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0393 PITCHER'S WAY - Health
LPITCHERS nis269 084 k. i' i o I , r� Town of Barnstable " Inspectional Services Department CAB ASS. Public Health Division 659.M 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7015 1730 0001 4987 8487 August 7, 2020 DECICCO, LINDA M TR 393 PITCHERS WAY HYANNIS, MA 02601 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 393 Pitchers Way, Hyannis, MA was inspected on 07/21/2020 by Brett Hickey, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. • The distribution box needs to be replaced. You are ordered to repair or replace the septic system within two (2)years from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH (�5as OcKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\393 Pitchers Way Hyannis.doc Town of Barnstable BARNSTABLF- p i639. ,�� Inspectional Services Department tfD MPS A Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean;CHO Feb 6, 2007 Rev. 4/26/19 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An "x" marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ❑ Structurally unsound septic tank or SAS ONE (1) YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box is above the outlet invert due to an overloaded or clogged SAS or cesspool ❑ A portion of the SAS, cesspool, or privy is below the high groundwater elevation ❑ A portion of the cesspool is located within a Zone 1 to a public well ❑ A portion of the cesspool is located within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2) YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑ Any "conditionally passed systems" (broken cover, relocation of a pipe, relocation of a driveway due to H-10 components, etc) ❑ Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHERi�C K v ✓�r i�^Ty �ij cJ;✓ J !d4 c, (GM�us7�✓1T (/c�e 7� Dvl r/oc /P�/ or C(�yzd S�-� ar CPJY�crl/ Repair deadline: V k CAI we WSEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc / Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ` 393 Pitchers Way u Property Address Linda&Joe Decicco Owner Owner's Name information is Hyannis Ma- 02601 7-21-2020 required for every y page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information 51 # 14(og(P on the computer, Brett Hickey use only the tab key to move your Name of Inspector cursor-do not B&B Excavation use the return Company Name key, .. ' 374 Route 130 4:1 Company Address Sandwich Ma 02563 City/Town State Zip Code r ¢a (508)477-0653 S113747 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. ❑ Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. M Fails BrettHickey ':.Digitally signed by Brett Hickey ll H k ;---Date:2020.oza>11:12:31-04'0a 7-21-2020 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 has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note:This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc-rev.7/262018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts I, Title 5 Official Inspection Form 1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 393 Pitchers Way i Property Address Linda&Joe Decicco Owner Owner's Name information is Hyannis Ma 02601 7-21-2020 required for every y page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary,: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ❑ 1 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: Report originally submitted as "Needs Further Review". At the request of The Health Department the system is determined to be in failure. 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined,"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. ) . *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 c Commonwealth of Massachusetts . �n Title 5 Official Inspection Form �= , Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 393 Pitchers Way Property Address Linda&Joe Decicco Owner Owner's Name information is Hyannis Ma 02601 7-21-2020 required for every y page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc-rev.7/26/2018 Title 5 Offidal Inspection Form:Subsurface Sewage Disposal System-Page 3 of 18 Commonwealth of Massachusetts �T Title 5 Official Inspection Form += , Subsurface Sewage Disposal System Form -Not for Voluntary Assessments /P 393 Pitchers Way Property Address Linda&Joe Decicco Owner Owner's Name information is required for every Hyannis Ma 02601 7-21-2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No El ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ a Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 18 c Commonwealth of Massachusetts �o Title 5 Official Inspection Form _ 15 Subsurface Sewage Disposal System Form Not for Voluntary Assessments 393 Pitchers Way Property Address Linda&Joe Decicco Owner Owner's Name information is Hyannis Ma 02601 7-21-2020 required for every y page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ 0 Static liquid level in the distribution box above'outlet invert due to an overloaded or clogged SAS or cesspool ❑ a Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/z day flow ❑ 'El Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ El Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ El Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ 0 Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ❑ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ❑ The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. Q ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well ,r l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 44N Commonwealth of Massachusetts �n p Title 5 Official Inspection Form -: iIo Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u 393 Pitchers Way Property Address Linda&Joe Decicco Owner Owner's Name information is Hyannis Ma 02601 7-21-2020 required for every y page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered"yes"to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed.The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no" for each of the following for all inspections: Yes No El ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ 0 Were any of the system components pumped out in the previous two weeks? ❑ 0 Has the system received normal flows in the previous two week period? ❑ 0 Have large volumes of water been introduced to the system recently or as part of this inspection? 0 ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) El ❑ Was the facility or dwelling inspected for signs of sewage back u ? 9 P El ❑ Was the site inspected for signs of break out? El ❑ Were all system components, excluding the SAS, located on site? El ❑ 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? ❑ a 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: El ❑ Existing information. For example, a plan at the Board of Health. ❑ Q 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)] w=. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 Commonwealth of Massachusetts �m Title 5 Official Inspection Form 5. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 393 Pitchers Way v Property Address Linda&Joe Decicco Owner Owner's Name information is Hyannis Ma 02601 7-21-2020 required for every y page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: No design plans 3 Number of bedrooms(design): Number of bedrooms(actual): NA DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): Description: No plans were available at the Board of Health and the filed permit does not list number of bedrooms. 0 Number of current residents: Does residence have a garbage grinder? ❑ Yes 0 No Does residence have a water treatment unit? ❑ Yes 0 No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ® Yes 0 No information in this report.) Laundry system inspected? ❑ Yes E] No Seasonaluse? ❑ Yes 0 No See below Water meter readings, if available(last 2 years usage(gpd)): Detail: 2018- unavailable per water Dept. 2019- 26,180/GPD Sump pump? ❑ Yes ❑■ No 4/2020 Last date of occupancy: Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form w Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ( 393 Pitchers Way V Property Address Linda&Joe Decicco Owner Owner's Name information is Hyannis Ma 02601 7-21-2020 required for every y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: NA Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Owner- last pumped 2018 Source of information: Was system pumped as part of the inspection? ❑ Yes ❑■ No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 393 Pitchers Way •{vim Property Address Linda&Joe Decicco Owner Owner's Name information is Hyannis Ma 02601 7-21-2020 required for every y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: E Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: 1979 per permit. Were sewage odors detected when arriving at the site? ❑ Yes No 5. Building Sewer(locate on site plan): _ 2'6" Depth below grade: feet Material of construction: ❑ cast iron H 40 PVC ❑ other(explain): Town water Distance from private water supply well or suction line. feet Comments (on condition of joints, venting, evidence of leakage, etc.): t5insp.doc•rev.7/26/2018 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 `' Commonwealth of Massachusetts �m Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1,5 �C 393 Pitchers Way Property Address Linda&Joe Decicco Owner Owner's Name information is Hyannis Ma 02601 7-21-2020 required for every y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): 18'1 Depth below grade: feet Material of construction: 0 concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No 1 Dimensions: 000gallons 5" Sludge depth: 3111 Distance from top of sludge to bottom of outlet tee or baffle 1" Scum thickness 6" Distance from top of scum to top of outlet tee or baffle 1611 Distance from bottom of scum to bottom of outlet tee or baffle measured 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.): The tank was in working order at the time of inspection. The tank is not in need of pumping at this time but should be pumped every two years for maintenance. The inlet cover of the tank is under a wall and in the basement. