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HomeMy WebLinkAbout0096 HAMDEN CIRCLE - Health 96 HAMDEN CIRCLE Hyannis i A= 290 - 169 . � Commonwealth of Massachuset#s Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 96 Hamden Circle l� Property Address I� Russell & Lorraine Carlson ' Owner Owner's Name / + + information is r/ required for every Hyannis Ma 02601 5/03/2018 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 filling out forms A. General Information on the computer, use only the tab 1. Inspector: key to move your cursor-do not Jeffrey M. Wall use the return Name of Inspector key. Wall Septic Service Company Name P.O. Box 771 , Company Address , Harwichport Ma 02646 City/Town State Zip Code 508 432 4908 673 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 (3 0 CMR 15.000). The system: Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority Inhesys' tem s re Date 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 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. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 .Lo VS I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 96 Hamden Circle Property Address Russell & Lorraine Carlson _ Owner Owner's Name — requireinformation is Hyannis Ma 02601 5/03/2018 required for every y page. Cityrrown 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) Sys m Passes: 1 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: One or more system components as described in the"Conditional Pass" section need to be r aced or repaired. The system, upon completion of the replacement or repair, as approved by the rd of Health, will pass. Check the box "yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not determined," pleas explain. The septic tank is metal d over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantia * filtration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is laced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection i is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less tha 0 years old is available. ❑ Y ❑ N ❑ ND (Explain below): 4� t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 96 Hamden Circle Property Address Russell & Lorraine Carlson Owner Owner's Name information is Ma 02601 5/03/2018 required for every Hyannis _ _ page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if umps/alarms are repaired. B) S\inspecti onally Passes (cont.): ❑ Oewage backup or break out or high static water level in the distribution box due tructed pipe(s) or due to a broken, settled or uneven distribution box. System will pf(with approval of Board of Health): ip s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is r oved ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is le led or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a yNr 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 [ e N [I ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N \E] ND (Explain below): red byt-tthe Board ©f-HeatNth� ❑ ConAzns.,,t xist which require further evaluation by the Board of Health in order to determine if the system 0 a to protect public health, safety or the environment. 1. System will pass unles Bogard of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is n&-fugtctioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface wateP^�. . ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetlan alt marsh t5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts H Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 96 Hamden,Circle__ _ — Property Address Russell & Lorraine Carlson Owner Owner's Name information is Hyannis Ma 02601 5/03/2018 required for every page. City(Town 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, safes ,@nd environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a face water supply or tributary to a surface water supply. ❑ The system*a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. �Mtip ❑ The system has a�gitic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank d SAS and the SAS is less than 100 feet but 50 feet or more from a private water suppl Method used to determine distance.",,,, �vhs� **This system passes if the well water analysis, Kgormed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence x ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criter a 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 ❑ Ej,�j/� Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Fq/NI� Liquid depth in cesspool is less than 6" below invert or available volume is less than '/z day flow I. ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4 96 Hamden Circle Property Address Russell & Lorraine Carlson _ Owner Owner's Name information is Ma 02601 5/03/2018 required for every Hyannis --- 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 pipe(s). Number of times pumped: ❑ E2 Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ��g 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. ❑ [�i�/� Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ �AI�� 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. ❑ Lq 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 efied-a-farge system-4He systef rf*u9t-serve-a#-eil+try-v+�Fa-a esign flow of 10,000 gpd to 15,000 gpd. For larg stems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in on D. Yes No ❑ ❑ the system i 'thin 400 feet of a surface drinking water supply ❑ ❑ the system is within 20 t of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitroge ensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II o blic water supply well If you have answered "yes" to any question in Section E the system i nsidered