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HomeMy WebLinkAbout0367 PITCHER'S WAY - Health oll 367 Pitcher's Way 'r y .Hyannis P _ I I A = 269 141 —J 1 - ' w g II o! 6 it I i 1 JT/OWN OF BARNSTABLE EC LOCAfi[ON_gk7 r/ /T C cT eoeS �`U� SEWAGE #,WW, — oala2 VILLAGE ASSESSOR'S MAP & LOT tj INSTALLER'S NAME&PHONE NO. —A?Z SEPTIC TANK CAPACITYpa�EV 54/ /620 1ZU "000 A LEACHING FACILITY: (type) �( ) I!� �i4 size X X /U ` NO.OF BEDROOMS 3 7 XS BUILDER O OWNE /�� PERMITDATE: COMPLIANCE DATE: t Separation Distance Between the: ` Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (1f any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exisi within 300 feet of leaching facility) �� Feet Furnished by r \� A 00 9- L f ' '� Fee ` No. Q `� �l �i r`i G p� I/ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ✓ Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zipplication for 33i6po5al *pgtem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. Assessor's Map/Parcel , 0 P,Yolk t W17 // S 1007 C 3 U Installer's Name,Address,annoTel,No. ITY t Designer s Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder(J- )4 Other Type of Building te-S No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow //0 gallons per day. Calculated daily flow 31 V gallons. Plan Date Number of sheets /' Revision Date Title Size of Septic Tank ZSL-X) 11) Type of S.A.S. �� P Description of Soil Nature of Repairs or Alterations(Answer when applicable) DESIGNING ENGINEER MUST SI P€ V46P INSTALLATION AND CERTIFY IN WRITING Date last inspected: THE SYSTEM WAS INSTALLED IN STRICT Agreement: ACCORDANCE TO PLAN. The undersigned agrees to ensure lie c structi nd maintenance of the afore described on-site sewage disposal system in accordance with the provisions of T' 5 f the E v' nmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued hi oard f H It . Signed Date Application Approved by Date /710 z Application Disapproved for theF ollowing reasons Permit No. Date Issued t 7 d � s n a. ONo. ( �,�4?l!1 GC , ( t// r . »akr T Fee '/ THE COMMONW fiALTH OF MASSACHUSETTS Entered m computer: Yes r , PUBLIC HEALTH DIV1'S16k' TOWN OF BARNSTABLE., MASSACHUSETTS f 0(pplicatton for Mtopooar 6potem Con!gtructton Permit Application for a Permit to.Construct( )Repair,(-' )Upgrade( )Abandon( ) El Complete System ❑Individual Components ` Lodation Address or Lot No. 1 Owner's Name,Address and Tel.No. Assessor's Map/parcel 36 7 , k, /,� Installer's Name,Address,an4 Tel.No. 11Y1` Designer's Name,Address and Tel.No. 3,2 RI%0-71�0p /o?. 6 4) ram, S"G, Ur l u Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(V4 «- Other Type of Building X-cS No.of Persons .Showers( ) Cafeteria( ) Other Fixtures Design Flow , gallons per day. Calculated'daily flow 3'�o gallons. Plan Date Number of sheets / Revision Date " Title Size of Septic Tank Z r� Type of S.A.S. of 1?4c . Description of Soil r l Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreeinent: The undersigned agrees to ensure co structi nd main enance of the afore described on-site sewage disposal system in accordance with the provisions of Ti 5 the E u• mental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued s oard H It " Signed Date Application Approved by A,,. L14M LIn Date Application Disapproved for the ollowing reasons Permit No. "?Cdu 7`.? Date.lssued /715 z r ---- —R----------------------j--------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Zerttftcate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded( ) Abandoned( )by P w at � �r r. we, a o1 rl a has been constructe in ccordance with the provisions of Title 5 and the for Disposal System Construction Permit No. )k k.)2-'11 Z dated d Installer Designer The issuance o hi permit shall not be construed as a guarantee that the syst wi14, ction asjl ' ed_ Date �� ° U Inspector t --------------------------------------- / No. n 0 a- —: e* Fee:' THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS MtgpoZar *pgteM (Congtructton Permit Permission is hereby granted to Con�Mc ( )Repair( )Upgrade( )Abandon( ) System located at� rwcA 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: 0 Z Approved by ) �A CRAIG R. SHORT, P. E. 235 Great Western Road P.O. Box 1044 Telephone(508)398-8311 South Dennis, MA 02660 Fax (508)398-3063 PROFESSIONAL CIVIL ENGINEER, SOIL EVALUATOR, SEPTIC INSPECTOR SEPTIC SYSTEM DESIGNS, COASTAL&BUILDING DESIGNS TO: Thomas McKean Health Director Barnstable Board of Health 200 Main Street Hyannis, MA 02601 RE: CERTIFICATION OF SUBSURFACE SEWAGE DISPOSAL SYSTEM LOCATION OF SYSTEM: 367 Pitcher's Way,Hyannis,MA. CLIENT: Ann Lombardi PLAN DATE: 12/13/01 revised 02/12/02 (to add note) FILE#: 1-899 DATE(S)OF/TYPE OF INSPECTIONS: 06/07/01 Inspect Overdig(by Robin Wilcox) .06/11/01. :..... . Inspect System, measure for As-Built and Take Photographs 1, Craig R. Short, Civil Engineer, duly licensed as such in the Commonwealth of Massachusetts, do hereby certify that this firm has visually inspected the constructed subsurface sewage disposal system shown on the referenced approved plan, and further certify that the system, as constructed and shown on the attached As-Built; generally conforms within acceptable tolerance to the regulations, as varied, set forth in 310 CMR 15.000 and the Town of Barnstable Board of Health Regulations. 1p r -2 0� Craig R ort,P.E.,Engineer ate cc: File 1-899 Client Ann Lombardi Contractor Scott Campbell The Septic Tank was revised to an Acme 2500(w/1500 septic tank& 1000 pump chamber) H10 with.a 6"Reinforced Concrete Top. A V II A V1 A!tA1 A10 LCl Ill1 oj . Department,of Health,Safety,and Environmental Services I► ""'Public Health Division , Date O„ 367 Main Street,Hyannis MA 02601 + DARMADM MASS.. �d k Date Scheduled'L'., �� /(J (� Time U f/U wl Fee Pd. I U0 0 Soil Suitability Assessment for ,Sewage Disposal Performed By: C r A r� Witnessed By: te.7 L(�Cr1'PION & GENERAL INFOIZ .A.TIQI Location Address 6 0 1 Owner's �u P���her5 1NN ' 1 Address Assessor's Map/Parcel: 2 (,9�j 4' / Engineer's Name CrrA NEW CONSTRUCTION REPAIR X Telephone H •S�8" 3 Ipe 63// Land Use Slopes(%) / Surface Stones ti v Distances from: Open Water Body R Possible Wet Area 7S R Drinking Water Well — n t Drainage Way 3 0 WO Property Line /4— (t Other R SIMTCH: (Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands in proximity to holes) �ri•sC "C21..7 k- 99 � 13c+s�✓� �i /Y S7' D 1 1 o VIE C/O✓i a� 0 �4 ///. a%3 Parent material(geologic) C4k .--✓C-r' Cc( ,8 Depth to Bedrock ✓G Q /T` Depth to Groundwater: Standing Water in Hole: Weeping from Pit Face .... i Estimated Seasonal High Groundwater G � ....b Y' tlY I A ZOIV +ORS ASON L. Y GI 'VYA X2 'I'�1I3LI; Method Used: Depth Observed standing in obs.hole: /0,3 in. Depth to soil mottles: �✓�� in, Depth to weeping from side of obs.hole: N�ll level. in. Groundwater Adjustment !i . 8 tt. Index Well#AIJ6 4.j Rcadine Date:/I ( e , '. C—- Index W Adj.factor 9� _� Groundwater Level X daft a D I'EJ COLA TIOIV TLST note Observation Hole 9 Time at 9" Depth of Perc Time at 6" Start PE -soak Time @i <" '• Time(9"-6") End'Pre-soak , a Rate Min./Inch ,z Site Suitability Assessment: Site.Passed A — Site Failed: Additional Testing Needed(YIN) Original: Public Health Division Observation Hole Data To Be Completed on Back ) Copy: Applicant t , DEtP 01381 AVA ZON ZOLI✓ Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,f3oulderes. QQnsistcncy. Gravel) Ldo 3o A so $ � �a.sy I 7,14 r� Na-Ta . t III _ DEEP OBSERVITIO.N HOLE L.OG Hole#; Depth from4 Sorl Horizon Soil Texture Soil Color + Soil Other i Surface(in.) (USDA). (Munsell ) Mottling' (Structure,Stones,Doul.deres. Qorisistencv.-Gravel), r- t . r t TJ1kl.OI38�R'VATIONOE LOG Cole# Depth from Soil Horizon Soil Texture SoiLColor Soil Other Surface(in.) (USDA) (Munsell) Moulin' (Structure,Stones,Boulderes. i lenc' °° ravel u e.. , k6 ...E t.✓:" yl a � DEEP OBSERVfSTION Hali ole Depth from Soil Horizon Soil Texture Soil Color Soil <r Other Surface(in.) (USDA) (Munsell) Mottlin cturc,Stones,Bo ilderes. sisicricy.°° ra el t Flood Insurance Rate i ao, Above 500 year flood boundary No_ Yes Within 500 year boundary `.No_ Yes Within 100 year flood boundary No— Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption.system? rt J If not, what is the depth of naturally occurring pervious material? j Cc1•tirication : " (date)I have passed the soil evaluator exarnihatrort approved.by,the °De arfinent bC�-r voionmental Protection and that the above analysis was erforrned'b me consistent with o (fie regtiired'trainiiig, expertise and experience described in 310 CMR 15.01l.: Signature Date ! 7 aJ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments p W Pro rty Addres ss Owner Ow s Name , information is hig D required for �J ► I (�} every page. City/To State Zip Code Date of nspedi n 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 A. General Information When filling out forms to the computer,use 1. Inspyctgr only the tab key to move your cursor-do not Nam Ins or,. use the return key. C p7an NanX o Com any dress 115, i frow I Slate Zip Code del one Number License Number B. Certification _..,; CD I certify,that I have personally inspected the sewage disposal system at this address and that the f information reported below is true,accurate and complete as of the time of the inspection.The Inspectgk was performed based on my training and experience in the proper function and maintenance ofc,9 site n sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15.3-40 of Title 5(310 CMR 15.000).The system:ATO'Pas.ses ❑ Conditionally Passes ❑ Falls c t ❑ Needs Further Evaluation by the Local Approving Authority Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. if the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. *"'*This report only describes conditions at the time of inspection and under the conditions of use ` at that time:.this inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins-09/08 Trtle 5 Official Inspection Form:Subsurface Sewage Disposal system-page 1 of 17 c Lb .r . A Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form-Not for Voluntary Assessments :36-7 Ak�WE5 idAd Pr erty Addre Owner information is Ow r ame ,`, C ,� /,� '^ •� required for 1kJ �Y U t7V every page. Ci ow 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: 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: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined,"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or.tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): t5ins•09/08 - Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 I - , Commonwealth of Massachusetts Title 5 official Inspection Form _ Sub 7rface Sewage Disposal System Form-Not for Voluntary Assessments Pro AddressM-W W&Ad 6 / 4' V Owner Ownerl Vame Ili information is required for IrJ every page. Citylrown, • 3 ; State Zip Code Date of Inspection B. Certification (cont.) 