HomeMy WebLinkAbout0625 PITCHER'S WAY - Health 625 Pitcher's Way, Hyannis
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Town of Barnstable Barnstable
Regulatory Services Department
• 1ARNWAM.P, • I
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M Public Health Division I
1639•
200 Main Street, Hyannis MA 02601 200�
Office: 508-862-4644 Richard V.Scalie,Director
FAX: 508-790-6304 Thomas A.McKean,CHO
CERTIFIED MAIL# 7012 1010 0000 2851 4310
September 4, 2014
Henry and Elise Galvin
625 Pitcher's Way
Hyannis, MA 02601
The septic system located at 625 Pitcher's Way, Hyannis,MA was last inspected on
• 8/17/2014 by Trever Kellett, 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:
• System is in hydraulic failure
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 BOARD OF HEALTH
Thomas McKean, R.S. CHO
Agent of the Board of Health
•
Q:\SEPTIC\Letters Septic Inspection Failures or Future Ev1\625 Pitcher's Way HY Aug 2014.doc
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
625 Pitchers Way
Property Address
Henry and Elise Galvin
Owner Owner's Name
information is required for every Hyannis MA 02601 8/17/2014
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 n
filling out forms
on the computer,
use onlythetab 1.' Inspector:
key to move your e
cursor-do not Trevor Kellett 1 J
use the return Name of Inspector
key. -
TK Septic Inspections
my Company Name
.. o
38 Vacation Lane
Company Address
West Yarmouth MA 02673
City/Town State Zip Code
508-579-5502 SI 13744
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 ins ion.The inspectiq
was performed based on my training and experience in the proper function and ma+nt nance ol*sites
sewage disposal systems. I am a DEP approved system inspector pursuant to. ion 15.:4Q of
Title 5(310 CMR 15.000).The system: € C=
❑ Passes ❑ Conditionally'Passes ® Falls --
❑ Needs Further Evaluation by the Local Approving Authority - Q.
8/18/2014
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.
t5ins•W13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17
I
Commonwealth of Massachusetts
Title 5 Official. Inspection Form,
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
625 Pitchers Way
Property Address
Henry and Elise Galvin
Owner Owner's Name
information is required for every Hyannis MA 02601 8/17/2014
page. City/Town State Zip Code Date of Inspection
B. Certification (coat.)
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 Heath,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)
Mrs•3113 Title 5 Ofidal Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
625 Pitchers Way
Property Address
Henry and Elise Galvin
Owner Owner's Name
required fo is Hyannis MA 02601 8/17/2014
required for every y -
page. City/Tom 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.
M `
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-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
625 Pitchers Way
Property Address
Henry and Elise Galvin
Owner Owner's Name
information is required for every Hyannis MA 02601 8/17/2014
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
` 2.'System will fail unless the Board of Health(and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil 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
® ❑ t. 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
t5ins•3/13 Tile 5 Ofidal Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form,
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments-
625 Pitchers Way
Property Address
Henry and Elise Galvin
Owner owner's Name
information is required for every Hyannis MA 02601 8/17/2014
page- City/Town State Zip Code Date of Inspection
B. Certification (cont.)
Yes No
❑ ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑ ® 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-
10,000gpd.
® ❑ The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303,therefore the system fails.The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"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•3113 Tille 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
625 Pitchers Way
Property Address
Henry and Elise Galvin
Owner Owner's Name
information is H annis MA 02601 8/17/2014
required for every y t
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?
El ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
® El available
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?
® E 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: r
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•3/13 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
625 Pitchers Way
Property Address
Henry and Elise Galvin
Owner Owner's Name
information is Hyannis' MA 02601 8/17/2014
required for every y
page. City/Town State Zip Code Date of Inspection
D. System Information
Description:
Number of current residents: 3+
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 years usage(gpd)):
Detail:
Sump pump? ❑ Yes ® No
Last date of occupancy: current
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•W13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17
Commonwealth of Massachusetts - r
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
o 625 Pitchers Way
Property Address
Henry and Elise Galvin
Owner Owner's Name
information is required for every Hyannis- MA 02601 8/17/2014
page. �Y
C' /Town State Zip Code Date of Inspection
D. System Information (cont.) t ,
Last date of occupancy/use: Date
Other(describe below):
General Information
Pumping Records: '
Source of information:
Was system pumped as part of the inspection? t ❑ 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 jibe 5 Official inspection Form:Subsurface Sewage Disposal System•Page 8 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
w 625 Pitchers Way
Property Address
Henry and Elise Galvin
Owner Owner's Name
information is Hyannis MA 02601 8/17/2014
required for every y _
page. City/Town State Zip Code Date of Inspection
D. System Information (cunt.) t
Approximate age of all components, date installed(if known)and source of information.-
1/8/2000 per BOH
Were sewage odors detected when arriving at the site? ❑ Yes 0 No
Building Sewer(locate on site plan): .
