HomeMy WebLinkAbout0047 PITCHER'S WAY - Health 47 PITCHER'S WAY, HYANNIS
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TOWN
,O1'F-,BARNSTABLE
PION / 1 SEWAGE #
VILLAGE (21711 .5 ASSESS 'S MAP& LOT
'NAME&PHONE NO.&,-k/Q 1 r
SEPTIC TANK CAPACITY /000 :{'ol -,7,,�,S v/. A
LEACHING FACILITY: (type) (size) AW)
NO.OF BEDROOM °2
BUILDER O OWNER l
PERMTTDATE: COMPLIANCE DATE:_
jeparation Distance Between the:
tfuimum Adjusted Groundwater Table and 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 eaching fa 27!
ty) _/�l Feet
Furnished by i
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SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
SKETCH OF SEWAGE DISPOSAL SYSTEM:
Include ties to adeast two permanent references,landmarks or benchmarks.
Locate all wells within 100 Feet.
L1y
4 . 0 .
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DEPTH TO GROUNDWATER:
Depth to groundwater: J Feet r
Method Determinatio o r ppr xima 'on: 1'?J 1'''l44 r�j3y Z4115, dC 7
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BORTOLOTTI CONSTRUCTION,INC. 966T
765 WAKEBY ROAD,MARSTONS MILLS,MA 02648 RUM
508-771-9399 508-428-8926 FAX: 508428-9399 'lop �.
SUBSURFACE SEWAGE - "DISPOSAL SYSTEM INSPECTION FORM �f r t a�
PART A
CERTIFICATION
Property.Address:
Date of Inspection:3-..)�_qj Inspector's Name: /
er's Name and Address: _ p
f,S fir•)(, 024jo
CERTIFI ATION STAT .MENT•
I certify that I have personally inspected the sewage disposal system at this address and that the informa-
tion reported below is true,accurate and complete as of the time of inspection. The inspection was per-
formed based on my training and experience in the proper function and maintenance of on-site sewage
disposal ostems. The System:
Passes
Conditionally Passes
Needs Further Ev uation By the Local Aproving Authority
Fails
Inspector's Signature: Date:. 71994
The System.Inspector shall submit a copy of this inspection report to the Approving ty
authori within thir-
ty(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 Department of Environmental Protection. The original should be sent to the system owner
and copies sent to the buyer,if applicable and the approving authority.
INSPECTION 1MMARY�
A)SYS� PASSES:
have not found any information which indicates that the system violates any of the failure
criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated .
below.
B)SYSTEM CONDITIONALLY PASSES;
One or more system components need to be replaced or repaired. The system,upon comple-
tion of the replacement or repair,passes inspection.
Indicate yes,nor,or not determined(Y,N,OR ND).Describe basis of determination in all instances. If
"not determined",explain why not.
The septic tank is metal,cracked, structurally unsound, shows substantial infiltration or
exfiltration,or tank failure is imminent. The system will pass inspection if the existing sep-
tic tank is replaced with a conforming septic tank as approved by The Board of Health..
Sewage backkup or breakout or high static water level observed in the distribution box is due
to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. The
system will pass inspection if(with approval of The Board of Health):
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SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Broken pipe(s)replaced
Obstruction is removed
Distribution Box is levelled or replaced
The System required pumping more than four 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
Obstruction is removed
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 the public health,safety and the environment.
1)SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE
SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE
PUBLIC HEALTH AND 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.
2)SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER
SUPPLIER,IF APPROPRIATE)DETERMINES THAT THE SYSTEM IS FUNCTION-
ING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE
ENVIRONMENT:
The system has a septic tank and soil absorption system and is within 100 Feet to a surface
water supply or tributary to a surface water supply. 9
The system has a septic tank and soil absorption system and is with a Zone I of a public
water supply well.
The system has a septic tank and soil absorption system and is within 50 Feet of a private
water supply well.
