HomeMy WebLinkAbout0248 STEVENS STREET - Health 248Stevens`St: :
Hyanis a -
N
LOCATION SEw9 PERMiT 110.
VILLAGE 74U
INS TA LLER'S FAME L ADDRESS
7—D el
BUILDER OR OWNill
GATE PERMIT ISSUED
DATE COMPLIANCE ISSUED /, � 17- �
��
�--�'=f
�- �'
i
f
Ng)�._9..C'.... Fms.> .0.................
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
6 I ............... .......................
OF.....................................................................•-...............-•--
v�4 Applua#ion for 11i epos al Works Tomitrnr#inn 1hrutit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
.........---•---_-......._..............................• - .. ..............................
Location-Address or Lot No.
caner Address
a ...1167 91 , :.......................................
--:.' %..... .------............---------------- ----•---------
Installer Address
Type of Building Size Lot.!4�,eZ 42_ ._._- .Sq. feet
Dwelling—No. of Bedrooms........./...................................Expansion Attic ( ) Garbage Grinder ( )
p, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
Other fixtures .....................................................
W Design Flow..........?.;3�.....................gallons per person per day. Total daily flow__-___--OS30.........................gallons.
WSeptic Tank—Liquid capacity/4aa..gallons Length................ Width................ Diameter................ Depth................
x Disposal Trench—No..................... Width.................... Total Len gth.....................Total leaching area.._�2.....sq. ft.
Seepage Pit No--------------------- Diameter.....................Depth below inlet.................... Total.leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results �frd by ;� Date
Test Pit No. 1- .....----rrr>nch Depth of Test Pit. 3?✓-------- Depth to ground watera ------.-
(s, Test Pit No. 2................mr inch Depth of Test Pit_ _ Depth to ground water °!!?! __.._.__
---------------------------------------------------------------•-------..........--•--------•------...-•--•---•----•-----•-•--......_...._.__.:
O Description of Soil.._�-"ly....... ��?Y---?!,T� 4-...._
------------------------------- '� .3-X-----.....6 0_4.,s��x�----- -------------------------------------------------------............... -
Uto of Repairs o lterations—Answer when applicable.........:......................................................................................
Agreement:
The undersigned agrees, to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLL 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 boa - of health.
Si ned.--- _.
Date
Application Approved BY----- ................. Al-------------
Date
Application Disapproved for the following reasons----------------•------------------------------------------------------------•-----------------••---------.......
......................................................-......................................................................................----------------------------•------------------•------------
Date
PermitNo......................................................... Issued............:...........................................
Date
i
f.
NOW
N . ` -_ Fps . ±..u............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
. .. .........................OF...................................._.....------......
Appliration for Disposal Works Tonstrurfiun Prrutit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at
Location-Address or Lot No."
..� wner Address
.. . .............................•--•----•-... ... /...... ------- ----•-•--.._.
Installer Address
Type of Building /f�
YP g Size Lot_.__.;,r____________________Sq. feet
Dwelling—No. of Bedrooms........._______............................Expansion Attic ( ) Garbage Grinder ( )
A4 Other—T e of Building a YP g ............................ No. of persons.............-.............. Showers ( ) — Cafeteria ( )
Otherfixtures ---------------------------------------------------------•------------------------
-------------------
W Design Flow__________e-3.0....................gallons per person per day. Total daily flow-______16s�0____.____._________._.___gallons.
W Septic Tank—Liquid capacity4tvCi__gallons Length................ Width................ Diameter................ Depth................
x Disposal.Trench—No..................... Width.................... Total Length.................... Total leaching area---Mt2.....sq. ft.
Seepage Pit No_____________________ Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
percolation Test Results Perfor d bY------------------------------•-•-•---------------- -•--- Date.
a
Test Pit No. Ls ______.__ per inch Depth of Test ....... Depth Depth to ground waterer ........
