HomeMy WebLinkAbout0185 PITCHER'S WAY - Health 185 Pitchers Way
Hyannis
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on site or within 200 feet of leaching facility) Peet
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Commonwealth of Massachusetts
Title 5 Official Inspection Form
31'
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
185 Pitchers Way t
GSM "
Property Address I
Juan Marichal
Owner Owner's Name/ 3>
information is Hy annis �/ Ma 02601 3/4/18 '
X.
required for every � •
page. City/Town State Zip Code Date of Inspection,;
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
Important:When A. General Information
filling out forms I A3
on the computer,
use only the tab 1. Inspector:
key to move your
cursor-do not Michael DiBuono.
use the return Name of Inspector
key.
DiBuono Sewer and Drain
reb Company Name
35 Content Ln
Company Address
Cotu it MA 02635
City/Town State Zip Code
508-364-9587 S113522
Telephone Number License Number
B. Certification
I certify that I have personally inspected the sewage disposal system at this address and that the
information reported below is true, accurate and complete as of the time of the inspection. The inspection
was performed based on my training and experience in the proper function and maintenance of on site
sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of
Title 5(310 CMR 15.000). The system:
® Passes ❑ Conditionally Passes ❑ Fails
❑ Needs Further Evaluation by the Local Approving Authority
3/7/18
spector'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 is a shared system or
has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the
report to the appropriate regional office of the DEP. The original should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving authority.
****This report only describes conditions at the time of inspection and under the conditions of use
at that time.This inspection does not address how the system will perform in the future under
the same or different conditions of use.
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form i
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
185 Pitchers Way
Property Address
Juan Marichal
Owner Owner's Name
information is required for every Hyannis Ma 02601 3/4/18
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E/always complete all of Section D
A) System Passes:
• r
® 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:
System contains a 1,000 gallon septic tank. As well as a concrete distribution box and 16 bio diffusers
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.
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):
,Sins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
185 Pitchers Way
Property Address
Juan Marichal
Owner Owner's Name
information is required for every Hyannis Ma 02601 3/4/18
page. CityfTown State Zip Code Date of Inspection
B. Certification (cont.)
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
B) System Conditionally Passes (cont.):
❑ Observation of sewage backup or break out or 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):
C) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form 1
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
M 185 Pitchers Way
Property Address
Juan Marichal
Owner Owner's Name
information is required for every Hyannis Ma 02601 3/4/18
page. Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
2. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil 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.
3. Other:
D) System Failure Criteria Applicable to All Systems:
You must indicate"Yes" or"No"to each of the following for all inspections:
Yes No
❑ ® Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less
than '/2 day flow
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of'17
f
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
M 185 Pitchers Way
Property Address
Juan Marichal
Owner Owner's Name
information is required for every Hyannis Ma 02601 3/4/18
page. Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
Yes No
❑ ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well.
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory,for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered.A copy of the analysis
and chain of custody must be attached to this form.]
❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd-
10,000g pd.
❑ ® The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the
questions in Section D.
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
If you have answered "yes"to any question in Section E the system is considered a significant threat,
or answered "yes" in Section D above the large system has failed. The owner or operator of any large
system considered a significant threat under Section E or failed under Section D shall upgrade the
system in accordance with 310 CMR 15.304.The system owner should contact the appropriate
regional office of the Department.
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
,M 185 Pitchers Way
Property Address
Juan Marichal
Owner Owner's Name
information is required for every Hyannis Ma 02601 3/4/18
page. Citylrown State Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate"yes" or"no" as to each of the following:
Yes No
❑ ® Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
❑ ® Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
® ❑ Were as built plans of the system obtained and examined? (If they were not
available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
® ❑ Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
❑ ® Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS) on the site has
been determined based on:
® ❑ Existing information. For example, a plan at the Board of Health.
® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
D. System Information
Residential Flow Conditions:
Number of bedrooms (design): 3 Number of bedrooms(actual): 3
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330
t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
185 Pitchers Way
Property Address
Juan Marichal
Owner Owner's Name
information is required for every Hyannis Ma 02601 3/4/18
page. Cityrrown State Zip Code Date of Inspection
D. System Information
Description:
Number of current residents:
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No
information in this report.)
Laundry system inspected? ® Yes ❑ No
Seasonal use? ❑ Yes ® No
Water meter readings, if available last 2 ears usage d 118 Gpd
9 ( Y 9 (gp ))�
Detail:
Sump pump? ❑ Yes ❑ No
Last date of occupancy: Date
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
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
�M 185 Pitchers Way
Property Address
Juan Marichal
Owner Owner's Name
information is required for every Hyannis Ma 02601 3/4/18
page. CitylTown State Zip Code Date of Inspection
D. System Information (cont.)
Last date of occupancy/use: Date
Other(describe below):
General Information
Pumping Records:
Source of information: Not provided " Recommended "
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped: gallons
How was quantity pumped determined?
Reason for pumping:
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)
❑ 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):
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
185 Pitchers Way
Property Address
Juan Marichal
Owner Owner's Name
information is required for every Hyannis Ma 02601 3/4/18
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components, date installed (if known)and source of information:
2009
Were sewage odors detected when arriving at the site? ❑ Yes ❑ No
Building Sewer(locate on site plan):
Depth below grade: 2.5
feet
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.):
Inlet is under deck
Septic Tank (locate on site plan):
Depth below grade: 1.5
feet
Material of construction:
® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain)
1,000
If tank is metal, list age: years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
Dimensions:
Sludge depth:
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form , 4
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
;M 185 Pitchers Way
Property Address
Juan Marichal
Owner Owner's Name
information is required for every Hyannis Ma 02601 3/4/18
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Septic Tank(cont.)
Distance from top of sludge to bottom of outlet tee or baffle
24"
Scum thickness
3"
Distance from top of scum to top of outlet tee or baffle
42"
Distance from bottom of scum to bottom of outlet tee or baffle Sludge stick
How were dimensions determined?
Tape Measure
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Pumping is recommended at this time
Grease Trap (locate on site plan):
De
pth 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
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
185 Pitchers Way
Property Address
Juan Marichal
Owner Owner's Name
information is required for every Hyannis Ma 02601 3/4/18
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan):
Depth below grade:
Material of construction:
❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Capacity: gallons
Design Flow:
gallons per day
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments (condition of alarm and float switches, etc.):
*Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
°M 185 Pitchers Way
Property Address
Juan Marichal
Owner Owner's Name
information is
required for every Hyannis Ma 02601 3/4/18
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Distribution Box (if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert Level and at normal level
Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any
evidence of leakage into or out of box, etc.):
Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ 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.
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17
I
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
M 185 Pitchers Way
Property Address
Juan Marichal
Owner Owner's Name
information is required for every Hyannis Ma 02601 3/4/18
page. Cityfrown State Zip Code Date of Inspection
D. System Information (cont.)
Type:
❑ leaching pits number:
® leaching chambers number: 16 Bio Diffusers
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
Negative
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
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form -
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
�M 185 Pitchers Way
Property Address
Juan Marichal
Owner Owner's Name
information is
required for every Hyannis Ma 02601 3/4/18
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
Privy (locate on site plan):
Materials of construction:
Dimensions
Depth of solids
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17
Commonwealth of Massachusetts
. Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
185 Pitchers Way
Property Address
Juan Marichal
Owner Owner's Name
information is required for every Hyannis Ma 02601 3/4/18
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to
at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate
where public water supply enters the building. Check one of the boxes below:
❑ hand-sketch in the area below
® drawing attached separately
I
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
°M 185 Pitchers Way
Property Address
Juan Marichal
Owner Owner's Name
information is required for every Hyannis Ma 02601 3/4/18
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
❑ Check Slope
❑ Surface water
❑ Check cellar
❑ Shallow wells
Estimated depth to high ground water: 10+ ft
feet
Please indicate all methods used to determine the high ground water elevation:
® Obtained from system design plans on record
If checked, date of design plan reviewed: 12/31/09
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:
Test hole data on plan
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17
V
3/6/2018 Assessing As-Built Cards
TOWN OF BARNSTABLE
LOCATION SEWAGE# DD/�- .9�
VILLAGE ASS E SOR'S MAP&PARCEL
'�SJr''�l°�o�
INSTALLER'S AME&PHONE NO. !l//9✓f'741�J .�/1 '� • g=6g5�f�9
SEPTIC TANK CAPACITY T- D
LEACHING FACILITY:(typ � 6 O (size)
NO.OF BEDROOMS_
OWNER h k nl.