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts �e Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 393 Pitchers Way Property Address Linda&Joe Decicco Owner Owner's Name information is required for every Hyannis Ma 02601 7-21-2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): NA 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 a Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: NA Material of construction: - ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 g c Commonwealth of Massachusetts P , Title 5 Official Inspection Form - ±= i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �t f� 393 Pitchers Way Property Address Linda&Joe Decicco Owner Owner's Name information is Hyannis Ma 02601 7-21-2020 required for every y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): o„ 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.): The d-box was in poor condition at the time of inspection and shows sign of past back up. D-box in need of replacement. R t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 c Commonwealth of Massachusetts �- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ` 393 Pitchers Way Property Address Linda&Joe Decicco Owner Owner's Name information is Hyannis Ma 02601 7-21-2020 required for every y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No" Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): NA * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: . Type: ❑ leaching pits number: 2 flow diffusers ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields, number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/262018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 `" c � Commonwealth of Massachusetts Title 5 Official Inspection Form _ .v += Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 393 Pitchers Way Property Address Linda&Joe Decicco Owner Owner's Name information is Hyannis Ma ' 02601 7-21-2020 required for every y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): The SAS was dry at the time of inspection but the flow diffusers were stained over the r, inlet invert. Flow diffusers had black sludge through out piping and chamber itself. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration NA 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 Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): xx '!P s` t5insp.ioc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 c Commonwealth of Massachusetts Title 5 official Inspection Form 11 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments } ` 393 Pitchers Way Property Address Linda&Joe Decicco Owner Owner's Name information is Hyannis Ma 02601 7-21-2020 required for every y page. City/Town State Zip Code Date-of Inspection D. System! Information (cont.) 13. Privy(locate on site plan): NA Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): i r t5insp.doc-rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts 6P Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 393 Pitchers Way Property Address Linda&Joe Decicco Owner Owner's Name information is Hyannis Ma 02601 7-21-2020 required for every y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: hand-sketch in the area below ❑ drawing attached separately Addition AlS I A1-10' 81.14' 2 A2.1T B2.17` F D I i o f w # Shed (piped into tank) t5insp.doc-rev,7/26/2018 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form _q J Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u 393 Pitchers Way Property Address Linda&Joe Decicco Owner Owner's Name information is Hyannis Ma 02601 7-21-2020 required for every y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope FMI Surface water ❑■ Check cellar FEW Shallow wells 4' 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 El 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: +i You must describe how you established the high ground water elevation: A hand hole was augured and water was encountered at 4'3". Bottom of SAS @ 3'. Bottom of SAS was above GW. i Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form ±= Subsurface Sewage Disposal System Form -Not for Voluntary Assessments I . � 393 Pitchers Way Property Address Linda&Joe Decicco Owner Owners Name information is Hyannis Ma 02601 7-21-2020 required for every y page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: �■ A. Inspector Information: Complete all fields in this section. 0 B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ❑■ C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria)and 6(Checklist)completed FOR D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included l5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 Commonwealth of Massachusetts 09 1 Title 5 Official Inspection Form Subsurface SoNage Disposal System Form-Not for Voluntary Assessments JqAP i60 VA, nj Property Address owner s Na bftrudton is t teWred for every fr QrJ 1 U A Xi,> rge. � Dash .� Pow State Zip Code Date of Inspecton inspmrtlon 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. MMOMIbrms A. Inspector information an the canpuwer. +tee orgy the tab �� itey to move you Name of Inspector cursor-do rhot .� G use the return Company Name q MY. (7G-5' D Company Address < A ILp�lG 4-1 d� 0Z.0-/I awfrmn state zip Co& Te"tione Numb License Number S. Certification I certify that I am a DEP approved system inspector In full compliance with Section 15.340 of Me 5 (310 CUR 15.000);t have personally inspected the sewage disposal system at the property address listed above,the information reported below is true,accurate and complete as of the time of my inspection:and the inspection was performed based on my training and experience in the proper function and maintenance of on-sine sewage disposal systems.After conducting this inspection 1 have determined that the system: 1. Passes Z ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fab /a�l— 2lJZy irspeows signature Date The system inspector shall submit a copy of tins inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.ti the system has a design flow of 10,000 gpd or gmater,the inspector and the system owner shall submit the report to the apropriate Mglonal ofilm of the DEP.The original form should be sent to the system owner and copies seat to the buyer,if applicable,and the approving authority. Please note:This report only describes conditions at the time of won and under the conditions of use at that time.This inspection does not address how ft system will perform+ In the future under the same or dill mad conditions of use. •rev.7f26f2018 TO 5 MW MWecln Fans Subsurface Serge mpow System•Pege 1 of fe Comrnortweafth Of Massacihuseft Tina 5 Official Inspection Farm &dararfaue sewn -Not for udwuftty Assessments l��i'l 'Z�UrS2S �4.`7 0M Ownefs Blain@ POOL QYfrom stdo Zip Code Dace of Impedtion C. Inspection Summary Inspection Summary: Complete 1,2, 3,or 5 and all of 4 and 6. 