HomeMy WebLinkAbout1101 PITCHER'S WAY - Health 1101 Pitchers Way (Hyannis) 77M
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TOWN OF BARNSTABLE V
LOCATION A/D P, /-cA ers Lt/a v SEWAGE# ®CP7
VILLAGE Igaht S ASSESSOR'S MAP&PARCEL 17 3 _ �D
INSTALLER'S NAME&PHONE NO.
SEPTIC TANK CAPACITY I10D0 /f
LEACHING FACILITY:(type) /}-ram+ /f c (size) 0 3' x 30
NO.OF BEDROOMS 3 `
OWNER � f"1c {��►�f' 'C n n
PERMIT DATE: , l`-(-CD COMPLIANCE DATE: 'I -2e>ZAZI 0°I
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility /P& f� . 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 OAftw i t-L e4a f n 6e) �.\ L
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No. Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
Application for Miow6aY *pgtem Cow5tructiou Permit
Application for a Permit to Construct Repair) Repair(>k Upgrade( ) Abandon( ) ❑ Complete System X Individual Components
Location Address or Lot No. 116 1 a P'i-L Owner's Name,Address,and Tel.No. R-he✓rra Q tjA✓er*? 1445 pr
Assessor's Map/Parcel a-7 3
Installer's Name,Address,and Tel.No. 1.d(u" t"4. 04vf661> Designer's Name,Address and Tel.No. I G L+td
(70 3oV- 7(.3 ZtS, C.!/�.�C3tM t 7
CLve-TE/t t/i t k_ dw r r w,ct rr to
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size l S, I i ± sq. ft. Garbage Grinder ( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 3 3 o gpd Design flow provided 34,
`t(o • 3 gpd
Plan Date 7—a - 011 Number of sheets Revision Date
Title 110 k Q iTJ,� 5 t A)AA,Size of Septic Tank nrl SJI,( _Qj( rS;kN . Type of S.A.S.CZ)
Description of Soil lvyv\ a, C, 91 CID 30'r
Nature of Repairs or Alterations(Answer when applicable) 61 s C 1000 ; 44 f M,c L I b I
1 O A CZ ) S rz L J eSS f Z A 'Z. c
13ia rJ I�>��5
Date last inspected: 2 D 01rj
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
Signed Date 7— /® ZO b 9t
Application Approved by Date 7—/If—
Application Disapproved by: Date
for the following reasons
Permit No. O�� _ ®� Date Issued
f p ff� l
�OQO� r}nvNo. lP Fee
' THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: jj
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ' Yes i
. i
2pplication for Xkoogal 6p6tem' Zonttruction Permit i
Application for a Permit to Construct( ) Repair(A Upgrade( ) Abandon O El Complete System Individual Components
Location Address or Lot No. 110 1 /- f 1-C r S Vj Owner's Name,Address,and Tel.No. /?o hevro 1445 nl2
I••E�/1wllis
Assessor's Map/Parcel a—7 3 zo3 5.1m
Installer's Name,Address,and Tel.No. CAPlAv,rift jn 1)*y Desigger's Name,Address and Tel.No. L C a
(90 6aV -7(03 715T4 e r4nL."
CGvt1L�/2t�ir(� t�/1f( G✓r!/rR//ars,
Type of Building:
Dwelling No.of Bedrooms �. Lot Size �Sl ( 19 sq. ft. Garbage Grinder ( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 330 gpd Design flow provided 3 3 gpd
Plan Date -7- a - on
Number of sheets It Revision Date
Title (�O k S (,,�h ,
Size of Septic Tank ( opt) 5,,A ( Q-Y, rSr �XK Type of S.A.S.C2> S)a'v PA-t3S T
Description of Soil C- 30
Nature of Repairs or Alterations(Answer when applicable) LY<S 1�1 1000 � � � �<►v+ C 1�
S A 2 c. 3 c. !-/ C
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
0* 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.
