HomeMy WebLinkAbout0088 STETSON STREET - Health 88 Stetson Street
Hyannis P
A = 306 073
1
0
\l
No. Fee
11E COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
01ppYication for disposal *pstrm Construction 3permit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon(e ❑Complete System ❑Individual Components
Location Address or Lot No. Owner's Nam �
e ddress,and Tel.No. locs3- '2>76 Sa
/ I1��n/5 �SleAlten I ��, 7oa Cinder Sf-,
Assessor's Map/Parcel p t) SOS
Installer's Name,Address,an Tf 1.No. SO*•` 91-9, � Designer's Name,Address,and Tel.No.
(tE"drs
Type of Buildin .
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)
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 Environment e a not to place the system in operation until a Certificate of
Compliance has been issued Board of Health.
i C� Date �'� / ��y
Application Approved by Date
Application Disapproved by Date
for the following reasons
Permit No. _Z1 Date Issued
kIf _i' t gi � d'' , r qva -•ram", f -'�
No.
Fee
T E COMMONWEALTH OF'M Yes
MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOW.N.,OF B,Q►RNSTABLE, MASSAC-HUSETTS
, 1pYicatlDn fOr .%s osat 6pstrmtCConstruction permit
Application for a Permit to Construct( ,� +Rep( ) Upgrade( ') Abandon(..� Complete System ❑Individual Components
' Location Address or Lot No. Owner's Name,Address,and Tel.No.
Assessor's-M p/Parcel36(A AAA otSq
Installer's Name,Address,and Tel.No. 5C6 ?7/- 9 3 Designer's Name,Address,and Tel.No.
( r+vlvf ,�ry,
Aklflosis
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other • Type of Building 'No.of Persons Showers( ) Cafeteria:(:. )
Other Fixtures
t 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) 4
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 EnvironmentaLC'o el a d'not to place the system in operation until a Certificate of
Compliance has been issued hi Board of Health.
e. - i Date
Application Approved by Date
Application Disapproved by l Date
r
for the following reasons
Permit No. Date Issued
a
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS II TO CERTIFY,that
the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded(; )
Abandoned �f b 7 IL" . LG/?57YZ /Cy�,-,Li�C '
- //Y� r
at 9, J 5,yj � �1//!��/?i S has been cons ct d i acc a
with the provisions of Title 5 and the for Disposal System Construction Permit No at
Installer Designer
#bedrooms Approved design flowA k gpd
The issuance of this perm. shall/t be construed as a guarantee that the system JWJJfun n as desig ed.
Date f ( inspector
---------------------- ---------------------------------------------------------------------------------------------------- ------
No. Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLI ' HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
Misposal 6pstem Construction 30ermit
Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon
System located at
k
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:Cons ction ust be c rr3#ted within three years of the date of this permit.
Date Approved by
k1 0o I kor AL
f
No. 0 Fee 1,
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
ftPlitation for Mispo8ar 6pstem Construction Permit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon ❑Complete System ❑Individual Components
Location Address or Lot No. T6 P) Owner's Name,Address,and Tel.No. /84 3U_'91 7*3t.
Assessor's Map/Parcel Cj ��yun� S 3C1 � lq% ®Q c
Installer's N�� e,A,ddress,and el.No. S�� '��/'I99 Design s Name, ddress,and Tel.No.
,(3P>/'/r��Ol7"� CAW7�s�. ,z—bic vsmi;d
O
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)
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 an no place the system in operation until a Certificate of
Compliance has been issued by this Board of Healt /
Signed—
Date
Application Approved by �� �`—.� Date4*1oo?
Application Disapproved by Date
for the following reasons
o.Permit N d — Date Issued
��f
No. 013 - - 1k � Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Y—�, \
es
PUBLIC HEALTH DIVISION-TOWN OF BARNSTABLE, MASSACHUSETTS
2pplitation for Zisposal 6pBtem Construction permit
Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon ❑Complete System ❑Individual Components
Location Address or Lot No. $ h Owner's Name,Address,and Tel.No. 8/* ;I.
Assessor's Map/Parcel 3c C, U J) 1��/C1 n r1%S A, (Gi(/h b I ✓U�3 y�Gt S�
17_ / I
Installer's Name,Address,and Tel.No.5D5-'�7/ S'.��9 DesignerA Name,Address,and Tel.No.
