HomeMy WebLinkAbout0018 STETSON LANE - Health [ STETSON.�LANE` .
Hyannis
A = 306 - 063
Message Page 1 of 1
Miorandi, Donna
From: Schlegel, Frank
Sent: Thursday, April 02, 2015 11:04 AM
To: Shea, Sally
Cc: Miorandi, Donna
Subject: RE: 16 Stetson Lane Hyannis
Hi Sally,
I looked at this property this morning and determined it would not interfere with emergency response identification.
Therefore, I have effectively changed the address for Map 306 Parcel 063 from#16 Stetson Ln. to#18 Stetson
Ln as posted on the building. The changes will show up in the address database tomorrow according to file
updates. Please make necessary changes to any hard copy files you may have.
Thanx,
Frank
-----Original Message-----
From: Shea, Sally
Sent: Wednesday, April 01, 2015 10:32 AM
To: Schlegel, Frank; 'Deputy Dean Melanson'
Subject: 16 Stetson Lane Hyannis
Frank,
Just an FYI I needed to permit electrically a septic pump for an electrician who states the homeowner is
using the address of 18 Stetson Lane in Hyannis. The electrician states this is posted on the home. Can
you please send a letter addressing this matter to the homeowner. It appears to be#16. Not sure what
Fire Has.
Thanks
Sally
4/2/2015
No._ D I L Fee ,
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:—AZ'
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
01p lYitation for Disposal *pstem Construction Permit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon(�/� ❑Complete System ❑Individual Components
Location Address or Lot No.1 ,\kr jrS O'n G'm�h 0,f\njS Owner's Name,Address,and Tel.No.
Assessors Ma /Parcel AC poffcsi 0��j �r� 1�
p r . 1 �' O-Ma%�V-oo4 \C�r� C,'f D�1S"1
Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
A>~mrN Y1 Ex c u4ck-H n
K 6
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( . )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd Design flow provided gpd
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) Z:e wcr C06 NM Q'n
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 1 e�allth..,�
- Signed ✓�� � Y P Datea(a30
Application Approved by / v � 5 Date U
Application Disapproved by Date
for the following reasons
Permit No. rGl Date Issued
gam. •_ - -
No. C7 14 ' �'/ ( _Q ' _ Fee �.
1 J THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Ye
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
01pplicatio' n for Disposal *pstrm (Construction 3permit
Application for a Permit to Construct( ) Repair( ) Upgrade( } Abandon(vj ❑Complete System ❑Individual Components
Location Address or Lot No. S�C fis 01A GYM Hy 0,Y)WS Owner's Name,Address,and Tel.No.
Ar i c 11u.. U rye d y
Assessor's Map/Parcel mG 3 G PGV ea 0 0(Z 4 1(� S O�n\q,r�tL o�� \C.i n r_Y D 0 S
Installer's Name,Address;,and Tel.No. Designer's Name,Address,and Tel.No.
S Ckt 1(rgr1 Ex r ova-�%Y\ e by
Type of Building: -1 y--6 3-C—y I a
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd Design flow provided gpd
.. Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
l Nature of Repa"irs 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 this Board of ealth.
