply well: - Any portion of a cesspool of privy is less than 100 Feet but greater than SO Feet from a private water.supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen' E)LARGE SYSTEM FAILS: following criteria a l to a large stem in addition to the criteria above:- The' g, PPY g system , The design flow of a system is`10,000 gpd or greater(Large System)and the system is asigniQcnt %threat to public health and safety and the environment because one or more of'the foliowiag+ conditions+exist s The system is,within 400 Feet of a surface dunking watecsupply ? The , m is within 200 Feet of a.tributary:.to a surface drinking water supply 1 The system is located in a nitrogen sensitive area'Interim Wellhead Protection Area", (I.WPA)era uiappect Zone.I1 of$public water supply welfl , �A <} =`iThe owner or.operator of any such:system shall bring the system and facility into;fuU compliance}v�ntlt, hhe, :groundwater treatment program'requirements of 314 CMR 5.00 and6.00. Please consult the{.local �,;�'r'., regional office of the Department for further information. SUBSURFACE SEWAGE DISPOSALSYSTEM INSPECTION FORM.` "y PART B CHECKLIST Pit Check if the following have;been done. „ . F 3 g 1 ping:infoimation was requested of the owner,occupant,and Boarci,.of Heait None of the stem components have been um for atleast two weeks and�t.,a sy n has. ri system lm pumped � been receiving normal flow rates.during that period.s L'arge:volumes,gf wt}ter' ante UPVI ,' I' introduced trite the system recently or as part of this inspection. ,; -built'plans:have been obtained and examined. Note if they are not available antlt N/k The facility or dwelling was inspected for signs of sewage back-up. The�`Ya�_m does not receive`non-sanitary odridustrial waste flow ' f ,:; was inspected for signs of breakout. 'All,system:;Qomponente,excluding the Soil Absorption System,have been located on arts ��The septic tank manholes were uncovered,opened,and.the interior of`the septictaiilrkacai>E r j Y spected for condition of baflles;or tees,material of construction,d, nsion-' depW of Hcluid, F. depth of sludge,depth of scum.{ t. f €,it atla // The size and location of the Soil Absorption System on the site has beeri determined based on existing information or approximated by non-intrusive methods. -.3 k� '�.�E^rithe+ rtt.�`a'i .+"' k,, °ud"*41n;: ry, T. -F a u . � s ..�,� h ''S.t s";�Fsc•.. �`i��'+ ��.��. .�. �j��,h.,�. �. ,. a� -0 bas. ?�, . h, ;.3iS� t�+� t.' r+( i.'?a ,+ x E,`s�i,:�,S w�' i'+ .fie";•`1�,aM"ft ' 1 ' ., a 7J,, f.-,, i. �9n t �� a 4� '� #-F 1 .j;t ry T ,...;�•. . r. � � + 3t'y + n;k rr t tfii i r'2-a 11'IY:. s _i '�4��f'2,i f;... • .;, x `ter t ,.�1n t r i i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM S ' ' ! PART B CHECKLIST(continued) .4, .. - '"The facility owner(and occupants,if differentfrom owner)were provided with information on the proper maintenance of Subsurface Disposal System wc ,SUBSURFACE SEWAGE DISPOSAL_SYSTEM INSPECTION;FORM _ PART C .. A . .1 SYSTEM INFORMATION FLOW CONDITIONS RESIDENTIAL: , owign glory; llons Number of Bedrooms:��Number of Current Residen ,(Garbage GrindeJ�r: AJL) Laundry Connected To System: Seasonal use. Water'1vlete Readings 'if.av Table: Last Daterotl Occupancy:: Type of Eslabhshment Dj gl -'' "'•'g'�' "i lons/di�y''Grease Trap Present:(yes or no) ndustrial Waste Holding Tank'Present: Non-Sanitary Waste Discharged To The Title V System: Water Meter Readings;If Available: Last Date of Occupancy: OTHER: Describe) Last Date.jOccupancy W GENERAL INFORMATION PIMPING RECORDS-and source of information: S stem.Pump o as part of inspection: If yes,-volume um ': Rayons.', n for'pump y g: TYP$ SYSTEM:'r„ar,r. Tank/Distnbutton Box/Soil'Absorption System e ' } Cesspool.. OveiIIow`CMpoor' Privy , Shared System(If yes,attach previous inspection records,if any) Other(explain) i OXIMATKAGE' f all components,date i stalled(if known) d source of.tnforwationN Q Sewa odor¢detected when arrifing at the site: 1 l t 1 a�i 1 SUBSURFACE,SEWAGE DISPOSAL SYSTEM:INSPECTION FORM _ PART C GENERAL INFORMATION (continued) . i SEPTICTANK: ' )kR�.