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HomeMy WebLinkAbout0187 STRAIGHTWAY - Health it`d' f /1 5 ;r Hyannis "ter „ r Y I '� e No. % `c Fee 5 0.00 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: !�� PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZIpprication for Mi5pooal *pgtem Con!6tructiott permit Application for a Permit to Construct( . )Repair( X)Upgrade( )Abandon( ) O Complete System O Individual Components Location Address or Lot No.1 8 7 Straightway Owner's Name,Address and Tel.No. 7 7 5—21 0 7 Hyannis Roger Parmenter Assessor'sMap/Parcel 268_221 187 Straightway, Hyannis Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No. 3 9 8—8 31 1 Wm E Robinson Sr Septic Craig Short PO Box 1089, Centerville PO Box 1044, S. Dennis t Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder Ito) Other 'Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. 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).I n s t a 11 a new Title 5 septic system to plans of Craig Short #1 -1005 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 Certifi- cate of Compliance has bee a by s eo f Health.✓ ,ate Signe Date<J Application Approved by Date Application Disapproved for the following reasons Permit No. '� �� Date Issued O :No. w" i 'E k.' r �' ¢ Fee$5AOO THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: t es PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01pprication for Zigponl *p.5tem Con5truction Permit Application for,a Permit to Construct( )Repair( X)Upgrade(. )Abandon( ) ❑Complete System ❑Individual Components Location Addressor Lot No.1 8 7 Straightway Owner's Name,Address and Tel.No. 775—21 O 7 Hyannis `'Roger Parmenter Assessor'sMap/Pazcel 268-221 187 Straightway, Hyannis Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No. 3 9 8—8 31 1 !.Wm E Robinson Sr Septic Craig Short PO Box 1089, Centerville PO Box 1044, S. Dennis Type of Building: Dwelling - No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder(po) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. 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) Install a new Title 5 sentic ' system to plans of Craig Short #1-1005 Date last inspected: Agreement: s 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 bees ued by this oar Hof Health. Signed Date/ Application Approved by Date y o Application Disapproved for the following reasonst Permit No. — �3 Date Issued O L . k THE COMMONWEALTH OF MASSACHUSETTS , Parmenter BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired(X )Upgraded( ) Abatidoned( )by Wm E Rohinaon Sr ,Anti n at 187 Straightway, Hyannis has been constructed in.accordance with the provis M s of Title 5 and the for Disposal System Construction Permit No. _:!�I ^oq I<3 dated Installer s �lr,Sg +, Designer' ,The issuance of is prrt shall not be construed as a guarantee that qe syste • u cti as designed. , D.a+x.. "'� Inspect Parmenter THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE} MASSACHUSETTS ligozal bpztem Con.5truction Permit Permission is hereby granted to Construct( )Repair(X )Upgrade( )Abandon( ) System located at 187 Straightway, i4yanni c 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:Construuc/ti must be completed within three years of eI date of is Date: / �o Lez Approveby Town of Barnstable 4P�°Fzr �"'ti Regulatory Services H O•n. Thomas F. Geller,Director ► anxnsrwstE + "'"59. i679• Public Health Division �� AIEDN"'�� Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: Designer: Craig Short Installer: Wm E Robinson Sr Septic Address: PO Box 1044 Address: PO Box 1089 S. Dennis, MA Centerivlle, MA On Wm E Robinson Sr Sept Vas issued a permit to install a (date) (installer) septic system at 187 Straightway, Hyannis based on a design drawn by (address) Craig Short dated 1 2-31 -03 (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 component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. OF (Installers Signature) �' �`� AIG st'1011T CIVIL l No. 27483 i' (De'signer's Signature) (Affi sv Unwvg'66�r s Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC-HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:HealtIVSeptic/Designer Certification Form ECT DESCRIPTION: S ��'�i s %S 77=^j ••AS 13?U J L 7" r sE r 7-1 eS Z'-7'� 31 I � 77 1 Fr G S�P7l� ro,vk c r/c 9 1 � _ 4 sNF.