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HomeMy WebLinkAbout0161 PITCHER'S WAY - Health 161 Pitcher's Way, Hyannis , A= x „ o 0 111 t� r 1 I�I TOWN OF BARNSTABLE LOCATION A./ P/4r4 vs (,A Y SEWAGE# 2 0/80 9-7 VILLAGE WY04.1 > ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO.- SEPTIC TANK CAPACITY /S 00 LEACHING FACILITY.(type),3 ,Soo 4UL CF c4k6v* (size) G w 3?.S NO.OF BEDROOMS OWNER m i pn aeoey PERMIT DATE: Z 8 COMPLIANCE DATE: l Separation Distance Between the: / Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility `5 Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) N A Feet Edge of Wetland and Leaching Facility(If any wetlands e ist within 300 feet of leaching ility) N Feet FURNISHED BY `ti. Id jr I I a t Z N; 3 x N w F Yt N N ' 04 1 � W d �. a TOWN OF BA.RNSTABLE 1.,C,CATION � s � '�'� . SEWAGE # VILLAGE X S,.,_ ASSESSOR'S MAP &LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) 'NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 JZ. b-e� g® IZU � � � , ``. J � _ �' .. — ' � � .e. �^J" _� � 0 V• t N 6' •�- Commonwealth of Massachusetts a S 9-- 67--T- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ..t M � 161 Pitchers Way Property Address rs Kyle Kellinghaus Owner Owner's Name information is Hyannis Ma 02601 3/21/2020 required for every y - page. City/Town State Zip Code Date of Inspection'- Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. Inspector Information filling out forms on the computer, use only the tab Sean M. Jones key to move your Name of Inspector cursor-do not S.M.Jones Title V Septic Inspection use the return Company Name key. 74 Company A Lane Co � Company Address Centerville Ma 02632 Citylrown State Zip Code 774-248-4850 smjonestitle5@gmail.com, SI4522 sean@smjonestitle5.com License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 3/21/2020 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system 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 form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: 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. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts :. Title 5 Official Inspection Form l° i, Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 161 Pitchers Way Property Address Kyle Kellinghaus Owner Owner's Name information is required for every Hy annis Ma 02601 3/21/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The property located at 161 Pitchers Way Hyannis is served by a Title V septic system consisting of a 1500 gallon septic tank, distribution box and 3 500 gallon leaching chambers. The system was found to be in proper working condition at the time of inspection. 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements.if"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years-old is available. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 161 Pitchers Way Property Address Kyle Kellinghaus Owner Owner's Name information is required for every Hyannis Ma 02601 3/21/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form 1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments z 161 Pitchers Way Property Address Kyle Kellinghaus Owner Owner's Name information is required for every Hyannis Ma 02601 3/21/2020 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: *' This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 161 Pitchers Way Property Address Kyle Kellinghaus Owner Owner's Name information is required for every Hyannis Ma 02601 3/21/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® 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 ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® 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. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts �n Title 5 Official Inspection Form i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments z u� 161 Pitchers Way Property Address Kyle Kellinghaus Owner Owners Name information is required for every Hyannis Ma 02601 3/21/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes" to any question in Section C.5 the system is considered a significant threat, or answered "yes" to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® 0 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)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 161 Pitchers Way Property Address Kyle Kellinghaus Owner Owner's Name information is required for every Hyannis Ma 02601 3/21/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 e o DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 gpd Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail Sump pump? ❑ Yes ® No Last date of occupancy: current Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4 161 Pitchers Way Property Address Kyle Kellinghaus Owner Owner's Name information is required for every Hyannis Ma 02601 3/21/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: I t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 r Commonwealth of Massachusetts Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4<. 161 Pitchers Way Property Address Kyle Kellinghaus Owner Owner's Name information is required for every Hyannis Ma 02601 3/21/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy Shared system es or no if es attach previous inspection records if an � Y (Y ) ( Y p p Y) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: system installed 4/30/2018 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 3.5feet Material of construction: ® cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): ` Joints in good condition, no leakage, vented through roof. I t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18 f - Commonwealth of Massachusetts �d Title 5 Official Inspection Form <1. Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 161 Pitchers Way Property Address Kyle Kellinghaus Owner Owner's Name information is required for every Hyannis Ma 02601 3/21/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 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: 1500 gallons Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle .5 Scum thickness 0" Distance from top of scum to top of outlet tee or baffle 711 Distance from bottom of scum to bottom of outlet tee or baffle 10" How were dimensions determined? Opened covers and took measurements Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank does not need to be cleaned now but should be done soon and again every 2 years for proper maintenance. Water level was even with outlet, tank was not leaking and was structurally sound. Access covers are 30" h-20 concrete, it is recommended that they be replaced with smaller more manageable units. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form to Subsurface Sewage Disposal System Form- Not for Voluntary Assessments •. 161 Pitchers Way Property Address Kyle Kellinghaus Owner Owner's Name information is required for every Hyannis Ma 02601 3/21/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. 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 l5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 I Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 161 Pitchers Way Property Address Kyle Kellinghaus Owner Owner's Name information is required for every Hyannis Ma 02601 3/21/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Distribution box was level and in good condition with no rot. Water level was even with 3 outlet inverts with no signs of past backup. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 Commonwealth of Massachusetts f Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 161 Pitchers Way Property Address Kyle Kellinghaus Owner Owner's Name information is required for every Hyannis Ma 02601 3/21/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): *If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 3 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form b Subsurface Sewage.Disposal System Form -Not for Voluntary Assessments 161 Pitchers Way Property Address Kyle Kellinghaus Owner Owner's Name information is required for every Hyannis Ma 02601 3/21/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): leaching chambers were video inspected and found dry with no signs of past overloading. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No j Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): I t5insp.cloc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form (' Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 161 Pitchers Way Property Address Kyle Kellinghaus Owner Owner's Name information is required for every Hyannis Ma 02601 3/21/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): i I t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments . ! 161 Pitchers Way Property Address Kyle Kellinghaus Owner Owner's Name information is required for every Hyannis Ma 02601 3/21/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. 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 p` S) v Z � 7�1 306. AZ Zv �L 3S- A3 z3 �33 6 y t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 161 Pitchers Way Property Address Kyle Kellinghaus Owner Owner's Name information is required for every Hyannis Ma 02601 3/21/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: C ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 12'+ feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: Groundwater was established by accessing town of Barnstable groundwater contour maps. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 161 Pitchers Way Property Address Kyle Kellinghaus Owner Owner's Name information is required for every Hyannis Ma 02601 3/21/2020 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria)and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank— Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 No. f �f� —®� Fee (� a THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS L' i pplitation for MisposaY 6pstem Cunstrurtion Permit Application for a Permit to Construct( ) Repair ) Upgrade Abandon( ) Complete System ❑Individual Components Location Address or Lot No. Owner's Name Address,and Tel.NQ N► �M �z=flt_TY Ge�1� Assessor's Map/Parcel Installer's-Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. �preQyEk S"0;' �az� � e���►ueo F�G1 i�; 560-2r,4 --:VLv;I3 508 -52'3, rvs Svc Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(IJ/A Other Type of Building 9ACX-)le No.of Persons Showers Cafeteria(I4 Other Fixtures Design Flow(min.required) 440 gpd Design flow provided �sQl gpd Plan Date 2- 2�l - Number of sheets Z Revision Date c � Title �2 c Jy g M lO R Size of Septic Tank ` - Type of S.A.S. -9) qN4� C�-Ocy,\AwS 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 Enviro al end t o place the system in operation until a Certificate of Compliance has been issued by this Board of He h. Signed Date Application Approved by `" Date 4—m-fr Application Disapproved by Date for the following reasons i Permit No. 01 Date Issued `( �� I� , f y a j // r► �l No. got ��� + Fee /`TV THE COMMONWEALTH OF MASSACHUSETTS THE in computer: tor Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ftpliratibn for Voposal �bpstpm Construction permit Application for a Permit to Construct( ) Repair( ) Upgrade',( Abandon( ) ;R Complete System ❑Individual Components Location Address or Lot No. °(o� '��-^r���Gy����i" V Owner's Name,Address,and Tel:No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. SAcc,4?jC111010 Type of Building: } Dwelling No.of Bedrooms Lot Size �� sq.ft. Garbage Grinder(AJ JA Other Type of Building ►���E' No.of Persons z) Showers Cafeteria( t✓) 3 a t3 t1 (y-,�� \ # Other Fixtures Z_c. Q '^CLi C P W \\h 1 { Design Flow(min.required) 4-4+0 gpd Design flow provided gpd Plan Date 17 2-01 Number of sheets 14-. Revision Date M I A Title o Size of Septic Tank Type of S.A.S. 2j — l c\ ` Description of Soil ` Q&c,Q�' Nature of Repairs or Alterations(Answer when applicable) l' V 1 Date last inspected: " Agreement: , The undersigned agrees to ensure the construction and ma: of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Env nmen)talode and mot�place the system in operation until a Certificate of Compliance has been issued by this Board of Health. 1 Signed Date - Application Approved by •.