Loading...
HomeMy WebLinkAbout0262 GREENWOOD AVENUE - Health 262 Greenwood Avenue Hyannis 288 179 x i. o m TOWN OF BARNSTABLE LOCATION �` � Gis ®� SEWAGE # VILLAGE ®� ASSESSOR'S MAP & LOT -/7 Rdff-AttE-R'S NAME&PHONE NO. SEPTIC TANK CAPACITY z -5,,f cc LEACHING FACII,ITY: (type) (size) NO. OF BEDROOMS (� BUILDER OR OWNER FMIMM'DATE: J - f `S 'COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom.of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by '�� o 4 ,. � �� ��1 v� 4? �h —�+. 0 \ s _ � � .. z 2 9 5 Z REDE.IVED MAY 3 12005 TOWN COMMONWEALTH OF MASSACHUSE L---H OALBH DEPTABLE Z F EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS Y M d DEPARTMENT OF ENVIRONMENTAL PROTECTION 4 Iq 350 MAIN STREET _ a "� ��� _ WEST YARMOUTH, ���C' & 508-775-2800 p" Cry:.r�� TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM ? 9 PART A CERTIFICATION Property Address: 262 GREENWOOD AVENUE HYANNISPORT,MA 02646 Owner's Name: SALYARD,BRIAN Owner's Address: 4 COUNTRY LANE WINCHESTER,MA 01890 Date of Inspection MAY 11,2005 Name of Inspector:(please print) JAMES D.SEARS Company Name: A&B Canco Mailing Address: 350 Main Street West Yarmouth,MA 02673 Telephone Number: 508-775-2800 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 function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CAM 13.000). The system: ✓ Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority ails Inspector's Signature: Date: The system inspector shall sub 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,ystem 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 tot he buyer,if applicable,and the approving authority. Notes and Comments ****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 Title 5 Inspection Forni 6/I5/2000 1 Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 262 GREENWOOD AVENUE HYANNISPORT,MA 02646 Owner: SALYARD,BRIAN Date of Inspection: MAY 11,2005 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: ./ I have not found any information which indicates that any of the failure criteria described in 310 CUR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: N/A 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 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. 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 distribution box is leveled or replaced 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 pipe(s)are replaced obstruction is removed ND explain: Title 5 Inspection Form 6/15/2000 2 Page 3 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 262 GREENWOOD AVENUE HYANNISPORT,MA 02646 Owner: SALYARD,BRIAN Date of Inspection: MAY 11,2005 C. Further Evaluation is Required by the Board of Health:N/A 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 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 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: Title 5 Inspection Form 6/15/2000 3 Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 262 GREENWOOD AVENUE HYANNISPORT,MA 02646 Owner: SALYARD,BRIAN Date of Inspection: MAY 11,2005 D. System Failure Criteria applicable to all systems: N/A 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 or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ✓ Liquid depth in pit is less than 6"below invert or available volume is less than%day flow 7 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 N/A Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply N/A Any portion of a cesspool or privy is within a Zone 1 of a public well N/A Any portion of a cesspool or privy is within 50 feet of a private water supply well N/A Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. (This system passes if the well water analysis performed at a DEP certified laboratory,for 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 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: N/A To be considered a large system the system must service 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 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well. If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system is 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. r Title 5 Inspection Form 6/15/2000 4 Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 262 GREENWOOD AVENUE HYANNISPORT,MA 02646 Owner: SALYARD,BRIAN Date of Inspection: MAY 11,2005 Check if the following have been done. You must indicate"yes" or"no"as to each of the following Yes No we 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? if Have large volumes of water been introduced to the system recently or as part of this inspection? N/A 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,including 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)has been determined based on: Yes No N/A Existing information. For example,a plan at the Board of Health. ✓ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3Xb)] Title 5 Inspection Form 6/15/2000 5 Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 262 GREENWOOD AVENUE HYANNISPORT,MA 02646 