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HomeMy WebLinkAbout0032 GREELY AVENUE - Health 32 Greely Avenue A= 246-005 Centerville UPC 12534 No. 2 1_53LOR HASTINGS. MN No. "i Fee ;0/(00 !!� !!//F�J ` THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01pphLation for -Misposaf *pstrm ConetCULtion Jermit Application for a Permit to Construct( ) Repair()6 Upgrade( ) Abandon( ) ❑Complete System [X Individual Components Location Address or Lot No. .3 Z GRGFL 4vF Owner's Name,Address,a o. Assessor's Map/Parcel 4(,?"1 bd. OYA")fSPae &tA Installer's Name,Address,and Tel.No. 7 6 g— Z'7..$$'t7 Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms N� Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) AIR /gpd Design flow provided V)W gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Re-Puk,6 c ts-�E Flom 74-0IL -r'O D -6©Y Rep"c.AE7 D-84K Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. SiMely Date Application Approved by Date //,P/-2-o I`t Application Disapproved b Date for the following reasons Permit No. Y�� Date Issued 1 2_1`o(7,-)� i. q Fee No. r` s THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes t. PUB.LICME ALTH DIVISION -TOWN OF BARNSTABLE�;,MASSACHUSETTS - l i a 1pIlk hcation for Disposal 6pstrm Constructioh Permit Application for a Permit to Construct.( ) Repair O) Upgrade( ) Abandon( ) ❑Complete System . 19Individual Components Location Address or Lot No. 3 G—R�F'�y AvO Owner's Name,Addr ess, o. �L�7FJQUlt.0 ^ STeVO U KI � OIJ Assessor's Map/Parcel o4f 6 .DO j BOX,`q6'1 1,4. 44Y.4No(SpoeT &1A Installer's Name,Address,and Tel.No. '3 O g-4`n..81T, ) Designer's Name,Address,and Tel.No. CEwtnE ?alS u,� N 1A Type of Building: )gyp Dwelling No.of Bedrooms /"►1 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) i Other Fixtures Design Flow(min.required) /M r gpd '**Design flow provided 'V� gpd Plan Date Number of sheets Revision Date Title Y Size of Septic Tank Type of S.A.S. Description of Soil t s Nature of Repairs or Alterations(Answer when applicable) Rel*)c gE.0 LI ti E FR, 7A-0 14- -M D -9 y X Date last inspected: { -, -_ Agreement: I The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place.,the system in operation until a Certificate of Compliance has been issued by this Board of Health. Si Date �''` Application Approved by Date Application Disapproved b Date for the following reasons Permit No. Z91 q -I �� Date Issued i ------------------ ------------------------- - THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(x) ! Upgraded( )Abandoned( )byL�-�-- at 3 6 (C�`� has been.constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit NoAy_N 77 dated (210/Zvi Installer CWG;ZJl n C Designer ' z #bedrooms �(ll� Approved design flow �l = gpd. The issuance of this permit sh 111 not be*construed as a guarantee that the system wilMinction as,designed: /f JJ �; !' ' Date F' ;'y,` �' 1�'7 Inspector v It tit �r 1 OV No. I Fee r THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS Misposai bpstem Construction permit Permission is hereby granted to Construct( ) Rpair(/`) Upgrade( ) Abandon( ) System located at 3 a &AeLL`{ /'t'U c �tC1z— 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 yeais Hof the.,date of this permit Date / Z/ '0/ Z01 y Approved by ec'l0 14OJ:48p p,1 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments � • r 32 Greely Ave ` Property Address Cathie Richardson Owner Owner's Name infannation required for is West Hyannis port MA 02672 12-10-14 4 every page. City/rawn State Zip Code Date of Inspection Q Inspection results must be submitted on this form. Inspection tons may not be altered in any way.Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer. _ZH OFIILq use only the tab 1. Inspector: :,� key to move your4n 0 �Cj• JAMES G ::L cursor-do not James D Sears =�: m use the velum Name of Inspector r„ key. CapewideEnterprises,LLC �•.o o :' 153 Commercial Street Company Address Mashpee _ MA 02649 Cityrrown State Zip Code 505-477-8877 S1623 Telephone Number License Number B. Certification I certifythat I have personally inspected the sewage disposal system at this address and that the P Y P 9 P Y 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 16.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 12-10-14 pector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. if the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority_ ""This report only describes conditions at the time of-inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. - -- I t5ins 3113 Title 5 Of ial Inspection Fmm:Subsurface Sewage Disposal System•Page 1 of 17 N/l Dec 1014 09:48p p.2 r, F Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 32 Greely Ave Property Address Cathie Richardson Owner Owner's Flame Information is West Hyannis port MA 02672 12-10-14 required for every page. CRyfrown State Zip Code Date of Inspection B. Certification (cont) Inspection Summary: Check A,B,C,D or E f 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: The system is a 1500 Gal.Tank D Box and two 1000 Gal Pits. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes",`no"or"not determined"(Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old"or the septic tank(whether metal or not)is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): 151ns•3113 rifle 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Dec,10 1409:48p p•3 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 32 Greely Ave Property Address Cathie Richardson Owner Owners Name Inkrimrequired is West Hyannis port MA 02672 12-10-14 required for every page. Citylrown State Zip Code Date of inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational.System will pass with Board of Health approval if pumpstalarms are repaired. B) System Conditionally Passes(cant.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluatlon is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water _ ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3l13 Tills 5 Official Inspection Forth:Subsurface Sewage Disposal Syskrn.Page 3 cf 17 Dec 10 14 09:49p P.4 „ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments \Vtj 32 Greely Ave Property Address Cathie Richardson Owner Owners Name i formation is West Hyannis port MA 02672 12-10-14 required for every page Cityrl'own State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has'a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank 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 weir*. Method used to determine distance: "•This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other. D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge ondin of effluent to the surface of the ground or surface waters D9 or ❑ ® P 9 due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool . . El ® Liquid depth in sompeo is less than 6" below invert or available volume is less than'/day flow PITS Wns-WS Title 5 Official Inspedon Form:sa=rfaee Sewage Disposal System-PaW 4 of 17 Dec,10 14 09:49p p.b Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 32 Greely Ave Property Address Cathie Richardson Owner Owners Name information is West Hyannis port MA 02672 12-10-14 required for every state Zip Code Date of Inspection page Cityffown B. Certification (cunt.) 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. 0 Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply_ ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet a from private water supply y I well with no acceptable water quality analysis. [This o p system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,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. 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 ayes'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. t5in5.3113 Tide 5 Official Inspection Foam:subsurface Sewsge Disposal System•Page 5 of 17 Dec 101409:49p p•6 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 32 Greely Ave Property Address Cathie Richardson Owner Owner's Name information is West Hyannis port MA 02672 12-10-14 required for every wn State Zip Code oats of Inspection page- C.C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No Cl ® Pumping information was provided by the owner,occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as 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)1310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 4 Number of bedrooms (actual). 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 440 t5ine•3113 nw 5 ollktal Inspedlan Forte:Subsurface Sewage Olepoael System•Page 6 of 17 Dec,10 14 09:50p P•/ Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 32 GreeIV Ave Property Address Cathie Richardson Owner Owner's Name Information is West Hyannis port MA 02672 12-10-14 required for every CitylTown State Zip Code Date of Inspection page. D. System Information Description: The s stem is a 1500 Gat. Tank D Box and two Pits. 2 Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(include laundry system inspection ❑ Yes ® No information in this report) Laundry system inspected? ❑ Yes No ® Seasonal use? El Yes Yes ® 2013-97,OOOGais Water meter readings, if available (last 2 years usage (gpd)): 2014-39,000 Gars Detail: _ _ ---- ❑ -Yes ® No - - - -- - Sump pump? Present Last date of occupancy: Dale CommerciaVindustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft,etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding.tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: .