44 Test Pit No. 2________________min es per inch Depth of Test Pit_.�ale-�`___ Depth to ground water ........
O Description of Soil__.0d.'43V.__.___40'' !'` _._ W.4_" !!`! .................................................... ------------•---••------------
.....................................v d� d'D�9�';Sa ' .S�9a+ . i> ---------•---------.•.---...--•-••---•-------...-•---•-----•--
x &.0 `�- ,"
•--.--.c. . �1r Z------- ,C, , ,giAAQ-
---- ----------------------------------------------------------------------
U ur of Repairso lterations—Answer when applicable.______________________________________________________________________________________________
Agreement
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TIT1Z 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 boa of health.
Si ned t f2, 717
................................. '" " C i
/y Date
Application Approved BY_ d '! .._. _.. .....................D�-••••-•-----.
ate
Application Disapproved for the following reasons-----=---------•-------------------------------------a-:.••••------•--•••--•--•----•------••------•••••-•-•••-•---
------••---------•-----------------•-•------------•-----••--•-•------•--•-•----•••••-•-•-------•••••-•------•••-•---•--••----
Date
PermitNo......................................................... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..........................................OF........................................_..._........................................
Trrtifiratr of Tompliam
THIS IS TO CERTIFY, Thqt4e Individual Sewage Disposal System constructed ( ) or Repaired ( )
bY................. ........... _...-•--•----•------------•-----•.............•----•---•-•---•------._._._........_..-----.......----•-----•--•--•-----••--
Installer
at........ _!±' A�!,S......Y.7_-....... `.........
has been installed in accordance with the provisions of TITLE 5 ofhe State Sanitary Code as described in the
application for Disposal Works Construction Permit No.-�� .Z_% _________________ dated................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATIS,FAC ORY.
Q .
DATE........................�----------------...-�• -!• .-`(.............. Inspector.-•-•----- �:".��::.. 4.c= .................................................
3 '
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OOF/� HEALTH
N q ............. .IV...OF........�2ly .Nf ! �. �._........._......._. o •
FEE... .............
Disposal Workii TrUans#r ion Prfutit
Permission is hereby granted--------. -------------- A_Q T.....................................................-------
to Construct (1--ror Repair ( ) an Individual Sewage Disposal Sstem
at No...... 1r li-��:.!`► £ 5',? .r .f�1 .......... i c..............�?'�r!y✓1_+Y- /f
Street
as shown on the application for Disposal Works Construction Permit No___________________�ated..........................................
DATE. •,� Hlth
FORM 1255 HOBBS & WARREN. INC., PUBLISHERS
in,
lir
onseiry
GROUP, INCORPORATED
Fax
To: Donna M. From: Mike Hilsinger
Fax: 508-790-6230 Pages: 16
Phone: Date: 11/9/2010
Re: CC:
❑ Urgent ❑ For Review ❑Please Comment ❑ Please Reply 0 Please Recycle
o Comments:
Hi Donna,
Please see the attached Septic System Inspection Report for 248 Stevens Street, Hyannis, Roy,
Catignanl will return tomorrow to follow up on this.
�TJ�a ks for'our help,
Mike Hilsin e
47
70
-A
2277 State Road, Plymouth, MA 02360 Mall to: PO Box 278 Sa amore Beach, MA 02662 Phone 508-888-6555 Fax 508-888-6566
Septic System Inspection Report
248 Stevens Street
Hyarnus,Massachusetts
September 28,2002
Prepared For:
Sam Barber
10 Hyannis Avenue
Hyannis Port, Massachusetts 02647
Prepared By:
William E. Robinson, Jr.—Scptic System Inspectioaas
43 Tomahawk Drive
Centerville, Massachusetts 02632
COMMONW-Ci ALT.H OF MASSACHUS13,17S
EXECUTIVE OFFICE OF ENV,RONMENTAL AFFAIRS
- DEPARTMENT Or ENVIRONMENTAL PROTECTION
TIME- 5
OJT,TTCZAL INSTECTION FORM,NOT FOR VOLUNTARY ASSESSMENTS
SUd3SURFACC SEWAGE DISPOSAL SYSTEM 1FOJRM
PART A
CERTIFICATION
Property Address: 248 Stevens Street,Hyannis
Owner's Name: Saba Barber
Ownces Address: 14 Hyannis Avenue
Hyannis Port,MA, 02647
Date of Inspection: September 28,2002
Name of Inspector: (please print) William E.Robinson,Jr.
