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HomeMy WebLinkAbout0102 GREELY AVENUE - Health t 102 GREELY AVE. ' Centerville A—245 - 148 oCYCIeo UPC 12534 No.2 R NAOTINO$,UN 4k `" °x Ridge Vent %" CDX Roof Sheathing 15 LB Tar Paper a � * EXtStinp, House Ice and Water Shield 30 yr Architectural Asphalt Roof Proposed Addition rf - t a ` X? x h 1X8 � :. �. r Factia PVC Trim 1X8 Soffit PVC Trim ..'.�..Y..e.s..._..�.'u�.,;:z;v. _...,....�.�� .,.1,,..z'�'•�....�..�..n..,.�.,�?:�.,,.....,�.;..`�k..'z.c,.,.�,At�,x.K.,�a:a;«..�.�,��E�.i4.�_.,c�'�z'��.:.�.u:=. 1%"Soffit Vent "' t R `; k 1X6 PVC Corner Board �' � ""� w < % CDX Sheathing Vertical ty '� > 1- 1 � r � � � , .� . Pella Awning Window 46 x30 PVC Window Trim, Brick Molding w 3 x 15 LB Felt paper, window LI i4 �,t s House Wrap �EN 7 k '3 3 White Cedar Shingles R&R 5" exp t Y�. '•., r ry i k i afi.s'ex k F r�a ,y+.r 4 4 .Y.• i �, r? r' x`y w ''• {t ej 49 Y C s t � �3 1� � l a �+ � � �i*�4 �Y I R ^��� �,�E., �`Y � a�s3+' { 's•t ��k�s '�,� �, .�Lw jfA, P ,f ,.,mH�......5... ..�t. ._.:..s.o.�.r�. :.a..+.rt�S-a.'».-.. NORTH ELEVATION Duffy Construction PROPOSED FLOOR PLAN Building & Dei n 102 GREEL Y A VE CENTERVI LLE C u 1p"11 °1 u l d MA 2 10' X 20r Addition 5ur"8-362-3939 J Existing House - �, ' Ridge Vent 2X12 Ridge %" CDX Roof Sheathing 15 LB Tar Paper � Ice and Water Shield " Proposed Addition A 30 yr Architectural Asphalt Roof ' 4 T k � � i. ! : ^� ,� 4 .'} 1XnT ✓' , rcC ''h K f > 4.rr v, S..J j. :=T tx pN 1 s i 's s gf. 1X8 Factia PVC Trim 1X8 Soffit PVC Trim 1% "Soffit Vent $ � � 1X6 PVC Corner Board � s %CDX Sheathing Vertical Pella Awning Window 46"x30" PVC Window Trim, Brick Molding 15 LB Felt paper, window House Wrap White Cedar Shingles R&R 5" exp 4 '' 00 F _ y k -4 '. k.+u�.wrwian.' •a . SOUTH ELEVATION Duffy Construction Building & Design 102 GREELY A VE CENTERVI LLE u mir"l u id 0_ 37 a 10' x 20' Addition 503®36 -3939 I •` :7 apse. ;� \ i @pII I J' _ i��ti I ♦. —i I I z!I N 04 I II 4" concret lab 00 00 :! Tip, II I; BEDROOM BEDROOM �°I ii x 11'-3" x 9'-3" s - — -_ 11'-2 1 Y2" - - ——�- 11 1-2 5/811 3/16"_ �yl�tlli� Double 2_X8 I eader Bean N � •�3K� ���y'� /-��i./l 2 a I�N� / �"-'//'/// l IY�`�'_..\ .. \ � \1©'\�V��V 11 � ..... _.?-�:.�ti \ ,.Iy��II .. � I / //• / i/ f � / ,'/ Ili �\\\ \ \\�\ \\ \\ .\\ • \ \ �,�e� rl` i j I Bedroarn E�Cp/nsiory/ , \\\ \ \Bedroom Ensian\ \ \ I I r� r�/ / �/ r// .r r/ /„ //r"r/ r �. •� \ ;\\ -\\ .. \\ \' \� ;`\ - ` it !'j' }� 42dlpt d214DC I I 3'-8 314" --� 4'-2" -=----6'-2 1/2"---- --4'-2" ,w 3'-8 3/4" huffy Construction PROPOSED FLOOR PLAN Build,ing & Des! 102 GREELY A VE CENTERVILLE Cummaguid MA 02637 10` x 20' Addition 03-362-393 n :o # T •..y.,� l 7-71314B 1—+— s7rz•--jt--la.ealb'— g11`iving z*FTfiv'.- —..��__L-t°?. e��I^°^•.,m"i"�"�,sr:^_�a ..^;•.PR• ?,.R+.:aJ MASTER BORM l ii 15 i Living BEDROOM I \� CLOSE-, � r 0 if I a 'Kitchen r !f'Bat f I m r m N 59ll BEDROOM EOROOM 2X8 Hder Be112618'-- " 11 se Doble �m Monitored Smoke ��:� ter, , \�•,�,� 730 i .191 1 l in Basement I 1 1 GARAGE ii i__r— .... a Ir.—Y-4 --�r1•3E) +'�. . PROPOSED FLOOR PLAN 106 GREELY AVE CENTERVI LLE 10'X 20'A ddition 0= Monitored Smokes Duffy Construction Y Building & Design Cummaquid MA 02637 December 2013 506-362-3939 I _ � 01 3 U V DATE: 9/1/99 ` PROPERTY ADDRESS: 102_ GreelY_Av_e_____ _ or ,10 � � + Mass • ----------------------- S` Cps 0 1999 On the above date, I inspected the septic system at ab ''V es`'s This system consists of the following: 4� 1 . 1-1500 gallon septic tank. £ q, 2. 1-Distribution box. 3 . 2-1000 gallon precast leaching pits packed in stone . Based on my inspection, I certify the following conditions: 4. This is title five septic system. ( 78 Code ) 5. �'The septic system is in proper working order at the present time . �. 