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0338 PITCHER'S WAY - Health
338 Pitcher's Way Hyannis P A = 290 117 I� ,i N { 'b'M r��—f -S- I tj '%A 10 � -- s , Ooo r - rt- AOQ 4S c aooa � QO CA Door 4-Ch.",r. _ o 00 � -� _ - _ u � � n V sdo"Y� )D/Q .42 Oo�,'1I i la�a7 -Aa'• n Up peV eV e( ! 1 J /I J \ 4 i c r vine,I - CD cr 33 b /,n D �,.•� � ! cam, � � . � � s. z n d a W m m i YQ L Q bCeA y v f 4,� _ [max mac. off. � � L.� _ � —• o Cuing r Health Inspector Town of Barnstable P OZVE rp� Office Hours o Regulatory Services 8:00—9:30 �. Thomas F.Geiler,Director 1:00—2:00 * snxxsrnac,e. : Only MASS. 1639. Public Health Division _ Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 AMNESTY PROGRAM APPLICANT QUESTIONNAIRE 1. General Information: Address: 338 VI-�i �5 '1 G�,,•,„ ►5 Map 2 D Parcel (1 Name: J ` I�pt9/ - Phone: 2. How many bedrooms exist on your property now? NFO 3 -_ 2a. Please include a copy of your floor plans for the entire property. 3. Is the dwelling connected to public sewer. YES or NO DEC 5 2002 If the dwelling is connected to public sewer, skip ques ' 4-9 below. 4. Location of dwelling ' INSIDE or OUTSIDE a Zone of Contribution to public supply wells? 5. Is the dwelling connected to an ONSITE WELL or to PUBLIC WATER? 6. Is a disposal works construction permit on file. YE or 6a.If yes,how many bedrooms were approved according to this permit? - ° Fff�-/ drooms. M 7. Were any building permits obtained for construction of additional bedrooms? YES or NO 8. Is there an engineered septic system plan on file at the Health Division? YES or 9. the septic system been inspected by a DEP certified inspector within the last two years? Oqb"" , YES or NO ----------=--------------------------------------------------------------------------------------------------------- FOR OFFICE USE ONLY TO BE SIGNED BY A HEALTH INSPECTORIAGENT ONLY The Public Health Divisio has no objection to bedrooms at this property. Signed: Date: 1 Inspector(Print): L f3w r 1elv '- -Q—fj roams. ea�+�,v� br useeQ as --R 6e1-X4J r t(G'Y'T/C4100. l�Cr`/�0�"Q I I m IQ'►/!G� p r� CD 11"1 , Q:PT/AMNESTY/PUBLCHLTH.doc V t! w ROAD � , GL 143.00FORT;,ST 763° g'10 E N LOT 33 tv c� N =W=__= x LOT 34 26.3 = � I 157•40 i � s77°44 4 p"W LOT 31 RES. ZONE.• "RB" This MORTGAGE INSPECTION Plan is For FLOOD ZONE- "C" TOWN: _HAffffIS Bank Use Only ____________ REGISTRY OWNER: _ JANET A._WRIGHT_____________ DEED REF: _ CTF. 1l7379—___—__BUYER: -REMAMM___________________ DATE: _4�28L92 _—__ ------ _____—_ PLAN REF: _22825 L —_--___--SCM97. = 30- FT. I HER CERTIFY TO CAPS COD RAAA & TRUSS CQ_ ��-S-1ZTY,-lNSLZBANCE'CQ.-_--THAT THE BUILDING YANKEE SURVEY SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS S- I,�O` \;&.; CONSULTANTS SHOWN AND THAT ITS POSITION DOES _ - CONFORM - ,T REQUIREMENTS OF THE ' �' TO THE ZONING LAW SETBACK RE '4 ='��=, it'�E�il;�i�✓1' ; ,. 143 ROUTE 149 TOWN OF _ BARNSTABLE _________ `: -, —_AND THAT ..., NO. �2,.90 �= MARSTONS MILLS, MA. 02648 IT DOES_1tiQT _ LIE WITHIN THE SPECIAL FLOOD HAZARD �F �y°u 'i F'01 TERE �J TEL: 428-005.5 AREA AS SHOWN ON THE H.U.D. MAP DATED_8�MZZ65 °" Co unit -Panel 250001 0008 C �"s�' J. FAX 420-5553 _---- THIS PLAN NOT MADE FROM AN INSTRUMENT PALTL A. M RIT W PLS SURVEY NOT TO BE USED FOR FENCES ETC. 8589 KJH 1- r ► Ja J� J7 �- � • a5 ;IIAI - 31- 3`I - I 43 l3 5 Gv/d u5— �� I L, Is L 7 , 1q ,o �y �s 07�_ _9_-�- _- - - - --- ---- - - ' Q/ -21 �y _ y6 4 �y Y1 22825Z FLU," c,f LA1,11' ';,, 1 , ,,,1 P^:�r:�P-�7 r�h�irr9 l.:ri�.� , ��Ut•V�'�'C)r� �.�/ N I--r .1.IU• S S W c.ls. N80° C ENTE1p 3 ^' � SS 55 29 e rm o cr l U dJ, in° _ Ln m N C.-9-08 1 9"E C.d-In h` f coW ' , 30 °O �o.o 45.75 -� c�, �� ;l pro 3 o � l7�.oO � � � � �c N - J 6 _ o ' 7� 7 7. m ` UZ- 3 ! Nag4r, p 7 °0�0 �OZ.9 ��° - 7 V "zg 5o w I 7 z c� Si3 N 7 6� W I D F) 6 (D 1 O u.h.;n /� 4_ 3•pip _ � C'e• � � `-- _ _ •7 38 3- 3 r' V a 17- 5.3 8 ° � J 0 OD �. N 65° LZ' 3C.•F n Z 1 ,5 � ,JO 0 N ,1.',.ir _.. 7 � , °) ti 3 9 j W ° � 3 �' N 4;� Q°Q 3 all. ,c Q, It 2 7 �7. tY � o N ;, Fes• _ I2O' z Ld 1 cf. �0 ti • I TOWN OF BARNSTABLE LOCATION 8 0//c/1 fib S SEWAGE# 7 r- 3Sj VILLAGE y!h o� _ ASSESSOR'S MAP & LOT .INSTALLER'S NAME PHONE NO. EA- --,7 -62" SEPTIC TANK CAPACITY /G®a LEACHING FACILITY:(type) NO. OF BEDROOMS _PRIVATE WELL O PUBLIC ATER BUILDER OR OWNER -7�1/9 w r 7— DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: 14,,Ste£CZ7Qti VARIANCE GRANTED: Yes No M 4 W O O q ..t' mod.. ,. ` •`,� l6`,C A T ION S [ WAG E PERMIT NO. VILL-AGE INSTALLER'S NAME i ADDRESS L 1 r6 S U. I L D E R OR 2WNR DATE PERMIT ISSUED P( DATE COMPLIANCE ISSUED y � t G r� Ce . IC w� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .�, ..................O F....5 ..b.l:e:.... ........................... Appliratiun for Uispusal Works Tunstrartiun Permit } Application is hereby made for a Permit to Construct ( ) or Repair ()() an Individual Sewage Disposal sy ..........................._........._ ......................--...........a ......._..................._......_..__.... • ti n-Addles or Lot No. ........C,df�� .---,�. b-<� ............................. Owner— Ad ress W � �-5 Gy.�c=2 v l� ..................................................... Installer Address ;z/ wO -t— Type of Building Size Lot......,1......:.............Sq. feet U Dwelling—No. of Bedrooms.............................. .. .Expansion Attic ( ) Garbage Grinder ( ) '4 Other—T e of Building No. of persons............................ Showers — Cafeteria a' Other fixture WW Design Flow.................. ..lP._..jj.:......--gallons pe - �r day. Total daily flow............a3.0................gallons �� z. WSeptic T k! �iquid capaci yX©QQgallons Length.8....6....._ Width..-_=f�... Diameter................ ep�ll_ . .. xDisposal —No. ................... Width....'./.. -....... Total Length.... .rS......, Total leaching area---................sq. ft. 3 Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box (111j Dosing tank ( ) r Percolation Test Results Performed by..,R,:.... Ws'.A�^' '.G................. � Gam• ��• � -----�r,-.-------�. - 1 Test Pit No. 1 ..._.__...minutes per inch Depth of Test Pit...7............. Depth to ground water.......:._._.......... 44 Test Pit No. 2..... ....minutes per inch Depth of Test Pit..f- n��...... Depth to ground water...j_,r........ -O Description '.�.' O•-/2 �'i`l/ i.2 � 3�'':C?�.:o�f--.��_.��.�.���-=•._S.lry-S,..A ��2`� 7.� " Co•r�sE 5��..� .: 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 operation until a Certificate of Compliance has b�su�the b an�oh Signed-..... .-..-/-�--� ................. ` A ��e Application Approved B ....._. .� Application Disapproved fort ollowing reasons:......................... -•.................................................................ate........___ ................. ..•---•----^..................------._.......................------•--•...............