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Home My WebLink About0002 COMPASS CIRCLE - Health 2 Compass Circle Hyannis A= 310- 390 r TOWN OF BARNSTABLE LOCATION C�d/►'+-�G SS G'lA2�C� SEWAGE#�}O/,�� 3 �. VILLAGE ASSESSOR'S MAP&PARCEL 3 0 ' 3 90 INSTALLER'S NAME&PHONE NO. /jf G 57 i fs!Gam, SEPTIC TANK CAPACITY LEACHING FACILITY.(type) (size) T JaA'- NO.OF BEDROOMS ►J /1 (�o OWNER DA My A 2- PERMIT DATE: 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 \ � v �� j `vJ 1�!� _ �: �<. � � v � � � � � S � Q � J s I r�/ — b0 No. po S Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Yication for his' aC *pstP11� �COTYBtCULtIOriQrt:�nd�iidual Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑Complete System Components Location Address or Lot No. Owner's Name,Address,and Tel.N 02 Cor�PaSS ��G-t�C�, f� /i /o �� D oZ S� �o� Assessor's Map/Parcel p U , G�f�C2 Gq� -3o?/S-9 ��\ A pt Installer's ame,Address,and Tel.No.V M k1fil/ L L. Designer's Name,Address,and Tel.No. e a. ea X 7 7/1 f��11JLcIh1"o%'ir o��/E,' 0/� ® 11 Type of Building: iA / Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided A 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) �� G� sox 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 / 1111_ Application Approved by Date f 3' Application Disapproved by Date for the following reasons Permit No. O Date Issued J 'f P No. O .. �. Fee ' 1 +'. THE COMMONWEALTH OF-MASSACHUSETTS Entered in computer: Yes :`. PUBLIC HEALTH DIVISION -TOWN OBARNSTABLE, MASSACHUSETTS t ' application for D18.p al *pstgm Construction Permit `r�k Application for a Permit to Construct Repair Upgrade(' ) Abandon Co -: ndm lete System =P ivid al Components Location Address or o. Owner's Name,Address,and Tel.No O Lot N O N �o,.c.rzr ' �. Cvr'� aSS cif-t_C�, ��•-r ' O i Assessors Map/Parcel gg,_,I p Gl G-f'a e"11Ce JeA 1M un t ? Installer's_t4ame,Address,and Tel.No.v/w 4vlgl1 L[-C- Designer's Name,Address,and Tel.No. I leZ f Sow• - /7 f�- Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( Other Type of Building No.of Persons y Showers( ) Cafeteria( ) Other Fixtures t Design Flow(min.required) gpd Design flow provided k/ gpd Plan Date Number of sheets Revision Date ' Y. Title Size of Septic Tank Type of S.A.S. Description of Soil , Nature of Repairs or Alterations(Answer when applicable) �e es e.. [J P ♦s , f - Date last inspected: i Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in r accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of< 't Compliance has been issued by this Board of Health. Signed Date Application Approved by / Date / i --Application Disapproved by Date for the following reasons • Permit No. d I Date Issued 1 r/ a _. __a .. ------ - - - - - `+ 1THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( (Upgraded( �) Abandoned( )by l/ /K Inj/41 1 4—L Cat- f�fs't S _ ��c=("( has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. p dated ,15 Installer ', Designer ,g #bedrooms '1 Approved design q �flow /! /� /T gpd The issuance of this ermit shall:not be construed as a guarantee that the system wi functio$as desi R ed. if Date fJ� .J'^. �,°' G i� +'t. Mw In pecto G/' ---------------------- ------- ----F -- --- ----- ----------- nn Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Disposal 6pstetn Construction Permit Permission is hereby granted to Construct( ) Repair(Veoo Upgrade( ) Abandon( ) System located at f .. 