� Depth below grade:" ''` Material of Construction: concrete metal FRP_Qthe;i G Dimisions: Sludge Depth: Scum Thickness: Distance from top of sludge to bottom of outlet tee or baffle: Distance,from bottom of scum to bottom of outlet tec or baffle: Comments:;(recommendation for pumping;condition of inlet and outlet tees or baffles,.depthof liquid level in relation to outlet invert,structural integrity,evidence of leakage,etc.) GREASE TRAP: ( Depth 1�elow Grade: Material of Construction: ,concrete_metal_FRP_Other' (explauaj ,. Dimensiod. `° `` Scum Thickness: Distance from top of scum,to top of outlet tee or bale: ,F Comments:(recommendation for pumping;condition of inlet and outlet tees.orbatlos,depth.,of Lquid ' -level in elation-to-outlet invert structural„integrity,evidence of leakage,etc.) tk ,,�=TIGHT,,OR HOLDING TANK:N 4•` ,�b�rft� Depth `Below Grade: Material of Construction:_concrete_metal' FRP Other(explain) ` Dimensions: Capacity: sallons Design Flow: �allonstiday Alarm Level: b, , Comments:(condition of inlet tee_,condition of alarm and float switches,etc) [ Y* 77 i i`dP# DISTRIBUTION BOX: /00 Depth of liquid 1.evef above outlet invert: Comments:(note if level and distribution is equal,evidence of solids carryover,evidence of leakage'into or out of box,etc.) �PUmpiP HAMi Pump is is working.order: `° N {. , e , Comments:(note'-condition of pump chamber,'coridition of pumps and appurtenances,etc.) -S- �sFT - cf.�Y, #trYM'Ea9"� r�` r - a°r. t't:a" 4.•..•� r tt ,;. �. —a ., a K�:x",. A ,,.,.,-,c„,-Via_ �q��t'�.. ^+ ��,�� 1,:t, i r.� ; :��'� k�� ��'"�p� ahr,y�i�7iY���#;".!�?.•.' i ;r:;d�� � �,j,r R � A � �{u�.�� `�' p t��'�'�r�'r!r„<; ��t; `r A#'•".': i ` 81-�', d• ti s z.nd,:F .. - .w, : wr.. �§ ,.W�.ai i� ''�� �frP'}�Jol'r��t�r, r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM y . PART C SYSTEM INFORMATION (continued) SOIL ABSORPTION SYSTEM(SAS):, (Locate on;site plan,if possible;excavation not required,but may be approximated by non-intrusive!:i�' methods)i:If not determined to be present,explain: "r,,Leaching pits,number: 'Leaching chambers, number: Leaching gallenes,number Leaching trenches,number,length: Leaching fields,number,dimensions: Overflow cesspool,number: . Comments:(note condition of soil,signs of hydraulic failure level of ponding,condition of vegetation, .etc.) — $ � ',,-,CESSPOOLS: ✓ k , Numberandconfiguration -'7;y6 Depth-top of liquid to inlet invert: N Depth of solids layer: Degth of scum ayes: Dimensionc of,Cesspool? Materials of construction• '�Indication of groundwater: Inflow(cesspool must be pumped as part of inspection) Comments:(note condition of soilk,signs of ydraulic f 'lure, lev f condition of vegetation, etc. �. •I Y . `. w�b���� < ' // � p.i�L PRIVY•-ice-lJ Materials of construction: Dimensions: Depth of Solids: - -- Comments:(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc.) i. . -6- t ' SUBSURFACE SEWAGE.DISPOSAL SYSTEM INSPECTION FORM PART C " SYSTEM INFORMATION (continued) SKETCH OF SEWAGE DISPOSAL SYSTEM: lnclude des'to adeast two permanent references, landmarks or benchmarks. Locate all-wells within 100 Feet. 1 DZPTHlO GROUNDWATER: ' Depth to groundwater: Z Feet Method dDete don qqrr Approximation: /'!� �y! }� . yL�'�1 u•J�=�� 0 -7- TOWN OF BARNSTAB*LE LOCATION :SEWAGE# VII,LAGE C Q U� ASSESSOR'S MAP &LOT D ;, •-� INSTALLER'S NAME&PHONE NO. AA A co .413 ex. 5 ow SEPTIC TANK CAPACITY A J'G LEACHING FACIL TY: (type) f=L0W C1l/ Afi6eX! (size) CQ Q 642 NO.OF BEDROOMS BUILDER OR OWNER PJZ.`�/� ,1.( PERMTTDATE: --Z t COMPLIANCE DATE: e7 - 3 -91? Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Welland 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 F it \ / TOWN OF BARNSTABLE LOCATION /0 & /4 A✓/V S7 SEWAGE # VILLAGE C Q�L/d 7 ASSESSOR'S MAP & LOT 0-"a INSTALLER'S NAME&PHONE NO. J AA A G Q .413 e,C. 50.41 SEPTIC TANK CAPACITY A LEACHING FACILITY: (type) '� C=LG UJ Clfd A4 - C'i4 s (size) CQ D SAL NO.OF BEDROOMS BUILDER OR OWNER j PERMTTDATE: l a —y i COMPLIANCE DATE: % i 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 I Lr i No. / S �::.— ,• Fee --x THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ZIPprication for 33iopozar *p.5tem Construction permit Application for a Permit to.Cons truct( )Repair( )Upgrade4X4Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.1."7 Main Street Owner's Name,Address and Tel.No. 71 7—7 6 4—3 7 7 5 Cotuit,Mass. 02635 Bill Simpson Assessor'sMap/Parcel 0 Sy a /d_ 2532 Hepplewhite,York,PA. 17404 Installer's Name,Address,and Tel.No. 5 0 8—7 7 5—3 3 3 8 Designer's Name,Address and Tel.No. — — J.P.Macomber & Son Inc. J.P.Macomber & Son Inc. Box 66 Centerville,Mass. 02632 Box 66 Centerville.,Mass. 02632 Type of Building: Dwelling XXXNo.of Bedrooms 5 Lot Size sq. ft. Garbage Grinder PO) Other Type of Building RES No.of Persons 4 Showers( ) Cafeteria( ) Other Fixtures Design Flow 5 5 0 gallons per day. Calculated daily flow 5 x 1 1 0=5 3 0 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank 1 500 Type of S.A.S. 6 330 cultec rechargers Description of Soil Loamy sand to coarse medium sand to fine sand. Nature of Repairs or Alterations(Answer when applicable) I N s t a l l i ng 1 —1 5 0 0 gallon tank, 1 — distribution box, 6-330 cultec rechargers packed in 3 of stone with drip pipe run within the rec argers. 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 nozvw t to lace the system in operation until a Certifi- cate of Compliance has been issued by this Boar f H th. Signed Date 8/12/9 8 Application Approved by Date 1— Application Disapproved for the following reasons Permit No. Date Issued /� No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computes Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01pprication for Migoml *pgtem Construction i3ermit Application for ii Permit to Construct( )Repair( )Upgrade)(XX Abandon( ) ❑Complete System ❑Individual Components Location Address or'Lot No.1."7 Main Street Owner's Name,Address and Tel.No. 71 7—7 6 4—3 7 7 5 Cotuit,Mass. 02635 Bill Simpson Assessor'sMap/Parcel 0 5�1 d 11 2532 Hepplewhite,York,PA..µ 17404 Installer's Name,Address,and Tel.No. 5 0 8—7 7 5—3 3.3 8 Designer's Name,Address and Tel.No. 5 0 8—7 7 5—3 3 3 8 J.P.Macomber & Son Inc. J.P.Macomber & Son Inc. „ Box 66 Centerville,Mass. 02632 Box 66 Centerville,Mass. 02632. Type of Building: Dwelling XXXNo.of Bedrooms 38S Lot Size sq. ft. Garbage Grinder NO) Other Type of Building RES No. of Persons Showers( ) Cafeteria_( ) Other Fixtures Design Flow ' 5 5 0 gallons per day. Calculated daily flow 5 x 1 1 0=5 3 0 gallons. Plan `Date Number of sheets Revision Date Title Size of Septic Tank 1 500 P . � ' ---Type-ofS.A.S. 6 330 cultec rechargers Description of Soil Loamy 'sand_ to coarse" medium sand to fibe sand. Nature of Repairs or Alterations,(Answer when applicable) INstalli.ng 1 -1500 gallon tank,1 - distribution box, 6`330, cultec rechargers packed in 3 of stone >, with drip pipe run within the rechargers. Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issue by this B. ard fHeth. Signed A/ Date 8/12/9 8 ' Application Approved by44=�: Date 3 Application Disapproved for the following reasons 101 Permit No. r�-"-S Z(o Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS { Certificate of (Compliance �k\ THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired( ) Upgraded Abandoned( )by J-P.Macomber & Son Inc, at 4*64H- Main Street Cotuit,Mass. has been constructed in a cordance witVA- rXisions of Title 5 and the for Disposal System Construction Permit No.