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HomeMy WebLinkAbout0241 COMPASS CIRCLE - Health 241 COMPASS CIRCLE" •Hyannis A= 310 -428 TOWN OF BMMST"LE `LOCATION, P rzxs ur SEWAGE# '_33 VILLAGE ��' t1�`S ASSESSOR'S MAP&PARCEL 6 (- INSTALLER'SNAME&PHONE NO. �Qy :nMFC SEPTIC TANK CAPACITY eSe(�t5 00 O Csca- ` LEACHING FACILITY: T S� (size) NO.OF BEDROOMS (type IN QC,..3 10%0 0 flmc-f OWNER c�..5 1 e1 PERMIT DATE: A (..[ [ [ 1 COMPLIANCE DATE: a 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 W 4� C r r 1 n P i No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered incom ter: Y � PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS application for -MispoSal 6pstem Construction 3pPrmit Application for a Permit to Construct( ) Repair, Upgrade( ) Abandon( ) ❑Complete System <dividual Components Location Address or Lot No. Cdn?GS S G(' Owner's Name,Address, and Tel.No. Assessor's Map/Parcel 4 r,cMkS �So x -dr" Installer's Name dress, d Tel. o. Designer's Name,Address,and Tel.No. 60C9"io Type of Budding: 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 gpd Plan . Date Number of sheets Revision Cate Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by t ' Board of Health. ed . o Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. Date Issued No. Fee T E COMMONWEALTH OF MASSACHUSETTS Entered in com, ter: Ye PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 9pplication for Misposal *pstem ConstrUrtlon Permit Application for a Permit to Construct( ) Repair(/ Upgrade( ) Abandon( ) ❑Complete System J2 Individual Components Location Address or Lot No. d t n G 5 5 Cc r Owner's Name,Address,and Tel.No. Assessor's Map/Parcel ,. c C S Installer's Name,Address,an Wel. o. 1 ' Designer's Name,Address,and Tel.No. Type of Budding: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures i Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title t Size of Septic Tank Type of S.A.S. Description of Soil N Nature of Repairs or Alterations(Answer when applicable) -��4��Q � �, 1 r-2! Z) �?nY 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. gned Date Application Approved by / ' V Date Application Disapproved by Date for the following reasons Permit No. Date Issued ------------------------------- THE COMMONWEALTH OF MASSACHUSETTS t O� BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,tat the On-site Sewage Disposal system Constructed( ) Repaired(k//) Upgraded( ) Abandoned( )by r at C has been constructed in accor ce with the provisions of Titl 5 and the for Disposa System Construction Permit No. // ted L Installer Designer #.bedrooms Approved design flow AA gpd The issuance of this pe t shal not be construed as a guarantee that the system will funJ7�v-l s desiZ_D Date Inspector i, --------------------- -------- - ----------------------------------------------------------------------------- No. Fees..--. THE COMMONWEALTH OF MASSACHUSETTS L/ PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Misposal §�pstpm Construction Vprmit Permission is hereby granted to Construct( ) Repair(< Upgrade( ) Abandon( ) System located at M to C, C N_r l S 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:Construc on st be completed within three years of the date of this permit. Date Approved by Town of Barnstable Barnstable ' Inspectional Services All-A,[Mcacj BA ABLE. NAM 9 %1 69'39. Public Health Division �0 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas A.McKean,CHO FAX: 508-790-6304 CERTIFIED MAIL#7015 1730 0001 4987 7541 July 25, 2019 ROBBINS, FAY PO BOX 685 CENTERVILLE, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE.5 The septic system located at 241 Compass Circle, Hyannis, MA was inspected on 06/19/2019 by Sean M. Jones, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Conditionally Passes" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • The"distribution box is rotted. 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 within the deadline period will result in future enforcement action. PER ORDER OF THE B ARD OF HEALTH Thomas McKean, R.S., CH Agent of the Board of Health I Q:\SEPTIC\Title V Inspection Report Letters Mailing\Conditionally Passes Letters\241 Compass Circle Hyannis.doc i WHE Town of Barnstable BARNS('ABM 9�A b 9 A Inspectional Services Department TfD MA'S Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 4/26/19 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. ❑ Structurally unsound septic tank or SAS 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) ❑ Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTUER V 464ed d - b"�� — - Repair deadline: Q:ISEPTICIDEADLINES TO REPAIR FAILED SYSTEMS.doc Commonwealth of Massachusetts 310' 70(-� Title 0 On cial Inspection Form Subsurface Sewage Disposal system Form-Not.for Voluntary Assessments b 241 Compass Circe Property Address Chandler Bosworth owner Owner's Name information it .E H annis ✓ Ma t12601 _ m. 6/19/2019 , .required for every _ .