HomeMy WebLinkAbout0572 PITCHER'S WAY - Health 572MRcher's;Way
Hyannis. P � -
i'A 270' 127
i
1
�-t TOWN OF BARNSTABLE
LOCATION 5 l 02 p ��-�J-S (a%( SEWAGE# QQk i� - "S
VILLAGE �IyT,per _ASSESSOR'S MAP&PARCEL a 0
INSTALLER'S NAME&PHONE NO. Jam' r v., SAS
SEPTIC TANK CAPACITY
LEACHING FACILITY: e v.1 .s- c4N" e,,_ -tsize) Q, >4 l 3 X a
NO.OF BEDROOMS
OWNER �.d2'�So� 0 v
PERMIT DATE: �(��( ' COMPLIANCE DATE:
Separation Distance Between the: c
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility J 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
FURNISHEDBYV-,,c7,pc-lSA Q�Qr �SGCs•4t.��
J
I
J�
rrt l�
W ca w
a
wco
sv .
No. C3 l I.5 Fee L6
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
01pplitatlon for -MispoBal 6pstem Constrllttloit Permit
Application for a Permit to Construct( ) Repair(+Upgrade( ) Abandon( ) ❑Complete System DKdiidual Components
Location Address or Lot No. �"'�a �'�lGlti �-�w C Owner's Name Address nd Tel.No.� `7- Q9—��b�
`E<21v6g �, �,
Assessor's Map/Parcel IQL
Installer's Name Address,and Tel.No. CC)Z Designer's Name,Address,and Tel No:3-:t Y—32Q— (�
Type of Building:
Dwelling No.of Bedrooms Lot Size cr 6ct 5sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 3 3 o gpd Design flow provided 3 S'a , s— gpd
Plan Date 4( 1 a. 1 Number of sheets Revision Date
Title
Size of Septic Tank Cx^13 (Zp(� k�S�'�wr, l Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) "�,,��c",d{ \ y1 act �{-a C', c
l r cad
t
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
Signed Date
Application Approved by e Date
Application Disapproved by Date
for the following reasons
Permit No. Date Issued
No. C A G ' 15 Fee
_ r
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
2pplication for Disposal 6pstem Construction 3perm,it
Application for a Permit to Construct( ) Repair(Upgrade(• ) Abandon( ) ❑Complete System dividual Components
Location Address or Lot No. S- PVCC ly. f- �'`,� ( Owner's Name,Address,and Tel.No.So 7-9 a9-s�bg
Assessor's Ivlap/Parcel d (a (AP{�9 S' �'���- T Ly>�p , or-�6d I
Installer's Name,Address,and Tel.No.5-0 - Gr3S< ' Designer's Name,Address,and Tel.
R,..w, c..�w�,G. Via- +�S �
o a < 9'? t ,.c , o2s`32
Type of Building:
Dwelling No.of Bedrooms Lot Size c 6't QGrC-! sq.ft. Garbage Grinder( )
Other Type of Buildings S, No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 3 0 gpd Design flow provided S` gpd
Plan Date Y Number of sheets Revision Date
Title
Size of Septic Tank I 0ZZjZ G4(CZ,,r`�, ,L`�n�1 Type of S.A.S. Soo 9S•p� C,,_
Description of Soil G C,
Nature of Repairs or Alterations(Answer when applicable)
ur
.J"v
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
Signed z , Date 6
Application Approved by C` J Date
Application Disapproved by Date
for the following reasons
Permit No. 90(6_ (� Date Issued Lf-=
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 � ., "�C- S .yr c.�U . c_
at cJ ? ,� c��T�_J V.�b, l has been constructed in accordance G
with the provisions of Title 5 and the for Disposal System Construction Permit No.a616-11 S dated -
Installer � ��c�-C-' Cq �,�. DesigneraK./�
#bedrooms Approved desi_n flow gpd
The issuance of this p'rmit shall not be construed as a guarantee that the system w'l func o as design 1. c
Date v` `1 Inspector +U`,,
-- ------
- - - --- - -------------------------------
No. 0�6 � 5 Fee�
-- - _
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
Disposal *pstrm Construction permit
Permission is hereby granted to Construct( ) Repair( Lr Upgrade( ) Abandon( )
System located at
and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
Title 5 and the following local provisions or special conditions.
Provided:Construction must be completed within three years of the date of this permit._ e ~
Date y- - l/ Approved by
I
Town of Barnstable
..�T"�'°�►-o Regulatory Services
Richard V. Scali, Interim Director
&AMSrnaLE,
9�AMASS. ,�$ Public Health Division
Teotia�° Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Installer &Designer Certification Form
Date: 1i� 1p Sewage Permit# of _ l ( 5 Assessor's Map�Parcei ��D l
Designer: 1,t4 �s ���� Installer: L C,
Address: Jv �JI/�G ��� Address: p<n 1 .r_
On issued a permit to install a
(date) (installer)septic system at s 1 RdtQ,S WAlq based on a design drawn by
(address)
im n-,f D dated
(desi ner)
YI certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank. Strip out (if required) was inspected and the soils
were found satisfactory.
I certify that the septic system referenced above was installed with major changes (i.e.
greater than 10' lateral relocation of the SAS or any vertical relocation of any component
of the septic system) but in accordance with State & Local Regulations. Plan revision or
certified as-built by designer to follow. Strip out (if required) was inspected and the soils
were found satisfactory.
I certify that the system referenced above was constructe _' e with the terms
of the IAA approval letters (if applicable) '
i
(Installer's Si nature)
V (Designer's Signature) (Affix Designer amp Here)
PLEASE RETURN TO B TABLE PUBLIC HEALTH DIVISION. CERTIFICATE
OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-
BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.
THANK YOU.
Q:\Septic\Designer Certification Form Rev 8-14-13.doc
I -
• f.
' I
Town of Ba>�-nstable P#--�-�
oF�
Department of Regulatory Services
• Public Health Division Date
• KA ��' i
i6J¢ .e 200 Main Street,Hannis MA 02601Y
'`rFa►rt►'t" .
Date Scheduled I �� v ' Time Tee Pd. U v
i
i
Soil Suitability Assessment fog- ►sew age Dos\�r �1
Performed By lti Y Yt?✓� �R- ! Witnessed By o t
i
LOCATION & GENERALINF
OItMATION
oc anon Address'57 Z t-r- �G w� Owner's Name
l fiZe�D2!G u S
2S' y 57Z PiTtra,:tl WA'f
Address ^r jrv)S 'A4
Ma tcel i VVIk Engineer's Name a ��rg✓� 14e- e
Assessois p� : 2`70/ r Z7
NEW CONS. Ut EON REPAIR � Telephone# O& 36,(-
Land Use �� �` �/z, Slo pes('Yo) ' Surface Stones
Distances from: ripen Water Body O� I � ft Drinking Water Well �- aft
ft Possible Wet Area
5 ft Other ft
Drainage Wa r� o C) ft Property Linc
-dinity to holes)
SKETCH:(Street name,dimensiods of lot
\ A9
EXISTING �\
DWELLING
TOP OF FNDN
\ EL = 49.B5 +— \
EDGE OF PAVEMENT
PITCHERS WA Y
Parent material(geologic)l
< 4a(e�� Wit' " "11 S 1 Depth to Bedrock '
Depth to Groundwater. Standing Water inHole:' / " i Weeping from Pit Faee
Estimated Seasonal High Groundwater —
DUTERNIINATION FOR SEASONAL HIGH WATER TAULE
Method Used: I __In, Depth to sail tnottlt?s: in.
Depth Clbserved standingiin obs.hole: i - in. Groundwater Adjustment
Depth toiweeping from side of obs.hole: , Adj.faetor.,,�.�- Adj.groundwater l eVal,.,,e-
Index Well# Reading Date index Well level
PERCOLATION TEST . Date `� 'xime
Observation I Time at 9" ------
1401c#
J_--
Time at 6"
Depth of Pere
03 ( Time(9"-6") -
Start Pre-soak Time.@
End Pre-soak
�
Rate MinJInch _�T:7
'.
Additional Testing Needed(YIN)
Site Suitability Assessment: Site Passed
Site Failed:
Original:.Public H41th Division
Observation Hole Data To Be Completed on Back
of wetland,you t first notify the
***If P ercola ibn testis to be conducted within 100' rs II1; '
0Acrvation Division at least one(1)wedk prior to beg
riP
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency.% ravel
bkj
tv
A lot
1
DEEP OBSERVATION HOLE LOG Hole# _
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface'(in.) (USDA) (Munsell) Mottling (Structure,Stores,Boulders.
