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HomeMy WebLinkAbout0897 PITCHER'S WAY - Health 897 PITCHERS '�VAY, HYANNIS A=272.139 / � k i f � e COMMONWEALTH OF MASSACHUSETTS f EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS s DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON, MA 02108 617-292-5500 �V yV�y WILLIAM F.WELD Michael Perry TRUDY COXE Governor Secretary ARGEO PAUL CELLUCCI 9 D B.STRUHS Lt.Govemor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FO ^ t o� mmissioner PART A g CERTIFICATION Property Address:897 Pitch rs Way, Hyannis , MA Address of Owner: A� Date of Inspection: �'41 9 (If different) P040F S 1999 Name of Inspector: Wm E Robinson Sr �9igy I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 0) '�!F Company Name: WM E Robinson Septic Servic A Mailing Address: PO Box 1 089, CPnt-ervi 1 1 a M11 02632 Telephone ' may Number r� ^� , 508` 77F;—R77( --r 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 inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: Passes _ Conditionally Passes Needs Further Evaluation By the Local Approving Authority _ Fails Inspector's Signature: Date: The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. INSPECTION SUMMARY: Check A, B, C, Or D: A] SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: B] S TEM 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. Ind ical yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not. _ The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tank was installed within twenty (20) years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 04/25/97) Page 1 of 10 DEP on the World Wide Web: http:lMww.magnet state.ma.usldep ej Printed on Recycled Paper I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 897 Pitchers Way, Hyannis , MA Owner: Michael Perry Date of Inspection:�..11-19 ✓ B] SY TEM CON DITIONALLY.PASSES (continued) r Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). Describe observations: broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced ,.The system required pumping more than four 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 C] FURTHE EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Co ditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the pu lic health, safety and the environment. 1) SY TEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER W ICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYS EM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE YSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVI ONMENT: The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTH (revised 04/25/91) Page 2 of 10 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 897 Pitchers Way, Hyannis, MA Owner: Michael Perry Date of Inspection: D] SYSTEM FAILS: Yt indicate ei-,!er "Yes" or "No" as to each of the following:o mus I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or 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 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E] LARG SYSTEM FAILS: You must indicate either "Yes" or "No" as to each of the following: e following criteria apply to large systems in addition to the criteria above: T e system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to p lic health and safety and the environment because one or more of the following conditions exist: Yes N 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) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requireme of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. ~ (revised 04/25/97) Page 3 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:897 Pitchers Way, Hyannis , MA Owner: Michael Perry Date of Inspection:'Iy l'-9 /yy Check if the following have been