[Sine-3113 Title 5 official Inspedion pamr SL6suvr2ce Sewage nisposal System•Page 7 or 17 Dec 1014 09:50p p.8 Commonwealth of Massachusetts Title 5 Official Inspection Form lv� Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 32 Greely Ave Property Address Cathie Richardson Owner Owners Name information is West Hyannis port MA 02672 12-10-14 required for every cityrrown State Zip Code Date of Inspection page. D. System Information (cons) Last date of occupancyluse: Date Other(describe below): General Information Pumping Records: NA Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes,volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank,distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system(yes or no)(if yes, attach previous inspection records, if any) InnovativelAlternative technology.Attach a copy of the current operation and Cl 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): t5rr W13 Title 5 official hspedion Form:Sub ►race Sswege Disposal System•Page 8 ar 17 Dea10 14 09:50p P•y Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 32 Greely Ave Property Address Cathie Richardson Owner Owner's Name information is West Hyannis port MA 02672 12-10-14 required for every State Zip Code Date of Inspection page. Cityrrown D. System Information (cont.) Approximate age of all components,date installed(if known)and source of information: Tank and one pit 85 other Pit Newer,2014 New D Box. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate Ion site plan): 2' Depth below grade: feet Material of construction: ❑ cast iron ®40`PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints,venting,evidence of leakage, etc.): Pi ein is 4" PVC SCH 40. Septic Tank(locate on site plan): Depth below grade: feat Material of construction: ® concrete 0 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 1500 Gal. Precast H-10. --Dimensions: _ _ - 2" Sludge depth: rSma-an3 Tale 5 ornaer Impedoe Fomc sksurfew sewe9e asPO"system•Page 9 or 17 Dec 1014 09:51 p p.10 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ' 32 Greely Ave Property Address Cathie Richardson Owner Owner's Name information is required for every West Hyannis port MA 02672 12-10-14 page, Citylrown stale Zip Code Date of inspection D. System Information (cunt.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 28" Scum thickness 1 2'0 Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 16" How were dimensions determined? Asbuilt- Plan-TapeSludge Judge Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): Tank at working level.Tank and cover's at 1' below grade. Two inlet Tee's,out let tee. No sign of leakage or over loading. Note: Tank to be pumped afther inspection. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑metal ❑fiberglass El 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 t5fns•3113 71tle 5 DfRdel Inspection Form:Subsurface S&mage Disposal System•Page 10 of 17 Dec 10 14 09:51 p p.11 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 32 Greely Ave Property Address Cathie Richardson Owner Owner's Name Infbirriarequire fo is West Hyannis port MA 02672 12-10-14 required for every page. Cityrrown state Zip Code Date of Inspection D. System information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: concrete metal fiberglass other(explain): ❑ ret ❑ ❑ 9 ❑ polyethylene ❑ 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 151ns•3113 Title 5 Oftel lnspectlon Form:SubsuAeoe SmWege Diapasal System•Page 11 of 17 Dec 1014 09:51 p p.12 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 32 Greely Ave Property.Address Cathie Richardson Owner owners Name information is West Hyannis port MA C2672 12-10-14 required for every State Zip Code Date or Inspection page. Cityfrown D. System Information (cons.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0 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.): D Box is 16"x 16"-22" Below grade wltwo lines out D Box is new 12-2014 cover at 16' below grade. 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•3113 Tdle 5 Of el Inspection F&M:6LID -face sewage Oieposal system-Page 12 or 17 Dec 10 14 09:52p p.13 Commonwealth of Massachusetts IMEW Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 32 Greely Ave Property Address Cathie Richardson Owner Owner's Name Informatrequiredfo is West Hyannis port MA 02672 12-10-14 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cons) Type: ® leaching pits number. 