Signed /� /' r'C:Ur�� � Date IIWO
Application Approved by l y L✓�-c � 3y Date C L-
Application Disapproved.by Date
for the following reasons
Permit No. _6 ` _ Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS I,9'TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( )
Abandoned(1, b vL�
at has consancewith the provisions of Title 5 and the for Disposal System Construction Permit Noated
Installer - Designer -
#bedrooms Approved design flow gpd
The issuance of t s e t shall not be construed as a guarantee that the system wi ct on as desi ed. ° -�
Date Inspector /% f i
No. �D Fee --r'
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS
ti Bisposar 6pstem Construction 3permit
Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon(
System located at //� 5 � �/ � 4 4
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 be completed within three years of the date of this permit. C
Date l7— —r-) 3 No-- Approved by
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsu c Swage Disposa System Form -Not for Voluntary Assessments
a.nni S 0 -0(03
_" nnls M-306 P-63
Property Address
Shelley Cohen
Owner Owner's Name
information is required for every 7 Hallet Road, Yarmouth Port MA 02675 December 8, 2011
page. City/Town State Zip Code Date of Inspection
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
Important:When filling out forms A. General Information
/�� PY
on the computer, �(`�))
use only the tab 1. Inspector:
key to move your
cursor-do not Tro Williams
use the return key. Name of Inspector
Troy Williams Septic Inspections
Company Name
19 Hummel Drive
Company Address
South Dennis MA 02660
City/Town State Zip Code
(508) 385- 1300 S1682
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 I C340 ofg
Title 5(310 CMR 15.000).The system: =�
® Passes ❑ Conditionally Passes ❑ Fails
❑ Needs Further Evaluation by the Local Approving Authority co
December 8, 2011
Inspector's Signattfre 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•11/10 Title 5 Official InspecjFo : bsurface Sewa Disposal S tem-[age 1 of 17
r
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
.r 18 Stetson Lane, Hyannis(aka 16 Stetson Lane) _ M -306 P-63
Property Address
Shelley Cohen
Owner Owner's Name
information is 7 Hallet Road, Yarmouth Port MA 02675 December 8, 2011
required for every
page. City/Town 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:
® 1 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:
This inspection is not a guarantee or warranty on the future working conditions of cesspools, pipes or
the structural integrity of cesspools. Orangeburg pipe is prone to root growth and other problems that
may be of concern in the future. Pipes and cesspools were in working order at the time of inspection.
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 yearn 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):
N/A
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17
i
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
'< 18 Stetson Lane, Hyannis(aka 16 Stetson Lane) M -306 P-63
Property Address
Shelley Cohen
Owner Owners Name
information is every
7 Hallet Road
required for eve Yarmouth Port MA 02675 December 8, 2011
page. Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
B) System Conditionally Passes (cont.):
❑ 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):
N/A
❑ 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):
N/A
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•11/10 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 3 of 17
Commonwealth of Massachusetts
Form
Title 5 Official Inspection F o
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
18 Stetson Lane, Hyannis(aka 16 Stetson Lane) M -306 P-63
Property Address
Shelley Cohen
Owner Owner's Name
information is required for every 7 Hallet Road, Yarmouth Port MA 02675 December 8, 2011
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:
N/A
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 in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less
than 1/2 day flow
t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
WSubsurface Sewage Disposal System Form-Not for Voluntary Assessments
18 Stetson Lane, Hyannis(aka 16 Stetson Lane) M-306 P-63
Property Address
Shelley Cohen
Owner Owner's Name
information is required for every 7 Hallet Road Yarmouth Port MA 02675 December 8, 2011
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
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
Lt�5ins0regional office of the Department.
0 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
18 Stetson Lane, Hyannis(aka 16 Stetson Lane) M-306 P-63
Property Address
Shelley Cohen
Owner Owner's Name
information is 7 Hallet Road, Yarmouth Port MA 02675 December 8, 2011
required for every
page. Cityrrown 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 N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
® ❑ Were all system components, excluding the SAS, located on site?
❑ ® Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
® ❑ Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS)on the site has
been determined based on:
® ❑ Existing information. For example, a plan at the Board of Health.
® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
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): 330 gpd
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17
f
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
18 Stetson Lane, Hyannis(aka 16 Stetson Lane) M-306 P-63
Property Address
Shelley Cohen
Owner Owner's Name
information is every
7 Hallet Road
required for eve Yarmouth Port MA 02675 December 8, 2011
page. Cityrrown 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?[if yes separate inspection required] ❑ Yes ® No
Laundry system inspected? ® Yes ❑ No
Seasonaluse? ❑ Yes ® No
Water meter readings, if available last 2 ears usage d 10=56,000 gals.
g ( y g (gP ))' 09=49,000 gals.
Detail
Sump pump? ❑ Yes ® No
Last date of occupancy: August 2011Date
Commercial/lndustrial Flow Conditions:
Type of Establishment: N/A
Design flow(based on 310 CMR 15.203): N/A
Gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.): N/A
Grease trap present? ❑ 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: N/A
t5ins-11/10 Title 5 Official Inspection Forth: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
18 Stetson Lane, Hyannis (aka 16 Stetson Lane) M-306 P-63
Property Address
Shelley Cohen
Owner Owner's Name
information is required for every 7 Hallet Road, Yarmouth Port MA 02675 December 8, 2011
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Last date of occupancy/use: N/A
Date
Other(describe below):
General Information
Pumping Records:
Source of information: No pumping info was available.