done: You must indicate either "Yes" or"No" as to each of the following: No Pumping information was provided by the owner, occupant, or Board of Health: _ None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. _ As built plans have been obtained and examined. Note if they are not available with N/A. _ The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow. _ The site was inspected for signs of breakout. _ All system components, excluding the Soil Absorption System, have been located on the site. The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: _ The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub-Surface Disposal System. _ Existing information. Ex. Plan at B.O.H. 4 _ Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) [15.302(3)(b)] (revised 04/25/97) Page 4 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 897 Pitchers Way, Hyannis , MA Owner: Michael Perry Date of Inspection: FLOW CONDITIONS RESIDENTIAL: Design flow: f'ulQ g.p.d./bedroom for S.A.S. Number of bedrooms:_ Number of current residents: Garbage grinder (yes or no): p Laundry connected to system (yes or n#: _ Seasonal use (yes or no)/Z--,() Water meter readings, if available (last two (2) year usage (gpd): 1998 97 , 500 gal. Sump Pump (yes or no)�(� 1997 91 , _ gai. Last date of occupancy: COMM CIAUINDUSTRIAL: Type of a tablishment: Design flo gallons/day Grease trap present: (yes or no)_ Industrial ste Holding Tank present: (yes or no)_ Non-sanitary waste discharged to the Title 5 system: (yes or no)_ Water meter readings, if available: Last date o occupancy: OTHER: (D scribe) Last date cupancy: GENERAL INFORMATION PUMPING RECORDS and s urce of information: System pump as part of inspection: (yes or no)� 0 If yes, volume pumped: gallons Reason for pumping: TYPE OFF TEM 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) I/A Technology etc. Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed (if known) and source of information: Sewage odors detected when arriving at the site: (Yes or no))l- jt f'' (revised 04/25/97) Page 5 of 10 SUBSURFACE SEWAGE.DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 897 Pitchers Way, Hyannis ,. MA Owner: Michael Perry Date of Inspection: BUILDI SEWER: (Locate on site plan) Depth bel w grade: Material o construction: _cast iron _40 PVC_other (explain) Distance rom private water supply well or suction line Diamete Commen s: (condition of joints, venting, evidence of leakage, etc.) SEPTIC TANK: t/ (locate on bite plan) Depth below grade: Material of construction: -/concrete _metal _Fiberglass _Polyethylene —other(explain) If tank is metal, list age _ Is age confirmed by Certificate of Compliance _(Yes/No) Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffler Scum thickness: O t Distance from top of scum to top of outlet tee or baffle:_ 21>> Distance from bottom of scum to bottom of outlet tee or baffle: j How dimensions were determined: G Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, dep h of Ii uid level in relation to outlet invert, structural integrity,_,evidence of Ipakage,.eettc.) 64 0 6 GREASE TRAP: (locate o site plan) Depth be w grade: Material construction: _concrete _metal _Fiberglass _Polyethylene —other(explain) Dimensio s: Scum this ness: Distance rom top of scum to top of outlet tee or baffle: Distance rom bottom of scum to bottom of outlet tee or baffle: Date of I st pumping: Comments: (recommen ation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, a idence of leakage, etc.) A, (revised 04/25/97) Page 6 of 10 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) 'Property Address: 897 .Pitchers Way, Hyannis , MA Owner: Michael Perry Date of Inspection: —ef_g �1 TIG T OR HOLDING TANK: (Tank