HomeMy WebLinkAbout1001 PITCHER'S WAY - Health 1001 Pitchers Way
B�72-147 Hyannis
I
TOWN OF BARNSTABLE
LOCATION l001 IRAc1nr-r5 LJo-LA SEWAGE#. 20l-)-3_61a
VILLAGE �uo�n n�,5 ASSESSOR'S MAP&PARCEL Z*I2 14l
INSTALLER'S NAME&PHONE NO. g i B CXQgWc A;o r\ y Y1-OLS3
SEPTIC TANK CAPACITY /000 !;)�l
LEACHING FACILITY:(type) -rrcn c1,c.S (z) (size) Z x 3 x 33 '
NO.OF BEDROOMS 3
OWNERfyli'c \oclr .
PERMIT DATE: 10-Zo- 1 q1 COMPLIANCE DATE: Lob
5
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
.Private Water Supply Well and Leaching Facility(If any wells exist on
site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist within
300 feet of leaching facility) Feet
FURNISHED BY
A - 23,E
81 _ o$,G
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Fee G
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
21ppYication for Mispsal *pstrm Construction 3dPrmit
Application for a Permit to Construct( ) Repair(,X Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. /DO 1 Pi4cM-_r-5, QA Owner's Name,Address,and Tel.No.,
/+r1,cho.c I �roco�,�1 n
Assessor's Map/Parcel Z`)Z - 14 r)
Installer's Name,Address,and Tel.No.$#,a 6AccxV*_A;0 A Designer's Name,Address,and Tel.No.
%4 TcaScc' ry LO F-orcS j AQ IC- Fl-oJl t-44 )
I'S3 RoBoxa o
Type of Building:
Dwelling No.of Bedrooms �3 Lot Size /�i, 937 sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) Mo gpd Design flow provided ESQ gpd
Plan Date 10 jig ) ►r} Number of sheets Z Revision Date
Title
Size of Septic Tank /OCO 9a-) Type of S.A.S. !:rrr_nC)%C 5
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
Si a Date 101 Zo 1 1
Ar��,plication Approved by Date
Application Disapproved by Date
for the following reasons
Permit No.` Date Issued �� `�
No 13�/a/ �Q Fee 6 Q
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
'PUBLIC HEALTH DIVISION - TOWN OF, BARNSTABLE, MASSACHUSETTS
Application for Disposal pstrm Construction Permit
Application for a Permit to Construct( ) Repair(v� Upgrade( ) Abandori( ) ❑Complete System ❑Individual Components
Location Address or Lot No. )00) P+4c kft-'.5,,,,(q A Owner's Name,Address,and Tel.No,.
Yr);ctio.c I �Proca.cc i n 1 y
Assessor's Map/Parcel ZI Z 141
Installer's Name,Address,and Tel.No..8 J (j EX co,%JcxAi o/1 Designer's Name,Address,and Tel.No.
1y 7z� Str ry LrJ F.a.1\trAy Etjvio�'mzr�-lAl
$ G i7 0 ► a v
f' Type of Building: ,
Dwelling No.of Bedrooms Lot Size /1,T 9 3`] sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 0 gpd Design flow provided gpd
Plan Date 10 I 1 q Number of sheets Z Revision Date
T� '
Title
Size of Septic Tank OCO !)o. Type of S.A.S. "CtcnC)j!C
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected: i
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
' ompliance has been issued by this Board of Health.
Si a Date 10120) 1 r)
Application Approved by Date
Application Disapproved by Date
for the following reasons ,
Permit No.���''3 6 Date Issued ZQ 0X5P /-2
------------------------------------------------------------------------------------------------------------------------------=--------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(✓S Upgraded( )
Abandoned( )by 13 E xca y.,4 t O/\
at 00 -P;-Ie�1,s rs QA N has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit N & 3l0(o dated
Installer Q 4.Q E'xCayo.'1, ON Designer�a��c F'\o,h c r•a u
#bedrooms 13 Approved design flow �.5, 9 gpd
The issuance of this permit shay not be construed as a guarantee that the system t�inch n�s, igned.
Date` / y� Inspector
------------------------------------------------------------------------------ --------------------------------------------------------
M
No. ( Fee l—
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
Nsposai *pstem Construction permit
Permission is hereby granted to Construct( ) Repair(v*j Upgrade( ) Abandon( )
System located at .1001 , c A c r Waq v
and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
Title 5 and the following local provisions or special conditions.
Provided:Construct�ZZ12
mpleted within three years of the date of thispermit.
Date Approve
d`by
Town of Barnstable
Regulatory Services
Richard V. Scali,Interim.Director
U.
w�srxa •
Public Health Division
Al
Thomas McKean,;Director
200 Main Street,Hyannis,MA 02601
Office:.508=862-4644 Fax: 508-790-6304
Installer&Designer Certification Form
Date: 0 2 t1 Sewage Permit# 2oi�► - 361, Assessor's MaplParce1292 l.y`l
Designer _ l"crju !r'►Jy'�rorv-,cno•l Installer: 8 L3 ExeQuc��io✓�
Address: 90 ,307, 81 Address: It
�arma���.0of� F0rz5-}c�v�lc.
On o 20 I n o was issued apermit to install a
date) (installer)
septic system at /oo ;4 c.l.crS i a based on a design drawn by
(address)
no�,cry 4 r,,.;r]Dmr-A-1 1 dated
_(designer)
I:certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation of the
.,distribution-box and/or septic tank. Strip out (if required) was in and the soils
were found satisfactory:
I certify that the septic system referenced above was installed wit
h mayor changes (i.e,
greater than 10' lateral relocation of the SAS or any vertical relocation.of any component
of the septic. system) but in accordance with State& Local Regulations: .Plan revision or
certified m-built by designer to follow. Strip:out(if required)was inspected and the soils
were found satisfactory.
L certify that the system referenced above was constru te' fiance with the terms
of the IAA approval letters (if applicable) �� crss90
�o DAVID
o D.
FLAHERTY,JR.
taller's.Si e) No. 1211
0
�G/S TE��
SgNITARI
(Designer's Si afore) (Affix Designer's Stamp Here)
PLEASE RETURN TO BARNSTABLE PUBLIC HEALTIi DIVISION. CERTIFICATE
OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH TH_IS FORM AND,AS.
BUILT.CARD:ARE RECEIVED BY THE BARN STABLE.PUBLIC HEALTH DIVISION.
THANK YOU.
Q\Septic\Designer.Certification Form Rev 8-14-13.doe
w Town of Barnstable P#
dFTME
Department of Regulatory Services
.. „,B,E : Public Health Division Date
200 Main Street,Hyannis MA 02601 �
Date Scheduled Time Fee Pd.
/ CD
Soil Suitabili segment for Sew ge Di posal a_.
X.