`- Z 6 dated e? Installer J.P.Macomber & Son INc. Designer J.P'_.Ff255&ber & Son INC. The issuance of this permit shall not be construed as a guarantee that the syste wi f�n�iion as designed. Date ?7 "� _ CR Inspector NO. _�-'�� - _ - -- - Fee$ 50.00THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS 'Wi5po-5ar br6tem Congtruction permit Permission is hereby granted to Construct( )Repair( )UpgradAXX)Abandon.( ) System located at 1AR3 Main Street Cotuit,Mass. T /O 6 7 .. and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this it. ; Date: 1 1 3�J�'� —Approved by �� IOl9/97 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. a CERTIFICATION OF SKETCH ANDAPPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT ENGINEERED PLANS) 1, Joseph P.Macomber Jr. , hereby certify that the application for disposal works construction permit signed by me dated 8/1 2/98 , concerning the 1otoq _ property located at LJ40 Main Street Cotuit,Mass: meets all of the following criteria: • There are no.wetlands located within 100 feet of the proposed leaching facility There are no private wells within 150 feet of the proposed septic system o There is no increase in flow and/or change in use proposed • There are no variances requested or needed. If the proposed leaching facility will be located within 250 feet of any wetlands, the bottom of the proposed leaching facility will =be located less than fourteen (14) felt above the maximum adjusted groundwater table elevation. t Please complete the following: A)Top.of Ground Elevation (according to the Engineering Division G.I.S. map) B)Observed Groundwater Table Elevation (according to Health Division well map) SIGNED : DATE: LICE SEPTIC SYSTEM INSTALLER IN TH TOWN OF BARNSTABLE NUMBER (Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted). q:health(older:cen i I a 6-330 Cultec r in ' -of 1 n i 42' Perforated 4" pvc pipe F. I Distribution box 1500 gallon .septic ' -, an (� o i 10G7 i - d SENDER: Gam 7 / I also wish to receive the 'o ■Complete items 1 and/or 2 for additional services. �+ ■Complete items 3,4a,and 4b. following services(for an ■Print your name and address on the reverse of this form so that we can return this extra fee): j card to you. I ■Attramc i this form to the front of the mailpiece,or on the back if space does not 1. ❑ Addressee's Address a) ■Write'Retum Receipt Requested'on the mailpiece below the article number. 2. ❑ Restricted Delivery y ■The Return Receipt will show to whom the article was delivered and the date I� C delivered. Consult postmaster for fee. a I -a 3.Article Addressed to: 4a.Article Number cc E �J� 4b.Service Typeze 0 CqZ ❑ Registered Certified °C rn n ❑ Express Mail ❑ Insured S ❑ Return Receipt for Merchandise ❑ COD � c 7.Data of livery w p 5.Received By:(Print Name) 8.Addr ssee' Address(Only if requested c 9and fee is aid) 0 g 6.Si�tressee orZAgQ 0 rn PS FoYm 3 , December 1994 102595-97-13-0179 Domestic Return Receipt UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid USPS Permit No.G-10 a • Print your name,address, and ZIP Code in this box • Public Health DivIS1011 ` town of Barnstable P.O.Box 534 Hyannis,Massachusetts 02601 a Z 203 500 288 " US Postal Service Receipt for Certified Mail No Insurance Coverage Provided. Do not use for International Mail See reverse Sent to Street um P r (tic ,State,&ZJP�Code//'ui� Postage $ Certified Fee Special Delivery Fee Restricted Delivery Fee LO Return Receipt Showing to Whom&Date Delivered Q Retum Receipt Showing to Whom, Q Date,&Addressee's Address QTOTAL Postage&Fees 1$ Zf711>_ M Postmark or Date 0 ur U) a Stick postage stamps to article to cover First-Class postage,certified mail feerand charges for any selected optional services(See front). 1. If you want this receipt postmarked,stick the gummed stub to the right of the return address leaving the receipt attached, and present the article at a post office service window or hand it to your rural carrier(no extra charge). 