••.........._..................I..........................-- PermitNo...... ....................._................._ Issued--................................................... 1., Hate ._ tgS_ 3.5 Ste= f F$s.......___. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Appliration for Disposal Works Tonstrudion Permit Application is hereby made for a Permit to Construct ( ) or Repair X) an Individual Sewage Disposal System at: 0333 8 P,tc h e s »/� •Location-•Address •. •- or Lot No- (_,_-RA%q...6 I?Z)W/!fir..............................--- .............................................................................. i� r T A.DMZ! 9.....__.. Address W ,�,e'/ H ��•N S% � G' -i'-,��/ G e_ f•,ei 7 L:.r2 v�/+'E"' Installer Address / T Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms.............................. ... .Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building No. of persons............................ Showers — a YP g ............................ p ( ) Cafeteria ( ) a • - �. W Other fixtures ................ .. . . ... -....__.:....._.......-••-•--•............. Od Septic Tank,—' Liquid capacaity�?���gallons p L negth:�pe�°.�yWidt��`�fl�Diamete�-..��-----••---•-S�Gns.y Design Flow... .. 3 Disposals No. ...... ........... Width....Z_�::.._�. Total Length...._�J__.$'......-. Total leaching area....................sq. ft. 3 Seepage Pit No.....................Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box Dosing tank ( ), , �- , a Percolation Test Results Performed b .................................................may__.•__--•----....... Date.._.....:...... ....---............... ,.a Test Pit No. 1_.�.'"..._minutes per inch Depth of Test Pit... '�......_.. Depth to ground water.....-................. f= Test Pit No. 2..... _....minutes per inch Depth of Test Pit.................... Depth to ground water......... a ........... ....................... ............ O 4^ /� . // / - 3 6 /"e���7, 3 6� r�-� C_ Rs s s Description of Soil..............................•-----.............-••---.....--•-----.......... ......... .......... /.� _ Vic{ 'rc'.a-7 , 36' - F/.ri` S i 7� �.� tS.-C - % 2 �cl.n- 5 G ?s . _. ' 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 operation until a Certificate of Compliance has been issued,by the board of health.�C Sign � _... ............... .................. ..... ........... Application Approved B 4 e�S -......:. I ate Application Disapproved for t following reasons________________________________________________________________________...................................___ ........................................................................................----•-•••....._...------------------•---................---........---------•--------...-•--••--••-----______ Date PermitNo.............................-....-........---._ Issued.--..................................._._.......__.... Daft THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH A' ..........................................OF............................................ ...................-...-..-......... Tertif irate of Tomplianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ') y...............................�.............. - -/-•../........................................................................................-.........................................._ j i r C h�i' (. /l> /414"tom i✓r S at.....-••.......:...................................•-•........ ..._........•-_... .--•--.......---------•................................................. ---•--•-•... ........ has been installed in accordance with the provisions of TITLE;- 5 of^The State Sanitary Codeas described in the application for Disposal Works Construction Permit No....................._.___'_._.._.!_._. dated......--._-.r...-...--- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. #`� DATE...................................L..:....../.: ........- 3 ...,...._.A Inspector......................_._........_................... ... • ............ THE COMMONWEALTH OF MASSACHUSETTS t BOARD OF �ALTH � 5 - ? a..........................................OF..................................................................................... 0C) Disposal lurks 6nutrurtion frrmit � i '.z e ,0/ if" ,• 5' r r v _L r - Permission s hereby granted..-! -•----•-•..............................•---..-_._...-...----............_._.-.._............-......._...-_..-...-........._........ to Construct_( ) or. Repair (,) an Individual Sewage Disposal System Street as shown on the application for Disposal Works Construction Permit No.......-........L -Dated............:............................. � - ..............•-----._...----•-------............ ................................................... Board of Health DATE................................................. f'a FORM 1255 HOBBS & WARREN. INC., PUBLISHERS yo�YEEEg�� ( TbwN OF.BARNISTABLE OFFICE OF BAsasTAU ®AR® OF HEALTH 9®® 039 i6�q 367 MAIM STREET HYANINIIS, MASS. 0260E October 17, 1984 , Mr.. Craig Baldwin P. 0. Box 661 Dennisport, Ma. 02639 Dear Mr,. Baldwin: ' You are granted a variance from Regulation 15.15 (3) and (6) and Regulation 15.02 (17), of 310 CMR 15..00,' of the 'S.tar.e .Environmental Code, to upgrade an 'existing septic system at 338 Pitchers Way, Hyannis, with the following conditions: ('1) All other regulations contained in Title .5, of the State-.Environmental Code, and the Town of Barnstable Health Regulations must be complied with. (2) The designing engineer must be on site to supervise construction of the onsite sewage disposal system. (3) Prior to any occupancy or the issuance of a Certificate of Compliance, T, , the designing engineer must certify in writing to the Board that g*is design has been complied. with. r•. This variance is granted because it, is an upgrading of a failing 'system consisting of cesspools in ground water. 2er, truly yours; Robert L.' Childs, ';Chairman Ann,J e shba M. BOARD .OF HEALTH TOWN OF BARNSTABLE JMK/mm . Y t a A a R. J. O'HEARN, INC. REGISTERED LAND SURVEYORS eswan 2 REGISTERED SANITARIANS 35 ,=Route 734 eSout�z 1�ennia, �a.. o266o 394-1265 June 3 , 1985 Board of Health Town of Barnstable Hyannis, MA Re : Lot #34 Pitcher' s Way Barnstable Craig Baldwin Gentlemen: This office has inspected the installation of the on site sanitary facility at the above referenced project. All unsuitable material was removed and the system was installed in strict accord- ance with the approved plans. Very truly yours, fchard Hearn Presi ent I' Commonwealth of Massachusetts l � W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments a� M 338 PITCHERS WAY f'�✓ Property Address WRIGHT Owner Owner's Name information is required for HYANNIS MA 02632 4-14-15 every page. Cityrrown 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 l- forms on the computer,use 1. Inspector: Cr only the tab key to move your DOUGLAS A BROWN cursor-do not Name of Inspector use the return key. D.A.BROWN INC Company Name , P.O. BOX 145" Company Address CENTERVILLE MA 02632 City/Town State Zip Code 5084204534 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: Passes ❑ Conditionally Passes ❑ Fails .