HomeMy WebLinkAbout0177 STRAIGHTWAY - Health 177 Straight Way
Ilya'nnis., MA 02601
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Commonwealth of Massachusetts
,p Titles Official Inspection Form
t Subsurface Sewage Disposal System Form -
P y Not for Voluntary Assessments
r r i
177 Straight Way
Property Address r
Kevin and Kathryn Price p
Owner Owner's Name f '
information is T '
required for every Hyannis MA 02601 8-7-2019
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
filling out forms A. Inspector Information 45j 4
on the computer,
use only the tab Darrell Stone
key to move your Name of Inspector
cursor do not
return
use the return Cape Cod Septic Inspection key. Company Name
P.O. Box 1466
raa Company Address
Harwich Ma 02645
City/Town State Zip Code
(508) 240-2500 S14995
Telephone Number License Number
B. Certification
certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5
(310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address
listed above; the information reported below is true, accurate and complete as of the time of my
inspection; and the inspection was performed based on my training and experience in the proper function
and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined
that the system:
1. ® Passes
2. ❑ Conditionally Passes
3. ❑ Needs F rt er Evaluation b e Local Approving Authont
4. ❑ Fail
8-7-2019
Ins or'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 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 form should be sent to the system owner and copies sent to
the buyer, if applicable, and the approving authority.
Please note: 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.
t5insp.doc•rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
u
177 Straight Way
Property Address
Kevin and Kathryn Price
Owner Owner's Name
information is
required for every Hyannis MA 02601 8-7-2019
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary
Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6.
1) System Passes:
® I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 31,0 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
The septic tank was pumped during the inspection
2) System Conditionally Passes:
❑ One or more system components as described in the "Conditional Pass" section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass.
Check the box for"yes", "no"or"not determined" (Y, N, ND) for the following statements. If"not
determined," please explain.
The septic tank is metal and over 20 years old"or the septic tank (whether metal or not) is structurally
unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass
inspection if the existing tank is replaced with a complying septic tank as approved by the Board of
Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years old is available.
❑ Y ❑ N ❑ ND (Explain below):
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18
Commonwealth of Massachusetts
p Title 5 Official Inspection Form
1. Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
177 Straight Way
Property Address
Kevin and Kathryn Price
Owner Owner's Name
information is Hyannis required for every Y MA 02601 8-7-2019
page. City/Town State Zip Code Date of Inspection
Co Inspection Summary (cont.)
2) System Conditionally Passes (cont.):
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
❑ 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):
3) 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.
a. System will pass unless Board of Health determines in accordance with 310 CMR
16.303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
t5insp.doc•rev.7/2612016 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18
Commonwealth of Massachusetts
,�p Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
177 Straight Way
Property Address
Kevin and Kathryn Price
Owner Owner's Name
information is required for every Hyannis MA 02601 8-7-2019
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
❑ 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
b. 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.
c. Other:
4) 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
;Sinsp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18
r'
Commonwealth of Massachusetts
IF Title 5 Official Inspection Form
b Subsurface Sewage Disposal System Form-Not for
� Y Voluntary Assessments
177 Straight Way
V�
Property Address
Kevin and Kathryn Price
Owner Owner's Name
information is
required for every Hyannis MA 02601 8-7-2019
page. Citylrown State Zip Code Date of Inspection
C. Inspection Summary (cont.)
4) System Failure Criteria Applicable to All Systems: (cont.)
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/z 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 water supply
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 2000 gpd-
10,000 gpd.
❑ ® 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.
5) 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 CA.
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
t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 16
u ,
Commonwealth of Massachusetts
1� Ip Title 5 Official Inspection Form
11 c:
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
........... �% 177 Straight Way
Property Address
Kevin and Kathryn Price
Owner Owner's Name
information is required for every Hyannis MA 02601 8-7-2019
page. Cityfrown State Zip Code Date of Inspection
C. Inspection Summary (cont.)
If you have answered "yes" to any question in Section C.5 the system is considered a significant
threat, or answered "yes"to any question in Section CA above the large system has failed. The
owner or operator of any large system considered a significant threat under Section C.5 or failed
under Section CA shall upgrac'e the system in accordance with 310 CMR 15.304. The system owner
should contact the appropriate regional office of the Department.
6. You must indicate "yes" or"no" for each of the following for all inspections:
Yes No
® ❑ Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
® ❑ Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
® ❑ Were as built plans of the system obtained and examined? (If they were not
available note as N/A
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
® ❑ Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
® ❑ Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS) on the site has
been determined based on:
® ❑ Existing information. For example, a plan at the Board of Health.
® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18
Commonwealth of Massachusetts
119 Title 5 Official Inspection Form
i_
I. Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
177 Straight Way
Property Address
Kevin and Kathryn Price
Owner Owner's Name
information is H annis
required for every Y MA 02601 8-7-2019
page. City/Town . State Zip Code Date of Inspection
Do System Information
1. Residential Flow Conditions:
Number of bedrooms (design): 3 Number of bedrooms (actual): 3
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330
Description:
3 bedroom residential dwelling
Number of current residents: 2
Does residence have a garbage grinder? ❑ Yes ® No
Does residence have a water treatment unit? ❑ Yes ® No
If yes, discharges to:
Is laundry on a separate sewage system? (Include laundry system inspection
information in this report.) ❑ Yes ® No
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
15insp.doc•rev.7126)2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18
Commonwealth of Massachusetts
�ro - Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
177 Straight Way
Property Address
Kevin and Kathryn Price
Owner Owner's Name
information is required for every Hyannis MA 02601 8-7-2019
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
2. 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
Water treatment unit present? ] Yes ❑ No
If yes, discharges to:
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
Last date of occupancy/use: Date
Other(describe below):
3. Pumping Records:
Source of information: Discount Septic Pmping (508) 240-2500
Was system pumped as part of the inspection? ® Yes ❑ No
If yes, volume pumped: 1500
gallons
How was quantity pumped determined? Weight
Reason for pumping: Maintenance
5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
�w Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
177 Straight Way
Property Address
Kevin and Kathryn Price
Owner Owner's Name
information is Hyannis required for every y MA 02601 8-7-2019
page. Cltyrrown State Zip Code Date of Inspection
D. System Information (cont.)
4. Type of System:
® Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner) and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other(describe):
Approximate age of all components, date installed (if known)and source of information:
2005 per BOH
Were sewage odors detected when arriving at the site? ❑ Yes ® No
5. Building Sewer(locate on site plan):
Depth below grade: 8
feet
Material of construction:
❑ cast iron n 40 PVC ❑ other(explain):
Distance from private water supply well or suction line: feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
Apparent good condition
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18
l
u
Commonwealth of Massachusetts
�m ,9 Title 5 Official Inspection Form
' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
177 Straight Way
Property Address
Kevin and Kathryn Price
Owner Owner's Name
information is
required for every Hyannis MA 02601 8-7-2019
page. City/Town State Zip Code Date of Inspection
D. System Information -(cont.)Y (
6. Septic Tank(locate on site plan):
Depth below grade: 2"feet
Material of construction:
® concrete ❑ metal ❑ fiberglass ❑ polyethylene [° other(explain)
If tank is metal, list age: years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
Dimensions:
1500 gallon
Sludge depth:
12"
Distance from top of sludge to bottom of outlet tee or baffle
20"
Scum thickness 1/2
Distance from top of scum to top of outlet tee or baffle
6"
Distance from bottom of scum to bottom of outlet tee or baffle
16"
How were dimensions determined? Sludge Judge
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Normal liquid level No sign of leakage SCH 40 outlet tee
The septic tank was pumped during the inspection
Recommended maintenance pumping every 2-3 years
t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•F.age 10 of 18
. Co
mmonwealth of Massachusetts
�s Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
f
�C� % 177 Straight Way
Property Address
Kevin and Kathryn Price
Owner Owner's Name
information is Hyannis required for every y MA 02601 8-7-2019
page. Clty/Town. State Zip Code Date of Inspection
Do System Information (cont.)
