HomeMy WebLinkAbout0122 STRAIGHTWAY - Health 122 Straightway Street
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A= 268-107
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TOWN OF BARNSTABLE
LOCATION o SEWAGE # O /
VILLAGE �/ �rl ASSESSOR'S MAP & LOT :
INSTALLER'S NAME&PHONE NO. �- �?�� J,✓,
SEPTIC TANK CAPACITY -A6W ZIM6 �-o
LEACHING FACILITY: (type) Z� /�✓ J� (size)
NO. OF BEDROOMS {/
BUILDER OR OWNER
PERMITDATE: COMPLIANCE DATE: L
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist,
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
r
1
o VIC\
�L
T
Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: - p�
PUBLIC HEALTH DIVISIOli- TOWN OF BARNSTABLE, MASSACHUSETTS Yet
21ppYitatiou for Misposal 6pstem Coustruttion jermit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. /ZZ J-4�*(n/ f Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel 26f 107
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.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd Design flow provided gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable Lo4J S�
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 p a the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
ed Date
Application Approved b Date 3
Application Disapproved by Date
for the following reasons
Permit No. Ly 9'0 Date Issued
3` f .. Mtx-.•--..nh+:�.Trr::o��,,,CAS,fi,,,.f.:......-•.�.;.,yry..:.:-+www- s•-r-..-.,r.... -.--,,,,.. .,. .,.. =a:Ks„•... �.rry...
�No. .-,� Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISId1 4_OWN OF BARNSTABLE,MASSACHUSETTS Yes
Witatiott for ]Disposal 6pstettt Construction jermit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑complete System
� R p y El Individual Components
Location Address or Lot No. Z Z _Ow/ner's Name,Address,and Tel.No.
Assessor's Map/Parcel 2 ��/�� / �/� n
Installbr's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
Type of Bu' ing:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd Design flow provided gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations Answer when applicable)A?,
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
- accordance with the provisions of Title 5 of.the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
Sighed f y7 �( Date
Application Approved bC Date ( "
Application Disapproved by Date
,.
for the following reasons
Permit No. C 1�? G/ Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On� �7_Se wage Disposal system Constructed( ) Repaired(-�p�Upgraded( )
Abandoned( )b`y
at /C 7 /I j { / has been construct d in aac/(ccoo,tdance
with the provisions o Title 5 annd`t e for disposal System Construction Permit No:d ) �t'p5dated
Installer U" l S �G '� Designer r4 7/i / gn �? P /
#bedrooms Approved design flow „A ° gpd
The issuance of this/permiishall n-t e construed as a guarantee that the system will funct�flas designed.! ,
Date I ' � /�i` Inspector !/ �1,� r /U
No. �C� �i ""`"',�� ,, Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
Misposat 6pstetn Construction Permit
Permission is hereby granted to Construct( ) Repaira'A
Upgrade( ) Abandon( )
System located at I22 0/f ti�
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.
fib'j'C}f
Provided:Construction must be completed within three years of the date of this permit. f `
Date / { 1 �� Approved by �� •� l � �__---^ -�
Town of Barnstable
Regulatory Services
4
Thomas F. Geiler,Director
snxxsrnsis.
MAM ��$ Public Health Division
1659.
'Foram" Thomas McKean,,Director
200 Main Street,Hyannis,MA 02601
Offce:. 508-862-4644 Fax: 508-790-6304
Installer&Designer Certification Form
Date: +e b .Sewage Permit# — 0 Assessor's Map\Parcel ���`✓ �
Designer: r Installer:
i
Address: . . A1W S Address: y 01Aj� S �
On Y was issued a permit to install a
at ) "taller)
septic system at J22- 4 based on a design drawn by
l / (address
dated o�
( es' fir)
I certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank. Stripout (if required) was inspected and the soils
were found satisfactory.
I certify that the septic system referenced above was installed with major changes (i.e.
greater than 10' lateral relocation of the SAS or any vertical relocation of any component
of the septic system) b ' accordance with State & Local Regulations. Plan revision or
certi d as-built by signer to follow. Stripout (if required) was inspected and the soils
w re and satisf ory.