6 . at the septic tank at time of inspection . SIGNATURE: /J Name:_,. P, Macomber_jrs______ Company: J_oseTh_P. Maco.mber_& Son , Inc . Address: Box 66 . Centerville , Ma . 02632-0066 Phone: 508_775_3338_____ THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY • JOSEPH P. MACOMBER & SON, INC. Tan ks-Cesspools-LeachfleIds Pumped & Installed Town Sewer Connections P.O. Box 66 Centerville, MA 02632-0066 775.3338 775-6412 i COMMONWEALTH OF AASSACHTJSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS " DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON MA 02108 (617) 292.6500 TRLD c ARGEO PAUL CELLUCCI DAvID B. . Co:nr• Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM WSPECTION FORM PART A CERTIFICATION Property Address: 102 Greely Ave Nama of ownar Samuel Coco West Hyanni o t Mass . Ad&&s,of Owrw:�n nrvor, Re6Nt1 oat.oftnsp.cts«i: ��4%�9 e11esly ,Mass . 02481 N erne of 1r�.sp.otor:(?teas*PAn%) Joseph P.Mac o m b e r J I . 1&.m a DEP oved aystam Insp,ac'tO(PW&UWn to Section 16.3-0-0 of Thie 6 (310 CMR 16.000) orrt Cp.arty Name:J.P.Macomber & Son Inc . IdarTusgAddyass:Rnx 66 C'antrsrvi11e.'Mass_ E2632 T al.phone N umber: S n R—Z7 5,•.3 3 CERTIFICATION STATEMENT I cartify that I hays personally Inspected the sewage disposal system at this address and that the Information reported below is true. accu, and complete as of the time of Irupection. The Inspection was performed based on my uaining and experience In the proper function and maintenance of on•slle sewage disposal systems. The system: /Passes Conditionally Passes _ Needs Further Evaluation By the Loca Approving Authority _ Fails Inspector's Siyunues Date: The System Inspector shall submit a copy of this Inspection report to the Approving Authority(Board of Health or DEP)within thirty 1301 d completing this Inspection. If the system Is a shared system or has a design flow of 10,000 gpd or greater, the Inspector and Ins system ' "if submit the report to the appropriate regional office of the Department oKnvironmerttal Protection. The original should be sent to 4se system owner.and copies tent to the buyer.If applicable, and the approving authority. ' NOTES AND COMMENTS revised 9/2/98 Page I of 11 " rmled on R"6d/rp4V SUBSURFACE SEWAGE DISPOSAL SYSTFJ"WSPECTION FORM , PART A i CERTIFICATION (continued) propertyAddrass: 102 Greely Ave West Hyannisport ,Mass . owner: Samuel Coco Date of IrLsP*ct�«+:9/1/9 9 INSPECTION SUMMARY: Check A, B, C, or D: A. SYSTEM PASSES: I have not found any information which Indicates that any of the failure conditions described In 310 CMR 16.303 exist. Any failure /_9C__7.critsds not evaluated are Indicated below. COMMENTS: B. SYSTEM CONDITIONALLY PASSES: '(hJ One or more-system components as described_in the.'Conditlonal 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. Indicate yes no, or not determined (Y, N, or ND). Describe basis of daterminatlon In all Instances. If 'not determined-, explain why not. The septic tank Is metal, unless the owner or operator has provided the system Inspector with a copy of a Certificate of Compliance (attached)Indicating that the tank was Installed within twenty (20) years prior to the date of the inspection; or the septic tank, whether or not metal,Is cracked,structurally unsound, shows substantial Infiltration or exfiltration, or tank failure Is Imminent. The system will pass Inspection If the sxlsting septic tank Is replaced with a complying septic tank as approved by the Board of Health. Sewage backup or breakout or high static water level observed in the distribution box Is due to broken or obstructed pips(s) or due to a broken, settled or uneven distribution box. The system will pass Inspection if(with approval of the Board of Health). broken pipes)are replaced obstruction Is removed