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HomeMy WebLinkAbout0543 PITCHER'S WAY - Health 54� A 543 Pitcher's MY Hyannis F%R A = 270 144 y f I I ' TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION Date U/ Z( Time: In Out Owner �e(�Iy1��1�— ��w�5 Tenant t;�A h/1tM e:��p l I, Address ��3 G�'r S Address Compliance Remarks or Regulation# Yes NO Recommendations 2. Kitchen Facilities �1 3. Bathroom Facilities MD C44- 4. Water Supply 5. Hot Water Facilities S 6. Heating Facilities 7. Lighting and Electrical Facilities 8. Ventilation 9. Installation and Maintenance of Facilities 10. Curtailment of Service 11. Space and Use 12. Exits 13. Installation and Maintenance of Structural Elements 14. Insects and Rodents 15. Garbage and Rubbish Storage and Disposal 16. Sewage Disposal �Z 7-1 3 6t�, 17.Temporary Housing /v A 18. Driveway Width ���N S �� M 17,,o 19. Number of Tenants Observed (f� PART II 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition Number of Bedrooms Number of Vehicles Allowed (max) Number of Persons Allowed (max) Person(s) Interviewed OLL4JO- Inspector If Public Building such as Store or Hotel/Motel specify here 3 TO OF BARNSTABLE £L ti n A 'ION SEWAGE # i�UDa ` 39-7 VILLAC I f n n 1'_f L �`� ASSESSOR'S ISSOR'S MAP & LOT 9 ?o - q INSTALLER'S NAME&`PHONE NO. l '� e. 6�a r_y SEPTIC TANK CAPACITY b r g LEACHING FACILITY: (type) ize) NO. OF BEDROOMS BUILDER OR OWNER. ao PERMPTDATE: COMPLIANCE DATE: Separation Distance Between the: 'r 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 .v � Z o .� _--- � c� � � ��� � �, � ► � � � � � � � �- r • Aj TOWN OF BARNSTABLE LOCATION 543 Pitchers Way SEWAGE # VILLAGE Hyannis ASSESSOR'S MAP &LOT 270-144 INSTALLER'S NAME&PHONE NO. Arch (508) 775-1362 SEPTIC TANK CAPACITY 1000 Gallon LEACHING FACILITY: (type) (size) NO.OF BEDROOMS 3 BUILDER OR OWNER. Charles Akins PERMIT DATE: 2/9/9 3 COMPLIANCE DATE: 2/10/9 3 Separation Distance Between the: Greater than Maximum Adjusted Groundwater Table and Bottom of Leaching Facility 12 Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Unknown Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching fa�ciip None Present Feet Furnished by d ✓/ :o'� i�1 � `�— "�`� i No. -aOO2 -3 a -7 r zo^� ) ° Fee /. THE C MONWEALTH OF MASSACHUSETTS Entered in computer: i/ Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 2pplitation for Migool *pztem Construction i3ermit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. L�3 r-5 Owner's Name,Address and Tel.No. Assessor's Map/Parcel ?Q/ c I i'i Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. t, ke L, GQ/` ✓ l � SO/it Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow j. S o gallons per day. Calculated daily flow —3 y a gallons. Plan Date 77— l 4' " d Number of sheets Revision Date Title Size of Septic Tank / Type of S.A.S. Description of Soil 5 l G Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 Qf the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issue by tlu oard of th. ®^ 2 Signed Date Application Approved by �- Date Application Disapproved for the following reasons Permit No. 00,�— 7 Date Issued 0 Z U 3 a .>_s Fee.rC /V THE.0 WEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALT,H.Z VISION —TOWN OF BARNSTABLES MASSACHUSETTS 01ppYication for Mi6pogaY pgtem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. G C.e.,Q 9�ner's Name,Address and Tel.No. Assessor's Map/Parcel ?Q/, L/!� Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. L Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder x Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow jJ © gallons per day. Calculated daily flow — gallons. Plan Date ":7 �ti " © Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. / Description of Soil z�' �' /GG,I-N Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: . The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 f the Environmental Code and not to place the system in operation until a Certifi- Cate of Compliance has been issu by thi oard optQth. Signed A Date Application Approved by Date 7-30 —v 2.. Application Disapproved for the following reasons A Permit No. 2 C4 a r 7 Date Issued--7,/7n b0 .Z a THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded( ) Abandoned( )by k...e L 4-f at �`�.3 !���G A t^.S l v' `I has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 2 OU�)-"?;—7 dated 6 u Installer Designer / The issuance o this permit shall not be construed as a guarantee that the Sys ctiQn ne as desi d. Date Inspector IV - --------------------------------------- No. ,) )(J�� �27 Fee ✓ ` THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Mi6pogar Opotem (ConfStruction Permit Permission is hereby granted to Construct,(/ )Repair( )Upgrade( )Abandon( ) t System located at `� � I'"/ C c r-S C:x 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: -7I�3oho 12 Approved by 4^.,. 1 f/ r T� ARNSTABLEB �L �a 7LOCATION n VILLAGE Y1 1_f ASSESSOR'S MAP& LOT 70 — I yq INSTALLER'S NAME&PHONE NO. I`A L SEPTIC TANK CAPACITY _b g LEACHING FACILITY: (type) :,� �" l°-size) NO.OF BEDROOMS BUILDER OR OWNERoo PERMITDATE: 02: COMPLIANCE.DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well.and Leaching Facility. (If any wells exist. on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by 1>1 f - COASION= 'EAL'H OF INIAS'SACHUSE,17S ExECUTivE OFFICE OF EN`JIR.ONMEN-T.AL,AFF-AIRS ' DEPARTMENT OF ENVIRONMENTAL PROTECTION r Vq TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Q 0 Property Address: t ic W _ �4 I Owner's Name: grVIC VV Owner's Address: Bate of Inspection- e IWb5"` ` Name of Inspector: plea a print) m�c�n,a,G� /e E tE t F M Company Name t h✓i _� ' W Ldi64oGtS Mailing'Address: To o,c Telephone Number: _ 0� 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 15340 of Title 5(310 CMR I5.000). The system: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority _ Fails Inspector's Signature: hate; 6 tb_ 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. 