HomeMy WebLinkAbout0365 COMPASS CIRCLE - Health 365 Compass Circle,Hyannis
i
TOWN OF BARNSTABLE
LOCATION 3�5 Co hn po s5 C i rk SEWAGE# AQ 10— 0
VILLAGE ASSESSOR'S MAP&PARCEL b
INSTALLER'S.NAME&PHONE NO. Q� ,
SEPTIC TANK CAPACITY �6
LEACHING FACILITY:(type)
NO.OF BEDROOMS y� 3 W Sfun
OWNER I 0 NkW
PERMIT DATE: 3 )-0 COMPLIANCE DATE: 3Lk 2_
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
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33 5 r ° Aq
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5 11104
y
No. Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
- Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHU'SETTS
01ppliLatlon for �DispoSaf 6pstem Const ictlon 3p¢rmit
Application for a Permit to Construct( ) Repair r\ Upgrade( ) Abandon( ) ❑Complete System Kndividual Components
Location Address or Lot No. 3tj-6 .C%-M-19. Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel 1 y h '"�r i (Zo�-t, ,,
Installer's NamgAddress,and Tel.No. Designer's Name,Address,and Tel.No. '7741—V
Type of Building: p
Dwelling No.of Bedrooms 3 Lot Size C�/ Z Z 3 sq.ft. Garbage Grinder(W19
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 3 7 V gpd Design flow provided gpd
Plan Date "7 T0,-y U ZO Number of sheets Revision Date
Title
Size of Septic Tank 0 Vy Type of S.A.S. j �QJ�
Description of Soil Se L i4e Ac . 17W-l?` 2�9
Nature of Repairs or Alterations(Answer when applicable) V' It-fie ;&W /4W, 2ye s,,c T c,,J7.3 //—70
l�-olu 303-0 G iwt-C t � Z�' 1 `' L X 17 ;K /We64
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 Co e and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of H
ned C 0 Date
Application Approved by _ Opp# Date Z
Application Disapproved b Date
for the following reasons
F
Permit No. ILI Date Issued TIM
`4
No. Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered-in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
21pplication for Nsposal �&pstrm Construction Permit
Application for a Permit to Construct( ) Repair X
Upgrade( ) Abandon( ) ❑Complete System dividual Components
Location Address or Lot No. 34S"6>w1 _ C;re4i Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel>! A-411 C i f (ZO ke 0,
Installer's Name ddress,and Tel.No. Designer's Name,Address,and Tel.No. -771V_Z 1 P
0 Ur, E. HA 1-0- 6., 6f2-
Type of Building: ✓
Dwelling No.of Bedrooms Lot Size t U t 3 sq.ft. Garbage Grinder
Other Type of Building S F/ No.of Persons Showers( ) Cafeteria( )
Other Fixtures
1 Design Flow(min.required) 310 gpd Design flow provided S gpd
Plan Date "� T/9N' La L0 Number of sheets Z Revision Date
Title
r Size of Septic Tank _A LVO Type of S.A.S./_3 — / 310J�0
Description of Soil C. i/��., ? - /� ' Z31
xt
Nature of Repairs or Alterations(Answer when applicable) V mil/i re Jd.;Gd /Pl1,A iw l e4- A fi_"A4,3 Z D
6G, &-v„V v AI'-- 97- p
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 EnvironmentaZoe and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health.V_
S4' ed C Date
Application Approved by / a^, �; Date
/ - /J4
Application Disapproved b v l s x Date e v
for the following reasons ti
Permit No. ( Date Issued
I
--------------------------------------------------------------------------------------------- -----------------------------------------
E COMMONWEALTH OF
L THBARNSTABLE MASSACHUSETTS
3/U ,MASSACHUSETTS- lyq
(Certificate of Compliance
THIS IS TO CE TIFFY,that the On-site Sewa e Disp,sal s s em Constructed( ) Repaired(�) Upgraded
Abandoned( )by
at 1 �� ep per„ �_C` ��/� has been cons c in accar ce
�
with the provisions of Titl 5 and the for Disposal System Construction Permit N -V ed `( a
` Installer �j p Designer
#bedrooms V Approved design flow T 7_r_ gpd
The issuance of thisipermit shall not be construed as a guarantee that the system will�functio as designed.
Date D Inspector 2S
' N -- --a---�------------
_.
-
o. -
Fee
THE COMMONWEALTH OF MASSACHUSETTS 1
y y PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
Bisposal ,*pstem Construction permit
Permission is hereby granted to Construct( ). Repair( //Upgrade( ) Abandon( ) 4
System located at 6 S (0-14 % 1 Gi
7
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.
� / j
_Provided:Construcii u�t e pleted within three years of the date of this permit.
Date /d Approved'by
Town of Barnstable
oFn+E T Regulatory Services
c Richard V. Scali,Director
Public Health Division
�e6 '� `m� Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Homeowner Certification Form for Alternative Systems
Property Address: �J� e a �Cb S 5 C. I r
Assessor's Map\Parcel: jib G 0, '77 3
Property Owners Name: CUlf Le�,q r—
In accordance with Massachusetts DEP alternative system approval letters, the following certification
information is required by the Owner of record. The Owner of record must place an 'Y' in the
applicable box next to each line certifying the information.
Yes N\A
. -IN ❑ I have been provided a copy of the Title.5 VA technology Approval letters.