1) System Passes; I have not found any won which indicates that any of the failure criteria described In 310 CIMR 15.303 or In 310 CHAR 15.304 exist.Any fbilum criteria not evaluated are Indicate below. Comments: Ll kavl�c� ` ' v,b tuv� GuveySer cv�ear �- Q�ar�r _ �u�n c�vlrejet evo b�s��u►zfp c� �a 2) System CondWonatly c1 e'd(� S ❑ or more system components as described In the"Conditional Pass"sermon need to be or repaired.The system.upon corrxr of the replacement or reps,as approved by the of Health,will pass. Check the "yes°,W or"not determined"(Y,N,ND)for the following statementh.if not determined." eln. The septic tank is m and over 20 years old*or the septic tank(whether metal or not)Is structurally unsound,exhibits . infiltrationor exfA#ratlon or tank failure is Imminent,System will pass Irgwtlon if the existing k Is replaced with a complying septic tank as approved by the Board of gilt. "A metal septic tank will pass' . n If lt is structurally sound,not leaking and if a Certfficate of Compliance indkating that the to Is less than 20 years old is available. ❑ Y ❑ N ❑ ND( below): rwamvuoo•rev.7188f2Dts Ties s ova xrepedn ramc SubwAfwe SMOP ONPOW syamrn•PeOe 2 of 18 Coinmw wealth of Mae"dw"Iits Title 5 Official Inspection Form Sabswta m s Vftp*W System ftm-Not for Voluntary Assessments chuners mane p Al Y t;9tylroum State Zip code Date cf lneped w C. Inspection Summary (tons.) l� 2) S Qmdit1onailyPosen(cone): ❑ Pu Chamber pumpsfahnn not operational.System will pass with Board of Health appcovat 9 pure alarms are ❑ Observation sawage backup or break out or high static water level in the distribution box due to broken or pipes)or due to a broken,settled or uneven dWbu km box.System witi pass lrion approval of Board of Health): ❑ broken pipe( are replaced ❑ Y ❑ N ❑ NO(Explain below}: ❑ obstruction Is p Y ❑ N ❑ NO(Explain below): Q distribution box is ed or replaced 0 Y ❑ N ❑ NO(Explain betow): ❑ The system required pumping more than 4 ti es a year due to broken or obstructed pipes).The system will pass inspection I(with approval of a Board of Health}: 0 broken ph*s)are replaced Y ❑ N ❑ NO(Explain below): ❑ obstruction Is removed ❑ 0 N ❑ NO(plain below}: 3) err Evatuadon Is Rsgedred by the Board of Heatrh: ❑ Conditions ex ire fwlher evaluation by the Board of Health in order to determine if the system is bbV to safety or the environmerrL a. System w#1 poss uwdess Board of Haaflh term accordance with 310 CZAR 153o3(lXb)that the system is cat*mcdonkV In a manner protect pubtic health. =hq and thnv&at e 67�pdoc nb1r.7f 18 TM 8 OftW hapudw Fam 8 e&MV SY9t"*A%P 96f18 Commornmafth of MamchuSeft Tine 5 Official inspection Form She ftwage DMpow System ftm-Not for V&U tary&V=WW is P4 -- r Owner's Mama � Zhh p"NOW ft4%y CitytToaal S Y�la �1 147 ap code Date or If"%- m C. inspection Summary (cunt.) 0 1 or is within 50 feet of'a P'�Y surface water ❑ Cass I or privy is within 50 fit of a bordering vegetated wetland or a salt marsh b. System will Via Board of Health(and Public Water der,if any) 11110 glib that tore is AmadorAng In a nuarmer OW proftwis the pubft ice, saliely aW env ❑ The system has asap tank aid soti absorption system(SAS)and the SAS is within 1OD feet of a surface water or tributary to a surface water supply. ❑ The sysMn has a septic and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank SAS and the SAS is within 50 feet or a private water supply ❑ The system has a septic tank and and the SAS is less than 100 fast but 50€eel or owe fnam a private water supply war*. Method used to determine distance: "*This system passes if the well water analysis, ed at a DEP certified laboratory,for fecal cdlform bacteria Indicates absent and the presence ammonia nitrogsu andnitrate nitres is equal to or less than 5 pp m, provided that no other failure are triggered.A copy of the analysis ftist be attached to ft form. c. Other: 44) Syd m Failure Criteria Apse to Ail ems= you ire"Yes"or"No"to each all the following for gL!inspecdons: Yes No ❑ Backup of sewage Into bdity or system component due to overloaded or af�ed SAS or cesspool ❑ Discharge or Pofkft of effluent to the surfer of the ground or surface waters due to an overloaded or dogged SAS or cesspool •M.?r 8=O Mft 5 0MCW MWOOM Fame&flu m S m"s DkpoW System•Pqe 4 of 18 Commonwealth of Massachusetts Tale 5 Official Inspection Form 01*0 l Ncrt W Wuntary Assesments Property Addres�� ��W D ow"Is PW CRY/Tom State Zip Code Deb of irspedon C. limpe+t n Sunrnary{cunt.} 4) System Failure Criteria Applicable to All Systemw:(coot,) Yes No Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ �`� Liqu id depth In cesspool Is less than 6"below invert or available volume is less Man%day flow ❑ Required pumping more than 4 times in the last year NOT due to dogged or obstructed pipe(s).Number of times pumped: ❑ Any Pin of the SA.%cesspool or privy is below high ground water elevation. ❑ Any tin of cesspool or privy is wit#dn 100 feet of a surface water supply or tributary to a surface water supply. ❑ jj1A- portion of a c or privy is V tin a Tone 1 of a public water supply ❑ OJlX Any Portion of a cesspool or privy is Wo*50 feet of a private water supply well. ❑ IPPla Any portion of a casspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water.gw ty eirmlyals, [This system Pasm NOW well water analysis,performed at a DEP certMled taboratory,110 fecd colVem baderla inrdicaes absent and We preseme, of ammonia ndi mgm snit nee nlbogenn is aqua#to or less titan 5 ppm, Provided the no asm rrlterla are mod.A comet of Illm auk and clualn of mstody mast be attadmd to this form] ❑ 4[Ar The system is a cesspool serving a%dity with a design flow of 2000 9* 10,000 gpd. ❑ j The system Ift i have determined that one or more of the above failure criteria eriat exit an described in 310 CMR 15.303,ttwe ore the sysem fart.The system owner should contact the Board of keaM to determine what wilt be neoessany#a correct the failure. A)&S) Large!!;; conskUrel a hwp system Sue system must serve a facility with a desIpr gpd to 15,if00 gpd. For fmust indicate eutlw W or"no""to each of the following.In addition to the questi Yes ❑ e is within 400 feet of a surface drinking water supply (� he system is 200 f�of a tributary to a surface drinking water supply e system b kt a nitrogen sensitive area(interim Welll ead Protection rea—Mf PA}of a m Zane If of a public water supply welt 1 p+doa•nM7fa61�O1S 7ffiesoarl pa tin Fam8uboataoe swap DbPWdsywan•PepSells %pummormeafth of massachuftft Title 5 Official Inspection s,itou se�►� �'� n Form Fwm.Not for Vduntary Assessment *Onnatlon Is 9wnwe Name emery Ana w> i _ z > 3� Zip Code >3a0e ar�n V. ow on Sumn SFY(cunt,) If you have answered°yes°to any question in Section C.5 the system is considered a signbPic aM throat,or answered ayes"to any question in Section CA above the owner or g3ecator of any large system considered a si System e Section has fabiml.The under Section CA shall upgrade the system th armorwith 310 CMR 15.304.The.5 s i should contact the apPmpriate regional otRc s of go Department owner 6. You trust Indicate"yes"or"no"for each of the folbwlttg for aft lnspedlon: Yes No P ❑ Pumping information was ProvWBOy or Scam of HeaM Were any of the system c 0mpont Pumped out In the previous two weep? ® Has the system received normal flows in the previous two week period? ® Have large voatrtsee of water been introduced to the system or as of tht Inspection? rec�rntly ❑ Were as built plans of the system obtained and examined?(if they were not avallable note as WA) ❑ 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, c 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 fadity owner(and o=4mft 9 dWersent from owner)provided with bnfamation on the POW maintenance of sUbSUr1a0e sewage disposal systems? The sleeand bcaftn �,of' been determined based m )on the site has / �.1.. .�- 1 ❑ Existing information. For am"*,a plan at the Board of Health.\� Determined in the field(if any of the failure criteria related to Part C is at issue appimbnation of dunce is ptable)(31Q CMR 15.302(5)1 c•rov.7tL8tm18 T&a QUW F,;8UWW0WftWW pig gam-pep a of 9a r Commonwealth of hlawsachusetts Title 5 Official Inspection Form sribsarkm Sew+u►ga Disposal syafsm 7-Not for Voluntary Assessments IF Owner owner's Name &domMon is CKWTown v Stele Zip Code Date of Inepection D. System Infornmition 1. Resid widat Flow CattuRtIons: Number of bedrooms(design): , Number of bedrooms(actual): --� DESIGN flow based on 310 CAA'R 15.203(for example: 1 la gpd x#of bedrooms): L rmav►-L' L�Zs . vo die 400.� ���) �3acz-v��� s��n� Number of currard residents:_ ante have a grinder? ❑ Yes No Does residence garbage Does residence have a water treatment unit? ❑ Yes No If yes,discharges to: is laundry on a separate sewage system?