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 le completed within three years of the date of this permit-:-- Date �"3`" Approved by I • ar Town of Barnstable Barnstable Regulatory Services Department U49mamcft • 1ARNSfABLE, s O D 39. Public Health Division 2007 200 Main Street, Hyannis MA 02601 . r Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL # 7014 1200 0001 0358 5876 October 7, 2015 . Tina R Salamone TR %Russell SalamoneTR 2 Compass Cir Realty Trust 34 Wood Lane Maynard, MA 01754 • ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE TITLE 5 The septic system located at, 2 Compass Circle, Hyannis, MA,was last inspected on 9/8/2015 by Fred Swain, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Failed"under the guidelines, of the 1995 TITLE 5 (310 CMR 15.00) due to the following: • Distribution-Box needs ,to be replaced You are ordered to repair or replace the septic system within one(1)year from the date you receive this notification. Failure to repair/replace the septic system with in the deadline period will result in future enforcement action. P RDER OF TH BOARD OF HEALTH Thomas McKean, R.S. CHO . Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Evl\2 Compass Circle,HY Oct 2015.doc Parcel Detail Page 1 of 2 L 'r°' 't E / `a y, , � BdE1R57rtBLE• T .. �gs Logged In As: Parcel Detail Tuesday,October 6 2015 Parcel Lookup Parcel Info Owner Info Owner 1,SALAMONE,TINA R TR Co-owner %oSALAMONE, RUSSELL TR Streetl t2 COMPASS CIR REALTY TRUST Street2 34 WOOD LANE City"'MAYNARD State.MA I zip 01754 Country F Land Info Acres FO.-281 use Single Fam MDL-01 zoning RB y...I Nghbd 0104 �� Topography Level I Road Paved Utilities jPublic Water,Gas,Septic I Location Construction Info Building 1 of 1 Year 1979 ) Roof Gable/Hip Ext Wood Shingle J Built Struct Wall Living f Roof As�`ph%F�GIs/Cmp AC None Area I°64 Cover! Type ?, Style lRanch Intwall 'Drywall a.�� Rooms 2 Bedrooms Bed Z PTO is ,1q Model Residential —1 Floor Carpet Rooms�' Full-0 Half mera a Heat Total GAR :HAS Grade Type Hot Water I Rooms 4 Rooms 22 4 ,BITMT z . Heat Found Stories 11 Story Oil Fuel ation Poured Conc. ra 3fi Gross F2228 4 _I Area Permit History ---- --------- -- ----- ., Issue Date Purpose Permit# Amount Insp Date Comments 1/1/1979 Dwelling B20993 $0 1/15/1980 12:00:00 AM HY 1 STOR Visit Histo Date' Who Purpose 5/13/2015 12:00:00 AM Anne Leonelli Change of Address 5/9/2003 12:00:00 AM Paul Talbot Meas/Est 3/19/2001 12:00:00 AM Paul Talbot Meas/Listed-Interior Access 10/15/1987 12:00:00 AM ME Meas/Est Sales History http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=25909 10/6/2015 Parcel Detail Page 2 ofi2 { Line, Sale Date Owner Book/Page Sale Price < 1 2/6/2001 SALAMONE, TINA R TR 13541/13 $10 2 5/15/1994 SALAMONE, TINA R 9194/34 $1 3 12/15/1982 SALAMONE, PETER A&TINA 3630/296 $44,500 4 5/13/2015 1 SALAMONE, RUSSELL TR MI15PO968EA $0 Assessment History Save# Year Building Value XF Value OB Value Land Value Total Parcel Value 1 2015 $70,700 $30,900 $1,100 $67,000 $169,700 2 2014 $70,700 $30,900 $1,100 $67,000 $169,700 3 2013 $70,700 $30,900 $1,100 $67,000 $169,700 4 2012 $70,700 $30,200 $900 $67,000 $168,800 5 2011 $99,400 $3,300 $0 $67,000 $169,700 6 2010 $99,300 $3,300 $0 $103,100 $205,700 7 2009 $98,500 $2,600 $0 $139,700 $240,800 8 2008 $117,900 $2,600 $0 $145,500 $266,000 10 2007 $117,300 $2,600 $0 $164,400 $284,300 11 2006 $103,500 $2,600 $0 $164,800 $270,900 12 2005 $98,500 $2,600 $0 $131,200 $232,300 13 2004 $79,900 $2,600 $0 $98,400 $180,900 14 2003 $72,100 $2,600 $0 $36,400 $111,100 15 2002 $72,100 $2,600 $0 $36,400 $111,100 16 2001 $72,100 $2,600 $0 $36,400 $111,100 17 2000 $54,300 $2,500 $0 $22,400 $79,200 18 1999 $54,300 $2,500 $0 $22,400 $79,200 19 1998 $54,300 $2,500 $0 $22,400 $79,200 20 1997 $49,500 $0 $0 $19,200 $68,700 21 1996 $49,500 $0 $0 $19,200 $68,700 22 1995 $49,500 $0 $0 $19,200 $68,700 23 1994 $51,600 $0 $0 $23,100 $74,700 24 1993 $51,600 $0 $0 $23,100 $74,700 25 1992 $58,700 $0 $0 $25,600 $84,300 26 1991 $64,100 $0 $0 $41,700 $105,800 27 1990 $64,100 $0 $0 $41,700 $105,800 28 1989 $64,100 $0 $0 $41,700 $105,800 29 1988 $49,500 $0 $0 $18,900 $68,400 " 30 1987 $49,500 $0 $0 $18,900 $68,400 31 1 1986 1 $49,500 $0 $0 $18,9001 $68,400 Photos G http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=25909 10/6/2015 - s Town of Barnstable s + BAMWABL& pf�9 �,.