Depth below grade: 1.5 _
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.):
Septic Tank(locate on site plan):
_
Depth below grade: 1feet
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: 1000 gal
Sludge depth:
2"
t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17
Commonwealth.of Massachusetts '
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
625 Pitchers Way
Property Address
Henry and Elise Galvin -
Owner Owner's Name
information is required for every Hyannis MA 02601 8/17/2014
page. City/Town state Zip Code Date of Inspection
D. System Information (cont.)
Septic tl
. p Tank(cont.)
Distance from top of sludge to bottom of outlet tee or baffle
29"
Scum thickness 1 2
Distance from top scum of to to of outlet tee or baffle 8
P
Distance from bottom of scum to bottom of outlet tee or baffle 16
How were dimensions determined? Measured
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert,evidence of leakage, etc.):
Septic Tank is water tight and structurally sound with both tees intact,there is however a layer of-
scum around the entire tank indicating backup
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
t5fns•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
625 Pitchers Way
Property Address
Henry and Elise Galvin
Owner Owner's Name
information is Hyannis MA 02601 8/1712014, .
requireded for every y
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.):
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 worldng 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 Inspeclion Form:Subsurface Sewage Disposal System-Page 11 of 17
7
Commonwealth of Massachusetts
Title 5 Official Inspection- Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
625 Pitchers Way
Property Address
Henry and Elise Galvin
Owner Owner's Name
information is required for every Hyannis MA 02601 8/17/2014
page. Cityrrown 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 1 inch
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 level and water tight with some signs of carryover and scum above invert
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:
t5ins-3/13 Title 5 Official Inspection Form Subsurface Sewage Disposal System-Page 12 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
1 Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
625 Pitchers Way
Property Address
Henry and Elise Galvin
Owner Owner's Name
information is required for every Hyannis MA 02601 8/17/2014
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Type:
® Teaching pits number: 2
❑ leaching chambers number:
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions
❑ overflow cesspool number:
❑ innovative/alternative system
Typetname of technology:
Comments(note condition of soil,signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
New 1000 gal Pit installed 6/16/94 is completely full with staining on the lid and up the cement riser
indicating back up and failure
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-W3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of W
Commonwealth of Massachusetts
Title 5 Official- Inspection,form
;tl Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
625 Pitchers Way
Property Address
Henry and Elise Galvin
Owner Owner's Name
information is required for every Hyannis MA 02601 8/17/2014
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 Forth:Subsurface Sewage Disposal System•Page 14 of 17
f
Commonwealth of Massachusetts
Title 5 official Inspection Forme.
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
625 Pitchers Way
Property Address
Henry and Elise Galvin
Owner Owner's Name
information is required for every Hyannis MA 02601 8/17/2014
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
A B
1
Al 26' O
A2)28'
A3)31' •
A4)3T 2
A5)42'
B1)27'
B2)30'
B3)34'
B4)41'
B5)30' � 5
4
t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17
Commonwealth of Massachusetts _
1. Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
625 Pitchers Way
Property Address
Henry and Elise Galvin
Owner Owner's Name
information is required for every Hyannis MA 02601 8/17/2014
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Site Uam:
❑ Check Slope
❑ Surface water
❑ Check cellar
❑ Shallow wells
Estimated depth to high ground water. 45
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 ground water between 40 and 50 feet
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins•3M3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
625 Pitchers Way
Property Address
Henry and Elise Galvin
Owner Owner's Name
iron is
requiequiredd for every y H annis MA 02601 8/17/2014
page. City/Town State Zip Code Date of Inspection
E. Report Completeness Checklist
® Inspection Summary: A, B, C, D, or E checked
® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed
® System Information—Estimated depth to high groundwater
® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17
TOWN OF BARNSTABLE
}LOCATION t��� ��TC���.�' '�"��SEWAGE#
--\-.VYLLAGE �i��'�'/f' ASSESSOR'S MAP&PARCELS 70 -
INSTALLER'S NAME&PHONE NO. -5-- ®7 07
SEPTIC TANK CAPACITY�"X�-J'�f /Q o`% 6r.4 e-
LEACHING FACILITY: (type) C43'.— (size)
NO. OF BEDROOMS
OWNER
PERMIT DATE: COMPLIANCE DATE:
Separation Distance Between the: ® '�✓�T�`Q ri
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility / 3'� 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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CO Postage $
Certified Fee
Postmark
E3 Return Receipt Fee =p Here
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(Endorsement Required)
Restricted Delivery Fee SEP-3 2014
C3 (Endorsement Required)
Total Postage&Fees GrS n_
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rq
r Henry and Elise Galvin
625 Pitcher's Way
Hyannis, MA 02601
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o A record of delivery kept by the Postal Service for two years
Important Reminders:
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a duplicate return receipt,a USPSe postmark on your Certified Mail receipt is
required.
o For an additional fee, delivery may be restricted to the addressee or
addressee's authorized agent.Advise the clerk or mark the mailpiece with the
endorsement"Restricted Delivery
j o 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:Save this receipt and present it when making an inquiry.
PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047
4
z
Town of Barnstable P#
Department of Regulatory Services
MASS. j Public Health Division Date
A i679 200 Main Street,Hy ais MA 02601
' tEU MA't A
y a�
Date Scheduled_ �fi Time Fee Pd.
v V I_
Soil Suitability Assessment for ,sewage Disposal
Performed By: Witnessed By:
LOCATION& GENERAL INFORMATION
Location Address �� t Owner's
�►�/ Address`
Assessor's Map/Parcel: Engineer's Name t!jz to/;p ae000w,4�P-0/" VT
NEW CONSTRUCTION REPAIR
Telephone# •
Land Use Slopes surface Stones
Distances from: Open Water Body ft- Possible Wet Area ft Drinking Water Well ft
Drainage Way ft Property Line ft Other ft
SIMTCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes)
a
t
Parent material(geologic) Depth to Bedrock
Depth to Groundwater. Standing Water in Hole: Weeping i5'om Pit Face
Estimated Seasonal High Groundwater
DETERMINATION FOR SEASONAL HIGH WATER TABLE
Method Used:
Depth Observed standing in obs.hole: In, Depth to soil mottles: In.
Depth to weeping from side of obs,hole: in, Orouadwntrr AdJuatmt nt_ ft.
Index Well# Reading Date: Index Well level Ad,fh0tor_ Adj.dYoundwater Level,,,,e,
PERCOLATION TESL' Date_._ Time,
Observation ,{
Hole# YI Tinto at h"
Depth of Pere Time at 6"
Start Pre-soak Time @ Time(9"-6")
End Pre-soak
Rate Min./Inch
Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N)
Original: Public Health Division Observation Hole Data To Be Completed on Back-----------
***If percolation test is to be conducted within 100' of wetland,you must first notify the
Barnstable Conservation Division at least one (1) week prior to beginning.
Q:\SP-PTIC\PERCFORM.DOC
DEEP-OBSERVATION ROLE LOG Dole#
Depth from Soil Horizon Soil Texture Sdil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Stnucture,.Stones;Boulders.
U
onsis e t ncy,%'Gravel)
VA
DEEP OBSERVATION HOLE LOG Dole#
Depth from Soil Horizon Sail Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
onsisten % ra
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)
]DEEP OBSERVATION HOLE LOG: Role#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stooes;Boulders,
Cons' ten
c
y
Flood Insurance Rate Map:
Above 500 year flood boundary No Yes _
Within 500 year boundary No Yes es
Within 100 year flood boundary No. Yes
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring per,1 titerial exist in 1 areas observed throughout the
area proposed for the soil absorption system?
If not,what is the dep h o naturally occurring per sous material'?
Ceftification
I certify that on (date)I have passed the soil evaluator examination approved by the
Department of Envir mental Protection and that the above analysis was performed by me consistent with .
the requir aining, us a d experience described in�10 CMR 15.01..�/
Signature Date v
Q:\5EMC\PERCPORM.DOC
No. Fee r
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
AppliLation for Misposal.6pBtem Construrtiori permit
Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) ❑Complete System ndividual Components
Location Address or Lot No.�, 3'' /T` �1. `D�y Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel eP .70 c�
Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) Q gpd Design flow provided 3�9 gpd
Plan Date Number of sheets J Revision Date
Title
Size of Septic Tank��j.PTir'G �'�®� 6Z-4<Type of S.A.S. er eeL
Description of Soil •d'�` ��'>"-/'
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board lth.
S121 Date
Application Approved by Date el'?6 7.m1
Application Disapproved Date
for the following reasons
Permit No. Zz w— 3 S 0 Date Issued l
NoA ,— ( Fee*/QD
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION;- TOWN'OF BARNSTABLE, MASSACHUSETTS
Rpplication for Die-OoSal 6pstem Construction Permit
Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) [:]Complete System ndwidual Components
Location Address or Lot No.6 Z $'&'P/7le,4 60-P 14 ''fy Owner's Name,Address,and Tel.No.
y �,Q G Ll i✓
Assessor's Map/Parcel 10 "j�f
Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
.�' e4F p ez-,A- 7_7 s' 07 0 7
Type of Building: g
Dwelling No.of Bedrooms Lot Size sq.8. Garbage Grinder( )
Other Type of Building 4f`,do' No.of Persons Showers( ) Cafeteria( )
Other Fixtures
' Design Flow(min.required) O gpd Design flow provided 9 gpd
Plan Date Number of sheets /1 Revision Date
Title
Size of Septic Tank�`X/�T�i oo"Oalo 6ZAlType of S.A.S. C c2~ Gz E3r_e
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected: p
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 o lth.
