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HomeMy WebLinkAbout0128 SAINT FRANCIS CIRCLE - Health A28 St. Francis Street A'—291 -'228 `.� Hyannis f 4 lI I l(tl' Commonwealth of Massachusetts �� -, Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments =� 128 Saint Francis Circle %R1 Property Address ---- - ------ - >-- ---- Jon Stainbrook '' Owner Owner's Name, ------------ -----....._- information is required for every Hyannis MA 02601 2/26/16 page. City/Town State Zip Code Date of i%—peciion—j------ Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms on the computer, c� use only the tab 1. Inspector: key to move your cursor-do not Gerardo Valentin use the return key. Name of Inspector — ---- ----_— Wind River Environmental Company Namefa ---- ---- 577 Main Street., Suite 110 Company Address -- ------------ _Hudson _MA 01749 CitylTown - State - Zip Code - - ----- 800-499-1682 SI 13834 -- -- _ --- 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(31 CMR 15.000). The system: Passes ❑ Conditionally Passes ❑ Fails ❑ N eds Further Evaluation by the Local Approving Authority Inspe is Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. M t5ins-3/13 s Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 0 �S i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °p 128 Saint Francis Circle Property Address Jon Stainbrook Owner Owner's Name information is required for every Hyannis MA 02601 2/26/16 - page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: System in working order, 1000 gallon tank, proper level, inlet and outlet tee in place, structurally sound, h20 distribution box liquid level good, structural integirty good, 3 lines going out to leaching field. B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 128 Saint Francis Circle Property Address Jon Stainbrook Owner Owner's Name information is required for every Hyannis MA 02601 2/26/16 - page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins-3/13 Title 5 Official Inspection Form Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 128 Saint Francis Circle Property Address Jon Stainbrook Owner Owner's Name information is required for every Hyannis MA 02601 2/26/16 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, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No El ® 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 Static liquid level in the distribution box above outlet invert due to an overloaded El ® or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than day flow L15m. 113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 f Commonwealth of Massachusetts uqTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 128 Saint Francis Circle Property Address Jon Stainbrook _ Owner Owner's Name information is required for every Hyannis MA 02601 2/26/16 - 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: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1.of a-public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ . ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments "M 128 Saint Francis Circle Property Address Jon Stainbrook Owner Owner's Name information is required for every Hyannis MA 02601 2/26/16 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 Z ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual). 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins•3/13 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 128 Saint Francis Circle Property Address V Jon Stainbrook Owner Owner's Name information is required for every Hyannis MA 02601 2/26/16 - page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 4 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 82 gpd 9 ( Y 9 (gpd)): . Detail: water records Sump pump? ® Yes ❑ No Last date of occupancy: current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 128 Saint Francis Circle Property Address Jon Stainbrook Owner Owner's Name information is required for every y H annis MA 02601 2/26/16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: The home owner and Wind River Environmental are the sources of the information. Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1000 gallons How was quantity pumped determined? The quantity was determined by the pump truck and it was measured. Reason for pumping: To check the structural integrity of the septic tank. Type of System: ® Septic tank,-distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 128 Saint Francis Circle Property Address Jon Stainbrook Owner Owner's Name information is required for every Hyannis MA 02601 2/26/16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 1961 per owner Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 24 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Finished basment, not able to inspect, venting good. Septic Tank (locate on site plan): Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 8'Lx4'Wx5'H Sludge depth: 6 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 f Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 128 Saint Francis Circle Property Address Jon Stainbrook Owner Owner's Name information is required for every Hyannis MA 02601 2/26/16 page. CityrFown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 30" Scum thickness 3 Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? The dimensions were determined by sludge judge, rod and ruler. Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Recommend yearly service, inlet baffle intact, outlet tee pvc in good condition, structural integirty good, liquid level related to outlet invert good, no evidence of leakage. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection - Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 128 Saint Francis Circle Property Address Jon Stainbrook Owner Owner's Name information is required for every Hyannis MA 02601 2/26/16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °t< 128 Saint Francis Circle Property Address Jon Stainbrook Owner Owner's Name information is required for every Hyannis MA 02601 2/26/16 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 0 box is 16" below grade 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.): Box is level and distribution to outlets is equal, some evidence of solids carryover, no evidence of leakage into or out of box. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No" Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): " If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 128 Saint Francis Circle Property Address Jon Stainbrook Owner Owner's Name information is required for every Hyannis MA 02601 2/26/16 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: 3-31'Lx8'W ❑ 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.): Sandy soil, no signs of hydraulic failure, no ponding, no damp soil, normal vegetation. Cesspools (cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 r Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 128 Saint Francis Circle 'Property Address Jon Stainbrook Owner Owner's Name information is required for every Hyannis MA 02601 2/26/16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments - ea 128 Saint Francis Circle Property Address Jon Stainbrook Owner Owner's Name information is Hyannis MA 02601 2/26/16 required for every _ -- - page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage.Disposal System Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks,or.benchmarks..Locate all wells within 100 feet. Locate where public water supply,enters,the buii.,ing". Check one.of the boxes below: tQ. and-sketch in, ie area Wow cii ae si att8CIIe6-86patatety F Q;nc,v 1.0 D4o op O O I JJ A- OOVRv bNiJLW A-D-W -S01Sr1 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ° M 128 Saint Francis Circle Property Address Jon.Stainbrook Owner Owner's Name information is required for every Hyannis MA 02601 2/26/16 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 7+ 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: 3/7/12 Date ❑ Observed site (abutting hole within 150 feet of SAS ( 9 ) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers -(attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: High ground water per as built, ground water elevation 83" Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 128 Saint Francis Circle Property Address Jon Stainbrook Owner Owner's Name information is required for every Hyannis MA 02601 2/26/16 page. City/Town State Zip Code Date of Inspection i E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins.3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System.Page 17 of 17 YOU WISH TO OPEN A BUSINESS? 1 For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L. -it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. DATE: f / ly Fill in please: APPLICANT'S YOUR NAME/S: ��- �r a BUSINESS YOUR HOME ADDRESS: I Zg C;c-cJ �Cls�l 381-�Qlyya�,..Z5 f rM cDZ��1 TELEPHONE # Home'Telephone Number 3 '1 NAME OF CORPORATION: 3+6,J�h�odL Pti.ofog c0.c,1.y NAME OF NEW BUSINESS TYPE OF BUSINESS IS THIS A HOME OCCUPATION? YES NO ADDRESS OF BUSINESS IZ`9 k A-,, A q)ZC-O t MAP/PARCEL NUMBER (Assessing) When'starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST. GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING CO t R'S OFFICE This individ an #o e f ny r it re--gyy��irements that pertain to this type of business. G tom_, MUST COMPLY WITH HOME OCCUPATION Au rized--Sig re** RULES AND REGULATIONS. FAILURE TO COMMENT f G 2. BOARD OF EALTH This individual has en rr� f the permit requirements that pertain to this type of business: MUSTW�DMPLY WITH ALL ° V Authorized Signature** �C.7ARDGIIS MATERIAL S RFCIIL,QS1^N+^ COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: + TOWN OF BARNSTABLE Date: �=i/ Z- / ►� TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: OVI -To$ 6-C p_O y BUSINESS LOCATION: /Z8 C,gl-0-t µ���h i 5, i INVENTORY MAILING ADDRESS: TOTAL AMOUNT: TELEPHONE NUMBER: CONTACT PERSON: _�cw\_ EMERGENCY CONTACT TELEPHONE NUMBER: -r�Z- 3>Zq-7 4-7 4 MSDS ON SITE? TYPE OF BUSINESS: INFORMATION/RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The board of health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene,#2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt&roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform, formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes Laundry soil &stain removers (including bleach) Spot removers&cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS App cant's Signature Staff's Initials �'WE Town of Barnstable Barnstable AFfteficaCft IIARNSlABLE, Regulatory Services Department ' + 9 MASS. �A 039. Public Health Division TED MA'S 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO November 8, 2013 Ray Caterino Northern Excavation,&Paving PO Box 995 Dennisport, MA 02639 RE: 128 Saint Francis Circle, Ha Dear Ray, We have left a few messages regarding the septic permit#2012-045 issued to the above- mentioned address. The Health Division has a policy of not allowing crossed out or marked up septic permits. Permit#2012-045 was issued incorrectly for the# 129 Saint Francis Circle instead of# 128.. Attached is a re-written permit, restating everything on the original permit of# 2012-045 with the exception of the house number which has been corrected to # 128. 1 have also sent along a copy of the original for your review. Please sign the enclosed permit as soon as possible. A postage-paid return envelope is enclosed for your convenience. Thank you for your attention to this-it is appreciated. Since , �n Sharon Crocker Administrative Assistant Enclosures No. of 01 a V Fee 100 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ftpYitation for Disposal *, pstrm Construction Permit Application for a Permit to Construct( ) Repair X Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. i a F-,a r Cn S m Owner's Nae,Address,and Tel.No. '7�7 e9 -(a 14(a Assessor's Map/Parcel a q v a a$ I (• ia u m(t S K C� I Installer's I�ame,Address,and Tel.fro. :3�$ - -1 Lf Designer's Name,Address,and Tel.No. t-11 7- 6 3/3 t110r�1r� Cxccnvaho� + Privi✓� Engfn ee��✓tq Wo rr-.S acix q D or c�vos� ;e1 r-,reS�-c,c l Type of Building: o, j y /W a ��✓!SYIGz�� Dwelling No.of Bedrooms 3 Lot Size i q q 0 U sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ). Other Fixtures Design Flow(min.required) 3 3 d gpd Design flow provided 330 . gpd Plan Date { { 1 a Number of sheets a Revision Date Title Pfo Q e il cU o // 1 Size of Septic Tank 1(BOO Type of S.A.S. y (, l0 I-1 C 11 r)i j Description of Soil D�� I o� 1 all - 3 (o � C 3& Nature of Repairs or Alterations(Answer when applicable) Ujl� S Date last inspected: 1 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. ISigned Date Application Approved by Date J Application Disapproved by Date for the following reasons Permit No, JQ .J Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired() Upgraded( ) Abandoned( )by Noy- -Irl[J it n E-X CC ya o K) -t- Pa V I ✓�ct at 1 c, $ d&jfl} 'F-Mn C1 (•Jl rC�JP_ has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. -U ated Installer N 9�rn ( x C Gi.\/CkAA 0 V\- + P G V' Designer C N e Pam✓i✓1 VJ U lr L S #bedrooms 3 Approved design flow gpd The issuance of this permit shal not b construed as a guarantee that the system will function as designed. Date Inspector No. ���� ' �LA.5 Fee f00 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal Opstetn Construction 3permit Permission is hereby granted to Construct( ) RepairpO Upgrade( ) ' I Abandon( . ) System located at $ Vl (;V3'1/J��` S Cl V-( 'le N1 r 1 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:Construction m st be co pleted within three years of the date of this permit. Date Approved by No. �% �' �1 /f Fee kv TEIE`COMMO"NWEALTH OF MASSACHUSETTS Entered in computer: ` i PUBLIC HEALTH DIVISION -T WOF BARNSTABLE, MASSACHUSETTS Yes Alit'ation for Mispozat OpStem Construction Ve mit Application for a Permit to Construct( ) Repairklo Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components I/ Location Address or Lot No. . e-*7- r°' rwrier's Name,Address,and Tel.No. 7 7,0,- 6 4,h Assessor's Map/Parcel 2`I/ L 9 g J�i,o 1- fiul.�•a C+1Lc-,u Installer's Name,Address,and Tel.No. 3 - 6esigner's Name,Address,and Tel.No. .4 7 7- r:9 13 «v�n-- Iry�.,�cc.�,�. wu.,,I--t '.