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HomeMy WebLinkAbout0112 CANTERBURY CIRCLE - Health 112. Canterbury Circle Hyannis. P A 249 129 i i v 4 f' 11 TOWN OF BARNSTABLE LOCATION `®� PA✓��2- �v�Y C i SEWAGE # VILLAGE H ly ASSESSOR'S MAP & LOT lN9Y'* '8 NAME & PHONE NO. A & B CANCO 775-6264 SEPTIC TANK CAPACITY LEACHING FACILITY:(type) 0 fr (size) NO.OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER ?d y,"y1f DATE PER HT133MD: I1 VARIANCE GRANTED: Yes No M n r �° Q O �` Y � V� aJ TOWN OF BARNSTABLE LOCATION //i� �f�/V� �G//ej/ �li�C° SEWAGE # VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. A & B CANCO 775-6264 -SEPTIC TANK CAPACITY LEACHING FACILITY:(type) / G�7' (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER L/ BUILDER OR OWNER O C® ,d Ole JaWl TZ DATE PERMIT ISSUED: c f (� DATE COMPLIANCE ISSUED-- VARIANCE GRANTED: Yes No I _ ��� �� � � �1 �� ` \� a �� d 4U , �� ,1 LO-CATI N SEWAGE PERMIT NO. Code msiza V I L-L Ad E �' I N S T Vill. ER'S NAME & ADDRESS J� IJ B U It DE R OR OWNER ez DATE PERMIT ISSJiED "�0,.27-77 DAT E COMPLIANCE ISSUED e '-3I - 7F'• /� c ' ?' o J � � N S TOWN OF BARNSTABLE LOCATION �1��' N1�c►ziJCJfc�/ ll'lCs SEWAGE # �9*3 VIL-LAGE �J ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO. OF BEDROOMS BUILDER OR OWNER PERMITDATE: ®3 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 � � '� a o R O �, .� -..��� C,� � . 1 � ' ' � �� � . ,^� � � � e O � ^•� a o -�_ V1' ,�.....- 1 j No. a 00 S e 3 q l , Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 2pplication for ]Dt5pooar OpOtem Con.5truction Permit Application for a Permit to Construct( )Repair(11Kpgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. �/a i4n fc/`h�2y r. Owner's Name,Address and Tel.No. Assessor's Map/Parcel O, / v I t S tt S'a vw r_ Installer's Name,Ad(ksgag Td f4CO Designer's Name,�ress and Tel.No. 350 CCM��ainl�S'ttreet tlAq,, � W. Yarmouth- MA 02672S8S Oa`� 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 3.36 gallons per day. Calculated daily flow 25'oa gallons. Plan Date 7 Aj o 13 Number of sheets Revision Date w Title Size of Septic Tank F:k /6 crn Type of S.A.S. Description of Soil r- k Aj Nature of Repairs or Alterations(Answer when applicable) Ao—t /"14-A 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 by this Bo of ealth. Signed Date Application Approved by � Aa - Date U Application Disapproved for the following reasons Permit No. A-()()3—3g 3 Date Issued d Fee THE COMMONWEALTH OF.MASSACHUSETTS -i' ' Entered in computer:- t11 PUBLIC HEALTH DIVISION -70WN OF BARNSTABLE., MASSACHUSETTS 01ppfication for Miopool *pftem Congtruction Permit Application for a Permit to Construct( )Repair( tl pgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. //a �Cr,lcI al C i r , Owner's Name,Address and Tel.No. . Assessor's Map/Parcel t 1 ., d "A C_ Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. ntryer Sr3S ra 4 Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 3 3 G) gallons per day. Calculated daily flow 2 5-d gallons. Plan Date 7.4 c,13 Number of sheets Revision Date .,j °+' Title ) i f r - • .a Size of Septic Tank: /0 u Type of S.A.S. Description of Soils(' �t`d ti l Nature of Repairs or Alterations(Answer when applicable) /O"t A14�11 i 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 by th s Bo of ealth. Signed ' \ Date Application Approved by ip Date r U Application Disapproved for the following reasons Permit No. a 0 o 3—.3g13 Date Issued d THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS 4 Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired( L,-rGpgraded( ) Abandoned( )by C--7 -J C y at //c) rAr-)4rC0c;P(/ C:rl. 0 ^ ;c, has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 2003-3 93 dated L /S"0 3 Installer Designer r The issuance of tth4 perml't shall not be construed as a guarantee that the syste w' u '3e f ned. Date / 1 0 o 3 Inspector / .