Signed Date 7- /O - 2009
_3 Application Approved by S Date
Application Disapproved by: Date
for the following reasons
Permit No. 02 00� - 0� Date Issued -1 11 O /
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS,
_ (Certificate of Compliance
THIS IS TO CERTTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired Upgraded ( )
Abandoned( )by ` C-4 02W i J e- 6 v1 T e,r Ar t S G L<.
at /l U/ /'i i t(q t✓S L.-)4 y 14-y#4 d/✓l i S has been constructed in accordance q
with the provisions of Title 5 and the for Disposal System Construction Permit No. ;Z 409- 9 0 q dated
Installer d✓-l(�&W,Itt 04V Q✓r�-Gy Designer J l• C V1 ►?C
#bedrooms 3 Approved de ' n fl, Z'�ae gpd
The issuance of this permi`shall of be construed as a guarantee that the system 11 fun tion as d�26
Date '� �9 Inspector 11N•
1
--------- ---------- ————--
a
No. g06 1 — PO-1Fee 00
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION — BARNSTABLE, MASSACHUSETTS
'Wi5po5al *pgtem Couttruction Permit
Permission is hereby granted to Construct ( ) Repair (>() Upgrade ( ) Abandon ( )
System located at //U / P/T< GI C.►'S W t4�/ �-��% ✓1✓) i 6
and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty
to comply with Title S and the following local provisions or special conditions.
Provided: Construction must be completed within three years of the date of this ps
Date -7- )Lf' � Approved by
P
town of oarnstame
Regulatory Services
s RAa "Le, 1 Thomas F, Ooiler, Director
Public Health Division
Thomas McKean, Director
200 Mahn Street,BMWs, MA 02601
'Zoo q - zo5
Office: 508-862•4644 Fax: 50-790-6304
I staller esl CUT c on Forth
Date:
Deslgtaer: installer: It,tk-, Enher�resv_�
Address: _ zF,.SY Ccr,ibe-c--r f4i.qViwo
Address:
Cask..Woce4i amp R �Z=�3�.i,.. G2,w4-M.—Y
On Y�-I�l- L009 a 2lo3Z
�•-. � _ 2___was issued a permit I o install a
(installer)
septic system at t 10 t Echc is ��I- based on a design drawn by
(address)
L �� �Cecc �►G. dated Ju ty ti l uv
(designer) _ 1..._-•------
. 3�
✓�I certify that the septic system i•cf'erenced above was installed substantially according to
�.a the design, which may include minor approved changes such as lateral relocation.o£thfi
distribution box and/or septic tank.
I certify that the septic system referenced above was installed with major changes (t.e
greater than 10' lateral relocation of the SAS or any vertical.relocat:,on of any component
of the septic system) but in accordance with State & Local Regulations. Plan revision o:
certified as-built by designer to follow.
101•1"2 t-CHQR
alley' Si a�urt) ;R
IVIL
ll8t)7
(Designer's-Si c) (Affi es g amp Herej��
PLEASE HARK L ri C IS 1V. CE IFI 'ATE;
F CO L C L N L A
Bt T ,� �' I'V SION
.h . YOU.
Q: Health/Septic/Desiper C.e►iification FotTn
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TA •A J QCGI 41 7 P n a "MTN=I=I !T�IW-4nr I.IH F.CA 0T C.GG7-77-1nr
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Town of Barnstable P# 21
Department of Regulatory Services
Public Health Division Date 6 (OVU
��fD tYton"�� 200 Main Street,Hyannis MA 02601
Date Scheduled V Time Fee Pd. —
Soil Suitability Assessment for Se a is osal
u n p
Performed By: `t,f�eA `l m en (=j� C S C tv
y Witnessed By: ✓1
LOCATION& GENERAL INFORMATION
Location Address !c, Owner's Name i p�T�Lt ors w Ay.