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 CIGAR 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-09MB TNe 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Mchea 3V VVki Pr, erty Addre u) �AdLhd CORU Owner n r Name' / information is required for every page. City/1-owl 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: septic tank and soil absorption system SAS and the SAS is within ❑ The system has a p rp y (SAS) 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 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 ❑ LRr 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•09/08 Title 5 Offidal Inspection Forth:Subsurface Sewage Disposal System•Page 4 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal.System Form-Not for Voluntary Assessments 36 "OLS h)k4 Pro n rty Ad re Owner , information is s Name required for V every page. \Cityfro ' 1 State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ 0__� Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ 0 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 Il 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-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments rf 3 1!/ A*ly-g-s Pr erty Addre 13D 1A) 7EAa1&Ar( r(-)PU`\)D Owner Ow 's Name' information is required for every page. City ow State Zip Code Date of nspection 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 ❑ El 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: ElExisting 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): Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): �� t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official inspection Form Subsurface Se ge Disposal System Form-Not for Voluntary Assessments ProqeXty Addres ICUW �AddAd 69M Owner Own' Name 1 t information is required for i every page. City own 1 i ,- State Zip Code Date oft spectio D. System Information Description: /4®® xV'&tAx2 Number of current residents: Does residence have a garbage grinder? ❑ Yes �lo Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes,?Flo Laundry system inspected? ❑ Yes No Seasonal use? ❑ Yes No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? es ❑ No Last date of occupancy: a 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Alme-s-, p� (O Prc rt IIIAddress y Addr - ,alaid 6gaw Owner Name information is '� a required for -A ALS v every page. City own State Zip Code Date of Ins edion D. System Information (cont.) Last date of occupancy/use: Date . Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes 20'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/Altemative 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): l5ins-09f08 Title 5 Official Inspectbon Forth:Subsurface Sewage Disposal System•Page 8 of 17 ' Commonwealth of Massachusetts Jff-,4�W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 3 b7 §01,kk� Pro Address 011alS rm fj) -A k Owner OwAer7Mmre information is ) required for ` 1(J every page. City/Town,. State Zip Code '(Date of In editin D. Sys em Information (cont.) Approximate age of all /lcomponents, date installed (if known)and source of information: Were sewage odors detected when arriving at the site? ❑ YesIo Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑cast iron �0 PVC ❑other(explain): f7 / Distance from private water supply well or suction line: fe @— -- Comments(on condition of joint venting,evidence of leakage,etc.): Septic Tank(locate on site plan): Depth.below grade: feet Material of construction: Wconcrete ❑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: -f'6 `,C�,��� Sludge depth: / tsins•oaroe Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 36-2 A-)PIus IA)PrU, Pr rty Address ' A a6c! Owner e s ame%1 information is required for ll every page. CitylTdwd State Zip Code Date of In pectin D. Syst6m Information (cont.) Septic Tank(cunt.) J/ 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.): / keA; 01,k. A s Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•09/08 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 10 of 17 I _ i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 3o A+—Ipj P'U ,r Prq rty Address 1 ofl) �Adlud Cou'll Owner Owne s Name infortnation is required for � t[�te every page. ci w , ! Zip Code Date of I spectio D. S stem Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑concrete ❑metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions. Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: • Alarm in working order. ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•0901 Title 5 Official Ins pection Form:Subsurface Sewage Disposal System•Pege 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments rf �� � ✓V Pr' rty Address Ownerame information is required for - . 'q every page. City/Towq I State Zip Code Date of Insp lion D. System Information (cont.) . 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.): 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.): Soil Absorption System(SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Se ge Disposal System Form-Not for Voluntary Assessments oto-7 s LAki t Pro N dre i r 10 VAOUAd 6 R VP Owner Ow s Name y i ,, ; t• information is required for every page. City ,o n y ) f I state Zip Code ;; Date of Ins ectiori D. Sy ern Information (cont.) . Type: ❑ leaching pits number: leaching chambers number: ❑ leaching galleries number: ❑ y leaching trenches number, length: ❑ leaching fields number,dimensions: ❑ overflow cesspool number: ❑ innovative/altemative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): 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-09= 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 30 fid&t-s WfW Pr rty Addre oil) '[Ua- S' (w-j Owner Own is Name n „ information is ,S If rV I_�Ja, Rip"?ok required forevery page. City wn state Date o Inspedi n D. Sys em 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•OMB Title 5 O}Bdal Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 i r r Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sew ape Disposal System Form-Not for Voluntary Assessments 36 i Pr rty Addres 4 , , • t ,Y � •- � (aAd Owner n Name , }� information is _ required for - (J ((J every page. City o n . ,t ) State Zip Code . Date of In ectlon D. Sys em 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 1 t5ins•09108 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 15 of 17 . Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments -3(n? fiiill'� A )fta ,ate P rtjAddre 0 fA, Lt io Owner rs Name — %ft— w , _ A information is ��-l00 1 required for S every page. Ci w State Zip Code Date of ihspectionr D. Sy tem Information (cont.) Site Exam: heck Slope Surface water heck cellar jo 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 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: Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•09108 TFUe 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Se ag Disposal System Form-Not for Voluntary Assessments r P rty Address YY Owner Ow Name information is required for U (Q every page. City wn to Zip Code Date of Ins Ction E. Report Completeness Checklist Inspection Summary:A, B, C, D, or E checked ;L�n In ction SummaryD(System Failure Criteria Applicable ( y pp cable to All Systems)completed S em Information—Estimated depth to high groundwater Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 06-12-2002 08:46AM FROM SWEETSER ENGINEERING TO 1508?906304 P.03 FROJ of crtzi oN: �Ti C. �S Y�r ,�-r ;Q ,� !L T. ' TnR of �Qu�-►-7ATia�r E[ /QG.O s A; PE .2'vv*,ear : sEp rr c /N 3S 88 o4.r Ss�G � Zn 'a JN 99 �s i C3 aT .S. A.S. CC v/•vyc CDs I7.6' 0.0=a.8.s'' \ c i 3 - o - z.� ,. z ,9� -4d"8 �IS� � Ar AV r ja 13 A�L�QV v ..q-\ I 1 ! 6x/s7/.vG d W Member ASC13awe CRAIG R.SHORT, P:E ;�q� cFWtG P.Q.BOX IQ" .``: S:i o v�T �.. SOUrri DENNIS.MA 02= j<+ LOCUS: �L 7 GVIL p•��N��� V✓fJ Profo K ft cmi G,..;,,.,,,.- Na 27433 y7 A. +'y„mi SQII pft lnq 'P TOW A%tAJ v 57/c:4, ./ I�.�✓. liCerssed C.onstiucdon Supervisor�Sepdc Ir�peCtOt v �'sT£�° �`� ..�------ seaft 'Site-PWS-Shmtsevi-HoufOeeicgra s a1VAl UA'Tt: l2 0 0 L� 1 2 FILE-# /- 91 !;nr:rr ut� l TOTAL P.03 W r) Commonweafth of MassachusettsCyfttCt1V19 Executive Office of Environmental Affairs Department ofwi4� Environmental ProtectionWilliam F.Weld Gowmor TrudyCoze SecreyEOEA David B.Struhs Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM MAP# e 1 .3 �L2 PART A PAR# R ;-49- yl CERTIFICATION /7 rQR GE Property Address: 30 P/TcHE�� wAY Owner: P Y /•i v.v�s Address of Owner: Date of Inspection: -/-1 (if different) Name of Inspector: 7,4m£S -Z S r,4,es Company Name, Address and Telephone Number: A & B Canco 350 Main Street West Yarmouth, MA 02673 (508) 775-2800 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: _V Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature: �9''/�-F ^�' Date: Y '3�/ 4 The System inspector shall submit a copy of this inspection repon 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 Departmen! of Environmental Protection. The olinal should be sent to the System oy.ner and cople� iu ti,u buyer, if app:1cab;c and the appro.ing aj-hority. INSPECTION SUMMARY: Check A, B, C, or D. A] SYSTEM PASSES: have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B] SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair, passes inspection. Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not) The septic tank is metal, cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 8/15/95) 1 One Winter Street • Boston, Massachusetts 02108 0 FAX(617)556-1049 • Telephone (617)292-5500 �, Primed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A ` CERTIFICATION (continued) Property Address: Owner: Date of Inspection: B]SYSTEM CONDITIONALLY PASSES (continued) Sewage ba up or breakout or high static water level observed in t e distribution box is due to broken or obstructed pipe(s) or du to a broken, settled or uneven distribution box. Th system will pass inspection if(with approval of the Board of Hea h): broken pipe(s) are replaced obstruction is removed distribution box is levelled or re laced _ The system requir d pumping more than four times a yea due to broken or obstructed pipe(s). The system will pass inspection if(with pproval of the Board of Health): broken pipe(s) are replaced obstruction is removed C) FURTHER EVALUATION IS REQUIRE BY THE BOARD OF H LTH: Conditions exist which require furt er evaluation by the oard of Health in order to determine if the system is failing to protect the public health, safety and the enviro ent. 1) SYSTEM WILL PASS UNLESS BOAR OF HEALTH ETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLI HEALTH A D SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 eet of surface water Cesspool or privy is within 50 et of bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THlJ THE SYSTEM IS FUNCTIONING IN A MA NER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: ` 1he systen) has a septic tank a U Sui aUSUIFriiull !,y�lCni and is within 103 fee', Lo a Surface water suppi) or tributar, to a surface water supply. _ The system hay a septic tank nd soil sorption system and is within a Zone I of a public water supply well. _ The system has a septic tan and soil a sorption system and is within 50 feet of a private water supply well. _ The system has a septic to and soil ab orption system and is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis or coliform bacteria and volatile organic compounds indicates that the well is free from pollution from at facility and t e presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm• D) SYSTEM FAILS: I have determined that the sy em violates one or mor of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is ide ified below. The Board o Health should be contacted to determine what will be necessary to correct the failure. Backup of sewa into facility or system comp nent due to an overloaded or clogged SAS or cesspool. _ Discharge or p nding of effluent to the surface f the ground or surface waters due to an overloaded or clogged SAS or cesspool. (revised 8/15/95) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION F RM PART A CERTIFICATION (continued) Property Address: Owner: Date of Inspection: D] SYSTEM FAILS (continued): Static liquid level ' the distribution box above outlet invert due to overloaded or clogged SAS or cesspool. Liquid depth in cess of is less than 6" below invert or available olume is less than 112 day flow. Required pumping mor than 4 times in the last year NOT du to clogged or obstructed pipe(s). Number of times pumpe Any portion of the Soil Abs ption System, cesspool or pri is below the high groundwater elevation. Any portion of a cesspool or p ivy is within 100 feet of a urface water supply or tributary to a surface water supply. Any portion of a cesspool or pri is within a Zone I of a public well. Any portion of a cesspool or privy i within 50 feet a private water supply well. Any portion of a cesspool or privy is I ss than 100 eet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If th well has en analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic comp nds, a monia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: The following criteria apply to large systems in addi on to the criteria above: The design flow of system is 10,000 gpd or greate (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the followin conditions exist: the system is within 400 feet of a surf ce drinking ater supply the system is within 200 feet of a tr' utary to a surfa a drinking water supply the system is located in a nitrogen sensitive area (Inte im Wellhead Protection Area (IWPA) or a mapped Zone 11 of a public water supply well) The owner or operator of any such system shall bang the system and facili 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 8/15/95) 3 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: fi-"Che s Owner: 6P_O P[j FAR Date of Inspection: Check if th�efofollowing have been done: ► Pumping information was requested of the owner, occupant, and Board of Health. 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. 1( As built plans have been obtained and examined. Note if they are not available with N/A. Zhe facility or dwelling was inspected for signs of sewage back-up. YThe system does not receive non-sanitary or industrial waste flow V The site was inspected for signs of breakout. ✓All system components, Oxcluding the Soil Absorption System, have been located on the site. Zhe 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. Y"The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. Zhe iacihi� om*-e: land 0ccuPant1, i(d;iferen; iro7.-. c„ e^, '. erc provided \+i;h information on the proper maintenance of Sub- Surface Disposal System. (revised 8/15/95) 4 trxw;a SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 247 P f4e4-s W t�¢ann/S Owner: 6eorje A Dj Date of Inspection: 41 - FLOW CONDITIONS RESIDENTIAL- Design flow: 7 Y- gallo s Number of bedrooms: Number of current residents: Garbage grinder(yes or no): /✓O Laundry connected to system (yes or no): YES S Seasonal use (yes or no):ud pp Water meter readings, if available: �ArzZn(5�(3� I��TeR /9UCj 9'y" 9 9,300 CX4 C 72 Last date of occupancy: COMMERCIAUINDUSTRIAL: 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 PUMPING RECORDS and source of information: Na System pumped as part of inspection: (yes or no)_ O if yes, volume pumped. gallons Reason for pumping: TYPE QF 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) Other(explain) PCAJA/7" APPROXIMATE AGE of all components, date installed (if known) and source of information: _�r7 / Sewage odors detected when arriving at the site: (yes or no) /V (revised 8/15/95) 5 � n SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: c36 7 d?4C 'ee3 Owner: Date of Inspection: SEPTIC TANK:v (locate on site plan) .�Depth below grade: � Material of construction: i/concrete_metal _FRP_other(exp lain) Dimensions: 000 G Sludge depth: 3p, 8 Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: o Distance from top of scum to top of outlet tee or baffle: /s Distance from bottom of scum to bottom of outlet tee or baffle: Comments: (recommendation for pumping, condition of inI tend outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) A44— AT- 2 t l!"- 1^14 tr 0A/ P4AC GREASE TRAP:_ (locate on site plan) Depth belov,, grade: Material of construction: _ oncrete _metal _FRP _other(explain) Dimensions: " Scum thickness: Distance from top of scum to top of tlet tee or ba>outlet Distance from bottom <rt,m to bnttn. of outlet tComments: (recommendation for pumptng. co�dttton of in ; a or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, et(.) (revised 8/15/95) 6 Ff�t . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: W/4yHnn�S Owner: Geoc-q 2 FA2.T 1 Date of Inspection: TIGHT OR HOLDING TANK: (locate on site plan) Depth below grade: Material of construction: _concrete metal _FRP —other(explain) Dimensions: Capacity: gallons Design flow: gallons/day Alarm level: Comments: (condition of inlet tee, condition of alarm and fl t s 'tches, etc.) DISTRIBUTION BOX: (locate on site-plan) Depth of liquid level above outlet invert: 0 Comments: (note if level and distributic^ i eti '. e•.idcnce c! So!id> carte.o�.er evidence of leakage into or out of box, etc.) , /6 X/G; �4" 2£Low G�A3�F a s ,c F u rL AD� S aLJ ax S C�sA� i.�iTif/ /t SQL►� 7oP PUMP CHAMBER:_ (locate on site plan) Pumps in working order.(yes or no) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 8/15/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 344 P,4cL e-r5 On 4 (�e�iS Owner: Geory r—Ar—DU I / Date of Inspection: 07_1 C?4 l SOIL ABSORPTION SYSTEM (SAS): V (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number:_ leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Comments: (note condition of soil, signs of h,yoraulic failure, level of ponding, condition of vepetation,etc.) S S► GA IL-£YY 1.2p 6 El,w RAII 47 G�<1rY His ) AC'' it'/ss.e F- 1-510rTwi- AAi,/ cavr._ is ' iL Gr@AJ r. G gkj-ry 4/Nvi P) A A r,e_ /Vice L Pvinid /ti .6,#Sf 1nt4'7_ CESSPOOLS: _ (locate on.site plan) Number and configuratio 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 p mped as pari/of inspection) i Comments: (note condition of soil, sign:\oh/draulic failure, level of ponding, condition of vegetation, etc.) PRIVY:_ (locate on site plan) Materials oi 'construction: Dimensions: Depth`of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (revised 8/15/95) 8 Y SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 36 P�c ,,,-S 100171 k 19040 LS Owner: 660rye 4921-y Date of Inspection: / SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' c 4.0 l Ed If DEPTH TO GROUNDWATER Depth to groundwater: q feet method of determination or approximation: Wc �£f/ y/ ✓ /�f `� � Alit (zevised B/15/95) 9 ii HIGH GROUND-WATER LEVEL COMPUTATION Site Location: 3 0 /i fir-�i P1�f Ann lS Lot No. Owner: /nr e �A►2/�v Address: Contractor: /7�- � ►�� Address: 3�6 m/4 Notes: STEP 1 Measure depth to water table tonearest 1/10 ft. .............................................................................. Date 7 month/day/Year STEP 2 Using Water-Level Range Zone S. and Index Well Map locate site and determine: a OAppropriate index well.................................................... /Y► © Water-level range zone ..................................................... STEP 3 Using monthly report "Current Water Resources Conditions" determine current depth to water level for index well ........................... month/year lr STEP 4 Using Table of Water-level Adjustments for index well (STEP 2A), current depth to water level for index well (STEP 3), and water-level zone (STEP 2B) i I I2 determine water-level adjustment .......................................................................................... STEP 5 Estimate depth to high water by subtracting the water- level adjustment (STEP 4) from measured depth to water s levelat site (STEP 1) ............................................................................................................. Figure 13.