Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0595 PITCHER'S WAY - Health
595 itc er s Way, Hyannis A= , o TOWN OF BARNSTABLE IrOCATIGN.c59 rJ 'Pi7bzJh X'S ( C .t a _.SEWAGE # 3-5 VILLAGE liu tl,nn* in ASSESS6 MAP& LOT-a3a INSTALLER'S NAME&PHONE NO. 11-V 1 n A0 8 Yq-tJ SEPTIC TANK CAPACITY 4L4 6- C'qQ-I br15 LEACHING FACELITY: (type) `�1 'I" (size) v NO.OF BEDROOMS \ BUILDER OR OWNER �C3P�-� PERMITDATE: CI LD 1 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 fa:,ility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by Q10b2a- s ,bac1 i 4 V I; O i IA f Ln i No. Fee�o�Z — oZ -4/Ceu°a THE COMMONWEALTH OF MASSACHUSETTS Entered in compute PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftphratlon for Mispoeal ,pstem Construction 3pPrmit Application for a Permit to Construct( ) Repair(V/) Upgrade( ) Abandon( ) ❑Complete System Vindividual Components Location Address or Lot No.59 5 Wy Owner's Name,Address,and Tel.No. j G '��,y' D (44AP0 S 1r GYCz-W()eV Assessor'sMap/Parcel aw 1 3�i G o.)S tL �'�i(htJt�l Installer's Name,AcJdress,and Tel.No., O8�P/7 ' 9977 Designer's Name,Address,and Tel.No. LC.,fQ- cu_ Zk'1�-�''r" QS t S3 -laasKat•Et, T �, 04 Type of Building: Dwelling No.of Bedrooms Lot Size , 31 sq-fl. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided NA— gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) _P\xC2 C 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 a //rr�� Sig ofHe - cg:2 Date !d»a "" — Application Approved by Date L (9 'Z- Application Disapproved by Date for the following reasons Permit No. Date Issued P No. Fee ZotZ — yoZ /cam°° THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2pplication for Disposal *pstem Construction Orrmit Application for a Permit to Construct( ) Repair( Upgrade( ) Abandon( ) ❑Complete System individual Components Location Address or Lot No. 595 WoX Owner's Name,Address,and Tel.No. Assessor's Ma /Parcel �V p � $�i� i�'c �f 00 I4ywJJi Installer's Name,Address,and Tel.No., og.y77. $`$?7 Designer's Name,Address,and Tel.No. r P^ es ►5 3 C-44,u ,oac rr'Iq Type of Building: ? Dwelling No.of Bedrooms NA- Lot Size ' ✓' sit. 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 Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: ttAgreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Sigtj Date Application Approved by .. '. Date -1— Application Disapproved by Date for the following reasons '" £ rt Permit No. Date Issued - - - --------------------- THE COMMONWEALTH OFMASSACHUSETTS BARNSTABLE,MASSACHUSETTS 4 Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired Upgraded( ) Abandoned( )by Cf&L 4J at 0(_1 has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 2 v l -!L�0',,dated r :(41; ?— Installer C0.91LW,�2 CnTQ+( VV Designer #bedrooms NM Approved design fio gpd The issuance of this permit s all not be construed as a guarantee that the system will functi n as designed. Date ��- U � Inspector -�(/ y� P�1� ��' ---- --- ---- ------ - -(- - - ._. No. Z — Z Feel�U THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS Bisposal ,pste Construction 31ermit Permission is hereby granted to Construct( ) Repair( Upgrade( ) Abandon( ) System located at 9 S ��c1���s W r� and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty-o comply with Title 5 and the following local provisions or special conditions. _ . _,__ •,_, i Provided:Construction must be completed within three years of the date of this permit. Date 17 7-Oi7 Approved by �_� t � 0 N ul . I . . _ mtj m Postage $ i 0 Certified"Fee /�� s N e Return Receipt Fee /L P Here (Endorsement Required) "��, Y Restricted Delivery Fee ens. O rl (Endorsement Required) ? ^U o Total Postage&Fees` �.Jyr -a O O r` Barbara Kelly 595 Pitcher's Way Hyannis, MA 02601 Certified Mail Provides: (eslanea)ZOOb eunr'OOse uliO4 Sd la A mailing receipt Is A unique identifier for your mailomee " o A record of delivery kept by the Postal Service for two years Important Reminders: o Certified Mail may ONLY be combined with First-Class Mail®or Priority Mail®. e Certified Mail is not available for any class of intemational mail. - • NO INSURANCE COVERAGE IS PROVIDED with. Certified Mail. For valuables,please consider Insured or Registered Mail. it For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt,ls required. - •For an additional fee, delivery may be restricted to the addressee or addressees authorized agent.Advise the clerk or mark the mailpiece with the endorsement'Restricted-Defivery"., ® If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. `IMPORTANT:Sive this receipt and present it when making an inquiry. Internet access to delivery information is not available on mail addressed to APOs and FPOs. UNITED STATES POSTAL SERVICE First-Class Mail Postage&.Fees Paid LISPS Permit No.G-10 • m dress • Sender: Please print your name, ad , and ZIP+4 