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0911 PITCHER'S WAY - Health
911 Pitcher's Way Hyannis P s A = 272 140 a o a I aa" r r 'rry � Commonwealth A�Ulas�sachusett� a k d� s1 " it + fa5fiz ripe�cti . F'orr � * x y < Subsurface arage Disposal S►yete ri F,oim, Not.fo Uoittnlaary Assesst ants 991 Pt#t:her's iNa ° inttis A m 14 �s li � PropertyAr$ssz� _.. lath;A .Day ' Jf(}$J 4, �Wftel'$ atn8 i & x& _ y, € a d11i0fJY18t(0T113 x fsqu 911 tthes y r sne3 l5116rd o ' 1 r� t�f " at# ,; ztyrrown y r, stater; �p`Code`^ t�totlr,spectibil A "'IN €� P bmtttet o t 'll tnfcne rtyntbe iai Fiy lne ecti t rssuits muatbta su x y sa ,. . . & �2� -Al"�,� s �may Please see comPietene chii'Mist at the end of the form MG } az� "i n a1 Intorlr lat- n r S4 raa3 ,. w a `� = us ° ttre tab 1x '.lPOP ertor it Ti1OY£yt7llf s i sari d'o nth N ®an A§peakman hBzr@tufn r d r h�R££ti d r timpny Name T AR rPs 'Compan}tA" r Y .. tom✓ mow"', a a _ r a M> MA � i32645 / Y 3#ate < 2�S Cade Pi Tphi$Nurrtf ° v s � sW,< Y L3csns$Numb$f $f Xx' % � '.. n3N Vl! atll/l � x l cerfify thet i have personally, tn"spacted thoiss7E2vvage ltsposai system at this address«and,that:ttie � l, rnsrrnatior repot tedbekiw is true,accurate and complete asf the=ttrno of the tnspecn Thy irspectPn perEorr»ed basedFonmyjtrantng antl expertenceAtn the;proper�functitan antl rrtnteriance ofon site., r ' s' "Citle'Se disposal systems 1 am a DEP approved system iris�e for Pursuant tc'Sectlbn 1&340 of ( 9 t DAAR 16 tipOj.The system rr 3 R [ NeetlsEFur#ht3r�Evaluatton by ttte£loral Approving Ata#honty -fea' xrt 3 ,4� F .r rgf .,s ,, �.� �. t S s n �r8 t. + f / ' ny'xs✓ $e�lln$t�lt s ,... „...„.............w.......... w }at$ r s Ogg 3 j The systeti tr►s}�ec#c��shallssuhrnrt a co of#his ins coon re ort to the A roviti Author"E G PY Pe P pp gY(Beard z x ti of Hearth or D P)viiithih, }: ays of'+completrng this�nsp c#t66.4f46 sy tem "rs a sli ,red-system`or � has a do owof 14,o6t3gpti or greater, the irispectoc any!the sysfen owner shall ubmif report yto the appropr>ate regrorial oice of she DEA The'orrgiriel shoultl b8 stun#to the systerriowner x 5` / Yap gpptes sin##o tl sbuyer;rf applicable;any!the approving uthttr�ty w `' r i m'r3� inp acehe- tnttonso use f at that time Tftis 1nsPeotit)n tines not atldress horitit•tie syiwtem tNrili Perfot�nt iri the future under j P '" b .:the sams+or dlttersrtt o�+ndltians flf use: °'- ;'� x. Rwp 'V 114 Rao. s % ti1s 3I13 � 5 } TtUe 5 ` tin Felri»5ubsurfatxa j r 3: tJNtd9(ktsp9cti SBvrF Di8{mseI System:•Page 1 r w £ t `` Commonwesi of Massach Whusefor tts F fi x �ubaurfspe Wag 5ee©4poaal Systs r Fore' N�t:for Votu ita 'A ssessrrments' a s �" 911 Pitcher's Nfay ilyannis k '!fr:.'f<.•k9W;�,u ,y �,5p'7✓yt y,�,n.'R'J.ItQP©ray Y ! snformatwn e 47 991 Pitcher's Wa H annis tSAA t}2fi01 11/25116 £ requared for every ___� i�4 W page � CityfT//o�w�nj s raj �lT`/ " Win^ #ate= Zip Code: 17ate cf tnspe lan oB"F Ak�s £'a>�Y �fl �#CCf iV� � n _. ✓b < zxc. L +. _. x a, N re q � InsprrCtaon Summary: Checks A,B,C or E!afway corriplete all' of,Sct�r�ri t7` "k'•" $f z. _ a X 3 yste Pa'tesY hL y1 hive not found anv nformao�whct mci�cates thaf any nfaha failure crlr� `described: �n;310 CNlR 15 3 or srt 3,1{7xCMC 1;5;3C}4+exist.An facture cr�terla trot ev�luateri are 4 r,> '4 r '• w 1 r ^a Nrndicated7etOW,: p , ;,>s Comments ' i g- Di s t 4 ti a K _ F � pq M/Mw ° ate.• 4 Sy'$terri Ctnttioaynally Pastes. a2 aw, y f, ryYxa � C] One Orsmora sysrn com,99 ponents as d85CrltJBd in Ah e-Conci�onat Pass"section need tb be refaced or rep�rred Ttaystin, optic oomptetan,of the replacement r3r repair,as approved by t3oardaof Heattl'%y {{apass. , t Check the boX€ors"y s�, no"Four"not determined"={Y, N, NC3)for the fo{iowm statements If"not k SOM r " rdeterltlift8d, < Please . X}�a111s g Y3 c up,i, � � The sepbC tank�s metal and over 20 years old`or the septic tank{whether metat or;not}�s structurally" t r y �unstautt"d,eXh btts`substai►tial infilt-tion or'exfilt►iab or,tan failure is in inr�nt System�uvilI pass , £ inspection if tt a exrat ng�ank�rs replaiced"With a complying septic tank�as:.approveif by the 8s�ard 0 '� 1 p✓x< .�£�€3 s' It y,,: %:' a t. •t•,"�.9 • ;c:.: errs Y .4 i' z P.'. , :f-'E, { � � f� A me. {septic tank rrvill.pass ins on;if at rs structurally sound, not leak�ng;and �f a Ceetificate of Comp{i�nce mdscating that:tle=tank is{es tlian,'20 years'old is avalii*.: ' < <�c�vl« II> y H t ,._?ate b s•. y,,: ,Y�1. < T'$ r ; - MM z y 'fMsky gam°d i a [ R11Q�in leijr- rw):' a „ 'y >- A " ' i5rs 31l3 ' Me ,o(riaai It;spBGbrt Porrn:Stibsurfiec�SeSasge system-page 2 of:17 s c ' i ,� •"a v 'zfsfl xn c `'. � ommoinwaal of'Massachus�tt �r a" a* .� : qrDM I n s px tl: n ��t ��•'t ., �'gam+ .", 7 '1i� R f "°s i '4 �. .l a 11 v fiy/ .; , -Sui�s�url c wa a C? posa Sys Fctrrri tary ssessments l Lein Nat'fior"Uolun Al1 Pltahet's 1Nay;Hyannts ° r 'n rfy+Acldreas I F F tatn A i7a° y S �y.�.�� r 3�.�, 3r� r s ti11r�sCf �1t8R1P / } ,g jnfinrrnatronA8 & a rA) ` t`rat,r1w for eirery 911 Pitcher's Way, Hyatttlis �> MA; O i01 < 11125116 t i� P �.fi x , x- /w , .eta ofiinspat�idn j 'y�f Ti State Zip Gb!P Ll x 4 4 y : ] Putrtp C#ambe putttpslalarrns.nat apereti,� Sys#em wit`l'pass.uvith oard,of Health,approva'�f f y, --C : 4. r,Y a+;f:, pumpstatarms s t " o -- .. "�.' =e repaired Bj �,i $!11 C+1?ilClittlllIly P$$Se$�(Catlt}«, of F ': f 4n� q � g r a - � , ❑ C7t seevat an of sewegs backup ar bask+�Ut or high,'stst�c"ter'.ievei n the distrtbution,bax dui . �' to broken ar obstrviceu t . .. �� �A p pegs}or dUe.to a oaken, se#tled;:or.unevn distribution bax .System irt11.� � , pass mspecttort tf(wi#li approval of Board of Health};, « « �f ,& h � e � �, y y brokert pipe{sj°are�r placed C Y Q N ` ] Nd +lax iairt,below �� { p } h ..� 5 .. W � 4Q, o"strtrcfian is removed , , 0,Y� [,, (d ] Nl7�t=xplain betnw} r Y[] t+stnbuton bax ts�levsled or tplacei fir;Ys [ N %C3,N0:(Explat betaw} y"1z , �. S _. , � _ i 5Qzp' a� x ra - T x ` t W s � s ",� '� s'� r s T Y: F Zxffi' , �,.:, ,.g ,. . °, a y 9 © Ttte system;recutred ptamptng more than 4'timed a year due to broken ' obstructed pipes}.The `_� . ; ` ,.� a s i `` system vvtll passtnspectton£tf(uvtthapprovaif tha Board of.Health) k f ux Q= btoken pipes}are replaced. ©°Y [ N ( Nd(Expiairt beic�w} ,,� ,, � d � X t3 p �* 0°i5t!U1i t$Tt3t1IOVet �,. r ' Y C1 N, '[ ND.(Bxpiain below}q Y W , � <: " � , ,, ", s u ` , e �r x , T .» "s ? - sa �y _. y __ ,� -._, _ _ _ _. _._. _ p.,,r .. 1r�'�d >�■■ Q��y y� y y. j �y�yy� Y y is ,,,`f',F,``k Fz! f , 0)'M, t'�I i e4l 'M��Q 1'6d'R Mi`{TY d ,.{�. p®viiiY q INe�iit:f:.� F. hA5�w� .e. y 1 y�, s j e z T "% ,. x Ccsrtdt#ton&exrs uuttth sgtttre#utter evatUataan:lay the t3oard caf Health tri`order;ttr deterrntne"if ¢_ - N Cv t wsymem is fall{ng to"protect pt1blic;health,;safety or,'the envir'' m ,a 4 F ,1 "SY to ,vvi{I patas unless t3oartl of Health determines in=accortiaitce v�irii3lo CMR fi"' d , ' 303t'l�b)tit t tt .."systems s not functioning itt a manner which°will public health, �> s safe y ep ttie®nvrronment o,a Krr t a surface water , r �Cesspot�l ar pCtvyS is within 54.feet of: n I Cesspool ar privy is vvlthtnt3"feet of a bariertng vege�teti wetland or a'salt marsh n f5tris 3+31 t3 1 5 Qfrid8l q x , ' , loon sae`Sever 1]ispu�mt Systert Pepe c 17 } a M ss 3 F J # k f.; i t ;a 1 3 1 ten � ,F 4'b°b'� ' Spy £:t S 3L. M, a .. . offMai�C#� ��:' m ot +� STh uk urface$evvage�pis i!"System 1~orrn l i i,?t for Voluntary Assessments F r, 9`11 litchi "s.yUay Mjrannls Prrerty.Adt9rs Y.e .. . e �3 3 s � laiai i i n.A, (( sy r 3^� lt �'inn 1.7 /:%•^ - ,< •x +. A regl(eci forV6lSt 31'1litcher's VYa .anniS MA. 2611 , 1.1122I16 h p G# t/i awn tate +de' bate of Ir�spe an Op ' 2 Systiikt will fall unlash this a' d of l eatkh{and publlc watite'tupl lliilr,,ll anY) g � w - di ears""that�+�$y�i�si'irt la tui�ctiorilr�g'in a=msnn+Eir that pratircts the puts# heo tti, A ry z sa> ty and>�nvtronrden#,;. [� The sys#et has a s ptia r l an soil sbst�rptlor►syst� {SAS}arid"# s SAS:is wt#tiin 9;{ l feet of a surfammater su I bf"Id utar 0 a surface ulster supply Pp Y T�h}}e system jhas a sop#i tank and SAS' the SAS.is within a'lane 1 0#a public water pp I Q TheAs ttam„l�s a sr�phc tank and SAS and the'SA5 Is m4hin.5t fee#:ref a pnvata voter T r y� supply Well TI#e system has a septic tank and SAS,and the SAS;is teas#hard,l p feet taut 60 fie#or �✓ d Y ] , 9 � e mare frori a}�r►v��yy#E9 wrafer,SU 1 well*A, ' •' K' j' p Y ppr a lUl hod user#to deti�rmrne da f x s.TYm i _ ;. . M� h �, This ystem passes if t#te well war analysis;performed at a©EP certil ed'istioratory,for fecal ` calrform bacteria mdir#ss sit and the presence of emmon nitrogn andiiite nitrogen is equal #o z r lass#hari ,ppm;prt�vided.that no other,failure crlier a are�ti ggered.'A' 'of of the analysis^must` 9 � attached to tiis,for „ y s _ 0 ^' x ay �r t a x - _ n i 1, !y y Y r,iro ,G r r r D)' §yt >-ilit Gi t1ar 1 plic8ble t15�All yst8irt ,, z g ,y You Irld t8 .,:Yes a►r.rNo to @a It of�#he foilcrwing fr r. ll Ihspectluriis: � s x ys ua t f seviragE ^Into facility or sy terri cornpor►ent due to over9oaded or-" =E r C8s3pool .. _. .e � 3 9 p rr a car ponding t f effluent to the surf 6o of the ground or surface waters . due to an iverioacietl or clogged 5AS or cesipc- tab laqu .l vel,in tWdistributibn box eve cru et,invert Niue to an r verlaat ez"li r k r�J cr1ir 4 r ,oI»r c ` eaA or cesspoo sspo yhigilcdeptehI , pi t an 6"bolnuM i,n. veoavailaleol thaU d urm e is less �t�W 13 '. s ,YW JMA6 Q* sp�sai Page TStle 5 Otrt.tnQn farm.,8 Di 5y�sm`* 4 c'�17 Commonwealth OT- lmassachuso;" 7 ° 07 Su#xsurfa+r. Not S+�wst +�©#spersal Systerii Form: sfor V g oluntary Assessments ° Pitcher's UVa #{ Ti11tS r ry € Prpperty Addisss a r g lain;A Day, A 'A" a" ft1eT x r)wner'S Name m s � 111f6Sf!'Yi1tlQn IS '' ,r r required 91t 801fog Wsaa 1�l25J16 page P �City/Tc�,vn State Zip Code abate of ln3pection C ttlrt n ont J W x x s 7 ,eKe'Y IY� ¢'Y6 �s« _ Required�pirmping nlare`fhan times in the last'year 1VC3T due torcingged`or at s#Ttacted,pipe(s}: i 4% b` •of tlmes pumped R Z t A portion of fhe SAS,ycesspoaior pTIVy is beiaaUxhlgh groundxvl water.elevatlan Eli > _ ,.s e. Y T-.. %Any portion f cesspool or}envy is within`100 fret of a surfaces water supply or x x i£ -tnbutary to a surface wafer supply; M � AnWpoi, a�n of a cesspool ar privy is ,mnthin a Zone 1 of a public well. , { r r AA z' p rtian of a cesspool or,pnvy%is' ithin 50�ei, if,g Ppnvate water s ipply'wel1 r � Any potion of a cesspc)ol or envy,is less than 10{3 fast lout gTeater;than 50 feet f,` pr#vat6vater`supply wail with no acceptable water�uali y ar alysas [This g r R¢ X, Aystbm assis,if the vve{iwa#er anal aTfis, ertormed at a Curs certified r ba>rter�a a absent and the pr s nc+ of rmmi »i�i nitren and-nitrate ni#ragen rs aqua{tad or{es "than 5.ppm ° a � Yrz ' prP�ri+ded that no other failure criterla are triggered A copy of the.analysis y a s andchtiin of custody moat be attached to this forrrij , _✓ CCU' PThe system its a o�esspool serving faci{itji avitli a design how of 2000opd gPCJ " The ssyets!rtfa#�s l`hays determined that;one.,or,-mare tf fheatvs failure r € ,1 �cTiter�a :xlst as described in 310�'CMR 1 `3C1 ,therefore the system flails The x �systerriowner should contact theoard ofiealth to d�termine +that�nrill be mY k necessary to"corredt the failure r ,� � ) .l. rge To tie considered a large system the system rrivat serve a facility with a T r Vdes{gn f#ow of 10,000Rgpd`tn ia,tlOt!'H# . $` large systems,you must indicate eitfier yes :ar, no,to each of thexfollowhg,Nrn additlon:to the f y questions m Sect)on'.D v A YeS < a a No 13 rrv7"x"` r r > d a z t4 a, s z the systems- nth�n:4t0 feet of a surface Ttnk�n wafer:supply e r F Q€& thwsystem t5 within 200 feet of a tributary:to a surface lnnking water.supply WZ 9 k ` w> the system is locate t in a it trogen sensitive area{lrlteri»lltlelll eaci F'rateetion ` Area 1WPfj or a mapped:Zone:I I of a public avatar supply:auel! ` ir` �zN n if you#ays answerer yes toany question r..... n. fhe system is'consjdered sl nlficant•threat, f or ansvreTed"yes"m:8ee#ion D above the large`systemhas failed.The awne%`aT.,operataT of any large ! k �� � x system considered a significant thr'eaf under Se"c#ion or faded under;5ecticin D shall upgrade the- sysfern in ar, rd e�shcit ld coritect#he:appr:spr ah � N regions l office of the Deparfman y ttt 3li3 c aRk r TiUo 5 fNftCi�i onorni s 3 P 7 t lnspeci D�ispo y3t�ri• age5 of 1 r F.Z.:r'$ •r, z.