❑ Needs Further Evaluation by the Local Approving Authority Cal Q 4-14-15 Inspector's Anature 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. V t5ms•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Pa 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 338 PITCHERS WAY Property Address WRIGHT Owner Owners Name information is required for HYANNIS MA 02632 4-14-15 every page. Cityrrown 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 MET ALL MINIMUM PASSING REQUIREMENTS AT TIME OF INSPECTION THIS REPORT DOES NOT PREDICT FUTURE PERFORMANCE UNDER THE SAME OR INCREASED USE 8) 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 Farm:Subsurface Sewage Disposal System•Page 2 of 17 s r � Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �M 338 PITCHERS WAY Property Address WRIGHT Owner Owners Name information is required for HYANNIS MA 02632 4-14-15 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 338 PITCHERS WAY Property Address WRIGHT Owner Owner's Name information is required for HYANNIS MA 02632 4-14-15 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 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments s 338 PITCHERS WAY Property Address WRIGHT Owner Owner's Name information is required for HYANNIS MA 02632 4-14-15 every page. Cityfrown 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 El ❑ 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 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M , 338 PITCHERS WAY Property Address WRIGHT Owner Owner's Name information is HYANNIS MA 02632 4-14-15 required for every 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 ® ❑ 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): 3per as- Number of bedrooms(actual): - 3 built 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 M 338 PITCHERS WAY Property Address WRIGHT Owner Owner's Name information is HYANNIS MA 02632 4-14-15 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: ACCORDING TO AS-BUILT CARD SYSTEM CONSISTS OF A 1000 GALLON SEPTIC TANK D- BOX AND A 38 FT LEACH FIELD IN A 38 X 12 FT AREA Number of current residents: UNKNOWN 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. El- Yes No Water meter readings, if available last 2 ears usage d SEE BELOW 9 ( Y 9 (gP ))� Detail 2013-------303 2014---289GPD Sump pump? ❑ Yes ❑ No Last date of occupancy: APR 2015 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•3113 Title 5 Official Inspection Forth: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 M , 338 PITCHERS WAY Property Address WRIGHT Owner Owner's Name information is required for HYANNIS MA 02632 4-14-15 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): v General Information Pumping Records: Source of information: OWNER STATED YRLY PUMPING 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 I Commonwealth of Massachusetts w W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 338 PITCHERS WAY Property Address WRIGHT Owner Owner's Name information is required for HYANNIS MA 02632 4-14-15 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: UNKNOWN Were sewage odors detected when arriving at the site? ❑ Yes ® No _ t Building Sewer(locate on site plan): Depth below grade: feet Material of construction: cast iron 4 V El cast PVC El 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: 1.75 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: APPEARS TO BE 1000 GALLON Sludge depth: 0 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 338 PITCHERS WAY Property Address WRIGHT Owner Owner's Name information is required for HYANNIS MA 02632 4-14-15 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 0 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,Y liquid levels as related to outlet invert, evidence of leakage, etc.): OWNER STATED REGULAR PUMPING FOR MAINTENANCE. TANK WAS CLEAN AT TIME OF INSPECTION Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions:. Scum thickness a 4 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 338 PITCHERS WAY Property Address WRIGHT Owner Owners Name information is required for HYANNIS MA 02632 4-14-15 every page. Citylrown 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 L15,'.s13 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 w„ 338 PITCHERS WAY Property Address WRIGHT Owner Owner's Name information is required for HYANNIS MA 02632 4-14-15 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 0" 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 SOLID CARRY OVER 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: THE FIELD WAS NOT EXPOSED BUT I DID PROBE INTO THE STONE BED IN SEVERAL AREAS AND FOUND DRY SOILS WITH NO STAINING, I ALSO LOCATED A PIPE EXITING THE D-BOX AND FOLLOWED IT FOR A FEW FEET AND FOUND NO DARK SOILS OR STAINING AND DRY SOILS AS WELL 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 338 PITCHERS WAY Property Address WRIGHT Owner Owner's Name information is required for HYANNIS MA 02632 4-14-15 every page. Cityrrown 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: 1 12X38 per as- built ❑ 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.): see comments at the bottom of page 12 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 338 PITCHERS WAY Property Address WRIGHT Owner Owner's Name information is required for HYANNIS MA 02632 4-14-15 every 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 338 PITCHERS WAY Property Address WRIGHT Owner Owner's Name information is required for HYANNIS MA 02632 4-14-15 every page. Cityrrown 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 building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately L15,.s* 113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Tithe 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 338 PITCHERS WAY Property Address WRIGHT Owner Owners Name information is required for HYANNIS MA 02632 4-14-15 every page. Cityrrown 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: 6.8 and 1Oft see below 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: 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: 2 previous passing inspection reports one dated 8-29-02 and one dated 10-30-1998 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 °M 338 PITCHERS WAY Property Address WRIGHT Owner Owner's Name information is required for HYANNIS MA 02632 4-14-15 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 II t t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART'C\ _ SYSTEM INFORMATION(continu( d) y, Property Address: 338 PITCHERS WAY,HYANNIS Owner: WRIGHT,JANET i Date of Inspection: OCTOBER 30, 1998 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100(locate where public water supply comes into house) • ' 1 y r (revised 04/25/97) ^-s Page 9 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 338 PITCHERS WAY, HYANNIS Owner: WRIGHT,JANET Date of Inspection: OCTOBER 30, 1998 Depth to groundwater 6'8" Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record X Observation of Site(Abutting property,observation hole,basement sump etc.) Determine it from local conditions Check with local Board of health Check FEMA Maps Check pumping records Check local excavators,installers Use USGS Data Describe in your own words how you established the High Groundwater Elevation.