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the QQ) return address of the article,date,detach,and retain the receipt,and mail the article. 6 3. If you want a return receipt,write the certified mail number and your name and address rn on a return receipt card,Form 3811,and attach it to the front of the article by means of the gummed ends if space permits. Otherwise,affix to back of article. Endorse front of article a t RETURN RECEIPT REQUESTED adjacent to the number. Q I 4. If you want delivery restricted to the addressee, or to an authorized agent of the O addressee,endorse RESTRICTED DELIVERY on the front of the article. M 5. Enter fees for the services requested in the appropriate spaces on the front of this E receipt. If return receipt is requested,check the applicable blocks in item 1 of Form 3811. �`6 6. Save this receipt and present it if you make an inquiry. 102e95-97-e-0145 a Town of Barnstable v� • Department of Health, Safety, and Environmental Services MAW 1639. ,� Public Health Division � Fo ntia'�" P.O. Box 534, Hyannis MA 02601 Office: 508-790-6265 Thomas A McKean,RS,CHO FAX: 508-790-6304 Director of Public Health Ruth and Robert Simpson July 9, 1998 c/o John Conathan 9 Parker Rd. Osterville, 02655 ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL CODE, TITLE 5. The septic system owned by you located at 1067 Main Street, Cotuit was inspected on June 9, 1998 by Robert Bortolotti, a Massachusetts licensed septic inspector. The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • Buckup of sewage into facility or system component due to an overloaded or clogged cesspool. • Cesspool had 24 inches of wastewater at the time of inspection and showed signs of being'up to 60 inches of wastewater. You are directed to hire a licensed Town of Barnstable septic system installer to submit a sketch diagram of a proposed system to the Town of Barnstable Health Division Office (Town Hall, 367 Main Street, Hyannis) that will bring the septic system into compliance with 310 CMR 15.00, The State Environmental Code, Title 5 within (30)thirty days of receipt of this notice. You are also directed to bring the septic system into compliance within sixty(60) days of receipt of this order letter. You are further directed to maintain the system by hiring a licensed septage hauler to pump the septic system to prevent discharge of sewage or effluent into the buildings, onto the surface of the ground, or in to surface waters. Town of Barnstable : Department of Health, Safety, and Environmental Services MwsreBc.>s, 9MASS. a`�p Public Health Division F°^"0 367 Main Street, Hyannis MA 02601 Office: 508-790-6265 Thomas A.McKean,RS,CHO FAX: 508-790-6304 , Director of Public Health i c -� C-4Adadian DATE: c�l� �r-i9 ORDER TO COMPLY WITEF310 CMR 15.00, THE STATE ENVIRONMENTAL CODE, TITLE 5. The septic system owned by you located at was inspected on a Massachusetts licensed septic inspector. - The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due O the following: e L12 You are directed to hire a licensed Town oi;�arnstable septic system installer to submit a sketch diagram of a proposed system to the Town of Barnstable Health Division Office (Town Hall, 367 Main Street, Hyannis) that will bring the septic system into compliance with 310 CMR 15.00, The State Environmental Code, Title 5 within days of receipt of this notice. {30) ,5/X are also directed to bring septic ticsy stem into compliance within t 9 You ;Fdays of P receipt of this order letter. You are further directed to maintain the system by hiring a licensed septage hauler to pump the septic system to prevent discharge of sewage or effluent into the buildings, onto the surface of the ground, or in to surface waters. Any person aggrieved by any order issued by the local approval authority may appeal to any court of competent jurisdiction as provided for by the laws of the Commonwealth. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, R.S., C.H.O. Agent of the Board of Health Any person aggrieved by any order issued by the local approval authority may appeal to any court of competent jurisdiction as provided for by the laws of the Commonwealth. BO �OFHEALTH Thomas A. McKean, R.S., C.H.O. Agent of the Board of Health q\health\dbfiles\title5i.doc cc: T. Geiler R.Bortolotti N/F J CBIDH / Richard C. .& , rn P. Leahy ! CBIDH Fn d 29021245 S 64ol3'07" E ,% / 294. 75 Fnd; �. •� •\a � � 287,E ;` %�` CC) ------T-ION CD 72, MIN W N O _ Existing o,o Z �� 2 Sty �F c� � C) U N W N N. ... f' 4 26 O Exis tin 9 C� L „�O SB Sepiic ` QI -_._. b B0' Cord I i 0BE REMO vED r N i Q_. 0 - 01 r 000 /N --� EExis tin l 9 Porch 3J O PROPOSED SEPTIC SYSTEM - ! 6 (SEE SHEET 2 OF 2 FOR DETAILS) ' PRO. TION ` w DIRECTIONS: From Hyannis - Take Route 28 towards Cotuit; C Take a left at the lights in Cotuit onto Putnam !; Avenue, and follow to the end; Take a left onto 'V Main Street, and house is on the right, #1067. \ r f:•-� ff ,;,1 !4�.`56@Ball .� OVERLAY DISTRICT.- j /79 '�• "o•�'i' l' � AP - Aquifer Protection District °'� •� � As Shown on Plan Entitled ` \x •'�''�' :. �.��; 'Revised Groundwater Protection `•• �'-`-�•• �l I Overlay Districts" - April, 1993 .V1 . 8 . ZONE: NOTES: r i ed� j. •; COW �•�'� il aEls� RF & RPOD 1.) The property line Information shown was ,LOCUS Area (min.) 87,120 SF compiled from available record Information. �r Frontage (min) 150' r \ 40? :•. 2.) The location of the existing structures was obtained �1rd n 5 r�"=.� � ` :•;,;: Setbacks: from an on the ground survey performed on July 19, 1998. Front 30' or between 21/August/02 and 5/September/02. SUwV \`` C`p / ` u •Ib y - Side 15' NO.29� J LJ Rear 15' 3.) The topographic information was obtained ( ,J ' ac • _N ;F y�/r .Ti'f from the Town of Barnstable G.I.S. c+0V00- \ �Fn U LOCATION MAP: FLOOD ZONE: 4.) The datum used is NGVD '29, a fixed mean sea level datum. Scale: 1" - 2000' Zone C \ i ASSESSORS REF.: C 50001 Panel No. \ 250001 0018 D Map 34, Parcel 15 July 2, 7992 Title: Site Plan Prepared By. Prepared For: Date: 06127105 S Proposed Improvements Sullivan Engineering, Inc. CapeSury William H, • & Judith A. Simpson _ A t . PO Box 659 7 Parker Rood Drive Scale., 1' — 20' Osterville, MA 02655 Osterville MA 02655 2532 Hepplewhite 1067 Main Street York, PA, 17404 Barnstable (Cotuit) MASS, (508)428-3344 (508)428-3115 fax (508)420-3994 (508)420-3995 fox Pro ec t #•' 25022 i PSu11PE®bol.com capesurvGcapecod-net DESIGN DATA Single Family - 6 Bedroom With NO Garbage Grinder Daily Flow= 110 x 6 = 660 GPD FT EL.35.0 F.G:EL.30.0 Septic Tank: 660 GPD x 200 % = 1320 GPD '' E' 340 See Note4(t,%T.) R Use 1500 Gallon H-20 Septic Tank I Mi Toy 27.Gn —3 { LEACHING AREA fil 660 GPD / 0.74 = 892 SF Required 1500 Gallon q Septic Tank D-Box 7 " H-20 Sidewall = 202' + 5 5')2 = 268 SF 1 Flow Equilizers __JXh3 7, _ As Re utr «' - ,. Leaching Bottom Area.= I x 5 5 = 660 SF i q E rt4" Chamber -� FI-zo 4 - ; 928 SF Total Provided r ,.�r � - 1 1' - {,,. IS- s°l__ Bot fl.z4.0 Bedding;"T ile Baffels T r.� 10' _I as Per Title 5 AU 11 urnemd Remn.•e li Refof _ 1 LEACHING CHAMBER DESIGN 1 fi n• (See Notes) TheQmeiPeumeterof'�TheSymem I 10'Min.-Slab 20' n-Foam anon All Pipes to be Schedule 40. Use I DEVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM EL.2.S t 6-500 Gal. Leaching Chambers in a f NOT TO SCALE Appmx.Grotmdwear I 12' x 55' Washed Stone Field as Showm. 1 NOTES 1 j1. Water Supply For This Lot is Municipal Water. 