� 7"-fLla ro�.s l/ `x 37 x /o" 7'l2�NCtY row a;c ,G a�,✓�.q_Ti_oi,.. f� 5-SUM F2? ,�_..L. .�_��,� 7 'gAl OS ,r our If r , r, 9 7. 6 S -.......... D s r .ci a x ..r © VT .g7 a T7'e>.�-► or S. A. S . " 9G,G G - ,EJQ v- Member ASCE ,� FOR: Pf f CRAIG R. SHORT, P.E. vv.4 y P.O. BOX 1044 ° % CRAIG �yG LOCUS: SOUTH DENNIS, MA 02660 SHORT r. TOWN:�' L3A,eNS>A,t3L�' M�JS•5'� Professional Civil Engineer • Soil Evaluator 0 CIVIL VIL Licensed Construction Supervisor • Septic Inspector Septic • Site • Piers • Structures • House Designs A� f \ 40. DATE. /$V'n FILE. / —/oe)S 'A Office: (508) 398-8311 Fax: (508) 398-3063 .. � SC lot) / � ZQ' SHEET f OF / Commonwealth of Massachusetts { Title 5 Official Inspection Form i' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address —�-- O G 2 A/'A92 n to e - Owner Owner's Name �yJ information is �� required for every -- page. City/Town State Zip Code Date of In pecti n Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. Inspector in ation p filling out forms / iY Ife,on the computer, use only the tab key to move your Name of Inspector /0 cursor-do not Y ^— use the return Company Name `, Id- Company key. Zo do J� Address I - mZ CrS �Q _ A'4 (o Qt City/Town O State, `on Zip Code 11jr a8o-��9 Telepho Numbed License Number B. Certification I 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 71,IOM, 1. sses 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails lnspecto 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. ?i2e 5 kcal insper-on Fom::subsuaace Sewage D:sposai System•Page of i8 ,5insp•doc-rev.71261201,8 t Commonwealth of Massachusetts 9 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address Owner Owner's Name information is e f Q required for every �J A o4l-S or 1-- 7 page. Cityrrown State Zip Code Date of nspec on C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System P es: 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: 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", `nol' 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): 15insp.tlOC-rev.725/2018 7R1e 5 ot�aai jrspeczor,=om:Suosurace Sewage Disposa System-Page 2 of 18 Commonwealth of Massachusetts p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address Owner Owner's Name H s information is - b O/ �/ ,9 required for every AEI41 l page. City(Town State Zip Code Date of spection C. Inspection Summary (cons.) 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 ❑ NO (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ NO (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ NO (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): 71 broken pipe(s)are replaced ❑ Y ❑ N ❑ NO (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ NO (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 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/26/2018 -itte 5 Official;rspection corm:Suosurface Sewage Disposal System•?age 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address �rv'�2n ter Owner Owner's Name f / �I �7 information is q��� //9 required for every page. City/Town State Zip Code Date of I spection C. Inspection Summary (cons.) ❑ 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 LLL��� / clogged SAS or cesspool El Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool .tie 5 pffidai'nspec5on Port Subsurface Sewage Disposal System•Page a of 18 t5inso.doc-rev.7262018 Commonwealth of Massachusetts ' Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address, Cie dl Owner Owner's Name information is / 4 required for every N67A 6?