�,;P f5_ cu bJ Date Application Disapproved by o Date for the following reasons Permit No. ( r D Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( % Upgradedl(-�11<y Abandoned( )byC _. .. at ` - � r. 'S lx3c..� has been constructed in accordance , with the provisionsof Title 5 and �the +yfor Disposal System Construction Permit No ��0 R dated Installer s QCl +.,i C)0--\, Designer Us b"'Q #bedrooms Approved design flow , gpd The issuance of this permit shall not be construed as a guarantee that the system will 1 f�unc`fio as ie igv\ned. Date \ �i ------ --------- - ------ -- - -_-- - -- ---- -------------- ----------- --------------------------------- --- No. ^f� ` - Fee ( vV THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS BiSpoSar 6pstem Construction J)ermit Permission is hereby granted to Construct( ) 'Repair( ) Upgrade Abandon( ) System located at �n C t •�! h�'�C' '� (�9c^,s., 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:Construction must be co m eted within three years of the date of this permit. Date Lf-- (?-'-( Approved by ti Town of Barnstable �fNE► Regulatory Services Richard V. Scali,Director MAK ` Public Health Division 1639. ,0�' '°riro�A Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-8624644 Fax: 508-790-6304 Date: 4-30- /IrSewage Permit# Assessor's Map/Parcel iZ¢ B Installer& Designer Certification,Form Designer: G�-� ���`��`° T- Installer: S b Address: t�O �t,9C rl 29 Address: �( On Qftf6aAILIY-1�1W RkSK was issued a permit to install a (date) (installer) septic system at �ZV �/7-c'&�s`� 2' 4IVVl/ based on a design drawn by (address) 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. Stripout (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. Stripout (if required) was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed u mpliance with the terms of the I/A approval 1 ers (if applicable). of Di41/ID cycN :D. , �` :tiERTY JW N (Iris er's e) to. 1211 T p (Designer's gna e) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. q:loffice formsldesignercertification form.doc i, v < t S Town of Barnstable P# s s co y Department of Regulatory Services $ 11RNaTAnr4 Public Health Division Dated F MA&4 200 Main Stroac,Hyannis MA 02601 CA CD LLL .ems✓,. ��} Date Scheduled TimeFee Pd. ��� ' .a K Soil Sugta0zlity Assessment for S e Disposal . Performed-By: `�'" � - Witnessed By: LOFATION& &GENERAL INFORMATI C Location Address /����C � S etc/ Owner's Name W �✓L v s�-- '� O'Q Address U l r S /59',_r Assessor's Map/Parcel• Engineer's Name 45 c�/R NEW CONSTR ION REPAIR Tole hone# $-27 s'• .Cyv 1� (96) a'4 Z Surthce Stones �l caw f Land Use• Slopes Distances ttnm: Open Water Body ft Possible Wot•Area ft Drinking Water Well Dmihago We ft Property Line � ft Other ti ft SICE-MIC(Street name,dimensions of lot,exact locations of test holes&pera testa,locate wetlands-in proximity to holes) Parent material(geologic) V,/-r(�opth to Bedrock ,(/ Depth to Groundwater, nding Water In Hole: Weeping from Pit Face Me Estimated Seasonal High Groundwater l'3 DETERMINATION FOR SEASONAL•IUGH WATER TABLE Method used: . De th Ohio rvcd standing in obs.hole: In. Depth to aoll mottles, Dolith to weeping from side of obs holo: In, Groundwater dJuetment Index Welly Reading Dato: Index Well lm o Adj,•fhotbr AcQ_Clraundwater•1 eva1,,_ PERCOLATION TEST Date z7 Time Observation Hole# Z Time at 0" Depth of Pero '• �tT" Time at 6" Start Pro-soak Time 0 'Time(4"41 `e) End Pre-soak Rate Min./Inch Site Suitability Assessment: Sltd Passed Sito Failed: Additional Testing Needed(YIN) Q Original: Public Health Division Observation Hole Data To Be Completed on Back-- ' ***If percolation testis to be conducted within 100' of wetland,you must first notify the Barnstable Conservation Division at least one(1)week prior to beginning. Q:\S8PTIC\PHRCF0RM.D0C DEEP.OBSERVATION HOLE LOG Hole# Depth from Solt Horizon Soil Texture Shcl Color Soil. Other Surface(in.) (USDA) (Munsell) Mottling (Sanctum,Stona f;Boulders, o talstency.96't3rival) 5e J L • !�_ Z�� (� 1��.Sit w� '7. 5 R-e"6 ✓l/' • ZU L •�� Gcszr Y4 C/ � ��'► C/ -ec/ cam, c1 DEEP OBSERVATION HOLL LOG Hole# _s Depth from Sall Horizon Soil Texture Sall Color Soil Other Surface(in.) 2 (USDA) (Munsell) Mottling (Structure,Stones,Boulders. 3 e• 2Z" /4 qu--4 e4- 1 V �AL:o-a Lq le-r. DEEP OBSERVATION HOLE LOG 11010# Depth firm Soil 7iorizon Soil Texture Soil Color Sall Other Surface(In.) (USDA) (Muosell) Mottling (Structure,Stones,Boulders.. DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soli Texture : Sall Color 8011 Other Surface(in.) (USDA) (MunsoU) Mottling (Struetura,S�ooes,Boulders, Consistency. Flood Insurance Rate Man: 4\ Above 500 year Mood boundary No— Yes Within 500 year boundary No Yes Within 100 year flood boundary No.� Yes Depth of NaturaUV ccurrine Pervious Materl'al Does at least four feet of naturally occurring pervlou mtiterlal exist in all areas observed thrpughout the area proposed for the soil absorptibn-system? e> If not,what is the depth of naturally occurring Per7lous material? ,.. Ceftl�on .. I certify that on f� 95 (date)I have passed the soil evaluator examination approved by the Department of En lro mental Protection and that the above analysis was performed by me consistent with . the required tr exp tise it d experience described in�10 CMR 15.017. Signal: Dats_ 2- ZILI 7 Q-.MPTlLVR1tCPORM.DOC '7` , ,Q' ua✓!� DATE: PROPERTY ADDRESS:1-61 FM iers Way Hyannis,Mass . RECEIVE EC 0.2601 . . , APR. ? 5 1996 HEALTH D`P. . TOWN OF FARM S iA LE On the above date, I inspected the septic system at the above address. This system .consists of the* following: l 1 1.-bldck 'oes sip oo1 :61''x6Z. 1,-1000 gallon leaching pit.11. PARCEL NO: Based on my Insroection, i certify the following conditions: ..1 . ;This is not a title five, septic `sys;,gm. 11 2..:-T11%.& i-d. a. sewaga_-system. 3. :The e'ewage system is—in failure. Water is. Bovegpq t pipe to .the main cess ooll, water is also above .the invert i to: tn leach it. p P. .B P�. `4. -System Wust be. upgraded to •a 'title.'five saphd, system. ': /$-Bedroom design. SIGNATURr: Name: J_P_M_acbmber Jr... 7 — ---- Company•'J•P_Macoc)ber— &_Son- *Inc . • —Address:- --Centerville __ JMAs_s_ -0.2.6,3*2 Phone:--, SQ8.�Z7..5,.3338--.----= .., 1 • THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY .OR WARRANTY JOSEPH P. MACOMBER & SON, INC. T&nks•Ceupoois-Leschflelds Pumpod & Installed Town Sewer Connections f P.O, box 66' Centerville, MA 02632.0066. t 77�5-3338 775-8412 4 d a ���{ � i« C. :J ,,.-'r r � � Commonweolth of Massachusetts ExecutNe Office of Environmental Affairs Department of Environmental Protection WUllam F.W@ld Trudy Cox@ oor+nwr S.cr.tary LL� ul Celluccl David BStr1uhsr SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A _ CERTIFICATION Propertyaadress: 161 Pitchers Way Hyannis ,Mass Address of owner. Arlene Sherman Date of Insprct;on: 4/2/96 (If different) 39 Paul Revere Road Name oflnspoctor. Joseph P. Macomber Jr. Lexington,Mass Company Na.ne,Address and Telephone Number. 02173 J.P.Macomber & Son Inc. Box 66 Centerville ,Mass . 02632 508-775-3338 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: _ Passes _ Conditionally Passes Needs Further Evaluation By the Local Approving Authority Ina toys Si gnat „ Date: P� f@+ /� The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner And copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Check A.B, C,or D: Al SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. Bl SYSTEM CONDITIONALLY PASSES: Al�1 One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes inspection. Indicate yes, no,or not determinod(Y,N,or ND). Describe basis of determination in all instances. If"not determined",explain why not) Nd'&p, The septic tank is metal,cracked, structurally unsound,shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a yonforming septic tank as approved J by the Board of Health. (revised 11/03/95) 1 On@ Winter Street 0 Boston,Massachusetts 02108 0 FAX(617)556-1049 9 Telephone(617)292.5500 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) PropertyAddres+a 161 Pitchers Way Hyannis,Mass . 02601 Owner. Arlene Sherman Date of Inspeo4on3 /2/9 6 a BI SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or hr static water level observed in the distribution boat is due to broken or obstructed pipes) . or due to a broken,settled or uneven distribution box. The system will pass inspection If(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed distribution boar is lsvelled or replaced ' The system required pumping more than four times&year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(:)us replaced obstruction is removed Cl FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH' AConditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS'NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Ald Cesspool or privy is withini 60 feet of a surface water tLla Cesspool or privy is.within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: •t`lb The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a surfacs water supply. The system has a septic twA and soil absorption system and is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and is within 60 feet of a private water supply well. AD The system bas a septic tank and soil absorption system and is less than 100 feet but 60 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility,and the presencs of ammonia nitrogen and nitrate nitrogen is equal to or less than 6 ppm. 3) OTHER This is a sewage system. The system consists of one 6tx6t gallon leaching nit. na.ekPd ';n stone. • i i (revised 11/03/95) 2 " , SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (oontinuod) Property Address: 161 PitchertsWay Hyannis ,Mass . 02601 owner. Arlene Sherman e Date of Inspoction: 4/2/9 6 r D) SYSTEM FAILS& I have determined that the system violates one or more of the following failure criteria as defined in 310 CUR.15.303. The bsuis for this determination is identified below. The Board of Health should be contacted to determine what will be nacosaary to correct the . failure. ` Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the tround or surface waters duo to an overloaded or clogged SAS or c"SpcoL / 14 Static liquid level in the distribution box above outlet invert duo to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool it leas than 6"below invert or available volume is leas than 112 day flow. Required pumping more tL8z 4 times in the last year NOT_due to slogged or obstructed pipe(s). Number of times pumped_. Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. 1�11 Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Alb Any portion of a cesspool or privy is within 60 feet of a private water supply well. UL� Any portion of a cesspool or privy is loss than 100 feet but greater than 50 feet from a private water supply well with 110 acceptable water quality analysis. If the well has been analyzed to be acceptable,attach copy of well water analysis for . coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. El LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: -1 The system serves a facility with a deign flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: the system is within 400 fast of a surface drinking water supply the system is within 200 fast of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area(IWPA)or a mapped Zone Hof a public water supply well) The owner or operator of any such system sha.l bring the system and facility into Egli compliance with the Vowid"ter tn'ttnent Proms requirements of 314 CMR 5.00 and 6.00. Pleaze consult the local regional office of the Department for further information.. (revised 11/03/95) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Prop-ertymd:ess: 161 Pitchers Way Hyannis ,Mass . 