&,'e^ I'Iry x ''s,s'"3 y; f 2 FM Pe s > Commonwealth +of Ma$s huslletts WM P �Teif + iln� :cti; ►r� o►rm �P x Subsurface Sedge C�l$gol.„Stein!F untary Assessments=: x" k 91.1'P!#cherrs Uyay Hyanrls "� S f Property Add €o t � h laln'A Day, L, aired#or a ery = 1 i'P�#cher's 1►IIeY, iannis MA Od111125I,18 page�k� �� '��dyJ'rpwn ��` ' =ti. � � St�t>�'� 7.tp Coda� �Ciete t5►Inspa�tio�;^ _ '� MIic � w 4k OEM .; MP g Check if ! f6llowlnbah' been done Yo l�rnust'andlcafe oyes or"no"as to ch'ofthe foil6win k" s t { �� ,,` Purn lin .info"rn ation'was' roviiied"ti the owner,,,occu ant °or Board of Heaith' ; p. 9 I? y p.. 11 � ,u a arty of the system ccsmprsnents pumped out r%the previous two weeks' °� f :- ❑' Has the"system received normal flmus m the previous#wo week penod2x <Havelei ge volumes'r#virater;been in#rodu>rsd#o the sys#em recently ores part'of r, i F ® th lnspectlz�r�? w h xy �:. g3 s Were asbullt plans of the system"ot#alnedand examinsri7{If they were not n r 'M� ' avallabte note as:NIA) - 4 5 w Was tti"e- clii#y or dwelling Iraspec#ed for signs of sewag ;,back up? 3 x 1lVas the site lnspectei fON ort signs of t3l=eak out?z� 3 ' g ❑; (1TUere sll sys#ertl cppc� ben ts,excitacling the SAS,`zkxter on site? .q y°` � 1 �^ �`• Y "' ,kNere fire septic,tank manhales`uiicovefd,°opened,and=the interior of°the tank ;. r nspec#ezi for the cond lilanofi the baffles crrtees,"rnatenat:c►f constric#iiin, tllrrtensons,depth of Mould,:depth©f sludge and depth oifscum7 ,Was the facility owner{and occupants!f deferent from ovuner)provided with ®N -in orm"ati n on"the proper maintenance of subsurface sev age disposal systems The able andtlatlon of the Soil Absol~ptlon System:.{SAS}can the site has (s a. been d�?tetined based # ` �f f ❑� xlst!!1g lnfomratlon,.For exarripie, a;plan at the Board of Health. : r xr j to 'the f e Pati f f L. !s at Issue. R S ro , approxirn;ttlonidistaneisnaceptabf e1C'ClylR 1a3d2{a) 1hY s <x^ y dim llfi+�rmaton * ' A r on on d _ , k Nurnkre of bedrooms{d3. esign) =z Nrimtr of bedroomsre{eetuai) 3 U pEalGi flow based gran 10; IVIR 1 d3;(for exemple 11tt gpd x#rsf ettroams): 30 z a * b a e , mv F r R i €: r Ki ` iSih6f13 �?, Tt16$OffiGHl MSp0F1Wl Form of 17 era ;- " �` a# rs F 4 P... [ f v t v421, s z _ Coimmorv�re�lthofAa4*ustts t pit ffiia �lnpction 'trm ' RSubsurf�tce Sev+rag�pttpo1 Sys#etrr Farm;: Ndt:fpr Voluiritary Assessments: , x a 9i 1 P�#cher"s�1Va H annis t Pra a Addrg .r r " x w OWnf oSfiiner8 NBCn 3n#ormatfon!S r a ja > , tequtreti far every 911`Pt#cher's VNNay lyanrns MA 121190 1 V2511S k p ' Ry11 bwn r - Sttate'4 Ztp Cody pate taf; nspecfitin �� ` f d. 5�ste Irifari �ti�in P, It �erJCrlp#!on i' f{ `,SaA �� J' �{ Y t A, S g M'1! ,� z � qa umb�rhof ctarrent=restden#s & T � � ads 40oes res�denip avei; garbage gnn er?; .❑ Yet No , his launtlry on a separate sevwage system'�,(lnciude laundry system �nspecttari ; � Yes No ���,n�rmhon � °ri°�. S t Laundry systemx�nspected?` ❑ Yes ❑ No 6 : s Seaorial use? . '[ Ye"s ® Rlo ° z k 1Ma r rr�eter readings,t#auailbfe(last2 yeaCs-usage{9pd)} P�� 07, Won- � N+ y Sump pump 3 ❑ No Y 7� b a Last date of oixupoY to ant v u it Cw�oi1'itt18TC�t�UIi1l�U8r�81 � �+otldrtirttns d i a c F a r + 3 sg t Type ntE Estpbltshmen# �--- t ��� 17s�giflow{based4+an10 CHAR >a 2t# )a = t tv Mv , r Cations per dray{gpd) r J Sans o design flraw{seatsdpers�snslsq#t.;;eta.).- p f pa 2 1ndu a!waste holdjng tank present? Yes ❑ mm : § Non sn�#ary"waste d�arged,to'the title system?r © Yrs ❑ No a 4 3 UVa#er.me#er CeBd' ,if ava�iabl r _. s r+s�31 3 c r - 7ito'b bfF(t n Karin:5 wfaos Sewsge,0spossi System Pats Y of 77 rl ` fy f Ng 4 x `< �Cornmanwaal t of M�asmb sachus'ertts ' ��� _ T1e5 } ficil Inspetior � �►rrn ` �k5ubsurfa�i (Sewage�3isp+�sl System iFarnri; Not.for,Voiuntary Assessments. i�11SPItCh6r%JWAyjNy8r11118 y, Ptnpertyr Address �., K t7wnser>r� {3umers Na T OfMIRIOAIS- �y 4 rewired for eve+,d911 Pitctiei's V11eyy Nyafinrs Nl 2609� . 11125116 F� �° page x��� GltytlTcrum � � dip Ct�dB `�'3a#�i of lrisps�i�sfl x 'Stste; D S s't 0- 'atf date of odbWPA tii use:% Gurrefit' �" u _; yaq _ yY rA W N' Gs YYVVi� j Mr P def er8l kifairnatt n. NP -`2 ,✓ �' r 3 r Pump ngRetPWL Ms ' ; SCbWt"C O 1nfi5im 18ti41 goly d ry " a ` Ullas syste m pumWk. part (the inspect on? Q,Y ® " No tf qs,�N'0'1Wme Wm �� � Novu uuas c}W> ntrt�rpumped rletennined?: X i ' ° � � Reasnfior pmpyng W g of Sys#+gym AW ` b Sepik tank distiibWtio box so:absorptiofi. Y �y _ -� r = <#,, s stem Singie csspovt �a flV r oW CEsspop. y ka� ` ❑ Shared S stem gs ar no If" es attach' revioWS Ifis t'ctiOfi rerx3rdS Iffi t p Y, (Y, ){ ye i p P +) G tnnrsrratrvalAlterr�at�v$techfiaiogy,Attach a copy i�f,the current operattofi and ^ r, �. maintenance contract{to'be.obtained from systerrt„owner).and ccipy of i�test u N,, �nsection,of the IJA system by systiriri o}�ratar Wader contract tangy Attacha c opy'of the C1EP approval;: E , �s ; ©ttaer{descnbe)', gg�tN t Commbhw, r 1#�of Ma thus+ t#s' i", z�� �ytx��`k�in��i � <Y��� ����i�s�� ��1/►�� ... SDI x y ¢Sulri�urfacf a Sewage pltpittel f5ya�ten Fiorrrr. Not for Voluntary I!AsseSrsrrtEEnt$' t �r r��y�y.��r a 911:��tCf18�`S VilBy 'H�te�r�i�1S b ' P. x r rPrOp8ltyl�ttld[1$S # �. teen . �,��,,,� � rtj equ far every 911'P�tctter�s UVay Wanrtls MA 02601 '11125116 7' GityJl cwn Stag dip Codjt: F�Clate of lnspsction az e rf dx . S�'S@t>`f'�CtOtt1ICit (c©rtt )x yg ;Approxjmete age C)f ali txarxiporrierlts;(i8te'tl5taliE'ci(if knwn)antl source of,irifiorrnation; 3. l � F ` a J 8w cw4.° v�ere S a`Od0 et rs r3 ,ectecl when;amv ng site? � `(es N6 t x e Bulldlrtg Sewer{ioteteaon°site plan}. / Ft WMM"""'d ow - .t � -- % s ,rMetenal sffconsiruct�an A pother(explein)..' yY Defence from pnvate wa#er su I well.or suo#soh din€ € a ppy 1 q, t comments{on coed twn of jt�irsts,ven#09"..ev derice .5 77 OWN 12M�,RR a ! " a a Septic Teak(loCatt'x,orlySte plan) n Depth"k*li�w_grace 12 z feet : £Material t�f cbnstructlon h&E' , FP xZ ��L7iiJ'�alRxrc' rietai,n • --:Q t'ibergiass`' [ pofij+e#hylone:. 4 Q other.(explain) i ma j r " i gxIf teak is metl,list age 4 age-donrfrmed bya Ce> fioete3gCt�ml�ance?;(attach a copy c�fycerttrcat ) � h ,€D1meCt Mons �101�q G 31 i u g f� ty� e' Gl lvpt f.. ZIP F1 Y Y Y $ # i t 3it3 tea!jnspe n Ftsm:Suhswfe Sswagg Clisposa!System`,Peke 9 t 9] f aP' } 1 4 rF 7T, Comq�monw ll th of Mass chin ttsxa ��E' a :� x • t� w w T a c nsp►ecti, I F Of�Y "°f Sul urface S�awage Dl pa al System or�ti', Naf fir llaiuntary A ssitments": t g11`Pjtatier'S Way; Hyannis P000, ,dress , � � f `� lam b � r <eq rear every �11'PttChet'5 UV8y3HyanrnS MA ty _2609�I2�16 p8ge G4tyJTaWt! x" StetB- Z!p Cod+e' t7ate of 1t�spetaint } a a s 3 D, Sstmin>nrttt�ortcart } �� � geptia?ank�(cant,:j t Pp y j ? D�stanre frarr%ti�p of=slutlge toSbattom of outlet tee ar baffle <�� r r 3 rE $CtJrrl:thiCknes'S D r' of1 t ' rata nam`ttap af"sc .��� ;©tstan fiarr battor �of to� _ tm of auttet ee arebaffle x€�� ���� �3 �.•�'" s � measured#/ 5 a Hair were dimensroris determrned?=A ff "N. atT1tY18ntS(�3tt OUtYi(�Int� TYiIiISEt{�e"lti ff}S, Irll�t c�rli9�3Utf�'1 t �'Or tf8ffl COnLl1ha11,rSt1'uc re"#I Ir1tL'C,JiI� 9 G' � ;hqu�ctlovels,a rafted tt)auet.lrivert,avdance cif aakae, etc:}r �� Tank�ri aatl candit�cnautlet Tea is riisn i 9 % # iv F rx r a j Al ' Greas Trap(locate on ante p!anj:ng '` k s �. t f ©epthfbelaw rade r teat' P F. PW � � nStru s �-.1111.,3 k p. f xQ cararete ;jQ metal`9. [ fiberglass Q polytnylene 'C at#ier{explain) g s e e ^kA! •Y •�''fix�� °; x e A, . r �u g�� grteS c - ! k r d s i�istanowL M tap of sctstn Xg trs tap.,of autlet'tee ar•baffle`" ' ., v '" = A a Iistantfram batta�trt of scum to txttam,of auttet tee or Craifie b � s fi s , � ©ate of last pumping41 date ,: ► �� its k Tate s btfi lmspecllona7n Suta�5wwage Dispose!system%3��a an W 1r r k z Ccet�monwealth of asach use fts k �� ubsurfac Sewage pispaai Systt + Forms Nat;ftr Voluntary Assessments; r y .., S i 911;Pttcheris V11ay Hyannis Ptt1p81'iy Ad$ k ,,� � q. .�su✓ t la�n,A�Da� n�. 4 � v Clwnsr'e!dam � �6��nfnmiaUan� .� � ,� required for every 91y1.Prtcher"s WaY Hyartms MA . Q26fl1 11125/16 p C�tylTown State'" dip Cotle: a3ate t�fnspedion kt, } C3.R;Systm Inforrratl<8n (cort) x y� nth n j y�ey j, /� Spey y+�.pyy..}} r� y� } r p 7 ;:Comtnin#s{aft puft"I1ng recommendat�ans, inlet�,nd atltlEt#ee or baffle candtlon,,w�t1:4iLirGal=irltEgrlty;fi .�c i�qutd le ""it,;eyitence of leakage,ettr`j: I. a z a q °� Tight or Haiding,,Ta�nk of�{tsrk must beump at-time mspect►on}'{iacate,an s#e.pan) ; r .`Npth`belowv�grade A ate e'1l oorsuctan.. E 4 ®concrete, x.Q metal.; ®tb less of etl !aria o#h ex pain ; -q z" r u' 9 ©p Y Y CJ { p ) s x ft n FRI t... -,. .. i $ y t t t�es�gri Flom £ 6110ns.lmr.t8 �x x 1�y Alarm presetlt, Yss [ ' No: V ,,1. !e Al arm,i 11��n�� r.^. f of 4S pl 1pr ; LZM t)attF' ' s Gcamments{cond�tior of alarmwand float svi+rtches etc.).. „ , g zY y& Xt jIN— z ay s j ##acl cr y ofi currer t p6 pIn9;t ntrae#'{r qulred),ls'r py attaotr ri?r < [ Yes M, [ l+ia= 6 K 1 i5na 3t�3 p Twe S"Offic ai i Form:Siibsitttaa9 Sr wB Dasp(rsgt Syst�utt+Pie a1 of l7 j gP R, 1.. 1f"MonwoAh",'. Psa'�i�\I �V® F' - SubaurFac+ra SeYrtag �Dis " 1"Syst+ ri Form Nat far Voluntary As5es5rerits , of !