HomeMy WebLinkAbout0005 CASTLEWOOD CIRCLE - Health 5 Castlewood
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Separation Distance Between the: Z /
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility no 1� Feet
Private Water Supply Well and Leaching Facility(If any wells exist on
site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist within
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Commonwealth of Massachusetts 33 0(
Title 5 Official Inspection Form
< Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
5 Castlewood Circle
Property Address R?
Thomas Leduc
Owner Owner's Name "
information is -e
required for every Hyannis Ma. 02601 7/25/2018 0
page. City/Town State Zip Code Date of Inspection -h
P.�
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.
Imng out forms A. General Information S'l# f L filling out forms
on the computer,
use only the tab 1. Inspector:
key to move your
cursor-do not Sean M. Jones
use the return Name of Inspector
key.
S.M.Jones Title V Septic Inspection
Company Name
74 Beldan Lane
Company Address
Centerville Ma 02632
Citylrown State Zip Code
774-248-4850 smjonestitle5@gmail.com S14522
Telephone Number License Number
B. Certification
I certify that I have personally inspected the sewage disposal system at this address and that the
information reported below is true, accurate and complete as of the time of the inspection. The inspection
was performed based on my training and experience in the proper function and maintenance of on site
sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of
Title 5(310 CMR 15.000). The system:
® Passes ❑ Conditionally Passes ❑ Fails
❑ Needs Further Evaluation by the Local Approving Authority
7/25/2018
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 has a design flow of
10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate
regional office of the DEP. The original should be sent to the system owner and copies sent to the
buyer, if applicable, and the approving authority.
****This report only describes conditions at the time of inspection and under the conditions of use
at that time.This inspection does not address how the system will perform in the future under
the same or different conditions of use.
t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17
i
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
5 Castlewood Circle
Property Address
Thomas Leduc
Owner Owner's Name
information is required for every Hyannis Ma. 02601 7/25/2018
page. Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E/always complete all of Section D
A) System Passes:
® 1 have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
The dwelling located at 5 Castlewood Circle Hyannis is served by a Title V septic system consisting
of a 1000 gallon septic tank, distribution box and The system was found to be in proper working
condition at the time of inspection.
B) System Conditionally Passes:
❑ One or more system components as described in the"Conditional Pass" section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health, will pass.
Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not
determined," please explain.
The septic tank is metal and over 20 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):
l5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
5 Castlewood Circle
Property Address
Thomas Leduc
Owner Owner's Name
information is required for every Hyannis Ma. 02601 7/25/2018
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
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
t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
5 Castlewood Circle
Property Address
Thomas Leduc
Owner Owner's Name
information is required for every Hyannis Ma. 02601 7/25/2018
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 fecal
coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal
to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must
be attached to this form.
3. Other:
D) System Failure Criteria Applicable to All Systems:
You must indicate "Yes" or"No"to each of the following for all inspections:
Yes No
❑ Z. Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less
than %day flow
t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
<! Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
5 Castlewood Circle
Property Address
Thomas Leduc
Owner Owner's Name
information is required for every Hyannis Ma. 02601 7/25/2018
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
Yes No
❑ ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well.
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory,for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered. A copy of the analysis
and chain of custody must be attached to this form.]
❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd-
10,000gpd.
❑ ® The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the
questions in Section D.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection
Area—IWPA) or a mapped Zone II of a public water supply well
If you have answered "yes" to any question in Section E the system is considered a significant threat,
or answered "yes" in Section D above the large system has failed. The owner or operator of any large
system considered a significant threat under Section E or failed under Section D shall upgrade the
system in accordance with 310 CMR 15.304. The system owner should contact the appropriate
regional office of the Department.
t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17
I
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
5 Castlewood Circle
Property Address
Thomas Leduc
Owner Owner's Name
information is required for every Hyannis Ma. 02601 7/25/2018
page. • Cityrrown State Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate"yes" or"no" as to each of the following:
Yes No
❑ ® Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
® ❑ Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
® ❑ Were as built plans of the system obtained and examined? (If they were not
available note as N/A)
® ❑ Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
® ❑ Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
® ❑ Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS)on the site has
been determined based on:
® ❑ Existing information. For example, a plan at the Board of Health.
® Determined in the field (if any of the failure criteria related to Part C is at issue
El
approximation of distance is unacceptable) [310 CMR 15.302(5)]
D. System Information
Residential Flow Conditions:
Number of bedrooms(design): 2 Number of bedrooms (actual): 2
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 220 gpd
t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
5 Castlewood Circle
Property Address
Thomas Leduc
Owner Owner's Name
information is required for every Hyannis Ma. 02601 7/25/2018
page. Cityrrown State Zip Code Date of Inspection
D. System Information
Description:
Number of current residents: 1
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No
information in this report.)
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: current
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
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
t5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
5 Castlewood Circle
Property Address
Thomas Leduc
Owner Owner's Name
information is required for every Hyannis Ma. 02601 7/25/2018
page. Cityrrown 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)
❑ 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):
t5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
5 Castlewood Circle
Property Address
Thomas Leduc
Owner Owner's Name
information is required for every Hyannis Ma. 02601 7/25/2018
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components, date installed (if known)and source of information:
system repaired 4-19-2011 per town records
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
Depth below grade: 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.):
Joints ok, no leaks , vented through roof
Septic Tank(locate on site plan):
Depth below grade: .5
feet
Material of construction:
® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain)
If tank is metal, list age: years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
Dimensions: 1000 gallons
Sludge depth:
3"
t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17
i
Commonwealth of Massachusetts
p Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
i�'-t5v"Fol
5 Castlewood Circle
Property Address
Thomas Leduc
Owner Owner's Name
information is required for every Hyannis Ma. 02601 7/25/2018
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 3.5'
Scum thickness
1
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
101,
How were dimensions determined? opened covers and took
measurements
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tank does not need to be cleaned now but should be done soon and again every 2 years for proper
maintenance. water level was even with outlet, tank was not leaking and was structurally sound.
