Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0297 STRAIGHTWAY - Health
j' 297 STRAIGHTWAY,HYANNIS 1 A= 268 273 &1 A y w� 71TOi/'�f�?Ff !$ /:YtIS7GA.BI.E[+ �tf !�c- L(?Cgy�Qfd' � '� sr AGE VILLArp ASSESSfltt'S't41r a`t$.QT INSTALu.E 'S t�ti a�'pifl�No SEIalIC T'A1�II�Ci 'AtTY z. ►c:�mc F�,cat.tom) 'P a b" �se� /BCD OW 1EItMITDATE Ct Wf.." t 6A - LttWCgqrLetween the Maxiionuta Azfjusted t'sroundwatsr TalIe to the Battom of Leaching Facility - t~eee Private�ktater Supply well and LeaCg pacttity �atiy�relts extsE opi siEs or:wittiin het`of lesactnttg fatty) lFeeE lEtlge`of WEt�atid end Lract�rig f ty If any wet," exist vii.Etuii 3 feet d teachingh. f � Feet �� Ob v ta �J r-6 �' , ' TOWN OF BARNSTABLE LOCATION Z97 AMakA Qy 144 SEWAGE# z'1 VILLAGE ASSESSOR'S// MAP&PARCEL INSTALLER'S NAME&PHONE NO. Ye?r� SEPTIC-TANK CAPACITY LEACHING FACILITY:(type) JbP C4Ary-besS(size) /a,S-X 2-FXZ NO.Of BEDROOMS OWNER C L 441,e L PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: l Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) /y/W Feet Edge of Wetland and Leaching Facility(If any wetlands exist within �/� 300 feet of leaching fac' ' ) A% Feet FURNISHED BY �-sue O � ram, V � s a coo r,4 Q sr co TOWN OF BARNSTABLE LJCAIC '' , rM SEWAGE # VII.�AGE, ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEP'ITC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNE N REM=AtE: I�3 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) ! Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 het of le Ching facility) Feet Furnished by ip'�" �� � � � � � � I, � ��� _ � � � � I'I S S .�;. �.7`�' W � � � � ;j �W �� — o ��, �r C N � ': r � � ' ,! � N I � i r No. Fee 0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 0[ppYitatiou for Bisposal *pstem Construction Permit Application for a Permit to Construct( ) Repair 0 Upgrade( ),Abandon( ) ❑Complete System ;;Individual Components Location Address or Lot No.I°(rl TT4.Alcl ktj l"'kLl ' Owner's Name,Address,and Tel.No.Z000 � .S Assessor's Map/Parcel 7C.$ 27 3 S Ayhx- Ingaller's Nan ,Aft,and Tel.No. �3�e--.�<< S Designer's Name,Addres ,and Tel.No. Fi D k (� (9�i S' 0 w►c..&. V`� OZ S(a,- }��e_d SOA S 60 X q lr I '��f--e Sb o 3Y/r Type of Building: Dwelling No.of Bedrooms Lot Size (( 5 Sq.ft. Garbage Grinder(/v Other Type of Building f S n j�L. ��dtM;��No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 U gpd Design flow provided ZS gpd Plan Date ! 2 Z.- ( 5 Number of sheets Revision Date Title Size of Septic Tank (VOO �69 Type of S.A.S. Le _,L(, x 2-- Description of Soil Nature of Re airs or Alterations(Answer when applicable) 12ef p0 14 �-/4 y an��:n -e_.k , S"$. (-e j�L L4. A 7 lt✓1 A-110A (-e-A CA C4141"h els w 9 4-" q ,S ,^X Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date Application Approved by 4r Date 7- Application Disapproved by V Date for the following reasons Permit No. O i-1 s Date Issued 2 - 171 �J is ' No. I Fee Mo f .= THE COMMONWEAL M�...O—�il }ASSACHUSETTS Entered in computer: �.� PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ftplication 6r13isposAl 6pstem Construction Permit Application for a Permit to Construct( ) , Repair(6 Upgrade( )_ Abandon( ) ❑Complete System ,Individual Components Location Address or Lot No.2cj rl S 7 t A I G(h I ("'AIA 14A Owner's Name,Address,and Tel.No. It A L.Lf i LLA � �"LweI/ Assessor's Map/Parcel 2 2 7 3 5 A�rn e Installer's Name,Address,and Tel.No. .0.-e e c.i(, S Designer's Name,Address,and Tel.No. a co & �, S !�✓i c. O 2 5 f6 3 1" GM e .5 o x 2CD,> L SA-1ow,c h 5Z ti 37/1 Type of Building: Dwelling No.of Bedrooms ? Lot Size M y 6— sq.ft. Garbage Grinder(N ' Other Type of Building �',A cj �f r/hM,/ No.of Persons Showers( ) Cafeteria( ) Other Fixtures ; 7 _..� Design Flow(min.required) 3 O / gpd— Design flow p''rov aed-J' Z $ gpd Plan Date 2 2 - 1 S Number of sheets 2 Revision Date ✓t o NJ Title Size of Septic Tank 1 000 �e X Type of S.A.S.�r((an Le cl,"t, 6�iS x 2— Description of Soil t_ Nature of Repairs or Alterations(Answer when applicable) . �i WI ti L� b A/ton s= 4, Le A-- ` Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed ,�/ G;� �` Date Application Approved by twt ' ,r r Date 7 d G Application Disapproved by Date for the following reasons Permit No. d L/ ` Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired Upgraded( ) Abandoned( )by 6/e- / L 1(( S (-s n 0 A C R-,'c,h 4 E x.c. at Z 6 J 41 61_i c, �1 4- WAk14 /-/u",I r S has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. d( - dy dated Installer Q �a �)11 S Designer/e r o iI S #bedrooms x_e- Approved design flo �ya. 5� gpd The issuance of this ermit ha�not be construed as a guarantee that the system w 1 fun , as desi ned. Date Inspector ^ No. . 0 f��.2 f� - - - Fee I)y THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair(Y Upgrade( ) Abandon( ) System located at Z S`�"i %I G !� L✓�'!