02601 Owner. Arlene Sherman Date of Inspeatlon: 4/2/96 Chock if the following have boon done: �Pumpiag information was requested of the owner, occupant, and Board of Health. None of the system components have been pumped for*at least two weeks and the system has boon receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. Y-4i built plans have been obtained and examined. Note if they are not available with N/A. , The facility or dwelling was inspected for signs of sewage back-up. 2The system does not receive non-sa)Mary or industrial waste flow ,_, The rite was inspected for eigns of breakout. All system components,&Xcludiag the Soil Absorption System, have been located on the site. Nd 1&The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or teas,material of construction,dimensions,depth of liquid,depth of sludge, depth of scum. , /The size and location of the Soil Absorption System on the site has been determined based on exiding information or a prozimatod by non-intrusive methods. The facility owner(and occupants, if different from owner) were provided with information on the proper maintenance of Sub. .Surface Disposal System. (revised 11/03/95) 4 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION ProportyAddre.,; 161 Pitchers Way Hyannis ,Mass . 02601 Owner. Arlene Sherman Date of Inspeotlon: 4/2/96. FLOW CONDITIONS RES KM Design flow:��D ga1)ons A24'A i) Number of bedrooms: Number of current reeideats:Ac Garbage grinder(yet or no):d Laundry connected to systa (yee or no):_ Seasonal use(yes or no): 4x) L Water meter•readiugs,if available: >d!t GT .t1 ���,Q Last date of occupancy:=0/2 G/ COMMERCIAL/I ND U S TRIAL: Type of ertablis ent• kin Design flow: A2&6allons/day Grease trap present: (yes or no).kf Industrial Waste Holding Tank present: (yes or no)-4 Non-sanitary waste discharged to the Title 5 rystem: (yes or no)" Water meter readings, if available: - Last date of occupancy: OTHER:(Describe) IM Last date of occupancy: 4)ft GENERAL INFORMATION PUMPING Ric RDS d so of' o t'cn: System pumped as part of ins act:g�4 ,AVI&OP (yes or no)_ If yes,volume pumped:Qons Reason for pumping env S:�L /e+_ C.�Di4G/r?/ TYPE OF SYSTEM AO Septic tank/distribution box/soil absorption system Single l Over "_ l ^� �r ilow.cesspo4l "•7E.I Privy Shared system(pas or no) (if yes, attach previous inspection records, if any) Other(explain) APPRO)aMAT&AGE of all components, date iastalled(if known) &n�&ource of= tion:&W6g J �� Sewage odors detected when arriving at the site: (yes or no)�v (revised 11/03/95) 6 Name: Arlene Sherman Robert: 617-861-6788 Customer Code: Address: 161 Pitchers Way ® ashe Town: Hyannis State: Zip: Mailing address: 39 Paul Revere Rd Lexington Ma 02173 Motes: 9114188 system LP 1500.00 pump.70.00 9128188 416190 pump r105.00 4127190 411192 pump0135.00 419192 4111194 pump 1 pool 145.00 4119194 6113195 pump 1 pool 145.00 6123195 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(oontinued) propertymdresa: 161 Pitchers Way 5�annis ,Mass. 02601 Owner. Arlene Sherman. Date of Inspection:4/2/9 6 SEPnQ TANK:AbW, e' (locate on site plan) Depth below grader Material of ww trucdon;�ncrete metal FRP._other(ezplain) AJA Dimensions• 9 Sludge depth: Distance from top of sludge to bottom of outlet tee or baflle;Ai ft Scum thiclmess: A Distance from top of scum to top of outlet tee or baflle:_AJ 6 Distance from bottom of scum to bottom of outlet tee or baMe: A) Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity, evidence (leakage,etc.)' Vo CAk,4W CAI i GREASE TRAP: ,0t (locate on site plan) Depth below grade: V Material of constructioni0poncrete metal_FRP_other(axplain) Dimensions: NA Scum thickness: IVA Distance from top of scum to top of outlet tee or baffle:fu A1� Distance from bottom of scum to bottom of outlet tee or baffle:ru of Comments: (recommendation for pumping,condition of inlet and outlet tees or bafIles,depth of liquid level in relation to outlet invert,structural integrity, ev de"of leakage,etc.) NO yss jVA)7' (revised 11/03/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(oontinued) PropertyAddresa: 161 Pitchers Way Hyannis ,Mass . 02601 Owner. Arlene Sherman Date of Inspection: 4/2/9 6 e TIGHT OR HOLDING TANK-&0,?<- ; (locate on site plan) e Depth below grads:_&d Material of constructionconcrete_metal_FRP_other(e:plain) - AA Dimensions:_ Capacity M ralloni Design flow:=-�Ajjq__gallons/day Alarm Is tel: _ Comments: (condition of inlet tee,•condition of alarm and float switches, etc.)/ n irr l A rf� N 1 0 �i/717 DISTRIBUTION BOX: bVC, (locate on site plan) Depth of liquid level above outlet invert: &W Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) AO' Cn,yl N'IPA7T� PUMP CHAMBFJb& , (locate on sits plan) Pumps in working order:(yes or no)_V2 Comments: (note oon4*n of pump chamber;condition of pumps and appurtenances,etc.) (revised 11/03/9S) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(oontinued) Property Address: 161 Pitchers Way Hyannis ,Mass . 02601 Owner. Arlene Sherman Date of Inspection: 4/2/96 SOIL ABSORPTION SYSTEM(SAS): (locate as site plea,if possible;excavation not required,but may be approximated by non-intrusive methods) If not determined to be present,explain: e Type: laachiz pits,number.—L leaching chambers,number lee:hing galleries,number: leashing trenches,number,length 6 leaching fields,number, ) overflow cesspool,number: Comments:(note n lition of iL signs of ulic failure,level of ponding,condition of vegetation,etc.) Loamy sN(F to medium sa� a;N. Guns of hydraulic failure or ponding. invert PIPe. pgrflr9or9 t0 a litile five sep ic ' s-item. CESSPOOLS: (locate on site plan) Number and configuration: j Depth-top of liquid to inlet invert: CU►4 W DRB A tVX Depth of solids layer. 1�•u Depth of scum layer. Dimensions of cesspool: Materiels of construction: AJ O k-e-!4P, Indication of groundwater: A 9 A A Q�, inflow(cesspool moat be p pod es part of inspection) Comments:(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetatio etc' Loamyand to medium sand•No si ns of hydraulic faiture or ponding; All -,ragPtatinn Is normal Cesspool filled ,y o its capaci ,wa er up over the invert of pipe. System must be upgraded to a tjtle five septic system. PRIW:. N� (locate on site plan) Materials of oo AM Dimensions:. AM Depth of solids:n Commas (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) IU N e.•�wtA n,�t-S (revised 11/03/95)- 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(oontinued) prop.AyAddress: 161 Pitchers Way Hyannis ,Mass . 02601 Owner. Arlene Sherman Date of Inspection: 4/2/9 6 o SKETCH OF SEWAGE DISPOSAL SYSTEM: o inchrda ties to at least two permanent references landmarks or benchmarks locate all wells within 100' Hyannis Water Company 775-0063 nrd�r DEPTH TO GROUNDWATER Depth to groundwater.20' + feet method of determination or approximation: Installed leaching pit in 1988 No water Aneo»n . .red at 14" House on knob (revised 11/03/95) g TOWN OF Barnstable BOA1ZD OF HEALTH S1111SHFACE SFWAGE DISPOSAL SYSTEM INSPECTION FORM - PAH'r D .- CERTIFICATION ............ -TYPE OR PRINT CI,EARL)'- PROPERTY INSPECTED STREET ADDRESS 161 Pitchers Wa3 1Jy_ annJn ,MsAs .02601 ASSESSORS MAP , BLOCK AND PARCEL # OWNER' s NAME A-1-eme Sbexman - PA117' D - CE1?7'IF1CA7'10N NAME OF INSPECTOR Tnqpl)'h P_ MRoamber Jr. . COMPANY NAME J.P.Macomber & Son Inc. COMPANY ADDRESS Box 66 Centerville,Mass . 02632 Street Town or City State LIP COMPANY TELEPHONE (508 ) 775 3338 FAX ( 508 790-1578 CER'fIFICATION STATEMENT I certify that I have personally inspected the sewage disposzij system at this address and that the information reported is true , accurate , and complete as of the time of .iinspection . Tile inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . Check one : Systeui PASSED The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public health or Lile enviro'nment, as defined in 310 CHR 15 . 303 . Any failtire criteria not evaluated are as stated in the FAILURE CRITERIA section of this form . XXXXXXXXSystem FAILED The inspection which I have conducted has found that the system fails to protect the public health and the environment in accordance with Title 5 , 3.10 CHR 15 . 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . Inspector Signature Date 4/15/96 One copy of this c1�1�t_ i fication must be provided to the OWNER, the BUYER ( where applicable ) and the 130ARD OF 111EAL1'll. If the inspection FAILED the owner or"" 'Aerator shall upgrade ' the system within one year of the date of th'e inspection , unless allowed or required otherwise as provided in 310 CHR 15 - 305 . Partd.doc �1ca. SIB,j w � Y 1sss� 1�� 11f 3�� THE COMMONWEALTH OF MASSACHUSETTS NT OF ENVIRONMENTAL PROTECTION DEPARTME BE IT KNOWN THAT Joseph P. Macomber, Jr. Has satisfied the Department's qualifications as required aTad is hereby authorized to use the title CERTIFIED TITLE 5 SYSTEM INSPECTOR as provided in 310 CMR 15.340 and Section 13 of Chapter 21A of the General Laws. Issued by The Department of Environmental Protection. June 8, 1995 Acting Director of the ' 'ion of Water Pollution Control P ATLANTIC ENVIRONMENTAL ' P.O.BOX 2384 MASBPEE,MA 02649 JON 2 •i 1g56 Attn: Commonwealth of Massachusetts Date: 06/13/96 1P1.% F Town of Barnstable `; . E Board of Health ` 367 Main Street Barnstable, MA 02601 From : Mr Michael DeDecko Po Box 2384 Mashpee MA 02630 Dear Board of Health Official; I certify that I have personnally inspected the sewage disposal systems at the following address : 161 Pitchers Way. Hyannis, Ma. The informations reported are true, accurate and complete as of the time of the inspection. If you have any questions regarding this inspection,please contact me at this number: (508)477-14-20. Thank you. Sin erely, Michael DeDecko phone 508 477-1420 P i F _ . _ �. ' .. � M - — t ,. \ s " r _. - 7 ,_ e .� r Commonwealth of Massachusetts Executive of Environmental Affairs Department'of Environmental Protection SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 161 Pitchers Way. Hyannis, M a. Address of Owner: R obe4S-herman (if different) 39 Paul Revare Road. Lexington, Ma 02173 Date of Inspection: 06/09/96 N amp of I nspector: M ichael D eD ecko Company Name, Address and Telephone number: Atlantic Environmental P.o B ox 2384 - M ashpee M a 02649. Tel : (508) 4771420 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection . The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. The system Passes ---- Conditionally Passes ---- Needs further evaluation by the local Approving Authority ---- Fails I nspector ' s Signature. , Date: 06/13/96 The system Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office or the Department of Environmental Protection. The original should be sent to the system owner and copy sent to the buyer, if applicable and the approving authority. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 161 Pitchers Way. Hyannis Ma. O wners : Robert Sherman Date of Inspection : 06/09/96 INSPECTION SUMMARY: Check A, B, C, or D A)SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CM 15.303. Any failure criteria not,evaluated are indicated below B) SYSTEM CONDITIONALLY PASSES: ---- One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair, passes inspection. Indicate yes, no, or not determinate (Y,N, or ND). Describe basis of determination in all instances. If"not determinated", explain why not. ---- The septic tank is metal, cracked, structurally unsound, shows substantial infiltration or exfiltration , or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. ---- Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). ----- 'broken pipe(s) are replaced ----- obstruction is removed ---- distribution box is levelled or replaced ---- T he system required pumping more than four times a year due to broken or obstructed pipe(s). T he system will pass inspection if(with approval of the B oard of H ealth): ----- broken pipe(s)are replaced ----- obstruction is removed I_ I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address : 161 Pitchers Way. Hyannis Ma. 0 wner : R obert S herman Date of Inspection : 06109/96 C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: ---- Conditions exist which require further evaluation by the Board of Health in order to de- termine if the system is failing to protect the public health , safety and the environ- ment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: ---- Cesspool or privy is within 50 feet of a surface of water ---- Cesspool or privy is within 50 feet of a bordering vegetated wetland or a small marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FLINC- TIONING INAMANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT. ---- The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a surface water supply. ---- The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. ---- The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. ---- The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analy- sis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate notrogen is equal to or less than 5 ppm. D)SYSTEM FAILS: -- I have determined that the system violates one or more of the following failure criteria as defined in 310 CM 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to cor- rect the failure. --- Backup of sewage into facility or system component due to an overloaded or or clogged SAS or cesspool. 