� Regulatory Services Department fD µ/Cl Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 7/6/15 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An"x"marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool , ONE (1) YEAR DEADLINE-CRITERIA ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑Any portion of the:cesspool within a Zone 1 to a public well ❑Any.portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2) YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑ Any"conditionally passed systems" (broken cover,relocation of a pipe, relocation of a driveway due to H-10 components, etc) o.Leaching pit or cesspool with high liquid level, <12"below inlet(per Town Code §360-9.1) OTHER a e Ud JIB �P In(jQ Lf. Repair deadline: 1VeAr WSEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc f Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 2 Compass Circle Ml Property Address I„ Russell Salamone t— Owner Owner's Name .° information is �l required for every Hyannis MA 02601 September 8, 2015 page. City/Town State Zip Code Date of Inspection + - Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms on the computer, use only the tab 1. Inspector: key to move your cursor-do not Fred Swain key the return Name of Inspector -- ------- Y Wind River Environmental Company Name ----- 577 Main Street Suite 110 Company Address - --- -- ---- Hudson MA _ 01749 City/Town State Zip Code 1-800-499-1682 651 Telephone Number License Number B. Certification 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 CMR 15.000). The system: ❑ Passes ® Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority September 8, 2015 - 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 to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. I t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Com monwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 2 Compass Circle Property Address — Russell Salamone Owner information is Owner's Name required for every Hyannis MA 02601 Member 8, 2015 _ page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 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 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. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 2 Compass Circle Property Address — Russell Salamone Owner Owner's Name information is required for every Hyannis MA 02601 September 8, 2015 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cont.): ® Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ® distribution box is leveled or replaced ® Y ❑ N ❑ ND (Explain below): Distribution box infiltrating roots and needs to be replaced ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further 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. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 2 Compass Circle Property Address Russell Sala more Owner Owner's Name information is required for every Hyannis ber 8, 2015 page. City/Town MA 02601 September_ _—p State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: *"This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool I� ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts u W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 2 Compass Circle Property Address — Russell Salamone Owner Owner's Name -- — information is required for every Hyannis MA 02601 September 8, 2015 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipes . Number of times um O pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet 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 fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts N Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 2 Compass Circle Property Address — Russell Salamone Owner — information is Owner's Name required for every Hyannis MA 02601 September 8, 2015 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 2 Number of bedrooms (actual).