(15 page Standard Conditions letter and the specific technology letter)
® ❑ I have been provided with the Owner's Manual
1 ❑ I have been provided with the Operation and Maintenance Manual
® ❑ For.Systems installed under a Remedial Use Approval,I agree to fulfill my
responsibilities to provide a Deed Notice as required by 310 CMR 15.287(10)
and the Approval
W ❑ For Systems installed under a Remedial Use Approval, I agree to fulfill my
responsibilities to provide written notification of the Approval to any new Owner, as
required by 310 CMR 15.287(5)
1& ❑ If the design does not provide for the use of garbage grinders,the restriction is understood
and accepted
CK . ❑ Whether or not covered by a warranty, I understand the requirement to repair,replace,
modify or take any other action as required by the Department or the LAA,if the
Department or the LAA determines the System to be failing to protect public health and
safety d th environment, as defined in 310 CMR 15.303
agree to comply with all terms and conditions above.
Prop ers panted name
3
r perty Owners Signature Nte
47ol-iThis form must be submitted along with the septic system disposal works permit
application for all Rk systems including new construction, repairs\upgrades, with and
without aggregate (stone) and with conventional design criteria or credited design
criteria.
Q:\Septic\IA homeowner certification 2.doc
As the owner of record, I hereby certify that the above information has been provided in accordance
with the DEP App al Letter for Infiltrator chambers.
i
r of record, 365 Compass Circle, Hyannis
If you have any questions or comments, please do not hesitate to contact me at the above number.
Sinc rely,
Glen E. Harrington, R.S.
J
Word/documents/Infiltrator Owner Certification
Town of Barnstable
°fWE, Inspectional Services
Public Health Division
tiARNSTABM
"tA
9 A Thomas McKean, Director
i63 • ��
Ar�o�►�° 200 Main Street,Hyannis,MA 02601
Office: 508-8624644 Fax: 508-790-6304
Installer & Designer Certification Form
Date: 3/6 �� Sewage Permit# �y2 - �' Assessor's Map\Parcel
� � "
Designer: Yu^�c h�ll -Vlh 9�7i Installer:
Address: C� LeWa 4f e-1-ti Address:
On - q - was issued a permit to install a
(date) (in taller)
• r
septic system at 3G27 Cewr� U � ��s based on a design drawn by
(address)
f dated -7 3i!/ ZOzo
(designer
I certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank. Strip out (if required) was inspected and the soils
were found satisfactory.
I certify that the septic system referenced above was installed with major changes (i.e.
greater than 10' lateral relocation of the SAS or any vertical relocation of any component
of the septic system) but in accordance with State & Local Regulations. Plan revision or
certified as-built by designer to follow. Strip out (if required) was inspected and the soils
were found satisfactory.
I certify that the system'referenced above was constructed in compliance with the terms of
the I\A approval letters (if applicable)
OFMq�s
l,. �o GLEN
(Installer s.Signature) ERIC
HARRINGTON
No.1070�
(Design s Signature) (Affix D , re)
PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVI O CERTIFICATE
OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-
BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.
THANK YOU.
WoAdeptAHEALTIASEWER connect\SEPTIC1Desiper Certification Form Rev&14-13.DOC
�E TOWN OF BARNSTABLE N
LOCATION 3 r SEWAGE# `
VILLAGE ASSESSOR'S MAP & LOT I 1
INSTALLER'S NAME & PHONE NO. A & B CANCO 775-6264
SEPTIC TANK CAPACITY y,
LEACHING FACILITY:(type)6 axe.*/?'+e9/a/lA (size) 3 je 6
NO. OF BEDROOMS ,3 L O PUBLIC WATER_
7
BUILDER OR OWNER .'L
DATE PERMIT ISSUED: l ' "
DATE COMPLIANCE ISSUED: t1— ��-
VARIANCE GRANTED: Yes No
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APPROVED
CanA., • D m rat Fas.......
THE COMMONWEALTH OF MASSACHUSETTS pcvf-
igned Date BOARD OF HEALTH 6
TOWN OF BARNSTABLE
App iration fur Di►i.pwial World, Tomitrnrtinn ramit
Application is hereby made for a Permit to Construct ( ) or Repair ( --I/an Individual Sewage Disposal
System at:
.....&05.... ... 'am 5------C'`-�............... ..............---
f�
LocatUnn-Address- or Lot No.
/. `.—o ................................................. ----- --------------------- �-----•---............................................
' Owner AddressQ � .n.0 ------ -------1 ..... � ..........t..........
Installer Address
d Type of Building Size Lot.................... Sq. feet
Dwelling—No. of Bedrooms.....__..._3----------------------_----Expansion Attic ( ) Garbage Grinder .(CVO)
aOther—Type of Building --- ----------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( )
Q' Other fixtures _______________________________ _ _
d .........
Design Flow............................................gallons per person per day. Total daily flow..._........._._..._............._..........gallons.
W
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........................................
Test Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................
44 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................
W4 ---------•-----------------------------------------------------•---•-•--•-•-•------•-•---....................................................................
ODescription of Soil.......................................................................•---•-------------------- -------------•-------••-•--•--------------------------......---•.------
x
W -----------•---------------------------------------------------------------------------------•••----------------------..........------------ ......• -- .......
UNature of �2epairs or Alterations—Answer when applicable--2Aji.A_0........00._........�_n' .1._�_:Fir�k... . ..... .
