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HomeMy WebLinkAbout0829 PITCHER'S WAY - Health 829 Pitcher:'s`Way . Hyannis ; A 271 162 '= Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 829 Pitchers Way Property Address Joanne Uchman Owner Owner's Name information is required for every Hyannis ✓ Ma 02601 12/3/2016 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When. A. General Information filling out forms on the computer, use only the tab 1. Inspector: key to move your cursor-do not Sean M. Jones use the return Name of Inspector key. S.M.Jones Title V Septic Inspection r� Company Name 74 Beldan Ln. Centerville Ma 02632 City/Town State Zip Code 774-248-4850 smjonestitle5@gmail.com SI4522 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(316 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by.the Local Approving Authority Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ""This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 829 Pitchers Way Property Address Joanne Uchman Owner Owner's Name information is required for every Hyannis Ma 02601 12/3/2016 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: The dwelling located at 829 Pitchers Way Hyannis is served by a Title V septic system consisting of a 1000 gallon septic tank, distribution box and 2 500 gallon precast leaching chambers. The system was found to be in proper working condition at the time of inspection. B) System Conditionally Passes: ❑ One or more.system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 829 Pitchers Way Property Address Joanne Uchman Owner Owner's Name information is required for every Hyannis Ma 02601 12/3/2016 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 829 Pitchers Way Property Address Joanne Uchman Owner Owner's Name information is required for every Hyannis Ma 02601 12/3/2016 _ page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M y 829 Pitchers Way Property Address Joanne Uchman Owner Owner's Name information is required for every Hyannis Ma 02601 12/3/2016 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water,supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ 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. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 41 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 829 Pitchers Way Property Address Joanne Uchman Owner Owner's Name information is required for every Hyannis Ma 02601 12/3/2016 page. Citylrown 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? ® ❑ 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 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 gpd t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 829 Pitchers Way Property Address Joanne Uchman Owner Owner's Name information is required for every Hyannis Ma 02601 12/3/2016 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: unknown Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 829 Pitchers Way Property Address Joanne Uchman Owner Owner's Name information is required for every Hyannis Ma 02601 12/3/2016 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/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): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 829 Pitchers Way Property Address Joanne Uchman Owner Owner's Name information is required for every Hyannis Ma 02601 12/3/2016 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: system repaired 8/15/05 per town records, tank original 1975 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1.5 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.): Joint were ok, no leaks, vented through the roof Septic Tank(locate on site plan): Depth below grade: 1 feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gallons 9,. Sludge depth: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ;M 829 Pitchers Way Property Address Joanne Uchman Owner Owner's Name information is required for every Hyannis Ma 02601 12/3/2016 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 3" Scum thickness 3" 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 10" How were dimensions determined? opened covers, took measurements Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank should be cleaned soon and again every 2 years for proper maintenance. Water was even with outlet, outlet tee intact. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 829 Pitchers Way Property Address Joanne Uchman Owner Owner's Name information is required for every Hyannis Ma 02601 12/3/2016 page. Cityrrown 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.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 829 Pitchers Way Property Address Joanne Uchman Owner Owner's Name information is required for every Hyannis Ma 02601 12/3/2016 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Distribution box was video inspected and found to be in good condition, no rot, water level was even with outlet invert. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No" Alarms in working order: ❑ Yes ❑ No" Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 829 Pitchers Way Property Address Joanne Uchman Owner Owner's Name information is required for every Hyannis Ma 02601 12/3/2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 2 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): leaching facility'was video inspected from vent and was found to be dry with no stain lines. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 829 Pitchers Way Property Address Joanne Uchman Owner Owner's Name information is required for every Hyannis annis Ma 02601 12/3/2016 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 829 Pitchers Way Property Address Joanne Uchman Owner Owner's Name information is required for every y H annis Ma 02601 12/3/2016 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately t 1 -TI � r i �2 s �` 12 A2 z� z A3 37 f3� Yr t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments G M z 829 Pitchers Way Property Address Joanne Uchman Owner Owners Name information is Hyannis Ma 02601 12/3/2016 required for every y 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: 12'+ 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: Groundwater elevation was determined by accessing Town of Barnstable groundwater contour map. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 829 Pitchers Way Property Address Joanne Uchman Owner Owner's Name information is required for every Hyannis Ma 02601 12/3/2016 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 TOWN OF BARNSTABLE ° LOCATION i �C. A A 9 LIE"1;Z SEWAGE # VILLAGE_111A ` ASSESSOR'S MAP /& LOT INSTALLER'S NAME&PHONE NO.;1�� b i°A.X.t -7 7, SEPTIC TANK CAPACITY /% ` e LEACHING FACILITY: (type) �` L (size) NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE: S�``J"G COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by v '� `- D THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: '✓ Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTAB.LES MASSACHUSETTS ftphration for Mzpooar bpgtem, Conot.rurt on Vermit Application for a Permit to Construct( , )Repair(K )Upgrade( )Abandon( ) ❑Complete System E3 Individual Components Location Address or Lot No. Owner's Name,Addres''s and Tel.'No. 8�9 Pitchers Way, Hyannis Todd Uchman Assessor's ap/Parce �j j 829 Pitchers Way, Hyannis Installer's Name,Address,and Tel.No. 7 7 5—108 7 7 6 Designer's Name,Address and Tel:No. 3 6 4—0 8 9 4 Wm E Robinson Sr Septic Eco-Tech PO Box 1,089, Centerville 43 Triangle .Cir, Sandwich Type of Building: p<< A0 7���(� Dwelling' No.of Bedrooms Lot Size sq.ft." Garbage Grinder( ) Other 'Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow, gallons. Plan Date Number of sheets Revision Date. Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Install a new Title 5 leach system to plans of Eco- ec . 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 Certifi- cate of Compliance has been issued by t ' B d of Health. Signed ► Date Application Approved by 10. w Date rF•-f S w 1 Application Disapproved forte following reasons Permit No. Date Issued (S�_a S� _V01 No. d ' g� 4, 19 6, r` a -- Fee$1 0 0.0 0 ±' THE COM'MONWEA4LTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppli ratio n :for--Mte;pogal *pStem Conotruttion Permit Application for a Permit to Construct( )Repair( X)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. -" 1939 829 Pitchers Way, Hyannis Todd Uchman Assessor's Map/Parcel ^? —) / 829 Pitchers Way, Hyannis Installer's Name,Address,and Tel.No. 7 7 5-8 7 7 6 Designer's Name,Address and Tel.No. 3 6 4—0 8 9 4 Wm E Robinson Sr Septic Eco-Tech l PO Box 1089, Centerville 43 Triangle Cir, Sandwich 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 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date - Title Size of Septic Tank Type of S.A.S. Description of Soil ..