Sig d Date d'
Application Approved by Date (i ZG Zol
Application Disapproved b Date
for the following reasons
Permit No.���� I p Date Issued ozg/-Z.I �
-------------------------------------------------------------------------------------------------------------------------- ------------
TH�COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( A1001, Upgraded( )
Abandoned( )by Jy1 de e,00e- /f cn�'' t ✓'y4C -
at K':l -T- 4�/TGf,��a-r 4,.4-k Zj6e.•has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. - 3 e dated Z6 I Zo I y
Installer J',,�!Vp Ze497a"9" Designer vr/j .g?
#bedrooms -';' Approved design flow :Z��9 gpd
The issuance of this permit shall not be const ed as a guarantee that the system will. notion as*egii- d.
Date �� i C � Inspector _
--------------------------------------------------------------------------------------------
No�(LI 31 - -- Fee �C�
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS
Disposal 6pstem Construction Permit
Permission is hereby granted to Construct( ) Repair( Upgrade( ) Abandon( )
System located at 4!<.1 /�GJ��`4l✓ l�'/�� /��i�
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 perm/it./..
Date r(,71J�I l Approved byv
1 __
'Town of Barnstable
Regulatory Services
Richard V. Scali,Interim Director
Public Health Division
ATE1 M9� Thomas McKean,Director
c
200 N L-dn Street,Hyannis,iNIA 02601
Office: 508-862-6 Fac: 503-790 63�4
Installer &Desie-ner Certification Form
b
SesraQe �erlXlitir Assessors Map%Parcel
Date:
Desiap.• er: lC _ -'� ,� Installer:
Address: � '� � Address:
On — u-'� was issued a permit to install a
(date) (installer)
septic systeu., at '' based on a design dra,+vn by
(address)
�� %r/• ated 2� z ol
(designer)
I certify that the septic systen referenced above was installed substantially according to
he design, which may includes inor approved changes such as iatera relocation or the
distribution box and/or septic tarok. Strap out (if required; was ir�pected and the soils
were found satisfactory.
I certify that the septic system referenced above was installed wi..h major changes (i.e.
greater than 10' lateral relocation of the SAS or any vertical relocation of any corr_ponent
of the septic system) out in accordance -with State & Local Regida7ons. Plan revision or
certi:ed as-built by designer to follow. Strip out (if required) was inspected and the soils
were found satisfactory.
I certify that the system referenced above was coi=acied in Cc. fiance %ith the terms of
the i1A approval let ems (if apFlicablel
(lnstaUerc'ss Signature) 4 fiai�\S�Pr i R !
r
esil Signature) (Aix Deszc Isere i
PLEASE RETURN TO BARN—STABLE PUBLIC HEALTH DIVISION. CERTIFICATE
OF CONIPLI_ANNCE NYTLL NOT BE ISSUED L NTIL BOTH TLIIS FORM AND AS-
BUILT CARD ARE RECEIVED BY TRE.BARNSTABLE PUBLIC HEALTH DIVISION.
TH�i_NK YOU.
Q:1SepticTesigner Cmificaticn Fors Rev 8-14-13.doc
Commonwealth of Massachusetts
k1
' Executive Office of Envirownental Affairs
Dept. of Environmental Protection
One winter Street, Boston,Ma. 02108 .John Grad
D.E.P. Title V Septic Inspector
P.O. Box 2119
Teaticket,MA 02536
W►LLIAM F.WELD (508) 564-6813
Governor
ARGEO PAUL CELLUCCI Ii
Lt.Governor
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORMPART A
c�I' �O
CERTIFICATION `�Y
406, 'peg
Property Address: 625 Pitchers Way Hyannis Address of Owner: j��'Hpp 8 j99
Date of Inspection:816197 (If different) //4 t NSj , ti
Name of Inspector:John Grad Trombley �EPj�lE N
I am a DEP approved system inspector pursuant to Section 15.340 of Title%.(310 CMR 15.000)
Company Name,Address and Telephone Number: 1
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate
and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and
maintenance of on-site sewage disposal systems. The system:
X_ Passes This inspection is based on criteria defined in Title V
Conditionally Passes code 310 CMR 16.303.My findinqs are of how the system is
performinq at the time of the inspection.My inspection does
Needs Fu er Eva ation By the Local Approving Authority not imply any warranty orquaranteeof the longevitvofthe
Fails septic system and any of its components useful life.
Inspector's Signature: Date: 816/97
The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this
inspections. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit
the report to the appropriate regional office of the Department of Environmental Protection.
The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority.
INSPECTION SUMMARY:
Check A. B.C, or D:
A] SYSTEM PASSES:
X I have not found any information which indicates that the system violates any of the failure criteria
defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below.
COMMENTS:
B] SYSTEM CONDITIONALLY PASSES:
_One or more system components need to be replaced or repaired. The system, upon completion
of the replacement or repair, passes inspection.