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder
Other Type of Building No.of Persons Showers( ) Cafeteria( )}
Other Fixtures
C'k—°Design Flow(min.required) gpd Design flow provided gpd
d,
Plan Date Number of sheets Revision Date
Title
' Size of Septic Tank Type of S.A.S.
Description of Soil
f Nature of Repairs or Alterations(Answer when applicable)
i
Date last inspected:
Agreement: Y !
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 S of the Environmental Code and not place•the system in operation'until a Certificate of
Compliance has been issued by this Board of Health. `
` — Signed Date
p -
Application Approved by Date 1/ h
Application Disapproved by � Date
31
for the followinereasons
Permit No. ( � Date Issued
---------------------------------------------------------------------------------------------------------------------------------------
TH F COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
(,AP
Certificate of C0ltltlllallCE
T IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired'( ) Upgraded( )
Abandoned)by ,
i
at ' has been constructed in accordance
with the provisions of Title 5 and the for Disposal ystem Construction Permit No. d( —// dated r
Installer Designer
#bedrooms vf' �1 Approved design flow gpd
The issuance of this permit shall not be construed as a guarantee that the system•will-functi8n<as designed.
Date �rr/ ' " // Inspector t -- �--
---------------------------------------------------------------------------------------------------------------------------------------
No. C 7 " /1 Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
Disposal 6pstem Construction i3Crmit
Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon(�
System located atj
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 in st be completed within three years of the date of this permit
Date L� ' 7 Approved by ��
•MPLETETIVS SECTION:: CMIPLETE THIS SECTIGN ON DELIVERY :
.;. .r s Also complete A. Sig ture
s Com plete it em 1,2, 3.
item 4 if Restricted Deliveand.ry_
is desired. X ❑Agent
IN 'Print your name and addres`s'on.the reverse , 7;.; <;e%`M ❑Addressee
so that we can return.the card to you. x a g,R c by(Printe Nam) Y C. ate of Delivery
■ Attach this card to the back of the mallplecer
or on the front if space permits _
Very addressed ere t fr8tn dem,la? a❑Yes
" GARY LAMB,-,& JOANNE MCGEE LA enter del'ive or V. el,, No
13043 ETNkST
.
LEY GLEN CA 91401
f�CeryfL!Ma11 ❑ t all
❑ReglsteresJ rn pt-for Merch Ise
I ❑Insur�Fd MaIl4�w�C� ,D t,}"
3T", 4. Restrictetl I)76 iy�Fee) ❑Yes
2. Article Number ( 7 012 101 T d.� 2848 117 9
(transfer from servke/abet) t �mF�_0'
PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540;
a
UNITED STATES POSTAL SERVICE First=Class Mail
J Postage&'Fees Paid
USPS
Permit No.G-10
• Sender: Please'print,your-name, address, and ZIP+4 in this box •
I
= Sewer'Connect I
' .Public Health Division
s� I
iTown,o Barnstable
I .., =i200:Main Street I
Hyannis,MA 02601
AZ-
- I
I � �
N I�` •
FICIAL USE
co Postage $
C3 � p,N N/S
0 Certified Fee
Retum Receipt Fee / Postmark'
Q (Endorsement Required) 1 �it�A�Here p
��7! N
Restricted Delivery Fee 8�
O (Endorsement Required)
O Total Postage&Fees Fs c • \qS
t-�
� GARY LAMB & JOANNE MCGEE-LAMB
13043 AETNA ST
VALLEY GLEN, CA 91401
Certified Mail Provides:
o A mailing receipt
o A unique identifier for your mailpiece
o A record of delivery kept by the Postal Service for two years
I
Important Reminders:
o Certified Mail may ONLY be combined with First-Class Maile or`Priority Mail&
o Certified Mail is not available for any class of international mail.
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.
o 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
y I
...
:l Barnstable
'THE, Town of Barnstable
.�. Regulatory Services Department AFAmedca0vv
SARNSTASM I I
9� is ,0� Public Health Division
----- --.___.-------2II0'7------------.__..- -
Office: 508-862-4644 Thomas F.Geiler,Director
FAX: 508-790-6304 Thomas A.McKean,CHO
CERTIFIED MAIL#7012-1010-0000-2848 -1179
March 28, 2013
GARY LAMB & JOANNE MCGEE-LAMB
13043 AETNA ST IMPORTANT NOTICE
VALLEY GLEN, CA 91401 Map & Parcel: 306- 073
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 88 Stetson St., 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 T BOARD OF HEALTH
as 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
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 your 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:
11ttp://www.town.barnstable.ma.us/edba (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.barnstable.ma.us/PublleWorksTech/sewerinstalIers. 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 connecttLetters Stewart Creek Sewer Connects\MA1LING LetA Sewer 2Pgs Merged 3-28-13 Yr2015.doc
T IrsZ's
ECOJECH MAP �q"q.F5W,-%
Environmental PARCEL ; ®��
www.eco-tech.us LOT It.