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
t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
5 Castlewood Circle
Property Address
Thomas Leduc
Owner Owner's Name
information is required for every Hyannis Ma. 02601 7/25/2018
page. City/Town 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
t5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17
i
Commonwealth of Massachusetts
Uo
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
5 Castlewood Circle
Property Address
Thomas Leduc
Owner Owner's Name
information is required for every Hyannis Ma. 02601 7/25/2018
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Distribution Box(if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert
0"
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.):
Distribution box was in good condition, no rot, water level was even with outlet inverts. Cover is on a
riser.
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.):
* If pumps or alarms are not in working order, system is a conditional pass.
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
i
t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17
i
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
5 Castlewood Circle
Property Address
Thomas Leduc
Owner Owner's Name
information is required for every Hyannis Ma. 02601 7/25/2018
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Type:
❑ leaching pits number:
❑ leaching chambers number:
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
❑ 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.):
Lleaching facility was video inspected from d-box and was found to be dry with no signs of past
hydraulic overloading.
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
t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17
Commonwealth of Massachusetts
p Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
5 Castlewood Circle
Property Address
Thomas Leduc
Owner Owner's Name
information is required for every Hyannis Ma. 02601 7/25/2018
page. Cityfrown 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.):
s
t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17
i
Commonwealth of Massachusetts
lugTitle 5 Official Inspection Form
Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
5 Castlewood Circle
Property Address
Thomas Leduc
Owner Owner's Name
information is
required for every Hyannis Ma. 02601 7/25/2018
page. Cityrrown State Zip Code Date of Inspection
M System Information (cont.)
Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to
at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate
where public water supply enters the building. Check one of the boxes below:
® hand-sketch in the area below
❑ drawing attached separately
3
xislf� N Ptho
I
t
'a x34.6' a`andA'
A -3='45,'X 8-3-as:s„
A-*-a3;7" 6-4=3<17'
t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
< Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
5 Castlewood Circle
Property Address
Thomas Leduc
Owner Owner's Name
information is required for every Hyannis Ma. 02601 7/25/2018
page. City/Town 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: 12+
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:-
Groundwater elevation was determined by accessing Town of Barnstable groundwater contour map.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
15ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
< Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
5 Castlewood Circle
Property Address
Thomas Leduc
Owner Owner's Name
information is required for every Hyannis Ma. 02601 7/25/2018
page. Citylrown 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
t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17
Town of Barnstable Pit
yop
Department of Regulatory Services
Public Health Division elEa � 200 Main Street,Hyannis MA 02601 Date"
r-
Date Scheduled_ t
Time" A-nn Fe e Pd. t� C
N
Foil Suitability Assessment for SeZ441� D'
Performed BY:
(,,`` Is osal
��
Witnessed By: �
LOCATION& GENERAL FORMATION /''10.f:
Location Address / /
hs7/Z wC aG1 Owner's Name
_/ Pe rron
y�n✓1�J Address s..�.._„
Assessor's Map/Parcel: 0 -7 3 V D 1 I
b j Engineer's Name
NEW CONSTRUCTION REPAIR
\\ Telephone# �U�--�3 �^
Land Use : 2
Slopes(%) Surface Stones /V
Distances from: Open Water Bod IVIP'
Y—/�--__ft Possible Wet Area! ft Drinking Water Well
/�.I L l�'� OJ/}
i �ft
Drainage Way ft Property Line (6
ft Other ft
SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity t• t a ` P ty o holes)
IQ
Parent material(geologic) n• 4 CJ,/��- VJ-
Depth to Bedrock
Depth to Groundwater. Standing Water in Hole:_'/U/
Weeping from Pit Face A�12%
Estimated Seasonal High Groundwater
a
DETERMINATION FOR SEASONAL HIGH WATER TABLE
Method Used:
Depth Observed standing in obs.hole: In, Depth to loll mottles:
Depth to weeping from side of obs.hole: Groundwater Adjustment in.
Index Well# Reading Date: Index Well level __- fr.j,fhCtor Adj.draundwaterLevel PERCOLATION TESL' Date Time
Observation
Hole# ' +�
Time at 9° ._._..,,,_..,, ...,..,..__• I
Depth of Perc Time at 6"
Start Pre-soak Time @ 24 5,JkW, `_1
TimC(9"•6")
End Pre-soak L l o"I.,
Rate MinJlnch Site Suitability Assessment: Site Passed�_ Site Failed:
• Additional Testing Needed(Y/N)
i
Original: Public Health Division Observation Hole Data To Be Completed on Back--------
i
***If percolation test is to be conducted within 100' of wetland,you must first notify the,
Barnstable Conservation Division at least one (1) week prior to beginning.
Q:\.SEPTICIPERCFORM.DOC
DEEP.OBSERVATION HOLE LOG
Furfan..)
Soil Horizon Soil Texture Hole#_ 1
(USDA) Soil Color Soil. Other
(Mansell) Mottling (Structure,Stones;Boulders.