--Nature of Repairs or Alterations(EAnsweiwhen a cable) Install a new Title 5 leach sys em o p ans Eco-Tech. 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 Certifi- cate of Compliance has been issued by thi o�pl of Health. Signed I ��' tv✓✓ Date Application Approved by - ( _ - Date Application Disapproved for the following reasons Permit No. 2 how Date Issued 9-" (S —C) 4. THE COMMONWEALTH OF MASSACHUSETTS Uchman BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired ( Upgraded( ) Abandoned( )by Wm E Robinson Sr Septic Service at 829 Pitchers Way, Hyannis has been constructed in accordance with the provisions of Title-5 and the for Disposal System Construction Permit No._20 5`-34 fdated =(S-G_r Installer � au's e1-r� Designer The issuance of this permit shall not be construed as a guarantee that the system w'� fu' tion as designed. Date 5 Inspector f No. oaS ' 3 F$e 0 0.0 0 Uchman THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS - Mizpogat *pgtem Cow5truction permit Permission is hereby granted to Construct( )Repair( X)Upgrade( )Abandon( ) System located at 829 Pitiches Wavy; Hyannis_ 1 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 ospecial conditions. Provided: Construction ust be completed within three years of the date of thus p i. Date: / Approved by ` r Town of Barnstable Regulatory Services Thomas F. Geiler,Director + BARNSTABLE, v� 163S. Public Health Division ATED ' Thomas McKean,Director `F 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: Designer: Eco-Tech Installer• Wm E Robinson Sr .Septic Address: 43 Triangle Circle Address: PO Box, 1089 Sandwich Centerville On Wm E Robinson Sr Septjas issued a permit to install a (date) (installer) septic system at 829 Pitchers Way, Hyannis based on a design drawn by (address) Eco-Tech dated (designer) —a_'1_f"c'ertify 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. OF 14,9 �o DAVID ( staller's Signature) o D. V COUGHANOWR y No. 1093 �FQcsTEa�� Sgro1TAQ% (Designer's Signature) (Affix De 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/Desiper Certification Form 1 Notice: This Form Is To Be Used For the Repair Of Failed Septic Systems Only PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM I, � e OL U !� Covu fIYD L✓r ,hereby certify that the engineered plan signed by me dated G/-1 1 2'1 6 S ,concerning the property located at W44 y meets all of the following criteria: • Two soil evaluations excavated for detailed examination(no hand augering)and two percolation tests shall be conducted. 0 This failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. • The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. • The bottom of the proposed leaching facility will be located no less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable] Please complete the following: A) Top of Ground Surface.Elevation(using GIS information) C6.6 9 B) G.W. Elevation 0 +adjustment for high G.W 3, _ 4. 0 DIFFERENCE BETWEEN A and B SIGNS J- oj � DATE: kv, NOTICE Based upon the above information, a repair permit will be issued for bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. gASeptic\percexemp.doc UoCQ ION = L,p��. 5EW6,61E PERMIT MO. . UILLACaE — — — — — — — — — Ih1STQ LERS �NIE ADDRESS - BUILDER 5.--Q &VAF- ADDRESS - -- - _ -- DNTE-PER-KA T- 15SUED — � 7-zq�� -- - D ATE.- COMPLI &MCE ISSUED 1 Ov P DO C� t X ` '12 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF.................................................................................... Appliration -fur 43iti mal Works Cnunutrurtion Puniff Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: _ Ott ��yz��S...Qw L cT.......: .............................................. ati A1.�11`.!__ 4r._ ST coffin tAddr ss, ..LV. C.4.__. d ---�2lor L ot I� .)1. �_�J_7_ Owner / !`!�_ • d-d,eesls A...... .��t:�F���►2 Y.,2 J.,�_}Li_�Sht ... .Ai ---------------------------------- Installer Address Q 'Type of Building Size Lot_=.L. _j__y_L4Z-__Sq. feet Dwelling T No. of Bedrooms._3--------------------------------------Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building No. of ersons.