THIS FORM IS A FACSIMILE OF THE STANDARD SEPTIC INSPECTION FORM ISSUED BY THE MASSACHUSETTS DEPARTMENT
OF ENVIRONMENTAL PROTECTION(revised 6/15/2000)
TITLE 5
OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 88 Stetson Street
Hyannis REC EI\J E®
Owner's Name: Barbara Ochen
Owner's Address: 1753 63`d street
Brooklyn,NY 11201 $EP 1 0 NO
Date of Inspection: September 6,2003
Name of Inspector: (Please Print) David D. Coughanowr,R.S. TOWH OF
HEALTH DEPTAgLE
Company Name: Eco-Tech Environmental
Mailing Address: 43 Triangle Circle
Sandwich,MA 02563
Telephone Number: (508)364-0894
CERTIFICATION STATEMENT:
I certify that I have personally inspected the sewage disposal system at this address and that the information reported
below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my
training and experience in the proper function and maintenance of on-site sewage disposal systems. I am a DEP
approved system inspector pursuant to section 15.340 of Title 5(310 CMR 15.000).The system:
X Passes
Conditionally Passes
Needs Further Evaluation By the Local Approving Authority
Fails
Inspector's Signature 2S Date: 5(P'f e 20 0 3
The System Inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or
DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000
gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the
DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving
authority
NOTES AND COMMENTS
Inspector's Note—> A septic system is deemed to pass this Real Estate Transfer Inspection if it does not trigger
any of the failure criteria listed below. The septic system has been evaluated according to the conditions observed
on the day it was inspected. No estimate or guarantee of system longevity is made or implied by a passing determination.
****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.
Title 5 Inspection Form 6/15/2000 page 1
Page 2 of 11
OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 88 Stetson Street
Hyannis
Owner: Barbara Ochen
Date of Inspection: September 6,2003
INSPECTION SUMMARY: Check A,B,C,D or E/ALWAYS complete all of section D:
A] System Passes:
X I have not found any information which indicates that any of the failure criteria described in 310 CMR
5.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below.
COMMENTS:
B] System Conditionally Passes:
One or more system components as described in the"Conditional Pass" section need to be replaced or
repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass.
Answer yes,no,or not determined(Y,N,or ND). in the_for the following statements.If"not determined"please
explain.
The septic tank is metal and over 20 years old*or the septic tank(whether metal or not),is structurally
unsound,exhibits substantial infiltration or exfiltration,or tank failure is imminent. System will pass inspection if the
existing tank is replaced with a complying septic tank as approved by the Board of Health.
*A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance
indicating that the tank is less than 20 years old is available.
ND explain:
Observation of sewage backup or breakout or high static water level in the distribution box is due to broken or
obstructed pipe(s)or due to a broken,settled or uneven distribution box.The system will pass inspection if(with
approval of Board of Health).
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced.
ND explain
The system required pumping more than four times a year due to broken or obstructed pipe(s).The system will
pass inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
ND explain
2
Page 3 of 11
OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 88 Stetson Street
Hyannis
Owner: Barbara Ochen
Date of Inspection: September 6,2003
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 and 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
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 by a DEP certified laboratory, for coliform
bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and
the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other
failure criteria are triggered. A copy of the analysis must be attached to this form
3) OTHER
3
ti
Page 4 of 11
OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION continued
Property Address: 88 Stetson Street
Hyannis
Owner: Barbara Ochen
Date of Inspection: September 6,2003
D)System Failure Criteria applicable to all systems:
You must indicate either"yes"or"no"to each of the following for all inspections:
I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303.
The basis for this determination is identified below. The Board of Health should be contacted to determine what
will be necessary to correct the failure.
yes no
X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool.
X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
clogged SAS or cesspool.
X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool.
X Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow.
X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number
of times pumped
X Any portion of the SAS,cesspool or privy is below high groundwater elevation.
