The URL can be used to link to this page

Home My WebLink About0140 PINE RIDGE ROAD - Health T 140,�Pinfe Ridge"Road M A-a:7'0:08 ' .--. -- - -- --- 11 I r I ffi 1 llllmeda� J�,RE cvct F0`o� UPC 12834 a' No. 2-153LW °ST-LONJ�� HASTINGS. MN ..: 1 � ,ice �� r i r I No. �o(� ( I % ': Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ftpliLation for Disposal 6pstpm Construction Vermit Application for a Permit to Construct( ) Repair( ) Upgrade Abandon( ) [:]Complete System ❑Individual Components Location Address or Lot No./ h fi Ore nr's NAea ame,Address,and Tel.No. Cnl G. k0lot If Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Na e,Address,and Tel.No. PKK ee()trpcfix:s g - keger +gns !=n •—pp 60X RS I TI pe of Building: r i Dwelling No.of Bedrooms `'t Lot Size sq.ft. Garbage Grinder( ) Other Type of Building R495�0 �_ No.of Persons Showers( ) Cafeteria( ) Other Fixtures `',, 1 Design Flow(min.required) 440 gpd Design flow provided () gpd Plan Date cZ n_ 118 b� Number of sheets �— Revision Date Title " CZ �� Size of Septic Tank 1-5-0 Q�/iip� Type of S.A.S. Description of Soil Jj Nature of Repairs or Alterations(Answer when applicable) / llafim Map Ar 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 TitlFf 4nr �nt �' ode and not to pl e the system in operation until a Certificate of Compliance has been issued by this B V_ J Signed Date O o Application Approved by �q Date Application Disapproved by 1 Date for the following reasons P1,dfi�j �j1 . �n -J� Permit No. Date Issue ' s No. 4V(([ Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in-computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS JYes A f' .s} � appHcatl.On for MISpDBaY 6p8teltt COlIBtrULtlDn permit Application for a Permit to Construct( ) 'Repair( J Upgrade Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. /40 Pit)e le i O ner's Name,Address,and Tel.No. (,p-tvA + ( r� G, uc Ca ll Assessor's Map/Parcel J Installer's Name,Address,and jel.No. Designer's N e,Address,and Tel.No. PKH Clo�tro4t)m nG �$ - ke�er -� ins Tnc — pp Qo� 48 313 No (6c1� & OemI'S ooV q/ 385�993 F SGnclu/i(1a- O S 3 Type of Building:r Dwelling No.of Bedrooms 4 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building IZJ�61 CC ()4 6 No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 440 gpd Design flow provided gpd Plan Date 'Aft-IIM °R 11� 1�° Number of sheets Revision Date Title R,,&0 rG1 G. MC Ca 1M ` Size of Septic Tank )-60 QQ 11,9 Type of S.A.S. QQG� Description of Soil (a i �p (m- op�I-t 50,1 J Nature of Repairs or Alterations(Answer when applicable) C120 an0a, l - 1 20 13 0 11 n C-Ac loe r"S" "o I . e lnv_ 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 df e En o, ental`Code and not to pl ce the system in operation until a Certificate of Compliance has been issued by this Board < He Signed CJ Date 0 Application Approved by C Date 3 O ((., Application Disapproved by � (��e,6 2 � P5 Date J p for the followin reasons°Y, l�ul�f1/�-5 Gn AT-6(-6 i� �/�g, 1/t /0 - 5g tip• j&�42,(G1,t ' Permit No. Date Issued ------------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS c BARNSTABLE,MASSACHUSETTS . == ; (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded,P'O Abandoned( )by �{l l't�H (1-}1'Ta (S o<, `` r f' ar - has-been constructed in accordance ll - with the provisions of Title 5 and the for Disposal System Construction Permit No. �' '�l 7 S dated 21 �/.�, Installer I�n Pi 130 12� � � Designer HQ.�{Q( Sons Tn C r 1�lr.#bedrooms ( Approved design fl\ow-� 44 f) gpd ; The issuance o, this pe- it shall not be construed asya guarantee that the system vFil1 function as designed. Date 1 g I}� Inspector -------------------------------------------------------------------------------------------------- ------------------------------------ No. t�o f(, — b �S Fee Sn i s THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Die-posal *pstem Construction Permit Permission is hereby granted to Construct( ) Repair( ) Upgrade(� Abandon rr110 ( ) System located at IfJ � dct_ 5 and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. { Date 3& Approved by 1 I I Town of Barnstable ..