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Home My WebLink About0052 PITCHER'S WAY - Health 52 PITCHERS WAY HYAN N IS A=289-063 TOWN OF BARNSTABLE LOCATION SEWAGE # VILLAGE i i f—aeAn,t.S — ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. ? ' IRZ U-1-4.6-- SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE; COMPLIANCE DATE: Separation Distance Between the: ' Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facili ) P 11 Feet Furnished by "`. - ,` �, � Y � — � o s K �' ► rt� �' R U QQ�� L� . 4 TOWN OF BARNSTABLE LOCATION S� }��4-CAC SEWAGE#a0-Z6 --4.3/ VILLAGE ASSESSOR'S MAP&PARCEL.09 �QC-5 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY I SOCK //-/0 A)&,A) LEACHING FACILITY:(type)��G,c,�I #-/b Combo. (size) ) NO.OF BEDROOMS 3 OWNER 1a•z.za PERMIT DATE:�7—A q-20.20 COMPLIANCE DATE: 7'30 2028 Separation Distance Between the: N aNe 6--k-er—e OF Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility EP0(C Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY � JNn N � s N 1 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftpliLAtion for I is osal 6pstem Construction Vermit Application for a Permit to Construct( ) Repair(' Upgrade( ) 4Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. `pc"e(s k)a�Y Owner's Name,Address,and Tel.No. Assessor's Map/Parcel a 6q QG 3 Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. V,A r)� aJ,,j Tac. so".,) Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building �S� �11G No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 3C) gpd Design flow provided _4 gpd Plan Date 'Z —RO —�10aO Number of sheets / Revision Date Title P "" Size of Septic Tank / / � Type of S.A.S. ,2j=gCJ ^j a—10 60ViW-rS(de1`5;b-V Description of Soil Nature of Repairs or Alterations(Answer when applicable) , 1 SC.r� c, GvJV � SZ� 1lows IAZA q1 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. Si ed Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. —� r Date Issued i 00) N . (O ! Fee _ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: t Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 21pplicatlon for DIS oBal Opstpm ConstrUctlon..Verm,It Application for a Permit to Construct( ) Repair(� Upgrade( )*Abandon( ) . ❑Complete System El-individual Components Location Address or Lot No. vtk1 c-($ Lk)cty Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 3 r Installer's Name,.Address,and Tel.Noa Designer's Name,Address,and Tel.No. VA Type of Building: - Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building �SK�RV�rICn No.of Persons Showers( ) Cafeteria{ ) Other Fixtures Y ��r'' Design Flow(min.required) `3 3� gpdDesign flow provided gpd Plan Date? 2.0 -:2&20 'Number of sheets / Revision Date Title Size of Septic Tank 15r ,/ Type of S.A.S. CPGfI(+�n3•.1�—i(� C�1"ilh� Lt'� ° Description of Soil � . 1 ii `Nato a of Repairs or Alterations(Answer when applicable)t ,t A}e+e,-)t a 15-M) ICi)l ItO 54�OiI 61 Date last inspected: ' Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in 1 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. S(i ed Date Application Approved by `` ----- ,_ Date Application Disapproved by F 4'v ' Date . for the following reasons ' "- PermitNo. `""� ! Date Issued --- ----------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance x THIS IS .1.TO CERTIFY,that the On-site c -Seewage Disposal system Constructed( ) Repaired( Upgraded( ) Abandoned( )bty ,tom _ , `� A(o. k J &r µ at � �1�(Vl!'I S ec y �� V"M S has been constructed in accordance 1 with the provisions of Title 5 and the for Disposal System Construction Permit Nvo� dated Installer ,i) A , 1") rxijt,.� 17Aj C Designer #bedrooms "� _ Approved design flow - gpd The issuance of this pre i shall not ,e construed as a guarantee that the system'll fungi M. de\sjg�ned. /E .. !! -Date Inspector�,.,,--_ •�^ i / r No. _'rV1S_'r_y:�) -Fee r;;Oe-J - -- THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS DIStJoBaY *ps t to truction permit � �on 8 Permission is hereby granted to Construct �( ) Repair( ) Upgrade( ) Abandon( ) System located at , s}' � Yy"/S �f 1f Gr'y N P t - / 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 com leYed within three years of the date of this permit. �,... ..e..,,, Date � .. �� Approved by f- �-, } �. e , IT I� ��r a Out _ 4 M; Ihl`r�eE e a Amour; �i ' ICU # � s 3 z i F 14 -if fw D- ON M.