7. Grease Trap (locate on site plan):
Depth below grade:
feet
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping: Date
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
8. 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
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18
6
Commonwealth of Massachusetts
V-11
Title 5 official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
177 Straight Way
Property Address
Kevin and Kathryn Price
Owner Owner's Name
information is required for every Hyannis MA 02601 8-7-2019
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
8. Tight or Holding Tank (cont.)
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping:
Date
Comments (condition of alarm and float switches, etc.).-
*Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
9. Distribution Box(if present mast be opened) (locate on site plan):
Depth of liquid level above outlet invert
0"
Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any
evidence of leakage into or out of box, etc.):
Grade to box 12" 1 outlet No scum
Normal liquid level Nc sign of leagage OK condition No sign of failure
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18
Commonwealth of Massachusetts
�m l� Title 5 Official Inspection Form
11. Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
177 Straight Way
Property Address
Kevin and Kathryn Price
Owner Owner's Name
information is Hyannis required for every Y MA 02601 8-7-2019
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
10. 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.
11. Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
Type:
❑ leaching pits number:
® leaching chambers number: 7
❑ leaching galleries number:
❑ leaching trenches number, length: -
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18
6
Commonwealth of Massachusetts
Ip Title 5 Official Inspection Form
'= I Subsurface Sewage Disposal System Form- Not for Voluntary Assessments
177 Straight Way
V�
Property Address
Kevin and Kathryn Price
Owner Owner's Name
information is required for every Hyannis MA 02601 8-7-2019
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
11. Soil Absorption System (SAS) (cont.)
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp scil, condition of
vegetation, etc.).-
7 Cultec rechar er 180 chambers with stone 60'x5x14"
9 ( )
Grade to chamber 20" Inspection port 4" Bottom 37" Dry
No sign of hydraulic failure
12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration
Depth—top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
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Commonwealth of Massachusetts
p Title 5 Official inspection Form
Iz
III Subsurface Sewage Disposal System Form- Not for Voluntary Assessments
177 Straight Way
Property Address
Kevin and Kathryn Price
Owner Owner's Name
information is Hyannis required for every Y MA 02601 8-7-2019
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
13. Privy(locate on site plan):
Materials of construction:
Dimensions
Depth of solids
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 1 a
Commonwealth of Massachusetts
�11 =I Tide 5 official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
177 Straight Way
u
Property Address
Kevin and Kathryn Price
Owner Owner's Name
information is required for every Hyannis MA 02601 8-7-2019
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
14. 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
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1 31- 6 21-0
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15insp.doc-rev.7/2612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18
Commonwealth of Massachusetts
�n Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
177 Straight Way
Property Address
Kevin and Kathryn Price
Owner Owner's Name
information is Hyannis required for every Y MA 02601 8-7-2019
page. City/Town State Zip Code Date of Inspection
®.-System Information (cont.)
15. Site Exam:
❑ Check Slope
❑ Surface water
® Check cellar
❑ Shallow wells
Estimated depth to high ground water: >5
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: 2005
Date
❑ Observed site (abutting property/observation hole within 150 feet of SAS)
® Checked with local Board of Health -explain:
Plan on file
❑ Checked with local excavators, installers-(attach documentation)
❑ Accessed USGS database -explain:
You must describe how you established the high ground water elevation:
Engineer certified installation
Bottom of SAS ELV. 20.6
Bottom of Test hole ELV. 13.95 GW
Adj GW ELV. 15.5
Separation >5'
I
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18
Commonwealth of Massachusetts
Title 5 official Inspection Dorm
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
1 177 Straight Way
Property Address
Kevin and Kathryn Price
Owner Owner's Name
information is required for every Hyannis MA 02601 8-7-2019
page. City/Town State Zip Code Date of Inspection
E. Report Completeness Checklist
Complete all applicable sections of this form inclusive of:
® A. Inspector Information: Complete all fields in this section.
® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked
® C. Inspection Summary:
1, 2, 3, or 5 completed as appropriate
4 (Failure Criteria) and 6 (Checklist) completed
® D. System Information:
For 8: Tight/Holding Tank—Pumping contract attached
For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached
For 15: Explanation of estimated depth to high groundwater included
t5insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-F.age 18 of 18
p 1HE Town of Barnstable o
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Regulatory Services �-
I pumas I . Gciler, Director
BA NSTAB E,
MASS.
"'"�-
t639 Public Health Division
A `0$
�TFp �s Thomas Mck:ean, Director
200 Main Street, IINla►nris,AIA 02601
Office: 508-862-4644 Pax: 508-790-6304
Installer & Designer Certirication Form
Date:
Designer: Eco—Tech Installer: Wm E Robinson Sr Septic
Address: 43 Triangle Circle Address: PO Box 1089
Sandwich Centerville
On Wm E Robinson Sr Septiavas issued a permit to install a
(date)
septic syste t 1 77 Straightway, Hyannis based on a design drawn by
(address)
Eco—Tech dated 08-17-05
(designer)
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.
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 componcrtt
of the septic system) but in accordance with State & Local Regulations. Plan revision or
certified as-b ilt by designer to follow.
Gli moo`' DAVID CyGN
(Installer's Signature) D.
COUG ANOWR N
No. 1093
NlTARti
��Q1SRk
SgPN
(Designer's Signature) (Affix Designer's Stamp Here)
PLEASE RETURN TO BARNSTABLE PUBLIC IIEALTH DIVISION. CERTIFICATE
OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-
BUILT CARD ARE R.ECEIN.'ED BY TILE BARNSTABLE PUBLIC HEALTH DIVISION.
TIIANh 1'0U.
Q: Health/Septic/Designer Certification Form
McKean, Thomas
From: Suzanne M. Broderick[sxm10@health.state.ny.us]
Sent: Wednesday, February 01, 2006 9:08 AM
To: Health
Cc: colleenhkramer@earthlink.net
Subject: 177 straightway
Mr. McKeon, I attest that when my family purchased the home at 177 straightway in January,
1983 there were 3 bedrooms. The agreement to purchase-even states in has 3"bedrooms.
