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LOCATION t' IV15 ZVAGE #
VILLAGE,�,�/c P✓i//c ASSESSOR'S MAP & LOT
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INSTALLER'S NAME & PHONE NO `2'11 -3cg-5�
SEPTIC TANK CAPACITY 1,5W %Al_ ^ d ` o93- 003--00j
LEACHING FACILITY:(type)��6 406LTy.��.SD/�(size) - (g
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER 4,4Aft 6rrf )!�
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
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� THE COMMONWEALTH �Z 61SL18
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Move
Appliration for %spaaal Works Tontitrurtion Orrmit oq-?
Application is hereby made for a Permit to Construct or Repair ^an Individual Sewage Disposal
System at:
........;7-41 ly.vo. .......SMV......... ............
In'staller Address
om elle Expansion Attic Garbage Grinder
Dwelling—No. of Bedro
Septic Tank—Liquid capacity,/
9 ,50 gallons Len;h ---//OWidth................ Diameter---------------- Depth.le,!�_
Zv�c u��o�v box \~^ � _ �
Its Per-formedPercolation Test Res sb�. --»�r- y������/?.��.---_-__ Date '
Teo Pit No inchDepthof Test Pit................... Depth to ground vvatec'---__._-
r3� Test Pit No. per inch Depth of Test Depth m ground water'_-'__-'
Ver-
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-'--------' v---'--' '��x�~�-"�c''--------------------------------'-------
�ii .----------------'_------_-__---.----.----..-_---------.---.-..---'-.----_----_-'-'--_-
U Nature of Repairs or Alterations--Answer applicable---------------------------------------------------------- ....................................
.................................................... . '��m�°��-~.�-----------------.---..--'_______..________________.
�
Agreement: ~
The undersigned agrees to install the uforedesccibc6 Individual Sewage Disposal System io accordance with
the i i fTL ITALS 5 of the State Sanitary Code The d i to place the ayatep in '
� operation- until Certificate of Compliance has Ren issued b he b rd alt �
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0//,�
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� [�uu��roved6n the rxuxom�/-__-_'----'_'-'----_--_____-.---_____________
........................'....................
Date
Permit No.........!��.A................:3
4 Issued-'-'----------
(a,sm ......I............................
Sys Application is hereby made for a Permit to Construct or Repair an Individual Sewage Dispos'al
tem
System at:
Dwelling—No. of Bedrooms.............. ....................Expansion Attic Garbage Grinder
Z Other Distribution box Dosing tank-(
e es Performed b
T pit
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O
�4 .._._-------'_--_-'---'_-_'----.-_-_-._-_-_-'----_.----_'----------_.—'_-_--___-.
U Nature of Repairs or Alterations
....................................................
Agreement:
The undersigned agrees to install the uforedescribed Individual Sewage Disposal System in accordance with
the provisions ofIZ'IL 5 of the State Sanitary
operation until a Certificate of Compliance has.�'�en issued bb,,Ihe b rd f It
(�~~
Application Approved 8v-. v ............Application Disapproved
Date
forthe following reasons:................................................................................................................
---_-__---_---__----_--'-___.'-__.____--___-_---__-------'--___--_.---_--.-.--__- �
`27xi 3 ~^~Permit No �
| .... *...........�����'-����---- Issued.....................................................
Date
THE cowMowvvEAcr* or mxssAonussrrs
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INCORPORATED
8450 Cole Parkway n Shawnee, KS 66227 ■ Phone 913-422-0707 ■.Fax: 912-422-0808
e-mail: onsite()biomicrobics.com■www.biomicrobics.com■800-753-FAST 3278
PRODUCT REGISTRATION REPORT
Pro
duct Registration
stration Report mu
st be completed and returned to Bio-Microbics, Inc. in order to effect warranty.
Y
Date of Start-Up Date Shipped to End User 6/22/04 Serial#2N793
OWNERS
NAME Thomas Powers
ADDRESS 32 Hemeon Way
CITY/STATE/ZIP Hyannisport,MA 02647
PHONE/FAX
•x ,:
NAME Wastewater Treatment Services,Inc.
ADDRESS 44 Commercial Street
CITY/STATE/ZIP Raynharn, MA 02767
PHONE/FAX 508-880-0233 FAX: 508-880-7232
OEM
�" lw^„ sd• xr
^ror..�:�?�' wp 4� t� 1
��" �;,� .f.x,,��.�,���� INSTALLER K. ,eh Y..a#:��" ,3:Na�.
NAME Br yan Kisslin
ADDRESS Town Brook Road
CITY/STATE/ZIP West Yarmouth,MA 02673
PHONE/FAX 508-778-0444
NAME Weller&Assoc.