Co i ten.s� la t2s�8
DEEP 013SERVATION HOLE LOG
Depth from Soil Horizon Hole#
Surface(in.) . Soil Texture Soil Color 'Soil
(USDA) (Munsell) Other
) Mottling (Structure,Stones,Boulders.
i s to
J % ravel
sc—
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon 'Soil Texture
Surface(in.) Soil Color `Soil Other
(USDA) (Munsell) Mottling (Structure,Stones,Boulders.
to
DEEP OBSERVATION HOLE LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color. Soll
Surface(in.) Other
(USDA) (Munsell) Mottling (Structure,Stones',Boulders.
Consistency.
Flood Insurance Rate Map:
Above 500 year flood boundary No_ Yes
Within 500 year boundary No %b Yes
Within 100 year flood boundary NO. Yes .
Depth of Naturally Occurring Pervious Material'
Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the
area proposed for the soil absorption system?
If not,what is the depth of naturally occurring pe io�ial?
Certification f
I certify that on 10.�) (date)I have passed the soil evaluator examination approved by the
Department of Environmental Protection and that the above analysis was performed by me consistent with .
the required trai ' ,expertise and experience described in 310 CUR 15.017.
Signature Date
Q:ISBPTIC`\PERCFORM.DOC
No. ` l
Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
'PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes
2ppfitation for Misposal *pstem Construction permit
Application for a Permit to Construct( ) Repair tK) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No, 5 C qsv\end (. ro Owner's Name,Address,and Tel.No. P om. L ej,t
Assessor's Map/Parcel oZ��j—l0 1
Installer's Name,Address,and Tel.No.Ca Pe,a;,1,Q .�a�kf��s,ei Designer's Name,Address,and Tel.No.
�k'1 1 s 3 Co.m r►�rc,vac S E� 2 W Gas��c[J fB.�, a6Q
/Yicas4 ✓L1 iA ,
Type of Building:
Dwelling No.of Bedrooms Z Lot Size fo 21K .F sq.ft. Garbage Grinder( )
Other Type of Building "�%,�Nk 4W.";I v No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) �3® gpd Design flow provided 3 gpd
Plan Date —(�—?� Number of sheets Revision Date
Title 5 C.tsthC�tw��ca CaY�I� /
Size of Septic Tank Opn X,a M� Type of S.A.S. K3 S S i O✓�1��5
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) X`��♦�, S,12{�L "bj ,, l3 zy,
Date l'ast'inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the,provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health G
Signed Date
Application Approved by a Date —� f
Application Disapproved by Date
for the following reasons
Permit No. ;-O ( —" B 1 I Date Issued —/'
n• ..Y R-.wti�%sN.µ:•+�;::t%.::IPW..-!.. - +.'•t.,. ...._ -i . wJ _. a �"...i..e a .'wSF+ ._-.. .., ., -.-. S:,.:
-6qjNo. Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
. PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes
application for Misposai Opstem,Constructiori permit
Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. ( qs;\Q;, A (;r,1 Q Owner's Name,Address,and Tel.No.o,,,c L
Assessor's Map/Parcel
E
Installer's Name,Address,and Tel.No.C e> Designer's Name,Address,and Tel.No. t
11 U 1 �.S3Con;✓+arc nL Sr Cif I4tB.ar Gd 12 W G+.7jsFG�cJ �die�ll�Ala
Type of Building:
Dwelling No.of Bedrooms Lot Size l0 2 E sq.ft. Garbage Grinder( )
Other Type of Building 5 �,�a ��,,�;1��No.of Persons Showers( ) Cafeteria( )
Other Fixtures
a
Design Flow(min.required) 30 gpd Design flow provided 3 7 gpd
Plan Date y—(o—Zo Number of sheets Revision Date
Title,,/S !.-r 1t e
Size of Septic Tank (Oc7n 10 Type of S.A.S. B12.¢1
Description of Sdil
Nature of Repairs or Alterations(Answer when applicable) o h L 1N"k 1-b /�e,,,J —3 a I[
1 v l e aj _� C, 1
Date last inspected: `
Agreement:
Fd. ,
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage,disposalsystem in
i
` accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
4 Compliance_,has been issued by this Board of Health.
Signed Date
Si
Application Approved by e -Date t
°• Application Disapproved by Date 77
for the following reasons
Permit No. 90 0.—" 611 Date Issued
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of.Compliance
THIS IS TO CERTIFY,that the On--site Sewage Disposal system Constructed( ) Repaired(�� Upgraded( )
Abandoned( )by �11i).n1,,,/ I-p
at 5 �4 �� _; has been constructed in accordance F
with the provisions of Title 5 and the for Disposal System Construction Permit No. d , dated L/`O
Installer C., f_,, /moo, 62-4 Designer //Cs
#bedrooms Approved design flov� /, gpd
The issuance of•his permit shall not be construed as a guarantee that the system w'lllunction as designed.
Date ! I ! Inspector / t/ 1w
._--No. �OI�—���--------------- -•----
"-------�---------------------------------•---- --------�_---_-=--=-=Fee=-=1�---------_'_'
THE COMMONWEAL_TH OF MASSACHUSETTS =
PUBLIC HEALTH DIVISION BARNSTABLE;MASSACHUSETTS
Misposal Opstem Construction Permit
Permission is hereby granted to Construct( ) Repair( ✓) Upgrade( ) Abandon( )
System located at
i
I
and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
Title.5 and the following local provisions or special conditions.