Consistency.%Gravel)
'ledSY
S ►�
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency, Gravel)
DEEP ObSkRVATION HOLE LOG Hole#_
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) DA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency. I
Flood Insurance Rate Map: X
Above 500 year flood boundary No Yes
Within 500 year boundary No Yes
Within 100 year flood boundary No Yes
Depth of Naturally Occurrine Pervious Material
Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the
area proposed for the soil absorption system?
If not,what is the depth of naturally occurring pervious material?
Certification
I certify that on (date)I have passed the soil evaluator examination approved by the
Department Enviro"mental Protection and that the above analysis was performed by me consistent with
the required train' g xpertise and experience described in 3,10 CMR 15.017.
Signature I Date
Q:\.SBPrICWERCFORM.DOC
TO/WN OF 13.4RNSTABLE
LOCATION 5702 W-c',17SEWAGE #
'i fLLAGE Gl dl _ ASSESSOR'S MAP& LOT—
INSTI kLLER'S NAME&PHONE NO.
SEPTIC TANK-CAPACITY `�gm
LEACI-HNG T'tE,.CILI'TY: ( ) �� (size) JOD-0
NO.OF'BEDROOMS,,._,.
i
BUILDER OR OWNER.
PERMTT®ATE: COWL LANCE 1DATE:
Separadon Distance Between ft
Maximum Adjustcal Groundwater Table to t{ae Bauom ofuiching Facility 512
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200(eat of leaching facility) ., Feel
Edge of Wetland and leaching Facility(if any.we ds exist
witiain 300 Peet leaching.f cRi /t�G '/�/ __..et
Furnished by
0c �
�k
-�- 35
J�
h
l'.
TOWN OF BARNSTABLE .
LOCATION,L' P/-tef j p P , SEWAGE# 0ZJK9 -D��
VILLAGE ASSESSOR'S MAP&PARCEL D ,
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK.CAPACITY /DOO
LEACHING FACILITY:(type"��/�p, ,o�S (size)
NO.OF BEDROOMS
OWNER edT- o o
PERMIT DATE: COMPLIANCE DATE: J
Separation Distance etw& 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
i
No. eZ D D — 9 Fee i
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
fttlfitation for MispoBal 6pBtent Construction VPrmit
Application for a Permit to Construct( ) Repair�ade( ) Abandon( ) ❑Complete System Individual Components
Location Address or Lot No.�5 .2 . Owner'7Ne,Address,and Tel.No.�/1//CwoAssessor's Map/Parc
Installer's N, e A dre a Tel. ////G`*;r /`1 Designe�' NpamAeAress, d Tel.No
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(min.required) (� gpd Design flow provided gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank /2S7 " � Type of S.A.S. /O �• Q
Descripfion of Soil i
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 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health. r
Si _ Date D
Z//5�//
Application Approved by 4V- �. Date/A o
Application Disapproved by Date
for the following reasons
Permit No. a�fl/0 ^0 9/ Date Issued Y o
Ak,-
I
Fee
' THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ✓
Yes
PUBLIC HEALTH DIVISION ,TOWN OF BARNSTABLE, MASSACHUSETTS
v ZippYication for Disposal *pstem Construction permit _
A "lication for a Permit to Construct Repair� U�' rade Abandon Complete System Individual Como ents
pP� ( ) P UiJ pg ( ) ( ) ❑ p Y P
Locati n Address or Lot 144� Owner's Name,Address,and Tel.No. �/fC
Assessor's Map/Parced' 12 Z ��G� L/fI
Installer's Nine,Address;a d_Tel.N /c�,�t�//�/may /ll e/ Designer's Name.A ress,_nd Tel.No1_7_D- '�V99
Type of Building:
Dwelling No.of Bedrooms __...L-of-Size- sq.ft. Garbage Grinder( )
Other Type of Building ;Z21�j 1~ ~- No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd Design flow provided7- � gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank A�OC2 Type of S.A.S.Zgg l 5 i✓ ZZ• ' 0
Description of Soil e tt iA
r '
Nature of Repairs or Alterations(Answer when applicable) 3
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health. — G .>
_
Si e // Date L / 0
/ r
Application Approved by / f Date / o
Application Disapproved by Date
for the following reasons
Permit No. a 0 /U ^ M Date Issued 'ry /o
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
at � /E-'"i��i!�/,C� �� i/,Q.. has been constructed in accordance
with the provisions of Title 5 and the for Disposal System C nstruction Permit No. /U 'd 1 dated J
I
Installer Designer
#bedrooms Approved design flordesigned.
gpd
The issuance of this permit shall not be construed as a guarantee that the system w' fa cti .
�JI�Date Inspector �
No. —?Old —0 / Fee oo —
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS
Vsposal *pstem Construction permit w
Permission is hereby granted to Construct( ) Repair(Ll� Upgrade( ) Abandon( )
System located at t
and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
Title 5 and the following local provisions or special conditions.
- I
Provided:Construction must/be completed within three years of the date of this permit.
Date (�// Approved by ( et
Town of Barnstable
'"E'�`�.� Regulatory Services
Thomas F. Geiler,Director
UAPNWABLL
A Public Health Division
Thomas McKean, Director
200;Main Street,Hyannis,MA 02601
Office: 508-8624644 Fax: 508-790-6304
Installer & Designer Certification Form
Date: 4 1 A Sewage Permit# Assessor's ivlap\Parcel 2�0 Z
Designer: Da M Installer: VV l butA* 01tJ(,1C-tz-
Address: 439 Address: Flo �O tit�l tom-�r
� Y S�9 Wlw M4 62S37 S
On 0 W641 O/A/,Ck— was issued a permit to install a
(date) / (installer)
septic system at J 2 Pl /C1'119 S w4� based on a design drawn by
(address)
dated 7 w
(designer)
x l certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation of--the
distribution box andior septic tank.
I certify that the septic system referenced above was installed with major changes (i.e.
greater than 10' lateral relocation of the SAS or any vertical relocation of any component
of the septic system) but in accordance with State & Local Regulations. Plan revision or
certified as-built by designer to follow.
OF
c
o DAR, M ✓+
I ME -
(Installer's tgnatu 1 0. 1 0
N1 TAR�p� u.q.,t U
(Designer's Signature) (Affix Designer's Stamp Here)
PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF
COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE
RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU
Q: Health/Septic/Designer Certification Form 3-26-0doc
YOU WISH TO OPEN A BUSINESS?
For Your Information: Business Certificates cost $30.00 for 4 years. A Business Certificate ONLY REGISTERS THE BUSINESS
NAME in town (which you must do by M.G.L.- it does not give you permission to operate.) You must first obtain the. necessary,
signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 15t FL., 367 Main Street,
Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law.
m Fill in please: Date:
APPLICANT'S NAME:
YOUR HOME ADDRESS: .5+2 P irct4f/LS wA'C 7d>NNi S HA . 0 2 0 �
' BUSINESS TELEPHONE # HOME TELELPHONE #:
NAME OF CORPORATION. -7
FID #
NAME'OF NEW BUSINESS ` EED S TYPE OF$USLNESS Z�
1S THIS A HOME OCCUPATION? YE NO
ADDRESS OF BUSINESS In (/V1� • }, _ �.pl-rc(49)LS wA-
r ,AnicvcJ •04MAPIPARCEL NUMBER 24 n (Assessing)
When starting a new business there are several things you must do to be in compliance with the rules and regulations of. the Town of
Barnstable. This form is to assist you in obtaining the information you may need. You MUST GO TO 209 aLn. . (corner.of Yarmouth Rd.
& Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in town.
1... BUILDING CO • SS NER'S OFFICE _
This individ al as eeni, o f a y permit requirements that pertain to this type of business/1UST COA/fPLY.WfTH HOME OCCUPATION
RULES AND REGULATIONS. FAILURE TO
A�uthorizied Sign re** COMPLY MAY RESULT IN FINES.
OMMEN, �i (
2. BOARD OF HEALTH
This individual his en infor d of the emit requir menu that pertain to this type of business.
Authorized Sig ature** ` MUSTCOMPIYWTHAII:
COMMENTS: HAZARDOUS MATERIALS REGULATIONq
3. .CONSUMER AFFAIRS (LICEN ING AUTHORITY)
This individual has en in a d f the licensing requirements that,pertain to this type of business.