a significant threat, or answered "yes" in Section D above the large system has failed. The ow or operator of any large system considered a significant threat under Section E or failed under Section II upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the a riate regional office of the Department. t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 96 Hamden Circle Property Address Russell & Lorraine Carlson _ Owner Owner's Name information is Hyannis Ma 02601 5/03/2018 required for every Y - - 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 ❑ [9 Were any of the system components pumped out in the previous two weeks? [2 ❑ 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? E/ ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) R1 ❑ 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, ex ing the SAS, located on site? lld ❑ 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. 2 , ❑ 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): — Number of bedrooms (actual): --- DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): t5ins.doc•rev.6116 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts -- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments .'' 96 Hamden Circle Property Address Russell & Lorraine Carlson Owner Owner's Name — information is required for every Hyannis Ma 02601 5/03/2018 _ __ _ _ _ page. City/Town State Zip Code Date of Inspection D. System Information Description: ----- Number of current residents: a Does residence have a garbage grinder? ❑ Yes Ej/'No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ['No information in this report.) Laundry system inspected? ❑ Yes 2"'No Seasonal use? ❑ Yes [},/No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ^^ _- ❑ Yes E4-v**'No Last date of occupancy: ate -e am m._-Mei_-KndtistrkrFR w- -M- Type tablishment: ----- Design flow(based o 0 CMR 15.203): cations per day(gpa)� - Basis of design flow (seats/persons �etc.): - --- Grease trap present? �`` . ❑ Yes ❑ No Industrial waste holding tank present? ten. ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? "^� �N Yes ❑ No Water meter readings, if available: — t5ins.doc•rev.6/16 Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 7 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 96 Hamden Circle Property Address Russell & Lorraine Carlson Owner Owner's Name information is H nnis Ma 02601 _5/03/2018 required for every �a. - page. City[Town State Zip Code Date of Inspection D. System Information (cont.) Las't"date-QL.occupancy/use: Date Other(describe b elo)7� M General Information Pumping Records: Source of information: Was system pumped as part of the inspection? B/Y'es ❑ No If yes, volume pumpe& gallons How was quantity pumped determined? Reason for pumping: Type of System: Septic tank, bt be*,-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 i ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): i . I l5ins.doc rev.6/16 Title 5 Official Inspection Form;Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 96 Hamden Circle Property Address Russell & Lorraine Carlson Owner Owner's Name information is _H Yannis Ma 02601 5/03/2018 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate.age of all components, date installed (if k`n/ownn)) and source of information: Were sewage odors detected when arriving at the site? ❑ Yes CR'No Building Sewer(locate on site plan): Depth below grade: — feet Material of construction: ❑ cast iron ❑ 40 PVC other(explain)- — — Distance from private water supply well or suction line: � 7 feet Comments (on condition of joints, venting, evidence of leakage, etc.): e Septic Tank (locate on site plan): Depth below grade: feet i Material of construction: oncrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) I If tenk Is FAetal, list '--- years — is age GGAfi4med a ifiasate ofopl+aaee (ettacft-a copy�ferifiea# )T ].'des - too -- Dimensions: CI tc` IC2- L. Sludge depth: ---�-�`' --- t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-J ge 9 of 17 i Commonwealth of Massachusetts w Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 96 Hamden Circle Property Address Russell & Lorraine Carlson Owner Owner's Name information is Hyannis Ma 02601 5/03/2018 ! required for every Y —_ page. City/Town State Zip Code Date of Inspection j D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 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 //— How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, vidence of leakage, etc.): oiJ / <1e71* e ��e, � o _L��'e�rl! S�GcG 1vYE�,�. �E �./°'� °__..�.� r.+?�t�•►� . NO .�(J� l��rC-P eeate en site-plan)i Depth belo de: feet -- Material of construction: ❑ concrete ❑ metal fiberglass ❑ polyethylene ❑ other(e plain): Dimensions: --- Scum thickness ------ i 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.doc•rev.6A6 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 I Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 96 Hamden Circle _ Property Address Russell & Lorraine Carlson Owner Owner's Name Y — information is Hyannis Ma 02601 5/03/2018 required for every y --- ---- --- page. Cityfrown State Zip Code Date of Inspection ). System Information (cost.) oftnts(o�n pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as reIaLed to outlet invert, evidence of leakage, etc.): rightmr-rimm -b ate on site plan): Dep below grade: — - — Material o nstruction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: — — Capacity: �� gallons — Design Flow: gallons per day — Alarm present: \EE1 Yes ❑ No Alarm level: -- Ala' in working order: ❑ Yes ❑. No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Nk Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 