PERMIT DATE; COMPLIANCE DATE:
Separation Distance Between e:
Maximum'Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility(If any wells exist on
site or within 200 feet of teaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist within
300 feet of leaching facility) Fed
FURNISHED BY
r'33
A �-y =y9�
http://www.townofbarnstable.us/Assessing/HMdisplay.asp?mappar=289023&seq=2 1/2
Commonwealth of Massachusetts
Title 5 Official Inspection Form
_ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
185 Pitchers Way
Property Address
Juan Marichal
Owner Owner's Name
information is required for every Hyannis Ma 02601 3/4/18
page. Cityrrown State Zip Code Date of Inspection
E. Report Completeness Checklist
❑ Inspection Summary: A, B, C, D, or E checked
❑ Inspection Summary D (System Failure Criteria Applicable to All Systems) completed
❑ System Information—Estimated depth to high groundwater
❑ Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17
r .
pYi�r�
Town of BarnstableBarnstable
doAffhwWcaCftv` Regulatory Services Department
MRNSTABM
9$ 6 9 ��' Public Health Division
200 Main Street, Hyannis MA 02601 2007
Office: 508-862-4644 Thomas F.Geiler,Director
FAX: 508-790-6304 Thomas A.McKean,CHO
CERTIFIED MAIL# 70081830000205009007
10/08/2009
Today Real Estate c/o David Holt
1533 Falmouth Road
Centerville,MA 02632
ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5
The septic system located at 185 Pitcher's Way, Hyannis MA was last inspected.on
October 3, 2009,by Shawn McElroy, a certified septic inspector for the State of
Massachusetts.
The inspection of the septic system showed that the system"Failed"under the guidelines
of 1995 TITLE 5 (310 CMR 15.00) due to the following:
• Backup of see iage into facility or system component due to an overloaded or
clogged SAS.
• Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS.
You are ordered to repair or replace the septic system within Sixty (60) days from the
date you receive this notification.
Failure to repair/replace the septic system within the deadline period will result in future
enforcement action.
PER ORDER OF THE OARD OF HEALTH
as cKean, R.S., CHO .
Agent of the Board of Health 11�10 GIV
O
y
w
CT
I
S
�-' 0� ..1
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
185 Pitchers Way
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for Hyannis MA 02601 10-3-09
every page. City/Town State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way.
A. General Information
1. Inspector:
Shawn Mcelroy
Name of Inspector
Upper Cape Septic Services
Company Name
29 Atwater Dr
Company Address
E. Falmouth MA 02536
City/Town State Zip Code
508-495-0905 S13971
Telephone Number License Number
B. Certification
Ea a
1 certify that I have personally inspected the sewage disposal system at this ad f s and thaw the Z
information reported below is true, accurate and complete as of the time of the+winspection. Be in ectlon
was performed based on my training and experience in the proper function an4maintenance of onrsite
sewage disposal systems. I am a DEP approved system inspector pursuantLWSection�,5.34.0-xbf
Title 5(310 CMR 15.000).The system:
❑ Passes ❑ Conditionally Passes ® Fa j s
❑ Needs Furth r Evaluation by the Local Approving Authority 10 M
10-3-09
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 is a shared system or
has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the
report to the appropriate regional office of the DEP. The original should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving authority.
****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.
LvlI-
D�
t5insp official document•03108 Title 5 Official Inspection Form:Subsurface Sewage Dis al System•Page 1 of 15
r
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
�M 185 Pitchers Way
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for Hyannis MA 02601 10-3-09
every page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E/always complete all of Section D
A) System Passes:
❑ I have not found any information 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:
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.,
Answer yes, no or not determined (Y, N, ND) in the ❑ 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.
ND Explain:
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s) are replaced.
❑ obstruction is removed
t5insp official document-03/08 Title 6 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 15
Commonwealth of Massachusetts
4 Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M 185 Pitchers Way
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for Hyannis MA 02601 10-3-09
every page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
B) System Conditionally Passes (cont.):
❑ distribution box is leveled or replaced
ND Explain:
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
❑ broken pipe(s) are replaced
❑ obstruction is removed
ND Explain:
C) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health,safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or:privy is within 50 feet of a bordering vegetated wetland or a salt marsh
2. System will fail unless the Board of Health (and Public`Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption.system (SAS) and:the SAS is within
100 feet,of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 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.
t5insp official document•03/oa Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 15
f
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
�M
185 Pitchers Way
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for Hyannis MA 02601 10-3-09
every page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
C) Further Evaluation is Required by the Board of Health (cont.):
❑ 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 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.
3. Other:
D) System Failure Criteria Applicable to All Systems:
You must indicate"Yes"or"No"to each of the following for all inspections:
Yes No
® ❑ Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
® ❑ Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ ® Liquid depth in cesspool is less than 6"below invert or available volume is less
than '/ 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.
t5insp official document•03/08 - Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
185 Pitchers Way
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for Hyannis MA 02601 10-3-09
every page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
D) System Failure Criteria Applicable to All Systems (cont.):
Yes No
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well.
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory,for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered.A copy of the analysis
and chain of custody must be attached to this form.]
❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd-
10,000gpd.
® ❑ The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CM 15.303,therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the
questions in Section D.
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
If you have answered "yes"to any question in Section E the system is considered a significant`threat,
or answered "yes"in Section D above the large system has failed. The owner or operator of any large
system considered a significant threat under Section E or failed under Section D shall upgrade the
system in accordance with 310 CMR 15.304. The system owner should contact the appropriate
regional office of the Department.
t5insp official document•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15
r—
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
185 Pitchers Way
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is.
required for Hyannis MA 02601 10-3-09
every page. City/Town State Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate "yes" or"no" as to each of the following:
Yes No
❑ ® Pumping information was provided by the owner, occupant, or Board of Health
❑ ®- Were any of the system components pumped out in the previous two weeks?.
❑ ® Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
❑ ® Were as built plans of the system obtained and examined? (If they were not
available note as N/A)
❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
® ❑ Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
® ❑ Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS) on the site has
been determined based on:
❑ ® Existing information. For example, a plan at the Board of Health.