�o@ WINSLOW �Gm
VI
nstaller S'gnature) M. �
cam, SPOFFORD a,
q #20363 4
�.�.FGISTE��O
,•
esigner's ign (Affix De—s'igffis Stamp Here)
PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTMCATE
/Z/Z 11A
OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-
BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.
THANK YOU.
QASeptic\Designer Certification Form Rev 03-09-06.doc
f
Town of Barnstable Barnstable
Regulatory Services Department seAmmieatty
iaaysrast.e,
' ►
� A,�� Public Health Division
200 Main Street, Hyannis MA 02601 2007
Office: 508-862-4644 Thomas F.Geiler,Director
FAX: 508-790-6304 Thomas A.McKean,CHO
July 28, 2008
Hortensia Medeiros
117 Straightway Street
Hyannis, MA 02601
ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE,TITLE 5
The septic system located at 122 Straighway Street, Hyannis,MA was last inspected on
Jul 23, 2008 b Joseph M. Martins a certified septic 'Y � Y P p inspector for the State of
Massachusetts.
The inspection of the septic stem showed that the system "Conditionally "
p Y y t><onally Passed
under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following:
Orangeburg leach pipe in SAS has 3' of stone above it, sand beneath, with holes facing
up. Excavation of portion of SAS showed clean 'ean sand. SA p p S pipe is � below outlet invert
pp
in cesspool. Outlet tee needs to be replaced and pipe is clogged at cesspool. Cesspool
borders edge of stone driveway/parking area.
You are ordered to repair or replace the septic system within two (2) years from the date
you receive this notification.
Failure to repair/replace the septic system within the deadline period will result in future
enforcement action.
PER ORDER OF T E BOARD OF HEALTH
mas c ean, R.S., CHO
Agent of the Board of Health
CERTIFIED MAIL#7006 2150 0002 1041 7583
Q:\SEPTIC\Letters Septic Inspection Fai1u1_es\122 Straightway Street.doc
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTmzmT OF ENMON=NTAL PROTECTION
TITLE 5
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: �-
1 y
Owner's Name: Ik rlt,ns ti. mledel o-os
Owner's Address: //
Date of Inspection: •7 2. 3 0
a
Name of Inspector.(please print) Joseph M.Martins Z!!
Company Name: Accu Sepcheck ° R
Mailing Address: 17 Northside Dr., S.Dennis,MA 02660 i`;z can
Telephone Number: 508-385-5891
v�
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposal system at this address and that the' formafibn reportted
below is true,accurate and complete as of the time of the inspection.The inspection was ed based on my
training and experience in the proper fimction and maintenance of on site sewage disposal systems.I am a DEP
approved system inspector pennant to Section 15-W of Title 5(310 CMR 15.000} The system:
Passes
-Conditionally Passes
� Needs Further Evaluation by the Local Approving Authority
Fails
Inspector's Signature: Date: 7 3 0
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 man.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: G d v�'1/lL,e �Sv✓�.wtt R�Y
****This report only describes conditions at the time of inspection and ender the conditions of we at that
time.This inspection does not address haw the system will perform in the future under the same or different
conditions of use.
Page 2 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address:
Owner: 122 Straightway St.,Hyannnis,MA
Date of Inspection: Medeiros
7/ 23 /2008
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 indi tes that any of the failure criteria described in 310 CMR
15.303 or in 310 CMR 15.304 exist.Any fail 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 appr ved by the Board of Health.
*A metal septic tank will pass inspection if it is struc y sound,not leaking and if a Certificate of Compliance
indicating that the tank is less than 20 years of available.
ND explain:
Observation of age backup or break out or high static water level in the distribution box due to broken or
obstructed pipe(s due to a broken,settled or uneven distribution box.System will pass inspection if(with
approval of Bo 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:
Title 5 Inspection Form 6/15/2000 2
Page 3 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address:
122 Straightway St.,Hyammis,MA
Owner: Medeiros
Date of Inspection• 7/ 23 /2008
C.
Further Evaluation is Required by the Board of Health:
1/ Conditions exist which require further evaluation by the Board of Health in order to determine if the system
is failing to protect public health,safety or the environment.
