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HomeMy WebLinkAbout0766 PITCHER'S WAY - Health 766 Pitchers cly 1lyannis A=271 =044 °rG G x TOWN OF BARNSTABLE • ' LOCATION 6= SEWAGE VILLAGE�"AJ!S7'.d ' ASS SSOR'S MAP & LOTn27/ INSTALLER'S NAME&PHONE NO. 0/4Z 4A2fj 2j A F i2 SEPTIC TANK CAPACITY /'SOD LEACHING FACILITY: (type) 'Sr ,1 /�"//it 7DP!�' _ (size) ,/� `� S" NO.OF BEDROOMS BUILDER OR OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 A / No. ���.;��' l � _ .. � ,�+-�.'`��. Fee A �- THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ZIpplicatton for Mfgpogar *potent Conotruction Permit Application for a Permit to Consttuct><Repatr( )Upgrade( )Abandon( ) Complete System ❑Individual Components Location Address or Lot No. (d(Q Owner's Name,Address and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's-Name,Address and Tel.No. (V2 r D I A,sC r' sic Emu, Sacs. 539'4-9(o to . "� Type of Building: C 1 �Jc[ k . 0VA Gn Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(� Other Type of Building K)r-w-io No. of Persons o"2 Showers( V) Cafeteria Other Fixtures 1-4,3 A m 2+t t ki A-C ya,r. Design Flow 5?>o gallons per day. Calculated daily flow 3U86 gallons. Plan Date al ©.s Number of sheets Revision Date Title ca C S ou Size of Septic Tank I"Sno c,n',V Type of S.A.S. 5 rN F1LT*-A-TZ-Z..S Description of Soil 26-&c- ! TM P\Cc, Nature of Repairs or Alterations(Answer when applicable) C_-x- �m 4r\ 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 EnvironmentalZode and not to place the system in operation.until a Certifi- cate of Compliance has been issu b oard o . Signed � Date Application Approved bya,_24.22 4V. Date 1 u, Application Disapproved for the following reasons Permit No. U�' �`,�� Date Issued S J/ _ S Al o. �V� (}K d .l .. 'ai � Fee p THE COMMONWEALTH OF MASSACHUSETTS� Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE,, MASSACHUSETTS Z(pprication for Zigpool *pgtem Congtruction Permit Application for a Permit to Consttu,�)Repair( )Upgrade(, )Abandon( ) ,Complete System ❑Individual Components Location Address or Lot No. —4 G L- Owner's Name,Address and Tel.No. Assessor's Map/Parcel )11 w�r rvlp�_ .(��- O c' M Installer's Name,Address,and Tel.No. Designer's ame,Address and Tel.No. AjSe_ Silfl`f �nJ `jiCS. 539 -"9(o10 -..+ `mot v. gat Type of Building: Dwelling No.of Bedrooms Lot Size 14,5l7d sq.ft. Garbage Grinder Other Type of Building -+ no No.of Persons Showers Cafeteria( V/ Other Fixtures Design.Flow gallons per day. Calculated daily flow 331,Igo gallons. Plan Date '?ITT-.S Number of sheets_ Revision Date Title �. ?Mrxoscl \ st!: C Sc.' em Foy r- Sh_(X�h LorcAlo Size of Septic Tank I .StIC� G�� Type of S.A.S. 5 { ' Description of Soil O� P\GC Nature of Re atrs 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 EnvironmentalZode and not to place the system in operation until a Certifi- cate of Compliance has been issued by his Board oaf Health. Signed ° lz/ Date Application Approved by. tiu 2 S Date Application Disapproved for the following reasons � _ y Permit No. .2 �S`- 0 Date Issued -I/- & S THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed(7G )Repaired ( )Upgraded( ) Abandoned( )by , at 2,(o rr,(f r j wr- has been constructed in accordance with the provisions of Title 5 and the for Dis oral System Construction Permit No. S-_Qtt dated Installer Designer The issuance of this pe t shall not be construed as a guarantee that t.e syste '1 function"andesigned. Date to, , Inspect No. U C, V u Fee . THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE,, MASSACHUSETTS lie;pogaf *pgtem Congtruction Permit Permission is hereby granted to Cpnstruct(>O)Rep it( )Upgrade( )Abandon( ) System located at 76 p.