�.CS N (�9�.r IL Gar trC•.b(�J�,�� � Type of Building: Dwelling No.of Bedrooms 3 Lot Size 14t l 0 O sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.relined) �j 3.0 gpd Design•flow provided 3 o gpd Plan Date . Z- C Number of sheets Z Revision Date Title t nE�oi: b c_)' r - UrjlsTC», Size of Septic Tank Type of S.A.S. j Description of Soil A ©"- t ZZ L 3 k 7 3 4 l`--- Nature of Repairs or Alterations(Answer when applicable) 9 v y /9 �\ Date last inspected: Agreement: cThe 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 Heal Date 2 rL Application Approved by tr'i' ; Date Application Disapproved by Date for the following reasons Permit No. "'� I Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(X) Upgraded( ) Nedrooms /\ U�� ,+ ,.,� � Ac 9✓� i Z. J�Y� t� , . l- � , j T-- `,-Z v c, i + +�L has been constructed in accordance \ �� of Title 5 and the for Disposal System Construction Permit No. �����jdated -r-,,.r,• C_ r c f �'.. Designer C _. / j g � iuG i .y i-�.. e s S Approved design flow 3 U gpd The issuance of this permit shall not be construed as a guarantee that the system ill-unction"- de� � 'geed. Date '`yr a—� L - -- -----------------------=---------- -- �J�� ' Fee THE COMMONWEALTH OF MASSACHUSETTSC . PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Nzpozal *pztem Construction permit Permission is hereby granted to Construct( ) Repair( Xf Upgrade( ) Abandon( ) System located at J 2- 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:Constiuction,i list be completed within three years of the date of this permit. Date ` Approved by i � �TK, Town . of B.arnstab�le Barnstable �o Gy , Regulatory Services Department Y MASS. � , a. Public Health Division PTfD Mp't 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO November 20, 2013 I, Sharon Crocker, Keeper of the Records for Town of Barnstable Public Health Division, certify this is a True Attested Copy of the Public Health Division's Disposal System Construction Permit completed on March 7, 2012 for 128 St.Francis Circle, Map/Parcel 291-228, Hyannis, MA. . s Sharon Crocker Keeper of the Records Q:\Legai\Records Req for COC 128 St.Francis Cir Hy 2013.doc Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 128 SAINT FRANCIS CIRCLE Property Address STAINBROOK Owner Owner's Name information is required for HYANNIS MA 02601 12/30/13 every 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 A. General Information When � forms on the computer,use 1. Inspector: only the tab key I G( to move your DOUGLAS A BROWN (J yVl cursor-do not Name of Inspector use the return key. DOUGLAS A BROWN INC Company Name P.O. BOX 145 Company Address CENTERVILLE MA 02632 City/Town State Zip Code 508-420-4534 S14297 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: 0 Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 12/30/13 Inspector's Ignature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 101000 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•3/13 Title 5 Official Insp an orm:Subsurface Sewage Disposal System•Page 1 of 17 I Commonwealth of Massachusetts Ij Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 128 SAINT FRANCIS CIRCLE Property Address STAINBROOK Owner Owner's Name information is required for HYANNIS MA 02601 12/30/13 every page. City[Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: LEACHING SYSTEM AT TIME OF INSPECTION IS NOT EVEN 2 YEARS OLD B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it'is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 128 SAINT FRANCIS CIRCLE Property Address STAINBROOK Owner Owner's Name information is required for HYANNIS MA 02601 12/30/13 every 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 pumps/alarms are repaired. B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed_ ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t51ns•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 128 SAINT FRANCIS CIRCLE Property Address STAINBROOK Owner Owner's Name information is required for HYANNIS MA 02601 12/30/13 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 128 SAINT FRANCIS CIRCLE Property Address STAINBROOK Owner Owner's Name information is required for HYANNIS MA 02601 12/30/13 every page. Cityrrown 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: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes"in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 128 SAINT FRANCIS CIRCLE Property Address STAINBROOK Owner Owner's Name information is required for HYANNIS MA 02601 12/30/13 every page. Cityfrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 I- Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M , 128 SAINT FRANCIS CIRCLE Property Address STAINBROOK Owner Owner's Name information is required for HYANNIS MA 02601 12/30/13 every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: ACCORDING TO AS-BUILT SYSTEM CONSISTS OF A 1000 GALLON TANK DISTRIBUTION BOX AND 18 ARC 36 HC CHAMBERS. SYSTEM IS NOT DESIGNED FOR A GARBAGE GRINDER Number of current residents: Does residence have a garbage grinder? ❑ Yes ❑ No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ❑ No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonaluse? ❑ Yes ❑ No Water meter readings, if available(last 2 years usage (gpd)): Detail: 9U Ul Sump pump?' ❑ Yes ❑ No Last date of occupancy: Date Commerciallindustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,M 128 SAINT FRANCIS CIRCLE Property Address STAINBROOK Owner Owner's Name information is required for HYANNIS MA 02601 12/30/13 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): I General Information Pumping Records: Source of information: 3-2012 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 128 SAINT FRANCIS CIRCLE Property Address STAINBROOK Owner Owner's Name information is required for HYANNIS MA 02601 12/30/13 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: LEACHING SYSTEM INSTALLED IN 2012 Were sewage odors detected when arriving at the site? ❑ Yes ® 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: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 GALLON Sludge depth: LIGHT t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments GSM 5 '' 128 SAINT FRANCIS CIRCLE Property Address STAINBROOK Owner Owner's Name information is required for HYANNIS MA 02601 12/30/13 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness TRACE/CLUMPING 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? WOODEN POLE Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): RECOMMEND PUMPING EVERY 2-3 YRS Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑.metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments i �M 128 SAINT FRANCIS CIRCLE Property Address STAINBROOK Owner Owner's Name information is required for HYANNIS MA 02601 12/30/13 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 128 SAINT FRANCIS CIRCLE Property Address STAI NBROOK Owner Owner's Name information is required for HYANNIS MA 02601 12/30/13 every page. Cityrrown 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 01. 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.): BOX LEVEL NO SIGNS OF LEAKAGE OR FAILURE i Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: NO OBSERVATION PORTS FOUND t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 128 SAINT FRANCIS CIRCLE Property Address STAINBROOK Owner Owner's Name information is required for HYANNIS MA 02601 12/30/13 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 18 ARC 36HC ❑ 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.): < Aet�tX)rJ Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 128 SAINT FRANCIS CIRCLE Property Address STAINBROOK Owner Owners Name information is required for HYANNIS MA 02601 12/30/13 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, !{ etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M yr. 128 SAINT FRANCIS CIRCLE Property Address STAINBROOK Owner Owner's Name information is required for HYANNIS MA 02601 12/30/13 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) I Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 128 SAINT FRANCIS CIRCLE Property Address STAINBROOK Owner Owner's Name information is required for HYANNIS MA 02601 12/30/13 every page. City town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: ELE 83.5 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: 12-2013 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: DESIGN PLAN N Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form, Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 128 SAINT FRANCIS CIRCLE Property Address STAINBROOK Owner Owner's Name information is required for HYANNIS MA 02601 12/30/13 every page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 7/10/13 Assessing As-Built Cards . TOWN OF BARNSTABLE LOCATION l Z-(9 VA•rr T I/z.,g SEWAGE# 2'G'L- D VILLAGE IV�19- r✓ S ASSESSOR'S MAP&PARCEL -Z 9! L z 6` INSTALLERS NAME&PHONE NO. J?,gy,r'c sve -2�g 94 2t SEPTIC TANK CAPACITY ,c LEACHING FACIU -(type) 18 Alec 36 1-�G. (size) 3 f%• 4— NO.OF BEDROOMS S OWNER ► d �1 Y'�5 / PERMIT DATE: 2•I Z7 /i z COMPLIANCE DATE: Separation Distance Between the: �, ✓ _ Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility, 3 ' 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) 2- Feet FURNISHED BY C-kJ ss e L ea c.L V r • � 25 3� l4� ,, Z Sv s 6 so 6 I McKean, Thomas From: McKean, Thomas Sent: Tuesday, December 24, 2013 8:29 AM To: steven@pizzutilaw.com' Subject: 128 St. Francis Circle Good Morning Steven, A certificate of compliance was issued on March 7, 2012 for a complete replacement of the soil absorption system at 128 St. Francis Circle, Hyannis. This is considered a repair. In my opinion, it is also considered an upgrade. This Certificate of Compliance is valid for two years, until March 7, 2014, for the purposes of transferring real estate in compliance with the State Environmental Code, Title 5. Sincerely, Thomas McKean, C.H.O. 1 Toww of Barnstable_ P# 3 c-? Department of Regulatory:Services POP41-th Divsion _ Z Z, r/ 200 Mam,S ,._y i Date _ .,,�H anms MA 02601 , i Date Scheduled Time Fee Pd. v Soil Suitability Assessmen for Sewage disposal � � Performed By: Witnessed By: LO,CA`I'ION-=&GEN�R.�L INTOIIMA�.'IaN Location Address Owner's Name '� P2� -S at ���- �i"c�vt�S C: r 7 a�►-t ��L r H`P�h v►�S Address )Zg SA f��aw Lr,�S. C .l A h s f'� c12 Assessor's Map/Parcel: 2� —Z Z� Engineer's Name Per- lam.i NEW CONSTRUCTION REPAIR X Telephone# 7T7—� Land Use JZe) Slopes(%) Surface Stones �l r i Distances from: Open Water Body toG ft Possible Wet Area ft Drinking Water Well s a ft Drainage Way ,J A ft Property Line Z-d — Z5—ft Other ft SKETCH..(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) Zf i 0 jw Parent material(geologic) y3 Depth to Bedrock /V LA Depth to Groundwater: Standing Water in Hole: Weeping from Pit Face A) A Estimated Seasonal High Groundwater ! /---- IETERMINATIO�T FOIL SEAS©N4I.kIIGH WATER TABU Method Used. Z'�y r 13 Z Depth Observed standing inobs.hole: in. Depth to soil mottles: ` in. ,Depth,to weeping from aide of 9bs.hole_ _in. Groundwater_AdiustmenY__ " ft._ Index Well# Reading Date. Index Well level Adj.factor Adj.Groundwater Level PERCO.I:ATION TEST Date Time Observation Hole# Time at 9" Depth of'Pere . 2/el Time at 6„ Start Pre-soak Time ? 5`t��►13 ® Time(9"-6") . End Pre-soak Rate Min:Llnch �- Z Site Suitability Assessment: Site Passed `7 Site Failed: Additional Testing Needed(Y/N) Original: Public Healtht:Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100'of wetland,you must first notify the Barnstable Conservation Division at least one(1)week prior to beginning. Q:1SE7I10PERCFORM.DOC - DEEP OB ERVATIflN+HOSE L G. Dole Depth from Soil Horizon Soil Texture : Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Stricture;Stones,Boulders. Consistency %Graven 7 sin.% bap O�BSERVATI011 F dLE LOG Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in:) .(USDA) (Munsell) Mottling (Structure,Stones,Boulders. 7 -5"r2 DEEP OBSERVATION'HOL LOG" Hole Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) DEEP OBSERVATION''HOLE LOG Hole#` Depth from Soil Horizon Soil Texture Soil Color . Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Graven Flood Insurance Rate Map: Aliove'500 year flood boundary No_ Yes Withm 500 year boundary No Yes a ' M Wj ,:100:year flood boundary No Yes thin Deotb.of Naturally Occurriu¢=Pervious Material Does at least four feet of naturally occurring pervious material exist in all;areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pervious material? Certification At . - . ,. __ y th Y P 1.YI certify that on (date)I have"passed.the soil evaluator examination approved b Department ofBnvironmental Protection and that the above anal srs.was performed b me consistent with the'required i—ng;expertise�and expenence'desCitibed'in,-310 CMR-1'5.017: 'Signature � � �1 y'� Date - �+,- Q:\SEPUC\PERCFORM.DOC TOWN OF BARNSTABLE WCATION Z rd (,G rq 7' T/ZAVJc tJ (fe IZ SEWAGE# Z'v!L- 011r- VILLAGE /7�//;' S. —ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. /V0�7��c�., 1 -9v, -1- Su`o, a w 94 7� SEPTIC TANK CAPACITY /v o o G Tisv A-- LEACHING FACILITY:(type) Aae- 3G i-t c_ (size) 3 NO.OF BEDROOMS 3 OWNER PERMIT DATE: 2-12-7 ,► Z COMPLIANCE DATE: F> 7�2_ Separation Distance Between the: c c v 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) Z Feet FURNISHED BY IL-7•c:k-),A"r-L L4a c. °d' i ' I o k4\ a cc T V- 4 -F)OH P r o V-A�' c f '-M DM No. D O l� V� 1 �� r Fee 100 ®' THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS �) 9pplication for MispoBal 6pstrm ConetrUctlon Permit Application for a Permit to Construct( ) Repair 94 Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 1 a n S G, i,� Owner's Name,Address,and Tel.No. -7 7 �O (0 f Assessor's Map/Parcel aci 1 - a a$ I v S K eF-raricAsi Installer's Name,Address,and Tel.No. 3 q$ - �1 LI 7 G) Designer's Name,Address,and Tel.No. L1 1 '7- S 3 i 3 NOr-�,lnef✓) C-xcava 7,6t) + pavio EnginZ�ri►�q Worr-S boy q � or-� o (�ro5s .el a • Fi�lres�-c�lc� l� Type of Building: � I'N a ' S ffe- - Dwelling No.of Bedrooms Lot Size I q q c)U sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 3 o gpd Design flow provided 330 gpd Plan Date I III I 1 a Number of sheets a Revision Date Title PrO 0Se U IA Size of Septic Tank Type of S.A.S. r C, _?,to 4 C 11 dl i Description of Soil �} - I pl Qj ) o� 3 rp 3 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 this Board Signed Date , IX Application Approved by ate Application Disapproved by Date for the following reasons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(,Y.,) Upgraded( ) Abandoned( )by N 0 r4-ln eAfY-) -9 CC,Vk-H