#1 f-f ��' page. City/Town State Zip Code Date of nspec'on C. Inspection Summary (cons.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No J Static liquid level in the distribution box above outlet invert due to an overloaded r clogged SAS or cesspool Liquid depth in cesspool is less than 6" below invert or available volume is less than' day flow � L—✓•!/ 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. u Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. I 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.] j7 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 C.4. Yes No I I 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 it of a public water supply well t5irup.tloc•2v.7262018 T:;Ie 5 ctficai inspection on:suosu`ace Sewage tisoosal system•Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address A A4,o e Owner Owner's Name information is 01 0d required for every page. CityRown State Zip Code Date of In pectin 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 C.4 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 GA shall upgrade 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 o ❑ umping 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 xbeen 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)] Title 5 ot`dal inspenon Fc—Suosuface sewage Disposal syste-n•?age 6 of 18 t5insp.doc•rev.7/252018 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments/( rc it 0)441IV4 Property Address to r Owner Owners NameAX �/7 b of 7 �information isQ�Nlsrequired for everypage. CitYlTo'nm State Zip Code Date pection D. System Information A. -r?14 "VA" l"4 W .1. Residential Flow Conditions: J Number of bedrooms (design): dumber of bedrooms (actual): 3 3a DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): Description: �7 7 a w 4,-s4l��� G 1k, c q^4- Number of current residents: Does residence have a garbage grinder? ❑ Yes ET 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 ❑ Yes No information in this report.) ❑ Yes 2r No Laundry system inspected? ❑ Yes �o Seasonal use? Water meter readings, if available (last 2 years usage(gpd)): Detail: ❑ Yes �No Sump pump? Last date of occupancy: Date ?We 5 3 aai�.specaon=cm:sucsu'ace Sewage Disposal system•Page 7 of 18 t5insp.doc•rev.7262018 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address G�I✓�PN7'QY' Owner Owner's Name information is of q vl N�S Al/I ocw/ �g required for every page. Cit (Town State Zip Code Date of Aspectign 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: s Source of information: Was system pumped as part of the inspection? ❑ Yes o If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.00c-rev.7126/2018 -ite 5 oifiaai inspector.Four:suosurtace Sewage Disposal system•?age 8 of 18 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address Rrv"12h-�°N Owner / Owners Name /?ct, information is Q �5 od601 � required for every page. City/Town State Zip Code Date Insn D. System Information,(cont.) 4. Type of Sy Septic tank, distribution box, soil absorption system 1- *,"wey GkQ�,,,�, ❑ 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)a d source of information: Were sewage odors detected when arriving at the site? ❑ Yes E to 5. Building Sewer(locate on site plan): cp- 0 Depth below grade: Teet Material of constructi;/40 ❑ cast iron PVC ❑ other(explain): ! d Distance from private water supply well or suction line: feet v Comments (on condition of joints, venting, evidence of leakage, etc.): ';t;e 5 fdal inspection Fom.su�sur,,ace sewage oisposai system•?age 9 of 18 t5insp.doo•rev.7/2 612 0 1 8 Commonwealth of Massachusetts = Title 5 Official Inspection Form �} Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address