�.,.__..._......�.,M....�..�, _..,. .._.�,._.__..._. page City/Town state Zip Code .: Dated Inspection Inspection results must be submitted on this form. Inspection forms may not be Filtered in any way.Phase see completeness checklist at>the end of:the form. When filling out forms A. Inspector Information 61 I3� 35 on the computer, use only the tab Sean M.MJones . Key to move your Name of Inspector -- cursor do not. s.M,Jones Title V Se to Inspection use the return Company Name w;_. .. ... .. _. Key. VQ74 seldan Lane Company Address Centerville Fula 02632 _..�...... �...� �,..� City/Town state Zip Code t 568-658-3456, 774-248-48 0 S14522 Se it 4srn onestitle ,Cori _ Licensetu..mber: B.,Certification, l certify that: l astir a D P approved system,Inspector in full compliance with.Section f 5 30 of Title 6 (310 CM R 16.000); l have personally inspected the sewage disposal system at the property address listed above;.the information reported.below is true,;accurate and complete as of the time of m inspection, and the inspection was performed based on my,training and experience in the proper function and maintenance,of on-site sewage disposal systems.Afterconducting this inspection l have determined that the system 1.. El Passes. 2; ® Conditionally lasses 3. n bleeds Further Evaluation by the Local Approving Authority 4. ❑ Falls 61 19/2019 Inspectors Signature hate 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 has a.design flow of 10,000 gpd or greater,the inspector and the system owner shall submit tale report to the appropriate regional office of the ©ER The original farm should be sent to thesystem owner and coples sent to the buyer, if applicable,and the approving authority; Please note: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. EStmt.dor n ,.7.12 18 T 5� th than Fom ate Swm Cis Sy�tsrn-P a l:d 18 � r Commonwealth of ft chusetts Title Off l Inspection Form Subsurface Sewiage Disposei System Form•Not for Voluntary,Assessments 241 Gcym ass (rloe __ Property Addres3s _ �..�M..�..�,.,�.�....�: :_..:�..�........�.�_,..�.. Chandler Bosworth Owner Owners.Name - ., _---—,,,,,In1br .., ... .. rlrtatlon is Hyannis _ 02601., 6f19/201,9 requied for every pale, 04frown Mate Zip Cade Date of Inspection C. Inspection Summary Inspection Summary; Complete 1.,2, 3,or 5 and all of 4 and 6. 1) system Passes: ❑ 1 have not found any information which indicates that any of the failure criteria described in 310 CI F( 15.303 or in 310 CMR 15,304 exist. Any failure criteria not evaluated are indicated below. Cornmerit , 2j System Condlitionally 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 D)for the following:statements. if"not determ ned,"please explain: The septic tank,is metal and over 20 years old" or the septic tank(whether metal car not) Is,structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent System wilt pass inspection if the existing tank is replaced with a complying septic tank asapproved by the Board.of :Health. "A metal septic tank will pass inspection Wit is structurally sound, not leaking and If a Certificate of Compliance.indicating that the tank is less than.20 years old is available, 0 Y . [Q N' 0 ND(Explain below). t6[r t,GaG•Eev.7fL l2431$ fft 5 Mew InspeGttliFl FpttXt; .$Ubsudamlow"a RFsposo system• 2 ar t8: Commonwealth old Massachusetts" y Title 5 OfficialInspectionForm Subsurface Sewage Disposal system Fort».Not for voluntary Assessments 241 Compass Cidc e Prq*rty Address Chandler Bosworth Owner _.m m. ........ ...�.......�.. requir►stian is- H anrns .::::: . ., l a., 02601 6119f2019, _._ required for every ..... -, ... page. CRY/Town State Zip Cade Date cftnspecaan C. Inspection Summary ry (carts) 2) System Conditionally Passes(cunt'); ❑ Pump Chamber pumps/alarms not operational, System will pass with Board of Health approval if pumpstalarms are repaired. ❑ 96servation 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 0 Y 0 H ❑ lid(Explain below). ❑' obstruction is removed ❑ Y ❑ ld 1 NO(Explain WOW): distribution box is leveled or.replaced 0 Y ❑ N ❑ ND(Explain below). D-box;was video Inspected and was found to be.rotted at water line and had root infiltrac4n; ❑ 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): :Cl' broken pipe(s)are replaced; ❑ Y ❑ N ❑ NO(Explain below), obstruction is removed ❑, Y ❑ N ❑ NE?