(Must be completed) NOTE:6'8"TO WATER BOTTOM OF LEACHING IS TBELOW GRADE.3'8"ABOVE GROUND WATER. (revised 04/25/97) Page 10 of 10 I Barnstable Assessing Search Results Page 2 of 2 Land and Building Information Land Building Lot Size(Acres) 0.49 Year Built 1972 Appraised Value $33,600 Living Area 1400 Assessed Value $33,600 Replacement Cost$ 111,095 Depreciation 15 Building Value 94,400 Construction Details Style Raised Ranch Interior Floors Carpet Model Residential Interior Walls Drywall Grade Average.Grade Heat Fuel Electric Stories 1 Story Heat Type Typical Exterior Walls Wood ShingleClapboard AC Type None Roof Structure Gable/Hip edrooms 3 Bedrooms Roof Cover Asph/F GIs/Cmp Ba Total Rooms 6 Rooms Extra Building Features Code Description Units/SQ ft Appraised Value Assessed Value BGAR Bsmt Garage 1 $3,400 $3,400 SHED Shed 120 $1,000 $ 1,000 BLA Bsmt Liv-Aver 987 $21,000 $21,000 Property Sketch Legend BAS First Floor, Living Area FST Utility Area (Finished Interior) UAT Attic Area(Unfinished) BMT Basement Area Unfinished FTS Third St ory to Living Area Finished UHS rY 9 (Finished) Half Story(Unfinished) CAN Can FUS Second Story Living Area(Finished) UST Utility Area(Unfinished) FAT Attic Area(Finished) GAR Garage UTQ Three Quarters Story(Unfinished) ; FCP Carport GRN Greenhouse . UUA Unfinished Utility Attic FEP Enclosed Porch PTO Patio UUS Full Upper 2nd Story(Unfinished) FHS Half Story(Finished) SFB Semi Finished Living Area WDK Wood Deck FOP Open or Screened in Porch TQS Three Quarters Story(Finished) I E i ' I - I http://www.town.bamstable.ma.us/tob02/Depts/AdministrativeServices/Finance/Assessing/Asse 12/9/02 i TOWN OF BARNSTABLE LOC JN 3 r R17c//f,,e 3 A6* SEWAGE# VILLAGE ASSESSOR'S MAP&LOT a L INSTALLER'S NAME&PHONE NO. Al d ,S- Xe SEPTIC TANK CAPACITY+ cQ®X ' / £��1�e Vm LEACHING FACILITY: (type) (size) NO.OF BEDROOMS d� BUILDER ORfOWNE `�/� ! l�✓✓dF/t�/f PERMTUDATE: 1 ? COMPLIANCE.DATE: f �� 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) m Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) ,, Feet Furnished by '' ry77 oe o4) ,t No. V C 1 Fee !V THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS application for ;Diopool *pztem Conotruction Permit Application for a Permit to Construct( )Repai"r�(Y Upgrade( )Abandon( ) ❑Complete System k1ndividual Components Location Address or Lot No. 3 f y jP/`Te/f-1'^ 'WO ' Owner's Name,Address and Tel.No. #Y _T?A/£T_ l.,_.,1P161)�Y H� Assessor's Map/Parcel 33 8' 1 I 1 c 'I f''3 w O r!9 Installer' Nam ,Address,and Tel.No. Designer's Name,Address and Tel.No. Cl tw— S'v9iP rI7�e2 p`®o Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building #d USL No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 1,14,4 C Im f�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 Certifi- cate of Compliance has been issued jZy this Board of Healt Signed Date Application Approved b Date. Application Disapproved for the following reasons Permit No. , Z Date Issued �' "1,,,,,x, ...,,�."r...... ... � a.,t....n,W-rr°' . "' .. i'+-.,, "... r r •r-•---. .,... w,•---w..�;,,.�-r.'--�r«..+,,..+^na...«..•...a+-.,.;, 9 Yr No. �-- �` � � �,,l,.,. - Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: - Yes - PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS , Zfpplication for Miopogal *pftem Construction Permit Application for a Permit to Construct( )Repair(y Upgrade( )Abandon( ) ❑Complete System Individual Components Location Address or Lot'No. Pi C/4fir°s "wry Owner's Name,Address and Tel.No. ° # Y �AV C7 j:d 7Y X Y Assessor's Map/Parcel `, 33 it P 17 d r ej AI Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. ¢6 C/�NC o 3 S-0 ihyi A, .5 77L rOo i Type of Building: Dwelling No.of Bedrooms Lot Size `' sq.ft. Garbage Grinder( ) Other Typelof Building ht0 41S£ No.of Persons Showers( ) Cafeteria( ) Other Fixtures P Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets "Revision Date- - Title Size of Septic Tank Type of S.A.S. Description of Soil - Nature of Repairs or Alterations(Answer when applicable) op r044 C I 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 Certifi- cate of Compliance has been issued by this Board of Healt Signed Date //" '?'jP 7 Application Approved b ./� Date Application Disapproved for the following reasons Permit No. 7 -- / Date Issued r p i THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired(,4")Upgraded( ) Abandoned( )by `/4 6 .j2e ,CO 3 S �i3O 41A.- ST w->414 at 3 p4 7c re-1 w.4 Y has been constructed in accordance with the pro sions of Title 5 and tAe for Disposal System Construction Permit No.` dated ///—47- V. Installer Designer The issuance of this permit s all not be construed as a guarantee that the sys will fu 1% s design Date ��"" �'" Inspector r� d, No. ��`� 1 j�------------ `�—----------=--Fee="wM/ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION, - BARNSTABLES MASSACHUSETTS Mi5pogai *pgtem Conotruction Permit Permission is hereby granted to Construct( )Repair( ,Z'S Upgrade( )Abandon( ) System located at 33 9" 40>7E1I res and as described in the above Application for Disposal System Construction Permit.The applicant recognizes 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 b ter' s " tU TOWN OF BARNSTABLE LOCATION ��>'c/�f� S �5;' SEWAGE # VILLAGE ASSESSOR'S MAP &LOT INSTALLER'S NAME&PHONE NO. ed ILL) '' SEPTIC TANK CAPACITY o f•,4el, C r>sy�..=� LEACHING FACILITY: (type) (size). No.OF BEDROOMS BUILDER OROWNE AA.,zi 1t✓.`F/�/fT 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 facility) Feet Furnished by 1.y1 b >� CONIM NWEALTII OF MASSACIIL'SEFIS EXECI TIVE OFFICE OF ENVIRONMENTAL. AFFAIRS ' l I�yr UFPAIZTMFN7 OF ENVIR()NWNTAL PROTECTION \ ONT: \\INIFR STRFFi. 