® ❑ Determined in the field(if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
t5insp official document-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 15
L
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
,M 185 Pitchers Way
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for Hyannis MA 02601 10-3-09
every page. City/Town State Zip Code Date of Inspection
D. System Information
Residential Flow Conditions:
Number of bedrooms (design): 3 Number of bedrooms (actual): 3
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x #of bedrooms): 330
Number of current residents: 0
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system? (if yes separate inspection required) ❑ Yes ® No
i
Laundry system inspected? ❑ Yes ® No
Seasonal use? ❑ Yes ® No
Water meter readings, if available (last 2 years usage (gpd)):
Sump pump? ❑ Yes ® No
Last date of occupancy: 6-09
Date
Commercial/industrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CM 15.203): Gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
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):
t5insp official document-03/08 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 7 of 15
Commonwealth of Massachusetts y -
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M 185 Pitchers Way
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for Hyannis MA 02601 10-3-09
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
General Information
Pumping Records:
Source of information: N/A
Was system pumped as part of the inspection? ❑ Yes ® No
If yes,volume pumped: gallons
How was quantity pumped determined?
Reason for pumping:
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)
❑ 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:
1980's
Were sewage odors detected when arriving at the site? ❑ Yes ® No
t5insp official document-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 15
V
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
wM 185 Pitchers Way
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for Hyannis MA 02601 10-3-09
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Building Sewer(locate on site plan):
Depth below grade: 24
feet
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.):
Good condition.
Septic Tank(locate on site plan):
Depth below grade: 18"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: 1000gal
Sludge depth: 12'
Distance from top of sludge to bottom of outlet tee or baffle
20" -
3"
Scum thickness
Distance..from top,of scum to top of outlet tee or baffle 47
Distance from bottom of scum to bottom of outlet tee or baffle 14"
How were dimensions determined? Tape
t5insp official document•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15
Commonwealth of Massachusetts
u W Title 5 Official Inspection - Form
a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
185 Pitchers Way
�M
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for Hyannis MA 02601 10-3-09
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tank is in good condition with baffles installed and no sign of leakage.
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.):
Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan):
Depth below grade:
Material of construction:
❑ concrete ❑ metal El fiberglass ❑ polyethylene ❑ other(explain):
t5insp official document-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
185 Pitchers Way
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for y H annis MA 02601 10-3-09
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Tight or Holding Tank (cont.)
Dimensions:
Capacity:
gallons
Design Flow:
gallons per day
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
Distribution Box(if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert N/A
Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any
evidence of leakage into or out of box, etc.):
` Pump Chamber(locate on site plan):
Pumps in working order. r - „ ❑JYes ❑ No
Alarms in working order: ❑ Yes ❑ No
t5insp official document•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 15
r
Commonwealth of Massachusetts
Title 5 Official Inspection Form
o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
185 Pitchers Way
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) a
Owner Owner's Name
information is
required for Hyannis MA 02601 10-3-09
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
Type:
® leaching pits number:
1
❑ leaching chambers number:
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation,etc.):
Leach pit has signs of hydrolic failure with stain lines above inlet invert.
t5insp official document•03/08 Title 5 Official inspection Form:Subsurface Sewage Disposal System•Page 12 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M 185 Pitchers Way
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for Hyannis MA 02601 10-3-09
every page. City/Town State Zip Code Date of•Inspection
D. System Information (cost.)
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
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
Privy(locate on site plan):
Materials of construction:
Dimensions
Depth of solids
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5insp official document•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 15
Commonwealth of Massachusetts t
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
�M 185 Pitchers Way
Property Address
Bank Owned (Contact David Holt @Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is
required for Hyannis MA 02601 10-3-09
every page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties
to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet.
Locate where public water supply enters the building.
n 5tLr� <
� k I
O
� D
t5insp official document•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
185 Pitchers Way
Property Address
Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)
Owner Owner's Name
information is required for Hyannis MA 02601 10-3-09
every page. City/Town State Zip Code Date of Inspection
D. System Information cont.
Site Exam:
❑ Check Slope
❑ Surface water
❑ Check cellar
❑ Shallow wells
Estimated depth to high ground water: 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:
USGS maps show groundwater at greater than 12'.
t5insp official document-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15
Town of Barnstable
WE
�41 Regulatory Services
Am Thomas F. Geiler,Director
KAMPublic Health Division
Thomas McKean, Director
200 Main Street,Hyannis,MA 02601
Office: 503-8624644 Fax: 503-790-6304
Installer & Designer Certification Form
I
i
Date: �� Sewage Permit# Assessor's Map\Parce10��
Designer: �l>°/
g installer:
Address: Address:
On �?26 was issued a permit to install a
(date) (installer)
\
septic system at � �1� piS �p `ip
based on a design drawn by
i I 0,n (address)
dated
(designer)
JL I certify- that the septic s ystem referenced above was installed s ailed substanttally accord ma- to
the design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank.
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.
DER. E cy
(Installer's ignature " No: 114
S0ITA1��a�
(Designer's Signature) (Affix Designer's Stamp Here; '
PLEASE RETURN TO BA ASTABLE 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: Heal th/Septic/Designer Certification Form 3-26.4)edoc
TOWN OF BARNSTABLE
LOCATION s SEWAGE# D�,`
VIi,LAGE ASSE SOR'S MAP&PARCEL.
INSTALLER'S AME&PHONE NO. � j� �/Z�R '30
SEPTIC TANK CAPACITY
LEACHING FACILITY:(typerlz�la >D,U. S' (size)
NO.OF BEDROOMS
OWNER /k n;
PERMIT DATE;/ COMPLIANCE DATE: 12,431109
Separation Distance Between e:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility(If any wells exist on `
site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist within
300 feet of leaching facility) Feet
FURNISHED BY
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No. 2®O Lf�3 Fee /00
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes
Rlpfltation for I8 8aY *pstrm Construction permit
Application for a Permit to Construct( ) Repair ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot C Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel �'� '�` �- F
Installer's N ddress and Tel ! c Designer's Name,Address,and Tel No
Type of Building:
Dwelling No.of Bedrooms Lot Size d sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd Design flow provided gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Z /fJO Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) /,.' 0Y-- 5�
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of He th.
Signed Date/
Application Approved by c Date
Application Disapproved by Date
for the following reasons
Permit No. 2 D 0 — Zl2 3 Date Issued %2 20 8
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No. 2 00 L�Z3 Fee �Od -r--
THE'COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC—HEALTH—*DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes
9ppfication for Zisposal 6pstrm Construction 1rrmit
Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot N . C Owner's Name,Address,and Tel.No. ��f�
Assessor's Map/Parcel' -
Installer's N e Address and Tel oCVr/1/ laoyl Designer's Name Address and Tel.No.:✓fRQF 62
/U(
/
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) ��j G gpd Design flow provided �/ � gpd
Plan Date Number of sheets Revision Date
Title TT
Size of Septic Tank /:�17' /�U U Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Cbde-and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
d Signe 1 Dat � 9
e
t Application Approved by . Date2,I ./d!
Application Disapproved by Date'
for the following reasons
Permit No. 2 0 0 _ G�Z Date Issued / /Z 1120 o:�
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-si ewage.Disposal system Constructed( ) Repaired( Upgraded( )
Abandoned( )by f//AW
at �✓� 67_1 has been constructed in accordance
with the provisions of T)W6*dM"spo9l System Construction Permit NoZ005- X/29 dated /2 1291Z 00 9
Installer 2 � 0//VC 'Z Designer / 11 IF y if . '
#bedrooms 3 Approved design flow J 3 o gpd
The issuance of this permit shall not be construed as a guarantee that the Sys w 1 c!t\!
signed.
Date Inspect r
-- - -
No. 2 G D cl — ,q 2 3 Fee A)p
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS
Misposal 6pstrm Construction 3prrmit
Permission is hereby granted to Construct( -�)-� Repair(� Upgrade( ) Abandon( )
System located at
�l/�
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 completed within three years of the date of this permit.