Provided:Construction must be completed within three years of the date of this permi3M)Q- n
Date L _ S( I Approved by �C IS
•
Town of Barnstable
Regulatory Services
Thomas F.Geder,Director
Public Health.Division
Thomas McKean,Director
200 Main Street, Hyannis,MA 02661
Office: 50&862.4644 Fax: 508-790-6304
Date: Iq l 1 Sewage Permit#,ZO I(- o�I Assesi es Map/Parcel I `
Installer&Designer CerdticatiQn Form
Psi^ -r T• MC5�v.t�Q2 J�r--_ . ..
Designer:
l�n i n�t�� Worms \rC Installer: Ca "''' MAA r 4jz_A
5 5
Address: tz wAs'r CM 5s e Id� � Address: O - (lax ?�
�s "4C-A MA a Z-��4 C�,,.�-• 1\¢ (VIA a 2G 3?
pn was issued a permit to install a
(date) (insta er)
septic system at -r �Sk""°C'� C'�r' ah�n:f based on,a design drawn by
a ass)
M L5 A t`e dated `f & I l�
(designer)
/C I certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank. Stripout (if required) was inspected and the soils
were found satisfactory.
I certify that the septic system referenced above was installed with major changes (i.e.
greater than 10' lateral relocation of the SAS or any vertical relocation of any component
of the septic system) but in accordance with State &Local Regulations..Plan revision or
certified as-built by designer to follow. Stripout(if required) acted and the soils
were found satisfactory. ��QytK OFP440
«� PETER T.
NICE
Lijgnature). CIVIL ti
,9 No.35109
• ��.o����9 T6R 4��`��
S
(Designer's Signature) (Affix Desig ere)
PLEASE. TURN TO BARNSTABLE PUBLIC HEALTHDIVISIONCERTIFICATE
CONIPLL4,NCE WILL NOI BE ISSUED UNTIL BOTH FORM S-
ARD ARE MCEIVED13YTHE BARNSTABLE PI JC ALTH DIVI
THANK YQU.
q:lofflca totmAdcaigaerceRification fcnn.doc
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
M 5 Castlewood Circle
Property Address
Marilyn Perron
Owner Owner's Name
information is required for Hyannis Ma. 02601 9/7/2010
every 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: A. General Information
When filling out
forms on the /
computer,use 1. Inspector:
only the tab key l(J
to move your Robert Paolini
cursor-do not Name of Inspector
use the return
key. Capewide Enterprises,LLC.
Company Name
Q P.O.Box 763
Company Address
Centerville Ma. 02632
�nen City/Town State Zip Code
(508)428-4028 S14454
Telephone Number License Number
B. Certification
I certify that I have personally inspected the sewage disposal system at this address and that the
information reported below is true, accurate and complete as of the time of the inspection. The inspection
was performed based on'my training and experience in the proper function and maintenance of on site
sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of
Title 5(310 CMR 15.000). The system:
❑ Passes ❑ Conditionally Passes ® Fails
❑ Needs.Further Evaluation by the Local Approving Authority FSE
9/7/2010 b RECT J
Ins ctor's Ignatu Date � — �_
13
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.
LD
l
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disp at System•Page 1 of 17
t
q
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form Not for Voluntary Assessments
,M 5 Castlewood Circle_
Property Address
Marilyn Perron
Owner Owner's Name
information is required for Hyannis Ma. 02601 9/7/2010
every page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E I.always complete all of Section D
A) System Passes: E {
❑ 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
t 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): ;
f
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 117
Commonwealth of Massachusetts
v. Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
5 Castlewood Circle
Property Address
Marilyn Perron
Owner Owner's Name
information is required for y H annis Ma. 02601 9/7/2010
every 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 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
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
5 Castlewood Circle
Property Address
Marilyn Perron
Owner Owner's Name
information is required for Hyannis Ma. 02601 9/7/2010
every page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
2. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner'that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from.a private water supply well`*.
Method used to determine distance:
"*This system passes if the well water analysis, performed at a DEP certified laboratory,for 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
❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less
than '/z day flow
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17
i
Commonwealth of Massachusetts
Title 5 Official Inspection Form -
o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M 5 Castlewood Circle
Property Address
Marilyn Perron
Owner Owner's Name
information is required for Hyannis Ma. 02601 9/7/2010
every page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
Yes No
❑ ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well.
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply
well.
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory, for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered. A copy of the analysis
and chain of custody must be attached to this form.]
❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd-
10,000gpd.
® ❑ The.system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
E) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the
questions in Section D.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection
Area— IWPA)or a mapped Zone 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.
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17
I
Commonwealth of Massachusetts
v Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
M 5 Castlewood Circle
Property Address
Marilyn Perron
Owner Owner's Name
information is required for Hyannis Ma. 02601 9/7/2010
every page. City/Town 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?
K ❑ Was the site inspected for signs of break out?
® ❑ Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth,of scum?
Was the facility owner(and occupants if different from owner) provided with
® ❑ information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS) on the site has
been determined based on:
❑ ® Existing information. For example, a plan at the Board of Health.
❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
D. System'Information
Residential Flow Conditions:
Number of bedrooms (design): 3 Number of bedrooms (actual): 3
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330
l5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17
I
Commonwealth of Massachusetts
Title 5 Official .Inspection .Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M 5 Castlewood Circle
Property Address
Marilyn Perron
Owner Owner's Name
information is required for H annis Ma. 02601 9/7/2010
y
every 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 ® No
Laundry system inspected? ® Yes ❑ No
Seasonal use? ❑ Yes ® No
Water meter readings, if available last 2 ears usage d 2008:36,000
9 ( Y 9 (gP )) 2009:19,000
Detail:
Sump pump? ❑ Yes ® No
Last date of occupancy: unknown
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
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
,M 5 Castlewood Circle
Property Address
Marilyn Perron
Owner Owner's Name
information is required for Hyannis Ma. 02601 9/7/2010
every page.a e. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Last date of occupancy/use:' Date s
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)
❑ 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):
t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17
i
Commonwealth of Massachusetts
v, Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
5 Castlewood Circle
Property Address
Marilyn Perron
Owner Owner's Name
information is required for Hyannis Ma. 02601 9/7/2010
every page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components,.date installed (if known)and source of information:
New pit installed 1990
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
14" -.
Depth below,grade: _ . 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.):
Joints appear tight.No evidence of leakage.system vented through the house vents.
Septic Tank(locate on site plan):
811
Depth below grade: 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 gallon
Sludge depth:
6"
t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
5 Castlewood Circle
Property Address
Marilyn Perron
Owner Owner's Name
information is required for Hyannis Ma. 02601 9/7/2010
every page. City/Town 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
26"
10"
Scum thickness
Distance from top of scum to top of outlet tee or baffle
2"
Orr
Distance from bottom of scum to bottom of outlet tee.or baffle
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.):
Heavy solids in tank.Pump tank every two years.lnlet and outlet tees are in place.No evidence of
Ieakage.Tank appears structurally sound.
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
t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17
i
Commonwealth of Massachusetts
Title 5 Official Inspection Form -
o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
,M 5 Castlewood Circle
Property Address
Marilyn Perron
Owner Owner's Name
information is required for Hyannis Ma. 02601 9/7/2010
every page. City/Town 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.):.
-5
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
t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
,M 5 Castlewood Circle
Property Address
Marilyn Perron
Owner Owner's Name
information is required for Hyannis . Ma. 02601 9/7/2010
every page. City/Town 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 No
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.):
Box is Ievel.Box has one outlet lateral.Evidence of solids carryover.No evidence of leakage.
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:
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17
Commonwealth of Massachusetts
v. Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M 5 Castlewood Circle
Property Address
Marilyn Perron
Owner Owner's Name
information is required for y H annis Ma. 02601 9/7/2010
every page. City/Town 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.):
Sandy soil.System shows signs of hydraulic failure.Stain line was over invert in pit.Observed septage
debris on wall of pit.Observed Solids on top of outlet invert in tank.
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
t5ins-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17
Commonwealth of Massachusetts
w _ Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
,M 5 Castlewood Circle
Property Address
Marilyn Perron
Owner Owner's Name
information is required for Hyannis Ma. 02601 9/7/2010
every page. City/Town 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.):
t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17
Map Page 1 of 2
Town of Barnstable Geographic Information System
Parcel Viewer I Custom Map Abutters I
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r—,;r hf )nnr_,)n1n T--of Rornefahln nen cu rinhf¢ro�on„
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M 5 Castlewood Circle
Property Address
Marilyn Perron
Owner Owner's Name
information is required for Hyannis Ma." 02601 9/7/2010
every page. Cityrrowh 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: •Bottom of LP 50'
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:
As-built
❑ Checked with local excavators, installers- (attach documentation)
❑ Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
USED:USGS Observation Well Data.USED:Technical Bulletin 92-0001 plate#2 annual ranges of
groundwater elevations.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17
r
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
5 Castlewood Circle
Property_Address
Marilyn Perron
Owner Owner's Name
information is
required for Hyannis Ma. 02601 9/7/2010
every 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
t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17
_C
1
vl
M
V
l
OZ l.!d i ! t; ►,► lain
i
Town of Barnstable Barnstable
Regulatory Services Department j*rMca j
+ •AMSfABM
MAM
Public Health Division
v i639 100� m
200 Main Street, Hyannis MA 02601 2007'
Office: 508-8624644 Thomas F.Geiler,Director
FAX: 508-790-6304 Thomas A.McKean,CHO
CERTIFIED MAIL# 70083230000251782268
2/9/2011 t
Marilyn Perron
5 Castlewood Circle
Hyannis, MA 02601
ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE,TITLE 5
The septic system located at 5 Castlewood Circle Hyannis,MA was last inspected on
September 7, 2010, by Robert Paolini, a certified septic inspector for the State of "}
Massachusetts.
The inspection of the septic system showed that the system "Failed"under the guidelines
of 1995 TITLE 5 (310 CMR 15.00) due to the following:
• System.shows signs of hydraulic failure. Stain line was over invert in pit. Solids
observed on top of outlet invert in tank. -
You are ordered to repair or replace the septic system within Sixty (60) days from the
date you receive this notification.
Failure to repair/replace the septic system within the deadline period will result in future
enforcement action.
PER ORDER OF THE BOARD OF HEALTH
Thomas McKean, R.S.,CHO
Agent of the Board of Health
1�
r TOWN OF BARNSTABLE
LOCATION t9-030GT SEWAGE # q(9'c�
VILLAGE ASSESSOR'S MAP & LOT
INSTALLER'S NAME & PHONE NO. C O Qf—LS4,v
.7
.SEPTIC TANK CAPACITY G U15 `2i Arn_i
LEACHING FACILITY:(type) --Gi � (size) r,,-)
NO. OF BEDROOMS PRIVATE WELL O �UBLICWAR
BUILDER OR OWNER 'S P--e-,e-V0yLJ
DATE PERMIT ISSUED:
' E
DATE COMPLIANCE ISSUED:
'VARIANCE GRANTED: Yes � No !/
r
_ e
L
No. t/i Fes$.. ...........