Owner: SALYARD,BRIAN Date of Inspection: MAY 11.2005 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: 330 Number of current residents: NO Does residence have a garbage gender(yes or no): NO Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no): YES Seasonal use(yes or no): NO Water meter readings,if available(last 2 years usage(gpd)): 2004—15,675 GAL/2003—22,500 GAL Sump pump(yes or no) NO Last date of occupancy: UNKNOWN COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): Basis of design flow(seats/persons/sgft,etc.): 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: N/A Was system pumped as part of the inspection(yes or no): If yes,volume pumped: gallons—How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM Septic tank, 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 copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: UNKNOWN Were sewage odors detected when arriving at the site(yes or no): NO Title 5 Inspection Form 6/15/2000 6 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 262 GREENWOOD AVENUE HYANNISPORT,MA 02646 Owner: SALYARD,BRIAN Date of Inspection: MAY 11,2005 BUILDING SEWER(locate on site plan): ✓ Depth below grade: 16" Materials of construction: ✓ Cast iron ✓ 40 PVC _ other(explain) Distance from private water supply well or suction line: Continents(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK(locate onsite plan): ✓ Depth below grade: 2" Material of construction: concrete metal fiberglass polyethylene _ other(explain) If tlik is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1000-GALLON PRE CAST Sludge depth: 2" Distance from top of sludge to the bottom of outlet tee or baffle: 28" Scum thickness: I Distance from top of scum to top of outlet tee or baffle: 8" Distance from bottom of scum to bottom of outlet tee or baffle: 17" How were dimensions determined: TAPE&PROB Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): MAIN TANK AT WORKING LEVEL,COVER AT 2"TWO INLET TEE'S—ONE OUTLET TEE. NO SIGN OF OVER LOADING OR SOLID CARRY OVER. GREASE TRAP(located on site plan) 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 battle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Continents(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Title 5 Inspection Form 6/15/2000 7 Page 8 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 262 GREENWOOD AVENUE HYANNISPORT,MA 02646 Owner: SALYARD,BRIAN Date of Inspection: MAY 11,2005 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: N/A if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.,): PUMP CHAMBER: N/A (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.): Title 5 Inspection Form 6/15/2000 8 Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 262 GREENWOOD AVENUE HYA,NNISPORT,MA 02646 Owner: SALYARD,BRIAN Date of Inspection: MAY 11,2005 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits,number: 1 leaching chambers,number: leaching galleries,number leaching trenches,number,length leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative 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 ONE 1000-GALLON PRE CAST PIT WITH COVER AT 18"—F WATER. STAIN LINE AROUND 30." NO SIGN OF OVER LOADING OR SOLID CARRY OVER. CESSPOOLS: N/A (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.) Title 5 Inspection Form 6/15/2000 9 ` Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(contint:ed) Property Address: 262 GREENWOOD AVENUE HYANNISPORT, MA 02646 Owner: SALYARD.BRIAN Date of Inspection: MAY 11.2005 ^ 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. �v 0 j Title 5 Inspection Form 6/15/2000 10 Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 262 GREENWOOD AVENUE HYANNISPORT, MA 02646 Owner: SALYARD,BRIAN bate of Inspection:. MAY 11, 2005 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to groundwater 20+ feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observation site(abutting property/observation hole within 150 feet of SAS) Checked.with local Board of Health-explain: Checked with local excavators,installers-(attach documentation Accessed USGS database-explain: You must describe how you established the high ground water elevation: AREA HIGH. NO SIGN OF GROUND WATER. to d�7 i 1 Title i Inspection Form 6/15/2000 11 I cuN(NI rr _ 7• 50' BUFFER E • 30 PHRAGMITES 7©" EE jEDGE OF CAM,I 4 y Z —1 PAVED DRIVE a' W la w IZ Q Z INN Plant List rUNCI(I':Ir CAGING Quantity Common Name Scientific Name Planting Size 1 5 cinnamon fern Osmunda cinnamomea 1—GOI WA I k E(Fc I 4 Inkberry holly Ilex glabra 5—Gal ... FIELDSTONE r, PATIO / LAWN AREA ( 3 Arrowwood viburnum Viburnum dentatum 3—Gal 22 pennsylvania sedge Carex pensylvanica 1—Gal r 19 switch grass Panicum virgatum 1—Gal 4 Common winterberry Ilex verticillota 3—Gal OPEN STEP '- TO BASEMENT ...N_of'es IL - o 4, * Ali work to comply with an order of conditions from Barnstable �o Conservation Comm. SHWR * Plant one male winterberry and three female winterberry * This plan shows plant locations, types