HomeMy WebLinkAbout0028 STERLING ROAD - Health ,cI r20 Ster inaTRoad! s�
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TOWN OF BARNSTABLE J
LOCATION �� ^, �2� SEWAGE#
VILLAGE VD ,;S ASSESSOR'S MAP&PARCEL o?�
INSTALLER'S NAME&PHONE NO. �
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) (size)
NO. OF BEDROOMS 7—Alte,
OWNER 4
x�
" PERMIT DATE: COMPLIANCE DATE: .
Separation Distance Between t e:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility S• / Feet
Private Water Supply Well and Leaching Facility(If any wells exist on
site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist within
300 feet of leaching facility) Feet
FURNISHED BY �,�/
a
�, r \
R
No. Iq 7 Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
application for his oral 6pstem Construction Perm"t
Application for a Permit to Construct( ) Repair( Up ) Abandon( ) El Complete System Individual Components
Location Address or Lot No.o�B .S v►� P Owner's Name,Address,and Tel.No.
6
Assessor's Map/Parcel g,f A;J Za tuing 7, 1i-4, 7G
Installer's Name,Address,and Tel.No. faV 7)6- V�6 Designer's Name,A ress,and Tel.No.
_ 401 ek,L=-
Type of Building:
Dwelling No.of Bedrooms Lot Size pa sq.ft. Garbage Grinder( )
Other„ Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures �/Q
Design Flow(min.required) Q J gpd Design flow provided 7 / ,d 101 gpd
Plan Date a J 62051, d Number of sheets Revision Date
Title
Size of Septic Tank tf� Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
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
Signed Date
Application Approved by Date a7—
Application Disapproved by Date
for the following reasons
Permit No. Date Issued
�Ft Fee
No. '— �� 7
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTHDIVI§IDN -�TOWN�OF BARNSTABLE, MASSACHUSETTS' Y��
01pplication for 6s'Josal *pstent Construction Per t
Application for a Permit to Construct( ) Repair( r Upg�Abandon( ) ❑Complete System Individual Compon nts
Location Address or Lot No. a
Owner's Name,Address,and Tel.No. X.
Assessor's Map/Parcellel &2 &ell,{ lli k)/Yi1r-& 5W 7/
��-Installer's Name,Address,and Tel.No. SGd"7)(� V,/O Designer's Name,Address,and Tel.No. �-''
L A,, 72M�Cle; 1'e 01 461-A
Type of Building:
Dwelling No.of Bedrooms / Lot SizeOpaO sq.ft. Garbage Grinder
Other, Type of Building i �c^ ,• No.of Persons Showers( ) Cafeteria( )
Other Fixtures 11
Design Flow(min.required) 0 gpd Design flow provided �9 d G gpd
Plan Date a4l GG G?o Number of sheets j Revision Date
Title
Size of Septic Tank rI� Type of S.A.S. w S
Description of Soil 14 1/
r
Nature of Repairs for Alterations(Answer when applicable) ,+
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 thi&Broa feral
Signed Date 4
Application Approved by Date
Application Disapproved by Date
for the following reasons
yJ
Permit No. Date Issued
---------------------------------------------------------------- ----------------------------------------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-siteZ_-Ove-
ge Disposal system Constructed( ) Repaired( ) Upgraded( )
Abandoned( )b(y r 12,.
�J at Al Gq has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. dated ()
Installer % 1 Designer
#bedrooms :thf ur Approved design flow A gpd
The issuance of this permit s hall not be construed as a guarantee that the system will nctio, designed.
Date (o�' I1 Inspector
j
_______________________j__�___________._------__-----___---__ k.._'!__-__________________________-_
No, tdl Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
Misposai 6pstrm Construction 3permit
Permission is hereby granted to Constr/u tt( ) Repair ) Upgrade( ) Abandon( )
System located at 2e SACr/jHn t, 4AA fS'
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 mustbe c m
/ p et//e��d within three years of the date of this ermit.
Date U��� p� J Approved by--
®.