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH'
TOWN OF BARNSTABLE
ApplirFa#ion for Disposal Works Tonstrnr#ion lirrutit
Application is hereby made fora Permit to Construct ( ) or Repair (---),an Individual Sewage Disposal
System.at:
..... 7-- k$T 'li=..--I�CsZ.N k...J i2 V S.r...... 1r .5u4s�6hr4.� ............... .... -
Location-Address or Lot No.
�UoyyLc`w . 0 v av�J t5 ............................................ ......
---
Owner d e
.......... (Sal S ------------------------- ------------- �Qsr _!._.� ---.. ` t 1�^
S,a�4�!!
Installer Address
dType of Building Size Lot............................Sq. feet
U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( )
P4 Other fixtures ......... ---•---------------•___
W Design Flow.............................-..............gallons per persop 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.
3 Seepage Pit No--------d------------ Diameter-----�j�t....... Depth below inlet_________t___________ Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water.........................
(i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
�+ -----------------------------------........................................................................................................................
0 Description of Soil...................----•=---••.:._...-•••-•-••-----•---•._......••--••-•-••-=----------------•---••-•--------•---•--•-•-•----------•-•••••••-•--------•-•---•-_------
W
V ....•••••------•----•---•-•.....................•-••••-•-•-•--------•-•••-•--••••-•-•--•••--••--------•••...•-•------••••--••----•-------•-•-------•-----•--•-•---•--••-••--•----••------•----•-••-------
W -----------------------------------------------------------------------------•--------••-••--•---•-•--------------------------------•-•-------•-•-•-•-•-•-•-••--- •-•-•---••••--••••-•-•----.._....--
U Nature of Repairs or Alterations—Answer when applicable_____ .............. __ __�-s1�a_.... 'e.._____..
x ip (o c
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Com liance has bee issued by the b rd of health.
Sighed .......... ................. ....>v........ ..... �............. ..... ".Da...�........ ......
Application Approved By ---------------�� U. .. .......................-----------............................----...... .:....$"—.31....:�U.....
Date
Application Disapproved for the following reasons: ........................................................................................................................................
Dare
N . -3� uPermit � _ ------------------------------- -----.........................---------------------------.----------
Date
'- THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliratiun for Disposal Works Tonutrnrtiun Permit
Application is hereby made for a Permit to Construct ( ) or Repair (r�)'Iarl Individual Sewage Disposal
System at: }f�`
.............�.�e_.�•`�'�'"'` �Itij�_er£r-1 �.1r7�.1� WG'�-tAyn .ti, ...._.............._... .............................r
v i'••-•--3=�•.�...Ly _ ..- ..c..-........ ................. r .1. '�-�.
Location-Address v or Lot No.
1 -----—? ------ -------------- -•------....... :1R?!\c-� :.__..... .. ....- ...
r Owner Address
�^
L' {{1�11 ' yott/?I4a( 't/� ....... ............... Sxc4x..L,T2 :.._. L...i.�4.... .. . ! t�
(_..�_. .
Installer Address
Type of Building Size Lot............................Sq. feet
V Dwelling—No. of Bedrooms---... .................................Expansion Attic ( ) Garbage Grinder ( )
1 a Other—Type of Building ............................ No. of persons.......................... Showers ( ) — Cafeteria ( )
Other fixturges -------------------•-----------• . . .
W Design Flow........:-'-:.........................gallons per person per day. Total daily flow....,....a...... .......................gallons.
WSeptic Tank—Liquid'capacity.f. '.gallons Length................ Width................ Diameter.---............ Depth................
x 'Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No........I---------.. Diameter.....�.d:--..... Depth below inlet.... ......... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
~' Percolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water.........................
w Test Pit No. 2................minutes per inch/:Depth of Test Pit.................... Depth to ground water.---....................
a ......----••......--•-••......•----------•............................................•-•••••---•-.........-----•----.......--•-•-•--------
0 Description of Soil.........................................................................................'--------------------------------------•--------------------------------....----
x
W
U Nature of Repairs or Alterations—Answer when applicable---.--4.0.0.... 5. .......
L�;<. jar ''�.�.� ,�.•. G� ,D�T�.-.•---------------------------- ------------------------------------------------
Agreement:
',The undersigned agrees to install the afocedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Compliance has been issued by the boo rd of health.
Signed .......... _ .:�:..... . ........... . ........ .......
...............
Date
Application Approved By ............... V '-,w'",.'.k>--------------------.....--- ......---....------------------ ........- 1...: U ..
Date
ApplicationDisapproved for the following reasons: ........................................................................................................................................
..........................................................
---- -- - ....-..--......................... .................................................................................................................................................. ........................................
3�( Date
PermitNo. ...... ......................................................... Issued ...................................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
C'Iertifirate of C araptianre
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ; ) or Repaired ( �.
...
_ Installer '4
at ................................ ....... .W"s` e ` ....... ......--...------. .sN. � ........
has been installed in accordance with the provisions of TITLE 5 o The State Environmental Code as described in
the application for Disposal Works Construction Permit No. ....... �.-. --,cl',�,..... dated ................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE � --------------------------------------- Inspector ............�?` Ji✓ ..... ... ..