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. Title 5 Inspection Form 6/152000 page I Wage 2 of 11 OEEI[CIAI.INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMW4T'S OUBSURFACE SEWAGE DISPOSAL:SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) ( Property Address- lff5 Owner: Date of Inspection: A Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: _ I havemot 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 replaced or repaired.The system,upon completion of the replacement or repair,as approved by the B of Health,will pass. :Answer yes,no or not determined(Y,N,NvTD)in the for the following sta tints.If"not determined"please explain. The septic tank is metal and over 20 years old*or the septic (whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiiltration or tank ' is imminent.System will pass inspection if the existing tank is replaced with a complying septic tank as appr ed by the Board of Health. *A metal septic tank will pass inspection if it is struschwA ound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is av ' e. ND explain: Observation of sewage backup or' out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, ed or uneven distribution box.System will pass inspection if(with approval of Board of Health): broken pipe(s)ared obstr uctiaa is removed distribution box is kwled of replaced ND explain: The syste equired pumping more than 4 times'a year due to broken or obstructed pipe(s).The system will Pass inspection (with approval ofthe Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: f Page=of l fi OFFICIAI,INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM.INSPECTION]FORM PART A CERTIFICATION(continued) Property Address: Owner: -rRt-40&_ Hate of inspection: -- p C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determin ' he system is failing to protect public health,safety or the environment. L System will pass unless Board of Health determines in accordance with 310 'R 15.303(I)(b)that the system is not functioning in a manner which will protect public health,s ty 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 w and or a salt marsh 2. System will fail unless the Board of Health(an blic Water Supplier,if any)determines that the system is functioning in a manner that protects public health,safety and environment: _ The system has a septic tank and soil rption system(SAS)and the SAS is within 100 feet of surface water supply or tributary to a s ce water supply. _ The system has a septic tank an AS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septi 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 ' the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile ganic compounds indicates that the well is free from pollution from that facility and the presence of onia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria ar ggered.A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of 1 l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE POSAL�SYSTEM INSPECTION FORM =' PART.A- CERTIFICATION(continued) Property Address: "Ufa ..,;,y Owner: Date of Inspection: b-5, D. System Failure Criteria applicable to all systems: You must indicate"yes"or`moo"to each of the following for illinspections: Yes No Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool Liquid depth in cesspool is less than 6"below invert or available volume is less than'!6 day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped Any portion of the SAS,cesspool or privy is below high ground water elevation. Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _ Any portion of a cesspool or privy is within a Zone 1 of a public 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.IThis system passes if the well wateranalysis, performed at a DEP certified laboratory,for cofiferm 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 thaw 5lnpm,provided that no other.f"ure criteria are triggered.A copy of the analysis must be attached to this form.] (Yes/No)The system fails.I have determined that one or more of the above fat ure 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 he considered a large system the system must serve a facility a design How of 10,000 gpd to I5;000 gpd- You must indicate either`Yes"or"no"to each of the folio (The following criteria apply to large systems in additi the criteria above) yes no the system is within 400 feet of a ace drinking water supply _ — the system is within 200 feet a tributary to a surface drinking water supply _ the system is located in nitrogen sensitive area(interim'Wellhead Protection Area—IWPA)or a mapped Zone H of a public r supply well If you have answered"yes" o any question in Section E the system is considered a significant threat,or answered "yes"in Section D abov the large system has failed.The owner or operator of any large system considered a. significant threat unde 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- 4 Page 5 of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: c Owner. cJ" t-ievl, _ Date of Inspection: �Yj' Check if the following have been done.You must indicate`yes"or"no"as to each of the following: Yes No A� Purnping information was provided by the owner,occupant,or Board of Health Were any of the system components pumped out in the previous two weeks? Has the system received normal flows in the previous two week period? Have large volumes of water been introduced to the system recently or as part of this inspection? _ Were as built plans of the system obtained and examined?