Date / Z�Z 5�2DD�-1 Approved by / ,/2, S
i
t _
Town of B�mstable P#--�
Department of Regulatory Services
Public Health Division Date z GMOM
`7
s$ 200 Main Street,Hyannis MA 02601
ffD lA1't
Z ?Ti i u /1 Fee Pd. _-F-_D O —
Date Scheduled i __ a
i
Soil Suitability Assessment for Sewage Disposal
I �h Y C i�Performed By: III/l°lam Witnessed By:
i
p �LOCATION & GENERAL INFORMATION
Location Address'.i b5 CTG��S 1/1/ vX GSOU
�Y O"t'ner's Name � �Tj Y3 MT�
Address DR,-L-Ars l TAG 7SZ6 S
Assessor's Map/P4rcel: �pq /OZ3 Engineer's Name1�a rre,1 M�,y�.r
NEW CONSiliU�'TION G O 1( REPAIR Telephone# 52 2 Z9 ZZ
Land Use ?�' 1 GI 6 L z' I Slopes(�'o) i Surface Stones 1
7 Z.vv ft Drinking Water Well 7L�ft
Distances from: ripen Water Body > ft Possible Wet Area —
ft
Drainage Way I ft Properly Line ft Other
i
i
'i
SIKETCH:(street
Fur
I-F
n,
t.
i � o
----------I ----- '-----
i
�o�C,(Cd o veRS ll I Depth to Bedrock
Parent material(geglOgic) A) �
/� �} I Weeping from Pit Face
Depth to Groundwatdr: Standing Water in Hole:'t'• i
Estimated Seasonalifligh Groundwater
DtTERM NATION FOR SEASONAL HIGH WATER TALE
Method Used: Depth to soil mottles: In.Depth obi erved standing in obs_hole: i in. Groundwater Adjustment
Depth toiweeping from side of obs.hole: 77�, Adj.factor Adj.Crouttdwaterlevel,,.e
Index Well# Reading Date Index Well level �.....
j
PERCOLATION TEST Date I--
Observation I Tinte6 't9" N LA
-•---
Hole# !
,�•/t t� Time at G"
Depth of Pere '—
Time(9"-6")
Start Pre-soak Time.@ —
End Pre-soak
,i
Rate MinJlnch .
X Site Failed•, Additional Testing Needed(YIN)Site Suitability Assessment: Site Passed
Original:.Public I c'lth Division
Observation Hole Data To B e Completed on Back---
***If ercola ibn test is to be conducted within 100' of wetland,ye must first notify the
.,__. P tir.. rAiicrrvation Division at least one(1)week prior to b g g
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
.Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
onsistenc
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency,%Gravel
2 ti
4?"- l32" '1 2 741
DEEP OASERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistenc %Gravel
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency. gravel)
t
Flood Insurance Rate Map:
Above 500 year flood boundary No_ Yes '\__
Within 500 year boundary No X Yes
Within 100 year flood boundary No X Yes
Depth of Naturally Occurrine Pervious Material "
Does at least four feet of naturally occurring pervious material exist_in all areas observed throughout the
area proposed for the soil absorption system? —, e' —_
If not,what is the depth of naturally occurring pe of ious material?
Certification
I certify that on 10 99 (date)I have passed the soil evaluator examination approved by the
Department of Environ ental Protection and that the above analysis was performed by me consistent with
the require ni g,expertise and experience described in 3:10 CMR 15.017.
.4
�— �gc
Signature � Date
Q:WPTICVERCFORM.DOC
Y 7o 7
-,V73-C'A T 10 N S E W A G E PERMIT_ NO.
VILLAGE
INSTA L L E 'S NAME & ADDRESS
JOH,N A. AALTO BACKHOE SERVICE
IbU Walnut Street
_West Barnstable. Mass. 02668
a U 1 L D E R OR OWNER
DA., TE PER T ISSUED
DAT E CO'MPLIANCE ISSUED 11,:7 r
NA
I
i
No.....d O_.2_0--2 Fxs .............
THE cOMMOiC'w AL1 H OF MASSACQUSETTS
BOAR® OF HEALTH
CS.. t�.0................OF...... ?OA.a.Pe V... ........................................
Appliratilau for Biipnsal Mork.6 Tomitrurtiaau Prrutit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
•-•-- ........ ... ... ---------••-•----------------.------•-.-------
7 Location-Address or Lot No.
........ ..........l`�.!3: j............................... -----•-•----.-----------......---•--.--..--.._....__
Owner .-- Address
w ► —:s�;� >� h
.................. . - ...... �1 .
Installer Address
PQ
< Type of Buildi� Size Lot............................Sq. feet
�U, Dwelling—No. of Bedrooms......... .............. _Expansion Attic ( ) Garbage Grinder ( )
Other—T e of Building No. of persons-------------_______________ Showers — Cafeteria
Other fixtures ----.._..---•------------------- .
W Design Flow............ ____________________gallons per person per day. Total daily flow:.........-3.a......................gallons.
WSeptic Tank—Liquid capacity-0.00_gallons Length................ Width................ Diameter---------------- Depth................
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No-------1------------- Diameter.......A.0 B_..... Depth below inlet.....(_pb........... Total leaching area..s�k:!Q....sq. it.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by------------------------•----......---------------------------•----------- Date........................................
aTest Pit No. 1................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........................
P •---•---••----=-------------------------------------•--•---•------------._..........------....--•-•----•----•-----------•----------•-----•---••----••--------
0 Description of Soil.........................:.........................................................................=...................................................................
x
V
------------------- ----------------------- ---------------------------------------------------------------------------------------------------------•-•--------------------.._.................
0 Nature of Repairs or Alterations—Answer when applicable...._...........................................................................................
............................................-...........................................................................................................................................................
Agreement:
The undersigned agrees to install the aforedescribed Individual.Sewage Disposal System in accordance with
the provisions of IT1 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has b issued by the board of health.
f
Si ed-• ............ .......--- ................................. .........
/ / _.......
Date
Application Approved By r
X��O/- Date
Application Disapproved for the following reasons------------------------=------------------------------------------------------•---------------•-----....._:._
...............................................•--•---•-------•--•---•-•.....-••--------.......----•--_..._
Date
PermitNo......................................................... Issued.......................................................
Date
0`�
• '.
r
I
f
' �
..
4-
e
,��
THE COMMONWEALTH OF MASSACWUSETTS
BOARD OF HEALTH
Appliration for Uiipar i al Workii Tomuurtinu Prrutit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
ss ......... .... .•---•--- .---------------------------------------r'Lo-'No...:--------------------------------------
Location-Address or Lot No.
.......... ��-- t _... _ r ..... ._.... .... .................... -...---......
Owner { Address
a •............... � " " . " _._. _.._.....I _.....-•--•---•-----...........................................
Installer Address
dType of Buildin Size Lot............................Sq. feet
U Dwelling?No. of Bedrooms.._.....................................Expansion Attic ( ) Garbage Grinder
Other "Type of Building -_-- No. of persons............................ Showers
ag`-------------•-------- P ( ) — Cafeteria ( )
Fa Other fixtures -----•------------•....... ----• .
Design Flow..._. :. _:_._ _gallons per person per day. Total daily flow____.._ .A 43 gal
W lops.
Septic Tank—Liquid capacityiQ_gallons Length................ Width................ Diameter__:___----------------
Depth................
xDisposal Trench—No..................... Width.._.................... Total Length.........f..._..... Total leaching area--------------------sq. ft.
Seepage Pit No.._....(..............Diameter .10# Depth below inlet..._(ae............ Total leaching area.4 V.....sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by-......................................................................... Date.......................................