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
/ TOWN OF BARNSTABLE FEE. 2?
Disposal Works Turtstrnrtiun "permit
Permission is hereby granted-------------- ;'�. ..9 t RIJV .,.................---:...........---.........---....................
to Construct ( ) or Repair ( `mn Individual Sewage Disposal System
atNo............... -J?- ,. aA s???�Q._.....G �ff�.�cP-----------------------------------------------------------------------------------------
Street as shown on the application for Disposal Works Construction Permit No?Q92?1... Dated..........................................
..............••••......... :.........----------...................------...........----
Board of Health
DATE................................................................................
FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS
ti
LEGEND N Locut
EXISTING LEACH PIT EXISTNG LEACH PIT -- 98 -- EXISTING CONTOUR
'- (approx.) f approx.) x 100.98 EXISTING SPOT GRADE TO BE REMOVED TO BE REMOVEDCc243She &)28A) (SEE, ALSO, NOTE 11) (SEE, ALSO, NOTE 11) W EXISTING WATER SERVICE49 6109 ( G EXISTING GAS SERVICEPB194 / PG Lot 99.71 VENT N 12'06'48" E -O:H:W.- OVERHEAD WIRES 3
1 '9 , s4tg kade fence "" I TEST PIT
i1 TP=2_ 5, _ 99_9� I BENCHMARK
ao �10�J.0 - 0 TLC -}� II
I �, E __ ---�- ; S ED I� LOCUS MAP
20 ,I INSTALL 40 MIL POLY LINER NOT TO SCALE
ITP�1 100,20 O 0.14 I TOP OF LINER, EL.=96.5 BOTT. OF LINER, EL.=94.0
4 + 100.13
Benchmark Set N , I EXISTING SEPTIC TANK GENERAL NOTES:
100.20 I ( pp )
OUTSIDE COR. OF BULKHEAD N ,>0a I I TOP OF TANK, EL.=97.78t 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL
EL.=101.50(Assumed datum) 99,64 �� x 10 �42 /NV.(OUT)=96.65f(verify) BOARD OF HEALTH AND THE DESIGN ENGINEER.
_ 99.72 /x_10_1.11 x 1 � [I 2• ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS
' I OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE
ca INv.=99.20 I I LOCAL RULES AND REGULATIONS EXCEPT AS REQUESTED BELOW:
-310 CMR 15.405(1)(b):
t`, rn 1) A 1' variance to the 3' maximum cover requirement, for 4' of
I / EXIST(# ) = I PATIO Z I
� es-� HOUSE 5 U I -• v j ti max. cover. S.A.S. shall be H-20 and vented.
2) A 4' variance, S.A.S. to cellar wall (bulkhead), for a 1 6' setback.
T.O.F.=101.5f a I t° cn I �� I 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR
TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE
I U a� I DESIGN ENGINEER.
0
o` PORCH I 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING
of0,32 I �� i FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN
y �. � 101.57 I
I ENGINEER BEFORE CONSTRUCTION CONTINUES.
5. ALL ELEVATIONS BASED ON ASSUMED DATUM.
100.19 100.38 3 \��\ x I I {
6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF
GARAGE , i THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF
�G v , I HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION.
100.88 P v� I i 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE.
99.75 \ 3 �� 0��v i 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S.
• i 100.1 Q l 101 9� h�}80,77 ,i 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS
AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE
100.00 1 DIRECTED BY THE APPROVING AUTHORITIES.
9.97 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY
THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING
99.78 �' ..\ (LOTS 28 & 28A)vv' I CONSTRUCTION.
`�-116 �09� �APN 273-�� 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS
IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND
C99.75 99,66 7,628-S.F.t(R,ecord) REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3).
12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE
I INSPECTED BY DESIGN ENGINEER PRIOR TO BACKFILL.
0, 99.60 ! 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND
oo IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY.
OF M4ss9� `/� �O, y
o PETER T. �l'� S•00' `AIP� PROPOSED SEPTIC SYSTEM UPGRADE PLAN
McENTEE F vv 5 CASTLEWOOD CIRCLE, HYANNIS, MA
o CIVIL "' 99.36 98.92
�N Prepared for: Capewide Enterprises, P.O. Box 763, Centerville, MA 02632
No. 35109
Engineering by: SCALE DRAWN JOB. NO.
OFF E P ± OWNER OF RECORD Engineering Works, Inc. 1"=20' P.T.M. 134-11
N/F PERRON, MARILYN
5 CASTLEWOOD CIRCLE 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET N0.
HYANNIS, MA 02601 (508) 477-5313 4/6/1 1 P.T.M. 1 of 2
1 NOTE: TO PREVENT BREAKOUT, THE PROPOSED
r FINISH GRADE SHALL NOT BE < EL.96.3 I 35' I
SEPTIC TANK PROPOSED D-BOX FOR A DISTANCE OF 15' AROUND THE -----
PERIMETER OF THE S.A.S. ao , ,
INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & WATERTIGHT PROPOSED S.A.S. u, I ROPOSED S.A.
