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1017 PITCHER'S WAY - Health
1017 PITCHER's WAY, HYANNIS` 5 t h, t a TOWN.OF BARNSTABLE r- LOCATION i 0f-7 0,4z`-Y SEWAGE# VILLAGE M 1,,GQ ASSESSOR'S MAP&PARCEL c9iX7.1 INSTALLER'S NAME&PHONE NO. G• I• ®�- '�1 �-939� SEPTIC TANK CAPACITY 0XI Zeno.4,A-L— � r LEACHING FACILITY.(type) (size) �- i-�•�S K NO.OF BEDROOMS 3 OWNER ��U PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility — Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) hl Feet FURNISHED BY L7 Cam, 101 9� n '4 �^ No. (/ Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Ye PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ftplitation for Misposal *pstem ConstrUttlon permit Application for a Permit to Construct( ) Repair(Z Upgrade( ) Abandon( ) ❑Complete System 9(Individual Components Location Address or Lot No. wner's Name,Address,and Tel.No. rlf7�J_ a(5'l 1 f 0-s 'leAle tAl Assessor'sMap/Parcel lql rt/S 1 / Ii n owgo Installer's Name,Address,ano Tel.No.,S'08-q,�S-W 07(p Designer's Name,Address,and Tel.No.aS06-3&p`q,.5•yl Qx.^.1.010 bk 0.n 5kr 'on,14 c LIS-"USITY OOU4 CL,44w- M4 in 61-- oa&0s Type of Building: Dwelling No.of Bedrooms .3 Lot Size /�, �b5i } sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 33U gpd Design flow provided 3qg gpd Plan Date l rc' :31``, 1a' 'Z� nn Number of sheets / Revision Date Title {��5 cJl` YIlSnr,Q+1C /U17 TI�L�rt�S ¢U J4! nntS. A4A Size of Septic Tank ext'S�,JNY)5at Type ofS.A.S.o2- N�ioSacarmQC' Description of Soil l 2 Nature of Repairs or Alterations(Answer when applicable) f/O ���ri�/i�p��¢, J y _ a /f N�US0%C � �� 1 A.rrpLO m4td sg6ay in a �SLX �aC i5•LJ jy�mq au l.:a /6,¢,(!Stri73 5C1 p4./l7 Al X- li 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 Co not place the system in operation until a Certificate of Compliance has been issued by this f Health. S ed Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No.apG l--1-114a Date Issued r.,-._.,,.. .-,:. ..-...-� ..w y ,.. „ r'^pr•' .0 -.,. r v*a _ ,* .b .+1 w'°•*.r y-*cA.,..:.�m.,T-+r7 +r'�,-n'.r•^fs-� _�.. .. a,."",a."'""'7. h Ir _. . .. No. e. Fee /�ao ,.0 THE COMMONWEALTH OF'MASSACHUSETTS Entered in coin ter: Yes' � PUBLIC HEALTH 'DIVIS'ION TOWN OF BARNSTABLE, MASSACHUSETTLS 01ppYication.lor Nsposal 6pstent Construction Permit 8 Application for a Permit to Construct( ) .'Repair(A/,) Upgrade•( ) Abandon( ❑Complete System PIndividualomponents Location Address or Lot No. 161 rJ -�t{� Ly(t f ij/'jl/- Owner's Name Address,and Tel.No. 2(a Assessor's Map/Parcel ?.71 t/�1LJ1 �1 ' ' 14 urn n i vt/l aaton 1 Installer's Name,Address,and Tel.No. SC1$-��$-a�r ho Designer's Name,Address,and Tel.No.Soy-36 i�x�r'•1-olat ``C�ns#rur,.�tor�,�.r►c. �{.Susl-ry !�• noc�u�e 4x�y;neer•�rg,�r?c ��q',N4inS1-• J\lars Jtilr:4.ln ,Y\ o� � �lar`Y1rlat.a, r�• 1A o ac�75 Type of Building: Dwelling No.of Bedrooms —3 Lot Size �, qb� t sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 33v gpd Design flow provided 3Y9 gpd Plan Date fykrc,n 31• o�Va( Number of sheets i Revision Date Title !l� 5 'rrA► Pk,-,A I0 M 24,�P- 'S 0.17, 14W,nniS MA � •� Size of Septic Tank `L'x l sknq 16(yX yttk Type of S.A.S.o2- 4I�Opa.P clLun&K �.S L K Ia�$l t.1..n An V Description of Soil - 7 4 9k L( ©J ;¢. Nature of Repairs or Alterations(Answer when applicable) k Ju/"7i'�t1�L�Ck/��.,�W in.� �LX /� 2lIlt.Y�lTctAhLntr. LY_�1+Q . -4�1h/4�y`.�sr�,S�,S'K; 'ioe•�rr .gn/�. �� Date last inspected: Agreement: '. - -' M ' The undersigned agrees to ensure the construction and mamtenanicof the afore described on sewage disposal system in w� accordance with the provisions,of Title,5,of the`Environmbntal Code-** not to place,the system in operation until a Certificate of 'j , -'r(P n.Rr4fiy_ - �' `jl C. �w.r... 4� • 1 _.) (. ,'t Compliance has been issued by this oat of Health. Signed ; A-- Date_ Application Approved by " ~ ! _ , Date Application Disapproved by Date t for the following reasons l Permit No, ,4-4 '—'/C.31 .17 ; ' Date Issued THE COMMONWEALTH°OF MASSACHUSETTS; BARNSTABLE,`MASSACHUSETTS Certificate of Compliance, THIS IS TO CERTIFY,that the On/-site Sewage Disposal system Constructed( ) Repaired(� 'Upgraded Abandoned'( ,ST/'/1CiY1; at /D/,j T,* iy/"5 .&A, V . WIIAAi has been constructed in accordance` with the provisions of Title 5 and the for Disposal System Construction Permit No- Q ,= dated Installer C74I"�!a It o�SKtLHl1Yl e-1-,nG Designer r�3��111 „,�► t.y1d i�Fd�0✓1 lXi .1 riG #bedrooms- 3 Approved design flow gpd The issuance of this permit shall of be construed as a guarantee that the syste . wil�nction designed. Date Inspector r.r _� Fee / 0(3 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS 4 s oral 6pstem Construction Permit Permission is hereby granted to/�Const)nzc�t� ) °Repair(i� Upgrade( ) Abandon( ) System located at /D/� /"y hA✓C r�l//i / /G2 �/ r {vj / 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:Constructions must be co pleted within three years of the date of this permi. Date l car Approved by JUN-03-2021 22:16 From: To:15087906304 Pase:1/1 r' Town of Barnstable Inspectional Services Public Health Division ' a >,�e,erNla:l Thomas McKean,Director i6J9.•s Q� 200 Main Street,Hyannis,MA 02601 Fux: 509-790-6304 Office: 508-862.4644 Installer&Designer Certification_Form Sewage permit# :?021- /aG Assessor's Map\Parcel .Z72 48) Date: g Designer: . Wn e �1'I Inl �InG Installer: &rZX r Address: 9 M po Ult Address: V 30WOUtfi Wr ,Mkt 02 a-?5 ArS o�y8 O:n /,i a I �,r �, C. " r was issued a permit to install a (date) (installer) septic"system at " 1-017 ifine 'S WN 1 based on a design drawn by (address)�^ D'O tO_ Pli dated_ 03-31-2021. esigner) 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 inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the-septic system) but in accordance with State&Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required)was inspected and the soils were found satisfactory. I certify ttl cyst referenced above was constructed' C A with the terms of 2(lnbta he approval 1 ers(if applicable) ' DANIELA. ,� 4 OJALA CIVIL cn 1� No.46502 er's Signature) �o�'rFGISra��°�,� �SS�ONnL E�0 (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNS-TABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF CO P •IANCE WILL NOT BE OWED U IL B TH THIS FORM AND AS- BUILT CARD ARY RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVIS N. THANK OU. WoU01)UNHEALTMEW/ER eonnecASEPTIMPigner Cenlacefion Foam Ray&14-13.DOC LOCATION SEWAGE PERMIT NO. VILLAGE pi s vu < INSTALLER'S, NAME i. ADDRESS { B- UILDER OR O.INNER. -6IL DATE PERMIT ISSUED �/�/ DATE COMPLIANCE ISSUED/��/�� r- - �-�® ,� �! -- �� h� � �� -'' i ��� .