Town of Barnstable
Regulatory Services
Thomas F. Geiler,Director
} t I . Public Health Division '
1639-
• Thomas McKean,Director
200 Main Street, Hyannis,MA 02601
Office: 508- 62- 44 _,.... -_: Fax: 508-790-6304
Date: (O Sewage Permit#c9 7 Assessors Map/Parcel 2 9
Installer& Designer Certification Form
1
Designer: �i,.J�?fa'2 ���''`� �yG Installer: ���
Address: /, 7 Address:
On D� G� 0�1�r02) co�vlorpt was issued a permit to install a
(date) (installer)
septic system at �T�2ci.���°� �` " based on a design drawn by
(address)
,�O r77'cw_ �,tJ�,/itJrayv.�� dated
/ (designer)
V I certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank. Stripout (if required) was inspected and the soils
were found satisfactory.
I certify that the septic system referenced above was installed with major changes (i.e.
greater than 10' lateral relocation of the SAS or any vertical relocation of any component
of the septic system)but in accordance with State &Local Regulations. Plan revision or
"certified as=built by designer to follow. Stripout(if requ was inspected and the soils
were found satisfactory. �t +c 4+a J q�
/I4V TEREi JCE L J
(� M a
(InstalleP,ature f-IAYES I
.. ........ . ....._ No. 9l'9
J...... F . cc a
0
.. ?sTF `
Sq?d1 TARO
aN
(Designer's Signale) (Affix Designer's Stamp Here)
PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE
OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-
BUELT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.
THANK YOU.
gAoff-ice formsWesignercertification form.doc
I
Town of Barnstable
Inspectional. Services Department
i639' Public Health Division
,�
200 Main Street, Hyannis MA 02601
Office: 508-8624644
FAX: 508-790-6304 Thomas A.McKean,CHO
CERTIFIED MAIL#7015 1730 0001 4988 1067
November 8, 2019
HEALY, LAWRENCE J & HELEN C
28 STERLING ROAD
HYANNIS, MA 02601
ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE,TITLE 5
The septic system located at 28 Sterling Road, Hyannis, MA was inspected on
11/05/2019 by Joseph M. Martins, certified Title V Septic Inspector for the State of
Massachusetts.
The inspection of the septic system showed that the system"Fails" under the guidelines
of 1995 TITLE V (310 CMR 15.00) due to the following:
• Any portion of the SAS, cesspool, or privy below high groundwater elevation.
You are ordered to repair or replace the septic system within one (1) year 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 B ARD OF HEALTH
ean, R.S., CHO
Agent of the Board of Health
Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\28 Sterling Road Hyannis.doc
Town of Barnstable
• BARNSfABM
6 9 ,�� Inspectional Services Department
Public Health Division
200 Main Street, Hyannis MA 02601
Office: 508-862-4644
FAX: 508-790-6304 Thomas A.McKean,CHO
Feb 6, 2007
Rev. 4/26/19
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
❑ Structurally unsound septic tank or SAS
ONE (1) YEAR DEADLINE CRITERIA
❑ Static liquid level in the distribution box above outlet invert due to an overloaded or
clogged SAS or cesspool
4 y 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 facility with standing liquid level at or above the invert pipe (per Town
Code §360-20 h)
OTHER
Repair deadline:
Q:ISEPTICIDEADLINES TO REPAIR FAILED SYSTEMS.doc
r
Commonwealth of Massachusetts °?�
Title 5 Official Inspection Form
�- i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
28 Sterling Road, Hyannis, MA
Property Address '
Lawrence Healy 28 Sterling Road ;,
Owner Owner's Name
information is Hyannis MA 02601 11/5/2019
required for every page. City/Town State Zip Code Date of Inspection _a t
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 Information
filling out forms
on the computer,
use only the tab Joseph M Martins
key to move your Name of Inspector
cursor-do not ACcu Sepcheck
use the return Company Name
key.
de Drive
Company
o
as Companyparry Address
South Dennis MA 02660
City/Town State Zip Code
508-385-5891 SI 147
Telephone Number 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 the system:
1. ❑ Passes .
2. ❑ Conditionally Passes
3. ❑ Needs Further Evaluation by the Local Approving Authority
4. ® Fails
11/5/2019
Inspe ors Signature Date
The system inspector shall submit a copy of this inspection report to the Approving Authority (Board
of Health or DEP) within 30 days of completing this inspection. If the system has a design flow of
10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate
regional office of the DEP. The original form should be sent to the system owner and copies sent to
the buyer, if applicable, and the approving authority.