@.O' ' �.. ..5 P 4� lI 1. �.'.�l•F. I rm �. on, . - f F x' If t,{ if I fa �IIs�J,��i,'��a � �• .._. p+..�n' �y}'.y.gl p�i�l{!G'9�IJ.1 .` i��l{.�Lf.l�e�_ !"�I Qy'µq t, _� i _ �� Tom!!• �e AP i. � _oe:W ffe-d,al�=- I!b L111.6 . -- ' - . q F - � .. w ti E spry yfl m ,. ti .. • r3a CO OFFICIAL USE c:E) Certified Mail Fee 6.Services&Fees(checkbow add fee as appropriate) I ❑Return Receipt(hardcopy) $ . If Q ❑Return Receipt(electronic) $ Postmark 0 ❑Certified Mail Restricted Delivery $ tt Here II D ❑Adult Signature Required $ J�\ []Adult Signature Restricted Delivery$ —— -- O - _ m l� MILLETTE,MARIANNE Ui,i 52 PITCHERS WAY a HYANNIS, MA 02601 r`j Certifies!Mail service provides the following benefits: ■A receipt(this portion of the Certified Mail label). for an electronic return receipt,see a retail ■A unique identifier for your mailpiece. associate for assistance.To receive a duplicate ■Electronic verification of delivery or attempted return receipt for no additional fee,present this delivery. USPS®-postmarked Certified Mail receipt to the 1 ■A record of delivery(including the recipient's retail associate. signature)that is retained by the Postal Service" Restricted delivery service,which provides for a specified period. delivery to the addressee specified by name,or Important Reminders: to the addressee's authorized agent 0' -Adult signature service,which requires the �y e You may purchase Certified Mail service with signee to be at least 21 years of age(not First-Class Mail®,First-Class Package Service®, available at retail). r or Priority Mail®service. Adult signature restricted delivery service,which ■Certified Mail service is not available for requires the signee to be at least 21 years of aged international mail. and provides delivery to the addressee specified n Insurance coverage is notavailable for purchase by name,or to the addressee's authorized agent 3 with Certified Mail service.However,the purchase (not available at retail). F., of Certified Mail service does not change the s To ensure that your Certified Mail receipt is insurance coverage automatically included with accepted as legal proof of mailing,it should bear a, certain Priority Mail items. USPS postmark.If you would like a postmark on Trf For an additional fee,and with a proper this Certified Mail receipt,please present your endorsement on the mailpiece,you may request Certified Mail item at a Post Office-for the following services: + F ` postmarking.If you don't need a postmark on this Return receipt service,which provides a record Certified Mail receipt,detach the barcoded portion_ of delivery(including the recipient's signature). of this label,affix it to the mailpiece,apply You can request a hardcopy return receipt or an appropriate postage,and deposit the mailpiece.C electronic version:For a hardcopy return receipti complete PS Form 3811,Domestic Return Receipt,attach PS Form 3811 to your mailpiece; IMPORTANT.Save this receipt for your records. PS Form 3800,April 2015(Reverse)PSN 7530-02-000-9047 i SENDER: COMPLETE THIS SEC TION COMPLETE THIS SECTION, . ■ Complete items 1,2,and 3. A. Signature ■ Print your name and address on the reverse X Agent so that we can return the card to you. res. ■ Attach this card to the back of the mailpiece, 9FTeceive y Printed Name) C. Date bf Deli'ery or on the front if space permits. .—"" ddress different from item V'10Y delivery address below: ❑ fm�-' MILLETTE,MARIANNE - 52 PITCHERS WAY HYANNIS, MA 02601 it I�IIIOI I II 101 I Ilil III II I I I I II II III I III i i III 0—deN,ce-pure ❑Registered Priority ed press® O Adult Signature ❑Registered Mail*^ � ❑ dult Signature Restricted Delivery ❑RegIstered Mail Restricted ai 9590 9402 5745 0003 5532 29 Certifirtined Mail Restricted Deliverytum Recant for ❑Collect on Delivery t Merchandise 2. Article Number(Transfer from service label) ❑Collect on Delivery Restricted Delivery ❑Signature ConftrmationTm Ll,lnsured Mall ❑Signature Confirmation i[ E i;i Restricted Delivery Restricted Delivery � 70.15 °1"730 ,0�01�.,4988 � 1722� c-��;� I-PS Form 3811,July 2015 PSN 7530-02-000-9053 v ` Domestic Return Receipt USPS TRACKING# First-Class