(If they were not available note as NIA) _ 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 Ain�e_nance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no Existing information_For-example,a plan at the Board of Health. _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)) 5 Page 6 of I! OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION /� Rr - � ' l Property Address- �7 t t`t�.v�(,�'S Owner t`Ch. Date of Inspection: a �a RESIDENTIAL FLOW CONDITIONS Number of bedrooms(design): 3 Number of bedrooms(actual). DESIGN Row based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): Number of current residents: (7 Does residence have a garbage grinder(yes or no): Is laundry on a separate sewage system(yes or no):Nu_ [ifyes separate inspection required) Laundry system inspected(yes or no):w Seasonal use:(yes or no):fP Water meter.readings,if available(last 2 years usage(gpd)): Sump pump(yes or no): /OD Last date of occupancy: olrell"' COMMERCIAL0(DUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): C1Pd Basis of design flow(seats/persons/sgft,etc. Grease trap present(yes or no): Industrial waste holding tank prese yes or no):_ Non-sanitary waste discharged the Title 5 system(yes or no): Water meter readings,if av ' able: East date of occupancy e: OTHER(desc ' }: Damping Records GENERAL INFORMATION Source of information: Was system pumped as part of the inspection(yes or no): If yes,volume pumped: sallons—How was quantity pumped determined? Reason for pumping: 'I YPE OF SYSTEM �C Septic tank,distribution box,soil absorption system —Single cesspool Overflow cesspool —Privy —Shared system(yes or no)(if yes,attach previous inspection records,ifany) _Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) —Tight tank _Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Were sewage odors detected when arriving at the site(yes or no): W t1 6 f Page 7 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSU ACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address - Owner: Rate of Inspection: BUILDING SEWER(locate on site plan) _ Depth below grade: A3rt Materials of construction:_cast iron /( 40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK:I(Iocate on site plan) Depth below grade:—!�._ Material of construction concrete_metal fiberglass_polyetane —other(explain) yle if tank is metal list age:_ Is age confirmed by a Certificate of Compliance certificate) P (yes or no):i(attach a copy of Dimensions:_1660 54� Sludge depth:_ IT Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: Ca Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee orb e:_ t 6- How were dimensions determined: A4&A6/) r Comments(on pumping recommendations,bilet and outlet tee or baffle condition,structural integrity,liquid levels as �Iated outlet inv�rt,evidence of leakageri etc.): ( 1 GREASE TRAP:_(locate on site plan) Depth belowgrade:_ Material of construction: concrete m fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to to f outlet tee or baffle: Distance from bottom of sc to bottom of outlet tee or baffle: Bate of last pumping: Comments(on pumping ommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to otntiet inve evidence of leakage,etc.): 7 Page 8 of I l OFFICIAL,INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM .PART C SYSTEM INFORMATION(continued) Property Address: �ilt: le 'S Owner: Rate of inspection: a�(—O� TIGHT or BOLDING TANK: (tank must be pum time of inspection)(locate on site plan) Depth below grade: Material of constriction: concrete m fiberglass polyethylene other(explain): Dimensions: Capacity: ga ns Design Flow: anons/day Alarm present(yes or no),- Alarm level: Al in working order(yes or no): Date of last pumping: Comments(conditio of alarm and float switches,etc.): DISTRIBUTION BOX:/(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Mit, Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage in or out of box,etc.): PUMP CHAMBER: (locate on site ) Pumps in working order(yes o o :. Alarms in working �in or no): Comments(note copump chamber,condition of pumps and appurtenances,etc.): S Page 9 of 11 OFFICE. INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENtTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOR%' PART C SYSTEM EWORMATION(continued) Property Address: ! � flvvner at ttL4 - Date of Inspection: O� SOIL ABSORPTION SYSTEM(SAS): A (locate on site plan,excavation not required) If SAS not located explain why: Tye leaching pits,number: _leaching chambers,number. leaching galleries,number: leaching trenches,number, length: Ieaching 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.): Xn�;5 s 6Y,6 'r-et&s`t L CL C> �c�oca e ars f e CESSPOOLS. (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth—top of liquid to in invert:_ Depth of solids Iayer. Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater i low(yes or no): Comments(note conditio 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 o oil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 9 Page 10 Of?l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: �ts Owner: Date of Inspection:' 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. ss _ Page 11 of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL,SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner:_ JI-,t V( Bate of Inspection: SITE EXAM Slope 00 Surface water $)0 Check cellar 1&G5 Shallow wells wo Estimated depth to ground water 90 feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design,plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation) K Accessed USGS database-explain: You must describe how you established the high ground water elevation: n `r ol-k 0%J a 01�PJC� 11 Commonwealth Of Massachusetts Executive