Performed By: /F-' Witnessed By: 1116RI 6-15
_ LOCATION&GE RAL INFORMATION r
Location Addressnrs 1,/ Owner's
//'V
Address
.Assessor's Map/Parcel: �Z1/y� Engineer's Name �/�.�/�,��/�/1Vv6/
NEW CONSTRUCTION REPAIR Telephone# '7't t� % (Q
Land Use ` Slopes(%) 0— Surface Stones/v
Distances from: Open Water Body-`*�r/0V ft Possible Wet Area�sR Drinking Water WellR
Drainage Way �. J _ft Property Line�(ofl Other
.SKETCH:(Street name,dimensions of lot,exact locations of test holes k pere tests,locate wetlands in proximity to holes)
Parent material(geologic) tm- , Depth to Bedrock
Depth to Groundwater: Standing Water in Hole: Weeping from Pit FaceIA—
Estimated
Seasonal High Groundwater
DETERMINATIONyFUR SEA50NAGHIGH WATERTABLE
Method Used:
Depth Observed standing in obs.hole: in. Depth to soil mottles: in.
Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft.
Index Well# 'Reading Date: Index Well level Adj.factor Adj.Groundwater Level_
v PERCOLATION TEST Hate t� Tune n
Observation
Hole# Time at 9" '1
Depth of Pere Time at 6"
Start Pre-soak Time C Time(9"-6')
End Pre-soak
Rate Min./Inch 4
Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(YIN)
Original: Public Health Division Observation Hole Data To Be Completed on Back-----------
***If percolation test is to be conducted within 100'of wetland,you must first notify the
Barnstable Conservation Division at least one(1)week prior to beginning.
Q:\SEPTIC\PERCFORM.DOC
e l
rZ M
DEEP OBSERVATION HOLLE LOG
�.�... .,
Depth from Soil Horizon Soil Texture Soil Color Soil ther
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistent %Gravel)
V` --- ---� -- ---'--
L J
C
DEEP OBSERVATION HOLE LOG,,;,
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
AA,Consistenty,%Gravel
/v
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in J (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency.%Gravel)
DE'EPOBSERVATION HOLE LOG '' . Rote
Depth from Soil I lorizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency.%Gravel)
Flood Insurance Rate May:
Above 500 year Flood boundary No X Yes_/'_
Within 500 year boundary No_- Yes
Within 100 year flood boundary No X Yes
Depth of Naturally Occurrine Pervious Material
Does at least four feet of naturally occurring pervio ferial exist in all areas observed throughout the
area proposed for the soil absorption system?
If not,what is the depth of naturally occurring p9lvious material?
Certification I certify that on !r 12 (date)I have passed the soil evaluator examination approved by the
Department of Env o ntal Protection and that the above analysis was performed by me consistent with
the required trainin a pertise;a, des cf din 310 CMR 15.017.
Signature { Date jT
Q:ISEPTIC)PERCFORM.DOC
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6707COMMUZZ
o
E' Certified Mail Fee
Er
Extra Services&Fees(check box,add fee as appropriate) Cs
� ❑Re turn Receipt(hardcopy) $
o Return Receipt(electronic) $ Postmark `
o ❑Certified Mail Restricted Delivery $ r Here
o ❑Adult Signature Required $ ,, tfvT
Adult Signature Restricted Delivery$ I `"" 1 " 2017 ,
o Postage �I
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9 _
PROCACCINI, MICHAEL V&KATHERINE A
0 5
N 1001 PITCHERS WAY
C HYANNIS,MA 02601
r r r ,r r„•, -
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signature)that is retained by the Postal Service- Restricted delivery service,which provides
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You can request a hardcopy return receipt or an appropriate postage,and deposit the mailpiece.0
electronic version.For a hardcopy return receipt, J.
complete PS Form 3811,Domestic Return
Receipt;attach PS Form 3811 to your mailpiece; IMPORTANT:Save this receipt for your records.
PS Forth 3800,April 2015(Reverse)PSN 7530-02-000-9047
_ 1
COMPLETE1 1 • ON
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so that we can return the card to you. ❑Addressee
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i_AcficlP Addressed3nc.-- _Il_Ic delivery address different,from item 1? ❑Yes
enter delivery address below: ❑No
C
PROCACCINII,MICHAEL V&KATHERINE A �' ►a
1001 PITCHERS WAY - ,11-4
HYANNIS, MA 02601
—, a Type Q Priority Mail Express@
III I�III�I I�0 I91 I II II II I ITIIIII I I ITII III 0I I I I� ❑Adult Signature Q Registered Mall1rd
O�ldalt Signature Restricted De�very ❑Registered Mail Restricted
Rifled Mail® silvery
9590 9402 1934 6123 0978 45 0 Certified Mail Restricted DelMery VL Receipt for
❑Collect on Delivery Merchandise
2(Article Number(Transfer from service label)
❑Collect on Delivery Restricted Delivery 0 Signature Confirmation
vlC� ❑Signature Confirmation
7t015 j173q 000'1j 4990 ;404'9 ,[('I Y Restricted
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P •III■ PPIP I �
I PS Form 3811,July 2015 PSN 7530-02-000-0053 Domestic Return Receipt
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USPS
Permit No.G-10
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United States •Sender:Please print your name,address,and ZIP+4®in this box*
Postal Service
I Town of Barnstable
_ Health Division �
l 200 Main Street
I
Hyannis,MA 02601
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39iiJ�iltl t Walatt i{i{!�-3 iilff�jxlSi°�i$$iij 'li: ��Ittttlil riiil
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Town of Barnstable Barnstable
Regulatory Services Department 1 edcaC 1
saerisraat.e.
9 1639. ,�� Public Health Division
200 Main Street, Hyannis MA 02601 2007
Office: 508-862-4644 Richard V.Scali,Director
FAX: 508-790-6304 Thomas A.McKean,CHO
CERTIFIED MAIL#7015 1730 0001 4990 4049
October 17, 2017
PROCACCINI, MICHAEL V & KATHERINE A
1001 PITCHERS WAY
HYANNIS, MA 02601
ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5
The septic system located at 1001 Pitcher's Way, Hyannis MA was inspected on
10/11/2017 by Patrick T Sullivan, certified Title V Septic Inspector for the State of
Massachusetts.
The inspection of the septic system showed that the system "Fails" under the guidelines
of 1995 TITLE V (310 CMR 15.00) due to the following:
• Leaching facility with standing liquid level at or above the invert pipe (per
Town Code 360-20h).
You are ordered to repair or replace the septic system within two (2)years from the date
you receive this notification.
Failure to repair/replace the septic system within the deadline period will result in future
enforcement action.
PER ORDER OF THE BOARD OF HEALTH
Thomas McKean, R.S., CHO
Agent of the Board of Health
Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\I001 Pitchers Way Hyannis.doc
• aF 1"F rare, '
Town of Barnstable
i 4
Regulatory Services Department
Public Health Division
200 Main Street,Hyannis MA-02601
Office: 508-862-4644 Richard Scab,Director
FAX 508-790-6304 Thomas A McKean,CHO
Feb 63 2007
Rev. 5111116
DEADLINES TO'REPAIR FAILED.SYSTEMS
(Town Code §360-44 and Title V: 310 CMR 15.000) _
'An`Lx"marked in the D is the failure criteria and associated repair deadline
60 DAY DEADLINE CRITERIA
❑Discharge or ponding of effluent to the surface of the ground w .