distribution box Is levelled or replaced �_ - The system required pumpMQ-man than-four-times a•yeardue to broken or obstructed pipe(s). The:y:Tern will•pesr^ Inspection If(with approval of the Board of Health): broken pips(s) ars•replaced obstruction Is removed i revised 9/2/98 Page 2ofII ' 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (coat mwd) Pr,p,.Addraru:102 Greely Ave West 'Hyannisport ,Mass . owner: Samuel Coco Dart,Of Uupec"—: 9/1/9 9 C. FURTHER EVALUATION IS REO:UIRED BY THE BOARD y-F HEALTH:the Board of Health In order to determine if the system is failing to Protect the Conditlons exist which d quirenvi th6f Ov lustion by SYSTEM public health, safety 310 CNIR 15.303(1)(b)THAT THE ARD OF HEALTH MINES IN ACCORDANC SAFETY AND.�ENZBONMEfiT' 1) SYSTEM WILL PASS UNLESS BONS P CT THE PUBLIC HEAL TK AN IS NOT FUNCTIONING IN A MAN ,f/0 Cesspool or privy is within 60 foot of surface water Cesspool or privy Is within 50 feet of a bordering vegetated wetland or a salt marsh. HEALTH(AND PUBLIC WATER SUPPLIER,IF ANY)DETERMINES THAT THE SYSTEM IS Z) SYSTEM WILL FAIL UNLESS THE BOARD OF PROTE THE PUBLIC HEALTH AND SAFETY AND THE ENViRONMENT: CTS FUNCTIONING IN A MANNER THAT of a surface we The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet public water supplyrweisupply or tributary to a surface water supply• i well. SAS Is less than 100 feet but 50 feet or more from a is tank and soil absorption system and the SAS is within 60 feet of a privets water suPP Y The system has s septic tank and soil absorption system and the SAS is within a fee o �jj The system has a septic organic compounds indicates that the AV The system has a septic tank and soil absorption system and the private water supply well,unless a well water or for coliform bacteria and volatile from pollution from that facility and the presence o�PProximadotn not valid)rogen and nitrats niVogen is equal to or less well Is free P than 5 pPm• Method used to determine distance 31 OTHER p,ge 3 of 11 revised 9/2/98 i Y ' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) prop,rtyAddiros: 102 Greeley Ave West Hyannisport ,Mass . Owner: Samuel Coco Dew of In:pection:q/1/9 9 D. SYSTEM FAILS: You jnU3t Indicate either "Yes" or "No" to each of the following: I have determined that one or more of the following failure conditions exist as described In 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of-eewage Intofecility-er-system component daette an overloaded or9cleggedSiAS-or'eessDooi. 3- 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 d4 s ribytt ion bq#-4ove outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in 9*&Vp0e}i3 less than 6 below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped-t. Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. ZAny portion of a 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 potion 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for -coliform bacteria,volatile organic-compounds, ammonia nitrogen•and nitrate nitrogen. E. LARGE SYSTEM FAILS: You must indicate either"Yes" or "No" to each of the following: The following criteria apply to large systems in addition to the criteria above: AD The system serves a facility with a design flow of 10,000 gpd or greater(Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes NO 1/ the system is within 400 feet of a surface drinking water supply the system•is-within 200 faetof e-t+ibutarjr-to-a+uFfeoo4gnkiwg-water'+uPPIY' __ . . _--.