°�T"E'Owti Regulatory Services HAP C� Richard V. Scali, Interim Director • anxNysrna[.e. . MASS. Public Health Division i639• ♦� ATE1 3as°i Thomas McKean, Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: 7 -'0 � Sewage Permit# Assessor's Map\Parcel C)! � �(�2) Designer: Installer: Address: d l'J0_� C�lz� � Address: On was issued a permit to install a (date) 1 (installer) septic system at 1 �7 V11e1 based on a design drawn by (address) < <� dated ( esign r) )(Icertify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out (if required) was inspected and the soils were found satisfactory. I cVq that the system referenced above was constructe e with the terms ,o �A approval letters if applicable) �E 7n�str's ignature) NO �- 3 �bl�lo igner's gnature) (Affix DesignerMmp Here) PLEASE RETURN TO BARNST LE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:\Septic\Designer Certification Form Rev 8-14-13.doc C�' Town of Barnstable Barnstable Regulatory Services Department p snsuvsrast�, 6 Public Health Division fD'" A 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 t Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7015 1730 0001 4990 4636 January 20, 20.16 Richard McCall 56 Silker Road Glen Gardener,NJ 06826 x ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE,TITLE 5 The septic system located^at 140 Pine Ridge Road, Cotuit,MA was last inspected on • October 26, , 2015,by Shawn Mcelroy,a certified septic inspector for the State of Massachusetts: The inspection of the septic'system showed that the system"Failed" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: C Leaching pit or cesspool with high liquid level,<12" below inlet)per Town_ _ Code 360-91). You are ordered to.repair or replace the septic system within two (2)years) 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 = Thomas McKean R.S., CHO: Agent of the Board of Health ` G� i Q:\SEPTIC\Letters Septic Inspection Failures or Future Evl\140 Pine Ridge Rd Cot Nov 2015 Town of Barnstable E AHN3f" A MASn& ,gym Regulatory Services Department ArFp MAC� Public Health Division 200 Main Street,Hyannis MA 02601 Office: 508-862-4644 Richard Scab,Director FAX: 508-790-6304 Thomas A McKean,CHO Feb 6,•2007 Rev. 7/6/15 DEADLINES TO REPAIR"FAILED SYSTEMS (Town Code §366-44 and Title V: 310 CMR 15.000) An"x"marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ONE:(1)YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or.cesspool ❑Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑ Any portion of the cesspool within a Zone 1 to a public well ❑Any.portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2)YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑Any"conditionally passed systems" (broken cover,relocation of a pipe,relocation of a�driveway due to H-10 components., etc) Leaching pit or cesspool with high liquid level, <12"below inlet(per Town Code §360-9.1) OTHER Repaii deadline: WSEPTICIDEADLINES TO REPAIR FAILED SYSTEMS.doc Commonwealth of Massachusetts Title 5 Official Inspection fdr'nm Subsurface Sewage Disposal System,Form -Not for Vol untaryAssessments• , M 140 Pine Ridge Rd s _ Property Address ^a Richard McCall 4a' Owner Owner's Na , h information is it MA 02635 t ou 10-26-15 - required for every C page. City/Town r ,. State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection fonns'niay 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 address and that the f , , ,information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I•am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000).The system: ❑ .,Passes / ❑ Conditionally Passes,.-� ® Fails Ej Needs Further Evaluation by.the Local Approving Authority, s t •,,_ 16'26-15' Inspector's Signature ' Date ` ' The system inspector shall submit a copy'of tfils'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. �0 �S t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal Page 1 of 17 Commonwealth of Massachusetts ' W Title 5 Official, Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 5•�''t 140 Pine Ridge Rd Property Address Richard McCall Owner Owner's Name information is required for every Cotuit MA 02635 10-26-15 page. Cityrrown 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: ti 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. r Check the box for"yes", "no"or"not determined" (Y, N, ND)for,the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): 1 t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts y. ._ '..• :- _ Title 5 Official. Inspection Form Subsurface Sewage Disposal System Form;-Not for Voluntary Assessments ; 140 Pine Ridge Rd i A Fes. Property Address Richard McCall Owner Owner's Name information is required for every Cotuit - +r MA 02635 10-26-15. ry e. CityFrown State Zip Code Date of Inspection page. ti P B. Certification (cont.) � +_ . ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if ' pumps/alarms are repaired: B) System Conditionally Passes(cont.): > Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or'uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ ~ broken pipe(s) are replaced y❑ Yr' ❑ N ❑ 'ND (Explain below): ' ❑' .obstruction is removed' i, ❑ Y '❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced '❑ Y ❑'N ' ❑''ND (Explain below): ' .r to b L, ❑ 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: , ; ,, r i ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment: ' 1 t System will pass'unless doard of Health'determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑' .Cesspool or"privy'is within 50 feet of a surface water ❑ 3 Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh i t5ins•3/13 r Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts m W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments, 140 Pine Ridge Rd Property Address P Y Richard McCall Owner Owner's Name information is required for every Cotuit MA 02635 10-26-15 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: I I . . ❑ 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 and 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 ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool s El ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in,the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ® ❑ Liquid depth in cesspool is less than 6° below invert or available volume is less than Y2 day flow t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts F Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form Not for Voluntary Assessments. 140 Pine Ridge Rd ,,w ;, • -i,, f Property Address Richard McCall Owner Owner's Name information is required for every Cotuit MA 02635 10-26-15 c page. City/Town State Zip Code Date of,inspeption B. Certification (cost.) Yes No ❑ ® 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. ❑ ® 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 ' ❑ '® j Any portion of a cesspool or,privy is within 50 feet of a private water supply well. ` -❑ ® ,Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water'supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] The system is a cesspool serving a facility with a design flow of 2000gpd- ® ,. 10%000gpd. r 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 system.owner should contact the Board of Health to determine what will be necessary.to correct the failure. �, = E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. - For,large systems, you must indicate either"yes"or"no"to.,each of the following, in addition to the questions in Section D.,! , , +•. - t, Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface.drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area= IWPA) or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments � 140 Pine Ridge Rd Property Address Richard McCall Owner Owner's Name information is required for every Cotuit MA 02635 10-26-15 page. Cityfrown State Zip Code Date of Inspection C. Checklist f 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? El ® Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ ® Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of 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 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): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form+ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 140 Pine Ridge Rd Property Address f Richard McCall Owner Owner's Name information is required for every Cotuit •MA 02635 10-26-15 page. CityfTown State Zip Code Date of Inspection D. System Information , -{•' ,, . Description: W Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundryon a separate sewage system? Include laundry system inspection P 9 Y ( rY y , . . . ❑ information in this report.) Yes ® No Laundry system'Inspecied? p ❑ Yes E No p Seasonal use? _ , ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)):. ,,r Detail: s i• e ,• i .roc Sump pump? , r i �. , _ r *� , ❑ Yes ® No p 11-2015 Last date of occupancy: _ Date Commercial/Industrial Flow Conditions: e �. -► Type of Establishment: Design flow(based on 310.CMR.15.203): ,: - , Gallons per day(gpd) r, Basis of design flow(seats/persons/sq.ft., etc.):., Grease trap present? ❑ Yes ❑ No , •i. Industrial waste holding tank present?,. , -. , ,' ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts ' Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 140 Pine Ridge Rd Property Address Richard McCall Owner Owner's Name information is required for every Cotuit MA 02635 10-26-15 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: 01 Source of information: Owner--pumped 3 weeks ago Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: 11 • gallons How was quantity pumped determined? Reason for pumping: Maintenance 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form =Not4or Voluntary Assessments t . M 140 Pine Ridge Rd r Property Address Richard McCall Owner Owner's Name information is required for every Cotuit - MA 02635 10-26-15 .. ' page. City/-rown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1970's Were sewage odors detected when arriving at the site? ifs 0 Yes ® No Building Sewer(locate on site plan): Depth below grade: ► ' ' ' ' r 24"feet' Material of construction: t• r, , ®'cast iron y ® 40 PVC ®'other(explain):' Orangeburg . Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Good condition. Septic Tank(locate on site plan): Depth below grade: N/A feet '• Material of construction: 5 ❑ 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: Sludge depth: t5ins•3/13 , Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 140 Pine Ridge Rd Property Address Richard McCall Owner Owner's Name information is required for every Cotuit MA 02635 10-26-15 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 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 How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions` Scum thickness Distance from top of scum to top of outlet tee or baffle' Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3113 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. , ., L'M 140 Pine Ridge Rd Property Address Richard McCall A, t ,' Owner Owner's Name information is required for every Cotuit MA 02635 10-26-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) ., :,, , - .., , Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage; etc.j:t' ' 'Jt I t, 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts ' Title 5 Official Inspection Form Subsurface Sewage Disposal System Form•Not for Voluntary Assessments M 140 Pine Ridge Rd - Property Address Richard McCall Owner Owner's Name information is required for every Cotuit MA 02635 10-26-15 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.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 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,. - 140 Pine Ridge Rd x Property Address Richard McCall Owner Owner's Name information is Cotuit MA 02635 10-26-15 required for every ' page. Cityrrown State , Zip Code Date of,Inspection t D. System Information (cont.) Type: - ❑ leaching pits ' number: ❑ leaching chambers ,number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number;dimensions: ® overflow cesspool number: 1-6x6 ❑ innovative/alternative system t Type/name of technology: ; Comments,(note,condition of soil, signs of hydraulic failure, level of,ponding,damp soil, condition of vegetation, etc.): , Leaching cesspool was filled beyond capacity at inspection. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration 2-Inline Depth—top of liquid to inlet invert 0--Over Depth of solids layer 0 Depth of scum layer 0 Dimensions of cesspool 6x6 Materials of construction Block Indication of groundwater inflow ❑ Yes ® No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 140 Pine Ridge Rd Property Address Richard McCall Owner Owner's Name information is Cotuit �` MA 02635 10-26-15 " required for every ' page. Cityrrown 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.): Both cesspools were in poor condition and in need of repair at inspection. 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 _ Commonwealth of Massachusetts W Title 5 Official Inspection. Form 'm o Subsurface Sewage-Disposal System Form -Not for Voluntary Assessments- w >a 140 Pine Ridge Rd Property Address Richard McCall Owner Owner's Name information is required for every Cotuit MA 02635 10-26-15. f page. City/Town State Zip Code Date of Inspection " D. System Information (cont.) Sketch Of Sewage Disposal 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 ' iU - V ti' 0A . l '•, 1 r Ff"•E . 'A3 i-y y�.. „ 1 °`'.'J 1-"' rt't. r t5ins•W 3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 140 Pine Ridge Rd Property Address Richard McCall - Owner Owner's Name information is Cotuit MA 02635 10-26-15 required for every ' page. City/Town State Zip Code Date of Inspection D. System Information (cont.) - Site Exam: ❑ Check Slope ° fi ❑ Surface water , ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 12'+ 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 12'. I Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3113 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 140 Pine Ridge Rd Property Address Richard McCall Owner Owner's Name information is required for every Cotuit MA 02635 10-26-15 page" City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Town of Barnstable P# Department of Regulatory Services RUIBLA Public Health Division Date w 200 Main Street,Hyannis MA 02601 KAM - Date Scheduled " Time _ Fee Pd. lUl/ f/k • i _ 1, _ Fi s � u Soil >!ritahility Assess�a er�i fog,Sew a Disposal41 Performed By: ) 1" t Qi ! Witnessed By: ^ i LOCATION t5i GENERAL INFORMATION Location Address Owner's Name M 6 Cl t- (� r ` p 50 S 1 t,Y-e� �D Address G(.ate N4,19ri PIT Assessor's Map/P�tcel: 0100 ,Engineer's Name' �(��/60T i .