Owner 60/ O / 6N wner's Name information is �� �60 ��4pe(fbion�: required for every Gl✓��/,fpage. City/Town State Zip Code Date o 1 D. System Information (cons.) 6. Septic Tank (locate on site plan): Depth below grade: feet ?en fconstruction: rete ❑ 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: _X 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 — /O[�P 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.): tit P"Id i✓7 I a C4 C✓ v►c/ /74 API . t5insp.doc-rev.726=18 T me 5 offioaa inspecwn=oi-n suosurace sewage IDsposal System-Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments , Property Address ariVh�iM-� Owner Owner's Name /� � D 40/ // information is / � � a required for every page. City/Town State Zip Code Date of spe ion D. System Information (cost.) 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 Tole 5—maa'.!rspecuon Form:Suosuface Sewage Disposai System•?age i t of 18 t5insp.doc•rev.7/2612018 A • f Commonwealth of Massachusetts Title 5 Official inspection Form eNSubsurface Sewage Disposal System Form -Not for Voluntary Assessments 16111 , Property Address /- Q�e� Owner Owner's Name / information is q� f �� Oa6oI required for every page. Cityrrown Z State Zip Code Date of Inv6ection 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 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.): SO / o .L�a4s ?rtle 5 Of9Qai!nspecbon Form.suosu'ace sewage Disposal system•?age 12 of 18 t5insp.00c•rev.7262018 Commonwealth of Massachusetts �- ? Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form Not for Voluntary Assessments. 4" I Property Address Owner Owner's Name yd6 d information on is � / required for every State Zip Code Date of I spection page City/Town D. System Information (cost.) 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.): 77 O p Vo owl T,o * 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: ULY Type .1- l leaching pits number: [� leaching chambers number: leaching galleries number: 0 leaching trenches number, length: [� leaching fields number, dimensions: (� overflow cesspool number: Innovativelaite native system Type/name of technology: ----- ot5aai:nspe don=cm.:SuDsIm"oe Sewage'Disposal System•?age 13 of 18 t5insp.doc•rev.7126/2018 Commonwealth of Massachusetts Title 5 Official Inspection Form j Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address � ✓ —"— Owner Owner's Name /�j/f� information is required for every 11 Akid I r 'i Q l v-6 page. City/Town State Zip Code Date of Ins6ection D. System Information (cost.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): 17V 64e 6i Hd Sod CI,�,;4h (2 G t &/'� 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.): We 5 OtfQai Inspe=on-OT:s"surface sewage Disposal sysiem•?age 14 of 18 t5insp.dor•rev.7262016 Commonwealth of Massachusetts Title- 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments c Z01 Property Address a✓✓ze Owner Owner's Name information is required for every 0411 if _ page. Cityrrown State Zip Code Date of Ins ction D. System Information (cons.) 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.): 45insp.tloo-rev.7262018 Tiue 5 Cftaei:nspzcoon rortr.xos�r`ace Sewage disposal System .age 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address Owner Owner's Name information is / G K 0)601 required for every page. C41-town State Zip Code Date oMnspecTion 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: ❑ d-sketch in the area below drawing attached separately i � I i iU6 to i I i i i i i . I I I i I t5insp.doc•rev.712612018 Tzue 5 fical irspecaon Fcrm:suosc:tace Sewage Disposal System•Page 15 of 18 d � IWECT DESCRIPTION:' I. A',E 23 gv 4-1. CK � ► `� �&P'/C ' AIL S n... �, Q S �. � T'a�✓� i'N �7 wi y. - // X A,777/4Z 11 1 T o -45 �A S S v rA/v, -�` � ���` .