❑Pumping more than 4 times during the last year not due to clogged or obstructed
pipe. :.
❑Backup of sewage into the house due to an overloaded or clogged SAS or cesspool
ONE(1)YEAR DEADLINE CRITERIA
❑ Static liquid level in the distribution box above outlet invert due to an overloaded or
clogged SAS or cesspool
❑Any portion of the SAS, cesspool, or privy below high groundwater elevation
❑Any portion of the cesspool within a Zone 1 to a public well
❑Any portion of a cesspool within 50 feet of a private water supply well with no
acceptable water quality analysis. (This system passes if the water analysis
indicates the well is free from pollution).
TWO 2 YEAR DEADLINE CRITE
q m e
❑Any"conditionally passed systems" (broken cover,relocation of a pipe,relocation
of a driveway due to H-10 components, etc)
o Leaching pit or cesspool with high liquid level, <12"below inlet (per Town Code
§360-9.1)
ALeaching facility with standing liquid level at or above the invert pipe (per Town
Code §360-20 h)
OTHER
Repair deadline,
CIA SEPTICOEADLINES TO REPAIR FAILED SYSTEMS.doc
Commonwealth of Massachusetts
q- Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �Ta�
1001 Pitcher's Way
Property Address
Kates & Michael P rocaccin i..--...----------------.....----------------- ------- ------- ------- "_ -
Owner Owner's Name
information is / ifa
y
H annls ✓ MA 02601 October 11, 2017
required for every -- -----------------_____--------------------- ---------
page. City/Town State Zip Code Date of inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
Important:When filling out forms A. General Information
on the computer,
use only the tab 1. Inspector:
key to move your
cursor-do not Patrick T Sullivan
use the return ----- ------------
Name of Inspector
key.
Ready Rooter Excavting
� Company Name
PO Box 89
Company Address
Forestdale MA 02644
City/Town State Zip Code
508-888-6055 SI 12843
Telephone Number License Number
B. Certification
I certify that I have personally inspected the sewage disposal system at this address and that the
information reported below is true, accurate and complete as of the time of the inspection. The inspection
was performed based on my training and experience in the proper function and maintenance of on site
sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of
Title 5 (310 CMR 15.000). The system:
❑ Passes ❑ Conditionally Passes ® Fails
❑ Needs Further Evaluation by the Local Approving Authority
October 11, 2017
Inspector's lgnature Date
The system inspector shall submit a copy of this inspection report to the Approving Authority (Board
of Health or DEP) within 30 days of completing this inspection. If the system 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 systern owner and copies sent to the
buyer, if applicable, and the approving authority.
****This report only describes conditions at the time of inspection and under the conditions of use
at that time. This inspection does not address how the system will perform in the future under
the same or different conditions of use.
t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
1001 Pitcher's Way
Property Address
Kathy & Michael Procaccini — — —— — ----- ---- -_.--- _ __ _ _
Owner Owner's Name
information is
required for every Hyannis_ _ _ M_A_ 02601 _ _ October 11, 2017
page. City[Town State Zip Code Date of Inspection
B. Certification (cont.) --- — - - --
Inspection Summary: Check A,B,C,D or E/always complete all of Section D
A) System Passes:
❑ I have not found any information whic ndicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR .304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
B) System Conditionally Passes:
❑ One or more system components as described the "Conditional Pass" section need to be
replaced or repaired. The system, upon comp tion of the replacement or repair, as approved by
the Board of Health, will pass.
Check the box for"yes", "no" or"not determi d" (Y, N, ND)for the following statements. If"not
determined," please explain.
The septic tank is metal and over 20 ye rs old* or the septic tank (whether metal or not) is structurally
unsound, exhibits substantial infiltratio or exfiltration or tank failure is imminent. System will pass
inspection if the existing tank is repl ed with a complying septic tank as approved by the Board of
Health.
* A metal septic tank will pass in pection if it is structurally sound, not leaking and if a Certificate of
Compliance indicating that the ank is less than 20 years old is available.
❑ Y ❑ N ND (Explain below):
t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
1001 Pitcher's
Property Address
Owner Kathy & Vichael Procaccini
Owner's Name
information is
required for every Hyannis MA 02601 October 11, 2017 ------
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
0 Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired,
B) System Conditionally Passes (cont.):
❑ Observation of sewage backup or break out or i h static water level in the distribution box due
to broken or obstructed pipe(s) or due to a br en, settled or uneven distribution box. System will
pass inspection if(with approval of Board of ealth):
❑ broken pipe(s) are replaced 0 Y Ej N n ND (Explain below):
F] obstruction is removed E] Y E] N F] ND (Explain below):
n distribution box is level d or replaced ❑ Y F1 N F] ND (Explain below):
------............. -------
❑
—---------The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
❑ broken pipe(s) are replaced E] Y E] N E] ND (Explain below).,
❑ obstruction is removed E] Y Ej N F] ND (Explain below):
----------------- ------ ------------
----------- ---------------
C) Further Evaluation is oa h t by Required rd of Health:
Required❑
by 0'
Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect publi health, safety or the environment.
1. System will pass unless Bo rd of Health determines in accordance with 310 CMR
15.303(1)(b) that the system i not functioning in a manner which will protect public health,
safety and the environment:
❑ Cesspool or privy iswithin 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
t5ins.doc-rev,6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17
I
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
1 1001 Pitcher's Wa
Property Address
Kathy & Michael Procaccini -------.---- -- ------._..---------------------------
Owner Owner's Name
information is H annis _MA 02601 _ October 11, 201_7_
required for every —y — ------------------------------------
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.) _ —
2. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil sorption system (SAS) and the SAS is within
100 feet of a surface water supply or tribu ry to a surface water supply.
❑ The system has a septic tank and S S and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank an SAS and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic tank an SAS and the SAS is less than 100 feet but 50 feet or
more from a private water sup p well".
Method used to determine di ance:
** This system passes if the ell water analysis, performed at a DEP certified laboratory, for fecal
coliform bacteria indicates sent and the presence of ammonia nitrogen and nitrate nitrogen is equal
to or less than 5 ppm, prov ded that no other failure criteria are triggered. A copy of the analysis must
be attached to this form.
3. Other: /
D) System Failure Criteria Applicable to All Systems:
You must indicate "Yes" or"No" to each of the following for all inspections:
Yes No
® ❑ Backup of sewage into-faet+r#q-er system component due to overloaded or
clogged SAS or cesspool
❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less
than '/z day flow
t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17
< Commonwealth of Massachusetts
- -� Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
.°' 1001 Pitcher's
Property Address
----- ---------------------------------------------------
Kathy & Michael Procaccini --- ------ --- --- -- - --- ----------._...
Owner Owner's Name
information is
required for every Hyannis_--- —--- MA 02601 October 11, 2017
-------- - --- ---- -- --- ----------- - ------ — ------------------- -- --
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
Yes No
❑ ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped: __.
❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑ Z Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well.
❑ N Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory, for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered. A copy of the analysis
and chain of custody must be attached to this form.]
❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd-
10,000gpd.
® ❑ The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either". s" or"no" to each of the following, in addition to the
questions in Section D.
Yes No
❑ ❑ the system i within 400 feet of a surface drinking water supply
❑ ❑ the syste is within 200 feet of a tributary to a surface drinking water supply
❑ ❑ the sy em is located in a nitrogen sensitive area (Interim Wellhead Protection
Are - IWPA) or a mapped Zone II of a public water supply well
If you have answered " s" to any question in Section E the system is considered a significant threat,
or answered "yes" in ection D above the large system has failed. The owner or operator of any large
system considered a significant threat under Section E or failed under Section D shall upgrade the
system in accordance with 310 CMR 15.304. The system owner should contact the appropriate
regional office of the Department.
l5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17
Commonwealth of Massachusetts
aY, Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
" 1001 Pitcher's Wa
Property Address
Kathy Michael Procaccini_ _-
Owner Owner's Name
information is H y annis MA 02601 _ October 11, 2017
required for every - ------------------------------------- ------------
page. City/Town State Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate"yes" or"no" as to each of the following:
Yes No
® ❑ Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
® ❑ Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
® ❑ Were as built plans of the system obtained and examined? (If they were not
available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
® ❑ Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
Was the facility owner (and occupants if different from owner) provided with
® El information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS) on the site has
been determined based on:
® ❑ Existing information. For example, a plan at the Board of Health.
® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
D. System Information
Residential Flow Conditions:
Number of bedrooms (design): 3---- --- - Number of bedrooms (actual): -3----- -
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 GPD
t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17
Commonwealth of Massachusetts;
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
100-1 Pitcher's Way
Property Address
Kathy___& Michael Procaccini
Owner Owner's Name
information is
required for every MA 02601 October 11, 2017
page. Cityrrown State Zip Code Date of Inspection
D. System Information
Description:
-------------------------------
Number of current residents:
Does residence have a garbage grinder? El Yes [Z No
Is laundry on a separate sewage system? (Include laundry system inspection El Yes 0 No
information in this report.)
Laundry system inspected? El Yes [] No
Seasonal use? El Yes Z No
Water meter readings, if available (last 2 years usage (gpd)): 2015= 247 GPD
2016= 178 GPD
Detail:
Sump pump? El Yes Z No
Last date of occupancy: CurrentDate
Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow (based on 310 CMR V/5203):
Gallons per day(gpd)
Basis of design flow (seats/per ons/sq.ft., etc.):
Grease trap present? 0 Yes Ej No
Industrial waste holding ank present? El Yes Ej No
Non-sanitary waste Xsc El Yes to the Title 5 system? Yes [] No
,
Water meter read gs, if available:
t5ins.doc-rev 6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17
. .
. .
Commonwealth of Massachusetts
~N~~��8�� �� �*����~��~��� 0������������°���� ����N°���
Title �� �°�� � ������� Inspection �~��mmmn
Subsurface Sewage Disposal System Form ' Not for Vo|unturyAoseosments
1001 Pitcher's Way
-_ _---______-__-_______'_-_____-
Property Address
�
Kathy & MichaelP i i
Ownerowne/swamo
information is
required for every H is MA 02601 Ocbober11 2017
| page. C/nv/»w» State Zip Code Date ofInspection
D. System Information (cont.)
Last date ofoocupano/use.
Date
Other(describe be|mw):
General Information
Pumping Records:
Source ofinformation: '
Was system pumped as part of the inspection? IEl Yes N No
|f yes, volume pumped:
gauvon
How was quantity pumped determined? '
Raaoon for pumping: -
-----
Tvpemf System:
Septic tank, distribution box. soil absorption system
L� Single cesspool
Overflow cesspool
EJ Privy
L] Shared system (yes or no) (if yes, attach previous inspection records, if any)
�l |nnovativa/A|ternadvaheohno|ogy Attach a copy of the current operation and
maintenance contract (to be obtained from system owner) and a copy oflatest
inspection of the |/A system by system operator under contract
Tight tank. Attach a copy of the DEPapproval.
Other(describe):
t5ins.doc-rev,6/16 Title 5 Official Inspection Formi Subsuilace Sewage Disposal System-Page 8 of 17
Commonwealth of Massachusetts
--- Title 5 Official Inspection Fora
_ t
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
1001 Pitcher's
Property Address
Kathy & Michael Procaccini-- ------------- ---------___ -. - --- -------------
Owner Owner's Name
information is
required for every ty�annis _ MA 02601 October 11, 2017
---- ------ ..__..._..__.-...--._- - ...- - - --- ....-- ------- ---- --- ----- -- ---
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components, date installed (if known) and source of information:
System installed 6/29/1981_ Certificate of Compliance on file at Health
Were sewage odors detected when arriving at the site? ❑ Yes ® No
I
Building Sewer(locate on site plan):
Depth below grade: 3
feet
Material of construction:
❑ cast iron / 40 PVC ❑ other(explain): ---- -- -- - --- -- ---
Distance from private water supply well or suction line: N/A
feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
------
------------- ------- .._:—------ --------- ---- -- ------
Septic Tank (locate on site plan):
Depth below grade: 2'4"-_ — _-
feet
Material of construction:
® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain)
If tank is metal, list age: ---------- --- ---------
years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
Dimensions: 8_5' x 4_5' x 4.5' 1000 gallons_
Sludge depth: ------ ----—
t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
1001 Pitcher's Way
Property Address
Owner Owner's Name
information is
required for every MA, 02601 October 11, 2017
page. City/Town State. Zip Code Date of Inspection
D. System Information (cont.)
Septic Tank (cont.)
Distance from top of sludge to bottom of outlet tee or baffle -33"
Scum thickness
Distance from top of scum to top of outlet tee or baffle 6"
Distance from bottom of scum to bottom of outlet tee or baffle
�
How were dimensions determined? -Dip tube andha �
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, otcj:
Inlet and outlet tees in place. Liquid level at outlet invert. Risers bring covers within 8^ of grade. Zabel
effluent filter in place in outletto
<3reaaeTrap (loouteonnbep|an):
Depth below grade:
Material of construction:
F1 cuxueu` metal El fiberglass F-1 polyethylene other(explain):
Scum thickness
Distance from mto topo1 foutlet tee mbaffle
7
Distance from bott 7 of scum to bottom ofoutlet tee nrbaffle
Date nf last pumping:
Date
� m"s.dm"-re°onv. Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page mm`,
�
_
Commonwealth of Massachusetts
- Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for voluntary Assessments
1001 Pitcher's
Property Address ---------------------------------- -- ----------
Kathy & Michael Procaccini
Owner Owner's Name
information is
required for every Hyannis_ MA _ 0_2601 _ October 11, 2017 _
page. CityTTown State Zip Code Date of Inspection
D. System Information (cont.)
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan):
Depth below grade: — ----------
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other (explain):
Dimensions: ---.... ------- - ---.__-...--------
Capacity: gallons ----- -- —
Design Flow: --- -- -- --------- ---------
gallons per day
Alarm present: ❑ Yes ❑ No
Alarm level: --- -- --------- Alarm in working order: ❑ Yes ❑ No
Date of last pu m ping: -- ---------- - -------- -------- --
Date
Comments (condition of al'arm and float switches, etc.):
— ..__...-- ---- ---------------.._..........__.._._... -- --- ---- -- - - --------
"Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17
Commonwealth of Massachusetts
_ Title 5 Official Inspection Form
� I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
.'y 1001 Pitcher's Way
Property Address
Kathy & MichaelProcaccini
Owner Owner's Name
information is H annis MA 02601 October 11, 2017
required for every --y----------- ------------------ — ------- -------— ---- -----------
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Distribution Box (if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert 0
Comments (note if box is level and distribution to,outlets equal, any evidence of solids carryover, any
evidence of leakage into or out of box, etc.):
One inlet, one outlet. Heavy solids_3_below�rade
Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No*
Alarms in working order: ❑ Yes ❑ No*
Comments (note condition of pump ch/' cition of pumps and appurtenances, etc.):------------------------------------ --- ---------— — —
* If pumps or alarms are not in working order, system is a conditional pass.
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
t5ins.doc•rev.6/16 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Paae 12 of 17
Commonwealth of Massachusetts
Title 5 official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
= �c 1001 Pitcher's Way
Property Address _ ---- ----------- - - -- — --
Kathy & Michael Procaccini
Owner
Owner Owner
- -------------- -- ----------
------ -—------------------- ------------ --------
information is
required for every Hyannis - _-- _MA _ 02601_ October 11, 2017
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Type:
® leaching pits number: 1-6' x 6' w/2'
stone
❑ leaching chambers number: - --- ---
❑ leaching galleries number: --- --- -
❑ leaching trenches number, length: ----
❑ leaching fields number, dimensions: — -
❑ overflow cesspool ! number: --- ----
❑ innovative/alternative system
Type/name of technology: ----------- --------- --- --
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
Leach pit overfull at time of inspection. Located and inspected with camera. Liquid level 4+" over
invert. Leach_pit is in hydraulic failure_-_-_--_-_- __ —-_ - --------- -- -----_ _---- -
-- --------- ------------------- ------ -- —
Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
1 '
Number and configuration ---- ------------
Depth -top of liquid to inlet invert --- - ----
Depth of solids layer -------
Depth of scum layer --------- --
Dimensions of cesspool ---- --_
Materials of constructio ------------..--_--.-.----__-_-.__.________._---
Indication of groundw ter inflow ❑ Yes ❑ No
t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17
Commonwealth of Massachusetts
-- -- Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not'for Voluntary Assessments
- ------
�r
1001 Pitcher's Way__-
----- -------_-----... ---------------------
Property Address
Kathy Michael Procaccini _
Owner Owner's Name
information is required for every H annis MA: 02601 October 11, 2017
-� --------- ---------------- —= ------ ------------ -..------------------------------
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
Privy (locate on site plan):
Materials of construction: ---------- --- ---- —
Dimensions --- — ------ ----- ------
Depth of solids -—- -- ------..--------- ---- ---- --
Comments (note condition of soil, si ns of hydraulic failure, level of ponding, condition of vegetation,
etc.)
i
i
i
t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17
Commonwealth of Massachusetts
- Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
1001 Pitcher's Way ------ --- --- ------------ -----------
Property Address
Kathy & Michael Procaccini
Owner --- — ----------------------
Owner's Name --- ------- ----- ----
information is y required for every —H annis MA 02601 October 11, 2017
----- ------------------------ —=— ------._...---- — ----------------------
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to
.at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate
where public water supply enters the building. Check one of the boxes below:
® hand-sketch in the area below
❑ drawing attached separately
I r
- I '
v
I �
<a
1 -
.O O C
•t
-
_ 1
t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
." 1001 Pitcher's
_ ----------------- ---..--------------------------------------------------------Property Address
Address
Kathy & Michael Procaccini
— -- - ---— ..._..:. ---- ---- ----------- - -- .._...--------------------------—
Owner Owner's Name
information is Hyannis_annis MA 02601 October 11, 2017
required for every — ------------ -- --------------- ------- ---
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
❑ Check Slope
❑ Surface water
❑ Check cellar
❑ Shallow wells
Estimated depth to high ground water. >2------------ ---
feet
Please indicate all methods used to determine the high ground water elevation:
® Obtained from system design plans on record
If checked, date of design plan reviewed: 12/29/1980
Date
❑ Observed site (abutting property/observation hole within 150 feet of SAS)
❑ Checked with local Board of Health -explain:
❑ Checked with local excavators, installers- (attach documentation)
® Accessed USGS database - explain:
maps.mass�cisstate.ma.us/oliver�hp _
You must describe how you established the high ground water elevation:
Test hole in 1984 to 144" (12') found no ground water. Base of leach pit 10' below round._
------------------------------------------------------ ----- —
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
15ins.dor.-rev.6/16 title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17
Commonwealth of Massachusetts
Title 5 official Inspection Fora
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
1001 Pitcher's Way
Property Address
Kathy_ & Michael Procaccini--- ----- ___ .---__ .---.-.._.__.-----------...-_--
Owner Owner's Name
information is required for every H annis _ _ MA 02601 October 11, 2017 _—� _ _ __- _
page. City/Town State Zip Code Date of Inspection
E. Report Completeness Checklist
® Inspection Summary: A, B, C, D, or E checked
® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed
® System information— Estimated depth to high groundwater
® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17
0001
LO, CA-TION SEWAGE PERMIT NO.
VILLAGE
INSTA LLER'S N>AME i ADDRESS
� G
i-U 111)E R OR OWNER
AF
D'ATTE PERMIT ISSUED
DkT' E. COMPLIANCE ISSUED
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No. ......✓��...... FE ..............................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF ��-AI/EALTH
----------.- �- //�... OF.._..-..,9�1! +.` 1. ......................_.
Appliration for Dispog al Workii Ton.5trurthin Prrutit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an IInddiividual Sewage Disposal
ZSystem at: •-•------------------ ---------•--•------. / /..........................................
Locati /lddres Lot No.
-------------- .F..... � ............. . � C� ...........
j ..... O . -- .... Yll/ ✓ -�llfX..!_._... ddres; �`.Y.. :...........
Installer Address
Type of Building Size Lot:,/4 1 ....--.Sq. feet
Dwelling—No. of Bedrooms............. ----•----_----..___--_•Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
a' Other fixtures ..................!..............................................................................................
W Design Flow.................... .. ..............gallons per person per day. Total dail _y"flow.._......__3. 0.0.............._gallons.
WSeptic Tank—Liquid capacitX_/-gallons Length....___.•__ Width___.�Lff.._..... Diameter________________ Depth....3._--.....
Disposal x Disposal Trench—No.,.&0.41 ....... Width...... .y�r..... Total Length........ ._.... Total leaching area___. —sq. ft.
Seepage Pit No.-___----/_.____.. Diameter.._..ItP __ Depth below inlet..... ............ Total leaching area.._.__._.__._....sq. ft.