�. NEW CONSTRUeCION REPAIR X ° Telephone# -Sb X 3.6v^ Land Use �J�N t l�1 v Slopes(To) - Surface Stones 260 2�0 ft Drinking Water Well ft Distances from: Open Water Body ft Possible Wet!Area Drainage Way �b ft 1 Property Line �l� i-•ft, `.:Other � ft J SKETCH:(street name,dimensions of lot,exact locations of test holes&Pere tests,locate wetlands in proximity to holes) Y-v �)A p � . Parent material(ge(ilogic) (n�'(v✓�5 Depth to Bedrock Depth to Groundwater, Standing Water in Hole q ;. i Weeping from Pit Face Estimated SeasonaMigh Groundwater / )A-- - - Dt ATION FOR SEASONAL HIGH WATER TALE Method Used: ! in. Depth td Sall mottles: in, Depth ubpse ed standing in obs.hole: in. aroundwater Adjustinent Depth tolweeping from side of obs.hole _ A Adj,Oroundwaterl ev�el,,,,e, Index Well# Reading Date: Index Well level - dI I PERCOLATION TI ST • Date— TIni-t—. Observation L 3 Time at 9" A -- Hole# - .. Time at G" Depth of Pere 1 Q?j I l2 i Time'(911-6") Start Pre-soak Time.@ I End Pre-soak Rate Min-Aneh Additional Testing Needed(Y/N) Site Suitability Assessment: Site Passed__ —_ Site Failed: original:.Public b41th Division Observation Hole Data To B e Completed on Back— ***If percolaOn test is to be conducted within 100 of wetland,you must first notify the Barnstable C4.4servation Division at least one(1)week prior to beginning. DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistenc %Gravel ILA b" 'Iti' fT LoGw► SA,49 I�� 31y t (0 . Su'A r. DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistenc %Gra el �" 2,' rv► SAID ( "l v >f it Se 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 d DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color $oll Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consisten ra I 0` 2 'Z � Flood Insurance Rate Map: 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 pervious material? a Certification I certify that on cflD (date)I have passed the soil evaluator examination approved by the Department of Environn iental Protection and that the above analysis was performed by me consistent with the required tra nin a pertise a experience described in 30 CNM 15.01 Signature Date 3 . Q:\.SEPTIC\PERCFORM.DOC i UNITED.STATES POSTAL SERVICE First-Class Mail USPS9e&Fees Paid Permit No.G-10 • Sender. Please print your name, address, and ZIP+4 in this box• Town of Barnstable. � Health Division ,F 200 Main Street91 �FO MC . Hyannis,MA 02601 WON 13"7 1 lilt'111111111 FIT 171 I COMPLETE THI SECTION ON DELIVERY IN Complete items_1,2,and 3.Also complete A. Signat item 4 if Restricted Delivery is desired. ❑Agent ■ Print your name and address on the reverse X ❑Addressee so that we can return the card to you. el' &P�1 Name) C. Date of Delivery ■ Attach this card'to the back of the mailpiece, '' or on the .ont,if space permits. ' �. Is delivery'add d' re from Rem 1? ❑Yes 1. Article Addre to: r If YES,enter d v ry add s below: ❑No 3. 11Ss vie= VOSEFFIeturn MailCert D'Regl j Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes j 2. Article Number i., s t r f � t r 6 0.'• �061ri:a . • rua �"' `" est 6 Return I#eceipt 1025957M-1540 i 4e• Certified Mail#7006 0810 0000 3524 8806 �0.pIKE ro Town of Barnstable Regulatory Services * BARNS-TABLE, ' 9 MASS. Thomas F. Geiler,Director �O 16S9. �0 Arf4MAta Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Ski x=, Office: 508-862-4644 Fax: 508-790-6304 March 9, 2007 r. Richard McCall 56 Silker Road Glen Gardner,NJ 08826 ' NOTICE TO.ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE II — MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE CODE CHAPTER 170. The property owned by you located at 140 Pine Ridge Road, Cotuit, was inspected on March 8, 2007 by Meredith Morgan, Health Inspector for the Town of Barnstable. This inspection was conducted on the basis of the rental registration in accordance with Chapter 170 of the Town of Barnstable Code. The following violations of the State Sanitary Code were observed: 105 CMR 4.10.482 —Smoke Detectors. Inoperable smoke detectors. You are directed to correct the violations listed above within thirty (30) days of your receipt of this notice by providing operable smoke detectors on every habitable floor, and just outside each separate sleeping area. You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the order is served. Non-compliance will result in a fine of $100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. Should you have any questions regarding the above violations, please contact the Town Health Division and ask to speak with the inspector who performed the inspection. QAOrder letters\Housing violations\Rental ordinance\140 Pine Ridge Road.doe PER ORDER OF T BOARD OF HEALTH s A. McKean, R.S., CHO Director of Public Health Town of Barnstable Cc: David Hendrick Cc: Meredith Morgan, Health Inspector .QAOrder letters\Housing violations\Rental ordinance\140 Pine Ridge Road.doc Certified Mail#0000 0000 0000 0000 0000 r Town of Barnstable art ' Regulatory Services Thomas F. Geiler, Director Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 date loivdr Ss ,P L us city,state,zip NOTICE TO ABATE VIOLATIONS OF 105 CMR 41 0.0001 STATE SANITARY CODE II — MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE CODE CHAPTER 170. The property owned by you located at d I 2 0� I as inspected (Address) on 3/ /� by M ' Health Inspector for the Town (date) (Inspector's name) of Barnstable, Il (Reason for inspection) The following violation(s) of the State Sanitary Code were observed: State code violation number-violation des ri tion 105 CMR 410.�� _ S 1' AX 105 CMR 410: 105 CMR 410. 105 CMR 410. Q:\Order letters\Housing violations\Rental ordinance\template.doc 105 CMR 410. The following violation(s) of the Town of Barnstable Code were observed: (Town code violation number-violation description) , §170-_ - §170-_- You are directed to correct the violations listed above within t ) days.. • (written W of your receipt of this notice by 1'' I �S /va', C +e P taxlq- You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the order is served. Non-compliance will result in a fine of $100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. Should you have any questions regarding the above violations, please contact the Town Health Division and ask to speak with the inspector who performed the inspection. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean,R.S., CHO Director of Public Health Town of Barnstable Cc: NIA (Name,tenant,owner,Fire Dept.,Building Dept....) Cc: / l (Health inspector's name) (Generic codes located at Q:\Order letters\Housing violations\Rental Ordinance\GENERIC CODES.DOC) QAOrder letters\Housing violations\Rental ordinance\template.doc Town of Barnstable Regulatory Services R BA BM Thomas F. Geiler,Director a0 NAsfi 16;9.. $ public Health Division ArFO MAC A, Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 March 8, 2007 Attn: COMM Fire Health Inspector Meredith E. Morgan conducted, a rental inspection in accordance with Chapter 170 of the Town of Barnstable Code. In accordance with the State Sanitary Code, 105 CMR 410.482, the Health Department is required to notify the Fire Department if there is a smoke detector violation, or possible smoke detector violation. The following property had possible smoke detector(and\or.CO detector) violation(s): 140 Pine Ridge Road, Cotuit,Assessors Map-Parcel: ( 018-008): Rental property lacking operable smoke detectors. Property currently unoccupied. Mere th E. Morgan -Health Inspector Q:\Order letters\Housing viol ations\Rental ordinance\\Fire Violations\FIRE TEMPLATE.doc FORM30 l,H&W HOBBSBWARREN'M THE COMMONWEALTH OF MASSACHUSETTS • B RD OF HEALTH CITY/TOWN = W i4l,lab �� v I DEPART ENT MtWAW ADDRE !� / q '"n, SV a�`•�. LEPH E Address Ao l �_�'[ `e �li►. L U tpant_ J�_),1 wy,- Floor Apartment No. 1 _No. of Occup nts_ -� - No.of Habitable Rooms No.Sleeping Rooms No. dwelling or rooming units N ores_ _ Name and address of ownerx� 1_� rrd n7wY Remarks Reg. Vio. YARD Out Bld s.: Fences: Garbage and Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: ❑ B ❑ F ' ❑ M Doors,Windows: Rocf Gutters, Drains: Walls: Foundation: Chimney: BASEMENT Gen.Sanitation: Dampness: Stairs: Li htin STRUCTURE INT. Hall. Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: Central ❑ Y ❑ N Equip. Repair TYPE: Stacks, Flues,Vents: 5� C` .-r N- PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusing,Grnd.: AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den Living Room Bedroom 1 j� Bedroom 2 ,,9 Bedroom 3 ve Bedroom 4 Hot Water Facil. Sup.Ten., Gas, Oil, Elect.: Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink Stove Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin,Shower or Tub: Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: General Building Posted Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR. (See Over) "THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES Ok R ER UR . ' INSPECTOR �, V TITLEI A. DATE TIME `T 5' _ P.M. >b A.M. THE NEXT SCHEDULED REINSPECTION P.M. s �, f q'`rr.T .. .