•• - •- 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) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2)• Please consult the local regional office of the Department for further information. revised 9/2/98 Page 4of11 I ' I ) j' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B r CHECKLIST PropertyAddr.: 102 Greely Ave West Hyannisport ,Mass . Owner: Samuel Coco Date of Inspection:9/1/9 9 Check if the following have been done:You must indicate either"Yes" or"No" as to each of the following: Yes No i Pumping information was provided by the owner,occupant, or Board of Health. -None of the system sompoaants.hama:bean poatipad4osra4•Jeastt+wo•aweWw awdthe-rystem h"Ambeosscaiaiagassaaw flow rates during that period. Large volumes of water have not been Introduced Into the system recently or as part of this Inspection. _ As built plans have been obtained and examined. Note if they are not available with N/A. Z _ The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow. _ The site was inspected for signs of breakout. _ All system components,:bTecluding the Soil Absorption System, have been located on the site. The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction,dimensions,depth of liquid,depth of sludge, depth of scum. The size and location of the Soil Absorption System orrthe site has been determined based on: _ Existing information. For example, Plan at B.O.H. _ Determined in the field(if any of the failure criteria related to Part C Is at issue,approximation of distance is unacceptable) (15.302(3)(b)) _ The facility owner.(and.orcupant ..if diffaraut tnfnrmatioaDn 0 proper maintana,v ..f Subsurface Disposal Systems. l i i i revised 9/2/98 page sorii i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION PropertyAddress:102 Greely Ave West Hyanni sport ,Mass . Owrw: Samuel Coco Date of hnpsction9/1/9 9 FLOW CONDITIONS RESIDENTIAL: Design flow: 110 g•p.d./bedroom. Number of bedrooms esi ) Number of bedrooms(actual): Total DESIGN flow; e Number of current residents: 02 Garbage grinder(yes or no):-up _ Laundry(separate system) ( es o no If yes, separate Inspection,required Laundry system inspected yes r no) Seasonal use(yes or no): Water meter readings,if ava ble(last two year's usage(gpd): Sump'Pump(yes or no): Last data of occupancy,:22st There is a sprinkler system^. COMMERCIAUINDUSTAIAL: Type of establishment: Design flow: 114 d ( Based on 15.203) Basis of design flow Grease trap present: (yes or no) Industrial Waste Holding Tank present:(yes or no)A/Y Non-sanitary waste discharged to the Title 5 system: (yes or no)AIA _ Water meter readings,if available: - Last date of occupancy:��d OTHER:(Describe) Ah Last date of occupancy: • GENERAL INFORMATION PUMPING RECORDS and source of information: Pumped System pumped as part of ins action: (yes or no) If yes, volume pumped: ga one Reason for pumping: TYPE OF YSTEM Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool - -- - - - - _Ab Privy Shared system(yes or no) (if yes, attach previous inspection records,if any) I/A Technology otp. Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other �j ff AWOXI TE AGE of al co ne , date f taged{if k wn)•en source 04nformation: -• �C} (�7 Sewage odors detected when arriving at the site: (yes or no)�LA revised 9/2/98 Page 6oril SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM r. PART C rt SYSTEM INFORMATION(continued) Er,penyAdd,esa; 102 Greely Ave West Hyanni sport ,Mass . Owner: Samuel Coco Daft of Inspectk=9/1/9 9 BUILDING SEWER: (Locate on site plan) fl Depth below grader �/� Material of construction:_cast iron.0 w3 PVC_other(explain) Distance from private water supply well or suction line Diameter y Comments:(condition of joints, venting, evidence of leakage,-etc.) - Joints appear tight No evidence of leakage SEPTIC TANK: 00, (locate on site plan) r( Depth below grade:y Material of construction: concreteNt4metal�Fiberglassl/,Oolyethylene� other(explain) If tank Is Enetal,list age 1s.age-confirmed by Certificate of Compliance (Yes/No) Dimensions: orLLO Sludge depth: Distance from top of sludge to bottom of outlet tee