(Explain below): ..3) Fui then Evratuattoh is Roulmd:_ y the Board<of Health,. ® Conditions exist which requ1re Furth revaluation by the Board of.Health in order tQ determ`ine.if the system is failing to protect'public Freafth,safety or the.env rronment. . System wilt pass unless Board:of Health determines In accordance with 310 CMR 1&303(1)(b):thsat the system is not,functioning in a manner which will protect public health, safety and the:environment, t5irtsp.C�C•rsv lCd8f2tb1B. TWO 5 n Form:S~Aw Sawage Deposal System:"Page 3 4Y 18 Commonwealth of Massachuseft Title ,5 OfficialInspection Form. Subsur f ace Sewage Disposal Sys r n Form-Not for Voluntary Assessments 41 compass Cirice Property Address Chandler Bosworth .......... . Ebner ........�,.�, ._.. tamer`s Name lnformawn is H annrs m Ma 02601 l6/19/2019 required for every �!;_ .. ..._.. _ .. page. C(tytT�am State. Zip Code Date of Inspectidn C. Inspection Summary (Font.) C] 'Cesspool or pclvy is within 50 feet of a surface water 17,1' Cesspool or,privy is within 50 feet of.a;bordering vegetated wetland Ora salt marsh tr: System will fall unless the Roard of Health(and public Water Supplier,if any) detenrtines that the system is functioning in a manner that protects the public health; safety and environment 0 The system has aseptic 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.. Q The system has a septic tank and SAS and the SAS is within a Zone 1 of a>public water supply. 0 The system has a sepVc tank and SAS and the SAS is within 50 feet of a privatelwater' supply°trvell. The system its 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 MEP certified laboratory,for fecal. caliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that nor other failure criteria are triggered. A copy of the analysis must be attachedto this fortn. c.. Other:: 4)_ System Failure Criteria;Applicable to All Systems.. Yau MUd indicate"Y :"or" +d"to each of the followino.for jL1 inspections: Yes No Backup of sew ge into WHO or,systern component dale to overloaded or clogged SAS or cesspool 0 2. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overlaaded or clogged SAS or cesspool ter sp,d= ram.M 18 'r1 S Official OWaction Form'Sutwur1 Sys€m<Pegs 40918 Commonwealth of Massachusetts Title5 Official i r n 'Form Subsurface Sewage Disposal Systom orm-Not for Voluntary Assessments 241 Cass Grace Pro�irty Address Chandler Bosworth Owner ..� Owner's Name require t for e M annis Ma 02661' 6/1312019 required for every .. page. c tyao m State Zip Code Rate of Inspection C Inspection Summary (cant) 4) System Failure Criteria Appbicabie to All Systems:(Pont,) Yes No E E] Static liquid,level in the distribution"box above outlet invert due loan overloaded or clogged SAS or cesspool Liquid depth.in cesspool is'less than 6'belo.w`invert or available volume is less than` "day ow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s): Plumber of times pumped; D 0 Any,portion of the SAS,cesspool.or privy is below high,ground water elevation. O Any portion of cesspool or privy is within 100 feet of a surface water sup ply, tributary to surface water supply. Any portion of a cesspool or,privy is within a Zone 1 of a:public water supply well. Any portion of a cesspool or privy is within 50 test of.a private,water supply Well.. Q 0: Any portion of a cesspool or privy is less than 100 feat but greater than 50 feet from.0 private water supply well with no acceptable water quality analysis. [This. "system pass If the will`water analysis,performed at a oEP certified laboratory,for fecal coloorm bacterla;lnd 11 lcstes absent and the presence of,ammonia''nitrogen and nitrate nitrogen Is equal to or lose than of ppm, provided that no other failure criltarlseareVIgIgered.A copy of the analysts and'chain.of custody.must be attachad to this form.] The system is a cesspool serving a facility with a design flow of 2000 gpd. 10,40o gpa E) 0 The system Ids. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system falls.The system owner should contact the ftard of Wealth to determine what will be necessary to correct the failure. .5) Large Systems: To be considered a[ergs system the system must nerve s facility with"a design flow:of 40,000,gpd to'l6,000 gpd. Far large systems,.you must indicate"either"yes"or"no"to each of the following, in addition to the questions in Section C.4. Yes No ❑ the system is within 400 fleet of a surface drinking water supply ( the system is within 240 feet of a:tributary to a surface drinking water supply e system is located in a nitrogen sensitive area(tnterim Wellhead.Protection Q Area'--IWPA)or a mapped Zone 11 of a public water supply well t�alnsra.cktG•rev:7P2.