in this box Town of Barnstable Public Health Division 200 Main Streety.. Hyannis, MA 02601 SECTIONSENDER: COMPLETE THIS SECTION COMPLETE THIS DELIVERY ■ Complete items 1,2,and 3.Also complete A. Sign ture item 4 if Restricted Delivery is desired. Age ■ Print your name and address on the reverse X [3 Addressee z�—Ag� so that we can return the card to you. B. Received by(Printed Name) C. Date of Delivery ■ Attach this card to the back of the mailpiece, or on the front if space permits. D. Is delivery address different from Item 1? ❑Yes e1. Article Addressed to: If YES,enter delivery address below: ❑No I I Barbara Kelly _ f 595 Pitcher's Way i I Hyannis, MA 02601 3. Service Type I y ❑Certified Mail ❑Express Mail I I 0 Registered ❑Return Receipt for Merchandise I ❑Insured Mall 0 C.O.D. i 4. Restricted Delivery?(Extra Fee) ❑Yes I I 2. Article Numbers s I (Transfer from service iahe/) ` ?0 6 0A 10 0 0 0 0 ' 3 5 2 4 7 3 6 6 PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 1 K4 Town of Barnstable Barnstable pFTHE Tp�y p®-MmicaCO � BOARD OF HEALTH Il �BARNSTABLE,I: 200 Main Street� Y Hyannis MA 02601 m s T MASS. � 2007 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M. Junichi Sawauanagi CERTIFIED MAIL# 7006 0810 0000 3524 7366 October 24, 2012 Barbara Kelly 595 Pitcher's Way Hyannis, MA 02601 y ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located 595 Pitcher's Way,Hyannis,MA was last inspected .10/4/2012, by James D. Sears, a certified septic inspector for the state of Massachusetts. The inspection of the septic system showed that the system "Conditionally Passes" under the guidelines of the 1995 TITLE 5(3 10 CMR 15.00); • The Distribution-box needs to be replaced You are ordered to repair or replace the septic system within two (2) years from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER.ORDER OF TH BOARD OF HEALTH cI ean, R.S. CHO Agent of the Board of Health i Q:\SEPTIC\conditionally passed\595 Pitcher's Way Hy..doc { t 1 f 1 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 595 Pitcher's Way Property Address Barbara Kelly Owner Owners Name information is required for every Hyannis MA 02601 10-4-12 page_ Cityrrown 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. Im t:when filling *ut A. General Information on the cofrnputer, use only the tab 1. Inspector •���� - cy�� key to move your p :'. JA M ES :N cursor-do not ,fames D. Sears co kuse ey. return SEAR y Name of Inspector �—� Capewide Enterprises,LLC Company NameGam: "It-ll 153 Commercial St. ��rrrruiu 1010�'\``\ Company Address Mashpee MA 02649 Citylrown state , Zip Code 508-477-8877 81623 Telephone Number License Number B. Certification t 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: 0 Passes ® Conditionally Passes ❑ Fails 0 Needs Further Evaluation by the Local Approving Authority 10-8-12 spectoes 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 1 0,000 gpd or greater, the inspector and the system ownerxshall submit the report to the appropriate regional office of the DEP. The original should be sefitto the system owner and copies sent to the buyer, if applicable,and the approving authority. c ,y *"*This report only describes conditions at the time of inspection and underthe conditions"of use at that time.This inspection does not address how the system will perform in the,(uture'under the same or different conditions of use. PP r9 d ��Of") t5iru•11/t0 Title 5 offidal StAnurfaee Sang"Msgiasd system•Pege t of 17 I I f; Commonwealth of Massachusetts Title 5 Official Inspection Form y Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 695 Pitcher's Way Property Address Barbara Kelly Owner Owner's Name information is required for every Hyannis MA 02601 10-4-12 page- Cityfrown state Zip Code Date of Inspection B. Certification (Cont) Inspection Summary, Check A B C D or E f alway s s complete all of S y p action 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 ConditFonally 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): I (Sins-19/10 Title S O fidal m spacban Form:Subsurfaca Sgwaga p{RwsW Systwn•page 2 err 17 Z-d d 1Z:60 Z l, 01•100 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System form- Not for Voluntary Assessments 595 Pitcher's Way Property Address Barbara Kelly Owner Owners Name irlfomlaI fb required for is Hyannis MA 02601 10-4-12 every -Y page. cityrrown State Zip Code Gate of Inspection B. Certification (cunt.) B) System Conditionally Passes(coat.): ® 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): Need to replace D Box ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspectlon if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N 0 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 fairing 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 Zino•t 1110 Title 5 offi M Inspeacm i;mt&tmur m swwaw Disposal