orbaffie Scum thickness:_ Distance from top of scum to top of outlet tee or baffle:_� Distance from bottom of scum to botto f outlet a or baffle: How dimensions were determined: Comments: (recommendation for pumping,condition of inlet and outlet tees or-baffles,depth of liquid level in relation to outlet invert, structuraHntegrity, evidence of leakage,etc.) Pump tank annually . Garbage disposal is present . Inlet 9 outlet tees are in plarp _Thp tank is strnrtiirall � annnd GREASE TRAP: e (locate on site plan) Depth below grade: _ __ Material of construction WAconcrete'l*metal414Fibergl ass&'A Polyethylene jother(explain) 4-44 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: 1. Date of last pumping: Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet Invert, structural integrity, evidence of leakage,etc.) Grease trap is not present revised 9/2/98 . Page 7of11 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION lcantinued) Property Address: 102 Greely Ave West Hyannisport ,Mass . Owner: Samuel Coco Date at Inspection:9/1/9 9 TIGHT OR HOLDING TANK:_4&LI,(Tank must be pumped prior to, or at time of, inspection) (locate on site plan) Depth below grader Material of construction-4 concrete NA metaWAFiberglassNrQPolyethyleneVlother(explain) IM Dimensions: Capacity: AIA gallons Design flow: AM gallons/day Alarm present Alarm level: AM Alarm In working order:Yes40 N%4X Date of previous pumping: Xj'R_ Comments: (condition of inlet tee, condition of alarm and float switches,etc.) TiRht or holding tanks are not present DISTRIBUTION BOX:z (locate on site plan) Depth of liquid level above outlet Invert:�i Comments: (note•if level and distribution is equal, evidenoe of solids carryover, evidence of leakage into or out of box, etc.) — — Distribution box has two laterals .No evidence of solids rarrg nvpr Nn evi dPnrc of •I eaka-ge into or out of the be' . PUMP CHAMBER: tif74. (locate on site plan) Pumps in working order:(Yes or No) Alarms in working order(Yes or No) Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) Puma chamber is not present e revised 9/2/98 Page 8of11 p, SUBSURFACE SEWAGE DISPOSAL S 1STEM INSPECTION FORM PART C SYSTEM 1NFORMATiON(coertinued) 3 PropeMAd&"4: 102 Greeley Ave West Hyannisport ,Mass Owner' Samuel Coco Data of 4upoctkm: 9/1/9 9 SOIL ABSORPTION SYSTEM(SAS)-_ (locate on site plan,If possible,excavation not required,location may be approximated by non-Intrusive methods) If not located, explain: Type: leaching pits, number: Issching chambers,number: C� Issching gallariss,number:� leaching trenches,number,length: leaching fields,number, dlmansi ns: overflow cesspool,number: Alternative system: G Name of Technology: Comments: (not@ condition of soil, signs of hydraulic failure,level of ponding, damp soil, condition of vegetation, etc.) oamy sand to tine sand No si gncn'F hgdyan1 ; c CESSPOOLS:dZipe (locate on sit@ plan) Number and configuration: Depth-top of liquid to Inlet Invert: 7.4 Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: Inflow(cesspool must be pumped as part of Inspection) Cesspools are not nrPgant Comments: (note condition of soil, signs of hydraulic fallurs,.level of.ponding,condition of-vegetation, etc.) _ esspoo s are not ZrPgPnt PRIVY: (locate on site plan) Materials of constru 9p: Dimensions: Depth of solids: Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation;etc.) rivy is not prpspnt revised 9/2/98 Page 9of11 _ SUBSURFACE SEWAGE DISPO$A'!SYSTEM WSPEC)lON FORM PART C SYSTLu WFORmAT1ON(corttirr+ad) s' PropemAddrw: 102 GrVeley Ave West Hyannisport ,Mass . °wr"e: Samuel Coco . Dos..of� +: 9/1/9 9 1 . . SXETCH OF SEWAGE DISPOSAL SYSTEM: . Include tlas to at Fait two permanent ra(arsncs landmarks or benchmarks locsts all walls within 100'(Locate whirs public water supply