4 G1Y1d1f y Address 5�'Vrti2
Assessor's Map/Parcel; Z, 7 3/2 'L / Engineer's Name Crii.e�,.l wtv�vt]c,
NEW CONSTRUCTION REPAIR y Telephone# 501E�%_(1224 U 2d
Land Use gym` ' (o+mi(y Slopes(R'o) 1'Z Surface Stones '
Distances from: Open Water Body — ft Possible Wet Area ft Drinking Water Well ft
Drainage Way _ ft Property Line 710 ft Other ft
SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes)
sew
Parent material(geologic) CO ku'[a5(A Depth to Bedrock 712(o (OS 5
Depth to Groundwater. Standing Water in Hole: _*55 Weeping from Pit Face
Estimated Seasonal High Groundwater 7 12 6" �0%5
DETERMINATION FOR SEASONAL HIGH WATER TABLE
Method Used: DytC-H 605e,0JOAtOet
Depth Observed standing in obs.hole: -7 I Z('_ „e in, Depth to sell mottles., 7(2b in.
Depth to weeping from side of obs.hole: .7 (Z°4 in, . Oroundwater Adjustment��zk ft.
Index Well# o Reading Date: Index Well,level Adj,factor_� Adj.Groundwater Level R
PERCOLATION TESL' mute `7 6-v9 Thne /Q yrr
Observation
Hole# Time at 9"
Depth of Perc y$4 Time at 6"
Start Pre-soak Time @ �V/ A Time(9"-6")
End Pre-soak
Rate MinJlnch L
Site Suitability Assessment: Site Passed V Site Failed: Additional Testing Needed(Y/N) N
Original: Public Health Division C 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:\SEPTIC\PERCFORM.DOC
1
DEEP-OBSERVATION HOLE LOG Hole# I
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
CousistencX.%Gravel)
A 31, —
16- 3d LS /(9 Yr SIb
loose
DEEP OBSERVATION HOLE LOG Hole# 2-
Depth from• Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
Consistency,%Gravel)
a- _ F1 41
ld-3� 3 GS b0Yr s6 - p-/3 o jeo-e-(
ZO Zlo L NS 2.5 Y 6�� - $-1 1d J,rave l
.
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 Hole#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
ns'stcricy,
.t
Flood Insurance Rate Maa:
Above 500 year flood boundary_ No_ Yes
Within 500 year boundary No ✓ Yes
Within 100 year flood boundary No ✓ , Yes-
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the
area proposed for the soil absorption system? je.5
If not,what is the depth of naturally occurring pervious material? ,.�
Certification
I certify that on 10-2,7-9.9 (date)I have passed the soil evaluator examination approved by the
Department of Environmental Protection and that the above analysis was performed by me consistent with ;.
the required training,expefi,a an xperience described in 310 CUR 15.017.
Signature Date -0
Q:\.S.EPTIC1PERCFORM.DOC
COMMONWEALTH OF MASSACHUSETTS
f EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL
. � e c
7 R
W�
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1,4 SVOv
jUg 2 7 2001
TOWN OF BARNSTABLE
HEALTH DEPT.
TITLE 5
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM v/
PART A
CERTIFICATION
Property Address: 1101 Pitchers Way
Hyannis,MA
Owner's Name: Jackie Judge _
Owner's Address: 1101 Pitchers Way
Hyannis,MA
Date of Inspection: 6/19/01
Name of Inspector: (please print) Mr.Carmen E. Shay
Company Name: Shav Environmental Services,Inc.
Mailing Address: 34 Thatchers Lane
East Falmouth,MA 02536
Telephone Number: (508)-548-0796
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 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:
�H OF
XX Passes
Conditionally Passes
Needs Further Evaluation by the Local Approving Authori E.
Fails h
Inspector's Signature: Date: 6/19/01
s
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.
Notes and Comments
1.5' effective depth available at time of inspection. Evidence of liquid level being 6" higher in Leach Pit.
****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. "
Title 5 Inspection Form 6/15/2000 page 1
Page 2 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 1101 Pitchers Way
Hyannis,MA
Owner: Ms.Jackie Judge
Date of Inspection: 6/19/01
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. System Passes:
XX I have not found any information which indicates that any of the failure criteria described in 310 CMR
15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below.