Z Other Distribution box ( Dosing tank -
' 4 Percolation Test Results Performed by----------------- ��1��..�� ®y���,��......_ Date....��`��_.��...
H� Depth to ground water.______
Test Pit No. l.._._��___sa�_mmutes per inch Depth of Test Pit_______..//--__. __ p gr
Test Pit No. 2.. g .minutes per inch Depth of Test Pit--------- --------- Depth to ground water........................
P4 ...............................................................................................................................
O Description of Soil------ ------� cc= C�------� _
UC', �V--------- f W -•-----------------------• -------------------•-----•----- •---•-...--••-•--•-•-----------------•-------•---•---•-•---•--•-----------•---•-------------••_-------
UNature 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 i i
p 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been iss b the board f 1 eal
Sign .- --- -- -
. ...---.... . .. ----.............
l Date
Application Approved BY . ... ..........••----•-- /-- �
Date
Application Disapproved for the following reasons:............................ ..........................................................._...._..............
•-------------------------------------..........................................................-............-..........................................................................................
Date
PermitNo......................................................... Issued.......................................................
Date
1 '
;� 1Z
No................ ..... Fps.... '�..
` THE COMMONWEALTH OF MASSACHUSETTS
t, BOARD OF HEALTH
Appliration for Uhipaaal 3Vnrki Tonvarurtinn Prrutit
Application is hereby made for-a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at
V
�/! 1/ � 1
...••--•-....�. .............. gin_ ..,�- .-- .................... ----_.. .........._......._ ........................................
.. -4-
Locatiox,- ddress. 7 - oL Lot No.
Ow er Address
.............•......�.... ....... ......
Installer Address
QType of Building Size Lot.A'✓,f7---•-Sq. feet
U Dwelling—No. of Bedrooms.............. ---------------Expansion Attic ( ) Garbage Grinder ( )
�_l Other—Type T e of Building No. of ersons.J::_________ ____'
P� YP g ---------------------------- P __---- Showers ( ) — Cafeteria ( )
114 Other
fixtures
--= Length
..........................................................-,-- -•--•-----
Design Flow.................... —........•_.gallons per person pe a Total dal flow__._......_ . ni . a .._.........___g ...
P4 Septic Tank—Liquid ca acitY //Agallons Len th._--._- ..-.'.Width.... '... Diameter................ Depth..............
Disposal Trench—No � ....... Width....... Total LIingth..................... Total leaching area-------�_'_.:____..sq. ft.
;
Seepage Pit No.___.__. `__..... Diameter...... .w��... Depth below inlet................ Total leaching area..ci...�:`...sq. ft.
Z Other Distribution box (PIJ Dosing tank
Percolation Test Results Performed by....______._.....%I..�....��-�....�..... �r................ 'l �
/,/ r
Date.....
Test Pit No. I....._ ._Q.mmutes per inch Depth of Test Pit_________ ____ ___.Depth to ground water..........
(i Test Pit No. 2.........5�Lniinutesper inch Depth of Test Pit______ Depth to ground water--------------------------
•••• ....................................... ---------................................
0 Description of Soil....... .X
...........................a. :.......--�=--Ili-------a " r. .--.._ ...........................
x
W vmr
---•••---------- ------- -------- ---------------- • -•-----•.....................---•-•-----•----------------------------------•-----•----•••----------------••......-•-•••••...•-•....••--
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 TTTL
p S of the State Sanitary Code.— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been is by the board f heal, .
r
Sign '..��P..... 1!_---r---. -: ... .............
!� !
ate /+ f
Application Approved By---------- -- --- -- -- ••----• ...1 414 � --•---••-- ."" I '- .Q"r--.
Date
Application Disapproved for the following reasons---------------------------------------------------------------------------....................................
-•-•.............•••••-•----•----•---......•-•-•••-•-----•-•------•---•---•------•----•---••••--------------•----•-•--------••---•----•------•------•-•---•----••••-•----•--------•--•--•------••••--•--
Date
A
PermitNo......................................................... Issued_....................................................
Date
THE COMMONWEALTH:OF MASSACHUSETTS
BOARD—OF HEALTH
..:...........OF..........: c /`......................................................
Trtifiratr of TlintpfiFanrr�.,
THI IS TO CEQTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( )
y� Installer r
at �tJK•r f£ r ---------- - � - ---- ------ ---•---------•---------
has been installed in accordac ^.with the provisions of T j of he State Sanitary Code as des, be m the
application for Disposal Works Construction Permit No_______ _________ ..__.... dated___.._1"..._��"__ .. ..............
TIME ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION /SATISFACTORY !)
DATE G Ctor--- -- --------------------
THE COMMONWEALTH OF MASSACHUSETTS '=Fe
/ BOA
RD41.?*91 8 .
.........................OF...................1........._..•-----------------•-_._...............................
�i��ru��a1 nr1 �.nn��rttnn err i �}
Permission is hereby granted••••• - • ....... ........ --7...... ----------•----•---
to Construct _ or Repair (, ) a,, Individual Sewage Disposal System
at No .......................
. ,�/ _._...-•-- ------------------------•----------.....---- ----------- .
,,. Street / c}
as shown on the application for Disposal Works Construction�,P��No ; :. t._aDated r' .._/_."_'._1---'" .............
•-4
w.�/ Board.of.Health f..
G DATE----
FORM 1255 HOBBS & WARREN. INC., PUBLISHERS
COVERS
BE
TIGHT AND
TOP OF FOUNDATION BROUGHTOTO WITHIN R6" OF FINAL GRADE , SEPTIC SYSTEM PROFILE Flaherty Environmental Services
EL. 100.0' EL. 98.0' (not to scale)
INSP. PORT W/I 3" OF GRADE P.O,yBOX 81.
2" PEASTONE OR EL.98.0'f CLEAN SAND ,� Yarmouth'Port, MA 02675'
4" CAST IRON or EQUIVALENT•^ GEOTEXTILE 774,894.1166
MIN. PITCH 1 4" PER FOOT FILTER FABRIC _VENT (IF REQUIRED)
4' SCHEDULE 40 PVC PIPE
4" SCHEDULE 40 PVC PIPE •� •• �• ••:°-' .�''• ' . ;
FLOW LINE
Iflrst2'to be/evel)
25' 5%
EL, 93.5'
'.a.'•; L.EXIST.
EL. EXIST EL 94.25' —� _f Z'
it' EL.92.83' EL.90.8'
EL.93.0' CLEAN, DOUBLE=
GAS BAFFLE EL.92.8' SOIL ABSORPTION SYSTEM H-20DBOX -�--� , , , WASHED 3i TO 1 " STONE
6"CRUSHED STONE OR (2) TRENCHES 3 W X 331 X 2 D USING 5.3'
'g' '"..`'a,.'::' A I MECHANICALLY COMPACTED PERFORATED PIPE AND SURROUNDED -
1000 GALLON SEPTIC TANK BY DOUBLE-WASHED 4" TO 1 J" STONE
(DATUM: ASSUMED) (EXISTING) J EL. 85.5'
BOTTOM OF TEST HOLE EL. 85.5'
USGS ADJUSTMENT: N/A LOCATIONMAP
GROUNDWATER ELEV: N/A
N TH
Rt. 132 -
118.60'
�y
LOT 19
98 Y 16,937 SFt I Hwy
LOCUS
• 1 , a
BENCHMARK: EXISTING Rt.28
TOP OF FNDN DWELLING
EL. 100.0' J
EXIST• S.T. O • . -- --'-
O _.- — N NTS ,..