- 2 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 220_pd-- I t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M ,••'"r 2 Compass Circle Property Address Russell Salamone Owner Owner's Name information is required for every Hyannis MA 02601 September 8, 2015 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection information in this report.) ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): 46 gpd Detail: Very low water use. Seasonal use. Total days a year occupied one month Sump pump? ❑ Yes ® No Last date of occupancy: Seasonal Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): — — —_- Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts 4 Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 2 Compass Circle Property Address Russell Salamone Owner Owner's Name information is required for every Hyannis MA 02601 September 8, 2015 page. City/Town State Zip Code Date of inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Owner never pumped _ Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1,000 gallons How was quantity pumped determined? Tank size Reason for pumping: Check integrity Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. I ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 8 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 3a 2 Compass Circ le Property Address —- Russell Salamone Owner Owner's Name - information is required for every Hyannis MA 02601 September 8, 2015 page. CltylTown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 1979 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 22 inches feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: 25 feet feet Comments(on condition of joints, venting, evidence of leakage, etc.): No visual leaks. Lines clean and clear. Septic Tank (locate on site plan): Depth below grade: 8 inches feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 10'x 4'x 4' Sludge depth: 12 inches t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 2 Compass Circle Property Address — Russell Salamone Owner - information is Owner's Name required for every Hyannis MA 02601 September 8, 2015 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 23 inches _ Scum thickness 1 inch Distance from top of scum to top of outlet tee or baffle 6 inches Distance from bottom of scum to bottom of outlet tee or baffle 10 inches How were dimensions determined? tape measure Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Inlet tee and outlet baffle intact. Main line clear.Tank was at a high level due to roots in the distribution box-removed and clear flow. Grease Trap(locate on site plan): Depth below grade: _ feet 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: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 2 Compass Circle Property Address Russell Salamone Owner Owner's Name — information is required for every Hyannis MA_ 02601 September 8, 2015 page. Cltyrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: — Capacity: _ gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): " Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts u W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments °M 2 Compass Circle Property Address Russell Salamone Owner Owner's Name — information is required for every Hyannis MA 02601 September 8, 2015 _ page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(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.): Distribution box is 12"x 12". Box full of roots.Tank was at high level due to roots. When removed roots line was clear. Distribution box has roots infiltrating and needs to be replaced Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments '�M s 2 Compass Circle Property Address Russell Salamone Owner Owner's Name information is required for every Hyannis MA 02601 _ September 8, 2015 _ page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: One ❑ 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-6'x 6' precast pit. Dry at this time. Only 1'stain on