Authorized Signature**
COMMENTS:
Date: j /2-c / t I
` TOWN OF BARNSTABLE
TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY
NAME OF BUSINESS: C.OY'S N661(06 oc Cool-mj
BUSINESS LOCATION: 5+2- nTCr4�_(I5 woVe �keAaNt� rtc, Z32ca+ INVENTORY
MAILING ADDRESS: S�2 P �Tgci�rLS `'u�� r ly�'�'^"S I'11� c7Luc1 TOTAL AMOUNT:
TELEPHONE NUMBER: 2JL 5 L-
CONTACT PERSON: KAe T t 0�-;�--
EMERGENCY CONTACT TELEPHONE NUMBER: 58 292L— }2 MSDS ON SITE?
TYPE OF BUSINESS:
INFORMATION/RECOMMENDATIONS: Fire District:
Waste Transportation: Last shipment of hazardous waste:
Name of Hauler: Destination:
Waste Product: Licensed? Yes No
NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use,
storage and disposal of 111 gallons or more a month requires a license from the Public Health Division.
LIST OF TOXIC AND HAZARDOUS MATERIALS
The board of health and the Public Health Division have determined that the following products exhibit toxic or
hazardous characteristics and must be registered regardless of volume.
Observed / Maximum Observed / Maximum
Antifreeze (for gasoline or coolant systems) o Miscellaneous Corrosive
o ❑ NEW ❑ USED o Cesspool cleaners
Automatic transmission fluid 0 Disinfectants
Engine and radiator flushes 10 Road salts (Halite)
Hydraulic fluid (including brake fluid) o Refrigerants
Motor Oils Pesticides
o ❑ NEW ❑ USED (insecticides, herbicides, rodenticides)
O Gasoline, Jet fuel,Aviation gas o Photochemicals (Fixers)
O Diesel Fuel, kerosene, #2 heating oil o ❑ NEW ❑ USED
Miscellaneous petroleum products: grease,
Photochemicals (Developer)
O lubricants, gear oil ❑ NEW ❑ USED
ID Degreasers for engines and metal o Printing ink
a Degreasers for driveways &garages o Wood preservatives (creosote)
0 Caulk/Grout o Swimming pool chlorine
b Battery acid (electrolyte)/Batteries o Lye or caustic soda
o Rustproofers eo Miscellaneous Combustible
o Car wash detergents ,o Leather dyes
0 Car waxes and polishes o Fertilizers
O Asphalt& roofing tar o PCB's
® Paints, varnishes, stains, dyes Other chlorinated hydrocarbons,
O Lacquer thinners (including carbon tetrachloride)
o ❑ NEW ❑ USED Any other products with "poison" labels
- - (including chloroform,formaldehyde,
o Paint&varnish removers, deglossers o hydrochloric acid, other acids)
o Miscellaneous. Flammables Other products not listed which you feel
Floor&furniture strippers may be toxic or hazardous (please list):
Metal polishes
Laundry soil &stain removers
(including bleach)
Spot removers&cleaning fluids
(dry cleaners)
O Other cleaning solvents
o Bug and tar removers
o Windshield wash
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initials
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
572 Pitchers Way
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for Hyannis MA 02601 3-30-10
every 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.
A. General Information
1. Inspector: k Wm
Shawn Mcelroy
Name of Inspector
Upper Cape Septic Services
Company Name
29 Atwater Dr
Company Address
E. Falmouth MA 02536 .
City/Town State Zip Code
508-495-0905 S13971
Telephone Number License Number
B. Certification
I certify that I have personally inspected the sewage disposal system at this address and that the
information reported below is true, accurate and complete as of the time of the inspection. The inspection
was performed based on my training and experience in the proper function and maintenance of on site
sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of
Title 5 (310 CMR 15.000).The system:
❑ Passes ❑ Conditionally Passes ® Fails
❑ Needs F rther Evalu tion by the Local Approving Authority
3-30-10
In pector's Signature Date
The system inspector shall submit a copy of this inspection report to the Approving Authority (Board
of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or
has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the
report to the appropriate regional office of the DEP. The original should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving authority.
****This report only describes conditions at the time of inspection and under the conditions of use
at that time.This inspection does not address how the system will perform in the future under
the same or different conditions of use.
LAI
572 Pitchers Way Hyannis-03/08 Title 5 Official Inspection Form:Subsurface S ge Disposal stem 1 Page 1 of 15
t
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
c�M 572 Pitchers Way
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is
required for Hyannis MA , 02601 3-30-10
every page. City/Town State Zip Code Date of inspection
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E/always complete all of Section D
A) System Passes:
❑ I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are
indicated below.
Comments:
B) System Conditionally Passes:
❑ One or more system components as described in the "Conditional Pass"section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health,will pass.
Answer yes, no or not determined (Y, N, ND) in the ❑ for the following statements. If"not
determined,"please explain.
❑ The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is
structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent.
System will pass inspection if the existing tank is replaced with a complying septic tank as
approved by the Board of Health.
i * A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate
of Compliance indicating that the tank is less than 20 years old is available.
ND Explain:
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s) or due to a broken,settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s) are replaced
❑ obstruction is removed
572 Pitchers Way Hyannis-03/08 Title
5 Official Inspection Form:Subsurface Sewage Disposal System Page 2 of 15
f
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
572 Pitchers Way
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for Hyannis MA 02601 3-30-10
every page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
B) System Conditionally Passes (cont.): I
❑ 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:
C) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and-the environment:.
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
2. System will fail unless the Board of Health'(and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
' safety and environment: `
❑ The system has a septic tank and soil..-absorption system (SAS) and the.SAS is within.
100 feet of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
r ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
572 Pitchers Way Hyannis•03l08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15
r
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
572 Pitchers Way
M
Property Address
Bank Owned (Contact David Holt @-Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for Hyannis MA 02601 3-30-10
every page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
C) Further Evaluation is Required by the Board of Health (cont.):
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well".
Method used to determine distance:
* This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform
bacteria indicates absent and-the presence of ammonia nitrogen and nitrate nitrogen is equal to or
less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be
attached to this form. ,
3. Other:
D) System Failure Criteria Applicable to All Systems:
You must indicate"Yes"of"No" to each of the following for all inspections:
Yes No
® ❑ Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
® Discharge or ponding of effluent to the surface of the,ground or surface waters
due to an overloaded or clogged SAS or cesspool
❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or•cesspool
® Liquid depth in cesspool is less than 6"below invert or available volume is less
than '/ 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:
❑ ® 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.
572 Pitchers Way Hyannis•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15
Commonwealth of Massachusetts
Title 5 official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
572 Pitchers Way
Property Address
Bank Owned (Contact David Holt c@ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for Hyannis MA 02601 3-30-10
every page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
D) System Failure Criteria Applicable to All Systems (cont.):
Yes No ., r . . .•,•
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well.
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory,for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered.A copy of the analysis
and chain of custody must be attached to this form.]
The system is a cesspool serving a facility with a design flow of 2000gpd-
❑ ® 10,000gpd.
® ❑ The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CM 15.303,therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
a
For large systems, you must indicate either`fifes" or"no"to each of the following, in addition to the
questions-in Section D. '
Yes No
❑ ❑, the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
❑ 0 the system is located in a nitrogen sensitive area (Interim Wellhead Protection
Area— IWPA)or a mapped Zone II of a public water supply well
If you have answered "yes"to any question in Section E the system is considered a significant threat,
or answered "yes"in Section D above the large system has failed. The owner or operator of any large
system considered a significant threat under Section E or failed under Section D shall upgrade the
system in accordance with 310 CMR 15.304. The system owner should contact the appropriate
regional office of the Department.
"572 Pitchers Way Hyannis•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15
Commonwealth of Massachusetts
w Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
'wM 572 Pitchers Way
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for Hyannis MA 02601 3-30-10
every page. City/Town State Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate "yes"or"no" as to each of the following:
Yes No
❑ -® Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
❑ ® Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
❑ ® Were as built plans of the system obtained and examined? (If they were not
' available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
® ❑ Were all system components, excluding the SAS, located on site?
®
r'❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
® ❑ Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS) on the site has
been determined based on:
❑ ® Existing information. For example, a plan at the Board of Health.
® ❑ Determined in the field(if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CM 15.302(5)]
572 Pitchers Way Hyannis•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
572 Pitchers Way
Property Address
Bank Owned_ (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for Hyannis MA 02601 3-30-10
every page. City/Town State Zip Code Date of Inspection
D. System Information
Residential Flow_Conditions:
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): 330
Number of current residents:
0
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No
Laundry system inspected? ❑ Yes ® No
Seasonal use? ❑ Yes ® No
Water meter readings, if available (last 2 years usage (gpd)):
Sump pump? ❑ Yes ® No
.Last date of occupancy: 2-10
Date
Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow(based.on 310 CM 15.203)- Gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
Industrial waste holding tank present? ❑ Yes ❑ No
` Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No.