Please note: This report only describes conditions at the time of inspection and under the
conditions.of use at that time. This inspection does not address how the system will perform
in the future under the same or different conditions of use.
t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18
Commonwealth of Massachusetts
r� Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
49
28 Sterling Road, Hyannis, MA
Property Address
Lawrence Healy 28 Sterling Road
Owner Owner's Name
information is required for every Hyannis MA 02601 11/5/2019
page. Cityfrown State Zip Code Date of Inspection
C. Inspection Summary
Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6.
1) System Passes:
❑ 1 have not found any information which indicates at any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 a Any failure criteria not evaluated are
indicated below.
Comments:
2) System Conditionally Passes:
❑ One or more system components as described in the "Conditional Pas " e tion need to be
replaced or repaired. The system, upon completion of the replacem or repair, as approved by
the Board of Health, will pass.
Check the box for"yes", "no"or"not determined" (Y, N, ND)for a following statements. If"not
determined," please explain.
The septic tank is metal and over 20 years old* or the s tic tank (whether metal or not) is structurally
unsound, exhibits substantial infiltration or exfiltratio r tank failure is imminent. System will pass
inspection if the existing tank is replaced with a c plying septic tank as approved by the Board of
Health.
*A metal septic tank will pass inspection ' it is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is s than 20 years old is available.
❑ Y ❑ N ❑ (Explain below):
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
�- A Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
�s 28 Sterling Road, Hyannis, MA
Property Address
Lawrence Healy 28 Sterling Road
Owner Owner's Name
information is required for every Hyannis MA 02601 11/5/2019
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
2) System Conditionally Passes (cont.):
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of ealth approval if
pumps/alarms are repaired.
❑ Observation of sewage backup or break out or high static water leve n the distribution box due
to broken or obstructed pipe(s) or due to a broken, settled or unev 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 ❑ ❑ ND (Explain below):
❑ distribution box is leveled or re ced ElN' ElND (Explain below):
X V
z / IK
❑ The system r/�inspect*
more than 4 times a year due to broken or obstructed pipe(s). The
system will pwith approval of the Board of Health):
❑ brokelaced ❑ Y ❑ N ❑ ND (Explain below):obstrd ❑ Y ❑ N ❑ ND (Explain belo
3) _Further Evaluation is Required by the Boar/determis
❑ Conditions exist which require further evalBoard Health in order to determine if
the system is failing to protect public health a Ironment.
a. System will pass,unless Board of Hes in accordance with 310 CMR
15.303(1)(b)that the system is not functanner which will protect public health,
safety and the environment:
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18
Commonwealth of Massachusetts
r� Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
28 Sterling Road, Hyannis, MA
Property Address
Lawrence Healy 28 Sterling Road
Owner Owner's Name
information is required for every Hyannis MA 02601 11/5/2019
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or alt marsh
b. System will fail unless the Board of Health (and Public Water Supplie , if any)
determines that the system is functioning in a manner that protects t public health,
safety and environment:
ElThe system has a septic tank and soil absorption system (SAS) a the SAS is within
100 feet of a surface water supply or tributary to a surface water su ly.
El The system has a septic tank and SAS and the SAS is within Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is wi in 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS and the SAS i 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, pe rmed at a DEP certified laboratory, for fecal
coliform bacteria indicates absent and the presenc of ammonia nitrogen and nitrate nitrogen is equal
to or less than 5 ppm, provided that no other fail a criteri are triggered. A copy of the analysis must
be attached to this form.
c. Other:
4) System Failure Criteria Applicable to All Systems:
a
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
t5insp.doc•rev.7/26/2018 - Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18
r
cAp°o\ Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M � 28 Sterling Road, Hyannis, MA
Property Address
Lawrence Healy 28 Sterling Road
Owner Owner's Name
information is Hyannis MA 02601 11/5/2019
required for every y
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
4) System Failure Criteria Applicable to All Systems: (cont.)
Yes No
❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less
than '/2 day flow
❑ ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
® ❑ Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply
well.
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory,for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered.A copy of the analysis
and chain of custody must be attached to this form.]
❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd-
10,000 gpd.
® ❑ The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303,therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
5) Large Systems: To be considered a large system the system must serve cility with a
design flow of 10,000 gpd to 16,000 gpd.
For large systems, you must indicate either"yes" or"no"to each th I ing, in addition to the
questions in Section CA.