Company Name: William E.Robinson,Jr. septic Inspections'
Mailing Address: 43 Tomahawk Drive
Centerville,MA. 2632
Telephone Number: (508)775-7986
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 wq)c fence in the proper function and maintenance of on site sewage disposal Vstom5.7 am a DPP
approved system Inspector pursuant to Section 15.340 of Title 5(310 CMR].5.000). The systetu:
X Passes
Conditionally Passes
Needs Fu lier Evaluation by the Local Approving Audnority .
Fails
Inspector's Signature: '-
Date:
1 '&
lu
The system inspector shall subunit a copy of this inspection report to the Approving Authority(.Hoard of Health or
DES within 30 days of Completing this inspection.If the system is a shawl system or has a design flow of 1.0,000
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
The septic system appeared to be in good functioning condition on the day of inspection.
""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.
Page 2 of 11
' OF+ CIAL INSPECTION FORM—NOT FOk VOLUNTARY,ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM JNSPECTION FORM
PART A
CERTTFICATTON (continued)
Property Address: 248 Stevens Street,Hyannis
Owner: Sam Barber
Date of Inspection: September 28,2002
Inspecdon Summary; Check A,1l,C,D or B/ALWAYS complete all of Section D
A. System passes:
X l 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 evahiated,are indicated below.
Comments: Th.. a septic system wfltfound tq be in good working cgndition n the day ofJo6p ti2n.
B. System.Conditionally passes: NIA
One or more system components as described in the"Conditional Pass"section need to be replaced or
repaired_The system,upon completion of the replacemedt or repair,as app,saved by the Board of Health,will pass,
Answer yes,no or not determined(Y,N,ND)in the for the following statements, if"not determined"please
cxplai.n
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 exfritration or tank failure is imminent.System will pass inspect:i.on if the
existing tank is replaced with a complying septic tank as approved by the Board of Health.
VA metal septic tame will pass inspection if it is struchr.rally 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 break out or high static water level in the distribution bos due to broken or
obstructed pipes)or,due to a brolcen,settled or uneven distribution box.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 4 times a year due to broken or obstructed pipe(s).Tlie system wall
pass inspection if(with,approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
ND explain:
J
Page 3 of I I
OF"CUL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM lNSP1CCTION FORM
i PART A
CERTrFTCATZON(continued)
Property Address: 248 Stevens Street,Hyannis
Owner: Sam Barber
Date of Inspection: September 28,2002
C. Further Evaluation is Required by the Board of Health., N/A
Conditions exist whicil require further evaluation by the Board of Health in order to determine if tltc system
is failing to protect public health,safety or the environment:.
I. 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 withdn 50 fact 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,
r
_ The system„has a septic Lu►k and SAS and the SAS is within a Zone I ora public water supply.
The system has a septic tank and SAS:tad the SAS is within 5o feet of a private water supply well.
_ The system has a septic tank and SAS and the SAS is lesic than 100 fret but 50,feet or in frorn a
private water Supply well'r*.Method used to determine distance
*`This system passes if the well water analysis,performed at a DpP certified laboratory,for cotiform
bacteria azd volatile organic compounds indicates that the well is free from pollution from that facility and
the presettcc of amuronia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other
faihtrc criteria are triacmd_A copy of the analysis must be attached to this form.
3. Other;
i
IPage 4•of 11
OT'ICTA,L INSPEMON FORM—NOT FOR VOLUNTARY ASSESSMENTS
I SUBSURFACE SrMAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
. I
Property Address; 248 Stevens Street,Hyannis
Owner. Sane Barber
Date of Inspection: September 28,2002
I). System Failure Criteria applicable to all systems:
You roust indicate"yes"or,"no'to each of the following for an inspections:
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
Liquid depth in cesspool is leg%than 6"below invert or available volume is less than day flow
_ Xs 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 ground water elevation. .
X Any portion of cesspool or privy is witbin 100 feet of a surface water supply or tributary ton surface
water supply, ,
X Any portion of a cesspool or privy is within a Zone I of a.public well.
X Any portion of a cesspool or privy is within 50 feet of a private water supply well..
t _ 7 Any portion of a cesspool or privy is less Chan 100 feet but greater than 50 feet from a private water
i supply well with no acceptable water quality analysis. (This systern passes if the well water analysis,
performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds
y 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 thie form.)