• � �, `�- ,, �' _,, oar _/r g3 S2 /S T, rCi�k J�v'x a5f"' 97.._4-V 1 i , a V T: i roT1'mi+-► poi-'" 5.A/9 S 91,GG e vq/o -e.:.cc1 �:_:; Member ASCE. PAR&7E77 2 v � CMG, R. SHORT, P E F t,aLZEiA'j+ ' _ P 0 80X 1044 Or AIG yG LOCUS: /�7 STR�/ANT wA y $ .SOVTH DENNI`S. MA 02660,, «S , a ° HORT t F cIvlr_ N rowN: 46A�e�u Ig7A " r s ProfessionaI Civil-Engineer • ,Soil 'Evoluator; p 274i33 Licensed'Construction,Supervisor! Septic Inspector. Septic Site •°Piers+� Structures <• House.,Des"gns . '�f '9£ .� OA7E G ¢/�¢ .: FlLE' 0#fice. :SID 398 8311 Fax SOi3 398=3063, SHEET OF )" 5 e�`LE./ z0 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address Owner Owners Name information is required for every 01 A-146 page. Cityf7own C7" 1 State Zip Code Date of irApection D. System Information (cost.) 15. Site Exam: U Check Slope ❑ Surface water i ❑ Check cellar ❑ Shallow wells fo Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) Checked with to Board of Health - explain: AhS �F�f IJ645 ❑ Checked with local excavators; installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe no you e abllshed the high ground water elevation'. / AA Av-i or- -SVvvk a-1 2 02. 1 6" /`,- �S s / ✓ -el Ia h �i • ��� "' �Q 1r i � o✓l a Before filing this Inspection Report, please see Report Completeness Checklist on next page. 5insp.doc-rev.72512018 7:tie 5 oi5aa! ,specci=om:suosudace sewage Disposal system•Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form kwv Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Property Address Owner Owners Name WA information is G)NvI r r O16o O required for every 67 page. CitylTown State Zip Code Date of Insp coon E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: A. Inspector Information: Complete all fields in this section. Q Certification.- Signed & Dated and 1, 2, 3, or 4 checked C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (F re 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 True 5'�aai inspection Form:SuosuCace Sewage D�sposai System•?age 18 0;t8 oinsp.Goc.rev.7/26/2018 + _ Town of Barnstable sKE o Regulatory Services Thomas"F. Geiler,Director • euwsrws[e • MASS., Public Health Division �b79• �0 ..Thomas McKean,Director 200 Main Street,Hyannis,MAA2601 Office: .508-862-4644- Fax: 508-79:0-6304 Installer& Designer Certification Form Date: �/4�o;, Designer: Cr.aiq Short T- , Installer: Wm E Robinson Sr Septic Address: PO Box 1044 ,, Address: PO Box 1089 S_ Dennis, MA > Centerivlle,. MA I. On Wm E Robinson`-Sr, Sept!As issued a permit to install a (date) -°:A (installer) septic system at 1'' . . Straightway' nni6 based on a design drawn by s„ (ad "ess); Craig Short = ;n dated ;1 2-31 -03 (designer) y ' '' '�` I certify that the septic system referenced above was installed substantially according to , y rI the desi - which;ma include minor approved changes such as lateral relocation of the Y • pp g distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than7Xr lateral relocation of the SAS o,any vertical relocation.of any component of-ther septic system)r but in accordance with State & Local Regulations. Plan revision or certified as-built by'designer to follow: a� �t�3 � i�ssa (Installer's Signature) yp� " Gun�AtGT41 �y Y.` 4 '•}.` Y 1 1 _� CIVIC No. 2743 k (Des gaer's Signature) tamp Her N "PLEASE.-RET-URN TO,BARNSTABLE PUBLIC:HEALTH DIVISION. . CERTIFICATE `; ,*`;' ' OF 'COMPLIANCE WILL NOT BE 'ISSUED•UNTIL BOTH'THIS FORM AND 'AS ' BUILT CARD'ARE RECEIVED.BY THE BARNSTABLE-PUBLIC HEALTH DIVISION. d THANK YO;U. ,. Q Health/Septic/Designer Certification Form t, * f;; No. i -- f Fee$5 0.0 0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer. a� Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Zipplication for Mi5pozat6p5tem Con!5truction Permit Application for a Permit to Construct( )Repair( X)Upgrade( )Abandon( ) O Complete System O Individual Components Location Address or Lot No.1 87 Straightway Owner's Name,Address and Tel.No. 7 7 5—21 0 7 Assessor'sMap/Parcel Hyannis Roger Parmenter 268-221 187 Straightway, Hyannis Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No. 3 9 8—8 31 1 Wm E Robinson Sr Septic Craig Short PO Box 1089, Centerville PO Box 1044, S. Dennis Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder do) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. 