--Reproducible computation form. 15 s COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS. - . _- a DEPARTMENT OF ENVIRONMENTAL PROTECTION S�• 350 MAIN STREET WEST YARMOUTH,MA Cc'�'1CO 508-775-2800 TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION MAP C103 PARCEL R269 Property Address: 367 PITCHERS WAY HYANNIS,MA 02601 IRVcj�jvs Owner's Name: ANN LOMBARDI Owner's Address: 367 PITCHERS WAY HYANNIS,MA 02601 p 2 Date of Inspection SEPTEMBER 13,2001 S� 6PRNSTP,BI.E Name of Inspector: lease Tint JAMES D.SEARS TOWHEpF,�TH pEpT. sP (P print) Company Name: A&B Canco Mailing Address: 350 Main Street West Yarmouth,MA 02673 Telephone Number: 508-775-2800 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 15.340 of Title 5(310 CMR 15.000). The system: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority X Fails I�q Inspector's Signature: Date: oy 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 tot - he buyer,if applicable,and the approving authority. Notes and Comments ****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. I Title 5 Inspection Form 6/15/2000 1 Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 367 PITCHERS WAY HYANNIS,MA 0260f Owner: LOMBARDI,ANN Date of Inspection: SEPTEMBER 13,2001 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: N/A _ I have not found any information which indicates that any of the failure criteria described in 310 CUR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 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 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. _ 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 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: _ 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 obstruction is removed distribution box is leveled or replaced ND explain: 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 obstruction is removed ND explain: Title 5 Inspection Form 6/15/2000 2 Page 3 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 367 PITCHERS WAY HYANNIS,MA 02601 Owner: LOMBARDI,ANN Date of Inspection: SEPTEMBER 13,2001 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 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 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 septic tank and SAS and the SAS is within a Zone 1 of 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 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 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: Tide 5 Inspection Form 6/15/2000 3 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 367 PITCHERS WAY HYANNIS,MA 02601 Owner: LOMBARDI,ANN Date of Inspection: SEPTEMBER 13,2001 D. System Failure Criteria applicable to all systems: X You must indicate"yes"or"no"to each of the following for all inspections: 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 leaching is less than 6"below invert or available volume is less than'/z 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 X Any portion of the SAS,cesspool or privy is below high ground water elevation N/A Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply N/A Any portion of a cesspool or privy is within a Zone 1 of a public well N/A Any portion of a cesspool or privy is within 50 feet of a private water supply well N/A 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 cotiform 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 is equal or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.) YES (Yes/No)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: N/A To be considered a large system the system must service 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: (The following criteria apply to large systems in addition to the criteria above) 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 R 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 is 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. Title 5 Inspection Form 6/15/2000 4 Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 367 PITCHERS WAY HYANNIS,MA 02601 Owner: LOMBARDI,ANN Date of Inspection: SEPTEMBER 13,2001 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 Health X Were any of the system components pumped out in the previous two weeks? X Has the system received normal flows in the previous two week period? X Have 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 dwelling 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? 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)has been determined based on: Yes No X Existing information. For example,a plan at the Board of Health. X 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(3xb)] I Title 5 Inspection Form 6/15/2000 5 Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 367 PITCHERS WAY HYANNIS,MA 02601 Owner: LOMBARDI,ANN Date of Inspection: SEPTEMBER 13,2001 FLOW CONDITIONS RESIDENTIAL Number of Bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms: 440 Number of current residents: 3 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): YES Seasonal use(yes or no): NO Water meter readings,if available(last 2 years usage(gpd)): 2000 88,800/2001 101,900 Sump pump(yes or no) YES Last date of occupancy: PRESENT COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): Basis of design flow(seats/persons/sgft,etc.): 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/use: OTHER(describe): i GENERAL INFORMATION Pumping Records Source of information: N/A Was system pumped as part of the inspection(yes or no): NO If yes,volume pumped: gallons—How was quantity pumped determined? Reason for pumping: 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) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank Attach copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: MARCH 6, 1992 PERMIT#92-87 Were sewage odors detected when arriving at the site(yes or no): NO Title 5 Inspection Form 6/15/2000 6 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 367 PITCHERS WAY HYANNIS,MA 02601 Owner: LOMBARDI,ANN Date of Inspection: SEPTEMBER 13,2001 BUILDING SEWER(locate on site plan): N/A Depth below grade: Materials of construction: Cast iron 40 PVC _ other(explain) Distance from private water supply well or suction line: Comments Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK(locate onsite plan): X Depth below grade: 14" Material of construction: X concrete metal fiberglass polyethylene _ other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1,000 GALLON PRE CAST Sludge depth: 2" Distance from top of sludge to the bottom of outlet tee or baffle: 28" Scum thickness: V Distance from top of scum to top of outlet tee or baffle: 12" Distance from bottom of scum to bottom of outlet tee or baffle: 17" How were dimensions determined: ASBUILT AND TAPE Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): TANK AT WORKING LEVEL.INLET AND OUTLET BAFFLES IN PLACE.TANK SHOWS SIGNS OF BEING OVERFULL GREASE TRAP(located on site plan) N/A 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(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Title 5 Inspection Form 6/15/2000 7 Page 8 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 367 PITCHERS WAY HYANNIS,MA 02601 Owner: LOMBARDI,ANN Date of Inspection: SEPTEMBER 13,2001 TIGHT or HOLDING TANK: N/A (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/day Alarm present(yes or no) Alarm level: Alarm in working order(yes or no): Date of last pumping Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: X (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: OVER 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.,): DISTRIBUTION BOX IS 16"X16",26"BELOW GRADE. BOX IS FULL. 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.): Title 5 Inspection Form 6/15/2000 8 Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 367 PITCHERS WAY HYANNIS,MA 02601 Owner: LOMBARDI,ANN Date of Inspection: SEPTEMBER 13,2001 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: leaching chambers,number: X leaching galleries,number 3 leaching trenches,number,length leaching fields,number, dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) LEACHING IS THREE GALLEYS. LEACHING IS 32"BELOW GRADE WITH COVER AT 16"BELOW GRADE. LEACHING IS FULL,NOT LEACHING. CESSPOOLS: N/A (cesspool must be pumped as part of inspectionX 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 or no): 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.) Title 5 Inspection Form 6/15/2000 9 r Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 367 PITCHERS WAY HYANNIS„MA 02601 Owner: LOMBARDI,ANN Date of Inspection: SEPTEMBER 13,2001 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch 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. ��.Lo X. Vol i`' I Title 5 Inspection Form 6/15/2000 10 Page 11 of 11 - - OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 367 PITCHERS WAY HYANNIS,MA 02601 Owner: LOMBARDI,ANN Date of Inspection: SEPTEMBER 13,2001 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to groundwater 10 feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observation site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation X Accessed USGS database-explain: You must describe how,you established the high ground water elevation: GROUNDWATER TEST HOLE 10' WATER. uS G .5 2.S' G/fA-D F 4 3� 7oP of /D G,4tc y d.w• G' w Title 5 Inspection Form 6/15/2000 11 TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: / S�r�-t, `�,�fii c0 Mail To: BUSINESS LOCATION: -5' Z %�iT� �� ir// Board of Health ��-� Town of Barnstable MAILING ADDRESS: P.O. Box 534 TELEPHONE NUMBER: 7 7 5- Hyannis, MA 02601 CONTACT PERSON: �j �oln//i42b- EMERGENCY CONTACT TELEPHONE NUMBER: 1461`0-9 7%kk4V o? 7 7/- 7 'IVD Does your firm store any of the toxic or hazardous materials listed below, either for sale or for your own use, in quantities totalling, at any time, more than 50 gallons liquid volume or 25 pounds dry weight? YES NO