Water meter readings, if available:
Last date of occupancy/use: Date
Other(describe):
572 Pitchers Way Hyannis•03M8 Title 6 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 15
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
572 Pitchers Way
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1=800-966-2448)
Owner Owner's Name
information is required for Hyannis MA 02601 3-30-10'
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
General Information
Pumping Records:
N/A
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:
Type of System:
® Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool `
❑ Privy
❑ Shared system (yes or no) (if yes, attach previoussinspection 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:
1980's
Were sewage odors detected when arriving at the site? ❑ Yes ® No
572 Pitchers Way Hyannis-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 15
Commonwealth of Massachusetts
Title 5 official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
572 Pitchers Way
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for Hyannis MA 02601 3-30-10
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Building Sewer(locate on site plan):
Depth below grade: 18
feet
Material of construction:
❑ cast iron ® 40 PVC ❑ other(explain):
Distance from private water supply well or suction line: feet
Comments (on condition of joints,venting, evidence of leakage, etc.):
Good condition.
Septic Tank(locate on site plan):
Depth below grade: 12"feet
Material of construction:
® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain)
If tank is metal, list age:
years II
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
Dimensions: 1000gal
Sludge depth:..
12"
Distance from top of sludge to bottom of outlet tee or baffle
20"
3"
Scum thickness .
Distance.from top of scum to top.of outlet tee or baffle 5
Distance from bottom of scum to bottom of outlet tee or baffle 13
How were dimensions determined? Tape
572 Pitchers Way Hyannis•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15
T
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
,M 572 Pitchers Way
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for Hyannis MA 02601 3-30-10
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tank is in good condition with baffles installed and no sign of leakage.
Grease Trap (locate on site plan):
Depth below grade: feet
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping: Date
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tight or Holding Tank (tank must be pumped at time of inspection)(locate on site plan):
Depth below grade:
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
572 Pitchers Way Hyannis-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 15
I
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M 572 Pitchers Way
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for Hyannis MA 02601 3-30-10
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Tight or Holding Tank (cont.)
Dimensions:
Capacity:
gallons
Design Flow:
gallons per day
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments (condition of alarm and float switches, etc.):
Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
Distribution Box(if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert N/A
Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any
evidence of leakage into or out of box, etc.):
Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No
Alarms in working order: ❑ Yes ❑ No
572 Pitchers Way Hyannis-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15
Commonwealth of Massachusetts `
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
1M 572 Pitchers Way
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for Hyannis MA 02601 3-30-10
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
Type:
® leaching pits number:..
1-1000gal
❑ leaching chambers number:
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
Leach pit had clear signs of failure with stain lines above inlet invert.
572 Pitchers Way Hyannis•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
�M 572 Pitchers Way
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) .
Owner Owner's Name
information is required for Hyannis MA 02601 3-30-10
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Cesspools(cesspool must be pumped as part of inspection)(locate on site plan):
Number and configuration
Depth —top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
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.):
572 Pitchers Way Hyannis•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15
{
Commonwealth of Massachusetts '
. Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M 572 Pitchers Way
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for Hyannis MA 02601 3-30-10
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
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.
0D
0 � 6
572 Pitchers Way Hyannis-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 15
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
;M 572 Pitchers Way
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for Hyannis annis MA 02601 3-30-10
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
❑ Check Slope
❑ Surface water
❑ Check cellar
❑ Shallow wells .
Estimated depth to high ground water: 20'
feet
Please indicate all methods used to determine the high ground water elevation:
❑ Obtained from system design plans on record
If checked, date of design plan reviewed: Date
® Observed site (abutting property/observation hole within 150 feet of SAS)
® Checked with local Board of Health -explain:
® Checked with local excavators, installers- (attach documentation)
® Accessed USGS database - explain:
You must describe how you established the high ground water elevation:
USGS maps show groundwater at 20'
P ry
572 Pitchers Way Hyannis-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15
d
5 2 (®
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIR
DEPARTMENT OF ENVIRONMENTAL PROTE TI r:—
Uh
W
SEP 1 12003
OW
io1M 5�0v` TOWN OF Far'w,,.-
HEALTH pEPT.
TITLE 5
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 572 PITCHERS WAY HYANNIS 02601
Owner's Name: RAY CERICOLA
Owner's Address: 33 LORENA RD
Date of Inspection: 8/12/03
Name of Inspector: (please print) JOHN GRACI,INC.
Company Name: SEPTIC INSPECTIONS
Mailing Address: P.O.BOX 2119 TEATICKET,MA. 02536
Telephone Number: 508-564-6813 FAX 508-564-7270
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is
true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and
experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system
inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system:
X Passes
_ Condit onally sses
_ Needs Furt valuation by the Local Approving Authority
Fails
Inspector's Signature: Date: 8/12/03
The system inspector shall submit copy of this inspection report to the Approving Authority(Board of Health or DEP)within
30 days of completing this inspecti n. 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
SYSTEM PASSED TITLE V INSPECTION. REOCMMEND PUMPING EVERY TWO YEARS TO PROLONG THE
SYSTEM'S USEFUL LIFE.
****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 S incnartinn Fnrm 6/1 S/?nnn 1
Page 2 of I 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 572 PITCHERS WAY HYANNIS 02601
Owner: RAY CERICOLA
Date of Inspection: 8/12/03
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. System Passes:
X I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310
CMR 15.304 exist.Any failure criteria not evaluated are indicated below.
Comments:
SYSTEM PASSED TITLE V INSPECTION.REOCMMEND PUMPING EVERY TWO YEARS TO PROLONG THE
SYSTEM'S USEFUL LIFE.
B. System Conditionally Passes:
_ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired,The system,
upon completion of the replacement or 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.
n/a 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.
ND explain: n/a
n/a Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed
pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of
Health):
_ broken pipe(s)are replaced
_ obstruction is removed
_ distribution box is leveled or replaced
e
ND explain: n/a
n/a The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass
inspection if(with approval of the Board of Health):
_broken pipe(s)are replaced
_obstruction is removed
ND explain: n/a
Page 3 of 11
OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 572 PITCHERS WAY HYANNIS 02601
Owner: RAY CERICOLA
Date of Inspection: 8/12/03
C. Further Evaluation is Required by the Board of Health:
_ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to
protect public health,safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is
not functioning in a manner which will protect public health,safety and the environment:
_ Cesspool or-privy is within 50 feet of a surface water
_ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the
system is functioning in a manner that protects the public health,safety and environment:
_ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water
supply or tributary to a surface water supply.
The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply.
_ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well.
_ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water
supply well".Method used to determine distance n/a
"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:
n/a
Page 4 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 572 PITCHERS WAY HYANNIS 02601
Owner: RAY CERICOLA
Date of Inspection: 8/12/03
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 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 NOT IN THE LAST YR. TNFO FROM OWNER.
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 a cesspool or privy is within a Zone 1 of a public well.
_ X Any portion of a cesspool or privy is within 50 feet of a private water supply well.
X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with
no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP
certified 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.]
NO (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in
310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E. Large Systems:
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:
(The following criteria apply to large systems in addition to the criteria above)
yes no
X the system is within 400 feet of a surface drinking water supply
_ X the system is within 200 feet of a tributary to a surface drinking water supply
X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped
Zone II of a public water supply well
If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered
"yes" in Section D above the large system has failed.The owner or operator of any large system considered a significant threat
under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner
should contact the appropriate regional office of the Department.
d
Page�5 of I 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 572 PITCHERS WAY HYANNIS 02601
Owner: RAY CERICOLA
Date of Inspection: 8/12/03
Check if the following have been done. You must indicate "yes" or"no"as to each of the following:
Yes No
X _ Pumping information was provided by the owner,occupant,or Board of Health
X Were any of the system components pumped out in the previous two weeks
X _ Has the system received normal flows in the previous two week period
X Have large volumes of water been introduced to the system recently or as part of this inspection '?
X _ Were as built plans of the system obtained and examined?(If they were not available note as N/A)
X _ Was the facility or dwelling inspected for signs of sewage back up?
X _ Was the site inspected for signs of break out
X _ Were all system components,excluding the SAS, located on site ?
X _ Were the septic tank manholes uncovered,opened, and the interior of the tank inspected for the condition of the
baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum
X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance
of subsurface sewage disposal systems`?