-__._. r� YP g ---------•------------------ p —3................. Showers ( ) — Cafeteria ( ) Other fixtures g_RTIf f l-_<j e-ldP t_1N-AL-HA--R------------------------------------------------------------------ Design Flow..;:.......:' ___________________________gallons per person per day. Total daily flow........._5�_-_______--____-.--_-...gallons. WSeptic Tank—L Liquid capacity-1 000-gallons Length................ Width................ Diameter____-..._.____ Depth................ x Disposal Trench—No- ____________________ Width.................... Total Length-------------------- Total leaching area--------------------sq. ft. Seepage Pit No......I............. Diameter__��l�A._�Depth beloa inlet__________.._.___. Total leaching area------------------sq. ft. z Other Distribution box ( ) Dosing tank ( ) ►-' Percolation Test Results Performed bY........................................................................... Date-----•-------------------------------- Test Pit No. 1................minutes,per inch Depth of "lest Pit-------------------- Depth to ground water.---__--_____--_--_---- fzq Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water------------------------ 9 •----------------------------------•---•--....---••-....---•--•••-----•------------------------•-•---------•----------------•---•-------------------....... ODescription of Soil------................................................................................................................................................. •-------------- x W VNature of Repairs or Alterations—Answer when applicable-------------------------------------------------------------------------------_---------------- ---------------------------------------------------Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article \I of the State Sanitary de—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b is ued b" the and e.al-th Signed . - ----- - _ -----� ' Date Application Approved B q-'A............................................................................... J�/ Date Application Disapproved for tie following reasons:........................................................................................................7....... -------------•---------•---•--------------------------------------_.--------•-------------•--••--------•-------------------••-----•-----------------------------------------•----------------•---------- Date PermitNo.__.e/6-3----------••-•------------------------- Issued........................................................ Date ti No.._._.._.y _.... Fl�s. oG . 1t1.�.,,............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF Allp irtttio.n :fur, M-4mittl Works C omitrurtion Vane t ApphcaYion"is hereby made for, a 'Permit to Construct ( ) or Repair ( ) an Individual Swage Disposal System at: ......v A0.1_o U_ t+ v i t_It:_► c �.► -t ...lN --( 1- .s------------------------------'----'--.......------ ca ion A dr ss "'•-•- or Lot No. er ...�. n j� 1+ _✓?�_ Y � � 11i1 .;d rests.-'-••--"'--•------•---------•-- Installer Address Q Type of Building Size Lot._:4:,._.4. 3---Sq. feet Dwelling L No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons......_.�____________________ Showers ( ) — Cafeteria ( ) dOther fixtures I--- K_ i--1NX-s-1f-a-�_ ----------------------------------------------------------------- W Design Flow-----------!_5 ________________________ __gallons per person per day. Total daily flow------lM_____-__.._.________----_____gallons. WSeptic Tank I Liquid capacity-i_fA-l_gallons Length---------------- Width................ Diameter__-__---_--____ Depth--_--____-_-..._ x Disposal Trench—No. ...................... Width-------------------- Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit No........_............ Diameter_j_l__M. Depth below inle� ..... Total leaching area------- ----------sq. ft. z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch .Depth of Test Pit.................... Depth to ground water_.