Yes No
❑ ❑ the system is within 400 feet surface drinking water supply
❑ ❑ the system is within 2 feet of a tributary to a surface drinking water supply
❑ ❑ the system is to ed in a nitrogen sensitive area (Interim Wellhead Protection
Area— IWP or a mapped Zone II of a public water supply well
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 18
r ,
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
g p Y ry
�a
28 Sterling Road, Hyannis, MA
Property Address
Lawrence Healy 28 Sterling Road
Owner Owner's Name
information is required for every Hyannis MA 02601 11/5/2019
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
If you have answered "yes"to any question in Section C.5 the system is considered a significant
threat, or answered "yes"to any question in Section CA above the large system has failed. The
owner or operator of any large system considered a significant threat under Section C.5 or failed
under Section CA shall 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 No
® ❑ Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
® ❑ Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
® ❑ Were as built plans of the system obtained and examined? (If they were not
available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of r ak o ?
Id1c�.
® ❑ Were all system components, a ding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
® ❑ Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS) on the site has
been determined based on:
❑ ® Existing information. For example, a plan at the Board of Health.
® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18
Commonwealth of Massachusetts
r� Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
28 Sterling Road, Hyannis, MA
Property Address
Lawrence Healy 28 Sterling Road
Owner Owner's Name
information is required for every Hyannis MA 02601 11/5/2019
page. City/Town State Zip Code Date of Inspection
D. System Information
1. Residential Flow Conditions:
Number of bedrooms (design): n/a Number of bedrooms (actual): 3
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330
Description:
1500 GALLON SEPTIC TANK, ORANGEBURG PIPE AND 2 6'X4'LEACH PITS W 2'STONE
Number of current residents: 1
Does residence have a garbage grinder? ® Yes ❑ No
Does residence have a water treatment unit? ❑ Yes ® No
If yes, discharges to:
Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No
information in this report.)
Laundry system inspected? ❑ Yes ❑ No
Seasonal use? ❑ Yes ® No
Water meter readings, if available last 2 ears usage d 34
9 ( Y 9 (gp ))�
Detail:
2017: 13,000 G 2018: 12,000 G
Sump pump? ❑ Yes ® No
Last date of occupancy: 11/5/2019
Date
t5insp.doc-rev.7/2612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18
Commonwealth of Massachusetts
r� Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
28 Sterling Road, Hyannis, MA
Property Address
Lawrence Healy 28 Sterling Road
Owner Owner's Name
information is required for every Hyannis MA 02601 11/5/2019
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
2. Commercial/Industrial Flow Conditions:
Type of Establishment:
Design flow(based on 310 CMR 15.203): Gallons per day(gpd)
Basis of design flow (seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
Water treatment unit present? ❑ Yes ❑ No
If yes, discharges to:
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
Last date of occupancy/use: Date
Other(describe below):
3. Pumping Records:
Source of information: NONE PER HEALTH DEPARTMENT
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped: gallons
How was quantity pumped determined?
Reason for pumping:
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18
Commonwealth of Massachusetts
!m _. Title 5 Official Inspection Form
iSubsurface Sewage Disposal System Form -Not for Voluntary Assessments
28 Sterling Road, Hyannis, MA
Property Address
Lawrence Healy 28 Sterling Road
Owner Owner's Name
information is required for every Hyannis MA 02601 11/5/2019
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
4. Type of System:
® Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology.Attach a copy of the current operation and
maintenance contract (to be obtained from system owner) and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank.Attach a copy of the DEP approval.
❑ Other(describe):
Approximate age of all components, date installed (if known) and source of information:
GUESS 45 YEARS. HOUSE BUILT IN 1974.
Were sewage odors detected when arriving at the site? ❑ Yes ® No
5. Building Sewer(locate on site plan):
Depth below grade: IN FLOORfeet
Material of construction:
❑ cast iron ® 40 PVC ❑ other(explain):
Distance from private water supply well or suction line: >10feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
NO LEAKS EVIDENT.
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18
c Commonwealth of Massachusetts
Title 5 Official Inspection Form
1- i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
28 Sterling Road, Hyannis, MA
Property Address
Lawrence Healy 28 Sterling Road
Owner Owner's Name
information is required for every Hyannis MA 02601 11/5/2019
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
6. Septic Tank (locate on site plan):
Depth below grade: 0.5
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: APP 10X6X5' 1500 G
Sludge depth: 8 INCHES
Distance from top of sludge to bottom of outlet tee or baffle 26 INCHES
Scum thickness 4 INCHES
Distance from top of scum to top of outlet tee or baffle 6 INCHES
Distance from bottom of scum to bottom of outlet tee or baffle 13 INCHES
How were dimensions determined? CORETAKER
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
HAS CONCRETE INLET TEE. HAS CONCRETE OUTLET TEE- BOTH IN GOOD CONDITION.