---•--•.
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—T e undersigned further agrees not to place the
system in.operation until a Certificate of Compliance Mse e .ssu d by the board of health.Signed ................. .. .1 .......... ................................. ........Z...lKa-...' ....1
Dare
Application Approved BY
3.,2 .-1.......... . .. ...................................... y
Dat
Application Disapproved for the following rear on . ............ ...................................................... ..........................
............................................................. .......................... . ......................... -- .......................---- -- .... ........................................
Permit No. ........�� ...-....�..Q..� Issued
--.................. .-.................................................................
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y_ log
No... - FE.......... �.....
E COMMONWEALTH OF MASSACHUSETTS P
/t/4VBOrARD OF HEALTH
�J
TOWN OF BARNSTABLE
Appliration for Diripaiial Wnrk,g Towitrurtion Errant
Application is hereby made for a Permit to Construct ( ) or Repair ( %-_�an Individual Sewage Disposal
System at:
.....-....�!_�.......................... _. .........._-_•.......................... ..._......--•-•-....._..._.........._.._....__........._......._..............................._..
1 a Location-Address or Lot No.
AJ
............. - --••--....----- --••••••-----•••-••-•---•-•-••----•--••-•--•--•-..-•-•• ...................... /} ...........................................................
Owner ). ®.....././�-C( i tAddress i
Installer Address
d Type of Building F� ,� Size Lot............................Sq. feet
U Dwelling No.,of.Bedrooms.______-___s-->_____________________- ..Expansion Attic Garbage Grinder b
p,, 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.
3 Seepage Pit No_____________________ Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. I................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................
Git Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
a -----------------------------••-•-•.........•--••••---••---•-----•••••••...••....-•----•---•-................................................................
0 Description of Soil........................................................................................................................................................................
--------------------- ........................................................... --------- ••--
U Nature of ]Repairs or Alterations—Answer when applicable.-.- k. a.Ll........C�.......__r.n- -f-I_ / ? _____jo fiA
...... s..--•- AA-K------...... a.. C ...........
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—Tke undersigned further agrees not to place the
system in operation until a Certificate of Compliances een�i`ssuerd)by the board of health.
Signed .................. vl-�..G.1...... . ,��.................................. .......... __ �.�...`��..�
Application Approved By ....................` - �....... - ,,��..........................-... �� 1--
Application Disapproved for the following reasons: .. . ... ..... ............... ............... . .. ....................................... ....................
...... ................................................................................................. ............................ --.................... . ....... ........................................
! Dace
PermitNo. ......... ....-.....�..(�`�-------------------- Issued _..................................................................
Dare
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.—.- — _.- ----.o------------,..,---:—:-- a----.. — -•.._.---- —
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certifirate of Tompliance
THIS IS 70 CERTIF , That the Individual Sewage Disposal System constructed ( ) or Repaired
by ................))✓. ...... ...................................................
..................... j - - ._. ................. .....................................................
at --- . 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. ...........7Y--.-_I.0_ dated ......................._..................._.
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
e�
DATE---....... .-� .` r.....-.-._._..__...... Inspector .. - - �.. ...........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
N.
TOWN OF BARNSTABLE
No. r< E r� FEE..... .........
�i��Ia�ttl �>k� ���t�tr�rtilan rrutit
Permission is hereby granted----- 7� ) J --- ------------------------------ ------•----...............
......
to Construct ( ) or Repair ( -- an Individual Sewage Disposal System
at fr. ........ --------- ------------------------- ------------ -------------------------------------
StreetL/ //
i as shown on the application for Disposal Works Construction Permit No._..,7P'Ar"Dated-_---_- ._ ��.-...�.._....
Board of Health
DATE........3---v:�-/ �----� --------------------•---------•-• /
FORM 3890E HOBBS R WARREN,INC.,PUBLISHERS ` .- jU // / , / l
AsBuilt Page 1 of 1
TOWN OF BARNSTABLE
LOCATION 3 S l_P.(t 4A4'-V SEWAGE #
VILLAGE ASSESSOR'S MAP & LOT /
INSTALLER'S NAME& PHONE NO. A & B CANCO 775-6264
SEPTIC TANK CAPACITY �,
LEACHING FACILITY:(type)G ;r.A- e4lo/a� (size) 3)e 6 o3 rAv-t
NO.OF BEDROOMS 3 i►A L O j PUBLIC WATER_�Z
BUILDER OR OWNER
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED; el—
VARIANCE GRANTED: Yes No
1
M ea y ccii
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http://issgl2/intranet/propdata/prebuilt.aspx?mappar=310449&seq=1 7/10/2019
COMMONWEALTH OF MASSACHL'SETTS
EXECUTIVE OFFICE OF E'�VIRO�NIE\TAL AFFAIR` j�
DEPARTMENT OF EN IRO�'�IENTAL PR�TECTION 6
44
A 199
ONE NVINTER STREET. BOSTON. MA 0_106 61"•_9_•'S�t�,.� i
UILLI.A�'F A'ELD ` RUDl'C01T
Governc• Secretor%
ARGEO PAUL CELLUCCI D.AVID B STRUHIS
Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissioner
PART A
CERTIFICATION
Property Address: 3�5 ('3N)e's C►tit (�Wwls Address of Owner. Mv-tl lti��iRr,n�-crvTa>J
Date of Inspection: y���51 of different)
Name of Inspector:
I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000)
Company Name:Alla g "p„►
Mailing Address: Rp Acn,c e_32'9 ti h+ASs/oeQ H -1- v
Telephone Number: r.5-e
CERTIFICATION STATEMENT
I certit that 1 have personall% inspected the sewage disposal system at this address and that the information reported below is true, accurate
and complete as of the time of inspec,o-. The inspection was performed based on my training and experience in the proper function and
maintenance of on-site sev,age disposa systems Tire system:
AI Passes
_ Conc,t-onai!\ Passes
'-eecs Furtne• E%a'jat;o� 9t the Local Apprpvmg .quthont\
F-. s
Inspector's Signature: Date:
The Svste- Inspe io• sha" submi: a cop\, of this inspection report to the Approving Authorft within thirty (30) days of completing this
inspection. It the sNsiem is a shared —stem o• ha; a design floe of 10,000 god or greater, the inspector and the system owner shall submit
the repo-: to the appropriate regional office of the Department of Environmental Protection. The origna! should be sent to the system owner
and copes sent to the buyer, if applicable, and the approving authorm
INSPECTIO% SUMMARY: Check A, B, C, or D:
AJ SYSTEM PASSES:
I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303.