Comments:
B. System Conditionally Passes:
One or more system components as described in the"Conditional Pass"section need to be replaced or
repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass.
Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined"please
explain.
The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally
unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the
existing tank is replaced with a complying septic tank as approved by the Board of Health.
*A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance
indicating that the tank is less than 20 years old is available.
ND explain:
Observation of sewage backup or break out or high static water level in the distribution box due to broken or
obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with
approval of Board of Health):
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
ND explain:
The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will
pass inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
ND explain:
Page 3 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 1101 Pitchers Way
Hyannis,MA
Owner: Ms.Jackie Judge
Date of Inspection: 6/19/01
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(l)(b)that the
system is not functioning in a manner which will protect public health,safety and the environment:
_ Cesspool or privy is within 50 feet of a surface water
_ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the
system is functioning in a manner that protects the public health,safety and environment:
_ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a
surface water supply or tributary to a surface water supply.
_ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply.
The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well.
_ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a
private water supply well". Method used to determine distance
"This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform
bacteria 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,provided that no other .
failure criteria are triggered.A copy of the analysis must be attached to this form.
3. Other:
i I
Page 4 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 1101 Pitchers Way
Hyannis,MA
Owner: Ms.Jackie Judge
Date of Inspection: 6/19/01
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or"no"to each of the following for all inspections:
Yes No
Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
clogged SAS or cesspool
Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool
Liquid depth in cesspool is less than 6"below invert or available volume is less than '/2 day flow
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 coliform bacteria and volatile organic compounds
indicates that the well is free from pollution from that facility and the presence of ammonia
nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria
are triggered. A copy of the analysis must be attached to this form.]
(Yes/No)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.
You must indicate either"yes"or"no"to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
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.
S,
Page 5 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 8 Thoreau Drive
Centerville,MA
Owner: Mr. Richard McQuire
Date of Inspection: 1/24/01
Check if the following have been done. You must indicate"yes"or"no"as to each of the following:
Yes No
XX Pumping information was provided by the owner,occupant,or Board of Health
XX Were any of the system components pumped out in the previous two weeks ?
XX _ Has the system received normal flows in the previous two week period`?
XX Have large volumes of water been introduced to the system recently or as part of this inspection ?
N/A Were as built plans of the system obtained and examined?(If they were not available note as N/A)
XX _ Was the facility or dwelling inspected for signs of sewage back up?
XX _ Was the site inspected for signs of break out?
XX _ Were all system components,excluding the SAS, located on site?
XX _ 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 ?
XX _ 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:
Yes no
XX _ Existing information. For example,a plan at the Board of Health.
XX _ 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(3)(b)]
d
k
Page 6 of I 1
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 1101 Pitchers Way
Hyannis,MA
Owner: Ms.Jackie Judge
Date of Inspection: 6/19/01
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): 3 Number of bedrooms(actual): 3
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330
Number of current residents: 0
Does residence have a garbage grinder(yes or no): No
Is laundry on a separate sewage system(yes or no): 'No [if yes separate inspection required]
Laundry system inspected(yes or no):_
Seasonal use: (yes or no): No
Water meter readings, if available(last 2 years usage(gpd)):
Sump pump(yes or no): No
Last date of occupancy: Currently Unoccupied-Unknown
COMMERCIALANDUSTRIAL
Type of establishment:
Design flow(based on 310 CMR 15.203): gpd
Basis of design flow(seats/persons/sgft,etc.):
Grease trap present(yes or no):_
Industrial waste holding tank present(yes or no):_