1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the
system is not functioning in a manner which will protect public health,safety and the environment:
_ Cesspool or privy is within 50 feet of a surface water
_ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the
system is functioning in a manner that protects the public health,safety and environment:
_ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a
surface water supply or tributary to a surface water supply.
The system has a septic tank and SAS and the SAS i a Zone 1 of a public water supply.
The system has a septic tank and SAS a SAS is within 50 feet of a private water supply well.
The system has a septic and SAS and the SAS is less than 100 feet but 50 feet or more from a
private water supply w .Method used to determine distance
**This s m 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: /
�e 1' Tres 3/ m r x xe 4 love -z td kelf
> e f"
pw& --11) r-esspoa/
p o e- is clo y yee/
mF sf �,,erwe�.v ,/����1 �1�'P�ARA ve(aQ��
Title 5 Inspection Form 6/15/2000 3
Page 4 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address:
122 Straightway St.,Hyannnis,MA
Owner: Medeiros
Date of Inspection: 7/ 23 12008
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
_NZ4_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''/s 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.
r/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.]
F4 ejrl°r
2vat (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 facility with a design flow of 10,000 gpd to 1.5,000
gpd.
You must indicate either"yes"or"no"to each of the flowing:
(The following criteria apply to large systems in ition to the criteria above)
yes no
the system is within 400 feet of surface drinking water supply
the system is within 200 of a tributary to a surface drinking water supply
the system is locate a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped
Zone II of a pub ' water supply well
If you have answered" es"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.
Title 5 Inspection Form 6/15/2000 4
Page 5 of l l
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address:
Owner: 122 Straightway St.,Hyammis,MA
Date of inspection: Medeiros
7/ 23 /2008
Check if the following have been done. You must indicate"yes"or"no"as to each of the following:
Yes No
✓ Pumping information was provided by the owner,occupant,or Board of Health
✓Were any of the system components pumped out in the previous two weeks?
_ Has the system received normal flows in the previous two week period?
Have large volumes of water been introduced to the system recently or as part of this inspection?
WkWere 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,e *Ming the SAS,located on site?
Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition
of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum?
Was the facility owner(and occupants if different from owner)provided with information on the proper
maintenance of subsurlace sewage disposal systems?
The size and loca Lion.of..tke Soil Absorption System(SAS)on the site has been determined based on:
Yes no
✓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(3)(b)]
Title 5 Inspection Form 6/15/2000 5
j '
Page 6 of I I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address:
Owner: 122 Straightway St.,Hyannis,MA
Date of inspection: Medeiros
FLOW CONDITIONS 7/ 23 /2008
RESIDENTIAL Number of bedrooms(design): A)��Number of bedrooms(actual): 3 3 3v
DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms):
Number of current residents: q
Does residence have a garbage grinder(yes or no): NO
Is laundry on a separate sewage system(yes or no):AV [if yes separate inspection required]
Laundry system inspected(yes or no):_/f
Seasonal use:(yes or no): 1Vd o20 v
Water meter readings,if available(last 2 years usage(gpd)): o'k-O 0 6
Sump pump(yes or no): AV
Last date of occupancy:j_;RD &4v
COMMERCIALANDUSTRIAL
Type of establishment:
Design flow(based on 310 CMR 15.203):
Basis of design flow(seats/persons/sq 1etc.):
Grease trap present(yes or no):_
Industrial waste holding tank present s or no):—
Non-sanitary waste discharge a Title 5 system(yes or no):_
Water meter readings, ' - ailable:
Last date of occWmi cy/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information: A 0 T A/ -as T 7 yPa(-'CS
Was system pumped as part of the inspection(yes or no):
If yes,volume pumped: /DW gallons--How was quantity pumped determined? f L� ✓ 2
Reason for pumping: Ae,t FRO Id*1 ��
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)