comas Into house) revised 9/2/98 ?sit toort) z y r SUBSURFACE SEWAGE DISPOSAL SYSTEM%INSPECTION FORM PART C d i3 SYSTEM INFORMATION(continued) Property Address: 102 Greeley Ave West Hyannisport ,Mass . Owner: Samuel Coco Data of kupection:9/1/9 9 NRCS Report name Soll Type_ Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep _ SITE EXAM Slope Surface water Check Cellar Shallow wells r Estimated Depth to Groundwater��Feet Please Indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observed.Site (Abutting propert observation hole, basement sump atc.) Determined from local conditions Checked with local Board of health /Checked FEMA Maps Checked pumping records �hecked local excavators.Installers Used USGS Data i Describe how you established the High Groundwater Elevation. (Muni be completed) Used water contours map . Gahrety & Miller -Model----_ -____-- 12/16/94 Installed system 1/4/95 Permit# 94-710 No• water encountered at 14 ' Bottom of pits are 9 ' below grade. t ✓F� revised 9/2/98 Page 11of11 k >•n.tnrw.-n.•.•�.-.t7��rn:tm•nse.r.s�+na�.xrsrnr.�.•r.�.r�.n.enrm nervy n�.s>sen.er .r�rT-.yr,.r.-'...-.r•y TOWN OF Barnstable BOARD OF HEALTH J SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D .- CERTIFICATION •••an�•:: .-r...�-.�rrunr.+nrrr.s.rna.a.enan'rerrr•a•rrtvrn-�snmr�'v�+.aw�.e�mr�e+�rr� +�+nn ..�rrr•r.--.r-, � -TYPE OR PRINT CLEARLY- PROPERTY INSPECTED Y Y 102 Greeley Ave West H anni sport ,Mass . ' STREET ADDRIrS$ ASSESSORS MAP, BLOCK AND PARCEL # Z y riY3 OWNER' s NAME Samuel Coce PART D - CERTIFICATION NAME OF INSPECTOR Joseph P.Macomber Jr . COMPANY NAME J.P.Macomberr & Sotr'lnc . COMPANY ADDRESS ' Box 66 Centerville ,Mass . 02632 . Street Town or City State LIP COMPANY TELEPHONE ( 508-) 775 - 3338 FAX ( 508 1 790 - 1578 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the iliforination reported is true , accurate , and omplete as of the time of -inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . Check one : v System PASSED The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15 . 303 , Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form . System FAILED* The inspection which I have con acted has found that the system fails to protect the jiublic health and the environment in accordance with Title 5 , 310 CMR 15 . 303, and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . Inspector Signature Date D[n6 copy of this certification must be provided to the OWNER, the BUYER where applicable ) and the 130ARD OF HEALTII. * If the inspection FAILED, the owner or•""o` erator shall u P pgrade ' the system. within o'ne year of the date of the inspection, unless allowed or required otherwise as provided in 3.10 CMR 16 . 305 . partd.doc TOWN OF !3,kRNSTABLE LOCA"...0N O ee/c � SEWAGE # S' VILLAGE ASSESSOR'S MAP & LOT 'f INSTALLER'S NAME PHONE NO. - -�? ieJCpol7�7 /' SEPTIC TANK CAPACITY LEACHING FACILITYAtype)Q 1�� 'S (size) /000 NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No o � Q iq �e� e GUI $ 30 00 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Allp trativit for Uiupuual Wor1w Towitrurttun rrrmi Application is hereby made for a Permit to Construct ( ) or RepairX(XX) an Individual Sewage Disposal System at: 102 Greeley Ave West Hyannisport Mass. -----------------•......--•............................................................. Location-Address or Lot No. Louis Zushuk Owner Address a J.P.Macomber Jr. Installer Address UType of Building Size Lot............................Sq. feet ., Dwelling X- No. of Bedrooms_____________------------------------------Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Otherfixtures --------------------------------------------------------------------------------------- ----------------------------------•-------------------------- W Design Flow............................................gallons per person per day. Total daily flow--------------------------------------------gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width__..._.