{` G s �' 3 '
p I CR
DRIVEWAY 9 '
~ EXIST. L.P. TH-1 ter--- L. T',J
LP TH-2 /STE
SHE � 7O X NITAR
pp a+/
9 1 DATE' . REVISED:
157.57
10' SITE AND SEWAGE PLAN FOR
98 6 & B EXCAVATION INC./
MICHAEL V. PROCACCINI
- 1001 PITCHER'S WAY
SCALE : 1 " = 30' HYANNZSMa
REF•PB 271 PG 84 PAGE 1 OF2
. .. ............... . ........ . .. . ........ ..... . ..... ... . .... ............................ ........................................................................................................... ......................................................... ............... .................................................................................................................. . ................................................. ...........................................
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GENERAL NOTES DESIGN CAL CULA TIONS SYSTEM DETAIL Flaherty Environmental ServiCes
P. 0. Box 81
1. ALL PRECAST COMPONENTS TO BE H-1 0 Yarmouth Port, MA 02675
RATED. ALL COMPONENTS WITH ANY NUMBER OFACTUAL BEDROOMS 3
508.362.1657
ANTICIPATED VEHICULAR TRAFFIC TO BE
GARBAGE DISPOSAL UNIT NO OBS, PORT
H-20 RATED,
2. THE DESIGN OF THIS SYSTEM DOES NOT
TOTAL ESTIMATED FLOW .
ALLOW FOR THE USE OFA GARBAGE
(110GALIBRIDAYX3BR) 330 GAL./DAY
GRINDER.
61
3. MUNICIPAL WATER IS AVAILABLE. REQUIRED SEPTIC TANK CAPACITY 660 GAL.
4. ALL CONSTRUCTION TO CONFORM WITH
310 CMR 15.000 AND ALL OTHER SIZE OF SEPTIC TANK 1000 GAL (EXISTING)
APPLICABLE LOCAL, STATE AND FEDERAL
SOIL CLASSIFICATION
CODES AND REGULATIONS. 33'
5. INSTALLERICONTRACTOR TO REVIEW&
DESIGN PERCOLATION RATE <5 MIN./INCH
VERIFY ALL ELEVATIONS AND DETAILS
AND REPORT ANY DISCREPANCIES TO
EFFLUENT LOADING RATE 0.74 GAL./DAY/FTC
DESIGNER PRIOR TO CONSTRUCTION OR
ASSUME ALL RESPONSIBILITY, LEACHING AREA
6. INSTALLER/CONTRACTOR IS BOTTOM.- (3'X33)X2= 198 FT' 9' MIN, OF SOIL
RESPONSIBLE FOR MAINTAINING SAFE SIDES.-
2' PEASTONE OR FILTER FABRIC—"'�
WORK AREA, VERIFYING ALL UTILITIES [(2'X33)X2+(2'X3)X2]X2= 288 FT-
AND NOTIFYING "DIG SAFE" TOTAL= 486 FT2
X0.74 359 GAUDA Y
(1-888-344-7233) 72 HOURS PRIOR TO
2
CONSTRUCTION.
7. ANY CHANGES TO OR DEVIATIONS FROM USE(2)TRENCHES OF PERFORATED PIPE SURROUNDED BY,
THIS PLAN MUST BE APPROVED IN
J"TO I J"STONE, EACH TRENCH CONFIGURED AS
WRITING BY FLAHERTY ENVIRONMENTAL XWIDE X 33'LONG AND 2'DEEP
31 —
SERVICES AND LOCAL BOARD OF
HEALTH. RESERVE LEACHING CAPACITY NIA
8, FINISH COVER OVER COMPONENTS IS
NOT TO EXCEED 3'PER 310 CMR 15.000
(NTS) TRENCH END VIEW
UNLESS SHOWN PER PLAN.
9. ALL ABANDONED SEPTIC SYSTEM
COMPONENTS TO BE PUMPED DRY AND
FILLED WITH CLEAN SAND OR REMOVED SOIL EVALUATION '
AND REPLACED WITH CLEAN SAND, OOF
TESTHOLE#1 F#15522 TESTHOLE#1 F#15522
10.ALL COMPONENTS TO BE PROVIDED Evaluator., David D.Flaherty Jr.,RS,REHS Evaluator- David D.Flaherty Jr.,RS,REHS
DAV I
WITH WA TER TIGHT ACCESS PORTS SE#2755 SE#2755
BOH Witness: Don Desmarais,RS BOH Witness: Don Desmarais,RS.
WITHIN 6" D.
OF FINISH GRADE.
Date. October 16,2017 Date. October 16,2017 E to
11.ALL SEPTIC TANKS, DISTRIBUTION F
BOXES AND PIPING TO BE INSTALLED 0.
TH-I ELEV. V.96.0' TH-1 ELEV.96.0' 4$�
WATERTIGHT. G/STS
0%43" N1 AR
12.N0 KNOWN WETLANDS OR WELLS FILL 0'-43" FILL
WITHIN 100 FEET OF PROPOSED
43"-49" A LS 10 YR 312 43"-49' A LS I0YR312
LEACHING.
13.THIS IS NOT CERTIFIED PLOT PLAN 49"-62" B LS 10YR 616 49"-62" B LS 10YR 616
AND UNDER NO CIRCUMSTANCES IS THIS
PLAN TO BE USED FOR ZONING OR
BUILDING PURPOSES.
62"-126' C MS 2.5Y614 J 62%120" C MS 2,5Y614 f
14.LOT IS SHOWN AS ASSESSOR'S MAP 272 5%gravel&cobbles PERC 5%gravel&cobbles SITE AND SEWAGE PLAN FOR
PARCEL 147. 7 certify that on November 12,2002, have passed
8 & B EXCA VA TZON INC./
the examination approved by the Department of
15. LOCUS PROPERTY'S PROPOSED SYSTEM MZCHAEL V. PROCACCZNZ
APPEARS TO BE WITHIN AN A QUIFER Environmental Protection and that the above analysis
has been performed by me consistent with the
1001 PITCHER'S WAY
G.W.ELEV.NIA G.W.ELEV.NIA
PROTECTION DISTRICT(ZONE II). required training,expert/se,and experience described
In 310 CMR 15.018(2). HYANNZS,.MA
BOTTOM TH-1ELEV. 85.5'1 BOTTOM TH-IELEV. 86.0
PAGE20F2
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I
TYPICAL SYSTEM PROFILE
A R E A PLAN FDN TOP 524 l / FINISH GRADE== NOT TO SCALE i
�� i, FINISH �
SCALE : I = 00" FINISH GRADE OVER TANK= 57400_ GRADE OVER PIT-''-'l'00
/VC 7- THE B1?,k Alm 7-11 f,[...E F'L C 0L) PL A >1V I -
48.oa' FVcoR rob ' o o
0`A� A.& �F_kV19 77/0 4/ O V C I . TEES 97,33' e . ��/' • 0 1 0 0 ',
/V G 'I�'� \ _
BSMT • / V �7 �r..lO o.�.. o. .�o.. "v V 1 1 e . • • e . e �.
