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HomeMy WebLinkAbout0177 GREENWOOD AVENUE - Health 177 Greenwood Avenue Hyannis P A = 288 068 ll e u i ts No. Fee / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ✓ Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01ppCitation for Misposal *pstrm Construction permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon e ❑Complete System ❑Individual Components Location Address or Lot No. 7 rl &QEEUA�otb AVt Ow er's Name,Address,and Tel.No. H�i]1S rR <.© l3+r cc.H i Assessor's Map/Parcel (.Z GLUC Xj jZ,1 Installer's Name,Address,and Tel. o. �'®$a eEZ?�1�17 Designer's Name,Address,and Tel.No. 5 C Type of Building: J d� Dwelling No.of Bedrooms /L ` / Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) IV A— gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health Signed Date .3—3—a.01 S Application Approved by '—� you Ix Date -L/ Application Disapproved by Date for the following reasons Permit No. Date Issued I 1` qq No. G 1 /" G - - Fee � 5 / -7 < / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Zip fratiou for -Misposal 6pstem Construction Permit 3 Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( El Complete System El Individual Components .Location Address or Lot No. (1� �Q��Cd7 AU Owner's Name,Address,and Tel.No. rj �+� H`h4w�llS ��J<'.O 13EGC�f 1 Assessor's Map/Parcel a2s jj tpz 6LUG;- 1 Installer's Name,Address,and Tel. o. j Og-q -I—qv-7 Designer's Name,Address,and Tel.No. C� kWiDE q r=39PA .sr_t u ' N/A 5 c S Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria,( ) y Other Fixtures Design Flow(min.required) N gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil 1 Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in s 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 , Signed Date ,3—3—AO l S Application Approved by Date �3 1E, — Application Disapproved by Date for the following reasons Permit No. Date Issued --------------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) Abandoned(X)by �F (br= at 1-777 `fi)k&le(j� has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 201 S- 031 dated Installer 0—"GIx Dir G,Jl 1<JSS (.CSC.. Designer N/�! #bedrooms h/ /-/---- Approved design flow �.. gpd The issuance of this perm t shall not be construed as a guarantee that the system wV_ etition as signed. Date ( � Inspector ' ��, --------------------------------------------------------------------------------------------------------------------------------------- No. go I S % G 3 Fee S" THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal *pstem Construction Permit Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon(x) System located at j 11 r7 gZp'z) 2AUC;� }-f\jk 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 Approved by I �tKE T� Town of Barnstable Barnstable ' Regulatory Services Department ;"` C j SARNSTABLE. MAC. Public Health Division i639• ��' m �f039 A 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7014 1200 0001 0358 2073 February 9, 2015 FRANCO & MARY BECCHI 62 BLUE RIDGE DR IMPORTANT NOTICE STAMFORD, CT 06903 Map & Parcel: 288-068 DEADLINE APPROACHING According to our records your dwelling at 177 Greenwood Ave, Hyannis, MA, should be connected to public sewer on or before 3/30/2015. This is a reminder that all permits need to be in place before this date to be in compliance: 1) Septic Abandonment Permits ($ 25) are issued at the Public Health Division, 200 Main Street, Hyannis. The old septic system must be either removed or filled in due to future safety concerns. This may be done by the same contractor who connects you to the sewer. 2) Contractors, approved to perform sewer.connection work in the Town of Barnstable must obtain and file a Sewer Connection Permit with DPW-Water Pollution Control Division, 617 Bearse's Way, Hyannis—contractors, please call Dave Anderson at(508) 790-6244. FOR ANY QUESTIONS /ASSISTANCE: Len Gobeil at the Town Manager's Office is available to provide you with direction you may need in reference to the Stewart Creek Sewer Connections. You may contact him at 508-862-4701. Thomas A. McKean, R.S., C.H.O. Agent of the Board of Health r` ` Town of Barnstable Barnstable t�r oxq� Regulatory Services Department M-ftfMcaC" sAertsrAec e I.F NAM 163q __ _ - -Public Health-Division 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7012-1010-0000-2848 -0370 March 28, 2013 FRANCO &MARY BECCHI 62 BLUE RIDGE DR IMPORTANT NOTICE STAMFORD, CT 06903 Map & Parcel: 288- 068 The Department of Public Works informed us that public sewer lines are now available in your neighborhood. According to our records, your property has a septic system. This letter directs you to connect your dwelling, at 177 Greenwood Ave, Hyannis,MA, to