�Yr.. ��" . Y. , ' .. !h�-r:.Are.. s*` '-'' . <, ;♦ »«�y,„ ' r, - . r 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions, when found to exist in residential premises, shali be deemed conditions which may endanger or impair the heaith, or safety and well-being of a person or persons occupying the premises. This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter 11, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B) and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450,,410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of teadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof, foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. i (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2) and 410.150(A)(3)or any defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B): (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0) shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the Board of Health. TOWN OF BARNSTABLE LOCATION Iq le \ZiA4c \ZI SEWAGE# 0'0/6-571 VILLAGE �^� �-u►} ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. P 1L A S63_ 3?S'"S9 q J SEPTIC TANK CAPACITY LEACHING FACILITY: (type) :.l 11<44 eHffi(stze) gz y NO.OF BEDROOMS OWNER M f-.c rd PERMIT DATE: 3"f S'-/6 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 5� q eL j ?ca `77 ° m va ) - PS A4 �3' W-7 Nn g`y'' � 93 OD �� 37'6 TQ dl~B & ABE L.VA17014 . I �"6 �� e� SEWAGE e iMT J.J-ER'S N',* E Pl I{?l I�itl SE MC'TAN LEACkIIlNG;�ACL ' BtTIE C?R ow-MR,, F�l 'FD1�T8: �t7l�PLI�iNC�:I?ATE:, Sopatstton Distance Betvteen E3ae ' AM lvlaxiuriumAdjsted Gmundwatsr Table to the Bottom of I.eachingFacii�ty �FEet` Pnxate�b►aterSupply deli and L eac#ung Failatyfaay vreBs ex�si oa$1 a or.watt 'n 2(30 feet of IeaclnU fat ty} � Edge of VFfatland and'I.eactung l�ac•.ility(If any wetlands eXtsi` within 3fl(1`feet leaciun�facility) C : Le Furnished by' :` G ^f. Sin v � C7 0-3cf' 0 -3 f' VO L0 C A T n 9 SEWAGE PERMIT N0 1116 Al f i 64 /L VULAG E I N S T A LLER'S NAME i ADDRESS a U I L D E R OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE- ISSUED /Nv w� F .r TOWN OF BARNSTABLE LOCATION _ JqQ ��le 1Zid4e �ZI SEWAGE# }l(G—�7S VILLAGE ASSESSOR'S MAP&PARCEL 01 Q—M O INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY /SC)O �w LEACHING FACILITY: (type) 3 _00 •-;,I ICU a h6ffi(s2ze) NO.OF BEDROOMS LF OWNER D CC C J J PERMIT DATE: 3" S�—�(o 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 J 44 i L f �aV, Ohl • � 9 R b. ._. { TOWN Or BLS AB ?v LOCATIota ' c�� o sEwAc VII.I.AGE_( o pt c ASSESSORS MAP&LOT - IINSTALL—MS NAW&.PHOM NO. SEI''IZC T.&NK CAFAC T Y IEACILING FAC 'I'`f..(tYpe): � dd (size) 'NO.OF-BEDROOMS bun om OR OWNER PER FDATE: CMULtA M DATE:' Separation Distance Between tbe: maximumAdjusted GroundwaWTabie to'ihe Bottom of LeadhitigFacility Fe -Private water Supply Well and Leaching facility. (If any weUs mist e site or u ithin 200,Aet af.les chug faelira') Edge of wetland and Leaching r=Mty:(if any.wedan&,exist within 300.feet -leaching faei ) e Furnished by �� Lj10 4 _ ,0-3Y, U 3 f� C, i 1 L0 C A T nn SEWAGE PERMIT NO. VILLAGE INSTA LLER'S NAME i ADDRESS A U I L D E R OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED a r2�� u COTUIT SCHOO 5T. • Ltd US PARCEL ID �"V ryP., 018 f 12 �DOGE PINE � LOOP ul BEAVH. PARCEL ID ' f '. 018/ T' � . r. x fi PARCEL ID. LOCUS MAP Tib , -� l ;} 40 018 10 LOCUS INFORMATION + PLAN REF, 371 95 k a✓+A , F,. +� ` " Tl TLE REF. 21336 f 2f 5 }e PARCEL Its. MAP18 PAR. 08 "u.ay �YY1NOT IN ZONE 11 FLOOD ZONE: "X" , je 0 ._ , COMMUNITY PANEL. 25001C4752J :DATED:07,i/16/14 co WOODED / . ___ PARCEL 10: 40 018/08 SEPTIC SYSTEM • `=2Vf6. J` A2 * s.�. T FARE REPAIR PLAN LOCATED AT: Dtck r.. 140 PINE RIDGE ROAD COTUIT, MA. UPOLE E - �l PARCEL ID. PREPARED FOR 018/09 GENERAL NOTES: , � � R I H R D G. LL FEBRUARY 18, 2016 REV: 3/3,/1C,°3,/1r /'15. 1 A ALL CHANGES TO THIS PLAN MUST BE APPROVeD BY THE NA Ai. 0, w co BOARD OF HEALTH AND THE DESIGN ENGINEER.ER. Iry 2.. ALL WORK AND IuIA'TERIALS SHALL CONFORM TO THE REQUIREMENT 5 OF THE STATE ENVIRONMENTAL CODE. TITLE V, AND <ANY APPLICABLE t � �� LOCAL RULES AND REGULATIONS. 3. THE SEWAGE DISPOSAL SYSTEM $HALL NOT BE BACKnLLED PRIOR x' '� D E TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE DESIGN ENGINEER, 0,1q R ...� v y . 4. A,NY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING TBMUM: COO � 0 FROM THOSE SHOWN HEREON SHALL RE REPORTED TO THE DESIGN BR. PLFM ' ENGINEER BEFORE CONSTRUCTION CONTINUES. FL 26.00 6, ALL ELEVATIONS BASED ON ASSUMED DATUM. UPOLE S. THE DESIGN ENGINEER IS NOTRESPONSIBLE. FOR THE FAILURE OF THE. CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF HEALTH FOR PROPER INSPECTN!ONS DURING CONSTRUCTION. 