Any failure criteria not evaluated are indicated below.
COMMENTS:
BJ SYSTEM CONDITIONALLY PASSES:
One or more system components ar 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.
Indicate yes, no, or not determined (Y, N, or ND!. Describe basis of determination in all instances. If"not determined", explain why not.
The septic tank is meta!, uniess the owner or operator has provided the system inspector with a copy of a Certificate of
Compliance (anachedt indicating that the tank was installed within twenty(20) years prior to the date of the inspection; or
the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank
failure As imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank
w approved by the Board of Health.
trov.sed 04/25/97) Pago 1 of 10
DEO o the woria Wiae weD htty rAwww magnet state rria Aa+aec
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTIO% FORM
PART A
CERTIFICATION (continued)
Property Address:
Owner.
Date of Inspection:
4
Bj SYSTEM CONDITIONALLY PASSES iconnniod
_ Sewage backup or breakout or high static water level obse ed in the ids-6"-,on box is due to broken or obstructed
pipets) or due to a broken, settled or uneven distribution ox. The system %al pass inspection if(with approval of the
Board of Health). Describe observations:
broken pipe(s) are replaced
obstruction is removed
distribution box is levelled or repla ed
The system required pumping more than four times year due to broken or obstructed pipe(s). The system will pass
inspection if tw•rth approval of the Board of Health):
broken pipe!si are replaced
obstruction is removed
C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:
Conditions exist which recuire further evaluation by t e Board of Health in order to determine if the system is failing to protect the
public health. Wen- and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER
WHICH WILL PROTECT THE PUBLIC HEALTH D SAFETY AND THE ENVIRONMENT:
Cesspool or prl%-, is within 50 feet of surface water
Cesspool or pri-, is within 50 feet of bordering vegetated wetland or a salt marsh.
2) SYSTEM WILL FAIL UNLESS THE BOARD O HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT
THE SYSTEM IS FUNCTIONING IN A MA ER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE
ENVIRONMENT:
The systerm has a septic tank an soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or
tributary to a surface water sup h
The system has a septic tank a d soil absorption system and the SAS is within a Zone I of a public water supa'v well-
The system has a septic tank nd soil absorption system and the SAS is within 50 feet of a private water supply well.
The system has a septic tank nd soil absorption system and the SAS is less than 100 feet but 50 feet of more from a
private water supply well, iess a well water analysis for coliform bacteria and volatile organic compounds indic;m tho
the well is free from pollut n from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or
less than 5 ppm. Method used to determine distance (approximation not valid).
3) OTHER
(revzeed 04,25/97) Page 2 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORrv1
PART A
CERTIFICATION (continuedi
Property Address:
Owner:
Date of Inspection:
D) SYSTEM FAILS:
You must indicate either "Yes- or "No' as to each of the following
I have determined that the system violates one or more of the followin failure criteria as defined in 310 CmR 15.303 The nast-
for this determination is identified below. The Board of Health shoul be contacted to determine what will be necessan• to torma
the failure.
Yes No
Backyp of sewage into facility or system component due o an overloaded or clogged SAS or cesspool.
Discharge or pondmg of effluent to the surface of the gr and or surface waters due to an overloaded or clogged SAS or
cesspool
Sta:ic !ioj.d level in the disinb;,tion boa above outlet nvert due to an overloaded or clogged SAS or cesspoo!.
LiCuid depth in cesspool is less than 6" below invert or available volume is iess than 112 day floe.
_ Recu,red pumping more than 4 times in the last ye r NOT due to clogged or obstructed pipe's .
Number of times pumped _
An% ponoon o'the So!! Absorption System, cessp of or privy is below the high groundwater elevatior,
An•, por::on o'a cesspool or privy is within 10 feet of a surface water suppl,.• or tributary to a surface water supply
And po,�jor of a cesspoo' or privy is w rthun a one I of a public we!I.