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 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):
15ins•11110 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
18 Stetson Lane, Hyannis(aka 16 Stetson Lane) M-306 P-63
Property Address
Shelley Cohen
Owner Owner's Name
information is required for every 7 Hallet Road, Yarmouth Port MA 02675 December 8 2011
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:
Cesspools are original to home. Pipe added from lower bath cesspool to overflow on 7/17/11 per
compliance.
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
Depth below grade: 18"feet
Material of construction:
® cast iron ®40 PVC ®other(explain): orangeburg,
Distance from private water supply well or suction line: N/A
feet
Comments(on condition of joints, venting, evidence of leakage, etc.):
Flushed lines and found clear at the time of inspection. Note: Orangeburg pipe is prone to root growth
and other problems that may be of concern in the future.
Septic Tank(locate on site plan):
Depth below grade: N/Afeet
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:
N/A
Sludge depth:
N/A
t5ins•11/10 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 9 of 17
Commonwealth of Massachusetts
Title 5 official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
y 18 Stetson Lane, Hyannis(aka 16 Stetson Lane) M-306 P-63
Property Address
Shelley Cohen
Owner Owner's Name
information is 7 Hallet Road, Yarmouth Port MA 02675 December 8, 2011
required for every
page. Cityrrown 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 N/A
Scum thickness N/A
Distance from top of scum to top of outlet tee or baffle N/A
Distance from bottom of scum to bottom of outlet tee or baffle N/A
How were dimensions determined? N/A
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
N/A
Grease Trap(locate on site plan):
Depth below grade: N/Afeet
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
N/A
Dimensions: N/A
Scum thickness N/A
Distance from top of scum to top of outlet tee or baffle N/A
Distance from bottom of scum to bottom of outlet tee or baffle N/A
Date of last pumping: N/A
Date
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
18 Stetson Lane, Hyannis(aka 16 Stetson Lane) M -306 P-63
Property Address
Shelley Cohen
Owner Owner's Name
information is required for every 7 Hallet Road, Yarmouth Port MA 02675 December 8, 2011
page. Cityrrown 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.):
N/A
Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan):
Depth below grade: N/A
Material of construction:
❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain):
N/A
Dimensions: N/A
Capacity: N/A
p gallons
Design Flow: N/A '
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.):
N/A
*Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
t5ins-11/10 Title 5 Official Inspedion Form:Subsurface Sewage Disposal System-Page 11 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
18 Stetson Lane, Hyannis(aka 16 Stetson Lane) M-306 P-63
Property Address
Shelley Cohen
Owner Owner's Name
information is required for every 7 Hallet Road, Yarmouth Port MA 02675 December 8, 2011
page. Cityrrown 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 N/A
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.):
N/A
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.):
N/A
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
t5ins•11110 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17
f
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
18 Stetson Lane, Hyannis(aka 16 Stetson Lane) M-306 P-63
Property Address
Shelley Cohen
Owner Owner's Name
information is required for every 7 Hallet Road, Yarmouth Port MA 02675 December 8, 2011
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Type:
❑ leaching pits number:
❑ leaching chambers number:
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
® overflow cesspool number: 1 -4'X 6
❑ innovative/alternative system
Type/name of technology:
Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
Leach pit was dry on inspection. No evidence of hydraulic failure was found present at the time of
inspection.
Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration 2 main cesspools
Depth—top of liquid to inlet invert 4' dry both
Depth of solids layer 3" both
Depth of scum layer none both
Dimensions of cesspool
4'X 5' both
Materials of construction
Cesspool block
Indication of groundwater inflow ❑ Yes ® No
t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
.° 18 Stetson Lane, Hyannis(aka 16 Stetson Lane) M-306 P-63
Property Address
Shelley Cohen
Owner Owner's Name
information is 7 Hallet Road, Yarmouth Port MA 02675 December 8, 2011
required for every
page. CitylTown 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.):
Pvc outlet tee was present. No evidence of hydraulic failure was found at the time of inspection in
either cesspool.