_Tight tank _Attach a copy of the DEP approval
_Other(describe):
Approximate age of all components,date installed(if known)and source of information:
7 3,0 �6r�a.cs aQ*e. N7 E40%-�
Were sewage odors detected when arriving.at the site(yes or no): /V O
Title 5 Inspection Form 6/15/2000 6
Page 7 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:
Owner: 122 Straightway St.,Hyannnis,MA
Date of inspection: Medeiros
7/ 23 /2008
BUILDING SEWER(locate on site plan)
Depth below grade: Z—3 /
Materials of construction t iron _40 PVC_other(explain):
Distance from private water supply well or suction line: >l o t
Comments(on condition
o joints,venting,
ntievidence of leakage,etc.):
SEPTIC TANK:_(locate on site plan)
Depth below grade:
Material of construction:_concrete_metal_fiberglass polyethylene
other(explain)
Iftank is metal list age:_ Is age confirmed by a Certificate of Compli es or no):_(attach a copy of
certificate)
Dimensions:
Sludge depth:
Distance from top of sludge to bottom of et tee or baffle:
Scum thickness:
Distance from top of scum to of outlet tee or baffle:
Distance from bottom o um to bottom of outlet tee or baffle:
How were dimens' determined:
Comments( umpiiig recoitiiiieodatioug,inlerand otitlet'tee or baffle condition,structural integrity,liquid levels
as related to outlet invert,evidence of leakage,etc.):
GREASE TRAP:_(locate on site plan)
Depth below grade:_
Material of construction:_concrete_metal_fiberglass_polyeth _other
(explain):
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee affle:
Distance from bottom of scum to botto outlet tee or baffle:
Date of last pumping:
Comments(on pumping reco endations,inlet and outlet tee or baffle condition,structural integrity,liquid levels
as related to outlet inv ,evidence of at,
etc.):
Title 5 Inspection Form 6/15/2000 7
Page 8 of i 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:
Owner: 122 Straightway St.,Hyannnis,MA
Date of Inspection: Medeiros
7/ 23 /2008
TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan)
Depth below grade:
Material of construction: concrete metal fi ass_polyethylene other(explain):
Dimensions: _
Capacity: Qall
Design Flow: allons/day
Alarm present(yes or no
Alarm level: larm m working order(yes or no):
Date of last p mg:
Comments(condition of alarm and float switches,etc.):
DISTRIBUTION BOX: (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,con ' ' o pumps and appurtenances,etc.):
Title 5 Inspection Form 6/15/2000 8
Page 9 of l l
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:
Owner: 122 Straightway St.,Hyannnis,MA
Date of inspection: Medeiros
7/ 23 /2008
SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required)
If SAS not located explain why:
Type
leaching pits,number:_
leaching chambers,number:
leaching galleries,number:
leaching trenches,number,length:
_LGleaching fields,number,dimensions: -O�— jo �?0 X j(0 X I- 3
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.):
C. iweK P)D Leorel.s 40jo, c ess dd l �v o Q v leg �,�•e
o ol�e -S S-iod , above- qnd aAalcw
Pls a4� i s about-Qp,��i�Pfoe h s holes v?
CESSPOOL (cesspool must be pumped as part of inspection)(locate on site plan)
Number and configuration: Ro v4 d &2 yt iXe.
Depth-top of liquid to inlet invert:
Depth of solids layer: 2-0
r'
Depth of scum layer: & '$ /2
Dimensions of cesspool: y-5'W X. 6- en de-P
Materials of construction: t-D Ck
Indication of groundwater inflow(yes or no):_#_0
Com ents note conilition of soil si s of hydraulic failure,level of ponding,condition of vegetation,etc.):
iq al /Ale / o
O ? S -e v kv ✓
PRIVY: (locate on site plan)
Materials of construction:
Dimensions:
Depth of solids:
Comments(note condition of soil,signs of hydrauG ne,level of ponding,condition of ve tion,etc.):
Title 5 Inspection Form 6/15/2000 9
Page l0 of 11
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:
Owner: 122 Straightway St.,Hyannnis,MA
Date of Inspection: Medeiros
7/23/2008
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.
. 3 ,
i
n
3'� �; BI =qa
33 l a9,=3
30 .
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
Title 5 Inspection Form 6/15/2000 10
Page 11 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:
Owner: 122 Straightway St.,Hyannnis,MA
Date of Inspection: Medeiros
SITE EXAM 7/ 23 /2008
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water J I
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:
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:
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141.