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................
Test Pit No. 2................minutes p'er inch Depth of Test Pit.................... Depth to ground water........................
•--•------------------------------------•--•----.........--•----•---•---..........------,------...............................................................
x Description of Soil..............
......................................--...............................................-..................................................................
V ---------------------------•------------...------------•--•--......----•--•--...--•-•----.....----------•-•-----•-------------------------••------------......-------•-•-•----------•.....--------------
W --•-------------•-...._...------------•----..-•-----•--------------------------•- ......................................:...............................................................................
UNature of Repairs or Alterations—Answer when applicable.......................................:....................................................:..
Agreement:
The tindersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TTTIZ, y g g p y
5 of the State Sanitary Code—The undersigned further agrees not to lace the system in
operation until a Certificate of Compliance has issued by the board of health `
Sined .......•......... ...................................................
Date
Application Approved By........ .......---'__:_ �'1/� -� �
Date
Application Disapproved for the following reasons:..............................................................................................................
....................•-•------•---............---.....----•-•---------------------•---------•---.........-•-----•....----•----------------...........................................-..................
Date .
PermitNo......................................................... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
+�':... ..............OF..... ::...:...........:....................................
Tntif iratr'oaf Toutpliaattrr
T IS IS TO CERTIF , That the Individual ew g Disposal System constructed ( or Repaired ( )
bye► '.. ...`�..� �.i... ----...-•-----••---.....---•---•-------
Installer c,,
at .-- """ } - ----- - ---�---�-G"1 �tr ---- '4;��-- �t:•� '�!tiz`tl t
has been installed in accordance with the provisions of TITLE j of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No...O�, '�?y>._....... dated.._.___:.....................•.._..__._..____._
THE ISSUANC OF THIS CERTIFICATE SHALL NOT BE CONS D AS A GUARANTEE THAT THE
SYSTEM WIL FU CTION SATISFACTORY.
a
DATE..... ..1�� f................ Inspector --•• .
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH, 3
'''.e-l.`.......... .OF..... ,,� ...................................
No�..................... ! FEE
Disposal Workii Tuttutr ion trout
Permission Thereby granted.......... _ _...... t...... ._ .
to Construct ( ) or Repairs( ) an Individual Sewage Disposal System
at No.. " j 1Ch1G1�5... �aLAjry . .. �.��
treet
as shown on the application for Disposal Works Construction Permit No..................... Dated ----------------------------------.......
.
ti Board of'�Health
DATE............. -- ...• .....------•-•-•----Q ko.—A � �I
FORM 1255 HOBBS,.& WARREN.. INC., PUBLISHERS -
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ORSE t St��. S, R. to
o p No.10951
\ Fss�Utr'Al FCC ;
^_1 c-LE TII ctiAPTE�7� - C
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LEGEND Of 'CERTIFIED PLOT PLAN
EXISTING SPOT ELEVATION ®x0
EXISTING CONTOUR --_ 0 _ --. o T S r iTcf�� ns 1w
FINISHED SPOT ELEVATION
FINISHED CONTOUR Q °
;. I N
APPROVED s BOARD OF HEA. TA
4No sua �� e
DATE AGENT SCALE, / 30 DATES
VOREDGE ENGNlIEER/AIG CCd lIV Cl IENT .� I CERTIFY THAT THE PROPOSED
EGISTERE. R8ISTLRQ r, �O� 9� BUILDING SHOWN ON THIS PLAN
CIVIL -LA.ND' X CONFORMS TO THE ONIN LAWS 1
QRrBY� }S8. �53 ENGIN KM . OF BARNSTA E
712 MAIN` STREET
` H YA N.N.I St.:M A;S S. g.H[ET.,. OFF'`Z DATE 00. LAND SURVEYOR
IV07e /F E/TNER THESEPTIC TANK OR
?O FT. M/IV. 1-Z4CH/NG PIT ARE' MORE THAN /2"BE4ow
/D P7. M/N. GRAPE, ,4 24`,p1A W ET.ER CONCRETl� COPZV
SNALL &,F BROUGHT TO 4RAOF•�i4N .EXTRA
CpNCRETE .0"PVC p/PE N477AVy CAST IRON CO�/�R S'flALL aA- USE.O
M/N. P/TCN /f/Iy pR/V,-WA Y
�. �L�l/� /QzS GOYERS /B"PFiQFT
;• 2 JL MIN. CDNCRL�TE
A►is G AOE Co VER CLEAN SANG
LQ///O LEVEL
z*LAYER
46
.. � I . ,s.' •� Q� /�8' JAB"
CAST
�
D/ST, o e 4' WASHED S7?9NE
PAFM r'T. SEPTIC TANK • • • • • . • • • • • • e .
f� • •a 3/ ' ~oPr�a �-� '• P / • �EFiECT/VC • ► WASXED/STONE .
.�� - • o • • DEPTH • • • • • vm
::.¢ .•o I . : • • • • • p D • PiQEC,AST SEEPAGE
1/`,eRT e'LEI�AT/OJVS �Fri Zf= 470 . ae�.` • • • •. e • • • • e•�o P/T OR E VIV. 5
-/8 x. r o = �8. . . . O s EL. 92.�—
/NVZRT AT El!/L.D/NG 9,S FT c.a psi c17 y S4 8 Glo
/a FT. (SSE 77WVL.AT)aN,
ET_ .SEPT*C T.4NI�f
99 3
Ot/7 ET S'EPg/G TANK iT
/N.GE7"D/STRIB�/T/ON BOX '9 9-o FT SECT/O/V 4F
GROVNp NA7*,Eq TABLE
OtlT1ETD/STIR/Bf?/ON Aox 98 9 F7..
9a.� %SZAVAG� 01S.4006A L SY.5 r"W,"
/w/ r LEpclr/nr� PST �_FT.. P T TA&ZlLAT/DN
LZACHZ V6'. / D/MENs/oIV �t 3::` PT.:.
DES/61V CIq/TER/fit JCA L
PT m 'Af'-
NMBER OR SEpR00MS 3
D/NIEN�i/®n/ Gam_
U
C,A,qaA IGIE 015,00M A.UNIT d SOIL LOG SO/L TEST
TOT!4L E,�T// 4TED I�Low 336 G�c./�ta�► SO/L TEST 0/ SO/t TEST 2
NVA48 qF L,EACNIIVY. RITS f . LEY. /Oo,2 ArLEK OATS'OP'`SO/L: TEST. I/ �_� �g
S/pE AGH/A/G PER P/T ._L$�_3Ya RES�/LTS PV/TNESSED BY✓/7 / �I 1COXr-.
9oT7-oM LE,4CN/NG PER P/r- Lv yf PER COL AT/ON RATE Iy/NVINCH
TOTAd LEACHING AREA Vp SQ. FT. - . S'w B e i L PZRCOLAT%ON RATE 02 7-/-P"f"v 11//4.1/NCH
RESERVE LF4CN,p V6 4REA 26Co SQ. FT. .
tH OF�Ass9 �HOF v 1 f�'/�1 G D T S P/ 7C,H c-2.s
E r.f D
ROBEMORSE
.p No..ns74 C A ��� EL DREDGE o
ENG/NEER/A/G CO,INC.
FG�STE��'O� o���lsTEa��a Fe y. 88.2 7f� MAIN .5 r HYANN/9, MASS.