Please respond to my email at the following address: sxm10@health.state.ny.us. thank you
for your assistance
Suzanne M. Broderick PhD. R.N, Deputy Director
Division of Home and Community Based Care
t
r
1
o�t"E
Town of Barnstable
BARNSTABLE. * Assessing Division
9 s $ 367 Main Street,Hyannis MA 02601
www.town.barnstable.ma.us
Office: 508-862-4022 Paul A.Matheson,III
FAX: 508-862-4722 Director of Assessing
January 31, 2006
Colleen Kramer, Esq.
477 Main Street
Yarmouthport, MA 02675
RE: 177 Straightway, Hyannis
Thomas Broderick
Dear Attorney-.Kramer:
The house at 177 Straightway, Hyannis owned by Thomas Broderick was
inspected by the Town of Barnstable field inspector on January 30, 2006. After
inspection it has been determined there are 3 bedrooms, a kitchen, a dining room and a
living room in the home; for a total of 6 rooms.
According to our records,we have had the property inaccurately listed as a 2
bedroom for many years. The field card from 1973 lists the home as having 6 rooms
which is the same as today. Enclosed please find the field card reflecting the change in
the number of bedrooms.
Please feel free to contact me if you need further assistance.
Sincerely,
4
Sheila Fowler
Office Manager 1
cc: Thomas Broderick :
Board of Health r
enc �?
�— M
McKean, Thomas
From: McKean, Thomas on behalf of Health
Sent: Wednesday, February 01, 2006 5:24 PM
To: 'Suzanne M. Broderick'
Subject: 177 Straightway Road, Hyannis
Thank you for your e-mail today attesting that the property at 177 Straightway Road,
Hyannis contained three bedrooms since the date you purchased the home in 1983, 23 years
ago. I also received a copy of the letter from Sheila Fowler of the Assessing Division
dated January 31, 2006 indicating there was an error in the assessing records for many
. years and that this has been a six room (three bedroom) home.
Therefore, the Health Division has no objections to three (3) bedrooms maximum at this
property. The disposal works construction permit record was updated today to reflect
three bedrooms total.
L
Scere
TYiomas A. McKean S'_ H C 0
Director of Public Health
-----Original Message-----
From: Suzanne M. Broderick [mailto:sxml0@health.state.ny.us]
Sent: Wednesday, February 01, 2006 9:08 AM
To: Health
Cc: colleenhkramer@earthlink.net
Subject: 177 straightway _
Mr. McKeon, I attest that when my family purchased the home at 177 straightway in January,
1983 there were 3 bedrooms. The agreement to purchase even states in has 3 bedrooms.
Please respond to my email at the following address: sxm10@health.state.ny.us. thank you
for your assistance
Suzanne M. Broderick PhD. R.N, Deputy Director
Division of Home and Community Based Care
E
1
ofTHE
r
Town of Barnstable
* EAMSMM * Regulatory Services
y Mnss.
1639. °i Thomas F. Geiler'Director
rFo�'t
Public Health Division
Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
July 13, 2005
Mr Thomas Broderick
39 Empire Circle
Rensselaer,NY 12144
NON-COMPLIANCE WITH STATE ENVIRONMENTAL CODE TITLE V.
The septic system owned by you located at 177 Straight Way,Hyannis MA was inspected on
June 2nd, 2005 by Arthur Bloomquist, a certified septic inspector for the State of Massachusetts.
The inspection of your septic system showed that your system has Conditionally Passed under the
guidelines of 1995 TITLE 5 (310 CMR 15.00)DUE TO THE FOLLOWING:
The two cesspools are in the water table.
You have two years from the date of the system inspection to bring the system into compliance.
If there are any questions about this reminder,please feel free to contact the Barnstable Health
Department.
BARNSTABLE HEAL H DEPARTMENT
r
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
x
V
TITLE 5
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESS N% a
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A `--
CERTIFICATION
Property Address: 177 Straight Way,Hyannis Q
Owner's Name: Tom Broderick C i-K Z;
Owner's Address: 39 Empire Circle,Rensselaer,NY 12144 /Izzc -, cc
Date of Inspection: June 2,2005 r.,) r-
Cn rn
Name of Inspector: Arthur Bloomquist www.titlevinspections.com
Company Name: Arthur Bloomquist
Mailing Address: 109 West Street
Plympton,Ma.02367
Telephone Number: 1-877-291-1066
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:
Passes
Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
x is
Inspector's Signature: Date: June 2,2005
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
The two cesspools are in the water table.
****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.
Page 2 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 177 Straight Way,Hyannis
Owner's Name: Tom Broderick
Owner's Address: 39 Empire Circle,Rensselaer,NY 12144
Date of Inspection: June 2,2005
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. System Passes:
no 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 pipc(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: 177 Straight Way,Hyannis
Owner's Name: Tom Broderick
Owner's Address: 39 Empire Circle,Rensselaer,NY 12144
Date of Inspection: June 2,2005
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:
T 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:
Page 4 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 177 Straight Way,Hyannis
Owner's Name: Tom Broderick
Owner's Address: 39 Empire Circle,Rensselaer,NY 12144
Date of Inspection: June 2,2005
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or"no"to each of the following for all inspections:
Yes No
x Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
x Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
clogged SAS or cesspool
x_ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool
_x Liquid depth in cesspool is less than 6"below invert or available volume is less than%day flow
x Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Number of times pumped
x_ Any portion of the SAS,cesspool or privy is below high ground water elevation.
x Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply.
_x_ Any portion of a cesspool or privy is within a Zone 1 of a public well.
x_ Any portion of a cesspool or privy is within 50 feet of a private water supply well.
_x_ 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 (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
E`
Page 5 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 177 Straight Way,Hyannis
Owner's Name: Tom Broderick
Owner's Address: 39 Empire Circle,Rensselaer,NY 12144
Date of Inspection: June 2,2005
Check if the following have been done.You must indicate"yes"or"no"as to each of the following:
Yes No
x _ 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?
x Has the system received normal flows in the previous two week period?
x _ 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)
x _ Was the facility or dwelling inspected for signs of sewage back up?
x _ Was the site inspected for signs of break out?
x _ Were all system components,including the SAS,located on site?
n/a_ _ 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?
x_ _ 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
x Existing information.For example,a plan at the Board of Health.