Office Of Environmental Affairs Department Of Environmental Protection TITLE 5 Official Inspection Form -Not For Voluntary Assessments Subsurface Sewage Disposal System Form Part A Certification Property Address: 543 Pitcher's Way Hyannis Ma.02601 Owners Name: Paula Matos Owners Address: Date of Inspection: 11/8/2008 Name of Inspector(please print)Sean M.Jones#SI4522 Company Name: S.M.Jones Title V Septic Inspection Mailing Address:74 Beldan Ln. Centerville Ma.02632 Telephone Number:774-248-4850CD CERTIFICATION STATEMENT w< {n I certify that I have personally inspected the sewage disposal system at this address and that the information reported; below is true,accurate and complete as of the time of the inspection.The inspection was perform$d:'.l�ased on m training and experience in the proper function and maintenance of on site sewage disposal systems am a DP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system c- t •• co r rn X► Passes Conditionally Passes Needs further evaluation by the Local Approving Authority Fails Inspectors Signature Date: 1 v����r 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. 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. Page 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(coty mjm) Property Address: 543 Pitcher's Way Hyannis Ma.02601 Owners Name: Paula Matos Owners Address: Date of Inspection: 11/8/2008 Inspection Summary:Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: X I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: 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 the 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 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: OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 543 Pitcher's Way Hyannis Ma.02601 Owners Name: Paula Matos Owners Address: Date of Inspection: 11/8/2008 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 310CMR15.303(1)(b)that the System functioning in a manner that protects the public health,safety and the environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a Surface water supplyor 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 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: OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTMED) Property Address: 543 Pitcher's Way Hyannis Ma.02601 Owners Name: Paula Matos Owners Address: Date of Inspection: 11/8/2008 D. System Failure Criteria applicable to all systems: 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 cesspool is less than 6"below invert or available volume is less than '/7.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. X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of cesspool or privy is within Zone 1 of a public well. X Any portion of cesspool or privy is within 50 feet of a private water supply well. X Any portion of 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 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 pp,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] X (Yes/No)The system fails.I have determined that one or more of the above.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 serve a facility with a design flow of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of the following: 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 1I of a public water supply well If you 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 CM15.304.The system owner should contact the appropriate regional office of the Department. OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 543 Pitcher's Way Hyannis Ma.02601 Owners Name: Paula Matos Owners Address: Date of Inspection: 11/8/2008 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 system components pumped out in the previous two weeks? X Has the system received normal flows in the previous two week period? 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 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 tee,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? J The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes No X _ Existing information.For example,a plan at the Board of Health. _X_ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of. distance Is unacceptable)[310 CMR 15.302(3)(b)J OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 543 Pitcher's Way Hyannis Ma.02601 Owners Name: Paula Matos Owners Address: Date of Inspection: 11/8/2008 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):-3— Number of bedrooms(actual): 3_ DESIGN flow based on 310 CMR 15.203 (for example): 110 gpd x#of bedrooms):J340.4 gpd provided` Number of current residents:- 0-Does residence have a garbage grinder(yes or no): no Is laundry on a separate sewage system(yes or no): no [if yes separate report required] Laundry system inspected(yes or no): n/a Seasonal use:(yes or no)no Water meter readings,if available(last 2 years usage(gpd): Sump pump(yes or no): no Last date of occupancy/use:_ COMMERCIAL/INDUSTRIAL:N/A Type of establishment: Design flow(based on 310 CMR 15.203): gpd 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): GENERAL INFORMATION Pumping records Source of information: Was system pumped as part of the inspection(yes or no): no If yes,volume pumped: gallons--How was this 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 the system owner) Tight tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information:system repaired 2002 Were sewerage odors detected when arriving at the site(yes or no): No OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION.(continued) Property Address: 543 Pitcher's Way Hyannis Ma.02601 Owners Name: Paula Maros Owners Address: Date of Inspection: 11/8/2008 BUILDING SEWER(locate on site plan) Depth below grade: 2`+/- Materials of construction: cast iron_X_40 PVC other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): Joints were in good condition,no.sign of leakage. SEPTIC TANK: X_(locate on site plan) Depth below grade:_8"_ Material of construction:_X_concrete—metal—fiberglass polyethylene other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no):,(attach a copy of certificate) Dimensions: 8`6"X5`6"X4`10"= 1000 Gallons Sludge depth: 104, Distance from top of sludge to bottom of outlet tee or baffle: 3` Scum thickness: 4" Distance from top of scum to top of outlet tee or baffle:_4" Distance from bottom of scum to bottom of outlet tee or baffle: 8" How were dimensions determined:Opened covers and took measurements Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels As related to outlet invert,evidence of leakage,etc.): Inlet and outlet baffles intact,water level was at bottom of outlet invert,tank structurally sound and not leaking. Tank should be cleaned soon and again eve!y 2 years to prolong systems lifespan. GREASE TRAP: N/A (locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass----polyethylene other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid,levels As related to outlet invert,evidence of leakage,etc.): OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 543 Pitcher's Way Hyannis Ma.02601 Owners Name: Paula Matos Owners Address: Date of Inspection: 11/8/2008 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:_0` Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of Leakage into or out of box,etc.): D-box was level and in good condition.Water level was at bottom of outlet invert.Box showed no signs of past hydraulic overloadim 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.): OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 543 Pitcher's Way Hyannis Ma.02601 Owners Name: Paula Matos Owners Address: Date of Inspection: 11/8/2008 SOIL ABSORPTION SYSTEM(SAS)_X_(locate on site plan,excavation not required) If SAS not located explain why: Type Leaching pits.Number: _X_Leaching chambers,number:- 2-Leaching galleries,number: Leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: innovative/alternitave system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): Soil was da and vegetation was normal. S.A.S.was located but not excavated,stone was probed in various locations and was not saturated. CESSPOOLS: N/A (cesspools 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 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.): l � OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 543 Pitcher's Way Hyannis Ma.02601 Owners Name: Paula Matos Owners Address: Date of Inspection: 11/8/2008 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 12+ feet Please indicate(check)methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: 7/14/2002 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: Design plan on file at Town of Barnstable Board of Health dated 7/14/2002 shows no groundwater encountered @ 144". OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 543 Pitcher's Way Hyannis Ma.02601 Owners Name: Paula Matos Owners Address: Date of Inspection: 11/8/2008 SKETCH OF-SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent referencelandmarks or Benchmarks.Locate all wells within 100 feet.Locate where water supply enters the building REAR OF HOUSE A 6 Cf 0 1 TANK A-1=16' 8-1=22' C 2 A`72=27 8-2=2W ❑ 3 O-BOX A-3=28' 8-3=31V SAS. A-4=16' B-4=43' Commonwealth of Massachusetts Executive Office of Environmental Affairs Department Of �11-1-1112 Environmental Protection �•. William F.Weld ' c� . Gawmor /� f/W 4 �%� Trudy Coxo �.' t/ A, I� { I eu.r.ry,EOU 'Y 2 9 David D. Struhs U !y comm6 a lon er 199,6 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM , PART A CERTIFICATION Property Address: 543 Pitchers Way, Hyannis Address of Owner: c/o Atty. Matthew Dupuy Date of Inspection: March 29, 1996 (If different) 25 Mid—Tech Drive Name of Inspector. Robert W. Saben West Yarmouth, MA 02673 Company Name, Address and Telephone Number: Barnstable County Systems Inspectors 25 Mid—Tech Drive West Yarmouth, MA 02673 CERTIFICATION STATEMENT (508) 778-0101 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 %vas performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: X Passes . _ Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature: Date: March 29, 1996 The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this inspection. if the system is a shared system or has a design floe•of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Check A, B. C, or D: At SYSTEM PASSES: X I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.30). Any failure criteria not evaluated are indicated below, U) SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system, upon completion of the replieement (Ir rrhair, panes inspection. Indicate yes, no, or not determines! (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 exfiltralion, 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 e/15/95) 1 . AX{G17 55F1040 G17) 29? Orin VRnter Street • Poston, Ninssrtchusetts 02100 •55CO h SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 543 Pitchers Way,, Hyannis Owner: Charles Akins Date of Inspection: 3/29/96 B) SYSTEM CONDITIONALLY PASSES (continued) _ Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced _ a year due to broken or obstructed pipe(s). The sys em will pass The system required pumping more than four times inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is fai ing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IV A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:. _ Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within SO feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND TH ON'"k{ENT: _ The w5tem hip ,1 Septic lltlk and soil absorption system and is within 103 foci to a surface watet tupp:) Gt surface water supply. _ The system Im, a septic tank and soil absorption system and is within a Zone I of a public water supply _ The System ha+ a septic tank and soil absorption system and is within 50 feet of a private water supply, +•ell. _ The sy>ieni a septic tan% and soil absorption system and is less than 100 feet but 50 feet or more fro n a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. D) SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined in 310 OAR 15.103. The basis for this determination is identified below. The.Tlonrd of Health should be contacted to determine what will be ne•rs,--iry to correct , the failure. Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or c logged SAS or cesspool. (revised 8/15/95) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 543 Pitchers Way, Hyannis Owner: Charles Akins Date of Inspection: 3/29/96 DI SYSTEM FAILS (continued): 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 G" below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of 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 So feet of a private water supply well. _ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. i El LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: The design flow of system is 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: the system is within 400 feet of a surface drinking water supply _ the system is within 20.0 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area (IW A) or a mapped Zone II of. public water sup{rly well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 8/15/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 543 Pithcers Way, Hyannis Owner: Charles Akins Date of Inspection: 3/29/96. Check if the following have been done: X Pumping information was requested of the owner, occupant, and Board of Health. X None of the system components have been pumped for at least two weeks and the system has been receiving normal (low rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. X As built plans have been obtained and examined. Note if they are not available with N/A. X The facility or dwelling was inspected for signs of sewage back-up. X The system does not receive non-sanitary or industrial waste flow X The site was inspected for signs of breakout. X All system components, excluding the Soil Absorption System, have been located on the site. X The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. X 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. X The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub- Surface Disposal System. (zeviaed 8/1S/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 543 Pitchers Way, Hyannis Owner: Charles Akins Date of Inspection: 3/29/96 FLOW CONDITIONS RESIDENTIAL: Design flow: 1,00 allons Number of bedrooms: 3 Number of current residents: 0 Garbage grinder (yes or no):XQ_ Laundry connected to system (yes or no): Yes Seasonal use (yes or no):No Water meter readings, if available: 11/4/94-4,000cu.ft. 2/3/95 to 2/7/96 12,000 cu.ft. Last date of occupancy: November 1995 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 S 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: 7/21/86 — Board of Health System pumped as pan of inspection: (yes or no)_ If yes, volume pumped. gallons 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) Other (explain) - APPROXIMATE AGE of all components, date installed (if known) and source of.information: 3 years (2-10/93) leaching Board of Health. Septic tank appears to be over 20 years old Sewage odors detected when arriving at the site: (yes or no) No (revised 8/15/95) S SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 543 Pitchers Way, Hyannis Owner: Charles Akins Date of Inspection: 3/29/96 SEPTIC TANK: X (locate on site plan) Depth below grade: 1011 Material of construction: Xconcrete metaf_FRP—other(explain) Dimensions: 8x4x5 Sludge depth: 8" Distance from top of sludge to bottom of outlet tee or baffle: 1' 11" Scum thickness: 7" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 11" Comments: (recommendation for pumping, condition of inlet and outlet Ices or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) Recommended pumping inlet baffle appears adequate. Outlet tee in good condition: Liquid level at bottom of outlet. Concrete covers in poor condition, evidence of inadequate maintenance of system causing backup of system. GREASE TRAP:_ (locate on site plan) Depth below grade: Material of construction: _concrete _metal _FRP —other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Diva rice from botior M <ryim M ontinm of otitiet tee or naitle: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of Ieakagv, elL.i (revised 8/15/9S) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 543 Pitchers Way; Hyannis Owner: Charles Akins Date of inspection: 3/29/96 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 float switches, etc.) DISTRIBUTION BOX: No Distribution Box (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distribu;ior. is cqu:.', c•';dence of solids ca:r,•over, evidence of Ieakzge into or out of box, etc.) Recommend installation of Distribution Box, 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.) f (revised 8115195) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 543 Pitchers Way, Hyannis Owner: Charles Akins Date of Inspection: 3/29/96 SOIL ABSORPTION SYSTEM (SAS):_ (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Unable to confirm exact location. Numerous exploratory holes dug and probed, best estimate is provided on sketch plan. Type: leaching pits, number:_ leaching chambers, number: 2 Infiltatiors 12 x 8 leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.) Coarse and boney soil Normal vegetation CESSPOOLS: _ (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 ground%.ate1. inflow (cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY:_ (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.) j (revised 8/15/95) $ a " SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 543 Pitchers Way, Hyannis Owner: Charles Akins Date of Inspection: 3/29/96 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' �gqQ of Dwel.Liub 8` & 30- zyo, Ce4 �/j I A4� A�i�eKiM 4TCll DEPTH TO GROUNDWATER Greater than Depth to.groundwater: 12 feet method of determination or approximation: USGS Maps --- i (revised 8/15/95) 9 jzu-, I,aj C II &X4e�� 0/,/ XU)ZIal ZI YCV(tc,((�ej, Michael.S. DukaKis / Governor cJ4�LU2Q� c/f�11fJt�LQiL �/i}�� s�L7ilL Philip W. Johnston <n O Secretary 30S 'su!/z.yG�el, �ai�ta�ca �lariz, 0?7.i'(� )orah Prothrow-Stith, M.D. LETTER OF LEAD A13ATEMEN T COMPLIANCE Commissioner DATE January 21 , 1992 ,I Dear Mr. Akins . This letter is to certify that-I inspected your property located at 543 Pitchers Way , apartment no. and relevant common areas, in the city or town of Hyannis for lead abatement compliance on January 21 , 1992 and on that date those sur- faces cited in the initial inspection report of January 6,, 1992 were found to be in compliance with Massachusetts General Laws, Chapter 111, Section 197, and 105 CMR 460.000 Regulations for Lead Poisoning Prevention and Control. Massachusetts law does not require the abatement of all residential lead paint. 1 he residential premises or dwelling unit and relevant common areas shall remain in compliance only as long as there continues to be no peeling, chipping or flaking lead paint or other accessible leaded materials and as long as coverings forming an effective barrier over such paint or other leaded materials remain in place. See the reverse side of this letter for the location(s) of surfaces which were covered as an abatement method to achieve compliance, if applicable. Sincerely, i Inspector GJ UPH Registration No. i i INSPECTION AND ABATEMENT HISTORY :l f Susan G. Rask C1239 Name and Registration Number of Inspector Who Performed Initial Inspection Date of Reoccupancy Reinspection Name and Registration Number of Inspector (if applicable) Who Performed Reoccupancy Reinspection Name(s) and Certification or License Number(s) of Department of Labor. and Industry Authorized Deleading Contractor(s) Who Performed Abatement: James W. Anderson, Jr. Devine Deleading DC000583 -AREAS WHERE LEAD PAINT OR OTHER LEADED MATERIAL HAS BEEN COVED AS f LEAD ABATEMENT METHOD. INTERIOR Room No. Side Surface or Fixture Type of Covering (As indicated on Initial Inspection Report) EXTERIOR Side Surface or Fixture T yF pe of Covering E i i r r Should you have questions about this letter at any point in the future, contact the Department of Public Health, at (617) 522-3700, ext. 188. TOWN OF BARNSTABLE LOCATIONS- / j i J;1=25 GZ/,`/ SEWAGE # %3 VILLAGE /ry jAyy +// S ASSESSOR'S MAP & LOT ;�,G• INSTALLER'S NAME & PHONE NO.A 2 el-4 .7 -2 S /3Ar-Z) SEPTIC TANK CAPACITY la®Q LEACHING FACILITY:(typeQ iw%=�l2A`-7aE� (size) / aC NO. OF BEDROOMS _PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER C14 f2 /�S A/f .r✓j DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: - I b, VARIANCE GRANTED: Yes No /f f 4 � mat I s � A r g >1 bn 9 e,.- y ! s / No...q�a..... F�a........ .. . .... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Appliration for Diripmial Works Totwtr!rti rt Permit Application is hereby made for a Permit to Construct ( ) or Repair ) an Individual Sewage Disposal System at: ...... '-s--•......................................................... L;cation-Address or Lot No. ......................C�/> ........................................................ •----•S.¢".. -----------'-------•---......----------- Ow er Address C '..................................................... ........................... 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 ( ) a' Other fixtures ------------------------------- -- WDesign 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. 3 Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ ,`i� Test Pit No. 1................minutes per inch Depth of Test Pit---__--__--___--___ Depth to ground water........................ fXq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ C4 ----------------------------------- •----•-------------------------------•---.-...-•--••-•-•--•---.-......-..--...-..--------------------- .... .--------------- 0 Description of Soil.........---•--........-•-----------------------------------------------------------------------------••-------------------•-----------.................._....-•-..••--- V ................••••--•-•---•--••••-••-.....-•••-•---••-•••-•---••--••-•------•••••••--•-----•-•---•••••••-••----•---•-••••••----•-•••---•••-•--•--•-••---••-•-----•-•-•-•--•--•---...------...........-- W ...................................................................... .............................................. .. • i U Nature^of�2epairs or Alterations Ans vet when applicable_. .._ ... �� r^�f �T�'gr..`.tom TO tXrs�i�✓�i /,�/e yS%Z rh Agreement. Y The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned fur r agrees not to place the system in operation until a Certificate of Complia sn ed by t Sign .... ......................................... �.....1�............�..... Dare Application Approved By ------ . ..... ................._........ - � Application Disapproved for the following reasonr: .. ........................ .. .............................. ........