�ND S�loNA\-
SUR�� �
L
® No GROVND kV.4TL'R A5VCOUNTfRER CLYAFAI7' PA7W /2-/2 `8/
Q GROGINZ> LVATER Ar. ELEV JOB NO. l l SHEET Z OP' z
TOWN OF BARNSTABLE
L CATION / �J �2e-S [rug SEWAGE # '"
VILLAGE_4 4 `/ ASSESSOR'S MAP & LOT,�``�e :P.-_Z
INSTALLER'S NAME & PHONE NO.��
SEPTIC TANK CAPACITY eelo` S - :�
LEACHING FACILITY:(type) �� �`� � ✓_(size) l
NO. OF BEDROOMS PRIVATE WEL.L< ��ATE
BUILDER OR OWNER,-,,, Inc
DATE PERMIT ISSUED: �? /"
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No �
� � � ���
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-� � � c
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�� ��� /�
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III
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Existing Leach Pits
-� 28 Note 10) LEGEND
/ 29 /� PROPOSED CONTOUR W. MAIN ST.
PROPOSED SPOT GRADE.
30 —— g$ —— EXISTING CONTOUR
+ 96.52 EXISTING SPOT GRADE STERLING RD.
.32 W— EXISTING WATER SERVICE SITE
TEST PIT
ROST LN.
j TA-2 i -Exis-tin ,000
i g .1 g
/ ep —Tn.�` / /`
i I Q 1''�� _ i
P
i
r / V •
E0 / DR/ t� , r
/TH11 l l war it W i LOCUS MAP N.T.S.
GENERAL NOTES:
�C?( // / • -.L l ` 1• W ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL
�l I 20 ft Z WATER HEALTHBOARD OF ONE — ^ �� 2. ALL AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS
OZ
I I I Z / / 'I OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE
t I J F CO / / ! / F- LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW.
O - 310 CMR 15.405 (1) (B):
\ LL/ n / / l� 1 w 1) A 1.61 FT. VARIANCE FROM 310CMR15.221(7) TO ALLOW LEACHING TO BE
/ I I W ; 4.61 FT BELOW GRADE VS REQ'D 3 FT. (H20/VENT PROVIDED)
i \ LLJ l l l [ 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR
0 TO/l I a ` ESINSPGN E TI NEER D APPROVAL BY THE BOARD OF HEALTH AND THE
I \ ' ✓Ll I 14 tL ti 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING
0 FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN
\ I / I I !Q I ENGINEER BEFORE CONSTRUCTION CONTINUES.
I I LN• 1 ' I I f W 5. ALL ELEVATIONS BASED ON ASSUMED DATUM.
r 1 ( I 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF
° i w• \ \ L O T 5 I / W THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF
\ \ I ' / � Of MAS`S9 7. WAFTER SUPPLY TH FOR RPROVIDED BY TOWN WATER SERVICE.OPER INSPECTIONS DURING UCTION.
A R E1A = 9 3 9 O s f i-H`- I --� ��, �y
DA E ✓+ 8. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED
i - _ _ TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR.
28 / - ----_ \ \ 32 !! {.�� ��,` �„` - 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY
I �9.-6 f - �- - \ i No' 1 0 THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING
j t 29 -1- -i 3� 28 t� CONSTRUCTION. UTILITIES SHOWN ARE APPROXIMATE.
/PF1(,/ E�c� 10. EXISTING LEACH PITS TO BE PUMPED, CRUSHED AND REMOVED PER TITLE V.
//I a \ 30 P 4NITAR\a� FILL WITH CLEAN MEDIUM SAND.
-----_-- --- -----------
11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION
- zQ��--- � 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY
r AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY
OST
� 13. NO PRIVATE WELLS WITHIN 100 FT. OF PROPOSED LEACHING
IN
14. ALL PIPING TO BE 4" SCH 40 0 1/8"/FT (UNLESS SPEC. OTHERWISE)
` 15. THE DESIGN OF THIS SYSTEM DOES NOT ALLOW
R FOR THE USE OF A GARBAGE GRINDER
16. NO WETLANDS WITHIN 100 FT. OF PROPOSED LEACHING
17. PROPERTY IS IN ZONE 11 OR NITROGEN SENSITIVE AREA.
BENCH MARK r 17. INSTALLER TO FIELD VERIFY H2O CERTIFICATION PRIOR TO INSTALLATION.
PAINT SPOT ON
CONCRETE STEP
ELEVATION = 29. 60 I
BARNSTABLE CIS DATUM PROPOSED SEPTIC SYSTEM UPGRADE PLAN
185 PITCHERS WAY, HYANNIS, MA
MAP:289 Prepared for: Mike Dedecko
SURVEY REFERENCE: LOT., 023 Engineering by: Surveying by: SCALE DRAWN
;:•. DEED BOOK., .17852 DARRENM.MEYER,R.S. B'co-Tech Environmental 1„=201 DMM
�.y. PLAN OF LAND BY ED KELLOGG, 'PE DEED PAGE., 281 PO BOX981 (508) 364-0894
E4STSANDW/CH,MA02537 DATE: CHECKED SHEET NO,
DATED:- FEBRUARY 11, 1964 M 50"62--2922 12/28/09 DMM 1 Of 2
I
4
NOTE:ITO PREVENT BREAKOUT, THE PROPOSED
NOTE: MAGNETIC TAPE TO BE PLACED OVER ALL COVERS FINISH GRADE SHALL NOT BE < EL:24.89
FOR A DISTANCE OF 15' AROUND THE
(PERIMETER OF THE S.A.S.
SEPTIC TANK PROPOSED D-BOX PROPOSED S.A.S. I
T.O.F. EL.=30.85 INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & COVER INSTALL A 4" DIAMETER INSPECTION PORT OVER ��� OF MgsS
OUTLET AND SET TO 6" OF FINISH GRADE SET TO 6" OF GRADE ONE CHAMBER (MIN.) AND SET TO 3 OF F.G.
F.G. EL.=29.50f F.G. EL.=29.5f F.G. EL: 29.5f -F.G. EL: 29.5-28.5(MAX.) VENT o DA� I M.
f ' MEYER
Wo
L 10'"t 9" MIN COVER/
0 S-1% MIN.) 36" MAX COVER L m 15' L - 10'(MAX) INSTALL,TWO INSPECTION PORTS (MIN.)
( 0s-1X (MIN.) ® S=196 (MIN.)