System•Page 3 of 17 £ d dZZ•60 ZL 061c0 r Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 595 Pitcher's Way Property Address Barbara Kelly Owner owner's Name information is required for every Hyannis MA 02601 10-4-12 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health(and Public Water Supplier,tf 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 suppiy. ❑ 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 %day flow thine•1111a Title 5 Official MSPectim Farm:Subsurface Sewage DiWosal system-Page A of 17 �'d dZZ:60 Z l 01.100 l - IiAN Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 595 Pitcher's Way Property Address Barbara Kelly Owner Owner's Name informations required for every Hyannis MA 02601 10-4-12 page. City(fown State , Zip Code Date of inspection B. Certification (cunt.) Yes No ❑ Required pumping more than 4 times in the last year NOTdue 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. ❑ Z 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 Beet of a private water supply well. ❑ 1 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 forma ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 16,000 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 11 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. tslns•I1n.o Tift 5 Oftal insvecdm Fwm:.Subsudace Sewage Disposal System-Page s or 17 g"d dZZ:60 Z 1, 01•100 Commonwealth of Massachusetts N. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 595 Pitcher's Way Property Address Barbara Kelly Owner Owners Name info mation W. rrequiredfor every Hyannis MA 02601 10-4-12 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 node as N/A) 19 ❑ Was the facility or dwelling inspected for signs of sewage back up? ED ❑ 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) 1310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 440 t5im•t+M 0 Title 5 Official Mspemlon Form:Subsurface Sa+s'age Disposal System•Pepe 6 0(17 9-d d£Z:60 Z 6 0 L 100 f Commonwealth of Massachusetts I @ UTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 595 Pitcher's Way Property Address Barbara Kelly Owner Owners Name "f°"nati°"'s Hyannis MA 02601 10-4-12 required for every page. Citylrown state Zip Code Date of Inspection D. System Information Description: The system is a 1250 Gal Precast Tank D Box and two Pits Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No is laundry on a separate sewage system?[if yes separate inspection required) ❑ Yes ® No Laundry system inspected? Q Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): 2010-45-000Gal 2011-26.000Gal Detail: Sump pump? ❑ Yes 0 No Last date of occupancy: Present Date Commerciallindustrial Flow Conditions: Type of Establishment Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seatstpersonslsq.ft, etc.): Grease trap present? Q Yes Q No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: i Sins•11110 Title 5.OM031 Yispeoti°a Fame Subsu4e0e Sewage D13poeal System•Paw 7 of 17 L'd d£Z:60 Z6 0l 100 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 595 Pitcher's Way lvl Property Address Barbara Kelly Owner Owner's Name information is required for every Hyannis MA 02601 104-12 page. cityfrown 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: NA 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 Q Single cesspool ❑ Overflow cesspool ❑ Privy El Shared system(yes or no) (if yes, attach previous Inspection records, if any) ❑ Innovative/Aitemative 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•I7/TO TWO S offidW Inspee w Fwm;Subudaw Sewage Disposal System•Pape 8 of V g•d d£Z:60 Z 6 0.1•100 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 595 Pitcher's Way Property Address Barbara Kelly Owner Owner's Name information is Hyannis MA 02601 10-4-12 required for every y page. Cityfrown State Zip Code Date of Inspection D. System Information (cunt.) Approximate age of all components,date installed(if known)and source of information: 1977 Were sewage odors detected when arriving at the site? ❑ Yes No Building Sewer(locate on site plan): Depth below grade: 32" 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.): Pipeing Tank to Box, Box to Pits 4" PVC SCH 20 Septic Tank(locate on site plan): Depth below grade: 2` 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: 1250 Precast Sludge depth: 3" tsins•11110 Title 5 Of6dal trmpecdw Form:Subudace Sear Dispa"Syetem•Page 9 of 17 6-d dt Z:60 Z 6 01, hO Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 595 Pitcher's Way Property Address Barbara Kelly Owner Owners Name _-- information required for every Hyannis MA 02601 10-4-12 e page. City/town state Zip Code Date of tnspedion D. System Information (cost.) Septic Tank.(cont.) Distance from top of sludge to bottom of outlet tee or baffle 27" Scum thickness 2"-..