96 Hamden Circle Property Address Russell & Lorraine Carlson Owner Owner's Name information is H annis Ma 02601 5/03/2018 required for every -- --- 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 Np b ' ( st,tl 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.): Pumps in king order: ❑ Yes ❑ No* Alarms in working orde . ❑ Yes ❑ No* Comments (note condition of pump c"Ira ber, 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: 'i_�_ t5ins.doc•rev.6116 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 12 or 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w 96 Hamden Circle Property Address — Russell & Lorraine Carlson Owner Owner's Name information is required for every Hyannis Ma 02601 5/03/2018 _ page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: leaching pits number: ❑ 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.): o' 7- Q- � ao 57`f tPIT -e ,oe-er e 7-(Yt V-C'Z77 - 0/'A g L HroPR��a `oFf'��1 . 11 eGC'7/ ioa* Number configuration - Depth —top of liqui nlet'invert --- ---- Depth of solids layer - Depth of scum layer - Dimensions of cesspool p Materials of construction Indication of groundwater inflow ❑ , ❑ No t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Dispo Qystem-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 96 Hamden Circle _ Property Address Russell & Lorraine Carlson _ Owner Owner's Name information is required for every �H annis Ma 02601 5/03/2018 _. 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. F►): Materials nstruction: — -- -- Dimensions - Depth of solids -- — Comments (note condition of soil, signs of hydraulic faille, level of ponding, condition of vegetation, etc.): t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts : y Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 96 Hamden Circle Property Address 4 Russell & Lorraine Carlson Owner Owner's Name information is required for every Hyannis Ma 02601 5/03/2018 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 7whe a public water supply enters the building. Check one of the boxes below: hand-sketch in the area below ❑ drawing attached separately i w� All .._....__.. ems_. o frlCef67,1Ve Z _.� __....._..._..__ v ti?-- I n 0 6.),Tti /boa e of PST 1 Sew c l5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 96 Hamden Circle Property Address Russell & Lorraine Carlson _ Owner Owner's Name information is Hyannis Ma_ 02601 5/03/2018 required for every _—�-- page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: Check Slope [� Surface water [11� Check cellar Shallow wells Estimated depth to high ground water: �4-4 — 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: Tt You must describe how you establi�ssh�,hed the high ground water elevation: AV Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc-rev.6116 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 96 Hamden Circle Property Address _Russell & Lorraine Carlson Owner Owner's Name information is Hyannis Ma 02601 5/03/2018 required for every y _ _ _ _ page. City/Town 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.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Table 3-2 Do's and Don'ts of Private Septic System Management DO... I70 NIT... Do have the on-site system Inspected and pumped by Do not use the toilet or sink as a trash can by a licensed professional approximately every 3 to 5 dumping non-biodegradable material (cigarette butts. years. Failure to pump out the septic tank can cause diapers, feminine products, etc.)or grease down the system failure. If the tank fills up with an excess of sink or toilet, Non-biodegradable matehal can clog solids, the wastewater will not have enough time to the pipes,while grease can thicken and clog the settle in the tank. These excess solids will then pass on pipes, Store cooking oils, fats, and grease in a can I to the leach field,where they will clog the drain lines for disposal in the garbage. and soil. Do know the location of the on-site system and drain Do not put paint thinner, polyurethane, anti-freeze, field, and keep a record of all inspections, pumping, pesticides, some dyes, disinfectants,water repairs,contract or engineering work for future softeners, and other strong chemicals into the references. Keep a sketch of it handy for service visits, system. These can cause major upsets in the septic i tank by kiVing the biological part of the on-site system and polluting the groundwater. Small I amounts of standard household cleaners, drain cleansers,detergents, etc.will be diluted in the tank and should cause no damage to the system. Do grow grass or small plants (not trees or shrubs) Do not use a garbage grinder or disposal,which above the on-site system to hold the drain field in feeds Into the on-site tank. If there is one, severely place.Water conservation through creative limit its use.Adding food wastes or other solids landscaping is a great way to control excess runoff. reducesneed to p p the on-site tank. If a grinder pacity and is used, I the system must be pumped more often. l Do install water-conserving devices in faucets, Do not plant trees within 30 feet of the system or showerheads and toilets to reduce the volume of water park/drive over any part of the system. Tree roots will running into the on-site system. Repair dripping faucets ciog pipes, and heavy vehicles may cause the drain i and leaking toilets, run washing machines and field to collapse. I dishwashers only when full, and avoid long showers. Do divert roof drains and surface water from driveways Do not allow anyone to repair pr pump the system and