Non-sanitary waste discharged to the Title 5 system(yes or no):
Water meter readings, if available:
Last date of occupancy/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information: None Available
Was system pumped as part of the inspection(yes or no):_
If yes, volume pumped: 1,000 gallons--How was quantity pumped determined? measured
Reason for pumping: Soilds&Scum heavy and could not see tank baffles properly
TYPE OF SYSTEM
XX 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)
_Tight tank _Attach a copy of the DEP approval
_Other(describe):
Approximate age of all components,date installed(if known)and source of information:
1973- per Owner&BOH Records
Were sewage odors detected when arriving at the site(yes or no): No
' f
.I
Page 7 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 1101 Pitchers Way
Hyannis,MA
Owner: Ms.Jackie Judge
Date of Inspection: 6/19/01
BUILDING SEWER(locate on site plan)
Depth below grade: 18"
Materials of construction: cast iron XX 40 PVC_other(explain):
Distance from private water supply well or suction line:
Comments(on condition of joints,venting, evidence of leakage,etc.):
SEPTIC TANK: XX (locate on site plan)
Depth below grade: 18" to tank top
Material of construction: XX concrete_metal_fiberglass_polyethylene
—other(explain)
If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of
certificate)
Dimensions: 5' deep x 5'wide by 8' long (1,000 gallons)
Sludge depth: 1.5'
Distance from top of sludge to bottom of outlet tee or baffle: 6"
Scum thickness: 4 inches scum layer noted
Distance from top of scum to top of outlet tee or baffle: scum almost up to top of baffle
Distance from bottom of scum to bottom of outlet tee or baffle: 12"
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.):
Structural integrity of tank was ok. No evidence of cracks, leaks, or water infiltration/eAltration. Baffles present at inlet
end. Outlet baffle present and in good condition. Liquid level equal with outlet invert.
GREASE TRAP:_(locate on site plan)
Depth below grade:_
Material of construction:_concrete_metal_fiberglass_polyethylene_other
(explain):
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
Date of last pumping:
Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels
as related to outlet invert,evidence of leakage,etc.):
r
t
Page 8 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 1101 Pitchers Way
Hyannis,MA
Owner: Ms.Jackie Judge
Date of Inspection: 6/19/01
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: gallonslday
Alarm present(yes or no):
Alarm level: Alarm in working order(yes or no):
Date of last pumping:
Comments(condition of alarm and float switches,etc.):
DISTRIBUTION BOX: Not Present (if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert:
Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover, any evidence of
leakage into or out of box,etc.):
PUMP CHAMBER: (locate on site plan)
Pumps in working order(yes or no):
Alarms in working order(yes or no):
Comments(note condition of pump chamber, condition of pumps and appurtenances,etc.):
Page 9 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 1101 Pitchers Way
Hyannis,MA
Owner: Ms.Jackie Judge
Date of Inspection: 6/19/01
SOIL ABSORPTION SYSTEM(SAS): XX (locate on site plan,excavation not required)
If SAS not located explain why:
Type
XX leaching pits,number: 1
leaching chambers, number:
leaching galleries,number:
leaching trenches,number, length:
leaching fields,number,dimensions:
overflow cesspool,number:
innovative/alternative system Type/name of technology:
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation,
etc.): No evidence of hydraulic failure,ponding damp soil or stressed vegetation. Excavated cover and
inspected pit—1.5'effective depth available. No evidence of past hydraulic Failure noted. Liquid level
has been 6" higher than at time of inspection.
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 or no):
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
PRIVY: (locate on site plan)
Materials of construction:
Dimensions:
Depth of solids:
Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,etc.):
Page 10 of I 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 1101 Pitchers Way
Hyannis,MA
Owner: Ms.Jackie Judge
Date of Inspection: 6/19/01
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or
benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building.
Pitchers Way
Swing Ties:
A- Tank In— 16'
B- Tank In—33'
Exist House
A-Tank Out—21'
B -Tank Out—37'
A B A- -Leach Pit-28'
B—Leach Pit-44'
O Septic Tank
(1000 Gal.)
O
O Leach Pit
i
,„�,, 10
Page l l of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 1101 Pitchers Way
Hyannis,MA
Owner: Ms.Jackie Judge
Date of Inspection: 6/19/01
SITE EXAM
Slope
Surface water - '/z mile+/-
Check cellar -Yes
Shallow wells—None
Estimated depth to ground water Over 15' feet
Please indicate(check)all methods used to determine the high ground water elevation:
Obtained from system design plans on record-If checked,date of design plan reviewed:
XX 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)
XX Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
Checked with Quadrangle of USGS Map
...........