The system has a septic tank and soil absorption system and is less than 100 Feet but 50
Feet or more from a private water supply well,unless a well water analysis for coliform
bacteria and volatile organic compounds indicates that the well is free from pollution from , .
the facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less
than 5 ppm.
D)SYSTEM FAILS:
I have determined that the system violates one or more of the following failure criteria as Health
in 310 CMR 15.303. The basis for this determi
nation is identified below. The Board of
should be contacted to determine what will be necessary to correct the failure.
Backup of sewage into facility or system component due to an overloaded or clogged SAS
or cesspool.
Discharge or,ponding of efluent 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 clog-
ged SAS or cesspool.
Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2
day flow.
Required pumping more than 4 times in the last year NDJ due to clogged or obstructed
pipe(s). Number of times pumped
2-
y
E SUBSURFACE
C SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
-Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater
elevation.
Any portion of a 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 I 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. If the well has been analyzed
to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic
compounds,ammonia nitrogen and nitrate nitrogen.
E)LARGE SYSTEM FAILS:
The following criteria apply to a large system in addition to the criteria above:
The design flow of a system is 10,000 gpd or greater(Large System)and the system is a significant
threat to public health and safety and the environment because one or more of the following
conditions exist:
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..
The owner or operator of any such system shall bring the system and facility into full compliance with the
groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local
regional office of the Department for further information.
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Check if the following have been done:
!l Pumping information was requested of the owner,occupant,and Board of Health.
None of the system components have been pumped for atleast two weeks and the system has
been receiving normal flow rates during that period. Large volumes of water have not been
introduced into the system recently or as part of this inspection.
`As-built plans have been obtained and examined. Note if they are not available with N/A.
r/The facility or dwelling was inspected for signs of sewage back-up.
—,The system does not receive non-sanitary or industrial waste flow. -
-,-The site was inspected for signs of breakout.
c�All system components,excluding the Soil Absorption System,have been located on site.
The septic tank manholes were uncovered,opened,and the interior of the septic tank was in-
spected for condition of baffles or tees,material of construction,dimensions,depth of liquid,
depth of sludge,depth of scum.
s/The size and location of the Soil Absorption System on the site has been determined based on
existing information or approximated by non-intrusive methods.
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SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST(continued)
T-he facility owner(and occupants, if different from owner)were provided with information on
the proper maintenance of Subsurface Disposal System
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART,C�-
SYSTEM INFORMATION
FLOW CONDITIONS
RYSIDENTIALe
Design Flow: 3vZ allons Number of Bedrooms: Nut of Current Residents:
Garbage Grinder: 6 Laundry Connected To System: reS Seasonal Use:
Water Meter Readings, if d able:
Last Date of Occupancy: �i-/'P.r� ►L
CO MERCLAIANDUSTRIAi
Type of Establishment:
Design Flow:L aallons/day Grease Trap Present: (yes or no)
Industrial Waste Holding Tank Present:
Non-Sanitary Waste Discharged To The Title V System:
Water Meter Readings,If Available: Last Date of Occupancy:
OTHER: Describe)
Last Date of Occupancy:
GENERAL INFORMATION
'PUMPING RECORDS and source of informa 'on:�
"System Pumped as part of inspection: if yes,volume pumped: gallons,
Reason for pumping:
TYPE F SYSTEM:
Septic Tank/Distribution Box/Soil Absorption System
Single Cesspool
Overflow Cesspool
Privy
Shared System(If yes,attach previous inspection records,if any)
Other(explain):
APP OXIMATE AGE of all com nen ,date i taped(if known)and source of information:
!'i
Sewage odors detected when arriving at the site: 1VQ
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SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
r
SOIL ABSORPTION SYSTEM(SAS):��
(Locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive
methods) If not determined to be present,explain:
Type
Leaching pits,number: / Leaching chambers, number: Leaching galleries,number:
Leaching trenches,number,length:
Leaching fields,number,dimensions:
'Overflow cesspool,number:
Comments: (note condition of soil;signs of hydraulic failure level of pondin ,condition of vegetation,
etc. is l / - 1:ry
CESSPOOLS: A
16
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(cesspool must be pumped as part of inspection)
Comments: (note condition of soilk,signs of hydraulic failure, level of ponding,condition of vegetation,
etc.)