walls Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth-top of liquid to inlet invert Depth of solids layer _ Depth of scum layer _ Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 2 Compass Circle Property Address Russell Salamone Owner Owner's Name information is required for every Hyannis MA 02601 September 8, 2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °wM 2 Compass Circle Property Address - -- Russell Salamone Owner Owner's Name information is required for every Hyannis MA 02601 September 8, 2015 _ page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts 4 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 2 Compass Circle Property Address Russell Salamone Owner Owner's Name -- information is required for every Hyannis MA 02601 September 8, 2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: 10 + --_ feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date -- ® Observed 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: Observed site leach pit 1' below grade, 6'deep, S to 5' over dig and pit dry. No groundwater observed. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 2 Compass Circle Property Address Russell Salamone Owner Owner's Name information is required for every Hyannis MA 02601 September 8, 2015 page. City1rown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Date: 8/3/2015 Meter Reading History o� ; Page 1 of2 Customer# 605696-1 Q Prem ise#605696 Service: Water- Regular Metered METER READING TRANSACTION INFO Read Date Suuence# Meter# Face Sort # Read Code Readino Consumption _$kip count T vae Cade Sta us Bill Peri d Trans Date 05/11/2015 01 94109903 0 27010690 1 2 1 0 REG A R 201502 05/19/2015 02/04/2015 0.1 94109903 0 27010690 1 1 0 0 REG A R 201501 02/12/2015 yy {{1/iQ/ZQ3,4 , REG A R 201404 11/16/2014 REG A R 201403 09/03/2014 6s t s ear0 7 � `ht � vyt of REG A R 201402 05/15/2014 i y 'x.�-�'m al ��r� �'��tfr •', xti E4 eF g.k.�'n S��,C��x.,�i�"i f.� t ��x a 1 s£u a t��DbmY*a rr "�,`�p€ s ,, +f8p: y , ,. n,» ,.. • i rt�r� .�U� .. . i . REG A R 201401 02/19/2014 � � �� 7kC � ,� .?-"s ..�.�'�i�� V .�'��t;y,.�4+„2 ,{,'2'lri'� �hct�rc�t� �y'' r: f` u `i y yt.;.� a _:.-.., REG A R 201304 11/21/2013 - a' v ,t� wi Ks.;t< ha^s� 4sd�`tz �-�fl�� " REG A O 201304 09/12/2013 REG A S 201304 09/12/2013 REG A R 201303 08/23/2013 .�+�` �� ma 's=�."# _ `'� � � u��ag�� },�K '�1•�.� kxy " r�.F�. ��`�.�,��i„��•�F"t3 �' REG A R 201302 05/13/2013 .�� sy `R 1 'A sQtr, �, �t��fi 1. REG A R 201301 02/20/2013 11/15/2012 01 39239679 0 27010690 1 538 0 0 REG A R 201204 11/25/2012 08/14/2012 01 39239679 0 27010690 1 538 2 0 REG A R 201203 08/21/2012 05/15/2012 .01 39239679 0 27010690 1 536 0 0 REG A R 201202 05/24/2012 02/14/2012 01 39239679 0 27010690 1 536 1 0 REG A R 201201 02/23/2012 11/08/2011 01 39239679 0 27010690 1 535 0 0 REG A R 201104 11/22/2011 08/15/2011 01 39239679 0 27010690 1 535 1 0 REG A R 201103 08/23/2011 0.5/19/2011 01 39239679 0 27010690 1 534 0 0 REG A R 201102 06/02/2011 02/15/2011 01 39239679 0 27010690 1 534 0 0 REG A R 201101 02/28/2011 11/10/2010 01 39239679 0 27010690 1 534 1 0 REG A R 201004 11/22/2010 08/19/2010 01 39239679 0 27010690 1 533 4 0 REG A R 201003 09/02/2010 05/18/2010 01 39239679 0 27010690 1 529 0 0 REG A R 201002 05/27/2010 02/19/2010 01 39239679 0 27010690 1 529 0 0 REG A R 201001 02/24/2010 11/17/2009 01 39239679 0 27010690 1 529 0 0 REG A R 200904 11/24/2009 08/21/2009 01 39239679 0 27010690 1 529 2 0 REG A R 200903 09/03/2009 05/21/2009 01 39239679 0 27010690 1 527 0 0 REG A R 200902 06/29/2009 02/18/2009 01 39239679 0 27010690 1 527 0 0 REG A R 200901 02/18/2009 11/18/2008 01 39239679 0 27010690 1 527 1 0 REG A R 200804 11/18/2008 08/20/2008 01 39239679 0 27010690 1 526 2 0 REG A R 200803 08/20/2008 05/19/2008 01 39239679 0 27010690 1 524 0 0 REG A R 200802 05/19/2008 02/20/2008 01 39239679 0 27010690 1 524 0 0 REG A R 200801 02/20/2008 11/16/2007 01 39239679 0 27010690 1 524 1 0 REG A R 200704 11/16/2007 08/14/2007 01 39239679 0 27010690 1 523 1 0 REG A R 200703 08/14/2007 05/22/2007 01 39239679 0 27010690 1 522 0 0 REG A R 200702 05/22/2007 v _ vw4J Page 1 of 2 LOCH 10 SEWAGE FERMI N Y I L L 6 E �`T' INS TA LL-R'S NAME i ADD SS BUILDER OR NER DATE PERMIT ISSUED 40 O .