- �n,�s wri., 41744 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. "k Provided: Construction must be completed within three years of the date of this permit. Date: - Approved b �� 1/� , . -�. . PP Yy�-- � B RNST.AB E LAND COURT REGISTRY DEED RESTRICTION WHEREAS, Dennis M. Carey, of overlea Road, Hyannisport, MA 02647 is the owner of Lot 3, Pitcher' s Way located at Hyannis, MA 02601 (hereinafter referred .to as the "Property") and being shown on Land Court Plan 29356A; WHEREAS, Dennis M. Carey is the owner of said lot has agreed with the Town of Barnstable Board of Health to a restriction as to the number of bedrooms which can be included in any home built on said lot as a pre-condition to obtaining a disposal works construction permit in compliance with 310 CMR 15 . 000 State Environmental Code, Title 5, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage; WHEREAS, the Town of Barnstable Board of Health, as a pre-condition to granting a disposal works construction permit for a septic system in compliance with 310 CMR 15 .200, State Environmental Code, Title 5, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage, and authorizing the issuance of a building permit for the construction of a single family home on this property, is requiring that the agrement for the restriction on the number of bedrooms in any house constructed on the lot be put on record with the Barnstable County Registry of Deeds by recording this document, NOW, THEREFORE, Dennis M. Carey does hereby place the following restriction on his above-referenced land in accordance with his agreement with the Town of Barnstable Board of Health, which restriction shall run with the land and be binding upon all successors in title: i 1 . Lot 3, Pitcher' s Way, Hyannis, MA may have constructed upon the lot a house containing no more than one (1) bedroom. Dennis M. Carey agrees that this shall be a permanent deed restriction affecting the property located on Pitcher' s , Way, Hyannis, MA, and being shown on the plan recorded on Land Court Plan 29356A, as Lot3 until such time as the property may be connected to and served by town sewer system. For title see Land Court Certificate of Title No. 59378 . Executed as a sealed instrument < day of March, 2005 . Owner' s Signature COMMONWEALTH OF MASSACHUSETTS Barnstable, ss: On this � day of MA CAN 2005, before me, the undersigned notary public, personally appeared DENNIS M. CAREY, and proved to me through satisfactory evidence of identification, which was a driver' s license, to be the person whose name is signed on the preceding or attached document, and acknowledged to me that he signed it voluntarily for its stated purpose. KENNETH RUSSELL WADE 4AJ V6`'Ir A W&0?- , Notary Public Notary Public m Commonwealth of Massachusetts My Commission Expires March 31,2011 My commission expires: 3 31- Zc i!l BARNSTABLE COUNTY REGISTRY OF DEEDS A TRUE COPY,ATTEST v�-Tk s . II =aE OF JOHN F.MEADE,REGISTER Town of Barnstable Regulatory Services s I Thomas F,Geller,Director a Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office; 508-862-4644 fax; 508-790-6304 Installer& Designer Certification Form Date: ✓ �'dr�os Designer: Shay EnvironMe,ntal Services; ac. Installer: Address: P.O. 'Sox 427 Address: �&�o11� Bast Falmouth, MA 02536 On ( O Uy was issued a permit to install a (installer septic system at �� ��t,.4 based on a design drawn by (address) Shay Environmental Sezvices, Inc�__ dated-' ram. jS (designer) I 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, I certify that the septic system referenced above was installed with major changes (i.e. greater ar, 10' lateral relocation of the SAS or any vertical relocation of anly component of the ptic system) but ire accordance with State & Local kegulations. Plat, revision or certif as-built by designer to follow. v i 7) �� sF10P'kA�� < --' t � CARMEN cARMEN o (Instal 's Sign e) o E. U SHAY N N No. 