_= 1� (Yes/No)The sy9teun falls,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 Roard of Health to
determine what will be necessary to correct die failure_
E. Large Systems: N/A
To he 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
_ _ r 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 n mapped
Zone 11 of a public water supply well,
If you have answered"yek"to arty question in Section E the system is considered.a significant threat,or answered
"yes"in Section D above die 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 accordavice with 310 CMR
15.304.The system owner should contact the appropriate regional office of the Department.
A 6
Pa.. ge 5 of 11,
OFFICIAL WSPECICIO.N FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SXS7TM INSPECTION FORM
PART B
CHECKLIST
Property Address: 248 Stevens Street,Byannis
Owner: Sam Barber
Date of Inspection: September 28,2002
Check if the following have been done,You must indicate' es'or`.nC as to caclu of iltc following!
Yes No
X Pumping information was provided by die owner,occupant,or Board of Hcalth((xme.rl
X Were any of the system componcnis,puumped out in 1.11c previous two weeks 7
Has the system received normal flows in the previous two week period 7
X Have large volumes of water been introduced to the system recently or as part of dais inspection 7
?z _ Were as built plans of the system obtained and examined?.(If they were not available note as N/A)
W Was the facility or dwelling inspected,for signs of sewage back up 1(
X _ Was the site inspected for signs of break oat 7
X Were all system components, excluding the SAS,located on site'l
X _ Were the septic tank manholes uncovered,opened,and the interior of ilic tank inspected for the condition
of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum 7
Was the..facility owner(and occupants if different from owner)provided with information on the proper
maintenance of subsurface sewage disposal systems?
i
The size and location of the Soil Absorption System(SAS)on the site lugs been determined based on:
I Yes no
X ___, Existing information..For example,a plan at the Board of Health;
X _ Determined in the field(if any of the failure criteria related to Pat C is at is
sue apprommauon ofdistance.
is unacceptable) [310 CMR 1,5.302(3)(b)]
i
I
AG 08 6
,�F Pagc6ofll
OFFICIAL INSPECTION FORM,NOT FOR VOLUNTARY ASSESSMENTS
SURSIDWACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 248 Stevens Street,Hyannis
Owner: Sam Barber
Date of Inspection: September 28,2002
!!LOW CONDITIONS
RRSIDENTIA.L
Nwrrber of bedrooms(design): Number of bedrooms(actual):
DESIGN flow based on 310 CMR 15.203 (for example: ms actgpd x#of bedrooms):
Number,of current.residents:
Does residence lave a garbage grinder(yes or no):
Is laundry on a separate sewa,W System(yes or no): [if Yes' �ratc inspection dry system ins y pc c Lion rcq�uredl
�� inspected(yes or no):
Seasonal use: (yes or no):
Water meter readings,if available(last 2 years usage(gpd):
Sump pump(yes or no):
Cast date of occupancy:
COMMERCIAL/MDUSTRIAL N/A
Type of establishment: tail rt al
Design Design.flow(based on 310 CMR 15,203); See omm is be[M gpd
Basis of design flow(seatslpersoris/sa f3,,etc.):
Grease trap present(yes or no): �-- --
Industrial waste holding tank present es or�no
Qi Non-saxdtary waste discharged to the Title 5 systerti s _
Water meter readings,if'available: Not a ilable d v of ia9aection
Last date of occupancy/use: Currently in use
OTHER(describe): Septic system originally designed for R 2 bedroom ttroom home. Home since converted into an
art P11cry. System provides 354.23 gpd leaching capacity.
GENERAL INFORMATION
PrrrMping Records
Source of information: JDArnstS a tm n Plan o inf a i avail
Was system pumped a9 part of she i.nspcction(yes or no): ro
If yes,volume pumped ,gallons'-How was quantity pumped determined?