X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply.
X Any portion of a cesspool or privy is within a Zone 1 of a public well
X Any portion of a cesspool or privy is within 50 feet of a private water supply well
X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water
supply well with no acceptable water quality analysis.(This system passes if the well water analysis,
performed by a DEP certified laboratory, for coliform bacteria and volatile organic compounds
indicates that the well is free from pollution from that facility and the presence of ammonia
nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria
are triggered. A copy of the analysis must be attached to this form)
No (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as
described in 310 CMR 15.303,therefore, the system fails.The system owner should contact the Board of
Health to determine what will be necessary to correct the failure.
E)Large Systems:
To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000
gpd
You must indicate either"yes"or"no"to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
yes no
the system is within 400 feet of a surface drinking water supply
the system is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped
Zone 11 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.
4
Page 5 of 11
OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 88 Stetson Street
Hyannis
Owner: Barbara Ochen
Date of Inspection: September 6,2003
Check if the following have been done: You must indicate either"Yes"or"No"as to each of the following:
Yes No
X _ Pumping information was provided by the owner,occupant or Board of Health.
X Were any of the system components pumped out in the last two weeks?
X Has the system received normal flows in the previous two week period?
X Have large volumes of water been introduced to the system recently or as part of this inspection?
n/a _ Were as built plans of the system obtained and examined?(If they were not available as N/A)
X _ Was the facility or dwelling inspected for signs of sewage back-up?
X _ Was the site inspected for signs of breakout?
including
X _ Were all system components,exe'ds"the SAS. located on site?
n/a _ Were the septic tank manholes uncovered, opened,and the interior of the septic tank inspected for
the condition of the baffles or tees,material of construction,dimensions,depth of liquid, depth of sludge and depth of
scum.?
X _ Was the facility owner(and occupants,if different from owner) provided with information on the proper
maintenance of subsurface disposal systems?
For information on the proper maintenance of subsurface disposal systems please go to:
WWW.ECO-TECH.US
The size and location of the Soil Absorption System(SAS)on the site has been determined based on:
X Existing information.For example,Plan at the Board of Health.
X _ Determined in the field(if any of the failure criteria related to part C is at issue,approximation of distance
is unacceptable) 1310 CNM 15.302(3)(b)]
5
Page 6 of 11
OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 88 Stetson Street
Hyannis
Owner: Barbara Ochen
Date of Inspection: September 6,2003
FLOW CONDITIONS
RESIDENTIAL
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): n/a—no plan on file at Health Dept.
Number of current residents 0
Does the residence have a garbage grinder(yes or no): no
Is laundry on a separate sewage system(yes or no): no :(If yes, separate inspection required)
Laundry system inspected (yes or no): n/a
Seasonal use(yes or no):yes
Water meter readings,if available(last two year's usage(gpd): 28 gpd
Sump Pump(yes or no): no
Last date of occupancy: August,2003
COMMERCIAL/INDUSTRIAL:
Type of establishment:
Design flow(based on 310 CMR 15.203):: gpd
Basis of design flow(seats/persons/sgft/etc.):
Grease trap present: (yes or no)_
Industrial waste holding tank present: (yes or no):
Non-sanitary waste discharged to the Title 5 system: (yes or no).
Water meter readings,if available:
Last date of occupancy/use:_
OTHER: (Describe):
GENERAL INFORMATION
PUMPING RECORDS
Source of information: System last pumped 1 year ago(Owner)
Was system pumped as part of the inspection: (yes or no) 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
X Overflow cesspool
Privy
Shared system(yes or no)(if yes,attach previous inspection records,if any)
Innovative/Alternate technology. Attach a copy of the current operation and maintenance contract(to be
obtained from system owner)
Tight Tank Attach a copy of the DEP approval
Other(describe)
APPROXIMATE AGE of all components,date installed(if known)and source of information:
Age unknown—no information on file at Board of Health
Were sewage odors detected when arriving at the site: (yes or no) no
6
Page 7 of 11
OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 88 Stetson Street
Hyannis
Owner: Barbara Ochen
Date of Inspection: September 6,2003
BUILDING SEWER_(Locate on site plan)
Depth below grade: 2 ft
Material of construction: X cast iron _40 PVC_other(explain)
Distance from private water supply well or suction line 20+
Comments:(on condition of joints,venting,evidence of leakage, etc.)