Mail Postage&Fees Paid USPS Permit No.G-10 9590 9402 '574T UD03 5532 29 United States •Sender: Please print your name,address,and ZIP+4®in this box* Postal Service Town of Barnstable q Health Division 200 Main S e� treet II� O Hyannis,MA 02601 I . I L I T Town of Barnstable Inspectional Services Department BARNMA SS 99A8S ' Public Health Division . o " 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7015 1730 0001 4988 1722 June 12, 2020 MILLETTE, MARIANNE 52 PITCHERS WAY HYANNIS, MA 02601 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE,TITLE 5 The septic system located at 52 Pitcher's Way, Hyannis, MA was inspected on 05/18/2020 by Darrell Stone, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: Q • Leaching facility with standing liquid level at or above the invert pipe (per Town Code 360-20 h). You are ordered to repair or replace the septic system within two (2) years from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH c ean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\52 Pitchers Way Hyannis.doc �.try rqy, Town of Barnstable BA"STABLE Inspectional Services Department rfD MAti A Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 4/26/19 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An"x" marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ❑ Structurally unsound septic tank or SAS ONE (1) YEAR DEADLINE CRITERIA o Static liquid level in the distribution box is above the outlet invert due to an overloaded or clogged SAS or cesspool ❑ A portion of the SAS, cesspool, or privy is below the high groundwater elevation ❑ A portion of the cesspool is located within a Zone 1 to a public well ❑ A portion of the cesspool is located within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2) YEAR DEADLINE CRITERIA ❑ Single Cesspool o Any "conditionally passed systems" (broken cover, relocation of a pipe, relocation of a driveway due to H-10 components, etc) beaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER Repair deadline: Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc Commonwealth of Massachusetts 0?89_ O&3 Ib ,9 Title 5 Official Inspection Form ' Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 52 Pitchers Way Property Address Marianne Millette-Kelley Owner Owner's Name information is required for every Hyannis MA 02601 5-18-2020 page. CltylTown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any' way. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information on the computer, use only the tab Darrell Stone key to move your Name of Inspector cursor-do not Cape Cod Septic Inspection, use the return key. Company Name P.O. Box 1466 Company Address Harwich Ma 02645 City/Town State Zip Code (508) 240-2500 S14995 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ❑ Passes 2. ❑ Conditionally Passes 3. ❑ Needs F rt er Evaluation y the Lo pproving Authority 4. ® aFail : 5-20-2020 Inspegnature 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 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 form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: 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. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 P Y s Commonwealth of Massachusetts F Title 5 Official Inspection Forrn i� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments J� 52 Pitchers Way Property Address Marianne Millette-Kelley Owner Owner's Name information is 9 required for every Hyannis MA 02601 5-18-2020 page. City/Town State Zip Code Date of Inspection Co Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) 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: k, 2) 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): ,5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts _ �e Title 5. Official Inspection Fora Subsurface Sewage Disposal System Form Not for Voluntary Assessments - % 52 Pitchers Way Property Address Marianne Millette-Kelley Owner Owner's Name information is required for every Hyannis MA 02601 5-18-2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. a ❑ 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): 3) 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. a. 