LIQUID LEVEL IS 48"AT OUTLET INVVERT. NO EVIDENCE OF LEAKAGE.
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18
Commonwealth of Massachusetts
r� Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
�n
28 Sterling Road Hyannis, MA
Property Address
Lawrence Healy 28 Sterling Road
Owner Owner's Name
information is required for every Hyannis MA 02601 11/5/2019
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
7. Grease Trap (locate on site plan):
Depth below grade: N/A
feet
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ poly ylene ❑ other(explain):
Dimensions:
Scum thickness
Distance from top of scum t/invert, evidence
affle
Distance from bottom of scutlet tee or baffle
Date of last pumping: Date
Comments (on pumping recnlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to ouce of leakage, etc.):
8. Tight or Holding Tank (tank must be pumped at ti /Elpolyethylene
site plan):
Depth below grade:
Material of construction:
❑ concrete ❑ metal ❑ fibergl ❑ other(explain):
Dimensions:
Capacity: gallons
Design Flow: gallons per day
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18
Commonwealth of Massachusetts
r� Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
28 Sterling Road, Hyannis, MA
V
Property Address
Lawrence Healy 28 Sterling Road
Owner Owner's Name
information is required for every Hyannis MA 02601 11/5/2019
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
8. Tight or Holding Tank (cont.)
Alarm present: ?etc.):
❑ No
Alarm level: orking order: ❑ Yes ❑ No
Date of last pumping:
Comments (condition of alarm and fl t
*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 NO DBOX PRESENT
Comments (note if box is level and distribution to outlets equal, any evidence of solids carryo r, any
evidence of leakage into or out of box, etc.):
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18
. Commonwealth of Massachusetts
r� Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
28 Sterling Road, Hyannis, MA
Property Address
Lawrence Healy 28 Sterling Road
Owner Owner's Name
information is required for every Hyannis MA 02601 11/5/2019
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
10. Pump Chamber(locate on site plan):
Pumps in working order: /-of
❑ Yes ❑ No*
Alarms in working order: ❑ Yes ❑ No*
Comments (note condition of pump chamber, cand appurtenances, etc.):
* If pumps or al/xplain
orking order, system is a conditional pass.
11. Soil Absorptio (locate on site plan, excavation not required):
If SAS not locat
Type:
® leaching pits number: 2 6'X4'W 2'
STONE
❑ leaching chambers number:
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18
Commonwealth of Massachusetts
M Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
28 Sterling Road, Hyannis, MA
Property Address
Lawrence Healy 28 Sterling Road
Owner Owner's Name
information is required for every Hyannis MA 02601 11/5/2019
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
11. Soil Absorption System (SAS) (cont.)
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
LEACH PITS ARE IN SERIES. NO OUTLET TEE PRESENT? 1ST PIT SHOWS MODERATE
STAINING TO INVERT. 2"D PIT HAS LIGHT STAINING TO WITHIN 6"OF INLET PIPE. CLEAN
STONE AND DEF,ININTION IN LEACH HOLES THROUGHOUT. GRADE TO 2"D LEACH PIT
BOTTOM IS 5.75'
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 infl ❑ Yes ❑ No
Comments (note conditio of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18
. Commonwealth of Massachusetts
r� Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
28 Sterling Road, Hyannis, MA
Property Address
Lawrence Healy 28 Sterling Road
Owner Owner's Name
information is required for every Hyannis MA 02601 11/5/2019
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
13. Privy (locate on site plan):
Materials of construction:
Dimensions
Depth of solids
Comments (note condition of soil, signs of hydraul' /lure, level of ponding, condition of vegetation,
etc.):
t5insp.doc-rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18
Commonwealth of Massachusetts
ro Title 5 Official Inspection Form
t- Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
28 Sterling Road, Hyannis, MA
Property Address
Lawrence and Helen Healy 28 Sterling Road
Owner Owner's Name
information is required for every Hyannis MA 02601 10/23/2019
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
14. Sketch Of Sewage Disposal System:
Provide a view of the sewage disposal system, including ties to at least two permanent reference
landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters
the building. Check one of the boxes below:
® hand-sketch in the area below
❑ drawing attached separately
i
POOL
` • 1
I
�3=33_'
Lill
9 r-
J 1 •.