& 18 'nft 5 OftW ftpsegon Farm;Stb%daw swMPOOPOW swom•Pop' 61:1 r Commonwealths of Massachuseft Title 5 Officiat Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 241 Compass Ciric Property Addre s Chandler Bosworth owner _..:�:..._..... owner's Name .. information is.. required for every Hyannis. Ma 02601 6/1912019 page Cityrrown — State Zip Code Crate of inspection C. Inspection Summary (cant) If you Lave answered"yes"to any question in Section C.5 the system is considered a significant: threat;,or answered"yes"to any question in Section CA above the large system has failed,The owner or operator cif any large system considered a significant threat under;Section C.5 or failed under Section CA shall upgrade the system in_accordance with 310 CMR 15.304.The system owner should contact the appropriate regional of5ce of the Department 6., You.must indicate`#yes."Vr"no"for each of the fot[owing,for all Inspections-:: Yes No Pumping information; ras provided ley the Owner;occupant,or.Board of Health Were any of the system components pumped out in the previous two weeks? Q 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), d` Wasthe facility or dwelling inspected for signs of sewage back up? ®'; trt/as the site inspected for signs of break out? Were aII7 system components, excluding the SAS, located on site? Were the septic tank manholes uncovered opened, and the interiorof the tank. inspected for the condition of the baffles or tees,material of construction. dimensions, depot of ItquidA 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 and1ocation 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 aEl ny cif the failure criteria reiatett to Part C is at issue ®'' approximation of distance is unacceptable)[310'CMR 15:302(5)j I t5cssp.d rave 7126Y201$ Tide 5 o ai k%OWI n Farm:WwWo$ma .D4s -8ysi +Pale 6 of,t8. Commonwealth of Massachulsett Title 5 Official Inspection Form Subsurface SewageDisposal System Form-Not for Voluntary Assessments 241 Compass C rice .._ ....... „m PrapertY address Chandler Bosworth Owner ......... Owners Name ir►tam a.fo H annis M 02,60.1 611912©19 required tar every . ,_....:�. ,,..: . _.._ page- City Tawri Mete iip a Oafs of Impectiorf D. SyStem Information. 1. Residential low.CaadM s; Number of bedrooms(design); - --- Number df bedrooms(actual): DESIGN flow;:basecl on 310 CMR 15.203(for example. 110 gpd x of bedrooms); gQ_ap i Descr ption: Number of current residents: f . Does,residence have a garbage g lnder? [3 Yes Q No Goes'residence have a grater treatment_unit? Yes ❑ No If yes, discharges to ....... Is laundry ors a separate sewage system?(Include laundry system inspection (l Yes ❑ No information in this report.) Laundry system inspected? Q Yes Q No Seasonal use? ❑ 'Yes No Water miter readings, if available(Iasi 2 years usage(gpd)) --� Sump;pum ? 171 Yes G) No Last date of,occupancy: vacant/unknown- Date t&i604m ram TrAwle. TWOS. # trspeck" 0M subwfam vispow "s :•PageT 0 19 CcmmQnwoalth old Massachusetts Title 5 Official. Inspection.. Form Subsurface,Sewage DisposaE,System Form-Not for Voluntary Assessments 241 Coom ss Gir(ce Praperty:Address _ Chandler Bosworth Owner C3 er's r4arne information Hyannis Ma 02601 611 /2019' required-far-every page CttyRawm State Zip Cade Cate or the Lion D. System Information (cunt.) 2. Cotmmerclaltlndustrial Flow Conditions; Type of Establishment; ....._m. _�_.Design.flow.-(based on 310 CMR 15.2031y Gallons perday(gpd). Basis.of design flow(seatslpersonsfsq.ft.,etcl: _ ...._.. Grease trap present? ❑ Yes 0 No VVater treatment unit present? ❑ Yes No If yes, discharges;to:; ........ .. .....�„ Industrial waste holding tank present?'' ❑ Yes No Non-sanitary waste:discharged>to the Title 5 system? ❑ Yes 0 No Water meter readings, if available mast date of oewpancyfuse Date Other(describe below): 3, Pumping Records: Source of information:` Was system pumped as part of the inspection? ❑ Yes Z No If yes,,volume pumped: g�ttans Nowt was quntity;pumped determined? Reason for pumping; tSft B d ''mv.tests Tit $0ft#V#000n Focal:$ubawt SystW`PW 8 ef is � Commonwealth of Massachusetts. Title 5 t ffi i 1 + t n F rm. Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 241 CCiass Gi rice ...