--- 8„ Distance from top of scum to top of outlet tee or baffle 16„ Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Asbuilt-Tape Sludge-Judge 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 at working level, tank at 2'below grade out let Tee. Small outlet cover, 16"centercover. No sign of leakage or overloading. 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 tsirt9-r ino Tales Official Onspecbw Fwm s,buataoa Sewage Disposal System-page 10 of 1T 0 6'd dtbZ:60 Z 1, 0 l 100 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal!System Form-Not for Voluntary Assessments xvl��j 595 Pitcher's Way Property Address Barbara Kelt Owner Owners Name - - information is required for every Hyannis MA 02601 10-4-12 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 ❑fibergiass ❑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 15ins-11110 Title 5 Of6dal kmpec&m Fam SubwAam Sewage Disposal System•Page 110 17 l t'd dtiZ:60 Z6 01•100 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal:System Form-Not for Voluntary Assessments 595 Pitcher's Way Property Address Barbara Kell Owner Owner's Name -^ information is Hyannis MA required for every 02601 10-4-12_ page. City/Town state Zip Code Date of Inspection D. System Information (oco..) 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.): D Box is 16"x21"-30" Below grade w/two lines out, wall's are gone, Need to replace box, Note: Lines in and out of box 4" PVC SCH 20 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_): Soil Absorption System(SAS)(locate on site plan, excavation not required): If SAS not located, explain why: t5ins•11110 TWe 5 Official Inspedfon Fenn Subsurface Sewage Diaposa System-Page 12 of 17 Z 6'd dt Z:60 Z 6 0 6100 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 595 Pitcher's Way Property Address Barbara Kelly Owner Owners Name information is required for every Hyannis MA 02601 10-4-12 per. City[Town State Zip Code Date of tnspecdon D. System Information (cont) . Type: ® leaching pits number. 2 ❑ leaching chambers number: ❑ teaching galleries number. ❑ leaching trenches number, length: El 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.): Leaching is two 6'x6' Precast Pits w/1' stone Pit 1-40" Below grade wet,stain line at 2' Pit 2- 32"-6"water stain line at 2' No sign of over loading or solid carry over 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 5M-11110 Tips 5 OMc4W Impaction Fafm Subsurface sewage Disposal system-Pegs 13 of 17 £6'd d9Z:60 Z 1. 06100 Commonwealth of Massachusetts Title 5 Official Inspection Form i Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 595 Pitcher's Way Property Address Barbara !Sq!!y Owner Owner's Name — - - - infomtation is Hy required for every annlS MA 02601 10-4-12 page. cityrrottn► State Zip Code Date of Inspection D. System Information (cunt.) 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-11110 TiUe 5 OMdal Vwpecuon Form:Subsurface Sewage Di*oeal System-Page 14 at V tq'd d9Z:60 ZI. 0L 100 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 595 Pitcher's Way Property Address Barbara Kell Owner Owner's Name information is Hyannis MA 02601 10-4-12 required fur every page. Cityfrown State Zip Code Date of inspection D. System Information (cunt.) 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 alf 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 r7/pi✓£ wAY C /41 Q O O o t � � Q3 /a a_ A.-3 /3- .3 : 3 0-� I 4e--y = �2s, C- y= t5ins•11/10 Us 5 tfficid Inspection Fan Subwrtaoe Sewage Disposes System•Pages 15 of 17 9 l,•d d9Z:60 Z i• 06100 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 595 Pitcher's Way Property Address Barbara Kelly Owner Owners Name infarmation is required for every Hyannis MA 02601 10-4-12 page. Citylrown State Zlp Code Date of inspection D. System information (oont.) 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: Engineer Plan 9-9-77 NO GW 12'+ Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5'sss.11/1 o Tide 5 OQidal lnspeWm Fomr Subwdace Selvage Disposal System-Page 16 of 17 9l•'d d9Z:60 Z 1 0 61c0 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r 595 Pitcher's Way Property Address Barbara Kelly Owner Owner's Name - information is required for every Hyannis MA 02601 10-4-12 page. City/Tawn 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•11110 Tida 5 Official the peolion Form Sldwudaoe Sewage Disposal System•Page 17 of 17 L l,'d dK:60 Z1, 01,100 i�UvlQ f�s-9S' 0'-C*T ION ! � SEWAGE PERMIT NO. VILLAGE L� INSTA LLER'S NAME ADDRESS t U I'L D E N OR , 6WNER DATE ERMIT ISSUED DATE COMPLIANCE ISSUED r4 m -C No FizE ' e, THE COMMONWEALTH OF MASSACHUSETTS f BOARD F HEALTH _.. ...... (14 - OF........... ....G '-...... - ....._..... - .._......... Appliration -fur Biupuutti Worko Cnuuu#rurtiuu Prrutit Application is hereby'made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: --------------A)-----1----._�......t�...........