�,I f THE COMMONWEALTH OF-M,jSSACHUSETTS B®AR® OF ,HEALTH OF Appliration for Diip.aiial Work.5 Tougtrurtion ranfit Application is hereby made for a Permit to Construe) or Repair ( ) an Individual Sewage Disposal System at ................_�l1/7.._ � = .......... .... .................. L ion-Address n-r i i 7�y� /� �f ddress/�� n nstaller Address / l -s U .Type of Building Size Lot.......:........ q. feet Dwelling—No. of Bedrooms___________ ____•.---_--__-__•__--__.-Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ............................ W Design Flow...................�.5...............gallons per person per day. Total dail`flow__.___......__. _.3..................gall�s. WSeptic Tank—Liquid capacity ��.gallons Length......9...... Width...... Diameter_............. Depth.......... Disposal Trench—No. .__�._..... Width:....-.. .. Total Length............... Total leaching area... _. sq. ft. Seepage Pit No---------_--------- Diameter...../�.r�__ Depth below inlet......-......... Total leaching area_W sq. ft. Z Other Distribution box U� Dosing tank ( ) / / '-' Percolation Test Results Performed by_.____.___. ' c' 1 ....._ ` ,• .. Date......1V d� 1_----..'. Faj Test Pit No. I...�_�minutes per inch Depth of Test Pit......L�.41..... Depth to ground water.... V/11-. Test Pit �,ro. 2................minutes per inch Depth of Test Pit------�.0!_. Depth to ground water_.__ _... ----•- . - ---- 0 Description of Soil.--- X� �j� _' ------...4 i --------� `_/ = ------ x � .---------------•--•--- ....................................................... -- � rim----- �---- -------- - - - - - ------- W c.. �, -----••••••••. 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 AiTL 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 iss ed by the board of h h. . Application Approved By••. E- •-�`. ----/-- Date Application Disapproved for the following reasons-------------------------.--------------------------------------------------------------........ ................ ----------•---------------------------------•----------------...-•-------------------........-••••--•-•-•----•--••••--••-------•--------•------------------••-••--...._.------•----•---•-----------••-. Date PermitNo......................................................... Issued-....................................................... Date No----..../!/..... .. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH-- /.......r!!!v. ... _....OF......... .............................................................................. Appliration for Disposal Works Tonstrnrtiun Prrmit Application is hereby made for a Permit to Construct) or Repair ( ) an Individual Sewage Disposal System at 5*/f// &1;li 1_:'/ G7f�� -------------------•---------------------------...........---•----------------..._............... ..............................................•-••n.............................................. ` Locat on-A dress 11 or I19 T...._ f` G��: /� G.r�! / ;e'-<c'�/fir i Ownez- Address r Installer Address ... f� S feet U Type of Building Size Lot.......................... q. Dwelling—No. of Bedrooms...........................................Expansion Attic ( ) Garbage Grinder ( ) aP4 Other—T e of Building No. of persons............................ Showers Other—Type g ---------------------------- P ( ) — Cafeteria ( ) Otherfixtures-.......................... ..................... --•••- ----------------- = ' W Design Flow........................................... per person p Oay. Total da'yrflow____..._..._.........��..._.._........._.g�lfo>3s. W Septic Tank—Liquid capacit j�! ..gallons Length................ Width...__ ._.._.. Diameter________________ Depth....._-.___..... �' ._ V / x Disposal Trench—NY..✓�-��._._.. Width..e;_;. .; -- Total Length.........a" / Total leaching area-._' jF� �sq. ft. Seepage Pit No--------------------- Diameter..................... Depth below inlet.._............._.... Total leaching area.........__.......sq. ft. Z Other Distribution box ( ') Dosing tan !( / 'r ��, ' ' Percolation Test Results Performed by_____________________________________________�... _!� Date................................2...... ¢ Test Pit No. l.... ..q minutes per inch Depth of Test Pit .�.!__ Depth to ground water-___ 44 Test Pit No. 2................minutes per inch Depthi of Test Pit.................... Depth to ground water........................ _.___ ____._.--_••................. Description of Soil.... _•..._._ ..................... . x P .. �', ----------------------------- W ----- r_ -........................................................ VNature of Repairs or Alteration Answer when applicable_______________________:._.----__-_________.-------______________.____-__-_.------••-••-_-----. --------------------------------•--•-----------------------------•----------------------------•--•-•--•-•-••••••-•--------•-----••------•----••••------------•-•--•••-•••••••-•••-••••••••••......-•••-- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System;in accordance with the provisions of'T L 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 i s ed by the board of healfhJ �y ; • . -------•-•-•.....••• ---•-• . .•. .......................... -- � rApplication Approve# By- ••-•-- ••••. •• •• .• --••••..... Date Application Disapproved for the following reasons-----------------------------------------------•----------------•••-••-•-......-•••--•-•••-• --•-•---.....