OK) + Pa V;V-1 g at lag Seen} T—mri U S 1J11(c e, has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. ated Installer Npr-And Cx c(4 yrA-ion• t 9CA V V1 Designer ujo r jc_S #bedrooms Approved design flow gpd The issuance of this permit shal not b construed as a guarantee that the syste will func' n d ned. Date 3 / Inspecto No. ;Lola - C)LI.5 Fee /00 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Misposal 6pstem Construction Vermit Permission is hereby granted to Construct( ) Repair. Upgrade( ) 1 Abandon( ) System located at S c6�_" F-rc"I ci S C, r( e, 4y4 h n 1 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. A Provided:Construction in st be co ' leted within three years of the date of this permit. Date Approved by 665r/c IC-70 11 No. Dog, -V -i Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS CO9pplication-for disposal 6pstent Construction Permit O Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) Complete System Q'Individual Components Location Address or Lot No. Owner's Name,Address,and Tel.No. -7,,? (p L/ (9 r t S� PcA n o's C.,rC �'L�o m C�s K P )I� s� Assessor's Map/Parcel 3, ` - a.a$ f-• a rC 1 14 C Yl y)i S Installer's Name,Address,�and Tel.No. 3 9 - C�l 1 L.i Designer's Name,Address,and Tel.No. .iq 7 '7- 6 31 3 rJ6f HErr� CxcavCA-V)0 + PCAv;rl 15ngineeri'�� �;orl;s �. Type'of Building: (.a (Z_a N a; A 1 tj a C ,r7 5-IAA,,-- Dwelling No.of Bedrooms .3 ;Lot Size I q q C) sq.ft. Garbage Grinder( ) Other Type of Building r No of Persons r Sh"owers(. ) Cafeteria( ) Othe-r�ixtures — r..-� �, ��.w. },;...�� nz{ �M_ i..�.. � ew✓;V' r,.= ✓r�Rt � .:ft.w.�;...}.. �r :r=: •� g.:a.fir---, _.` z Design Flow(min.required) ) 3 C) gpd Design flow provided gpd Plan Date 1 i ► ' 1 Number of sheets oZ Revision Date Title p-co SQ r 5P V\ ( CU 0 _ Size of Septic Tank 000 Type of S.A.S. ],. C 1 i Description of Soil - I �1 1 3i� 3 (o C •3 Co '� � Nature of Repairs or Alteraiions(Answer when applicable) S { 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. w. Signed r /, Dale w 7 Application Approved by.....__ 1 ate `/� p V Application Disapproved by Date for the following reasons Permit No. '0 Date Issued R ----------------------------------------------- -------- ------ - ------ -------------- ----------- ------- - ------------ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS +• (Certificate of Com Aiance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed.( ) Repaired O Upgraded( .J Abandoned( )by N o r�-Mn P�('�/1 L�C•�G�V G� ✓1 + �a V' ✓�g at I a 8 S l n+ T-CCA O U.S `• r 'y,(.\ . has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. a Q-Uq-§ated Installer + No V1 Designer U, i P4',.✓i'✓) o J ' #bedrooms Approved design flow gpd i The issuance of this permit shall not be construed as a guarantee that the syste le,on e ned. } :. pecf Date �� // In s No. aol q - QY 5 ' Fee /UO THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal 6pstem Construction Permit Permission is hereby granted to Construct( ) . Repair'(( ) Upgrade( ) Abandon System located at $ C6 V T--Y A..Y1((,A i V' and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. / Date Approved by 1 J - --_ _ .-�..� -.�r.r ,`per\\` � � `^�`\ ,� � � � � . � �i �� � `"� � � _ �� � � {� � � � . � .� � �, � � n � ' �-�� � � k � a No. gg `��/�� Fee THE-COMM ONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TCyW OF BARNSTABLE, MASSACHUSETTS Yes 01pplitation for Misposal *pstem Construction Permit Application fora Permit to Construct( ) Repair X Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components / Location Address or Lot No. '-*T 1`6' �� Owner's Name,Address,and Tel.No. 7 7 8- 6¢6 ( I12.8 S.Q,N-r F m4•a 4.i el J-4-6 7'FF0 M C �G 4 Assessor's Map/Parcel Z 9/ - Z 2-% 12.1 f��w r J�i�9•. C� Lc.�� /�.�.. 1 Installer's Name,Address,and Tel.No. LI WL7 -� Designer's Name,Address,and Tel.No. .¢7 7- 9-3/3 1�U7" g�lJ .�a'�"ti�(�I�.T It lvCcrC�.cft���.�c/� �� pap% nJ-4 Type of Building: Dwelling No.of Bedrooms 3 Lot Size 14'41 0 U sq.ft. Garbage Grinder( ) •L Other Type of Building No.of Persons Showers( Cafeteria( ) Other Fixtures Design Flow(min.requii ed) -J 3 0 gpd Design flow provided 3 3 D gpd Plan Date t/ �► ►2- Number of sheets Z_ Revision Date Title P^-&ro t:, n SZ OR 0" U pG-Jf4-1,S Size of Septic Tank SO D d Type of S.A.S. 8 A)u. 3 6 HC. L,7—T Description of Soil /4 O - ►Z 1` a 1 L'n - 3 l " 3 11-- Nature of Repairs or Alterations(Answer when applicable) ® V y w ` /9- S . 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 Heal i ne Date 2/�Z_ XZ_ Application Approved by -® Date Application Disapproved by Date for the following reasons Permit No. '�' Date Issued OF D � Fee No. , TFI;E GoO:L►AMO EA T4PF ACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TCWN—OF BARNSTABLE, MASSACHUSETTS Yes ZippYication for disposal 6pstent Construction 3pertnit Application for a Permit to Construct( ) Repair>� Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components r Location Address or Lot No. iriid �Ovr's Name,Address,and Tel.No. 77 - v 4 6 1 Is �A, -r F1--$J G i, �1 �cc _"L1UNsA( 'LX Assessor's Map/Parcel Z 9/ - 2 2 P, 2 ,j zl,N; ,a C ,<< N - 1 Installer's Name,Address,and Tel.No. 3 Designer's Name,Address,and Tel.No. ,4 7 2 L47� 3 (/ ("71. / rh ( 'ati- IL fv:crC ., :s ,- , � �. � �' KU,.. Srd4c �� Type of Building: f • Dwelling No.of Bedrooms Lot Size 14'9 U U sq.8. Garbage Grinder( ) Other Type of Building No.of Persons Showers( �, Cafeteria-(" ) Other Fixtures `' t Design Flow(min.required) ?� 3 U gpd Design flow provided /3 3 0 t + gpd Plan Date ��' 1 Z Number of sheets Z Revision Date Title i�r�o,pot: n J Z e fY S ; C- Size of Septic Tank /0 U 0 Type of S.A.S. / A)tc 6 H C y =5 Description of Soil A O - 1 Z rtu t L z t C_ 3 b Y Nature of Repairs or Alterations(Answer when applicable) a r t: 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. Date r 7 1 r Application Approved by Viev Date Application Disapproved by Date for the following reasons Permit No. Date Issued r THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(X) Upgraded( ) Abandoned( )by N 0 11-%1 ;,."'A ("- 14-I c 19Ve1__1_-2 ,_ e_7 J3/,:) y • �^v I at .12 9 ,ram ,,,, T- 1 1t - C-,i 1 11,L c has been constructed innccor0iance with the provisions of Title 5 and the for Disposal System Construction Permit No.xay dated G Installer 0,1­1 -,-, L xc n > , z £ r'�✓ Designer 1!�5 ry e- #bedrooms :72 Approved design flow 3 T U gpd The issuance of this permit shall no be construed as a guarantee that the system •rl•ITiltitti - e 'geed. "{ Date - Inspector --- -------------------------------�=-----------------------------------------------------------------------------------�---�--------- No. 7� Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Misposal 6pstent (Construction 3permlt Permission is hereby granted to Construct( ) Repair( Upgrade( ) Abandon( ) System located at 121 9 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. 