PROVIDE PRECAST CONCRETE GENERAL NOTES
T.O.F. EL.= 66.8'+- EXTENSION RISER WITH CONCRETE INISH GRADE OVER D-Box= 66.0'+- 4"SCHEDULE 40 PVC MIN. SLOPE 1 % FINISHED GRADE OVER DIFFUSERS = 65.3' - 65.9-
COVER TO WITHIN 6"OF F.G. OVER SLOPE @ 2% MIN.
INLET AND OUTLET COVERS. REMOVABLE WATER-TIGHT COVER OVER INSPECTION PORT WITH ACCESS BOX TO 1. UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION
FINISH GRADE RISER TO WITHIN 6"OF FINISHED GRADE WITHIN 3-OF F.G. (ONE PER TRENCH) METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL
@ FND. EL.= 66.4'± FINISHED GRADE OVER TANK EL. 66.0'+ 5" DIA. OUTLET(S) CODE AND ANY APPLICABLE LOCAL RULES.
---------- ------------- 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE
DESIGN ENGINEER.
PROPOSED 4" 9" MIN. 3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL
EXISTING 4" 36"MAX. 9"MIN.
SEWER PIPE PVC SEWER PIPE 36"MAX. TOP OF SAS B.O. 63.13' SYSTEM UNLESS OTHERWISE NOTED.
6' 30 3" DROP MAX PROVIDE WATERTIGHT 4. TO PREVENT BREAKOUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN
2-DROP MIN 3" 9"
MIN.SLOPE 1% JOINTS(TYP.) ELEVATION =63.13' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS A
40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S.AND THE TOP OF
-F
10" C IN FROM
14" '\-*63.7'± SEPTIC TANK 4"PVC OUT TO 1.33' 16"TYP THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION.
O LEACHING FACILITY 0.90, (TYP.) 10.75"TYP 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM.
CONTRACTOR CONTRACTOR SHALL 12"71 12" 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL.
1 71 63.00'OUTLET TEE 63.1 MIN.
SHALL VERIFY SIZE 48' VERIFY CONDITION OF 62.701 61 .80' (LAID FLAT) -2.875-(34.5-) 5.75' 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK
AND CONDITION OF EXISTING TEES 22"ZABEL FILTER 6"CRUSHED STONE -... 5 0' (TYP.) FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS
EXISTING SEPTIC AND REPLACE AS MODEL#Al 801-4x22 OVER MECHANICALLY (TYP.) NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH
TANK NECESSARY (GAS BAFFLE ON BOT.) COMPACTED BASE 5'MIN. 11.50' AND DESIGN ENGINEER.
5 OUTLET DISTRIBUTION BOX 30.0' (TYP FOR BOTH TRENCHES) 8. ELEVATIONS BASED ON APPROXIMATE M.S.L. DATUM OF 68.00' ESTABLISHED
TO BE INSTALLED ON A LEVEL STABLE ON A NAIL SET IN A 12"OAK TREE AS SHOWN ON PLAN.
BASE. FIRST TWO FEET OF OUTLET GROUND WATER ELEV.= < 54.90' 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION
EXISTING 1,000 GALLON CONCRETE SEPTIC TANK PIPES TO BE LAID LEVEL. THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT
CROSS SECTION VIEW BIODIFFUSER (PROFILE) BIODIFFUSER (END VIEW) 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES
TO THE DESIGN ENGINEER.
*CONTRACTOR TO VERIFY EXISTING ELEVATION PRIOR SEPTIC TANK PROFILE DISTRIBUTION BOX DETAIL 12 ARC 36HC (#3616BD) BIODIFFUSERS
TO ANY WORK & NOTIFY ENGINEER IF DIFFERENT. NOT TO SCALE NOT TO SCALE NOT TO SCALE 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONC. STRUCTURES SHALL BE MADE WATERTIGHT.