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) Ins to 11 a new Title 5 septic system to plans of Craig Short #1 -1005 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 Certifi- cate of Compliance has bee a by s o of Health Signe ` Date Application Approved by Date 4416 0 Application Disapproved for the`following reasons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS Parmenter BARNSTABLE, MASSACHUSETTS _ Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired(X .)Upgraded( ) Abandoned( )by Wm 1~' Robinson Rr Simni-i r F at 187 Straightway, Hyannis has been constructs in-accordance With the provis" s of Tide 5 and the for Disposal System Construction Permit No. `1 n�5�6 / 3 dated In 1 ram. Designer s cti as desi ned. 't shall.not be con strued as a guarantee that e s to e'of 's� a al •`T The ssuanc g y g Date tT/ Inspect .��,,P , a . to •3 HENCHIIAFtK 4" SCHEDULE 40 PVC PIPE OBSERVATION PIPE TOP OF FOUNDATION 20 FT MINIMUM FROM CELLAR MIN. PITCH 1/8" PER FT. 1 -CLEAN SAND 4'" Pv(l' PIPE PAINTED SOIL TEST _ /cv.00 10 FT. MINIMUM 10 FT. MINIMUM FROM SLAB OR CRAWL SPACE 1 - 2" LAYER Or- Fl-AT DARK GREEN OR DATE OF SOIL TEST ELEV. __�_ 2" PRESSURE PIPE 1/8~ TO 1/2" BROWN WITH CARBON SOIL TEST DONE BY �i! i2. - r l -dr 150 PSI MINIMUM ELE� _ �t WASHED STONE F-IIL IS REQUIRED WITNESSED BY (ASSUMED) -� E� 99. 2 M - 99.ao�i.� PUMP SWITCHES DETAIL CONCRETE rsf_.�S 'N _ __ OBSERVATION HOLE 1 ELEV.=_�_ COVERS �� _z PERCOLATION RATE <2_ MIN./INCH AT INCHES - f _ - I I DEPTH HORIZ TEXTURE COLOR MOTT. OTHER O� " �4 97, 3 4 _ _ 4" CAST IRON PIPE INVERT ELEVATION 9T 7.3` _- i laa�„}. /o yR (OR EQUAL) MINIMUM ° ° _ o I �� ° L1 w �/ �o PITCH 1/4" PER FT. A L Al IL / LEVEL =4 ` ` " 3an1 S ELEV = 6" SUMP ELEV. = 9 7.3 0 (ELEV' 9 - 7 FLOW LINE �7,70 ( i ALARM ON ELEV !�g I �� �r ELEV. 9Z_� 7 lo" DISTRIBUTION ELEV. = I 1 _ -- --- MIN. I - a 3/8" DRILL BOX 9� ZJ q-HIGH CAPACITY INFILTRATORS W17H STONE z PUMP ON ELEV. 912 AFFLEGAS I HOLE /N AN // lC 3 7 x/o �TRENCF FORMA TION M I ��/ ?9 _ - ►�( M C cl -4 � _ 9G. l - TO BE WATER TESTED WELL ,4�� r4 I I C j4=, .,c4 7/G ELEV. - __ ?�- ELEV. �S o i (TO BE PLACED ON FIRM BASE) CHECK 3/4" TO 1 1/2" SOIL ABSORPTION INDEX CHECK !� I _ PUMP OFF LEV. _9? .SSA _ LIQUID OUTLET VALVE WASHED STONE SYSTEM SAS ADJUST 2.8 _ I !p (TO BE PLACED ON FIRM BASE) J \ BOTTOM OF INSIDE 9�7S L-T- L -� 1-3 4 FEET 14 INCHES __ BOTTOM OF TANK 9v 2S -T 5 FEET 19 INCHES /SWGALLON - 6 FEET 24 INCHES PUMP \ USGS PROBAB..E WATER TABLE ELEV = �1:..4 8 7 FEET 29 INCHES OBSERVED WATER TABLI (�4/��/�''=y) ELEV. _ WATER ENCOUNTERED AT _6. ELEV. 8 FEET 34 INCHES SEPTIC TANK: CHAMBER \- ,o " CONCRETE BOTTOM OF TEST HOLE ELEV = L o ' CONCRETE LEGEND: DESIGN CALCULATION PUAP CHAR ZR_ GALCULA 770 V S' EXISTING SPOT ELEVATION 00„0 NUMBER OF BEDROOMS tiaT `4 o� SEWAGE DISPOSAL SYSTEM PROFILE REQUIRED FLOW PER CYCLE 25 X�3O = 82 SGAL. /CYCLE EXISTING CONTOUR -00 GARBAGE DISPOSAL UNIT VOLUME PER CYCLE _3$.f 3A_/CYCLE /7.48 GAL ICU FT. _ !�•a3 CU. FT./CYCLE FINAL SPOT ELEVATION TOTAL ESTIMATED FLOW NOT TO SCALE VOLUME OF WATER IN PIPE 314 X 0.00694 X 441- FT. _ 0•��U FT. FINAL CONTOUR - (110 a4LIM.1DAYX 3 B/?� ��� GAL./DAY SOIL TEST LOCATION �j, REQUIRED SEPTIC TANK CAPACITY GAL. TOTAL MNEMUM VOLUME PER CYCLE 1L./ CU FT UTILITY POLE -O ACTUAL SEPTIC TANK CAPACITY J CAL. DISCHARGE ��_<t CU. FT. / 36.11 CU.FT /FT = _--_33-_ FT. `f - ! 