�/ No. 0 003—M 3 Fee 1�_G THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Migpogal *pgtem Construction Permit Permission is hereby granted to Con/stcuct( )Repair( -)6pgrade( )Abandon( ) System located at .4.5 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 conditions. Provided: Construction must be completed within three years of the date of thisr ermi . n Date: �/S'/U Z Approved by \ b � r i TOWN OF BARNSTABLE -__ram LOCATIONN�el2- v' lr '�" SEWAGE 0 VII,LAGE �aN�s ASSESSOR'S MAP &LOT 2_1 - 2� INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 021 LEACHING FACILITY: (type)� `� y4 (size) NO.OF BEDROOMS / BUILDER OR OWNER PERMIT DATE: Q 1 `0 3 COMPLIANCE DATE: Separation Distance Between the: Feet Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 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 Feet within 300 feet of leaching facility) Furnished by J3= 50 WeK f 3 COMMONWEALTH OF MASSACHUSETTS x EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION 350 MAIN STREET WEST YARMOUTH,MA 508-775-2800 TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 112 CANTERBURY CIRCLE RECEIVED I-IYANNIS,MA 02601 Owner's Name: JUDIII-I O'CONNOR Owner's Address: 112 CANTERBURY CIRCLE MAY - 2 2001. HYANNIS,MA 02601 Dale of Inspection APRIL 18,2001 TOWN OF BARNSTABLE HEALTH DEPT. Name of Inspector:(please print) JAMES D.SEARS Company Name: A&B Canco Mailing Address: 350 Main Street West Yarnouth,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 fimction and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 1.5.340 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: 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 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. Title 5 Inspection Form 6/15/2000 1 Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 112 CANTERBURY CIRCLE HYANNIS,MA 02601 Owner: O'CONNOR,JUDITH Date of Inspection: APRIL 18,2001 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 of the failure criteria described in 310 CUR 15.303 or in 310 CUR 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: 112 CANTERBURY CIRCLE HYANNIS,MA 02601 Owner: O'CONNOR,JUDrrH Date of Inspection: APRU, 18,2001 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: 112 CANTERBURY CIRCLE HYANNIS,MA 02601 Owner: O'CONNOR,JUDITH Date of Inspection: APRIL 18,2001 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 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 X Liquid depth in pit is less than 6"below invert or available volume is less than%2 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 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"of"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. 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: 112 CANTERBURY CIRCLE HYANNIS,MA 02601 Owner: O'CONNOR,JUDrM Date of Inspection: APRIL 18,2001 Check if the following have been done. You must indicate"yes"or"no"as to each of the following 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? N/A 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? 