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 161 Pitchers Way. Hyannis,M a Owner: Robert Sherman Date of Inspection: 06/09/96 D) SYSTEM FAILS (continued) -- 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 over- loaded or clogged SAS or cesspool. --- Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. --- Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). number of times pumped --- Any portion of the S oil Absorption System,cesspool or privy is below the high groundwater elevation. --- Any portion of cesspool or privy is within 100 feet of a surface water supply ortributary to a surface water supply. ---Any portion of a cesspool or privy is within a Zone I of a public well. --- Any portion of a cesspool or privy is within 50 feet of a private water supply well --- Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality ana- lysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 161 Pitchers Way. Hyannis, Ma. Owner: Robert Sherman Date of Inspection : 06/09/96 E) LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: The design flow of system is 10,000 gpd or greater Large System and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist : --- the system is within 400 feet of a surface drinking water supply --- the system is within 200 feet of a tributary to a surface drinking water supply --- the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area - IWPA)or a mapped Zone I I of a public water supply well. The owner or operator of any such system shall bring the system and facility into full compli- ance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please, consult the local regional office of the Department for further information. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 161 Pitchers Way. Hyannis, Ma. Owner: Robert Sherman Date of Inspection: 06/09/96 Check if the following have been done : -x Pumping information was requested of the owner , occupant and Board of Health. --x None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during the period. Large volumes of water have not been introduced into the system recently or as part of this inspection. --x As built plans have been obtained and examined. Note if they are not available with N/A. --x The facility or dwelling was inspected for signs of sewage back-up. --x The system does not receive non-sanitary or industrial waste flow. --x The site was inspected for signs of breakout. --x All system components, excluding the S oil Absorption System,have been located on the site. --x The septic tank manholes were uncovered, opened and the interior of the sep- tic tank was inspected for conditions of baffles or tees, material of construc- tion, dimensions, depth of liquid,depth of sludge, depth of scum. ---x The size and location of the Soil Absorption System on the site has been deter- mined based on existing information or approximated by non-intrusive methods ---x The facility owners and occupants if different from owner were provided with information on the proper maintenance of Subsurface Disposal System. r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 161 Pitchers Way. Hyannis, Ma. Owner: Robert Sherman Date of Inspection: 06/09/96 RESIDENTIAL: Design flow : gallons a� Number of bedrooms •. Number of current residents: 02 Garbage grinder (yes or no) : r Laundry connected to system (yes or no): ue.s Seasonal use(yes or no) : r v Water meter readings, if available: Last date of occupancy : .� COMMERCIALANDUSTRIAL : Type of establishment: Design flow : gallons/day Grease trap present: [yes or no) Industrial waste holding tank present (yes or no) : Non-sanitary waste discharged to the Title 5 system (yes or no): Water meter readings, if available : Last date of occupancy : Other: (Describe) .........................:.................................................................................. Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information : System pumped as part of inspection (yes or no):... ........... if yes, volume pumped: .................... gallons Reasonfor pumping:............................................................................................................ 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 161 Pitchers Way. Hyannis, Ma. Owner: Robert Sherman Date of inspection: 06/09/96 TYPE OF SYSTEM --- Septic tank/distribution box/soil absorption system --- Single cesspool --- Overflow cesspool --- Privy --- Shared system(yq; or no) (if yes, attach previous inspection records,if any) - Other (explain).. ........ Q APPROXIMATE AGE of all components, date installed (if known) and source of information ........................................................................... . ................................................................................................................................................ ................................ Sewage odors detected when arriving at the site: (yes or no).... ?. . SEPTIC TANK : ............'2 ... (locate on site plan) Depth below grade: .......... Material of construction: ....... concrete ......... metal ........ FR P ........ other (explain) ................................................................................................................................................ Dimensions: .................. Sludge depth:............... Distance from top of sludge to bottom of outlet tee or baffle:.............................. Scum thickness :..................... Distance from top of scum to top of outlet tee or baffle: ....................................... Distance from bottom of scum to bottom of outlet tee or baffle :......................... Comments : (recommendation for pumping , condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.)...................... ................................................................................................................................................ ................................................................................................................................................ ................................................................................................................................................ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PAR T C SYSTEM INFORMATION (continued) Property Address: 161 Pitchers Way. Hyannis,Ma. Owner: Robert Sherman Date of inspection: 06/09/96 GREASE TRAP : .......0Q).... (locate on site plan) Depth below grade: ............... Material of construction: ........concrete.........metal........FRP........other(explain).... . .......................................................................................................................................... Dimensions:............................... Scum thickness:........................ Distance from top of scum to top of outlet tee or baffle:....................................... Distance from bottom scum to bottom of outlet tee or baffle:............................... Comments: (Recommendation for pumping condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.)........................ ................................................................................................................................................ ................................................................................................................................................ TIGHT OR HOLDING TANKS:.... ��.... (locate on site plan) Depth below grade:.. Material of construction:........concrete........metal.........FRP..........other (explain).......... ................................................................................................................................................ Dimensions:............................ Capacity:....................gallons Design flow:...............gallons/day Alarm level:............................. Comments: (condition of inlet tee, condition of alarm and float switches, etc.) ................................................................................................................................................ ................................................................................................................................................ r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 161 Pitchers Way. Hyannis Ma. Owner: Robert Sherman Date of inspection: 06/09/96 DISTRIBUTION BO :..Oo.. (locate on site plan) Depth of liquid level above outlet invert:................... Comment: (note if level and distribution equal evidence of solids carryover, evidence of leakage into orout of box, etc.).................................................................................................................. ................................................................................................................................................ ................................................................................................................... ............................ PUMP CHAMBER:....P.P.... (locate on the site) Pumps in working order: (yes or no)............... Comments: (note condition of pump chamber, condition of pumps and appurtenances,etc.).................... ................:............................................................................................................................... ................................................................................................................................................ SOIL ABSORPTION SYSTEM ($AS):....... s.... (locate on site plan, if possible, excavation not required,but may be approximated by non- intrusive methods) if not determined to be present, explain: ................................................................................................................................................ Type: leaching pits, number: ...1. leaching chambers,number:........ leaching galleries, number:........... leaching trenches, number ,length:..................... leaching fields,number, dimensions:................... overflow cesspool,number:.......... Comments: (note (Glondition of soil , signs of hydraulic failure, level of ponding, condition of (vegetation, �tc.]. t, ...q v".\.(wC.:'::n ...........f.1�1.1.`).L,....���.�.�.�..+.. cJ.4 1A�0 r�.�...e-..' � C.c�.o..UF.�-�---b--e � V•c-rat.-��G w-� @�'2 r�- SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C . SYSTEM INFORMATION (continued) Property address: 161 Pitchers Way. Hyannis,M a. Owner: Robert Sherman Date of inspection: 06/09/96 CESSPOOLS:.............. (locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: .....!9................... Depth of solids lager: .....0....................................... Depth of scum layer: .....`?........................................ Dimensions of cesspool: .... ......... Materials of construction: ....C'.<? Indicator of ground water: .....NO.......... inflow (cesspool must be pumped as part of inspection) ..N v........................................................................................ ................................................................................................. Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, tl_ c,,}-.} �+.y tl�1� ... �C':�v.;aP. ...... .A ..1. PRIVY : ....NP.... (locate on the site) Material of construction: ................................... Dimensions: ...................... Depth of solids: ................ Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.) . ................................................................................................................................................ ................................................................................................................................................ Ilk SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 161 Pitchers Way. Hyannis, Ma. Owner: Robert Sherman Date of inspection: 06/09/96 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate at wells within 100'. 6 DEPTH TO GROUNDWATER: Depth to groundwater: .:a......feet Method of determination or aap'proximative: V.:5....�`• .•���,G..�a�...�i:'Jv..�;�;e,;�:�. .�..��:��i.Y�-:�:�.�......e�::\2':5..:.��_1.�'S.�'�':�.�!Y.�.h... t ..................... .. ................................................................................................................................................ COMNIONWEALTH OF N ASSACHL'SETTS EXECUTIVE OFFICE OF DwIRONMENTAL AFFAIRS ' DEPARTMENT OF ENVIRONMENTAL PROTECTION 1 ONE WINTER STREET. BOSTON. NIA 02108 617-29-2-5400 WILLIAN'F.WELD TRUDN'CO?M GovemO• Secretary ARGEO PAUL CELLUCCI DAVID B.STRUHS Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissioner PART A CERTIFICATION Property Address: �`c�' `y�`""'�� Address of Owner: �1�� Date of Inspection: O�� �i (If different) �J p P � Name of Inspector: �,_ a _ L ` ��e � I am a DEP approved system inspector pursuant to Section 15.34 of Title 5 (310 CMR 15.000) Jr�C�� Company Name: l G� -L G.t1r'trr�u� n ` J Mailing Address: r�O /�o� 9 -"2 M Telephone Number: CERTIFICATION STATEMENT I cenif\ that I have personally inspected the sewage disposal system at this address and that the informatio v` is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and r e function and maintenance of on-site sewage disposal systems. The system: �a A ✓- Passe: REeEiv�� _ Cond;tionall� Passes �- !-,eeds Further Evaluation the Local Approving Authority 1997 Fails to J U N 2 5 TOWN OF BARNSTABLE Inspector's Signatu(e: Date: l HEALTH DEPT , The System Inspector shal' submit a copy of this inspection report to the Approving Authority withint ° 00) days of giinL leting this inspection. If the system is a shared system or has a design flow of 10,000 or greater, the ins ct 'dith'e s ste owner shall submit Pe Y g god g Pe I"y� the report to the appropriate regional office of the Department of Environmental Protection. The original sho -be-sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: A] SYSTEM PASSES: X- I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: B] SYSTEM CONDITIONALLY PASSES: One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tank was installed within twenty (20) years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (reviiod 04/25/97) ?ag* 1 of 10 DEP on the World Wide Web http.liwww.magnet.state.ma.us/Cep Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) � Property Address:� ` r-1 kka'�-S Owner: /Z-- - SHc�v� Date of Inspection: B] SYSTEM CONDITIONALLY PASSES (continued; Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). Describe observations: broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed C] FURTHER EVALUATION 15 REQUIRED BY THE.BOARD OF HEALTH: Conditions(existywhich require further evaluation by the Board of Health in order to determine if the system is failing to Mrotect the public health, satety;an e environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER ., WHICH WILLI PROTECT. THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT. Cesspool or priv%•,is within 50 feet of a surface water Cesspool or pricy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or tributary to a surface water supply. _ The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supo!y well. _ The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation,not valid. 3) OTHER (zevieed 04/25/97) Page 2 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: ,&-/ c y- /yG " `Z-� Owner: , S-A0 Date of Ifispection: D) SYSTEM FAILS: You must indicate either "Yes" or "No" as to each of the following I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day floe- Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipers). Numb?r of times pumped _. Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation Am portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. And portion of a cesspool or pri,,y is within 50 feet of a private water supply well. Any- portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copv of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: You must indicate either "Yes" or "No" as to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 god or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area- IWPA) or a mapped Zone II of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program_ requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 04/25/97) ' Page 3 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 4 CILO h1y� ' Owner: Date of Ifispectio©� �! Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes No Pumping information was provided by the owner, occupant, or Board of Health. _ None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. As built plans have been obtained and examined. Note if they are.not available with N/A. The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary" or industrial waste flow. The site was inspected for signs of breakout. All system components, excluding the Soil Absorption System, have been located on the site. _•. _ The septic tank manholes were uncovered, opened. and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soil .Absorption System on the site has been determined based on: The facility owner (and occupants. if different from owner) were provided with information on the proper maintenance of Sub-Surface Disposal System. Existing information. Ex. Plan at B.O.H. Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) (15.302(3)(b)J (revised 04/25/97) Pago 4 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C / SYSTEM INFORMATION Property Add ess: -��� I , �Gt�IJ1 L �`� 117� Owner: Date of Inspection: FLOW CONDITIONS RESIDENTIAL: Design flow: p.d./bedroom for S.A.S. Number of bedrooms:©*Z� Number of current residents: C> Garbage g,i der (yes or no): NY—) Laundry corrected to system (yes or no): 14rts Seasonal use tyes or no):—f)%.j Water meter readings, if available (last two (2) year usage (gpd): tin Sump Pump (yes or no):—O� Last date of occupancv:—kjc—�jxu"<�- �— yvt COMMERCI.AUINDUSTRIAL: Type of establishment. Design flow: Qallons/day Grease trap present: ryes or no,_ Industrial Waste Holding Tank present: (ves or no;_ Non-sanitary waste discharged to the Title 5 system. ;yes or no Water meter readings. if available Last Pate of o cupanc\ OTHER: (Describe Last date of occuoancv. GENERAL INFORMATION PUMPING RECORDS and source of information System pumped as part of inspection: ryes or no)_ If yes, volume pumped: ¢allons Reason for pumping TYPE OF SYSTEM Septic tank/distribution box/soil absorption system Single cesspool '.�—, 'V.�' Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) VA Technology etc. Copy of up to date contract? aher APPROXIMATE AGE of all components, date installed (if known) and source of information: Sewage odors detected when arriving at the site: (yes or no) (revised 04/25/97) page 5 of 10 SUBSURFACE SEW AGE DISPOSAL SYSTEM INSPECTION FORM PART C ' SYSTEM INFORMATION (continued) Property Address: ���/ Owner: y/ _ S���N Date of Inspection: BUILDING SEWER: (Locate on site plan) Depth below grade: Material of construction: _cast iron _40 PVC _other (explain) Distance from private water supply well or suction Ii Diameter Comments: (condition of joints, venting, evidence of leakage, etc.) SEPTIC TANK: (locate on site plani Depth below grade: Material of construction: _concrete _metal _Fiberglass _Polyethylene _other(explain) If tank is metal, list age _ Is age confirmed bv Certificate of Compliance _ (Yes./No: Dimensions Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: Distance from top of scum to top of outlet tee or baffie. Distance from bottom of scum to bosom of outlet tee or barie: How dimensions were determined: Comments: (recommendation for pumping, condition of inlet and outlet tees,or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) GREASE TRAP: t (locate on site plan) Depth below grade: Material of construction: _concrete _metal _Fiberglass _Polyethylene —other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) (revised 04/25/91) Pag• 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner: �9 Date of Inspection: TIGHT OR HOLDING TANK: :Tank must be pumped prior to, or at time, of inspection) (locate on site plan) Depth below grade: Material of construction: _concrete _metal _Fiberglass _Polyethylene _other(explain) Dimensions: Capaciry: gallons Design floes: gallons.da\ Alarm level. Alarm in working order_ Yes; _ No Date of previous pumping Comments: (condition of inlet tee. condition of alarm and float switches, etc.) DISTRIBUTION BOX: (locate on site plan: Depth of liquid level above.outlet inver': Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) PUMP CHAMBER: fib (locate on site plan Pumps in working order: (Yes or No) Alarms in working order (Yes or Noi Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (zevieed 04/25/97) page 7 of 10 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) R .' Property Address: /��! ICLo Uc-)=c c Owner: �j Date of Inlpe-coon:�" �`` SOIL ABSORPTION SYSTEM (SA -*,�) (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number: 1 (.X6 leaching chambers, number.— leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions. overflow cesspool, number: Alternative system: Name of Technologv: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) CESSPOOLS: eS (locate on site plan) Number and configuration: Depth-top of liquid to inlet invert. Depth of solids layer: fo<< Depth of scum layer:_f�" Dimensions of cesspool: (c;1-1 Materials of construction: 'Lane"a— \ Indication of groundwater: t lk-) inflow (cesspool must be pumped as part of inspection) t3 Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) a PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (revised 04/25/97) Page a of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner: Date of Inspection: vc-� SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) (zaviaad 04/25/91) Page 9 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C / SYSTEM INFORMATION (continued) Property Address: ./fwy �t—C � C%C�._.y - y u k4.� Owner: R Date of Inspection: Depth to Groundwater 1%5Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from,Design Plans on record Observation of Site (Abutting property-observation hole, basement sump etc.) Determine it from local.conditions Check with local Board or health Check FEMA neaps Check pumping records Check local excavators. installers Use l SGS Data Describe in your own words how you established the High Groundwater Elevation. Must be completed) 5 . (revised 04/25/97) Page 10 of 10 t6z.. 548 659 887 r 01'7 Receipt for Certified Mail No Insurance Coverage Provided � Do not u UNITED STATES se for International Mail POST45EINICE (See Reverse) CO Sen,t rn rn t S ee an N L cd P. t nd ZIP Code O p Hostage co M E Certified Fee O ' LL Special Delivery Fee R""esiFictetl'D�iive�y Fee' IR"eiuin'!$`�ce`i(ittSlio"aiing? I to Whom&Date Delivered a Return Receipt Showing to Whom, Date,and Addressee's Address TOTAL Postage &Fees Postmark or Date I t ' STICK POSTAGE STAMPS TO ARTICLE TO COVER FIRST CLASS POSTAGE, CERTIFIED MAIL FEE,AND CHARGES FOR ANY SELECTED OPTIONAL SERVICES(see front). 