Privy (locate on site plan):
Materials of construction: N/A
Dimensions N/A
Depth of solids N/A
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
N/A
t5ins-11110 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 14 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
18 Stetson Lane, Hyannis(aka 16 Stetson Lane) M -306 P-63
Property Address
Shelley Cohen
Owner Owner's Name
information is required for every 7 Hallet Road Yarmouth Port MA 02675 December 8, 2011
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
i l
I
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32 �
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t5ins•11110 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
y 18 Stetson Lane, Hyannis(aka 16 Stetson Lane) M -306 P-63
Property Address
Shelley Cohen
Owner Owner's Name
information is required for every 7 Hallet Road, Yarmouth Port MA 02675 December 8, 2011
page. Cityrrown 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: 10.01+
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:
MIW 29 Zone B 7.9' 2.2'adjustment
You must describe how you established the high ground water elevation:
Hand auger hole 2.5' below bottom of deepest cesspool with no water found at 11.0'. Groundwater
adjustment in area at the time of inspection was 2.2'. Bottom of deepest part of leaching at 8.5'was
found not to be located in the high groundwater elevation.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
y< 18 Stetson Lane, Hyannis(aka 16 Stetson Lane) M -306 P-63
Property Address
Shelley Cohen
Owner owner's Name
information is required for every 7 Hallet Road Yarmouth Port MA 02675 December 8, 2011
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
I
t5ins-11/10 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17
WE, 42L r? 3�3
COMPLETESENDER:4� •W, COMPLETE THIS SECTIONON DELIVERY
■ Complete items 1,2,and 3.Also complete A. Signature
item 4 if Restricted Delivery is desired. X 2 ❑Agent
■ Print your name and address on the reverse ❑Addressee
so that we can return the card to you. p B. R�ivecpby(Printed�Namej. C. o elivery
■ Attach this card to the back of the mail iece,
or on the front if space permits. 1
I D. Is delivery address different from item 1 ❑Yes
1, Article Addressed to: If YES,enter delivery address below: ❑No
SOPHIE COHEN, TRH
°/a KENNEDY, ARIELLE & JOHN '
476 SKIFF MOUNTAIN RD
I KENT, CT 06757 3. Se ' eType
7Certifled Mail ❑0 Wress Mail
❑Registered MKeturn R pt for Me an e
Q41 ❑Insured Mail ❑C.O.D. W
1" I I 4. Restricted Delivery?(Extra Fee) yes
2. Article Number it, 7 012 1010 0000 2848 10 7 0
(riansfer from service/a6e�
PS Form 3811,February 2004 Domestic Return Receipt 102595-02-Ma540
UNITED STATES POSTAL SERVICE First-Class Mail
Po tage&Fees Paid
LISPS.
Permit No.G-10
• Sender: Please print your name, address, and ZIP+4 in this box •
I
I
1 II
Sewer Connect
Public:°Health Division
0 Town of Barnstable
200 Main Street
Hyannis, MA'02601
I•
rq
tp : I d SS-F
ti Postage $ �P�N� Mqo
Certified Fee �O
� O
Retum Receipt Feeif13
O (Endorsement Required) e
O
Restricted Delivery Fee
r3 (Endorsement Required)
a P S
O Total Postage&Fees $
ru SOPHIE COHEN, TR.
C3 % KENNEDY, ARIELLE & JOHN
476 SKIFF MOUNTAIN RD
KENT, CT 06757 y
r
Certified Mail Provides-
o A mailing receipt
o A unique identifier for your mailpiece
n A record of delivery kept by the Postal Service for two years N..
Important Reminders:
o Certified Mail may ONLY be combined with First-Class Maile or Pribrity Mail®.
a Certified Mail is not available for any class of international mail. e
e NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For
valuables,please consider Insured or Registered Mail.
o.For an additional fee,a Return Receipt may be requested to provide proof of
delivery.To obtain Return Receipt service,please complete and attach a Return
Receipt(PS Form 3811)to the article and add applicable postage to cover the
fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for
a duplicate return receipt,a USPSe postmark on your Certified Mail receipt is
required.
a For an additional fee, delivery may be restricted to the addressee or
addressee's authorized agent.Advise the clerk or mark the mailpiece with the
endorsement"Restricted Delivery".
o If a postmark on the Certified Mail receipt is desired,please present the arti-
cle at the post office for postmarking. If a postmark on the Certified Mail
receipt is not needed,detach and affix label with postage and mail.