Reason for pumping: -
TYPE OF SY5TFM
X Septic tank,distribution box,soil absorption system
Single cesspool
Overflow cesspool
—Privy
Shared system byes or no)(if Yes,attach previous inspection records,if any)
_�Innovative/Alte.lnative 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):
i Appxo IMte age of all components,date installed(if known)and source of information,
5vstem 1 21 years oldl From Hen artment records
Klb Dom,,..,�„
Were sewage odors detected when arr lug at the site(yes or no): No
9 i
' Page 7 of 11
OMCIAL INSPECTION FORM—,NOT]FOR VOLUNTARY.ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 248 Stevens Street,Hyannis
Owner. Sam Barber
Date of Inspection: September 28,2002
BUILDING SEWER(locate on site plan)
Depth below grade. E
Materials of construxtion:_cast iron 7X 40 PVC,other(explain): ^^
Distance AT=private water supply well or suction line: N/A
Comments(on condition ofjoints,venting,evidence of leakage,etc.):
Joint-sin-good condition. No evidence of Ig .4>tc. Sewer pronerly vented
SEPTIC TANK: X (locate on,site plan)
Depth below grade: 18"to 20"(inlet side to outlet side)
Material of construction: X concrete,metal fiberglass_polyethylene
other(explain)
If tank is metal list age:^ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of
certificate)
Dimensions: 8.55'x 4'
Sludge depth: 8"
Distance from top ofsludgo to bottom of outlet tee or baffle: 2,1
Scum thickztess: plone Bent
Distance from top of scoria to top of outlet tee or baffle: /A
Distance from bottom of scum to bottom of outlet tee or baffle: �T(®
How were. dimensions determined: Direct meawrernept
Comments(on pumping moommendations,inlet and outlet tee or balRe condition,structural integrity, liquid levels
as related to outlet invert,evidence of leakage,etc.):
blot bAfte and outlet bg Rd"cod condition No signs of lenkaec liquid level at outlet invert. Recommend
pump ng4us o anoouut of elud
GREASE TRAP: N/A (locate on site plan)
Depth below grade:T
Material of construction:—concrete metal .—fiberglass__polyethylene_other
(explain):
Dimensions:
Scam thickness:
Distance from top of scam to top of outlet tco or baffle:
Distance fl'om bottom of scam 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.):
AG 10 16
31
Page S of 11
O' T.COAL MSPEC ION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SU.i3SURFACE SEWAGE DISPOSAL SYSTEM.INSPECrrON r.+OItM
PART C
5'- -EM XNFORMA TXON(continued)
Property Address: 240 Stevens Street,IIyannis
Owner: Sam Barber
' Date of inspection: September 28,2002
TIGHT or HOLDING TANK: N/A, (tank must be pu nped at time of iuspcciion)(locate on silo plan)
Depfli below grade:
Material of construction, concrete Metal_-fiberglass__polyetlaylette of hi r(expl;d,n);
Dimensions:
Capacity: allons
Design Flow: >;altons/day
Alam present Cm or no):
Alarm level: ' — alarm in working order(yes or no):
' Date of last pumping.
Comments(condition of alarm and Moat switches,etc,):
DISTRMUTION BOX: (if present must be opencd)(locatc on site plan)
Depth of liquid level above outlet invert: 0"
Comments(]note if box is level,and distn'bution to outlets equat,any evidence of solids carryover,any evidence of
leakage into or out of box,etc.):
level o evil ucc of opds ca ver o evidence of lea
i
PUMP CHAMBER N/A (locate on site plan)
Pumps in worldng order(yes or no):
Alarms in wonting order(yes or no):
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):
Y
i
PAGE 15 16
LOCUS.NAP &-SEPTIC SYSTEM SKETCH
I;
• i
Page 9 of 11
OFMCIA,L INSPEC _ ,TIOIlT FORM NOT iGOR VOLUNTARY ASSESSMENTS
i. . SUBSURFACI; SEWAGE DISPOSAL SYSTEM INSPECTION I?OT2M
PART C
SYSTEM INFORMATION'(continued)
Property Address: 248 Stevens Strect
.1 Hyannis
Owner; Sam.Barber
Date of Inspwoon: September?8,20112
SIDIL,ABSOR>PTION SYSTEM(SAS): X (locate on siir plan,excavation not required)
If SAS not Iocated explain why:
' 31 Tyne
X leaclung pits,nwnber:1 leach's it(with Z.S'oft a all around
leaching chambers,number:leaching galleries,number:
leaching trenches—number,length:
Leaching fields,number,dimensions:
overflow cesspool,number:
innovative/alternative system Typeloamc of technology:
Comments(note condition of soil,signs of hydraulic failure,level of,ponding,damp soil,condition of vegetation, .