'ligi o rn !ST Epic ANTA190 (Designer's Signature (Af x D� s tamp Isere) PLEASE RETURN TO BARNSTABLE PUBLIC REAL`IH DIVISION. CERTIFICATE OF COMPLIANCE 'SILL NOT' B]E ISS[JFD UNTIL .80T1 THIS FORM Al�i'ID AS- BUILT CATt>:1 ARE RECEIVED BY TIDE 13ARNSTABLE PUBLIC IJEALTIl DIVISION, THANK YQU. Q;H.calth/Scptic/Do lgnerCef ifcation Form f Town of Barnstable THe Regulatory Services $ 1 BAAN9TA Thomas F. Geiler,Director BL6, Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax; 508-790-6304 Installer& Designer Certification Form Date: 01/1 11 d 9 0 5 Designer: _Shay Environmental Services, Inc, Installer: _ a i. E 5:541f`f'or)� Address: P.O. Box 6,27 Address: '��`��A East_Falmouth, MA 02536 On U \ was issued a permit to install a (date) (installer septic system at vs L )%)based on a design drawn by (address) Shay Environmental Services, Inc. dated ��s' 400s (designer) 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. 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. qa` 114 OF lN,q CARMENE. (Installer's Signature) SHAY N No. 1181 Gl STEP N1 TAR% (Designer's Signalure (Af x De i 'tamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTII DIVISION. CERTIFICATE OF _COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HE,ALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form 6 QCN COMMONWEALTH OF MASSACHUSETTS z EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS �� h m DEPARTMENT OF ENVIRONMENTAL PROTECTION Z� David B.Mason,R.S,Certified Title V Inspector,508-833-2177 TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 766 Pitchers Way,Hyannis,MA ner' Name: n Sutherland Ow s N . Do Suth l d Owner's Address: 766 Pitchers Way, Hyannis,MA I Date of Inspection: May 14,2008 Name of Inspector: (please print)David B.Mason Company Name:—N.A. Mailing Address: 4 Glacier Path East Sandwich,MA 02537 Telephone Number: 508-833-2177 CERTIFICATION STATEMENT 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 ® t%ainmg and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP a proved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: X Passes Conditionally Passes Needs Further Evaluation by the Local Approving Author' Fail n Inspector's Signa re: ate: 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: Tank should be pumped as a matter of maintenance. The information as idenjified represents only the condition of the system on May 14, 2008 at Noon. Increase in occupancy may cause hydr is failure,, � r . { .7` ****Thus report only describes conditions at the time of inspection and under the conditioi f use ag4at time.This inspection does not address how the system will perform in the future under th me or differen conditions of use. G Title 5 Inspection Form 6/15/2000 page I Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 766 Pitchers Way,Hyannis,MA Owner: Sutherland Date of Inspection: May 14,2007 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: Parking area should be defined to prevent parking on septic tank and pump chamber. 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. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Titles S Tncm-ptinn Fnrm All 5/100(1 2 Page 3 of 11 PART A CERTIFICATION(continued) Property Address: 766 Pitchers Way,Hyannis,MA Owner: Sutherland Date of Inspection: May 14,2008 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 e system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well".Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A Titles Tncnartinn Fnrm 4/1 S/InOO 3 Page 4 of 11 CERTIFICATION(continued) Property Address: 766 Pitchers Way,Hyannis,MA Owner: Sutherland Date of Inspection: May 14,2008 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 _NA_ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool NA_ 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 _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 the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well 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. OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Titles G Tnenartinn Fnrm 6/1 S/1000 4 Page 5 of I 1 Property Address: 766 Pitchers Way, Hyannis,MA Owner: Sutherland Date of Inspection: May 14,2008 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 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'?(INCLUDING THE SAS) _X_ _ Were the septic tank manholes uncovered,opened, and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum ? _X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no _X_ _ Existing information.For example,a plan at the Board of Health. _X_ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Titles S Tncnartinn Fnrm All S/IOA0 5 Page 6 of 11 PART C SYSTEM INFORMATION Property Address: 766 Pitchers Way,Hyannis,MA Owner: Sutherland Date of Inspection: May 14,2008 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):_3 Number of bedrooms(actual): 1 per assessors records DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 gallons per day Number of current residents:_2 Does residence have a garbage grinder(yes or no): (Not Allowed) Is laundry on a separate sewage system(yes or no): [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use: (yes or no): Water meter readings,if available(last 2 years usage(gpd)): See attached Hyannis Water Co. Records Sump pump(yes or no):No Last date of occupancy: Current COMMERCIALANDUSTRIAL Type of establishment:_ Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Take out-No seating_ 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: Last date of occupancy/use: Within I year OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Barnstable Board of Health Was system pumped as part of the inspection(yes or no):NO If yes,volume pumped: gallons--How was quantity pumped determined? Reason for pumping: Maintenance pumping conducted after inspection TYPE OF SYSTEM _X Septic tank,distribution box, soil absorption system _Single cesspool _Overflow cesspool _Privy _Shared system (yes or no) (if yes,attach previous inspection records,if any) _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): With pump chamber 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): NO OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Tifla 5 Tnenartinn Fnrm All r%i7nnn 6 I Page 7 of 11 PART C SYSTEM INFORMATION(continued) Property Address: 766 Pitchers Way,Hyannis,MA Owner: Sutherland Date of Inspection: May 14,2008 BUILDING SEWER(locate on site plan) Depth below grade: Approx. 262 Inches Materials of construction:_cast iron _X_40 PVC other(explain): Distance from private water supply well or suction line:_NA Comments(on condition of joints,venting,evidence of leakage, etc.): Appears in good condition. SEPTIC TANK: N.A.