� a ; i x, 531�Pitcner's Wa H" nni5 r Property Address° v }�lain A E sH9'>�'��y�n�yPrrq,y����w un V9Y71i7{���Ille � � .y .. ,.. • ..' .. �. ���,tnfnrmatr�r}rvS 3 requ re fibr e+iery g11 Pitcher's Way;Hyanrars MA 02601 11125!'6 �� �#�age �� CI�rlToutm 4 State. � ,�rpCt�tle� [l�tpafi`r�spe�tion .: � , Y z D: ysf `m lnfolrrnatl<on ( "dh } f s t M Deptlj cif liquid levet above outteVinvert, y, Iromments{Hate rf bcix rs level and arstrrb'bbrt Wbutldts equal;any euldeppe.af 5raalic9 carryover,any ` sr v ovrdence of,leakage ntc�For-out F ' e 5 .. ,FI A R3 �, � r • NA I s k5 � VM al R „. HE f :` Pumpa�nnberr{locateon srte•pina' l ✓d MIK,�,,-,TRWAN, %�� Pumps rn working oMer :a Ql YesN ❑ 4 x T Y a Alarms`rnKworkrngFofder '; ❑ Yes ❑ Nod H Cc�mrnrrnts{riots canditron>of pump chamter,.corrdr#ton of pumps and appurtenances; y + r v -01 14 Ri a % t � 4 F z 3�� r f rr3 *If pumpsfor alarms:are not in worlring order, system �s a conditional, ass a p str'1t Ab�til fl`tott SysIr�Blrt${SAS)`(lacate on site plan, excavaticmil nbt requlrear c �' If SAS;not tracked,a cplain Fiuhy: a § �� A r r 'd 6 t { ' £ t5irre 3rf3 £' c' y.' r t9 5 Ofl is Fium:5ubsaut8te�Disposal System�Page 12 of 17 4 ,. "N_ �' �' , .. •� i l fr Commonwealth of Nlas�achus etw s � t + 5 frFn; tr ►n `corm , � Sul urface Sev�rage�Cfispo ai System.Form-1Vat"forVasuntary:Assessmen PropertyAWTO lasn A Da �� Ch+dnerP d owner's Mains w x e r �rt�ormatlon WAs � rsd#�r everyhes U1Jay, Hyannis state `�Z P Code Date a).nson r , ©:System Intorrratan. t T�/� ; � .. leachtn its number; e [] leaching chambers nut i er YT & ❑ leachrtg gallenes` number.. P " $ r u.leaching liresiches:,- numbr,'lengtb: , -: Cl leachingeeldsn< number, dimensions x r f ❑ averElcsav ceSSpoa1 num% ber. y innavabve/alternat�ve sySterrt Typ�lname<oftechnalogy- `R fkls� ;� Comrrients��{y�/a�te condition of sail,srgns�af hyds ulic failure, level of ponding,A' s isl„coeds on of pfvegetatian,atd „ ,77 �� r 1 ieachs �#an ok condabon, I Ad;level 2'+! below invert: r _ Y a fr. ss 77 , sm J. r : µ ,f �Ces�spoo s{ SOO must be pumped as par#of inspec#son);{locate on site'plan) I' X ftmb r and caiifiguratwn'. 4 Devt pth', top df li'usd,�inlet invert', 4 a ,-Depth of solids layer'IN `... } Y l 5:1ptlut i,lY1 `r'r. fro• $ ,S 4 q Y..,- «. , Dlsrssans of Cesspool ,t f t+watenalS of const(v tiara " f lndtc tson of round ater tr fla v ©, Yes :❑�N ` , 61 is,g 3/13 True S Otr Mspedlon Fmtt1&ntssuAaoe Sewage CNsposai Syslam i3017 s' P: z r � r Commonwealth of Massachusetts fbft dttoh k Subsurface Sewage Oipaaf System Formi: tVat for Voluntary Assessments ' �3 9 i 1 Pitcher"s Way, Hyannis 3 lam=ArDay p E iQwnr flw(tsr 8 Name nformatibri is t �equir for 8vef� 911 Pa#che s Weyy Hyannis A b 01 . 11 5116 b ' p >�e citylTown Staff: Zap Caie= Bate af�inspediora D. Systpm"A' ormatron (cons;): * r Comments.(no#e co0tion;of sai,signs.ofi`hydraulac.failu�e,:level of,pandiryg,conditign of vegetatian, F p i --------------- x t w x x Privy(lacateon stteplanj r ;D1tYtenSiOnS Depwbf solidi n � r ; Comr�i ntS{note aynd�tion of Soil,,signs of,hydraulic feilUre, level of'•pondingw:rtcand�tian of vegetation, gg Rg � sJ A � .� h r , u s Ap;.,;. 1 I'S ago s d ME t � 3J4931. T619 5 GHQ inspection form.,SubsuNace Sewage t3lapoi4si System+Page 14' 17 a ]r A� .'' S>CairaEtmair�y vealt t`of A� ach �s�atts � e Xrsec �►nFor NV{.fb 1F dIun'to i l ✓h's .rs�bs3 sat} l: & y 7 ���� � z� �91� Fitrtter'sW�ly.Hystttlr� 1 � laiwk M Vyy;NyBnrrr$ t�dyl�Ay i�2/iMjX� }112`�cI i 5 OR, 1{y`� a ,-. Sketch t3ieDspcsai System Provide a view of ttre sewage tirs6sai system, rnciudtng ties to ; E at i tvva ie�rnn� rt�t'referent iaridrTtarkS ar be hiYteft°Locati a weds wi#h ieeL Locate . f .°� "wh'ere Pubirc'wa r suppty'enters the;ti iridrng:;Chic t�rre.af ths..baa es i i w TO s « x s r 1 ce x` z '�a � �.� // r = t .;_mot 'z �y♦ - � _ a , L �w .���'�'bz�`{°b$ C "'� i:•f. ,X { $; "a 'fit N f i �f .a�`r�i� r� ✓ � � S � s % } ✓.. _ ' M ir '. .. 5 .. r� � � Y m r =3&l` a"��' ,f r 4r•�'�, B ��z. � � � 7� t A a i > S x f fie, FW Rp >` � 4:0 f Cammanweal ofssacius ►tt a � � { ►fifcl. npctan Fc�rrn t $u( i1YIPaCi@ Sewi3ge C1i8uparal°System Farm Not for Voluntary l4ssassrril2r ts; 4 � 4 i ....... Hyannis � � FrOpertY A � ddress =lain'A Qa F_ w 4,7 fYtBt F r . x!:Nmt 8 Na'mOs 4, tpinfOrmation t5 t �z uireci ior4eVey $'f 1 Pitchef's Wa' H aftiils ' AM 02601 11t25118 . , ' � �;�� ��� ,City/TOwtt ��' dip COd�r; �Qate Of Inspection D.;S stem Imor�rll latian y -- x t w �a'(L21 A Check t7�L!ft S F. ® Surtac8{Naf4 Cellar (y, Fl� ma`lo s ll € ( x l�stimeted depth to high ground water ' I � kease ltldlt:ate�aU tneftl ds°,used to de"ti�rrraine tt a high ground water elevat�ori.; 2 »SFr s ;SU tamed from system iesign plans on retx�rd < OR lf oheckeci,bate of design plan3reviewed ante - x = yF "WAI � `©bsarveti Sl�(abutting propertyJtibservatlor hole unthin 'i"5t}feet:of SASj x fi Q Checked with local^Bc3aird of Health :explain':: • © Checked.with local exca`v`ators, instailers-(a#tach,�iocufnentatiori) ex 'A iessed U&GS database explain;;. 'N �°^' F+ k _ a y22�r d - .:. .....w..�... .;. .meµ, .W:.::........ R�h „� de5€Ctll}e how yrfU^estat3lished the high,grOialid wat@r elevahan V. t f h1 5 f Fr 'er p{�r�eVi�opugawr��inspect�, j�n/�r{e�pc�rt by EAS Sur~rsy lnc Fland augerl 3'below prt noMroud;vvaer� t'� £ Y ft �., enrountered V�yil,atREleVi' tiott _�� 'sn •a ? FS. S 1 1 r ;xf: , Ty r m '1 ' 40, r ' s �> , Bfarlinthis ine+ tion R+epoit,gptease s Rpor#`Cr�rripleten+assr"Chekiist crri ri+�x#/page 4 ' i5+n 3#43 , e 7€tle 5 tNYiiaai kmcUon Fmm,.SubBurfi�Ce,Sgvrage.D+s�osal3yse�n•'Page 6 60T a4 xh ya:av, iw . O nmOt weal #t cf ass c usetts d ■ r. } T �t1ei ff + i nsption :lFcrni i Scut eu�fa a Sewage Ois l System l=orm 4 Nat:# r a�l�nt ry Asses merit F ; "` 911;Pitcher`sWay Hyariiis <� P Al" lam A D Wfi a N4tY18 1 � ��nformat�on i , L ret;uiresd fot every 1 V.PftCh- Way; My hni5 NIA t MO 11125/16 pegs `4 Ci y/(own State dip t +e•" 138te of 1+�siiion E..' teprtFC� � . : . mpleteness Checklist 4 ,zf ® lnsctiari Surr�rary A,x'B,C,I ,ar rvheck ' ;® lns op On`S mrirtery D Syster Pailuia Cate i App icebl+r to A1f Systems)ao ttpleted t ,Sys#em:ir fiarma#ian-�_ttimate f rlep#h`to high rnun iv}r�ate sketch o Sewega D sposal'System�e then drawn,an,pages 1'5 ar eftchlbd' separate ale x << ° F F° •spl% /n'.!fit. -r`w"' yk _:.•y :.y 5� 0.. 4 r m} Y S x ! , u x t � t 4 Y / x - �" r z r , ' el 3� az r x� �F� ✓+r v€ � as e ' 4 s, I r rr y @ a x y i € IN Ex;, a ✓y,fza`x $ r - t5lns St13 `'TaNe Shciei lnsadfon Fo 17 of 17 r c s s , K S COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL-AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ►VIAP Z, . PARCEL LOT f 2 TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS s SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A. CERTIFICATION Property Address: / i ��s IL ; RECEIVED owner's Name: joh. Davills cn Owner's,4dd,,ess: E 4-c.ke 1`to1 APR 2 0 2004 Date of Inspection: 4 y O TOWN OF BARNSTABLE Name of Inspector: lease print *Sri*Sribn JS.7.1411 HEALTH DEPT. Company Name: C Malling Address: — CandLZ0,.j ]jr-. Fay HOL► 24g2 Telephone Number: SOS— 2:<-!C-93 q3 ``GERT-IFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Sec 'on 15.340 of Title 5(310 CMR 15.000). The system: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: ks��� Date: �b 0 The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments ""This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page I Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A nn CERTIFICATION(continued) Property Address: � t'! fG4e✓S Wftw_ Owner: Date of Inspection: Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System P sses: 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; • / C UN& /�tle • �_ J a✓ i (Woks • 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. _ 1 Answer yes,no or not determined(Y,N,ND)in the for the following statements.If"not determined"please jIV 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 ex&ttration 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 T 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: Title 5 Inspection Form 6/15/2000 2 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: Owner: Date of Inspection: 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 I 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 1 - 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: Title 5 Inspection Form 6/15/2000 3 Page 4 of i l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: j/ IS Owner: Date of Inspection• D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No _ V 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 0.clogged SAS or cesspool V Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or OOK cesspool _ ` Liquid depth in cesspool is less than 6"below invert or available volume is less than'/z day flow LZRequired pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number ✓of times pumped My 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 }'Ater supply. _ ✓Any portion of a cesspool or privy is within a Zone 1 of a public well. _ ZAny 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 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.] N(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 Il 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 II 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. Title 5 Inspection Form 6/15/2000 4 Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 911 car Owner: Date of Inspection: 4/4167 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes o `/Pumping information was provided by the owner,occupant,or Board of Health V 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 T�Have large volumes of water been introduced to the system recently or as part of this inspection? T Were as built plans of the system obtained and examined?(if they were not available note as NIA) ✓ Was the facility or dwelling inspected for signs of sewage back up? Was the site inspected for signs of break out? . I v 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 ba es 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 infonauation 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/�o Existing information.For example,a plan at the Board of Health. V Determined in the field(if any of the faihute criteria related to Part C is at issue approximation of distance is unaeceptable)13 10 CMR 15.302(3)(b)] 5 Title 5 Inspection Form 6/1512M Page 6 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: — —M--� Owner: Date of Inspection:_ FLOW CONDITIONS RESIDENTIAL 2 Number of bedrooms(design): 3 Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms):33 D Number of current residents: 2- Does residence have a garbage grinder(yes or no): � Is laundry on a separate sewage system(yes or no):00[if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use:(yes or no):-O Water meter readings,if available(last 2 years usage(gpd)): Sump pump(yes or no): Last date of occupancy: COMMERCIALANDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no): _ Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use:, OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: ��� Was system pumped as part of the inspection(yes or no): If yes,volume pumped:_—gallons--How was quantity pumped determined? Reason for pumping: TYPFj F SYSTEM _peptic 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): Approximate age of all components,date installed(if known)and source of information: Uri lex�owy� Were sewage odors detected when arriving at the site(yes or no): Title 5 Inspection Form 6/15/2000 6 Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C q"SYSTEM INFORMATION(continued) Property Address:��� �lY c�•4J5 ! o''`' Owner-. Date of Inspection• _ BUILDING SEWER(locate on site plan) I/ Depth below grade: L Materials of construction:_cast iron _4✓0 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evide�nee of leakage,etc.): PC2 y;aT c :SL Ls�k�hu ►r.