-------------------------- ' .fps--- -------------------------------------------- //-- .. L cation-, dress or/�j' Lit No _ f /' N� P.............. Lot --•--•---•--.............................. Owner Address W t Is--Ee rr Address U Type of Building ��LL Size Lot...L3.A.,4�VV--_-_-Sq. feet �-, Dwelling—No. of Bedrooms.........................._ ..._.Expansion Attic ( ) Garbage Grinder (�•) Other—Type of Building ____ ______________________ No. of persons............................ Showers ( ) — Cafeteria ( ) WOther fixtures --•------- •-••-------•-------------------------------•-----------------------------------.------ W Design Flow.............. '---_� __'�_ _gallons per person per day. Total daily flow.............X9_0------------------gallons. WSeptic Tan4L' Liquid capacity./.2 S dgallons Length---------------- Width................ _.-_._.. Diameter --__.-..-_-__ Depth------.._ _... . x Disposal Trench—No- -------------------- Width____._________,.___ otal Length.................... Total leaching area--------------------sq. ft. Seepage Pit No..r2.CA Diameter- below inlet.... ___ __ _ Total leaching area------- ----------sq. ft. z Other Distribution box ( ) Dosing tank ( ) - 0, _ 91- /z- 77 Percolation Test Results Performed by---------- -------------------•----------------------------------•-------- Date--------•-----------------------------.. Test Pit No. 1----------------minutes per inch Depth of "Pest Pit.................... Depth to ground water...._---.---.------._... G4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water--..-.-.-_---------_-_- .-•-- --••--- . O ----�.�.,�../. Description of Soil-----------------�-- ------- =� ----T d2- ----A� V -------------------------------------------------------------------------------------------------------------------------------------- --------------------- -------------------------------------- ------------------W V 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 Article NI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued b ----------------------------- y the board of health. Signed. _ _ 6l ' -- ���_j¢ Date Application Approved ,y - ---------- -- -- ---•----•-• ---------- - = 1�-.Z. T----------- Date Application Disapproved for the following easons:----••-------------------------•----•---•-------•------•------•-•-••----•----_-----------------•--------------- ---•---------••-----------------•---------.... ® Date 6 � >� Permit No.......................................................... . Issued----- -- -----�----�-�-------•---•---•--- Date �_ if v " f _ No.........................� Fala.......... THE COMMONWEALTH OF MASSACHUSETTS -r BOARD,-OF HEALTH ...... ..... ._.. ,/. ......... -....OF..... :"e,t-14-L................................... Apphration -for D� tipwial Worku C onstrurtimn Prruld Application is hereby'made for a Permit to Construct ( ) or Repair ( } an Individual Sewage Disposal System at: / ///j I'. . 7 /� A, f-;.--Ir�i I•z: , .-mow �. /ly,4,jyt�.. .. 1.414 •----•--------------------------•--•----•--•-------•-----•-•-------•••••-•-••-•-••••---••-••.----- ---•----- ............----''-}•--•-----•----••---------------------.........---... Location-Address /' or Lot No. Owner f t Address W ----------------------------------------------....-------------------------•----•----------------- -----------------------------------------------------. Installer Address UType of Building Size Lot...1 3.:_Y-_`'._______5 q. feet Dwelling—No. of Bedrooms_______________�_f__-__-_________--_---.___Expansion Attic ( ) Garbage Grinder (-I"•) per-, Other—Type of Building .......... .................. No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures :' =--'---`-------------------------__---------------•••-------.................-------------------------------------------- W Design Flow____________- -__�_--___ S_.._-_gallons per person per day. Total daily flow------------------------------------------.gallons. P4 Septic Tank/-Liquid capacitv42_,5_°gallons Length---------------- Width------.......... Diameter---------------- Depth...__--__._._--. xDisposal Trench—No..................... Width-------------------- Total Length------------_----- Total leaching area--------------------sq. ft. Seepage it f - _ Diameter -_'-_____:__,Depth below inlet____________________ Total leaching area_--___.__-_.-----sq. it. z Other Dissttribution box ( } Diame Dosing tank ( ) 'h- • ` - r _ /- /z F � Percolation Test Results Performed by----------------------------------•.-.---------•------------------------- Date---------------------------------------- Test Pit No. 1................minutes per inch Depth of "Pest Pit-------------------- Depth to ground water-------._.--------- ._.-. t14 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water__-_-._____-______.... Ix ...............