and spacing, for all else see site plan by Baxter and Nye or deck construction plan EXISTING DWELLING *Install heavy duty weed fabric in the section of planting area next to #262 E`v' phrogmites to prevent phrogmites intrusion into planting. o� t 7 switch grass *work plan for new planting area: install siltation contol along work limt, 2Pt remove turf, install planting, mulch with bark mulch, water during growing New deck, l seasons as needed. stairs," t'- landtn 4 winterberry 12 Scale 1" = 10' an an 11" x 17" sheet " TREE EXISTING 2 Inkberry holly DECK 5 cinnamon fern Mitigation Planting Plan revised E LAWN AREA 2/1/2016 262 Greenwood Ave IAWN AREA 2 7RE 3 Arrowwood viburnum Hyannis Ma Great Hill Horticultural Services a ORE 824 sq. ft. new planting area Bob Hoxie, MA Certified Horticulturist NAIURAI.E Y Install draw wattle tubing 8"-10" staked in place along length of new planting area 508 3117 0405 Vr.01o'IATCD AREA 12 switch grass 2 Inkberry holly 22 pennsylvanio sedge No. CDO-,q Fee, O THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 2pplication for Mfi6poeat *p5tem Con!5truction Permit Application for a Permit to Construct( . )Repair(_151upgrade( )Abandon( ) O Complete System ❑Individual Components Location Address or Lot No. 0& Owner's S e�ddres and Tel.No.n p Assessor's Map/Parcel �C11�.� �+�1 y aA : Installer's Name,Address,and Tel.No. 9—, Designer's Name,Address and Tel.No. V^ Type of Building: Dwelling No.of Bedrooms Lot Size - sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. 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) uLaD(rr , o Ue XNL Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued b this B lth. S Date Application Approved'gned I Date �� O Application Disapproved for the following reasons Permit No. C> _ Date Issued �— "'t•` i.. --�-,.....tip-�,..-.;-..p.-.:.... •... ...-..r r- -_-v--a. N..,,�.•.�.�.�.-fa. ,....,_:.w..... ^tom t-� r._..... No. C� _ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: - Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 4 ZIppfication for/j3i2;po5al'*pgtem Congtruction Permit Application for a Permit to Construct( , )Repair(grade( )Abandon( ) O Complete System O Individual Components 1 Location Address or Lot No. aZ(o �p�LQ��O� Owner's Name,Address and Tel.No. Assessor's Map/Parcel �yn� ^-f ea l c 7 S�av�� 2 _ Rc3c e\0�,,n.To"f\ w^W , Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. AQCa�c.a 3;'r-0V-r,va,%V\ S C Zj\ Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other T1 pe of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date I Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable)Date last inspected: #4 j F Agreement: II The undersigned agrees to ensure theconstruction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued b this B f th. S ned l Date Application Approved b` Date /�c G Application Disapproved for the following reasons Permit No. go Date Issued �? THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( --rupgraded( ) Abandoned( )by at _ o'L(o as been constructA i ac/�ordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 7 0o - dated Installer Ph.a Och.\-\c o Designer A1 The issuance o+this permit shall not be construed as a guarantee that the sysiSM will function as designed. Date I<z �ON Inspector ______ - _/�_ . . .. �C�D —'3 � � -------------------------_ No. Fee GG THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Mi0po9;al bpg;tem Construction Permit Permission is hereby granted to Construct( )Repair( grade( )Abandon( ) System located at a(o weQ%i\, e%nA 4�j-e-_ S (an•�.�" and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special condi 'ons. Provided:Construction ust be •ompleted within three years of the date of this pe t. // G Date: / Approved BARN4TABLE FIRE'DISTRICT APPLICATION FOR PERMIT -. TO INSTALL..-:AL UTsI. •OIL,'BURNING,EQUIPAENT o.the mead of the Fire Department > a ra aaz m mom a o � a 0 m w». - M �' Cn a m Application is, hereby made in accordance with the provisioas of Chap 148, G i:':,and IL " m " m m o b. Ng , o a Regulatrons made under.authotrty thereof.by undersigned for.permrt to install`, alter, for x F t4 = z the person or persons and of the location Warned herein certain equipment for the keepiatg, , m o _ r, M�•M > storage or use,of fuel or otmher flammable tiquid,products used for.fuel as described below: m b c m �o� > c b w .