1. If you want this receipt postmarked,stick the gummed stub to the right of the return address leaving the receipt attached and present the article at a post office service window or hand it to your rural carrier(no extra charge). S 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the return C13 address of the article,date,detach and retain the receipt,and mail the article. rn 3. If you want a return receipt,write the certified mail number and your name and address on a return receipt card,Form 3811,and attach it to the front of the article by means of the gummed co ends if space permits.Otherwise,affix to back of article.Endorse front of article RETURN RECEIPT REQUESTED adjacent to the number. C 4. If you want delivery restricted to the addressee,or to an authorized agent of the addressee, 0 endorse RESTRICTED DELIVERY on the front of the article. E 5. Enter fees for the services requested in the appropriate spaces on the front of this receipt.If 1L return receipt is requested,check the applicable blocks in item 1 of Form 3811. to a 6. Saxe this receipt and pr�sgnl et-if you make inquiry. 105603-93-B-0218 Town of Barnstable • Department of Health, Safety, and Environmental Services BARNBPABU& L MASS. Public Health Division 039.Ep�A 367 Main Street, Hyannis MA 02601 Office: 508-790-6265 Thomas A.McKean FAX: 508-775-3344 Director of Public Health July 19, 1996 Arlene Sherman 39 Paul Revere Road Lexington, MA 02173 ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL CODE, TITLE 5. The septic system owned by you located at 161 Pitchers Way, Hyannis was inspected on April 2, 1996 by J.P. Macomber a Massachusetts licensed septic inspector. The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • Back-up of sewage into components due to an overloaded leaching facility. You are directed to hire a licensed Town of Barnstable septic system installer to submit a sketch diagram of a proposed system to the Town of Barnstable Health Division Office (Town Hall, 367 Main Street, Hyannis) that will bring the septic system into compliance with 310 CMR 15.00, The State Environmental Code, Title 5 within (14) fourteen days of receipt of this notice. You are also directed to bring the septic system into compliance within thirty (30) days of receipt of this order letter. You are further directed to maintain the system by hiring a licensed septage hauler to pump the septic system to prevent discharge of sewage or effluent into the buildings, onto the surface of the ground, or in to surface waters. Any person aggrieved by any order issued by the local approval authority may appeal to any court of competent jurisdiction as provided for by the laws of the Commonwealth. PER ORDER OF THE BOARD OF HEALTH "Thomas A. McKean, R.S., C.H.O. Agent of the Board of Health ti [Installer letter] TO: 1y1'en0- - �? 'Y�� � (Date) . 74 MA ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL CODE, TITLE 5. The septic system owned by you located at A�/ was inspected on . Eby a Massachusetts licensed septic inspector. The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: 11 ` You are directed to hire a licensed Town of Barnstable septic system installer to submit a sketch diagram of a proposed system to the Town of Barnstable Health Division Office (Town Hall, 367 main Street, Hyannis) that will bring the septic system into compliance with 310 CMR 15.00, The State Environmental Code, Title 5 within (14) fourteen days of receipt of this notice. You are also directed to bring the septic system into compliance within thirty (30) days of receipt of this order letter. You are further directed to maintain the system by hiring a licensed septage hauler to pump the septic system to prevent discharge of sewage or effluent into the buildings, onto the surface of the ground, or in to surface waters. Any person aggrieved by any order issued by the local approval authority may appeal to any court of competent jurisdiction as provided for by the laws of the Commonwealth. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, R.S., C.H.O. Agent of the Board of Health Town of Barnstable �r September 28, 1996 Ms. Barbara Sullivan Public Health Office Assistant Town of Barnstable 367 Main Street Hyannis, MA 02601 re: 161 Pitchers Way, Hyannis Dear Ms. Sullivan, Enclosed please find the two sewage disposal system inspection reports mentioned in the attached letter from Mr. McKean. As this letter outlines, please note'voluntary" in the computer on each. We were previously advised by the respective inspectors that both of these reports were filed in your office. If this is not the case please contact me. Thank you. Sincerely, q "L, t-4 . Robert Sherman 39 Paul Revere Road Lexington, MA 02173 ENCS. � 7 ✓ .t I 1 z, 1 c ,L I_. Town `of���Barnsta 1e' sAMsrAaL% � Department of Health, Safety, and Environmental Services >►AS&1639. Public Health Division �� 367 Main Street, Hyannis MA 02601 Office: 508-790-6265 Thomas A.McKean FAX: 508-775-3344" Director of Public Health September 24, 1996 Robert Sherman 39 Paul Revere Road Lexington, MA 02173 RE: 16.1 Pitchers Way, Hyannis Dear Mr. Sherman: I am in receipt of your letter requesting the Town of Barnstable Public Health Division to, classify two septic system inspections at the above.referenced property as"voluntary." If and when we receive the inspection reports, the Public Health Division Office.Assistant, Barbara Sullivan,will note >� - "voluntary" in the computer, as you requested. Sincerely yours, T omas A. Mc Kean, R.S. CH ti Director of Public Health Town of Barnstable TM/bcs I, t kk 7 Commonwealth,of Massachusetts` Executive of Environmental Affairs Department of Environmental Protection SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address:. 161 Pitchers Way. Hyannis,M a. Address of Owner: Robe't-Sherman (if different) 39 Paul Revare Road. Lexington, Ira 02173 Date of Inspection: 06/09/96 Name of Inspector: . Michael D eD ecko Company Name, Address and Telephone number: Atlantic Environmental P.o Box 2384 M ashpee Ma 02649. Tel: (508) 4771420 CERTIFICATION STATEMENT certify that I have personally inspected the sewage disposal system at this address'and that the information reported.below is true, accurate and complete as of the time of inspection . The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. The system X- Passes -: Conditionally.Passes , Needs further evaluation b the local A rovin Authorik---- y pp roving y --- . Fails Inspector ' s Signature , Date: 06113196 The system Inspector shall submit a copy of this inspection report to the Approving 'Authority within thirty (30) days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit khe report to khe appropriate regional office or the Department of Environmental Protection. The original should be sent to the system owner and copy sent to the buyer, if applicable and the approving authority. r, SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM' PART A CERTIFICATION (continued) Property Address: 161 Pitchers Way. Hyannis Ma. 0 wners : Robert Sherman Date of Inspection : 06/09/96 INSPECTION SUMMARY: Check A,B, C, or D A)SYSTEM PASSES: 1 have not found any information which indicates that the system violates any of t'he failure criteria as defined in 310 CM 15.303. Any failure criteria not evaluated are indicated below B)SYSTEM CONDITI0NALLYPASSES . ---- One or more system components need to beM replaced or repaired. The system, upon completion of the replacement or repair, passes inspection. :.Indicate.yes, no,or,not determinate(1(,N,or ND). Describe basis of determination in.all instances. If "not determinated", explain why not. ---. The septic tank is metal, cracked, structurally unsound, shows substantial infiltration or exfiltration , or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. - Sewage backup or,breakout or high static water level observed in,the,distribution box is due to broken or obstructed pipe(s) or due to a broken;settled or uneven ' distribution box. The system will pass inspection if(with approval of the Board of Health). ----- broken pipe(s) are replaced obstruction ;..is removed , -` distribution box is le' velled'or replaced' r ' ---- The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if (with approval of the Board of Health): ---- broken pipe(s)are replaced -- obstruction is removed if SUBSURFACE SUBSURFACE SEWAGE DISPOSAL SYSTEM�INSPECTION_FORM PART A CERTIFICATION (continued) Property Address : 161 Pitchers Way. Hyannis Ma. Owner: Robert Sherman Date of Inspection : 06/09/96 C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: ---- Conditions exist which require further evaluation by the Board of Health in order to de- termine if the system is failing to protect the public health,safety and the environ- ment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETYAND THE ENVIRONMENT: ' --- Cesspool orprivy is within 50 feet of a surface of water ---- Cesspool or privy is within 50 feet of a bordering vegetated wetland ova-small marsh. 2) SYSTEM WILL FAIL UNLESS THE.BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IFAPPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNC- TIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT. ---- The system has a septic tank and soil absorption system and is within 00 feet.to a surface water supply or tributary to a surface water supply: ---- The system has a septic tank and soil absorption system and is within a Zone of a public water supply well. ---- The system has a septic tank and soil absorption system and,is within.50 feet j of a private water supply well. --- The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well, unless a well water.analy- sis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nokrogen is equal to or less.than 5 ppm. D) SYSTEM FAILS. - I have determined that the system'violates'one or more of the following failure criteria:: > > as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to cor- rect the failure. --- Backup of sewage into facility or system component due to an overloaded or. or clogged SAS or cesspool. 3 SUBSURFACE SEWAGE,DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 161.Pitchers Way. Hyannis,Ma Owner:' Robert Sherman Date of Inspection: 06/09/96 D)SYS T E M FAI LS (continued) -- 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. over- loaded. or clogged SAS or.cesspool --- Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. --- Required.pumping more than 4 times in the last year NOT .due to clogged' or obstructed pipe(s). number,of times pumped --- Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. --- Any portion of cesspool or privy is within 10.0 feet of a surface water supply, ortributary to a surface water supply. ---Any portion of a cesspool or privy is within a zone I of a publicwell. -=- 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 ana lysis. If.the well has been analyzed.to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. } 5. 1 kr 'S! V a l t FF SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION-FORM � z PART A CERTIFICATION (continued) Property Address: 161 Pitchers Way. Hyannis, Ma Owner: Robert Sherman Date of Inspection: 06/09/96 E) LARGE SYSTEM FAILS: The following criteria apply to large systems in,addition to the criteria above The design flow of system is 10,000 gpd or greater Large System and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist : ' --- the,system is wither 400 feet of a surface drinking eater supply -=- the system is within 200 feet of a tributary to a surface drinking:.water:,supply --- the system is located in a. nitrogen sensitive area (1 nterim Wellhead Protection Area -.IWPA)or a mapped Zone II of a public water supply well. The owner oroperator,of.any,such system sh. all.bring the system and;facility:into full complf-; ance with the groundwater treatment program requirements of 31 CMR 5.00 anPd 6.00. Please,consult the local regional office of the Department for further information. i r i ` F f 4 - t SUBSURFACE SEWAGE DISPOSAL tS'YSTEM1INSPECTION FORK"), PART B CHECKLIST Property Address: 161 Pitchers lay. Hyannis,M a. Owner:. Robert Sherman Date of Inspection: 06/09/96 Check if the following have been done -x Pumping information was requested of the owner,occupant and Board of Health. --x None of the system components have been pumped for at least, two weeks and the system has been receiving normal flow rates during the period. Large volumes of water have not been introduced into the system recently or as part of this inspection. --x As built.plans have been obtained and examined. Note,if they are not available with N 1A --x The facility or dwelling was inspected for signs of sewage back-up. -x The system does not receive non-sanitary or industrial waste flaw. --x The site was inspected for signs of breakout: --x All system components, excluding the Soil Absorption System, have been located on the`site. --x The septic tank manholes were uncovered,opened and the interior of the sep tic tank was inspected for conditions of baffles or tees, material of construc- tion, dimensions,depth of liquid,depth of sludge, depth of scum. ---x The size and location of the Soil Absorption. System on the site has been deter- mined based on existing information or approximated by non-intrusive methods ---x The facility owners and occupants if different from owner were provided with information. on the proper maintenance of. Subsurface Disposal System. x r K s'lil i - � 1• r ,: � F t Eq f_pll 1 ft`�t,-ia 1 i� .'