23 TOWN WATER �W W SOIL CL A SSIFICA 77ON -�- STORAGE CAPACITY ( 30 (:AL./DAY /7.48 GAL /CU.FT./36.11 CU.FT./FT - __-__ FT. CATCH BASIN `®� DESIGN PERCOLA77ON RATE �S• A/IN/INCH _!.Z 31 REQUIRED t.! PROVIDED GAS LINE EFFLUENT LOADING RATE GAL IDAY/SF. CLEAN OUT __-C� LEACHING AREA (/i-'� 17�f �9Ga � SO. FT. CESSPOOL C.P. LEACHING CAPACITY 48 7A . 74 3 4 C) GAL./DA Y RESERVE LEACHING CAPACITY "�� GAL.IDAY j NOTES.- i ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E P TITLE 5 AND i THE TOWN RULES AND REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE. ?. ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO WITHIN 6" OF FINISHED GRADE. I J. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE O j WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS. H-20 LOADING SHALL BE USED UNDER OR WITHIN 10 vT. OF DRIVES OR PARKING AREAS. 4 ANY MASONRY UNITS USED TO BRING COVERS TO GRADE SHALL BE MORTARED N PLACE. 5. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANt,E WITH DEEDED OR I Z3N:tv3 t�ZvvLAT;01N`'. '_'ANEp /! A(70L� A•�T !S T/l -eTh1AI SUCH i DETERMINATION FROM APPROPRIATE AUTHORITY. V I E. UTILITIES SHOWN ARE APPROXIMATE ONLY, EXCAVATION CONTRACTOR i5 TO CALL "DIG-SAFE" AT 1-888-344-7233 AT LEAST 72 HOURS PRIOR TO i' COMMENCING WORK ON Si TE 7 CONTRACTOR IS TO VERIFY GRADES AND LLEVATION`i AS WELL AS SITE 'I t 102 2 CONDITIONS PRIOR TO COMMENCING WORK ON SITE ANY VARIATION IS TO BETI ID BROUGHT TO THE ATTENTION OF THE DESIGN ENGINEER IMMEDIATELY. OOO' j B PARCEL IS IN FLOOD ZONE _ C 98.0 _ • 1D0.3 9. LOT IS SHOWN ON ASSESSORS MAP ��"G 8 AS PARCEL. 10. ALL UNSUITABLE MATERIAL SHALL BE REMOVED FROM UNDER, AND FOR A ■ 96.5 101.4 MINIMUM OF 5 FEET FROM AROUND THE SOIL ABSORPTION SYSTEM, AND BE 101.9 REPLACED WITH SAND AS SPECIFIED IN 310 CMR 15.255 (3) (I.E. TITLE 5) IF ENCOUNTERED BELOW S.A.S. PIPE INVERT. 101.0 1 EXISTING SEPTIC SYSTEM TO BE PUMPED AND FILLED WITH SAND OR REMOVED. I i GRAVEL' - 'T1. A ZABEL A1800 FILTER IS TO BE INSTALLED. CONTRACTOR TO PROVIDE SHORING AS NEEDED TO PROTECT BUILDING AND 1 ►-0BR- - $9.4--- - i 100.7 � 'x* . . PROPERTY LINE. I `A 96.9 14. CONTRACTOR TO UNCOVER TANK OUTLET 10 CONFIRM ELEVATION BEFORE 99 3 BIT-DR1VE INSTALLING S.A.S. • r 15. AN ELECTRIC PERMIT IS REQUIRED TO WIRE PUMP AND ALARM 7 2 49.2 --- . 99.8 -_ --+i 100.4 1 t f; � ' � ! PUMP AND ALARM ARE TO BE ON SEPARATE CIRCUITS J " 100. /�' // ,. 9�1 D99 3 SEPTIC TANK AND PUMP CHAMBER ARE TO BE IPX OR ASPHALT I 99 4 I y?: 99.7 . 101.4 ) WATERPROOFED BY THE MANUFACTURER. 18. ALARM IS TO BE BOTH AUDIO AND dVISUAL. I ' I(\,n � 99.9 99. I I 95" SEPTIC �n , 99.9 yhGK- - -----� � --- -- - -.._ LEGEND: • 100. i O T,,,,,� Q101.3 �� CANOLt PROPOSED SEPTIC DESIGN EXISTING SPOT ELEVATION -0.0 I /o , DWEc,LIN(;i FOR EXISTING CONTOUR . . . ----00---- I ^"/^� (� r' ` z T v, FINAL SPOT ELEVATION o� ' i C� 4 �' - - �� t ROGER PARMENTER FINAL CONTOUR --(�- 1y ~ ?5 I ---- - - --- SOIL TEST LOCATION �/�.� ,- UTILITY 4 �,101 2 L 1Q7 STRAIGHTWAY i POLE `Q� ' L IL puMP ` � a j LOC. CATCHTOWN WATER -W \a�W� I S � ~'q"' 98.9 10,000 S.F. kA, ��� BARNS TABLE, MASS. I CATCH BASIN GAS LINE -c 99.5 101.4 V' y�9 �Vv -_-- - -- HYANNIS GAS METER 1GG © - z GAS VALVE �' 95.5 96 7 o Ir .7 CESSPOOL GRA 4F SMITH ST CRAIG R. SHORT, P. E. CLE.ANouT C.0 100 j t e � S'-I 508- 235 GREAT WESTERN ROAD ELECTRIC BOX 10 Q P. 0. BOX 1044 101DENNIS, ( 1 . - .3 b. . • 101 �ol.6 �P� 398-8311 SOUTH DENNIS, MASS. ELECTRIC UNE -e -E e 02660 ELECTRIC MANHOLE ® ELECTRIC METER .® r Ot 6 DATE Z ALE C 1 " ' - � FLAGPOLE DEC.HYDRANT � D J� , 2003 - LIGHTPOST C MANHOLE . . . . . . O APPROVED: BOARD OF HEALTH REV - _- I JOB NO. 4BS. WELL 1 -1 005 SEWER LINE. . -- s --s - s - SEWER MANHOLE . . .( - - (� REV. TELEPHONE Box � --_-_ ----- _--_ _ - -_ _ --- _ I LOCATION MAP _ _ �; L ! SHEET 1 OF 1 � WATER SHUT OFF ----- - --------� WATER VALVE DATE 4GENT 01-1005 Pormenter.dwg 02003 CRAIG R. SHORT, P.E. I