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)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(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: 112 CANTERBURY CIRCLE HYANNIS,MA 02601 Owner: O'CONNOR,JUDTTH Date of Inspection: APRIL 18,2001 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: 1 Does residence have a garbage grinder(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)): Sump pump(yes or no) NO Last date of occupancy: PRESENT COMMERCL4 L/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): 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 copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: AROUND 1978 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: 112 CANTERBURY CIRCLE HYANNIS,MA 02601 Owner: O'CONNOR,JUDITH Date of Inspection: APRIL 18,2001 BUILDING SEWER(locate on site plan): N/A Depth below grade: Materials of construction: Cast iron 40 PVC _ other(explain) Distance from private water supply well or suction 177 Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK(locate onsite plan): X Depth below grade: 14" Material of construction: X concrete metal fiberglass polyethylene _ other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1,000 GALLON PRE CAST Sludge depth: 2" Distance.from top of sludge to the bottom of outlet tee or baffle: 28" Scum thickness: V Distance from top of scum to top of outlet tee or baffle: 12" Distance from bottom of scum to bottom of outlet tee or baffle: 17" How were dimensions determined: TAPE Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): TANK AT WORKING LEVEL. OUTLET BAFFLE,TANK AND COVERS 14"BELOW GRADE. NO SIGN OF BACK UP OR OVERLOADING SEEN IN TANK. 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 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.): Title 5 Inspection Form 6/15/2000 7 Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 112 CANTERBURY CIRCLE HYANNIS,MA 02601 Owner: O'CONNOR,JUDITH Date of Inspection: APRIL 18,2001 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: X (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: 0 Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.,): D-BOX IS NEW.BOX IS 9"X15",27"BELOW GRADE. ONE LINE IN,ONE LINE OUT. 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: 112 CANTERBt)RY CIRCLE HYANNIS,MA 02601 Owner: O'CONNOR,JUDITH Date of Inspection: APRIL 18,2001 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: Type X 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.) ONE 1,000 GALLON PRECAST PIT.PIT 3'BELOW GRADE. COVER 10"BELOW GRADE.20"WATER, STAIN LINE AT 2'.WALLS CLEAN,NO SIGN OF OVER LOADING. 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 F Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 112 CANTERBURY CIRCLE I.IYANNIS,MA 02601 Owner: O'CONNOR,JUDI-Ffl Date of Inspection: APRIL 18,2001 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two pennanent reference landmarks or benclunarks. Locate all wells within 100 feet. Locate where public water supply enters the building. �t P� �D c W o 0 i �N r Title 5 Inspection Form 6/15/2000 10 . o a Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 112 CANTERBURY CIRCLE HYANNIS,MA 02601 Owner: O'CONNOR,JUDITH Date of Inspection: APRIL 18,2001 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to groundwater 27.2 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) X Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation X Accessed USGS database-explain: You must describe how you established the high ground water elevation: G.I.S. AND USGS WELL DATA AT HEALTH DEPARTMENT. I Title 5 Inspection Form 6/15/2000 11 No. U —ZZ Fee r THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS ZIppfication for �Digpogal *ps�tem Con5truction Permit Application fora Permit to Construct( )Repair(A')Upgrade( )Abandon( ) ❑Complete System Al<dividual Components Location Address or Lot N . , Owner's Name,Address and Tel.No. G 7 //A C' f'1!le'3,1,e 0 jc O A'role PTA a�7f/ Assessor's Map/Parcel Z `/ c_ /a y /-/A C14O Tr.e 46'-X Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. /0511(.d 0414'c ® 3 5 o ssi,0 i•v ��' `ri /< 5-0 Y 7 7s-0�Per Type of Building: Dwelling No.of Bedrooms 3 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) 't 'r ®L C F 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 iss d by this Board of Health. h Signed _�' Date Application Approved by Date.1--40 Application Disapproved for the following reasons Permit No. Date Issued TOWN.OF _ . . - BARNSTABLE� , LOCATION Lit eQGL= SEWAGE # -Zwv I-2 Li 7Z VILLAGE tiNl ASSESSOR'S MAP LOT a2 La J IN STALLER'S S NAME PHONE NO. ; A' & B CANC 0 77 -6264 A SEPTIC i TANK CAPACITY T T'i E C"AL %Y 4 a k-1 t.r.