� � l/?rilol i S , and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must pe co leted within three years of the date of this permit. Date (� ! j Approved by 0 V7w . ( 1 AU /05/201—DAEIi 03:33 FM FAX No. P. 001 Town of Barnstable Regulatory Services Richard V.Scali,Interim Director NAMPublic Health Division Thomas McKean',Director .200 Main Street,Hyannis,MA 02601 Office: 508.862 4644 fax: 508-790-6304 Installer&Designer Certification Form �r Date: J Sewage Permit# Assessors MapTarcel �D -?I Designer: WQ A#4 4 S, 5 Installer: Address: Address: an (date) installer) was issued a permit to install a septic system at 1 based on a design drawn.by (address) dated -7lza4). (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. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State&Local Regulations.-Plan revision or certified as-built by designer to follow. Strip out(if required)was inspected and the soils were found satisfactory. I certify that the system referenced above was constru fiance with the terms of the LA approval letters(if applicable) A of n ARREN l tkA i � �'NIT 1A� e ' er Signature) tamp There) PLEASE RETURN TO BARNS LE PUBLIC HEALTH[ DIVISION. CERTIFICATE OF COMPLIANCE WILL NO E ISSUED LTNM BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK'YOU. Q.15epria\Dasiper Certification Form Rev 8-14-13.doe Town of BA nstable P it Department of Regtilatory Services grAOLF, s � • 1'ubYie Health Division Bate 200 Main Street,Hyannis MA 02601 Date Scheduled �" ' Time JDArl Fee Pd. i Soil Suitability Assessment,fog- Se yv a Disposal Performed fiy l/\. J�'�^ "\. ���� Witnessed By: r V e( f � LOCATION & GENERAL INFORMATION locationAddress'. — � ��It�n� i'�/ Q� Owner's Name ��J Address s p Assessor's Map/P4rcel: a �p`j 3 I Engineer's Name I NEW CONSIRUtION REPAIR X Telephone# j V 360 i pp l J `(� . Land Use �,P�1 VlD��� �{/ Slopes(30) Surface Stones Distances from: Open Water Body Z0 0 Ft Possible Wee Area ' 2, ft Drinking Water Well f[ Drainage Way d ft Property Linc l(a ft Other ft SKETCH:(Street name,dimensiods'of lot,exact locations of test holes&pert tests,locate wetlands in proxitnity to holes) i I _ I I i I I i Parent material(geologic) t'1°"' T� Depth to Bedrock l.l I Wee in from Pit Face Depth to Groundwatdr. Standing Water in Hole: P_ , P g Estimated Seasonal;High Groundwater DtTIi; ATION FOR SEASONAL ffiG]E�WAT��TA1�L� Method Used: 'J A I In. Depth Gbperved standing in obs.hole: in. Depth to SOII InOtt1Rs; it. i in. aroundwnter Adjustment Depth toiweeping from side of obs.hole: _ A faetOr, r Adj.Oroundwater Level,,o Index Well# Readiug Date Index Well level -- pI+;RCOLATION TEST Date . 'xlnse Observation I Tune at 9" �J Hole# o1J��tt r Time at G" Depth of Pere. Time(9"-6'�) Start Pre-soak Time;@ End Pre-soak i I Rate Min-Arch sed — Site Failed; Additional Testing Needed(YIN) Site Suitability Assessment: Site Pas original:.Public llcdlth Division Observation Hole Data To Be Completed on Back— of wetland,you must.first notify the ***If percolat;ibn testis to be condracted within 100' , ' VS Barnstable C44servation Division at least one (1) week prior to beginning. p y-d y DEEP OBSERVATION HOLE LOG Hole#T— Depth from Soil Horizon Soil Texture f e oil(Muns Color Soil Other ell) Mottling (Structure,Stones,Boulders. Surface(in.) Consistenc %Gravel q DEEP OBSERVATION HOLE LOG Hole# y Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gra el 0 ti Aop j 3 l � T DEEP OBSERVATION HOLE LOG Hole# 1 Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency, ra I i i Flood Insurance Rate Mau: Above 500 year flood boundary No— Yes V_ Within 500 year boundary No J Yes Within 100 year flood boundary No 7 Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervipus material exist.in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pervious material? Certification I certify that on b (date)I have passed the soil evaluator examination approved by the Department of Enviro mental Protection and that the above analysis was performed by me consistent with the required trai a q.rtise and experience descri(in0 CMR 15.017. Signature Date l O:\.SEPTIC\PERCFORM.DOC t UHWE Town of Barnstable Barnstable RAMSTAMMRegulatory Services Department j Public Health Division m 200 Main Street,Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7014 1200 0001 0358 4909 . July 7,2015 Todd Elwell 297 Straightway Hyannis, MA 02601 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 297 Straightway, Hyannis,MA was inspected on 6/20/2015 by Shawn.Meelroy, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Fails" under the guide- lines of 1995 TITLE V (310 CMR 15.00) due to the following: • Leaching pit or cesspool with high liquid level,<12" below inlet (per Town Code 360-9.1 You are ordered to repair or replace the septic system within two (2)years from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in • future enforcement action. PER