An% pc^-o- c-a cesspoo• or priv is within '0 feet of a private water supple well
Am po^.or. o:a cesspool or prvoy is less th n 100 feet but greater than 50 feet from a private water supply well with no
acceotable Ovate, qualm analysis. If the w 11 has been analyzed to be acceptable• attach cope of well water analysts fur
cohiorm bacteria. vo:a:ile organic compo ds, ammonia nitrogen and nitrate nitrogen.
E] LARGE SYSTEM FAILS:
lou must indicate either "Yes' o, "No- as to each of the f Ilowing:
The fo!iowcng cn:erl2 app;,. to large systems in dditron to the criteria above:
The system serves a facilm with a design flow, of 10,000 gpd or greater (Large System; and the system is a significant threat to
public health and safety and the environment because one or more of the following conditions exist
Yes No
the system is within 4D0 feet of 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 nitr en sensitive area (Interim Wellhead Protection Area - IWPA) or a mapped Zone II of a
public water supply well)
The owner or operator of an) such system shall bring the system and facility into full compliance with the groundwater treatment progrwn
requirements of 31, CniR 5.00 and 6.00. Ple a consult the local regional office of the Department for further information.
(revised 04/2S/97) Page 3 of 10
y �
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART 6
CHECKLIST
Property Address: 5t.S Cpw%,Pw�S L%t_
Owner: A JpQio
Date of Inspection:
Check if the following have been done: You must indicate either 'Yes" or 'No"as to each of the following:
Yes N0
`!y _ Pumping information was provided by the owner, occupant, or Board of Health.
_ hone of the system components have been pumped for at least two weeks and the system has been receiving normal
flow rates during that period. Large volumes of water have not been introduced into the system recently or
as pan of this inspection
_ As built plans have been ootamed and examined. Note if they are not available with N/A
_ The fac:li-, or d%e!img %%as inspected fo/ signs o-sewage back-up.
_ The system does not receive non-sanitary or industrial waste flow.
_ The site %%as inspected for signs pf breakout.
_ All s%sterr components. excluding the So,! Adsorption System, have been located on the site. u
The septic tank nmanhoie� %ere uncovered, opened, and the interior of the septic tank was inspected for condition of
baffies or tees, mater;ai o;construction, dimensions,depth of liquid, depth of sludge, depth of scum.
The size and location of the Soi' Absorption System on the site has been determined based on
_ The facda\ o%ne• ,ane occupants if dineren: from owner were provided with information on the proper maintenance of
Sub-Surface Disposal Svstern.
_ Existing information. Ex. Plan at B.O_H.
_ Determined in the field :r an% of the failure criteria related to Part C is at issue, approximation of distance is
unacceptable .113.302.3;b?
(revised 04/2S/57, Page 4 of 10
SLBSURFACE SEA%AGE DISPOSAL SYSTEM INSPECTION FORM
PART C '
SYSTEM INFORMATION (continued)
Property Address: 3(o5 & .,p 67uC-11�¢.
Owner: Z'
Date of Inspection:
BUILDING SEWER:
(locate on site plan)
Depth below grade.
Material of construction. _cast iron _40 PVC _other (explain'
Distance from private water supply well or suction Ire
Diameter
Comments: (condition of joints, venting, evidence of leakage, etc.)
SEPTIC TANK: 1A,45
(locate on site plan
Depth belo% grade .OK
material of construcoon Aconcre:e _meta _Fiberglass _Polyethvlene _othertexplam
li tank is metai, Ifs: age _ I; age cor.f.rmec b\ Cen;fica:e of Compirance _(Yes,;No
Dimensions I jL(�irk
Sludge depth (nN
Distance from top o: siudee to bonon of outlet tee o, ba��e
N
Scum thickness 0 _ .t
Distance from top o' scum to top o' outlet tee or ba^,e 10, _ h
Distance from bosom o' scu-n to bo-o- of oucle. tee c• bane 1 s�
Mow dimensions were determ,nec li
Comments
trecommendation for pumping rondition v inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert structural
integrity, e%idence of leakage, a:c i '��pu%ANP �'Sg.t t L#%) 1 k,av►& (JL"—\ a4-y 1
L�i �Tc'�v t � em\4t �0.acl
GREASE TRAP:
(locate on site plan:
Depth below grade.
Material of construction: _concrete _metal _Fiberglass _Polyethylene _other(explain)
Dimensions:
Scum thickness: -
Distance from top of scum to top of outlet tee or baffle.
Distance from bottom of scum to bottom of outlet tee or baffle:
Date of last pumping.
Comments:
(recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural
integrity, evidence of leakage, etc.;
(re,irad 04/25:9-,) Page 6 of 10
5 �
r
SUBSURFACE SEWAGE DISPOSAL SYSTEM I%SPECTIO% FOR..M
PART C
rr SYSTEM INFORMATIOti
Property Address: S v47yRQ �%n. .
Owner:'`riuj pl
Date of Inspection:
`1
FLOW CONDITIONS
RESIDENTIAL:
Design floN _g p.d..rbedroom for S.A S
Number of bedrooms O'
Number o'current residents Q�
Garbage g•, der (yes or no.,
Laundry cc-•^ected to system (yes or no` .Aec,
Seasonal use tyes or no,.AJ� (�
Water meter readings. if available (last two i2 year usage tgpdi: �C1— NiCeAJ (iCrtet
Sump Pump (yes or nor
Las da,e o'occupancy
COMMERCIAL'IN- DUSTRIAL:
Type of establishment
Design fio%% _gahonvda\
Grease trap presen, Ives or no_
Industrial %%ante Holding Tani; Dresen; -ves or no_
'ion-sannan vaste discnarged to the T!t,e 5 system cyes or no_
\later meter readings if avallabie
Las: da;e o, o ,;:pane.