public sewer on or before 3/30/2015. The old septic system must be either removed or filled in due to future safety concerns. This may be done by the same contractor who connects you to the sewer. Septic Abandonment Permits ($ 25) are issued at the Public Health Division, 200 Main Street, Hyannis. Failure to comply with this Board of Health Order may result in a complaint against you, in a court of law. For additional information pertaining to the sewer connection, please see the reverse side of this page. PER ORDER OF THE BO RD OF HEALTH r Thomas A. McKean, R.S., C.H.O. Agent of the Board of Health Cc: Barbara Childs,WPC/Roger Parsons, Town Engineering, DPW Enc. QASEWER connect\Letters Stewart Creek Sewer Connects\MAIL.ING L.etA Sewer 2Pgs Merged 3-28-13 Yr2015.doc t� t Public Health Division March 28, 2013 ADDITIONAL INFORMATION AND REMINDERS FROM OTHER DIVISIONS: SAVINGS AVAILABLE/GRINDER PUMP: A reminder to those of you who need a grinder Rump for your connection: Department of Public Works (DPW) sent you a letter in December 2012 stating the town, for a limited time of two years, only from the receipt of the DPW letter, would provide you with the pump at no charge. (This can save you thousands of dollars.) Please note: You must pay the installation cost through your own contractor. Please make your contractor aware of this, if interested. Also be aware: this is a shorter deadline than the Public Health Division's deadline on the reverse side of this page. SAVINGS AVAILABLE/PERMIT FEE: The Town offers a waiver of the residential sewer connection fee of $420.00 for those properties that connect within two years of the receipt of the DPW December 2012 letter. LOANS: For loan(s) available, please see the enclosed brochure, or see the town website: 11ttp://www.town.bai-nstable.ma.us/cdbg (under the "CDBG Programs", see "Sewer Connection Loan Program). For loan specific questions, you may contact Kathleen Girouard, Growth Management, at 508-862-4702. CONTRACTORS: Information on Licensed Sewer Installers is available on our web site at www.town_bartistable.ma.Lls/PublicWoi-ksTech/sewerinstallers. Contractors, approved to perform sewer connection work in the Town of Barnstable must obtain and file a Sewer Connection Permit with DPW-Water Pollution Control Division, 617 Bearse's Way, Hyannis—contractors, please call Dave Anderson at (508) 790-6244. FOR ANY QUESTIONS /ASSISTANCE: Len Gobeil at the Town Manager's Office is available to provide you with direction you may need in reference to the Stewart Creek Sewer Connections. You may contact him at 508-862-4701. QASEWER connect\Letters Stewart Creek Sewer ConnectS\MAILING L.etA Sewer 2Pgs Merged 3-28-13 W2015.doc S-T- a P.0 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFASSESSORS MAP N0: �S �S DEPARTKP,NT OF BIRMONMENTAL PROT David B.Macon,R.S,Certified Title V Inspector,508-833-2777U L 0 2 20 04 N OF BARNSTABLE HEALTH DEPT. TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 177 Greenwood Ave,Hyannis,MA Owner's Name:Betsy McGovern Owner's Address:Same Date of Inspection:June 22,2004 Name of Inspector: (please print)David B.Mason Company Name:AA. Mailing Address:4 Glacier Path East Sandwich,MA 02537 Telephone Number:50$-1333-2177 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the 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.fimction 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: X Passes _Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: C-, O 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. Notes and Comments: System as inspected appears to have operated based on occupancy level. Increase in occupancy may cause hydraulic failure.The information as identified represents only the condition ofthe system on .Tune 24,2004 at 2:00 PM. .� ****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. Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 177 Greenwood Ave,Hyannis,MA Owner: Betsy McGovern Date of Inspection:June 22,2004 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: _X I have not found any information which indicates that any ofthe failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the 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 lealdng and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: 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 obstruction is removed COMPLETED) distribution box is leveled or replaced (THIS IS REQUIRED TO BE ND explain: 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 pipes)are replaced obstruction is removed ND explain: Page 3 of l 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 177 Greenwood Ave,Hyannis, MA Owner: Betsy McGovern Date of Inspection:June 22,2004 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. I. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(l)(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 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 well**.Method used to determine distance **This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility 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: OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS Page 4 of 1 I PART A CERTIFICATION(continued) Property Address: 177 Greenwood Ave,Hyannis,MA Owner: Betsy McGovern Date of Inspection:June 22,2004 D. System Failure Criteria applicable to all systems: You must indicate"yes"or`no"to each of the following for all inspections: Yes No _X_ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool —X— Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or — cesspool NA_ Liquid depth in cesspool is less than 6"below invert or available volume is less than %day flow _X_ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s)- Number of times pumped _X_ Any portion of the SAS,cesspool or privy is below high ground water elevation. —X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. �X Any portion of a cesspool or privy is within a Zone 1 of a public well. _X Any portion of a cesspool or privy is within 50 feet of a private water supply well. —X 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 able water quality analysis.[This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic cpmpounds indicates that the well is free from pollution from that facility 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.] NO (Yes/No)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. 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) yes no the system is within 400 fat of a surface drinking water supply _ the system is within 200 fat 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 W 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. Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 177 Greenwood Ave,Hyannis,MA Owner: Betsy McGovern Date of Inspection:June 22,2004 Check if the following have been done.You must indicate"yes'_or"no"as to each of the folly owing _ Yes No X _ Pumping information was provided by the owner,occupant,or Board of Health ;-X Were any of the system components pumped out in the previous two weeks? X Has the system received normal flows in the previous two week period? _X Have large volumes of water been introduced to the system recently or as part of this inspection? X _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) _X , Was the facility or dwelling inspected for signs of sewage back up? X— — Was the site inspected for signs of break out? X _ Were all system components,excluding the SAS,located on site?(INCLUDING THE SAS) X _ 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? X _ 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: Yes no X _ Existing information.For example,a plan at the Board of Health. X_ 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(3)(b)) Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 177 Greenwood Ave,Hyannis,MA Owner: Betsy McGovern Date of Inspection:June 22,2004 FLOW CONDITIONS RESIDENTIAL 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): 330gpd Number of current residents:_1 Does residence have a garbage grinder(yes or no):NO(Not Allowed) Is laundry on a separate sewage system(yes or no):NO [if yes separate inspection required]Per owner Laundry system inspected(yes or no):NA Seasonal use: (yes or no):NO Water meter readings,if available(last 2 years usage(gpd)): 2003;60,000 gal. 2002;50250 gal. Sump pump(yes or no):No Last date of occupancy:(current) COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15,203): eod Basis of design flow(seats/persons/scActc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no):_ Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information:Property owner Was system pumped as part of the inspection(yes or no):NO If yes,volume pumped: gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM X 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) _Tight tank _Attach a copy of the DEP..,dpproval _Other(describe): Approximate age of all components,date installed(if known)and source of information:Tank is about 15 years old: Leaching is about 6 years old. Were sewage odors detected when arriving at the site(yes or no):NO Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 177 Geenwood Ave,Hyannis,MA Owner: Betsy McGovern Date of inspection:June 22,2004 BUILDING SEWER(locate on site plan) Depth below grade:Approximate;22 Inches Materials of construction: cast iron X 40 PVC other(explain): Distance from private water supply well or suction line: NA Comments(on condition of jowts,venting,evidence of leakages etc.): Appears in good condition. No evident leakage. Sewer line is pvc. SEPTIC TANK:N.A.