-•---- -••-•-•-••-•••-•••--•--•••---••-•----•--••••••--•--•••••••••-•••-•-• ••--•-••••--•••----••-•••-••-••-••-••--•--•-•--••••-•--•---...................................................................... Date PermitNo................................... ------------------- Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..... �'.............OF............; v,. �.p�..,.f... (.Ferrtifirttle laf fanrntltnrr THIS IS TO CER�-T--IFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by....V0. -------------•----•----..........--•-----------•------- -•--------........---....------•---•---•--------------..............--- ,/n� �/ / Ins ler l at F ` 1=t 4 `- fihO ------------- _:_------ ... , has been installed in accordance with the provisions of r1 j�he StaS,anita Code as described in the application for Disposal Works Construction Permit i o------ ...... ................... dated.... .................. ___........_.._... THE ISSUANCE OF THIS�CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE � ✓ Inspector !r .f _ �< x r .� P ti. ri� = r�'� �.r tJ:$J�`A"'tJ�9Yt '``.t ` _� _ "� i" ''Yr:.�1�'� -•fib <`{. - ,.t'..eiei.'shv f-C.Y:.14fr7 . '*le ..++w.}SarY 1i ate. , 1. - r vv +. _ ., .ear , ... •a�a C ,ar �tY "' THE COMMONWEALTH OF MASSACHUSETTS BOARD - F HEALTH r �/ /001 ..:.......���w......... ���..�, o.•....................... Disposal k ��f � a� iaan Prnti q� Permission > hereby granted •••••. ----------.. { . + ` t • +" ....... to Construct ( 7�) or Re a'a ) an Inrliv al. ewa e 1 posal System Street as shown on the application for Disposal Works Construction No _---ei.___._j ated..—7--` --�_.-.•-._.__-•---- ... --- -----•-----.----- r � oar of Health DATE.... .....................................----------- -- ---- -------------------------------•---• FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS !I - Co irnonwealth of Massachusetts Imo .— TMe 5 Official sped"o _. n Form subsur;ace Sewage Disposal System Form - No f--��-- r ; or\•c,unary Assessmie— Pro-el-y-Address ---�-- /-------- ------ - --�__�------ -------- -- --- VV 0 ) *,5:1✓1 f Own-- Ovv�nrinT0m^,2tion Is recuiredfor �v►n�t /�.� 0�2601 Zip CGJiatB Gir_Dat 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, I� I Important: --_ — ,ii+ When filling out A. General Information forms on the ecomputer,:,;e �� only the tab Key inspector: � to move your 52 cursor-do not ---- — use the return Name of In SP e ct,or ----- ----- ----- I; 'Key. _ /7' f.I'` -do Mprny"Jame d0-y- /d YIF__ - 1 Company Address ----- — ------ ------ �ip �,.de Tel i" - — -- --- ------ '-r License Number ----- B. (Certi caflani - �j� =I I certify that i have personally inspected the sewage disposal system at -his adotress and that the l information reported beiow is true, accurate ar:d Compete as 01`the time of t"e inspection. The inspection was performed based on :i.y training; and experience in the proper function; and maintenance of o:, site sewage disposal systems. I aril a DEP approved system inspector pursuant to Section 15.340 of Titre 1`5 (310 ,MP 1 ,.000). T h , system: des _ i `� Con !tionaly Passes �I Fails ^I Veeus Furfhar Evaluations by the Local Approving Autnori v inspector's iGnaiure ----- mate �� -- ----------- 1 The system inspector shal! submit a copy of this inspection repo e - ojr i :c { Health or !/ lltilil report to tl1 p Q:i t;� V of He Et j to 1310 days, of competing this inspection. If the systel;I _ - y� has a design `,ewv of i0,000 gpd or great--;. the inspector and the syste;, owner s a,! report to the aop-opriate recioral office of he DEP. ; and copies sent to the buyer, if applicable; and the he o,iciral should Ce se.:. to .;;e s;;:; I appro�inc all tncr I y. J ; fi e -"**,This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address hov,the system wiif perform in the future under j the same or different conditions of use. 5,,s.o cal b Tile 9 i. Commonwealth of -Massachusetts. i Rile Official Inspection Form I= Subsurface ."`,ewa-gQ Disposal System Form No,for Volun ar,,Assess,—,:en's Pope,iV Address - - — ------- n--ormation is L 2 rec,ui-eo for G1 to Ni f -- A4 Od 6 0/ C�`/p7 every page. City/Towr, — --5- - --- ---- z.a _p Ccce ate of ns;.,ec:ic_ Inspection Sum ma Check A,B,C,D or ;---:i always compiete all of Section D A) Syste;n Passes: i I�ati ICI I e nat found anv in orr; atson wh ch indicates :hat any n, he :a;!'ljre criteria .e i� c.,..� .,,,c in 310 CkR;; 155.303 or in 310 CIMR 5.304 's� re -ite, _exist.And fai:is „ ., is not evaii._.ec re indicated be Clw. Comments: -( �'�1, ` ---- -- ----- .------ -- --- W _ B) System Conditionally Passes: I=- L One or more system components as described in `he "Corditionel Pass" section need to be I replaced or repaired. :he system, upon CC)MpletlCr ofi the repiacern=nt or repair, as aoQro'rec w the a d of -1 arch, il; pass. Check the box for"yes", "no"or`not determined" (Y, N, ND)for the f01olNing statements. li nGt. determined," please eX,olain. The septic tank is metal and over 20 years old*or".-he septic tank (whether metal or not) is " structurally unsound,exhibits substantial infiltration or exfiltration tank`allure is iru ,inent. S,1ste 1 will pass inspection, if f e exist!:n tank is replaced with o complying sE otic tank as approved bV ir`;e Board of health. A meta' septic,tank -will pass Inspection if it is structuraif sound. not leaking and - " Y a e :ca,e Compliance nC catinc that the tank is less:hen 20 years old is available. v i� 'ti I_i, ND (Pxpia'n below): st iA r 7r COM1710r wealth, of [Wassachusetts U1.111cial Inspection — I, Subsurrace Sewacie Disposal System Form -Not for Voluntary,assess-ents k ; Procerty Address — � �_ ----- ----- — Owner Ov:ner's tiame ✓-----— --- ---- -----— -------- information is / y : required for —---[ A to P? 62 C) Q i every page. Gh1rrov n state Code— �G-- ---- _ a Zi se ._ . B) System Conditionally passes :;coni.): �I 'Observation of sewage backup or break out or high static water level in the dlstrlbUtio:n box due- to broken or obstructed, pipe(s) or due to a broken, settled or uneven distribution oox. System v:ill pass inspection if Miti^ approval of Board of Heaith): i broken pipe(s are reniaced _] `l ❑ It ND (Explain beo+w`: !i obstruction is removed Y j N — ND (E ^e xcia, , 'o .;. = ; it. i distributicn box is leveled"or replaced =j Y N L! ND (Explain bei'ov-,,).