2 ❑ leaching chambers number. ❑ leaching galleries number: ❑ leaching trenches number, length: Cl leaching fields number, dimensions: ❑ overflow cesspool number, ❑ innovative/altemative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation,etc.): Leaching is two 1000 Gal. Precast Pits w/2 1/2'stone. Pit"1 at 3' below grade w/30"water. No Higher stain line or solid cant'over. Pit"2 at 27"below grade, dry like new. Cesspools (cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No [Sins-3M 3 Title 5 Offidd Irepealon Form:Srtmrrtare Sewage Disposal System-Page 13 or 17 Dec 1014 09:52p p.14 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 32 Greely Ave Property Address Cathie Richardson Owner Owners Name information is requiredquired for every West Hyannis port MA 02672 12-10-14 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.): 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.): Uns•3113 Tine 5 Olfidal Inspection Form Submdaw Sewage Dowar System•Pape 14 of 17 Dec 1014 09:52p p.15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 32 Greeiy Ave Property Address Cathie Richardson OWFW Owners Name informations required for every West Hyannis port MA 02672 12-10-14 page. Cityfrown State Zip Code Date of Inspection D. System Information (cost.) 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 -1/3, A L � �cK L 33 a7 33� 3 t5dns•3H 3 Title 5 OBdal trnpectl n Fam:Subswfta SeuWv Disposal System-Page 15 of 17 Dec 10 14 09:53p p.16 - Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 32 Greely Ave Property Address Cathie Richardson Owner Owner's Name Informrequired bon is West Hyannis port MA 02672 12-10-14 required for every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) . Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth high ground water. feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 3-1-85 Date ❑ Observed site(abutting propertylobservation 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: T.H.on File at H.O.H.3-1-85 No G.W. at 12'+. Bottom of pit at 9' below grade. Bettom of pit at 3' above T.H. Depth. Before filing this Inspection Report, please see Report Completeness Checklist on next page. 15ins-3113 rMe 5 Official Inspection Potm:Subsurface Sewage Disposal SyMem-Page 16 d 17 Dec 1 014'09:53p p.17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 32 Greely Ave Property Address Cathie Richardson Owner Owner's Name information is required for every West Hyannis port MA 02672 12-10-14 page. Cityrrown 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 15ins-3r13 Tille 5 OfFeW Inspaaan Form:Scbsurfaee Sewage Disposal System•Pape 17 d 17 L0CATI I ] /� EWACE P RMIT NO. P I L L A G E I N S T A LLER'S NAME j A RESS S U I L D E R OR OWNER 8Q v S& 8j2i.aels "V DATE PERMIT ISSUED DATE COMPLIANCE ISSUED r w oas tl�3 J!f 3 r 5 r l y | ^ THE COMMONWEALTH oF MAseAc*ussTrs � �V- BOARD OF HEALTH Application is hereby made for a Permit to Construct -T"or Repair an Individua] Sewage Disposal System at: Ow e Ad,dress Installer Address � Type V � . ' . feet Dw�i�—N� � 8edmo� ��^uoo � ��c ��) ~..~ u^ ��d� `��' Other—Type of Building - - W �-o-. of peru000-`��--_-_-- Showers (o) -- Cafeteria Wc-) Other ,��%J���� ^� ^ .--- ---.-.--.---__'_----'----.--.-.-.-.--------------_--------- Deo6ro F�n�-___����-__.__'-_ duy. Total daily flow. 335.52 Seepage Pit Nu-_----' Diaoetec-_-_--- Depth 66mw inlet.................... Total leaching area..................sq. 6. Z Other Distribution box h9() Dosing tank Percolation Test Results Performed by---- 04 XT.-'r-a- oy_e----------_-------- Date-----3/-------_-_-_---------- cZ4 Test Pit No. l................minutes per bzob Depth of Test Pit.................... Depth to ground water........................ ��� / —'--' ----'-----'---'--'-' -- il ' ' ___ .------------_--_---'------_---...--____.-'-------_''-'-_--------------__-----__ U Nature of Repairs or Alterations--Answer when uonlicub��............................................................................................... | --------------'----------------------'-----------'-------------------'----'--'--'-'--- '`"__-_-. ' The undersigned agrees to install the aforedescribe0 Individual Sewage Disposal System in accordance with the provisions of Ti I THE 5 of the State nitary Code—The undersigned further agrees not to place the system in tion until Cc 'ficate of Com 1* e has been issued by the board of health. Date Application Disapproved for the following reasons:.............................................................................................................. - ......................................................................................................................................................................................................... | Date � � Date � y o _a %/ �5 w THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH t9 `i.............. oF..... ................................... AVVIiration for Disposal Works Tonstrurtiun Prrutit Application is hereby made for a Permit to Construct (✓�or Repair ( ) an Individual Sewage Disposal System at: rr �- ,.e......... �.: :C.vt. _l. ... ........... ........