(locate on site plan) Depth below grade: l 0" Material of construction:X_concrete____metal_fiberglass_polyethylene X_other(explain)_Cesspool Block If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: Typical 1000 Gallon Tank Sludge depth: S inches Distance from top of sludge to bottom of outlet tee or baffle:24" Scum thickness:4" Distance from top of scum to top of outlet tee or baffle: 16" Distance from bottom of scum to bottom of outlet tee or baffle: 14" How were dimensions determined:actual measurements Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.)Requires maintenance pumping. Outlet tee is precast and in good condition. Appears to be slight plumbing leak due to continual flow. GREASE TRAP, N.A. Depth below grade:— 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: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS Page 8 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 177 Greenwood Ave, Hyannis,MA Owner: Betsy McGovern Date of Inspection:Jane 22,2004 TIGHT or HOLDING TANK:-.N.A.-(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/day Alarm present(yes or no): , Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX:_Yes(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Even with outlet pipes. One outlet pipe had a flow leveler. Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of bo),etc.): Viewed with camera.No evidence of solid carryover. One outlet with effluent level with outlet invert. PUMP CHAMBER:_(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.): OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C [rt 7[tiTTl�.f T%TjM0%"1Lff 1 TT/ll►T, 11 Page 9 of 11 Property Address: 177 Greenwood Ave,Hyannis,MA Owner: Betsy McGovern Date of Inspection:June 22,2004 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: Type X leaching pits,number(1)6'wide x 4' deep w/approx.3'of stone around _leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: innovativetalternative system Typelname of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc)indication of staining 2'off bottom of pit,6"of effluent in bottom of pit,no ponding or damp soil,no vegetation over pit. CESSPOOLS: NA (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 or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY:—N.A.—(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.): Page 10 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 177 Greenwood Ave,Hyannis,Ma Owner: Betsy McGovern Date of Inspection:June 22,2004 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch 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. /l W �1 I / r t Page 11 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 177 Greenwood Ave,Hyannis,MA Owner: Betsy McGovern Date of Inspection:June 22,2004 SITE EXAM Slope Surface water Check cellar (crawl space) Shallow wells Estimated depth to ground water 20_feet Please indicate(check)all methods used to determine the high ground water elevation: X Obtained from system design plans on record-If checked,date of design plan reviewed: X Observed site(abutting property/observation hole within 150 feet of SAS) X_Checked with local Board of Health-explain:Recent Test Hole, Existing engineer records with BOH X Checked with local excavators,installers-(attach doementation) Accessed USES database-explain: You must describe how you established the high ground water elevation: Utilized existing site design information on file with the Board of Health. Additionally,existing site and abutting site topography does not indicate ground water to be within 5 feet of bottom of leaching facility. Depth of ground water would exceed 20 feet below grade. Home: Departments:Assessors Division: Property Assessment Search Results . 177 GREJENWOOD AVIE UE2. Owner: Property Sketch Legend MCGOVERN,WALTER F MaplParcel/Parcel Extension 288 /068/ 77A Mailing Addns , MCGOVERN,WALTER F MCGOVERN,MADELYNE L H PO BOX 27 HYANNISPORT, MA.02647 2004 Assessed Values: Appraised Value Assessed Value Building Value: $75,600 $75,600 Extra Features: $2,400 $2,400 Outbuildings: $0 $0 Land Value: $183,800 $183,800 Interactive Property Map: P requires Plug in: Totals:$261,800 $261,800 I have visited the maps before . Show Me The Mac April 2001 photos available Sales History: Owner: Sale Date Book/Page: Sale Price: MCGOVERN,WALTER F 2251/55 $0 2004 Tax Information: Tax Rates: (per$1,000 of valuation) Town Tax $ 1,730.50 Town Fire District Rates Other Rates 6.61 Barnstable 2.01 Land Bank 3%of Town Tax Hyannis Fb Tax $531.45 '` C.O.M.M. 1.10 Cotuit 1.52 Land Bank Tax $51.92 Hyannis 2.03 West Barnstable 1.36 Total: $2,313.87 Due to rounding