(locate on site plan) Depth below grade: 22 Inches 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: Typical 1500 gal. Sludge depth: 4 inches Distance from top of sludge to bottom of outlet tee or baffle: 28inches Scum thickness: variable 0 inches to 6 inches Distance from top of scum to top of outlet tee or baffle: 0 inches Distance from bottom of scum to bottom of outlet tee or baffle: Not applicable no scum at outlet tee How were dimensions determined: actual 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 tee is PVC.Outlet tee is PVC and appears in good condition. No evidence of leakage. Structure of tank appears adequate.Effluent level with outlet tee. Maintenance pumping is required. GREASE TRAP: N.A. Depth below grade:_ Material of construction:_concrete_metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Titles C Tnenvrtinn Fnrm (,/1 S/')/lM 7 Page 8 of 11 PART C SYSTEM INFORMATION(continued) Property Address: 766 Pitchers Way,Hyannis,MA Owner: Sutherland Date of Inspection: May 14,2008 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: YES_(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Level with outlet invert Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box, etc.): There is no indication of solids carryover,dbox is in good condition. Dbox is 12 inches below grade to risers. Dbox is 24"below grade. 3 outlets which are level. PUMP CHAMBER:_(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 Titles S Tncnartinn Fnrm All S/?0M 8 • Page 9 of 11 PART C SYSTEM INFORMATION(continued) Property Address: 766 Pitchers Way,Hyannis,MA Owner: Sutherland Date of Inspection: May 14,2008 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:_5 Infiltrators with 4 feet stone around_ _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.): leaching is 32 inches below grade. CESSPOOLS: NA (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 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.): I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Titles S Tncnartinn Fnrm A/1 Ci')nnn 9 Page 10 of 11 PART C SYSTEM INFORMATION (continued) Property Address: 766 Pitchers Way,Hyannis,MA Owner: Sutherland Date of Inspection: May 14,2008 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. P-1 0 O 4 FRONT O A El w i Al 15' 131 18' A2 20' B2 23' Stone A3 29' B3 28' Drive A4 34' B4 29' OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Titles 5 Inenartinn Fnrm F/1 r%i,)nnn 10 I , Page 11 of 11 PART C SYSTEM INFORMATION (continued) Property Address: 766 Pitchers Way,Hyannis,MA Owner: Sutherland Date of Inspection: May 14,2008 SITE EXAM Slope Surface water Check cellar (crawl space) Shallow wells Estimated depth to ground water_20_feet Please indicate(check)all methods used to determine the high ground water elevation: _X_Obtained from system design plans on record-If checked,date of design plan reviewed: _X_Observed site(abutting property/observation hole within 150 feet of SAS) _X_Checked with local Board of Health-explain: Recent Test Holes, Existing engineer records with BOH _X_Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Utilized existing site design information on file with the Board of Health. Additionally,existing site and abutting site topography does not indicate ground water to be within 4 feet of bottom of leaching facility. Test holes in the area on file do not indicate ground water within 20 feet of grade. TitlP S Tnenartinn Fnrm Ail V1000 11 i a_ J _ 05/19/2008 09:27 Pennicnuck Water Works PG 1 starckj jU/B CONSUMPTION HISTORY REPORT ubcasinq ~o 0 ACCOUNT # CUSTOMER NAME PARCEL T766 ON STATUS �1 SERVICE MAN METER # CD BAD OAT TIME BY BILL # CURR EAD REPL USAGE CHARGE AMT BILLED AMT ------------------------------------------------ ------------------------------ ----- --------------------------------- 230607597 62975 DONALD H SUTHERLAND 271043 TCHERS FINAL HYQCON- 1 HYQCON 059933628137 A 04/14/2008 857995 390 (,7Q 0 1.62 28.56 HYQCON- 1 HYQCON OS9933028137 A 01/10/2008 783945 389 5 0 8.10 3S.04 HYQCON- 1 HYQCON 059933828137 