Indicate yes, no,or not determined(Y, N, or ND). Describe basis of determination in all instances. If "not determined", explain why not.
The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of
Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection; or
the septic tank,whether or not metal, is cracked,structurally unsound, shows substantial infiltration or exhlbation,or lank
failure is imminent.The system will pass inspection if the existing septic tank is replaced with a conforming septic tank
as approved by the Board of Health.
(revised 04127/97)
One Winter Street 9 Boston,Massachusetts 02108 9, FAX(617)556-1049 9 Telephone(617)292-5500
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 625 Pitchers Way Hyannis
Owner: Trombley
Date of Inspection:8/6/97
— Sewaae backup or.breakout.or hiah.static water level observed.in.the distrihution box is due to a broken.
or obstructed pipe(s)or due to broken, settled or uneven distribution box.The system will pass inspection if
(with approval of the Board of Health). Describe observations.
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
_The system required pumping more than four times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
C] FURTHER EVALUATION 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 the public health, safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS
NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND
SAFETY AND THE ENVIRONMENT:
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 APPROPRIATE)DETERMINES
THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE
ENVIRONMENT:
— The system has a septic tank and soil absorption system and is within 100 feet to a
surface of water supply or tributary to a surface water supply.
— The system has a septic tank and soil absorption system and is within a Zone 1 of a public watersupply well.
— The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well.
— The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a
private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that
the well is free from pollution from that facility and the presense of ammonia nitrogen and nitrate nitrogen is equal to or
less than 5 ppm. Method usedto determine distance (approximation not valid)
3)Other
D] SYSTEM FAILS:
You must Indicate either"Yes'or"No"as to each of the following:
I have determined that the system violates one or more of the following failure criteria as defined in
310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be
contacted to determine what will be necessary to correct the failure.
Yes No
Backup of sewage in facility or system component due to an overloaded or clogged SAS or
cesspool.
Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or rlorgged
cesspool.
SAS is in hydraulic failure.
(revised 0427197)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 625 Pitchers Way Hyannis
Owner: Trombley
Date of Inspection:816197
D] SYSTEM FAILS(continued)
Yes No
Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool.
Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow.
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Numbers of times pumped
Any portion of the Soil Absorption System, cesspool or privy is below the-high groundwater elevation.
Any portion of a cesspool or privy is within 100 feel 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for
coliform bacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen.
E] LARGE SYSTEM FAILS:
You must indicate either"Yes"or"No"as to each of the following:
The following criteria apply to large systems in addition to the criteria:
The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to
public health and safety and the environment because one or more of the following conditions exist:
Yes No
the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area (IWPA)or a mapped Zone II of a
public water supply well)
The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program
requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information.
(revised 04/27/97)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECLIST
Property Address: 625 Pitchers Way Hyannis
Owner: Trombley
Date of Inspection:816/97
Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following:
— Pumping information was requested of the owner,occupant, and Board of,Health.
x — None of the system components have been pumped for at least two weeks and the and the system has been receiving normal
flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this
inspection.
X As built plans have been obtained and examined. Note if they are'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.
— The site was inspected for signs of breakout.
X _ All system components,excluding the Soil Absorption System, have been located on the site.
x The septic tank manholes were uncovered,opened, and the interior of the 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
The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of
x Sub-Surface Disposal Systens.
— Existing information. Ex. Plan at B.O.H.
X Determined in the field(if any failure criteria related to Part C is at issue, approximation of distance is
unacceptable)(15.302(3)(b)]
(revised 064/27/97)
f
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 625 Pitchers Way Hyannis
Owner: Trombley
Date of Inspection:8/6/97
FLOW CONDITIONS
RESIDENTIAL:
Design flow: 330 g.p.d./bedroom for S.A.S.
Number of bedrooms: 3
Number of current residents: t
Garbage grinder(yes or no): No
Laundry connected to system(yes or no): Yes
Seasonal use(yes or no): No
Water meter readings,if available:(last two(2)year usage(gpd):
n/a
Sump Pump(yes or no): No
Last date of occupancy: n/a
COMMERCIAL/INDUSTRIAL:
Type of establishment: n/a
Design flow:0 gallons/day
Grease trap present:(yes or no) No
Industrial Waste Holding Tank present: (yes or no) No
Non-sanitary waste discharged to the Title 5 system: (yes or no) No
Water meter readings,if available: We
Last date of occupancy: n/a
OTHER: (Describe) n/a
Last date of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and source of information:
System was last pumped in 1994
System pumped as part of inspection: (yes or no)No
If yes,volume pumped: 0 gallons
Reason for pumping: n/a
TYPE OF SYSTEM
X Septic tank/distribution box/soil absorptions system
Single cesspool
Overflow cesspool
Privy
Shared system(yes or no) ( if yes, attach previous inspection records,if any)
I/A Technology etc. Copy of up to date contract?