11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING
TEST PIT DATA REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM
PERC NO. 12622 APPROPRIATE AUTHORITY.
14
INSPECTOR: David W.Stanton, R.S. 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS
LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE
EVALUATOR: Michael Pimentel, E.I.T.
n THEY SHALL WITHSTAND H-20 LOADING.
; C.S.E.APPROVAL DATE: Oct. 1999 -
•
13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES.
DATE: July 6, 2009
TEST PIT#: 1 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE
MAP 273 MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY.
ELEV TOP= 65.40'
REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY,
PARCEL 204-16
ELEV WATER= <54.90' FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3).
MAP 273
co5. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN
co PERC RATE < 2 min./inch
U) PARCEL 203 ZONE 2 SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK.
S70. PROPOSED DISTRIBUTION BOX DEPTH OF PERC 30"-48"
41,
'111� 16. PROPOSED PROJECT IS LOCATED WITHIN:
MAP 273 EXISTING 1000 GALLON SEPTIC it ASSESSOR'S MAP 273 PARCEL 202
TEXTURAL CLASS: 1
C%j -
"I PARCEL 202 TANK TO BE UTILIZED AS PART
0
0 AREA=1 5,119 S.F.± OF THIS DESIGN OWNER OF RECORD: ROBERTA P. & MARCIO A. KASPRZAK
M
z r ADDRESS: 1101 PITCHER'S WAY
1� -LU 1 015-- • 01 65.40'
MAP 273
CO Fill HYANNIS, MA 02601
65.07'
PARCEL 204-15 4" Loamy Sand
03 N _65-
A 1 OYr 3/1
10"
64.57' FEMA FLOOD ZONE C
PROP. TOTAL 12 ARC 36HC BIODIFFUSERS Loamy Sand
COMMUNITY PANEL# 2500010005 C
(6 BIODIFFUSERS EACH TRENCH) TP B 1 OYr 5/6
I
66x3 17. DEED REFERENCE: DEED BOOK 23106, PAGE 100
(10-15%gravel)
TP 2 66
65. 30" 62.90,
65.4! ; !g 18. PLAN REFERENCE: PLAN BOOK 271, PAGES 83&84
PROPOSED INSPECTION PORT WITH Perc
ACCESS BOX TO GRADE (TYP OF 2) 0 48" 61.40' 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION.
65x6 20, PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY
Medium Sand FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY
#1101 (5)
cr C FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE.
EXISTING PATIO & 2.5Y 6/6
SHE� A, PATIO 0)
LP B H. 3-BEDROOM Q oil. (5-10%gravel)
1 DWELLING 0-ft OF (loose)
I BIT. DRIVE
(0 TOF 66.8'±
CD C-)
65X5 DECK '0m LOCUS PLAN
APPROX. LOC. OF EXIST.j � -4
LEACH. PIT TO BE PUMPED & 0 co SCALE: 1" 1000' 126" 1 54.90'
FILLED WITH CLEAN COARSE GAS it
SAND & ABANDONED 65x8 No Mottling, Standing or Weeping Observed
Ln
0
66 0
DESIGN DATA TEST PIT DATA
LEGEND
PERC NO. 12622
MAP 273 INSPECTOR: David W.Stanton, R.S. 50X0 EXISTING SPOT GRADE
NUMBER OF BEDROOMS (DESIGN) 3