differences these values may vary http://www.town.bamstable.ma.us/t.../displayparce103.asp`.hmppar=288068&SearchBy=Addres 6/24/04 Land and Building Information Land Building Lot Size(Acres) 0.31 Year Built 1962 Appraised Value$ 183,800 Living Area 1033 Assessed Value $183,800 Replacement Cost$93,314 Depreciation 19 Building Value 75,600 Construction Details Style Ranch Interior Floors Hardwood Model Residential Interior Walls Drywall Grade Average Minus Heat Fuel Gas Stories 1 Story Heat Type Hot Water Exterior Walls Wood Shingle AC Type None Roof Structure Gable/Hip Bedrooms 3 Bedrooms Roof Cover Asph/F GIs/Cmp Bathrooms 1 Bathroom Total Rooms 5 Rooms Extra Building Features - Code Description Units/SQ ft Appraised Value Assessed Value FPL1 Fireplace 1 $2,400 $2,400 Property Sketch Legend BAS First Floor, Living Area FST Utility Area(Finished Interior) UAT Attic Area(Unfinished) BMT Basement Area(Unfinished) FTS Third Story Living Area(Finished) UHS Half Story(Unfinished) CAN Canopy FUS Second Story Living Area(Finished) UST Utility Area(Unfinished) FAT Attic Area(Finished) GAR Garage UTQ Three Quarters Story(Unfinished) FCP Carport GRN Greenhouse UUA Unfinished Utility Attic FEP Enclosed Porch PTO Patio UUS Full Upper 2nd Story(Unfinished) FHS Half Story(Finished) SFB Semi Finished Living Area WDK Wood Deck FOP Open or Screened in Porch TQS Three Quarters Story(Finished) http://www.town.bamstable.ma.us/t.../displayparce103.asp?mappar=288068&SearchBy=Addres 6/24/04 6—• C, f TOWN OF BARNSTABLE y LOCATION__j :2 ? Cune-zL,wadd' SEWAGE L VILLAGE c. . ASSESSOR'S MAP& LOT INSTALLER'S NAME PHONE NO. SEPTIC-'TANK CAPACITY U �. LEACHING FACILITY:(tppe) (size) NO. OF BEDROOMS /PRIVATE WELL O:R' PUBLIC.WATER BUILDER.OR OWNER r. L l��✓ G� ;A - DATEPEAMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No F a � tit I U S � 1� Nt,-j -c r � c �-J THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratinn for Di i-pwiul Wnrbi Toutitrnrtinn Permit Application is hereby made for a Permit to Construct ( ) or Repair ( �an Individual Sewage Disposal System at ..7 ------- ....................-............................................................................. Loc:t',n-:\Mr ess or Lot No. .............?�L�k.. 6•!..J--•---------------. �� ... o „ Aad� ---- --------------------------- a � = -----------------•--- ---------. - ...... .......... Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.__---------------------------------_-----Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Q' Other fixtures -------------------- --------- w Design Flow...........6.Z5.........................gallons per person p r day. Total daily flow-----7zq ..._..____............,..gallons. WSeptic Tank E Liquid capacity _..gallons Length___.. .......... Width--.- ..... Diameter---------------- Depth................ x Disposal Trench--No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No------ ............. Diameter--_--jP0...... Depth below inlet___........... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by........--................................................................. Date........................................ 14 Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water........................ Gi, Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ a ------•---•..............................•-•---•••---•-•-•-•---•----------------•---.........-----...........-----------........-----..........---........_. 0 Description of Soil........................................................................................................................................................................ x w UNature of Repairs o Alterations—Answer when applicable._._4 ..� 4 ._�0 ___�' A------ .�.t. ...... �-.. ------------"- c-�---"'�� .--.....--�`---`_'�-------------------------------------•--.............................-- 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 Q }ia°ne€ I been ' ut�he—bo�4a/ro th. nedSig ---------- --------- ----- ---------------- ........... ----- ------------ .... c.. .' :...... Dace Application Approved BY .. $ '.. .....--�'L.. 7�e Application Disapproved for the following reasons: .................................... . .................. -- ........................... .................... ........ ... ....................................... ................... .. ........................ . ................I---------------- ...............................I........ Dace Permit No. -------------T... ..:'....- -- - 1 ... .. Issued .... ....... Dare .�'Yw"L...��+i✓4..--.J w,ti,,,,�.•r..�+....w+u�,,."'v"w.,,»ti,..,•���v+'4r-'--�•�r--•...iK.-+-"tit'.-7`.✓`..,�....•Y... .�..: .,,,. . ..�4' .,. ... ,._.R_��,.