Other:
APPROXIMATE AGE of all components,date installed(if known)and source information:
1977 original with new pit and d•box installed in 1994
Sewage odors detected when arriving at the site: (yes or no) No
(revised 04/27/97)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 625 Pitchers Way Hyannis
Owner: Trombley
Date of Inspection:8/6/97
SEPTIC TANK: X
(locate on site plan)
Depth below grade: 16'
Material of construction:X concreate metal_FRP_Polyethylene_other(explain)
If tank is metal, list age 20 . Is age confirmed by Certificate of Compliance No (Yes/No)
Dimensions: L B'6'H 5'7'W 4'10'
Sludge depth:2"
Distance from,top of sludge to bottom of outlet tee or baffle: 25"
Scum thickness:1"
Distance from top of scum to top of outlet tee or baffle:6"
Distance form bottom of scum to bottom of outlet tee or baffle: 17"
How dimensions were determined: Measured
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.)
Septic tank and all components are structurally sound.Recommend pumping septic system every two years for maintenance.
GREASE TRAP:_
(locate on site plan)
Depth below grade: n/a
Material of construction: _concrete_metal_FRP Polyethylene_other(explain)
Dimensions: n/a
Scum thickness:n/a
Distance from top of scum to top of outlet tee or baffle:n/a
Distance from bottom of scum to bottom of outlet tee or baffle: n/a
Date of last pumping,va
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.)
n/a
BUILDING SEWER:
(Locate on site plan)
Depth below grade: 2'
Material of construction:_cast iron X 40 PVC_other(explain)
Distance from private water supply well or suction linellown
Diameter: a'
tn/amments:(conditions of joints,venting, evidence of leakage,etc.)
(revised 04/27/97)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 625 Pitchers Way Hyannis
Owner: Trombley
Date of Inspection:816/97
TIGHT OR HOLDING TANK:
(locate on site plan)
Depth below grade: n/a
Material of construction:_concrete_inetal_FRP_Polyethylene_other(explain)
Dimensions: n/a
Capacity: n/a gallons
Design flow: We gallons/day
Alarm level:—n/a Alarm in working order?_Yes_No
Date of previous pumping:
Comments:
(condition of inlet tee, condition of alarm and float switches, etc.)
n/a
DISTRIBUTION BOX: X
(locate on site plan)
Depth of liquid level above outlet invert: Liquid level with bottom of pipe.
Comments:
(note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box etc.)
D-box is structurally sound.
PUMP CHAMBER:
(locate on site plan)
Pumps in working order:(yes or no)No
Alarms in working order(yes or no)Yes
Comments:
(note condition of pump chamber,condition of pumps and appurtenances, etc.)
n/a
(revised 04127197)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 625 Pitchers Way Hyannis
Owner: Trombley
Date of Inspection:816/97
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:
n/a
Type:
leaching pits, number: 2-1,000 gallon leach pits
leaching chambers,number:n/a
leaching galleries, number: n/a
leaching trenches,number, length: n/a
leaching fields, number, dimensions:n/a
overflow cesspool, number:n/a
Alternate system: n/a Name of Technology:_n/a
Comments:(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
The leach pits are structurally sound and functioning properly.The new pit was empty at the time of the inspection.
CESSPOOLS:_
(locate on site plan)
Number and configuration: n/a
Depth-top of liquid to inlet invert: n/a
Depth of solids layer: n/a
Depth of scum layer: n/a
Dimensions of cesspool: n/a
Materials of construction: n/a
Indication of groundwater: n/a
inflow(cesspool must be pumped as part of inspection)
n/a
Comments:(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.)
We
PRIVY:_
(locate on site plan)
Materials of construction: n/a Dimensions: n/a
Depth of solids: n/a
Comments:(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
n/a
(revised 04/27/97)
V r
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Properly Address: 625 Pitchers Way Hyannis
Owner: Trombley
Date of Inspection: 9J6197
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references, landmarks or benchmarks
locate all wells within 100'(Locate where public water supply comes into house)
ae
Otc
0 � A
G�
GO
37
�� 36
�c 36
(revised 04127l97) Pogo 9 of 10
L
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 625 Pitchers Way Hyannis
Owner: Trombley
Date of Inspection: 9/6/97
Depth to Groundwater 12+ Feet
Please indicate all the methods used to determine High Groundwater Elevation:
Obtained from Design Plans on record
Observation of Site IAbuttrng property, observation hole, basement sump etc.)