�ac,'t•. SEPTIC TANK: _(locate on site plan) Depth below grade: Material of construction:_ o�-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) r Dimensions: 6I's 1(4 /oa x 4: Sludge depth: 9 61 Distance from top o sludge to bottom of outlet tee or baffle: Scum thickness: Distance from top of scum to top of outlet tee or baffle:�_ It Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensions determined: D i P ie�C � a She-k h1�raof AU'KVY�' j. Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc. : aryeA 2 ulw 1 SCu r_ GREASE TRAP:_(locate on site plan) Depth below grade:_.. Material of construction:_concrete_.metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: ` Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Title 5 Inspection Form 6/15/2000 7 f Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: / "W lkky O"er• Date of Inspection: 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): t,J 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:—(if present must be opened)(locate on site plan) I Depth of liquid level above 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.): 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.): Title 5 Inspection Form 6/15/2000 8 Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS , SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: Date of Inspection: Afilbf SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: _.,.leaching chambers,number: _leaching galleries,number:_ leaching trenches,number,length: 'leaching fields,number,dimensions:, overflow cesspool,number: _innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, . etc.): t VI to"Pei �; j No �sl;" �s'c-�C VD OY �lv Se t d Ca vro�.ws 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 or no):' Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: (locate on site plan) N I Materials of construction: Dimensions: Depth of solids: Comments(note condition-of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): f Title 5 Inspection Form 6/15/2000 9 Page 10 of 11 OFFICIAL INSPECTION FORM-,NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: "?// r/ X#V3 �A'a✓f Owner: Date of Inspection:. _ SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public,water supply enters the building. NOT To SCALD \AoOs� �e,j' A of 20 12ei4. 1 2' NO wader 400 ig.TAsK a A - I 23� 3 9- 1 25 A - Z 29 � g - Z Zo/ e = 3 10 Title 5 Inspection Form 6l15J2000- Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) tY P Pro er Address: q11 nle/ J t S Owner: dK Date of Inspection: , SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 'Z+- feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: _Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: hecked with local excavators,installers-(attach docum tation) Accessed USGS database-ex pl ain: tr . i You must describe how you established the hi ground water elevation: A Z t b aw (c , Title 5 Inspection Form 6/15/2000 11 7.4-no, .. ;:�ff'Cn;� :';(-;3t;` �f HLW 23 '� _ ! NIW __ _ �GCW 168 r N Y '�� r XNW 19 TRW 13 r ESSE.. + t� CSWB -TA .. - _. _ iowAl�TM....3 �`. W 4G2 �VPV�/7 i "` + :)` CJ W �-y iS� . 1 � f FRAIIAL N ORW 63 HW 384X ' 4M XHMW a �OF 44 t BCW 36,m�w W�CE.,. __ I.�t � ._..._.__�_ �R PTW 51 ( SCYW 3 S6W f 9GW 7`--"_ YW 641% "C 167 1 _ 14 SYW 177TW tq4 gw t..�- J CTW 165 PC N 214 HHW 31 WSW 26 WSW 2 51iQULE;t:X i'� HAPAPSHiRE HHW 1 BKWyB7 13ERKSHtYii f WXW 20 POW 23 HRW 169 ySW 27 - 12 WKW RU6Al IV 12 / UW 10 �XSW 27 ;�V�GMW 2 �,,/, 4112 W GS r,,,.✓' CuW �~ 'lf XGW f' nrw7 1� �" N1,�.SS.1C�1.�;5 ;TT' b XG 4 BEW 9 �C W 9 UDW 31 XGW 2 NORFOLK WW 62 NXw54 NNW 27 D4 79 SJW 58 GLW 5 HAAIPDEN XW HGW 76 SW 1 __ .M. . LgSVW 95 �WLW 1 _ ry� 2 `EBw 30 D4WV i Y t 89 BO 396�: BUW 18 :&UV2B5 } MT'W 82 ^ 4 BUW 397 PWW 22'7 '° 'WNW 17 BUW 3 , UW 39 L I F 0118117Ef 'E y 136 TAW�37 INLKW 14� is wr t (?:.+ r 1. III )DE I�PRW�6 S FLl'MOUTH ;t. i BMW22 t'l SHW275 13 EXPLANATION Fpw2so 43 wFws,!_. DW252 ,BnRwz1i4' FOW4 ,rd �t ��,` — s GMW 2 COW 34 nw 4 WC,'MI f NGW 1�qE �y.� HW 1'.8 p1 W 247 136 a� BkiSTO. Al �230,u '' OBSERVATION WELL AND LOCAL WELL NUMBER WGW 18,�c >,�4.1h;. 1�'- t w Dz53 .... ,? i KEN''��WpG G �....nU-£S'', rb• 3_a: d BAR STV/1, PTW51 R EXW t5` "'"XVJ 3 , Q51�IW�27 +��, ^t1;:;: ,MIW2 OBSERVATION WELL WITH RECORDER AND Exwa7sXW:55 - � `` fit; LOCAL WELL NUMBER HpW 67 X Yf SIJE E g�LTiw 1;2 RIW G00 N����a ✓�,, RI jA, NC'1'O!J 1"SNw515 �n:� ri?ulrr. r 1 Ct W 587 CHIV 586 RIW 417 ! ` WE 522 ' "'i -P - ENW 52- p 10 2D 3t1 4U $U�11LTS ��'- HW �,}1 4 t_'I"_"�_'T'_rT_—`_— l�I�• �t-)L` '�? .._Y„NB,W228 0 1U 20 30 41) 31)KfLn11T:TFRS + ,.*IHW 258 SUMMARY OF GROUND-WATER LEVELS MARCH 2O04 PROVISIONAL (NOTE: Wells with * also available in real-time at top of•Ground-Water Data page; OWc, monthly measured value used in high ground-water level estimation report, USGS Open-File Report 80-1205. ) WELL L START NET CHANGE DEPARTURE WATER LEVEL T I YEAR IN MONTH IN ONE FROM BELOW LAND- 0 T OF YEAR MONTHLY SURFACE P H RECORD MEDIAN DATUM 0 0 tows) (FEET) (FEET) (FEET) (FEET) DAY MASSACHUSETTS ACTON 158 * TS 1965 - 0.15 - 1.35 - 0.71 18.72 31 ANDOVER 462 VS 1968 + 0.08 - 0.66 - 1.06 15.37 30 ATTLEBORO 83 VS 1964 + .0.18 - 0.88 - 0.54 3.81 29 C7 BARNSTABLE 230 FS 1957 ------ - 1.72 - 0:91 23.98 23 a C7 BARNSTABLE 247 FS 1962 - 0.13 + 0.32 - 0.24 24.43 23 O BECKET 12 TS 1986 + 0.28 - 0.95 + 0.02 3..25 24 BILLERICA 363 HS 1962 + 0.86 - 2.08 - 4.75 8.97 30 BLANDFORD 9 VS 1986 + 0.28 - 0.59 + 0.13 2.09 24 BOURNE 198 FS 1962 - 0.26 - 1.15 - 1.30 33.72 24 BREWSTER 21 FS 1962 - 0.05 + 1.27 - 0.32 10.35 24 BREWSTER 22 * FS 1962 - 0.08 - 0.26 - 0.33 31.30 31 CHATHAM 138 FS 1962 - 0.13 - 0.65 + 0.24 23.25 24 CHESHIRE 2 HT 1951 + 4.50 - 3.26 - 0.93 3.69 24 CHICOPEE 95 TS 1984 - 0.44 + 1.68 - 0.23 21.76 23 COLRAIN 8 VS 1965 - 0.59 - 1.80 - 1.25 18.95 23 CONCORD 165 TS 1965 - 0.22 + 1.18 - 1.49 43.53 29 CONCORD 167 TS 1965 + 0.59 - 1.65 - 2.02 7.91 29 CUMMINGTON 13 VS 1986 + 0.136 - 2.48 0.84 4.89 24 DEDHAM 231 ST 1965 ------ - 0.92 - 1.01 5.62 29 DEERFIELD 44 VS 1965 + 0.12 - 0.23 + 0.04 2.38 24 DOVER 10 TS 1965 =----- 1.30 - 1.29 33.46 29 DUXBURY 79 * VS 1965 + 0.13 - 1.03 - 0.22 8.02 31 DUXBURY 80 VR 1965 + 0.05 - 0.71 - 0.09 21.50 26 EAST BRIDGEWATER 30 HT 1958 + 1.20 ' - 3.59 - 3.18 7.90 26 EDGARTOWN 52 VS 1976 - 0.01 + 0.35 + 0.78 17.75 26 ; FOXBOROUGH 3 TS 1965 - 0.05 - 0.97 - 0.86 18.95 29 FREETOWN 23 'TS 1964 - 0.26 - 0.55 - 0.70 13.81 29 GEORGETOWN 168 VS 1965 + 0.54 - 0.86 - 0.57 4.23 30 GRANBY 68 VS 1954 + 0.02 - 0.98 - 0.97 7.27 25 GRANVILLE 5 TS 1965 - 0.73 + 2.09 + 1.59 31.73 23 GRANVILLE 6 SS 1965 + 1.00 ------ - 1.79 5.00 23 GREAT BARRINGTON 2 VT 1951 + 1.83 - 1.31 1.27 8.80 23 HANSON 76 VS 1964 + 0.11 - 0.47 - 0.58 4.68 26 HARDWICK 1 TS 1965 + 0.94 - 4.24 - 1.91 14.15 27 HARDWICK 31 TS 1984 ------ ------ ------ ------ HAVERHILL 23 TS 1960 .0.28 - 2.08 - 2.59 12.94 30 HAWLEY 8 ST 1986 + 0.24 - 0.89 + 0.24 3.26 24 LAKEVILLE 14 * TS 1964 + 0.38 + 1.71 + 0.56 13.29 31 •LEXINGTON 104 VS 1965 + 0,71 - 0,41 + 0.25 1.72 29 Y MASHPEE 29 FS 1976 - 0.04 1.28 - 0.47 8.35 24 MIDDLEBOROUGH 82 VT 1965 - 0.32 - 4.52 - 4.52 9.13 26 MONTGOMERY 19 SS 1986 - 0.01 - 1.01 - 0.70 1.47 24 NANTUCKET 228 FS 1976 + 0.08 - 0.61 + 0.51 24.94 26 NEW BEDFORD 116 VS 1964- + 0.18 1.19 - 0.38 4.05 29 http-Hma.water.usgs.gov/cuffeiit-cond/data/2004-03.txt 4/14/200� f 5 NEWBURY 27 VT 1965 + 1.18 - 4.17 - 1.60 6.31 30 SUMMARY OF GROUND-WATER LEVELS MARCH 2O04 PROVISIONAL (NOTE: Wells with * also available in real-time at top of Ground-Water Data page; OWc, monthly measured value used in high ground-water level estimation report, USGS Open-File Report 80-1205. ) WELL L START NET CHANGE DEPARTURE WATER LEVEL T I OF IN MONTH IN ONE FROM BELOW LAND- 0 T RECORD YEAR MONTHLY SURFACE P H MEDIAN DATUM 0 D (OWC) (FEET) (FEET) (FEET) (FEET) DAY a MASSACHUSETTS (CONTINUED) NORFOLK 27 * VS 1965 + 0.34 - 1.24 - 0.47 6.11 31 NORTHBRIDGE 54 VS 1984 - 0.01 - 0.65 - 0.25 4.23 27 NORTON 37 FS 1964 + 1.05 - 2.15 - 1.35 6.86 26 ORANGE 63 TS 1985 - 0.10 - 1.83 - 0. 50 7.50 24 OTIS 7 VS 1965 + 0.96 - 2.18 - 1.13 7.90 23 PELHAM 23 * SR 1984 + 0.57 - 2.66 - 2.77 14.57 31 PELHAM 24 SS 1984 + 1.10 - 0.55 0.56 3.32 30 PETERSHAM 16 ST 1984 ------ ------ ------ ------ PITTSFIELD 51 * VS 1963 + 1.23 - 0.96 - 0.15 14.82 31 PLYMOUTH 22 TS 1956 - 0.59 - 0.16 - 0.39 24.11 26 PLYMOUTH 494 SS 1985 - 0.34 + 1.01 + 0.25 30.03 26 SANDWICH 252 FS 1962 - 0.01 0.41 0.12 47.24 24 SANDWICH 253 FS 1962 - 0.08 + 1.51 - 0.71 50.59 24 SEEKONK 275 VS 1964 + 0.18 - 0.78 + 0.29 5.51 29 SHEFFIELD 58 FS i987 - 0.35 + 2.40 + 1.01 12.50 23 SOUTHBOROUGH 12 HT 1990 + 3.63 - 1.23 - 0.95 2.83 29 SOUTHWICK 95 TS 1986 - 0.22 - 0.31 - 0.45 3.08 23 STERLING 1 ST 1947 + 1.58 - 1.73 + 0.43 2.47 27 STERLING 177 SS 1995 + 0.36 - 1.04 - 0.81 14.39 < 27 SUNDERLAND 7 SS 1957 ------ ------ ----- ------ SUNDERLAND 68 VS 1983 ------ ------ ------ ------ TAUNTON 337 TS 1964 + 0.07 - 1.23 - 0.71 8.75 26 TEMPLETON 3 VS 1957 + 0.53 - 0.71 - 0.16 3.27 27 TOPSFIELD 1 HT 1936 + 1.08 - 3.57 - 2.52 11.17 30 TOWNSEND 13 TS 1965 + 0.12 + 0.46 + 0.02 12.96 30 TRURO 1 TS 1950 - 0.04 - 0.45 - 0.07 10.56 24 TRURO 89 TS 1962 + 0.04 - 0.90 - 0.50 12.15 24 WAKEFIELD 38 * FS 1965 + 0.33 - 1.87 - 0.94 6.77 31 - WARE 43 VS 1965 ------ ------ ------ ------ 0 WAREHAM 51 TS 1959 + 0.22 - 1.52 - 1.57 8.09 26 WAYLAND 2 TS 1965 + 0.16 - 0.90 - 0.69 16.09 29 WEBSTER 1' . HS 1958 + 0.23 - 1.11 - 0.99 14.48 27 WELLFLEET 17 VS 1962 ------ - 1.77 - 1.51 11.47 24 WENHAM 76 VS 1965 + 0.18 - 0.68 0.56 2.55 30 WEST BOYLSTON 26 SS 1995 + 1.10 - 3.45 - 2. 81 5.85 < 27 WEST BROOKFIELD 2 TS 1959 ------ ------ ------ ------ WESTHAMPTON 20 SS 1986 - 2.05 ------- - 1.81 12.57 24 WESTFIELD 62 SS 1957 - 0.43 - 2.04 - 1.72 7.72 25 WESTFIELD 152 TS 1986 - 0.21 - 0.69 + 0.23 2.86 25 http:7/ma.water.usgs.gcv/current con.d/data/2004 03.txt 4/14/20OZ WESTFORD 160 VS 2001 + 0.18 - 0.92 ------ 10.87 30 WEYMOUTH 2 FT 1965 + 1.24 - 3.51 - 3.10 10.60 30 WEYMOUTH 3 VS 1965 + 0.30 - 0.50 - 0.24 4.65 30 WEYMOUTH 4 TS 1965 + 0.71 - 0.76 - 0.34 6.46 30 WILBRAHAM 55 TS 1965 - 1.61 - 2.17 - 2.66 40.80 23 WILMINGTON 78 * FS 1951 + 0.41 - 2.00 - 1.72 8.22 31 WINCHENDON 13 ST 1939 + 1.93 - 1.23 - 0.81 4.24 27 WINCHESTER 14 ST 1940 + 3.66 - 2.09 - 1.90 10.02 30 SUMMARY OF GROUND-WATER LEVELS MARCH 2O04 PROVISIONAL (NOTE: Wells with * also available in real-time at top of Ground-Water Data page; OWc, monthly measured value used in high ground-water level estimation report, USGS Open-File Report 80-1205. ) WELL L START NET CHANGE DEPARTURE WATER LEVEL T I OF IN MONTH IN ONE FROM BELOW LAND- 0 T RECORD YEAR MONTHLY SURFACE P H MEDIAN DATUM O 0 (OWC) (FEET) (FEET) (FEET) (FEET) DAY RHODE ISLAND BURRILLVILLE 187 TS 1968 + 0.04 - 0.40 - 0.87 15.36 30 BURRILLVILLE 395 UT 1992 + 1.22 - 1.34 - 0.72 6.50 30 BURRILLVILLE 396 VT 1992 - 0.36 - 0.94 - 0.62 5.35 < 30 BURRILLVILLE 397 HT 1992 ------ - 3.67 - 5.31 16.78 30 ------ - - BURRILLVILLE .,98 HT 1992 1.39 1.34 7.91 < 30 CHARLESTOWN 18 FS 1946 - 0.17 - 2.19 - 2.23 18.31 30 CHARLESTOWN 586 VT 1992 + 0.03 - 0.39 - 0.19 3.67 30 CHARLESTOWN 587 ST 1992 + 1.10 - 2.38 - 2.92 7.34 30 COVENTRY 342 VS 1991 + 0.66 - 1. 