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: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3,of 18 Commonwealth of Massachusetts " �p Ip Title 5 ®fficial Inspection Form 'T A Subsurface Sewage Disposal System Form- Not for Voluntary Assessments e % 52 Pitchers Way Property Address Marianne Millette-Kelley Owner Owner's Name information is required for every Hyannis MA 02601 5-18-2020 page. Cityrrown State Zip Code- Date of Inspection C. Inspection Summary (cont.) ❑ 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 b. 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 aseptic 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. c. Other: 4) 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 t6insp.doc•rev.7/26/2016 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts P Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 52 Pitchers Way Property Address Marianne Millette-Kelley Owner Owner's Name information is required for every Hyannis MA 02601 5-18-2020 page. City/Town State Zip Code Date of Inspection Co Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® 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 ❑ ® 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 water supply 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 2000 gpd- 10,000 gpd. ® ❑ 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. 5) 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. F For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section CA. 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System.Page 5 of 18 Commonwealth of Massachusetts Title 5 official Inspection Form JJ Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 52 Pitchers Way Property Address Marianne Millette-Kelley Owner Owner's Name information is required for every Hyannis MA 02601 5-18-2020 page. City/Town State Zip Code Date of Inspection Co Inspection Summary (cont.) If you have answered "yes"to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate "yes" or"no" for each of the following for all inspections: 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)] ;Sinsp.doc•ray.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 16 Commonwealth of Massachusetts p Title 5 Official Inspection Form aI�� Subsurface Sewage Disposal System Form- Not for Voluntary Assessments G 52 Pitchers Way Property Address Marianne Millette-Kelley Owner Owner's Name information is required for every Hyannis MA 02601 5-18-2020 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): NSA Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Description.- 3 bedroom residential dwelling Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes•® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes Z No Seasonal use? ® Yes ❑ No Water meter readings, if available last 2 ears usage d 185.4 gpd 9 ( Y 9 (gpd)): Detail: 2019 - 105,468 gal 2018 -29,920 gal Sump pump? ❑ Yes ® No Last date of occupancy: Unknown Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 16 r Commonwealth of Massachusetts :. Title 5 official Inspection, Form '= ja Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 52 Pitchers Way Property Address Marianne Millette-Kelley Owner Owner's Name ..: information is required for every Hyannis MA 02601 5-18-2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. 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 Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Unknown Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: I [5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 52 Pitchers Way Property Address Marianne Millette-Kelley Owner Owner's Name information is required for every Hyannis MA 02601 5-18-2020 page. City/Town State Zip Code Date of Inspection ®o System Information (cont.) 4. Type of System: ❑ Septic tank, distribution box, soil absorption system ❑ Single cesspool M . 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): Approximate age of all components, date installed (if known) and source of information: pre 1978 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. 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.): t5insp.doc•rev.712612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts �b =. Title 5 Official Inspection Form & Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ............ 