(include laundry system inspection ❑ Yes No information in tits report.) Laundry system Inspected? ❑ Yes No 61 a Seasonal use? ❑ Yes No Water racer readings,if available(fast 2 years usage Data ,ZOZ(� &-,c � P01tGJ�-}�N '�P(2 Z©L (1 gnihA I o, Sump pump? -- ❑ Yes No Last date of occupancy. bate eoc•tsk7/1812018 TMeSOMid topeOM Fore o98BWWQbP0 ed$Y$Mm•PaP7or19 COMMO"W98 '1 Of Mfta chusetls Title 5 Official Inspection Form ftwM*WSPOS It System Form-Not for Voluntary Assessments klmnation Is Mqu1t"ed for emyf Pe19a- CftyR"n State Zip Code Date of inspection N 2. C rdalifind F 'Q uu low Conditions: Type of lishmertl: Design flow ased on 310 CMR 15.203Y Getow per day(gpd) Basis of design w(9eatslpersons1sgJL,etc.): Grease trap per► ❑ Yes ❑ No Water treatment unit - ❑ Yes ❑ No If Yes, to htdustriat waste homing tern ❑ Yes 0 No Non4ar tart'waste d1scharged to Title 5 system? ❑ Yes ❑ No Water meter readings.If available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: 2.0 1 2=� Source of lriformaflon:Source —z— Was system pumped as part of the ikon? ❑ Yes No iF yes,volume pumped: t Now was quantity pumped determined? � Reason for pumping: ft-fetr.TO=$ . Titles PC=sum swage avow syaem•Page s of 1a Commonwealth of AAachusett� Fide 5 Official Inspection Form SubsuffW*Sewage fug Leh l%rm-Not for Voluntary Assessnmfle PMPWVAddfou e owners Nwne MmUonle VL( SMP&Wforem { ' City/Town state. Zip Code Dwo of im"a Gon D. item lnfafrmation (coat.) 4. TyM of system: Septic tank,distribution box,soft absorption system ❑ Sfngle cesspool ❑ Overflow cesspool ❑ Privy ❑ Shaved system(yes or no)(if yes,atch previous inspection nerds,if any) ❑ lnnovedWAltemat#vee technology.Attach a copy of the current operation and maintenance contact(to be obtained from system owner)and a copy of latest inspection of the YA system by system operator ter contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Ober(describe): Apgro�lmate age of all components,date installed(N known)and source of informeMon: o6#11 A- 7W1 ?1 yam. 's Alley �� ��G b�✓� ,� 9 �� /� h�PzcG�/ e 5 5/_ )earl, 7c od'�when ahTiving at the site? `jYes ❑ No S. BuNdtag Sewer(locate on site pla n� 74;�V e) Iz:' -/a1 k j i Depth 1 Z 2 ,n✓.e��� below gam. aQ �/ cn a;f®l ov�o . fit Material of construction: t�fcast iron OrCe Coc��her(expl/aink Distance from privatewafier supply well or suction fln®:�✓`usP$ �W�0o� � �fbet 1 414e4ev, Comments(on oondpgn ig, vlkdence of teak ,etc.): (7��j ', •rew 788/ZW B TWO 6 Offal knpedlan Famc Sdmubw Syebm•Paps 9 of 18 Commormeatth of Massachusetts Tide 5 Official Inspection Form Subswhm Sewage Wspwal System ft m-Nat for Volwtery Asses smarts 39 P/J 0WW9 NW* o- t-za PW Ctty GM Stab zo Code Date of Inspection D. Sysfem Wormadon (cunt.) S. Septic Tank(ku:ate on site plan): l y2 Depth below grede: �t (Material of construction: concrete ❑ metal ❑ftberglass ❑polyethylene ❑other(explain) // �r) Gr r'2ZY oL1r C if tank is meld,fist age: Yeam Is age confirmed by a Certificate of Compiimme?(attach a copy of cedi icats) ❑ Yes ❑ NoA1lA Dimerislarrs: Sludge depth: 5 Discartoe from top of sludge to bottom of outlet tee Seim thidmess � 9 Distance from top of scum to top of outlet tee baffle 1G y Distance from bottom of scum to bottom of outlet tee 1 How were dimensions delermirned? (on pumping recomm ,Infer and a#fle oo r� , r1f ,%"as - to outlet' ace kage, r /a K -5 C-//�?/� �" Svc e'a Z,, Oel lddI Al,a�Nnl %;;Ir et�7 K U ftAlafl deo•rev 7/2912018 Me 6 Of W hm0edm Pam&*wrbW Oft ep DWOW Syefem•Pegs 10 d 18 Commonwealth of!Massachusetts � Tine 5 Official inspection Farm Serbsurface SeWW MPosat SyOM Form-Not for doluffty Assessmerft 0 f"perty AddMU OSIM Owner's Name ftffAWIMISMWMd nr�s ft%WY A 4Z6o/ is-�-za p CWfrown Stag zo CO& Wft of mopes# D. Syst m inkmaWn (cont.) P)l,�?. Trap(locate on site plant): Depth ow grade. �t Material of c tlon: ®concrete CO metal ❑fiberglass ❑polyethylene ❑other(e)(alaln): Dimensions: Scum thickness Dance inert top of swim to top of t� befits Distance from bottom of scum tD outlet f�or baffle Date of last pumping: oars Comments(on pumping reaommendatians,in and outlet tee or b�fie condition,structufai irrfty, liquid levels as related to outlet invert evMence leakage etG): N19 & T` or Wring Tank(tank must be pumped at time of inspection)(locate on site plena Depth grade: Material of concrete stet ❑fiberglass a poiyethytene Q other(e ln): I Dimensions: ` i Design Flow. gasps pardsgr •r�r.7fZ8t�18 tme a omaw wmedbodm Sinew •Page 11 d 18 Commonwealth of Massaachuee is Title 5 Official Inspection Form woe Fwm-Not for Vdur"Assessments Oem� owner's Flame emy tom. CIiylTown state Zt code We of irspeftn D. Sysfem infoirrvation (cwt.) dv)A& To" Holding Ta*(cant.) Goa 4- Alarm preset: ❑ Yes ❑ No Alarm level: Alarm in wori ft order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float s es,etc.). Attach copy of current pumping contract(required).is copy attached? ❑ Yes ❑ No 9. Disiafbution Box(if present must be opened)(locate on site plan Depth of liquid level strove outlet invert Comrnents(note box is level and udw to .# equal any evident of souls canyon ,any cif into or out of etc.} c -mow •� o 6e cpyju�C � -To lace., vex+( - r a sc lie �sUM 12s �-�e �„>�•�-(,� v ��l �v ��� � C'�+p0oe•tev.7126f2018 T�S1 h�edlm►fotnt 8IIwsge 8ye0em•�1Yc418 ComnWnY eem of Massachusetts Title 5 Official Inspection Form sew form-Not for Vdw tary Assessmerfs 71:2e C. owe s kftmmtbnfs for every Ctt town state zip Cie Dift of trapaft D. System Info muffm (cons) ot�% Pump (locate on site plan): Pumps:Inworking o order: ❑ Yes ❑ NO` Alarms er: ❑ Yes ❑ No*Comm (note co of pump chamber,edition of pumps and appurtenances, etc.): ' If pumps or alarms are not in working order,s ls a conditional pass. 11. Sob Almorpthm System(SAS){locate on site plan,excavation not required): 'SAS located. %Aft: - c�a-tea¢i�-J v�ecrrl �f�Zo> eea s G1�i -�vSoVf �• � �,l.B 1� � �5�teCl �S e d. .e t. -/a(r�c�? SAS- ht'f ova 5 t c✓ pQ C7-~ a 442. 4AZ".-,7 TYW. ❑ leaching pits number: l f leaching chambers number: i1O Cs� �2rdcG,¢SS' ❑ Mdft gagerfes number: � cdr�ra«essl ❑ leaching trenches number,length: ❑ Iesdtirtt�fiNds number,dimensions: ❑ overtloNr col number: ❑ Innove hwW emattn system Typelhame of tednobgy. -ro.rya teesoMidraMsuasuimseweporopaWsybm-ate 13or16 Commonwealth of M� Tie 5 Official Inspection Form Subsurtbce Sewage Disposal Systiem" form•Ift for VbWntary Agents sNM8 PCKYJTCM siew Zip Code cti D. System information (cunt) 11. So#Absapftn SyStem(SAS)(Cont.) C.onwMft(note w of son, oPy�r u4ic fisilure C91M �f lirt! cry�8 of vegetation,etc. (l,� o�n�it�r+ d z0 c�P-07cr- -P vsot-r Q �g/ �� Y. !i?•! ��5�� �� CUY}!P►�d<GPSS �v bG7'�"�"'1 7�-� s��Rr �drp �vy�e /T'•(/� �a/r91/j/G+b ,$0T70 a/= cS� a�l� �e1/- ;fir`�1-r^ aVPf/a cal/� Y /G (X/a =ZS �-�, �rl��X2•'> Xv9G r�va-G r�al�d9� ¢�� s a wed .6 330 �i` `p ��%.,4 a,.Q Pf of A 12. (cesspool must be pumped as part of pection�(locate on site plan d� :(a�sates N nd oonfiguretian Depth—top id to inlet invert Depth of sands to Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater Inflow 0 Yes ❑ No Comments(now condition of soil,signs of is fanrue,level of ponding,condition of vegetation, 04 I as aoo•�r.7r�ar10+a TM6 O&W hopcftn Fen aftwfaw ftw pVftw l$jvWm•Paptoafto common est of Massachuseft Title 5 Official Inspection Form Sew sswMG otspMW 41BlM IFa m-Not for Vduntary Asftwenft �J P��� , ,,, -- — — 2c cd D Owner's Nam Ad ckyrro digs zip code Dabs of InWecft D. System Information {cons.}. �k 93. (locate on site pkmt Matede of construction: Dimensions Depth of solids Comments(note coed ' n of soft,signs of hydraulic faifure,level of ponding, condition of vegetation, •iev 71�8fla18 Tea 5 oiku Meson Few sftgp om syasrn•Pass 15 of is COrrurtot'>Ewireai#h of Massachusetts Title 5 Official Inspection For 41ftm I -i vcunia,y � 3 ae ev-5�1 OWM man rs ownM's Na" f�eve►y P� C;h�'� 7 ' State Zip Cie Date of inspec�n D. SystemIt on (tit.) 14. Sketch Of Sewap Disposal System; Provide a view of the sewage disposal system including ties to at least taro permanent reference landmarks or benchmarks.Late all wells within 104 feet.Locate where public water supply enters Me building.Check one of the boxes below: hand-sketch in the area below drewing aftched separately A—c— s D, I se a�CAI y d CG&fit►RLG�-1Ai45 (-r PG-c K. N I � oo r b h�SpAoo•esk 1/2�Y018 Mk 5 MW ADW&Mwbm SM aps •Page 16 of is r � � Comrnonvtrealth of Mamochuseft Title 5Ofificial Inspection Form w- Ism? Property Addmem Woftd� j n S Wld- LG� o- t - Z t� ewn CWTowrr I- state 7Jp Cate Date of kwpecft De System intamutiion (cunt,) 15. efts I�carn: LpCheck Slope ('lo j� Surface water aeJ-49 E4&V/8 (� Chgk cellar clvl/C�a Shallow wells—tal-J kJ L J �-e V Estimated depth to high ground water. fay Please indwate all mettxt used to cetetmine the high ground water elevation: ❑ Obtained from system design plars on record If checked,data of design plan reviewed: Date Observed site(abutting property{observation hole within 150 feet of SAS) Checked with local Board of Health-explain: 61 FtJ2 ptann AC*W-528-P; (] Checked with local excavators,installers-(attach docum�tation)-a' Accessed USGS database-explain: You must describe how you established the high groundwater elevation: k r o L ..,n g pTU z3•o MA `� cr9U h @ °�e��V �•S r Z �` - 4 e e b c t o H` 383�c 'E'�S�+by1M�►�Z9 Ev Before Aft this InspaMon Report,please see Repot Completeness Checkfst on next page k�9ntpdoe•1ev.7I�B�p18 Tale$ I inert Forth oeS�e Sy�n•Pape 17 011p COj1't MMweam of Mamci,..ft Title 5 Official Inspection Form R Aftm C, -- MqUired for everyt PW cawrownStotts c� Dabs I kODOC 0n E. R@ PC"COmpletene" 0MCIdi$t Comp191e all applicable sections