=............................. •---------------------•--•--•--- ..............--- -----------------`----•-----------•-------•'-----.------ D Description of Soil---------=_------`1 =' j. _.+...._J ids,-� r _��-1-._� rf!-------------- V ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- W V 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 Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. --•�-----` i� Signed......_ __� f, - ---—----- = •----- ---------------------------------------- .-- Date Application Approved f$Y 4- / �1�i24-<�r>�- •-------------=------------------- ----------------------- / Date Application Disapproved for the following reasons:.......... ..•----.-------.-----.------------------ --..-----_----.---._--------------------------•------...... ----------------•------•------------•--•----•---------------•-.--•-----------------------------•------•----------•-----•------------•--------------•--------•-•-•---•-----------------.-....------------ Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH - / r r ..............................OF_........... ` ........ �erti�ir�tr gf f��ut�li�t�rr ' THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired ( ) b ... -------------------------------------- �'�f Installer / at. = �� i --•--------------------------•----------•------•---------•---------- ------• ?�/, = _° has been installed in accordance with the provisions of Article XI of The State SanitaryfCode as described in the application for Disposal Works Construction Permit No. :_......___5. .(_____________ dated__.__...'-_�G.:_.7_. __.-____....._.. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL U CTION SATISFACTORY. DATE................. .�Q ............................... Inspector......... Q THE COMMONWEALTH OF MASSACHUSETTS —� BOARD OF HEALTH No......................... FEE---� ............... Dinpagal > rk �instrurtion Vrrmit Permissionis hereby granted--------••--------------------------------•------•------•--•-----------------------------_..------------------•------------•--•-•--.-•-•---- to Construct,( ) or Repair Q ) an Individual Sewage/Disposal System atNo..........................................................' • - , ` — r izs raJ,l- --- r R Street as shown on the application for Disposal Works Construction Permit No __-________________ Dated.... ... .. _� ' ---.... ------- -- ---' .................... �,�, =(�� .............................. r j DATE................................................................................ Board of Health�.' FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS 4, I nc --D, ;l I 161 Q n .4-1 2: pt�Z-G 4�11e-TD.Ne 4Ao 6.FD- po. t to 6 5T Y, $A' �-A OP k4 z A 1.0 WILLIA P ?- N Y E -,,"o 19334 rat G VSTIF SO Tc, T-W r,T.4 121 L INV. -FA hi WL -d-- 1mv CA& LsAn N LocATIW-.: -6°G LJ G CA L t- -7-7 A$ Wo TIOD i*OA,-r Ti-4t=- FouLjDAT)oQ -50.01,Ajl-.j Q T?- a -1 c W L A.4 Of= -T*r-;C-- 0 Z IN'R 0 3TA L <-L F-v a TIW; Ct-PE VJ I De �V, Co. eZ 3 y N R � Commommoolth of Mossochusetis '� /lJq fCF�VEo R Executive Office- of.Environmentol Affoirs � Department of loftoFe� T 199?, ► Environmental Protection os� William F.Weld 6+ Go+romor Trudy Coxo - Davld B. Struhs commlf f loner SUBSURFACE SINVACE DISPOSAL SYSTEM INSPECTION FORti1 PART A CERTIFICATION Property Address 595 Pitchers Way, Hyannis Address of Owner: 308 Victory Road Date or Inspection: March 5, 1997 (If different) Marina Bay Name of Inspector: Robert W. Saben �Quincy, MA 02171. Company Name, Address and Telephone Number: Barnstable County Systems Inspectors 25 Mid-Tech Drive West Yarmouth, MA 02673 CrUIFICATION STATrMrNT (508) 778-0101 1 certify that 1 have personally inspected the sewage disposal system it this address.and that the information reported below is true, accurat and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function an. maintenance of on-site sewage disposal systems. The system: X Passes f _ Conditionally Passes _ t is FroK r Evaluation By the Loc Approving Authority — Fails Inspector's Signature: Date: March 5, 1997 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 his a design flow of t0,000 gpd or greater, the inspector and the system owner shalt urbm l the report to the appropriate rerional office of the Depanment 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: AJ SYSTEM PASSES: X 1 have not found any information which indicates that the system violates any of the failure Criteria as deGnrd in 310 GtR t 51.10) Any failure criteria not evaluated are indicated below. fi) SYSTEM CONDITIONALLY PASSrS: One or more system components need to be replaced or repaired. The system, utfoxf eomple6on of the rrt+lacr flit-r.e of rrt+:vr• passes inspection. Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"nnt determined", rvtflain why nor) _ The septic tank is metal, cracked, structurally unsound, shows substantnl infiltration or exfiltration, or tint: failure is imminent. The system will pass inspection if the existing septic tint: is replaced with a.conforming septic tank . approved by the Board of Health. 1 (revised 8/15/95) 0nn'%1.1ntnr gtreet • P.osfnn, Llsssnchttsetts 02100 • FAX(617) 5%,10.19 • Telephone (617)292-ijrM rrmt.l n.+reel.I'd I•.f I" i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 595 Pitchers Way, Hyannis Owner: Robert Norton Date of Inspection: March 5, 1997 B) SYSTEM CONDITIONALLY PASSES (continued) _ Sewage backup or breakout or high static water level observed in the distribution box is due to broken ar 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 pipes) 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 f+ass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed 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 fai inn to protect the public health, safety and the environment. t) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING I V A XiANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ Cesspool or pri.h• is within 10 feet of a surface water Cesspool or privy is within SO feet of a bordering vegetated :wetland or a salt marsh. ?) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DEfERhIINES-THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND TH: ENVIRON'MEN'T- _ 1 he w5tem 11:1% 1 septic rani; anti soil absorption system and is within 103 fcri lu a Sur(zCe water W04 Or surface :water supply. _ The sytrrm ha• a septic mril, and snit absorption system and is %viihin a Zone I of a public grater supply _ The system lim i se a ptic Cant: nd soil absorption system and is :within 50 feet of a private %+•ater sut+pll, %•ell. _ The sy>ti•114 a septic tan;, and soil absorption system and is Icss than 100 feet but 50 feet or more fro n a private i:.�tc� supply well, unless a well water analysis for eoliform 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• D) SYSTEM FAILS: I have rleterminerl that the system violates one or more of the following failure criteria is defined in 310 CMR 15.103. The basis for this determ;n.16nn is identified below. The floard of I-tealth should be contacted to determine what will be ne.rssary to com-ri the failure. Backup of sev.,age into facility or system component due to an overloaded or cloneed SAS or cesspool. _ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or r IoFeed SAS or cesspool. 2 (revised 2/1S/9S) SUBSURFACE SEVVACE DISPOSAL SYSTEM 1NSPECTtON FORM PART A CERTIFICATION (continued) Property Address: 595 Pitchers Way, Hyannis Owner. Robert Norton Date of inspection: March 5, 1997 D) SYSTEM FAILS (continued): Static liquid level in the distribution box above outlet invert due town overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6' below invert or available volume is less than 112 day flow. Required pumping more than R 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 elevatior. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surf. %vater 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 -apply well with nc acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of-el: water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. , E) LARGE SYSTEM FAILS: The followinr, criteria apply to large systems in addition to the criteria above: The design now of system is 10,000 gpd or greater (Large System) and the system is a significant threat to publi: health and safer, and the environment because one or more of the following conditions exist: the system is within 400 feet of n 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 (Ib1'fA) or a rn. •d lone II of. public tvdlet sal+l+t}• �+'cl(1 The owner or operator of any such system shall bring the system and facility into full compliance with the Froundwater t eatment program requirements of 314 CMR 5.06 and 6.00. Please consult the local regional office of the Department for.further informati-m. (revised tt/15/95) 3 SUBSURFACE SnVAGE DISPOSAL SYSTEM INSPECTION FORM PART ti CHECKLIST Property Address: .595 Pitchers Way, Hyannis Owner: Robert Norton Date of Inspection: March 5, 1997 Check if the following have been done: X Pumping information was requested of the owner, occupant, and Somd of Health. X None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rat during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. X As built plans have been obtained and examined. Note if they arc not available with NIA. X The facility or dwelling was inspected for signs of sewage back-up. X The system does not receive non-sanitary or industrial waste flow X The-site was inspected for signs of breakout. X All system components, excluding the Soil Absorption System, have been located on the site. _.S_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. X The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusiv(- methods. X°The facility ovine' (arid nccupants, if different from owner) were provided with information on the proper maintenance ofSulr 5urface Disposal System. 