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Home My WebLink About0095 STETSON STREET - Health 95 Stetson. Street Hyannis A= 306— 060 9 I I v v SENDER: COMPLETE.THIS SECTI N COMPLETE THIS SECTION ON DELIVERY rmplete items 1,2,and 3.Also complete A. signature m 4if Restricted Delivery is desired. ❑Agent. nt your name and address on the reverse ❑Addressee so that we can return the card to you. B:Meived (Print Name) C. D f Deli ery ■ Attach this card to the back of the mailplece, or on the front if space permits. - D. Is delivery addresf different from item 1? ❑Yes 1.,Article Addressed to: If YES,enter delivery address below: ❑No STEPHEN KEEFE ' { 702 LINDEN STREET -°BOYLSTON,.MA 01505 3. Service Type I ertified Mail ❑Express Mail ❑Registered "turn Recelpt foWarch dise I N ❑Insured Mail ❑C.O.D I 4. Restricted Delivery?(Extra Fee) ❑Yes 12. Article Number 7 OI E 101�01, 0 0 0 q °2 8 48, 118 6'' I (Transfer from servicelabeq �!� ��YtMisi�t! lfi� PS Form 3811,February 2004 Domestic Return Receipt 1:02595-02-M4540 UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid LISPS I Permit No.G-10 I • Sender: Please print your name, address, and ZIP+4 in this box • I A Sewer Connect nmw Public Healtb Division C Town of Barnstable 200 Main Street Hyannis, MA 02601 I sl x, I• • • • • -r Co rq OFFICIAL r Co Postage $ ru Certified �,(NNN/S O Fee n I C3 Return Receipt Fee Postmark 9 O (Endorsement Required) �9 Here O Restricted Delivery Fee ?D r (Endorsement Required) f� H C3 Total Postage&Fees �.f GSpS I o STEPHEN KEEFE I N 702 LINDEN STREET j BOYLSTON, MA 01505 Certified Mail Provides. r 4 0 Amailing receipt is A unique identifier for your mailpiece j a A record of delivery kept by the Postal Service for two years R Important Reminders: o Certified Mail may ONLY be combined with First-Class Maile or Priority Mail®. e Certified Mail is not available for any class of international mail. a 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 USPS®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 Town of Barnstable Barn .�. Regulatory Services Department AMMMUC j BAMSfAHM I 'NAB Public Health Division . ,�� 200 Main Street,Hyannis MA 02601007------- --- Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7012-1010-0000-2848 -1186 March 28, 2013 STEPHEN KEEFE 702 LINDEN STREET IMPORTANT NOTICE BOYLSTON, MA 01505 Map & Parcel: 306- 060 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 95 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 E BOARD OF HEALTH mas 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\MAILING LetA Sewer 2Pgs Merged 3-28-13 Yr2015.doc y. a 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 yur 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: littp://www.town.barnstable.ma.us/cdb!� (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/PublicWorksTecli/sewei-installei-s. 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. Q:\SEWER connect\Letters Stewart Creek Sewer Connects\MAILING LetA Sewer 2Pgs Merged 3-28-13 Yr2015.doc Main Level d I 0 3 i F . L..-_-:T�-_-.-.... ._. .�> F Ud"Arc. ffiA9 lti t it aa" s6 ® lE�auruom. _! fifdae.nHty�.. � � o .firomsm f{ 3 � �7, F A : Z6 # IT Main Level KEEFEISTFLR 6/8/2012 Page: 1 Main Level II .._................................_._.........._.._._.........................-__..........................._...._...._.....—._...._.._....___.._....__......................_.............................._........__._...._._--------._.------......... .31................_....._ _............ ........_........... __... __ ... _ ............._.......... ......... .. .— --...._.. ...................._...—_____..—_ _....... ....................... _........ ... TIr— t- r - P" _.._. - �..�.�✓ r _i�.A' �. o _. ..._. .:3'. ... . ITT. �T 8° 4 4 � 1 vy°y- 3 x 1 i i 3 e I I KEEFE2NFLR 6/8/2012 Page: 1 AsBuilt Page 1 of 1 LOCATION SEWAGE PERMIT NO. VILLAGE INST LER'S NA E i ADDRESS ~ 44"t'"R ON OWN ER VvC DATE PERMIT ISSUEDL �- DATE COMPLIANCE ISSUED -71 http://issgl2/intranet/propdata/prebuilt.aspx?mappar=306060&seq=1 6/12/2012 Commonwealth of Massachusetts o? Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 95 Stetson Street Property Address Bill Hebenstreit Owner Owner's Name information is required for every Hyannis MA 02601 10/10/10 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 A. General Information filling out forms on the computer, use only the tab 1. Inspector: key to move your cursor-do not Michael Kellett use the return Name of Inspector key. Aardvark Environmental Inspections ,L Company Name P.O. Box 896 Company Address East Dennis MA 02641 City/Town State Zip Code 508-385-7608 SI 3742 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 fo:Section f6,346R Title 5(310 CMR 15.000).The system: -- A ® Passes ❑ El ;Conditionally Passes Fails ❑ Needs Further Evaluation by the Local Approving Authority ' N Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 95 Stetson Street Property Address Bill Hebenstreit Owner Owner's Name information is required for every Hyannis MA 02601 10/10/10 page. Cityf 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: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 95 Stetson Street Property Address Bill Hebenstreit Owner Owner's Name information is required for every Hyannis MA 02601 10/10/10 page. City[Town 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): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 95 Stetson Street Property Address Bill Hebenstreit Owner Owners Name information is required for every Hyannis MA 02601 10/10/10 page. Cityrrown 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 coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool El ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/day flow Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ' 95 Stetson Street Property Address Bill Hebenstreit Owner Owner's Name information is required for every Hyannis MA 02601 10/10/10 page. City(rown 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 regional office of the Department. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments- y 95 Stetson Street Property Address Bill Hebenstreit Owner Owner's Name information is required for every Hyannis MA 02601 10/10/10 page. Citylrown 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): 4 Number-of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Commonwealth of Massachusetts lugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 95 Stetson Street Property Address Bill Hebenstreit Owner Owner's Name information.is required for every Hyannis MA 02601 10/10/10 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes E; No Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 08/10 Date 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 I Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 95 Stetson Street Property Address Bill Hebenstreit Owner Owner's Name information.is required for every Hyannis MA 02601 10/10/10 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: 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) El 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): Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 95 Stetson Street Property Address Bill Hebenstreit Owner Owner's Name information is required for every Hyannis MA 02601 10/10/10 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 12/17/79 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1.1 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 0.6 feet- Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gal 3„ Sludge depth: Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 95 Stetson Street Property Address Bill Hebenstreit Owner Owner's Name information is required for every Hyannis MA 02601 10/10/10 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 28" Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 16" How were dimensions determined? measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): The tank was sound and tight with tees in place and liquid at outlet invert. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t . Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments �< 95 Stetson Street Property Address Bill Hebenstreit Owner Owner's Name information is required for every Hyannis MA 02601 10/10/10 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 95 Stetson Street Property Address Bill Hebenstreit Owner Owner's Name information is- required every Y for e Hyannis MA 02601 10/10/10 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Even 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.): The box was level and tight with no sign of carryover. 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.): Soil Absorption System (SAS) (locate on site plan, excavation not required): • If SAS not located, explain why-: Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 95 Stetson Street Property Address Bill Hebenstreit Owner Owner's Name information is- Hyannis MA 02601 10/10/10 required for every y page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ 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.): This system has 6'x6' precast pit surrounded by two feet of stone. There was no sign of ponding or failure in the stones. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments ,ey 95 Stetson Street Property Address Bill Hebenstreit Owner Owner's Name information i required for every Hyannis annis MA 02601 10/10/10 e page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 95 Stetson.Street Property Address Bill Hebenstreit owner Owner's Name information is Hyannis MA 02601 10/10/10 p required for every Pam• Citylrown State Zip Code Date of Inspection D. System Information (cost.) 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: 0 hand-sketch in the area below 0 drawing attached separately v • i I V' II R • f ka Type of pollution Decimal Rounded percent Acid 0.183 0.18 18% Animal Wastes 0.125 0.13 13% Thermal 0.108 0.11 11% Sediment 0.016 0.02 2% Pesticides 0.125 0.13 13% Fertilizers 0.15 0.15 15% Organic Wastes 0.158 0.16 16% Pertoleum Products 0.1331 0.13 13% a P , Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 95 Stetson Street Property Address Bill Hebenstreit Owner Owner's Name information is required for every Hyannis MA 02601 10/10/10 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ❑ Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: 20.0 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: You must describe how you established the high ground water elevation: i USGS maps show an elevation of over 20.0 feet Before filing this Inspection Report, please see Report Completeness Checklist on next page. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 95 Stetson Street Property Address Bill Hebenstreit Owner Owner's Name requinform r on is. Hyannis MA 0260,1 10/10/10 requiredd for every y 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 !� \ � Car O /w r _ � v � N V1 C s '^ a � o: 0 ,.. � ... . �... �_-J..�.._.._.,__�..._.._..._._. ,`'`��`�/ �� j � /J 7%' +' � �� . ,+ �,.�� . . • J THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH . ................OF..... :.......... .... Appliratilan for Diinvoiia1 Wjarkfi Tiatmu 'rrn a ti Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at: r .. s_. - .. ....--. ....1 .. ........................ .----- ------------------------------ Q Loca' .Addres ( y — or Lot No Y - . ._..-•------•---•...................................... -•----------------••---W-' ........ .. .. .......................... + ress l . Installer Address //, Q Type of Buildin Size Lot_!_._ _ o___..Sq. feet U Dwelling No. of Bedrooms................................ _Expansion Attic ( ) Garbage Grinder ( ) U Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a Other fixtures ------------------------•----••. - W Design Flow______________________________•.._.._.