ADDRESS P.O.Box 417
CITY/STATE/ZIP Centerville,MA 02632
PHONE/FAX 508-775-0735
Good Bad NA Good Bad NA
ELECTRICAL PANEL(S) TREATMENT UNITS)
Visual Alarm Operating Air vent clear
Audio Alarm Operating Septic tank level
BLOWER(S) Septic tank meets min. size [�
Wired for correct voltage Septic tank filled to
operating level
Inlet/outlet piped correctly ( Air Lift Operation
Filter element installed Recirculation tube in place (� .
Blower hood secure G/ Fasteners tight
Blower works correctly [ WATER-TIGHT JOINTS
Blower located within 100'of Treatment unit to septic tank
treatment unit
Air line clear Entrance tube to insert cover
Air inlet screen clear Insert to insert cover �.
Blower hood vents clear Q Discharge line connection LLB/
Factory Authorized Personnel: Title:
Firm: Wastewater Treatment Services Inc. Date: LI J
v
1
t
Y!/ c//`ell'L%72C'/ZCi'cJP/tUGCP6'�� cJ/LG.
44 Commercial Street
Please complete all items marked'. Raynham, MA
including three signatures. Mail 02767 a
signed original contract to:
Wastewater Treatment Services.Inc. z." Tel: (508) 880-0233
44 Commercial Street 508 880-7232ax:
Raynham,MA 02767 F (
INSPECTION AND EFFLUENT TESTING AGREEMENT.-
Agreement entered into by and between Wastewater Treatment Services,Inc. (herein called WTS)and
the FAST®System OWNER(herein called OWNER)for the inspection by.WTS of certain equipment
of OWNER which is described below.
Upon acceptance of this agreement at WTS's office, WTS will rdnder the following services only:
Equipment will be.inspeclCd at least 4 times per year that this Agreement remains in effect,with the first
inspections beginning '. 4 ,. These.inspections will,include: "
1) Testing of the sludge depth in the septic tank.
1) Inspection,power testing and clean/replace intake filter of the air blower.
1) Inspection of the alarm system.
1) Inspect overall condition of FAST®System.
1) Notification to OWNER of any problems encountered.
1) Service other than routine maintenance will be billed at an rate;plus travel and parts.
WTS shall notify the local board of health and Department of Envifonmental Protection in writing within
24 hours of a system failure or alarm event including corrective measures that have been taken.
OWNER will be billed standard WTS charges for any parts used in repairs or maintenance. Any .._w .
additional labor.time will be billed to the OWNER at standard labor rates of$74.00 per hour.
Emergency service between regular inspections will be provided at standard labor rates during normal
business hours; at.time and one-half after 5:00 PM and on Saturdays; and at double time on Sundays and
holidays. Emergency service charges will include a minimum four(4)hours of labor, plus standard
WTS charges for parts,plus mileage and travel charges. The annual rate includes routine maintenance,
but does not include repairs required for damages caused by abuse,accident,theft,acts of third persons,
forces of nature,or alterations made to the equipment. WTS shall not be responsible for failure to render
the agreed services if caused by strikes, labor disputes,non-cooperation by OWNER, or other factors
beyond the control of WTS.
OWNER understands and agrees that WTS is not responsible for special,incidental or consequential
damages, including loss of time, injury to person or property, or equipment failure.
OWNER agrees that WTS may enter OWNER's property and have acceptable access to all areas
deemed by WTS to be necessary or appropriate for WTS to perform its duties hereunder.
This is a two-year contract which will be billed annually. All payments are non-refundable: OWNER'S
failure to pay invoices promptly or to otherwise comply with this contract may result in suspension of µ
service, cancellation of contract and/or nullification of warranties,at the election of WTS. This
agreement is not assignable without the consent of WTS and will remain in force until canceled by either
party through written notice.
MANUFACTURER MODEL NO. SERIAL NO. LOCATION ANNUAL RATE
Bio-Microbics MicroFAST yj Hyannisport,MA $420.00
EOUIPMENT OWNER Wastewater Treatment Services Inc.
*Signed by OWNER•
�A_
Thomas Powers Signed:
*Address:
32 Hemeon Way 44 Commercial Street
Raynham,MA 02767
Tele: (508) 880-0233
*City: State: Zip: Fax: (508) 880-7232
Hyannisport MA 02647
*Telephone 508-775-2436 Effective Date of Agreement
*Daytime Telephone
OWNER understands that(1)ANNUAL RATE payment is for one year only of this two-year agreement
and is non-refundable; and(2)Current law requires OWNER to maintain a service agreement for the life
of the FAST'System. I UNDERSTAND,THE FOREGOING.- ,*
*Signed by OWNER:
Effluent Testing
Effluent sample taken quarterly and delivered to a qualified testing lab for evaluation. Results sent to
State and local Agencies as well as the OWNER. OWNER is responsible for providing acceptable
access to effluent to enable a grab sample to be taken for laboratory testing performed.