This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site other than your mailing address: ADDRESS: TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous character- istics and must be registered regardless of volume. Please estimate the quantity beside the product that you store: Quantity/Case Quantity/Case ) Antifreeze (for gasoline or coolant systems Drain cleaners Automatic transmission fluid >/9-ti, Toilet cleaners D Engine and radiator flushes Cesspool cleaners Hydraulic fluid (including brake fluid) >4L Disinfectants Motor oils/waste oils _ 0 Road Salt (Halite) (� Gasoline, Jet fuel 0 Refrigerants 0 Diesel fuel, kerosene, #2 heating oil _� Pesticides (insecticides, herbicides, 0 Other petroleum products: grease, lubricants rodenticides) _0 Degreasers for engines and metal _� Photochemicals (fixers and developers) D Degreasers for driveways & garages V Printing ink 0 Battery acid (electrolyte) _( Wood preservatives (creosote) 0 Rustproofers 0 Swimming pool chlorine 0 Car wash detergents y Lye or caustic soda O Car-waxes and polishes 0 Jewelry cleaners Q Asphalt & roofing tar 0 Leather dyes 0 Paints, varnishes, stains, dyes 0 Fertilizers (if stored outdoors) bra Paint & lacquer thinners _) PCB's _0 Paint & varnish removers, deglossers Other chlorinated hydrocarbons, 0 Paint brush cleaners (inc. carbon tetrachloride) 0 Floor & furniture strippers 0 Any other products with "Poison" labels 0 Metal polishes (including chloroform, formaldehyde, Laundry soil & stain removers hydrochloric acid, other acids) (including bleach) y Other products not listed which you feel may d Spot removers & cleaning fluids be toxic or hazardous (please list): (dry cleaners) 0 Other cleaning solvents 0 Bug and tar removers -Household cleansers, oven cleaners White Copy- Health Department/ Canary Copy-Business r TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: 5;4,gZ Mail To: BUSINESS LOCATION: _5' ( ,7 Board of Health Town of Barnstable MAILING ADDRESS: P.O. Box 534 TELEPHONE NUMBER: -7 7 l _ U y 5- Hyannis, MA 02601 ' CONTACT PERSON: EMERGENCY CONTACT TELEPHONE NUMBER: /-AUo - 9 7 y-kkdo ov 77l 7 VVO i Does your firm store any of the toxic or hazardous materials listed below, either for sale or for your own use, in quantities totalling, at any time, more than 50 gallons liquid.volume or 25 pounds dry weight? YES NO I This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience: If you answered YES above, please indicate if the materials are stored at a site other than your mailing address: , ADDRESS: TELEPHONE: 1 t LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous character- . ; istics and must be registered regardless of volume. Please estimate the quantity beside the product that you store: Quantity/Case Quantity/Case Antifreeze (for'gasoline or coolant systems) 7 Drain cleaners Automatic transmission fluid > Toilet cleaners D `` Engine and radiator flushes D Cesspool,cleaners �7 Hydraulic fluid (including brake fluid) > Disinfectants Motor oils/waste oils Road Salt (Halite) 0 Gasoline, Jet fuel 0 Refrigerants 0 Diesel fuel, kerosene, #2 heating oil �_ Pesticides (insecticides, herbicides, O Other petroleum products: grease, lubricants rodenticides) a Degreasers for engines and metal —� Photochemicals (fixers and developers) C7 Degreasers for driveways & garages y Printing ink O Battery acid (electrolyte) _� Wood preservatives (creosote) 0 Rustproofers 0 Swimming pool chlorine Car wash detergents 0 Lye or caustic soda D Car waxes and polishes U Jewelry cleaners - C� Asphalt & roofing tar Leather dyes 0 Paints, varnishes, stains,dyes 0 Fertilizers (if stored outdoors) CAI Paint & lacquer thinners _� PCB's v' .4 (� Paint& varnish removers, deglossers Other chlorinated hydrocarbons, Paint brush cleaners (inc. carbon tetrachloride) 0 Floor & furniture strippers Any other products with "Poison" labels C? Metal polishes (including chloroform, formaldehyde, ?/�,�1 Laundry soil & stain removers hydrochloric acid, other. acids) (including bleach) . Other products not listed which you feel may y Spot removers & cleaning fluids,, be toxic or hazardous (please list): (dry cleaners) D Other cleaning solvents - ® Bug and tar removers IC�L Household cleansers, oven cleaners White Copy- Health Department/ Canary Copy-Business t TOWN OF BARNSTABLE LOCATION G / Pl����'� 1,4Y SEWAGE # l 7 VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. ANeQ .SEPTIC TANK CAPACITY LEACHING FACILITY:(type) �° .Q L C <f'S 3 (size) NO.OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR(OWNER) DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED- VARIANCE GRANTED: Yes No ni p � w cl, y O I L Rv TOWN OF BARNSTABLE p LOCATION SEWAGE #�� " o VILLAGE Llt:�c, w 5 ASSESSOR'S MAP & LOT t j INSTALLER'S NAME & PHONE NO.CA,^ SEPTIC TANK CAPACITY LEACHING FACILITY:(type) C .A!:,s C3 (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: 13 6 2a , DATE COMPLIANCE ISSUED: 7- VARIANCE GRANTED: Yes No • VVKK / . /6a 4 at 6 'Y qq No...,l_o�.::.. 2.. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Appliratiun for Dwposal Warkii Totsarurtiun Famit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at ... 7......... .. ... ... .• .... - ----------..........-•-----•----------------------•--------------......---............ .......Lo. ion...-AdYdr`es� 3 P v C L-V e�• -�•-^ -- ............... ..................... ...... oA dt of ' � V� 4 �.........�-1 w er `l II `U � 1 rn a= .ress� ( ) C C•S.�._Jl'......_ Installer Address Type of Building Size Lot............................Sq. feet �-t Dwelling—No. of Bedrooms.........-----------------------------------Expansion Attic ( ) Garbage Grinder ( ) a`4 Other—T e of Building ............... No. of persons............................ Showers YP g ------------- ( ) — Cafeteria ( ) Other fixtures ......................................................... Desi n Flow............................................ allons er erson per day. Total daily flow__._.._.._.........__.......................gallons. gg P P P Y� WY (4 Septic Tank—Liquid'capacity............gallons Length................ WidthWx ....._...._..... Diameter-----___-___-_- Depth................ Disposal Trench-'No..................... Width.....____........... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( .) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of.Test Pit.................... Depth to ground water........... .------------ ---•----------------- ----AL- L- ---•---------------------------•---------------------------•--•----------------------------------------- ---------- ...... 0 Description of Soil.............---S- -. .•���-� ---,--....--•------------•---------------------------•-----------------------•----------------------•--------•-•----- U ........................ ----------------------•-----------.....------------•----------•---------•-------•--•-----------...-----...--•------ ---- - ------------------------------•-----------------------------. - - ------------------- - 014 U Nature of Re airs or terat'o s—A wen applicablte�_____u_____________ t --------------- 5 �.. .. -- -- = I _ .�.1. 5 Agreement:. The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Envir mental Code—The undersigned further agrees not to place the system in operation until a Certificate of Co plia ce as been i sued by the board health. \ 6 ^ �2 Signe .-C.....1�... .. 1. Date Application Approved By ------------------- � J ------------------------------------------------------------------------------ ---------------------------------------- Date Application Disapproved for the following reasons- ........................... ----------------------------- ---- ---------------- ---------- - --------- ----- -------- ............................................... ............................................... .. ------. ......--- --- �. --... Date Permit No. Issued 3........................................-------- -------- Date THE COMMONWEALTH OF MASSACHUSETTS _ 7 BOARD OF HEALTH TOWN OF BARNSTABLE 1 Appliratiuu for Disposal Works Cnumuurttuu rrrutit Application is hereby-made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: Loc Lion-Ad;rees j]I o �e a Address C.t O,w er 4-� �,�`-� .............................. ................ � Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.........................•_-___--_----------Expansion Attic ( ) Garbage Grinder `( ) aOther—Type of Building ............................ No. of persons......._.................... Showers ( ) — Cafeteria ( ) dOther fixtures ---------------------------------------------------------••------------.........------. W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal .Trench ' No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by---------................................................................. Date..............................-......... W7 Test Pit No. I................minutes per inch , Depth of Test Pit.................... Depth to ground water................._...... 44 Test Pit No. 2................minutes per inch 'Depth of Test Pit.................... Depth to ground water........................ =---_---------------------k..--••-••-------•--••-•--•----------•------------•......-----•................................................................ D Description of-Soil................�. .0.......- - U ------ ............................. , W ------------------------------------------------------------------------ -- ••-. - r - ••----- - -•ns—A 8w w n applicable. 1� e a.�. .. � o •. . � c ...-- �..... Nature o Repairs or lteratao, --••----- --'� ­'s............................................ Agreement. The undersigned agrees to install the aforedescribed Individual Sewage Disposal Systemin�accor6rice with the provisions of TITLE•5 of the State Envir mental Code—The undersigned further agrees not to place the system in operation until a Certificate of Co pli�ce 'has been i sued by the board,6f health. Signe .Cn... � • Date Application Approved By -------------- - i Date Application Disapproved for the following reasons: ..... ------------------------------------------------------------------------------ ------------' --------------- li Permit No. .-------1....Q�.� (7 ..------------ --- Issued ......3...