-____--__-___-__-__---. f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ------------------------------------------------------------------------------------------ •--------- ---- '------------------------------------- --------------- ODescription of Soil----------------------------------------------------------------------------------------=--------------------------------------------- -------------- ------------ -- x W UNature of Repairs or Alterations—Answer when applicable.-___________________________________________________________________________________________.. ----•••------------------------------------------------------------------------------------------------------------------------------------------------------= ----------- ---------------------------- Agreement: t The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary de—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has Lb -n iss d by she boa of healtly Signed. A2 f� ./ D°� Application Approved By------ ='----------------------•------••------•-------------••-•------ ----- --------- ---=-------------------- -------------- Date Application Disapproved for the following reasons--------------------------------•---•-•-------------------------•-----____.........-•-•---••-••-•---•-••-'•----- ............./ /•/ ------------------------------(p �• Date PermitNo.....................................----•--........... Issued...........-------------------•-•---------•------------ r Date THE COMMONWEALTH OF MASSACHUSETTS t BOARD OF HEALTH ................................OF. G/� ifirttt r �I - � l I I TIFY That t Individual Sewage Disposal System constructed � )�o URepaiped ( ) Installer at---------------------------- -----------------•---•-------••--•----•------------•-•--------------------•-----------------------------------------------•------___-•-------•----------•---•--------- has been installed.in accordance Vktt the provisions of Article XI of The State Sanitary Cozle as described in the application for Disposal Works Cki%truction Permit N� ___ dated r_________________________________________ t c ', : _:. THE ISSUANCE OF THIS CERTIF;CATE SH IdOT BE C �Ib tT{n� E S A? ARANTEE THAT TIME '} L SYS M NJILL �UfV T90 5�AIMIF �CTORYr DATE ---------•---4-- <In actor ~' -' Y P 7 AS old 7 � � OMMONWEAL H OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF................................................................:.............. ..-.. No......................... FEE........................ Norki. TO r+:.ace Permisorf i ereby ratg'O ` ---------------- i *I 6 t+:ftY''�•` "4w n. to Construct (,5 ) or Repair ( J�7 I v tzaI IS ' —xc�4�yste;wf Y. '16 r, f atNo......... - ---=---------•------•----- �t ............................. ..................................................... j Street � li 7 as shown on the application for Disposal Works Construction Permit;No_____________________ Dated__/ _-__._-__ ............................... Board of Health DATE............. ----------------------------------•--- if FORM '1255 HOBBS & WARREN, INC PUBLISHERS '" S t 2 L�x 104 b JWILLIAML ' y St�R't PY `h-Wr T14G r-Z;,utom►f)dnvu ,t�� � , m A.5 me zr)N�06, %Y .Al\AjS OF: 'TNT T N a #AA,246n w 4 CORP. t� t�.cz�•s't�,�3 �'' t �,, sv► . tit p CA cA itz Vxa d ,� p . 70 I , ONTOURS PLAN REFERENCE G � 2 BENCH MARK ; m J , PLAN BOOK 271 PAGE 83 EXISTING - PAINT SPOT ON ASSESSOR'S MAP: 271 MINIMAL GRADING PROPOSED ° N BULKHEAD CORNER � LOT: 162 -o ELEVATION - 62.20 -0 LOCUs BARNSTABLE GIS DATUM • '" 2 v co FgLMOUjH h OAD 223.05 ft o, �? VENT PIPE TEL ` ' SHED F —` HYANNIS. MA ~ — � a Nbl srOluE DRIVEWAY LOCUS M A P ATO �- WA TER LrdE WATER NOT TO SCALE / Nile BENCH DATE / MARK .. 24 rtx12.5fix2rt - m LEACHING GALLERY 23 f, EXISTING rP s 2 BEDROOM DWELLING ? (n 20 0 El"6 Fz"o°N- � �'J LEGEND o QC IOOOT GALLON ev o SEPTIC O TANK p I y $ \ TEST 61� Q V TEST PIT ® L '' LOT 5 i _ EXISTING � AREA - 24443 s/' •- [�j� LEACH PIT UTILITY POLE $ DRAIN 2Q71 f► / TREE NIZ -sae s ro our+E ar evcrEs.cerre DENOTES TYPE rPE d D-OAX M-HAFLE P-Poc- I PLAN ALL PIPE ELEVATIONS SPECIFIED ARE INVERT ELEVATIONS SCALE: I in - 30 f1 FLOW PROFILE TOP OF FOUNDATION RAISE COVERS TO WITHIN �`VENT 6 ih OF FINAL GRADE PIPE j EL ' 62.20 +— ONE INSPECTION RISER FOR LEACHING GALLERY { 60.50 ,�D-BOX MAX 2 '2 STONE"$- SEWAGE DISPOSAL SYSTEM PLAN 3" DROP , FLOW LINE -TO SERVE EXISTING DWELLING 10- = 4 PRECAST 3i4•-I1/4• ��,,(tkOFAfft JOANNE O'CONNOR & TODD UCHMAN 48- GAS STONE O�' DAVID yG �., BAFFLE �RYWELL ,n 58.4D. 5+- 6 in BOTTOM OF 829 PITCHERS WAY HYANNIS. MA EXISTN STONE 5688 LEACHING I r SYYSTEMSOIL SORPTION COUGHANOWR N w ECO-TECH ENVIRONMENTAL E X18TN0 BASE No. 1093 57.05 GALLERY �F �� 43 TRIANGLE CIRCLE SANDWICH MA 0256 EXISTING EXISTING 58,75 5.00 r, . olSTEM 1000 GALLON (END VIEW) 54.7;5 �{ A ITAR As 508 364-0894 I/2 EXIaTiNG SEPTIC TANK 32.5 4 ------/f /1 b 5 r{� 12.5 {i `��L� ETE-2149 AUG 12. 