of thia form Induslve of: A. Inspector Informadon:Complete all fields in this section. S'w on:Sighted&Dated and 1,2,3,or 4 checked C. Inspection Summary: 1,2,3,or 5 completed as appropriate 4(Failure C kit)and$(C+addist)Completed 1 D.Ste"Inca': For 8:TightrHolding Tank—Pumping contract acted For 14:Sketch of Sewage Disposal System dnwm on pg. 16 or attached For 15:Explanation of estimated depth to high groundwater Included �aax•re►�rya Ties �ne0se6an Fa= aew$W _pd&"leaf a ' I Commonwealth of Massachusetts Title 5 Official Inspection form Subsurface Sewage Disposal,System Form-Not for Voluntary Assessments 393 Pitcher's Way` Property Address Linda DeCicco Revokable Trust, Linda M. De.Cicco;,Tr. Owner Owner's Name information is Barnstable H annis ✓ MA 02601 Ma 1, 2021 required for every y Y . page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspectiori'forms may not be altered in any way. Please see completeness checklist atthe end of the form. Important:When A. Inspector Information sl 45 Bob filling.out forms on the computer, David D: Flaherty Jr:, RS, REHS .use only the tab Y key to move your Name of inspector cursor-do not Flaherty Environmental Services use the return key. Company Name (► PO Box`331 Company Address Harwich MA _ 02646 Cityrrown State Zip Code ream 774.994.1166 SI#4713 Telephone Number License Number. B. Certification I certify that: lama DER approved system,inspector in full compliance with Section:15.340;of Title 5 WO CMR.5.000); 1 havepersonally inspected the sewage,disposal system at the property address. listed above;"the information reported"below is'-true;accurate and"complete`as of the time of :my inspection; and the inspection was.performed based on my training and experience in the propecfunction; acid rnainfenance of on-site sewage disposahsystems.After conducting this inspection I'have.determiried` that the system: -1'. ® Passes 2. ❑ Conditionally Passes, 3. ❑ Needs Further Evaluation by the Local Approving Authority 4: ❑ Fails May 2, 2021, Inspectors ignature Date The system inspector shall submit'a copy;_Of this;inspection report to the Approving Authority(Board, of Health or DEP)within"30 days,of completing this inspection. if the system has a design flow of 10,OOQ"gpd or greater, the inspector,and the system owner shall submit the report tathe appropriate regional office of the DEP.The original form shoultl be sent to the system owner and'coplessenf to the buyer, if applicable, and the approving_authority. Please note:This report only describes conditions-at the time of inspection and under the conditions of use at that time."This inspection does not address how.the system wilFperform in the,future..undera>.he same or:_different conditions of use: t5insp.doc•rev.7J M018 Tale 5 Official Inspection Fame Subsurface Sewage Disposal System+Page l of 18 Commonwealth of Massachusetts Title: 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 393 Pitcher's Way Property Address Linda DeCicco Revokable Trust, Linda M. DeCicco,Tr:. Owner Owner's Name information is required for every Barnstable(Hyannis) MA 02601 May 1,.2021 page. Cityrrown State Zip Code Date of Inspection; G. Inspection Summary Inspection-Summary: Complete 1,2, 3, or.;5 and.all of 4 and 6. 1)' System Passes: ® I have not found,:any information which indicates that any;of the failure criteria described in=310 CMR 15.303 or in 310.CMR 15:304 exist. Any failure criteria not evaluated are indicated below. Comments-. 2) System Conditionaliy 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 b:y the Board of Health,will pass. R. Check the box for"yes", "no or"not determined'? N, NW-for the following statements. If"not. determined,"_please explain.. The septic tank is metal and over 20 year.5 old''or the septic tank(whether metal.or not) is structurally im unsound, exhibits substantial infiltrafion or'exfiltration ortartkfailureis minent: System wilrPss inspection if the.existing tank is replaced vrith a cornplying septic tank as approved by the,Board of Hewitt. *A metal septic tank will pass inspection if it is.,structurally sound,not leaking and if a Certificate..of 7. Compliance cating thatahe tank is less than_20 years old.is available." ❑. `Y' ❑ N' ❑ ND(Explain below): t5insp.doc•rev,`7r261201,8 Tille 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of18'. Commonwealth of Massachusetts Title 5 Official -Inspection Form L- Subsurface Sewage Dh posal;System Form:-Not for Voluntary Assessments r 393 Pitcher's Way Property Address Linda DeCicco Revokable Trust; Linda M. DeCicco;Tr. Owner Owners Name information Is required for every Barnstable(Hyannis) MA 02601 May'1, 2021 page. Cityrrown State Zip Code Date of Inspection C. Inspeptio..n Summary. (writ.) 2) System Conditionally Passes(cont.) . ❑` Pump Chamber pumpslalarms not operational. System will pass with Board of:Health:approval if pumpslalarms.are repaired'. ❑ Observation of sewage,jbackup or break out or high static water level in the distribution box due to broken or obstructed..pipe(s)or duet o a"broken, settled or un 1.even distribution box. System will pass inspection`if(wift approval 10 Board of Health)!: broken.pipe(s)are replaced. ❑ `Y ❑ N ❑ NO(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 pipes},The system-will pass;'inspection,if.(with"approval of the'Board of'Healthj broken pipes)are-replaced ❑ Y ❑ N ❑ ND (Explain below): obstruction is removed: . ❑,'Y ❑ N ❑ ND(Explain below): 3) Further Evaluatio'n;is Required by the Board of He ❑ Conditions exist:which require further:evaluation by.the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. " a. System will pass unless Board of Health determines in.accordance with 310 CMR 1'5.303(1')(b)that the.system`is not functioning in a;manner which will protect public health, safety and.the..environment t5insp.doc•rev.7126/2018 Title 5:0fiidal Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official In Form Subsurface Sewage Disposal System Form-Not,for Voluntary Assessments 393 Pitcher's Way Property Address Linda DeCicco Revokable Trust, Linda M. De.Cicco, Tr: Owner Owner's:Name: information dfot is every Barnstable(Hyannis) MA 02601 Ma 1 2021 required for eve _� page. city/Town State Zip Code Date.of Inspection C: inspection Summary. (cone) ❑ 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 b; System will,fail unless the Board of Health (and Public Water Supplier,'if.any). determines that the system is functioning in a manner hat protects the public health, safety.and environment: Q 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: 'R The system has a'.septic tank and SAS and the SAS is within`a Zone 1 of a public water upply: El The system has a septic tank and SAS and the SAS is within.50 feet'of a private water supply well: El The system hat.a septic tank and.SAS and the SAS is Jess than 100 feet:but 50 feet or more from a private water supply well"*. Method used to:deter-in- distance: '*This system passes if the well water analysis, performed at a DEP certified:laboratory, forfecal coliform bacteria indicates absent and the.presence of ammonia;nitrogen and nitratenitrogen is equal to or less'than 5 ppm, provided that-no"otherfailure critena:are triggered. A copy of tt e,analysis must be attached to this'form. c. Other.- 4).. System Failure Criteria Applocable to All Systems: x'- 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 orcesspool Discharge or.--ponding bf effluent to the surface of the ground or surface waters ®` due to an overloaded or clogged SAS or.cesspo%ol 6insp.doc rev:7/26/2018 Title 5-0fficial Inspedhon Form,SubsurfaceSewage Moosal System•Page of.18 Commonwealth of Massachusetts Title-5 Official Inspection Form Subsurface Sewage Disposal.System Form-Not for Voluntary Assessments 393 Pitchers Way Property Address Linda DeCicco Revokable Trust, Linda.M. DeCicco;Tr. Owner Owner's Name ; information is Barnstable(Hyannis) MA 02601: May.1 2021 required for every ( Y ) ._ Y page. Cityfrown State Zip Code Date of Inspection C. Inspection Summary (cont.). 4) System Failure Criteria Applicable to All,Systems: (cont.) 'Yes: No, El Static liquid level i i the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool Liquid_depth in cesspool'is less than,61 below invert or available volume is.less than'%2 day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). m Nubei of times pumped: Any portion of the.SAS, cesspool or privy is below high.;ground water:elevation; 1z Any portion.of cesspool or privy is within 100 feet`of a surface water supply or tributary to a surface water,supply.` Any portion of a cesspool or privy is within a Zone 1 of a public,water supply well El M. 