OTHER; Describe
Last care oT occucanc.
GENERAL INFORMATION
PUMPING RECORDS and source of fo a;on
LI
tN �( 5 t�tic�. Qdan�eA 1`I�y
System pu ped as par, or m pea1on: rues or no Jf�
If yes, volume pumped Gallons
Reason for pumping
TYPE OF SYSTEM
Septic tank/distribution box/soil absorption system
Singe cesspool
Overflow cesspool
i Pm�•
Shared system (yes or no; (if yes, attach previous inspection records, if any)
I/A Technology etc. Copy of up to date contract?
Other
APPROXIMATE AGE of all components, date installed (if known)and source of information: 1 `i
Sewage odors detected when arriving at the site. Ives or no)Iv�
(revased 04/25/9')1
tip• 5 of 20
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOR•m
PART C
r�,,,, SYSTEM INFORMATION (continued)
Propert% Address: 3to5 ewly L,V.
O%ner,
Date of Inspection:
TIGHT OR HOLDING TANK: a� -rank must be pumped prior to, or at time, of inspection: .
(locate on site plan.
Depth below grade
Material of construction _concrete _metal _Fiberglass _Polyethylene —other(explain)
Dimensions:
Capacm gallons
Deng^ floes gaLons-da,
Alarm level Alarm ,n �%orking order_ Yes. _ No
Date of previous pumping
Comments
(condition of role! tee. condiuon o• a'a,rr and float switches, etc.)
DISTRIBUTION BOVAC) 12 6o><c S
)locate on site p:a-
Dep,h o'. hcuid le e' aoo•.e oune; in�e^ —JOSS. Wa P�T�'15 , New p.T I rt��?�t eu�TTNVe1t.►_
Corgi nents
mote if leve' a-d cl!wibu;,or, * eoua' evidence of solids carryover, evidence of leakage into or out of box, etc.) Q�,o k ';� Ck"
v -
(��STRe�S��ov�1 1►J �o o\d �k T3�Sh ac.�3 1t4n 1ATU6TtYC 7a L
1x�Cir_y i k10 �1 ►n2lUCL ��C.o�Cit .
PUMP CHAMBER:jt�b
(locate on site plan.
Pumps in working order: (Yes or No,
Alarms in working order.(Yes or No
Comments.
(note condition of pump chamber, condition of pumps and appurtenances, etc.)
4
(zevaaed 04/25/97) Page 1 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
a-ropertN Address: 1Jb5�w1PMSS (.tip.
to nert{'ja zf3 t
sate of Inspection:
SDIL ABSORPTION((SYSTEM (SAS):4ZS
ocate on site_plan, if possible, exca,ation not required, but may be approximated by non-intrusive methodsi
not determined to be present, explain:
_`-
leaching pits, number.Iyoeo':j.\ £ja;'.a\ 'Pi\
leaching chambers, number.�tQe_w-Vp, \CT o`t�S ' 3Xv w` Z'ST"o+�+G
leaching galleries, number.
leaching trenches. number•iength:
leaching fields, number, d.•nensjon.s
ovei4low cesspool, number
Alternative system
Name of Techr,oiop
D-nments
-^oie condition of soli, signs of hydraulic failure, level of ponding cpQ`1-1'ion.•of vegetation, etc.t (�
��+s l— Ct��1f t\ ua S►�a� o t- 4�a.td�..`�� �• l _�wr.1 � N I ys. l/,C_a.o�4�•+-• -IVo reJ✓1t�Y,
55POOL5:
: :ate on site plar
nber and coniigura:-on
=_oth-top of liquid to inlet Inver,
__Dth of solids lave•
__Dth of scum laver
m,ens)ons of cesspool
-•.:atertals of construalo^
-cation of groundv,ate-
rnflow tcesspool must oe pumpeC as pan of inspection
Z_-rnments:
r_xe condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
WIVY:_
:rote on site plan)'
-.w.aterials of construction: Dimensions.
=ppTh of solids.
�! mments:
-ote condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
=wvzeed 04/25/97) Page 8 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION' (continued)
Propertm Address: 34S Caoxon3
Owner: T,&UTDn1
Date of Inspection: /A 5
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least tovo permanent reierences landmarks or benchmarks
locate all wells within 100' (Locate where public water supply comes into house)
C
z
3a
t.
y �
G s
A -70`
�.S •S�' gS •a.5.
4`- aS' �b• ao'
(zevased 04125/57) Page 9 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECT10% FORM
PART C
SYSTEM INFORMATION (continued)
Propert% Address:
Owner: iic"r r-)
Date of Inspection:
Depth to Groundwater AS Fee;
Please indicate all the methods used to determine High Groundwater Elevation:
Obtained irom Design Plans on record
Observation o4 Site (Abutting property. obsenauon hole, basement sump etc.)