- ------- Property MOM Chandler Bosworth _ �._.. ..... Owner Owner`s Man e required IS H`ennis Ma 02601 � W1 912019 requlrsd for emery � ,.;�....µ :..�.. CO/Town State Zip Code Crate of Ins than D. System Informati n (cont) 4. 'hype of System: Septic tanks distribution box.,soil absorption system 0 Single cesspool } Overflow cesspool Privy 0. 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-llA system by system operator under contract [Q' Tight tank. Attach:a copy:of the DEP approval. Other(describe);: Approximate;age of all components, date.:installed (if Known)and source of information.. on irtai s stem 7t2311978 Were;Sewa a odors:.detected when arriving:at the,site? n Yes t3 5:. Building Serer(locate on site plan.)> .... Depth below grade feet 1a et _.._.µ..., ... Material of construction; ®cast iron 0,40 PVC F-I crater(explain). Distance.from private water supply well or suction line: yet - - -�-- Comments(on condition of joints,venting,,evidence of leakage, etc.): Joints ok,.no leaks or blockages.Vented through roof t5tnr •rev:TCd6t2Qt 6 Title 5.Qf Form fit 8t OW lep"S)Mtom•Per 9 0€18. Commonwealth of Massachusetts Titte 5 OfficlatinsPection Form Subsurface Sewage Disposal System Form,-Not for Voluntary Assessments 241 Compass Cirice Property Address Chandler Bosworth; Owner owners Narne informs tion H annis lyia t12601 repired far every _ .._._..f 6l1912019 page; Cityfrown _.. - state �. 7Ip Cade Gate of Ins ion Q. System Information (cont) 6. Septic Tank(locate on site plan): Depth below grade,., feet Material of construction: f concrete [ metal ❑fiberglass [Q polyethylene other(explain) It tank.is metal, list age; years is age confirmed by a Certificate of Comiplionce?(attach a copy of certificate) Q Yes No Dimensions: 1000 gallons 6" Sludge"depth; Distance from top of sludge to bottom of outlet tee or baffle: 3 Scum thickness 61 Distance from top of scum to top of outlet tee or baffle -- -- - - - Distance from bottom of scurn to bottonn of outlet tee or baffle 11" How were:tlitttensions determined?: measurements covers end took measurements- comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural ral integrity, liquid levels as related to outlet:invert, evidence of leakage, etc.): Tank does not need to be cleaned now but should be done soon and again every 2 years for proper maintenance, water level was even with outlet,,tank was not leaking and was structurally sound n**C•rev.'fPAMI8 Tim S Qtrida woes iFom:subvAaw sftw000ew system•Pso 100he Commonwealth of assachuset tie 5 Officiallaspection. Form Subsurface Sewage Disposal System Form-Not for Voluntary,Assessments 241 Compass Circe Rropertyaddtess Chandler Bosworth Owner tenet's Nance iequiredlan Is N annis Ma; 02601 6/19/2Q1'9 requir�dfarevery ���.—,_ .. .,.,,,,.. .__...�::.....m,. _ page. Cttyffavm State Zip Cade Date oftnspedon D. Sir term Ir�>��►r�lmati0f) (cont.); 7. Grease Trap(locate,on site plan). Depth below grade: �.. ...,.._ fefe�t Material"of construction: ( concrete metal Q fiberglass ( polyethylene: C3 other(explain); Dimensions $cum 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 _.._...ram Date of last pumping: �.... ... . .Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, llquid,leve,ls as related,to putlet invert, evidence of leakage;etc.): 8: Tight,or Hoiding'Tank(tank must be pumped at time of inspection)(locate on site plan),. Depth below grade: --....._,....,_., Material of construction: Q concrete [] metal Q fiberglass polyethylene Q other.(expmain);; Dimensions: . ._ ., ..., : ..,. _. ... .. ... . Capacity: _ gallons Design Flow: gallons pet day t5�r t. ,.PCd6JZ�t8: TM 5 Of dat kapeakon form:S system Page t t of is I V Commonwealth of Massachusetts Title 5 Offbaialinspoction Form Subsurface Sewage Disposal System Form-I ciE for Voluntary Assessments 241 compass Cirice Pro"rty Address Chandler Bosworth Owner Owner`s Name reinfo+iredfoion is e H annis Ma 02601 6/19/2019 requ�retl for every _ ._ ...___...,em...a__._.�........�.. Pale, m Sty Zip Code Date::ol'rnspsdan D. System lnfdrrnati (cant) 8 Tight or~'Holing Tank.(cant) Alamn present: (�, Yes No Alarm-levet, Alarm in working order; 0 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 I.istribution Box(if present must be opened)(locate.on site plan): Depth of liquid level.above otlet,'invert a Comments (note.if box is level and disthbution to outlets equal,any evidence of solids carryov.ert any evidence of leakage into or out of`box,etc:); Distribution.box was vidr o inspected from d-box and was found with.hoots and was rotted.at water' line,'Box needs tobe replaced; t5 t.dae•.rev;.Tt3913tEt8' --- TWOSOMdej lemon Form:Wandaw.8swep Dispow Syswn-Pop 12 of 18. Cclmmonweailth af Massachuse.fts f Title 5 Official Inspection Form A Subsurface Sewage Disposal,System Form Not for Voluntary Assessments 241 Compass CI'CIce Propertyr Address .Chandler Bosworth Owner ors N ar neInfor , required ion � Hyannis Ma 026t11 6t1912019 required for every �,.