- L she system 1—acquired p.urnpi;ng rr:ore than 4 times a year due to broken or cosTucted pipes : `he system Will pass Inspection if(with approval of the Board of Heaitsn): —J broken pipe(s) are replaced ❑ Y I N [I ND (Explain belo'V"& 71 obstruction is removed i! Y 77 N ND ^ ^(Ex.,ia i�� b�'o+;� 1 C) Eerther Evaluation s Required by the Board of health: l I CCndlilOriS exist's!i ICh reCiUire iurtiner evaluation bV the Board Of r Q?iih JfC r t0 dole;. e'; the system, is falling t0 protect public health, safety or t'le e�nviron i ie n.i. 1. System will pass u iless Board of Health determines in accordance with 310 C-MIR `t5.303(`)(b) that the systeM is not functioning in a manner which will protect public health;. sa:Fety and the ervironmert: Cesspool cr privy is within 50 feet U a Surface water i i ❑ Cesspool or privy is within 50 feet of a bordering ve�atatec lvvetiand (sins•cs/os G�: 13's; i t r i ,)s ,I �� � Cmimonweafth o Ulassachusetts Title li'l � � �� ®� �✓ Subsurface Sewage Disposal Syste;n Form - Not for Voluntary Assessments Prope Gv,;r,e-s fame -- — inform.!atior is re uired for � ✓� r.f �/ G _� �60� q «lie� every page. Ciiy�ow. - State fat_a Zip Code f±nspecaor-------- + , . Certification (GOnt.) 2. System will fall unless the Board of Health (and Public Water Supplier, if any) dei:errmnes that the system is functioning in a manner that protects the nubiic health,. safety and environment: f, The system has a septic tank and soil absorption System (SAS) and the SAS is ?ditl,a i 100 feet of e surface\eater supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is a.ithin a Zone 1, o; a pub!ic x Supply. 17 The System has a septic tank and SAS and the SAS is ,v`ithin 5 feet f Private `,!a! c + ) FC � SAS t7 e • O a Nrl\ ,.c:..r supply wsl . _i The system has a septic tank and SAS and the SAS is less t"an 100 feet but 50 teet or more from a private water supply well** (Method used to determine dstan:ce: t *' This system passes if the well water anaNsis; performed at a DEP ce tried laboratory. for colifo,-,+ bacteria indicates absent and the presence ol-ammonia nitrogen and nitrate nitrogen is equal to or. ,i less than 5 ppm, provided that no othier failure criteria are triggered. A copy Of the 2:n2lySis m+USt 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 foilowina for all inspections: i +, es No i Backup of sewage Into facility or, system component due to o,er ioa,J c, ;p ,--, ,Clogged SAS or cesspool. k Discharge or pondinc of effluent t0 the suurface O, :++e `C-Un - - ��►�,� `�� I due to an overloaded or clogged SAS or on---spool Ste iC? GX above G+quid ;eve* in the distribution b b Ic ;n -`t an 1t ! .,U�i i or clogged SAS or Cesspool Liquid depth in cesspool is less than 6" b�lotnr i+ �+ d�'.Iflo+� .� nverl 0;2,VP Gv: .�0� }i+ ianSS t. / �. plain G �i .. +�ir5•O�iQa . I ifle 5 ia:J3,InSp=_t.,,^i-Lf71'$,ice-Su.-•2C=J24.- _,].c 1; i Cmmonweaft- of Massachusetts _ = Title Official Inspect" ion Form ,- Subsurface Sewage Dispesal System Form - Not for Voluntary Assessments Prope,..�Address - --- - — --- -------- Owner 0%mn s m� ---- --- ------ infon-ial flo is C�r ��aj j { re,;uired`or -- ��, every page. CItV�C'v"i� � ----- State Li,C Code �aie i it�S�e C:;Gn I' B. Certification (cont,) i Yes i\!o Require,- P P 9 q im he quire., um �n mar e ihan t'�les i-: t. ast yea.' NC 1 d72 O CIGCg2c cr C —/obstructed pipe(s). Number of times purnpec`: �i ❑ _` any porion of the SAS, cesspool _, prsivy is be10V✓higi`1 ground .,ater ele,;at o;i. /�l;✓30riion of cesspool Or privy is within n `;'00 feet O-a surface ace vt!ater S up El 0 —J tributary to a surace water supply. IZ Any portlon Of a cesspool or privy is within t a Zone 1 of a public well. L Any portion of 2 cesspool or privy is within� 5.50 Peet of a private �^Dater SupD'iV\°ie.iEl Any porion or a cesspool or privy is less than 00 feel but greater than. - eet from a private water supply well with no acceptable water cuaiity ar ai'lsis. [This system passes if the well water analysis; perfcrmad 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 i° and chain of custody must be attached to this for IF rT he system is a cesspool serving afacility with a Lesion flow' Of 200.Ogpd- Fi li J,000ggd. r r- ,- �Th-o system fair. I have determined that one or more Of i :e above i_a,ili:re criteria exist as described C ibed in 310 ys; s h d .�1� 15.�03; mere:ore �lne s ...=m tali... n„ system owner should contact the Board of Health to dete,mine? hat wi!i ce 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 or`no" to each,, of the `lowing. in addi.lan o e Pa-: .n� questions in Section D.` Yes lua ti ie system is wit^in 400 feet of a surface d'I 1k; :O 2ter Su—no'. the system is within 200 feet Oi a tributar✓to a surface dri ak'n 71-le system is located in a nitrogen sensitive area (IaE =!, eac ; iea - W:W or a rnaaPed Zone it of a pu}biic 1j2ter uo !}, ei# i y0u -i iav jeered `yes' io any quest . Section E the s� ' ' - e answered any ion n yse,m is cons;� �, � �, ,, - or answered yes" in Section D move lhe ;arge system has failed. The o„M-2,r 3D system considered a signf,icant threat under'Section E or fi under Section D shell c+ accordance witl - 310 CUP 15.304. The system owner should contact : Pnnrj- regio�gal o`f;cE of :he epartment. - %�Ornmortweaith of Vassachusetts � �, � :' H� riaInspection Subsur-iace Sewage Dispc;saj System Form - Not for Voluntary Fassessments a. - Property Address ---- ---- - --- ----- — Ov.ner Crm Name Mj --- - -- -- information is //7J required for t/!✓Jtf --- — /' '�j ©02 6 01 it ever,oag�. Ciri//TaviK ---- - Sta Zip p Code i1 Check if the following have been done. You must indicate"yes1 or `no" as to eac:- of the fc!! °nc: fir's No V L� Pumping information was provided by the owner, occupant_ of Eoard ci I—! 'ram vere any of the system components pu,nped out in the previous t:,-a ,lee;;? ! [I was the system received normal flows i the previous two e � n pre ous ,��week period?. + J C ave farce volumes of water been ?n'trod :ced to t`le systern. rece nitiv or as oa'i cf !