__ ._ allons per person per day. Total daily flow................._...........................gallons. WSeptic Tank . Liquid capacity/!J4gallons Length................ Width---------------- Diameter................ Depth................ x Disposal Trench—'Vo_____________________ Widt __�.............._ Total Length..........t........ Total leaching area--------------------sq. ft. Seepage Pit No.....)------------- Diamet ............ Depth below inlet-_. __.._._......_. Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) 1-4 Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ 0-4 4, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_.__-______-___•-______- - - .. -----------------------Description of Soil............................................ ... ..................... x W -------------•------------•......................... •---•••••-•---------- ..................................... --••--•- --------------------•-t-- •- -• ---------•--•- U Natu e of R pairs orAlterationso� —Answ when a licable__ _____ ________ ________ _ ______________ ___ _.._.._._._�� .__. ....• ............................. Agreement: The _undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'TTL: p 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has*bbeenisd bthe board o 1 lth.Signed. ........ -------------------------------- Date Application Approved By. x- �% -_-_--__-•--------•---- I? _� `_/._ .�.,�.._ Date Application Disapproved for the following reasons---------------------------------------------------------------------------------------------------------•-•--•- .\ --Date ,._ Issued +�'.......... 7 Permit No................................•-------...... �._� 7 - j / ate q THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............._OF....... .'z --------------------------------------------- Appliration for Dhip'og al Works C on.6trur -on Frrutit Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at: `�'.5._...--.!:�T J.v..........5 ......... .....................•--•----------------------..:: Location-Address or Lot No. Owner Address_ Installer Address UType of Building Size Lot..Y9.,0 Qd.._....Sq. feet Dwelling—No. of Bedrooms_______%.............................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Buildin a YP g ---------•---• No. of persons............................. Showers ( ) — Cafeteria ( ) P4Other fixtures ------------------------•------------------••---------•-•----•-••-•--•--.------------. --•--••-•-•--•••••-••••-••••---•-•-•-•••-•--•-•••---•----•-•- W Design Flow............................................gallons per person per day. Total daily flow.............................................gallons. WSeptic Tank—" Liquid capacity/ gallons Length................ Width................ Diameter---------------- Depth................ x -.,Disposal Trench—No. .................... Width_. _._......_._._.. Total Length..___._._. _ Total leaching area....................sq. ft. ��Seepage Pit No........./....... Diameter..._ .___._...... Depth below inlet-_49............. Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by •-•.............••...---•--•• Date Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ rX Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ - --- -- -------- -------•----•---------------.... --•-------_______--------••------------------ -....--••-----•- --------------- Description of Soil--------, �Q:A ...... .._..�/!/'164- - -------------------•----------------------------------. ---- 0 -------------------•----- x ------------------------------------------------------------------- UW ------------------------------------------------------------------------------------------------------------- ./......--•••-••-•--••-•----••-......._ Nature of Repairs or Alterations—Answer when applicable :_-- __.__._._I�16Z -- ....../ -•- -�--- -----------•------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iT tT Lu p 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed...4....... ...... ....................................... j Date Application Approved BY- t1 % 3" -•... --••••. Vie:•./��1_1-)f-- Date Application Disapproved for the following reasons---------------------------------------------------------------•-----------------•----------------------•••-•---- .........-•----------------•-----•-••------....-•-•--------...-------------••---------.......---------------•----•--•-•---•-••-•-----------------•-•------------------------------------------------•--- e Permit No............ Issued-.... z- ,l -? � ---•-•- Datea i THE COMMONWEALTH OF MASSACHUSETTS 'rR f.: BOARD OF HEALTH L.CC7..G4tj...A.............OF.......r4k1.'.4..5.T-#�12.4&.............. ............... Trrtifiratr of ToutpliFattre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by . . G: ...................................................................,- Installer ............. _......._...... has been installed in accordance with the provisions of T j af The State Sanitary Code as described in the application for Disposal Works Construction Permit No. %_:..___ !� ......... dated-.--------- .................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE-;CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE............1.- -..... ......../ ._Cy.............................. Inspector--�:�.V�1...t...................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH . . .............................. a y� � ! ..........OF..... .'QV.S �. Z O.~,�. _..._S:t.l.f✓ �` FEE ......._ Diu u��t1 urk� �l�uutrurtiuu rrutit Permission is hereby granted..-_ .44.4-:... ............ to Construct ( ) or Repair an Individual Sewage Disposal System atNo..........'75........... ' ---------------�' ........ '.,� ?111�!d -------------------------............................................ Street as shown on the application for Disposal Works Construction >r it No--------- -- • Dated.......................................... n04 •----- of Health DATE...... ::�_._.�_�•�.�+�--��........................ FORM 1255 HOBBS & WARREN, INC., PUBLISHERS ,