� 0�0 e d Q o m ° m NAME hQ-tt�`I I�12s191I. m ` b E Emma-°° `9G w mp+ 0mn . m , o p m m g o - ADDRESS f!o Z Arian t!o J �e > m rn ^' Description. Name EC R_ c :, m m m c o m o. � o o ro o Manufacture _ 1 .liu. m z. m .. c o y D ' Burner Type 7k �x .._. tlho �Q � o• o m � � � A � C) �___­Modelor Size If N` FL � Location �QSa YN o.. Mass A.pproved No Q o'm c :� it �' z Z w $ROrago T$rilCi 7Vpe,_ 1 7 m m m m m m �. (� Capac�EY !dais: (or) Size x o m �, iroration / NJ x ° J° o c n o R i Amount of#uel required fior testin ur ose__ z a o g P P. gals. };m �z C m b ' This application is made with full`knowledge of the current requirements of the o o :L:a �.m o m ►� regulations governing such installation, which will.be made in compliance therewith. �> z e° 0 n m M o �• W > �• Note; If this application involves alterations to existing equipment, py A e � � p' C p.,� z � r r7 n describe .fully ,on reverse side. o - Cr ° p „ m o m E oCDP! o ►� O C �• p ryj O p.y .;.. ... x y a 9 m �• m y l CD m r • a `N° Etl i�tt 1?i.m m `° ° ° 'gym m "� ►°'� CD . �' ° o s° g. > Signature pf Ap leant mm � 0p �' pp _ p ° `° o z° '� By r_ meo Gam? 94 �aP APpI. Rec'd a° m c o Address �3 S oJ!cti+n o f�/ Permit Issued Certificate f Competency # d ��S Permit # o CL � m "HYANN;S FIRE PREVENTION BUREAU' . Aso HYANNIS FIRE DEPARTMENT- 95 HIGH SCHOOL RD. EXT HYANNIS, NIA 02601 [A I OWN OF BARNSTABLE - UNDERGFIUUND FUEL AND ClIF.!7 : L./11.. S 1 01-R60E RFG I S1 P6I I ON MAP NO. PARCEL. NU. (_`� _._ TAG NO. J�s ADDRESS OF TANK: GfenP A 1oxo� kye • VILLAGE : f4--I WW mtr��fe .MAILING ADDRESS ( IF DIFFERENT FROM ABOVE ) : OWNER NAME: � ��i(`E 1 C. \�.,C I '•�-1 \ 1 I I L L - PHONE: INSTALLATION DATE: ?S1 �I BY: t_'t'w..K U r i INSTALLER ADDRESS: 3 t� '1 1 jt' 1 . �f t � 4��t .."1}'� 'CERT .N0. o �`(c *TANK LOCATION: ABOVE BELOW (DQmom I me TANK LOCATION W Z 1-H ,QOPQCT TO mU Z LD Z NO) CAPAC I TY TYPE OF 'TANK Sir L L AGE /2 YRS. /CHEMICAL . TESTING CERTIFICATION [ ] PASS [ ] FAIL DATE LEAK DETECTION [ ] CHECK IF N/A TYPE/BRAND ZONE OF CONTRIBUTION [ ] YES [ NO DATE TO BE REMOVED FIRE DEPT. PERMIT ISSUED YES [ ] NO DATE CONSERVATION [ ] CHECK IF N/A DATE BOARD OF HEALTH TAG NO. [ I S S ] DATE ! /U/a I >k PI EASE ;PROV I DE_yA;x SKETCH _SHOWING._THE WnTAN,K,3i_LOCAT I,ON,, ON,w THE—BA-K ,OF. T.H,I&',CARD '� OFTNE STABLE Town of Barnstable 9� 1 . �Eo +A Board of Health 367 Main Street, Hyannis MA 02601 Office: 508-790-6265 Susan G.Rask,RS. FAX: 508-790-6304 Ralph A.Murphy,M.D. Brian R.Grady,R.S. J &B Home Reality, Inc. PO BOX 608 Hyannis Port, MA 02647 March 21, 2001 Dear Home Owner: On March 19, 20011 inspected your home at 262 Greenwood Avenue for an underground storage tank(UST). Upon this inspection no evidence of a UST was found, but an above ground tank was in the basement for home heating oil. This new tank has been registered with the Health Department, and you will need to attach the enclosed tag to the fill pipe outside your home. If you have any questions,please contact me at(508) 862-4644. Thank you for your cooperation, Korin Scheible, MPH 4 ASSESSORS MAP NO:_ • S PARCEL NO: THE COMMONWEALTH OF MASSACHUSETTS., BOAR® OF HEALTH APPROVED TOWN OF BA R N STA B L E Barnstable Conservation QCpg .4 Ajr" W Application is hereby made for a Permit to Construct ( ) or Repair ( an ndividual Sewage Disposal System at: �- .... .................................................... Oz ...... ......... ................ .`� ... : :. .... W. .................................................. NJocatio� dd�s Lot No. •-- -- A .•. .............................. -- � ........................................................... �Ow..... AA —Jr......................................... Installer Address Q Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms---&.1..._.................................Expansion Attic ( ) Garbage Grinder ( ) a Other—T e of Building No. of persons............................ Showers Pk YP g ---------------------------• P ( )--- Cafeteria ( ) Otherfixtures -----•-------------------------------------------• •..••---•--•-••---•---•-•------•-----••......•------------------ ......•... W Design Flow....�tC . pe ----.....•_________________gallons per person r day. Total daily flow-_-_.�.�........................gallons. WSeptic Tank—Liquid capacity`gallons Length.. .........:.. Width----L.S_..... Diameter................ Depth................ x Disposal Trench—Noel. ......... Width...... `...... Total Length__d_)!J........ Total leaching area....................sq. ft. Seepage Pit No-------------------_ Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z . Other Distribution box ( ) Dosing tank ( ) 1­4W Percolation Test Results Performed by.......................................................................... Date........................................ 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........................ 0 Description of Soil........................................................................................................................................................................ W V ----------------------- ---------------.------------------•--------------•-----------------------•---------------------------------------------•-----------------------•------------------•---- W U Nature of Repairs or Alterations—Answer when a plicable.___ ( �_�___._�.. .-c .< .4_--�_ 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 been i d-b• e bo d of health. Signed _ ^-------------------- - . ............... ... - --------- Date Application Approved By .... . . . .................. ........... .... . ...... .... ........ .. ....... .... ..... ................... ........................................ Date Application Disapproved for the following reaso s ---------------------------------------------------------- ................................ ------------------------------------------- -- - ----.-...-.....-------------------------------------------------------.- - .. ------ .-.--Date...... ....... P D a te Permit No. -- ------------------- Issued ------------ ------ 7 7 No. - F�s...� ..................... THE COMMONWEALTH OF MASSACHUSETTS y K BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Did ,anal Mirkii Towitrurt nip mit 9 Application is hereby made for a Permit to Construct ( ) or Repair (�. 'an/Individual Sewage Disposal System at: a V . wC2�fJ r4 v-2 ocatton-Address or Lot No. .2.7.......... Owner-- .............. -•--•----•-.................................Address. ............. a C � 4- 4ar 2J ��i i 3 C_ C�� 4/�C ..............................I-•••----...------------.....--- Y..................-•-•-_..... ......... ............................................ —� Installer Address d Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms.._r .......................................Expansion Attic ( ) Garbage Grinder ( ) `4 Other—Type T e of Building No. of persons............................ Showers C4 YP g -------•-------•-----------• P ( ) — Cafeteria ( ) p" Other fixtures .................................. W Design Flow......:, _^57........................gallons per person per day. Total daily flow______ a.......................gallons. WSeptic Tank Liquid capacity-----------gallons Length._...------- Width----- ..... Diameter________________ Depth................ x Disposal Trench—No.�-!.. ...... Width...... _'.____.. Total Length---/._r/..!....... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ a Test Pit No. 1................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........................ ---------------------------------••--•--.........._...--•--------...-•----------......------..............-----•--------------....--•-•-------••----....-- Descriptionof Soil...--------------------•-•------------•--------------•--.............---------------------------------------------------------•-•-------------•-----••-•---------------- x w x ---------------------------------------------------------------------------- --------------•---------------------------------------------------------------............................................ U Nature of Repairs or Alterations—Answer when applicable._-_ _T"�- Q``___..1.!'.7:r- .;5 _I_C�4 - - :17— Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposaal 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 been is ued--byy`_the board of health. Signed .--- ........................................ ' ------..... �...Z,--- ---- ^ � Application Approved By .......----- Al------ .Jr�� Ate-------------- to 1 �... .. Dace Application Disapproved for the following reasons ------------------------------------------------------- ----------�....--.......-----.-- -----. ----------....----- .............. ............... :.i----------...8 --. .----.. .-------------------------------.........................-....-----.. ----------------- -------1 ---- -------- ----------------Date----------------- J� , j G� Permit No. l .- .-/�1:=�J- _.... Issued �/-/.•/..........�'^-................... f /Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE C�ertifi ate of Tompliance y THIS IS TO CERTIFY, the Individual Sewage Disposal System constructed ( ) or Repaired by.......... ........ t^--C.V--�.r�--..5- .�- ------- ---- --- ---- - --------------------------------------------------......................................... Installer at ----------------------------------------- �9 ..................................... ` ..............................................4-F fi r`--- --------------- has been installed in accordance with the provisions of TITL 5 9f The t. Environmental Code as described in the application for Disposal Works Construction Permit No. -- --./? ....."1,.ta --..... dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT E CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE - .----......�::---- ----I-------, ..A............................I.......... Inspector ---- --. --.. ....... .......--•---..------- ................................. 8 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE D No. �. FEE - ............ Permission is hereby granted........ .....p..... s...... to Construct ( ) or Repair ( 4) an Individual Sewage Disposal System ' at No... ozCo :......---- Y..�.✓t... ..-......-`-......------. . .. ...................................... ^ R' Street r c / as shown on the application for Disposal Works Construction Per No ._ .. ated.._.. l0. `a�T ................. i Board off Health ----------- DATE.................................. ----------------- FORM 36508 HOBBS R WARREN,INC..PUBLISHERS