ORDER OF THE BOARD OF HEALTH Thomas McKean,R.S., CHO Agent of the Board of Health QASEPTICU.etters Septic Inspection Failures or Future Evl\297 Straightway Hy Jul 2015.docm Town of Barnstable Barnstable - : RAMszABLE, _ Regulatory Services Department p M � 0 D03 Public Health Division m 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL # 7014 1200 0001 0358 4909 July 6, 2015 Todd Elwell 297 Straightway Hyannis, MA 02601 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 297 Straightway, Hyannis, MA was inspected on 6/20/2015 by Shawn Mcelroy, certified Title V Septic Inspector for the State of Massachusetts. - The inspection of the septic system showed that the system "Fails" er the guide- lines of 1995 TITLE V (310 CMR 15.00) due to the following: • Leaching pit or cesspool with high liquid level,<12" ewper wn Code 360-9.1 You are ordered to repair orreplace the septic system within twfrom the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH ��mas c ean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Evl\297 Straightway Hy Jul 2015.docm 7/1/2015 1 Parcel Detail y R� � r �`� ,� ram:• .�.�... ^. IN Logged In As: Parcel Detail Wednesday, ]uly 1 2015 Parcel Lookup Parcel-Info Parcel ID 268-273� ( Developer Lot LOT8 _ -) Location 297 STRAIGHTWAY _I Pri Frontage 20 Sec Road f ~- „ — y I Sec Frontage - -~ Village'HYANNIS I Fire District iHYANNIS Town sewer exists at this address 'No _ I Road Index 1543 Asbuilt Septic Scan: Interactive Map " i 268273_1 V r I �t Owner Info _ owner ELWELL, TODD C&ALl'i Co- Owner: Streeti 297 STRAIGHTWAY .(Street2 City HYANNIS state MA- _ 4)zip 02601 - _ - (country - Land Info Acres r0.26 I use Single Fam MDL-01 ( zoning RB Nghbd 0105 � Topography,Le�I I Road Payed I Utilities iPublic Water,Gas,Septic( Location ,Rear Location I Construction Info Building 1 0€ 1 ---- ------ -- - - - -- Year'1986 " - - J Roof#Gable/Hi Ext Wood Shingle Built Struct p ll Wa g Living i1092 I Root fAs h/F GIs/Cm AC Central Area Cover p p Type _ Style Ranch Int Bed '3 Bedrooms Wall!Drywall' Rooms Model 'Residential _ Floor Carpet R oms 2 Full-0 Half Grade Minus Heat ':Hot Air Total 6 Rooms Type � Rooms Stories ,1 Story Heat 'Gas_ I Found- Poured Conc. J Fuel ; 1 ation Gross 2520 ,•� A rea Permit History Issue Date Purpose Permit# Amount . Insp Date Comments 11/17/2003 Wood Deck 73038 $3,200 6/9/2004 12:00:00 AM 3/1/1986 Dwelling B28987 $50,000 1/15/1987 12:00:00 AM HY 1 STOR httpJfiissgl2rintranet/propdatalParcelDetail.aspx?ID=19596 1/3 ; Town of Barnstable anjuvsr�tE, • 63q�� �' Regulatory Services Department prED MA`l► Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 4/28/15 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An"x"marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ONE (1)YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑ Any portion of the cesspool within a Zone 1 to a public well ❑ Any portion of a cesspool within 50 feet-of a private water"supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2)YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑ Any "conditionally passed systems" (broken cover, relocation of a pipe, relocation of a driveway due to H-10 components,etc) (Leaching pit or cesspool with high liquid level, <1.2"below pit(per Town Code §360-9.1) OTHER Repair deadline: Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc Commonwealth of Massachusetts P f Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ��M r 297 Straightway Property Address Todd Elwell Owner Owner's Name information is required for every Hyannis MA 02601 6-20-15 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. A. General Information 1. Inspector: ' Shawn Mcelroy Name of Inspector r. `i 'f11�'iEa1 'a;s Upper Cape Septic Services Company Name P.O. Box 73 ` Company Address f E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S13971 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the 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 ® Fails ❑ Needs Further Evaluatio a Local Approving Authority 6-20-15 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 297 Straightway Property Address Todd Elwell Owner Owner's Name information is required for every Hyannis MA 02601 6-20-15 page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of 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): t5ins•N13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 297 Straightway Property Address Todd Elwell Owner Owner's Name information is required for every Hyannis MA 02601 6-20-15 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑Y Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health)-. '❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1: System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins-3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 3 of 17 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 297 Straightway Property Address Todd Elwell Owner Owner's Name information is required for every Hyannis MA 02601 6-20-15 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes"or"No"to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ® ❑ Static liquid level if,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 Y2 day flow t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Pace 4 of 17 Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form.