etc.):
d n h alit fail n ndin no 1 ctati n.
i
.. CESSPOOLS: 'I
NSA (cesspool must be pumped.as part of inspeetion)(locale on site plan)
Number and comf"pmtiou:
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 or no):
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
PRIVY: NIA (lomte on site plan)
j` Materials of construction:
Dimensions:
Depth of solids:
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc,):
i
Page 10 of 1,1
OFnCIA-L INSPECTION.FORK[-NOT FO.R VOLUNTARY ASSESSmENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION)FORM
PART C
j SYSTEM INFORMATION(continued.)
Property Addre.,s: 248 Steven.,Street,Hyannis
Owner: Sane Barber
Date of Inspection: September 28,2002
I
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two permanent rel'brcnce landmarks or
benchmarks,Locate all wells within 100 feet.Locate where pnbUc water supply enters the btulding.
i
i
_ Please see attached sketch
f . Page.l.l of 11
OFFICIAL INSPEC11ON FORM—NOT I�OlIt VOLUNTARY ASSESSMENTS
311
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPrCTION FORM
PART C
SYSTEM INFORMA77ON(con(inued)
C
Propeirty Address: 248 Stevens Street,Hyannis
Owner: Sam Barber
Date of Inspection: September 28,2002
SITE EXAM
S10pe: Slight slope to the south in SAS area
Surface water: None on-site or in area
Check cellar: No water -�
Shallow wells: ;done in area
Estimated depth to ground water 9,8 feet(below at the SAS)
Please indicate(check)Al methods used to determine the high ground water elevation:
}
Obtained from system design plans on record If chocked,date of design plan reviewed: _
Observed site(abutting property/observation hole within 150 feet of SAS)
Checked with local Board.of Health-explain:
Chocked with local excavators,installers-(attach documentation) T�
X Accessed USGS database-explain:
You must describe}sow you established the bigh ground water elevation:
Seasonal high groundwater was determined by comparing USGS/Cape Cod Commiminn groundwater data
and Town of Barnstable GIs data,to'field measurements and installation as-built information.
The surface of the ground in the SAS area was estimated from the Barnstable GIs topographic map to be at
elevation 36. The bottom of the SAS wars measured to be approximately .10 ' below the surface at an
approximate elevation of 26. The elevation of groundwater was estimated from the Barnstable GIS map
(June 1992)and found to be at elevation I.A. Therefore,groundwater is approximately 8' below the bottom of
the SAS.
Using the Cape Cod Commission method to estimate the seasonal high groundwater elevation,the site was
found to be'within the area of groundwater indicator well A1W-230(Zone Q. According to the June 1992
data(Barnstable Health Department)the adjustment for that well is 4.W upward. When snbtractcd from the
separation between encountered groundwater and the SAS bottom (8') the resultant separation is.3.2' from
seasonal high groundwater and the SAS bottom.
j
Septic System Sketch
PLEASANT RULL LANE
S
T
{
E
T
)
�ii�i's;�5t�i�::f'•i
iu !-
s
,s.
. ...F7Ysii'�i:i.:r"Fi•'•r :i:.:!:'•:!ii:<?';;:::`:'i'::i;;.:'.:':::::.;,>
}
:iSrit%•• >b X
y::4fi�i
{ rr
55
S
I'15`u
a
y 2,1:f• e
i
2 C
i{v!!
C T
'x
SSA
34' 1 f �� ♦ x
�3 s
i
k E
Basement Stairway � #
46. ' 5,
3
g f -
Septic Tank
} e
Cross Section 3
Ground Surface ?
W, —
3,6"
-,;�� �� . • 'SAS,.
Foundation Septic Wank b" Box
adjusted Groundwater Elevation t
--------- --------.._..--.._--------------------------
...