must be pumped prior to, or at time, of inspection) (loca on site plan) Depth below grade: Materi I of construction: _concrete _metal _Fiberglass _Polyethylene _other(explain) Dimen ions: Capaci gallons Desig flow: gallons/day Alar level: Alarm in working order_Yes; _ No Date o previous pumping: Comm nts (conditi in of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert:_ Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of I akag nto or out of box, etc.) PUMP HAMBER:_ (locate in site plan) Pumps i i working order: (Yes or No) Alarms ii working order (Yes or No) Commeits: (note co idition of pump chamber, condition of pumps and appurtenances, etc.) b , - i. (revised 04/25/97) Page 7 of 10 s SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:897 Pitchers Way, Hyannis , MA Owner: Michael Perry Date of Inspection-�-__I'�_Q y' SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number: leaching chambers, number: leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Alternative system: Name of Technology: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) 131 CESSPOOLS: _ (locate on site plan) Number and configuration: Depth-top of liquid to inlet inve Depth of solids layer: Depth of scum layer: Dimensions of cesspool Materials of construction: Indication of groundwater: inflow (cesspool must be pumped as part of inspection) Com nts: (note c ndition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY: (locate o site plan) Materials o construction: Dimensions:- Depth of so ids: Comments: (note conditi of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (revised 04/25/97) Page 8 of 10 a SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 897 Pitchers Way, Hyannis, .MA Owner: Mic ael Perry Date of Inspection:;/-- SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) A. 6 C-D 1 (revised 04/25/97) Page 9 of 10 DISPOSAL SYSTEM INSPECTION FORM SUBSURFACESEWAGE , PART C SYSTEM INFORMATION (continued) PropertyAddress:897 Pitchers Way, Hyannis , MA Owner: Michael Perry Date of Inspection: Depth to Groundwater J�, Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record ✓Observation of Site (Abutting property, observation hole, basement sump etc.) Determine it from local conditions Check with local Board of health ti Check FEMA Maps v- Check pumping records Check local excavators, installers Use USGS Data Desc�ri a in your o n words how you established the High Groundwater Elevation. (Must be completed) (revised 04/25/97) Page 10 of 10 7 .r d 7 Ln ATION /,,' SE.WACE PERMIT N0. 97 MSTA LLER'S NAME" i ADDRESS BUILDER OR DATE PERM1 YED �� � �..�� DATE COM°PLIANCE 1SSUE'D­, J� FJ TOWN OF BARNSTABLE e ° LOCATION b7 SEWAGE # 7 7 �1 VIE LAGE ASSESSOR'S MAP& LOT INSTALLER'S NAME&PHONE NO. 6 ..4-,$b SEPTIC TANK CAPACPTY LEACHING FACILITY: (type) _�—� `� —�—e (size) NO.OF BEDROOMS BUILDER OR OWNERC; / 7 PERMIT DATE: 1 OMPLIANCE DATE: -'3""2 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 .T Coo a i� cb At o r THE COMMONWEALTH OF-MASSACHUSETTS �J BOARD OF HEALTH ....--.....OF............... ........... Applira#iun for Di-qVuua1 Worko Tomtrurtiuu ramit Application is hereby made for a Permit to Construct X) or Repair ( ) an Individual Sewage Disposal System at: s..•r. "rr• ''c .... . ..... ... �.----................................................................. ' L tiRAdd. s �� orc .............. _r:..� . . ------------------- &-- - -•----. t o. O er ess •-- � nstaller Address- � U Type of Building Size Lot...... -......•..•....... ..Sq. feet Dwelling—No. of Bedrooms___-..__.__. __________________________Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria F+ Other fixtures d W Design Flow...................... ._..