�� i. . _ - - ,.a.a �.aaaaw i A1.1L11 I,.;(type1-Ll�QO.ar G. /�J _(size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER j BUILDER OR OWNER Q Ca"-/ Ole DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: it VARIANCE GRANTED: Yes No 1 . f-.#.y.n''si t..r,1`F l:•..,. .. C .. .. .. ,.., .. _ -- -. ., e z ,-. y t:,t:e^��trx`b'',�..,�t����. O 4f t ZIP- iq No. Fee THE­COMMONWEALTW�.OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH-D.IVISION 4,TrCNVN OF BARN9TABLE., MASSACHUSETTS 01ppYication for Construction Permit Application for a Permit to Construct( )Repair(;-)Upgrade( )Abandon( ) El Complete System A<dividual Components Location Address or Lot N Owner's Name,Address and Tel.No. //;. Pr '"rfiP��,PY t°,,� //Y- a 'COA-,vof -J-0 -) Assessor's Map/Parcel n $/ 7_ 197 a C / CA,—T-eX_ e w f y,. Ir Installer's Name,Address,and Tel.No. / Designer's Name,Address and Tel.No. `j .a7 Pop Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.-ft. Garbage Grinder( ) Other Type of Building No:'of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated Elaily flew gallons. Plan Date Number of sheets Revision Date Title ��rv. 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 Certifi- cate of Compliance has been iss d by this Board of Health. Signed Date Application Approved by _ Agep& Date!y 40"d -Application Disapproved for,the"following reasons Permit No. Date Issued --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance r. THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired( /)Upgraded( ) Abandoned( )'by 4 1( ('/>ATO !?J_-' ra X/•- ST` 4".. at / 4/Y T Zr y/r'r C i� / y'r has been constructed in accordance with the p isions of Title 5 and the&r Disposal System Construction Permit No."Z dated "ZO-© Installer Designer The iss nce of this pegruiVshall pot be construed as a guarantee that the syste funct' na signe . Date Za Z0 Inspector �� 2'`� -------�--`� --------------- No. ZGG Fee �i'"•/'• '/ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Migogar *potem Con.5truction Permit Permission is hereby granted to Construct(�Repair(k)Upgrade( )Abandon( ) System located at-," C'.4/y rle 9f 0/le `l' /9/Al 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 conditions. Provided: Construction must be completed within three years of the date of this Date: Zl ar Approved by- F .,Y 1 S, -� THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ..........................................OF.......................................................................................... Applira Lion for Dispogal Workii Toustrurtion ramit Application is hereby made for a Permit to Construct ( s/) or Repair ( ) an Individual Sewage Disposal System t: . Location-Address or No. y .......... o_C\\��n®n ..y�►�- �► eS //��ner %Add ... W..... vi!�rl4tl�.l. . ...._.. I le ` ddress UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.__..!..Z..............................Expansion Attic Garbage Grinder (.�) pa., Other—Type of Building rJQnA. a=P_,. No. of ersons-----------&.............. Showers Cafeteria ) a Other fixtures �ok --�..' Si�� � � i�_ ��5al r._Wer..sfE._ t �-------------------------------- W .g 5.6....................