110STON. NIA 02109 61 -1_91.c500 �\ W II.I IAM F �\FLD TRUDY C(1XF Govcrnnr 350 MAIN STREET Sccrcun AAWEST YARMOUTH, MA AR(M['At11.Cf1.Lt1( 1 �" DAVIDII STRUM 508=775-2800 1.1 (invrrnnr Commiccumrr SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOR PART A CERTIFICATION MAP 290 PAR 117 PROPERTY ADDRESS: 338 PITCHERS WAY,HYANNIS AD RESS OF OWN e DATE OF INSPECTION: OCTOBER 30, 1998 JA 1WRIgA�lT NCO 0 NAME OF INSPECTOR : JAMES D.SEARS '77ff�y, n" I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 CM 0) 'jis 9 ►r�, COMPANY NAME: A&B Canco MAILING ADDRESS: 350 Main Street,West Yarmouth, MA 02673 TELEPHONE NUMBER: (508)775-2800 Z CERTIFICATION STATEMENT 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 inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: X PASSES CONDITIONALLY PASSES NEEDS FURTHER EVALUATION BY THE LOCAL APPROVING AUTHORITY FAILS INSPECTORS SIGNATURE: � a. DATE: NOVEMBER 6, 1998 The system Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(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 SUMMARY: Check A, B, C, or D: A] SYSTEM PASSES: X I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: SITE OVERALL PASSES, INSPECTION OF SYSTEM IS BASED ON CONDITION OF SYSTEM AT THE TIME OF THE INSPECTION.THERE IS NO GUARANTEE ON THE LIFE OF THE SYSTEM. B SYSTEM CONDITIONALLY PASSES: N/A 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 b the Board of Health,will pass. Indicate yes,no,or not determined(Y,N,or NO). Describe basis of determination in all instances. If"not determined", explain why not) The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was installed within twenty(20) Years prior to the date of the inspection;or the septic tank,whether or not metal, is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank is failure is imminent. The system will pass 4 inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board i .of Health. Page 1 of 10 (Revised 04/25/97) ,. DEP on the World Wide Web:http://www.magnet.state.ma.un/d SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (CONTINUED) Property Address: 338 PITCHERS WAY, HYANNIS Owner: WRIGHT,JANET Date of Inspection: 0CTOBER 30, 1998 B]SYSTEM CONDITIONALLY PASSES(continued) Sewage backup 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). Describe observations: broken pipe(s)are replaced obstruction is removed distribution box is leveled 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: N/A 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 FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone 1 of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS 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 that facility and the presence of ammonia nitrogen and nitrate nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER fi (Revised 04/25/97) Page 2 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A ` CERTIFICATION(continued) Property Address: 338 PITCHERS WAY,HYANNIS Owner: WRIGHT,JANET Date of Inspection: OCTOBER 30,1998 D]SYSTEM FAILS: You must indicate either"Yes"or"No"as to each of the following: N/A I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303.The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an over- loaded 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 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 Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of 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: You must indicate either"Yes"or"No"as to each of the following: The following criteria apply to large systems in addition to the criteria above: N/A The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No the system is within 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 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. (Revised 04/25/97) Page 3 of 10 4 - SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 338 PITCHERS WAY,HYANNIS Owner: WRIGHT,JANET Date of Inspection: OCTOBER 30, 1998 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: Yes No X Pumping information was provided by the owner,occupant,or Board of Health. X None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. X As built plans have been obtained and examined. Note if they are not available with N/A. X The facility or dwelling was inspected for signs of sewage back-up. X The system does not receive non-sanitary or industrial waste flow. X The site was inspected for signs of breakout. X All system components,including the Soil Absorption System,have been located on the site. X The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid depth of sludge,depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: X The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub-Surface Disposal System. X Existing information. Ex. Plan at B.O.H. X Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable)[15.302(3)(b)] M (Revised 04/25/97) Page 4 of 10 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 338 PITCHERS WAY,HYANNIS y Owner: WRIGHT,JANET Date of Inspection: OCTOBER 30,1998 FLOW CONDITIONS RESIDENTIAL: Design flow: 330 g.p.d./bedroom for S.A.S. Number of bedrooms: 3 Number of current residents: 3 Garbage grinder(yes or no): NO Laundry connected to system(yes or no): YES Seasonal use(yes or no) NO Water meter readings, if available(last two(2)year usage(gpd): 1998 43,000/1997 32,000/1996 21,000 Sump Pump(yes or no): NO COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow: gallons/day Grease trap present:(yes or no): Industrial Waste Holding Tank present:(yes or no) Non-sanitary waste discharged to the Title 5 system:(yes or no) Water meter readings,if available: Last date of occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION II� PUMPING RECORDS and source of information: N/A System pumped as part of inspection:(yes or no) NO If yes, volume pumped: Gallons Reason for pumping TANK PUMPED AFTER INSPECTION TYPE OF SYSTEM X 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) I/A Technology etc. Copy of up to date contract? Other APPROXIMATE AGE of all components,date installed(if known)and source of information: 1985 PERMIT#85-353 Sewage odors detected when arriving at the site:(yes or no) NO (revised .04/25/97) Page 5 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 338 PITCHERS WAY,HYANNIS Owner: WRIGHT,JANET Date of Inspection: OCTOBER 30, 1998 BUILDING SEWER: N/A (Locate on site plan) Depth below grade: Material of construction cast iron 40 PVC other(explain) Distance from private water supply well or suction line Diameter Comments:(condition of joints,venting,evidence of leakage,etc.) SEPTIC TANK:_X (Locate on site plan) Depth below grade: 8" Material of construction X concrete _ metal _ Fiberglass _ Polyethylene _ other(explain) If tank is metal,list age Is age confirmed by Certificate of Compliance (Yes/No) Dimensions: 1,000 GALLON PRE CAST Sludge depth: 4" Distance from top of sludge to bottom of outlet tee or baffle: 28" Scum thickness: 6" 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: 8" How dimensions were determined AS BUILT&TAPE 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.) TANK AT WORKING LEVEL,TANK AND COVERS 8"BELOW GRADE,INLET TEE,OUTLET TEE,TANK PUMPED 10-28-98 AFTER INSPECTION. GREASE TRAP: N/A (locate on site plan) Depth below grade: Material of construction _ concrete _ metal _ Fiberglass _ Polyethylene _ other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert, structural integrity,evidence of leakage,etc.) (revised 04/25/97) Page 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 338 PITCHERS WAY,HYANNIS Owner: WRIGHT,JANET Date of Inspection: OCTOBER 30, 1998 TIGHT OR HOLDING TANK: N/A (Tank must be pumped prior to,or at time,of inspection) (Locate on site plan) Depth below grade: Material of construction concrete metal Fiberglass Polyethylene other(explain) Dimensions: Capacity: Design flow: gallons/day Alarm level: Alarm in working order _ Yes; _ No Date of previous pumping: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) DISTRIBUTION BOX:X_ (locate on site plan) Depth of liquid level above outlet invert: 0 Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc,) D-BOX IS 9"X 15",BOX IS 2'BELOW GRADE,ONE LINE IN,TWO LINES OUT,BOX IS NEW,CLEAN AND LEVEL. PUMP CHAMBER: N/A (locate on site plan) Pumps in working order:(Yes or No) Alarms in working order(Yes or No) Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) (revised 04/25/97) Page 7 of 10 .p l . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION continued Property Address: 338 PITCHERS WAY,HYANNIS Owner: WRIGHT,JANET Date of Inspection: OCTOBER 30, 1998 SOIL ABSORPTION SYSTEM(SAS):X (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: 12'X38' overflow cesspool,number, alternative system: Name of Technology: Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) NOTE:PROBED ABOVE AROUND FIELD, NO OVER LOADING PROBLEM FOUND, NO PONDING OR VEGITATION AREA NOT WET. CESSPOOLS: N/A (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(cesspool must be pumped as part of inspection) Comments:: (note condition of soil,signs of hydraulic failure, , level of ponding,condition of vegetation,etc.) PRIVY: N/A (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.) (revised 04/25/97) Page 8 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 338 PITCHERS WAY,HYANNIS Owner: WRIGHT,JANET Date of Inspection: OCTOBER 30, 1998 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100(locate where public.water supply comes into house) �►,4 ' yB Y � g i y (revised;64/25/97) ' Page 9 of 10 f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 338 PITCHERS WAY,HYANNIS Owner: WRIGHT,JANET Date of Inspection: OCTOBER 30, 1998 Depth to groundwater 6'8" Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record X Observation of Site(Abutting property,observation hole,basement sump etc.) Determine it from local conditions Check with local Board of health Check FEMA Maps Check pumping records Check local excavators,installers Use USGS Data Describe in our own words how you established the High Groundwater Elevation. Must be completed) Y Y 9 ( P ) NOTE:6'8"TO WATER BOTTOM OF LEACHING IS TBELOW GRADE.3'8"ABOVE GROUND WATER. (revised 04/25/97) Page 10 of 10 COMMONWEALTH OF MASSACHUSE'I"1'S EXECUTIVE OFFICE OF ENVIRONMENTAL AFFA RECEIVED DEPARTMENT OF ENVIRONMENTAL PROTEC 'ION . E v � SEP 1 0 2002 d 4 TOWN OF BARNSTABLE HEALTH DEPT. ee TITLE 5 OFFICIAL INSh4:CTI6'N FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE;SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 338 PITCHERS WAY HYANNIS,MA 02601 2ct b - I �� Owner's Name: JANET WRIGH' ' Owner's Address: 338 PITCHE C RS.WAY HYANNIS,MA 02601 Date of Inspection: 8/29/02 :5 Name of inspector: (please print) 1 JOHN GRACI Company Name: SEPTIC INSPECTIONSIft Mailing Address: P.O. I30X 2119 TEATICKET,MA.02536 Telephone Number: 508-564`68l'3 FAX 508-564-7270 CERTIFICATION STATEMENT 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 1$.340 of Title 5(310 CMR 15.000). The system: X Passes, Co4dasses` _ NeFurthvalu 11 ation by the Local Approving Autlio�sty Fa Inspector's Signature: Date: 8/29/02 The system inspector shall suf 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 uflice of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. 2• Notes and Comments SYSTEM PASSED TITLE V INSPECTION. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG TI lE SYSTEM'S USEFUL LIFE. •i;: ' "` ****This report only describes'coud`itions'at the time of inspection and under the couditiuus t►f list III lhlll Ilnle,'Phis inspection does not address how the,syste:n will perform in the future under the same or different conditions of use. a d q Title C lnznortlnn Fnrm 611 S/7(AO f;'age 2 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE;;SEWAGE DISPOSAL SYSTEM INSPECTION FOIil11 PART A CERTIFICATION (continued) Property Address: 338 PITCHERS'WAY HYANNIS, MA 02601 Owner: JANET WRIGHT Date of Inspection: 8/29/02 Inspection Summary: Check A,B,C,D'or E/ALWAYS complete all of Section D A. System Passes: X 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 PASSED TITLE V INSPECTION. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. 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,yepair,,as approved by the Board of Health,will pass. Answer yes,no or not determined'(Y',N,ND) in the for the following statements. If"not determined"please explain. n/a The septic tank is metal and overr'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. ND explain: n/a n/a Observation of sewage backups or breakout or high static water level in the dijtt-ibution 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 obstruction is removed _ distribution box is leveled or replaced ND explain: n/a n/a 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): 5 _broken,pipe(s)are replaced _obstruction is removed ND explain: n/a r , J'age 3 of I I OFFICIAL INSI'EGTI`ON FORM - NOT FOR VOLUNTARY ASSESS VENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 338 PITCHERS WAY.HYANNIS, MA 02601 Owner: JANET WRIGHT . Date of Inspection: 8/29/02'' C. further Evaluation is Required by flip Board of Health: Conditions exist which requir6 further''evaliaation by the Board of I lealth in order to determine if the system is failing to protect public health,safety or the envir`oiiment. 