� DATE COMPLIANCE ISSUED P r 0r�r� �� lvx a f o � - http://www.town.bamstable.ma.us/Assessing/I I Mdisplay.asp?mappar-3103 90&seq=1 8/4/2015 Assessmg As-BUilt Cards Page 1 of 2 LOCA 10 SEWAGE PENN W N VILLAGE( I 1 �� l'�/`g44 INSTALL R'S NAME A ADD SS !� 11UI-LDER OR WNER DATE PER.MIT ISSUED 7,-- DATE COMPLIANCE ISSUED L) 0 http://www.town.bamstable.ma.us/Assessing4 Mdisplay.asp?mappat=310390&seq=1 8/4/2015 t� Date: 8/3/2015 Meter Reading HigIM � Page 1 of 2 Customer# 606696-1 9 Premise#605696 Service: Water- Regular Metered METER READING TRANSACTION INFO Read Date Sequence# Meter# Face Sort # Read Code Readino Consumption Skip Count Type Code Sta#us Bill Period Trans D 05/11/2015 01 94109903 0 27010690 1 2 1 0 REG A R 201502 05/19/2015 02/04/2015 01 94109903 0 27010690 1 1 0 0 REG A R 201501 02/12/2015' 11f10/ 0{14 Al 941Q99z0 ,, 1OOk <r 'k ti ' " ems rt i0 REG A R 201404 11/16/2014 REG A R 201403 09/03/2014 Y��•t./g�.c;c� -v$. fca ,€ nt •t� srz0.'7� D'`.a �t x t ..r, c°' 15 '° 5 ,.M s.:. REG A R 201402 0511512014 REG A R 201401 02/19l2014 REG A R 201304 11/21/2013 REG A O 201304 09/12/2013 REG A S 201304 09/12/2013 REG A R 201303 08/23/2013 ,y. h �5' P ._., �j1f� a , � � � "' 3 � REG A R 201302 05/13/2013 �k " .y ;„ REG A R 201301 02/20/2013 11/15/2012 01 39239679 0 27010690 1 538 0"` 0 REG A R 201204 11/25/2012 08/14/2012 01 39239679 0 27010690 1 538 2 0 REG A R 201203 08/21/2012 05/15/2012 01 39239679 0 270106.90 1 536 0 0 REG A R 201202 05/24/2012 02/14/2012 01 39239679 0 27010690 1 536 1 0 REG A R 201201 02/23/2012 11/08/2011 01 39239679 0 27010690 1 535 0 0 REG A R 201104 11/22/2011 08/15/2011 01 39239679 0 27010690 1 535 1 0 REG A R 201103 08/23/2011 05/19/2011 01 39239679 0 27010690 1 534 0 0 REG A R 201102 06/02/2011 02/15/2011 01 39239679 0 27010690 1 534 0 0 REG A R 201101 02/28/2011 11/10/2010 01 39239679 0 27010690 1 534 1 0 REG A R 201004 11/22/2010 08/19/2010 01 39239679 0 27010690 1 533 4 0 REG A R 201003 09/02/20.10 05/18/2010 01 39239679 0 27010690 1 529 0 0 REG A R 201002 05/27/2010 02/19/2010 01 39239679 0 27010690 1 529 0 0 REG A R 201001 02/24/2010 11/17/2009 01 39239679 0 27010690 1 529 0 0 REG A R 200904 11/24/2009 08/21/2009 01 39239679 0 27010690 1 529 2 0 REG A R 200903 09/03/2009 05/21/2009 01 39239679 0 27010690 1 527 0 0 REG A R 200902 06/29/2009 02/18/2009 01 39239679 0 27010690 1 527 0 0 REG A R 200901 02/18/2009 11/18/2008 01 39239679 0 27010690 1 527 1 0 REG A R 200804 11/18/2008 08/20/2008 01 39239679 0 27010690 1 526 2 0 REG A R 200803 08/20/2008 05/19/2008 01 39239679 0 27010690 1 524 0 0 REG A R 200802 05/19/2008 K: 02/20/2008 01 39239679 0 27010690 1 524 0 0 REG A R 200801 02/20/2008 u 11/16/2007 01 39239679 0 27010690 1 524 1 0 REG A R 200704 11/1612007 08/14/2007 01 39239679 0 27010690 1 523 1 0 REG A R 200703 0811412007 05/22/2007 01 39239679 0 27010690 1 522 0 0 REG A R 2nn702 0517219n7 LO4C ,'10 SEWAGE NO. VILLAGE INS TA LL R'S NAME ADD SS 5 8 U I L D E R OR WNER X 0 DA T E PERMIT I S S U E D DATE COMPLIANCE ISSUED _ l C v V t*I� I J F�s............................ THE COMMONWEALTH OF MASSACHUSETTS ' BOARD OF HEALTH ....... --Town--....------.....OF.......Ba-xn.s.table-------------------------------------------------•- Appliration for Disposal Morks Tonstrnrtion Vrrmit Application is hereby made for a Permit to Construct ( —or Repair ( ) an Individual Sewage Disposal Systemat* .... .------...-•-------------- -----•.........---••-------•. -•---- ---... .. .� Q......_..... �.. Locatio ddress or Lo o. - ..�.., _....... ..-----. r ------------ Owne -- " A dr ss 'r' ...._. _ .... Installer - � Address Type of Building Size Lot...