hillsides away from the on-site system. Keep sump without first checking that they are licensed system pumps and house footing drains away from the on-site professionals. I system as well. Do take leftover hazardous chemicals to an approved Do not perform excessive laundry loads with a hazardous waste collection center for disposal. Use washing machine. Doing load after load does not bleach, disinfectants, and drain and toilet bowl cleaners allow the on-site tank time to adequately treat wastes sparingly and in accordance with product labels. and overwhelms the entire on-site system with i excess wastewater. This could flood the drain field without allowing sufficient recovery time. Consult with II an on-site tank professional to determine the gallon capacity and number of loads per day that can safely go into the system, Do use only on-site system additives that have been Do not use chemical solvents to clean the plumbing allowed for usage in Massachusetts by MA DEP. or on-site system, Wirade" chemicals will kill Additives that are allowed for use In Massachusetts microorganisms that consume harmful wastes. have been determined not to produce a harmful effect These products can also cause groundwater to the individual system or its components or to the contamination environment at large. rmD'•l1urw.Mau,govld0 ph"erlruoj-c"mpq 3-17 A;-SESSOR'S MAP NO. PARCEL LOCATION SEWAGE PERMIT NO. VILLAGE I N S T A LLER'S NAME A ADDRESS J f? A c d Zvi /3.e 2 -r S0A1 d OR OWNER r , DATE PERMIT ISSUED ;.; DATE COMPLIANCE ISSUED � ��, ` •� a �� � �' �- � ' ,, .� ,� i � � .�'j _ J r � ' � �: .F i r , q F:zs. 30.00 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH q TOWN OF BARNSTABLE Vv__ Appliration for Di-qVnsal Works C utuitrurtion ramit Application is hereby made for a Permit to Construct ( ) or Repair g) an Individual Sewage Disposal System at: 96 Hamden Circle Hyannis . -•- _._ ----••--•-•................•----------...------------.................... --••-••----•-•••-•-----•-•••--•-•--•------••------•-------------•----------------..............--- Location-Address or Lot No. ..Russell C 1. --.�=.................................................... W J.P.Macomber Jr.Owner Address Installer Address dType of Building Size Lot............................Sq. feet U Dwelling-X No. of Bedrooms.--•--------_3...........................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria W Other fixtures ------------------------------........... w Design Flow............................................gallons per person per day. Total daily flow.............................................gallons. 04 Septic Tank—Liquid capacity............gallons Length................ Width---------------- Diameter----.--..--..... Depth................ w Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. x Seepage Pit No..................... Diameter.........---.--...-- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1----------------minutes per inch Depth of Test Pit--------_-------•- Depth to ground water------------------------ 0i4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water....................---. R+' -----------•-----------------------------------------------•-----.---------------•--------------------------------- ----------------------- .................... O Description of Soil............................................Sand & Gravel x .-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------••---•-•--••--•••-----•-. w Nature of Repairs or Alterations—Answer when applicable............................................................................................... V -..................................... gal:!?!I_leach... it............... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE,5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has ee -ssu d by the b rd health. Signed -- !------------------------ ------3/c.�./ ..0----------- Dace Application Approved B PP PP Y .> - .-..9D......-. Daze Application Disapproved for the following reasons- -------------------------------------------------------------------------------------------................................-------- --------------- -------- -- ...........................................................-------- -------------------------------- ----------------------------------------------------- -----------------------............... q Dare PermitNo. ----------� --"-.,9e---------------------------- Issued .----------- ------------------ ------ Dace r THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE p Appliration for 11iipua al Workii Tint utrttrtiun Frrutit Application is hereby made for a Permit to Construct ( ) or Repair P) an Individual Sewage Disposal System at: 96 Hamden Circle Hyannis. ................__ -....................................................................... ••••-•••••--••---•••••--•-••-•••--•-••.....-----•••••-•-••••-•••...................-------••---•-- Location-Address or Lot No. --Russe_1.1_ Cax:. nn------•---•...........................•--.........•. •••••••-----................................ - ..._.................... 1 owner Address W J.P.ftcomber Jr. a ................................................................................................. ..----••••--••----•-------•••-•-...•-----......-------•-----••-...----------------.......--•------ �� Installer Address Q Type of Building Size Lot----------------------------Sq. feet U` Dwelling-X No. of Bedrooms...............3...........................Expansion Attic ( ) Garbage Grinder ( ) P4 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a Other fixtures -----------------------------------•---------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench--No..................... Width.................... Total Length.................... 