52 Pitchers Way Property Address Marianne Millette-Kelley Owner Owner's Name information is Hyannis MA 02601 5-18-2020 required for every y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. 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: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): :5inso.doc-rev.7/26Y2018 A Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts i= ,/�p Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments rr 52 Pitchers Way Property Address Marianne Millette-Kelley Owner Owner's Name information is required for every Hyannis MA 02601 5-18-2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. 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: I Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts �d p Title 5 official Inspection Form 1 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments %/ 52 Pitchers Way V Property Address Marianne Millette-Kelley Owner Owner's Name information is required for every Hyannis MA 02601 5-18-2020 page. Cltyfrown State Zip Code Daespection D. System Information (cont.) 8. Tight or Holding Tank(cont.) 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 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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.): 15inso.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 Commonwealth of Massachusetts 19 Title 5 Official Inspection For J,a Subsurface Sewage Disposal System Form- Not for Voluntary Assessments e% 52 Pitchers Way Property Address Marianne Millette-Kelley Owner Owner's Name information is required for every Hyannis MA 02601 5-18-2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. 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. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ® overflow cesspool number: 1 ❑ innovative/alternative system Type/name of technology: ;5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 16 Commonwealth of Massachusetts I # :. ip Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 52 Pitchers Way Property Address Marianne Millette-Kelley Owner Owner's Name information is required for every Hyannis MA 02601 5-18-2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.).- 1 (6x6') cesspool , Grade to cesspool 13" Bottom 96" Dry Baby wipes stuck to bottom of cover and sidewalls up to the top This system is in hydraulic failure 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration 1 (5x5) Depth —top of liquid to inlet invert Depth of solids layer 24 + Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ondin condition of vegetation, 9 Y P 9, 9 , etc.): Grade to cesspool 19" Orangeburg inlet with roots growing into the pipe Orangeburg outlet broken t5inSD.d0C•rev.7/26/2018 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts ip Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 52 Pitchers Way Property Address Marianne Millette-Kelley Owner Owner's Name information is required for every Hyannis MA 02601 5-18-2020 page, City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 D t •. I Commonwealth of Massachusetts is ,p Title 5 official Inspection 'Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 52 Pitchers Way ` V Property Address Marianne Millette-Kelley Owner Owner's Name information is required for every Hyannis MA 02601 5-18-2020 page. Cityrrown ` State Zip Code Date of Inspection D. System Information (coat.) 14. 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 REAR 0 i 2 I A I j 16- o l,*o 0 2 35_g Z p I I ICI I - f- I t5insp.doc-rev.7/25/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts s Title 5 official Inspection Fora a Subsurface Sewage Disposal System Form - Not for Voluntary a � ry Assessments 52 Pitchers Way Property Address Marianne Millette-Kelley Owner Owner's Name information is Hyannis required for every y MA 02601 5-18-2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked date of p design pl an an reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Groundwater separtation was not determined due to the failure of the system Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 Df 18 Commonwealth of Massachusetts Title 5 Official, Inspection Form � Subsurface Sewage Disposal System Form - Not for Voluntary a Y Assessments r� < � 52 Pitchers Way Property Address Marianne Millette-Kelley Owner Owner's Name information is Hyannis required for every y MA 02601 5-18-2020 page. Cltyfrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included f t5insp.aoc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 ,yno�aa'••'rw a:-a,.,.:-c-;••xt..c��.