Determine it from local conditions
Check with local Board of health
Check FEMA Maps
Check pumping records
Check local excavators, installers
x Use USGS Data
Describe in your own words how you established the High Groundwater Elevation. (MUST be completed)
USGS Maps and Charts
(revised 04/27/97) Pays 10 of 10
1 TOWN OF BARNSTABLE
L` :ATION 2,5" ,�01�7G'f:eiQS' WA y SEWAGE # 3 2
VILLAGE ,AAIAI�.S' ASSESSOR'S MAP LOT274-"4�?yl
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INSTALLER'S NAME & PHONE NO. C 0Al/.3�� t SBit/
SEPTIC TANK CAPACITY !f (b D
LEACHING FACILITY:(type) (size) A 0 00
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER
Wft-DEA OR OWNER 0 '0'ov
DATE PERMIT ISSUED: �'�G°r��-
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No L'
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No..... a-..�-.M�M Finc $....30.•00
APPRO THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
OWN OF BARNSTABLE
ppliratiult for Diripoi3ttl Workii Tomitrur#tun ramit
Application is hereby made fora Permit to Construct ( ) or Repair (XX) an Individual Sewage Disposal
System at:
� 625 Pitchers Way Hyannis .
..............................•---•------......_....----._...--------------------•-•---•-••_------ -•--•----•--------------------•-••-•-----•----....------........._........-•-••-•----••••---_...--
Trombley Location-Address or Lot No.
Owner Address
W J .P.Macomber Jr.
Installer Address
Type of Building Size Lot............................Sq. feet
Dwelling-X-No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ---------------------------- No. of persons-_-_----_-----__-_-_--..---- Showers ( ) — Cafeteria ( ' )
a' Other fixtures ------------------------------- - -
W Design Flow............................................gallons per person per day. Total daily flow--------------------------------------------gallons.
WSeptic Tank—Liquid capacity............gallons Length---------------- Width---------_---.- Diameter----..-_----.-- Depth-_-_-_-_--_-----
x Disposal Trench—No- -------------------- Width-------------------- Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No--------------------- Diameter-----.----..--.-.--. Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
a
a Test 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........................
R+' ----------•-------------------------------------------------------------•-------------------._...---.........................................................
0 Description of Soil........................................................................................................................................................................
Sand & Gravel
V ----------
----------------------------------------------------------------------------------------------------------------------------------------
-------------------------------
•-•-----------------
W
V Nature of Repairs or Alterations—Answer when applicable------------------------------------------------------------------------------------------------
1-1-Q Q Q----gia-1.1 Q>'z_._l-=K a ch.._p t---1:ndi..s tz i_3 ati-an.._box.-------------------------------------------------------------------------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with,
the provisions of TITLE 5 of the State Environmental Code —The undersigned further agrees not to place the
system in operation until a Certificate of Complia ce has be i ue by the b rd f health.
Signed 6-/1.6./9 4--------:.. .
.......... ...............
20 ce
Application Approved BY g'--- �--��.`...7
-------- ----- ------ .............
Dace
Application Disapproved for the following reasons- ----------- ----- - ........ ..---------------------------------------------------------------------- ------------------
. ............................................................ --------------- ------------- ---------------......-------------------------- -------------- ------ �............----------------------------
Permit No. .. ........ n � / `.
- - ----- � ----------------- Issued ..... -- ---- -----------
Dare
No. � ✓-- Final....30.00...
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliration for-Dhripnittl Worlai Towitrurfilart rami#
Application is hereby made for a Permit to Construct ( ) or Repair (}fig) an Individual Sewage Disposal
System at:
4-' 625 Pitchers Way Hyannis .
................................................................................................. ------•-------•----•--•-••-----•-•------....-----•---..........--•--------•--------•--.........•--
Location-Address or Lot No.
Trombley
Owner Address
aJ....Macomber Jr.
9Q Installer Address
UType of Building Size Lot............................Sq. feet
Dwelling-X- No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( )
aOther—Type
of Building ---------------------------- No. of persons------------------------.... Showers ( ) — Cafeteria ( )
dOther fixtures --------------------------------------------------------------------------------------- --------------------------------------------------------•----
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity............gallons Length................ Width---------------- Diameter---------------- Depth................
x Disposal Trench—No- -------------------- Width-------------------- Total Length-------------------- Total leaching area....................sq. ft.-
Seepage Pit No..--.---_ ---------- Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by-------------------------------------------------------------------------- Date........................................
W
Test 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....-----_---..........
04 ---------------------------------------------•-----------------•------------.......-----------...............................................................
ODescription of Soil.....................................................................................--................................................................................
W Sand & Gravel
U ------------------------•---------------------------•----------------------------------------------------------------------------------------------------------......................................
W
Z. .......................... ------------------------------ ---------------------------------------------------------------------------------•------------------•--------------------------...............
U Nature of Repairs or Alterations—Answer when applicable...............................................................:................................
1-100Q---gallon leach--pit 1-distributi-on- box.
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Compliance has been issued by the board f health.
f/
Signed .. ., `.`� f a'— - .._..... -- 6/16/94
f }/
Application Approved BY 1- —mot .. -G-- - -------`- /----/------ ------7
- €�..
Date
Application Disapproved for the following reasons- ........................................ ----------------------------------------------------------------------------------------------
----------------------------------------------------------------------------------------/----------------------------- ------------------------------------------------------------------------------------- ........................................