4 Provided:Cons ction st be completed within three years of the date of this permit. Date Approved by r, Town of Barnstable W 1atory Services Thomas F. Geiler,Director Public Health Division Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Date: 3/7 Z,2, Sewage Permit# 2-0 tZ-U 4-s Assessor's Map/Parcel Installer&Designer Certification Form Designer: E,-,%? W a r•Lc s. Inc . Installer: N Address: 2 W. Cca s s e ►el R4• Address: On Z(L7 Z ° '�`�'t okii n S was issued a permit to install a (date) (installer) septic system at 12� S+,�a�.t�S C��rti� �\ Q� based on a design drawn by (address) Ev\,�0—� 6' dated \l 1Z� j?�v Z��y IZ (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. Stripout (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. Stripout (if required) was cted and the soils were found satisfactory. H OFil;gs � sq� RETER T. Gn'. (Installer's Signature) C.D E LEE A 9 No.35109 Q ,t�s Q�37E (Designer's Signature) (Affix Design • re) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION.. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUELT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. gAoffice formsWesipercertification form.doc EXCERPT FROM BOARD OF HEALTH MEETING MINUTES 2/14/2012: I. Variances — Septic (New): Peter McEntee, Engineering Works, representing Thomas Kelly, owner— 128 Saint Francis Circle, Hyannis, Map/Parcel 291-228, 14,900 square feet lot, septic variance(s) due to site constraint. Peter was present. The staff had no problems with the plan. Upon a motion duly made by Mr. Sawayanagi, seconded by Dr. Canniff, the Board voted to approve the variances as requested with the following: 1) a 3 bedroom Deed Restriction recorded at the Barnstable County Registry of Deeds and 2) a proper copy of the recorded deed restriction be submitted to the Public Health Division. (Unanimously, voted in favor.) Engineering Worksjnc. EXISTING FLOOR PLAN 12 W. Crossfield Road 128 Saint Francis Cir., Hyannis, MA Forestdale, MA 02644 Job No. 270-11 Date: 01/11/12 (508) 477-5313 Page 1 of 1 ENTRY FAM. RM. _j BED RM 11 'x17' Q 10'x111' CLOSET F BATH & STORAGE LAUNDRY BASEMENT FLOOR DECK ENTRY CL. BED RM. KIT./DIN. DN 13'x13' 12'x 17' CL. CL. DECK HALL LI V. RM. .BED RM. 12'x17' BATH 11 'x12' TjY M FIRST FLOOR NOTE: SKETCH IS FOR SCHEMATIC PURPOSES ONLY — NOT TO SCALE Bk 26094 P0230 �9310 02-21--2012 DEED RESTRICT_IQN_ WHEREAS, Thomas C. Kelly and Lynn A. Kelly, of Hyannis, MA, are the owners of 128 Saint Francis Circle, Hyannis, MA, and being shown as Lot Won a plan of land entitled F "Subdivision Plan of Land in Hyannis, Barnstable, Mass, Petitioners,John Rosario and Joaquim Rosary'-dated November 1961 and filed at the Barnstable County Registry of Deeds in Plan Book 167, Page 85. WHEREAS, Thomas C. Kelly and Lynn A. Kelly, as owners of said Lot have agreed with the Town of Barnstable Board of Health to a restriction as to the number of bedrooms which can be included in any home built on said Lot as a pre-condition of obtaining a disposal works construction permit in compliance with 310 CMR 15.000 State Environmental Code, Title V, Minimum Requirements for'the Subsurface Disposal of Sanitary Sewage. WHEREAS, the Town of Barnstable Board of Health, as a pre-condition to granting a Disposal Works Construction Permit for a septic system in compliance with 310 CMR 15.000, State Environmental Code, Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage is requiring that the agreement for the restriction on the number of bedrooms in any house constructed on said Lot be put on record with the Barnstable County Registry of Deeds by recording this document. NOW THEREFORE, Thomas C. Kelly and Lynn A. Kelly, do hereby place the following restriction on their above referenced land in accordance with their agreement with the Town of Barnstable Board of Health which restriction shall run with the land and be binding upon all successors in title: 1. 128 Saint Francis Circle may have constructed upon it a house containing no more than three (3) bedrooms. Thomas C. Kelly and Lynn A. Kelly agree that this shall be a permanent deed restriction affecting the dwelling located at 128 Saint Francis Circle, Hyannis, MA and being Lot 18 in Plan Book 167, Page 85. Page 1 Bk 26094 Pg 231 #9310 For title, of see deed recorded in the Barnstable County registry of Deeds Book 21105, Page 15. Executed as a sealed instrument this a2/sT day of �C W 26 A IG1 , 2012. T atKelly Lyn A. COMMONWEALTH OF MASSACHUSETTS A,a y e TA 6 fib- , ss Date jITA oZ t , 2012 Then personally appeared the above named T w4s C. 64LY 14.vD IV-,v&A, known to me to be the person/s who executed the following instrument and acknowledged the same to be their free act and deed, before me. .yam otary Public My commission expires: my ion 11us,2018�� AAArvS TRLc COUN?Y Page 2 REGISTRY OF DEEDS A TRUE COPY,ATTEST JOHN F.MEADE, REGISTER'" BARNSTABLE REGISTRY OF DEEDS 2 O,Ct�_AT-11.0-N�- _ SEWJJ,-G-E-P-ER-M-1T-1�1.0. • -���-��.r� - . VI-L--L—A G,E--• I- — — — 13-U-1_L-D-E-R-_5=tJ-lam tail E A D-D-R-E—SS MA 5- --- v�1T 155U--ED = - - — D AT_E-CO KA l:I-AN-c-E-1-SS.0 ER: = e 4 n�n Vv 7,1 �'. .T� . R' • III .............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....-....OF........... ..................................-------- Apphration -for Bispviial Evrkii Tomitrurtion Vrrmft Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System a ----------tol4i.......Z.0.......................................... Location- dd es 0 Lot No.. ---------------- ---R6r es-.-. .................. ........... O r Address (Address .................................................Address..... .................................... Installer, Type of Building Size Lot._/_//.&)--------Sq. feet 1114— Garbage Grinder (IWT Dwelling—No. of Bedrooms------------C� .........................Expansion Attic pay Other—Type of Building ---------------_-_-----No. of persons_=7==7777777=:::-:__ Showers Cafeteria P4 Other fixtures --------- --------------------- --------------------------------------------------- Design Flow---------------- -------------------gallons per person per day. Total daily flow.............X___ ga"1,1,o---n's, ;?4 Septic T,,iik,7—Liquid capacitv.1000-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 Jeaching Ltf e�k.. ---s(l, f t. Other Distribution box Dosing tank Percolation Test Results Performed by.____-.- -- --- -----&J9"Aafte--------------- ----------------------- Test Pit No. 14-Z-9-f--minutes per inch Depth of Test Pit.................... Depth to ground water........ --------------- Test Pit No. 2................minutes De di f Test Pit..______.______pe�rjn ��th.o...es . Depth o ground water..-.._._.__._____._.-. A - .. ..... Z....... ...................................................--------- 14 ....10 ..S. i 0 Description of Soil--------- ............................................................................................................. ------------------------------------------------ x U --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------- ------------­-------------------------------------- -------------------------------------------------------------------------------------------------------------------- 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 Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b n ssued e bo d of ealt Sign ---------- — 4,1 Application Approved By---- - ----- - .......... ........ . ------------ ealt Sign ... . -- --------- a tt/. . . ...... ate Application Disapproved for the following reasons:_------------- ----------------------------------------------------------------......----------------------------- &,-------------- ate 7 / Permit No........................................................................ Issued. /ate-_ ................... ---------------------------------------- - -- -- ------ --------- -- --- -------- - ----------------------- --- -- No.__ Fizz .............. THE COMMONWEALTH OF MASSACHUSETTS BOARD gF HEALTH .. .... ........OF......... .................................................. Appliration -for Dispaiiat Morko Tonotrurtion Prrmit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System, Q.......................................... ........... . ............................... --Location Add ......................V.... ---- - ----- ----- .... ........ .... ........... . ..... ........... ------ r ,Address ress 6T4 al V -----------7-------- . ....... .. .................................................................................................. Installer Address,"' A�,qf Building -1-t-W Size Lot_. ----------Sq. feet U -�_`�Dwelling—No. of Bedrooms__.______._.:................._____Expansion Attic (Ag_ Garbage Grinder Other—Type of Building ---------------------------- No. of persoiis.=����--- Showers Cafeteria Other fixtures --------------•X . .................. ---------------------------------------------------------------------------- - -- ---- ek Design Flow---------------lol?-------_----------gallons per person per day. Total daily flow............ ... ........ ---- ----------------gallons. 1:4 Septic Tunk Liquid capacity-1004)..gallons Length................ Width..-_..._-_._._._ Diameter...__._...._''__Depth.__._-.__-.-.._ W Disposal Trench—No---------------____ Width____...._.....__.... Total Length._..._.__._._._._... Total leaching area------------- ------sq. f t. Seepage Pit No--------------------- Diameter_._.Qy_J?------- Depth below inlet___________.__.__.__ Total ea Ing e.7 --Sq. I I t. Other Distribution box Dosing tank c1l 4 aj i...../*....k Percolation Test Results Performed by--------- C......; . ate--------------------------------- ...... 'test Pit No. L.JsQ_J ..rninutes per inch Depth of Test Pit____________________ Depth to ground water------------------------ f14 Test Pit No. 2.................riftnutej p\e n1h DeUtb of Test Fit.._....___.____ -- Depth ground ----------- ........... ............................ ....... _0 Description of Soil-------------------- ­--­----------------------t-7...................-------------------------------------------------------------------------------------------------- ................................................................................................................................ ......................................................---------------- U --------------------------------------I­--------------------------------------------------------------------------------------------------------------------------------------------------------------- U Nature of Repairs or Alterati6ns—Answer when applicable.-._______________________________________ __: -----------------------------------------------I ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the'State Sanitary C d­ e—The undersigned further agrees not to place the system in. operation until a Certificate of Compliance has b n /,he b d of ealt Signr ....... .......................... .. ........ ....... Application Approved By--- . . . ............. ... .. .. ate pplication Disapp fhe ollowin reasons:._.___ fg .............................................................................................. A roved or t ............ ......................................................................................................................................................................................................... Date PermitNo......................................................... Issued............. ............................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF H LTH ................OF.............. ....... ............:................ ......................... AT QLatifirate of IT'limpliana 1 0 ERTI Y 'hat the or Repaired/�ftdividual Sewage Disposal System constructed (14 S, C Y Is I by....... ... .... YA ............. . ........................................ Installer . ... .... ........ .........4—,- at...... ........ .............................. ...... t...... . ........ ----------has been installed in accordance with the provisions 0 Article XI of The State Sanitar C descrilxd in he t d Coe ,L ion for Disposal Works Construction Permit No... ...... application ------------------ da e THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GU RANTEE THAT THE SYSTEM Wll� F CT N SATISFACTORY. DATE............... ... ... ..... ------........................... Inspector.................................................................................... Z THE COMMONWEALTH OF MASSACHUSETTS BOARD HEALTH ....................... .. .............OF.... ... . ..................................... No...Ixrl..... . FEE...Ile.......... 011. Perrhissidn-se hereby granted-..-.-. . . .4­ Ic----------- ............................................................ to C R at N V di' idual Sewa e Di al Sys .. . ... . ......... j�� ..or.... .. ............. ...... ............................. Street struction P ------ .. ..... c ........I............. as shown on the plication for Disposal Works Con No. .......... -- - - -------- ---- .. .. ............... ,n/th e oard of He th DATE.... Z2- -----�r- -------------------------............ FORM,. 12 5 OR HOBBS.& WARREN. INCo. PUBLISHERS 74 s- 2 isJ. _ FO4VIV OF 64RWS7A, Z-:* DoNa�.o ' Pn�OPOSZ O Sz rl�R SC S yO ,��1 �_,.. ....._._.. - ---�?ds.�.G Li_r!t�l__C...O. . ._..._. _..•--. �iA�;t^�S'/ppJP L F-4VG,v� , LOB Crown to d/vort surface wator Cover at grade Perco/otion rota 2 i»in. por Bay/kIri11 C1%A, o l $r ; ot;;� 9 i 0 p Ga• t0 2fi C/JJ/I 5t01I tt I OF i ! I o p ♦ it COT ► g 10 -ourssl pit to we//. 6�are.st well to pit = j_%A�-t ` ok 71 T T 9-,A ME !tA jAL a. . ��' ♦RCA,: kQ Lip r tj - �L Loa cko�:p srF'RAArc/S 0/2C SCo/p ,Y NJ WCJ1'�r r c cV N LOCUS N nF C1N BK f67/ 85 (LO 18) o S�F, PLAN S. q a Lot 18 APN 291 -228 w°y 14,900tS.F.(Record) D G0 eet Pond FA m m WATER SURFACE EL.=83.5t, 06 JAN 2012 LOCUS MAP 83.44 (ASSUMED DATUM) NOT TO SCALE EDGE 83.49 - LEGEND OF WA X. _ �_ - -- 18 -- EXISTING CONTOUR �- � �R ' x INLAND BANK x 16-82 EXITjNG SPOT GRADE ------- --___ _ -W EXISTING WATER SERVICE -E 84,11 VEGETATED - 484.05 WETLAND -G EXISTING GAS SERVICE Ak- -O.-H.K/- -OVERHEAD WIRES 84.91 84.78•®•®.s....-O..®• Lot 17 85,49 v-1o1 ® WETLAND FLAG �•�• V•102 EDGE OF V-103 g VW APN 291 -229 4__ WETLAND SYMBOL �• v_101• V-104 House #114 TEST PIT 85.38 lij� BENCHMARK z O� o� + ao h0 �� 86,57. � W 87,59 tie ret. wall 87,37 SHED o 0 Lot 19 88.68 - APN 291 -227 --- - 88.65 House #146 1111154 } :•o N DECK r --90----- - --- - X 89.29 X 89.60 EXIS77NG LEACH PIT %,,5o, FF TONE ----- TO BE REMO VED _ (SEE NOTE 11-SHEET 2) NE'ER Ate• EXISTING 91.59 HOUSE(1128) WORK LIMIT & 9 + _ tie re W lls DECK / T.O.F.=91.8f -- SILT FENCE .92 -- _ CELLER FLOOR EL.