44 - 1.42 8.56 30 COVENTRY 411 SS 1961 + 0.09 - 1.07 - 1.74 22.16 30 COVENTRY 466 VT 1992 + 0.12 - 0.49 - 0.44 2.88 < 30 CRANSTON CITY 439 ST 1992 0.20 - 5.86 - 4.91 14.78 25 CUMBERLAND 265 SS 1946 + 0.77 - 1.89 - 0.57 11.99 30 EXETER 6 VS 1948 + 0.08 - 0.76 - 0.80 5.61 30 EXETER 158 ST 1991 + 0.27 - 2.35 - 2.11 7.48 30 EXETER 238 FT 1991 + 0.21 - 0.91 - 0.72 11.92 < 30 EXETER 278 HT 1991 + 0.84 - 4.65 - 4.90 12.10 30' EXETER 475 VS 1981 - 0.24 - 0.51 - 1.28 14.54 30 EXETER 554 SS 1988 - 0.11 - 0.87 - 1.00 10.12 30 FOSTER 40 HT 1991 + 0.95 - 1.03 - 0.61 3.65 30 FOSTER 290 HT 1992 + 0.54 - 2.36 - 1.85 6.36 25 HOPKINTON 67 ST 1991 '+ 0.10 - 1.50 - 3.42 15.82 30 LINCOLN 84 VS 1946 + 0.34 - 1.73 - 1.32 5.13 30 LITTLE COMPTON 142 ST 1992 + 1.60 - 4.61 - 4.91 13.83 < 29 NEW SHOREHAM 258 UT 1991 + 0.39 - 0.78 - 0.54 11.32 29 NORTH KINGSTOWN 255 VS 1954 + 0.32 - 1.15 - 1.05 8.24 30 NORTH SMITHFIELD 21 TS 1947 + 0.98 - 1.46 - 0.56 6.92 30 PORTSMOUTH 551 HT 1992 + 3.11 - 5.63 - 7.60 37.14 < 30 PROVIDENCE 48 TS 1944 - 0.22 - 0.38 + 1.57 4.62 30 RICHMOND 417 VS 1976 + 0.06 - 0.68 - 0.41 6.51 30 RICHMOND 600* TS 1977 + 0.37 + 0.19 - 0.13 33.36 31 RICHMOND 785 FS 1989 - 0.48 - 0.54 - 0.80 24.58 30 http://ma.water.usas.gov/current cond/data/2004 03.txt 4/14/200 ta5v-rvi ' SOUTH KINGSTOWN 6 VS 1955 - 0.11 - 1.16 - 1.24 12.20 30 SOUTH KINGSTOWN 1198FS 1988 + 0.01 1.31 - 1:45 8.42 30 TIVERTON 274 TT 1990 + 0.66 - 0.29 - 0.32 1.29 30 WARWICK 59 ST 1991 + 0.18 - 0.67. 0.50 4.96 30 WESTERLY 522 FS 1969 + 0.21 - 0.64 - 0.92 12.36 30 WEST GREENWICH 181 US 1969 + 0.55 0.58 - 0.48 15.21 30 WEST GREENWICH 206 'ST 1991 + 0.18 - 0.53 - 0.30 3.97 30 --------------------------------------=---------------------------------------- >> SET NEW HIGH OR EQUALED HIGHEST RECORDED WATER LEVEL FOR PERIOD OF RECORD > SET NEW HIGH OR EQUALED HIGHEST RECORDED WATER LEVEL FOR END OF MARCH << SET NEW LOW OR EQUALED LOWEST.RECORDED WATER LEVEL FOR PERIOD OF RECORD < SET NEW LOW OR EQUALED LOWEST RECORDED WATER LEVEL FOR END OF MARCH ------ - DATA NOT AVAILABLE TOPOGRAPHIC (TOPO) SETTING: F=FLAT, G=FLOOD PLAIN, H=HILLTOP, S=HILLSIDE, T=TERRACE, U=UNDULATING, V=VALLEY, W=UPLAND DRAW LITHOLOGY (LITHO) : G=GRAVEL, R=ROCK, S=SAND, T=TILL CONTENTS OF MAJOR RESERVOIRS (ESTIMATED END OF MONTH READINGS) (MILLIONS OF CUBIC FEET) MONTH-END PERCENT OF PERCENT RESERVOIR CONTENTS AVERAGE FULL BORDEN BR + COBBLE MTN RES, MA 3127 116, 92 QUABBIN RESERVOIR, MA 51193 --- 93 SCITUATE RESERVOIR, RI 5056 109 103 STREAMFLOW FOR SELECTED INDEX STATIONS (CUBIC FEET PER SECOND) MONTH-END PERCENT MAXIMUM DATE MINIMUM DATE STREAM MEAN MEDIAN FOR MONTH FOR MONTH CHARLES RIVER, MA 283 53 333 31 203 1 E. BR. HOUSATONIC RIVER, MA 160 88 571 27 50 1 PAWCATUCK RIVER, RI 195 64 253 7 164 16 WARE RIVER, MA 202 63 ---- -- ---- -- ------------------------------------------------------------------------------- A MONTHLY REPORT PREPARED BY THE U.S. GEOLOGICAL SURVEY, WATER RESOURCES DIVISION 10 BEARFOOT ROAD, NORTHBOROUGH, MA 01532 IN COOPERATION WITH THE MASSACHUSETTS DEPT_ OF CONSERVATION AND RECREATION, CAPE COD COMMISSION, RHODE ISLAND DEPT.. OF ENVIRONMENTAL MANAGEMENT, AND THE PROVIDENCE WATER SUPPLY BOARD http://ma.water.usgs.gov/current—cond/data/2004-03.txt 4/14/200 LOCATION.. SEtlYAGE PERMIT NO. VILLAGg. _ �q�►hhis 114STA LL 'S NAME & ADDRESS BUILDER OR OWNER DkT E PERMIT ISSU E.D WATE C M-PLIANCE 1 SUED tov yip ttc4 /�l a P 1 )V,oy r'v��.�r/y CND! -.. � � l J1/pr 1 i l FEg:..:�-ram � .... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ......lave:'!�.............OF............�!7�11�.:.�/.. ........................... Appliration for Diipnaal Workii Application is hereby made for a Permit to Construct (1) or Repair ( ) an Individual Sewage Disposal System at • • �/• � . !�L � j ........................................... �`� -cation- ddr ss e ................r of N/f f�`—'` .r ......•...--- ne ddress a � .......... } ��� . !ham... ........ Installer Address LL// Type of Building Size Lot_ ----- T ......Sq. feet Dwelling—No. of Bedrooms.__......3 Expansion Attic ( ) Garbage Grinder ( ) 1:14 Other—Type of Building ............................ No. of persons-----__--__-._-____._______ Showers ( ) — Cafeteria ( ) Q+ Other fixtures .........................................................=............................................................................................. M I W Design Flow..................5,).....................gal lons per person per day. Total daily flow----------- ........................gallons. WSeptic Tank—Liquid capacitvl00f)-gallons Length._ ,LLF1-. Width....../ _ Diameter................ Depth....Y!..�.... x Disposal Trench—No. -.-./V,4........ Widtl....._.� .... Total Length.................... Total leaching area.......:...... ..sq. ft. Seepage Pit No-------j............ Diameter.,l0_----6- -_. Depth below inlet__.............. Total leaching area...d�.....sq. ft. Z Other Distribution box ( V� Dosing tank ( )/ ( Percolation Test Results Performed b .................... 11.u�x/f' ..._ 1 .v�!"...�J .._.___ Date _�� a y , V �. Test Pit No. I....._�__)..__minutes per inch Depth of Test Pit......`........... Depth to ground water--------A1 ..__ .. Test Pit No.:2....!.,)-___minutes per inch Depth of Test Pit....60........... Depth to ground water------/-/-?......... a ------- y----- J -------•--•-----------------------••---- O Description of Soil.. - X.C. �f'.dt ------. 0-- '.?l =� 1LA. `�r'� --------------------------- (('! ------------------•-----•----•-•-------•----•-•-----------------------------••--•------•----------------------------------•-------.--••--------....................................................... U 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 iT` IE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been is ed by the board f 1 It / Sigd.------. _.. ...._.` .. y� 4/ .................... / ate Application Approved By------ ,� .... -- ............. ....... Date Application Disapproved for the following reasons---------------------•----------------------------------------------.....------•--------------------------•---•- •------------------------------•-•••-------------------•------••-•-•-•---•••----•---•----------•----•--••----•-----•-------••--••--••---•---••--•--------------•-------••-----•-••-••-----••--•--------- �/ ----. Dal ------------ Issued.-•••--... -- e Permit No--------------------------------------------- . •• ------ Date .............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ✓.. ..........O F.....................I r�/�Ifl. .................................... Appliration for Uiipn.13al Workii Tnnitrnrtion ranfit i Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at• R -------------- -� : -� ------ `........ ----...--- .......�'��°-- �`�-----------------------...----------------- ' Location-Addr ss �. / ....... --__or t i%i f��! QWne r ,.EAddress ZZ Installer Address �/,f ___ 0� UType of Building - II Size Lot_________ _____Sq. feet ,-.-, Dwelling—No. of-.Bedrooms.........3 ------------------------ Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ ShowersCafeteria ( ) % a' Other fixtures'.._._... ................_-_--._- W Design Flow...................:` _.........:........gallons per person per day. Total daily flow..........IV.......................gallons. W Septic Tank—Liquid'capacitv_1QUU_gallons Length-_ k:_ _�-- � Width...... rt.. Diameter________________ Depth....` . Disposal Trench—No.__NA........ Widths.....`� .... Total Length.................... Total leaching area...................sq. ft. Seepage Pit No------- _..-____-._ Iameter__/t'__.__ _.._.. Depth below inlet.... �_ ___________ Total leaching area___h _._._sq. ft. Other Distribution box"( Dosing tank ( ) // t 1 Percolation Test Results Performed by_____________________!'.hc'1��?_..:?�9�?.!�-r Date.......�fa_l��'�'.._.. ,aa Test Pit No. 1.....!-___)_._minutes per mch Depth of Test Pit___-_ ._ ...... Depth to ground water........`V.�._._.. Test Pit No. 2__... -_4._--minutes per inch Depth of Test Pit....?�16'-J......... Depth to ground water______ ......... W ; _ n---- ------------- -------------------�--------------- - O Descri Description of So11 i'P P n l +� ra.Z- ve .> .._.. 1 .4----------------------------------------------------------- -- W ---------------------------------------------- - --•---------.....-•------------------------•---------------•---------------------------------------------------------------------------•---•--•---- UNature of Repairs or Alterations—Answer when applicable...__!tA..----'---------------------------------------------------------------------------- Agreement: ' The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Ty: y g g p y 5 of the State Sanitary Code—The undersigned further agrees not to lace the system in operation until a Certificate of Compliance has been issued by the board o lie It . r l � � .- Sig :d----------- ------ ------•-------------.......- •----• ./� . its- �"---------------•--------•- ................... ate Applica aipnApproved By...... .................... - --- Date Application Disapproved for the following reasons:................................................................................................................. {n ---------•----------------------------------------------------------------------------------------------------------------------------- ' Date PermitNo......................................................... Issued....................................................... Date THE.COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..................... .............oF................. d: .!1.. .............................................. Trrtifiratr of f omplianrr T I IS TO ERTI , That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) ^ . 'by.. 'r ..................................•---...._.................•---•----- ^-..... has been installed in accordance with the provisions of T j f The State Sanitary Code describe in the application for Disposal Works Construction Permit N ./__.___ _'________________ da.ted_...-�__�- -'_�__ ___._._._.__..... THE.ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. � DATE........ J ��` •=--------------------------- Inspector.--•-•-------------- - -........ THE COMMONWEALTH OF MASSACHUSETTS BOARD ®�_F HEALTH f, i/vc.. O F............2........................................................................ ...0 FEE.:__.................... Disposal Workij Tomitr uan rr tt Permission <s her granted - € V•----•----- to Constr'uc ( � rRepair o (, ) and Individual Sewage Disposal System at No.------. �1 �t ............. Street (� as shown on the application for Disposal Works Construction P N __ Dated_.__ .' / .. _..._.... .... __...�.............. ------............---- � Board of Health DATE.....F '1 .....