-.,. _ _ .v'N w _ir _ _-_�� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Diripooul Works C ongtrnr#tun 11rrutit Application is hereby made for a Permit to Construct ( ) or Repair ( �an Individual Sewage Disposal System at: ---------- Location-Address �( /j or Lot No .n!_?_Q V!l .........•._._.•.. / l{_!r�F�.................. ..._. t r --------------•--....•..... �/�� (mot .- O ;ncr� -- - •----•-•---/-C•--- ,Wa --•--••......_ E ? -1 9Y/it A7-- -----------------•------•-- ......-- IT t'!�Add7enss................. -•• �y L,stall r Address UType of Building Size Lot.................... ......Sq. feet .. Dwelling—No. of Bedrooms-----,�--- ------------------------•-_---._Expansion'Attic ( ) Garbage Grinder ( ) `4 Other—Type of Building ............................ No. of ersons-------_---_-_---------.---. Showers a g P ( ) -- Cafeteria ( ) dOther fixtures -------------------------------------------------- --........................................ 9 Design Flow.........+- . .... ....................gallons per person er da Total dail flow......._...2_�-•�._.. W Y Y = gallons. WSeptic Tank Liquid capacity!'0___gallons Length._._��....... Width-._�=._..... Diameter----------------,Depth................ x Disposal Trench—No. .................... Width------....._._.___.. Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No.................... Diameter.----�_�.f__..._ Depth below inlet.........r........ Total leaching area....,........_._..sq. ft. Z Other Distribution -ox ( ) Dosing tank ( ) aPercolation Test Results Performed by..--...................................................................... Date....................................... .a 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........................ a' ---•----•-••••.....•---------------•----....-----•----•--•-.......--•-----...----•-..........-•-............--••-•-•-.......----.........................---- 0 Description of Soil.............................................................................................................................................I........................ W U •--••-----------------------------•--------.......----------...--------------•---•-------................--------------••---------------•---------------•-----------------...---•---•----....-•---•--•-- W x --•-•-•------------------------------------------•------------------•---•---•--....--------...---------•-••....------------._...------------•----••----••---•-•-•-----•-------..._........-•----------•. U Nature of Repairs or Alterations—Answer when appli.cable.-.-_. �.Zrs�-��..�Off... r�7............. ---•- r ..................................-•...................................•-----.............-•-- 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 Conplfiance ha been i s"ued_by the—boaarrd of he/a-I�th. Signed ...........`1.r '" /— ....1 -.. ..:�"I�1 ---------------------- .............. ...--- II .. ... ....�y...----........ Dace Application Approved By ...... ............---------------------- -------- ......................... ... ... ...-.. .(` Application Disapproved for the following reasons: ...... . .................... ............................................ . ............ ..............--........ ................................................. ............................................... ......................................... Dare Permit No. . V......... � Issued � -� Dare THE COMMONWEALTH OF MASSACHUSE17S BOARD OF HEALTH TOWN OF BARNSTABLE CZe>r#ifi a e of CZomplianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired byG ` vim .. .... ...................................... .................... ...... ` Installer at ..............................._........._... P.. ......................... ........ ....... .. -- has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ....9. _--..�/. .�y .......--- dated -------___-------_._......._.__....THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE ........... �'.... �� Inspector rya aFu..-a- .m ra�.a �. �r-----—------a——a—————_-- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No ? TOWN OF BARNSTABLE Dispusttl Vorkii Tonotrttrtion "erntit �- -----•-•---••-••--•----•---•.................•..--- Permission is hereby granted--------------------------------• -----�-`-=�--c-�----------•--------•------•- to Construct ( ) or Repair (U—atf Individual Sewage Disposal System atNo................................................ 6-.`e........................................................................ Street q _ as shown on the application for Disposal Works Construction Permit No._ . .:_f.V_rDated.... -`�........... t ` / DATE.................. --�_= -�'�......................... &1rd of Health FORM 36508 HOBBS e,WARREN.INC..PUBLISHERS