11
Title 5 Inspection Form 6/1 512 0 0 0
Town of Barnstable
P��F THE Tp��
o� Regulatory Services
BARNSTABLE, Thomas F. Geiler,Director
y MASS. g
$ 0 9. Public Health Division
ArED MA'S�
Y
Thomas McKean, Director
200 Main Street, Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
REGARDING SEPTIC INSPECTIONS BY PRIVATE CONTRACTORS
DISCLAIMER
This septic system inspection report was completed by a private inspector who is certified by
the State of Massachusetts, Department of Environmental Protection.
Although the Town of Barnstable Health Division received the original or copy of the report;
this Division does not warranty the functionality of the septic system in the future nor does
this Division agree with any technical observations and interpretations contained within this
report.
In addition, by receiving this report the Town of Barnstable Health Division does not
automatically approve the number of bedrooms listed within this report. The actual number
of bedrooms approved at a particular property would be listed on the "Disposal Works
Construction Permit".
If you should have any questions regarding this report, please contact the certified Septic
System Inspector who conducted the inspection.
QASEPTIC\Disclaimer Private Septic Inspections.DOC
p
�i
DEEP OBSERVATION DEEP 1' OBSERVATION
Locus -IIOLE LOG HOLE LOG
s 4
Test Hole #1 Test Hole #2 BClr
(EL = 27.8 f) (EL = 28.3 t) Bdr
#2 #1
&, D1 py, Soil Soil Soil I1�Pfh B° Horizon Texture Color pq (m) �h) Horizon Texture Color (ia) �ft)
.v O (USDA) (Munsell) (USDA) (Munsell)
c. 0 - 4" 27.5 OEA LOAMY SAND 10YR5/1 0 - 12" 27.3 Fill
0 4" - z4" 25.8 B LOAMY SAND 7.SYR5/6 f2" - 36" 25•3 B LOAMY SAND 7.5YR5/6 Bth
`C 24" -78" 21.3 CI COARSE SAND f0YR6 6 36" - 168" 14.3
/ C COARSE SAND >OYR6/6
. BLOTCHES
78" — 156" 14.8 C2 FINB/MED SAND 2.5Y7/4t LlY
Locus Map
• Deep Obs Hole Date: 914/08 Deep Ohs Hole Date: 914/08 -
Soil Evaluator. ED STONE Soil Evaluator. ED STONE
_ Witnessed By. DONNA MIORANDI Witnessed By: DONNA MIORANDI Bdr -
Perc Rate: - Perc Rate: i < 2 MIN/IN® 72" EP Fell d #3 -
Soil Survey Description: CARVER Soil Survey Description: CARVER
- Geologic MateriaL• cauaAa OMASH YDRWNZ Geologic Material: CLACIAL O TIIASH YDBBAtVW
Depth to Standing Water. NA Depth to Standing Water. NA
Depth to Weeping Water. NA Depth to Weeping Water. NA 7y�7 y�
Depth to Mottlinh GW'r): NA Depth to MoEtl igh GW'. NA Floor o of PI a n S
Est Seasonal High GW: NA Est Seasonal High GW: NA
USGS Observation Well, NA USGS Observation Weil: NA
Date of lest Measurement_ NA Date of Last'.Measurement NA N. T S
Comments: Comments:
Map 268 Parcel 116
Map 268 Parcel 108
Proposed sed Proposed 1,500 (11H-20)
D - �> 5 6) Gal S—Tank I
-- — e• 6- 175. 00 (2
2si) 1286 N Obs Hole v% i Owner of Record
Angelo & Hortensia Medeiros
Playhouse. 5' 2 ��6• I
on stilts ; :::: .......................... 1) ti I I Deed Reference
6) :;:•:;::::•::•::•:•:::::•:..........::::•:::::........ 21' (26 I I Bk. 6319 P 210
(2a' roposed rJ ';:!,::::•::::.•:::::•:::::::•.:•::::;•:: ?: I g
Vent � ;...:. ::�: 11• — I
Proposed SAS---Ci :::::.. ' '
^i ..;;:;•: ;.;: :::::;i;:::::;•::::::•::•:......:: Plan Reference
l26 21 I i PI Bk 197 Pg 123
Obs Hole l2B 3....•.. B5 j'ii: ;:i f:: _ O — — — c0 I I Lot 40
� #2 ti Pere 3) �' �2 I i
Map 268 Parcel 117 �2e 52A
2g. � (� 0•� O I
ASSESSORS MAP 268 LOT 107
Garage Remove Existing Cesspool Cam, I Q I
Pump, Crush and Sand I I
Con c Slab Fill Per Ti tle 5 1 1 !� I
Elev = 28.9E y�6.0) Septic Upgrade Repair Plan
in
0 6) 1 I
\�2 Gravel D/fr 0) Barnstable, MA
I Located At
Area = 11,2502 S. F.