PARCEL 200 EVALUATOR: Michael Pimentel, E.I.T. 50 EXISTING CONTOUR
DESIGN FLOW 110 GAUDAY/BEDROOM C.S.E.APPROVAL DATE: Oct. 1999 50 PROPOSED CONTOUR
Benchmark DATE:
TOTAL DESIGN FLOW 330 GAUDAY July 6, 2009
0
Nail Set in 12"Tree DESIGN FLOW X 200 % 660 GAUDAY TEST PIT#: 2 E/T/C EXISTING UNDERGROUND UTILITIES
Elev. =68.00' GO)
Approx. M.S.L. USE EXISTING 1,000 GALLON SEPTIC TANK ELEV TOP = 65.40' D/H/W EXISTING OVERHEAD UTILITIES
0,
ELEV WATER= < 54.90' GAS EXISTING GAS LINE
MAP 273 PERC RATE EXISTING WATER LINE
rn INSTALL 12 - ARC 36HC (#3616BD) BIODIFFUSERS
DEPTH OF PERC
PARCEL201 4) TEST PIT LOCATION
SYSTEM CAPACITY TEXTURAL CLASS: 1
3) HC EXISTING 1,000 GALLON SEPTIC TANK
I
0 % (TOTAL L.F.OF BIODIFFUSERS)(7.8 SF/LF)(0.74 GPD/SQ.FT.)= GPD P70
(60.0')(7.8 SF/LF)(0.74 GAUSQ.FT.)= 346.3 GAL. LEACHING DAY 0. 65.40' PROPOSED 4"SOLID SCHEDULE 40 PVC PIPE
4' Fill 65.07'
Loamy Sand 13 PROPOSED DISTRIBUTION BOX
2) #1101 A
EXISTING TOTALS: 1 OYr 3/1 64.57'
BH B.H. 3-BEDROOIV1 10" Loamy Sand PROPOSED ARC 36HC (#3616BD)BIODIFFUSER
DWELLING TOTAL NUMBER OF BIODIFFUSERS: 12 B 1 OYr 5/6
TOF 66.8'i TOTAL NUMBER OF COUPLINGS: 0 (10-15%gravel)
TOTAL LEACHING AREA: 468.0 SQ.FT. 30" 62.90' DATE BY DESCRIPTION
TOTAL LEACHING CAPACITY: 346.3 GAL./DAY
PROPOSED SEPTIC SYSTEM UPGRADE
Medium Sand PREPARED FOR:
NOTE: C 2.5Y 6/6 CAPEWIDE ENTERPRISES
EFFECTIVE LEACHING AREA OF 7.80 SF/LF OBTAINED FROM THE (5-10%gravel)
DEPARTMENT OF ENVIRONMENTAL PROTECTION APPROVAL LETTER (loose) LOCATED AT
"MODIFIED CERTIFICATION FOR GENERAL USE" ISSUED TO
NOTE: ADVANCED DRAINAGE SYSTEMS, INC. ON OCTOBER 3, 2003(LAST 1101 PITCHER'S WAY
MODIFIED JULY 23, 2008). TRANSMITTAL NUMBER=W000052. HYANNIS, MA 02601
1.) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE
TOP EDGE OF EACH SEPTIC SYSTEM COMPONENT. SWING-TIES SCALE: 1'i--20' 126" 154.90' SCALE: 1 INCH = 20 FT. DATE: J U LY 8, 2009
V4 OF 0 10 20 40 80 FEET
I I I I I
DESCRIPTION HC BH No Mottling, Standing or Weeping Observed
2.) CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE J HN L. ------------- ------
CH RCHI L I PREPARED BY:
LOCATION OF THE PROPOSED LEACHING FACILITY TO ENSURE BIODIFFUSER CORNER(1) 223 24.2' RESERVED FOR BOARD OF HEALTH USE L 0 JC ENGINEERING, INC.
CONSISTENCY WITH TEST PIT DATA SHOWN ON THIS PLAN. BIODIFFUSER CORNER(2) 52.2- 49.0' 41
REPORT TO ENGINEER AND LOCAL BOARD OF HEALTH IF SOILS 2854 CRANBERRY HIGHWAY
ARE NOT CONSISTENT WITH TEST PIT DATA. BIODIFFUSER CORNER(3) 53.1' 54.5'
EAST WAREHAM, MA 02538
SITE PLAN BIODIFFUSER CORNER(4) 24.1- 33.9' 508.273.0377 -
3.) PROPERTY IS LOCATED WITHIN A DEP APPROVED ZONE 2. SCALE: 1"=20' Drawn By: MCP Designed By:MCP JLC JOB No.1639