__.._..._ gallons per person per day. Total daily flow. .___-_•--_-_�----- gal 4 -------------- lons. WSeptic Tank—Liquid capacity/.OUZ_gallons Length------ !rfi Width-__ V_.rr_ Diameter________________ Depth.... Gr'. x Disposal Trench—No. -----N.q_...... Width..__.�NiG..... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No......I------------- Diameter./U_._�__.___. Depth below inlet..... ............. Total leaching area..o26......sq. ft. Z Other Distribution box ( i/) Dosing tank .) '~ Percolation Test Results Performed b ._----.__ __-AAA A..f�..S a�� A Date........./. c�9 �a y ,�__.__.___;.................... ,�...,1..__.__._._.. a Test Pit No. 1...`�-7_A____minutes per inch Depth of Test Pit....... C...... Depth to ground water...... ......... Test Pit No. 2....':A----minutes per inch Depth of Test Pit------j��a....... Depth to ground water-----[Y/�........... a' .......... ....----•- ......... ._(0 Description.ofSoil---••• --- . . " /. .....................................6✓ ------------U W t x ----•----------------------°........-------------------------------------------------------------------------------------------------------------------------------------------------------------------- Nature 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:Tm,' `of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been ' u by the Il o r f alth. f. '. Signed •-�•--•-- • �- ----- /.,... v.... Application Approved By---•-. . • ...... . -• • --�---. •----•• -•--•---•---- Date^ 7!0!�� gyp / lid.^ - -:• --- - �.�..��� --'-"Date ---/---- Applieation Disapproved for the following reasons:-------•----------------------------------------- -------•--------------------•------•-•-••---•---••-••••- 4 Date PermitNo......................................................... Issued..... . / Date ...... - Fxs.. ..........:..► THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH lV...............OF.............I819e5vS/ '- L . App irtttion for Uigpnatt1 Workg Tvastrnrtinn rumit Application is hereby made for a Permit to Construct X) or Repair ( ) an Individual Sewage Disposal System at: ... J,/G/ P/"'r ... €> ! ................__.....••••. ...... ------------------------------.....----.....-----..............--- /J f'" atio j Address, ry 3 7 or t '10 ----• % -------------•-•---•-• _..... .._._ J0',411tl 01ne�7r'7t Rl- f =2dress y'6/° d./4#f Installer AddressQ ) Type of Building Size Lot....................-3...Sq. feet V Dwelling—No. of Bedrooms.___________________________________Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ;_----------------------------------------------------------------------------------------------------------- W Design Flow..................... .....................gallons per person per day. Total daily flow............... ` _________.___._.___gallons. WSeptic Tank—Liquid capacityl��"�'.._gallons Length____---------------- Width____` __.r__ Diameter________________ Depth___`/_/_�:-- x Disposal Trench—No. ____ .! ........ Width______.t`? 4_____ Total Length.................... Total leaching area__.__.______�_____sq. ft. U Seepage Pit No-----f-------------- DiameterZ _.: ..-__..__ Depth below inlet______........... Total.leaching area_e �.......sq. ft. Z Other Distribution box (V� Dosing tank (` ) ` / Percolation Test Results Performed by-___________e_pl l�� e5...�A_0`?!.....!0�___________- Date________`�kikq_.____.... 1-.4 Test Pit No. 1._ '._ _____minutes per inch Depth of Test Pit_____. '_.....____ Depth to ground water.....!�).......... GL, Test Pit No. 2...�_A-----minutes per inch Depth of Test Pit_____ 6_..____. Depth to ground water_-__!y/)'.____.___. P4 ... O Description o Soil _ P(/-a7 ----- -- " "* • -- W --------------------------------------------------------------- UNature of Repairs or Alterations—Answer when applicable._.