4"SCH40 PVC 4"SCH40 PVC 4"SCH40 PVC a
�NITAR�a�
°" t4" e 11.3" TO Z.0
\INV.=27.10 48"LIQUID INVERT
�INV.=26.85
(t LEVELGAS BAFFLE PROD BOX D INV.=25.05 4 ROWS OF 4 UNITS AT 6.25'/UNIT = 25'/ROW
4 SOIL ABSORPTION SYSTEM PROFILE
I INV.=25.25 �=� INV.=24.50
EXISTING 1.000 GALLON SEPTIC TANK
RESTORE VEGETATIVE COVER
EXISTIN(. SEWER OUTLET
BACKFILL WITH CLEAN PERC SAND 75"
TO TOP OF CHAMBERS
NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING
PIPE INVERTS PRIOR TO CONSTRUCTION
2) D-BOX SHALL BE SET LEVEL AND TRUE TO BREAKOUT=TOP ELEV.=24.89
INV. ELEV.= 24.50
GRADE ON A MECHANICALL COMPACTED SIX BOTTOM ELEV.= 23.56
INCH CRUSHED STONE BASE, AS SPECIFIED IN EXISTING SUITABLE
310 CMR 15.221(2) 2.83 MATERIAL
3) REPLACE EXISTING 1,000 GALLON SEPTIC 5' MIN. ABOVE BOTTOM OF ( 76.. _
TANK WITH 1500 GALLON SEPTIC TANK
T.P. EXCAVATION OR G.W. EFFECTIVE WIDTH 4 x 2.83' = 11.32 ��
(6.06 PROVIDED) USE 4 ROWS OF 4-HIGH CAPACITY
IF FAILED, DAMAGED, OR UNDERSIZED. PROFILE
4) INSTALL INLET & OUTLET TEES AS REQUIRED ADJ. GROUNDWATER EL.=17.50 _ ADS BIODIFFUSER UNITS-NO STONE
SEPTIC SYSTEM PROFILE TYPICAL SECTION 16°
N.T.S. s.ra 11+2
DESIGN CRITERIA SOIL LOG P#: 12804
NUMBER OF BEDROOMS: 3 BEDROOMS DATE: DECEMBER 23, 2009
34" �I
SOIL TEXTURAL CLASS: CLASS 1 SOIL EVALUATOR: ' DARREN M. MEYER, R.S., CSE. #1614 SECTION END CAP
WITNESS: DAVE STANTON, BARNS. BOH
DESIGN PERCOLATION RATE: <2 MIN/IN TP-1 16"" HIGH CAPACITY (H-20) BIODIFFUSER UNIT
Elev. Depth Elev. TP-2 Depth DAILY FLOW: 330 G.P.D. � �_
DESIGN FLOW: 330 G.P.D. 28.50 0"1 28.50 0"
FILL FILL MODEL 16 HICAP
GARBAGE GRINDER: NO (NOT DESIGNED FOR GARBAGE GRINDER) 26.83 20" 26.83 20"
LENGTH 76" NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT
PROPOSED SEPTIC TANK: USE EXISTING 1,000 GALLON CAPACITY A LOAMY SAND A LOAMY SAND EFFECTIVE LENGTH 75" TO CHANGE WITHOUT NOTICE, PRODUCT DETAIL MAY
LEACHING AREA REQUIRED: 330 = 445.94 S.F. 10YR 3/2 10YR 3/2 DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE.
( ) 26.67 22" 26.58 23" SIDE WALL HEIGHT 11.2"
.74 B I B
OVERALL HEIGHT 16"
LOAMY SAND LOAMY SAND
DISTRIBUTION BOX: 5 OUTLETS (MINIMUM) 10YR SA 10YR 5/8 OVERALL WIDTH 34" 4640 TRUEMAN BLVD
PRIMARY S.A.S. 13.6 CF a HILLIARD, OHIO 43026
USE 4 ROWS OF 4 - 16" ADS 160OBD BIODIFFUSER H-20 UNITS-NO STONE 24.50 C 48" 24.58 C 47" CAPACITY (101.7 GAL) ADVANCED DRAINAGE SYSTEMS, INC.
BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.70 SF/LF OF BIODUFUSER) MED. SAND MEU. SAND
(BIODIFFUSERS) 16 UNITS x 6.25 LF x 4.70 SF/LF = 470 SF 2.5Y7/4 PERC 023.0 2.5Y7/4 PROPOSED SEPTIC SYSTEM SITE PLAN
DESIGN FLOW PROVIDED: 0.74(470 GPD/SF) = 347.80 GPD > 330 GPD req'd I 185 PITCHERS WAY, HYANNIS, MA
i 17.50 132!' 17.50 132"
c PERC RATE <2 MIN/IN. ("C" HORIZON) Prepared for: Mike Dedecko
# NO GROUNDWATER OBSERVED Engineering by: Surveying by: SCALE DRAWN JOB. NO.
DARRENM.MEYER,R.S. 1f'co-71e0h B'aviroamental NTS D.M.M.
• I, Darren M. Meyer, R.S., CSE, hereby certify that I am currently approved by MADEP pursuant to 310 CMR 15.017
P PO BOX8B1 (508) 364-0894
to conduct soil evaluations and that the above analysis has been performed by me consistent with the DATE CHECKED SHEET NO.
requirements of 310 CMR 15.017. 1 further certify that I have passed the Soil Eval. Exam in October, 1999. �STSANDW/CH,MA02537 28 09
50e-3e2-2922 12/ / D.M.M. 2 of 2
f
k
28 Existing Leach Pits
(Note 10) i LEGEND
/ 29 t PROPOSED CONTOUR W. MAIN ST.
iJ %Sh ED --/---- - ® PROPOSED SPOT GRADE
/J .j �` cb•% ,ga 32 30 I —— 98 —— EXISTING CONTOUR
I y —1 + 96.52 EXISTING SPOT GRADE STERLING RD.
32 ° W— EXISTING WATER SERVICE SITE
19 TEST PIT n
tF�-2 ��� FROST LN.
T �'
I --Exulting 1,000g I
;� . LOCUS MAP N.T.S.
i THJ 1 / J WA Y / O
GENERAL NOTES:
C)' ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL
C)/ BOARD OF HEA I I AND THE DESIGN ENGINEER.
20 rt Q / WATER `Ind ' — 1 �\•/' 2. ALL ORK ANDLTH MATERIALS SHALL CONFORM TO THE REQUIREMENTS
OF THE STATE ENVIRONMENTAL CODE, TITLE V. AND ANY APPLICABLE
CO l / - LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW:
—J / / i J Z - 310 CMR 15.405 (1) (B):
I \ JJI ICJ (i / / l 1 r 1) A 1.61 FT. VARIANCE FROM 310CMR15.221(7) TO ALLOW LEACHING TO BE
l I \ X 0 W 4.61 FT BELOW GRADE VS REQ'D 3 FT. (H20/VENT PROVIDED)
\ W JJ l l ! J �. 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR
\ � l l Mi J Q TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE
LLJ�O J / / /� J a DESIGN ENGINEER.
LL- 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING
0 ( FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN
I I \ 1 I ( (Q ENGINEER BEFORE CONSTRUCTION CONTINUES.
I I 1 > ' I / I JLLJ 5. ALL ELEVATIONS BASED ON ASSUMED DATUM.
LOT
T i J 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF
THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF
LLJ OF ,yq HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION.
A R FAA = 9390 s f j H� / �Q ss'�� 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE.
Of
L - L-__ j IJ \�\ \\ 1! l I o DA yG 8. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED
_ �` ( l' TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR.
28 J--- -- \ J "' "' 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY
f_- --- ------- \ �,i' 32 / " NO. 1140 " THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING
t FILL WITH�9 c� CLEAN MEDIUM CONSTRUCTION. UTILITIES SHOWN ARE APPROXIMATE.
� a I 30 P
ii �/$TEK�� 10 CL M SAND PITS TO BE PUMPED, CRUSHED AND REMOVED PER TITLE V.
AN1 TAR\�`
---_-_--- �---- 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION
---------------- _ r 2S 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY
AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY
R OST
13. NO PRIVATE TO B WITHIN OF PROPOSED LEACHING
L A �� � 14. ALL PIPING TO BE 4" SCH 40 ® 1/8-/FT (UNLESS SPEC. OTHERWISE)
15. THE DESIGN OF THIS SYSTEM DOES NOT ALLOW
FOR THE USE OF A GARBAGE GRINDER
16. NO WETLANDS WITHIN 100 FT. OF PROPOSED LEACHING
17. PROPERTY IS IN ZONE 11 OR NITROGEN SENSITIVE AREA.
BENCH MARK 17. INSTALLER TO FIELD VERIFY H2O CERTIFICATION PRIOR TO INSTALLATION.