�. ......�-� v---- - Date s/ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE f. Certificate, of Compliance T rb5 IS TO CERTIFY, That t e Individual Sewage is�posal System constructed ( ) or Repaired y.... .... --------- -------- - ---------------------- ------------------------------------------------------------------------ Installer at .......... A't X- '�- ` e. r ........... �niron �" --------------------------------------------------------- has been installed in accordance with the provisions of TITLE 5 oTThe State mental Code as described in the application for Disposal Works Construction Permit No -----g- --------- dated ................................................ t THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........... `� -- l off. �� ----------------------- ---------------------------------- Inspector ----------------------------------------- ............. ................ THE COMMONWEALTH OF MASSACHUSETTS l BOARD OF HEALTH TOWN OF BARNSTABLE ? Q .c�c No.... _-.. ` FEE........................ • �tu�u 1 fur ,� �utt�� t�u� rrf v\, Permission is hereby granted--- r-`----------......---------------�......--V­7------------..._...----....----- ..................................... Fto Construct ( ) or Repair (Egan Individual Sewage Disposal System --------------- ----.-------------------- --- Stree as shown on the application for Disposal Works Construction Permit No.__7, :. . Dated..................,....................... Board of Health DATE •••_.. � .t....-•---------•-•-•--•............. FORM 36508 HOBBS&WARREN,INC..PUBLISHERS 06-12-2002 08:46AM FROM SWEETSER ENGINEERING TO 15087906304 P.02 CRAIG R. SHORT, P.E. 235 Great Western Road P.O.Box 1044 Telephone(508)398-8311 South Dennis.MA 02660 Fax (508)398-3063 PROFESSIONAL CIVIL ENGINEER,SOIL EVALUATOR,SEPTIC INSPECTOR SE MC SYSTEM DESIGNS,COASTAL&BUILDING DESIGNS TO: Thomas McKean Health Director Barnstable Board of Health 200 Main Street Hyannis.MA 02601 RE: CERTIFICATION OF SUBSURFACE SEWAGE DISPOSAL SYSTEM LOCATION OF SYSTEM: 367 Pitcher's Way,Hyannis,MA. CIMM: Ann Lombardi PLAN DATE: 12/13/01 revised 02/12/02(to add note) FILE* 1-999 DATF.(S)OWME OF INSPECTIONS: 06/07/01 Inspect Overdig(by Robin Wilcox) 06/11/01 Inspect System,measure for As-Built and Take Photographs L Craig R Short Civil Engineer, duly licensed as such in the Commonwealth of Massachusetts, do hereby certify that this firm has visually inspected the constructed subsurface sewage disposal system shown on the referenced approved plan, and further cer ify that the system, as constructed and shown on the attached As-Built,generally conforms within acceptable tolerance to the regulations, as varied, set forth in 310 CUR 15.000 mad the Town of Banrstabk Board of HeaM Regulations. Craig R. or;P.E.,Engineer bite cc: File 1-899 CIient Ann Lombardi Contactor Scott Campbell Tye Septt'c Tank was revised to an Acme 25N(w/1500 septic tank& 1000 pump chamber) H10 with a 6"Reinforced Concrete Top. PROJECT' DESCRIPTION: C- y�T� Top cF oc-au.v-D.9T/,o EC I CC-00 P 1 P E 2 Q V,E I2,_1'"(51.__F'AJZ .F 1, Y J ' 13 —T S. A. S. r t V��1�L ,L �•vF.c? 6'i V ��' -- r 13 AA 4AZ f 4 4N _ t Member ASCE CRAIG.R..SHORT RE CRAtG �.\v P.O.sox 1044. SHO =i T_ y�'Tc v✓A . SOUTH DENNIS,MA 02660 LOCUS: � G v CIVIL No.27483 Professional Civil Engineer w Soil Evaluator ,� � a TOWN. �- Ucensed Construction Supervisor•Septic Inspector �sr�or� t un•rr. ��!2;a 2 Septic'•Site'e'Piers Structures House Designs ,. i Cffice.(508)398-83t 1 Fax(508)398-30M ( � 21 b2' 06-12-2002 01:14PM FROM SWEETSER ENGINEERING TO 15097906304 P.02 Doea8631392 63-35-2M 3t29 BARNSTNM LARD COURT RMISTR1f DEED RESTRICTION In accordance with provisions of C.M_R 15.201(2)Tide S.a minimum reauired design flaw for a single family dwelling shall be for 3 bedrooms or flows of 330 gallons per day.No more than dwee(3)bedrooms mmdmum are authorized at this property Dens.Study rooms,offices finished attics, sleeping logs, and sirnflar type rooms acre considered"bedrooms"according to the MA Department of Environmental Prot w ion. Notice is hereby given by the recording of this Deed Restriction that the following property has had a 3 bedroom Title S Septic System designed limiting the use of said property to a maximum of 3 bedrooms. Property Located at:367 PITCHER'S WAY,flYANNW,(BARNSTABLE)MA. Town Assessors: Map 269 Parcel 141 Plan Reference: L.C. 2MSP And shall rum concurrent with the deed of the property refe=c ed above. Barnstable Registry of Deeds Deed Reference. CERTIFICATE C140316 For. James D.Lombardi& Ann L Lombardi 367 Pitchers way. Hyannis,MA 02601 4 &OL4 J Owner Name Owner Name Daik TOTAL P.02 - - - TOWN OF BARNSTABLE EC_ LOCATION 6 / �//T G�l��� �� SEWAGE #,W 77 VILLAGE ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. Z 4/Ozy—fo?r 5� SEPTIC TANK CAPACITYC-91V 441 /520 5F5e 1 AZ 0 LEACHING FACILITY: (type) ,D !2 C,4 (size) X X /U NO. OF BEDROOMS �0 _ /� 10A6�0 BUII.DER O PERMITDATE: 7' dC2 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 f e jig O y! ' R i Town of Barnstable SAFtN$7`ABLE, s , 039. Board of Health 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Susan G.Rask,R.S. FAX: 508-790-6304 Sumner Kaufman,MSPH Wayne Miller,M.D. January 25, 2002 Mr. Craig R. Short, P.E. P.O. Box 1044 So. Dennis, MA 02660 RE: 367 Pitcher's Way, Hyannis Dear Mr. Short, You are granted variances, on behalf of your client,. Ann Lombardi, to construct an onsite sewage disposal system at 367 Pitcher's.Way, Hyannis.. The variances granted are as follows: 310. CMR 15.211: The soil absorption system will be located six (6) feet away from the property line, in lieu of the ten (10) feet minimum setback required. PART VIII SECT 1.00: The soil absorption system will be located 78 feet away from a bordering vegetated wetland, in lieu of the 100 feet minimum setback required. PART VIII SECT., 1.00: The septic tank will be located only 62 feet away from the wetland, in lieu of the 100 feet minimum separation distance required. The variances are granted with the following conditions: (1) No more than three (3) bedrooms maximum are authorized at this property. Dens, study rooms, offices, finished attics, sleeping lofts, and similar-type rooms are considered "bedrooms" according to the MA Department of Environmental Protection. (2) The applicant shall record a properly worded deed restriction, signed by the owner of the property, at the Barnstable County Registry of Deeds Short? I restricting the property to three (3) bedrooms maximum. A copy of the recorded deed restriction shall be submitted to the Health Agent prior to obtaining a disposal works construction permit. (3) The septic system shall be installed in strict accordance with the engineered plans dated. December 13, 2001. (4) The designing engineer shall supervise the construction of the onsite sewage. disposal system and shall certify in writing to the Board of Health that the system was installed in substantial compliance with the submitted plans dated December 13, 2001. These variances are granted because physical constraints at the site severely restrict the location of a soil absorption system due to the fact that wetlands adjoin the property. The proposed new septic system is designed to meet the. maximum feasible compliance standards contained within the State. Environmental Code, Title V. Sincerely yours, Susan G. Rask, R.S. Chairperson Short? Town of Barnstable Board of Health 200 Main Street,Hyannis MA 02601 Office: 508-862-4644 Susan G.Rask,R.S. FAX: 508-790-6304 Sumner Kaufman,MSPH Wayne Miller,M.D. Mr. Craig R. Short, P.E. January 25, 2002 P.O. Box 1044 So. Dennis, MA 02660 RE: 367 Pitcher's.Way, Hyannis. Dear Mr. Short, You are granted. variances, on. behalf of your client, Ann Lombardi, to construct an.onsite sewage disposal. system at 367 Pitcher's.Way, Hyannis. The.variances granted are as follows: 310 CMR 15.211: The soil absorption system will be located. six (6) feet away from. the. property line, in. lieu of the. ten (10) feet minimum setback required. PART VIII. SECT. 1.00:. The soil. absorption system. will be located. 78. feet away from a. bordering. vegetated. wetland, in lieu. of the 100, feet minimum setback required. PART VIII. SECT.. 1.00: The. septic tank will be located only 62 feet away from the wetland, in lieu of the 100 feet minimum separation.distance required. The variances are.granted with.the following.conditions: (1) No. more than three (3) bedrooms maximum. are authorized. at this. property. Dens, study rooms, offices, finished attics, sleeping lofts, and similar-type rooms are considered "bedrooms" according. to the. MA Department of Environmental Protection. (2) The. applicant, shall. record a properly worded deed restriction, signed by the owner of the property, at the. Barnstable County. Registry of Deeds Short? restricting the property to. three (3) bedrooms maximum. A copy of the recorded deed restriction shall be submitted to the Health Agent prior to. obtaining a disposal works construction permit. (3) The septic system shall. be installed in. strict accordance with the engineered plans dated. December 13, 2001. (4) The designing engineer shall supervise the construction. of the. onsite sewage. disposal system. and shall certify in.writing. to the Board of Health. that the system. was installed. in. substantial compliance with the submitted. plans dated December 13,.2001. These. variances. are. granted. because. physical constraints. at the site severely restrict the location of a soil absorption system. due. to the fact that wetlands adjoin. the property. The proposed new septic system is designed to meet the. maximum feasible compliance standards contained within the State Environmental Code, Title V. Sincerely yours,. Susan. G. Rask, R.S. Chairperson Short? I RECEIVED JAN - 8 2002 TOWfV OF StiFfivJ i htiLE �rttHE T HEALTH DEPT. DATE: • �..C�. FEE: 1ARNSrAffi.ffi 9 MAS& 165 `0� REC.. BY FO Mp'�b Town oaf`Barnstable S®. DATE: Board of Efealth 367 Main.Street, Hyannis MA 02601 Office:,508-862-4644- Susan G.Rask,R.S. FAX 508-790-6304 Sumner Kaufman,M.S.P.H. Ralph A.Murphy,M.D. VARIANCE REQUEST FORM LOCATION Property Address: 367'Pitcher's Way,Hyannis,MA Assessor's