. k I ' y`; ii ;[ r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM s PART C SYSTEM INFORMATION Property Address: 161 Pitchers Way. Hyannis, Ma. Owner: Robert Sherman Date of Inspection: 06109/96 RESIDENTIAL: Design flow.: gallons Number of bedrooms : �3 Number of.current residents:022 Garbage grinder(yes or,no): N�0 Laundry connected to system(yes or no): Seasonal use (yes.or.no). U. Water meter readings,.if available: ►A� . Last date of occupancy: COMMERCIALIINDUSTRIAL." .Type of establishment Design flow: _.,gallonslday Grease trap:present-(yes or no) Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system (yes or.no) : Water meter readings, if available Last date of occupancy Other: (Describe) ..... Last date of occupancy: p y: GENERAL INFORMATION : P M PI NN Gy�R E CO R DS and source of information:.. '..)5...\. .P:'�!^Sa:4�s?`.. ....MY\O+V..... fK3;L Z •N ` _'_ f/v�. System pumped as part of inspection (yes or no):..:f! ?°........... if yes,volume pomped: .................... gallons Reasonfor pumping ............ .......... .... ............................................. ......................... M .' ,:{ .. ,Jr:• .. t „s �.. +Yr 1 -', {M1 p,t{ 4," t * i�..°� I �i ! t �. SUBSURFACE SEWAGE DISPOSAL"SYSTEM INSPECTION'FORM PART C SYSTEM INFORMATION (continued) Property Address: 161 Pitchers Way. Hyannis,M a. Owner: Robert Sherman Date of inspection: 06/09/96 TYPE OF SYSTEM -- Septic.tank/distribution box/soil absorption system --- Single cesspool --= Overflow cesspool -=- Privy --- Shared system (yes or no) (if yes, attach previous inspection records,if any) - Other ex lain ovc........Y_ Q .• APPROXIMATE AGE of all com onents,date installed(if known)and source of information .�� :... .+ R.�. ...... . .... .................... ...... ...... ................:.... ......................... Sewage odors detected when arriving at the site: (yes or no).... ? . SEPTIC TANK: ...............400 (locate on site plan) Depth below grade: .......... Material of construction: .... concrete metal FR P other (explain)..: s. ................ ........ ....................................................................... .... Dimensions: .............. imensions: ..: ......... , Sludge depth: ............: Distance.from top of sludge to bottom of outlet tee or baffle:.............................. Scum thickness Distance from top of scum to top of outlet tee or.baffle: .................... ............. Distance from bottom of scum to bottom of outlet tee or baffle:........ ........... Comments (recommendation for pumping ,condition of inlet and outlet tees o.r baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage,etc.)...................... ................................................................................................................................................ i 1 { . -. ifs � I. ➢' i F .. SUBSURFACE SEWAGE DISPOSAL;SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 161 Pitchers Way. Hyannis,Ma. R �' d y y Owner: Robert Sherman Date of inspection: 06/09/96 GREASE TRAP : ........IJO.......... (locate on site plan) Depth below grade: ............... Material of construction: ........concrete.........metal.........FRP..:....;other(explain).... Dimensions:.:..............:.....::... .. ......... ...... ......... . ....... ..................................�. . Scum thickness:...::................... Distance from top of scum to top of outlet tee or baffle:........................................ Distance from bottom scum to bottom of outlet tee or baffle:.................... Comments: (Recommendation far pumping condition of inlet,and outlet tees,or baffles,depth of:liquid level in relation to outlet invert,structural integrity, evidence of leakage, etc.)....... .... .... ..... ................................................................................................................................................ .........:....... ..... ....... ..... ....... .........................;..... .......... TIGHT OR HOLDING TANKS:..... ........ (locate on site plan].' r r Depth below grade Material of construction....::. .concrete......'..metal.........FRP..........other(explain] ....... D imensions:...........:.:....... Capacity:....................gallons Design flow:...........I....gallons/day Alarm level:........................:.... Comments: (condition.of inlet tee,condition of alarm and float switches, etc.) ` .................... .......... ..................................................................... ........................... ..... t SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 161 Pitchers Way. Hyannis Ma. Owner: Robert Sherman Date of inspection: 06/09/96 DISTRIBUTION BOX:..OA. (locate on site plan) Depth of liquid level. above outlet invert:..........:......:. Comment: - (note if level and distribution equal evidence of solids carryover,evidence of leakage into orout of box,,etc.). ................................................................................... ................... .... 1 ......................................................................................:......................................................... ........................................................,....................................................................................... PUMP CHAMBER:....N.d.... (locate on the site) Pumps in working order: (yes or no)............... Comments: (note condition of pump chamber, condition of pumps and appurtenances,etc.).................... SOILABSORPTION SYSTEM (SAS)• s (locate on site plan,if possible; excavation not required,but may be approximated.by non- intrusive methods) if not determined to be present, explain: .... ................. leaching pits, number. ... .. .R leaching chambers, number:....... leaching galleries,number:........... leaching trenches,number, length:.....:. .... leaching fields, number, dimensions:...... overflow.cesspool,number:.......... Comments: (Hoke ndition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, tc.). o M.I. c, ...c ... ?ti ..�.h ad..r...N.o.SAC'c-s. . . .... ........A&.15.1.y.�......�. .�.Q: .,.. : . .�,, SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property address: 161 Pitchers Way. Hyannis,hula. Owner: Robert Sherman Date of inspection: 06/09/96 CESSPOOLS:.............. (locate on site plan) Number and configuration: ...�.Vsr�.M ............. Depth-top of liquid to inlet invert: .....�0.....:. ...... Depth of solids lay}er: .....a .... ... .. Depth.of scum layer: .... .......... Dimensions of cesspool: ...� ............ Materials of construction: .... 'C � z- Indicator of ground water: .....NR.......... inflow (cesspool musk be pumped as part of inspection) Nv........... .................................... ................................................................................................. Comments: (note condition of soil, signs of hydraulic failure, level of ondin condition of vegetation,' . y P 9. e �a ........ .......... ; � t...{a�?U °,^ PRIVY: ...NP. ... (locate on the site)` Material of construction ...... ......:. . ...... Dimensions:........ Depth of solids: 4 Comments: (note condition of soil: signs of hydraulic failure;level of ponding,'condition of vegetation; etc.) ......................................... ........................ .......... ............................... . ........... _.,. ... . .. ... . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address : 161 Pitchers Way. Hyannis, Ma. Owner: Robert Sherman Date of inspection: 06/09/96 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate at wells within 100'. 6 DEPTH TO GROUNDWATER: Depth to groundwater: .15feek Method of determination or approximative ��-:�5;..��'Terms::�s-.s�-...Abe:Q��:C..;:A:)T-1X3��:?:::':..�:: .....�'.la:'.-::::�•.'`-��Y�?z,...`:�:t....:�� ................................................................................................................................................ ,V Vk .i 4 0 t No.---.�+�1.�.a 8� F>cs....�....2.0.....0.0 THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH Town OF Barnstable .. ......... ................................................•- AVp tration for Disposal Works Tonstrurtion Upumit Application is hereby made for a Permit to Construct ( ) or Repair XX3 an Individual Sewage Disposal System at: 161 Pies Wy-_Hyannis: .................................. --------------- --••--------....---...........------------------------.....------...-----------------------•------ Location-Address or Lot No. Arl_e_ n__e kl.� Iris YI.-•----•---•----------------------------•----- .................................................................................................. Owner Address ............1..P-._Macomber.................................................... .------•-----------------...........----•..................----....------..........--------------- Installer Address Type of Building Size Lot............................Sq. feet U DwellingY-X No. of Bedrooms..............3--.-_---_-----------.----Expansion Attic ( ) Garbage Grinder ( ) pa,, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) P4 Other fixtures -------------------------------- . w Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid*capacity............gallons Length................ Width_............. Diameter--.------.------ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit................--.. Depth to ground water-.--------------------_. f� Test Pit No. 2................minutes per inch Depth of Test Pit----................ Depth to ground water.----------------.-----. -----------------------------------------------------------•---.....------------------....----------......................................................... 0 Description of Soil........................................................Sand...&---Grave-1,--------------------------------------------------------------------------- x U ----•-•---------------------••------------....----•--•-•-----------------------•--•-----....-----------------------•-----•----•-------•-----------------•----•---•----------------•-------•-----------•- w VNature of Repairs or Alterations—Answer when applicable-----------1,1.ODD....gallon---Leach---jLi-t-_.--_---_---. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'i T L J p of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be issue b oard of It Signed. ----------------------- ....... •-.--9/1.3./88 �Dfat`e Application Approved By............... -•-•- r,�=y .. -----� -D e- Application Disapproved for the following reasons:.............................................................................................................. ---------------------------- ............... ----------------....... ---- ------------------- Date Permit No.-------.0.0. `��� .................... Issued Dsto Fmc THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .............Tawn----------------OF............13axns-t-a-bl-e---------------------------------------------- Appliration for Disposal Works Tonstrurtion "unlit Application is hereby made for a Permit to Construct or Repair JXX an Individual Sewage Disposal System at: .............kr ------------------- -------------------------------------------------------------------------------------------------- 0�tio$a C ly r or Lot No. ............Afru.. ... Address ............ 