••••....••... •--- z �.. .....�' Loca' n-Ad re o -•� P` " Wit..#?.`L'.. �?.!.. 4 S__t* d ------•-----•-----------------------------•-- or t N . t � t � Owner G .r--! Ad re a ........... 1----'�....._._ 1..�_ (W.-` 5.................................. �__................._.. �`;:.. .........................................•............ Installer Address UType of Building Size Lot..a4_16..____..Sq. feet a Dwelling—No. of Bedrooms......... -�7--------------------•__--_--Expansion Attic kjd) Garbage Grinder (NO) a Other—Type of Building ..jtic _ - '..___.... No. of persons._ ..................... Showers " — Cafeteria Other fixtures ..---•--�Ja�ve...--•-••--••••......... w Design Flow............ _.0....................gallons per person per day. Total daily flow....1.3-�2...........................gallons. WSeptic Tank—Liquid capacityl.OAV.gallons Length----!_0....... Width.............. Diameter----(¢......... Depth.... x Disposal Trench—No.IQ .. Width.................... Total Length.................... Total leaching area..A._Q.< ------ ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box (-A ) Dosing tank ( ) 1 4 Percolation Test Results Performed by...B.Pi.X_nF1_, _....• .... ._ --_-.--•-___--_ Date_._a � -----_------_-_----------- Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 0-4 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water......................... P4 •-•-••-•--••-•----------•-••-•-••-•••--•--••-•-•-•......••-••••.....•-•---•........................•..................................... ---•-------------- 0 Description of Soil...........................................................................................................................................................•--•••..._.. x U •••-••••-•••••••-•••-••••--••-•••..._..--•--•••-•----•-•-...---•-•-••-•--•--•-••••••••-----•---•••••--....-•••-••••••--••-•----•--•--••-••-•-•••--••--••••••-•••••--•••••-•-•-••-••-•-••......-••--••••. w VNature of Repairs or Alterations—Answer when applicable.............................................................................................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T I TLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed..t, !s°? 1GI_. ._ _- t'.. .... Dat — e Application Approved By_ _ ="-y r�� 1 Jt_• -----------------------•-••-•------ --------a Z - a e� Application Disapproved for the following reasons-------------------------------------•-----------------------------------------------......................... ................•---•-••••....-•-•-•-•••-•---•••---•••---••••--............----•••••••----•._...••-•-•---••••-••••-••-••---••---••••---•••-••••....•---••••----•-------•••----••--••-------•••••...•---- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEAL, ............. 7............OF....... .ti G12211. v.....K'(. ..............................._ Tnrtifiratr of Tuutpliaurr THI$ IS TO CERTIFY fi the Individual Sewage Disposal System constructed ( ) or Repaired ( ) fnstaller has been installed in accordance with the provisions of TITLE�f T ? to Sanitary Cow d sc ' n the �= �� application for Disposal Works Construction PermitNo......................................... dated___..---__. -_.___... ...___.___....._._........ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONS RUl D AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. \ DATE.....---.. .. ---------------------------------------- Inspector........---- �} . _..---••-• THE COMMONWEALTH OF MASSAC SETTS BOARD OF HEALTH OF < CY FEE:.t_.a.f:�..�....... Disposal Works T tr ' it Urrutit Permission is hereby granted..------. .-•- .......���/S�'{....-- ----•-----------------------•-•--------.....----.................-•----. to Construct ( ) or Repair ( ) an Individual Sewage Disposal,, y tem at No Street as shown on the application for Disposal Works Construction_Permit,/Ng� _ - _t. Date .....=..r..... ~.................. Prf_ec---------------------------------— Board of Health DATE................................................................................ FORM 1255 A. M. SULKIN, INC., BOSTON r S'///GLE FA/y/L Y "' 3 BE0.2UOrv1 Ga'�c�C.,.►� �'��, OA/L //D X 3 = 330 SE.oT�C T,4.c/� = 33oX/Soo =`fAw 9S .01 so s,� X �a = s-o �.•ad. �,� �� � � OES/G� P.E.P-GOL�JT/apt/�2,QT�' �y _ AV 2 119/14/. O.e GE.SS-OF IJ \ F °� x P 7eh ay/' �J Clj� Ilih�•� 1 oj'� � t n/ A tic. I'�oP 5 tc Lam rto r.j Ile -71 law, /GOp 7 <sAe- /�Y✓ BOX /N✓. G.4L. 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