— .his inspection;? is III �i Jere as buy;t plans of the system obtained and examined? (if ii;ey:ve.re no; gvailab'e note as N/A) �.;, o l �` �, f► ;Jt� L Was t i-Icliity G.'G'dJ l lr;g inspected for signs sewage back !p Il ❑ VJJas the siie inspected for signs of break out? `P ere all sys'em components, excluding the SAS, located, on site? Were the septic tank man+iicl uncovered, opened: ano' t", eS U% G erect, ,. e interior of ii c inspected for the condition of the baffles or tees, material of construction: dimensions, depth of liquid; depth of sludge and depth of sc!rn'% l \l-!as the facility owner{and occupants if dif e-en from ev✓ner) NrG4iiced +:+,i ;~; information on the proaer maintenance of subsur`ace sewage disposal c•;ct gas he sire and iocation of the Soil Absorption System (SAS) on the slte ias been de?ermined based on: I r 1 C E :sting information. For example, a plan a- the Board of Hl'eai-h. Determined in the field {if any of the -allure G icria related t0 F�c.'t Deter m - C is at issue L� • approximation of distance is unacceptable) 1-310 CmR 15.302(5)l l is I# Residential Flovv Conditions. Number of bedrooms (dcsil-.n.): --�-- Number of bedrecn;s DESIGN flow baseb on 310 �;" , rf�^ ) ��O C- �;� "i�.2i,�3 ,, .r,.xai�'lpie: 110 gpd X 0;_ I,li �i5ins•^9iG8 'E 5 f -,,L Commonwealth of Massachusetts OFF Title ' Offic'al inspect'ion Form Subsurf'ace -etwaae Disposai System Form -Not for Voluntary Assessmen's Z� t A)19 le---c Pro cl ei-`,7 —------ ss Owner informetici-I is required 10-- every 02og vin State Zip Cade Date of lns�ec,-ion D. System Information Description: 1/0 L-1 7-- 7 6 61 S.7L it �. i � Number okcurren!' resident: Does residence have a garbage grinder? ;—i Yes 0 it Is laundry on a separate sewage system? Fif yes separate ins!oeclion re,,-:Ui,-ed-' Yes L Laundry system inspected? Yes Seasonai use? L_j. Yes 71-<0 '.Fate- rneter readings, if available (I ast 2 years usage (gpd)): Detail: Sump pump? 1:11, Vic I V IN o Last date of occupancy: Commercia[Andustrial Flow Conditions: Type of Design fi.low (based or., 310 CM R 1 5.2�03): G12T1----ns—p-,-r d:-:v (go Basis of design ;:low (seats/persons/sqft, etc.): Grease trap present? :No Yes, Industrial waste holding taink present? 77 i N 1 1 �+4i1 I Nor-sanitary W2sle discharged to tie Title 5 system? e,s Water meter readings, If available: Tifl'e 5 c.-i-i�i!nscc-jD, Conirnonwealth of Massachusett's UJ �z M A e 5 nifficial Inspection Form i - Subsu-.-ace Se-,jvz,!ge D1_spcsa! System Form Not for Vc!unrlary Assess,-nen.ts Property Addr ss T_Is% r'S info.rmation is rf—_,ui-ed or if A9 0 0 every page. Citv,7 v. S"ate Zic Code C 7'0,-, Date of int,.- e D. Sysiern Informnation (Cont.) All Las' date of occupanc\i./use: Other (describe beiow): General Infornlaflon Punnoirg Records: Source of in'.7ormation: Was system pumped as oart of the inspection? Ell -S ff yes, VO!UM6 plumped: g?llons 1; Hov%,was quaimity pumped determined? Reason for pumping: Type of Syctern, ILV Septic tank,'disuribution box, soil absorption systenn Singe c ss.pooi C"'ver-flov,,--esspoo! Privy Shared system (yes or no 'i'ves, attach previous inspection reccircs. A innovative/Alternative technoloQv.Aftach a copy of-e cljrreni ooer;_:�4` maintenan-ce contract (to be obtained from sv-- -t n e r) F n e c�,,:D emo ;.n.spection of the II/A system by Svstern operator uncer cont,a F7 Attach a COPPV C)f fj'-,e DED approval. Other(describe): Tie Commonwealth of MassachUSettS 17-p 7' t-le 5 Official Inspection Form Subsurface Sewage Disposai System Form -Not for Voli-m-tary.Assessme.r-its Ni Civvner Ovurerls (gar— infcrrnatior is required fo- e1z zw -Q' C) /41- every page. CityrTcvvn a t e Zip Code )=13n C D. Sy ternhnforrnation (cont.) Approxima.te,age of all co,,-.,00n ent S date ;nstalled (if kno,,,vn) and scurce o! iinfonna'ion: VVere s-evvace odors detected when arriving at the site? 0 Building Sr wer(locate on site plan" Depth below,grade., Material of cons riict:o cast iron �A 0 P\ =.;n): other(ex,plal Distance from private water supply well or s.uction line: I-ez comments (on condition o.fJoints, venting, evidence of leakage, etc.,': Septic Tar!k (locate on site plan): Depth below grad.e: —_/� -- Ma er ial of cons'Fuicti c !'iet2l fiberglis — ass —h e x-ot li tangy: is metal, list age: Is :=ne confirmed b,,/a Certificate Of Compliance? �a-uach a cop M H, V y Dim-cnsians- 'x Sludge depth: Commonwealth of Pqlassachmsetts Title 5 Official Inspection Form SubsuriTace Sewace Disposal-z, stem Form No', Tor Voluntary Assess:-:-,.ents Propei'\' Address Owne, w-nor's N' i nfo,m 2-L iof�is 5��� "ol squired e . ,—%M r? -ij;rj for every page. tyffov nLCde -a D. System Information (cont.) Septic Tank (Cont.) D -tarce from, top oFs!udge to bottom of Outlet tee Or baffle i— S iroM Of SCUM- to top 07 OU'Ll e-, ee or baffle -om of so Distance from, Cc(t I um to bottom ofoutlet tee or baffie i-iovv were c!0-,ensions de'Le,:-mined? CZ�—C--C-- Comments (on P ium-ping recommendations, iniet and outlet-tee or ba fflle condition. structural 'nteeritv. . I . i, , liq.i-:id levels as related tn- outlet invert. evidence of leakage, e-c.� ::2 t-4 5; C)b V/ Grease Trap (loca'e on site plan): Deptn below grade: Bel, Nlaterial of construction: 0 concrete ❑ metal fiberglass 'i—I ociveVivIene I other ex-I D.mensions:, 4, Scum thickness Distance f,orn to'P Of s,01-1m to top of outlet t' 0:-baffle -3e Distance -:;-om bottom of Scum to bot-Lom of outlet tee or baffle Date Of last Pumping: t5ins- ?/0,. Tie 5 Dit oi"C:n:1,S P e CIN C,�F 0 i - Commonwealth of Na:ssacf-susctts Title 5 Official 11,nspection Form Subsurface Sewage Dtpposai/Systeim Form - Not for Voluntary Assessments -� - -------- LAG Property Ad ress --- ------ ---------- ----------- LA Owner — � - P —-- —'- -- ---- - - Owner's WING , � -- -- - recuired for G v1 0i{ La — ever;/Days Citv[Town Jia`.e =p%CCecciiOn -.._ D. System Ifformation-(cont.) l I In 'la II f Comments (On pumping recommendations, Inlet and outlet tee or baffie Condition, s ruct'.1ral,;-,:'rt)': �cc liquid levels as rel re'-d to outlet invert: evidence of leakage: etc.): ---------------- ----- f. 1 Tight or Ho!ciing Tanis (tank must bs purnped at time of inspection) (locate on site ylan): Depth below grad: ----__—_ — _ -- Nflateria! of construction: ,� ❑.crDrlcrete ,I metal fiberglass v n — pi ❑ [ pol��,.th ale, e _� diner (ex;,iain j: kill r11 �i ! ------ ---- ---- --- ---------- Dimensions: --- - -- --- �i Capacity: — -- ---- — Design Flom/: pzilons per a--,: -- -- ---- Alarml present: [-7 Ye L-i i\1c ..alarm level: ---_.