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.......................................................................... Date........................................ a Test Pit'No. I................minutes per inch Depth of. Test Pit-------------------- Depth to ground water--_--_--_____-__-_-__--. rX4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a --------------------------------•-------------------------•---.......--••------............................•••--•--••-•-••---..................-•-•--•----- O Sand & Gravel -------------------- Description of Soil ----...------•-•-----••-••---------------......•••.._....•---•--•--•-•-••----•---------------. x U --------:- W UNature of Repairs or Alterations—Answer when applicable............................................................................................... 1/1000 p-allon leach- pit Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The,undersigned further agrees not to place the system in operation until a Certificate of Compliance has been 'ssued by the board of health. Signed ----- -.�.1 -.- �-been -- ----- �..................... ......�.��/9Q...-�------ Date ApplicationApproved By ............... . cs .` --------------------------------------------------------......................... 3 -Zae- - -9------- Application Disapproved for the following reasons- ----------------------------------------------------------------------------------------------------------- ---------------------- ------ --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------- Permit No. .............. /' .......-✓ ............................. Issued ............................................... ......... �'w - 9 Dace THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE 01-1rrtiftrate of C�oraylianre THIS IS TO CERTIFY.;.That the Individual Sewage Disposal System constructed ( ) or Repaired�XX ) J.P.Macomcer or. by-----...... ............................................................................................. Installer �- at -....... .6....Hamd.en...C%:rc.1 e....Hyan.n r.---------------------------------• ...............----.....-----------------------........-----------------------------..............._......... .. has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ...... ........ dated ........................------------------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT Bf CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL-FFUUNCCT'ION SATISFACTORY. DATE----------------✓1...... ------........--------...---------...... Inspector .... �. .1..... `--... .... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH qCy TOWN OF BARNSTABLE No...���.:..<.��.. �' FEE........30.00 r Eliupuuttl Marko Taanutrttrtiun rrrutit Permission is hereby granted.........J•P.Ma e omb e r Jr. . ..... .......................................................................... ff fo Construct ( ) or Repair (XX) an Individual Sewage Disposal System at No......... Camden Circle Hyannis. .......... ............... ....... .••. -•-•......•-•...--- Street as shown on the application for Disposal Works Construction Permit No, �::I� ...... Dated.......................................... ...................••••....... . ... ............................................ DATE. . ................•-•--------•---.....----•-•----......_................••••.. `Board of Health FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS AsBuilt Page 1 of 1 ASSESSOR'S MAP NO. PARCEL LOCATION SEWAGE PERMIT NO. VILLAGE I N S T A LLER'S NAME ADDRESS 1-UT 1111— OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED l � v �k' l r J 1 http://issgl2/intranet/propdata/prebuilt.aspx?mappar=290169&seq=1 4/26/2018 �9G LOCATION SEWAGE PERMIT NO. r —/ge, r- -- VI L' AG k INSTA LLER'S NAME & ADDRESS BUILDER OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED ��/ w�r- � t -- ` G C ICI �33 y /�L ®r 9 No. a -- Fimz.............................. THE COMMONWEALTH OF MASSACHUSETTS BOAR® F HEALT _ _n ..._--- -- ./.....OF........ .. 1 I- -- -------------".. Appliration for Disposal Works Tonstrnstinn Vrrmit Application is hereby made for a Permit to Construct (-�}-or Repair ( ) an Individual Sewage Disposal :. system : ;.;.':- 9Lo�cation-Addr or Lot No. Owner Address _ T..1 �.. i�i/..a1. ...... ...... ` I'y� -----------------------• Installer Address d Type of Building Size_Lot_l_ _� ------Sq. feet Dwelling—No. of Bedrooms........... . . --____---_Expansion ttic ( ) Gdrbage Grinder ( ) aOther—Type of Building _D� - gg o. of persons________ _________________ Showers ( ) — Cafeteria ( ) d Other fixtures ........... Design Flow..................��.............gallons per person per ay. Total dail$ flow____-___--- -(;!.....__._.____.._.._gallons. WSeptic Tank—Liquid capacity .gallons Length----- Width_.._!__..... Diameter________________ De th_._...,_........ ` x Disposal Trench—No..................... Width...../............. Total Length...........o....�;Total leaching area.. sq. ft. 3 Seepage Pit No_________ ________ Diameter.__..__..__._... Depth below inlet.____..... Total leaching area... .-sq. ft. ,. V Z Other Distribution box ( ) Dosing t nk ( ) / '-'- Percolation Test Resul,0 Performed by._. bI Date----- ----..minutes per inch Depth of Test Pit.................... Depth to ground water-._-_-_________Test Pit No. 1. _. Test Pit No. 2................minutes per inch Depth of Test Pit..___.........._._.. Depth to ground water____-_- , . `. ._._. 