7. WATER SUPPLY" PROVIDED BY TOWN WATER SERVICE. 8 ALL. ARC DISTURBED DURING CONSTRUCTION SMALL BE RED. TO A CUN�IDITNON AGREED UPON BETYVEEN OWNER AND Cr�'PNTNi'AC'on 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE SCALE- 1`0_:30t THE LOCATION OF ALL UNDERGROUND 1TT1UnES. PRIOR TO BEGINNING MEYERC INC.I SONS, CONSTRUCTION. � 10. EXISTING CESSPOOLS TO BE PUMPED, CRUSHED AND FILLED PER TITLE '5. -LEGENDP. O. BOX r 8 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION PROPOSED CONTOUR T UR 0 12, THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY EATSANDWICH , A. 5 7 AND 1S NOT TO BE CONSIDERED A PROPERTY LINE SURVEY PROPOSED SPOT GRADE 13. NO PRIVATE WELLS WITHIN 150' OF PROPOSED LEACHING. 14 NO WETLANDS WITHIN 1 t�I?' OF PROPOSED LEACHING. .,.., .a... �� ,a......,.a,. EXISTING CONTOUR FAX��. : (774)413-9468 �� '��""'� 1 I& ALL PIPING TO BE a SCH 40 0 1,/8"/FT (UNLESS SPECIFIED) + 96.52 EXISTING -SPOT GRADE' 16, TO THE BEST OF OUR KNOWLEDGE, THIS PROPERTY IS NOT IN ZONE It, meyerandsonsinc@gmail.com NOR ESTUARIES PRAT. DISTRICT" AND IS NOT ABUTTED BY ANY PROPERTIES " EXISTING WATER SERVICE SN "NCED BY A PRIVATE tiIIEN.L: TEST` I�IT,>s _ _ MEET 1 0F 2 J l 809 ELEV. TOP FOUNDATION, NOTE: PLACE MAGNETIC MARKING TAPE OVER ALA. COVERS (Existing) B "° RING ALL COVERS TO WITHIN FINISH GRADE FINISHED GRADE (21.5) 25.6 F.G.EL- 24.3 F.G,EL; 23.0 F.G. EL: 22.0 MAINTAIN MIN SLOPE OVER LEACHING AREA A. 2" 4F 3/8" DOUBLE V, WASHED �r F.G,EL; 22.2 NE C9R FILTER FABRIC ,` 3/4" ,� 1-1/2" .� , . . • DOUBLE WASHED STONE �..... , 4" 5CH 40 PVC 001 �►: TE*S ARE TQ eE 1' �` III . �I � > � � � 4" SC'H 40 PVC F. DEPTH �6119010113 Wawa 63 63110 II` V. 0-95 INV. 19.8 GAS PROPOSED DB--3 EXISTING OUTLET BAFFLE EFFECTIVE LENGTH = 33.5' III '. 22. ' II'� 'd 21 .2 . ' DISTRIBUTION BOX (H D I NV. E:LE'V.= 18. 0 PROPOSED 1 ,500 GALLON SEPTIC TANK GAS BAFFLE TO E INSTALLED ON ��` �� ' ��,� BREAKOUT OUTLET TEE AS MANUFACTURED BY TUF- ITE, ZABEL, OR EQUAL TOP CONC. ELEV.- 19.60 NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING 10 .3 3I63163 PIPE INVERTS PRIOR TO CONSTRUCTION 6 63636363 2) TANK AND D-BOX SHALL BE SET LEVEL AND VITA `�`� , BOTTOM EL.= 16.60 a II631@1@10 TRUE TO GRADE ON A MECHANICALLY 'COMPACTED 3. FT. 3, - SIX INCH CRUSHED STONE BASE, A$ SPECIFIED IN +� ' �' ' 310 CMR 15.221(� � EFFECTIVE� I'I D TIC 1 ' 1 SEPARATION 5.00 FT. 3) INSTALL INLET & CUTLET TEES W SEPTIC GAS BAFFLE AS REQUIRED SYSTEM PROFILE BOTTOM OF TESTHOLE EL: 11 .60 SOIL A05QRPTIQU ' YTEM S TI N 500 GALLON LEACH CHAMBER SOIL LOGS , :1 DESIGN CRITERIA NUMBER OF BEDROOMS: 3 BEDROOOM EXIST./4 BEDROOM DESIGN DATE FEBRUARY 2, 2016 SOIL TEXTURAL CLASS:: CLASS 1 (0.74 GPD/SF) SOIL EVALUATOR: DARREN MEYER, R.S., CSE #1614 DESIGN PERCOLA11 fN DATE: t2 MIN IN WITNESS: DAVE STANTON, BARNSTABLE HEALTH DAILY FLOW: 1"1D G.P.D. X 4 BR = DESIGN FLOW: 440 G.P.D. GARBAGE GRINDER. NO (not designed for garbage grinder) SEPTIC TANK, Elev. TP-1 Depth Elev.' TP-- Elev. TP-3 Depth EMo TP-4 h th 440 gPd x 200 880 gPd, USE PROPOSED 1,500 GAL. SEPTIC TANK 23.0 A on 22.6 A on 23.0 A A pt LEACHING AREA REQUIRED: ( = 594.59 S.F. LOAMY SAND LOAMY SAND` LOAMY MY' SAS LOAMY SAND .74 1OYR 3/2 1OYR 3/2 10YR 3/2 1OYR 3/2 22.0 12'" 21.6 B 12" 22.0 12"` 21.6 12"' USE THREE (3) 500 GALLON PRECAST LEACH CHAMBERS W/ 4' LOAMY SAID LOAMY SAND � LOAMY SAND LOAMY LOAMY SAID STONE ON ENDS & .75' STONE ON SIDES. 33. ' L x 12.5' W x 2"D 1O R 5/8 Im 5/8 10YR' 5/8 1" 5/82fl.C18 35" 19.6S 35" 20�bB 35" 19.61� 35'" Bt�TTi3�l AREA: 33,5 x 12.5 � 418.75 SF` C' C C C 'SIDE AREA: (33.5 + 12.5) X 2 X 2 = 14 SF MEDIUM_ MEDIUM- MEDIUM- MEDIUM TOTAL SQUARE FEET PROVIDED - 602 vs. 594.59 REC"D CASE SAND COARSE SAND SSE AID COARSE SAND DESIGN FLOW PROVIDED: 0.74(602 S.F.) = 446 G.P.D. vs. 440 G-P-0. r eq'd 2.5Y 6/4 2.5Y 6/4 2.5Y 6/4 2,5Y 6/4 1 PROPOSED SEPTIC STEM UPGRADE PLAT 12,0 132"" 11.60 132" 12.0 132" 11.601 132" 14�C PINE RIDGE ROAD, COTUIT, MA <2MIIN/rt�ICH IN "Co ;Sa1LS <2Mnty/INCH:IN "C" SCaiLS 140 GROUNDWATER OBSERVED NO GROUNDWATER OaSVTvW Pre cared for: McCall Engineering and Survey by. SCALE DRAWN DATE 1, Darren M. Meyer, R,S.. CSE, hereby<cerlify that I am currently approved by MADEP pursuant to 310 CMR 115.017 MEYER 49 SOW, INC. N.T.S. DMM 02 f 18 /16 to conduct;soil curaluatigns and that the above analysis has been performed by me ssonsre,tsnt with the iPD 6"OX 1 re4ulromonts of 310 CMR 15.017. 1 further c"y that I have passed the Sail Eval« Exam in October. 19"9". EAsrsmowcK MA=37 REV DATE REV 2 DATE SHEET'" NO. 03/03/16 03/10/16 2 of