FLR 44,00 /GL GAL. 4 . ° q72
J' 1 1 1 0 • • o o � o o
REINFORCED DI ST. BOX , 1 , 1 • . o e 0 0 0
CONCRETE 8" TO BE INSTALLED ON ° ' ° ' • � • ` ' ° 1
A LEVEL STABLE BASE 1 1 a • • 0
.o �,.. I e a • 1 • • o 0 1 0 0 —
SEPTIC TANK
TO BE INSTALLED ON A 1 0 • • • . . 1 ,
LEVEL STABLE BASE 1 • • • o o ,
i . . . . . • • 0 0 lot
t:
2"-1/8' 1/2 "WASHED PEASTONE ALL
- BRICK 8� MORTAR COURSES AS r 1 • 1 ,> • 1 0 0 0 0 -
I, AROUND FREE OF IRONS, FINES
I REQUIRED TO BRING COVER TO GRADE I AND DUST IN PLACE _
24 C.I . MANHOLE COVER a 3/4 TO 1 -1/2 WASHED CRUSHED
LEACHING PIT
FRAME - SEE DETAIL STONE ALL AROUND FREE OF BASE TO BE LEVEL
IRONS, FINES AND DUST IN ( f �
PLACE J
FOR FIN. GRADE
SEE SYSTEM PROFILE r
_ SOIL AND PERCOLATION
I DATA
4 I
70
W O o -- =- - e�-- - -- - — -' — PERC. RATE . MIN /IN-
PRO
�s sBR L 4 " - FOR INV. ELEV SEE C D. SPOHR
`/ ) /'� sccveotic o
32 ly ! INLET _ ° SYSTEM PROFILE TAKEN BY .
c0 % r�z_ f � A o
06 .
ry LINE ° o I \ WITNESSED BY:
° 0 OPENINGS W/4-I/8 DATE : r�
OUTER DIA. a 1 -3/4
sE�pkoFic� tV. PRO.. Vjj/yE � �: 7' I ,- � , o D INSIDE DIA . 0 ° TEST PIT -GND ELEV. f51.'75 '
�c asrcavc - — '� \. q 0 6 1 '- _ 0 0 TOTAL
Lo�c,v7MG P/r P. ,4R£��rrESCA?_V&xr'r r � � ° o o AREA o � 3 4 �
J-A7EQ0.—54'� o 0 0 0 - o -- ` VEG, L 014,L/-
taerRas ° _
p o
✓'��7. ;�' " 1 `V t� _.._ — ' ° 0 0 0 0
LO' T 6 DIA .
_EFFECTIVE DIA. BOT. PERC. HOLE
DOWN
��►. '� LEACHING PIT SECTION
NO SCALE DESIGN DATA :
NOTE: DO NOT RUN HEAVY EQUIPMENT OVER SYSTEM
NO. OF BEDROOMS I
DISPOSAL
LEACHING PIT NOTES: EST. TOTAL DAILY EFFLUENT GALS .
I . CONC. TO BE 4000 P-S.l a 28 DAYS . SEPTIC TANK G AL.
_ 2 . REINF W 6 " x 6 " 06 GA. W. W. M.
�LE��r/Q'1S �SC�
PLAN! REF: 3. 2 'AND 4 ' SECTIONS ARE AVAILABLE FOR
a�' �V��1'��� ��CEAJ7-/- A0 O�L07` � .�7SSUM D i- 5a•o GREATER DEPTH REQUIREMENTS GENERAL NOTES
I . ALL SYSTEM COMPONENTS SHALL BE INSTALLED IN
D,FAF °0.Ss PL,"A/ BovK 27/ NOTE : ACCORDANCE WITH TITLE OF THE STATE SANITARY CODE
EXCAVATE TO ELEV. OR LOWER AS DATED JULY 11977 & ANY LOCAL RULES APPLICABLE.
REQUIRED TO REMOVE ALL LOAM AND CLAY CONTAINING 2. ANY CHANGE TO THIS PLAN MUST BE APPRV 1N 1
{ MATERIAL BENEATH PIT. REPLACE EXCAVATED MATERIAL WRITING BY MR. CHARLES D. SPOHR.
WITH CLEAN,CLAY FREE GRAVEL, MECHANICALLY 3. WHEN CONSTRUCTION IS COMPLETED, PRIOR TO BACKFILLiNG,
COMPACTED IN PLACE. NOTIFY THE ENGINEER AND BOAR) OF HEALTH FOR INSPECTION.
SIDE AREA = ' 98 S. F.0 � `�S. F./GAL 't"`}=L GALS
BOTTOM AREA= '` S. F. S. F./GAL GALS 4. FOUNDATION ELEV. MUST BE CHECKED WHEN COMPLETED.
TOTAL AREA = - S. F TOTAL �" GALS 5. THESE ELEVS. MUST NOT BE CHANGED WITHOUT WRITTEN j
APPROVAL BY CHARLES D. SPOHR,
LEGEND 6. FOUNDATION INSPECTION REHQD. WHEN EXCAVATED.
OWNERS BL I LD-LkS • A:\EA P L -' [ I + 50.0' EXIST. GROUND ELEV.
CLAki< 4 f'LVA/A,l BUILL)E"AS PP_,i5`A44)i _EZ-) F-ROA4 'LOT PLAA! 50.0' FINISH GROUND ELEV."UNDERLINED"
,80)C 3 7 G'.EA/T�k!//,C-L OP t'-A AIJ> /A/ /L+'y4/V N 0Z,, &pq • 1475 O` PIPE INVERT- ELEV. R E V D A T E D E S C R I P T 1 O N
MA, 2 G 3 2- Fps C ` F B U/L I.>E7e5, SCgL E-
-' /VOY, 29, /980 BY O TEST PIT LOCATION SEWAGE DISPOSAL SYSTEM
C�F'.E /SLla/�L7� SUQUjEy1A1G Cr^ FOR
o � SEPTIC TANK ^, _ � LY(,�
CLi,-�K . fv� BUILDERS
❑ DISTRIBUTION BOX k S WAY
�Ft,
DESIGNED. !�JT # 19 F I T C H E i
4 " C. I . PIPE
7463
ttt+tl-i- 4"BIT. FIBER PIPE - TIGHT JOINTS o Cha �Y��� �� I S. MA�
S
PROPERTY LINEC.D SPOHR DATE:19MC _ DRAWING NO.
/� 01 i�� VO MIN. CODE DISTANCE DRAWN : CS. SCALE:AS SHOWN
� �
L_
1AP SEC PCL LOT HOUSE CHECKED: C. D. S