IMPORTANT. Save this receipt and:present it when making an inquiry. "
PS Form 3800,August 2006(Reverse)PSN 7530-02.000-9047
u �t Town of Barnstable
�.�. Barn
Regulatory Services Department Ofte`ca0 j
■ARNSTASM I
9� MASS.
Public Health Division
200-Mai7n—Strom,-Hyannis NIA 02601 -
Office: 508-862-4644 Thomas F.Geiler,Director
FAX: 508-790-6304 Thomas A.McKean,CHO
CERTIFIED MAIL#7012-1010-0000-2848 -1070
March 28, 2013
SOPHIE COHEN, TR.
% KENNEDY, ARIELLE &JOHN
476 SKIFF MOUNTAIN RD IMPORTANT NOTICE
KENT, CT 06757 Map & Parcel: 306- 063
The Department of Public Works informed us that public sewer lines are now
available in your neighborhood. According to our records, your property has a septic
system. This letter directs you to connect your dwelling, at 16 Stetson Lane, Hyannis,
MA, to public sewer on or before 3/30/2015.
The old septic system must be either removed or filled in due to future safety
concerns. This may be done by the same contractor who connects you to the sewer.
Septic Abandonment Permits ($ 25) are issued at the Public Health Division, 200 Main
Street, Hyannis.
Failure to comply with this Board of Health Order may result in a complaint
against you, in a court of law.
For additional information pertaining to the sewer connection,please see the
reverse side of this page.
PER ORDER OF THE BOARD OF HEALTH
Thomas A. McKean, R.S., C.H.O.
Agent of the Board of Health
Cc: Barbara Childs, WPC/Roger Parsons, Town Engineering, DPW
Enc.
QASEWER connect\Letters Stewart Creek Sewer Connects\MA1LING LetA Sewer 2Pgs Merged 3-28-13 Yr2015.doc
r
Public Health Division March 28, 2013
ADDITIONAL INFORMATION AND REMINDERS FROM OTHER DIVISIONS:
SAVINGS AVAILABLE/GRINDER PUMP:
A reminder to those of you who need a grinder pump for your connection:
Department of Public Works (DPW) sent you a letter in December 2012 stating the town,
for a limited time of two years, only from the receipt of the DPW letter, would provide
you with the pump at no charge. (This can save you thousands of dollars.) Please note:
You must pay the installation cost through ygur own contractor. Please make your
contractor aware of this, if interested. Also be aware: this is a shorter deadline than
the Public Health Division's deadline on the reverse side of this page.
SAVINGS AVAILABLE/PERMIT FEE:
The Town offers a waiver of the residential sewer connection fee of $420.00 for those
properties that connect within two years of the receipt of the DPW December 2012 letter.
LOANS:
For loan(s) available, please see the enclosed brochure, or see the town website:
http://www.towti.barnstable.ma.Lls/cdba (under the "CDBG Programs", see "Sewer
Connection Loan Program). For loan specific questions, you may contact Kathleen
Girouard, Growth Management, at 508-862-4702.
CONTRACTORS:
Information on Licensed Sewer Installers is available on our web site at
www.town.bar,nstable.ma.us/Pub]1eWorksTech/sewerinstallers. Contractors, approved to
perform sewer connection work in the Town of Barnstable must obtain and file a Sewer
Connection Permit with DPW-Water Pollution Control Division, 617 Bearse's Way,
Hyannis—contractors, please call Dave Anderson at (508) 790-6244.
FOR ANY QUESTIONS /ASSISTANCE:
Len Gobeil at the Town Manager's Office is available to provide you with direction you
may need in reference to the Stewart Creek Sewer Connections. You may contact him at
508-862-4701.
QASEWER connect\Letters Stewart Creek Sewer Connects\MAILING LetA Sewer 2Pgs Merged 3-28-13 Y0015.doc