�+-a:- - ycwnvasr.+�-•�+xaa-•-z'a--ate. :s>,-. a-z.�u:swa�cs..x•.s�as�ms�•s'+Or�li.=-eark�fRa.�-*�.�.:...�+4"�Arwx1•a*a-r.ese+rsu:""_- ..� •..�,-.sac.x 7P�••triM_®tav=. - .. .�•`.M♦ eaV.r_ - _ _ . yam.' i�.�V� �yL=F/�!�.�M�. i]��'1-� �' .. j.!• � /_� j .._ .... � �iJ"'� _.-_. . w '4 - .-_ -. ai• ✓-.- •. _-..w... .._d' .. �riiw.al.F �.+�C �,.� ..w. .a _Y s _... .-vS. a,c[ � a- - The instailation shall izo-nt'iiy kt,Rh Vie date Environrn__ntaI Code)ii ie'a�r. i TOWn C►f 4� malt �� n': arc!o, Health Regu':it s. S r•. . _ � _ C►�'�" 1e_ �i `j - `�'C� c+ i'?5 Lefil J;3VGvlJ orb r Fi$Man 53lall rlOt be in5id!:!ti •_:'1i11 e'1+:'lS@d town i!15ta>le( _ �..... • �( ]�\J �� f '• ept�C'�S �� : :. �f (,�/ f FceiveS approval-and i r r i=psi it►ti=�r;permit front the applicab.'a o installation, _ .r.. . . . _r y he location of !.i , sewer p s ---�- �.r'. . . - ��-�� ltJ►� � '• Prior allarfOn,ll;(` :t,�1{G' K:':-i�lera� if t IC^ 4?•i''iC'" St''�rf; .iV :ic^.S 49 `:•, � - - eftsli ::u existing septic coiliporieni:s , , In5tall3tlari. ► T7►ga 1 I? ... ='y All gravity sewer piping is to- be 4►nc r:scheffule�a PVC at 3;=�' ;,.; foe Inc. first z feet ou: ..-;e distribution box shall he VVel. A:1;_iping connections to be vl�,pr . y �� =:is septic,design ulav is n:: r,:t )e ,t ! _,-d for property lin l�,r-rrnir a°.i Ur for any other Y �� Sri:rpose other tM.n the ra-ap'-A d 5�,'Oc System installation. F Aii Title V cornpor_ent o e I::rr'�--'� =`We%/specifications. ! - ,,,1�1 _ j• '��i king shall be p o:iik.ite t ;�� i lEi�.�;rt,m;,c�ncnts unle;::�-nprr}:-nis a;F HZ{3 s'oar�ed. � if '?:r rite existing leaching crr-�>;t:a;;i;51-,0 be purnpend and filled wi h matpr'al,oer Title V l ' f abandonment proceduc l act?i:ir, and cesspool(s)and t•s�,ta;r;in�ter� 5c,ils wit in the PWO Osed SAS shall be ft�._i.:t E ar .- t t Ve a-• ;-' p ter' ►.- �e;,laced with c-ean Said fier `i;aF �.�s�._t.+fir_at:ans. F _i Septic components are zor tl� 10' ';--j. .a wlater service fine_5ewet',;yes CfCi,S;ng a water line ;►: ;; tq Lf be sleeved with an appr:k�. , si-F schedule 40 PVC with ��;c��.gTouter:: The water service- , "I'—' or file Septic line•�.;. is.`L+ ! iOlth thesleeve be;ng;y .',tta "� bot'� Cide5 ,7[ D . Jssing the line- garbage tf.; garbage grinder exists i:? Tb-:- j.,i,;�, r Y`D, _ , _ _ •e,it is to be. removed if _,!_ sera system is not �� sigr;ed to acecyrnrt�cr'=.r ,.:' �4� gr;i,�ier. s 3 � -T t--3 i:'ki-instalier i5 red(;Cn-sC u -Vr a' rr,!c�V3tiUfif 8raut`:i dl, .ii;�i::t i;t. tt> ;.:ropetty and � .._. __ . . _. . . _ .._� .,. ... _ t%r'(liecting the structu:a# i,� >�rr;t, ,; Y;1:trust;lre5 Qt,fiflg tl; :r;:,tdllPifr lC 100c�5s Of this septic t Y P 4 ptir can bee instal. #<;r-i t 1-a l 'sy meeting Title O-dn only re T�St?R'`S r'i'ipe a .,p't! 5;+5tet?T� ;�,, 1 a ,f{� ,+-�• 0,' i 119 ..a - � D ,, ('KLtlfE+rlienfS. } - 1 ;:A G_I l;ie PrOC?Prty4['Vfier''#7�t' 't`"!I- tV t}tzty criteria to approve ii,-,tent%(' ail-:':A"' of bedroor,'Isan(..' a p ; : � -sign flow. lnstallatic;:fif lrl,' .eptic_ ..tern as proposed a;:d rc.e:pi v' :,.�•r;neat for the design shall be deemed appro-,a 44 tt5r:'' rikse r',criteria f]v the prQAarj�f c�i�'�Igr o'':+{'f t of. ' le validit of t►i ian+: ail: t ! !re with v t t f •ir('t ;{�` ( �� . . ,r <�": -•�j�V _ y s P P the.,expiration of t.is �•,: ir' ::7r. permit issue-' t;:i plan or the valiilli�: s '"' £+13r 5`it]ll P_XOIi �?►�t#�P.f'?(171rc�tii%:i a!'i}P f.F'r; flCate of Compliant.:: Q ` {` r�1 f r f .�i%iN iv,u cl forthe i,l5iiil :i 1st,• ►::Ltrt� `�f!System('•� .his plan, a - l _?.� - 1lg �` = f l t `i -j d DA4/li, �' µsr MAC J fv >� i Q .rrs, h _._. 111 -Dot c TIN 'Alf psi. •�- .F �r 3 f a, 2s `x lZ+�3 7a�Z y � F aea�.�.aa^rarna:-:non..�c�..�-•sr.�x....:-t�yw��w�ct-arwn�rae+a.�,+�twm�.•.+ r..i.-•e.:..-,.::ar.+-.rn xss---� i• � :a •j�E _ V (f rep • '' _.-__ ...__..._�__- -- ��:. . _ ' - "'•f��r••±~��I;__ ;fir cs'�,tw.Ra.aa. 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