1 nstal I er Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............... Expansion Attic Garbage Grinder 3--------------------------- Other—li%e of Building ____________________-------- No. of persons............................ Showers Cafeteria Otherfixtures ...................................................................................................................................................... Design Flow............................................gallons per person per day. Total daily flow...........................................gallons. P4 Septic Tank—Liquid capacity............gallons Length................ Width........___.__.. Diameter.___............ Depth......_..._..... Disposal Trench—No..................... Width.........._.._...... Total Length.........._........_ Total leaching area....................sq. ft. Seepage Pit No_____________________ Diameter._._..__.___._...... Depth below inlet.............._.._.. Total leaching area..................sq. f t. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date_..------------------------------------ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water________.---..........__. 44 Test Pit No. 2................minutes per inch Depth of Test Pit__._._.............. Depth to ground water_________-__--__---..... P4 ............................................................................................................................................................. 0 Description of Soil--------------------------------------------------------S_dfRy---&...Gf ---------------------------*.......... .................................... W U .......................................................................................................................................................................................................... W ........................................................................................................................................................................................................ . ......... U Nature of Repairs or Alterations—Answer when applicable-"_______________ crh... i7t. ........ ...................................................................................................................................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'T'a 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of ComplianceSigned.has beeh issued,by^h�/-�,���j board of I" Ith ... r ----------------------- ---------9/ V Date- Application Approved By.............. .......... Date Application Disapproved for the following reasons:................................................................................................................. ......................................................................................................................................................................................................... Permit No. �a....... .................... Issued...........................................Date------- ... . .............. ----- Da'_ .THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .............Toiny...............OF........Barrrat-ab-l­er............................................. (Urtifiratp of Toutpliatirr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired. by-------- r--------------------------------------------------------------------------------------------------------------------------------------------------- Installer at.------...1-6-1----tL7'jt7Cjj-C-7r7S--- ......................................................................................................................... E_ I has been instilled in. accordance with the provisions of TIT-1, 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.._....... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE...................... ............................ Inspector... - I.). ............................................ ---------------0 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH . ............... ............ .. .........Darns-b-zi.2. -c.......................................... FEE... k...:2a-.0.0 Disposal Works Tonstrudion ";Irrmit Permissionis hereby granted........j_v-P-;-Ma7co-aiber----------------------------------------------------------------------------------------------------- to Construct ( ) or Repair (X�Xan Individual Sewage Disposal System at .... No---1--&!----P�itcl-ters...Wa7r--�h-y-al is--�---------------------------------------------------lr2'1�-11- street OR —65.;); as shown on the application for Disposal Works Construction Permit No........... ..... - ated.......... ............................... . ......................................... ............................................................ Board of Health ....... . .... ................... DATE-- ........... ----- FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS i, HYANNIS LOT 1 LOT 2 T GARAGE ROTARY r FEN`_ o VENT — - 102.73' - LOCU- S ' I ' 33.5 30 ` � Tw/OAK � .. I. 31 OAK . w ::::. 1 1 O p o N o \ LOCUS MAP OAT \ - "" 3 .9 BRB \ �Q LOCUS INFORMATION: A.M.289/17 .: zI 123 . k p „ \ r PLAN REF: 183/19 r I o N O� \ TITLE REF: 30785/118 O I ► \ PARCEL ID: MAP 124 PAR. 88 \ ZONING: "RB" U!I OAK i i i i i i i FLOOD ZONE: "X" I DECK COMMUNITY .PANEL: 25001 CO568J DATED:07/16/14 #161 r = �� o!� \ � SEPTIC SYSTEM LOT 3 \^ U7 REPAIR PLAN 11.0. O Cn�- F:29.46 ,5p z \\ LOCATED AT: TANK O 13.1' INv: 27.s „ 161' ' PITCHER'S WAY 1 N C.O. c�®� DvEWA 31 0 _. \\ '� HYANNIS, MA. \ PREPARED FOR 01 M 8c M REALTY GROUP II ��/ COR. BLHD i i i - - EL-33.18 t.e — GUY U OLE'\ PUMP • CRUSH AND \ —G G \ F DECEMBER 29, 2017 SANDFILL OLD LEACHPITS ��i ...� G PER TITLE 5 I \. �N of Alj LOT 4 s9� ��. _ o?� EDWARD y� AREA 11,419t S.F. � s TW/OAK TW C a A. 117f'63 STONE H „ F. .ti.. - S86.2210 W N .28980 s �o N/F CAMPBELL e2 Ali a N/F MURRAY E . A. S. - ALE Y SURVEY INC. _ GRAPHIC. SC P.O. BOX 1729 20 0 10 20 ao 80 SANDWICH,,MA. 02563 NOTE: ENTIRE PROPOSED SEPTIC ' SYSTEM IS BELOW THE BASEMENT ( IN FEET ) { BUS:(508)888-3619 CELL:(508)527-3600 1 inch = 20 ft. SHEET 1 OF 2 J#1991 � � S- _- ��.- a «.. � .. .. 44 / > y /e ,+�F • ♦ 1, __ h' �, �e F 3 ' r^ a •♦ .�._. `_+�e i .^�,{ ts'... �Y;+� � ,_. .,;� -*.. ..t �'-e' „•_ -t� - :i'.:t �••iLfi=.�..'"- �.'rw"' #._ ':.�;_- r .?K .,,; - f�:, Y, a•" ,..f k "+,'x,•-„� ;s , .. ., r : - vi:..,,. .. � ��. 'F ,. .'ir". �1 Lt •�,4d i 1 i • IN . + - e - _ �`+. z✓ r --�... ,_,•.�... aV s w, s...:,•w - .�,. `� .. � ..�, ��, e ,�.,.i`:.x Y..i,;. ry a , r r, h .t i� ,.d: i-•y.�.,,,..0„' .� _'.:�• r'�.-7u :"S .1"'.';' „,..t'. ZS'1w+'. .`�"""".T;.:t ft"...�i i .., - P ~ r .. r t,�' i,.�rt,y � y. .. £}� . t A•' �� i 1 i.�- i' - F•�} "n /. 'L« ..��ek.r'V • • �.�' "--,:,r.._ iL.-•Y . L .tom � e e.;/',.. 1 ai�� 1u,� �_ JAI ..•+. ' e w ^� Si • s� Y .....4�4.jr'_ —�Y"%"• `�' �° r'".. Yx" ''> •+r t - ,. I` - `. rt,. . •v`..Y�-` 4 f t J Sall 2„ LAYER OF DOUBLE"WASHED STONE VENT 4" SCHEDULE 40 P.V.C. OR FILTER FABRIC MIN. PITCH 1/8" PER Fool CLEAN -SAND FILL CLEANOUT SCREWCAP 32.0 32.0 31.2 31.0 31.0 BASE. 32.0 ZFOR iiiiiiiiiFL..EL. :::: : : iiiiiiiiii �� iiiiiii iiiiiii iiiii ..... iiiiiiiiiiii iiiiiiii 4" SCHEDULE 40 P.V.C. RI46 T ® S 3 RISER RISER THI D CHAM ER13' ® 5=.03 MIN. PITCH 1/8" PER FOOT 26 74 FIR T CHA BER 26.7CLEANOUT t _ _ 33' ® S=.02. VEL LONGEST 4 4' W/SWEEP �� LIQUID LEVEL 2' 23' ® 5=.01 OTO GRADE 27.0 MIN. 14 26.8 ® ® ® O ® ® ® ® ® O TIE 27.5 27.3 INV. INV. 00 ® ® ® ® ® ® ® ® ® ® ® ® 0 C ENDS EXIST. INV. 26.14 6 BASE OF 25.97 0 ® ® INV. MECHANICALLY INV• 0 0 48" ADD COMPACTED SAND 4 4' 23.74 GAS PROP. DB3 25.74 BAFFLE H-20 INV. 3/4" TO 1&1/2" ( ) DOUBLE WASHED STONE o DISTRIBUTION 33.5' z w Box CL 3-500 GAL. (H-20) CHAMBERS 6" BASE OF MECHANICALLY COMPACTED SAND c (5'-O"W X 8'-6"L' X 3'-0"H) v LO PROPOSED WIGGINS PRECAST OR EQUAL 1,500 GALLON TANK - SOIL ABSORBTION (TRENCH FORMATION) (H-20) ` SYSTEM (S.A.S.) 13' X 33.5' PROFILE OF BOTTOM OF TEST PIT #1 ELEV.= 17.9 SEWAGE DISPOSAL SYSTEM DES GN NUMBER OF BEDROOMS........•--4N0 (NOT TO SCALE) GARBAGE DISPOSAL.................______- DATA: TOTAL ESTIMATED FLOW (110 GAL./BR./DAY X 4 BR.) --4 40 ' 440GPD X 200% = 880 GAL GENERAL NOTES I CERTIFY THAT I AM CURRENTLY APPROVED BY THE DEPARTMENT OF USE NEW 1 500 GALLON TANK ENVIRONMENTAL PROTECTION PURSUANT TO 310 CMR 15.017 TO CONDUCT 1. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. SOIL EVALUATIONS AND THAT THE ABOVE ANALYSIS'HAS BEEN PERFORMED INSTALL: 3(H-20) 500GAL CHAMBERS (W/4' CRUSHED STONE TITLE 5 AND THE TOWN OF BARNSTABLE RULES AND REGULATIONS BY CONSISTENT WITH THE REQUIRED TRAINING, EXPERTISE, AND EXPERIENCE DESCRIBED IN 310 CMR 15.017. I FURTHER CERTIFY'THAT THE RESULTS OF MY ON THE SIDES AND ENDS) AND BACKFILL FOR SUBSURFACE DISPOSAL OF SEWERAGE. SOIL EVALUATION, AS INDICATED ON THE ATTACHED SOIL EVALUATION FORM, 2. ALL ACCESS PORTS OVER TANK TEES SHALL BE ARE ACCUR A D IN ACC Df NCE WITH 310 CMR 15.100 THROUGH 15.107. WITH CLEAN SAND FILL PER 310. CMR 15.255 ACCESSIBLE WITHIN 6" OF FINISH GRADE. SOIL CLASSIFICATION................ 3. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE EDWARD A. STONE, PLS, CLR11PIED SOIL EVALUATOR SE#2359 DESIGN PERCOLATION RATE..... <2 MININ. CAPABLE OF WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN 10' OF DRIVES OR PARKING AREAS THEN THEY 1 EFFLUENT LOADING RATE.........=_74-_- MUST WITHSTAND H-20 LOADING. 15560 REQUIRED LEACHING CAPACITY.....4_40 GA f DAY TEST PIT RESULTS: P.► 4. THE EXCAVATION CONTRACTOR SHALL VERIFY THE LOCATION # LEACHING CAPACITY PROVIDED.....459 GAL/DAY OF ALL UTILITIES PRIOR TO ANY EXCAVATION.. t 5. ANY MASONRY UNITS USED TO BRING COVERS TO GRADE SOIL TEST DATE: DECEMBER 27 2017 SIDEWALL: (13 + 33.5 )x2x(2 SIDES)(.74)= 137 GAL/DAY OR WITHIN 6" OF GRADE SHALL BE MORTARED IN PLACE. BOTTOM: (13' x 33.5')(.74)= 322 GAL/DAY 6. FINISH GRADE SHALL HAVE A MINIMUM OF 2% GRADE B.O.H. AGENT: DON DESMARAIS OVER THE S.A.S. AND DISTRIBUTION BOX. TOTAL= 459 GAL/DAY 7. SEPTIC TANK SANITARY TEES SHALL BE CONSTRUCTED OF SOIL EVALUATOR: EDWARD A. STONE SE#2359 SCHEDULE 40 PVC AND SHALL EXTEND A MINIMUM OF 6" ABOVE -� BACKHOE: ELLIS BROS. 459 GPD PROVIDED - 440 GPD REQUIRED 19 GPD RESERVE THE FLOW LINE AND SHALL BE ON THE CENTERLINE AND LOCATED DIRECTLY UNDER THE CLEANOUT MANHOLES. SEPTIC SYSTEM DETAIL PAGE 8. THE INLET PIPE INVERT ELEVATION SHALL BE NO LESS THAN TH#1 EL.= 30.9 2 INCHES NOR MORE THAN 3 INCHES ABOVE THE INVERT ELEVATION OF THE OUTLET PIPE. ELEV. IDEPTH (IN.) HORIZON TEXTURE COLOR MOTTLING OTHER #161 PITCHER'S WAY 9. THE SEPTIC TANK SHALL HAVE A MINIMUM COVER OF 9 INCHES. 30.6 0"-4" A LOAMY SAND 10YR4/3 N/A 10. THE OUTLET SANITARY TEE SHALL BE EQUIPPED WITH A GAS H YAN N I S, MA. BAFFLE, 4 INCHES IN DIAMETER AND CONTRUCTED OF 4" PVC. 29.2 4"-20" B LOAMY SAND 7.5YR5/6 N/A 11. ALL PIPES SHALL BE SCHEDULE 40 PVC SEWER PIPE AND FIRST TWO FEET OUT OF THE DISTRIBUTION BOX SHALL 21.9 20 -108" C1 COARSE SAND 2.5Y6j6 N/A DECEMBER 29, 2017 BE LEVEL. 17.9 108"-156" C2 I MEDIUM SAND I 2.5Y7/6 I N/A 12. CHANGES OR REVISIONS TO SEPTIC DESIGN REQUIRE NOTIFICATION NO MOTTLES, NO GROUNDWATER TO EAS SURVEY, INC. FOR B.O.H. AND DESIGN ENGINEERS REVIEW AND APPROVAL. �tH DF Mq s TH#2 E L.= 31..1 (P E R C BOTTOM •@ 5 4" <2 M P I) 13. PROPERTY IS WITHIN ZONE II � 9Oy CONSTRUCTION NOTES: ELEV. DEPTH. (IN.) HORIZON TEXTURE COLOR MOTTLING OTHER �o D V D E. A . S 1. CONTRACTORS / INSTALLERS SHALL VERIFY GRADES AND 30.6 0"-6'� A LOAMY SAND 10YR4/3 N/A F H R Y i . SURVEY,' INC. ELEVATIONS AND SITE CONDITIONS PRIOR TO COMMENCING 29.3 6"-22" B LOAMY SAND 5YR5/6 N/A P.O. BOX 1729 7. WORK ON THE SITE. ClCOARSE SANG 2:5Y6/6 N/A PERC 2 1 O SANDWLCH, MA. 02563 21.9 22"-110': F 2. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE C/S T E� WITH DEEDED OR ZONING REGULATIONS. OWNER / APPLICANT 18.1 110"-156 C2 MEDIUM SAND 25Y7/6 N/A SAN1 t R\pN IS TO OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. BUS:(508)888-3619 CELL:(508)527-3600 3. ALL SYSTEM COMPONENTS SHALL BE MARKED WITH MAGNETIC MARKING NO MOTTLES, NO GROUNDWATER I C TAPE OR A COMPARABLE MEANS. SHEET 2 OF 2 #1991 �3