•_:.NA_________________________________________________________________________________ -------------------------------------------•-------------------•--------------------•-•-•-----------------------------------...-- =•-----------------•-•-----------------------•----•---•••....__•-•--• Agreement: The undersigned.agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Ti`T p 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been 'sled by the board o health. Signed ,# J_, f••� /------------------- ................................b......-........----••----------- ° 7 DateP1 ��,•� I Application Approved B ____________________Date PP PP Y----------� ,- Application Disapproved for the following reasons: -----------•-----------------------------------•----_._... - .................................................... --------------------------------------------_._....---------•----------•-•----------------•---------------------•-----•---_...-----------•••----•- Date PermitNo........................................................... Issued,--•-- ---------------------------------- ------ Date THE COMMONWEALTH OF MASSA'CHUS:ET:TS`, rt BOARD O1EALTH ............. _: .-......-....OF.........-.- , S �rr�i�irtt�r laf f�unt�littnr�e �,e IS S TO CE FY • t the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by • ._.•_ ... -:..... I alley ) /� has been installed in accordance with the prov> ions of T " '' j of T State nitary Code as described in the application for Disposal Works Construction Permit No :_!z'___ __ ___________________ da.ted__ _ .-'. ............... application THE ISSUANCE OF THIS CERTIFICATE SHAL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. s DATE...............•-f--` `. /....----•-------•--•--•--•----...._. Inspect or...... � ---••---•-_..... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF pHEALTH j ....... Fg��l._�..'�... . i n ttl nrk r n r Un , M p ., Permission is hereby granted........= _ - ------- to Construct. >0 or Repair ( ) an Indivi.ual Sewage Disposal System - S eet as shown on the application for Disposal Works Consti un Pe it _..__�__._ Dated.... . g ._"'- __..._'......... �+ � ' oard of Health --••••-••---- DATE....L_�.!_w-�-------•---•-- --= ................................. o FORM 1255 HOBBS & WARREN, INC., PUBLISHERS r , $50 t: No. Fee , THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE,, MASSACHUSETTS 01pplication for Mi-opogal *r5tem (Construction Permit Application for a Permit to Construct( )Repair(X )Upgrade( )Abandon( ) El Complete System El Individual Components Location Address or Lot r4.97 Pitchers Way, O is Name d ss and Tel.No. Hyannis, MA rier ae� erry Assessor'sMap/Parcel 897 Pitchers Way, Hyannis, MA Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Wm. E. Robinson Septic Servixe P.O . Box 1089, Centerville , MA Type of Building: Dwelling No.of Bedrooms 3 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. r` Description of Soil Sand. / Gravel Nature o R airs orA ter tions werwh en a licable New Title 5 Leach System, consisting a -�'ox ands. tawo ' gal. '�ecas� -LeachchamiDers . 