A 10/09/2007 709362 384 5 Q 3 0 8.10 35.04 HYQCON- 1 HYQCON 059933828137 A 07/11/2007 633977 379 6 0 8.70 31.50 HYQCON- 1 HYQCON 059933628137 A 04/11/2007 561754 373 5 O 7.25 30.05 - HYQCON- 1 HYQCON 059933828137 A 01/10/2007 489336 368 4 0 5.00 28.60 HYQCON- 1 HYQCON 059933828137 A 10/21/2006 415173 364 5 0 7.25 30.05 HYQCON- 1 HYQCON 059933828137 A 07/11/2006 343162 359 5 0 7.25 30.05 HYQCON- 1 HYQCON 059933628137 A 04/18/2006 241577 354 4 0 .00 .00 HYQCON- 1 HYQCON 059933828137 A 01/10/2006 9085587 350 0 0 .00 .00 •• ERD OF REPORT - Generated by Jayne Starck *• u n n C u t 3 C D 4 1 ' $D V Jti Town of Barnstable Of r01y P� o Regulatory Services ■ARNSTABLE, : Thomas F. Geiler, Director ArEo �a Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 REGARDING SEPTIC INSPECTIONS BY PRIVATE CONTRACTORS DISCLAIMER This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original or copy of the report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observations and interpretations contained within this report. In addition, by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would be listed on the "Disposal Works Construction.Permit". If you should have any questions regarding this report, please contact the certified Septic System Inspector who conducted the inspection. Q:ISEPTIC\Disclaimer Private Septic Inspections.DOC 3� + TOWN OF BARNSTABLE BAR-W 4 915 j Ordinance or Regulation WARNING NOTICE (:�6n S6_Ny 11-, 4 ¢ Q Name of Off ender/Manager e r)-a n tJl ( / Address of Offender � � P i 5 O t4 MV/MB Reg.# Village/State/ZipAN G n►n, :a fA 1 o l.6" O I Business Name ;3V am/pm, on0L 2N 204-C Business Address Signature of Enforcing Officer IVillage/State/Zip Location of Offense 'IW� P'� I SG ..y 4 �j Enfbrcing Dept/Division Offense 0� Facts l ltli'�2 � ��a C � �^C�s �+ C✓I'l ( ( X-C ( This wiTI-serve only as a warning. At' this time no 'legal action has been taken. It is the goal of Town agencies to achieve voluntary, compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance: Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. TOWN OF BARNSTABLE ~^ BAR-W r 4 915 Ordinance or Regulation WARNING NOTICE Name of Offender/Manager pr )z-n Address of Offender W06.) t MV/MB Reg.# Village/State/Zip Business Name U am/pm, ono L 7tt 20r1-C Business Address Signature of Enforcing Officer Village/State/Zip Location of Offense Enfbrcing Dept/Division O f f e n S e 1 r L � �_�a�'*� n, ,��•�"" `- �. (',�r��' _ �1.�,;��r,t � �-„ir-a F 1�r`c fA- Facts �tf � tee,' C , � t. ry s-,k� �7 '� # �1� C r k,, k/n iThis wi1fl"serve only as a warning. At" this time no 'legal action has been taken. -N- It is the goal of Town agencies to achieve voluntary compliance of - Town 'Ordinances, Rules and Regulations. Education efforts andwarning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. TOWN OF BARNSTABLE BAR-W 4915 f Ordinance or Regulation WARNING NOTICE Name of Offender/Manager L r% 3(Z't h Address of Offenders Y ' ~ i MV/MB Reg.# Village/State/Zip '` ' '� Business Name t am/pm,­,,onl} f' ?' 1 20 1; Business Address Signature of Enforcing Officer Village/State/Zip Location of Offense - �€ ' ' �' ► ' ` ' ' Enforcing Dept/Division Offense C> 41/ Facts This will serve only as a warning. At this time no "legal action has bean taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and,.,warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. 4 . WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. • 1�4 . F . . . 1• . .. .. 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I .