2005 A ADJUSTED 34.1 v 6%'5 t 12 , 2-0 6 THS PLAN IS TO BE CONSIDERED A DRAFT PLAN UNLESS IT SEASONAL HIGH BEARS THE STAMP AND SIGNATURE OF THE DESIGN ENGINEER GROUNDWATER ORIGINAL PLANS INTENDED FOR SUBMITTAL TO THE BOARD { OF HEALTH WILL BE SIGNED N BLUE AND STAMPED N RED. SOIL TEST LOG DATE OF TEST: AUGUST IL- 2005 _ CAyLCUL �ATIONS SOIL EVALUATOR: DAVID D. COUGHANOWR. RS WITNESS REQUIREMENT WAIVED NO VARIANVES REQUIR DESIGN CD -- ---- NO TEST PIT I PARENTT WATE MADTERIAL: E ROGLACIALDOUTWASH PERC AT 62 in : 2 MIN/INCH IN C SOILS DESIGN FLOW: 2 BEDROOMS X 110 GPD - 220 GPD 3 �r- ELEVATION - 60:68 -- of SEPTIC TANK: 220 GPD X 2 DAYS - 440 GALLONS DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER (INCHES) HORIZON TEXTURE (MUNSELU MOTTLING USE EXISTING 1000 GALLON SEPTIC TANK IF IN SOUND STRUCTURAL 60.68 CONDITION. IF NOT, INSTALL 1500 GALLON SEPTIC TANK (MINIMUM ALLOWED) O-4 FILL 4-6 O SANDY LOAM 10 YR 3/2 NONE FRIABLE DISTRIBUTION BOX: USE 3 OUTLET D-BOX. 6-8 E LOAMY SAND 10 YR 6/1 NONE FRIABLE SOIL ABSORBTION SYSTEM: A 24 ft x 12.5 ft x 2 ft LEACHING GALLERY CAN LEACH 8-10 A LOAMY SAND 10 YR 4/4 NONE FRIABLE A b o 1 - ( 24 x 12.5 ) - 300 s f 10-42 B LOAMY SAND 10 YR 5/6 NONE FRIABLE A s d w - ( 24 + 24 + 12.5 + 12.5 ) x 2 - 146 s f 57.18 42-144 C MEDIUM SAND 10 YR 6/3 NONE LOOSE A 1 o t - 446 s f 48.68 Vt 0.74 x 446 - 330.04 GPD USE A 24 ft x 12.5 ft x 2 ft GALLERY. V1 - 330.04 GPD > 220 GPD REQUIRED NO GROUNDWATER TEST PIT I PARENT MATERIAL: E ROGLACIALDOUTWASH ELEVATION - 61.00 .- PERC AT 60 in : 2 MIN/INCH IN C SOILS DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER (INCHES) HORIZON TEXTURE (MUNSELU MOTTLING 61.00 0-3 O SANDY LOAM 10 YR 2/2 NONE FRIABLE LEACHING GALLERY 3-5 E LOAMY SAND 10 YR 6/1 NONE FRIABLE 500 GALLON DRYWELL DIMENSIONS AND DETAL 5-9 A LOAMY SAND 10 YR 4/4 NONE FRIABLE CONSTRUCTION DETAIL USE H40 CWT 9-40 B LOAMY SAND 10 YR 5/6 NONE FRIABLE DRYWELL UNIT INSTALL ONE INSPECTION 57.67 IX 40-130 C MEDIUM SAND 10 YR 6/3 NONE LOOSE 8'-6'x 4'-10'x y'-g' STONE RISER TO WITNA SG 2 it EFF. DEPTH •+ INCHES OF FINAL GRADE AND INDICATE LOCATION 50,17 24.0 f t ON AS-BU/L T. PLAN - O r^, ` 0 33 NOTES to v1 in N O in N Op�gOp �Op �00�0 1) GARBAGE GRINDER NOT ALLOWED WITH THIS DESIGN �00000000ao ��� 2) ALL LINES TO BE SCH 40 PVC AND PITCH AT 1/8 INCH PER FOOT MINIMUM. ��Dop 3) ALL COMPONENTS INSTALLED SHALL MEET THE MINIMUM REQUIREMENTS 3.5' 8.5' 8.5' 3.5' �j OF MASSACHUSETTS TITLE 5 SEPTIC CODE (310 CMR 15) 24.0 ft NOT ro �02 �n SCALE 4) INSTALLER TO VERIFY LOCATIONS OF ALL UNDERGROUND UTILITIES BEFORE EXCAVATING FOR SYSTEM. 5) EXISTING LEACH PIT TO BE PUMPED. COLLAPSED. AND FILLED, OR REMOVED 6) ALL STONE TO BE DOUBLE WASHED AND FREE:-OF., IRON. FINES AND DUST IN PLACE GROUNDWATER 7) LINES EXITING D-BOX TO RUN LEVEL FOR 12 O'- BEFORE PITCHING DOWN ADJUSTMENT SEWAGE DISPOSAL SYSTEM PLAN 8) ECO-TECH ENVIRONMENTAL RECOMMENDS THE `INSTALLATION OF LOW FLOW FIXTURES AND APPLIANCES. AND BIANNUAL PUMPING OF THE SEPTIC TANK EXISTING GROUNDWATER LEVEL -TO SERVE EXISTING DWELLING BASED ON BARNSTABLE GIS 9) SYSTEM IS NOT DESIGNED TO WITHSTAND •VEHICULA,R LOADING. DO NOT DEPARTMENT RECORDS JOANNE O'CONNOR TODD UCHMAN PARK OR DRIVE VEHICLES OVER SEPTIC SYSTEM. A OBSERVED GW: 31.0 829 PITCHERS WAY HYANNIS. MA 10) INSTALLER TO OBTAIN DISPOSAL WORKS PERMIT-BEFORE STARTING WORK. INDEX WELL: AIW-230 ZONE: D 11) SEPTIC TANKS SHALL BE INSTALLED LEVEL.-'-AND-A TRUE TO GRADE ON A LEVEL READING: AUG 2005 ECO-TECH ENVIRONMENTAL STABLE BASE THAT HAS BEEN MECHANICALLY COMPACTED AND ON TO WHICH LEVEL: 22.8 SIX INCHES OF CRUSHED STONE HAS BEEN PLACED.,TO MINIMIZE UNEVEN SETTLING ADJUSTMENT: 3.1 ft 12) SEPTIC TANK TO BE PUMPED DRY AT TIME OF SYSTEM ;REPAIR AND CHECKED ADJUSTED GW: 34.1 43 TRIANGLE CIRCLE SANDWICH MA 02563 FOR STRUCTURAL INTEGRITY. INSTALL PVC OUTLET TEE FITTED WITH GAS BAFFLE. - ETE-2149 I AUG 12. 2005 2/2