x_ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of
distance is unacceptable)13 10 CMR 15.302(3)(b)]
Page 6 of 11
OFFICIAL INSPECTION FORM--NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 177 Straight Way,Hyannis
Owner's Name: Tom Broderick
Owner's Address: 39 Empire Circle,Rensselaer,NY 12144
Date of Inspection: June 2,2005
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):_yes
Seasonal use:(yes or no):_yes
Water meter readings,if available(last 2 years usage(gpd)):_attached
Sump pump(yes or no):_no
Last date of occupancy: seasonal,(some weekends)
COMMERCIAL/INDUSTRIAL
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: neighbor
Was system pumped as part of the inspection(yes or no):yes_
If yes,volume pumped:^500_gallons--How was quantity pumped determined? approximate
Reason for pumping:
TYPE OF SYSTEM
—Septic tank,distribution box,soil absorption system
—Single cesspool
x_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)
T Tight tank _Attach a copy of the DEP approval
Other(describe):
Approximate age of all components,date installed(if known)and source of information: 30+years
Were sewage odors detected when arriving at the site(yes or no): no
Page 7 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 177 Straight Way,Hyannis
Owner's Name: Tom Broderick
Owner's Address: 39 Empire Circle,Rensselaer,NY 12144
Date of Inspection: June 2,2005
BUILDING SEWER(locate on site plan)
Depth below top of foundation: 67"
Materials of construction:_cast iron xSchedule 40 PVC_other(explain):
Distance from private water supply well—or—suction line: 100+
Comments(on condition of joints,venting,evidence of leakage,etc.): good condition
SEPTIC TANK:_(locate on site plan)
n/a
Depth below grade:
Material of construction:_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:
Sludge depth:
Distance from top of sludge to bottom of outlet tee or baffle:
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:
How were dimensions determined:
Comments(on pumping recommendations,inlet and outlet 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^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.):
Page 8 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 177 Straight Way,Hyannis
Owner's Name: Tom Broderick
Owner's Address: 39 Empire Circle,Rensselaer,NY 12144
Date of Inspection: June 2,2005
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/day
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: . (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: 177 Straight Way,Hyannis
Owner's Name: Tom Broderick
Owner's Address: 39 Empire Circle,Rensselaer,NY 12144
Date of Inspection: June 2,2005
SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required)
If SAS not located explain why: I removed the cover from both of the cesspools
Type
leaching pits,number:_
leaching chambers,number:
leaching galleries,number:
leaching trenches,number,length:
leaching fields,number,dimensions:
x overflow cesspool,number: one cesspool and an overflow
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.): The soil was in good condition. There were no signs of hydraulic failure.
CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan)
Number and configuration: 2 one cesspool and one overflow cesspool
Depth—top of liquid to inlet invert: 16"
Depth of solids layer: <1"
Depth of scum layer: <1"
Dimensions of cesspool: 6x6
Materials of construction: block
Indication of groundwater inflow(yes or no):_yes
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): The
soil condition is normal.
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 1 I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 177 Straight way,Hyannis
Owner's Name: Tom Broderick
Owner's Address: 39 Empire Circle,Rensselaer,NY 12144
Date of Inspection: Jane 2,2005
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.
cejj 0,0
i4
' Page'14 of I 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 177 Straight Way,Hyannis
Owner's Name: Tom Broderick
Owner's Address: 39 Empire Circle,Rensselaer,NY 12144
Date of Inspection: June 2,2005
SITE EXAM
Slope 0-1%
Surface water none
Check cellar dry
Shallow wells none
Estimated depth to ground water`5r 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:
x Observed site(abutting property/observation hole within 150 feet of SAS)
x Checked with local Board of HeaW"xplain: comparing the maps that were available at the BOH along
with the pert tests for the neighbor indicates that the estimated seasonal water table is approximately 65 inches
below grade. The cesspool bottom is 96 inches below grade. Effluent was in both cesspools even though the level
was not up to the overflow pipe.
Checked with kcal excavators,installers-(attach documentation)
Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
I augured a hole near the cesspool to determine the current water table. The plans at the BOH indicated that it was
in the Ml W29C zone which has an adjustment of 3.6 feet.
Co d ni
C ��f�„®
r
COX
30
TOWN OF BARNSTABLE
LOCATION _ /"? S'rfa la .. Q r.I. SEWAGE #
VILLAGE �►niJ ASSESSOR'S MAPc& LOT "�a®
i r r w S•D��r/ /U✓fit P. ,��7/J I.//IO
INSTALLER'S NAME&PHONE NO.. �✓+'u �— ��1
SEPTIC TANK CAPACITY
(�r�tt P�et><.�tr l�D (size)J�x& X� S OaRXrd
•• LEACHING FACII.I'I'Y: (type) � ,
NO.OF BEDROOMS 3
BUILDER.OR OWNER` �rr�Gre!Irl�
PERM TTDATE: i O COMPLIANCE,DATE: /b q' OS
i ��� I
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility
S Feet
I
Private Water Supply Well and Leaching Facility (If any wells exist /V A Feet
on site or within 200 feet of leaching facility)
Edge of Wetland and Leaching Facility(If any wetlands exist /V Feet
within 300 feet of leaching facility)
Furnished by
ACC ov Hooso
Ed
YY
t
a
r
O O
7AAly Ib
A-1 _ �ib i
ar
®x
H ..
r TOWN OF BARNSTABLE ✓
LOCATION PCX. SEWAGE # �S" 41P
VILLAGE ` ) ASSESSOR'S MAP & LOT F'0�0�0
INSTALLER'S NAME&PHONE NO. Iet. Sb%
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) 7 61 Yee Qedkr4 r 119b (size)SAtoaxa S_
NO. OF BEDROOMS 3
BUILDER OR OWNER pJfederirP--
PERMITDATE: O COMPLIANCE DATE: /6 q- oS
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility .S Feet
Private Water Supply Well and Leaching Facility (If any wells exist N A
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist IV IA
within 300 feet of leaching facility) Feet
Furnished by T0r3 GAS
I"
v
4 9
e9 .�
h �
No. S F61 00.00
Entered in computer:
THE COMMONWEALTH OF MASSACHUSETTS � Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLEa lASSACHUSETTS
91pprication for Migpogaf &pgtem Conotructtar' 3permit
Application for a Permit to Construct( , )Repair(X )Upgrade( )Abandon( ) C Complete:System C Individual Components
Location Address or Lot No. Owner's Name,Address and Tel:No. 771 =3 9 2 6
177 Straightway, Hyannis Thomas & `Suzanne Broderick .
Assessor's Map/Parcel 2 6 8/2 2 0
39 Empire Cir, Rensselaer, NY
Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No. 3 6 4—0 8 9 4
Wm E Robinson Sr Septic Eco—Tech
PO Box 1089, Centerville 43 Triangle Cir, Sandwich
Type of Building: p rr^ � �l G'� ? r�ro ur�� o�'� ss t 5
Dwelling No.of Bedrooms . rJ "`� Lot Vze sq.ft. J Garbage Grinder p n�
Other Type of Building No.of Persons Showers( ) Cafeteria( )CQ wed f
Other Fixtures '
�r
Design Flow gallons per day. Calculated daily flow gallons.ON,;IM
Plan Date Number of sheets Revision Date �r�°f
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
u4t,
Nature of Repairs or Alter bons(An wer when a 1'cable Install a new Title 5 septic
system to pans of EcoSTIE , — , witri p um ing raise
by master plumber.