-'. � s . _ SECTION �� 'i ALL OU TIF T PIPES FROM Rff _ •NOTT Al L PIPES ARE I' BE 4" SCHF UUl F 40 P.V.C. orsmeunoN BOx SHALL BE _ 10' min. fro m -- - PROFILE VIEW OF ADDITION TO LEACIII.'VC SYSTEM SET LEVEL FOR AT LEAST i FT - i2 ,- CaNCRt R CAVFR NEW Foundation house to septic tank _ _ -- S' of 1/8' - 1!7" Washed Peastone f r Septic tank covers must De \\ - I 3 - 5' OUTLET TOF E I E V. 101.00 within 6 in of firovhed grade F 1 1 2 ' Wnshed Crushed Stone KNOCKOUTS 9 `- -code over SAS - 99.00 3/4 0 - . Gade over Septic Tank - 99 2" __Grade over U-Bo• 99.00 \ ", .. -- - L. ___ .� t 4• P- (CAPPED) INSPECTION PORT TO BF \ 155' OUTLET , I 12' -INLET- m lJ 766Fifth..Wy ____ INSTAI-LED AND TO 81 WITINN 6. Or GRAM _ S - 0 Ol I LF H 10 -Top Lood nev. -97 2.5 n ! 6 -0 10 .S NO 3' Max-- Cover -- _ - - tit h TEST. BOX _ -_ )R CREA TF R Top of SAS -- F Lev. =96.7, --Is 5* - .4 12' �. S- 0.010• per toot I 4_.._ 4' SCN 40 Te 't 75' 1,500 SAL. / --10" FNective Depth / sEPnc TANK v ?0" - _ - ` PLAN_ SECTION CROSS-_SECTION T H-10 r. " 4 0 20' 5 Unit,, P 6.25' - 30' % ue.8.0% 3' I LX1 FOUNLU N IiU � II 11 C, a 0 }0 83' (10 nches) .a _! I' 3_ HOLE H=1-0 DISTRIBUTION BOX TLM f'ROFILL_ { c«„potted atone 2 y u A , 4_ -) T f ffec tive LPngth NOT TO SCALE Not to Scale -I I, n --- - ---- - -- --- - - -...--- v 4 y - 4' S❑Il ABS❑RPTI❑t AS) -- --- - ------ --- --- -- - --- --- - Q -►------ t�'- - ---I 9 INF IL I Al RIIR HIGH CAPACI I r !F; '0 L❑ADINGV ]F OR(IF ❑'BRIEN QUAF RAL. N Q1 ES_ 6 In.of 3:'4- 1 112- --- -------- -- - --._------ --- -- - -- _..--------- _ J :ompacted stone T.7 If fec tive TOR EUUIVALE- Width Not t!; 5cr --- - ---- --. _ ___- -- �. .-._--- - ---__ -- -_-_I 0 1. Contractor Is responsible for Digsate notification NOTE ALL COMPONENTS MUST HAVE RISERS TO WITHIN 6' BELOW GRAPE winNOTE. OVFRALT- HEIGHT OF INFILTRATOR IS 18" /[1FECTIVE HEIGHT IS 10" and protection of all underground utilities and pipes. u bottom of Test Hole Hev.-azso P 9 P P ♦Obs. Groundwater Tr•st Hole 2 Fle,,.= NONE OBSEPVED 2 The septic tank and distribution box shall be se level on 6" of 3/4" 1 1/2" stone. i. . -. sand or gravel with no Rackfill should be � lean ra ii C_ _ stones over 3" in size 11 E_ f<<_()I__AT 10 N I l -?T -- - - - --- - -- E' 4. This system is subject to inspection during installation _--_-- _---- -- _ --_-- ► PROJECT H F N C H MARK ( ,�..� INOTE: SITE IS IN A ZONE OF CONTRIBUTION - REOUFST A 1 BEDFtO(�A PERMIT r)Nt � by Carmen E. Shay - Fnvironrnental Services, Inc. Dnte of Percolation Test IEBRUARY 16. 2005 E l EV. - 100.00 (Assumed) with The contractor shall install this system in accordance Test Performed By CARMEN E. SHAY, R.S. C.S.E. with Title V of the Massachusetts state code, the approved plan Witnessed By DONALD DESMARAIS (BARNSTABLE B.O H) I and Local Regulations. SHAY ENVIRONMENTAL SERVICES, INC. F� ,I 6. If, during installation the contractor encounters any Percolation Rate. 2 MPI 0 36' \ soil conditions or site conditions that are different I i cfl from those shown on the soil lay or in our design I i I I installation must halt Sc immediate notification be Test Hole mode to Carmen F. Shay Environmental Services. Inc. No. 1 \ 7. No vehicle or heavy machinery shall drive over the OFPTH I;urlS FLEV. septic system unless noted as H 20 septic components. 0 99.40 i i� 8. Install Tuf-rite gas baffles or equals on ail outlet tee ends. i Sandy lia 1� 9. All Distribution Lines shall be 4" diameter Schedule 40 NSI PVC pipes. Loam I 1 W to Yu 3,'2 i I \ J,a �`Fl 10, All solid piping, tees & fittings shall be 4" diameter )" 8" _!)iIA/E i CA \ �f S, Schedule 40 NSF PVC pipes with water tight joints. I`: '�eS'• f�f 11 Municipal Water is Connected to The Residence and Abutting Sandy i I I 14' Loam I I �'1\0• l) Properties Within 150 Feet. YR 5/6 8" 40'! H. �96.00 r C) I Q -_ - ------ ------.