� P person 1 pe Y � 3� �(��---------------•-------- lonks,. . Design Flow............. gallons per per day. Total daily flow.._..... �__ WSeptic Tank—Liquid*capacity/.0An.gallons Length____--_-___ Width-------S._..... Diameter----N-i_..... Depth..: _ .... x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area.............__----sq. ft. Seepage Pit No......I------------ Diameter...../0._....... Depth below inlet....�.d_.......... Total leaching area..................sq. ft. Z Other Distribution box (,Jr) Dosin jtto k Percolation Test Results Performed by__..1�1 G Ar ... eR�r t D ................... �Q Q�a1-� ........... . ._------ Date-------- J- � -- Test Pit No. L..: .____minutes per inch Depth of Test Pit---16'0----- Depth to ground waterADhP__$n ,Vj 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ----------- ------- ........................................................... ---------------...... ....... .................. . Description of Soil... ...' x -••--------................................................... W U Nature of Repairs or Alterations—Answer when applicable_.._..._ 01AC...........................................................•.............. ---------------------•--------------------------•---------•----•--•......•---••.....•-----•-----•-••-------•---•-----------•--•--•--•••-•-•-••-••----•----•-----•-••......... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITj L 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed......-..... .... =-rlx! / a s�� Date Application Approved BY----- .%� M. .-L.--e ?_ 1.� s/ ------.......................... -----Y _...2 �.-_7.x_.... Date Application Disapproved for the following reasons---------------•---,---•----••-----••••-----••-----•------------•-•-••-•-••••-•--------------------•--••-•....... .................................•---------------------------------------....---•-------•--•-•-------------...---------------------•-------•-------•-•-•------------.----•-----------•---••------------ Date Permit No......................................................... Issued....... ,�l— 7 Date No.........kil..... Fizic .. .................. THE, COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......................I....................0 F.....................................I.,.................................................. AVVfiraffou for BhiVoiiat Vorkg Tonstrurtion Frrmit Application is hereby made for a Permit to Construct (V) or Repair an Individual Sewage Disposal SysteM at: .......�..ov&eukuty..Lli At,__�..y A A.q,0........... ..........Lzt.tzv................................................................. r7 i Location ocation-Address k�'Y.Gmliu .... ...... .. .....Q J ................................................ ......... caner Addess...W ..&P.P.11A.41f. ....q..7............... j ......Tw.-e s, it, 7S ........�t Address Type of Building Size Lot............................Sq. feet Dwelling No. of Bedrooms..............3..........................Expansion Attic Garbage Grinder Other—Type of Building No. of pe ons............(a." Showers (,,19) Cafeteria Other fixtures ..3...�)[!. t.'92...b6iAct.3, �.fv... -el................... Design Flow.................5-E....................gallons per person per day. Total daily flow______._______0.3.0...................gallon�. Septic Tank—Liquid-capacityll.0N.gallons Length------- Width.__._____._ Diameter---- ..... Depth. Disposal Trench—No_..................... Width_____...____..._____ Total Length_.____._____._.____. Total leaching area....................sq. f t. �4 Seepage Pit No........_1--------- Diameter........),I)-/---- Depth below inlet..... ...... Total leaching area..................sq. f t. Z Other Distribution box DosinVat( a) I kii......... r Percolation Test Results Performed by........