Date last inspected:
Agreement: I w�Er
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 Certifi-
cate of Compliance has been issued by s azd of Heal �, J
Signe Date
Application Approved by Date
Application Disapproved Porthefollowing reasons
Permit No. gi C� Date Issued S
No. Fee$100_00
.. i t f
t" Entered in computer:
4� -4;,4 aoa .-`�jS �1'HE'COMMONWEALTH OF M SSACHUSETT
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABd,; MASSACHUSETTS Yes
01ppYication for Migpool p$tent Construction Permit_
Application for a Permit to Construct( )Repair( N)Upgrade( + )Abandon( ) O Complete System (]Individual Components ;
Location Address or Lot No.F� T= Owner's Name,Address and Tel.No. 7 71 -3 9 2 6
177 Straightway, Hyannis Thomas &'Suzanne Broderick
Assessor's Map/Parcel 2 6 8/2 2 0 `
39 Empire- Cir, Rensselaer, NY
Installer's Name;Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No. 3 6 4—0 8 9 4
Om E` Robingon Sr Septic Eco-Tech
PO Box 1.089, Centerville 43 lsriahigle Cir, Sandwich o r,
( / ! r,
Type of Building: �G( c0' !y jW l(�(:I o r - 3 r�m°M�...:c_ c� ��b nr id s)v 5 S« i l l,
DwellingNo.of Bedrooms -o dot Sine s .ft. Garbage Grinder )\D� /(p/r�
( 1 J/��-- ". q g
Other Type o Building �FNo .of Persons ' ( ) Cafeteria( ) 1 (q�1�+ Showers ,
Other Fixtures
Design Flow ~gallons per day. Calculated daily flow gallohs,,,_roo,A,
Plan Date Number of sheets A' Revision Date
Title fro r
Size of Septic Tank Type of S.A:S. PO
Description of Soil ,
L4&iL
Nature of Repairs or Alterations(Answer when a plicable) Install a"new Title 5 septic
system to plans of Eco- ech, #ETE-2U89, with p um ing ,raise cG�e
by master plumber. ,� pt16,e
Date last inspected: ft7 SQ i� 5
,< Agreement: Tr-
z; +
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system �0
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in,operation until a Certifi- '.
cate of Compliance has been issued by thisiBo6d of Health.
- , Signed i Date
Application Approved`by 9. J 5- bate 9 k )Y-��MC
Application Disapproved N the following reasons
F
Permit No. 2 U _ Date Issued - 1 �
THE COMMONWEALTH OF MASSACHUSETTS
Broderick
BARNSTABLE, MASSACHUSETTS
4,s Certificate of Compliance
THIS )S TO CER�.IFY that the On-site Sewage Disposal System Constructed ( )Repaired+(Upgraded{ )
Abandoned t �)abyf. k�A=Y Robi, (bn Sr Septic Service
at 177 Straightway, Hyannis has been constructed in accordance
with the provisions of��Tr e 5 and the for Disposal System Construction Permit No. Q)F,n 1�`- y dated -,2/-v��
Installer I! �)S�CJY� Designer 9Ae
The issuance of this permit shall n t b onstrued as a guarantee that the stem wi t1 n s designed.
Date �� Inspector ,...,_._...
No. t_;��c IL Fe°e100.00
Broderick
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
Mizpogal *pgtem Congtruction Permit
Permission is hereby granted to Construct( )Repair( '.Upgrade( )Abandon( )
System located at 177 Straightway., Hiannis :'�
I v
and as described in the above Application for Disposal System Construction Permit. The applicant recognizes 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 ermit.
Dater_ — r. : Approved by h �
t °
•
Notice: This Form Is To Be Used For the Repair Of Failed
Septic Systems Only
PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM
I, Qaytd D. 4f0')fha4, w'i' ,hereby certify that the engineered plan signed by me
dated A4 �7� S,concerning the property located at
177 meets all of the
following criteria:
• Two soil evaluations excavated for detailed examination(no hand augering) and two
percolation tests shall be conducted: P ere Lvq 5
lo�F�re -(fie pits w�Ve �et4v; o(
• This failed system is connected to a residential dwelling only. There are no commercial or
business uses associated with the dwelling.
• The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes
per inch.
• There is no increase in flow and/or change in use proposed
• There are no variances requested or needed.
• The bottom of the proposed leaching facility will be located no less than five feet above the
maximum adjusted groundwater table elevation. [Adjust the groundwater table using the
Frimptor method when applicable]
Please complete the following: TL-51 t
24- ►Z 2('oGU
A) Top of Ground Surface Elevation(using GIS information) S!tS
B) G.W. Elevation 13.15+adjustment for high G.W.
DIFFERENCE BETWEEN A and B o / 5-6 S
SIGNED�,�`, � DATE. ,
NOTICE
Based upon the above information, a repair permit will be issued for "2— bedrooms
maximum. No additional bedrooms are authorized in the future without engineered septic system
plans.
gASeptic\percexemp.doc
Barnstable'Assessing Search Results k Page 1 of 2
Al
Home;: Departments:Assessors Division: €,opertyr Assesam€srit Search Results ,
177 ST"RA11G`H:TrWAA '.
Owner: F
BRODERICK;_THOMAS PAUL Property etti'Leeid `,';'y .
Map/Parcel/Parcel Extension
268 /220/
LINE, RE Y €
Mailing Address
BRODERICK,THOMAS PAUL 1
39 EMPIRE CIR
RENSSELAER,,NY. 12144
2005.Assessed Values:
- .. - a t�'i deli• 3,�yo" ''3
Appraised Value Assessed Value wF '
Building Value: $ 103,200 $ 103,200
r`
Extra Features'; $2,600 $,2,600
,Outbuilding _ $0 $0 ;4u x if
Land Value' $ 128,100 $ 128,100 Interactive P.ro er`t M8 Ma re uires Plu in:
Totals.:$233,900 $233;900 - I have visiteii the maps before
ShoWWe The Maps N
April 20,01 photos a
Sales H.j.it rig:
Owner '4 %, „ Sale Date. Book/Page: Sale Price ,
BRODERICK,THOMAS PAUL 10/17/1996 10439/090 $ 1
BRODERICK,.THOMAS P&PEARL 3/15/1995'' 9573/137 $1 aka
BOUDREAU, PHILIP M 3/15/1995 9573/136 $ 1
ERODERICK,THOMAS P& PEAR 7/15/1994 P1079AD1 $ 1 4 .t
BRODERICK,'THOMAS P&PEAR 3/15/1992 7923/093 $1 '
BRODERICK,iTHOMAS P 4/1�5/1983n 3726i 217' -$571 000
BRODERICK NANCY J M-792
?008 R 'AL E �' "E Tax Inforrnatior�`: Tait Rates: (per 000 of v lu z�tar)
Land Bank Tax~ $42A5 Town Fire District Ratesr, Other l'
2, $6:05 Barnstable' Residential $2.12 Land B•
Barnstable CoMffi6 cial $2.80
Hyannis FD Tax(Residential) $355.53 C.O M M. All Classes $1.01
>~
Cotuit FD All Classes $1.28
Town Tax(Residential) $ 1,415:10' Hyannis,-'R sidehtial $1.52
http://www.town.barnstable.ma.'us/tob02/Depts/AdministratliveServ*-, T j-a 'J %Assessing... 9/21/2005
Barnstable Assessing Search Results Page 2 of 2
a E
Hyannis-Commeroial $2.39
r W Barnstable-Residential $1.44
.W Barnstable'-Commercial $2.10
Total: $ 1,813.08 .Due to rounding differences these values may vary
y y'
Land and Building Information
Land, Building ?
y...