------------
William E. Robinson, Jr. !Location: 249 Stevens Street
Septic system Figure 2
Inspections Hyannis, MA ;
43 Tomahawk Drive Not To Scale \\ 3
Centerville, Ma 02632 ;Rate: September �8, x002 �
Based on Visual Observations �
i
I
A � o l �'J '•.+y�ww,M+MwM11'�'-�`- '. +M:.i•'r. tyy',�#1w... �f� - '-�Y.
Q.°�8 S-re v n28
s �'
E I
a
9_
Norte- L'u,sr��/G wE[•�. � i � ' I I I � I I 3o E'• I� h
1
5 A'O 1
Sipe- eF Lrs7rsnNG
o
DIwtC�r.�G � 30, I
I ,
/ •� I l �• I 'I V
1 � /o• yl I I
eL I c \
..° ..,Tt3s�caf.., Jt,• �� i�ni \
-' '�•"�i4-. �.:.._,•, . CONCRETE COVER "
• -S�ONJ.oc�•c OVER — s� � 11
, � :• _
Lp
4' CAST IRON -
� ° 12�� MAX. , . 12"MAX "«. I. ;0
0
PIPE (OR
EOUIV.) - MIN 4 E - MI BURG(OR EQUIV.) •, v r
° PIPE - MIN. . LEACH \ &ox _
• • PITCH, I/4"PER. PITCH I/4••PER.FT PIT �'1 fly I 1
o •° -+!L PRECAST
o'O,o LEACHINGF'IVE�
EL..
SEPTIC TANK INVERT pIST. INV RT I w o �' PIT OR 11 DV
o INVER /000 . . . GAL EL.48,B VET BOX EL ! ,• >= 0 EOUIV,
e; EL.. /.7 q� I INVERT �9 ww 0: :,. 3/4"TO II&
48. 0 ` I
EL....•�S EL•949.0 �o WASHED T ► 3' I
w STONE h i T I V)
-- --6 DIA �.. T (1 /L
,• Nr�NE I
DIA.
PROFILE OF - - - - -- - - - - d' 01
SEWAGE DISPOSAL' SYSTEM
NO SCALE __ __------___-_- �97 '� - - Q'� I �•
z I
3
SOIL LOG WITNESSED BY : Zp
M /S/y8/ /0 00 A .P• �. Ci ��Kp 2 S. 2 h
DATE '`�I , . TIME . . .-. r7 . . , BOARD OF HEALTH
TEST HOLE I TEST HOLE 2
T/�1F�rsAS �. ,�LGE•V P.E. ENGINEER
E L E V. S'¢ 70 ELEV. 0 0
DESIGN DATA . v
l4 0 L(P.F r of Dir t'
Sf7 NUMBER OF BEDROOMS 1 Sra/u Rr
TOTAL ESTIMATED FLOW 'Z30. . . . GALLONS/DAY /
---- 7L' 80770M LEACHING AREA SO.FT. /PIT ( /
SIDE LEACHING AREA /8� S v SQ.FT./ PIT
GARBAGE DISPOSAL (50 % AREA INCREASE) or
TOTAL LEACHING AREA 247 SOFT n,o,NAs
PERCOLATION RATE .3o sue'• MIN/INCH
4
iy/p LEACHING AREA PER PERCOLATION RATE �30. SQ.FT. (�,� H �,4` Wit! /��/ ✓C�C:G- � ~ Lot •
WATER ENCOUNTERED �/STE
NUMBER OF LEACHING PITS Zp�r 6//r7,/ 7A/o Ft_'r � Y.►o-;,'
OFF .Syr,^/6 On/ .QLL S/D6 S .z /S G 7a-/3 1 0/= STD N L'�In A 7C[r C- • ,G C LCL
APPROVED . . . . . . . . . . . BOARD OF HEALTH 1 rL_'C--C. C/ta�.t:, Svi.'�/t-y0 A:::
ci
DATE . . . . � SAS E. KELLEY CO. .� M i7�4�v r D /�•'JA 5 S . • ; ./
AGENT OR INSPECTOR
H U � '!t t1
ERS—SRVEYORS
I 33KG POND DRIVE �Su�
7-L7 .� 7T,N�� Ln/ /�: /�c �v�./ F TJ 60,rwaxavzH,2►cwss.02664