---.-..._......-*........................... ....... ............................................................................ Permit No. ......... ..�,,7�.... Issued ...................... r............... .........Date................... IfwJTy _w+_:z,,i�-',w.:.,ror,..•r„rx�•�.ww--��,:ia.,.[��<.: _.;.. �.r�+4+::cv�.e�:-�'r'W"j ��,�°.�`"'vv� �,, �r ;y.:'-a;,;n�yr=y�.r;c: b - a =�t �� ~. ._�....J . 0� No.. FRi& - .. l THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE , ppliratiou for Diapwml World, Tomitrurtiun Ilermit Application is hereby made for a Permit to Construct ( ) or Repair ) an Individual Sewage Disposal System at: - ..... ..... -•.......... ..........•---- .. ..... -•-•-•.......................... .._........ L1 ../ ..... :... ... . ... / Location_:Address or Lot No. / Q O cner Address Installer Address Type of Building Size Lot............................Sq. feet �., Dwelling—No. of Bedrooms----- .............._----------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) QI Other fixtures ------------------------------------------------------ - W Design Flow............................................gallons per person per day. Total daily flow................................. ...........gallons. rx Septic Tank—Liquid capacity............gallons Length............... Width---------------- 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 ( ) Percolation Test Results Performed by-------------------------------------------------------------------------- Date........................................ a Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fT Test Pit No. 2................nimutes per inch Depth of Test Pit-_.__--.----____-_- Depth to ground water........................ 1:+4 ........................................................................................................... Descriptionof Soil..................................................................................................................-----------------------------•-•-•--••............---- x U ........-•----•-----...--•-••-••-••--•--•--••-••--...-•---•--•-•---•-••-•--•---------•-•-------•••-•-••------•--•---•-•--------------------••-------.....------........................................ w -------------------•----• --•------------...........-••-••---------- ----------------•••••--•--•-------...... - e,.------........•. •-.........•-----•-----•------•----•--•-•---- U Nature of Repairs or Alterations—Ans ver when applicable._.A� ._._��%.D_....lr'�.�%.�7�'aT..�� 70 Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Complian ce-h3s -een'slued by th %bar>d o ease - Signe ..... .. ...... -- -' -- ............................................. ...�-....�..-3..... ' r' o � Dare Application Approved By .....I .... �i L ......L... ........._..........r'_.-l!1......... ...... l............. --------- Da.e Application Disapproved for the following reasons: ..... ....... ............. ...................---.......r..................-.. ........................................................ ................................... --� L � Permit No. --------- 7.. ............:g .--.�_t?------- Issued ...t..........................-- --.�........ l/ Dare� � `' ' <1 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE V��TT ertifirate of t!11 omplialarE THIS IS TO C RTIFY, That the-Individual Sewage Disposal System constructed ( ) or Repairedby ` --..._ G- l�S� � rT ..............................._... ............................................... ........y/ - - - - - .. Insrdlcr 7cat ......... C (/��%--------------------------------------------------------------------------------------------------------------------------------- has been installed in accordance with the provisions of TI"fLE f > ,e State Environmental Code as described in the application for Disposal Works Construction Permit No. `. ..'�" ? dated ....... 7\{ ?-.�..- -a���....._ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE:THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE----- -...�f� ------- - --..-----. -.......... ....--- Inspector ....--........ .. ' .. ........ .._ .. ........--......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Permission is hereby granted-------------.f-:----'_-----lam__--•-.__.--------------------------------------------- to Construct ( ) or Re air,(i) an nI divifh al Sewage Disposal System at No..........- `y 3l'Glrl 9� -•--- ------ ...--•--•-•-•--.------•-------- .Street as shown on the pplication for Disposal Works Constructi ri P irmit No........ ----------- .......................................... -----•.. ------ ------- -----Board---- /l`�/ _�.,l..... Board of Health\v V Gj Z, ` DATE.... 1 -, '........-................................. / I FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS t ASSESSORS MAP : 2.70 TEST. HOLD._ LOGS c ' PARCEL : SOIL EVALUATOR : lj � C7 J FLOOD ZONE • �i/D/ �/�i�C�/G C. ` � � CDM WITNESS : 1 REFERENCE: - DATE: tom- 1J � , 1 PERCOLAT I UN RATE: 14 Iq, 8 S_..._: v _.. TN- 1 TN-2 � ILrI' � C� rl.t-4v 6 1 r LOCATION MAP WTI - + 6 flu -_ 1pt 06 LL U 1 ee , . SEPTIC SYSTEM DESIGN FLOW E 1T I MATE BEC)ROOMS AT GAL/DAY/BEDROOM -3 GAL/DAY SEPTIC TANK YD 2 6AL/DAY x 2 DAYS - ��lJ GAL ��(�j ►► -_ Ll h,I , :r, 12 / USE `�.� GALLON SEPTIC TA Ki1�I�Jl 01L /3SORPTISN SYSTEM �: z, 5 x ►�2k�G�451 D !�"" Tbc�a li�rvQAUG.( l i i � D BOTTOM AREA: SEPT I SYSTEM SECT I ON o 1 to5z k,t,• Y DB SX L. 47,1 6 GAL 7,�J 1 SEPTIC TAN I G, OF L 1 � II 1 MAS� w SITE AND SEWAGE PLAN XVAT z LOCATION : 3lTG1-} bJN -- P R E P A RED FOR t M G o �1 I� L 2- j e SCAL DAV I D B . MASON RS DATE : I d DBC ENVIRONMENTAL DESIGNS DATE HEALTH AGENT EAST SANDWICH . MA ( 508 ) 833 2I77 W Z A