Lot 3ize.(Acres) 0.23 Year Built :.t1972
4 -
Appraised Value $ 128,100 4 Lving Area A ,1144
Assessed`Value $ 128,100 Replacement Cos 121,432
. ,
y,
Depreciation "=:1'6
Building Value 101200
Construction Details
Style Ranch Interior Floors Carpet h. Ia
Model -Residential Interior Walls Drywall
Grade, , Y, 'Average Minus Heat Fuel Gas \` �� ? ,r
,V,
Stories 1 Story Heat Type Hot Air 1 a' t, i1� �`a^
Exterior Walls Wood Shingle AC Type None
l
Roof Structure:Gable/Hi T 'Bedrooms j +2 Bedrooms
Roof Cover Asph/F GIs/Cmp Bathrooms 2 Bathrooms ; ;A 3INa�
Total Rooms-.,6':Rooms
Extra Biding Features
Code' Description Units/SQ ft Appraised Value Assessed Value
r
FPL1 Fireplace 1 $2,600
Projabnty Skefgh Legend
BAS First Floor Living Area FST Utility Area(Finished Interior) x A UAT� Attic Area(Unfinished)
i, ka".
BMT Basement Area (Unfinished) FTS ThirdfStory Living Area(Firnshed)' UHS sHalf Story(Unfinished)
,.
CAN Canopy FUS 'Second Story Living Area (Finished) UST Utility A#ea (Unfinished)
FAT Attic Area(Finished) GAR•=Garage UTQ Tliree Quarters Story(Unfinished)
FCP Carport GRN Greenhouse UUA Un.finished Utility Attic
FEP Enclosed Porch PTO. Patio UUS.- Full,Upper 2nd Story(Unfinished)
FHS Half Story(Finished) SFB Semi Finished Living Area WDK Wood Deck
FOP Opewor Screened in Porch TQS Thi ee Quarters Story(Finished)
http.//WWw�to.wiz:barnstable.ma:us/tob02/Oepts/AdmimstrativeServices/.Finance/Assessing... 9/21/2005
Town of Barnstable
�FtHE T�
Reblliatory Services
Thomas F. Ceiler, Director
• BARNFTABLE,
9� ,'b9. Public Health Division
AlE0 A Thomas McKean, Director
200 Main Street, 1.1yannis, t\IA 02601
Office: 508-862-4644 Fax: 508-790-6304
Installer && Designer Certification Form
Date:
Designer: Eco-Tech Installer: Wm E Robinson Sr Septic
Address: 43 Triangle Circle Address: _PO Box 1089
Sandwich Centerville
Oil Wm E Robinson Sr Septivas issued a permit to install a
(date) (installer)
septic system at 177 Straightway, Hyannis based on a design drawn by
(address)
Eco—Tech dated 08-17-05
(designer)
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.
I certify that the septic system referenced above was installed with major changes (i.c.
greater than 10' lateral relocation of the SAS or any vertical relocation of any component
of the septic system) but in accordance with State �ti, Local Regulations. Plan revision or
certified as-b tilt by designer to follow.
of�ssgo
DAVID
(Installer's Signature) o D.
0 COUGHANOWR N
No. 1 093
SgNI7AR\PN
(Designer's Signature) (Affix Designer's Stamp Here)
PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICA'I I?
OF CO IPLIANCE WILL NOT BE ISSUED UNTIL BOTH TIRS FORM AND AS-
BUILT CARD ARE R.ECEIVED BY ,FUIE BARNSTABLE PUBLIC HEALTH DIVISION.
TII:-NK 1'OU.
Q: Hcalth/Septic/Designer Certification Donn
Suzanne M. To health@town.barnstable.ma.us
Broderick/DHCBC/OHSM/DO
W 7 H cc colleenhkramer@earthlink.net
02/01/2006 09:08 AM bcc
Subject 177 straightway
Mr. McKeon, I attest that when my family purchased the home at 177 straightway in January, 1983 there
were 3 bedrooms. The agreement to purchase even states in has 3 bedrooms. Please respond to my
email at the following address: sxm10@health.state.ny.us. thank you for your assistance
Suzanne M. Broderick PhD. R.N, Deputy Director
Division of Home and Community Based Care ^
0 F
l -2-A N nJ r`l. �Q C�,�k- C�
p'{OOh
KATHLEEN L.SAVAGE
Notary Public
4 State 9682of New York
Qualified in Albany County Ofov
Commission Expires June 18
i
co
o
r11 �
f'o'1
r
02/02/2006 11 :05 AM NYS Office for Technology 518-402-4807 1/1
OFFER70 PURCHASE REAL ESTATE
"THIS IS A LEGALLY BINDING CONTRACT. IF NOT UNDERSTOOD,SEEK COMPETENT ADVICE"
F jT..01ce ol:
Harvard fflems y 830C sates
TO I Irene W. Kahn 17 High School Road
177 strafWVW) REALTORIS Hyannis, Ma. 026,,-,,l
q
West 11yannisport, Ma. DATE January -10, lr)1t�'
I hereby offer to buy thearty herein referred tA and ideptifled f 11 3 bedroom ranch home
located at lritraightway, yannispV1,0 W. 144'6rded-with"thu BarriatabTe
Na ..........................................................
"�h ftf-29. ............................
.................................I................................................................................................
I hereby offer to buy said property under the following terms and conditions:
(1) 1 will pay ty&'reOU-2 1000.00
. - ($ dollars, of which:
(a) is paid berewithas a dcposit-to-bind this Offer,
(b) $... ......I........... is to be paid as an additional deposit upon execution of Purchase and Sale Agreement
as provided for below.
U•1 .100.00
W A--�............ is to be paid in cash,certified check or bank draft at the time of the delivery of the Deed.
t(e)d) $. 5.7 Xod, .... is the Total Purchase Price....................*.........................................................................
................ .
until 4;00 January 14, 83
(2) This f0fier is good Non — 9�y at or before which time a copy-hereof shall be
signed by you,the Seller-and your(wife)(husband),signifying acceptance of this Offer,and returned tame forthwith,otherwise
this Offer shall be considered as rejejed d herewith s .1 be returned to me.forthwith.
.M F!"'AsetRole, 1�5
(3) The parties hereto shall,on or before—,M.on 19—execute a Purchase and Sale Agreement,
which when executed,shall be the Agreement between the parties hereto. 2:00P
(4) A--- tan efficient Deed8!fnveying j5&"4,fj6 1W marketable title of record shall be delivered at— M.on"
pily--F112 19 at the County Registry of Deeds, unless some other time and place are
mutually agreed upon.