9C-- ' . QW.,. Description of oil-------- /-- 7v-- 4 ---•- •------ L , ®_���c --------------- U Nature of Repairs or Alterations—Answer when applicable..._----------------------------------------------------------------------------_____.......... B ••------•------------------------•--•----••-----•-•-------•---------------...-----------------•-••--------....-----------------------------•----------•----------------------------................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal. System in accordance with the provisions of iITLh 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been i sued by the board of health? Sied ............................ Date Application Approved By----- ..•. ---- 2 F % =s-- ®� 7�' Date Application Disapproved for the following reasons:................-------.......................................................................................... x. ............................•----...-------•--------......------------------...-•-•---•------.....----... ......................-----...---------------------------------...-----------------•-- Date �_ :. .. - Permit No......................................................._ Issued-...... ---- -- ------------------......._ ....-- Date k ' No... ................. YmB............................_ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTHY .... Appliration for Uhipos al Works Tonotrurtion Errant Application is hereby made for a Permit to Construct (_)_or Repair ( ) an Individual Sewage Disposal System at. s 5,, Location Address or Lot No s Owner Address ............. • .............. .............. ...--- Installer Address Type of Building Size Lot_ :-O. V-----Sq. feet Dwelling—No. of Bedrooms.............-...........................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Buildin . I a yp g ._.�.k�".�?,4` .�� No. of persons ;.................. Showers — Cafeteria P ( ) ( ) Other fixtures .... `' W Design F1,ow................... "..................gallons per person per day. Total daily/flow....... J.). ....................gallons. WSeptic Tank, Liquid capacity." gallons Length._... _... Width.._ f....._ Diameter .____ De t ................ x Disposal Trench—No..................... Width.....:............ Total Length............ ..�,Total leaching area.---,- rea.__-, -sq. ft. Seepage Pit No......... ........ Diameter....._ ......... Depth below inlet--- - ..... Total leaching area.. sq. ft. 13 Z Other Distribution box ( ) Dosing tank '—' Percolation Test ResultA Performed by. a '......1'n n.4-V4.-VA4.1. Date... . 1'-"' ,aa Test Pit No. LZ _-----minutes per inch Depth of Test Pit.................... Depth to ground water.................... f Test Pit No. 2................minutes per inch Depth of Test Pit......A............ Depth to ground water-------- A .... -• -- O Description of Soil............. •- .,'�`�f ` ' ?_. - d.................... .y_ _. r!' ------------------------------------------ W --•----------------- ........................................................................................------------•--•-•------••-----•--------•-----••-•....................................... 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 TITI1 5 of the State Sanitary Code—The undersigned further agrees not1to place the system in operation,until a Certificate of Compliance has been byby the board of health:'" f r �'--- .............. J r Date ;2B 7 QC- Sig d Application Approved By..... -- Date Application Disapproved for the following reasons---------------•- ----...-----...-----------------•----------------------------------. ------•-•••------•- --------------------------------------------•------------------• --------------•-•-----•--------•----.................-----•---------------•-----------------------------------•••----••.....•-•--- Date PermitNo...................•................................... Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH O F...... UT rfif iratr of TO-Ml rliFana THIS IS TO CERTIFY, That the Individual Sewage Disposal System ,constructed (—A—Or Repaired ( ) �a ............................................................. _ e /� „Installer at �,, „� . has been installed in accordance with the provisions of T `_ 5 of `T��he State Sanitary as scribed inhe T r I� y� application for Disposal Works Construction Permit No_7 .__ f. .7�-..._..._.._ dated._ .... _._ ........................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL UNCTION SATISFACTORY. DATE............... .....`... ................................................... ........ --.....---...........----•-•-•-•--••--.. Inspector ......................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEALTH •.,..` No............ !Z.x.. - FEE........................ ipaat1 ]Varkv T �aoirnr#in �er�ntii Permission is hereby granted..... .��+ .._ ---------- +` R .. f ' ----• . - ........ .. to Construct ( ) or Repair ( ) an Individual Sewage Dispo al System i -- -- ... Street as shown on the application for D>sposal Works Construction P No. --#Boar ated••. -•--•- ..... F. 0, 7A- Health DATE..--- . -............................................ FORM 1255 HOBBS & WARREN. INC., PUBLISHERS - x . , �Fe�_tw .rS:_ _FiH+sM G�.aac-•_yy F�iv�sN 611FAVLO Grttvad• �"`----� Oveit- rA NK 9X4 1 To aF F"a,1wtp. ! Ecc✓.- �•�����.•��'�`�d:�Y/�,v1,Jlr�<��.�.vrf,�a,vim;'.�►«�',�.:I ,v7I�✓t �' •i 4"t r ,-- D weSLL IN Cr - 1 e. . .tyG a �vEEx+�n Q�c�cFi�G j A }} r 7rzr-a CELL.! fZ F� I — ♦ ♦ O G p L fV• s 3 Z ! l• -""",__—-^ `` , / I E � •.. `! p I.J T �Q X �" 2 ♦ 1 ! 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