-Not for Voluntary Assessments M 297 Straightway Property Address Todd Elwell Owner Owner's Name information is required for every Hyannis MA 02601 6-20-15 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis 4 and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area- IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3113 Tdle 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 f ` Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 297 Straightway Pro artY Address Property Todd Elwell Owner Owner's Name information is required for every Hyannis MA 02601 6-20-15 page. CitylTown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® 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 NIX) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? P 9 ® ❑ 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 (f any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: 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): 33 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Pace 6 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 297 Straightway Property Address Todd Elwell Owner Owner's Name information is required for every Hyannis MA 02601 6-20-15 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 6-2015Date 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? r ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-3113 Tdle 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts , Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 297 Straightway Property Address Todd Elwell Owner Owner's Name information is required for every Hyannis MA 02601 6-20-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: N/A Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution Cox, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Pace 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 297 Straightway Property Address Todd Elwell Owner Owner's Name information is Hyannis- �` MA 02601 6-20-15 required for every H y ' page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1982 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 48"feet Material of construction: ® cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Good condition. Septic Tank(locate on site plan): Depth below grade: 40"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: 1000 gal 16" Sludge depth: t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Forma Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 297 Straightway Property Address Todd Elwell Owner Owner's Name information is required for every Hyannis MA 02601 6-20-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 16" Scum thickness 6" Distance from top of scum to top of outlet ee or baffle 4" Distance from bottom of scum to bottom of outlet tee or baffle 12" How were dimensions determined? Tape Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is in good condition with baffles installed and no sign of leakage. 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts - F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 297 Straightway Property Address Todd Elwell Owner Owner's Name information is required for every Hyannis MA 02601 6-20-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) . Comments (on pumping recommendations, inlet_ and outlet tee or baffle condition, structural integrity, liquid levels as related to'outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in 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 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts , Title 5 Official Inspection For _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 297 Straightway Property Address Todd Elwell Owner Owner's Name information is required for every Hyannis MA 02601 6-20-15 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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.): D-box starting to fall apart and has stain lines above inlet invert. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 I i Commonwealth of Massachusetts Title 5 Official Inspection Form �m Subsurface Sewage Disposal System Form -Not for Voluntary Assessments G M , 297 Straightway Property Address Todd Elwell Owner Owner's Name information is required for every Hyannis MA 02601 6-20-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type. I . ® leaching pits number: 1-1000 gal ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: f Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leach pit empty at inspection with stain lines above inlet invert. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts , W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 297 Straightway Property Address Todd Elwell Owner Owner's Name information is required for every Hyannis MA 02601 6-20-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form, r Subsurface Sewage Disposal System Form -Not for Voluntary Assessments GSM , 297 Straightway Property Address Todd Elwell Owner Owner's Name information is required for every Hyannis MA 02601 6-20-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately 0i 0 COF 6- PC) 46 04 _ 7 Z4 - r� -2 7�ff 13-f 3i t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts , Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 297 Straightway Property Address Todd Elwell Owner Owner's Name information is required for every Hyannis MA 02601 6-20-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 20 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health-explain: ® Checked with local excavators, installers- (attach documentation) ® Accessed USGS database- explain: You must describe how you established the high ground water elevation: USGS and town maps show groundwater at 20'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form "b o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 297 Straightway Property Address Todd Elwell Owner Owner's Name information is required for every Hyannis. MA 02601 6-20-15 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 APPLICATION FOR PERCOLATION TEST AND OBSERVATION PITS LOCATION L�, �r� 5';iZ4 i� .�`rri./j y NO. 7 � VILLAGE DATE 0- APPLICANT j�,g v� i✓T'/.�pS FEE .35 ADDRESS ",e- �L . f/�,l�/�gC TELEPHONE NO. 77f-�5 (Non-refundable) ENGINEER , LL �, >��� 4=.�/��Z /I/ _TELEPHONE NO.Z7S-dds'� D,TE_ SCHEDULED (Applicant' s signature) • O _O O O O O . O • O O O a O O O O O • • • O O O • O O O • • . 0 0 . O • • • O • • • O • . • • O O O 4• . • • • O • O • O • • • O O . O • • . • • ASSESSOR'S MAP & LOT NO: Z,,,�$ Z73 SOIL LOG SUB-DIVISION NAME rA,4Weo Pe-41- �sT,¢7'.� DATE_ - �� �� TIME 14jo,0 EXPAN$I.ON AREA: YES,.p/NO� ENGINEER' :K TOWN WATER APRIVATE WELL r 1%a/Cis AAA BOARD OF HEALTH 4A ,L i® EXCAVATOR SKETCH: (Street name,etc. ,dimensions of lot, exact location of test holes and percolation tests, locate wetlands in proximity to test holes) NOTES : T717 2.0 ZZ M 1 v: o � a o /p Vfa PERCOLATION RATE: �/� '��� / Afi;z4, , TEST HOLE NO: % ELEVATION: 5/.' TEST HOLE NO: Z ELEVATION: 34V 2 2 oP�s'ri.3 3 3 4 4 5 45 5 8 5, 9 9 10 10 11 11 1 12 12 13 13/ z0 14 ; 14 h/D 15 15 16 16 SUITABLE FOR SUB-SURFACE SEWAGE: ,/ LEACHING FIELD - LEACHING PITS LEACHING TRENCHES UNSUITABLE FOR SUB-SURFACESEWAGE. REASONS: NOTE: ENGINEERING PLANS MUST SHOW NUMBER A4SIGNED ON PERC TEST APPLICATION ; ORIGINAL: COMPLETED IN ENTIRETY BY P. E. AND RETURNED TO BOARD OF HEALTH COPY: RETAINED BY APPLICANT 13 U 104 . S E W A G E PE RM T NQ v NSTA LLERj,S MA V ADDRESS llkk UILDER 4P 0 ER _%. DA> T E P. ERMIT,, IS5U ED OAT CDMPLIANCE IS SUED �'/ � �'�� � � � s� �� �`� � . ".1� - ` � - � � d l I `+ �. 4 i Fmi .... ........... ..... ................... THE COMMONWEALTH OF MASSACHUSETTS I wt's— BOARD OF HEALTH C,:>RW140 ................OF.....� -—------- .........*... Appliration for Dh4pnoal Workg Tomitrurtivit Frrutit Application is hereby made for a Permit to Construct ( or Repairan Individual Sewage Disposal System at: ..ce_- ................. .................................................................................................. _)Lo.c ytAfdress I or Lot No. .. ............ ....)" .......... . ..... ....... ei.";.......... J../........ ..... Own Addroaf- I SS ............... ... ........ 7/.�. .. ......................................................................... Installer Address Type of Building Size Lot... ....Sq. feet Dwelling—No. of Bedrooms.........3................................Expansion Attic Garbage Grinder ( ) Other—Type of Building ............................ No. of persons............................ Showers Cafeteria ( ) Otherfixtures ...................................................................................................................................................... < Design Flow........................... .........gallons per person per day., Total daily flow.._...1.:%4?..........................gallons. 9 Septic Tank—Liquid capacity/$:.�P_gallons Length Width....li.' _.. Diameter_______'.-__-._. Disposal Trench—No. .................... Width.................... Total Length................._.. Total leaching area....................sq. f t. Seepage Pit No......./----------- Diameter...... ......... Depth below inlet.....1.......... Total leaching area..2.,.0-4 sq. ft. Z Other Distribution box ( K) Dosing tank ( ) — Percolation Test Results Performed by_.,k�4..... ............... Date..Z_n..4_nX4................. Test Pit No. I......9......minutesperinch Depth of Test Pit----- Depth to ground water........................ Test Pit No: 2.......Z.....minutes per inch Depth of Test Pit....ZZ yam,--- Depth to ground water.....=:=...... .............................................................................................................................................................. 0 Description of Soil......Z"-a=�............ — 4.�—�. ..... ":Z _-� �4 ........ ... ... --------------_ ...................................................... U ........................................................................................................................................................................................................ ................ ....................................................................................................................................................................................... U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ......................................................................................................................................................................................................... Agreement: The undeisigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—.The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. r Signed-------- ... .. .............................................. ............Date.............. ApplicationApproved By.................................................................................................. ....... Date Application Disapproved for the following reasons:................................................................................... .......................... .........................................................................................................I............................................................................................... -6 Date PermitNo......................................................... Issued....................................................... Date ----------- q No................I.... Fizz THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -7777Z lN................OF.....- .E.7............................ Aplifiration for Disposal Works Tonstrurtion rtruat Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: .......................................................................................... ................................................ ........................ Location-Address or Lot No. ................................................................................................. . ............................................. "----------- Owner Xwjress .......... ......... Installer Address Type of Building Size Lot...Z4_Z� ...Sq. feet Dwelling—No. of Bedrooms.___.._.31................................Expansion Attic Garbage Grinder Other—Type of Building ............................ No. of persons....._____._...._._____._.__ Showers Cafeteria aOther fixtures Design Flow...........................5.ng........gallons per person per day. Total daily flow......Atnl;*..........................gallons. Septic Tank—Liquid capacityYl.%Agallons Length_/,O. Width___ Diameter_.__._...__.._.. Depth__!;.'.f-.-... Disposal Trench—No..................... Width_..._._......_.___.. Total Length..___....__...._.__..".. Total leaching area....................sq. Seepage Pit No.___.._,!_-:.____.__ Diameter.___..6"?_........ Depth below inlet........7........... Total leaching area...r_24k4-._..sq. ft. Z Other Distribution box Dosing tank Percolation Test Results Performed by.._eL44.... ..........I............... Date...,? ................ Test Pit No. I.......a.....minutes per inch Depth of Test Pit___..Zgek�. Depth to ground water_.___"'' ':____. LL, Test Pit No. 2........7-....niinutes per inch Depth of Test Pit...../Z_�?... Depth to ground water_...___ ...... P4 ............................................................................................................................................................. '��4, ! 9q 0 Description of Soil.........>. ............. .................. .. i .................................................. W Ir • U ......................................................................................................................................................................................................... ........................................................................................................................................................................................................ U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ......................................................................................................................................................................................................... Agreement: The undersigned agrees to install, the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T I T IS 5 of the State Sanitary Code—.The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed................................................................................I...... ............................... Date Application Approved By..... . ........ ............................................................................................ ..... .. .. .l`�...... Date Application Disapproved for the following reasons:..........................................................................................................--- ........................................................................................................................................................................................................ Date PermitNo............ ........ Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS es:"i k/e� BOARD OF HEALTH L-CE t"j................OF...... .... 1!.. (Intifirate of Toutphanu THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired by................................................................................................................................................................................................... Installer at............................................................................................................................ has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the I application for Disposal Works Construction Permit No.... ........ ----- dated--------------,L .......... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.............. ........... ..... Inspector............ «................................................................. THE COMMONWEALTH OF MASSACHUSETTS tv)NC'* BOAR OF HEALTH > .._ ter!wig!.. O F..�' p. .a" �. t "..t mot, ..+ .... a i Fzz.-:L Disposal Yorks Tonstrudiott frrmft Permission is hereby granted............... ....... .... ....................................................................... to Construct ( 4,t�epair an Individual Sewage Disposal System at No........ .......:............. V -I --Y�'.'=....................................................................... Street as shown on the application for Disposal Works Construction Permit No.."--/......... Dated.......... .......................... ............ .............---------- .................. -------------- Board of Health DATE....(;�.P ..... .............. FORM 1255 A. M. SULKIN, INC., BOSTON I -6 1�c al, 1 f No Sca-Ce M I00 �_ 030. ��/2.04 , N 7 ' 392 9�.p.d. �+ t9' '®TP, . l 500 -;7,7 .tot 7 3:I.8 -1(0t 1/ 33. 5 1500 PR R44: E 0 n I .CO t $� / S 9>'.0 0 o Ntt Cape Fnc�ne��r'uu 1�lan Scc�le l 30 149 iIo-c ,-\Gad date 2-I0-86 I I j4ganni., Ma. 02601 c. ; d ! yl... I , I 2 0' I t4,C wade sketch nLayc o� .L'and to Idr�crnzi�s, lea, ! 90.t Pa it Fi�o4.t-� euua �,o-t, 8 as shown on a ptan. -ceco4ded -cn �Ce r1� og �eed� bfz, 331 pq• 58. �euationa_�fwwn .aiae Ga4.e2 on an a-.Auxed d4.tvo. i feat Pit #P-5739 j i ('i de 2-4-86 �a�e,• - A�ent;-p��Ze-P�0ciuZ"0g'7�l�h -- Wit. 9. rkKecwc No w ate2 eveao uvrtet e2 PeAc ",ate 2 auvr. pet !u i top 3�.& top 3o.i 1 ;o U44 e- roult4z o F honey honey ���, /� WILLIAM �G ?,g H. . perc. _... � FARDIE �. No. $995 4 % `''SfONALc-�� I I June 2, 1986 Barnstable Board of Health 367 Main St. Hyannis , MA. 02601 RE: Paul Antiposti Lot 8 off Straightway, Hyannis, MA. The septic system was installed according to plan. All Cape Engineering 49 Harbor Road Hyannis, MA. 02601 Tel. : 778-0058 qW. 1 John H. Milne, R.L.S' cis;; y o r No.32-i83 P '�' �F61STF�r a�w Ji„�ONgI lAtyV'� . z HYANNIS LEGEND —®--� PROPOSED CONTOUR Mq�N 98 PROPOSED SPOT GRADE LOCUS U'� ST. ROTARY _— 98 —— EXISTING CONTOUR y + 96.52 EXISTING SPOT GRADE �0 BEN'S P W— APPROX. WATER SERVICE y POND JDlz:p ® TEST PIT G 1 SMITH �P',. .. '; F r _ � • � III b LOCUS MAP ° \ LOCUS INFORMATION f _� - `� TITLE REF: BK 27332 PG 266 / j 200.00' r+ WATER GATE PARCEL ID: MAP 268 PAR. 273 � _ - , - - - - - - - - W. _ vento �-_ . ____ . _ . _ 1 . _.____ . _ . - . . SEPTIC SYSTEM o I o' I � -�� � 80,00' � REPAIR PLAN Q O LOCATED AT: 297 STRAIGHTWAY D :' -4� , HYANNIS, MA. z �o cr\ s,Y °� PREPARED FOR 71 TODD & ALYSSA `\` \`\\\�� BENCH MARK DULY 22, 2015 \ \\' \ " ! ) % PAINT SPOT ON CORNER OF \ �. </ i/ / o OF CONCRETE PAD Q. 31 .94 o DAI'R Ke EN USGS DATUM ASSUMED � R Lmo' o. 11,40 10G�n^ \ •\�� ' REGISTE�O SANITAR0�`� t. MEYER & SONS INC. �9 pp: P.O. Box 981 50 — --39.30 �5.37' E. SANDWICH, MA 02537 _ - ' �`a '� EXLST. 