2. Location of Utilities Shown on This Plan Are Approx. timoh Grede Lk L At Least 72 Hours Prior to Any Excavation For This 1 Fil to eo paned Fill- /---Faroe Project the Contractor Shall Make the Required i Notification to Dig Safe (1-888-344-7233) Pea Stnne ; - 1 3. The. Contractor is Required to Secure A ro riate Permits From Town Agencies For Construction Defined by This Plan. Illilij I4 g LEACMNG .,, sty e Wald 4. Install Risers to Within 6 of 1, I r n. CHANMER ry Finished Grade. 1 -,•r ` H'�0 is U ,� .= '1 , 5. All Structures Buried Four Feet or More or Subject. if N Traffic OF to Vehicular Trac to be H-20 Loading. '°" "� PETER 6. Septic System to be Installed in Accordance With ( ' S1JWVAI!1! 310 CMR 15.00 Latest Revision and the Town of fi CROSS SECTION OF CHAMBER '2IL Barnstable Board of.Health Regulations. C4Vil NOT TO SCALE 7. All Piping to be Sch: 40 PVC. 8. The Septic Tank Shall Have. an Inlet Tee That I Extends 10" Below the Flow Lane, and an Outlet: Tee that Extends 19" Below the Flow Line. Title: P re ared B PreDared For: 1�0 �`; Site Flan. papeSury o6�27i1 Fro posed Ire rovemertsQ, iNi rn. Sullivan..ullivan Erair7eerin� Inc. W' (,a� N. & Audit. � A. Si,' pson — cr ` 9� Parker Rood PO Box 6 7 Pk Rd r-l1 Scu(e. �S lVG"veU+ At � f�:�s2 Hepplewhite Drive "Q Osfervilie, MA, 02655 osferville MA 02655 1067 Main Street York IDA, 1. 7404 (508)428-3344 (508)428-3115 for (508)420--'3994 (508)420-3995 fox Barnstable (Cotuit), MASS, f'ro„ec c? Cc. PSu11PEQvo1.c om copeaurv�capecod.ne: �' F • _ N/F CB/G H f11 Richard C. & Ann P. Leahy Fn ai CB/DH S 0 Ora 13 '0 7" iE 2902/245 j- 294. 75 ' Fn d \ -O 2871 -�� oo C6 cc 0 2 L / 70 \_ r� O O Existing i _� Sty W�F �� Z '� i wellin v yy - . � - �� .O � lu C 1067 g - # s o i i O Exis t.i p g (J Q ✓ ' `O Septic O - BOH Card 1 TO BE O ' I 1 REMO VED IN 0 Existing / s W O /, Porch W__^ .F, L ERECTIONS; _ _ ._._ _ __ _. -__ �3J �'' - PROPOSED SEPTIC SYSTEM 6 = y y - �" E SHEET 2 OF 2 FOR DETAILS) PRO. CC) a is Take Route 28 towards Cotuit; (St x!� �� T/O^/ :cte a iej.r at r.r;t lights in Cotuit onto Putnam Aver,.—_ arc: follow to the end; Take a left onto Mc � ;Ec oart,' house is on the right, Jj'1067. -- J- ' � � r O' i ! 2 I-- . > 9q .i'.Beach OVERLAY DISTRICT: qi,c AP — Aquifer Protection District `• `—1 V f 4{w' �, r As Sho n on Plan Entitled `9Sp� �d9Q,� \_ O y 1¢ ! 'Revised Groundwater Protection - ia — Overlay Districts" — April, 7993 �• �2 >�� ` r3yoCic 'Landing ZONE: NOTES. Cotuit i* 3 y I I RF & RPOD 1.) The property line information show was LOCUSArea (min.) 87,120 SF compiled from available record Information. w Frontage (min) 150' t J r 2.) The location of the existing structures was obtai,ed14, t Setback s: from an on the ground survey performed on July '9, 1998. Front 30' or between 21/August/02 and 5/5eptember/02. _ Side 15' OF Rear 15' 3.) The topographic information was obtained from the Town of Barnstable G.I.S. PETER SB i LOCATION MAP: FLOOD ZONE: 4.) The datum used is NGVD •29, o fixed mean Sl1LUVAN �.., ; sea level datum. UO 2973.E Fn d Scoie: = 2000' Zone C 61VIL L Community Panel No. ASSESSORS REF.: /250001 00le D - ua"T s4, P&Cei 15 July 2, 1992 .Revision ; Add Perc Tes Doic Dote: 07/27/05; i TH(e: Si to P(a rt Prepared By: Prepared For: Date: 06/27/0� Proposed IMcrcvements ; Ca eSury Sullivan Engineering, Inc. Wi((iar� H, 8� Judith A. Simpson At PO Box 659 7 Parker Road - Scales 1' 20' 1067 Main Street Osterviile, MA 02655 Osterville MA 02655 25- 2 Hepplewhite Drive o crnS'ab(e CCotui U MASS, (508)428-3344 (508)`28-3715 fax (508)426-3994 (508)420-3995 fax York, PA. 17404 Project #ti 250?2 � PSutiP�®bol,cam capesurv®caaecod.ne. . DESIGN DATA ! Single Family - 6 Bedroom With NO Garbage Grinder F.F EL.15.4 Daily Flow= 110 x 6 = 660 GPD F.O.EL.le.p F.G.EL.30:0 Septic Tank: 660 GPD x 200 %= 1320 GPD # (, lzzz See Note 4(t)p.> Use 1500 Gallon H-20 Septic Tank aR�We EL 32 0 Min. 3 1, LEACHING AREA ! 1500'Gallon 660 GPD /0.74 = 892 SF Required - 7 •'� r."r= ,w.; ;�7°'># -,..