- --- -- --- ----- ---- ------ ------ - I Medium- I I W / _ onrse I �, t1'� IHE PROPERTY LINES ARE APPROXIMATE AND 15,and - I I I 37.25' ~`6�rp C 4OMPILED FROM THE SURVEY FLAN GENERATED BY cr I I 253' O ! FD KELIOG & ASSOCIATES OF W. BARNSTABLE, MA ENTITLED _ TEST HOLE #2 F'IAN Of LAND IN BARNSTABI F(Hyannis), MA LC 29356 I o 11 - ELFv = 99.00 DATED FEBRUARY 2, 1961. IT SHOULD BE USED FOR NO PURPOSE / OTHER THAN THE SEPTIC SYSTEM INSTALLATION. I l �'• l o B0k , NOTE ROPOSED y ONDS ARE PRESENT WITHIN 200 FE ET E OF PROPERTY. I - NO WETLANDS _-- I I DESK '{ ASSESSORS MAP 211 l0f - 044 _ r: F rdD j V\ �r12rrl� -- I � I;OPJING - RESIDENTIAL iF I>T HOLE #1 22 � _ _ r„ 9 -- - --- - _-- #7615 - y \ I Fl OOD TONE. C Depth to Perc 40" to 58" i PROPOSED <-s' Perc Rate- ' MPI i �( A (O - �_A 1HFRE ARE NO WE1,ANDS I .)CAT[P WITHIN r, 2U0' RADIUS t)roundwoter Not Observed j; 1 ��(� �`� 01 THE 51TE D SEPTIC ,YSTLM. - -- No Observed E SHWT I p NEW 1500 gal TOh' = FhF.'t' 701.00 f A [( AI)AY;lf D H2O Flev None - Septic Tank BSMNT F'LR = 93.50 - -52.174t -- NSH .0.2' LOT #3 c+; 0 4X WF SPOT Ti GR ADI 14,500 Square Fet 4,1lest Hoin r � No. 7 DENCTFS [ X ISTING .4 6 � 01 GRADE D I'TH SOILS ELEv � � 30.5' 0 .00 rl i PROF' \ �1f ;and✓- j� O, ' `=' DRi O5f IY 1 `.� PL PROPS RTl' LINE i VFI 10 YR Sit , - �r Loort' I 4) -- d ��► } - PROPOSED CONTOUR U" lU" n. 4H 20 \` '•? o` I , -97 nndy _ 1 jy /� " _ .9.) I _ - --- FISTIPJG CONTOUR ' 1. 1 l loom �7' l - DE F P I FST HOLE 10 ss, B. ae.ou & t - - R = 247• P[_RCOLATION TEST LOCATION CoarseMedium- ( _ I - SandI 2. �� E(>or sT�cKA�F FF Nc:E 36" 12n C, ,��~ 96 _ - - (40 F ooT t1r _ - l - kfGF1T OF WAY) -- - CO f OE PRO POSL_ D `_� LPI SYSTEM 0 ;0 ��? IYf l(,,,1_ 1 >�:�O...GAL ON `_;E E' 11C JAN�_ - - - - - O NOT TO SCALk _ Perc #2 ! �NOF ,S Qr F-0 1_J \1 DATI 0 N L A I [J NE°' PREPARED FOR Depth to Perc: 36" to 54" ( [T • In I OADING) GILBERT Perc Rate= 2 MPI T. r , r- m IT 1-f ,T E E=: I :� �N ' TA D T Groundwater Not Observed C r 4' aIu oAHII ':''NPs AT No Observed FSHWT SC,AI_E: 1 - '/0 .S 24' DIAM, ACCESS MANHOIF', U vJ '1 _ ADJUSTED H2O Elev. = None - --- 10• 6 - - - - / - -- - -- - - -.--.-- ---- - - ---- -- -_ _ _ - b WAY .. INLET ! I 8 Limn I I I. m n ro a.nrt - 11- ',17t,•.�C�/� Deslgn Calculatlon� I TTT r r e ""- 4 alnIT -� 'tT r \� _ MI I m INIf I I 1 .�qui•1 .evel I , ( - ._ C� , n I 1 lo• l Number of Bedrooms 1 Equivalent to 110 Gal. Da I. q / y (330 Gal./Day Min. per Title V) -- - � � I �_ Garbage Grinder. No INtFi t-_ 4. 0 min R E FPARFD lj o>..nr tLiquld depthLeaching Capacity Proposed: 330 Gai./Day Minimum (Min. Per Title V) INAI • au ET _y T T Y , Septic Tonic 3 x 330 Gal./Day - 660 USE NEW 1,500 GAl_. Septic Tank. ._� f, I • L, . ,� I/-1 SOIL ABSORPTION AREA: Using percolation rate of <2 min./inch - ----- - - - Bottom Area. 0.74 goi/sq. ft. x 370 sq. ft. 273.8 gallons y �_ L - -- _10. 0 _y s_6;- - O A RV C, , INC. o s _ ,�_�_ .',_y. ` NVIR NMENT L SE I F�' 1 Sidewall Area: 0.74 gal./sq. ft ', 78 sq ft. = 58 gallons STEEL REINFORCED PRECAST CONCRETE CROSS _`J ' END_-SECTION P.O. BOX 627 P Ing: - 331.80 gallons EAST FALMOUTH, MA 02536 THE ACCESS COVERS fOR nif SEPTIC TANK. 4 Use: (5) INFILTRATOR HIGH CAPACIT H 10 UNITS, gAVING A 0.83' (10 INCHES) EFFECTIVE DISTRIBUTIONDISTRIBUTION BOY AND tFACHING COMPONENT __LT : 508-548-0796 DEPTH, TO BE USED WITH 4.0' OF WASHE THE SIDES, AND 3.5' OF WASHED STONE SHALT BE RAISED TO W THIN b' (N cL. FINISHED GRADE ON THE ENDS N0 STONE UNDER. SCALE: 1 •�=20' DRAWN BY: CES DA�L: MARCH 2, 2005 INSTALL TUE-TI TE GAS EiAtI r F OR F UUAI S --- -- -- ---- ON ALI OUTLET TEE ENDS PROJECT#SD699 FILENAME: SD699PP.DWG SHEET 1 OF 1