�.......,..� page. Cityrr"n xtat Zip Code ... 09%of inspection m. . Di Syst Information (cunt.) 1 Q. Pump Chamber,(locate on sits plan): Pumps in working order: Q' Yes [ N€.- Alarms in working order. ® Yes E I Comments(note,condition of pomp chamber,condition of pumps and.appurtenances,etc.), *If pumps or alarms are not in working order, system is conditional pass... 11. Stoll/ t#sQrption System.ISAS) (locate on site,plan, excavation not required); If SAS not located', explain why; Type`; leaching pits nuimber .-.- --. d leaching chambers number: leaching galleries number; Q leaching trenches number,length: - --- - - - leaching fields number, dimensions: 13 overflow,cesspool number: :.__...... innovativelaltemative system Typetname of technology, L%W.d=.rev.Tt26P I To 5 IWOCOnFOM, 8 $ .pop 13.018 Commonwealth of Massachusetts Title 5 Official-Inspection. Form Subsurface Sewage Dl"al System Form—Not for Voluntary Assessments. 241 Compass Cirlc Property Address Chandler Bosworth Owner O er's Nwe Informsfion Is required far every Ma ..Page-CO/Town stste Zip Code: Dste of inspecNon _ . D. SIystem Information (cunt.) 11. Soil Absorption System(SAS){cant.} Comments(note condition of soil,signs cif hydraulic failure, level of ponding, damp soil, condition of vegetation, etc* leach;pit was video inspected, pit was found4ry with no signs of past hydraulic overloading;.; 12, Cesspools:(cesspool.must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top.o.f liquid to inlet invert ....... , ....- , v.,...__.. Depth of solids layer Depth of scum layer Dimensions of cesspoot :M.. ... _ _ _ ...,. .,... Materiels of copstruct on Indication:of gfoundwater inflow ❑ Yies, n No Comments(note condition of soil, signs of hydraulic failure, level of ponding condition:of vegetation, etc.): MnV,doc•rsv.7=018: Tits 8 r apr $yftn:-P8q0 14'cr 18 Commonwealth.of MAssachosetts Title 5 Official pectiOnForm --Hns Subsurface Sewage Disposal System Fonn: Not for Voluntary Assessments 241 Compass Cldce Property Address Chandler Bosworth Owner 6�;Ws Name information Is requlred,6 every Hyannis: Ma 02601. -6/19/2010 page. Cfty/Town State. Zip Code. Datevflnspedort D. SYsteminformation (cont), 13, PrOvy'(locate on site pW.n). Materials of construction: ..........—---—--------- ................. Dimensions .Depth of solids Comments(note condition,,of soil,:signs of,hydraulic failure, level of ponding, condition of vegetation, etc.}:. .................... ............... ............. Tift 5 official Inspecran Fars:M%trfam Sawap Uspa"'System-.Poo 15.af 16 Commonwealth of Massachusetts Title 5 Official Inspedtion Form Subsurface Sewage Disposal System.form-Not for Voluntary Assessments. 241 Com ass Cic ,,.,,,, _ Property Address" Chandler Bosworth Owner ownets tdame. Information is required for.every Hyannis Ma 02601 ._._.. 6/19/2019 required _.. -m---�-- POW Cltyfrowrr State Z. Code. Date of inspection Q. System Information (coat. 14. Sketch Cat Sewage Dispool System. Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks: Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below:, ❑ band-sketch in the area below [J drawing attached separately t5nW:d=•mv.MAW1 0 TIM&5 OMdW tqVWJ on r m'Um rf a Dj VW,$Y Pa 016 d,48 I Commonwealth of Maasach Me Title 5 Official Isn Fora. Subsurface-Sewage Disposal System Form-Not for Voluntary,Assessments 241 Compass Cirice Property Adore .. .... Chandler Bosworth Owner Owner`s Neme information is aunts Ala 02601 6113/2019 required for:every _yen pale, CityfTown _,..,.m.. Stets Zip Code � Bats afirtapei�ian D. System Information,(coot) 15. site lm El Gheck-$l1ope ® Surface water [] Check cellar Q Shallow hells Estimated depth to high ground rater: 12 feet Please indicate all methods used o determine the high ground water elevation:. ET Obtained.from system design plans on record if checked,date of design plan reviewed. gate - Observed site(abutting property/observation hale.within 150 feet of SAS) Q Checked with local Board of Health=explain:. (� Checked with local excavators, installers. (attach documentation) ❑ A=esserd USt3S database-.pxplain: You must:describe how you established