Determine it from local conditions
Cnec'k +ith local Board o• �ea!,.r
Chec:. FEMA niac*
Check pumping records
Check loca! eacavato,s ir+sta'lers
l_'se LSCS Da'a
Descibe in %cx c— %%ooroscn,•.+ %o:: es:ao!-shed tre '-iig!% Ground%ate! Elevation. (Must be completed C n
V•5.c-VWka 51 Q'C . 1- c��2010 5 s,c, a N�GCT�9 N►'11 d w
t:.vz...d :4/2519 Page 10 of 20
SITE PLAN GENERAL NOTES
SCALE: 1 " = 20' o SITE N
1. ADDRESS: R
— #365 COMPASS DRIVE, HYANNIS, MA
B.M. — 49.95 (ASSUMED) ON
0 F BULKHEAD 2. ASSESSORS NUMBER: MAP 310 PARCEL 449
CORNER P 3. DEVELOPER'S S LOT: LOT 36
Ln
4. TOPOGRAPHIC INFORMATION WAS COMPILED FROM AN
ON THE GROUND INSTRUMENT SURVEY.
5. TOWN WATER IS PROVIDED TO SITE & SURROUNDING PROPERTIES. o
6. REFERENCE PLAN: LAND COURT PLAN 17201H ~
7. NO WETLANDS ARE LOCATED WITHIN 200 FEET OF THE PROPOSED SAS. 3 �n
8. NO POTABLE WELLS ARE LOCATED WITHIN 150 FEET OF SAS.
9. UTILITIES WERE LOCATED BY DIGSAFE.
10: THIS DESIGN PLAN SHALL BE USED FOR THIS SEPTIC INSTALLATION ONLY. eE4RSE,
11. THE DLSIGNER IS NOT RESPONSIBLE FOR UNDOCUMENTED SEPTIC COMPONENTS. S K'AY "HYANNIS"
LOCUS
1 72 3WALTON AVENUE N0 SCALE
town Fter 084
a
93.88
95 FALMOUTH ROAD
X 5034' x' 4' chain 49.5#��x MAP 311 PARCEL 073
=link f x town water x ence 8
PROPOSED SAS " / B'M/ - 6 choirs link x�_x
ce
29 -3 L X 12 -2"W X 24 D leaching LOT 36 50.32'
trench using 3 H-20 3050 Infiltrator A10,223f S ft
chambers in 4' =
of stone with observation port 1' X q i
.... ALL OUTLET PIPES FROM THE
SO
DISTRIBUTION BOX SHALL 8E
49.43' xis TING/M ; SET LEVEL FOR AT LEAST 2 FT. 12" CONCRETE COVER
:. : :.... rY /V
i
I,
...... /////// /� ...... ..................................... ..... / 49.27' !OUTLE4T
T3w
_ �.... D 18" I 12" INLET
2 I4 w
4 I I II / 3.
A 8 8w
o00
Q C N •: 22' X O j ,X�48 56' 18" ET
3"
3 o c D T w o PLAN—SECTION CROSS SECTION
4937• " cuRn STOP ry 3 HOLE H-20 DISTRIBUTION BOX
.0 OSSTTION c .91ev
::::::::::
Q t/ ::i: i PORT ::..... W / NOT TO SCALE
g Ca 49.57' '•Pgaic:•:ririi::......
4' SCH 40 PVC V 50.0'::::::i:i ::i?::.....:.... i:::rt:ri:isr:irr
vent w/ carbon fitter
o 48.02'
PROPOSED SEPTIC SYSTEM REPAIR
OF�Aq 49....... ................ �..... U a 4951 X :� PREPARED FOR
s .. Q LEGEND MICHAEL LEARY
a-...... ..47.....L....... to /F0c EXISTING 1000 GAL AT
g RI 1 a� H-10 SEPTIC TANK
HA I a� L J/ �eP mot ::. Q 365 COMPASS DRIVE
............. 47 2a X ;. 4816 4
70
................................
/A / \ 1 EXISTING LEACH PITO (HYANNIS) BARNSTABLE, MA
��'tS��Q` x 4&90' ` TO BE PUMPED AND FILLED
'�N1'TgR�P >(ae2i 0 R: ROMA J. HAWN
49 22 \
49••••'' DENOTES EXISTING
Ink fence v X 104.46 SPOT GRADE PREPARED BY:
4 Chain g NORTHPORT LANE I Glen E. Harrin4ton, R.S.
APP&?&kSCAjIQN MAP 310 PARCEL 32 {, "'•95.........I.."' EXISTING COP(TOUR 9 Leda Rose [one
""", f Marstons Mills, MA 02648
town water DEEP TEST HOLE Tel: 774-238-1813
!\ , W^ Approx. location Email: ghorr88®hotmail.com
W existing water line ,
SCALE: 1"=20 DRAWN BY; GEH DATE: 7 JAN 2020
DATUM: ASSUMED FILE: Leary365Composs SHEET 1 OF 2
r
10' min. from *NOTE: ALL PIPES ARE TO BE 4" DIA. SCHEDULE 40 P.V.C. CROSS SECTION
house to septic tank j NOT TO SCALE
Existing House USE WIGGIN Provide 4" SCH 40 PVC 3/4" to 1 1/2" double-washed "to1/2" double- he�
c e a geo-t,Xh ,
9 3 HOLE H-20 'observation port 3" below grade crushed stone
bric
DIST. BOX
To of Fndn. ELEV.=50.95' EXISTING GRADE ELEV.=49.4'.t OR EQUAL Finished grade over system=2% slope away Existing Grade Elev.=49't
Tank covers shall be D-Box cover shall be 2a min. 1 8" to 1//2" double-w hed
S = 0 02' ft within 6" of finished grade within 6" f finished grade 6 max, cnlshed et0 0 or geo-tex Is fabric
Existing Inv. Elev.=47.78' 5=0.01' ft. Level for 2' FI - 30" 24"
•EXISTING S=0.011/ft. ,
full cellar ' Ex, = 7 1,000 GAL. 12' 5' In le .=46 50'
H-10 n . elev.=46.96' • • • .