4 (revived 8/15/95) f i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORD{ PART C SYSTEM INFORMATION Property Address: 595 Pitchers Way, Hyannis Owner. Robert Norton Date of Inspection March 5, 1997 FLOW CONDITIONS RESIDENTIAL: Design flow: 440 gallons Number of bedrooms: 4 Number of current residents: 0 Garbage grinder(yes or no): No Laundry connected to system (yes or no): Yes Seasonal use (yes or no):Yes Water meter readings, if available: 11/8/95 to 11/7/96 — 4 500llon 11/4/94 to 11/8/95 — 5.550 gal' ' Last date of occupancy: September/Off & On during the summer. COMMER CIA UINDUSTRIAL• Type of establishment: Design flow: rallons/day. Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non-sanitary Waite discharged to the Title 5 system: (yes or no)_ Water motor readings, if available: Last date of occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PU&(PING RErORQS and source of information: 5]23 90; 7/18/95 — Barnstable Water Polution, Control System pumped as par, of inspection: (yes or no) No If yes, volume pumped, gallons Rexon for pumping: TYPE OF SYSTEM X Septic tank/distribution boylsoil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) Other (explain) APPROXIMATE ACE of all components, date installed (if known)and source of information: 20 'years/ 9/16/77 arriving at the site: (yes or no) No Sewage odors detected when am g y (revised 8/15/951 5 f - SUIISUrrACE SLIVAGE DISPOSAL SYSTEM INSPECTION FORA{ PART C. SYSTEM INFORMATION (continued) Property Address: 595 Pitchers Way, Hyannis Owner: Robert Norton Date of Inspection: March 5, 1997 SEPTIC TANS::_ (locate on site plan) Depth below grade: 24" Material of construction: X concrete _metal_FRP_other(expbin) Dimensions: 5x10x5 Sludge depth: 4" �� Distance from top of sludge to bottom of outlet tee or baffle: 20 Scum thickness: 0 Distance from top of scum to top of outlet tee or baffle: No Scum Distance from bottom of scum to hottom of outlet tee or baffle: 1011 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.) Liquid level well below invert due to very 1 imi tpd ,t-gp Test for leakage due to low>.effluent level indicated. No evidence of leaking septic tank Overall condition of system ayneared good GREASE TRAP:_ (locate on site plan) Depth below grade: Material of construction: concrete _metal _FRP—other(explain) Dimensions Scurn thickness: Distance from top of scum to top of outlet tee or baffle: Digance from hollo r no lrtl^l I- heittnm Ot 0110M tee Or baste: Comments: (recommendation for pumptnr, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet inven, structural integrity,evidence of leak-ter, etc. (revised 8/1S/95) L SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 595 Pitchers Way:, Hyannis Owner. Robert Norton Date of Inspection: March 5, 1997 TIGHT OR HOLDING TANK:_ (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.) DISTRIBUTION BOX: X Unable to verify due to significant depth of (locate on site plan) Distftbution box in ,-,ground. Depth of liquid level above outlet invert: Comments: (note if Ievc-1 and dist(ibuci;,i: r,:dence of soGck ca:r;o:•e% evidence of leat:a-e into or out of boY, etc.) PUMP CHAMBER:_ (locate on :ate plan) ' Pumps in working order.(yes or no) Comments: (note condition of pump chamber, Condition of pumps and appurtenances, etc.) • 7 (revised a/1S/95) I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) . Property Address: 595 Pitchers Way, Hyannis Owner: Robert Norton Date of Inspection: Match 5, 1997 SOIL ABSORPTION SYSTEM (SAS):X (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 eesiponl, number: Comments- (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegeta►ion,etc.) No signs of hydraulic failure. No levels of ponding, normal vegetation. Location of S taken from as built card from Board of Health records - CESSPOOLS: (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,rrounth Mel. inflow (cesspool must be pumped as pan of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY:_ (locate on site plan) Materials of rnn:truetinn:_ Dimensions: Depth of sntids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) D . (revised 0115195) F SUQSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continue Property Address: 595 Pitchers Way, Hyannis Owner. Robert Norton Date of Inspection: March 5, 1997 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' Yo 71 o s qs may, 6 07C 6-. DEPTH TO CROUNDIVATrz Depth to rroundwater. > 12 feet method of determination or approximation: No groundwater encodntered at a depth of 12 fPea- as reported on engineers plan,---dated 9/9/77 re ar'ed{+. (revised o/1S/9S)