Map and Parcel Number: MAP 269 PARCEL 141 Size of Lot: .28 acres Wetlands.Within 300 Ft. Yes XX Business Name: No Subdivision Name: APPLICANT'SNAME:: Ann Lombardi Phone: 508-771-9605 Did the owner of the property authorize you to represent him or her? Yes No PROPERTY OWNER'S NAME CONTACT.PERSON Name Ann Lombardi, Name Craig R.Short,P.E. Address 367 Pitcher'"s Way Address P. O.Box 1044• Hyannis,MA 02601, South Dennis,MA 02660- Phone 508-771-%05 Phone 508-398-8311 VARIANCE FROM REGULATIONS REASON FOR VARIANCE See attached-sheet See attached sheet: Maximum feasible compliance NATURE OF WORK: House Addition 0 House Renovation 0 Repair of Failed Septic System- Checklist-(to be completed by ofce staff-person receiving variance request application) Four(4)copies of the completed variance request form Four(4)copies of engineered plan submitted(e.g,septic system plans) Four(4)copies of labeled dimensional floor plans submitted(e.g..house plans or restaurant kitchen plans) _ Signed letter stating that the property owner authorized.you to represent himtber for this request Applicant understands that the abutters must be.notified by certified mail at least ten days prior to meeting date at applicant's expense (for Title V and/or local sewage regulation variances only) Full menu submitted(for grease trap variance requests only) Variance request application fee collected(no fee for lifeguard modification renewals,grease trap variance renewals[same ownedleasee only),outside dining variance renewals[same ownerileasee only],and variances to repair failed sewage disposal systems [oniy.if no expansion to the building proposed]) Variance request.submitted at least 15'days prior to meeting date VARIANCEAAPPROVED Susan G.Rask;M.,Chairman NOT APPROVED Sumner Kaufman,M.S.P.H. REASON FOR DISAPPROVAL Ralph A.Murphy,M.D. Q:/WP/VAR=EQ ROARI)OF HEALTH VARIANCE REQUEST Ann Lombardi 367 Pitcher's Way Hyannis,MA 02601 TITLE 5 REGULATIONS Section 15.103(3)(C)2. Soil Profile Determine Maximum Ground.Water- A Variance requested to use maximum wetland elevation instead Section 15.211 Minimum Distances Distance between S.A.S.and Property Line—10' required A 4'variance requested TOWN OF BARNSTABLE REGULATIONS Part VIII Section 1:00 Distances between Wedand and Septic System-100' required A 22"Variance requested for S.A.S. A 38' Variance requested for Septic Tank . .i.o.; i ; +.••--y r. ' ?;r.�..�? .._1 �— s ! ! f f t ICI t i 1 i r•�� t i "' I I i- { Grp i=1 -� .., t 1 I ..`-iTrj ocl- - I hi i � r q I I I , , ; _, _I i I __I___�• I f I I - I�( I- ......I I ' •rr' . ..j � ! 4 ti .I...r.-' � � 1 I I I ... r �. I ► � �•ri i ' .i�! I ; i i i--� i ~W�� I i j ���.�.� fir` . t i t I i 1 i i r.. _.__,-•--i•-- . ..... !r-• �-- i I I �,��I r I l I �! i I I TI I + ! �! i ' - r '�}vim, ' '`-'��__ !^-•_J���__.__ ... •- •`_ --� �-_ b ....... `r�i � I yi I I f ' —� i-`' i 1 ` -•-I-' I I I i t 4...a� � I Rf4;�� t I i � i I I iT• i 1 I i j �� i j� I � � i i ! # I I IF k t_ tH� — I -}-d-}ter I`I i I ���-i j ,� j��� �j-ti '`"-? � ' -�-i---�^•.- -j-- ' f I ') t 1 I�l�}....�} I j 1}'-�'�+E�--�I.�j.. f •.�y"_i t 1�.�...i ( (� I .,..•_�.__I �'_.. I i I I`�i � ! I I I I � � � f I � ��—I i � r � ` .. •. !j^-, � 1 'fit ` II� S � k ' 1 _ � ul,-' _... _ � i w+�...•I I +I�--�-�-�-•t i - I i j S I I 'I t xAiG R. SHORT, P.E. _;235 Great Western Road P.O. Box 1044 Telephone(508)398-8311 South Dennis,MA 02660 Fax (508)398-3063 PROFESSIONAL CIVIL ENGINEER, SOIL EVALUATOR, SEPTIC INSPECTOR SEPTIC SYSTEM DESIGNS,COASTAL&BUILDING DESIGNS NOTIFICATION TO ABUTTERS OF: Applicant: Ann Lombardi Certified Mail 367 Pitcher's Way Return Receipt Requested Hyannis,MA 02601 Re: Septic System Upgrade @ 367 Pitcher's Way,Hyannis,MA Dear Abutter, Please be advised that an application for variances from the Regulations of the Massachusetts Department of Environmental Protection,Title 5, and/or the Town of Barnstable Regulations for Subsurface Disposal of Sewage,has been submitted to the Barnstable.Health Department for approval. The following variances are requested: Title 5 Regulation and Barnstable Board of Health Regulations Section 15.103(3)(C)2. Soil Profile Determine Maximum Ground Water A Variance requested to use maximum wetland elevation instead Section 15.211 Minimum Distances Distance between S.A.S and Property Line—10' required A 4' variance requested Barnstable Part V1H Section 1:00 Distances between Wetland and Septic System 100' required A 22' Variance requested for S.A.S. A 38' Variance Requested for Septic Tank The application and plans are available for review at the Barnstable Health Department, 200 Main Street, Hyannis,MA 02601, Monday through Friday(excluding holidays)from 8:30 am.to 4:30 p.m. A Tentative hearing date is scheduled for Wednesday,January 23,2002 beginning at 7:00 PM.to be . held at Barnstable Town Hall, 367 Main Street, Hyannis,MA. Please call Barnstable Health Department to confirm.(508-862-4644) This letter is to serve as an official notification to abutters. Sincerely, Craig R. Short, P.E. Cc: File Barnstable Board of Health Abutters ABUTTERS OF: Ann Lombardi 367 Pitcher's Way, Hyannis, MA MAP 269 PARCEL 141 CRS Job# 1-8993 James D. Lombardi Ann E. Lombardi AM 269/141 367 Pitcher's Way Hyannis,MA 02601 Town of Barnstable 367 Main Street AM 269/140 Hyannis,MA 02601 Melissa M. Lima 18 Ferndale Road AM 269/139 Hyannis, MA 02601 Darlynne D. Selens 15 Princess Pine Road AM 269/88 Hyannis, MA 02601 Kevin D. Ratliff Debra A. Poirier AM 269/87 20 Princess Pine-Road Hyannis,MA 02601 Brace E&Rosalind Edwards c/o Rosalind.C. EdwardsAM 269/93 383 Pitcher's Way Hyannis,MA 02601. I Lillian Senteio 97 Oak Neck Road AM 290/15-2 Hyannis,MA 02601 John J. R . 0 c/o Benjamin&Patricia Perry AM 290/16 341 North Street Hyannis,MA 02601 N.y � �i-,SIAIG R. SHORT, P. E. 235 Great Western Road P.O. Box 1044 Telephone(508)398-8311 South Dennis, MA 02660 Fax (508)398-3063 PROFESSIONAL CIVIL ENGINEER, SOIL EVALUATOR, SEPTIC INSPECTOR SEPTIC SYSTEM DESIGNS,COASTAL&BUILDING DESIGNS ZuTeosie'UEALTH E.D NOTIFICATION TO ABUTTERS OF: 2001 Applicant: Ann Lombardi Certified ARNSTABLE 367 Pitcher's Way Return Receipt REPT. Hyannis,MA 02601 Re: Septic System Upgrade @ 367 Pitcher's Way,Hyannis,MA Dear Abutter, Please be advised that an application for variances from the Regulations of the Massachusetts Department of Environmental Protection,Title 5, and/or the Town of Barnstable Regulations for Subsurface Disposal of Sewage,has been submitted to the Barnstable Health Department for approval. The following variances are requested: Title 5 Regulation and Barnstable Board of Health Regulations Section-l5.103(3)(C)2. Soil Profile Determine Maximum Ground Water A Variance requested to use maximum wetland elevation instead Section,15:214 :, :_, Minimum Distances Distance between S.A.S and Property Line—10'required -, AA-4',variance requested Barnstable Part VIR Section 1:00 Distances between Wetland and Septic System 100' required A 22' Variance requested for S.A.S. A 38' Variance Requested for Septic Tank The application and plans are available for review at the Barnstable Health Department, 200 Main Street, Hyannis, MA 02601, Monday through Friday(excluding holidays) from 8:30 a.m.to 4:30 p.m. A . Tentative hearing date is scheduled for Wednesday,January 23,2002 beginning at 7:00 PM. to be held at Barnstable Town Hall, 367:Main Street, Hyannis,MA. Please call Barnstable Health Department to confirm(508-862-4644) This letter is to serve as an official notification to abutters. = Sincerely,. S''Z Craig R.-Short, P.E. J-, Barnstable Board of Health Abutters BENCHILA 4" SCHELULE 40 PVC PIPE SOIL TEST TOP OF FOUNDATION 20 FT. MINIMUM FROM CELLAR MIN, PITH 1/8" PER FT. CLEAN SAND PAINT DARK FLAT GREEN DATE OF SOIL TEST 12107L01 100 00 10 FT. MINIMUM 10 FT. INIMUM FROM SLAB OR CRAWL SPACE 2" LAYER OF CARBON FILTER SOIL TEST DONE BY CNAlG�2_ i,Q�T�e, _ ELEV. = 2" PRESSURE PIPE LOAM OR 1/8" TO 1/2" WITNESSED BY -"\T. ______ (ASSUMED) 150 PSI MINIMUM ELEV. = 100.70 MAX. GRAVEL WASHED STONE VENT H?o C.z , _95.25_ 100.58 MIN. PUMP SWITCHES DETAIL OBSERVATION HOLE 1 ELEV.=__99.3_ COVERS 4 PERCOLATION RATE < � MIN./INCH AT �� INCHES FRAME H2� "{�vC z DEPTH HORIZ TEXTURE COLOR MOTT. OTHER FULL, 99.58 a, 40 M L 24" FILL LOAMY SAND NO UNSUITABLE CELLAR 4' 4" CAST IRON PIPE `I V/NYC MATERIAL (OR EQUAL) MINIMUM 2'0' ° ° o00000oo�ooa�oo�o ° PITCH 1/4" PER FT. LEVEL �0 10" ° UNSUITABLE BEL A1800 FILTER ELEV. = ELEV. _ __ o = _98_25_ 30 A LOAMY SAND 10YR5/1 NO 6" SUMP 99.20 ° o ° ELEV. MATERIAL FLOW LINE -a"_ &S v 98.00 ALARM ON ELEV, = 91.75 i1 PLUMBING ELEV. = 96.00 10" DISTRIBUTION ELEV. = oft 0a9i PDX 48" B LOAMY SAND 2.5Y7/4 NO ELEV. � 95.3t TO BE RAISED __ 4-H2O HIGH CAPACITY INFILTRATORS 21 3" MIN. GAS j 3/8" DR ILL BOX 91LId WITH STONE IN AN z_ 5.25' PUMP ON ELEV. = 91.50 AND RE-PIPED BY HOLE /� - MAVEL LICENSED PLUMBER I ELEV. - _95.50 --� BAFFLE v' TO BE WATER TESTED 11' X 34' X 10" TRENCH FORMATION WELL MIW29 " 78" Cl COARSE SAND 2.5Y7/6 NO CELLAR FLOOR AT ELEV. 93.0t H 2 0 !' L� CHECK OBE PLACED 03/4RM OB 1 1/2 SOIL ABSORP11ON INDEX 9.9 12 01 18_ 8" PUMP OFF ELEV. = 90.83 COARSE LIQUID OUTLET FIRM B SE VALVE WASHED STONE SYSTEM (SAS) /ADJUST 7.0 10' 10" 144" C2 MEDIUM SAND 2.5Y7/6 NO 4DEPTH TEE FEET 19 INCHES (TO BE PLACED ON A ) O ELEV. = 90.00 5 FEE 2500 GALLON MY=RS SRM 4 ELEV, = 89.50 WATER ENCOUNTERED AT 1A.3_ ELEV. 6 FEET 24 INCHES VA7H PUMP (OR EQUAL) USGS PROBABLE WATER TABLE ELEV. = 9��__ 6 8 FEET 34 :INCHES SEPTIC TANK CHAMBER OBSERVED WATER TABLE (12 /07/01 ) ELEV. = 89_0__ 8Y WIGGINS PRECAST cb00 DAL) BOTTOM OF TEST HOLE ELEV. = 87_3__ (OR EQUAL) im) _s525- PUMP CHAMBER CALCULATIONS: LEGEND: DESIGN CALCULATIONS ELEV. AT INVERT INLET EXISTING SPOT ELEVATION OOxO NUMBER OF BEDROOMS _ 3__ ELEV. AT ALARA ON -g1 Z5- REQUIRED FLOW PER CYCLE .25 X _ _ _�� GAL./CYCLE EXISTING CONTOUR ----00---- GARBAGE DISPOSAL UNIT _ NO_ SEWAGE DISPOSAL SYSTEM PROFILE ELEV. AT PUMP ON -_915Q- VOLUME PER CYCLE _ 82_5 GAL/CYCLE /7.48 GAL,/CU. FT. = 11_03_ CU. FT./CYCLE FINAL SPOT ELEVATION O0.0 TOTAL ESTIMATED FLOW NOT TO SCALE ELEV. AT F OFF -�-�- VOLUME OF WATER IN PIPE 3.14 X 0.00694 X- L5 FT. _ CU. FT, FINAL CONTOUR ( 110 GAL./3R./DAY X �_ BR.) _.UQ_ GAL./DAY BOTTOM OF OUTSIDE PUMP CHAMBER UTILITY POLE -O- RE ,�5?9 BOTTOM OFF INNSIDE PUMP CHAMBER -��- TOTAL MINIMUM VOLUME PER CYCLE -U.B CU. FT. SOIL TEST LOCATION REQUIRED SEPTIC TANK CAPACITY _1 GAL. _ .;�Q_ U DISCHARGE _],],� CU. FT. / 17 CU.FT,/FT. _ __67 FT. (H20) ACTUAL SIZE OF SEPTIC TANK _2000 GAL, (. FFEGT. STORAGE CAPACITY ( 33Q GAL./DAY /7.48 GAL./CU.FT./ 17 CU.FT./FT. _ __2&9 FT, TOWN WATER =W W SOIL CLASSIFICATION -_2&Q REQUIRED _3.50 PROVIDED CATCH BASIN \®/ DESIGN PERCOLATION RATE _<_� MIN./IN. GAS LINE G EFFLUENT LOADING RATE _QL7�_ GAL./DAY/S,F, CLEAN OUT C•0. LEACHING AREA _ 9_ SO. FT. CESSPOOL C.P. 0 (11'X34')+(90'X10"/12) LEACHING CAPACITY (AREA X RATE) _X2_ GAL./DAY 449 X 0.74 RESERVE LEACHING CAPACITY _jjL&_ GAL./DAY TITLE 5 & TOWN B.C.H. VARIANCE REQUESTS: NOTES: /SECTION 15.103(3)(C)2. SOIL PROFILE DETERMINE MAXIMUM GROUND WATER. A VARIANCE REQUESTED TO USE MAXIMUM WETLAND ELEVATION INSTEAD. 1. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. 1 TITLE 5 AND THE TOWN RULES AND REGULATIONS FOR THE SUBSURFACE p�A � G � D �•x�s�"y,�. � SECTION 15.211 MINIMUM DISTANCES: DISPOSAL OF SEWAGE. DISTANCE BETWEEN S.A.S. AND FROPERTY LINE (10' REQUIRED) A�A ' D�/vt w.4 y To 2. ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO IN P �� ���acsir�.7 A 4' VARIANCE REQUESTED WITHIN 6" OF FINISHED GRADE. 1 3. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF 1rL'SS Sqs�^'_ ? J - TOWN OF BARNASTABLE B.O.H. VARIANCE REQUESTED: WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN v Ar `N '-�� - o.vy4 PART VIII SECTION 1:00 10 FT. OF DRIVES OR PARKING AREAS. H-20 LOADING SHALL BE U T 1 TRINL i s y �o/Vl v �� CH. \ O DISTANCES BETWEEN WETLAND & SEPTIC SYSTEM USED UNDER OR WITHIN 0 F . OF DRIVES OR PARKING AREAS. ��A I - L l 1 A 22' VARIANCE REQUESTED FOF S.A.S. 4. ANY MASONRY UNITS USED TO BRING COVERS TO GRADE SHALL 99.2 l BE MORTARED IN PLACE.� A 38' VARIANCE REQUESTED FOR SEPTIC TANK yg , 5. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING REGULATIONS. OWNER / APPLICANT IS TO 1 99 + _. /�? 02 vAn.IANC�''S fflP20VC':� ,r�� �8R12n/S A4Lc'_,�ol� __.__� _ ___ . OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. „ 99.5 \ 1�/ \ �. > _ _N/,� THE 3 AC aR,94N1. O_. '•�'G1 lbw"T2/C T/C�✓ 6. UTILITIES SHOWN ARE APPROXIMATE ONLY, EXCAVATION CONTRACTOR ( r \ \ �,\ VE,Y7' IS TO CALL "DIG-SAFE" AT 1-888-344-7233 AT LEAST 72 HOURS Srg1cED ��.� PRIOR TO COMMENCING WORK ON SITE. 7. CONTRACTOR IS TO VERIFY GRADES AND ELEVATIONS AS WELL AS ,e waJcIC �[. \ D/57-, SITE CONDITIONS PRIOR TO COMMENCING WORK ON SITE. ANY VARIATION IS TO BE BROUGHT TO THE ATTENTION OF THE DESIGN ENGINEER J o' 6 , ` IMMEDIATELY. A t IN 0 C -9 9 P RCE IS FLOOD ZONE 2 _ --. ..,_._. _..�.__�__.._ _ _. _. 9, LO-f iS SHOWN-ON ASSESSORS. MAIr' AS PARCEL --147-- r/cv 10. ALL UNSUITABLE MATERIAL SHALL BE REMOVED FROM UNDER, AND FOR A MINIMUM OF 5 FEET FROM AROUND THE SOIL ABSORPTION SYSTEM, AND BE REPLACED WITH SAND AS SPECIFIED IN 310 CMR 15.255: (3) O - SEE NOTE #10 „"-' (I.E. TITLE 5) IF ENCOUNTERED BELOW S.A.S, PIPE INVERT. F G E „ 8.8 ;"ta s' i '`. 11. EXISTING SEPTIC SYSTEM TO BE PUMPED AND FILLED WITH SAND 20 A 8 4 � t` ,r', OR REMOVED \ x 9 � �, - °'` `` APPROVED: BOARD OF HEALTH F A � � CELLAR AT ✓ N 7 EL. 93.2 3.2 � EXISTING � 1 ,����� EDGE OF WETLAND M °ECK', DATE AGENT FL A` Qv I is n � u� . �`V DWE_LING PIPE AS o_ `. (' � Z 2 s0 HENDRICKSON WETLAND 9�. ` SHO 9 - - SCIENTIST 3 FULL o PROPOSED SEPTIC DESIGN \��3 CELLAR,. gq - G I "A FOR #1� x 92.7\ B ,.. E !S1•�"j6 , � -�.8 �r ANN LOMBARDI 4 • 98.4 92 \ a *Tlp gSL/ ;"` GV% QT2.0 SH ro WATER \ \ � AT ELEV \ :� - -- - o I a��'__IZ " ?_oY_ D._ .Sr. /J ,r LQ� IAT 92, 367 PITCHER'S WAY 91.5 'rA� 98.3 BARNSTABLE (HKANNIs4 MASS CMGR SHOfr .9 9-7 0 • 508- P. 0. BOX 1044 SOUTH DENNIS, MASS. � \ piN�' 7zb cvS 398-8311 02660 S3 a<�T�7> \ - LRNA SvC?J"�CT # cAwcrTT3 - 7'0 k �ow+p DATE DEC. 13, 2 0 01 SCALE 1 " 2 0' •\ REVISED PV JOB NO, NoTas ADDaD 2 i a a 2. 1-$99 \� LOCATION MAP J REVISED -� SHEET 1 OF 1 J 0 2001 CRAIG R. SHORT, P.E. 1101CHMAM 4" SCHEDULE 40 PVC PIPE SOIL TEST TOP OF FOUNDATION 20 FT. MINIMUM FROM CELLAR MIN. PITCH 1/8" PER FT. CLEAN SAND PAINT DARK FLAT GREEN DATE OF SOIL TEST 12 Q7Z 2 LAYER OF CARBON FILTER Q)-------- op 10. 1 1 G " 10 FT. MINIMUM FROM SLAB OR CRAWL SPACE SOIL TEST DONE BY ELEV. 100.00_ 10 FT. MINIMUM 2" PRESSURE PIPE LOAM OR 1/8" TO 1/2" rriWITNESSED BY -Q&�jjATQj�_______ (ASSUMED) 150 PSI MINIMUM ELEV. = 100.70 MAX. GRAVEL WASHED STONE VENT H2O C r 95.25_ 100.58 MIN. OBSERVATION HOLE 1 ELEV.=__99.3_ COVERS a' - " PUMP SWITCHES DETAIL PERCOLATION RATE __<_A__ MIN./INCH AT __-H__ INCHES FRAME H2 �-��PvC z Pipe DEPTH HORIZ TEXTURE COLOR MOTT. OTHER FULL 99.58 CELLAR 4- Q, 24" FILL LOAMY SAND NO UNSUITABLE 4" CAST IRON PIPE " V::V YC (OR EQUAL) MINIMUM ° ° ° MATERIAL PITCH 1/4" PER FT, 0 B L AI 0 FILTER R = ELEV. _ _4b.2S_ UNSUITABLE ELEV. = 6" SUMP ELL= 99,�Q - 10 30' A LOAMY SAND 10YR5/1 NO MATERIAL FLOW LINE -92A- ALARM ON ELEV. = 91.75 _ 10" DISTRIBUTION ELEV. = E« v geoo PLUMBING ELEV. = 96_00 _ va ash a•t 21" TO BE RAISED -THIN a 4-H2O HIGH CAPACITY INFILTRATORS 3- 48" B LOAMY SAND 2.5Y7/4 NO V. 95.3t 1 2 3/8" DRILL --�� WITH STONE tN AN AND RE-PIPED BY GAS D HOLE BOX z_ 5.25' PUMP ON ELEV. = 91.50 GRAVEL LICENSED PLUMBER ELEV. - _9S_SO BAFFLE (A TO BE WATER TESTED 11' X 34' X 10" TRENCH FORMATION WELL 18. . 78" Cl COARSE SAND 2.5Y7/6 NO FL AT V. 93.0t 0 (TO BE PLACED ON FIRM BASE) 'n ZONE 8 y 2 �� CHECK 3/4" TO 1 1/2" SOIL ABSORPTION INDEX 9 12 1 PUMP OFF ELEV. = 90.83 COARSE LIQUID OUTLET - VALVE WASHED STONE STEM (SAS) ADJUST 10' • 4 FEET t a INCHES-DEPTH TFF (TO BE PLACED ON FIRM BASE) V - O 10 144 C2 MEDIUM SAND 2.SY7/6 NO 5 FEET 19 INCHES MYERS SRM 4 6 FEET 24 INCHES 2500 GALLON " PUMP (OR EQUAL) _ H T T A = »ten __ ELEV. = 89.50 6• WATER ENCOUNTERED AT �I_ ELEV. 7 FEET 29 INCHES , USGS PROBABLE WATER TABLE ELEV. = 96.0 8 FEET 34 INCHES SEPTIC TANK CHAMBER OBSERVED WATER TABLE ( 12 /07/01 ) ELEV. _ 0__ BY WGGINS PRECAST am M-) BOTTOM OF TEST HOLE ELEV = 3 (OR EOUAL) LEGEND:ELEV AT INVERT INLET _�'� _ PUMP CHAMBER CALCULATIONS: DESIGN CALCULATIONS EXISTING SPOT ELEVATION OOxO NUMBERBEDROOMS 3 ELEV AT ALARM ON REQUIRED FLOW PER CYCLE 25 X __, Q = _ ,,'S GAL./CYCLE EXISTING CONTOUR ----00---- GARBAGE DISPOSAL UNIT SEWAGE DISPOSAL SYSTEM PROFILE ELEV. AT PUMP ON -VIM VOLUME PER CYCLE _ 825 GAL/CYCLE /7.48 GAL./CU. FT il_0�_ CU. FT./CYCLE FINAL SPOT ELEVATION To-.151 TOTAL ESTIMATED FLOW NOT TO SCALE ELEV AT PUMP OFF -20.&3- VOLUME OF WATER IN PIPE 3.14 X 0.00694 X _-tA-- FT. _ __. _ CU. FT. FINAL CONTOUR ( 110 GAL./3R./DAY X 3 SR.) _3,�Q_ CAL./DAY BOTTOM OF INSIDE PUMP CHAMBER - �• - TOTAL MINIMUM VOLUME PER CYCLE -UM- CU. FT SOIL TEST LOCATION REQUIRED SEPTIC TANK CAPACITY _1W GAL. BOTTOM OF OUTSIDE PUMP CHAMBER _�;2.,'�4_ DISCHARGE _Iu.,� CU. FT ' 17 CU.FT./FT. _ __67 _ FT. (H20) UTILITY POLE -4- ACTUAL SIZE OF SEPTIC TANK _jrJw GAL. (E FFG�GT. STORAGE CAPACITY (__= GAL./DAY /7.48 GAL./CU.FT./ 17 CU.FT./FT. _ �,�Q FT. TOWN WATER =W W SOIL CLASSIFICATION -_2M REQUIRED -3.SO PROVIDED CATCH BASIN \®7 DESIGN PERCOLATION RATE <_5__ MIN./IN. GAS LINE C EFFLUENT LOADING RATE _0,74_ GAL./DAY/S.F. CLEAN OUT LEACHING AREA _449_ SO. FT. CESSPOOL C.P. 0 (11'X34')+(90'X10"/12) LEACHING CAPACITY (AREA X RATE) _ Z_ GAL./DAY 449 X 0.74 RESERVE LEACHING CAPACITY _ALA_ GAL./DAY TITLE 5 & TOWN B.O.H. VARIANCE REQUESTS: 3� ,SECTION 15.103(3)(C)2. SOIL PROFILE DETERMINE MAXIMUM GROUND WATER. NOTES: 4( A VARIANCE REQUESTED TO USE MAXIMUM WETLAND ELEVATION INSTEAD 1. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. ^J DR SECTION 15.211 MINIMUM DISTANCES: TITLE 5 AND THE TOWN RULES AND REGULATIONS FOR THE SUBSURFACE 'g `^ DISPOSAL OF SEWAGE. A i2La� R ' O�ivtw.o y To DISTANCE BETWEEN S.A.S. AND PROPERTY LINE (10' REQUIRED) 2. ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO QE ,efd OC.;ppWC A 4' VARIANCE REQUESTED ALL F F N 6 0 INISHED GRADE. plNE 3. ALL COMPONENTS OF THE SANITARY SYSTEM HA CAPABLE S� E SHALL BE C P BLE OF NyL TOWN OF BARN ASTABLE B.O.H.B.O.H VARIANCE REQUESTED: WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN �0/vj L v/ PART VIII SECTION 1:00 10 FT. OF DRIVES OR PARKING AREAS. H-20 LOADING SHALL BE P R 3 DISTANCES BETWEEN WETLAND & SEPTIC SYSTEM USED UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS. \ A 22' VARIANCE REQUESTED FOR S.A.S. 4. ANY MASONRY UNITS USED TO BRING COVERS TO GRADE SHALL I A 38' VARIANCE REQUESTED FOR SEPTIC TANK BE MORTARED IN PLACE. 5. fVU DETEnMN,4AT'0N riAS BEEN MADE AS TO COMFOANCE YVi H DEEDED OR ZONING REGULATIONS OWNER / APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. 6. UTILITIES SHOWN ARE APPROXIMATE ONLY, EXCAVATION CONTRACTOR r \ vevr ) IS TO CALL "DIG-SAFE" AT 1-888-344-7233 AT LEAST 72 HOURS 4 oo PRIOR TO COMMENCING WORK ON SITE. t` \ DUST = 7. CONTRACTOR IS TO VERIFY GRADES AND ELEVATIONS AS WELL AS \ ` SITE CONDITIONS PRIOR TO COMMENCING WORK ON SITE. ANY VARIATION L ,�OctX \ IS TO BE BROUGHT TO THE ATTENTION OF THE DESIGN ENGINEER V. IMMEDIATELY. \7 2 8. PARCEI IS IN FLOOD ZONE _ 9. LOT IS SHOWN ON ASSESSORS MAP 269_ AS PARCEL 141__ 10 ALL UNSUITABLE MATERIAL SHALL BE REMOVED FROM UNDER, AND FOR A MINIMUM OF 5 FEET FROM AROUND THE SOIL ABSORPTION SYSTEM, AND BE REPLACED WITH SAND AS SPECIFIED IN 310 CMR 15.255: (3) r! tee, - SEE NOTE #1 C; (I.E. TITLE 5) IF ENCOUNTERED 'BELOW S.A.S. PIPE INVERT. c'�I DwAy ' r` 11. EXISTING SEPTIC SYSTEM TO BE PUMPED AND FILLED WITH SAND • ,j \ '� ---- _. _.... '� � ��'�:�QF -` �•' ! OR REMOVED vJ Do� CRAIQ A 'CELLAR AT n e = !� APPROVED: BOARD OF HEALTH SHORT r• �� " 3 +` EL. 93.2 CIVIL �. �o. 274 .- EDGE OF WETLANDDECK EXISTING FLAGGED BY LISA # DWELLING PIPE AS - xr Z 2 s0 DATE AGENT � HENDRICKSON WETLAND 92 9 SHO (•�� � SCIENTIST 3 FULL PROPOSED SEPTIC DESIGN CELLAR ,. Jam,. 20 �� FOR i 02 r ` r 4 ,s - ANN LOMBARDI WATER AT ELEV \ - - -_ � � . IAT 92, 367 PITCHER'S WAY 91.5 BARNSTABLE (H YAwsI MASS } C'REG R SHORZ P.R 235 GREAT WESTERN ROAD •` P4/�/Cdr.i. 508-11 SOUTH 0. BOX 104ASS. Ro .>� v S 398 83 _ 02660 - ,� DATE DEC. 13, 2 "'' = 20' ro «oc�ra�..,G,. �► REVISED JOB NO 1_899 � j LOCATION MAP i REVISED -j LSHEET 1 OF 1 _ _ C 2001 CRAiG R. SHORT, P.E.