______.__ Diameter._._.._.________ Depth................ x Disposal Trench—No. .................... Width-------------------- Total Length.................... Total leaching area....................sq. ft. Seepage Pit No...................... Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ 1.4 Test Pit No. I................minutes per inch Depth of Test Pit-------------------- Depth to ground water..................... 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 1:4 ...................................... .................................................................................................................. ••-- 0 Description of Soil....... and..,t.._Gray.e I............................................................................................................................ x w ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- U Nature of Repairs or Alterations—Answer when applicable--------Adding---Qf----1.O9-0---ga-11-on...1e-ach...pir te...e ciEting...1.5.QD-•-gall...tank-._bax..-anti---pit----------------------�.` ' - ............................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliarkce has be,n :f health. Signed - -- ---- -- ------- ............ --------1.216.19-4------- Dace Application Approved By ..............`` .... . ...............-.................... 07- "�� "� Application Disapproved for the following reafonf- ------------------------ ----------------------------------------------------------------------------------------------------------- -- . .......................... . . . ................................. .................................................. ---------------------------------------- Da PermitNo. ........ ...... . �.....-------------------------�..-..7 C� Issued ........................................................ ......- Due Fi$....��'....30.-.0.0. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -� TOWN OF BARNSTABLE Allplirativit for Uhnpm ttl Wurk,i C omitrnrtiun rrrmi Application is hereby made for a Permit to Construct ( ) or RepairX(XX) an Individual Sewage Disposal System at: .............102 Greeley Ave WTJst Hyannisport,,Mass. - ---- .... ...... ----•-------------------------------- Location.Address or Lot No. Louis 'USb.uk ......................-.......................................................................... -•---------•-------••••------...---••-----...---------•-••-•---------............................- Owner Address a . ..............................................J.P.Macomber Jr --------------- ------------....--------------•-----••---•---- ------.----...................•-••...... � Installer Address Type of Building Size Lot............................Sq. feet t, Dwelling"—No. of Bedrooms............. ------------------------_---Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ------------------------_- No. of persons.-----------.-------------.- Showers ( ) — Cafeteria ( ) dOther fixtures- ----------------------------------------------------------------- •----------....------. ---.......•------•---------------...-••-------••---••-....... W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity------------gallons Length---------------- Width--.------------. Diameter--.............. Depth----.---..-----. x Disposal Trench—No. .................... Width-------------------- Total Length..-----......--..... Total leaching area--------_--•------sq. ft. Seepage Pit No-----------_-------- Diameter.................... Depth below inlet.---........---..... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.................................................................... ----- Date................. _... a Test Pit No. l................minutes per inch Depth of Test Pit----------.--------- Depth to ground water------------------------ 44 Test Pit No. 2................minutes per inch Depth of Test Pit--.--..--.---------. Depth to ground water....----.-.-----.------. P4 -----------------------------------•--------------------------------------------•--------------------------------- ------------------ ............. . D Description of Soil......S,3xld...A.-Gxavel____________________________________________.- V .....--•--------•----...----••••-----------•••---•--•----•-••--•-••••••-••-----•-•------------------------••--•--------------------------.••-- W ------------------------- ---------------------------------- ----------------------------------------------------------------------------------------------------------------------------•-••.......... U Nature of Repairs or Alterations—Answer when applicable.--.---Add ing-_a ---1 ) gallon..l to existing ..�n -- ....n ........................�'" 8 Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has beenf/issued by the board of health. Signi -..----------------------- .......1.22/ 1.94 Date r^ Application Approved BY - ." _c. .......... .-. Date Application Disapproved for the ollowing reasons- ------------------- --------------------------------------------------------------------------------------------------------------- ----------------------------------------------...--------------------------------..........._---------------------..........................-... PermitNo. ------�1.... �....- 7 �............................ Issued --------------------------------------------------------- Date -------------------------------------------- ----------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE C�ertifirate of %QT;nmjj1ianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired( ) by J.P-.Macomber Jr. _.__.............. ............... -----------.....--------------------------..................-------...--------------.....----------- Inst ller at -- 102 Greeley Ave...best...Hvanni-sdport...-M�s.s.-... has been installed in accordance with the provisions of TITLE 5 f The State Environmental Code as described in the application for Disposal Works Construction Permit No. ------ --- 0-------- dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. y DATE.. 'r"'--- - - -------- - - Inspecto _. V_ :..:.... - �J / -------------------------------------------------------- -------�r-------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No....�.j....7 FEE....a...3 0.s.Q ) Dwpaual Workii Tunitru.tttinn "amit Permission is hereby granted-------J.P.Macomber Jr.. ------.---•---------------------------------------------------------------- ....................................... to Construct t( o. Repair`(X ) a Iividual,Sewa e Disposal System _xEefey Hve t,�st Hyannispo�Ct,Mass. atNo.. ..U. -••••-----•----------- A. -•-...... S....•---••--- --•----•••--••••--•-•---••------•----------------------•------......•-----------...------------.....---•--............... Street as shown on the application for Disposal Works Construction Permit No.,9.�1__7111)_- Dated.----,��'.�_."...... � j'i ---------------------- L Board of Health DATE------- - - �.'... ---•••- FORM 3890E HOBBS&WARREN.INC..PUBLISHERS TOWN OF BARNSTABLE LOCATION ����` y `l/ SEWAGE # �° VILLAGE C _ ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. J A� A C 0 N► XC° t- S a41 SEPTIC TANK CAPACITY /,S 0 LEACHING FACILITY:(type) T 5 (size) (O 0 NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER OR OWNERp,11 �' DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: "� �' p VARIANCE GRANTED: Yes No �- 37 _ 1 c �