PRIVY:
Materials of construction: Dimensions:
Depth of Solids:
Comments: (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,
etc.)
S
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SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
GENERAL INFORMATION (continued)
SEPTIC TANK:_
Depth below grade: '/� ~ ✓
ep gr Material of Construction: concrete m 1 eta FRP Other
(explain) —
Dimisions:?, V Y4 'Y S Sludge Depth: H Scum Thickness: /b '�
Distance from top of sludge to bottom of outlet tee or baffle: 3 y
Distance from bottom of scum to bottom of outlet tee or baffle: y
Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid
level in relation o outlet invert,structural integrity,evidence of leaka ,etc.) S
04 Q Lei , /. Coll
d 7
/0�� e -Fri,cwcir
GREASE TRAP:,— Ali
Depth Below Grade: Material of Construction:—- concrete metal—FRP Other 1
(explain) —
Dimensions: Scum Thickness:
Distance from top of scum to top of outlet tee or baffle:
Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid ;
level in relation to outlet invert, structural integrity,evidence of leakage,etc.)
TIGHT OR HOLDING TANK:
Depth Below Grade: Material of Construction:_concrete_metal_FRP_Other(explain)
Dimensions: Capacity: gallons Design Flow: gallons/day
Alarm Level:
Comments:(condition of inlet tee,condition:of.alarm and float switches,etc.)
DISTRIBUTION BOX:_
Depth of liquid level above outlet invert: ,j� �to��e� ,✓
Comments: (note if level and distribution is evidence of solids carryover,evidence of leaka a inp
or ut of box,
O�.�i�o��yL�,.�,�
J
PUMP CHAMBER:
Pump is in working order: t
Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.)
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L0CAa ON�.O�I� j� SEWAGE PERMIT NO.
"VILLAGE p
,)-,INSTA LLER'S NAME, i ADDRESS 44.
i
► S UILDE R OR OWNER A
DATE PERMIT ISSUED
DATE -: COMPLIANCE ISSUED
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FEB....
..........................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.............. ....... ...................OF.............................................-..........................................
Appliration for Dhipoiial Workii Tomitrurtion Prrutit
Application is hereby made fora P,.Pfmit to Construct or Repair an Individual Sewage Disposal
System at
................... .......... ......... .............� ...........................................
L flon Address
or Lot N�A-
........................ ....... .... ..............
Owne Address
......... ... . .... . . .....I Address
.....*-------......."......................
Installer
Type of Building Size Lot............................Sq. feet
--
4 Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder
P4 Other—Type of Building ............................ No. of persons............................ Showers Cafeteria
Otherfixtures .......................................................................................................................................................
Design Flow............................................gallons per person per day. Total daily flow............ ...............gallons.
1:4 Septic Tank—Liquid capacityAVd�.gallons Length................ Width..._............ Diameter__-_.__..._..... Depth....._..........
Disposal Trench—No. .................... Width....._.............. Total Length.................... Total leaching area.,?--Ct---;;?.sq. ft.
>
Seepage Pit No......... ------
Diameter.................... Depth below inlet._.._.._._..___._._. Total leaching area..................sq. f t.
Z Other Distribution box Dosing tank
Percolation Test Results Performed by..... _...........X.0........................................ Date....
Test Pit No. I.................minutes per inch Depth of Test Pit...._............._. Depth to ground water.._._._.............___.
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water......_............._.__
.............. ........................................... ... ..... ......
0 Description of Soil-------_..
�4 "e�.f......I ....................... .........
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 4I TI U 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance as been iss—poeby the board of health.
..........ign d. z z �—........... L .. ..... ..... ......
Application Approve ...............w.......................................... ..... ... .. ...
...... - ----------------------------
Date
.. ..............................N........................................
Application Disapproved r e following ea ons:... ..... ......................