1 ,000 GAL PH. (508)360-3311 fax (774)413-9468 SEPTIC TANK � � - meyerandsonstitle5©gmail.com SCALE: 1"=20' SHEET 1 OF 2 J#1491 ELEV. TOP FOUNDATION NOTE: PLACE MAGNETIC MARKING TAPE OVER ALL COVERS (Existing) BRING ALL COVERS TO WITHIN 3" OF FINISH GRADE FINISHED GRADE (32.0) 33.99 F.G.EL: 31.0 F.G. EL: 31.8 F.G.EL: 30.75 VENT a l f 1 MAINTAIN 2% MIN SLOPE OVER LEACHING AREA M. 2" OF 3/8" DOUBLE WASHED 3/4" 1-1/2" F.G,EL• 27.50 •• • . STONE OR FILTER FABRIC DOUBLE WASHED STONE a 6 4". SCH 40 PVC 10 I (MIN. ®®®®• 0 ®®®® A: TEE'S ARE TO BE 6 ®®®®®®®®®®® © S 190 2, EFF DEP ®®®®®®®®®®® 4" SCH 40 PVC INV.25.90 TH ®®®®®®®®®®® INV.26.50 GAS - INV.25.73 2 X 8.5' q' 4' PROPOSED DB 3 EFFECTIVE LENGTH = 25' EXISTING OUTLET BAFFLE ... ,;. • . :. ... . -DISTRIBUTION BOX INV. 26.75 4, (H20)� INV. ELEV.= 25.68 EXISTING 1,000 GALLON SEPTIC TANK GAS BAFFLE TO BE INSTALLED ON ���N of Mssq BREAKOUT OUTLET TEE AS MANUFACTURED BY o� RE D N`M. Sys ELEV.= 26.68 TUF-TITE, ZABEL, OR EQUAL F TOP' CONC. ELEV.- 26.68 - NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING - N 1140 INV. ELEV.= .25.68 PIPE INVERTS PRIOR TO CONSTRUCTION ti ®®®®®®® SHALL BE SET LEVEL AND TRUE TO � GRADE ON- A MECHANICALLY COMPACTED SIX �p� ®®®®®®® �NIWW( BOTTOM EL.= . 23.68 ®®®®®®® , INCH CRUSHED STONE BASE, AS SPECIFIED IN 1. 3.75 5 . FT. 3.75 310 CMR 15.221(2) 3) REPLACE EXISTING 1,000 GALLON SEPTIC TANK ( EFFECTIVE WIDTH = 12.5'. WITH 1500 GALLON SEPTIC TANK IF FAILED, ' SEPARATION 5.08. FT. DAMAGED, NOT H2O LOADING, OR UNDERSIZED. SEPTIC SYSTEM PROFILE SOIL ABSORPTION SYSTEM (SECTION 4) INSTALL INLET& OUTLET TEES W/ BOTTOM OF TESTHOLE EL: 18.60 GAS BAFFLE As REQUIRED (500 GALLON (H20) LEACH CHAMBER) GENERAL NOTES: 1 SOIL LOGS P : 1475s DESIGN CRITERIA ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL NUMBER OF BEDROOMS: 3 BEDROOMM n BOARD of HEALTH AND THE DESIGN ENGINEER. 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS DATE: JULY 16, 2015 SOIL TEXTURAL CLASS: CLASS I (0.74 GPD/SF) OF THE STATE ENVIRONMENTAL CODE, TITLE V. AND ANY APPLICABLE DESIGN PERCOLATION RATE: <2 MIN/IN LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW: SOIL EVALUATOR: DARREN MEYER, R.S., -CSE #1614 - 310 CMR 15.405 (1) (B): WITNESS: DAVID STANTON, BARNSTABLE B.O.H. DAILY FLOW: 110 G.P.D. X 3 BR DESIGN FLOW: 330 G.P.D. 1) A 1.6 Fr. VARIANCE FROM 310CMR15.221(7) To ALLOW LEACHING GARBAGE GRINDER: NO (not designed for garbage grinder) TO BE 3.70 Fr (APPROX.) BELOW GRADE VS REO'D 3 Fr. (H2O/VENT PROVIDED) I z) A 1.0 Fr. VARIANCE FROM 310CMR15.211) To ALLOW LEACHING i Depth Elev.. SEPTIC TANK: 330 gpd x 200% = 660 gpd, USE EXISTING 1,000 GAL. SEPTIC TANK W Elev. TP-1 TO BE 19.0 Fr FROM.DWE DWELLING VS REQ'D ZO FT. TP-2 _De_� 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR 32.50 0" 31.60 0" (330) = 445.94 S.F. 1% TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE FILL FILL LEACHING AREA REQUIRED: DESIGN ENGINEER. I 31.50 .74, - 31.50 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING 12" A 12" FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN LOAMY SAND LOAMY SAND USE TWO (2) 500 GALLON (H20) PRECAST LEACH CHAMBERS W/ 4' ENGINEER BEFORE CONSTRUCTION CONTINUES. IOYR 3/1 IOYR 3/1 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. 30.75 21" 30.75 21" STONE ON ENDS & -3.75 STONE ON. SIDES: 25 L x 12.5 W x 2 D B 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF LOAMY SAND n B LOAMY SAND BOTTOM AREA: 25 .x 12.5= 312.5 SF THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF 10YR 5/8 10YR 5/8 HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. 29.34 C 38' 29.34 C 38' SIDE AREA: (25 + 12.5) X 2 X 2 = 150 SF 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. PERC ® EL. 28.65 8.ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED TOTAL SQUARE FEET PROVIDED-= 462 vs. 445.94 REQ'D TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. MEDIUM SAND - - R MEDIUM SAND DESIGN FLOW PROVIDED: 0.74(462 S.F.) 342.25 G.P.D. vs. 330 G.P.D. req'd 9. IT SHALL BE THE RESPONSIBILITY OF., THE CONTRACTOR TO VERIFY THE 2.5Y 6/4 2.5Y 6/4 THE LOCATION OF ALL UNDERGROUND UTILITIES. PRIOR TO BEGINNING PROPOSED SEPTIC SYSTEM UPGRADE PLAN CONSTRUCTION. 10. EXISTING LEACHING TO BE PUMPED, CRUSHED AND FILLED PER TITLE 5. 20.0 150" 18.60 156" 11. as HOUR NOTICE FOR ENGINEER CERTIFICATION ' 297 STRAIGHTWAY, HYANNIS, MA 12..THIS PLAN IS TO BE,USED FOR-SEPTIC SYSTEM PURPOSES ONLY PERC RATE <2 MIN/IN. ("C" HORIZON). Prepared for: Elwell AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY NO GROUNDWATER OBSERVED Engineering and Survey by: SCALE DRAWN 13. NO PRIVATE WELLS.WITHIN 150 OF'PROPOSED LEACHING. ' MEYER&SONS,INC. DMM • I, Darren M. Meyer, R.S., CSE, hereby certify that I cm'currently approved by MADEP pursuant to 310.CMR 15.017 N.T.S. 14. NO WETLANDS WITHIN 100 OF PROPOSED LEACHING. k POSOX981. to conduct soil-evaluations and that the above onolysislF hos been performed by me consistent with the DATE CHECKED SHEET NO. 15. ALL PIPING TO BE 4" SCH 40 ®`1/8"/Fr_(UNLESS SPECIFIED) requirements of 310 CMR 15.017. 1 further certify that I have passed the Soil Eval. Exam in October, 1999. EASTS4NOWICH,MA02537 506-3622922 07/22/15 DMM 2 of 2 tl