The size and location of the Soil Absorption System (SAS)on the site has been determined based on:
1
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)]
S
Page 6 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 572 PITCHERS WAY HYANNIS 02601
Owner: RAY CERICOLA
Date of Inspection: 8/12/03
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):330
Number of current residents: n/a
Does residence have a garbage grinder(yes or no): NO
Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required]
Laundry system inspected(yes or no): NO
Seasonal use: (yes or no): NO
Water meter readings,if available(last 2 years usage(gpd)): ..
Sump pump(yes or no): NO
Last date of occupancy: 7/1/03 ® 'S
COMMERCIAL/INDUSTRIAL
Type of establishment: n/a
Design flow(based on 310 CMR 15.203): n/agpd
Basis of design flow(seats/persons/sgft,etc.): n/a
Grease trap present(yes or no): NO
Industrial waste holding tank present(yes or no): NO
Non-sanitary waste discharged to the Title 5 system(yes or no): NO
Water meter readings, if available: n/a
Last date of occupancy/use: n/a
OTHER(describe): n/a
GENERAL INFORMATION
Pumping Records
Source of information: NOT IN THE LAST YR. INFO FROM OWNER
Was system pumped as part of the inspection(yes or no): NO
If yes,volume pumped: n/agallons--How was quantity pumped determined? n/a
Reason for pumping: n/a
TYPE OF SYSTEM
X Septic tank,distribution box,soil absorption system
_Single cesspool
_Overflow cesspool
_Privy
_Shared system(yes or no)(if yes, attach previous inspection records, if any)
_Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from
system owner)
_Tight tank Attach a copy of the DEP approval
Other(describe): n/a
Approximate age of all components,date installed(if known)and source of information:
NEW 14 YRS AGO PER OWNER
Were sewage odors detected when arriving at the site(yes or no): NO
f
I �
Page 7 of I l
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 572 PITCHERS WAY HYANNIS 02601
Owner: RAY CERICOLA
Date of Inspection: 8/12/03
BUILDING SEWER(locate on site plan)
Depth below grade: 18"
Materials of construction:_cast iron X40 PVC_other(explain): n/a
Distance from private water supply well or suction line: n/a
Comments(on condition of joints,venting,evidence of leakage,etc.):
TOWN WATER
SEPTIC TANK: X(locate on site plan)
Depth below grade: 12"
Material of construction: Xconcrete_metal_fiberglass_polyethylene other(explain)n/a
If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate)
Dimensions: L 8' 6" H 5' 7" W 4' 101"1
Sludge depth: 1"
Distance from top of sludge to bottom of outlet tee or baffle:33"
Scum thickness: 1"
Distance from top of scum to top of outlet tee or baffle: 6"
Distance from bottom of scum to bottom of outlet tee or baffle: Poor (. lot
How were dimensions determined: MEASURED
Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related
to outlet invert,evidence of leakage, etc.):
SEPTIC TANK AND ALL SEPTIC TANK COMPONENTS ARE STRUCTURALLY SOUND AND FUNCTIONING
PROPERLY. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE.
GREASE TRAP:_(locate on site plan)
Depth below grade: n/a
Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a
Dimensions: n/a
Scum thickness: n/a
Distance from top of scum to top of outlet tee or baffle: n/a
Distance from bottom of scum to bottom of outlet tee or baffle: n/a
Date of last pumping: n/a
Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related
to outlet invert,evidence of leakage, etc.):
n/a
7
Page 8of11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 572 PITCHERS WAY HYANNIS 02601
Owner: RAY CERICOLA
Date of Inspection: 8/12/03
TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan)
Depth below grade: n/a
Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a
Dimensions: n/a
Capacity: n/a gallons
Design Flow: n/a gallons/day
Alarm present(yes or no): N/A
Alarm level: N/A Alarm in working order(yes or no): NO
Date of last pumping: n/a
Comments(condition of alarm and float switches,etc.):
n/a
DISTRIBUTION BOX:X(if present must be'opened)(locate on site plan)
Depth of liquid level above outlet invert: LEVEL WITH BOTTOM OF PIPE
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 IS STRUCTURALLY SOUND.
PUMP CHAMBER: _(locate on site plan)
Pumps in working order(yes or no): NO
Alarms in working order(yes or no):NO
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):
n/a
R
Page 9 of I 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 572 PITCHERS WAY HYANNIS 02601
Owner: RAY CERICOLA
Date of Inspection: 8/12/03
SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required)
If SAS not located explain why:
n/a
Type
1000 GAL 6' X 6' leaching pits, number: 1
n/a leaching chambers, number: n/a
n/a leaching galleries, number: n/a
n/a leaching trenches, number, length: n/a
n/a leaching fields, number: n/a
n/a overflow cesspool, number: n/a
n/a innovative/alternative system
Type/name of technology: n/a
Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.):
THE LEACH PIT IS STRUCTURALLY SOUND AND FUNCTIONING PROPERLY.THE PIT WAS EMPTY AT
THE TIME OF THE INSPECTION.THE BOTTOM IS AT 10'
CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan)
Number and configuration: n/a
Depth—top of liquid to inlet invert: n/a
Depth of solids layer: n/a
Depth of scum layer: n/a
Dimensions of cesspool: n/a
Materials of construction: n/a
Indication of groundwater inflow(yes or no):NO
Comments(note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation,etc.):
n/a
PRIVY: (locate on site plan)
Materials of construction: n/a
Dimensions: n/a
Depth of solids: n/a
Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.):
n/a
r
4
rPage 10 of 11
, f
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 572 PITCHERS WAY HYANNIS 02601
Owner: RAY CERICOLA
Date of Inspection: 8/12/03
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.
A
Qom,
® � AA
PA
�c a�
CC
y an
Page-1'1 of 1 I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 572 PITCHERS WAY HYANNIS 02601
Owner: RAY CERICOLA
Date of Inspection: 8/12/03
SITE EXAM
_Slope
_Surface water
_Check cellar
_Shallow wells
Estimated depth to ground water 12+feet
Please indicate(check)all methods used to determine the high ground water elevation:
NO Obtained from system design plans on record-If checked,date of design plan reviewed: n/a
YES Observed site(abutting property/observation hole within 150 feet of SAS)
NO Checked with local Board of Health-explain: n/a
NO Checked with local excavators, installers-(attach documentation)
NO Accessed USGS database-explain: n/a
You must describe how you established the high ground water elevation:
GROUNDWATER WAS DETERMINED FROM HAND AUGER-NO WATER AT 12'
TOWN OF BARNS TABLE
LOCATION { 'd 4w,_ SEWAGE # " /
VILLAGE ASSESSOR'S MAP & LOT
INSTALLER'S NAME Sz PHONE.NO. 1 ft�A ll!
SEPTIC TANK CAPACITY .fig
LEACHING FACILITYAtype) '� 6 L �4 (size) . .`
NO. OF-BEDROOMS w PRIVATE WELL OR PUBLIC WATER'
BUILDER OR OWNER k, € '
DATE PERMIT ISSUED:'
'w DATE COLPLIANCEi
ISSUED-VARIANCE GRANTED: Yes No
` ti `'`� g
� �.�>,W �
��
y
' f 4 � r `
'rM .. .. i
��
..- ��
�- !��"
.� ��� . . .
.. `-� . .-
i
TOWN OF BARNSTABLE
LOCATION �� i� P �,.. SEWAGE #
a
VILLAGE / <c ASSESSOR'S MAP & LOT
INSTALLER'S NAME & PHONE NO. IZ4y
SEPTIC TANK CAPACITY /wo
LEACHING FACILITY:(tppe) L_Q��T (size)
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER .yr�as�-,
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
r
a7"`
v
f.
No..- :...yal.. Fis....K `.:`.�'........
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
...................... ...................OF............................................
Applira#ion for Bi"oii al Work.6 Tnnitrnrtinn Permit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
......... ..............l
.....
: A AV........................... ......._.........•--•-------•-•----•-•.--•--•------...........-•---.....................--^......•Locatio Adress or LotNo.Owner Address
rem v r� ( � �roN d A
.............................. ..��........-•----..............._..-•----.........-•------• ...... 4d--•-...�a.
Installer Address
Type of Building Size Lot............................Sq. feet
�--� Dwelling No. of Bedrgoms____�.....................................Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building .............. No. of persons........_._..._......__.__.. Showers — Cafeteria
a' Other fixtures ......................
W Design Flow......;Fq..............................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity/bee..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 ( )
aPercolation Test Results Performed by.......................................................................... Date........................................
a Test Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................
Test Pit No. 2................minutes per inch Depth of Test Pit..._____--______-__- Depth to ground water........................