___-- A(ar rn in;v rQer: ; ' Yes j 1I J"kiric, r - ;NG Date of last pumping: Date---- ------ ---- -- C.orniments (condition of alarm and float switches, etc.): 4 , Affach PY of .U..er:. pu-npinc coy1:r:ct (required). ,s coc'y �'.- Commonwealth of Massachusetts ion Form Subsurface vet��;;A y Disposa? System Flo- s Not for Voluntary Assessr,"eats Prep--,i Address -— �-------------- -------- IM O --- -- ----+.vrer's I �e Oamer rlf0r�l�il0fi is k � ------ required for A✓114 ej �i� Vd-& even pace. C,ih;TTo111vr --- -- ,yt 1 - ---- a. -p Cod= --fat e _ -- D_ System Mstrib;-;t or Box (if prese-it must ce opened) (Iccate c;, site p1an;: 1-',Ieptr, o-i quid 'evai bove ou let avert ---���� — — — ----- �orTrner._ (notte if`»k is ,LJE' and distribution to cutlets ecual, cnv evdence ofsoil,, ca r Over ainv eli l:ler-,c. Df,e-.',ae ii-�to c-cut o=cox, etc.): -- OO li Pump Chamber (locate on site plan): Pumps in working order: Yes Ji ;'c Ala..rrns in working order: I Yes J No Comments (note condition of pump cumber, condition of pumps and appurtenances, etc.): i� SOP Absor p ion System (SAS) (locate_ on Cite 'an, excavation�t r o-L re c;; p qur�e.. . If SAS nct bcated, explain v�,hy: 1I�.Sips•sm3 `. aa�:rgp=rle 5 o LJ11, - - I I € Zx ccmmonwealth of Massachusetts f . _ :_„ vial inspecficfn Form +�', -I 'v, Subsurface Sg ace Di"c pcsai System Form Not for Voluntary Assessments essments grope:-[y Address �1 — — ------------ v inner s Na --------- ------ ;nfor:cation i / ever. d.or Gt W►/� 15 ever.; gage. City,'TCvan p� ----- }<f -- -- .ate LIP,Code Date lnso=crcin D. System Information (cunt.) --- -- Type: iea.ching pia number: --- L-i ieacN:ng chambers number: s,i1 '.II 1i , j eaching galleries nu,Ice;: ------------ leaching r i trenches number. length' ---- l --- leaching fields number: dimensions: 14 ❑ overflow cesspool number: - --- / r innovative,aiternat've system Type/name of technology: — ------ Comments (note condi`ion of soil, signs of hydraulic fai Ure, level o ppci ndtn0, damp soli, concii!O 0' vegetation, etc.): '1Z / vf.( -:-1 o V-e r CesspooEs (cesspool must be pumped as part of inspection) (locate on i`e plan): Number and configuration __-- Depth -t-p of !gUid to inlet invert _ Depth of solidsayer —_-- -- Depth� Of scum layer . IDimensions of cesspool -- 11"! ,� ' Materials of construction _ indication ' i Oi groundwater Inf-low y Yes ,Sins•0?iQS � J _ Comm, onwealth cfloassachusefts TI'Ve 5 Official Inspection Form !I Subsurface Sewage Disposal System :::c).-m [�ot !o �Eg ff�9_�2ff if�1' VO!LI:-,-ai y Assessrnem Orooery Add-ess n r Owner's Name :mOirmation is required for 1,2— Cr- eve--/pace. J,/T o State 7iD Code Da�.0- /in S,�:,e C-!,o n. D. System inforg-nati-on (cont.� j Comments (note condition of soil, signs o, hydraulic failure, level of ponding, co;dition of veoetation. etc.): JAII Privy (locate on site plan',: Materials of con str,;.ic-11ion: Dimensions Depth of solids Comments (note condition of soil, Sions cf hydraulic failure, level of Pcinding. condition oi etc-;- 15i's M03 Tje 5 o COMmonwealta`t Of Massachusetts _- c io `o Subsu face Sewage Disposal System ;=orm -Not for Voiuntar v,gssessmen`s 1610 PropervAdd-ess Owner AJ _/ wne --- --- -- -- ---- ----- --- .— ------- -- required for _ _ lil�'1 �S — i MM ever' page. City/-ovdn - State iio Code �� .� _ �- --- �I ilit i�li I .acte I nsc,„�_:.cn _D. System Informat'lon (cone.) i. Sketch Of Sewage �ispcsai System: Provide a view of tie se--,,vage disposal system; including ties at least two permanent reference landmarks or benchmarks. Locate ail ^,�eiis within 100 feet. Locate li: w ,e e �oiic water su_opiy enters the building. Check one of the coxens below: iiarld-S ketCti � the area below ul� drawingt a�-ached separately I i C I! i5 1 1 L1/ 143 60 l I I i i . C®�e�f� vvealth of massachus ells ►'• Tifle 5 Official Inspection Form ;7. _;^ I- Subsurface Sewage Disposal Syste,-n Form -Not for Voiuntar✓,ass_ essmerlts /D/'� �� r� lil '11 �I r Property Address --- --- — -— �,� ---- — --- i ! - 0 Owner Owner's i1 ...e --- --- -- -------- ----- — _ F information is required for Gj AN ever`,/pace. cityrr O'fJrl Gate LiD Code a' cno^';0p ✓ f Irr i D. SS — y Site Exam: Chec', Sopa I,� � C1eC`. CeiSi' i Estimate' depth to high, ground water: t feet ------ - s i Please ir,d Gil m.erhods used to deter,ine the high ground water elevation: Obta -ed ,om system design plans on record i' If checked. date of design clan reviewed: '^ -- -------- Observed site (abutting property/observation hole within 150 feet of SAS) Nl----�Checl d with local Board of Health - explain:": I Checked wiih local excavators, installers (attach uo-u men:ation) r� Ell Accessed USCS database.- axolain: 'i You must describe how you established the sigh ground water elevation: I, - — ,skill 10C4hC1.%�-v / . ------------------ ii p Before filing this t,:spectio:i Report; please see Report Co le � I1i ,5,n.n9,cs p teness Checklist on next page, 1 ]I I� li I Titi�5 OE:e:n c _ - i f Cornmonweam-a oof Nflass2-chusetts T 5 Official Inspection Form " Itle 5 il Subsurface Sewage Disposal System Form Not fo.r VO'Ul7il2i'y Al.ssessment"s Propertv Addi-es Ov,,n -)v/ner s i 4a_. e -,S -"e imo,-Mation required for /If Zio Code every pace. City/To,ivn State Date oi . E. Report, Corr,Pleteress Checklist 'fill"i� k I i.pection Summary: A: E31 C: D. Or E checked lixinspecticn, —Summary D (Systern Failure Criteria Applicable to AJI Svstem!s; completed • ; 1 Sys t In'ormation — Estimated depti- to high oro--undv,,ater a""-; etch of Sew-7-ge Discosal System either drawn on page If 5 Or @-Ht2ohed in separate i f"',ile ff It Tri 5 j" J, Tl TOWN OF BARNSTABLE — UNDERGRUUND FUEL AND CHEMICAL STORAGE REGISTRATION MAP PARCEL N0. TAG N0. I3 Y 5 �a c ADDRESS OF TANK.. � �Z� V I L L A G E: /1/' /! , Number Ylr��t MAILING ADDRESS ( IF DIFFERENT FROM ABOVE ) : D1 ail � �� W OWNER NAME: /'/ (f��� j v� � �C PHONE;�p INSTALLATION DATE s —0 BY: INSTALLER ADDRESS: PV 13Cl L � `d �� i�'��_,� CERT.NO. *TANK LOCATION: ABOVE BELOW (DC�OPt I as TANK LOCATION W I TH ft 7crYO CAPACITY Z-56 TYPE OF TANK � l AGE A/e:-✓YRS. FUELCHEMICAL TESTING CERTIFICATION PASS [ ] FAIL DATE LEAK DETECTION [ ] CHECK IF N/A TYPE/BRAND ZONE OF CONTRIBUTION [ ] YES [ ] NO DATE TO BE REMOVED FIRE DEPT . PERMIT ISSUED [ ] YES [ ] NO DATE CONSERVATION [ ] CHECK IF N/A DATE BOARD OF HEALTH TAG NO. [ ] DATE PLEASE PROVIDE A SKETCH SHOWING THE TANK LOCATION ON THE BACK OF THIS CARD ^G:�,,. !