�.Q.("V ...V0, _14-------------*....... Date._._ ............. Test Pit No. l_.-.V....minutes per inch Depth of Test Pit.../.!�./Q Depth to ground water.IISMVI... Test Pit No. 2................minutes per inch Depth of Test Pit__.___.__._..______. Depth to ground water________._.._______.____ ............................................................................................................. I I ;...V -------;-----1------------------------------- ..q� caopu.��_savd In 0 Description of S il TT r2" ................................................................................................... ................................................ -----------------------------------------------------------------------------------------........................................................................................................... U Nature of Repairs or Alterations—Answer when applicable....tv A ....................................... ...................................... ........................................................................................................................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. S' d--- -----------------------------------------------"................................. zS'49.7/7-7...... e Application Approved-By....... ............. ... --------------------------------- ..... V Date Application Disapproved for the following reasons:................................................................................................................ ......................................................................................................................................................................................................... rb Date ''Permit No....................................................... IssuedL....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........... ...............1, .............OF... t4...... ... . . . . .......4........ .................................. Trrtifiratr of Toutliftaurr THIS IS TO CERTIFY, That-'the Individual Sewage Disposal System constructed (0 or Repaired by---------------------­------C................................................ .................................................................................................................. Installer at....LA2- L.' AV.2,n V1 1�................................................................................................ has been installed in accordance with-9tl e pr i i f T�ovisions 0 of The State Sanitary Coa_2_7`..7 e as described in the application for Disposal Works Construction .......... dated--M _7Permit No. ........ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE..... ...7,56-.' ..... .................... Inspector...... .......................U........................................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF -HE,&,l TH all **%-Lem 4.-h........... ............0 F...... ................................ N6................. :FEE .......... at IV rkn Tom ton Vrrmit Permission hereby gTantM. ._!'0.2V. .....................................................L........................... t6 Const Repair an V!yddual Spj�,;.ge %jpo Sy t at ... .. ..... iZ......... No...- . .... ......... .... ............... *........................... Stree /0-o77- 77 its shown on the application for Disposal.Works Construction Pe wl No 'oe.- Dated__..Permission ?ail s ....... ----- . ................................... Board of Healt DATE_".............................................................................. J FORM 1255 HOBBS & WARREN, INC., PUB.LISHERS ASSESSORS MAP :2-1m TEST HOLE -LOGS NOTES: PARCEL : 7�°� ,� 1) THE INSTALLATION MUST BE IN SUBSTANTIAL COMPLIANCE WITH v WITNESS �� UI►�o SO I L EVALUATOR : '�-!Me , R.S CSE THIS PLAN, 1995 ` MASSACHUSETTS TITLE V & TOWN OF FLOOD ZONE : ^ `�' y—�--� 0,NST�1NZ BOARD OF HEALTH REGULATIONS. CAP-A.