=84.31- fence 33 92 82 VENT- 93 94• C) f 76` _ 2�'� shrubs BM shrubs �94.07 ,n _1 ;7 - 9' WALK 96.01 �\o 0192.69 PO __ 94.93 "EXISTING SEPTIC TANK t - 7 n--7_ .-. 9 .38 5.17 1 -1�-11__J �� TOP OF TANK, EL-=93.84 f TP-1 TP,. � 95111 ��� iNV.(OUT)=9250E 0 STONE 94,78 DRIVEWAY_, �. 135.00' SLEEVED 9A 3 SEWER •� 100•BUF,�ER 95'39 �532 WORK LIMIT & -�'•�- 95.12 SILT FENCE ��NE,-• : , •"`� fence -- �:o.�.. •��Y• •Vim.• X77- 96.04 95.89 95.64 edge of lawn 95.17 SAINT FRANCIS CIRCLE GENERAL NOTES: 1- ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL BOARD OF HEALTH AND THE DESIGN ENGINEER. �E PK SET 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS li 1 9534 OF THE STATE ENVIRONMENTAL CODE, TITLE V. AND ANY APPLICABLE LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW: -LOCAL REGULATION Chapter 360. Article 1 - Setback Requirements 1) A 28' variance, S-A.S. to Wetland, for a 72' setback. 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE DESIGN ENGINEER. BENCHMARK SET 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING MAGNETIC NAIL SET FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN EL.=95.94 (Assumed Datum) ENGINEER BEFORE CONSTRUCTION CONTINUES. t 5. ALL ELEVATIONS BASED ON AN ASSUMED DATUM. 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF M4Ssq THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF P� � HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. o PETER T. Gam, 7- WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. MCENTEE 8- THERE ARE NO WELLS WITHIN 100' OF THE PROPOSED S.A.S. o� CIVIL. " 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS "No. 35109 AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE DIRECTED BY THE APPROVING AUTHORITIES. WETLAND DELINEATION o C/STFRE� �� 10. IT-SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY VACCARO Environmental 'P�F ���� THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING Consulting ssi L CONSTRUCTION. P'0. Box 955 11. WHERE REQUIRED, 'CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS Sandwich, MA 02563 IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND (508) 888.-5855 '�1� REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). FLOOD PLAIN DATA OWNER OF RECORD 12, AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE COMMUNITY PANEL NO.250001 0006 D KELLY, THOMAS INSPECTED BY DESIGN ENGINEER PRIOR TO BACKFILL. .Revised July 2, 1992 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND. FLOOD ZONE "C" DESIGNATION 128 SAINT FRANCIS CIRCLE IS NOT CONSIDERED TO BE A PROPERTY LINE SURVEY. i HYANNIS, MA 02601 14. ENGINEER IS NOT RESPONSIBLE FOR ANY UNDOCUMENTED SEPTIC PLAN REVISION - 22/14/12 SYSTEM COMPONENTS NOT SHOWN ON THE PLAN. SOIL LOG TYPO CORRECTED TO REFLECT MSHGW AT 83.5 Engineering by: SCALE DRAWN JOB. NO. PROPOSED SEPTIC SYSTEM UPGRADE PLAN Engineering Works, Inc. 1"=20' P.T.M. 270-11 12 West Crossfield Road„ Forestdole, MA 02644 DATE CHECKED SHEET NO. 128 SAINT FRANCIS CIRCLE HYANNIS MA (508) 477-5313 1/11/12 P.T.M. 1 of 2 Prepared for: Thomas Kelly, 128 Saint Francis Circle, Hyannis, MA 02601 441 NOTE: TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE < EL.91.3 FOR A DISTANCE OF 15' AROUND THE PERIMETER OF THE S.A.S. SEPTIC TANK PROPOSED D-BOX PROPOSED S.A.S. CHARCOAL VENT INSTALL OUTLET AND ERS SET8T0 6VERS OF �VER FINISHNLET &GRADE COVER SETS TO 6" OF GRADEINSTALL INSPECTION PORT/S MAY CONNECT NNECT LTHROUGH ONE(MIN.) SET TO 3" BELOW SIDE PORT CO U LERS T.O.F.=91.8t FINISHED GRADE F.G. EL.=95.4t F.G.= 93.83 (MAX.) F.G. EL.=95.2t � F.G. EL: 94.3t MAINTAIN 2% GRADE (MIN.) OVER S.A.S. BIAXIAL GEOGRID-BX TYPE INSPECTION L = 26' L = 6'(MAX) EXTEND 1 FT. BEYOND S.A.S. PORT 7 ® 5=1� (MIN.) ® 5=1� (MIN.) 2 MINIMUM 4"SCH40 PVC 4"SCH40 PVC 12" ( ) MM" 6" t0"I L 4- 10.75" TO EXISTING 48" LIQUID INVERT LEVEL ADD } I- cAs BAFFLE INV.=91.17 PROPOSED INV.=91.00 3 ROWS OF 6 UNITS AT 5.0'/UNIT + 2 COUPLERS = 31.4' INEXISTI G SOIL ABSORPTION SYSTEM (PROFILE) EXISTING INV.=90.90 EXISTING SEPTIC TANK FATLANTA GEOGRID / BX TYPE CED BY TENSAR CORP. GEORGIA 1> RESTORED DRIVEWAY SURFACE COMPACTED, CLEAN GRAVEL BACKFILL 18" MINIMUM COVER NOTES: OVER UNITS BREAKOUT=TOP M2.83' ; 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE TOP ELEV.=91.33 INVERTS, PRIOR TO INSTALLATION. INV. ELEV.=90.90 12" 2) D-BOX SHALL BE SET LEVEL AND TRUE TO GRADE ON A MECHANICALLY COMPACTED SIX BOTTOM ELEV.=90.00- INCH CRUSHED STONE BASE, AS SPECIFIED IN 310 CMR 15.221(2). 5' MIN. SEPARATIONEFFECTIVE WIDTH=8.5' 3) INSTALL INLET & OUTLET TEES AS REQUIRED. TO HIGH GROUNDWATER 4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE EXISTING SUITABLE AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. EST. SEASONAL HIGH G.W. EL.=83.5 = UNITS MUST BE STAMPED H-20 MATERIAL USE 3 ROWS OF 6-ADS Arc 36HC UNITS + 2 COUPLERS WITH NO SEPARATION BETWEEN EACH ROW & NO STONE TYPICAL SECTION SEPTIC SYSTEM PROFILE N.T.S. SOIL LOG DATE: JANUARY. 10, 2012 (REF P#13,507) SOIL EVALUATOR: PETER McENTEE (SE#1542) -' -- `WITNESS'`DONALD DESMARAIS-HEALTH AGENT Elev. TP- 1 Depth Elev. TP-2 Depth 94.1 A 0" 94.5 FILL 0" SANDY LOAM 94.2 A 4" 7.446 10YR 4/2 SANDY LOAM INS 93.1 12" B 93.3 10YR 4/2 14" GTH 9.45" SANDY LOAM g 1OYR 5/6 SANDY LOAM 16" 91.1 36" 1 OYR 5/6 t 2.37" C 91.0 C 42" PERC 10.38" 42"/54' INVERT DOME END HEIGHT M-C SAND M-C SAND POST END 2.5Y 6/4 2.5Y 6/4 $F33.715" 83.5 MOTTLING 127" 83.5 MOTTLING 1-42" 7.5YR 5/8- 7.5YR 5/8- 83.1 132" 83.0 138" PERC RATE: <2 MIN/IN. ("C" HORIZON) NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT NO GROUNDWATER OBSERVED TO CHANGE WITHOUT NOTICE. PRODUCT DETAIL MAY ESTIMATED HIGH GROUNDWATER, EL.=83.5 (MOTTLING) DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE. DESIGN CRITERIA 4640 TRUEMAN BLVD HILLIARD, OHIO 43026 UNITS MUST BE STAMPED H-20 ADVANCED DTWNAGE SYSTEMS.INC.w Are 36HC SIDE PORT COUPLER NUMBER OF BEDROOMS: 3 BEDROOMS 63.25" SOIL TEXTURAL CLASS: CLASS I DESIGN PERCOLATION RATE: <2 MIN/IN 1s" DAILY FLOW: 330 GPD DESIGN FLOW: -330 GPD 34.5" GARBAGE GRINDER: NO LEACHING AREA REQUIRED: (330) = 445.9 SF .74 TOP VIEW EXISTING SEPTIC TANK: 1000 GALLON CAPACITY 60" PROPOSED D-BOX: 1 INLET, 3 OUTLET (MINIMUM), H-20 RATED END CAP END CAP USE 3 ROWS OF 6-ADS Arc 36HC UNITS + 2 COUPLERS PER FRONT VIEW SIDE VIEW END CAP ROW WITH NO SEPARATION BETWEEN EACH ROW & NO STONE REAR/TOP VIEW BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.80 SF/LF OF UNIT) NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT SIDE VIEW (Arc36HC Units) 18 UNITS x 5.0 LF x 4.80 SF/LF = 432.0 SF DI CHANGE WITHOUT NOT ACT PRODUCT DETAIL MAY DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE. (COUPLERS) 6 COUPLERS x 1.2' x 4.80 SF/LF = 34.6 SF 4640 TRUEMAN BLVD TOTAL AREA = 466.6 SF HILLIARD, OHIO 43026 Arc 36HC DETAIL d DESIGN FLOW PROVIDED: 0.74(466.6 S.F.) = 345.3 G.P.D. ADVANCED DRAINAGE SYSTEMS,INC.mu. UNITS MUST BE STAMPED H-20 Engineering by: SCALE DRAWN JOB. NO. PROPOSED SEPTIC SYSTEM UPGRADE PLAN Engineering Works, Inc. N.T.S. P.T.M. 270-11 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET No. 128 SAINT FRANCIS CIRCLE HYANNIS MA (508) 477-5313 1/11/12 P.T.M. 2 of 2 Prepared for: Thomas Kelly, 128 Saint Francis Circle, Hyannis, MA 02601