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 1 Q0 feet but greater than.50 feet. from a�private water supply,well with no acceptable water quality analysis., [This system passes,if the well'wateranalysis, performed'atA DEP certified' laboratory,for fec"al coliform bacteria indicates absent and'the presence Of ammonia nitrogen7and`nitratd nitrogen is equal to or'less than 5 ppm, provied that-no other failure A'criteria are triggered., copy of the analysis and chain;of custody must be attacedh to;this form.] Thesystem is a cesspool serving a facility with adesign flow of 2000 gpd- ' 10,000g9pd- The system,fails.] have determined that one or more of the above failure criteria exist as described in'.310 CMR 15:303;'therefore'ttie system.-fails.The system owner should contact the Board.of Health to determine'what will be necess to ary correct the failure. 5);:, Large Systems: To be considered a large system the system must serve a facility with a. design flow of"10,000 gpd td IS',000 gpd. For laege-systems, you must indicate either"yes"or"non to each of the following, in addition to the questions in Section C.4. Yes' No El' El, the system is within 400 feet of a,surface drinking water.supply El ❑ the system is within 200,feet of a tributary-to a surface:drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area=IWPA)or a mapped;Zone II-of'a public water supply well' t5insp.doc-rev.7/26/2018 Title-:5 official inspection Form:Subsurface.Sewage:Disposal System r.Page 5 of.18 Commonwealth of Massachusetts -- Title 5 Official Inspection Form Subsurface Sewage Disposa6System Form-.Not for Voluntary Assessments 393 Pitcher's Way _ Property Address Linda D'eCicco Revokable Trust, Linda M. DeCicco,Tr. Owner Owner's Name iforrredfor every is required for Barnstable(Hyannis) MA 02601 May 1 -2021 page- City/Town State Zip Code Date of Inspection C. Inspection Summary (cant:) If you have answered"Yes"to any question in Section G.5 the system.is considered a significant threat, or answered"yes"to any question in Section C:A'above`the large system has`failed.The owner or operator of any large system considered a significant threat`under Section C.5 or failed under Section C.4 shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department., 6: You must indicate"yes or"no for each of Ahe following for aff inspections: Yes No ( ❑ Pumping information was provided by the owner; occupant, or Board of Health JZ Were;any of the system components pumped out:in the previous two weeks? 0 Q 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 ofEl 0 this inspection Were as built plans of the system obtained::and examined? (If they were not available note::as.N/Aj M Q Was the facility or dwelling inspected for signs of sewage back up? 0. Q Was thp,site inspected for signs of,break„out? 0 Were all system components, excluding,the SAS,.;ocated on site? M El Were the septic tank manholes un:covered,;opened, and the interior of the tank inspecfed.for the condition of the baffles or tees, material of construction, dimensions, depth of'liquid.depth:of sludge and depth ofzcurn Was the facility owner(and.-6ccupants if different from,owner)provided with 1Z :El information on-the proper maintenance of subsurface sewage disposal -teMO The size a n di location of the Soil{Absorptton S.ysterri(SAS)onthe site has been deterrriined based on: z . ❑:. Existing information ',For example,,a plan at the Board of:Health. z ri 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)] t5insp.doo•-rev.7126/M 8 Title 5 Official Inspection Form:Subsurface Sewage:Disposal System•Page 6 of 18- Commonwealth of Massachusetts` Title 5 Official lnnspection Form Subsurface Sewage,Disposal System Form-Not for Voluntary Assessments_ 393 Pitcher's Way Property Address Linda DeCicco Revokable Trust, Linda M. DeCicco;Tr Owner Owner's Name information is Barnstable required for every (Hyannis) :MA 0260.1 May 1,,2021 Page. Cityfrown State Zip Code Date of Inspection D. System Information 1_ Residential Flow;Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR.1`5.203(for.example: 110 gpd x#of bedrooms): 330 Description: Number of current residents: 0 Does-'residence have a garbage grinder? ❑ Yes ® No Does;residence have a water.treatment unit? ❑ Yes 0 No. If yes, discharges to: Is laundry on;a separate sewage system?(Include laundry system inspection. mforrration°in this report.) Yes: No Laundry system inspected? ❑ Yes ❑ No Seasonal.use? El Yes 0 No. 18: 195 gpd;20 Water meter:readings, if Tavailable.(last 2 years.usage(gpd)): 23 gpd Detail` Sump pump? ❑ Yes ® No 2020.:. Last date of occupancy,: gate t5insp.doc-rev.7/26/2018 Trite 5 Official Inspection Form::.Subsurfaoa Sewage Disposal System=Page 7 of 18- I Commonwealth of Massachusetts Title 5 Official Inspection.1form Subsurface Sewage Disposal System Form-Not for VoluntaryAssessments. 393 Pitcher's Way Property Address. Linda DeCicco Revokable Trust, Linda M. DeCicco,Tr. Owner Owner's Name information is Barnstable (Hyannis) MA 02601 May 1 2021 required for every y , page. Cityrrown State Zip Code Date of;Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(god) Basis''of design flow(seatslpersons/sq_ft, etc:):' Grease trap present? ❑ Yes. ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to Industrial waste holding tank present? ❑ Yes ❑ No Non=sanitary:waste.:discharged to the Title 5-system? ❑ Yes ❑ :No; Water meter readings, if available: Last date of gccupancyluse: Date Other,(describe below): [3. RUM in Records,:. Source of information: owner's agent,-pumped 1 Q00 allons in 2018 Was system;'purriped as^Part of the inspection? ❑ Yes. ® : No .If yes, volume pumped: gallons Hp-w was quantity pumped determined? Reason for pumping; t5insp.doc.•rev.7l26lMB rMe5 Offiad Inspecllon Form::Subsurface Sewage`Disposal System•Page of 113 Commonwealth of Massachusetts Title 5 Official .Inspection Form t Subsurface Sewage Disposal System Form.-Not for Voluntary Assessments 4 393 Pitcher's Way Property Address Linda DeCicco Revokable Trust; Linda M. DeCicco, Tr. Owner Owner's Name information is y required for every Barnstable(Hyannis) MA 02601 May'1 2021: page. GityfTown State Zip Code Date of Inspection.. D. System Information (cost.) 4. Type of.System: Septic tank, distribution box, soil absorption.system ❑ Single cesspool ❑ Overflow cesspool ❑; Privy Shared system (yes or no)(if yes, attach previous inspection records; if any) ❑ Innovative/Alternative technology..Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the l!A system by system operator under contract ❑ Tight tank.Attach,a copy of the DEP approval:., ❑. Other(describe): Approximate,.age of,all components, date installed (if known)and source of information: 1979;per 13130H Were sewage odors:detected when arriving at the site' ❑ Yes ❑ ;No: 5. Building Sewer(locate on-site,plan):' Depth,belo Grade 25 _. Material of construction: ®,cast iron ®40;.PV.0 ❑other(explain): Distance from private water:supply well,or;suction line:. feet Comments(on condition of joints-,yentin,'evidence of leakage,;etc.) jbints tight, venting through.;dwelling adequate,'no evidence of leakage: t5i -nsp..doa.•rev.MG2018- - Me 6 official Ins .. -pection Form;PSubsurface$ewageDisposal System•Page 9 or 18 Coimmonwealth of Massachusetts Title 5 Official Inspection Form ' Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Pitcher's Way Property Address Linda DeUcco Revokable Trust, Linda M. DeCicco; Tr: Owner Owner's Name informati on Barnstable (Hyannis) MA 02601 May 1; 202'1 required forevery page, Citylrown State Zip Code Date.of Inspection D. System Information (cont.) 6. Septic Tank(locate on site:plan): Depth below grade 1 5 ; feet Material of construction: ® concrete ❑ metal ❑fiberglass. ❑ polyethylene ❑other(explain) If,tank is metal, list age; years Is age confirmed by;a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gallon Sludge depth: 3" Distance.from top of sludge to-bottom.of outlet tee or-baffle 31 Scum thickness: Distance from top of scum to top ofoutlet,tee.or-baffle , 6 Distance from m botto of scum to bottom of outlet tee.or'baffle 16' ' How were dimensions determined? dipstick,tape measure Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural':integrity;_ liquid>levels as related to outlet iiivert, evidence of leakage; etc.): maintenance pumping regaired every,two,to.three years, inlet-&outlet baffles>intact tank seem structurally sound,'lquid leyel'appropriate; no evidence of"leakage 15insp.doc•rev.7/26/2016 Tille 5'Official Inspection Form:Subsurface Sewage Disposal System Page 10 of 18 Commonwealth of Massachusetts 1p Title 5 Officia Inspection Farm Subsurface Sewage Disposal.System Form-Not for Voluntary Assessments 393 Pitchers Way. Property Address Linda DeCicco Revokable Trust, Linda M. DeCicco,Tr; Owner Owner's Name information is required for every Barnstable(Hyannis) MA 02601 May 1, 2021 page, Cltyffown :State Zip Code Date:of Inspection D. System. nformation (cont.) 7. Grease Trap(locate on site plan):. Depth below:grade: reef Material of construction: ❑concrete El metal ❑fiberglass ❑ polyethylene ❑other(explain): I Dimensions: Scum thickness Distance from top of scum;to top of,outlet:;tee orbaffle Distance from bottom of scum to bottom;of outlet-tee orbaffle Date of last pumping;: Date Comments(on pumping recommendations inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet`invert, eyid' of leakage;etc:): 8. T"t or Holding Tank(tank must be pumped at.time of inspection) (locate on-site-Plan):. Depth:belouV;grade:. - Material of construction:. ❑concrete ❑_M*01 fibIerglass> ❑ polyethylene ❑other;(expla n): Dimensions: Capacity.: gallons Design Flow: gallons,per-day t5insp.doc•rev.7/26/2018 Title Official Inspection Form;:Subsurface Sewage.Disposal System.