-k- REFERENCE 13V_. j4t�S DATE: JUL 3 2) THE INSTALLER SHALL VERIFY THE LOCATION OF UTILITIES, �VE� �� PERCOLAT I N RATE: �-2�"1 h�� SEWER INVERTS AND SEPTIC COMPONENTS PRIOR TO S ITL CLASS T So 1 L� LTA-►'L -._p 5 q 11% INSTALLATION. O TH- I cL SS•7U TH-2 3) THIS PLAN SHALL BE USED FOR SEPTIC SYSTEM INSTALLATION n LOAA ONLY, AND SHALL NOT BE USED FOR PROPERTY LINE 11 S y 10y0/' DETERMINATION. "I —5s.37 Ai 4) ALL PIPING TO BE 4" SCHEDULE 40 @ 1/8 "/ FOOT. (UNLESS l.l�A►�� (�1-_ IV JA SPECIFIED OTHERWISE) L 0 CA T I ON MAP(N 1_:S) �+` S AAD 5) THE DESIGN OF THIS SYSTEM DOES NOT ALLOW FOR THE USE OF A GARBAGE DISPOSAL. S2.?sJ �I rJE 2 / 6) SEPTIC TANKS AND DISTRIBUTION BOXES (WHEN INSTALLED) b Q_ MUST BE PLACED ON A MECHANICALLY COMPACTED BASE OR ON G S � jp7 A BASE OF 6"OF CRUSHED STONE. ,i 7.) IV4,I,EP}GN_1'tT Jb � ._.PuM►° �� GKuSh'-eo C,4 >�/TE R Qu Ie-� CI R.CLE SEPTIC SYSTEM DESIGN �. r .Ps wl � 'o CO)/UvV�/zl tvc.65_r-4m 7?71,E Y OR w ._._0c-....9&,W5 . ._:_. FLOW ESTIMATE � .3 BEDROOMS AT 110 GAL/DAY/BEDROOM GAL/DAY 1 I O SEPTIC TANK GAL/DAY x 2 DAYS - lo(D GAL ' USE 1 c Yj GALLON SEPT I C TANK-EK/5PN� I ( � SOIL AgSORPT I ON SYSTEM UNdE) 1.), w ' 51vu4, W Ai-c, s E,5 �2.5 V i-x 13'10 x z I lb) I Lz�)2-4-(i3) z e 2 SIDE AREA: �T-_ EL S�j,° BOTTOM AREA: Z,�- r l: x O. q q = zvo. SU RSS vnn%�1 r� 19 _ 35 2. 19 4146 SEPTIC SYSTEM SECTION ' 336 a --_ TBM = TOF �/ (l'' �GYr'/�/j'` iy ►1/ !� /__._.__.-_. -___-----____._ -.._._._.....__.,_,.--- �•Sip. �S�1� 131 VA41✓1/3�1M147� (N SS.�7 �l E�• A 4�s SS.l7 `- 2''-34'' vblt pUaShcc( Sfy�t 2s' SS,y2. BnF �' r JY&nc ` —_ L_C t� D D-Box 2� 1,0�.Q. GAL S41 �fl's�' 1� �1 � c�a SEPTIC TANK 7`a,� k��� = � =r s- 3a �� -- U f----- �2 S'L x I3 rtn7 x 2 70 SITE AND SEWAGE PLAN y V1 OF Af4 L O C A T I ON 112 (,, K 80,e_V C(zZLIIE tH o A, R �I ,A /V14 STEVEN W � � � E1�I=R � urvla No. 1140 PREPARED FOR : HELOASE s�f9-/C&4ES NNp SUR1\4 SgNITAR1Pt` - u / 26 W U(�U�li `y1 -Z `'� - � DARREN M. MEYER, R.S. SCALE : / 43 VINE STREET DATE: DUXBURY, MA 02332 Z DATE HEALTH AGENT (781) 585-0293 MSL t ToP of FOUNOAT/ON - .qo 37 36 TIg.Ai vk 33 • .3�43 36.02 3o.oZ . - - - _ - -- CX15 f-79 cirocind p/-of; /e C..� 7 � o / �J f/� �E' T. — o—o - o ---o- /proPo3Gol cJrounc� card, /e SGNEO- 40 Pl/. C. OEM m;nirr►u� pC/- foof , z'" of �s /2" washed St'o.-�t EQlJ.9L TO SEF'T/G �--- --t- �__ ---3 1A.1 r e 17 OEM ' o 6,, surnF-- • � e o /000 6rAC. SE�'T/G TigN& 57 � T 1 , C-/ Sc�7LE• : �� / '- o" G�i9GH F'/T -77 H- � ' ',ns ao 3/D'y 25 � - C 0 7 z4 ; a / G A-1 B E 0.E�0 pM iIO U Se- OA T-E /o ISIZ77 rE S T By /CH��'O Frq/�BA�y,r'S p e �0 27't d4evdoo� F'&,4eC_ �E'AT� LZ w/T�/E5s _ AyG Mv,E-',E'�9Y ee Cnf _- 27 " iit/ i�/C H �Al S�©AY \ �30 OATun� M.SG.t TalNn of Barnsfc-b/e. • � .4 TEST HOL�' '�/ TEST HOLE # 2. SB PT/G Ti9 n./,� 33o x / S = 49 �' � /� >✓SE � /OOO GAL. TAN. Y/ E:I. = 38./ � to t c I�j 0` 6" 0 5O e%= 374 �o• � reserve � � Co� 2�) [..EAGH F'/T: /oa" 1 EFF UEfaTN _� G/ean 3-;rr e z 7- Z Z �sAt3� gave o _ /Z .�y 3g 9 S.F x /, U = � ., o". �/ ias�oJ seiE,Q 7107-,gL = _ G.9L5. /17�9Y �Z e/.•32./ c ea.n S ycQ 06./ ^-- Nr> cti,4rt 2 tN'f('cJN7E2C D . 1044-)1-7 G a.)O e- e r-7 q I r-7 e- e r n / L V G- ZA//z:? 64r-- /- C..... Iz? AJ c/ ,..G„A. E s /c0)e LOT e4 �-- f G �4/t1 S C�c�k Z D 5 f'�9 G�• �j5 ,PTA. low -�-- Y'�d•�Mourrt' , MASS. Q�'EF'A.E EGA F0 AE : - 7- \'� 5G� �E AS SHol v.v OA TE : 0CTOis6,o / - f rait► 40 , c0,-7-f-0u s B OF t-/ LTH - o o--o--o -- - propoSeo/ GDnf out S f3f�iE'It/5Ti4f..3 ,/_, � , MASS.