(5) (a)If you(Seller)do not fulfill your(Sellers)obligations under this Agreement,said Agreement shall be enforceable both at law and in
equity, (inclusive of specific performance).
(b)If I(Buyer) do not ftdffl]my obligations under this offer, the deposit(1) (a) mentioned above shall become your(saws)
property as liquidated damages without recourse to either party.
(0) Time is of the essence hereof.
'
(7) A fee of will be paid by the Seller to the listing broker,upon passing shtle.
Harvard Realty Associates
This pUrcha" is Contingent upon buyers obt&lnlne. mortirege
financing from a recognize d 'Iending ,inatututian. wamier—, Dryer,
�2ti 1 re rr-Fg—erVo F—a—nc-Farepe Pie s are to be inciuded as a part ol' tF1.13 a ri-e r,,�:
WITNESS my (our) hand(s) and seal(s), SIGNED Thomas and Pearl Broderic"!
731 ConEord HOSWer) trinni)
X
Marlboro, Na. "u*65-840•
(Address)
This Offer is accepted upon the foregoing term and conditions at Iv1. on 19
Receipt of the deposit of$ —is hereby acknowledged.
WITNESS my(our) hand(s) and seal(s).
(Selwa Spouse) (Se Her)
(Broker)
......----------------------------------------------------
January 10, RE$�ff FOR DEPOSIT
9
Received from Thomas an C1 Pearl glro—de—Rck 100.00 11 as deo t
(8ur)a 0
under the term and conditions of the a ove offer to be held in escrow by
i3
Dennis M. Cirey (Broker)
01/31/2006 15:14 5083948318 LUDDEN & KRAMER PAGE 01
LUDDEN&KRAMER
Attorneys At Law
Coach House Comer
477 Main Street,Rt. 6A
Post Office Box 251
Yarmouth Port,MA 02675
Colleen H. Kramer Telephone No. (508)362-7614
Rockwell P. Ludden Fax No. (509)362-5314
TO: Thomas A. McKean FROM: Colleen H. Kramer
FAX NO: 508 790-6304 MY FAX NO: 508.362-5314
NUMBER OF PAGES: 2 DATE: 1/31/2006
RE: 177 Straightway, Hyannis,MA
Dear Mr. McKean:
I represent Mr. Thomas Broderick,the owner of the home located at 177
Straightway, Hyannis. His Father owned it before him, It has always had 3 bedrooms as
does the home abutting it. Both homes were built at the same time in the 1970's,the
identical footprint.
Mr. Broderick was in the process of signing a Purchase and Sale Agreement when
the issue of number of bedroom
s arose. The home has always had 3 bedrooms and the
septic is built for 3 bedrooms but the assessor field card from 2002 notes 2 bedrooms.
The assessing inspector viewed the premises this week and determined that he had made
an error and the field card now reflects that this is a 3 bedroom home.
Enclosed is a letter from the Assessing Division confirming the 3 bedrooms.
The Buyer will sign the Purchase and Sale Agreement when the Board of Health
confirms 3 bedrooms. I would appreciate it if you would confirm this on the bottom of
this letter and fax it to (508) 362-7614. Your help in this is much appreciated.
Very truly yo
Colleen H. er
01/31/2006 15:14 5083948318 LUDDEN & KRAMER PAGE 02
— "'°° 111 EARNSTA&E ASSESSORS PAGE 01/82
Town of Barnstable
Assessing Division 367 Main Street,Hyanials MA 02601it
1
www.towA,bamstablema.w
olnco: 59d.W4022
FAX: SW 862•4722 Paul A.Mathesole,III
DiRG10T of ASSOMang
January 31,2006
Colleen Kramer, Esq.
477 Main Street
Yarmouthport,MA 02675
RE: 177 Straightway,Hyannis
Thomas Brodcrick
Dear Attorney.Kramer:
The house at 177 Straightway,Hyannis owned by Thomas Broderick was
inspected by the Town of Barnstablc field inspector on January 30,2006. After
inspection it has been detemined there are 3 bedrooms,a kitchen,a dining room and a
living mm in'the honic; for a total of 6 rooms.
According to our records,we have had the property inaccurately listed as a 2
bedxoom for many years. The field card from 1973 lists the home as having 6 rooms
which is the same as today. Enclosed please find the field card reflecting the change in
the number of bedrooms.
Please feel flree to contact me if you need Airther assistance.
Sincerely,
Sheila Fowler
Office Manager
cc: Thomas Broderick
Board of Health
enc
PLAN REFERENCE CONTOURS a cPNDLEWIGK
LANE >
3 ?
PLAN BOOK 240 PAGE 15 EXISTING - - - - - - - 50 -+
ASSESSOR'S MAP: 268 FINAL 50 HAYBALE
LOT: 220 c LOCH
BARRIER z
gg 25 "' f
24 23 22 21 IO1).00 f t 2I 22 23 24 0 ><
N >
0
QUAD 0 GRAIGVILLE BEACH 90 Q
/ 7
BENCH MARK � � � HY,,AMs. MA
TOP OF CONC BOUND I 1 ��� 1 AY LOCUS M A P
ELEVATION - 24.56 �� PAVED NOT TO SCALE
USGS DATUM ASSUMED ! — �
1
NOTE l `
SEWER LINE IN BASEMENT IS (50 ft 5 x ft
ER Y
LEACHING GALLERY
TO BE RAISED TO ELEVATION LE G I 26
INDICATED ON FLOW PROFILE. 24 O z 1 ' LEGEND
_z o +
NOTE 2 SOIL REMOVAL AREA r pf Q J LL WATER LINE / 1500 GALLON
FINAL GRADE OF BACK YARD TO SLOPE 10 r O W J L N O O O
AWAY FROM LEACHING GALLERY. SLOPE o O W a O SEPTIC TANK O
TO PROPERTY LINE IS NO O BE / r OJ A� � O W D-BOX
TO PREVENT SILT RUNOFF
STEEPER THAN 3:I. o O p
2 fr O` _� \` ` 00 j TEST PIT
NO TE 3 k ��� EXISTING 60)
USE HAYBALES AS INDICATED LL CESSPOOL
ONTO ADJACENT PROPERTIES. 23 I �L O T S
W
N �R�A\ I00 0 sf
TREE
N
-NUMBER REFERS TO DIAMETER '�P
� !N NCHES. LETTEP, DENOTES TYPE
\ O-OAK M-MAPLE P-PINE
LOW PROr— ILE 22 21 2O 100.00 ft 20 21 22 23 24 25 26
TOP OF FOUNDATION RAISE COVERS TO WITHIN ��HAYBALE
lEL - 24.86 6 in OF FINAL GRADE BARRIER PLAN
24.00 ?3.'S ' SCALE: I in - 20 f t
,� - ox N 2.11/2YESTONE
2- DROP 8' SEWAGE DISPOSAL SYSTEM PLAN
FLOW LINE L 3/4'-1 1/4' -TO SERVE EXISTING DWELLING
lo-u 47E` STONE
THOMAS & SUZANNE BRODERICK
22.75 � GASH RECHARGER 180 �ZHOFMgs
PROPOSED BAFFLE 6 in BOTSOILTOM OFABSORPTION �oFA DAVID s9c�GN 177 STRAIGHT WAY HYANNIS. MA
\�_22.25 BASES LEACHING SYSTEM ENVIRONMENTAL
EXISTING 21.80 D. E C O-TECH E
6 in STONE BASE 21.97 GALLERY, COUGHANOWR
22so 5.00 ft ' No. 1093 43 TRIANGLE CIRCLE SANDWICH MA 025621
I500 GALLON (END VIEW) S .E��° 508 364-0894
zl.n �S ETE-2089 AUG. 17. 2005 I/2
SEPTIC TANK 20.60
l5.55 � ADJUSTED
SEASONAL HIGH .� �D S THS PLAN IS TO BE CONSIDERED A DRAFT PLAN UNLESS IT
10 fr 24 ft 5 ft 5 ft GROUNDWATER l4v gUS ! BEARS THE STAMP AND SIGNATURE OF THE DESIGN ENGINEER
ORIGINAL PLANS INTENDED FOR SUBMITTAL TO TW BOARD
OF HEALTH WILL BE SIGNED N BLUE AND STAMPED N RED.