.................................................................. ....... ...... .. ......... . .. ......................................................................
Date
PermitNo......................................................... ssuedL.......................................................
Date
FEs..............................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
:..._._.........:_...................O F........ ................................ ...-......
4.
t A,p liration for Mipplial luorkii Toniitrur#iun erutt#
Application .is hereby made for ermit to ostruct ( ) or Repair ( ) an Individual Sewage Disposal
System at: '.00
........ . ... .......... �'-
we f/l{; �t ati cjtlres (/ No.
...
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-
..�`+-9ta•__ •Addr s'�°'r°'.' .....� ....• �........ ..... .......�....................••................. ... ...................................
Installer Address
QType of Building Size Lot.................... .....Sq. feet
U
Dwelling—No. of Bedrooms.............................................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons.......................----- Showers ( ) — Cafeteria ( )
a Design Flow.Other fixtures ............................................................... allons per person per day. Total daily flow........ .... . gallons..
WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................:_
x Disposal Trench—. o. ...................:Width.................... Total Length........:........... Total leaching ar ,.,�..._..sq. ft.
Seepage Pit No._._ ...,_._.... Diameter.................... Depth below inlet.................... Total leaching a �....�......sq. f t. 4
Z Other Distribution box ( ) Dosingt�r3bE
Percolation;Test Results Performed by.....................�--_................_......................... Date ,
t`c yl�
Test 'Pit No. I................minutes per inch,• .Depth of Test Pit._..............._.. Depth to grou water_ _.__.._..........._
Test Pit No. 2................rninutes per inch Depth of Test Pit.................... Depth to ground water........................
' - - -
O Description of Soil... "-"'--------------------------------- a�..... .
x ..............
---- - .............................-------- - -
U -----------------------------==--------------------------------------------••-----------------.-----•---... --------------•--------------------
... -------- --------.--------•------- ------
W
U Nature of Repairs or Alterations—Answer when applicable...............................................................................................
---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------••-•-...._......--•••-
Agreement:
The.,undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance.with
the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in 1
operation until a Certificate of Compliance as sued by the board of health.
Application Approve ..................... , � -
Date
Application Disapproved r e following , as ns:.... ........ a.............................. -----------------------........................---•••-------
........................:;:........................................ •----- ..... -• --••- - .
Date
PermitNo......................................................... ssued•.......................................................
....-•------•---• Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........................................OF.....................................................................................
Tntif iraW of ToutpPatta
T CE IFY, '1:4at the In idual S age Disposal System`coyftructedj or Repaired ( )
�•p-t I..... I
by es / f - tall ••.
l --Installer
c
at / .....
� ------- •----------------------------------- -----------------------• -----------
has been installed in ac .ordance with the provisions of T ��State Sanitary Code as described in the
application for Disposal Works Construction Permit No.. ................................. dated-..............__......__._._._.................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE........................... ................................. Inspector:...._- ...............................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
f� ....... ........0 F.....................................................................................
No.Q FEE. .................
�iri�.l7a'�FY� lingirwill rmif
Permission is eby gra d , 7 ` ' Ce...
............
to Constr or R victual Sewage Disposal System
at No..
----�y...._ . ------..---•..--. '
Street j
as shown on the application for Disposal Works Construction Permit No. ........ Dated.__,....... .........................
�^ � - � .Board of Health
-
DATE-------------=- --------------------= d
FORM 1255 A. M. SULKIN, INC., BOSTON ''
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TONAL
LEGEND
CERTIFIED PLOT Pt..