D�te
Permit No. --'-------" �`--?7-------------------- Issued ..---------o4!5"'-- /��------
Dare `
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Ger#ifirate of Complinure
TTHIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (KXX )
by J.P.Macomber Jr.
625 Pitchers Way Hyannis . - -at ----- -...._------------------------------------------------------ -
..
has been installed in accordance with the provisions of TITLE a of The � �nvaronmental Code as de cribe� in
the application for Disposal Works Construction Permit No. �..j�`------!P . 24_. dated .. ------- .... .
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE ..... ..... .._._.. ".... -- - Inspector .... - 4t1
--------------------------------------------- -------------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
. � TOWN OF BARNSTABLE $ 30.00
7 FEE........................
Dispop tl Works Tunotrur#ion f rrmit
J P Macomber Jr .
Permissionis hereby granted-------'----------------------------------------------------------------•--------------------------------.....----------•---.............
to Construct ( ) or Repair (XX)Xan Individual Sewage Disposal System
at No. 25 Ditchers Way Hyannis
Stre // �� /�_ /
as shown on the application for Disposal Works Construction Permi .-:n:�------------- Dated----.-��--.----<- "
Board of Health
DATE....... ........................... .. ..........................
FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS
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..............,....
ASSESSOtiS MAP : Z7p
- TEST HOLE LOG34
PARCEL : -
v 1) The insliillation shall caiili.,, wall Tillc V and 'Town of - hoard ol.
, I leallli Iteguladons.
FLOOD ZONE: So I L EVALUATOR :
cam- �� �. c. 2) The installer shall verify the location of'ulililies, sewer inverts and septic
WITNESS . G.-�I � �
REFERENCE: coin )onents prior to installation and selling; base elevations.
6 kf,. f0 27 f� - �� DATE:
_ 3), All gravity septic piping to be 4 inch Sch 40 PVC at 1/8"per lirol.The first
-
PERCOLATION� RATE:-.—` two leet out of the d-box to the leaching shall be level.
nA
�� - x •c- *�' \ � t 4)' This plan is not to be utilized for property line determination nor an other
Tt-1- 1 TI-1-2 purpose other than the proposed system installation.
5) All septic components must meet Title V specifications.
I �11 LID ! 6) Parking shall not be constructed over 1110 septic compoueuls.
>�l 71 7) The property is bounded by property corners and property lines.
8) The property owner shall review design considerations to approve of total
LOCATION MAP 517� design flow and number of bedrooms to be considered for design. Iteceipt
of payment fir the plan and installation based on the plan shall be deemed
approval of the design flow by the owner.
9) The existing leaching or cesspools shall be pumped and filled with material
�t per Title V abandonment procedures. Those within the proposed SAS shall
be removed along with contaminated soil and replaced wilh clean sand per
*` Title V specs.
I � � 9& 10)System components to be 10 feet from water line. Sewer lines crossing (lie
water line shall be sleeved with 4 inch SCI 140 PVC with ends grouted if
applicable. The proposed SAS is being installed below the water service
_ } I line. The line is to be sleeved as aforementioned and maintained in place
l) If a garbage grinder exists it is to be removed and is the responsibility of the
�____ SEPT I C SYSTEM DES I G N
-1E 17r owner to ensure such.
- 0
/ 12)The installer is to take caution in excavation around the gas line if such
( FLOW ESTIMATE 1 exists.
00 ,' ? K 1 r 13)The installer shall verify the location, quantity and elevation of the sewer
BEDR QMS AT � GAL/DAY/BEDROOM -� GAL/DAY lines exiting (lie dwelling prior to the installation.
14)This plan is representative only that a system can fit oil a property meeting
D Q SEPTIC TANK 'Title V requirements.
ID ° GAL/DAY x 2 DA lS - GAL
Mla' o —� USE IOMOALL014 SEPTIC TANK(Lf;4'AT?
10 , SOIL ABSORPTION SYSTEM
ys
' fl
I s )
SIDE AREA: �-' 5 �$�' - a
�lE�7 MASON n
C7 ~i
BOTTOM AREA: 2 ' x � I 2 `' s � ,
i' �-'""M' s r
C 'SYSTEM SECTION
ICU tit��a >� ,� " ---_�__ �. 0 •
COXl�j] i It,t 6'�
► � U ID I 9,w1
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1
GAL ��t� _
SEPTIC TAN 11)v
lef
Z ' �w� Ho dui 36t I
SITE AND SEWAGE PLAN
o LOCAT I mi : �2 -Ff-F&H066 W
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PREPARED FOR : �Tl
SCALE:
DAV I D B . MASON,F\5 DA*IE: 8 Z5
DBC ENVIRONMENTAL DESIGNS
EAST SANDWICH . MA
DATE HEALTH AGENT ( 508 ) 833- 2177