Sewer is vented through roof and appears structurally sound with no evidence of leakage or backup into dwelling
SEPTIC TANK: none (locate on site plan)
Depth below grade:
Material of construction:_concrete_metal_fiberglass_polyethylene
other(explain)
If tank is metal,list age_ Is age confirmed by Certificate of Compliance_(yes or no):_(attach a copy of
certificate)
Dimensions:
Sludge depth:
Distance from top of sludge to bottom of outlet tee or baffle:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
How dimensions were determined:
Comments: (on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity, liquid levels
as related to outlet invert,evidence of leakage, etc.):
GREASE TRAP: none (locate on site plan)
Depth below grade:
Material of construction:_concrete_metal_fiberglass_polyethylene
other(explain)
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:_
Date of last pumping:
Comments: (on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity, liquid levels
as related to outlet invert,evidence of leakage,etc.):
7
I
Page 8 of 11
OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 88 Stetson Street
Hyannis
Owner: Barbara Ochen
Date of Inspection: September 6,2003
TIGHT OR HOLDING TANK: none (Tank must be pumped at time of inspection)(locate on site plan)
Depth below grade:
Material of construction:_concrete_metal _fiberglass_polyethylene_other(explain)
Dimensions:
Capacity: gallons
Design flow:_gallons/day
Alarm present(yes or no):_
Alarm level:_ Alarm in working order(yes or no):_
pumping:Date of last
Comments:(condition of inlet tee, condition of alarm and float switches,etc.)
DISTRIBUTION BOX: none (if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert:
Comments:(note if box is level and distribution to outlets is equal,any evidence of solids carryover,any evidence of
leakage into or out of box,etc.)
PUMP CHAMBER: none (locate on site plan)
Pumps in working order: (yes or no)
Alarms in working order: (yes or no)
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):
8
Page 9 of 11
OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 88 Stetson Street
Hyannis
Owner: Barbara Ochen
Date of Inspection: September 6,2003
SOIL ABSORPTION SYSTEM(SAS): (locate on site plan;excavation not required)
If SAS not located,explain why:
Type:
_leaching pits,number
_leaching chambers,number
_leaching galleries,number
_leaching trenches,number,length
_leaching fields,number,dimensions
X overflow cesspool, number I overflow,I primary(see below)
—innovative/alternate system Type/name of Technology
Comments: (note condition of soil, signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.)
Soils above both cesspools appeared unsaturated.No evidence of surface ponding breakout,lush vegetation,or
other evidence of hydraulic failure was observed. Both cesspools were dry
CESSPOOLS: yes (cesspool must be pumped at time of inspection)(locate on site plan)
Number and configuration: two in series
Depth-top of liquid to inlet invert: priyM cesspool was dry
Depth of solids layer: none
Depth of scum layer: none
Dimensions of cesspool: approximately 6 foot diameter,6 foot depth(beehive configuration)
Materials of construction: concrete block
Indication of groundwater inflow(yes or no):
Comments: (note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation,
etc.):
Primary cesspool was da and appeared in satisfactory condition Outlet tee was present
PRIVY:none (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.):
9
Page 10 of 11
OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 88 Stetson Street
Hyannis
Owner: Barbara Ochen
Date of Inspection: September 6,2003
SKETCH OF SEWAGE DISPOSAL SYSTEM:
Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or
benchmarks.Locate all wells within 100'(Locate where public water supply enters the building)
LOCATIONS
OVERFLOW
O CESSPOOL A g
1 30.5 ft 36.5 ft
2 37 ft 52 ft
PRIMARY
OCESSPOOL
i
B A
EXISTING
DWELLING
# 88
W
T-L-
J
W
3
STETSON STREET NOT TO SCALE
10
Page 11 of 11
OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 88 Stetson Street
Hyannis
Owner: Barbara Ochen
Date of Inspection: September 6,2003
SITE EXAM
Slope
Surface water
Check Cellar
Shallow wells
Estimated Depth to ground water: 20+ feet
Please indicate(check)all methods used to determine high ground water elevation:
Obtained from system design plans on record-If checked. date of design plan reviewed
X Observed Site(abutting property/observation hole within 150 feet of SAS)
Checked with local Board of health-explain:
_ Checked local excavators,installers-attach documentation)
X Accessed USGS database
You must describe how you established the high ground water elevation.
Comparison of USGS Topography maps indicated that lot is over 20 feet above groundwater.
11