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 e and not to place the system in operation until a Certifi- cate of Compliance has been issue by this B d v ealth. Signed Date -..4v9 Application Approved by Date Application Disapproved for th ollowmg reasons Permit No. Date Issued No. L 7 Fee $5 0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01pplication for �izpooal *pq;tem Con5tructton Permit Application for a Permit to Construct Repair(K )Upgrade Abandon El Complete System El Individual Components Location Address or Lot 107 Pitchers Way, $1 ner' cjAleserys anrd Tel.No. Hyannis, MA ,11C M Assessor's Map/Parcel 897 Pitchers Way, Hyannis, NA Installer's Name Addre§s,and Tel.No. Designer's Name,Address and Tel.No. Wm. E . Robinson Septic Service P.O. Box 1089, Centerville , MA Type of Building: Dwelling,/;', No.of Bedrooms 3 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 Sand. Gravel Nature(f Rwirs or A e) New Title 5 Leach System, consisting x an -Cwo JJL L;CL tj Nterations08swer w,_�en applicabI ga t leach chambers , 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 e-de and not to place the system in operation until a Certifi- cate of Compliance has been i y this and Health. Signed_s2r) Date —92 Application Approved by Date, ';P, - 9 Application Disapproved for thpfollow,lng reasons Permit No. 1-1 7 Date Issued --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS perry BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO RTC,t4 the On-site Sega�e is m Constructed Repaired Upgraded Notl Syste Abandoned by me 0 o inson e 1 elvice at 897 Pitchers Way, Hyannis, MA has been constructed in accordance with the provisions of Tide 5 and the for Disposal System Construction Permit No. 'Y 7—dated Installer Wm. E. Robinson Septic Sere Designer The issuance of this permi 'shall.p tb construed e _�sterrnrwillfunct 4 d sig5ed. e cons u ion q e: Date C/ Inspector —,V AU, No. C/9 - L/ ? Fee $50 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Perry lwi!5pozal 6potem Construction Permit X Permission is hereby granted to Construct Repair( )Upgrade Abandon Systemlocatedat 897 Pitchers Way, Hyannis, Y1A and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this permit. Date: Approved by U 1/6/99 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) I, hereby certify that the application for disposal works construction permit signed by me dated ' �z "02 9 concerning the property located at ' '7 F IC 1�e(2-6' W.o meets all of the following criteria: JThe 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. • vf �here are no wetlands within 100 feet of the proposed septic system •V There are no private wells within 150 feet of the proposed septic system •� There is no increase in flow and/or change in use proposed •V There are no variances requested or needed. • The bottom of the proposed leaching facility will not be located less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable] • If the S.A.S.will be located with 250 feet of any vegetated wetlands,the bottom of the proposed leaching facility will not be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation(using GIS information) B) G.W.Elevation +the MAX.High G.W. Adjustment. _ DIFFERENCE BETWEEN A and B SIGNED : 1 )�1 ( „' //� DATE: O' oZ 77 [Sketch proposed plan of system on back]. q:health folder:cert C� Cl v I TOWN OF BARNSTABLE e�a LOCATION�� J� �!2 V j b 1 SEWAGE # VILLAGE ASSESSOR'S MAP & LOT l INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY _L6-� r LEACHING FACILITY: (type) <"-9 —2 / � „ — I !� (size) NO.OF BEDROOMS �.j� BUILDER OR OWNER ,P'7�n/2—( PERMIT DATE: _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 as: TYPICAL SYSTEM PROFILE A R E A PLAN FDN TOP / FINISH GRADE:: '-" NOT TO SCALE FINISH SCALE I "- ti �`'� � FINISH GRADE OVER TANK= 1rl• OC: GRADE OVER PIT= 51, /A��/`��IT�.n�.n. (wr�wwr�w..�wfw}/--�rrw�ri /`�,.�1 T ! >1�71a�`�ryL !_ }_ / v V / / / `0 / 1 1..—. &�``bj S / �b L E F{,,,„ O` !i./ 0 JL 1-4 >< r`�.f - I - � + . •�'• • ,e 1 1 0 48.0o P v c OR 47 to 7' ° ° �� �t�: Vf`i �` fj' •�l.•' i+d' °..►� .. ;. �C. I . TEES 47.3� • • 1 1 1 e0 _ 4 7. 4' ��. 