__ Cri.. .....Sq. feet �-, Dwelling—No. of Bedrooms......................................Expansion Attic ( ) Garbage Grinder ( ) 'k Other—T e of Buildin a yp g -•--_----_ Other _No. of persons......`t�................... Showers ( ) — Cafeteria ( ) der fixtures -------------•-•--•--•----••...... --•----•-•-•----••••-----•-•-•-•••-••-------------------------•----•------------•-•-••••-•-------•••........-•-- W Design Flow.........S75............................gallons per person per day. Total daily flow__._,PA0...............................gallons. WSeptic Tank—Liquid capacityl 90P..gallons Length._'..,V...._._ Width... Diameter---------------- Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area................,---sq. ft. Seepage Pit No........./-__-_-__-- Diameter...._4............ Depth below inlet----(0A......... Total leaching area.. .....sq. ft. Z Other Distribution box ( ) Dosing tank ( ) a Percolation Test Results Performed by.e��.... ....................... Date.... :. ............. Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ f14 Test Pit No. 2................minutes per inch Depth of Test Pit.........._......... Depth to ground water...............-------- 04 •--••- ................ 0 Description of Soil............ .. Srr._....._..... x V -----•-•--•-•---•-----•----•---------------------••-•---------•----•••------------•......--------- ----------------------------•---------------------•------- .................................----•----•---•--•-•-----------......--•------•-------•-•------------•-••----•-----•-•-••--•--•------•-----•- U Nature of Repairs or Alterations—Answer when applicable________________________________________________________________________________------------__. -------------------------------------------------------•----------------•--...------•-•--...---•------------...------------------------•----------....----------------------------•--••••---•--••.•••-•- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITi IE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been sued by the boar iealth. IN Si ne .... Date Application Approved BY Date Application Disapproved for the following reasons:-------•----------------------------------•------------•------------------------•--------------------........... ... .... ........•-••------•••---•--•---•---•-------••••...•------•----••---•••---•--••-•--•••-----•-----•••--•••••-•--•-•---•--•-••------•-•-•------••-••---...------ ` Date= Permit No.......................................................... Issued_..�`� ._ �_'� .._ Date ............. '+ ' FEB.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........`1101V7 3.-- ------. OF.-...-.Be.-rnat ------•-•--------------------------------_---__-__ ApAration for RopmFal Works Tomitratrtion lbrutit Application is,hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at �, � ........................ ____--------••-•---- ••. Viz '------- ........ v r:... _...._. Location-Address or Lot,"No: .._.......--•-•.................:...:..................................•-------•---••-----•-•-••-- ..........--..................................................................................... Owne Adr ss aI? !F.s r ,LM' .$....--•--------•--•....................................... ,. ...... ............... oo? Installer Address V Type of Building Size Lot---I Fk:ct=: .Sq. feet Dwelling—No. of Bedrooms _ f_ ____ _______________________________Expansion Attic ( ) Garbage Grinder ( ) aOther —Type of Building _ _ .___.__. No. of persons______ __________________ Showers ( ) — Cafeteria ( ) dOther fixtures ---------------------- •--------•--___---•-----------------------------------------------------------------------------•------------------------- W Design Flow....:..... _...........................gallons per person per day. Total daily flow...... F.0..............................gallons. WSeptic Tank—Liquid"capacity_10.C.