OUTLET AND SET TO 6" OF FINISH GRADE COVER SET TO 6" OF GRADE INSTALL INSPECTION PORT OVER END UNIT ____ ______r _—_—
NO
T.O.F. CHARCOAL C3 g26, p�1°� o
EXISTING F.G. 100.3(MAX.) VENT b) N
F.G. EL.=100.2t F.G. EL: 100.2t
�
MAINTAIN 2% GRADE (MIN.) OVER S.A.S. N
/ I L = '(MAX)6INSPECTION ,
L = 25' PORT BACK OF HOUSE
® S=14 (MIN.) ® SCH4 (MIN.)
4"SCH40 PVC 4"SCH40 PVC I
6"
I
,O" 14" 6" 10.75" TO EXISTING z
EXISTING 48" LIQUID INVERT HOUSE(#5)
LEVEL GAS BAFFLE INV.=96.17 PROPOSED INV.=96.00 3 ROWS OF 7 UNITS AT 5.0'/UNIT = 35.0' T O.F=101.5f CL
INV.=96.65t D—BOX INV.=95.90 SOIL ABSORPTION SYSTEM EXISTING (PROFILE) /p I
EXISTING SEPTIC TANK S.A.S.LAYOUT
ESTABLISH VEGETATIVE COVER
BACKFILL WITH CLEAN NATIVE OR �—4" TYP. 22" ��4"
NOTES: PERC SAND TO TOP OF CHAMBERS T
1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE I} s.'•'
INVERTS, PRIOR TO INSTALLATION. BREAKOUT=TOP `= `` ::' �::.+:::':::•
2) D-BOX SHALL BE SET LEVEL AND TRUE TO TOP ELEV.=96.33 22.5
GRADE ON A MECHANICALLY COMPACTED SIX INV. ELEV.=95.90 ;,:.' 1 r 11
INCH CRUSHED STONE BASE, AS SPECIFIED IN "' p 9.5" 5
310 CMR 15.221(2). BOTTOM ELEV.=95.00— '
3) INSTALL INLET & OUTLET TEES AS REQUIRED. 5' MIN. ABOVE BOTTOM OF 2.83' -22—'i 1-4" POLYSEAL INLETS T U4„
3-4" POLYSEAL OUTLETS
4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE T.P. EXCAVATION OR G.W. EFFECTIVE WIDTH=8.5'
AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. D-BOX SHALL BE RATED H-20
NO G.W., EL=90.0 4 EXI MATERIAL
NG ITABLE DISTRIBUTION BOX
USE 3 ROWS OF 7-ADS Arc 36HC UNITS WITH NO
SEPARATION BETWEEN EACH ROW & NO STONE 63.25"
SEPTIC SYSTEM PROFILE TYPICAL SECTION
d7�'Wl6"
N.T.S.
DESIGN CRITERIA SOIL IOG 34.5"
DATE: APRIL 1, 2011 (REF#13,234
NUMBER OF BEDROOMS: 2 BEDROOMS SOIL EVALUATOR: PETER McENTEE (SE 1542)
WITNESS: DAVID STANTON R.S. TOP VIEW
SOIL TEXTURAL CLASS: CLASS I HEALTH AGENT 60"
DESIGN PERCOLATION RATE: <2 MIN/IN ELEV. TP- 1 DEPTH ELEV. TP-2 DEPTH END CAP END CAP
DAILY FLOW: 220 G.P.D. 100.2 A SANDY LOAM 0 100.0 A SANDY LOAM 0 FRONT VIEW SIDE VIEW END CAP
1OYR 4/4 10YR 4/4 REAR/TOP VIEW
DESIGN FLOW: 330 G.P.D. 99.2 B 12" 99.0 B 12" hmfti"
GARBAGE GRINDER: NO SANDY LOAM SANDY LOAM NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT SIDE VIEW
To NOTICE. MAY
10YR 5/8 10YR 5/8 DIIFFERANCE SLIGHTLYOUT FROM ACTUALR RODUCT ODUCTETAIL APPEARANCE.
LEACHING AREA REQUIRED: (330) = 445.9 S.F. 97.7 30" 97.0 36"
74 C1 C1 4640 TRUEMAN BLVD
36" HILLIARD, OHIO 43026 Are 36HC DETAIL
EXISTING SEPTIC TANK: 1000 GALLON CAPACITY PERC ADVANCED DRAINAGE SYSTEMS,INC.a UNITS MUST BE STAMPED H-20 ak
PROPOSED D—BOX:: 1 INLET, 3 OUTLET (MINIMUM), H-20 RATED 048' PROPOSED SEPTIC SYSTEM UPGRADE PLAN
USE 3 ROWS OF 7—ADS Arc 36HC UNITS WITH NO F-M SAND F-M SAND 5 CASTLEWOOD CIRCLE, HYANNIS, MA
SEPARATION BETWEEN EACH ROW & NO STONE 2.5Y 5/4 2.5Y 5/4
( Prepared for: Copewide Enterprises, P.O. Box 763, Centerville, MA 02632
BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.80 SF/LF OF UNIT) I Engineering by: SCALE DRAWN JOB. NO.
(Arc 36HC Units) 21 UNITS x 5.0 LF x 4.80 SF/LF = 504.0 SF 90.2 120" 90.0 120" NTS P.T.M. 134-11
PERC RATE <2 MIN/IN.("C" HORIZON) Engineering Works, Inc.
DESIGN FLOW PROVIDED: 0.74(504.0 S.F.) = 373.0 G.P.D. NO GROUNDWATER ENCOUNTERED 12 West Crossfield Road, Forestdale, MA 02644 DATE 6 11 CHECKED SHEET
(508) 477-5313 / 2/ P.T.M. 2 Of 2