DATE OF TEST: JULY 8. 2005
SOIL TEST LOG SOIL EVALUATOR: DAVID D. COUGHANOWR. RS DESIGN' " CALCULATIONS
WITNESS REQUIREMENT WAIVED - NO VARIANCES SOUGHT G{
I����vs' ffl p
GROUNDWATER ENCOUNTERED AT 74 in A``/Vlu 3� G�
TEST PIT I PARENT MATERIAL: PROGLACIAL OUTWASH D IGN FLOGV: 3 BEDROOMS X 110 GPD - 330 GPD G'^ `�`' '
ELEVATION 20.12 •- PERC AT 60 in : 2 MIN/INCH IN C SOILS
SEPTIC TANK: 330 GPD X 2 DAYS - 660 GALLONS C �/ r
DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER INSTALL 1500 GALLON SEPTIC TANK (MINIMUM ALLOWED)
(INCHES) HORIZON TEXTURE (MUNSELL) MOTTLING
2012 DISTRIBUTION BOX: USE 3 OUTLET D-BOX.
0-6 O LOAMY SAND 10 YR 3/I NONE FRIABLE
SOIL ABSORBTION SYSTEM: A 60 ft x 5 ft x 1.17 ft LEACHING GALLERY CAN LEACH
6-9 E LOAMY SAND 10 YR 4/1 NONE FRIABLE
Abot - ( 60 x 5 ) - 300 sf
9-15 A LOAMY SAND 7.5 YR 3/4 NONE FRIABLE Asdw - ( 60 -► 60 5 + 5 ) x 1.17 - 151 sf
Atot - 451.7 sf
15-38 B LOAMY SAND 10 YR 4/6 NONE LOOSE
16.95 Vt 0.74 x 451.7 - 334.2 GPD
38-120 C MEDIUM SAND 10 YR 6/3 NONE LOOSE USE A 60 ft x 5 ft x 1.17 ft GALLERY. Vt - 334.2 GPD > 330 GPD REQUIRED
13.95 _
10.12
GROUNDWATER ADJUSTMENT LEACHING GALLERY
OBSERVED GW 13.95 CONSTRUCTION DETAIL
INDEX WELL MIW-29 USE 7 CUL:TEC RECHARGER 180 CHAMBERS
ZONE C
READING DATE JUNE.'2005
READING 6.9
ADJUSTMENT 1.6 11-3 ft 5 ft
ADJUSTED GW 15.55
3.75 7.5 ft 7.5 ft 7.5 ft 7.5 ft 7.5 ft 7.S ft 7.5 ft 3.7
f' `'NOTES
60 ft
1) GARBAGE GRINDER NOT ALLOWED WITH THIS DESIGN
2) ALL LINES TO BE SCH 40 PVC AND PITCH AT 1/8 INCH PER FOOT MINIMUM.
3) ALL COMPONENTS INSTALLED SHALL MEET THE MINIMUM REQUIREMENTS
OF MASSACHUSETTS TITLE 5 SEPTIC CODE (310 CMR 15) 2 in PEASTd
4) INSTALLER TO VERIFY LOCATIONS OF ALL UNDERGROUND UTILITIES INC I I/2
14 in I16 In
BEFORE EXCAVATING FOR SYSTEM,
NCH STONE �F
5) EXISTING CESSPOOLS TO BE PUMPED. COLLAPSED. AND REMOVED. CONTAMINATED I ft 3 ft I ft
SOILS ECOUNTERED IN THE AREA ARE TO BE REMOVED AND REPLACED WITH CLEAN SAND.
6) ALL STONE TO BE DOUBLE WASHED AND FREE OF IRON. FINES AND DUST IN PLACE 5 f t
7) LINES EXITING D-BOX TO RUN LEVEL FOR 2'-0' BEFORE PITCHING DOWN
8) ECO-TECH ENVIRONMENTAL RECOMMENDS THE .INSTALLATION OF LOW FLOW FIXTURES
AND APPLIANCES, AND BIANNUAL PUMPING OF THE SEPTIC TANKSEWAGE DISPOSAL SYSTEM PLAN
9) SYSTEM IS NOT DESIGNED TO WITHSTAND VEHICULAR LOADING. DO NOT
PARK OR DRIVE VEHICLES OVER SEPTIC SYSTEM. -TO SERVE EXISTING DWELLING
10) INSTALLER TO OBTAIN DISPOSAL WORKS PERMIT BEFORE STARTING WORK.
11) SEPTIC TANKS SHALL BE INSTALLED LEVEL AND TRUE TO GRADE ON A LEVEL THOMAS & SUZANNE BRODERICK
STABLE BASE THAT HAS BEEN MECHANICALLY COMPACTED AND ON TO WHICH 177 STRAIGHT WAY HYANNIS. MA
SIX INCHES OF CRUSHED STONE HAS BEEN PLACED TO MINIMIZE UNEVEN SETTLING
12) SEPTIC TANK TO BE PUMPED DRY AT TIME OF SYSTEM REPAIR AND CHECKED ECO-TECH ENVIRONMENTAL
FOR STRUCTURAL INTEGRITY. INSTALL PVC OUTLET TEE FITTED WITH GAS BAFFLE.
13) CONTAMINATED SOILS ENCOUNTERED WITHIN THE SOIL REMOVAL AREA ARE TO BE 43 TRIANGLE CIRCLE SANDWICH MA 02563
REMOVED DOWN TO THE MEDIUM SAND STRATUM AND ARE TO BE REPLACES WITH
CLEAN MEDIUM SAND PER TITLE 5.
ETE-2089 AUG 17. 2005 2/2