-V._gallons Length__ ' ______ Width_.. Diameter________________ Depth................ Disposal Trench—No_____________________ Width.................... Total Length......__._____3_____ Total leaching area--------------------sq. ft. Seepage Pit No........../--------- Diameter_______ ___________ Depth below inlet..... _____.... Total leaching area___ ----sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by-N.................. - ______________________ Date...... ............................... ,.� Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ DDescription of Soil............. ,? , � `�:.._.... ? Ssc �'...-- --------------------------------------------------------------- x c., W ----••----••----------•--•-----------------=-•-----•---•-------•-••-•••••••-••---------...-•----•-----•--••--•--------•--•••--------------..-•--•---------------•------•-------•-------•--•......-•-_.... V Nature of Repairs or Alterations—Answer when applicable............................................................................................... -•--------------------------•--------------•---------------•-----------------...---•---•------------------------------------------------------------------------------------------------..........------ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of 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. Sined----------••--•----•-•-•....................•-•----•-------------....-•------------_.. Date Application Approved By :.............•----•----------•-------•------ ` Date Application Disapproved for the following reasons:-------•--------------------------------------------------------------------•-------------------------••_••---- ......................•---...---------••-------••••-------------•---- ---•••-••..._..._..------......_.::::---------------------•----•--------•---------•-•------•----------•-------••-•---••-•---------- Date PermitNo......................................------------------ Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS ,BOARD OF HEALTH i :r+.............. ...OF..... .. :p .. ..................................... Trr#ifirtt#r of ToutpliFana THIS IS TO CERTIFY„That the Individual Sewage Disposal System constructed (" ) or Repaired ( ) by------------------------------------------------- ------------•------------------___-------------------------------___------------------------ 1 '� Installer has been m Called in accordance with tl e provisions of TI 5 6�Wate Sanitary Code as describe in the ---- dated_-. -! "r" d `" -- application for Disposal Works Construction Permit No.__-< ---_--- � ............... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CON TRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTIO SATISFACTORY. L DATE................ -- ............._..� .......- ..... Inspector...._._ ... --- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH f � --V....................OF...: p� .........-__.-........................ Disposal Ivork ono#rt dwu erutit Permission is hereby granted... -------------------------------------••-•----=--------•-• •-_-•---................... to Construct (y) .or Repair ( ) a m,divldual Sewage Disposal System Street .as shown on the application for Disposal Works Construction Permit No.__644.____ .Dated... ±C•` _t� /�'� ..........:a_____________ :._ '._: ....................................... _......._.....-L�-.5,. Board of Health DATE---_ - oP! ' f 1r-- ................................. FORM 1255 HOBBS & WARREN•-INC., PUBLISHERS A V 0 4 v;VAve,, OVfa /ZI/7 47vo 4"c r e 14 'A i I Cp k 440 AT 0 42 r) A. e c 1-0 Lit. ASOr 7 0 Ow OvIr OT L O-T L 0�T -rcn4z v,41i-y AZ- apsl: A 4V WL PA 41C.51 "M ISO PIT 0; L .514 0 -150,6-sa e- 7-60 Z 4.1 Aol L(OT CO I A.10 INCr re.V AS SCALE OWWACAe GEdAAe 04 RRIA AN AlOrIVAIV 6';rOsSMq/V Re. �Pcssw 4 yl� i�f. �+r4 �z�-�•*"+c �` .- 224 �QGGy';POl�1rT �t'17 • ' XG -*, S-T lqL IL