^s"'.^�w +ma's. .sKe.'+*"" :'.WC ,�+''iiA'r'P'.`-rws'�r- w.�,A,+.-,.-,-•+.a--'^1e`�: .w.rs-+dw�;t�rYrl+.y�'`r'' '*r'r. -,i n% . y TOWN OF BARNSTABLE -:-UNDERGRUUND~ FUEL AND CHEMICALSTORAGE REGISTRATION MAP N- . PARCEL NO. TAG NO. 13 q q - � s � ADDRESS OF 'TANK: / ; 4 rf VILLAGE: ' - • ► Number a •tr��t �i MAILING ADDRESS ( IF DIFFERENT FROM ABOVE ) : vp �� OWNER NAME: J v �S PHONE: v.LDO INSTALLATION DATE: fd / Q A INSTALLER ADDRESS: y lJ:� / �� ;CERT ',NO. *TANK LOCATION: ABOVE BELOW.. ; llc reQ101f�gi Zan T AN K L.00AT I ON 'WITH RQOPwCT TO au S LSD 2 NO) CAPACITY �a� TYPE OF TANK 4t-) % I AGE A/e-VYRS. FUEL/CHEMICAL TESTING CERTIFICATION , f.]•T PASS C ] FAIL DATE ry t $ 3 LEAK DETECTION - [ < 7 CHECK .IF ' N/A -TYPE/BRAND ZONE OF; CONTRIBUTION [ ] YES [ ] N0 DATE TO BE REMOVED FIRE DEPT. PERMIT ISSUED [: ] YES [ ] NO DATE CONSERVATION [ ] CHECK IF N/A DATE BOARD .OF HEALTH TAG NO. [ ] DATE PLEASE PROV I DE A SKETCH SHOWING THE TANK LOCAT,I.O,,N. ON „THE BAC K„ QF ,T.,H,I S .CARD TOWN OF BARNSTABLE - UNDERGRUUND FUEL AND CHEMICAL 'ST'., AGE REGISTRATION ' 4 _ MAP' NO. PARCEL NO. TAG NO. 13 w 9 ADDRESS OF TANK r, % [ '01a �/1 � � �S', ,-/ VILLAG Ag /t.. s � Number : Ytr�•-t MA I L I,NG ADDRESS ( IF DIFFERENT FROM A'B�o'VE�) OWNER NAME: //o j3>�'� c/�' - 7` / PHONE : %t� ��t,� / �iJ sl INSTALLATION M1DATE: A- Jf HY�: # T I"') (;�:: -_ Y`S I ��� r t. \jo _ INSTALLER ADDRESS: (1 4 tJ / �. .fk;� ���, ��` �`sCERT iVO. i_ *TANK LOCATION: ABOVE BELOW ti(z Koo' I am . TANK LOCATION WITH nuamkCT TC of ulz L.D I NO•), CAPACITY `i'' TYPE OF T '�' I ��' AGE �Vf 61)YRS. FUEL/.,CHEM I CA,L,_ TESTING CERTIFICATION ] Abs FAIL DATE [ ] r LEAK DETECTION [ ] CHECK IF N/A NTYPE/BRAND r , ,i t 1 ". ZONE OF CONTRIBUTION [ ] YES [ ]� N0 DATE TO BE REMO`VEDt FIRE DEPT. PERMIT ISSUED [ ] YES [ ] NO= DATE CONSERVATION [ ] CHECK IF N/A DATE BOARD -OF HEALTH TAG N0. [ ;`' ] DATE s PLEASE PROVIDE SKECH SHOWING THE TANKxgLOCAwTI ONCzN1;THE B.AC�I< OFT.H I Sr :`CARD � � � �� � � � ��� �\`\\ h V � �. � � M N e � M^ � , � � � � . �� 6� ��� � �� �fi z �� ri 1 ivirliN 95 HIGH SCHOOL ROAD EXTENSION HYANNIS, MASS. 02601 Paul D. Chisholm Sih'Ul'eetectvr� JLICfe �LG'ed BUSINESS: 775-1300 CHIEF EMERGENCY: 775-2323 To Town of Barnstable , Board of Health - T. McKean Town of Barnstable, Conservation Commission - From ; Fire Prevention Bureau, Hyannis Fire Department Subject ; The installation of above ground storage tanks . Date /���% 7 Persuant to the applicable sections of 527 CMR - Fire Prevention Regulations , this Department has inspected the following location for above ground storage . ADDRESS : 1017 Pitcher's Way Hyannis �G OWNER/OCCUPANT PHONE : SIZE OF TANK (S) 275 gal. Steel / BASEMENT COMMODITY STORED . : # 2 fuel oil PURPOSE FOR STORAGE : Heating THIS INSTALLATION IS : PRE-EXISTING A REPLACEMENT NEW X This installation complies does not comply with the required installation regulation listed below. FIRE .PREVENTION OFFICE For: PAUL D. CHISHOLM, CHIEF HYA!\CIS FIRE DEPART"fENT F, F =s2.00 TYPICAL SYSTEM PROFILE A R E A PLAN FDN TOP FINI 7SH GRADE= NOT TO SCALE SCALE : I "-- `� " �i• �®_.. FINISH I FINISH GRADE OVER TANK= =��.G�O GRADE OVER PIT=_' I LOT— -2 0 �� 7—C H�i� 'S W�``" , ��� ��, �► . �a .. , . N r lv' THE f6AkA.IS7—ABLE F,L:_OOD F'L_I /n _ --_- .- 48.00C41 VC OR 47. 67 0 0 .�• A10 _..- u_A/ lac' Vo0c? `r O A r`�.l'�.`1 O L... Vj': .) i . TEES 4733 � . � • � � o � ' 47.84 �1750' �. BSMT • c !SLR . GAL. 4 7. o ° ° NFORCED DIST- BOXONCRETE 8 TO BE INSTALLED ON e + • • o ° ° A LEVEL STABLE BASE • r • • ° o ° 1-07' 2/ SEPTIC TANK TO BE INSTALLED ON A ° LEVEL STABLE BASE 2"-1/8'1 1/2 "WASHED PEASTONE ALL BRICK a MORTAR COURSES AS AROUND FREE OF IRONS, FINES ° ' • ° ° ° ° REQUIRED TO BRING COVER TO GRADE } �I AND DUST IN PLACE G �� LEACHING PIT 24 C.I . MANHOLE COVER a 3/4 TO 1 -1/2 WASHED CRUSHED FRAME SEE DETAIL STONE ALL AROUND FREE OF BASE TO BE LEVEL IRONS, FINES AND DUST IN PLACE FOR FIN. GRADE \ SEE SYSTEM PROFILE SOIL AND PERCOLATION 1 J2 ° A+ - -A 4 - I DATA -- - - - 8„ - - - PE C. RATE ' M IN �IN. 41" .— , " :a FOR INV. ELEV SEE �,°T�••,� C. D. SPOHR INLET SYSTEM PROFILE � TAKEN BY : ' ,, 14 LINE • ` ° - „ 6 ` ° WITNESSED BY: ILE, PEI L fw/CJiFi '�Y B .�• ° o OPENINGS W%4 I;i8 „0 ° �, OUTER DIA. a 1 -3/4 DATE : 29 -r-�:L /9� _ ° s r Q ' INSIDE DIA . 0 °, f ;;I, ' 7 _ , . o � TEST PIT ELEV. 7$ ik,f PRO, N � 6 - a o TOTAL LO ' '•-r .� - - o 0 o AREA 0- _ • '.� vE 1.4 +a. NO RUST, LEUC,r' i000 Gay. CAST cscrt�rj ,� ?fzf� I O '�YATF=:. ° •. F, o SUB. S Q .�FrlT/C T19rtiK-59M PW)=14E' PF.,•CAS r CGNCF2E7"E I?-Bch--sE€Pieor/ram _ .__ �iq I f' _ o u o 0 0 0 0 o p ° 2-4 i:UR.4.'Sc f k®yVr<. . �T ry,z''.�G. .t�et'I V.,sr• �� i ,•, � _ r P1cECsaSr G�>VCR�7� r�EfiG:���/G: err _ �� � •. •----- �, !! _ _ _ _ ---- ssA'x pr,- \ •J I -._._ 6 6 D i A . - BOT. PERC. HOLE LCT;$2 `� � /D EFFECTIVE DIA. �8' 9 4 DOWN '� '�' LEACHING PIT - SECTION f �eza) ..�- -ar ��.,z2 ��-• No SCALE DESIGN DATA : 'L c NOTE' DO NOT RUN HEAVY EQUIPMENT OVER SYSTEM L� F BEDROOMS NO 0 DISPOSAL LEACHING PIT NOTES: EST. TOTAL DAILY EFFLUENT f<n GALS . I . CONC. TO BE 4000 P.S.I a 28 DAYS . SEPTIC TAN K /`.- G AL. ,4.E'YAT/OA13 $.9J3'E"U OA1 f44)YeA4A"7" f_ el ', 2 . R E I N F W 6 " x 6 0 6 GA. W. W. M. CENT.!'2L!A/E- OF' 407- @ ASSUA-0i`v SU.D 3• 2 SAND 4 � SECTIONS ARE AVAILABLE FOR PLAN REF: GENERAL NOTES GREATER DEPTH REQUIREMENTS p �r,>� I . ALL SYSTEM COMPONENTS SHALL BE INSTALLED IN �'ANS7' l'�� � �'�''' �` NOTE : ACCORDANCE WITH TITLE OF THE STATE SANITARY CODE C4P- I?j"EE/_ f9A 5 —P,L / A500h<- EXCAVATE TO ELEV. ` OR L-OWER AS DATED JULY 111977 8r ANY LOCAL RULES APPLICABLE. 