-•-------•--•----------••-------------------- FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS - }H juell COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION c TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION aw Property Address: ✓/ Owner's Name: U e Q(pQ -s Owner's Address: Q alp ,s Date of Inspection: G 'Z� - ? Name of Inspector: (please rint ���✓ ,!�/J �7D�t/�" .�, /'�, Company Name: Mailing Address: v ! Z9 -j o-> Telephone Number: CERTIFICATION STATEMENT �- r I certify that 1 have personally inspected the sewage disposal system at this address and that the informal®repoorrted below is true,accurate and complete as of the time of the inspection. The inspection was perfo ed 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 5.340 of Title 5(310 CMR '5.000). The system: asses C nditionally Passes eeds Furth r E"a13by the Local Approving Authority ails aInspector's Signature: Date: The system inspector shall submit a copy of this inspect' n 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,end the approving authority. Notes and. mments � / U o` ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Paoe 2.of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A > CERTIF/ICATION (continued) Property Address: I / YI►7. Owner: 9 $ Date of Inspection: 6 - Z 7 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D OSystem sses: I have _ e 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: 2 C�'I�1i B. S tem Conditionally Passes: One o ore system components as described in the"Conditional Pass"section need to be replaced or repaired. The sys , upon completion of the replacement or repair,as approved by the Board of Health, will pass. Answer yes, no or not dete ' ed(Y,N,ND)in the for the following statements. If"not determined"please explain. The septic tank is metal and ove 0 years old* or the septic tank(whether metal or not)is structurally unsound, exhibits substantial infiltration or filtration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying sep ' tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is s cturally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is av ' able. ND explain: Observation of sewage backup or break out or high static ater level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution x. 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 p e(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of 1 I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: Owner: _ Date of Inspection: O� C. Further Evaluation is Required by the Board of Health: Conditions e ' t which require further evaluation by the Board of Health in order to determine if the system is failing to protect pub ' health, safety or the environment. y 1. System will pass unle Board of Health determines in accordance with 310 CMR 15.303(l)(b)that the system is not functionin in a manner which will protect public health,safety and the environment: Cesspool or privy is with 50 feet of a surface water Cesspool or privy is within 0 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of H Ith (and Public Water Supplier,if any)determines that the system is functioning in a manner that prot cts the public health,safety and environment: _ The system has a septic tank and soil ab orption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface ater supply. The system has a septic tank and SAS and a SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and th SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the AS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determ' distance `*This system passes if the well water analysis,performe at a DEP certified laboratory, for coliform bacteria and volatile organic'compounds indicates that the 11 is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equa or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attac d to this form. 3. Other: ------------- Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: g//� �✓� mot Owner: o Date of Inspection: D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No _ ackup 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 F/ iquid depth in cesspool is less than 6"below invert or available volume is less than '/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 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. —4,,2 Any portion of a cesspool or privy is within a Zone 1 of a public well. k(4_ � Any portion of a cesspool or privy is within 50 feet of a private water supply well. '12A 21 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.] e,2 (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. Lar a Systems: A114 To be co idered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd• You must indic either"yes"or"no"to each of the following: (The following crite ' apply to large systems in addition to the criteria above) yes no the system is within 4 feet of a surface drinking.water supply the system is within 200 feet o tributary to a surface drinking water supply the system is located in a nitrogen sense ' e 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 sy m is considered a significant threat,or answered "yes" in Section D above the large system has failed.The owner o erator of any large system considered a significant threat under Section E or failed under Section D shall upgra he system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of Department. 4 Page 5 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: Owner: Date of Inspection: p Check if the following have been done You must indicate"yes"or"no"as to each of the following: Yes o Pumping information was provided by the owner,occupant,or =Health Were any of the system components pumped out in the previous two weeks? l/Has the system received normal flows in the previous two week period? t/ Have large volumes of water been introduced to the system recently or as part of this inspection ? I L — p 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, S§Wft a 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? _ v 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 ✓_ Existing information. For example, a plan at Board of He la th. 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)) a ' 5 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: Owner: L Date of Inspection: 6 - Z ?-,Q-) RESIDENTIAL FLOW CONDITIONS Number of bedrooms(design): 3 Number of bedrooms(actual): -3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): ff 3cb Number of current residents: Does residence have a garbage der(yes or no): Ne Is laundry on a separate sewage system(yes or no):,_!to (if yes separate inspection required) Laundry system inspected(yes or no):Iq Seasonal use:(yes or no):ovo Water meter readings, if available(last 2 years usage(gpd)): Sump pump(yes or no): Last date of occupancy: ti� COMM RCIAL/INDUSTRIAL Type of es ta ent: Design flow(base 310 CMR 15.203): gpd Basis of design flow.(sea rsons/sqft,etc.): Grease trap present(yes or no): Industrial waste holding tank present r no):— Non-sanitary waste discharged to the Title 5 s (yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records r Source of information: �j�(/iuy5 T /.( 1_z „ Was system pumped as part of the inspection(yes or no):_�� If yes, volume pumped:�allons--How was quantity pumped determined? IV Reason for pumping: /Y6 /(� od /-/1/o Sc ,., /►�a �� TYPF-0'F SYSTEM Septic tank,dam,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): Approximate age of all cojtnponents,date installed(if known)and source of information: Were sewage odors detected when arriving at the site(yes or no): Q 6 Page 7 of] 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 9i ���3 " Owner:_ '/ 11 P e� Date of Inspection: G — ? _ BUILDING SEWER(locate on site plan) Depth below grade: / Materials of construction:_cast iron ''_4 0 PVC_other(explain): Distance from private water supply well'or suction line: til,4 To�✓�/�,/ / �jLv�� , / i/ / Comments(on condition of'oints,venting,evidence of leaks 3,e,etc.): SEPTIC TANK:—t-61ocate on site plan) Depth below grade: / Material of construction:_concrete_metal fiberglass_polyethylene —other(explain) If tank is metal list aged/ Is age confirmed by a Certificate of Compliance(yes or no)4��(attach a copy of certificate) 4 / f Dimensions: /D _�' �v � ��'t' AoOG d fl zrz&pc+Sludge depth: S <, Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: Distance from top scum to top of outlet tee or baffle: Distance from bottom of scum to bottompf outlet too baffle: How were dimensions determined: � Comments(on pumping recommendations, inlet and o I'llit.11tee or paffle condition, structural inte ity, liquid levels s related to ou t invert,evid ce of.leak ge, etc.): d0 o� aY�''d v / e � � `P ✓� ,All GRE E TRAP:_(locate on site plan) Depth below grade:_ Material of construction:— crete_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,s a] integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page 8 of l l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM FORMATION(continued) Property Address: ��( (!'c f��e c y o•.T Owner: ( � Date of Inspection: eob TIG T or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth be grade: Material of c struction: concrete metal fiberglass_polyethylene other(explain): Dimensions: Capacity: allons Design Flow: allons/day Alarm present(yes or no): Alarm level: Alarm' orking order(yes or no): Date of last pumping: Comments(condition of alarm and flo switches,etc.): DISTRIBUTION BOX: (if present must be ope d)(locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal, ny evidence of solids carryover,any evidence of leakage into or out of box,etc.): V//, 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.): g Page 9 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 9���7�%QG GfJ�j '7' Owner: e J Date of Inspection: e5 - Z c7'7 SOIL ABSORPTION SYSTEM (SAS): �(Iocaten site la ( ) plan,excavation not required) *SAS wit located ePqyVi � La Type leaching pits,number: OG1Z' -C -1 e'✓cP leaching chambers,number: d� g o t r. leachinggalleries, �_ ?g s,number: FlWko y leaching trenches,number, e .�,✓�� 4 l''o k'i''� ' � •� tl leaching fields,number,dimensions: overflow cesspool,number: z it -72, t `� innovative/Fndition ative system Type/name of technology: (b P Ica Comments(notei of soill signs of by aulic failure, level of ponding,damp soil,conditio f vegetation, etc.): � / J CESSPOOLS ESSPOO (cesspool must be pumped as part of inspect ion)(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,conditio vegetation,etc.): PRIVY: (locate on site ) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic fail vel of ponding,condition of vegetation,etc.): 9 i Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 9V 0/"/4i'. z'/. J dh� s Owner: Date of Inspection: lv-Z 7-v? SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage dis , including ties to rmanent reference landmarks or benchmarks. Locate all wells in 1,00 t.L cate where is water supply a ters the building. A,IZ14 (A/ Pq y �( e a C ` 73c o _ 1 I Z _Coy 14 13 _ 3 c - 3 9�I 2 - 10 Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 4, / � S Owner: Date of Inspection: G SITE EXA. Slope 11. — ? Surface water A/o ✓� Check cellar a/, / Shallow wells 04 �el/ SPv�/eS Est Sc cQ �!Z/ 60 v oo Estimated depth to ground water feet Please indicate(check)all metho used to determine the high ground water elevation: . / T�/!