the high.ground water elevation: Groundwater was;established by accessing town of Barnstable groundwater contour maps, Before filing this inspection Report,please see.Report Completeness Checklist on next page. t r.anc•rev.tt2r it 8 Title 5 MW Wpaction Faim S sys*m•Pape 17 4f 10 Gommonweaft i of Massachusetts Title 5 Officia.1 Ins.pection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 241 Com ass Cirice PrtY Address Chandler Bosworth` Owner, owner's Name; Information is required fo r every Hyannis Me 02641 6/19/2019 page. City/Town State: Zip Code pate of inspection E. Report Completeness Checkllst: Complete ail applicable sections of this form inclusive of. A, inspector information. Complete all heids;in this section. B. Certification: Signed& Dated and 1, 26 3,or 4 checked, ® C. inspection Summary- 1,21 3,of 5 completed as.appropriate 4(Failure Criteria)and 6(Checklist)completed, D, System Information; .For 8:Tight(Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 18 or attached For 15: Explanation of estimated depth to high groundwater inclined t6lt .dttC't v,T/2$rZp1B TMOOftd W FWM Ste_ U SYatem'PW Eootis ,LOCATION SEWAGE PERM I NO• VILLA E --T- r . INSTALLER' NAME & ADDRES 0 U I L D E R OR OWNER � :a DATE PERMIT ISSUED IQ — 2 DATE COMPLIANCE ISSUED g 1 \F f �4r h Nrys h 1 ~. F�s. - o ...... fi.� S ..............._ 'l.•AE COMMINWEALTH OF MASSACHUSETTS �oo��t1 C�Y BOARD OF HEALTH qj . ............... OF........... AVVIi tt i n for Disposal arks Tonitrnrtiun ami# ✓31 h eb Applici oAs 42de for a Permit to Construct- ( ) or Repair ( ) an Individual Sewage Disposal System at: , .. . ..... ..... .. �............ -----------------------...-----------.....--------------------------------.......•--•.- ---•��-- �/Locat"* Address Lot No. ...,[ ...__ 5f?1 / .-.E�---------•-••-•-------------- P.._. � ........... --............. Owner AddreAge ss F-1 --•-•--•--•-----........ Ra Installer Address Type of Building Size Lot........ f_ _�.Q._Sq. feet Dwelling—No. of Bedrooms�...�---•-------------- Expansiol� Attic ( ) Garbage Grinder ( ) �n No. of ersons..... �--------•----------- Showers — Cafeteria a Other—Type of Building _ :e' ...:__...__._._. p ( ) ( ) dOther fixtures --------------------------------•----•----•--•----•-------------------- --------------- --------•-•--••--.....•-•-•••-•-••----...-•-•--------..------ W Design Flow........:.: ....:.......................gallons per person per day. Total daily flow------- .................gallons. W Septic Tank—Liquid capacityl a@agallons Length.......... _.....�..... Width_$.......... Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area.....4_�I..7....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.....!_,ram_ .. ........ Date.... Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water___-_-_____-_-__.-_____- Lz, Test Pit No. 2................minutes per inch Depth of Test Pit--------------------- Depth to ground water........................ �+ --- ...... 0 Description of Soil.... ..e,��r ----------------•-------------.............----...------------------ ------------------------------------------- ----------...............................................0....................................................................................... W -----••-----------------------------------------•-----•-•---.--------------------------•-•--••••-•••----•-----•-----------------------------•---------------...•-•---•--------•--•-•-----•---•-•--•--••- UNature 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 TIT I.;... 5 of the State Sanitary Code—The undersigned further agrees not to place the system i operation.until a Certificate of Compliance has been issu by the ar of health. / Sig d.......( - = --------•----_----_ / �� fd� at Application Approved BY !f.,Zo -.. ---- ............... Date - Application Disapproved for the following reasons----------------•------•-----------------------------•---------•-------------•---------------------........----•- ---------•-•----•----•-•----•.....•-••-•--•-•--•--•••-------••----•----••---•------••...•---- Date PermitNo......................................................... Issued.. .r .......7 ..�.................. Date Nod .�.ys..... t THE COMMONWEALTH OF MASSACHUSETTS s _ BOARD OFF HEALTH ! .t✓.......................OF ........... �-- fir !l. ^ Appliratinn for Disposal Works Tomtrurtinn Vrrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: �!�� �- 1.....�..................4.ca�iL�mss J._........ .... .. ..... •• --............._ � �^ ovLot No. ..... __................... ............................. ................................................--- �,1 Owner / � Address .= - .....-'.....-•---••........................... ........ =....................................................................................... Installer Address UType of Building Size Lot......_.Ze 1 -%`_'_ L!_Sq. feet Dwelling—No. of Bedrooms........ �..--. .....................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building g No. of persons...... ................... Showers — Cafeteria 04 d Other fixtures ......................................................'............................................................................................... W Design Flow........ ...`=......... ................gallons per person per day. Total daily flow............. ....................gallons. 9 ;Septic Tank—Liquid capacity.l.�fPegallons Length........`..... Width....k.......... Diameter................ Depth................ }Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....LI._7_'2....sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ' ) Dosing tank ( ) / '_4 Percolation Test Results Performed by._...4'�!?:r �-:^....._S�-�.�.�. %? �....... Date.....Z 4 �_`:.....g aTest Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water..............._........ (1 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P+ ---------------- D Description of Soil..... r.Et / .4...----- .. !r�. � .s .................................................................... V .---------------------------•-•-----------••---------•-----------------•--------------....-•••••-•-------_-•.......---•--••--•----------------...----------•-------•••---••------•---.......---•------ W x .......................... -•------•---•-•--•--•-•-----••-------•-•-------------•••----....•-----•-•----------•-••---••-------•----•----•--•--•••--•-------•----------•----•----•-•--•---------•-------. UNature of Repairs:of Alterations—Answer when applicable............................................................................................... _. ..... ..... ,f .. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TiTLEE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issu by the board of health. _ ,! Sig d. ----- A- .•---------- -- -•-•- ......C/_'_��r �t Application Approved By---... . °" •_ -- --•._. ... t�.?.' � ...... ` Date Application Disapproved for the following reasons:.............................................................................................................. ........-•-•--•-----•........................•--•--•-•------••-----------........------------.........._..-----•----•-------•----------------------•----------------------------------------•--•--------- b. Date PermitNo......................................................... Issued-.................................... - ' Date - .. 0. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....................................OF.... ...................................... Trrtifiratr of Tompliiinre THIS IS TO CERTIFY, Thatthe Individual Sewage Disposal System constructed ,� ) or Repaired ( ) / Q/ Installer has been installed in accordance with the provisions of 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No d .................. dated__.. /X!r'�/4`—_-'7A.'........... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A UARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........ .. . 2 -------------•------. Inspector.... ................................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALT ..............OF.....� s...�!��......�................,................. No. ...... .............. a FEE.t' ....... Dispno a Workii Tatuitrnrtian ranfit Permission is hereby granted. faIndividad ..e.-------.� ✓/ �� •- =- :... to Cons tr ct/(� or Repair�( ) Al Seut' ge Disposal System ,u ` -�� � at No.. G' y ' .............-11 t' •-------•-------- Street as shown on the application for Disposal Works Construction P�,rVt No Dated....t a."Af...................... yr.r.. ................•-_..... f oar of Aea DATE......f r -• .......................... FORK 1255 HOBBS & WARREN. INC., PUBLISHERS i - k r E 4 _ _�f�lf��x� I F/N+SN G�F'.�DG•��Q � F"��v4SN �s•Qr1'DE �►N�.,�N G7PAIJL� - - -�--•---` pvf& Ti4 NK i To d g F'.sypro. • :vw�� • IN v - --- � �, -�--__ _�:14) '- , { „ G� + � -_ 1 y- --�• KFILG � 3-O�ASTa N6 J�wELL Cr ` j�, CELL R tr Et,�✓ s q^ ! 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Y 'f �'� " /V'orF'r'?A,N` .A/ dr• . y / ,04.0 r 224 �oLL /,IAss• r s Ma r ri 0, y,. )Y n