,,EXISTING SPOT ELEVATION Ou0
EXISTING CONTOUR --- 0 --� Lo T 8 P1TcHc es WAy
»FINISHED 'SPOT ELEVATION �oNCp �Q HyaNAllS f'onr
FINf$NED CONTOUR 0
APPROVED BOARD AF HEALTH yoo Hi�q
BATE AGENT SCALE� I �' '� '' DATB� ' %9k
L N 4SE ENGINEERING CQ
CLIENT N�ck�t�►S I CERTIFY THAT TINE I01,
14
EGISTEwE REGISTERED JO® 'NO. 9 y A 2-3 BUILDING SHOWN ON TNt'S
CIVIL LAI#a . CONFORMS TO THE iQNINS , I.S
ENG' I�ER UR EY DR.BY "�. OF. 6ARNSTAB MASS Y
712 MAIN STREET CH: ®Y: E
H YA N N I S,. MASS.
SHEET_LOF Z _DATE RED. LAND SURVEYOR
20 FT. M/N- E/TNL&R THE SEPT/C TANK. DR
T /2"E
LEACKiNG P/ ARE MOPE THAN LO .,
COf�EiY' lAGRAO , AM A
SHALL 710 4AA PAF,(AV EXTRA
�� CONG�ETE 9 PVC P/PZ /yr--,4VY CA ST/RON Co l/�R SfVAL L DE USED
COVERS M/N. �►/TCN /, /.IV DR/✓EN/A Y
2 rrR� M/M. C4/VCRL�TE
G�lAOE CO✓ER CL EA)V .SAND
a
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LJgll/D LEYE rL
2 LAYER
4; 4"CAST
• /RDN P/PF /DoD
GAL. ° • � • . . . • .• ► a • .e ��,"
dr /►�J/V.P/TGlI' p/ST. '• WASHED S7u/YE
PtR J-r. SEPTIC TANK ' ♦ s • • • • ♦ a
:••: BOX v • r e • . • ° • ► . • •.
� • • r • •� 3�4. - f �2�'m `
• • o DEPTt/ • • • • . wA5N.F9> 570NE
• op PREG4.ST SEE.R4GE'
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y o P/7 OR EAU/V.
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1,VYERT AT 0411LD/IV6" ol 3' Fr ;
!HEFT .SEPTIC TANK c FT.;
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OUTLET S&P77C 7.o4NX f c FT.
//T/ON. BOX. o F7. SECT/QN;DF//VLFT OJSTRAB GROuNo WATER Tit�FLE
0UTLErn137W/BAMOnr Fr, SEl�VAGE. O/S�OrSA L SYSTAFM
/A/LET LEACNIM4 f�/7- -�+�Fr. —rXWLAT/DN
LEACHIMCP P/7'
SCALE %s
DESIGN.. CR/rh:'TIA D/r1ENS/oN 8 F•r•
` NIJMdER OF DtEGRoO/+!S s _ DJMEN /O/Y G °FT..-/►'IiiV
G.�xeAGED�sPoswL u�rir 1c/ON� SOIL LOG S01J, TEST
TOTAL EITJMATEO FLOM/ 330 0AL.1DAV SOJL TEST 01 SOIL TEST*•2
MUM Me QlF LEACNINS P/TS / _ f`FLEY. /dz, r"-EL.MrY, — OATS OF SOIL TEST
S/OELEACH/NG PER PJT RES[/1TS IVJTNESSED BY ��GC I
9oTTOM 464CN/NG PER P/T W. F T. AWACOLATION RATlg
TOTAL LEACH//VG AREA 2-lo7 s4t fT. ' „ PENCOLAT/ON RATE 1 2 MJN.IINCH.
A16"RVE GE4CN!/V6 AREA SQ. /=T.
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1 4• PNIItP/S C1 �1 /pA_ . ROBERT G
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•u 366 �: ELDRED Yr. SAS F.LORF. . E�IKT/N�►R1 1 MvJNCr.
F f . 74t2 MAIN. 9-rp /qYAMVl-1,.MASS.
'Gip C�STEF` .. r � - .. ,^ ,,(,,�0•�:�.._ ,..'. :. , r - _
FpONAI'.'. , ` .�� KG GR�IJNd YYATEI ENG'OtJNT1�R�P CL/ENT N S DATE
c 5 .�/� Q" GRO wee 1�/ATE.Q'_AT LEY. ' Sfd Z 3 SHELT�OR
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