PEWMIT:
*(PLEASE CHECK ONE) ( )GENERAL ( ) REMEDIAL (X)PROVISIONAL
*SPECIAL CONDITIONS PER LOCAL BOARD OF HEALTH (Y)or(N)if YES,please attach copy of
permit
(X )CBOD5,TSS,pH,Nitrate,Nitrite,TKN,Alkalinity O Other:
*Cost for testing: $255.00/visit
Operator assigned: William Everett
Telephone: 508 400-3868 *Engineer: Weller&Associates
*Approval for Effluent Testing ;.
om is Signature
J P
44 Commercial Street
Raynham, MA
02767
w
(508) 880=0233
Fax''(508)'880=7232
August 5, 2004
Barnstable Board of Health
200 Main Street
Hyannis, MA 02601
Attention: Board of Health Agent
Reference: Home FAST Treatment
Serial Number: 2N793 .
Attached please find a copy of the Product Registration Report for the FAST Treatment
System for work performed on 08/04/2004 at the home of Thomas Powers located at 32
Hemeon Road, Hyannisport, MA. Also, attached is a copy of the fully executed
Inspection&Effluent Testing Agreement.
If you have any questions or require additional information please do not hesitate to call.
in r I S ce e y,
g
Donna L. Callahan ^
} `
Enclosures
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ADDITIO
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GENERAL NOTES:4_
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REPAIR EXISTING DECK
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OSTURBF-0 BY NEW'' ice. - .$ .-. - r" ,"' i.
. - _ a � •. � i t: �! :I I .CO STRUCTON:. A a '� ""#' _;: ,,.e .'�,�'
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LINEN
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2.T/kLL LININ CABNIET.: OOk
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PANEL:TO MAT nITY, - >` �•.^r . ,
•. .. - :a Y,...i - s �' 1 S NE SHOWER SPEC: • Y
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OF SU I,`. 03 TIL - .1/2'FRAMELESS GLASS SHOWER ,d: _ §Fw •s ..
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STONE TILE WALLS CE -, -
1. ( ILII'IG AND ;T=
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36•z72•WHIRL POOL TUB TO BE {, -
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• '�� � '_� -'�- - `` ( 1 '? SELECTED BY OWNER.CENTER ON
1O R
.GUEST OOM ei NDE E `TUB PLATFORM..
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FLOO G (C RPET C1 U E IN :o IM A04 f:
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BUILT-IN TV CABINET/8 � :'. O O _ c :' ram.'.� � ., _ - • �'-�+'r' �^�. �.
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. PROJECT NUM BER:•
q - " 20'-0'«-EXISTING • - .-18'-6'PROPERTY LINE VERIFY.UY FIELD _ ca s
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SCALE:BY:
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DATE.AUGUST 04,2004-
GENERAL NOTES
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I. BATHROOM COUNTERTOP,STUB PLATFORM AND SHOWER,.
D
` - - T'HOLD TO BE GRANIT WITH A STANDAR EDGE.'DETAIL."
Y
COLOR TO BE SELECTED BY OWNER. .''` '"
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+ 2 CARRY STONE TILE FLOORS, WALLS AND CEILING IN THE ,± U ._ ,t, ,� - • *` d {
- SHOWER. CARRY STONE TILE FLOOR IN BATHROOM -
ALLOWANCE FOR BOTH$20 SF INSTALLED a r, '•:x - + 1t.�
3. ALL MTERIOR DOORS.TRIM PROFILES,"FpY15HE5 ECT SHALL -`° N , 3 n' - - ff
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MATCH THE EXISTING HOUSE '�" a DRAWING-KEY r 9'
I' '' � FIRST FLOOR PLAN ^ -
4. PROVIDE DUST CONTROL AT DOOR 101A DURING „• - ® new con3TRucnolg 6 oo sounrse sr - .r
CONSTRUCTION. • 'fi .hs
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5.' INSTALL. OF THIS CONTRACT'A SINGLE ZONE `
AS A PART 0 ryusrna consrrtucrlon - - - ; ` -
To
SPLIT HEATING/COOLING SYSTEM SIZED TO,SUIT'"(90«HIGH a R O P_xls�uw aonarreverkxr °'�` A
EFFICIANCY,DIRECT VENT TO BE DISTRIBUTED FROM THE, IQ
`"" . �'* - 7o ec cEn+ous.+eo r
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