• t
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18
is
Commonwealth of Massachusetts
Title 5 Official Inspection Form
e Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
28 Sterling Road, Hyannis, MA
Property Address
Lawrence Healy 28 Sterling Road
Owner Owner's Name
information is required for every Hyannis MA 02601 11/5/2019
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
15. Site Exam:
® Check Slope
® Surface water
® Check cellar
® Shallow wells
Estimated depth to high ground water: 4.0 FROM GRADE
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:
FRIMPTER TABLES FOR ZONE MIW29B
You must describe how you established the high ground water elevation:
HAND BORING THRU 2ND PIT IN SERIES. GROUNDWATER ENCOUNTERED AT 6.9'. GRADE
TO SAS BOTTOM IS 5.75'. GROUNDWATER ADJUSTMENT FOR MIW29B FOR OCTOBER 2019
IS 2.9'. SEPARATION MATH: 6.9-(5.75+2.9) = -1.75'
I
I
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5insp.doc-rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18
Commonwealth of Massachusetts
m Title 5 Official Inspection Form
�- Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
28 Sterling Road, Hyannis, MA
Property Address
Lawrence Healy 28 Sterling Road
Owner Owner's Name
information is required for every Hyannis MA 02601 11/5/2019
page. City/Town State Zip Code Date of Inspection
E. Report Completeness Checklist
Complete all applicable sections of this form inclusive of:
® A. Inspector Information: Complete all fields in this section.
® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked
® C. Inspection Summary:
1, 2, 3, or 5 completed as appropriate
4 Failure Criteria and 6 Checklist completed
® D. System Information:
For 8: Tight/Holding Tank—Pumping contract attached
For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached
For 15: Explanation of estimated depth to high groundwater included
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18
4" SCHEDULE 40 PVC PIPE LOAM AND SEI-D SQL LEST
TOP OF FOUNDATION 20 FT. MINIMUM FROM CELLAR OR CRAWL SPACE MIN, PITCH 1/8' PER FT. CLEAN SAND 2" LAYER OF T
DATE � SOIL TEST aC SOBER 8� 2020�
= 100.00 10 FT. MINIMUM 10 FT. MINIMUM FROM SLAB 1/8" TO '/2" $OIL TEST DONE BY
EN INQ�RING
ELEV _ 2" PRESSURE PIPE WASHED ';TONE TPT-20_2O8 I
WITNESSED BY ,_QL: iM?R__A15
(ASSUMED) 150 PSI MINIMUM --, ELEV. _ � �_ 98.5 M OR FILTER FABRIC rVENT y
CONCRETE COVER LE QU / X �.25 W. REQUIRED OBSERVATION HOLE 1 ELEV.=_ 93.4_
COVERS
QUICK
DISCONNECT TEE FLOW g PERCOLATION RATE _ _Z__ MIN./INCH AT A51 INCHES
UNION LEVELERS INSPECTION PORT 95$
7
9.0t 9a8 0� ELEV. = DEPTH HORIZ TEXTURE COLOR MOTT. OTHER
! 4" CAST IRON PIPE A •
SLAB ELEV. - - (OR EQUAL) MINIMUM _ o o C= a L3 m ❑ C% -:10 ❑ C7 ❑ 0-8" Ap LOAMY SAND 10YR5/1 NO ROOTS -
�` PITCH ML
1/4" PER FT _ LEVEL o ° ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 61r ° _ 94.00 VINYL 8-31" B LOAMY SAND 10YR7/4 ROOTS
ABEL A180 IL ELEV . :_ o ELEV. _ _ LINER 31-126" C LOAMY SAND 2.5Y7/4
6" SUMP = -
FLOW LINE �p p'
ELEV. _ �LQ 10 S 1 RIBUT1ONELEV WATER ENCOUNTERED AT _ 14__ ELEV. _ _ 83.9 _
- MIN. 3/8" DRILL BOX 3 FLOW DIFFUSORS WITH Z 90.6 OBSERVATION HOLE 2 ELEV.= 93.4,
ADD AS -- HOLE
ELEV. = _ _ TO BE WATER TESTED 11.1
BAFFLE 5(ONE IN AN �
= fi0.38_ _ (TO BE PLACED ON FIRM BASE) DEPTH HORIZ TEXTURE COLOR MOTT. OTHER
ELEV.