•-------------------------------------•--------------------------------.....----.....--•-•---------.....----------•--------------------•-•...............---
0 Description of Soil....e s°nc:L..... ---------------------------•--------•----------------......--------...------------
U ...................................•....................................•-•---
W
------------------------------------------------- .........................................................................
.........................................................................
M. Nature of Repairs or Alterations—Answer when applicable__;�:04- -___t_U�C lr't___ . .......................................
------------------------------------------•--...----------•------------------------------------------------•••_.._...------------------------••-----------••-•••-----••-•---•--•--•••-••---•--•---•----
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
Date
Application li Approved By � s� --------------------------------- -•------ -/ =g-?------
��' �l `- �
Date
Application Disapproved for the following reasons:----------------------------------------------------------------------------------------------------------------
Date
PermitNo......................................................... Issued-.......................................................
Date
l '
No.. `�:...7� ... FE$..............................
THE COMMONWEALTH OF MASSACHUSETTS
'BOARD OF HEALTH
.................. ........................O F........................................................----••---------••---......--------
Appliration for Dispati al Works Tonitrnrtion ami#
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
........... G ✓ 7c�.+ /a y
�.fLocation-•Address or Lot No.9r..... � ! .....................•----=- ...
/ Owner Address
....... ° .....................................-
Installer r� Address
Type of Building 4 Size Lot............................Sq. feet
,., Dwelling No. of Bedrooms___-=_-------
.-------------------------------Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( )
p•' Other fixtures ..................................
-.
W Design Flow....:'."..................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity_'�p_..gallons Length................ Width................ Diameter................ Depth................
x Disposal Trench—No..................... Width..................._ Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No,_s'.--------------------- Diameter...`.............. Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water_____-__--___•__--__,_-.
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
•-------•--------------------------•-----------------------•---.....--------------------------••----.........................................................
D Description of Soil...'''. '.:..._.... "'�{
x •-••.
U -•---•--•--------------------------•---•-•---------------------------------------•------•----•---------------------------------------•--
W
U Nature of Repairs or Alterations—Answer when applicable__ � l Ne sN
Z�'.=a -7:N--________________________________________
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
SignedZz..: .--�= =_..... J�
-- ............................ ................................
Date
Application Approved By............ - .d t ...--e..--------------------------•------- ---------e - hV -U------
�. Date
Application Disapproved for the following reasons________________________________________________________________________________________________________•.._..._
-----------------------------•---•-•-----...----•---------------••-------....------------------------.....-----------------------------------...........................................................
Date
PermitNo......................................................... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.......... A;( .............OF.......... .,mow!-= � `..................................
C-5rdifiratr of TomptiFanrr
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired
by--•••••-_• 6t?.! --------------------------------------------------•------..._... ------............._...................-..............------------------.
Installer
v. ••... __,-�11
has been installed in accordance with the provisions o 1.1Z 5 of 'Re' State Sanitary Code as described in the
application for Disposal Works Construction Permit No------,?S'.T... _ _.... dated------------------------------------------------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE................................................................................ Inspector......................
.............................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
:::. 1:'?w:............OF............ ; .....; r:r •^�
No......................... FEE....
Disps a1 orks Tons#r wit prrmit
Permission is hereby grantedr `-.r t ..............................
to Construct ) or Repair, "] a�n Individual Sewage Disposal System
at No............ cy 7` �1 V-. I ��
as shown on the application for Disposal Works Construction Permit No.f�*--_ --_._- Dated..........................................
�, ..............................
DATE..--•----------_ f ------------------------ Board of Health
FORM 1255 HOBBS & WARREN. INC':. PUBLISHERS
Date:
TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
NAME OF BUSINESS: /Z
BUSINESS LOCATION:
MAILINGADDRESS: Mail To:
TELEPHONE NUMBER: Board of Health
Town of Barnstable
CONTACTPERSON: 1111e P.O. Box 534
EMERGENCY CONTACT TELEPHONE NUMBER: S.3 �� �` Hyannis, MA 02601
TYPEOFBUSINESS:
Does your firm store any of the toxic or hazardous materials listed below, either for sale or for you own
use? YES NO
This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed
envelope for your convenience.
If you answered YES above, please indicate if the materials a stored at a site other than your mailing
address:
ADDRESS:
TELEPHONE:
LIST OF TOXIC AND HAZARDOUS MATERIALS
The Board of Health has determined that the following products exhibit toxic or hazardous character-
istics and must be registered regardless of volume. Please estimate the quantity beside the product that
you store. NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS.
Quantity Quantity
Antif reeze(for gasoline or coolant systems) Drain cleaners
NEW USED Cesspool cleaners
Automatic transmission fluid Disinfectants
Engine and radiator flushes Road Salt (Halite)
Hydraulic fluid (including brake fluid) Refrigerants
Motor oils Pesticides
NEW USED (insecticides, herbicides, rodenticides)
Gasoline, Jet Fuel Photochemicals (Fixers)
Diesel fuel, kerosene, #2 heating oil NEW USED
Other petroleum products: grease, Photochemicals (Developer)
lubricants, gear oil NEW USED
Degreasers for engines and metal Printing ink
Degreasers for driveways & garages Wood preservatives (creosote)
Battery acid (electrolyte) Swimming pool chlorine
Rustproofers Lye or caustic soda
Car wash detergents Jewelry cleaners
Car waxes and polishes Leather dyes
Asphalt & roofing tar Fertilizers
_ Paints, varnishes, stains, dyes PCB's
Lacquer thinners Other chlorinated hydrocarbons,
NEW USED (inc. carbon tetrachloride)
Paint &varnish removers, deglossers
Any other products with "poison" labels
Paint brush cleaners (including chloroform, formaldehyde,
Floor& furniture strippers hydrochloric acid, other acids)
_ . Metal polishes
Laundry soil & stain removers Other products not listed which you feel
(including bleach) may be toxic or hazardous (please list):
Spot removers & cleaning fluids
(dry cleaners)
Other cleaning solvents
Bug and tar removers
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS
11`
LEGEND
PROPOSED CONTOUR N
® PROPOSED SPOT GRADE. v 't
a98 — EXISTING CONTOUR
j 111 I' JI n + 96.52 EXISTING SPOT GRADE
1 3'
1 W— EXISTING WATER.SERVICE SITE
E
TEST PIT
I
1 LOCUS MAP N.T.S.
—� = GENERAL NOTES:
/ I = �`: 1• ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL
B E I J': H P✓I A R K BOARD OF HEALTH AND THE DESIGN ENGINEER.
P.airaT saoT ON 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS
I PPICK STEP OF THE STATE ENVIRONMENTAL CODE, TITLE V. AND ANY APPLICABLE
ELEVATION - 5 0 , LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW:
i
E, gr,IST1.BLE GIS D ,Tur_i - 310 CMR 15.405 1 B :
i - --- _ �e a 1) A 1.01 FT. VARIANCE FROM 310CMR15.221(7) TO ALLOW LEACHING TO BE .
`C` = i 4.01 FT BELOW GRADE VS REQ'D 3 FT. (H20/VENT PROVIDED)
3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR
Existing 1,OOOg TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE
Sep tic Tar)k DESIGN ENGINEER.
4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING
FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN
ENGINEER BEFORE CONSTRUCTION CONTINUES.
1 `l Existing. Leach Pits 5. ALL ELEVATIONS BASED ON ASSUMED DATUM.
(Note 1 0) 1' 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF
THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF
HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION.
7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE.
8. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED
1�� r �� OF �/qs TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR.
9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY
yG THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING DAR N CONSTRUCTION. UTILITIES SHOWN ARE APPROXIMATE.
TH-2 , M� N 10. EXISTING.LEACH PITS TO BE PUMPED, CRUSHED AND REMOVED PER TITLE V.
N �140 FILL WITH CLEAN MEDIUM SAND.
r., 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION
12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY
_ ` Sq �p� AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY
`l. __ NITAR
13. NO PRIVATE WELLS WITHIN 100 FT. OF PROPOSED LEACHING
14. ALL PIPING TO BE 4" SCH 40 ® 1/8"/FT (UNLESS SPEC. OTHERWISE)
15. THE DESIGN OF. THIS SYSTEM DOES NOT ALLOW
FOR THE USE OF A GARBAGE GRINDER
'Z+• ! 16. NO WETLANDS WITHIN 100 FT. OF PROPOSED LEACHING
sus `fs 17. PROPERTY IS IN ZONE II OR NITROGEN SENSITIVE AREA.