�E f-'"' ' S tic Tank D-Box H 20 Flow Equilizers H 20 M ` ) ,J z� _ Sidewall = 2(12' 55')2 = 268 SF As-Requiredr,i:x:,... k p ;j Leaching xY NOF ! Bottom Area= 12' X 55' = 660 SF ! EL.2 0 4: Chamber I - g- H-20 -t� 928 SF Total Provided T Bot El.24.0 Pt TER Bedding,"T"s,&Baffels SULLIVAN Ia as Per Title 5_I I IfF_a mtered Remove&Replace Q '4-0.2973> Wt. ADUrsuteWeSoilstl:tdnYor �. LEACHING CHAMBER. DESIGN (See Note 8) ! (3VIL The Other Perimeter oI7Te Syclem 4 i 10'Min.-Slab -� e! 20'Min.-Fo -lion - - -- ! } 'Ce All Pipes to be Schedule 40. Use ! DEVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM EL.2.. J a Approx.Groundwater �� 6-500 Gal: Leaching Chambers in a NOT TO SCALE �!! 12' x 55' Washed Stone Field as Shown. { I � ► -FuuehGrade NOTES PERC TEST: 11 ,043 , - -- I i. 1. Water Supply.For This Lot is Municipal Water. r�aa ` x Filter PERFORMED BY SLILL.IVAN ENGINTERING Min Fabric Compacted Fill WITNESSED BY DONALD DESMARAIS.R.S. { � 2. Location of Utilities Shown on This Plan Are Approx. F ' 1 1 s«�"k', 1-a°•lr^ J?_;LY 21.2005 P�Stene I At Least 7:, Hours Prior to .Any Excavation For This { TEST HOLE 1 ! TEST HOLE - 2 EL.30.0 , Project the. Contractor Shall Make the Rea 'red - !FiL. U.0 i I ( Notification to Dig Safe (1-888-344-7233) O LAYER P OYR 3,3 I ' , O LAYER 1(lY'R 3/3 { j j rt I DARK BROWN ! DARK BROWN 3. The Contractor is Required to Secure Appropriate LEACHING Double Washed 2 ORGANICS -9.8 3" ORGANICS 129.8 Permits From Town Agencies For Construction I `r CHAMBER x A LAYER IOYR 411 A LAYER 10YR 41 Defined by This Plan. ! I i ! s H-20 Fti�� i DARK GRAY DARK GRAY i 6"i SANDY LOAM 29.5 7". SANDY LOAM 129.4 4. Install Risers to Within 6" Of is= - E LAYER IOYR 6'2 E LAYER IOYR 62 ; i Finished Grade. i LIGHT BROWNISH GRAY LIGHT BROWNISH GRAY i LOAMY SAND !�n.l to"! L.OANIY SAND 129 2 ; 5. All Structures Buried Four Feet or More or Subject 1 r 5i 7 , B AVER.�aY'R 5 6 B LAYER irR 10Y R � � j � to Vehicular Traffic to be I-I-_0 Loading. ##i I CROSS SECTION OF CHAMBER y YELLOWISH BROWN YELLOWISH BROVIN 1 i 6. Septic System to be Installed in Accordance With t NOT TO SCALE 26J LOAMY SAND ;�7.8 25"I LOAMY SAND 127.9 IlJ i ! C LAYER 2.5Y 6'4 i C LAYER 2.5Y 6A i. 1. 310 CMR 15.00 Latest Revision and the Town of LIGHT YEl LOvi7S1P BROWN LIGHT YEL,.LCAVISH BROWN ! ( MFD.SAND i I 1 Barnstable Board of.Health Regulations. �- i M.r� SAND ( 7. All Piping to be Sch. 40 PVC. 1 33" PERC TEST 27 3• 110 PERC TEST 2f).8 i 25 GALLONS IN 5 MIN.30 SEC, i 120" LESS THAN 2 MIN.INCH 2O.0 i I 8. The Septic Tank Shall .Have an Inlet Tee That: I 1_41` LESS THAN 2 MIN INCH 1 1y,7 NO(rROt-\7)R'A1 s;R ENCT OL�,rF-RED r i c f '! - I Extends I0 ' :Below the Flow Line, and an Outre� � No GROTUNDLt ATER ENCOITINTM-RED Tee that Extends 19" Beloxv the F1owLine. Revision 1 Add Pero Test Datc Date: 07 27%05i � Title; Site P10r ared e By. rp r or, Prepared �roposeol Ir)�rcvPr?erts �ullivap En�ineerin . Inc. CapeSury `W i I iia it. ' &. JL! '1th A. S?r?Psor AT p , Porker Roos J ' �^' _O(e V ter l Box 559 � ! � � e r f e ! n c- s r !\ Osierville, MA C.2655 0ste-vibe MR 026545 tt.Gam: Vi Li t , V� 1067 Marr, Street - - r� -- - _ _-. r, (508)42H-3344 508j425- 115 fax l o ! ? { Barns able (COtUlt) MASS, _5 8)426-3994 (508j42G-3995 fox I C �,'^C'Je[ is-" r 2Z50 1_:; PSuIFE0boi.com capeaurvdkcpecod.net TJ E v � , low �In ly �qc S ,- c�,r Jrtt \ t•, ttt /, X VA KI TcuE-N - r scREEN 11 r hGAc I v � ; II EATING/SlTT►NG tt ly I tom: - ' I- c tti ;or 4 �E rG VA-C,�- LAUNDR" . ..�. .. ii,'r aii" aid'' uLL.. .Y T .! .� .t •I -err; G-, - R� 1 ' /+ ^.�,h •t;�,_ `^ X n rl b(lr, ( ra � .-- _ - PORCHwALL �Ix - n Vi 2-5 3/4 X 2-5 '.'A ll- ly tt Z >\l r ks) m n, at 1L ' 1 f„ `�r u;•� FRONT PORGYty ^ rl -Tc/ Qicl VVV jov r0. Odt-" a Z HI ty F Q \� l o� ty Ul I e F 1 R S T FLOOR PLAN 2 ry In � { �y (t� -4- U1 uJ 0 0 N N w IT o,c 11 LD ID X ��.y i - - - �f--- -- / a 41 _ 4' L » 2 �r, BEDROO 5 ` 3 , � O I I r in J)! W LTI �. 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