, v
SEPTIC TANK } Inv, elev.= 46.84' 24"
h 48 48
GAS BAFFLE Inv. elev.-
29'- " Facility Eiev.=44.5 -
6" OF 3/4"-11/2" STONE
6" OF 3/4"-„/r STONE j 6.2' (s MIN. required)
3/4" to 1 1/2" double-washed
crushed stone Bottom of Test Hole #1 EI.=38.3' PROPOSED SOIL ABSORPTION SYSTEM
SYSTEM PROFILE- LEACHING TRENCH Use Infiltrator 3050 chambers
Design Calculations Not to Scale ACCEPTS 4' SCH 40 PIPE FOR OPTIONAL
CLEANOUT OR INSPECTION PORT
Number of Bedrooms: 3 Existing
Garbage Disposal: Not allowed with this design I'
Design Flow: 3 Bedrooms x 110 gal/bedroom =330 gpd
Application Rate for <2 min./inch = 0.74 gal/sq. ft. ObIFOLL, o s Ir(DIR sm (C',HMIS R
Septic Tank Required: 330 gpd x 200% = 660 gpd. 1,500 GAL MIN. PER TITLE V
Septic Tank Provided: Use Existing 1,000-gallon Septic Tank (310 CMR 15.404(3) NOMINAL CHAMBER SPECIFICATIONS
Leaching Capacity Required: 330 gpd x 0.74 gal/SF = 446 SF SIZE (W x H x INSTALLED LENGTH) 50.5 x 30.0' x 85.4'
Proposed Leaching Structure: 1- 29'-3" x 12'-2" x 2' Leaching Trench 0
CHAMBER STORAGE 45.9 CUBIC FEET
Bottom Leaching Area Provided = 356 Sq.Ft. o o MINIMUM INSTALLED STORAGE 74.0 CUBIC FEET
Side Leaching Area Provided = 165 sq. ft. WEIGHT 75 LBS,
Total Leaching Area Provided = 521 sq. ft.
Leaching Capacity Provided =521 sq. ft X 0.74 gal/sq.ft.=385 gpd. > 330 gpd.
CONSTRUCTION NOTES tea``"°F�''4 9
1. Contractor is responsible for Digsafe notification .
� G
and protection of all underground utilities and pipes. 90.7' LOA N co
2. The septic tank anc� distribution box shall be set 0.1
level on 6 of 3/4 -11/2 stone.
3. Backfill should be clean sand or gravel with no 5.4' INSTALLED
stones over 3" in size. 1 ��rTAR�P
4. This system is subject to inspection during installation
by Glen E. Harrington, R.S.
5. The contractor shall install this system in accordance
with Title V of the Massachusetts Environmental Code
and the Regulations of the Town of BARNSTABLE. PROPOSED SEPTIC SYSTEM REPAIR
6. Provide a Wiggin Precast H-20 DB-3 D-Box PREPARED FOR
and 3 H-20 3050 Infiltrator chambers or equal. MICHAEL LEARY
7. No vehicle or heavy machinery shall drive over the Test Hole AT
septic system unless noted as H-20 septic components. No. 1
8. Install gas baffle or equal on septic tank outlet tee end. #365 COMPASS DRIVE
9. All existing inverts and site conditions shall be verified by contractor. EP SOILS ELEV.
(HYANNIS) BARNSTABLE, MA
10. If, during installation the contractor encounters any soil conditions
or site conditions that are different from those shown on the soil toe epn d PERK TEST & SOIL EVALUATION 0 M
log or in the design, the installer shall halt installation immediately 1 7T Date of Perc. Test & Soil Evol.:Jonuary 6, 2020 RO A J. HAW
and notify Glen E. Harrington, R.S. 12" 48•3 Test Performed By. Glen E. Harrington, R.S. PREPARED BY:
11. Designer not responsible for undocumented septic components. ;y� EXCAVATOR: Mike Leary WITNESSED BY: David Stanton, R.S., HEALTH AGENT Glen E. Harrington, R.S.
12. The existing leach pit shall be pumped and backfilled. " Mni• 46.55 PERK DEPTH: 44'--62" 9 Leda Rose Lane
BEGIN SOAK: 00:00 Marstons Mills, MA 02648
13. Install Infiltrator 3050 chambers according to manufacturer's c/ END SOAK: 09:00 MIN Tel: 774-238-1813
m-c sand
specifications. ears/s 24 GALS APPLIED IN 15 MIN. Email: gha&880hotmail.com
l s
14. Remove and replace unsuitable soil, if encountered, with soil meeting �e USE <2 MPI FOR DESIGN PURPOSES
3f13 SCALE: 1"=20' DRAWN BY: GEH DATE: 7 JAN 2020
310 CMR 255. NO GROUNDWATER ENCOUNTERED DATUM: ASSUMED FILE: Leary365Composs SHEET 2 of 2