1. System will pass unless,Board,of Health determines in accordance with 310 CMR 15.303(i)(b) that the system is not functioning in a manner which will protect public health,safety and the environment: _ Cesspool or privy is within,'S0 feet of a surface water Cesspool or privy is within'SO;feet of,a'bordering vegetated wetland or a salt marsh 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 sep`tic,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'dete'r'n iiie distance n/a **This system passes if'the wel51,watei•,analysis,performed at a DCP certified laboratory, for coliform bacteria and Od • �e presence of ammonia t facility and tl volatile organic compound ;mdicates,that the well is free from pollution from that y J nitrogen and nitrate nitrogen; s'equaI'to'or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to,tilis form. 1 - j ?.1 t 3. Other: n/a �a i_ i Page 4 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSLS,SA-1ENTS SUBSURFACE S..E'WAGE DISPOSAL SYSTEM INSPECTION FORM � t PART A CERTIFICATION(continued) Property Address: 338 PITCH);htS WA'1' FIYANNIS, MA 02601 Owner:'JANET WRIGHT ;I• Date of Inspection: 8/29/02 " t` D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each.of the following for alLinspections: Yes No _ X Backup of sewage into,facility or system component due to overloaded or clogged SAS or cesspool X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool X Static liquid level in the distribution.box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in cesspool is less than 6"below invert or available volume is less than %2 day flow X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped 2 YRS BY"OWNER. _ X Any portion of the SAS,cesspool or privy is below high ground water elevation. X Any portion of cesspool''or privy'i`' within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspootor privy is(within a Zone 1 of a public well. X Any portion of a cesspool,or privy is within 50 feet of a private water supply well. X 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 laboratorji for:coliform;bacleria and volatile organic compounds indicates that the well is free from pollution from that Tacility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provi4ed'that no other failure criteria are triggered. A copy of the analysis must be attached to this form.) (YesfNo)The system fails.,1,.have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system failis.',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 tile systemmust serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"'no"to,each of the following: ('rhe following criteria applysto large systems.ln addition to the criteria above) yes no X the system is within 400-feet of a surface drinking water supply X the system is within 260 feet of�a U'-ibutary to a surface drinking water supply X the system is located hi`a mirogen sensitive area(Interim Wellhead Protection Area—I WPA)of a mapped Zone II of a public'water4su,pply'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 laige'syslcnl haS,f�ild, The owner or operatnl•of any lame 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 1' . should contact the appropriate regional'office of the Department. d Page 5 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPEC'CION FORM PART B CHECKLIST Property Address: 338 PITCHERS WAY HYANNIS,MA 02601 Owner: JANET WRIGHT Date of Inspection: 8/29/02 Check if the following have been done.,.YOU must indicate "yes"or"no" as to each of the following: Yes No X _ Pumping information.was provided by the owner,occupant,or Board of 1-lealth X Were any of the systen,components pumped out in the previous two weeks? X _ Has the system received normal flows in the previous two week period ? X [lave large volumes of,water been introduced to the system recently or as part of this inspection ? X _ Were as built plans of the system obtained and examined?(if they were not available note as N/A) X _ Was the facility or dwefl'iig inspected for signs of sewage back up? X _ Was the site inspected for signs of break out X _ Were all system components, excluding the SAS, located on site 9 X _ 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 ? X _ 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: Yes no ; < X _ Existing information. For example,a plan at the Board of Health. X _ Determined in the field(i(any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302Q)(b)] �i r .,y 5 Page G of 3 OFFICIAL INSPECTION FORNI-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FoRAI PART C SYSTEINIINFORMATION Property Address: 338 PITCHERS WAY HYANNIS, MA 02601 Owner: JANET WRIGHT Dale of inspection: 8/29/02 f LOW CONDITIONS RESIDENTIAL 'a`4 •,t Number of bedrooms(design):3 �;Nuni.ber of bedrooms(actual): 3 DESIGN now based on 310`CNIR 15.203 (for example: 110 gpd x li of bedrooms):330 Number of current residents: 4 Does residence have a garbage grinder(yes,or no): NO Is laundry on a separate sewage system (-yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no)': NO Seasonal use: (yes or no): NO Water meter readings, if available(last 2 years usage(gpd)): nfd Sump pump(yes or no): NO ' ' Last date of occupancy: n/a 00.3 t COMMERCIALANDUSTRIAL 01- —7Z Type of establishment: n/a 1 2-- Design flow(based on 310 CMR',15.203):'n/agpd Basis of design flow(seats/persons/sgli,etc.): n/a Grease trap present(yes or no): NO Industrial waste holding tank present(yes or no): NO Non-sanitary waste discharged to the Title 5 system(yes or no): NO Water meter readings, if available: n/a Last date of occupancy/use: n%a` OTHER (describe): n/a GENERAL INFORMATION Pumping Records Source of information:2 YRS BY OWNER Was system pumped as part of the inspection(yes or no):NO Ifyes, volume pumped: n/agallons--flow was quantity pumped determined?n/a Reason for pumping: n/a TYPE OF SYSTEM X Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool 3 _Privy F _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) I ` _Tight tank Attach a copy of the DEP api�iroval Other(describe):n/a Approximate age of all components,date installed(if known)and source of information; 1975 BY OWNER Were sewage odors detected when arriving at the site(yes or no): NO t r, Page 7 of I I OFFICIAL INSPECTION FORM-NOT FOR N'OL€INT'ARY /kSSI SSA91?N'I'S SUBSURFACE SENVAGE DISPOSAL SYSITIA1 INSPECTION FORM PART C SYSTEM INFORNIAT'ION(continued) Property Address: 338 PITCHERS WAY HYANNIS, MA 02601 Owner: JANET WRIGIIT Date of Inspection: 8/29/02 BUILDING SEWER(locate on site plan) Depth below grade: 12" Materials of construction:_cast iron K40 PVC_other(explain): n/a Distance from private water supply well or suction line: n/a Comments(on condition of joints, venting,evidence of leakage,etc.): TOWN WATER SEPTIC TANK: X(locate on site plan) Depth below grade: 6" Material of construction: Xconca-ete_metal_fiberglass_polyethylene other(explain)n/a If tank is metal list age: n/a Is age'eoiifirrned by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) Dimensions: 1000G L 8' 6" 11 5'.,.7";W 4' h0"" Sludge depth: I" Distance from top of sludge to bottom of outlet tee or baffle: 33" Scum thickness: 1" ' 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: 17" Flow were dimensions determined: 119EASUIIED Comments(of]pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. GREASE TRAP:_(locate on site plan) Depth below grade: n/a Material of construction:_concr`ete_nietal_fiberglass_polyethylene other(explain): n/a Dimensions: n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle: n/a Date of last pumping: n/a Comments(on pumping recommendations, inlei and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): 1 tx Y' f n/a z. 