12' X 32' X 1Y TRENCH FORMI.TION Ln WELL___MIW 29
0 8" Ap� LOAMY SAND 10YR5/1 NO RIOTS
CHECK ^' �p �y` 8-31" B LOAMY SAND -� 10YR7/4 ROOTS �+
r LIQUID OUTLET VALVE 3/4" TO 1 1/2" CLEAN SOIL ABSORPTION ZONE 9.46 (9/2020) _---�_T
TEE
DEPTH (EXISTING) z m DOUBLE WASHED STONE ADJUST_
4 FEET 14 INCHES I �� SYSTEM SAS j 31-132" C LOAMY SANG 2.5Y7/4
5 FEET 19 INCHES 500 GALLON FREE OF FINES do SILT J
6 FEET 24 INCHES MYERS SRM 4 - WATER ENCOUNTERED AT 114"_ ELEV = ` 83.9
7 FEET 24 INCHES 0.4 HP (MAX.) USGS PROBABLE WATER TAKE ELEV. -
8 FEET 34 INCHES SEPTIC TANK�HAMBER (OR EQUAL) OBSERVED WATER TABLE (10/8/2020) ELEV. _ _ S DESIGN CALCULATIONS
BOTTOM OF TEST HCLE FI_EV. = -_A2i4 _ NUMBER OF BEDROOMS 3
ELEV AT INVERT INLET 90.00 PUMP CHAMBER CALCULATIONS: GARBAGE DISPOSAL UNIT
TOTAL ESTIMATED FLOW `
SEWAGADISPOSALY M P R FI ELEV. AT ALARM ON _87.E
E SYSTEM PROFILE ELEV. AT PUMP ON _87.18 REQUIRED FLOW PER C d5 x _ -- _ SAL jt TCLE ( 110 GAIEPTIC./Idl1Y X �_ �.) _�' _ GAL./DAY
VOLUME PER CYCLE _a+ GAL/CYCLE /7.48 GAL./CU FT. = 11.C1,3 CU. FT./CYCLE REQUIRED SEPTIC TANK CAPACITY _ GAL.
ELEV. A7 PUMP OFF - 88_83- VOLUME OF WATER IN PIPE 3.14 X 0.00694 X _15_ FT. _ _4 }_ CU. FT. ACTUAL SIZE OF SEPTIC TANK (EXMI trG) _lam GAL.
BOTTOM OF INSIDE PUMP CHAMBER -ONG -A-
DISCHARGE MINIMUM VOLUME PER CYCLE _�„V CU. FT. SOIL CLASSIFICATION -
BOTTOM OF OUTSIDE PUMP CHAMBER -83.87- DISCHARGE _I1,J4 CU. FT. 34.67 CU,FT FT. _ _ 0.33 FT DESIGN PERCOLATION RATE <_'� MIN./IN
/ / (1000 G.S.T.)
STORAGE CAPACITY ( GAL./DAY /'7 48 GAL /CU.FT./34.67 CU.FT./FT. - -1•27- FT. EFFLUENT LOADING RATE � GAL../DAY/S.F
REQUIRED _2,W- PROVIDED - LEACHING AREA SQ. FT. I
(1�)+( )
LEACHING CAPACITY (AREA X RATE) 349,28 GAL./DAY
BUOYA;VC CAL LATTONS: 4 LE x a74
RESERVE LEACHING CAPACITY NQC GAL./DAY j
1000 GALLON PUMP CHAMBER (MONO)
WEIGHT OF WATER DISPLACED NOTES:
B.S"d34s&9-8&87)x6z5 8,2W LIM I ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO Q.E P.
WEIGHT OF TANK PER MANUFACTURER 9.200 LBS. TITLE 5 AND THE TOWN'S RULES AND REGULAYIONS FOR
WEIGHT OF WATER IN SUMP THE SUBSURFACE DISPOSAL OF SEWAGE.
2. ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO
WEIGHT OF CONCRETE_ WITHIN 6" OF FINISHED GRADE.