-Page 11.of 18 Commonwealth of Massachusetts Title 5 Official Inspection fForm Subsurface Sewage Disposal System Form-Not for Voluntary Assessments . y 393 Pitcher's Way Property Address Linda DeCiccoRevokable Trust, Linda M. DeCicco,Tr: Owner Owner's Name' information i e required for every Barnstable(Hyannis) MA 02601 May 1,2021 page. CitylTown State Zip Code Date of nspedion D. System Information (cont.) 8. Tight or Holding.Tank(cone:) 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 El Yes- ❑ No 9.. Distribution.Box(if present must:be opened).(locate on site plan) Depth.of liquid level above outlet invert 011' Comments(note.if box is level and distribution to:outlets equai,;any evidence of solids carryover, any evidence of leakage:into r.8ut of box,-etc:): dbox eems level, rio evidence'of leakage or,solids carryover:.. , [3insp doc..iev 4/J2 /2018 Tile 5 offidal-inspedion Ponn•.Suhsurface Sewage Disposal.System•Page 12 of 18 Commonwealth of;Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments' 393 Pitcher's Way` Property;Address Linda DeCicco.Revokable Trusti Linda:M. DeCicco,Tr.. Owner Owner's Name information is Barnstable(Hyannis) MA 02601 May`1,'2021 required for every page. Cityfrown State Zip Code Date:of Inspection D. System I.n.formatiOn (coat:) 10. Pump Chamber(locate°on_site plan): Pumps in working order: ❑ Yes ❑ No* Alarms.in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.); I *If pumps or alarms are not in working order, system is.a conditional,pass. 1`1:.. Soil.Absorption System (SAS) (locate on,site plan excavation not required): If SAS not located„explain why:' Type: ❑: leaching pits: number:, leaching chambers number: (2) ❑:. leaching;galleries number:- ❑' leaching trenches:- _ number., length: leaching fields number, dimensions; overflow cesspool number: ❑ innovative/alternative system Type/name of technolo t5insp.doc-rev.V612018 Tide 5;Offioial Inspection Form.Subsurface Sewage Disposal System Page 13'of 18 Commonwealth of Massachusetts Title 5 Official In pection Form Subsurface Sewage Disposal;System Form.-Not for Voluntary Assessments 393 Pitcher's Way Property Address Linda DeCicco Revokable Trust, Linda M. DeCicco,Tr:: Owner Owner's Name information is Barnstable(Hyannis) MA 02601 May'1 2021 required for eve y ;eq every 1 page_ Citylrowrt State Zip Code Date of Inspection: Di SysternAnformation (coat) 11. Soil Absorption System;(SAS)(cone:) Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation;etc.)` (2)4iw x 81 x 1.0`D flow diffussors with 4'stone':around laid side by side, no signs of hydraulic failure or breakout,soils sandy, no vegetation (patio) I i 12. Cesspools (cesspool must be pumped as part of inspection) locate on site plan)': Number and;configuration i Depth—top of liquid to inlet invert. Depth of solids layer. i Depth of scum layer Dimensions of cesspool Materials of construction Indication of-groundwater inflow ❑ Yes. El. No Comments (note conditionof soil,signs of hydraulic failure, lev6 of ponding, condition of vegetation, etc): 15insp:doc rev.7/26/2018 Title.5 Official Inspection Form:Subsurface Sewage Disposal System,•Pa9e 14 of 18 f Commonwealth of.Massachusetts LW Title. 5 Official Inspection: Form ' Subsurface Sewage Disposal-.System Form-Not for Voluntary Assessments. 393 Pitcher's Way Property Address Linda DeCicco Revokable Trust; Lin&i M. DeCicco,Tr. Owner Owner's.Name information is required for.every Barnstable(Hyannis) MA 02601 May 1,;2021 page. Cityrrown State Zip Code Date of Inspection` D. System Information (cont.) 1,3. Privy.(locate on site plan): Materials of construction: Dimensions Depth of solids Comments.(note condition of soil,;signs of hydraulic failure, level of bonding, condition of vegetation, etc.):. _ ,. .... l5insp.doc•rev: 128/2018. TiUe 5 Ofrival Inspection Form:subsurfare.Sewage Disposal System-Page 15 of 18 r Commonwealth of Massachusetts Title 5 Ofifi .cial Ins action F r p om ' Subsurface Disposal Sewage Dis g p System Form-Not for Voluntary Assessments 393 Pitcher's Way Property Address Linda DeCicco Revokable Trust, Linda M..DeCicco,Tr Owner . Owners Name ; i information is gamstable(Hyannis MA 02601` May 1, 2021 required for every ) y - page. City/Town State Zip Code Date of.Inspection D. System lnformafion (cont.j!. l _ 14. Sketch Of Sewage Disposal System:. Provide:a view of the sewage,disposal system, including ties to at least two permanent reference landmarks or benchmarks:Locatei 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 c ❑ drawing attached separately U, R f U1 b Q 4 (l. c da l( cJarkl v S7 pc►.G tC_ �; IAJ MW Mir, eh t ooJ Vie-ran:7t29taTta: Tile 5 o 8eu aV $Y3WM•Page 18ot 8 a Commonwealth of Massachusetts F Title 5 Official Inspection_ Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 393 Pitcher's Way Property Address Linda.DeCicco Revokable Trust, Linda M. DeCicco,Tr. Owner Owner's Name information is mquired for every Barnstable (Hyannis) MA 02601 May 1, 202.1. page., Cityffown State. Zip Code. Date of Inspection D. System Information (cont.j 15. Site Exam: ® Check Slope_ Surface water ® Check cellar Shallow wells Estimated.depth tib high grountl water: 5'0 feet I Please indicate all methods used to determine the� high, round`water elevation:' g g El Obtained fromsystem,design.plans on record`. If checked, date of design plan reviewed: ( Date. Observed site,(abutting property/observation-hole within 150 feetof SAS): E Checked with local Board of Health-explain: t Checked with local excavators,installers-(attach docurnentation) 0 Accessed USGS database,-explain;; i You must describe how you estab'lished,the hioh ground watecelevation;. hand augered through flow>diffussor, encountered groundwater at 5.0"below bottom of SAS Before filing.this Inspection Report, please.see,Report Completeness Checklist,on,next page. t5insp.doc•:rev.,7/26/2018 Title'5'Official Inspection Form:-Subsurface Sewage'.Disposal system•.Page.17 of 18 r Commonwealth of Massachusetts Title 5 Official ,josiDection,: Form ' Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 393 Pitcher's Way Property Address Linda.DeCicco Revokable Trust, Linda M. DeCicco,Tr, Owner Owners Name information is Barnstable H required for every (Hyannis) MA; 02601 May 1, 2021 page. City/Town State Zip Code: Date of Inspection E. Report Completeness.Checklist Complete all applicable sections of this form inclusive of: A. Inspector Information: Complete all fields in this section., i B. Certification: Signed& Dated and 1, 2, 3,,or 4 checked: C. Inspection Summary: ( 1, 2, 3.or 5 completed'at appropriate E 4(Failure Criteria)and 6(Checklist)completed D. System Information; Forr8:Tight/Holding Tank—P.umping contract attached' For14:Sketch of Sewage DisposaVSystem drawn on pg..16 or attached For 15: Explanation of;estimated depth to high groundwater.included f i f� i { i i f ' f i t5insp.doc reu`7l2613016 TiNe 5 Offidal Inspection Form;Subsurface Sewage Disposal System:•Page:'18'of 18 LO CAT ION�� � SEWAGE PERMIT NO. ,.�3 hef-s �m l VILLAGE INST LLER'S NAME S ADDRESS 4 U I l D E R OR OWN ER CeRue-ro DATE PERMIT I S S U E D DAT E COMPLIANCE ISSUED , L a r No.........5��. .. F�s.. 5 ........... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH To� n....-.oF..Barns.table .. ................................................•. gy A Iiration for Di,s asa1 Works Tomitrur#iun rrmit �q �� Application is hereby made for a Permit to Construct. ( ) or Repair ( X) an Individual Sewage Disposal System at: ...3-93...P.1chers Way_................................................ Location-Address or Lot No. Rugar t...Qxay.en.................................................. .....Annis .... = ... - -............... Owner Address aJosefh_.P....Macomber..&..Son-,-...Inc_'--•-....• --- Centervllle.............................................................. Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) `4 Other—T e of Building No. of persons............................ Showers — Cafeteria A4 Other fixtures ......................... -- --------------------------•----------------_..._................. ••-•-------•------------------------- W Design Flow............................................gallons per person per day. Total daily flow._._........................_...............gallons. W Septic 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........................................ F.7 Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Gz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ x •• --•••-•••---••---•-••••----•••-••---•-•-•-•-•••...-•-•--•-•--•-••........................••----•---••--•..._.._......--•-....---••--••-............. x •- 1 . 0 Description of Soil........S�,21d...&... r�,.vel___._.. U •....•-••-•.....-•--•••----•................•-.............!' _.........••• ..... U .......................................................AltAlterations ---- - :.-PP... : -1-- 0 ....gal - _ ..tank & �-4 ,z- � >n Nature of Repairs or Alterations—Answer when �hcable_�-�/��_.�y _../ e Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of M.;,,. 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b n ssued by the board of th. Sign -•-- .....- ... Date Application Approved By••••-• .......... .. .. _ ------......•--•- -•---• '�/`..?. .... Application Disapproved for the following reasons--------------------•-----------------------------------•------...._.._._....._..._..._____._Date----•___.___« ..............................................................--....................................................................... •---••----••-•-••--••---•--•-•••-•••-••--•----•-•---•----........ PermitNo......................................................... Issued.......... .........................................� � l ate Date 7q No.........-J1f.21._.. ........:. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....... .............TO.WR......oF..Barnstab]e.--....---.---------------•--................----------- Applirntinn for. Disposal Works Tonstrur#inn Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( g) an Individual Sewage .Disposal System at WaY................................................. Location-Address or Lot No. ...4,.rZalie-t-..CM&.uP.xl~------------------------------•---------•----...... ....Hvannis.......................................................................... Owner - Address JoselDh__P. Macomber & .Son, Inc . Centerville ........................ -•-•-•• - •--•....................••--•-•--........-.....---------•--•••.. PQ Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms_________________________________ _____Expansion-Attic ( ) Garbage Grinder ( ) '4 Other—Type T e of Building No. of ersons____________________________ Showers (� YP g ---------------•--------•--- P ( ) — Cafeteria ( ) PL4 Other 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........................................ 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........................ x -- --------------•------------....._.._....---•--------.._..•••-----..-...-.....-•-•--•-•....---.................-...••---------------------------------- O Description of Soil........Sand..tie__Grame l-.......................................................................................................................... W V ...................•-------------•-•._.....---------..-..--------------------------•------------------•-•-------------------•----._.....---------•--••--•-------------...-.....------•--•----•-•----•.... W .................-............................................................................................................................................................................,........ U Nature of Repairs or Alterations—Answer when applicable_ .-.1499.__ga:]lQn_-_tank_•&---1-1000___gallon ------------------------------------•----------------------------------------------------------------..........-------------- ............................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T'L; 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance hasjDeenlued by,,the ��rd of l�th. C Sign; _ Q e;.?:.^-two-.-- �1/-f ------ f ........................... Date PP on Approved By----• - - `--./ � �Y i................. Date Application PP on Disapproved for the following reasons:---•----------•-------••-------------------------------•-----------------------•-•--•--------•-•-----....------- ...................:------:---_--.--.---------•--•-----------••-•-•--------------•-----•--•-----------------------------------------------------------------------------•----------------------•------- Date PermitNo......................................................... Issued----=--=................................................ Date THE COMMONWEALTH OF MASSACHUSETTS— BOARD OF HEALTH . ...........Z 91M......OF.....Barns•tab le.................:............................ e.1 THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (K ) by -Joseph....P. Macomber & Son Inc. ----------------•-••--••••••--•----•---........................................................................................... =---------•---•-----•••...... ...................... Installer at--.393___Pitchers Way, Hyannis Craven . ------- has been installed in accordance with the provisions of T 1 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.__.___ _____ "�l_.y:-_____. dated-...., --------------- FeTHE ISSUANCE OF THIS CERTIFICATE. SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY.''. DATE... .- --.... b Inspector( ktin'"yti*t '-`�..ki £X>i4`W'kii•NY ,s3 Tt v"r s• Nf �s is A r dst •dya itt"���'T fir} ry,•'vna"F a"_Ft 'ty e. , .w? . :_ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ... .....................7O'VA.........OF...�ir�.l n�'�,��31 e........._-....................................... ,�,G No............ .: FEE._-9-m....... Disposal Works Tuoustrudion rnmit Perm ission is hereby granted_.iggi Jtl-_Pt... comber.&..Son... C-°----•--•--••.0•-3 to Construct � ) or Repair ( X) an Individual Sewage Disposal System at No... � a h l^' .. ... ! Y1ri 3s... Craven Street as shown on the application for Disposal Works Construction Per Nor'_-__- ___- D ted_�_`.��"_��'............... .... ...1- ............................ J� 1 Board of Health DATE.----- - / �../ ---------------------• /// FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS xy " J LO CAT ION� SEWAGE PERMIT *0. VILLAGE t'NST LiER'S NAME i ADDRESS ,R U I*L D E R on OWN ER C42AUlfrC DATE PERMIT ISSUED DAME C ® MPLIANCE ISSUED ce- U x w I I pp 1ME Jp Town of Barnstable Public Health Division '" ti' ,.+•y� F '�': U.S.POSTAGE>>PITNEY BOWES BARNRLE.g 200 Main Street - :. J{,3' .:,4 , }; '� :� /•-- ,� ® �'"JEnru+°0 Hyannis,MA02601 QA` ZIP 7015 1730 0001 4987 8487 02 4VV601 006�900 ` 0000373143 AU 0.7. 2020. IT DECICCO, LINDA M TR s. 393 PITCHERS WAY i iVIxIE 015 DE 1 PPTIIRN Tn CF1Ur7FR If L�l!4 i�A M E i D i UNABLE TO FORWARD I U1N'C BC: 02601400200 *102 2-01085 -10-•45 rI 6_0_4 '& __.T�.._2 I�I�o��fl,I`11�i�IIi1��lIi11P1y,gilll,t�1111111��0�111'1111'I!tI y..rA F •. . •r ... •J: it } • • • • • ON i 0 Complete items 1,2,and 3. A. Signature 4 I ■ Print your name and address on the reverse O Agent so that we can return the card to you. X ❑Addressee ■ Attach this Card to the back of the mailpiece, B. Received by(Printed Name) C. Date of Delivery or on the front if space permits. I I - a -- -ddress different from Item 11 ❑Yes r delivery address below: ❑No j I I ! DECICCO, LINDA M TR _ I 393 PITCHERS WAY I ,I HYANNIS MA 02601 I III6IIISIIIIIICIIIIIIIIIIIIIIIIIIIIIIBIIIIIII s: aervic ryPtl ❑Priority Mail Express(a) ❑Adult Signature ❑Registered MaIlaiITMT"' 0 Adult Signature Restricted Delivery ❑Registered Mail Restricted ----------------- I -9590 9402 5745 0003 5533 80 ?Certifed Mall Delivery I j Certified Mail Restricted Delivery Return Receipt for � ❑Collect on Delivery Merchandise j 2-Article-Number-(Transfer from service labo) ❑Collect on Delivery Restricted Delivery ❑Signature ConflnnationTM ❑Signature Confirmation I ;: I 7015 .1730 0001 ,,,4.9 8 7 t 8 4 8 7 f l Restricted Delivery Restricted Delivery � PS Form 3811,July 2015 PSN 7530 02-000-9053 Domestic Return Receipt Vme Town of Barnstable Inspectional Services Department BARNSTASM Public Health Division 1639.9 MAS&9S. '�Fcr9A 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIEp MAIL#7015 1730 0001 4987 8487 August 7, 2020 DECICCO,LINDA M TR- 393 PITCHERS WAY HYANNIS, MA 02601 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 393 Pitchers Way, Hyannis, MA was inspected on 07/21/2020 by Brett Hickey, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. • The distribution box needs to be replaced. You are ordered to repair or replace the septic system within two (2)years from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH as cKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\393 Pitchers Way Hyannis.doc b