{ S e ivs�j l (�- V ined from system desrgirp}nns_on fecord-if checked,date of design reviewed: Observed site(abuttin ervation hole within 150 feet of SAS) _ II hecked with loc oard of Heal explain: fil/LP �'v5 f Checked with loc rs,installers-(attach documentation) ,,,"Accessed USGS database-explain: You mu t descri how you established he high ground water glev lion: s v /Z � p�B o�✓ fee aka �- .. 72 TiI rJ►o c CL�' ► ^' o T "� il,L! X1.�' I y. (sl ✓[//�s /°l//��� /1�,Q�,Y 20U� ��'I�/,��f/�' Z. /.7 � V L . I1 Ha ar ous Materials Inventory Sheet Checklist Date Physical Street Address-Check database to ensure it exists ---__Working Phone Number /i---Actual Amounts -( ie. gas being used to fuel machines, thinner to ,, / clean brushes all count as hazardous materials-no blanks) �v Storage Information -location of storage, how long is storage for? If none, note that. Disposal Information -where and who? If none, note that. Applicant Signature - understand what is listed and noted Staff Initial -any questions, know who to ask Vehicle Washing/Rinsing? -give a vehicle washing policy and /explain it Attach the Business Certificate with your sign off and comments **The inventory form should explain what the business consists of and the procedures they are doing. Notes need to be left to explain what you discussed with them. YOU WISH TO OPEN A BUSINESS? For you r Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME m town [which. you must do by M.Qs'.L.-it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, 1"FL., 367 Main Street, Hyannis, MA 02601 (Town Hall] `. DATE: l 0 L p Fill in please: Ii cU�twfi 5 R� Ii":,n:4 iv,:�4 yy rr ,rt� P-�' APPLICANT'S YOUR NAME/S: ��il FJr 8F t Uill'1� >Ti. .. L N C[�L 1 ,Pa',L BUSINESS YOUR HOME ADDRESS: L / i fcLee�s TELEPHONE # Home Telephone Num �4.�, r;l�. La 111.�.�2;=`,'i do.¢• ( 4NN7t:0,(tlll:c4J.7A'i+j'�'90':}� r ` Iq NAME OF CORPORATION: Gi So n r TYPE OF BUSINESS � � �r NAME OF NEW BUSINESS v r�`P DES NO e IS THIS A HOME OCCUPATION? —YES MAP/PARCEL NUMBER (Assessing) ADDRESS OF BUSINESS i ;' G6icrs L egulations of the Town of W hen starting a new business there are several things you must do in order to be in compliance with the rules and r Barnstable. This form is intended to assist you in obtaining the information you required to legally operUST GO ate a your usiness in this town.armouth Rd. & Main Street) to make sure you have the appropriate permit g 1. BUILDING COMMISSIONER'S OFFICE This individual has been informed of any permit requirements that pertain to this type of business. Authorized Signature** COMMENTS: r` 2. BOARD OF HEALTH infor ec]p�the p r it requ' e Ents that pertain to this type of business. This individual has�Authorized gnature** M1NOtLYWRNALL HA?AAOOIISY� COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS; v Dat�I /d I /U TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS -SITE INVENTORY � NAME OF BUSINESS: U D u,rd5 Av ru BUSINESS LOCATION: �/� P; � nJc�.�.t ��, r , lvl� 02&01 INVENTORY MAILING ADDRESS: Sit Irn,6 TOTAL AMOUNT: TELEPHONE NUMBER: CONTACT PERSON: EMERGENCY CONTACT TELEPHONE NUMBER: S©F 2,86 V02-Y MSDS ON SITE? TYPE OF BUSINESS: Im "oh"ch r 6 or INFORMATION/RECOMMENDATI S: Fire District: Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The board of health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene,#2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal Printing ink Degreasers for driveways &garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform, formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be is or hazardous (please list): Metal polishes ` Laundry soil &stain removers (including bleach) Spot removers&cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initials I COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAI AFFAIRS John Graci DEPARTMENT OF ENVIRONMENTAL PROTECTION DEP Title V Septic Inspector ONE WINTER STREET BOSTON MA 02108(617)292-3500 P.O.Box 2119 TeaTicket,Ma. (508)564-6813 TRUDY COXE Secretary ARGEO PAUL CELLUCCI DAVID B.STRUHS Govemor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 911 PITCHERS WAY HYANNIS MAP 272 PAR 140 L 12 `f Name of Owner BILL BRIDGES QQ Address of Owner: 86 OLD STRAWBERRY HILL RD.HYANNIS 'b(I OCT /�/`tO . 2 Date of Inspection: 10/6/99 < 199 Name of Inspector:(Please Print)JOHN GRACI `9`lama DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) j��9�(r� •a Company Name: n/a Mailing Address: n/a Telephone Number: n/a e 9 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: X Passes The Inpection is based on criteria defined in Title V Conditionally Passes code 310 CMR 15.303.My findings are of how the system is _ Needs Further Evaluation By the Local Approving Authority performing at the time of the Inspection.My Inspection does _ Fails not imply any warranty or guarantee of the longgevity of the septic system and any of its components useful life. Inspector's Signature: Date:10/8/99 The System Inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)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. NOTES AND COMMENTS THE SYSTEM PASSES TITLE V INSPECTION.RECOMMEND PUMPING THE SYSTEM EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE.RECOMMNED REPLACING COVER ON THE LEACH PIT.THE LEACH PIT HAS NOT HAD MORE THAN V OF WATER IN IT. revised 9/2/98 Page 1 of 11 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 911 PITCHERS WAY HYANNIS MAP 272 PAR 140 L 12 Owner: BILL BRIDGES Date of Inspection:10/6/99 INSPECTION SUMMARY: Check A, B, C, o/D: A. SYSTEM PASSES: I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist.Any failure criteria not evaluated are indicated below. COMMENTS: System passes Title V inspection B. SYSTEM CONDITIONALLY PASSES: nLa 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. Indicate yes,no,or not determined(Y,N,or ND).Describe basis of determination in all instances.If"not determined",explain why not. nLa 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 complying septic tank as approved by the Board of Health. nta Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken,settled or uneven distribution box.The system will pass inspection if(with approval of the Board of Health). broken pipe(s)are replaced obstruction is removed distribution box is levelled or replaced nLa 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 revised 9/2/98 Page 2 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 911 PITCHERS WAY HYANNIS MAP 272 PAR 140 L 12 Owner: BILL BRIDGES Date of Inspection:10/6/99 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 the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 16.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT ThE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of 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 AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water 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 nla_(approximation not valid). 3) OTHER . nLa revised 9/2/98 Page 3 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 911 PITCHERS WAY HYANNIS MAP 272 PAR 140 L 12 Owner: BILL BRIDGES Date of Inspection:1016199, D. SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: I have determined that one or more of the following failure conditions exist as described 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 X Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. X Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 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 Wa. X Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. X Any portion of a 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 I 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.If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic ompounds, ammonia nitrogen and nitrate nitrogen. X The liquid level in the SAS is over the invert pipe,is in Hydraulic Failure. E. LARGE SYSTEM FAILS: 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: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No X. the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.30412).Please consult the local regional office of the Department for further information. revised 9/2/98 Page 4 of 11 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 911 PITCHERS WAY HYANNIS MAP 272 PAR 140 L 12 Owner: BILL BRIDGES Date of Inspection:10/6/99 Check if the following have been done:You must indicate either"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 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. X As built plans have been obtained and examined.Note if they are not available with N/A, X The facility or dwelling was inspected for signs of sewage back-up. X The system does not receive non-sanitary or industrial waste flow. X The site was inspected for signs of breakout, X All system components,excluding the Soil Absorption System,have been located on the site. X The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum.The size and location of the Soil Absorption System on the site has been determined based on: X Existing information,For example,Plan at B4O,H, X Determined in the field(if any of the failure criteria related to Part C is at issue,1appr?ximation,of distance is unacceptable) (1 5.302(3)(b)] X The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of SubSurface Disposal Systems. ,f. revised 9/2/98 Page 5 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 911 PITCHERS WAY HYANNIS MAP 272 PAR 140 L 12 Owner: BILL BRIDGES Date of Inspection:10/6/99 FLOW CONDITIONS RESIDENTIAL: Design flow:-M g.p.d./bedroom Number of bedrooms(design): 3 Number of bedrooms(actual):.1 Total DESIGN flow: = Number of current residents:Q Garbage grinder(yes or no):NO Laundry(separate system)(yes or no): NQ If yes,separate inspection required Laundry system inspected(yes or no).,M Seasonal use(yes or no): YES Water meter readings,if available(last two year's usage(gpd): nLa Sump Pump(yes or no): NQ Last date of occupancy: Wit COMMERCIAL/INDUSTRIAL Type of establishment: nLa Design flow: D&gpd(Based on 15.203) Basis of design flow: Wa Grease trap present:(yes or no): pLQ Industrial Waste Holding Tank present:(yes or no): NQ Non-sanitary waste discharged to the Title 5 system:(yes or no):NQ Water meter readings.if available:n& Last date of occupancy: n& OTHER: (Describe) nta Last date of occupancy: n(a GENERAL INFORMATION a PUMPING RECORDS and source of information: DLa System pumped as part of inspection:(yes or no):NQ If yes,volume pumped nLa- gallons Reason for pumping: nla ' 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) I/A Technology etc.Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other: nla APPROXIMATE AGE of all components,date installed(if known)and source of information: 1981 PERMIT 81-08 Sewage odors detected when arriving at the site:(yes or no): NQ revised 9/2/98 Page 6 of 11 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 911 PITCHERS WAY HYANNIS MAP 272 PAR 140 L 12 Owner: BILL BRIDGES Date of Inspection:10/6/99 BUILDING SEWER: (Locate on site plan) Depth below grade: 1 Material of construction:_ cast iron X 40 PVC _ other(explain) Distance from private water supply well or suction line: TOWN Diameter: n/a Comments: (condition of joints,venting,evidence of leakage,etc.) nta SEPTIC TANK: X (locate on site plan) Depth below grade: V Material of construction:X concrete_ metal_ Fiberglass _ Polyethylene _ other(explain) nla If tank is metal,list age Is age confirmed by Certificate of Compliance(Yes/No): lYQ Wa Dimensions: L 8'6"H 6'7"W 4'10 Sludge depth: Z Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: Distance from top of scum to top of outlet tee or baffle:l Distance from bottom of scum to bottom of outlet tee or baffle: 17" How dimensions were determined: MEASURED Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage, etc.) SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND RECOMMEND PUMPING EMERY TWO YEARS FOR MAINTENANCE, GREASE TRAP: (locate on site plan) Depth below grade: Material of construction:_concrete_ metal_ Fiberglass _ Polyethylene_other(explain) n1a Dimensions: Wa Scum thickness: Wa Distance from top of scum to top of outlet tee or baffle:_Va Distance from bottom of scum to bottom of outlet tee or baffle n1a Date of last pumping: n& Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage, etc.) Wa revised 9/2/98 Page 7 of 11 f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM-INFORMATION(continued) Property Address: 911 PITCHERS WAY HYANNIS MAP 272 PAR 140 L 12 Owner: BILL BRIDGES Date of Inspection:1016/99 TIGHT OR HOLDING TANK: NO (Tank must be pumped prior to,or at time of,inspection) (locate on site plan) Depth below grade: nLa Material of construction:_ concrete_ metal_ Fiberglass _Polyethylene_ other(explain) DIA Dimensions: nLa Capacity: ii& gallons Design flow: nta gallons/day Alarm present: NQ Alarm level:j2La- Alarm in working order:Yes—No—: NQ Date of previous pumping: Wa Comments: (condition of inlet tee,condition of alarm and float switches,etc.) n/a DISTRIBUTION BOX: X (locate on site plan) Depth of liquid level above outlet invert:nla Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) PUMP CHAMBER: NO (locate on site plan) Pumps in working order:(Yes or No): NO { Alarms in working order(Yes or No): NQ Comments: (note condition of pump chamber,condition of pumps and appurtenances.etc.) nLa . revised 9/2/98 Page 8 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 911 PITCHERS WAY HYANNIS MAP 272 PAR 140 L 12 Owner: BILL BRIDGES Date of Inspection:10/6199 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain: nla r Type leaching pits,number: 1000 GALLON LEACH PIT leaching chambers,number: jaLa leaching galleries,number: _nLa leaching trenches,number,length: nta leaching fields,number,dimensions: n& overflow cesspool,number: nIA Alternative system: nLa Name of Technology: jiLa Comments: (note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) THE LEACH PIT IS STRUCTURALL SOUND AND FUNTIONING PROPERLY.THE PIT WAS EMPTY AT THE TIME OF THE INSPECTION.- CESSPOOLS: (locate on site plan) Number and configuration: nLa Depth-top of liquid to inlet invert: nLa Depth of solids layer: nLa Depth of scum layer. n1a Dimensions of cesspool: nLa Materials of construction: Wa Indication of groundwater: n& inflow(cesspool must be pumped as part of inspection)nLa Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) n1a PRIVY: _ (locate on site plan) Materials of construction:n& Dimensions:nLa ; Depth of solids: Wa Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) nLa y a revised 9/2/98 Page 9 of 11 y a; lk SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 911 PITCHERS WAY HYANNIS MAP 272 PAR 140 L 12 Owner: BILL BRIDGES Date of Inspection:10/6/99 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) n/a Deck A b O� C AA a3 4 a� AC �3 CA � arc revised 9/2/98 Page 10 of 11 5. A fi 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 911 PITCHERS WAY HYANNIS MAP 272 PAR 140 L 12 Owner: BILL BRIDGES Date of Inspection:10/6/99 NRCS Report name: nLa Soil Type: nLa Typical depth to groundwater: nLa USGS Date website visited: nLa Observation Wells checked: XG Groundwater depth:Shallow Moderate _ Deep _ SITE EXAM _ Slope _ Surface water _ Check Cellar Shallow wells Estimated Depth to Groundwater 12 Feet Please indicate all the methods used to determine High Groundwater Elevation: _ Obtained from Design Plans on record Observed Site(Abutting property,observation hole,basement sump etc.) Determined from local conditions Checked with local Board of health Checked FEMA Maps _ Checked pumping records _ Checked local excavators,installers XUsed USGS Data Describe how you established the High Groundwater Elevation.(Must be completed) USGS MAPS AND CHARTS-12+FEET •,. revised 9/2/98 Page 11 of 11 I COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Signat item 4 if Restricted Delivery is desired. ❑Agent ■ Print your name and address on the reverse X ❑Addressee so that we can return the card to you. B. RecLived lo(Printed Name) C. Date of Delivery ■ Attach this card to the back of the mailpiece, I or on the front if space permits. kv)wm 5UA1712-r 2- D. Is delivery address different from item 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑No II 3. SServ' Type M L�YCertified Mail EU3 F Mail 1 V(/1/�[��Q 1 ' �6o f ❑Registered U'Retum Receipt for Merchandise I ❑Insured MaG ❑C.O.D. I 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number I ;;� 7005 116BiO000" 019], =0?14� F (Transfer from service labeq , • , PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 UNrrED STATE�L���€i�'+s,�` - X `m • Sender: Please print your name, address, and ZIP+4 i 'this,b6x • Od�4� Town of Barnstable G-; g Health Division 200 Main Street r Hyannis,MA 02601 I 11!MI All AlHI1.fIM113.1111MILE3 1111111?411!??il.Elil Certified mail#7005 1160 0000 0191 0140 Town of Barnstable o� Regulatory_Services aAsrABi; t Thomas F. Geiler, Director Public Health Division Thomas McKean,Director 200 Main.Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 January, 31, 2008 Wagner Santos 911 Pitcher's Way Hyannis, MA 02601 NOTICE TO ABATE VIOLATIONS OF TOWN OF BARNSTABLE CODE The property owned by you, located 911 Pitcher's Way, Hyannis was inspected on January 31, 2008 by Town of Barnstable Health Inspector Timothy B. O'Connell because of a complaint. The following violation of the Town of Barnstable Board Code was observed: § 353-1 Responsibilities of Owners: Garbage and rubbish observed in the back yard not within proper receptacles You are directed to remove the garbage and rubbish from your property and dispose of it properly within 7 days of your receipt of this notice. y You may request a hearing before the Board of Health if written petition requesting same is received within ten(10) days after the date the order is served. Failure to comply with an order'will result in a fine of$100.00. Each day's failure to comply with an order shall constitute a separate violation. PER ORD OF THE B ARD OF HEALTH mas A.McKean,R.S., CHO Director of Public Health Town of Barnstable QAOrder letters\Refuse\911 pitchers way,Hyannis 2.doc F F � ``- `�C, _ TYPICAL SYSTEM PROFILE - ----_--_------ — A R E A PLAN FDN TOP FINISH GRADE /, _ NOT TO SCALE SCALE : 1 = �` `' �' CC FINISH GRADE OVER TANK= � GRADEISOVER PIT=_� /VV F I ! V f T7I' hi� � ! �Z��.�O_, i...i/ 4�`Gr^ f`�'+L— f !'..� 0 �— MCRC C OR O O �--- e • • • • . . e o N '� ` � � i„✓ 9 7. 6 I' -4 7 TEES • • e V 784 �J. 5-�• r von BSMT o'er_ e o a:: a e e o • • • e . o o e '.� ��/ s'1 s FLR -44,OD c'�� GAL. 4�� i e e o • • • o o ° -° NFORCED DIST. BOX `�7, 25' e o ° e • • e o o ° 0 0 • NCRETE � _8 TO BE INSTALLED ON e ° • • • I • • • ° o e -.� A LEVEL STABLE BASE • e a • • o o r V e e o • • • • o • • 0 1 , SEPTIC TANK • ° , TO BE INSTALLED ON A LEVEL STABLE BASE • • e e �f 2"-I/8'L 1/2 "WASHED PEASTONE ALL , LGT 1 i BRICK a MORTAR COURSES AS • • • , ' • • • ' , • • AROUND FREE OF IRONS, FINES • • • • • • ° ° ° • REQUIRED TO BRING COVER TO GRADE AND DUST IN PLACE �• LEACHING PIT I 'D 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 Ste' �6 -'CJ" z--- , ` IRONS FINES AND DUST IN PLACE C FOR FIN. GRADE SEE SYSTEM PROFILE SOIL AND PERCOLATION SEF'7'M. 774A.eiei 5E�A40F/!� I — 11= LC7 DATA PRO. -- �O - _ , � � —L_ _ - - -- -- - -- - - a _AL 8 PERC. RATE : MIN /IN. _ FOR INV. ELEV SEE 2z E �SF1Lo ` ) INLET ° o SYSTEM PROFILE ° u TAKEN BYY : C. D. SPOHR PiPCC<iST COA/C4 li5 D-BO>r I 6 s ticroF-ic o Mk Ff `'�_ LINE ° ;_ -' `o -r ° OPENINGS W,'4 �1;8 ° '° � � •- WITNESSED BY: �AO' �. PRO, DR/vE' ; . OUTER DIA. & 1 -3/4"° ',' �; DATE : L9 DEC, /9 � 7 6,: . ° a INSIDE DIA .TOTAL ° TEST PIT -GND ELEV. ° U ° AREA n � '', Rk—GCA5_7-CM ICX07r tJ&-s9CA11A/4� Prr 5_3? /moo., SF� I?£Tsflt S ¢' P�'oF/L6 43 .�� o •` SUf� SG/L NO /�U57,L1L UC;t. I 0 ° 0 0 0 0 0 24' 0 0 0 0 CDAk'S6 fjkOW� L07 3 - - 1 2 ' 6 _ 6 DIA . L0 7-4t//1/ 4 - - - BOT. PERC. HOLE 1016 EFFECTIVE DIA. J LEACHING PIT - SECTION ( IREQa) DOWN� ._; NO SCALE DESIGN DATA '- NOTE', DO NOT RUN HEAVY EQUIPMENT OVER SYSTEM NO. of BEDROOMS DISPOSAL LEACHING PIT NOTES: EST. TOTAL DAILY EFFLUENT 3 ��' GALS . I . CONC. TO BE 4000 P.S.1 a 28 DAYS . SEPTIC TANK >C)O GAL. ELEYAT/O/VS F AsFD OA/ Po9:;lvA'MA�-a17- 2 . REINF W 6 x 6 06 GA. W. W. M. 4Vr,,C CEti7-4Ze ../A/� CVC LOT 0 ASS vA4,Ep PLAN REF• 3. 2 SAND 4 ' SECTIONS ARE AVAILABLE FOR jam, L>ElEla j P4A)V,a' = GREATER DEPTH REQUIREMENTS GENERAL NOTES 1 . ALL SYSTEM COMPONENTS SHALL BE INSTALLED IN T-39�E' NOTE : 77 1 ACCORDANCE WITH TITLE5 OF THE STATE SANITARY CODE EXCAVATE TO ELEV. ` OR LOWER AS DATED JULY 1, 1977 8 ANY LOCAL RULES APPLICABLE. 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 COMPACTED IN PLACE. 3. WHEN CONSTRUCTION IS COMPLETED, PRIOR TO BACK FILLING, a c 9� NOTIFY THE ENGINEER AND BOARO OF HEALTH FOR INSPECTION. SIDE AREA = S. F.0 _S. F./GAL GALS BOTTOM AREA= 87 S. F. d@ S. F/GAL 87 GALS 4. FOUNDATION ELEV. MUST BE CHECKED WHEN COMPLETED. TOTAL AREA = 7Q � S. F TOTAL 'C� GALS 5. THESE ELEVS. MUST NOT BE CHANGED WITHOUT WRITTEN APPROVAL BY CHARLES D. SPOHR, LEGEND 6 FOUNDATION INSPECTION READ WHEN EXCAVATED. OWNERS 4- EU I LDERS• *F,EA PLAN: + 50.0' EXIST. GROUND ELEV. 50.0 � FINISH GROUND ELEV.��UNDERLINEC�� _ C L I e,.*; � FL-V A/IV Q U/L d»'R.5 �,E?�'F�f3�c' D FIFO" PL D T" P•L AN 80X 3 1., C gg-A17-R'R YI L 4 4 AM, OF L.4N0 J AJ /�/S�L�/VA!/S� A/A- 4 7 5 0 PIPE INVERT. ELEV. REV DATE D E S C R I P T I O N O 2 6 13 2 FOk C , � F-, 84,)1 L A>,ERS .SC,)L E //I= -4o /VCR/, 29, /9?o a O TEST PIT LOCATION SEWAGE DISPOSAL SYSTEM CAPS FOR CO. o O SEPTIC TANK FL- \ N ^ , BU f Lt EkS _ ❑ DISTRIBUTION BOX . _ L_O I 12 P >tiTCHERS WAY 4 C. I . PIPE ,r 1-c"w8 HY A N N I S , MASS. !fi11t+tti— 4 BIT. FIBER PIPE - TIGHT JOINTS o S P- 7 D PROPERTY LINE N EXEC: o. 7468 �� 4 DESIGNED C.D.SPOHR DATE.19 . .Pt� DRAWING NO. — -- — MAP SEC f--PCL LOT HOUSE � MIN. CODE DISTANCE , Ess,oa��r DRAWN SCALE:4SSHOwN I l � —� CHECK ED: C. D. S J