27/ S., REQUIRED TO REMOVE ALL LOAM AND CLAY CONTAINING 2. ANY CHANGE TO THIS PLAN MUST BE APPR'D. 1N 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. SIDE AREA = I LE' S. F.0_S. F./GAL GALS NOTIFY THE ENGINEER AND BOHRJOF HEALTH FOR INSPECTION. BOTTOM AREA= " S. F. S. F/GAL GALS 4. FOUNDATION ELEV. MUST BE CHECKED WHEN COMPLETED. _ 1= ` 5. THESE ELEVS. MUST NOT BE CHANGED WITHOUT WRITTEN TOTAL AREA S. F. TOTAL GALS APPROVAL BY CHARLES D. SPOHR, LEGEND 6 FOUNDATION INSPECTION READ. WHEN EXCAVATED. IJWN\ __kS EU I LP[kS' AREA PLA�� . + 50.0� EXIST. GROUND ELEV. r✓',L�% r: ` FL�'AI FL/lL�s, f`-' '�07 �,t:./C�dL/ 50.0` FINISH GROUND ELEV.2'UNDERLINED" BOX 7 C _,&1 rjjM2 V/L, t D�' ,L.9il./L7 !A/ /��i' rf/�i,1,�,5 .�4. 4 7 5 0` PIPE INVERT. ELEV. R E V DATE D E S C R I P T I O N i � TEST PIT LOCATION SEWAGE DISPOSAL SYSTEM / - 40, AOY. 2`3 /9 �� _ G' F��• f,:�L �/L .S,SLJi `r'f,�l!`Ct _0 o SEPTIC TANK FO R C LA RK F L_Y [,,j N BU I LDERS ❑ DISTRIBUTION BOX °' L(I)T `_ 2() P I TCHER'S WAY 4 C. 1 . PIPE r a=.etef 4 H YA N N I S �! \S ' 1 1-11 !f_I_ 4"BIT, FIBER PIPE - TIGHT JOINTS ,_ F N.p. 7468 w - -- PROPERTY LINE �� G/57ea���V'�� DESIGNED C D.SPOHR DATE: 1941-' An DRAWING N0 l . DRAWN, G. SCALE.A S S H O W N MIN. CODE DISTANCE MAP SEC PCL LOT HOUSIt CHECKED: C. D. S . SYSTEM PROFILE �K �MAGNETCTAP O BE NOTES (NOT TO SCALE) COMPARABLE MEANS FOR FUTURE LOCATION. 1. DATUM IS NAVD 88 ACCESS COVERS TO WITHIN 6" OF FIN. GRADE 2" PEASTONE OR GEOTEXTILE CONCRETE COVERS TO WITHIN 3" GRADE 2. MUNICIPAL WATER IS EXISTING \ TOP FOUND. EL. 66.7 FILTER FABRIC OVER STONE 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. 64.0' MINIMUM .75' OF COVER OVER PRECAST 2% SLOPE REQUIRED OVER SYSTEM 63.0' WATERTEST„D'BOX FOR LEVELNESS BLOCKS OR 4. DESIGN LOADING FOR ALL PROPOSED PRECAST o PRECAST H-10 o 0 RISERS (TYP.) MIN. 2 WALL THICKNESS PRECAST RISERS UNITS TO BE AASHO H-LQ 63.27 4"OSCH40 PVC MORTAR ALL INVERT IN 59.17' > y PIPES LEVEL 1ST 2' COMPONENTS 5. PIPE JOINTS TO BE MADE WATERTIGHT. o o ,.: 4' TYP. 4' 2 G o W EXISTING 1000 GAL. ENDS SIDES 60.0 cc a 10" SEPTIC TANK** 14" °o°o°o " - o000 000 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE r ; o` TEE TEE 61.94f'* ®®®® ®�®® ®E! ®®® o ° o o WITH 310 CMR 15.000 (TITLE 5.) c° o� ° ° ° ° ° ° 6" MIN. SUMP °°°°°°°° R �� � ® �®In® 00000 0 1� Locus °°o°o°o°o°Qo 12" MIN. INT. DIM. o ° °° 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND o GAS BAFFLE::; ®®®®®®®® ®® ®®®®®®®®®®® °oo° NOT TO BE USED FOR LOT LINE STAKING OR ANY 3 r 59.6' 59.4 o000 ° ° ° 0 57.17 OTHER PURPOSE, a Q� H-10 500 GAL. LEACHING CHAMBERS BY ACME PRECAST OR EQUAL. 3/4"-1-1/2" DOUBLE WASHED STONE 4' MIN. 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. ALL AROUND PRECAST STRUCTURES (2) UNITS REQUIRED �o 6" CRUSHED STONE OR MECHANICAL OVERALL DIMENSIONS TO OUTSIDE OF STONE: 25.00, X 12.83, 9. COMPONENTS NOT TO BE BACKFILLED OR COMPACTION. (15.221 [2]) ^ CONCEALED WITHOUT INSPEC11ON BY BOARD OF N HEALTH AND PERMISSION OBTAINED FROM BOARD (A-2% SLOPE) (2.5% SLOPE) "' OF HEALTH. FOUNDATION EXIST. SEPTIC TANK 35' D' BOX 12' LEACHING 10. CONTRACTOR SHALL BE RESPONSIBLE FOR FACILITY CALLING DIGSAFE (1-888-344-7233) AND LOCUS MAP VERIFYING THE LOCATION OF ALL UNDERGROUND & 51.9' BOTTOM TH-2 OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF SCALE 1"=2000't NO GROUNDWATER FOUND WORK. I 11. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL ASSESSORS MAP 272 PARCEL 148 0 BE REMOVED BENEATH AND 5' AROUND THE 6 z PROPOSED LEACHING FACILITY. LOCUS IS WITHIN FEMA FLOOD ZONE X (AREA OF MINIMAL FLOOD HAZARD) AS a 6ti AN EXISTING LEACHING FACILITY AND SHALL WITH PUMPED Eo SHOWN ON COMMUNITY PANEL #25001 CO566J AND REMOVED OR PUMPED AND FILLED WITH CLEAN LEGEND- o SAND. DATED 7/16/2014 LOT 20 �0 99- EXISTING CONTOUR d ° 18,984f S.F. o **INSTALLER SHALL CONFIRM MINIMUM X 99.1 EXIST. SPOT ELEV. SEPTIC TANK SIZE AT 1000 GALLONS O AND ITS SUITABILITY FOR RE-USE. [99]-- PROPOSED CONTOUR ° REPLACE WITH 1500 GALLON SEPTIC d TANK APPROPRIATE TO SITE �9a8 4] PROPOSED SPOT EL. CONDITIONS IF NOT SUITABLE SYSTEM DESIGN: TH1 TEST HOLE *THE INSTALLER SHALL VERIFY THE GARBAGE DISPOSER IS NOT ALLOWED O 2% SLOPE of GROUND ° _o LOCATIONS OF ALL UTILITIES AND ALL EXISTING 3 BEDROOM DWELLING BUILDING SEWER OUTLETS AND UTILITY POLE ELEVATIONS PRIOR TO INSTALLING ANY DESIGN FLOW: 3 BEDROOMS @ 110 GPD = 330 GPD j PORTION OF SEPTIC SYSTEM o €IRE HYDRANT USE A 330 GPD DESIGN FLOW NOTE: NOT ALL SYMBOLS MAY APPEAR IN DRAWING W CO o' 6� SEPTIC TANK: 330 GPD (2) = 660 TEST HOLE LOGS a " **RE-USE EXISTING 1000 GAL. SEPTIC TANK "SH D N 6 a LEACHING: ENGINEER: DANIEL E. GONSALVES, SE #13587 T A o E ° " o SIDES: 2 (25 + 12.83) 2 (.74) = 112 GPD WITNESS:' DAVE STANTON 6, d 6� 1 '00 - DATE: 3/16/21 " :'I BOTTOM 25 x 12.83 (.74) - 237 GPD 6 PERC. RATE = < 2 MIN/INCH / 6g '� TOTAL: 472 S.F. 349 GPD USE 2 500 GAL. LEACHING CHAMBERS ACME OR EQUAL CLASS 1 SOILS P# 21 -53 EXISTING WITH 4' STONE ALL AROUND _ DWELLING 6� 1 �J,I------ FFLR EL 3 ELEV. ELEV. x I t =66.7' N C-4 �, Ops If A A 6t` o LS LS x GRA nn Z MA 1OYR 3/3 1OYR 3/3 PI T/ DECK APPROVED DATE BOARD OF HEALTH 6» 4» B B X TITLE 5 SITE PLAN LS LS '\LP/ N \ co 6� OF 10YR 5/6 ,� 10YR 5/6 �0'0 64 , 30 60.2 28 0.57 OXx GRA 1017 PITCHERS WAY 6,3 o �� DRIV AY = HYANNIS MA TH C C BENCHMARK '7 �' of qs ZN q 1 COR-CONC STEP �``P`�H M YSg1 � of M ssq PREPARED FOR PERC EL. = 66.16' ° �o� DANIEL G DANIELA.OJALA A. BORTOLOTTI CONSTRUCTION ��`�� ��/. � , MS MS CIVIL � � OJALA TEMP 0000 \ NO 4 650 ' '< � 3 No 4Q 80 ` o a . „ , DATE: MARCH 31, 2021 GARAGE !�� 10YR 7 4 1 OYR 7 4 N86'S3 22 E � a , X_ 118.607 `Pt \\r o ` r z +)JAI t g r �� off 508-362-4541 �0' CIVIL J �� O p:LA I fax 508-362-9880 6 Q 7762 1"{ No.46502 JA I. downca e.com ,allo,�109�3U� � P • R oFPss`�t down copy eIlg�n�e��n , Inc 51.7 132 51.9' 'ry _u0 Y civil engineers NO GROUNDWATER ENCOUNTERED Scale: 1 = 20 �j --3 land surveyors 939 Moin Street ( R to 6A) T o 10 20 30 40 50 FEET DATE DANIEL A. OJALA, P.E., P.L.S. YAR"OUTHPORT MA 02675 DCE #'21--064 21-064 BORTOLOTTI-PIVA.DWG a