7.50' TOW ` ti1/� ��IL ,+�� � T i-I E' 5 —� e S M T ) O 0 C` .: FLR 44,00 GAL. 4 �f725 e • o o • . • • o e � `• REINFORCED FIST. BOX • e , . • • e • • o o " If CONCRETE _8 TO BE INSTALLED ON e o 1 • • • • • 1 e 1 A LEVEL STABLE BASE • 1 + • • • • 1 SEPTIC TANKo � � e e • / 1 • 1 e 1 . . • . r + 1 LQTs'/2 TO BE INSTALLED ON A • • • + o LEVEL STABLE BASE o • • / • o 0 ' 48'� BRICK 8r MORTAR COURSES AS 2"-I/8'� I/2 '�WASHED PEASTONE ALL ' ' ' ' • � ' ' ' ' / e ►. .� AROUND FREE OF IRONS FINES • • • e . • • • • 0 / a / mom 7/07 ' •'� , � \EQUIRED TO BRING COVER TO GRADE AND DUST IN PLACE ., � LEACHING PIT 24 C.I . MANHOLE COVER a 3/4 TO 1 -1/2 ' WASHED CRUSHED FRAME - SEE DETAIL ` STONE ALL AROUND FREE OF BASE TO BE LEVEL IRONS, FINES AND DUST IN ( I � •� PLACE s FOR FIN. GRADE SEE SYSTEM PROFILE LOT#33 SOIL AND PERCOLATION �e.� Yl , _ l000 G�IC. FlIeCCs35T CDNC4eE` C ` , �� Air 5L 13 I _ ----�_4 ,. �\ i I DATA SFPric THiIIK, S FkOEE F' FrLE �i p 12p 7,t --- / PERC. RATE : MIN.�IN ReEC:,)ST COrVC�67E_ D-�^ /� - �; /d4 _ _ - --- - - - — L FOR INV. ELEV SEE ° ' i TAKEN BY SfEP 't�Fic.E' '� p — Ar � Foa ; M INLET ° ' SYSTEM PROFILE „ C. D . SPOHR e� Re Ss,^k W, - •`1 Per X LINE . . _ 06 WITNESSED BY io i Q i� OPENINGS Wi 4-1/8 „0 DATE : 9C, 1 OUTER DIA. 8, 1 -3/4 p'� ^ �1P£C.�T ux.C�.?�"rE' [E�CN/IVf• PIT/�f'EQ,D, 10 ••- INSIDE DIA . Q ° TEST PIT -GND ELEV. SEC DETA/�S P,rZD�/;.� 7 0 ° . ' Z LDT� // � - -6 o ° TOTAL ° Q , ` AREA o 3 G� v o o 0 0 0 o L A/O ROST, ` ° 0 0 `` ,U6 ��l t L t`'` ok_ eo o0000 0 0 0 0 �` �_ S�NL 6 '- 6 ' DIA . BOT. PERC. HOLE EFFECTIVE DIA. -- DOWN ,.'. I I 1b. 1A �. L E A C H I N G PIT - SECTION I ���DJ /9�I'' N �07- *l0 NO SCALE DESIGN DATA : NOTE'. DO NOT RUN HEAVY EQUIPMENT OVER SYSTEM NO. OF BEDROOMS DISPOSAL LEACHING PIT NOTES: EST. TOTAL DAILY EFFLUENT GALS. E"LEV<> n cA.16 B�£fa Oj r P,4vAa41:7AJ7 E/�G� I . CONC. TO BE 4000 P.S.I a 28 DAYS . SEPTIC TANK /COO GAL. ccAl -RL.I 1 OF L.AT(S Et, 50.0 2 . REINE W 6 x 6 �6 GA. W- W. M. PLAN REF: 3. 2 'AND 4 ' SECTIONS ARE AVAILABLE FOR 1`i1V t� GENERAL NOTES GREATER DEPTH REQUIREMENTS �q/ /i/STN�SLE' r-,446ri5rRrl OF 1 . ALL SYSTEM COMPONENTS SHALL BE INSTALLED IN L> ,t" N SC E; 27I NOTE ' EXCAVATE TO ELEV. OR LOWER AS ACCORDANCE WITH TITLE OF THE STATE SANITARY CODE DATED JULY 111977 & ANY LOCAL RULES APPLICABLE. PAGE S REQUIRED TO REMOVE ALL LOAM AND CLAY CONTAINING 2. ANY CHANGE TO THIS PLAN MUST BE APPR'D. IN MATERIAL BENEATH PIT. REPLACE EXCAVATED MATERIAL WRITING BY MR. CHARLES D. SPOHR. WITH CLEAN,CLAY FREE GRAVEL, MECHANICALLY 3. WHEN CONSTRUCTION IS COMPLETED, PRIOR TO BACKFILLING, COMPACTED IN PLACE. NOTIFY THE ENGINEER AND BOARL) OF HF4ALTH FOR INSPECTION. SIDE AREA = I %"_S. F.0 - -+S. F./GAL -ILL GALS BOTTOM AREA= S. F. o S. F./GAL 8 GALS 4. FOUNDATION ELEV. MUST BE CHECKED WHEN COMPLETED. 5 THESE ELEVS. MUST NOT BE CHANGED WITHOUT WRITTEN TOTAL AREA = S. F TOTAL S 84— GALS APPROVAL BY CHARLES D. SPOHR. LEGEND 6 FOUNDATION INSPECTION READ. WHEN EXCAVATED. + 50.O OWNERS � BU I LDERS : AREA PPLAN: i EXIST. GROUND ELEV. 11 50.0 FINISH GROUND ELEV.- UNDERLINED C1-L1 A2K � FL YAJA1 13 v/�.�J ,:' �'�eEpAoeen F4O A4 PLOT PL A A, 4 7 5 0 PIPE INVERT. ELEV. R E v. DATE D E s c R I P T I o N Box 3 7, C E• rG k V14.1-A6F OF l-A AID I AI 14,/o0A1 Af f.5 M 47 , F"Q R C � F 8 u/L DE'A,�5, S.Cq/-,E' • TEST PIT LOCATION SEWAGE DISPOSAL SYSTEM / II= 40 `� "ov. .29,0 1960 ' y o O SEPTIC TANK FOR CAP, isL n�as su> r'�riti� LL-ARK FL1 f J1 1 BUILDERS L] DISTRIBUTION BOX --- r- ,-: ! 7-• I I P I T C H:R S WAY 4 C. I . PIPE 11 ) ANN I MASS. ttttttti--f- 4 BIT. FIBER PIPE TIGHT JOINTS z g -------- o1� DESIGNED C.D_SPOHR DATE: 19 DI_C, '~:. D R A W I N G N0. PROPERTY LINE F& f- NV ia6h � 27 2 j I '�fssfGNA� DRAWN : SCALE:4S SHOWN I (� I `� MAP SEC PCL L_CT HOUSE � MIN . CODE DISTANCE _ �J CHECK FD C. D S .