'ilk i i' Page 8 of I I OF1+ICIAL, INSPECTION FORM—NOT .F0It VOLUN'.l'ARY ASSESSnl1iATS SUBSURFACE SEAVAGL ,CI! STOSAL SYSTEM INSITC"140N FORAM I'A RT C SYSTEM 'AIOltiMATION (contiuu"J) Properly Address: 333 1 1TC11ERS WAY HYANNIS, 11IA 02601 Owncr: JANUF NNIUGIIT Dale of Inspccliou: 8/29/02 TIGHT or IIOLDI JG TANK: (tatik unit be humped at time of inspcctioli)(loca(coil -,i le I?tau) Depth below grade: n/a M::rteriel of construction:_concrete_metal fiberglass polyethylene_olher(ex1?I,rin): u,'a Dimensions: n/a Capacity: n/a gallons Design flow: n/a gallons/day Alarin present (yes or no): N/A Alarm level: N/A Alarm in working order(yes or no): NO Dale of last pumping: n/a Comments(condition of alarm and I`luat'switcl'ies,c•tc.): n/a DISTRIBUTION BOX: X(if presenCmust be opcned)(locate on site plan) Depth of liquid level above outlet invert; LEVEL MV14'11 BOTTON1 OP- PIPE Comments(note if box is level and distribution to outlets e(lual, any evidence of solids carryover,any evidence of leakage into or out of box,etc.): D-BOX US STRUCTURALLY SOUND. I'UM11 C11AMBER:-(locate on site plan) Pumps in working order(yes or no): NO Alarms in working order(yes or no):NO Continents(note condition of punip chamber,condition of pumps and appurtenances,etc.): n/a - , e n . R ['age 9 of I 1 OUTICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSLSSMI NTS SUBSURFACE' SEWAGE 111_Si'OSAL SYSTI i1I I_NSITCT'ION FORM PART C SYSTLIM "A ORNIATION (continual) Properly Address: 333 IT UCIIERS WAY IIYANNI:S, NIA 02601 Omier: JAN1 T WRIGIIT Date of Inspection: 8/29i"02 SOIL ABSOlRVYION SYS'I f M (SAS): X (locate on site plan,excavation nut required) If SAS not located explain wily: n/a Type n/a leaching hits, number: nla n/a leaching chambers, number: ilia ►/a leaching galleries, number: it/a 2 leaching trenches, number, length: 38 n/a leaching fields, number: rr/a n/a overflow cesspool, number: n/a innovative/alternative system Type/name of technology: ilia Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil,condition of vegetation,etc.): TRENCI t E'S ARE STRUCTU.,ALLY SOUND,`ND FUNCTIONING I'RC110tLY.SYSTLNI SHOWS NO SIGNS OF FAILURE. CLSSI'OOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: n/a Depth--top of liquid to inlet invert: nhi Depth of solids layer: n/a Depth of scum layer: n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater inflow(yes or no): NO Continents(note condition of soil,signs of Irydr'd lk failure, level of Funding, condition of vegeta(ion,etc.): n/a PRIVY: (locate on site plan) Materials of construction: n/a Dimensions: n/a Depth of solids: n/a Conmieiits(note condition of soil, signs of hydraulic failure, level of ponding,con::;ition of vegetation,etc.): n/a 4 Page 10 of 11 01 14CIAL INS1'1.CTt-.)N FORM—NOT FOII VOLUN VARY A`yS.E SNIEN`I'S SUBSU11 ACE St"NVAGl DISPOSAL. SYSTE"Nt iNSPIXTIONFORM PAIL'I' C SY'S TL11I!t&OKIIIATION (contiir..-ccl) Property Address: 338 PI TC11ERS WAY ILYANNIS, MA 02601 Owner: JANI?T NNIRIGIIT llatc of Inspection: 3/29/02 SKETCH OF SG\VAGE DISPOSAL SVS'''EM Provide a sketch of the sewage disposal system including ties to at least two permaimit reference landmarks or twnclunarks. Locate all wells within 100 feet. Locate where public water supply enters the building. ri I CG I j a `► n� Ij to l Page. I I of I I OFFICIAL INSPEC'17110N FORM —NOT 11OR VOLUNTARY ASSESSAIE JTS SUBSURFACE SENVAGE DISPOSAL SYSTEM INSVECTION FORM VA RT C SYSTEM I ,&O-RAIATION (continued) 1'rolscrty Address: 338 111TC11I:RS-WAN' IIYANNIS, NIA 02601 Owner: JANET AVRIGIIT Date of Inspection: 8/29/02 SITE EXAM _Slope _Surf•We water _Check cellar Shallow wells Gslimated depth to ground water 10 lect Please indicate(clieck)all methods used to detearmine the Iiigh ground water elevation: NO Obtaincd from system design Plans on record - I f checked,date of design plan reviewed: n/a YES Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of I lcallh-explain: n/a NO Checked with local excavators, installers-(allach documentation) NO Accessed USGS database-explain; n/a You must describe how you established the high ground water elevation: HAND AUGER- 101 FT. `I r, 11 ..- 20 FT MIN. 10 FT MIN. 1 - CONCRETE r?� '_ -__- ✓�°` 4' SCH. 40 PVC COVERS CLEAN SAND PIPE- MIN. PITCH 1/8" PER FT. 4' DOUBLE PERFORATED 2" LAYER OF PIPE - MIN. PITCH 4 CAST IRON 12"MAX. PVC PIPE 1/8"- 1/2" WASHED _ ! , A o : 1/4 PER FT. a: STONE /yam _o �? ►C FLOW_ LINE _ ►N n ��; l rx s rrnl�, o MIN. F.L = 10 .2. 3EL o o� EL.=� � G D Di ST LOCATION MAP BOX 3/4'-1 i/' .... WASHED STONE -- ---- -- - I 4o oa GAL f SEPTIC GROUND WATER TABLE EL. = 9s' 2 TANK g8: -�� - " SEWAGE DISPOSAL SYSTEM ?T TO SCALE 0 DF .S6GN CALCULATIONS r SOIL TEST V NUMBER OF BEDROOMS J . +3 1 �A � � T ?\ � �cGx1sTr.✓� R9 'Tao �c�".hv✓.fC� DATE OF SO±L. TEST 1 a Ac tJ/ GARBAGE ,DISPOSAL UNI i PCIOR ry 191--C TOTAL ESTIMATED FLOW WITNESSED BY GAL/BR ;DAY x BR. ; GAL./DAY PERCOLATION RATE ;MIN./ INCH REQUIRED SEPTIC TANK CAPACIT� ( GAL- OBSERVATION HOLE I OBSERVATION HOLE 2 s f Z ? U SIZE OF SEPTIC TANK. _ f - ELEVATION i �, ,;� �-% �(.• ,�%j- �O�i ACT A' �. � ELEVATION � , LEACHING AREA REQUIREMENTS I � C iyj �� 1 SIDEWALL AREA - GAL./S.F. D o 4 F H - -�ps� BOTTOM AREA f"' GAL./S.F. Ia 1 NrpoQ ` �tlC ;LEACHING CAP4CITY ( BOTTOM SIDEWALL) s� GAL. 'P AT- 3 6 x 1 Z ,��.. 9 S. 7 sJr~ Fi LTY t SA^�G• \RESERVE I_FACHINr- CAPACITY S6 GAL. !,WA g 40 NOTES � \�: L I ALL WORK4ANSH P AND MATERIALS SHALL CONFORM j } 3 TO D.LQ.E , T`TLE 5 AND THE TOWN OF13 R LES AND tREGULATIONS FOR SUBSURFACE DISPOSAL, k o�� IJF t Dr O SANi Tr•q7 S E WAG E j ���` • *�-� ¢ 2.CQMPLIANC , WITH ZONING REGULATIONS SHALL BE ; 15 �I moo= DETERMINE' :) BY BSJILDING INSPECTOR OR BUILDING BUILDING SETBACK REGULATIONS PER BUILDING *', I� ✓� ! \ COMMISSIONER INSPECTOR OR BUILDING COMMISSIONER f 3.EXISTING AND FINAL GRADES SHALL REMAIN ESSENTIALLY MIN. FRONT SETBACK i ,- MIN. REAR SETBACK _ I -P THE SAME �iLL �- ? MIN. SIDE SETBACK _ APPROVED : BOARD OF HEALTH ///� ��, �1'Z1L`tJL.L lZ.>Ii2tili.t_13 FIE". ^, t�EGi�._ ttW"1 10L)~/o �t`":-�/�. l o/ 1 L�l L-?`f' }r1E.T"•A � ,�: ..� R>zZ>=s2vl`_ AQC�. `�ii2.i~A ter- Pf:�i�ar�t �Y'Srt1v� St-1ALL ,., ., A& Q"&K�t. A *�k DATE AGENT r `�t,h. E.fe r Cs,L '�t, -, PROJECT LOCATION: � � �. VAt�i�UC.L, �ctLau+ir.ttJ r evvt Ktta.u��l] Z ---�� =-•`�° 3'±T�``� ,Y _� � - . ,_C 'v l + q , ., yi ..4 '', C���-14.+ �� f1 P-i1.�. 51�...%1-►1 :Li ti.S T •:7 AMLj(l� 'TO_ PiL� 1.1A t2! L,. _ 4? e APPLICANT: r 135E�t� C Sir T<iv1 r� P-LA� Fib', � K � w�,--�2 i'�e'�Ll t , �- LEGEND : - � � ° -;- �"` >" SCALE DR. BY: �` DATE / EXISTING SPOT ELEVATIONS OOxO EXISTING CONTOUR - - - - - - 00------ ttCfAk17 �, -. �fiw ��: `, JOB N0. � APPD. BY REV. k % ks FINAL SPOT ELEVATIONS ��*� ezit . O HEARN,- FINAL CONTOUR 00� R. V. INC. DRAWING REG. LAND SURVEYORS - REG. SAN/TAR/ANS SITE PLAN ' . - SCiL TES ' LOCATION , NO. �f 13 4 8 ROUTE 13 4 - P. 0. BOX 1263 SCALE � ' .�� r, `�� EAST DENNIS , MASS. OF