}1U•� SOIL y4 <+ 3. ALL COMPONENT'S OF THE SANITARY SYSTEM SHALL BE CAPABLE OF
TEST I • EXCESS WEIGHT TO OFFSET FLOTATION WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN
9200-8586 912 LB& 10 FT. OF DRIVES OR PARKING AREAS, H-20 LOADING SHALL. BE
`Z PUMP BO �"' 1 USED UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS.
CRAM R 320 ?•,s,`�: • NT 4. ANY MASONARY UNITS USED TO BRING COVERS TO GRADE SHALL
BE. MORTARED IN PLACE
S. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH
0' G DEEDED OR ZONING R. �� ,�•,�, ,, �( � .� .- � " 'µEGULATIONs{OWNER /�APPLICANT IS TO
90.9 a u
I kz. 6. UTILITIES SHOWN ARE APPROXIMATE ONLY, EXCAVATION CONTRACTOR
SOii_ IS TO CALL "DIG-SAFE" AT 1-888-344-7233 AT LEAST 72 HOURS
IMIT Of_:j TEST 2 PRIOR TO COMMENCING WORK ON SITE. a!
7. CONTRACTOR IS TO VERIFY GRADES AND ELEVATIONS AS WELL AS
1(9 SITE CONDITIONS PRIOR TO COMMENCING WORK ON SITE. ANY VARIATION 1
' t } IS TO BE BROUGHT TO THE ATTENTION OF THE DESIGN ENGINEER
1500 GALLON •/93.9 IMMEDIATELY.
SEPTIC TANK 8. PARCEL IS IN FLOOD ZONE
93.3 9. LOT IS SHOWN ON ASSESSORS MAP AS PARCEL
92. WALKOUT 10 PUMP AND ALARM ARE TO BE ON SEPERATE CIRCUITS.
rDECK 11. ALARM IS TO BE BOTH AUDIO AND VISUAL.
g2;8 12. A ZABEL A1800 FILTER IS TO BE INSTALLED.
I; 13. AN ELECTRIC PERMIT IS REQUIRED TO WARE PUMP AND ALARM.
I 93.3 ING 14. ALL UNSUITABLE MATERIAL SHALL BE REMOVED FROM UNDER AND
FOR A MINIMUM OF 5' AROUND SOIL ABSORPTION SYSTEM AND BE
EXl 3�g GROOM REPLACED WITH MATERIAL AS SPECIFIED IN 310 CMR 15.255:(3).
15, PUMP CHAMBER IS TO BE WATERPROOFED AT THE MANUFACTURER.
16. EXISTING PITS ARE TO BE PUMPED AND BACKFILLED WITH SAND.
a 97.7 J 17 THE INSTALLER IS TO GIVE THE ENGINEER A MINIMUM OF 48 HOURS
(2 WORKING DAYS) NOTICE FOR THE FINAL INSPECTION (NUMBER BELOW'
�. , . 97.7 APPROVED: BOARD OR HEALTH
EryaY
LOT 18 ��alrl
12,093 7 t S.F. s5.o DATE AGENT
V
10 �CIY �#vv ` PROPOSED SEPTIC DESIGN
/STE_ , �. FOR
110 Imo- / � VAI_ LAyDSJ r LA"ENCE HEALY I
T�bRLING READ \ 28 STERUNNG ROAD, LOT 18
#28 S WEST MAIN HYANNIS, MASS.
'
STERLING swm7wi R AMBYZETM
203 SETUCKET ROAD
�a r1.� ,•;; F.� 508- P. 0. BOX 713
LE( D: __ c_3 00 385-6900 SOUTH DENNIS, MASS. 02660
EXISTING SPOT ELEVATION 0010 Vµ �G�
EXISTING CONTOUR ----00----- 3�s _ •`
DATE SCALE '
FINAL SPOT ELEVATION ..... OCT. 8, 2020 1 - ZO
FINAL CONTOUR.
SOIL TEST LOCATION f . REV JOB N0. ��00
UTILITY POLE -•CF-
TOWN WATER -W-+•�-W=----
CATCH BASIN `®�
GAS LINE G
CLEAN OUT , CA- LOCATION MAP REV. - I SHEET 1 OFrt~1 1 !
CESSPOOL C.P. 0
C.' �58`PRO✓�8445-00\dWg\8445-.SASDOC- 02M SWETSER ENS�!EI RItyV