+ 17. INSTALLER TO FIELD VERIFY H2O CERTIFICATION PRIOR TO INSTALLATION.
o
o } ,
PROPOSED SEPTIC SYSTEM ,UPGRADE PLAN
SYSTEM TIES: `
572 PITCHERS WAY, HYANNIS, MA
ti
MAP:
• .70 c Prepared for: Mike Dede_ko
SURVEY REFERENCE: Engineering by: Surveying by: SCALE DRAWN
DEED BOOK.' 17703 DARRENM.MEYER,R.S. Zoo-Tech Earironmentel 1"=30' DMM
PLAN OF LAND BY CHARLES N. SAVERY, RLS �' P DEED PAGE. 337 POBoxssf (508) 364-0894
EASTSANDW/CH,MA02537 DATE: CHECKED SHEET N0.
DATED: SEPTEMBER 10, 1.971 1 Of 2
:. - � - .,�. ' � ". � ` 5os-3sz-zs2z 04/07/10 DMM
NOTE: TO PREVENT BREAKOUT, THE PROPOSED
NOTE: MAGNETIC TAPE TO BE PLACED OVER ALL COVERS FINISH GRADE SHALL NOT BE < EL:44.99
FOR A DISTANCE OF 15' AROUND THE
PERIMETER OF THE S.A.S.
SEPTIC TANK PROPOSED D-BOX PROPOSED S.A.S.
1'. T.O.F. EL.=49.85 INSTALL RISERS & COVERS OVER INLET & INSTALL RPSER & COVER INSTALL A 4" DIAMETER INSPECTION PORT OVER �� OF M4s
OUTLET AND SET TO 6" OF FINISH GRADE SET TO 6" OF GRADE ONE CHAMBER (MIN.) AND SET TO 3" OF F.G.
• F.G. EL.=49.25t F.G. EL.=49.15tG
F.G. EL: 49.Ot F.G. EL:49.0-48.5(MAX.) VENT o DAjRR N M. ,r+
I I 4
9° MIN COVER No. 1140
L 10 MI / L = 45' L = 10'(MAX) INSTALL TWO INSPECTION PORTS (MIN.)
(MIN.) 36" MAX COVER 0 S=1% (MIN.) 0 S=1% (MIN.) �jr''1 � a�
4"SCH40 PVC 4"SCH40 PVC 4"SCH40 PVC ��$TE
�NITAR�
t 0" s"
\INV.=46.641'
48" LIQUID 1a• 1INVERTO �' 7 ' l U
LEVEL �INV.=46.39
GAS BAFFLE PROPOSED INV.=45.30 4 ROWS OF 4 UNITS AT 6.25'/UNIT = 25'/ROW
D-BO SOIL SORPTION SYSTEM (PROFILE)
INV.=45.50 DB-5. INV.=44.60 AB
EXISTING 1.000 GALLON SEPTIC TANK
EXISTING SEWER OUTLET RESTORE VEGETATIVE COVER
BACKFILL WITH CLEAN PERC SAND I 75"
TO TOP OF CHAMBERS I I
NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING
PIPE INVERTS PRIOR TO CONSTRUCTION -"•�'f' f':f•' ->, `'
BREAKOUT=TOP ELEV.=44.99
2) D-BOX SHALL BE SET LEVEL AND TRUE TO INV. ELEV.= 44.60
GRADE ON A MECHANICALLY COMPACTED BOTTOM ELEV.= 43.66
. STABLE BASE, AS SPECIFIED IN 310 CMR 15.221(2) EXISTING SUITABLE
3) REPLACE EXISTING 1,000 GALLON SEPTIC 5' MIN. ABOVE BOTTOM OF MATERIAL
&tam
TANK WITH 1500 GALLON SEPTIC TANK EFFECTIVE WIDTH = 4 x 2.83' = 11.32 I 76"
IF FAILED, DAMAGED, OR UNDERSIZED. T.P. EXCAVATION OR G.W.
4) INSTALL INLET & OUTLET TEES AS REQUIRED (6.16' PROVIDED) USE 4 ROWS OF 4-HIGH CAPACITY PROFILE
ADJ. GROUNDWATER EL.=37.50 _ ADS BIODIFFUSER UNITS-NO STONE
i
SEPTIC SYSTEM PROFILE TYPICAL SECTION N
�
N.T.S. N.rs
11.2" 16
DESIGN CRITERIA SOIL LOG P#: 12805 ±-- f
NUMBER OF BEDROOMS: 3 BEDROOMS DATE: DECEMBER 23, 2009
�--34"---►I
SOIL TEXTURAL CLASS: CLASS I SOIL EVALUATOR: DARREN M. MEYER, R.S., CSE. #1614 SECTION END CAP
WITNESS: DAVE STANTON, BARNS. BOH
DESIGN PERCOLATION RATE: <2 MIN/IN TP-2 16"" HIGH CAPACITY (H-20) BIODIFFUSER UNIT
Elev. TP-1 Depth Elev. De
DAILY FLOW: 330 G.P.D. � Depth - 'I
DESIGN FLOW: 330 G.P.D. 48.5 A LOAMY SAND 0" 48.5 A 0"
LOAMY SAND „
tOYR 3/2 10YR 3/2 MODEL 16 HICAP
GARBAGE GRINDER: NO (NOT DESIGNED FOR GARBAGE GRINDER) 48.0 6" 48.0 6"
PROPOSED SEPTIC TANK: USE EXISTING 1,000 GALLON CAPACITY B B LENGTH 7 NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT
LOAMY SAND LOAMY SANG EFFECTIVE LENGTH 75" TO CHANGE WITHOUT NOTICE. PRODUCT DETAIL MAY
10YR 6/8 10YR 6/8 DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE.
LEACHING AREA REQUIRED: (330) = 445.94 S.F. 44.67 46" 44.75 45" SIDE WALL HEIGHT 11.2"
•74 C c OVERALL HEIGHT 16"
DISTRIBUTION BOX: 5 OUTLETS (MINIMUM) b 4640 TRUEMAN BLVD
MED. SAND MED. SAND OVERALL WIDTH 34"PRIMARY S.A.S 2.5Y 6/4 2.5Y 6/4 13.6 CF HILLIARD, OHIO 43026
USE 4 ROWS OF 4 - 16" ADS 160OBD BIODIFFUSER H-20 UNITS-NO STONE CAPACITY (101.7 GAL) ADVANCED DRAINAGE SYSTEMS, INC.
NOTE: INSTALLER CAN SUBSTITUTE HIGH CAPACITY INFILTRATOR CHAMBERS. PERC 043.10 PROPOSED SEPTIC SYSTEM SITE PLAN
BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.70 SF/LF OF BIODUFUSER) 572 PITCHERS WAY, HYANNIS, MA
(BIODIFFUSERS) 16 UNITS x 6.25 LF x 4.70 SF LF = 470 SF
/ 37.50 132" 37.50 132"
DESIGN FLOW PROVIDED: 0.74(470 GPD/SF) = 347.80 GPD > 330 GPD req'd PERC RATE <2 MIN/IN. ("C" HORIZON) Prepared for: Mike Dedecko
NO GROUNDWATER OBSERVED Engineering by: Surveying by: SCALE DRAWN JOB. NO.
DARRENM.MEYER,R.S. Boo—Tech Environmental NTS D.M.M.
• I, Darren M. Meyer, R.S., CSE, hereby certify that I am currently approved by MADEP pursuant to 310 CMR 15.017 POBOX981 (508) 364-0894
to conduct soil evaluations and that the above analysis hoe been performed by me consistent with the DATE CHECKED SHEET NO.
EAST SANDWICH,MA 02537 04 07 1 0
requirements of 310 CMR 15.017. I further certify that I have passed the Soil Evol, Exam In October,_1999. / / D.M.M. 2 Of 2
508-362-2922
2
LEGEND
PROPOSED CONTOUR
+49:45 ' 98 PROPOSED SPOT GRADE D
gg -- EXISTING CONTOUR
cJ' ,
I � + 96.52 EXISTING SPOT GRADE
I
W— EXISTING WATER SERVICE 3 SITE
I .
C� 1 i TEST PIT
o� CC I +49.20 50
C I v..
I
00
i
� I � LOCUS MAP N.T.S.
GENERAL NOTES:
\r, Q 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL
B E NI H MARK BOARD OF HEALTH AND THE DESIGN ENGINEER.