Via) -122 Straightway
I Hyannis, MA 02601
175. 00 I I Applicant
' Jeff Ha11
122 Straigh t way
Hyannis, MA 02601
Map 268 Parcel 118 Map 268 Parcel 106 , I y
f SCALE I" = 20' DATE: September 15, 2008
' WINSLOW
f►; f� !1. I PREPARED BY
Fc !` MFORO
e A & M Land Services
�+ q 618 Main Street Unit 3
West Yarmouth, MA 02673
AMU (508) 771—5263 Cell (508) 737-1777
Dn. IF 5048.d w
f
TOP OF Raise covers to within 6" of
+ FOUNDATION finish grade install risers. as needed 4 LRaise one cover to within 6" of
EL 26.8 i
finish. grade install risers. as needed
(27.0) 4
Kv..o) GROUND SURFACE EL-28_3 __ Yeoop
Proposed k
D — BOX wt MIN 2' LAYER DOUBLE WASHED
t 1/8'- 112' STONE MIN 2' LAYER DOUBLE WASHED
MIN 2' LAYER DOUBLE WASHED °j
1/8'- 112, STONE
24 2 2'111IN--3"MAX 1/e•- vI STONE
24.0 Top EL Z I
INVERT EL 23.85 10"
Existing 23.65 _ 24"
INVERT EL INSTALL 4/ INV EL — — — — — — — — — — — — ESIDEWALVE
L 36"
d GAS 23.25 8'SIM"BASE
BAFFLE INV EL 23.10 23.0L b b L3/4'- 112' DOUBLE
INV EL INV EL _ Two 500 Gal Conc (H-20� ti b ED STONE
s'STONE BASE Chambers with _4' stone all around3/4'- 1 1/2' DOUBLEWASHED STONE (4-10' x 8-6" x 3=0')Proposed (H-2 BOTTOM EL0) o h
1,500 Gal Septic Tank
S = 0.02 1 S = 0.16 Is =0.01
17'
25" 11 O" I
EL 14.8 got Test (No Grd Water)
SAS (10' 10" x 25' 0') I Pit # 1
STANDARD NOTES DESIGN DATA Owner of Record
Angelo & Hortensia Medeiros
I) THIS PLAN.IS FOR THE /REPAIR OF A SEPTIC SYSTEM 3
.2) ALL INSTALLATION PROCEDURES AND MATERIALS SHALL CONFORM TO 310 CAR 15000, THE STATE ENVIRONMENTAL CODE, r Number of Bedrooms: Deed Reference
TTI ND LE 5" A THE TOWN OF Barnstable_-_ SUBSURFACE DISPOSAL REGULATIONS. Garbage Grinder: N� Ek 6319 Pg. 210
3) NO DETERhQNATION HAS BEEN MADE AS TO COMPEZANCE OF AVAILABLE PROPERTY INFORMATION WITH RECORDED DEEDS Design Flow: 330
OR ZONDVG REGULATIONS. (110 Gel/BR/Day a Number of BR)
Plan Reference
4) THIS PROPERTY IS SERVICED BY TOWN WATER Septic Tank: (H-20) 1,500 PI Bk 197 Pg 123
5) THERE ARE NO KNOWN WELLS WITHIN 100' OF THE PROPOSED SOIL ABSORPTION SYSTEM (Minimum = Design now a 200%) Gal. Lot 40
6) ALL COVERS OF SYSTEM COMPONENTS SHALL BE BROUGHT TO WITHIN 6" OF FTMSHED GRADE Leaching Area:
7) ALL SYSTF-V COMPONENTS SHALL REMADV ACCESSIBLE FOR INSPECTION. NO STRUCTURES SHALL BE LOCATED DIRECTLY Sidewall:
UPON OR ABOVE THE COMPONENT ACCESS LOCATIONS, WHICH WOULD INTERFERE WITH TILT PERFORMANCE" ACCESS, INSPECTION (2 Sidewalls a 25OFc a 2 Ft) +
PUMPING OR REPAIR
(2 i'.ndways a12 83Y7 g ---'--Ft) 151.3 ASSESSORS MAP 268 LOT 107
8) NO DRIVEWAY" PARKING OR TURNING AREA, OR OTHER IMTERVIOUS AREA SHALL BE LOCATED ABOVE A SOIL ABSORPTION Bottom: 320.8
SYSTEM, EXCEPT WHEN VEN77NG HAS BEEN PROVIDED. 12.83 Ft x 25 O'n) 472 SF
9) SEPTIC TANKS" GREASE TRAPS, DOSING CHAMBERS AND DISTRIBUTION BOXES SHALL BE PLACED ON A 6" STONE BASE Long Term Acceptance Rate (LTAR):x 0.74 Septic Upgrade Repair Plan
TO ENSURE STABILITY AND PREVENT SETTLING.
10) OUTLET DISTRIBUTION LINES SHALL REMAIN LEVEL FOR A MINIMUM OF THE FIRST TWO FEET OF THEIR LENGTH. Leaching Area Design Capacity 349 GpD in
11) ALL SYSTEM COMPONENTS SHALL BE CAPABLE OF WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN 10' (Sidewall Area + Bottom Area) a LTAR
Barnstable, MA
OF DRIVEWAYS OR PARKING OR TURNING AREAS, IV WHICH CASE H-20 COMPONENTS SHALL BE USED.
12) ALL BUILDING SEWER LINES SHALL HAVE AN INNER DL4METER OF 4" AND SHALL BE CAST-IRON OR SCHEDULE 40 PVC. 349 GPD, Provided - 330 GPD Required = 19 Reserve Located At
13) TIIE DEPTH OF TIIE TOP OF ALL SYSTEM COMPONENTS SHALL NOT EXCEED 36" UNLESS VENTING HAS BEEN PROVIDED. - 122 Stra1 h t wa
14) DV THE AREAS OF EXCAVATION" EXISTING GRADES SHALL BE REESTABLISHED UNLESS NOTED AS PROPOSED CONTOURS. g y
15) IF SOILS ARE ENCOUNTERED DURING THE EXCAVATION OF THE SOIL ABSORPTION SY.STAM, THAT DIFFER NOTABLY FROM HyannlS, MA 02601
THE DEEP OBSERVAHOM HOLE LOG, CONTACT A & M LAND SERVICES AND TOWN BOH BEFORE PROCEEDING. Applicant
16) CONTRACTOR TO VERIFY LOCATION OF ALL UNDERGROUND UTILITIES PRIOR TO CONSTRUCTION Jeff Ha II
17) CHANGES OR REVISIONS TO SEPTIC DESIGN REQUIRE NOTIFICATION )
TO A &N LAND SERVICES AND TOWN BOH.MR REVIEW AND APPROVAL � 122 Straightway
18) CONTRACTOR SHALL NOTIFY TOWN AND DESIGN ENGINEER AT LEAST H7Tannis, ILIA 02601
24 - 48 HOURS PRIOR TO INSPECTION(S).
19) MAGNETIC TAPE TO BE PLACED OVER ALL COMPONENTS ACCESS PONTS WINSLOW SCALE.' 1" = 20' DATE.- September 15, 2008
� s�FaRn
t #Q'J983 PREPARED BY
A & M Land Services
s. QN 618 Main Street Unit 3
AL West Yarmouth, MA 02673
(508) 771-5263 Cell (508) 737-1777
Dwg. �f 5048.dwg