PAINT SPOT ON
CONCRETE STEP
ELEVATION = 29. 60
BARNSTABLE GIS DATUM ' PROPOSED SEPTIC SYSTEM UPGRADE PLAN
185 PITCHERS WAY, HYANNIS, MA
MAP•289 Prepared for: Mike Dedecko
SURVEY REFERENCE: LOT.* 023 Engineering by: Surveying by: SCALE DRAWN
I DEED BOOK• 17852 DARRENM.MEYER,R.S. Zoo-Teoh Znvi"amemW 1"_20' DMM
PLAN OF LAND BY ED KELLOGG, PE
DEED PAGE., 281 PO BOX 981 (508) 364-0894
EASTSANDWICH,MA02537 DATE: CHECKED SHEET NO.
DATED: FEBRUARY 11, 1964 50&3822922 12/28/09 DMM 1 of 2
NOTE:'TO PREVENT BREAKOUT, THE PROPOSED
NOTE: MAGNETIC TAPE TO BE PLACED OVER ALL COVERS FINISH GRADE SHALL NOT BE < EL:24.89
IFOR A DISTANCE OF 15' AROUND THE
PERIMETER OF THE S.A.S.
SEPTIC TANK PROPOSED D-BOX PROPOSED S.A.S.
T.O.F. EL.=30.85 INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & COVER INSTALL A 4" DIAMETER INSPECTION PORT OVER ��� OF SASS
OUTLET AND SET TO 6 OF FINISH GRADE SET TO 6 OF GRADE ONE CHAMBER (MIN.) AND SET TO 3 OF F.G. 'ell
F.G. EL.=29.50f dG
" F.G. EL.=29.5t F.G. EL: 29.5t F.G. EL: 29.5-28.5(MAX.) VENT D RREN M.
c E ER� -a
o. 1 '40
L 10'"� 9" MIN COVER/ L s 15� L m I0'(MAX) INSTALL TWO INSPECTION PORTS (MIN.)
0 S-1W(MIN.) 36" MAX COVER 0 S�1� (MIN.) 0 S-1X (MIN.) �� E
4"SCH40 PVC 4"SCH40 PVC 4"SCH40 PVC NITAR��`�
" lo" 6 c/
t4" 1 INVERT Za'
71NV--27.10 48" LIQUID
Lr ►�L INV.=26.85
t PROPOSED
1 GAS BAFFLE BOX INV.=25.05 4 ROWS OF 4 UNITS AT 6.25'/UNIT
IL,-. �� INv.=24.50 SOIL ABSORPTION SYSTEM (PROFILE)
INV.=25.25
EXISTING 1,000 GALLON SEPTIC TANK
f RESTORE VEGETATIVE COVER
I EXISTING SEWER OUTLET
BACKFILL WITH CLEAN PERC SAND 75" 1
TO TOP OF CHAMBERS
NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING
:.;. ..
PIPE INVERTS PRIOR TO CONSTRUCTION '
BREAKOUT=TOP ELEV.=24.89 ••,� <•
2) D-BOX SHALL BE SET LEVEL AND TRUE TO INV. ELEV.= 24.50
GRADE ON A MECHANICALL COMPACTED SIX BOTTOM ELEV.= 23.56
INCH CRUSHED STONE BASE, AS SPECIFIED IN EXISTING SUITABLE
310 CMR 15.221(2) 2.83 MATERIAL
3) REPLACE EXISTING 1,000 GALLON SEPTIC 5' MIN. ABOVE BOTTOM OF EFFECTIVE WIDTH = I� 76" `I
T.P. EXCAVATION OR G.W. 4 x 2.83 = 11.32 r
TANK WITH 1500 GALLON SEPTIC TANK (6.06' PROVIDED) USE 4 ROWS OF 4-HIGH CAPACITY
IF FAILED, DAMAGED, OR UNDERSIZED. ADJ. GROUNDWATER EL.=17.50 _ ADS BIODIFFUSER UNITS-NO STONE PROFILE
4) INSTALL INLET & OUTLET TEES AS REQUIRED -
SEPTIC SYSTEM PROFILE TYPICAL SECTION �- 16"
N.T.S. e.rs. 11+2
DESIGN CRITERIA SOIL LOG P#: 12804
R DATE: DECEMBER 23, 2009 f 34" �
NUMBER OF BEDROOMS: 3 BEDROOMS
SOIL TEXTURAL CLASS: CLASS I SOIL EVALUATOR: DARREN M. MEYER, R.S., CSE. #1614 SECTION END CAP
WITNESS: DAVE STANTON, BARNS. BOH
DESIGN PERCOLATION RATE: <2 MIN/IN ���� (HIGH CAPACITY H-20 BIODIFFUSER UNIT
DAILY FLOW: 330 G.P.D. Elev. TP-1 Depth- - -Elev. TP-2 oecn� 16
DESIGN FLOW: 330 G.P.D. 28.50 0"-, 28.50 0"
FILL FILL MODEL 16" HICAP
GARBAGE GRINDER: NO (NOT DESIGNED FOR GARBAGE GRINDER) 26.83 20" 26.83 20" LENGTH 76"
NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT
PROPOSED SEPTIC TANK: USE EXISTING 1,000 GALLON CAPACITY A LOAMY SAND A LOAMY SAND EFFECTIVE LENGTH 75 TO CHANGE WITHOUT NOTICE. PRODUCT DETAIL MAY
LEACHING AREA REQUIRED: (330) = 445.94 S.F. 10YR 3/2 10YR 3/2 DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE.
26.67 22"',, 26.58 23"
LOAMY SIDE WALL HEIGHT 11.2"
74 B SAND LOAMY SAND B OVERALL HEIGHT 16"
DISTRIBUTION BOX: 5 OUTLETS (MINIMUM) 10YR 5/8 10YR 5/8 OVERALL WIDTH 34" 4640 TRUEMAN BL IUD
PRIMARY S.A.S. 13.6 CF HILLIARD, OHIO 43026
USE 4 ROWS OF 4 - 1 C ADS 160OBD BIODIFFUSER H-20 UNITS-NO STONE 24.50 C VA C48" 24.5s 47" CAPACITY (101.7 GAL) ADVANCED DRAINAGE SYSTEMS, INC.
VA
BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.70 SF/LF OF BIODUFUSER) MED. SAND 0PERC 0 23.0 MED• SAND PROPOSED SEPTIC SYSTEM SITE PLAN
(BIODIFFUSERS) 16 UNITS x 6.25 LF x 4.70 SF/LF = 470 SF 2.5Y 7/4 2.5Y 7/4
DESIGN FLOW PROVIDED: 0.74(470 GPD/SF) = 347.80 GPD > 330 GPD req'd 185 PITCHERS WAY, HYANNIS, MA
17.50 132" 17.50 132"
k4 PERC RATE <2 MIN/IN. ("C" HORIZON) Prepared for: Mike Dedecko
NO GROUNDWATER OBSERVED Engineering by: Surveying by: SCALE DRAWN JOB. NO.
DARRENM.MEYER,R.S. Sao-Tech B'nrkonmentel NTS D.M.M.
p • I, Darren M, Meyer, R.S., CSE, hereby certify that I am currently approved by MADEP pursuant to 310 CMR 15.017 PO BOX 881 (508) 364-0894
to conduct soil evaluations and that the above analysis hos been performed by me consistent with the DATE CHECKED SHEET N0.
requirements of 310 CMR 15.017. 1 further certify that i have passed the Soil Evol. Exam in October, 1999. SST CH,MA 02537 1 2 28 O9
508382-2922 2822 / / D.M.M. 2 of 2