PAINT SPOT ON 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS
1 I I t r j �c4� BRiCt, STEP OF THE STATE ENVIRONMENTAL CODE, TITLE V. AND ANY APPLICABLE
EI EVATICNa = 50.07 LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW:
I,� /\/C� / BARNSTABLE GIS DATUM - 310 CMR 15.405 (1) (B):
1) A 0.45 FT. VARIANCE FROM 310CMR15.221(7) TO ALLOW LEACHING TO BE
EL „ - F ` 3.45 FT BELOW GRADE VS REQ'D 3 FT. (H20/VENT PROVIDED)
SD,V ' Existing 1,000g 2) A 2.4 FT. VARIANCE FROM 310CMR15.211 TO ALLOW LEACHING TO BE
17.6 FT FROM DWELLING VS REQUIRED 20'.
Septic Tank
3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR
TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH 'AND THE
DESIGN ENGINEER.
Existing Leaching 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING
FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN
(Note 10). ENGINEER BEFORE CONSTRUCTION CONTINUES.
5. ALL ELEVATIONS BASED ON ASSUMED DATUM.
"I O % 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF
THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF
^ .��! = HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION.
OF Mgjs 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. REROUTE AS SHOWN.
8. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED
D R E s TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR.
TM-1 TH-2 M R ya 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY
THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING
1140 CONSTRUCTION. UTILITIES SHOWN ARE APPROXIMATE.
10. EXISTING LEACHING TO BE PUMPED, CRUSHED AND FILLED PER TITLE V.
11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION
Q#ITAR\a 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY
l Prop. Re—routed AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY
water service -L V� 13. NO PRIVATE WELLS WITHIN 100 FT. OF PROPOSED LEACHING
(Note 7) I� 14. ALL PIPING TO BE 4" SCH 40 ® 1/8"/FT (UNLESS SPEC. OTHERWISE)
15. THE DESIGN OF THIS SYSTEM DOES NOT ALLOW
FOR THE USE OF A GARBAGE GRINDER
16. NO WETLANDS WITHIN 100 FT. OF PROPOSED LEACHING
17. PROPERTY IS IN ZONE II OR NITROGEN SENSITIVE AREA.
PROPOSED SEP
TIC SYSTEM UPGRADE PLAN
572 PITCHERS WAY, HYANNIS, MA
MAR-270 Prepared for: Ready Rooter Exc./Idrovo
1
I a LOT. 127 Engineering by: Surveying by: SCALE DRAWN
SURVEY REFERENCE: _ ;
DEED BOOK. 17703 DARRENM.MEYER,R.S. 14co-Tech Fhvironmeata! 1"=30�' DMM
PLAN OF LAND BY CHARLES N. SAVERY, RLS 1 DEED PAGE- 337 PO BOX981 (508) 364-0894
DATED: SEPTEMBER 10, 1971 ( EASTSAVDKICH,MA02537 DATE: CHECKED SHEET NO.
508-362--2922 04/08/16 DM M 1 of 2
NOTE TO PREVENT BREAKOUT, THE PROPOSED
NOTE: MAGNETIC TAPE TO BE PLACED OVER ALL COVERS FINISH GRADE SHALL NOT BE < EL:44.99
!, FOR A DISTANCE OF 15' AROUND THE
PERIMETER OF THE S.A.S.
SEPTIC TANK PROPOSED D-BOX PROPOSED S.A.S.
T.O.F. EL.=49.85 INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & COVER INSTALL A 4" DIAMETER INSPECTION PORT OVER VENT
OUTLET AND SET TO 6' OF FINISH GRADE SET TO 6" OF GRADE ONE CHAMBER (MIN',.) AND SET TO 3" OF F.G.
F.G. EL.=49.25t F.G. EL.=49.15t F.G. EL: 49.0f F.G. EL:49.0(MAX.) f "'
9" MIN COVER/
L = 10'"t L = 45' L = 10'(MAX) 2" OF 3/8" DOUBLE WASHED 3/4" - 1-1/2"
0 S=1% (MIN.) : 36" MAX COVER ® S=1% (MIN.) 0 S=1% (MIN.)
4"SCH40 PVC - 4"SCH40 PVC 4"SCH40 PVC STONE OR FILTER FABRIC DOUBLE WASHED STONE
to"I 6 -
ta' jjj ®®®® Q ®®®®
INV.=46.64 48"LIQUID ®®®®®®®®®®®
LEVEL ®®®®®®®®®®®GAs BAFPLEI. INV.=-46.39
PROPOSED INV.=45.30 ®®®®®®®®®®®D-BOX INV.=45.50 De-
4' 2 X 8.5' 4'
EXISTING 1,000 GALLON SEPTIC TANK
EFFECTIVE LENGTH = 25
EXISTING SEWER OUTLET INV. ELEV.= 44.55
BREAKOUT
NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING ELEV.= 45.55
PIPE INVERTS PRIOR TO CONSTRUCTION TOP CONC. ELEV.= 45.55
2) D-BOX SHALL BE SET LEVEL AND TRUE TO INV. ELEV.- 44.55 ®®� 0 ®®
GRADE ON A MECHANICALLY COMPACTED ®®®®®®® .
STABLE BASE, AS SPECIFIED IN 310 CMR 15.221(2) r ®®®®®®®
®®®®®®® ..
3) REPLACE EXISTING 1,000 GALLON SEPTIC ®®®®®®E3
TANK WITH 1500 GALLON SEPTIC TANK BOTTOM EL.= 4Z.55 3.75' 5 FT. 3.75'
IF FAILED, DAMAGED, OR UNDERSIZED.
4) INSTALL INLET & OUTLET TEES AS REQUIRED
SEPARATION 5.05 FT. EFFECTIVE WIDTH = 12.5'
SEPTIC SYSTEM PROFILE BOTTOM OF TESTHOLE EL: 37.50 r, SOIL ABSORPTION SYSTEM (SECTION)
N.T.S. (500 GALLON H2O LEACH CHAMBER)
DESIGN CRITERIA SOIL LOG P#: 12805
NUMBER OF BEDROOMS: 3 BEDROOMS DATE: DECEMBER 23, 2009
SOIL TEXTURAL CLASS: CLASS I SOIL EVALUATOR: ' DARREN M. MEYER, R.S., CSE. #1614
WITNESS: ° DAVE STANTON, BARNS. BOH �� �F MqV
DESIGN PERCOLATION RATE: <2 MIN/IN
DAILY FLOW: 330 G.P.D. Elev. TP-1 Depth Elev. TP-2 Depth DA REN M.
DESIGN FLOW: 330 G.P.D. 48.50 0" 48.50 0" ME R
GARBAGE GRINDER: NO (NOT DESIGNED FOR GARBAGE GRINDER) A LOAMY SAND " A LOAMY SAND No.�-11'40
PROPOSED SEPTIC TANK: USE EXISTING 1,000 GALLON CAPACITY 10YR 3/2 10YR 3/2 0
. 48.0 B 6" 48.0 6"
B RFCIStE�
LEACHING AREA REQUIRED: (330) = 445.94 S.F. LOAMY SAND LOAMY SAND
1OYR 6/8 10YR 6/8
.74
DISTRIBUTION BOX: 5 OUTLETS (MINIMUM)(H20) 44.67 46" 1 44.67 C 46"
USE TWO (2) 500 GALLON PRECAST H2O LEACH CHAMBERS W/ 4' MEDIUM- l STONE ON ENDS & 3.75' STONE ON SIDES: 25' L x 12.5' W x 2'D 2.5 MEDIUM-
SAND/4 2.5Y 6/4
BOTTOM AREA: 25 X 12.5 = 312.5 SF ' PROPOSED SEPTIC SYSTEM/SITE PLAN
SIDE AREA: (25 + 12.5) X 2 X 2 = 150 SF - 37.50' 132" 37.50 132 572 PITCHERS WAY, HYANNIS, MA
TOTAL SQUARE FEET PROVIDED = 462 vs. 445.94 REQ'D PERC RATE <2MIN/IN. ("C' HORIZON) Prepared for: Ready Rooter Exc./idrovo
DESIGN FLOW PROVIDED: 0.74(462 S.F.) = 342.25 G.P.D. vs. 330 G.P.D. req'd NO GROUNDWATER OBSERVED
Engineering by: Surveying by: SCALE DRAWN JOB. NO.
MEYER& SONS INC. Boo-Tech Fnvir»amental NTS D.M.M.
• I, Darren M. Meyer. R.S., CSE, hereby certify that I am currently approved by MADEP pursuant to 310 CMR 15.017 pO BOX 981 (508) 364-0894 CHECKED
to conduct soil evaluations and that the above analysis has been performed by me consistent with the EAST SANDWICH,MA 02537 DATE SHEET NO.
requirements of 310 CMR 15.017. 1 further certify that I1have passed the Soil Evol. Exam in October,'1999. 04 08 16 D.M.M. 2 Of 2
50"2-2922 / /